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 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.

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 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.

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 observe the effect of enriched rehabilitation training on cognitive function, plasma mir-146a-5p microRNA precursor levels and inflammatory factors in persons with post-stroke cognitive impairment (PSCI).Methods:Fifty-eight persons with PSCI were randomly divided into an observation group and a control group, each of 29. The observation group was given enriched rehabilitation training, while the control group was provided with conventional cognitive rehabilitation training. The Montreal Cognitive Assessment Scale (MoCA), the Digit Span Test (DST), parts A and B of the Trail Making Test (TMT A-B) and the Modified Barthel Index (MBI) were used to assess the subjects′ cognitive functioning and their ability in the activities of daily living (ADL). Plasma levels of mir-146a-5p, IL-6 and TNF-α were detected before and after the treatment.Results:After treatment, the average MOCA, DST and MBI scores, as well as the average TMT A-B times had improved significantly for both groups. However, the observation group′s averages were significantly better than those of the control group on all three tests. After the treatment, the average plasma expression of miR-146a-5p had increased significantly in both groups, but the increase in the observation group was significantly greater. Plasma IL-6 and TNF-α levels were significantly lower than before the treatment, with the average TNF-α level in the observation group significantly lower than that of the control group.Conclusions:Enriched rehabilitation training can improve the cognition of stroke survivors more effectively than conventional cognitive rehabilitation training. That may be related to the up-regulation of plasma miR-146a-5p and reducing inflammation.

Objective:To screen the common low-frequency mutation sites in primary biliary cholangitis (PBC) by whole exome sequencing (WES), in order to find PBC-related new susceptibility genes.Methods:From January 2000 to December 2017, the clinical data of seven patients with PBC of three PBC families diagnosed at General Hospital of Tianjin Medical University and two healthy controls were collected. The DNA blood samples were extracted and analyzed by WES. SAMtools 1.3 software was used to detect gene single nucleotide polymorphism (SNP) and indel sites, and gene mutation sites were screened from known databases of 1000 Genome, ExAC, ESP6500 and Novo-Zhonghua gene database. Pymol V2.3.2 software was performed to simulate the three-dimensional structure of major histocompatibility complex-Ⅱ (MHC-Ⅱ), and the amino acid position corresponding to the common mutation sites among families were observed.Results:The age of first diagnosis of seven PBC patients was (61.2±10.2) years. The results of serum test of seven patients indicated that alkaline phosphatase (ALP) level was (306.9±242.5) U/L, γ-glutamyltranspeptidase (GGT) level was (121.7±85.9) U/L, alanine aminotransferase (ALT) level was (47.6±33.1) U/L, aspartate aminotransferase (AST) level was (55.7±34.1) U/L and immunoglobulin G level was (14.9±3.1) g/L. The antinuclear antibody were all cytoplasmic granule types and anti-mitochondrial antibody were all positive. Five PBC patients developed intra-abdominal lymphadenopathy; two patients had extrahepatic autoimmune diseases and the pathological results of liver biopsy of two patients both showed interface hepatitis and small bile duct lesions. Eighteen SNPs were common in three PBC families, which were located in the gene of OTOA, OBSCN and human leucocyte antigen- DRB1( HLA- DRB1). rs200988634 located in OTOA gene was a common polymorphic locus among the three families. rs746424683, rs545316651, rs553144914, rs533059830 and rs56087721 located in OBSCN caused the changes of nine amino acids of different location. There were 12 SNP variations located in HLA- DRB1 gene, which leaded to the changes of 12 amino acids of different location, among them rs16822698, rs112796209 and rs11554463 mutation induced G154A, Y152C and Y107X amino acid variation of MHC-Ⅱ beta chain, and Y107X amino acid was located in the groove region of MHC-Ⅱ binding with peptide. Conclusions:WES in PBC families is a good strategy to elucidate the candidate deleterious mutation genes OBSCN and OTOA. HLA- DRB1 which is a susceptible gene of PBC may affect MHC-Ⅱ mediated antigen presentation process by the changing amino acid sequence.

Objective To investigate the techniques and signifcations of endoscopic forehead lift when it was done alone or in combination with conventional facelifting.Methods For the patients with forehead transverse wrinkle,vertical frown line and eyebrow ptosis,resection of partial frontalis muscle,procerus muscle and eorrugator muscle was performed.If the patients had obvious excessive and drooping skin in middle face and lower face together with the wrinkles that were mentioned above,endoscopic forehead lift in combination with conventional facelifting was done at the mean time.The excessive skin was tailored and removed,SMAS was complicated or resected and sutured.Results 104 patients were subjected to the endoscopic forehead lift,in which 20 cases underwent it alone,and another 84 cases were treated in combination with the conventional facelifting.Of all cases,104 patients presented satisfactory results of forehead.They showed the eliminating of transverse wrinkle of forehead,glabellas vertical fold and lifting of eyebrow ptosis.Complications were less and minimal,including minimal local depression,retrodisplacement of hairline of forehead,recurrence of wrinkle and numb of forehead.No injuring of temporal branch of facial nerve occurred in this group.The cases that underwent endoscopic forehead lift in combination with conventional faeelift showed the coordinate and consistence of rejuvenation from forehead to middle face and lower face.Conclusions Endoscopic forehead lift is a minimally invasive technique,and it presents more satisfactory results with less severe complications.Its operative principle is reasonable,procedure is safe and reliable,and therefore it represents the tendency of developing of plastic surgery and cosmetic surgery.If patients have obvious excessive and drooping skin in middle face and lower face,endoscopic forehead lift is suggested in combination with the conventional facelift,and this resolution shows more balanced and coordinate cosmetic correction of whole face.