Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Purpose/Significance To analyze the dynamic changes,influencing factors and weak links of e-health literacy of middle-aged and elderly people,so as to provide references for improving e-health literacy of middle-aged and elderly people.Method/Process A questionnaire survey is conducted among 505 middle-aged and elderly people in Guangzhou,and the results are analyzed by using SPSS 24.0.Result/Conclusion The average score of e-health literacy of middle-aged and elderly people is in the middle level;The weak link of e-health literacy is the lack of health information interaction and evaluation capacity.Individual factors are the primary factors that affect e-health literacy of middle-aged and elderly people.It is suggested to increase policy and financial support,carry out"the younger population helps the aging population"mode,and elderly-oriented transformation of digital health Apps.

Objective To investigate the protective effect of sappanone A(SA)against high-fat diet-induced myocardial lipotoxicity through ferroptosis in rats.Methods Sixteen healthy male rats were equally divided into the normal diet(NCD)and model groups(n=8).Another 40 healthy male rats were equally divided into the high-fat diet(HFD),high-fat diet+normal saline(HFD+saline),high-fat diet+low-dose SA(HFD+10 mg/kg SA),high-fat diet+medium-dose SA(HFD+20 mg/kg SA),and high-fat diet+high-dose SA(HFD+40 mg/kg SA)groups(n=8).Ultrasonography detected the changes in cardiac systolic function in the rats.Changes of myocardial hypertrophy,myocardial fibrosis,and myocardial cell apoptosis were evaluated by HE,Masson,Sirius red,and TUNEL staining.Differen-tially expressed genes in the myocardium of the HFD+20 mg/kg SA and HFD groups were analyzed by transcriptome sequencing.The SA signaling pathway was analyzed using the Kyoto Encyclopedia of Genes and Genomes.Results Compared with the NCD group,the model group had significantly increased left ventricular wall thickness,cross-sectional area of the myocardium,percentage of myocardial fibrosis,myocardial collagen deposition,and apoptosis,and significantly reduced short-axis shortening rate(all P＜0.05).Compared with the HFD group,the SA treatment groups has significantly reduced left ventricular wall thickness,cross-sectional area of the myocardium,percentage of myocardial fibrosis,myocardial collagen deposition,and apoptosis,and significantly increased short-axis shortening rate(all P＜0.05).Transcriptome sequencing revealed that ferroptosis was the most abundant pathway.Conclusion High-fat diet can induce myocardial lipotoxicity,and SA has a protective effect against myocardial lipotoxicity through ferroptosis.

OBJECTIVE To provide reference for the regulation of electronic prescription circulation under the mode of “medical science + pharmacy”. METHODS Based on evolutionary game theory， a tripartite evolutionary game model was constructed for related parties of electronic prescription circulation （government agencies， internet hospitals and third-party drug platforms） under the mode of “medical science + pharmacy”. The influential factors of the three parties’ strategy selection were analyzed and verified by simulation. RESULTS & CONCLUSIONS The strategic choices of all parties in the game were affected by the other two parties. Reducing the cost of strict supervision or increasing the punishment for the other two parties would increase the probability of strict supervision of government agencies. Enhancing reputation losses， increasing penalties， and reducing the cost difference when choosing different strategies would have regulatory and binding effects on internet hospitals and third-party drug platforms. It is suggested that government agencies can introduce diversified supervision mode and establish an integrated “intelligent supervision + traceability” system； pay attention to the construction of reputation mechanism， and promote the coordinated linkage of all parties； increase the punishment for violations， provide policy support， reduce the cost of compliance behavior to promote the high-quality development of electronic prescription circulation under the mode of “medical science + pharmacy”.

Objective To study the regulation of Withaferin A on apoptosis-related proteins in lung squamous cell carcinoma and its effect on cell epithelial-mesenchymal transition.Methods Lung squamous cell carcinoma cell line SK-MES-1 were cultured in vitro.The SK-MES-1 cells were treated with the final mass concentration of 0 (control),5,10,20,and 40 μg/ml for 28 h,and the general morphology and shedding of the cells were observed under phase contrast microscope;MTT assay was used for detection of cell viability;flow cytometry was used for detection of apoptosis;immunofluorescence and real-time fluorescent polymerase chain reaction (RT-PCR) was used for detection of apoptosis-related proteins and genes bcl-2 and bax,and expression of the epithelial marker E-cadherin and the interstitial marker Vimentin.Results Different concentrations (0,5,10,20,40 μg/ml) of Withaferin A inhibited the activity of SK-MES-1 cells with cell viability of 0.62±0.05,0.42±0.04,and 0.33±0.06,0.21±0.03,0.17±0.04,respectively,which suggesting that this inhibition was related to the concentration of Withaferin A (F =386.505,P =0.005).After treatment with SK-MES-1 cells for 24 h at different concentrations (0,5,10,20,40 μg/ml) of Withaferin A,the apoptosis rates of each group were (0.180±0.011) ％,(0.310±0.013) ％,(0.500±0.021) ％,(0.540±0.018) ％,and (0.410± 0.027) ％,which suggesting that Withaferin A rarely caused apoptosis,mostly necrotic cells (F =1 065.78,P =0.124).In SK-MES-1 cells treated with different concentrations of Withaferin A for 24 h,the results of immunofluorescence showed that the expression of Vimentin was decreased in the experimental group at a concentration of 20 μg/ml compared with the control group,and the fluorescence intensity was lower than that of the control group,but the fluorescence intensity of E-cadherin was higher than that of the control group;the intensity did not change significantly in the experimental group with the other concentrations.While the expression levels of bax and bcl-2 proteins in the control group and the experimental group did not change significantly.RT-PCR results showed that the mRNA expression of E-cadherin (6.7±0.6 and 6.4±0.9) in the experimental group at a concentration of 20 and 40 μg/ml was significandy higher than that in the control group (4.2±1.0),and the difference was statistically significant (both P ＜ 0.05),and the mRNA expression of Vimentin (4.7±0.5 and 4.7±0.5) was significantly lower than that in the control group (7.2±0.7),and the difference was statistically significant (both P ＜ 0.05).Conclusion Withaferin A can inhibit the growth of lung squamous cell carcinoma cells and inhibit the process of epithelial-mesenchymal transition,but it has no obvious relationship with apoptosis and apoptosis-related proteins.

Objective To explore nursing care of the ex-utero intrapartum treatment (EXIT) in fetal neck mass oppressing airway. Methods A case of EXIT in which a fetal neck mass was diagnosed on ultrasound was fully prepared supplies and carried out. Nursing care was well implemented and vital signs of the puerpera and fetus were observed in preoperative and intraoperative surgery. Results The EXIT procedure was successful performed and vital signs of the puerpera and fetus were steadied. The score of Apgar was seven to eight. Conclusions Adequate equipment, multi-department collaboration, preoperative exercise and close cooperation are the important guarantee for the success of ex-utero intrapartum treatment.

Objective To evaluate the efficacy of 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap for the treatment of complex anterior urthral strictures.Methods Between January 2006 and January 2013, 37 patients with complex anterior urethral stricture were treated by 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap.The mean age was 41 years ( 22 -71 years) .The etiology of stricture included trauma of 13 cases, iatrogenieity of 13 cases, gonorrhea infection of 2 cases, unknown reason of 9 cases.The penile urethral stricture was found in 22 cases, the bulbourethral stricture in 9 cases, and stricture extending from penile to posterior urethra in 6 cases.The mean length of anterior urethral stricture was 8.1 cm (range 5.0-14.0 cm).A circumferential island of the preputial/distal penile skin was mobilized by the technique of preserving penile fasciocutaneous wide vascular pedicle. The pedicle is composed of two layers of the dartos and the superficial lamella of Buck′s fascia, and the flap was divided in the midventral/middorsal plane back to the penoscrotal junction to convert the circular configuration to a longitudinal trip for urethral reconstruction.The dorsal and ventral inlaid flap urethroplasty was performed in 27 cases and tubularized flap urethroplasty was performed in 10 cases.Results The mean operative duration was 3.1 h (2.5-3.5 h).The mean length of the circular fascioctaneous preputial flap was 10.4 cm (range 9.0 -14.0 cm).All the patients were followed up for mean 22 months (3 -51 months).Thirty-two cases voided well and the mean peak urinary flow rate was 22.3 ml/s (15.0-29.0 ml/s).One-stage healing achieved in 32 cases (86.5%).Recurrent stenosis was noted in 4 cases, and meatal stenosis occurred in 1 patient, who required re-operation.Re-repair succeeded in 4 cases and total success rate was 97.3% (36/37).Conclusions The pedicle circular fascioctaneous preputial flap has advantage of good blood supply and autograft for new meatus.It could be a reliable and durable method for the treatment of complex anterior urthral strictures(≥5 cm) in 1-stage urethroplasty.

Objective: To investigate the effect with its possible mechanisms of zacopride on vasodilatation of isolated coronary arterial rings in experimental rats.
Methods: The tension of vasodilatation of isolated coronary arterial rings of male SD rats was recorded by Powerlab and DMT system. The rats were divided into 4 groups: +Endo (vehicle) group, +Endo (zacopride) group and -Endo (vehicle) group, –Endo (zacopride) group.n=6 in each group. The vasodilatation effects of zacopride on KCl (60 mmol/L) and U46619 (10-6 mol/L) pre-constricted arterial ring were recorded; the effects of different agents on zacopride caused vasodilatation were studied.
Results: In both +Endo (zacopride) and –Endo (zacopride) groups, zacopride showed a dose dependent vasodilatation effect on coronary ring pre-constricted by KCl and U46619. The maximum vasodilatation effect of zacopride in KCl treated+Endo (zacopride) group was (90.15 ± 6.38) %, in U46619 treated-Endo (zacopride) group was (81.67 ± 4.97 ) %; the maximum vasodilatation effect of zacopride in KCl treated-Endo (zacopride) group was (85.48±5.04) %, in U46619 treated–Endo (zacopride) group was (79.65 ± 3.51) %, compared to each corresponding vehicle group, allP<0.05. The inhibitor of IK1 channel, BaCl2 could signiifcantly reduce the vasodilatation effect of zacopride in KCl and U46619 pre-constricted coronary ring,P<0.05. However, the inhibitor of eNOS (L-NAME), the blocker of KCa channel (TEA), blocker of Kv channel (4-AP) and blocker of KATP channel (Glib) had no such signiifcant effects, allP>0.05.
Conclusion: Zacopride had vasodilatation effect on coronary arterial ring which was pre-constricted by KCl and U46619, which might be related to the channel of IK1.

Objective To probe into the cognitive function among elders in Xinzhongjie community and provide the evidence for corresponding nursing interventions. Methods Convenient sampling was used to recruit 193 elders who were equal to or older than 60 for the investigation by Montreal cognitive assessment ( MoCA) . Results There were 37 elders (19. 17%) who were abnormal on cognitive function. Cognitive function was related to age, educational level, and whether had brain disease. Elders, who were in older, with lower educational level, and had brain disease, were more frequently to have abnormal cognitive function (χ2 =9. 54, 20. 58,21. 92;P<0. 01). By Logistic regression analysis, older age and brain disease were risk factors for cognitive function declines, while high educational level was a protective factor for the cognitive function. Conclusions Community nurses should pay increasing attention on the changes of cognitive function among elders who are in older age, with lower educational level, and have brain disease. Non-pharmacological nursing intervention can be provided to elders according to their specific cognitive function decline.