With the trend of population aging, the number of patients with comorbidities is increasing, who are the main subjects of general practice service in general hospitals. Tongji Hospital created a new service model and opened a multidisciplinary outpatient clinic based on general practice department (MDT general practic clinic) for patients with comorbidities in December 2021, which has improved the clinical outcomes, and the medical experience and satisfaction of patients. This article elaborates on the organizational structure, team building, and operational process of the MDT general practice clinic for comorbidities; analyzes the characteristics of patients and the implementation effects, to provide a reference for comorbidity patient service in general hospitals.

With the trend of population aging, the number of patients with comorbidities is increasing, who are the main subjects of general practice service in general hospitals. Tongji Hospital created a new service model and opened a multidisciplinary outpatient clinic based on general practice department (MDT general practic clinic) for patients with comorbidities in December 2021, which has improved the clinical outcomes, and the medical experience and satisfaction of patients. This article elaborates on the organizational structure, team building, and operational process of the MDT general practice clinic for comorbidities; analyzes the characteristics of patients and the implementation effects, to provide a reference for comorbidity patient service in general hospitals.

Objective:To investigate the effects of salt induced kinase 1(SIK1)in the effects of aerobic exercise on neu-roinflammatory response and spatial learning and memory function in aging mice. Method:Fifty-four male C57BL/6 mice were divided into three groups:the young group(group C,n=18),the aging control group(group A,n=18),and the aging exercise group(group E,n=18).Mice in groups C and A were fed naturally,while the mice in group E were subjected to aerobic treadmill exercise intervention for 8 weeks.Morris water maze training and testing were used to evaluate mice's spatial learning and memory abili-ties.Transcriptome sequencing was used to screen the differential genes.Immunofluorescence was used to detect the fluorescence intensity of ionized calcium-binding adaptor molecule 1(Iba-1).The mRNA and protein expres-sion levels of SIK1,nuclear factor kappa-B(NF-κB)and interleukin 1β(IL-1β)were detected by real-time PCR and Western Blot. Result:The mean escape latency was prolonged and the number of crossings of the original platform was re-duced(P＜0.01)for learning and memory function-related indicators in aging mice;hippocampal neurons were significantly disrupted and microglia(MG)activation-related gene Iba-1 fluorescence intensity was increased(P＜0.01);transcriptome levels were disturbed,with 175 genes upregulated and 66 genes were downregulated;inflammation-related genes SIK1,NF-κB mRNA(P＜0.05,P＜0.01)and protein(P＜0.01,P＜0.01)expression was elevated and IL-1β mRNA expression was increased(P＜0.05).After exercise intervention,the mean es-cape latency was reduced and the number of crossing the original platform was increased in aging mice(P＜0.01),attenuated neuronal damage,reduced Iba-1 fluorescence intensity(P＜0.01),upregulation of 19 genes,downregulation of 12 genes,reduced expression of SIK1,NF-κB mRNA(P＜0.01,P＜0.05)and protein(P＜0.05,P＜0.05),and IL-1β protein expression was reduced(P＜0.05). Conclusion:Eight weeks of aerobic exercise can reduce the expression of hippocampal SIK1 and its down-stream NF-κB and IL-1β in aging mice,inhibit MG activation,reduce neuroinflammation,and ultimately im-prove spatial learning and memory function.

Objective　To evaluate the status and prognosis of multimodal neuroimaging screening before endovascular therapy in patients with symptomatic intracranial atherosclerotic disease(sICAD) in the real world.Methods　Patients with sICAD,who were hospitalized in our hospital from January 2016 to May 2019,were enrolled in the study retrospectively.The admission criteria was:proximal lesions of anterior circulation artery,stenosis rate ≥70%,baseline NIHSS score ≤20,standard medical therapy within 2 weeks after the onset or angioplasty within 3 months after the onset.The application of multimodal neuroimaging technology before endovascular therapy in the real world was studied,the gap between the current situation and the guidelines of endovascular therapy screening was analyzed.The clinical prognosis of DWI combined with traditional angiographic screening in patients with watershed infarction was evaluated.The clinical and safety outcomes of the patients were followed up and compared with those of the patients treated with standard drugs.Results　In this study,all patients received structural imaging examinations such as NCCT/DWI/FLAIR and vascular imaging examinations such as TCD/MRA;Only 5.3% of the 38 endovascular patients received perfusion imaging such as ASL or CTP before surgery.Compared with patients in the standard medical therapy group,the recurrence rate of stroke in the endovascular therapy group were significantly reduced at 6 months and 1 year (P=0.045;P=0.011),and there was no significant difference in intracranial hemorrhage and all-cause mortality between the two groups (P>0.05).Among the watershed infarcts selected by DWI,the 1-year recurrence rate in the endovascular therapy group was significantly lower than that in the standard medical treatment group (P=0.035).The recurrence rate of patients with non-watershed infarcts treated with the two methods was similar (P>0.05).Conclusion　The preoperative evaluation of cerebral perfusion in patients with endovascular therapy is not optimal;DWI combined with traditional angiographic examination can clarify the watershed infarct and local cerebral perfusion,and replace perfusion imaging as an indication screening method for endovascular therapy.