Objective:To investigate the status quo of pain management for cancer patients in hospice care wards of community health service centers.Methods:The electronic medical records of 373 cancer patients admitted in hospice wards of Kangjian Community Health Center of Xuhui District and Jinshanwei Town Community Health Center of Jinshan District from January 2015 to July 2021 were collected. The characteristics of cancer pain, the use of analgesic drugs, the effects of analgesic drugs and its influencing factors were analyzed.Results:The incidence of cancer pain in 373 patients was 93.0% (347/373), and the proportion of moderate to severe cancer pain was 55.6% (193/347). Analgesics were used in 304 patients, among whom 233 (76.6%) patients used oral analgesics, 297 (97.7%) used on time, 97.6%(285/292) used sustained-release opioids, and 94 (30.9%) used combinedly. Breakout pain occurred in 100 cases (32.9%), all of which was controlled with immediate-release morphine. Cancer pain was not relieved in 132 cases (43.42%), and multivariate logistic regression analysis showed that the pain degree on admission (moderate: OR=3.69, 95 %CI:2.09-6.49; severe: OR=5.52, 95 %CI:2.43-12.53), the presence of burst pain ( OR=3.28, 95 %CI:1.77-6.06), the type of analgesics used (non-steroidal+weak opioids: OR=0.39, 95 %CI:0.20-0.76; nonsteroidal+strong opioids: OR=0.20, 95 %CI:0.08-0.51) and the adverse reactions ( OR=1.92, 95 %CI:1.03-3.60) were the influencing factors of pain relief in cancer pain patients (all P<0.05). Conclusion:The pain of cancer patients admitted to community palliative care wards cannot be ignored. Although most cancer pain patients use analgesic drugs in a standard way, there are still a high proportion of patients whose pain is not controlled. Various factors affect the effect of analgesic treatment.

Objective By using mouse orthotopic lung transplant model, we investigated the immune mechanisms of an-ti-CD3 induced lung allograft protection .Our study intends to further dissect the features of lung transplant immunology and to provide a novel therapeutic insight for the clinical application of anti-CD3 mAbs after lung transplantation.Methods Murine orthotopic allogeneic lung transplants were performed in C57BL/6 wild type(WT) mice using major histocompatibility complex (MHC) fully mismatched BALB/c donors.Syngeneic transplants were also performed in WT C57BL/6 mice using C57BL/6 donors.For immunosuppressive therapy, allograft recipients received 50g dose of anti-CD3 by intraperitoneal injection on days 2, 3, 4, 5, 6 and 9 post-operation(n=4).At day 10, histopathologic characteristics and rejection status of the pulmonary grafts were assessed.The severity of acute rejection was graded by the pathological score , and T cell and neutrophil infiltration in the pulmonary grafts was evaluated by immunohistochemical(IHC) staining for CD3 and myeloperoxidase(MPO) respective-ly.Real-time RT-PCR was performed for FoxP3, IL-17A and IFN-γexpression in the pulmonary grafts.The percentage of FoxP3+Treg in total CD4+T lymphocytes from the recipient spleens was analyzed by FACS.Results 10 days after transplan-tation, histopathologic examination demonstrated that there is no apparent acute rejection observed in the pulmonary isografts , whereas allografts from untreated recipients have marked inflammatory cell infiltration and pulmonary parenchyma lesion .IHC staining for CD3 and MPO showed that the allograft-infiltrating cells of perivascular layers are mainly T lymphocytes , and the cells around the small airways are mostly neutrophils .Anti-CD3 treatment significantly alleviated the acute rejection of pulmo-nary allografts, when compared with the untreated group.Real-time RT-PCR showed that the expression levels of IL-17A and IFN-γin allografts were markedly elevated compared to those in isografts, and anti-CD3 increased the expression of FoxP3, and reduced the expression of IL-17A and IFN-γin the pulmonary allografts.FACS analysis of splenocytes showed that the percent-age of Treg in total CD4+T lymphocytes increased significantly in the anti-CD3 treated allograft recipients, as compared with the isograft and untreated allograft recipients.Conclusion Anti-CD3 mAbs may alleviate acute rejection of the pulmonary al-lografts by promoting FoxP3 expression and Treg development.

One hundred and fifty diabetic patients,who received management by community family doctors and hospital consortium (1+1+1) team for at least 1 year,were enrolled from January 2017 to May 2017.After that they continued to receive the management for 1 more year by the team which were trained with TeamSTEPPS (team strategies and tools to enhance performance and patient safety).The management effect before and after TeamSTEPPS training was compared.After the TeamSTEPPS training,the team management ability was improved,so that the compliance of diabetic patients with medical advice,regular examination of blood glucose,regular follow-up assessment,health education,regular exercise and diet control were all better than before,and the differences were statistically significant (all P＜0.01).Fasting blood glucose,postprandial 2 h-blood glucose,glycosylated hemoglobin and LDL-C levels were all lower than before,and the achieved rate of the above indicators were also increased (P＜0.05).It is suggested that application of TeamSTEPPS in team training can effectively enhance the management ability for chronic disease of family doctors and improve compliance and clinical indicators of patients with diabetes under management.

Objective To evaluate the application of TeamSTEPPS in training of community osteoporosis management team .Methods The TeamSTEPPS was applied for training of osteoporosis management team, and 1 513 residents aged ≥45 year were screened for osteoporosis in Kangjian community from January 2014 to March 2017.The identified patients with osteopenia and osteoporosis were intervened for one year.Cognitive level of the risk factors and symptoms associated with osteoporosis were assessed by questionnaires before and after the intervention .The bone density was examined at baseline and 6 months, 12 months after intervention.The effect of intervention was evaluated .Results A total of 467 patients (30.87%) with osteopenia and 476 patients (31.46%) with osteoporosis were detected .The cognitive levels of osteoporosis risk factors , including low calcium, vitamin D deficiency, lack of exercise, low weight, women menopause, matrilineal family history, smoking, excessive alcohol drinking and coffee drinking, were higher than those before intervention ( χ2＝62.909,78.742,59.974,50.478,29.512, 34.699,6.500,15.779,6.089,all P＜0.05).The awareness rates of symptoms , including lower back pain or body bone pain, shorter height and hunchback , low energy or nonviolent fracture , were also increased (χ2＝59.942,76.220,16.856,all P＜0.01).After intervention, the bone mineral density levels were increased compared to those before intervention (F＝530.28, P＜0.01 for osteopenia group; F＝339.51, P＜0.01 for osteoporosis group ); meanwhile, the differences were also significant between 6 months, 12 months after intervention and before intervention , between 12 months and 6 months after intervention (t＝-0.452,-0.968,-0.516,all P＜0.01 for osteopenia group; t＝-0.530,-1.045,-0.518, all P＜0.01 for osteoporosis group ).Conclusion The community osteoporosis management team trained by TeamSTEPPS can effectively improve the management levels of osteoporosis among residents in the community.

Objective: To examine the prevalence of depression and anxiety symptoms, and the related factors in family members of schizophrenic patients in a Shanghai community. Methods: From March to May 2017, the family members of 206 schizophrenic patients registered in Xuhui district Kangjian community of Shanghai were enrolled in this cross-sectional survey. The participants were evaluated with Patient Health Questionnaire Self-rating Depression Scale (PHQ-9) and the Anxiety Screening Scale (GAD-7). The factors related to depression and anxiety symptoms were analyzed. Results: The detection rates of depressive symptoms and anxiety symptoms in the family members of schizophrenia patients were 40.3%(83/206) and 37.9%(78/206), respectively.Univariate analysis showed that the relationship with the patient, education levels were the influencing factors of depressive symptoms (χ²=17.045, 9.702; P<0.01); while age, relationship with the patient, education levels were factors related to the occurence of anxiety symptoms (χ²=11.862, 22.042, 15.060; P<0.01). Multivariate regression analysis showed that the parents of patient was more prone to depressive symptoms than spouses (OR=2.861, P<0.01); higher education was more prone to be depressive than primary education (OR=10.071, P<0.01). Age group 18-40 years were more prone to anxiety than the age group ≥66 years (OR=0.060, P<0.05); sibling relationship is more prone to anxiety than spouse relationship (OR=10.018, P<0.01), followed by parental relationship (OR=7.467, P<0.01); higher education was more prone to anxiety than primary education (OR=5.119, P<0.05). Conclusions There is high prevalence of depression and anxiety symptoms in family members of schizophrenic patients, which is related to the relationship with the patient, the education level of family members and other factors.

Some managers and medical personnel in the institutions of maternal and child health were lack of ethical awareness.Their awareness about the protection of rights and interests of the subjects,informed consent,and research medical safety were not enough.There arised some ethical problems in reproductive medicine,prenatal diagnosis,new technology and new project review,and scientific research project application.Based on cause analysis,this paper put forward the corresponding countermeasures.Researchers should recognize the importance of medical research management and ethics review.It should strengthen the training of research ethics for hospital managers and researchers,meanwhile,strengthen the construction of ethics committee,strengthen the tracking and governance,and make good use of education and assessment measures,in order to promote the healthy development of maternal and child health medical research.

TeamSTEPPS(Team Strategies & Tools to Enhance Performance & Patient Safety)is an evidence-based set of teamwork tools,aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.It integrates teamwork skills with clinical practice to improve team performance in healthcare services and improve the quality of care effectively.The article introduces the TeamSTEPPS course and its clinical application.

TeamSTEPPS (team strategies and tools to enhance performance and patient safety) defines four core capabilities in teamwork which can be trained: leadership,situation monitoring,mutual support and communication.TeamSTEPPS is a successful medical team training project and its effectiveness has been proved.The application of TeamSTEPPS can provide a new teaching model for general practice training.

Objectives To generate an orthotopic left lung transplantation model in mice, and to observe the early changes of respiratory system resistance andγδT lymphocytes infiltrated in grafts? Methods The research time was from March 2014 to May 2015? The male C57BL/6 mice ( n=35) and BALB/c mice (syngenic group,n=10) were randomly divided into five groups. Control group (n=5): wild C57BL/6 mice; syngenic transplant group ( n=10 ): C57BL/6→C57BL/6; allogenic transplant group ( allogenic group,n=10): BALB/c→C57BL/6; each transplant group was randomly divided into 3?day and 7?day subgroups ( n=5 )? Respiratory system resistance and histological features of grafts were assessed, and differences in graft infiltrating γδT lymphocytes and mRNA expression of interleukin ( IL )?17A were quantified on 3 and 7 days after transplantation? Multiple comparisons were performed using one?way analysis of variance and least significant difference analysis? Results ( 1 ) The respiratory system resistance of syngenic group and allogenic group were (2?61±0?59) cmH2O·s/ml and (2?84±0?31) cmH2O·s/ml 3 days post?operation, both of them increased compared to control group (1?39±0?17) cmH2O·s/ml (1 cmH2O=0?098 kPa) (P=0?001, 0?000). The respiratory system resistance of allogenic group were (4?33±0?67) cmH2 O·s/ml 7 days post?operation, which was significantly higher than that of syngenic 7?day subgroup (1?87±0?27) cmH2O·s/ml and control group (1?39±0?17) cmH2O·s/ml (P=0?000, 0?000)?(2) The isografts of syngenic group showed a relatively normal histological appearance with minimal infiltration of inflammatory cells, and the allografts of allogenic group infiltrated apparently by inflammatory cells, especially 7?day subgroup showed acute cellular rejection? ( 3) The percentage of γδT lymphocytes infiltrated in isografts and allografts were 3?90%± 0?86% and 4?40%± 0?57%, respectively, which were significantly increased compared to that of control lungs 2?00%±0?23% 3 days post?operation(P=0?000, 0?000);The percentage ofγδT lymphocytes infiltrated in 7 days allografts was 5?40%±0?98% , which was higher compared to that of 7 days isografts 2?60%± 0?54% and control lungs 2?00%± 0?23% ( P=0?000, 0?000)? (4) IL?17A mRNA expression levels were 3?37±0?55 and 5?23±1?50 in isografts and 6?77± 0?93 and 27?32±4?20 in allografts, on postoperative day 3 and 7 respectively? All of them were significantly upregulated compared to that of control lungs 0?99±0?08 (P=0?000, 0?000), and allografts exhibited significantly greater IL?17A transcript levels compared to isografts on postoperative day 3 and 7 ( P=0?000, 0?000) . Conclusion The rise of respiratory system resistance of lung grafts after transplantation may relate to the increased IL?17A?producing γδT lymphocytes infiltrated in the grafts.

Objectives To generate an orthotopic left lung transplantation model in mice, and to observe the early changes of respiratory system resistance andγδT lymphocytes infiltrated in grafts? Methods The research time was from March 2014 to May 2015? The male C57BL/6 mice ( n=35) and BALB/c mice (syngenic group,n=10) were randomly divided into five groups. Control group (n=5): wild C57BL/6 mice; syngenic transplant group ( n=10 ): C57BL/6→C57BL/6; allogenic transplant group ( allogenic group,n=10): BALB/c→C57BL/6; each transplant group was randomly divided into 3?day and 7?day subgroups ( n=5 )? Respiratory system resistance and histological features of grafts were assessed, and differences in graft infiltrating γδT lymphocytes and mRNA expression of interleukin ( IL )?17A were quantified on 3 and 7 days after transplantation? Multiple comparisons were performed using one?way analysis of variance and least significant difference analysis? Results ( 1 ) The respiratory system resistance of syngenic group and allogenic group were (2?61±0?59) cmH2O·s/ml and (2?84±0?31) cmH2O·s/ml 3 days post?operation, both of them increased compared to control group (1?39±0?17) cmH2O·s/ml (1 cmH2O=0?098 kPa) (P=0?001, 0?000). The respiratory system resistance of allogenic group were (4?33±0?67) cmH2 O·s/ml 7 days post?operation, which was significantly higher than that of syngenic 7?day subgroup (1?87±0?27) cmH2O·s/ml and control group (1?39±0?17) cmH2O·s/ml (P=0?000, 0?000)?(2) The isografts of syngenic group showed a relatively normal histological appearance with minimal infiltration of inflammatory cells, and the allografts of allogenic group infiltrated apparently by inflammatory cells, especially 7?day subgroup showed acute cellular rejection? ( 3) The percentage of γδT lymphocytes infiltrated in isografts and allografts were 3?90%± 0?86% and 4?40%± 0?57%, respectively, which were significantly increased compared to that of control lungs 2?00%±0?23% 3 days post?operation(P=0?000, 0?000);The percentage ofγδT lymphocytes infiltrated in 7 days allografts was 5?40%±0?98% , which was higher compared to that of 7 days isografts 2?60%± 0?54% and control lungs 2?00%± 0?23% ( P=0?000, 0?000)? (4) IL?17A mRNA expression levels were 3?37±0?55 and 5?23±1?50 in isografts and 6?77± 0?93 and 27?32±4?20 in allografts, on postoperative day 3 and 7 respectively? All of them were significantly upregulated compared to that of control lungs 0?99±0?08 (P=0?000, 0?000), and allografts exhibited significantly greater IL?17A transcript levels compared to isografts on postoperative day 3 and 7 ( P=0?000, 0?000) . Conclusion The rise of respiratory system resistance of lung grafts after transplantation may relate to the increased IL?17A?producing γδT lymphocytes infiltrated in the grafts.