In China, medical system reforms have made an obvious achievement in recent years .However, lots of urgent problems still exist.Doctors are not satisfied with their working environment.The high-pressure job with low remuneration reduces doctors'enthusiasm for work.Meanwhile, both the threat to personal safety and disrespect from patients bring negative effects to doctor's physical and mental health .The main factors causing this situation include the leaky health care system , the incomplete health -care legislation, the misleading reports and the poor medical knowledge of patients .Therefore, some countermeasures should be taken to solve problems mentioned above and the construction of medical ethics should be strengthened at the same time .

BACKGROUND:There are studies on three-dimensional finite element analysis of total knee replacement, but few research concerns contact pressure and contact area inside and outside polyethylene liner of fixed prosthesis and rotating platform prosthesis in total knee replacement. OBJECTIVE:To explore the contact pressure and contact area inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement. METHODS:We established three-dimensional finite element models of fixed platform prosthesis and rotating platform prosthesis in total knee replacement and compared contact pressure and contact area inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement. RESULTS AND CONCLUSION:The peak contact pressure inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement was minimum at 0° of genuflex. The peak contact pressure inside polyethylene liner was higher than that outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement at 0°-90° of genuflex (P<0.05). The peak contact pressure inside and outside polyethylene liner of fixed platform prosthesis was higher than that of rotating platform prosthesis in total knee replacement at 60°-120° of genuflex (P<0.05). The contact area inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement was maximum at 0° of genuflex. The contact area inside polyethylene liner of fixed platform prosthesis in total knee replacement was lower than that of outside at 0°-30° of genuflex (P<0.05). The contact area inside polyethylene liner of fixed platform prosthesis in total knee replacement was lower than that of outside at 0°-90° of genuflex (P<0.05). The contact area inside and outside polyethylene liner of fixed platform prosthesis was lower than that of rotating platform prosthesis in total knee replacement at 30°-120° of genuflex (P<0.05). These results suggested that peak contact pressure inside polyethylene liner of fixed and rotating platform prostheses was higher than that outside in total knee replacement, and the inside contact area was lower than that of outside. Inside and outside contact pressure of the rotating platform prosthesis was lower than that of fixed platform prosthesis. Inside and outside contact area of the rotating platform prosthesis was higher than that of fixed platform prosthesis.

0 05),BP decreased significantly,which was lower in group B than in group A (P

AIM: To prepare the sodium ferulate sustained-release pellets and evaluate its release characteristics and release mechanism in vitro. METHODS: Sugar core beads and drug-containing pellets were prepared by centrifugal granulation,and then coated by Surelease using the fluid-bed.The release characteristics and release mechanism of the pellets were studied by the dissolution method. RESULTS: The surface of the coated pellets was smooth and glossy and round.The release rate of sodium ferulate met lot-to-lot uniformity.The release rate of the pellet consisted of two kinds of pellets decreased with the increasing of the film thickness.The finishing time was 24 h.The dissolution profiles of sodium ferulate from the pellets showed a good fit of the Higuchi equation.(CONCLUSION): The pellets exhibit more ideal sustained-release characteristics in vitro.

Objective To investigate the effect of nephrostomy on the infections after ureteroscopic holmium laser lithotripsy.Methods From March 2007 to May 2008,100 patients with unilateral upper ureteral calculi complicated with hydronephrosis were divided into control and experiment groups according the patients number (50 cases in each). Ureteroscopic holmium laser lithotripsy was carried out in the control group,while in the experiment group,nephrostomy was performed two days prior to ureteroscopic holmium laser lithotripsy. The clinical data including highest body temperature after the operation,recovery of body temperature,blood routine and urine routine,as well as hospital cost,were compared between the two groups. Results Compared with the control group,patients in the experiment group showed significantly lower highest temperature [(37.8?0.5) ℃ vs (38.6?0.5) ℃,t=-8.000,P=0.000],quicker recovery of body temperature [(1.6?0.2) d vs (2.8?0.4) d,t=-18.974,P=0.000],blood routine [(2.7?0.4) d vs (4.1?0.6) d,t=-13.728,P=0.000],and urine routine [(3.6?0.6) d vs (5.2?0.7) d,t=-12.271,P=0.000],as well as lower hospital cost [(8.6?1.5) thousand RMB vs (9.5?1.1) thousand RMB,t=-3.421,P=0.000]. Conclusion Nephrostomy shows positive effect on relieving infections after ureteroscopic holmium laser lithotripsy.

Objective:To explore the application effect of optimizing the anti-epileptic drug (AED) administration nursing procedure for patients with severe epilepsy at the first time after ICU admission.Methods:A quasi-experiment study was conducted by convenience sampling. The 44 patients with severe status epilepticus admitted in our department from January 2016 to December 2017 were selected as the control group .The 44 patients with status epilepticus admitted in our department from January 2018 to December 2019 were selected as the experimental group .The experimental group was implemented the optimized administration procedure after ICU admission. The control group was implemented the routine administration procedure after ICU admission. Some data of the two groups were compared, including baseline data, first administration time after admission, administration step time, AED dose reserve, and seizures at different time periods and so on.Results:Comparative analysis of the time of the first drug administration after admission into the two groups .The administration time of the control group was 31.0 (10.0-69.0) min, which was significantly longer than that of the experimental group, 25.0 (16.0-31.8) min ( χ2 value was -2.760, P<0.05). Comparison and analysis of the time taken for each step of drug administration: The time taken for step 1(Patient admission—medical order confirmation) in the control group was significantly greater than that in the experimental group ( χ2 value was -2.811, P<0.05); step 2 (medical order confirmation—Prepare medicines)in the control group was significantly greater than that in the experimental group ( χ2 value was -4.327, P<0.05).There was no significant difference in the time taken for step 3(Prepare medicines—Drug delivery to complete)between the two groups ( χ2 value was -1.137, P>0.05). Control group AED reserve ratio 63.6% (28/44), experimental group AED reserve was 100.0% (44/44), and the difference was statistically significant ( χ2 value was 19.556, P<0.05). Epilepsy control in two groups of patients: the total control rate after the first administration of the experimental group was 93.2% (41/44), which was significantly higher than 61.4% (27/44) of the control group ( Z value was -3.445, P<0.001). Conclusion:It can shorten the time to first give AED and improve the patient's clinical symptoms that optimizing the first drug administration procedure for patients with status epilepticus after admission.

Objective:To investigate ulinastatin (UTI) combined with Xingnaojing injection in the treatment of acute cerebral hemorrhage (ACH) and its effect on the serum high sensitivity C reactive protein (hs-CRP),D-dimer (D-D) and neuron specific enolase(NSE) levels.Methods:110 cases of ACH patients admitted in our hospital from January 2015 to December 2016 were selected and divided into two groups according to the random number table method.The control group was given UTI treatment,while the observation group was given UTI combined with Xingnaojing treatment.Then the brain edema absorption effect,NIHSS score,serum hs-CRP,D-D and NSE levels before and after the treatment of the two groups were recorded and compared;the safety ofmedicidstion of the two groups was evaluated.Results:At the 14th day after treatment,the total effective rate of cerebral hematoma absorption in the observation group was 89.1％,which was significantly higher than 67.3％ of the control group (P＜0.01).At the 14th day after treatment,the NIHSS scores of both groups were significantly lower than those before the treatment (P＜0.01);compared with that of the control group of the same time period,at the 14th day after treatment,the improvement effect of NIHSS score in the observation group was more significant (P＜0.01).Compared with those before the treatment,the serum hs-CRP,D-D and NSE levels of both groups at the 14th day after treatment were significantly decreased (P＜0.01);at the 14th day after treatment,the serum indicators of the observation group improved more significantly than those of the control group (P＜0.01).The incidence rate of adverse reaction in the observation group was 3.6％ compared with 5.5％ of the control group (P＞0.05).Conclusion:Ulinastatin combined with Xingnaojing Injection could rapidly relieve or eliminate hematoma in the treatment of acute cerebral hemorrhage,control the inflammatory response,improve the blood coagulation system and fibrinolytic system,protect the nerve cells and reduce the neurological damagee.

Objective:To evaluate the accuracy of serum concentration of procalcitonin (PCT) in differential diagnosis of the etiology of bloodstream infections (BSI).Methods:Patients hospitalized in ICU of China-Japan Friendship Hospital from January 2015 to June 2020 with BSI and with PCT test simultaneously when blood drawing for blood culture were enrolled. Sequential Organ Failure Assessment (SOFA) were calculated based on parameters on the day of blood culture. Difference of various indicators among different pathogen infections were compared. Receiver Operating Characteristic (ROC) Curve was used to analyze the value of PCT in differential diagnosis of BSI by different pathogens.Results:Among 1 456 patients with BSI,1 261 (86.6%) patients with monobacterial infection, 80 (5.5%) patients with candidiasis and 115 (7.9%) patients with mixed infection. The 28-day mortality was 24.5% (356/1 456) and the 60-day mortality was 30.6% (446/1456). Mortality of both 28-day and 60-day in the mixed group was significantly higher than that in the bacteriacemia group and candidemia group. PCT levels was significantly higher in patients with bacteremia caused by gram-negative bacteria (GNB) than that in gram-positive bacteria (GPB) infected bacteremia and candidemia {3.4 μg/L[95% confidence interval (95% CI) 0.7-17.0 μg/L] vs 1.3 μg/L (95% CI 0.4-7.3 μg/L); 3.4μg/L (95% CI was 0.7-17.0 μg/L) vs 1.1 μg/L (95% CI was 0.4-3.4 μg/L); P<0.01} . ROC curve analysis showed that: ① the optimal cut-off value of PCT in differential diagnosis of monobacterial bacteremia and candidemia was 7.25 μg/L, with specificity of 90.0% and the area under the ROC curve (AUROC) was 0.612 (95% CI 0.533-0.691). When PCT value was greater than 0.51 μg/L, the sensitivity of diagnostic of bacteremia could reach 73.3%. ② the optimal cut-off value of PCT in differential diagnosis of bacteremia caused by GNB infection and candidemia was 7.32 μg/L, with specificity of 90.0% and AUROC was 0.695 (95% CI 0.614-0.776). When PCT value was greater than 0.51 μg/L, the sensitivity of diagnostic of bacteremia caused by GNB infection was 84.9%.③ the optimal cut-off value of PCT in differential diagnosis of bacteremia caused by GNB and GPB infection was 0.52 μg/L, with sensitivity of 84.9% and AUROC was 0.713 (95% CI 0.672-0.755). When PCT value was greater than 7.36 μg/L, the specificity of diagnostic of bacteremia caused by GNB infection could reach 80.1%. Conclusions:PCT can provide additional information about the possible etiology of patients with BSI, especially as high levels often indicate the possibility of GNB bacteremia.

Objective To investigate MR findings and analyze the misdiagnosed cases of pituitary macroadenoma.Methods MR features of 1 90 patients of pituitary macroadenoma confirmed by operation and pathology were reviewed.Results 1 6 cases were mis-diagnosed as craniopharyngioma,chordoma,or meningioma.Among the sixteen cases,eight cases with cyst degeneration and hemor-rhage were misdiagnosed as craniopharyngioma;five cases with clival and sphenoid sinus destruction were misdiagnosed as chordo-mas;three cases with suprasellar and anterior cranial fossa extension were misdiagnosed as meningiomas.Conclusion Craniophar-yngioma,chordoma and meningioma should be considered in the differential diagnosis of atypical pituitary macroadenoma.The com-prehensive analysis should be based on a variety of signs.

Objective To compare the accuracy of bispectral index (BIS),Narcotrend index (NI),index of consciousness (IoC) versus auditory evoked potential index (AAI) in monitoring the depth of sedation induced by propofol.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 41-64 yr,with body mass index 20-30 kg/m2,scheduled for elective surgeries under general anesthesia,were enrolled in the study.Propofol was given by target-controlled infusion (TCI) with the initial target effect-site concentration (Ce) of 0.8 μg/ml using Marsh pharmacokinetic model,and then the Ce of propofol was increased by 0.1 μg/ml,and OAA/S was performed.Before TCI of propofol,the values of BIS,NI,IoC and AAI were recorded,and at the same time the value of OAA/S score was 5.During TCI of propofol,when OAA/S score reached 4,3,2 and 1 in turn,the Ce of propofol was recorded,the sequence for determination of the values of BIS,NI,IoC and AAI was determined using a random number table,and the values were then recorded for 5 s after the values were stable and then averaged.The parameters for vital signs were maintained within the normal range.Pearson correlation of BIS,NI,IoC and AAI values with Ce of propofol was analyzed.Results The correlation coefficients of BIS,NI,IoC and AAI values with the Ce of propofol were rBIs-Ce =-0.829,rSI-Ce =-0.886,rloC-Ce =-0.881 and rAAI-Ce =-0.791,respectively.There was no significant difference between rBIS-Ce,rNI-Ce,rIoC-Ce and rAAI-Ce.Conclusion There are no significant differences in the accuracy of BIS,NI,IoC or AAI in monitoring the depth of sedation induced by propofol in middle-aged patients with non-noxious stimuli.