Objective To study the clinical significance of detection of infectivity index in patients before transfusion. Methods A total of 12 863 patients in hospital were examined for hepatitis B virus surface antigen(HBsAg),anti-hepatitis C virus(anti-HCV),anti-AIDS virus(anti-HIV)and treponemiasis test(TRUST)before operation and transfusion. Results The positive rates of HBsAg,anti-HCV,anti-HIV and TRUST were 12.59%,1.90%,0.02%and 0.80%respectively.Conclusion The detection of infectivity index before transfusion has a very,important role in the prevention of blood transmissible disease and reduction or medical treatment dispute caused by infection after transfusion.

One hundred forty-four residents registered at department of anesthesia of West China Hospital from 1999 to 2010.The duration of residency training is 5 years (3 + 2).The residents enrolled during 1999-2002 were on the staff.They were assigned to work at this hospital after graduation from medical school and became staff anesthesiologist of this hospital after 5 year training.The residents enrolled during 2003-2010 were trainees and not on the staff.They had to apply for a job as anesthesiologist somewhere after 5 year training.After 3 year training the residents are qualified to undergo subspecialty training.Thirty-nine of the 144 residents dropped out of the training program.The reasons for their withdrawing from the program included finding a regular job,failing the qualifying examination,changing profession studying abroad and death.In order to reduce dropout rate,correct public opinion on the importance of residency training,raising the quality of the residents and improving income of the residents are needed.

Objective To explore the effect of GAS MAN assisted instruction on theory learning of volatile anesthetics in anesthesiology residency training.Methods A total of 32 residents in the first stage of anesthesiology training were enrolled and randomly assigned to either study(S) or control (C) group.Theory-test l(Test-1) was conducted for all residents after the lecture-based learning (LBL).Next,reference book self-reading strategy was used in both groups while computer-based simulation(CBS) using GAS MAN was only developed in S group.Then,theory-test 2(Test-2)was conducted for residents in both groups and residents in S group completed the questionnaire smvey.In addition,thirty-four resident teachers observed the CBS courses and completed the questionnaire smvey.Results The mean scores of Test-1 did not differ significantly between the two groups(P=0.64).However,the mean Test-2 score of S group(81.3 ± 13.6) was significantly higher than that of C group(61.3 ± 15.4) (P=0.001).100％(16/16) residents believed that CBS was beneficial to the theoretical study of volatile anesthetics,93.8％(15/16) residents considered GAS MAN could help understand the concepts and improve efficiency during self-learning.97.1％ (33/34) and 91.2％ (31/34)resident teachers agreed that CBS was helpful for analyzing complex concepts and improving study effectiveness,respectively.Conclusions CBS using GAS MAN improves theory knowledge and study effectiveness for anesthesia residents.Both residents and resident teachers find GAS MAN highly ac ceptable.Therefore,GAS MAN has the potential to be the assistant teaching tool for LBL in anesthesiology residency-training program.

Objective To observe the effects of scalp acupuncture on cognitive impairments after traumatic brain injury (TBI). Methods 42 cases of TBI were randomized into experiment group (n=23) and control group (n=19). The control group accepted cognitive training and Donepezil, and the experiment group accepted scalp acupuncture in addition for 3 months. They were assessed with event related potential P300 and Montreal Cognitive Assessment (MoCA) before, 1 and 3 months after treatment. Results The results of P300 and MoCA improved significantly 3 months after treatment (P<0.001) in both groups, and improved more in the experiment group than in the control group (P<0.001). Conclusion Scalp acupuncture could improve outcomes of cognitive impairments after TBI.

This article provides an overview of the severe acute respiratory syndrome (SARS) epidemics in mainland China and of what we have learned since the outbreak.The epidemics spanned a large geographical extent but clustered in two regions:first in Guangdong Province,and about 3 months later in Beijing and its surrounding areas.The resulting case fatality ratio of 6.4％ was less than half of that in other SARS-affected countries and regions,partly due to younger-aged patients and a higher proportion of community-acquired infections.Strong political commitment and a centrally coordinated response were most important for controlling SARS.The long-term economic consequence of the epidemic was limited.Many recovered patients suffered from avascular osteonecrosis,as a consequence of corticosteroid usage during their infection.The SARS epidemic provided valuable experience and lessons relevant in controlling outbreaks of emerging infectious diseases,and has led to fundamental reforms of the Chinese health system.Additionally,the epidemic has substantially improved infrastructures,surveillance systems,and capacity to response to health emergencies.In particular,a comprehensive nationwide internet-based disease reporting system was established.

Objective:To investigate the clinical characteristics,treatment and prognosis of primary pe-noscrotal extra-mammary Paget’s disease (PSPD).Methods:The clinical and pathological data of 22 cases of primary PSPD were retrospectively reviewed.Survival rate of the overall patients,the invasive patients,and the patients with positive surgical margin or negative surgical margin were analyzed with Ka-plan-Meier survival curve method.Results:Among all the patients with primary PSPD,the median age of onset was 64.5 (39 -84)years,the median time of disease duration was 40 (2 -300)months,and the median long diameter of lesion was 4.75 (1 -10)cm.In the study,12 patients (54.5%)were in pathological stage A1,6 patients (27.3%)were in pathological stage A2,and 4 patients (18.2%) were in pathological stage B.Scrotum and penile of most patients (n =12,54.5%)were involved,5 patients (22.7%)were scrotum only,and 5 patients (22.7%)were penile only.Erythema (n =18, 81.8%),itchiness (n =16,72.7%),ulcerate (n =12,54.5%),exudation (n =11,50.0%),and pain (n =4,18.2%)were the major manifestations.All the patients with primary PSPD were treated with wide surgical excision.The rate of invasive patients was 77.3% (n =17).Of them,6 patients had positive surgical margin.The surgical margins of non-invasive patients were all negative.Twelve patients exhibited local recurrence or/and metastases,and the status of surgical margins (P =0.015)and the depth of invasion (P =0.010)were important risk factors.Inguinal lymph nodes were generally in-volved.The difference of the delay of diagnosis between metastasis and non-metastasis was significant (P =0.040).The 5-year survival rates of the overall and invasive patients were 33.7% and 27.9%, respectively.The patients with positive surgical margin had poor prognosis.Conclusion:Primary PSPD, with the characteristics of long duration,high invasive tendency and high incidence of local recurrence or metastases,generally occurs in the elderly.Surgery should be performed at first.The delay of diagnosis, positive surgical margins and the involvement of inguinal lymph node are important risk factors.Biopsy, frozen section and inguinal lymph node biopsy (ILNB)can standardize diagnosis and treatment.

Objective:To investigate the methylation status of the RASSF1A gene promoter in upper tract urothelial carcinoma (UTUC)tissues and its correlation with clinicopathologic characteristics and postoperative recurrence of primary UTUC.Methods:In a retrospective design,a total of 687 patients who underwent surgeries for primary UTUC in the urology department of Peking University First Hospital were enrolled.The methylation status of the RASSF1A gene promoter was analyzed using methylation-sen-sitive polymerase chain reaction on tumor specimens.Results:Aberrant methylation for the RASSF1A gene promoter was detected in 183 (26.6%) DNA samples in total.Aberrant methylation of the RASSF1A gene was strongly associated with tobacco consumption (P =0.044),ipsilateral hydronephrosis (P <0.001 ),tumor location (P <0.001 ),tumor stage (P =0.001 ),tumor grade (P =0.007), lymph node metastasis (P =0.001 )and growth pattern (P =0.013).The methylated RASSF1A gene promoter was an independent risk factor for bladder recurrence (P <0.001,HR =0.471)and contrala-teral recurrence (P =0.030,HR =0.269)of UTUC after surgery.Hypermethylated RASSF1A was pre-dictive for improved bladder recurrence-free survival (BRFS)(P <0.001)and contralateral recurrence-free survival (CRFS)(P =0.021)in the UTUC patients.Compared with the patients with unmethylated RASSF1A,the patients containing tumors with hypermethylated RASSF1A had tendency toward longer re-currence-free survival time [(114.4 ±3.9)months vs.(84.0 ±3.2)months for BRFS,(138.1 ±1.8) months vs.(132.9 ±1.9)months for CRFS]and higher estimated cumulative recurrence-free survive rates (five-year survival rate for example,79.8% ±3.4% vs.57.4% ±2.6% for BRFS,98.9% ± 0.8% vs.93.0% ±1.4% for CRFS).Additionally,tumor multifocality (P =0.002,HR =1.538), and ureteroscopy before surgery (P =0.001,HR =1.725)were independent risk factors for bladder re-currence in postoperative UTUC patients.Conclusion:The methylation status of the RASSF1A gene pro-moter appears to be a promising epigenomic biomarker for assessing the aggressiveness of UTUC and a predictor predicting the urinary tract recurrence after surgery.

Objective:To analyze the progress of the contracting service model in community health centers in the typical areas in China, and provide empirical evidence for the hierarchical system targeted to make first contact and orderly dual transfer. Methods: Purposive sampling was adopted. Twelve community health centers in Beijing, Shanghai , Zhengzhou and Chengdu areas where the general practitioner model was conducted earlier and set to be the representative one, were selected as the field survey sites. A thematic framework analysis was used to describe the key factors around the contacting service model. Results:This model was developed around the following key factors:using the general practice team as the main service provider, taking the patients with chronic diseases as the main contracting groups and extending to their family members with the number of contracted ranging around 1500~2000 , freely providing both essential public health and medical services, fully using the family physician room as the con-tracting service platform and highlighting the actively serving concept, building the financial and non-financial incen-tives, health insurance benefits and green transfer mechanisms in order to efficiently guarantee the contracting service development. Conclusions: Based on the information platform, the contracting service model in the sample sites played a great role in the appointment and referral services development as well as the self-health management among residents, improving the relationship between physicians and patients, and promoting the formation of orderly health service pursuing pattern.

Objective To understand the infectious pathogens distribution and drug resistance in the surgical departments of our hospital from 2007 to 2011 to provide the basis for the anti-infective therapy in the surgical patients.Methods TheVitek automatic microbial identification system was used to identify bacteria and fungi.The Kirby-bauer (KB)method was used to study the antibi-otic resistance in the pathogens isolated from the patients in the surgical departments.Results 1218 strains of pathogens were iso-lated,including 669 strains(55%)of Gram-negative bacteria,440 strains(36%)of Gram-positive bacteria and 109 strains (9%)of fungi.The top five of bacteria in turn were Escherichia coli in 182 strains(15%),Pseudomonas aeruginosa in 171 strains (14%), Staphylococcus aureus in 105 strains (9%),Klebsiella pneumoniae in 86 strains (7%)and Enterococcus faecalis in 61 strains(5%). Among 283 strains of Escherichia coli,Klebsiella pneumoniae and proteus mirabilis,the detection rate of ESBLs producing strains was 29.7%.Methicillin-resistant Staphylococcus aureus(MRSA)accounted for 63% of Staphylococcus aureus.The resistance rates of Staphylococcus and Enterococcus to multiple antibacterial drugs were above 50%.Enterobacteriaceae bacteria were more sensi-tive to carbapenems as well as compound antibacterial drugs containing enzyme inhibitor.The lowest resistance rate of Acinetobact-er to cefoperazone/sulbactam was 21.1%.Pseudomonas aeruginosa showed the most sensitive to compound antibacterial drugs con-taining enzyme inhibitor and its lowest resistance rate to cefoperazone/sulbactam was 17.4%.Conclusion The drug resistance phe-nomenon in the pathogens isolated from the surgical patients are relatively serious,this study provides some basis for the preventive antimicrobial drugs use in the perioperative period and the empirical medication in the infection therapy.

Objective: To explore the utilization and effects of informatization in perfecting the community health service mode. Method:Through purposive sampling, 12 community health service centers in Beijing, Shang-hai, Chengdu, and Zhengzhou were selected for site investigation. The heads of the health administrative department and community health service centers were interviewed, with a focus on the construction and utilization of the local community health informatization and a discussion of the role of informatization in perfecting the community health service mode. Results:The information systems can be divided into core systems, core auxiliary systems, and periph-eral support systems. Informatization provides strong support to perfecting the community health service mode in opti-mizing the service process, improving work efficiency, strengthening institutional cooperation, promoting quality regu-lation, optimizing performance appraisal, and strengthening doctor-patient interaction. Conclusion: Informatization plays a key role in perfecting the community health service mode. Recommendations were proposed to strengthen community health informatization construction and utilization:optimizing service processes, promoting the efficient co-ordination of safe health services, optimizing performance appraisals, and strengthening doctor-patient interaction.