Objective: To understand the current development status and challenges of college hospitals in Shandong and to seek scientific countermeasures, so as to promote the development of college hospitals. Methods: A total of 178 college hospitals in Shandong Province were surveyed by a questionnaire in December 2022. Additionally, 30 university hospital directors were selected for field investigations and telephone interviews by direct selection method. The survey covered aspects such as management and operation, human resources, departmental staffing and hospital functions. Results: About 65.73% of college hospitals were affiliated with the logistics department of their respective colleges. Tier 1 hospital accounted for 28.09% of the total. Personnel shortage in university hospitals was evident, and there were 109(61.24%) hospitals where the number of nonpermanent staff exceeded that of permanent staff. About 143 university hospitals (80.34%) had requirements for the promotion of professional and technical personnel. A total of 102(57.30%) college hospitals had incomplete departmental configurations. A survey of 30 college hospitals showed that 7 schools set up health professionals with a ratio of 600∶1. The number of people aged 40 and above was the highest, accounting for 53.12%; and the professional titles were mainly junior and intermediate, accounting for 83.95%. The department settings mainly included internal medicine (96.67%), preventive health care (63.33%) and surgery (60.00%). A total of 12 schools offered public health education courses. Conclusions There are deficiencies in the management and operation, hardware facilities, personnel department allocation and functional performance of college hospitals in Shandong Province. It is necessary to clarify the functional positioning of the college hospitals, improve both software and hardware facilities, strengthen talent construction, innovate health education, in order to effectively improve the service level of college hospitals.

bjective　To analyze the drug resistance screening status and drug resistance influencing factors of high-risk groups of drug-resistant pulmonary tuberculosis in Qingdao, and to understand the inclusion of rifampicin patients in treatment, so as to provide a reference for the prevention and treatment of drug-resistant pulmonary tuberculosis. Methods　The medical records of 726 cases of drug-resistant pulmonary tuberculosis among high-risk populations registered in Qingdao from 2018 to 2022 were obtained from the National Health Insurance Information System of the China Center for Disease Control and Prevention. The drug resistance to five anti-tuberculosis drugs, namely isoniazid (INH), rifampicin (RFP), ethambutol (EMB), levofloxacin (Lfx), and amikacin (Am), in the high-risk populations of drug-resistant pulmonary tuberculosis was analyzed. Univariate and multivariate logistic regression were used toidentify factors influencing rifampicin resistance, and the detection and inclusion of treatment for rifampicin-resistant patients were evaluated. Results　Of the 726 subjects, 278 were drug-resistant, with a total drug resistance rate of 38.29%. The drug resistance for the five anti-tuberculosis drugs in descending order was: INH 25.90%(188/726), RFP 22.87%(166/726), Lfx 14.19%(103/726), EMB 11.29%(82/726), Am 2.48%(18/726). Analysis of the drug resistance spectrum showed that among those resistant to one drug, RFP was most common, accounting for 13.67% (38/278); among those resistant to two drugs, INH+RFP was predominant, accounting for 15.83% (44/278); among those resistant to three drugs, INH+RFP+Lfx was most frequent, at 7.19% (22/278); and among those resistant to four drugs, INH+RFP+EMB+Lfx was highest, at 6.12% (17/278). Multivariate logistic regression analysis of rifampicin resistance showed that compared with patients under 25 years of age, the risk of developing rifampicin resistance was lower in the groups aged 45 to under 65 and those aged 65 and above (OR=0.356, 95%CI: 0.181-0.700; OR=0.352, 95%CI: 0.170-0.729). Compared with migrant patients in other provinces, local patients from within the same county or district had a lower risk of developing rifampicin resistance (OR=0.599, 95%CI:0.383-0.962). Compared with patients who were smear-positive at the end of the second month of initial treatment, the risk of developing rifampicin resistance was higher in patients with relapse/return, failure of retreatment/chronic, and other categories of patients (OR=9.380, 95%CI:3.717-23.671;OR=25.749, 95%CI:8.037-82.490; OR=36.651, 95%CI:8.438-159.201). Conclusions　The situation of drug-resistant pulmonary tuberculosis in Qingdao cannot be ignored. Individuals under 25 years old, migrants from other provinces, and patients with relapse/return, failure of retreatment/chronic, and other categories are significant risk factors for developing rifampicin resistance in the high-risk groups of drug-resistant pulmonary tuberculosis.

The purpose of this study is to provide a culture for mouse bone marrow-derived macrophages (BMDM) and peritoneal macrophages (PM) and to characterize their molecular and cellular biology. The cell number and purity from the primary culture were assessed by cell counter and flow cytometry, respectively. Morphological features were evaluated by inverted microscope. Phagocytosis by macrophages was detected by the neutral red dye uptake assay. Phenotypic markers were analyzed by real-time fluorescent quantitative PCR. Our results show that the cell number was much higher from culture of BMDM than PM, while there was no significant difference regarding the percentage of F4/80+CD11b+ cells (98.30%±0.53% vs. 94.83%±1.42%; P>0.05). The proliferation rate of BMDM was significantly higher than PM in the presence of L929 cell conditioned medium, by using CCK-8 assay. However, PM appeared to adhere to the flask wall and extend earlier than BMDM. The phagocytosis capability of un-stimulated BMDM was significantly higher than PM, as well as lipopolysaccharide (LPS)-stimulated BMDM, except the BMDM stimulated by low dose LPS (0.1 μg/mL). Furthermore, Tnfα expression was significantly higher in un-stimulated BMDM than PM, while Arg1 and Ym1 mRNA expression were significantly lower than PM. The expression difference was persistent if stimulated by LPS+IFN-γ or IL-4. Our data indicate that bone marrow can get larger amounts of macrophages than peritoneal cavity. However, it should be aware that the molecular and cellular characteristics were different between these two culture systems.
Animals ; Bone Marrow Cells ; physiology ; Cells, Cultured ; Culture Media, Conditioned ; Lipopolysaccharides ; metabolism ; Macrophages ; classification ; physiology ; Mice ; Phagocytosis

Objective To summarize the surgical outcomes of neonates with critical and complex congenital heart diseases in the last 15 years to determine the optimal operation time and improve the prognosis.Method From January 2004 to December 2018,data of patients with complex congenital heart disease (CHD) who received surgery in our center were retrospectively analysed.All patients were diagnosed using echocardiography,some patients also received multidetector computed tomography (MDCT) examination.According to the operation date,patients were assigned into three groups:2004-2008,2009-2013 and 2014-2018 groups.Follow-up data were obtained from outpatient check-up and telephone interview.Result A total of 357 (261 males and 96 females) neonates were included.They received the operation at 2-28 days after birth and their body weights were 2 100 ～ 4 900 g.13.4％ (48/357) were diagnosed before birth.Percutaneous oxygen saturation (SpO2) ＜ 0.95 were detected in 315 patients (88.2％,315/357),among whom 60 had SpO2 ≤0.60(19.0％,60/315).Cardiac murmur were detected in 181 patients (50.7％,181/357).Among the 357 patients,221 neonates had transposition of the great arteries (TGA),55 had total abnormal pulmonary venous connection (TAPVC),43 had pulmonary atresia and intact ventricular septum (PA/IVS) and severe pulmonary stenosis and intact ventricular septum (SPS/IVS),20 had severe coarctation of the aorta (CoA)/interrupted aortic arch (IAA)/severe aortic stenosis (AS)/hypoplastic left heart syndrome (HLHS) and 18 had other types of complex CHD.The rate of onestage repair was 83.8％ (299/357) and 58 neonates underwent palliative surgery.28 patients died in hospital (7.8％,28/357).The rate of prenatal diagnosis in three groups increased [3.0％ (2/67),6.3％ (7/111),21.8％ (39/179)] and in-hospital mortality of all patients,especially patients with TGA,were remarkably decreased in the last 15 years [11.9％ (8/67),5.4％ (6/111),2.8％ (5/179)].329 patients survived after surgery and discharged.The follow-up rate was 97.9％ (322/329),7 patients were lost during follow-up,the median duration of follow-up was 63 months (3 ～ 183 months).5 died during follow-up,9 underwent second-stage radical operation,3 had re-operation due to the RVOT/LVOT stenosis.The majority of survivors were asymptomatic and with Ⅰ degree (NYHA classification) during follow-up.Conclusion Cyanosis is the most common manifestation in neonates with complex CHD.The rate of prenatal diagnosis increased gradually in the last 15 years,and in-hospital mortality of all patients,especially patients with TGA,was remarkably decreased.Most symptomatic neonates with complex CHD can survive radical operations with high success rate and good curative effect.Palliative procedures are also important for critical and complex CHD.

Objective: To investigate the outcomes of coarctation resection and aortoplasty with autologous pulmonary artery patch for treating coarctation of the aorta combined with hypoplastic aortic arch in infants. Methods: Clinical data of 21 infants with coarctation of the aorta and hypoplastic aortic arch, who underwent coarctation resection and aortoplasty with autologous pulmonary artery patch in Fuwai hospital from January 2009 to June 2016 were retrospectively analyzed. The age of the patients was 4 (2, 5) months,and the body weight of the patients was (5.3±1.6) kg. The patients were followed up to observe the surgery effect. Results: No perioperative death and serious complications occurred. When the patients were discharged,the systolic blood pressure of the right upper limb was lower than the preoperative systolic blood pressure ((85.7±5.9) mmHg(1 mmHg=0.133 kPa) vs. (100.7±16.6) mmHg, P<0.001),and the systolic blood pressure of the right lower limb was higher than the preoperative systolic blood pressure ((98.7±13.3) mmHg vs. (85.6±20.8) mmHg, P<0.001). The pressure gradient of aortic coarctation detected by echocardiography was lower than the preoperative pressure gradient ((13.1±3.8) mmHg vs. (46.2±17.1) mmHg, P<0.001). No restenosis was detected by echocardiography at discharge. Follow-up data were obtained in 19 patients, and the follow-up time was 18 (8, 45) months.The patients grew well, and no death occurred. Restenosis occurred in 3 cases, 1 patient underwent aortic balloon dilatation and the remaining 2 patients were under follow up observation. Computed tomography angiography showed that the morphology of aortic arch was normal without signs of aortic aneurysm. Conclusion Coarctation resection with autologous pulmonary artery patch aortoplastystrategy is considered as a safe and effective surgical method for management of infant coarctation with hypoplastic aortic arch, and this surgery method is related with satisfactory early and mid-term outcomes in this patient cohort.

Objective:To evaluate the clinical effects of topical administration of phenytoin ( PHT) on wound healing. Methods:The clinical trials on PHT topically used for wound healing were collected from Cocharne Library and PubMed ( from database establish-ment to May, 2016. Meta-analysis was performed using RevMan 5. 0 software and Stata 12. 0 software. Results:A total of 15 stud-ies involving 1 048 patients were included. Topical PHT treatment was significantly associated with complete healing rate (OR=3. 28, 95%CI:1. 23-8. 75, P=0. 02), production rate of health granulation tissue (OR=2. 18,95%CI:1. 33-3. 59, P=0. 002) and aver-age percentage reduction of wound surface size (SMD=1. 77, 95%CI:0. 53-3. 02, P<0. 000 01). However, heterogeneity existed in complete healing rate and average percentage reduction of wound surface size among the studies. Meta-regression analysis showed that wound types (P=0. 02) and treatment periods(P=0. 08) were associated with the heterogeneity of complete healing rate outcomes, and mean age was associated with the heterogeneity of average percentage reduction of wound surface size(P=0. 07). Conclusion:Meta-analysis suggests that topical PHT treatment has significant positive clinical effect on wound healing. There is heterogeneity among the studies, so topical PHT treatment still should be applied in clinical practice prudently.

Objective The localization of pulmonary nodules in surgery remains a clinical challenge .In this study we dis-cussed the diagnostic and treatment value of CT-guided coil localization followed by real-time digital subtraction angiography ( DSA)-guided accurate resection of solitary pulmonary nodules (SPN) with video-assisted thracoscopic surgery (VATS). Methods This study involved 82 cases of SPN treated in the Department of Cardiothoracic Surgery of Jinling Hospital from September 2011 to May 2014 .The SPNs were preoperatively positioned by placing a metal coil close to the lesion under CT guidance on the same day of surger -y.Then VATS wedge resection of the SPNs was performed under the guidance of real -time DSA and further procedures followed in ac-cordance with the results of intraoperative pathology . Results The success rate of coil localization was 100%, the mean time of po-sitioning was (15.3 ±3.2) min, and the mean time of VATS wedge resection was (24.2 ±12.1) min.Pathological results revealed 45 cases of malignancy and 37 cases of benign lesions . Conclusion Preoperative CT-guided coil localization of SPNs showed a high accuracy and no serious complications , and by real-time DSA-guided VATS that immediately followed , the nodules could be precisely removed with the cutting edge 2 cm above the lesion , which achieved both the purposes of diagnosis and treatment of SPNs .

OBJECTIVETo investigate the result of surgical treatment of active infective endocarditis in patients with recent cerebrovascular events, and to evaluate the optimal indication and timing of surgical intervention.

METHODSThe clinical data of 26 patients with cerebrovascular complications before surgery Between December 2007 and December 2013 were analyzed retrospectively. There were 17 male and 9 female patients, aged (42±14) years. Types of disease included single aortic valvular disease (n=8), single mitral valvular disease (n=12), multiple valvular disease (n=5), and aortic valvular disease with ventricular septal defect (n=1). Type of cerebrovascular complication included cerebral infarction (n=25) and cerebral hemorrhage (n=1). Thirty-one valves were involved in 26 patients, mechanical prosthetic valve replacement (n=25), bioprosthetic valve replacement (n=4), and mitral valve repair (n=2).

RESULTSThe interval between onset of cerebrovascular event and surgical intervention was less than 14 days (n=3), 14 to 21 days (n=13), over 21 days (n=10), and the mean was (20±4) days. There were 33 vegetations found intraoperatively. The mean size of vegetations was (10±4) mm and 19 were found in mitral valve. Two patients died in hospital. One case relapsed after 1 year and underwent reoperation for prosthetic valve endocarditis. The remaining patients recovered with cardiac function of New York Heart Association class I to II after the period of 3 months to 5 years follow-up.

CONCLUSIONSAppropriate surgery may effectively improve the outcome of IE patients with cerebrovascular complications. The surgical indications and risks of further neurologic deterioration after cardiac surgery should be assessed comprehensively before surgical intervention.

Adult ; Aortic Valve ; Cerebral Hemorrhage ; etiology ; Endocarditis ; Endocarditis, Bacterial ; complications ; surgery ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Heart Valve Diseases ; Humans ; Male ; Middle Aged ; Mitral Valve ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Time Factors

Aim To investigate the effects of paeonol on lipopolysaccharide ( LPS) and adenosine 5′-triphos-phate ( ATP) induced NLRP3 inflammasome activation in primary rat microglia and the mechanisms responsi-ble for this anti-inflammatory effects. Methods Pri-mary rat microglia were identified immunohistochemi-cally using the cluster of differentiation 11 b ( CD11 b ) antibody. Proinflammatory cytokine IL-1β was deter-mined by ELISA. Western blot was performed to ob-serve the protein expression of NLRP3 , ASC and caspase-1 in cultured primary rat microglia. The level of intracellular reactive oxygen species ( ROS) was mo-nitored by using the fluorescent probe 2′, 7′-dichlo-rofluorescein diacetate ( DCFH-DA ) . Results LPS (0. 5 mg · L-1 )/ATP ( 5 mmol · L-1 ) significantly increased intracellular ROS level and IL-1β secretion and upregulated NLRP3 , ASC and caspase-1 protein expression in primary rat microglia. Paeonol signifi-cantly decreased intracellular ROS level and IL-1β se-cretion, and inhibited LPS/ATP induced overexpres-sion of NLRP3 , ASC and caspase-1 in cultured primary rat microglia. Conclusion Paeonol can inhibit LPS/ATP induced NLRP3 inflammasome activation in pri-mary rat microglia, and this inhibitory effect may be through the suppression of intracellular ROS.

Objective To study the mechanism underlying attentional biases toward event-related potentials (ERPs) in healthy male subjects.Methods 18 male healthy subjects performed emotional stroop task by pressing the buttons to the picture border color of two categories including the neutral and positive.The RT and Accuracy were recorded automatically.The ERPs were recorded by Neuroscan system.Results The behavioral results showed that neither the reaction time (628.11 ± 55.46) ms vs (628.81 ± 53.92) ms nor accuracy (96.87 ± 4.42) ％ vs (95.76±7.41)％ found difference under two conditions.ERPs results showed that the positive pictures evoked more greater P2 ((8.16±4.99)μV vs (4.30±3.83)μV) and P3 ((6.31±4.53)μV vs (4.27±4.16)μV) than neutral pictures.Conclusion Attentional biases toward positive emotion can be found in healthy male subjects,which can be related to emotional control process.