〔Abstract〕 Taking some college and university libraries in China and the United States as investigation objects, based on internet and literature investigation methods, the paper compares the situation of embedded subject service in the US and China from the aspects of embedded in learning environment of students, embedded in teaching environment of teachers, embedded in scientific research environ-ment of users, etc.Then it points out the shortage and gives some suggestions for embedded subject service in Chinese college and univer-sity libraries.

OBJECTIVE:To provide reference for systematic reform in national state-owned hospital.METHODS:System reforms of township hospitals in Zhangjiagang were analyzed.Then three kinds of reform modes were summarized including privatization,town-owned-town-management and sino-foreign joint venture.Reform effects were also discussed.RESULTS & CONCLUSIONS:The achievement that the reformed township hospitals have made in Zhangjiagang in improving the medical insurance and pharmaceutical management system,reforming hospital management system and operation mechanism and creating a harmonious relationship between doctor and patient can provide a reference for domestic state-owned hospital reform.

OBJECTIVE:To discuss the dispensing of prescriptions of traditional Chinese medicine.METHODS:According to the dispensing procedure of Chinese traditional medicine and the principle of drug use,the problems occurred during Chinese traditional medicine dispensing were pointed out and analyzed.RESULTS:The problems occurred in the dispensing of prescriptions of traditional Chinese medicine were mainly resulted from doctors,pharmacists and nurses' lack of basic rationale or they had no intimate knowledge of operation regulations.These problems can be avoided if with efforts.CONCLUSION:Only through strictly following the prescription of Chinese traditional medicine can the quality and efficacy of Chinese drugs dispensing be guaranteed.

Objective To explore ways and means to improve the investigator compliance through the evaluation and analysis of the investigator compliance of TCM clinical research projects of chronic diseases. Methods Totally 28 studies from the project Chinese medicine clinical study on prevention and treatment of chronic disease started in 2010 or 2011 and ended in 2015 were collected. The investigator compliance was analyzed by the evaluation form, which were drafted by quality control core team of TCM projects of chronic diseases, as research method performance, compliance of subjects inclusion and exclusion, integrity, accuracy and normalization of case report form in final quality evaluation for TCM clinical research on chronic diseases. Results There were 19 excellent studies according to investigator compliance, accounting for 67.9%, including 3 studies with ten score, accounting for 10.7%. There were 8 good studies according to investigator compliance, accounting for 28.6%. There was 1 study up to standard, accounting for 3.6%. 11 studies included unreasonable changes in the record during the process of implementation. 12 studies included missing in the filling of research records during the process of implementation. Conclusion In general, 28 studies of TCM linical research projects for chronic diseases show high investigator compliance. The existing problems are mainly found in the integrity and normalization of research records.

Background Our previous study demonstrated that microglial activation is closely associated with photoreceptor apoptosis in rd mice.Recent studies on central nervous system (CNS) showed that activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase plays a key role in the microglia activation and neural cell death.However,the mechanism of NADPH oxidase during the retinal degeneration and the effect of NADPH oxidase inhibitor on photoreceptor apoptosis are concerned.Objective The aim of this study was to further explore the production of reactive oxygen species (ROS) by NADPH oxidase in the retinal degenerative process of rd mice and protection of NADPH oxidase inhibitor on photoreceptors.Methods Sixty rd mice at postnatal day 9 (P9) were randomized into the experimental group and the control group by throwing coins method.Apocynin,a NADPH oxidase inhibitor,was intraperitoneally injected in the dose of 10 mg/kg (0.01 ml/kg) once daily for 5 days (P13) in the experimental group,and the equal amount of PBS was used in the same way in the control group,and 10 C57BL/6N mice without injection of any drugs served as the wild type mice group.All the mice were sacrificed in P14 for the preparation of retinal sections.The expression of ROS in the retina was detected by dihydroethidium (DHE) fluorescence staining.Expression level of rhodopsin mRNA in the photoreceptor of the mice was determined by real-time PCR,and the thickness of retinal outer nuclear layer (ONL) in the mice of the experimental group and the control group was measured using hematoxylin & eosin staining.The use and care of the animals complied with the Statement of Association for Research in Vision and Ophthalmology.Results DHE staining showed that the ROS presented with the red fluorescence in the mouse retinas.In the rd mice of the experimental group,the ROS fluorescence intensity was dramatically enhanced in comparison with C57BL/6N mice,but weakened in comparison with the rd mice of the control group.Real-time PCR revealed that the relative expressing level of rhodopsin mRNA in the photoreceptor was (4.21±0.33) in the experimental group and (0.93±0.24) in the control group,showing a significant difference between them (t =2.360,P =0.000).The thickness value of retinal ONL was (35.95±1.63)μm in the mice of the experimental group,which was significantly higher than that in the mice of the control group ([23.17±1.38] μm) (t=3.850,P=0.016).Conclusions In the retinal degeneration of rd mice,activation of NADPH oxidase increases the ROS production.Apocynin can slow the apoptosis procedure of photoreceptor cells of rd mice.

This paper sampled 79 TCM hospitals above county level in Jiangsu Province for research.With hospital ownership,board governance and hospital directors as three dimension of internal governance structure,the multiple regression model was used to investigate the impact of such structure on its social responsibility performance.Education level,number of hospital directors,and their values are found to be significant factors on their social responsibility performance.

Objective To investigate the clinic-pathological characteristics and prognosis of 48 female cases with peritoneal pseudomyxoma(PMP).Methods The clinicopathologic features and follow-up data of 48 female patients with PMP diagnosed in the General Hospital of People's Liberation Army from Jan.1982 to Dec.2011 were retrospectively reviewed.The relationship between clinic-pathological characteristics and prognosis were analyzed using log-rank test and Cox proportional hazards model.Results (1) Clinicopathologic features:the mean age of the 48 cases was 58.8 years (range from 24 to 79 years).Symptoms:abdominal distention and abdominal discomfort were the main symptoms.Imaging examinations showed nonspecific abdominal and pelvic lesions in most cases.Treatment:all the 48 patients underwentlaparotomy and cytoreductive surgery (CRS),in which 15 (31％) patients with completeness of the cancer resection (CCR)-1,24(50％) cases with CCR-2,and CCR-3 in 9(19％) cases.Six (12％) cases were treated by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin,20 (42％) patients were treated with different options postoperative adjuvant chemotherapy.Pathological types:the cases were histologically classified into 3 subcategories:disseminated peritoneal adenomucinosis (DPAM),peritoneal mucinous carcinomatosis (PMCA),and PMCA with intermediate or discordant features (PMCA-I/D),which were 22 (46％) cases,9 (19％) cases and 17 (35％) cases,respectively.Appendiceal tumors:44(92％) cases underwent appendectomy,in which 38 cases presented appendiceal tumors (including 20 cases of low-grade appendiceal mucinous adenoma and 18 cases of appendiceal mucinous adenocarcinoma),2 cases were diagnosed as appendicitis,4 cases with unknown pathologic diagnosis.And the other 4(8％) cases,who didn't undergo appendectomy at the first operation,presented peritoneal tumor recurrence and appendiceal mucinous tumors 1,11,32 and 85 months after surgery,respectively.Parenchymal organs involved:ovarian involving was happened in 34 (71％)patients including 15 cases with the right ovary involving,13 cases in both sides,and 6 cases involving the left side.The other parenchymal organs in 10(21％) cases.(2) Prognostic factors:11 patients died,31 survived and 6 cases were lost to follow-up.The mean survival time was 99 months(ranged from 1 to 312 months).The 3-year,5-year and 10-year survival rates were 73.3％,68.0％ and 46.6％,respectively.Univariate statistical analysis showed that age,pathological type and parenchymal involvement were significantly relationship with the survival time (all P ＜ 0.05).But the operation times,appendiceal tumor type,ovarian involvement,CCR,intraperitoneal HIPEC and post-operative adjuvant chemotherapy were not significantly correlate with survival time (all P ＞ 0.05).Multivariate analysis showed that age and pathologic type were independent prognostic factors (P ＜ 0.05).Conclusions No specific clinical features presented in PMP.CRS with HIPEC should the recommended treatment.Both ovaries exploration and appendectomy should be carried out routinely in CRS.The 10-year overall survival of PMP is low.Age,pathological type and parenchymal organs involvement other than ovarian are correlated with the prognosis.And the pathological type and age are independent prognostic factors of PMP.

The clinical features, electroneurophysiology, neuroimaging and gene characteristics of one case of early adult-onset dentatorubral-pallidoluysian atrophy (DRPLA) with an onset of epilepsy were reported. The female patient had the onset manifestation of epilepsy. Whereafter, she progressively developed marked cerebellar ataxia, mental retardation and choreic movement. Electroencephalography showed that there were multiple complex slow waves in the whole brain cortex. Magnetic resonance imaging showed the patient had marked atrophies in the cerebral cortex, brainstem and cerebellum. Atrophin-1 gene detection revealed that the numbers of CAG repeats were 15/65 (the patient) and 14/54 (her father) respectively. Her father had no clinical manifestations until now. The mother and brother were normal. DRPLA has diverse clinical presentation,heterogeneous phenotypic spectrum, early adult-onset DRPLA is rare, and the specific gene detection can be helpful for a definitive diagnosis.

Objective To understand the trends of the prevalence of hyperuricemia of urbanized community residents Sijiqing Streets in Jianggan district in Hangzhou in the past 4 years,and analyze the correlation between hyperuricemia and metabolic factors,which provide scientific endence for prevention and treatment of hyperuricemia in communities.Methods 1 670 cases equal to or greater than 20 years old were randomly selected to analyze the trends of the prevalence of hyperuricemia in the past 4 consecutive years,which from urbanized community physical examination in 2010 to 2013 (male 749 cases,female 921 cases).Comparative analysis of age,BMI,waist circumference,systolic blood pressure,diastolic blood pressure,fasting blood glucose,glycosylated hemoglobin (HbA1C),TG,TC,LDL-C,and HDL-C levels between hyperuricemia group(male 264 cases,female 181 cases) and non hyperuricemia group (male 485 cases,female 740 cases) on 2013,and analyze the related metabolic factors to hyperuricemia by using non conditional logistic regression analysis.Results ①From 2010 to 2013,male hyperuricemia prevalence rates were 27.9％ (209/749,standardized rates were 27.4％)、29.1％ (218/749,standardized rates were 27.9％),33.2％ (249/749,standardized rates were 31.8％) and 35.2％ (264/749,standardized rates were 32.9％).The prevalence rates of female were 12.6％ (116/921,standardized rates were 11.7％),13.5％ (124/921,standardized rates were 11.9％),18.0％ (166/921,standardized rates were 15.7％) and 19.7(181/921,standardized rates were 17.2％),showed a increased tends year by year (the x2 of tends of male and female were 11.907 and 22.759,respectively,all P ＜ 0.01).In age stratified,the prevalence of hyperuricemia in middle and elder age group were increased significantly (the x2 of middle and elder aged man were 4.387、8.545,The x2 of middle and elder aged woman were 12.043、12.274,all P ＜ 0.05).The annual rate of male was higher than female (the x2 were 61.764、62.060、51.241、51.393,respectively,all P ＜ 0.01).② The male and female hyperuricemia group of age,BMI,waist circumference,systolic blood pressure,diastolic blood pressure,TG,TC,LDL-C levels were higher than those in non hyperuricemia group (the t of male were-2.052,-8.624,-8.772,-3.932,-4.380,-5.006,-3.564,-3.834,respectively; The t of female were-6.021,-8.839,-7.586,-4.702,-4.431,-6.334,-5.317,-5.119,respectively,all P ＜ 0.01),HDL-C levels were lower than those of non hyperuricemia group(the t of male and female were 6.097 and 3.170,respectively,all P ＜ 0.01),fasting blood glucose,HbA1c levels of non hyperuricemia group in female were also higher than the non hyperuricemia group (t =-2.750,-3.711,all P ＜ 0.01),however,Nor was statistical significance in male between the two groups (t =0.432,1.315,all P ＞ 0.05).③The non conditional Logistic regression analysis showed that,independent risk factor for male hyperuricemia were overweight (OR:2.151,95％ CI:1.439-3.215) or obese (OR:2.882,95％ CI:1.541-5.389),hypertension (OR:1.564,95％ CI:1.100 -2.224),dyslipidemia (OR:1.678,95 ％ CI:1.165-2.417) and abdominal obesity (OR:1.708,95 ％ CI:1.146-2.547),independent risk factors for hyperuricemia in women were overweight (OR:2.067,95％ CI:1.290-3.313) or obese (OR:2.843,95％ CI:1.523-5.309),hypertension (OR:1.530,95％ CI:1.042-2.248),dyslipidemia (OR:1.784,95 ％ CI:1.191-2.672) and hyperglycemia (OR:1.768,95％ CI:1.221-2.561).Conclusions The community people have a higher prevalence of hyperuricemia,which showed a increased trend,especially in the middle and old age year by year; overweight or obesity,abdominal obesity,hypertension and dyslipidaemia influence male prevalence rate of hyperurieemia,overweight or obesity,hypertension,hyperglycemia and dyslipidemia influence female prevalence rate of hyperuricemia,we should strengthen the comprehensive prevention and treatment of hyperuricemia in this community.

Objective To investigate the correlation of short-term systolic blood pressure variability (SBPV) with esti?mated glomeruar filtration rate (eGFR) in the elderly. Methods In physical examination for the third time of kailuan group, the method of cluster sampling was used to collect randomly retired employees, age≥60 in kailuan group. The 24-hour am?bulatory blood pressure monitoring was given to these objects. Finally, 1 405 participants with integral data were recruited in?to the survey. SBPV indices were standard deviation of systolic blood pressure (SD), variability independent of the mean (VIM), maximum-minimum difference (MMD), and average real variability (ARV). Multivariate stepwise linear regression models were used to analyze the influence of short-term SBPV on eGFR. Results (1) Among 1 405 participants (67.16 ± 5.82) years, 933 individuals (66.4%) were male and 472 (33.6%) were female. (2) Study population were divided into four groups based on the 24-hour mean SBP, daytime mean SBP, night time mean SBP (group 1:mean SBP<120 mmHg, group 2:120≤mean SBP<140 mmHg, group 3:140≤mean SBP<160 mmHg, group 4:mean SBP≥160 mmHg), respectively. Values of SD, MMD and ARV, but not VIM were increased with increased mean SBP. (3) The participants were grouped according to the median SBPV with between-group comparison of the eGFR. The average eGFR levels were lower in the high 24-hour SB?PV group (SD, VIM, MMD and ARV), day-time SBPV group (SD, VIM, MMD and ARV) and night-time SBPV group (SD, MMD and ARV) than those in the low SBPV groups (P<0.05). (4) Multivariate stepwise linear regression showed that eGFR increased with 3 indices of 24-hour SBPV (SD, MMD and ARV) and 2 indices of day-time SBPV (MMD and ARV) but not for night-time SBPV (β=-0.07,-0.11,-0.07,-0.12 and-0.07, respectively). Conclusion There is a certain degree of asso?ciation between short-term SBPV indices and eGFR.