Objective To identify objective methods for medical service performance evaluation,and means to improve the efficiency of medical services.Methods By means of collection of medical records from 10 tertiary hospitals in Yunnan in 2012,and Diagnosis-related groups of Beijing version(BJDRGs)as a risk-adjustment tool,medical service performance was made to such hospitals.Results The capacity,efficiency and medical safety of hospital of the hospitals were subject to a comprehensive evaluation of their medical service capabilities.In terms of discharged inpatients and total weight,hospital A were found to be the highest(77 458 cases,104 227.5 respectively),and hospital I the lowest(25 450 cases,38 162.28)among these hospitals in 2012; compared with other hospitals,DRG groups of hospitals A,b and D were found higher,while the case mix index(CMI)of hospitals e and I were higher.The expenditure index of hospital C is the lowest(0.9359,0.8514); the mortality in cases of low risk of hospitals B,c and D were the lowest,while hospital F was the highest.Conclusion DRGs as a risk adjustment tool,can significantly improve the reliability,science and continuity of medical service performance evaluation,providing reliable basic data for hospitals accreditation in Yunnan.

Objective:To investigate the competency of informed consent in new admitted schizophrenia pa-tients.Methods:Fifty-three patients who were consecutively admitted to the hospital and diagnosed as schizophrenia according to the International Statistical Classification of Diseases and Related Health Problems,Tenth Revision (ICD-10)were recruited and assessed in seventy-two hours.The competence of informed consent was assessed by the MacArthur Competence Assessment Tool-Treatment (MacCAT-T).The insight was assessed by the Insight and Treatment Attitude Questionnaire.The severity of illness was assessed by the Brief Psychiatric Rating Scale (BPRS).Correlations between the competence of informed consent and the factors mentioned above were discussed.Results:Forty-five (84.9%)patients had lower MacCAT-T scores,especially the scores of understand-ing dimension (1.58 ±1.85)and appreciation dimension (2.40 ±1.47).The competence of informed consent was significantly correlated with insight (r =0.73,P <0.01)but not correlated with age,education,duration of illness and BPRS scores.Logistic regression demonstrated that insight (OR =0.69)was a protective factor of competence of informed consent while thought disturbance (OR =1.39)was a risk factor.As to the involuntary admitted pa-tients,34.1% of them had competence of informed consent.Conclusion:The competence of informed consent in new admitted schizophrenia patients is widely impaired especially in understanding and appreciation dimension.The competence of informed consent is correlated with insight and thought disturbance.Voluntary or involuntary hospi-talization does not reflect the level of competence of informed consent.

Objective To investigate the dynamic changes of serum autoimmune antibodies before and during treatment in auto-immune liver disease(AILD)and to study their clinical application and the practical significance.Methods The indirect immunoin-fluorescence was used to measure serum anti-nuclear antibody(ANA)on admission and at different clinical treatment time (1,3,12, 24 months)in 64 cases of autoimmune hepatitis(AIH)and 57 cases of primary biliary cirrhosis(PBC).At the same time the immu-noblot analysis was adopted to detect the liver disease related antibodies (anti-AMA-M2 antibody,anti-Sp100 antibody,anti-gp210 antibody,anti-LKM-1 antibody,anti-LC-1 antibody and anti-SLA antibody).The correlation analysis was performed by combining with the detection results of the liver enzymology.Results The detection rate of serum ANA before treatment was 57.8% in the AIH patients and 61.4% in the PBC patients respectively,and the titer was mostly distributed in 1∶320 and 1∶640.During treat-ment,the positive rate and titer of serum ANA in the AILD patients had no obvious change with the disease condition relief(P>0.05);in the liver disease antibodies detection,only anti-AMA-M2 antibody,anti-Sp100 antibody and anti-gp210 antibody were de-tected in the PBC patients,and the detection rates were in turn 73.7%,17.5% and 26.3% respectively;6 items of antibody were detected to different extent in the AIH patients,but which was dominated by the specific detection of anti-LKM-1 antibody,anti-LC-1 antibody and anti-SLA antibody;the liver function indexes in the ALID patients were gradually recovered after 1,3,12,24 months treatment(P<0.05),there was no significant change in the autoimmune antibodies detection(P>0.05).Conclusion The autoimmune antibodies detection plays a very important role in diagnosis and differential diagnosis of AILD,but which has no change with the disease condition relief,thus can not be used as the index of the clinical curative effect observation.

The paper introduces the system design of internet platform in novelty assessment and selective dissemination of informa-tion of medical science and technology project in Zhejiang province, including the exploitation of environment , processing of novelty as-sessment and selective dissemination of information as well as main function design. This system has noticeable advantages, such as com-prehensive functions, multiple participation, transparent service process, which could finish the relevant work on the internet, improve the quality of information service and enhance the efficiency.

Objective To explore a new method of nasal tip plasty and its clinical effect,which is much accorded with biomechanical properties of the human body.Methods From June 2010 to March 2016,a total of 33 cases of nasal tip surgery,6 males and 27 females,were performed.Ages ranged from 22 to 46 years in this group.Ear cartilage was trimmed into two strips and sutured them together in a M shape.When located to the original position of the nasal alar cartilage,theM shaped cartilage could be used in nasal tip;when fixing part of it on the nasal septum or lengthened nasal septal cartilage,the M shaped cartilage could be used in cosmetic surgery of nasal tip lengthening.Results The follow-up period was from one month to 60 months,with average 14 months.29 patients (87.9 ％) were satisfied with the efficacy and 2 patients were suffered from infection (6.1 ％).Conclusions When the M-shaped cartilage is fixed with lengthened nasal septum,it can lengthen the nasal tip much more and the contouring and texture of nasal tip are better than that of using a shield or a cap cartilage graft.

Objective To study the effects and the mechanism of the ethanol extract of Blueberry(BE) on relaxation vascular endothelium or smooth muscle.Methods To use rat aorta as the specimen,to observe the effects of BE on induced relaxation of the phenylephrine-precontracted aorta.and approach the mechanism on vascular endothelium or smooth muscle.Results BE induced relaxation of the phenylephrine-precontracted(1.0×10~(-5)mol·L~(-1) aorta in a dose-dependent way(P<0.01),which was disappeared by removal of functional endothelium(P<0.01).Pretreatment of the aortic tissues with NG-nitro-L-arginine methyl ester(L-NAME),methylene blue,or 1H[1,2,4]-oxadiazole-[4,3_a]-quinoxalin-1-one (ODQ) inhibited the vascular relaxation induced by BE(P<0.01).BE-induced vascular relaxations were also markedly attenuated by addition of verapamil or diltiazem,while the relaxant effect of BE was not blocked by pretreatment with indomethacine,glibenclamide,tetraethylammonium(TEA),atropine,propranolol(P<0.01).Conclusion These results suggest that BE dilates vascular smooth muscle via endothelium-dependent nitricoxide-cGMP signaling pathway,possible involvement of L-type Ca~(2+) channel.

AIM: To probe into the method of field processed products of Paeonia suffruticosa Andr. and inspect its quality. METHODS: Through field processed investigation alcohol-macerated extracts and paenol content compared among the smoked, de-epidermis, drying and direct drying in the sun. RESULTS: Paeonia suffruticosa Andr. with the epidermis is better than others. CONCLUSION: The method of integrating field cutting crude drugs into pieces with processing of Paeonia suffruticosa Andr. has feasible standardization and industrial benefits.

Various new ophthalmic formulations have been prepared to enhance ocular bioavailability,while lots of irritant sub-stances are applied,including surfactants,polymers and other cationic materials. Therefore,safety of the preparations has been paid more and more attention besides the efficacy. Since in vitro experiments lack of associated enzymes and integral reaction of organiza-tion,the reasonability and correlation of the results extrapolated to the animal experiments still need to be further proved. The in vivo common eye irritation methods( winking,histopathological slices,Draize score and confocal microscopy test etc)were reviewed,eval-uated and analyzed in the paper.

Objective To study the feasibility of rat models of renal edema based on disease combined with traditional Chinese medicine syndrome yin-deficiency and yang-deficiency types .Methods Gastric gavage of thyroxine and tail vein injection of Adriamycin were performed to induce a rat model of kidney Yin deficiency edema , and intramuscular injection of hydrocortisone and tail vein injection of Adriamycin were used to establish a rat model of kidney Yang deficiency edema .The 24 h urine protein content , triiodothyronine ( T3 ) , thyroxine ( T4 ) , cyclic adenosine monophosphate ( cAMP ) , cyclic guanosine monophosphate ( cGMP ) , estradiol ( E2 ) and testosterone ( T ) and other indicators were assayed to determine whether the rat models were successfully established .Result The rats of Yin deficiency edema group had clinical presentation such as hyperactivity , hair loss, dry stool, weight loss and temperature rise.Compared with the blank group , T3, T4, cAMP, E2, and 24 h urinary protein levels were significantly increased , cGMP and T content decreased , and cAMP/cGMP ratio was significantly increased , showing significant differences ( P<0.05 for all).The Yang deficiency edema animals displayed reduced activity , diarrhea, decreased body weight and body temperature, and other signs of disease.Compared with the blank group, T3, T4, cAMP, and E2 contents were significantly decreased , cGMP, T, and 24 h urinary protein levels were significantly increased , and cAMP/cGMP ratio decreased , showing significant differences ( P <0.05 for all ) .Conclusions The rat model of renal edema disease combined with TCM syndrome yin-deficiency was successfully induced by thyroxine in combination with Adriamycin , and the rat model of renal edema based on disease combined with TCM syndrome yang-deficiency is successfully established by administration of hydrocortisone plus Adriamycin .These two rat models demonstrate similar clinical manifestations of human renal edema based on disease combined with TCM syndrome yin-deficiency and yang-deficiency, respectively, therefore, may serve as useful tools for further research on this disease .

Objective To observe the effects of in vitro isolated Schwann cells co-cultured with chemically acellular nerve allografts on improving repair of large facial nerve defects. Methods A total of 30 Wistar rats were equally randomized into three groups, ie, experimental group, allograft group and autograft group. Nerve defect of 12 mm in length was made in the left inferior buccal branch of facial nerve and repaired with acellular nerve allograft implanted with Schwann cells, acellular nerve allograft and fresh tibial nerve autograft respectively. At the 5th month postoperatively, the function and morpholo-gy of the regenerated nerves were observed by electrophysiological method, methylene blue staining and transmission electron microscope. Results In experimental group, the recovery rate (operation side/normal side) of amplitude of nerve-muscle action potential was (35.8±2.5)%, the lantency recovery rate (normal side/operation side) (65.8±2.9)%, the number of the regenerated axon 1 570±188 and the myelin thickness (0.383±0.031) μm. The results in the experimental group were significantly supe-rior to those in the acellular nerve allograft group (P < 0.05), with similar results to fresh nerve autograft group (P > 0.05). Conclusion Transplantation of Schwarm cells in acellular nerve allograft can im-prove repair of large facial nerve defects.