Objective:To explore the current implementation status and challenges of family doctor contract services (FDCS) from the perspective of contracted residents.Methods:This qualitative study used purposive sampling to select contracted residents from 11 primary healthcare institutions across five cities in China. Semi-structured interviews were conducted from March to December 2024, covering topics such as awareness of contracting, service experience, health needs, service continuity, and policy recommendations. Thematic framework analysis was applied to organize, code, and summarize the data.Results:A total of 25 contracted residents were interviewed (6 men, 19 women; 11 from central urban areas, 14 from suburban or rural towns; 8 with chronic diseases). Three main themes and ten sub-themes emerged: Theme Ⅰ: Pathways to improved service accessibility (optimized chronic disease management, more efficient referrals, and improved health education). Theme Ⅱ: Structural misalignment between supply and demand (limited specialty services despite patient needs, insufficient coverage and public awareness of home-based medical care, imbalanced human resources, and service disruption due to clinician turnover). Theme Ⅲ: Challenges in service awareness and communication mechanisms (information asymmetry and public misperception regarding FDCS, perverse incentives in administrative performance evaluation, and communication barriers in building patient-doctor trust).Conclusions:While FDCS has shown progress in chronic disease management, referral coordination, and health education, structural supply-demand gaps and communication challenges continue to hinder service quality. Improvements in resource allocation and service models are needed to support high-quality development.

The shortage of donor organs is the primary factor limiting the availability of liver transplantation (LT) and is a leading cause of death among patients on the waiting list. The reuse of liver allografts, while rare, represents a significant and unconventional donor resource, offering a promising strategy to expand the donor pool. This approach has been documented in international literature, demonstrating favorable surgical outcomes and long-term follow-up results. Here, we report the first case of liver allograft reuse in the Liver Transplantation Center, Department of General Surgery, Huashan Hospital, Fudan University. In this case, the first recipient underwent orthotopic LT for acute liver failure and hepatic encephalopathy. However, their condition deteriorated on the seventh postoperative day, culminating in brain death. Following evaluation and maintenance, the liver allograft was successfully re-transplanted into a second recipient, who had undergone LT six days earlier but experienced acute hepatic artery embolism leading to rapid liver function deterioration. The second recipient's liver function recovered smoothly after surgery, and they were discharged on the 28th postoperative day. This case highlights the significant value of liver allograft reuse in expanding the donor pool and providing life-saving options for critically ill patients requiring urgent LT.

CD20 is a surface marker protein of B-cell lymphoma, and its extracellular region is the target of specific antibodies and drugs. To obtain a cheap and easily modified specific preparation targeting CD20, we optimized the gene of CD20 extracellular region according to codon degeneracy to facilitate its expression in Escherichia coli. The optimized gene was cloned into pGEX-4T-1 vector, and the recombinant vector was transformed into E. coli BL21(DE3) for expression. The purified protein was identified by SDS-PAGE and Western blotting. Systematic evolution of ligands by exponential enrichment (SELEX) was employed to screen the ssDNA aptamer that specifically binds to the fusion protein, and the affinity of the aptamer to CD20 was detected by flow cytometry. Then, the cytotoxicity test was carried out to examine the inhibitory effect of the aptamer on B lymphoma cells. In this study, we established the prokaryotic expression method of CD20 and obtained the aptamer specifically binding to the extracellular region of CD20, which laid a foundation for the development of therapeutic drugs targeting CD20.
Humans ; Escherichia coli/metabolism* ; SELEX Aptamer Technique/methods* ; Aptamers, Nucleotide/genetics* ; Antigens, CD20/metabolism* ; Ligands

ObjectiveTo investigate the prevalence and its influencing factors of hyperuricemia (HUA) among the employed individuals who undergo occupational health screening in Shanghai, so as to provide a scientific basis for the prevention and control of HUA and for the health promotion in this population. MethodsCluster sampling methods were performed to recruit all the employed individuals who underwent routine health check-ups at the Shanghai Health and Medical Center from January to December 2023. Relevant data, including physical examination results, laboratory tests, and questionnaire surveys, were collected for analyses. Based on the diagnostic criteria for HUA, participants were categorized into HUA group and non-HUA group. Logistic regression analysis was used to identify the influencing factors of HUA. ResultsThe detection rate of HUA in the employed population of Shanghai was 23.26%, with a significantly higher rate in males (31.12%) than that in females (10.43%) (χ²=381.853,P<0.001). The detection rate of HUA increased with age (χ²_trend=5.728, P_trend=0.017). Logistic regression analysis revealed that males had a higher risk for HUA the females, with overweight, obesity, meat-predominant diet, hypertension, and dyslipidemia being positively correlated with HUA risk. While, individuals aged 40‒ and 50‒ years had a lower risk for HUA compared with those aged 20‒ years. ConclusionThe prevalence of HUA among the employed individuals who undergo health check-ups in Shanghai is relatively high. Attention should be paid to maintaining a healthy lifestyle and keeping a balanced diet. Targeted health management should prioritize for males, individuals with hypertension and BMI overweight and obesity, and those with dyslipidemia to reduce the risk of HUA.

Objective:To discuss the expression and clinical significance of inositol polyphosphate-4-phosphatase type Ⅱ(INPP4B)gene in hepatocellular carcinoma(HCC)based on The Cancer Genome Atlas(TCGA)database and experimental verification with clinical samples.Methods:Based on data from 424 clinical samples in the TCGA database(including 374 HCC tissues and 50 paracarcinoma tissues),Kaplan-Meier method and Cox regression analysis were used to evaluate the relationship between INPP4B gene and the clinical characteristics and survival prognosis of the HCC patients.The correlations between INPP4B gene and the number of 24 types of immune cells,matrix,immune cell infiltration and tumor purity in tumor tissue,and the expression level of the high-frequency mutant gene tumor protein 53(TP53)in HCC were analyzed.The clinicopathological data and paraffin-embedded tissue sections of 60 HCC patients treated with surgical resection from December 2022 to December 2023 were collected.According to clinical diagnosis,they were divided into poorly differentiated group(HCC-L group),moderately differentiated group(HCC-M group)and well-differentiated group(HCC-H group),with 20 cases in each group;20 patients during the same period who underwent biopsy and were pathologically diagnosed as non-tumor were selected as normal group,and their clinicopathologic data and liver tissue paraffin sections were collected.HE staining was used to observe the pathomorphology of HCC tissue and normal liver tissue of the subjects in various groups;immunohistochemistry method was used to detect the expressions of Ki-67 and INPP4B proteins in the HCC tissue and normal liver tissue of the subjects in various groups.Results:The TCGA database analysis results showed that compared with normal tissue,the expression level of INPP4B mRNA in HCC tissue was significantly increased(P<0.01).Compared with INPP4B low expression group,the overall survival(OS)of the patients in INPP4B high expression group was significantly prolonged(P<0.05).The univariate Cox regression analysis results showed that tumor stage,pathological stage,tumor status and residual tumor had impacts on OS of the HCC patients(P<0.05).The univariate regression analysis results showed that the INPP4B prognostic risk model score ratio was HR=0.781,95％confidence interval(CI):0.552-1.105,P=0.168.The AUC value for the impact of INPP4B on OS of the HCC patients was 0.558,indicating that the INPP4B gene prognostic risk model had certain predictive value in survival prognosis.The INPP4B mRNA expression level was not correlated with TNM stage,stage,patient gender,age,race or body mass index(BMI)(P>0.05).In tumor tissue with high and low INPP4B expression,22 types of immune cells showed statistically significant differences(P<0.05);the INPP4B mRNA expression level was positively correlated with the number of 23 types of immune cells except T helper(Th)17 cells(r>0),among which all Th cells except natural killer(NK)CD56+cells were statistically significant(P<0.01);INPP4B was significantly correlated with matrix(r=0.475),immune cell infiltration(r=0.641)and tumor purity(r=0.599)in tumor tissue(P<0.01).INPP4B was correlated with TP53(r=0.287,P<0.01).The HE staining results showed that clear and complete lobular structure,neatly arranged cells and slight inflammatory cell infiltration were observed in liver tissue of the subjects in normal group;completely destroyed lobular structure,significant hepatocellular steatosis,massive inflammatory cell infiltration,and lesions such as ballooning degeneration and small cell hyperplasia in some cells were observed in HCC tissue of the patients in HCC-L,HCC-M and HCC-H groups,and the lower the HCC differentiation degree,the more severe the tissue destruction;The immunohistochemistry results showed that compared with normal group,the expression levels of Ki-67 protein in HCC tissue of the patients in HCC-L,HCC-M and HCC-H groups were significantly increased(P<0.01),and the lower the differentiation degree of the HCC patients,the higher the Ki-67 positive rate.Brownish-yellow granules evenly distributed in the cells and INPP4B protein was highly expressed in liver tissue of the subjects in normal group;compared with normal group,the expression levels of INPP4B protein in HCC tissue of the patients in HCC-L,HCC-M and HCC-H groups were significantly decreased(P<0.01),and the lower the differentiation degree of the HCC tissue,the lower the INPP4B positive rate.Conclusion:INPP4B is a protective factor for the prognosis of HCC patients;as a new tumor suppressor gene,INPP4B may become a potential target for new drug screening in HCC treatment.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To evaluate the safety and efficacy of early precise lower limb weight-bearing functional rehabilitation after open reduction and internal fixation of ankle fractures.Methods:A restropective multi-center study was conducted to enroll the eligible 120 patients with malleolar fracture who received the same surgical treatment from March 2023 to December 2023 at the trauma centers in 7 tertiary hospitals according to the inclusion criteria. They were assigned into a study group ( n=60) for precise lower limb weight-bearing functional rehabilitation with the assistance of intelligent lower limb walking rehabilitation crutches and a control group ( n=60) for conventional weight-bearing functional rehabilitation which was gradually increased according to their own feelings under the protection of a walking boot. All the 60 patients in the study group completed their final follow-ups. They were 25 males and 35 females, with an age of (43.8±16.6) years and a body mass index of (25.3±2.3) kg/m 2. Only 51 patients in the control group completed their final follow-ups. They were 27 males and 24 females, with an age of (45.1±16.4) years and a body mass index of (24.7±2.3) kg/m 2. When their incisions healed and their sutures were removed 2 weeks after operation, the patients were guided to start lower limb weight-bearing functional rehabilitation, and exercises for foot and ankle joint mobility and lower limb muscles. The end point of follow-up was 12 weeks after operation. The 2 groups were compared in terms of the crutch-off rates, thigh circumferences, calf circumferences, dorsiflexions, plantarflexions, ankle swellings, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, and visual analog scale (VAS) pain scores at 6 and 12 weeks after operation. The complications were also recorded in the 2 groups. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups, indicating comparability ( P>0.05). At 6 and 12 weeks after operation, the crutch-off rates [41.7% (25/60) and 100.0% (60/60)], dorsiflexions (69.3%±21.6% and 82.9%±26.3%) and AOFAS ankle-hindfoot scores [(68.5±7.6) points and (96.9±3.7) points] in the study group were significantly better than those in the control group [13.7% (7/51) and 39.2% (20/51), 61.5%±16.5% and 72.0%±14.3%, (61.9±9.3) points and (90.1±7.2) points] ( P<0.05). At 6 weeks after operation, the thigh circumference (97.4%±1.9%), calf circumference (97.3%±1.9%), and plantarflexion (76.6%±19.8%) in the study group were significantly higher than those in the control group (95.9%±2.5%, 94.6%±3.2%, and 63.9%±16.9%) ( P<0.05). There were no significant differences between the 2 groups in ankle swelling at 6 or 12 weeks after operation, or thigh or calf circumference, plantarflexion, or VAS pain score at 12 weeks after operation ( P>0.05). No wound complications, secondary fracture displacement, or loosening of internal fixation occurred in either group during the follow-up period. There were no cases of nonunion or delayed union. Conclusions:Early lower limb weight-bearing functional rehabilitation after open reduction and internal fixation of ankle fractures demonstrates good safety. Precise weight-bearing rehabilitation accelerates functional recovery of the ankle, enabling earlier return to normal daily activities.

Objective:To observe the efficacy and safety of subcutaneous stripping combined with gold radiofrequency dot matrix microneedles in the treatment of atrophic acne scar.Methods:A total of 122 patients with atrophic acne scar in Dongying People′s Hospital from January 2023 to January 2024 were prospectively included and divided into two groups by random number table method: Observation group, 61 patients, including 37 males and 24 females, aged 20-43 (31.5±4.7) years, received subcutaneous stripping combined with gold radiofrequency dot matrix microneedles; Control group, 61 patients, including 33 males and 28 females, aged 22-44 (32.6±4.5) years, were treated with subcutaneous dissection. Patients in both groups were treated once every 4 weeks for a total of 3 times. The total effective rate, skin barrier function, wound recovery time, scar condition and adverse reactions were compared between the two groups.Results:The total effective rate of the observation group was 93.4% (57/61), which was higher than that of the control group [75.4% (46/61), P=0.005]. After treatment, the corneum protein content, lactate stimulation test score, skin erythema (a value), and transdermal water loss (TEWL) of the observation group were (29.52±3.22) μg, (1.72±0.18) min, 15.10±2.21, and (18.31±3.35) g/(h·m 2), respectively. They were lower than those (35.24±4.17) μg, (2.75±0.24) min, 19.14±2.57, and (21.23±4.52) g/(h·m 2) in the control group (all P<0.001). The wound healing time, shedding time and scab time in the observation group were (3.42±0.67), (6.57±1.21) and (1.73±0.32) d, respectively, which were shorter than those (5.31±0.99), (8.26±1.48) and (2.85±0.47) d in the control group (all P<0.001). The acne scar clinical score scale (ECCA) and Vancouver scar scale (VSS) scores in the observation group were (38.10±5.29) and (5.23±0.82) points, respectively, which were lower than those (43.65±6.44) and (6.34±0.97) points in the control group (all P<0.001). The incidence of adverse reactions was 11.5% (7/61) in the observation group and 8.2% (5/61) in the control group, the difference was not statistically significant ( P=0.540). Conclusion:Subcutaneous stripping combined with gold radiofrequency dot matrix microneedles is effective in the treatment of atrophic acne scars, which can improve skin barrier function, shorten wound recovery time, and improve scar symptoms with good safety.

Objective:To investigate improvement of dexamethasone(DM)treatment after intrauterine adhesion decomposition on uterine fibrosis and inflammatory factors.Methods:A total of 60 patients with moderate to severe intrauterine adhesions admitted to The Reproductive Medicine Center of Jilin Provincial People's Hospital from March 2021 to March 2023 were selected,and divided into experimental group and control group according to random number table method,with 30 cases in each group.Control group under-went simple hysteroscopic adhesion decomposition,and experimental group underwent intrauterine infusion treatment with DM injec-tion after intrauterine adhesion decomposition.Improvement of clinical symptoms in the two groups was observed.RT-qPCR was used to detect changes in mRNA levels of intimal receptivity-related factors ER,EGFR,LIF,ITGB3,HOXA10,HOXA11,fibrosis-related factors TGF-β1,E-cadherin,N-cadherin,Smad,and inflammatory related factors IL-8,IL-2 and CD138 in two groups.Western blot was used to detect changes in expression levels of inflammatory related proteins IL-8,IL-2 and CD138.Results:Compared with before treatment,endometrial thickness,mRNA levels of ER,EGFR,LIF,ITGB3,HOXA10,HOXA11 and E-cadherin were significantly increased,while mRNA levels of TGF-β1,N-cadherin,Smad,IL-8,IL-2 and CD138,protein levels of IL-8,IL-2 and CD138,and endometrial blood flow parameters PI,RI and adhesion were significantly decreased.Eendometrial thickness,mRNA levels of ER,EGFR,LIF,ITGB3,HOXA10,HOXA11 and E-cadherin in experimental group were significantly higher than those in control group,while mRNA levels of IL-8,IL-2,TGF-β1,N-cadherin,Smad,CD138,IL-8,IL-2 and CD138,and endometrial blood flow parameters PI,RI and adhesion were lower than those in control group(P<0.05).Conclusion:Treatment of DM after intrauterine adhe-sion decomposition can improve intrauterine adhesion,blood flow parameters and endometrial receptivity,and prevent the recurrence of intrauterine adhesion,which mechanism may be related to up-regulation of E-cadherin expression and down-regulation of IL-8,IL-2,CD138,TGF-β1,N-cadherin and Smad expressions.

Objective:To investigate improvement of dexamethasone(DM)treatment after intrauterine adhesion decomposition on uterine fibrosis and inflammatory factors.Methods:A total of 60 patients with moderate to severe intrauterine adhesions admitted to The Reproductive Medicine Center of Jilin Provincial People's Hospital from March 2021 to March 2023 were selected,and divided into experimental group and control group according to random number table method,with 30 cases in each group.Control group under-went simple hysteroscopic adhesion decomposition,and experimental group underwent intrauterine infusion treatment with DM injec-tion after intrauterine adhesion decomposition.Improvement of clinical symptoms in the two groups was observed.RT-qPCR was used to detect changes in mRNA levels of intimal receptivity-related factors ER,EGFR,LIF,ITGB3,HOXA10,HOXA11,fibrosis-related factors TGF-β1,E-cadherin,N-cadherin,Smad,and inflammatory related factors IL-8,IL-2 and CD138 in two groups.Western blot was used to detect changes in expression levels of inflammatory related proteins IL-8,IL-2 and CD138.Results:Compared with before treatment,endometrial thickness,mRNA levels of ER,EGFR,LIF,ITGB3,HOXA10,HOXA11 and E-cadherin were significantly increased,while mRNA levels of TGF-β1,N-cadherin,Smad,IL-8,IL-2 and CD138,protein levels of IL-8,IL-2 and CD138,and endometrial blood flow parameters PI,RI and adhesion were significantly decreased.Eendometrial thickness,mRNA levels of ER,EGFR,LIF,ITGB3,HOXA10,HOXA11 and E-cadherin in experimental group were significantly higher than those in control group,while mRNA levels of IL-8,IL-2,TGF-β1,N-cadherin,Smad,CD138,IL-8,IL-2 and CD138,and endometrial blood flow parameters PI,RI and adhesion were lower than those in control group(P<0.05).Conclusion:Treatment of DM after intrauterine adhe-sion decomposition can improve intrauterine adhesion,blood flow parameters and endometrial receptivity,and prevent the recurrence of intrauterine adhesion,which mechanism may be related to up-regulation of E-cadherin expression and down-regulation of IL-8,IL-2,CD138,TGF-β1,N-cadherin and Smad expressions.