In a survey on chronic disease management in Xujiahui Community,we found that the general practice team was facing the following problems：①Heavy burden of follow-up work by a relatively smaller number of physicians;②Misunderstanding of health and insufficient recognition of the importance of chronic disease management among community residents;and③Delayed database construction and inefficient performance.In this study,we described the strategies to improve chronic disease management in communities.

Objective To investigate the effects of methylprednisolone pulse therapy on the expression of phosphorylated signal transducer and activator of transcription 1 (STATI) and DNA-binding activity of STATI in T cells in patients with severe systemic lupus erythematosus (SLE). Methods Six patients were included. Patients were given 0.5～1 g of methylprednisolone on 3 consecutive days. Western Blotting was conducted to explore the phosphorylated STATI expression and electrophoretic mobility shift assays (EMSA) were carried out to detect the DNA-biding activity of STATI. Results Methylprednisolone pulse therapy decreased phosphorylated STATI expression of T cells from patients with severe SLE. The expression of phosphorylated STATI decreased to about 30% 72 h after the methylprednisolone pulse therapy started (t=2.858, P<0.05). Methylprednisolone pulse therapy down-regulated DNA-biding activity of STATI of T cells in patients with severe SLE. The STATI DNA-biding activity was inhibited to about 40% 72 h after methy-Iprednisolone pulse, therapy started (t=3.058, P<0.05). Conclusion Phosphorylated STATI expression and DNA-binding activity of T cells is markedly decreased in patients after methylprednisolone pulse therapy, suggesting that inhibition of STATI signaling contributes to the clinical efficacy of this agent.

Objective To investigate the intervention of family doctor management system on the loneliness in people who lost their only child.Methods Sixty two residents who lost their only child in Shanghai Xujiahui district were enrolled in the study from December 2015 to June 2016.The participants were randomly divided into study group and control group with 31 cases in each group;the participants in study group were signed by family doctors and the psychological intervention was provided,those in control group had no intervention,the participants were followed up for 6 months,the psychological status was evaluated with UCLA loneliness scale in two groups.Results There were no significant differences in UCLA scores (63.26 ±7.17 vs.60.03 ±7.59,t =1.709,P ＞0.05) and in the severity of loneliness (mild 0/30 vs.1/31,moderate 9/30 vs.11/31,severe 21/30 vs.19/31,x2 =1.284,P ＞ 0.05) between study and control groups before the intervention.There were significant differences in UCLA scores (63.26 ±7.17 vs.40.13 ± 5.61,t =15.631,P ＜ 0.05) and in the severity of loneliness (mild 0/30 vs.17/30,moderate 9/30 vs.13/30,severe 21/30 vs.0/30,x2 =38.727,P ＜ 0.05) before and after 6 months of intervention in study group;while there were no significant changes in UCLA score (60.03 ± 7.59 vs.59.64 ± 6.90,t =0.650,P ＞ 0.05) and in the severity of loneliness (mild 1/31 vs.0/31,moderate 11/31 vs.14/31,severe 19/31 vs.17/30,x2 =1.471,P ＞ 0.05) in control group after 6-month follow-up.The UCLA scores (40.13 ±5.61 vs.59.64 ±6.90,t =12.086,P＜0.05) and the severity of loneliness (mild 17/30 vs.0/31,moderate 13/30 vs.14/31,severe 0/30 vs.17/31,x2 =34.030,P ＜ 0.05) in study group were significantly lower than those in control group after intervention.Conclusion The family doctor management system can improve the loneliness and mental health status of people who lost the only child,to reduce the risk of mental illness and the family and social burden.

Objective    To characterize surgical outcomes of supra-cardiac total anomalous pulmonary venous connection (TAPVC), investigate risk factors for postoperative death, and explore informed LASSO machine learning methods to solve "small sample size problem" in research of rare congenital heart diseases. Methods    A retrospective analysis of 241 patients with supra-cardiac TAPVC who underwent surgical repair in Guangdong Provincial People's Hospital from 2009 to 2019 was conducted, including 179 males and 62 females with a median surgical age of 71 (33, 232) d. Detailed clinical data of the postoperative death-related factors were extracted. Univariable Cox proportional hazard models were used to initially screen potential risk factors for postoperative death. Factors with P鈮?.05 were retained. To solve the limitation of small sample size and the "P>n" problem, we proposed a novel LASSO method for conducting multivariable Cox regression analysis that was capable of bringing in findings of related studies to improve analysis power and to reduce false-negative findings. Results 聽 聽Univariable Cox analyses showed several potential clinical risk factors, among which highly significant factors (P<0.001) included: surgical weight鈮?.5 kg (HR=16.00), main pulmonary artery diameter (HR=0.78), prolonged cardiopulmonary bypass time (HR=1.21), aortic block time (HR=1.28), and postoperative ventilator-assisted time (HR=1.13/d). LASSO multivariable analysis revealed that independent risk factors for postoperative death included cardiopulmonary bypass time (aHR=1.308/30 min), age (aHR=0.898), postoperative ventilator-assisted time (aHR=1.023/d), weight鈮?.5 kg (aHR=2.545), right vertical venous return (aHR=1.977), preoperative pulmonary venous obstruction (aHR=1.633) and emergency surgery (aHR=1.383). Conclusion 聽 聽Our proposed informed LASSO method can use previous studies' results to improve the power of analysis and effectively solve the "P>n" and small sample size limitation. Cardiopulmonary bypass time, surgical age, postoperative ventilator-assisted time, weight, right vertical venous return, preoperative pulmonary venous obstruction, and emergency surgery are risk factors for postoperative death of supra-cardiac TAPVC.