The integrated medical and elderly care is a major livelihood issue in China, and also an important measure to positively respond to the national strategy of population aging.In July 2024, the Aging Health Department of the National Health Commission issued the "Standard for the Elderly to Shift of Beds Between Elderly Care and Medical Zones Within the Integrated Area of Medical Treatment and Maintenance(WS/T845-2024)" . This standard takes comprehensive geriatric assessment as the main focus, determines the dynamic evaluation indicators for bed conversion between elderly care and medical zones, and establishes an evaluation standard, which is of great significance for standardizing the development of the integrated area of medical treatment and maintenance and meeting the health needs of the elderly in different periods.This article introduced the background and significance of the standard formulation, interpreted the content of the standard in detail, and summarized the overall thinking and usage methods when formulating the standard, which was helpful for relevant personnel to correctly understand the standard and promote its implementation.

Objective To investigate the expression of serum exosomal long non-coding RNA X chromo-some inactivation specific transcript(LncRNA XIST)and microRNA(miR)-130a-3p in gestational diabetes mellitus(GDM)patients and its relationship with pregnancy outcome.Methods A total of 149 GDM patients(GDM group)and 149 healthy pregnant women(control group)admitted to the hospital from January 2021 to January 2024 were selected.Serum exosomal LncRNA XIST,miR-130a-3p and glucose and lipid metabolism indexes of the two groups were detected and compared.The correlation of LncRNA XIST and miR-130a-3p levels with glycolipid metabolism indexes was analyzed by Pearson method.Univariate and multivariate Logis-tic regression models were used to analyze the influencing factors of pregnancy outcomes in GDM patients.Re-ceiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of serum exosomal Ln-cRNA XIST and miR-130a-3p levels alone and in combination for pregnancy outcomes in GDM patients.Results Serum exosomal LncRNA XIST levels,fasting insulin(FINS),fasting blood glucose(FBG),insulin resistance index(HOMA-IR),2-hour postprandial glucose(2 hPG),total cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)levels in GDM group were higher than those in control group(P＜0.05),and the levels of miR-130a-3p and high density lipoprotein cholesterol(HDL-C)were lower than those in the control group(P＜0.05).LncRNA XIST was positively correlated with FINS,FBG,HOMA-IR,2 hPG,TC,TG and LDL-C,and negatively correlated with HDL-C(P＜0.05).miR-130a-3p was negatively correlated with FINS,FBG,HOMA-IR,2 hPG,TC,TG and LDL-C,and positively correlated with HDL-C(P＜0.05).Among the 149 GDM patients,43 cases showed adverse pregnancy outcome,accounting for 28.86％.The increase level of FBG,the increase level of LncRNA XIST and the increase of HOMA-IR were risk factors for adverse pregnancy outcome in GDM patients,while the increase of miR-130a-3p was a protec-tive factor.The ROC curve analysis showed that the predictive efficacy of combined detection was superior to that of single indicator detection.Conclusion The serum exosomal LncRNA XIST of GDM patients is highly expressed,and miR-130a-3p is lowly expressed,and the combined detection of the above indexes has a high predictive value for pregnancy outcome.

Objective:To explore the technique methods and clinical application value of β-electrode (a plasma needle shape electrode) assisted laparoscopic repair of complex vesicovaginal fistula (VVF).Methods:Clinical data of one patient with complex VVF admitted to Chinese PLA General Hospital in April 2025 was retrospectively analyzed. A 36-year-old female presented with urinary leakage 2 months after hysterectomy. Computed tomography urography excluded ureterovaginal fistula. Cystoscopy revealed a 2 cm fistula on the posterior bladder wall with both ureteral orifices adjacent to the fistula edge. The procedure involved two steps: first, transurethral β-electrode pretreatment was performed to protect the ureteral orifices and create a passage from the bladder to the abdominal cavity. Then, laparoscopic separation, suture closure of the fistula, and omental flap coverage were conducted.Results:Total operation time was 180 min (the time of β- electrode operation was 30 min) with intraoperative estimated blood loss of 50 mL. The catheter was removed 3 weeks postoperatively, and the patient voided well without leakage during 4-month follow-up.Conclusions:β- electrode assisted laparoscopic repair of complex VVF have the advantage of precise manipulation, minimal invasion and rapid recovery. No similar technique have been reported domestically or internationally. This technique provides a new approach for the treatment of complex VVF.

The integrated medical and elderly care is a major livelihood issue in China, and also an important measure to positively respond to the national strategy of population aging.In July 2024, the Aging Health Department of the National Health Commission issued the "Standard for the Elderly to Shift of Beds Between Elderly Care and Medical Zones Within the Integrated Area of Medical Treatment and Maintenance(WS/T845-2024)" . This standard takes comprehensive geriatric assessment as the main focus, determines the dynamic evaluation indicators for bed conversion between elderly care and medical zones, and establishes an evaluation standard, which is of great significance for standardizing the development of the integrated area of medical treatment and maintenance and meeting the health needs of the elderly in different periods.This article introduced the background and significance of the standard formulation, interpreted the content of the standard in detail, and summarized the overall thinking and usage methods when formulating the standard, which was helpful for relevant personnel to correctly understand the standard and promote its implementation.

Objective:To explore the efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve (RLN) anastomosis in the treatment of unilateral vocal fold paralysis (UVFP) and to analyze the effect of different pathogenic factors on efficacy.Methods:From January 2010 to January 2022, 428 patients (187 males and 241 females) at Changhai Hospital with UVFP who underwent ansa cervicalis anterior root-RLN anastomosis due to thyroid surgery, thoracic surgery, idiopathic vocal ford paralysis or high cranial base injury were analyzed. The course of nerve injury ranged from 6 to 24 months. Videostroboscopy, auditory perceptual evaluation parameters (GRBAS including Grade, Roughness, Breathiness, Asthenia, Strain), Voice Handicap Index (VHI-10), acoustic analysis including Jitter, Shimmer and noise to harmonic ratio (NHR), maximum phonation time (MPT) and laryngeal electromyography were used to evaluate the surgery efficacy, and the therapeutic difference of the above 4 different etiology patients receiving the operation was compared. Data processing was performed using SPSS 26.0 statistical software, and Wilcoxon signed rank test was used. Kruskal Wallis one-way ANOVA was used for those with equal variance.Results:At 12 months after operation, the affected vocal ford position, vocal ford edge, glottal closure, symmetry and regularity of vocal ford vibration were significantly improved in all four groups ( P<0.01). G, R, B, A, S, VHI-10, Jitter, Shimmer and NHR were significantly lower than those before operation, while, MPT was significantly longer ( P<0.01). Also, the maximum voluntary motor unit recruitment (VMUR) in the affected thyroarytenoid muscles and posterior cricoarytenoid muscles was significantly improved after surgery ( P<0.01). However, the results of thyroid surgery group, thoracic surgery group and idiopathic vocal ford paralysis group were better than those of high cranial base injury group respectively, and the differences were statistically significant ( P<0.05). Conclusion:Ansa cervicalis anterior root-RLN anastomosis has an obvious efficacy on the recovery of phonatory function in UVFP patients with different causes, but the high cranial base injury is significantly worse than that of vocal ford paralysis caused by other causes.

OBJECTIVE To assess the efficacy of bioabsorbable steroid-releasing sinus stents for improving surgical outcomes and subjective symptoms when placed in the bilateral frontal sinus opening(FSO)following full functional endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).METHODS CRSwNP patients who had under full functional endoscopic sinus surgery with complete data of nasal endoscopy and sinus computed tomography data were identified and included in the study.The patients were divided into a control group consisting of patients receiving only full functional endoscopic sinus surgery(n=92)and a stent group consisting of patients receiving full functional endoscopic sinus surgery combined with placement of steroid implants in both FSO(n=38).The visual analogue scale(VAS)subjective symptom scores and surgical outcomes were compared preoperatively,and on postoperative day(PD30 and PD90)between the two groups.RESULTS Compared to baseline,the overall symptom VAS scores of patients after operation decreased significantly in both groups(P<0.05),and the degree of improvement of overall symptoms in the stent group was significantly better than in the control group(P<0.05).On PD30,the proportion of patients requiring postoperative interventions for bilateral FSO was reduced by 42.3%in the stent group,and was significantly lower than in the control group(P<0.05).Compared to the control group,the proportion of patients needing postoperative intervention in both ethmoid sinus on the stent group decreased by 17.7%(P>0.05).The results at PD90 were consistent with those at PD30.CONCLUSION Full functional endoscopic sinus surgery in combination with bilateral frontal sinus stent implantation is better than full functional endoscopic sinus surgery alone.

Objective:To investigate the effects of cervical cold knife conization (CKC) on preterm delivery, other pregnancy complications and neonatal outcomes, and explore the relationship between preterm delivery risk and the depth and volume of conization.Methods:The clinical data and pregnancy outcomes of 272 women who underwent CKC in Peking Union Medical College Hospital from January 2002 to March 2018 (conization group) and 1 647 pregnant women who gave birth in Peking Union Medical College Hospital during January to December 2019 (control group) were collected. The preterm delivery, premature rupture of membranes, other pregnancy complications and neonatal outcomes of the two groups were compared, and the relationship between the depth and volume of conization and the risk of preterm delivery in postoperative singleton pregnancy was analyzed.Results:(1) There were no significant differences between the two groups in delivery age, parity, proportion of singleton pregnancy, proportion of assisted reproductive technology (all P>0.05). (2) The rate of preterm delivery in the conization group was significantly higher than that in the control group [14.8% (39/264) vs 5.7% (91/1 589); χ2=28.397, P<0.001]. There were still significant differences in preterm delivery rates between the two groups at <34 weeks and 34-37 weeks (all P<0.01). There was no significant difference in the incidence of premature rupture of membrane between the two groups [23.5% (62/264) vs 23.4% (372/1 589); χ2=0.001, P=0.979], but the incidence of preterm premature rupture of membrane in the conization group was significantly higher than that in the control group [11.4% (30/264) vs 2.2% (35/1 589); χ2=56.132, P<0.001]. (3) The rate of cesarean section in the conization group was higher than that in the control group [59.6% (162/272) vs 38.8% (639/1 647); χ2=41.377, P<0.001]. The birth weight of preterm infants in the conization group was significantly higher than that in the control group [(2 409±680) vs (2 150±684) g; t=2.184, P=0.030]. However, there were no statistically significant differences in the incidence of gestational diabetes mellitus, hypertensive disorders in pregnancy, the birth weight of full-term infants, incidence of small for gestational age infant and neonatal intensive care unit admission rate between the two groups (all P>0.05). (4) The preterm delivery rates of coning depth >15 mm, cone size ≥2 cm 3 and cone size <2 cm 3 were higher than that in the control group (all P<0.05). When the coning depth ≤15 mm, the preterm delivery rate in the conization group was higher than that in the control group, but there was no significant difference ( P=0.620). The rate of preterm delivery of pregnant women with coning depth >15 mm was significantly higher than those with coning depth ≤15 mm ( RR=3.084, 95% CI: 1.474-6.453; P=0.001). There was no significant difference in the preterm delivery rate between pregnant women with cone size >2 cm 3 and those with cone size ≥2 cm 3 ( RR=1.700, 95% CI: 0.935-3.092; P=0.077). Conclusion:The risk of preterm delivery and preterm premature rupture of membranes in subsequent pregnancies are increased after cervical CKC, and the risk of preterm delivery is positively correlated with the depth of cervical coning.

Objective:To explore the efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve (RLN) anastomosis in the treatment of unilateral vocal fold paralysis (UVFP) and to analyze the effect of different pathogenic factors on efficacy.Methods:From January 2010 to January 2022, 428 patients (187 males and 241 females) at Changhai Hospital with UVFP who underwent ansa cervicalis anterior root-RLN anastomosis due to thyroid surgery, thoracic surgery, idiopathic vocal ford paralysis or high cranial base injury were analyzed. The course of nerve injury ranged from 6 to 24 months. Videostroboscopy, auditory perceptual evaluation parameters (GRBAS including Grade, Roughness, Breathiness, Asthenia, Strain), Voice Handicap Index (VHI-10), acoustic analysis including Jitter, Shimmer and noise to harmonic ratio (NHR), maximum phonation time (MPT) and laryngeal electromyography were used to evaluate the surgery efficacy, and the therapeutic difference of the above 4 different etiology patients receiving the operation was compared. Data processing was performed using SPSS 26.0 statistical software, and Wilcoxon signed rank test was used. Kruskal Wallis one-way ANOVA was used for those with equal variance.Results:At 12 months after operation, the affected vocal ford position, vocal ford edge, glottal closure, symmetry and regularity of vocal ford vibration were significantly improved in all four groups ( P<0.01). G, R, B, A, S, VHI-10, Jitter, Shimmer and NHR were significantly lower than those before operation, while, MPT was significantly longer ( P<0.01). Also, the maximum voluntary motor unit recruitment (VMUR) in the affected thyroarytenoid muscles and posterior cricoarytenoid muscles was significantly improved after surgery ( P<0.01). However, the results of thyroid surgery group, thoracic surgery group and idiopathic vocal ford paralysis group were better than those of high cranial base injury group respectively, and the differences were statistically significant ( P<0.05). Conclusion:Ansa cervicalis anterior root-RLN anastomosis has an obvious efficacy on the recovery of phonatory function in UVFP patients with different causes, but the high cranial base injury is significantly worse than that of vocal ford paralysis caused by other causes.

Objective:To evaluate the effectiveness of hands-on training and video demonstration in training of forceps delivery for residents.Methods:Forty nine residents who were rotating in the obstetrics department of Peking Union Medical College Hospital from 2019 to 2021 were enrolled. The residents were randomly divided into two groups: the instructor group ( n=24) was taught by hands-on training of forceps delivery and the video group ( n=25) was instructed by watching video demonstration. All the trainees completed the self-confidence questionnaire survey, and were evaluated by written tests and objective structured assessment of technical skills scoring system. Results:The scores of self-confidence in each item after the simulation training were higher than those before training in both groups; and there were no significant differences between two groups in the increment of scores(mastering knowledge: 1.54±0.98 vs. 1.40±0.71, U=266.68, P=0.480;mastering operation skills: 1.42±0.93 vs.1.80±0.87, U=233.47, P=0.161; mastering forceps structure: 1.63±1.10 vs. 1.88±0.93, U=261.63, P=0.416; confidence in independent operation: 1.13±0.90 vs. 1.00±1.08, U=287.74, P=0.799; evaluation of simulation training: 0.21±0.51 vs. 0.16±0.55, U=288.27, P=0.776). In the written tests, the scores of the instructor group were significantly higher than those of the video group (83.00±7.18 vs.70.56±10.37; t=4.86, P<0.001). In the practical operation, the instructor group significantly outperformed the video group in items of “right blade placement” (0.71±0.46 vs. 0.20±0.41, U=147.54, P<0.001), “objective total score” (6.17±1.46 vs. 4.72±1.65, U=155.49, P=0.003) and “correct traction” (0.85±0.31 vs. 0.56±0.51, U=213.86, P=0.036). Conclusion:Training delivered via hands-on instruction and demonstration was generally more effective than that delivered via video, although both groups show a increased self-confidence in learning and performing forceps delivery.

OBJECTIVE: To validate a fetus with high risk for trisomy 13 suggested by non-invasive prenatal testing (NIPT). METHODS: The fetus was selected as the study subject after the NIPT detection at Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences on February 18, 2019. Clinical data of the pregnant woman was collected. Fluorescence in situ hybridization (FISH), chromosomal karyotyping analysis and chromosomal microarray analysis (CMA) were carried out on amniotic fluid and umbilical cord blood and the couple's peripheral blood samples. Copy number variation sequencing (CNV-seq) was also performed on the placental and amniotic fluid samples following induced labor. RESULTS: The pregnant woman, a 38-year-old G4P1 gravida, was found to have abnormal fetal development by prenatal ultrasonography. NIPT test suggested that the fetus has a high risk for trisomy 13. Chromosomal karyotyping analysis of fetal amniotic fluid and umbilical cord blood were 46,XN,add(13)(p10). The result of CMA was arr[hg19]1q41q44(223937972_249224684)×3, with the size of the repeat fragment being approximately 25.29 Mb, the fetal karyotype was thereby revised as 46,XN,der(13)t(1;13)(q41;p10). Chromosomal karyotyping analysis and CMA of the parents' peripheral blood samples showed no obvious abnormality. The CNV-seq analysis of induced placenta revealed mosaicisms of normal karyotype and trisomy 13. The CNV-seq test of induced amniotic fluid confirmed a duplication of chr1:22446001_249220000 region spanning approximately 24.75 Mb, which was in keeping with the CMA results of amniotic fluid and umbilical cord blood samples. CONCLUSION NIPT may yield false positive result due to placenta mosaicism. Invasive prenatal diagnosis should be recommended to women with a high risk by NIPT test. And analysis of placenta can explain the inconsistency between the results of NIPT and invasive prenatal diagnosis.
Humans ; Female ; Pregnancy ; Trisomy 13 Syndrome/genetics* ; DNA Copy Number Variations ; Placenta ; Chromosomes, Human, Pair 1 ; In Situ Hybridization, Fluorescence ; Prenatal Diagnosis/methods* ; Fetus ; Amniotic Fluid ; Chromosome Aberrations ; Trisomy/genetics*