Objective To explore and implement a differentiated management strategy for multi-campus hospitals to improve patient experience and satisfaction,and achieve the goal of homogenized management.Methods In December 2021,the Picker Patient Experience Questionnaire was used to survey the patient experience at 3 campuses of a tertiary A hospital in Hangzhou,and the reasons for the differences were analyzed.Based on policy document reviews,special group discussions,and expert meetings,differentiated management strategy for multi-campus hospitals was formulated.The patient experience and satisfaction before(December 2021)and after(December 2023)the implementation were compared.Results After the application of the one-hospital multi-campus difference management strategy,the overall medical experience score of the patients in the 3 campus was(58.54±2.36)points,which was higher than(58.13±3.24)points before the application(t=-3.223,P=0.001),and there was no statistically significant differences among the patients in the 3 campuses(F=0.781,P=0.458).After the application of the management strategy,the overall satisfaction score of the patients in the 3 campus was(98.44±6.22)points,which was higher than(97.98±6.87)points before the application of the management strategy(t=-2.490,P=0.013),and there was no statistical significance among the patients in the 3 campus(F=1.128,P=0.324).The number of banners and letters of commendation received by the 3 campuses increased from 1 661 before the application to 2 190 after the application,with a growth rate of 31.85％.Conclusion Differentiated management in a multi-campus hospital,aiming at homogenized quality through differentiated strategies,is practicable and can significantly improve the patient experience and satisfaction across different campuses.

ObjectiveTo investigate the clinical efficacy of Gandouling tablet （GDL） on abnormal lipid metabolism in Wilson's disease （WD） and the correlation between the prediction model of hepatic steatosis and the related indexes of lipid metabolism in WD. MethodA total of 86 patients with abnormal lipid metabolism in WD were selected. The 24-hour urine copper， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， serum triglyceride （TG）， total cholesterol （TC）， apolipoprotein B （ApoB）， low density lipoprotein cholesterol （LDL-C）， bile acid （BA）， γ-glutamyl transferase （GGT）， prediction model of hepatic steatosis ［hepatic steatosis index （HSI） and Zhejiang University index （ZJU index）］， ultrasonic attenuation coefficient imaging （ATT）， and traditional Chinese medicine （TCM） syndrome score were statistically analyzed before treatment. Pearson correlation test was used to analyze the correlation between TG， TC， LDL-C， ApoB， ALT， AST， ALT/AST， BA， GGT， TCM syndrome score， ATT， and HIS and ZJU. The patients were divided into an observation group and a control group by random number table method， with 43 cases in each group. The observation group was treated with GDL combined with sodium dimercaptopropane sulfonate （DMPS）， while the control group was only treated with DMPS as a control. After six courses of treatment， 24-hour urine copper， TC， TG， LDL-C， ApoB， HSI， ZJU， ATT， TCM syndrome score， and clinical efficiency before and after treatment were observed and compared between the two groups. The correlation between HSI and ZJU and serum TC， TG， LDL-C， ApoB， ALT， AST， ALT/AST， BA， GGT， TCM syndrome scores， and ATT was analyzed. ResultPearson correlation analysis showed that serum TC （r = 0.811）， TG （r = 0.826）， LDL-C （r = 0.802）， ApoB （r = 0.820）， ALT （r = 0.497）， ALT/AST （r = 0.826）， TCM syndrome score （r = 0.716）， and ATT （r = 0.736） were positively correlated with HSI （P<0.01）， while AST， BA， and GGT had no significant correlation with HSI. TC （r = 0.718）， TG （r = 0.765）， LDL-C （r = 0.667）， ApoB （r = 0.699）， ALT/AST （r = 0.403）， TCM syndrome score （r = 0.666）， and ATT （r = 0.684） were positively correlated with ZJU （P<0.01）. ALT， AST， BA， and GGT had no significant correlation with ZJU. The total effective rate of the observation group was 86.05 （37/43）， and that of the control group was 72.09% （31/43）. The total effective rate of the observation group was higher than that of the control group （Z = -2.301， P<0.05）. After treatment， the 24-hour urine copper of the two groups increased significantly. The levels of TC， TG， LDL-C， and ApoB were significantly decreased， and the HSI， ZJU， and ATT were significantly decreased （P<0.01）. Compared with those in the control group after treatment， the above indexes improved better in the observation group （P<0.05， P<0.01）. ConclusionGDL can effectively improve the level of copper and lipid metabolism in patients with WD， with high clinical safety and good clinical application value. The prediction model of hepatic steatosis can effectively reflect the degree of abnormal lipid metabolism in WD.

Objective:To understand the macronutrient content and influencing factors of donated breast milk in breast milk bank.Methods:A total of 458 first-time breast milk donors and their donated breast milk from June 2016 to June 2018 in Shanghai were selected as research objects by the convenient sampling method to determine the macronutrient content in donated breast milk. Multiple linear regression was used to analyze the influencing factors of the macronutrient content of donated breast milk.Results:In macronutrient content of 458 donated breast milk, the protein content was (0.95±0.24) g/dl, fat content was (4.03±1.25) g/dl, sugar content was (7.44±0.38) g/dl, dry matter was (12.75±3.16) g/dl and energy content was (71.12±11.33) kcal/dl.The results of multiple linear regression analysis showed that the time of milk donation and infant gender were the influencing factors of protein content in donated breast milk ( P<0.05). The time of milk donation, mode of delivery and season of birth were the influencing factors of the sugar content in donated breast milk ( P<0.05). The time of milk donation was the influence factor of energy content in donated breast milk ( P<0.05) . Conclusions:The content of macronutrients in donated breast milk in this study is lower than the demand for macronutrients in premature infants. The macronutrient composition of donated breast milk varies greatly among individuals, which is related to the time of milk donation, the mode of delivery, the infant gender and birth season of the baby. Therefore, further research is needed on how to add breast milk additives to donated breast milk in the later stage for targeted reinforcement to meet the growth and development needs of premature infants.

Children with short bowel syndrome(SBS)are at high risk for catheter-related bloodstream infection(CRBSI). They suffer from strikingly high rates of morbidity and mortality, due in part to their susceptibility to life-threatening microbial infections.This article reviews the latest research on the CRBSI in the SBS children, in order to find and prevent CRBSI as soon as possible.

Objective To investigate the expression of sialic acid-binding immunoglobulin-like-lectin-1 (Siglec-1)in the peripheral blood mononuclear cell (PBMC) of patients with autoimmune thyroiditis ( AIT) and its relationship with AIT. To explore the moduratory role of activated Siglec-1 on the differentiation of T cells and the promotion of in flammation after PBMC culture. Methods The peripheral whole blood and serum samples were collected from 30 AIT patients with normal thyroid function and 30 sex-and age-matched controls. The expression of sSiglec-1 in serum was detected by ELISA. The expression of Siglec-1 in PBMC was detected by RT-PCR and WB. The expression of Siglec-1 in CD14+ monocytes and the proportion of Th1 and Th17 cells in each group were detected by flow cytometry. The PBMC in AIT or control was stimulated with NaI in the presence or absence of LPS for 72 h. The expression of Siglec-1 in CD14+ monocytes and the proportion of Th1 and Th17 cells were detected by flow cytometry. Results sSiglec-1 in serum, Siglec-1 mRNA, and Siglec-1 protein in AIT patients'PBMC were higher than those in control group ( P＜0. 01). The expression of Siglec-1 in CD14+ monocytes by flow cytometry and differentiation of Th1 and Th17 cells were significantly higher than that in control group ( both P＜0. 01). The expression of Siglec-1 in control and AIT patients was up-regulated by 5×10-5 mmol/L to 1×10-2 mmol/L stimulated with NaI in the presence or absence of LPS for 72 h (P＜0.01), but the differentiation of Th1 and Th17 cells was up-regulated only in patients (P＜0.01), and in a dose-dependent manner. Conclusion Elevated Siglec-1 expression in PBMCs and monocytes can potentially serve as a biomarker for AIT. Iodine may affect Th1 and Th17 cell differentiation by activating Siglec-1 to adjust the AIT immune response.

Objective To investigate the associations ofa disintegrin and metalloproteinase with thrombospondin type 1 motifs (ADAMTS1) gene single nucleotide polymorphism (SNPs) with vulnerability of carotid plaque formation and atorvastatin lipid-efficacy in patients with cerebral infarction.Methods Seven hundred and seventy-eight patients with anterior circulation infarction,admitted to our hospital from June 2010 to June 2015,were divided into the following 3 groups according to their carotid ultrasound examination results:vulnerable plaque group (n=291),stable plaque group (n=286) and no plaque group (n=201).Atorvastatin was given in patients from the 3 groups and the low density lipoprotein cholesterin (LDL-C) level was detected to evaluate the atorvastatin lipid-efficacy in 151 patients from vulnerable plaque group 4 weeks after treatment.The SNPs of rs402007 (G/C) in ADAMTS1 gene of all patients were detected by PCR amplification and DNA sequencing.Results There were statistically significant differences in age,fibrinogen (FIB) level,homocysteine (HCY) level and percentage of patients having diabetes among the three groups (P＜0.05).The frequencies of GC+CC genotype and C allele in rs402007 (G/C) ofADAMTS1 gene in the vulnerable plaque group were significantly higher as compared with those in the no plaque and vulnerable plaque groups (P＜0.05).After adjusting risk factors (age,FIB,HCY and diabetes),GC+CC genotype was the independent risk factor of vulnerable plaque (OR=1.559,P=0.015,95％CI:1.089-2.232).There were no significant differences in LDL-C levels before and after atorvastatin treatment among the GG,GC,and CC genotypes in vulnerable plaque group (P＞0.05).Conclusion C allele in ADAMTS1 gene might increase the risk of plaque's instability;no correlation exists between A DAMTS1 gene polymorphisms and LDL-C lowing efficacy to atorvastatin.

Objective To investigate the early diagnostic and prognostic value of plasma D-dimer level in acute aortic dissection.Method Data of totally 500 acute chest pain patients were studied,in which 250 cases were in group of acute aortic dissection (group AAD) confirmed by aortic computerized tomographic angiography (CTA) or cardiac ultrasonography,and the rest 250 cases were in non AAD group (group control).The D-dimer test was performed in all patients within 72 hours after onset of chest pain,and comparison of plasma D-dimer concentration was carried out between two groups.The D-dimer diagnostic value in AAD was analyzed by plotting the receiver operating characteristic (ROC) curve.According to AAD patients with aortic CTA findings,the whole aortic artery was divided into four segments by the major vascular branches,and the false lumen area was measured by degree score,the relationship between the score and D-dimer level were analyzed.To study the prognostic value of D-dimer in AAD,the comparison of D-dimer level was carried out between survival group and death group,and the AAD patients were further stratified by the surgery and Stanford type.Results The plasma D-dimer concentrations in AAD group were significantly higher than those in controls (P ＜0.01).The sensitivity,specificity,positive predictive value and negative predictive value of D-dimer (＞ 1.14 mg/L) in the diagnosis of AAD were 81.2％,79.39％,74.63％ and 72.4％ respectively,and the area under the ROC curve was 0.083.The elevated level of D-dimer was positively correlated with the extent of AAD false lumen (Spearman-Rho =0.418,P ＜ 0.01).D-dimer levels in the death group were higher than those in the survival group.Conclusions D-dimer may be a valuable biomarker in early diagnosis of AAD.The elevated level of D-dimer was useful to evaluate the extent of the dissection and prognosis of AAD.

Phthalate esters (PAEs) are commonly used plasticizers and have caused pollution to the environment due to their widespread use.Therefore, many countries have listed such compounds as a priority list of pollutants, and it is of great significance to establish an accurate analysis method for monitoring the pollution of PAEs in water.A method of solid phase membrane extraction combined with ultrasonic wave desortion-gas chromatography-mass spectrometer for analysis of PAEs in water was established in this study.The extraction and desorb conditions were optimized.In this study, the samples were ultrasonic wave desorbed for 7 min at bath temperature of 40℃ and ultrasonic powder of 50%.The detection limits (S/N>3) of this method were between 0.05 μg/L and 0.26 μg/L, the recoveries in different matrixes were between 76.2% and 112.3%, and the relative standard deviations were below 10%.

Objective: To explore the imaging manifestations of multi-slice spiral CT angiography (CTA) and relationship with in-hospital death in patients with aortic dissection (AD). Methods: The clinical data of 429 patients with AD who underwent CTA in Zhongshan Hospital of Fudan University between January 2009 and January 2016 were retrospectively analyzed. AD patients were divided into 2 groups, including operation group who underwent surgery or interventional therapy (370 cases) and non-operation group who underwent medical conservative treatment(59 cases). The multi-slice spiral CTA imaging features of AD were analyzed, and multivariate logistic regression analysis was used to investigate the relationship between imaging manifestations and in-hospital death in AD patients. Results: There were 12 cases (3.24%) of in-hospital death in operation group, and 28 cases (47.46%) of in-hospital death in non-operation group(P<0.001). AD involved different vascular branches. Multi-slice spiral CTA can clearly show the dissection of true and false lumen, and intimal tear was detected in 363 (84.62%) cases, outer wall calcification was revealed in 63 (14.69%) cases, and thrombus formation was present in 227 (52.91%) cases. The multivariate logistic regression analysis showed that the number of branch vessels involved (OR=1.374, 95%CI 1.081-1.745, P=0.009) and tearing false lumen range(OR=2.059, 95%CI 1.252-3.385, P=0.004) were independent risk factors of in-hospital death in AD patients, and the number of branch vessels involved (OR=1.600, 95%CI 1.062-2.411, P=0.025) was independent risk factor of in-hospital death in the operation group, while the tearing false lumen range (OR=2.315, 95%CI 1.019-5.262, P=0.045) was independent risk factor of in-hospital death of non-operation group. Conclusions Multi-slice spiral CTA can clearly show the entire AD, true and false lumen, intimal tear, wall calcification and thrombosis of AD patients. The number of branch vessels involved and tearing false lumen range are the independent risk factors of in-hospital death in AD patients.

Artificial sweeteners ( ASs ) have gained more and more attention by environmental scientists because some of them such as acesulfame, have the potential to be the ideal tracers of domestic wastewater for environmental monitoring. In contrast to the existing methods of artificial sweeteners, the analytical method of ASs as a new tracer for environmental samples requires better sensitivity and selectivity to avoid matrix interference. A highly sensitive method for the simultaneous determination of four frequently-used artificial sweeteners in water samples using solid-phase extraction and ion chromatography triple quadrupole mass spectrometer with an electrospray ionization source ( IC-MS/MS) in negative ion mode was developed. The separation effect of different separation columns was compared and a 2-mm ion chromatography column AS19 was chosen in the experiment. Chromatographic separation of all the 4 artificial sweeteners was carried out in 9 min in isocratic elution mode using 60 mmol/L sodium hydroxide as eluent. Different kinds of solid phase extraction cartridges were evaluated to obtain satisfactory recoveries of all of the analytes. Merk LiChrolut EN (200 mg, 3 mL) was preconditioned with 2 mL of methanol, followed by 2 mL of H2 O. About 200 mL of sample (pH<2. 0) was passed through the cartridge at a flow rate of 4 mL/min, and then the cartridge was eluted using 2 mL of methanol. 2 mm suppresser (75 mA) was used to reduce the background noise and to remove the matrix interference. The limits of detection were below 5. 0 ng/L for various artificial sweeteners based on 3-fold the S/N. The recoveries of different matrices in the samples were 65%-120%. The method described here is time-saving, accurate and precise, and is suitable for monitoring artificial sweeteners in different water matrices. The method has also the potential to trace other contaminants in groundwater.