OBJECTIVE To investigate the clinical efficacy of integrating pharmacists into family health teams （FHTs） for long-term medication therapeutical management （MTM） in stroke patients， and empirically evaluate the service model. METHODS A pharmacist team， jointly established by clinical and community pharmacists from the Affiliated Suzhou Hospital of Nanjing Medical University （hereinafter referred to as “our hospital”）， developed a pharmacist-supported MTM model integrated into FHTs. Using a prospective randomized controlled design， 170 stroke patients discharged from our hospital （July 2022-December 2023） and enrolled in FHTs at Suzhou Runda Community Hospital were randomly divided into trial group （88 cases） and control group （82 cases） according to random number table. The control group received routine FHTs care （without pharmacist involvement in the team collaboration）， while the trial group xhz8405@126.com received 12-month MTM services supported by pharmacists via an information platform. These services specifically included innovative interventions such as personalized medication regimen optimization based on the MTM framework， dynamic medication adherence management， medication safety monitoring， a home medication assessment system， and distinctive service offerings. Outcomes of the 2 grousp were compared before and after intervention， involving medication adherence （adherence rate， adherence score）， compliance rates for stroke recurrence risk factors [blood pressure， low-density lipoprotein cholesterol （LDL-C）]， and incidence of adverse drug reactions （ADR）. RESULTS After 12 months， the trial group exhibited significantly higher medication adherence rates， improved adherence scores， higher compliance rates for blood pressure and LDL-C targets compared to the control group （P＜0.05）. The incidence of ADR in the trial group （4.55%） was significantly lower than that in the control group （8.11%）， though the difference was not statistically significant （P＞ 0.05）. CONCLUSIONS Pharmacist involvement in FHTs to deliver MTM services significantly enhances medication adherence and optimizes risk factor for stroke recurrence， offering practical evidence for advancing pharmaceutical care in chronic disease management under the family doctor system.

Humans ; Norepinephrine ; Bacterial Infections/drug therapy* ; Immunity, Innate

AIM: To evaluate the refractive status through computer refractometer and OPD-Scan III auto refractometer in cataract patients after extended depth of focus(EDOF)intraocular lens implantation.METHODS: Retrospective observational study. A total of 61 cases(76 eyes)that received phacomulsification and implanted with TECNIS® Symfony ZXR00 intraocular lens in Shanghai Eye Diseases Prevention & Treatment Center from May 2022 to May 2023 were collected. Measurements from the computer refractometer, OPD-Scan III auto refractometer, and subjective refraction, were taken from all patients on the same day postoperatively.RESULTS: There were statistical significant difference in sphere(S)and spherical equivalent(SE)readings from the computer refractometer and subjective refraction(all P<0.01), with mean differences of -0.67±0.37 D and -0.75±0.35 D, respectively, and the S and SE obtained from computer refractometer more incline to myopia than those from subjective refraction; there were statistical significant difference in computer refractometer and subjective refraction(P<0.01), with a relative small absolute difference(0.21±0.24 D). The S, cylinder(C)and SE of computer refractometer(S, C, SE)were positively correlated with subjective refraction(r=0.7994, 0.7929, and 0.8118, respectively, all P<0.01). Additionally, there were statistical significant differences in S, C and SE of OPD-Scan Ⅲ and subjective refraction(P<0.01), and the absolute differences of S(0.63±0.36 D), C(0.35±0.26 D)and SE(0.53±0.36 D)were small. Furthermore, the S, C and SE of OPD-Scan Ⅲ were positively correlated with subjective refraction(r=0.4410, 0.4982, 0.5224, all P<0.01).CONCLUSION: In patients who received implantation of EDOF lenses, the consistency of computer refractometer, OPD-Scan III auto refractometer and subjective refraction was good. The average difference of the S and SE obtained via computer refractometer was large, but both exhibited a myopic shift relative to those derived from subjective refraction, and the C values demonstrated minimal discrepancy. Furthermore, the differences between OPD-Scan III auto refractometer and subjective refraction were small, but the direction of the difference is unstable, sometimes it is myopic deviation, while sometimes it is hyperopic deviation.

Objective To explore application of feedforward control nursing intervention in anesthesia recovery management of patients undergoing robot-assisted thoracoscopic radical resection for lung cancer.Methods Sixty-four patients underwent robot-assisted thoracoscopic radical resection for lung cancer at People's Hospital of Liaocheng City in Shandong Province from December 2021 to May 2022 were selected as research objects.They were randomly divided into control group and experimental group,with 32 cases in each group.Control group received routine nursing measures,while experimental group received nursing intervention under guidance of feedforward control on basis of control group.Pass rate of nurses relevant theoretical knowledge,incidence of perioperative complications,nursing satisfaction,nursing quality score,recovery room stay time,self-rating anxiety scale(SAS)and self-rating depression scale(SDS)scores before operation and when leaving recovery room were compared between two groups.Results Pass rate of nurses relevant theoretical knowledge in experimental group was significantly higher than that in control group(P<0.05).Total incidence rate of pressure injury,incidence rate of fluid circuit problems,agitation and hypothermia in experimental group were significantly lower than those in control group(P<0.05).Nursing effect,nursing professionalism,nursing operation and nursing attitude scores of experimental group were significantly higher than those of control group,and recovery room stay time of experimental group was significantly shorter than that of control group(P<0.05).When leaving recovery room,SAS and SDS scores of experimental group were significantly lower than those of preoperative in this group and control group(P<0.05).Conclusion Application of feedforward control nursing intervention in robot-assisted thoracoscopic lung cancer patient anesthesia recovery management can effectively reduce incidence of perioperative complications,shorten recovery time,improve nursing satisfaction and nursing quality scores,and improve patients'early postoperative anxiety and depression status,which is worthy of clinical application and promotion.

The miR-34 family plays an important role in gastric cancer, and the inactivation or reduced expression of the miR-34 family is detected in gastric cancer cell lines and gastric cancer tissues compared with normal gastric mucosa tissues, indicating it is associated with the occurrence and development of gastric cancer. Studies have shown that miR-34 plays a key role in inhibiting gastric cancer progression by regulating IGF2BP3, survivin, Bcl-2 and epithelial-mesenchymal transition-related pathway, indicating that miR-34 is an important target for gastric cancer treatment. In terms of clinical treatment, miR-34 has not only been proved to have radiochemotherapy sensitization, but also achieved good curative effect in tumor clinical trials. With the emergence of miR-34 vectors targeting gastric cancer, it is possible to use it for gastric cancer treatment. Deep understanding of the molecular basis and clinical efficacy of miR-34 for gastric cancer treatment can help to evaluate the potential of the miR-34 family as a new therapeutic target for gastric cancer.

Objective:To investigate the effect of Mediterranean diet on blood glucose control and cardiovascular risk factors in patients with type 2 diabetes.Methods:As to December 2021, the PubMed, Cochrance Central Register of Controlled Trials and Cochrance Database, Cochranc Library, Embase, China National Knowledge Infrastructure and Wanfang Medical Network system were searched for clinical randomized controlled trials(RCTs) of Mediterranean diet in patients with type 2 diabetes to conduct Meta-analysis The main observation index were cardiovascular risk factors, and the mean difference and its 95% confidence interval were used to estimate the effect size.Results:There were six RCTs, and 1181 patients met the inclusion criteria and entered the Meta-analysis. Compared with the control group, the intervention group can significantly reduce the level of systolic blood pressure ( MD=-1.20, 95% CI-2.21 to -0.19) and diastolic blood pressure ( MD=-4.17, 95% CI-7.12 to -1.22) in patients with type 2 diabetes mellitus, but there were no significant difference in the level of TC ( MD=2.92, 95% CI-0.84 to-6.67), HDL ( MD=2.33, 95% CI-0.27 to -4.92) and LDL ( MD=-2.34, 95% CI-5.67 to -0.99) between the two groups (all P>0.05). Conclusions:The meta-analysis provided evidence the Mediterranean diet showed the beneficial improvements in blood pressure glycemic control, but the effect of Mediterranean diet on lipid profile was not significant, which needed further verification.

Alfalfa(Medicago sativa L.)is the most important legume forage crop worldwide with high nutritional value and yield.For a long time,the breeding of alfalfa was hampered by lacking reliable information on the autotetraploid genome and molecular markers linked to important agro-nomic traits.We herein reported the de novo assembly of the allele-aware chromosome-level genome of Zhongmu-4,a cultivar widely cultivated in China,and a comprehensive database of genomic variations based on resequencing of 220 germplasms.Approximate 2.74 Gb contigs(N50 of 2.06 Mb),accounting for 88.39％of the estimated genome,were assembled,and 2.56 Gb contigs were anchored to 32 pseudo-chromosomes.A total of 34,922 allelic genes were identified from the allele-aware genome.We observed the expansion of gene families,especially those related to the nitrogen metabolism,and the increase of repetitive elements including transposable elements,which probably resulted in the increase of Zhongmu-4 genome compared with Medicago truncatula.Population structure analysis revealed that the accessions from Asia and South America had rela-tively lower genetic diversity than those from Europe,suggesting that geography may influence alfalfa genetic divergence during local adaption.Genome-wide association studies identified 101 sin-gle nucleotide polymorphisms(SNPs)associated with 27 agronomic traits.Two candidate genes were predicted to be correlated with fall dormancy and salt response.We believe that the allele-aware chromosome-level genome sequence of Zhongmu-4 combined with the resequencing data of the diverse alfalfa germplasms will facilitate genetic research and genomics-assisted breeding in variety improvement of alfalfa.

Objective:To understand the epidemiological characteristics of human adenovirus(HAdv)in Xuzhou area.Methods:A total of 7 257 swab samples from influenza-like illness children in Xuzhou children’s Hospital were collected during 2013-2019. Real-time PCR was used to detect adenovirus, and then the positive specimens were subjected to amplification for the hexon gene by polymerase chain reaction (PCR) for genotypic analysis. Adenovirus 55 was cultured by Hep-2 cells and analyzed by whole gene sequencing.Results:A total of 227 strains of adenoviruses were detected out of 7 257 samples, and the detection rate was 3.13%. Infections were mainly found in children aged 3 to 6, with a peak of detection in May and June. Typing data showed that the infection was mainly adenovirus type 3 and type 7, and the dominant type of adenovirus in different years alternated between type 3 and type 7. Complete gene sequencing showed only a few point mutations in genes of adenovirus type 55 we isolated, and no other gene mutation and recombination were found.Conclusions:The main types of adenovirus were types 3 and 7 among children with inluenza-like illness in Xuzhou from 2013 to 2019, and the infected population was mainly preschool children, and the detection peak was in spring and summer.

As the main body of providing medical and health services, public hospitals always bear the important responsibility of maintaining people′s life and health.In the period of normal epidemic prevention and control, public hospitals are also facing a series of new situations, including changes in social environment, demands for reform and development and transformation of target functions. It is urgent to solve many problems, such as inadequate capacity building, continuous heavy operational pressure, impact on traditional modes, and constant adjustment of positioning and mode.Therefore, both the state and the government should adhere to the public welfare as the fundamental standpoint, accelerate the implementation of scientific planning and balanced distribution of medical resources, through the fundamental adjustment of the system and mechanism, and actively help public hospitals to choose the appropriate development mode, as soon as possible to relieve pressure rescue; Public hospitals should actively make use of the extensive application of Internet and other technologies and the huge potential contained in scientific and technological innovation to achieve high-quality development goals of improving quality and efficiency, and provide more powerful support for the overall national strategy.

Objective:To investigate the effects of programmed death-ligand 1 (PD-L1) expression on the biological behaviors of gastric cancer cell line MKN45.Methods:The PD-L1 gene of gastric cancer cell line MKN45 was silenced by RNA interference technique. MKN45 cells were divided into blank control group, si-NC group (transfected with siRNA-NC) and si-PD-L1 group (transfected with siRNA-PD-L1). Quantitative real-time PCR was used to detect the mRNA expressions of PD-L1 and epithelial-mesenchymal transformation (EMT)-related proteins E-cadherin, Vimentin and Snail in MKN45 cells, and Western blotting was used to detect the expression levels of PD-L1 protein in MKN45 cells of each group. Transwell migration test, Transwell invasion test and MTT test were used to detect the migration, invasion and adhesion abilities of MKN45 cells.Results:The relative expression levels of PD-L1 mRNA in the blank control group, si-NC group and si-PD-L1 group were 1.002±0.092, 1.005±0.121 and 0.237±0.017, respectively, with a statistically significant difference ( F=75.61, P<0.001). The protein expression levels of PD-L1 in the three groups were 0.944±0.028, 1.008±0.088 and 0.269±0.015, respectively, with a statistically significant difference ( F=172.99, P<0.001). The mRNA and protein expression levels of PD-L1 in the si-PD-L1 group were lower than those in the other two groups (all P<0.001), but there were no statistically significant differences between the blank control group and si-NC group (all P>0.05). The cell migration rates of the blank control group, si-NC group and si-PD-L1 group were (1.000±0.020)%, (1.012±0.084)% and (0.488±0.050)%, respectively, with a statistically significant difference ( F=80.73, P<0.001). The cell invasion rates of the three groups were (0.929±0.087)%, (0.924±0.208)% and (0.300±0.100)%, respectively, with a statistically significant difference ( F=19.37, P<0.001), and the cell adhesion rates of the three groups were (100.000±5.407)%, (99.280±4.845)% and (59.723±2.674)%, respectively, with a statistically significant difference ( F=79.87, P<0.001). Compared with the blank control group and si-NC group, the migration, invasion and adhesion abilities of MKN45 cells in the si-PD-L1 group decreased significantly (all P<0.001). The expression levels of E-cadherin mRNA of the three groups were 1.000±0.023, 0.981±0.051, 3.618±0.201, the expression levels of Vimentin mRNA were 1.000±0.043, 1.108±0.150, 0.328±0.011, the expression levels of Snail mRNA were 1.061±0.103, 1.090±0.110, 0.304±0.043, respectively, with statistically significant differences ( F=477.17, P<0.001; F=65.97, P<0.001; F=72.70, P<0.001). Compared with the blank control group and si-NC group, the mRNA expression levels of Vimentin and Snail of MKN45 cells in the si-PD-L1 group decreased, while the expression level of E-cadherin mRNA increased, with statistically significant differences (all P<0.001). Conclusion:Silencing the expression of PD-L1 can reduce the migration, invasion and adhesion abilities of MKN45 cells, and the mechanism may be related to the effect of PD-L1 on the EMT pathway of gastric cancer.