Objective:Based on the unreasonable structure,fragmentization and insufficient resources of medical and health service system in China,the literature review was conducted on the analysis of integrated medical and health service system.Methods:It sorted out and analyzed the existing related literature in the academic field.Results:The integrated health system was developed by their elements and methods,which lacked the evaluation and analysis on the responsibility among different stake holders and effects after the integration.Conclusion:Further research should be developed into the implementation of dual referral based on integrated health system;the responsibility relationship among different stakeholders in the integration progress,the integration and optimization of medical and health service system under the background of Internet+,etc.

Based on literature review determining evaluation dimensionality,and with the relevant policies,the original index system is determined.Through using two rounds of focus group discussion and two rounds of expert consultation method,a set of county hospitals comprehensive reform of index system,which consists of 3 primary,14 secondary indicators and 64 tertiary indexes,is established.The analytic hierarchy process is used to determine the weight of evaluation index.At the same time,the reliability and validity of index system are tested.This proves that the established evaluation index system can give scientific and reasonable assessment results for comprehensive reform of county-level hospitals.

Objective To examine the effect of family environment and family function on suicide behavior in schizophrenic patients.Methods 53 schizophrenic patients with suicidal behavior in the last month were selected for the schizophrenic suicide group.53 schizophrenic patients and 53 normal controls matched with the schizophrenic suicide group were selected for the schizophrenic no suicide group and normal control group.All of them completed family environment scale and family assessment device.Results The cohesion factor,the expressiveness factor,the active-recreational orientation factor and the control factor of family environment scale in the schizophrenic suicide group were significant lower than those in the schizophrenic without suicide group(separately 5.70 ± 1.29 vs 6.62± 1.23,4.77 ± 1.49 vs 5.96 ± 1.11,3.94 ± 1.63 vs 5.68 ± 1.98,2.68 ± 1.68 vs 4.40 ± 1.81,P＜ 0.05),but the conflict factor in the schizophrenic suicide group was higher than in the schizophrenic without suicide group(3.55 ± 1.60 vs 2.81 ± 1.52,P ＜ 0.05).The affective responsiveness factor,the affective involvement factor and the behavior control factor of family assessment device in the schizophrenic suicide group were significant lower than those in the schizophrenic without suicide group(separately 16.05 ± 2.57 vs 14.53 ± 3.38,19.13 ± 4.09 vs 16.58 ± 2.82,23.35 ± 3.52 vs 21.60 ± 3.25,P ＜ 0.05).Multiple liner regression analyses showed that the expressiveness factor,the active-recreational orientation factor,the control factor,the affective involvement factor and the behavior control factor were important factors for schizophrenic suicide(F=21.583,P=0.000,adjusted R 2 =0.519).Conclusion Attempted suicide patients with schizophrenia have some deficiencies at family function and family environment.

Objective To evaluate the technical method,clinical effect,safety and complication of the endovascular interventional therapy of intracranial A1 segment aneurysms of anterior cerebral artery(ACA).Methods The data of 14 cases with ruptured A1 segment aneurysms received interventional therapy were analyzed retrospectively.All patients were admitted with subarachnoid hem-orrhage (SAH)and classified by Hunt-Hess scale.There were 3 cases of Grade Ⅰ,5 cases of Grade Ⅱ,and 6 cases of Grade Ⅲ. One of fourteen patients was treated by stent implantation alone and 10 patients were treated by coiling alone.The other 3 patients were treated by stent-assisted coiling.Results All the cases were embolized successfully and cured.Angiography immediately after procedure showed Raymond Ⅰ in 1 1 patients,RaymondⅡ in 2 patients and Raymond Ⅲ in 1 patient.In one patient a coil loop was partly left in the parent artery.All of them showed excellent outcome without any serious complication except that one patient suf-fered transient left hemiparesis.Conclusion Endovascular interventional therapy is a safe,effective method in the treatment of the intracranial A1 segment ACA aneurysms.

Objective To investigate the difference of clinical efficiency and safety in obsessive-compulsive disorders (OCD) treatment with escitalopram or paroxetine.Methods A total of 156 OCD patients were randomly divided into escitalopram group (ESC group) and paroxetine group (PAR group).Yale-Brown Obsessive Compulsive Scale (Y-BOCS),Hamilton Depression Scale (HAMD) and Treatment Emergent Symptom Scale (TESS)were used to evaluate the clinical efficiency and safety before and after1,2,4,6,8 weeks treatment.Results The cure rate(21.79％ vs 17.95％) and effective rate(70.51％ vs 71.79％) had no statistically difference between ESC group and PAR group,and incidence of side effect had no significant difference between two groups(x2 =1.99,P＞0.05).Compared with the group before treatment,HAMD scores were significantly decreased from the first weekend in ESC group,but in PAR group HAMD scores did not decrease until the second weekend,and the differences were also significant(P＜0.05).Conclusion Escitalopram is a safety,effective and well-tolerated drug in the treatment of obsessive-compulsive disorder.

Objective To analyze the effects of adenohypophysis function after treating with thyrotropin releasing hormone and its clinical significance in patients with brain trauma. Methods There were 22 cases with traumatic brain injuries from July 2010 to September 2012 in Chinese people's Liberation Army nine eight hospital,after injuried within 4 to 12 hours,then 1 1 cases who were given thyrotropin-releasing hormone(TRH)were selected as experimental group,while 1 1 cases who were given the same amount of isotonic saline were selected as control group,then the score of GCS, ICS,RLS85 and the improvement of adenohypophysis function were observed. Results After treatment,the score of glasgow coma scale (GCS ), innsbruck coma scale (ICS),and the reaction level scale (RLS85)between two groups were significantly increased in three days compared with before treatment,and within three days after injury situation,the improvements of ICS and RLS85 in experimental group were better than control group(P<0.05 ). Compared with control group,the levels of each gland pituitary hormone in experimental group were significantly increased(P<0.05 ),and on the third day,the growth hormone (GH)was reduced significantly,finally 50%of that in control group. Conclusion Patients with brain injury treated with thyrotropin releasing hormone,has no significant adverse reactions,with the characteristics of safe and effective.

OBJECTIVE: To investigate the pattern of cervical lymph node metastasis in hypopharyngeal carcinoma. METHOD: Forty-five cases of hypopharyngeal squamous cell carcinoma were analyzed retrospectively. RESULT: (1) The total rate of lymph node metastasis was 75.56%. 11.11% metastases for bilateral neck and 4.44% did unilateral neck in 10 bilateral neck dissection. The total distance metastasis rate out of lymph node were 79.41%. The rate of bilateral distance metastasis and unilateral distance metastasis were both 5.88% in 10 bilateral neck dissection. (2) 163 of 411 lymph nodes (39.66%) were positive. The percentage of positive lymph node were 0.61%, 49.08%, 25.77%, 21.47% and 3.07% in region I, II, III, IV and V respectively. The rates of lymph node metastasis were 3.57%, 62.02%, 37.17%, 42.17% and 8.62% in region I, II, III, NV and V respectively. (3) The statistical significant differences were found between region I + V and II + III and IV (P < 0.05), among II, III and IV (P < 0.05), between II and III + IV (P < 0.05), between II and III (P < 0.05), between II and IV (P < 0.05), among I, II, III, IV and II + III + IV (P < 0.05), among V, II, III, IV and II + III + IV (P < 0.05). There were not statistical significant differences in region between III and IV (P > 0.05), between I and V (P > 0.05). (4) There were not statistical significant differences in the rates of lymph node metastasis and capsule invasion between T1 + T2 and T3 + T4 (P > 0.05), among T1, T2, T3 and T4 (P > 0.05). (5) There were not statistical significant differences in the rates of lymph node metastasis and distance metastasis between pyriform sinus and out of it (P > 0.05). (6) There were not statistical significant differences in the rates of lymph node metastasis and distance metastasis between cervical esophagus invasion and not (P > 0.05). (7) There were not statistical significant differences in the rates of lymph node metastasis and distance metastasis among N1, N2, N3 (P > 0.05). (8) There were statistical significant differences in the rates of lymph node metastasis between clinical stage I + II + III and IV, between II and IV (P < 0.05). While there were not statistical significant differences in the rates of distance metastasis between III and IV (P > 0.05). CONCLUSION The lymph node metastasis was mainly in the region II, III and IV, especially in the region II. T stage, primary site and cervical esophagus invasion were not related to neck lymph node metastasis and distance metastasis. N stage was not related to distance metastasis. Clinical stage IV had a higher lymph node metastasis rate.
Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; Female ; Humans ; Hypopharyngeal Neoplasms ; pathology ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies

OBJECTIVETo carry out clinical and genetic analysis for three pedigrees affected with myotonic dystrophy type 1 (DM1).

METHODSThree probands with clinically diagnosed DM and their familial members were recruited. Clinical data of the patients including clinical manifestations, electrocardiogram (ECG), and electromyogram (EEG) was collected.

RESULTSThe clinical symptoms of all probands have progressed slowly and included myotonia, muscle weakness and muscle atrophy as the main manifestations. Disorders of other systems have included cataract, arrhythmia, alopecia, sexual dysfunction, and cognitive impairment. The EEG of the probands showed characteristic myotonia discharges. Genetic analysis revealed over 50 CTG repeats at the 3' end of the DMPK gene in all three probands.

CONCLUSIONDM1 is a complex hereditary disorder involving multiple systems and overlaps with other diseases. In addition to clinical symptoms and EEG, genetic testing can facilitate its diagnosis at early stages.

Adult ; Electrocardiography ; Electroencephalography ; Female ; Genetic Testing ; Humans ; Male ; Middle Aged ; Myotonic Dystrophy ; genetics ; physiopathology ; Pedigree

Adult ; Ataxin-1 ; genetics ; DNA Mutational Analysis ; Family Health ; Female ; Humans ; Male ; Middle Aged ; Pedigree ; Spinocerebellar Ataxias ; diagnosis ; genetics ; Trinucleotide Repeat Expansion ; genetics

Adult ; Aged ; Aged, 80 and over ; Essential Tremor ; genetics ; Female ; Humans ; Male ; Middle Aged ; Parkinson Disease ; genetics ; Torticollis ; genetics