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Medical mutual aid is an important component of multi-level medical security system. West China Second University Hospital of Sichuan University led the establishment of the pediatric specialty alliance " West China Women and Children Alliance". Based on customized and inclusive mutual insurance product " Family Doctor Mutual Aid Plan", the alliance implemented key links such as mutual aid product forms, patient risk protection, institutional financing and hematopoiesis, and distribution of benefits to all parties, explored innovative mutual aid funding, payment, and incentive mechanisms, forming a closed-loop pediatric tiered diagnosis and treatment service system with the Mutual Aid Plan as the core. This system operated continuously under the " Four-in-One" framework, stimulating the integration of medical insurance and service supply systems while enhancing the synergistic effect between mutual insurance and social security. It has formed a distinctive health-centered multi-level medical security system within the alliance, and could provide reference for the construction and exploration of hierarchical diagnosis and treatment system.
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ObjectiveTo observe the effect of Jianpi Yangzheng Xiaozheng decoction （JYXD） on the proliferation and stemness of the human gastric cancer （GC） cell line HGC-27 by inhibiting aerobic glycolysis， and explore the underlying mechanism. MethodMethyl thiazolyl tetrazolium （MTT） assay was employed to determine the survival rate and chemotherapy sensitivity of HGC-27 cells treated with JYXD （0.25， 0.5， 1， 2， 4， 8， 16， 32 g·L-1）. Colony formation assay was employed to detect the effect of JYXD （2， 4， 8 g·L-1） on the colony formation of the cells. The aerobic glycolysis level of HGC-27 cells after treatment with JYXD was measured by glucose assay kit and lactic acid assay kit. The proportion of stem cell subsets in HGC-27 cells was detected by flow cytometry. Western blot was employed to determine the expression of glycolysis-associated proteins such as lactate dehydrogenase （LDH）， hexokinase 2 （HK2）， glucose transporter 1 （GLUT1）， and pyruvate kinase isozyme M2 （PKM2）， and the expression of stemness-associated proteins such as octamer-binding transcription factor 4 （OCT4）， SRY-box transcription factor 2 （SOX2）， and Nanog. ResultJYXD （0.5， 1， 2， 4， 8， 16， 32 g·L-1） inhibited the activity of HGC-27 cells （P<0.05， P<0.01）， with the inhibitory concentration 50（IC50） of 4.83 g·L-1， and it improved the sensitivity of HGC-27 cells to cisplatin chemotherapy. Compared with the control group， JYXD （2， 4， 8 g·L-1） reduced the colony formation number of HGC-27 cells （P<0.01） in a concentration-dependent manner. Flow cytometry showed that compared with that in the control group， the proportion of CD44+CD24+ALDH+ population in the cells treated with JYXD （2， 4， 8 g·L-1） decreased （P<0.05）. In addition， JYXD （2， 4， 8 g·L-1） inhibited the glucose uptake and lactic acid production of HGC-27 cells. Western blot showed that compared with the control group， JYXD （2， 4， 8 g·L-1） down-regulated the expression levels of SOX2， Nanog， OCT4， PKM2， LDH， GLUT1， and HK2 （P<0.05， P<0.01） in a concentration-dependent manner. ConclusionJYXD may inhibit the proliferation and reduce the stemness of HGC-27 cells by regulating the aerobic glycolysis.
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" Two-way referral, and synergy between the tertiary hospitals and primary institutions" is the core measure for promoting hierarchical diagnosis and treatment in the region. The authors introduced the exploration and practice of constructing a two-way referral path in the medical alliance based on telemedicine in West China Second University Hospital of Sichuan University. As of May 2021, the hospital had established a two-way referral path with 52 member hospitals of the medical alliance. By clarifying the functionality and positioning of these institutions, optimizing work processes and IT support, building the mechanism of referral and liaison, and that of appraisal as support, these efforts had achieved progresses in such fields as innovative medical service modes, lean management of referral processes, and promotion of hierarchical diagnosis and treatment system building.
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As one of the main forms of the medical alliance, the specialty alliance functions as a service carrier for hierarchical medical service and resources integration in the region. The authors introduced the exploration and practice of the West China Women′s and Children′s Alliance, the first pediatric specialty alliance in Sichuan, established by the West China Second Hospital of Sichuan University. Based on family doctor contracted services, the West China Women′s and Children′s Alliance took such measures as differentiated functional positioning, assessment of certified physicians, continuous online quality control, construction of referral platforms, and innovative payment mechanisms. Such efforts effectively integrated the three stages of pre-hospital " preventive care" , in-hospital " disease diagnosis and treatment" , and post-hospital " follow-up management" , exploring the homogenization of medical services within the alliance, and forming a pediatric closed-loop health management system, hence improving the primary medical services.
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Objective To investigate primary anti-tuberculosis drug resistance in patients with acquired immunodeficiency syndrome (AIDS) and tuberculosis in Chongqing area.Methods Clinical data of 119 patients with AIDS and tuberculosis were retrospectively collected.Anti-tuberculosis drug resistance rates were analyzed according to drug susceptibility testing, and their correlations with CD4+ T lymphocytes counts, initially treatment or retreatment and clinical forms of tuberculosis were also analyzed.Comparison between groups was analyzed by x2 test.Results Thirty-eight patients (31.9%) showed anti-tuberculosis drug resistance among the 119 patients with completed results of drug susceptibility testing results.The percentages of mono-resistance, poly-resistance, multi-drug resistance (MDR) and extensive drug resistance (XDR) were 11.7%, 7.6%, 6.7% and 5.9%, respectively.The resistance rate of isoniazid (22.7%, 28/119) was the highest among first-line anti-tuberculosis drugs and that of pasiniazide (11.0%, 14/119) was the highest among second-line drugs.Drug resistance rates among patients with different levels of CD4+ T lymphocytes counts did not differ significantly (the cut-off of CD4+ T lymphocytes count was 50/μL: x2=0.545, P=0.461;cut-off value was 100/μL: x2=0.652, P=0.420).Patents with milliary pulmonary tuberculosis had a significantly higher drug resistance rate (64.0%) than those with secondary pulmonary tuberculosis (27.6%).Conclusions The prevalence of anti-tuberculosis drug resistance prior to anti-tuberculosis treatment initiation is high among AIDS patients with tuberculosis in Chongqing area.Patients with milliary pulmonary tuberculosis tend to have higher anti-tuberculosis drug resistance, but drug resistance does not appear to correlate with CD4+ T lymphocytes counts.