Objective·To explore the effect of all-trans retinoic acid(ATRA)of different concentrations on osteogenic differentiation of jaw bone mesenchymal stem cells(jBMSCs)in rats.Methods·jBMSCs from 4-week-old Sprague-Dawley(SD)rats were isolated and cultured with whole bone marrow adherence method.The surface antigens were identified by using flow cytometry.Alkaline phosphatase(ALP)staining/alizarin red staining,oil red O staining and alcian blue staining were used to prove the multilineage differentiation potential of jBMSCs after osteogenic,adipogenic and chondrogenic induction respectively.jBMSCs were induced in osteogenic medium with ATRA of concentration of 0.01,0.1,1,5,10,20 μmol/L in vitro,and dimethyl sulfoxide(DMSO)was used as control group.Cell viability of jBMSCs in different groups were determined by CCK8.ALP staining and alizarin red staining were used to investigate the osteogenic ability of jBMSCs in each group and screened the concentrations for subsequent experiments.Quantitative real-time polymerase chain reaction(qPCR)and immunofluorescence staining were used to analyze the expressions of osteogenesis-related genes and proteins in jBMSCs of different concentrations.Results·The flow cytometry analysis showed that more than 98%of P1 jBMSCs were positive for CD29+CD90+CD31-CD45-,which was congruent with the characteristics of bone mesenchymal stem cells.The results of ALP staining/alizarin red staining,oil red O staining and alcian blue staining indicated that the P1 jBMSCs had the multilineage differentiation potential of osteogenesis,adipogenesis and chondrogenesis.The results of ALP staining/alizarin red staining showed that the osteogenic activity and mineralization ability of jBMSCs in 0.01,0.1 and 1 μmol/L ATRA groups were increased compared with those in the control group,while the osteogenic activity and mineralization ability were decreased when the concentration of ATRA increased,especially higher than 5 μmol/L(all P<0.05).qPCR analysis showed that the mRNA expression levels of osteogenesis-related genes such as Alp,bone sialoprotein(Bsp),collagen type Ⅰ α1(Col1a1)and osteocalcin(Ocn)were higher in the 0.1 and 1 μmol/L ATRA groups compared to the control group.However,further increasing the concentration of ATRA led to a decrease in gene expression levels,and when the concentration exceeded 5 μmol/L,it began to be lower than the control group level(all P<0.05).The immunofluorescence staining showed that the expression of osteogenic related proteins SP7,ALP and OCN in the 0.1 and 1 μmol/L ATRA groups were increased compared to the control group,while further increasing the concentration of ATRA led to a decrease in protein expression.When the concentration was higher than 5 μmol/L,it began to be lower than the control group level(all P<0.05).Conclusion·Lower concentrations(0.1,1 μmol/L)of ATRA can promote the osteogenic differentiation of rat jBMSCs,and the promoting effect reaches its peak at 0.1 μmol/L,while the effect can be weakened by further increasing the concentration.Higher concentrations(5,10,20 μmol/L)of ATRA could inhibit the osteogenic differentiation of rat jBMSCs,showing an inhibitory effect.In this study,the dual-directional effect of retinoic acid on osteogenic differentiation of jBMSCs was demonstrated in vitro,and 0.1 μmol/L ATRA was identified as the optimal concentration for osteogenic differentiation of jBMSCs in rats,which provided a reference basis for the development of in vivo studies and clinical application of ATRA.

Objective:To investigate the alteration in iodine nutritional status and influence on thyroid function in the elderly aged≥65 years following water source modification in high iodine areas.Methods:Data from Yaoji Town, Xuzhou, Jiangsu(an area with high iodine due to water sources) of the national epidemiological survey on thyroid diseases, iodine nutrition, and diabetes(TIDE study) in 31 provinces and cities in China from 2015 to 2017 were utilized. Additionally, data from the screening, monitoring, and intervention on thyroid diseases(TOPS study) in the elderly(≥65 years) in Shunhe Town, Suqian, Jiangsu(an area with iodine levels exceeding the recommended amount), and Yaoji Town, Xuzhou from May to August 2021, are included. Each subject completed a questionnaire, physical examination, laboratory tests and thyroid ultrasound examinations. A total of 2 717 subjects aged≥65 years were included, including group 1, 258 subjects in TIDE study; Group 2, 1 313 subjects in TOPS Xuzhou area; Group 3, 1 146 subjects in TOPS Suqian area.Results:The urinary iodine concentration(UIC) in group 2 was significantly lower than that in group 1 [(235.16±67.09)μg/L vs (491.58±384.93)μg/L, P<0.001], but no significant difference compared with group 3 [(235.16±67.09) μg/L vs(231.62±66.11) μg/L, P>0.05]. The serum TSH level in group 2 was significantly lower than that in group 1 [(2.92±5.14)μIU/mL vs (4.15±9.19)μIU/mL, P<0.001]. Compared with group 2 and 3, the prevalence of subclinical hypothyroidism in the elderly in group 1 was the highest(22.48% vs 10.13% and 8.12%, P<0.001). TSH levels were linearly correlated with age in both excessive iodine and more than adequate iodine nutrition areas. TSH level was gradually increased with age. Conclusion:The alteration in TSH levels among the elderly is notably linked to both aging and iodine status. The prevalence of hypothyroidism in the elderly can be significantly reduced when the iodine nutrition status of the elderly returns to normal.

Objective:To compare the short-term efficacy and the safety of microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of benign thyroid nodules (BTNs).Methods:This prospective randomized controlled trial, performed from December 2019 to September 2021, included 36 patients with solid or predominantly solid BTNs who met the eligibility criteria and provided written informed consent at the Nanjing sub-center (Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine). Patients were assigned to either the MWA group or the RFA group (18 patients in each group) at a ratio of 1∶1 using a block randomization design and allocation concealment using sealed envelope randomization. The independent-sample t-test and χ2 test were used to compare the volume reduction rates (VRRs), effective rates (VRRs≥50%), cosmetic scores, and complication rates at 1, 3, and 6 months after treatment between the two groups. Results:The clinical characteristics of the two groups of patients were comparable. After ablation, the nodule volume was significantly reduced in both groups. At 1, 3, and 6 months, there was no significant difference in the volume between the two groups (all P>0.05). At 3 months, the RFA group had a larger VRRs than that in the MWA group (62.08%±12.46% vs. 46.90%±23.16%, t=-2.45, P=0.021). However, at 1 and 6 months, no statistical significance was observed (both P>0.05). No significant difference was observed in the effective rates at the last follow-up (14/18 vs. 18/18, P=0.104). However, the RFA group had a lower cosmetic score than that in the MWA group (1.78±0.43 vs. 2.17±0.51, t=-2.47, P=0.019). There was no statistically significant difference in the complication rates between the two groups (all P>0.05). Conclusions:Both MWA and RFA were effective and safe treatments for BTNs, with no significant differences in short-term efficacy and safety. In addition, the RFA group showed slightly more favorable outcomes than the MWA group in terms of cosmetic improvement.

Objective:To investigate the factors influencing fall risk scores in elderly individuals.Methods:A total of 4 419 individuals were randomly selected using the cluster sampling method from Beijing, Nanning(Guangxi), and Yinchuan(Ningxia).Data on demographic characteristics and fall-related incidents were gathered and analyzed for their correlation with fall risk scores.Results:The fall risk score showed significant associations with various factors, such as the history of falls within one year( β=-3.607, 95% CI: -3.881 to -3.332), care methods( β=2.442, 95% CI: 2.226 to 2.658), exercise( β=0.714, 95% CI: 0.443 to 0.986), retirement( β=-0.585, 95% CI: -0.819 to -0.351), age( β=0.173, 95% CI: 0.159 to 0.187), and use of walking aids( β=-3.737, 95% CI: -4.054 to -3.421). Conclusions:Fall risk scores in older adults are influenced by a variety of factors.Factors such as no history of falls within the past year, living independently, engaging in physical activity, and being employed may contribute to lower fall risk scores in older adults.

Objective:To investigate the clinical efficacy of butylphthalide combined with hyperbaric oxygen therapy on post-stroke cognitive impairment in patients with acute ischemic stroke.Methods:A total of 90 patients with post-stroke cognitive impairment who were hospitalized within 72 hours of onset in Suining County People's Hospital from December 2019 to November 2020 were included in this study. They were randomly divided into a control group and an observation group ( n = 45/group). The control group was given conventional treatment and the observation group was given butylphthalide combined with hyperbaric oxygen therapy in addition to conventional treatment. The National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score, and Activities of Daily Living score were compared between the two groups before and after treatment. Results:Before treatment, there were no significant differences in the National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score, and Activities of Daily Living score between the two groups (all P > 0.05). At 14 days and 1 month after surgery, the National Institutes of Health Stroke Scale scores in the observation group were (4.02 ± 2.18) points and (3.21 ± 2.03) points, which were significantly lower than (5.21 ± 2.24) points and (4.62 ± 2.68) points in the control group ( t =2.55, 2.81, both P < 0.05). At 1 and 3 months after treatment, the Montreal Cognitive Assessment score in the observation group were (19.79 ± 5.67) points and (23.69 ± 2.67) points, which were significantly higher than (16.88 ± 5.12) points and (19.74 ± 2.29) points in the control group ( t = 2.56, 7.53, both P < 0.05). At 1 and 3 months after treatment, Activities of Daily Living scores in the observation group were (54.85 ± 5.69) points and (74.38 ± 4.98) points, which were significantly higher than (46.78 ± 6.24) points and (63.21 ± 5.24) points in the control group ( t = 6.41, 9.76, both P < 0.05). Conclusion:Butylphthalide combined with hyperbaric oxygen therapy for the treatment of post-stroke cognitive impairment in patients with acute ischemic stroke can alleviate neurologic deficits, and improve cognitive function and the ability of daily life.

Objective:To explore the incidence of secondary hemophagocytic lymphohistiocytosis (sHLH) in elderly patients with severe SARS-CoV-2 infection, and to analyze and summarize its clinical features and risk factors for early identification of high-risk groups.Methods:A retrospective cohort study was conducted. From January to May 2020, No. 960 Hospital of People's Liberation Army, the Second Hospital Affiliated to Cheeloo College of Medicine of Shandong Province, the First Rehabilitation Hospital of Shandong Province, the Public Health Clinical Center Affiliated to Shandong University, and Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine received 248 patients over 60 years old who were diagnosed with severe SARS-CoV-2 infection during their assistance to Hubei or support for diagnosis and treatment of SARS-CoV-2 infection in Shandong Province. The clinical data of patients were collected. According to the hemophagocytic lymphohistiocytosis diagnosis scoring (HScore) criteria, the patients were divided into sHLH group (HScore > 169) and non-sHLH group (HScore < 98). The demographic data, clinical features, laboratory results, the proportion of organ failure and 60-day mortality of patients were collected and compared between the two groups. The risk factors of sHLH and 60-day death were evaluated through binary multivariate Logistic regression analysis in elderly patients with severe SARS-CoV-2 infection. The receiver operator characteristic curve (ROC curve) was plotted to analyze the diagnostic value of indicators only or combined for sHLH.Results:Among 248 elderly patients with severe SARS-CoV-2 infection, 82 patients with incomplete data and untraceable clinical outcomes, and 35 patients with HScore of 98-169 were excluded. Finally, 131 patients were enrolled in the final follow-up and statistics, including 25 patients in the sHLH group and 106 patients in the non-sHLH group. Compared with the non-sHLH group, plasma albumin (ALB), hemoglobin (Hb), lymphocyte count (LYM), platelet count (PLT), fibrinogen (Fib) and prealbumin (PAB) in the sHLH group were significantly reduced, while alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), MB isoenzyme of creatine kinase (CK-MB), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ferritin (Fer), lactate dehydrogenase (LDH), procalcitonin (PCT), cardiac troponin I (cTnI), triglycerides (TG), interleukin-6 (IL-6), total bilirubin (TBil) were significantly higher. The fever and fatigue in the sHLH group were more severe than those in the non-sHLH group, and the patients in the sHLH group had higher rates of shock, acute kidney injury, liver dysfunction, and cardiac injury than the non-sHLH group. The 60-day mortality of patient in the sHLH group was significantly higher than that in the non-sHLH group [84.0% (21/25) vs. 40.6% (43/106), P < 0.01]. Binary multivariate Logistic regression analysis showed that high Fer [odds ratio ( OR) = 0.997, 95% confidence interval (95% CI) was 0.996-0.998], D-dimer ( OR = 0.960, 95% CI was 0.944-0.977), LDH ( OR = 0.998, 95% CI was 0.997-0.999) and TG ( OR = 0.706, 95% CI was 0.579-0.860) were independent risk factors for sHLH in elderly patients with severe SARS-CoV-2 infection (all P < 0.01), while elevated Fer ( OR = 1.001, 95% CI was 1.001-1.002), LDH ( OR = 1.004, 95% CI was 1.002-1.005) and D-dimer ( OR = 1.036, 95% CI was 1.018-1.055) were independent risk factors for 60-day death of patients (all P < 0.01). The death risk of the sHLH patients was 7.692 times higher than that of the non-sHLH patients ( OR = 7.692, 95% CI was 2.466-23.987, P = 0.000). ROC curve analysis showed that a three-composite-index composed of LDH, D-dimer and TG had good diagnostic value for sHLH in elderly patients with severe SARS-CoV-2 infection [area under the ROC curve (AUC) = 0.920, 95% CI was 0.866-0.973, P = 0.000]. Conclusions:Elderly patients with severe SARS-CoV-2 infection complicated by sHLH tend to be critically ill and have refractory status and worse prognosis. High Fer, LDH, D-dimer and TG are independent risk factors for sHLH, and are highly suggestive of poor outcome. The comprehensive index composed of LDH, D-dimer and TG has good diagnostic value, and can be used as an early screening tool for sHLH in elderly patients with severe SARS-CoV-2 infection.

Objective:To evaluate the effects of ketogenic diet(KD) on pancreatic β-cell dedifferentiation in db/db mice.Methods:In animal study, 8-week-old db/db male mice with type 2 diabetes mellitus(T2DM) were randomly divided into 3 groups: T2DM model group(ND), KD group, 75% caloric restriction(CR) group, and male C57BL/6 mice of the same age as normal control group(C) fed with standard diet. Both C and ND groups were on ad lititum feeding of chow, the KD group was free to eat the ketogenic diet, and the CR group was the positive control group, consuming 75% of the calories of the ND group every day. Four weeks after different diet intervention, body weight, fasting blood glucose, fasting insulin, glucose tolerance and blood β-hydroxybutyric acid(BHB) were measured. Morphology and structure of pancreatic islet was observed by hematoxylin-eosin staining(HE). Immunofluorescence co-staining was used to observe the expression of mouse pancreatic β-cell specific transcription factors.Results:After 4 weeks diet intervention, the fasting blood glucose, insulin and the area under the curve of blood glucose in KD group was significantly decreased( P<0.05); When compared with ND group, the morphology and structure of the islets in the KD group were more regular, and the number of islet cells increased as revealed with HE staining. Pancreatic immunofluorescence co-assay showed that KD not only restored the number and arrangement of β-cells and the ratio of β/α-cell in the pancreatic islets, but also reversed the expression of specific β-cell transcription factors such as pancreatic duodenal homeobox factor-1(PDX1). Conclusion:KD can reduce fasting blood glucose, fasting insulin and improve glucose tolerance in db/db mice, which may be related to its ability to restore the expression of specific β-cell transcription factors and reverse the dedifferentiation of pancreatic β-cells.

Objective:To investigate the epidemiological characteristics and relevant factors among individuals characterized by their longevity in multiple regions of Guangxi Zhuang Autonomous Region, and provide a valuable scientific perspective for the research in health and longevity of the elderly in Guangxi.Methods:Registration and face-to-face questionnaire on a door-to-door basis were adopted to collect the demographic characteristics of the long-lived individuals (≥90 years old) in Bama of Hechi city, Yongfu of Guilin city, Dongxing of Fangchenggang city, Guangxi. Then, among the local general population, individuals within the age group between 40 and 85 years old were selected randomly as controls. Correlations were then analyzed between the relative health and longevity of the subjects and their gender, ethnicity, family history, disease history, marital status, the number of family generations, the number of children, smoking, drinking, outdoor activities, sleep and other health-related factors, then the result was subject to further analysis by comparing the long-lived population and the control population respectively.Results:Among 691 500 of the permanent residents of Bama, Yongfu and Dongxing city, 1 005 cases were 90 years old and over with a ratio of 145.34 out of 100 000 persons; within the 1 005 cases, 944 were aged between 90 and 100 (longevity rate: 136.51/100 000) with an average age of (93.28±2.57); 61 cases were aged 100 or over, arriving at a centenarian rate of 8.82/100 000 with an average age of (102.00±3.05) years. Significant differences were found just among three particular factors — regional distribution ( P=0.014), history of disease ( P=0.002), four generations of family ( P=0.008) between nonagenarians and centenarians ( P<0.05), while the other 15 indicators did not show anything noteworthy. The result indicated that longevity and centenarians might be the same group and then we combined both groups into one. By cross-comparison between the longevity-plus- centenarians and the control group in the region, factors listed below exhibited significant correlation with health and longevity: marital status ( OR=26.469, 95% CI: 13.208-53.045), number of generations within the family ( OR=5.419, 95% CI: 3.418-8.592), number of male offspring ( OR=2.013, 95% CI: 1.555-2.607), number of female offspring ( OR=1.380, 95% CI: 1.122-1.696), and the frequency of outdoor activities ( OR=10.226, 95% CI: 3.164-33.045). Conclusions:The longevity rate is higher in the general natural population in Bama, Yongfu and Dongxing of Guangxi. The phenomenon may owe to favorable family structure, atmosphere within or out of the family or other elements related with social surrounding. Among them all, mentality, inclination to physical exercise and regular rhythm of life may all exert tremendous contributory influence here.

Objective:To explore the epidemiologic characteristics of long-lived population and influencing factors in Shanglin county of Guangxi and provide scientific basis for the study of health and longevity in Guangxi.Methods:We collected and analyzed the general demographic cross-sectional data of the long-lived individuals (≥90 years old) in 11 villages and towns by multi-source registration and face-to-face interview. The age group control design was adopted to conduct a comparison among the longevity group (90-100 years old), centenarian group (≥100 years old), the longevity plus centenarian group and control group (local population aged 40-85 years), and identify the factors related to longevity.Results:Among the 496 007 people registered in Shanglin, 1 533 were aged ≥90 years, including 1 453 in the longevity group, with an average age of (92.84±2.46) years, and 80 in the centenarian group, with an average age of (102.67±2.60) years. The spatial distribution of long-lived individuals and centenarians was mainly in the north and central areas, and sparse in southwest area. Analysis on factors related to health and longevity indicated that old people with Zhuang ethnic ( OR=1.551,95% CI:1.308-1.838), married ( OR=55.507,95% CI:36.087-85.377) and moderately high waist-to-hip ratio ( OR=258.056,95% CI:27.775-2 397.569), and SBP ( OR=1.019,95% CI:1.013-1.026) tended to live longer. Conclusions:We found that the rate of longevity in Shanglin was higher than the average level in Guangxi and China. Longevity in Shanglin country had unique spatial and population distribution characterics of female longevity more than male longevity, mainly Zhuang ethnic and so on. Being women, married, family history of longevity, appropriate high waist-to-hip ratio, SBP and blood sugar level might be positive factors for longevity in Shanglin, but the impacts of other factors on longevity need further study.

Objective:To explore the efficacy and safety of the remedial stent implantation after mechanical thrombectomy for acute cerebral infarction.Methods:From October 2014 to December 2018, the clinical data of 16 patients with acute cerebral infarction who could not maintain forward blood flow after mechanical thrombectomy in 985 Hospital of joint service support force of PLA were analyzed retrospectively.To analyze the score of National Institutes of Health Stroke Scale (NIHSS), degree of vascular recanalization after operation thrombolysis incerebral infarction(TICI) classificatio, mechanical thrombolytic number, postoperative vascular reocclusion rate, incidence of intracranial hemorrhage, NIHSS score 1 week later, good clinical result after 90 days(improved Rankin scale, mRs= 0-2) and other indicators.Results:After mechanical embolectomy, 16 stents were implanted (15 of them were Solitaire stents, 1 of them was Apollo stents), 12 patients with TICI=3, and 4 patients with TICI=2b.The average number of times of mechanical thrombectomy was(3.25±1.09). Balloon expansion was performed before stent placement in 7 patients with limited stenosis.The time from the onset to the reperfusion was(10.96 ± 3.24) hours. Computed tomography angiography(CTA) was reexamined 24 hours after operation, showing vascular of 3 cases were reocclusion and 3 cases occured intracranial hemorrhage(all less than 10 ml). In 2 cases of decompressive osteotomy, NIHSS score was improved from preoperative (24.25±4.58) points to postoperative (7.44±5.09) points.After 90 days, 10 patients had a good prognosis (mRs ≤ 2) and 1 patient died (pulmonary infection).Conclusion:After mechanical thrombectomy of acute cerebral infarction, if there is severe stenosis or forward blood flow can not be maintained, use the Solitaire stent or other stent to remedy the placement, with fewer complications and better clinical effect.