Relevant factors of clinic attendance for contracted residents in a community health service center in Shanghai / 中华全科医师杂志

Objective:To analyze factors related to clinic attendance for contracted residents in a community health service center in Shanghai.Methods:It was a cross-sectional study. Through the 'Cloud Management of the Community' APP and the 'Service Fee of Contracted Residents' APP, the basic information, contracted time, hospital visits, number of visits, and medical insurance expenses of the contracted residents in Shanggang Community Health Service Center in 2021 were collected, the visiting rate to the contracted community health center and the contracted medical combination hospitals were analyzed.Results:In 2021, the contracting rate of all residents in the community was 49.96% (51 478/103 033). The contracting rate of the key population was 84.59% (43 545/51 478),among whom 66.28% (34 118/51 478) were over 60 years, 49.93% (25 702/51 478) had been contracted for more than 3 years, and 37.43% (19 270/51 478) had hypertension and/or diabetes. The number of contracted general practitioners was 4.89 times of contracted TCM doctors (1 345.17/274.81). Among all contracted residents 78.75% (40 540/51 478) had at least one visit annually, and 65.00% (33 463/51 478) had at least one visit to community health service center and the average number of visits was 17.63(5.00, 24.00)annually. The rate of visit to contracted the community health service center was (46.97±38.37) %, and 41.78% (16 937/40 540) had≥60% visit to contracted community center; the average visiting rate to the combination hospitals was (70.59±34.57) %, and 55.75% (22 602/40 540) had consultation rate≥80%. These residents were older in age, had longer contract time, higher proportion of hypertension and diabetes, and higher medical expenses, compared to those with less visits to contracted community health center and combination hospitals ( P<0.01). Meanwhile, 11 736 residents (35.07%) only visited to the contracted community health service center. Conclusion:The contracted residents are mainly the elderly and the sick ones in the community, but the use of contracted service is inadequate. Improving the visiting rate to community health center is a challenge for make a full use of the contracted health facilities.

Increasing the rate of timely completion of a rapid frozen-section pathological report using the PDCA cycle / 中国基层医药

Objective:To investigate the application value of the PDCA cycle in increasing the rate of timely completion of a rapid frozen-section pathological report.Methods:The basic data of 1 926 rapid frozen section pathological reports not managed by the PDCA cycle in the Department of Pathology, Zhoushan Hospital, during January to August 2019 were collected. The number of pathological reports completed within 30 minutes and the rate of timely completion of pathological reports were calculated and compared with those calculated based on 1 051 pathological reports managed by the PDCA cycle during September to December 2019.Results:After management by the PDCA cycle, the rate of timely completion of frozen-section pathological reports was significantly increased from (84.51 ± 3.61)% to (91.87 ± 1.37)% ( t = 3.86, P < 0.05). Conclusion:Application of the PDCA cycle to pathology management can help monitor the completion of pathological reports on frozen sections. This facilitates determination of reasonable intervention measures and thereby increases the rate of timely completion of pathological reports on frozen sections.

Development Process and Value Manifestation of Pharmaceutical Care / 中国药房

OBJECTIVE：To improve the level of pharmaceutical care，enhance the professional value and social status of pharmacists by clarifying the development process of pharmaceutical care and summarizing the value of pharmacists in pharmaceutical care. METHODS：The development process of pharmaceutical care at home and abroad（service objects，service contents and service methods）was summarized；the current situation of pharmaceutical care in China was analyzed；the value of pharmaceutical care were defined in respects of rational drug use，humanistic value and medical resources. The development of pharmaceutical care in the future was prospected. RESULTS & CONCLUSIONS：The development of pharmaceutical care can be divided into three stages：“drug supply as the center”“promoting rational drug use as the center”and“patients as the center”，and the service objects，service contents and service methods in different stages are expanding and diversifying. Compared with developed countries，the overall level of pharmaceutical care in China lags behind，and there are differences in level of pharmaceutical care modes in hospitals at different levels. Pharmacists ensure the safety，effectiveness and economy of drug use through pharmaceutical care，and promote rational drug use；the compliance，quality of life and satisfaction of patients have been improved through pharmaceutical care；pharmacists participate in medical quality management to save medical and health resources through pharmaceutical care. Pharmaceutical care，as an important part of the medical and health system，plays an important and irreplaceable role in the medical process，which is suggested that the relevant government departments should fully understand the value of pharmaceutical care and further strengthen their support for pharmaceutical care；pharmaceutical staff should improve their self-cultivation and cooperate with other disciplines to achieve the sustainable development of hospital pharmacy in different regions and medical institutions.

Effect of modified Shaoyao Gancao decoction on hyperprolactinemia caused by amisulpride / 中国基层医药

Objective:To investigate the clinical efficacy and safety of modified Shaoyao Gancao decoction in the treatment of hyperprolactinemia caused by amisulpride. Methods:Ninety patients with hyperprolactinemia caused by amisulpride who received treatment in Kangci Hospital from June 2018 to October 2019 were included in this study. They were randomly divided into the placebo control, control and observation groups ( n = 30/group). The placebo control group was treated with the decoction with the taste and color (without drug ingredients) similar to that of modified Shaoyao Gancao decoction. The control group was treated with Shaoyao Gancao decoction. The observation group was treated with modified Shaoyao Gancao decoction. All patients were treated for 8 weeks. Clinical efficacy, serum prolactin level and Positive and Negative Syndrome Scale score before and after treatment, Treatment Emergent Symptom Scale score after treatment, glucose and lipid metabolism, liver and kidney function before and after treatment were compared among the three groups. Results:The effective rate in the placebo control, control and observation groups was 90.0% (27/30), 96.7% (29/30) and 100.0% (30/30), respectively, and the difference among the three groups was statistically significant (χ 2 = 7.027, P < 0.05). After treatment, serum prolactin level in the observation group [(48.2 ± 15.7) μg/L] was significantly lower than that in the control group [(52.5 ± 13.7) μg/L] and placebo control group [(57.7 ± 16.9) μg/L, t = 7.134, 7.034, both P < 0.05]. After treatment, Positive and Negative Syndrome Scale score in the observation group [(51.02 ± 3.98) points] was significantly lower than that in the control group [(54.07 ± 4.19) points] and placebo control group [(58.13 ± 4.24) points, t = 5.813, 6.317, both P < 0.05]. After treatment, Treatment Emergent Symptom Scale score in the observation group [(5.2 ± 1.3) points] was significantly higher than that in the control group [(4.9 ± 1.4) points] and placebo control group [(4.4 ± 1.2) points, t = 7.011, 7.231, both P < 0.05]. After treatment, blood glucose, low-density lipoprotein cholesterol, triglyceride, total cholesterol, alanine aminotransferase, aspartate aminotransferase levels in the observation group were significantly lower than those in the placebo control and control groups (all P < 0.05). Serum level of high-density lipoprotein cholesterol in the observation group was significantly higher than that in the placebo control and control groups (both P < 0.05). Conclusion:Modified Shaoyao Gancao decoction is highly effective in the treatment of hyperprolactinemia caused by amisulpride. It can reduce serum prolactin level and has good safety.

Comparison of contracting status for combination medical service between elderly residents in Shanghai urban and suburban communities and its influencing factors / 中华全科医师杂志

Objective:To compare the contracting status for combination medical service( "1+1+1" contract)between elderly residents in Shanghai urban and suburban communities and its influencing factors.Methods:Total 574 outpatients aged over 60 were selected with stratified sampling and convenient sampling method from 3 urban community health service centers and 3 suburban community health service centers in Shanghai. A questionnaire survey was conducted from July to September 2017, the survey included the general information, health status, health concern, purpose of this visit, satisfaction with the center, frequency of visit, choice of first contact, willingness of referral, understanding "1+1+1" contract and preferential policies, contract signing status and reasons.Results:Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with an effective rate of 98.25%. Of the 292 participants in urban areas, 167 (57.2%) had signed the contract; of the 272 participants in the suburbs, 133 (48.9%) had signed the contract. Univariate analysis showed that self-evaluated health status, visits to the community health service center, satisfaction with the center, concerning health knowledge, long-term medication, the choice of community health center as first contact, the willingness of referral, knowing the "1+1+1" contract policy were associated with the contract-signing in urban residents (χ 2=13.05, 8.51, 13.89, 10.76, 6.26, 12.98, 24.73, 76.77, respectively; all P<0.05); while age, self-evaluated health status, the purpose of this visit, medical examination, type of chronic disease, long-term medication, the choice of community health service center as first contact, the willingness of referral, knowing the "1+1+1" contract policy were associated with the contrct-signing in suburban residents (χ 2=9.56, 14.26, 13.83, 18.30, 18.65, 11.96, 5.99, 5.46 83.44, respectively all P<0.05). Multivariate analysis showed that self-rated health status and awareness of "1+1+1" contract were independent influencing factors for contract-signing in urban residents ( P<0.05); while the awareness of "1+1+1" contract, the purpose of this visit and the frequency of physical examination were influencing factors for contract-signing in suburban residents ( P<0.05). Conclusion:The "1+1+1" signing rate in urban residents is higher than that in suburban residents due to more self health-concerns and higher awareness of the "1+1+1" contracts. It is suggested that the government attach importance to construction of the "1+1+1" contract system for suburb community health service institutions.

Efficacy and Safety of Apatinib Combined with TACE in the Treatment of Moderate and Advanced Liver Cancer ： A Meta-analysis / 中国药房

OBJECTIVE：To systematically evaluate the efficacy an d s afety of apatinib combined with transcatheter arterial chemoembolization（TACE）in the treatment of moderate and advanced liver cancer ，and to provide evidence-based reference for rational drug use in the clinic. METHODS ：Retrieved from Cochrane Library ，Embase，PubMed，Web of Science ，SinoMed， CNKI，Wanfang，VIP database ，RCTs about apatinib combined with TACE （trial group ）versus TACE （control group ）in the treatment of moderate and advanced liver cancer were collected from inception to Sep. 2019. After screening the literature and extracting the data ，the quality of included literatures was evaluated by using bias risk assessment tool recommended by the Cochrane system evaluator manual 5.1.0 and the modified Jadad scale. Meta-analysis was carried out by using Stata 12.0 software. RESULTS：Totally 16 RCTs were included ，involving 1 043 patients. Results of Meta-analysis showed that objective response rate [OR ＝3.10，95％CI（2.38，4.03），P＜0.001]，disease control rate [OR ＝3.56，95％CI（2.62，4.83），P＜0.001] and survival rate [OR ＝2.40，95％ CI（1.86，3.10），P＜0.001]，the incidence of diarrhea [OR ＝2.27，95％ CI（1.21，4.24），P＝0.011]， hypertension [OR ＝6.97，95％ CI（1.21，40.15），P＝0.030]， proteinuria [OR ＝12.44，95％CI（2.51，61.71），P＝0.002] and com hand foot syndrome [OR ＝32.50，95％CI（12.03，87.77），P＝ 0.001] of trial group were significantly higher than those of control group. The serum level of VEGF [SMD ＝－ 3.64， 95％CI（－5.06，－2.22），P＜0.001]，MMP-9 [SMD＝－3.21，95％CI（－4.31，－2.10），P＜0.001]，AFP [SMD ＝－3.54， 95％CI（－7.03，－0.06），P＝0.046] after treatment ，the incidence of myelosuppression [OR ＝0.61，95％CI（0.39，0.97），P＝ 0.035]，fever [OR ＝0.63，95％CI（0.42，0.95），P＝0.027]，nausea and vomiting [OR ＝0.70，95％CI（0.51，0.97），P＝0.030] in trial group were significantly lower than those of control group. There was no statistical significance in the incidence of abdominal pain [OR ＝0.87，95％CI（0.54，1.39），P＝0.547] and skin itching [OR ＝1.63，95％CI（0.36，7.50），P＝0.530] between 2 groups. CONCLUSIONS：Apatinib combined with TACE can significantly improve clinical efficacy ，prolong survival time ，reduce tumor recurrence and metastasis. It can reduce the occurrence of related ADR as diarrhea after TACE ，but increase the occurrence of apatinib-related ADR as myelosuppression.

Establishment of A Patient-derived Xenotransplantation Animal Model for Small Cell Lung Cancer and Drug Resistance Model / 中国肺癌杂志

BACKGROUND@#Small cell lung cancer (SCLC) is characterized by poor differentiation, high malignancy and rapid growth fast, short double time, early and extensive metastatic malignancy. In clinical, chemotherapy is the main treatment method, while resistance to multiple chemotherapy drugs in six to nine months has been a major clinical challenge in SCLC treatment. Therefore, It has important clinical value to building SCLC aninimal model which is similar to patients with SCLC. Animal model of xenotransplantation (PDX) from the patients with small cell lung cancer can well retain the characteristics of primary tumor and is an ideal preclinical animal model. The study is aimed to establish SCLC PDX animal model and induce the chemoresistance model to help to study the mechanism of chemoresistance and individual treatment.@*METHODS@#Fresh surgical excision or puncture specimens from SCLC patients were transplanted into B-NSGTM mice subcutaneous tissues with severe immunodeficiency in one hour after operation the B-NSGTM mice subcutaneous in 1 hour, and inject chemotherapy drugs intraperitoneally after its tumor growed to 400 mm³ with EP which is cisplatin 8 mg/kg eight days and etoposide 5 mg/kg every two days until 8 cycles. Measure the tumor volum and mice weights regularly, then re-engrafted the largest tumor and continue chemotherapy.@*RESULTS@#Nine cases were conducted for B-NSG mice modeling. Three of nine cases could be engrafted to new B-NSG mice at least two generation. The SCLC PDX animal models have been established successfully. After adopting chemotherapy drugs, the chemoresistance PDX models have been established. High homogeneity was found between xenograft tumor and patient's tumor in histopathology, immunohistochemical phenotype (Syn, CD56, Ki67).@*CONCLUSIONS@#The SCLC PDX animal model and the chemoresistance PDX animal model have been successfully constructed, the success rate is 33%, which provides a platform for the clinical research, seeking for biological markers and choosing individual treatment methods of SCLC.

Characteristics of elderly frequent clinic attenders in a Shanghai community health service center / 中华全科医师杂志

Objective To analyze the characteristics of elderly frequent clinic attenders in a Shanghai community health service center.Methods The medical records of patients over 60 year who visited Shanghai Weifang Community Health Center clinic from October 2014 to October 2017 were obtained from the hospital outpatient management system.The persistent frequent attenders were defined as whose visiting times were among the top 10％ of attendance in the three consecutive years.The general condition and disease characteristics of persistent frequent attenders were analyzed and compared with those of non-frequent attenders and transient frequent attenders.Results There were total 19 240 patients paying 1 171 thousand clinic visits in the center for three years,the persistent frequent attenders accounted for 5.3％ (1 029) of total patients and had 21.4％ of total visits (251 thousand);those figures for transient frequent attenders were 10.2％(1 965) and 23.9％ (280 thousand);for non-frequent attenders were 84.5％ (16 246) and 54.7％(640 thousand),respectively.The average annual visits of three groups were (81.4 ± 27.5),(47.5 ± 21.4) and (13.1± 11.1) times,respectively.The reasons for encounter in persistent frequent attenders were:coronary heart disease (11.2％,48 thousand),cerebral insufficiency (3.5％,15 thousand),joint pain (2.5％,11 thousand),osteoporosis (2.9％,13 thousand) and sequelae of stroke (2.1％,9 thousand).Age above 70(OR=2.163,95％CI:1.872-2.498),age above 80 (OR=2.243,95％CI 1.895-2.655),female sex (OR=1.426,95％CI:1.249-1.627) and contracting general practitioners (OR=5.665,95％CI 4.217-7.611) were associated with persistent frequent attendance (P＜0.05).Conclusion Elderly frequent attenders occupy large outpatient resources of community health center,and age,gender and contracting status could affect their attending frequency.

Risk Factors of Nosocomial Infection in 383 Children with Hypospadias after Operation and Nursing Countermeasures / 中国实用护理杂志

Objective To explore the main risk factors of hospital infection in children with hypospadias after operation and to formulate targeted nursing measures so as to provide accurate nursing strategies for effective prevention and control of hospital infection after operation. Methods Totally 383 children who underwent hypospadias surgery in the hospital from January 2016 to December 2017 were selected as the research objects. The clinical data of all cases were reviewed and sorted out. The hospital infection rate, infection site and main risk factors of hospital infection after operation were analyzed to formulate prevention strategies. Results 71 of 383 children suffered from hospital infection, and the incidence rate of hospital infection was 18.5% .The distribution of infection sites was: respiratory tract infection in 30 cases, accounting for 42.25% ;Urinary tract infection was found in 25 cases (35.21% ). Incision infection was found in 14 cases (19.72%).Gastrointestinal infection occurred in 2 cases (2.82%). Logistic multivariate analysis showed that age, length of hospital stay after operation were closely related to hospital infection. Conclusions The major risk factors for postoperative nosocomial infection in children with hypospadias are age and postoperative hospital stay.Nursing measures: The hospital stay of children after operation can be shortened as much as possible by reminding and standardizing the routine maintenance of urinary catheter and strengthening the cooperation between doctors and nurses through charts. Strict implementation of visiting and accompanying system, good environmental control, strengthening hand hygiene, standardization of preoperative skin preparation and other nursing measures are adopted to protect children to the greatest extent.

Effect of non nutritive sucking combined with maternal voice stimulation on feeding in premature infants / 中国实用护理杂志

Objective to explore the effect of non nutritive sucking combined with maternal voice stimulation on feeding process in premature infants. Methods A total of 129 premature infants admitted to the neonatal department of a tertiary hospital from July 2016 to July 2017 were randomly selected. According to the random number table method, there were 3 groups: NNS group, control group (routine nursing group), and NNS+MSS group, each with 43 cases. Non-nutritive sucking was given in the NNS group, general routine treatment and nursing in the control group, and non-nutritive sucking combined with mother's voice stimulation in the NNS+MSS group. The duration of feeding, initial feeding and hospitalization were observed in 3 groups. Results NNS+MSS group feeding transition time, the first feeding duration, hospitalization days three points respectively (8.60 ± 1.24)d, (8.16 ± 1.74)min, (13.26 ± 1.84)d, and NNS group respectively (12.09 ± 2.10) d, (4.72±1.45) min, (14.70±1.79) d, the control group, respectively (17.70±2.30) d (2.28 ± 1.39) min (19.81± 4.17) d. The differences between the three groups were statistically significant (F=242.085, 159.313, 63.856, all P<0.05). Conclusions Non nutritive sucking combined with mother sound stimulation can promote early feeding from nasal feeding to complete transoral feeding as soon as possible, reduce intermediate conversion time, accelerate feeding process and shorten hospitalization time.

Risk Factors of Nosocomial Infection in 383 Children with Hypospadias after Operation and Nursing Countermeasures / 中国实用护理杂志

Objective@#To explore the main risk factors of hospital infection in children with hypospadias after operation and to formulate targeted nursing measures so as to provide accurate nursing strategies for effective prevention and control of hospital infection after operation.@*Methods@#Totally 383 children who underwent hypospadias surgery in the hospital from January 2016 to December 2017 were selected as the research objects. The clinical data of all cases were reviewed and sorted out. The hospital infection rate, infection site and main risk factors of hospital infection after operation were analyzed to formulate prevention strategies.@*Results@#71 of 383 children suffered from hospital infection, and the incidence rate of hospital infection was 18.5%.The distribution of infection sites was: respiratory tract infection in 30 cases, accounting for 42.25%;Urinary tract infection was found in 25 cases (35.21%). Incision infection was found in 14 cases (19.72%).Gastrointestinal infection occurred in 2 cases (2.82%). Logistic multivariate analysis showed that age, length of hospital stay after operation were closely related to hospital infection.@*Conclusions@#The major risk factors for postoperative nosocomial infection in children with hypospadias are age and postoperative hospital stay.Nursing measures: The hospital stay of children after operation can be shortened as much as possible by reminding and standardizing the routine maintenance of urinary catheter and strengthening the cooperation between doctors and nurses through charts. Strict implementation of visiting and accompanying system, good environmental control, strengthening hand hygiene, standardization of preoperative skin preparation and other nursing measures are adopted to protect children to the greatest extent.

Status and influencing factors of signing combination contract for primary care among elder residents in Shanghai communities / 中华全科医师杂志

Objective@#To investigate the signing status of combination contract( "1+1+1" contract) for primary care among elderly residents in Shanghai communities and its influencing factors.@*Methods@#The policy of combination contract for primary care has been implemented in Shanghai since 2015, the residents signed a service contract with general practitioners in community health service center as well as with one of the secondary or tertiary hospitals ( "1+1+1" ). The questionnaire survey on the signing status of "1+1+1" contract was conducted among residents over 60 years in 6 communities in Shanghai which were selected by stratified and convenience sampling method from September 2017 to November 2017. The questionnaire was designed based on the previous research results of the qualitative interviews. The contents of the questionnaire included the basic characteristics, health status, understanding of the "1+1+1" signing policy, the status and reasons for contract signing, and so on. The date were analyzed by descriptive method, chi-square test, and binary logistic regression.@*Results@#Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with a recovery rate of 98.25%. Among all participants, 300 (53.2%) had signed and 264 (46.8%) had not signed. Univariate analysis showed that age, self-evaluated health status, chronic disease, medication, visits to the community health service center, the purpose of this visit,satisfaction with the community health service center, medical examination, concerning health knowledge, the willingness of community doctor as gatekeeper, the willingness of community referral, whether or not know the "1+1+1" contract policy, influence the rate of signing were associated with the signing of the contract (all P<0.05). Multivariate analysis showed that whether or not know the "1+1+1" contract policy, the willingness of community referral, and self-evaluation health status were independent factors affecting "1+1+1" contract signing (all P<0.05). The reason for signing the contract were convenience to visit doctor (69.00%, 207/300), and having a good relationship with family doctor (29.33%, 88/300). The reasons for not signing the contract were not understanding the policy (65.15%, 172/264), lack of help for signing (25.38%, 67/264), and restricted choice of seeking medical services (7.58%, 20/264).@*Conclusion@#Whether or not know the "1+1+1" contract policy, the willingness of community referral, and self-evaluation health status are the main influencing factors of signing "1+1+1" contract for primary care among elderly residents in Shanghai communities.

Effect of non nutritive sucking combined with maternal voice stimulation on feeding in premature infants / 中国实用护理杂志

Objective@#to explore the effect of non nutritive sucking combined with maternal voice stimulation on feeding process in premature infants.@*Methods@#A total of 129 premature infants admitted to the neonatal department of a tertiary hospital from July 2016 to July 2017 were randomly selected. According to the random number table method, there were 3 groups: NNS group, control group (routine nursing group), and NNS+MSS group, each with 43 cases. Non-nutritive sucking was given in the NNS group, general routine treatment and nursing in the control group, and non-nutritive sucking combined with mother's voice stimulation in the NNS+MSS group. The duration of feeding, initial feeding and hospitalization were observed in 3 groups.@*Results@#NNS + MSS group feeding transition time, the first feeding duration, hospitalization days three points respectively (8.60 ± 1.24)d, (8.16±1.74)min, (13.26 ± 1.84)d, and NNS group respectively (12.09 ± 2.10) d, (4.72±1.45) min, (14.70±1.79) d, the control group, respectively (17.70±2.30) d (2.28 ± 1.39) min (19.81± 4.17) d. The differences between the three groups were statistically significant (F=242.085, 159.313, 63.856, all P<0.05).@*Conclusions@#Non nutritive sucking combined with mother sound stimulation can promote early feeding from nasal feeding to complete transoral feeding as soon as possible, reduce intermediate conversion time, accelerate feeding process and shorten hospitalization time.

Efficacy and Safety of Selective Janus Kinace 1 Inhibitor Upadacitinib and Filgotinib in the Treatment of Rheumatoid Arthritis ： A Meta-analysis / 中国药房

OBJECTIVE： To evaluate the therapeutic efficacy and safety of 2 kinds of selective Janus kinase 1 （JAK-1） inhibitor Upadacitinib and Filgotinibfor in the treatment of rheumatoid arthritis， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from PubMed， Medline， Embase， the Cochrane library， CBM， CJFD， Wanfang database and VIP， RCTs about placebo （control group） versus Upadacitinib or Filgotinibfor （trial group） in the treatment of rheumatoid arthritis on the basis of methotrexate or other antirheumatic drugs were collected during the establishment of the database to Jan. 2019. Meta-analysis of therapeutic efficacy [the proportion of patients with remission rate of 20％ （ACR20）， ACR50， ACR70 according to the criteria of American Rheumatism Association， the proportion of patients with 28-joint disease activity score （DAS28）＜3.2] and safety [the incidence of adverse event （AE）， severe adverse event （SAE）， infection， severe infection， herpes zoster， liver injury] were conducted by using Rev Man 5.3 software after data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0. RESULTS： A total of 8 RCTs were included， involving 2 738 patients. Meta-analysis showed that the proportion of patients with ACR20 [OR＝3.37，95％CI（2.80，4.05），P＜0.001]， ACR50 [OR＝3.78，95％CI（2.98，4.78），P＜0.001] and ACR70 [OR＝4.31，95％CI（3.05，6.09），P＜0.001]， the proportion of patients with DAS28＜3.2 [OR＝3.86，95％CI（2.98，5.00），P＜0.001]， the incidence of AE [OR＝1.33，95％CI（1.11，1.61）， P＝0.002]， the incidence of infection [OR＝1.43，95％CI（1.12，1.81），P＝0.004] in trial group were significantly higher than control group； there was no statistical significance in other indexes （P＞0.05）. CONCLUSIONS： JAK-1 inhibitors Upadacitinib and Filgotinib can improve the effect indexes of ACR20， ACR50 and ACR70 and the proportion of patients with DAS28＜3.2 of rheumatoid arthritis patients； it can not increase the incidence of SAE， severe infection， herpes zoster， liver injury， but can increase the risk of AE and infection.

Correlation between empowerment and medical support in patients with type 2 diabetes mellitus / 中华护理杂志

Objective To investigate the status of empowerment and medical support in patients with type 2 diabetes mellitus,and to explore the relationship between empowerment and medical support.Methods A multi-centered collaboration and cross-sectional survey was used in this study.With the method of simple random sampling,1512 patients with type 2 diabetes mellitus from 18 tertiary hospitals in Hunan Province were investigated from January 2016 to April 2016.General information,empowerment and medical support were investigated using general information questionnaire,Diabetes Empowerment Scale-DAWN Short Form,Patient Assessment of Chronic Illness Care DAWN Short Form.Results The mean score of empowerment ability for patients with type 2 diabetes mellitus was (53.20±16.40).The mean score of medical support for patients with type 2 diabetes mellitus was (34.56±11.64).There was positive correlation between the empowerment ability and medical support in patients with type 2 diabetes mellitus.Conclusion There is positive correlation between empowerment and medical support in patients with type 2 diabetes mellitus.But the received medical support is not enough.It is necessary to increase the supply of medical support to promote the empowerment of patients with type 2 diabetes.

Comparative Study on Antitussive, Antiasthmatic, Phlegm-resolving and Anti-inflammatory Effects of Fritillaria cirrhosa and Fritillaria unibracteate / 中国药房

OBJECTIVE:To investigate antitussive,antiasthmatic,phlegm-resolving and anti-inflammatory effects of Fritillaria cirrhosa and Fritillaria unibracteata. METHODS:Mice and guinea pig were randomly divided into blank control group (distilled water),ethanol extract groups,water extraction groups and powder groups of F. cirrhosa and F. unibracteata(1.13 g/kg for mice, 0.42 g/kg for guinea pig,calculated by crude drug),positive control group,with 10 mice(guinea pig)in each group. Each group was given relevant medicine intragastrically once a day for consecutive 5 d. Relative indicators were detected 30 min after last medication. The ammonia water induced cough method was used to investigate antitussive effect (dextromethorphan hydrobromide as positive drug,0.013 g/kg)by determining coughing latent period and coughing times within 3 min. After inducing asthma with 2％ histamine phosphate for 15 s, antiasthmatic effect (aminophylline as positive drug, 0.033 g/kg) was investigated by determining coughing latent period and the number of guinea pig with convulsive fall. The phenol red injection method was used to investigate phlegm-resolving effect (ambroxol as positive drug,21.304 g/kg) by determining the content of phenol red in the trachea of mice in phenol red expectoration test. The anti-inflammatory effect(dexamethasone acetate as positive drug,9.225×10-4 g/kg)was investigated by determining ear swelling degree and inhibition rate of ear swelling mice in xylene-induced inflammation test. RESULTS:Compared with blank control group, coughing latent period and cough induction latent period prolonged significantly in ethanol extract of F. cirrhosa and F. unibracteata groups,F. cirrhosa and F. unibracteata powder groups,positive control group, and coughing time decreased significantly within 3 min. The number of mice with convulsive fall decreased significantly in F. cirrhosa powder group, F. unibracteata ethanol group,F. unibracteata powder group and positive control group. The content of phenol red in the trachea of mice increased significantly,while ear swelling and inhibitory rate of ear swelling decreased significantly,with statistical significance (P<0.05 or P<0.01). There was no statistical significance in each index of mice between powder group and positive control group (P>0.05). Compared with corresponding groups of F. cirrhosa,coughing latent period of mice prolonged significantly in F. unibracteata ethanol extract group (P<0.05), other indexes had no statistical significance(P>0.05). CONCLUSIONS:The antitussive,antiasthmatic,phlegm-resolving and anti-inflammatory effects of F. cirrhosa are similar to or worse than those of F. unibracteata.

Ultrasonography-guided wire-localization and nano-carbon staining for detection of sentinel lymph node in breast cancer / 肿瘤研究与临床

Objective@#To evaluate the usage of ultrasound guided wire-localization, nano-carbon staining and the combination of the above two methods in detecting sentinel lymph node (SLN) in breast cancer.@*Methods@#A total of 159 cases of breast cancer from May 2015 to December 2017 in Shanxi Provincial Cancer Hospital were selected, and they were treated with ultrasound guided wire-localization, nano-carbon staining and combination of the two methods separately to detect SLN before the operation. After the operation, SLN and axillary lymph node in each group were marked and made pathological diagnosis.@*Results@#There were 69 cases with pathological diagnosis of SLN metastasis and 90 cases without abnormal representation. With the patient as the unit, the sensitivity of ultrasound guided wire-localization was 100.0% (69/69), the sensitivity of nano-carbon staining was 98.6% (68/69), and the sensitivity of combination of the two methods was 97.1% (67/69). The specificity of ultrasound guided wire-localization was 3.3% (3/90), the specificity of nano-carbon staining was 2.2% (2/90), and the specificity of combination of the two methods was 5.6% (5/90). With the count of SLN as the unit, the combination of the two methods had the highest diagnostic efficiency in detecting SLN, and the difference was statistical significant (χ2 = 34.31, P < 0.001).@*Conclusions@#Ultrasound guided wire-localization and nano-carbon staining are safe and accessible methods for detecting SLN. It provides a precise treatment for early breast cancer, and it can protect medical staff from radiation, which is expected to be the best method for detection of SLN in breast cancer.

Cultivation and incentive mechanism for general practitioners in community health service center / 中华全科医师杂志

The article introduces the practice of cultivating general practitioners (GPs) in Shanghai Weifang Community Health Service Center of Pudong New Area. The center has long emphasized in talent introduction and professional training for them. The cultivation of introduced talents included study in Zhongshan-Weifang general teaching clinic, the "3+ 2" continual education, study in specialty clinics and various assessment approaches, aiming to improve the their clinical competence. At the same time, the incentive mechanism is used, including salary raising, engagement in research projects, and position promotion. To build an excellent community health service team is the foundation for the quality service and comprehensive health system reform in community health service centers.

Contracted family doctor service in Shanghai Weifang Community Health Service Center / 中华全科医师杂志

Weifang Community Hearth Service Center started a pilot program of contracted family doctor service in 2011,and the program included 3 stages:1st stage was the establishment of the health archives of the residents;2nd stage was the service signed with key groups in the community;3rd stage was extension of contracted service to whole community.The working mode of responsible family doctor team was formed,and the health service for contracted residents was managed by the family doctor teams.The individualized service was provided to residents according to their different needs.As a trial,the "Pediatrics Studio" was designed to provide special service for focused group among signed residents.Through a series of measures,the signing rate and the extended prescriptions in Weifang community both ranked the first in Pudong New Area,and the visiting rate by the signed patients increased from 30％ to 41％.The preliminary impact of the contracted family doctor service has appeared in Weifang community.

Construction of an eukaryotic expression plasmid for AY358935 gene / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To construct an eukaryotic expression plasmid for AY358935 gene and explore its function.</p><p><b>METHODS</b>cDNA of the AY358935 gene was amplified by reverse transcription-PCR and cloned into pGEM-Teasy. The pGEM-T-AY was validated by sequencing and served as a template for the construction of eukaryotic expression plasmid. The pcDNA3.1-AY recombinant was validated by double enzyme digestion and used for transient transfection of M14 cells. Expression of the AY358935 protein and proliferation of the M14 cells were determined respectively by Western blotting and 3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-di-phenytetrazoliumromide (MTT) colorimetry.</p><p><b>RESULTS</b>The amplicons of RT-PCR were confirmed to have similar size with the cDNA fragment of the AY358935 gene as well as cloned region of pcDNA3.1-AY. The cloned region of pGEM-T-AY was sequenced to be identical with cDNA sequence of the AY358935 gene. M14 cells were transfected by the AY358935 gene, pcDNA3.1 and liposomes, respectively. After 48 h, expression of the AY358935 protein in M14 cells transfected with the AY358935 gene was significantly higher than other two groups. They also had a significantly higher absorbance value (A=0.74) than other two groups (A=0.39 and 0.46, respectively; P<0.05).</p><p><b>CONCLUSION</b>An eukaryotic expression plasmid of the AY358935 gene was successfully constructed. Product of the AY358935 gene may promote the proliferation of M14 cells.</p>