Objective To develop an evaluation index system of health management services for the elderly with the perspective of combining medical service and long term care, and laying the foundation for the field assessment. Methods Using Delphy expert consultation method to improve Andersen health service utilization model. Excel was used for data input, SPSS 22.0 statistical software was used for analyzing the data from the expert consultation questionnaire to determine the importance and feasibility of the scores including mean, standard deviation and coefficient of variation. Constituent ratio analysis was done for expert positive coefficient, and the expert authority coefficient and coordination coefficient were analyzed by chi square test. The indicator's weight was calculated by using average method and multiplicative cumulative combination weighting. Results We constructed the framework for evaluating the effectiveness of health management service for the elderly in the community, the evaluation index system of the community health service was established. The system included 4 first level indicators, 12 second level indicators, 35 third level indicators, each index had a corresponding weight. Conclusions The evaluation index system is an effective way to assess health management service, selection of the indexes should be consistent with the connotation and characteristics of elderly health management under new aging care policy. Further empirical investigation is needed to modify the index system in order to provide decision-making basis for improving and regulating health management services for the elderly.

Objective To Analyze CD4+ cell count which embodies curative effect in HIV and patients with AIDS, who have treated with TCM for half a year. Methods According to CD4+cell count, the patients were divided into 4 phases. Their CD4+cell count were analyzed before and after the treatment. Results 1.Rank sun test showed that CD4+cell count were significantly improved in people who used TCM treatment. On the whole, CD4+cell count was(317.76±175.61) in 1 cu mm before treatment, which was(350.60±175.92) in 1 cu mm after treatment, P<0.01. 2. Ridit showed that patients whose CD4+cell count more than 500 were in phase I. Their R=0.614, and the 95%confidence interval was 0.5702 to 0.6579. Patients whose CD4+cell count more than 350 and less than 500 were in phase II. Their R=0.575, and the 95%confidence interval was 0.5439 to 0.6062. Patients whose CD4+cell count more than 200 and less than 350 were inphase III. Their R=0.460 and the 95%confidence interval was 0.4347 to 0.4849. Patients whose CD4+cell count less than 200 were in phase IV. Their R=0.428, and the 95%confidence interval was 0.3971 to 0.4589. There was no overlap between phase III, phase IV and phase I, phase II in 95% confidence interval. Conclusion TCM has the advantages in strengthening vital qi, but that is worse than western medicine in effort of expelling pathogen.

0.05). (3)The incidence rate of the single-branch lesions in

Nitric oxide (NO) plays an important pathophysiological role in osteoarthritis and cartilage metabolism. To determine the relationship between NO and the synthesis of type II collagen in cartilage, we measured levels of type II collagen by ELISA and procollagen (II) mRNA by RT-PCR in cultured lapine chondrocytes that were incubated with some kinds of reagents. 0.2mM sodium nitroprusside (SNP, a NO donor) can release high levels of NO, decreasing type II collagen, suppressing the expression of procollagen (II) mRNA (COL2A1).At the same time, chondrocytes showed a large increase in NO synthesis, a decrease in type II collagen and COL2A1 mRNA in response to 100u/ml IL-1. When 1mg/ml N-nitro-L-arginine methyl easter (NAME, an inhibitor of NO synthase) was mixed with IL-1, NO production was inhibited, the amounts of type II collagen recovered partially and COL2A1 mRNA recovered completely.These data indicate NO can inhibit type II collagen synthesis as IL-1 downstream molecule by suppressing procollagen (II) mRNA.

Objective:To standardize the clinical information of the nose.Methods:Based on the 1034 descriptions on the clinical manifestation of nose in the database of the clinical records of Chinese medicine in the past dynasties,according to the hypothesis of symptomatic unit,the symptomatic units,the second-level clinical characteristics and the limiting factors were summarized in the paper.Results:All the descriptions on the clinical manifestation of nose include 11 symptomatic units,7 second-level clinical characteristics and 1 limiting factor.Conclusion:Comparing with the symptoms in the authoritative works of Chinese medicine,cold-feeling of the nose while breathing was the new fi nding,nares flaring and ozena recorded in the authoritative works were the second-level clinical characteristics of polypnea and rhinorrhoea respectively.Nose diseases,such as nasal eczema,were usually diagnosed by several symptomatic units,so they were not symptomatic units.

Objective To research the way of micro-traumatic ligation of PDA.Methods 40cases of PDA patient were ligated at auscultation triangle for PDA and the results were compared with 20cases of the passing chest methods.Results The results of new method were better than those of usual ligation in many studies.Conclusions This method could be used for all PDA patients except the patient combined with pulmonary hypertension or second operation and other cardic deformity.

Objective To construct a genetically-stable double auxotrophic,in which the uracil and leucine were mutated,using the Candida parapolymorpha ATCC26012 as materials.Methods Based on the physical and genetic engineering methods,the chromosome of the C.parapolymorpha strain was modified,where the ura3 and leu2 genes were directly mutated,to obtain the uracil and leucine double auxotrophic strain.Then the constructed strain was identified by the analysis of its biological properties,such as genetic stability,the change of the genes,and the physiologic and biochemical characteristics.Results The uracil and leucine double auxotrophic strain is obtained by screening.The biological identification results show that the obtained strain is genetically stable and the targeted genes are directly altered.In addition,the physiologic and biochemical analyses indicate that the auxotrophic can utilize various kinds of carbon and nitrogen nutrient sources,and its growth is good.Conclusion The successful construction of double auxotrophic mutant strains facilitated the genetic studies on C.parapolymorpha to meet various investigational purposes.Moreover,the constructed auxotrophic strains can be applied as advantageous host cells to express multiple proteins/antigens simultaneously,which is of great significance in the development of vaccines.

The paper reports the systematic study on felodipine and its impurities in tablets, to improve its quality standards for the control of the related substances. HPLC-DAD, UPLC-MS, IR and NMR methods were used for the isolation of felodipine and its impurities in tablets, their identification and the zebrafish animal model was used for the analysis of the toxic impurities. In felodipine material and its tablets, three impurities are isolated and identified. They are impurity 1 [dimethyl 4-(2, 3-dichlorophenyl)-2, 6-dimethyl-1, 4-dihydropyridine-3, 5-dicarboxylate], impurity 2 [ethyl methyl 4-(2, 3-dichlorophenyl)-2, 6-dimethylpyridine-3, 5-dicarboxylate] and impurity 3 [diethyl 4-(2, 3-dichlorophenyl)-2, 6-dimethyl-1, 4-dihydropyridine-3, 5-dicarboxylate], separately. The result of zebrafish animal model analysis showed that the teratogenic effects of four compounds were: impurity 3 > or = felodipine > impurity 1 > impurity 2, lethal effects were as follows: impurity 2 = impurity 3 > felodipine > or = impurity 1. This study confirmed the toxicity of three impurities in felodipine. According to the results, the paper suggested the amendments to the standard of the medicine and provided the support to the control of impurities in the manufacturing process.

BACKGROUND: Different pretreatments of the tendon allograft for repairing hand tendon defect due to traumatic injuries have received much attention in the study of tissue engineering for hand surgeries.OBJECTIVE:To explore the characteristics of deep-frozen glutaraldehyde-treated tendon allograft for repairing hand tendon defect.DESIGN: A self-controlled study.SETTING:Ward of Orthopedic Department, Huizhou People's Central Hospital.PARTICIPANTS:Fifteen patients (aged 20-35 years) with 17 defected tendons were hospitalized in the Department of Orthopedics of Huizhou People's Central Hospital between January 1997 and August 2001. Among the 17 defected tendons, 8 were extensor tendons and 9 flexor tendons,with the length of defects varying from 2 to 9 cm.METHODS:The allogenic tendon grafts were obtained from young donors died in accidents or non-replantable amputated limbs due to traumatic injuries with informed consent obtained from the donors or their family members. These grafts were stored at -80 ℃ and immersed in 3.5 g/L glutaraldehyde solution before transplantation. Surgical operation was conducted following standard microsurgical procedures. According to the assessment criteria for total rang of motion (ROM) recommended by International Hand Surgery Association, the outcome of the surgically repaired hands was graded as excellent, good, acceptable and poor.MAIN OUTCOME MEASURES:Total ROM of the digits and graft rejection.RESULTS:None of the 15 patients was lost for analysis. The follow-up lasted for 8 months, during which 4 transplanted tendons had excellent, 6good, 4 acceptable and 3 poor functions, with a total effective rate of 82.36% (14/17). Neither cortical hormone nor immunosuppressants were used in these cases and no acute graft rejection or rupture of the tendons occurred.CONCLUSION: The antigenicity of the tendon allografts can be lowered after deep freezing of the grafts at -80 ℃ with preoperative glutaraldehyde treatment, which also increases the strength and tenacity of the tendons and decreases the risk for infection. The treated grafts provide a good alternative for autologous tendon graft but the complication of tendon adhesion still awaits to be tackled.

BACKGROUND: The characteristics of cervical anatomy and pedicle screw, operational specification, and individual screw implantation are the key factors of a successful implantation treatment.OBJECTIVE: This study was designed to investigate the cervical pedicle screw and host response as well as the recovery of spinal nerve functions during the surgery and follow-up period of cervical spine fracture-dislocation.DESIGN: A case analysis.SETTING: Department of Orthopaedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Lianning Province, China.PARTICIPANTS: A total of 41 patients with cervical spine fracture-dislocation, who have complete follow-up data, were admitted to the Department of Orthopaedics, General Hospital of Shenyang Military Area Command of Chinese PLA between February 2002 and February 2006. Of the included patients, 18 were complicated by spinal cord injury (according to Frankel classification system, 6 were graded as A, 1 as B, 4 as C, and 7 as D.METHODS: Forty-one patients with cervical spine fracture-dislocation were treated by implanting a screw through the cervical pedicle and fixing it. Prior to surgery, all patients were subjected to X-ray, CT and MRI examinations. According to measurements, each cervical pedicle screw was individually implanted. The entire surgery was accomplished by Xiang Liang-bi, chief physician, whose qualification corresponds to the responsibilities.MAIN OUTCOME MEASURES: Material and host response during and after screw implantation as well as in the follow-up period. Recovery of spinal nerve function after screw implantation.RESULTS: All patients were followed up for 6-12 months and all incisions were healed primarily. Material and host response during the process of screw implantation: A total of 218 screws were implanted. After initial implantation, 12 screws were loosened, and such a phenomenon disappeared in 11 screws by adjusting inserting point and inserting direction or/and increasing screw diameter or length. The remaining 1 screw was stabilized by increasing the fixed segments. After drilling, poles of 10 screws bled much and treated by hemostasis. C1-2 venous plexus hemorrhage was caused in 3 patients and stopped by compression, and Apofix internal fixation was used in 1 of 3 patients due to unclear surgical visual field. Material and host response after surgery and during the follow-up: A total of 218 screws were inserted. Of the 218 screws, 196 were in correct position, and 22 were deviated to different degrees. Deviation of 1 screw caused injury to nerve root and that of another screw led to injury to blood vessel. Thirty-eight patients acquired satisfactory reduction and bone union. Three patients presented with symptoms of nerve root irritation due to incomplete reduction in the old fracture-dislocation. Among the 3 patients, 1 was subjected to anterior approach due to screw removed, and neither injury to vertebral artery, spinal cord, and nerve root nor internal fixation destroy was found in any other patients. Recovery of spinal nerve function after implantation: Among the 18 patients complicated with spinal cord injury, 6 patients, who were assessed as grade A spinal cord injury, did not exhibit improvement in spinal cord function, while the remaining 12 presented with 1 or 2 grades of improvement.CONCLUSION: There is a lower probability for biocompatibility reaction, and spinal nerve function recovers better after implantation of cervical pedicle screw. So implantation of a cervical pedicle screw system is an effective and relatively safe method for treatment of cervical spine fracture-dislocation.