Objective:To explore the quality improvement in the organization structure and management model of the integrated community child health services.Methods:This was a qualitative study, including two parts: cause analysis and service improvement suggestions. In the analysis part the data mining was conducted to identify valuable patterns and relationships in the comprehensive child health services. Semi-structured interviews were conducted with 12 relevant department heads and health workers of the comprehensive child health service team at Gumei Community Health Service Center in December 2023, and the causes of the key problems were explored. In the service improvement part, focus group discussions were held to propose suggestions, then improvement measures were formulated to address the identified problems.Results:Through data mining and semi-structured interviews, the key problems were identified: information isolation among multiple departments and lack of coordination mechanism in the comprehensive child health service team. A team organizational structure based on the "three definite" principle was established. The organizational structure should include the pediatric family doctor team, general practitioner management team and departments of pediatrics, maternal and child health care, immunization and child rehabilitation; the management model should include a cross-department resource and information sharing mechanism, the pediatric family doctor model, optimization and integration of physical space, and enhancement of publicity activities for the comprehensive child health services.Conclusion:Based on the analysis in Gumei health service center, this study identified key problems in community integrated child health services, and proposes the quality improvement measure in the organizational structure and management model of the service team.

Objective:To explore the effect of pentraxin 3 (PTX3) on memory improvement and Aβ expression in Alzheimer's disease (AD) model mice.Methods:(1) Ten 5-month-old 5×FAD mice were randomly divided into PTX3 group and model group ( n=5); 5 C57BL/6 wild-type mice at the same age were selected as control group; mice in the PTX3 group and control group were stereotactically injected 4 μL 0.5 g/L PTX3 or same dose of phosphate buffered saline (PBS); Morris water maze test was used to detect the learning and memory abilities, Y maze test was used to detect the short-term memory, and ELISA was used to obsevre the contents of Aβ 40 and Aβ 42 in the brain hemisphere. (2) Twenty-five 3-month-old 5×FAD mice were randomly divided into model group, 2 μg/kg PTX3 group, 4 μg/kg PTX3 group, 8 μg/kg PTX3 group, and 16 μg/kg PTX3 group ( n=5); 5 C57BL/6 wild-type mice at the same age were selected as control group; mice in the PTX3 groups were intranasally injected 2, 4, 8, and 16 μg/kg PTX3, respectively; those in the model group and control group were intranasally injected same dose of PBS; injection was given once every 96 h for a total of 7 times. Morris water maze test was used to detect the learning and memory abilities, Y maze test was used to detect the short-term memory, and ELISA was used to obsevre the contents of Aβ 40 and Aβ 42 in the hippocampus. Results:(1) Compared with the model group, the PTX3 group had significantly shorter platform latency, higher percentage of exploration time and higher percentage of spontaneous alternations ( P<0.05). Compared with those in model group ([63.38±21.42] pg/mL, [29.77±6.11] pg/mL), the concentrations of Aβ 40 and Aβ 42 in the brain tissues of PTX3 group ([15.87±2.11] pg/mL, [16.55±1.95] pg/mL) were statistically lower ( P<0.05). (2) Compared with the model group, the 16 μg/kg PTX3 group had significantly shorter escape latency and higher percentage of exploration time ( P<0.05); compared with the model group, the 2 μg/kg PTX3 group and 16 μg/kg PTX3 group had significantly higher percentage of spontaneous alternations ( P<0.05). The contents of Aβ 40 and Aβ 42 in the hippocampus of 8 μg/kg PTX3 group and 16 μg/kg PTX3 group were statistically lower compared with those in the model group ( P<0.05). Conclusion:PTX3 may attenuate cognitive deficits and decrease Aβ expression in the brain or hippocampus tissues of 5×FAD mice with AD.

Objective:To explore the role of ARAF mutation in RAF inhibitor resistance in lung cancer cells.Methods:The lung cancer cell lines A549 and NCI-H1688 with ARAF gene knockout were constructed using CRISPR-Cas9 method. Overexpression of wild-type ARAF (ARAF WT) and mutant ARAF (ARAF V145L, S214F, S214C, or D429A) in lung cancer cells with ARAF gene knockout was achieved through lentiviral packaging infection method, while the control group consisted of untreated A549 or NCI-H1688 cells with ARAF gene knockout. A549 or NCI-H1688 cells in each group were treated with different concentrations of RAF inhibitor belvarafenib or AZ-628. The CCK-8 method was used to detect cell viability, and the half maximal inhibitory concentration ( IC50) of cells in each group against belvarafenib or AZ-628 was calculated. A549 or NCI-H1688 cells in each group were treated with IC50 (263 nmol/L) of belvarafenib in the ARAF WT group, and the expression levels of key proteins in the ARAF and MEK/ERK/RSK signaling pathways were detected by Western blotting. The 6-8 week old male BALB/c nude mice were selected and subcutaneously injected stable overexpression of ARAF WT or mutant ARAF A549 or NCI-H1688 cell suspension with ARAF gene knockout into the axilla to construct a xenograft tumor model, and 30 mg/kg belvarafenib or AZ-628 solution was administered continuously by gavage per day; tumor volume was compared among the groups at the 16th day. Results:Compared with the ARAF WT group, the IC50 of belvarafenib or AZ-628 in A549 or NCI-H1688 cells of the ARAF D429A group was lower, while the IC50 of the ARAF S214F and ARAF S214C groups was higher, and the differences were statistically significant (all P < 0.05). Compared with the ARAF WT group, the relative expression levels of p-MEK, p-ERK and p-RSK in A549 or NCI-H1688 cells treated with belvarafenib in the ARAF WT and ARAF D429A groups were all lower, and the differences were statistically significant (all P < 0.05), but there were no statistically significant differences in the relative expression levels of ARAF, MEK, ERK, and RSK (all P > 0.05); compared with the ARAF WT group, the ARAF S214F and ARAF S214C groups treated with belvarafenib had higher relative expression levels of p-MEK, p-ERK and p-RSK, and the differences were statistically significant (all P < 0.05), but there were no statistically significant differences in the relative expression levels of ARAF, MEK, ERK, and RSK (all P > 0.05). On the 16th day after gavage with belvarafenib or AZ-628, the tumor volume of nude mice transplanted with A549 or NCI-H1688 cells in ARAF WT and ARAF D429A groups was lower than that in the corresponding ARAF WT and ARAF D429A groups without belvarafenib or AZ-628 intervention, and the tumor volume of nude mice transplanted with A549 or NCI-H1688 cells in ARAF D429A group was lower than that in the corresponding ARAF WT group with belvarafenib or AZ-628 gavage, and the differences were statistically significant (all P < 0.05). On the 16th day after gavage with belvarafenib or AZ-628, the tumor volume of nude mice transplanted with A549 or NCI-H1688 cells in ARAF S214F and ARAF S214C groups was not significantly different from that in ARAF S214F and ARAF S214C groups without belvarafenib or AZ-628 intervention (all P > 0.05), and compared with nude mice transplanted with A549 or NCI-H1688 cells in ARAF WT group with belvarafenib or AZ-628 gavage, there was no significant difference (all P > 0.05). Conclusions:The ARAF D429A mutation increases the sensitivity of lung cancer to RAF inhibitors, while the ARAF S214F and S214C mutations increase the resistance of lung cancer to RAF inhibitors.

Professor ZHANG Boli believed that the core pathogenesis of heart failure with preserved ejection fraction （HFpEF） is weak pulse at yang and wiry pulse at yin. By referring to the theory of “damp-turbidity and phlegm-rheum type of diseases”， he proposed that yin pathogens of damp-turbidity and phlegm-rheum may damage yang qi in each stage of HFpEF， thus aggravating the trend of weak pulse at yang and wiry pulse at yin， which played an important role in the deterioration of HFpEF. Therefore， Professor ZHANG Boli advocated that importance should be attached to the elimination of yin pathogen and the protection of yang qi during the various stages of HFpEF in order to delay the aggravation of weak pulse at yang and wiry pulse at yin； he put forward the idea of staged treatment that “yin pathogen should be dispelled and yang qi should be demonstrated”； and he formulated the treatment strategy of treating the disease as early as possible， eliminating pathogens and protecting yang， interrupting the disease trend， using warm-like medicinals， and activating blood circulation， to enrich the theoretical system of traditional Chinese medicine in the treatment of HFpEF.

This paper summarized professor ZHANG Boli's experience in treating stubborn bi （痹） with the herbal pair of Ruxiang （Olibanum）- Moyao （Myrrha）. The basic pathogenesis of stubborn bi is channel and collateral stasis and obstruction. Ruxiang and Moyao are thus used in mutual reinforcement to rectify qi and diffuse bi， activate blood and relieve pain， thereby removing static and obstructed qi and blood， unblocking the obstructed channels and colla-terals， which is especially suitable for stubborn bi caused by channel and collateral obstruction. In clinical practice， the herbal pair of Ruxiang-Moyao is used together with qi-moving and blood-activating medicinals to treat chest bi by expelling stasis and diffusing stagnation， dissipating cold and unblocking vessels. To treat long-term wither and weakness in late stage of stroke， the medicinals of boosting qi and invigorating blood， unblocking channels and venting collaterals can be added to the herbal pair so as to soothe and drain vessels and collaterals， harmonize and regulate qi and blood. Simiao Yongan Decoction （四妙勇安汤） can be integrated in the treatment of vessel bi by moving qi and dissolving stasis， and for the long-term stubborn vessel bi， integrated internal and external treatment is suggested by external use of Ruxiang-Moyao to vent bi with aromatics. Moreover， it is emphasized to use the herbal pair of Ruxiang-Moyao in accordance with indications and cautions.

Objective:To investigate the protective effect of chrysin on the newborn rats with ischemic hypoxic brain damage and its related mechanism.Methods:The rats were randomly divided into sham-operated group, model group, low and high-dosage group of chrysin with 12 rats in each group. Except sham-operated group, the rats in other three groups were used as hypoxic-ischemic encephalopathy model. After the modeling, the rats in the low and high dosage groups were intraperitoneally injected with 30 mg/kg and 60 mg/kg chrysinimmediately, while the rats in the sham-operated group and the model group were intraperitoneally injected with equal volume of normal saline for 4 days. The HE staining was used to observe the protective effect of drugs on brain. The superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA) levels in cells were measured by biochemical method. Western blot was used to detect the expression of heme oxygenase-1 (HO-1) and transcription factor NF-E2-related factor 2 (Nrf2).Results:The neurons in the cortex of rats in sham-operated group were arranged orderly with round nuclei and obvious nucleoli; the brain tissue of rats in model group showed edema and the arrangement of neurons was loose, the degeneration and necrosis of neurons in low and high dosage of chrysin groups were less than those in model group. Compared to the model group, the SOD activity (55.74 ± 5.14 U/mg, 69.84 ± 5.05 U/mg vs. 37.64 ± 6.41 U/mg) and CAT activity (2.44 ± 0.22 U/mg, 2.59 ± 0.42 U/mg vs. 2.08 ± 0.37 U/mg) in the brain tissue of rats in the low and high dose group were significantly increased ( P<0.05). The MDA level (3.74 ± 0.05 mmol/mg, 2.60 ± 0.18 mmol/mg vs. 4.35 ± 0.24 mmol/mg) in rat brain tissue of low and high dose group was significantly decreased ( P<0.05). The expressions of HO-1 (0.43 ± 0.08, 1.02 ± 0.15 vs. 0.14 ± 0.07) and Nrf2 (0.48 ± 0.07, 0.79 ± 0.09 vs. 0.26 ± 0.08) protein in rat brain tissue of low and high dose group were significantly decreased ( P<0.05). Conclusions:The chrysin could alleviate nerve injury in rats with hypoxic-ischemic encephalopathy, and its mechanism may be related to the up-regulated HO-1 and Nrf2 protein expression.

Objective To explore the classic MRI appearance of secondary hemochromatosis (SHC)related liver iron overload, and the feasibility of quantitative evaluation of liver iron overload by iterative decomposition of water and fat with echo asymmetry and leastGsquares estimationGiron quantification (IDEALGIQ).Methods 20 patients with SHCGrelated liver iron overload (experimental group)and 20 healthy adults (control group)underwent routine liver MRI and IDEALGIQ.The MRI images were comparatively analyzed to assess the hallmark of liver iron overload.In both two groups,the R2 ? values were measured on R2 ? maps,which were generated by IDEALGIQ,then the differences in age,gender and R2 ? value between two groups were comparatively analyzed.In experimental group,the serum ferritin (SF)was detected,and a correlation analysis was tested with R2 ? value.Results For all of the 20 patients, there was signal drop of liver parenchyma on T1 and T2 Gweighted images,signal loss with susceptibility artifact on DWI images,and signal dropped on inGphase images relative to outGofGphase images.Among the 20 patients,18 cases appeared "a dark liver parenchyma"on T2 G weighted images,and the spleen signal in 3 cases was similar to liver parenchyma’s hallmark.The R2 ? values in experimental group and control group were 395.58±255.75 Hz and 41.18±7.86 Hz (t＝－6.12,P＝0.00),respectively.No significant differences between two groups were found in gender and age (χ2＝0.10,P＝0.10 and t＝0.09,P＝0.93).The liver iron overload R2? value was not correlated with SF (r＝0.1 5 3 , P＝0.15).Conclusion On MRI,the typical appearance of liver iron overload is hypointense on T1 and T2Gweighted images,especially"a dark liver parenchyma"on T2 WI,signal drops on inGphase images relative to outGofGphase images,and signal loss with susceptibility artifact on DWI images.R2 ? value of IDEALGIQ can quantitatively evaluate the liver iron overload,without a correlation with SF.

Objective: To explore the psychological experience of the caregivers of Hepatocellular Carcinoma with Hepatitis B virus. Methods: Semi-structured Interviews were performed in a total of 12 main caregivers of Hepatocellular Carcinoma with Hepatitis B in the Chinese Academy of Medical Sciences from October 2016 to March 2017, and the original data was analyzed according to the Colaizzi 7-step method. Results: A total of five topics were extracted, including Awareness of relief stress when the diagnosis was informed, Indebtedness and self-blame, fear and sadness of possible loss of loved ones, stressful anxiety (stress of economy, loss of function, worrying about being infected), and joint stigma. Conclusions Many psychological experiences of main caregivers of patients with hepatocellular carcinoma combined with hepatitis B coexist in the course of care. Exploring and providing effective care support based on the psychological experience and needs of caregivers is one way to improve physical and mental health and the quality of care for patients.

Objective To evaluate the value of 3.0T MRI diffusion-weighted imaging (DWI)in diagnosis and staging of cervical cancer. Methods A total of 65 cervical carcinoma patients were enrolled and performed T2 WI,DWI and LAVA-Flex dynamic contrast-enhancement before operation.MR images were analyzed by two radiologists to evaluate the staging performance.Results All the cervical cancers were detected in DWI,while three lesions were missed in T2 WI and one lesion was missed in LAVA-Flex dynamic contrast-enhanced MRI.Respectively,the accuracy of staging with DWI,T2 WI and LAVA-Flex dynamic contrast-enhanced MRI was 90.8%,78.5%and 87.7%.Accuracy of DWI was significantly higher than that of T2 WI(P =0.04),while there was no significant difference of accuracy between DWI and LAVA-Flex dynamic contrast-enhanced sequence (P =0.39).Conclusion DWI shows relatively higher accuracy than T2 WI in the staging of cervical cancer which makes it an ideal method to replace LAVA-Flex dynamic contrast-enhanced MRI for exact staging.