Objective To explore the relationship between geriatric nutritional risk index(GNRI)and adverse outcomes in elderly patients undergoing maintenance hemodialysis(MHD).Methods A prospective cohort trial was conducted on 337 MHD patients aged ≥60 years in hemodialysis centers of 11 hospitals in Beijing from April to June 2017.Their baseline data were collected,and they were divided into non-malnutrition(GNRI≥98,226 cases),mild malnutrition(92≤GNRI＜98,81 cases),and major malnutrition groups(GNRI＜92,30 cases).All of them were followed up until June 2018.The endpoint events were all-cause mortality and cardiovascular disease(CVD)mortality.Kaplan-Meier survival analysis was used to compare the cumulative survival rate among the 3 groups.Multivariate Cox regression model was employed to analyze the relationship of GNRI with all-cause and CVD mortality.Results The mild and major malnutrition groups had significantly lower BMI,serum albumin level and GNRI(P＜0.01).During the median follow-up of 52(4.4-52.0)weeks,56(16.6％)patients died of all-cause death and 25(44.6％)of CVD death.Kaplan-Meier survival curve showed significant differences in all-cause mortality(x2=30.484,P＜0.01)and CVD mortality(x2=22.398,P＜0.01)in the 3 groups.Multivariate Cox regression analysis indicated that,as a continuous variable,elevated GNRI was a protective factor for all-cause mortality(HR=0.910,95％CI:0.870-0.952,P=0.000)and CVD mortality(HR=0.895,95％CI:0.852-0.940,P=0.000),and as a categorical variable,mild and major malnutri-tion were independently correlated with all-cause and CVD mortality(P＜0.05).Conclusion GNRI is an independent risk factor for all-cause and CVD mortality in elderly MHD patients.Mo-nitoring the nutritional status using GNRI can predict the risk of adverse prognosis.

Objective:To study the effects of the alternate rapid maxillary expansion and constriction(Alt-RAMEC)with maxillary protraction on different parts of upper airway by CBCT.Methods:20 Angle Class Ⅲ patients aged 9-12 years were included,and CBCT images were taken before treatment and after Alt-RAMEC with maxillary protraction,the total volume of the upper airway,the volume of each part of the nasopharynx,palatopharynx,linguopharynx and laryngopharynx,the cross-sectional area of the division in-terface,and the minimum cross-sectional area were measured after 3D reconstruction using Dolphin software,the data were analyzed using SPSS 26.0 software.Results:The total upper airway volume,nasopharyngeal volume,and palatopharyngeal volume were in-creased by the average of 1 385.39 mm3(P=0.013),546.74 mm3(P=0.011)and 768.03 mm3(P=0.035)respectively after Alt-RAMEC with maxillary protraction treatment;the area of the nasopharyngeal and palatopharyngeal division interface increased by 73.79 mm2(P=0.002),the cross-sectional diameter by 1.41 mm(P=0.037),and sagittal diameter by 1.52 mm(P=0.022)respectively;however,there was no statistically significant change in the volume,minimum cross-sectional area,partition area,and partition transverse and sagittal diameters of the linguopharynx and laryngopharynx(P＞0.05).Conclusion:Alt-RAMEC with maxil-lary protraction can significantly increase nasopharyngeal and palatopharyngeal volumes,with no significant effect on the linguopharyn-geal and laryngopharyngeal segments of the airway.

Objective:To explore the application effect of pelvic floor outpatient intervention during pregnancy on vaginal delivery of full-term primiparous women.Methods:Single birth primipara who were willing to establish a card and have a desire to give birth naturally in the First People's Hospital of Longquanyi District from January 2021 to December 2021 were divided into odd and even number groups according to the order of filing:the odd group received routine obstetric outpatient management and pelvic floor outpatient intervention(Kegel exercise joint perineum massage)in 200 cases(research group),and even number group received routine obstetric outpatient management in 200 cases(control group).The incidence of vaginitis,cesarean section rate,vaginal delivery rate,obstetric laceration,vaginal midwifery rate,perineal incision,delivery outcome and the length of perineal body and reproductive hiatus before and 42 days after delivery,vaginal width andother vaginal delivery complications(urina-ry retention and puerperal hemorrhoids)were compared between the two groups.Results:87 cases were includ-ed in the final study group,while 104 cases were included in the control group.The perineal incision rate,perineal integrity rate,vaginal midwifery rate,l degree and Ⅱ degree perineal laceration rate,postpartum hemorrhage in the study group were better than those in the control group(P＜0.05).The length of reproductive hiatus 42 days after delivery in the study group was shorter compared with that in the control group(P＜0.05).There were no signifi-cant differences in the incidence of vaginitis,cesarean section rate,time of the second stage of labor,vaginal wall laceration rate,Apgar score of newborns neonatal birth trauma rate,urinary retention,puerperal hemorrhoids,post-partum vaginal width and perineal body length between the two groups(P＞0.05).Conclusions:Pelvic floor outpa-tient intervention during pregnancy can reduce the harm caused by vaginal delivery in full-term primiparas to a cer-tain extent,and does not increase the incidence of neonatal delivery complications,it is worthy of clinical promotion.

Objective:To investigate the correlation between macular cherry red spot (CS) and severity of neurological manifestations in Chinese children with sialidosis (SD) type I.Methods:A evidence-based medical study. "China", "Sialidosis" and "Sialidoses" were used as Chinese and English search terms. The literature was searched in CNKI, Wanfang and PubMed. The cases were all from China and matched the diagnostic criteria. According to the presence or absence of CS in the fundus, the SD children were divided into a group with CS (+) and a group without CS (-), and the correlation between the occurrence of ocular CS and neurological manifestations was compared with meta-analysis by RevMan 5.3 software.Results:Sixty-eight studies were initially retrieved according to the search strategy, and 17 studies were finally included, and 5 studies with CS+ and CS- were meta-analyzed. Among the 43 patients, 28 were male and 15 were female, with a median age of 12 years. Visual impairment was observed in 37 cases (90.2%, 37/41, 2 cases not recorded), and CS was present in 24 cases (55.8%, 24/43). The most common neurological manifestation was myoclonus (97.7%, 42/43), followed by cerebellar ataxia (95.1%, 39/41, 2 cases not recorded) and seizures (91.4%, 32/35, 8 cases not recorded). Pathogenic NEU1 gene mutations were detected in 42 cases and one case was undocumented. The incidence of seizure in group CS+ (100%, 20/20) was higher than that in group CS- (80%, 12/15). Meta-analysis showed that there was no statistically significant difference between the incidence of myoclonus or ataxia [relative risk ( RR)=1.13, 95% confidence interval ( CI) 0.79-1.63, P=0.49] and seizure ( RR=1.13, 95% CI 0.84-2.06, P=0.24) among the children in the CS+ and CS- groups. Conclusions:The incidence of ocular CS in Chinese children with type I SD was 55.8%. There was no correlation with neurological manifestations, however the incidence of seizure was significantly higher in patients with CS than in others without CS.

AIM: To compare the efficacy of different dosing regimens of conbercept in the treatment of pathological myopic choroidal neovascularization(CNV).METHODS: Prospective clinical study. Totally 42 patients(42 eyes)who were diagnosed with pathological myopic CNV in our hospital from January 2019 to January 2022 were selected in the study. According to two different initial dosing regimens, the patients were divided into 1+pro re nata(PRN)group, with 20 patients(20 eyes), and 3+PRN group with 22 patients(22 eyes). The patients in the 1+PRN group were given one intravitreal injection and then given PRN, the patients in the 3+PRN group were given intravitreal injection once a month for 3 mo and then given PRN. Followed-up for 12 mo after initial treatment, the best corrected visual acuity(BCVA), central macular thickness(CMT), CNV area and injection times were compared between the two groups.RESULTS: The BCVA was improved, CMT was decreased, and CNV area was reduced at 1, 3, 6, and 12 mo after the initial treatment(P<0.01). However, there was no statistically significant difference in BCVA, CMT and CNV area between two groups(P>0.05). The average injection in the 1+PRN group was significantly less than that of the 3+PRN group [2(1, 3)times vs 3(3, 4)times, P<0.05], but the average reinjection in the 1+PRN group was more than that of the 3+PRN group [1(0, 2)times vs 0(0, 1)times, P<0.05].CONCLUSION: Two regimens were both safe and effective in the treatment of pathological myopic CNV by Conbercept, which can improve BCVA, decrease CMT, and reduce CNV area, with less total times of injection in the 1+PRN regimen, and less times of reinjection in the 3+PRN regimen.

Objective:To explore the application effect of pelvic floor outpatient intervention during pregnancy on vaginal delivery of full-term primiparous women.Methods:Single birth primipara who were willing to establish a card and have a desire to give birth naturally in the First People's Hospital of Longquanyi District from January 2021 to December 2021 were divided into odd and even number groups according to the order of filing:the odd group received routine obstetric outpatient management and pelvic floor outpatient intervention(Kegel exercise joint perineum massage)in 200 cases(research group),and even number group received routine obstetric outpatient management in 200 cases(control group).The incidence of vaginitis,cesarean section rate,vaginal delivery rate,obstetric laceration,vaginal midwifery rate,perineal incision,delivery outcome and the length of perineal body and reproductive hiatus before and 42 days after delivery,vaginal width andother vaginal delivery complications(urina-ry retention and puerperal hemorrhoids)were compared between the two groups.Results:87 cases were includ-ed in the final study group,while 104 cases were included in the control group.The perineal incision rate,perineal integrity rate,vaginal midwifery rate,l degree and Ⅱ degree perineal laceration rate,postpartum hemorrhage in the study group were better than those in the control group(P＜0.05).The length of reproductive hiatus 42 days after delivery in the study group was shorter compared with that in the control group(P＜0.05).There were no signifi-cant differences in the incidence of vaginitis,cesarean section rate,time of the second stage of labor,vaginal wall laceration rate,Apgar score of newborns neonatal birth trauma rate,urinary retention,puerperal hemorrhoids,post-partum vaginal width and perineal body length between the two groups(P＞0.05).Conclusions:Pelvic floor outpa-tient intervention during pregnancy can reduce the harm caused by vaginal delivery in full-term primiparas to a cer-tain extent,and does not increase the incidence of neonatal delivery complications,it is worthy of clinical promotion.

Objective:To explore the application effect of pelvic floor outpatient intervention during pregnancy on vaginal delivery of full-term primiparous women.Methods:Single birth primipara who were willing to establish a card and have a desire to give birth naturally in the First People's Hospital of Longquanyi District from January 2021 to December 2021 were divided into odd and even number groups according to the order of filing:the odd group received routine obstetric outpatient management and pelvic floor outpatient intervention(Kegel exercise joint perineum massage)in 200 cases(research group),and even number group received routine obstetric outpatient management in 200 cases(control group).The incidence of vaginitis,cesarean section rate,vaginal delivery rate,obstetric laceration,vaginal midwifery rate,perineal incision,delivery outcome and the length of perineal body and reproductive hiatus before and 42 days after delivery,vaginal width andother vaginal delivery complications(urina-ry retention and puerperal hemorrhoids)were compared between the two groups.Results:87 cases were includ-ed in the final study group,while 104 cases were included in the control group.The perineal incision rate,perineal integrity rate,vaginal midwifery rate,l degree and Ⅱ degree perineal laceration rate,postpartum hemorrhage in the study group were better than those in the control group(P＜0.05).The length of reproductive hiatus 42 days after delivery in the study group was shorter compared with that in the control group(P＜0.05).There were no signifi-cant differences in the incidence of vaginitis,cesarean section rate,time of the second stage of labor,vaginal wall laceration rate,Apgar score of newborns neonatal birth trauma rate,urinary retention,puerperal hemorrhoids,post-partum vaginal width and perineal body length between the two groups(P＞0.05).Conclusions:Pelvic floor outpa-tient intervention during pregnancy can reduce the harm caused by vaginal delivery in full-term primiparas to a cer-tain extent,and does not increase the incidence of neonatal delivery complications,it is worthy of clinical promotion.

Objective:To explore the application effect of pelvic floor outpatient intervention during pregnancy on vaginal delivery of full-term primiparous women.Methods:Single birth primipara who were willing to establish a card and have a desire to give birth naturally in the First People's Hospital of Longquanyi District from January 2021 to December 2021 were divided into odd and even number groups according to the order of filing:the odd group received routine obstetric outpatient management and pelvic floor outpatient intervention(Kegel exercise joint perineum massage)in 200 cases(research group),and even number group received routine obstetric outpatient management in 200 cases(control group).The incidence of vaginitis,cesarean section rate,vaginal delivery rate,obstetric laceration,vaginal midwifery rate,perineal incision,delivery outcome and the length of perineal body and reproductive hiatus before and 42 days after delivery,vaginal width andother vaginal delivery complications(urina-ry retention and puerperal hemorrhoids)were compared between the two groups.Results:87 cases were includ-ed in the final study group,while 104 cases were included in the control group.The perineal incision rate,perineal integrity rate,vaginal midwifery rate,l degree and Ⅱ degree perineal laceration rate,postpartum hemorrhage in the study group were better than those in the control group(P＜0.05).The length of reproductive hiatus 42 days after delivery in the study group was shorter compared with that in the control group(P＜0.05).There were no signifi-cant differences in the incidence of vaginitis,cesarean section rate,time of the second stage of labor,vaginal wall laceration rate,Apgar score of newborns neonatal birth trauma rate,urinary retention,puerperal hemorrhoids,post-partum vaginal width and perineal body length between the two groups(P＞0.05).Conclusions:Pelvic floor outpa-tient intervention during pregnancy can reduce the harm caused by vaginal delivery in full-term primiparas to a cer-tain extent,and does not increase the incidence of neonatal delivery complications,it is worthy of clinical promotion.

Objective:To explore the application effect of pelvic floor outpatient intervention during pregnancy on vaginal delivery of full-term primiparous women.Methods:Single birth primipara who were willing to establish a card and have a desire to give birth naturally in the First People's Hospital of Longquanyi District from January 2021 to December 2021 were divided into odd and even number groups according to the order of filing:the odd group received routine obstetric outpatient management and pelvic floor outpatient intervention(Kegel exercise joint perineum massage)in 200 cases(research group),and even number group received routine obstetric outpatient management in 200 cases(control group).The incidence of vaginitis,cesarean section rate,vaginal delivery rate,obstetric laceration,vaginal midwifery rate,perineal incision,delivery outcome and the length of perineal body and reproductive hiatus before and 42 days after delivery,vaginal width andother vaginal delivery complications(urina-ry retention and puerperal hemorrhoids)were compared between the two groups.Results:87 cases were includ-ed in the final study group,while 104 cases were included in the control group.The perineal incision rate,perineal integrity rate,vaginal midwifery rate,l degree and Ⅱ degree perineal laceration rate,postpartum hemorrhage in the study group were better than those in the control group(P＜0.05).The length of reproductive hiatus 42 days after delivery in the study group was shorter compared with that in the control group(P＜0.05).There were no signifi-cant differences in the incidence of vaginitis,cesarean section rate,time of the second stage of labor,vaginal wall laceration rate,Apgar score of newborns neonatal birth trauma rate,urinary retention,puerperal hemorrhoids,post-partum vaginal width and perineal body length between the two groups(P＞0.05).Conclusions:Pelvic floor outpa-tient intervention during pregnancy can reduce the harm caused by vaginal delivery in full-term primiparas to a cer-tain extent,and does not increase the incidence of neonatal delivery complications,it is worthy of clinical promotion.

Objective:To explore the application effect of pelvic floor outpatient intervention during pregnancy on vaginal delivery of full-term primiparous women.Methods:Single birth primipara who were willing to establish a card and have a desire to give birth naturally in the First People's Hospital of Longquanyi District from January 2021 to December 2021 were divided into odd and even number groups according to the order of filing:the odd group received routine obstetric outpatient management and pelvic floor outpatient intervention(Kegel exercise joint perineum massage)in 200 cases(research group),and even number group received routine obstetric outpatient management in 200 cases(control group).The incidence of vaginitis,cesarean section rate,vaginal delivery rate,obstetric laceration,vaginal midwifery rate,perineal incision,delivery outcome and the length of perineal body and reproductive hiatus before and 42 days after delivery,vaginal width andother vaginal delivery complications(urina-ry retention and puerperal hemorrhoids)were compared between the two groups.Results:87 cases were includ-ed in the final study group,while 104 cases were included in the control group.The perineal incision rate,perineal integrity rate,vaginal midwifery rate,l degree and Ⅱ degree perineal laceration rate,postpartum hemorrhage in the study group were better than those in the control group(P＜0.05).The length of reproductive hiatus 42 days after delivery in the study group was shorter compared with that in the control group(P＜0.05).There were no signifi-cant differences in the incidence of vaginitis,cesarean section rate,time of the second stage of labor,vaginal wall laceration rate,Apgar score of newborns neonatal birth trauma rate,urinary retention,puerperal hemorrhoids,post-partum vaginal width and perineal body length between the two groups(P＞0.05).Conclusions:Pelvic floor outpa-tient intervention during pregnancy can reduce the harm caused by vaginal delivery in full-term primiparas to a cer-tain extent,and does not increase the incidence of neonatal delivery complications,it is worthy of clinical promotion.