Objective To explore the effect of responsibility system of family doctors( RSFD) for community management of the patients with diabetic retinopathy ( DR ) .Methods Fifty -two cases with non -proliferative diabetic retinopathy( NPDR) found in annual health examination in community health care centers were selected and randomly divided into intervention group(30 cases) and control group(22 cases).The intervention group received RSFD service mode and the control group received conventional management mode for 1 year.Patients'visual acuity, fundus,fasting blood-glucose(FBG),glycosylated haemoglobin(HbA1c) were observed and compared before and after intervention.Results In this study,the efficacy in improving patients'visual acuity and retinopathy was 73.3%in the intervention group and 45.5%in the control group,there was statistically significant difference between the two groups(χ2 =4.168,P=0.041).Before intervention,the control rates of patients'FBG were 36.4% and 30.0%respectively,and HbA1c was 27.3%and 33.3%.There were no statistically significant differences between the two groups(P>0.05).After intervention,the control rates of patients'FBG and HbA1c were 86.6% and 80.0% in intervention group,and 59.1%and 54.5%in the control group,there were statistically significant differences between the two groups (χ2 =5.147,P=0.023;χ2 =3.861,P=0.049).Conclusion RSFD service mode was conductive to control patients'blood sugar and improve visual acuity and retinopathy,we could disseminate and apply it to manage-ment of DR in community.

Objective To analyse the effect of progesterone on peripheral blood corticotropin releasing hormone ( CRH ) and delivery time in women with premature rupture of membranes ( PROM ) .Methods 80 patients who were diagnosed with PROM in Department of Obstetrics and Gynecology, China Medical University were collected.Randomly divided into dexamethasone (DEX) group, dexamethasone plus progesterone (DEX+P) group, progesterone ( P) group and control group, three groups were detected on admission, admission 24 h, 48 h on peripheral white blood cell count, C-reaction protein, CRH level and time of delivery, neonatal weight, and analysis of CRH the level of the correlation and delivery time.Results Compared with the other three groups, the level of CRH in peripheral blood of DEX group were higher (P<0.05);CRH (P<0.05) increased faster;shorter delivery time (P<0.05); the level of CRH was negatively correlated with delivery time (r=-0.832, P<0.05).The results were statistically significant.Conclusion Dexamethasone treatment can make the premature rupture of fetal membranes of peripheral blood CRH levels rise, shorten the delivery time, progesterone can inhibit this process.

Objective To investigate the effects of omega-3 polyunsaturated fatty acids (ω-3 PUFA) on inflammatory response,nerve damage,and outcomes in patients with severe traumatic brain injury (sTBI).Methods Altogether 120 sTBI patients were selected from January 2013 to September 2014 in Jinjiang Hospital of Traditional Chinese Medicine and divided with a random number table into experimental group (with ω-3 PUFA supplementation,n =60) and control group (without ω-3 PUFA supplementation,n =60).Sixty blood samples from healthy people visiting the physical examination clinic were collected as normal controls.The serum levels of tumor necrosis factor-α (TNF-α),interleukin (IL)-1,IL-6,S100B and neuron-specific enolase (NSE) were detected with enzyme-linked immunosorbent assay (ELISA).Glasgow Coma Scale (GCS) score,Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score and outcomes of the two groups were compared.Results The serum levels ofTNF-α,IL-1,IL-6,S100B,and NSE protein significantly increased in patients with sTBI compared with the normal controls (all P ＜ 0.05).Compared with the control group,the serum levels of inflammatory related factors (TNF-α,IL-1,IL-6) in the experimental group were significantly decreased on the 3rd day [(213.81 ±29.33) μg/L vs.(267.76 ±31.35) μg/L,(121.81 ± 10.63) μg/L vs.(152.60 ± 11.45) μg/L,(81.89 ± 8.34) μg/L vs.(106.62 ± 10.35) μg/L,all P ＜ 0.05],S100B and NSE protein expressions were significantly decreased on the 7th day [(1.32 ± 0.09) μg/L vs.(1.67 ± 0.12) μg/L,(12.57 ± 1.53) μg/L vs.(17.57 ±2.30) μg/L,both P ＜0.05].Compresd with the control group,the experimental group showed significantly higher GCS scores (9.32 ± 1.64 vs.7.14 ± 1.30,P =0.02) and significantly lower APACHE Ⅱ scores (14.37 ± 2.27 vs.17.00 ± 1.85,P =0.04) on the 14th day.Compresd with the control group,the experimental group showed lower mortality during the follow-up [11.7％ (7/60) vs.15.0％ (9/60)],but with no significant differences (P =0.49).Conclusion Supplementation of ω-3 PUFA could exert neuroprotective effect by effectively regulating inflammatory response and reducing the damages to glia and neurons in patients with sTBI,which is a promising agent for clinical application.

Prospective research have shown that whole exome sequencing (WES) may be considered when a diagnosis cannot be obtained using routine prenatal methods, e. g., chromosomal karyotyping and copy number variation sequencing, for fetuses with significant structural anomalies. WES can increase the diagnostic rate of genetic disorders in such fetuses by 8%~10%. Prenatal WES has been gaining wide acceptance. However, due to the limitations of fetal phenotypic evaluation and complexity of ethical issues in prenatal diagnosis, to justify and standardize the application of prenatal WES and maximize its clinical utility has become an urgent need. In view of this, a consensus has been formed by referring to the latest guidelines, expert consensus and authoritative literature. This consensus has put forward suggestions on the suitable objects of prenatal WES, pre-test consultation, sampling and laboratory testing, results report, post-test consultation, pregnancy outcome follow-up, multidisciplinary consultation of difficult cases, preservation of prenatal WES samples and data information.

Objective:To investigate the genetic etiology of a child with epilepsy accompanied by motor retardation.Methods:A patient with epilepsy and motor retardation in Henan Provincial People′s Hospital in January 2020 and his parents′ peripheral blood 2 mL were collected.G-banded karyotyping and array-based comparative genomic hybridization (aCGH) were used to analyze the duplication / deletion of chromosome segments in child and her pa-rents.Results:The karyotype of the patient revealed 46, XX, and add(19)(p13.3→qter), whereas aCGH detected a 9.50 Mb duplication at 19q13.33q13.43[arr(hg19)(49593920_59092570)×3]. This region contains 471 genes.No abnormality was discovered in the karyotyping and aCGH analysis of the patient′s parents.The phenotypes of the patient conformed to the previously reported clinical characteristics of 19q13.3 duplication.Conclusions:The de novo 19q13.3 duplication is the cause of epilepsy and motor development retardation for the patient.Combined with aCGH, the traditional G banding is valuable to diagnose the patient with developmental delay.

Either injury or reconstruction of anterior cruciate ligament (ACL) may damage proprioceptive sense, remodel central ner-vous system and impair motor control. It is necessary to systematically remodel neuromuscular function, including proprioceptive sense cor-rection, central nervous system remodeling and motor control strengthening etc., for patients after ACL reconstruction.

The measurement of intramedullary pressure is particularly important in the research of spinal cord injury. This article ana-lyzed the influence factors and the measurement methods of intramedullary pressure. The influence factors included edema, vascular regula-tion and bleeding, spinal dural, pia mater spinalis, cerebrospinal fluid, canalis vertebralis and body position, etc. The measurement methods included direct measurement methods, as the sensor placed in the parenchyma of spinal cord, intradural extramedullary or lumbar catheter, and measuring in vitro, and indirect measurement methods, as computer modeling and intraocular pressure measuring.

With the development of science and technology, and the emergence of artificial intelligence, wearable technology is becom-ing a hot topic in the field of rehabilitation medicine. Wearable technology is characterized by miniaturization, intelligency and convenience, and has been widely researched and applied in many fields, such as neurological rehabilitation, orthopaedic rehabilitation, spinal cord injury rehabilitation and rehabilitation for senile degenerative diseases. The further research may focus on the reliability of signals under dynamic monitoring, the comfortable feeling during long-term use of wearable devices, the data security based on personal privacy, and so on.

Objective To explore the feasibility and effectiveness of lateral gastrocnemius muscle branch nerve transferring for deep pe-roneal nerve injury. Methods Thirty-two adult female Sprague-Dawley rats were divided into control group (n=8), sham group (n=8), nerve direct repairing group (n=8) and nerve transferring group (n=8). Twelve weeks after the anastomosis, the nerve anastomosis was observed vi-sually, the length of lateral of gastrocnemius muscle branch (L1), the diameter at the point of entering muscle (D1), the maximum detachable length of nervus peroneus communis (L2), the diameter of deep peroneal nerve (D2) and the distance between branch point and neck of fibu-la (S) were measured. The peroneal nerve functional index (PFI), the amplitude of compound muscle action potential (CMAP), nerve con-duction velocity (NCV), the weight of the tibialis anterior and the creatine kinase (CK) activity of theanterior tibial were compared among groups. Results L10.05). Conclusion It is feasible that lateral head muscular branches of gastrocnemius nerve transferring can repair deep peroneal nerve injury, which is needed to separate superficial peroneal nerve and deep peroneal nerve in the epineurium without damaging nerve for tension free neuroanastomosis. Lateral head muscular branches of gastrocnemius nerve transferring can repair the func-tion after deep peroneal nerve injury.