Objective: To assess trends of β-blocker use within 24h of admission in ideal candidates with acute myocardial infarction (AMI) in eastern urban China from 2001 to 2011. Method: A 2-stage random sampling design was performed. In the first stage, a simple random-sampling was used to identify participating hospitals. In the second stage, a systematic sampling was conducted in 2001, 2006 and 2011 to select cases from the participating hospitals. Data was obtained by central medical record abstraction. 10-year trend and predictors of early β-blocker application were assessed with weighted calculation for each year to represent the overall situation of eastern urban China. Results: 35 hospitals were sampled and 32 of them were finally participated. With necessary exclusion, 1399 ideal candidates were included in this analysis. The early weighted β-blocker application rates in 2001, 2006 and 2011 were 64.7%, 69.7%, and 60.9% respectively, P=0.0447 for trend. Patients with chest pain at admission (OR=2.22, 95% CI 1.19-4.13), higher systolic blood pressure (OR=1.40, 95% CI 1.11-1.77) or faster heart rate (OR=2.01, 95% CI 1.58-2.55) were more likely to use β-blocker; in contrast, compared with NSTEMI patients, STEMI patients seemed less likely to receive such treatment (OR=0.55, 95% CI 0.37-0.81). Conclusion: The early β-blocker therapy in eastern urban China is suboptimal for ideal AMI patients who could benefit from it. The application pattern has not been changed from 2001 to 2011 which might be related to physicians' misunderstanding of relevant evidence or guidelines. Our study may help to create an important target to improve the quality of AMI care.

Objective To explore the method of isolation, identification and in vitro differentiation of islet stem cells in neonatal rat. Methods The whole pancreata of neonatal rats were digested with collagenase, then,under the (condition) of pH 7.4～7.6,the digested tissue fragments were cultured with serum and serum-free RPMI 1640 (( bFGF), EGF, N2).The whole formation process of new islet cell-like cell masses was examined.The insulin (release) test was used to detect islet function. The expression of nestin was tested by immunocytochemistry. Results The nestin positive cells can be found within 36 h of culture of the digested pancreatic fragments.After addition of bFGF,ECF,N2,nestin positive cells proliferated fast and formed new islets-like cell masses after 18～24 d, and (insulin)ssion could be confirmed. Conclusions The nestin positive cells of pancreatic cells possess the character of islet stem cells, and can form islet like cell masses through culture in vitro.

Objective To explore the isolation, culture of nestin positive cells of the pancreas in newborn rats. Methods The whole pancreas of neonatal rats were digested with collagenase, followed by incubation under pH 7. 6 serum RPMI 1640 for 24 - 36 h and then under pH 7. 4 serum free RPMI 1640 (bFGF.EGF 20 ng/ml.1% N2) for 18-24 d. The expression of insulin.glucagon and nestin were detected by immunofluorescence technique. Nestin.CK19 were detected by RT-PCR. Resides Cells attached to the surface of plates after 24 h incubation under pH 7. 6 condition, and islet-like masses were obtained after 18 -24 d incubation. A monolayer of cells grew out after 24 h of passage of islet-like masses. Nestin positive cells was detected after 24 - 36 h incubation, with no expression of insulin and glucagon. Positive cells of insulin and glucagon were detected in islet-like masses after 24 h passage. Nestin positive cells were detected by RT-PCR in islet-like masses after 24 h passage, but no CK19. Conclusion Insulin and glucagon were expressed in islet-like masses after passage. Nestin positive cells in the pancreas of neonatal rats possessed character of islet stem cells.

Objective To explore the relationship among psychological flexibility,coping style and job burnout of nurses.Methods A total of 694 nurses from one district level grade A tertiary general hospital in Yunnan were assessed using acceptance and action questionnaire 2nd edition (AAQ-Ⅱ),simplified coping style questionnaire (SCSQ) and nursing burnout scale (NBS).The relationship among psychological flexibility,coping style and job burnout of nurses was analyzed using structural equation model and Bootstrap test.Results (1) Correlation analysis showed that the total scores of AAQ-Ⅱ (21.81 ± 8.23),job burnout (22.71 ± 6.60) and its three dimensions including emotional exhaustion (8.93 ± 2.87),depersonalization (6.64±2.30)as well as reduced personal accomplishment(7.14±2.52) were positively correlated with negative coping dimension of coping style (10.86±4.99) (r=0.324-0.510,all P＜0.01),while negatively correlated with positive coping dimension(26.44±5.86) (r=-0.102--0.143,all P＜0.01).(2) Structural equation model analysis showed that positive and negative coping dimension had partial mediating effects on the relationship between psychological flexibility and job burnout (x2/df=2.30,GFI =0.91,AGFI =0.90,NFI=0.90,IFI=0.93,TLI=0.92,CFI=0.93,RMSEA=0.04).(3) Bootstrap test showed that the mediating effect sizes for positive and negative coping were 3.8％ and 8.9％ respectively and totally mediating effect size of coping style was 12.7％.Psychological flexibility had much larger effects on job burnout,and the direct effect size was 87.3％.Conclusion Coping style plays a mediating role in the relationship between psychological flexibility and job burnout,but its effect is less important.Psychological flexibility plays a major role and more directly influences on job burnout.

Objective Based on clinical surgical statistical instances,the influence of double fenestration branch stents on the blood flow field after different depths of implantation in the diseased thoracic aorta was investigated.Methods Thoracic aorta,thoracic aorta-coated stent,and branch vessel-coated stent were established.The finite element calculation method was used to analyze the branch stent implanted into the diseased aorta at different depths(5,10,and 15 mm),and experimental verification was performed using an in vitro tachymetry experimental platform.Results There were certain patterns for maintaining stable perfusion of the blood flow field with branch stent implantation at different depths in the thoracic aorta.The branch blood perfusion rate in Group D10-5(the implantation depths of the left common carotid artery branch stent and left subclavian artery branch stent were 10 mm and 5 mm,respectively)was at a good level,and TAWSSmax was at the lowest level(44.94 Pa),thereby showing the best simulation results.Conclusions When the left subclavian artery branch stent implantation in the thoracic aorta was short,the depth of the left common carotid artery branch stent implantation in the aorta was appropriately increased to obtain a more stable blood flow field.This study provides a theoretical reference for the double-fenestration technique in clinical practice.

Objective:To analyze the differences in information needs of doctors, middle managers, and hospital leaders in tertiary public hospitals in the process of new technology access.Methods:From January to October 2018, 1 200 doctors and hospital administrators from 30 tertiary public hospitals in 8 provinces were selected. The importance scores of different positions for decision-making information demand of new technology introduction were collected through questionnaire survey, and the scores were analyzed by SPSS 25.0 software. Descriptive statistical analysis was performed.Results:1 032 valid questionnaires were obtained. Hospital-level leaders, middle-level managers, and doctors scored higher on the clinical application, safety, and effectiveness of technology at home and abroad(more than 4 points, maximum 5 points). Hospital-level leaders and middle-level managers had higher scores on effectiveness, evidence quality, possibility of being covered by medical insurance, ethics and relevant indicators of strategic level, while doctors had higher scores on health economics and organizational indicators.Conclusions:There are some differences in the information demand for new technology access among different positions in tertiary public hospitals. Understanding the decision-making needs of different positions is conducive to promoting the actual implementation of hospital-based health technology assessment standards in China′s public hospitals.

Gallstone is one of the most common diseases in hepatobiliary, cholesterol gallstone is the most common type of gallstone. One of the important causes of gallstone formation is the precipitation of cholesterol crystals caused by cholesterin supersaturation. Scavenger receptor type BI (SR-BI) is a kind of multifunctional membrane receptor protein, which can mediate the selective uptake of cholesterol in liver and then affect the content of cholesterol in bile. Its role in the formation of gallstone has been initially revealed. In this paper, the relationship between the occurrence of cholesterol gallstones and scavenger receptor type B type I was summarized in order to provide new ideas for the further study of the pathogenesis of gallstone.

Objective: To explore the efficacy and safety of recombinant human interleukin-11 (rhIL-11) in treatment of chemotherapy-induced thrombocytopenia of acute leukemia. Methods: Acute leukemia patients with chemotherapy-induced thrombocytopenia [Platelets (Plt) < 50×10⁹/L] in 6 centers nationwide from February 2016 to July 2016 were treated with rhIL-11 (2 mg/time, twice per day) by subcutaneous injection. Treatment lasted 7 days or at least until Plt≥ 50×10⁹/L. The Plt recovery was observed during treatment. Results: A total of 112 patients were enrolled, and 2 patients decided to drop out of study. The efficacy population consisted of 110 patients, and the total response rate reached 74.5% (82/110). The average variation of Plt during treatment was (70±54)×10⁹/L, and recovery average time of Plt for the patients with favorable efficacy was (8.7±3.0) days. In treatment with severe thrombocytopenia, rhIL-11 alone could shorten the recovery time compared with rhIL-11 combined with Plt transfusion [(8.0±2.6) d vs. (9.6±3.5) d, t=2.17, P=0.03]. Conclusion rhIL-11 twice a day of subcutaneous injection can effectively promote Plt recovery and reduce Plt transfusion with less adverse reactions, which is worthy of further application.

Objective: To identify the key pathogenic genes of leptin regulating gallbladder contraction and secretion in mice and to reveal the potential molecular mechanism by comprehensive bioinformatics. Methods: The expression profile of GSE3293 was downloaded from Gene Expression Omnibus (GEO) database. The data contained 8 samples, including 4 leptin-treated gallbladder samples and 4 saline-treated gallbladder samples. The most valuable 250 differentially expressed genes (DEGs) were obtained by grouping analysis of GEO online GEO 2 R-TOP 250 software or tools, and further analyzed by bioinformatics. The GO function and KEGG pathway enrichment of DEGs were analyzed by DAVID online software. The protein-protein interaction (PPI) network of DEGs was constructed from STRING database. Results: A total of 250 differentially expressed genes were identified from the GSE3293 dataset, of which 197 genes were up-regulated and 53 genes were down-regulated. GO analysis showed that the biological functions of DEGs were mainly concentrated on MHC class II protein complexes, plasma membrane, extracellular exosome. KEGG pathway analysis showed that these DEGs were mainly involved in tuberculosis, leishmaniasis, cell adhesion molecules, bacteriophages, infection and other signaling pathways. PPI network showed that these DEGs coded proteins interacted strongly, and the first five pairs of DEGs with the strongest correlation were screened out. Conclusions The molecular mechanism of cholelithiasis is predicted from gene level by bioinformatics analysis of function enrichment and PPI of DEGs in mouse gallbladder. However, the function of DEGs still needs a lot of clinical and molecular biological experiments to confirm.

Objective: To understand the awareness, treatment, and control of hypertension in residents aged 35-75 years in eastern China, analyze the treatment mode for antihypertensive agents while identifying those factors affecting awareness, treatment and control. Methods: The data collected in eastern China from the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project were used to obtain the information about the awareness, treatment and control of hypertension in the residents and the antihypertensive medication treatment mode in this area. Multilevel mixed-effects model was used to explore the association of the demographic characteristics of hypertension patients with the rates of awareness, treatment and control of hypertension. Results: A total of 640 539 participants aged 35-75 years, mean age (56.9±9.6) years, were included in the analysis, women accounted for 59.7% and 318 741 (49.8%) of the participants suffered from hypertension. Among those hypertensive patients, 46.5% were aware of their condition, 38.1% were taking prescribed antihypertensive medications, and 11.1% had achieved the control of hypertension, the differences were significant among provinces, between urban area and rural area and among different demographical groups. Calcium-channel blockers was the most commonly used medication (45.1%), and 78 735 hypertension patients (86.2%) took only one type of medication. Older age, higher household income, higher level of education, and histories of myocardial infarction, stroke and diabetes were associated with higher awareness, treatment and control of hypertension (P<0.05). Conclusions The rates of awareness, treatment and control of hypertension were low in residents in eastern China. The differences in hypertension management were significant among provinces and between urban area and rural area. Further efforts are needed to enhance the system of hypertension prevention, screening, diagnosis and treatment.