The pilot work urban workers medical network settlement of Anhui province has launched in full scale,effectively facilitating the population seeking medical service elsewhere.In this regard,the medical settlement of a pilot hospital is cited as an example to introduce the networked medical settlement in remote places,summarizing problems encountered,and coming up with proposals accordingly.

Objective To observe the effects of exercise and respiratory training on patients with chronic obstructive pulmonary disease. Methods Fifty-six patients were randomly divided into an observation group (with 30 subjects) and a control group (26 subjects). Both groups received routine medical treatment, while the observation group received movement exercise and respiratory training in addition. Results After 3 months of treatment, there were significant differences between the two groups in terms of the improvement in pulmonary function and quality of life. Conclusion Movement exercise and respiratory training can improve pulmonary function and the quality of life of patients with chronic obstructive pulmonary disease.

Objective To analyze the clicinal feature and therapy of the children with severe pancreatitis.Methods The clinical data of 12 children with severe pancreatitis were collected and analyzed retrospectively.Results All the cases had acute onset,10 cases had abdominal pain and fever,6 cases had abnormal blood glucose,2cases had gastrointestinal bleeding.All these cases had abdominal distention,hypoactive bowel sounds,ascites,intestinal obstruction.All these cases had a higher level of blood and urine amylase than normal,and abnormal liver function.9 cases had elevated WBC,3 cases had descendant blood calcium,edematous and inflammatory thymus were presented in 12 cases,2 of whom were associated with expancreatical damage,such as liver,intestinal,and biliary tract stones.Conclusion The early stage of severe pancreatitis is not obvious in symptoms and signs,and is prone to multiple organ damage or failure to which all pediatric clinicians should have high alert.

Objective Toinvestigatetheeffectofrehabilitationrobothandontheupperlimbmotor functioninpatientswithstrokeandhemiplegia.Methods Theeffectsoftraditionalrehabilitation therapy or robot rehabilitation treatment of 15 stroke patients with hemiplegia were analyzed retrospectively. There were 4 females and 11 males. According to the group order,they were divided into either a robot rehabilitation group (n=8 )or a general rehabilitation group (n =7 ). The patients of the general rehabilitation group received general rehabilitation training at the Department of Rehabilitation Medicine for 4 weeks,3 times a week,and 30 min for each time. At the same time,they also conducted family rehabilitation training,5 times a week,once for 1 h;the patients of the robot rehabilitation group received the general rehabilitation training for the same length of time as the general rehabilitation group,and they also performed robot rehabilitation training,5 times a week,once for 1 h. The patients of both groups were evaluated with the modified Ashworth scale (MAS )scores,Fugl-Meyer motor assessment of the upper extremity(FMA-UE),andWolfmotorfunctiontest(WMFT)beforeandaftertreatment.Results Compared with before training,the MAS score of the robot rehabilitation group was decreased significantly after four weeks of training. The time in WMFT was shortened significantly and the function score was improved obviously. The scores of upper extremity,hand score,and total FMA score in FMA-UE were improved significantly,and there were significant differences (all P <0. 05 ),while there were no significant differences in various indicators in the general rehabilitation group (all P>0. 05). Comparing the effects after four weeks of rehabilitation in both groups,the robot rehabilitation group was superior to the general rehabilitationgroupforthehandscoreinFMA-UE(allP<0.05).Conclusion Therehabilitation robot hand effectively lowered the upper limb spasticity. It has significant effect for recovery motor function of hand;however,it did not have a significant effect for motor rehabilitation on wrist.

Objective To clarify the role of nuclear factor κB(NF-κB) signaling pathway in pathogenesis of Kashin-Beck disease(KBD) by observing the expression of NF-κB p65 in the whole blood samples of patients with KBD and controls,and the expression of NF-κB p65 in C28/I2 chondrocyte, and to analyze the role of NF-κB p65 molecule in chondrocyte apoptosis. Methods Through a case-control study, 161 patients with KBD (KBD group) were selected from Xunyi, Yongshou, Changwu, Linyou, Qianyang and Long counties in KBD endemic areas and 312 healthy people(control group) were matched by age and sex in Shaanxi Province. Venous blood samples were collected from patients and healthy controls, which were anticoagulated and used for determination of NF-κB p65 protein.According to the group design,the model of C28/I2 chondrocyte oxidative damage was established.The experiments were divided into 4 groups including control group(C), tBHP injury group (O, tBHP 300.00 μmol/L), low selenium pre-protection group (OS1, 0.05 mg/L Na2SeO3+ 300.00 μmol/L tBHP), and middle selenium pre-protection group(OS2, 0.10 mg/L Na2SeO3+ 300.00 μmol/L tBHP). Then, cell apoptosis was detected by Hoechst 33342 and reactive oxygen species (ROS) was detected by dichlorfluorescein(DCF) method. The protein was extracted by Trizol method, then protein expression level of NF-κB p65 molecule was detected by Western blotting in whole blood samples and C28/I2 chondrocyte. Results The differences in age and sex were not statistically significant between KBD group and control group (t = 0.336, P > 0.05; χ2= 0.407, P > 0.05). The protein expression level of NF-κB p65 in KBD group was 1.835 times as high as that of control group (KBD:0.167 ± 0.026, control: 0.091 ± 0.014, t = 5.147, P < 0.01). Under the fluorescence microscope, chondrocyte showed strong blue fluorescence in tBHP group and the level of ROS(1.219 ± 0.104) was higher than those of low and middle selenium pre-protection groups(0.832 ± 0.077, 0.635 ± 0.070, P < 0.05).The protein expression level of NF-κB p65 in tBHP group (1.563 ± 0.351) was higher than that of control group (0.451 ± 0.069, P < 0.05), and protein levels of NF-κB p65 had a decreasing tendency in low and middle selenium pre-protection groups compared to tBHP group. Conclusion The NF-κB signaling pathway is up-regulated in KBD patients, moreover, chondrocyte experiments show that cell apoptosis is mediated via upregulation of NF-κB p65,which suggests NF-κB signaling pathway may play an important role in pathogenesis of KBD.

Objective: To explore the clinical features, the serotype distribution and drug resistance of the isolates in patient with invasive pneumococcal disease (IPD). Methods: By retrieving the laboratory information system in 18 children′s hospitals from 2012 to 2017, the children with IPD were enrolled. Streptococcus pneumoniae (Spn) must be isolated from the sterile sites (blood, cerebrospinal fluid, hydrothorax and joint effusion etc.). The clinical characteristics, serotype, drug resistance, treatment and prognosis were reviewed and analyzed. According to the telephone follow up results, the patients were divided into death group and recovered group. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis. Results: There were 1 138 children with IPD, including 684 male and 454 female. The proportion of male to female was 1.5∶1. The age ranged from one day to 16 years. The median age was 1 year 3 month. The majority was under 5 years of age (89.3%, n= 1 016), especially under 2 years of age (61.9%, n=704). In all cases, 88.2% (n=1 004) were community acquired infection. The infections included meningitis (n=446, 39.2%), pneumonia with bacteremia (n=339, 29.8%), and bacteremia without focus (n=232, 20.4%). Underlying diseases were found in 242 cases (21.3%). Co-infections were determined in 62 cases (5.4%) with mycoplasma, 27 cases (2.4%) with adenovirus and 34 cases with influenza virus (3.0%). The penicillin insensitivity (PNSP) rates in meningitis and non-meningitis isolates were 69.5% (276/397) and 35.9% (221/615), respectively. There were 81 strains serotyped, in which 93.8% (76/81) were covered by 13-valent protein-polysaccharide conjugate vaccine (PCV13). In the 965 patients who were followed up by phone call, 156 cases (16.2%) were confirmed dead. The independent risk factors for the death were under 2 years of age (OR=2.143, 95%CI 1.284-3.577, P=0.004), meningitis (OR=3.066, 95%CI 1.852-5.074, P<0.01), underlying disease (OR=4.801, 95%CI 2.953-7.804, P<0.01), septic shock(OR=3.542, 95%CI 1.829-6.859, P<0.01), disseminated intravascular coagulation (DIC) (OR=4.150, 95%CI 1.468-11.733, P=0.007), multiple organ failure (OR=12.693, 95%CI 6.623-24.325, P<0.01) and complications of central nervous system (OR=1.975, 95%CI 1.144-3.410, P=0.015). Conclusions Most children with IPD were under 5 years of age, having underlying diseases and acquired the infection in community. The independent risk factors for death were under two years old, meningitis, underlying diseases and multiple organ failure. The problem of drug resistance was severe. The universal immunization of PCV13 would be effective to prevent IPD in Chinese children.