Objective:From the perspective of policy tools,it aimed to explore the policy focuses for promoting the high-quality development of compact county medical communities.Methods:It utilized content analysis method to encode and quantify the policy texts of county medical community.Results:A total of 107 policy documents on the construction of county medical community were screened,and 319 codes were obtained.The classification statistics showed that authoritative tools accounted for 34.80%,persuasive tools accounted for 30.41%,capacity-building tools accounted for 15.99%,system transformation tools accounted for 11.60%,and incentive tools accounted for 7.21%.Conclusion:The policy tools for building county medical communities in China are becoming increasingly diversified,but the strategies for using these tools still need to be strengthened.The government should gradually change the application strategy of authoritative tools and persuasive tools,further strengthen the supervision function of the government,and increase the intensity of policy publicity and guidance.At the same time,policies should strengthen the effective utilization of capacity-building tools,system transformation tools,and incentive tools,so as to establish the long-term mechanism of compact county medical communities,form scientific effective sustainable incentive mechanism,and promote the developmint in healthy,long and sustainable cooperative direction.

Objective:From the perspective of policy tools,it aimed to explore the policy focuses for promoting the high-quality development of compact county medical communities.Methods:It utilized content analysis method to encode and quantify the policy texts of county medical community.Results:A total of 107 policy documents on the construction of county medical community were screened,and 319 codes were obtained.The classification statistics showed that authoritative tools accounted for 34.80%,persuasive tools accounted for 30.41%,capacity-building tools accounted for 15.99%,system transformation tools accounted for 11.60%,and incentive tools accounted for 7.21%.Conclusion:The policy tools for building county medical communities in China are becoming increasingly diversified,but the strategies for using these tools still need to be strengthened.The government should gradually change the application strategy of authoritative tools and persuasive tools,further strengthen the supervision function of the government,and increase the intensity of policy publicity and guidance.At the same time,policies should strengthen the effective utilization of capacity-building tools,system transformation tools,and incentive tools,so as to establish the long-term mechanism of compact county medical communities,form scientific effective sustainable incentive mechanism,and promote the developmint in healthy,long and sustainable cooperative direction.

Objective To investigate the impact of body mass index (BMI) on the outcome of intrauterine insemination (IUI) for infertility patients. Methods A total of 1 393 infertility patients undergoing their first cycle of IUI were selected as study subjects, and were divided into normal BMI group (n=824), overweight group (n=394) and obese group (n=175) based on BMI. Age, duration of infertility, type of infertility, sex hormones, fasting blood glucose, fasting insulin, thyroid function, timing of insemination, number of progressively motile spermatozoa, biochemical pregnancy rate, clinical pregnancy rate and miscarriage rate were compared among the three groups. Multiple linear regression analysis was used to analyze the influencing factors of BMI; the effects of age, BMI, fasting blood glucose and fasting insulin on IUI outcome were analyzed by binary Logistic regression. Receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of BMI for biochemical pregnancy and clinical pregnancy, and the cut-off value was calculated. Results There were no significant differences in age, time of insemination, number of progressively motile spermatozoa, clinical pregnancy rate and miscarriage rate among the three groups (P>0.05). The duration of infertility, fasting blood glucose and fasting insulin levels in the obese and overweight groups were significantly longer or higher than those in the normal BMI group (P < 0.05). The follicle-stimulating hormone (FSH) level in the obese group was significantly lower, while the free thyroxine (FT4) level in the obese group was significantly higher than that in the overweight group and normal BMI group (P < 0.05). The biochemical pregnancy rate in the obese group was significantly higher than that in the normal BMI group (P < 0.05). Multiple linear regression analysis showed that BMI was negatively correlated with FSH and estradiol (E2) (P < 0.01) and positively correlated with fasting blood glucose and fasting insulin (P < 0.01). Multivariate binary logistic regression analysis showed that age and BMI were influencing factors for clinical pregnancy (P < 0.05), while age, BMI, and fasting insulin were influencing factors for biochemical pregnancy (P < 0.05). The ROC curve showed that the area under the curve (AUC) for BMI predicting biochemical pregnancy and clinical pregnancy was 0.608 and 0.610, respectively, with a cut-off value of 23.05 kg/m² for both. Conclusion BMI affects the endocrine and glycolipid metabolism of infertility patients. BMI can be used as an independent factor to predict biochemical pregnancy and clinical pregnancy in IUI.

Objective:To analyze the current development status, research hot-spots and development trends of county-level Chinese hospitals in China.Methods:By retrieving the papers of county-level Traditional Chinese Medicine (TCM) hospitals in China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodicals Full-text Database (VIP), Wanfang and China Biomedical Database (SinoMed ) with CiteSpace 5.5.R2 software to draw maps of the author, institution and keyword and make analysis.Results:A total of 598 papers are included in this study, and the trend of publications shows an upward trend and then a downward trend. Researchers conduct research in the form of forming research teams. The research institutions are mainly medical colleges and scientific research institutions. The most frequently showed keyword is "medical reform". The keyword knowledge map shows that the research content mainly involves medical reform, problem analysis and countermeasures, economic operation efficiency, TCM service capability, data envelopment analysis and so on.Conclusions:The county-level TCM hospitals generally show sound development trend in China. The research trend is dominated by county-level TCM hospitals. Scale development has been transformed into the study of hospital operation efficiency. County-level TCM hospitals need to start from their own actual conditions, strengthen cooperation in the form of teams and strengthen academic cooperation among institutions, so as to realize the basic TCM services for ordinary people.

Objective: To investigate the relationship between dietary polyunsaturated fatty acid (PUFA) intake and blood lipid, C-reactive protein (CRP) and homocysteine (Hcy) in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods: Patients with acute ischemic stroke or TIA were enrolled consecutively from Nanjing Stroke Registry Program. The total dietary PUFA intake level was assessed by the food semi-quantitative frequency questionnaire. Venous blood samples were collected in the morning of the day after admission to the hospital to detect the levels of serum total cholesterol, triacylglycerol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, Hcy, and CRP. According to the median level of total PUFA intake, the patients were divided into low PUFA group and high PUFA group. The relationship between PUFA intake and blood lipid, CRP and Hcy was analyzed by Spearman correlation analysis, and multiple linear regression analysis was used to determine the independent correlation. Results: A total of 170 patients (85.1%) with acute ischemic stroke and 31 patients with TIA (14.9%) were enrolled. Their age was 62.9±14.1 years, 143 were males (71.1%), and the median PUFA daily intake was 12.8 g (interquartile range: 8.05-17.5 g). Compared with the high PUFA group (n=100), patients in the low PUFA group (n=101) were older, serum high-density lipoprotein cholesterol levels were lower, and CRP and Hcy levels were higher. The above differences were statistically significant (all P<0.05). Spearman correlation analysis showed that total dietary PUFA intake was significantly negatively correlated with the serum CRP (r=-0.24, P=0.001) and Hcy (r=-0.17, P=0.013) levels, and there was no significant correlation with the blood lipid levels. Multiple linear regression analysis showed that CRP was significantly negatively correlated with PUFA intake after adjusting for confounding factors (B=-0.28, P=0.012). Conclusions Dietary PUFA intake in patients with acute ischemic stroke or TIA may affect blood metabolism index and oxidative stress index. It is necessary to adjust the dietary structure of patients with low PUFA intake to reduce the risk of stroke recurrence.

Objective To investigate the correlations of P2Y1 and ITGB3 single nucleotide polymorphisms (SNP) with aspirin resistance (AR) in patients with large atherosclerotic stroke (LAA) in a Chinese Han population.Methods Patients with first-ever LAA from Anhui stroke registration system were enrolled.Thrombus elasticity diagram was used to detect the platelet function.TaqMan technology was used to detect the P2Y1 and ITGB3 genotypes.Results A total of 206 patients with LAA were enrolled.Thirty-one patients (15.0％) had AR and 175 (85.0％) were aspirin sensitive (AS).The frequency of P2Y1 rs701265 G allele in the AR group was significantly higher than that in the AS group (43.5％ vs.26.9％;x2 =7.074,P=0.008).The frequency of P2Y1 rs701265 AA genotype in the AR group was significantly lower than that in the AS group (32.3％ vs.53.7％;x2 =4.850,P=0.028).There were no significant significances in the frequencies of P2Y1 rs1065776 and ITGB3 rs5918 alleles and genotypes between the AR group and the AS group.Multivariate logistic regression analysis showed that P2Y1 rs701265 G allele was an independent risk factor for AR in patients with LAA (odds ratio 2.186,95％ confidence interval 1.190-4.016;P=0.012).Conclusion The P2Y1 rs701265 polymorphism is associated with AR in Chinese Han patients with LAA,while the P2Y1 rs1065776 and ITGB3 rs5918 polymorphisms are not.

Objective To test the immune therapeutic effects of PICKCa adjuvant rabies vaccine for the post-exposure mice and beagle dogs and immune memory effect for human.Methods For the mice and beagle dogs first to infect with rabies wild virus and then immunize with PICKCa rabies vaccine.For volunteers, first to immunize with PICKCa rabies vaccine after 2.5 years to take peripheral blood mononuclear cell and then to check cells secreted interferon-gwith flow cytometry. Results In 3 independent assays of post-explosure immunization of mice and beagle dogs PICKCa rabies vaccine were much better then commercial adjuvant-free rabies vaccines, the protective rate from 20%-30%to 70%-100%Also, in the assay of cells secreted IFN-γby peripheral blood mononuclear cells from volunteers immunized by PICKCa rabies vaccine the IFN-γcell levels were much higher than control.Conclusions Compared with commercial adjuvant-free rabies vaccines the PICKCa rabies vaccine had significant immune therapeutic effects in the mice and dogs.Also PICKCa rabies vaccine had good immune memory effect in human.

BACKGROUND:Endothelial progenitor cels are widely used in the treatment of various vascular diseases, and early exercise training contributes to restore motor function after spinal cord injury. However, the therapeutic effects of endothelial progenitor cel transplantation or early exercise training alone are unfavorable. OBJECTIVE:To observe the influence of transplantation of endothelial progenitor cels combined with early exercise training on blood vessel regeneration and hind limb function in rats after spinal cord injury. METHODS:Eighty adult Sprague-Dawley rats were enroled to establish spinal cord injury models using the modified Alen’s method, and then randomly divided into four groups. Rats were respectively given culture mediumvia the tail vein, injection of endothelial progenitor cels (3×106)via the tail vein, roler and treadmil trainings for 2 weeks, or injection of endothelial progenitor celsvia the tail vein folowed by 2 weeks of roler and treadmil trainings in the model, cel transplantation, exercise and combined groups. RESULTS AND CONCLUSION:At 2 weeks after transplantation, the hindlimb motor function of rats in the combined group was better than that in the cel transplantation group and exercise group, and moreover, the percentage of CM-Dil positive cels, the number of horseradish peroxidase-positive nerve fibers, capilary density and expression of vascular endothelial growth factor and brain-derived neurotrophic factor were also significantly higher in the combined group than the cel transplantation group and exercise group. These findings indicate that early exercise training has a neuroprotective role in spinal cord injury; endothelial progenitor cel transplantation combined with early exercise training can promote regeneration of synapses and blood vessels and improve hindlimb motor function of rats, probably by increasing expression levels of vascular endothelial growth factor and brain-derived neurotrophic factor.

BACKGROUND:Studies have shown that neural stem cel transplantation combined with exercise training can promote the recovery of hindlimb motor function from spinal cord injury in rats, but its mechanism of action has not been fuly elucidated. OBJECTIVE:To investigate the effects of early exercise training combined with neural stem cel transplantation on the recovery of hindlimb motor function in rats with spinal cord injury. METHODS:Sixty Sprague-Dawley rats with spinal cord injury were randomly divided into three groups: control group (n=20, given conventional treatment after injury), cel transplantation group (n=20, given neural stem cel transplantation after injury), experimental group, (n=20, given neural stem cel transplantation combined with early exercise training after injury). Recovery of the hindlimb motor function was assessed by Basso, Beattie and Bresnahan scale and inclined plane test before and at 1, 7, 14, 21 days after injury. Western blot assay was used to detect caspase-3 and myeloperoxidase expression. Hematoxylin-eosin staining was done at 21 days after injury to observe the structure changes of the injured spinal cord. RESULTS AND CONCLUSION:(1) Scores of Basso, Beattie and Bresnahan scale and inclined plane test were significantly better in the experimental group than the cel transplantation group folowed by the control group (P < 0.05). (2) In the control group, the expression of caspase-3 and myeloperoxidase was significantly increased at 14 days after injury. In the cel transplantation, the expression of caspase-3 and myeloperoxidase was significantly higher than the experimental group (P < 0.05). (3) Pathological inflammation was reduced most in the experimental group folowed by the cel transplantation group. In the experimental group, the structure of injured spinal cord was improved and became relatively clear and intact. These findings indicate that neural stem cell transplantation combined with early exercise training can effectively promote the recovery of hindlimb motor function from spinal cord injury in rats, by reducing the expression of caspase-3 and myeloperoxidase and alleviating secondary lesion of the spinal cord.

Objective Meningovascular syphilis is the intima inflammation of blood vessels caused by the syphilitic infec-tion, which is associated with the occurrence of ischemic stroke.The study analyzed the clinical, imaging features and prognosis for meningovascular syphilis so as to improve its diagnosis and treatment. Methods 14 patients diagnosed with meningovascular syphilis were collected prospectively from December 2007 to March 2015 in the neurological department of Jinling Hospital.The patients were followed for a period of 21.5(range 10.2~37.9)months,and the prognosis were evaluated. Results Patients with meningovascular syphilis presented with dizziness, hemiplegia, hemidysesthesia and cognitive decline.Lesions showed multiple, scattered on MR ima-ging, intracranial vascular stenosis was seen in the CTA/MRA, and the laboratory examination had characteristic changes.With a large dose and sufficient courses of penicillin treatment, meningovascular syphilis may hopefully get predominant effects.78.57%patients got good prognosis(modified Rankin Scale ,mRS≤2)at 3 months and 85.71% patients got goodlong-term prognosis(mRS≤2). Conclusion Meningovascular syphilis was usually presented as acute onset, lacks the specific clinical and neuroimaging manifesta-tions.Most patients has favourable prognosis after treatment of syphilis with full course of penicillin.