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.

Objective Activin A, a member of the transforming growth factor (TGF ?) superfamily, has been reported to overexpress in liver cirrhosis. The aim of this study was to examine the expression changes of activin A in the process of carbon tetrachloride induced rat hepatic fibrosis. Methods Hepatic fibrosis was induced in rats by subcutaneous injections of 40% carbon tetrachloride oily solution for a period of 1 to 7 weeks. 6～10 rats were killed at week 1,2,3,4,5,6 and 7 weeks. The kinetics of activin A messenger RNA expression and its protein localization were assayed by semi quantity reverse transcription polymerase chain reaction (RT PCR) and immunohistochemistry. Results RT PCR and immunohistochemistry showed normal rat liver could express activin A mRNA and protein, and its expression was transiently decreased and became undectable after carbon tetrachloride injections for 2 or 3 weeks, then increased grandually. After carbon tetrachloride injecting for 6 and 7 weeks, activin A mRNA and protein expression were significantly enhanced in rats liver ( P

Objective:To investigate the use of simple pooling and bivariate model in meta-analyses of diagnostic test accuracy (DTA) published in Chinese journals (January to November, 2014), compare the differences of results from these two models, and explore the impact of between-study variability of sensitivity and specificity on the differences. Methods:DTA meta-analyses were searched through Chi-nese Biomedical Literature Database (January to November, 2014). Details in models and data for four-fold table were extracted. Descriptive analysis was conducted to investigate the prevalence of the use of simple pooling method and bivariate model in the included literature. Data were re-analyzed with the two models respectively. Differences in the results were examined by Wilcoxon signed rank test. How the re-sults differences were affected by between-study variability of sensitivity and specificity, expressed by I2 , was explored. Results:The 55 systematic reviews, containing 58 DTA meta-analyses, were included and 25 DTA meta-analyses were eligible for re-analysis. Simple pooling was used in 50 (90. 9%) systematic reviews and bivariate model in 1 (1. 8%). The remaining 4 (7. 3%) articles used other models pooling sensitivity and specificity or pooled neither of them. Of the reviews simply pooling sensitivity and specificity, 41(82. 0%) were at the risk of wrongly using Meta-disc software. The differences in medians of sensitivity and specificity between two models were both 0. 011( P<0. 001, P=0. 031 respectively). Greater differences could be found as I2 of sensitivity or specificity became larger, especially when I2 >75%. Conclusion:Most DTA meta-analyses published in Chinese journals(January to November, 2014) combine the sensitivity and specificity by simple pooling. Meta-disc software can pool the sensitivity and specificity only through fixed-effect model, but a high proportion of authors think it can implement random-effect model. Simple pooling tends to underestimate the results compared with bivariate model. The greater the between-study variance is, the more likely the simple pooling has larger deviation. It is necessary to increase the knowledge level of statistical methods and software for meta-analyses of DTA data.

Objective To study the association between sympathetic skin response (SSR) and diabetic neuropathy,and explore its use as the objective base for its early diagnosis. Methods The latencies and amplitudes of the initiation,waves N and P in SSR of the extremities in 80 diabetic patients and 30 healthy controls were determined using electrophysiological measurements. Results The latencies of the initiation,waves N and P of SSR test were prolonged significantly in the diabetic patients as compared to the controls ( P 0.05). All but two patients (97.5%) demonstrated abnormal SSR in at least one limb. Seven patients (8.8%) had no responses in SSR in both the feet and hands. The frequency of abnormality in the latency of initiation and waves N and P was 86.9%(139/160)in the upper limbs,and 89.4%(143/160)in the lower limbs. Conclusions The SSR can detect the early dysfunction of the small sympathetic fibers in diabetes millitus and may be a useful electrophysiologic testing for the early diagnosis of diabetic neuropathy.

Objective: To study the effect of water extracting and alcohol extracting process to anthraquinone content in Rhubarb. Methods: Choosing water and different concentration of alcohol as the solvent, the effect of permeating time, the extracting time, the degree of extracting, the amount of solvent and concentration of alcohol to total, conjugated, and deoxidized anthraquinone content were determined by orthogonal test. Results: Using water as the solvent, the degree of extracting is the significant factors to total anthraquinore with ( P

Objective To explore the role of somatosensory evoked potentials elicited by paraspinal stimulation in the detection of spinal cord lesions.Methods Patients with clinically suspected spinal cord lesions underwent somatosensory evoked potentials(SEPs)and spinal cord conduction velocity(SCCV)test using paraspinal stimulating method.96 patients aged 15 to 75 years old with suspected spinal cord lesions of various aetiologies were tested.36 patients had demyelinating disease of the spinal cord,26 had sub-acute combined degeneration of the spinal cord,19 had myelopathy,10 had acute myelitis,5 had spinal cord corhpression.Results Paraspinal stimulation elicited somatosensory evoked potentials were Performed on all 96 patients,68 of whom underwent spinal MRI as well.SEPs and SCCV were found abnormal in a high ratio in all kinds of spinal cord lesions ; in general,78 among the 96 patients had abnormal SEPs with a sensitivity of 81.25%.27 out of 36 with demyelinating disease of the spine had abnormal SEPs with a sensitivity of 75.00%,23 out of 26 with subacute combined degeneration of the spinal cord had abnormal SEPs with a sensitivity of 88.46%,8 out of 10 with acute myelitis had abnormal SEPs,15 patients with myelopathy having abnormal findings,all 5 patients with spinal cord compression had abnormal SEPs.42 of 68 patients undergoing MRI revealed to be abnormal,in which 35 patients also had abnormal SEPs.The other 26 patients had normal spinal MRI,in which 21 patients had abnormal SEPs.Conclusions Paraspinal stimulation somatosensory evoked potentials and spinal cord conduction velocity may objectively document the abnormalities of electrophysiology,which occurs earlier than those of anatomy and radiological finds, therefore it may detect the dysfunction of spinal cord at an early stage.It is even more useful in the detecting of the metabolic myelopathy,which can hardly be detected by MRI.This technique is simple,inexpensive, and maybe useful in the diagnosis for patients with suspected spinal cord lesions.

AIM　To improve the treatment efficacy of anti-tumor drug mitoxantrone, the conjugation of mitoxantrone-loaded nanospheres and anti-C-erbB-2 monoclonal antibodies were prepared. METHODS Mitoxantrone-loaded nanospheres were prepared with emulsion-heating solidification technique. A heterobifunctional reagent, N-succinimidyl 3-(2-pyridyldithio) propionate (SPDP), was used as the crosslinker of mitoxantrone-loaded nanospheres and anti-C-erbB-2 monoclonal antibodies; pharmaceutical properties of immunonanocapsuls were studied; the conjugates of nanospheres and monoclonal antibodies was confirmed with immunological methods such as slide agglutination test, fluorescent immunossay and rosset formation test, fluorescent staining and scanning electron microscope. RESULTS　Mitoxantrone-loaded nanospheres were spherical, with smooth surface and median diameter of 0.665 micron. When stored at 3-5, 20-25 and 37℃, RH 75% for three months, the appearance, morphology, size distribution, drug loading and in vitro release characteristics showed no significant change and the stability was satisfactory. The size analysis demonstrated that there was no obvious increase in the particle size of nanoparticles after conjugation. Immunological tests indicate highly selective binding of antibody-targeted nanospheres to C-erbB-2-overexpressing cells SK-BR-3. CONCLUSION　The conjugation of mitoxantrone-loaded nanospheres and anti-C-erbB-2 monoclonal antibodies can keep the activity of anti-C-erbB-2 and increase the therapeutic efficacy of anti-mammary cancer drugs.

Objective To explore the clinical character,diagnosis and treatment principals of pyeloureteritis glandularis and cystitis glandularis.Methods The clinical manifestation,character of imageology and endoscopy images of the case for one year follow-up were analyzed and the relevant literatures were reviewed.Results During one year follow-up,there was no clinical symptoms and any progress on imageology.The patient is still in close following-up.Conclusions According to literatures,cystitis glandularis is not common in clinical,and it should be paid more attention by clinicians.There were a few reports about the ureteritis glandularis.Pelvis,ureter and bladder have the same epithelial tissue,pyelitis glandularis is very rare,up to now there is no efficient treatment ways.

Tumor genesis and development often result from deregulation of important biological pathways at the gene expression level. Although there has been much work focused on searching gene sets using gene expression data or other prior information, proper statistical testing of the gene sets is still an open question. Most studies have expanded the testing method of a single gene into the gene sets. Parametric statistical analysis of gene sets ( p-SAGE ) was presented for determining the significant gene sets or pathways associated with a phenotype of interest. The method was applied to brain tumor experiments to identify many gene sets. Some of the newly discovered gene sets were related to signal transduction and immunity. This simple and effective method gives useful biologically meaningful results.

Objective To analyze the effect and safety of interventional therapy by trans uterine artery for treatment of tubal pregnancy. Methods Forty-two patients with tubal pregnancy were performed two side uterine arteries. MTX perfusion and embolization with gelfoam particles guided by DSA fluoroscopy. Results Forty patients obtained the decline of serum β-HCG value and 39 patients' ectopic mass absorption after treatment. Two patients occurred ectopic mass bleeding after interventional therapy and emergency surgical operation were done, but the amount of bleeding was low than 400ml. Conclusion Interventional therapy by trans uterine artery for treatment of tubal pregnancy could preserve the function of fallopian tubal, it was more benefit for patients who want normal pregnancy.