The detection of coagulation function is helpful for the diagnosis of blood diseases,the assess-ment of bleeding and thrombus risks in patients,and the treatment of hemostasis and anticoagulation.It plays an important role in the diagnosis,treatment,and prevention of diseases.Solidification curve waveform analy-sis is a newly developed method for assessing coagulation function.It obtains more sensitive parameters for e-valuating the coagulation function of the body by taking the order derivative of the waveform reflecting the co-agulation process in routine coagulation experiments.Compared with traditional coagulation function tests,co-agulation cuvre waveform analysis curves is more comprehensive and effective in assessing the risk of bleeding and thrombosis.

Objective To investigate the potential mechanism of miR-21-5p in alleviating cerebral ischemia-reperfusion injury by targeting STAT3.Methods The HT22 cells were induced by OGD/R to construct a cell model of cerebral ischemia reperfusion injury.The expression of miR-21-5p was detected by RT-qPCR.The CCK-8 assay,TUNEL staining and flow cytometry were respectively used to detect the cell viability and apoptosis.ELISA assay was used to determine the contents of inflammatory factors IL-6,IL-10 and TNF-α in the cell supernatant.Western blot was used to detect the expression levels of p-STAT3/STAT3,Cleaved-Caspase-3,Bax and Bcl-2 proteins.The TargetScan database was used to predict the binding sites of miR-21-5p and STAT3.The dual-luciferase reporter gene assay was used to verify the targeting relationship between miR-21-5p and STAT3.Results The relative expression level of miR-21-5p was down-regulated in HT22 cells which induced by OGD/R(P<0.001).The cell viability(P<0.0001)was decreased and the apoptosis rate(P<0.001)was increased in OGD/R induced-HT22 cells.The contents of pro-inflammatory factors IL-6(P<0.001)and TNF-α(P<0.001)was increased,while the content of anti-inflammatory factor IL-10(P<0.001)decreased.After transfection with miR-21-5p mimic,cell viability was enhanced,apoptosis rate was reduced and neuroinflammation was inhibited.MiR-21-5p could target and bind to STAT3.After miR-21-5p inhibitor transfection,cell viability decreased,apoptosis was promoted,and neuroinflammation occurred;STAT3 inhibitor Stattic could reverse the effect of miR-21-5p inhibitor.Conclusion MiR-21-5p could specifically bind to STAT3 and reduce the neuroinflammation and apoptosis of OGD/R induced-HT22 cells.

Objective To explore the predictive value of CXC chemokine receptor 2(CXCR2)and Zonula occluden-1(ZO-1)for postoperative cerebral vasospasm in subarachnoid hemorrhage(SAH)patients with ruptured intracranial aneurysm.Methods A total of 215 SAH patients with ruptured intracranial aneurysm admitted to our hospital between May 2020 and October 2023 were recruited,and according to occurrence of postoperative cerebral vasospasm or not,they were separated into a spasm group(70 cases)and a non-spasm group(145 cases).The spasm group was further divided into mild,moderate and severe subgroups(14,38 and 18 cases,respectively).ELISA was applied to detect the serum levels of CXCR2 and ZO-1;Spearman and Pearson corre-lation analyses,multivariate logistic regression analysis,and ROC curve analysis were applied to test the correlation,influencing factors,and predictive value of indicators,and their AUC values were calculated.Results The spasm group had significantly higher CXCR2 and ZO-1 levels,inci-dence of intracranial hemorrhage,and larger proportions of Glasgow coma scale(GCS)score of 3-8 at admission,Hunt-Hess grade Ⅲ,and Fisher grades m and Ⅳ than the non-spasm group(P＜0.01).Intracranial hemorrhage volume,Hunt-Hess grade and Fisher grade were positively correlated with CXCR2 and ZO-1 levels,and the GCS score at admission was negatively correlated with the levels of the two indicators in the SAH patients with ruptured intracranial aneurysm(P＜0.01).CXCR2 and ZO-1 were independent risk factors for postoperative cerebral vasospasm in these patients(P＜0.01).The AUC value of CXCR2,ZO-1 and their combination in predicting postoperative cerebral vasospasm was 0.839(95％CI:0.780-0.898),0.813(95％CI:0.750-0.876),and 0.910(95％CI:0.869-0.951),with the combination showing better predictive per-formance(Z=2.391,Z=3.266,P＜0.05).The serum levels of CXCR2 and ZO-1 in the severe subgroup were significantly higher than those in the moderate subgroup and then followed by the mild subgroup in order,with statistical differences(P＜0.01).Conclusion Serum CXCR2 and ZO-1 levels are associated with postoperative cerebral vasospasm in SAH patients with ruptured intracranial aneurysm,and can be used as potential biomarkers for prognosis prediction.

The standardization of medical management is critical for facing the challenge of public health emergencies in primary medical and health institutions. During the COVID-19 epidemic a quality standard system for pharmacy management was developed in Shanghai Gubei Community Health Service Center, which included 4 standardized modules: medication management module, pharmacy administration modules, pharmacy service module and specialized disease management module. In this article the author discusses the construction of pharmacy quality management standards, its application and roles in COVID-19 epidemics, to provide reference for quality pharmacy management during public health emergencies in grass-roots medical and health institutions.

Objective:To explore the cost-effectiveness and cost-benefit of chronic obstructive pulmonary disease (COPD) screening and intervention based on family doctor contract services.Methods:From January 2023 to October 2023, using purposive sampling and a cross-sectional survey method, 1 040 individuals aged 60 to 75 years who underwent physical examinations at community health service centers in Shanghai Minhang district were selected as research subjects. The subjects were divided into a control group ( n=532) and a study group ( n=508). The control group received conventional community health education and participated in a COPD screening and intervention program provided by the examination center. The study group received COPD screening and intervention provided by contracted family doctors under a tightly integrated medical consortium. The screening content for both groups included initial and follow-up risk assessment questionnaires, pulmonary function tests, bronchodilator tests, and CT scans. A comparative analysis was conducted on the screening compliance rate, positive rate, and cost-effectiveness and cost-benefit between the two groups. Results:A total of 251 individuals at high risk for COPD and confirmed COPD patients were identified through initial and re-screening in both groups, accounting for 24.13% of the subjects, including 222 individuals at high risk (21.35%) and 29 confirmed patients (2.79%). The study group had significantly higher compliance rates in questionnaire-based initial screening, questionnaire-based re-screening+pulmonary function tests, bronchodilator experiments, diagnosis, and subsequent CT scans than the control group ( χ2=33.563, 41.425, 24.842, 17.363, all P<0.05).There were significant higher proportions of high-risk individuals and patients identified through screening in the study group than those in the control group ( χ2=44.880, all P<0.05). The study group had significantly higher positive rates of questionnaire-based initial screening, pulmonary function tests, bronchodilator experiments, and CT scans than the control group ( χ2=29.191, 11.313, 12.370, 4.429, all P<0.05). The overall costs of the screening in the control and study groups were 36 100 and 53 900 yuan, respectively. The cost of pulmonary function tests in the screening for the control and study groups was 1.44 million and 2.45 million yuan, respectively, accounting for 43.19% of the total cost, which was the highest proportion among all costs. The per capita cost for identifying one high-risk individual or patient with COPD was 358.46 Yuan, and the cost in study groups was significantly lower than that in the control group (322.75 vs. 429.45 yuan, χ2=20.396, P<0.05). The per capita net benefits and cost-benefit ratios for the overall subjects in the two groups were 0.37 million yuan and 43.50, respectively. The average net benefit of the study group and the control group was 0.49 million yuan and 0.26 million yuan respectively. The average net benefit of the study group was 0.23 million yuan higher than that of the control group. The cost-benefit ratio of the study group and the control group were 46.77 and 38.61, respectively. The cost-benefit ratio of the study group was 8.16 higher than that of the control group. Conclusion:The screening and intervention for COPD based on family doctor contract services have significant effectiveness, with a marked improvement in screening compliance and high cost-effectiveness, and can be used in community medical institutions with relatively sound family doctor and medical consortium services for targeted COPD screening.

Objective:To explore the quality improvement in the organization structure and management model of the integrated community child health services.Methods:This was a qualitative study, including two parts: cause analysis and service improvement suggestions. In the analysis part the data mining was conducted to identify valuable patterns and relationships in the comprehensive child health services. Semi-structured interviews were conducted with 12 relevant department heads and health workers of the comprehensive child health service team at Gumei Community Health Service Center in December 2023, and the causes of the key problems were explored. In the service improvement part, focus group discussions were held to propose suggestions, then improvement measures were formulated to address the identified problems.Results:Through data mining and semi-structured interviews, the key problems were identified: information isolation among multiple departments and lack of coordination mechanism in the comprehensive child health service team. A team organizational structure based on the "three definite" principle was established. The organizational structure should include the pediatric family doctor team, general practitioner management team and departments of pediatrics, maternal and child health care, immunization and child rehabilitation; the management model should include a cross-department resource and information sharing mechanism, the pediatric family doctor model, optimization and integration of physical space, and enhancement of publicity activities for the comprehensive child health services.Conclusion:Based on the analysis in Gumei health service center, this study identified key problems in community integrated child health services, and proposes the quality improvement measure in the organizational structure and management model of the service team.

The gut microbiota plays a crucial role in maintaining overall health.Dysbiosis of the gut microbiota can promote the occurrence and progression of tumors,especially hepatobiliary and pancreatic tumors,by affecting intestinal homeostasis,gut metabolism,and immune function.Therefore,a better understanding of the role of the gut microbiome in the development and progression of hepatobiliary and pancreatic tumors may provide opportunities for developing new prevention and treatment strategies for patients with these malignancies.This article reviews recent research on the role of gut microbiota in the development and progression of hepatobiliary and pancreatic malignancies,aiming to provide a reference for future studies.

In recent years,the effective management of patients with chronic kidney disease(CKD)is gaining growing attention.In 2014,our hospital established the CKD generalist-specialist combination management model,which incorporates a set of CKD management processes.The generalist component incorporates the following,general practitioners from 6 community health centers in the surrounding areas(with about 650 000 permanent residents in the region)joining hands,setting up a management team composed of doctors and nurses,and formulating management protocols for patient follow-up,patient record management,screening,risk assessment,examination and treatment,nutrition and exercise,and two-way referrals.The specialist component of the model incorporates the following,providing trainings for general practitioners in the in the community in the form of lectures on special topics and case discussion sessions,and organizing 7 national-level workshops for continuing medical education in the past decade,covering about 1 400 participants.In addition,regular meetings of the support groups of patients with renal diseases were organized to carry out information and education activities for patients.We have set up 4 community-based training centers and 6 specialized disease management centers,including one for diabetic nephropathy.We have retrospectively analyzed the risk factors of elderly CKD patients by establishing the elderly physical examination database(which has a current enrollment of 26 000 people),the elderly community CKD cross-sectional survey database,and the elderly CKD information management system.After 10 years of management practice,the level of institutionalization and standardization of CKD specialty management in our hospital has been improved.Moreover,we have expanded the management team and extended the management base from the hospital to community.We have improved the level of CKD management in community health centers and improved the specialty competence of the general practitioners in the communities.The generalist-specialist combination management model makes it possible for CKD patients to receive early screening and treatment,obtain effective and convenient follow-up and referral services,and improve their quality of life.Patients with complications such as diabetes,hypertension,and sarcopenia could access treatments with better precision.It is necessary to carry out the generalist-specialist integrated management of CKD,which is worthy of further development and improvement.

Objective:To investigate the prevalence of hyperuricemia (HUA), patients′ awareness of HUA, and related factors among elderly in community.Methods:The health check-up data of 6 897 residents aged over 65 years in Gumei Community of Shanghai were collected from January 2019 to January 2020. There were 1 156 subject with increased serum uric acid levels (HUA group) and 5 741 with normal uric acid levels (non-HUA group). The differences of clinical indicators between HUA group and non-HUA group were analyzed and the risk factors of HUA was determined by multivariate logistic stepwise regression. A questionnaire survey on the knowledge of HUA and the adoption of relevant health behaviors was conducted among HUA patients.Results:The overall prevalence was 16.8% (1 156/6 897) in this population. The prevalence in males was significantly higher than that in females[26.4%(842/3 195) vs. 8.5%(314/3 702), P<0.001); and the prevalence in females increased with age (χ 2=7.56, P=0.023). Body mass index(BMI), waist circumference(WC), total cholesterol(TC), triglyceride(TG), serum creatinine, alanine aminotransferase(ALT) and albumin/urine creatinine ratio(UACR) in the HUA group were significantly higher than those in the non-HUA group, while estimated glomerular filtration rate(eGFR) and high-density lipoprotein(HDL) were lower than those in the non-HUA group (all P<0.01). The prevalence of hypertension, decreased renal function, overweight or obesity, abdominal obesity, fatty liver and renal cyst in HUA group was significantly higher than that in non-HUA group (all P<0.01). High values of TG, low-density lipoprotein(LDL), WC, hypertension and fatty liver were risk factors for HUA( OR=1.14, 1.20, 1.03, 1.43, 2.19; P<0.01); while female gender, eGFR, HDL and glycosylated hemoglobin A1c(HbA1c) were protective factors for HUA( OR=0.32, 0.94, 0.65, 0.78; P<0.01). The questionnaire survey was conducted among 1 090 HUA patients, and the results showed that 73.2% (798 cases) were aware of the disease after the health check-up results released; only 30.9% (337 cases) knew the diagnostic criteria of HUA, 21.1% (230 cases) knew that HUA needed life-long follow-up care, 56.3% (614 cases), 49.2% (536 cases) and 47.9% (522 cases) thought that HUA should eat less seafood, broth and soya bean products, 17.0%(185 cases) were atcohol drinker and the awareness rates of above questions in patients with gout were higher than those in patients without gout ( P<0.05). Conclusion:The study shows that the prevalence of HUA among the elderly in Gumei community of Shanghai is high, and the HUA related knowledge levels and health behavior performance are not ideal, especially for HUA patients without gout, therefore health education should be strengthened for elderly residents in the community.

Objective To analyze the epidemic characteristics of imported dengue fever in Pudong New Area of Shanghai from 2008 to 2020，and to explore its prevention and control strategy and measures． Methods The data of dengue fever cases in Pudong New Area from 2008 to 2020 were collected from the China Information System for Disease Control and Prevention. Descriptive epidemiological method was used to analyze the epidemic characteristics. Results A total of 45 cases of dengue fever were reported in Pudong during 2008-2020, all the cases were mild, and no deaths were reported．The male-to-female ratio was 2.46:1. The group aged 20-49 years accounted for 86.67%．The most common occupation was commercial service personnel and cadres (25 cases, accounting for 55.56%). The peak of incidence was from July to October with a total of 35 cases (77.78%). All the cases were imported from abroad, mainly from Southeast Asia and South Asia (43 cases, 95.56%). 15 cases (33.33%) had been ill before entry. 22 cases (48.89%) were first treated in tertiary hospitals. The median time intervals from onset to first clinic visit, from first clinic visit to diagnosis, and from onset to diagnosis were 1.0 d, 5.0 d, and 7.0 d, respectively. Serotypes of dengue virus were mainly Type I, Type III and Type II, which were 9 cases, 7 cases, and 6 cases, respectively. Conclusion The epidemic situation of dengue fever in Pudong New Area from 2008 to 2020 is relatively stable, all imported from abroad. The focus of the prevention and control is to promote the health education for overseas travelers, strengthen the monitoring sensitivity at border ports, enhance the diagnostic level of medical institutions, and timely find and report cases.