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As an important measure to improve the supply of essential health services, the implementation of hierarchical medical system has encountered obstacles in different regions. Due to different referral standards in hospitals, temporal and geographical factors during treatment, it is difficult to promote the development of regional medical consortiums. Shanghai Pudong New Area People's Hospital, together with seven community health centers, established a Chuansha Medical Consortium, specifically for treating chronic kidney disease (CKD), using an accurate hierarchical management program for CKD supported by information technology, a hierarchical diagnosis and treatment system designed based on CKD management programs recommended by relevant guidelines, a CKD knowledge base in which medical information and referral criteria are incorporated, and a joint management model integrating hospital and community care. Empirical evaluation indicated that the hierarchical diagnosis and treatment model based on a CKD knowledge base could greatly contributed to accurately identifying vulnerable and high-risk population of CKD, timely screening and assessing patients with early stage CKD, and improving the efficiency of health management and diagnosis and treatment.

Simple Summary: Lactate (L-lactate and D-lactate) is the main production of the Warburg effect, which is vital for carcinoma cell metabolism. This review retrospects the lactate isomer metabolism in the cancer progress. The related enzyme and proteins have been listed as prognostic biomarkers for cancers, and the lactate down-streamed molecular cancerogenic signaling is also introduced. This review will provide a new strategy for anticancer therapy that targets lactate metabolism. Lactate mediates multiple cell-intrinsic effects in cancer metabolism in terms of development, maintenance, and metastasis and is often correlated with poor prognosis. Its functions are undertaken as an energy source for neighboring carcinoma cells and serve as a lactormone for oncogenic signaling pathways. Indeed, two isomers of lactate are produced in the Warburg effect: L-lactate and D-lactate. L-lactate is the main end-production of glycolytic fermentation which catalyzes glucose, and tiny D-lactate is fabricated through the glyoxalase system. Their production inevitably affects cancer development and therapy. Here, we systematically review the mechanisms of lactate isomers production, and highlight emerging evidence of the carcinogenic biological effects of lactate and its isomers in cancer. Accordingly, therapy that targets lactate and its metabolism is a promising approach for anticancer treatment. [ABSTRACT FROM AUTHOR]

Background: Endplate inflammation remains a difficult disease to treat, in part due to its unclear pathology. Previous experiments showed that patients with idiopathic inflammation presented a systemic upregulation of Th17 cells. Here, we investigated how this change might affect the inflammatory environment in endplate inflammation. Methods: Peripheral blood was obtained from patients and healthy controls, and Th17 cells were examined.Results: Th17 cells significantly increased the differentiation of CD11c+ and DC-SIGN+ dendritic cells (DCs) from circulating monocytes in the absence of exogenous stimulation as well as in the presence of LPS stimulation. Th17 cells also increased CD80 and CD86 expression by DCs. Importantly, although Th17 cells from both healthy controls and patients with endplate inflammation could induce CD11c, DC-SIGN, CD80, and CD86 expression, Th17 cells from patients with endplate inflammation showed significantly more potent capacity. Both contact-dependent and IL-17-dependent mechanisms were employed by Th17 cells, since blocking cell-to-cell contact significantly inhibited Th17-mediated differentiation of CD11c+ DCs, and neutralization of IL-17 reduced the expression of CD80 and CD86. Strikingly, DCs following incubation with Th17 cells, but not the DCs derived directly from monocytes without Th17 cells, could significantly promote the expression of IL-17 from naive CD4+ T cells. Conclusions: These results demonstrated that Th17 cells from patients with endplate inflammation could potently induce the differentiation and activation of DCs that preferentially promoted IL-17 response in a positive feedback loop. [ABSTRACT FROM AUTHOR]

Purpose: Evaluation of the internal biomechanics of the foot-and-ankle complex is challenging for the prescription of orthosis particularly for midfoot arthritis patients in which the joint condition is crucial., Methods: Using computational modeling and design optimization techniques, the objective of this study was to compare the biomechanical functions among different combinations of design factors using computer simulation. A finite element foot model was reconstructed from a midfoot arthritis patient. Orthotic designs with 3 levels for each of the 3 design factors (arch height, lateral wedge angle, and insole stiffness) contributed to 9 configurations using a fractional factorial design were tested., Results: An increase in peak plantar stress of the midfoot was facilitated by a medium arch height and wedge angle, and stiffest insole material, notwithstanding the combination neither reduced the peak plantar stress of other foot regions nor was consistent with the combination that minimized the stress of the articular cartilage., Conclusions: Insole with high arch (H = 30 mm), low stiffness (E = 1.0 MPa), and medium wedge angle (A = 5°) could minimize the stress of the cartilage at the arthritic joint (primary outcome) and could be beneficial to the patients. Also, insole stiffness predominantly influenced cartilage stress. However, secondary outcomes including the stress of the navicular and medial cuneiform and the regional plantar stress did not produce the same solution. Future studies can consider a patient-specific loading profile to further the investigation on the stabilizing effect and the attenuation of load transfer induced by the insole.