ObjectiveTo investigate the effects of forkhead box protein O4 （FOXO4） expression on gastric precancerous lesions （GPL）， and to clarify its mechanism in mediating the therapeutic effect of Celastrus orbiculatus extract （COE） on GPL by regulating aerobic glycolysis. MethodsReferring to the previously established combined modeling protocol in our research group， a rat model of gastric precancerous lesions （GPL） was constructed through the following procedures： rats were given free access to 170 μg/mL N-methyl-N′-nitro-N-nitrosoguanidine （MNNG） solution for ad libitum drinking， fed with a diet supplemented with 0.03% ranitidine hydrochloride， and treated with a cycling regimen of “2-day feeding followed by 1-day fasting”. Specifically， on the afternoon of each fasting day， the rats received intragastric administration of 2% sodium salicylate at a dose of 10 mL/kg body weight. FOXO4-silenced and overexpression model rats were constructed by tail vein injection of plasmids. The rats were randomly divided into control， model， COE， overexpression negative control （OE-NC）， FOXO4 overexpression （OE-FOXO4）， OE-FOXO4+COE， silencing negative control （shNC）， FOXO4 silencing （shFOXO4） and shFOXO4+COE groups. Gastric mucosal histopathological changes were observed in each group. Lactic acid content in gastric mucosal tissues was detected by colorimetry. The expression levels of FOXO4， HK2， PKM2， LDHA and GLUT1 were evaluated by immunohistochemistry （IHC）， and their mRNA levels were determined by RT-PCR.Results Compared with the control group， the COE， OE-FOXO4 and OE-FOXO4+COE groups exhibited significantly improved gastric mucosal lesions， reduced lactic acid levels， weakened expression of aerobic glycolysis-related proteins （PKM2， HK2， LDHA， GLUT1）， and enhanced FOXO4 expression. The OE-FOXO4+COE group showed the lowest lactic acid level and more pronounced changes in related protein expression compared with the COE and OE-FOXO4 groups. In contrast， the shFOXO4 and shFOXO4+COE groups displayed increased lactic acid levels， enhanced expression of aerobic glycolysis-related proteins， and reduced FOXO4 expression compared with the model group.ConclusionFOXO4 expression is involved in the inhibitory effect of COE on GPL， possibly by regulating the aerobic glycolysis process.

Objective:To explore the influence of Internet diversified rehabilitation medicine education on self-efficacy and quality of life in newly diagnosed breast cancer patients.Methods:A prospective study was performed in 130 newly diagnosed breast cancer patients admitted to Beijing Friendship Hospital, Capital Medical University from February 2020 to February 2021. According to the method of randomly number table, these patients were divided into control group and intervention group, 65 cases in each group.The control group was treated with routine treatment scheme, and the intervention group added the intervention of Internet diversified education of rehabilitation medicine on the basis of routine treatment scheme. Compared the general data of the two groups, the General Self-Efficacy Scale (GSES) and the cancer patients′ Quality of Life Questionnaire-Core 30 (QLQ-C30) were used to compare the self-efficacy levels of the two groups before operation, 4 months and 8 months after operation, evaluate the quality of life. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; Chi-square test was used for comparison of enumeration data between groups. Results:Before operation, there was no significant difference in general data, GSES score and QLQ-C30 score between the two groups ( P> 0.05). Four months after operation, GSES scores [(27.39±4.68) score vs (25.91±3.18)score], somatic function [(65.50±4.34) score vs (63.07±5.42) score], cognitive function [(67.63±10.32) score vs (63.29 ± 11.36) score], role function [(50.82±10.80) score vs (45.59±13.94) score], and total quality of life [(63.47 ± 6.98) score vs (59.26±7.98)score] were compared between the intervention group and the control group, the difference was statistically significant ( P< 0.05). There was no significant difference in the scores of emotional function [(57.60±11.72) score vs (55.53±10.61) score] and social function [(49.86±12.11) score vs (46.13±10.25) score] ( P> 0.05). Eight months after operation, the GSES score [(28.82±3.31) score vs (26.73 ± 3.06) score] of patients in the intervention group and the control group, and the scores of functional areas and overall quality of life in QLQ-C30 score were significantly different ( P< 0.01). Conclusion:the Internet diversified rehabilitation medicine education has a significant effect on improving the self-efficacy of new breast cancer patients, and can improve the quality of life of patients.

Objective To evaluate the township hospitals'medical service efficiency in Shandong province,and to provide references for the development in township hospitals under the background of the essential medicine system.Methods The method of data envelopment analysis(DEA)was used to analyze the township hospitals' medical service efficiency in Shandong province before and since the implementation of the essential medicine system.Results For the township hospitals in Shandong province in general,their relative efficiency ratio of the medical service efficiency dropped from 66.67% to 53.33% since the implementation of the essential medicine system.In terms of the input and output,the non-DEA effective township hospitals are found with insufficient output as measured by the output indicator,while some input indicators input were found as excessive.Conclusion The low scale efficiency has become the main factor for the low service efficiency of such hospitals since the implementation of the essential medicine system in Shandong province.In order to improve the medical service efficiency,it is important to continue to improve the essential medicine system,increase the medical staff's incentives, improve the fiscal compensation policy,and keep the policy continuity.

Objective To study the different types of medication guidance for community doctors in the context of essential medicine system,and analyze its influencing factors.Methods SPSS 1 9.0 was called into play for statistical analysis of data gathered,and the medication guidance behavior of the doctors were graded on the two dimensions of personal willingness and practical action.With important quadrant method,the medication guidance behavior of such doctors was classified,while the multiple linear regression was used to study the influencing factors.Results Most of the community doctors of the fourteen counties fall into the area of “high willingness and less action”,with only a few falling into the area of the “high willingness and more action”. Major influencing factors of their willingness on medication guide were found to include impacts on job autonomy,attention to essential medicine system, and the forms to improve income.Major factors of the doctors'actions on medication guide include awareness of essential medicines,awareness of essential medicines catalog,and training outcomes. Conclusion The community doctors have high personal willingness for medication guidance related to essential medicines,but only a number of them carried it in their work.Therefore,it is necessary to take actions to strengthen awareness of the doctors for medication guidance and encourage them to carry it out.