BACKGROUND Change management has become an important tool for hospitals to continuously improve themselves in a competitive market. This questionnaire-based study aimed to compare the attitudes of 78 midwives before and after management changes in work schedules and performance-related pay between March and October 2022 at a women's and children's hospital in China. MATERIAL AND METHODS The survey utilizing a job involvement scale and a self-designed questionnaire was distributed through WeChat group chat for all midwives of the hospital. The hospital has 87 midwives. A total of 78 midwives participated in the questionnaire survey. RESULTS The midwives' score ranges of work initiative, work attitude, work value, work recognition, and work enthusiasm and focus before change management were 21-39, 19-37, 23-29, 12-18, and 12-20, respectively, but that after change management they were 22-39, 19-37, 23-30, 13-18, and 14-23, respectively. After change management, both of the P values for work attitude and work enthusiasm and focus were less than 0.05, 80.23% of the midwives were willing to work across the 2 campuses, and all surveyed midwives agreed on unified accounting of performance pay under the condition of working across the 2 campuses. Their views changed from "maintaining the status quo: taking the initiative - passive resistance" to "questioning" to "openness to change: acceptance". CONCLUSIONS The change management implemented within our department is feasible and the clinical risk is controllable. More attention was paid to the midwives' perceptions and humanized management was applied during change management, leading to a success of change.
This study was designed to confirm haemodynamic effects of short-term infusion of recombinant human atrial natriuretic peptide (rhANP) at the prespecified dose in patients with acute decompensated heart failure compared to placebo when both were added to standard care.
Methods
This was a randomised, double-blind, placebo-controlled, multicenter study. After the placement of a Swan–Ganz catheter, 121 patients with acute decompensated heart failure were randomly assigned to double-blind treatment with placebo or rhANP (initiated at a rate of 0.1 µg/kg/min, adjusted to 0.15 ug/kg/min half an hour later if the systolic blood pressure was more than 100 mmHg and the PCWP was 15 mmHg or higher, and stopped one hour later from the initiation). The haemodynamic parameters were measured at 0.25, 0.5, 0.75, 1, 3, 6 and 12 h after the start of study drug. The primary end-point was PCWP at 1 h. Adverse events were monitored through study day 3, and mortality was assessed through a month.
Results
93 patients were randomised to rhANP group and 28 to the placebo group at a ratio of 3:1 using block of size 4. Baseline characteristics were similar among patients in the study groups, and PCWP were 23.71 ± 7.0 and 25.66 ± 8.78 mmHg in rhANP and placebo group, respectively (p = 0.226). The mean reduction in PCWP was greater with rhANP (−5.45 mmHg) than placebo (-2.03 mmHg) at 30 min, and there was significant difference for the mean PCWP between groups (p = 0.002). The maximum decrease of PCWP in rhANP group was observed at 1 h (−7.74 vs −1.82 mmHg with placebo), and the mean PCWP of the two groups were significantly different (p < 0.001). At 3 h, PWCP was sustainedly lower in rhANP group (19.52 ± 6.55 mmHg) than in placebo group (24.79 ± 8.42 mmHg) (p < 0.001). However, no significant differences were found between the two groups for PCWP at 6 h (21.43 ± 6.51 and 24.79 ± 10.64 mmHg, p = 0.125). The rate of hypotension and other adverse event were even in the two groups (p = 0.111).
Conclusions
The short-term infusion of rhANP has prompt haemodynamic improvement in patients with acute decompensated heart failure compared to placebo added to standard care.
Objective:To study the profective effects of DS on isoproterenol induced myocardial injury.Methods:The electrical activities of papillary muscle cells of guinea pigs were induced by standard glass microelectrode and analyzed synchronously by the microcomputer Doctor 851 program.The effects of DS on the electrical activities of these cells were observed.Results:DS could lighten isoproterenol induced myocardial injury by means of the plateau period of action potential shortened.Conclusion:These results showed that blocking slow channel decreasing cellular calcium load might be one of the important channels of the protective effects of DS on the myocardium.
The diagnosis of paraduodenal hernia is still a challenge in clinical practice due to lacking of specific symptoms. Case presentation: An 83-yr-old male patient presented to our department due to severe abdominal pain for 8 h. Abdominal contrast enhanced computerized tomography (CT) scan indicated intussusception in the duodenum and the upper segment of jejunum, as well as internal hernia. He complaint of progression in the abdominal pain, and then laparoscope was carried out, which indicated left-sided paraduodenal hernia. Subsequently, the patient was transferred to celiotomy, during which slight ischemic changes were noticed in the intestinal canal. Meanwhile, a hernial orifice was noticed in the left orifice of the duodenum. Conclusions: In this case, we presented our experiences on the diagnosis of paraduodenal hernia and intussusception. Our study contributed to the understanding, early diagnosis and selection of surgical options for the surgeons.
The aim of this study was to validate the accuracy of left ventricular ejection fraction (LVEF) obtained by quantitative gated single photon emission tomography (QGS) perfusion imaging in comparison with gated blood-pool imaging. Resting gated myocardial perfusion imaging was performed in 269 patients with suspected or known coronary artery disease, and followed by equilibrium nuclear cardiac blood-pool imaging in one week. The later was considered as the reference standard. The LVEF from both methods were analyzed. The LVEF were calculated with QGS using Cedars Cardiac Quantification software. We found that LVEF from QGS and blood-pool (Bp)-LVEF were highly correlated (r=0.819, 0.05), whereas when ESV was smaller than 15 mL, QGS-LVEF was significantly higher than Bp-LVEF (mean ± SD: 80.53% ± 7.01%vs 65.06% ± 10.37%, P<0.05). Our findings demonstrate that when ESV values are larger than 15 mL, QGS- LVEF could replace Bp-LVEF. However, when ESV value is smaller than 15 mL, LVEF should be assessed in combination with blood-pool imaging.
Abstract The aim of the present study was to determine the effect of microRNA (miR)-132 on cardiac fibrosis in myocardial infarction (MI)-induced heart failure and angiotensin (Ang) II-treated cardiac fibroblasts (CFs). Experiments were carried out in Sprague-Dawley rat treatment with ligation of left coronary artery to induce heart failure, and in CFs administration of Ang II to induce fibrosis. The level of miR-132 was increased in the heart of rats with MI-induced heart failure and the Ang II-treated CFs. In MI rats, left ventricle (LV) ejection fraction, fractional shortening, the maximum of the first differentiation of LV pressure (LV +dp/dtmax) and decline (LV -dp/dtmax) and LV systolic pressure (LVSP) were reduced, and LV end-systolic diameter (LVESD), LV end-diastolic diameter (LVEDD), LV volumes in systole (LVVS) and LV volumes in diastole (LVVD) were increased, which were reversed by miR-132 agomiR but deteriorated by miR-132 antagomiR. The expression levels of collagen I, collagen III, transforming growth factor-β (TGF-β), and α-smooth muscle actin (α-SMA) were increased in the heart of rat with MI-induced heart failure and CFs administration of Ang II. These increases were inhibited by miR-132 agomiR but enhanced by miR-132 antagomiR treatment. MiR-132 inhibited PTEN expression, and attenuated PI3K/Akt signal pathway in CFs. These results indicated that the up-regulation of miR-132 improved the cardiac dysfunction, attenuated cardiac fibrosis in heart failure via inhibiting PTEN expression, and attenuating PI3K/Akt signal pathway. Up-regulation of miR-132 may be a strategy for the treatment of heart failure and cardiac fibrosis.
Adult duodenal intussusception rarely occurs, and the majority of duodenal adenomas are located in the descending part of the duodenum. Therefore, adenomas in the horizontal part of the duodenum presenting as duodenal intussusception in adults are extremely rare.A 36-year-old man complained of abdominal pain for 13 d. Blood analysis showed anemia. Magnetic resonance cholangiopancreatography and computed tomography revealed a tumor in the horizontal part of the duodenum as the main finding, leading to duodeno-duodenal intussusception. No obvious abnormalities were found on endoscopy or upper gastrointestinal radiography. He was diagnosed with duodenal intussusception secondary to duodenal adenoma. Laparotomy showed duodeno-duodenal intussusception and a tumor in the horizontal part of the duodenum near the ascending part. Postoperative pathology revealed tubular-villous adenoma with low-grade glandular intraepithelial neoplasia (local high-grade intraepithelial neoplasia). He was discharged without complications.This case highlights that rational use of computed tomography, magnetic resonance cholangiopancreatography, endoscopy and upper gastrointestinal radiography for preoperative diagnosis and timely surgery is an effective strategy for the treatment of adult duodenal intussusception with duodenal masses.
Objective To investigate the differences of platelet membrane glycoprotein PAC-1 and CD62P expression in patients with cerebral small vessel disease and its subtype and large artery atherosclerotic stroke and to compare the traditional platelet activation markers and inflammatory chemokine platelet factor 4 （PF4）. Methods Peripheral blood platelet PAC-1,CD62P positive rates and serum PF4 concentration in 30 patients with large artery atheroscle- rotic stroke, 45 patients with cerebral small vessel disease and 30 controls were detected using flow cytometry and enzyme-linked irnmunosorbent assay. The differences between the groups were compared. Results The PAC-1, CD62P positive rates and serum PF4 concentration in the large artery atherosclerotic stroke group were 63.21% ± 9. 78%, 55.91% ± 8. 17%, and 30. 55 ± 15.56 ng/ml, respectively. They were significantly higher than 40. 65% ±17.42%, 36. 49%±14. 60%, and 12. 59 ± 5. 57 ng/mlin the cerebral small vessel disease group （all P = 0. 000）, and the latter was still higher than 13.55% ± 3. 14%, 9. 00% ± 2.32%, and 4. 95± 2. 82 ng/ml in the control group （all P = 0. 000）. There were significant differences in all the subtypes groups of cerebral small vessel disease between the PAC-1, CD62P positive rates and serum PF4 concentration. The leukoaraiosis with lacunar infarction group （n = 15; 47. 72%± 15.52%, 43.75%± 12.54%, and 13.96 ±5.23 ng/ml） and the simple lacunar infarction group （n = 15; 49. 87% ± 14. 65%, 43.98% ± 10. 55%, and 14. 41 ± 5.53 ng/ml） was significantly higher than the simple lacunar infarction group （n = 15; 24. 44%±8.45%, 21.74%±7. 19%, and 9. 40 ±4. 99 ng/ml） （P =0. 000, 0. 000, and 0. 013, respectively）. There was no significant difference between the former 2 groups （P = 0. 658, 0. 952, and 0. 858, respectively）. The peripheral blood platelet PAC-1 positive rate had significant correlation with CD62P positive rate in patients with ischemic cerebral disease （r = 0. 964, P = 0. 000）, and the serum PF4 concentration showed linier correlation with the PAC-1 （r =0. 846, P =0. 000） and CD62P （r = 0. 857, P =0. 000） positive rates. Conclusions The platelet membrane gtycoprotein PAC-1 and CD62P expression showed linear correlation, and they were consistent with the changes of PF4 concentration. This suggested that platelet activation and its mediated inflammatory mechanisms played an important pathophysiological role in the processes of atherosclerosis and thrombosis. This mechanism had sigrtificant difference between the different lesion types.
Key words:
Platelet membrane glycoproteins; P-selectin; Platelet factor 4; Stroke; Brain ischemia; Brain infarction; Atherosclerosis
To explore the expression of nestin and glial fibrillary acidic protein (GFAP) at different time and sites after spinal cord injury in adult rats.Seventy-two adult Sprague-Dawley rats, aging 8 weeks and weighing from 180 to 220 g, were randomly divided into 11 experimental groups (66, n=6) and 1 control group (n= 6). In the experimental groups, the rat spinal cord injury models were established by aneurysm clip compression, and the expression and proliferation of nestin and GFAP at different time (1 day, 3 days, 5 days, 1 week, 2 weeks, 3 weeks, weeks, 5 weeks, 6 weeks, 7 weeks and 8 weeks) and at different sites (injured site and adjacent site) were observed with toluidine blue staining, immunofluorescent staining and the analytical system of photographs. In control group, the same site of the rat spinal cord was exposed without aneurysm clip compression. The same preparation and examination were done as the experimental groups.Toluidine blue staining results showed that contour of neurite and pericaryon were distinct and nucleus were deep blue in normal control rats. One day after injury, the number of big and medium-sized neuron decreased obviously; neurite was deep blue with clouding Nissl bodies and ellipse or triangular typed nucleus. In the normal control group, the expression of nestin was hardly seen except ependymal cells of central canal, and the low expression of GFAP was seen. In the experimental groups, the nestin and GFAP expressions increased obviously in the injured sites and adjacent sites 24 hours after injury, reached the peak value after 3-7 days and followed by gradual decrease. There were statistically significant differences in the nestin and GFAP expressions between the experimental groups and the control group.The above results suggest that spinal cord injury can induce the expression of nestin and GFAP. There is a positive correlation between nestin expression and the proliferation of the reactive astrocytes.
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