Objective:To build a performance evaluation index system of family doctor contracting service for urban communities, so as to evaluate the effects of such service.Methods:Based on the conceptual framework of performance appraisal of family doctor contracting service, such means as Delphi method and analytic hierarchy process were employed to evaluate the performance appraisal system of such service. A measured simulation test was made in Guangzhou.Results:A library of performance appraisal candidate indexes for such service was established, based on the performance appraisal concept framework of " structure, input, output, result" of such service. A questionnaire made based on such a library was developed for correspondence inquiry of 20 experts from December 2018 to June 2019. Based on results of such inquiry, a performance appraisal system for family doctor contracting service in Guangzhou was developed, consisting of 4 level-1 indexes, 10 level-2 indexes and 34 level-3 indexes. In the system, level indexes include organizational structure and management(weight 0.21), resource input(weight 0.24), contracting service process(weight 0.19), and contracting service effect(weight 0.36). A community health center in Guangzhou was used as the measurement site, for adjustment and improvement of data acquisition methods of individual indexes or scoring criteria.Conclusions:The index system is developed scientifically; appraisal tools are designed focusing on results and outputs, ensuring the appraisal of contracting service quality from multiple perspectives of supply-demand sides and health management patterns; the system can provide appraisal tools for policy appraisal authorities to evaluate the performance of contracting service reform.

Over the last few years,elevated phospholipase D(PLD)expression and activity found to be mediated by Wnt/ β-catenin and NF-κB signaling axis sharing the same downstream genes have been involved in tumorigenesis,controlling cancer cell invasion and metastasis. New studies have revealed that Wnt signaling/ NF-κB signaling can induce PLD upregulation and increased enzymatic activ-ity. PLD/ PLD-generated phosphatidic acid( PA),as a critical regulator,might positively modulate β-catenin-dependent T-cell factor and NF-κB transcriptional activity via a targeted motif and a positive feed-back loop to reinforce pathway output including cyclin D1 ,c-myc,survivin,vascular endothelial growth factor and cyclooxygenase-2,while PLD/ PA inhibitors can reverse all the effect mentioned above and achieve significantly better anticancer effects. The PLD/ PA signaling pathway can be a novel therapeutic target for the treatment of cancer.

OBJECTIVE : To prepare the sustained release tablets of salbutamol sulfate,and to establish the method of quality control.METHODS: The sustained release tablets were prepared by using salbutamol sulfate, lactose, sodium carboxymethyl starch, HPMC, EC, and MCC and coated with enteric soluble acrylic resin.HPLC was employed to determine the content of salbutamol sulfate, while at the same time dissolution grade in vitro was determined, and stability was investigated.RESULTS: : The detectable concentration of salbutamol sulfate showed a good linear correlation with peak area in the range of 1.25～20.00?g/ml.The average recovery of salbutamol sulfate was 98.60% (RSD=0.66%).The prepared tablets showed a timing release 5 hours after administration.No evident changes in dissolution were found in all tests of stability.CONCLUSION: The formulation of the preparation is reasonable; the preparation technique is simple and feasible, and the quality is stable and controllable.

Objective To analyze the clinical significance of aberrant hepatic artery which originated from superior mesenteric artery in liver cancer and gastric cancer operations.Method Four hundred liver cancer patients who underwent digital subtraction angiography (DSA) and multislice spiral computed tomography angiography (MSCTA) and 86 gastric cancer patients who underwent MSCTA between June 2008 and June 2010 and operated at the First Affiliated Hospital of Guangxi Medical University were included in this study.Preoperatively,the origins of the aberrant hepatic arteries from superior mesenteric arteries were detected by medical imaging.Postoperatively,immunohistochemistry of lymphoid tissues around the aberrant hepatic arteries of the gastric cancer patients were performed using recombinant human cytokeratin 20 (CK20) and carcino-embryonic antigen (CEA) to determine the incidence of lymph node metastases around the aberrant arteries.Results Among 486 patients,49 patients with liver cancer and 14 patients with gastric cancer had an aberrant hepatic artery which originated from the superior mesenteric artery.The rate was 12.96％ (63/486).The hepatic artery ran in front of the pancreas in 2 patients (3.17％) and behind the pancreas in 61 patients (96.83％).Immunohistochemical analyses of CK20 and CEA were negative which revealed no metastases in the lymphoid tissues surrounding the aberrant arteries.Conclusions Aberrant hepatic artery originated from the superior mesenteric artery can be classified into the pre-pancreas type and postpancreas type.The majority of aberrant hepatic artery belonged to the post-pancreas type.The clinical significance of aberrant hepatic artery is that the hepatic hilar lymph nodes should be dissected in liver cancer and gastric cancer operations.

ObjectiveTo study the dissecting necessity of lymph node around normal and abnormal hepatic artery in distal gastric cancer undergoing D2 lymphadenectomy.MethodsSixty gastric cancer patients receiving distal D2 lymphadenectomy by the same surgeon between June 2008 to June 2010 at the Department of Gastrointestinal Surgery, First Affiliated Hospital of the Guangxi Medical University were included in this study. The lymph adipose tissue around the anatomically normal and aberrant hepatic artery was carefully dissected, and the lymph nodes sent for recombinant human cytokeratin 20 (CK20) and carcino-embryonicantigen( CEA )micrometastasisimmunohistochemistry.ResultsWiththe micrometastasis immunohistochemistry of CK20 and CEA, we found the metastasise rate of lymph node around the normal hepatic artery was 27％.Patient age, tumor size, Borrmann type, TNM staging were correlated with the lymph node metastase. There were 7 cases with abnormal hepatic artery originating from the superior mesenteric artery. The hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 6 cases. We found there are no metastases in the lymph adipose tissue surrounding the abnormal artery.ConclusionsCK20,CEA are suitable immunohistochemical targets for estimating the lymph node micrometastasis. In distal gastric cancer age at 60 or older years, tumor larger than 3 cm and Borrmann Ⅲ-Ⅳ type were risk factors for metastasis of lymph nodes around normal hepatic artery, while aberrant hepatic arteries originating from the superior mesenteric artery are much less likely to have positive lymph nodes in D2 lymphadenectomy.

Objective Comparing the clinical effect between Cinepazide Maleate and low Molecular weight Dextran,to the one which is more effective,safer and less unhealthy to patients after digital replantation.Methods From April 2010 to April 2012 in our hospital during single finger replantation patients,the observation group 120 cases of postoperative to Cinepazide Maleate injection 320mg/d intravenous drip,the control group of 120 cases treated with low Molecular Dextran 500ml/d IVGTT.Results The effective rate of observe group and control group was 96.67％ and 92.50％,respectively.The difference between the two groups was too small to have statistically significant difference (P ＞ 0.05),but the adverse effect of treatment group was only 5.8％,much lower than 14.17％ in control group however with the statistically significant difference (P ＜0.05).Conclusion Cinepazide Maleate Injection and low Molecular weight Dextran both have apparent effect in patients after digital replantation surgery.Both of them significantly improved microcirculation,enhanced the survival rate of replantation.However Cinepazide Maleate injection has fewer adverse effects,which is one of idea auxiliary medicine and deserved more extensive clinic application in currently microsurgery.

Objective To detect viable myocardium in patients with old myocardial infarction(OMI) by using quantitative tissue velocity imaging(QTVI) in low dose dobutamine stress test(LDDSE).Methods(Twenty-five) patients with OMI were accepted QTVI examination including 2-chamber,4-chamber apical view.QTVI indices included peak velocity in isovolumic contraction(V_(IVC)),peak velocity in systolic(V_S) and time of isovolumic contraction(T_(IVC)).Results Two hundred segments were divided into the normal(group N,72 segments),viable myocardium(group V,77 segments) and non-viable myocardium(group NV,51 segments).At baseline,compared with group N,V_(IVC),V_S of group V and group NV decreased significantly(P

Objective Evaluate the diagnostic value of PET/CT in the preoperative advanced gastric carcinoma comparing with mult;-slice spiral computed tomography. Methods Thirty-nine advanced gastric carcinoma patients taking PET/CT and abstract 40 advanced gastric carcinoma patients performing MSCT before operation,were done the TNM staging, and the Results were compared with the operation histopathology. Results For diagnosing primary lesions, regional lymph nodes, N3 lymph nodes ,PET/CT was accurate in 92.3% , 66.7% and 100.0%.Instead, MSCT was accurate in 82.0% , 50.0% and 62.5%. Conclusions (1) PET/CT and MSCT have high accuracy in diagnosing primary lesions and regional lymph nodes. But for detecting the N3 lymph nodes and distant metastasis, PET/CT has higher accuracy than MSCT. PET/CT combining abdominoscopy may decrease or avoid exploratory laparotomy.

Objective To assess the left ventricular function of patients with acute myocardial infarction (AMI) treated by percutaneous coronary intervention (PCI) by speckle tracking imaging (STI).Methods 75 AMI patients who had AMI for the first time and have been treated by primary PCI were enrolled.Dynamic images were acquired before PCI,at 6 months after PCI and analyzed by STI.Dynamic images were analyzed for longitudinal peak systolic strain (LPSS),radial peak systolic strain (RPSS) and circumferential peak systolic strain (CPSS) values by STI.According to the comparison of left ventricular ejection fraction (LVEF) before PCI and 6 months after PCI,patients were divided into left ventricular function improved group (△LVEF≥5％) and not-improved group.Results Compared to non-improved group,LPSS (P ＜0.001),RPSS (P ＜0.05,P ＜0.001) and CPSS (P ＜0.001) of improved group were all higher before and 6 months after PCI.LPSS (r =-0.578,P ＜0.001) and CPSS (r =-0.817,P ＜0.001) before PCI were both closely related to △LVEF.In single parameter mode of ROC curve analysis,the area under the ROC curve (AUC) (0.867),sensitivity (94.7％) and specificity (74.4％) of CPSS are relatively higher than other STI parameters.In multiple parameters united mode of ROC curve analysis,AUC (0.897),sensitivity (94.7％) and specificity (74.4％) of LPSS,RPSS and CPSS united were the highest among all the combinations of all STI parameters.Conclusions Left ventricular function improvement of patients with AMI 6 months after PCI is accurately assessed and predicted by STI.CPSS is a strong predictor for left ventricular function improvement 6 months after PCI of AMI patients among all the STI parameters and is an effective indicator for the assessment of left ventricular function improvement of AMI patients.

ObjectiveTo evaluate the usefulness of speckle tracking imaging(STI) for assessment of systemic right ventricle (RV) function in patients with acute inferior myocardial infarction(MI) and the changes 7 days after percutaneous coronary interventions(PCI).MethodsTwo-dimensional imaging at the four chamber view was obtained with tracing of the entire RV endocardial border in 44 patients with acute inferior MI and 50 healthy volunteers.Peak longitudinal systolic strain and strain rate (S,SR)in six RV segment included the basal,mid,and apical segments of the RV free wall and septum.And thirty patients reexamined 7 days after PCI.ResultsThe S values in the base and mid segmental of RV free wall and all segments of right septum were significantly lower in patients with acute inferior MI( P ＜0.05).But the SR values only decreased in mid segment of right septum.Except the apical parts of RV free wall and right septum,the S values of others segmental were significantly improved( P ＜0.05) 7 days after PCI.But the SR values had no changes( P ＞0.05).ConclusionsSTI is a new and useful technology for assessment of RV function in acute inferior MI and the RV function can be improved by emergency PCI.