Objective To explore the factors affecting the success rate of operation in patients with end-stage renal disease by analyzing and comparing the differences of patients'basic conditions and clinical laboratory data.Methods A total of 107 patients who underwent forearm autogenous arteriovenous fistula surgery in Nujiang Lisu Autonomous Prefecture People's Hospital from January 2021 to August 2024 were selected and divided into AVF failure group and AVF success group according to whether internal fistula occluded during the operation or within 1 week after the operation.The basic data and clinical laboratory data of enrolled patients were collected.Correlation statistical methods were used to compare whether there were differences between the two indexes.Results Univariate analysis showed that there were statistically significant differences between the two groups in smoking history,diabetes history,nephritic syndrome history,gender,preoperative blood pressure,hemoglobin,low density lipoprotein and total cholesterol(P<0.05).However,There was no significant difference between the two in history,age,white blood cell count,neutrophil count,lymphocyte count,monocyte count,platelet,creatinine,urea nitrogen,triglyceride,blood calcium,blood phosphorus,calcium-phosphorus product,fibrinogen,D-dimer and albumin(P>0.05).Binary Logistic regression analysis showed that gender,diabetes history,nephritic syndrome history,preoperative blood pressure,hemoglobin and low-density lipoprotein were independent risk factors for AVF initiation failure(P<0.05).Conclusion Female patients,history of diabetes mellitus,history of nephrotic syndrome,low hemoglobin,elevated low-density lipoprotein,and poor blood pressure control are independent factors affecting the failure of AVF initiation.

Lotus medicinal herbs have the effects of resolving blood stasis and stopping bleeding， invigorating the spleen and benefiting the kidneys， restoring coordination between heart and kidney， and tranquilizing the fetus. Lotus root， lotus leaf， lotus seed， Lotus plumule， Shilianzi（Nelumbo nucifera Gaertn） and other lotus herbs are used to treat various female reproductive system diseases. For example， lotus leaf tip with modified Youshi Pangxing Shuangtu Decoction （伍尤氏胖型双土汤）， lotus root section with modified Youshi Shouxing Shuangteng Decoction （尤氏瘦型双藤汤） were used for polycystic ovary syndrome； Youshi Yangchao Formula （尤氏养巢方） （containing lotus seed）， Gengnian Formula （更年方） （containing lotus plumule） for ovarian reserve dysfunction； Lotus seed - Shihu （Dendrobium nobile） as the herb-pair， lotus stamen with ginseng flowers and Sanqi Flower for thin endometrium； Shilianzi（Nelumbo nucifera Gaertn）， lotus leaf tip， lotus stamen， lotus seed， lotus room， lotus root section can be used for premature abortion， and we summarized the characteristics of clinical medication， compounding experience， drug dosage and precautions of each lotus drug in different diseases.

Age-dependent loss of skeletal muscle mass and function is a feature of sarcopenia, and increases the risk of many aging-related metabolic diseases. Here, we report phenotypic and single-nucleus transcriptomic analyses of non-human primate skeletal muscle aging. A higher transcriptional fluctuation was observed in myonuclei relative to other interstitial cell types, indicating a higher susceptibility of skeletal muscle fiber to aging. We found a downregulation of FOXO3 in aged primate skeletal muscle, and identified FOXO3 as a hub transcription factor maintaining skeletal muscle homeostasis. Through the establishment of a complementary experimental pipeline based on a human pluripotent stem cell-derived myotube model, we revealed that silence of FOXO3 accelerates human myotube senescence, whereas genetic activation of endogenous FOXO3 alleviates human myotube aging. Altogether, based on a combination of monkey skeletal muscle and human myotube aging research models, we unraveled the pivotal role of the FOXO3 in safeguarding primate skeletal muscle from aging, providing a comprehensive resource for the development of clinical diagnosis and targeted therapeutic interventions against human skeletal muscle aging and the onset of sarcopenia along with aging-related disorders.
Animals ; Humans ; Sarcopenia/metabolism* ; Forkhead Box Protein O3/metabolism* ; Muscle, Skeletal/metabolism* ; Aging/metabolism* ; Primates/metabolism*

Objective:To explore the expression of circ-KEL in patients with acute myeloid leukemia (AML) and the effect and mechanism of circ-KEL on leukemic cells.Methods:The expression of circ-KEL was detected by quantitative real-time polymerase chain reaction in bone marrow mononuclear cells collected from 116 patients with AML and 40 healthy donors. The correlation of circ-KEL expression with the clinical characteristics of patients with AML was further systematically analyzed. The modulations among circ-KEL, miR-335-5p, and LRG1 were predicted through bioinformatics analysis and validated by dual luciferase assay. Cell proliferation and apoptosis were detected using CCK8 and flow cytometry.Results:The expression of circ-KEL was significantly elevated in patients with AML compared with the healthy controls (Relative expression level, -Δct, AML: -7.117±1.831; control: -8.669±1.771, P<0.001) . Moreover, patients with high circ-KEL expression have significantly worse overall survival. The level of circ-KEL in patients with AML was downregulated after chemo-treatment. In addition, circ-KEL could serve as the sponge of miR-335-5p and regulate LRG1. Bioinformatics analysis showed that miR-335-5p correlates with good prognosis and was negatively associated with LRG1. LRG1 could promote cell proliferation and inhibit cell apoptosis. Our results also exhibited the higher expression of LRG1 in patients with AML. Moreover, circ-KEL exerted functional effects via sponging miR-335-5p and regulating LRG1. Conclusion:circ-KEL expresses highly in patients with AML and correlates with poor prognosis, suggesting its important role in the genesis and progress of AML.

Objective: To carry out the 4^th round of third-party evaluation on the implementation and effect of the 1^st year of the 2^nd Phase National Healthcare Improvement Initiative(abbreviated as Initiative)since 2015. Methods: The 4^th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations. Results: The 4^th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces(autonomous regions, municipalities directly under the Central Government)and Xinjiang Production and Construction Corps.Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1%, 96.7%for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved. Conclusions The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction.

The 2nd round of the third-party evaluation of the National Healthcare Improvement Initiative was made during Dec 2016 and Jan 2017.The methods, organization and implementation of the survey and the technical roadmap were the same as those of the 1st round of evaluation.The total number of respondents was 94 218,including 19 773 doctors,24 315 nurses,29 105 outpatients and 21 025 inpatients. 142 typical cases were collected from sample hospitals.The key findings showed that, the National Healthcare Improvement Initiative has been implemented quite well in the 2nd year, achievements and challenges exist side by side.The overall satisfaction rate of both outpatients and inpatients was good, both were about 90%.Further improvement is expected.Hospital staff have been actively involved in this Initiative,but they are not satisfied with their working environments and compensations.

Objective To explore the influencing factors of outpatients′satisfaction in different types of hospitals,and to generate evidence for further healthcare improvement in different types of hospitals. Methods Based on the inpatient satisfaction survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals,we divided the outpatients in four groups according to the hospital types as general, traditional Chinese medicine, maternal and child and specialty hospitals.SPSS 22.0 and SAS 9.4 were used to conduct the Pearson Chi-square test, variance analysis, Bonferroni test for univariate analysis, and multiple stepwise logistic regression analysis of the influencing factors of outpatients′satisfaction in different types of hospitals.Results A total of 29 105 complete questionnaires were collected from the outpatients.There were statistically significant differences between the overall outpatient satisfactions of different types of hospitals(P <0.01).Hospital experience was the common most significant positive factors affecting the overall satisfaction of outpatients in all types of hospitals(P<0.01,OR=4.10,4.39,3.83,4.36).Waiting time for consultation was the common most significant negative influencing factor of the overall outpatient satisfaction of all types of hospitals(P<0.01, OR=0.99).Conclusions In the next round of healthcare improvements, all types of hospitals should focus on shortening outpatient waiting time.In a short run, hospitals can address this issue through more appropriate allocation of resources within hospitals.In a longer run, there is a need to rationalize the allocation of multiple resources within the overall health service delivery system.It is necessary to strengthen patient centered humane care,and to meet diverse healthcare needs.Western areas are called for enhanced investment and strengthened healthcare improvements.

Objective To analyze impacts of the referral system on outpatient satisfaction with the background of developing a hierarchical medical system, and to provide recommendations for further improvements of the referral system.Methods Based on the outpatient satisfaction survey results of the National Healthcare Improvement Initiative Third Party Assessment(2016-2017),the propensity matching method was used to analyze the satisfaction of outpatients who were referred and not referred.Results Compared with the overall satisfaction score of the non-referred outpatients, that of the referred outpatients was 0.11 points lower(P<0.01,95%CI=-0.17, -0.06).The patient experience satisfaction score of the referred outpatients was 0.06 points lower than that of the non-referred(P=0.03,95%CI=-0.11,-0.01).Conclusions Under the policy background of the hierarchical medical system in China, the current referral system has failed to positively improve patient satisfaction.To further improve the referral system and to raise patient satisfaction,there is a need to take following actions,to link the referral system construction with the public hospital reforms, in order to motivate the tertiary hospitals to be more actively involved in the strengthening of the referral system,to strengthen the medical capacity of the primary health care institutions, to standardize the referral criteria and procedure, and to formulate a more rational and effective health insurance payment method and reimbursement system.In addition, it is critical to further regulate and optimize the referral procedures,so as to set up reasonable and effective insurance payment and reimbursement for the referred patients, to promote the dissemination and to raise public awareness of the referral policy.Finally,it is necessary to enhance the diagnostic and treatment skills of the primary level of the health care delivery system.

Objective To learn the satisfaction influencing factors of outpatients with different registration approaches, in order to improve outpatient registration and appointment services at hospitals. Methods The composition of outpatients with different registration approaches was analyzed based on the outpatient survey results of the third party evaluation of the National Healthcare Improvement Initiative(2016-2017).Binary multivariate logistic regression analysis was conducted for outpatients with appointment and service counter registration approaches respectively, to analyze the influencing factors of outpatient satisfaction.Results Among the validated respondents, 16 588 cases(56.99%)were registered at the service counter, only 12 517 cases(43.01%)had prior appointment.Outpatients in eastern region hospitals had a higher rate of appointment registration than in western regions.Except in maternal and child hospitals,the outpatients in general hospitals,traditional Chinese medicine hospitals and specialty hospitals still tend to register at the service counter.The satisfaction of outpatients registered at service counters was significantly lower than those with appointment(P<0.05).With control of the social and demographic characteristics of outpatients, medical experiences were the common statistically significant positive influencing factor of the overall satisfaction for outpatients registered via both service counters and appointment(P <0.001), while waiting time ranked their common statistically significant negative satisfaction influencing factor(P<0.001).Conclusions The overall satisfaction of the outpatients with appointment was higher than that of the outpatients registered at service counters.Appointment registration is to be further promoted at large tertiary hospitals in China.

Objective To understand the current situation of inpatients′perceptions of doctor-patient relationship and its influencing factors, and to make policy recommendations for further targeted healthcare improvement.Methods Based on the survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals,we analyzed the inpatients′perceptions of doctor-patient relationship.SPSS 22.0 software was used to conduct Kruskal-Wallis test and Dunn-Bonferroni test,and SAS 9.4 was used to conduct multivariate logistic regression to analyze the influencing factors of inpatients′perceptions of doctor-patient relationship.Results The mean perception score of the inpatients pertaining to doctor-patient relationship was 4.34 ±0.84,and the median was 5.00.The perception score of the male inpatients pertaining to doctor-patient relationship was significantly higher than that of the female respondents(P<0.05),that of the inpatients who had fixed physicians or general practitioners before visiting was higher than that of the inpatients who did not have(P <0.05).The overall satisfaction of inpatients during hospitalization(P <0.01, OR =2.73)and doctors′satisfaction to have enough communication time with patients(P <0.01, OR =1.84)were the most significant protection factors to inpatients′perceptions of doctor-patient relationship.The process and structure evaluation results of hospitals in harmonization of doctor-patient relationship was a significant risk factor.Inpatients who had fixed physicians or general practitioners before visiting(P<0.01, OR=1.31)was another statistically significant positive influencing factor of inpatients′perceptions of doctor-patient relationship.Conclusions It is imperative to strengthen communications between doctors and patients and to improve healthcare service, in order to raise patients′satisfactions for a harmonized doctor-patient relationship.In addition to establish a working mechanism for medical disputes as a post-incident strategy, hospitals are recommended to take proactive and preventive measures.In addition,measures like integration of family doctor system and medical alliance system,as well as encouraging patients to contract their family doctors will help to harmonize the doctor-patient relationship.