The digital transformation of China's community health management is a key step in the high-quality development of medical and health services,and is of great significance in enhancing the health and well-being of all residents.Using literature analysis,logical analysis and other research methods,it analyzes the practical foundation and constraints of the digital transformation of China's community health management,and proposes optimization strategies.It concludes that national policy,infrastructure development and social demand provide a realistic foundation for the digital transformation of community health management in China,but it also faces the problems of insufficient transformation of thinking,the concept of digital management has not sufficiently replaced the traditional concepts;the technical foundation is weak,and the construction and operation of the digital application platform started late;the structural barriers are prominent,and the lack of sound system construction leads to insufficient cooperation among the main bodies;the lack of digital standards,and the lagging operation of digital standardization of community health management;and the lack of digital standards.Management digital standardized operation lagging behind the constraints.Accordingly,it is proposed to promote the identity of the digital transformation of community health management,to build an operational space for digital community health management,to improve the digital system to regulate the activation of synergistic governance of the main body,and to optimize the supervision and guarantee of technology in digital management.

Objective:To investigate the application effect of kangaroo mother care on anxiety and parenting stress in premature mothers during hospitalization.Methods:From January to December 2018, 230 premature mothers were admitted to the neonatal intensive care unit of Ningxia Medical University General Hospital.They were randomly divided into the intervention group( n=114) and the control group( n=116). The premature infants in control group only implemented routine developmental support care.The premature infants in the intervention group was on the basis of routine developmental support care, 2 hours per day of kangaroo mother care was performed from the 2nd day incharge to discharge.Parental Stress Scale: Neonatal Intensive Care Unit and Parenting Stress Index-Short Form was performed using the 2nd day and the 14th day of hospitalization, and the two groups of premature mothers were evaluated for anxiety and parenting stress. Results:There were no significant differences in the scores of PSS: NICU((3.65±0.91) vs (3.63±0.91)) and PSI-SF((90.32±8.95) vs (90.12±7.17))(both P>0.05) between the two groups on the 2nd day of hospitalization (before intervention). On the 14th day of hospitalization (after intervention), the total scores ((2.57±0.80) vs (3.47±0.93))and each dimension scores of PSS: NICU in the intervention group were lower than those in the control group (first part (2.41±0.78) vs (3.81±0.73), second part (2.61±0.71) vs (3.14±0.83), third part (2.75±0.86) vs (3.57±1.06), fourth part(2.49±0.80) vs (3.35±0.94))( P<0.01). In addition, the total score of PSI-SF((79.09±8.02) vs (89.46±8.74)), parenting Distress((32.32±9.48) vs (37.15±9.67)), Parent-Child Dysfunctional Interaction((24.26±5.07) vs (27.34±5.26)), and Difficult Child scores((22.51±4.88) vs (24.97±5.05)) in the intervention group were lower than those in the control group( P<0.01). Conclusion:Kangaroo mother care can reduce the anxiety of premature mothers during hospitalization and help relieve the parenting stress of premature mothers.

Objective:To explore the influence of family function on the psychological resilience of mothers of premature infants.Method:Totally 2 836 mothers of premature infants who met the inclusion criteria were investigated with general information questionnaire, family APGAR index (APGAR) and Connor-Davidson resilience scale (CD-RISC) in three third-class A general hospitals and two specialty hospitals in Ningxia.SPSS 23.0 software was used for statistical analysis.Pearson correlation was used to analyze the relationship between psychological resilience and family function of preterm mothers.Hierarchical regression was used to analyze the impact of family function on psychological resilience of preterm mothers.Results:Total score of resilience scale in mothers of premature infants was (68.38±16.59) and the total score of family function was (9.07±1.53). There were 1 550 cases with good family function and 1 286 cases with family dysfunction.The total score of psychological elasticity and the score of all dimensions in the group with good family function were higher than those in the group with family dysfunction( P<0.05). The total score of psychological elasticity ( r=0.771, P<0.01) and self-improvement ( r=0.410, P<0.05), tenacity ( r=0.492, P<0.01), optimism( r=0.438, P<0.05) were positively correlated with family function.Stratified regression analysis showed that cooperation( β=1.016) and intimacy( β=0.389) were the important influencing factors of preterm mothers' psychological resilience ( P<0.05). Conclusion:Psychological resilience of mothers of premature infants is closely related to their family function.Good family function can help mothers of premature infants improve their psychological resilience and promote their mental health.

Objective: To explore the influence of early essential newborn care(EENC) on the development of omphalitis in preterm infants following normal delivery. Methods: A total of 184 preterm infants, admitted to General Hospital of Ningxia Medical University from January 2017 to December 2017, were retrospectively collected as EENC group. During the same period, 161 preterm infants who were born in Yinchuan Maternal and Child Health Hospital were included in the control group. Preterm infants in EENC group were managed based on the clinical practice guideline of "Early Essential Newborn Care", while those in the control group underwent routine care after birth. The incidence of omphalitis between the two groups were compared using independent-samples t test and Chi-square test. Influencing factors of omphalitis were analyzed using univariate analysis and multivariate logistic regression analysis. Results: The incidence of mild omphalitis was lower [5.4% (10/184) vs 11.8% (19/161), χ²=4.520, P<0.05], and the separation and drying up time of cord stump were both earlier in the EENC group than those in the control group [(5.5±1.5) vs (8.2±1.2) d, t=4.169; (2.6±1.4) vs (3.2±1.4) d, t=4.513; both P<0.05]. Logistic regression analysis showed that gestational age≤34 weeks (OR=1.885, 95%CI: 1.109-6.757, P=0.032), early umbilical cord clamping (OR=3.615, 95%CI: 1.372-9.381, P=0.001) and bandaging of the umbilical stump (OR=1.921, 95%CI: 1.257-11.893, P=0.035) were independent risk factors of omphalitis in preterm infants. Conclusions Umbilical cord treatment based on EENC could reduce the incidence of omphalitis by avoiding its risk factors in preterm infants following normal delivery.

Objective To observe the effect of long-term intake of low iodine diet on thyroid morphological structure and sodium iodine transporter (NIS) in parental and second filial generation rats, and to explore the changes of NIS protein expression in iodine deficiency disease (IDD), so as to further verify and explore the mechanism of IDD. Methods Referring to "Nutritional Composition of Experimental Animals With Feed" (GB 14924.3-2010), the crops widely planted and with high edible rate in the traditional cretinism epidemic area of Xinjiang were used as the main feed components to prepare different levels of iodine (low iodine groups 1 and 2 feed the iodine contents were about 50 and 20 μg/kg). The IDD rat model was established by the three-generation two-nest method, that is, 132 SPF Wistar rats were selected after weaning, half males and half females, randomly divided into 3 groups according to body mass by random number table method: control group (N, 52 rats, 22 females, 30 males, the iodine content was about 300 μg/kg), low iodine groups 1 and 2 (LⅠ, LⅡ, 40 rats, 22 females, 18 males in each group). Twelve rats in each group were sacrificed at the end of 3, 6, 9 months, respectively, half males and half females. The relative weight of thyroid was calculated and the gross structure and microscopic pathology were observed. The expression of NIS protein was determined by Western blotting. At the end of 3 months after feeding, four female rats in each group were selected to mate with male rats in group N in 1 : 1, and the newborn mice were fed the same way for three months and then subcultured again. The rat generation continued to be fed according to the mother group, and 10-12 rats were sacrificed at the end of 3, 6, 9 months, respectively, and the specimens and observation indexes results were collected same as the parental rats. Results The relative weight of the thyroid in parental LⅠand LⅡ groups were higher than those in the N group at 6 and 9 months [female:(19.67 ± 5.60), (23.81 ± 4.08) vs (10.14 ± 1.20);(22.24 ± 2.06), (33.51 ± 3.24) vs (9.80 ± 1.96);male:(13.0 ± 3.70), (13.84 ± 4.08) vs (5.90 ± 1.20);(14.20 ± 2.67), (19.98 ± 2.84) vs (6.06 ± 0.76), P < 0.05], the females were higher than the males at 3, 6, 9 months (P<0.05). The relative weight of the thyroid in second filial generation LⅠand LⅡgroups were higher than that in the N group at 3, 6 and 9 months (P < 0.05). Except the 6 month LⅠ group, the relative weight of thyroid in the other groups was higher than that in the male (P<0.05). In prolonged iodine-deficiency process, LⅠ and LⅡ groups, the color of the thyroid gland for parental and second filial generation rats appeared darkening, hyperemia and swelling. At the same time, microscopic pathology showed that the thyroid gland of different generations showed increased follicles and smaller follicular cavities. Epithelial cell hyperplasia and interstitial fibrosis and interstitial inflammatory cell infiltration at the end of 9 months were observed. At 3, 6, and 9 months after low iodine, the expression of NIS protein in the LⅠ and LⅡ parental and second filial generation rats was higher than that in the N group (P<0.05). Conclusions Long-term low iodine in different levels of feed can cause compensatory thyroid enlargement and hyperplasia in both parental and offspring rats, the expression of NIS protein has continued to rise.

To describe a novel particles surface display system which is consisted of gram-positive enhancer matrix (GEM) particles and anchor proteins for bacteria-like particles vaccines, we treated Lactobacillus rhamnosus GG bacteria with 10% heated-TCA for preparing GEM particles, and then identified the harvested GEM particles by electron microscopy, RT-PCR and SDS-PAGE. Meanwhile, Escherichia coli was induced to express hybrid proteins PA3-EGFP and P60-EGFP, and GEM particles were incubated with them. Then binding of anchor proteins were determined by Western blotting, transmission electron microscopy, fluorescence microscopy and spectrofluorometry. GEM particles preserved original size and shape, and proteins and DNA contents of GEM particles were released substantially. The two anchor proteins both had efficiently immobilized on the surface of GEM. GEM particles that were bounded by anchor proteins were brushy. The fluorescence of GEM particles anchoring PA3 was slightly brighter than P60, but the difference was not significant (P>0.05). GEM particles prepared from L. rhamnosus GG have a good binding efficiency with anchor proteins PA3-EGFP and P60-EGFP. Therefore, this novel foreign protein surface display system could be used for bacteria-like particle vaccines.

Objective To investigate the security and efficacy of one stage and bilateral resection of thymic tissue and clearance of mediastinal fat by uniportal-video-assisted thoracic surgery(VATS) to cure patients with myasthenia gravis(MG).Methods A number of 131 patients with MG who underwent resection of thymic tissue and clearance of mediastinal fat by VATS in one single center from February 2009 to December 2013 were selected in this retrospective study.76 patients underwent unilateral resection of thymic tissue and clearance of mediastinal fat by three portal VATS from February 2009 to March 2012 and 55 patients underwent one stage and bilateral resection of thymic tissue and clearance of mediastinal fat by small uniportal-VATS from April 2012 to December 2013.The time for operation,the bleeding volume during operation,the volume of postoperative drainage and drainage time,the improvement of symptoms,the postoperative pain,hospital stays and the occurrence of myasthenia gravis crisis were compared between the two groups.Results The general condition and pathological type did not have significant statistical differences between the two groups.The operating time in the uniportal-VATS group was significantly longer than that in three portal VATS group,but the pain was lighter,and the hospital stay was shorter.There were no significant differences between groups in terms of blood loss,postoperative drainage time,and volume of drainage.The follow-up was from 32 to 90 months,and 118 (90.08％)patients completed the follow up.94.5 ％ of the patients in uniportalVATS group acquired complete stable remission(CSR),while it was 84.2％ in three portal VATS group(P ＜ 0.05),and the uniportal-VATS group had lower rate of myasthenic crisis (P ＜0.05).Conclusion One stage and bilateral resection of thymic tissue and clearance of mediastinal fat by small uniportal-VATS is safe and effective with shorter hospital stay and less pain,and it can get higher CSR and less myasthenic crisis,its efficacy is superior to traditional three portal VATS.

Objective To investigate the correlation of endothelial inflammation in patients with acute myocardial infarction (AMI)with no-reflow and severity of coronary lesion.Methods A total of 120 patients with AMI were all treated with percutaneous coronary intervention (PCI).The patients who had intraoperative no-reflow were in case group (n=40).The patients who were also treated by PCI but did not have no-reflow in the same period in our hospital served as the control group (n=80).According to the results of coronary angiography, no-reflow group patients were divided into three subgroups:single lesion group (n=14),two-lesion group (n=10), and three-lesion group (n=1 6 ).We monitored these patients’immediate postoperative endothelial microparticles (EMPs)and soluble intercellular adhesion molecule-1 (sICAM-1 )levels in both groups with flow cytometry and ELISA methods.Results In the case group,immediate postoperative EMPs and sICAM-1 levels in the blood circulation were significantly higher than those in the control group.EMPs area and sICAM-1 area under the curve in the case group were 0.755 and 0.701,which showed that EMPs and sICAM-1 levels had a good correlation with the occurrence of non-reflow in AMI patients after PCI.Gensini score and EMPs level rose with the increase of the lesion counts,and the level of EMPs was positively correlated with Gensini score.Conclusion In patients with AMI,the EMPs and sICAM-1 levels can well predict the occurrence of no-reflow and are of some value in predicting the severity of coronary lesion.

Objective To understand the status of endemic cretinism in Southern Xinjiang,and to put forward effective measures for diagnosis,prevention and control of the disease.Methods Follow-up visits were carried out to patients of endemic cretinism that at risk from 2006 to 2009,eliminating death and emigration cases of previous findings,increasing new cases,and all of the patients were conducted epidemiological survey and physical examination.Research contents included the history of patient's general situation,cousin marriage,family history,physical examination including mental retardation,hearing speech disorders in patients with thyroid function,nervous system disorder,thyroid palpation,low performance and cretinism faces,at the same time,a 3 ml venous blood sample was used to determine the thyroid function index.Results Totally 216 cases of endemic cretinism patients from 16 counties of Southern Xinjiang were confirmed,including 122 males and 94 females,aged between 11-20 years old.Neural endemic cretinism patients (167) were in the majority;its main performances were mental retardation,hearing speech disorders and nervous system disorders.Gummy swollen endemic cretinism patients(22) had thyroid hypofunction,but no nervous system disorders.Hybrid endemic cretinism patients (27) had manifestations of the neural and gummy swollen.Thyroid function index inspection results showed that the neural and hybrid endemic cretinism patients triiodothyronine [(2.41 ± 0.48),(2.38 ± 0.38) nmol/L],thyroxine [(118.72 ± 20.92),(120.77 ±21.55) nmol/L],free triiodothyronine [(5.25 ± 0.98),(5.14 ± 0.83) pmol/L],and free thyroxine [(15.81 ± 2.60),(15.58 ±2.99) pmol/L] were higher than those of gummy swollen patients [(1.51 ± 0.73),(39.25 ± 16.95) nmol/L,(3.02 ± 1.05),(6.42 ± 1.99) pmol/L,all P ＜ 0.05],but thyroid stimulating hormone [(2.26 ± 1.04),(2.83 ± 0.91) mU/L] was lower than that of gummy swollen patients [(58.56 ± 24.83) mU/L,P ＜ 0.05].Gummy swollen patients bad typical hypothyroidism,which was conformed to clinical manifestations,and all three types of patients had low thyroid antibody positive rate.Conclusions Southern Xinjiang is the prevalence area of endemic cretinism,the work of prevention and control has a long way to go,in addition to the need to improve the environmental iodine deficiency,it is urgent to improve the level of people's economy.

Objective To determine the serum thyroid hormone level of Uygur patients with local Curtin in southern Xinjiang region, to understand the thyroid function of Curtin disease in terms of diagnosis, treatment and prevention and to provide a background information.Methods One hundred and eighty-eight Uygur endemic cretinism were selected as cases [divided into neuval (144), myxedematous (19), mixed type groups (25)], 121 local healthy people as control group, 125 mothers of the case group as mother group from southern Xinjiang region from September 2014 to October 2014, 3 ml venous blood sample was collected of each subject, serum thyroid stimulating hormone (TSH), triiodothyronine (T3), tyroxine (T4), free triiodothyonine (FT3), free tyroxine (FT4), anti-thyroglobulin antibody (A-TG), and thyroid peroxidase antibody (A-TPO) levels were tested.Results There were statistically significant differences of the thyroid function index (T3, T4, FT3, FT4) between the four groups (neural, myxedematous type, mixed type cretinism patients and control groups, F =22.92, 42.58, 38.84, 56.31, 103.29, all P ＜ 0.05).Levels of T3, T4, FT3, FT4 [(2.41 ± 0.48), (118.72 ± 20.92)nmol/L, (5.25 ± 0.98), (15.81 ± 2.60)pmol/L] in neural type patients were significantly higher than those of myxedematous type patients [(1.51 ± 0.73), (39.25 ±16.95)nmol/L, (3.02 ± 1.05), (6.42 ± 1.99)pmol/L], TSH was lower than that of myxedematous type patients [(2.26 ±1.04) vs.(58.56 ± 24.83)mU/L, all P ＜ 0.05];mixed type patients T3, T4, FT3, FT4 [(2.38 ± 0.38), (120.77 ±21.55)nmol/L, (5.14 ± 0.83), (15.58 ± 2.99)pmol/L] were significantly higher than those of myxedematous type patients, TSH was lower than that of myxedematous type patients [(2.83 ± 0.91) vs.(58.56 ± 24.83) mU/L, all P ＜0.05];myxedematous type patients T3, T4, FT3, FT4 were significantly lower than those of control group [(2.53 ± 0.50),(121.93 ± 22.01)nmol/L, (5.49 ± 0.82), (15.93 ± 2.76) pmol/L], and TSH was higher than that of control group [(2.94 ± 1.17)mU/L, all P ＜ 0.05].TSH of neural type patients [(2.05 ± 1.45)mU/L] was lower than that of mother group [(2.27 ± 1.63)mU/L, t =10.57, P ＜ 0.05];T3, T4, FT3, FT4 of myxedematous type patients [(1.81 ± 0.66),(56.73 ± 29.56)nmol/L, (2.97 ± 1.34), (5.95 ± 2.74)pmol/L] were significantly lower than those of mother group [(2.16 ± 0.35), (125.48 ± 24.78)nmol/L, (4.29 ± 0.42), (14.90 ± 2.38)pmol/L], and TSH of mother group [(2.35 ±0.56)mU/L] was lower than that of myxedematous type patients [(57.72 ± 44.69)mU/L, t =7.59, 7.07, 16.07, 10.95,245.23, all P ＜ 0.05].There was no significant difference in comparison of A-TG and A-TPO in the four groups (x2 =1.60, 3.64, all P ＞ 0.05).Conclusion The neural type patients and the mixed type patients have normal thyroid function, the myxedematous type patients have obviously lower thyroid function.