Objective:To analyze the co-morbidity patterns of chronic diseases among the elderly in China and provide suggestions for health management strategies.Methods:It was a cross-sectional study. A total of 9 383 respondents aged ≥60 years with complete data of key variables (chronic disease status, age, gender, marital status, etc.) in the 2020 China Health and Aged Care Tracking Survey (CHARLS) dataset were selected as study subjects. Systematic clustering was used to analyze the pattern of multimorbidity among urban and rural elderly, and probit model was used to analyze the relevant factors associated with the risk of multimorbidity in order to provide suggestions for health management strategies.Results:There were similarities in the multimorbidity patterns of chronic diseases among the elderly in both urban and rural areas in China, including emotional and mental problems, Parkinson′s disease and malignant tumors such as cancer as a group of psychosomatic and neurodegenerative disease pattern, and stroke, asthma and liver disease as a group of inflammatory response disease pattern. However, there were differences, with dyslipidemia clustered as a separate group among the urban elderly, and memory-related diseases with diabetes or elevated blood glucose, chronic lung disease and kidney disease clustered as another group; and in rural elderly, gastric or digestive disorders were clustered with memory-related disorders, diabetes or elevated blood glucose, chronic lung disease, and kidney disease. Registered residence in rural areas ( Z=-0.530), and heavy physical activity (Z=-0.024) were negatively with the risk of multimorbidity. Age ( Z=0.037), alcohol consumption ( Z=0.037), smoking ( Z=0.042), depression score ( Z=0.130), and length of sleep ( Z=0.027) were positively correlated with the risk of multimorbidity (all P<0.05), with domicile location being the most strongly associated factor, and depression score being the second one. Conclusion:The pattern of chronic disease co-morbidity among the elderly in China differs between urban and rural areas. It is recommended that targeted chronic disease management strategies should be developed based on the characteristics of chronic disease co-morbidity among the elderly in urban and rural areas in China to improve the effectiveness of chronic disease co-morbidity prevention and management.

Objective:To analyze the co-morbidity patterns of chronic diseases among the elderly in China and provide suggestions for health management strategies.Methods:It was a cross-sectional study. A total of 9 383 respondents aged ≥60 years with complete data of key variables (chronic disease status, age, gender, marital status, etc.) in the 2020 China Health and Aged Care Tracking Survey (CHARLS) dataset were selected as study subjects. Systematic clustering was used to analyze the pattern of multimorbidity among urban and rural elderly, and probit model was used to analyze the relevant factors associated with the risk of multimorbidity in order to provide suggestions for health management strategies.Results:There were similarities in the multimorbidity patterns of chronic diseases among the elderly in both urban and rural areas in China, including emotional and mental problems, Parkinson′s disease and malignant tumors such as cancer as a group of psychosomatic and neurodegenerative disease pattern, and stroke, asthma and liver disease as a group of inflammatory response disease pattern. However, there were differences, with dyslipidemia clustered as a separate group among the urban elderly, and memory-related diseases with diabetes or elevated blood glucose, chronic lung disease and kidney disease clustered as another group; and in rural elderly, gastric or digestive disorders were clustered with memory-related disorders, diabetes or elevated blood glucose, chronic lung disease, and kidney disease. Registered residence in rural areas ( Z=-0.530), and heavy physical activity (Z=-0.024) were negatively with the risk of multimorbidity. Age ( Z=0.037), alcohol consumption ( Z=0.037), smoking ( Z=0.042), depression score ( Z=0.130), and length of sleep ( Z=0.027) were positively correlated with the risk of multimorbidity (all P<0.05), with domicile location being the most strongly associated factor, and depression score being the second one. Conclusion:The pattern of chronic disease co-morbidity among the elderly in China differs between urban and rural areas. It is recommended that targeted chronic disease management strategies should be developed based on the characteristics of chronic disease co-morbidity among the elderly in urban and rural areas in China to improve the effectiveness of chronic disease co-morbidity prevention and management.

Objective In order to explore the influence and effect of case teaching method based on real patients in oto-rhinolaryngology on clinical practice ability of general practice.Methods 96 trainees of general practice in otolaryngology de-partment from January 2018 to January 2021 were randomly divided into two groups:a CBL group and a control group.In the CBL group,CBL teaching method was adopted based on real patients in Otorhinolaryngology.Conventional teaching method was used in the control group.Results The theoretical scores of written test and the examination of clinical skill operation scores of the CBL group and the control group were analyzed.There was significant difference between the two groups(P＜0.05).The students in CBL group were more satisfied with clinical thinking ability,analysis and problem solving ability,active learning abil-ity,learning efficiency,teacher-student interaction,doctor-patient communication ability and consultation skills than the control group.There was significant difference between the two groups(P＜0.05).Conclusion The CBL teaching method can obvi-ously improve the learning enthusiasm and clinical practice ability of general resident training doctors.The teaching quality has been significantly improved.It is of great value to cultivate excellent general practitioners.

OBJECTIVE To construct an evaluation index system for the effectiveness of cough and wheeze pharmaceutical care clinic （CWPC） among asthma patients， and to provide assessment tools and a theoretical basis for improving the control level of asthma patients and standardizing pharmaceutical care. METHODS Literature analysis and semi-structured interviews were used to establish the evaluation index system for the effectiveness of CWPC among asthma patients. Delphi method was used to conduct two rounds of expert correspondence consultation， and the index weights were determined by the analytic hierarchy process. The reliability and validity of the constructed index system were analyzed by questionnaire. RESULTS Totally 29 experts from three disciplines of medicine， pharmacy and nursing were selected from the third-grade class A hospitals in Henan province. After two rounds of expert correspondence consultation， the effectiveness evaluation index system of CWPC asthma patients （including 9 sub- dimensions， such as lung function， symptoms； 35 measurement items， such as wheezing and respiratory rate） was finally determined from three core dimensions of structure level， function level and literacy management level， and the weight value of each dimension index was determined. The results of the reliability and validity analysis confirmed the scientific rationality of the index system. CONCLUSIONS The constructed CWPC effectiveness evaluation index system for asthma patients has a high degree of recognition， reliability and validity， and can be used as a measurement tool for the effectiveness evaluation of asthma patients.

Objective To investigate the effects of anti-HLA donor-specific antibodies(DSA)and desensitization for DSA+patients on engraftment of haploidentical hematopoietic stem cell transplantation(haplo-HSCT).Methods The patients who underwent haplo-HSCT and examinations for HLA antibodies and DSA in our department from March 2017 to July 2023 were recruited in this study.The effects of desensitization measure on engraftment in the DSA+patients after haplo-HSCT were analyzed.Results Among the 70 patients who underwent haplo-HSCT and test for HLA antibodies,15(21.4％)patients were DSA positive,including 7(46.7％)cases of strong positive,3(20.0％)cases of moderate positive,and 5(33.3％)cases of weak positive.The median duration for neutrophil implantation was significantly extended in the DSA+patients than the negative patients(P=0.027).For the 6 patients developed graft failure(GF),4 were DSA+which was statistically higher than the DSA-patients(P=0.025).Multivariate regression analysis showed that DSA was an independent factor affecting GF(HR=9.273,95％CI:1.505～57.124,P=0.016).Among the 10 patients(7 strong positive and 3 moderate positive DSA)received desensitization therapy,4 patients received combination desensitization,with a 100％rate of successful transplantation,and 6 received single desensitization,with 4(66.7％)experiencing GF,so the GF rate was obviously lower in the combination than the single desensitization(P=0.008).Conclusion In haplo-HSCT patients,DSA is an important factor leading to implantation delay and GF.While,single desensitization treatment has limited efficacy.In combined DSA desensitization therapy,the decrease of antibody titer should be dynamically monitored to ensure the successful implantation of stem cells and reduce GF rate.

Objective To describe the diagnosis,treatment,and clinical course of a patient with severe acute organophosphorus pesticide poisoning(AOPP)complicated by recurrent respiratory failure,intermediate syndrome(IMS),multiple organ dysfunction syndrome(MODS)and sepsis.Methods On May 8,2021,a patient who self-administered the pesticide Dimethoate AOPP was admitted to the department of internal medicine intensive care unit(MICU)of the First People's Hospital of Yunnan Province.After 29 days of treatment,the patient was successfully cured and discharged.The clinical diagnosis and treatment process was introduced.Results The 78-year-old male patient suffered from severe AOPP due to self-ingestion of the pesticide leptophos.Upon admission,he rapidly developed respiratory failure requiring urgent endotracheal intubation and mechanical ventilation support.A series of targeted treatments were administered,including the use of reactivators such as pralidoxime iodide,anticholinergic agents like atropine and scopolamine,as well as antibiotic therapy and management of water-electrolyte balance and acid-base equilibrium.Throughout his treatment,the patient experienced multiple complications,including episodes of sepsis,fluctuating cholinesterase levels,infections from multidrug-resistant bacteria,and recurrent respiratory failures.After 29 days of meticulous care,the patient was successfully weaned off the ventilator,regained normal organ function,and was discharged.Conclusion The analysis of this case highlights the importance of closely monitoring and managing drug dosage adjustments,preventing and treating infections,addressing septic shock,paying attention to the prevention and control of ventilator-associated pneumonia(VAP),conducting timely psychological evaluations,and providing interventions during the treatment process for AOPP.

Objective:To investigate the correlation between serum inflammatory cytokines and different characteristics of major depressive disorder.Methods:Serum inflammatory cytokines were detected by ELISA,compared differences of serum inflamma-tory cytokines in melancholy/underpowered depression(MPD)group,anxiety/somatization depression(ASD)group and healthy con-trol(HC)group.Spearman was used to analyze the correlation between inflammatory cytokines and HAMD-17 total score and each fac-tor score,independent risk factors for major depressive disorder with different characteristics were analyzed by binary Logistic regres-sion.Results:Compared with HC group and ASD group,serum IFN-α and IL-6 levels in MPD group were increased(P<0.05);level of serum TNF-α was negatively correlated with the score of cognitive impairment in MPD group(P<0.05),level of serum TNF-α was negatively correlated with the score of cognitive impairment in ASD group(P<0.05),and level of IL-6 was negatively correlated with the score of sleep disorder(P<0.05).Conclusion:Inflammatory cytokines are associated with symptoms of different characteristics of major depressive disorder;IFN-α,TNF-α,IL-6 and IL-10 are independent risk factors for melancholy/underpowered major depres-sive disorder,and IFN-α and IL-6 may serve as objective biomarkers to distinguish melancholy/underpowered from anxiety/somatiza-tion major depressive disorder.

Chronic obstructive pneumonia cancer transformation refers to the malignant transformation of long-term repeated chronic inflammation of the lung. Traditional Chinese Medicine believes that the etiology and pathogenesis of chronic obstructive pneumonia cancer transformation always belong to the deficiency of origin and excess of signs. Chronic obstructive pulmonary disease causes damage to the qi of the lung, spleen and kidney. Qi is yang, and qi deficiency leads to yang deficiency. Yang deficiency and abnormal warm would result in qi stagnation, phlegm coagulation and blood stasis. It is the key to the transformation of chronic obstructive pneumonia cancer. Kidney yang is the root of yang qi. Deficiency of kidney yang is the initiating factor for the transformation of chronic obstructive pneumonia cancer. Deficiency of lung yang is the fundamental factor for the transformation of chronic obstructive pneumonia cancer. Deficiency of kidney yang and deficiency of spleen yang are the driving factors for the transformation of chronic obstructive pneumonia cancer. Therefore, this article discussed the role of kidney yang in the transformation of chronic obstructive pneumonia cancer from the theory of "Qi Zhu Xu Zhi", in order to broaden the thinking of clinical diagnosis and treatment of the disease.

Objective:Cushing′s disease(CD) is caused by the pituitary adrenocorticotroph hormone(ACTH) secreting adenomas, leading to increased serum cortisol levels and various abnormal metabolic processes. Untreated CD is linked to high mortality, thus it is critical to elucidate its pathogenesis. This study aims to explore the pathogenesis of pituitary ACTH adenomas using whole-genome sequencing analysis.Methods:Fresh tumor tissues and peripheral blood samples were collected in 9 confirmed cases of pituitary ACTH adenomas who underwent surgery. Whole genome sequencing was then performed, followed by analysis and verification of single nucleotide mutations, copy number variation(CNV) and chromosome structure variations.Results:Somatic USP8 mutations(p.Ser718del, p. Ser718Pro, p. Pro720Arg, p. Pro720Gln) were found in 5 patients, with a rate of 55.6%; CNV of USP8 was detected in 1 patient; TP53(p.Cys135Tyr), NF1(p.Val1049Glufs*11) and KMT2C(c.3323+ 1G>A) mutations were identified in 1 patient harboring wild-type USP8. CNV analysis showed a loss of heterozygosity in multiple chromosomes in a wild-type USP8 patient. Structural variations were found in 2 with unknown significance. No germline gene mutations were detected in this study.Conclusion:Somatic USP8 mutations, increased copy number of USP8, variations of tumor-related genes such as TP53 and extensive somatic CNV all contribute to pathogenesis of CD. Chromosomal structure variations may suggest high-risk pituitary ACTH adenomas, and call for frequent follow-up and aggressive treatment.

Objective To evaluate the effect of transcutaneous neuromuscular electrical stimulation on prevention of intensive care unit-acquired weakness (ICU-AW) in chronic obstructive pulmonary disease (COPD) patients with mechanical ventilation. Methods A prospective randomized controlled study was conducted. Sixty COPD patients aged 18-85 years old who were accepted mechanical ventilation therapy admitted to general intensive care unit (ICU) of the First Affiliated Hospital of Hunan University of Medicine from October 2017 to October 2018 were enrolled. Patients were divided into control group (n = 30) and intervention group (n = 30) by random number table method. All patients were accepted routine treatment, and on this basis, the intervention group was applied transcutaneous neuromuscular electrical stimulation on the extremities (twice a day, 30 minutes each time) after 24 hours of admission until ICU discharge. The Medical Research Council muscle strength score (MRC-Score), grip strength, incidence of ICU-AW on the 7th day after admission and on the day of ICU discharge; modified Barthel index score on the day of ICU discharge; and duration of mechanical ventilation, the length of ICU stay, and the length of hospital stay were compared between the two groups. Results Twenty-nine and 27 patients in the control group and the intervention group respectively finally completed the study in dividually. There was no significant difference in gender, age, Barthel index score before 2 weeks of ICU admission, body mass index or acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) in ICU between the two groups. There was no significant difference in the MRC-Score, grip strength or incidence of ICU-AW on the 7th day after ICU admission between the two groups. Compared to the control group, the MRC-Score, grip strength and Barthel index score in the intervention group were significantly increased [MRC-Score: 55.97±8.43 vs. 46.32±7.36, grip strength (kg): 33.46±11.62 vs. 27.42±9.64, Barthel index score:46.04±5.46 vs. 42.13±3.32, all P < 0.05], the incidence rate of ICU-AW was significantly decreased [7.4% (2/27) vs. 31.0% (9/29), P < 0.05], and duration of mechanical ventilation, the length of ICU stay, the length of hospital stay were significantly shortened [duration of mechanical ventilation (days): 5.12±2.01 vs. 7.24±4.35, the length of ICU stay (days): 8.34±2.36 vs. 10.45±2.62, the length of hospital stay (days): 13.21±2.21 vs. 15.38±3.67, all P < 0.05]. Conclusion Transcutaneous neuromuscular electrical stimulation can effectively improve the muscle strength of COPD patients with mechanical ventilation and reduce the incidence of ICU-AW.