The integrated medical and elderly care model provides comprehensive medical and elderly care services by establishing medical facilities in elderly care institutions or forming close cooperative relationships with surrounding medical institutions. Currently， there are 87，000 paired partnerships established nationwide between medical and health institutions and elderly care service institutions， and more than 7，800 integrated medical and elderly care institutions have obtained the qualifications of medical and health institutions and completed elderly care service registration. This model not only meets the elderly’s healthcare needs but also provides life care， psychological support， and social activities， thereby improving their quality of life. However， the integrated medical and elderly care model also faces numerous ethical dilemmas in practice. This paper aimed to explore in depth the ethical dilemmas and countermeasures optimization in the work of elderly care institutions under this model， to promote the improvement of service quality， comprehensively guarantee the rights and interests of the elderly， and promote the healthy development of this model in practice. Under this model， the elderly care institutions not only bear the responsibility of providing long-term care and life services but also need to cooperate with medical institutions to provide healthcare and health management services for the elderly. By exploring the practical paths for elderly care institutions to address the ethical dilemmas faced with this model， feasible solutions were proposed to enhance the welfare of the elderly and promote the harmonious development of society.

Autophagy is the main degradation and recycling pathway for abnormal aggregates and damaged organelles in cells,and it maintains the normal metabolic balance and material renewal in cells.Autophagy has neuroprotective effects and can affect the functional state of the nervous system by regulating homeostasis,development,apoptosis,and other physiological processes of neurons and glial cells.In recent years,a large number of studies have shown that nervous system diseases are closely related to abnormal autophagy,and inhibition or overactivation of autophagy affects the occurrence and development of depression,neurodegenerative diseases,and schizophrenia.Understanding the mechanisms of autophagy in nervous system diseases is of great significance for their prevention and treatment.This paper mainly reviews the current progress of autophagy research and the above diseases of the nervous system,providing a reference for further research into these diseases.

Objective:To investigate the effect of Hong's One Stitch Method in pancreaticoduodenectomy(PD).Methods:A total of 40 patients who underwent PD in our hospital from Jan 2021 to Dec 2022 were divided into two groups according to random number table method,with 20 patients in each group.The control group was treated with end to end pancreatojejunal anastomosis,and the observation group was treated with"Hong's One Stitch Method".The perioperative indicators,complications,secondary surgery,mortality and quality of life were compared between the two groups.Results:The pancreatoenteroanastomosis time,operation time and hospitalization time in the observation group were shorter than those in the control group,and the incidence of pancreatic fistula was lower than that in the control group(P＜0.05).There were no significant differences in intraoperative blood loss,pancreatic biochemical leakage,bile fistula,hemorrhage,localized abdominal infection,gastric emptying obstruction,pulmonary infection,secondary surgery and mortality between the two groups(P＞0.05).The mental health score,emotional function score,social function score,energy score,general health status score,body pain score,and physiological function score in the observation group were higher than those in the control group(P＜0.05).Conclusion:In PD surgery,the application of"Hong's One Stitch Method"to perform pancreatoenterostomy is beneficial to shorten the pancreatoenterostomy time,operation time and hospitalization time,accelerate the postoperative recovery,reduce the incidence of pancreatic fistula,and improve the quality of life of patients.

Background/Aims: Ubiquitination is widely involved in the progression of hepatocellular carcinoma (HCC) by regulating various cellular processes. However, systematic strategies for screening core ubiquitin-related genes, clarifying their functions and mechanisms, and ultimately developing potential therapeutics for patients with HCC are still lacking. Methods: Cox and LASSO regression analyses were performed to construct a ubiquitin-related gene prediction model for HCC. Loss- and gain-of-function studies, transcriptomic and metabolomics analysis were used to explore the function and mechanism of UBE2S on HCC cell glycolysis and growth. Results: Based on 1,423 ubiquitin-related genes, a four-gene signature was successfully constructed to evaluate the prognosis of patients with HCC. UBE2S was identified in this signature with the potential to predict the survival of patients with HCC. E2F2 transcriptionally upregulated UBE2S expression by directly binding to its promoter. UBE2S positively regulated glycolysis in a HIF-1α-dependent manner, thus promoting the proliferation of HCC cells. Mechanistically, UBE2S enhanced K11-linkage polyubiquitination at lysine residues 171 and 196 of VHL independent of E3 ligase, thereby indirectly stabilizing HIF-1α protein levels by mediating the degradation of VHL by the proteasome. In particular, the combination of cephalomannine, a small molecule compound that inhibits the expression of UBE2S, and PX-478, an inhibitor of HIF-1α, significantly improved the anti-tumor efficacy. Conclusions UBE2S is identified as a key biomarker in HCC among the thousands of ubiquitin-related genes and promotes glycolysis by E3 enzyme-independent ubiquitination, thus serving as a therapeutic target for the treatment of HCC.

Interleukin (IL)-17A, a pro-inflammatory cytokine, is a fundamental function in the onset and advancement of multiple immune diseases. To uncover the primary compounds with IL-17A inhibitory activity, a large-scale screening of the library of traditional Chinese medicine constituents and microbial secondary metabolites was conducted using splenic cells from IL-17A-GFP reporter mice cultured under Th17-priming conditions. Our results indicated that some aureane-type sesquiterpene tetraketides isolated from a wetland mud-derived fungus, Myrothecium gramineum, showed remarkable IL-17A inhibitory activity. Nine new aureane-type sesquiterpene tetraketides, myrogramins A-I ( 1, 4- 11), and two known ones ( 2 and 3) were isolated and identified from the strain. Compounds 1, 3, 4, 10, and 11 exhibited significant IL-17A inhibitory activity. Among them, compound 3, with a high fermentation yield dose-dependently inhibited the generation of IL-17A and suppressed glycolysis in splenic cells under Th17-priming conditions. Strikingly, compound 3 suppressed immunopathology in both IL-17A-mediated animal models of experimental autoimmune encephalomyelitis and pulmonary hypertension. Our results revealed that aureane-type sesquiterpene tetraketides are a novel class of immunomodulators with IL-17A inhibitory activity, and hold great promise applications in treating IL-17A-mediated immune diseases.

Objective:To investigate the current situation of students' academic procrastination behavior in medical colleges and universities and its influencing factors, and to put forward suggestions to reduce the academic procrastination of medical students.Methods:A total of 1 327 undergraduate students from three medical colleges and universities in Heilongjiang Province were randomly selected to receive questionnaire investigation on life satisfaction, anxiety, and academic procrastination. SPSS 23.0 was used for data analysis.Results:①The total procrastination scores of medical students were (35.00±8.92) points. ②There were statistical differences in the academic procrastination of medical students with different genders, whether the only children, the reasons for choosing the major, and the level of achievement ( P < 0.05). There was no statistical difference in academic procrastination among medical students of different ages and grades ( P > 0.05). ③Medical students' procrastination was positively correlated with their anxiety level ( r = 0.102, P < 0.01), and negatively correlated with life satisfaction ( r = -0.117, P < 0.01). ④Regression analysis showed that the following six predictive variables including the level of achievement, gender, life satisfaction, anxiety, reasons for choosing the major, and whether the only children could effectively explain the variance of 14.2% academic procrastination of medical students. Conclusion:The overall degree of academic procrastination of medical students is higher than that of non-medical students. And the students' achievement level, gender, life satisfaction, anxiety, the reasons for choosing this major and whether the only child are the influencing factors of academic procrastination.

Objective:To investigate the resistance of adult Aedes albopictus to commonly used insecticides, in order to scientifically select and use insecticides. Methods:In Siming, Jimei and Haicang districts of Xiamen City in September 2018, and in Siming, Jimei and Xiang'an districts of Xiamen City in August 2019, larvae and egg blocks of Aedes albopictus in the field were collected by ladle method, and then raised to adult mosquitoes in the laboratory. The resistance of adult Aedes albopictus to 7 commonly used insecticides was determined by the contact tube method, and the knockdown rate of 1 h and mortality rate of 24 h recovery were calculated. The resistance level was determined according to the mortality rate: ≥98% was the sensitive group (S); 80% - < 98% was potential resistant group (M); < 80% was resistant group (R). Results:In 2018 and 2019, adult Aedes albopictus were exposed to 0.1% deltamethrin, 0.4% beta-cypermethrin, 0.5% lambda-cyhalothrin, 1.4% alpha-cypermethrin, 3% permethrin, 0.5% malathion and 0.05% propoxur, the knockdown rates of 1 h were 95.1% (117/123), 98.3% (115/117), 100.0% (116/116), 99.2% (120/121), 98.4% (123/125), 97.5% (119/122), 100.0% (127/127) and 96.7% (118/122), 98.6% (143/145), 100.0% (139/139), 100.0% (149/149), 98.0% (146/149), 96.8% (121/125), and 100.0% (126/126), respectively. In 2018, the mortality rates of 24 h recovery were 91.1% (112/123), 78.6% (92/117), 75.0% (87/116), 88.4% (107/121), 96.0% (120/125), 99.2% (121/122), and 100.0% (127/127), respectively. In 2019, the adjusted mortality rates of 24 h recovery were 74.9%, 76.9%, 79.5%, 91.4%, 92.3%, 100.0%, and 100.0%, respectively. Conclusions:Adult Aedes albopictus in Xiamen City is sensitive to malathion and propoxur, and it has a high resistance to pyrethroids insecticides such as deltamethrin, beta-cypermethrin and lambda-cyhalothrin. Therefore, it is necessary to strengthen resistance monitoring and use different insecticides in turn to reduce and delay the development of resistance.

Objective:After general anesthesia and mechanical ventilation for laparoscopic colorectal cancer resection, about 90% of patients would have different degrees of atelectasis. Authors speculated that an open-lung strategy (OLS) comprising moderate positive end-expiratory pressure (PEEP) and intermittent recruitment maneuvers (RM) can reduce atelectrauma and thus reduce the incidence of oxygenation-impairment during low-tidal-volume ventilation for laparoscopic colorectal cancer resection. The purpose of this study was to verify this hypothesis and provide a better intraoperative ventilation scheme for laparoscopic colorectal cancer resection.Methods:This was a prospectively randomized controlled clinical trial which was approved by the Ethics Committee of the Sixth Affiliated Hospital, Sun Yat-sen University (2017ZSLYEC-002), and registered at the ClinicalTrials.gov (NCT03160144). From January to July 2017, patients who underwent laparoscopic colorectal cancer resection, with age > 40 years, estimated pneumoperitoneum time ≥ 1.5 h, pulse oxygen saturation ≥ 92%, and risk grade for postoperative pulmonary complications ≥ 2 were prospectively enrolled. The patients with American Society of Anesthesiologists physical status ≥ IV, body mass index ≥ 30 kg/m 2, pneumonia, acute respiratory failure or sepsis within 1 month, severe chronic obstructive pulmonary disease, pulmonary bullae and progressive neuromuscular diseases, and those participating in other interventional clinical trials were excluded. The enrolled patients were randomly assigned (1:1) to the OLS group (with a PEEP of 6-8 cm H 2O and intermittent RM), and the NOLS group (without using PEEP and RM). Partial pressure of arterial oxygen (PaO 2) /fraction of inspired oxygen (FiO 2) and shunt fraction (Q S/Q T) were calculated via arterial and central venous blood gas analysis performed at 0.5 h (T 1), 1.5 h (T 2) after pneumoperitoneum induction and at 20 min after admission to the recovery room. Driving pressure immediately before pneumoperitoneum induction (T 0) and at T 2 were calculated via monitoring data. The primary outcome was oxygenation-impairment (PaO 2/FiO 2 ≤ 300 mmHg) during mechanical ventilation. Results:In each group, 48 patients under general anesthesia and low-tidal-volume ventilation were included in the final analysis. During ventilation, the oxygenation-impairment occurred in 7 patients (14.6%) of OLS group and in 17 patients (35.4%) of NOLS group, whose difference was statistically significant between two groups (χ 2=5.556, RR=0.31, 95%CI: 0.12 to 0.84, P=0.033). During ventilation, the patients in the OLS group had higher PaO 2/FiO 2 [T 1: (427±103) mmHg vs. (366±109) mmHg, t=-2.826, P=0.006; T 2: (453±103) mmHg vs. (388±122) mmHg, t=-2.739, P=0.007], lower Q S/Q T [ T 1: (9.2±6.5) % vs. (12.6±7.7) %, t=2.322, P=0.022; T 2: (7.0±5.8)% vs.(10.9±9.2)%, t=2.408, P=0.019], and lower driving pressure [T 0: (6±3) cm H 2O vs. (10±2) cm H 2O, t=7.421, P<0.001; T 2: (13±3) cm H 2O vs. (17±4) cm H 2O, t=5.417, P<0.001] than those in the NOLS group, with stratistical differences in all comparisons. In recovery room, though PaO 2/FiO 2 [(70.3±9.4) mmHg vs. (66.8±9.4) mmHg, P=0.082] was still higher and Q S/Q T [(18.6±8.3)% vs. (21.8±8.4)%, P=0.070] was still lower in the OLS group as compared to the NOLS group, the differences were not statistically significant (both P>0.05). Conclusion:The application of such an OLS during low-tidal-volume ventilation can greatly reduce the incidence of oxygenation-impairment in laparoscopic colorectal cancer resection, and such effect may last to the period of emergence from anesthesia.

Objective:After general anesthesia and mechanical ventilation for laparoscopic colorectal cancer resection, about 90% of patients would have different degrees of atelectasis. Authors speculated that an open-lung strategy (OLS) comprising moderate positive end-expiratory pressure (PEEP) and intermittent recruitment maneuvers (RM) can reduce atelectrauma and thus reduce the incidence of oxygenation-impairment during low-tidal-volume ventilation for laparoscopic colorectal cancer resection. The purpose of this study was to verify this hypothesis and provide a better intraoperative ventilation scheme for laparoscopic colorectal cancer resection.Methods:This was a prospectively randomized controlled clinical trial which was approved by the Ethics Committee of the Sixth Affiliated Hospital, Sun Yat-sen University (2017ZSLYEC-002), and registered at the ClinicalTrials.gov (NCT03160144). From January to July 2017, patients who underwent laparoscopic colorectal cancer resection, with age > 40 years, estimated pneumoperitoneum time ≥ 1.5 h, pulse oxygen saturation ≥ 92%, and risk grade for postoperative pulmonary complications ≥ 2 were prospectively enrolled. The patients with American Society of Anesthesiologists physical status ≥ IV, body mass index ≥ 30 kg/m 2, pneumonia, acute respiratory failure or sepsis within 1 month, severe chronic obstructive pulmonary disease, pulmonary bullae and progressive neuromuscular diseases, and those participating in other interventional clinical trials were excluded. The enrolled patients were randomly assigned (1:1) to the OLS group (with a PEEP of 6-8 cm H 2O and intermittent RM), and the NOLS group (without using PEEP and RM). Partial pressure of arterial oxygen (PaO 2) /fraction of inspired oxygen (FiO 2) and shunt fraction (Q S/Q T) were calculated via arterial and central venous blood gas analysis performed at 0.5 h (T 1), 1.5 h (T 2) after pneumoperitoneum induction and at 20 min after admission to the recovery room. Driving pressure immediately before pneumoperitoneum induction (T 0) and at T 2 were calculated via monitoring data. The primary outcome was oxygenation-impairment (PaO 2/FiO 2 ≤ 300 mmHg) during mechanical ventilation. Results:In each group, 48 patients under general anesthesia and low-tidal-volume ventilation were included in the final analysis. During ventilation, the oxygenation-impairment occurred in 7 patients (14.6%) of OLS group and in 17 patients (35.4%) of NOLS group, whose difference was statistically significant between two groups (χ 2=5.556, RR=0.31, 95%CI: 0.12 to 0.84, P=0.033). During ventilation, the patients in the OLS group had higher PaO 2/FiO 2 [T 1: (427±103) mmHg vs. (366±109) mmHg, t=-2.826, P=0.006; T 2: (453±103) mmHg vs. (388±122) mmHg, t=-2.739, P=0.007], lower Q S/Q T [ T 1: (9.2±6.5) % vs. (12.6±7.7) %, t=2.322, P=0.022; T 2: (7.0±5.8)% vs.(10.9±9.2)%, t=2.408, P=0.019], and lower driving pressure [T 0: (6±3) cm H 2O vs. (10±2) cm H 2O, t=7.421, P<0.001; T 2: (13±3) cm H 2O vs. (17±4) cm H 2O, t=5.417, P<0.001] than those in the NOLS group, with stratistical differences in all comparisons. In recovery room, though PaO 2/FiO 2 [(70.3±9.4) mmHg vs. (66.8±9.4) mmHg, P=0.082] was still higher and Q S/Q T [(18.6±8.3)% vs. (21.8±8.4)%, P=0.070] was still lower in the OLS group as compared to the NOLS group, the differences were not statistically significant (both P>0.05). Conclusion:The application of such an OLS during low-tidal-volume ventilation can greatly reduce the incidence of oxygenation-impairment in laparoscopic colorectal cancer resection, and such effect may last to the period of emergence from anesthesia.

Objective To examine the current situation of the career plateau among anesthesiologists and analyze the impact of occupational stressors on it. Methods A questionnaire survey was conducted on the anesthesiologists. A total of 300 questionnaires were distributed and 278 questionnaires were effectively collected. Statistical analysis using SPSS 19.0 was performed to assess the status quo of career plateau among anesthesiologists. Pearson correlation analysis and stepwise regression analysis were used to analyze the influence of occupational stressors on career plateau . Results The average value of occupational stressors among anesthesiologists was (3.22±0.55), and the average value of career plateau was (3.90±0.70). Occupational interest in the occupational stressors of anesthesiologists is negatively correlated with the occupational plateau (r=-0.552, P<0.01), and career development is negatively correlated with occupational plateau (r=-0.541, P<0.01) as well. Both occupational interest and career development show a negative predictive effect on the career plateau (β=-0.359, P<0.01 andβ=-0.334, P<0.01, respectively). Conclusion Career plateau among anesthesiologists is at a medium-to-high level. Occupational interest and occupational development in occupational stressors have a negative predictive effect on occupational plateaus, so hospital managers should pay attention to them.