Expressions of TGF-ß1 and Eâ ¢A-FN after Rat Skeletal Muscle Contusion and Wound Age Estimation.

ABSTRACT: Objective To study the expressions of transforming growth factor-ß1 （TGF-ß1） and EⅢA-fibronectin （EⅢA-FN） at different time points of antemortem injury, antemortem injury postmortem expression and postmortem injury and to explore their application value in wound age estimation. Methods A model of rat skeletal muscle contusion was established. The rats were randomly divided into normal control group （n=5）, antemortem contusion group （n=40）, antemortem contusion postmortem expression group （n=110） and postmortem injury group （n=25）. The expressions of TGF-ß1 and EⅢA-FN after rat skeletal muscles antemortem contusion were detected with immunohistochemical staining. Expression changes of TGF-ß1 and EⅢA-FN mRNA in each group were analyzed with real-time fluorescence quantitative PCR. Results Immunohistochemical staining results showed that a large number of polymorphonuclear leukocyte, mononuclear cells and fibroblastic cells showed a strong expression of TGF-ß1 in wounded zones 12 h-14 d after antemortem contusion. EⅢA-FN was mainly distributed in the extracellular matrix, 3 to 7 d post-traumatic. Real-time fluorescence quantitative PCR results showed that TGF-ß1 and EⅢA-FN mRNA in antemortem injury group reached the peak at 3 and 5 d post-traumatic respectively. The expressions of TGF-ß1 and EⅢA-FN mRNA in antemortem contusion postmortem expression group peaked at 6 h and 12 h postmortem. The expression of TGF-ß1 and EⅢA-FN mRNA in postmortem injury group 0.5-12 h postmortem was significantly lower than those of the normal control group and the antemortem contusion group. Conclusion TGF-ß1 and EⅢA-FN might become a reference index for skeletal muscle wound age estimation.

A quality assessment index framework for public health services: a Delphi study.

OBJECTIVES: This study sought consensus-based indices for quality assessment of the public health service (QAPHS) to evaluate the service quality of public health in Shenzhen and other cities in China. STUDY DESIGN: A qualitative study. METHODS: A list of quality assessment indices was formed based on Donabedian theory. These indices were presented to an expert panel in a two-round Delphi study to establish a consensus view. A weight of indices was established to validate the applicability and practicability of the framework. The specialist authority coefficient and Kendall's W were also calculated based on statistical analysis. RESULTS: A total of 30 experts participated in the Delphi study. Consensus was reached on four first-grade indices, nine second-grade indices and 28 third-grade indices. The specialist authority coefficient (Cr) was high (between 0.88 and 0.92), while Kendall's coefficient (W) of all the indices was ＞0.5 with statistical significant differences (P ＜ 0.05). This indicated correlation among panelists and had high reliability. CONCLUSIONS: A unified and hierarchical quality assessment index framework for public health services was established. The framework should be further tested and improved in practice.

Implementation and community involvement in DOTS strategy: a systematic review of studies in China.

OBJECTIVE: To summarise data on the implementation of the DOTS strategy in China in terms of actual observation and treatment adherence, and to review the effectiveness of quality improvement interventions for tuberculosis (TB) control in China. DESIGN: We included survey studies that reported data on the implementation of DOTS in China and controlled studies that evaluated TB care in specified communities. We excluded studies outside mainland China, pharmacological intervention trials and reviews. RESULTS: We included 12 survey studies that reported on the performance of TB control services in China. The pooled analysis showed that more than half of TB patients were treated by self-administration (52%) and that only 20% actually had their treatment observed by health workers. We include 85 intervention studies that evaluated the effect of quality improvement interventions. Treatment observers were family members in 37 studies, and health workers in 20 studies. The pooled odds ratio (OR) for cure was 2.48 (95%CI 1.97-3.11, I(2) = 70.9%, P < 0.001); the pooled OR for treatment completion was 2.87 (95%CI 2.23-3.69, I(2) = 66.3%, P < 0.001). Sensitivity analysis found that the estimated treatment effects in meta-analyses using reported and imputed data were much reduced, but still statistically significant. CONCLUSION: The proportion of TB patients whose treatment was strictly observed was much lower than reported by official statistics in China. The treatment completion rate was not optimal, which may be an important reason for the reported increases in drug resistance. Community health personnel have become the main work force for TB control in China.

Ornithine transcarbamylase deficiency.

Two infants, one male and one female, with elevated serum ammonia levels, were shown, based on urine organic acid analysis and DNA studies, to have ornithine transcarbamylase (OTC) deficiency. OTC deficiency is one of the most common urea cycle disorders. Hyperammonemia occurred at 3 days of age in the male infant, and at approximately 7 days of age in the female infant. Administration of sodium benzoate and sodium phenylacetate lowered the serum ammonia level effectively in both cases. Other modalities, including peritoneal dialysis and protein restriction, were also important in the control of the serum ammonia level. The mother of the male infant was shown to be a carrier of the OTC gene mutation by allopurinol loading test. The mutation site of the OTC gene for the female infant was identified, but her mother did not have the mutation. OTC deficiency, an incompletely dominant X-linked disorder, is a severe disease even for females and prompt treatment and precise genetic counseling are mandatory.