Enlightenment of ambulatory patient groups on medical insurance payment system in China / 中华医院管理杂志

The current outpatient payment method based on fee-for-service induced serious demand, which increased the waste of medical insurance fund. The authors briefly introduced ambulatory patient groups(APG)with the same concept of diagnosis-related groups. According to the current situation of outpatient medical insurance payment and the degree of informatization in China, suggestions are put forward: launch a pilot project first and starting with chronic disease to promote reform; improve the quality of outpatient electronic medical records, and develop APG suitable for China; under the background of aging, cooperate with the total budget to ensure the security of medical insurance.

Study on the shift of ocular vestibular evoked myogenic potentials frequency tuning of Meniere′s disease / 中华耳鼻咽喉头颈外科杂志

Objective@#To study the shift of oVEMP frequency tuning of unilateral Meniere′s disease, by analyzing oVEMP of air-conducted tone bursts in various frequencies.@*Methods@#From May 2016 to October 2017, 33 patients with unilateral Meniere′s from Aerospace Center Hospital were tested for oVEMP in 500 Hz and 1 000 Hz air-conducted tone bursts respectively, and 20 healthy subjects(40 ears), matched for age and sex, were used as healthy control. The amplitudes of the N1-P1 wave and the frequency amplitude ratios of 500/1 000 Hz in affected ears, unaffected ears and normal ears were compared; and receiver operating characteristic curve was analyzed for frequency amplitude ratios of 500/1 000 Hz.@*Results@#By the 500 Hz tone-burst stimulus, the provocation rates of the oVEMP were 84.9%(28/33), 93.9%(31/33) and 97.5%(39/40) in affected ears, contralateral ears and the ears of normal controls, respectively. By the stimulus of 1 000 Hz tone-burst, the provocation rates of the oVEMP were 81.8%(27/33), 87.9%(29/33) and 82.5% (33/40) in affected ears, contralateral ears and normal control ears, respectively. Amplitudes of N1-P1 waveforms in 500 Hz air-conducted tone bursts in affected ears were under normal control ears and contralateral ears. There was significant difference between affected ears and healthy control ears (P<0.05). Amplitudes of N1-P1 waveforms in contralateral ears were also significantly smaller than those in normal control ears (P<0.05). There were no significant differences in amplitudes of N1-P1 waveforms between affected ears, contralateral ears and normal control ears in 1 000 Hz tone bursts stimulus(P>0.05). Frequency amplitude ratios of 500/1 000 Hz in affected ears were significantly under contralateral and normal control ears (P<0.05). According to ROC, the frequency amplitude ratio critical value of frequency tuning was set as 1.17, the positive rate of frequency tuning shift in affected ears was 54.5%(18/33) and significantly higher than in contralateral ears(18.2%, 6/33, χ2=9.429, P=0.002) and normal control ears (7.5%, 3/40, χ2=19.530, P=0.000). In contrast, there was no significant difference in the incidence of frequency tuning shift between contralateral ears and normal ears(χ2=1.909, P=0.167).@*Conclusions@#Frequency tuning oVEMP with Meniere′s disease will be changed.Frequency tuning of oVEMP with Meniere′s disease shifts from low frequency region to high frequency region in comparison with healthy people. Frequency amplitude ratio is helpful for diagnosis of Meniere′s disease.

Study of Pathogenic gene spectrum in benign familial infantile epilepsy / 中华实用儿科临床杂志

Objective To investigate the gene mutations in benign familial infantile epilepsy(BFIE)in Chi-na. Methods Data of all BFIE probands and their family members were collected from Peking University First Hospital and other three hospitals between October 2006 and June 2017. Clinical phenotypes of affected members were analyzed. Genomic DNA was extracted from peripheral blood samples with standard protocol. Mutations in PRRT2 were screened using Sanger sequencing. For families that PRRT2 mutations were not detected by Sanger sequencing,candidate gene mutations were further screened by next - generation sequencing. Results A total of 71 families including 227 affected members were collected. Genetic testing led to the identification of gene mutations in 52 families (52 / 71,73. 2％). Forty - three families had PRRT2 mutations (43 / 71,60. 6％),including 40 families with frameshift mutations(hotspot mutations c. 649_650insC and c. 649delC were detected in 29 families and 6 families,respectively),one family with nonsense mutation,one family with a loss of a stop codon,and one family with a microdeletion of the gene. C. 560_561insT and c. 679C > T were novel PRRT2 mutations. Five families had SCN2A mutations. All SCN2A mutations were missense mutations(c. 668G > A,c. 752T > C,c. 1307T > C,c. 4835C > G,c. 1737C > G). Mutation c. 752T > C, c. 1307T > C,c. 4835C > G,and c. 1737C > G were novel mutations. Three families had KCNQ2 mutations. All KCNQ2 mutations were missense mutations(c. 775G > A,c. 237T > G,c. 1510C > T). Mutation c. 237T > G and c. 1510C > T were novel mutations. One family had a novel GABRA6 mutation c. 523G > T. In 71 BFIE families,16 families had mem-bers who showed paroxysmal kinesigenic dyskinesias(PKD)and subclassified as infantile convulsions with paroxysmal choreoathetosis syndrome(ICCA). Fifteen ICCA families were found having PRRT2 mutations (15 / 16,93. 8％). The remaining ICCA family was not detected with any pathogenic mutation. Conclusion There is high frequency of gene mutations in BFIE families. Mutations in KCNQ2,SCN2A,and PRRT2 are genetic causes of BFIE. PRRT2 is the main gene responsible for BFIE. GABRA6 mutation might be a new cause of BFIE.

Clinical observation of acupoint application therapy on senile female bladder neck obstruction / 中国针灸

<p><b>OBJECTIVE</b>To observe the clinical efficacy on senile female bladder neck obstruction treated with acupoint application, therapy and western medication.</p><p><b>METHODS</b>Fifty cases of senile female bladder neck observation were randomized into an obstrvation group and a control group, 25 cases in each one. Tamsulosin hydrochloride capsules were taken orally in the two groups, 0.2 mg every night, continuously for 100 days. In the observation group, with radix aconiti lateralis preparata, semen brassicae and fructus ligustri lucidi contained, bushentongyu plaster was used at Shenque (CV 8), Sanyinjiao (SP 6), Pangguangshu (BL 28), Zhongji (CV 3) and Sanjiaoshu (BL 22), once every two days. Eight treatments made one session and 6 sessions were required totally. The international prostate symptom score (IPSS), the bother score (BS), the residual volume (RV) and the maximal urinary flow rate (MFR) were observed before and after treatment in the two groups. The clinical efficacy was compared between the two groups.</p><p><b>RESULTS</b>Every score in IPSS after treatment was reduced apparently as compared with that before treatment in the two groups (all P < 0.01). The improvements in feeling of incomplete, bladder emptying, intermittency < 2 h, urgency, interupted urination and nocturia in the observation group were more advantageous than those in the control group (all P < 0.05). The total effective rate was 95.65% (22/23) in the observation group, higher than 85.71% (18/21) in the control group (P < 0.05). After treatment, RV, MFR and BS were significantly different as compared with those before treatment (all P < 0.05).</p><p><b>CONCLUSION</b>The combined therapy of acupoint application of bushentongyu plaster and oral administration of tamsulosin hydrochloride capsules achieves the significant efficacy on senile female bladder neck obstruction as compared with the simple administration of tamsulosin hydrochloride capsules.</p>

Congenital cholesteatoma of middle ear: 20 patients' clinical symptoms and imaging features / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the location, staging, clinical symptoms, imaging features, and surgical treatment of the congenital cholesteatoma of middle ear (CCME).@*METHOD@#This was a retrospective review of 20 CCME cases.@*RESULT@#Of 20 cases with CCME, 2 cases were classified as Postic stage I, 0 as stage II, 13 as stage III, 5 as stage IV. Conductive hearing loss was the most common clinical symptom. The mean preoperative PTA was 54.1 dB, and the mean ABG was 41.7 dB. One case underwent a modified mastoidectomy and a second-stage ossicular reconstruction; 2 cases experienced a radical mastoidectomy without ossicular reconsturction for extensive cholesteatoma; 5 cases underwent modified mastoidectomy and a one-stage tympanoplasty, with one case diagnosed as congenital malformation of ossicular chain (stapes hypoplasia); other 12 cases underwent a one-stage tympanoplasty. The cholesteatoma localized to the posterior-epitympanum or mesotympanum in all patients, mainly located in the incudostapedial joint. The mean postoperative PTA from 16 cases was 35.3 dB, and A-B gap was 20.2 dB. All patients were followed-up for at least 1 year after operation and recurrence was found in 2 cases. Three cases were accompanied with congenital malformation of ossicular chain.@*CONCLUSION@#CCME is a rare entity and diagnosis is usually delayed in clinical practice due to the silent nature of disease in its early stage. The prognosis of CCME mainly depended on the stage of the lesions.

Clinical features and PRRT2 mutations in infantile convulsions with paroxysmal choreoathetosis / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze the phenotypes and proline-rich transmenbrane protein 2 (PRRT2) gene mutations in patients of infantile convulsions with paroxysmal choreoathetosis (ICCA).</p><p><b>METHODS</b>Clinical data were collected from ICCA patients and their family members. Genomic DNA was extracted from peripheral blood samples with standard protocol. Mutations of PRRT2 were screened using PCR amplification and Sanger sequencing.</p><p><b>RESULTS</b>Eleven families and one sporadic case with ICCA were recruited in this study. In 11 ICCA families, 49 family members were affected, of which 15 individuals had benign infantile convulsions (BIC) alone, 18 individuals had only paroxysmal kinesigenic dyskinesia(PKD), and 16 individuals had BIC followed by PKD. The seizure onset age of infantile convulsions was between 3 and 12 months. The onset age of PKD was ranging from 5 to 17 years old. Four affected members in two ICCA families had PKD or ICCA co-existing with migraine. The one sporadic ICCA case had afebrile seizures between 3.5 and 4 months, and developed paroxysmal twists of limbs after 3 years and 9 months of age. He had good response to treatment with oxcarbazepine at the age of 4 years and 10 months. PRRT2 mutations were identified in all 11 ICCA families. The most common mutation, c.649_650insC (p.R217PfsX8), was detected in 6 of the 11 families (54.5%). PRRT2 mutation (c.649_650insC) was also found in the sporadic ICCA case, and was identified as de novo mutation.</p><p><b>CONCLUSION</b>The phenotype of PKD in ICCA families occurred in childhood or adolescence. Few affected members in some ICCA families may have migraine. PRRT2 is the causative gene of ICCA and the mutation c.649_650insC was the hotspot of PRRT2 mutations. PRRT2 mutation was also found in sporadic case with ICCA.</p>

Causal analysis and management strategies of cerebrospinal fluid leakage following translabyrinthine approach for acoustic neuromas / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The purpose of the report was to investigate the causes of CSF leakage and discuss the methods for prevention and management of CSF leakage following translabyrinthine resection of acoustic neuromas.</p><p><b>METHODS</b>A retrospective review of cerebrospinal fluid leakage following translabyrinthine approach for 152 acoustic neuromas patients, from January 1983 to December 2013, was performed. The cases were divided into two groups, traditional and modified closure techniques. The incidence of CSF leakage was compared between the two groups.</p><p><b>RESULTS</b>The incidence of postoperative CSF leakage by translabyrinthine approach was 5.9% (9/152), with four cases of rhinorrhea, two case of wound leakage, one case of rhinorrhea and otorrhea, one case of otorrhea, and one case of rhinorrhea and wound leakage. The CSF leakage incidence of traditional closure technique was 14.3% (5/35); the incidence of modified closure technique was 3.4% (4/117). After introducing a modified closure technique, the incidence of the CSF leakage significantly decreased.</p><p><b>CONCLUSIONS</b>As a common complication of translabyrinthine approach, the incidence of CSF leakage is closely related to the closure technique. The incidence of the CSF leakage should decrease dramatically when adopting the modified closure technique.</p>

Phenotypes and PRRT2 mutation analysis in families with benign familial infantile epilepsy / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the phenotypes and proline-rich transmembrane protein 2 (PRRT2) mutations in families with benign familial infantile epilepsy (BFIE).</p><p><b>METHOD</b>Data of all BFIE probands and their family members were collected from Peking University First Hospital between September 2006 and August 2013. Clinical phenotypes of affected members were analyzed. Genomic DNA was extracted from peripheral blood samples with standard protocol. Mutations in PRRT2 were screened using PCR amplification and Sanger sequencing.</p><p><b>RESULT</b>Twenty-nine BFIE families were recruited in this study. In total, 110 family members were affected. The age of seizure onset of these affected members was between 2 and 12 months (median: 4.5 months). All probands presented with clusters of seizures. Two probands had one seizure induced by diarrhea respectively at 25 months and 31 months. In four BFIE families, four family members had a history of febrile seizures. PRRT2 mutations were found in 17 of the 29 (58.6%) BFIE families. Mutation c.649_650insC was detected in 12 of the 17 families with PRRT2 mutations. Mutation c.649delC (p.R217EfsX12) was identified in three families. Mutation c.323_324delCA (p. T108SfsX25) and c.904_ 905insG (p. D302GfsX39) were detected in one family, respectively.</p><p><b>CONCLUSION</b>The minimum seizure onset age of affected members in BFIE families was 2 months of age. The seizures often occur in clusters. PRRT2 is the major causative gene of BFIE in Chinese families. Mutation c.649_650insC is the hotspot mutation of PRRT2. A novel mutation c.323_324delCA was first reported in BFIE family. Few affected members with PRRT2 mutation presented with febrile seizures phenotype.</p>

Preparation and clinical application of polyvinyl alcohol/drug-loaded chitosan microsphere composite wound dressing / 生物医学工程学杂志

In order to prepare and apply the polyvinyl alcohol/drug-loaded chitosan microspheres composite wound dressing, we first prepared chitosan microspheres by emulsion cross-linking method, and then added chitosan microspheres into the reactants during the acetalization of polyvinyl alcohol and formaldehyde. We further studied the morphology, water absorption, swelling degree, mechanical properties and in vitro release of the sponge with different amount of chitosan microspheres. The results showed that polyvinyl alcohol/drug-loaded chitosan composite sponge has porous structure with connectionism. Increasing the amount of chitosan microspheres would make the apertures smaller, so that the water absorption and the swelling of sponge decreased, but the tensile strength and compressive strength increased. With the increase of the amount of chitosan microspheres, the drug absorption of cefradine and the release rate increase, and the release time become longer. With the results of toxicity grade of 0 to 1, this type of composite sponge is non-toxic and meets the requirement of biocompatibility. The observation of rabbit nasal cavity after surgical operation suggested that polyvinyl acetal sponge modified with the chitosan has antiphlogistic, hemostatic and non-adherent characteristic, and can promote the healing and recovering of the nasalmucosa. After using this composite material, best growing surroundings for patients' granulation tissue were provided. Exposed bone and tendon were covered well with granulation tissue.

Pathogens of Catheter-related Bloodstream Infection / 中华医院感染学杂志

OBJECTIVE To analyze distribution of the pathogens of catheter-related bloodstream infection ( CRBSI ), and provide doctors with the laboratory evidence of CRBSI diagnosis. METHODS A retrospective analysis of CRBSI pathogens′ distributions from 261 inpatients whose catheter culturing was positive in General Hospital of PLA from Jan 1, 2002 to Aug 31, 2004 was done, and from which true cases of CRBSI were judged and true pathogens or contaminants were identified and counted. RESULTS There were 88 (33.72%) patients diagnosed as CRBSI among 261 cases. They were from intensive care unit (41), surgical department (22), medicine (12), the old patients ward (10), and pediatric ward (3). The first four by rank order of the CRBSI pathogens were Acinetobacter baumannii (15.9%), coagulase-negative staphylococci (14.8%), Pseudomonas aeruginosa ( 11.4% ), and Candida albicans (9.1%). The prominent contaminants were as follows: coagulase-negative staphylococci , Streptococcus pyogenes, Micrococcus and Gram-positive rods. CONCLUSIONS To get a better understanding about distribution of CRBSI pathogens will help its diagnosing as early as possible.

Detection of methicillin-resistant Staphylococcus by resistance phenotype and amplification of mecA gene / 中华检验医学杂志

Objective To study the detection characteristics of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococcus.Methods Disks with 1 ?g of oxacillin and 30 ?g of cefoxitin were used to detect the inhibition zone of staphylococcus aureus and coagulase-negative staphylococcus at both 35℃ and 30℃ according to the method and breakpoint recommended by CLSI.The agar surface of oxacillin plate with sodium chloride was spotted.mecA gene was amplified by PCR.Results For detection of MRSA, disks of oxacillin and cefoxitin at 30℃ have the same sensitivity of 100%, however, the sensitivity of cefoxitin( 94.7%) is a little higher than that of oxacillin (93.3%) at 35℃. For detection of MRCNS, the sensitivity of 100% can be obtained by disks of both oxacillin and cefoxitin at both 30℃ and 35℃.The sensitivity and specificity of oxacillin plate with sodium chloride are the same as those of disks of oxacillin and cefoxitin at 30℃ for detection of MRSA, its sensitivity is lower than that of disks for detection of MRCNS.Conclusion The detection of methicillin-resistant Staphylococcus can be improved by the use of cefoxitin disk.

Protective effects of M_3 receptor agonists on the arrhythmias of rats induced by barium chloride / 中国药理学通报

Aim To observe the protective effects of choline and pilocarpine,the M3 receptor agonists,on the arrhythmias of Wistar rats induced by barium chloride.Methods Barium chloride was used to induce the experimental arrhythmias of Wistar rats.Choline,pilocarpine,and 4-diphenylacetoxy-N-methylpiperidine-methiodide (4-DAMP),the selective antagonist of M3 receptor,were used to explore the effects of M3 receptor on the arrhythmias induced by barium chloride.The occurence and the severity of arrhythmias were observed.Results Choline 10 mg?kg-1 and pilocarpine 0.2 mg?kg-1 inhibited the occurence of arrhythmias,shortened the duration of arrhythmias (P

Depression and Anxiety in Female Students of Children's Normal School / 中国心理卫生杂志

Objective:To investigate the rates of depression and anxiety in female students of a children's normal school Method:919 female students of a children's normal school were collected by stratified cluster sampling, they completed BDI (Beck Depression Inventory), SAS (Zung's self-rating anxiety scale), EPQ, FES (family environment scale) and a self-made inventory on risk behaviors of adolescents Result:The rate of depression was 48 75%, that of anxiety was 16 32% Students of different grades had different rates of depression, but not different rates of anxiety Students with depression had higher N score and P score, and lower E score and less Lying in EPQ than normal control In family environment, the depressed students had poorer cohesion, expressiveness, independence, achievement, intellectual and organization than normal Logistic regression analysis showed depression related to where the students come from (rural or urban), intimacy, dieting, academic achievement and education level of their mother Anxiety related to expressiveness, dieting and drinking within one month Conclusion:Depression and anxiety are so common in female students of children's normal school, which need more attention from mental health professionals

Study of inducible resistance of erythromycin to clindamycin in Staphylococcus / 中华检验医学杂志

Objective To investigate the resistance of Staphylococcus to erythromycin and clindamycin and detect the percentage and gene for inducible resistance. Methods Disk diffusion method was used to test the resistance phenotype of Staphylococcus aureus and coagulase-negative staphylococcus according to the standards of NCCLS. The inducible resistance of erythromycin to clindamycin was checked by D-test and the gene for erythromycin ribosome methylase was detected by polymerase chain reaction.Results Co-resistance to erythromycin and clindamycin accounted for 62.7% and 54.8% in MRSA and MRCNS respectively. D-test positive rate was 17.7% among all Staphylococcus tested. The rate of inducible resistance to clindamycin (D-test positive) was 67.6% and 45.3% in Staphylococcus aureus and coagulase-negative Staphylococcus which possessed erythromycin resistant and clindamycin sensitive by individual disk diffusion test. The predominant gene for inducible resistance was ermC with the percentage of 74.5%.Conclusion The inducible resistance of erythromycin to clindamycin in Staphylococcus should be checked by D-test in clinical microbiology laboratory in order to help physicians to select MLSB antimicrobial agents correctly.

Extended Spectum ?-Lactamases Producing E.coli and K.pneumoniae:Their Distribution and Resistance to Antimicrobial Agent / 中华医院感染学杂志

OBJECTIVE To investigate the prevalence and resistance of extended spectram ?-lactamases(ESBLs) producers in Escherichia coli and Klebsiella pneumoniae.METHODS ESBLs producing strains were screened by double disk test and confirmed by the NCCLS confirmatory test.Susceptibility test to antimicrobial agents was performed by disk diffusion method and analyzed by WHONET 5.3 and Excel.RESULTS The isolated ratio of ESBLs producing E.coli and K.pneumoniae increased from 14% and 15% in 1999 to 30.1% and 30.4% in 2002.Bacteremia caused by the two kinds of ESBLs producers accounted for 30.2% and 30.4%,respectively.ESBLs producing K.pneumoniae and(ESBLs) producing E.coli were 19.8% and 14.0% for outpatient and 26.6% and 31.6% for inpatient.The resistance of(E.coli) to 17 kinds of agents was similar,no matter it was isolated from blood,urine or sputum.Susceptibility of(ESBLs) producing E.coli and K.pneumoniae in urine to cefoperazone/sulbactam,and piperacillin/tazobactam were 85% and 65.2%,66.6% and 29.4%,although to other 15 agents there were no difference.None of the(isolates) showed resistance to imipenem.CONCLUSIONS There is an increasing trend of ESBLs producing E.coli and K.pneumoniae(isolated) from various kinds of specimens and from different wards.It is important for clinical physicians to understand the distribution and the resistance characteristics of ESBLs producing E.coli and(K.pneumoniae) to antibiotics.