Objective: This study aims to investigate the positive practice environments evaluation of doctors in public hospital and provide suggestions for Chinese health care reform from the perspective of health service providers.Methods: Using self-designed questionnaire, a national cross-sectional survey was performed in 77 public hospitals across seven provinces/ metropolis, involving a total of 3564 doctors.Positive practice environment includes organizational management and doctor-patient two-dimension relationships.Results: The doctor''s mean score of positive practice environment evaluation was 18.02±4.86 (out of 40).Doctors had a higher evaluation (score) of organizational management than doctor-patient relationship.In the organizational management dimension, the personal advice got the lowest scores(2.24±1.04);and in doctor-patient relations, evasion of medical risk got the lowest scores(1.59±0.81).There was a difference in the positive practice scores of physicians in different regions, and the scores of doctors from the western China were the lowest (P<0.001.Doctors from western medicine hospitals had lower evaluation of positive practice environments than ones from Chinese Traditional Medicine hospitals(P=0.002.Conclusion: As per the analysis conducted in this investigation, the current medical practice environment of doctors in China is not a promising one.Doctor-patient relationship is worse than organizational management.Hospitals should adopt a participatory decision-making model in management and establish a broadband performance based compensation to motivate junior doctors.Besides, government should establish reasonable compensation incentive mechanism, with the aim of promoting doctor-patient trust.

OBJECTIVETo reveal the possible mechanism involved in patella-femoral degenerative arthritis (PFDA) in- duced by torsion-deformity of tibia via analyzing the relationship between torsion-deformity of the tibia in patients with PFDA and the disorder of patella-femoral joint under the static and dynamic conditions.

METHODSFrom October 2009 to October 2010, 50 patients (86 knees, 24 knees of male patients and 62 knees of female patients) with PFDA were classified as disease group and 16 people (23 knees, 7 knees of males and 16 knees of females) in the control group. The follow indexes were measured: the torsion-angle of tibia on CT scanning imagings, the patella-femoral congruence angle and lateral patella-femoral angle under static and dynamic conditions when the knee bent at 30 degrees of flexion. Based on the measurement results, the relationship between the torsion-deformity of tibias and the disorders of patella-femoral joints in patients with PFDA were analyzed. Finally,the patients were divided into three groups including large torsion-angle group, small torsion-angle group and normal group according to the size of torsion-angle, in order to analyze the relationship between torsion-deformity and disorders of patella-femoral joint, especially under the dynamic conditions.

RESULTSCompared with patients without PFDA, the ones with PFDA had bigger torsion-angle (30.30 ± 7.11)° of tibia, larger patella-femoral congruence angle (13.20 ± 3.94)° and smaller lateral patella-femoral angle (12.30 ± 3.04)°. The congruence angle and lateral patella-femoral angle under static and dynamic conditions had statistical differences respectively in both too-big torsion-angle group and too-small torsion-angle group. The congruence angle and lateral patella-femoral angle under static and dynamic conditions had no statistical differences in normal torsion-angle group.

CONCLUSIONTorsion-deformity of tibia is the main reason for disorder of patella-femoral joint in the patients with PFDA. Torsion-deformity of tibia is always accompanied by instability of patella-femoral joint,especially under the dynamic condition, thus causing PFDA. It can not only provide arrangement information and degenerative condition of patella-femoral joint,but also provide guidance through the analysis on the relationship for better clinical prevention and early treatment of degenerative bone and joint disease.

Adult ; Female ; Femur ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; diagnostic imaging ; etiology ; Patella ; diagnostic imaging ; Radiography ; Tibia ; diagnostic imaging ; Torsion Abnormality ; complications ; diagnostic imaging

Background The filtration surgery is the main method of treating glaucoma,which usually fails due to postoperative scarring.The study about application of anti-scarring agents in filtration surgery is a hotspot.Objective This study was to investigate whether topical administration of hydroxycamptothecin (HCPT) could be used to prevent postoperative scarring in after experimental glaucoma filtration surgery,and explore its optimal dose.Metbods Trabeculectomy was performed on the right eyes of 40 New Zealand white rabbits to establish the trabeculectomy animal models.The rabbits were then randomized into normal saline solution group,0.3 g/L mitomycin C(MMC) group,0.3 g/L HCPT group and 1.0 g/L HCPT group based on the intraoperative topical drugs using randomized number table method.The different drugs above-mentioned were put beneath the conjunctival flap and scleral flap for 5 minutes during the surgery.The intraocular pressure (IOP) was measured before and day 1,4,7,14,21 and 28 after the surgery with Icare tonometer,and the filtering area and height were measured under the slit lamp microscope to assess the efficacy of various drugs.The adverse effects were evaluated by examining the responses of the ocular anterior segment and retinal change.The specimens at operative zone were obtained in 7,14 and 28 days after surgery with the size 5 mm×5 mm for the hematoxylin-eosin staining and Masson trichrome staining to estimate the anti-fibrosis effect of various drugs,and to evaluate the survival time of functional bleb.Kaplan-Meier analysis was used to compare the survival time of functional bleb of different groups.The use and care of the animals complied with the Regulation for the Administration of Affair Concerning Experimental Animals by State Science and Technology Committee.Results The IOP was significantly different in the rabbits from different groups among various time points (Fgroup =20.79,P =0.00 ; Ftime =85.34,P =0.00 ; Fiion =2.13,P =0.01).From 1 day through 28 days after operation,the IOPs in MMC group and 1.0 g/L HCPT group were significantly lower than those before operation (all at P＜0.05).The survival time of functional bleb of different groups was (11.3 ±2.8),(19.5 ±2.4),(13.3 ±2.2) and (20.2 ± 4.5) days,respectively,showing a significant difference (log rank =11.92,P ＜ 0.01),with a considerable prolong in the 1.0 g/L HCPT group.No significant change was found in the bleb area and height among the four groups within 7 days after operation,but postoperative 7,14,28 days,the area and height values of bleb were significantly smaller in the normal saline solution group and 0.3 g/L HCPT group compared with the MMC group and 1.0 g/L HCPT group (all at P ＜ 0.05).Histopathological examination showed loosen subconjunctival tissue,less inflammatory cells and weaker collagenous fibrillary staining in the MMC group and 1.0 g/L HCPT group in comparison with the normal saline solution group and 0.3 g/L HCPT group.Conclusions The topical administration of 1.0 g/L HCPT inhibit the inflammatory response and collagen fibrosis and therefore prolong the survival time of functional bleb after glaucomatous filtering surgery.

To evaluate the efficacy of a variety of lacrimal duct obstruction diseases treated by Nd: YAG laser lacrimal duct forming surgery using Meta analysis.
●METHODS: Relevant database in 1995 - 2012 and other network resources were retrieved by computer and manual, using MetaAnalyst software on the Meta analysis. Analysis of indicators: disease prevalence between men and women, the prevalence of various lacrimal duct diseases and the effective rate of Nd: YAG laser lacrimal duct forming surgery to treat a variety of lacrimal duct obstruction diseases.
●RESULTS: According to the inclusion and exclusion criteria, 38 subjects were selected, the cumulative number of patients included 4638 cases, the men combined prevalence was 23%; the women combined prevalence was 77%; lacrimal punctum occlusion combined prevalence was 6. 0%, combined treatment efficiency was 88. 1%; lacrimal canaliculus obstruction combined prevalence of 17. 9%, combined efficiency was 85. 6%;lacrimal common canaliculus obstruction combined prevalence was 14. 0%, 92. 7% of the combined effective rate; nasolacrimal duct obstruction combined prevalence of was 43. 6%, 93. 3% of the combined effective rate;chronic dacryocystitis combined prevalence was 18. 4%, 76. 6% of the combined efficiency. All study has heterogeneity. Selection of random effects model combined effect size. Model was statistically significant (P<0. 001).
●CONCLUSlON: The prevalence of lacrimal duct obstruction diseases of women are higher than men, lacrimal canaliculus obstruction in the lacrimal duct obstruction is in the lowest prevalence, nasolacrimal duct obstruction is the main type of lacrimal duct obstruction disease, Nd: YAG laser lacrimal forming surgery has slightly efficacy different in various lacrimal duct obstruction diseases.

Animals ; Arsenic ; toxicity ; Comet Assay ; DNA Damage ; drug effects ; Lymphocytes ; drug effects ; metabolism ; Male ; Malondialdehyde ; metabolism ; Rats ; Rats, Wistar ; Tobacco Smoke Pollution ; adverse effects

This retrospective analysis compared standard regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) with the dose-dense ABVD regimen (ABVD-21) in terms of efficacy and toxicity. Patients who had early-stage unfavorable or advanced Hodgkin's lymphoma (HL) according to German Hodgkin Study Group criteria from March 1999 to February 2011 were analyzed for treatment response, long-term survival and hematological toxicity. There were 85 patients in the ABVD-21 group and 118 patients in the ABVD group respectively. The complete remission rates after completion of treatment were 92.9% and 90.7% for ABVD-21 and ABVD, respectively. During a median follow-up period of 62 months, no significant difference was found in projected 10-year progression-free survival (PFS) and overall survival (OS) rates (84.7% and 94.1% respectively for ABVD-21; 81.4% and 91.5% for ABVD). Subgroup analyses showed that ABVD-21 was significantly better than ABVD for patients with IPS≥3 in terms of PFS and OS rates. Grade 3 to 4 leukopenia (51.8% vs. 28.8%, P=0.001) and neutropenia (57.6% vs. 39.0%, P=0.009) were more common with ABVD-21. We were led to conclude that dose-dense ABVD did not result in better tumor control and overall survival than did ABVD for early-stage unfavorable HL. However, patients at high risk, for example, with IPS≥3, may benefit from dose-dense ABVD.

Objective To explore the long-term predictive value of serum concentration of N-terminal prosoma brain natriuretic peptide (NT-proBNP) in the early acute coronary syndrome (ACS). Methods The 164 patients firstly hospitalized and finally diagnosed as acute myocardial infarction (AMI) were selected, and then the serum concentration of NT-proBNP was determined in less than 12 hours. According to the 75 percentage points of serum concentration of NT-proBNP, the patients were divided into two groups: low concentration group (n = 123) and high concentration group (n = 41 ). The major adverse cardiac events (MACEs) were followed and compared at one month, six months and twelve months between low group and high group. Results At 1-, 6-, 12-month follow-up, the odds ratio (OR) of death event were 4.1, 5.6 and 4.0 in high group respectively, and the nonfatal heart failure occurred in 4, 4 and 7 patients in high group. Multiple factor logistic regression analysis showed that NT-proBNP was an independent risk factor of the MACEs at different periods including short time, middle time and long time in ACS patients (P＜0. 05). Conclusions NT-proBNP is a strong predictor of the long-term MACEs in patients with early ACS.

Objective To evaluate effects of chronic arsenic exposure and arsenic exposure time on oxidative DNA lesions in humans. Methods A cross-sectional study was conducted in 108 subjects exposed to high concentrations of arsenic in drinking water and 75 control subjects. A cohort study was conducted in 64 subjects exposed to high levels of arsenic in drinking water for 7 or 9 years. Urinary 8-oxo-7,8-dihydredeoxygnanine(8-OHdG) levels were analyzed by the enzyme-linked immunosorbent assay kit(ELISA). Urinary arsenic concentration was detected with hydride generation atomic absorption spectroscopy. Results In the cross-sectional study, the median of urinary arsenic concentration was 484.17 mg/kg Cr for the arsenic-exposed group, and 13.80 mg/kg Cr for the control group, and the difference between the two groups was statistically significant (t=32.57, P<0.01). The median of urinary 8-OHdG levels was 16.60 and 21.88 mg/kg Cr for arsenic-exposed children and adults respectively, much higher than control children(10.50 mg/kg Cr) and adults (9.11 mg/kg Cr), and the difference was statistically significant (t=5.049, 6913, all P<0.01). Urinary 8-OHdG levels were signifieandy lower for children than adults in the exposed group(t=-1.997, P<0.05). In the cohort study, the median of urinary arsenic concentration was 461.3 mg/kg Cr for the 7-year-exposed subjects and 422.90 mg/kg Cr for the 9-year-expesed subjects, and no significant difference was observed(t=-0.250, P 0.05). The median of urinary 8- OHdG levels for 9-year-exposed children and adults were 23.46 and 24.30 mg/kg Cr respectively, significantly increased compared with those of 7-year-exposed(14.29 and 18.38 mg/kg Cr), and the difference had statical signhqcanees (t= -2.949,-3.055, all P<0.01). Conclusions Chronic arsenic exposure can lead to oxidative DNA lesions in humans. The arsenic-induced DNA lesions may aggravate with the exposure time in a certain period.

Objective To explore the qualification and consuming of iodized salt at wholesale and household levels after Salt Iodization.Methods Iodized salt surveillance at wholesale and household levels every year by detecting iodine content.Direct titration method(GB/T 13025.7-1999)was used for salt iodjne detecting and arbitration method was used for Sichuan salt and special salt.Results Five thousand six hundred and seventy five samples of 227 batches from 3 wholesale industries were detected during 1996-2000,batch qualification rate was 60.79%(138/227)and iodized salt qualification rate was 61.83%(3509/5675).During 2001-2007,2556 samples of 252 batches from wholesale levels were detected.The batch qualification rate and iodized salt qualification rate were 1 00%(252/252)and 99.88%(2553/2556),respectively.At household level.1583 samples from 236 villages were detected during 1996-2000.Iodized salt qualification rate was 74.24%(1 170/1576)and consuming rate of qualified iodized salt was 73.91%(1 170/1583)and iodine median was 45.14 mg/kg.During 2001-2007,13 140 samples from 1656 villages were detected.Iodized salt qualification rate,consuming rate 0f qualified iodized salt and iodine median were 98.03%(12 830/13 088),97.64%(12 830/13 140)and 30.13 mg/kg,respectively. The most difference of iodine content was 3.46 mg/kg in 3 wholesale industries.At household level there was a 4.95%reduction in comparison with at wholesale level.Conclusions Salt iodization level and edible iodine salt reach the national requirements of iodine deficiency control from the starting stage.The quality 0f iodized saIt at household level related to the exclusive wholesale industry and loss phenomenon maybe existed when salt was sold from wholesale industries to residents.

Actins ; metabolism ; Bone Neoplasms ; blood ; complications ; diagnostic imaging ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Hypophosphatemia ; blood ; etiology ; Ilium ; Mesenchymoma ; blood ; complications ; diagnostic imaging ; pathology ; surgery ; Middle Aged ; Osteomalacia ; blood ; etiology ; Phosphates ; blood ; Platelet Endothelial Cell Adhesion Molecule-1 ; metabolism ; Tomography, X-Ray Computed