The integration of medical treatment and disease prevention(hereinafter referred to as"med-prevent integra-tion")constitutes a vital strategy for achieving universal health objectives.Party-building initiatives in university-affiliated hospi-tals present a novel approach to enhance this integration at the primary care level.This study identifies three major challenges in current practice,including insufficient conceptual integration between medical and preventive services,inadequate cross-depart-mental coordination and resource allocation,and imperfect accountability mechanisms within Party-building frameworks.From the perspective of integrated governance,we propose a comprehensive pathway where party-building facilitates the systematic conver-gence of ideological orientation,organizational structure,cultural values,and institutional mechanisms.These findings provide both theoretical framework and practical guidance for university-affiliated hospitals to deepen primary-level med-prevent integration through Party-building initiatives.

The integration of medical treatment and disease prevention(hereinafter referred to as"med-prevent integra-tion")constitutes a vital strategy for achieving universal health objectives.Party-building initiatives in university-affiliated hospi-tals present a novel approach to enhance this integration at the primary care level.This study identifies three major challenges in current practice,including insufficient conceptual integration between medical and preventive services,inadequate cross-depart-mental coordination and resource allocation,and imperfect accountability mechanisms within Party-building frameworks.From the perspective of integrated governance,we propose a comprehensive pathway where party-building facilitates the systematic conver-gence of ideological orientation,organizational structure,cultural values,and institutional mechanisms.These findings provide both theoretical framework and practical guidance for university-affiliated hospitals to deepen primary-level med-prevent integration through Party-building initiatives.

Objective:To investigate the clinical effects and related mechanism of antibiotic bone cement in treating diabetic foot ulcer (DFU).Methods:A prospective randomized controlled study was conducted. From August 2020 to August 2022, 24 patients with DFU who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. According to the block randomization, the patients were divided into 2 groups, with 12 patients in each group. In antibiotic bone cement group, there were 7 male and 5 female patients, aged (64±8) years, with the ulcer area of (41±21) cm 2. In silver sulfadiazine group, there were 8 male and 4 female patients, aged (62±8) years, with the ulcer area of (38±19) cm 2. Under the condition of ensuring the patency of at least one main inferior genicular artery in each patient, the continuous vacuum sealing drainage was performed for 3-5 days after thorough debridement. Thereafter, the wounds in antibiotic bone cement group were treated with gentamicin-laden bone cement, and the wounds in silver sulfadiazine group were treated with silver sulfadiazine cream for dressing change. After 3 weeks of dressing change, the wound was covered with split-thickness skin graft from the lateral thigh on the affected side. Before debridement and after 3 weeks of dressing change, the blood flow intensities of wound tissue and normal skin tissue in foot were measured using laser Doppler flowmeter, and then, the percentage of relative blood flow intensity of wound and the change rate of blood flow intensity were calculated. After 3 weeks of dressing change, the wound margin tissue was taken, the number of CD31-positive neovascular and the vascular morphology were observed and detected by immunohistochemical staining, the morphology of blood vessels surrounded by CD31 and α-smooth muscle actin (α-SMA) double-positive cells was observed by immunofluorescence staining, the cell proliferation activity was evaluated by immunofluorescence staining (denoted as the ratio of Ki67 positive cells), and the protein expression of vascular endothelial growth factor receptor 2 (VEGFR2) was detected by Western blotting. The skin graft survival was observed 3-5 days after skin grafting, and the wound healing time was recorded. Data were statistically analyzed with independent sample t test and Fisher's exact probability test. Results:The percentages of relative blood flow intensity of wounds of patients before debridement were similar between the two groups ( P>0.05). After 3 weeks of dressing change, the percentage of relative blood flow intensity of wounds and the change rate of blood flow intensity of patients in antibiotic bone cement group were (44.7±2.0)% and (129±12)%, respectively, which were significantly higher than (28.3±1.2)% and (41±8)% in silver sulfadiazine group (with t values of 24.15 and 20.97, respectively, P<0.05). After 3 weeks of dressing change, compared with those in silver sulfadiazine group, the number of CD31-positive neovascular in the wound margin tissue of patients in antibiotic bone cement group was significantly increased ( t=33.81, P<0.05) with larger diameter and more regular arrangement, the vascular wall continuity surrounded by CD31 and α-SMA double-positive cells was better, and the ratio of Ki67 positive cells and protein expression of VEGFR2 were significantly increased (with t values of 40.97 and 47.38, respectively, P<0.05). On post skin grafting day 3-5, all the patients in antibiotic bone cement group and 8 patients in silver sulfadiazine group had good skin graft survival, while 4 patients in silver sulfadiazine group showed spotted/patchy skin graft necrosis, which were cured after corresponding treatment. The wound healing time of patients in antibiotic bone cement group was (47.1±2.9) d, which was significantly shorter than (58.8±2.3) d in silver sulfadiazine group ( t=10.86, P<0.05). Conclusions:Compared with silver sulfadiazine, clinical application of antibiotic bone cement for treating DFU has the characteristics of accelerating wound healing and better reconstruction of local blood flow, which may be closely related to the fact that antibiotic bone cement promoted the local angiogenesis effectively in the wound through enhancing the expression of VEGFR2.

CaMKII is essential for long-term potentiation (LTP), a process in which synaptic strength is increased following the acquisition of information. Among the four CaMKII isoforms, γCaMKII is the one that mediates the LTP of excitatory synapses onto inhibitory interneurons (LTP_E→I). However, the molecular mechanism underlying how γCaMKII mediates LTP_E→I remains unclear. Here, we show that γCaMKII is highly enriched in cultured hippocampal inhibitory interneurons and opts to be activated by higher stimulating frequencies in the 10-30 Hz range. Following stimulation, γCaMKII is translocated to the synapse and becomes co-localized with the postsynaptic protein PSD-95. Knocking down γCaMKII prevents the chemical LTP-induced phosphorylation and trafficking of AMPA receptors (AMPARs) in putative inhibitory interneurons, which are restored by overexpression of γCaMKII but not its kinase-dead form. Taken together, these data suggest that γCaMKII decodes NMDAR-mediated signaling and in turn regulates AMPARs for expressing LTP in inhibitory interneurons.
Calcium-Calmodulin-Dependent Protein Kinase Type 2/metabolism* ; Hippocampus/metabolism* ; Interneurons/physiology* ; Long-Term Potentiation/physiology* ; N-Methylaspartate/metabolism* ; Receptors, AMPA/physiology* ; Receptors, N-Methyl-D-Aspartate/metabolism* ; Synapses/physiology*

Objective To observe the influence of once pre-injection dexmedetomidine(DEX) on clinical effect in general anesthesia induction.Methods Sixty patients,ASA Ⅰ-Ⅲ,no sex limitation,undergoing elective laparoscopic cholecystectomy under general anesthesia were selected and divided into the 1ug/kg DEX group(D) and normal saline control group(C),30 cases in each group.The BIS values were recorded after medication infusion.Then the target controlled infusion(Marsh mode) of propofol was performed according to the plasma concentration.The plasma concentration was gradually increased until BIS value reaching 40.Then the effect-site concentration(Ce) of propofol was recorded at this time and sufentanil 0.5ug/kg was injected within 10 s.The bucking incidence rate within 1 min after injection of sufentanil was recorded and cisatracurium was injected again.The tracheal intubation was performed when the TOF value was 0.The time of train-of-four stimulation(TOF) to 0(effect onset time) and intubation time were recorded.The hemodynamic indexes were recorded at pre-administration(T0),post-administration(T1),after induction(T2),and after intubation(T3).The incidence rate of intraoperative awareness was recorded.Results The bucking incidence rate at 1 min after sufentanil injection in the group D was significantly lower than that in the group C(3.33％ vs.13.3％,P＜0.01).Ce of propofol in the group D was lower than that in the group C(P＜0.01).HR af T1 in the group D was decreased;HR and MAP at T2 in the group C were decreased,which at T3 were increased.No intraoperative awareness occurred in all cases.Conclusion Pre-injection of DEX 1ug/kg before induction can decrease the propofol dose and maintains hemodynamic stability.

Objective To investigate the effects of dexmedetomidine plus ropivacanie on lumbar plexus-sciatic nerve blocks and sedation. Methods One hundred and twenty patients( ASA Ⅰ-Ⅲ) scheduled for unilateral arthroscopy of the knee received lumbar plexus-sciatic nerve blocks. The patients were randomly divided into 4 groups(n = 30 in each). In group R,dexmedetomidine was not used for nerve. In group RLD,dexmedetomidine was only used for lumbar-plexus block. In group RSD,dexmedeto-midine was only used for sciatic nerve block. In group RD,dexmedetomidine was used for both lumbar-plexus block and sciatic nerve block. Onset time and maximum time of sensory and motor block,duration of analgesia,Ramsay scores,HR,and the incidence of anesthetic toxicity were recorded at different time points(T0-T4). Results There were no significant differences in the onset time of sensory and motor block among the groups(P > 0. 05). However,there were significant differences in the maximum time of sensory and motor block for the lumbar plexus among the RLD group[(1008. 00 ± 104. 99)min and (800. 00 ± 97. 56)min],RD group[(922. 00 ± 149. 05)min and(732. 00 ± 139. 52)min],RSD group [(768. 00 ± 108. 48)min and(602. 00 ± 84. 09)min],and R group[(742. 00 ± 129. 44)min and (612. 00 ± 109. 62)min]. There were significant differences in the maximum time of sensory and motor block for the sciatic nerve among the RLD group[(1006. 00 ± 117. 58)min and(810. 00 ± 105. 41) min],RD group[(932. 00 ± 144. 18)min and(744. 00 ± 136. 09)min],RSD group[(738. 00 ± 120. 16)min and(582. 00 ± 96. 04)min],and R group[(708. 00 ± 126. 45)min and(548. 00 ± 111. 12)min]. Compare with the R group,the Ramsay scores of at the time point of T1-T4 were higher and the HRs were lower in the RLD group,RSD group and RD group. There were significant differences in the analgesia duration among the RLD group[(1006. 00 ± 117. 58)min],RD group[(918. 00 ± 83. 60)min],RSD group[(898. 00 ± 131. 34)min],and R group[(808. 00 ± 119. 72)min]. No local anesthetic intoxication was noticed. Conclusion Perineural dexmedetomidine plus ropivacaine increase the effects of lumbar plexus-sciatic nerve blocks in a dose-dependent manner. Dexmedetomidine provides a good sedative effect,however,it may lead to bradycardia.

Taking children respiratory infectious diseases as the research object, CDSS transform from isolated clinical data to an integration Model. With integrating pharmacy and laboratory knowledge, the system establishes children typical characterization data of common infectious diseases and medical efficacy data repository to providing treatment recommendations for doctor. Based on the clinical characteristics of children infectious diseases, this paper proposes knowledge inference engine and an information integration model. decision-making inference engine, medical information integration model.
Child ; Clinical Decision-Making ; Communicable Diseases ; Databases, Factual ; Humans ; Medical Informatics ; Pediatrics ; methods ; Respiratory Tract Infections

Objective To report a pedigree with X?linked dominant protoporphyria(XLDPP), and to detect 5?aminolevulinic acid synthetase 2(ALAS2)gene mutations in this pedigree. Methods A clinical investigation was performed in a pedigree with XLDPP, and relevant data were collected from family members. A next?generation sequencing method was applied to screen possible mutation sites, and Sanger sequencing was performed to determine pathogenic gene mutations. Dermoscopy was conducted to observe skin lesions in the patients with XLDPP, and the Fotofinder system and very high frequency (VHF) ultrasound system were utilized to assess the severity of photodamage. Liver and gallbladder ultrasonography as well as blood examination were performed for all the family members. Results A deletion mutation, c.1706?1709ΔAGTG, was detected in the ALAS2 gene on the X chromosomes of all the patients in this family, which led to replacement or loss of 19-20 C?terminal residues through transcriptional frameshifting, and eventually caused an increase in ALAS2 activity. In the patients with XLDPP, skin photodamage was relatively severe;protoporphyrin?induced hepatobiliary damage was observed and aggravated with age;anemia and iron deficiency occurred sometimes. Conclusion The deletion mutation c.1706?1709ΔAGTG of the ALAS2 gene may be the underlying cause of XLDPP in this pedigree.

Objective To investigate the clinical effect of dexmedetomidine combined with ropi-vacanie in brachial plexus block (BPB)through modified coracoid approach.Methods Sixty patients scheduled for selective upper extremity surgery were randomly divided into two groups,30 patients in each group.BPB was performed at the point of 2 cm below coracoid directed by nerve stimulator. Ropivacaine (200 mg)was diluted into 40 ml in group R (n=30)and ropivacaine (200 mg)+1 μg/kg dexmedetomidine diluted into 40 ml in group RD (n=30).Motor and sensory block onset times and blockade durations were recorded.HR,SBP,DBP and SpO2 were recorded before drug administration and 1 5,30,60,90 and 120 min after drug administration.Visual Analog Scale (VAS)of normal up-per extremity in group RD was recorded before drug administration and 30 min after drug administra-tion.Side effects were recorded in both groups.Results Sensory and motor block onset time was sig-nificantly longer in group R than those in group RD;Sensory and motor blockade durations in group R was significantly shorter than in those group RD (P <0.01).Compared with group RD,MAP,HR at 30,60,90,120 minutes after drug administration were significantly higher in group R(P <0.05 ). VAS of normal upper extremity in group RD before drug administration and 30 min after drug admin-istration had no statistical significance.7 patients were treated with atropine for bradycardia in group RD.Conclusion Dexmedetomidine combined with ropivacaine for BPB shortens the sensory and motor block onset time and prolongs the duration of sensory and motor blockade.

Objective To compare the influence for intravenous dexmedetomidine and midazolam during combined spinal and epidural anesthesia (CSEA) on sedation,respiratory and circulatory.Methods Ninety patients with lower extremity fractures and internal fixation,were divided into dexmedetomidine group,midazolam group and control group by random digits table with 30 cases each.CSEA was performed at L3-4 interspace.After block reached T8 level,dexmedetomidine,midazolam and 0.9％ sodium chloride were given to the three groups.Ramsay score,mean arterial pressure (MAP),heart rate (HR),partial pressure of carbon dioxide in end expiratory gas (PErCO2),respiratory rate (RR) were recorded before anesthesia(T0),after CSEA (T1),and 10,15,30,45,60 min after giving drug (T2-T6),and intraoperative awareness was recorded.Results Ramsay score in dexmedetomidine group and midazolam group at T2-T6 were higher than those in the group T0,T1 and concurrent control group (P ＜ 0.05),MAP were lower than those in the group T0,T1 and concurrent control group (P ＜ 0.05).HR in dexmedetomidine group at T2-T6 were lower than those in concurrent midazolam group and control group (P ＜ 0.05).PETCO2 in midazolam group at T2-T6 were higher than those in concurrent dexmedetomidine group and control group (P ＜ 0.05),RR were lower than those in concurrent dexmedetomidine group and control group (P ＜ 0.05).The rate of intraoperative awareness in dexmedetomidine group and midazolam group was lower than that in control group [16.7％(5/30) and 13.3％(4/30) vs.93.3％(28/30),P＜0.05].Conclusions Dexmedetomidine and midazolam provide good sedation to reduce intraoperative awareness,slight inhibition of blood pressure.Dexmedetomidine can decrease HR,but it does not influence respiratory function.Midazolam restrains respiratory function.