Based on the analysis of the existing problems and implementation dilemmas in family doctor contracting and first-return-visits faced by primary medical institutions in China, the authors propose countermeasures to provide reference for managers of primary health care institutions.

Objective To investigate the anti-inflammatory effects of Bupi Yichang Pills on mice with experimental colitis and its potential mechanism of action.Methods Dextran sulfate sodium(DSS)was used to model the experimental colitis,and low-,medium-and high-doses of Bupi Yichang Pills(1.5,3.0,6.0 g·kg-1·d-1)and Mesalazine(300 mg·kg-1·d-1)were fed at the same time.Mice were observed for general behavior and weighed.Hematoxylin-eosin staining was used to observe the pathological injury of colonic tissues.qPCR and ELISA were used to detect the levels of inflammatory cytokines(TNF-α,IL-1β,IL-6,IL-10,IL-35 and TGF-β1),qPCR and Western Blot were used to detect the mRNA and protein levels of glucose transporters and glycolytic kinases.Results Low-,medium-and high-doses of Bupi Yichang Pills significantly down-regulated disease activity index in colitis mice(P＜0.05,P＜0.01).The body mass and colon length were significantly increased,while colon mass,colon mass index and unit colon mass index were significantly reduced(P＜0.05,P＜0.01),and ulcer formation and inflammatory cell infiltration in colonic tissue were significantly improved.In addition,medium-and high-doses of Bupi Yichang Pills significantly down-regulated the mRNA levels and concentrations of pro-inflammatory cytokines including TNF-α,IL-1β and IL-6(P＜0.01),while significantly up-regulated the mRNA levels and concentrations of anti-inflammatory cytokines such as IL-10,IL-35 and TGF-β1(P＜0.01).We further found that high-dose of Bupi Yichang Pills significantly down-regulated the mRNA and protein expressions of glucose transporters(Glut1,Glut2,Glut4)and glycolytic kinases(HK2,Aldolase A,PKM2)in colonic tissue(P＜0.01).Conclusions Bupi Yichang Pills effectively alleviates DSS-induced experimental colitis,and its specific mechanism of action is related to the improvement of glycolytic metabolic pathways and the regulation of inflammatory cytokine expression.

Objective:To investigate the correlation between the changes in homocysteine, uric acid, and lipid metabolism and the psychopathological status of patients with first-episode schizophrenia.Methods:Between June 2021 and June 2023, a total of 82 patients with first-episode schizophrenia who received treatment at Wenzhou Seventh People's Hospital were included in the study group. Additionally, 82 individuals who underwent physical examination at the same hospital during the same period were included in the control group. The homocysteine levels were measured using the enzyme cycling method, while uric acid levels were determined via the uric acid enzyme method. Lipid metabolism levels were assessed using a fully automated biochemical analyzer. The positive and negative syndrome (PANSS) scale scores, which assess positive, negative, and general psychopathological status in patients with first-episode schizophrenia, were obtained. Serum homocysteine and uric acid levels, as well as lipid metabolism levels, were compared between the two groups. Pearson correlation analysis was used to assess the correlation between general psychopathological status scores and homocysteine, uric acid, and lipid metabolism levels. Multivariate logistic regression analysis was performed to investigate the factors (homocysteine, uric acid, or lipid metabolism levels) that affect first-episode schizophrenia.Results:The patients with first-episode schizophrenia exhibited positive symptom scores of (25.74 ± 5.63) points, negative symptom scores of (23.12 ± 6.76) points, general psychopathological status scores of (37.91 ± 5.87) points, and a total score of (86.77 ± 7.75) points. The serum homocysteine and uric acid levels in the study group were (23.12 ± 3.78) μmol/L and (345.12 ± 27.38) μmol/L, respectively. These values were significantly higher than those in the control group [(8.81 ± 2.19) μmol/L, (218.48 ± 23.51) μmol/L, t = 29.66, -31.78, both P < 0.05]. There were no significant differences in total cholesterol and triacylglycerol levels between the two groups (both P > 0.05). However, serum level of low density lipoprotein cholesterol in the study group was (3.26 ± 1.04) mmol/L, which was significantly higher than that in the control group [(2.34 ± 0.78) mmol/L, t = -6.41, P < 0.05]. Serum level of high density lipoprotein cholesterol in the study group was (1.02 ± 0.13) mmol/L, which was significantly lower than that in the control group [(1.17 ± 0.14) mmol/L, t = 7.11, P < 0.05). Pearson correlation analysis indicated a positive linear correlation between the general psychopathological status score and homocysteine, uric acid, and low density lipoprotein cholesterol levels. Conversely, it exhibited a negative linear correlation with high density lipoprotein cholesterol levels. Multivariate logistic regression analysis further showed that homocysteine, uric acid, and low density lipoprotein cholesterol levels were strongly associated with first-episode schizophrenia. Conclusion:In patients with first-episode schizophrenia, homocysteine, uric acid, and low density lipoprotein cholesterol levels are elevated, while high density lipoprotein cholesterol levels are reduced. There markers are closely related to patients' psychopathological status.

Objective:To analyze the epidemiological and clinical characteristics of respiratory syncytial virus (RSV) infection in children in Jiangsu Province from 2014 to 2023.Methods:The acute respiratory infection cases in children aged 0-14 years were selected from outpatient/emergency or inpatient departments in 2 surveillance sentinel hospitals, respectively, in Nanjing, Suzhou and Taizhou of Jiangsu from 1 July 2014 to 31 December 2023, and RSV nucleic acid test was conducted and the intensity of the RSV infection was accessed by WHO influenza epidemiological threshold method, and case information and clinical data were collected. χ2 test was used to compare the differences between groups, and the Bonferroni method was used for pairwise comparisons between groups. Results:In 4 946 cases of acute respiratory infections, the RSV positive rate was 8.21% (406/4 946), and the age M( Q1, Q3) of the cases was 1 (0, 3) years. The RSV positive rate was 10.92% (258/2 362) during 2014-2019 and 6.06% (118/1 948) during 2019-2023, the difference was significant ( χ2=31.74, P<0.001). RSV infection mainly occurred from October to March during 2014-2019, with the incidence peak in December and moderate or higher intensity. The seasonality of RSV infection was not obvious during 2019-2023, with low intensity. The RSV positive rate was highest in children in age group 0- years (17.85%, 151/846), and the positive rate declined gradually with age ( χ2=184.51, P<0.001). The RSV positive rate was higher in inpatient cases (9.84%, 244/2 480) than in outpatient/emergency cases (6.57%, 162/2 466) ( χ2=17.54, P<0.001). In the 155 RSV infection cases with complete clinical data, the clinical symptoms mainly included cough (99.35%, 154/155), fever (55.48%, 86/155), and shortness of breath (45.16%, 70/155). In the cases aged <6 months, the proportion of those with fever was low, but the proportion of those with shortness of breath, transferred to intensive care units, and receiving oxygen therapy were higher (all P<0.05). Children aged <6 months and those with underlying diseases were more likely to have severe RSV infection (all P<0.05). Conclusions:RSV infection in children in Jiangsu Province showed seasonal prevalence in winter from 2014 to 2019. Since 2020, the seasonal characteristics of the epidemic have changed, the epidemic period has been dispersed and the epidemic intensity has decreased. Infants <1 year old were at high risk for RSV infection, and those <6 months old and with underlying diseases might have severe infection.

Objective:To understand the current knowledge, attitude, and practice (KAP) on influenza and influenza vaccine among pregnant women in Suzhou and to analyze its influencing factors to provide technical support data for public health strategies for promoting influenza vaccination in pregnant women.Methods:A questionnaire was designed, and a stratified sampling method was used to conduct a face-to-face survey among pregnant women at different stages of pregnancy who received antenatal examinations at different levels of medical institutions in Suzhou, Jiangsu Province, in 2023. KAP status and influencing factors were analyzed by χ2 test and logistic regression analysis. Results:A total of 2 195 valid questionnaires were collected in this survey. The M( Q1, Q3) of knowledge about influenza and influenza vaccine among pregnant women in Suzhou was 7.60 (5.23, 9.80) points, and the score range was 0.20-14.71 points, the passing rate was 34.12%, the awareness rate of influenza vaccine was 57.45%, and the vaccination rate of influenza vaccine was 1.91% within one year before the survey. The willingness to receive influenza vaccine during pregnancy was only 3.57%. Multivariate analysis of influenza and influenza vaccine-related knowledge scores showed that the passing rate was positively correlated with education level and gestational age. In contrast, family income was negatively correlated with living in rural areas, working as migrant workers, and having no medical insurance. Multivariate analysis of vaccination intention showed that decreased effectiveness of influenza vaccine and increased adverse reactions decreased vaccination intention during pregnancy. Conclusions:The pregnant women in Suzhou pay more attention to influenza, and vaccination rates and intentions are generally low. Pregnant women with early and second trimester of pregnancy, low education, living in rural areas, working as migrant workers, and not purchasing medical insurance are the key groups to popularize the knowledge about influenza and influenza vaccine.

Objective:To investigate the effect of clozapine on endocrine hormone levels in patients with schizophrenia, and to analyze the factors causing metabolic abnormality.Methods:The clinical data of 102 patients with schizophrenia who received treatment at the Wenzhou Seventh People's Hospital from January 2021 to January 2023 were retrospectively analyzed. All patients were treated with clozapine. They were divided into a normal metabolism group ( n = 76) and a metabolic abnormality group ( n = 26) according to whether or not metabolic abnormality occurred after treatment. The glycolipid metabolism levels, thyroid function, and gonadal hormone levels were recorded and compared between the two groups. Logistic regression analysis was then performed to determine the relevant factors influencing the occurrence of concurrent metabolic abnormality in these patients. Results:After treatment, the levels of triglyceride, low-density lipoprotein, glycosylated hemoglobin, triiodothyronine, and prolactin in patients were all significantly increased compared with those measured before treatment, while estradiol level was significantly decreased compared with that measured before treatment ( t = 2.84, 3.36, 25.35, 3.26, 4.88, -5.76, all P < 0.05). Body mass index, disease duration, and the levels of triglyceride, glycosylated hemoglobin, triiodothyronine, and prolactin in the metabolic abnormality group were significantly higher than those in the normal metabolism group, while the levels of low-density lipoprotein, FT 4, and estradiol in the metabolic abnormality group were significantly lower than those in the normal metabolism group ( t = 4.41, 5.67, 3.20, 4.71, 3.49, 3.97, -4.84, -4.51, -4.25, all P < 0.05). The results of the logistic regression analysis indicated that high body mass index ( OR = 7.410, 95% CI = 1.485-36.988), prolonged disease duration ( OR = 1.385, 95% CI = 1.088-1.764), low low-density lipoprotein level ( OR = 0.003, 95% CI = 0.000-0.453), elevated glycosylated hemoglobin level ( OR = 4.222, 95% CI = 1.067-16.706), decreased FT 4 level ( OR = 0.238, 95% CI = 0.086-0.655), and low estradiol level ( OR = 0.845, 95% CI = 0.726-0.984) were the factors associated with metabolic abnormality (all P < 0.05). Conclusion:The use of clozapine in the treatment of schizophrenia will affect the patient's glycolipid metabolism, thyroid function, and gonadal hormone levels. At the same time, it is found that high body mass index, long disease duration, low low-density lipoprotein level, high glycosylated hemoglobin level, low FT 4 level, and low estradiol level will increase the risk of metabolic abnormality in patients. Therefore, targeted interventions should be carried out according to the actual situation.

Objective:To explore the application effect of preoperative autologous blood localization method in laparoscopic resection of gastric stromal tumors in unfavorable areas of the stomach.Methods:A retrospective analysis was conducted on the case data of 40 patients with gastric stromal tumors in unfavorable locations admitted to Jinjiang Hospital from January 2019 to December 2022. The patients were divided into a control group (intraoperative endoscopic localization method) and an autologous blood localization group according to different intraoperative lesion localization methods, with 20 cases in each group. The surgical time, intraoperative blood loss, hospitalization time, postoperative exhaust time, and adverse reactions were compared between the two groups.Results:The surgery time of the autologous blood localization group was shorter than that of the control group [(92.30±8.80)min vs (108.20±14.87)min, P<0.05]. There was no statistically significant difference in intraoperative bleeding, hospitalization time, and postoperative exhaust time between the two groups (all P>0.05). Two groups of patients did not show an increase in inflammatory indicators such as white blood cells and C-reactive protein on the day after surgery. Both groups of patients did not experience adverse reactions such as fever, abdominal pain, or postoperative complications. Conclusions:The autologous blood injection localization method provides a safe, simple, and effective method for preoperative localization of gastric stromal tumors in unfavorable areas of the stomach under laparoscopy, and is worthy of clinical promotion and use.

Objective　To investigate the epidemiology and genomic characterizations of carbapenem-resistant Escherichia coli (CREC) from a tertiary hospital in Guangzhou, Guangdong province, China from January 2021 to December 2023. Methods　The non-repetitive CREC isolates identified at the hospital from January 2021 to December 2023 were included and their clinical characteristics were analyzed through the clinical record system. A total of 42 CREC isolates were randomly selected for species identification, antimicrobial susceptibility testing, and multilocus sequence typing. Whole-genome sequencing and bioinformatics analysis were conducted to investigate the antimicrobial resistance genes, virulence-related genes, replicons, and plasmid types carrying the carbapenem resistance genes in CREC. Results　A total of 2 887 Escherichia coli (EC) isolates were collected from the hospital between January 2021 to December 2023, including 105 CREC strains. The prevalence rates of CREC over the three years were 1.76%, 2.80%, and 5.69%, respectively, showing a significant upward trend (P<0.001). All 42 CREC isolates showed resistance to multiple antibiotics, with resistance rates for amoxicillin-clavulanate, ceftazidime, and cefepime all at 100.00%, ertapenem and imipenem at 97.62%, levofloxacin at 83.33%, and amikacin at 45.24%. All CREC isolates were susceptible to tigecycline. The 42 CREC strains were classified into 14 ST types, with the main types being ST167 (28.57%), ST410 (26.19%), and ST131 (9.52%). ST410 CREC isolates carried significantly more fim, algA, icsP/sopA, and high-pathogenicity island (HPI) related virulence genes than ST167 isolates (P<0.05), whereas aslA and hcp-2 were significantly lower than ST167 (P<0.05). The carbapenem resistance genes carried by CREC were primarily blaNDM-5 (n=34), followed by blaNDM-1 (n=6), with only one isolate carrying blaKPC-2. These carbapenem resistance genes were mainly located on IncF (n=27) and IncX3 (n=11) type of plasmids. Conclusions　The prevalence of CREC significantly increased from 2021 to 2023 in this hospital, with ST167 and ST410 as the dominant types. ST410 CREC is a newly prevalent high-risk clone carrying adhesion, biofilm formation, and HPI-related virulence genes, and there is an urgent need to monitor its epidemiological status and transmission characteristics to provide a basis for the formulation of control measures.

Objective:To evaluate the efficacy and safety of mitoxantrone hydrochloride liposome injection in the treatment of peripheral T-cell lymphoma (PTCL) in a real-world setting.Methods:This was a real-world ambispective cohort study (MOMENT study) (Chinese clinical trial registry number: ChiCTR2200062067). Clinical data were collected from 198 patients who received mitoxantrone hydrochloride liposome injection as monotherapy or combination therapy at 37 hospitals from January 2022 to January 2023, including 166 patients in the retrospective cohort and 32 patients in the prospective cohort; 10 patients in the treatment-na?ve group and 188 patients in the relapsed/refractory group. Clinical characteristics, efficacy and adverse events were summarized, and the overall survival (OS) and progression-free survival (PFS) were analyzed.Results:All 198 patients were treated with mitoxantrone hydrochloride liposome injection for a median of 3 cycles (range 1-7 cycles); 28 cases were treated with mitoxantrone hydrochloride liposome injection as monotherapy, and 170 cases were treated with the combination regimen. Among 188 relapsed/refractory patients, 45 cases (23.9%) were in complete remission (CR), 82 cases (43.6%) were in partial remission (PR), and 28 cases (14.9%) were in disease stabilization (SD), and 33 cases (17.6%) were in disease progression (PD), with an objective remission rate (ORR) of 67.6% (127/188). Among 10 treatment-na?ve patients, 4 cases (40.0%) were in CR, 5 cases (50.0%) were in PR, and 1 case (10.0%) was in PD, with an ORR of 90.0% (9/10). The median follow-up time was 2.9 months (95% CI 2.4-3.7 months), and the median PFS and OS of patients in relapsed/refractory and treatment-na?ve groups were not reached. In relapsed/refractory patients, the difference in ORR between patients with different number of treatment lines of mitoxantrone hydrochloride liposome injection [ORR of the second-line, the third-line and ≥the forth-line treatment was 74.4% (67/90), 73.9% (34/46) and 50.0% (26/52)] was statistically significant ( P = 0.008). Of the 198 PTCL patients, 182 cases (91.9%) experienced at least 1 time of treatment-related adverse events, and the incidence rate of ≥grade 3 adverse events was 66.7% (132/198), which was mainly characterized by hematologic adverse events. The ≥ grade 3 hematologic adverse events mainly included decreased lymphocyte count, decreased neutrophil count, decreased white blood cell count, and anemia; non-hematologic adverse events were mostly grade 1-2, mainly including pigmentation disorders and upper respiratory tract infection. Conclusions:The use of mitoxantrone hydrochloride liposome injection-containing regimen in the treatment of PTCL has definite efficacy and is well tolerated, and it is a new therapeutic option for PTCL patients.

Objective To investigate the regulatory effect of Bupi Yichang pill(BPYCP)on CD4+T cell subsets of ulcerative colitis(UC)mice.Methods Forty-eight C57BL/6 mice were randomly divided into 4 groups:the control group(n=10),the model group(DSS group,n=13),the model +BPYCP group(DSS+BPYCP group,n=13)and the model+ mesalazine(5-ASA)group(DSS+5-ASA group,n=12).The mouse UC model was induced by 2.5%dextrosan sulfate(DSS)solution.The DSS+BPYCP group and the DSS+5-ASA group were given BPYCP or 5-ASA for 2 weeks,respectively,and fecal viscosity and blood in stool were observed.The colon length was measured.Colonic mass index and unit colonic mass index were calculated.Hematoxylin-eosin(HE)staining was used to observe pathological changes of colon and to score the pathological tissue damage.The level of CD4+T cell subsets in mesenteric lymph nodes was detected by flow cytometry.The expression levels of cytokines interferon-γ(INF-γ),interleukin(IL-4),IL-17A,IL-10 and IL-21 secreted by CD4+T cell subsets in colon tissue were detected by ELISA.Real-time fluorescence quantitative PCR was used to detect colon tissue CD4+T cell subset nuclear transcription factors,mRNA expression levels of T-frame protein 21(T-bet),GatA-binding protein 3(GATA-3),retinoa-associated nuclear orphan receptor γt(RORγt),B cell lymphoma-6(Bcl-6)and Foxp3 in rats.Results Compared with the DSS group,the diarrhea and hematostoecium symptoms of UC mice in the DSS+BPYCP group and the DSS+5-ASA group were significantly improved,body weight and colon length of mice were increased,and colon mass,colon mass index and unit colon mass index were decreased(P＜0.05).The mucosal epithelium was more complete than that in the DSS group,and gland arrangement was more regular.The inflammatory cell infiltration was less,and the pathological tissue damage score was significantly decreased(P＜0.01).The proportion of Th2 cells in mesenteric lymph nodes was decreased,the proportion of Th17 cells and the level of IL-17A were decreased,and the mRNA levels of T-bet,GATA-3,RORγt and Bcl-6 in colon tissue were decreased(P＜0.05).In the DSS+BPYCP group,the proportion of Th1 cells decreased,the proportion of CD4+CD25+Treg cells,CD4+CD25+Foxp3+Treg cells and the level of IL-10 increased,and the proportion of CD4+CXCR5+Tfh cells and the level of IL-21 decreased.The level of Foxp3 mRNA increased(P＜0.05).The proportion of Th1 cells and the level of IFN-γ were decreased in the DSS+5-ASA group(P＜0.05).Conclusion BPYCP may alleviate UC by remodeling the homeostasis of CD4+T cell subpopulations.