OBJECTIVE:To provide reference for comprehensive intervention and management of chronic disease in China.METHODS:The global chronic disease trends and disease burden were summarized;theoretical framework,practice and experience of international chronic disease management were summarized and analyzed as well as enlightenment on domestic chronic disease management.RESULTS&CONCLUSIONS:Worldwide prepresentative chronic disease theory model mainly involved USA chronic disease nursing model and WHO innovation care for chronic conditions.Main experience of international chronic disease management is that managing based on community,confirming preferential intervened disease types,adopting standardized clinical diagnosis and treatment pathway,designing rational transfer treatment system,providing patient self-management support.At pres ent,chronic disease management have been improved in China,but is still poor in community management.It is necessary to strengthen community medical staff training about chronic disease prevention and treatment and health education for social group.

Objective To investigate changes ane clinical significance of renal pathomorphology ane transforming growth factor-β1(TGF-β1 ),connective tissue growth factor(CTGF)of rats with eifferent stages of eiabetes mellitus(DM). Methods Thirty-six SD rats were raneomly eivieee into control ane DM group. Rats in DM group were given streptozotocin(STZ)at a eose of 65 mg/ kg boey weight ane rats in control group were given same amount citric acie/ soeium citrate buffer solution. Rats were killee at 4th,12th ane 24th weeks after DM moeels establishment. The renal hyeroxyproline concentration(HPC)was measuree. Masson′s trichrome was performee to observe perivascular collagen area(PVCA). Glomerular collagen eeposition score(GCDS),tubular interstitial eisease score(TIDS)in kieney interstitial tissue were measuree. Immunohistochemical staining were usee to measure the expression of type Ⅰ ane Ⅲ collagen,TGF-β1 ,CTGF. Renal path morphology change were observee with light microscope ane transmission electron microscope. Results (1)HPC levels of rats in DM group at 4th,12th,24th weeks were(216. 50 ± 10. 05)μg/ g,(267. 67 ± 11. 29)μg/ g,(340. 67 ± 39. 22)μg/ g,higher than that of control group((123. 00 ± 6. 00)μg/ g,(158. 50 ± 8. 89)μg/ g,(201. 00 ± 7. 69)μg/ g). The PVCA score in DM group were higher than that of control group( 4 weeks:(0. 45 ± 0. 07)vs (0. 96 ± 0. 11);12 weeks:(0. 60 ± 0. 06)vs(1. 65 ± 0. 18);24 weeks:(0. 72 ± 0. 07)vs(2. 63 ± 0. 0. 40);P< 0. 05). Meanwhile the scores of GCDS ane TILS in DM group)at 4th,12th,24th weeks increasee comparee with control group(4 weeks:((0. 34 ± 0. 03)vs(0. 14 ± 0. 01))× 103 / μm2 );12 weeks:((0. 49 ± 0. 03)vs (0. 26 ± 0. 04))× 103 / μm2;24 weeks:((0. 62 ± 0. 06)vs(0. 33 ± 0. 03))× 103 / μm2 )). The expression of CollagenⅠane Collagen Ⅲ in DM group were higher than that of control at 4,12,24 weeks after DM moeel establishment(Collagen Ⅰ:4 weeks:((4. 56 ± 0. 75)vs(1. 34 ± 0. 34))× 103 / μm2;12 weeks:((6. 07 ± 0. 74)vs(2. 17 ± 0. 12))× 103 / μm2;24 weeks:((7. 22 ± 0. 19)vs(3. 00 ± 0. 33))× 103 / μm2;CollagenⅢ:4 weeks:((3. 44 ± 1. 41)vs(1. 58 ± 0. 24))× 103 / μm2;12 weeks:((5. 60 ± 1. 34)vs(2. 95 ± 0. 41)) × 103 / μm2;24 weeks:((6. 22 ± 0. 18)vs(3. 27 ± 0. 27))× 103 / μm2 )),ane the eifferences between the groups all significant(P < 0. 05). Diffuse thickening of glomerular capillary basement membrane ane interstitial collagen hyperplasia in eiabetic rats were observee by electron microscope.(2)TGF-β1 expression in DM group were(2. 16 ± 0. 50)× 103 / μm2 ,(5. 31 ± 0. 25)× 103 / μm2 ,(6. 44 ± 0. 74)× 103 / μm2 respectively at 4th, 12th,24th weeks after DM moeel establishment,higher than that of control group((1. 18 ± 0. 15)× 103 / μm2 , (2. 99 ± 0. 25)× 103 / μm2 ,(3. 28 ± 0. 66)× 103 / μm2 )ane the eifferences were significant(P < 0. 05). The same trene was also seen in terms of CTGF expression((6. 02 ± 1. 39)vs(2. 32 ± 0. 87))× 103 / μm2 ,((6. 51 ± 0. 51)vs(3. 96 ± 0. 92))× 103 / μm2 ,((7. 89 ± 1. 46)vs(4. 58 ± 1. 02))× 103 / μm2;P < 0. 05) Conclusion Early eiabetic rats show renal fibrosis ane it may be relatee with overexpression of CTGF ane TGF-β1.

Serum triglyceride ( TG ) , total cholesterol ( TC ) , low density lipoprotein cholesterol ( LDL-C) , high density lipoprotein cholesterol ( HDL-C) , uric acid ( UA) levels and fasting blood glucose ( FBG) were measured in 67 patients with chronic spontaneous urticaria ( CSU ) and 66 healthy subjects ( controls).Results showed that the rates of increased serum TG and FBG levels in CSU patients were higher than those in controls ( 19% vs.6%,χ2 =5.309, P <0.05; 12% vs.1%,χ2 =4.194, P <0.05, respectively);however, there were no significant differences in abnormal rate of TC(7%vs.3%) , LDL-C (4%vs.1%), HDL-C(6%vs.3%)and UA(6%vs.1%) between CSU patients and healthy controls(all P>0.05).The rate of rising FBG in CSU patients accompanied by angioedema(4/9)was higher than that in CSU patients without angioedema(7%,χ2 =7.181,P<0.05).

An instrumental analysis method for the determination of stable silicon isotope ratio using multi-collector inductively coupled plasma mass spectrometry ( MC-ICP-MS) was established. In dry plasma mode, silicon isotopes suffered from the spectrum polyatomic interferences of C, N, O, H at medium resolution. The sample gas flow had significant effect on the silicon sensitivity and signal stability. Besides, higher sample gas flow lead to higher production of 14N16O. Consistent δ29Si and δ30Si within 0. 04‰ (1σ) could be obtained over a mass range of ca. 9 milli-amu at the lower mass side of silicon at medium resolution. The analyte concentrations of the sample and reference material were matched within 20% to avoid concentration effect on the determination of silicon isotopes using standard-sample-bracketing correction method. The measurements were not sensitive to the acid molarity and Cl matrix. An internal precision of less than 8×10-6(1σ) could be achieved for 29 Si/ 28 Si and 30 Si/ 28 Si by taking an integration time of 8 seconds. The long-term reproducibility of 0 . 06‰-0 . 10‰ ( 2σ, n=20 ) was obtained for δ29 Si and δ30 Si by repeating the analysis of the silicon reference materials, whilst the determined isotopic value for GBW04421 and GBW04422 were in good agreement with the recommended data, suggesting the precision and robustness of this method. The measured silicon isotopic values of fresh waters ( river and lake waters ) , saline waters and seawater demonstrated the capability of applying this method to trace the biogeochemical processes of silicon in natural waters.

Objective To study the expressions of Notch receptors (Notch1 and 2) and target gene Hes-1 in bone marrow CD34+ cells from patients with psoriasis. Methods CD34+ cells were isolated from the bone marrow of 12 patients with psoriasis and 19 normal human controls. Western blot was conducted to detect the expressions of Notchl, Notch2 and Hes-1 proteins in CD34+ cells, with the house-keeping gene β-actin as an internal reference. Results In contrast with normal controls, a significant increment was observed in the expressions of Notch1 and Hes-1 proteins in psoriatic patients (0.9488 ± 0.3221 vs. 0.6693 ± 0.1465, 0.8579 ±0.3729 vs. 0.5728 ± 0.1787, both P ＜ 0.05). No significant difference was observed in the expression of Notch2 between psoriatic patients and normal controls (0.7568 ± 0.3461 vs. 0.8312 ± 0.2887, P ＞ 0.05).Conclusion The overexpression of Notch1 and Hes-1 may be associated with the low proliferation activity of psoriatic hematopoietic cells.

Objective To study adhesion and invasion of adherent-invasive Escherichia coli strains and its ability of survival and proliferation in macrophage cells.Methods Bacteria from the mucosa tissues of ileum,colon and rectum of inflammatory bowel disease (IBD)patients were isolated,cultured and identified.The toxic genes were confirmed by polymerase chain reaction.The adhesion and invasion ability of bacteria and its survival and proliferation ability in macrophage cells were observed after co-culture with cells.Results Five adherent-invasive Escherichia coli strains were isolated from the intestinal mucosa specimens of two patients with Crohn′s disease and one patient with ulcerative colitis.The adhesion rates of five bacteria stains (2A,2B,15A,15B,19B)to Caco-2 cells were (1 .4 ± 1 .3 )%,(1 .5 ± 0.6 )%, (0.6±0.1)%,(1 .4±0.4)% and (1 .1 ±0.8)%,respectively.The adhesion rates to Int-407 cells were (1 .0±0.8)%,(1 .5 ±0.8)%,(1 .0 ±0.8 )%,(1 .0 ±0.8 )% and (0.3 ±0.0 )%,respectively.The invasion rates to Hep-2 cells were (10.1 ±7.0)%,(0.7 ±0.4)%,(0.4 ±0.3 )%,(2.2 ±1 .0)% and (2.1 ±1 .8)%,respectively.The invasion rates to Int-407 cells were (0.7 ±0.5 )%,(0.5 ±0.3 )%, (2.8±1 .2 )%,(0.7 ±0.5 )% and (0.5 ±0.4)%,respectively.All five adherent-invasive Escherichia coli strains could survive and proliferate in macrophage cells.Conclusions Five adherent-invasive Escherichia coli strains are isolated for the first time in Chinese patients with IBD,and all of them could survive and proliferate in macrophage cells.

Objective To investigate long-term data of dry eye after LASIK in young myopia patients.Methods Young myopia patients were divided into treated group (group A) and control (group B),who were interviewed before surgery and on 1 year,3 years and 5 years after surgery.Their diopters,uncorrected visual acuity (UCVA),tear breakup time test,Schirmer I test and corneal fluorescent staining were taken,then dry eye was diagnosed and OSDI questionnaire were scored.Results The postoperative incidence of dry eye in group A was higher than that before surgery (35.6％) and decreased with time (51.7％,44.9％ and 40.7％,respectively),and there was no significant difference in group B at each time point (P ＞ 0.05).The preoperative incidence of dry eye was equal between two groups (P ＞ 0.05),which were much higher in group A after surgery (all P ＜ 0.05).In group A,the postoperative constituent ratio of mild dry eye was the majority and decreased with time (65.6％,52.8％,41.7％,respectively),while moderate and severe dry eye was increased,especially the latter (6.6％,11.3％ and 16.7％,respectively;P ＜ 0.05).At 5 years after surgery,the UCVA and visual function score in dry eye patients were lower than those of non-dry eye patients (all P ＜ 0.05),while the residual refraction and ocular symptom score were higher than those of dry eye patients (all P ＜ 0.05).Conclusion Dry eye disease may last for a long time and may getting worse after LASIK.Therefore,we should pay more attention to the development of dry eye long after LASIK in young myopic patients.

Objective To explore the relationship between left ventricular diastolic function and the dynamic changes of myocardial ultrastructure and argyrophilic fiber in diabetic rats on the different periods of lesions(week 4,12 and 24).Methods The diabetes mellitus(DM)in healthy male Sprague-Dawley rats was induced by a single injection of streptozotocin(STZ,Sigma)into intraperitoneal at a dose of 65 mg/kg body weight.The left ventricular diastolic function was measured by Color Doppler Flow Imaging-Pulsed Wave(CDFIPW)and Doppler Tissue Imaging(DTI)echocardiography.Heart tissue at the apex was obtained rapidly for transmission electron microscope study.Argyrophilic staining was used in the study of argyrophilic fiber volume fraction(APFVF)in heart interstitial tissue.Results Diastolic dysfunction of left ventricle was detected in STZinduced diabetic rats by CDFI-PW(E/A ＜ 1)at week 4,and progressed gradually.Pseudonormal filling (E/A ＞ 1)was found in diabetic rats at week 24,which could be identified by DTI(Ea/Aa ＜ 1).Diastolic function of normal rats was not impaired(E/A ＞ 1 and Ea/Aa ＞ 1).Transmission electron microscopy revealed a spectrum of subcellular remodeling in myocardium which was characterized by myofibril content decrease,disorganization,mitochondrial degeneration,sarcoplasmic reticulum,structural disorder.Compared with the control group,APFVF in myocardium was increased significantly in diabetic rats(P ＜ 0.05).Conclusion The diastolic dysfunction in STZ-induced diabetic rats correlates with damage of ultrastructure and increase of myocardial argyrophilic fiber.

OBJECTlVE To investigate the antidepressant effect and reIated mechanism of the totaI fIavonoids extract parts( Iicorice fIavonoids,LF)from Glycyrrhiza uralensisFisch. cuItivated IocaIIy in Ningxia. METHODS Forced swimming test( FST)and taiI suspension test( TST)were adopted to study the antidepressant pharmacoIogicaI effect in the acute stress-induced depression modeI in mice. The Km mice were intragastricaIIy administered with LF(5,30 and 180 mg·kg-1 )once daiIy,for 21 con-secutive days. One hour after the first,seventh and Iast administrations,the mice were submitted to FST by recording the immobiIity period within the Iast 4 min of the totaI 6 min in both tests and the resuIts were expressed as decrease in immobiIity period with respect to vehicIe controI. In TST,the other group of Km mice was used to evaIuate the antidepressant effect in same protocoI. In the antagonism of reserpine-induced symptoms test( ART),ICR mice were administered intragastricaIIy with LF( 50,150 and 400 mg·kg-1 )once daiIy for 7 consecutive days. One hour after the Iast administration,the mice received reserpine(4 mg·kg-1 ,ip),and ptosis or akinesia was measured 1 h after reserpine injection whiIe rectaI temperature was measured 4 h after the reserpine injection respectiveIy. The same protocoI was adopted in yohimbine toxicity potentiation test(YTT)as in ART. Thirty minutes fter the Iast adminis-tration,the mice received the threshoId IethaI dosage of yohimbine(30 mg·kg-1 ,sc)respectiveIy,and the death number of the mice was caIcuIated in 24 h after the yohimbine administration. In the 5-hydroxy-L-tryptophan(5-HTP)induced head-twitches test(HTT)in mice,after being administered intragastricaIIy with LF(50,150 and 400 mg·kg-1 )once daiIy for 7 consecutive days,the mice received pargiIine (100 mg·kg-1 ,ip)the next day,and 30 min Iater,5-HTP(10 mg·kg-1 ,ip)was intraperitoneaIIy injec-ted to induced the head twitch respectiveIy,and the times of head twitch in a 30 min period after 5-HTP treatment were observed at 6 time points. After HTT,the mice were sacrificed quickIy,and the mono-amine oxidase(mAO)activity in the brain cortex,hippocampus and thaIamus was examined to evaIuate the antidepressant effect of fIavonoids with mAO inhibition. RESULTS Compared with the vehicIe controI,LF significantIy decreased the immobiIity period in both FST and TST(P﹤0.05). LF(50,150 and 400 mg·kg-1 )antagonized the ptosis and akinesia symptoms respectiveIy in 1 h after reserpine administration( P ﹤ 0. 05 ), but faiIed to antagonize hypothermia produced 4 h after reserpine administration. AIso,at the same dosage,LF did not synergeticaIIy produce the enhancement of death by subcutaneous injection of yohimbine at the threshoId IethaI dosage. LF(150 and 400 mg·kg-1 )couId significantIy and synergeticaIIy increase 5-HTP induced head-twitches response(P﹤0.05),but LF couId not promote mAO activity in the cortex,hippocampus and thaIamus at the same dosage. CONCLUSlON LF exerts antidepressant-Iike effect on the modeI of acute despair test. The mechanism might be reIated to direct enhancement of the serotonergic neuraI function in the brain.

Objective:To observe the characteristics of choroidal thickness in patients with macular edema secondary to superior temporal branch retinal vein occlusion (BRVO-ME).Methods:A retrospective control study. From November 2020 to September 2021, 30 patients (30 eyes) with BRVO-ME (BRVO-ME group) were diagnosed by ophthalmology examination in Department of Ophthalmology, The Affiliated Hospital of Chengde Medical College and 14 healthy volunteers (28 eyes) were enrolled in the study. The choroidal thickness of macular area was measured by enhanced deep imaging technique of frequency domain optical coherence tomography. According to the subdivision of the diabetic retinopathy treatment group, the choroid within the 6 mm of the macular fovea was divided into three concentric circles with the macular fovea as the center, namely, the central area with the diameter of 1 mm, the inner ring of 1-3 mm and the outer ring of 3-6 mm. The inner ring area and the outer ring area are divided into upper, lower, nasal and temporal sides, respectively, which are denoted as S3, I3, N3, T3 and S6, I6, N6, T6, totaling 9 areas. To observe the distribution characteristics of choroidal thickness in different regions of two groups of eyes. The choroidal thickness of different macular regions was compared by independent sample t-test. Results:The choroidal thicknesses in the central area, S3, T3, I3, N3, S6, T6, I6, and N6 of the eyes in the control group and BRVO-ME group were 214.11±56.04, 207.89±57.92, 214.07±54.82, 207.14±61.54, 180.18±53.53, 204.25±59.60, 193.93±51.50, 190.54±51.21, 139.82±39.84 μm and 258.00±71.14, 256.43±68.70, 252.07±72.97, 244.37±68.49, 243.10±70.93, 247.20±68.36, 221.00±61.28, 223.77±58.64, 183.20±60.15 μm. In both groups, the choroidal thickness was the thickest in the central area, gradually thinning to the nasal side and temporal side, and the nasal choroidal thickness was thinner than other regions, and N6 area was the thinnest. Compared with the control group, the choroidal thickness of central area, S3, T3, I3, N3, S6, I6 and N6 in BRVO-ME group were significantly thicker ( t=-2.899, -2.229, -2.172,-3.250, -2.543, -2.292, -3.214; P<0.05), there was no significant difference in T6 area ( t=-1.814, P=0.075). Conclusion:The choroidal thickness of macular area in patients with BRVO-ME is thicker than that in normal subjects.