Objective To investigate the effects of ischemic postconditioning (IP) on interleukin-1β (IL-1β) and tunor necrosis factor-α (TNF-α) expression in focal cerebral ischenia/reperfusion in rats in order to clarify the rnechanism of neuroprotective effect of IP.Methods One hundred and ten healthy adult male Sprague-Dawley rats were randomized into sham operation (n =10),ischemia/reperfusion and IP groups.The latter two groups were redivided into 6-,12-,24-,48- and 72-hour subgroups (n =10 in each subgroup) according to their reperfusion time.A focal cerebral ischemia/reperfusion model was induced by the middle cerebral artery intraluminal suture method.After middle cerebral artery occlusion for 2 hours,reperfusion for 15 seconds was conducted using the IP method,and this was repeated for 3 times.The neurobehavioral scores of the rats were evaluated in each group.The infarct volume was measured with 2,3,5-triphenyltetrazolium chloride staining.The expression of TNF-α and IL-1β protein in brain tissue was detected by immunohistochemistry assay.The expression of IL-1β and TNF-αmRNA was determined by in situ hybridization.Results Compared with the ischemia/reperfusion group,the neurobehavioral score and and cerebral infarct volume in the IP group decreased significantly (all P ＜0.05).Expressions of IL-1 β,TNF-o protein and mRNA were slight in the frontoparietal cortex in the sham group; however,they were apparent in ischemia/reperfusion group and IP groups,and began to increase at 6 hours and reached the peak at 24 hours (compared to other time points all P ＜0.05),then decreased gradually.There was the same dynamic change trend in the IP group,and the expression at each time point was significantly lower than that in the ischemia/reperfusion group (all P＜0.05).Conclusions IP significantly down-regulates the expressions of IL-1 β and TNF-α and reduces the infarct volume of the ischemia/reperfusion in rats.These findings indicate that IP may play a neuroprotective role by inhibiting the inflammatory response in brain tissue after ischemia/reperfusion.

Minor stroke is characterized by the mild symptom and rapid recovery,and does not easily cause disability,but a part of patients with minor stroke are the high risk population of recurrent stroke,and can cause disability,cognitive impairment,and emotional disorders.Early prediction of the prognosis in patients with minor stroke,screening for the high risk population of recurrent stroke and disability,and giving appropriate treatment may prevent recurrent stroke and improve the prognosis of patients.This article reviews the predictors of prognosis in patients with minor stroke.

The optimal therapeutic regimen for patients with asymptomatic carotid artery stenosis (ACS) has been controversial.Early research suggests that carotid endarterectomy (CEA) is effective for the treatment of patients with severe ACAS.In recent years,as a minimally invasive treatment,carotid artery stenting (CAS) is as effective as CEA.It has a trend of replacing CEA.In recent 10 years,medicine standardized treatment has made great progress.Recent studies have shown that the risk of stroke is lower using the optimal medical treatment in patients with ACAS compared with CEA and CAS.The key of choosing optimal therapeutic regimen is to identify the high risk patients with stroke.

Objective:To explore the changes of shoulder joint function in patients with clavicle fractures after open reduction and internal fixation at different periods, and analyze its influencing factors.Methods:From January 2019 to June 2020, convenience sampling was used to select 120 clavicle fracture patients with open reduction and internal fixation in Shanghai East Hospital. Patients were investigated using the General Information Questionnaire and the Constant-Murley Score for shoulder joint function at one week, one month, and three months after the operation.Results:The total scores of shoulder joint function of patients at one week, one month and three months after open reduction and internal fixation of clavicle fractures were (42.91±7.38) , (73.13±3.96) and (98.04±3.89) , respectively. Repeated analysis of variance showed that patients with clavicle fractures after open reduction and internal fixation had statistically significant differences in pain, activities of daily living, joint range of motion, muscle strength, and total score of shoulder joint function in different periods ( P<0.01) . One week after the operation, there were statistically significant differences in shoulder joint function of patients with clavicle fractures after open reduction and internal fixation at different ages, with or without caregivers, and functional exercise ( P<0.05) . One month after the operation, there was a statistically significant difference in shoulder joint function in functional exercise ( P<0.05) . Three months after the operation, there was no significant difference in the scores of shoulder joint function among patients with different characteristics ( P>0.05) . The results of multivariate analysis showed, age, caregivers and functional exercise were the influencing factors of shoulder joint function one week after open reduction and internal fixation ( P<0.05) . Conclusions:There are different characteristics of shoulder joint function in different periods after open reduction and internal fixation of clavicle fractures. In the acute phase, attention should be paid to the wound pain at the surgical site, and medical and nursing staff and caregivers should provide daily care and psychological counseling to the patient. In the subacute phase, joint exercises should be strengthened and continuous nursing should be carried out to ensure the continuing effectiveness of rehabilitation exercises.

We retrospectively analyzed and summarized the experience of observation and nursing care of 9 neonates with pleural effusions caused by peripherally inserted central catheter line insertion ( PICC ) infusion. All of the 9 neonates were with different degrees of shortness of breath, cyanosis, difficult breathing or frequent apnea. The exciting cause of pleural effusion was the shift of catheter tip of PICC which was confirmed by chest X-ray. The primary causes were the growth of height and limbs, positions, catheter maintenance and difficulties in catheter placement. The experience of nursing care included making neonates maintain natural positions during PICC infusion, closely observing patient′s condition especially for respiratory conditions, dynamically monitoring the change of position of catheter tip, timely notifying doctors of perfecting the related examinations of bedside sternum, ultrasonic and so on when patient′s condition changed, stopping the PICC infusion immediately when doubting that the changes of patient′s condition were related to PICC infusion, providing respiratory support for patients with respiratory dysfunction to improve respiratory function, assisting with thoracentesis or closed drainage of thoracic cavity when necessary to relieve the oppression. All of the 9 neonates were recovered and discharged hospital via active treatment.

Objective To investigate the status of quality control of dental X-ray equipment in Beijing Dongcheng District, to explore the problems involved in radiation protection. Methods 41 medical dental X-ray machines were detected in Beijing Dongcheng District in accordance with Specification for testing of quality control in dental X-ray equipment (WS 581—2017). Results The qualified rate was higher in imported machines (100%) than that in domestic machines (76.92%), the overall qualified rate was 92.68%. In performance detection, the qualified rates were 100% except for the deviation of loading time (92.68%) and tube voltage (95.12%). No leakage was detected in 41 dental institutes. Conclusion The overall status of dental X-ray machines was good in Beijing Dongcheng District. More attention was paid to shield protection than to quality control of dental X-ray machines. Therefore, health administration should take measures to strengthen advocation of WS 581—2017, and improve radiation protection through routine equipment performance test, supervision of X-ray protection and radiation health education.

Objective:To analyze the change in human resources within China′s Centers for Disease Control and Prevention (CDC) from 2010 to 2020.Methods:The self-reported information from provincial, prefectural (city), and county (district) levels of China′s CDC, covering employee counts, staff composition, professional qualifications, educational backgrounds, technical titles, and tenure, were extracted from the China Disease Prevention and Control Information System. The demographic context was provided by the annual population figures from the China Statistical Yearbook (2010-2020). The profile of CDC personnel was described, and the average annual percentage rate change (AAPC), average annual percentage rate change (APC), human resource agglomeration degree (HRAD) and the difference between HRAD and population agglomeration degree (PAD) were calculated. The Joinpoint regression model was used to analyze the time trend.Results:The decade under review witnessed a net increase of 17 300 active and 18 300 enrolled personnel in the CDC, surpassing the national population growth rate with AAPCs of 0.93% and 1.03%, respectively. This upward trajectory was statistically significant ( P<0.05). The ratio of disease control personnel per 10 000 population escalated from 1.14 to 1.21. An initial decline in active CDC workforce density (from 1.31 to 1.27 per 10 000 population between 2010 and 2017) was followed by an increase (from 1.28 to 1.37 between 2018 and 2020), with APCs of -0.40% and 3.73%, respectively. The proportion of professional and technical staff in 2019 was highest in the eastern region (86.01%), followed by the western (83.75%) and central regions (79.54%). The period also saw an enhancement in the average academic degree (from 1.91 to 2.43 points) and professional title scores (from 1.39 to 1.53 points) of CDC personnel. While the average tenure in the eastern and western regions showed a slight decline, the central region experienced an increase, with HRAD values indicating a higher concentration in the eastern and central regions compared to the western region. The HRAD-PAD discrepancy revealed a negative value in the eastern region, nearing zero in the central and western regions. Conclusion:Between 2010 and 2020, China′s CDC experienced notable growth in human resources and underwent structural optimization, albeit with significant regional disparities in concentration.

Objective:To analyze the change in human resources within China′s Centers for Disease Control and Prevention (CDC) from 2010 to 2020.Methods:The self-reported information from provincial, prefectural (city), and county (district) levels of China′s CDC, covering employee counts, staff composition, professional qualifications, educational backgrounds, technical titles, and tenure, were extracted from the China Disease Prevention and Control Information System. The demographic context was provided by the annual population figures from the China Statistical Yearbook (2010-2020). The profile of CDC personnel was described, and the average annual percentage rate change (AAPC), average annual percentage rate change (APC), human resource agglomeration degree (HRAD) and the difference between HRAD and population agglomeration degree (PAD) were calculated. The Joinpoint regression model was used to analyze the time trend.Results:The decade under review witnessed a net increase of 17 300 active and 18 300 enrolled personnel in the CDC, surpassing the national population growth rate with AAPCs of 0.93% and 1.03%, respectively. This upward trajectory was statistically significant ( P<0.05). The ratio of disease control personnel per 10 000 population escalated from 1.14 to 1.21. An initial decline in active CDC workforce density (from 1.31 to 1.27 per 10 000 population between 2010 and 2017) was followed by an increase (from 1.28 to 1.37 between 2018 and 2020), with APCs of -0.40% and 3.73%, respectively. The proportion of professional and technical staff in 2019 was highest in the eastern region (86.01%), followed by the western (83.75%) and central regions (79.54%). The period also saw an enhancement in the average academic degree (from 1.91 to 2.43 points) and professional title scores (from 1.39 to 1.53 points) of CDC personnel. While the average tenure in the eastern and western regions showed a slight decline, the central region experienced an increase, with HRAD values indicating a higher concentration in the eastern and central regions compared to the western region. The HRAD-PAD discrepancy revealed a negative value in the eastern region, nearing zero in the central and western regions. Conclusion:Between 2010 and 2020, China′s CDC experienced notable growth in human resources and underwent structural optimization, albeit with significant regional disparities in concentration.

Objective: To explore the safety and effectiveness of transthoracic endoscopic thyroid surgery in thyroid surgery. Methods: Retrospectively analyzed 230 patients with thyroid tumor aged from 19 to 71 years, including 67 males and 163 females, who were admitted to General minimally invasive surgery, First Affiliated Hospital of Henan University of Chinese Medicine from March 2018 to August 2019. All patients were divided into traditional operation group (n=95) and endoscopic group (n=135) according to the operation method. The general information of the two groups of patients before surgery, including the time of surgery and tumor removal, amount of bleeding during surgery, postoperative drainage and extubation time, were compared. And the hospital stay, hoarseness, postoperative bleeding, incision infection, numbness, twitching, satisfaction and other related indicators were calculated also. SPSS 22.0 software was used for statistical analysis. Normally distributed measurement data were expressed as Mean±SD, and conparisons between groups were calculated by t test or χ² test. The non-normally distributed data were expressed as M(P₂₅, P₇₅) and were analyzed by the Mann-Whitney U test. Results: Compared with the preoperative general data, the number of nodules in the traditional group was 3.00 (2.00, 3.00), and the number of nodules in the endoscope group was 2.00 (1.00, 3.00). The difference was statistically significant (Z=-4.461, P<0.01). The maximum diameter of the tumor in the traditional group is 1.00 (1.00, 2.00) cm, and the maximum diameter of the tumor in the endoscope group is 1.00 (1.00, 2.00) cm. The two are statistically significant (Z=-2.041, P=0.041). There were no significant differences in age, gender, course of disease, nodule type, cystic change, nodule location, aspect ratio, nodule echo, nodular morphology, and nodular calcification (all P>0.05). Comparison of intraoperative indicators, the operation time of the traditional group was shorter than that of the endoscope group [(67.51 ± 9.27) min vs (89.86 ± 10.32) min, t=11.462, P<0.01]; the tumor removal time of the traditional group was also shorter than that of the endoscope group [( 28.37 ± 8.94) min vs (33.35 ± 7.39) min, t=5.456, P<0.01]; the blood loss in the traditional group was significantly more than that in the endoscope group [(51.34 ± 3.26) ml vs (20.65 ± 5.89) ml, t=14.723, P<0.01]. The recurrent laryngeal nerve was explored intraoperatively in both groups with a detection rate of 100%, the anesthesia was good in both groups, and the drainage tubes were indwelling in both groups. The drainage volume of the traditional group was significantly higher than that of the endoscope group [(135.76 ± 60.55) ml vs (69.12 ± 37.13) ml, t=10.805, P<0.01]. The extubation time was longer in the traditional group than in the endoscope group [(5.54 ± 1.44) d vs (4.66 ± 1.55) d, t=2.384, P=0.023]. In terms of hospitalization time, the traditional group was significantly longer than the endoscope group [(10.48 ± 5.37) d vs (7.25 ± 3.68) d, t=11.549, P<0.01]. There were 11 cases of hoarseness in the traditional group and 4 cases of hoarseness in the endoscope group, and there has statistically significant (χ²=6.790, P=0.009). There were 5 cases of postoperative bleeding in the traditional group, 1 case of postoperative bleeding in the endoscope group, the difference between the two was statistically significant (χ²=4.365, P=0.037); 5 cases of incision infection in the traditional group, none in the endoscope group, and the difference was statistically significant (P=0.012); 4 cases of numbness convulsions in the traditional group, none in the endoscope group, and there was statistical significance (P=0.028); 87 cases of satisfaction in the traditional group, and 134 cases of satisfaction in the endoscope group, and the difference was statistically significant (χ²=6.825, P=0.009). Conclusions Transthoracic endoscopic thyroid surgery has fewer complications in thyroid surgery and quicker postoperative recovery. It is worthy of widespread promotion, but the specific implementation plan needs to be further optimized.

OBJECTIVE：To prom ote the implementation of clinical comprehensive evaluation of drugs in China ，promote the return of drugs to clinical value ，improve the utilization efficiency of limited resources ，and provide reference for decision makers of health departments. METHODS ：By combing the relevant policy documents and literatures of clinical comprehensive evaluation of drugs，the evolution and research progress of relevant policies in China were introduced ；the advanced experiences （including evaluation subjects ，evaluation value dimensions ，evaluation methods ，evaluation procedures and results applications ）of Canada ，the United States ，the United Kingdom ，Australia，Europe，International Society for Pharmacoeconomics and Outcomes Research and other countries （regions/organizations）were analyzed and summarized ；relevant suggestions on the construction of China ’s clinical comprehensive evaluation mechanism for drugs were put forward. RESULTS & CONCLUSIONS ：It is suggested that the following measures should be taken to construct the clinical comprehensive evaluation mechanism of drugs in China including that the development goal and orientation of clinical comprehensive evaluation of drugs should be further clarified with the guidance of decision-making needs ；the government should play a leading role and strengthen inter departmental cooperation and policy coordination；the traceability quality control system of internal and external standards should be established ，adhere to openness ， fairness and fair ；at the same time ，it is suggested to give full play to the role of informatization and big data ，strengthen the exploration of evaluation methodology and standards ，strengthen the transformation and application of evaluation results ，and promote the service of evaluation results to policy decision-making.