Objective:To investigate the training needs of general practitioners in community health center in health care and management of older patients for developing a curriculum for the Extension for Community Health Outcomes (ECHO) project accordingly.Methods:This was a qualitative study. The semi-structured interviews were conducted with 20 community health center general practitioners (GPs) using focus groups between March 2024 and April 2024. The interview data were collated using Nvivo12 software and coded using thematic analysis. The focus of the interviews was on the challenges GPs face in health care of older people in the community and relevant training needs.Results:Three male and 17 female GPs took part in the interviews. The interviews showed that GPs in comminity health service centers faced multiple challenges in the helth management of older patients, including implementation of holistic treatment plans, time-consuming comprehensive patient assessment, lack of standardized medication selection, unclear referral processes and difficulties in establishing a trusting doctor-patient relationship. The study suggested that the design and development of training programs should encompass eight core components: differentiated end-of-life care for patients, nutritional advice, positive psychological intervention, software data-based health assessment, systematic geriatric medicine, updated clinical research findings, medication selection and treatment guidelines, and insulin resistance management.Conclusion:Through qualitative investigation, this study explored the challenges faced by general practitioners in providing health care for older patients and relevant training needs, which provids evidence for designing and developing corresponding curricula for ECHO projects.

Objective:To investigate the training needs of general practitioners in community health center in health care and management of older patients for developing a curriculum for the Extension for Community Health Outcomes (ECHO) project accordingly.Methods:This was a qualitative study. The semi-structured interviews were conducted with 20 community health center general practitioners (GPs) using focus groups between March 2024 and April 2024. The interview data were collated using Nvivo12 software and coded using thematic analysis. The focus of the interviews was on the challenges GPs face in health care of older people in the community and relevant training needs.Results:Three male and 17 female GPs took part in the interviews. The interviews showed that GPs in comminity health service centers faced multiple challenges in the helth management of older patients, including implementation of holistic treatment plans, time-consuming comprehensive patient assessment, lack of standardized medication selection, unclear referral processes and difficulties in establishing a trusting doctor-patient relationship. The study suggested that the design and development of training programs should encompass eight core components: differentiated end-of-life care for patients, nutritional advice, positive psychological intervention, software data-based health assessment, systematic geriatric medicine, updated clinical research findings, medication selection and treatment guidelines, and insulin resistance management.Conclusion:Through qualitative investigation, this study explored the challenges faced by general practitioners in providing health care for older patients and relevant training needs, which provids evidence for designing and developing corresponding curricula for ECHO projects.

Objective: To understand the change of smoking status among middle school students in Quzhou City from 2012 to 2017, and to provide a basis for school tobacco control. Methods: Through stratified cluster sampling method, Zhejiang youth health-related behavior questionnaire survey was conducted among 1 454 students in May 2012 and among 1 655 students in May 2017. Results: Among middle school students in Quzhou, attempting smoking rate, ever-smoking a whole cigarette reporting rate and current-smoking report rate decreased from 31.36%, 17.81% and 8.73% in 2012 to 21.70%,12.45% and 6.22% in 2018 respectively, with statistically significant differences(χ2=37.30,17.52,7.12,P<0.01). Among the current-smoking students, the rate of smoking frequency≥20 d/month and heavy-smoking rate decreased from 30.71% and 7.09% in 2012 to 15.53% and 0.97% respectively. It showed that attempting smoking rate, ever-smoking a whole cigarette reporting rate and current-smoking report rate of male students were higher than that of female students(χ2=117.50,63.99;47.14,51.26;110.18,22.50), and the non-ordinary high school students were higher than that of ordinary high school students and middle school students across two waves surveillance(χ2=47.14,51.26;70.34,43.77;62.67,22.50)(P<0.01). Conclusion School tobacco control have made a great progress，the tobacco use behavior of middle school students declines sharply in Quzhou.

Objective To explore the clinical effect of Tongbi capsule combined with acupuncture for the patients with knee osteoarthritis and explore the mechanism of inflammatory response and hemorrheology. Methods According to the random table method, 88 KOA patients in our hospital from February 2016 to January 2017 were divided into the control group and the research group with 44 in each group. Patients in the control group were treated bycelecoxib capsule, while the patients in the research group were treated by Tongbi capsule combined with acupuncture. The treatment courses of two groups were two months. The clinical total effective rate of two groups of patients were compared after treatment. At the same time, the osteoarthritis index visual scale (WOMAC) and morning stiffness, joint tenderness index score were detected and compared after the treatment.The levels of serum tumor necrosis factor-α(TNF-α), interleukin (IL)-1β and IL-6 were detected by enzyme linked immunosorbent assay before and after the treatment. The hemorheology indexes were tested by automatic biochemical analyzer. In addition, the incidence of adverse reactions of two groups of patients was observed during treatment. Results The clinical total effective rate of the research group was 93.18％ (41/44), which was significantly higher than the control group72.73％ (32/44), and the difference was statistically significant (χ2=6.510, P=0.011). After treatment, the WOMAC (31.26 ± 6.12 vs. 36.17 ± 7.09, t=-3.477), joint tenderness index (1.75 ± 0.46 vs. 2.11 ± 0.54, t=-3.366) and morning stiffness score (1.62 ± 0.53 vs. 2.14 ± 0.51, t=-4.690) of the research group were significantly lower than those of the control group (P<0.05). The levels of TNF-α (7.36 ± 1.45 pg/ml vs. 8.02 ± 1.54 pg/ml, t=-2.070), IL-1β (27.82 ± 5.22 μg/ml vs. 33.05 ± 5.17 μg/ml, t=-4.722), IL-6 (2.81 ± 0.58 ng/ml vs. 3.34 ± 0.53 ng/ml, t=-4.475) of the research group were significantly lower than those of the control group (P<0.05). The whole blood high shear viscosity (12.09 ± 3.46 mPa?s vs. 14.22 ± 3.51 mPa?s, t=-2.867), whole blood low shear viscosity (2.53 ± 0.68 mPa?s vs. 3.32 ± 0.71 mPa?s, t=-5.330), whole blood viscosity (1.35 ± 0.29 mPa?s vs. 1.60 ± 0.41 mPa?s, t=-3.302), erythrocyte sedimentation rate (7.10 ± 2.06 mm/h vs. 8.02 ± 2.13 mm/h, t=-2.059), fibrinogen (2.71 ± 0.53 g/L vs. 3.42 ± 0.65 g/L, t=-5.615) and erythrocyte deformation index (0.57 ± 0.16 vs. 0.71 ± 0.19, t=-3.739) of the research group were significantly lower than those of the control group (P<0.05). The incidence of adverse reactions of control group was 11.37％ (5/44), while the incidence of adverse reactions of resarch group was 6.82％ (3/44), which the difference of the incidence of adverse reactions between two groups showed no statistical significance (χ2=0.550, P=0.458). Conclusions The Tongbi capsule combined with acupuncture can reduce the degree of inflammation, and also improve hemorheology indexes of KOA patients.

Objective To investigate the value of quantitative analysis of the left ventricular longitudinal strain in patients with hypertrophic cardiomyopathy (HCM) and with normal left ventricular ejection fraction (LVEF) by using two-dimensional speckle tracking imaging.Methods Twenty-eight HCM patients with normal LVEF (all of the cases were non obstructive HCM),who were diagnosed by clinical and ultrasound echocardiography between January 1,2015 and January 1,2016 in the First Affiliated Hospital of Dalian Medical University,served as the experimental group.And twenty healthy volunteers served as the healthy control group.The peak longitudinal strain (LPS) of the left ventricle and the systolic peak of the left ventricle were calculated by the STE technique.The indexes such as the transmural gradient (△ LS=LPSEndo-LPSEpi)and the transmural gradient percentage (△ LS％=△ LS/LPSEndo) were calculated.The Peak systolic longitudinal strain of endocardium (LPSEndo),the peak systolic longitudinal strain of mid-cardium (LPSMid),the peak systolic longitudinal strain of epicardium (LPSEpi),the peak systolic longitudinal strain of basal segment (LPSb),the peak systolic longitudinal strain of middle segment (LPSm),the peak systolic longitudinal strain of apical segment (LPSa),the global peak systolic longitudinal strain (GLPS) and other left ventricular myocardial strain,such as △ LS,△ LS％,in both the HCM group and the healthy control group,were analyzed by using independent samples t test comparison.For each layer of the left ventricle and the overall myocardial longitudinal strain,two independent sample t test was used for comparison between groups,and LSD-t test was used for intra-group comparison.Results (1) There was a gradient of LPS among the three layers and the three segments in both of the two groups:LPSEndo and LPSMid [(18.36±4.97)％ vs (13.80±4.23)％,(26.41±2.93)％ vs (22.19±2.49)％],the difference was statistically significant (t=5.550,8.529,P ＜ 0.05);LPSEndo and LPSEpi [(18.36±4.97) ％ vs (11.91 ±3.63)％,(26.41±2.93)％ vs (19.43±2.20)％],the difference was statistically significant (t=5.550,8.529,P ＜ 0.05);There was significant difference between LPSMid and LPSEpi in the healthy control group [(22.19 ± 2.49)％ vs (19.43 ± 2.20)％,t=3.709,P ＜ 0.05)],that was,LPSEndo ＞ LPSMid ＞ LPSEpi.LPSa and LPSm,the difference was statistically significant (t=4.029,6.839,P ＜ 0.05);LPSa and LPSb,the difference was statistically significant (t=5.304,9.887,P ＜ 0.05);There was significant difference between LPSm and LPSb in the healthy control group (t=4.170,P ＜ 0.05);that was,LPSa ＞ LPSm ＞ LPSb.In the HCM group,LPS in the 3 layers,3 segments,and the whole left ventricular wall were lower than that of the the healthy control group,the differences were statistically significant [GLPS:(14.63± 3.75)％ vs (22.68±2.51)％,t=-8.347;LPSEndo to LPSEpi:t=-6.477,-7.909,-8.242;LPSa to LPSb:t=-6.647,-8.790,-7.267;all P ＜ 0.05).(2) Compared with the healthy control group,both the segmental gradient and global transmural gradient in the HCM group were found reduced,but the difference had no statistical significance (all P ＞ 0.05).(3) The transmural gradient percentage both in the healthy control group and the HCM group were reduced from the apical segment to the basal segment,the difference were statistically significant (HCM group:t=9.985,5.969;healthy control group:t=17.513,7.043;all P ＜ 0.05).Compared with the healthy control group,the △ LS％a and the △ LS％m of HCM group were significantly higher [(58.86± 11.32)％ vs (43.70±4.73)％,(28.43± 11.48)％ vs (20.30± 3.66)％],and the difference was statistically significant (t=5.634,3.049,all P ＜ 0.05).Conclusions (1) Using 2D-STI could accurately determine the regional or the global left ventricular systolic function in patients with HCM.(2) The transmural gradient percentage can be more sensitive to reflect the change of the transmural gradient,and more research needed to explore its value for clinical application.

Objective To investigate the relationship between procalcitonin (PCT),neutrophil to lymphocyte ratio (NLR) and prognosis of acute pancreatitis.Methods Retrospective analysis was made on the levels of PCT and NLR in 102 patients with acute pancreatitis and the same number of healthy controls who sought routine medical care in the hospital,and comparisons were made between the 2 groups.Then,the relationship between PCT/NLR levels and clinical features of the patients were analyzed.Multivariable logistic regression model and receiver operating characteristic (ROC) were used to evaluate the relationship between NLR/PCT and prognosis of acute pancreatitis.Results The levels of NLR and PCT in the patients with acute pancreatitis were significantly higher than those of the healthy individuals,and both NLR and PCT were closely associated with the patient conditions.The area under curve (AUC) for PCT and NLR were respectively 0.81 and 0.84,and the AUC in multivariable combination usage was 0.96.Conclusion Both NLR and PCT were associated with prognosis of acute pancreatitis,and the combined use of NLR and PCT would facilitate to predict the prognosis of acute pancreatitis.

Alzheimer′s patients bring heavy burden to their family and society, causing potential safety prob-lems unable to escort for a long time with the family, physical constraints between protection and between self-es-teem and the mental health law,the quality of life and life values produce a series of contradiction and ethical is-sues,also make close contact with their nursing staff have to face the moral and ethical dilemma.The suggestions are:Hospital provides professional full-time, professional pension caregivers of alzheimer′s patients for long-term care, Strengthen the communication of nursing staff and patients′families, Reasonable and legitimate use tools, Perfect medical system construction, buildMedical support combinedcare system, Carry out the comprehensive rehabilitation nursing intervention, improve the patients quality of life, Change service concept, strengthening the study of ethical knowledge and application to promote the doctor-patient relationship.

Aim To evaluate the effects of notoginsen-oside R1 on store-operated calcium entry ( SOCE ) in pulmonary arterial smooth muscle cells ( PASMCs ) of chronic hypoxia ( CH)-and monocrotaline ( MCT)-in-duced pulmonary hypertension ( PH) rats. Methods Mn2+ quenching of Fura-2 and measurement of intra-cellular free calcium concentration ( [ Ca2+] i ) using fluo-3 were examined in PASMCs of CH-exposed and MCT-treated rats. Results ①CH-exposed and MCT-treated rats exhibited profound PH when examined 3 weeks after hypoxia exposure or MCT injection, respec-tively. ②In the presence of 3 μmol·L-1 nifedipine, 10 μmol · L-1 notoginsenoside R1 significantly re-duced cyclopiazonic acid ( CPA )-induced the percent reduction in Fura-2 fluorescence measured 500 sec af-ter application of Mn2+, the maximal rate of Mn2+quenching, the amplitude of the Ca2+ influx transient and the resting [ Ca2+] i in PASMCs of CH-exposed and MCT-treated rats. Conclusion Notoginsenoside R1 inhibits SOCE and reduces resting [ Ca2+] i in PASMCs of CH-and MCT-induced PH rats.

Objective To investigate the undergraduates′cognition ,attitude and behavior about low‐carbon life and then to provide a relatively scientifically strategy .and provide scientific basis to formulate countermeasures about undergraduates′low‐car‐bon lifestyle .Methods By multistage sampling ,382 students′knowledge ,attitude and practice about low‐carbon life in Wuhan Uni‐versity of science and technology were analyzed .Results The students′cognition about low‐carbon life was good ,the awareness rate of girl was higher than that of boy ;Their attitude was positive ,grade and knowledge awareness were the two influence factors ;the behavior situation was unsatisfactory ,the origin of students and attitude enthusiasm were the elements affect rationality of be‐havior .Conclusion Undergraduates should strengthen the cognition of low‐carbon life ,improve attitude enthusiasm ,and form a good behavioral habit of low‐carbon life .

Objective To observe clinical efficacy of brinzolamide on mechanical contusion ocular trauma . Methods 50 patients(57 eyes) of mechanical contusion ocular trauma were selected and divided into observation group and control group randomly and evenly ( 29 eyes in the observe group ,28 eyes in the control group ) .On the basis of mechanical contusion ocular trauma basic treatment for all the patients , the observing group was added brinzolamide ophthalmic suspension .Their vision , intraocular pressure and ERG were observed .Results The vision of patients in the observing group was obviously better than that in the control group (χ2 =4.49,P<0.05).Intraocular pressure in the observing group (14.88 ±0.83)mmHg was obviously lower than that in the control group (19.64 ± 2.30)mmHg(P<0.05).Sum of a-wave amplitude and sum of b-wave amplitude after treatment were better than those before treatment ,and those in the observing group were higher than theose in the control group ( observation group:ta =0.44,tb =0.24;the control group:[ ta =1.03,tb =0.32;between two grous:ta =3.35,tb =2.37,P<0.05 ) ] .Conclusion Using Brinzolamide ophthalmic suspension to treat mechanical contusion ocular trauma preven -tively can obviously improve patients′vision, control their intraocular pressure and promote the recovery of retinal function.It has positive clinical effect .