The reasonable distribution of healthcare human resources is the fundamental requirement to improve medical efficiency and service quality,satisfy public's diverse requirement for medical care,and realize medical service fairness.However,various factors hinder the reasonable distribution of healthcare human resources and the realization of medical service fairness in the present medical system,including the imperfect system of human resources management,the immature system of performance appraisal,the imbalanced development of different regions,and the unpleasant environment of medical practice.This paper reflects on those issues from an ethical perspective.

Clinic probation teaching is an important part of medical education practice, whose teaching effect andquality have impact on the quality of cultivation for medical students. To solve the existing problems, Gannan MedicalCollege has combined the single clinic probation with social practice activities, expanded the probation teaching area,made the full use of students' capability, reformed the traditional probation teaching pattern, defined teaching objectivereasonably, which gives rise to the improvement in clinic teaching quality.

Objective To explore the effect of acupuncture combined with facilitated technique on lower limb function and activities of daily living of stroke patients.Methods 120 stroke patients with lower limb palsy were divided into the group Ⅰ (treated with acupuncture combined with facilitated technique), group Ⅱ (treated with acupuncture), third group Ⅲ (treated with facilitated technique) and the group Ⅳ (treated with medicine). The lower limb function and ADL of four groups were evaluated with Functional Ambulation Classification (FAC), Fugl-Meyer Assessment (FMA), Modified Barthel Index (MBI) before and 10 weeks after treatment.Results The scores of FAC, FMA and MBI of all the groups improved significantly, but it was more significantly in the first group than the in other groups (P<0.01), in group Ⅰ, Ⅱ, Ⅲ than in group Ⅳ (P<0.01). The difference between the group Ⅱ and Ⅲ was insignificantly(P>0.05).Conclusion Acupuncture combined with facilitated technique can improve the lower limb function and activities of daily living of stroke patients more effectively.

Objective To observe the effects of Qizhi Zhoufei Granules on IL-8, TNF-αand ET-1 in serum and bronchoalveolar lavage fluid (BALF) of chronic obstructive pulmonary disease (COPD) model rats, and to study its mechanism of preventing and treating COPD. Methods Wistar rats were randomly divided into blank group, model group, positive control group, Qizhi low-dose group, Qizhi medium-dose group and Qizhi high-dose group. The COPD model was established by smoking and infusing lipopolysaccharide (LPS). After 15 days, the rats were given the drugs by orally taking once a day. On the 43rd day, the change of IL-8, TNF-α and ET-1 content in serum and BALF were measured by radio-immunity assay. Results Compared with the blank group, the level of IL-8, TNF-α and ET-1 in serum and BALF were considerably raised in model group (P<0.05). Whereas compared with the model group, the level of TNF-αin serum of Qizhi high-dose group was remarkably lowered (P<0.05), the level of IL-8 in serum of Qizhi low-dose group and Qizhi high-dose group was remarkably lowered (P<0.05), the level of TNF-αin BALF of Qizhi medium-dose group was remarkably lowered (P<0.05), the level of IL-8 in BALF of Qizhi low-, medium- and high-dose group was remarkably lowered (P<0.05), and the level of ET-1 in BALF of Qizhi high-dose group and Qizhi medium-dose group was remarkably lowered (P<0.05). Conclusion Qizhi Zhoufei Granules have protective effect on lung tissue of COPD rats, and can adjust the content of IL-8, TNF-α and ET-1, which may be one of its mechanisms of intervening occurrence and development of COPD.

Objective To propose an improved discrete wavelet transform (DWT ) and to apply it in multimodal medical im‐age fusion .Methods Firstly ,the source medical images were initially transformed into the high frequency and low frequency images by DWT ;then the high frequency part adopted the big direction absolute values ,which effectively preserved the detailed informa‐tion of image ,while the low frequency part used the fusion rule of local energy ratio for preserving the most of image information ;finally ,the discrete wavelet reverse transform was used for reconstructing the fusion sub‐images into fusion image .Results By comparing the fusion images by 3 groups of medical images ,this proposed algorithm was superior to other existing algorithms in the aspects of subjective visual effect and objective evaluation indicators .Conclusion The proposed algorithm of medical image fusion is rapid and accurate ,has excellent performance in the noise environment and clinical examples ,can obtain the high quality fusion im‐age and has higher clinical application value .

Disorder of consciousness is the dysfunction of recognition and awareness of the surrounding environment and its own state. In recent years, studies have shown that transcranial direct current stimulation has achieved considerable results in improving the disorder of consciousness. In this paper, the research progress on the neural bases of transcranial direct current stimulation for treatment of disorder of consciousness, comparison of different stimulation protocols and its value of differential diagnosis for levels of consciousness are summarized as follows.

Objective: To investigate the effects of ambient air pollution on the school age children s diseases, symptoms and school absence, and to provide a reference for preventing the harmful effect of air pollution on students. Methods: Health questionnaires surveys were conducted among 792 students of the fourth grade in a primary school in Hangzhou, and the incidence of diseases and symptoms were continuously monitored every day during the winter of 2014-2017. The generalized additive model based on Poisson regression was used to analyze the health effects caused by single pollution. The multivariate Logistic regression model was used to analyze the comprehensive effects of family, living environment and air pollution on student health. Results: Totally 415 students(52.4%) had a history of diseases and 265 students(33.5%) had a history of allergy. During the investigation, the average concentrations of PM 2.5 , PM 10 , SO 2 and NO 2 were (81.0±2.8) (122.2±3.9) (17.9±0.6) and (68.9±1.4)μg/m 3. Strongest associations were found for lag 3 day of exposure among PM 2.5 , PM 10 and NO 2 on illness and absence. Increases of 10 μg/m 3 in PM 2.5 , PM 10 and NO 2 were associated with 1.02(95% CI =1.01-1.02), 1.04(95% CI =1.03-1.06) and 1.03(95% CI =1.02- 1.04 ) increases in daily illness rates. SO 2 lag for 5 days had the most significant effect on students health. Father s education was the protective factor for illness ( OR =0.83) and symptoms( OR =0.84 ). The risk factors for symptoms included furniture replacement within one year( OR =1.78), pet feeding( OR =1.94), respiratory infections within one year( OR =1.82), allergies rhinitis( OR =2.24), family history with coronary heart disease/hypertension( OR =1.46), indoor activity time ( OR =1.02) and atmospheric PM 10 concentration( OR =1.09)( P <0.05). Conclusion The increase of air pollution concentration has an impact on the illness, symptoms and absence from school, and there is a lag effect. Father s education is a protective factor for the health of students. Indoor pollution and outdoor air pollution can lead to the occurrence of illness and symptoms.

Objective:To investigate the predominant serotypes and diversification of Echovirus (ECHOV) from viral encephalitis children in Quzhou area of Zhejiang province and the molecular characteristics of the ECHOV VP1 genes.Methods:Cerebrospinal fluid samples from 53 children with viral encephalitis were collected for viral isolation/culture. Fluorescent RT-PCR or PCR was used to detect human enteroviruses (HEV) including ECHOV, coxsackievirus(CoV) and new enterovirus (EV), and japanese encephalitis virus(JEV), mumps virus(MuV), west Nile virus(WNV) and chikungunya virus(CHLKV) or herpes simplex virus(HSV) and cytomegalovirus(CMV) in the cerebrospinal fluid samples. The complete VP1 gene sequence of HEV-B group in the HEV-positive cerebrospinal fluid samples was amplified by RT-PCR and sequenced, and then the typing of Echovirus isolates was performed. The VP1 genotypes of Echovirus isolates, gene recombination, inheritance and evolution characteristics were analyzed using multiple bioinformatic software.Results:Six viral strains were isolated by cell culture using rhabdomyosarcoma (RD) cells but not human epithelial-2 (Hep-2) cells. Eleven cerebrospinal fluid samples were positive for HEV by RT-PCR but the detection result of all the other viruses were negative. In the 11 HEV-positive samples, 6 samples were positive for ECHOV (4 for ECHO6, 1 for ECHO7 and 1 for ECHO30 serotype), which was coincident with the isolation result , but CoV and EV were undetectable. The 4 ECHO6 isolates belonged to ECHO6-C2 subgenotype but can be divided into two epidemic clones (ECHO6-41/46 and ECHO6-45/48). The ECHO7 and ECHO30 isolates belonged to ECHO7-C and ECHO30-C genotypes. The VP1 gene recombination between the ECHO6 and ECHO30 isolates were found during their evolutionary process.Conclusions:ECHOV is the major pathogen of viral encephalitis children in the area, and there is a possibility of local outbreak or epidemic. Because of the possibility of recombination of the VP1 gene of ECHO6 and ECHO30 virus, ECHO6 may become the dominant ECHOV serotype.

Objective:To explore the clinical features of programmed cell death-1 (PD-1) inhibitor-associated hypophysitis and improve the understanding of the disease.Methods:For the present retrospective case series study, the clinical data of patients with PD-1 inhibitor-associated hypophysitis who were treated at the Affiliated Hospital of Hebei University and the 3rd Hospital of Hebei Medical University from January 2020 to May 2023 were collected for analysis of clinical manifestations and prognosis.Results:Fifteen cases of PD-1 inhibitor-induced hypophysitis were included, with 13 males and 2 females. The mean age of onset was (62.1±7.5) years, and the median time of onset was 6.5 (4.7, 11.6) cycles of PD-1 inhibitor. At diagnosis, 14 patients complained of gastrointestinal symptoms, and 12 patients complained of fatigue. There were 12, 1, 1, 5, and 1 cases of hyponatremia, hypokalemia, hypoglycemia, hypotension, and fever, respectively. Secondary adrenocortical insufficiency occurred in all cases. Moreover, four patients had secondary hypothyroidism, and two patients had secondary hypogonadism. Posterior pituitary hypofunction was not found. Pituitary MRI showed one case each of vacuolar sella turcica, pituitary cystic lesion, pituitary stalk slightly shifted to the left, high metabolism in the sella turcica, and pituitary abnormal signal, while no abnormalities were found in 11 cases. The follow-up time was (47.66±11.93) weeks. At the last follow-up, one patient′s serum levels of adrenocorticotropic hormone and cortisol returned to normal.Conclusions:Hypophysitis associated with PD-1 inhibitors occurs later, and gastrointestinal symptoms and fatigue are the most common clinical manifestations. PD-1 inhibitor-associated hypophysitis mainly manifests as adrenocortical hypofunction, and some cases manifest as hypothyroidism and hypogonadism. In addition, patients with PD-1 inhibitor-associated hypophysitis show no obvious imaging changes in the pituitary gland.

BACKGROUND/AIMS: Early adverse life events (EALs) are relevant to irritable bowel syndrome in adulthood. Maternal separation (MS), as one of the EALs, has proved to induce visceral hypersensitivity in adult rats. However, the effect of MS on visceral hypersensitvity from the post-weaning period to adulthood remains unknown. METHODS: One hundred and ten neonatal Sprague-Dawley rats were randomly divided into 2 groups: rats in the MS group were exposed to 3 hours daily MS on postnatal day (PND) 2–14; the normal control (NC) group remained undisturbed. Visceral sensitivity was determined by measuring the visceromotor response to colorectal distention on PND21, 35, and 56. Anxiety-like behaviors were measured by the open field test. RESULTS: Compared with NC rats, MS rats showed significant visceral hypersensitivity from the post-weaning period to adult. The proportion of visceral hypersensitive rats decreased with age from 87.5% to 70.0% in the female MS group and from 90.0% to 66.7% in the male MS group. The relative VMR ratio of MS and NC on PND21 was higher than PND35 and PND56. MS rats showed decreased ability of movement and exploration to the novel environment in the post-weaning period, obesity in the prepubertal period, and more anxiety-like behaviors in adulthood. CONCLUSIONS: MS can significantly affect visceral sensitivity and behaviors of rats in different age stages, especially in the post-weaning period. Visceral hypersensitivity of MS rats is more pronounced in the post-weaning period and slightly restored in adults. Thus, visceral hypersensitivity in the post-weaning period might play a more meaningful pathophysiologic role in the formation of adult irritable bowel syndrome.
Adult ; Animals ; Female ; Humans ; Hypersensitivity* ; Irritable Bowel Syndrome ; Male ; Maternal Deprivation ; Obesity ; Rats ; Rats, Sprague-Dawley