Healthcare delivery is transforming from hospital-centric episodic care to a more patient-centric comprehensive and continuing care that caters to the changing needs of an ageing population and finite healthcare resources. The transition period during which patients move between healthcare settings is a period of vulnerability that requires well-executed care transitions. The relatively less-developed primary, intermediate and long-term care sector further underlines the importance of good transitional care. This article serves to introduce Family Physicians to the importance of transitional care, its broad concepts and a simple framework to help manage complex patients comprehensively in any Family Medicine practice setting.

Objective To investigate the effect of somatostatin on pancreatic blood flow and pancreatic function on the patients with acute pancreatitis.Methods 120 patients with acute pancreatitis from March 2015 to March 2017 were collected, and were randomly divided into the observation group and the control group.The control group were given routine treatment, at the basis of this, the observation group were given somatostatin.octreotide 0.6 mg was dripped into intravenous continuously, and was reducted to 0.3 mg, continuous treatment for 7 d.The changes of blood flow and the curative effect of pancreas were compared between the two groups before and after treatment.Results The total effective rate was 96.67%(58/60)in the treatment group and 80.00%(48/60)in the control group.The total effective rate in the observation group was significantly higher than that in the control group, the difference was statistically significant (P<0.05).There was no significant difference in blood flow(BF), blood volume(BV)and capillary surface permeability(PS)between the two groups before treatment.1 and 7 days after treatment, BF, BV in the observation group were higher than those in the control group, the levels of PS were significantly lower than that in the control group, the differences were statistically significant(P<0.05).Before treatment, the differences of(CP), insulin(INS), glucagon(GLU), serum lipase(LIP), amylase(AMY)and trypsinogen-2(TPS)were measured in the two groups were not statistically significant.1 and 7 days after treatment, CP and INS in the observation group were significantly higher than those in the control group, and GLU, LIP, AMY and TPS-2 were significantly lower than those in the control group, the differences between the two groups was statistically significant (P<0.05).Conclusion It has a protective effect on pancreatic blood flow and function which somatostatin was used in the treatment of the patients with acute pancreatitis, it can improve the overall state of pancreas, and has significant therapeutic effect.

BACKGROUND:Ankylosing spondylitis is an autoimmune disease involved in chronic systemic inflammation. Tumor necrosis factor and interleukin-6 levels increased in patients with ankylosing spondylitis. Inflammatory factors such as tumor necrosis factor and interleukin-6 can suppress CD36 expression in monocytes. OBJECTIVE: To analyze the correlation between CD36 expression in monocytes and ankylosing spondylitis. METHODS:A total of 84 newly diagnosed ankylosing spondylitis patients and 111 healthy individuals were included in this study. CD36 expressions in monocytes in ankylosing spondylitis patients and healthy individuals were tested using flow cytometer; meanwhile, biochemistry, immunology, routine blood examination and related inflammatory markers were determined between the two groups. RESULTS AND CONCLUSION:Results of baseline data in both groups demonstrated that CD36 fluorescence intensity in monocytes was significantly lower in patients with ankylosing spondylitis compared with healthy controls (P < 0.01). CD36 fluorescence intensity in monocytes was negatively correlated with C-reactive protein, erythrocyte sedimentation, interleukin-6 and tumor necrosis factor. In addition, CD36 fluorescence intensity in monocytes was negatively correlated with BASDAI score. Logistic regression analysis showed that erythrocyte sedimentation, interleukin-6, tumor necrosis factor and CD36 fluorescence intensity in monocytes were associated with ankylosing spondylitis, and risk factors for ankylosing spondylitis (P < 0.05). These findings confirm that inflammatory cytokine in patients with ankylosing spondylitis weakened the expression of CD36 in monocytes. There was a remarkable association between low expression of CD36 expression in monocytes and ankylosing spondylitis. CD36 expression of monocytes clinicaly may be considered to be an effective indicator to evaluate inflammation and disease activity in patients with ankylosing spondylitis.

Objective To investigate the state of thyroid hormones and thyrotropin level in different gestation periods. Methods FT3, FT4, TSH and hCG were measured in 623 patients by ACS-180 automatic chemiluninescence analyzer. The urinary iodine was random measured by the use of iodine catalytic reaction mechanism of Arsenic-Cerium, rapid urinary iodine was detected with cold digestion method of quantitative detection. Result Serum FT3,FT4 ,and hCG levels in the first and second trimester were higher than in the third trimester ( F =53. 19,78.00,58.77, P ＜0. 05) ,and TSH levels were lower than in the third trimester ( F =5.68, P ＜0.05). The incidence of thyrotropin level disorder was 7. 54%, there were no significant differences in the gestation periods ( χ2 = 3.92, P ＞ 0. 05 ). The incidence of subclinical hypothyroidism,subclinical hyperthyroidism, hypothyroidism and hyperthyroidism were 3.53%, 2. 57%, 1.12% and 0. 32%, respectively. The incidence of subclinical hypothyroidism in the first and third trimester was high, while the incidence of subclinical hyperthyroidism in the second trimester was high. Conclusions Thyrotropin level in the third trimester was lower than that of the first and second trimester. HCG changes were not the main reason that caused the thyrotropin level disorder during the pregnancy.

Acute myocardial infarction (AMI) is caused by acute occlusion of the coronary artery. The partial necrosis of the myocardium is caused by severe and prolonged ischemia,which is characterized by persistent and severe chest pain, the high mortality rate. Fast recovery can be achieved the coronary artery blood circulation by emergency percutaneous coronary intervention (PCI), can improve myocardial is-chemia, save moribund myocardium. The medical profession is generally believed that on the basis of en-suring the safety of patients with AMI, the normal rehabilitation should be carried out as soon as possible. In this article, the domestic in recent years, AMI emergency PCI in early postoperative rehabilitation treatment method, the intensity and evaluation index of three aspects were summarized. The starting time of the early rehabilitation of AMI patients in foreign countries is earlier than our country. As we all know that via radial artery PCI has the smaller puncture and more convenient hemostasis, so there is no doubt that it can pro-vide favorable conditions for recovery of patients. Therefore, it is necessary to expand the research field in order to determine the best rehabilitation opportunity and the most excellent rehabilitation program , so as so determine the best recovery time and the most excellent rehabilitation program in patients with AMI after PCI operation.

Objectives To explore the clinical effect of coupling meglumine cyclic adenylate (MCA)and the human granulocyte colony-ostimulating factor (G-CSF)on rat with diastolic heart failure(DHF).Methods Totally 60 rats of DHF model were evenly divided into 4 groups according to random number:Control group(n=15,control),Model group(n=15,DHF model),MCA group(n =15,treated with MCA)and MCA+GCSF group(n=15,treated with MCA plus G-CSF).MCA group were administered by intragastric injection of MCA 30 mg/kg/d for 15 d,MCA+G-CSF group were administered by intragastric injection of MCA 30 mg/kg/d and plus G-CSF 100 μg/kg/d for 15 d,while Control group and Model group were given same volume of saline solution.BIOPAC SYSTEM was used to analyze the model establishment.The mRNA levels of GATA-4 and Cx43 were measured by RT-PCR.The protein expressions of GATA-4,Cx43,cTNI and c-kit were measured with western blotting.ELISA and flow cytometry were used to detect cAMP and differentiation rate of bone marrow mesenchymal stem cells (BMSCs),respectively.Results Compared with MCA group,the denaturation degree of myocardial tissues in DHF rat was significantly improved than in MCA+G-CSF group.Moreover,the level of GATA-4 (1.62 ± 0.09),Cx43 (1.02 ± 0.07),cTNI (1.42 ± 0.12),c-kit (0.65±0.02),cAMP(283.67± 18.09)nmol/L and BMSCs cell differentiation rate(38.62 ± 1.52)％ in MCA + GCSF group were significantly promoted (all P＜ 0.05)than in MCA group,GATA-4 (0.82±0.07),Cx43 (0.52±0.05),cTNI(0.86 ± 0.13),c-kit (0.48 ± 0.03),cAMP(198.83 ± 16.03) nmol/L and BMSCs cell differentiation rate (19.82 ± 0.89)％.Conclusions The combination of MCA with G-CSF is significantly improved DHF than single MAC treatment,which may regulate BMSCs differentiation though cAMP/PKA signaling pathways.

OBJECTIVETo compare the difference in the clinical efficacy on mild and moderate female stress urinary incontinence (FSUI) between transcutaneous acupoint electrical stimulation and oral administration of midodrine hydrochloride tablets.

METHODSNinety cases of mild and moderate FSUI were randomized into an observation group and a control group, 45 cases in each one. In the observation group, the transcutaneous acupoint electrical stimulation was applied to Ciliao (BL 32), Shenshu (BL 23), Zigong (EX-CA 1), Guanyuan (CV 4) and Qihai (CV 6), once a day. In the control group, midodrine hydrochloride tablets were prescribed for oral administration, 2. 5 mg per treatment, three times each day. The duration of treatment was 4 weeks. The score of international consultation on incontinence questionnaire-urinary incontinence short form (ICI-Q-SF) and leakage of urine in 1 h urinal pad test were observed before and after treatment in the patients of the two groups, and the efficacy was compared between the two groups.

RESULTSThe score of ICI-Q-SF and leakage of urine in urinal pad test after treatment were all improved apparently as compared with those before treatment in the two groups (all P<0. 01), and the results in the observation group were better than those in the control group (both P<0. 01). The total effective rate was 86. 7% (39/45) in the observation group, which was better than 68. 9% (31/45, P<0. 05) in the control group.

CONCLUSIONThe transcutaneous acupoint electrical stimulation achieves the better efficacy on FSUI as compared with the oral administration of midodrine hydrochloride tablets. This therapy effectively improves the patient's urine control ability and reduces leakage of urine.

Acupuncture Points ; Adult ; Female ; Humans ; Middle Aged ; Transcutaneous Electric Nerve Stimulation ; Treatment Outcome ; Urinary Incontinence, Stress ; physiopathology ; therapy

Objective To understand the environmental lead pollution level caused by a lead smeltery.Methods From the surrounding of the investigated factory,the farmland soil,sediment,water,ambient air,courtyard dust,waste and 7 kinds of crops were collected to determine the lead level.Results Respectively,the lead concentration was 3.1 mg/L in the agriculture irrigation water,exceeded the allowed limit by 30 times,was 0.07 mg/L in the pond water,exceeded the allowed limit by 0.4 time,was 1 101.5 mg/kg in the sediment of the pond,exceeded the allowed limit by 0.10 time,was 7 400.0 mg/kg in the river sediment,exceeded the allowed limit by 6.40 times,was 47.0-287.9 mg/kg in the farmland soil and within the 400 m bound around the lead smeltery,the average level in the soil was 195.0 mg/kg.Conclusion The lead smeltery has caused the lead environment pollution in degrees,it is the main source of lead pollution that caused high blood lead in some people living in that area.

Objective To investigate the protective effect of osthole on focal cerebral ischemia-reperfusion injury in rats.Methods Focal cerebral ischemia-reperfusion model in rat was made by transient occlusion of the middle cerebral artery for 2 h and followed by reperfusion for 24 h.Osthole 5 and 10 mg/kg were iv injected through sublingual vein at 1 h after the onset of ischemia,respectively.After 24 h of reperfusion,the influence of osthole on neurological behaviour deficit score,brain edema,and infarct size were evaluated.The activity of Na+,K+-ATPase,Ca2+-ATPase,and myeloperoxidase(MPO)in the ischemic hemisphere cortex of the middle cerebral artery area was assayed by spectrophotometry.The level of IL-8 was detected with radioimmunoassay.Results Osthole significantly reduced the neurological behaviour deficit score,brain edema,and infarct size,enhanced the activity of Na+,K+-ATPase and Ca2+-ATPase,inhibited the activity of MPO,and decreased the level of IL-8 in the brain tissue.ConclusionThe results suggest that osthole could attenuate the brain damage following focal cerebral ischemia-reperfusion in rats and its mechanism may be partly related to the inhibition of inflammation and brain edema induced by ischemia-reperfusion.

AIM To study the inhibitory effect and mechanism of n itrary flavone in Hep and U 14 tumor. METHODS The Hep or U 14 tumor cells were injected in the armpit subcutaneous layer of right foreleg of BALB/c strain mice. After 24 h,nitrary flavone at a does of 100 mg?kg -1 ?d -1 body weight or combine nitrary flavone with 5-Fu(100 mg?kg -1 ?d -1 body weight)was given (ip) and inhibitory rate of nitrary flavone for transplanted tumor and the immune function of mice were determined. RESULTS Administration of nitrary flavone to mice for 10 consecutive days exhibited significantly the inhibitory rate for Hep and U 14 by 34 11%,32 14% and 50 73%,47 22%,respectively, as well as the weight of immune organs of mice, formation value of serolysin and phagociytic index were significantly enhanced(P