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 investigate the characteristics and risk factors of an outbreak of acute hemorrhagic conjunctivitis (AHC) in a boarding middle school in Guangdong Province, in order to provide a scientific evidence for effective prevention and control of campus AHC outbreaks. Methods: From September 1st to 28th 2023, case identification was conducted among 559 students and 60 faculty members using standardized definition. Descriptive analysis was conducted on the three distrubution patterns of the outbreak. Questionnaires were designed, and a case-control study was adopted to analyze the possible risk factors of the disease transmission. The propensity score matching (PSM) method was used to control the difference of baseline data. Results: A total of 269 cases of AHC were identified, with an attack rate of 43.46%. The pathogen was confirmed as Coxsackie virus A24 variant (CA24v). Among these, 264 cases were students (attack rate of 47.23%) and 5 were staff (attack rate of 8.33%). A total of 153 pairs of PSM were successfully matched. After PSM matching, there were no statistically significant differences in gender, grade and class between the case group and the control group ( χ 2=0.12, 5.41, 11.24, P >0.05). The results of multivariate Logistic regression analysis showed that middle school students whose towels contacted with others ( OR =1.81), and direct contact with other AHC cases recently ( OR =4.89) were more likely to have AHC; while wearing glasses ( OR =0.43) and frequent use of hand sanitizer ( OR = 0.37 ) were less likely to have AHC ( P <0.05). Conclusion The outbreak of AHC is caused by CA24v, demonstrating rapid spread and extensive impact within the school setting.

Objective: To explore the effects of Cldn14 gene knockout on renal metabolism and stone formation in rats，so as to provide reference for research in the field of urinary calium metabolism and stone formation. Methods: Cldn14 gene knockout homozygous rats and wild-type rats of the same age were randomly divided into 4 groups：wild-type control (WC) group，wild-type ethylene glycol (WE) group，gene knockout control (KC) group and gene knockout ethylene glycol (KE) group，with 10 rats in each group.The WE and KE groups were induced with ethylene glycol + ammonium chloride to form kidney stones，while the WC and KC groups received normal saline gavage.After 4 weeks of standard maintenance feeding，the urine samples were collected to detect the venous blood.The kidneys were collected for HE，Pizzolatto's staining and transmission electron microscopy.The protein in renal tissues was extracted to detect the expressions of Claudin16 and Claudin19. Results: Crystal deposition was observed in the renal tubular lumen of the WE and the KE groups，and more crystals were detected in the KE group.The WE group had a large number of intracytoplasmic black crystalline inclusions observed in renal tubular epithelial cells under transmission electron microscope，followed by the KE and KC groups.Compared with WC and WE groups，KC and KE groups had significantly decreased serum calcium and magnesium levels but significantly increased urinary calcium level.In addition，the urinary calcium level was higher in the WE group than in the WC group and higher in the KE group than in the KC group.The KE group had lower level of Claudin16，but there was no significant difference in the level of Claudin19 among the 4 groups(P>0.05). Conclusion: Knockout of Cldn14 gene alone cannot effectively reduce urinary calcium excretion or reduce the risk of stone formation in rats，which may be related to the decrease of Claudin16 level.

OBJECTIVE: This study aimed to identify high-risk areas for type 2 diabetes mellitus (T2DM) mortality to provide relevant evidence for interventions in emerging economies. METHODS: Empirical Bayesian Kriging and a discrete Poisson space-time scan statistic were applied to identify the spatiotemporal clusters of T2DM mortality. The relationships between economic factors, air pollutants, and the mortality risk of T2DM were assessed using regression analysis and the Poisson Log-linear Model. RESULTS: A coastal district in East Guangdong, China, had the highest risk (Relative Risk [RR] = 4.58, P < 0.01), followed by the 10 coastal districts/counties in West Guangdong, China (RR = 2.88, P < 0.01). The coastal county in the Pearl River Delta, China (RR = 2.24, P < 0.01), had the third-highest risk. The remaining risk areas were two coastal counties in East Guangdong, 16 districts/counties in the Pearl River Delta, and two counties in North Guangdong, China. Mortality due to T2DM was associated with gross domestic product per capita (GDP per capita). In pilot assessments, T2DM mortality was significantly associated with carbon monoxide. CONCLUSION High mortality from T2DM occurred in the coastal areas of East and West Guangdong, especially where the economy was progressing towards the upper middle-income level.
Diabetes Mellitus, Type 2/epidemiology* ; China/epidemiology* ; Humans ; Risk Factors ; Spatio-Temporal Analysis ; Air Pollutants/analysis* ; Socioeconomic Factors ; Bayes Theorem ; Female ; Male ; Middle Aged

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 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 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 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:With the aging of the population and the increase of medical treatment in different places,chaperone services are gradually emerging,but there are problems such as insufficient training of patient navigators and lack of rules and regulations in the industry.It is necessary to strengthen supervision and standardized management to improve service quality.To explore the current situation and risks of the chaperone service industry from the perspective of patient navigators and doctors,and to provide suggestions for policy formulation.Methods:The Theory of Planned Behavior(TPB)and Knowledge-Attitude-Practice(KAP)models were developed to outline the interview.A total of 22 doctors and patient navigators were selected from 5 large Grade Three hospitals and 20 online consultation platforms in Shanghai for semi-structured interviews.The data were analyzed using"7 Steps of Data Analysis in Colaizzi Phenomenology Research".Results:The chaperone service industry faces risks such as lack of professional norms,vague definition of legal responsibilities,insufficient professional competence among practitioners,and regulatory gaps.Conclusions:We should further establish a unified industry standard and certification system,strengthen the training of patient navigators,improve the supervision of online platforms,and effectively protect the rights and interests of doctors,so as to better promote the development of the industry and provide quality services for patients and doctors.