Objective:To survey the quality of medical care and management for chronic obstructive pulmonary disease (COPD) in Shanghai community health service centers.Methods:A questionnaire survey on the institutional capacity for COPD care was conducted among 248 community health service centers in Shanghai from October to November 2023; the contents of self-designed questionnaire included the equipment, drugs, technical support, information exchange and management of COPD in the institutions. At the same time, a questionnaire survey on the knowledge and skill of COPD care was also conducted among half of all physicians selected by stratified sampling from half of the institutions selected by the random cluster sampling, including the knowledge about early screening, diagnosis, treatment and management of COPD, and related training needs .Results:(1)Survey results showed that the most common equipment for diagnosis and treatment of COPD available in community health centers was pulse oxygen saturation detector (97.6%, 242/248), X-ray radiography (96.8%, 240/248) and nebulizer (96.0%, 238/248), The availability of 6-min walking test system, non-invasive ventilator and rehabilitation training instrument in urban community health service centers was higher than that in rural ones ( P<0.05). The availability rates of common COPD drugs in community health service centers were theophylline (91.5%, 227/248), oral glucocorticoid (85.9%, 213/248), intravenous glucocorticoid (81.0%, 201/248), the availability of oral and intravenous glucocorticoids in urban community health service centers was higher than that in rural ones ( P<0.05). The availability rates of COPD diagnosis and treatment techniques were 95.6% (213/248) for pulmonary function test, 93.5% (232/248) for pulse oxygen saturation test, and 53.2% (132/248) for non-invasive respiratory therapy. The availability rate of pulmonary function test, blood gas analysis, non-invasive ventilation and rehabilitation in urban centers was higher than that in rural centers ( P<0.05). Early screening of COPD was conducted in 85.1% (211/248) of community health service centers, the health record system and referral system were established in 66.5% (165/248) and 62.9% (156/248) of centers, respectively; and the establishment of outpatient and referral channels for respiratory diseases in urban areas was higher than that in rural areas ( P<0.05). (2)A total of 1 873 community doctors, aged(38.9±7.8)years and with (15.5±9.1)years of working experience, participated in the COPD knowledge and skill survey. The survey showed that 79.3% participants (1 485/1 873) knew the concept of COPD, 52.6% (986/1 873) mastered the diagnostic criteria, 41.6% (779/1 873) knew the risk factors and 15.5% (291/1 873) mastered the application of glucocorticoids. More than 79% of the community doctors showed the needs for training of knowledge, skills, rehabilitation of COPD and the performance of pulmonary function tests. Conclusion:Availability of COPD diagnosis and treatment equipment in community health center in Shanghai is different, and the availability of basic diagnosis and treatment equipment and drugs is better. The knowledge, skills and management of COPD need to be improved for community doctors, particularly in clinical application of pulmonary function test and active case finding.

Objective:To analyze the trend and hot spots of research on multimorbidity.Methods:The Chinese and English literature in databases of CNKI, Wanfang data and Web of science from inception to July 2022 were retrieved using "multimorbidity" and "multiple chronic conditions" as the search terms. The scientific knowledge mapping software VOSviewer was used to analyze the co-occurrence network of scientific knowledge from the aspects of countries, Chinese and English keywords,burst terms and existing research results; and the status quo and hot trends of studies on multimorbidity at home and abroad were summarized and compared.Results:A total of 251 Chinese publications and 6 351 English publications were included. From the perspective of research trends, the overall trend of domestic and international publications showed a fluctuating upward trend in general, but the pace of development was different. The cooperation network represented by the United States, England, Canada, China, Japan, Australia and other countries was the largest regional cooperation network. Germany, the Netherlands, the United States, Australia and other countries were the first regions to carry out studies on multimorbidity. Studies on multimorbidity in China mainly focused on three topics: diagnosis, treatment and care of multimorbidity, common disease management of multimorbidity, and research methods of multimorbidity. The English literature mainly focused on the clustering of three topics: multi-disease co-diagnosis and care research, multi-disease co-management model research, and multimorbidity related research. The analysis of burst terms indicated the research focus and trend change in different time periods. The results of the outburst word analysis showed that the recent research hotspots of multimorbidity were public health, machine learning, geriatric medicine and so on.Conclusions:The number of studies on the multimorbidity is rapidly increasing both domestically and internationally, and related research in China is still in the early stages of development. In terms of research hotspots, the research of multimorbidity has gradually shifted from phenomenon description to topics such as medical services and research methods of multimorbidity.

Objective:To investigate the efficacy of venetoclax-based combined regimen in treatment of adult patients with acute myeloid leukemia (AML).Methods:The data of 50 adult AML (non-acute promyelocytic leukemia) who received venetoclax-based combined regimen in the First Affiliated Hospital of Xiamen University, Dongguan People's Hospital, the First Hospital of Longyan City, Jieyang People's Hospital from December 2018 to May 2021 were retrospectively analyzed. Different doses venetoclax combined with demethylation drugs or low-dose chemotherapy regimen were used to analyze the therapeutic efficacy. The related factors influencing efficacy were analyzed by using logistic regression.Results:The composite complete remission (CR) rate of 50 AML patients was 62.0% (31/50), the overall response rate (ORR) was 76.0% (38/50); 28 patients achieved effectiveness [CR and partial remission (PR)] after the first cycle and could achieve effectiveness by 3 courses of treatment at the latest. Among 50 patients, 28 cases were newly diagnosed AML, the composite CR rate was 60.8% (17/28), ORR was 78.6% (22/28); 22 cases were recurrent and relapsed, the composite CR rate was 63.6% (14/22), ORR was 72.7% (16/22); and there was no statistically significant difference of ORR between the both groups ( χ2 = 0.23, P = 0.743). Logistic regression multivariate analysis showed age was the only independent influencing factor for the treatment effectiveness ( OR = 8.451, 95% CI 1.306-54.697, P = 0.025). The median duration time of patients receiving venetoclax treatment regimen was 4.5 months (1.1-15.0 months); 16 cases who had treatment effectiveness finally relapsed, the median time of maintaining effectiveness was 5 months (1.1-11.0 months). Additionally, the common treatment-related adverse reactions included bone marrow suppression after treatment, followed by some gastrointestinal reactions like nausea, vomiting and stomachache. In addition, no patient stopped medication for more than 1 week due to bone marrow suppression related complications. Conclusion:Venetoclax-based combined regimen shows a good short-term efficacy in treatment of AML. It is also effective and tolerable for elderly patients receiving reduced dose therapy.

Objective:To investigate the clinical, pathological and genetic characteristics of neonatal alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV).Methods:The clinical manifestations, radiographic examinations, pathology and parental genetic analysis of a newborn with FOXF1 variation induced ACDMPV, who was hospitalized in the Department of Neonatology of Shenzhen Children′s Hospital in January 2020, were extracted and analyzed. Related literature up to March 2020 with the key words of “Alveolar capillaries dysplasia” “Alveolar capillary dysplasia with misalignment of the pulmonary veins” “FOXF1” in PubMed, CNKI, Wanfang, CQVIP database and Leiden Open Variation database (LOVD) were searched.Results:A full-term male newborn （1 hour of age） was admitted due to anal atresia. Surgical repair of anal atresia and omphalocele was performed on the first day of life, and gallbladder absence and Meckel′s diverticulum were identified during the operation. Respiratory distress with hypoxemia developed at about 6 hours of life, and persistent pulmonary hypertension developed and progressed after surgery, with poor response to mechanical ventilation and pulmonary vasodilators. This infant passed away at 26 days of life. Lung biopsy showed decreased alveolar units and thickened interalveolar septa, reduced alveolar capillary density and thickened walls of peripheral pulmonary arteries, and misaligned pulmonary veins adjacent to the pulmonary arterioles, which were consistent with ACDMPV. The whole exome sequencing revealed a heterozygous novel frameshift of FOXF1 gene located in chromosome 16q24.1 c376_377insT; p.(Pro126fs). According to the bioinformatics analysis, this variation was likely to be pathogenic as it was associated with coding disorder of FOXF1 Pro126, resulting in truncation of the encoded protein. This novel variation had not been reported in the human gene mutation database (HGMD), ESP6500siv2_ALL, 1000g2015aug_ALL or dbSNP147 database. Previous 6 literatures reported 54 variants, including 28 missense, 10 nonsense, 11 frameshift, 2 deletion, 1 synonymous, and 2 extensions. Only three of the reported 45 cases （24 males, 21 females） were still alive as of the time of this study.Conclusions:Typically, ACDMPV is a catastrophic disease in neonatal period with high mortality. Lung biopsy and genetic testing should be considered in infants who present with persistent pulmonary hypertension and refractory hypoxemia, especially when combined with extrapulmonary abnormalities.

OBJECTIVE:To explore the role of clinical pharmacists participating in the individualized treatment for purulent meningitis. METHODS:Clinical pharmacists participated in the therapy for a patient with purulent meningitis complicated with Staphylococcus aureus infection. According to patient's condition,clinical pharmacists assisted physicians to formulate preliminary therapeutic plan. Reviewing relevant guidelines,domestic and foreign literatures,clinical pharmacists suggested to combine with dexamethasone so as to relieve inflammatory reaction. According to the results of drug sensitivity test,based on vancomycin plasma concentration monitoring and population pharmacokinetics model fitting,clinical pharmacists suggested to reduce the dose of vanco-mycin to 0.5 g,ivgtt,q12 h. The pharmaceutical care were conducted throughout the therapy,including efficacy evaluation of an-ti-infective therapy,ADR monitoring,renal function monitoring,etc. RESULTS:Physicians adopted some suggestions of clinical pharmacists. The disease condition of the patient was recovred,and no ADR related to vancomycin was found. On the 16th day, the patient was discharged from the hospital. CONCLUSIONS:Clinical pharmacists participate in treatment of purulent meningitis, assist physicians to optimize therapy plan based on relevant guideline,literature,etiological examination,blood concentration moni-toring and pharmacokinetics model fitting results. It not only guarantee therapeutic efficacy of anti-infective therapy,but also pre-vent and reduce the occurrence of ADR.

Objective To observe the influence of highflux hemodialysis(HFD)on homocysteine(Hcy) level and major cardiovascular events of maintenance hemodialysis (MHD) patients. Methods Patients eligible for inclusion were randomly divided into HFD group and low flux hemodialysis(HD)group with 30 cases in each group. Patient′s serum homocysteine (Hcy),major cardiovascular events and various clinical indicators were observed for 12 months then the data were analyzed. Results Hcy baseline levels in 2 groups(21.02 ± 11.79 mmol/L vs. 19.86 ± 6.97 mmol/L)indicated no significant difference(P = 0.162)before hemodialysis but Hcy levels had significant difference(20.29 ± 11.45 mmol/L vs. 24.57 ± 13.23 mmol/L),(P=0.045)after 12-month observation. There was lower incidence of major cardiovascular events in HFD when compared to that in HD group (10.0% vs. 33.3%) which showed significantly statistical difference (P=0.034),and there was no mortality in HFD group but 1 case of death in HD group. All-cause mortality in 2 groups showed no significant difference (P > 0.05). Conclusion Long-term HFD treatment significantly reduces Hcy levels and the incidence of major cardiovascular events of MHD patients

Objective To study the effcts of total parathyroidectomy with autotransplantation (tPTX+AT) on fibroblast growth factor-23 (FGF-23) in maintenance hemodialysis (MHD) patients with severe secondary hyperparathyroidism (SPTH). Methods Maintenance hemodialysis patients with severe SPTH treated in our hospital from 2014 to 2016 were enrolled and divided into two groups:tPTX+AT group and non-surgical group. Two groups' biochemical indexes and FGF-23 level before and after 6 months treatment were compared. Results A total of 48 patients were included in the study, including 22 in the tPTX+AT group and 26 in the non-surgical group. Age, duration of dialysis, primary disease, rate of hypertension, parathyroid hormone (iPTH), FGF - 23, cholesterol (TCH), triglyceride (TG), albumin (ALB), and hemoglobin (HGB) level showed no significant difference between the two groups (P>0.05); but serum calcium and alkaline phosphatase (ALP) of that tPTX+AT group were significantly higher than those of the non-surgical group (P<0.01). After 6 months the blood iPTH, calcium, phosphorus and the calcium-phosphorus product level of tPTX+AT group were significantly lower than those of non-surgical group (P<0.05). Blood lipids, propagated, HGB, and ALP level had no statistical differences in the two groups (P>0.05); serum FGF-23 progressive declined after 1 week, 1 month, 3 month and 6 month in tPTX+AT patients, and after 6 months, the level of FGF-23 was significantly lower than that of non-surgical patients[1462.9(903.7, 5826.9) ng/L vs 12627.9(5488.9, 16844.4) ng/L, P<0.01]. Conclusion tPTX+AT can significantly alleviate calcium and phosphorus metabolism disorders and in 6 months gradually reduce FGF-23 level in patients receiving MHD.

Objective To investigate the association between serum cytokines and depression and understand the effect of sertraline on serum leveI of interleukin 2(IL-2),interleukin 6(IL-6),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP).Methods A total of 50 depressive patients(study group) and 25 healthy controls(control group)were included in this study.The levels of serum IL-2,IL-6 and TNF-α were measured by enzymatic-linked immunosorbent assay(ELISA)on baseline and after treatment,CRP were measured by scatter rate nephelometry.Depressive patients were assessed by Hamilton depression sere(HAMD)on baseline and after treatment.Results The levels of IL-2(41.4±15.7)pg/ml,IL-6(63.4±17.2)pg/ml,TNF-α(81.4±19.3)pg/ml and CRP(8.2±2.9)mg/L in study group were significantly higher than those in control group(13.2±4.6)pg/ml,(21.3±7.7)ps/ml,(35.1±7.8)ps/ml,(2.9±0.5)mg/L,(P<0.01).Compared with baseline,the levels of serum IL-2(20.1±9.1)ps/ml,IL-6(38.5±11.6)pg/ml,TNF-a(49.5±12.6)pg/ml and CRP(4.2±1.6)mg/L after treatment by sertraline decreased significantly(P<0.01).In study group,there were significant positive correlations between the serum level of IL-2,IL-6,TNF-α and present age,the total score of HAMD(P<0.05,P<0.01).There were significant positive correlations between variation rates of serum IL-2,IL-6,TNF-αand reduction rate of HAMD(P<0.05,P<0.01).Conclusion The serum levels of IL-2,IL-6,TNF-α and CRP increased in patients with depression.Sertraline may affect depressive patients'serum levels of IL-2,IL-6,TNF-αand CRP.

Objective To investigate the relationship between serum omega-3 polyunsaturated fatty acid (ω-3PUFA) and insulin resistance(IR) in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease (NAFLD). Methods This trial involved 51 patients of type 2 diabetes mellitus with NAFLD (G4 group), 50 patients of type 2 diabetes alone(G3 group), 45 patients of NAFLD alone (G2 group) and 42 healthy control subjects (G1 group). Serum ω-3PUFA profile was analyzed with capillary gas chromatography. Insulin resistance was assessed by homeostasis model assessment (HOMA-IR). ALT, AST, γ-glutamyltransferase(GGT) and serum lipids were measured. Results The levels of HOMA-IR were higher in G4 group than those in G3, G2 and G1 group(4. 90 ± 2. 54 vs 2. 38 ± 1.23, 2. 20 ± 1.15, 1.13± 0.42;P<0.05). The level of ALT, AST, GGT, TC, TG, LDL-C were higher in G4 group than those in G3, G2 and G1 group(P < 0. 05). The level of ω-3PUFA was signifieantly lower in G4 group than those in G3, G2 and G1 group(5.68 ±2.02 vs 7. 17 ±2. 38, 6.97±2.32, 10.08±2.76;P <0.05). ω-3PUFA cocentration was negatively correlated with HOMA-IR, TC, TG and LDL-C (r = -0.491, -0. 376, - 0. 462, - 0. 408, P < 0. 05). Conclusions Serum ω-3 PUFA is significantly decreased in patients with type 2 diabetes mellitus and NAFLD. Serum ω-3PUFA is negatively correlated with insulin resistance. ω-3PUEA plays a very important role in the development of diabetes mellitus and NAFLD.

Objective:To investigate the relationship between fester capacity and clinical efficacy on allergic asthma treated by scarring moxibustion.Methods:The patients were randomly divided into scarring moxibustion 9-cone group,3-cone group and 6-cone group.The biggest area,scab-lost time,first-festering time and scarring time of moxibustion sore,and the clinical efficacy in each group was observed.Results:The biggest post-moxibustion sore area in 9-cone group was larger than that in 3-cone group,but had no difference in comparison with 6-cone group;the scab-lost time,first-festering time and scarring time of post-moxibustion sore in each group were of no difference.The clinical efficacy was better in 9-cone group than in 3-cone group,but had no difference in comparison with the 6-cone group.Conclusion:Fester capacity in treating allergic asthma by scarring moxibustion is related to the clinical efficacy and definite fester capacity is the key to good results on allergic asthma.