OBJECT IVE To deeply unders tand the utilization of monoclonal antibody drugs in different levels of medical institutions in China ，so as to provide an empirical basis for further promoting tiered healthcare delivery system. METHODS The basic informations of listed monoclonal antibody drugs in China as of May 2021 were collected through the official websites of government agencies such as National Medical Products Administration and National Healthcare Security Administration ，so as to understand the overall development status of monoclonal antibody drugs in China. The clinical utilization data of monoclonal antibody drugs in all categories of antitumor drugs and immune modulators were collected through “chemical drug terminal of Chinese public medical institutions ”database of Metnet ；the clinical application of monoclonal antibody drugs in medical institutions at different levels was analyzed. RESULTS As of May 2021，there were 53 monoclonal antibody drugs had been approved for listing in China ，including 31 imported monoclonal antibody drugs and 22 domestic monoclonal antibody drugs. From 2015 to 2019，the amount and quantity of monoclonal antibody drugs used in urban medical institutions were the highest among the three levels of medical institutions （both accounted for more than 95％ for five consecutive years ），but the growth rate of drug use in county-level medical institutions was the fastest. In 2019，the cumulative proportion of DDDs and drug amount of the top 10 monoclonal antibody drugs ranked in DDDs were the highest among county-level medical institutions ，being 97.09％ and 94.16％ respectively. From the change trend of DDDc of monoclonal antibody drugs from 2015 to 2019，DDDc of cetuximab decreased the most （70.32％），followed by trastuzumab （67.29％） and bevacizumab（62.89％）. From 2015 to 2019，the number of monoclonal antibody drugs with B/A value of no less than 1 ranked the top 10 of the annual cost were 6，6，6，7 and 5， respectively. CONCLUSIONS In China ，the overall approval and listing speed of monoclonal antibody drugs has accelerated，their quantity has increased rapidly ，and the accessibility is also improved. Among them ，the quantity of monoclonal antibody drugs has increased the fastest in county-level medical institutions ，and they are mainly medical insurance drugs ，and the effect of tiered healthcare delivery system has gradually appeared.

Guangdong province is experimenting with a model composed of various types of medical alliances, having achieved initial success with some of them and preliminarily has formed a holistic governance pattern. Experiences behind such initial success lied in a coordinated top-level design, reasonable and classified guidance, leader role of key governance subjects, and the construction of a telemedical system. However, as analyzed from the angle of collaborative governance, existing medical alliances have not yet formed a community of services, that of responsibility, that of interests, and that of services. In this consideration, the authors recommended to strengthen the collaborative governance of such alliances by respective governance subjects based on the theories of integrated medical service system and collaborative governance, eventually forming an integrated medical and health service system.

As a member of the AFF (AF4/FMR2) family, AFF4 is a transcription elongation factor that is a component of the super elongation complex. AFF4 serves as a scaffolding protein that connects transcription factors and promotes gene transcription through elongation and chromatin remodelling. Here, we investigated the effect of AFF4 on human dental follicle cells (DFCs) in osteogenic differentiation. In this study, we found that small interfering RNA-mediated depletion of AFF4 resulted in decreased alkaline phosphatase (ALP) activity and impaired mineralization. In addition, the expression of osteogenic-related genes (DLX5, SP7, RUNX2 and BGLAP) was significantly downregulated. In contrast, lentivirus-mediated overexpression of AFF4 significantly enhanced the osteogenic potential of human DFCs. Mechanistically, we found that both the mRNA and protein levels of ALKBH1, a critical regulator of epigenetics, changed in accordance with AFF4 expression levels. Overexpression of ALKBH1 in AFF4-depleted DFCs partially rescued the impairment of osteogenic differentiation. Our data indicated that AFF4 promoted the osteogenic differentiation of DFCs by upregulating the transcription of ALKBH1.
Biomarkers ; metabolism ; Cell Differentiation ; Cells, Cultured ; Dental Sac ; drug effects ; metabolism ; Gene Expression Regulation ; Humans ; Osteogenesis ; genetics ; Repressor Proteins ; Transcription Factors ; genetics ; metabolism ; Transcriptional Elongation Factors ; metabolism

Objective:To construct the post competency index system of the standardized training of traditional Chinese medicine(TCM)residents, and to provide reference for the curriculum design of TCM residents′ standardized training.Methods:Based on the analysis of relevant literature, 22 experts engaged in clinical, teaching or administrative management of TCM residential training were consulted by Delphi method from August to December 2019, and the evaluation indexes were screened and the importance was assigned. Then, analytic hierarchy process was used to determine the weight of each index. In January 2020, the index system was tested by questionnaire survey.Results:The competency evaluation index system of TCM residents was composed of 7 first-level indexes and 61 second-level indexes. The first-level indexes included occupational values and professionalism(weight: 0.208 2), clinical skills(weight: 0.208 2), mastery and application of medical knowledge and related knowledge(weight: 0.208 2), communication skills(weight: 0.198 4), management and teamwork ability(weight: 0.114 1), critical thinking and learning research ability(weight: 0.033 4), group health and health systems(weight: 0.029 5). The total Cronbach α coefficient of the self-evaluation questionnaire designed according to the evaluation index system was 0.976. The results of KMO test and Bartlett spherical test respectively were 0.954 and 0.000, indicating that the questionnaire had high reliability and validity, and the evaluation index system could reflect the post competency level of TCM residents. Conclusions:The index system of TCM resident competency is highly reliable. TCM resident training should strengthen the cultivation of TCM clinical thinking, and urgently need to supplement the content of medical humanities education.

Objective To observe the nursing of deep venous catheter implantation with two Dacron cuff and to evaluate clinical efficacy.Methods Group A with 20 cases was carried out avul-sion sheath implanted cuffed long-term catheter in right internal jugular vein and group B with 18 cases was implanted long-term catheter by the right external jugular vein incision.The amount of bleeding during the operation,related index of dialysis and catheter -related infection were record-ed.And Kt /V value and catheter dysfunction time were calculated.Results NO catheter -related infection was occurred and bleeding in the group B was less than that in the group A,and there was statistical difference in two groups(P <0.05).Conclusion The operative risk of group B was less than group A and there were no significant differences in dialysis efficacy,catheter dysfunction time and infection rate of two groups after education and nursing.Therefore,both methods could be se-lected in clinic for different patients.

Objective To observe the nursing of deep venous catheter implantation with two Dacron cuff and to evaluate clinical efficacy.Methods Group A with 20 cases was carried out avul-sion sheath implanted cuffed long-term catheter in right internal jugular vein and group B with 18 cases was implanted long-term catheter by the right external jugular vein incision.The amount of bleeding during the operation,related index of dialysis and catheter -related infection were record-ed.And Kt /V value and catheter dysfunction time were calculated.Results NO catheter -related infection was occurred and bleeding in the group B was less than that in the group A,and there was statistical difference in two groups(P <0.05).Conclusion The operative risk of group B was less than group A and there were no significant differences in dialysis efficacy,catheter dysfunction time and infection rate of two groups after education and nursing.Therefore,both methods could be se-lected in clinic for different patients.

Objective This study aimed to survey students' satisfaction and cognitive attitude of elaborate course of social medicine to provide a basis for exploring appropriate teaching mode. Methods Purposive sampling was used with questionnaire to survey 646 students who had learned social medicine in 5 universities in Guangdong province. The survey included the social medicine curriculum, teaching situation, students' satisfaction and cognitive attitude of elaborate course of so-cial medicine. Descriptive statistical analysis was used to describe the demographic characteristics and curriculum. The t test and one-way ANOVA were used to compare the means of students' satisfaction and cognitive attitude of elaborate course in different universities, using the test level of 0.05. Results The lecture-based learning was the main teaching mode. 335(52.7%) students thought it necessary to learn social medicine, but only 27.2%of the students(173 students) were interested in social medicine and 65(10.2%) students could take the initiative to read about extracurricular books. Overall satisfac-tion with using network resources of elaborate course in two universities that had university-level elab-orate course of social medicine were (2.78 ± 0.55) and (3.01 ± 0.30) respectively and the difference was statistically significant(t=-3.97,P<0.01). The cognitive attitude of the students in 5 universities with using network resources of elaborate course was (3.09±0.66) and the difference was statistically significant(F=3.70,P<0.01). Conclusion Social medicine teaching has been paid attention to in 5 universities, but there were some common problems: ①putting emphasis on theory and ignoring prac-tice in teaching mode; ②putting emphasis on credit and ignoring effectiveness in learning; ③and putting emphasis on construction and ignoring using in network resources of elaborate course of social medicine.

Objective To investigate the effect of propofol pretreatment on hypoxia-induced apoptosis of alveolar epithelial type Ⅱ (AE Ⅱ) cells in fetal rats. Methods Primary cultured AE Ⅱ cells isolated from fetal rats were seeded in 96-well plates (1 × 106/L, 180 μl/well) and randomly assigned to one of 3 groups (n = 72each):normal control group (group C), hypoxia group (group H) and propofol-hypoxia group (group P-H).Group H and P-H were exposed to hypoxia (5% O2). In group P-H, propofol (final concentration 5 μ mol/L) was added 1 h prior to hypoxia (5% O2). The apoptotic rate and expression of hypoxia-inducible factor (HIF)-1αmRNA, Bnip3L mRNA, HIF-1α protein and Bnip3L protein were determined at 3, 12, 24 and 48 h of hypoxia.Results The apoptotic rate and expression of HIF-1α mRNA, Bnip3L mRNA, HIF-lα protein and Bnip3L protein were significantly up-regulated in group H compared with group C (P ＜ 0.05). Propofol pretreatment could significantly inhibit the hypoxia-induced changes mentioned above (P ＜ 0.05). Conclusion Propofol pretreatment can inhibit hypoxia-induced apoptosis of AE Ⅱ cells, and the mechanism is related to inhibition of HIF-1αactivation and down-regulation of Bnip3L expression in fetal rats.

Objective We aimed to discuss the influence of establishment of a hospital which makes people satisfied on nursing management. Methods We improved our nursing work by establishing quality-control groups, training staff, checking once a week and making feedback once a month through decomposing and subdividing the standard of building a hospital which makes people satisfied from March 2002 to December 2006. Results The qualified rate of nursing management increased from 69.3% to 97.6% every year, which has statistical difference (P<0.01). Conclusions Establishment of a hospital which makes people satisfied improved the general level of nursing management quality and nursing staff. We acquired good social and economic befenit.

Objective To evaluate the changes in peripheral?1-adrenergic receptor sensitivity in a rat model of chronic high spinal cord injury (SCI)Methods Thirty male 18-week-old Wistar rats weighing 290-310g were randomly divided into 2 groups: SCI group (n=24) and control group (C n=6) . The animals were anesthetized with intraperitoneal 2 % pentobartital 50 mg?kg-1 and subjected to spinal cord injury (SCI) at T4 according to modified Allen's method. Successful high SCI was confirmed by bilateral hindlimb flaccid paralysis. Three weeks after SCI the animals were further divided into 4 subgroups (n=6) receiving 4 different doses of phenylephrine 1, 2, 3 and 4 ?g?kg-1 i.v. Femoral artery was connulated for BP (SBP and DBP) and HR monitoring. HR and SBP and DBP were recorded before and after i.v. phenylephrine injection. In control group phenylephrine (PE) 1,2,3 and 4 ?g?kg-1 were injected i.v. successively at an 1h interval. % changes in HR, SBP and DBP were calculated: % change = (post-injection value- baseline value) / baseline value. Results The animals lost weight and HR was significantly slower and SBP and DBP were significantly lower 3 weeks after SCI as compared with control group. In both group C and SCI, HR was significantly decreased and SBP and DBP were significantly increased after i.v. PE injection as compared to the baseline value before PE. The % changes in HR, SBP and DBP were significantly greater in group SCI than in group C. Conclusion In a rat model of chronic high SCI, peripheral?1-adrenergic receptor sensitivity is significantly increased 3 weeks after high SCI.