This report evaluates the preliminary outcomes of a "six-in-one" integrated cough and asthma center developed under a dual-contract physician model at the Changfeng Community Health Service Center in Putuo District, Shanghai. By combining the efforts of family doctors and medical specialists, the center integrated six core functions-clinical treatment, prevention, nursing, rehabilitation, pharmacy, and nutrition-into a seamless management system covering screening, diagnosis, therapy, and follow-up. Supported by specialist guidance and teaching clinics, the model significantly enhanced comprehensive respiratory disease management capabilities within the community setting. The initiative not only improved patient health outcomes but also strengthened multidisciplinary collaboration and resource efficiency, offering a replicable example for improving chronic disease management in primary care through integrated and coordinated service delivery.

Since 2017, Changfeng Community Health Service Center in Putuo District, Shanghai, has innovatively integrated the "Dual-Contracting" program by combining integrated general-specialist outpatient services with teaching clinics. This integration has progressively evolved into a comprehensive general practitioner (GP) training model. This model cultivates competencies encompassing: core service delivery, specialized disease diagnosis and treatment, complex case management, chronic disease management within specialties, teaching and mentoring skills, and capacities for self-reflection and continuous learning. It effectively bridges the training objectives and needs for GPs across both pre-service and in-service stages. Against the backdrop of senior medical experts being deployed to primary care settings, this model not only systematically enhances the professional competencies of community GPs but also optimizes medical resource utilization and elevates the overall quality of healthcare services.

This report evaluates the preliminary outcomes of a "six-in-one" integrated cough and asthma center developed under a dual-contract physician model at the Changfeng Community Health Service Center in Putuo District, Shanghai. By combining the efforts of family doctors and medical specialists, the center integrated six core functions-clinical treatment, prevention, nursing, rehabilitation, pharmacy, and nutrition-into a seamless management system covering screening, diagnosis, therapy, and follow-up. Supported by specialist guidance and teaching clinics, the model significantly enhanced comprehensive respiratory disease management capabilities within the community setting. The initiative not only improved patient health outcomes but also strengthened multidisciplinary collaboration and resource efficiency, offering a replicable example for improving chronic disease management in primary care through integrated and coordinated service delivery.

Since 2017, Changfeng Community Health Service Center in Putuo District, Shanghai, has innovatively integrated the "Dual-Contracting" program by combining integrated general-specialist outpatient services with teaching clinics. This integration has progressively evolved into a comprehensive general practitioner (GP) training model. This model cultivates competencies encompassing: core service delivery, specialized disease diagnosis and treatment, complex case management, chronic disease management within specialties, teaching and mentoring skills, and capacities for self-reflection and continuous learning. It effectively bridges the training objectives and needs for GPs across both pre-service and in-service stages. Against the backdrop of senior medical experts being deployed to primary care settings, this model not only systematically enhances the professional competencies of community GPs but also optimizes medical resource utilization and elevates the overall quality of healthcare services.

Objective To study the protective effect and possible mechanism of dexmedetomidine on sevoflurane-induced cognitive impairment.Methods 40 rats were randomly divided into a blank group,model group,dexmedetomidine group,and combination group,10 for each group.A rat model of sevoflurane-induced cognitive impairment was established in the model group,dexmedetomidine group,and combination group.The dexmedetomidine group and combination group were intraperitoneally injected with dexmedetomidine of 50 μg/kg 30 min before modeling,so was the combination group injected with sulindac of 5 mg/kg.The blank group and model group were intravenously injected with equal amount of saline.Morris water maze test was used to detect cognitive function.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of homocysteine(Hcy)and monocyte chemoattractant protein-1(MCP-1);high-performance liquid chromatography was used to detect hippocampal glutamate(Glu)and γ-aminobutyric acid(GABA)contents.Immunoblotting was used to detect hippocampal glycogen synthase kinase 3β(GSK-3β)and β-catenin protein expression levels.Results The escape latency in the dexmedetomidine group rats was shorter than that in the model group(P<0.05),the number of crossing the original platform was greater than that in the model group(P<0.05),and duration staying in the original platform quadrant was longer than that in the model group(P<0.05).The escape latency in the combination group was longer than that in the dexmedetomidine group(P<0.05),the number of crossing the original platform was smaller than that in the dexmedetomidine group(P<0.05),and duration staying in the original platform quad-rant was shorter than that in the dexmedetomidine group(P<0.05).Serum levels of Hcy and MCP-1 were higher in the model group than in the blank group(P<0.05),lower in the dexmedetomidine group than in the model group(P<0.05),and higher in the combination group than in the dexmedetomidine group(P<0.05).Hippocam-pal Glu content was higher in the model group than in the blank group(P<0.05),while GABA content was lower(P<0.05).Hippocampal Glu content was lower in the dexmedetomidine group than in the model group(P<0.05),whereas GABA content was higher group(P<0.05).Hippocampal Glu content was higher in the combination group than in the dexmedetomidine group(P<0.05),and GABA content was lower(P<0.05).Hippocampal GSK-3β protein expression level was higher in the model group than in the blank group(P<0.05),but the β-catenin protein expression level was lower(P<0.05).Hippocampal GSK-3β protein expression level was lower in the dexmedetomidine group than in the model group(P<0.05),while β-catenin protein expression level was higher(P<0.05).Hippocampal GSK-3β protein expression level was higher in the combination group than in the dexme-detomidine group(P<0.05),whereas β-catenin protein expression level was lower(P<0.05).Conclusions Dexmedetomidine may improve cognitive function in rats with sevoflurane-induced cognitive impairment by activat-ing the Wnt/β-catenin signaling pathway,reducing inflammation,and enhancing neurotransmitter activity.

Objective To observe the clinical efficacy and side effects of docetaxel combined with epirubicin dose-dense regimen and convention regimen neoadjuvant chemotherapy in patients with triple negative breast cancer.Methods Eighty-one patients with triple negative breast cancer from January 1, 2008 to December 31, 2011 were selected, and they were divided into dose-dense group (40 cases)and convention group(41 cases).All the patients received 2-6 cycles of docetaxel combined with epirubicin neoadjuvant chemotherapy.Chemotherapy scheme was intravenous drip of docetaxel (75 mg/m2)for 1 h and intravenous drip of epirubicin(90 mg/m2)in Day 1.Every 14 d was 1 cycle in dose-dense group,every 21 d was 1 cycle in convention group.The clinical efficacy and side effects of 2 groups were observed and compared, and the 5-year survival rates were analyzed.Results All patients were evaluated.The pathologic complete response rate and the response rate in dose-dense group were significantly higher than those in convention group:20.0%(8/40)vs.12.2%(5/41)and 85.0%(34/40)vs.70.7%(29/41),and there were statistical differences(P<0.05).The 5 years disease-free survival rate and overall survival rate in dose-dense group were higher than those in convention group: 77.5%(31/40)vs.58.5%(24/41)and 87.5%(35/40)vs.73.2%(30/41),and there were statistical differences(P<0.05).In side effects, there were no statistical differences in the incidences of bone marrow suppression, gastrointestinal reactions, abnormal liver function and hair loss between 2 groups (P > 0.05).Conclusions In the neoadjuvant chemotherapy of triple negative breast cancer, compared with convention regimen, the dose-dense regimen can receive higher pathologic complete response rate and response rate,prolong disease-free survival rate and overall survival rate.Side effects is similar,and it is worth to be used in clinic.