Objective:To construct an evaluation index system for the development of compact county medical communities, so as to provide evaluation tools for promoting the high-quality development of county medical communities in China.Methods:Based on the evaluation criteria and monitoring system related policy documents for the construction of county medical communities released at the national level, an evaluation index system for compact county medical community development was constructed through policy text analysis and expert discussions. The system was applied to evaluate the construction of medical communities in Shaxian County of Fujian Province, A County of Shanxi Province, and B County of Yunnan Province.Results:The evaluation index system included four primary indicators: responsibility community, management community, service community, and interest community, covering 11 secondary indicators and 32 tertiary indicators. The evaluation results showed that the construction level of the compact county medical community in Shaxian County (91.3 points) was slightly higher than that of A County and B County (83.1 and 83.9 points), and its advantages were mainly reflected in management community and interest community. There was still room for improvement in the construction of compact medical communities in all three regions.Conclusions:The evaluation system in this study combined scientific rigor and practical guidance value. It could provide guidance for promoting the construction of compact county medical communities in various regions of China, and provide a basis for relevant policy formulation and optimization.

Objective To explore the use of indirect methods to establish a reference interval for serum car-bohydrate antigen 242(CA242)in adults in Shanghai and to validate it.Methods A total of 51 897 cases of CA242 testing data from the laboratory information management system of the Department of Clinical Labo-ratory at the hospital from August 2022 to July 2023 were collected.After data cleaning and normal transfor-mation,the Turkey method was used to remove outliers,and 19 653 cases of data were finally included in the study.Then,the Hoffmann method was used to establish the P95 reference interval for serum CA242.The study selected 691 apparently healthy individuals from January to March 2024 to validate the self built refer-ence interval for CA242.The physical examination population with the reference interval recommended by the reagent instructions≤CA242 value

Objective To investigate the impact of smoking cessation on high-resolution compu-ted tomography(HRCT)phenotypes in smokers with chronic obstructive pulmonary disease(COPD)and its relationship with the frequency of acute exacerbations.Methods A retrospective study was conducted in 237 smokers with COPD who could cooperate with a 1-year follow-up.Among them,160 patients underwent a comprehensive 1-year smoking cessation intervention,and were divided into smoking cessation failure group(87 patients)and smoking cessation success group(73 patients)based on whether they successfully quited smoking.The remaining 77 smokers with COPD who did not receive smoking cessation intervention were designated as smoking group.HRCT phenotypes,total lung volume(TLV),total emphysema volume(TEV),emphysema index(EI)and the number of acute exacerbation at different time points were compared among the three groups.Pearson correlation analysis was used to explore the correlation between smoking cessation and the number of acute exac-erbations.Results There was no statistically significant difference in the proportion of A phenotype patients among the three groups before intervention and at 3 and 6 months of intervention(P＞0.05).At the 9th and 12th months of intervention,the proportion of patients with A phenotype in the smoking group was lower than that in the smoking cessation failure group and smoking cessation success group(P＜0.05).Before the intervention and at the 3rd,6th and 9th months of interven-tion,there were no statistically significant differences in the proportion of patients with E phenotype among the three groups(P＞0.05).Before intervention and at the 3rd and 6th months of interven-tion,there were no statistically significant differences in the proportion of patients with M phenotype among the three groups(P＞0.05).At the 9th and 12th months of intervention,the proportion of patients with M phenotype in the smoking group was higher than that in the smoking cessation failure group and smoking cessation success group(P＜0.05).Before intervention,there were no statisti-cally significant differences in TLV,TEV and EI among the three groups(P＞0.05).One year af-ter the intervention,TLV,TEV and El in the smoking cessation failure group and smoking cessation success group were lower than those in the smoking group(P＜0.05).At the 3rd,6th,9th and 12th months of intervention,the number of acute exacerbations in the the smoking cessation failure group and smoking cessation success group was less than that in the smoking group(P＜0.05).At the 9th and 12th months of intervention,the number of acute exacerbation in the smoking cessation success group was less than that in the smoking cessation failure group(P＜0.05).The results of Pearson correlation analysis showed that smoking cessation was negatively correlated with the number of acute exacerbation in smokers with COPD(P＜0.05),and this negative correlation gradually in-creased with the extension of smoking cessation duration.Conclusion Smoking cessation can im-prove HRCT phenotypes and effectively reduce the number of acute exacerbation in smokers with COPD.

[Objective] To study the molecular biological mechanism for a case of ABO blood group B subtype, and perform three-dimensional modeling of the mutant enzyme. [Methods] The ABO phenotype was identified by the tube method and microcolumn gel method; the ABO gene of the proband was detected by sequence-specific primer polymerase chain reaction (PCR-SSP), and the exon 6 and 7 of the ABO gene were sequenced and analyzed. Homologous modeling of Bw.03 glycosyltransferase (GT) was carried out by Modeller and analyzed by PyMOL2.5.0 software. [Results] The weakening B antigen was detected in the proband sample by forward typing, and anti-B antibody was detected by reverse typing. PCR-SSP detection showed B, O gene, and the sequencing results showed c.721 C>T mutation in exon 7 of the B gene, resulting in p. Arg 241 Trp. Compared with the wild type, the structure of Bw.03GT was partially changed, and the intermolecular force analysis showed that the original three hydrogen bonds at 241 position disappeared. [Conclusion] Blood group molecular biology examination is helpful for the accurate identification of ambiguous blood group. Homologous modeling more intuitively shows the key site for the weakening of Bw.03 GT activity. The intermolecular force analysis can explain the root cause of enzyme activity weakening.

Objective:To construct an evaluation index system for the development of compact county medical communities, so as to provide evaluation tools for promoting the high-quality development of county medical communities in China.Methods:Based on the evaluation criteria and monitoring system related policy documents for the construction of county medical communities released at the national level, an evaluation index system for compact county medical community development was constructed through policy text analysis and expert discussions. The system was applied to evaluate the construction of medical communities in Shaxian County of Fujian Province, A County of Shanxi Province, and B County of Yunnan Province.Results:The evaluation index system included four primary indicators: responsibility community, management community, service community, and interest community, covering 11 secondary indicators and 32 tertiary indicators. The evaluation results showed that the construction level of the compact county medical community in Shaxian County (91.3 points) was slightly higher than that of A County and B County (83.1 and 83.9 points), and its advantages were mainly reflected in management community and interest community. There was still room for improvement in the construction of compact medical communities in all three regions.Conclusions:The evaluation system in this study combined scientific rigor and practical guidance value. It could provide guidance for promoting the construction of compact county medical communities in various regions of China, and provide a basis for relevant policy formulation and optimization.

Objective To analyze the effects of immediate multi-vessel percutaneous coronary inter-vention(MV-PCI)and staged vascular intervention(Staged-PCI,immediate PCI for culprit-only followed by a delayed treatment of all other lesions)on the prognosis in elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 417 elderly acute STEMI patients who underwent PCI in Baoding First Central hospital from January 2021 to June 2023 were enrolled,and according to different treatment strategies,they were divided into MV-PCI group(87 cases)and Staged-PCI group(330 cases).A propensity score matching(PSM)model was established based on baseline data of the two groups,there were 84 cases in each group.During a mean follow-up period of 13.5 months,with the occurrence of main adverse cardi-ovascular and cerebrovascular events(MACCE)as endpoint,the incidence of MACCE was com-pared between the two groups after PSM.Cox proportional hazard regression model was used to analyze the risk factors of MACCE.Results Before PSM,there were significant differences be-tween the two groups in terms of age,proportions of hypertension,diabetes and hyperlipidemia,family history,stroke history,peripheral artery disease,preoperative SBP,lesion vessels(such as left anterior descending branch and left circumflex branch),and number of non-diseased vessels(P＜0.05).Kaplan-Meier survival curve showed that the incidences of MACCE and all-cause mor-tality were significantly lower in the MV-PCI group than the Staged PCI group(Plog rank＜0.05).Multivariate Cox proportional hazard regression model showed that MV-PCI was a protective prognostic factor for MACCE(HR=0.263,95％CI:0.105-0.659,P=0.004)and all-cause death(HR=0.236,95％CI:0.007-0.722,P=0.016).Conclusion MV-PCI can significantly improve the prognosis of elderly patients with acute STEMI with multivessel disease.

Objective:To explore the effectiveness of LEARNS model combined with video health education in patients undergoing painless gastrointestinal endoscopy.Methods:From February 2021 to November 2022, convenience sampling was used to select 128 patients who underwent painless gastrointestinal endoscopy at the Endoscopy Center of Affiliated Hospital of Shaoxing University as research subjects. A total of 64 patients admitted from February to December 2021 served as control group, while 64 patients admitted from January to November 2022 served as observation group. Control group patients received routine health education, while observation group was treated with LEARNS model combined with video health education on the basis of control group. The degree of cooperation, psychological state, and satisfaction with health education were compared between two groups of patients.Results:The proportion of patients in observation group who actively cooperated was higher than that in control group, and there was a statistically significant difference in the degree of cooperation between the two groups ( P<0.05). Thirty minutes before and after the endoscopy, the scores of both subscales of the State-Trait Anxiety Inventory (STAI) in observation group were lower than those in the control group, and the difference was statistically significant ( P<0.05). The satisfaction scores of observation group patients with health education in all dimensions were higher than those of control group, and the differences were statistically significant ( P<0.05) . Conclusions:LEARNS model combined with video health education can effectively improve the cooperation of patients undergoing painless gastrointestinal endoscopy, alleviate their pre-examination anxiety, and enhance their satisfaction with health education, which is worthy of clinical practice.

Frailty, which predicts high dependency and mortality, is a major challenge for healthcare systems in nations that are rapidly aging and is receiving increasing attention. Cirrhosis is often combined with frailty, which has a significant impact on patient health outcomes. Understanding the risk factors for frailty, elucidating the mechanism of cirrhosis combined with frailty, and early recognition and slowing down the occurrence and development of frailty are of great significance for the prognosis of cirrhotic patients. This article reviews the current research status of cirrhosis combined with frailty, including the definition and risk factors, mechanism, correlation, and intervention measures, in order to improve understanding and provide assistance for strengthening early identification, management, and intervention.

Objective:To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) on the discharge outcome in elderly patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT).Methods:Elderly patients with AIS received IVT in the Department of Neurology, the Second Affiliated Hospital of Soochow University from August 2018 to August 2020 were retrospectively included. The modified Rankin Scale was used to evaluate discharge outcome, and the score >2 was defined as poor outcome. Symptomatic intracranial hemorrhage (sICH) was defined as any intracranial hemorrhage found on imaging examination accompanied by neurological deterioration, where the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 from baseline or bleeding led to death. Multivariate logistic regression analysis was used to determine independent risk factors for sICH and poor discharge outcome. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of NLR for sICH and poor discharge outcome. Results:A total of 228 elderly patients with AIS receiving IVT were enrolled, including 118 males (51.8%), aged 73.64±8.16 years, with a baseline NIHSS score of 6.23±6.54. Ninety patients (39.5%) had poor outcome at discharge, and 16 (7.0%) developed sICH. Univariate analysis showed that the NLR in the poor outcome group was significantly higher than that in the good outcome group ( P<0.01). Multivariate logistic regression analysis showed that a higher NLR was an independent risk factor for poor discharge outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.044-1.484; P< 0.05) and sICH ( OR 1.124, 95% CI 1.010-1.251; P<0.05). ROC curve analysis showed that the area under the curve of NLR for predicting poor discharge outcome was 0.693 (95% CI 0.620-0.765; P<0.01). The optimal cutoff value was 4.345. Its corresponding sensitivity and specificity were 47.8% and 87.7%, respectively. The area under the curve of NLR for predicting sICH was 0.651 (95% CI 0.498-0.804; P<0.05). The optimal cutoff value was 3.515. Its corresponding sensitivity and specificity were 68.8% and 61.8%, respectively. Conclusions:A higher NLR is independently associated with sICH and poor discharge outcome in elderly patients with AIS receiving IVT, and have certain predictive value for sICH and poor discharge outcome.

Cryoablation (CRA) and microwave ablation (MWA) are two main local treatments for hepatocellular carcinoma (HCC). However, which one is more curative and suitable for combining with immunotherapy is still controversial. Herein, CRA induced higher tumoral PD-L1 expression and more T cells infiltration, but less PD-L1^highCD11b⁺ myeloid cells infiltration than MWA in HCC. Furthermore, CRA had better curative effect than MWA for anti-PD-L1 combination therapy in mouse models. Mechanistically, anti-PD-L1 antibody facilitated infiltration of CD8⁺ T cells by enhancing the secretion of CXCL9 from cDC1 cells after CRA therapy. On the other hand, anti-PD-L1 antibody promoted the infiltration of NK cells to eliminate PD-L1^highCD11b⁺ myeloid cells by antibody-dependent cell-mediated cytotoxicity (ADCC) effect after CRA therapy. Both aspects relieved the immunosuppressive microenvironment after CRA therapy. Notably, the wild-type PD-L1 Avelumab (Bavencio), compared to the mutant PD-L1 atezolizumab (Tecentriq), was better at inducing the ADCC effect to target PD-L1^highCD11b⁺ myeloid cells. Collectively, our study uncovered the novel insights that CRA showed superior curative effect than MWA in combining with anti-PD-L1 antibody by strengthening CTL/NK cell immune responses, which provided a strong rationale for combining CRA and PD-L1 blockade in the clinical treatment for HCC.