Objective:To analyze the dynamic development of physical, psychological, and cognitive degenerative multimorbidity among middle-aged and older Chinese adults (≥45 years old) while estimating the longitudinal association between socioeconomic status (SES) and the progression of multimorbidity.Methods:Based on data from the China Health and Retirement Longitudinal Study (2011-2020), the Sankey diagram was used to show the dynamic development of physical, psychological, and cognitive degenerative multimorbidity from 2011 to 2020. SES was constructed based on the level of education and total household wealth. Logistic regression was used to estimate OR and 95% CI to evaluate the association between SES and the progression of multimorbidity. Results:Of the 5 393 participants included, 4 484 (83.14%) of them developed new diseases, and the prevalence of physical, psychological, and cognitive degenerative multimorbidity increased from 38.04% to 74.23%. Compared to those with no reported disorders at baseline, participants with psychological disorder (for newly developed physical-cognitive multimorbidity: OR=4.59,95% CI: 2.89-7.29), cognitive disorder (for newly developed physical-psychological multimorbidity: OR=2.24,95% CI: 1.40-3.60), or their multimorbidity at baseline were more likely to progress to physical, psychological, and cognitive degenerative multimorbidity. After adjusting covariates, individuals with low SES were more likely to develop physical diseases ( OR=1.45, 95% CI: 1.11-1.89), cognitive disorder ( OR=1.84, 95% CI: 1.16-2.91), physical-psychological multimorbidity ( OR=1.87, 95% CI: 1.37-2.56), physical-cognitive multimorbidity ( OR=3.58, 95% CI: 2.54-5.06), psychological-cognitive multimorbidity ( OR=5.66, 95% CI: 3.04-10.55), and physical-psychological-cognitive multimorbidity ( OR=3.21, 95% CI: 2.06-5.01) in comparison to those with high SES. There is a dose-response relationship between SES and the multimorbidity progression (all trend P<0.001). Conclusions:The prevalence of physical, psychological, and cognitive degenerative multimorbidity increased significantly among middle-aged and older Chinese adults. Lower SES was associated with multiple patterns of physical, psychological, and cognitive disorders progression.

Objective:To observe any effects of electroacupuncture (EA) on urodynamics and bladder c-Kit expression in rats with urination disorders after spinal cord injury (SCI).Methods:Complete spinal cord injury models were created in female Sprague-Dawley rats by transecting the spine at the thoracic or sacral level. On day 22 after the injury, the rats with successful modeling were randomized into a thoracic spinal cord injury (TSCI) group, a TSCI+ EA group, a sacral spinal cord injury (SSCI) group and an SSCI+ EA group, each of 10. Both EA groups were given 15 minutes of EA at the Guanyuan (CV4) and Sanyinjiao (SP6) points daily for 14 days. After the intervention, urination function was evaluated using bladder volume, compliance and residual urine volume. Hematoxylin and eosin staining was used to observe any morphological changes in bladder tissues. The gene and protein expression of c-Kit in bladder tissues were detected using real-time quantitative polymerase chain reactions and western blotting.Results:Compared with the sham group, the bladder volume and compliance of the TSCI group decreased significantly, while the average residual urine volume increased significantly. In the SSCI group the average residual urine volume, bladder volume and compliance all increased significantly. The modeling altered the morphology of the bladder in all of the SCI rats. The average expression of c-Kit mRNA and protein increased significantly in TSCI group, but both decreased significantly in the SSCI group. EA improved the histological structure of the SCI rats′ bladders.Conclusions:EA can bi-directionally regulate bladder c-Kit expression, and that is a possible mechanism for improving urinary incontinence and urine retention after an SCI.

Objective:To analyze the changes of NOD-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasomes in peripheral blood of patients with diabetic nephropathy (DN) and its clinical significance.Methods:208 patients with type 2 diabetes (T2DM) admitted to our hospital from Feb. 2018 to Dec. 2020 were selected and were divided them into 3 groups according to the urine albumin (UA) /urinary creatinine (UC) ratio (UACR) : simple T2DM group (UACR<30 mg/g) 83 cases, microalbuminuria group (UACR 30-300 mg/g) 70 cases, and massive proteinuria group (UACR>300 mg/g) 55 cases; Fifty healthy volunteers were selected as the control group. General data of each group were collected. Western blot was used to detect the level of NLRP3 in peripheral blood, and enzyme-linked immunosorbent assay (ELISA) kit was used to detect the level of serum interleukin (IL) -1β and IL-18. Logistic regression was employed to analyze the occurrence of DN in T2DM patients. Receiver operating characteristic curve (ROC) curve was used to analyze the value of NLRP3, IL-1β, IL-18 in the diagnosis of DN in peripheral blood.Results:Compared with the control group, the course of disease, FBG, LDL-C, TG, TC, SCr, BUN, HbA1c, NLRP3 protein, IL-1β and IL-18 significant increased in the other 3 groups, and HDL-C, ALB, and eGFR were significant decreased, and the difference was statistically significant ( P<0.05) . The order of their level changes was: massive proteinuria group>microalbuminuria group>pure T2DM group; Pearson test found that peripheral blood NLRP3, IL-1β, IL-18 levels were significantly positively correlated with UACR, LDL-C, TG, and TC ( P<0.001) , while they were significantly negatively correlated with HDL-C ( P<0.001) .The results of unconditional Logistic regression analysis showed that the course of disease, FBG, HDL-C, LDL-C, TG, TC, SCr, BUN, ALB, HbA1c, eGFR, NLRP3 protein, IL-1β and IL-18 may all be related to DN-related in patients with T2DM ( P<0.05) . Multivariate analysis found that high levels of BUN, ALB, HbA1c, EGFR, NLRP3 protein and IL-1 were found β and IL-18 are high risk factors for DN in patients with T2DM ( P<0.05) . The ROC curve showed that the combination of peripheral blood NLRP3, IL-1β, and IL-18 predicted the highest AUC, sensitivity, and specificity of DN in patients with T2DM as 0.918, 93.40%, and 90.13%, respectively. Conclusions:Different stages of DN are often accompanied by increased levels of NLRP3, IL-1β, and IL-18 in peripheral blood. Strengthening the monitoring of NLRP3 inflammasome levels can help assess the renal function of patients and provides a theoretical basis for early diagnosis of DN.

Objective:To evaluate the effect of clinical pathway implementation on medical efficiency and medical expenses of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" diseases by using diagnosis related group (DRG) related indicators.Methods:The data of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" included in the clinical pathway management from January 2017 to December 2019 in the Department of Rheumatology and Immunology of Jinhua Hospital, Zhejiang University School of Medicine were carried out. The impact of clinical pathway implementation on the average hospital stay, average cost and average drug cost of patients with the two diseases were analyzed and compared , so as to evaluate the effect of the implementation of the clinical pathway.Results:From the implementation of clinical pathway in 2017 to 2019, the number of patients admitted and total medical specialty services in the two groups of " rheumatoid arthritis" and " ankylosing spondylitis" increased year by year ( P<0.01). The average length of stay, average cost and average drug cost of patients in the " rheumatoid arthritis" disease group decreased year by year, with statistically significant differences between groups (all P<0.01). The average length of stay in the ankylosing spondylitis group was shortened year by year, and the difference was statistically significant ( P<0.01). Compared with 2017, the average cost in 2018 decreased significantly, and the difference was statistically significant ( P<0.01). There was no significant difference in average cost between 2018 and 2019 ( P>0.05). The average cost in 2018 was significantly higher than that in 2017 ( P<0.05). After analyzing the causes and optimizing the clinical pathway, the average cost in 2019 was significantly lower than that in 2018 ( P<0.01). Conclusions:Through the implementation of clinical pathways and continuous optimization of pathway connotation during use, the diagnosis and treatment efficiency of patients with " rheumatoid arthritis" and " ankylosing spondylitis" can be significantly improved, and medical costs can be reduced, which is in line with the current medical reform needs.

Objective To investigate the role of proprotein convertase subtilisin/kexin type 9 (PCSK9) in the pathogenesis of psoriasis by detecting the level of PCSK9 in the plasma of patients with psoriasis and evaluating its effect on the secretion of interferon gamma (IFN-γ) and interleukin-17A (IL-17A) by peripheral CD4+ T cells.Methods Totally,30 outpatients with psoriasis vulgaris and 30 healthy volunteers (controls) were enrolled from Hospital for Skin Diseases,Chinese Academy of Medical Sciences between February 2016 and December 2017.Of the 30 patients,16 were males,and 14 were females.Their age varied from 18 to 66 years,and the course of disease ranged from 1 month to 15 years.Peripheral venous blood samples were obtained from the patients and controls,and the plasma and was performed to measure mRNA expression of PCSK9 in the PBMC,and enzyme-linked immunosorbent assay (ELISA) to determine the concentration of PCSK9 in the plasma.Peripheral CD4+ T cells were isolated from the PBMC by magnetic bead method,and divided into 2 groups to be co-cultured with (experiment group) or without PCSK9 protein (control group).After 24-hour treatment,ELISA was conducted to detect the levels of IFN-γ and IL-17A in the culture supernatant.Statistical analysis was carried out by using two-sample t test for the comparison between the two groups,and Pearson correlation analysis for analyzing correlations between the plasma level of PCSK9 and psoriasis area and severity index (PASI) score in the patients with psoriasis.Results PCSK9 mRNA expression was undetected in the PBMC of the patients with psoriasis and controls.The plasma level of PCSK9 was significantly higher in the patients with psoriasis ([243.58 ± 11.91] μg/L) than in the healthy controls ([199.74 ± 31.09] μg/L,t =5.761,P ＜ 0.001).After co-culture of the peripheral CD4+ T cells from patients with PCSK9 protein,the levels of IFN-γ and IL-17A both significantly increased ([6 150.00 ± 212.13] ng/L,[1 532.00 ± 11.31] ng/L,respectively) compared with the control group co-cultured without PCSK9 protein ([4 650.00 ± 212.13] ng/L,[698.5 ± 266.58] ng/L,respectively;t =7.071,4.418 respectively,both P ＜ 0.05).IFN-γand IL-17A were undetected in the culture supernatant of CD4+ T cells from the healthy controls in the experiment group or control group.Conclusion The plasma level of PCSK9 increases in patients with psoriasis,which may be involved in the pathogenesis of psoriasis by activating peripheral CD4+ T cells.

Objective: To determine the frequency of chromosomal abnormalities and outcome of pregnancy for fetuses with increased nuchal translucency (NT). Methods: Between July 2014 and February 2018, 247 fetuses with increased NT (>95th centile)were analyzed by chromosome microarray analysis (CMA). The fetuses were divided into ones with isolated increased NT(168 cases), increased NT with cystic hygroma(20 cases), increased NT with edema(12 cases) or increased NT with other abnormalities(47 cases). All couples were followed up by telephone calls. Results: The rate of chromosomal abnormalities was 31.6% (78/247), which included 66 cases with chromosomal aneuploidies and 12 with copy number variants(CNVs). CNVs accounted for 31.4% (11/35) of total abnormalities among fetuses with isolated increased NT, whilst only 2.3% (1/43)of the total abnormalities among fetuses with non-isolated increased NT. Three fetuses with a normal CMA result had mental and physical retardation. Two of them were diagnosed with single gene disorders by whole exome sequencing. Conclusion CMA can detect more chromosomal microdeletion/microduplications among fetuses with isolated increased NT. Furthermore, fetuses with increased NT and anegative CMA result during pregnancy cannot exclude all adverse outcomes.

OBJECTIVE: To determine the frequency of chromosomal abnormalities and outcome of pregnancy for fetuses with increased nuchal translucency (NT). METHODS: Between July 2014 and February 2018, 247 fetuses with increased NT (>95th centile)were analyzed by chromosome microarray analysis (CMA). The fetuses were divided into ones with isolated increased NT (168 cases), increased NT with cystic hygroma (20 cases), increased NT with edema (12 cases) or increased NT with other abnormalities (47 cases). All couples were followed up by telephone calls. RESULTS: The rate of chromosomal abnormalities was 31.6% (78/247), which included 66 cases with chromosomal aneuploidies and 12 with copy number variants (CNVs). CNVs accounted for 31.4% (11/35) of total abnormalities among fetuses with isolated increased NT, whilst only 2.3% (1/43) of the total abnormalities among fetuses with non-isolated increased NT. Three fetuses with a normal CMA result had mental and physical retardation. Two of them were diagnosed with single gene disorders by whole exome sequencing. CONCLUSION CMA can detect more chromosomal microdeletion/microduplications among fetuses with isolated increased NT. Furthermore, fetuses with increased NT and anegative CMA result during pregnancy cannot exclude all adverse outcomes.
Aneuploidy ; Chromosome Aberrations ; Chromosomes ; DNA Copy Number Variations ; Edema ; Female ; Fetus ; Humans ; Lymphangioma, Cystic ; Microarray Analysis ; Nuchal Translucency Measurement ; Pregnancy ; Pregnancy Outcome ; Prenatal Diagnosis ; Ultrasonography, Prenatal

With regard to teaching of gynecology, the integrated medical pattern should be built up and applied, which could help culturing students' ability of active thinking, analyzing and solving clinical problems. To set up the concept of individual-based treatment, we applied the concept of holistic integrated medicine in clinical teaching of gynecology, combing the aspects of teaching, clinic and resources. A reform in teaching content design and teaching mode had been carried out. The results showed that the students are highly satisfied with teaching process, their enthusiasm of learning has been effectively boosted, their clini-cal thinking has been initially cultivated. In a word, this teaching reform has achieved good results in practice.

Objective To study the effect of perioperative nursing intervention for laparoscopic ovarian cystectomy.Methods A total of 120 patients who underwent laparoscopic ovarian cyst resection in our hospital were selected as research subjects.All the patients were divided into control group and observation group according to random number table method,with 60 cases in each group.The patients in the control group were received routine care,and the patients in the observation group were given perioperative nursing intervention based on the control group.The postoperative anal exhaust time,bedridden time,length of hospital stay,postoperative pain and complication rate were statistically analyzed and compared between the two groups.Results The time of anal exhaust,bedridden time and hospital stay were lower in the observation group than that in the control group (P ＜0.05);There was no significant difference in VAS score after operation between the two groups (P ＞0.05).The VAS score of the observation group was significantly lower than that of the control group at 24,48 and 72 hours after operation (P ＜ 0.05).The overall incidence of postoperative complications in the observation group was lower than that in the control group (8.3％ vs.23.3％,P ＜0.05).Conclusion Laparoscopic ovarian cyst resection in patients with perioperative nursing intervention can effectively shorten the recovery time of patients,reduce the risk of complications and promote patient rehabilitation,so it is worthy of application and promotion.

Objective To study the effect of perioperative nursing intervention for laparoscopic ovarian cystectomy.Methods A total of 120 patients who underwent laparoscopic ovarian cyst resection in our hospital were selected as research subjects.All the patients were divided into control group and observation group according to random number table method,with 60 cases in each group.The patients in the control group were received routine care,and the patients in the observation group were given perioperative nursing intervention based on the control group.The postoperative anal exhaust time,bedridden time,length of hospital stay,postoperative pain and complication rate were statistically analyzed and compared between the two groups.Results The time of anal exhaust,bedridden time and hospital stay were lower in the observation group than that in the control group (P ＜0.05);There was no significant difference in VAS score after operation between the two groups (P ＞0.05).The VAS score of the observation group was significantly lower than that of the control group at 24,48 and 72 hours after operation (P ＜ 0.05).The overall incidence of postoperative complications in the observation group was lower than that in the control group (8.3％ vs.23.3％,P ＜0.05).Conclusion Laparoscopic ovarian cyst resection in patients with perioperative nursing intervention can effectively shorten the recovery time of patients,reduce the risk of complications and promote patient rehabilitation,so it is worthy of application and promotion.