Outpatient care services are usually the patient's first contact between the patients and the most bas-ic health care. The provision of outpatient care contributes to immediate and large gains in health status. The pay-ment method is one of the most common incentive methods applied by purchasers to guide the performance of outpa-tient care providers. This systematic review applied cochrane review method, and searched, screened, assessed and synthesized the relevant original studies. 19 studies were finally included. It was found that existing payment methods combined with P4 P interventions could probably slightly improved the health professionals' use of some tests and treat-ments ( adjusted RR median = 1 . 095 , range 1 . 01 to 1 . 17 ) , but may have led to little or no difference in patients' utilisation of health services ( adjusted RR median = 1 . 01 , range 0 . 96 to 1 . 15 ) and may have led to little or no difference in the control of blood pressure or cholesterol ( adjusted RR = 1 . 01 , range 0 . 98 to 1 . 04 ) . Pay for per-formance involves a complex design, each detail design may contain different incentive effect, therefore policy makers intend to apply pay-for-performance to guide the behavior of health providers, the design on each components of pay for performance should be analyzed in order to find more potential intervention points.

Objective To analyze the survey results of iodine nutritional level among women of childbearing age,pregnant,lactating women and infants before and after the adjustment of iodine concentration in salt of Zibo City,in order to provide a scientific basis for reasonable iodine supplement.Methods The iodine content in the residents' edible salt samples was determined in 2011 and 2015.Four groups of target populations including women of childbearing age,pregnant,lactating women and infants from 7 districts and towns of Zibo were investigated to test their urinary iodine level in 2011 and 2015.The monitoring results of the two years were compared and analyzed.Results A total of 2 100 and 2 160 residents edible salt were monitored in 2011 and 2015,and the median of salt iodine were 30.2 and 22.7 mg/kg,there was statistically significant difference in the constitute of salt iodine level between the two years (x2 =141.90,P ＜ 0.01).A total of 354,402,403,362 urine samples of women of childbearing age,pregnant,lactating women and infants' were detected and the median urinary iodine were 161.80,127.20,138.80,147.10 μg/L in 2011,and 350,706,350 and 352 of the corresponding target population's urine samples were detected and the median urinary iodine were 127.80,129.95,70.20 and 152.35 μg/L in 2015.Conclusions The salt iodine median has reduced and the urinary iodine in childbearing age women and infant is in the appropriate level,while it is insufficient in the pregnant women and lactating women after the adjustment of iodized salt concentration in Zibo.It is necessary to promote health education and instruct pregnant women and lactating women to supplement iodine,additionally,surveillance of the iodine nutrition status of the targeted populations should be strengthened.

ObjectiveTo investigate the expressions ofheparinase,matrix metalloproteinase 2 (MMP2) and tissue inhibitor of metalloproteinase 2(TIMP2) in malignant melanoma lesions and their significance.MethodsSkin specimens were obtained from the lesions of 30 patients with malignant melanoma,30 patients with melanocytic nevus and the normal skin of 15 healthy controls.Immunohistochemical SP method was used to detect the protein expression of heparinase,MMP2 and TIMP2.ResultsThe malignant melanoma tissue specimens significantly differed from the melanocytic nevus and control tissue specimens in the expression rate of heparinase (63.33％ vs.6.67％ and 0.00,x2 =21.172,27.805,both P ＜ 0.01 ),MMP2 (70.00％ vs.13.33％ and 0.00,x2 =19.817,19.866,both P＜ 0.01) and TIMP2(60.00％ vs.6.67％ and 0.00,x2 =19.200,15.000,both P ＜ 0.01 ).ConclusionThe expression of heparinase,MMP2 and TIMP2 is significantly higher in malignant melanoma lesions than in melanocytic nevus lesions and normal skin tissue.

Abstract: Objective To compare the application value of metagenomic next generation sequencing (mNGS) with traditional culture in diagnosis of pulmonary infection pathogens. Methods　The clinical documents of 310 patients with suspected pulmonary infection admitted to the General Hospital of Center Theater Command from February 2021 to September 2022 were retrospectively analyzed. The results of mNGS and traditional culture were analyzed, followed by comparison on the positive rate, sensitivity, specificity, accuracy (ACC), positive predictive value (PPV) and negative predictive value (NPV) between the two methods. Results　 The study revealed that mNGS can simultaneously detect multiple pathogens, with the highest efficiency of detection for bacteria and the lowest for fungi. And the sequencing numbers of bacteria, fungi and viruses shown by mNGS were significantly different (H=70.361, P<0.001). In comparison, mNGS displayed a higher positive detection rate (88.40%) than traditional culture (29.70%) (χ2=162.373, P<0.001), but the consistency between the two methods was not significant (Kappa = -0.003, P=0.902). The sensitivity, specificity, ACC, PPV and NPV of mNGS were 91.29%, 28.26%, 81.94%, 87.96%, and 36.11% respectively, compared to corresponding 30.30%, 73.91%, 36.77%, 86.96% and 15.60% of traditional culture respectively. Through analysis, it is confirmed that the sensitivity and specificity between the two methods were statistically significant (91.29% vs 30.30%, χ2=148.120, P<0.001 and 28.26% vs 73.91, χ2=13.793, P<0.001). Conclusions　mNGS can significantly improve the detection rate of pathogens in pulmonary infections and provide a complementary tool besides to traditional culture method for accurate anti-infection therapy. Furthermore, both traditional culture and mNGS pathogen detection methods are highly dependent on sample quality and detection quality control. mNGS requires the correct interpretation of comprehensive, non-destructive pathogenic genetic information to accurately identify pathogens.

Objective To investigate the effects of dexmedetomdine on hemodynamics and myocardial injury in patients with pulmonary hypertension undergoing mitral valve replacement.Methods Forty ASA Ⅱ or Ⅲ patients with pulmonary hypertension,aged 18-64 yr,undergoing mitral valve replacement,were randomized into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv midazolam 0.05 mg/kg,sufentanil 1 μg/kg,etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg and maintained with combined intravenous-inhalational anesthesia.Narcotrend index values were maintained at 40-50.The patients were tracheal intubated and mechanically ventilated.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min after intubation followed by infusion at 0.5 μg· kg-1· h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Venous blood samples were taken immediately before dexmedetomidine administration,at 10 min after termination of cardiopulmonary bypass (CPB),at the end of operation,and at 6 and 24 h after operation for determination of plasma levels of creatine kinase MB (CK-MB) and cardiac troponin Ⅰ (cTnI) by ELISA.Before and after administration of dexmedetomidine,at skin incision,at sternum splitting,before and after CPB,and at the end of operation,HR,MAP,mean pulmonary arterial pressure (MPAP),cardiac output (CO),systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were detected by using Swan-Ganz catheter and Vigilance Ⅱ monitor.The requirement for vasoactive drugs and condition of spontaneous heart beats were recorded.Results In group D,each hemodynamic parameter was maintained stable at skin incision and sternum splitting,and MPAP was decreased after CPB and maintained at a lower level.The plasma levels of CK-MB and cTnI,consumption of phenylephrine and dopamine,and requirement for epinephrine were significantly lower in group D than in group C (P ＜ 0.05).There was no significant difference in the consumption of milrinone and rate of spontaneous heart beat between the two groups (P ＞ 0.05).Conclusion During mitral valve replacement for patients with pulmonary hypertension,dexmedetomidine infused at 0.05 μg·kg-1· h-1 after a loading dose of 1 μg/kg is helpful in maintaining systemic circulation and pulmonary circulation stable and provides myocardial protection to some extent.

Objective Using transcranial Doppler (TCD) to evaluate the effect of selective shunt (SS) during carotid endarterectomy (CEA). Methods TCD was used for intraoperative bilateral middle cerebral artery (MCA) cerebral blood flow continuous monitoring in 169 patients with carotid stenosis treated with CEA. The patients were divided into shunt (n =32)and non-shunt (n = 137) groups according to whether they performed shunt or not. The open approaches of anterior collateral circulation were recorded. The peak systolic velocity (PSV),mean velocity (MV), pulsatility index (PI), and ratio of MV in bilateral MCA were compared after anesthesia, before and after carotid artery occlusion, before and after shunt, and after carotid artery open. Results MV before carotid artery occlusion in the shunt and non-shunt groups were 34.73 ± 13.54 cm/sand 35.32 ± 13.18 cm/s, respectively, and there was no significant difference (P = 0. 825). MV in the shunt group after carotid artery occlusion was significantly decreased in the non-shunt group (P =0. 000). The mean decline rate of MCA MV was 69.34% ± 20. 93%, and it was decreased more significantly than that in the non-shunt group (P=0. 000). The decline rate of MCA MV was increased significantly after shunt operation, the average increase was 35.68 ± 16.69 cm/s (P=0. 000). Conclusions TCD can objectively evaluate the hemodynamic changes before and after shunt operation.

Objective To explore the high-risk factors,clinical characteristics,therapy and prognosis of invasive fungal infection (IFI)in patients underwent allogeneic haemopoietic stem cell transplantation (AlloHSCT). Methods One hundred patients underwent Allo-HSCT at our department from March 2002 to July 2010 were analyzed retrospectively,among whom 26 patients had invasive fungal infection(IFI). Seven patients had pulmonary IFI before allo-HSCT, 14 patients had pulmonary IFI after allo-HSCT,3 patients had respiratory tract system IFI, and 2 patients had intestinal IFI. We observed the occurrence of Graft-versus-host disease (GVHD) ,cytomegalovirus( CMV )infection, Lymphocyte subsets and chronic basic diseases in patients with IFI. The twenty six cases were divided into two groups: experience therapy group with 12 cases and preemption therapy group with 14 cases. Results Among 26 patients with IFI,20 cases suffered from GVHD,6 cases had CMV infection,19 cases had low cellular immune function simultaneously. 1 case had diabetes,3 patients had pulmonary tuberculosis and 1 case had bronchiectasis as complications. In experience therapy groupe: 8 cases (67%)recovered completely but 1 case(8% )suffered from progressive infection. In preemption therapy groupe:3 cases ( 21% ) recovered completely but 5 cases ( 36% ) suffered from progressive infection. Conclusion Clinician should pay close attention to the patients with high-risk factors of IFI after allo-HSCT.

Objective To observe the changes in transfer rates of epigoitrin, forsythoside A and forsythin in Ganmao Tuire Granules prescription medicinal materials by water decoction extraction, vacuum concentration and atmospheric concentration.Methods Prescription medicinal materials fromGanmao Tuire Granules were decocted in water and the decoction was condensed by vacuum and atmospheric concentration process. The contents of epigoitrin, forsythoside A and forsythin at different states were measured by HPLC for transfer rates.Results The transfer rates of epigoitrin, forsythoside A and forsythin were 72.97%, 29.27%, 72.84%, respectively after decocted in water. The RSD of epigoitrin, forsythoside A and forsythin were less than 2% in the process of vacuum concentration. The transfer rates of epigoitrin, forsythoside A and forsythin by atmospheric concentration decreased by 13.51%, 7.38% and 4.24% respectively compared with vacuum concentration when concentrated to the same state.Conclusion The method for simultaneous determination of epigoitrin, forsythoside A and forsythin by HPLC has been established. A more suitable extraction and concentration process should be chosen for the preparation ofGanmao Tuire Granules.

ObjectiveTo establish a method for content determination of total iridoid compounds and baldrinal and 11-ethoxyviburtinal from Valerianae Jatamansi Rhizoma et Radix; To determine the contents of total iridoid compounds and baldrinal and 11-ethoxyviburtinal in Valerianae Jatamansi Rhizoma et Radix from three medicinal origins.Methods UV spectrophotometry was applied, 11-ethoxyviburtinal (cyclopentane-pyran-7-formaldehyde, 4-ethoxy methyl) was set as the reference substance, and the content of total iridoid compounds was determined at 288 nm. HPLC method was used to simultaneously determine the contents of baldrinal and 11-ethoxyviburtinal. The HPLC analysis was performed on a Phenomenex Luna C18 column (250 mm×4.6 mm, 5μm). The mobile phase was composed of acetonitrile-water in gradient elution at a flow rate of 0.95 mL/min. The detection wavelength was 288 nm and the column temperature was 30℃.Results The total iridoid compounds, baldrinal and 11-ethoxyviburtinal were in good linearity within the ranges of 2.088–14.616μg/μL, 74.88–224.64μg, and 41.6–249.6μg, respectively. This method was precise, and with good repeatability, stability and recovery rate.Conclusion The method is accurate, simple, rapid, which can be used for the quality control of Valerianae Jatamansi Rhizoma et Radix.

The paper introduced the concept and background ofdisciplines convergingmanagement,holding that this management philosophy can encourage dialogues among disciplines in a holist concept.It is believed that with an innovative mechanism in the management and operation,such converging has initially proven its value,promoting disciplines from high refinement to coordination and synergy,supporting research hospitals in development.