Objective Bone marrow mesenchymal stem cells (BMSCs) were induced to differentiate to the special histological types of neurons in vitro.The morphological change of cells and positive expression of specific antigen on membrane were studied,and the function of connection between the induced BMSCs was also detected.The feasibility of BMSCs differentiate to the special histological types of neurons was investigated.Methods BMSCs were divided into group Ⅰ (induced with bFGF+GDNF),group Ⅱ (induced with bFGF+GDNF+WHI-P131 +Shh),and control group (no revulsive).The morphologic change of cells was observed,and the positive rate of neuron specific surface antigen and the content of dopamine were detected.Formation of mature synaptic structure was detected by immunohistochemical assay of postsynaptic density protein 95 (PSD-95) expression,and synaptic loop was shown by FM1-43 stain synaptic vesicles.Results By immunohistochemical staining,the positive rates of dopamine transporter (DAT) and tyrosine hydroxylase (TH) in group Ⅱ were significantly higher than those in group Ⅰ,and dopamine can been detected in cell culture supematant of group Ⅱ.After BMSCs was induced into dopamine neuron-like cells,number and length of cell protrusions,positive rate of PSD-95 and fluorescence intensity of FM1-43 in group Ⅱ were significantly higher than those of group Ⅰ.Conclusions There were no significant change in positive rate of neuron-specific surface markers,rate of cell survival and differentiation rate after BMSCs differentiated to dopaminergic neuron-like cells.The number and length of cell protrusions,content of dopamine in cell culture supematant,positive rate of dopaminergic neuron-specific surface antigen (DAT and TH),synaptic function index (positive rate of PSD-95 and fluorescence intensity of synaptic loop) of group Ⅱ were all significantly higher than that of group Ⅰ.

Objective:To explore the current situation of balance function in elderly patients with chronic obstructive pulmonary disease (COPD) and analyze the related factors affecting balance function in COPD patients.Methods:In this study, data from the 2015 China Health and Retirement Longitudinal Study (CHARLS) were selected as research data, and 593 COPD patients aged 60 years or older were selected as research objects by multi-stage stratified cluster sampling method. The balance function was evaluated by standing test with both feet in front and behind. COPD patients whose standing test reached 60 s were divided into the good balance group (n=194), and those who did not reach 60 s were divided into the poor balance group (n=399). The balance ability of COPD patients of the two groups was compared, and the influencing factors of balance ability of the patientss were analyzed by Logistic regression analysis.Results:Univariate analysis showed that there were significant differences in balance ability between two groups in terms of age, education, cognitive function, and peak expiratory flow (PEF). ( P<0.05). Logistic regression analysis showed that age, cognitive function and PEF were influencing factors of balance ability of COPD patients ( P<0.05) . Conclusions:Patients with COPD have poor balance function. Clinicians should pay attention to the evaluation of balance function in patients with COPD and take targeted intervention measures in time to reduce the risk of falls.

Objective? To explore the cognition and attitude towards palliative care of family members among elderly chronic diseases patients and to analyze its influencing factors. Methods? From October 2017 to April 2018, we selected 180 family members of elderly chronic diseases patients at Peking Union Medical College Hospital as subjects by convenience sampling. All of them were investigated with the self-designed cognition and attitude towards palliative care questionnaire. The simple correlation was used to analyze the influencing factors of cognition and attitude towards palliative care of family members among elderly chronic diseases patients. Results? A total of 166 valid questionnaires were collected. There were 85 (51.2%) family members of elderly chronic diseases patients understanding palliative care, 133 (80.1%) of them agreeing with implementing palliative care. The reasons of supporting palliative care included that relieving the pain on the deathbed, patients had the right to choose, long-term torment of disease. There were statistical differences in the cognition and attitude towards palliative care among family members with different ages, education levels, occupations, incomes and patients' ages. Conclusions? Family members of elderly chronic diseases patients have insufficient understanding of palliative care with a high approval rate. The higher the approval rates, education levels and ages of family members are, they agree more with palliative care.

Objective:To evaluate the effects of different psychological interventions on depression and pain in patients with arthritis using the method of network Meta-analysis.Methods:Randomized controlled trials (RCTs) on psychological interventions for arthritis patients were systematically searched in PubMed, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, WanFang and CNKI databases. The retrieval time limit was from the establishment of databases to September 30, 2021. The literature was screened according to inclusion and exclusion criteria, and quality was assessed using the Cochrane Manual recommended RCT bias risk assessment tool. STATA 15.0 software was used for network Meta-analysis according to frequency framework.Results:A total of 59 RCTS were included, involving 8 psychological interventions and 5 726 patients. For the primary outcome of depression, at post-intervention, the ranking results showed that relaxation was the most likely to be the best intervention. However, in the comparison of different intervention effects, only cognitive behavioral therapy showed statistically significant difference compared with the control group ( P<0.05) . At follow-up, the ranking results showed that cognitive behavioral therapy was the most likely to be the best, and the difference was statistically significant compared with the control group ( P < 0.05) . After intervention, for the secondary index pain, the ranking results showed that hypnosis intervention was the most likely to be the best, but the intervention effect of relaxation intervention and cognitive behavioral therapy was statistically significant compared with the control group ( P< 0.05) . At follow-up, the ranking results showed that the best possibility of receiving commitment therapy was the highest, and the difference was statistically significant compared with the control group ( P < 0.05) . Conclusions:Cognitive behavioral therapy has the best effect on depression indicators in arthritis patients, and relaxation intervention and acceptance commitment therapy have the best effects on pain indicators after intervention and at follow-up, respectively. The potential interventions include relaxation intervention and hypnosis intervention, which are worthy of further study.

Objective:To construct the prediction model of knee degeneration in patients with knee osteoarthritis based on bioelectrical impedance index, and evaluate the prediction performance and application efficiency of the model.Methods:This was a cross-sectional study. From May to July 2021, 248 knee joints of 124 patients with knee osteoarthritis at home from Shijiazhuang Yuqiang Community Health Service Center who participated in physical examination were selected by convenience sampling to establish the model. According to Kellgren-Lawrence (K-L) grading system, the knee joints were divided into four groups, namely K-L1 ( n=19) , K-L2 ( n=103) , K-L3 ( n=96) , and K-L4 ( n=30) . The indicators included in the model were selected through analysis of variance or Kruskal-Wallis test, and a prediction model of knee degeneration was established using support vector machine, and the model was optimized using grid parameter optimization method. The prediction performance of the model was evaluated by the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, accuracy, positive predictive value and negative predictive value. Results:The indicators in the model included age, complications, lumbar/back/hip pain, high-risk occupation, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) -pain, WOMAC-function, capacitive reactance and phase angle. The area under the ROC curve of the training set model was 0.999, the prediction accuracy was 0.920, and the 95% confidence interval was 0.868 to 0.957. The area under the ROC curve of the test set model was 0.833, the prediction accuracy was 0.682, and the 95% confidence interval was 0.572 to 0.780.Conclusions:The prediction model of knee degeneration has good prediction performance and is easy to use, which can be used as a screening tool for knee degeneration in patients with knee osteoarthritis.

Objective:To analyze the clinical application of different diagnostic methods for heart failure with preserved ejection fraction (HFpEF) in maintenance hemodialysis (MHD) patients.Methods:It was a single-center retrospective cohort study. Uremia patients who underwent hemodialysis at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2020 to June 2021 were enrolled. The demographic characteristics, laboratory indicators, and echocardiography parameters were collected. The 2016 European Society of Cardiology (ESC) criteria, H 2FPEF score [composite score based on weighted scores of heavy (H), hypertensive (H), atrial fibrillation (F), pulmonary hypertension (P), elder (E), and filling pressure (F)], and Heart Failure Association (HFA) -PEFF score [including pre-test assessment (P), echocardiography and natriuretic peptide score (E), functional testing (F) and final aetiology (F)] were used to diagnose HFpEF, respectively, and the difference of three diagnostic methods was compared. The association between HFpEF diagnosed by the three methods and poor outcomes (all-cause death, cardiovascular death) was analyzed. Results:A total of 160 MHD patients were included, whose age was (58.5±13.4) years, median dialysis age was 5.0 (2.3, 9.6) years, median H 2FPEF score was 2 (1, 3), median HFA-PEFF score was 4 (3, 5), and 92 (57.5%) were males. Of these patients, 118 patients (73.8%) met the 2016 ESC criteria for diagnosis of HFpEF, 4 (2.5%) met H 2FPEF score for diagnosis of HFpEF, and 56 (35.0%) met HFA-PEFF score for diagnosis of HFpEF. The consistency of three methods in diagnosing HFpEF was poor with κ values of 0.018 between ESC criteria and H 2FPEF score, 0.322 between ESC criteria and HFA-PEFF score, and 0.056 between H 2FPEF score and HFA-PEFF score. After a median follow-up of 2.6 years, 20 (12.5%) of the 160 MHD patients died. The Kaplan-Meier survival analysis showed a significant difference in mortality between patients diagnosed with HFpEF and those without using the H 2FPEF score (Log-rank test, χ2=6.95, P=0.008). After adjusting for demographic and clinical parameters, multivariate Cox regression analysis showed that HFpEF diagnosed by HFA-PEFF score was associated with all-cause mortality ( HR=2.73, 95% CI 1.07-6.98, P=0.036) and cardiovascular mortality ( HR=4.77, 95% CI 1.31-17.30, P=0.018). Conclusions:The 2016 ESC criteria, H 2FPEF score, and HFA-PEFF score have high heterogeneity and poor consistency in diagnosing HFpEF in MHD patients. Among the three diagnostic methods, only the diagnosis based on HFA-PEFF score is associated with the prognosis of MHD patients. The HFA-PEFF score can be used to assess the risk of HFpEF in MHD patients, and more clinical studies are needed to further verify it in the future.