Identification of Foramen Ovale With H-Figure Fluoroscopic Landmark Improves Treatment Outcomes in Idiopathic Trigeminal Neuralgia.

BACKGROUND: Because it is traditionally difficult and time-consuming to identify the foramen ovale (FO) with fluoroscopy, we recently developed the H-figure method to acquire fluoroscopic view of FO with shorter procedure time and less radiation. However, the impact of such an H-figure approach on the clinical outcomes of trigeminal ganglion radiofrequency thermocoagulation (RFT) in treating idiopathic trigeminal neuralgia (ITN) remains unclear. METHODS: In a 12-month follow-up retrospective cohort study, patients with ITN had fluoroscopy-guided RFT of trigeminal ganglion via either classic approach (n = 100) or H-figure approach (n = 136) to identify FO. Data of continuous variables were analyzed with a Shapiro-Wilk test for normality and subsequently with a Mann-Whitney test, and the binary data were analyzed with a χ 2 test. The primary outcome was the facial pain measured by a Visual Analog Scale (VAS) 1 year after the treatment. The secondary outcomes included the quality of the fluoroscopic FO views, the threshold voltage to provoke paresthesia, the procedure time, the number of fluoroscopic images, and the facial numbness VAS. RESULTS: Compared with the classic approach group, the H-figure approach group was associated with better long-term pain relief after the procedure, with significantly fewer patients had pain 3 months (6.6% vs 17.0%, P = .012) and 12 months (21.3% vs 38.0%, P = .005) after the procedure, and among patients who had pain after the procedure, patients in the H-figure group had significantly less pain 6 months after the procedure (VAS median [interquartile range (IQR)]: 3 [2-6] vs 6 [4-7], P < .001). Moreover, compared to the classic approach, the H-figure approach provided better fluoroscopic view of FO, lower threshold voltage to elicit paresthesia (median [IQR]: 0.2 [0.2-0.3] vs 0.4 [0.4-0.5] V, P < .0001), with shorter procedure time (median [IQR]: 7.5 [6.0-9.0] vs 14.0 [10.0-18.0] min, P < .0001), and required fewer fluoroscopic images (median [IQR]: 4.0 [3.0-5.0] vs 8.0 [6.0-10.0], P < .0001). CONCLUSIONS: RFT of the trigeminal ganglion using the H-figure approach is associated with superior longer term clinical pain relief than the classic approach in treating ITN.

Application of Antidromic Conduction Monitoring in Ganglion Radiofrequency Thermocoagulation for Locating Trigeminal Branches in Trigeminal Neuralgia.

OBJECTIVE: The aim of this study was to investigate whether antidromic conduction monitoring (ACM) can be utilized to map the trigeminal system under sedation as a potential substitute for subjective paresthesia description (SPD) during percutaneous ganglion radiofrequency thermocoagulation (PGRT). METHODS: Eighty-two patients with 152 pain divisions of trigeminal neuralgia (TN) were treated by computed tomography (CT)-guided PGRT. After the puncture needle entered the foramen ovale (FO), sensory and motor stimulation were applied to locate the pain division. And the corresponding voltage values were recorded by patients' SPD. In the following, the proper location was certified by ACM. The corresponding earliest waves and voltage values in the identified trigeminal branch were also recorded to outline a comparison between two methods. RESULTS: The correlation of ACM and patients' SPD with voltage at ≤ 0.5 V was statistically significant (P < 0.05, r = 0.159; Spearman's rank correlation analysis). Although ACM and SPD showed weak correlation, as their interclass correlation coefficient was significant (F = 1.868, P < 0.01) with coefficient of internal consistency. Moreover, the two methods had consistency. Kruskal-Wallis test showed that ophthalmic (V1), maxillary (V2), and mandibular (V3) divisions had significant differences for test sensitivity (H = 15.945, P < 0.01). For comparison of sensitivities with ACM, V3 was most sensitive followed by V2 and then V1. CONCLUSION: ACM could potentially substitute for SPD of the paresthesias intra-operatively, enabling greater specificity and eliminating the need to interrupt the administration of anesthetic. These improvements would increase patient satisfaction and practitioner efficiency and accuracy.

Masticatory Muscles Dysfunction after CT-guided Percutaneous Trigeminal Radiofrequency Thermocoagulation for Trigeminal Neuralgia: A Detailed Analysis.

OBJECTIVE: The aim of this study was to investigate the severity and the natural course of masticatory muscles weakness that developed after CT-guided percutaneous trigeminal radiofrequency thermocoagulation (PT-RFT) for the treatment of idiopathic trigeminal neuralgia (ITN). METHODS: Twenty-seven patients with ITN were treated by CT-guided percutaneous trigeminal radiofrequency thermocoagulation. Each patients' occlusal function and surface electromyographic (sEMG) activity of the ipsilateral anterior temporalis (TA) and masseter muscles (MM) at mandibular postural position (MPP), and during a fast maximum voluntary clenching (MVC) from MPP to intercuspal position (ICP), were simultaneously recorded by the T-Scan III system and Bio-pak sEMG III system before (baseline), 3 days, 3 months, and 12 months after procedure. The incidence, degree, and prognosis of masticatory muscles dysfunction related to trigeminal nerve motor-branch injury were analyzed. RESULTS: Three days and 3 months after procedure, both the occlusal symmetry and the sEMG activity of ipsilateral TA and MM became significantly decreased compared to the baseline (P < 0.05). However, they demonstrated a gradual improvement toward preoperative values in follow-up, returning to complete in 23 patients at 12 months after procedure. None reported permanent masticatory paralysis. Pain relief was most significant on the third day after procedure. At the final clinical visit, a pain-free status was observed in 25 patients (92.6%). Meanwhile, the intensity of facial dysesthesia was mildest, whereas there were statistic differences compared with baseline. CONCLUSION: CT-guided PT-RFT for ITN remains an effective and safe surgical procedure, but there is a high rate of temporary masticatory dysfunction during a short time after procedure, appearing to be reversible in a period of 12 months.

Long non-coding RNA Snhg16 Lessens Ozone Curative Effect on Chronic Constriction Injury mice via microRNA-719/SCN1A axis.

We investigated the function and molecular mechanism of long non-coding RNA (lncRNA) small nucleolar RNA host gene 16 (Snhg16) in modifying ozone treatment for neuropathic pain (NP) in a mouse model of chronic constriction injury (CCI). Pain-related behavioral responses were evaluated using paw withdrawal threshold (PWT), paw lifting number (PLN), and paw withdrawal latency (PWL) tests. Interleukin (IL)-1ß, IL-10, IL-6, and tumor necrosis factor-alpha (TNF-α) were measured by ELISA and qRT-PCR to evaluate neuroinflammation. qRT-PCR was performed to detect expressions of Snhg16, microRNA (miR)-719, sodium voltage-gated channel alpha subunit 1 (SCN1A), and inflammatory factors. Bioinformatics, dual-luciferase reporter assay, and RNA pull-down verified the underlying molecular mechanisms. Snhg16 expression increased in CCI mice. Snhg16 overexpression retarded the curative effect of ozone and induced NP. miR-719 was sponged by Snhg16. SCN1A was a target of miR-719. Inhibition of miR-719 markedly reversed the effects of Snhg16 on pain-related behavioral responses and neuroinflammation. Upregulation of SCN1A partly abrogated the effects of elevated miR-719 levels on the occurrence of NP. The findings demonstrate that lncRNA Snhg16 promotes NP progression in CCI mice by binding to miR-719 to increase SCN1A expression. The Snhg16/miR-719/SCN1A axis may influence the curative effects of ozone therapy in treating NP.

Coblation Discoplasty Alleviates Cervical Chest Pain After Positive Ultrasound-Guided Nerve Root Block: A Retrospective Study.

OBJECTIVE: Cervical chest pain (CCP), as 1 atypical symptom associated with cervical spondylosis, often overlaps with other chest-related diseases. CCP obviously relieved after ultrasound-guided cervical nerve root block near a herniated disc should be considered as a potential pathologic source. The purpose of this study is to investigate whether coblation discoplasty can alleviate CCP after positive ultrasound-guided nerve root block. METHODS: From August 2016 to September 2019, 21 patients with high suspicion of CCP experienced over 50% pain relieve after ultrasound-guided diagnostic nerve root block. Through 12 months of follow-up, the primary efficacy was assessed with visual analogue scale (VAS) of CCP, and secondary outcomes included: neck pain VAS, neck disability index (NDI), the proportion of significant CCP relief, the rating of CCP alleviation, the patient satisfaction index (PSI), and analgesic consumption. Adverse events were recorded to evaluate safety. RESULTS: Following postoperative 12 months, a time-course analysis confirmed a robust decline in VAS of CCP (P < 0.0001), and a similar recovery trend was shown in VAS of neck pain and NDI (P < 0.0001). After treatment, the number of patients taking analgesics decreased (P < 0.0001), and around 60% of patients reported notable relief and satisfaction with treatment. No serious complications were observed. CONCLUSIONS: After positive ultrasound-guided nerve root block, coblation discoplasty can provide up to 12 months of relief for intractable CCP.

Novel fluoroscopic landmark to significantly facilitate the visualization of foramen ovale in treating idiopathic trigeminal neuralgia.

BACKGROUND AND OBJECTIVES: Access through the foramen ovale (FO) is essential in performing trigeminal ganglion injection, glycerol rhizolysis, balloon compression, and radiofrequency thermocoagulation (RFT) to treat idiopathic trigeminal neuralgia (ITN). However, identification of the FO under fluoroscopy can be difficult and time-consuming, and thus exposes patients to increased radiation and procedure risks. Here we present the 'H-figure' as a novel fluoroscopic landmark to quickly visualize the FO. METHODS: The H-figure landmark can be recognized as the medial border of the mandible and the lateral edge of the maxilla as the two vertical lines, and the superior line of petrous ridge of temporal bone (S-P-T line) as the horizontal line, and the FO fluoroscopic view is then optimized at the center of the H-figure immediately above the S-P-T line. We applied this landmark in a clinical cohort of 136 patients with ITN who underwent fluoroscopy-guided RFT of the trigeminal ganglion. We also compared the H-figure method with the traditional method. The primary outcome was the total number of fluoroscopic images required to visualize the FO (as a proxy of radiation exposure). Secondary measures included the procedure time required to finalize the FO view and the sensory testing voltage for paresthesia. RESULTS: With the H-figure approach we were able to view the FO with an average of 4.2 fluoroscopic shots at an average time of 6.8 min. When compared with the non-H-figure traditional technique, the H-figure method required almost half the fluoroscopic shots in nearly half the procedure duration time, and paresthesia was evoked with half of the voltage. CONCLUSION: The H-figure is an easy fluoroscopic landmark that can help to view the FO with less radiation and procedure time, and the needles placed with this approach can be closer to the target for the RFT treatment of patients with ITN.

Cervicogenic dizziness alleviation after coblation discoplasty: a retrospective study.

OBJECTIVE: Little is known about the therapeutic relationship between coblation discoplasty and cervicogenic dizziness (CGD). CGD can be caused by abnormal proprioceptive inputs from compressed nerve roots, intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc. The aim was to analyze the efficacy of coblation discoplasty in CGD through intradiscal nerve ablation and disc decompression in a 12-month follow-up retrospective study. METHODS: From 2015 to 2019, 42 CGD patients who received coblation discolplasty were recruited as the surgery group, and 22 CGD patients who rejected surgery were recruited as the conservative group. Using intent-to-treat (ITT) analysis, we retrospectively analyzed the CGD visual analogue scale (VAS), neck pain VAS, CGD frequency score, and the CGD alleviation rating throughout a 12-month follow-up period. RESULTS: Compared with conservative intervention, coblation discoplasty revealed a better recovery trend with effect sizes of 1.76, 2.15, 0.92, 0.78 and 0.81 in CGD VAS, and effect sizes of 1.32, 1.54, 0.93, 0.86 and 0.76in neck pain VAS at post-operative 1 week, and 1, 3, 6, 12 months, respectively. The lower CGD frequency score indicated fewer attacks of dizziness until postoperative 3 months (p < 0.01). At post-operative 12 months, the coblation procedure showed increased satisfactory outcomes of CGD alleviation rating (p < .001, -1.00 of effect size). CONCLUSIONS: Coblation discoplasty significantly improves the severity and frequency of CGD, which is important inbridging unresponsive conservative intervention and open surgery.Key messagesThere is a correlation between the degenerative cervical disc and cervicogenic dizziness (CGD).CGD can be caused by abnormal proprioceptive inputs from a compressed nerve root and intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc.Cervical coblation discoplasty can alleviate CGD through ablating intradiscal nerve endings and decompressing the nerve root.

Facile design and development of photoluminescent graphene quantum dots grafted dextran/glycol-polymeric hydrogel for thermoresponsive triggered delivery of buprenorphine on pain management in tissue implantation.

A novel nano-formulations of biocompatible, biodegradable and thermo-responsive graphene quantum dots (GQDs) loaded dextran/poly(N-isopropylacrylamide) (Dex/PNIPAM) copolymeric matrix was synthesized and analyzed the materials characterization, sustained drug delivery system, tissue feasibility in the tissue implantation site. This research report was aimed to grafting and functionalizing thermo-responsive (Dex/PNIPAM) copolymeric composite with presence of graphene quantum dots to achieve thermal responsive drug delivery (TrDD) with no harm effect in the implantation site. The synthesized GQD by using ionic liquid were evaluated by spectroscopic (DLS, PL, XRD and Raman spectroscopy) and Transmission electron microscopic analysis (TEM). The ultra-small GQDs loaded Dex/PNIPAM and was appeared to be asymmetric and open uniform porous structure, which can be significantly favorable for cell uptake and greatly influenced to be an effective drug carrier into the cellular compartment with good fluid flow. The PNIPAM polymeric composite were exhibited sustained and enhanced drug release percentages with increasing temperature at above low critical solution temperature (LCST) is 39 °C comparable to the cumulative drug release profile of below LCST (32 °C), which demonstrated that thermo-responsive polymer was played a significant role in the delivery system. The treated group of GQDs-Dex/PNIPAM was observed that no inflammation and shows noteworthy stromal cell infiltration, demonstrating that the synthesized drug carriers did not harm to the nerves and tissues and only was responsible for the pain management.

[Study on manpower allocation criteria of center of disease prevention and control in the context of province level, city level and county level].

OBJECTIVE: To set the manpower allocation criteria of center of disease prevention and control. METHODS: Expected allocation manpower criteria was obtained through adjusting the current manpower allocation of disease prevention and control centers. The principle was to fulfill public function and promote professional efficiency. RESULTS: Based on function requirement, in 3 - 5 years, the manpower allocation criteria of center of disease prevention and control at provincial-level is 336 persons, at city-level is 102 persons, and at county-level is 33 persons, that means in whole country 140016 persons should be needed. In 10 years, the manpower allocation criteria of center of disease prevention and control at provincial-level is 386 persons, at city-level is 112 persons, and at county-level is 38 persons, that means in whole country 159086 persons should be needed. CONCLUSION: The manpower allocation criteria advanced in the study indicated that current manpower quantity should be greatly reduced. It is an inevitable trend that disease prevention and control centers reduce the staff quantity and promote their quality.

The optimal radiofrequency temperature in radiofrequency thermocoagulation for idiopathic trigeminal neuralgia: A cohort study.

OBJECTIVE: Our previous study evaluated the effectiveness and safety of radiofrequency thermocoagulation (RFT) of trigeminal gasserian ganglion for idiopathic trigeminal neuralgia (ITN). The aim of this study was to evaluate the optimal radiofrequency temperature of computed tomography (CT)-guided RFT for treatment of ITN. METHODS: A retrospective study of patients with ITN treated with a single CT-guided RFT procedure between January 2002 and December 2013. Patients were divided into ≤75 °C, 75 °C, and ≥80 °C groups according to the highest radiofrequency temperature used. Pain relief was graded from poor to excellent, and facial numbness/dysesthesia from I (absent) to IV (most severe). RESULTS: A total of 1161 RFT procedures were undertaken in the 1137 patients. The mean follow-up time was 46 ±â€Š31 months. There were no significant differences in the rate of excellent pain relief according to the radiofrequency temperature used. However, more patients experienced with no facial numbness or facial numbness gradually resolved and those patients treated at 75 °C had a lower rate of grade IV facial numbness/dysesthesia than other groups. CONCLUSIONS: The optimal radiofrequency temperature to maximize pain relief and minimize facial numbness or dysesthesia may be 75 °C, but this requires confirmation.

Percutaneous trigeminal ganglion radiofrequency thermocoagulation alleviates anxiety and depression disorders in patients with classic trigeminal neuralgia: A cohort study.

Trigeminal neuralgia (TN) is a neurological condition that presents as excruciating facial pain. Depression and anxiety are commonly associated with TN; however, anxiety and depression disorders in patients with TN and the effects of the various therapeutic strategies for TN on these disorders are not well studied.To evaluate depression and anxiety in patients with trigeminal neuralgia (TN), identify factors that predict their occurrence and study the effect of the percutaneous trigeminal ganglion radiofrequency thermocoagulation (PRT) procedure for alleviating pain on depression and anxiety.Patients with classic TN, who received PRT treatment, were consecutively recruited between October 2014 and October 2015. Severity of pain was determined using the visual analogue scale (VAS) score. Beck Depression Inventory-II (BDI) and Beck anxiety Inventory (BAI) were used to evaluate depression and anxiety disorders pre- and post-PRT. Medical, demographic, and psychosocial backgrounds were also assessed as predictive factors. A BDI score of ≥14 represented depression and BAI score of ≥45 represented anxiety. VAS, BDI, and BAI scores were collected at the time of admission and on the day of discharge.Of the 167 patients who participated in the study, 121 (72.5%) had depression and 34 (20.4%) suffered anxiety. Pre-PRT procedure, female sex, age >50 years, ineffective treatment, and high pain intensity (VAS ≥7) predicted the development of depression and anxiety. Post-PRT procedure, all patients who experienced pain relief also reported amelioration of depression and anxiety.A considerable percentage of patients with TN developed depression and anxiety. Patients who were female, older than 50 years, or suffered from failure treatment and severe pain (VAS>7), were at higher risk of depression and anxiety development. Complete alleviation of pain by using surgical PRT could immediately attenuate depressive and anxiety disorders associated with TN.

Clinical study of cerebrospinal fluid neuropeptides in patients with primary trigeminal neuralgia.

OBJECTIVES: To investigate the expression levels of calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal peptide (VIP), and ß-endorphin in the cerebrospinal fluid (CSF) and peripheral blood of patients with primary trigeminal neuralgia (TN). PATIENTS AND METHODS: We included 20 patients with primary TN who underwent percutaneous radiofrequency thermocoagulation and collected four types of samples from all of them: sample A: CSF samples; sample B: peripheral blood samples; sample C: peripheral blood samples collected one day before the operation; sample D: peripheral blood samples withdrawn one day after the operation. Another 20 CSF samples of patients with nervous system disease or gynecological disease were collected as a control (sample E). Samples A and B were obtained at the same time. We also evaluated the expression of CGRP, SP, ß-endorphin, and VIP by visual analog scale (VAS) scores one day before and one day after the operation. In addition, heart rate (HR) at baseline and at the time of sample collection, mean arterial pressure (MAP), and all side effects of the procedure were recorded. RESULTS: Significance were found concerning about CGRP, SP, ß-endorphin, and VIP in TN patients and the controls (P<0.001). The expression of CGRP, SP, and VIP in sample A was higher than that in sample E. However, the ß-endorphin level in sample A was lower than that in sample E. There was a positive correlation between sample A and B regarding the expression of CGRP, SP, ß-endorphin, and VIP (P<0. 01). There was no relationship between the time of disease onset and the expression of CGRP, SP, ß-endorphin, and VIP in sample A and sample B (P>0.05). No difference was detected between the neuropeptides levels in samples B and C (P>0.05). Notably, VAS in sample D was significantly lower than that in sample C (P<0.01). Finally, there was no difference between the intraoperative HR and MAP values in the studied samples. CONCLUSION: In primary TN patients, the blood levels of CGRP, SP, ß-endorphin, and VIP were associated with those in CSF samples. There was a significant difference between the levels of the four neuropeptides in CSF and control samples. Our results also indicated that the levels of neuropeptides in blood samples can be tested for those in CSF. The disease onset and duration exerted insignificant effects on the production and release of CGRP, SP, ß-endorphin, and VIP.

Cervicogenic headache alleviation after cervical coblation nucleoplasty: A prospective cohort study.

A degenerative cervical disc is a pain generator for headaches, and headaches can benefit from cervical prolapse surgery. However, as an alternative intervention for open cervical surgery, no study has reported whether headaches can benefit from cervical nucleoplasty.The objective of this study was to evaluate the efficacy of cervical coblation nucleoplasty in the treatment of cervicogenic headaches.In a prospective cohort study performed between December 2013 and August 2015, 20 patients with cervicogenic headaches undergoing cervical nucleoplasty for shoulder-arm pain were recruited into group C, and 20 patients with cervicogenic headaches undergoing lumbar nucleoplasty for low back pain, matched for age and sex, were recruited into group L. Cervicogenic pain was diagnosed according to the International Headache Society criteria. During the 24-month follow-up, pain visual analog scale (VAS) scores were collected as the primary outcomes, and significant pain relief rate, Neck Disability Index (NDI) headache scores, and Patients Satisfaction Index (PSI) scores were recorded as secondary outcomes to evaluate headache severity and physical function postoperatively.During the 24-month follow-up, a significant decrease in headache VAS scores was observed in group C but not in group L. NDI and PSI scores in group C were better than those in group L. In comparison with the final follow-up, no significant differences in the NDI and PSI scores were found in all observations after surgery. In comparison to group L, ≥50% pain relief was significantly better in group C. No serious complications were observed except for ≤20% of ecchymoma at the needle insertion site.This prospective study indicated that cervicogenic headaches may benefit from nucleoplasty.

[Implementation analysis of public functions of centers of disease prevention and control of China].

OBJECTIVE: To evaluate the implementation of public function and items of the centers of disease prevention and control(CDC). METHODS: 161 centers of disease prevention and control have been investigated by two-stage stratified sampling. The implementation analysis of public function and items of CDC is measured by multiplying average operational proportion and average operational degree. RESULTS: 1. For investigated centers, the average rate of function implementation is 42.9% ,with 56.0% at provincial level and 43.7% at city level, 41.3% for the county level; while 49.3% in east areas, 45.4% in middle areas and 35.3% in west areas. 2. Among all 7 functional items, the implemented rate of disease prevention and control is 54.3%, 65.8% for emergency treatment, 35.0% for epidemic situation report and information management of health relative factors, 31.3% for inspection and control of health risk factors, 39.1% for the laboratory examination and evaluation, 36.4% for health education and health promotion, and 56.7% for technological guidance and application study. CONCLUSION: The implemented degree of public function of CDC was generally lower, varied with regions and levels. Among 7 public functional items, the emergency treatment function had the highest implementation, with the lowest for the inspection and control of health relative factors.

[Operational proportion of the public function and items of 161 centers of disease prevention and control in 7 provinces].

OBJECTIVE: To explicate the operational proportion of public function and items of the centers of disease prevention and control (CDC). METHODS: 161 CDC have been investigated by two-stage stratified sampling to provide the information about the operation of the public function and items of CDC. RESULTS: (1) The average operational proportion investigated CDC is 71.7%, the province level 92.0%, the city level 73.7%, the county level 68.5%. East areas 76.5%, middle areas 71.5%, west areas 68.1%. (2) The operational proportion of disease prevention and control function and emergency treatment function were higher, but that of epidemic situation report and information management of health relative factor, inspection and control of health relative factor, and the laboratory examination and evaluation were lower. CONCLUSION: Public function and items were rather poorly carried out by the centers of prevention and control in China, especially those in middle and west areas, and those in counties.

[Implementation analysis of public functions of 161 centers of disease prevention and control in 7 provinces].

OBJECTIVE: To evaluate the implementation of public function and items of the centers of disease prevention and control (CDC). METHODS: 161 centers of disease prevention and control have been investigated by two-stage stratified sampling. The implementation analysis of public function and items of CDC is measured by multiplying average operational proportion and average operational degree. RESULTS: (1) For investigated centers, the average rate of function implementation is 42.9%, with 56.0% at provincial level and 43.7% at city level, 41.3% for the county level, while 49.3% in east areas, 45.4% in middle areas and 35.3% in west areas. (2) Among all 7 functional items, the implemented rate of disease prevention and control is 54.3%, 65.8% for emergency treatment, 35.0% for epidemic situation report and information management of health relative factors, 31.3% for inspection and control of health risk factors, 39.1% for the laboratory examination and evaluation, 36.4% for health education and health promotion, and 56.7% for technological guidance and application study. CONCLUSION: The implemented degree of public function of CDC was generally lower, varied with regions and levels. Among 7 public functional items, the emergency treatment function had the highest implementation, with the lowest for the inspection and control of health relative factors.

[Human resources allocation in centers of disease prevention and control in China].

OBJECTIVE: To compare the human resources allocation of CDC in different areas and different levels. METHODS: By stratified cluster sampling we get 70 CDC's manpower data, which come from different areas(east, middle part, west)and different levels (province, city, county). RESULTS: (1) The average number of CDC's staff is 62. (2)CDC of province level are understaffed by 15%, while CDC of county level are overstaffed by 3%, and CDC of county level are overstaffed by 12%. (3) Structure of age: The average age of CDC's staff is 62, people under 35 years old in CDC is 39.4%, people above 55 years old is 3.5% (4) Structure of education: People with graduate degree are only 0.8%, and people come from technicalsecondary school are 57.0%. (5) Structure of specialty: A majority of people's majors are clinical medicine, and the percent of people having a non-medical-major are 36.6%. (6) Area distributing. Distribution of average quality score of staff are imbalance in different areas, the average quality score of staff in east area are 1.07 times than that in middle area, and 1.12 times than that in west area.

[Reform steps of reestablishing disease prevention and control system of China].

OBJECTIVE: To develop and demonstrate the reform steps of reestablishing disease prevention and control system of China. METHODS: A model named "strategies of fulfilling public functions of disease prevention and control system of China" has been employed to develop reform steps. 154 centers for disease prevention and control (CDC) have been sampled to consult the opinions about the reform steps developed by research team. RESULTS: To reestablish the disease prevention and control system of China, the following reform steps should be kept to: (1) increase government's attention to disease prevention and control, (2) insure feasible government investment to disease prevention and control, (3) increase the stability and efficiency of government financing, (4) reform management system to enhance the operation efficiency of the CDC, (5) revise labor regulation to attract and stabilize specialists, (6) be carefully to dispose the non-public-service now delivered by the CDC. The consent percent of all sampling CDC was 98.7%.

[A study on the cause of public health service delivery insufficiency of disease prevention and control system of China].

OBJECTIVE: To demonstrate the cause of public health service delivery insufficiency of disease prevention and control system of China. METHODS: 205 literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various causes of public health service delivery insufficiency of disease prevention and control system of China. RESULTS: Literatures review demonstrated that the financing from government to disease prevention and control system of China was insufficiency and show lower efficiency, which has been agreed by 99.3% of CDC. Literatures review demonstrated that the financing administration idea of permitting charging service caused the fee-for-service played a key role in the economic reimbursement of various levels of CDC, which has been agreed by 96.0% of CDC. CONCLUSION: The causes of public health service delivery insufficiency of disease prevention and control system of China were the government financing insufficiency and the defective administration strategies.

[Fundamental strategies to address the problem of public health service delivery insufficiency of disease prevention and control system of China].

OBJECTIVE: To develop and demonstrate the strategies to solve the problem of public health service delivery insufficiency of disease prevention and control system of China. METHODS: 205 literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various reform strategies. Based on the causes and mechanism of public health service delivery insufficiency of disease prevention and control system, the logic analysis has been employed to develop fundamental strategies, which has been demonstrated by 154 CDC using intention questionnaires. RESULTS: There are fundamental strategies to which the agreeing rate for sampling CDC was over 95%: to make sure government should afford the financing function of disease prevention and control and secure the feasible investment for centers of disease prevention and control. Meanwhile, the working efficiency of CDC should be improved through strengthening management and reforming government investing manner.