Objective To analyze the fairness of human resource allocation in professional public health agency (PHA) in Guangdong Province in 2022. Methods Health technical staff, other technical staff, and management staff from PHAs in Guangdong Province, such as disease prevention and control centers, specialized disease prevention and treatment institutions, maternal and child health institutions, health education centers, emergency centers/stations, blood collection and supply institutions, health supervision agencies, and family planning service centers under health departments, were selected as the study subjects. Data on human resource allocation in PHAs were collected, and the Lorenz curve, Gini coefficient, and Theil index were used to analyze the fairness of personnel allocation based on three dimensions: year-end resident population, geographical area, and regional gross domestic product. Results The number of PHA personnel per 10 000 population in four regions of the Pearl River Delta, eastern, western and mountain area in Guangdong Province was (7.49±3.74), (4.74±0.87), (8.73±1.67) and (10.33±1.80), respectively. There was no correlation between the per capita regional gross dumestic product of each prefecture level city and the number of PHA personnel (Spearman′s rank correlation coefficient=0.43, P>0.05). PHA resource allocation based on year-end resident population was more equitable than allocations based on geographical area or regional gross dumestic product, as indicated by the Lorenz curve being closest to the 45° standard line and the lowest Gini coefficient. The fairness of personnel allocation from high to low was ranked as follows: practicing (assistant) physicians, health technicians, registered nurses, managers personnel, and other technical personnel, with Theil indices of 0.035 0, 0.036 4, 0.044 6, 0.048 4, and 0.053 5, respectively. The differences in configuration fairness were derived from within group differences, with contribution rates of 76.0%, 73.9%, 71.8%, 82.9%, and 92.2%. The Lorenz curve, Gini coefficient, and Theil index were consistent in the distribution of permanent residents at the end of the year. Conclusion The fairness of professional human resource allocation in Guangdong Province based on the distribution of permanent residents at the end of the year is better than that based on geographical area and regional gross domestic product. The fairness of the allocation of practicing (assistant) physicians is better than that of other professional categories. Regional differences are the main reason for the relatively unfair allocation of PHA human resources in Guangdong Province.

Objective To investigate the effect of combination of rope-assisted proprioceptive neuromuscular facilitation(PNF)training and rope-assisted brain-computer interface(BCI)training on upper limb function in stroke patients with hemiplegia. Methods From March,2022 to February,2023,96 inpatients with stroke hemiplegia from the Second Affiliated Hospital of Guangxi Medical University were randomly divided into conventional group(n=32),PNF group(n=32)and combined group(n=32).All the groups received routine rehabilitation treatment.The conventional group re-ceived upper limb PNF training,the PNF group received upper limb rope-assisted PNF training,and the com-bined group received both upper limb rope-assisted PNF training and upper limb rope-assisted BCI training,for four weeks.They were assessed with Functiongal Test for the Hemiplegic Upper Extremity-Hong Kong version(FTHUE-HK),Fugl-Meyer Assessment-Upper Extremities(FMA-UE)and modified Barthel Index(MBI)before and after treatment. Results The intra-group effect(F>341.219,P<0.001),inter-group effect(F>21.705,P<0.001)and interaction effect(F>3.171,P<0.05)were significant in the scores of FTHUE-HK and MBI.The intra-group effect(F=520.472,P<0.001)and inter-group effect(F=41.939,P<0.001)were significant in the scores of FMA-UE,and the interaction effect was not(P>0.05).After treatment,the FTHUE-HK,FMA-UE and MBI scores were the best in the combined group(P<0.05). Conclusion The combination of rope-assisted PNF training with rope-assisted BCI device training could further improve the motor function of the upper limbs in stroke patients with hemiplegia,and enhance their activities of daily liv-ing.

ObjectiveTo investigate the effect of combination of proprioceptive neuromuscular facilitation (PNF) rope training and repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function of stroke patients with hemiplegia. MethodsFrom March, 2021 to February, 2022, 90 stroke inpatients with hemiplegia in the Department of Rehabilitation Medicine, the Second Affiliated Hospital of Guangxi Medical University were divided into control group (n = 30), rope group (n = 30) and combination group (n = 30) randomly. All the groups received routine rehabilitation, while the control group received routine PNF training, the rope group received PNF rope training, and the combination group received PNF rope training and rTMS, for four weeks. They were assessed with Functional Test for the Hemiplegic Upper Extremity-Hong Kong version (FTHUE-HK), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment. ResultsThe scores of FTHUE-HK, FMA-UE and MBI increased in all the three groups after treatment (t > 2.167, P < 0.05), and they were more in the combination group than in the rope group (P < 0.05), and in the rope group than in the control group (P < 0.05). ConclusionThe combination of PNF rope training and rTMS is more effective on motor function of upper limbs of stroke patients with hemiplegia than PNF training alone.

Objective:To investigate the diagnostic value of dynamic contrast enhanced MRI (DCE-MRI) quantitative parameters for preoperative staging of gastric cancer and its relationship with prognostic factors.Methods:The clinical data of 98 patients with gastric cancer from March 2021 to March 2022 in Guangyuan First People′s Hospital were retrospectively analyzed. All patients underwent DCE-MRI examination, MRI features were observed, and the DCE-MRI quantitative parameters were recorded, including the transport constant (K trans), volume fraction (V e) and rate constant (K ep). The expression levels of human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor (EGFR) in gastric cancer tissue were detected by immunohistochemistry methods. The correlation between DCE-MRI quantitative parameters and T stage, HER2, EGFR of gastric cancer was analyzed by Spearman method; the receiver operating characteristic (ROC) curve was used to evaluate the diagnosis value of DCE-MRI quantitative parameters in T staging of gastric cancer. Results:Among 98 patients with gastric cancer, T 1 to T 2 staging was in 50 cases, T 3 to T 4 staging was in 48 cases; HER2 positive expression in gastric cancer tissue was in 35 cases, negative expression was in 63 cases; EGFR positive expression in gastric cancer tissue was in 43 cases, negative expression was in 55 cases. The K trans and V e in patients with T 3 to T 4 staging were significantly higher than those in patients with T 1 to T 2 staging: (0.25 ± 0.04) min -1 vs. (0.19 ± 0.03) min -1 and 0.45 ± 0.11 vs. 0.39 ± 0.09, and there were statistical differences ( P<0.01); there was no statistical difference in K ep between the two ( P>0.05). The K trans and V e in patients with HER2 positive expression were significantly higher than those in patients with HER2 negative expression: (0.27 ± 0.06) min -1 vs. (0.19 ± 0.03) min -1 and 0.49 ± 0.13 vs. 0.38 ± 0.08, and there were statistical differences ( P<0.01); there was no statistical difference in K ep between the two ( P>0.05). The K trans and V e in patients with EGFR positive expression were significantly higher than those in patients with EGFR negative expression: (0.28 ± 0.07) min -1 vs. (0.17 ± 0.04) min -1 and 0.50 ± 0.14 vs. 0.36 ± 0.08, and there were statistical differences ( P<0.01); there was no statistical difference in K ep between the two ( P>0.05). Spearman analysis result showed that the K trans was positively correlated with gastric cancer T stage, and the expression of HER2, EGFR in gastric cancer tissue ( r = 0.539, 0.612 and 0.640; P<0.01), the V e was positively correlated with gastric cancer T stage, and the expression of HER2, EGFR in gastric cancer tissue ( r = 0.462, 0.551 and 0.583; P<0.01), while there was no correlated between K ep and gastric cancer T stage and the expression of HER2, EGFR in gastric cancer tissue ( P>0.05). ROC curve analysis result showed that the area under the curve of K trans combined with V e in diagnosis the T 3 to T 4 staging of gastric cancer was 0.929, with a specificity of 81.25% and a specificity of 92.00%. Conclusions:The DCE-MRI quantitative parameters K trans and V e have certain value in the diagnosis of gastric cancer T staging, and they are closely related to the expression of prognostic factors HER2 and EGFR.

Objective:To investigate the efficacy of therapeutic plasma exchange with continuous renal replacement therapy in patients with early septic shock.Methods:A total of 55 patients with septic shock admitted to ICU of Mindong Hospital Affiliated to Fujian Medical University from December 2017 to December 2020 were retrospectively analyzed. The patients were divided into the therapeutic plasma exchange group ( n=29) and standard-therapy group ( n=26) according to whether plasma exchange combined with hemofiltration was used. Patients in both groups were treated according to the 2016 Surviving Sepsis Campaign guidelines. No hemofiltration or/and plasma exchange therapy was performed in the standard-therapy group. In the therapeutic plasma exchange group, hemofiltration was performed immediately after plasma exchange within 24 h. The inflammatory indexes, hemodynamic indexes, organ function scores and 28-day mortality were monitored before and 24 h after treatment. χ2 test was used for counting data, t-test was used for measurement data, and Kaplan-Meier curve was used to evaluate 28-day survival status. Results:(1) There were no differences in sex, age, underlying diseases, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score before treatment between the two groups. (2) There were no significant differences in PCT, CRP and IL-6 between the two groups at enrollment. After treatment, PCT, CRP and IL-6 in the therapeutic plasma exchange group were significantly lower than those in the standard-therapy group [PCT (ng/mL): (50.07±14.54) vs. (57.93±13.42), P=0.043; CRP (mg/L): (85.71±46.05) vs. (115.10±44.42), P=0.042; IL-6 (pg/mL): (5 957.45±2 344.48) vs. (7 522.94±3 218.94), P=0.043], but there was no significant difference in WBC between the two groups. (3) There were no significant differences in norepinephrine dose, mean arterial pressure, heart rate, systemic vascular resistance index (SVRI), extravascular lung water index (EVLWI) and Lactate level between the two groups. After treatment, the norepinephrine dose, lactate level and EVLWI in the therapeutic plasma exchange group decreased significantly, while SVRI increased significantly {norepinephrine dose [μg/(kg·min): (0.76±0.39) vs. (0.54±0.39), P=0.044; lactate (μmmol/ L): (7.74±4.22) vs. (4.51±1.62), P<0.001; EVLWI (mL/kg): (10.04±2.77) vs. (8.23±2.23), P=0.008; SVRI (dyn·s/cm 2): (1 103.14±364.94) vs. (1 403.31±264.46), P=0.001}. Compared with the standard-therapy, the 24-h intravenous infusion volume was significantly decreased [(3 852.07±686.43) mL vs. (4 474.81±572.71) mL, P=0.001]. (4) There were no significant differences in APACHEⅡscore and SOFA score between the two groups at enrollment. After treatment, the APACHEⅡscore and SOFA score of the therapeutic plasma exchange group were significantly lower than those of the standard-therapy group [APACHEⅡscore: (14.07±4.30) vs. (19.23±5.44), P<0.001; SOFA score: (9.93±1.16) vs. (11.69±1.81), P<0.001)]. There were no significant differences in ICU mortality and 28-day mortality between the two groups ( P>0.05). Conclusions:Therapeutic plasma exchange with continuous renal replacement therapy can reduce the inflammatory response and improve hemodynamics in patients with septic shock. However, 24 h treatment did not improve the mortality of patients.

Objective:To investigate the effect of body mass management and mindfulness therapy on obese patients with polycystic ovary syndrome (PCOS).Methods:A total of 68 patients with PCOS admitted to Haikou People's Hospital(Haikou Hospital Affiliated to Central South Xiangya Medical College) from January to December 2018 were divided into observation group and control group by random digits table method, 34 cases in each group. The observation group was treated with body quality management combined with mindfulness therapy, and the control group was treated with routine nursing intervention. The total cholesterol (TC), triglyceride (TG), fasting blood glucose (FPG), 2 h postprandial blood glucose (2 hPPG), insulin (PINS), fasting insulin (FINS), Self Perceived Burden Scale (SPBS), quality of life score in the two groups were evaluated.Results:There was no significant difference in TC and TG between the two groups before intervention ( P>0.05); after 12 weeks of intervention, TC, TG were (4.21 ± 0.20), (1.60 ± 0.20) mmol/L in the observation group and (4.50 ± 0.31), (1.95 ± 0.55) mmol/L in the control group, there were significant differences between the two groups ( t values were 4.584, 3.487, P<0.01). There was no significant difference in FPG, 2 hPPG, PINS and FINS between the two groups before intervention and FPG, 2 hPPG after 12 weeks of intervention ( P>0.05); PINS, FINS were (72.60±28.46),(16.02±3.00)mU/L in the observation group and (102.61±50.10),(18.10±4.22)mU/L in the control group, there were significant differences between the two groups ( t values were 3.037, 2.342, P<0.01 or 0.05). There was no significant difference in the SPBS score between the two groups before intervention ( P>0.05); after 12 weeks of intervention, the SPBS score was (26.15 ± 2.02) in the observation group and (31.03 ± 1.00) in the control group, there was significant difference between the two groups ( t value was 12.624, P<0.01). There was no significant difference in the quality of life score between the two groups before intervention ( P>0.05); after 12 weeks of intervention, the scores of quality of life energy, sleep emotion, social life and physical activity were (80.62 ± 3.50), (79.10 ± 3.62), (75.02 ± 3.00), (77.26 ± 2.87) in the observation group and (71.23±4.02),(72.59±3.65),(69.20±4.11),(69.20±4.47) in the control group, there were significant differences between the two groups( t values were 7.234-10.272, P<0.01). Conclusions:The application of body mass management and mindfulness therapy can effectively improve the glucose and lipid metabolism level of obese PCOS patients, reduce the burden of psychological self perception, and improve the quality of life.

While the majority of all human cancers counteract telomere shortening by expressing telomerase, ~15% of all cancers maintain telomere length by a telomerase-independent mechanism known as alternative lengthening of telomeres (ALT). Here, we show that high load of intrinsic DNA damage is present in ALT cancer cells, leading to apoptosis stress by activating p53-independent, but JNK/c-Myc-dependent apoptotic pathway. Notably, ALT cells expressing wild-type p53 show much lower apoptosis than p53-deficient ALT cells. Mechanistically, we find that intrinsic DNA damage in ALT cells induces low level of p53 that is insufficient to initiate the transcription of apoptosis-related genes, but is sufficient to stimulate the expression of key components of mTORC2 (mTOR and Rictor), which in turn leads to phosphorylation of AKT. Activated AKT (p-AKT) thereby stimulates downstream anti-apoptotic events. Therefore, p53 and AKT are the key factors that suppress spontaneous apoptosis in ALT cells. Indeed, inhibition of p53 or AKT selectively induces rapid death of ALT cells in vitro, and p53 inhibitor severely suppresses the growth of ALT-cell xenograft tumors in mice. These findings reveal a previously unrecognized function of p53 in anti-apoptosis and identify that the inhibition of p53 or AKT has a potential as therapeutics for specifically targeting ALT cancers.

Objective: To investigate the timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age. Methods: The clinical data for 56 advanced age patients with acute pyogenic cholecystitis in the Department of Hepatobiliary Surgery, the 900th Hospital of the Joint Logistics Support Force of People′s Liberation Army from January 2018 to February 2019 were retrospectively analyzed. There were 31 males and 25 females, aged from 70 to 86 years, with average age was (75.52±3.57) years. According to the percutaneous transhepatic gallbladder drainage(PTGD) after laparoscopic cholecystectomy(LC) time interval, all patients were divided into three groups. Patients in the group A(n=12), B(n=21), and C (n=23) performed LC were within 2 months, during 2-4 months, and during 4-6 months, retrospectively. Observation indicators: (1) Surgical situations. The operation and postoperative basic condition of the three groups were compared. (2) Follow-up situations. Patients were followed-up by outpatient examination or telephone interview to detect the postoperative complication in the postoperative three months up to June 2019. Measurement data with normal distribution were represented as (Mean±SD), and comparison multiple groups was done using single factor analysis of variance (AVONA test) , and comparison between groups was done using the t test, and comparison of multiple groups in pairs was done using the SNK-q test, and hierarchical data were analyzed using Kruskal-wallis H test. Count data were analyzed using the chi-square test or Fisher exact probability. Results: (1) Surgical situations: the thickness of gallbladder wall before LC, the rates of converting to laparotomy, the volume of intraoperative blood loss, the operation duration, and the duration of postoperative hospital stay were (0.57±0.04) cm, 50.0%, (95.83±11.45) ml, (107.50±21.90) min, (5.67±3.40) d in the group A, and (0.43±0.03) cm, 9.5%, (69.52±24.59) ml, (71.43±12.16) min, (3.76±2.61) d in the group B, and (0.43±0.05) cm, 39.1%, (68.64±21.89) ml, (77.95±12.88) min, (5.05±2.95) d in the group C, respectively, showing significant differences in the above indicators between the three groups (P<0.05). The thickness of gallbladder wall before LC, the volume of intraoperative blood loss, the operation duration, those in group A were higher than the group B and C (P<0.05), and with no statistically significant different between the group B and C (P>0.05). The rates of converting to laparotomy, the duration of postoperative hospital stay in group B were better than the group A and C (P<0.05), and with no statistically significant different between the group A and C (P>0.05). The thickness of gallbladder wall before LC, the volume of intraoperative blood loss, the operation duration, and the duration of postoperative hospital stay were (0.43±0.03) cm, (46.67±9.82) ml, (67.69±7.77) min, (2.64±0.58) d in the gallbladder wall thickness of successful LC patients, and (0.52±0.04) cm, (123.53±17.30) ml, (134.12±25.51) min, (8.47±0.80) d in the laparotomy patients, respectively, showing significant differences in the above indicators between the two groups (P<0.05). (2) Follow-up situations: 56 patients were followed up and without perioperative death. No complications occurred after 3 months of follow-up. Conclusion Elective surgery that is performed in 2-4 months after PTGD for patients with acute pyogenic cholecystitis in the advanced age can reduce the volume of intraoperative blood loss and the rates of converting to laparotomy, shorten the operation duration and the duration of postoperative hospital stay, which is beneficial to the recovery of patients.

Objective To investigate the role of interleukin-22 (IL-22)-regulated autophagy in hydrogen peroxide (H2 O2 )-induced hepatocarcinoma cell damage. Methods HepG2 cells were transfected with pEGFP-LC3 and then cultured in RPMI 1640 medium free of fetal bovine serum (FBS) or containing 1％ or 10％ FBS. These cells were pretreated with rapamycin or an autophagy inhibitor (3-MA) and then stimulated with recombinat human IL-22 (rhIL-22). GFP-LC3 puncta formation and autophagy signaling ac-tivation were measured. MTT assay was performed to detect cell viability. Results rhIL-22 significantly promoted GFP-LC3 puncta formation and LC3-Ⅱ expression in HepG2 cells treated with different stimulation protocols. The autophagy pathway inhibitor, 3-MA, dramatically suppressed the rhIL-22-activated autophagy signals. rhIL-22 attenuated H2 O2-mediated HepG2 cell death and that could be inhibited by 3-MA. Conclu-sion IL-22 promoted the activation of autophagy signaling pathways and alleviated H2 O2-mediated HepG2 cell damage.

Objective To evaluate the effects of dexmedetomidine on hypoxic pulmonary vasoconstriction and oxygenation during one- lung ventilation (OLV) undergoing esophagectomy. Methods Fifty-six adult patients undergoing esophagectomy and requiring OLV were selected.During inhalational anesthesia with sevoflurane, patients were randomized to receive either dexmedetomidine (dexmedetomidine group,28 patients)or saline placebo(control group,28 patients). The bolus dose of 0.3 μg/kg over 10 min followed by a maintenance dose of 0.6 μg/(kg·h)was used in dexmedetomidine group. The arterial blood gas samples were obtained to evaluate the effects of dexmedetomidine on oxygenation in three times:T1:double-lung ventilation 10 min after anesthetic intubation;T2:OLV 10 min;T3:60 min after continuous infusion of dexmedetomidine. Outcomes included differences in hemodynamic parameters(heart rate and mean arterial pressure), end-tidal sevoflurane concentration, ephedrine dose and atropine dose.Results The levels of pH, arterial partial pressure of carbon dioxide(PaCO2)in two groups had no significant differences(P>0.05).The level of oxygenation index in two groups at T3had significant difference: (153.29 ± 19.00) mmHg(1 mmHg=0.133 kPa)vs. (117.79 ± 12.00) mmHg, 1 mmHg = 0.133 kPa, P < 0.01. At T3, the level of heart rate in dexmedetomidine group was significantly lower than that in control group:(68 ± 11)times/min vs.(89±13)tims/min;meanwhile, the level of end-tidal sevoflurane concentration in dexmedetomidine group was significantly lower than that in control group: (2.9 ± 0.8)% vs. (4.2 ± 0.1)%; there were significant differences (P < 0.01). The ephedrine dose in two groups had no significant difference(P>0.05).Conclusions Dexmedetomidine may provide clinically relevant benefits by improving oxygenation and decreasing the requirement of inhalational anaesthetic agents, thereby limiting its effect on hypoxic pulmonary vasoconstriction during OLV in adults undergoing esophagectomy surgical procedures.