Objective:To understand the difficulties in the development of community-based integrated general and specialized medical care in Shanghai, and to provide a scientific basis for further proposing strategies to promote the development of integrated general and specialized medical care.Methods:A mixed-methods study was used in this study. In the first stage, a quantitative method was used. From August to December 2023, 30 community health centers (CHCs) were randomly selected from 239 CHCs in the city that provided integrated general specialist care. In each of these CHCs, a questionnaire was administered to a manager and a general practitioner involved in integrated care for specific diseases. The content of the questionnaire included general demographic information and questions related to the integration of general and specialized care, covering six aspects: community-specific disease diagnosis and treatment, examination items, drug configuration, patient sources, support from specialists, and referrals. In the second stage, a qualitative method was used. From January to February 2024, face-to-face semi-structured interviews were conducted with the managers and general practitioners of the CHCs who had completed the questionnaire survey in the previous stage, to further understand the reasons for the difficulties in integrating general and specialist care.Results:(1) Quantitative research: a total of 30 community health center managers and 30 general practitioners participated in the questionnaire survey. The survey found that the top four difficulties were: lack of technology for diagnosis and treatment of special diseases (49, 81.7%), shortage of clinical medical technical examination (36, 60.0%), and insufficient drug configuration (33, 55.0%) and few patients with special diseases in the community (33, 55.0%). (2) Qualitative research: 12 community health center managers and 10 general practitioners participated in the interviews. The interviews explained the difficulties identified in the research from different angles, such as "lack of support from higher-level medical institutions, lack of ancillary examinations and drugs, and a single form of cooperation between and lower-level medical institutions". At the same time, the interviewees mentioned the difficulty of "insufficient staff involved in community-based integrated care", which complemented the research.Conclusions:There are difficulties in many aspects of community-based comprehensive and specialized treatment, such as collaboration between hospitals and community health institutions, specialist and general practitioner resources, patient sources, specialized treatment-related examination items and drugs, which need to be solved in a variety of ways to further promote the development of community-based integration of general practice and specialty care.

This study investigated the effect of small RNA ncBCG201 on the stress adaptation and intracellular survival of Myco-bacterium bovis.Differentially expressed ncRNAs were screened with RNA-seq after BCG infection of THP-1 macrophages.The ncBCG201 overexpression strain was constructed,and its stress survival,growth,biofilm formation,and intracellular survival were assessed.The ncBCG201 strain showed slower growth and earlier entry into stationary phase.Survival significantly increased under car-bon starvation but decreased under membrane pressure.Biofilm formation capability decreased.Intracellular survival in THP-1 macro-phages at 24 h and 48 h was significantly higher than observed in the control.Therefore,ncBCG204 enhances BCG survival within macrophages by modulating stress adaptability.

Objective:To understand the difficulties in the development of community-based integrated general and specialized medical care in Shanghai, and to provide a scientific basis for further proposing strategies to promote the development of integrated general and specialized medical care.Methods:A mixed-methods study was used in this study. In the first stage, a quantitative method was used. From August to December 2023, 30 community health centers (CHCs) were randomly selected from 239 CHCs in the city that provided integrated general specialist care. In each of these CHCs, a questionnaire was administered to a manager and a general practitioner involved in integrated care for specific diseases. The content of the questionnaire included general demographic information and questions related to the integration of general and specialized care, covering six aspects: community-specific disease diagnosis and treatment, examination items, drug configuration, patient sources, support from specialists, and referrals. In the second stage, a qualitative method was used. From January to February 2024, face-to-face semi-structured interviews were conducted with the managers and general practitioners of the CHCs who had completed the questionnaire survey in the previous stage, to further understand the reasons for the difficulties in integrating general and specialist care.Results:(1) Quantitative research: a total of 30 community health center managers and 30 general practitioners participated in the questionnaire survey. The survey found that the top four difficulties were: lack of technology for diagnosis and treatment of special diseases (49, 81.7%), shortage of clinical medical technical examination (36, 60.0%), and insufficient drug configuration (33, 55.0%) and few patients with special diseases in the community (33, 55.0%). (2) Qualitative research: 12 community health center managers and 10 general practitioners participated in the interviews. The interviews explained the difficulties identified in the research from different angles, such as "lack of support from higher-level medical institutions, lack of ancillary examinations and drugs, and a single form of cooperation between and lower-level medical institutions". At the same time, the interviewees mentioned the difficulty of "insufficient staff involved in community-based integrated care", which complemented the research.Conclusions:There are difficulties in many aspects of community-based comprehensive and specialized treatment, such as collaboration between hospitals and community health institutions, specialist and general practitioner resources, patient sources, specialized treatment-related examination items and drugs, which need to be solved in a variety of ways to further promote the development of community-based integration of general practice and specialty care.

This study investigated the effect of small RNA ncBCG201 on the stress adaptation and intracellular survival of Myco-bacterium bovis.Differentially expressed ncRNAs were screened with RNA-seq after BCG infection of THP-1 macrophages.The ncBCG201 overexpression strain was constructed,and its stress survival,growth,biofilm formation,and intracellular survival were assessed.The ncBCG201 strain showed slower growth and earlier entry into stationary phase.Survival significantly increased under car-bon starvation but decreased under membrane pressure.Biofilm formation capability decreased.Intracellular survival in THP-1 macro-phages at 24 h and 48 h was significantly higher than observed in the control.Therefore,ncBCG204 enhances BCG survival within macrophages by modulating stress adaptability.

Mastitis is one of the most widespread infectious diseases that adversely affects the profitability of the dairy industry worldwide. Accurate diagnosis and identification of pathogens early to cull infected animals and minimize the spread of infection in herds is critical for improving treatment effects and dairy farm welfare. The major pathogens causing mastitis and pathogenesis are assessed first. The most recent and advanced strategies for detecting mastitis, including genomics and proteomics approaches, are then evaluated .Finally, the advantages and disadvantages of each technique, potential research directions, and future perspectives are reported. This review provides a theoretical basis to help veterinarians select the most sensitive, specific, and cost-effective approach for detecting bovine mastitis early.

Objective:To survey the quality of medical care and management for chronic obstructive pulmonary disease (COPD) in Shanghai community health service centers.Methods:A questionnaire survey on the institutional capacity for COPD care was conducted among 248 community health service centers in Shanghai from October to November 2023; the contents of self-designed questionnaire included the equipment, drugs, technical support, information exchange and management of COPD in the institutions. At the same time, a questionnaire survey on the knowledge and skill of COPD care was also conducted among half of all physicians selected by stratified sampling from half of the institutions selected by the random cluster sampling, including the knowledge about early screening, diagnosis, treatment and management of COPD, and related training needs .Results:(1)Survey results showed that the most common equipment for diagnosis and treatment of COPD available in community health centers was pulse oxygen saturation detector (97.6%, 242/248), X-ray radiography (96.8%, 240/248) and nebulizer (96.0%, 238/248), The availability of 6-min walking test system, non-invasive ventilator and rehabilitation training instrument in urban community health service centers was higher than that in rural ones ( P<0.05). The availability rates of common COPD drugs in community health service centers were theophylline (91.5%, 227/248), oral glucocorticoid (85.9%, 213/248), intravenous glucocorticoid (81.0%, 201/248), the availability of oral and intravenous glucocorticoids in urban community health service centers was higher than that in rural ones ( P<0.05). The availability rates of COPD diagnosis and treatment techniques were 95.6% (213/248) for pulmonary function test, 93.5% (232/248) for pulse oxygen saturation test, and 53.2% (132/248) for non-invasive respiratory therapy. The availability rate of pulmonary function test, blood gas analysis, non-invasive ventilation and rehabilitation in urban centers was higher than that in rural centers ( P<0.05). Early screening of COPD was conducted in 85.1% (211/248) of community health service centers, the health record system and referral system were established in 66.5% (165/248) and 62.9% (156/248) of centers, respectively; and the establishment of outpatient and referral channels for respiratory diseases in urban areas was higher than that in rural areas ( P<0.05). (2)A total of 1 873 community doctors, aged(38.9±7.8)years and with (15.5±9.1)years of working experience, participated in the COPD knowledge and skill survey. The survey showed that 79.3% participants (1 485/1 873) knew the concept of COPD, 52.6% (986/1 873) mastered the diagnostic criteria, 41.6% (779/1 873) knew the risk factors and 15.5% (291/1 873) mastered the application of glucocorticoids. More than 79% of the community doctors showed the needs for training of knowledge, skills, rehabilitation of COPD and the performance of pulmonary function tests. Conclusion:Availability of COPD diagnosis and treatment equipment in community health center in Shanghai is different, and the availability of basic diagnosis and treatment equipment and drugs is better. The knowledge, skills and management of COPD need to be improved for community doctors, particularly in clinical application of pulmonary function test and active case finding.

Objective:To analyze the trend and hot spots of research on multimorbidity.Methods:The Chinese and English literature in databases of CNKI, Wanfang data and Web of science from inception to July 2022 were retrieved using "multimorbidity" and "multiple chronic conditions" as the search terms. The scientific knowledge mapping software VOSviewer was used to analyze the co-occurrence network of scientific knowledge from the aspects of countries, Chinese and English keywords,burst terms and existing research results; and the status quo and hot trends of studies on multimorbidity at home and abroad were summarized and compared.Results:A total of 251 Chinese publications and 6 351 English publications were included. From the perspective of research trends, the overall trend of domestic and international publications showed a fluctuating upward trend in general, but the pace of development was different. The cooperation network represented by the United States, England, Canada, China, Japan, Australia and other countries was the largest regional cooperation network. Germany, the Netherlands, the United States, Australia and other countries were the first regions to carry out studies on multimorbidity. Studies on multimorbidity in China mainly focused on three topics: diagnosis, treatment and care of multimorbidity, common disease management of multimorbidity, and research methods of multimorbidity. The English literature mainly focused on the clustering of three topics: multi-disease co-diagnosis and care research, multi-disease co-management model research, and multimorbidity related research. The analysis of burst terms indicated the research focus and trend change in different time periods. The results of the outburst word analysis showed that the recent research hotspots of multimorbidity were public health, machine learning, geriatric medicine and so on.Conclusions:The number of studies on the multimorbidity is rapidly increasing both domestically and internationally, and related research in China is still in the early stages of development. In terms of research hotspots, the research of multimorbidity has gradually shifted from phenomenon description to topics such as medical services and research methods of multimorbidity.

We studied the immunogenicity of pseudorabies virus gC DNA vaccination by fusing the murine complement C3d receptor binding domain. First, pseudorabies virus gC gene was linked to four copies of C3d receptor binding domain (M284), and then cloned into the vector pcDNA3.1 to construct the recombinant plasmid sgC-M284. Through the experiment of immunized BALB/c mice, we found that the enzyme linked immunosorbent assay (ELISA) antibody titer for sgC-M284 was 17-fold higher than that for sgC alone, and protective rate of mice was augmented from 25% to 88% after lethal dose PrV (316 LD50) challenge. In addition, the IL-4 levels for sgC-M284 immunization approached that for the pseudorabies virus inactivated vaccine. In conclusion, we demonstrated murine C3d receptor binding domain fusion significantly increased Th2-biased immune response by inducing IL-4 production.
Adjuvants, Immunologic ; physiology ; Animals ; Antibody Formation ; immunology ; Binding Sites ; Cloning, Molecular ; Complement C3d ; genetics ; immunology ; Herpesvirus 1, Suid ; genetics ; immunology ; Interleukin-4 ; immunology ; Mice ; Mice, Inbred BALB C ; Pseudorabies Vaccines ; immunology ; Receptors, Complement 3d ; genetics ; Recombinant Proteins ; biosynthesis ; genetics ; immunology ; Swine ; Vaccines, DNA ; immunology ; Viral Envelope Proteins ; pharmacology ; Viral Fusion Proteins ; immunology

Objective To establish a predictive model and to find the preoperative predictors for the nature of lesion in the setting of chronic pancreatitis. Methods The 121 patients from 7 tertiary medical centers in Shanghai from July 1998 to April 2007 with focal mass lesions in the setting of chronic pancreatitis were selected as the study population. The final diagnosis had to be confirmed histologically by surgical specimens (n =97) or by follow-up (n = 24). A case control study was conducted; the patients were divided into pancreatic cancer group and chronic pancreatitis group. The age, sex, past history, initial clinical presentations, lab results and imaging exams were collected by reviewing the medical records of these patients. χ~2 test and t test was used for univariate analysis, then the factors with P≤0. 25 were selected for further multivariate analysis, and multivariate logistic regression model was used to estimate odds ratio and 95% CI. Results Of 121 , 21 patients had a final diagnosis of pancreatic cancer and other 90 patients had a final diagnosis of chronic pancreatitis. Abdominal tenderness, direct bilirubin, CA19-9 and CEA were independent predictors of cancer in patients with focal mass lesions. Their odds ratios (95% CI) were 5. 691 (1.468, 22.070) , 1.011 (1.001 , 1.021) , 1.003 (1.001, 1.005) , 101.9 (0.988, 1.051) , respectively. Their P values were 0. 012, 0. 030, 0.003 and 0. 23 , respectively. Conclusions The logistic regression model may accurately predict the nature of lesion in the setting of chronic pancreatitis and may have certain clinical implication.

We constructed a recombinant plasmid encoding VP1 gene of O type foot-and-mouth disease virus fused to a molecular adjuvant, goat complement C3d gene. The goat C3d gene was cloned and three copies were tandem-linked with the linker (G4S)2 sequence. VP1 gene of O type foot-and-mouth disease virus was linked to three tandem repeats of C3d through the linker sequence and cloned into pUC19 to obtain the recombinant plasmid pUC19-VP1-C3d3. The VP1-C3d3 fusion gene was then subcloned into the eukaryotic vector pcDNA3.1(+) that had been modified to contain the tissue plasminogen activator (tPA) leader sequence to obtain pcDNA3.1-tPA-VP1-C3d3. HeLa cells were transfected with pcDNA3.1-tPA-VP1-C3d3 by Lipofectamine 2000. Indirect immunofluorescent assay and Western blot assay showed that VP1-C3d3 fusion gene was successfully expressed in HeLa cells. The fusion protein with the expected size 133 kD could be secreted outside the cells. This study laid a good foundation to further research on the novel vaccine against foot-and-mouth disease virus by using goat C3d as a molecular adjuvant to enhance the immunogenicity of VP1.
Animals ; Capsid Proteins ; biosynthesis ; genetics ; Cloning, Molecular ; Complement C3d ; biosynthesis ; genetics ; immunology ; Female ; Foot-and-Mouth Disease Virus ; genetics ; Goats ; HeLa Cells ; Humans ; Immunologic Factors ; biosynthesis ; genetics ; immunology ; Plasmids ; genetics ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; immunology ; Transfection