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。     

Principles of classification of life forms of plants

For classifying life forms of plants a proposal was made to use the principle of parallel divergence based on the hypothesis that life forms diverging to any degree preserve further the potential of evolving in a similar way, that is, in parallel series. Life forms of plants are divided into thirteen types corresponding to the nature of their basic metameres. Further, every type is divided into subtypes and sections according to the character of these metameres and then into smaller grades (classification units of the system of living forms corresponding to one trait and its evolutionary level) according to categories of traits: ramification, vegetative flexibility, rate of changes of metameres, types of habitat and environment. On the basis of the principle of parallel divergence scales of traits were constructed for each category. Corresponding to 26 paires of alternative traits 26 degrees of hierarchic classification were devised and within the limits of every type of life form there were 2(26) grades at the lowest rank. Separate systems were developed for single-celled and colonial forms.     

Shapes of curves of pH-dependence of reactions

A simple case is considered in which the rate of a two-step reaction depends on pH because the intermediate formed in the first step has to gain (or lose) a proton before it can react in the second step, and in which the rate-determining step therefore changes with pH. The curves of reaction rate against pH are shown to be symmetrical, and the sharpest peak possible has a width at half its height of 1.53pH units, i.e. of 2log(3+2 radical2). Any particular curve for this situation proves to be identical with a curve that could be generated for the pH-dependence of a single-step reaction in which the rate is proportional to the concentration of a particular ionic form of a reactant. Curves for the latter situation, however, can have forms impossible for the former case in which the rate-determining step changes, but only if the protonations that activate and deactivate the reactant are co-operative. The peak can then become even sharper, and its width at half its height can fall to 1.14pH units, i.e. to 2log(2+ radical3).     

Effect of composition of cellular lipids of formation of nonspecific antibiotic resistance of alkanotrophic rhodocoocci

The antibiotic resistance and lipid composition of rhodococci grown in rich organic media with gaseous or liquid n-alkanes were studied. Hydrocarbon-grown rhodococci exhibited an increased resistance to a wide range of antibiotics (aminoglycosides, linkosamides, macrolides, beta-lactams, and aromatic compounds). The enhanced antibiotic resistance of rhodococci grown on n-alkanes correlated with an increased content of total cell lipids (up to 14-28%) and saturated straight-chain fatty acids (C16:0, C18:0, C21:0) and was accompanied by the appearance of cardiolipin and phosphatidylglycerol in cells. These lipid compounds were supposed to promote the formation of nonspecific antibiotic resistance in rhodococci by decreasing the permeability of their cell envelope to antibiotics.     

Isolation of domains of the plasma membrane of hepatocytes

Several recent studies have demonstrated the ability of techniques based on immunoadsorption to selectively isolate specialized subregions of membranes, termed domains, which are derived from a larger more complex parent membrane like the plasma membrane. The immunoadsorbent is directed against a specific antigen that resides exclusively or predominantly in the membrane domain to be isolated. Thus, a monospecific antibody to the domain-specific antigen is required. In the present study we developed a method employing a modified immunoblotting strategy which could utilize polyspecific antibodies to isolate membrane vesicles derived from a specific membrane domain of the hepatocyte plasma membrane. We also used specific cell surface labeling of the hepatocyte plasma membrane by lactoperoxidase-catalyzed iodination at 4 degrees C and preparation of different sized vesicles by sonication to facilitate isolation of the specific domain. For this study, polyspecific antisera were raised in goats against a membrane fraction, denoted N2u, which is enriched in bile canalicular proteins. This antiserum recognizes, among other antigens, a 110,000 Mr polypeptide previously shown to be localized in the bile canaliculus (J. Cook et al. (1983) J. Cell. Biol. 97, 1823-1833). A monospecific antiserum was raised in rabbits against the rat hepatocyte asialoglycoprotein receptor, a sinusoidal domain-specific set of glycoproteins whose major form has a Mr of 43,000. These antisera were each coupled indirectly to different pieces of nitrocellulose by the immunoblotting protocol and were used to isolate membrane vesicles from a crude extract of liver plasma membrane prepared by sonication. The ratio of iodinated asialoglycoprotein receptor to the 110,000 Mr polypeptide in vesicles isolated by the affinity nitrocellulose immunoadsorbent method indicate a 10- to 15-fold enrichment of sinusoidal-derived vesicles relative to bile canalicular-derived membrane vesicles. These results show that the affinity nitrocellulose immunoadsorbent method can be used to isolate domain-specific vesicles. Further, the affinity immunoadsorbent method described here for the isolation of domains of the plasma membrane is an integrative one allowing isolation of vesicles present in relatively small concentration in crude cell extracts and it requires minimal ultracentrifugation time.     

Use of complex assessment of dermatoglyphic signs for prediction of the risk of development of occupational diseases

Dermatoglyphic investigations conducted by the authors made it possible to demonstrate a genetic predisposition to occupational diseases, in particular, to silicosis and silicotuberculosis. Methods based on the mathematical theory of pattern recognition were used for multifactor analysis of the data. It was shown that complex evaluation of 10 dermatoglyphic indices gave a reliable prognosis of the risk of the above two kinds of disease due to silica dust. The dermatoglyphic patterns which predict predisposition to simple silicosis or to silicotuberculosis were found to differ significantly.     

Paradoxes of replication of RNA of a bacterial virus

The extraordinary ability of the bacteriophage Qβ replicase to amplify RNA outside the cell attracted the attention of molecular biologists in the late 1960s-early 1970s. However, at that time, a number of puzzling properties of the enzyme was not explained. Not until recently has Qβ replicase begun to reveal its secrets, promising to give a key not only to understanding the mechanism of replication of the bacterial virus genome but also to the solution of more general fundamental and applied problems.     

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。     

Mechanism of perception of changes in the magnetic field by ampullae of lorenzini of elasmobranchs

The mechanisms of reception of changes in the magnetic field by electroreceptor formations were investigated in experiments on Black Sea rays in which spike activity was recorded from single nerve fibers connected with the ampullae of Lorenzini. The responses of the ampullae of Lorenzini to magnetic stimulation were shown to be due to induced electric currents creating potential gradients in the body tissues of the fish and the sea water. On the basis of differences in responses of different ampullae to magnetic stimulation, it is possible to distinguish between magnetic stimuli and other stimuli acting on the electroreceptor system. Potentiation of the receptor response to magnetic stimulation was found as the fish came closer to the "shore." The mechanisms and biological importance of reception of changes in the magnetic field by the ampullae of Lorenzini are discussed.I. P. Pavlov Institute of Physiology, Academy of Sciences of the USSR, Leningrad. Translated from Neirofiziologiya, Vol. 10, No. 1, 75–83, January–February, 1978.     

Analysis of the estimators of the average coefficient of dominance of deleterious mutations

We investigate the sources of bias that affect the most commonly used methods of estimation of the average degree of dominance (h) of deleterious mutations, focusing on estimates from segregating populations. The main emphasis is on the effect of the finite size of the populations, but other sources of bias are also considered. Using diffusion approximations to the distribution of gene frequencies in finite populations as well as stochastic simulations, we assess the behavior of the estimators obtained from populations at mutation-selection-drift balance under different mutational scenarios and compare averages of h for newly arisen and segregating mutations. Because of genetic drift, the inferences concerning newly arisen mutations based on the mutation-selection balance theory can have substantial upward bias depending upon the distribution of h. In addition, estimates usually refer to h weighted by the homozygous deleterious effect in different ways, so that inferences are complicated when these two variables are negatively correlated. Due to both sources of bias, the widely used regression of heterozygous on homozygous means underestimates the arithmetic mean of h for segregating mutations, in contrast to their repeatedly assumed equality in the literature. We conclude that none of the estimators from segregating populations provides, under general conditions, a useful tool to ascertain the properties of the degree of dominance, either for segregating or for newly arisen deleterious mutations. Direct estimates of the average h from mutation-accumulation experiments are shown to suffer some bias caused by purging selection but, because they do not require assumptions on the causes maintaining segregating variation, they appear to give a more reliable average dominance for newly arisen mutations.     

Subfunctionality of Hydride Transferases of the Old Yellow Enzyme Family of Flavoproteins of Pseudomonas putida

To investigate potential complementary activities of multiple enzymes belonging to the same family within a single microorganism, we chose a set of Old Yellow Enzyme (OYE) homologs of Pseudomonas putida. The physiological function of these enzymes is not well established; however, an activity associated with OYE family members from different microorganisms is their ability to reduce nitroaromatic compounds. Using an in silico approach, we identified six OYE homologs in P. putida KT2440. Each gene was subcloned into an expression vector, and each corresponding gene product was purified to homogeneity prior to in vitro analysis for its catalytic activity against 2,4,6-trinitrotoluene (TNT). One of the enzymes, called XenD, lacked in vitro activity, whereas the other five enzymes demonstrated type I hydride transferase activity and reduced the nitro groups of TNT to hydroxylaminodinitrotoluene derivatives. XenB has the additional ability to reduce the aromatic ring of TNT to produce Meisenheimer complexes, defined as type II hydride transferase activity. The condensations of the primary products of type I and type II hydride transferases react with each other to yield diarylamines and nitrite; the latter can be further reduced to ammonium and serves as a nitrogen source for microorganisms in vivo.     

Thermodynamics of the conformational transition of biopolyelectrolytes: the case of specific affinity of counterions.

A formal development of the Counterion Condensation theory (CC) of linear polyelectrolytes has been performed to include specific (chemical) affinity of condensed counterions, for polyelectrolyte charge density values larger than the critical value of condensation. It has been conventionally assumed that each condensed counterion exhibits an affinity free-energy difference for the polymer, (DeltaG(aff)). Moreover, the model assumes that the enthalpic and entropic contributions to DeltaG(aff), i.e., DeltaH(aff) and DeltaS(aff), are both independent of temperature, ionic strength and polymer concentration. Equations have been derived relative to the case of the thermally induced, ionic strength dependent, conformational transition of a biopolyelectrolyte between two conformations for which chemical affinity is supposed to take place. The experimental data of the intramolecular conformational transition of the ionic polysaccharide kappa-carrageenan in dimethylsulfoxide (DMSO) have been successfully compared with the theoretical predictions. This novel approach provides the enthalpic and entropic affinity values for both conformations, together with the corresponding thermodynamic functions of nonpolyelectrolytic origin pertaining to the biopolymer backbone change per se, i.e., DeltaH(n.pol) and DeltaS(n.pol), according to a treatment previously shown to be successful for lower values of the biopolyelectrolyte linear charge density. The ratio of DeltaH(n.pol) to DeltaS(n.pol) was found to be remarkably constant independent of the value of the dielectric constant of the solvent, from formamide to water to DMSO, pointing to the identity of the underlying conformational process.     

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.     

Patterns of distribution of phosphomono-esterases on surfaces of demineralized bone

Summary Decalcification over short periods (5 days) with MnNa₂ EDTA, MgNa₂ EDTA and EGTA according to a method described in the present paper, creates sections of high quality with simultaneous good preservation of phosphomonoesterases on bone surfaces. In fact, the enzyme distribution seems to be comparable to that obtained by using undecalcified sections.Na₂ EDTA creates, on the other hand, poor preservation of alkaline phosphatase probably due to the fact that this chelate contrary to the other chelates removes the essential metal from the protein, leaving an unstable enzyme molecule which undergoes denaturation.Decalcification over longer periods (15 days) does not influence the pattern of distribution of acid phosphatase, whereas the alkaline phosphatase reaction becomes depressed in certain surface areas. The significance of this differential distribution is discussed. It might be an indication of differential processes of bone transformations in such a way that bone surfaces corresponding to areas of enzyme reactions are depository whereas bone surfaces corresponding to areas of lack of enzyme reaction are resorptive. New experimental designs are, however, necessary before the phenomenon is fully perceived. Two different coupling agents were used in connexion with the demonstration of acid phosphatase reaction. When HPR was used as the coupler the final enzyme distribution coincided with that usually described in the literature, i.e., strong reaction of cells adjacent to resorptive surfaces and weak reaction of cells adjacent to depository surfaces. When, however, Fast dark blue R was used all surface cells reacted markedly. This method also revealed certain cell types with nuclear reaction.     

Possible mechanisms of implementation of toxic potential of lipopolysaccharides of pathogenic bacteria

The significance of variability of biological properties of lipopolysaccharides (LPS) is discussed in the paper within the pathogenesis of infectious process. On the basis of an analysis of published data and of results of independent research of two microorganisms (Yersinia pestis and Francisella tularensis) a conclusion is made on that a biologically inert LPS form (with a weak cytokine-inducing ability, apirogenicity and non-toxicity etc.) is typical of highly pathogenic bacteria. It is suggested that the above phenomenon is biologically expedient. Presumably, the inert LPS transforms to the active form inside a sensitive host and, according to an infection stage, each of them being functionally significant. It is the inert status of LPS that enables the pathogens, at the initial stages, to surmount freely the humoral and cell barriers of host. As the infection progressively aggravates and the proliferation of bacteria modifies itself due to LPS micro- and macroorganisms, its chemical structure and biopolymer conformation change. Both modification mechanisms enhance the LPS toxic potential. In case of a sensitive host, such variations transform the biologically inert LPS into a toxically active form with its function of endotoxin being realized. There is no LPS modification in a host insensitive to such infection, which entails either recovery or prolonged persistence of the pathogen inside the microorganism.     

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.     

Age and features of the skeletotopy of the roots of the lungs of newborn infants and children

In 186 roentgenograms of frontal projections, obtained in children from birth up to 7 years of age, made according to the vital indications (but without any pathology in the thoracic organs), and in 63 isolated preparation of lungs, skeletotopy and size of the lung roots have been studied. The skeletopic difference between superior and inferior margins of the roots near the medial surface of the lung in the newborns during the first day of life has been stated to make in the projection to the frontal thoracic wall 2 ribs, or 2 vertebrae (to the posterior wall), and to the end of the first month of life-3 ribs, or 3 vertebrae, respectively; during the first year-2.5 ribs, or 2 vertebrae, in children of 1-7 years of age-2 ribs, or 2 vertebrae, respectively. The projection borders of the lung roots from birth up to 7 years of age are noted to change in time and with various intensity.     

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.     

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.