Objective To research and develop an index system for training evaluation of national health emergency response.Methods A combinative approach was applied,including core expert group discussion,on-site investigation into parameters applied in Delphi assessment by field experts,national reviews by provincial health departments.Results Firstly,a framework of index system was constructed by core expert group based on literature;Secondly,the index was screened by mean score from field experts' investigation and suggestion of core experts,then an index system was formulated with 5 first level indexes,19 second level indexes and 46 third level indexes;Thirdly,index weight was determined according to the mean weight by field experts investigation and adjusted suggestion of core experts;Finally,the index system for training evaluation of national health emergency response was approved by Ministry of Health and applied to the whole nation.Conclusions The combinative approach is practical in research and developing index system.The index system covers a full range of related factors,and is applicable at provincial level.However,attention should be paid to improving training after evaluation.

Abstract：Objective To investigate the detection methods of newly discovered leprosy cases in Hunan Province in 2013-2022, and analyze the trend of changes, and provide scientific basis for the prevention and treatment of leprosy. Methods The detailed information of newly diagnosed leprosy cases in Hunan Province from 2013 to 2022 was collected through the Leprosy Management Information System (LEPMIS), and the descriptive epidemiological method was used to analyze the detection methods of newly discovered leprosy cases. Results From 2013 to 2022, a total of 250 newly diagnosed leprosy cases were detected in Hunan Province, including 143 cases (57.20%) were found in outpatient clinics, 33 cases (13.20%) were found in clue investigations, 27 cases (10.80%) were notifiable-reported, 23 cases (9.20%) were self-reported, 11 cases (4.40%) were found in other ways (e.g., group survey), 9 cases (3.60%) were found in contact examinations, 2 cases (0.80%) were found in census, and 2 cases (0.80%) were found in epidemic point inspection. From 2013 to 2022, the number of cases detected in outpatient clinics showed an upward trend (rs=0.515), while the cases detected in clue investigation (rs=-0.873), notifiable-reported (rs=-0.127), self-reported (rs=-0.301), contact examination (rs=-0.363), census (rs=-0.701) and epidemic point inspection (rs=-0.701) showed a downward trend. The majority of leprosy cases with different demography characteristics and clinical characteristics were found through outpatient clinics, except that the majority of leprosy cases in children were found by contact examination (66.76%). Of 165 male cases, 92 cases (55.76%) were found in outpatient clinics and 51 out of 85 female cases (60.00%) were found in outpatient clinics. Among age groups, 113 out of 187 cases aged 15 to 60 (60.43%) and 30 out of 60 cases aged over 60 (50.00%) were found in outpatient clinics. Among patients with differentoccupations, 112 out of 208 cases of farmers (53.85%) and 31 out of 42 cases of other occupations (73.81%) were found inoutpatient clinics. Among cases with different types of leprosy, 111 out of 185 cases of multibacillary leprosy (60.00%) and 32 out of 65 cases of paucibacillary leprosy (49.23%) were found in outpatient clinics. Among cases with different numbers of skin lesions, 4 out of 8 cases of skin lesion-free leprosy (50.00%), 3 out of 9 cases of single skin lesion leprosy (33.33%), and 136 out of 233 cases of multiple skin lesions leprosy (58.37%) were found in outpatient clinics. Of 72 cases without nerve damage, 48 cases (66.67%) were found in outpatient clinics. Of 27 cases with single nerve damage, 17 cases (62.96%) were found in outpatient clinics. Of 151 cases with multiple nerve damage, 78 cases (51.66%) were found in outpatient clinics. Among patients with different levels of malformation, 58 out of 102 cases with no malformation (56.86%), 28 out of 45 cases with Grade malformation (62.22%), 35 out of 68 cases with Grade Ⅱmalformation (51.47%), and 22 out of 35 cases with other types of malformation (62.86%) were found in outpatient clinics. Conclusions Outpatient clinics is the main way to detect newlydiagnosed leprosy cases under the low prevalence of leprosy in Hunan Province, and it is an important strategy to move the early detection of leprosy cases to comprehensive medical institutions in the future.

Objective To investigate the MRI features of spinal epidural angiolipomas.Methods Clinical and MRI data of 18 patients with spinal epidural angiolipomas confirmed pathologically were retrospective analyzed.The MRI features of lesion site,size,shape,signal,bone destruction,enhancement and typing were observed and analyzed.Results One case of 18 cases were located in cervical vertebra,15 cases were thoracic vertebra,and 2 cases were lumbar vertebra.Ten cases formed paravertebral lump through foramen intervertebrale and damaged adjacent bones.MRI showed that T1W1 signal intensity was either isointense (n 11),mixed intense (n=5) or hyperintense (n =2).T2WI showed signal intensity was hyperintense (n=13) or mixed intense (n=5).The fat signal was seen in 5 cases,both T1W1 and T2W1 showed hyperintense.All the 18 cases showed remarkable enhancement.Ⅰ type (lesions confined to the spinal canal) was 8 cases (8/18,44.44％),Ⅱ type (lesions were dumbbell-shaped to the spinal canal) was 10 cases (10/18,55.56％).Conclusion The location of occurrence and the manifestations of MRI in spinal epidural angiolipomas have certain characteristics,which provides important clues to the preoperative diagnosis.

Objective To discuss the value of hypotonic-MRCP combined with LAVA dynamic contrast-enhanced scan in diagnosis of duodenal tumor.Methods Five patients with duodenal adenocarcinomas confirmed by pathology were involved in this study.All cases underwent plain MRI and hypotonic-MRCP and LAVA dynamic contrast-enhanced scans.Results 4 of 5 cases were correctly diagnosed with MR imaging.Imaging signs included:the cavum of descending duodenum appeared as asymmetrical stenosis,masses with soft tissue signal intensity connecting the intestinal wall with wide base,the intestinal wall stiff,the intestinal mucosa destruction.The lesions would be slightly-moderately enhanced at LAVA dynamic enhancement scanning.Conclusion Hypotonic-MRCP combined with LAVA dynamic contrast-enhanced scan can display the direct and indirect sign of duodenal tumors,which was effective in identifying the circumscription of the tumor and its extension.

There are two populations of bacteria to affect the formation of urinary stones in humanity. The first one can promote the formation of urinary stone by increasing urinary pH, decreasing concentration of urinary inhibitors , and damaging the protective urothelial glycosaminoglycan layer. The second inhibit the formation of urinary stones. These bacteria ( mainly the intestinal oxalate degrading bacteria such as Oxalobacter formigenes, lactic acid bacteria, Enterococcus faecalis etc) can decrease urinary oxalate concentration by regulating exogenous oxalate. The problems faced and the developing direction were also indicated.

A high Streptolydigin-producing strain Streptomyces lydicus AS 4.2501-L8 with genetic stability was obtained from the original strain S. lydicus AS 4.2501-P28 by mutagenesis with UV and acridine orange, followed by resistance selection. Its yield of Streptolydigin was 177.0 ?g/mL, 96.2% higher than the original strain.

Objective To observe the effect of acupoint thread-embedding at Neiguan (PC6) and Zusanli (ST36) on anxiety and sleep disorders after heroin withdrawal. Method Sixty-seven patients with heroin addiction were randomized into a Neiguan group (25 cases), a Zusanli group (22 cases) and a Neiguan plus Zusanli group (20 cases), to receive corresponding treatments once every 20 d, for 4 sessions in total. The Self-rating Anxiety Scale (SAS) and Pittsburgh Sleep Quality Index (PSQI) were adopted to observe the anxiety and sleep condition before and after the treatment. Result After 60 d thread-embedding treatment, the total and standard SAS scores, sleep initiation time and total PSQI score were significantly decreased in the 3 groups (P<0.05), and the sleep durations were significantly extended (P<0.05); in comparing the improvement of anxiety, Neiguan plus Zusanli group > Neiguan group >Zusanli group (P<0.05); in comparing the improvement of sleep, Neiguan plus Zusanli group was superior to both Zusanli group and Neiguan group (P<0.05), while there was no significant difference between Zusanli group and Neiguan group (P>0.05). Conclusion It's effective to use thread-embedding at Neiguan and Zusanli independently or together for anxiety and sleep disorders after heroin withdrawal, but the efficacy is more significant when the two points are used in combination, indicating the synergy of acupoints.

Objective To investigate the association between polymorphism of TNFα-308 and mutations of HBV C region in patients with chronic HBV infection. Methods Ninety-five patients with chronic HBV infection were recruited in the study. The single nucleotide polymorphism(SNP) of TNFα-308 Was determined by restriction fragment length polymorphism(RFLP). Mutations of nt1762/1764, nt1896, nt1899, nt1862, as60, aa87 and as97 in HBV C region were detected by direct sequencing after PCR amplification. Mutations of the above points among different genotypes were compared by Fisher's exget test. Results Three different genotypes G/G(63/95, 66.3%), G/A(28/95, 29.5%) and A/A(4/95, 4.2%) were found in TNFα-308 site. The rates of mutations of aa87 and aa97 points in patients with G/G, G/A and A/A genotype were 39.3%(24/61), 11.5%(3/26) and 50.0% (2/4), respectively(F=7.658, P<0.05);while the mutation rates of nt1762/1764, nt1896, nt1864, nt1899 and aa60 were of no statistical significance among different genotypes(F=0.669, 1.542, 1.123, 2.420 and 0.966, P>0.05). Conclusion Compared with G/G genotype, antigenicity of HBV may be more stable in patients with TNFα-308 G/A genotype, which is beneficial to HBV clearance.

Objective To observe the corneal nerve fibres damage in different stage of diabetic retinopathy (DR) with type 2 diabetes.Methods A cross-sectional study.One hundred and twenty eyes of 120 patients with type 2 diabetes served as diabetes group.According to International Clinical Diabetic Retinopathy Disease Severity Scales (2002),diabetes patients were classified into 4 subgroups:patients without diabetic retinopathy (NDR),patients with mild or moderate non-proliferative diabetic retinopathy (mNPDR),patients with severe non-proliferative diabetic retinopathy (sNPDR) and patients with proliferative diabetic retinopathy (PDR),each subgroup has 30 eyes of 30 patients.Another 30 eyes of 30 healthy participants served as control group.All eyes were scanned with HRT3 in vivo corneal confocal microscopy.Images of sub-basal nerve plexus were quantified including nerve fiber length (NFL),nerve fiber density (NFD),nerve fiber branch density (NFB),and nerve tortuosity (NT).The correlations of corneal nerve fiber with age,duration of diabetes and glycated hemoglobin (HbA1 c) were analyzed using Spearman correlation analysis.Results NFL,NFD and NFB were found to be significantly lower in diabetic patients (F=147.315,142.586,65.898;P=0.000,0.000,0.000),NT was significantly greater in diabetic patients (F=39.431,P=0.000),when compared to control group.In diabetic patients,NFL,NFD and NFB were gradually reduced with DR severity,NT was gradually increased with DR severity.While the difference ofNFL,NFD,NFB,NT was not statistically significant between sNPDR and PDR subgroups (P＞.0.05),but was statistically significant between other subgroups (P＜0.05).Spearman correlation analysis results showed that age (r=-0.071,-0.080,0.001,0.100;P=0.391,0.328,0.991,0.224) and HbAlc (r=-0.109,-0.115,-0.126,0.025;P=0.238,0.211,0.169,0.781) had no correlation with NFL,NFD,NFB,NT.Duration of diabetes was negatively correlated with the NFL,NFD (r=-0.212,-0.264;P=0.020,0.004),positive correlated with NT (r=0.261,P=0.004),and had no correlation with NFB (r=-0.119,P=0.194).Conclusions Corneal nerve fiber loss and nerve tortuosity increased were found in patients with type 2 diabetes,and even without diabetic retinopathy.The progress of corneal neuropathy was correlated with the severity of DR,but it was not change significantly between sNPDR and PDR.

OBJECTIVE:To compare whether the numbers and species of strains of5probiotic products for medical pur-poses sold in the market are in line with those stated on the labels.METHODS:Viable count of probiotic products was per-formed by selective plating count method and species of the isolated strains were analyzed and identified using16S rDNA se-quencing.RESULTS:Regarding viable count,only one of the total25batches of samples in5products was lower than that stated on the label.As for species,of the10isolated strains,3failed to be in consistent with that stated on the label.CONCLU_ SIONS:For the5products investigated,inconformity was noted between strain species and that stated on the labels,however,the same viable counts are noted between the products and that stated on the labels.