In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction(hereinafter referred to as double allocation, double improvement), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.

Objective To investigate the distribution and drug resistance of pathogens in intensive care unit (ICU) so as to provide scientific basis for antibiotic adoption and the prevention and control of nosocomial infections. Methods The various specimens collected from the patients admitted into ICU in the First People's Hospital of Shunde Affiliated to the South Medical University from January 2007 to December 2014 were used to isolate the pathogens that might cause nosocomial infections and retrospectively analyze their clinical distribution and drug resistance. Kirby-Bauer paper diffusion and minimal inhibitory concentration (MIC) methods were applied to test the drug sensitivity, and according to National Committee for Clinical Laboratory Standards/Clinical and Laboratory Standards Institute (NCCLS/CLSI) standard, the results were identified.Results The sputum was the major specimen source in ICU, accounting for 68.8%, followed by urine (12.4%) and blood (6.8%). All together 557 pathogens in ICU causing nosocomial infections were isolated of which there were 377 gram-negative (G-) bacilli (67.7%), 103 gram-positive (G+) cocci (18.5%), and 77 fungi (13.8%). Among G- bacilli, the top three wereAcinetobacter baumannii (34.5%), Klebsiella pneumonia (17.8%), andPseudomonas aeruginosa (13.0%). Beside carbapenem, the drug resistance rates of Acinetobacterbaumannii to other antibiotics were more than 40%. The main G+ coccus causing nosocomial infection wasSaphylococcus aureus (36.9%) in ICU. The drug resistance rates ofSaphylococcus aureus to penicillin, gentamicin and erythromycin were higher than 50%. In 77 fungus strains,Candida albicans was ranked the first, accounting for 41.6%.Conclusion The main infection site in ICU is primarily respiratory tract, the G- bacilli are the predominate pathogens, and the drug resistance to antibiotics found in this report is serious, so clinically, the antibiotics should be properly used to avoid the occurrence of pathogenic strain with drug tolerance.

In this study we synthesized a micro- and mesoporous material, SBA-16. And later on we functionalized it with octyltrimethoxysilane and octadecyltrimethoxysilane, respectively. The materials of SBA-16 and its functionalized form were characterized by nitrogen adsorption isotherms at 77K, small angle X-ray scattering (SAXS), Fourier-transform infrared (FT-IR), thermal gravimetric analysis (TGA), and adsorption isotherms of single component n-heptane, toluene and water vapour. The data of FT-IR and TGA demonstrated the successful chemical modification of surface and porous wall of SBA-16 with different hydrocarbon chains. The results of SAXS, nitrogen adsorption at 77K, and adsorption isotherms of probe molecules revealed that the functionalized SBA-16 materials possessed relatively less regularity, smaller BET surface area and pore volumes, and lower adsorption capacities for the probe molecules compared to the original SBA-16. However, the functionalized SBA-16 materials showed much less affinity to polar molecules such as water. This work provides useful fundamental information for future study of novel mesoporous silica materials as potential drug delivery carriers.
Adsorption ; Drug Carriers ; chemistry ; Porosity ; Silicon Dioxide ; chemistry ; Surface Properties

ObjectiveTo assess the specificity of P50 auditory-evoked potential in schizophrenic patients with violent and aggressive behaviors， so as to provide objective biological markers for predicting violent behaviors of schizophrenic patients. MethodsA total of135 schizophrenic patients who met the diagnostic criteria of the International Classification of Diseases， tenth edition （ICD-10） were divided into aggressive group （n=70） and non-aggressive group （n=65） according to the assessment results of the Modified Overt Aggression Scale （MOAS）， meantime， another 60 healthy individuals matched for age and gender were set as healthy group. Then the P50 auditory-evoked potentials of all selected individuals were measured using EP/EMG system （MEB-9200， Nihon Kohden， Japan）. ResultsAmp S2 of the aggressive group was significantly higher than those of the non-aggressive group and healthy control group， with statistical differences ［（9.86±6.04）μV vs. （7.06±3.88）μV， P=0.004； （9.86±6.04）μV vs. （7.82±3.87）μV， P=0.031］. The proportion of S2/S1 ratio ≥0.5 was 72.88%， 43.86% and 30.00% in aggressive group， non-aggressive group and healthy group， which was the highest in aggressive group， with statistical differences （P<0.01）. The amplitude difference of P50 （S1-S2） of the aggressive group was lower than those of the non-aggressive group and the healthy control group， the differences were of statistical significance ［（4.35±9.39）μV vs.（9.89±8.48）μV， P=0.001； （4.35±9.39）μV vs.（13.42±9.81）μV， P<0.01］. ConclusionThe violent and aggressive behaviors in schizophrenic patients may be related to the sensory gating deficit.

Objective:To analyze the differentially expressed gene (DEG) in rats with sepsis-induced exogenous acute respiratory distress syndrome (ARDS) and explore the early diagnosis and protective mechanism of sepsis-induced ARDS at the transcriptome level.Methods:Twelve 6 to 8 weeks old male Sprague-Dawley (SD) rats were randomly divided into lipopolysaccharide (LPS) induced sepsis-induced ARDS model group (model group, intraperitoneal injection of LPS 15 mg/kg) and control group (intraperitoneal injection of the same volume of normal saline), with 6 rats in each group. RNA was extracted from the left lung tissue of the two groups, and the paired-end sequencing mode of the illumina Hiseq sequencing platform was used for high-throughput sequencing. The DESeq2 software was used to screen DEG with | log 2 (fold change, FC) | ≥ 3 and P < 0.001. Gene ontology (GO) function enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed on DEG. STRING and CytoScape software were used to construct a protein-protein interaction (PPI) network and screen key genes. The peripheral blood mononuclear cell (PBMC) of 20 septic patients admitted to the emergency and critical care medical department of Lianyungang First People's Hospital from March to November 2021 and 20 age-matched healthy people in the same period were isolated and extracted, and the key genes were verified by real-time fluorescent quantitative polymerase chain reaction (RT-qPCR). Results:A total of 286 DEG were screened, including 202 up-regulated genes and 84 down-regulated genes. GO enrichment analysis showed that DEG was mainly involved in biological processes such as neutrophil chemotaxis migration, antibacterial humoral response, host immune response, and humoral immune response. KEGG analysis showed that DEG mainly played a biological role through interleukin-17 (IL-17) signaling pathway, tumor necrosis factor (TNF) signaling pathway, and chemokine signaling pathway. In PPI analysis, a total of 262 node proteins were screened, and the interaction relationship was 852 edges. The first 15 key genes were IL-6, TNF, IL-10, IL-1β, chemokine ligand 1 (CXCL1), CXCL10, chemokine receptor 3 (CXCR3), CXCR2, CXCL9, chemokine ligand 7 (CCL7), CXCL11, CCL1, CXCL13, CCL12, and CCL22. Five representative key genes were performed on PBMC of blood samples from septic ARDS patients and healthy controls by RT-qPCR. The results showed that their expression was significantly higher than that in the healthy controls [IL-6 mRNA (2 -ΔΔCt): 2.803±1.081 vs. 0.951±0.359, TNF mRNA (2 -ΔΔCt): 2.376±0.799 vs. 1.150±0.504, CXCL10 mRNA (2 -ΔΔCt): 2.500±0.815 vs. 1.107±0.515, CXCR3 mRNA (2 -ΔΔCt): 1.655±0.628 vs. 0.720±0.388, CCL22 mRNA (2 -ΔΔCt): 1.804±0.878 vs. 1.010±0.850, all P < 0.05], and the trends were consistent with the RNA-Seq results. Conclusion:Biological processes such as chemotactic migration and degranulation of inflammatory cells, cytokine immune response, and signal pathways such as CXCL10/CXCR3 and IL-17 play important roles in the occurrence and development of sepsis-related exogenous ARDS, which would provide new ideas and targets for further study of lung injury mechanisms and clinical prevention and treatment.

Objective:To analyze the effectiveness and safety of robot-assisted percutaneous endoscopic posterior/transforaminal lumbar interbody fusion (RPE-P/TLIF) in the treatment of lumbar spinal stenosis with instability.Methods:From September 2018 to April 2022, 26 patients with lumbar spinal stenosis combined with lumbar segmental instability were treated with RPE-P/TLIF at the Department of Minimally Invasive Spine Surgery, Guangdong Provincial Hospital of Chinese Medicine. There were 13 males and 13 females, with a mean age of 57.92±7.09 years (range, 44 to 75 years) and a mean body mass index of 24.05±2.64 kg/m 2 (range, 19.38 to 29.06 kg/m 2). A total of 31 segments were included, including 21 cases of single-segment surgery (L 3, 4 in 2 cases, L 4, 5 in 18 cases, and L 5S 1 in 1 case) and 5 cases of two-segment surgery (all L 3-L 5). Before surgery and at 1, 6, and 12 months after surgery, as well as at the final follow-up, the visual analogue scale (VAS) was used to assess back pain and lower limb pain, and the Oswestry disability index (ODI) was used to evaluate spinal nerve function. Clinical efficacy was evaluated using the MacNab criteria at the final follow-up. Imaging evaluation indicators included pre- and post-operative intervertebral space height, lumbar lordosis angle, fusion rate, and accuracy of pedicle screw placement. Results:The follow-up time for the 26 patients was 42.88±10.09 months (range, 12 to 55 months). The mean operation time was 156.54±33.50 min, and the mean postoperative drainage volume was 27.23±20.20 ml. The VAS scores for back pain and lower limb pain before surgery were 4.35±1.23 and 6.08±0.63, respectively. These scores decreased to 2.08±0.69 and 1.85±0.54 at 1 month postoperatively, 1.85±0.54 and 0.77±0.59 at 6 months, 0.96±0.53 and 0.62±0.57 at 1 year, and 0.88±0.52 and 0.58±0.50 at the final follow-up, respectively. The differences were statistically significant ( F=85.943, P=0.001; F=547.946, P=0.014). The ODI scores before surgery and at 1, 6, 12 months after surgery, and at the final follow-up were 55.38%±5.89%, 28.38%±3.849%, 17.77%±2.67%, 12.58%±1.88% and 12.12%±2.27% respectively, with statistically significant differences ( F=783.289, P=0.010). According to the MacNab criteria, at the final follow-up, there were 18 cases of excellent, 6 cases of good, and 2 cases of fair, with an excellent and good rate of 92.3%. A total of 114 percutaneous pedicle screws were implanted with grades A, B and C being 109, 4 and 1, respectively. The preoperative, postoperative, and final follow-up intervertebral space heights were 10.55±1.96, 13.53±1.37, and 12.54±1.42 mm respectively, with statistically significant differences ( F=42.190, P<0.001). And the lumbar lordosis angles were 35.81°±10.80°, 35.69°±11.07°, and 36.08°±11.29° respectively, with no statistically significant differences ( P>0.05). At 12 months postoperatively, bone fusion was achieved in 25 cases, with a fusion rate of 96% (25/26). Conclusion:RPE-P/TLIF for lumbar spinal stenosis combined with lumbar instability were favorable. Being a safe and effective minimally invasive surgical option, it effectively enhanced the intervertebral space height in the surgical segment with fewer complications.