This thesis systematically summarizes the experience of Professor YAN Xiao-ping in treating palindromic rheumatism, the following conclusions we have got: ① Palindromic rheumatism is very much like panodynia in Yellow Emperor's Internal Classic, and the treatment of this disease should according to that of panodynia; ②The primary pathological mechanism is the deficiency of spleen and kidney, and the secondary is the invading of wind evil factor accompanying with some other evil factors; ③The treatment principals including: nourishing kidney and spleen for the radical treatment, expelling the evil factor such as wind, cold, dampness and hot, assisting with pungent and warm herbs to through channels when expelling hot and clearing away dampness, moving the blood stasis all the way. Because it is shortage of literatures about this disease, the thesis has some practical significance.

Objective To investigate the effect of chronic and unpredictable pre-gestational stress on the serum cortisol level of the offspring,as well as the expressions of brain-derived neurotrophic factor (BDNF) and tyrosine protein kinase B (TrkB) in hippocampus when they were 2 month old.Methods Adult female SD rats were divided randomly into 2 groups:the control group and the chronic unpredictable stress (CUS) model group.All rats were tested in the open field test and sucrose intake test before and after CUS protocol.All offspring rats were sacrificed when 2-month old.Serum cortisol (COR) levels were determined by using a standard radioimmunoassay kit.The expressions of BDNF and TrkB in hippocampus were studied by immunoreactivity quantitative analysis.Results 1.After CUS procedure,CUS group showed decreasing activities in the open field test and decreasing sucrose consumption in sucrose intake test compared to the control group and before CUS procedure.2.The serum COR levels in the female offspring rats of CUS group (128.9 ± 7.3) μg/L were higher than those of the control group (119.9 ± 9.0) μg/L,as well as the male offspring of CUS group(116.5 ± 10.9) μg/L compared with the control group(105.4 ± 10.4) μg/L,but the body weight and brain weight between the offspring of 2 groups were not statistic significance.3.Immunoreactivity quantitative analysis showed that the gray values of BDNF in the female offspring of CUS group (36.1 ± 8.5) decreased compared with the control group(42.4 ± 6.9),as well as the male offspring of CUS(39.6 ± 8.4)compared with the control group (43.7 ± 6.4).4.The gray values of TrkB in the female offspring of CUS group (47.1 ± 2.9) decreased than the control group(50.2 ± 3.9),as well as the male offspring of CUS (46.5 ± 6.7)compared with control group(50.5 ± 5.4).Conclusion Pre-gestational stress reduced the expressions of BDNF and TrkB in hippocampus of the offspring which may relate to hypothalamic pituitary adrenal.

Objective:To explore an effective mode of medical preventive integration, so as to further the construction of county scale health-centered medical alliances.Methods:This study took five medical alliances from a county in Hangzhou as an example, and carried out the semi-structured interview method and typical case analysis to summarize the medical preventive integration operation mode in January 2020; the self-developed questionnaire was used to understand the operation effectiveness evaluation on county medical alliances by medical staffs and residents from fowr aspects: medical preventive team, medical preventive resources, medical preventive services and medical preventive information fusion.Results:Each county scale medical alliance promoted the integration of medical preventive by innovating the organizational structure, strengthening organizational guarantees, and integrating teams, resources, services, and information on medical preventive. The questionnaire survey showed that medical staff had highest satisfaction with the medical preventive service integration (3.75 points), and lowest satisfaction with the medical preventive information integration (3.69 points); residents had highest satisfaction with health information functions in medical preventive information fusion (4.20 points), and lowest satisfaction with preventive health care services in medical preventive services fusion (4.15 points).Conclusions:The evaluation measures related to medical preventive integration services need to be improved, and the quality of services needs to be promoted, all the information systems need to be interconnected, and big data on the information platform needs to be mined and utilized.

Objective:To construct a primary health care institutions performance evaluation index system from the perspective of health value orientation under the background of countywide medical alliances construction.Methods:From May 2021 to February 2022, preliminary screening was made on core performance evaluation indexes via literature review; purposive sampling was used to select the dean/vice dean, persons in charge of medical service, and those in charge of public health service responsible for performance evaluation at the community health service center. Then semi-structured interviews were made on the existing performance evaluation and assessment plans as well as existing problems of primary medical and health institutions. Based on the " input-process-output" performance evaluation model, the thematic framework analysis method was used to analyze the interview data, and combined with literature research results, a preliminary performance evaluation index system for primary medical and health institutions was built under the guidance of health value. From March to May 2022, the Delphi expert consultation method was used to evaluate the importance and operability of indexes. The threshold method was used to screen indexes, and analytic hierarchy process was used to calculate the weights of evaluation indexes.Results:The health value oriented performance evaluation index system for primary healthcare institutions included 3 first-level indexes, 9 second-level indexes, and 50 third-level indexes. The first-level indexes were output (0.377 3), input (0.336 3), and process (0.286 4) in descending order of weight. The top three weighted second-level indexes were health manpower(0.177 8), health literacy and health outcomes (0.157 6), as well as responsiveness and satisfaction (0.142 6). The third-level indexes included 17 medical indexes, 16 prevention indexes, and 17 medical prevention integration indexes. The top three weighted indexes for inpatient services were resident satisfaction with medical treatment (0.052 4), medical staff satisfaction (0.050 1), and responsiveness of residents seeking medical treatment (0.040 1); The top three weighted third-level indexes excluding inpatient services were resident satisfaction with medical treatment (0.052 4), medical staff satisfaction (0.050 1), and surplus funds used for personnel incentives (0.045 5).Conclusions:The performance evaluation index system of primary health care institutions built under the health value orientation is scientific, conducive to promoting the health-orientated transformation and improving the efficiency of primary health care services.

ObjectiveTo explore the clinical selection and application of cell suspension examination (CSE) or histopathological technique (HPT) in detecting sperm in the testis tissue obtained by testicular sperm aspiration (TESA) in patients with non-obstructive azoospermia (NOA).

METHODSTotally, 1 006 NOA patients underwent TESA and their testis tissues were subjected to CSE or HPT for sperm detection. Based on the results of CSE, the testicular tissue samples were divided into groups A (with sperm, n = 567) and B (without sperm, n = 439) and the results were compared with those of HPT.

RESULTSHPT showed 508 cases with but 59 without sperm in group A, and 403 with and 36 without sperm in group B. The consistency rate of CSE with that of HPT was 90.56% (Kappa =0.809), and CSE exhibited a significantly higher rate of sperm detection than HPT (56.36% vs 54.08%, P=0.023).

CONCLUSIONSCSE combined with HPT for detecting sperm in the testis tissue of NOA patients undergoing diagnostic TESA helps clinical diagnosis and treatment. The results of CSE have a decisive significance for assisted reproductive therapy, while those of HPT may provide some definite etiological evidence for drug therapy or surgery.

Azoospermia ; Humans ; Male ; Reproductive Techniques, Assisted ; Sperm Retrieval ; Spermatozoa ; Suspensions ; Testis