The integrated medical and elderly care model provides comprehensive medical and elderly care services by establishing medical facilities in elderly care institutions or forming close cooperative relationships with surrounding medical institutions. Currently， there are 87，000 paired partnerships established nationwide between medical and health institutions and elderly care service institutions， and more than 7，800 integrated medical and elderly care institutions have obtained the qualifications of medical and health institutions and completed elderly care service registration. This model not only meets the elderly’s healthcare needs but also provides life care， psychological support， and social activities， thereby improving their quality of life. However， the integrated medical and elderly care model also faces numerous ethical dilemmas in practice. This paper aimed to explore in depth the ethical dilemmas and countermeasures optimization in the work of elderly care institutions under this model， to promote the improvement of service quality， comprehensively guarantee the rights and interests of the elderly， and promote the healthy development of this model in practice. Under this model， the elderly care institutions not only bear the responsibility of providing long-term care and life services but also need to cooperate with medical institutions to provide healthcare and health management services for the elderly. By exploring the practical paths for elderly care institutions to address the ethical dilemmas faced with this model， feasible solutions were proposed to enhance the welfare of the elderly and promote the harmonious development of society.

Background/Aims: Ubiquitination is widely involved in the progression of hepatocellular carcinoma (HCC) by regulating various cellular processes. However, systematic strategies for screening core ubiquitin-related genes, clarifying their functions and mechanisms, and ultimately developing potential therapeutics for patients with HCC are still lacking. Methods: Cox and LASSO regression analyses were performed to construct a ubiquitin-related gene prediction model for HCC. Loss- and gain-of-function studies, transcriptomic and metabolomics analysis were used to explore the function and mechanism of UBE2S on HCC cell glycolysis and growth. Results: Based on 1,423 ubiquitin-related genes, a four-gene signature was successfully constructed to evaluate the prognosis of patients with HCC. UBE2S was identified in this signature with the potential to predict the survival of patients with HCC. E2F2 transcriptionally upregulated UBE2S expression by directly binding to its promoter. UBE2S positively regulated glycolysis in a HIF-1α-dependent manner, thus promoting the proliferation of HCC cells. Mechanistically, UBE2S enhanced K11-linkage polyubiquitination at lysine residues 171 and 196 of VHL independent of E3 ligase, thereby indirectly stabilizing HIF-1α protein levels by mediating the degradation of VHL by the proteasome. In particular, the combination of cephalomannine, a small molecule compound that inhibits the expression of UBE2S, and PX-478, an inhibitor of HIF-1α, significantly improved the anti-tumor efficacy. Conclusions UBE2S is identified as a key biomarker in HCC among the thousands of ubiquitin-related genes and promotes glycolysis by E3 enzyme-independent ubiquitination, thus serving as a therapeutic target for the treatment of HCC.

There are some issues in the process of patient treatment in the medical field, such as knowledge inequality, difficulties in doctor-patient trust and interdisciplinary cooperation, disciplinary barriers, excessive diagnosis and treatment, and structural imbalance of medical resources. In response to these issues, combined with the advantages of conceptual integration, professional integration, and resource integration of medical social work, this paper proposed a practical path for integrating medical social work services in the medical field. The main paths include micro path that systematization, comprehensiveness, and personalization of patient’s diagnosis and treatment process, the integration of intermediary path that integration of disciplinary and professional perspectives, concepts, and practices, and macro path that collaboration and coordination among society, community, and healthcare systems.

Interleukin (IL)-17A, a pro-inflammatory cytokine, is a fundamental function in the onset and advancement of multiple immune diseases. To uncover the primary compounds with IL-17A inhibitory activity, a large-scale screening of the library of traditional Chinese medicine constituents and microbial secondary metabolites was conducted using splenic cells from IL-17A-GFP reporter mice cultured under Th17-priming conditions. Our results indicated that some aureane-type sesquiterpene tetraketides isolated from a wetland mud-derived fungus, Myrothecium gramineum, showed remarkable IL-17A inhibitory activity. Nine new aureane-type sesquiterpene tetraketides, myrogramins A-I ( 1, 4- 11), and two known ones ( 2 and 3) were isolated and identified from the strain. Compounds 1, 3, 4, 10, and 11 exhibited significant IL-17A inhibitory activity. Among them, compound 3, with a high fermentation yield dose-dependently inhibited the generation of IL-17A and suppressed glycolysis in splenic cells under Th17-priming conditions. Strikingly, compound 3 suppressed immunopathology in both IL-17A-mediated animal models of experimental autoimmune encephalomyelitis and pulmonary hypertension. Our results revealed that aureane-type sesquiterpene tetraketides are a novel class of immunomodulators with IL-17A inhibitory activity, and hold great promise applications in treating IL-17A-mediated immune diseases.

Objective To investigate the effect of bone marrow mesenchymal stem cells(BMSCs)on the inflamma-tory response of lipopolysaccharide(LPS)induced acute lung injury(ALI)in mice.Methods 32 SPF KM mice,aged 4 weeks were randomly divided into four groups,control group,LPS group,dexamethasone treatment group(LPS+DEX)and BMSCs treatment group(LPS+BMSCs).The latter three groups were injected with LPS by tra-cheal puncture to establish mouse ALI model 24 h after modeling,BMSCs isolated from the femur of mice were in-jected into the caudal vein,and DEX were injected into caudal vein at the same time in LPS+DEX group for 3 consecutive days.On the 4th day after cell transplantation or 24 h after DEX injection,the survival quantity of mice was recorded,lung function was detected,and the wet/dry weight ratio(W/D)of lung was measured.Then in-flammatory cells in bronchoalveolar lavage fluid(BALF),lung pathological changes and serum inflammatory cyto-kines were collected.Green fluorescent protein(GFP)staining was used to observe the homing of BMSCs in lung tissues.The mRNA and protein expression of TLR4,MyD88 and NF-κB in lung tissues were detected by RT-PCR and Western blot assay respectively.Results Compared with the control group,LPS model group showed de-creased lung function,significantly increase in the W/D weight ratio of lung,inflammatory cytokines in serum and inflammatory cells in BALF,and severe damage in lung tissue.Compared with LPS group,LPS+DEX group and LPS+BMSCs group showed improved lung function,reduced lung tissue damage,significantly decrease in the W/D weight ratio of lung,inflammatory cytokines in serum and inflammatory cells in BALF.And the expression of TLR4-MyD88-NF-κB signaling pathway-related genes and proteins decreased,the survival quantity increased.Conclusion Homologous BMSCs transplantation can effectively treat LPS-induced acute lung injury,and the mechanism may be related to the regulation of TLR4-MyD88-NF-κB signaling pathway and the reduction of inflam-matory response.These findings provide the experimental basis for BMSCs homologous transplantation for ALI.

Objective:To summarize the clinical characteristics and laboratory diagnostic methods of infant botulism caused by Clostridium botulinum type B. Methods:Clinical data of 3 infants with type B botulism who were admitted to Children′s Hospital Affiliated to Capital Institute of Pediatrics from May to November 2018 were retrospectively analyzed. Botulinum toxin was detected in fecal samples or fecal enrichment solution of the patients, and Clostridium botulinum was cultured and isolated from fecal samples. Results:The age of onset of the patients (two boys and one girl) was 3, 3 and 8 months old, respectively. Two cases had the onset in May and one case had the onset in November. There were two cases with mixed feeding and one case with breast feeding. One case′s family members engaged in meat processing. All of them were previously healthy. All the children presented with acute flaccid paralysis, cranial nerve involvement and difficult defecation. Two cases had secondary urinary tract infection. Electromyograms of two cases showed that action potential amplitude of the motor nerve were lower than those of their peers. After treatments including intravenous human immunoglobulin, respiratory tract management, urethral catheterization, nasal feeding, etc., three cases recovered completely 2 to 4 months later. Type B botulinum toxin was detected in the fecal diluent of one patient, and the TPGYT enrichment solution and cooked meet medium of the feces of 3 patients, respectively. Clostridium botulinum B was identified from the feces of 3 infants after culture, isolation and purification. Conclusions:Combined with typical clinical manifestations including acute flaccid paralysis, cranial nerve involvement symptoms and difficult defecation examination, infant botulism can be clinically diagnosed. The detection of fecal botulinum toxin and the culture and isolation of Clostridium botulinum are helpful for the diagnosis.

Objective To examine the current situation of the career plateau among anesthesiologists and analyze the impact of occupational stressors on it. Methods A questionnaire survey was conducted on the anesthesiologists. A total of 300 questionnaires were distributed and 278 questionnaires were effectively collected. Statistical analysis using SPSS 19.0 was performed to assess the status quo of career plateau among anesthesiologists. Pearson correlation analysis and stepwise regression analysis were used to analyze the influence of occupational stressors on career plateau . Results The average value of occupational stressors among anesthesiologists was (3.22±0.55), and the average value of career plateau was (3.90±0.70). Occupational interest in the occupational stressors of anesthesiologists is negatively correlated with the occupational plateau (r=-0.552, P<0.01), and career development is negatively correlated with occupational plateau (r=-0.541, P<0.01) as well. Both occupational interest and career development show a negative predictive effect on the career plateau (β=-0.359, P<0.01 andβ=-0.334, P<0.01, respectively). Conclusion Career plateau among anesthesiologists is at a medium-to-high level. Occupational interest and occupational development in occupational stressors have a negative predictive effect on occupational plateaus, so hospital managers should pay attention to them.

Objective To explore the impact of work-family conflict on job satisfaction and turnover intention of anesthesiologists in Heilongjiang Province.Methods Questionnaire survey was used for data collection.Descriptive statistics,Pearson correlation analysis and multivariate linear hierarchy regression analysis were performed to analyze the impact of work-family conflict on job satisfaction and turnover intention of anesthesiologists.Results The average value of work-family conflict among anesthesiologists was (2.99 ± 0.57).The finding indicated that work-family conflict of anesthesiologists had a significant negative effect on job satisfaction (β=-0.248,P＜0.01) and a positive effect on turnover intention (β=0.329,P＜0.01).Conclusion Anesthesiologists' work-family conflict is above the middle level in Heilongjiang Province.The work-family conflict of anesthesiologists can reduce job satisfaction and increase turnover intention.

Objective To investigate the current situation of quality of care for people with disabilities and the related factors. Methods In November, 2015, 399 disabled persons from five special service institutions in Hubei, China were conveniently sampled, and investigated with the Chinese version of Quality of Care and Support (QOCS) for people with disability scale and demographic questionnaire. Results The total score of QOCS was (38.11±6.24), and the proportion of total score in the dimensions of caring provision, caring environment and caring information were more than 70%. The score of QOCS was various with the age, domicile, employment, medical insurance, monthly household expenditure and expenditure for food of the people with disabilities, and the age (β=0.06, P<0.01) and medical insurance (β=-0.850, P<0.001) were the independent factors related with the score of QOCS. Conclusion People with disabilities self-reportedly satis-fied in the quality of care in Hubei, and it can be improved from the increase of medical insurance level.

Objective To study whether the usage of antibiotics and white -blood -cell counts affect the effects of 2~12-year-old children with acute otitis media (AOM ) .Methods A total of 126 children (2~12 years old)with AOM ,from Jan 2013 to Dec 2013 ,were retrospectively analyzed .Usage of antibiotics and white -blood-cell count were recorded at first ,and the relationships between two factors and outcomes of children with AOM were studyed in one week ,one month and three months after treatment ,respectively .Results White blood cell counts were higher than normal in 59 .52% (75/126) 2~12 -year -old children with AOM ,and antibiotics were used in 73 .81% (93 /126) .Ninty three cases were followed -up until 3 month or more .Antibiotics were used in 74 cases ,and watchful waiting were used in the other 19 patients .The effective rates of two groups were 59 .45% and 52 .63% ,75 .68% and 84 .21% ,85 .14% and 78 .95% in one week ,one month and 3 months after treatment ,re‐spectively .There were no statistically significant differences(χ2 values were 0 .295 ,0 .903 ,0 .799 ,P>0 .05) .But the effective rates were signifantly higher in 1 and 3 months than that of in one week (P<0 .05) .There was no sig‐nificant difference (P>0 .05) between one and three months .Whether white-blood-cell count higher than normal or not ,the difference in efficacy was not statistically significant in 1 week ,1 month and 3 months after treatment (P >0 .05) .Conclusion In 2~12-year-old children with acute otitis media (AOM ) ,the final outcomes were inde‐pendent of the usage of antibiotics and white -blood-cell count .