Objective To identify shortcomings in the current evaluation index system of medical quality. Methods The documentary analysis focused on the existing index system comprises the Hospital Management and Quality Evaluation Standards (2007) by China Hospital Association, Hospital Management Evaluation Guidelines (2005) by the Ministry of Health, and Implementation Rules of Hospital Management Evaluation Standards for Beijing (2007). JCI Accreditation Standards for Hospitals (edition 2) (2003), and New Hospital Accreditation Standards for Taiwan (2005, 2006) were referred to in the study. Results The shortcomings found include the weak operability of indexes, and the deficiency of evaluation indexes from the point of hospital visiting process by patients. Conclusion In view of the hospital visiting process of patients, add more indexes for patients' hospital visiting process,and quantize and highlight the operability of indexes, with summary and optimization of experiences in time by steps.

Objective To explore the physiological characteristics of synaptic transmission of anterior horn early development in thorac-ic spinal cord mediated byα-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors in rats. Methods 36 Wistar rats were divided into embryonic 17 days group (E17, n=12), embryonic 20 days group (E20, n=12) and postnatal 7 days group (P7, n=12). Immuno-fluorescent staining of calmodulin-dependent protein kinaseⅡ(CaMKⅡ) was used to test the distribution of AMPA receptors. Multi-elec-trode array technique (MED-64 system) was used to test the changes of field excitatory post-synaptic potential (fEPSP) of synaptic transmis-sion mediated by AMPA receptor. Results There was small amount of CaMKⅡ-positive neurons existing in gray matter of spinal cord at E17, CaMKⅡ-positive neurons migrated to the center, and the number of neurons became more and more in E20 and P7 rats. The number of evoked fEPSP gradually increased in rats from E17 to P7, and could be blocked by 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The range of synaptic connection in spinal cord gray matter significantly reduced (P<0.001). Conclusion AMPA receptors participate in the early development of spinal cord in rats and act as the main excitatory receptor of functional synaptic connection in neural network of ventricornu.

To explore how to create and optimize a promotion index system of medical quality evaluation, this article focuses on the hospital visiting process from patients, using analyzing collected those index system from couples of Grade Ⅲ hospitals in Beijing, and combining the results of literal study, field study and specialist consult, according to the different situation of general hospitals and specially hospitals, with the spirit of "maintaining the patients benefits, safeguarding the patients safety,and enhancing the medical quality", introduces the framework of the promotion index system, the rules to select the indicator, and so on, and discusses several problerns related to creating the index system.

Objective To analyze the clinical,laboratory and brain MRI features of patients with neurosyphilis(NS).Methods Eighty-five NS patients admitted to the Department of Neurology in Nanjing Second Hospital from November 2018 to November 2022 were retrospectively analyzed.According to the results of brain MRI,the patients were divided into two groups:normal brain MRI + unilateral lesions group and bilateral lesions group(more severe group).ROC were plotted and the areas under the curves(AUC)were calculated to evaluate the diagnostic value of clinical indicators for severe NS on MRI.Results Compared with normal brain MRI + unilateral lesions group,the mean age(P = 0.000),the rate of male(P = 0.008)and the rate of symptomatic NS(P = 0.006)were significantly higher in bilateral lesions group.Moreover,hypersensitive C-reactive protein(P = 0.028),basophil(P = 0.003),fibrinogen(P = 0.011),CSF tolulized red unheated serum test titer(P = 0.004),CSF protein concentration(P =0.000),CSF adenosine deaminase(P =0.003),and CSF white blood cell count(P =0.049)were significantly increased in patients with NS in bilateral brain lesions group.Multivariate regression analysis suggested that age(OR =1.085,P =0.019)and CSF protein concentration(OR =1.004,P =0.023)were risk factors for NS patients with bilateral brain lesions on MRI.The clinical model was established by age,CSF protein concentration,and basophil,the AUC for predicting NS patients with bilateral brain lesions could reach 0.83(95%CI:0.73-0.91,P＜0.01).Conclusions Clinical,laboratory and brain MRI examination should be integrated during the diagnosis and treatment of NS.Elderly patients and patients with high CSF protein concentration suggest severe disease,and reduction of CSF protein concentration is expected to improve the condition of NS patients.

【Objective】 To explore the effects and mechanism of p38 mitogen activated protein kinase (MAPK) pathway on the formation of calcium oxalate (CaOx) kidney stones in rats,so as to provide new ideas for the treatment of kidney stones. 【Methods】 A total of 40 rats were divided into control, SB203580, CaOx and SB203580+CaOx groups, with 10 rats in each group.Intragastric administration of a mixture of 1% ethylene glycol and 1% ammonium chloride was given to the CaOx and SB203580+CaOx groups to construct CaOx models, while intragastric administration of drinking water was given to the control and SB203580 groups.After molding, SB203580 and SB203580+CaOx groups were injected with 5 mg/kg SB203580 peritoneally once a day for 14 days, while the control and CaOx groups were injected with equal volume of normal saline.The renal mass of rats was measured and the renal coefficient was calculated; the serum levels of blood urea nitrogen (BUN) and serum creatinine (SCr) were measured with an automated biochemical analyzer; the urinary levels of neutrophil gelatinase-associated lipid carrier protein (NGAL) and kidney injury molecule-1 (KIM-1) were determined with enzyme-linked immunosorbent assay (ELISA); the crystal deposition and tissue damage in renal tissues were observed with Von Kossa staining; the apoptosis of renal tubule cells was observed with TUNEL; the expressions of autophagy markers in kidney tissues were detected with immunohistochemical staining; the molecular expressions of autophagy-endoplasmic reticulum stress related pathways in renal tissues were determined with RT-qPCR and Western blot. 【Results】 Compared with the CaOx group, the SB203580+CaOx group had increased body mass after molding (P<0.05); decreased kidney mass, kidney coefficient, BUN, SCr, NGAL and KIM-1 levels (P<0.05); alleviated pathological damage of kidney tissues; significantly reduced black crystal; down-regulated proportion of positive TUNEL cells, positive expression area of LC3B and Beclin-1, mRNA expressions of LC3B, Beclin-1, CHOP and GRP78, protein ratio of LC3-Ⅱ/LC3-Ⅰ, and protein expressions of Beclin-1, CHOP and GRP78 (P<0.05); but up-regulated mRNA and protein expressions of p62 (P<0.05). 【Conclusion】 The p38 MAPK pathway is involved in the formation of CaOx kidney stones in rats.Inhibition of this pathway can reduce the formation of kidney stones, which may be related to the regulation of autophagy and endoplasmic reticulum stress.

Objective To investigate the risk factors for post-traumatic epilepsy(PTE)after traumatic brain injury(TBI).Methods According to PTE,169 patients with TBI were divided into PTE group and non-PTE group.Clinical data of the patients were collected and compared.Non-parametric test and binary Logistic regression were used to analyze the risk factors of PTE.Results Compared with those in non-PTE group,there were significant differences in psychiatric symptoms,GCS score,abnormal imaging examination type,injury type and post-traumatic seizures(PTS)ratio in the PTE group(P<0.05-0.01).Binary Logistic regression showed that GCS score,abnormal imaging examination type,psychiatric symptoms and PTS were independent risk factors for PTE(OR=5.825,95%CI:1.062-31.947,P=0.042;OR=6.942,95%CI:1.542-31.244,P=0.012;OR=31.059,95%CI:9.295-103.786,P<0.001;OR=0.099,95%CI:0.042-0.231,P<0.001).Conclusion GCS score,abnormal imaging examination type,psychiatric symptoms and PTS are independent risk factors PTE after TBI.

BACKGROUND:The self-renewal and multi-directional differentiation of pluripotent stem cells possess the potential to revolutionize people's understanding of biology,medicine,development,and disease.Stem cells play an important role in the early stage of embryonic development,and the study of them could be beneficial to understanding of the basic principles of biological development and tissue or organ formation,exploring the potential mechanisms of various diseases,studying the repair and regeneration of damaged tissues or organs,and promoting drug discovery and personalized treatment. OBJECTIVE:To review the research progress of pluripotent stem cells,summarize and categorize the fundamental types of pluripotent stem cells,and elucidate the lineage situations of various types of pluripotent stem cells in common mammals. METHODS:PubMed,Web of Science,CNKI,and WanFang databases were searched systematically,with the keywords"pluripotent stem cells;embryonic stem cells;induced pluripotent stem cells;expanded potential stem cells;livestock pluripotent stem cells"in English and Chinese.The 99 articles related to mammalian pluripotent stem cells were systematically screened according to inclusion and exclusion criteria,and then reviewed. RESULTS AND CONCLUSION:(1)According to classical theory in mouse embryonic stem cell research,the pluripotent state of stem cells is divided into two forms:na?ve and primed.Na?ve state corresponds to the inner cell mass of pre-implantation embryos before attachment to the uterine wall,while primed state corresponds to the epiblast after implantation.These two states exhibit significant differences in epigenetic features,transcriptional activity,external signal dependency,and metabolic phenotype.It is later discovered that there is an intermediate state between na?ve and primed called formative pluripotency.Therefore,the pluripotency of pluripotent stem cells is a continuous developmental process rather than a unique cell state.(2)In addition to obtaining pluripotent stem cells from the inner cell mass,there are various methods and lineages for acquiring pluripotent stem cells,including embryonic germ cells established using primitive germ cells from mouse embryos,induced pluripotent stem cells created by the dedifferentiation of adult mouse and human fibroblasts with four factors—Oct3/4,Sox2,c-Myc,and Klf4;embryonic stem cell-like cell lines cultured from somatic cell nuclear transfer,parthenogenesis,neonatal or adult testicular or ovarian tissue,very small embryonic-like stem cells derived from various adult tissues and expanded pluripotent stem cells derived from pre-implantation stages.These pluripotent stem cells all share the common characteristics of continuous self-renewal,expressing core pluripotency factors and possessing the ability to differentiate into the three primary germ layers.(3)Currently,pluripotent stem cells are being used for disease modeling to study the mechanisms of various diseases and develop new drugs.Simultaneously,scientists are attempting to use pluripotent stem cells to cultivate various tissues and organs,offering new possibilities for regenerative medicine and transplantation.However,the clinical application of pluripotent stem cells faces safety challenges,including issues of cell mutations and immune rejection.Continual improvement in the methods of generating pluripotent stem cells will make them safer and more efficient for clinical applications.(4)Based on the methods of obtaining and lineage establishment of pluripotent stem cells in mice and humans,various types of pluripotent stem cells have been established in livestock,including embryonic stem cells,induced pluripotent stem cells,germ lineages of pluripotent stem cells,and expanded potential stem cells.Research on livestock pluripotent stem cells opens up new avenues for animal reproduction,breeding,genetic engineering,disease modeling,drug screening,and the conservation of endangered wildlife.