The theory of multiple streams,a vehicle of public policy analysis in the West,was used to analyze the policy development at Beijing′s suburban village clinics.This approach can clarify the issue steams,policy streams,and political streams,as well as the links between them,as a reference for standardized and quickened development such clinics.

In the early 20th century,the term Nursing was introduced into China.In 1884,with the arrival of the first batch of missionary nurse,modern nursing initiated by Nightingale was introduced into China and greatly changed the way of care.The missionary nurses were full of enthusiasm for the spreading Gospel of Christ,the love for nursing care and the empathy for Chinese people;and encountered the lack of staff and material,the mis-understanding and resistance from the local people and other multiple tests.With the untiring effort of them and the trained local nurses,China had led the international care in nursing education and practice standard.Based on this,nursing in Shandong gradually rose and had an unprecedented development as a new medical subject.By clearing up and consulting Chinese and English historical materials,this paper reviewed the 60 years of the mission-ary nurses in China,saw the early development of nursing in our country from the budding and development of Shandong nursing and provided more insights for understanding and solving the complex problems contemporary Chinese nursing faces.

The performance appraisal (PA) system establishment in scientific research institutes on traditional Chi-nese medicine (TCM) plays an important role in the management of TCM research work, which can set up both well-defined guidance and favorable appraisal regimen for scientific researchers, so that leads to the accomplishment of the scientific objectives. However, current PA system establishment has fallen seriously behind the real demand in most TCM research institutes. As a result, there is a serious lack of a mature, efficient, standardized, propagable PA system in TCM research field. In this paper, we tried to discuss the current situation and key issues in building modern PA system in TCM research institutes. The PA system development in scientific research institutes on TCM was pointed out. The PA system should be based on existed referenced similar platforms, with full consideration on professional features and Chinese culture. The PA system establishment should be with most science, systematicness, objectivity, and guidance. The PA system should also be established to evaluate the scientific researchers equitably, guide the scientific trend, provide proper institute, and promote scientific research.

Objective To compare the expressions of Beclin 1 and its 11 interacting proteins in subcutaneous fat and visceral fat,and to observe the expressions of these genes in 3T3-L1 adipocytes differentiation process.Methods In 3T3-L1 adipocytes,cells were harvested at day 0,2,4,6,8 in differentiation process,and then proteins or mRNAs were obtained and followed with Western blot and realtime PCR.Mice tissue proteins or mRNAs were detected with Western blot and realtime PCR.Results In 3T3-L1 adipocytes differentiation process,expressions of LC3,Beclin 1,and TNFAIP3 continued to rise,expression of BIRC5 was high to low,FEZ1 continued at a low level.In mice,expressions of LC3,Beclin 1,YWHAQ,FEZI,BAD,WAC,TNFAIP3,and GOPC in visceral fat were significantly higher than those in subcutaneous fat,while expression of SLAMF1was higher in subcutaneous fat.Conclusion Autophagy plays an important role in 3T3-L1 differentiation process and may be tissue-specific in visceral fat and subcutaneous fat.

Objective To evaluate the sonographic features of testicular adrenal rests tumors in minor males. Methods The sonographic feature of pathologically or clinically confirmed testicular adrenal rests tumor in 13 minor males was retrospectively analyzed;we analyzed the number, morphology and size of affected testis; the involvement of testicular mediastinum; lesion location; the growth pattern, shape, boundaries, size, internal echo and blood supply of lesions. Results All of the 13 cases were bilateral and there were 26 lesions in all, 5 cases (5/13, 39%) had normal testicular size and morphology, testicular mediastinum were seen in 12 cases (12/13, 92%);26 (26/26, 100%) TARTs were all located near the testicular mediastinum or the testis hilar;21 (21/26, 81%) lesions had irregular shape while 5 (5/26, 19%) lesions were round;26 (26/26, 100%) lesions all had clear boundary but had no echo envelope;the lesion size was (1.5 ± 1.0) cm in average;13 (13/26 , 50%) lesions showed homogeneous hypoecho, 11 (11/26, 42%) lesions showed inhomogeneous hypoecho and 2 (2/26, 8%) lesions showed inhomogeneous isoecho; 19 (19/26,73%) lesions displayed rich blood supply and 7 (7/26, 27%) lesions displayed scarce blood supply. Conclusion The sonographic appearance of TART in minor males was characteristic, ultrasonography has important clinical value.

Dermatomyositis with malignancy is a subtype of dermatomyositis, and the concurrence of malignancy is a major factor for poor prognosis of dermatomyositis. Malignancy usually occurs within 1 year before or after the diagnosis of dermatomyositis. Compared with classic dermatomyositis, dermatomyositis with malignancy mostly occurs in patients aged>50 years, and is typically characterized by the heliotrope sign, skin necrosis and presence of myositis-specific antibodies such as anti-transcriptional intermediary factor-1γ and anti-nuclear matrix protein-2 antibodies, etc. Thorough screening for malignancy or close monitoring and follow-up are necessary in patients with dermatomyositis.

Objective To investigate the feasibility of our new found 3-dimensional contrast-enhanced ultrasound 3D-CEUS registration system as an early assessment of the therapeutic response to radio frequency ablation for liver cancer Methods Twenty-seven patients with 28 lesions accepted 3D-CEUS before and after radio frequency ablation RFA the therapeutic respond to which would be assessed with 3D-CEUS registration system recording the rate of successful registration The CT was considered as the reference standard Results Ten cases 35 7% were successful matched with auto-registration and 24 cases 85 7% were succesful matched with interactive-registration relatively All cases were considered as complete ablated which were confirmed by CECT with 100% accuracy There were two cases achieving ablation margins ≥5 mm without local tumor progression LTP and nineteen cases achieving 0 -4 mm ablation margin with 3 LTP 3-month 6-month and 1-year later Conclusions The 3D-CEUS interactive-registration system can easily assess the therapeutic response of RFA in liver cancer immediately with high accuracy.

Objective To explore the diagnostic value of quantitative contrast‐enhanced ultrasonography(CEUS) for crush injury in the hind limb muscle of rabbits .Methods A totle of 120 New Zealand white rabbits were randomized to receive compression on the left hind limb for either 2 h( n =56) or 4 h( n = 56) to induce muscle crush injury ,another 8 animals were not injured and served as normal controls .CEUS parameters such as peak intensity(PI) ,area under curve(AUC) ,ascending slop(AS) and descending slop(DS) were measured at 0 5. h ,2 h ,6 h ,24 h ,3 d ,7 d ,14 d after decompression .Results Compared with the uninjured muscle ,reperfusion of the injured muscles showed early and high enhancement in CEUS .The time‐intensity curve showed a trend of rapid lift and gradual drop .The PI and AUC values differed significantly among the three groups and were positively correlated with serum and tissue biomarkers .Rabbits of the 4 h compression group showed significantly higher PI and AUC values compared with the 2 h compression group at each time points .Conclusions CEUS can effectively detect muscle crush injury and monitor dynamic changes of the injured muscle in rabbits .PI and AUC are promising diagnostic parameters for this disease .CEUS might play an important role in the pre‐hospital and bedside settings for the diagnosis of muscle crush injury .

Objective To investigate the influencing factors of quality of shear wave elastography (SWE) image and the reproducibility of using SWE for focal liver lesions .Methods A total number of 289 consecutive patients with 305 lesions (the lesions could be detected on baseline ultrasound with intercostals approach ,and the depth of lesion was less than 10 cm) were undergone SWE examination .The SWE values of both lesion and adjacent liver parenchyma were measured .The quality of images was classified into three grades:“Good” ,“Common” ,and “Poor” .The depth of lesion ,the distance from body surface to liver capsule ,diameter and location of lesion were compared among three groups .Twenty consecutive patients with 20 lesions were performed SWE by two operators and another 20 consecutive patients with 20 lesions were performed SWE by one operator at different time .Intra‐class correlation coefficient was used to evaluate the reproducibility of inter‐ and intra‐ observer .Results A total number of 179 lesions were“Good” ,107“Common” and 19 “Poor” .The distance from body surface to liver capsule was significantly different among three groups [(Good (1 3.4 ± 0 3.5)cm ,Common (1 6.3 ± 0 3.6)cm ,Poor (1 8.7 ± 0 3.9)cm , P < 0 0.01] .No significant difference was found for the depth ,diameter and location of lesions among three groups .For all parameters of SWE both lesion and adjacent parenchyma ,intra‐class correlation coefficient of inter‐and intra‐observer were higher than 0 7.5 .The reproducibility of max SWE value was best of four elasticity parameters for lesion ,which intra‐class correlation coefficient of inter‐and intra‐observer was 0 9.0 and 0 9.6 ,respectively .Conclusions For focal liver lesions which could be detected on baseline ultrasound and the depth of lesions was less than 10 cm ,SWE could be used to evaluate elasticity characteristics with good feasibility and reproducibility .

The study found that the physician-patient trust crisis results from overreliance on technology trust instead of interpersonal trust and institutional trust. The alleged “Paternalistic government innovation”in healthcare service has caused wastes of healthcare resources and gap below public expectancy due to its incompetence in resolving social problems,further eroding institutional legality and intensifying such crisis.This research aimed to identify government accountabilities in building such trust from three aspects.