With the further expansion of the connotations of the quality of medical services and the establishment of the bio psycho social medical model, it has become necessary to redefine quality evaluation of medical services. The authors give their interpretation of the quality of medical services and its evaluation from several perspectives, discuss the goals of quality evaluation of medical services, and expound in a rational manner the entire process and content of quality evaluation. On the basis of this, they make a comment on previous quality evaluation units and methods and put forward the tentative idea of conducting overall quality evaluation of whole process medical services.

Objective To detect the change and clinical significance of homocysteine (Hcy),hypersensitivity C response protein (hs-CRP) and hypersensitivity troponin I (hs-TnI) in patients with acute myocardial infarction (AMI).Methods Ninety-six cases of AMI were selected as the research group and 60 cases of coronary heart disease without AMI were enrolled in the control group.Blood samples were collected to measure the contents of serum Hcy,hs-CRP and hs-TnI.ROC curve was drawn and Logistic regression model was established to analyze the role of each index alone and combined detection in the diagnosis of AMI.Results The levels of Hcy,hs-CRP and hs-TnI in the research group were significantly higher than those in the control group (Hcy: (29.29±7.65) mol/L vs.(17.23±4.68) mol/L;hs-CRP: (15.47±5.01) mg/L vs.(9.21±3.15) mg/L;hs-TnI: (40.88±9.18) ng/mL vs.(7.34±2.12) ng/mL,t=2.78,8.66,34.36,P<0.05).The area under the ROC curve of Hcy,hs-CRP,hs-TnI were 0.802 (95%CI(0.729~0.874)),0.71(95%CI(0.62~0.792)),0.929 (95%CI(0.891~0.967)),respectively.The area under the combine detection curve was 0.971 (95%CI,0.950~0.992).The sensitivity of Hcy,hs-CRP and hs-TnI in the diagnosis of AMI were 79%,57%,87%,respectively,the specificity of the three groups were 72%,70%,90%,the sensitivity and specificity of combined detection were 96% and 88%.Conclusion Combined detection of Hcy,hs-CRP and hs-TnI plays a better role in the diagnosis of AMI than that of Hcy,hs-CRP,hs-TnI alone and has a high specificity and sensitivity in the diagnosis of AMI.

Glucagonoma is a kind of neuroendocrine tumor of the pancreas,which is rarely seen in clinical practice.Glucagonoma is characterized by necrolytic migratou erythema (NME),diabetes,anemia and body weight loss,and NME is the most characteristic clinical manifestation.The most important laboratory basis of glucagonoma is the levels of fasting plasma glucagon.Various imaging examinations are helpful for the localization of the tumor.Operation is the main method for the treatment of glucagonoma.A patient with glucagonoma was admitted to the Affiliated Hospital of Binzhou Medical College in December 2013,and the experiences in the diagnosis and treatment of glucagonoma were shared based on the data of this patient.

Objective To discuss the protective effect of creatine phosphate (CP)on isolated rat liver against cold preservation.Methods Isolated perfused rat liver model under simple cold preservation was established.The liver of the control group was perfused with pure University of Wisconsin (UW)solution. With UW solution as the base fluid,the liver of the low-dose group was perfused with 1 g/100 ml CP in UW solution;the liver of the middle-dose group was perfused with 2 g/100 ml CP in UW solution;the liver of the high-dose group was perfused with 3 g/100 ml CP in UW solution.The livers of each group were cold preserved in the corresponding perfusion fluid at 4 ℃.The content of alanine aminotransferase (ALT)and lactate dehydrogenase (LDH)in preservation solution in infrahepatic vena cava were determined.The content of malondialdehyde (MDA)and activity of myeloperoxidase (MPO)in liver tissues were detected.The apoptosis index (AI)of liver cells in liver tissues and positive expression rate of NF-κB in liver tissues were observed. Pathologic changes of liver tissues were observed under optical microscope.Results At 12 h after the cold preservation,the content of ALT and LDH in the rat livers of low-,middle-and high-dose groups were lower than those of the control group (all in P <0.05).At 18 h after the cold preservation,the content of MDA and MPO in the liver tissues of low-,middle-and high-dose groups were lower than those of the control group (all in P <0.05).At 12 h and 18 h after the cold preservation,AI and positive expression rate of NF-κB in liver cells in the rat livers of low-,middle-and high-dose groups were lower than those of the control group (all in P<0.05).At 24 h after the cold preservation,the content of ALT and MDA in preservation solution of the high-dose group was obviously higher than that of the control group as well as the low-and middle-dose groups (all in P <0.05).The results of pathological examination indicated that the injuries to the livers of the high-,middle-and low-dose groups were obviously lighter than that of the control group.There was no obvious difference among each dose group.Conclusions CP in UW solution may well protect the isolated rat liver against cold preservation,which is better than pure UW solution.

Clinical data of a case of occult pulmonary actinomycosis with foreign body admitted to Shenzhen Children′s Hospital were retrospectively analyzed, and the relevant literatures were retrieved and reviewed.A female patient aged 6 years and 9 months planned to receive hematopoietic stem cell transplantation due to thalassemia.During the plain chest CT examination before the transplantation, flakes of shadows were examined in the right lower lung.The child had no clinical symptoms or pulmonary signs.The granulation tissue hyperplasia of the right lower lobe was detected by tracheoscopy, which was harvested for examination under tracheoscopy, and actinomycete infection was confirmed.Several bone fragments were found wrapped inside the granulation.After 6 months of treatment with Amoxicillin and Clavulanate potassium, the tracheoscopic manifestations and chest CT were improved.Pulmonary actinomycosis is a rare pulmonary infectious disease, which is much rarer in children than adults, manifesting as an insidious onset and atypical clinical manifestations.However, foreign bodies in children′s airway are common, which is favorable to infection.In clinical detection of actinomycete infection, the cause of infection should be concerned to prevent misdiagnosis and mistreatment.

OBJECTIVETo analyze the value of the diagnostic criteria for bladder outlet obstruction in benign prostatic hyperplasia (BPH).

METHODSA total of 358 patients with BPH were divided into 3 grades according to fibrous urethrocystoscopy information on the severity of obstructions, which were classified as Grade 1 (slight), Grade 2 (moderate), and Grade 3 (severe). By Schäfer's graph they were divided into 7 grades, represented by 0 to VI. We analyzed the volume of prostate, maximum flow rate (Qmax), residual urine volume, International Prostatic Symptom Score (IPSS) and detrusor instability. Statistical analysis ANOVA (analysis of variance) was made, spearman correlation evaluated and the coefficient of determination measured.

RESULTSOf all the patients, 27 were classified as Grade 1, 236 as Grade 2 and 95 as Grade 3. Eighty-four patients had detrusor instability. The volumes of the prostate ranged from 16 ml to 145 ml, averaging (47.04 +/- 15.61) ml. The mean maximum flow rate was (10.02 +/- 2.12) ml/min and the mean residual urine volume was (84.06 +/- 36.50) ml. With the increase of the severity of obstruction, the volume of the prostate increased (F = 4.216, P < 0.05), IPSS rose (F = 8.408, P < 0.001), the maximum flow rate decreased (F = 22.43, P < 0.001), the residual urine volume rose (F = 163.232, P < 0.001), the incidence of detrusor instability increased (F = 23.637, P < 0.001) and Schäfer's grades were elevated (F = 202.897, P < 0.001). The volume of the prostate, the maximum flow rate (Qmax), residual urine volume, IPSS detrusor instability and Schäfer's grades were all correlated significantly with the severity of the obstruction. The correlation index and coefficient of determination were r = 0.29, R2 = 0.08; r = 0.35, R2 = 0.12; r = -0.69, R2 = 0.47; r = 0.60, R2 = 0.36; r = 0.33, R2 = 0.11; r = 0.72, R2 = 0.52; respectively. The correlation between the urethrocystoscopy information and Schäfer's graph on the severity of the obstruction were the best criteria of all.

CONCLUSIONThe severity of the obstruction at urethrocystoscopy correlates well with that at urodynamic investigation. Such criteria could improve the sensitivity and specificity of the diagnosis of bladder outlet obstruction.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; diagnosis ; Retrospective Studies ; Urinary Bladder Neck Obstruction ; diagnosis ; etiology ; Urodynamics

Objective To investigate the intra- and interobserver repeatability of coronary artery disease (CAD) diagnosis based on invasive coronary angiography (ICA) and CT coronary angiography (CTCA).Methods Two readers with comparable experience ( over 10 years) independently evaluated ICA results of 42 consecutive patients with a blind method. After 30 days,one of them reviewed the same patients again.Another two comparable-experience (over 10 years) readers evaluated the results of CTCA (prospectively ECG-triggering) from the same 42 patients in the same way.The inter-reader and intra-reader repeatability of ICA and CTCA were analyzed by performing Kappa test and calculating the percentage of the segments with agreement on stenotic degree.Using ICA as reference,the accuracy of CTCA in diagnosing CAD was studied by comparing the area under ROC. Results The Kappa between readers for ICA and CTCA were 0.91 and 0.81.Intra-reader Kappa were 0.92 and 0.83 respectively (x2 =509.4 and 432.5,all P ＜0.01 ).The percentage of the segments with agreement between readers on the degree of stenosis were 80.8％ (494/611) in ICA and 75.2％ (469/624) in CTCA ( x2 =2.75,P =0.10),and within the same reader,86.9％ (531/611)in ICA and 81.9％ (511/624) in CTCA(x2 =3.76,P =0.053).With≥ 50％narrowing as a CAD diagnosis criterion,the agreement rates for two readers were 96.6％ (590/611 ) in ICA and 94.4％ (589/624) in CTCA( x2 =3.36,P =0.07),and for the same reader,97.4％ (595/611) in ICA,95.4％ (595/624) in CTCA ( x2 =3.62,P =0.06).Using ICA as reference,two readers of CTCA results achieved a sensitivity and specificity of 84.9％ (530/624)and 98.1％ (612/624).The area under ROC was 0.94 (95％ CI 0.91-0.97).Conclusions Both ICA and CTCA demonstrate good repeatability in diagnosing CAD.The repeatability of ICA is superior to that of CTCA.A certain discrepancy exists in two readings from the same reader or two readers.

Objective:To study the characteristics and influencing factors of vaginal microbiota in normal pregnant women.Methods:This study was based on a cohort of pregnant women established in Anqing Municipal Hospital Affiliated to Anhui Medical University from February 2018 to February 2020. Vaginal samples of normal pregnant women who met the inclusion and exclusion criteria were ordered by the gestational weeks at sampling. Five samples were randomly selected from each gestational week group and if the samples were less than five, all samples were included. Sequencing of the V3-V4 region of the 16S rRNA gene was performed. Dominant species were analyzed by MicrobiomeAnalyst. Alpha diversity was measured with Chao1, Observed Features, Shannon diversity, Simpson diversity, Faith_pd and Pielou′s Evenness. The dominant status of Lactobacillus was also described and compared. Multiple linear regression and logistic regression were used to analyze the factors influencing vaginal microbiota. Analysis of variance and Kruskal Wallis test were used for statistical analysis of continuous variables, and Chi-square test and Fisher′s exact test were used for categorical data. The differences were considered statistically significant when the P value was less than 0.05. Results:This study enrolled 91 pregnant women (91 vaginal samples) with an average age of (27.37±3.60) years. There were 18, 56 and 17 vaginal samples collected at the median gestational age of 11.93 weeks (the first trimester), 19.43 weeks (the second trimester) and 38.29 weeks (the third trimester), respectively. The relative abundance of Firmicutes and Lactobacillus was 91.30% and 87.67%, respectively. Lactobacillus iners and Lactobacillus crispatus had a relative abundance of 43.95% and 36.33%, respectively. Moreover, Lactobacillus iners-dominated vaginal microbiota was detected in all trimesters. The number of samples with high relative abundance of Lactobacillus iners gradually decreased with gestational age. Lactobacillus crispatus-dominated vaginal microbiota was found in the second and third trimesters and the number of samples with high relative abundance gradually increased during pregnancy. The Alpha diversity of vaginal microbiota had a decreasing trend during the gestation. There were significant differences in Pielou′s Evenness diversity index of vaginal microbiota between different smoking groups ( P<0.05) and in Shannon diversity index between different drinking groups ( P<0.05). There were significant differences in Chao1, Observed Features and Faith_pd diversity index of vaginal microbiota between pregnant women with different education ( P<0.05) and in Shannon and Simpson diversity index between different income groups ( P<0.05). Conclusions:Vaginal microbiota was dominated by Lactobacillus in normal pregnant women. The dominance of Lactobacillus iners gradually decreased, while that of Lactobacillus crispatus increased during gestation. In normal pregnant women, the Alpha diversity of vaginal microbiota was correlated with smoking, drinking, education and family annual income. Smoking cessation and drinking before pregnancy were related to lower Alpha diversity of vaginal microbiota in pregnant women, while lower education and higher family income were associated with higher Alpha diversity.

Objective:To study the characteristics of vaginal microbiota in pregnant women with premature rupture of membranes (PROM) and to establish prediction models for PROM.Methods:This study involved 35 women with preterm premature rupture of membranes (PPROM), 180 with term premature rupture of membranes (TPROM) and 255 term birth cases without premature rupture of membranes (TBWPROM, control group). The V3-V4 hypervariable region sequences in the vaginal samples collected at 16-28 weeks of gestation were detected by 16S rRNA gene next-generation sequencing. The differences in Alpha and Beta diversity, and the attributes and metabolic function prediction of each recognized species among the three groups were analyzed. Subsequently, a random forest model was used to establish the prediction models for PROM using vaginal microbiota species and environmental risk factors.Results:Compared with the control group, the Alpha diversity of the PPROM group was higher (Observed features, P=0.022; Faith_pd index, P=0.024) and Beta diversity was also significantly different (Unweighted UniFrac, P=0.010; Jaccard index, P=0.008). In PPROM cases, Megasphaera genomosp. typeⅠ was significantly increased ( P=0.017) and Lactobacillus mulieris was significantly decreased ( P=0.003). In the patients with TPROM, Megasphaera was significantly increased ( P=0.009) and Lactobacillus mulieris was significantly decreased ( P=0.002). In terms of functional pathways, sulfur oxidation ( P=0.021), methanogenesis from acetate ( P=0.036), L-histidine biosynthesis ( P=0.009), adenosylcobalamin biosynthesis ( P=0.041) and fucose degradation ( P=0.001) were significantly increased in patients with PPROM; L-histidine biosynthesis ( P<0.001) and fucose degradation ( P=0.030) were significantly increased in patients with TPROM. The prediction models were established using the random forest model with vaginal microbiota species and environmental risk factors and the prediction model for PPROM performed well [AUC: 0.739 (95%CI: 0.609-0.869), sensitivity: 0.928, specificity: 0.659, positive predictive value: 0.750, negative predictive value: 0.906], which had a certain reference value. Conclusions:Vaginal microbiota might be related to the development and progression of PROM. Studying the differences in vaginal microbiota might provide a new idea for the prevention and treatment of PROM. Functional prediction provided a direction for further research on the mechanism of PROM. The established prediction model could prevent the occurrence of PPROM and promote maternal and infant health.

Background: Abnormal glucose metabolism is one of the malignant characteristics of tumors. LncRNA plays an important role in the process of aerobic glycolysis of tumors. Aims: To investigate the expression of LncRNA MEG3 in gastric cancer and its correlation with glycolysis. Methods: RT-qPCR was used to detect the mRNA expression of MEG3 in gastric cancer and paracancerous tissue. Immunohistochemical EnVision method was used to detect the protein expressions of PKM2, LDHA, mTOR, HIF-1α in gastric cancer and paracancerous tissue. Relationship between expressions of above-mentioned indices and clinicopathological features of gastric cancer were analyzed. The correlation between MEG3 and glycolysis level of gastric cancer was analyzed by Spearman correlation analysis, and its possible mechanism was explored. Results: The expression of MEG3 in gastric cancer tissue was significantly lower than that in paracancerous tissue (P< 0.05), and was correlated with lymph node metastasis (P<0.05). The positivity rates of expression of PKM2, LDHA, mTOR and HIF-1α in gastric cancer tissue were significantly higher than those in paracancerous tissue, and were correlated with the depth of tumor invasion, lymph node metastasis and pTNM stage (P<0.05). Spearman correlation analysis showed that the expression of MEG3 was negatively correlated with the expressions of PKM2, LDHA, mTOR and HIF-1α (r=-0.346，r= -0.306，r=-0.389, r=-0.338; P<0.05). The expression of MEG3 in HIF-1α