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".

BACKGROUND:As a dominant breed pig in southwest China,the southern Yunnan small-ear pig has been widely used as an experimental animal in the basic research of other disciplines,but there are still no reports on its application in anterior cruciate ligament reconstruction. OBJECTIVE:To establish a large animal model of the southern Yunnan small-ear pig with anterior cruciate ligament with autologous Achilles tendon was established. METHODS:Twenty adult female Yunnan small-ear pigs were equally randomized into two groups.In the autologous Achilles tendon group,the right knee anterior cruciate ligament was reconstructed with autologous Achilles tendon as a graft,while in the sham-operated group,a similar operation was performed on the right knee without any treatment of the anterior cruciate ligament.General conditions of each pig were observed and recorded before and 12 months after surgery.Ligaments and grafts were taken for gross observation and MAS scoring.Hematoxylin-eosin staining was performed to observe morphological characteristics of ligaments.The staining and arrangement of type I and type Ⅲ collagen were evaluated by immunohistochemistry.Transmission electron microscopy was used to observe the type,size,diameter,ratio,and distribution of collagen fibers in ligaments. RESULTS AND CONCLUSION:All animals had normal diet and activity,good wound healing,no obvious inflammatory reaction,no local purulent infection,and no significant changes in mental and urinary conditions compared with those before surgery.The reconstructed cruciate ligament of the knee was intact,with no stiffness and normal range of motion.Both the anterior drawer and Lachman tests were negative.Gross observation of the graft:12 months after surgery,the grafts was in good position,with good integrity,obvious tension,ligament color close to the original anterior cruciate ligament,and complete surface synovial coverage.Most of the intraarticular ligaments in the autologous Achilles tendon group were defined as MAS I type and a few were defined as MAS Ⅱ type.In the sham-operated group,the intraarticular ligament was defined as MAS I type.Hematoxylin-eosin staining indicated that,12 months after surgery,collagen fibers in the autologous Achilles tendon group began to appear bundled,isotropic,and uniformly arranged,with more obvious isotropic corrugations,and the nuclei were mainly linear or spindle-shaped,which were similar to those in normal anterior cruciate ligament tissue of the sham-operated group.Immunohistochemistry results indicated that,12 months after surgery,there was a higher expression of type I collagen and significantly less expression of type Ⅲ collagen in the reconstructed anterior cruciate ligament in the autologous Achilles tendon group.The degree of type I and type Ⅲ staining was similar in the two groups.Under the transmission electron microscope,the diameter,arrangement and density of collagen fibers in the reconstructed anterior cruciate ligament of the autologous Achilles tendon group were similar to those of the original anterior cruciate ligament at 12 months after surgery,indicating that the ligament remodeling process had been basically completed in the autologous Achilles tendon group at 12 months after surgery.Through a comprehensive evaluation of animal general conditions,ligament general view,MAS score,hematoxylin-eosin staining,immunohistochemistry,and transmission electron microscopy observation,we successfully established a large animal model of anterior cruciate ligament reconstruction using autogenous Achilles tendon in southern Yunnan small-ear pigs,with good morphological,histological and ultrastructural results.

Objective:To investigate the effect of clozapine on endocrine hormone levels in patients with schizophrenia, and to analyze the factors causing metabolic abnormality.Methods:The clinical data of 102 patients with schizophrenia who received treatment at the Wenzhou Seventh People's Hospital from January 2021 to January 2023 were retrospectively analyzed. All patients were treated with clozapine. They were divided into a normal metabolism group ( n = 76) and a metabolic abnormality group ( n = 26) according to whether or not metabolic abnormality occurred after treatment. The glycolipid metabolism levels, thyroid function, and gonadal hormone levels were recorded and compared between the two groups. Logistic regression analysis was then performed to determine the relevant factors influencing the occurrence of concurrent metabolic abnormality in these patients. Results:After treatment, the levels of triglyceride, low-density lipoprotein, glycosylated hemoglobin, triiodothyronine, and prolactin in patients were all significantly increased compared with those measured before treatment, while estradiol level was significantly decreased compared with that measured before treatment ( t = 2.84, 3.36, 25.35, 3.26, 4.88, -5.76, all P < 0.05). Body mass index, disease duration, and the levels of triglyceride, glycosylated hemoglobin, triiodothyronine, and prolactin in the metabolic abnormality group were significantly higher than those in the normal metabolism group, while the levels of low-density lipoprotein, FT 4, and estradiol in the metabolic abnormality group were significantly lower than those in the normal metabolism group ( t = 4.41, 5.67, 3.20, 4.71, 3.49, 3.97, -4.84, -4.51, -4.25, all P < 0.05). The results of the logistic regression analysis indicated that high body mass index ( OR = 7.410, 95% CI = 1.485-36.988), prolonged disease duration ( OR = 1.385, 95% CI = 1.088-1.764), low low-density lipoprotein level ( OR = 0.003, 95% CI = 0.000-0.453), elevated glycosylated hemoglobin level ( OR = 4.222, 95% CI = 1.067-16.706), decreased FT 4 level ( OR = 0.238, 95% CI = 0.086-0.655), and low estradiol level ( OR = 0.845, 95% CI = 0.726-0.984) were the factors associated with metabolic abnormality (all P < 0.05). Conclusion:The use of clozapine in the treatment of schizophrenia will affect the patient's glycolipid metabolism, thyroid function, and gonadal hormone levels. At the same time, it is found that high body mass index, long disease duration, low low-density lipoprotein level, high glycosylated hemoglobin level, low FT 4 level, and low estradiol level will increase the risk of metabolic abnormality in patients. Therefore, targeted interventions should be carried out according to the actual situation.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To explore any changes with age in the center of plantar pressure among normal people after walking.Methods:Fifty healthy subjects were divided into a young group and an elderly group, each of 25. Gait descriptors were collected for each subject using a model AL-600 gait and balance training and evaluation apparatus. The gait descriptors were the center of pressure displacement (COPD), and the COPD in the medial-lateral (COPD-X) and anterior-posterior (COPD-Y) directions before and after 10 and 15 minutes of walking.Results:The average COPD, COPD-X and COPD-Y of the elderly group increased after both 10 and 15 minutes of walking, but among the young group increases were observed only after 15 minutes. The average COPD, COPD-X and COPD-Y of the elderly group were always significantly larger than the young group′s averages.Conclusions:Gait stability among the elderly decreases after as little as 10 minutes of walking, but among the young decreases are observed only after 15 minutes.

Objective:To explore the value of contrast-enhanced ultrasound (CEUS) combined with Ovarian-Adnexal Reporting and Data System (O-RADS US) risk stratification and management system in differential diagnosis of ovarian-adnexal mass.Methods:Fifty-six patients with ovarian-adnexal mass who received transabdominal transvaginal ultrasound and CEUS in the Third People′s Hospital of Longgang District from September 2018 to January 2021 were enrolled. The images were classified by O-RADS US and diagnosed by CEUS by experienced and senior radiologist. On the basis of O-RADS US classification, the enhancement time, enhancement level and enhancement mode of CEUS were combined to upgrade or degrade the classification results of O-RADS US. The diagnostic accuracy was assessed using ROC curve analysis, the area under the ROC curve (AUC) was calculated. The reproducibility of O-RADS US was assessed by another senior radiologist.Results:The AUC of O-RADS US for diagnosing benign and malignant ovarian-adnexal masses was 0.844(0.722, 0.927), the AUC of CEUS was 0.833(0.710, 0.920), the AUC of O-RADS US combined with CEUS was 0.940(0.842, 0.986) (compared with O-RADS US, P=0.020; compared with CEUS, P=0.031). The intra-class correlation coefficient (ICC) was 0.897(0.824, 0.940) for O-RADS US. Conclusions:CEUS combined with O-RADS US classification can effectively improve the diagnostic efficiency for benign and malignant ovarian-adnexal masses.

To explore whether the downregulation of protein phosphatase 2A catalytic subunit(PP2Ac)involved in the pathogenesis of mitochondria fission/fusion dynamics and functional imbalance induced by human tau accumulation. After cotransfection with mito-dsRed plasmids and pIRES-eGFP-tau40 plasmids 48 hours,the rat primary hippocampal neurons were observed with a laser scanning confocal microscope for their changes in shape and distribution of mitochondria.The expressions of mitochondria fission/fusion protein and PP2Ac and PP2Ab were detected by Western blotting.Furthermore,the shape and distribution of mitochondria of rat primary hippocampal neuron and wild type 293wt cells were assayed 48 hours after co-transfection with siPP2Ac-EGFP plasmids and mito-DsRed plasmids,and the fission/fusion dynamics of 293wt cells was captured with live cell time-lapse imaging after co-transfection with siPP2Ac plasmids and mito-Dendra2 plasmids.After transfection with siPP2Ac plasmids,the relative level of mitochondria fission/fusion protein of 293wt cells was assayed by Western blotting,and mitochondria membrane potential was detected by JC-1 staining,and the cellular viability was measured by CCK8 assay.Finally,the shape and distribution and membrane potential of mitochondria of HEK293 cells with stable transfection of htau40(293htau)were detected after co-transfection with PP2Ac and mito-dsRed plasmids. Human tau40 expression decreased distribution of mitochondria and significantly lowered PP2Ac level in primary hippocampal neuron(=4.814, =0.0086).Down-regulation of PP2Ac caused mitochondria elongation and perinuclear accumulation in primary hippocampal neuron and 293wt cells;in addition,down-regulation of PP2Ac in 293wt cells significantly increased mitochondria fusion rate(=2.857, =0.0074)and the levels of mitochondria fusion protein mitofusin(MFN)1(=6.768, =0.0025),MFN2(=3.121, =0.0035),and optic atrophy 1(=3.775, =0.0199);however,the levels of dynamin-like protein-1 and Fis1 remained unchanged.The down-regulation of PP2Ac in 293wt cells led to the significant decrease in mitochondria membrane potential(=2.300, =0.0270)and cell viability(=6.249, <0.0001).Finally,up-regulation of PP2Ac attenuated the abnormalities in the shape,distribution and function of mitochondria in the 293htau cells. Down-regulation of PP2Ac is involved in the abnormal shape and distribution of mitochondria and its dysfunction induced by human tau40 in rat primary hippocampal neurons and HEK293 cells.
Animals ; Catalytic Domain ; Down-Regulation ; HEK293 Cells ; Humans ; Mitochondria ; Protein Phosphatase 2 ; Rats ; tau Proteins

Objective:To explore the factors related to cognitive dysfunction after traumatic brain injury.Methods:A total of 55 patients with traumatic brain injury were analyzed retrospectively. The clinical information about the patients, including age, gender, paralyzed side, course of the disease, type of injury, degree of injury, treatment, speech function (grades of Boston aphasia severity), swallowing function (7-level evaluation method), limb motor function (Brunnstrom stages of the upper limb, hand and lower limb), complications (tracheotomy, lung infection, urinary tract infection, pressure sores, electrolyte imbalance and hypoproteinemia), whether the patient received rehabilitation therapy, and D-dimer and coagulation examination results were recorded. Univariate analysis and ordered multi-class logistic regression analysis were conducted to screen the related factors using Rancho Los Amigos cognitive function grades as the dependent variable.Results:The results of the univariate analysis showed that consciousness, aphasia severity, swallowing ability, Brunnstrom stages, having received a tracheotomy, urinary tract infection, hypoproteinemia, fibrinogen and D-dimer all significantly predicted Rancho Los Amigos cognitive function grades. The logistic regression analysis showed that disordered consciousness, aphasia severity, Brunnstrom stage of the upper limbs, and urinary tract infection were significant predictors.Conclusions:Disordered consciousness, aphasia severity, Brunnstrom stage of the upper limbs, and urinary tract infection are factors related to cognitive dysfunction after traumatic brain injury.

PURPOSE: Studies suggest that regular use of metformin may decrease cancer mortality. We investigated the association between diabetes medication use and cancer survival. MATERIALS AND METHODS: The current study includes 633 breast, 890 colorectal, 824 lung, and 543 gastric cancer cases identified from participants of two population-based cohort studies in Shanghai. Information on diabetes medication use was obtained by linking to electronic medical records. The associations between diabetes medication use (metformin, sulfonylureas, and insulin) and overall and cancer-specific survival were evaluated using time-dependent Cox proportional hazards models. RESULTS: After adjustment for clinical characteristics and treatment factors, use of metformin was associated with better overall survival among colorectal cancer patients (hazards ratio [HR], 0.55; 95% confidence interval [CI], 0.34 to 0.88) and for all four types of cancer combined (HR, 0.75; 95% CI, 0.57 to 0.98). Ever use of insulin was associated with worse survival for all cancer types combined (HR, 1.89; 95% CI, 1.57 to 2.29) and for the four cancer types individually. Similar associations were seen for diabetic patients. Sulfonylureas use was associated with worse overall survival for breast or gastric cancer (HR, 2.87; 95% CI, 1.22 to 6.80 and HR, 2.05; 95% CI, 1.09 to 3.84, respectively) among diabetic patients. Similar association patterns were observed between diabetes medication use and cancer-specific survival. CONCLUSION: Metformin was associated with improved survival among colorectal cancer cases, while insulin use was associated with worse survival among patients of four major cancers. Further investigation on the topic is needed given the potential translational impact of these findings.
Breast ; Cohort Studies ; Colorectal Neoplasms ; Electronic Health Records ; Humans ; Insulin ; Lung ; Metformin ; Mortality ; Proportional Hazards Models ; Stomach Neoplasms

Objective To investigate the effect of adipose-derived stem cells (ADSCs) on pho toaging skin after laser pretreatment with GaAlAs.Methods ADSCs were isolated from healthy wistar rats,ADSCs were isolated and cultured to establish an adipose-derived stem cell culture system.ADSCs were pretreated with GaAlAs laser at a wavelength of 650 nm 4 J/cm2.A rat model of pho toaging aging was established.Different doses of ADSCs and low energy laser ADSCs were pretreated with ADSCs for the treatment of photoaging skin,and the morphological changes of epidermis and dermis were observed before and after treatment with low energy laser pretreatment.Results When the concentration of ADSCs was 103/100 μl,there was no significant difference in epidermal thickness and dermal thickness between ADSCs treated group and GaAlAs pretreatment group (P＞0.05).The thickness of epidermis in the GaAlAs pretreatment group was significantly lower than that in the ADSCs group (P＜0.05) at 104/100 μl.When the concentration of ADSCs was 5 × 104/100 μl,the epidermal thickness of the GaAlAs pretreatment group decreased significantly and the thickness of the dermis increased significantly,which was significantly different from that of the ADSCs group (P ＜ 0.05).Conclusions GaAlAs laser pretreatment can enhance ADSCs anti-skin photoaging ability.