The control handles( including financing, provider payment, organization, regulation and behavior) proposed by World Bank in health policy research as the basic framework,and the nature and positioning of family doctors′ contract-based service as the precondition, we recommended the system framework of such a mechanism, comprising one contract, three regulations, five control handles and seven supporting policies. Such a framework can serve as the cornerstone for family doctors′ contract-based service experiment in Zhejiang province for the sake of hierarchical medical system.

Objective To develop a microsphere-based suspension array for simultaneous detec-tion and identification of Salmonella H antigens by using Luminex xTAG technology and to evaluate its capa-bility in serotyping Salmonella strains. Methods The fliC and fljB genes, encoding the H antigen of Salmo-nella, were selected as the target genes. Universal upstream primers were designed based on the highly con-served regions of fliC and fljB genes, and the corresponding specific reverse primers were designed based on the variable regions. While synthesizing, the 5′end of each upstream primer was labeled with biotin and the 5′end of each specific reverse primer was modified with its certain TAG sequence. After amplified and la-beled with biotin and TAG sequence, the PCR products of specimens were hybridized with the mixture of va-rious MagPlex-xTAGTM microspheres. Each set of microspheres contained its unique anti-TAG sequences. The results of hybridization were analyzed by using Luminex MagPix reader system and the median fluores-cence intensity ( MFI) was reported. The H antigens of 145 Salmonella strains were identified with this de-veloped xTAG suspension array, and the results were compared with those obtained by using traditional ser-um agglutination test. Results The PCR products of different H antigens ranged from 94 bp to 245 bp and could be identified by hybridizing with MagPlex-xTAGTM microspheres. There was no cross-reaction between different H antigens or with DNAs derived from Escherichia coli, Vibrio cholerae, Vibrio parahaemolyticus and Shigella flexneri. Compared with the traditional serum agglutination test, the sensitivity and specificity of the xTAG suspension array in the identification of H antigens of 145 Salmonella strains were 95. 1% and 100%, respectively. Conclusion The developed xTAG suspension array was a specific, accurate and effective method for simultaneous detection and identification of 31 H antigens of common Salmonella serovars strains. It could be used for determining the H antigens of more than 90 Salmonella strains within 5 hours.

Objective To explore the influence of individualized nursing intervention on life quality of patients with rheumatoid arthritis. Methods 60 patients were divided into the intervention group and the control group with 30 cases in each group. The intervention group adopted individualized nursing projects according to the influencing factors of life quality based on routine nursing. The control group received routine nursing only. The life quality of the two groups was appraised by inventory before and after intervention. Results The status such as physiological function, mental function, social function and self-recognized health in the intervention group was greatly ameliorated and was statistically different from that in the control group(P＜0.05).Conclusion Individualized nursing intervention could dramatically improve the life quality of patients with rheumatoid arthritis

Objective To establish the genetic test technique of trisomy 21 concurrently conducts with prenatal diagnosis for hereditary hearing loss. Methods Fifty-four pregnant women who underwent prenatal diagnosis for hearing loss of their fetuses in Chinese People's Liberation Army General Hospital from March 2009 to May 2010 were enrolled in this study. All probands from the deaf families have confirmed the causative mutation for hearing loss in Genetic Testing Center in Chinese People's Liberation Army General Hospital. The mean age of 54 pregnant women is 31 years at pregnancy of 18 - 26 weeks, 5 cases ＞ pregnancy of 23 weeks, 9 cases ≥ 35 years. All subjects did not conduct the serologic tests for trisomy 21before. Fifteen to twenty ml amniotic fluid was drawn from 49 cases at pregnancy of 18 - 23 weeks and 5 cases ＞ pregnancy of 23 weeks. One to two ml umbilical blood was drawn from 5 cases ＞ pregnancy of 23 weeks. For 9 cases ≥ 35 years, amniotic fluid cell culture and karyotyping analysis were conducted concurrently. A multiple quantitative fluorescent ( QF) PCR and six microsatellite markers were applied to as trisomy 21. Results (1) Fifty-four fetuses were successfully conducted prenatal genetic diagnosis for hearing loss (included GJB2 and SLC26A4). Ten fetuses copied the exactly same genotypes as the probands. The other 44 cases fetuses did not copy the same genotypes as the probands and won't develop hearing loss. The hearing test showed normal hearing for the neonates. (2) All the 54 fetuses were excluded of trisomy 21 by QF-PCR and were verified after birth. Five fetuses with advanced maternal age were performed karyotyping analysis and showed normal. The diagnostic results of QF-PCR can be obtained in 1 - 3 days without misdiagnosed. Conclusions QF-PCR is an efficient, rapid and accurate technique for detection of trisomy 21 without increasing sample amount. It can be used for fetuses who were undertaken hearing loss gene test or other prenatal gene test.

Objective:To observe the effect of Jieyu Anmian prescription of Chinese medicine foot bath on gastrointestinal function in patients with digestive system tumor during perioperative period.Methods:A total of 130 patients with digestive system tumors were chosen from January 2019 to March 2020 for the first time visits to the first hospital of lanzhou university for surgical treatment, 15 cases lost follow-up, and the rest 115 cases of patients were divided into the experimental group (59 cases) and the control group (56 cases) according to random number table method. The control group using conventional care method, the experimental group was treated with Jieyu Anmian washing formula on the basis of routine nursing care for 10 days. During the foot bath, the recovery of gastrointestinal function, the time of the first exhaust and defecation, the length of stay, the cost of stay and the satisfaction of patients were compared between the two groups.Results:The recovery time of bowel sounds, anal exhaust time and first defecation time of the experimental group were all earlier than those of the control group (16.21±11.81) h, (19.64±12.40) h and (41.98 ±19.16) h, respectively, while those of the control group were (27.34±31.47) h, (35.81±18.26) h and (34.47±16.41) h, respectively. The differences were statistically significant ( t value was -2.41, -5.33, 2.17, P< 0.05). The results of the survey of patient satisfaction showed that the experimental group was superior to the control group, with 97.47 ± 4.37 in the experimental group and 94.19 ± 3.29 in the control group, with statistically significant differences ( t value was 3.89, P<0.01). The satisfaction of doctors in the experimental group was 97.41 ± 6.25 and 94.21±5.91 in the control group, with statistically significant difference ( t value was 3.95, P<0.05). The satisfaction of nurses in the experimental group was 97.58 ± 4.53 and 93.85±5.23 in the control group, and the difference was statistically significant ( t value was 4.12, P<0.05). There was no significant difference between the two groups in terms of length of stay and hospitalization expenses ( P>0.05). Conclusions:Jieyuanmian prescription of Chinese medicine foot bath can promote the recovery of gastrointestinal function, promote the exhaust and defecation, and improve the satisfaction of patients and nurses.

Objective To investigate the effect of multidisciplinary diagnosis and treatment including ex-utero intrapartum treatment (EXIT) procedure to improve the prenatal survival rate of fetus with neck mass.Methods Multidisciplinary diagnosis and treatment model were carried out in four pregnancy women with fetal neck mass from September 2007 to February 2010.The model included prenatal assessment and monitoring,EXIT procedure during cesarean section,neonatal reassessment and surgical treatment by the cooperation of obstetricians,neonatologists,children surgeons,sonographers and anesthetists.Results All patients underwent cesarean section after 37gestational weeks.Mean delivery time was 37+4 weeks (37-38+3 weeks); mean birth weight was 2972 g (2600-3250 g); mean operation time was 4 min (2-7 min).The gestational age of primary diagnosis of fetal neck mass was 24-34 gestational weeks.After delivery,the size of neck mass was from 3.0 cm × 2.0 cm × 1.0 cm to 6.2 cm× 5.8 cm × 6.8 cm.The tracheal compression and displacement were found by color doppler ultrasound scan and magnetic resonance imaging in all cases.Two of them were completed with polyhydramnios and the others with normal volume of amniotic fluid.EXIT procedure was successfully carried out during cesarean section.Neonatal reassessment showed the trachea of three infants were obviously compressed and lapsed by enhanced CT; the infants relied on mechanical ventilation after birth and underwent operation on day 6 to 8.Tracheal impression was not presented in one infant and trachea cannula was removed on the second day,operation was not performed.All of those infants had good outcomes.Conclusions The multidisciplinary diagnosis and treatment model,including EXIT procedure,is a safe,efficient and feasible strategy,which is necessary for fetus with neck mass.

Objective To evaluate the efficacy of liraglutide in the treatment of Nonalcoholic Fatty Liver Disease(NAFLD).Methods Randomized controlled trials(RCTs)that evaluated the efficacy of liraglutide for NAFLD treatment were searched in multiple databases,including Pubmed,EMBASE,the Cochrane library,CNKI,Wanfang database and VIP.Literature identification and data extraction were based on the inclusion and exclusion criteria.RevMan 5.3 software was used for Meta-analysis.Results A total of 7 RCTs with 500 patients of NAFLD were included.Improved liver histology,or improved the level of alanine aminotransferase[WMD=-25.32,95％CI(-37.22,-13.41),P<0.01] and aspartate aminotransferase[WMD=-24.56,95％CI(-35.10,-14.03),P<0.01] were seen in 12-48 weeks liraglutide treatment.However,liraglutide could not decreased the level of serum cholesterol[WMD=-14.38,95％CI(-48.95,-20.20),P=0.42] and triglyceride[WMD=-15.55,95％CI(-36.20,-5.10),P=0.14].Conclusion liraglutide has the therapeutic effect of NAFLD.

Based on an analysis of the compensation policy and its problems of the primary medical and health institutions, this paper put forward the corresponding reform framework in Zhejiang province. It proposed to change the compensation policy of " predefining revenue and expenditure, subsidizing its gap after performance appraisal" into " a mixed system of special subsidy and pay for performance". Related policies were also described including governmental functions, special subsidies for input-based payments, classified payments for output services, precautions against financial risks, etc. This paper also suggested that we focus on dealing with the six pairs of balance, such as that between subsidy for the supply and demand sides, and that between internal market and external market.

ObjectiveTo explore the multi-drug resistance condition and independent risk factors ofAcinetobacter baumannii infection in patients after liver transplantation.MethodsClinical data of 257 patients who underwent liver transplantation in Shanghai General Hospital between January 2010 and June 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Twenty-ifve patients were infected with multi-drug resistantAcinetobacter baumannii. Among the patients, 17 were males and 8 were females, 10 were younger than 50 years old and 15 were older or equal to 50 years old. Drug sensitive test was detected using concentration gradient method, metallo-beta-lactamase was detected using composite paper, and bacterial genotype was detected using repetitive sequence polymerase chain reaction (PCR) and gel electrophoresis. Drug resistance, drug-resistant spectrum, genotype distribution, infection time and inlfuence factors of infection for multi-drug resistantAcinetobacter baumannii were observed and analyzed. Single-factor analysis of multi-drug resistantAcinetobacter baumannii was conducted using Chi-squaretest and multiple-factor analysis was conducted using logistic regression analysis.ResultsThe incidence of multi-drug resistantAcinetobacter baumannii infection was 9.7%(25/257).Acinetobacter baumannii strains were highly resistant to aminoglycosides, quinolones, penicillins, cephalosporins and carbapenems, with the drug resistance of 100%. In addition, 96%(24/25) of the strains were metallo-beta-lactamase positive. Three genotypes were observed in the 25 strains ofAcinetobacter baumannii: type B (n=18), type A (n=5) and type C (n=2). Positive postoperative fungal culture (OR=5.470, 95%CI: 1.402-21.333,P<0.05) and re-intubation (OR=11.538, 95%CI: 2.228-59.742,P<0.05) were the independent risk factors for multi-drug resistantAcinetobacter baumannii infection.ConclusionsThe incidence of multidrug-resistant Acinetobacter baumannii infection in patients after liver transplantation is high. Multidrug-resistant Acinetobacter baumannii is highly resistant to multiple antibiotics, and type B is the main genetype. Positive postoperative fungal culture and re-intubation are the independent risk factors for multi-drug resistantAcinetobacter baumannii infection.

ObjectiveTo investigate the regulatory effects of Xuanfu Daizhetang on a mouse model of allergic asthma induced by ovalbumin （OVA）. MethodSixty female BALB/c mice （6-8 weeks old， SPF） were randomly divided into groups. Ten mice were assigned to the normal group and given 0.2 mL of saline， while the remaining groups received intraperitoneal injections of Al（OH）₃ at 5 g·L^-1 and OVA at 1 g·L^-1. The mice were divided into normal group （10 mL·kg^-1 saline）， OVA model group （10 mL·kg^-1 saline）， dexamethasone group （OVA+DEX， 1 mg·kg^-1）， OVA+ low-dose Xuanfu Daizhetang group （OVA+XL， 7.065 g·kg^-1）， OVA+ medium-dose Xuanfu Daizhetang group （OVA+XM， 14.13 g·kg^-1）， and OVA+ high-dose Xuanfu Daizhetang group （OVA+XH， 28.26 g·kg^-1）. An OVA-induced asthma model was established in mice. Hematoxylin-eosin （HE） and periodic acid-Schiff （PAS） staining methods were used to observe bronchial tissue pathological changes. Enzyme-linked immunosorbent assay （ELISA） was performed to measure the levels of immunoglobulin E （IgE）， interleukin-4 （IL-4）， IL-5， IL-13， IL-17A， and γ interferon （IFN-γ） in bronchoalveolar lavage fluid. Western blot was used to detect the phosphorylation of extracellular signal-regulated kinase （ERK）， p38 mitogen-activated protein kinase （MAPK）， and c-Jun N-terminal kinase （JNK） proteins in lung tissue. ResultCompared with the normal group， the OVA model group showed increased inflammatory cell infiltration in mouse alveoli， elevated levels of IL-4， IL-5， IL-13， IL-17A， IFN-γ in bronchoalveolar lavage fluid， and IgE in serum （P<0.05， P<0.01）， and promoted phosphorylation of MAPK signaling pathway-related proteins. Compared with the model group， the OVA+XL， OVA+XM， and OVA+XH groups showed reduced inflammatory cell infiltration in mouse alveoli， decreased levels of IL-4， IL-5， IL-13， IL-17A， IFN-γ in bronchoalveolar lavage fluid， and IgE in serum （P<0.05， P<0.01）， and inhibited phosphorylation of MAPK signaling pathway-related proteins. ConclusionThe results of this study suggest that Xuanfu Daizhetang has potential anti-allergic asthma activity， providing a theoretical basis for its future clinical application.