Objective:To evaluate the measurement agreement of Roche 25(OH)D immunoassay(evaluation method) with LC-MS/MS (reference method).Methods:A total of 909 residual serum samples from routine health check participants were collected from May to June in 2019. 25(OH)D concentrations were measured by evaluation method and LC-MS/MS, respectively. Passing-bablok regression, intraclass correlation coefficient (ICC), Bland Altman plots and Kappa test were used to analyze the consistency and bias on the results derived from the two measurement methods.Results:The 25(OH)D concentration derived from evaluation method was significantly different from those from LC-MS/MS method ( P<0.001). Slope of regression for evaluation method and LC-MS/MS was 0.962(95% CI 0.919-1.007), while intercept was -0.185 (95% CI -1.191-0.745). The ICC was 0.765 (95% CI 0.735-0.792). Altman plot showed that the average deviation between evaluation method and LC-MS/MS was -0.902 ng/ml (0.300%). The coincidence rate of evaluation method′s judgment of vitamin D sufficiency, insufficiency and deficiency with LC-MS/MS was 83.39%, and the weighted Kappa values was 0.790. Conclusion:Roche automatic 25(OH)D immunoassay shows acceptable correlation and agreement with LC-MS/MS, however, it is to note that the deviation between immunoassay and LC-MS/MS may lead to wrong judgment of vitamin D nutritional status. It is recommended that each laboratory should establish own corresponding reference values for 25(OH)D concentrations derived from these two methods.

Objective: To carry out the 4^th round of third-party evaluation on the implementation and effect of the 1^st year of the 2^nd Phase National Healthcare Improvement Initiative(abbreviated as Initiative)since 2015. Methods: The 4^th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations. Results: The 4^th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces(autonomous regions, municipalities directly under the Central Government)and Xinjiang Production and Construction Corps.Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1%, 96.7%for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved. Conclusions The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction.

Objective: To compare the anesthetic effects of subarachnoid anesthesia(SA)and epidural anesthesia(EA)for the procedure for prolapse and hemorrhoids(PPH)in elderly patients with benign anorectal diseases. Methods: A retrospective analysis was conducted in 60 patients with benign anorectal diseases admitted to Peking University Third Hospital from March to August 2018 and undergoing PPH.According to anesthesia methods, patients were divided into the SA group and the EA group (n=30 each). The level of sensory block was tested by acupuncture, and the degree of motor block was assessed by revised Bromage score.The anesthesia effect, operation time, blood loss, adverse events and hospitalization time were compared between the two groups. Results: The highest level of sensory block was similar between the two groups without significant difference(P>0.05). The median onset time of sensory block was longer in the EA group [270.0 s(interquartile range, 66.3 s)] than in the SA group [25.5 s(interquartile range, 14.3 s)]. The revised Bromage score was lower in the EA group than in the SA group [1.0(interquartile range, 1.0)vs.2.0 (interquartile range, 1.0), Z=6.657, -1.685, both P=0.000]. The risks of hypotension, nausea and vomiting, and urinary retention were lower in the EA group than in the SA group (χ²=6.405, 4.286 and 4.403, P=0.011, 0.038 and 0.044). There were no significant differences in anesthetic effect, operation time, blood loss and hospitalization time between the two groups(all P>0.05). Conclusions EA can provide a perfect anesthesia and analgesic effect for elderly patients receiving PPH, with the advantages of rapid recovery of limb movement and low adverse events.As a substitute for SA, EA is a suitable anesthesia method for promoting the enhanced recovery after surgery(ERAS)in patients with benign anorectal diseases.

Objective o evaluate the association between IL-28B ( rs12979860 ) polymorphism andantiviraltherapeutic effectbydetecting the genotype of interleukin-28B( IL-28 B) in patients with hepatitis C ( HCV ) .Methods Of total 1153 HCV patients, 303 diagnosed with CHC had been treated with pegylated interferon plus ribavirin for 24-48 weeks.IL-28B ( rs12979860 ) was genotyped by two-color fluorescent TaqMan assay.Results Among 1153 patients, CC, CT and TT genotype frequencies of IL-28B rs12979860 are 83.26%, 16.22%and 0.52%respectively.The results of HCV genotypingof 580 in 1153 cases, the frequencies of 1b, 2a and their non-1b/2a type are 63.45%, 35.00%and 1.55%respectively;In 303 CHC patients with clear medical history, the proportion of SVR was71.98% in patients with CC genotype and 16.90%in those with either the CT or TT genotypes.Logistic regression model was adopted to analyze the association of rs12979860 with SVR while adjusting for age, gender, viral load and HCV GT factors.Populations carrying combined genotype ( CT +TT) are making it harder to get SVR compared with those with CC genotype (OR, 95%CI:11.10,5.35-23.04;P<0.000 1).The percentages of SVR in HVC patients with 1b and 2a genotypeare 48.02% and 81.19% respectively.there is a statistically significant difference between these subgroups (χ2 =30.639,P<0.000 1).Conclusion IL-28B rs12979860 genotype is closely related to SVR in CHCpatients.Patients with CC genotype have a higher virus sustained response rate than those carrying CT or TT genotype.The SNP , rs12979860, might be applied as a predictor of clinical antiviral efficacy in the furture.

Under the background of globalization, public health issues are becoming more and more complicated. In the international arena, global health has gradually replaced international health and "global public health" as one of the dominant terms in the field of public health. However, until now, there is no unified understanding and definition for the concept of global health domestically and internationally. In this article, various foreign experts 'views and domestic experts' opinions about the concept of global health are collected and solicited, in order to generalize appropriate Chinese definition of global health of China.
China ; Global Health ; Humans ; Public Health ; Vocabulary

There are so many patients with different liver diseases in our country that the diagnosis and treatment of liver diseases directly relate to the people's healthy level.The requirement of diagnosis and treatment to clinical laboratories can be summarized as: ( 1 ) sensitivity,which means shortening window period;(2) specificity,which means various subtypes and variant can be detected;( 3 )speed,which means finding out the pathogen as soon as possible;(4)accuracy,which means providing physicians with accurate test reports.Detecting techniques,for instances,chemiluminescence,polymerase chain reaction and gene mutational site detecting method,were applied to the diagnosis and treatment of liver disease,thus improving the degree of precision,accuracy,sensitivity,specificity and detection speed and satisfying the requirement of diagnosis and treatment maximatily.

A lot of samples tested daily in clinical medical labs may contain one or more kinds of disease pathogeny which are potentially of biodamage toward surroundings and staff in the lab.Biosafety has since been an internationally important topic as public health control and the controllers' health under great negative impact.Following are some strategy which deserve more attention to strengthen our scientific management efficiency in biosafety of medical labs:(1)conduct bio-risk evaluation of the lab; (2) scientifically arrange layout and analysis proccsses in labs;(3 )providc with biosaf(e)ty instruments;(4)set up document series of biosafety; (5)strengthen safety protection on lab staffs;(6)handle samples and medical waste properly.

Objective To isolate and identify the causative agent in an incident with crowd fever of adults in Henan province.Methods The cells was inoculated by the throat swabs of the patients and followed by neutralization assay and other molecular methods.Then indirect immunofluorescence assay was performed to detect the specific IgM/IgG antibodies against virus in the serum of the patients.Results We have isolated 2 strain adenoviruses from 10 swab samples,which were both identified as Ad11 by sequence analysis and neutralization test.6 of 10 samples were positive fer IgM specific for adenovirus and 3 positive for IgG.The remaining sample was negative for both.Conclusion The causative agent in this incident with crowd fever of adults was Ad11 in group B.

Objective To describe the clinical characteristics and etiology diagnosis of an outbreak of acute respiratory tract infection in a military camp. Methods Two hundred and twenty-five cases were investigated using unified epidemiological questionnaires to describe the epidemiological characteristics. The etiological tests of 30 pharynx swab specimen were performed. The serum neutralized antibodies of 52 patients in acute and convalescence phases were detected by neutralization test. The patients and their close contacts were isolated. Air, stuffs and ground were all disinfected. Results Two hundred and twenty-five cases were distributed all the camp with obvious dormitory aggregation and the aggregation rate was 44. 9%. Among the 225 cases, all cases had fever and 161 (71.6%) had cough, 111 (49.3%) had pharyngalgia, 102 (45.3%) had headache, 31 (13.8%) had chest stuffy and 4(1. 8%) had dyspnea. Twenty (66. 7%) phargnxswab specimens turned to be adenorirus gene positive by polymerase chain reaction. Pharynx swab specimens were cultured in HepG2, Hela, RD and Vero cells, and 16 (53. 3%) presented with cytopathic changes. IgM antibody screening demonstrated that 24 cases were infected with Adenovirus, and neutralization test showed that antibodies increased ≥4 folds in paired sera from 28 cases. During 10 days after patient isolation and general disinfection, there was no new case of Adenovirus infection. Conclusions This outbreak of acute respiratory tract infection in a military camp was caused by Adenovirus, Timely andreasonable preventing measures can control the epidemic quickly.

Objective To develop an assay of PCR-produet direct sequencing to detect hepatitis B virus (HBV) YMDD mutation, and compare the results gained by the sequencing and traditional real-time fluorescent PCR assays. Methods Serum samples were collected from 103 patients with chronic hepatitis B. HBV DNA were extracted from sers. YMDD mutation was detected by a commercial real-time PCR assay. Meanwhile, HBV reverse transcriptase-encoding gene was amplified by a nested PCR assay. The PCR products were directly subjected to sequencing at two directions, and the sequencing results were analyzed by NTI program. Using Kappa test, comparison was made between the results of rtM204-site mutations obtained by the direct sequencing and YMDD mutations by the real-time fluorescent PCR. Results The direct sequencing assay proved to be highly effective with bread range of detection in viral load from 500 to 1010copies/ml. And it may simultaneously avoid inhibitory effect caused by high viral load. The coincidence rates between two assays were 100% for YIDD, 97. 1% for YVDD, 76. 2% for YIDD/YVDD coexistence (Kappa = 0. 853, P < 0. 01). Conclusions The direct sequencing assay for HBV drug-resistant mutation detection is highly sensitive with broad dynamic range. It has high coincidence rate with real-time fluorescent PCR assay with advantage of detecting YMDD, YIDD and YVDD mutations simultaneously.