Objective To evaluate the therapeutic responses to transsphenoidal surgery and medical therapy in terms of normalization of prolactin(PRL),mortality,morbidity and the cost-effectiveness of PRL normalization in order to establish an individualized therapeutic protocol for the patients with prolactinoma.Methods A retrospective study was undertaken of a consecutive series of patients with prolactinoma who were followed for at least 1 year after transsphenoidal surgery or medical treatment.The clinical characteristics and the long-term outcomes(normalization of PRL,morbidity or mortality)were assessed.Utilizing the principle of medical economics and data from the two types of treatment,we worked out a Markov chain and calculated the lowest cost of two kinds of therapeutic protocols.Results(1)The success rate of normalizing serum PRL through surgical treatment in microadenoma was 85%(22/26),and that of medical treatment was 95%(19/20).There was no statistical difference between the two therapies(P＞0.05).The success rate of normalizing serum PRL through surgical treatment in macroadenoma was45%(19/42),and that of medical treatment was 5/5.There was a statistical difierence between the two therapies(P＜0.05).(2)According to the Markov model,it would cost a microprolactinoma patient 25 129.25 yuan to normalize serum PRL by surgical treatment.This is comparable to the cost of medical treatment which would be 24 943.99 yuan.Whereas for a macroprolactinoma patient surgery would cost 35 208.20 yuan and medical treatment would cost 25 344.38 yuan.Conclusions Medical therapy is superior to surgical treatment in regard to complication rate and cost-effectiveness for macro-and extra big prolactinomas.Transsphenoidal surgery remains an option for patients with microadenomas.Markov model is an effective way to predict the treatment cost for patients with hyperprolactinoma at different ages and with different canses

Objective To analyze the true‐positive results ( ≥ 95% ) S/CO value of Treponema pallidum specific antibody (anti‐TP) positive samples caused by 2 different chemiluminescence detection assay in comparison with Treponema Pallidum Particle As‐say (TPPA) .Methods We collected the Treponema pallidum specific antibody positive samples of outpatient and hospitalization from October 2014 to January 2016 in Peking union medical college hospital as the research objects .There were 145 positive cases of Abbott laboratories (S/CO value of 1 .02 to 39 .29) ,24 positive cases of Roche (S/CO value of 1 .4 to 33 .07) .The 169 cases of Treponema pallidum specific antibody positive samples were detected with two methods of chemiluminescence detection at the same time ,TPPA was performed as repetition and confirmed test .Gathering and sorting the statistics of the positive predictive value seg‐mented ordered by specimen S/CO value ,to determine 95% or higher S/CO value of true positive results .Results After retested and confirmed by TPPA of the 169 positive cases ,the Abbott positive coincidence rate was 78 .7% ,the Roche positive coincidence rate was 81 .3% .When the S/CO value of Abbott ≥ 8 and the S/CO value of Roche ≥ 14 ,the positive predictive value was 100% . Conclusion When the S/CO value of Abbott ≥ 8 and the S/CO value of Roche ≥ 14 ,the S/CO value can be used as the true posi‐tive results( ≥ 95% ) .Abbott laboratories results S/CO value ≥ 8 ,Roche test results S/CO value ≥ 13 ,it is a 95% or higher S/CO limit of true positive results .

Objective:About half of Community Health Services ( CHS) in China are not government-owned, forming a multi-ownership situation of CHS .This study aims to examine the effect of “multi-ownership policy” on the development of CHS and put forward suggestions for improving the governance of CHS .Methods:We applied maxi-mum variation sampling to select health workers of different CHS specialties and administrators from local health bu -reaus in District T of Shaanxi province and District X of Shandong province .Inductive thematic analysis was utilized to interpret the development and ramification of multi-ownership policy , and then to formulate substantive theory .Re-sults:The adoption of multi-ownership in two districts was an adaptive strategy based on the limited public finance , institutional restriction of government , and diversity of health resources .This policy promoted the establishment of CHS network , and meanwhile the government's leadership of CHS development was transferred to multiple owners of CHS, which caused the lack of CHS autonomy , fragmented regulation power and deviated development of CHS .Con-clusions:The key problem of multi-ownership situation in CHS development is the problematic partition of governance power.In order to redeem the leadership of CHS development to the local government , it is necessary to strengthen service regulation while to decentralize the facility management power to CHS , to adjust service price ,and to deepen medical insurance coverage of CHS to enhance autonomy of CHS .