With the extended survival period of breast cancer patients and the increasing health demands, the concomitant diseases of breast cancer have gradually attracted the attention of both doctors and patients, and it is imperative to conduct comprehensive management of these diseases, in which the general practitioners, as the more comprehensive and complex medical talents, have not yet played their due roles. In this article, we report two cases of comprehensive management of concomitant diseases of breast cancer through collaboration of general practitioners and specialists (integrated general and specialist care). The role and function of general practitioners in this process were deeply analyzed, and the establishment of a consultation-liaison general practice model to further promote the role of integrated general and specialist care in integrated oncology care was advocated.

With the extended survival period of breast cancer patients and the increasing health demands, the concomitant diseases of breast cancer have gradually attracted the attention of both doctors and patients, and it is imperative to conduct comprehensive management of these diseases, in which the general practitioners, as the more comprehensive and complex medical talents, have not yet played their due roles. In this article, we report two cases of comprehensive management of concomitant diseases of breast cancer through collaboration of general practitioners and specialists (integrated general and specialist care). The role and function of general practitioners in this process were deeply analyzed, and the establishment of a consultation-liaison general practice model to further promote the role of integrated general and specialist care in integrated oncology care was advocated.

BACKGROUND:Laser therapy is a non-invasive and painless treatment that is considered to be an effective method suitable for the treatment of osteoarthritis due to its simplicity and non-invasive nature.Currently,the mechanism of action of laser therapy is unclear and the results of studies on its clinical application are controversial. OBJECTIVE:To review and summarize the latest research progress of laser therapy on chondrocytes,animal experiments and clinical efficacy,and to explore the possible mechanism of laser-mediated multi-pathway biological effects,so as to provide a theoretical basis for further research on the laser treatment of osteoarthritis of the knee joint. METHODS:A literature search was performed in CNKI,WanFang Data,VIP and PubMed databases for relevant literature published from 2018 to 2023,with"laser therapy,low level laser therapy,high level laser therapy,photobiomodulation,knee osteoarthritis,chondrocytes"as the search terms in Chinese and English,respectively.Together with 14 articles searched manually,70 articles were finally included for review. RESULTS AND CONCLUSION:Laser therapy in the treatment of knee osteoarthritis is mainly categorized into two types:low-level laser therapy and high-level laser therapy.Differences in laser parameters and treatment protocols have a direct impact on laser efficacy.When appropriate parameters are used,low-level lasers show positive effects in cellular experiments,animal models,and clinical efficacy.High-level lasers have been less studied in the treatment of knee osteoarthritis,but some preliminary clinical studies have shown positive results.Cell experiments have shown that low-level laser promotes chondrocyte proliferation and cartilage matrix synthesis,thereby reducing inflammatory response.Animal experiments have shown that low-level laser can reduce the release of pro-inflammatory factors,promote cartilage matrix synthesis,inhibit matrix degradation,and effectively improve the repair process of cartilage tissue.Low-level laser is also able to reduce oxidative stress damage and relieve pain in knee osteoarthritis.In clinical trials,both low-and high-level laser can reduce patients'pain and improve functional activities.The combination of laser therapy and exercise therapy modalities may improve the therapeutic effect.Lasers may affect intracellular signaling and cellular functions through photobiological or thermodynamic effects.This provides direct evidence that laser promotes articular cartilage regeneration.

Objective:To analyze the experiences and practice in the reform of public hospital salary system in Sichuan province, summarize the typical modes of such reform in the province, and provide references for further reform.Methods:As of October 29, 2021, the research group received 77 sets of typical experience materials submitted by the health commissions and public hospitals in Sichuan province on enforcing the reform of the public hospital salary system. The analysis framework was based on the five main elements proposed in the Guidance to Deepening the Reform of the Salary System of Public Hospitals for the purpose of furthering the reform. These five elements refer to " reasonably determining the level of salary in public hospitals" " fully implementing the autonomy of internal distribution in public hospitals " " establishing and improving the incentive and restraint mechanism for the remuneration of public hospital leaders" " improving the assessment and evaluation mechanism oriented to public welfare" and " funding sources ". A quantitative analysis was made on the typical experience materials using the social network analysis method, while a qualitative analysis was made on the typical experience materials using the content analysis method. Results:The results of social network analysis showed that the network density was 0.272; the highest point centrality was " fully implement the autonomy of internal distribution in public hospitals" (0.935), and the highest intermediary centrality was " improving the assessment and evaluation mechanism oriented to public welfare" (0.870), while the closeness to centrality of " establishing and improving the incentive and constraint mechanism for the salary of public hospital leaders" (0.434) and " funding sources" (0.421) were relatively low. The results of content analysis showed that the ones with higher frequency among all the typical experience materials were " fully implementing the autonomy of internal distribution of hospitals" (72 times) and " improving the assessment and evaluation mechanism oriented to public welfare" (67 times), while the ones with lower frequency were " establishing and improving the salary incentive and constraint mechanism for public hospital leaders" (17 times) and " funding sources" (14 times). In terms of unity and synergy, the typical models of public hospital salary system reform in the province could be categorized as the fine standard mode, the fair value mode, the autonomous synergy mode and the circular symbiosis mode.Conclusions:Deepening the reform of the salary system of public hospitals should unify the standards and improve the fair and refined assessment and evaluation mechanism; explore various forms of distribution and build an internal autonomous and synergistic incentive mechanism; pay attention to the weak remuneration incentive mechanism for hospital leaders and the problem of a relatively single source of funding.

Objective:To analyze the salary characteristics of medical institutions and the influencing factors of personnel expenditure as found in the salary system reform of public hospitals in Sichuan province, for reference in furthering such reform in public hospitals.Methods:The data of personnel expenditure, business operation and medical services came from 96 medical institutions in 21 cities(prefectures)of Sichuan province from 2017 to 2020 by means of institutional survey. The average salary level and salary structure of medical staff were used to describe the salary characteristics, and the total salary was presented by the level of personnel expenditure. The measurement data was represented by M(IQR), the counting data was described by frequency and constituent ratio, and the influencing factors of personnel expenditure were analyzed by generalized linear mixed model. Results:From 2017 to 2020, the personnel expenditure of medical institutions increased by 13.04% annually. In 2020, the per capita salary level of medical staff was 151 900 yuan, while the basic salary and performance salary accounted for 16.20% and 54.60% of personnel expenditure respectively. The analysis results of the generalized linear mixed model showed that the average cost of patients per visit( β=0.596), the level of drugs and sanitary materials consumed per 100 yuan medical income( β=0.286), the number of medical visits( β=0.328), and the years [(2018, 2019, 2020) β=0.025, 0.052, 0.066] were positively correlated to personnel expenditure, while the average length of stay( β=-0.693), the proportion of medical service income( β=-0.392), and the balance rate of income and expenditure( β=-0.062)were negatively correlated to personnel expenditure( P<0.05). The proportion of fiscal subsidy revenue, regional GDP and asset-liability ratio were not the influencing factors of personnel expenditure( P> 0.05). Conclusions:In the reform of the salary system of the province, its salary level of medical institutions has surpassed the current wage ceiling of these institutions. As the salary distribution was mainly made based on the workload, the " baton" role of the salary system reform has begun to pay off. However, the basic guarantee role of compensation has not yet been fully leveraged.Further reform is needed in upgrading refined management, and timely dynamic adjustment of personnel expenditure in combination with the hospital's financial performance and cost analysis, and reasonably optimizing the level of medical staff compensation.

Objective:To analyze the staff salary status and the influencing factors in traditional Chinese medicine(TCM) hospitals implementing the salary system reform in Sichuan province in 2020, for reference in optimizing the salary system reform of such hospitals.Methods:Cluster sampling and institutional survey were used to collect the salary information of 26 TCM hospitals in 21 cities(prefectures)of Sichuan province implementing the salary system reform in 2020. Such information was then subject to descriptive analysis, while the influencing factors of salary were subject to one-way analysis of variance and generalized linear model multifactor analysis.Results:15 428 staff from 26 TCM hospitals were included as the research objects. In 2020, personnel expenditure accounted for 40.23% of the total expenditure, and 24.34% of which came from financial subsidy in 26 TCM hospitals. The average annual payable income per person was(149 312±74 288)yuan, 67.82% of which being performance pay. Analysis of variance showed that there were significant differences among the salary levels of staff in different economic regions, hospital grades, hospital levels, gender, educational background, position, seniority, performance pay ratio, employment in the government system and other natures, senior and other professional titles, doctors and other positions( P<0.05), and the differences were still statistically significant after adjustment by generalized linear model( P<0.05). Conclusions:The reform of the salary system of Sichuan TCM Hospitals has basically achieved equal pay for equal work, and the income of low-level personnel has been improved. However, the salary level was not very motivated and the salary structure was not guaranteed. It is necessary to strengthen financial precision subsidies, increase the proportion of personnel expenditure, so as to support the increase of the absolute value of salary in non-core economic areas, improve the salary structure, reasonably widen the salary gap among different educational backgrounds and positions, further optimize internal distribution, and ensure the sustainable development of Chinese medicine talents.

【Objective】 To compare the effectiveness of the old mode of blood isolation and batch release (the old mode) and the new mode in Chengdu, so as to provide basis for optimizing working strategy. 【Methods】 1) The blood testing report was released one by one in the old mode but released uniformly in accordance with the blood batches classified by blood storage and supply department in the new mode. 2) In the old mode, apheresis platelet samples were detected by serological testing first and nucleic acid testing(NAT) later, and whole blood samples were reasonably arranged according to blood inventory and detection workload. In the new mode, platelets samples collected within our center headquarters were detected by serological test and NAT simultaneously, while those collected outside the center complied with the old strategy. As for whole blood, the same batch samples classified by blood storage and supply department should be arranged to the detection line with the fewest samples.3) The turnaround time(TAT) in the laboratory (referred to as sample TAT) and the TAT in the blood to-detect stock (referred to as blood TAT) in two phases(year 2016 vs 2018, pre- and post- the new mode), involving 164 748 and 179 488 blood samples, were compared by SPSS25.0 software. The constituent ratio of the TATs were compared with Chi-square test, and the difference of blood TAT between old and new mode were compared with Mann-Whitney U test. 【Results】 1) Significant difference was noticed in constituent ratio of TATs between old and new mode (P<0.05). 2)The blood TATof apheresis platelets using the new mode was 0.95(QR: 0.22)days, with the median 0.20 days shorter than that the old mode.. The blood TAT of whole blood in the new mode was 3.77 (QR: 1.99) days, with the median 0.90 days shorter than that in the old mode, and the difference was statistically significant (P<0.05). 【Conclusion】 Compared with the old mode, the new mode showed the following advantages: 1) It can realize the unified issuing of testing reports of blood with the same batch, contribute to the early discovery of errors that occurred during blood donation process, and located the errors wihin intra-batches for investigation. 2) It can advance the issuing of blood testing reports of the same batch. 3) It can make the flow of samples and blood with the same batch between different departments more standardized and orderly, and optimize the process of blood sorting thus shortening blood TAT. 4) It can realize the counting and checking of samples, within the same batch, at different states, so as to minimize the error issuing of unqualified blood and to-detect blood, and is more conducive to ensure the quality, safety and timely supply of blood.

Objective:To explore the application effect of structural formula based continuous nursing in colorectal cancer patients with ostomy.Methods:Using the convenient sampling method, a total of 128 patients with colorectal cancer stoma who were admitted to Liuzhou Worker's Hospital from July 2019 to September 2021 were selected as the research objects. According to the random number table method, they were divided into the observation group and the control group, with 64 cases in each group. Patients in the observation group received structural continuous nursing, while patients in the control group received traditional continuous care. Exercise of Self-Care Agency Scale (ESCA) and the Medical Outcomes 36-items Short Form Health Survey (SF-36) scores were compared between the two groups.Results:After 3 months of intervention, ESCA and SF-36 scores in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Structural formula based continuous nursing can improve the self-care ability and quality of life of colorectal cancer patients with ostomy.

Objective:To analyze the epidemiological characteristics of children with hand, foot, and mouth disease (HFMD) and herpetic angina (HA) in Wenzhou City and the influence of meteorological factors on the pathogenesis, and to provide basis for early warning and disease prevention.Methods:A total of 62 809 children diagnosed with HFMD and 56 005 with HA in the 2nd Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University during 2012 to 2017 were enrolled. The meteorological factors during 2012 to 2017 were collected monthly. The data were analyzed using Spearman rank correlation and multivariant linear stepwise regression model.Results:The number of cases of HFMD and HA began to rise in the spring, and decreased after reaching the peak from May to July. Then there was a secondary peak from September to December, and the incidence decreased significantly in winter. Univariate correlation analysis showed that the effects of different meteorological factors on HFMD and HA were basically the same. Multivariant linear stepwise regression analysis showed that there was a positive correlation between monthly mean temperature (X) and the number of HFMD cases. The regression equation was Y=-161.450+ 53.828X ( F=22.250, P<0.01). Monthly mean relative humidity (X 1) and temperature (X 2) were positively associated with the number of HA cases. The regression equation was Y=-3 521.196+ 46.814X 1+ 41.762X 2 ( F=18.351, P<0.01). Conclusions:The trends of onset time of HFMD and HA are similar. The meteorological factors are closely related to HFMD and HA, and their incidence trends are significantly affected by meteorological changes.

Objective To reevaluate the diagnostic efficacy of International Society of Thrombosis and Haemostasis (ISTH) and Japanese Association for Acute Medicine (JAAM) criteria for sepsis disseminated intravascular coagulation (DIC).Methods A total of 769 patients diagnosed as sepsis were enrolled in our study.Blood samples were collected within the first hour in ICU and the index of coagulation was detected.The correlation between the conventional coagulation index and the acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores was analyzed.The sensitivity and specificity of diagnostic efficacy were analyzed by receiver operating characteristic (ROC) curve.Results In the 769 cases,95 cases (12.35％) conformed to the standard of ISTH and 271 cases (35.24％) were in accordance with the standard of JAAM.Prolonged prothrombin time (PT) was seen in 726 cases (94.41％).Activated partial thromboplastin time (APTF) was prolonged in 434 cases (56.44％).Plasma fibrinogen (Fib) was decreased in 94 cases (12.22％) and increased in 365 cases (47.46％).Platelet (PLT) count decreased in 158 cases (20.55％).D-dimer was elevated in 759 cases (98.70％).Fibrin degradation product (FDP) was increased in 724 cases (94.15％).PT,APTT,D-dimer,FDP,PLT were correlated with APACHE Ⅱ (r value were 0.259,0.348,0.319,0.289,-0.275,all P values＜0.05)and SOFA score(r values were 0.409,0.445,0.407,0.411,-0.526,respectively,all P values＜0.05).The areas under the curve (AUCs) in the ISTH standard from high to low were accordingly PT (0.813),FDP (0.792),PLT (0.746),Fib (0.563).The AUCs from high to low were FDP (0.844),PLT (0.716),and PT (0.660),respectively in the JAAM standard.Under the criteria of ISTH,the diagnostic sensitivities of PT,PLT,Fib and FDP were 92.63％,67.37％,9.47％,98.95％,respectively,and specificities as 53.56％,86.05％,99.26％ and 33.38％％ respectively.As to the JAAM criteria,the diagnostic sensitivities of PT,PLT,and FDP were 74.54％,52.77％,91.51％ and specificities as 51.61％,84.94％,40.76％ respectively.Conclusions According to the ISTH and JAAM diagnostic criteria,the diagnostic efficacy of PT and PLT is relatively high,which is associated with the severity of DIC.D-dimer and FDP have the high sensitivity but the specificity is poor.The diagnostic specificity of Fib is good,yet with low sensitivity and poor overall efficacy.