Humans ; Amyloidosis ; Amyloid ; Cardiomyopathies

The construction of smart hospital is an important part of modern hospital management system,and it is also the key way to build the new system of high-quality hospital development.In terms of building smart hospitals,multi-campus hos-pitals face more difficulties and challenges than single campus hospitals,such as the lack of top-level design,the difficulty of in-tegrated management,the uneven development of hospitals and the widespread phenomenon of information islands.This study summarizes and analyzes the difficulties encountered in the construction and application of smart hospitals in multi-hospital areas.Guided by problems,it puts forward countermeasures and suggestions for the construction of refined and high-quality smart hospi-tals in multi-campus hospitals,including strengthening overall and forward-looking awareness,integrating management according to hospital conditions,characteristic development under demand guidance,establishing a data integration center for smart hospi-tals,scientific planning of talent reserve and discipline layout,etc.

BACKGROUND:Disseminated intravascular coagulation(DIC)is associated with increased mortality in sepsis patients.In this study,we aimed to assess the clinical ability of sepsis-induced coagulopathy(SIC)and sepsis-associated coagulopathy(SAC)criteria in identifying overt-DIC and pre-DIC status in sepsis patients. METHODS:Data from 419 sepsis patients were retrospectively collected from July 2018 to December 2022.The performances of the SIC and SAC were assessed to identify overt-DIC on days 1,3,7,or 14.The SIC status or SIC score on day 1,the SAC status or SAC score on day 1,and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify pre-DIC.The SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant initiation. RESULTS:On day 1,the incidences of coagulopathy according to overt-DIC,SIC and SAC criteria were 11.7％,22.0％and 31.5％,respectively.The specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14(P＜0.05).On day 1,the SIC score with a cut-off value＞3 had a significantly higher sensitivity(72.00％)and area under the curve(AUC)(0.69)in identifying pre-DIC than did the SIC or SAC status(sensitivity:SIC status 44.00％,SAC status 52.00％;AUC:SIC status 0.62,SAC status 0.61).The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC(0.79 vs.0.69,P＜0.001).Favorable effects of anticoagulant therapy were observed in SIC(adjusted hazard ratio[HR]=0.216,95％confidence interval[95％CI]:0.060-0.783,P=0.018)and SAC(adjusted HR=0.146,95％CI:0.041-0.513,P=0.003). CONCLUSION:The SIC and SAC seem to be valuable for predicting overt-DIC.The sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.

Objective To investigate the effect of Shenqi Dihuang decoction combined with recombinant erythropoietin and L-carnitine on renal function in patients with end-stage renal disease and the regulation of Janus activated kinase/signal transducer and activator of transcriptions(JAK/STAT)pathway.Methods A total of 144 patients with end-stage renal disease who were treated in the Second Affiliated Hospital of Xingtai Medical College from October 2019 to October 2021 were selected as the study objects.Patients were divided into Shenqi Dihuang decoction treatment group and conventional treatment group according to random number table method,72 cases in each group.Maintenance hemodialysis was performed in both groups.The conventional treatment group received recombinant erythropoietin and L-carnitine,while the Shenqi Dihuang decoction treatment group had Shenqi Dihuang decoction(prescription composition:30 g each of raw Astragalus,Parasitic loranthus,Eclipta,Polyporus,Poria bark,Raw coix seed,Salvia miltiorrhiza,and Pyrrosia,15 g each of Codonopsis pilosula,Dogwood,Herba lycopi,and Common yam rhizome,10 g each of raw Rehmannia glutinosa,Litchi core,Silkworm sand and Curcuma zedoary,6 g Cassia seed),once a day for 3 months.The clinical efficacy,renal function,microinflammatory status and serum JAK/STAT pathway related protein levels were observed after treatment in two groups of patients with different treatment modalities,and the occurrence of adverse reactions was recorded.Results The total effective rate of Shenqi Dihuang decoction was higher than that of conventional treatment group[90.28%(64/72)vs.77.78%(55/72),P<0.05].After treatment,the residual renal function(RRF),24-hour urine protein,blood urea nitrogen(BUN),blood creatinine(SCr)and inflammatory factors[hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)]were lower than before treatment,the post-treatment RRF of the Shenqi Dihuang decoction treatment group was higher than that of the conventional treatment group(mL/min:4.82±1.18 vs.3.96±1.05),while 24 hours urine protein(mg:62.26±12.16 vs.97.71±16.28),BUN(mmol/L:16.25±3.64 vs.20.65±4.13),SCr(μmol/L:242.25±25.62 vs.280.62±26.63),hs-CRP(mg/L:5.86±1.15 vs.7.78±1.32),IL-6(ng/L:3.26±0.64 vs.4.62±1.13)and TNF-α(μg/L:29.23±5.64 vs.32.66±6.13)were significantly lower than those in the conventional treatment group(all P<0.05).After treatment,JAK and STAT in Shenqi Dihuang decoction group were increased compared with before treatment,phosphorylated JAK(p-JAK)and phosphorylated STAT(p-STAT)were decreased compared with before treatment(both P<0.05),while the serum JAK/STAT pathway related protein levels in conventional treatment group were not significantly changed(all P>0.05).Therefore,JAK and STAT in the Shenqi Dihuang decoction treatment group after treatment were significantly higher than those in the conventional treatment group[JAK(μg/L):1.46±0.28 vs.1.26±0.26,STAT(μg/L):1.37±0.25 vs.0.99±0.24,both P<0.05],p-JAK and p-STAT were significantly lower than those in the conventional treatment group[p-JAK(μg/L):0.45±0.08 vs.0.65±0.13,p-STAT(μg/L):0.66±0.13 vs.0.82±0.28,both P<0.05].There was no statistically significant difference in the incidence of adverse reactions between the two groups[13.88%(10/72)vs.9.72%(7/72),P>0.05].Conclusion Taking Shenqi Dihuang decoction based on recombinant erythropoietin and L-carnitine treatment can effectively inhibit the JAK/STAT signaling pathway,and improve renal function and micro-inflammatory status in patients with end-stage renal disease,thereby improving the therapeutic effect.

Objective To investigate sex-related differences in left ventricular systolic dysfunction in heart failure with preserved ejection fraction(HFpEF)and type 2 diabetes mellitus(T2DM).Methods A total of 228 HFpEF patients who were treated in the Department of Endocrinology and Cardiology of the Second Hospital of Shijiazhuang from January 2019 to June 2023 were enrolled.They were divided into HFpEF group[women(n=61),men(n=73)]and HFpEF+T2DM group[women(n=49),men(n=73)]according to whether they had T2DM.Conventional echocardiography and left ventricular global longitudinal strain(GLS)data were measured.Sex-related differences of left ventricular structure and function were compared between the two groups.Multivariable linear regression analysis was performed for the determinants of impaired left ventricular GLS for HFpEF with T2DM patients and HFpEF patients of both sexes.Results LVMI was lower in women than in men in HFpEF group(P<0.05).The left ventricular remodeling rate of women was higher in HFpEF+T2DM group than that of men and women in HFpEF group,and the GLS of women was lower than that of men and women in HFpEF group(P<0.05).The E/E'was higher in women than in men in HFpEF and HFpEF+T2DM groups(P<0.05).Multivariable linear regression analysis showed that age,women,HbA1c and LVMI were the determinants of GLS impairement in HFpEF patients with T2DM.Age,T2DM,NT-proBNP and LVMI were the determinants of GLS impairement in HFpEF women patients,where as age,BMI,CHD,NT-proBNP and LVMI were the determinants of GLS impairement in HFpEF men patients.Conclusions There are sex-related differences in left ventricular systolic dyfunction in HFpEF with T2DM patients.With T2DM exerting a greater adverse effect onleft ventricular systolic dyfunction in women with HFpEF than men.

Objective:To investigate the iodine nutritional status of pregnant women in Jilin Province and its correlation with the distribution characteristics of water iodine in external environment, providing a basis for scientific iodine supplementation and prevention of iodine deficiency disorders.Methods:A retrospective analysis was conducted on the iodine survey data of drinking water for residents in Jilin Province in 2017 and the monitoring data of iodine deficiency disorders in 2021. The water iodine, salt iodine, and urinary iodine level of pregnant women were analyzed.Results:In 8 866 water samples from 873 townships (streets, hereinafter referred to as townships) of 60 counties (cities, districts) in 9 cities (autonomous prefectures) throughout the province, the median of water iodine was 4.60 μg/L, ranging from 0.00 to 81.30 μg/L. Among them, there were 758 townships with a median water iodine < 10 μg/L, accounting for 86.83% (758/873); 107 townships with a water iodine of 10 - < 40 μg/L, accounting for 12.26% (107/873). The median salt iodine was 23.50 mg/kg in 6 000 household consumption salt samples. The iodized salt coverage rate, iodized salt qualified rate, and qualified iodized salt consumption rate were 99.50% (5 970/6 000), 97.30% (5 809/5 970), and 96.82% (5 809/6 000), respectively. The iodized salt coverage rate in 9 cities (autonomous prefectures) were > 95%, the iodized salt qualified rate and qualified iodized salt consumption rate were > 90%. The median urinary iodine in 6 000 pregnant women's urine samples was 169.05 μg/L. Except for Bayshan City, which was iodine-deficient, the other 8 cities (autonomous prefectures) were iodine-suitable. The results of correlation analysis showed that there was no correlation between the urinary iodine level of pregnant women and the distribution of water iodine in the external environmental at the municipal (autonomous prefecture) level ( r = 0.60, P = 0.089). Conclusions:Most townships in Jilin Province are iodine-deficient in the external environment, and there are no water-borne high iodine area. The iodized salt coverage rate, iodized salt qualified rate, and qualified iodized salt consumption rate all meet the national standards. The iodine nutrition of pregnant women is generally at a suitable level, but there are still some areas where pregnant women are iodine-deficient, and there is no correlation with the distribution of water iodine.

Objective This paper aims to construct a scientific and standardized index system for evaluating the applica-tion effect of Diagnosis-Intervention Packet(DIP)in medical institutions.It seeks to determine the weights of indicators at all lev-els to provide a basis for evaluating the effectiveness of DIP used in various regions as well as a reference for improving DIP poli-cy.Methods This paper used literature analysis to develop an indicator pool preliminarily.The Delphi method was used to con-duct a questionnaire survey with 22 experts to establish the index system.It also used the Analytic Hierarchy Process(AHP)to determine the weight of each index.Results A total of two rounds of expert consultation questionnaires were conducted.The questionnaire exhibited high expert positive coefficients by 91.00％and 100.00％and higher authority coefficients of both 0.91 for two rounds.The coordination coefficients of the two rounds of expert consultation met the standard,and the expert opinions reached a consistence.Additionally,the questionnaire established comprised three primary indicators(efficiency of medical in-surance fund,medical service management,patient benefit,and satisfaction),9 secondary indicators,and 38 tertiary indicators.The AHP was used to determine the weight of indicators at all levels.Among the primary indicators,patient benefit and satisfac-tion had the highest weight(0.446 9).Among the secondary indicators,patients'medical cost burden had the highest weight(0.287 6).Among the tertiary indicators,the inpatient satisfaction had the highest weight(0.1592).The Cronbach's α coeffi-cients of the two rounds were＞0.7.Conclusion This paper utilized Delphi method and AHP to establish the evaluation system for assessing the implementation effectiveness of DIP.The approach is highly scientific and authoritative.It can be used to evalu-ate the application effect of DIP and provide an effective tool for medical insurance and hospital managers at all levels to assess DIP payment policies.

Objective To study the effects of different pellet feed hardness on the growth and reproduction,feed utilization rate,and environmental dust in laboratory mice.Methods One hundred of fifty 50 3-week-old SPF-grade C57BL/6JGpt and 150 ICR laboratory mice were randomly divided into three groups,with an equal number of males and females.They were fed diets with different hardness of 18.62 kg,23.15 kg,and 27.89 kg.Body weight,feed utilization rate,and dust levels in cages were recorded and calculated for mice aged 3-10 weeks.Forty-five 6-week-old male mice and ninety 4-week-old female mice from each strain were randomly divided into three groups and fed pellet feeds with three different hardness levels.After 2 weeks of adaptation to the same hardness feed,the mice were paired at a 1:2 male-to-female ratio and monitored for reproductive data for 3 months.Results At the age of 4 weeks,the body weight of male C57BL/6JGpt mice in 23.15 kg group was significantly higher than that in the 18.62 kg and 27.89 kg groups(P＜0.01),and the body weight of females in the 18.62 kg group was significantly higher than that in the 27.89 kg group(P＜0.05).There was no significant difference in body weight among ICR mice aged 3-10 weeks across different feed hardness groups(P＞0.05).For both strains,feed utilization rate for males was higher than that for females across different feed hardness groups at all weeks of age(P＜0.01).Compared to the 27.89 kg group,both the 18.62 kg and 23.15 kg groups showed a significant increase in the 50-mesh dust levels in cages for both strains aged 4-8 weeks(except for 7-week-old C57BL/6JGpt mice)(P＜0.05).For both C57BL/6JGpt and ICR mice,there was no significant difference in basic reproductive performance such as interval between the first litter and the monthly production index among the three feed hardness groups during the experimental period(P＞0.05).However,the monthly production index of C57BL/6JGpt mice first increased and then decreased with the increase of feed hardness,while that of ICR mice increased with increasing feed hardness,though these differences were not statistically significant(P＞0.05).Conclusion Different strains and genders had different tolerance to feed hardness.C57BL/6JGpt mice are more adapted to lower hardness feeds,while ICR mice are better suited to slightly higher hardness feeds.

Background There is a lack of research evidence on the association between sugar-sweetened beverage (SSB) consumption and gestational diabetes mellitus (GDM) in China. Objective To explore the association between frequency of SSB consumption before pregnancy and risk of GDM in pregnant women in Shaanxi Province, and to provide a scientific basis for targeted interventions to control maternal blood glucose. Methods The recruitment to the China Birth Cohort study started in October 2020. Pregnant women at 6-16 weeks who had their first prenatal examination at five hospitals in Shaanxi Province were recruited. A maternal health questionnaire was used to collect basic information about pregnant women. A semi-quantitative food frequency questionnaire was used to collect the consumption of carbonated beverages, fruit and vegetable juice beverages, coffee beverages, and milk tea beverages in one year before pregnancy, which were summed to obtain the SSB consumption. Pregnant women were divided into three groups according to SSB consumption, namely <1 serving·week⁻¹, 1-4 servings·week⁻¹, and ≥5 servings·week⁻¹. GDM was confirmed by oral glucose tolerance test (OGTT) between 24-28 weeks of gestation. A binary logistic regression model was applied to explore the association between SSB consumption and risk of GDM. Multiple linear regression was applied to investigate the associations between SSB consumption (per 1-serving·d⁻¹ increase) and OGTT fasting plasma glucose, 1-hour glucose, and 2-hour glucose. Results A total of 3811 pregnant women were finally enrolled in this study, of which 752 developed GDM, with an incidence rate of 19.7%. The incidence rates of GDM in pregnant women with SSB consumption frequency of <1 serving·week⁻¹, 1-4 servings·week⁻¹, and ≥5 servings·week⁻¹ were 18.0%, 21.1%, and 26.8%, respectively. After adjusting for maternal age, pre-pregnancy body mass index (BMI), education, number of children born, family history of diabetes, smoking, alcohol consumption, physical activity level, and total energy intake, the risk of GDM increased by 26% (OR=1.26, 95%CI: 1.05, 1.50) in the 1-4 servings·week⁻¹ group and by 76% (OR=1.76, 95%CI: 1.31, 2.38) in the ≥5 servings·week⁻¹ group compared to the <1 serving·week⁻¹ SSB consumption group, respectively. Further stratified analysis revealed no interaction effect (P_interaction>0.05) between SSB consumption and maternal age, pre-pregnancy BMI, or first labor or not. For each additional SSB consumption per day, the risk of GDM increased by 94% (OR=1.94, 95%CI: 1.37, 2.75); and the maternal OGTT 1-hour glucose and 2-hour glucose increased by 0.33 mmol·L⁻¹ and 0.18 mmol·L⁻¹, respectively (P<0.05), and no significant increase in fasting plasma glucose was found (P>0.05). Conclusion Higher SSB consumption before pregnancy increases the risk of GDM in pregnant women.

Objective:To investigate the effects of different doses of oxiracetam (ORC) on the neurological impairment and oxidative stress ability of lead(Pb)-exposed rats.Methods:Total 32 male SD rats with SPF grade were randomly divided into control group, the lead-exposed group, low-dose ORC intervention group and high-dose ORC intervention group according to the random number table method, with 8 rats in each group.The neurobehavioral indexes of rats were measured by gait score, tail flicking test, hindlimb support test and Morris water maze test.The lead content in hippocampal tissue was detected by spectrophotometry.The cell morphology of hippocampal tissue was observed by HE staining.Superoxide dismutase (superoxide dismutase, SOD) level in hippocampal tissues was detected by xanthine oxidase, and the level of malondialdehyde (MDA) in the hippocampus tissue was detected by the thiobarbiturate, and the level of glutathione peroxidase (GPx) in the hippocampus tissue was detected by chemical colorimetric.SPSS 24.0 software was used for statistical analysis, one-way ANOVA was used for multiple group comparisons and LSD- t test was used for further pairwise comparisons. Results:(1)After 8 weeks of lead exposure, there was no significant difference in body weight among the 4 groups( F=0.869, P=0.469). (2)Results of neurobehavioral indicators: there were statistically significant differences in gait scores, tail flick time, hind limb deployment distance, escape latency, and number of crossing platforms among the four groups of rats ( F=7.854, 13.630, 8.484, 23.485, 45.457, all P<0.05). The gait score, tail flick time, hind limb deployment distance, and escape latency of the lead-exposed group rats were higher than those of the control group (all P<0.05), while the number of crossing platforms was lower than that of the control group ( P<0.05). The gait score, tail flick time, hind limb deployment distance, and escape latency of the high-dose ORC intervention group were lower than those of the lead exposed group (all P<0.05), and the number of crossing platforms was higher than that of the lead exposed group ( P<0.05). (3)Lead content in hippocampal tissue: there was a statistically significant difference in lead content in the hippocampus of the four groups( F=309.013, P<0.001). The lead contents of lead exposed group ((1.21±0.10)μg/g), low-dose ORC intervention group ((1.03±0.10)μg/g) and high-dose ORC intervention group ((1.02±0.06)μg/g) were higher than that of the control group((0.02±0.00) μg/g) (all P<0.05), while the lead content in the low-dose ORC intervention group and high-dose ORC intervention group were both lower than that of the lead exposed group (both P<0.05). (4) HE staining showed that compared with the control group, the hippocampal tissue cells in the lead exposed group were arranged disordered, the tissue was loose, and the number of cells was reduced.Compared with the lead exposed group, the hippocampal histiocytes were closely arranged and regular, and the nuclei were fuller.(5)Oxidative stress levels in hippocampal tissue: there were significant differences in MDA, GPx content and SOD activity of hippocampal tissues in the four groups( F=69.879, 56.757, 11.644, all P<0.001). The levels of SOD ((2.03±0.18)U/mg, (3.42±0.26)U/mg), GPx((67.29±7.94)nmol/mg, (89.50±7.94)nmol/mg) in the hippocampus tissue of the lead exposed group were lower than those of the control group (all P<0.05), while the content of MDA was higher than that of the control group((43.73±3.74) nmol/mg, (16.42±1.60) nmol/mg)( P<0.05). The levels of SOD ((3.32±0.12) U/mg) and GPx ((84.11±6.26) nmol/mg) in the high-dose ORC intervention group were higher than those in the lead exposed group (both P<0.05), while the levels of MDA ((21.05±2.56) nmol/mg) was lower than that in the lead exposed group ( P<0.05). Conclusion:ORC can alleviate neurological damage in rats caused by lead exposure, which may be related to the up-regulation of antioxidant capacity of hippocampal tissues, thereby improving pathological damage.