Objective: To investigate patients' satisfaction rate towards referral in a class A tertiary hospital, so as to provide the evidence for promoting the highly efficient implementation of referral. Methods : The gender, age, type of referral, referral efficiency and referral cost of patients receiving referral services in 2021 were collected through the interconnected intelligent hierarchical diagnosis and treatment collaborative platform of Henan Provincial People's Hospital. Patients' awareness and recognition of the two-way referral system were investigated using questionnaire surveys, and factors affecting patients' satisfaction with referral were identified using a multivariable logistic regression model. Results: A total of 1 268 patients receiving referral services were surveyed, including 576 men (45.43%) and 692 women (54.57%), and the respondents were predominant at ages of 18 years and older (935 cases, 73.74%). There were 535 cases with overdue referral (42.19%) and 1 157 cases with free referrals (91.25%). There were 749 cases that were aware of the two-way referral system (59.07%), and 587 cases recognized the two-way referral system (46.29%). There were 975 patients with a satisfactory attitude towards referral, with a satisfaction rate of 76.89%. There were 1 030 cases (81.23%) that considered fluent communication of referral information, with a 78.54% satisfaction rate towards referral; 569 cases (44.87%) that considered simple referral procedures, with an 81.37% satisfaction rate towards referral, and 797 cases that were satisfied with the services provided by the referred medical staff (62.85%), with a 79.42% satisfaction rate towards referral. Multivariable logistic regression analysis showed that non-overdue referrals (OR=1.846, 95%CI: 1.411-2.414), free referrals (OR=1.815, 95%CI: 1.188-2.773), awareness of the two-way referral system (OR=0.624, 95%CI: 0.472-0.826), recognition of the two-way referral system (OR=1.621, 95%CI: 1.235-2.129) were factors affecting the satisfaction with referral. Conclusions The satisfaction rate towards referral was 76.89% among the study patients, and the awareness and recognition of the two-way referral system, referral efficiency and convenience are factors affecting the satisfaction with referral.

Objective To explore the effect of decoction of four-drug juice plus glutamine on nutritional support in the elderly critically ill patients. Methods One hundred and twenty-four elderly critical ill patients in The First Hospital of Jilin University from May 2010 to May 2012 were randomly divided into treatment group(n = 62)and control group(n = 62). Patients in both two groups were given enteral nutrition(EN)plus parenteral nutrition(PN)after the hemodynamics became stable. In addition,patients in control group were given routine EN + PN,while in treatment group was given decoction o four-drug juice + EN plus glutamine + PN. Prealbumin (PA),serum total protein( TP),transferrin( TF)and serum albumin( ALB)were detected before and after treatment of nutritional support. The informations including recovery of bowel sounds,the occurrence of complications,antibiotic use time and the duration of ICU stay were recorded. Results There were no significant differences between two groups in terms of nutrition indices before treatment(P > 0. 05). After treatment,the contents of pre albumin,transferrin,total serum protein,serum albumin in treatment group were( 145. 24 ± 6. 72)g/ L,(1. 93 ± 0. 98)g/ L,(79. 86 ± 10. 38)g/ L,(54. 91 ± 2. 91)g/ L respectively,better than those in control groups((139. 24 ± 38. 76),(1. 68 ± 0. 33),(74. 73 ± 7. 31),(49. 87 ± 2. 61)g/ L),and the differences were statistically significant( t = 3. 610,2. 929,4. 360,6. 767;P < 0. 05). The incidence of stress ulcer and double infection in treatment group were 42%(26 / 62),37%(23 / 62),significantly lower than the control group(59%(37 / 62),53%(33 / 62)),and the differences were statistically significant( χ2 = 5. 186, 5. 271,P < 0. 05). Antibiotic use time and the duration of ICU stay in treatment group were(8. 82 ± 0. 71)d and(16. 14 ± 3. 01)d,and reaching full eternal nutrition time was(6. 90 ± 1. 01)d,decreased less than that in control group((10. 21 ± 1. 30),(20. 67 ± 2. 29),(13. 91 ± 1. 51)d)and the differences were statistically significant(t = 8. 892,7. 786,3. 609,P < 0. 05). The average recovery time of bowel sounds and first anal exhaust time average in treatment group were(26. 8 ± 3. 6)h,(25. 4 ± 3. 2)h,lower than that in control group ((38. 4 ± 4. 8)h,(37. 6 ± 4. 9)h)and the differences were statistically significant( t = 3. 551,2. 516,P< 0. 05). Conclusion The application of decoction of four-drug juice plus glutamine on nutritional support of the elderly critically ill patients can reduce complications,shorten the duration of ICU,recover the intestinal function as soon as possible. Meanwhile,patients can transit to full eternal nutrition as soon as possible,then the cost of therapy is reduced and rehabilitation is quickly.

Objective To study the predictive value of acute gastrointestinal injury (AGI) grading system introduced into Sequential Organ Failure Assessment (SOFA) score in patients with severe acute pancreatitis (SAP) in order to provide a reliable clinical tool for the evaluation of prognosis of SAP.Methods Patients with acute pancreatitis admitted to ICU from July 2012 to July 2014 were enrolled for study.The criteria of exclusion were the age below 18 years old,pregnancy,or patients without consent to the treatment.A total of 63 patients with 37 males and 26 females aged (47 ± 15.3) years were included.The data of their acute physiology and chronic health evaluation (APACHE) Ⅱ score,the highest SOFA score and AGI grade within the first week,and the 28-day mortality rate were collected.Patients without AGI were defined as zero point,and AGI grade Ⅰ-Ⅳ were defined as 1-4 points.The receiver operating characteristic curve (ROC) was used to evaluate the value of APACHE Ⅱ score,SOFA score,and SOFA + AGI score in predicting the prognosis of SAP.The areas under ROC curve (AUC) of the APACHE Ⅱ score,SOFA score,and SOFA + AGI score were compared with MedCalc software,and P value less than 0.01 was considered to be statistical significance.Results (1) The 28-day mortality of the 63 patients with SAP was 20.6％ (13/63),in which 50 patients in the survival group,13 patients in the death group.The APACHEⅡ scores of two groups were (15.62 ± 4.33 vs.12.10 ± 3.74,P=0.0048),the SOFA scores were (14.77 ± 3.09 vs.9.24 ± 2.88,P ＜0.01),and the SOFA + AGI scores were (18.77 ±3.09 vs.10.74 ± 3.17,P＜0.01).(2) The AUC of APACHEⅡ score was0.748 ± 0.084 (95％ CI:0.622-0.849),the AUC of SOFA score was 0.902 ± 0.059 (95％ CI:0.801-0.962),and the AUC of SOFA +AGI score was 0.963 ± 0.037 (95％ CI,0.882-0.994);There was no significant difference in AUC between APACHE Ⅱ score and SOFA score (P =0.10),and there was statistical significance between the AUC of APACHE Ⅱ score and that of SOFA + AGI score (P =0.013),and the difference in AUC between SOFA score and SOFA + AGI score was statistically significant (P =0.008).The Youden index and the positive likelihood ratio of SOFA + AGI score system were the greatest to be 0.863 and 15.38,respectively.Conclusions SOFA scoring system has better predictive value in patients with SAP when AGI grading system was introduced into it.

OBJECTIVE:To study the inhibitory effects of recombinant adenovirus Ad-GFP-C197, which prepared by adenovirus vector system-loading human telomerase reverse transcriptase(hTERT)C fragment(C197),on the proliferation of 3 kinds of tumor cells in vitro. METHODS:Ad-GFP-C197 was amplified and purified with HEK293 cells. Human gastric cancer cells SGC7901,human breast cancer cells MCF7 and human colorectal cancer cells CaCO2 were infected by Ad-GFP-C197 respectively. Using blank adenovirus carrier (Ad-GFP) as reference,the protein expression of C197 in 3 kinds of tumor cells infected by Ad-GFP-C197 was detected by Western blot assay. The inhibitory effects of Ad-GFP-C197 on 3 kinds of tumor cells were detected by MTT assay. The cell proliferation curve was drawn and the proliferation inhibition rate was calculated. RESULTS:The protein expression of C197 was not detected in 3 kinds of tumor cells infected by Ad-GFP,while significant protein expression of C197 was found in above cells infected by Ad-GFP-C197. The proliferation curves of the 3 kinds of tumor cells infected by Ad-GFP-C197 were significantly inhibited with the time extended,and the proliferation inhibitory rate reached 37.31%-41.42%. CONCLUSIONS:Ad-GFP-C197 shows significant inhibitory effects on the proliferation of SGC7901,MCF7 and CaCO2 cells, which is rapid to make up for the slow effect of other telomerase inhibitors.

Objective:To investigate neuroprotective effect of alpinetin on ischemic stroke(IS)rats by regulating Shh/Gli1 signaling pathway.Methods:Fifteen rats were randomly collected as control group,remaining rats were used to construct an IS model.Rats that successfully modeling were randomly grouped into model group,alpinetin group(5 mg/kg),Shh/Gli1 signaling pathway inhibitor cycloparamide group(15 mg/kg)and alpinetin+cycloparamide group(5 mg/kg alpinetin+15 mg/kg cycloparamide),with 15 rats in each group,and administered once a day for two consecutive weeks,control group and model group were given equal amounts of physiological saline.Zea-Longa scoring method was applied to evaluate neural function;ELISA was applied to detect inflammatory factors levels;mass of brain tissue was weighed and water content of brain tissue was calculated;TTC staining was applied to measure volume of cerebral infarction;HE staining was applied to observe nerve cell damage;TUNEL staining was applied to detect neuronal apoptosis;qRT-PCR and Western blot were used to detect mRNA and protein expressions of Shh and Gli1.Results:There were no abnormalities in hippocampal tissue of control group,while hippocampal tissue structure of model group rats was abnor-mal,with disordered cell arrangement and nuclear pyknosis of nerve cells,cell damage rate,Zea-Longa score,infarct volume,IL-1β,IL-6,TNF-α,brain tissue water content,and cell apoptosis rate in model group were obviously higher than control group(P<0.05),mRNA and protein levels of Shh and Gli1 were obviously decreased(P<0.05);compared with model group,cells in alpinetin group were arranged more neatly,and phenomenon of neuronal cell nucleus pyknosis was improved,cell damage rate,Zea-Longa score,infarct volume,IL-1β,IL-6,TNF-α,brain tissue water content,and cell apoptosis rate were obviously decreased(P<0.05),mRNA and protein levels of Shh and Gli1 were obviously increased(P<0.05),trend of above indicators in cyclophosphamide group was opposite,ciclopramide reversed neuroprotective effect of alpinetin on IS rats.Conclusion:Alpinetin may exert neuroprotective effects on IS rats by activating Shh/Gli1 signaling pathway.

Objective:To understand the epidemiological characteristics and spatiotemporal distribution of viral encephalitis in children and adolescents in Henan Province from 2012 to 2023.Methods:The information about viral encephalitis cases from October 1, 2012 to July 26, 2023 were collected from Zhengzhou Children's Hospital (National Children's Regional Medical Center),Henan Provincial Children's Hospital for the analyses on temporal distribution the cases, the severe illness rate, age distribution, pathogen type and imaging findings of the cases.Results:A total of 6 276 cases of viral encephalitis were included in this study after excluding cases with incomplete information. The cases mainly originated from Zhengzhou (38.96%), followed by Zhoukou (9.93%), Xuchang (8.68%), Zhumadian (7.90%) and Pingdingshan (7.39%). The cases in boys accounted for 62.13% and the cases in girls accounted for 37.87%. Most cases (72.45%) occurred in age group 7-13 years. The overall rate of severe illness cases was 4.51% from 2012 to 2023. There were significant differences in severe illness cases among different areas and years ( χ2=5.33, P=0.021; χ2=48.14, P<0.001). Enteroviruses were mainly detected (31.57%), in which Coxsackie virus was predominant (58.37%). Imaging findings showed that cerebral hemisphere damage was most common in children and adolescents with viral encephalitis (54.93%). Conclusions:From 2012 to 2023, more cases of viral encephalitis occurred in boys in Henan. Children and adolescents aged 7-13 years were the main affected group. The prevention of enteroviruses infection, especially Coxsackie virus, needs to be strengthened. Special attention should be paid to the prevention of cerebral hemisphere damage after viral encephalitis diagnosis.

Objective:To analyze the efficacy of second-line regimens and prognostic factors in patients with first-relapsed multiple myeloma (MM) treated with bortezomib, cyclophosphamide, and dexamethasone (BCD).Methods:A retrospective cohort study. Clinical data were collected in first-relapsed MM patients after BCD treatment from three tertiary hospitals in north China from July 2009 to October 2022. Patients were classified according to the second-line regimen into the immunotherapy group, single novel agent group [either proteasome inhibitor (PI) or immunomodulatory drug (IMiD)], combination treatment group (both PI+IMiD), and traditional treatment group. Responses to second-line regimens and survival data were analyzed. The Kaplan-Meier method was used for survival analysis and the Cox proportional risk model was used for univariate and multivariate analyses.Results:A total of 217 patients were enrolled including 8.8% (19/217) in the immunotherapy group, 48.4% (105/217) in the PI/IMiD group, 29.9% (65/217) in the PI+IMiD group, and 12.9% (28/217) in the traditional treatment group. The median age was 62 years (range 31-83 years) and 56.2% (122/217) were males. The overall response rates (ORRs) in the four groups were 94.7% (18/19) vs. 56.2% (59/105) vs. 73.8% (48/65) vs. 32.1% (9/28) ( χ2=24.55; P<0.001), respectively. The progression-free survival (PFS) of the second-line regimens (2ndPFS) was 17.7 vs. 9.0 vs. 9.2 vs. 4.6 months ( χ2=22.74; P<0.001), respectively, among which patients in the PI/IMiD and PI+IMiD groups had comparable 2ndPFS ( χ2=1.76; P=0.923). Patients with high-risk cytogenetic abnormalities (HRCAs) achieved the longest 2ndPFS of 22.0 months in the immunotherapy group ( χ2=15.03; P=0.002). Multivariate analysis suggested that immunotherapy ( HR=0.11, 95% CI 0.05-0.27), achievement of efficacy of partial response or better ( HR=0.47, 95% CI 0.34-0.66), and non-aggressive relapse ( HR=0.25, 95% CI 0.17-0.37) were independent prognostic factors of 2ndPFS. Conclusion:In this real-world study, immunotherapy was associated with a more favorable efficacy and PFS for first-relapsed MM patients after BCD treatment, with similar outcomes in patients with HRCAs.

OBJECTIVETo investigate the characteristics, treatment and outcome of patients with primary central nervous system lymphoma （PCNSL）.

METHODSA total of 37 patients with PCNSL treated in Peking Union Medical College Hospital from June 1999 to June 2012 were enrolled into this retrospective study. The clinical characteristics, results of treatment and prognostic factors were analyzed.

RESULTSThe median age of 37 patients with PCNSL at diagnosis was 57 years（range 17 to 78 years） with a male to female ratio of 2.7:1. The symptoms or signs of elevated intracranial pressure and cognitive dysfunction were the most common initial manifestations. The median time period between onset of symptoms and diagnosis was 1.5 months. The majority of lesions were located in the cerebral hemisphere. At a median follow-up of 50 months, the median overall survival for all treated patients was 36.0 months （95% CI 21.7-50.3 months）, with a progression-free survival of 18.0 months（95% CI 9.1-26.9 months）. The 3-year cumulative survival rate was 46.9%. Compared to chemotherapy alone, combined-modality regimens which did not improve outcome were associated with a greater risk of neurotoxicity.

CONCLUSIONThe prognosis of PCNSL was still poor, and the optimal treatment strategy for these patients should be explored in the future clinical trials.

Adolescent ; Adult ; Aged ; Beijing ; Central Nervous System Neoplasms ; diagnosis ; pathology ; Disease-Free Survival ; Female ; Humans ; Lymphoma, Non-Hodgkin ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Rate ; Young Adult

Acinetobacter Infections ; epidemiology ; microbiology ; Acinetobacter baumannii ; isolation & purification ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cross Infection ; epidemiology ; microbiology ; Female ; Hematologic Diseases ; microbiology ; Hospital Units ; Humans ; Male ; Middle Aged ; Prevalence ; Young Adult