The integrated medical and elderly care model provides comprehensive medical and elderly care services by establishing medical facilities in elderly care institutions or forming close cooperative relationships with surrounding medical institutions. Currently， there are 87，000 paired partnerships established nationwide between medical and health institutions and elderly care service institutions， and more than 7，800 integrated medical and elderly care institutions have obtained the qualifications of medical and health institutions and completed elderly care service registration. This model not only meets the elderly’s healthcare needs but also provides life care， psychological support， and social activities， thereby improving their quality of life. However， the integrated medical and elderly care model also faces numerous ethical dilemmas in practice. This paper aimed to explore in depth the ethical dilemmas and countermeasures optimization in the work of elderly care institutions under this model， to promote the improvement of service quality， comprehensively guarantee the rights and interests of the elderly， and promote the healthy development of this model in practice. Under this model， the elderly care institutions not only bear the responsibility of providing long-term care and life services but also need to cooperate with medical institutions to provide healthcare and health management services for the elderly. By exploring the practical paths for elderly care institutions to address the ethical dilemmas faced with this model， feasible solutions were proposed to enhance the welfare of the elderly and promote the harmonious development of society.

There is increasing evidence that the activation of glucagon-like peptide-1 receptor(GLP-1R)can be used as a therapeutic intervention for cognitive disorders.Here,we have screened GLP-1 R targeted com-pounds from Scutellaria baicalensis,which revealed baicalein is a potential GLP-1 R small-molecule agonist.Mitophagy,a selective autophagy pathway for mitochondrial quality control,plays a neuro-protective role in multiple cognitive impairment diseases.We noticed that Glp1r knock-out(KO)mice present cognitive impairment symptoms and appear worse in spatial learning memory and learning capacity in Morris water maze(MWM)test than their wide-type(WT)counterparts.Our mechanistic studies revealed that mitophagy is impaired in hippocampus tissue of diabetic mice and Glp1r KO mice.Finally,we verified that the cognitive improvement effects of baicalein on diabetic cognitive dysfunction occur through the enhancement of mitophagy in a GLP-1 R-dependent manner.Our findings shed light on the importance of GLP-1 R for cognitive function maintenance,and revealed the vital significance of GLP-1R for maintaining mitochondrial homeostasis.Furthermore,we identified the therapeutic potential of baicalein in the treatment of cognitive disorder associated with diabetes.

Objective: To investigate the change of serum microRNA-15 a(miR-15 a) expression level in patients with gestational diabetes mellitus and its relationship with maternal and infant adverse outcomes. Methods: 143 cases of gestational diabetes mellitus patients were selected as the study group, and 124 healthy pregnant women were selected as the control group, and the expression levels of serum miR-15 a of the two groups were detected by real time fluorescent quantitative reverse transcription polymerase chain reaction(qRT-PCR). Follow up to delivery, the adverse maternal and infant outcomes of the two groups were observed, and the relationship between the expression level of serum miR-15 a and the adverse outcomes of maternal and infant in gestational diabetes mellitus was analyzed by multivariate Logistic regression analysis method. Results: The expression level of serum miR-15 a in the study group was higher than that in the control group, and the difference was statistically significant(P<0.05). The incidence rates of abortion, premature rupture of membranes, polyhydramnios, postpartum hemorrhage, postpartum infection, premature infants, macrosomia, fetal distress, neonatal asphyxia, neonatal respiratory distress syndrome and neonatal hypoglycemia and the total incidence rates of maternal and perinatal adverse outcomes in the study group were higher than those in the control group(P<0.05), but there was no significant difference in the incidence rate of fetal death between the study group and the control group(P>0.05). The proportions of age>35 years old, pre-pregnancy body mass index ≥24.0 kg/m2, history of adverse pregnancy and childbirth and poor blood glucose control and the expression level of serum miR-15 a in poor maternal outcome group and poor perinatal outcome group were higher than those in good maternal outcome group and good perinatal outcome group(P<0.05), and multivariate Logistic regression analysis showed that the above indicators were the risk factors of adverse maternal and infant outcomes in patients with gestational diabetes mellitus(P<0.05). Conclusion The expression level of serum miR-15 a in gestational diabetes mellitus patients abnormally increases, and it can increase the risk of adverse maternal and infant outcomes, which is closely related to the occurrence of adverse maternal and infant outcomes. Besides, the age, pre-pregnancy body mass index, adverse pregnancy history, blood glucose control also have a certain impacts on the occurrence of adverse maternal and infant outcomes in patients with gestational diabetes mellitus.

Recent years with the rapid progress in high-throughput omics techniques, the accumulation of population cohorts and biobanks, great advances in internet and information technology, and the emerging tools for big data utilization, health care big data provide abundant data resources and broad research platforms for epidemiological research. We aimed to review the opportunities and challenges of epidemiological research in the era of big data, and explore the future development of epidemiology. Epidemiology should seize the opportunities, open up new directions, develop new methods, and promote the translation of research results into public health and clinical medicine, which will eventually realize the vision of "Healthy China".