ObjectiveIntegrated medical and elderly care is a practical step to implement and enhance the health and quality of elderly care. This paper aims to delve into the underlying relationships among factors influencing institutional utilization of integrated medical and elderly care services， promote the efficient service utilization of integrated medical and elderly care model in institutions， and achieve substantial progress in elderly care welfare. MethodsThrough literature review， questionnaire surveys， and expert interviews， 15 key factors influencing the utilization of integrated medical and elderly care services in elderly care institutions were identified and screened. The TISM model and MICMAC method were employed to establish the mechanism of the influencing factors of the utilization of integrated medical and elderly care services in elderly care institutions， and the dependence and driving force among the influencing factors were analyzed. ResultsOverlapping functions among government departments， unclear boundaries of powers and responsibilities， and a low degree of improvement and implementation of the policy were the core driving factors affecting institutional utilization of integrated medical and elderly care services. ConclusionThrough in-depth analysis of the interaction among various influencing factors， practical suggestions for improvement were proposed to build a three-dimensional collaborative intelligent governance mechanism， shape the new advantages of the self-construction of elderly care institutions， and provide strategic support for the optimization of integrated medical and elderly care services utilization in China.

Objective To investigate the expression and clinical significance of extracellular nicotinamide phosphate ribose transferase(eNAMPT)and soluble programmed death ligand 1(sPD-L1)in serum of pa-tients with sepsis secondary to severe pancreatitis(SAP).Methods A total of 92 SAP patients admitted to the hospital from February 2019 to February 2022 were selected as(SAP grou),and divided into a sepsis group(42 cases)and a non-sepsis group(50 cases).Moreover,50 patients with mild to moderate pancreatitis who were diagnosed and treated at the same time were selected as the disease control group,and 50 healthy in-dividuals who underwent the physical examination in the hospital during the same pariod were selected as the healthy control group.Enzyme linked immunosorbent assay was used to detect serum levels of eNAMPT and sPD-L1.Pearson correlation analysis was used for correlation analysis.Multivariate Logistic regression analy-sis was used to analyze factors affecting the occurrence of secondary sepsis in SAP.The predictive value of ser-um eNAMPT,sPD-L1 and their combination in the secondary sepsis of SAP was conducted by receiver operat-ing characteristic(ROC)curve.Results The serum levels of eNAMPT and sPD-L1 in the SAP group were higher than those in the disease control group and the healthy control group,and the differences were statisti-cally significant(P＜0.05).The Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,white blood cell count,C-reactive protein,pancreatic nec-rosis,systemic inflammatory response syndrome,multiple organ failure,serum eNAMPT and sPD-L1 in the sepsis group were higher than those in the non-sepsis group,and the differences were statistically significant(P＜0.05).There was a positive correlation between serum eNAMPT,sPD-L1 and APACHE Ⅱ score,SOFA score in sepsis SAP patients(P＜0.05).Serum eNAMPT and sPD-L1 were independent risk factors for sec-ondary sepsis in SAP patients.The area under the curve(AUC)of the combination of serum eNAMPT and sPD-L1 for predicting secondary sepsis in SAP patients was 0.916(95％CI:0.868-0.947),which was signif-icantly larger than 0.846(95％CI:0.791-0.879)and 0.830(95％CI:0.774-0.861)of the single indicator detections,and the differences were statistically significant(Z=4.129,4.885,P＜0.001).Conclusion The serum eNAMPT and sPD-L1 levels in patients with sepsis secondary to SAP are elevated,which are related to the severity of the disease.The combination of serum eNAMPT and sPD-L1 has high predictive value for sec-ondary sepsis in SAP.

Objective To establish and verify the fluctuation of reference intervals for biochestry parameters in routine physical exami-nation. Methods The results of biochemistry parameters,i.e., total protein (TP), albumin (Alb), total bilirubin (T-Bil), alanine aminotransferase (ALT), glucose (Glu), urea (Urea), creatinine (Cr), uric acid (UA), triacylglycerol (TG) and total cholesterol ( TC) from 2 089 healthy subjects in routine physical examination during consecutive 2014, 2015 and 2016 were randomly collected, in which all the results were within the reference range. The ratio (λ1) of the results of 2015 to those of 2014, and ratio (λ2) of the re-sults of 2016 to those of 2015 were calculated. λ1was analyzed statistically to establish the fluctuation of reference interval (CIλ). CIλ was verified by λ2.The personalized reference interval (CIp) was established by multiplying each result of 2015 and the upper and low-er limits of CIλ. The CIpwas verified by the results of 2016. The ratios of CIpto the upper and lower limits of conventional reference in-terval were calculated. Results The values of CIλwere as follows: TP: 0.91 to 1.08, Alb: 0.91 to 1.08, T-Bil: 0.58 to 1.74, ALT:0.49 to 1.99, Glu: 0.84 to 1.20, Urea: 0.67 to 1.50, Cr: 0.82 to 1.22, UA: 0.77 to 1.32, TG: 0.51 to 1.98 and TC: 0.80 to 1.26. Compared with conventional reference interval, the ratio of the upper and lower limits of CIp was lessened. Conclusion The personal-ized reference interval (CIp) which may increase the sensitivity of conventional reference intervals was established and verified.

Objective To establish and verify the personalized reference interval of blood cells.Methods The results of blood cells from 2 089 health subjects in 2014,2015 and 2016 were collected.The ratio of the later results to the previous results was defined as the fluctuation (λ).The ratio (λ1) of the results of 2015 to the results of 2014 was calculated and λ1 was analyzed statistically to establish the fluctuation reference interval (CIλ).The ratio (λ2) of the results of 2016 to the results of 2015 was calculated.λ2 was used to verify λ2.The personalized reference interval (CIp) was established by multiplying each result of 2015 and CIλ.CIp was verified by results of 2016.The ratio of the upper and lower limits of CIp was calculated.The ratio of the upper and lower limits of the reference interval (WS/T 405) was calculated.Results The values of CIλ were as follows:WBC (0.66 to 1.53),L(0.67 to 1.51),M (0.50 to 2.00),N(0.56 to 1.78),E(0.4 to 2.51),PLT(0.76 to 1.32),RBC(0.92 to 1.12),Hb(0.92 to 1.11),Hct(0.91 to 1.12),MCV(0.95 to 1.07),MCH(0.95 to 1.05)and MCHC(0.94 to 1.06).The validation tests of CIλ and CIp showed that both CIλ and CIp were suitable for this laboratory.Compared with the reference interval of professional criteria,the ratio of the upper and lower limits of the CIp was smaller than that of traditional criteria.Conclusion CIp for this laboratory was established and verified.Compared with traditional criteria,CIp should be more personalized and highly sensitive.

Objective To compare the clinical efficacy of triple needling and conventional acupuncture in the treatment of cervical spondylosis of vertebral artery type. Methods 49 cases with cervical spondylosis of vertebral artery type were randomly divided into two groups ,24 patients of control group treated with conventional acupuncture,25 patients of observation group treated with triple needling,the clinical results of two groups were compared. Results The obvious effective rate of the observation group was significantly higher than the control group, there were significant differences between two groups( x2 =4. 69 ,P < 0. 05). The improvement of average flow velocity(Vm) of the observation group was better than the control group, there was significant difference between two groups ( P < 0. 05 ).Conclusion Triple needling in the treatment of cervical spondylosis of vertebral artery type had better clinical results, and it was worthy of concern.

Objective To evaluate the clinical efficacy and adverse effect of Traditional Chinese Medicine and acupuncture in treatment of ankylosing spondylitis. Methods 46 patients of ankylosing spondylitis with informed consent were randomly divided into observation group and control group by number table,each of 23 cases.The control group received traditional Chinese medicine,the observation group was treated with acupuncture and traditional Chinese medicine,the two groups were treated for 1 month,the clinical effect were observed. Results In the observation group,excellent in 18 cases(78.3%),effective in 3 cases(13.0%),ineffective in 2 cases(8.7%),the total effective rate was 91.3%,it was significantly higher than that of control group the 11 cases(47.8%),8(34.8%),4 cases (17.4%)and 82.6%,the difference between the groups was statistically significant(x2=4.572,P＜0.05).The patients of observation group had a rash in 1 case,1 case of pain;in the control group,1 case of rash,1 case of itching;all of the symptoms were relatively minor,did not affect the treatment.There were no significant adverse reactions in the patients of two groups. Conclusion Traditional Chinese medicine and acupuncture in treatment of ankylosing spondylitis had satisfactory effects and no significant adverse reactions,it was worthy to be recommended in the clinical application.

Objective To explore the in vitro culture conditions for neural stem cells to differentiate into neuron-like cells.Methods Neural stem cells were induced to differentiate by a medium containing bFGF and heparin through adhesive culture.Immunohistochemistry was used to identify the expressions of NSE and GFAP after differentiation.Results Positive cells for NSE were 47.3%?1.7% on the 7th day after induction.The number of NSE positive cells in the induction group was 3 times as many as that in the control group(P