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.     

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.     

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).     

Study of protective role of the polysaccharide-containing components of capsules of Azospirillum brasilense

The involvement of the carbohydrate components of the Azospirillum brasilense Sp245 capsules in bacterial protection from the action of extreme factors was investigated. The survival of encapsulated and non-encapsulated azospirilla exposed to elevated (46-48 degrees C) and below-freezing (-20 and -70 degrees C) temperatures, extreme pH values (2 and 10), and to drying was studied. High-molecular-weight carbohydrate-containing complexes (lipopolysaccharide-protein complex and polysaccharide-lipid complex) were isolated from the capsular material of azospirilla. It was shown that the addition of these complexes to the suspension of decapsulated cells before exposing them to extreme factors enhanced their survival rates by 15 to 51%.     

4种小鼠的寒、热体质研究

[目的]研究4种品系小鼠的寒、热体质。[方法]8~9周龄昆明、BALB/c、C57BL/6J、ICR小鼠,以及4~5周龄昆明小鼠,同步系统检测其生物学特性,然后以统一的评价标准评价4种品系小鼠的寒、热体质。并对BALB/c小鼠给予参桂理中丸和利血平做药物反证。[结果]①4~5周龄昆明小鼠与8~9周龄昆明小鼠比较体质明显偏热;②BALB/c小鼠与C57BL/6J小鼠比较体质偏寒;③8~9周龄雄性BALB/c小鼠、雄性和雌性C57BL/6J小鼠与8~9周龄相应性别昆明小鼠比较体质无明显差异;8~9周龄雌性BALB/c小鼠与8~9周龄雌性昆明小鼠比较体质偏寒;④8~9周龄ICR小鼠与8~9周龄BALB/c小鼠、C57BL/6J小鼠比较体质偏热;8~9周龄雄性ICR小鼠与8~9周龄雄性昆明小鼠比较体质偏热。[结论]4种品系小鼠存在寒、热体质差异。     

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.     

Correction of distortion of histologic sections of arteries

Histologic sections of arteries can be used to generate three-dimensional (3D) geometric models and identify structural constituents. However, geometric distortions are introduced by fixation, embedding and sectioning; distortions which can, for example, lead to errors in stresses predicted by finite element models. We developed a method to measure and correct for distortions caused by acrylic processing and applied it to intact, healthy porcine coronary arteries. Micro-computed tomography was used to image arteries in the fresh and embedded states. Tissue blocks were sectioned, stained and imaged using a light microscope. Each section contained four registration marks used to determine strains introduced by sectioning and staining. Using these three image sets, 3D geometric models were generated and distortions were measured. Fixation, processing, and embedding resulted in shrinkage of 6.4+/-2.3% axially and 35.4+/-5.0% in mean cross-sectional area (n=5). Shrinkage in a cross section was well characterized by a uniform, equibiaxial strain. Sectioning and staining resulted in additional compressive strains in the sectioning direction of 0.067+/-0.011 and, in the direction perpendicular to sectioning, of 0.023+/-0.005 (n=5). These strains are assumed uniform and form the basis for correcting section geometry. Reconstructions using corrections for sectioning and shrinkage-related distortions had errors of 1.6+/-0.5% (n=5) and 4.0+/-1.7% (n=5), respectively.     

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.     

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.     

Mechanisms of nuclear translocation of insulin

Insulin (Ins) and various other hormones and growth factors have been shown to be rapidly internalized and translocated to the cell nucleus. This review summarizes the mechanisms that are involved in the translocation of Ins to the nucleus, and discusses its possible role in Ins action, based on observations by the authors and others. Ins is internalized to endosomes by both receptor-mediated and fluid-phase endocytosis, the latter occurring only at high Ins concentrations. The authors recently demonstrated the caveolae are the primary cell membrane locations responsible for initiating the signal transduction cascade induced by Ins. Once Ins is internalized, Ins dissociates from the Ins receptor in the endosome, and is translocated to the cytoplasm, where most Ins is degraded by Ins-degrading enzyme (IDE), although how the polypeptides cross the lipid bilayer is unknown. Some Ins escapes the degradation and binds to cytosolic Ins-binding proteins (CIBPs), in addition to IDE. IDE and some CIBPs are known to be binding proteins for other hormones or their receptors, and are involved in gene regulation, suggesting physiological relevance of CIBPs in the signaling of Ins and other hormones. Ins is eventually translocated through the nuclear pore to the nucleus, where Ins tightly associates with nuclear matrix. The role of Ins internalization and translocation to the nucleus is still controversial, although there is substantial evidence to support its role in cellular responses caused by Ins. Many studies indicate that nuclear translocation of various growth factors and hormones plays an important role in cell proliferation or DNA synthesis. It would be reasonable to suggest that tial for the regulation of nuclear events by Ins.     

Photosynthetic properties of permaplasts of anacystis

A treatment procedure using lysozyme and ethylenediaminetetracetic acid gave intact but permeable cells (permeaplasts) of Anacystis nidulans. Rates of electron transport from water to carbon dioxide, ferricyanide, 2,6-dichlorophenol indophenol, benzoquinone, and methyl viologen, and from reduced indophenol to methyl viologen were measured as a function of treatment time. Rates of oxygen evolution in complete photosynthesis and electron flow from water to methyl viologen showed rapid and parallel decline with treatment time. Electron flow from water to ferricyanide and from reduced indophenol to methyl viologen increased during the first half hour of treatment (phase 1) to 60 to 80% of the original photosynthetic rate. Longer treatment (phase 2) resulted in decreased rate of ferricyanide reduction but not in rate of methyl viologen reduction from indophenol. Electron flow from water to quinone was two to three times higher than for complete photosynthesis in intact cells. It remained high during phase 1 and declined during phase 2. Phase 1 permeaplasts apparently retain high activity for photosystems 1 and 2 photoreactions.     

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.     

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.     

Determination of isoelectric points of oligomeric forms of mitochondrial creatine kinase

Using isoelectrofocusing in three pH gradients differing in the initial pH value of the ampholyte gel mixture and in gradient pH range, the isoelectric points for the dimeric and octameric forms of mitochondrial creatine kinase from bovine heart and pigeon breast muscle were determined. The isoelectric points for the dimer and octamer are equal to 9.67 +/- 0.01 and 8.93 +/- 0.05 for the heart enzyme and to 9.56 +/- 0.08 and 8.91 +/- 0.23 for the skeletal muscle enzyme. The correctness of identification of the oligomeric forms of mitochondrial creatine kinase was confirmed by ultracentrifugation in a sucrose density linear gradient. Since creatine kinase is known to bind to mitochondrial membrane cardiolipin by electrostatic forces, it can be assumed that both oligomeric forms of the enzymes can bind to the membranes. However, the properties of the creatine kinase dimer suggest its greater ability to bind to mitochondrial membranes.     

Significance of physical attachment of fungi for bio-treatment of water

The inhibitory effect of xenobiotics known to damage cell surface structures was studied. The sensitivity of suspended cells of the two fungi Candida maltosa and Fusarium proliferatum was compared with that of artificial or natural biofilms of these fungi. The results obtained indicate that the resistance of attached cell populations to model xenobiotics is increased compared with suspended cells. Only the attached fungal cells had the capacity to degrade acetone and phenol and to adapt to increasing concentrations of these substances, so they seem ideally suited for bioremediation of waste water.     

Urinary oligosaccharides of fucosidosis. Evidence of the occurrence of X-antigenic determinant in serum-type sugar chains of glycoproteins.

Urine of a fucosidosis patient contained a large amount of fucosyl oligosaccharides and fucose-rich glycopeptides. Six major oligosaccharides were purified by a combination of Bio-Gel P-2 and P-4 column chromatographies and paper chromatography. Structural studies by sequential exoglycosidase digestion and by methylation analysis revealed that their structures were as follows: Fucalpha1 leads to 6GlcNAc, Fucalpha1 leads to 2Galbeta1 leads to 4(Fucalpha1 leads to 3)GlcNAcbeta1 leads to 2Manalpha1 leads to 3Manbeta1 leads to 4GlcNAc, Galbeta1 leads to 4(Fucalpha1 leads to 3)GlcNAcbeta1 leads to 4Manalpha1 leads to 4GlcNAc, Galbeta1 leads to 4(Fucalpha1 leads to3)GlcNAcbeta1 leads to 2Manalpha1 leads to 6Manbeta1 leads to 4GlcNAc, and Galbeta1 leads to 4(Fucalpha1 leads to 3)GlcNAcbeta1 leads to 4Manalpha1 leads to 6Manalpha1 leads to 6Manbeta1 leads to 4GlcNAc. In additon, the structure of a minor decasaccharide was found to be Galbeta1 leads to (Fucalpha1 leads to)GlcNAcbeta1 leads to Manalpha1 leads to [Galbeta1 leads to (Fucalpha1 leads to)GlcNAcbeta1 leads to Manalpha1 leads to]Manbeta1 leads to 4GlcNAc.     

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.     

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。