Comorbidities will be a challenge faced by both Chinese and Western medicine in the future.The coexistence of multiple diseases logically begins with a holistic view of life that integrates form,qi,and spirit,and a holistic view of disease that integrates dis-ease and syndrome.From a Chinese medicine perspective,the core pathogenesis of comorbidities involves the interaction between ab-normal qi transformation and physical damage.The key to treatment lies in restoring the disordered state of qi.The basis for formula se-lection is the formula-syndrome.The therapeutic goal of the formula-syndrome is not a specific disease,but rather a holistic differenti-ation and treatment of the entire body.The"formula-disease-person"diagnosis and treatment model for treating comorbidities is a model for innovative theoretical guidance in clinical practice.It offers three approaches to diagnosing and treating comorbidities:formu-la-disease correspondence,formula-person correspondence,and formula-disease and formula-person correspondence,which provides a more original perspective and broader thinking for the study of comorbidity.

Comorbidities will be a challenge faced by both Chinese and Western medicine in the future.The coexistence of multiple diseases logically begins with a holistic view of life that integrates form,qi,and spirit,and a holistic view of disease that integrates dis-ease and syndrome.From a Chinese medicine perspective,the core pathogenesis of comorbidities involves the interaction between ab-normal qi transformation and physical damage.The key to treatment lies in restoring the disordered state of qi.The basis for formula se-lection is the formula-syndrome.The therapeutic goal of the formula-syndrome is not a specific disease,but rather a holistic differenti-ation and treatment of the entire body.The"formula-disease-person"diagnosis and treatment model for treating comorbidities is a model for innovative theoretical guidance in clinical practice.It offers three approaches to diagnosing and treating comorbidities:formu-la-disease correspondence,formula-person correspondence,and formula-disease and formula-person correspondence,which provides a more original perspective and broader thinking for the study of comorbidity.

In response to the major national strategic needs of "Healthy China" and "Chengdu-Chongqing Economic Circle", and in strict accordance with the requirements of "New Medicine" construction, Chongqing University builds the medical discipline with a high starting point, develops high-quality medical education, and promotes the exploration and practice of elite education of clinical medical talents in the cross-disciplinary context of medicine and engineering. From the perspective of SWOT, this study analyzed the situations and trends of clinical medical education in "Double First Class" universities which newly established the medical discipline. Combined with the training model of clinical talent class in Chongqing University and the practices of "Four Capacity-Buildings", "Four Integration-Measures", and "Three Optimization-Mechanisms", we discuss the thoughts and strategies of cultivating clinical medical talents in the background of "New Medicine" construction and in the cross-disciplinary context of medicine and engineering.

To explore the connotation of the holistic view of"formula-disease-person"diagnosis and treatment model of Professor Huang Huang from the aspects of construction process,thinking dimension,clinical practice,etc.It's believed that"formula-dis-ease-person"diagnosis and treatment model is based on the holistic view of"unity of form and spirit",and contains a wealth of consti-tution epistemology based on the holism of"form-qi-spirit",which has the characteristics of three-dimensional,scene character and embodiment.From the perspective of therapeutics,two key points are derived,namely"correspondence between formula and person"and"correspondence between formula and disease",which embodies the systematic and holistic thinking of"constitution differentia-tion,disease differentiation,syndrome differentiation,pathogenesis differentiation",emphasizes the unity of formula-person,formula-disease,formula-syndrome and formula-pathogenesis,and is the embodiment of the idea of combining disease and syndrome.The"formula-disease-person"diagnosis and treatment model combines the formula-syndrome view of"diagnosis-identification"and the treatment view of constitution differentiation-disease differentiation and incorporates a holistic view throughout the entire process of dis-ease diagnosis and treatment,which has guiding significance for the treatment of chronic diseases and difficult diseases.

Objective:To investigate the correlation of the expressions of programmed death ligand 1 (PD-L1) and interleukin-10 (IL-10) with the prognosis in uterine cervical cancer tissues.Methods:A total of 82 patients with uterine cervical cancer hospitalized at Nantong Maternal and Child Health Hospital from January 2015 to December 2019 were retrospectively analyzed, and the clinicopathological data of all patients were collected and sorted out. Immunohistochemical method was used to detect the positive expression of PD-L1 protein in cancer tissues, and Western blot was used to detect the expression level of IL-10 protein in cancer tissues. The survival of all patients for 24-month follow-up was recorded and 82 patients were divided into the survival group and the death group. The clinicopathological characteristics and the expressions of PD-L1 and IL-10 in both groups were compared. Multivariate Cox proportional risk model was used to analyze the factors affecting the survival of patients with uterine cervical cancer. The value of PD-L1 and IL-10 expressions predicting the survival in uterine cervical cancer was evaluated by using receiver operating characteristic (ROC) curve. The best cut-off value of IL-10 relative expression in cancer tissues obtained from ROC curve analysis predicting 24-month survival of patients was used to group; ≥ the best cut-off value was treated as IL-10 high expression group, and < the best cut-off value was treated as IL-10 low expression group. Kaplan-Meier method was used to compare the survival of PD-L1 positive and negative groups, IL-10 high and low expression groups.Results:There was no loss of follow-up in 82 patients during 24-month follow-up, of which 11 cases (13.4%) died and 71 cases (86.6%) survived. The proportion of patients with Federation International of Gynecology and Obstetrics (FIGO) staging Ⅲ-Ⅳ, poor differentiation, tumor long diameter > 4 cm and lymph node metastasis in the death group was higher than that of those in the survival group (all P < 0.05). PD-L1 was positive in 9 of 11 patients in the death group and 11 of 71 patients in the survival group ( P < 0.001). The relative expression level of IL-10 protein in the death group was higher than that in the survival group (1.18±0.32 vs. 0.89±0.21, P < 0.001). Multivariate Cox regression analysis showed that FIGO staging, tissue differentiation degree, tumor long diameter, whether lymph node had metastasis or not, whether PD-L1 was positive and the relative expression level of IL-10 protein were independent factors affecting patients' 24-month survival (all P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of PD-L1 and IL-10 single and the combination of both predicting 24-month survival in cancer tissues was 0.748 (95% CI 0.664-0.894), 0.710 (95% CI 0.655-0.884) and 0.839 (95% CI 0.742-0.951), respectively. There were 20 cases in PD-L1-positive group and 62 cases in PD-L1-negative group. The best cut-off value of relative expression level of IL-10 protein was 7.12. There were 19 cases in IL-10 high expression group and 63 cases in IL-10 low expression group. The overall survival of patients in PD-L1-positive group was worse than that in PD-L1-negative group (24-month overall survival rate: 55.0% vs. 96.8%, P = 0.001). The overall survival of patients in IL-10 high expression group was worse than that in IL-10 low expression group (24-month overall survival rate: 57.9% vs. 95.2%, P = 0.001). Conclusions:The prognosis of patients with positive PD-L1 and IL-10 high expressions in uterine cervical cancer tissues is poor. The combined detection of PD-L1 and IL-10 has a high predictive effect on the prognosis.

Objective To observe the level of imprinting gene p57kip2 and p27kip1 expression in different hydatidiform moles.To investigate the value of combined detection of p57kip2 and p27kip1 in diagnosis and differential diagnosis of hydatidiform moles.Methods We examined the immunohistochemical staining of p57kip2 and p27kip1 in 30 cases of complete hydatidiform moles and 86 cases of partial hydatidiform moles and 30 cases normal placenta,and also analyze the differences and correlation between the two genes of p57kip2 and p27kip1 in two different patterns of hydatidiform moles.Results The rate of expression of p57kip2 and p27kip1 in complete hydatidiform moles was obviously lower than that in partial hydatidiform moles and nor-mal placenta.There were significant differences in the expression of p57kip2 and p27kip1 among complete hy-datidiform moles,partial hydatidiform moles and normal placenta(P<0.05).p57kip2 had positive correlation with p27kip1 in complete hydatidiform moles(r=0.750,P<0.01),meanwhile there was negative correlation between p57kip2 and p27kip1 in partial hydatidiform moles(r= -1.000,P<0.01).Conclusion The differen-tial expression of p57kip2 and p27kip1 in complete hydatidiform moles and partial hydatidiform moles can be of certain value in the differential diagnosis of hydatidiform moles.Meanwhile,the combined methed is useful to the identification and classification of hydatidiform moles.

Objective To analyze plasma vitamin E and CoQ10 levels in patients with autosomal recessive cerebellar ataxia for finding the evidence of the related pathogenesis research and therapeutic strategies.Methods The plasma vitamin E and CoQ10 levels were detected by high performance liquid chromatography (HPLC) with diode array detector in 123 probands of autosomal recessive cerebellar ataxia pedigrees.Quantitation was performed using vitamin E and CoQ10 external standard and two 5-point calibration curve;clinical manifestations were analyzed simuhaneously.Results Vitamin E and CoQ10 levels of healthy subjects in the plasma were (8.77 ± 2.28) μg/ml and (1.31 ± 0.38) μg/ml,respectively;the plasma vitamin E and CoQ10 levels of patients were (5.61 ± 2.04) μg/ml and (0.79 ± 0.26) μg/ml,respectively,which were significantly lower than those in healthy controls (t =11.87,13.15;all P＜ 0.01).Clinical manifestations were characterized by cerebellar symptoms,and gait instability was usually the first recognized abnormality.Most of early onset occurred before the age of 25 years (111/123);dysarthria and abnormal eye movement were observed,with cerebellar atrophy on MRI;concomitant symptoms were also present.Conclusions HPLC analysis shows that the plasma vitamin E and CoQ10 levels of patients with autosomal recessive cerebellar ataxia are generally lower than those in the healthy controls.Several patients with significant reductions in these two levels have genetic defects.The combination of clinical phenotypes,biochemical indexes and genetic analyses will be helpful for the establishment of diagnosis and specific treatment.

Objective To investigate the inheritance principle of the expanded GAG repeat allele and the clinical features of spinocerebellar ataxias 3 (SCA3) in a consanguinity family with first cousin marriage.Methods The CAG repeats of SCA3 gene were amplified by means of polymerase chain reaction.Fragment analysis with laser-induced fluorescence in capillary electrophoresis were performed for the positive samples detected by agarose gel electrophoresis.Furthermore,the clinical features were analyzed carefully.Results Fragment analysis revealed that the proband carried 2 alleles with 56 and 72 CAG repeats separately.The proband' s father carried 28 and 66,and the expanded CAG repeat allele inherited from his grandfather.The proband' s mother carried 33 and 56,and the expanded CAG repeat allele inherited from his grandmother.The proband' s son carried 27 and 85 and presented with dystonia besides ataxia.Conclusions The proband' s parents have the common ancestors.Their alleles with expanded CAG repeats probably come from the same allele of their ancestor.The GAG repeat is more unstable in the paternal inheritance than in the maternal inheritance.The 71-year-old asymptomatic family member carry the allele with 56 CAG repeats,which indicates the 56 CAG repeats may be not associated with the disease.The patients within this family have variable clinical features,especially the juvenile-onset case presents with apparent dystonia.

Objective To investigate the clinical features and genetic mutations of spinocerebellar ataxia type 17 (SCA17).Methods The pathological CAG triplet repeat expansions of the SCA3,SCA1,SCA2,SCA6,SCA7,SCA8,SCA12,SCA17 and dentatorubral pallidoluysian atrophy genes were analyzed in 708 probands of autosomal dominant familial SCA and 1 19 sporadic SCA cases.The CAG repeats of TATA-binding protein (TBP) gene were amplified by means of polymerase chain reaction and agarose gel electrophoresis.For the samples with two alleles,fragment analysis based on CEQ8000 sequencer was applied to analyze the CAG repeat numbers.Furthermore,the correlation between clinical features and CAG repeat in the TBP gene was studied carefully.Results The expanded CAG repeats in the TBP gene was detected in 5 cases with 37/50,36/45,38/52,38/53,36/54 separately.And the main clinical manifestations were ataxia and memory impairment.Conclusion These findings indicate that SCA17 might be a rare subtype of SCA in the Chinese population and the clinical features of SCA17 cover a wider spectrum than previously reviewed.

Objective Mitochondrial transfer RNA for leucine 1(MTTL1)is one of the most important causative genes of oxidative phosphorylation disorders.To understand the clinical,pathological and molecular genetics features of the disordel's caused by MTTL1 mutation.18 patients with a causative mutation in MTTL1 were analyzed.Methods The clinical features,the findings of tlleir biochemistry tests.the neuroimagings,the pathology of biopsied muscles and hereditary characteristics were retrospectively summarized.Results The mutations mt3243A>G and mt3271A>T within MTTL1 gene led to variant syndrome,encephalomyopathies with lactic acidosis and stroke like episodes,diabetes mellitus,progressive external ophthalmoplegia,leish syndrome and complex mitochondrial syndrome were reported.Usually,most patients were sporadic but maternal transmission was the common inherited model.Conclusion The disorders caused by the MTTL1 mutation are hishly phenotypic vailable.There is no association between phenotype and heteroplasmy in muscle.