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:To investigate the feasibility of digital reconstruction technology in virtual planning of the free perforator flap of anterior tibial artery (ATA) for reconstruction of soft tissue defects in foot and ankle.Methods:From May 2018 to April 2023, 10 patients, including 7 males and 3 females, with foot or ankle defects were admitted in the Department of Orthopaedics Surgery, 920th Hospital of Joint Logistics Support Force. There were 5 defects in dorsal foot, 3 in plantar foot and 2 in medial malleolus. The sizes of defects ranged from 3.0 cm×2.5 cm to 5.5 cm×4.0 cm, all with exposed bones or tendons. Preoperative CTA scans from aorta abdominalis to feet were performed, and 3D digital models of bones, arteries and skin were reconstructed with Mimics. The most suitable perforators were selected to design the perforator flaps of ATA with the software, then the digital virtual flaps were superimposed onto the surfaces of donor sites and marked under a translucent image by Sina. During the surgery, flaps were harvested according to preoperative digital designs with the size of 3.5 cm×3.0 cm-6.0 cm×4.0 cm. The perforating branches were dissected along the way, and the origin, diameter, course, location and length of the perforators were recorded. The perforating branches of the flaps were anastomosed to the proximal vessels in the recipient sites, and the flaps were sutured to cover the wound. For the 10 donor sites, skin graft was used in 2 donor sites and direct suture were performed on 8 donor sites. After discharge of the patients, scheduled outpatient or online follow-ups were carried out to assess the progress of fracture healing as well as the appearance, texture and colour of flaps, and the recovery of donor sites. Ankle function was evaluated by Maryland foot scoring system.Results:Three-dimensional digital reconstructions of donor sites were successfully performed on all patients, enabling successful design and harvest of the free perforator flaps of ATA. The flaps were able to be used in complete reconstruction of the respective defects and made the anatomical parameters of perforators of the donor sites closely matching with those of preoperative modeling. Follow-up periods ranged from 6 to 19 months, apart from 1 flap experienced partial necrosis at distal endge, and another flap with partial exfoliation after blistering. The rest of 8 flaps were all survived smoothly, with appropriate thickness, aesthetic appearance, good texture and colour. Sensations in both donor sites and dorsal feet were all normal. Seven patients achieved excellent and 3 were good according to Maryland's ankle-foot function score. The donor sites healed well without scar hyperplasia.Conclusion:Digital reconstruction technology enables an accurate identification of perforators as well as individualised design and harvest procedures for perforator flaps of ATA, thereby it facilitates precise reconstructions of small-to-medium-sized defects in foot or ankle. It is a good method for vascular anatomy and flap harvesting.

Objective:To investigate the feasibility of digital reconstruction technology in virtual planning of the free perforator flap of anterior tibial artery (ATA) for reconstruction of soft tissue defects in foot and ankle.Methods:From May 2018 to April 2023, 10 patients, including 7 males and 3 females, with foot or ankle defects were admitted in the Department of Orthopaedics Surgery, 920th Hospital of Joint Logistics Support Force. There were 5 defects in dorsal foot, 3 in plantar foot and 2 in medial malleolus. The sizes of defects ranged from 3.0 cm×2.5 cm to 5.5 cm×4.0 cm, all with exposed bones or tendons. Preoperative CTA scans from aorta abdominalis to feet were performed, and 3D digital models of bones, arteries and skin were reconstructed with Mimics. The most suitable perforators were selected to design the perforator flaps of ATA with the software, then the digital virtual flaps were superimposed onto the surfaces of donor sites and marked under a translucent image by Sina. During the surgery, flaps were harvested according to preoperative digital designs with the size of 3.5 cm×3.0 cm-6.0 cm×4.0 cm. The perforating branches were dissected along the way, and the origin, diameter, course, location and length of the perforators were recorded. The perforating branches of the flaps were anastomosed to the proximal vessels in the recipient sites, and the flaps were sutured to cover the wound. For the 10 donor sites, skin graft was used in 2 donor sites and direct suture were performed on 8 donor sites. After discharge of the patients, scheduled outpatient or online follow-ups were carried out to assess the progress of fracture healing as well as the appearance, texture and colour of flaps, and the recovery of donor sites. Ankle function was evaluated by Maryland foot scoring system.Results:Three-dimensional digital reconstructions of donor sites were successfully performed on all patients, enabling successful design and harvest of the free perforator flaps of ATA. The flaps were able to be used in complete reconstruction of the respective defects and made the anatomical parameters of perforators of the donor sites closely matching with those of preoperative modeling. Follow-up periods ranged from 6 to 19 months, apart from 1 flap experienced partial necrosis at distal endge, and another flap with partial exfoliation after blistering. The rest of 8 flaps were all survived smoothly, with appropriate thickness, aesthetic appearance, good texture and colour. Sensations in both donor sites and dorsal feet were all normal. Seven patients achieved excellent and 3 were good according to Maryland's ankle-foot function score. The donor sites healed well without scar hyperplasia.Conclusion:Digital reconstruction technology enables an accurate identification of perforators as well as individualised design and harvest procedures for perforator flaps of ATA, thereby it facilitates precise reconstructions of small-to-medium-sized defects in foot or ankle. It is a good method for vascular anatomy and flap harvesting.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multi-organ and multisystemic involvement and various clinical manifestations.Bone marrow mesenchymal stem cells (BM-MSCs),a kind of non-hematopoietic stem cells originating from the mesoderm,are key components of hematopoietic microenvironment.Recent studies have indicated that SLE is a disorder of stem cells.Both hematopoietic and mesenchymal stem cells (MSCs) are abnormal in SLE,which mainly manifests as changes of biological characteristics,abnormal cytoskeleton and ultrastructure,shortened telomeres,increased telomerase and SA-β-Gal acitivity,decreased differentiative ability,aberrant immunoregulatory effect,and other features of senescence.The mechanism of MSC aging may be related to up-regulated expressions of aging-related genes p53/p21cip1,p16INK4a/Rb and p27kip1/pTEN,elevated levels of reactive oxygen species (ROS),endoplasmic reticulum stress,epigenetic alterations,etc.

Objective To evaluate biological behaviors of bone marrow mesenchymal stem cells (BMSCs) from patients with systemic lupus erythematosus (SLE),to confirm that the BMSCs are aging stems cells,and to explore mechanisms underlying their aging.Methods BMSCs were isolated from bone marrow of 6 patients with SLE (patient group) and 8 healthy human controls (control group) by density-gradient centrifugation and plastic adherence,and cultured in vitro.Optical microscopy was conducted to observe morphological changes and growth of BMSCs,and growth curves were drawn.The differentiation ability of BMSCs was evaluated through culture of them with adipogenic and osteogenic induction medium.Flow cytometry was performed to identify cellular surface markers and to analyze cell cycle and apoptosis,and scratch assay to assess the migration ability of BMSCs.Immunofluorcscence assay and Western blot analysis were carried out to analyze the distribution and expression of p27kip1/PTEN in BMSCs respectively.Results Patient-derived BMSCs,which had a broad,fiat and polygonal shape,showed decreased growth rate,migration activity as well as adipogenic and osteogenic ability compared with those from the controls.There was a significant increase in the proportion of BMSCs in early stage (17.98％ ± 3.26％ vs.8.23％ ± 3.25％,t =3.91,P =0.011) as well as in middle to late stages (16.80％ ± 9.63％ vs.3.33％ ± 2.21％,t =2.99,P=0.048) of apoptosis in the patient group compared with the control group.Moreover,compared with the control group,the patient group showed a significantly higher proportion of BMSCs arrested in the G0/G1 phase (92.34％ ± 5.80％ vs.78.65％ ± 3.22％,t =3.635,P =0.015),but a lower proportion in the S phase (0.86％ ± 1.72％ vs.5.06％ ± 1.874％,t =3.084,P=0.027).The protein expressions of p27 and PTEN were significantly higher in the patient group than in the control group (p27/β-actin:t =2.784,P=0.039;PTEN/β-actin:t=4.812,P =0.041).Conclusion The BMSCs from SLE patients exhibit senescence-related features,which may be associated with elevated expression levels of p27kip1/PTEN.

Objective To evaluate the feasibility of diagnostic and therapeutic peroral direct cholan-gioscopy (PDCS)using an ultra-slim upper endoscopy assisted by a snare.Methods Between November 2014 and January 2015,8 patients underwent PDCS with assistance of an ultra-slim endoscopy.After endo-scopic papillary balloon dilation,the duodenoscopy was withdrew,an ultra-slim endoscopy was inserted di-rectly into the biliary tract assisted by a snare,and biopsy or laser lithotripsy was performed.The snare was closed tightly in the bent portion of the scope,and the snare was pulled while scope shaft had to become the form of U loop by counterclockwise rotation,in order to advance the scope into common bile duct.Results PDCS succeeded in all eight cases,one common hepatic duct adenoma was diagnosed by biopsy,and con-firmed by surgery;one benign biliary stricture was diagnosed by PDCS;laser lithotripsy was successfully per-formed in 4 patients with large CBD stones;bile duct clearance was verified by PDCS in two patients who was suspected of residual CBD stones.No perforation,bleeding or post-operative pancreatitis was found.Con-clusion PDCS using an ultra-slim gastroscopy assisted by a snare is a safe,simple and practical procedure in the diagnosis and treatment of biliary tract diseases.

BACKGROUNDAutoimmune pancreatitis (AIP) is a chronic inflammatory disease of pancreas. We evaluated the clinical manifestations, imaging, and histological presentations of AIP in Chinese patients, and investigated the roles of immunoglobulin E (IgE) and allergic diseases in the diagnosis and pathogenesis of AIP.

METHODSThe clinical records of 22 patients diagnosed with AIP were reviewed and analyzed. All patients with AIP fulfilled the 2006 revised diagnostic criteria proposed by Japan Pancreas Society or the Korean Criteria for AIP.

RESULTSHalf (11/22) of AIP patients had allergic diseases. Twenty-one patients had elevated serum IgE levels, and 14 patients had IgE levels more than 3 times that of normal. There were no significant differences between the patients with higher or lower IgE, with or without allergic disease, in clinical features, laboratory tests, diffuse or focal lesions, or the choice of treatment methods; however, more complaints of body weight loss were observed in patients with higher IgE levels. Patients with higher IgE levels and with allergic diseases were more likely to have onset in March, April, May, August, September, or October. IgE levels decreased after therapy, but increased again during recurrence. Increased number of mast cells was found in the pancreatic tissue in AIP.

CONCLUSIONSIgE maybe a useful marker for monitoring therapeutic response and recurrence of AIP. Allergic processes may play an important role in the pathogenesis of AIP.

Adult ; Aged ; Aged, 80 and over ; Autoimmune Diseases ; blood ; Female ; Humans ; Hypersensitivity ; blood ; Immunoglobulin E ; blood ; Male ; Middle Aged ; Pancreatitis ; blood ; Retrospective Studies

Objective To study the expression of interferon regulatory factor 1 (IRF-1) in patients with systemic lupus erythematosus (SLE) and the influence of prolactin (PRL) upon it. Methods The level of serum PRL in quiescent condition was examined by electrochemiluminescence-meter in 30 patients with SLE and 20 healthy controls. Peripheral blood mononuclear cells (PBMC) were separated from all the subjects by gradient centrifugation density, and cultured with or without the presence of recombinant human PRL (rhPRL) for 24 hours. The expression of IRF-1 gene in cultured PBMC was detected by reverse transcriptase-PCR (RT-PCR) with gel image scanning. Results The relative value of IRF-1 gene expression was significantly higher in SLE patients than in normal controls (0.89±0.21 vs 0.78±0.18, P=0.026), and in SLE patients with high PRL than in those with normal PRL (1.06±0.26 vs 0.82±0.21, P=0.005). However, there was no significant difference between SLE patients with normal PRL and healthy controls in regard to the expression of IRF-1 gene (P=0.514). The stimulation with rhRPL significantly elevated the relative expression of IRF-1 gene in SLE patients with normal PRL (0.99±0.22 vs 0.82±0.21, P=0.036), but had no obvious effect on that in the normal controls. Conclusion The study reveals a high expression of IRF-1 gene in SLE patients, which may be related to the high level of PRL.

Objective To investigate the features of pit patterns by magnifying endoscopy on neo-plastic colorectal polyps. Methods The materials consisted of 129 polyps in 108 patients. Dye-assisted magnifying endoscopies were used to ascertain the pit patterns of polyps. Results Of 129 polyps, 106 were diagnosed pathologically as neoplastic lesions(adenomas and carcinomas) , in which 10 demonstratedⅡpit pattern with only mild to moderate atypia and no severe atypia; 73 ⅢL pit pattern; 1Ⅲs pit pattern; 7 Ⅳ pit pattern and 15 Ⅴ pit patterns which includes malignant change in 10 cases, and severe atypia in 5 cases. Ten lesions all demonstrated Ⅴ pit pattern were found to be carcinoma (7 mucosal and 2 submucosal and 1 advanced carcinomas). Of 7 mucosal carcinomas,6 showed ⅤA pit pattern,1 , Ⅴ N pit pattern; 2 submuco-sal carcinomas all showed VN pit pattern; 1 advanced carcinoma showed ⅤN pit pattern. Ten lateral sprea-ding tumors were also investigated, their pit patterns under magnifying endoscopy were Ⅲ LⅥor V pit pat-tern among them one case with malignant change. Conclusion The images of pit pattern obtained by magnif-ying endoscopy were essentially concordance to those provided by stereomicroscopy. The differentiation of tu-morous lesion or non-tumorous lesion can be fairly performed under the observation of pit patterns; it gives an important practical significance in diagnosing tumorous lesions.