A live attenuated vaccine confers superior mucosal and systemic immunity to SARS-CoV-2 variants

Vaccines are a cornerstone in COVID-19 pandemic management. Here, we compare immune responses to and preclinical efficacy of the mRNA vaccine BNT162b2, an adenovirus-vectored spike vaccine, and the live-attenuated-virus vaccine candidate sCPD9 after single and double vaccination in Syrian hamsters. All regimens containing sCPD9 showed superior efficacy. The robust immunity elicited by sCPD9 was evident in a wide range of immune parameters after challenge with heterologous SARS-CoV-2 including rapid viral clearance, reduced tissue damage, fast differentiation of pre-plasmablasts, strong systemic and mucosal humoral responses, and rapid recall of memory T cells from lung tissue. Our results demonstrate that use of live-attenuated vaccines may offer advantages over available COVID-19 vaccines, specifically when applied as booster, and may provide a solution for containment of the COVID-19 pandemic.

The use of the single purse-string parachute suturing technique for pancreaticojejunostomy in laparscopic pancreaticoduodenectomy / 中华肝胆外科杂志

Objective:To study the single purse-string parachute suturing technique for pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy, and to determine its feasibility and safety.Methods:The clinical data of 71 patients who underwent laparoscopic pancreaticoduodenectomy using the single purse-string parachute suturing technique for pancreaticojejunostomy from October 2018 to October 2021 at the Second Hospital of Hebei Medical University were retrospectively analyzed. There were 41 males and 30 females, with age (59.1±9.7) years old. The operative time, intraoperative blood loss, complication rate and other data were analyzed.Results:All 71 patients successfully underwent total laparoscopic pancreaticoduodenectomy, with 5 patients who underwent 2D laparoscopic surgery and 66 patients 3D laparoscopic surgery. There were additional vascular resection and reconstruction in 2 patients. The operative time was (388.9±92.9) min, the intraoperative blood loss was (411.3±176.9) ml, and the postoperative hospital stay was (14.1±5.8) d. The operation time of 71 patients who underwent the single purse-string parachute technique of pancreaticojejunostomy was (26.9±6.8) min. Postoperative complications occurred in 18 patients (25.4%). Grade B pancreatic fistula occurred in 2 patients (2.8%), and the longest time for removal of abdominal drain was 17 days after operation. Among the 71 patients, complications including biliary fistula occurred in 6 patients (8.5%), delayed gastric emptying in 5 patients (7.0%), pulmonary infection in 4 patients (5.6%), non-pancreatic fistula-related abdominal infection in 4 patients (5.6%), non-pancreatic fistula-related abdominal bleeding in 1 patient (1.4%), biliary tract bleeding in 1 patient (1.4%), and chylous leakage in 2 patients (2.8%).Conclusion:The single purse-string parachute technique of pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy had the advantages of being safe and reliable. The procedure is worthy of furthers promotion.

Nucleocapsid 203 mutations enhance SARS-CoV-2 immune evasion

Previous work indicated that the nucleocapsid 203 mutation increase the virulence and transmission of the SARS-CoV-2 Alpha variant. However, Delta later outcompeted Alpha and other lineages, promoting a new wave of infections. Delta also possesses a nucleocapsid 203 mutation, R203M. Large-scale epidemiological analyses suggest a synergistic effect of the 203 mutation and the spike L452R mutation, associated with Delta expansion. Viral competition experiments demonstrate the synergistic effect in fitness and infectivity. More importantly, we found that the combination of R203M and L452R brings in a 3.2-fold decrease in neutralizing titers to the neutralizing serum relative to L452R-only virus. R203M/L452R show an increased fitness after the initiation of global vaccination programmes, possibly associated with the enhanced immune evasion. Another rapidly emerging variant Omicron also bears the 203 mutation. Thus, we proposed that nucleocapsid mutations play an essential role for the rise and predominance of variants in concern.

Unconventional secretion of unglycosylated ORF8 is critical for the cytokine storm during SARS-CoV-2 infection

Coronavirus disease 2019 is a respiratory infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Evidence on the pathogenesis of SARS-CoV-2 is accumulating rapidly. In addition to structural proteins such as Spike and Envelope, the functional roles of non-structural and accessory proteins in regulating viral life cycle and host immune responses remain to be understood. Here, we show that open reading frame 8 (ORF8) acts as messenger for inter-cellular communication between alveolar epithelial cells and macrophages during SARS-CoV-2 infection. Mechanistically, ORF8 is a secretory protein that can be secreted by infected epithelial cells via both conventional and unconventional secretory pathways. The unconventionally secreted ORF8 recognizes the IL17RA receptor of macrophages and induces cytokine release. However, conventionally secreted ORF8 cannot bind to IL17RA due to N-linked glycosylation. Furthermore, we found that Yip1 interacting factor homolog B (YIF1B) is a channel protein that translocates unglycosylated ORF8 into vesicles for unconventional secretion. Blocking the unconventional secretion of ORF8 via a YIF1B knockout in hACE2 mice attenuates inflammation and yields delayed mortality following SARS-CoV-2 challenge.

Nucleocapsid mutation R203K/G204R increases the infectivity, fitness and virulence of SARS-CoV-2

In addition to the mutations on the spike protein (S), co-occurring mutations on nucleocapsid (N) protein are also emerging in SARS-CoV-2 world widely. Mutations R203K/G204R on N, carried by high transmissibility SARS-CoV-2 lineages including B.1.1.7 and P.1, has a rapid spread in the pandemic during the past year. In this study, we performed comprehensive population genomic analyses and virology experiment concerning on the evolution, causation and virology consequence of R203K/G204R mutations. The global incidence frequency (IF) of 203K/204R has rose up from nearly zero to 76% to date with a shrinking from August to November in 2020 but bounced later. Our results show that the emergence of B.1.1.7 is associated with the second growth of R203K/G204R mutants. We identified positive selection evidences that support the adaptiveness of 203K/204R variants. The R203K/G204R mutant virus was created and compared with the native virus. The virus competition experiments show that 203K/204R variants possess a replication advantage over the preceding R203/G204 variants, possibly in relation to the ribonucleocapsid (RNP) assemble during the virus replication. Moreover, the 203K/204R virus increased the infectivity in a human lung cell line and induced an enhanced damage to blood vessel of infected hamsters lungs. In consistence, we observed a positive association between the increased severity of COVID-19 and the IF of 203K/204R from in silicon analysis of global clinical and epidemic data. In combination with the informatics and virology experiment, our work suggested the contribution of 203K/204R to the increased transmission and virulence of the SARS-CoV-2. In addition to mutations on the S protein, the mutations on the N protein are also important to virus spread during the pandemic.

Skeletonized bilateral internal mammary artery harvesting with harmonic scalpel in coronary artery bypass grafting / 中国胸心血管外科临床杂志

@#Objective    To summarize the use of harmonic scalpel to harvest bilateral internal mammary artery in coronary artery bypass grafting (CABG). Methods    The clinical data of 54 patients of bilateral skeletonized internal mammary artery harvesting for CABG in our hospital from January 2016 to May 2020 were analyzed retrospectively. There were 51 males and 3 females with a mean age of 62.37±9.56 years. Results    All patients went through the procedure unevently and discharged from hospital. The number of grafts was 4.07±0.85 per patient, the operation time was 267.21±47.00 min, mechanical ventilation time was 342.43±132.17 min and hospital stay was 12.21±4.43 d. Conclusion    It is safe and effective to use harmonic scalpel to harvest skeletonized bilateral internal mammary artery in CABG.

Patient-derived mutations impact pathogenicity of SARS-CoV-2

The sudden outbreak of the severe acute respiratory syndrome-coronavirus (SARS-CoV-2) has spread globally with more than 1,300,000 patients diagnosed and a death toll of 70,000. Current genomic survey data suggest that single nucleotide variants (SNVs) are abundant. However, no mutation has been directly linked with functional changes in viral pathogenicity. We report functional characterizations of 11 patient-derived viral isolates. We observed diverse mutations in these viral isolates, including 6 different mutations in the spike glycoprotein (S protein), and 2 of which are different SNVs that led to the same missense mutation. Importantly, these viral isolates show significant variation in cytopathic effects and viral load, up to 270-fold differences, when infecting Vero-E6 cells. Therefore, we provide direct evidence that the SARS-CoV-2 has acquired mutations capable of substantially changing its pathogenicity.

Correlation of percutaneous vertebroplasty effect on osteoporotic vertebral compression fracture with injection amount and dispersion degree of bone cement / 中国组织工程研究

BACKGROUND: Previous studies show that the amount and diffusion degree of bone cement In vertebroplasty have some Influence on the postoperative recovery of patients with osteoporotic vertebral compression fracture, but there are few reports about the correlation between the amount and diffusion degree of bone cement In vertebroplasty and the recovery of vertebral body. OBJECTIVE: To Investigate the relationships between the effect of percutaneous vertebroplasty on osteoporotic vertebral compression fractures and the Injection amount and dispersion degree of bone cement. METHODS: Totally 102 osteoporotic vertebral compression fracture patients (109 vertebrae) who received treatment in the Sanya Hospital of Traditional Chinese Medicine from January 2017 to August 2018, including 42 males and 60 females at the age of 52-76 years, were retrospectively analyzed. All patients received percutaneous vertebroplasty. According to the Injection amount of bone cement, they were divided into two groups: observation group 1 (Injection > 4 mL, n=57) and control group 1 (injection ≤ 4 mL, n=45). According to the degree of dispersion of bone cement, they were divided into two groups: observation group 2 (filling rate > 15%, n=61) and control group 2 (filling rate > 15%, n=41). Visual analogue scale score, Oswestry disability index, anterior vertebral height, Cobb angle, and the occurrence of cement leakage were observed before and after surgery. The correlations of the Injection amount and dispersion degree of bone cement with the height of vertebral body recovered were analyzed. This study was approved by the Medical Ethics Committee of Sanya Hospital of Traditional Chinese Medicine. RESULTS AND CONCLUSION: (1) The visual analogue scale score and Oswestry dysfunction index of patients in the observation group 1 and control group 1 at 3 days after operation were decreased compared with before operation (P 0.05). There was no significant difference in the incidence of cement leakage between observation group 2 and control group 2 (P > 0.05). (4) The height of vertebral body recovery was positively correlated with the Injection amount and dispersion degree of bone cement (P < 0.05). (5) The results suggest that increases of the Injection amount and dispersion degree of bone cement properly can alleviate the pain, improve the mobility, correct the deformity of vertebral posterior concave, and restore the height of vertebral body of osteoporotic vertebral compression fracture patients. The Injection amount and dispersion degree of bone cement are positively correlated with the recovery height of vertebral body.

Macrophage migration inhibitory factor mediates peripheral nerve injury-induced hypersensitivity by curbing dopaminergic descending inhibition

Our previous works disclosed the contributing role of macrophage migration inhibitory factor (MIF) and dopaminergic inhibition by lysine dimethyltransferase G9a/Glp complex in peripheral nerve injury-induced hypersensitivity. We herein propose that the proinflammatory cytokine MIF participates in the regulation of neuropathic hypersensitivity by interacting with and suppressing the descending dopaminergic system. The lumbar spinal cord (L-SC) and ventral tegmental area (VTA) are two major locations with significant upregulation of MIF after chronic constriction injury (CCI) of the sciatic nerve, and they display time-dependent changes, along with a behavioral trajectory. Correspondingly, dopamine (DA) content shows the reverse characteristic change to MIF with a time-dependent curve in post-surgical behavior. The levels of both MIF and DA are reversed by the MIF tautomerase inhibitor ISO-1, and a negative relationship exists between MIF and DA. The reversed role of ISO-1 also affects tyrosine hydroxylase expression. Furthermore, CCI induces Th promoter CpG site methylation in the L-SC and VTA areas, and this effect could be abated by ISO-1 administration. G9a/SUV39H1 and H3K9me2/H3K9me3 enrichment within the Th promoter region following CCI in the L-SC and VTA was also decreased by ISO-1. In cultured dopaminergic neurons, rMIF enhanced the recruitment of G9a and SUV39H1, followed by an increase in H3K9me2/H3K9me3. These molecular changes correspondingly exhibited alterations in Th promoter CpG site methylation and pain behaviors. In summary, MIF functions as a braking factor in curbing dopaminergic descending inhibition in peripheral nerve injury-induced hypersensitivity by mediating Th gene methylation through G9a/SUV39H1-associated H3K9 methylation.

Effects of Low-frequency Repetitive Transcranial Magnetic Stimulation on Upper Limb Spasticity after Stroke: A Task-state Functional Magnetic Resonance Study / 中国康复理论与实践

@#Objective To investigate the clinical efficacy of low-frequency transcranial magnetic stimulation (rTMS) on post-stroke upper limb spasticity and its mechanism. Methods From September, 2015 to December, 2017, 23 patients with post-stroke upper limb paralysis were randomly divided into control group (n=13) and experimental group (n=10). Both groups received routine rehabilitation, and the experimental group received 1 Hz rTMS at primary motor area (M1) for eight weeks. They were assessed with modified Ashworth Scale (MAS), modified Barthel Index (MBI) and Fugl-Meyer Assessment-Upper Extremities (FMA-UE) before and after treatment, while the activation under fMRI in the task state was observed and the laterality index (LI) was calculated. Results The scores of MAS, FMA-UE and MBI improved after treatment in both groups (Z>2.121, t=6.248, P<0.05), and improved more in the experimental group than in the control group (Z>2.084, t=-2.095, P<0.05). The ipsilateral M1, ipsilateral sensory motor cortex and bilateral supplementary motor area were activated more in the control group than in the experimental group during the movement of affected hand. LI in the M1 increased after treatment in both groups (Z>2.366, P<0.05), and was more in the experimental group than in the control group (Z=-2.430, P<0.05). There was a positive correlation between the change of LI in the M1 and the improvement of the MAS and FMA-UE (r>0.612, P<0.05). Conclusion Low-frequency rTMS may improve the motor function and spasticity of upper limb after stroke by promoting reorganization of the cortex and inducing normalization of cortical function.

CT and MRI manifestation of branchial cleft fistula / 实用放射学杂志

Objective To discuss the diagnostic value of branchial cleft fistula with CT and(or)MRI.Methods CT and(or)MRI findings of 33 cases of branchial cleft fistula were collected and analyzed retrospectively.Results Branchial cleft fistula were divided into four types namely first,second,third and fourth according to its origin with each type having its own corresponding CT and MRI features.Among the 33 cases,7 cases (21%)were first branchial cleft fistula,which originated from external auditory meatus and the parotid gland.These lesions presented as a tubular structure around the ear,sometimes invading the facial nerve,causing facial nerve symptoms.1 8 cases (5 5 %)were second branchial cleft fistula,and were presented as tubular ones in the anterior triangle area of the neck or along the anterior border of the sternocleidomastoid muscle.8 cases (24%)were third or fourth branchial cleft fistula,which were difficult to differentiate,both of them originated from pyriform sinus and partly penetrated the thyroid.Conclusion CT and(or) MRI could show the location and range of the lesion clearly,making it valuable for diagnosis of branchial cleft fistula.

Laparoscopic pancreaticoduodenectomy combined with major vascular resection and reconstruction:an analysis of 7 patients / 中华肝胆外科杂志

Objective To review our experience in laparoscopic pancreaticoduodenectomy combined with major vascular resection and reconstruction.Methods Of 183 patients who underwent laparoscopic pancreaticoduodenectomy in our department from November 2013 to January 2017,major vascular resection and reconstruction using the SMA first approach for total mesopancreas excision was performed in 7 patients.The clinical data of these 7 patients were retrospectively analyzed.Results Total 3D laparoscopic surgery was performed in all these 7 patients.The mean operation time,mean blood loss and blood flow occlusion time were (551.4 ± 83.8) min,(671.3 ± 256.3) ml and (45.8 ± 6.7) min,respectively.Six out of 7 patients were pathologically diagnosed to have pancreatic adenocarcinoma with negative surgical margins.Two patients had lymphatic metastasis (the number of metastatic lymph node was 1 in each patient).The mean number of lymph nodes resected was (12.7 ± 5.8).The portal vein-superior mesenteric vein (PV-SMV) was segmentally resected and reconstructed using an end to end anastomosis following the preoperative plan in 4 patients.These included 2 patients who underwent total pancreatectomy.The portal vein was wedge-resected and reconstructed by venorrhaphy in 2 patients.The remaining 1 patient was histopathologically diagnosed to have a mass-type chronic pancreatitis.Only 1 patient was treated in the ICU for 1 day after surgery.Post-operative complications occurred in 2 patients and they were managed with nonsurgical treatment (PV-SMV thrombosis and gastric emptying disorder in 1 and a pancreatic leakage (level A) in 1).The mean length of post-operative hospital stay was (13.7 ± 3.2) days with no in-hospital mortality.Seven patients were alive by April 2017.The mean follow-up for the 6 patients with pancreatic adenocarcinoma was 4.5 (3.5 ～9) months.Conclusions Based on our experience in skillful and masterly major vascular resection and reconstruction in open surgery and on our experience in standard laparoscopic pancreaticoduodenectomy,laparoscopic pancreatieoduodenectomy combined with major vascular resection and reconstruction was feasible and safe.This surgery requires very mature skills in laparoscopic surgery.

Changes of renal interlobur artery hemodynamics in acute renal injury after operation of acute Stanford A aortic dissection / 中国介入影像与治疗学

Objective To explore the changes of hemodynamics in acute kidney injury (AKI) after acute severe Stanford type A aortic dissection.Methods Forty patients with acute Stanford A type aortic dissection were enrolled.Arterial peak systolic velocity (PSV),end diastolic velocity (EDV),pulsative index (PI),resistive index (RI),Serum creatinine (SCr) and urine volume were recorded and measured 1 day before operation,immediately after operation (enter the intensive care unit),6 h after operation,24 h after operation and 48 h after operation.Patients were divided into AKI group and non-AKI.group taking AKIN as a standard.Results Twenty-seven patients were in AKI group and 13 were in non-AKI group.The EDV,PI and RI had significantly differences between AKI group and non-AKI group at 6 h,24 h after operation.Correlation analysis showed that EDV negatively correlated with SCr (r=-0.508,P=0.001),while PI,RI positively correlated with SCr (r=0.411,0.443,P=0.009,0.005).Conclusion EDV,PI and RI in the interlobular arteries can be used to predict AKI early in the interosseous arteries,and the optimal time for ultrasonic measurement of renal arterial hemodynamics to predict is at 6 h and 24 h after operation.

Changes of renal interlobur artery hemodynamics in acute renal injury after operation of acute Stanford A aortic dissection / 中国介入影像与治疗学

Objective To explore the changes of hemodynamics in acute kidney injury (AKI) after acute severe Stanford type A aortic dissection.Methods Forty patients with acute Stanford A type aortic dissection were enrolled.Arterial peak systolic velocity (PSV),end diastolic velocity (EDV),pulsative index (PI),resistive index (RI),Serum creatinine (SCr) and urine volume were recorded and measured 1 day before operation,immediately after operation (enter the intensive care unit),6 h after operation,24 h after operation and 48 h after operation.Patients were divided into AKI group and non-AKI.group taking AKIN as a standard.Results Twenty-seven patients were in AKI group and 13 were in non-AKI group.The EDV,PI and RI had significantly differences between AKI group and non-AKI group at 6 h,24 h after operation.Correlation analysis showed that EDV negatively correlated with SCr (r=-0.508,P=0.001),while PI,RI positively correlated with SCr (r=0.411,0.443,P=0.009,0.005).Conclusion EDV,PI and RI in the interlobular arteries can be used to predict AKI early in the interosseous arteries,and the optimal time for ultrasonic measurement of renal arterial hemodynamics to predict is at 6 h and 24 h after operation.

System Review of Acupotomy Treatment for Stenosing Tenovaginitis of Flexor Digitorum / 中国中医药信息杂志

Objective To systematically evaluate the efficacy of acupotomy treatment for the stenosing tenovaginitis of flexor digitorum.Methods Articles about RCTs of acupotomy treatment and local blocking for the treatment of stenosing tenovaginitis of flexor digitorum were retrieved from CBM, CNKI, VIP, Wanfang database, PubMed, Embase, and Cochrane library. And then according to the requirement of Cochrane Handbook for Systemetic Reviews 5.1.0, two reviewers independently chose tests, extracted data, had a cross check, accessed methodological qualities and finally used RevMan 5.3 software for Meta analysis. The total effective rate, cure rate and improvement rate of acupotomy treatment and local blocking in treating stenosing tenovaginitis of flexor digitorum were assessed by using odds ratio (OR).Results Totally 10 articles involving 1426 cases were included. The cure rate in acupotomy treatment group was higher than that of local blocking group [OR=13.11 (95% CI: 8.23–20.89),Z=10.83 (P<0.000 01)], funnel plot Begg’s testP=0.858, Egger’s testP=0.579; the improvement rate of local blocking rate was higher than that of acupotomy treatment group [OR=0.14 (95% CI: 0.10–0.19),Z=11.60 (P<0.000 01)], funnel plot Begg’s test P=1.000, Egger’s testP=0.926; the total effective rate of acupotomy treatment group was higher than that of local blocking group [OR=18.26 (95% CI: 9.95–33.50),Z=9.38 (P<0.000 01)], funnel plot Begg’s testP=0.592, Egger’s testP=0.936.Conclusion Acupotomy treatment for stenosing tenovaginitis of flexor digitorum is superior to local blocking injection. However, the quality of the RCTs is low, so more large-sample, multi-center, and high-quality clinical RCTs are required for further verification.

Short-term outcome of surgical treatment of moderate ischemic mitral regurgitation / 中华胸心血管外科杂志

Objective To evaluate the short-term-outcome of MVP in the treatment of moderate IMR patients with CABG.Methods Data from 129 patients with moderate IMR who underwent surgical treatment in our department from June 2007 to September 2011,57 patients(44.2％) underwent CABG combined with MVP,and 72 patients(55.8％) underwent CABG.Postoperative follow-up of patients with heart function NYHA grade to evaluate the clinical status of patients,with LVESD,LVEF,LVEDD to evaluate the reverse of left ventricular remodeling;The postoperative residual mitral regurgitation and major cardiac cerebral vascular events were recorded.Results There was no significant difference between two groups in the preoperative data(P ＞ 0.05).The mortality rate was 3.9％ (5 cases),2 cases (2.8 ％) died in CABG group,3 cases (5.3 ％) died in the combined surgery group.The average follow-up was 24 months,9 cases of late death (5 in CABG group,4 in CABG + MVP group),the cumulative survival rate(P =0.645) and the major cardiovascular events(P =0.761) of the two groups were not statistically different.The degree of mitral regurgitation(P ＜ 0.01) was significantly decreased in the combined surgery group.Compared with the preoperative state,the two groups of left ventricular remodeling indicators such as LVESD,LVEF,LVEDD were significantly improved(P ＜0.05),but the difference between two groups was not significant(P ＞0.05).NYHA heart function classification was significantly improved (P ＜ 0.001).Conclusion MVP can effectively improve the reverse flow of patients with moderate IMR,but CABG combined with MVP can not bring more benefits in the reversal of left ventricular remodeling,short-term survival and cardiac function.

Molecular phylogeny and evolutionary dynamics of matrix gene of avian influenza viruses in China.

In China, several subtype avian influenza viruses consistently circulate in poultry. Numerous studies have focused on the evolution of the hemagglutinin gene; however, studies on the evolution of the matrix (M) gene are limited. In this study, a large-scale phylogenetic analysis of M gene sequences of avian influenza viruses isolated in China revealed that the M gene has evolved into six different lineages denoted as I-VI. The majority of lineages I and IV were isolated in terrestrial birds, while the majority of lineages II, III, V and VI were isolated in aquatic birds. Lineage I included 148 H9N2 subtype viruses (72.2%), lineage II comprised of 63 H6 subtype viruses (100%), and lineage IV included 157 H5 subtype viruses (97.5%). The mean substitution rates of different lineages ranged from 1.32×10(-3) (lineage III) to 3.64×10(-3) (lineage IV) substitutions per site per year. According to the most recent common ancestor of all lineages, lineage III was the oldest lineage, formed in 1981 or even earlier. And lineage V was the most recent, established around the year 2000. Selective pressure on M2 was stronger than that on M1. The strongest selection pressure was observed in lineage IV. In addition, site-by-site analyses of each lineage identified 8 positive selection sites, all in M2. Most of the sites (5 out of 8) were located in the extracellular domain, which is an antigen for vaccine development. The positive selection sites (amino acid positions 66, 82 and 97) are likely associated with virus budding. This study enhanced our knowledge of M gene evolution of avian influenza viruses, and is expected to improve the early detection of new viruses and lead to vaccine development.

The construction of performance evaluation index system for catastrophic disease insurance based on the Balanced Score Card / 中国卫生政策研究

The Balanced Score card ( BSC) is a new set of performance measurement and strategic management tools. Based on the basic theory of BSC, and on the basis of establishing the basic framework for performance evaluation of four dimensions, namely satisfaction, financial, internal operation, and growth and development, this paper systematically designs specific evaluation indexes from the 4 dimensions in order to construct the performance evaluation index system for catastrophic disease insurance. The objective of this study is to provide a more scientific and reasonable reference for the operational performance evaluation of catastrophic disease insurance offered to urban and rural residents.

Early and mid-term efficacy of endoscopic vein harvesting undergoing coronary artery bypass grafting in patients over 70 years old / 中华胸心血管外科杂志

Objective To evaluate the early and mid-term efficacy of endoscopic vein harvesting(EVH) undergoing coronary artery bypass grafting(CABG) in patients over 70 years old.Methods Patients' data of CABG were analyzed retrospectively in General Hospital of Shenyang Military Region from June 2011 to January 2013.400 patients were enrolled in the study according to the inclusion criteria.All patients were divided into two groups by the method of harvesting great saphenous vein (GSV):EVH group (n =200) and open vein harvesting(OVH) group(n =200).Each group was divided into two subgroups:group A(age≥70 years old) and group B (age ＜ 70 years old).The number of the group A was 85 in the EVH group and 79 in the OVH group.The number of the group B was 115 in the EVH group and 121 in the OVH group.The intraoperative findings,the quality of GSV and postoperative pain were evaluated,patients were followed up regularly after discharge.Results The postoperative complications occurred in the EVH group such as numbness and edema of lower limb in group A reduced greatly compared with group B(P ＜ 0.05).However,in the OVH group,there were no great difference in group A and group B(P ＞ 0.05) besides the postoperative pain (P ＜ 0.05).Conclusion The early and mid-term efficacy of EVH undergoing CABG is satisfied,especially in the patients over 70 years old.

Comparison of standard tangential field and multiple fileld radiotherapy in axillary lymph node after conserving surgery / 中国基层医药

Objective To investigate the difference of standard tangential field and multiple fileld radiotherapy in axillary lymph node after conserving surgery,to provide a reference for clinical treatment.Methods 20 cases of left breast cancer patients were selected,all patients underwent breast -conserving surgery,postoperative radiothera-py.All patients used standard radiotherapy wild tangent based and reverse -intensity modulated radiation therapy optimization.Armpit I,Ⅱ lymph nodes were used to calculate the extent of coverage of the original plan,target dose uniformity HI,dose conformal CI,dosimetric parameters were calculated.Results Under standard tangential field irradiation,I stand mean dose was (33.95 ±8.24)Gy,which was significantly higher than Ⅱ station (22.13 ± 6.67)Gy,and V50,V45,V40 were (22.45 ±6.32)%,(39.83 ±7.54)%,(49.65 ±8.31)%,which were higher than Ⅱ stand,I stand irradiation was significantly more,the differences were statistically significant (t =5.632,P =0.009;t =7.214,P =0.000;t =8.954,P =0.000;t =6.121,P =0.002).The whole breast irradiation armpit IMRT plan,19 patients (95.00%)reached 95% by volume APTV≥50Gy,coverage was better;but HI,CI were (1.11 ± 0.03),(1.36 ±0.07)respectively,which were significantly worse than the standard wild tangent,the differences were statistically significant (t =6.584,P =0.001;t =9.144,P =0.000).Under Hatano IMRT irradiation ipsilateral lung,heart suffered an average dose of (1 694.58 ±102.31)cGy,(645.54 ±74.44)cGy,which were significantly more than the standard tangential field irradiation,the differences were statistically significant (t =7.654,P =0.000;t =6.654,P =0.001).Conclusion Standard tangential field irradiation has poor coverage in Ⅱ axillary lymph node station,irradiation intensity modulated radiation has better coverage,but significantly increased the dose to normal tissues.