An evaluation scale of medical services quality was developed on the basis of "patients' experience". The questionnaires were developed by, among others, searching relevant literature, collecting well-established assessment scales, measuring patients' experience and satisfaction, brain-storming, literature analysis. Delphi method was adopted for expert consultation. Scale items were screened and revised. The key indexes were converted. Field surveys were conducted for testing the reliability and validity of the scale. Our modified evaluation scale for measuring medical services quality based on "patients' experience" included 6 dimensions (tangibility, reliability, responsiveness, assurance, empathy and continuity), and 50 items. The novel scale based on "patients' experience" may better serve the purpose of assessing medical services quality.

ObjectiveTo investigate the imaging features of anterior cruciate ligament(ACL) graft insufficiency.Methods X-Ray and MR imaging examinations in 24 consecutive patients who had ACL reconstructive graft insufficiency were retrospectively evaluated for tunnel position,osteoarthrosis and its related complications.Follow-up arthroscopy showed 16 graft tears and 8 graft laxities.Fisher exact test was used to compare tunnel malpositions,the proportion of graft tear on MRI and osteoarthrosis between graft tear group and graft laxity group.ResultsTwo malpositions of tibial tunnel and 3 malpositions of femoral tunnel were seen in graft tear group.Three-malpositions of tibial tunnel and 4 malpositions of femoral tunnel were seen in graft laxity group.The proportion of tibial or femoral malposition showed no significant difference between the two groups(P =0.289,P =0.167).In graft tear group,15 complete graft tears were diagnosed correctly,1 partial tear was misdiagnosed as normal on MRI.In graft laxity group,4 grafts were diagnosed as normal and 4 were considered as graft tear on MRI.A significant difference was seen between the two groups (P = 0.028) in the proportion of graft tear diagnosed on MRI.Fourteen osteoarthrosis were seen in graft tear group and 5 in graft laxity group.No significant difference was seen between the two groups ( P =0.289) in the proportion of esteoarthrosis.Conclusion The proportions of tunnel malposition and osteoarthrosis showed no significant difference between the graft tear group and graft laxity group.Most graft tears can be diagnosed accurately on MRI,but some cases of graft laxity may be misdiagnosed for graft tear.

Objective To understand the relationship between GATA -4,-5,-6 gene mutations and con-genital heart disease(CHD),and to provide grounds for early prevention and genetic counseling of children with CHD. Methods GATA -4,-5,-6 coding regions exons and the flanking intron sequences in 1 98 CHD patients were screened,including 66 cases of the ventricular septal defects,84 cases of the atrial septal defects,and 48 cases of the nonsyndromic conotruncal heart defects patients.A total of 300 healthy subjects were selected as controls.The acquired sequences were aligned with which those publicized in GenBank by the aid of program BLAST.All exons and bilateral partial intron -exon boundaries of GATA -4,-5,-6 genes were amplified by the polymerase chain reaction (PCR). The PCR products were purified and directly sequenced by automatic DNA sequence equipment.The acquired GATA -4,-5,-6 gene sequences were compared with GenBank standard gene sequences with the aid of program BLAST. Results A heterozygous missense mutation in the GATA -4 gene was identified in a ventricular septal defect patient and a persistent truncus arteriosus patient.The mutation was located in c.799G >A(p.V267M)in exon 4 of GATA -4. Multiple aligenment of GATA -4 proteins across species demonstrated that altered amino acid was highly conserved. Transcription factor GATA -5,-6 screening showed no mutations in children with CHD in this study.Conclusions Transcription factor GATA -4 gene mutation may be associated with the occurrence of CHD.Transcription factor GATA -4 gene may be susceptible gene in human CHD.

Objective To investigate the effect of removing laryngeal mask airway (LMA) in anaesthetized state on emergence agitation after sevoflurane anaesthesia in children.Methods Ninety children with subumbilical operation,ASA Ⅰ or Ⅱ grade,were divided into three groups by random digits table with 30 cases each:ET-A group (endotracheal tube and extubation while awake),ET-D group (endotracheal tube and deep extubation) and LMA-D group (insertion of LMA and deep removal).The incidence of preoperative emotional bad,anaesthesia time,sevoflurane administration time,emergence agitation,the numbers of treated with propofol and/or fentanyl and postoperative anaesthesia care unit(PACU)retention time were measured.Results There was no significant difference in incidence of preoperative emotional bad,sevoflurane administration time and anaesthesia time among the three groups (P ＞ 0.05).The incidence of emergence agitation,the numbers of treated with propofol and/or fentanyl and PACU retention time in LMA-D group were significantly lower than those in ET-A group [26.7％(8/30) vs.66.7％(20/30),8cases vs.20 cases and (23.9 ± 4.9) min vs.(32.9 ± 5.8) min,P ＜ 0.01].Conclusion Insertion of LMA and removing LMA in anaesthetized state can decreased emergence agitation in children after sevoflurane anaesthesia,especially suitable for the children who do not suitable for drug treatment.

Objective To assess whether there was strong association between antiphospholipid antibodies(APA) and coronary heart disease(CHD), to study the environmental factors of APA production and APA pathogenic mechanism in patients with CHD.Methods Blood samples from 76 patients with CHD and 30 controls were tested for anticardiolipin antibodies IgG(ACA-IgG),human cytomegalovirus IgG,IgM(HCMV-IgG,IgM) by enzyme-link immunosorbant assay(ELISA) and 6-keto-PGF1a,endothelin(ET) by radioimmunoassay(RIA).Results A total of 27 patients(35.53%) were ACA positive in 76, as compared to 2 of 30(6.67%) healthy individuals, P＜0.05. There was no difference in ACA among acute myocardial infarction(AMI,39.13%), old myocardial infarction(OMI,26.53%), unstable angina pectoris(UA,38.40%), P＞0.05. The number of ACA positive subjects was higher in HCMV infection patients with CHD than no HCMV infectious patients with CHD. There was no PGI2 and ET level difference between ACA-IgG positive and negative CHD.Conclusion There are strong association between APA and CHD. The HCMV infection may be an environmental factor of APA production in CHD patients with raised ACA. The alteration of PGI2 and ET are not the pathogenic mechanism of ACA in patients with CHD.

Objective Toinvestigatetherelationshipbetweendifferenttypesofinternalwatershed infarctionandtandemstenosesofinternalcarotidartery(ICA).Methods Atotalof55patientswith internal watershed infarction confirmed by head MRI and diffusion-weighted imaging (DWI )examination were enrolled. They all underwent the extracranial internal carotid artery (ICA ) ultrasonography and intracranial cerebral artery MR angiography (MRA)examinations. According to the findings of imaging,the 55 patients with internal watershed infarction were divided into a simple internal watershed infarction (IWSI)group and an internal watershed infarction accompanied with ipsilateral cortical watershed infarction (C-IWSI)group. The relationship between the two types of internal watershed infarction and tandem stenoses of ICA was analyzed. Results (1 ) Of the 55 patients with internal watershed infarction,24 cases (43. 6%)were in the internal watershed infarction group and 31 cases (56. 4%)were in the C-IWSI group. The ipsilateral vascular stenosis were ICA 20 cases (36. 4%,including extracranial segment 11 cases and intracranial segment 17 cases),middle cerebral artery (MCA)44 cases (80. 0%), and tandem stenoses of ICA 15 cases (27. 3%). (2)Ipsilateral tandem stenoses of ICA:2 cases were in the IWSI group (intracranial ICA+MCA 2 cases);13 cases were in the C-IWSI group (extracranial ICA+intracranial ICA +MCA 4 cases,extracranial ICA + intracranial ICA 1 case,extracranial ICA + MCA 2 cases,and intracranial ICA+MCA 6 cases). (3)Compared with the IWSI group,the incidences of ipsilateral ICA stenosis and tandem stenoses of ICA in patients of the C-IWSI group were higher (54. 8%[n=17]vs. 12. 5%[n=3],41. 9%[n=13]vs. 8. 3%[n =2]),and there were significant differences(P =0. 001, 0.006]). The incidences of extracranial and intercranial ICA stenosis were higher than those of the IWSI group (35. 5%[n=11]vs. 0,45. 2%[n=14]vs. 12. 5%[n=3]),and there were significant differences (P=0.003,0.009).Conclusion Inthedifferenttypesofinternalwatershedinfarction,theincidenceof tandem stenoses of ICA is different. The IWSI patients with ipsilateral cortical watershed infarction often accompany by tandem stenoses of ICA.

Yinchenzhufu decoction (YCZFD) is a classic formula for treating Yin Huang syndrome, which can improve liver injury caused by cholestasis. However, the mechanism of action of YCZFD still remains unclear. This article used network pharmacology, molecular docking, animal experiments, and molecular biology methods to explore the mechanism of YCZFD in treating liver injury caused by cholestasis. A mouse model of acute cholestasis induced by lithocholic acid was used to investigate the effects of YCZFD on liver injury. The experimental procedures described in this paper were reviewed and approved by the Ethical Committee at the Shanghai University of Traditional Chinese Medicine (approval NO. PZSHUTCM190823002). The results showed that YCZFD could reduce the levels of blood biochemical indicators and improve hepatocyte damage of cholestatic mice. Then, multiple databases were used to predict the corresponding targets of YCZFD active components on cholestatic liver injury. An intersection target protein-protein interaction (PPI) networks based on String database and Cytoscape software was used to demonstrate the possible core targets of YCZFD against cholestatic liver injury. The results indicated that core targets of YCZFD include tumor necrosis factor, interleukin-1β, non-receptor tyrosine kinase Src, interleukin-6, etc. GO (gene ontology) and KEGG (kyoto encyclopedia of genes and genomes) enrichment analysis indicated that YCZFD may regulate the tumor necrosis factor signaling pathway, nuclear factor-κB signaling pathway, bile secretion, and other related factors to ameliorate the cholestatic liver injury. AutoDockTools software was used to perform molecular docking verification on the core targets and components of YCZFD. To verify the results of network pharmacology, UPLC-MS/MS method was used to determine the effect of YCZFD on levels of bile acid profiles in mouse liver tissues. It was found that treatment with YCZFD significantly reduced the content of free bile acids, taurine bound bile acids, and total bile acids in the liver tissues of cholestatic mice. Then, results from real time PCR and Western blot also found that YCZFD can upregulate the expression of hepatic nuclear receptor farnesoid X receptor, metabolizing enzyme (UDP glucuronidase transferase 1a1), and efflux transporters (bile salt export pump, multidrug resistance-associated protein 2, multidrug resistance-associated protein 3, etc) in cholestasis mice, promote bile acid metabolism and excretion, and improve bile acid homeostasis. Moreover, YCZFD can also inhibit pyroptosis and inflammation by regulating NOD-like receptors 3 pathway, thereby inhibiting cholestatic liver injury.

Objective To investigate the function characteristics of CD4 T cell converted double negative T cell and provide a basis for further insight into the characteristics of mouse converted double negative T cell.Methods The gene expression profile was analyzed by transcriptome sequencing and protein mass spectrometry.The expression of cell active marker CD44,CD69 and OX40 was investigated by flow cytometry and the cytotoxicity of mouse double negative T cell was verified by CFSE staining.Results Mouse CD4 T cell converted double negative T cell expressed cell phenotype that differed from other mature CI4 T cells.Mouse converted double negative T cell expressed high level of active marker of CD44,CD69 and OX40.Cytotoxicity of PrfO DN T was significantly reduced.Conclusions Mouse CD4 T cell converted double negative T cell has distinguishing cell phenotypes,that are not identical to other mature CD4 T cells.Mouse double negative T cell overexpresses cell activation marker and cytotoxic cytokines.The immune suppressive function of mouse double negative T cell is mainly dependent on perforin pathway.

BACKGROUND: When the teeth affected abnormal biting force, tooth absorption and periodontium would be greatly damaged. OBJECTIVE: To study whether periodontal membrane fibroblast affected apoptosis following cyclic tensile stress stimulation and whether p38MAPK signaling pathway participated in apoptosis. METHODS: Fibroblasts at passages from 4 to 7 were randomly assigned to control, loading and SB203580 groups after synchronization. In the loading and SB203580 groups, 12% strain was applied at a loading frequency of 6 cycles per minute, i.e. 5 seconds for tension and 5 seconds for relaxation. In the SB203580 group, cells were treated with 20 mmol/L p38MAPK inhibitor SB203580 at 1 hour before loading. At 6, 12 and 24 hours after loading, cells from each group were harvested, and cell apoptosis was detected using a flow cytometry. Expression of bax mRNA was determined using reverse transcription-polymerase chain reaction. RESULTS AND CONCLUSION: Compared with the control group, apoptotic rate of fibroblasts and bax mRNA expression were increased after loading (P < 0.05), and enhanced over time, and peaked at 12 hour following loading, and then decreased gradually. Compared with the loading group, cell apoptosis was reduced at corresponding time points in the SB203580 group (P < 0.05), and bax mRNA expression was diminished. These results indicated that cells affected apoptosis after mechanics stimulation, and mitogen activated protein kinase p38MAPK signaling pathway participates in the process of apoptosis.

Objective:To assess the anatomy of superficial circumflex iliac artery perforator (SCIP) and its feasibility for tongue re-construction after tumor resection. Methods:From January 2014 to January 2015, a total of 15 patients with oral maxillofacial defects underwent SCIP flap surgery. Perforator identification and SCIA course were performed intra-operatively. The relationships among the SCIA, deep circumflex iliac artery (DCIA), and superficial inferior epigastric artery (SIEA) were determined intra-operatively. Surgical procedures, measurement of vessel's caliber and pedicle's length, SCIP flap anatomy, and their outcomes were described. Results:Flap mean thickness was approximately 1.2±0.3 cm. The mean diameter of the SCIA was 0.7±0.2 cm, and that of the superficial circumflex iliac vein was 1.2±0.2 cm. The relationships among SCIA, DCIA, and SIEA were described and subdivided into typeⅠ(8/15), typeⅡ(2/15), typeⅢ(2/15), typeⅣ(2/15), and typeⅤ(1/15) in intra-operative dissection. The flap sizes were in the range from 6 cm × 4.5 cm to 11 cm × 10 cm. A total of 14 SCIP flaps survived, and 1 SCIP flap underwent necrosis. Conclusion:The SCIP flap is a reliable, thin, and pliable flap with long vascular pedicles and hidden donor site morbidity. Its texture is a perfect match for tongue defect reconstruc-tion.