Under the background of the integrated development of the Guangdong-Hong Kong-Macao Greater Bay Area,the demand for medical services from Hong Kong and Macao residents in Guangdong continues to grow.As the main force in pro-viding medical services in Guangdong,public hospitals play a crucial role.This article aims to explore the current situation of the development of medical services for Hong Kong and Macao residents in Guangdong and propose development strategies from the perspective of hospitals to contribute to the integrated development of the Greater Bay Area.The SWOT method is used to system-atically evaluate the strengths,weaknesses,opportunities,and threats of Guangdong public hospitals in the development of medi-cal services for Hong Kong and Macao residents.A SWOT matrix is then constructed to formulate development countermeasures.The analysis shows that Guangdong public hospitals have advantages such as convenient transportation,cultural affinity,abundant medical resources,high service efficiency,and relatively low costs.However,they also face challenges such as inadequate cover-age of cross-border medical insurance,immature specialized services,inconsistent service standards,and insufficient exploration of cross-border medical care.At the same time,there are opportunities provided by national strategic support and strong market demand,while fierce market competition and slow integration of medical regulations among the three regions pose external threats.Based on the analysis,this article proposes countermeasures and suggestions,including strengthening publicity and innovative in-dustry cooperation,phased development of business,striving for policy coverage,enhancing business coordination,accelerating cooperation with the Hong Kong and Macao in medical care,and promoting international accreditation of hospitals.These sugges-tions provide decision-making references for the development of medical services for Hong Kong and Macao residents in Guang-dong's public hospitals.

Under the background of the integrated development of the Guangdong-Hong Kong-Macao Greater Bay Area,the demand for medical services from Hong Kong and Macao residents in Guangdong continues to grow.As the main force in pro-viding medical services in Guangdong,public hospitals play a crucial role.This article aims to explore the current situation of the development of medical services for Hong Kong and Macao residents in Guangdong and propose development strategies from the perspective of hospitals to contribute to the integrated development of the Greater Bay Area.The SWOT method is used to system-atically evaluate the strengths,weaknesses,opportunities,and threats of Guangdong public hospitals in the development of medi-cal services for Hong Kong and Macao residents.A SWOT matrix is then constructed to formulate development countermeasures.The analysis shows that Guangdong public hospitals have advantages such as convenient transportation,cultural affinity,abundant medical resources,high service efficiency,and relatively low costs.However,they also face challenges such as inadequate cover-age of cross-border medical insurance,immature specialized services,inconsistent service standards,and insufficient exploration of cross-border medical care.At the same time,there are opportunities provided by national strategic support and strong market demand,while fierce market competition and slow integration of medical regulations among the three regions pose external threats.Based on the analysis,this article proposes countermeasures and suggestions,including strengthening publicity and innovative in-dustry cooperation,phased development of business,striving for policy coverage,enhancing business coordination,accelerating cooperation with the Hong Kong and Macao in medical care,and promoting international accreditation of hospitals.These sugges-tions provide decision-making references for the development of medical services for Hong Kong and Macao residents in Guang-dong's public hospitals.

Objective:To investigate the correlation between cognitive function and living ability of older adult patients living in a mining community.Methods:A total of 180 older adult patients living in a mining community who received treatment during July-October 2019 were included in this study. They were randomly divided into the low-age group (< 68 years old, n = 94) and the high-age group (≥ 68 years old, n = 86). Cognitive function and living ability were evaluated using the Mini-Mental State Examination (MMSE), The Montreal Cognitive Assessment (MoCA), and the Activity of Daily Living Scale (ADL). The relationship between cognitive function and living ability was investigated using hierarchical analysis and Pearson correlation analysis. Results:The proportions of older adult patients with abnormal cognitive function identified by the MMSE and MoCA were 39.4% and 66.0%, respectively in the low-age group, and they were 32.6% and 61.6%, respectively in the high-age group. The MoCA had a greater performance in identifying abnormal cognitive function in each group than the MMSE ( χ2 = 26.69, 10.18, both P < 0.001). There were no significant differences in proportions of older adult patients with abnormal cognitive function identified by the MMSE and MoCA between low-age and high-age groups ( χ2 = 0.90, 0.36, both P > 0.05). The proportion of older adult patients with abnormal living ability was not significantly different between low-age and high-age groups (4.3% vs. 10.5%, χ2 = 2.58, P > 0.05). Compared with patients negative for MMSE items, living ability and instrumental activity of daily living increased by 7.0% and 9.4% in low-age patients positive for MMSE items (both P < 0.05). Compared with patients negative for MoCA items, living ability increased by 3.5% in low-age patients positive for MoCA items ( P < 0.05). Correlation analysis revealed that total scores of MMSE and MoCA were significantly negatively correlated with ADL score ( r = -0.26, -0.27, both P < 0.001) and instrumental activity of daily living score ( r = -0.27, -0.27, P < 0.001). Conclusion:Cognitive function and living ability are correlated in older adult patients living in a mining community. We should pay attention to the screening results of cognitive disorder in older adult patients and improve their living ability by improving their cognitive function.

Objective:To explore the factors influencing the severity and prognosis of vancomycin-associated acute kidney injury (AKI).Methods:Case reports on vancomycin-associated AKI were collected by searching the relevant databases home and abroad up to June 2020. Patients′ relevant information such as general condition, underlying diseases, infecting species, treatment of vancomycin, baseline serum creatinine (Scr), baseline estimated glomerular filtration rate (eGFR), time from medication to onset of AKI, Scr elevation rate, eGFR decline rate, management of AKI, and outcomes were recorded and descriptively analyzed. The influence factors of the rates of Scr elevation and eGFR decline in patients were analyzed using robust regression method and the influence factors of the prognosis of vancomycin-associated AKI were analyzed by comparing the main clinical features of patients with basic recovery and improvement of Scr level.Results:A total of 81 reports involving 109 patients were enrolled in the analysis, including 65 males and 44 females, aged from 1 to 84 years with a median age of 49 years, of which 20 were ≤15 years old and 61 (56.0%) suffered from underlying chronic diseases. The median daily dose of vancomycin was 2.00 (0.75, 6.00) g in 89 adult patients and 40.0 (10.3, 240.0) mg/kg in 20 pediatric patients. The median time from medication to onset of AKI was 7 (1, 135) days, and 80 (73.4%) occurred within 14 days after first medication. Seventy-five patients (68.8%) had concomitant use of drugs with potential nephrotoxicity. The median value of peak Scr was 408 (53, 1 000) μmol/L, and the median eGFR was 44.3 (4.2, 280.7) ml/(min·1.73 m 2) after developing AKI. Steady-state trough concentration of vancomycin was recorded in 57 patients, which was 46.2 (11.8,284.0) mg/L before or at onset of AKI. Except 4 patients died and 1 patient was lost to follow-up, the Scr level basically recovered in 50 patients, were improved in 51 patients, and did not recover in 3 patients, which required continuous renal replacement therapy. Robust regression analysis showed that the trough concentration of vancomycin and the number of concomitant nephrotoxic drugs were significantly correlated with the rates of Scr elevation and eGFR decline after AKI (all P<0.05). The age and peak Scr in patients with basic recovery of renal function were significantly lower than those in patients with improved renal function (all P<0.001), while the lowest eGFR value was significantly higher( P=0.036). Conclusions:Patients with higher trough concentration of vancomycin and more nephrotoxic drugs would have greater elevation of Scr and the decline of eGFR. Older age, higher Scr peak value, and lower eGFR was associated with worse recovery of the renal function.

Objective:To explore the factors influencing the severity and prognosis of vancomycin-associated acute kidney injury (AKI).Methods:Case reports on vancomycin-associated AKI were collected by searching the relevant databases home and abroad up to June 2020. Patients′ relevant information such as general condition, underlying diseases, infecting species, treatment of vancomycin, baseline serum creatinine (Scr), baseline estimated glomerular filtration rate (eGFR), time from medication to onset of AKI, Scr elevation rate, eGFR decline rate, management of AKI, and outcomes were recorded and descriptively analyzed. The influence factors of the rates of Scr elevation and eGFR decline in patients were analyzed using robust regression method and the influence factors of the prognosis of vancomycin-associated AKI were analyzed by comparing the main clinical features of patients with basic recovery and improvement of Scr level.Results:A total of 81 reports involving 109 patients were enrolled in the analysis, including 65 males and 44 females, aged from 1 to 84 years with a median age of 49 years, of which 20 were ≤15 years old and 61 (56.0%) suffered from underlying chronic diseases. The median daily dose of vancomycin was 2.00 (0.75, 6.00) g in 89 adult patients and 40.0 (10.3, 240.0) mg/kg in 20 pediatric patients. The median time from medication to onset of AKI was 7 (1, 135) days, and 80 (73.4%) occurred within 14 days after first medication. Seventy-five patients (68.8%) had concomitant use of drugs with potential nephrotoxicity. The median value of peak Scr was 408 (53, 1 000) μmol/L, and the median eGFR was 44.3 (4.2, 280.7) ml/(min·1.73 m 2) after developing AKI. Steady-state trough concentration of vancomycin was recorded in 57 patients, which was 46.2 (11.8,284.0) mg/L before or at onset of AKI. Except 4 patients died and 1 patient was lost to follow-up, the Scr level basically recovered in 50 patients, were improved in 51 patients, and did not recover in 3 patients, which required continuous renal replacement therapy. Robust regression analysis showed that the trough concentration of vancomycin and the number of concomitant nephrotoxic drugs were significantly correlated with the rates of Scr elevation and eGFR decline after AKI (all P<0.05). The age and peak Scr in patients with basic recovery of renal function were significantly lower than those in patients with improved renal function (all P<0.001), while the lowest eGFR value was significantly higher( P=0.036). Conclusions:Patients with higher trough concentration of vancomycin and more nephrotoxic drugs would have greater elevation of Scr and the decline of eGFR. Older age, higher Scr peak value, and lower eGFR was associated with worse recovery of the renal function.

Objective:To explore the reliability of preoperative diagnosis of low-grade infectious nonunion using haematological testing and radioisotope scanning (bone 3-phase image).Methods:A retrospective study was conducted of the 265 patients with bone nonunion who had been treated at Department of Orthopaedics, The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University and at Department of Orthopaedics, The Eighth People’s Hospital Affiliated to Shanghai Jiaotong University from June 2010 to June 2018.They were 151 males and 114 females, aged from 19 to 64 years (average, 39.7 years).The nonunions occurred mainly at the tibia (113 cases) and the femur (72 cases).The preoperative results of their white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and radioisotope scanning were recorded.Taking the intraoperative pathological observations as the gold standards, the sensitivity, specificity, area under curve (AUC) of receiver operator characteristic (ROC) and Youden index were statistically analyzed respectively for every preoperative haematological tests and radioisotope scanning as well as for different combinations of the radioisotope scanning and one or more haematological tests.Results:Compared with the pathological observations, the radioisotope scanning showed a sensitivity of 80.7%, a specificity of 73.3%, an AUC of 0.770 and a Youden index of 0.540.In the combinations of radioisotope scanning and one haematological test, that of radioisotope scanning and CRP produced the largest AUC of 0.683, a sensitivity of 98.0%, a specificity of 70.3%, and a Youden index of 0.848.In the combinations of radioisotope scanning and 2 haematological tests, that of radioisotope scanning and WBC and ESR produced the largest AUC of 0.895, a sensitivity of 94.3%, a specificity of 67.3%, and a Youden index of 0.616 and all the 3 ones yielded an AUC of more than 0.880.The combination of radioisotope scanning and all the 3 haematological tests produced a sensitivity of 96.5%, a specificity of 79.7%, an AUC of 0.925 and a Youden index of 0.762.Conclusion:Combination of haematological testing and radioisotope scanning can be a reliable preoperative diagnosis of low-grade infection nonunion.

Objective:The characteristics and prognosis of ear fullness feeling in patients with all-frequency sudden deafness were explored.Method:104 patients (104 ears) with unilateral all-frequency sudden deafness were collected in study from June 2015 to March 2019, including 50 males and 54 females, the mean age ranged from 23-65 years, and the disease duration ranged from 1-9 days. Of those, 56 patients accompanied with the feeling of ear fullness (FEF) were enrolled into'the ear fullness group′, and 48 patients without FEF were included in'the without ear fullness group′. Patients′ treatment strategy followed the Chinese Medical Association Guidelines for the diagnosis and treatment of sudden deafness (2015). Moreover, VAS scale scores and subjective grading of FEF were acquired in patients with FEF. We analyzed the clinical characteristics and prognosis of FEF with SPSS 23.0 software.Results:There were no differences between the two groups in terms of age, gender, duration of disease, the side of deaf ear, degree of hearing loss, and auditory brainstem evoked potential results (age, t=1.566; gender,χ 2=0.001; duration, t=0.057; side,χ 2=0.033; degree of hearing loss Z=-0.180; ABR,χ 2=0.001;all P>0.05) . There was a positive correlation between the subjective grading of FEF and the degree of hearing loss in patients with FEF ( r=0.599, P<0.001) . The total rate of hearing improvement following one month of treatments in patients with FEF vs with no FEF was 35/56(62.5%) vs 28/48(58.3%) ( Z=-0.641, P=0.521). After one month of treatment, the total effective rate of FEF was 94.6%(53/56), and the improvement of FEF had nothing to improvement of hearing ( r=0.040, P=0.769) . Conclusions:The degree of hearing loss is positively correlated with the degree of FEF in patients with all-frequency sudden deafness. Hearing recovery is not related to FEF. The recovery effect of FEF is good, and has no correlation with hearing recovery.

Objective To explore the methods of Y-V vascular pedicle lengthening technique for cover-age of the defect of great toe after wrap-around flap transfer, and decrease the morbidity of donor site in great toes. Methods Fifteen patients received three kinds of flap for immediate resurfacing of donor defect of the great toes during wrap-around flap transfer, all flaps were harvested with Y-V vascular pedicle lengthening technique. Among them, 9 cases received the free lateral tarsal flaps transplantation for coverage of defect in donor great toes, 5 cases was repaired by medial tarsal flaps, and only one was treated by the medial plantar flap. Results All the flaps survived postoperatively. The medial plantar flap encountered the venous crisis in postoperative 3 days, and regained the normal blood supply after continuous bleeding for 2 days. All patients were satisfied with cosmetic and functional outcome in average 10- month follow-up. The appearance and sensory function of donor toe repaired by medial tarsal flaps was best among three ones. Conclusion Depending on the Y-V vascular pedicle lengthening technique, the local pedical flaps of foots are enlarged scope for coverage of great toe after wrap-around flap harvest, which can decrease the complication of donor site at the most.