ObjectiveTo analyze the output and efficiency of chronic disease management services for hypertension and diabetes in community health service institutions in Shanghai, to evaluate the allocation and efficiency of chronic disease management resources, and to provide references for improving the efficiency of chronic disease management in Shanghai’s communities. MethodsA total of 73 community health institutions from 15 districts of Shanghai were selected. Based on the chronic disease management resource data of community health institutions in 2019, 2021, and 2023, descriptive methods and the BCC model in Data Envelopment Analysis (DEA) were used to analyze the resource allocation, service output, and the efficiency of chronic disease management services in community health institutions in Shanghai. ResultsFrom 2019 to 2023, the indicators of resource allocation and service output of community health service institutions in Shanghai all showed upward trends. In terms of service efficiency, the average number of chronic disease patients managed by each health technician decreased from 237 to 231, and the number of patients served per 1 000 working hours decreased from 54 to 44. DEA efficiency analyses showed that the average overall efficiency increased from 0.867 in 2019 to 0.886 in 2021 and then decreased to 0.811 in 2023. The average technical efficiency decreased from 0.901 to 0.847, which was the main reason for the decline in overall efficiency. The average scale efficiency showed an initial increase followed by a decrease, rising from 0.961 in 2019 to 0.977 in 2021 and dropping back to 0.955 in 2023. The number of strong effective districts (overall efficiency=1.000) decreased from 6 in 2019 to 3 in 2023, and the efficiency differences between districts expanded. The range of overall efficiency widened from 0.622‒1.000 to 0.513‒1.000, indicating a decline in overall efficiency and an increase in inter-district heterogeneity. ConclusionFrom 2019 to 2023, the total volume of resource allocation and service output for chronic disease management in community health service institutions in Shanghai increased continuously. However, both the service output efficiency and the overall resource allocation efficiency declined, driven primarily by a decrease in technical efficiency, and accompanied by widening inter‑district disparities.

Gene regulation relies on the precise binding of transcription factors (TFs) at regulatory elements, but simultaneously detecting hundreds of TFs on chromatin is challenging. We developed cFOOT-seq, a cytosine deaminase-based TF footprinting assay, for high-resolution, quantitative genome-wide assessment of TF binding in both open and closed chromatin regions, even with small cell numbers. By utilizing the dsDNA deaminase SsdAtox, cFOOT-seq converts accessible cytosines to uracil while preserving genomic integrity, making it compatible with techniques like ATAC-seq for sensitive and cost-effective detection of TF occupancy at the single-molecule and single-cell level. Our approach enables the delineation of TF footprints, quantification of occupancy, and examination of chromatin influences on TF binding. Notably, cFOOT-seq, combined with FootTrack analysis, enables de novo prediction of TF binding sites and tracking of TF occupancy dynamics. We demonstrate its application in capturing cell type-specific TFs, analyzing TF dynamics during reprogramming, and revealing TF dependencies on chromatin remodelers. Overall, cFOOT-seq represents a robust approach for investigating the genome-wide dynamics of TF occupancy and elucidating the cis-regulatory architecture underlying gene regulation.
Transcription Factors/genetics* ; Humans ; Chromatin/genetics* ; Animals ; Binding Sites ; Mice ; DNA Footprinting/methods*

Objective To modify the YOLOv5 algorithm with similarity attention mechanism(SimAM)to enhance the recognition and segmentation accuracy of CT images for cerebral hemorrhage.Methods A basic framework was established with a YOLOv5 algorithm consisting of a backbone network(Backbone),a neck module(Neck)and a head module(Head),and then SimAM was introduced at the end of Backbone to form a YOLOv5-Sim-B algorithm and at the end of Neck to construct a YOLOv5-Sim-N algorithm.The YOLOv5-Sim-B and YOLOv5-Sim-N algorithms were trained and validated using the CT image dataset for cerebral hemorrhage publicly available on the Kaggle competition platform,and compared with the traditional YOLOv5 algorithm for recognizing and segmenting cerebral hemorrhagic lesions in CT images.Results In case the value of IoU-T was 0.6,the mean average precision(mAP)was 0.967 for YOLOv5-Sim-B algorithm,0.960 for the YOLOv5-Sim-N algorithm and 0.964 for the traditional YOLOv5 algorithm during the recognition and segmentation of cerebral hemorrhagic lesions in CT images.Conclusion The proposed algorithm gains advantages in detection accuracy and robustness,and can efficiently identify and segment cerebral hemorrhage foci in CT images.[Chinese Medical Equipment Journal,2025,46(5):1-8]

Objective To propose an improved YOLOv8 algorithm based on polarized self-attention(PSA)and deformable attention(DAT)so as to enhance the detection of pulmonary nodules in CT images.Methods A basic framework was established with a YOLOv8 model consisting of a backbone network(Backbone),a neck module(Neck)and a head module(Head).PSA was introduced into the end of the spatial pyramid pooling-fast(SPPF)of Backbone to construct a YOLOv8-PSA algorithm,and DAT was involved in the medium-scale feature layer P4 in Head to form a YOLOv8-DAT algorithm.The YOLOv8-PSA and YOLOv8-DAT algorithms were trained and validated using the CT image dataset of pulmonary nodules from public platforms,and compared with the original YOLOv8 algorithm for the detection of pulmonary nodule lesions in CT images.Results When used for pulmonary module detection of CT images,the YOLOv8-DAT algorithm had the mean average precision(mAP)in case of intersection over union threshold of 0.5(mAP50),mAP in case of intersection over union threshold of 0.5 to 0.95(mAP50-95)and precision ratio being 0.918,0.588 and 0.960 respectively,which gained advantages over the YOLOv8-PSA algorithm with mAP50,mAP50-95 and precision ratio being 0.914,0.583 and 0.945 respectively,and over the original YOLOv8 algorithm with mAP50,mAP50-95 and precision ratio being 0.911,0.564 and 0.952 respectively.Conclusion The YOLOv8-DAT algorithm detects pulmonary modules in CT images effectively,and facilitates early screening and diagnosis of pulmonary modules clinically.[Chinese Medical Equipment Journal,2025,46(8):1-10]

OBJECTIVE To evaluate the influence of pharmaceutical quality control on the efficiency and outcomes of standardized medication therapy management （MTM） services for patients with coronary heart disease by using Economic， Clinical and Humanistic Outcomes （ECHO） model. METHODS This study collected case data of coronary heart disease patients who received MTM services during January-March 2023 （pre-quality control implementation group， n＝96） and June-August 2023 （post-quality control implementation group， n＝164）. Using propensity score matching analysis， 80 patients were selected from each group. The study subsequently compared the economic， clinical， and humanistic outcome indicators of pharmaceutical services between the two matched groups. RESULTS There were no statistically significant differences in baseline data between the two groups after matching （P＞0.05）. Compared with pre-quality control implementation group， the daily treatment cost （16.26 yuan vs. 24.40 yuan， P＜0.001）， cost-effectiveness ratio [23.12 yuan/quality-adjusted life year （QALY） vs. 32.32 yuan/QALY， P＜0.001]， and the incidence of general adverse drug reactions （2.50% vs. 10.00%， P＝0.049） of post-quality control implementation group were decreased significantly； the utility value of the EuroQol Five-Dimensional Questionnaire （0.74± 0.06 vs. 0.71±0.07， P＝0.003）， the reduction in the number of medication related problems （1.0 vs. 0.5， P＜0.001）， the medication adherence score （[ 6.32±0.48） points vs. （6.10±0.37） points， P＝0.001]， and the satisfaction score （[ 92.56±1.52） points vs. （91.95±1.56） points， P＝0.013] all showed significant improvements. Neither group experienced serious adverse drug reactions. There was no statistically significant difference in the incidence of new adverse reactions between the two groups （1.25% vs. 3.75%， P＝0.310）. CONCLUSIONS Pharmaceutical quality control can improve the quality of pharmaceutical care， and the ECHO model can quantitatively evaluate the effect of MTM services， making pharmaceutical care better priced and more adaptable to social needs， thus being worthy of promotion.

Senecavirus A (SVA) is a major viral pathogen causing disease in pigs, and effective monitoring of SVA infection is critical for disease control. In this study, we aimed to develop a reliable ELISA method for rapidly detecting neutralizing antibodies against SVA. We used HEK293F cells to express an SVA-specific porcine Fab antibody and verified the biological activity of the Fab antibody by indirect ELISA, immunofluorescence assay, virus neutralization test, and Western blotting. The Fab antibody was biotinylated and used as a competitive antibody to establish a competitive ELISA (C-ELISA) for detecting neutralizing antibodies against SVA. We then evaluated the C-ELISA in terms of sensitivity, specificity, repeatability, and result agreement rate with the VNT. The results showed that we successfully prepared an SVA-specific porcine Fab antibody, which showed high affinity for SVA. We named this antibody 1M33Fab and designated it as Bio-1M33Fab after biotin labeling. The assay conditions were optimized as follows: the coating concentration of SVA particles being 1 μg/mL, the working concentration of Bio-1M33Fab being 0.5 μg/mL, the optimal serum dilution of 1:10, and the optimal dilution of enzyme-labeled avidin being 1:30 000. At a percent inhibition (PI) of 47%, the assay demonstrated the highest sensitivity (96.88%) and specificity (100%), with no cross-reactivity observed with the positive sera of major porcine viral diseases. The intra-assay coefficient of variation ranged from 1.12% to 7.34%, while the inter-assay coefficient of variation ranged from 1.10% to 8.97%, indicating good repeatability. In the detection of 224 clinical pig serum samples, C-ELISA and VNT showed a result agreement rate of 93.75%. In conclusion, we successfully develop a C-ELISA method for detecting neutralizing antibodies against SVA by using a porcine-derived Fab antibody, which lays a foundation for the development of detection kits.
Animals ; Swine ; Antibodies, Neutralizing/immunology* ; Enzyme-Linked Immunosorbent Assay/methods* ; Immunoglobulin Fab Fragments/immunology* ; Antibodies, Viral/immunology* ; Picornaviridae/immunology* ; Humans ; HEK293 Cells ; Swine Diseases/diagnosis* ; Picornaviridae Infections/diagnosis*

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection,with a high mortality rate.Sirtuin 3,a deacetylase within mitochondria,plays an important regulatory role in cellular metabolism,oxidative stress,and inflammatory responses.In recent years,significant progress has been made in the study of the function and regulatory role of sirtuin 3 in sepsis-related diseases.Research has shown that sirtuin 3 can alleviate organ damage caused by sepsis by regulating mitochondrial function,reducing oxidative stress,and inhibiting inflammatory responses.The specific mechanisms include the regulation of mitochondrial bioenergetics,activation of antioxidant enzyme systems,and inhibition of inflammatory mediator expression.In addition,sirtuin 3 plays a protective role in the pathological process of sepsis by interacting with multiple signaling pathways.This article summarizes the functions and regulatory mechanisms of sirtuin 3 in various sepsis-related diseases,aiming to provide new targets and strategies for the prevention and treatment of sepsis in the future.
Sepsis/metabolism* ; Sirtuin 3/physiology* ; Humans ; Animals ; Oxidative Stress ; Mitochondria/metabolism* ; Signal Transduction

Objective:To discuss the protective effect of dexmedetomidine(DEX)on intestinal function in rats with enterogenous sepsis,and to clarify its potential mechanism based on E2F transcription factor 1(E2F1)/nuclear factor kappa B(NF-κB)signaling pathway.Methods:Sixty SD rats were selected,among which 50 rats were used to establish enterogenous sepsis models by cecal ligation and puncture(CLP),and the remaining 10 rats were used as sham operation group(only cecal separation without ligation or puncture).The 40 successfully modeled rats were randomly divided into model group,low dose of DEX group,medium,doses of DEX group,and high dose of DEX group,with 10 rats in each group.The rats in low,medium,and high dose of DEX groups were intraperitoneally injected with 20,40 and 60 μg·kg-1 DEX immediately after modeling,while the rats in sham operation group and model group were intraperitoneally injected with the same volume of saline.After 24 h of administration,the intestinal myoelectric activities of the rats in various groups were detected;the colony counts of Escherichia coli,Lactobacillus and Bifidobacterium in cecal contents of the rats in various groups were detected;the pathomorphology of small intestinal tissue of the rats was observed by HE staining;the levels of secretory immunoglobulin A(sIgA)in supernatant of small intestinal tissue homogenate and the levels of diamine oxidase(DAO)and D-lactic acid in serum of the rats in various groups were detected by kit;real-time fluorescence quantitative PCR(RT-qPCR)method was used to detect the mRNA expression levels of macrophage polarization markers in small intestinal tissues of the rats in various groups;Western blotting method was used to detect the protein expression levels of macrophage polarization markers,E2F1,phosphorylated NF-κB p65(p-NF-κB p65),and NF-κB p65 in small intestinal tissue of the rats in various groups.Results:Compared with sham operation group,the slow wave frequency and amplitude of intestinal smooth muscle of the rats in model group were decreased(P<0.05);compared with model group,the slow wave amplitude of intestinal smooth muscle of the rats in low dose of DEX groups was increased(P<0.05),the slow wave frequency and amplitude of intestinal smooth muscle of the rats in medium and high doses of DEX groups were increased(P<0.05);compared with low dose of DEX group,the slow wave frequency and amplitude of the rats in medium and high doses of DEX groups were increased(P<0.05);compared with medium dose of DEX group,the slow wave frequency and amplitude of intestinal smooth muscle of the rats in high dose of DEX group were increased(P<0.05).Compared with sham operation group,the colony count of Escherichia coli in intestinal tract of the rats in model group was increased(P<0.05),while the colony counts of Bifidobacterium and Lactobacillus were decreased(P<0.05);compared with model group,the colony count of Bifidobacterium in intestinal tract of the rats in low dose of DEX group was decreased(P<0.05),the colony count of Escherichia coli in intestinal tract of the rats in medium,and high doses of DEX groups was decreased(P<0.05),while the colony counts of Bifidobacterium and Lactobacillus were increased(P<0.05);compared with low dose of DEX group,the colony count of Escherichia coli in intestinal tract of the rats in medium and high dose of DEX groups was decreased(P<0.05),while the colony counts of Bifidobacterium and Lactobacillus were increased(P<0.05);compared with medium dose of DEX group,the colony count of Escherichia coli in intestinal tract of the rats in high dose of DEX group was decreased(P<0.05),while the colony counts of Bifidobacterium and Lactobacillus were increased(P<0.05).The HE staining results showed that the small intestinal mucosal structure in sham operation group was normal and intact;the small intestinal mucosal epithelial cells in model group were necrotic,with damaged,collapsed and disordered villi;Compared with model groups,the pathological changes of small intestinal tissues in low,medium,and high doses of DEX groups were improved.Compared with sham operation group,the level of sIgA in supernatant of small intestinal tissue homogenate of the rats in model group was decreased(P<0.05),while the protein expression levels of DAO and D-lactic acid in serum were increased(P<0.05);compared with model group,the level of DAO in serum of the rats in low dose of DEX groups was decreased(P<0.05),the level of sIgA in supernatant of small intestinal tissue homogenate of the rats in medium and high doses of DEX groups was increased(P<0.05),while the protein expression levels of DAO and D-lactic acid in serum were decreased(P<0.05);compared with low dose of DEX group,the level of sIgA in supernatant of small intestinal tissue homogenate of the rats in medium and high doses of DEX groups was increased(P<0.05),while the protein expression levels of DAO and D-lactic acid in serum were decreased(P<0.05);compared with medium dose of DEX group,the level of sIgA in supernatant of small intestinal tissue homogenate of the rats in high dose of DEX group was significantly increased(P<0.05),while the protein expression levels of DAO and D-lactic acid in serum were decreased(P<0.05).The RT-qPCR results and Western blotting results showed that compared with sham operation group,the mRNA and protein expression levels of CD86,monocyte chemoattractant protein-1(MCP-1),and CD80 in small intestinal tissue of the rats in model group were increased(P<0.05),while the mRNA and protein expression levels of CD206,interleukin-4(IL-4)and,CD163 were decreased(P<0.05);compared with model group,the expression levels of CD80 mRNA,CD86 protein and MCP-1 protein in small intestinal tissue of the rats in low dose of DEX group were decreased(P<0.05),and the expression levels of IL-4 mRNA,CD163 mRNA,CD206 protein,and CD163 protein were decreased(P<0.05),the mRNA and protein expression levels of CD86,MCP-1,and CD80 in small intestinal tissue of the rats in medium and high doses of DEX groups were decreased(P<0.05),while the mRNA and protein expression levels of CD206,IL-4 and CD163 were increased(P<0.05);compared with low dose of DEX group,the mRNA and protein expression levels of CD86,MCP-1,and CD80 in small intestinal tissue of the rats in medium and high doses of DEX groups were decreased(P<0.05),while the mRNA and protein expression levels of CD206,IL-4,and CD163 were increased(P<0.05);compared with medium dose of DEX group,the mRNA and protein expression levels of CD86,MCP-1,and CD80 in small intestinal tissue of the rats in high dose of DEX group were decreased(P<0.05),while the mRNA and protein expression levels of CD206,IL-4,and CD163 were increased(P<0.05).The Western blotting results showed that compared with sham operation group,the protein expression level of E2F1 in small intestinal tissue of the rats in model group was decreased(P<0.05),while the ratio of p-NF-κB p65/NF-κB p65 was increased(P<0.05);compared with model group,the protein expression levels of E2F1 and ratio of p-NF-κB p65/NF-κB p65 in small intestinal tissue of the rats in low,medium and high doses of DEX groups were decreased(P<0.05);compared with low dose of DEX group,the protein expression level of E2F1 in small intestinal tissue of the rats in medium and high doses of DEX groups was increased(P<0.05),while the ratio of p-NF-κB p65/NF-κB p65 was decreased(P<0.05);compared with medium dose of DEX group,the protein expression level of E2F1 in small intestinal tissue of the rats in high dose of DEX group was increased(P<0.05),while the ratio of p-NF-κB p65/NF-κB p65 was decreased(P<0.05).Conclusion:DEX can improve the small intestinal mucosal injury in the rats with enterogenous sepsis and promote the polarization of macrophages to M2 type in small intestinal tissues,and its mechanism may be related to the regulation of E2F1/NF-κB signaling pathway by DEX.

Enhanced recovery after surgery (ERAS) is a series of perioperative optimization measures based on evidence-based medicine aimed at achieving rapid recovery. Existing studies have shown that ERAS can effectively reduce surgical stress, decrease the incidence of complications, shorten hospital stays, save medical costs, and improve patient satisfaction. Although lung transplantation techniques have become increasingly mature, lung transplant recipients still have a high incidence of complications during perioperative period. To further improve the perioperative survival rate of lung transplant recipients, introducing ERAS concept into the perioperative management strategy of lung transplantation is of great significance for reducing incidence of perioperative complications, promoting rapid recovery and long-term survival of lung transplant recipients. This article discusses the advances in application of ERAS concept in the perioperative management of lung transplantation, aiming to provide references for optimizing the perioperative management of lung transplant recipients and reducing perioperative complications.

Acute myocardial infarction and acute upper gastrointestinal bleeding are both critical internal medicine conditions. The incidence of acute upper gastrointestinal bleeding in patients with acute myocardial infarction ranges from 5.31% to 8.90%, with a mortality rate as high as 20.50% to 35.70%. The pathogenesis may be related to the use of antiplatelet and anticoagulant drugs, as well as stress-induced injury. In treatment, the contradiction between antiplatelet/anticoagulation therapy and bleeding has made this disease a significant challenge in modern medicine. Therefore, re-exploring the etiology, pathogenesis, treatment principles, and methods of traditional Chinese medicine(TCM) for acute myocardial infarction and acute upper gastrointestinal bleeding is of great clinical importance. The research team has been working year-round in the coronary care unit(CCU), managing a large number of such severe patients. By revisiting classic texts and delving into the foundational theories of TCM and historical medical literature, it has been found that this disease falls under the category of "distant blood" in the Synopsis of the Golden Chamber. In terms of etiology, it is primarily associated with weakness of healthy Qi and damage caused by drug toxicity. In terms of pathogenesis, in the acute stage, it mainly manifests as insufficient spleen Yang, deficiency of spleen Qi, and failure of the spleen to control blood. In the remission stage, it is characterized by deficiency of both heart Qi and spleen blood. For treatment, during the acute stage, Huangtu Decoction is used to warm Yang and restrain blood, while in the remission stage, Guipi Decoction is administered to tonify Qi and nourish blood. During the treatment process, for patients with acute myocardial infarction complicated with acute upper gastrointestinal bleeding, it is crucial to flexibly apply the treatment principles of "Nil per os" in western medicine and "where there is stomach Qi, there is life; where there is no stomach Qi, there is death" in TCM. Early intervention with Huangtu Decoction can also prevent bleeding, with large doses being key to achieving hemostasis. It is important to address the pathogenesis of heat syndrome in addition to the core pathogenesis of Yang deficiency bleeding and to emphasize the follow-up treatment with Guipi Decoction for a successful outcome.
Humans ; Gastrointestinal Hemorrhage/etiology* ; Myocardial Infarction/drug therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Medicine, Chinese Traditional ; Acute Disease