Background/aims The reciprocal promotion of cancer and stroke occurs due to changes in shared risk factors, such as metabolic pathways and molecular targets, creating a “vicious cycle.” Cancer plays a direct or indirect role in the pathogenesis of ischemic stroke (IS), along with the reactive medical approach used in the treatment and clinical management of IS patients, resulting in clinical challenges associated with occult cancer in these patients. The lack of reliable and simple tools hinders the effectiveness of the predictive, preventive, and personalized medicine (PPPM/3PM) approach. Therefore, we conducted a multicenter study that focused on multiparametric analysis to facilitate early diagnosis of occult cancer and personalized treatment for stroke associated with cancer. Methods Admission routine clinical examination indicators of IS patients were retrospectively collated from the electronic medical records. The training dataset comprised 136 IS patients with concurrent cancer, matched at a 1:1 ratio with a control group. The risk of occult cancer in IS patients was assessed through logistic regression and five alternative machine-learning models. Subsequently, select the model with the highest predictive efficacy to create a nomogram, which is a quantitative tool for predicting diagnosis in clinical practice. Internal validation employed a ten-fold cross-validation, while external validation involved 239 IS patients from six centers. Validation encompassed receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and comparison with models from prior research. Results The ultimate prediction model was based on logistic regression and incorporated the following variables: regions of ischemic lesions, multiple vascular territories, hypertension, D-dimer, fibrinogen (FIB), and hemoglobin (Hb). The area under the ROC curve (AUC) for the nomogram was 0.871 in the training dataset and 0.834 in the external test dataset. Both calibration curves and DCA underscored the nomogram’s strong performance. Conclusions The nomogram enables early occult cancer diagnosis in hospitalized IS patients and helps to accurately identify the cause of IS, while the promotion of IS stratification makes personalized treatment feasible. The online nomogram based on routine clinical examination indicators of IS patients offered a cost-effective platform for secondary care in the framework of PPPM.

AIM:The carotid sinuses and aortic arch are baroreceptor-resident arteries (BRAs) and atherosclerosis-susceptible sites of brain-supplying arteries, which would impair baroreflex-mediated blood pressure (BP) regulation and prompt coronary atherosclerosis. We sought to determine the relationship between total atherosclerosis burden (TAB) of BRAs and coronary atherosclerosis burden (AB) in patients with ischemic cerebrovascular disease (ICVD) and explore the potential contribution of BP profiles to this relationship.METHODS:In this cross-sectional analysis of patients with ICVD who simultaneously undertook computed tomography angiography and 24-hour ambulatory BP monitoring, TAB of BRAs was scored based on the atherosclerotic vessel circumference ratio of the carotid sinuses and aortic arch, while the ABs of the intracranial, cervical, aortic, and coronary arteries were scored based on stenosis severity and plaque complexity as routine.RESULTS:Among the 230 patients analyzed, coronary AB was significantly correlated with TAB of BRAs, independently of, and more tightly than the ABs of the intracranial, cervical, and aortic arteries, and the stenosis- and complexity-based AB of BRA-located arteries (bilateral common and extracranial internal carotid arteries and aortic arch). Both coronary AB and TAB of BRAs were negatively associated with the night-to-day BP dipping ratios, which was quite different from the relationship between intracranial AB and 24-hour BP characteristics. These findings were also true for patients with ICVD without a history of coronary artery disease.CONCLUSION:Evaluating TAB of BRAs might provide a new link between atherosclerosis of brain- and heart-supplying arteries, connected partially by BP circadian rhythm. It might facilitate identifying patients with ICVD with heavy coronary AB and comprehensively managing vascular risk.

目的:探讨高良姜、大高良姜、红豆蔻3味山姜属中药黄酮对胃溃疡寒证大鼠胃消化液的影响及作用机制.方法:选择90只SPF级SD大鼠,随机抽取10只大鼠为空白组,其余大鼠进行胃溃疡寒证造模,末次造模结束后随机分为模型组,干姜姜辣素组,高良姜高、低剂量组,大高良姜高、低剂量组,红豆蔻高、低剂量组,共9组.采用灌服冰知母水煎液与15％冰乙酸制备大鼠胃溃疡寒证模型,以干姜姜辣素为阳性对照,测量大鼠胃液量、胃酸pH值,ELISA法测定胃蛋白酶活力、胃动素(motilin,MTL)、胃泌素(gastrin,GAS)、生长抑制素(somatostatin,SS)含量及H+-K+-ATP酶活力.结果:与空白组大鼠比较,模型组大鼠胃液量、胃蛋白酶活力、GAS、MTL含量、H+-K+-ATP酶活力均升高(P<0.01);胃酸pH值,SS含量显著减少(P<0.01).与模型组比较,干姜姜辣素组,高良姜、大高良姜、红豆蔻高剂量组大鼠胃液量、胃蛋白酶活力显著降低(P<0.01或P<0.05),pH显著升高(P<0.01或P<0.05);高良姜、大高良姜低剂量组胃液量显著减少(P<0.01或P<0.05),pH显著升高(P<0.01或P<0.05);干姜姜辣素组,高良姜高低剂量组,大高良姜、红豆蔻高剂量组大鼠胃组织GAS含量、MTL含量、H+-K+-ATP酶活力显著降低(P<0.01或P<0.05),SS含量显著增加(P<0.01或P<0.05).结论:3味山姜属中药黄酮类成分能够抑制胃溃疡寒证大鼠胃液分泌、提高胃酸pH值、降低胃蛋白酶活力,其作用机制与减少GAS、MTL含量、增加SS含量、减少H+-K+-ATP酶活力有关,推测其通过对胃肠活动的影响,减少胃液分泌以及胃肠活动,通过对质子泵的影响,抑制H+涌入胃腔,降低胃酸的生成,维持胃黏膜细胞内外离子平衡.

BackgroundAtherosclerosis of brain- and heart-supplying arteries (BHAs) are risk indicators for patients with ischemic stroke, but the atherosclerosis burden (AB) of intracranial, cervical, aortic, and coronary arteries in each and in total have not been simultaneously evaluated, and the associations with vascular risk remain unknown. Methods and ResultsWith computed tomography angiography, single-territory AB was triple ranked on the basis of the number of arterial segments with a significant atherosclerotic lesion. The total AB (TAB) of BHAs was triple ranked on the basis of the number of arterial territories with a significant atherosclerotic lesion, or according to the sum of 4 single-territory AB rank-scores. After a 12-month follow-up of 395 patients with ischemic stroke, a composite outcome of ischemic stroke, myocardial infarction, and vascular death occurred in 10.9%. The single-territory AB of intracranial, cervical, aortic, and coronary arteries showed distinct strata patterns and different associations with vascular risk. The score-based TAB of BHAs predicted vascular risk (crude hazard ratios [95% CIs]: per level increase, 2.35 [1.54-3.58]; median versus low, 3.37 [1.45-7.82]; high versus low, 6.00 [2.36-15.24]) independently of vascular risk factors and single-territory AB, providing more prognostic information than the TAB of BHAs measured by the number of significantly atherosclerotic territories. Vascular events occurred in 3.0%, 13.6%, and 22.6% of patients in the low (41.8%), median (44.8%), and high (13.4%) strata of the score-based TAB of BHAs, respectively. ConclusionsThe single-territory AB of intracranial, cervical, aortic, or coronary arteries might be not reliable for vascular risk stratification in patients with ischemic stroke, and evaluating the TAB of BHAs by quantitatively integrating the single-territory AB is advisable.

目的 以政策变迁理论为基础,了解村级卫生人力资源配置现状与问题,从"夯实基层基础作为固本之策"角度助力乡村振兴和健康乡村建设.方法 信息普查法:对H区14个农村乡镇村级卫生人力资源配置进行兜底调查;深入访谈法:以信息饱和为原则,抽取3个乡镇村卫生室和社区卫生服务站进行实地观察,对关键知情人进行个人深入访谈.结果 卫生政策环境在时空变化中发生重要改变,"空心村"与"倒挂村"并存、户籍人口与常住人口变动加速、老乡村医生与新乡村医生同掌接续、村卫生室与社区卫生服务站"双轨"并进.上述政策内外环境改变使村级卫生人力资源配置出现诸问题亟待研究.讨论 在政策外部环境与内部环境双重作用下,政策变迁是应然之举.村级卫生人力资源配置从政策上应进行体制并轨;职业发展机制实现上下贯通;队伍建设围绕适宜适用进行批量培养.

Background. The burden of cardiovascular diseases (CVDs) is increasing substantially due to population growth and aging. Determining effective prevention and understanding the underlying mechanisms remain desirable pursuits for increasing the quality of life. As centenarians and their offspring may have genetic advantages, they may present with healthier cardiovascular-related profiles. Methods. We launched a cross-sectional household-based survey of centenarian families, including 253 centenarians, 217 centenarian offspring, and 116 offspring spouses without centenarian parents from county-level Chinese longevity city Rugao. Among offspring and offspring spouses were the following arrangements: 101 paired offspring and offspring spouses who lived together, 116 unpaired offspring, and 16 unpaired spouses. We investigated their cardiovascular-related health status including waist circumference, body mass index (BMI), blood pressure, and plasma lipids and compared results among centenarians, centenarian offspring, and offspring spouses. Results. Centenarians ranged from 99 to 109 years with a median age of 100 years. Centenarian offspring, with a median age of 70 years, and offspring spouses, with a median age of 69 years, shared similar age. Results of blood pressure, plasma lipid levels, and BMI displayed no significant difference between centenarian offspring and offspring spouses. However, centenarians appeared to have lower waist circumference, BMI, TC, LDL-C, TG, and diastolic blood pressure but higher levels of systolic blood pressure (p<0.05). Multivariate analysis showed the prevalence of obesity, hypertension, and dyslipidemia was similar between centenarian offspring and offspring spouses, while centenarians appeared to have a lower prevalence of obesity and a higher prevalence of hypertension (p<0.05). Conclusions. Centenarians and centenarian offspring did not present healthier BMI, blood pressure, or plasma lipids than offspring spouses. Further research on longevity and cardiovascular diseases are desirable.

Objective . The aim of the study is to analyze the clinical characteristics of patients with H-type hypertension complicated with other chronic diseases in a community in Beijing and to explore the influencing factors related to the occurrence of the disease by means of a case-control study. Methods . A questionnaire was designed. 362 residents with H-type hypertension in a community in Beijing were randomly enrolled from January 2020 to December 2021. The general data and clinical indexes of the patients were collected and their clinical characteristics were analyzed. According to the complications of other chronic diseases, they were divided into the simple hypertension group ( n  = 65) and the other chronic disease group ( n  = 297). Univariate and multivariate analyses were used to analyze the influencing factors for H-type hypertension patients with other chronic diseases. Results . Among the 362 H-type hypertension patients, 21 cases were aged 35–45 years, 35 cases were aged 45–55 years, and 127 cases were aged 55–65 years. The number of patients aged ≥65 years was 179, and the number of patients aged ≥55 years accounted for the highest proportion with a constituent ratio of 85.00%. Only 65 patients were patients with simple hypertension. The remaining 297 patients were complicated with different kinds of chronic diseases. The types of chronic diseases include malignant tumors, diabetes, rheumatoid arthritis, coronary heart disease, asthma, chronic obstructive pulmonary disease, systemic lupus erythematosus, and stroke. The proportion of H-type hypertension complicated with coronary heart disease, diabetes, and stroke is higher. Among the 297 patients, most of them were local, resident, and nonagricultural patients with a constituent ratio of 89.90%, 95.96%, and 98.98%, respectively. The prevalence rate of the male was 59.60% higher than that of the female at 40.40%. The blood types B and AB were more common. 90.57% of patients were married and the proportion of body mass index (BMI) was 45.79%. 60.61% of patients had a history of smoking, 55.56% had a history of drinking, 35.02% had a regular physical examination, 14.81% had regular exercise, and 37.71% had a light diet. There were significant differences in marital status, smoking, alcohol consumption, regular exercise, and light diet between the simple hypertension group and the chronic disease group ( P < 0.05). The results of the logistic regression analysis showed that smoking, drinking, little exercise, and not eating lightly were the independent risk factors for other chronic diseases ( P < 0.05). Conclusion . The incidence of H-type hypertension is higher in people ≥55 years old. Most of them are accompanied by three other chronic diseases: smoking, drinking, little exercise, and no light diet are also risk factors for chronic diseases.

聚焦医学院校退役大学生士兵再适应及成长发展,通过集中座谈和深度访谈,研究和分析其在返校复学后出现的学业、校园融入、人际关系等再适应问题,面临的就业、政策落实、心理健康等成长发展困惑.提出引导和帮助医学院校退役大学生士兵再适应及成长发展的对策和建议,旨在为解决和处理好退役复学大学生的适应性问题提供科学参考.

Objective To evaluate the safety of initiating and maintaining propranolol therapy for infantile hemangioma (IH) and the safety of different doses. Methods The retrospective analysis included 336 consecutive cases of infants with IH treated between January 2016 and October 2017. The patients were assessed in the hospital at the initiation of the therapy and later in outpatient settings during the therapy. The monitoring included blood pressure (BP), heart rate (HR), blood glucose, hepatic and renal function, myocardial enzymes and serum lipids. Cardiac examinations in the outpatient follow-up included electrocardiography, ultrasound echocardiography, height, weight and head circumference. Results Propranolol decreased BP and HR at the initiation of treatment. The incidences of sinus bradycardia and hypoglycemia increased with the time of administration. Mean height, weight and head circumference were not affected during the treatment. The incidence of PR prolongation was 0%-5.7%. The effect of propranolol on the cardiovascular system, metabolism and physical development was not affected by its dose. Conclusion Oral propranolol is a safe treatment for IH. Serious side effects were not observed. Attention should be paid to the side effects during clinical treatment.

With the full implementation of the separation policy of medicine in China, the circulation of drugs in hospitals no longer produces direct economic value, but turns into the operating cost in the process of providing medical services. The research on the cost calculation of hospital pharmaceutical service can not only help the hospital to strengthen the internal cost management, but also provide the basis for the government policy compensation. This paper constructed a model of pharmaceutical service cost calculation based on job analysis, and produced basic pharmaceutical and advanced pharmaceutical service cost based on the data of a sample hospital.

基于"人类生命的二维性四重性"理论,结合大学生思想教育管理工作,对生命责任教育进行了理论和实践探索,提出生命责任教育的新模式——"两维四重"生命责任阶梯培养模式.该模式涵盖了丰富、立体的生命责任教育内容,同时以本科全程进阶式的培养原则,根据大学生的成长规律提出了具体措施,针对不同年级学生的生命责任问题设计相应的教育活动,以实现提高大学生生命责任意识和能力,提升高校生命责任教育实效性的效果.

Background: Instable blood pressure (BP) increased vascular risk independently of high BP level, which might be partially attributed to impaired arterial baroreflex. The receptors of baroreflex mainly distributed at carotid sinuses and aortic arch, where atherosclerosis (AS) is common in patients with ischemic stroke (IS) and potentially blunts the baroreflex. We aimed to test whether AS conditions of carotid sinuses and aortic arch would equally indicate BP instability in IS patients. Methods: The daytime and nighttime standard derivations (SDs) of systolic BP (SBP) and diastolic BP (DBP) were recorded by ambulatory BP monitoring on the sixth day after IS to measure BP stability (higher SD indicates less stability). Using computed tomography angiography, AS conditions of carotid sinuses (6 segments) and aortic arch (4 segments) were scored based on AS percentage of each segment circumference (0, none; 1, <25%; 2, 25%~49%; 3, 50%~74%; 4, ≥75%) and summed into “carotid sinuses AS burden (CSAB)” and “aortic arch AS burden (AAAB)”. AS conditions of cervicocephalic arteries were also scored. Results: Of the 245 patients with IS, 65.7% had carotid sinuses AS and 69.4% had aortic arch AS. Daytime SBP SD was positively correlated with CSAB ( r =0.230; P <0.001) rather than AAAB ( P =0.103). Patients with CSAB above the median had significantly higher daytime SBP SD than those with less CSAB (median 14 mmHg vs. 12 mmHg, P =0.001). CSAB remained related to ln- transformed daytime SBP SD after adjusting for age, sex, vascular risk factors, weighted 24-hour means of SBP and DBP, and cervicocephalic AS score (adjusted B =0.012; 95% CI, 0.004-0.020). In contrast, DBP SD and nighttime SBP SD had no statistically significant association with both CSAB and AAAB. Conclusions: Higher CSAB was independently associated with SBP instability during the daytime, while AAAB was less relevant to BP stability. Compared with AAAB, evaluating CSAB might be more important in the prediction of BP instability.

目的 以H区村落为现场,以中老年慢性病人群为对象,了解患慢性病村民生活方式现状,分析村落人际间的交往方式对慢性病人群生活方式的影响,探讨问题并提出对策建议.方法 以社会历史研究法为基本方法,以社会学实地研究为支撑,采用目的性抽样方法,在对H区3个乡镇的14个行政村的60名慢性病村民进行观察和访谈的基础上,对H区6个乡镇的48个行政村768名慢性病村民进行问卷调查.结果 村落基于血缘地缘的人际交往方式与因其产生的生活方式对慢性病的预防产生一定的正向作用,但在人际交往根脉与生活空间狭小的影响下所形成的交往方式使患慢性病村民"积习难改",对消除慢性病产生负向作用.结论 村落人际交往方式是生活方式的重要组成部分,应该立足村落环境,因势利导,提升慢性病村民健康素养,改善饮食习惯,科学运动健体,让村民真正拥有健康获得感.

A total of 207 general practitioners who participated in the "Beijing-Hong Kong Community Health Service Training Demonstration Center Project" training from 2013 to 2017 were selected for this questionnaire survey. A self-designed questionnaire was used, which contained the basic information of the trainees, the training purpose, the shortcomings of training, the satisfaction and suggestions for training. Total 192 valid questionnaires were retrieved with a recovery rate of 92.8%. The in-depth personal interviews were conducted among 8 trainees who served as key trainers in community health service centers and 4 managers from their institutions, to investigate the subsequent application of the learning results after they returning to work. The survey showed that the reasons of participating in training were knowledge updates (165, 85.94%), competence requirements (128, 66.67%), and due to administration decision (127, 66.15%). The highest comprehensive scores of training needs were improvement of general practice thinking ability (4.63), followed by clinical diagnosis and treatment ability (4.44), and general practice skills (3.97). For teaching contents, participants were most interested in diagnosis ability (4.03) and clinical operative techniques (3.20). For the training form, the participants more favored the case discussion method (80.73%, 155/192), clinical practice (52.08%, 100/192) and community practice (38.02%,73/192). The trainees were highly satisfied with the overall training organization, training time, training form, and training teachers of the Beijing-Hong Kong training project, and had a good grasp of the training content. Half of trainees (97, 50.52%) thought that the main shortcomings of training was the discrepancy between training content and practical work. Interviewees showed that after the training, the team management, communication skills and disease management ability for some minor specialties had been significantly improved; the enthusiasm for scientific research had been stimulated; they had a certain managerial thinking; and were able to apply what they leant in community health service. In summary, the training project has reached the initial training goals to promote the comprehensive ability of trainees.

By comparing the proportion of hospital pharmaceutical functions and work contents of different levels of pharmaceutical professionals at home and abroad, the authors divided pharmaceutical care in medical institutions into basic pharmaceutical care based on drug management and advanced pharmaceutical care based on drug treatment. Different pharmaceutical service levels created different pharmaceutical service values. Pharmaceutical classification service can stimulate the work potential of pharmaceutical professionals at all levels, improve the service level of pharmacists, and provide basis for the better distribution of medical costs in China.

目的 分析卫生管理专业大学生自我学习与成长满意度的现状.方法 以首都医科大学某学院本科学生为例,选取该学院卫生管理专业全体学生,共计137人,作为调查对象进行问卷调查,从学习态度、学习环境与条件、学习成绩、发展状态4个方面分析自我学习与成长满意度.结果 1)卫生管理专业大学生自我学习与成长满意度总体较好,但该专业学生在不同年级阶段,自我满意度存在差异.2)结合调查分析情况提出:关注中间年级、注重传授成长方法、专业培养结合就业规划的对策建议.结论 卫生管理专业大学生自我学习与成长情况较为理想,但需要加强对中间年级的关注,同时注重成长方法和就业能力的培养.

本科学位论文在高等教育本科培养过程中具有重要意义.基于北京市某高校2019届卫生法学专业本科学位论文抽检结果所发现的问题,根据卫生法学专业的特点,分别从培养工作、就业工作和生源三个层面分析了影响该专业本科学位论文质量的因素,并分别提出解决办法.以影响卫生法学专业学位论文质量的原因为依据,进一步揭示出当前卫生法学专业“招生—培养—就业”联动机制不完善的问题,并针对该机制存在的主要问题提出相应对策建议.

Objective We aimed to investigate the involvement of the endocytosis of occludin, a key component of tight junction (TJ), in the ethanol-induced disassembly of TJ in a model of alcoholic steatohepatitis. Methods Wild-type mice were fed an ethanol-containing or isocaloric liquid diet for 8 weeks and then assessed for liver injury (histopathology and measurement of serum enzymes), gut permeability (in vivo lactulose/mannitol and ex vivo dye leakage assays), intestinal epithelium ultrastructure (transmission electron microscopy), and intestinal occludin localization (immunofluorescence microscopy). The human intestinal epithelial cell line Caco-2 was also analyzed in vitro for the effects of ethanol on the barrier function (transepithelial electrical resistance), occludin localization (immunofluorescence microscopy and Western blotting), and endocytosis pathways (double-labeling immunofluorescence microscopy with selective pathway inhibitors). Results The ethanol-fed mice developed steatohepatitis and displayed intestinal barrier dysfunction, the disruption of intestinal TJ, and enhanced intestinal endocytosis of occluding compared with the control mice. In the Caco-2 monolayers, ethanol treatment decreased transepithelial electrical resistance, disrupted TJ formation, and enhanced occludin endocytosis in a dose- and time-dependent manner. These deleterious events were reversed by pretreating the Caco-2 cells with a selective pharmacological inhibitor of macropinocytosis, but not with the inhibitors of clathrin or caveolin-mediated endocytic pathways. Conclusion Chronic ethanol exposure may increase intestinal permeability by inducing the micropinocytosis of occludin, resulting in the disruption of intestinal TJ.

Aim Spontaneous subarachnoid haemorrhage (SAH) caused by ruptured cerebral aneurysm is a severe subtype of haemorrhagic stroke. Although the incidence of SAH is relatively low among all cerebrovascular diseases, the mortality is the highest. The critical management of SAH is challenging. We provide this evidence-based guideline to present current and comprehensive recommendations for the diagnosis and treatment of non-trauma SAH. Methods A formal literature search of MEDLINE (1 January 1990-30 June 2019) was performed. Data were synthesised with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The Chinese Stroke Association's levels of evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by Chinese Stroke Association's Stroke Fellow Committees. It is intended that this guideline be fully updated every 3 years. Results Evidence-based guidelines are presented for the care of patients presenting with non-trauma SAH. The focus of the guideline was subdivided into transfer and systems of care, diagnosis flowchart, aetiology and differentiation, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, management of vasospasm and delayed cerebral ischaemia, management of hydrocephalus, management of seizures and management of medical complications. Conclusions The guideline offers a framework for SAH management. Early professional and aggressive care of SAH might help dramatically.

With the constant growth of national investment in science and technology,biomedical scientific and technological achievements keep mushrooming.Hospitals,as a powerful force in high-tech research and development,experimental translation and industrialization of biomedicine research,play an important role in the transfer and translation of scientific and technological achievements.This paper analyzed the conflicts of interest in the achievements translation in hospitals,and considered that conflicts of interest are widespread in practice.Under the background of encouraging innovation and promoting the achievements translation,projects with conflicts of interest should be carried out in hospitals conditionally.While reducing the conflicts of interest,the achievements translation should be done properly.