With the trend of population aging, the number of patients with comorbidities is increasing, who are the main subjects of general practice service in general hospitals. Tongji Hospital created a new service model and opened a multidisciplinary outpatient clinic based on general practice department (MDT general practic clinic) for patients with comorbidities in December 2021, which has improved the clinical outcomes, and the medical experience and satisfaction of patients. This article elaborates on the organizational structure, team building, and operational process of the MDT general practice clinic for comorbidities; analyzes the characteristics of patients and the implementation effects, to provide a reference for comorbidity patient service in general hospitals.

[Objective]To explore the incremental cost of central line-associated bloodstream infections(CLABSI)after central venous catheterization(CVC)in critically ill patients in the intensive care unit(ICU),as well as the main cost of nosocomial infection prevention and control.By comparing these two costs,the medical personnel to pay more attention should CLABSI prevention and control from the perspectives of medical quality and economic benefits,and promote the implementation of prevention and control measures.[Methods]Cluster sampling was used to select 126 critically ill patients who underwent CVC in the ICU of a tertiary traditional Chinese medicine hospital from January 2021 to December 2023,including 65 cases in the CLABSI group and 61 in the non-CLABSI group.Patients'data were retrospectively collected from the hospital medical records,including the disease type,gender,age,length of hospital stay,outcome,and hospitalization expenses.The costs of different hand hygiene methods and differing approaches to environmental cleaning and disinfection were analyzed and compared.[Results]There were significant differences in the length of hospital stay(Z=-5.35,P<0.05)and total hospitalization expenses(Z=-6.79,P<0.05)between the CLABSI and non-CLABSI group.Total hospitalization expenses showed significant differences among patients with different lengths of hospital stay(H=43.01,P<0.05),with much higher median one in those with 60 or more days of hospital stay than other patients.Greater differences of median total hospitalization expenses were found in males than in females(Z=-3.98,P<0.05),as well as in patients aged 60-80 years than in patients of other ages(Z=-5.79,P<0.05).[Conclusions]The occurrence of CLABSI significantly increases the ICU patients'length of hospital stay and hospitalization expenses.There are differences in the costs of different hand hygiene methods and differing approaches to environmental cleaning and disinfection,but these costs are acceptable compared to the incremental costs directly attributable to CLABSI.Therefore,medical institutions should attach importance to the investment in prevention and control of nosocomial infections such as hand hygiene and environmental cleaning and disinfection,formulate practical,reasonable and feasible plans,and ensure their implementation,in order to avoid nosocomial infections,improve the medical quality,effectively control patients'length of hospital stay and hospitalization costs,and strive to maintain patient safety.

With the trend of population aging, the number of patients with comorbidities is increasing, who are the main subjects of general practice service in general hospitals. Tongji Hospital created a new service model and opened a multidisciplinary outpatient clinic based on general practice department (MDT general practic clinic) for patients with comorbidities in December 2021, which has improved the clinical outcomes, and the medical experience and satisfaction of patients. This article elaborates on the organizational structure, team building, and operational process of the MDT general practice clinic for comorbidities; analyzes the characteristics of patients and the implementation effects, to provide a reference for comorbidity patient service in general hospitals.

Background Previous research indicated that isomers and alternatives of per- and polyfluoroalkyl substances (PFAS) probably disturb glucose metabolism; however, current epidemiological evidence on the associations of PFAS with fasting blood glucose is inconsistent. Besides, studies on the joint association of multiple components of PFAS and fasting blood glucose as well as the key component are scarce. Objective To evaluate the associations of PFAS isomers and alternatives with fasting blood glucose and their joint effects, as well as identify the key component among population without glucose metabolism problems. Methods We selected 923 adults without glucose metabolism problems or missing data from the Isomers of C8 Health Project in China (2015—2016). Serum PFAS isomers and alternatives and fasting blood glucose were measured using ultra-performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS) and automatic biochemical analyzer. We applied multiple linear regression to explore the associations of 16 pollutants which were detected among over 80% participants with fasting blood glucose. Meanwhile, we utilized qgcomp and Bayesian kernel machine regression (BKMR) models to explore the joint effects of PFAS isomers and alternatives mixture on target outcome indicators and identify the key component. Results The average age among the 923 participants in this study was (62.4±13.8) years old, including 472 men (51.1%) and 451 women (48.9%). Among selected PFAS isomers and alternatives, the highest serum concentration was ∑3+4+5m-PFOS (perfluoro-3/4/5-methylheptanesulfonate) with a median concentration of 10.20 ng·mL⁻¹. The concentrations of linear perfluorooctane sulfonate (n-PFOS, 9.61 ng·mL⁻¹), perfluorooctanoic acid (PFOA, 4.55 ng·mL⁻¹), linear perfluorohexane sulfonic acid (n-PFHxS, 2.48 ng·mL⁻¹), 6:2 chlorinated polyfluorinated ethersulfonic acid (6:2 Cl-PFESA, 1.90 ng·mL⁻¹), perfluoro-6-methylheptanesulfonate (iso-PFOS, 1.85 ng·mL⁻¹), perfluorobutanoic acid (PFBA, 1.81 ng·mL⁻¹), perfluorinated n-nonanoic acid (PFNA, 1.39 ng·mL⁻¹), and perfluoro-1-methylheptanesulfonate (1m-PFOS, 1.27 ng·mL⁻¹) were higher than 1.00 ng·mL⁻¹. After being adjusted for selected confounders, PFAS isomers and alternatives were positively associated with fasting blood glucose. With 1 ln unit concentration increment of 6:2 Cl-PFESA and PFNA, the estimated changes of fasting blood glucose were 0.18 (95%CI: 0.13, 0.23) mmol·L⁻¹ and 0.24 (95%CI: 0.18, 0.30) mmol·L⁻¹, respectively. The multi-pollutant models indicated a joint association of PFAS isomers and alternatives mixture with fasting blood glucose. The BKMR models reveals that as the quantiles of mixture elevated from the 50^th to the 75^th percentile, the values of fasting blood glucose increased 0.25 (95%CI: 0.21, 0.30) mmol·L⁻¹, and the posterior inclusion probability of PFNA was 0.92, implying that PFNA was the key component. Conclusion PFAS isomers and alternatives are positively associated with fasting blood glucose. PFNA is the key component of the joint association.

OBJECTIVE：To study the effects of virus in activation treatment of plasma specimen on plasma concentration determination of voriconzole ，linezolid，vancomycin and teicoplanin. METHODS ：The remaining plasma of 36 inpatients in our hospital after routine blood concentration examination of voriconazole ，linezolid，vancomycin and teicoplanin were collected as specimen（9 drug-contained plasma specimens for each drug ），and merged into three different concentration levels （low，medium， high）of mixed samples according the results of routine blood test. Then the mixed samples with different concentration levels were divided into inactivated group and non-inactivated group ，with 3 samples in each group. The inactivated plasma samples were heated at 56 ℃ for 30 min in metal bath with constant temperature. Non-inactivated group were not treated. After pretreating plasma sample of 2 groups，2-dimensional liquid chromatography was used to detect plasma concentration of the four drugs ；the difference of detection result between inactivated group and non-inactivated group were analyzed. RESULTS ：Plasma samples containing voriconazole，linezolid，vancomycin and teicoplanin were still stable after heating at 56 ℃ for 30 min in metal bath with constant temperature. Compared with non-inactivated group ，relative error of plasma concentration detection result of above 4 drugs were all lower than 15％ in low ，medium，high concentration mixed samples of inactivated group. CONCLUSIONS ：Plasma samples can be inactivated by heating at 56 ℃ for 30 min in metal bath with constant temperature ，when the plasma concentration of voriconazole，linezolid，vancomycin and teicoplanin are determined by 2-dimensional liquid chromatography.

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are those over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%; among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus , cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of corona virus disease 2019 released by National Health Commission of China. It is an unavoidable fact that patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that there were not a few patients who go far afield because of various reasons when go to the hospital for treatment. During the period of epidemic prevention and control, this kind of "go far afield" style of seeking medical treatment may increase the exposure risk during transportation. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the "Five Measures" to encourage patients with chronic wounds to seek medical treatment proximately. The principle of this operation is that when seeking medical treatment, trying our best to reduce as much as possible the transportation distance for patients with chronic wounds to minimize the exposure risk during the epidemic period and eventually support the epidemic prevention and control campaign.

Objective The objective is to probe into the effects of astragaloside Ⅳ (AS-Ⅳ) on activity and proliferative function of endothelial progenitor cells (EPCs),which lays a foundation for further study on the effects of AS-Ⅳ on vascular neovascularization mediated by endothelial progenitor cells.Methods The mononuclear cells were isolated by the density gradient centrifugation in umbilical cord blood of full-term healthy infants,and EPCs were obtained by subculture and cell identification when the cells presented spindle shapes.The obtained EPCs were randomly divided into the experimental group and the control group.In the experimental group,EPCs were cultured by AS-Ⅳ with different concentration gradients (25 mg/L,50 mg/L,100 mg/L,200 mg/L and 400 mg/L),while in the control group,they were treated with the same amount of phosphate buffer saline (PBS) solutions.The effects of AS-Ⅳ on the proliferation of endothelial progenitor cells was studied by cell counting kit-8 (CCK-8) cell proliferation experiment,and the activity rate of EPCs cells was measured at the optimum concentration of EPCs proliferation.Results EPCs were successfully obtained after confirming nuclear staining test of CD31 antibody and 4',6-diamidi-no-2-phenylindole (DAPI).Further study showed that AS-Ⅳ can promote the proliferation of EPCs,and its optimal concentration of EPCs proliferation is 100 mg/L.Compared with the normal control group,the activity rate of endothelial progenitor cells after intervention of AS-Ⅳ was 98.7％,higher than 98.12％ in the control group,with significant difference (x2 =49.59,P ＜0.01).Conclusions AS-Ⅳ can enhance the activity of human EPCs and promote their proliferation in vitro.

Objective To research the clinical effect of audiovisual dispersion combined with atropine for preventing blood vessel vagus reflex (VVR) in the patients with procedure for prolapse and hemorrhoids (PPH).Methods One hundred and twenty six patients undergoing PPH in this hospital from January 2015 to January 2017 were numbered according to the order of admission and then divided into 2 groups according to parity number.The two groups were intraoperative given atropine to prevent VVR,the observation group additionally conducted the audiovisual dispersion intervention.The prevention effects were compared between the two groups.Results There was 1 case (1.59％) of VVR in the observation group,which was lower than 7 cases (11.11％) in the control group,and the difference was statistically significant (P＜0.05).The mean arterial pressure (MAP),heart rate (HR) level and anxiety score had no statistically significant difference between the two groups before entering the operating room (T1)(P＞0.05).The levels of MAP and HR at the time PPH was fired in the control group were decreased compared with those at T1 (P＜0.05),the decrease was more obvious compared with the observation group (P＜0.05);the score of anxiety in the observation group was decreased compared with that at T1 (P＜0.05),and was lower than that of control group (P＜ 0.05).The MAP,HR level and anxiety score at 30 min after surgery had no statistical difference between the two groups (P＞0.05).Conclusion Implementing the audiovisual dispersion intervention is beneficial to the intraoperative emotional stability in the patients with PPH and reduces the occurrence of VVR.

Objective To study the regulation of serum FSH and E2 in the treatment of menopausal syndrome with 17 beta estradiol combined with DRSP. Methods A total of 90 female patients with menopausal syndrome treated in our hospital from November 2013 to November 2016 were selected. The patients were randomly divided into three groups: 17β group (30 patients, 17β-estradiol alone), DRSP group (30 patients treated with DRSP alone) and 30 patients (17β-estradiol combined with DRSP). Kupperman's menopausal syndrome was used to evaluate the physical symptoms of the patients and to compare the patients after the treatment. The patients' treatment efficiency was observed. The items examined before treatment included liver and kidney function, hematuria routine , Fasting blood glucose, FSH, E2, LDL, blood TC, electrocardiogram, intracavitary Doppler ultrasound, breast ultrasound, HDL, Kupperman evaluation table in accordance with the evaluation before the end of each treatment measure again, And performs the above-mentioned inspection. Results In the combined group, there was no significant difference in the scores of other symptoms except the differences between the ants on the skin and the treatment before treatment. There were significant differences in the scores of pain, headache, body sensation, agitation, palpitation, Pain, fatigue, insomnia and hot flashes were significantly different (P<0.01). In the DRSP group, pain, depression and insomnia were improved after treatment (P<0.05), other symptoms were (P<0.05), other symptoms were not improved;the total effective rate of combined group was 90.0%, DRSP (P<0.05), and the total effective rate of the group was significantly higher than that of the control group (P<0.05) .There was no significant difference The total effective rate was 73.33% in the group and 70.0% in the 17β group. There was significant difference between the combined group and the other groups (P<0.05). The difference of TC, E2 and FSH in the combined group before and after treatment (P<0.05). There was no difference in FSH between the two groups before and after treatment. There was no difference between the two groups before and after treatment. Conclusion 17β-estradiol combined with DRSP in the treatment of menopausal syndrome patients achieved good clinical effect, the serum levels of FSH and E2 in the body is significant.

ObjectiveTo observe andanalyze the clinical efficacy of needle knife treatment for knee meniscus injury from improving knee biomechanical balance and to provide a therapeutic basis and method for clinical practice.MethodOne hundred patients (112 knees) with knee meniscus injury meeting the inclusion criteria were allocated, in order of visits, to observation and control groups, 50 cases each. They were treated with a needle knife and an injection of sodium hyaluronate injectio into knee joint cavity, respectively. Changes in the indices were observed and assessed in the two groups by recording the plantar pressure analysis score and the knee function score before and after treatment and at follow-up. The clinical therapeutic effects were evaluated in the two groups.ResultThemaximum load, time integral difference value and load ratio around the knee joint decreased significantly in both observation and control groups after treatment and at follow-up (P<0.05). The regulating effect on knee joint force balance was better in theneedle knife group than in the control group (P<0.05). The improving effect on knee joint function was significantly better in the observation group than in the control group (P<0.01). The excellence rate was significantly higher in the observation groupthan in the control group after treatment and at follow-up (P<0.05).ConclusionNeedle knife treatment restores the function of the knee joint by loosing focal soft tissues around the knee joint, improving knee joint load imbalance and correcting the mechanical equilibrium around the knee joint in patient with knee meniscus injury. It has a definite curative effect on the disease.