Objective:To explore the developmental trajectory of multimorbidity and its impact on new-onset disability to identify homogeneous groups with similar multimorbidity developmental courses and to provide evidence for interventions for disability risk among middle-aged and older adults in China.Methods:Data was retrospectively collected from China Health and Retirement Longitudinal Study with four consecutive surveys (2011-2018). Group-based trajectory modeling was used to fit multimorbidity developmental trajectories, and the impact of multimorbidity trajectories on new-onset disability was analyzed using the time-dependent Cox regression model.Results:A total of 8 580 participants were included in current analysis, and four multimorbidity trajectories were identified: no multimorbidity ( n=2 136, 24.90%), newly-developing ( n=3 758, 43.80%), moderate-developing ( n=2 270, 26.45%) and severe-developing ( n=416, 4.85%). Participants who belong to moderate-developing and severe-developing tended to be female, single, overweight or obese, live in rural areas, have poorer self-rated health and high levels of annual per capita household expenditure, and developed a new-onset disability. After adjusting for demographic and behavioral covariates, compared to the newly-developing, the severe-developing( HR=3.132, 95% CI:1.884-5.207) had the highest risk of disability, followed by the moderate- developing ( HR=1.400, 95% CI:1.026-1.909) and the risk for the no multimorbidity ( HR=0.631, 95% CI:0.424-0.938) was the lowest. Conclusions:There was great heterogeneity in the developmental trajectory of multimorbidity among middle-aged and older adults in China. Data showed that the risk of disability in the developmental trajectory of multimorbidity increases with increasing levels. We think that the elevating developmental trajectory of multimorbidity is a risk factor for developing disability.

Objective: To explore the clinical features, diagnostic methods and therapeutic strategy of silent sinus syndrome (SSS). Methods: A retrospective study was made on eight SSS patients treated during 2013-2016 in Longgang ENT Hospital and Otorhinolaryngology Hospital of the First Affiliated Hospital of SUN Yat-sen University. The following clinical data, including demographic data, symptoms, history of trauma and surgery, signs, imaging examination, endoscopic surgery and postoperative outcomes, were analyzed to summarize the diagnosis and treatment experiences. Results: Eight SSS patients showed the following clinical features: the proportions of both sexes and sinus sides were 4 to 4; seven cases (7/8) were adult, with an average of (48.1±11.8)y; seven cases (7/8) had long history of trauma or surgery, with an average of (17.9±10.5)y; seven cases (7/8) cannot recall the exact course of SSS; six cases (6/8) had no nasal symptoms; eight cases (8/8) had unilateral ocular discomforts; eight cases (8/8) had signs of unilateral enophthalmos (2-5 mm), accompanied with hypoglobus; and by CT and MRI scanning, eight cases (8/8) showed the unilateral maxillary sinus outlet obstruction, sinus full opacification, sinus wall bony rarefaction, sinus wall contraction, sinus volume loss, and the ipsilateral orbital floor bowing descent and orbital volume increase. After treated by endoscopic sinus surgery and followed-up for one year, four cases were cured, and the other four improved; no intra- or post-operative complications occurred; and no individual need a two-stage orbital plastic reconstruction. Conclusions SSS often develops in the unilateral maxillary sinus of adult patient with long history of trauma or surgery, but the nasal symptoms and signs are silent. Diagnostic for SSS depends on characteristic ocular sign and sinus CT imaging. Endoscopic sinus surgery helps to improve ocular and nasal signs and promote orbital self-reconstruction.