基于医疗服务绩效信息透明的质量促进效果研究综述

利用描述性综述的方法,总结近10年来医疗服务绩效信息透明对医疗质量促进效果,根据纳入排除标准检索Web of Knowledge、Pubmed等数据库,最终纳入31篇密切相关文献。结果表明,国外一般通过医疗报告卡或网站向公众公开医疗服务绩效信息,改善了医疗服务行为,但对病人选择服务提供者和临床结果的改善作用有限。我国应制定相关政策,推动医疗服务绩效信息向更广泛的使用者公开,引导病人利用医疗服务绩效信息选择医疗服务提供者。     

Comparison of adhesion of wound isolates of Staphylococcus aureus to immobilized proteins

AIMS: To determine the ability of 149 clinical isolates of Staphylococcus aureus from burns, other wounds and environmental isolates to adhere to immobilized proteins. METHODS AND RESULTS: The ability to bind to immobilized fibrinogen, fibronectin, laminin, collagen, IgG and lysozyme was studied using a microtitre plate assay. The strains were very diverse. Binding to fibrinogen was most frequent, followed by fibronectin, collagen and laminin. Binding to IgG and lysozyme was weak and few strains showed strong binding. Numerical analysis showed that 65% of the strains infecting burns had similar properties and bound to fibrinogen, fibronectin, collagen and IgG. The strains infecting other wounds had more variable characteristics. CONCLUSIONS: The ability to adhere to proteins is important in wound infection, but clinical isolates were diverse in their ability to bind to the proteins tested. Burn wounds were more likely to be infected with strains showing multiple binding characteristics. SIGNIFICANCE AND IMPACT OF THE STUDY: The study confirms the importance of adhesins in clinical infection.     

Limitations of pH-potentiometric titration for the determination of the degree of deacetylation of chitosan

The degree of deacetylation (DDA) of chitosan determines the biopolymer's physico-chemical properties and technological applications. pH-Potentiometric titration seems to offer a simple and convenient means of determining DDA. However, to obtain accurate pH-potentiometric DDA values, several factors have to be taken into consideration. We found that the moisture content of the air-dry chitosan samples can be as high as 15%, and a reasonable fraction of this humidity cannot be removed by ordinary drying. Corrections have to be made for the ash content, as in some samples it can be as high as 1% by weight. The method of equivalence point determination was also found to cause systematic variations in the results and in some samples extra acid as high as 1 mol% of the free amino content was also identified. To compensate for the latter effect, the second equivalence point of the titration has to be determined separately and the analytical concentration of the acid be corrected for it. All the corrections listed here are necessary to obtain DDA values that are in reasonable agreement with those obtained from (1)H NMR and IR spectroscopic measurements. The need for these corrections severely limits the usefulness of pH-metry for determining accurate DDA values and thus potentiometry is hardly able to compete with other standard spectroscopic procedures, that is, (1)H NMR spectroscopy.     

Evaluation of the age of onset of respiratory allergic symptomatology

Summary In order to evaluate the age of ouset of respiratory allergic symptoms we examined 2315 patients (656 children and 1659 adults) coming to our clinic as out patients. Each patient underwent the following diagnostic tests: anamnestic and clinical examination, skin-tests for the most common allergens and, when requested, Radioallergosorbent test (RAST) and specific and non specific BPT.We selected 278 children and 673 adults for whom it was possible to establish (on the basis of precise anamnestic considerations) the age at which the respiratory symptoms first appeared.Among these, 300 reacted only toParietaria pollen, 58 only to grass pollen, 420 only to house-dust mite, and 173 were not allergic.Patients reacting to multiple allergens were excluded from the analysis.The results of our study show a significant precocity of the onset of symptoms related to allergic sensitization to mites with peak level at 5 years.On the other hand, the onset of pollen-related symptoms was later on (peak level at 20–25 years forParietaria pollen and 30–35 years for grass pollen). For non allergic patients we did not find a definite age of onset.     

输卵管通水术268例临床分析

目的:探讨输卵管炎性不孕症通水试验的诊断及治疗的临床意义。方法:回顾分析对268例输卵管炎性不孕患者行输卵管通水术后的疗效。结果:来我院进行通水试验治疗的268例输卵管炎性不孕症患者,其中原发性不孕症67例,占发病总数的25%;继发性不孕201例,占75%。经通水反复局部药物治疗,严重者加全身治疗后,输卵管完全通畅者244例,成功率91.04%,术后随访宫内妊娠238例,有效治愈率达88.81%;发生异位妊娠3例,占1.12%。仅有24例经通水治疗无效后行输卵管碘油造影,术后宫内妊娠4例。输卵管通水治疗当月受孕占14.2%。结论:输卵管通水术是诊断和治疗输卵管炎性不孕症的有效方法,早期性生活是否有利于输卵管功能的恢复,有待进一步探讨。     

Modulation of phenotypic expression of fibroblasts by alteration of the cytoskeleton

Several studies indicate that the cytoskeleton may be involved in modulating the cellular response to environmental signals. We have studied the role of the cytoskeleton in regulating glycosaminoglycan (GAG) synthesis and secretion, hyaluronate (HA) endocytosis, the activities of hexoglycosidases, protein synthesis and secretion. Fibroblasts were treated with colchicine (1–8 μM ) and nocodazole (1 or 4 μM ) to alter microtubules or cytochalasin B (0·5–4 μM ) to alter microfilaments. Colchicine inhibited GAG synthesis and secretion in a concentration-dependent manner. It reduced protein and sulphated GAG secretion, while HA secretion was not affected. Concentration-dependent disruption of microtubules from the periphery toward the cellular centre with nocodazole inhibited only the secretion of GAG. Centrosomal microtubles appeared to be required to promote GAG synthesis; intact microtubules promoted the transport of secretory products, intercompatmental transport of lysosomal enzymes and lysosome maturation, but not protein synthesis and HA secretion. Cytochalasin B treatment inhibited, in a concentration-dependent manner, the synthesis and secretion of GAGs and proteins, and the endocytosis of HA. Intact microfilament mesh-works appeared to be required to promote synthesis and secretion of proteins and proteoglycans and to contribute to the transmembrane control of receptor-mediated endocytosis. Drug treatment of concanvalin A (Con A)-stimulated fibroblasts inhibited the stimulation of GAG synthesis. It is probable that this effect may result, in part, from drug-induced effects on Con A-mediated endocytosis.     

辽宁省高等植物多样性编目

为给辽宁植物多样性保护提供本底数据, 更准确地评价植物濒危及保护等级, 以及更好地给农学、林学、生态学、系统学等研究提供可靠的基础性数据, 本文首次将几代人在辽宁境内发现的高等植物进行汇总、编目, 包括苔藓植物和维管束植物。苔藓植物根据正式发表的文献和中国科学院沈阳应用生态研究所东北生物标本馆(IFP)馆藏采自辽宁省全域的苔藓植物标本编制。维管束植物主要根据5个方面的信息整理: 作者多年野外调查的一手资料、文献、同行交流、公众提供信息、标本等。编目内容包括辽宁省高等植物总名录、辽宁省栽培植物名录、辽宁省外来植物名录、辽宁省仅有栽培植物的科属目录、辽宁省仅有外来植物的科属目录; 编目中涉及的物种均有科属地位、中文名、拉丁名、生境、产地(县级), 总名录中附有每个物种的信息凭证, 包括标本信息、文献信息或照片依据。本编目共计收录植物254科1,176属3,241种73亚种447变种119变型。其中, 苔藓植物为辽宁地区首次披露名录信息, 计83科205属491种4亚种7变种(含藓类52科156属373种1亚种5变种, 苔类29科46属114种3亚种2变种, 角苔类2科3属4种)。维管束植物虽非首次披露名录信息, 但与以往发布的维管束植物名录相比, 本次收录的种类数最多, 计171科971属2,750种69亚种440变种119变型(含石松类植物2科3属13种, 蕨类植物17科39属83种2亚种7变种, 裸子植物5科19属47种1亚种13变种2变型, 被子植物147科910属2,607种66亚种420变种117变型)。经统计, 辽宁省所有苔藓植物均为本土野生植物。维管束植物中, 野生植物计149科741属2,077种62亚种378变种93变型(含石松类植物2科3属13种, 蕨类植物17科39属83种2亚种7变种, 裸子植物4科8属12种6变种1变型, 被子植物145科133属1,969种60亚种365变种92变型), 栽培植物计104科390属673种7亚种62变种26变型(含裸子植物5科17属35种1亚种7变种1变型, 被子植物99科373属638种6亚种55变种25变型); 本土植物计158科796属2,235种65亚种421变种116变型(含石松类植物2科3属13种, 蕨类植物17科39属83种2亚种7变种, 裸子植物5科14属29种12变种2变型, 被子植物134科740属2,110种63亚种402变种114变型), 外来植物计88科316属515种4亚种19变种3变型(含裸子植物3科10属18种1亚种1变种, 被子植物85科306属497种3亚种18变种3变型)。本编目仅是辽宁省高等植物的阶段性汇总, 尚需要根据野外工作的拓展和研究工作的深入不断完善。     

作物分枝的分子调控研究进展

分枝的数量及角度是决定作物株型的重要农艺性状.有效分枝数决定着作物的穗数或荚果数,进而决定着作物的产量;而分枝角度与光合效率、种植密度和抗病性密切相关,不仅影响作物的产量,也会影响作物的品质.由于分枝在作物生产中具有十分重要的作用,吸引了越来越多的研究者的注意,多个与分枝性状相关的关键基因被鉴定,分枝数目调控的分子机制...     

Analysis of evolution of exon-intron structure of eukaryotic genes

The availability of multiple, complete eukaryotic genome sequences allows one to address many fundamental evolutionary questions on genome scale. One such important, long-standing problem is evolution of exon-intron structure of eukaryotic genes. Analysis of orthologous genes from completely sequenced genomes revealed numerous shared intron positions in orthologous genes from animals and plants and even between animals, plants and protists. The data on shared and lineage-specific intron positions were used as the starting point for evolutionary reconstruction with parsimony and maximum-likelihood approaches. Parsimony methods produce reconstructions with intron-rich ancestors but also infer lineage-specific, in many cases, high levels of intron loss and gain. Different probabilistic models gave opposite results, apparently depending on model parameters and assumptions, from domination of intron loss, with extremely intron-rich ancestors, to dramatic excess of gains, to the point of denying any true conservation of intron positions among deep eukaryotic lineages. Development of models with adequate, realistic parameters and assumptions seems to be crucial for obtaining more definitive estimates of intron gain and loss in different eukaryotic lineages. Many shared intron positions were detected in ancestral eukaryotic paralogues which evolved by duplication prior to the divergence of extant eukaryotic lineages. These findings indicate that numerous introns were present in eukaryotic genes already at the earliest stages of evolution of eukaryotes and are compatible with the hypothesis that the original, catastrophic intron invasion accompanied the emergence of the eukaryotic cells. Comparison of various features of old and younger introns starts shedding light on probable mechanisms of intron insertion, indicating that propagation of old introns is unlikely to be a major mechanism for origin of new ones. The existence and structure of ancestral protosplice sites were addressed by examining the context of introns inserted within codons that encode amino acids conserved in all eukaryotes and, accordingly, are not subject to selection for splicing efficiency. It was shown that introns indeed predominantly insert into or are fixed in specific protosplice sites which have the consensus sequence (A/C)AG|Gt.     

山黧豆叶片蛋白质双向电泳技术的建立

以山黧豆叶片为材料,比较分析了蛋白质的不同提取方法,在此基础上着重于样品制备。对IPG胶条的选择,第一向等电聚焦和第二向SDS-聚丙烯酰胺凝胶电泳的电泳程序及参数、染色方法等相关技术进行了比较和条件优化。结果显示：采用TCA-丙酮沉淀法提取蛋白质,裂解液中加入Tris-base作为蛋白酶抑制剂,等电聚焦电泳时延长低电压的电泳时间（30V、12h,500V、1h,1000V、2h）以促进盐离子泳出的方法对山黧豆叶片蛋白质进行双向电泳,并用考马斯亮蓝和银染复合染色法进行凝胶染色,能够获得蛋白点清晰的双向电泳图谱,说明用优化后的方法建立起的山黧豆叶片蛋白质双向电泳技术,蛋白质样品制备质量好,电泳分辨率高,完全适合于进一步的蛋白质组学研究。     

Primary mechanisms of photoactivation of molecular oxygen. History of development and the modern status of research

This review starts from a brief historical account devoted to the principles of the Bach-Engler peroxidation theory and experiments and ideas which led A. N. Bach to its creation. Then, the discovery of photodynamic action is described, which was shown to result from pigment photosensitized activation of molecular oxygen. The dramatic history of mechanistic studies of oxygen photoactivation is reviewed starting from the Bach-Engler peroxidation theory to the hypothesis of moloxide, discovery of singlet oxygen and free radicals and, then, to modern views on the primary photoactivation processes. The origin of widely used division of photodynamic processes into type I and type II and the relation of these processes to the nature of the primary photochemical reactions of photosensitizers are discussed. New definitions of these reactions are proposed on the basis of the mechanisms of oxygen photoactivation. Photographs of the scientists who greatly contributed to the development of this field of research are presented. Published in Russian in Biokhimiya, 2007, Vol. 72, No. 10, pp. 1311–1329.     

Principles of covalent binding of reactive metabolites and examples of activation of bis-electrophiles by conjugation

Mechanisms of toxicity continue to be important in developing rational strategies to deal with chemicals present in the environment. Understanding and predicting toxicity have also become a critical step in the process of drug development. Covalent binding of chemicals to macromolecules is one aspect of toxicity, and the principles and outcomes of the process are considered. Two examples of chemicals for which several aspects of metabolism and reactions are understood are aflatoxin B(1) and polyhalogenated olefins. Ethylene dibromide is a compound that is activated to genotoxic half-mustards by conjugation with glutathione or the DNA repair protein O(6)-alkylguanine DNA alkyltransferase (AGT). The AGT reaction is unusual, in that crosslinking of the protein to DNA increases mutagenicity. One of the involved mechanisms is formation of N(7)-guanyl crosslinks and depurination to produce G-->T transversions; other reactions appear to yield the additional mutagenic events. The phenomenon of thiol conjugation to increase mutagenicity is widespread among bis-electrophiles.     

Effects of self-thinning of shoots on the nutrient budgets of Zizania latifolia

This experimental study focused on the seasonal changes and mobilization of nutrients between plant parts to understand the implications of self-thinning in the ecology of Zizania latifolia (Griseb.) Turcz. ex Stapf. The observations of shoot density, above- and belowground biomass, and total nitrogen and total phosphorus concentrations were conducted from February 2002 to August 2003. The biomass of shoots that died during the period and daily uptake of nutrients were determined. The shoot density sharply increased until mid-April and thereafter decreased significantly due to self-thinning of shoots. Total nitrogen and phosphorus concentrations of rhizomes decreased initially due to translocation to new shoots; however, the nutrients of rhizomes were slightly replenished from dead shoots during self-thinning. In contrast to other species, self-thinning of Z. latifolia shoots reallocates some of the minerals contained in the dead shoots back to the rhizomes, which can be regarded as a strategy to replenish the reduced resources of the rhizomes. The initial intensive growth of shoots can be regarded as a strategy to maintain resource competition.     

细菌鉴定方法

细菌的分类鉴定与细菌的研究和应用有着同等重要的地位。准确地鉴定细菌类别,根据其菌种种类不同,分别针对肠杆菌、阳性球菌、非发酵菌等菌种设计不同药敏板条的抗生素组合,可以指导临床应用用药。目前,细菌分类鉴定方法主要包括表型鉴定法和分子遗传学鉴定法两大类,针对这两大类鉴定方法,汇总其生理生化分类特征,简述各方法采用的关键技术,针对各技术讨论其优缺点。同时详细研究了表型鉴定法下数值分类法中自动化鉴定涉及的算法,结合目前细菌鉴定方法,对细菌分类鉴定的发展趋势进行了总结和展望。     

Modifications of stability and function of lysozyme

Approaches to improving the functionality of lysozyme are presented. Lysozyme was variously modified and the stabilities of the derivatives were determined by thermal denaturation experiments. Contributions of salt bridge(s), hydrophobic interactions(s), and cross-linkage(s) were evaluated. The stabilities against proteolysis were also considered. For the latter stability, it might be important to depress the rate of unfolding, i.e., to stabilize the native conformation. As a rule, salt bridges and hydrophobic interactions stabilize the native conformation and cross-linkages destabilize the denatured conformation. However, cross-linkages are apt to introduce strains in the native conformation and only suitable lengths of cross-linkages can stabilize the protein. The stabilization was shown to be generally effective in improving the functionality of proteins. Catalytic groups in lysozyme (Glu-35 and Asp-52) were variously modified and finally converted to the respective amides. The participation of these groups in the catalytic function was confirmed. The specificity of lysozyme was modified. Asp-101, which lies on the top of the active site cleft of lysozyme, was variously modified and the effects on the hydrolysis patterns of a hexamer of N-acetylglucosamine were analyzed. Some approaches to endowing lysozyme with altered functions are also presented. In order to give higher esterase activity to lysozyme, the complementarity of enzyme and substrate was investigated by modifying substrate and the active site cleft of lysozyme. An attempt was made to convert lysozyme into a transaminase by introducing pyridoxamine to the active site cleft of lysozyme. Finally, we have started to apply genetic engineering to this kind of investigation and would like to see how far we can go with protein engineering to improve the nature of proteins.This article was presented during the proceedings of the International Conference on Macromolecular Structure and Function, held at the National Defence Medical College, Tokorozawa, Japan, December 1985.     

河南种子植物区系地理研究

河南省地处中原 ,属于我国南北过渡和东西过渡的重要区域 ,植物区系成分复杂多样并于周围地区联系广泛 ,对其植物区系研究对深入认识本省的自然环境特征及其在我国多种自然区划中的位置等有着重要意义。该文在最新资料的基础上 ,运用区系学原理对河南省种子植物区系的种类组成、地理成分 (属、种 2个层次上 )等进行了系统的分析 ,在此基础上概括出河南植物区系的基本特征为 :(1 )植物种类比较丰富 ,多样性较高 ;(2 )起源古老 ;(3 )地理成分复杂 ,温带成分略占优势 ,过渡性突出 ;(4 )中国特有植物比较丰富。     

Ontology of areas of endemism

Areas of endemism have been recognized as important units in historical biogeography, and much attention has been given to methods of identifying these units operationally. Interestingly, little has been written about the philosophical nature of areas of endemism. The purpose of this essay is to make an ontological argument for areas of endemism as individuals and to discuss the consequences of such a conclusion. The recognition of species as individuals is crucial to the argument. Several criteria are identified for entities to be considered individuals, all of which are shown for areas of endemism. An ontological concept of an area of endemism is presented. Two of the consequences of regarding areas of endemism as individuals are that areas of endemism should be the preferred units of biogeography over the units used in event‐based methods and that parsimony analysis of endemism and similar methods may be operational tools for the discovery of areas of endemism.     

Discounting of sequences of delayed rewards of different amounts

The main purpose of this study was to determine whether the magnitude effect is present in cases where delayed sequences of rewards are discounted. The magnitude effect refers to the inverse relationship between the amount of a reward and the steepness of temporal discounting. This study was conducted with a computer program to estimate the indifference points, which served as indicators of the present subjective value of delayed sequences of small and large rewards. In the indifference point the subjective value of a single, immediate reward was equal to the subjective value of the delayed sequence (or to the value of a single delayed reward). As a control condition, we added an experimental task involving choices between single immediate and single delayed rewards. The experiment showed that the sequences of large rewards are discounted less steeply than are the sequences of small rewards. This finding suggests that the magnitude effect is present within the delayed sequences of rewards. In addition, when outcomes are relatively large, the results suggest that a single reward is discounted less steeply than the sequence of a total nominal value equal to this single reward. However, for relatively small rewards, the difference is not statistically significant. The less steep discounting of sequences of large rewards may explain the reward-bundling effect, which refers to less steep discounting of longer sequences than of shorter ones: longer sequences usually have greater overall nominal value. The present study was conducted on hypothetical rewards, and the results should be validated using real rewards.     

Consequences of forward translation of the point of force application for the mechanics of running

In running humans, the point of force application between the foot and the ground moves forwards during the stance phase. Our aim was to determine the mechanical consequences of this 'point of force translation' (POFT). We modified the planar spring-mass model of locomotion to incorporate POFT, and then compared spring-mass simulations with and without POFT. We found that, if leg stiffness is adjusted appropriately, it is possible to maintain very similar values of peak vertical ground reaction force (GRF), stance time, contact length and vertical centre of mass displacement, whether or not POFT occurs. The leg stiffness required to achieve this increased as the distance of POFT increased. Peak horizontal GRF and mechanical work per step were lower when POFT occurred. The results indicate that the lack of POFT in the traditional spring-mass model should not prevent it from providing good predictions of peak vertical GRF, stance time, contact length and vertical centre of mass displacement in running humans, if an appropriate spring stiffness is used. However, the model can be expected to overestimate peak horizontal GRF and mechanical work per step. When POFT occurs, the spring stiffness in the traditional spring-mass model is not equivalent to leg stiffness. Therefore, caution should be exercised when using spring stiffness to understand how the musculoskeletal system adapts to different running conditions. This can explain the contradictory results in the literature regarding the effect of running speed on leg stiffness.