Objective:To understand the current service capacity of village clinics in H District of Beijing, to find out the existing problems and deficiencies, and to provide the basis for the development of village health poli-cy. Methods:The census method was used to investigate all the village clinics in H District of Beijing, and 260 rural doctors were investigated. Purposive sampling method was used to select 3 townships in H District of Beijing and 6 villages in each township as the research field. Observation and in-depth interviews were used in this study, and the sample size was 18 rural doctors. Results: At present, the village clinic in H district of Beijing has the problems of low quality of personnel, lack of business premises, inadequate infrastructure, and poor service capaci-ty. Conclusion:In order to improve the service capacity of village clinic in H District of Beijing City, it is sugges-ted to establish human resources management system, improve the overall quality of rural doctors, manage systemat-ically and improve the level of resource allocation in village clinics.

OBJECTIVETo assess the efficacy and toxicity of the kangai injection combination of fludarabine (Flud), cytosine arabinoside (Ara-C), and granulocyte colony-stimulating factor (G-CSF) (FLAG) in refractory/relapsed acute leukemia (AL) patients.

METHODFrom 2004 to 2010 in our hospital, the 49 cases of refractory/relapsed acute luekemia were randomly divided into treatment group (28 cases) and control group (21 cases). The control group were treated by kangai injection plus FLAG regimen, and the control group were treated by FLAG regimen.

RESULTThe remission rate of treatment and total effective rate treatment group were 57.1% (16/28) and 71.4% (21/28), the control group were 52.3% (11/21) and 61.9% (13/21), there were no significant differences in the two groups. Duration of neutrophils less than 0.5 x 10(9)/L in treatment group was (14 +/- 6) day, control group was (23 +/- 3) day, Duration of platelet less than 25 x 10(9)/L in treatment group was (17 +/- 6) day, control group was (31 +/- 2) day, treatment group of III-IV degree of infection was 6.9% (1/28) and control group was 23.8% (5/21) between the two groups were significantly different (P < 0.05). treatment group of III- IV degree of gastrointestinal; toxicity was 10.7% (3/28) and control group was 28. 5% (6/ 21).

CONCLUSIONKangai injection plus FLAG regimen could increase the remission rate, shorten the period of bone marrow suppression, significantly reduced the incidence and degree of infection, play a important role in attenuated efficiency.

Acute Disease ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; adverse effects ; Cytarabine ; administration & dosage ; adverse effects ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; Female ; Granulocyte Colony-Stimulating Factor ; administration & dosage ; adverse effects ; Humans ; Injections ; Leukemia ; drug therapy ; Male ; Middle Aged ; Vidarabine ; administration & dosage ; adverse effects ; analogs & derivatives

This study was aimed to explore traditional Chinese medicine (TCM) professor Niu Jianzhao's medication rule in prescription with climacteric syndrome.Prescriptions treating climacteric syndrome that built by professor Niu were collected to build a database based on TCM Inheritance Assist System.The method of association rules with apriori algorithm was used to achieve frequency of single medicine,nature,taste and channel tropism of herbs,frequency of drug combination,association rules between herbs and core herb combinations.The data mining results showed 22 types of herbs used with high frequency,28 pairs of herb combination with most frequency,20 groups of herb association rules with the confidence of more than 0.95,52 herb pairs with high association,32 groups of three herbs as the core combinations,and 7 new prescriptions.It was concluded that in professor Niu Jianzhao's treatment of climacteric syndrome,the drugs were commonly used to invigorate the kidney,liver and spleen,and in combination with promoting blood circulation and calming the nerves.The medicinal properties of used herbs were even,warm or slightly cold.The tastes of used herbs were sweet,bitter and spicy.The channel tropisms of used herbs were the liver,kidney and lung meridian.This study highlighted data mining as an important tool for expedited analysis of TCM professor Niu Jianzhao's medication rules in prescriptions with climacteric syndrome.

Objective:To investigate the correlation of rural doctors' service ability and interest demands,and analyze the countermeasures for improving the service capacity of rural doctors from the perspective of the personal interest demands of rural doctors. Methods:Through the combination of qualitative and quantitative research meth-ods,we described the current situation and correlation of rural doctors'service ability and interest demands. Result:The interest demands of rural doctors mainly included raising the level of old - age insurance,increasing economic subsidies,clarifying the position of rural doctors,increasing the training opportunities and solving practice risk. These five demands had different level effect on the service ability of rural doctors. Conclusion:It should compre-hensively promote the progress of rural integration,improve the rural doctor's economic subsidies and pension secu-rity level and integrate rural doctor into medical and health system;establish a rural doctor' risk sharing mechanism to solve the practice risk of rural doctors;optimize the training mechanism for rural doctors to improve the technical level of rural doctors.

Objective:To summarize the experience of laparoscopic transabdominal preperitoneal hernia repair (TAPP) and to discuss its safety and feasibility.Methods:Data of 26 consecutive cases from January 2015 to March 2018 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. They were all males, aged (68.3±14.1) years, with a range from 57 to 86 years. Body mass index was (23.3±4.1) kg/m 2. Bathel indexwas 91.4±5.6. Intraoperative main procedures were done in accordance to Guideline of Standardized Operation for Laparoscopic Inguinal Hernia Repair. A drainage tube or catheter was not routinely placed intraoperatively. Patients were discharged but for any complaints. Observation data included intraoperative, postoperative and following-up data. The following-up period was more than 12 months by telephone or clinic. The long-term complications and the changes of Barthel index were observed. Paired sample t test was used to compare the changes of Barthel index before and after operation. Results:Of the 26 cases, none was converted to open procedure and no intra- or post-operative serious complications occurred. Occurrence of surgical site seroma was 17 (65.4%) cases. The operating time was (76.5±23.6) min. Intraoperative blood loss was (8.6±4.4) mL. The postoperative hospitalization was (2.3±1.2) d. Bathel index in 1 month postoperative was 96.9±3.2. It was higher statistically than that preoperative ( t=-6.968, P=0.000). Conclusions:TAPP in the treatment of huge inguinoscrotal hernia is safe and feasible. Mastering the anatomical characteristics and the according procedures is an important factor for successful operation.

Objective:To understand the satisfaction of villagers on the service of village clinics,in order to improve the service ability of village clinics.Methods:Choosing M County of Beijing as the research site,we chose five towns and chose 10 villages in each town as the studysites.In the extraction 50 villages,about 5 villagers from each village were selected to conducts questionnaire survey.Results:Of the villagers surveyed,the average age was (55.99 ± 11.71)years old.A total of 75.0％ of the villagers chose to seek medical care in village clinics when they had common diseases.The order of the number of people that villagers were satisfied with the village clinicsin all aspects from high to low was drug quality,basic medical care,public health,the type and quantity of drugs,medical equipment.Conclusion:It should give priority to the introduction of the village talent and weave tertiary health care network bottom tightly;pay attention to hardware equipment at basic level and tamp the service status of village clinics;give consideration to both the benefit and public welfare and improve health service ability.

Objective:To investigate the efficacy of the Mini-Mental State Scale (MMSE) versus the Montreal Cognitive Assessment Scale (MoCA) in screening cognitive impairment in patients with a lacunar cerebral infarction. Methods:138 eligible patients who received treatment in the Affiliated Hospital of Shanxi Datong University from January 2018 to October 2019 were recruited for this study. They received cognitive function evaluation by the MMSE and MoCA. These patients were grouped according to the median number of age or the median number of years of education. The sensitivity and consistency of the MMSE versus MoCA in screening cognitive impairment in patients with a lacunar cerebral infarction were analyzed using the χ2 test. The total cognitive scores of the MMSE and MoCA, and the scores of each cognitive domain such as memory, execution, visual space, attention, language, and orientation, were compared between groups using multiple linear regression analysis. Results:The sensitivity of MoCA in screening for cognitive impairment in low-age, high-age, low-year-education, and high-year-education groups and the whole population of patients with a lacunar cerebral infarction was 76.5%, 75.7%, 74.2%, 77.8%, 76.1%, respectively, which were significantly higher than those of MMSE (44.1%, 65.7%, 60.6%, 50.0%, 55.1%, χ2 = 12.17, 13.13, 9.33, 15.75, 23.86, all P < 0.01). The Kappa coefficients of low-age, high-age, low-year-education and high-year-education groups were 0.336, 0.391, 0.358, 0.389, and 0.373, respectively, all of which were less than 0.4 (all P < 0.01). These findings suggest that the consistency of the two scales in screening cognitive impairment is poor. The cognitive impairment detection rate by the MMSE was significantly higher in the high-age group than in the low-age group (65.7% vs. 44.1%, χ2 = 6.50, P < 0.05). The total cognitive scores of MMSE and MoCA and the scores of memory, execution, visual space, attention, language, and orientation in patients with a lacunar cerebral infarction were significantly lower in the high-age group or low-year-education group than in the low-age group ( tMMSE = 3.61, 2.49, 3.12, 4.26, 1.70, 3.69, 2.24, all P < 0.01; tMoCA = 3.83, 1.75, 3.28, 3.80, 2.21, 4.08, 2.52, all P < 0.05) or high-year-education group ( tMMSE = -2.87, -2.32, -0.85, -2.54, -0.73, -2.57, -2.96, all P < 0.01; tMoCA = -2.95, -1.12, -3.39, -1.54, -1.52, -3.09, -3.02, all P < 0.05). Conclusion:Combined application of MMSE and MoCA has a high clinical value in screening cognitive impairment in patients with a lacunar cerebral infarction. High-age patients with a lacunar cerebral infarction who receive low-year education have memory, execution, visual space, attention, language, and orientation impairments.

Objective:To estimate and analyze the occurrence of post-thyroidectomy syndrome (PTS) following endoscopic thyroidectomy via areola approach (ETAA) vs open thyroidectomy (OT) .Methods:Data of 903 consecutive cases, aged from 20 to 66 with 231 males and 672 females, in Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, from Jan. 2016 to Dec. 2017 were analyzed retrospectively. They were enrolled according to the same criteria. Based on different procedures, the cases were divided into ETAA group (n=162) and OT group (n=741) . Intraoperative procedure was according to unified principle. Drainage tube was removed if 24-hour drainage volume was less than 20 ml. Following-up was implemented by telephone or outpatient clinic. Data of 2 groups of 5 PTS items during 1 m, 3 m, 6 m and 1 y postoperatively and the scores of the medical outcomes study short form 36-item health survey (SF-36) V2 were analyzed by independent sample t test and repeated measures analysis of variance. Results:The patients of 2 groups were all followed up for more than 1 y with 43 cases censored (4.8%) . Demographic data of the rest of 2 groups were not different statistically ( P>0.05) . Median of every phase scores of the 5 items of PTS were 0 to 1. Scores of the 5 items were decreased gradually in accordance with time factor ( P=0.000) . The scores of peculiar feeling at the surgical site and discomfort in neck were different statistically during 1 m and 3 m postoperatively ( P=0.000) . Incidence of peculiar feeling at the surgical site in 1 m and 3 m postoperatively in ETAA group (54, 38.8% and 8, 5.8%) was higher than that in OT group (153, 21.2% and 20, 2.8%) . However, incidence of discomfort in neck in ETAA group (14, 10.1% and 0) was lower than in OT group (194, 26.9% and 53, 7.4%) . The other 3 items at all phases were not different statistically ( P>0.05) . The SF-36 V2 scores at 1 y postoperatively of 2 groups were not different statistically ( P=0.458) . Conclusions:PTS is a common symptom after OT or ETAA. It is frequent within early phase after thyroidectomy and is decreased significantly within 6 m. Peculiar feeling at the surgical site occurs less in OT than in ETAA in early postoperative phase and discomfort in neck occurs more, conversely.