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Based on the analysis of the existing problems and implementation dilemmas in family doctor contracting and first-return-visits faced by primary medical institutions in China, the authors propose countermeasures to provide reference for managers of primary health care institutions.
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By sorting out the differences and connections between family doctor teams and specialized disease teams, role competency and mutual collaboration, and introducing the learning health system (LHS) mechanism, a comprehensive operating system for community general practice learning organizations based on LHS was constructed, focusing on five single disease types. The system includes a combination of general and specialized medicine that links three levels of medical institutions, thereby opening up the business cooperation process between professionals in different institutions, and establishing a sustainable collaboration mechanism. This allows medical institutions at three levels to continuously tap the potential of their disciplines, achieve their own ability growth and feel higher work value, and also bring better health solutions to residents, guided by the common goal of "health centered, patient centered".
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ObjectiveTo explore the influencing factors of different scores on predicting death risk of extremely low birth weight infants (ELBWI). MethodsA total of 186 cases of ELBWI admitted by the Children's Hospital affiliated to Nanjing Medical University and the Lishui Branch of the Affiliated Zhongda Hospital of Southeast University were admitted from January 1, 2019 to January 1, 2021, and 125 ELBWIs were finally included after screening by inclusion and exclusion criteria. There were 47 cases in the death group and 78 cases in the survival group. General data and the items of score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB), clinical risk index for babies Ⅱ (CRIB-Ⅱ) and the national critical illness score (NCIS) were collected. Univariate and multivariate analysis was performed and nomogram was evaluated using receiver operating characteristic curve (ROC). ResultsIt was found that systolic blood pressure, maximum inhaled oxygen concentration, BE value and birth weight were important factors in ELBWI mortality risk assessment [systolic blood pressure OR: 0.968, 95%CI: 0.938-0.999, P=0.043; maximum inhaled oxygen concentration OR: 1.020, 95%CI: 1.006-1.034, P=0.006; BE OR: 0.868, 95%CI: 0.786-0.959, P=0.005; birth weight OR: 0.994, 95%CI: 0.991-0.997, P=0.000]. ROC showed that the area under the curve of the above four variables is 0.71, and the 95% confidence interval is 0.610-0.799, which is better than CRIB score. ConclusionLower systolic blood pressure, higher inhaled oxygen concentration, higher BE and lower birthweight are important influencing factors to predict the death risk of ELBWI. The above four items should be included in the newly developed score assessment to obtain a more effective ELBWI prediction system.
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OBJECTIVE@#To discuss the long-term outcome of convex epiphysiodesis in the treatment for congenital scoliosis (CS).@*METHODS@#The clinical data of 22 patients with hemivertebral deformity undergoing convex epiphysiodesis from the October 1998 to Febuary 2008 were respectively analyzed. There were 12 males and 10 females. The whole spine anteroposterior radiographs were taken preoperatively, at 3-month postoperatively and at the final follow-up to measure the main curve and the compensatory curve. The progression rate was calculated for each patient. Observing the correlation between the progression rate and annual progression of the scoliosis and age, gender, hemivertebral number, hemivertebral position, preoperative main curve Cobb angle and compensatory curve Cobb angle, comparing different ages, genders, hemivertebral number and position, and preoperative main curve Cobb angle on the progression of postoperative curve.@*RESULTS@#The mean Cobb angle of main curve changed from (40.5±9.8) ° before surgery to (39.5±11.1) ° at 3 months after surgery, which significantly increased to (46.8±13.9) ° in the final follow-up. Meanwhile the mean Cobb angle of compensatory curve was changed from (20.1±10.8) ° before surgery to (23.0±11.1) °, which significantly increased to (29.9±11.5) ° in the final follow-up. There were no significant differences in the Cobb angle of the main curve and the compensatory curve between postoperative 3 months and before operation (>0.05). The difference between the final follow-up and the preoperative, postoperative 3 months was statistically significant (<0.01). Twenty patients experienced progression of both main curve and compensatory curve, with a mean progression rate of (19.2±17.9)% for main curve and (39.6±37.0)% for compensatory curve. The annual progression volume was (1.5± 1.4) ° for main curve and (1.4±1.3) ° for compensatory curve. Three patients underwent lateral convex orthopedic internal fixation due to postoperative scoliosis progression. The curve progression was significantly correlated with age at the time of surgery and hemivertebral number. There was a significant correlation between the age of the operation, the main curve angle, the preoperative compensatory curve angle and the annual progression volume of the main curve (<0.05).@*CONCLUSION@#The convex epiphysiodesis technique cannot effectively prevent curve progression of CS patients in the long-term follow-up. It is not recommended to apply this technique to the treatment of patients with congenital hemivertebrae.
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Objective To observe the curative effect and experience of blood purification technology in the treatment of severe mushroom poisoning. Methods A total of 23 patients with severe mushroom poisoning in the Central Hospital of Pulandian District of Dalian were collected. On the basis of general therapy ( emetic, gastric lavage,oral activated charcoal,catharsis,atropine,adrenal cortical hormone,symptomatic and supportive treatment), the patients were given blood purification therapy:hemoperfusion,2 hours each time,1 time every two days;application in series with hemodialysis,hemoperfusion;bedside hemofiltration was performed (8-10) h/ time. Results Of the 23 patients,22 cases had liver injury (95. 7%),7 cases had renal injury (30. 4%),3 cases had central nervous system damage (13%),and 4 cases had other 17. 4%. Hemoperfusion was performed in 22 patients,with an average of (3.6 ±0.4)times per day,and 19 patients with bedside hemofiltration,with an average of (2.9 ±0.5)times per patient. Outcome:21 cases were improved,2 cases died. Conclusion Blood purification treatment should be done as early as possible for mushroom poisoning patients,and it is an effective method for the treatment of severe mushroom poisoning.
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Objective To explore the effect of ras-related C3 botulinum toxin substrate 3 (RAC3) on the proliferation, migration and invasion abilities of early trophoblast cells. Methods Villius samples from 20 unexplained spontaneous abortion (SA) and 20 induced abortion (IA) patients were collected between May 2015 and May 2016 in Changzheng Hospital of Navy Medical University (Second Military Medical University). qPCR was used to detect the expression of RAC3 mRNA in the villus tissues. mRNA Chip detection was performed on the placental tissues of 6.5, 14.5 and 19.5 days in mice. After interfering or overexpressing RAC3 in early human trophoblast cell line HTR-8/SVneo, the proliferation, migration and invasion abilities were detected by CCK-8 and Transwell assay, respectively. Results The expression of RAC3 mRNA was significantly lower in the villus tissue of unexplained SA patients than that in the villus tissue of IA patients (P0.05). Rac3 mRNA expressions were significantly higher in the placental tissues of 6.5 and 14.5 days in mice than that in the placental tissues of 19.5 days (both P0.05). Compared with the control group, the proliferation, migration and invasion abilities of the HTR-8/SVneo cells were significantly reduced by interfering RAC3 expression (all P0.05), and the proliferation, migration and invasion abilities were significantly enhanced by overexpressing RAC3 (all P0.01). Conclusion RAC3 plays an important role in regulating of the proliferation, migration and invasion of early trophoblast cells.
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<p><b>OBJECTIVE</b>To explore the effect of magnetic iron nanoparticles ( Fe₃O₄- MNP) in combination with arsenic trioxide and adriamycin on apoptosis and autophagy of Raji cells, a non-Hodgkin's lymphoma (NHL) cell line.</p><p><b>METHODS</b>The growth inhibition rate of Raji cells was analyzed by MTT assay, the cells apoptosis and intracellular concentration of ADM were determined by flow cytometry (FCM), the expression levels of apoptosis-related proteins such as BCL-2, NFκB, Survivin, BAX, P53, and Caspase-3, and related to autophagy-proteins, such as LC3, Beclin-1, and P62/SQSTM1 were detected by Western blot.</p><p><b>RESULTS</b>The growth inhibition of Raji cells in the group of ADM + As₂O₃were higher than that in the group of ADM or As₂O₃alone, however, lower than that in the group of Fe₃O₄- MNP combined with ADM and As₂O₃(ADM+As₂O₃+ MNP) (P < 0.05). The apoptotic rate and accumulation of intracellular ADM in the group of Fe₃O₄- MNP combined with ADM and As₂O₃were significantly higher than those in control, ADM, As₂O₃, and ADM plus As₂O₃groups (P < 0.05). The upregulation of BAX, P53 and Caspase-3 expression and the down regulation of BCL-2, NFκB, and Survivin expression at protein level were more remarkable in the group of ADM+As₂O₃ + MNP, compared with the other groups (P < 0.05). Moreover, the expressions of LC3 and Beclin-1 proteins in the group of ADM+As₂O₃+ MNP were higher, while the expression of P62/SQSTM1 was lower than that in other groups (P < 0.05).</p><p><b>CONCLUSION</b>The Fe3O4 - MNP combined with ADM and As₂O₃can increase the antitumor efficacy on Raji cells by promoting apoptosis and inducing autophagy. It would be a promising strategy for malignant lymphoma therapy.</p>
Subject(s)
Humans , Apoptosis , Arsenicals , Pharmacology , Autophagy , Cell Line, Tumor , Cell Proliferation , Doxorubicin , Pharmacology , Ferric Compounds , Pharmacology , Inhibitor of Apoptosis Proteins , Metabolism , Nanoparticles , Oncogene Proteins, Fusion , Metabolism , Oxides , PharmacologyABSTRACT
<p><b>OBJECTIVE</b>To investigate the effects of Annexin II (AnxA2) gene silencing by siRNA on proliferation and invasive potential of lymphoma cell line Jurkat cells.</p><p><b>METHODS</b>A synthesized siRNA duplex targeting to AnxA2 was transfected into Jurkat cells. Transfection efficiency was analyzed by real-time PCR and flow cytometry. MTT assay for cell proliferation and transwell plates for invasive potential were performed.</p><p><b>RESULTS</b>Compared with the negative controls, the cell proliferation inhibitory rate of the AnxA2 siRNA transfected Jurkat cells was significantly increased at 24 h, 48 h and 72 h [(17.4 +/- 2.3)%, (22.4 +/- 3.8)%, (37.6 +/- 1.5)% vs (-1.3 +/- 5.1)%, (-5.5 +/- 4.4)%, (-10.8 +/- 5.5)%, respectively, P<0.05]. The cell invasive potential of the transfected Jurkat cells was inhibited remarkably at 48 h (11.3 +/- 4.2 vs 54.3 +/- 8.7, P<0.01).</p><p><b>CONCLUSION</b>AnxA2 gene silenced by siRNA can inhibit the proliferation and the invasive potential of Jurkat cells remarkably.</p>
Subject(s)
Humans , Annexin A2 , Genetics , Metabolism , Cell Proliferation , Chemotaxis , Genetics , Gene Silencing , Jurkat Cells , RNA, Small Interfering , Genetics , TransfectionABSTRACT
The study was purposed to investigate the effect of arsenic trioxide (As(2)O(3))- induced p16 gene demethylation by a sensitive and specific PCR-based method (nested-methylation specific PCR, n-MSP) and DNA sequencing for rapid analysis of the promoter demethylation status, and to explore the possible mechanism of the p16 gene demethylation in human multiple myeloma U266 cells induced by As(2)O(3). The methylation status of the p16 gene in U266 cell line before and after treatment with As(2)O(3) was detected by the nested-methylation specific PCR and DNA sequencing, the mRNA of p16, DNA methyltransferase (DNMT 1, DNMT3A and 3B) gene were determined by RT-PCR, and the induced growth inhibition of U266 cell was assayed by growth curve, MTT and CFU; the DNA content of U266 cells was analyzed by flow cytometry after being exposed to As(2)O(3). The results showed that (1) all cytosines in CpG dinucleotides in untreated U266 cell not were changed, while all cytosines in treated U266 cells with As(2)O(3) had been converted to thymidine. (2) p16 gene was not expressed in U266 cell line after methylation. As compared with the beta-actin, the expression of U266 cell p16 gene mRNA was increased to (0.22 +/- 0.10), (0.59 +/- 0.11), (0.68 +/- 0.09) after exposed to 0.5 micromol/L, 1.0 micromol/L and 2.0 micromol/L As(2)O(3) for 72 hours respectively. (3) As(2)O(3) could significantly down-regulate DNA methyltransferase 1 (DNMT 1), DNMT3A and DNMT3B gene at mRNA level in a dose-dependent manner. (4) U266 cells line grew slowly and arrested at G(0) - G(1) phase after treatment with three different concentrations of As(2)O(3). It is concluded that As(2)O(3) can activate and up-regulate the expression of p16 gene which inhibits the proliferation of U266 cell through inducing the G(0) - G(1) arrest by demethylation or/and by inhibiting DNMT 1, DNMT3A and 3B gene.