Objective To explore the risk factors of carotid artery atherosclerotic plaque in ischemic stroke patients. Methods One hundred and forty-eight patients with ischemic stoke were allocated into two groups by ultrasonographic testing (80 with plaque and 68 without plaque). The carotid artery acoustic densitometry (IMT), blood pressure, blood glucose , blood lipid, fibriongen (FIB), c-reactive protein (CRP) were tested. First, single variable analysis was conducted and then multivariate non-condition stepwise logistic model analysis was conducted. Results Carotid IMT, age , total cholesterol (TC), low density lipoprotein (LDL)-CH, FIB, CRP level and the incidence of hypertension and diabetes were significantly higher in ischemic stroke patients with carotid artery plaques than patients without plaques (P≤0.05); Multiple logistic regression analysis showed the most important risk factors of plaques were CRP (OR=3.546, P=0.035) and FIB (OR=1.074, P=0.012) level. Conclusion The main risk factors of carotid atherosclerosis plaque are almost the same as atherosclerosis, such as age , hypertension ,diabetes, hyperlipidemia , high FIB and CRP level and increase in carotid IMT. CRP and FIB may play a crucial role in the development of carotid artery atherosclerosis plaque.
Objective To compare the characteristics of gelatin microspheres crossl inked by glutaraldehyde (GA) or geni pin (GP). Methods Gelatin microspheres, prepared by the improved emulsified cold-condensation method, were crossl inked by GP and GA, respectively. After being dispersed in PBS, two kinds of microspheres with 60% degree of cross l inking were compared in terms of morphology, swell ing and degrading properties. rhBMP-2 were loaded into the GP and GAmicrospheres, and the encapsulation rate, drug loading and releasing capacity were measured; 100%, 50% and 25% leaching l iquid of GP and GA microspheres were respectively cultured with rat osteoblast (DMEM group as the control), and cell prol iferation was measured by MTT method to grade the cell cytotoxicity. Results GP and GA microspheres were both spherical with the diameters of (78 ± 18) μm and (65 ± 10) μm, and there were no difference between both microspheres in drug loading and encapsulation rate. But, GP microspheres, with long degrading period (28 days) compared to GA microspheres (21 days), had better dispersibil ity, and swell ing rate (89.0% ± 4.8%), the percentage of cumulative drug releasing at 10 days (78.80% ± 4.96%) were both lower than GA microsphere (118.0% ± 7.6%, 90.50% ± 5.12%). The percentages of drug loading of GP and GA were (921 ± 73) and (965 ± 62) ng/g, and the encapsulation rates were 88.5% ± 2.1% and 89.7% ± 1.8%; showing no significant difference (P gt; 0.05). The cell cytotoxicity of 100%, 50% and 25% leaching l iquid of GP microspheres was all at the level I, but leaching l iquid of GA microspheres with corresponding concentration were at the levels of III, III and II. Conclusion GP crossl inked gelatin microspheres are superior to GA crossl inked gelatin microspheres and can be widely used in tissue engineering field.
ObjectiveTo measure the total factor productivity and its component changes of public secondary general hospitals in China from 2012 to 2018.MethodsFrom February to September in 2019, stratified systematic sampling method was used to collect the panel data of input and output indicators from 2012 to 2018 of 511 public secondary general hospitals in 5 provinces of China (Shandong, Hubei, Hainan, Anhui, and Shanxi), and Bootstrap-Malmquist-data envelopment analysis was used to calculate the total factor productivity and its component changes of the hospitals.ResultsFrom 2012 to 2018, the total factor productivity of the 511 public secondary general hospitals decreased by 0.22%, technical efficiency decreased by 5.24%, technical changes increased by 5.29%, pure technical efficiency decreased by 1.40%, and scale efficiency decreased by 3.89%, respectively.ConclusionsIn the past 7 years, the total factor productivity of public secondary general hospitals in China has declined slightly, mainly due to the decline of scale efficiency and pure technical efficiency, and the technological progress is the main reason for its improvement. The implications for the public secondary general hospitals are three folds: avoiding blind expansion and exploring optimum scale of beds, strengthening the internal fine management to improve the management practice and technical efficiency, and promoting technological progress by healthcare cooperating organizations.
With the aggravation of population aging, the medical and care needs of the elderly have increased significantly. Nowadays the integrated elderly care and medical services have been greatly promoted and various services modes have been developed in different regions. In order to promote the healthy development of integrated elderly care and medical services in China, we summarized the practical experience of integrated elderly care and medical services implemented in various parts of China, including six typical service modes such as elderly care in medical services, medical care in elderly care, cooperation between medical services and elderly care, community radiation, family doctor embedded and “Internet+”. Moreover, we compared their providers, service methods, construction specifications, service standards, regulatory agencies and payment methods. Finally, we analyzed the problems and their causes, and proposed corresponding improvements for outstanding problems in the practice of integrated elderly care and medical services in China.
Aiming at the shortcomings in the theory and practice of integrated elderly care and medical services in China, using the methods of literature analysis and comparative analysis, we summarize four typical models of integrated elderly care and medical services, namely, the American commercial pension model, the British national tax financing system pension model, the Japanese national security transformation, and the German long-term care insurance system, and compare the four models systematically from the aspects of system overview, service principle, operation mode, financing supervision, etc. The enlightenment for the policy and practice development of integrated elderly care and medical services in China is obtained: firstly, the service concept should be innovated; secondly, it is important to improve the relevant legal protection and supporting measures; thirdly, the refinement of the integrated elderly care and medical service projects are supposed to be promoted; fourthly, a multi-party linkage mechanism ought to be establishd; and fifthly, community endowment model should be advocated.
Objective To explore the present situation of the efficiency about public tertiary general hospitals in Shandong province, measure and compare the efficiency and the state of returns to scale of hospitals under different bed scales. Methods Based on the input and output data of 137 public tertiary general hospitals in Shandong province in 2017, two input indicators (the number of employees and the number of actual beds) and two output indicators (the total number of outpatients and emergent patients, and the number of discharges) were selected. The technical efficiency, pure technical efficiency and scale efficiency of sample hospitals were calculated by using data envelopment analysis, and a comparative analysis was carried out under different bed scales. Results Of the 137 public tertiary general hospitals, the mean of technical efficiency value was 0.666, the medians of pure technical efficiency value and scale efficiency value in 2017 were 0.817 and 0.919, respectively. In the 137 sample hospitals, there were 132 hospitals (96.4%) in ineffective status; there were 90 hospitals (65.7%) exhibiting increasing returns to scale, 11 hospitals (8.0%) exhibiting constant returns to scale, and 36 hospitals (26.3%) exhibiting decreasing returns to scale. There were significant differences in hospital efficiency and returns to scale under different bed sizes (P<0.001), and the scale efficiency was the highest when the bed size was 1001-2000. Conclusions The overall operating efficiency of the public tertiary general hospitals in the province was not high yet. Most hospitals were in ineffective status and most of them were in the state of increasing returns to scale. The optimal scale of actual beds is between 1001 and 2000 beds from the perspective of scale efficiency.
This paper systematically compares the common integrated elderly care and medical services models and related elements in China, analyzes the six major elements of system dynamics order flow, capital flow, equipment flow, personnel flow, information flow and material flow under the health care integration service model, compares the current situation of the application of system dynamics in the operation mechanism of the integrated elderly care and medical services model, supporting policies, cooperation and collaboration model, effect evaluation and industrial prediction simulation of key elements, summarizes the shortcomings of the existing application research and proposes research outlook, and provides a theoretical basis for the optimization research of the integrated elderly care and medical services model.
Objective To observe the effects of astaxanthin (AST) on the airway inflammation and remodeling in the asthmatic rats. Methods Fifty male Wistar rats were randomly divided into five groups (n=10 for each group): saline-sensitized and-saline-challenged group (the control group), bronchial asthma group (the asthma group), bronchial asthma+astaxanthin 5 mg/kg gavage treatment group (the AST 5 mg/kg group), bronchial asthma+10 mg/kg gavage treatment group (the AST 10 mg/kg group), and bronchial asthma+50 mg/kg gavage treatment group (the AST 50 mg/kg group). The level of interleukin-5(IL-5), interleukin-13(IL-13), interferon-γ(IFN-γ), tansforming growth factor-β (TGF-β), malondialdehyde (MDA) and superoxide dismutase (SOD) in the bronchoalveolar lavage fluid (BALF) and the total IgE level in the serum were measured using enzyme linked immunosorbent assay (ELISA).The infiltration of airway inflammatory cells and the degree of airway epithelial cells detachment, the extent of goblet cell hyperplasia and the severity of subepithelial collagen deposition were evaluated on the hematoxylin eosin (HE), periodic acid Schiff (PAS) and Masson trichrome stained lung sections. reverse transcription-polymerase chain reaction (RT-PCR) was used to measure the expression of mucin 5A and C (MUC5AC) messenger ribonucleic acid(mRNA) in lung tissue; Immunohistochemical staining was used to determine the expression of MUC5AC protein in the rat airway epithelium. Results The level of IL-5, IL-13, TGF-β, MDA and the total IgE in the serum respectively [(36.73±2.29), (53.99±2.70), (60.89±2.54)ng/mL,(18.65±0.76)umol/L, (54.50±2.91)ng/mL], the extent of inflammatory cells infiltration (46.24 ± 4.26), the extent of eosinophils infiltration (2.09± 0.13), the extent of epithelial cells detachment [(6.09±0.45)%], the extent of goblet cell hyperplasia [(13.65±1.90)%], the extent of subepithelial collagen deposition [(17.58±2.14)%], the MUC5AC mRNA expression level, and the lung tissue MUC5AC protein expression IOD value (187±12) in the asthma group were all higher than those in the control group (P<0.01 or P<0.001), the level of IFN-γ and SOD in the BALF[(26.38±1.70) ng/mL], [(16.37±1.22) U/L], was lower than that in the control group (P<0.001); The level of IL-5, IL-13, total IgE, TGF-β, MDA, the inflammatory cells infiltration in the airway epithelial, the degree of epithelial cell damage and detachment, the degree of goblet cell hyperplasia, the degree of subepithelial collagen deposition, the MUC5AC mRNA expression in lung tissue,and the MUC5AC protein expression in airway epithelial cells in the AST treated groups were all lower than those in the asthma group (P<0.05 or P<0.01 or P<0.001),the level of IFN-γ, SOD in the BALF was higher than that in the asthma group (P<0.05 or P<0.01). Conclusion Astaxanthin can inhibit airway inflammation, downregulate airway MUC5AC expression, inhibit goblet cell proliferation, and alleviate airway remodeling in rats with bronchial asthma.
ObjectiveTo measure the operational efficiency and explore the phenomenon of the economy of scale in secondary public general hospitals of China for improving the health service efficiency.MethodsFrom February to August 2019, the data set of two input indicators (the number of employees and actual open beds) and two output indicators (the numbers of outpatients and discharges) in 511 secondary general hospitals of Shandong, Anhui, Shanxi, Hubei and Hainan provinces in 2018 were collected for data envelopment analysis. The analysis processes were three folds: First, the technical efficiency, pure technical efficiency, scale efficiency and scale compensation status of the sample hospitals were calculated respectively. Second, the comparative analysis of efficiency value and scale compensation status was carried out in 5 groups according to the bed scale. Finally, the input and output projection analysis was carried out on the ineffective decision making units.ResultsThe medians of technical efficiencies, pure technical efficiencies, and scale efficiencies of the 511 secondary general hospitals were 0.472, 0.531, and 0.909, respectively. In the 511 hospitals, 493 hospitals (96.5%) were in ineffective state, of which 321 hospitals (62.8%) were in the state of decreasing return to scale. The staff redundancy of the group with beds >100 and ≤300 was 23.86%, and its service quantity could be increased by 39.37%.ConclusionsThe overall operating efficiencies are inefficiency in secondary general hospitals of China and the optimal scale of actual open beds is between 300 and 500 beds from the perspective of scale efficiency.
ObjectiveTo compare and evaluate the discrimination, validity, and reliability of different data envelopment analysis (DEA) models for measuring the effectiveness of models by selecting different input and output indicators of the model.MethodsData from health statistical reports and pilot program of diagnosis-related groups of tertiary hospitals in Hubei Province from 2017 to 2018 were used to analyze the discrimination, content and structure validity, and reliability of the models. Six DEA models were established by enriching the details of input and output on the basis of the input and output indicators of the conventional DEA model of hospitals.ResultsFrom the view of discrimination, the results of all models were left-skewed, the cost-efficiency model had the lowest left-skewed degree (skewness coefficient: -0.14) and was the flattest (kurtosis coefficient: -1.02). From the view of structure validity, the results of the cost-efficiency model were positively correlated with total weights, outpatient visits, and inpatient visits (r=0.328, 0.329, 0.315; P<0.05). From the perspective of content validity, the interpretation of model was more consistent with theory of production after revision of input and output indicators. From the view of reliability, the cost efficiency model had the largest correlation coefficient between the data of 2017 and 2018 (r=0.880, P<0.05).ConclusionsAfter refining the input and output indicators of the DEA model, the discrimination, validity, and reliability of the model are higher, and the results are more reasonable. Using indicators such as discrimination, validity, and reliability can measure the effectiveness of the DEA model, and then optimize the model by selecting different input and output indicators.