OBJECTIVE To explore the effects of multi-disciplinary comprehensive management team of tertiary hospital collaborated with the pharmacists from community health service center （hereinafter referred to as “community pharmacists”） on elderly patients with hypertension in the community. METHODS Elderly patients with hypertension from May 2020 to May 2021 in Yuhua Community Health Service Center of Nanjing were divided into control group （76 cases） and observation group （76 cases） according to the management style. The control group was treated with regular community medical services and the observation group received regular community medical services plus pharmaceutical care provided by the comprehensive management team collaborated with community pharmacists. The compliance， blood pressure control status and hypertension-related complications were compared between 2 groups before management and after 24 months of management. RESULTS After 24 months of management， the compliance and blood pressure compliance rates in both groups were higher than before management； meanwhile， the observation group was significantly higher than control group at the corresponding period （P＜0.05 or P＜ 0.01）. The blood pressure levels of both groups were significantly lower than before management， and the systolic blood pressure as well as the incidences of the whole complications and cerebrovascular injury in the observation group were significantly lower than control group at the 583867635@qq.com corresponding period （P＜0.05）. There was statistical significance in the effects of the rate of reaching the standard of blood pressure on the complications （P＜0.01）. CONCLUSIONS The hypertension management mode of comprehensive management team collaborated with community pharmacists can significantly improve the compliance and blood pressure compliance rate of elderly patients with hypertension， and reduce the incidence of hypertension-related complications.

Purpose: Invasive ductal carcinoma (IDC) accounts for 90% of triple-negative breast cancer (TNBC). IDC is mainly derived from the breast ductal epithelium which is innervated by the 4th to 6th thoracic sympathetic nerves. However, little is known about the contribution of the interactions between sympathetic nerves and breast cancer cells to the malignant progression of TNBC. Methods: The expression levels of the β2 -adrenergic receptor (β2 -AR, encoded by ADRB2 gene), nerve growth factor (NGF), and tropomyosin receptor kinase A (TrkA) were determined using immunohistochemistry (IHC). NGF expression levels in the serum were compared by enzyme-linked immunosorbent assay (ELISA). Cell proliferation was assessed using the Cell Counting Kit-8 assay. The β2 -AR, NGF, p-ERK, and p-CERB expression levels were determined using western blotting. TNBC cells and neuronal cells of the dorsal root ganglion (DRG) in 2-day-old Sprague Dawley rats were co-cultured. Using norepinephrine (NE), NGF, and β2 -AR, NGF/TrkA blocker pretreatments, the axon growth of each group of DRG neuron cells was detected by immunofluorescence analysis. Results: The sympathetic adrenergic neurotransmitter NE activated the ERK signaling pathway in TNBC cells. NE/β2 -AR signaling promotes NGF secretion. NGF further facilitates the malignant progression of TNBC by increasing sympathetic neurogenesis. In the coculture assay, the sympathetic adrenergic NE/β2 -AR signal pathway also enhanced NGF secretion. NGF binds TrkA in DRG neurons and promotes axonal growth. Conclusion These results suggest that NE/β2 -AR pathway promotes cell proliferation and NGF production in triple-negative breast cancer.

【Objective】 To study the annual financial expenditure in blood stations with different scales, and to establish the regression equation between blood collection units and total expenditure. 【Methods】 The annual total expenditure, the per capita cost of serving population, as well as the collection units of whole blood and apheresis platelet of 24 blood stations were collected. The financial expenditure required for collecting 10 000U blood was calculated.The statistical analysis was carried out with SPSS statistical software. 【Results】 From 2017 to 2020, the total annual financial expenditure of 24 blood stations showed an upward trend. The total expenditure among blood stations was different. The per capita cost of servicing population in the areas where the 24 blood stations were located had been increasing year by year. The 24 blood stations were divided into two grades according to the blood collection volume as 50 000 U, and the relationship equation between the blood collection volume and the annual total expenditure had been established. After testing, each equation was effective(P<0.05); There was no difference in the financial expenditure required for collecting 10 000U blood among blood stations with different scales. 【Conclusion】 From 2017 to 2020, the blood stations with an annual collection volume more than 50 000 U demonstrated a higher financial expenditure and the per capita cost of serving population than those <50 000 U. The blood collection volume of blood stations is significantly correlated with the annual total expenditure and the per capita cost of serving population.

Objective:To construct an Internet + linkage model based on medical alliance and evaluate its implementation effect.Methods:From October 2020 to June 2021, convenience sampling was used to select 132 patients with malignant tumors who were treated with peripherally inserted central catheters (PICC) chemotherapy and discharged with catheters in Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine. The 67 patients who returned to the PICC outpatient clinic of Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine during the treatment interval for PICC maintenance were set as the control group, and the routine maintenance method was adopted. A total of 65 patients who chose maintenance points near their residence for PICC maintenance during the treatment interval were set as the observation group. On the basis of the control group, the maintenance method based on the Internet + linkage mode of medical alliance was adopted. The PICC self-management ability, catheter-carrying satisfaction, PICC complication, average cost and average time spent on PICC maintenance during treatment were compared between the two groups.Results:There were no significant differences in the scores of daily life with catheters, exercise with catheters, catheter abnormality handling, compliance with catheter maintenance and confidence in catheter management between the two groups ( P>0.05) . There was no significant difference in the scores of Catheter Satisfaction Survey in the two groups of patients ( P>0.05) .There was also no significant difference in the incidence of PICC complications between the two groups ( P>0.05) . The registration fee, maintenance fee, and transportation fee for PICC maintenance in the observation group were lower than those in the control group, and the round-trip time and visit time were shorter than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The Internet + linkage model based on the medical alliance can ensure the quality of PICC maintenance for patients with malignant tumors undergoing PICC chemotherapy and discharged with catheters, and improve their PICC self-management ability, which has good economic and time benefits.

Objective:To explore the effect of narrative nursing in patients with retinal detachment undergoing surgery.Methods:From February 2020 to August 2021, 40 patients with retinal detachment who underwent surgical treatment in the Department of Geriatrics and Ophthalmology of Beijing Tongren Hospital, Capital Medical University were selected as the research object by the convenient sampling method. According to the random number table method, the patients were divided into the observation group and the control group, 20 cases in each. The patients in the control group were given routine nursing, and the patients in the observation group received narrative nursing on this basis. Before and after the intervention, Self-Rating Anxiety Scale (SAS) , Self-Rating Depression Scale (SDS) , Memorial University of Newfoundland Scale of Happiness (MUNSH) , and Generic Quality of Life Inventory-74 (GQOLI-74) were used to investigate the two groups of patients. The hospitalization time and complications of the two groups of patients were recorded.Results:At discharge, the SAS and SDS scores of the observation group were lower than those of the control group, the GQOLI-74 and MUNSH scores of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . The hospitalization time of the observation group was shorter than that of the control group, and the difference was statistically significant ( P<0.05) . There was no significant difference in the number of cases of postoperative intraocular hypertension between the two groups ( P>0.05) . Conclusions:Narrative nursing can effectively relieve anxiety and depression in patients with retinal detachment surgery, improve patients' well-being and quality of life, and shorten hospitalization time.

Objective:To systematically review the risk factors of postoperative delirium in patients with liver surgery, in order to provide reference for early clinical prevention of postoperative delirium in patients with liver surgery.Methods:PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI) , Wanfang Database, VIP and China Biomedical Literature Database were searched by computer from the establishment of the database to July 31, 2021. Two researchers conducted literature screening, quality evaluation and data extraction. RevMan 5.4 was used for data analysis.Results:Finally, 15 articles were included. Meta-analysis results showed that advanced age ( OR=1.13, 95% CI: 1.06-1.22, Z=3.49, P=0.0005) , history of cerebrovascular disease ( OR=3.27, 95% CI: 1.89-5.66, Z=4.24, P<0.000 1) , history of hepatic encephalopathy ( OR=2.49, 95% CI: 1.70-3.65, Z=4.68, P<0.000 01) , history of mental illness ( OR=2.82, 95% CI: 1.52-5.22, Z=3.30, P=0.001) , history of sedative-hypnotic use ( OR=4.12, 95% CI: 1.99-8.52, Z=3.82, P=0.000 1) , history of drinking ( OR=1.96, 95% CI: 1.18-3.26, Z=2.61, P=0.009) , postoperative infection ( OR=5.76, 95% CI: 4.24-7.84, Z=11.18, P<0.000 01) were independent risk factors for postoperative delirium in patients with liver surgery. Increased preoperative albumin level ( OR=3.31, 95% CI: 0.19-0.52, Z=4.52, P<0.000 01) was a protective factor for postoperative delirium in patients undergoing liver surgery. There were no statistically significant differences in effects of end-stage liver disease model score, preoperative serum total bilirubin level, postoperative increased serum sodium level, postoperative ICU admission, acute physiology and chronic health scores on postoperative delirium in patients with liver surgery ( P>0.05) . Conclusions:Advanced age, history of cerebrovascular disease, history of mental illness, history of hepatic encephalopathy, history of sedative-hypnotic use, history of alcohol consumption and postoperative infection are independent risk factors for postoperative delirium in patients with liver surgery, and elevated preoperative albumin level is associated with postoperative delirium. protective factor.

Objective:To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy.Methods:A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO′s recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results:A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR=1.42, 95% CI: 1.07-1.88, P=0.015), 46% ( OR=1.46, 95% CI: 1.13-1.88, P=0.004), and 64% ( OR=1.64, 95% CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR=2.87, 95% CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR=1.59, 95% CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes ( OR=1.58, 95% CI: 1.18-2.13, P=0.002) and premature delivery ( OR=1.52, 95% CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR=5.34, 95% CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR=1.44, 95% CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR=4.11, 95% CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR=1.46, 95% CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR=1.47, 95% CI: 1.13-1.92, P=0.004). Conclusions:Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.

Objective: To learn the epidemiological characteristics of coronavirus disease 2019（COVID-19）in Huzhou,so as to provide reference for prevention and control of COVID-19. Methods: All the confirmed cases of COVID-19 in Huzhou,diagnosed according to the COVID-19 Diagnosis and Treatment Plan（Sixth Version Trial）and reported from January 25 to February 7,2020,were recruited. The process of diagnosis and treatment,clinical manifestation,exposure history and close contacts were collected to analyze the epidemiological characteristics. Results: On January 25,the first confirmed cases of COVID-19 in Huzhou was reported. By February 7,totally 10 confirmed cases were reported and no asymptomatic infection was found. They were all imported,including three Wuhan residents,two with a trip to Wuhan,three with a trip to Suizhou,one with a trip to Hangzhou and one with a trip to Thailand（two Wuhan passengers on the same flight）. The ratio of male to female cases was 1∶1. The median age was 32 years old. Seven cases were found when they went to a doctor by themselves,and three cases were found during the quarantine. The main clinical manifestations were fever,dry cough and fatigue. The median time from onset to diagnosis was 3 days. By March 3,all the cases were discharged,with median course of 24 days. There were 312 close contacts,and all of them were released after 14 days of quarantine. Conclusions To prevent imported cases from outside and stop spread inside taken by Huzhou government was proved to be effective. All the COVID-19 cases in Huzhou were imported,mostly from Wuhan. No local cases were reported.

Objective: To investigate the radiographic manifestations and clinical relevance to central nervous system complications of leukemia (CNSCL)in children. Methods: The CT and magnetic resonance imaging(MRI) fin-dings and clinical features of 49 pediatric patients with CNCSL in Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from May 2010 to June 2018 were retrospectively analyzed. Results: (1) Cerebrovascular abnormalities in 23 cases included hemorrhage(20 cases), infarction(2 cases) and sinus thrombosis(1 case). One case of epidural hematoma and 19 cases of intracerebral multiple bleeding were seen in the hemorrhage group, which demonstrated high-density on CT and different signal on MRI as time went by.Microhe-morrhage displayed as low signal on susceptibility weighted imaging.(2) Among 23 cases of leukemic infiltration, the dura and/or skull were involved in 18 cases, which presented as fusiform or mass, with high density on CT, low signal on T1WI, intermediate signal on T2WI and strong enhancement; 6 leptomeningeal infiltration demonstrated as meningeal thickening and enhancement; 2 parenchymal involvement manifested with high-density mass; 2 oculomotor nerve and 1 optic nerve infiltration demonstrated thickening and enhancement.(3)White matter disease was seen in 2 cases, with hyper-intensity on T2WI.(4) One case of secondary tumor was glial tumor in the brainstem. Conclusions The radiographic manifestations of CNCSL in children are various.CT and MRI are of important diagnostic values.Choosing the best imaging examination method and sequence according to clinical symptoms and test results can provide more valuable information for clinical diagnosis and treatment.