OBJECTIVE To investigate the prevalence and influencing factors of potentially inappropriate medication （PIM） among the elderly in nursing homes in Urumqi based on three PIM screening tools， and to compare the applicability of different tools. METHODS A cross-sectional study design was adopted. Elderly individuals from six nursing homes in Urumqi were selected as the research subjects from May 2021 to September 2023. Demographic characteristics， disease burden and medication records of the elderly were collected. PIM screening was performed using the Chinese PIM criteria （2024 edition）， the American Geriatrics Society （AGS） Beers criteria （2023 edition）， and the Screening Tool of Older Person’S Prescriptions（STOPP）/Screening Tool to Alert to Right Treatment（START） （2023 edition）. Fleiss’s Kappa test was used to assess the consistency among the three screening tools， and multivariate Logistic regression was used to analyze the influencing factors of PIM. RESULTS The prevalence of PIM screened by the Chinese PIM criteria was 47.4% （323/682）， by the AGS Beers criteria was 43.4% （296/682）， and by the STOPP criteria was 50.9% （347/682）. The consistency among the three screening tools was low （Fleiss’s Kappa＝0.12， P ＜0.001）. Multivariate Logistic regression analysis showed that all three screening tools indicated that polypharmacy， aspirin use and psychotropic drug use were independent risk factors for PIM among elderly in nursing houses （all OR＞1， P ＜0.05）. CONCLUSIONS The prevalence of PIM among the elderly in nursing homes in Urumqi is relatively high. Polypharmacy， aspirin use and psychotropic drug use are common independent risk factors for PIM. There are differences in screening results among the three tools with low consistency. The Chinese PIM criteria can serve as a first-line tool for PIM screening in nursing homes.

Objective To explore the clinical value of three-dimensional(3D)fracture mapping in improving the consistency of Arbeitsgemeinschaft für Osteosynthesefragen(AO)/the Orthopaedic Trauma Association(OTA)classification and optimizing preoperative surgical planning for Pilon fractures.Methods This single-center retrospective cohort study included 60 Pilon fracture patients admitted to the Trauma Emergency Center of the Third Hospital of Hebei Medical University between January 2022 and December 2024.All patients underwent preoperative computed tomography(CT)scans.Image standardization and expert manual segmentation/annotation of fracture lines and fragments were performed with 3D Slicer software.3D fracture lines extracted from gold-standard models were registered to a unified standard tibial model.A 3D probability heatmap was constructed by counting spatial fracture frequency,with high-incidence zones analyzed via spatial clustering algorithms.Three orthopedic surgeons independently completed AO/OTA classification and preoperative planning with the assistance of conventional CT only and CT with 3D fracture mapping.Accuracy,time consumption,inter-observer consistency(Cohen's κ),planning time,plan modification frequency,and subjective scores were evaluated.Results The 3D fracture heatmap revealed that fracture lines predominantly concentrated in the anterolateral and posteromedial regions of the distal tibia,with an average of(4.2±1.1)hotspots,a coverage rate of(78.3±5.6)%,and(3.5±1.0)clustering areas.With 3D fracture mapping assistance,classification accuracy was improved to(88.0±5.0)%compared to(75.0±8.0)%with conventional CT(P=0.001);classification time reduced to(10.4±2.5)min from(15.2±3.1)min(P<0.001);and Cohen's κ increased from 0.68±0.05 to 0.82±0.03(P=0.002).For preoperative planning,the average planning time was(15.8±3.2)min in the 3D mapping-assisted group,which was significantly shorter than that of conventional CT group(22.5±4.3)min(P<0.001);the number of plan modifications was(1.5±0.7)times,lower than that of conventional CT group(3.2±1.1)times(P<0.001),and the subjective score was 8.9±0.9,higher than that of conventional CT group(6.8±1.2)(P<0.001).Conclusion The 3D fracture mapping accurately characterizes spatial distribution patterns of Pilon fractures,significantly improves classification accuracy,inter-observer consistency,and preoperative planning efficiency,and thus holds substantial clinical value.

Objective To investigate the association between intestinal microbiota dysbiosis and colonic polyps,Helicobacter pylori(Hp)infection,and intestinal metaplasia.Methods A total of 200 patients diagnosed with colonic polyps,Hp infection,or both conditions.These patients were classified into three groups:the colonic polyp group(n=90),the Hp infection with intestinal metaplasia group(n=49),and the colonic polyp combined with Hp infection and intestinal metaplasia group(n=61).Additionally,62 individuals who underwent routine health examinations at our hospital during the same period were enrolled as a control group.The study compared gut microbiota imbalances across these groups to investigate the association between intestinal dysbiosis and colonic pol-yps,Hp infection,and the co-occurrence of colonic polyps with Hp-related intestinal metaplasia.Logistic regression analysis was performed to identify risk factors associated with the development of intestinal metaplasia due to Hp infection in patients with colonic polyps.Results Compared to the control group,intestinal flora imbalance was significantly more prevalent in the colorectal polyp group,the Hp infection with intestinal metaplasia group,and the colorectal polyp combined with Hp infection and intestinal metaplasia group(P<0.05).Moreover,intestinal flora imbalance in the colorectal polyp with Hp infection and intestinal metaplasia group was significantly higher than that in both the colorectal polyp group and the Hp infection with intestinal metaplasia group(P<0.05).Regarding exhaled gas levels,H2 and CH4 concentrations were significantly elevated in the groups with colorectal polyps accom-panied by Hp infection and intestinal metaplasia,those with colorectal polyps alone,and those with Hp infection and intestinal metaplasia,compared to the control group(P<0.05).Similarly,exhaled H2S levels were significantly higher in the group with colorectal polyps complicated by Hp infection and intestinal metaplasia than in the control group(P<0.05).Furthermore,exhaled H2 and CH4 levels showed positive correlations with the presence of colorectal polyps,Hp infection with intestinal metaplasia,and colorectal polyps combined with Hp infection and intestinal metaplasia(P<0.05).Exhaled H2S levels were positively correlated with colorectal polyps complicated by Hp infec-tion and intestinal metaplasia(P<0.05).Logistic regression analysis indicated that a history of smoking,atrophic gastritis,peptic ulcer,and intestinal flora imbalance are independent risk factors for Hp infection-associated intesti-nal metaplasia in patients with colorectal polyps(P<0.05).Conclusion Intestinal flora imbalance is associated with colorectal polyps and Hp-induced intestinal metaplasia,suggesting that microbial dysbiosis may represent a potential risk factor for the development of these conditions.

Objective To explore the efficacy of precise surface positioning method in percutaneous screw fixation for Jones fracture.Methods Data of 46 patients with Jones fractures admitted to our hospital from September 2021 to December 2023 were retrospectively analyzed.According to the different treatment methods,the patients were divided into screw groups(24 patients fixed by percutaneous screws)and tension band groups(22 patients fixed by incision and reset tension band).The general conditions,follow-up time,surgical time,hospitalization time,fracture reduction quality,postoperative complete weight-bearing time,fracture healing time,and complications in the two groups were recorded and compared.The American Association of Foot and Ankle Surgery(AOFAS)system was used to assess the recovery of foot function.Results There was no statistically significant difference in the general data before the operation between the two groups of patients(P＞0.05).The follow-up time of the two groups was 6 to 24 months.Compared with the tension band group,the screw group had shorter operation time[(32.96±5.35)min vs.(47.27±9.42)min],shorter hospitalization time[(5.75±1.18)d vs.(7.68±2.05)d],earlier postoperative complete weight-bearing time[(6.47±0.73)w vs.(7.29±1.66)w],faster fracture healing time[(3.31±0.68)months vs.(4.29±1.29)months],higher AOFAS score[(89.13±2.62)vs.(79.59±4.49)](all P＜0.05).The tension band group of fracture reduction quality was better than the screw group(P＜0.05).The quality of fracture reduction during the operation in the tension band group was better than that in the screw group(P＜0.05).In terms of complications:no complications occurred in the screw group,one patient in the tension band group developed infection,and one patient had a loose Kirchner needle.Conclusion Precise surface positioning method in percutaneous screw fixation for Jones fracture is a safe and effective method with precise positioning,simple operation,small trauma,and rapid rehabilitation,which is worthy of clinical promotion,but the indications need to be strictly controlled according to the type of fracture.

Objective:To test the validity and reliability of the Chinese version of the Peer Mental Health Stig-matization Scale-Revised(PMHSS-R)in middle school students.Methods:A total of 1 099 middle school students were selected and randomly divided into Sample 1(n=549)and Sample 2(n=550)for exploratory factor analysis and confirmatory factor analysis,respectively.The total sample(n=1 099)was used to measure internal consisten-cy,and 87 of them were retested two weeks later.A total of 259 middle school students(Sample 3)was selected for the criterion validity test with the Depression Stigma Scale(DSS)and the Attitudes toward Seeking Professional Psychological Help Scale-Short Form(ATSPPH-SF).Results:Exploratory factor analysis identified 2 common fac-tors,namely stigma awareness and stigma agreement,with a cumulative variance contribution rate of 66.86％.The confirmatory factor analysis showed that the two-factor structure model fit was adequate(x2/df=3.70,CFI=0.97,TLI=0.96,SRMR=0.03,RMSEA=0.07).The PMHSS-R Chinese version scores were positively correlated with the DDS scores(ICC=0.58,P＜0.01)and negatively correlated with the ATSPPH-SF scores(ICC=-0.40,P＜0.01).The Cronbach α coefficients of the total scores and the two-factor scores were 0.90,0.92,0.85,respective-ly.The test-retest reliability coefficients(ICC)were 0.84,0.76,0.78,respectively.Conclusion:The Chinese ver-sion of the Peer Mental Health Stigmatization Scale-Revised(PMHSS-R)demonstrates good validity and reliability in assessing mental health stigma among middle school students.

Objective:To explore the impact of sleep disturbances on the symptoms and functional impairment outcomes in children with attention deficit hyperactivity disorder (ADHD) and their path analysis.Methods:A cross-sectional study was made.Two hundred and seventy-eight ADHD children aged 6-12 years were selected from the Center for Cognition and Sleep, the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2022 to March 2023.The Swanson, Nolan and Pelham Rating Scale Ⅳ was used to evaluate the core symptoms of ADHD (namely, attention deficit and hyperactivity).The sleep disturbance scale for children was used to assess sleep disturbances [including disorders in initiating and maintaining sleep(DIMS), sleep breathing disorders, sleep-wake transition disorders (SWTD), disorders of arousal, disorders of excessive somnolence (DOES) and nocturnal hyperhidrosis].The Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) was used to assess functional impairment (in family, learning and school, life skills, self-concept, social activities, and risky activities).The descriptive statistical analysis, t test, multivariate linear regression and path analysis were used for statistical analysis. Results:Compared with those without sleep disturbances, ADHD children with sleep disturbances had significantly more serious functional impairment in family [(0.87±0.42) scores vs.(0.63±0.45) scores, P<0.001], learning and school [(0.75±0.37) scores vs.(0.62±0.35) scores, P=0.011], life skills [(1.30±0.37) scores vs.(1.08±0.30) scores, P<0.001], self-concept [(1.20±0.57) scores vs.(0.92±0.49) scores, P<0.001], social activities [(0.88±0.44) scores vs.(0.67±0.42) scores, P<0.001] and risky activities [(0.28±0.24) scores vs.(0.21±0.21) scores, P=0.043].The results of multivariate linear regression analysis showed that after adjusting for gender, age, total intelligence quotient, and core symptoms of ADHD, the regression coefficients of DOES in domains of family ( B=0.02, P=0.042) and life skills ( B=0.03, P<0.001) and the regression coefficient of DIMS in self-concept were still statistically significant ( B=0.02, P=0.013).The path analysis results showed that DOES ( β=0.170, P=0.004), attention deficit ( β=0.223, P<0.001) and hyperactivity ( β=0.385, P<0.001) directly affected WFIRS-P.DOES indirectly affected WFIRS-P through attention deficit ( β=0.270, P<0.001), and SWTD indirectly affected WFIRS-P through hyperactivity ( β=0.199, P=0.004). Conclusions:Severer sleep disturbances are associated with severer functional impairment in children with ADHD, and sleep phenotypes can directly or indirectly affect functional impairment outcomes in different domains in children with ADHD through core symptoms of ADHD.

Objective:To test the validity and reliability of the Chinese version of the Peer Mental Health Stig-matization Scale-Revised(PMHSS-R)in middle school students.Methods:A total of 1 099 middle school students were selected and randomly divided into Sample 1(n=549)and Sample 2(n=550)for exploratory factor analysis and confirmatory factor analysis,respectively.The total sample(n=1 099)was used to measure internal consisten-cy,and 87 of them were retested two weeks later.A total of 259 middle school students(Sample 3)was selected for the criterion validity test with the Depression Stigma Scale(DSS)and the Attitudes toward Seeking Professional Psychological Help Scale-Short Form(ATSPPH-SF).Results:Exploratory factor analysis identified 2 common fac-tors,namely stigma awareness and stigma agreement,with a cumulative variance contribution rate of 66.86％.The confirmatory factor analysis showed that the two-factor structure model fit was adequate(x2/df=3.70,CFI=0.97,TLI=0.96,SRMR=0.03,RMSEA=0.07).The PMHSS-R Chinese version scores were positively correlated with the DDS scores(ICC=0.58,P＜0.01)and negatively correlated with the ATSPPH-SF scores(ICC=-0.40,P＜0.01).The Cronbach α coefficients of the total scores and the two-factor scores were 0.90,0.92,0.85,respective-ly.The test-retest reliability coefficients(ICC)were 0.84,0.76,0.78,respectively.Conclusion:The Chinese ver-sion of the Peer Mental Health Stigmatization Scale-Revised(PMHSS-R)demonstrates good validity and reliability in assessing mental health stigma among middle school students.

Objective·To investigate the effects of rutin on proliferation,apoptosis,migration and invasion of osteosarcoma cells and its possible molecular mechanisms.Methods·Human osteosarcoma MG63 and U2OS cells were treated with rutin at concentrations of 10,20 and 40 μmol/L,respectively.The effects of rutin on proliferation,apoptosis,migration,and invasion of MG63 and U2OS cells were assessed by using CCK-8 assay,colony formation assay,flow cytometry,scratch closure assay,and Transwell assay.The expression levels of cell proliferation antigen Ki67,B-cell lymphoma-2(Bcl-2),and Bcl-2 associated X protein(Bax)proteins were detected by Western blotting.Twelve BALB/c nude mice were subcutaneously injected with osteosarcoma MG63 cells to establish a subcutaneous transplant tumor model.The mice were randomly divided into two groups:a control group and a rutin 40 mg/kg group(6 mice in each group).The rutin 40 mg/kg group was intraperitoneally injected with rutin(40 mg/kg),and the control group was intraperitoneally injected with an equal volume of saline,once every other day for 4 weeks.The tumor volume was measured every week.After 4 weeks,the mice were euthanized,and the tumors were excised and weighed.Immunohistochemistry was used to detect the expression of Ki67 and vascular endothelial growth factor(VEGF)in tumor tissues.TUNEL was used to detect tumor cell apoptosis.Results·Compared with MG63 and U2OS cells not treated with rutin,MG63 and U2OS cells treated with rutin at 20 and 40 μmol/L showed a significant decrease in proliferation rate,an increase in apoptotic rate,a decrease in migration and invasion abilities,a significant downregulation of Ki67 protein,and a significant increase in Bax/Bcl-2 ratio,with statistically significant differences(all P＜0.05).In addition,rutin significantly inhibited the in vivo growth of osteosarcoma cells,reduced the expression of Ki67 and VEGF in tumor tissues,and promoted cell apoptosis(all P＜0.05).Conclusion·Rutin can inhibit the proliferation,migration,and invasion of osteosarcoma cells,and promote apoptosis.

Objective:To investigate the diversity, temporal dynamics and influencing factors of serotypes of Salmonella among asymptomatic workers in Yulin, Guangxi Zhuang Autonomous Region, from 2013 to 2023, and provide reference for controlling the hidden transmission of Salmonella and for disease prevention among healthy populations. Methods:Anal rectal swabs were collected from asymptomatic workers in Yulin from 2013 to 2023 for the isolation and identification of Salmonella. The diversity of serotypes of Salmonella was evaluated by using Shannon index, while the isolation rates and composition ratio of different serotypes were compared with χ2 test. Spearman correlation analysis was used to evaluate the correlation of natural and social factors with serotype isolation rates for more than eight years, and stepwise multiple linear regression analysis were used to evaluate the impact of social factors on the serotype isolation rates for more than 8 years. Results:A total of 8 073 strains of Salmonella were isolated from 2013 to 2023, with an overall isolation rate of 18.88‰ During the 11-year period, 135 serotypes of Salmonella were identified, and the serotype diversity increased first and then decreased. The serotype with the highest isolation rate was Salmonella Typhimurium (3.04‰), followed by Salmonella Rissen (1.70‰), Salmonella Corvallis (1.41‰), Salmonella Agona (1.36‰), Salmonella Derby (1.22‰), and Salmonella London (1.02‰), accounting for 51.67% of the total Salmonella serotypes isolated. There was no significant trend in isolation rate of Salmonella over the years ( χ2=0.67, P=0.415); however, season significantly influenced the isolation rate, with lower rate being observed in winter and higher rate in summer ( χ2=615.91, P<0.001). The isolation rate of different serotypes of Salmonella was influenced by social and natural factors, showing a positive correlation with temperature, precipitation, and poultry consumption and production levels. Conclusions:The serotypes of Salmonella carried by asymptomatic workers were complex and diverse in Yulin, Guangxi Zhuang Autonomous Region, from 2013 to 2023, and the isolation rates of multi-serotypes increased from 2013 to 2023. Higher isolation rate was observed in summer and the isolation rate was widely influenced by natural factors such as temperature and precipitation, as well as social factors such as economic conditions. It is necessary to pay attention to the Salmonella serotype carriage in healthy population, and strengthen monitoring of both healthy individuals and pathogenic bacteria.

Objective To explore the clinical value of three-dimensional(3D)fracture mapping in improving the consistency of Arbeitsgemeinschaft für Osteosynthesefragen(AO)/the Orthopaedic Trauma Association(OTA)classification and optimizing preoperative surgical planning for Pilon fractures.Methods This single-center retrospective cohort study included 60 Pilon fracture patients admitted to the Trauma Emergency Center of the Third Hospital of Hebei Medical University between January 2022 and December 2024.All patients underwent preoperative computed tomography(CT)scans.Image standardization and expert manual segmentation/annotation of fracture lines and fragments were performed with 3D Slicer software.3D fracture lines extracted from gold-standard models were registered to a unified standard tibial model.A 3D probability heatmap was constructed by counting spatial fracture frequency,with high-incidence zones analyzed via spatial clustering algorithms.Three orthopedic surgeons independently completed AO/OTA classification and preoperative planning with the assistance of conventional CT only and CT with 3D fracture mapping.Accuracy,time consumption,inter-observer consistency(Cohen's κ),planning time,plan modification frequency,and subjective scores were evaluated.Results The 3D fracture heatmap revealed that fracture lines predominantly concentrated in the anterolateral and posteromedial regions of the distal tibia,with an average of(4.2±1.1)hotspots,a coverage rate of(78.3±5.6)%,and(3.5±1.0)clustering areas.With 3D fracture mapping assistance,classification accuracy was improved to(88.0±5.0)%compared to(75.0±8.0)%with conventional CT(P=0.001);classification time reduced to(10.4±2.5)min from(15.2±3.1)min(P<0.001);and Cohen's κ increased from 0.68±0.05 to 0.82±0.03(P=0.002).For preoperative planning,the average planning time was(15.8±3.2)min in the 3D mapping-assisted group,which was significantly shorter than that of conventional CT group(22.5±4.3)min(P<0.001);the number of plan modifications was(1.5±0.7)times,lower than that of conventional CT group(3.2±1.1)times(P<0.001),and the subjective score was 8.9±0.9,higher than that of conventional CT group(6.8±1.2)(P<0.001).Conclusion The 3D fracture mapping accurately characterizes spatial distribution patterns of Pilon fractures,significantly improves classification accuracy,inter-observer consistency,and preoperative planning efficiency,and thus holds substantial clinical value.