No genetic causal association between periodontitis and ankylosing spondylitis: a bidirectional two-sample mendelian randomization analysis.

BACKGROUND: Observational studies that reveal an association between periodontitis (PD) and ankylosing spondylitis (AS) exist. However, observational research is prone to reverse causality and confounding factors, which make it challenging to infer cause-and-effect relationships. We conducted a two-sample Mendelian randomization (MR) study to examine the causal relationship between the genetic prediction of PD and AS. METHODS: In our study, single-nucleotide polymorphisms (SNPs) were defined as instrumental variables (IVs). The genetic association with PD came from the Gene-Lifestyle Interactions and Dental Endpoints (GLIDE) consortium, wherein 17353 cases of European ancestry and 28210 controls of European ancestry were included in this study. The genetic association with AS from the Neale Laboratory Consortium included 337,159 individuals from the United Kingdom, with 968 cases and 336,191 controls. MR analysis was mainly performed using the inverse-variance weighted (IVW) method. In addition, the robustness of the study findings was assessed using sensitivity, pleiotropy, and heterogeneity analyses. RESULTS: Eighteen independent SNPs with P-values significantly smaller than 1 × 10- 5 were used as IV SNPs for PD, while 39 independent SNPs with P-values significantly smaller than 1 × 10- 5 were used as IV SNPs for AS. The results of the IVW method revealed no causal association between PD and AS (odds ratio = 1.00, 95% confidence interval: 0.99953 to 1.00067, P = 0.72). The MR-Egger method did not support the causal association between PD and AS. It is unlikely that horizontal pleiotropy distorts causal estimates based on sensitivity analysis. No significant heterogeneity was observed in the Q test. The ''leave-one-out'' analysis demonstrated that the robustness of our results was unaffected by eliminating any of the IVs. Likewise, no significant causative effect for AS on PD was observed in the inverse MR analysis. CONCLUSIONS: The study results do not support shared heritability or a causal association between PD and AS.

Immediate Implant Placement With or Without Immediate Provisionalization in the Maxillary Esthetic Zone: A Systematic Review and Meta-analysis.

PURPOSE: To determine whether immediate implant placement and loading renders different outcomes from delayed loading with respect to midfacial mucosal level in the maxillary esthetic area. MATERIALS AND METHODS: A literature search was conducted in four electronic databases (PubMed, Web of Science, Embase, and Cochrane), identifying eligible clinical studies published prior to December 2021. Only randomized controlled trials (RCTs) comparing immediate implant placement with or without immediate loading in the maxillary esthetic zone with a mean follow-up of at least 12 months were selected for qualitative analysis and meta-analysis. The Cochrane Risk of Bias tool was adopted to assess the quality of the evidence. The heterogeneity between the pooled literature was analyzed through the chi-square test (P < .05) and quantified by the I2 index. A mixed-effects model was applied if it appeared that there was noteworthy heterogeneity; otherwise, a random-effects model was chosen. For continuous outcomes, the estimate of relative effect was presented to display the standardized mean differences (SMDs) and 95% CIs. For dichotomous variables, the Mantel-Haenszel statistical method was applied with effect sizes expressed as risk ratios (RRs) and 95% CIs. This study is registered on PROSPERO with number CRD42017078611. RESULTS: Out of 5,553 records, 8 RCTs were involved, providing data for 324 immediately placed implants (immediate implants subjected to immediate loading [IPIL]: 163; immediate implants subjected to delayed loading [IPDL]: 161) that had been in function within 12 to 60 months. Meta-analyses revealed significantly lower midfacial mucosal level changes for IPIL compared with IPDL, pointing to 0.48 mm (95% CI: -0.84 to -0.12; P = .01), as well as more significant papillary recession after IPDL (SMD -0.16; 95% CI: -0.31 to 0.00; P = .04). The differences regarding implant survival and marginal bone loss between the two loading groups showed no statistical significance. The result of metaanalyses revealed similar plaque score (SMD 0.03; 95% CI: -0.22 to 0.29; P = .79) and probing depth (SMD -0.09; 95% CI: -0.23 to 0.05; P = .21) for IPIL and IPDL. On the other hand, IPIL induced a trend toward more bleeding on probing (SMD 0.22; 95% CI: 0.01 to 0.42; P = .04) and less change in facial ridge dimension (SMD 0.94; 95% CI: -1.49 to -0.39; P < .01). CONCLUSION: After a follow-up ranging from 12 to 60 months, midfacial mucosa level change was 0.48 mm lower following IPIL compared with IPDL. Immediate implant placement and loading is conducive to the preservation of physiologic soft and hard tissue architecture, appearing to offer considerable benefits in the anterior zone. In summary, IPIL should be considered in the esthetic zone if the primary implant stability permits. Int J Oral Maxillofac Implants 2023;38:422-434. doi: 10.11607/jomi.10112.

Risk factors for neonatal asphyxia and establishment of a nomogram model for predicting neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture: a multicenter study / 中国当代儿科杂志

OBJECTIVES@#To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of neonatal asphyxia.@*METHODS@#A retrospective study was conducted with 613 cases of neonatal asphyxia treated in 20 cooperative hospitals in Enshi Tujia and Miao Autonomous Prefecture from January to December 2019 as the asphyxia group, and 988 randomly selected non-asphyxia neonates born and admitted to the neonatology department of these hospitals during the same period as the control group. Univariate and multivariate analyses were used to identify risk factors for neonatal asphyxia. R software (4.2.2) was used to establish a nomogram model. Receiver operator characteristic curve, calibration curve, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the model for predicting the risk of neonatal asphyxia, respectively.@*RESULTS@#Multivariate logistic regression analysis showed that minority (Tujia), male sex, premature birth, congenital malformations, abnormal fetal position, intrauterine distress, maternal occupation as a farmer, education level below high school, fewer than 9 prenatal check-ups, threatened abortion, abnormal umbilical cord, abnormal amniotic fluid, placenta previa, abruptio placentae, emergency caesarean section, and assisted delivery were independent risk factors for neonatal asphyxia (P<0.05). The area under the curve of the model for predicting the risk of neonatal asphyxia based on these risk factors was 0.748 (95%CI: 0.723-0.772). The calibration curve indicated high accuracy of the model for predicting the risk of neonatal asphyxia. The decision curve analysis showed that the model could provide a higher net benefit for neonates at risk of asphyxia.@*CONCLUSIONS@#The risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture are multifactorial, and the nomogram model based on these factors has good value in predicting the risk of neonatal asphyxia, which can help clinicians identify neonates at high risk of asphyxia early, and reduce the incidence of neonatal asphyxia.

Transcriptomic analysis of the ΔPaLoc mutant of Clostridioides difficile and verification of its toxicity / 中华预防医学杂志

Objective: Comparative analyses of wild-type Clostridioides difficile 630 (Cd630) strain and pathogenicity locus (PaLoc) knockout mutant (ΔPaLoc) by using RNA-seq technology. Analysis of differential expression of Cd630 wild-type strain and ΔPaLoc mutant strain and measurement of its cellular virulence changes. Lay the foundation for the construction of an toxin-attenuated vaccine strain against Clostridioides difficile. Methods: Analysis of Cd630 and ΔPaLoc mutant strains using high-throughput sequencing (RNA-seq). Clustering differentially expressed genes and screening differentially expressed genes by DESeq software. Further analysis of differential genes using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Finally, cytotoxicity assays of ΔPaLoc and Cd630 strains were performed in the African monkey kidney epithelial cell (Vero) and the human colonic cell (Caco-2) lines. Results: The transcriptome data showed that the ΔPaLoc mutant toxin genes tcdA and tcdB were not transcribed. Compared to the wild-type strain, CD630_36010, CD630_020910,CD630_02080 and cel genes upregulated 17.92,11.40,8.93 and 7.55 fold, respectively. Whereas the hom2 (high serine dehydrogenase), the CD630_15810 (spore-forming protein), CD630_23230 (zinc-binding dehydrogenase) and CD630_23240 (galactitol 1-phosphate 5-dehydrogenase) genes were down-regulated by 0.06, 0.075, 0.133 and 0.183 fold, respectively. The GO and KEGG enrichment analyses showed that the differentially transcribed genes in ΔPaLoc were enriched in the density-sensing system, ABC transport system, two-component system, phosphotransferase (PTS) system, and sugar metabolism pathway, as well as vancomycin resistance-related pathways. Cytotoxicity assays showed that the ΔPaLoc mutant strain lost its virulence to Vero and Caco-2 cells compared to the wild-type Cd630 strain. Conclusion: Transcriptional sequencing analysis of the Cd630 and ΔPaLoc mutant strains showed that the toxin genes were not transcribed. Those other differential genes could provide a reference for further studies on the physiological and biochemical properties of the ΔPaLoc mutant strain. Cytotoxicity assays confirmed that the ΔPaLoc mutant lost virulence to Vero and Caco-2 cells, thus laying the foundation for constructing an toxin-attenuated vaccine strain against C. difficile.

Advances in drug delivery strategies against Helicobacter pylori / 药学学报

italic>Helicobacter pylori (H. pylori) can cause a variety of digestive tract diseases, the serious may develop into gastric cancer. Nowadays, H. pylori infection rate exceeds 50%, and its eradication rate is declining due to the continuous increase of drug resistance, leading to the occurrence of plenty of stubborn infections, which seriously threaten human health. At present, it is difficult to achieve satisfactory curative effect by increasing the types of antibiotics combination or increasing their dose. In this review, the clinical treatments of H. pylori were introduced. Proceed from the characteristics and pathological background of H. pylori infection that makes H. pylori difficult to eradicate, the research advances of drug delivery strategies for improving H. pylori eradication rate were reviewed, such as strategies that could increase drug concentration in stomach (e.g. drug delivery systems with gastric acid-stabilized ability), increase drug concentration in H. pylori colonization sites (e.g. drug delivery systems with gastric retention or H. pylori targeted abilities), overcome H. pylori resistance (metal nanoparticles, anti-biofilm delivery systems), enhance host immune response (vaccine preparation) and so on. Novel drug delivery systems, such as cell membrane coating technology and phage therapy, are comparatively rare in the field of anti-H. pylori, but have broad application prospects. This review would provide reference for the development and application of therapeutic strategies to improve H. pylori eradication rate.

Improving oral absorption of BCS Ⅱ drugs by increasing solubility: frequently overlooked permeability / 药学学报

BCS Ⅱ drugs are characterized by low solubility and high permeability. Improving their solubility is considered an important approach to improve its oral absorption. Recent strategies to increase the solubility of poorly-soluble drugs may unexpectedly result in greatly depressed permeability, ultimately leading to failure in improving oral absorption. Based on the mathematics of membrane permeability coefficient of a drug, the membrane/aqueous partition coefficient is dependent on the drug's solubility in the gastrointestinal milieu, suggesting a unique interplay between the solubility and permeability of the drug, and treating the one irrespectively of the other may be insufficient. When we focus on the increase of drug solubility and overlook the efficacy of drug permeability, the positive effect of increased solubility to drug oral absorption might be traded off by depressed permeability. To provide rational formulary designs, by optimizing excipients and evaluation, this review summarizes solubility- permeability interplay for different types of solubilizing techniques, such as cyclodextrin, surfactants-based vehicle, cosolvent, amorphous solid dispersions, other infectors such as P-gp transporters and new techniques for simultaneous evaluation of drug solubility and permeability.

An in vitro method for preliminarily screening competing agents to enhance drug permeation in cyclodextrin inclusion complexes / 药学学报

Cyclodextrin can increase the solubility of poorly soluble drugs, but also decrease the permeability of poorly soluble drugs in inclusion complexes simultaneously, which partially or completely counteracts the contribution of improvement in solubility to the oral absorption of poorly soluble drugs. If a competing agent is added to the system to compete binding sites of cyclodextrins with drugs, drug permeability can be improved by increasing the concentration of free drugs in the inclusion complex system. In this paper, a rapid in vitro screening method for competing agents of cyclodextrin inclusion complex is proposed based on the principle that good drug permeability is in accord with good cell uptake. The equilibrium constants between drugs and hydroxypropyl-beta-cyclodextrin (HPCD) were determined by phase equilibrium solubility method. Cinnarizine (CN) with a high equilibrium constant was selected as a competing agent, coumarin 6 (C6) and 9-octadecyl berberine (BD) with smaller equilibrium constants were selected as model drugs. Both changes of solubility and uptake by Caco-2 and A549 cells of C6 and BD were investigated different concentrations of CN to the HPCD solution of C6 and BD. The results showed that the uptake of C6 and BD increased in a CN concentration-dependent manner, and the solubility of C6 and BD in HPCD solution decreased with the prolongation of equilibrium time. It might be due to increased free drug concentrations that resulted from the competition of CN for drug binding sites with HPCD. In our study, in vitro cell uptake method was firstly used to validate the ability of CN as a competing agent to increase drug permeability (cell uptake). This method can be used for preliminarily screening of competing agents for drug-cyclodextrin inclusion complexes.

Patient Trust in Physicians: Empirical Evidence from Shanghai, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patient trust in physicians, which can be considered a collective good, is necessary for an effective health care system. However, there is a widespread concern that patient trust in physicians is declining under various threats to the physician-patient relationship worldwide. This article aimed to assess patient trust in physicians through a quantitative study in Shanghai, China, and to provide appropriate suggestions for improving the trust in China.</p><p><b>METHODS</b>The data from a survey conducted in Zhongshan Hospital and Shanghai Tenth People's Hospital, which are two tertiary public hospitals in Shanghai, were used in this study. Patient trust in physicians was the dependent variable. Furthermore, a 10-item scale was used to precisely describe the dependent variable. The demographic characteristics were independent variables of trust in physicians. Binomial logistic regression was employed to analyze the factors associated with the dependent variable, which was divided into two categories on the basis of the responses (1: Strongly agree or agree and 0: Strongly disagree, disagree, or neutral).</p><p><b>RESULTS</b>This study found that 67% of patients trusted or strongly trusted physicians. The mean score of patient trust in physicians was 35.4 from a total score of 50. Furthermore, patient trust in physicians was significantly correlated with the age, education level, annual income, and health insurance coverage of the patients.</p><p><b>CONCLUSIONS</b>Patient trust in physicians in Shanghai, China is higher than previously reported. Furthermore, the most crucial reason for patient distrust in physicians is the information asymmetry between patients and physicians, which is a natural property of the physician-patient relationship, rather than the so-called for-profit characteristic of physicians or patients' excessive expectations.</p>

Health insurance and household income associated with mammography utilization among American women, 2000 - 2008 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided free or low-cost mammograms to low-income or no health insurance women in all of the states of the United States (US) since 1997. The objective of this study was to understand whether health insurance and annual household income impacted the mammography utilization since the implementation of NBCCEDP, in order to evaluate how the implementation of NBCCEDP impacted mammography utilization among American women.</p><p><b>METHODS</b>Data were from the database of Behavioral Risk Factor Surveillance System (BRFSS) of the CDC in US. Mammography utilization was measured by whether the American woman aged 40 to 64 years had the mammography within the last two years. The chi square test and multivariate Logistic regression were used to evaluate the associations between mammography utilization and health insurance, annual household income, and other factors for any given year.</p><p><b>RESULTS</b>From 2000 to 2008, the rate of mammography utilization among participants had a steady decrease on the whole from 86.7% to 83.8%. The results showed that the mammography utilization correlated significantly with health insurance and annual household income for any given year. The results also showed that compared with participants who were uninsured, those who were insured had a greater times higher rate of mammography in 2008 than any other year from 2000 to 2008, and compared with participants whose annual household income was below $15 000, those whose annual household income was above $50 000 had a greater times higher rate of mammography in 2008 than in 2004 and 2006.</p><p><b>CONCLUSIONS</b>Health insurance and annual household income impacted the mammography utilization for any given year from 2000 to 2008, and the implementation of NBCCEDP has not achieved its original goal on breast cancer screening.</p>

Coverage and utilization of the health insurance among migrant workers in Shanghai, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>According to the regulations of the Chinese and Shanghai governments, migrant workers employed in Shanghai should all be entitled to Shanghai Migrant Worker Hospitalization Insurance (SMWHI) without premium and the vast majority should also have the New Rural Cooperative Medical System (NRCMS). This study aimed to examine the status of the coverage and utilization of health insurance among migrant workers employed in Shanghai.</p><p><b>METHODS</b>Quantitative and qualitative research methods were employed in the study. A survey of 1020 migrant workers employed in Shanghai was conducted in 2010 with a structured questionnaire. Focus group discussions were held with respondents who were unable to maintain health insurance coverage through NRCMS or SMWHI. In-depth interviews were held with village heads and employers of the migrant workers, migrant workers who were hospitalized within the last year, and various individuals employed by the insurance agencies.</p><p><b>RESULTS</b>The study found that 72.9% and 36.5% of migrant workers were covered by NRCMS or SMWHI, respectively, while 16.7% of them had no health insurance. The coverage by NRCMS among migrant workers correlated significantly with education level and workplace, while the coverage by SMWHI correlated significantly with the length of employment in Shanghai and workplace. The qualitative results confirmed that migrant workers were the main group who were not covered by NRCMS, and the coverage by SMWHI was completely dependent upon the employers of the migrant worker. The results also showed that health insurance utilization among migrant workers was strongly limited by hospital location.</p><p><b>CONCLUSIONS</b>We observed that the status of health insurance among migrant workers was not accordant with theory, and that Chinese health insurance policy should be further reformed in order to realize full coverage and equal utilization of health insurance among migrant workers in China.</p>

Selection of sentinel sites for death surveillance,using cluster or unequal probability sampling / 中华流行病学杂志

To compare the sampling errors from cluster or unequal probability sampling designs and to adopt the unequal probability sampling method to be used for death surveillance.Taking 107 areas from the county level in Shaanxi province as the sampling frame,a set of samples are drawn by equal probability cluster sampling and unequal probability designs methodologies.Sampling error and effect of each design are estimated according to their complex sample plans.Both the sampling errors depend on the sampling plan and the errors of equal probability in stratified cluster sampling appeares to be less than simple cluster sampling.The design effects of unequal probability stratified cluster sampling,such as πPS design,are slightly lower than those of equal probability stratified cluster sampling,but the unequal probability stratified cluster sampling can cover a wider scope of monitoring population.Conclusions:Results from the analysis of sampling data can not be conducted without consideration of the sampling plan when the sampling frame is finite and a given sampling plan and parameters,such as sampling proportion and population weights,are assigned in advance.Unequal probability cluster sampling designs seems to be more appropriate in selecting the national death surveillance sites since more available monitoring data can be obtained and having more weight in estimating the mortality for the whole province or the municipality to be selected.

Assessment of capacity for logisty, public education, and training in public health emergency management in China / 中南大学学报(医学版)

OBJECTIVE@#To assess the capacity for logistics, public education, and training in managing public health emergency in China at present.@*METHODS@#Four provinces were selected using stratified sampling. All the municipalities of these 4 provinces were assessed using the 9th and 10th subscales (logistics, public education and training) of Preparedness and response capacity questionnaire for public health emergencies for provincial or municipal governments developed by the Center for Health Statistics and Information, Ministry of Health of China.@*RESULTS@#Sixty of the 66 questionnaires (90.91%) were collected. Among the 60 investigated municipalities, 80% established a specific agency to take charge of emergency material storage, management and allocation, 65% developed standard for material storage, 35% developed standard of places for material storage, 25% built regulation for testing, maintaining, and updating the emergency materials regularly, 45% arranged budget for routine payment, 27% established standard of emergency fund, and 28% set up the procedure to initiate emergency fund. The average of standard score of subscale 9 was 43.33 (95% confidence interval, 35.65~51.01). 25% of the 60 municipalities conducted assessment for training in the past 2 years, 53% developed plan for emergency personnel training, 20% developed effectiveness assessment regulation of emergency personnel training, 80% assigned a specific agency to be responsible for public education, and 23% established regulation for public education. The average of standard score of subscale 10 was 47.43 (95% confidence interval, 40.69~54.17).@*CONCLUSION@#Serious problems are found in logistics, public education, and training for public health emergency management in China. Measures should be taken immediately by the central and local government to improve these capacities.

Development and testing of a preparedness and response capacity questionnaire in public health emergency for Chinese provincial and municipal governments / 中南大学学报(医学版)

OBJECTIVE@#To develop a capacity questionnaire in public health emergency for Chinese local governments.@*METHODS@#Literature reviews, conceptual modelling, stake-holder analysis, focus group, interview, and Delphi technique were employed together to develop the questionnaire. Classical test theory and case study were used to assess the reliability and validity.@*RESULTS@#(1) A 2-dimension conceptual model was built. A preparedness and response capacity questionnaire in public health emergency with 10 dimensions and 204 items, was developed. (2) Reliability and validity results. Internal consistency: except for dimension 3 and 8, the Cronbach's alpha coefficient of other dimensions was higher than 0.60. The alpha coefficients of dimension 3 and dimension 8 were 0.59 and 0.39 respectively; Content validity: the questionnaire was recognized by the investigatees; Construct validity: the Spearman correlation coefficients among the 10 dimensions fluctuated around 0.50, ranging from 0.26 to 0.75 (P0.05). Criterion-related validity: case study showed significant difference among the 10 dimensions in Beijing between February 2003 (before SARS event) and November 2005 (after SARS event).@*CONCLUSION@#The preparedness and response capacity questionnaire in public health emergency is a reliable and valid tool, which can be used in all provinces and municipalities in China.

A novel mutation in the SEDL gene leading to X-linked spondyloepiphyseal dysplasia tarda in a large Chinese pedigree / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify the genetic defect in a four-generation pedigree with X-linked recessive spondyloepiphyseal dysplasia tarda (SEDT) from Southwest China.</p><p><b>METHODS</b>Linkage analysis with one panel of fluorescently labeled microsatellite markers on chromosome X and mutation screening of SEDL gene by direct sequencing were performed.</p><p><b>RESULTS</b>Linkage between SEDT and Xp22.2-Xp23.1 was established with maximum LOD score of 3.82 (theta = 0) between DXS987 and DXS8051. Upon sequence analysis, a point mutation within exon 4 of the SEDL gene (c.239A to G) was found which resulted in substitution of histidine with arginine at codon 80 (His80Arg).</p><p><b>CONCLUSION</b>A novel missense mutation (H80R) was identified for SEDL gene in the large Chinese SEDT pedigree.</p>

Investigation into the capacity for risk identification, assessment, and mitigation in managing public health emergencies in China / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the capacity for risk identification, assessment, and mitigation in public health emergency management in China.</p><p><b>METHODS</b>Four provinces were randomly selected using stratified sampling. All the municipalities under these four provinces were assessed using the 3rd subscale (Risk Identification, Risk Assessment, and Risk Mitigation) of Preparedness and Response Capacity Questionnaire for Public Health Emergencies Used in Provincial or Municipal Governments, which was developed by the Center for Health Statistics and Information, Ministry of Health of the People's Republic of China.</p><p><b>RESULTS</b>Sixty of 66 questionnaires (90.91%) were collected. Among 60 investigated municipalities, 35 (58%) identified the potential public health emergencies, 17 (28%) assessed the risks for the identified emergencies, and 5 (8%) conducted risk assessments for the locally accident-prone factories, mines, corporations, and big establishments, 6 (10%) identified the priorities in public health emergency management based on risk assessment, 6 (10%) developed special prevention strategies for main public health emergencies, 3 (5%) assessed the vulnerability of local residents to public health emergencies, and 34 (57%) assessed or were assessing the preparedness and response capacity for public health emergencies in the past 2 years. The mean of standard total score for risk identification, assessment, and mitigation was 24.05 (95% CI: 18.32, 29.77).</p><p><b>CONCLUSION</b>Risk identification, assessment, and mitigation still require further improvement in China, and both the central and local authorities should implement more effective and efficient measures.</p>

Identification of a detailed function list for public health emergency management using three qualitative methods / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>At present, many administrators lack a theoretical guide to build management systems to cope with public health emergencies. This study developed a detailed function list for public health emergency management to help building the management systems scientifically.</p><p><b>METHODS</b>The five steps in this study including literature review, semistructured interviews with experts, focus group, Delphi study and focus group were conducted to develop the detailed list of functions.</p><p><b>RESULTS</b>An initial list of 25 functions with 188 items was formed through literature review. The list was reduced to 10 functions with 57 items by semistructured interviews with experts and focus group. Next, all these 57 items reached the consensus through one-round Delphi study. Some revisions of the consensus were done by the same focus group.</p><p><b>CONCLUSION</b>The final 10 functions with 57 items could be used as a guide for most countries during their building of a public health emergency management system.</p>

Analysis of electric sacral neuromdulation and resiniferatoxin in treatment of primary female overactive bladder / 中国基层医药

Objective To analyze the efficacy of electric sacral neuromdulation and resiniferatoxin in patients with female overactive bladder.Methods 32 cases with IOAB female patients accepted percutaneous test sitmulation of the electric sacral nerves at S3 ,and treated by intravesical instillation with 100ml of 100nmol/L RTX.The effica- cy of voiding status were evaluated.The improvement of female patients life were evaluated comparing the rating of depression and anxiety.Results There were significant improvements in 32 cases in variables included the number of voiding,volume voided and signs every day and urgent uresis.In the rating of depression and anxiety,the patients improved a litter and still had stimulating symptom in urethra and bladder.Conclusion The treatment of IOAB with single administratoon of electric sacral neuromdulation and resiniferatoxin is effective,and can successfully im- prove the symptom with little side effects.

Main problems existed in the providers and the demanders of rural health service in China / 中国医学科学院学报

Based on the results of three national health surveys and relevant statistical data, this article reviews the main problems existed in the providers and demanders of rural health service in China and tries to provide evidences for health decision-makers.

Firmness evaluation of melon using its vibration characteristic and finite element analysis / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The "Huang gua" melons were measured for their physical properties including firmness and static elastic modulus. The vibrational characteristics of fruits and vegetables are governed by their elastic modulus (firmness), mass, and geometry. Therefore, it is possible to evaluate firmness of fruits and vegetables based on their vibrational characteristics. Analysis of the vibration responses of a fruit is suggested for measuring elastic properties (Firmness) non-destructively. The impulse response method is often used to measure firmness of fruits. The fruit was excited using three types of balls (wooden, steel and rubber) and the vibration is detected by an accelerometer. The Instron device was used to measure the static elastic modulus of the inner, middle and outer portions of melon flesh. Finite element (FE) technique was used to determine the optimum excitation location of the chosen measurement sensor and to analyze the mode shape fruits. Four types of mode shapes (torsional or flexural mode shape, first-type, second-type spherical mode and breathing mode shape) were found. Finite element simulation results agreed well with experimental results. Correlation between the firmness and resonant frequency (r2=0.91) and between the resonant frequency and stiffness factor (r2=0.74) existed. The optimum location and suitable direction for excitation and response measurement on the fruit were suggested.

Identification of rice seed varieties using neural network / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

A digital image analysis algorithm based color and morphological features was developed to identify the six varieties (ey7954, syz3, xs11, xy5968, xy9308, z903) rice seeds which are widely planted in Zhejiang Province. Seven color and fourteen morphological features were used for discriminant analysis. Two hundred and forty kernels used as the training data set and sixty kernels as the test data set in the neural network used to identify rice seed varieties. When the model was tested on the test data set, the identification accuracies were 90.00%, 88.00%, 95.00%, 82.00%, 74.00%, 80.00% for ey7954, syz3, xs11, xy5968, xy9308, z903 respectively.