With the progress of society and the continuous improvement of people′s living standards in China, the public′s demand for medical services is becoming increasingly diversified. How to move hospital services forward and improve medical services centered on patients has become a key consideration for hospitals to enhance patients′ sense of medical satisfaction. A certain hospital has established a one-stop patient service hotline, integrating functions such as number inquiry, medical consultation, appointment registration, appointment examination, praise and suggestions, complaint follow-up, etc., injecting a complaint handling management mode, and responding to and solving patient feedback problems in a timely manner. Since the launch of the patient service hotline, it has effectively solved the problems that patients encountered during their visits, effectively reduced the hospital′s complaint rate, and initially formed a service closed-loop management. From March to October 2023, the demand ratio of the 12345 hotline in the hospital has continuously decreased, and was significantly lower than the average level of 22 municipal hospitals in Beijing. In the future, we should further improve the communication skills between doctors and patients, focus on managing appeals and services, and continue to strengthen proactive governance.

Objective To investigate the effect of the long non-coding RNA FGD5 antisense RNA1(lncRNA FGD5-AS1)on myocar-dial cell injury induced by high glucose levels through regulation of the miR-195-5p/Pim-1 proto-oncogene(PIM1)axis.Methods The rat myocardial cell line H9c2 and human myocardial cells were randomly allocated to the control,model,lncRNA FGD5-AS1 overex-pression,miR-195-5p inhibitor,negative control,and lncRNA FGD5-AS1 overexpression+miR-195-5p mimic groups to determine the expression of lncRNA FGD5-AS1,miR-195-5p,and PIM1.In addition,cell proliferation,apoptosis,and pro-inflammatory cytokine levels of the cells in each group were analyzed.Results Compared with the control group,the protein and mRNA expressions of lncRNA FGD5-AS1 and PIM1 and the survival and proliferation rates in H9c2 and human myocardial cells in the model group decreased(P<0.05),and the expression of miR-195-5p,apoptosis rate,and production levels of tumor necrosis factorα(TNF-α)and interleukin-6(IL-6)increased(P<0.05).Overexpression of the lncRNA FGD5-AS1 reversed these pathological changes in model group cells,whereas upregulation of miR-195-5p could weaken the effects of overexpression of lncRNA FGD5-AS1.Conclusion Overexpression of lncRNA FGD5-AS1 enhances the expression of PIM1 by downregulating miR-195-5p,thereby inhibiting high glucose-induced myocyte inflamma-tion,promoting survival and growth,and alleviating apoptotic injury.

Objective:To investigate the risk factors of the occurrence of overt hepatic encephalopathy (OHE) in patients with liver cirrhosis and the effect of proton pump inhibitor (PPI) on OHE.Methods:This study was led by the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) and Shanghai East Hospital of Tongji University School of Medicine, and a total of 13 hospitals participated. From July 31, 2020 to December 10, 2021, a total of 184 liver cirrhosis patients without prior OHE and with ≥2-year follow-up from the above 2 leading hospitals, and other hospitals such as Guangzhou Eighth People′s Hospital of Guangzhou Medical University and Affiliated Hospital of Zunyi Medical University were enrolled. According to whether OHE occurred during the 2-year follow-up period, the 184 patients were divided into OHE group (22 cases) and non-OHE group (162 cases). The clinical data of all the patients were collected, including the laboratory parameters such as international normalized ratio (INR), the usage of PPI, the occurrence of gastrointestinal bleeding, infection, liver cancer and other complications, and survival status. Multivariate logistic regression model was used to analyze the independent risk factors for OHE in patients with liver cirrhosis. Kaplan-Meier survival curve was performed to analyze the effect of PPI on the survival rate of patients with liver cirrhosis. Chi-square test and Cochran-Mantel-Haenszel test were used for statistical analysis.Results:The result of multivariate logistic regression analysis showed that INR ( OR=11.331, 95% confidence interval (95% CI) 2.415 to 53.156, P =0.002) and PPI ( OR=6.794, 95% CI 2.359 to 19.567, P<0.001) were independent risk factors for OHE in patients with liver cirrhosis. The rate of PPI usage of the OHE group was higher than that of the non-OHE group (72.7%, 16/22 vs. 30.9%, 50/162), and the difference was statistically significant ( χ2=14.76, P<0.001). After the patients with gastrointestinal bleeding, infection and liver diseases-related deaths were excluded respectively, the rates of PPI usage of the OHE group were still higher than that of the non-OHE group (8/12 vs. 21.3%, 27/127; 11/16 vs. 25.0%, 35/140; 12/15 vs. 29.0%, 45/155), and the differences were all statistically significant ( χ2=9.71, 11.20 and 15.94; all P<0.01). Kaplan-Meier survival curve analysis showed that the 2-year cumulative survival rate of liver cirrhosis patients with PPI usage was lower than that of the patients without PPI usage (86.4%, 57/66 vs. 95.8%, 113/118), and the difference was statistically significant ( χ2=5.37, P =0.020). Conclusion:PPI is an independent risk factor for OHE in patients with liver cirrhosis, and may increase the risk of liver disease-related death.

Objective:To summarize the experience of assisted pregnancy through preimplantation genetic testing for monogenic diseases (PGT-M) in a Norrie disease family where the female has undifferentiated connective tissue disease and thrombosis.Methods:This article mainly reported the clinical process for a patient with a heterozygous deletion in exon 2 of the NDP gene combined with undifferentiated connective tissue disease and thrombosis, which was conducted through a multidisciplinary diagnostic and therapeutic process involving reproductive genetics, reproductive medicine, ophthalmology, rheumatology, and obstetrics. The stages of treatment included family pedigree construction, controlled ovarian hyperstimulation, embryo testing, frozen-thawed embryo transfer, amniocentesis, as well as antenatal and perinatal monitoring. Results:The patient successfully conceived and gave birth to a healthy baby girl at full term.Conclusion:Through multidisciplinary management, we successfully helped the couple achieve a healthy offspring with one PGT-M cycle, thus relieved their psychological and physiological burden.

Objective:To summarize the experience of assisted pregnancy through preimplantation genetic testing for monogenic diseases (PGT-M) in a Norrie disease family where the female has undifferentiated connective tissue disease and thrombosis.Methods:This article mainly reported the clinical process for a patient with a heterozygous deletion in exon 2 of the NDP gene combined with undifferentiated connective tissue disease and thrombosis, which was conducted through a multidisciplinary diagnostic and therapeutic process involving reproductive genetics, reproductive medicine, ophthalmology, rheumatology, and obstetrics. The stages of treatment included family pedigree construction, controlled ovarian hyperstimulation, embryo testing, frozen-thawed embryo transfer, amniocentesis, as well as antenatal and perinatal monitoring. Results:The patient successfully conceived and gave birth to a healthy baby girl at full term.Conclusion:Through multidisciplinary management, we successfully helped the couple achieve a healthy offspring with one PGT-M cycle, thus relieved their psychological and physiological burden.

Objective:To investigate the risk factors of the occurrence of overt hepatic encephalopathy (OHE) in patients with liver cirrhosis and the effect of proton pump inhibitor (PPI) on OHE.Methods:This study was led by the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) and Shanghai East Hospital of Tongji University School of Medicine, and a total of 13 hospitals participated. From July 31, 2020 to December 10, 2021, a total of 184 liver cirrhosis patients without prior OHE and with ≥2-year follow-up from the above 2 leading hospitals, and other hospitals such as Guangzhou Eighth People′s Hospital of Guangzhou Medical University and Affiliated Hospital of Zunyi Medical University were enrolled. According to whether OHE occurred during the 2-year follow-up period, the 184 patients were divided into OHE group (22 cases) and non-OHE group (162 cases). The clinical data of all the patients were collected, including the laboratory parameters such as international normalized ratio (INR), the usage of PPI, the occurrence of gastrointestinal bleeding, infection, liver cancer and other complications, and survival status. Multivariate logistic regression model was used to analyze the independent risk factors for OHE in patients with liver cirrhosis. Kaplan-Meier survival curve was performed to analyze the effect of PPI on the survival rate of patients with liver cirrhosis. Chi-square test and Cochran-Mantel-Haenszel test were used for statistical analysis.Results:The result of multivariate logistic regression analysis showed that INR ( OR=11.331, 95% confidence interval (95% CI) 2.415 to 53.156, P =0.002) and PPI ( OR=6.794, 95% CI 2.359 to 19.567, P<0.001) were independent risk factors for OHE in patients with liver cirrhosis. The rate of PPI usage of the OHE group was higher than that of the non-OHE group (72.7%, 16/22 vs. 30.9%, 50/162), and the difference was statistically significant ( χ2=14.76, P<0.001). After the patients with gastrointestinal bleeding, infection and liver diseases-related deaths were excluded respectively, the rates of PPI usage of the OHE group were still higher than that of the non-OHE group (8/12 vs. 21.3%, 27/127; 11/16 vs. 25.0%, 35/140; 12/15 vs. 29.0%, 45/155), and the differences were all statistically significant ( χ2=9.71, 11.20 and 15.94; all P<0.01). Kaplan-Meier survival curve analysis showed that the 2-year cumulative survival rate of liver cirrhosis patients with PPI usage was lower than that of the patients without PPI usage (86.4%, 57/66 vs. 95.8%, 113/118), and the difference was statistically significant ( χ2=5.37, P =0.020). Conclusion:PPI is an independent risk factor for OHE in patients with liver cirrhosis, and may increase the risk of liver disease-related death.

Objective:To investigate the prevalence of the decline of intrinsic capacity(IC)and to explore the effect of intrinsic capacity decline on falls and hospital readmission during 1 year follow-up.Methods:A total of 311 elderly patients treated in Geriatrics Department of Zhejiang Hospital were enrolled.General information and intrinsic ability data, including cognitive(simple mental state inventory), motor(Tinetti-Balance Scale and 4 m test), vitality(grip strength and mini-nutrition assessment table), perception(self-rated vision or hearing impairment), and psychosocial(Geriatric depression scale), were collected at admission.Falls and hospital readmission within 1 year after discharge were followed up.Multivariate Logistic regression analysis was used to investigate the relationship of baseline intrinsic ability at admission with falls and hospital readmission during 1-year follow-up.Results:Of 311 elderly hospitalized patients, 282(90.7%)had intrinsic capacity decline.During 1 year follow-up, 38 elderly patients(12.2%)had falls and 69 elderly patients(22.2%)were hospital readmitted.After adjusting for confounding factors such as age, gender, education level, comorbidities, multiple medications, fear of falling, and assistive tool use and so on, Logistic regression analysis showed that decreased balance ability was a risk factor for falls within 1 year in elderly patients( OR=3.515, 95% CI: 1.089-11.346, P=0.036), and slow walking speed was a risk factor for one-year hospital readmission( OR=2.426, 95% CI: 1.181-4.983, P=0.016). Conclusions:Decreased motor capacity is closely associated with falls and hospital readmission within 1 year in older patients.Great attention should be paid to the assessment and intervention of motor ability in elderly patients.

Objective:To investigate the risk factors of overt hepatic encephalopathy (OHE) in patients with liver cirrhosis, and to clarify the effect of sarcopenia on OHE.Methods:Based on the liver cirrhosis cohort established by our research group, from January 1, 2013 to December 31, 2017, 480 patients diagnosed with liver cirrhosis and underwent upper abdominal computed tomography were selected from 3 centers, including the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai East Hospital Affiliated to Tongji University, and Shandong Provincial Hospital. The L3 skeletal muscle index (L3-SMI) <44.77 cm 2/m 2 for males and L3-SMI <32.50 cm 2/m 2 for females were used as the diagnostic criterion for sarcopenia. The clinical data of all the patients were collected, including baseline medical history, age, serum total bilirubin, serum levels of aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT), albumin, sodium, prothrombin time (PT), international normalized ratio (INR), hemoglobin, platelet count, etc, as well as Child-Pugh classification of liver function, and model for end-stage liver disease (MELD) score. Independent sample t test, rank sum test, and chi-square test were used for statistical analysis. Binary logistic regression analysis was used to analyze the independent risk factors for OHE in patients with liver cirrhosis, and Kaplan-Meier method was used to analyze the effect of sarcopenia on the incidence of OHE in patients with liver cirrhosis. Results:After 2 years of follow-up, the incidence of OHE was 16.2% (78/480). The age, serum total bilirubin level, AST, GGT, PT, INR, Child-Pugh score, and MELD score of OHE patients were all higher than those of non-OHE patients ((59.67±10.30) years old vs. (53.41±12.06) years old, 35.25 μmol/L(20.10 μmol/L, 60.53 μmol/L) vs. 22.70 μmol/L(15.10 μmol/L, 35.20 μmol/L), 40.00 U/L(27.25 U/L, 61.00 U/L) vs. 33.00 U/L(24.75 U/L, 47.00 U/L), 52.50 U/L(26.25 U/L, 86.75 U/L) vs. 34.50 U/L(22.00 U/L, 73.00 U/L), (17.71±3.52) s vs. (15.50±2.98) s, 1.50±0.34 vs. 1.31±0.29, 8.95±2.19 vs.7.20±1.94, 13.56±4.42 vs.11.42±3.92), while serum albumin, serum sodium and platelet count of OHE patients were all lower than those of non-OHE patients ((29.72±5.55) g/L vs. (33.19±5.89) g/L, 139.00 mmol/L(136.00 mmol/L, 142.00 mmol/L)vs.140.00 mmol/L (138.00 mmol/L, 142.00 mmol/L), 60.00×10 9/L(43.75×10 9/L, 90.25×10 9/L) vs. 80.00×10 9/L(56.00×10 9/L, 131.00×10 9/L)), and the differences were statistically significant ( t=-4.77; Z=-4.10, -3.13, -2.24; t=-5.19, -4.71, -6.57, -3.98, 4.99; and Z=2.44 and 3.48; all P<0.05). The proportions of ascites, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis at baseline, and the incidence of sarcopenia in OHE patients were all higher than those in non-OHE patients (82.1%, 64/78 vs. 63.7%, 256/402; 41.0%, 32/78 vs. 3.5%, 14/402; 5.1%, 4/78 vs. 1.0%, 4/402; 14.1%, 11/78 vs. 2.5%, 10/402; 37.2%, 29/78 vs. 19.7%, 79/402), and the L3-SMI of OHE patients was lower than that of non-OHE patients ((43.14±8.97) cm 2/m 2 vs. (46.29±8.49) cm 2/m 2), and the differences were statistically significant ( χ2=9.11, 101.97, 4.52, 18.38, 10.53; t=2.86; all P<0.05). The results of binary logistic regression analysis indicated that platelet count ( OR=0.995, 95% confidence interval (95% CI) 0.991 to 1.000, P=0.038), L3-SMI ( OR=0.959, 95% CI 0.922 to 0.997, P=0.035) and hepatic encephalopathy ( OR=14.724, 95% CI 6.741 to 32.161, P<0.001) were independent influencing factors for OHE in patients with liver cirrhosis. The incidence of OHE in patients with sarcopenia was higher than that of patients without sarcopenia (26.9%, 29/108 vs. 13.2%, 49/372), and the difference was statistically significant ( χ2=10.53, P=0.001). The results of Kaplan-Meier analysis demonstrated that patients with sarcopenia were more likely to develop OHE ( P<0.001). Conclusion:Sarcopenia is closely correlated to OHE and is an independent predictor of OHE in patients with liver cirrhosis.

OBJECTIVE：To study the ef fects of Gegen qinlian decoction （GGQLD）on blood lipid and blood glucose of hyperlipidemia（HLP）model rats ，and to explore its mechanism from the perspective of intestinal flora. METHODS ：Totally 48 rats were randomly divided into blank control group （n＝8）and modeling group （n＝40）. For consecutive 5 weeks，model group was given high-lipid diet to induce HLP model ；blank control group was given routine diet. After modeling ，30 modeling rats were randomly divided into model group ，simvastatin group （positive control ，10 mg/kg），GGQLD high-dose ，medium-dose and low-dose groups （14.85，4.95，1.65 g/kg，by crude drug ），with 6 rats in each group. Blank control group and model group were given constant volume of normal saline intragastrically ；administration groups were given relevant medicine intragastrically ，once a day，for consecutive 11 weeks. At the same time ，each group was continuously given corresponding diet. After the last medication ， body mass and body length of rats were determined ，and Lee ’s index was calculated. Serum levels of TG ，TC，HDL-C，LDL-C and fasting blood glucose （FBG）were determined in rats. DNA of rat caecum content was extracted for 16S rRNA V 3-V4 region sequencing. The Two-part model was used to analyze the correlation between intestinal flora with lipids and blood glucose. RESULTS：After 11 weeks of administration ，compared with blank control group ，the body mass ，body length ，Lee’s index ， serum levels of TC ，TG，HDL-C and FBG of model group were increased significantly （P＜0.05 or P＜0.01），while the level of HDL-C was decreased significantly （P＜0.05）. Compared with model group ，body mass and Lee ’s index and serum levels of TG ， FBG of rats in GGQLD high-dose group ，and serum levels of TC ，TG in GGQLD medium-dose group ，as well as serum level of TG of rats in GGQLD low-dose group was decreased significantly （P＜0.05 or P＜0.01）. Correlation analysis with intestinal flora showed that TC and TG shared 3 operational taxonomic units （OTU），including OTU 559，OTU701 and OTU 135（OTU135 was also shared with FBG ），which were all positively correlated with the level of TC ，TG and FBG （P＜0.01）. The three OTU were annotated as Tyzzerella of Spirillaceae ，Anaerotruncus of Verrucaceae and Peptoclostridium of Streptococcidae ，respectively. High-dose and low-dose GGQLD had a down-regulating effect on Tyzzerella and Anaerotruncus（P＜0.05 or P＜0.01），while had up-regulating effect on Peptoclostridium（P＜0.01）. CONCLUSIONS ：High-dose GGQLD （14.85 g/kg）can effectively reduce the body mass and blood lipid of HLP model rats ，and can prevent the abnormal increase of blood glucose of model rats. The mechanism may be associated with that the reduction of intestinal flora （Tyzzerella，Anaerotruncus）content.

Objective To investigate the detection rate of motoric cognitive risk syndrome (MCR)and explore the possible risk factors.Methods A total of 429 elderly patients from geriatric department of Zhejiang Hospital from October 2014 to September 2018 were recruited in the crosssectional study.General information and functional assessment including fall history,self-reported visual impairment and hearing impairment,depressive symptom,cognitive function and gait speed were collected.Patients with MCR were screened out according to the MCR diagnostic criteria.Multiple logistic regression analysis was used to analyze the associated risk factors.Results Seventeen patients(4.0％)met the MCR diagnostic criteria.The proportions of obesity,polypharmacy,cerebral vascular diseases,self-reported hearing impairment,depressive symptoms and slow gait were higher in MCR patients than in non-MCR patients(P＜0.05).Compared with non-MCR patients,MCR patients had lower mini mental state examination (MMSE) scores (P ＜ 0.01).After adjusting for associated confounding factors,multiple logistic regression analysis showed obesity (OR =3.74,95 ％ CI:1.14-12.23,P ＜ 0.05) and depressive symptoms (OR =5.79,95％ CI:1.76-19.06,P ＜ 0.01) were risk factors for MCR.Conclusions MCR is not uncommon in elderly patients.Obesity and depressive symptoms are closely associated with an increased risk of MCR.