OBJECTIVE: To analyze the current status and trends of the disease burden of knee osteoarthritis (KOA) in China from 1990 to 2023, and to examine the epidemiological characteristics of age, gender differences, and attribution to high body mass index (BMI), in order to provide a basis for formulating prevention and treatment strategies to reduce the disease burden of KOA in China. METHODS: Based on the 2023 Global Burden of Disease Study (GBD) database, data on the number, rate, and age-standardized rate of incidence, prevalence, disability-adjusted life years (DALYs) for KOA, and DALYs for KOA attributable to high BMI in the Chinese population from 1990 to 2023 were integrated. The Joinpoint 5.4.0.0 software was used to analyze the age and gender differences in KOA and the epidemiological characteristics attributable to high BMI. RESULTS: The standardized incidence, prevalence, and DALYs rates of KOA in China in 2023 increased by 6.46%, 6.43%, and 6.93%, respectively, compared with 1990. In terms of age, the disease burden of KOA in China was lowest in the age group of 30-34 years, with the highest incidence rate in the age group of 50-54 years, whereas the prevalence rate and DALYs rate continued to increase with age, and both were highest in the age group of ≥70 years. In terms of gender, all disease burden standardized rate indicators were higher in females than in males, and the difference widened with age. The rate of BMI-attributable DALYs increased at an annual average rate of 1.57% (95% CI: 1.55, 1.59) from 1990 to 2023, again with significant age and gender differences. CONCLUSION The continued growth of the KOA disease burden and significant population differences characterizing China call for focused attention on the female middle-aged and elderly population, enhanced weight management, and implementation of targeted preventive and control measures.
Humans ; Osteoarthritis, Knee/epidemiology* ; China/epidemiology* ; Male ; Female ; Middle Aged ; Incidence ; Aged ; Adult ; Prevalence ; Body Mass Index ; Disability-Adjusted Life Years ; Cost of Illness ; Aged, 80 and over ; Sex Factors ; Global Burden of Disease ; Age Factors ; Young Adult ; Quality-Adjusted Life Years

Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

Objective To explore the association between physical activity levels and metabolic dysfunction-associated fatty liver disease(MAFLD)and the modifying effects of different types of obesity.Methods A cross-sectional study was conducted on 19925 participants recruited from the Chengdu sub-cohort of the Southwest China Natural Population Cohort.The participants were recruited between 2018 and 2019.The association between physical activity and MAFLD prevalence was examined using the inverse probability weighting(IPW)method based on the generalized propensity score(GPS).The odds ratios(OR)and the 95％confidence interval(CI)for moderate and vigorous physical activity were calculated using the mild physical activity group as a reference.A restricted cubic spline function was used to model the exposure-response relationship between physical activity and MAFLD risk.The potential modifying effects of obesity types on the association between physical activity and MAFLD were evaluated in male and female populations.Results The prevalence of MAFLD was 17.30％.Compared to those engaging in mild physical activity,individuals participating in vigorous and moderate physical activities had a lower risk of MAFLD,with OR(95％CI)being 0.76(0.67,0.86)and 0.85(0.76,0.94),respectively.The exposure-response relationship showed a nonlinear association between physical activity and MAFLD risks(Pnonlinearity=0.005).The protective effect of physical activity against MAFLD was observed when physical activity reached approximately 20 METs-h/d.However,when physical activity exceeded 70 METs-h/d,no significant effect on MAFLD risk was observed.Among the female population,obesity type significantly modified the association between physical activity and MAFLD(P＜0.05).In females with central obesity,the protective effect of physical activity on MAFLD showed a threshold effect,with the lowest disease risk observed at approximately 25 METs-h/d.However,physical activity exceeding 37.5 METs-h/d showed no statistically significant association with MAFLD risk.In contrast,for females with peripheral obesity,high levels of physical activity had limited effects on reducing MAFLD risks.Conclusion Moderate physical activity can significantly reduce the risk of MAFLD,and the obesity types can modify this association.It is recommended that individuals engage in approximately 20-70 METs-h/d of physical activity.For females with central obesity,physical activity should not exceed 37.5 METs-h/d,while for females with peripheral obesity,it should not exceed 30 METs-h/d.

Objective To investigate the disparities in the activities of daily living(ADL)among older adults living in urban and rural areas of Sichuan Province,China and the influencing factors,and to provide a basis for promoting the health of older adults and formulating relevant policies.Methods Using data from the Seventh Health Services Survey of Sichuan Province,we enrolled 7 369 older adults from urban and rural areas and analyzed their ability to perform ADL and the relevant influencing factors.All participants were aged 60 years or older.Chi-square tests and logistic regression were performed to identify the influencing factors.Results The ADL impairment rate among older adults living in urban areas of Sichuan Province was 17.7％,which was higher than the rate of 13.8％among older adults living in rural areas.According to the results of logistic regression analysis,age≥80 years(odds ratio[OR]=3.725;95％CI,2.460-5.639),accidental injuries(OR=2.375;95％CI,1.597-3.532),and good sleep quality(OR=0.420,95％CI:0.289-0.612)were factors influencing ADL among older adults living in urban areas,while age ≥ 80 years(OR=1.867;95％CI,1.459-2.390),being married(OR=0.805;95％CI,0.664-0.976),accidental injuries(OR=1.936;95％CI,1.564-2.397),and participation in social activities(OR=0.417;95％CI,0.352-0.495)were factors influencing ADL among older adults living in rural areas.Conclusion There are differences in ADL impairment rates and the relevant influencing factors between urban and rural older adults in Sichuan Province.These findings underscore the need to consider urban-rural differences when adopting relevant policies and measures.

Objective To investigate the association between 8 insulin resistance(IR)surrogate markers and incident atherosclerotic cardiovascular disease(ASCVD)in population with cardiovascular-kidney-metabolic syndrome(CKM)of stages 0-3,and to identify the surrogate marker with the best predictive performance.Methods A study was conducted on 20121 community residents classified as CKM stages 0-3 from the Chengdu cohort of the China Multi-Ethic Cohort.A Cox proportional hazards model was used to calculate hazard ratios(HRs)between each IR surrogate marker and incident ASCVD.Cubic spline regression was employed to explore the dose-response relationships between these markers and incident ASCVD.The relative relationships between different markers and incident ASCVD were examined through the ratio of HRs(RHRs).Time-dependent area under the receiver operating characteristic curve(TDAUC)and Uno's C-statistic were calculated to compare the predictive performance of each marker for incident ASCVD.Based on the PREVENT equation components and the 8 surrogate markers under analysis,random forest feature selection was used to determine the contribution of each marker to accurate prediction.Results During a follow-up period of82 741.93 person-years,1447 incident cases of ASCVD were recorded,with an incidence density of 17.49 per 1000 person-years.Association analyses indicated that the triglyceride to high-density lipoprotein cholesterol ratio(TG/HDL)and the TyG/(TG/HDL)index were not associated with incident ASCVD(P＞0.05).The TyG index combined with obesity measurement parameters emerged as a reliable predictor of ASCVD incidence.The most promising indicator,TyG index with waist-to-height ratio(TyG_WHtR),exhibited an inverted J-shaped association with incident ASCVD(P for nonlinearity=0.045;TDAUC=0.640;C=0.634),while the TyG index with body mass index(TyG_BMI),waist circumference(TyG_WC),and waist-to-hip ratio(TyG_WHR)showed positive linear associations(all P for trend＜0.05),with relatively lower predictive performance(C=0.564,0.588,and 0.598,respectively).Although both the TyG index and the metabolic score for insulin resistance(METS-IR)were associated with increased ASCVD risk(TyG:Q2 vs.Q1,HR=1.23 and Q4 vs.Q1,HR=1.24;METS-IR:P for non-linearity=0.045),they exhibited poor predictive performance for incident ASCVD.Conclusion The TyG index combined with obesity measurement parameters is an ideal IR surrogate marker for predicting incident ASCVD in populations with stages 0-3 CKM.Monitoring these markers will facilitate the prevention and control of cardiovascular diseases in CKM populations.

Objective To investigate the association between rest-activity rhythm(RAR)and the risks of rheumatoid arthritis(RA),and to evaluate whether genetic susceptibility modifies this relationship.Methods This prospective cohort study utilized data from the UK Biobank,including 88 060 participants who did not have RA at baseline.RAR parameters(e.g.,relative amplitude)were calculated using data obtained through wrist-worn accelerometers.The participants'genetic susceptibility to RA was assessed using a polygenic risk score.Cox proportional hazards models were employed to analyze the association between RAR and RA risk,with interaction terms incorporated to evaluate the effect modification by genetic susceptibility.Results Over a median follow-up period of 7.97 years,660 incident RA cases were identified.After adjusting for age,sex,ethnicity,educational attainment,Townsend deprivation index,drinking status,smoking status,dietary score,body mass index,and polygenic risk score for incident RA,the dose-response analysis revealed a linear relationship between the RAR-related parameters,including the average amplitude during the most active 10 h(M10),interdaily stability(IS),intradaily variability(IV),and the risk of developing RA(P>0.05).In contrast,relative amplitude and the average amplitude during the least active 5 h(L5)showed a nonlinear relationship with the risk of developing RA(P<0.05).Compared to those in the the highest quartile of relative amplitude,participants in the lowest quartile had a 49%increase in the risk of developing RA(hazard ratio[HR]=1.49;95%CI,1.17-1.90).Compared to those in the lowest quartile,participants in the highest quartile of L5 had a 40%increased risk of developing RA(HR=1.40;95%CI,1.12-1.75).Every time M10 increased by one standard deviation,the risk of developing RA decreased by 12%(HR=0.88;95%CI,0.80-0.96).No evidence of effect modification by genetic susceptibility was observed in the RAR-RA association(P>0.05).Conclusion Disrupted rest-activity rhythm is associated with an increased risk of RA,which is independent of genetic susceptibility to RA.Our findings suggest that improving rest-activity rhythm may help reduce RA risks.

Objective To investigate whether Yiqicongming Decoction(YCD)can alleviate dry eye syndrome in rats.Methods Thirty-six male SD rats at 6 weeks of age were divided into blank group,model group,positive group,YCD high-dose group,YCD medium-dose group,and YCD low-dose group,with six rats in each group.The rats underwent iris,tear secretion volume,and corneal epithelial damage scoring assessments.Conjunctival tissue was stained with PAS,and the activity of superoxide dismutase(SOD)and the content of malondialdehyde(MDA)were detected using the en-zyme-linked immunosorbent assay(ELISA).The level of reactive oxygen species(ROS)was measured by flow cytometry.Western blot was used to detect the protein expression of nuclear factor erythroid 2-related factor 2(Nrf2)and hymeoxyge-nase-1(HO-1)in corneal tissues.Results Compared with the blank group,the number of goblet cells in the conjuncti-va,corneal epithelial injury score,MDA content and ROS level in the model group were significantly increased at all time points(all P＜0.05).The tear secretion volume of rats decreased on days 3,7,and 14,and the number of conjunctival goblet cells and SOD activity also decreased(all P＜0.05).Compared with the model group,the conjunctival score,corne-al epithelial injury score,MDA content,and ROS level in the positive control group and high-,medium-,and low-dose YCD groups were significantly reduced(all P＜0.05),while SOD activity and protein expression levels of Nrf2 and HO-1 in rats on day 14 were significantly increased(all P＜0.05).Compared with the high-dose YCD group,the conjunctival score,corneal epithelial injury score,and ROS level in the low-and medium-dose YCD groups were significantly increased(all P＜0.05),while SOD activity and protein expression levels of Nrf2 and HO-1 on day 14 were significantly decreased(all P＜0.05).On day 14,the tear secretion volume and the number of goblet cells in the conjunctiva of rats administered a low dose of Yiqi Congming Decoction both decreased(all P＜0.05).Compared with the medium-dose YCD group,the conjunc-tival score,corneal epithelial injury score and ROS level in the low-dose YCD group were significantly increased(all P＜0.05),while the tear secretion volume and protein expression levels of Nrf2 and HO-1 on day 14 were significantly de-creased(all P＜0.05).Conclusion YCD can increase tear secretion,alleviate iris and corneal epithelial damage,acti-vate Nrf2/HO-1 pathway,regulate oxidative stress,and alleviate dry eye syndrome.

Objective To investigate whether Yiqicongming Decoction(YCD)can alleviate dry eye syndrome in rats.Methods Thirty-six male SD rats at 6 weeks of age were divided into blank group,model group,positive group,YCD high-dose group,YCD medium-dose group,and YCD low-dose group,with six rats in each group.The rats underwent iris,tear secretion volume,and corneal epithelial damage scoring assessments.Conjunctival tissue was stained with PAS,and the activity of superoxide dismutase(SOD)and the content of malondialdehyde(MDA)were detected using the en-zyme-linked immunosorbent assay(ELISA).The level of reactive oxygen species(ROS)was measured by flow cytometry.Western blot was used to detect the protein expression of nuclear factor erythroid 2-related factor 2(Nrf2)and hymeoxyge-nase-1(HO-1)in corneal tissues.Results Compared with the blank group,the number of goblet cells in the conjuncti-va,corneal epithelial injury score,MDA content and ROS level in the model group were significantly increased at all time points(all P＜0.05).The tear secretion volume of rats decreased on days 3,7,and 14,and the number of conjunctival goblet cells and SOD activity also decreased(all P＜0.05).Compared with the model group,the conjunctival score,corne-al epithelial injury score,MDA content,and ROS level in the positive control group and high-,medium-,and low-dose YCD groups were significantly reduced(all P＜0.05),while SOD activity and protein expression levels of Nrf2 and HO-1 in rats on day 14 were significantly increased(all P＜0.05).Compared with the high-dose YCD group,the conjunctival score,corneal epithelial injury score,and ROS level in the low-and medium-dose YCD groups were significantly increased(all P＜0.05),while SOD activity and protein expression levels of Nrf2 and HO-1 on day 14 were significantly decreased(all P＜0.05).On day 14,the tear secretion volume and the number of goblet cells in the conjunctiva of rats administered a low dose of Yiqi Congming Decoction both decreased(all P＜0.05).Compared with the medium-dose YCD group,the conjunc-tival score,corneal epithelial injury score and ROS level in the low-dose YCD group were significantly increased(all P＜0.05),while the tear secretion volume and protein expression levels of Nrf2 and HO-1 on day 14 were significantly de-creased(all P＜0.05).Conclusion YCD can increase tear secretion,alleviate iris and corneal epithelial damage,acti-vate Nrf2/HO-1 pathway,regulate oxidative stress,and alleviate dry eye syndrome.

Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

Objective:To explore the intervention effect of Jianpifuwei granule(JPFWG)on gastric mucosal injury in rats with precancerous lesions of gastric cancer(PLGC)by regulating the IL-6/JAK/STAT3 signaling pathway and its mechanism.Methods:The PLGC model rats were established by MNNG combined with composite factors,and randomly divided into 6 groups(20 rats/group):the blank group(untreated),model group(treated with normal saline),Weimeisu group(0.05 g/mL Weimeisu),JPFWG low-dose group(JPFWG-L,0.088 g/mL),JPFWG medium-dose group(JPFWG-M,0.176 g/mL)and JPFWG high-dose group(JPFWG-H,0.351 g/mL).After being treated with Weimeisu and different doses of JPFWG for 12 weeks,the animals were anesthetized and sacrificed,and the gastric tissues were collected.The pathological changes of gastric mucosa were observed by H-E staining,and the expression levels of IL-6-mediated JAK/STAT3 signaling pathway factors(including IL-6,JAK and STAT3)and the mRNA and proteins of their downstream target genes c-Myc and cyclin D1 in gastric mucosal tissues were detected by immunohistochemistry,qPCR and WB.Results:Compared with that in the model group,the gastric mucosal inflammatory cell infiltration was reduced in the Weimeisu group and the low,medium,and high dose groups of JPFWG;pathological condition was improved,most obviously in the high dose group of JPFWG;The protein expressions of IL-6,JAK1 and STAT3 decreased significantly(P<0.05 or P<0.01).The expressions of mRNA and proteins of c-Myc and cyclin D1 in the gastric mucosal tissues of the rats in the Weimeisu group and JPFWG-H group decreased significantly(P<0.05 or P<0.01).Conclusion:JPFWG can improve the histopathological changes of gastric mucosa in rats with PLGC,and its mechanism may be down-regulating the expressions of c-Myc and cyclin D1 through regulating IL-6/JAK/STAT3 signal pathway,thus blocking inflammation-cancer transformation process.