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21.
N. He J.-H. Li J.-J. Jia K.-D. Xu Y.-F. Zhou L. Jiang H.-H. Lu S.-Y. Yin H.-Y. Xie L. Zhou S.-S. Zheng 《Transplantation proceedings》2017,49(8):1923-1929
Background
To investigate the potential mechanisms of hypothermic machine perfusion (HMP)'s beneficial effects on kidney graft over static cold storage (SCS) in vitro.Methods
Ten kidneys of 5 Bama miniature male pigs were paired into 2 groups: SCS group and HMP group. Preservation solutions were taken at 0, 1, 3, and 6 hours for the measurement of K+, Na+, Cl?, blood urea nitrogen (BUN), creatinine (Cr), and lactate dehydrogenase (LDH) using the standard laboratory methods. Renal cortex were harvested at 6 hours for the following measurement: lactic acid (LD), adenosine triphosphate (ATP), malondialdehyde (MDA), neutrophil accumulation (MPO), interleukin-10 (IL-10), and transforming growth factor-β (TGF-β). Ischemia-induced apoptosis and the protein expression levels of total Akt, phospho-Akt, total Erk, and phospho-Erk were analyzed by Western blotting.Results
Almost all of the tested metabolites in preservation solutions were reduced with time in the HMP group. Levels of Na+, Cl?, BUN, Cr, K+, and LDH were lower in the HMP group compared with the SCS group, with differences in the first 4 reaching statistical significance. HMP alleviated ATP degradation and LD accumulation, diminished the MDA (P < .05) and MPO (P = .227) levels, and greatly raised IL-10 and TGF-β (P < .05) expression. A marked decrease of proapoptotic and a large increase of antiapoptotic markers (P < .05) along with greatly raised Akt (P < .05) and Erk (P < .01) phosphorylation was observed in the kidney of the HMP group compared with the SCS group.Conclusion
HMP's kidney graft protection involves inhibition of accumulation of toxic metabolites, oxidative damage, and apoptosis along with upregulation of the Akt and Erk signaling pathway. 相似文献22.
X. Yu R. Wang W. Peng H. Huang G. Liu Q. Yang J. Zhou X. Zhang J.H. Lv W. Lei J. Wu J. Chen 《Clinical microbiology and infection》2019,21(5):595-600
ObjectivesTo determine whether microbial contamination of preservation solution (PS) in kidney transplantation is associated with donor-derived infections (DDIs).MethodsWe retrospectively analysed data from 1077 deceased kidney transplant recipients of 560 donors. In all, 1002 PS samples were collected for microbiological assessment to establish the incidence and distribution of contamination. Comparisons between patients with contaminated PS and those with sterile PS were performed to assess the impact of microbial contaminations in perfusate on probable donor-derived infections (p-DDIs), and potential risk factors for p-DDIs were examined.ResultsThe contamination rate of PS was 77.8% (402/517). Bacterial species accounted for 85.6% (887/1036) of the total 1036 isolated microorganisms and 26.5% (275/1002) of the recipients' PS were contaminated by ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.). Enterococcus predominated the microbiological pattern. The incidence of infection was significantly higher in patients with microbial contamination than in patients with sterile PS (13.8% (107/776) versus 7.1% (16/226), p 0.006). The prevalence of p-DDIs was significantly higher in patients with ESKAPE contamination than in patients with other bacterial contamination in PS (7.2% (18/251) versus 1.0% (4/405), p 0.000). Univariate analysis indicated that ESKAPE contamination increased the risk of p-DDIs (p 0.001, OR 3.610, 95% CI 1.678–7.764). Multivariate analysis determined ESKAPE contamination as the only independent risk factor associated with p-DDIs (OR 3.418, 95% CI 1.580–7.393).ConclusionsThe high rate of microbial contaminations in PS is unusual and probably due to poor surgical procedures. Patients whose PS are contaminated by ESKAPE pathogens could have a significantly increased risk of p-DDIs at early post-transplantation. 相似文献
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Background
Problems with recruitment and retention of village doctors have led to shortages in many parts of rural China. The situation has been deteriorating since 2009, when health reforms led to an increase in patient flow to township facilities, reducing village clinic attendance and doctors' income. We aimed to assess an intervention to reverse the decline in village doctor numbers in Jiangshan County, Zhejiang province.Methods
This community-based prospective, non-randomised controlled trial was done across Jiangshan County, Zhejiang province, between January, 2012, and December, 2014. Our intervention group consisted of village clinics in Jiangshan County who voluntarily agreed to join the intervention group during the course of the study, with the remainder serving as controls. Clinics joined the intervention in a stepwise fashion: 17 in February, 2012, 17 in December, 2012, five in June, 2013, 47 in October, 2013, ten in January 2014, and eight in November, 2014. 104 village clinics (including five newly built clinics) had joined the intervention by the end of 2014. The remaining 83 village clinics served as controls. The intervention consisted of four components: (1) shift of the village clinic from private to collective ownership; (2) payments by local government to village doctors of ¥800 RMB per month, plus ¥4 RMB per patient visit; (3) introduction of a ¥5 RMB consultation fee, covered by health insurance; and (4) introduction of the zero-profit essential drug list (as in township hospitals) to discourage overprescribing and encourage patient attendance. Clinic records and doctors' views regarding job satisfaction and trust by patients, assessed by face-to-face interview, were compared at baseline and 36 months after initiation of the intervention. We obtained ethics approval from Zhejiang University, and participants gave oral informed consent.Findings
Our sample consisted of 104 village doctors working at 104 clinics who received the intervention and 83 doctors at 83 clinics who did not (controls). In the 64 intervention clinics for which we had data for January to December, 2014 (the final year of assessment), patient visits increased from an annual mean of 2494 (SD 1214) per clinic in the year preceding baseline to 4316 (1223) in the final year of assessment (mean difference vs 40 controls, 2163; p<0·0001). Doctors' mean income increased from ¥44?900 RMB (SD ¥13?700) at baseline to ¥63?500 RMB (¥16?000) in the final year of assessment and the mean cost per visit fell from ¥50 RMB (SD 14) to ¥32 RMB (7). In the 64 intervention clinics analysed, the proportion of patients who were prescribed antibiotics or intravenous injections out of all attending patients, per patient visit, reduced from 69% to 44% (difference vs 40 controls 30·2%; p<0·0001), and 71% to 49% (difference vs controls 16·5%; p<0·0001), respectively. Between baseline and 36 months, 28 clinics opened in villages previously without a doctor. Of 64 doctors randomly selected for interview in intervention village clinics, 53 [83%] were very satisfied with the intervention, 49 (77%) were very satisfied with their income, 47 (73%) thought patient care had improved, and 55 (86%) thought that the doctor–patient relationship had improved. All the control clinics in Jiangshan have since joined the intervention.Interpretation
In areas of rural China where local government can provide the necessary resources, the model we describe can address the shortfalls in health services at the village level.Funding
Zhejiang University Zijin Talent Programme. 相似文献26.
Background
In China, the reported incidence of workplace violence in hospitals has been increasing. Most research has focused on secondary and tertiary care facilities. We aimed to determine the incidence of workplace violence and its aftermath in county and township hospitals and community health centres in Zhejiang Province.Methods
A cross-sectional survey using stratified cluster sampling was carried out at 18 hospitals (eight county hospitals and ten township hospitals or community health centres) in Zhejiang Province from July 27, 2016 to Jan 20, 2017. Questionnaires were distributed to all health workers (including physicians, nurses, medical technicians, and administrative staff) present on the day of the survey. Ethical approval was obtained from Zhejiang University School of Public Health.Findings
2018 out of 2303 participants completed questionnaires from 596 men and 1417 women. In the past year, 140 (7%) respondents had experienced physical attacks and 384 (19%) physical threats. Men experienced around twice as many physical attacks (59 [10%] vs 80 [6%] of women; p=0·001), and significantly more threats than females (132 [22%] vs 252 [18%]; p=0·025). Doctors were most likely to be victims of physical attacks, and the commonest location was the emergency department. Most respondents did not report the physical attack (117 [85%] respondents), mainly because they regarded it as pointless (70 [52%] respondents) or didn't know who to report to (32 [24%] respondents). Of all those attacked or threatened, 312 (61%) wanted to quit direct patient care. In terms of impact, 413 [80%] victims said they had repeated, disturbing memories of the attack, 498 [97%] said they had become highly vigilant, and 386 [75%] were fearful dealing with difficult cases. Only four [3%] were satisfied with the way the incident was handled.Interpretation
Workplace violence is common at lower-level health facilities. The lack of a formal response to workplace violence implies an institutional tolerance which is of great concern. Guidelines for management of workplace violence need to be instituted in primary care facilities.Funding
Zhejiang University Zijin Talent Programme. 相似文献27.
[目的]为进一步加强自动售水机供应的生活饮用水卫生监督管理,探索现制现售水的管理对策。[方法]对82台自动售水机的卫生部涉水产品许可批件、经营公司（个体）管理情况、从业人员管理、自动售水机选址、日常维护和信息公示等情况进行现场调查,通过简单随机抽样抽取36台自动售水机的出水水质进行抽检,检验项目：色度、浑浊度、臭和味、pH、铅、耗氧量、亚硝酸盐氮、电导率、菌落总数、总大肠菌群、耐热大肠菌群、大肠埃希氏菌。[结果]82台自动售水机的维护人员均无有效健康体检证明,卫生许可信息（卫生部涉及饮用水卫生安全产品卫生许可批件）公示率为70．7％,日常维护内容（清洁、更换滤芯等）公示率为75．6％,提示用户清洗容器公示率为36．6％。规模不同的经营公司（个体）,其卫生许可信息、日常维护内容等信息的公示率差异有统计学意义（P〈0．01）。36台自动售水机水样色度、浑浊度、臭和味、pH、铅、亚硝酸盐氮、总大肠菌群、耐热大肠菌群、大肠埃希氏菌合格率为100．0％,耗氧量合格率为94．4％、电导率合格率为36．1％、菌落总数合格率为72．2％。规模不同的经营公司（个体）,其抽检样品合格率差异有统计学意义（P〈0．01）。[结论]加强市场准入,提高经营单位管理能力,完善信息公示,开展经常性卫生监督和自动售水机出水水质监测,确保该市使用的自动售水机水质的卫生和安全。 相似文献
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目的了解杭州市高危人群弓形虫感染和弓形虫病防治知识知晓情况。方法采用ELISA方法检测杭州市100例HIV/AIDS患者、100例恶性肿瘤患者、100例孕妇和100例健康对照者血清抗弓形虫抗体,对全部调查对象进行弓形虫病防治知识问卷调查。结果 HIV/AIDS、恶性肿瘤患者和孕妇血清抗弓形虫抗体阳性率分别为31%、30%和21%,均显著高于健康对照者的5%(χ~2=14.68,13.96和7.56,P均0.01)。孕妇对弓形虫病防治知识的知晓率整体较高,健康对照者对弓形虫病防治知识的知晓率整体较低;调查对象对"你知道弓形虫感染的危害吗?"、"你知道生食或食用未煮熟的肉类会感染弓形虫吗?"和"你知道接触被污染的土壤会感染弓形虫吗?"等问题的知晓率较低。结论杭州市HIV/AIDS、恶性肿瘤患者和孕妇等高危人群弓形虫感染率较高,且对部分弓形虫病防治知识知晓率较低。有必要加强对高危重点人群的弓形虫病防治知识健康教育,有效预防和控制弓形虫感染。 相似文献
29.
Deguang Zhang Lei Xie Gaofei He Liang Fang Yuwen Miao Zhezhe Wang Li Gao 《American journal of otolaryngology》2017,38(2):115-120
Purpose
Video-assisted lateral neck dissection (VALND) for papillary thyroid carcinoma (PTC) with lateral neck lymph node metastases (LNM) has been described previously, however, the advantages and drawbacks of VALND have not been demonstrated in previous studies. The aim of this study was to compare the surgical outcomes of video-assisted and open lateral neck dissection for PTC with lateral neck LNM.Materials and methods
Between May 2013 and November 2014, 92 consecutive patients with PTC and lateral neck lymph node metastases underwent total thyroidectomy with central compartment neck dissection and unilateral lateral neck dissection. These included 54 individuals who underwent video-assisted surgery, and 38 in whom an open approach was used. The two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes and oncological completeness.Results
The mean follow-up period was 18.6 months. The mean tumor size, tumor stage, mean numbers of retrieved lymph nodes, mean postoperative serum thyroglobulin levels, complication rates, and mean postoperative hospital stay were similar between the two groups. The mean operation time was longer (p = 0.0001) and mean age was lower (p = 0.0354) in the video-assisted group. The cosmetic results, evaluated by numerical scale and verbal response scale, were in favor of the video-assisted group (p = 0.0003 and p < 0.0001, respectively).Conclusions
The safety and oncological completeness of VALND was similar to that of open procedures, but the VALND resulted in improved cosmetic results. VALND is an effective treatment for the selected cases of PTC with lateral neck LNM. 相似文献30.
杭州疗养区人文景观的特征与应用 总被引：3，自引：3，他引：0
目的探讨杭州疗养区人文景观的特征,充分开发和合理利用人文景观疗养因子的疗养作用。方法收集杭州疗养区人文景观的相关资料,进行实地考察和综合分析。结果杭州疗养区人文景观以西湖风景、钱塘水系、寺庙文化、主题公园和名人故居等五条轴线分布,构成了积极向上、雅俗共存、丰富多彩的景观特色。结论杭州疗养区人文景观资源丰富,体现了自身的特色,并按一定的规律分布,应充分开发和合理利用。 相似文献