Objective:The paper aims to explore the structure and effectiveness of three health service systems in Anhui province and provide policy recommendations to promote the integration of health care systems. Methods:By using typical sampling method, this paper conducts case study analysis of health service system in Ma’anshan, Feidong and Feixi county of Anhui province. The data mainly come from questionnaires for the institutions, doctors and patients, as well as from interviews with key informants. By integrating quantitative and qualitative data analysis, this paper uses social network analysis method to analyze the system structure and its degree of integration. Results:The degree of integration of health service structure in Ma’anshan is the highest, followed by Feixi, and Feidong is the lowest. The system effectiveness is same as the degree of integration. All three health service systems have advantages and disadvantages regarding to system integration. Conclusion:The effectiveness of health service system integration and its implementation is the product of combined effects of internal and external environment of each health service system. The reforms in Ma’anshan and Feixi health service systems have not only integrated health care structures, but also had a positive impact on the effectiveness of the health service systems.

Objective:To elucidate the effect of hsa-microRNA-218(hsa-mir-218)on exogenous granulysin (GLS) expression in 293T cells.Methods:Total RNA was extracted from THP-1 cells induced by phorbol 12-myristate 13-acetatefor (PMA), and GLS gene was amplified by RT-PCR, and then cloned into pDsRed-Express-C1 to construct the GLS expression vector pDsRed-GLS.Then 293T cells were co-transfected with pDsRed-GLS and pGenesil-mir-218 (pGenesil-mir-control) and laser confocal microscopy was per-formed 36 h later to detect their co-expression .Total RNA and protein were extracted 48 h post transfection , and RT-PCR and Western blot were performed to detect the effect of hsa-mir-218 on exogenous GLS expression .Results:The GLS expression vector pDsRed-GLS was constructed successfully and laser confocal microscopy indicated that it was co -expressed with the interference vector .Compared with that of cells transfected with pGenesil-mir-control, Western blot showed a markedly decrease of GLS protein expression (50%) in the cells transfected with pGenesil-mir-218.However, GLS mRNA expression remained unchanged .Conclusion: hsa-mir-218 nega-tively regulates GLS expression at a post-transcriptional level , and this provides an experimental basis for future study of mechanism of GLS expression regulated by mir-218 .

Objective To explore the correlation between CAE and the ratio of white blood cell count to mean platelet volume ratio(WMR)in elderly patients.Methods A retrospective analysis was conducted on 238 patients who underwent coronary angiography(CAG)between January 2018 and January 2023 in Department of Cardiology of Tianjin First Central Hospital.According to the results of CAG and patient's age,they were divided into in elderly CAE group(age ≥65 years,100 cases)and non-elderly CAE group(age＜65 years,138 cases).Another 127 age-matched elderly individuals with normal coronary artery(age ≥65 years)served as normal con-trol group.The WMR levels were measured in all participants.Results The elderly CAE group had significantly higher WMR than the non-elderly CAE group and the normal control group(745.50±237.46 vs 672.43±194.52 and 610.11±144.22,P=0.000).Spearman correlation analy-sis showed that WMR was positively correlated with platelet count,neutrophil count and high-sensitivity C-reactive protein level(r=0.380,P=0.000;r=0.819,P=0.000;r=0.283,P=0.000).Multiple logistic analysis indicated that readmission,male,TC and WMR were significantly associated with CAE in elderly patients.ROC curve analysis revealed that the value of WMR to distinguish the presence of CAE in elderly patients was 0.604(95％CI:0.531-0.677,P=0.006).Conclusion Elevated WMR might be a cost-effective monitor in elderly CAE patients.

BACKGROUND:Careful regulation of bone immune response during repair of bone scaffold is important for bone regeneration. OBJECTIVE:To review the influence of bone immune response on bone repair and the design of bone tissue engineering scaffold with regulating bone immune function and its application in bone repair. METHODS:Relevant articles published from 1973 to 2023 were retrieved from Science Direct,PubMed,Web of Science,and CNKI databases.English search terms were"osteoimmunology,macrophages,bone repair materials,bone scaffold,bone defects,bone regeneration".Chinese search terms were"bone immunity,macrophages,bone repair material,bone stent,bone defect,bone regeneration".Totally 80 articles of the latest research progress in this field were summarized and analyzed. RESULTS AND CONCLUSION:(1)A detailed review was conducted on the important time points in the origin and development process of bone immunity,and it was explained that macrophages,as important members of the bone immune regulatory system,can be divided into two phenotypes:M1(pro-inflammatory)and M2(anti-inflammatory),and play a key role in different stages of bone regeneration.During the inflammatory phase,M1 type macrophages can activate osteoclasts,initiate tissue repair processes,and participate in the reconstruction of bone microvascular networks.On the other hand,during the bone tissue regeneration process in the later stages of inflammation,sustained high expression of M1 type macrophages can hinder the formation of new bones.During the repair phase,M2 macrophages can secrete osteogenic cytokines,stimulate osteogenic differentiation and mineralization of bone marrow mesenchymal stem cells,and promote bone formation.On the other hand,long-term activation of M2 macrophages can increase the secretion of fibrogenic molecules,leading to excessive formation of scar tissue and delaying the healing process.Therefore,regulating macrophages to undergo phenotype transformation at appropriate stages and constructing an immune microenvironment beneficial for osteogenesis has great significance for bone regeneration.(2)In the process of designing bone scaffolds with bone immune regulation characteristics,the physical and chemical properties such as scaffold roughness,pore structure,stiffness,hydrophilicity,surface charge,and surface functional groups can be changed to affect non-specific protein and cell adhesion,thereby affecting the interaction between bone scaffolds and the immune system.By designing surface functional coatings of bioactive substances such as hydroxyapatite,bioactive glass,metal ions,extracellular matrix,drugs,cytokines,and exosomes,the immune microenvironment can be actively regulated by releasing bioactive substances after implantation into the body,affecting macrophage polarization and crosstalk between macrophages and bone cells,and promoting more M2 polarization of macrophages,so as to build a bone immune microenvironment that is conducive to bone regeneration.(3)Based on the research and development of bone tissue engineering scaffolds,in addition to focusing on the direct regulatory factors of stem cell osteogenic differentiation,this article also proposes that attention should be paid to the management of the immune microenvironment of stem cell differentiation.By regulating the appropriate bone immune microenvironment,more stem cell osteogenic differentiation can be induced;the osteogenic efficiency of the scaffold can be enhanced,and the concept of"bone immune regulatory characteristics"can be condensed;deeply elucidated the multi-directional regulatory role of the bone immune microenvironment and introduced the existing strategies for changing the physicochemical properties and surface functional coating of scaffolds to endow them with bone immune regulatory potential,providing new ideas for guiding the development of a new generation of bone tissue engineering scaffolds with bone immune regulatory characteristics.However,the bone immune microenvironment is a dynamic equilibrium state,and most of the existing regulatory strategies do not consider the dynamic matching of regulation.Therefore,the research and development of intelligent bone immune regulatory scaffolds with efficient and targeted regulation of the immune microenvironment will be a key focus of attention for scholars in future.

Objective:To introduce evidence-based concepts into clinical nursing, and carry out perioperative nutritional risk screening for patients with primary liver cancer treated with Cyberknife, so as to enhance the overall nutritional management awareness and the level of nutritional nursing intervention of the nursing staff, and at the same time provide a basis and support for pushing nursing staff to multidisciplinary cooperation and broadening their professional horizons.Methods:From August 2019 to July 2020, in accordance with the practice model of the Australian Joanna Briggs Institute Evidence-based Health Care Center, we searched the evidence on nutritional risk screening of patients with primary liver cancer treated with Cyberknife in the European Society for Parenteral and Enteral Nutrition website and the Chinese Parenteral and Enteral Nutrition Society website, PubMed, China National Knowledge Infrastructure (CNKI) and Wanfang Data. The evidence was evaluated by the team and applied to nurses and patients in the Liver Oncology Department of the Fifth Medical Center of the People's Liberation Army General Hospital. A total of 21 nurses were selected to conduct a survey with the Nutrition Knowledge Questionnaire of Primary Liver Cancer Patients undergoing Cyberknife Treatment designed by the research team before and after the application of evidence. A total of 41 patients treated with Cyberknife for primary liver cancer admitted from August to December 2019 (without the use of this evidence) were selected as the control group, and 39 patients treated with Cyberknife for primary liver cancer admitted from January to April 2020 (after the application of the evidence) were selected as the observation group. The nutrition-related indicators of the two groups of patients were collected and compared when the patients were admitted to the hospital and when they were discharged after the Cyberknife treatment was completed.Results:After the application of the evidence, 21 nurses' awareness rates of perioperative nutritional risk-related knowledge of patients treated with primary liver cancer Cyberknife, nutritional risk screening implementation rates, patients' nutritional screening knowledge awareness rates and nutritional screening implementation rates were higher than those before the application of the evidence, the differences were statistically significant ( P<0.05) . Conclusions:The evidence-based nursing practice based on the practice model of the Australian Joanna Briggs Institute Evidence-based Health Care Center is used to screen the nutritional risk of perioperative patients with primary liver cancer treated with Cyberknife treatment, which enriches the nurses' knowledge about nutrition risk screening, enhances the initiative of nurses in clinical work, and is also conducive to strengthening multidisciplinary cooperation, and improving the quality of perioperative nutritional nursing management for patients with primary liver cancer treated with Cyberknife.