Objective To explore the relationship between fractional anisotropy (FA) of corticospinal tract (CST) and motor function in stroke patients using diffusion tensor imaging (DTI). Methods From January, 2013 to October, 2016, 36 stroke patients were evaluated with Fugl-Meyer Assessment (FMA), Japan Upper Limb Function Test and DTI before and eight weeks after rehabilitation. FA in posterior limb of internal capsule, cerebral peduncle and pons were obtained, including ipsilesional and contralesional CST. Results The FA values within three sections of CST were significantly lower in the ipsilesional side than in the contralesional side both before and after rehabilitation (t>5.330, P<0.001). In posterior limb of internal capsule, the FA value increased after rehabilitation (t=-3.415, P<0.05), and no significant dif-ference was found in the other two sections (t<1.653, P>0.05) in the ipsilesional side, as well as in all the sections in the contralesional side (t<1.021, P>0.05). The FA values were positively correlated with the scores of FMA and Japan Upper Limb Function Test in all the sections both before and after rehabilitation (r>0.43, P<0.05), especially the relationship between the FA value and the score of Japan Upper Limb Function Test in the posterior limb of internal capsule (r=0.67). Conclusion DTI can be used to evaluate CST injury and the relationship be-tween CST injury and motor function.

Objective To observe the relationship between injury of corticospinal cord tract (CST) in basal ganglia and upper limb func-tion after stroke using diffusion tensor imaging (DTI). Methods 18 stroke inpatients hospitalized from January, 2013 to July, 2015 accepted DTI, and their upper limb function was evaluated with simple Fugl-Meyer Assessment and Japan Upper Limb Function Test. The fractional anisotropy (FA) of CST in basal ganglia of affected and unaffected sides were compared, and the correlation between FA of affected CST and upper limb motor function were analyzed. Results The FA was significantly less in the affected CST than in the unaffected CST (t=-21.09, P<0.001). The FA of the affected CST correlated with the scores of simple Fugl-Meyer Assessment (r=0.570, P<0.05) and Japan Upper Limb Function Test (r=0.509, P<0.05). Conclusion CST is injured after stroke, which may related to the upper limbs motor function impairment.

OBJECTIVETo study the frequency of rare blood group Lu(a-b-) phenotype in a population from Shanghai region, and to explore the molecular basis of Lu(a-b-) by detecting the Lu and Lu relative mediator gene EKLF/KLF1.

METHODSDonors from Shanghai region were screened for Lutheran blood group by monoclonal anti-Lub using serological methods. Individuals with Lu(b-) were determined Lua, P1 and i antigens. Fifteen exons of the LU gene and 3 exons of the EKLF/KLF1 gene for the identified Lu(a-b-) samples were amplified and sequenced.

RESULTSTen Lu(a-b-) donors were obtained from 44 331 donors from Shanghai region. No homozygous or heterozygous mutations were found in the LU gene, whilst 7 mutations in EKLF/KLF1 gene were identified in the 10 samples.

CONCLUSIONThe frequency of rare Lu(a-b-) blood group in Shanghai was approximately 0.02%, and all the individuals had an In(Lu) phenotype. The molecular basis of such samples may be related to mutations in the EKLF/KLF1 gene.

China ; ethnology ; Humans ; Kruppel-Like Transcription Factors ; genetics ; Lutheran Blood-Group System ; genetics ; Mutation ; Phenotype

To deeply analyze the existing problems in the medical humanities MOOCs, this study adopts qualitative research methods such as participatory observation, interview and special panel discussion from two different perspectives of teaching and learning. On one side, the study follows the course building process of two medical humanities MOOCs in a medical university in South China, and conducts interviews and panel discussions with teaching teams, MOOC producers, and medical education experts in order to understand the problems, challenges and related countermeasures and thoughts in the construction process. On the other side, students' learning feelings, gains and opinions on medical humanities MOOCs in the existing national excellent online open courses have been investigated. Findings revealed that there obvious differences between the attitudes of teaching and learning, which reflects the challenges of the medical humanities MOOCs at the micro level, including difficulties in realizing autonomous learning under effective monitoring and achieving important teaching achievements, excessive workload of teachers, etc.. Furthermore, the differences between teaching and learning have shed a light on medical humanistic education concept, teaching mode and teacher cultivation. Finally, the macro development trend of online and offline coordination and complementarity of medical humanities MOOCs, and the coexistence of mass and personalized curriculum is predicted.

Backgrounds Insomnia is frequent in schizophrenia and is found to be negatively affected by stressful life events,psychotic symptoms and depressive disorder,while the relationship among the four remains understudied in community-dwelling patients with schizophrenia.Objective To analyze the effect of stressful life events on insomnia in community-dwelling patients with schizophrenia,and to explore the mediation effect of psychotic symptoms and depression,so as to provide references for the intervention of insomnia in community-dwelling patients with schizophrenia.Methods From April to June 2023,a sample of 1 105 patients with schizophrenia attending 48 community health centers in Chengdu,Sichuan province and fulfilling the International Classification of Diseases,tenth edition(ICD-10)diagnostic criteria were included.All subjects were assessed using Stressful Life Event Scale(SLEs),Athens Insomnia Scale(AIS),Psychosis Screening Questionnaire(PSQ),and Patient Health Questionnaire Depression Scale(PHQ-9).Spearman correlation analysis was used to determine the correlation among the scales.Then the mediation model was constructed using Smart PLS 4.0,and tested with partial least squares algorithm and Bootstrap techniques.Results 332 patients(30.05%)with community schizophrenia were found to have insomnia.AIS scores in patients with schizophrenia were positively correlated with the scores on SLEs,PSQ and PHQ-9(r=0.165,0.322,0.554,P<0.01).Stressful life events indirectly contributed to insomnia through both separate mediation path and chained mediation path of psychotic symptoms and depressive disorder,and the indirect effect size of 0.102,0.372 and 0.190 was obtained,accounting for 10.46%,38.15%and 19.49%,respectively.Conclusion The stressful life events not only directly exert an impact on insomnia,but also indirectly contribute to insomnia through both the separate and chained mediation effect of psychotic symptoms and depressive disorder.

Objective:To investigate the predictive value of stone composition prediction method based on dual-source stone energy spectrum CT for uric acid stones.Methods:The clinical data of 204 patients with urinary stones, 159 males and 45 females, admitted to Shanghai Sixth People's Hospital from July 2020 to July 2022 were retrospectively analyzed. The average age was (50.7±14.3) years. There were 187 cases of upper urinary tract (kidney, ureter) stones and 17 cases of lower urinary tract (bladder, urethra) stones. All patients underwent preoperative dual-source stone energy spectroscopy CT, measuring CT values at 150 kV and 100 kV, respectively, and the calculated dual energy ratio (Ratio) was used to predict stone composition. Of the 204 cases in this group, 33 cases underwent percutaneous nephrolithotomy and 171 cases underwent ureteroscopic lithotripsy. Postoperative stone specimens were analyzed for stone composition by infrared spectroscopy. Subject work characteristic (ROC) curves were used to analyze the efficacy of preoperative dual-source stone energy spectrum CT to predict uric acid stones.Results:In 204 patients, preoperative CT predicted 28 cases of uric acid stones and 176 cases of non-uric acid stones, including 136 cases of calcium oxalate stones, 38 cases of hydroxyapatite, and 2 cases of cystine stones. Postoperative IR spectral analysis detected 26 cases of uric acid stones and 178 cases of non-uric acid stones, including 129 cases of calcium oxalate stones, 47 cases of hydroxyapatite, and 2 cases of cystine stones. Compared with the preoperative CT results, there were 2 false positives and no false negatives in the classification of uric acid stones. The ROC curve showed that the sensitivity of the CT value for predicting uric acid stones at 100 kV was 96.2%, the specificity was 99.5%, and the area under the ROC curve (AUC) was 0.995, with the best prediction value of 620 HU.The sensitivity of the CT value for predicting uric acid stones at 150 kV was 96.2%, specificity was 85.5%, AUC was 0.916, and the best predictive value was 597.5 HU. The sensitivity of using Ratio values for predicting uric acid stones was 100.0%, specificity was 97.9%, AUC was 0.996, and the best predictive value was 1.14. The CT values for uric acid stones at 100 kV and 150 kV were (558.58±77.07) HU and (521.12±83.54) HU, CT values for calcium oxalate stones were (1 335.26±301.82) HU and (878.21±200.21) HU, CT values for hydroxyapatite were (1 104.09±203.61) HU and (710.38±178.44) HU, respectively.The CT values of cystine stones were (684.5±67.18) HU and (573.5±67.10) HU, respectively, and the differences between uric acid stones and other components were statistically significant ( P<0.01). The Ratio values of uric acid stones, calcium oxalate stones, hydroxyapatite, and cystine stones were 1.08±0.06, 1.52±0.08, 1.62±0.40, and 1.19±0.02, respectively, and the differences were statistically significant ( P<0.01) when comparing uric acid stones with other components. Conclusion:The CT and Ratio values of dual-source stone energy spectrum CT can effectively distinguish uric acid stones from other types of stones, and the accuracy, sensitivity, and specificity of this method for predicting uric acid stones are high.

Objective To explore the latent class and influencing factors between different behavioral lifestyles in community patients with diabetes, to classify the population and reveal the behavioral lifestyle characteristics of different types of diabetes, and to provide a scientific basis for active health management of diabetes, the identification of high-risk groups and maximization of the effect of intervention measures. Methods From June to August 2022, a behavioral and lifestyle follow-up survey was conducted on 1 179 diabetes patients with electronic health records from 18 community health service centers in Pingshan District, Shenzhen. The latent class analysis (LCA) method was used to cluster the life and behavior style of the study subjects, and the disordered multi-classification logistic regression was used to analyze the influencing factors of each class. Results The LCA results showed that there were three latent classes of community diabetes patients: ^“overweight and obese group^” (28.4%), ^“balanced diet group^” (30.8%), and ^“vegetarian but persistent exercise group^” (40.8%). Logistic regression analysis results showed that age, total cholesterol , LDL , fasting blood glucose, comorbidities, and hypertension history affected the latent classes of behavioral lifestyle in diabetic patients in the community (P<0.05). Conclusion The behavioral lifestyle of community diabetes patients has obvious classification characteristics and obvious differentiation in terms of eating behavior. Doctors and health managers can issue corresponding lifestyle medicine prescriptions and formulate corresponding active health management measures to prevent the occurrence of risk factors related to diabetes patients in advance and formulate personalized intervention measures.

Background Nitrogen dioxide (NO₂) is one of the main air pollutants, and though China's NO₂ pollution has been improving year by year, it maintains at a high level, threatening the health of the population. Objective To investigate the effect of short-term exposure to atmospheric NO₂ on the coagulation indexes in obese and normal-weight young individuals and potential modification effect of temperature. Methods Based on a parallel control panel study design, this study recruited 53 normal-weight and 44 obese young individuals. Three prospective follow-ups were conducted. Air pollution data were obtained from the fixed monitoring station closest to the participant's residences, and personal air pollution exposure was simulated based on time-activity log and infiltration factor for the week before every follow-up. Temperature was collected from China Meteorological Data Service Center. Venous blood samples were taken to measure platelet (PLT) count, mean platelet volume (MPV), soluble CD40 ligand (sCD40L), soluble P-selectin (sP-selectin), platelet aggregation rate (PAgT), and plasminogen activator inhibitor type-1 (PAI-1) during every follow-up. A linear mixed-effect model was used to assess the association between short-term atmospheric NO₂ exposure and the coagulation indexes of weight grouped young individuals, and a stratified analysis was used to explore potential modification effect of temperature. Results The median [interquartile range (IQR)] of personal atmospheric NO₂ exposure concentrations was 21.47 (8.01) µg·m⁻³. Short-term exposure to atmospheric NO₂ was significantly associated the increase of sCD40L and PAgT in the obese individuals, while the most significant association appeared at 5 d lag, and for each IQR increase in the average sliding exposure concentration of atmospheric NO₂ with a 5 d lag, sCD40L increased by 27.4% (95%CI: 4.2%, 56.6%) and PAgT increased by 37.5% (95%CI: 12.2%, 68.6%); short-term exposure to atmospheric NO₂ was significantly associated with the decrease of PLT and PAgT in the normal-weight individuals, while the most significant association appeared at 5 d lag or 7 d lag, and for each IQR increase in the average sliding exposure concentration of atmospheric NO₂ with a 5 d lag, PLT decreased by 11.8% (95%CI: −17.8%, −5.3%), and for each IQR increase in the average sliding exposure concentration of atmospheric NO₂ with a 7 d lag, PAgT decreased by 16.8% (95%CI: −30.6%, −0.4%). We didn't find statistically significant association of short-term exposure to atmospheric NO₂ with PLT in the obese individuals or sCD40L in the normal-weight individuals, nor statistically significant association between short-term exposure to atmospheric NO₂ and PAI-1, MPV, and sP-selectin in different weight grouped individuals. The stratified analysis found that short-term exposure to atmospheric NO₂ was significantly associated with PAgT in the normal-weight individuals, or with PLT, sCD40L, and sP-selectin in the obese individuals only at high temperature. Conclusions Short-term exposure to atmospheric NO₂ has adverse effects on the coagulation indexes of different weight grouped young individuals, and the obese individuals are more sensitive to it than the normal-weight individuals. High temperature can enhance the adverse health effect of short-term exposure to atmospheric NO₂.