Objective To obtain fairly exact patient information before the implementation in an all-round way of the basic medical insurance system and find out about the current situation of the hospital, the needs of patients, etc. so as to predict the trends of outpatient sources after the implementation. Methods Using the status-quo whole sampling survey method, an imvestigation and analysis on the outpatient services for one day was made by means of questionnaires, including the sources of outpatients to the hospital, the form of medical security, the specialties involved, the aims of patients visits, and the spectrum of outpatient diseases. Results The investigation covered 3 806cases of outpatients during the whole day and involved 25 specialties. Conclusion Adoption of the new medical insurance system will produce some impact on the outpatient volume of the hospital. Under the new situation, it is imperative to take appropriate strategies and give play to the strong points of the hospital according to the demands of the market.

Objective To study the effect of parenteral nutrition combined with chemotherapy on nutritional status and immunity function of patients with gastrointestinal cancer.Methods 100 gastrointestinal cancer patients were treated as research subjects,and they were randomly divided into the treatment group and the control group.The control group was not given special treatment during chemotherapy,while the observation group patients were given nutritional support according to the gastrointestinal function after admission.The nutrition indicators of ALB,TF,PA, immune function parameters IgA,IgG,IgM,T lymphocyte subsets and T cell immune function indicators(CD +4 ,CD +8 and CD +4 /CD +8 )were counted after the four courses.Results There was no significant difference between the preop-erative and after fourth courses of treatment(t =0.093,P >0.05)between the two groups in nutrition.Within group comparisons,data of Tf and PA levels in the observation group were significant different compared with the control group after fourth courses of treatment (t =3.302,P <0.05).After the first 4 postoperative course,IgM index was statistically significant(t =4.135,P <0.05)different between the two groups,three indicators within the observation group were higher than the preoperative level indicators,the difference was statistically significant(t =3.426,P <0.05).After the first 4 postoperative course,the CD +4 level was significantly higher in the observation group,the difference was statistically significant(t =0.087,P <0.05).Comparison between the two groups after the first four courses,the CD +4 /CD +8 level was higher than that of preoperative patients with a significant difference(t =3.359,P <0.05).Intra -group comparison of the control group,four courses of CD +8 was significantly lower than that of the pre-operative patients(t =3.265,P <0.05).Conclusion Parenteral nutrition combined with chemotherapy can improve the nutritional status of patients with malignant tumors of alimentary tract and improve the body's immune function, give parenteral nutrition support treatment and provide a theoretical basis for the digestive tract malignant tumor during chemotherapy.It is worthy of clinical popularization.

Objective To explore the role of family centered cognitive intervention in neonatal nursing. Methods According to the random number table method,100 newborns were randomly divided into observation group and control group,50 cases in each group. The two groups received routine health education,and the observation group received the family centered cognitive intervention. After the intervention, the neonatal physical development status (body weight,height,head circumference) and neonatal disease status of the two groups were analyzed. The active muscle tension, passive muscle tension, primitive reflexes, behavior ability, general evaluation and neonatal behavioral neurological assessment score ( NBNA score ) were evaluated and analyzed. Results The body weight [(4753.88±434.59)g],length[(55.16±1.17)cm],headcircumference[(37.34±0.51)cm]after1month discharge of the observation group were better than those of the control group[(4295. 78 ± 344. 63) g,(52. 25 ± 0.58)cm,(35.67 ±0.21)cm],the differences between the two groups were statistically significant(t =2.564, 6. 235,8. 679,all P<0. 05). The incidence rate of born disease of the observation group was 14. 00%,which of the control group was 32. 00%,there was statistically significant difference between the two groups(χ2 =4. 574,P <0. 01). The active muscle tension,passive muscle tension,behavior ability,original reflection,the general evaluation and NBNA scores of the observation group were significantly higher than those of the control group, the differences were statistically significant(all P<0. 01). Conclusion Family centered intervention can significantly improve the growth status of newborn infants,reduce the incidence of the disease,it is beneficial to improve the patients' neurological behavior,it is worthy of wide application.

Objective:To investigate the frailty state transition in the community-dwelling elderly undergoing health check-up, and related influencing factors.Methods:From September to October 2016, 3 833 residents aged ≥ 60 years undergoing health check-up in Xidu Community Health Center were enrolled in this prospective cohort study by multistage random sampling. All participants completed a questionnaire survey, health examinations, and frailty assessments as measured with the Fried frailty phenotype. A second assessment of frailty status was conducted from June to July 2020, the frailty state transition was analyzed by comparison between two assessments of frailty states. Logistic regression was used to analyze the influencing factors related to frailty progression.Results:The final cohort consisted of 3 061 participants. At the entering of the study, the median age of participants was 71.0 years, 41.0% were male, 1 563 (51.1%) were prefrail, and 156 (5.1%) were frail. At the follow-up, the frailty status of 1 304 (42.6%) participants was progressed and that of 395 (12.9%) participants was improved from their baseline levels, respectively. Logistic regression showed that age ( OR=1.170,95% CI:1.147-1.194), marital status (married: OR=0.377,95% CI:0.292-0.486), physical exercise (never vs. every day: OR=18.610,95% CI:14.461-23.950; sometimes vs. every day: OR=4.210,95% CI:2.186-8.107), baseline frailty state (robust vs. frail: OR=20.464,95% CI:11.779-35.553;prefrail vs. frail: OR=2.147,95% CI:1.270-3.632), stroke ( OR=2.195,95% CI:1.454-3.313) and diabetes ( OR=1.811,95% CI:1.346-2.437) were identified as independent factors influencing frailty progression (all P<0.05). Conclusions:Frailty state progression is common among older adults, and its related factors include age, unmarried status, physical exercise, baseline frailty state, stroke and diabetes. It is necessary to identify elderly at high risk for frailty progression and implement medical interventions.

Paget's disease of bone (PDB) is a common metabolic bone disease that is characterized by aberrant focal bone remodeling, which is caused by excessive osteoclastic bone resorption followed by disorganized osteoblastic bone formation. Genetic factors are a critical determinant of PDB pathogenesis, and several susceptibility genes and loci have been reported, including SQSTM1, TNFSF11A, TNFRSF11B, VCP, OPTN, CSF1 and DCSTAMP. Herein, we report a case of Chinese familial PDB without mutations in known genes and identify a novel c.163G>C (p.Val55Leu) mutation in FKBP5 (encodes FK506-binding protein 51, FKBP51) associated with PDB using whole-exome sequencing. Mutant FKBP51 enhanced the Akt phosphorylation and kinase activity in cells. A study of osteoclast function using FKBP51V55L KI transgenic mice proved that osteoclast precursors from FKBP51V55L mice were hyperresponsive to RANKL, and osteoclasts derived from FKBP51V55L mice displayed more intensive bone resorbing activity than did FKBP51WT controls. The osteoclast-specific molecules tartrate-resistant acid phosphatase, osteoclast-associated receptor and transcription factor NFATC1 were increased in bone marrow-derived monocyte/macrophage cells (BMMs) from FKBP51V55L mice during osteoclast differentiation. However, c-fos expression showed no significant difference in the wild-type and mutant groups. Akt phosphorylation in FKBP51V55L BMMs was elevated in response to RANKL. In contrast, IκB degradation, ERK phosphorylation and LC3II expression showed no difference in wild-type and mutant BMMs. Micro-CT analysis revealed an intensive trabecular bone resorption pattern in FKBP51V55L mice, and suspicious osteolytic bone lesions were noted in three-dimensional reconstruction of distal femurs from mutant mice. These results demonstrate that the mutant FKBP51V55L promotes osteoclastogenesis and function, which could subsequently participate in PDB development.
Acid Phosphatase ; Animals ; Asian Continental Ancestry Group ; Bone Diseases, Metabolic ; Bone Remodeling ; Bone Resorption ; Femur ; Humans ; Mice ; Mice, Transgenic ; Osteitis Deformans* ; Osteoblasts ; Osteoclasts ; Osteogenesis ; Phosphorylation ; Phosphotransferases ; Tacrolimus Binding Proteins ; Transcription Factors

Objective    To provide recommendations for the management of intensive care unit patients without novel coronavirus disease 2019 (COVID-19). Methods    We set up a focus group urgently and identified five key clinical issues through discussion. Total 23 databases or websites including PubMed, National Guideline Clearing-House, Chinese Center for Disease Control and Prevention and so on were searched from construction of the library until February 28, 2020. After group discussion and collecting information, we used GRADE system to classify the evidence and give recommendations. Then we apply the recommendations to manage pediatric intensive care unit in the department of  critical care medicine in our hospital. Results    We searched 13 321 articles and finally identified 21 liteteratures. We discussed twice, and five recommendations were proposed: (1) Patients should wear medical surgical masks; (2) Family members are not allowed to visit the ward and video visitation are used; (3) It doesn’t need to increase the frequency of environmental disinfection; (4) We should provide proper health education about the disease to non-medical staff (workers, cleaners); (5) Medical staff do not need wear protective clothing. We used these recommendations in intensive care unit management for 35 days and there was no novel coronavirus infection in patients, medical staff or non-medical staff. Conclusion    The use of evidence-based medicine for emergency recommendation is helpful for the scientific and efficient management of wards, and is also suitable for the management of general intensive care units in emergent public health events.