Objective:To explore the mechanism of social support and self-efficacy in rehabilitation exercise in the relationship between psychological resilience and kinesiophobia in hip fracture patients.Methods:Totally 284 hip fracture patients treated at the Department of Trauma and Orthopedics, Binzhou Medical University Hospital from May 2022 to April 2023 were selected by convenience sampling. Data were collected using the general information questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the Social Support Rating Scale (SSRS), the Self-Efficacy Rehabilitation Outcome Scale (SER), and the Tampa Scale for Kinesiophobia (TSK). Process 4.1 was used for chain mediation effect analysis.Results:The scores for the 284 hip fracture patients were as follows: CD-RISC (58.72±7.77), SSRS (29.70±5.11), SER (91.23±8.41), and TSK (38.07±3.65). Psychological resilience, social support, self-efficacy in rehabilitation exercise, and kinesiophobia were all significantly correlated pairwise (all P<0.01). Social support and self-efficacy in rehabilitation exercise had a chain mediation effect between psychological resilience and kinesiophobia, with mediation effect values of -0.020 and -0.079, accounting for 17.52% and 67.70% of the total effect, respectively. Conclusions:Psychological resilience directly influences the level of kinesiophobia in hip fracture patients and has an indirect effect through the chain mediation of social support and self-efficacy in rehabilitation exercise.

Oleanolic acid (OA), a pentacyclic triterpenoid, exhibits a broad spectrum of biological activities, including antitumor, antiviral, antibacterial, anti-inflammatory, hepatoprotective, hypoglycemic, and hypolipidemic effects. Since its initial isolation and identification, numerous studies have reported on the structural modifications and pharmacological activities of OA and its derivatives. Despite this, there has been a dearth of comprehensive reviews in the past two decades, leading to challenges in subsequent research on OA. Based on the main biological activities of OA, this paper comprehensively summarized the modification strategies and structure-activity relationships (SARs) of OA and its derivatives to provide valuable reference for future investigations into OA.
Oleanolic Acid ; Structure-Activity Relationship ; Anti-Inflammatory Agents/pharmacology* ; Triterpenes ; Anti-Bacterial Agents/pharmacology*

Objective:To investigate the changes of thyroid hormones and the flow velocity of superior thyroid artery in patients with Graves' disease and Hashimoto's thyrotoxicosis before and after treatment with methimazole.Methods:A case-control study was conducted to select 45 cases of Graves' disease and 45 cases of Hashimoto's thyroiditis from October 2021 to December 2022 in the Department of Endocrinology, North China University of Science and Technology Affiliated Hospital. The changes of thyroid hormone and blood flow velocity of superior thyroid artery in patients with Graves' disease and Hashimoto's thyroiditis before and after treatment with methimazole were analyzed. Measurement data satisfying normal distribution were expressed by xˉ±s, and the mean between two groups was compared by t test. Measurement data not satisfying normal distribution were expressed by M( Q1, Q3), and the median between two groups was compared by Wilcoxon rank sum test. χ 2 test was used to compare the constituent ratio of enumeration data among groups. Results:There was no significant difference in thyroid stimulating hormone (TSH) between the two groups before treatment, and there was no significant difference in TSH between the two groups after 1 month and 3 months of treatment (all P>0.05). The levels of free triiodothyronine (FT3) were (24.09±9.29) pmol/L and (17.41±9.36) pmol/L in Graves' disease group and Hashimoto's thyroiditis group respectively before treatment. FT4 were (60.23±20.82) and (43.47±21.71) pmol/L, respectively, and the peak stolie vloiy (PSV) were (69.53±5.70) and (52.65±4.64) cm/s, respectively in Graves' disease group and Hashimoto's thyroiditis group respectively before treatment. There were significant differences between the two groups ( t values wrere 3.39 and 3.74, Z=13.83, all P<0.001). The difference of FT3 between one month after treatment and before treatment was (-6.36±5.32) and (-12.64±9.08) pmol/L ( t=4.02, P<0.001) and the difference in FT3 between 3 months of treatment and before treatment was (-10.14±9.50) and (-17.80±11.17) pmol/L, respectively ( t=3.51, P<0.001) between the Graves disease group and the Hashimoto's thyroiditis group. The difference in FT4 between the Graves disease group and the Hashimoto's thyroiditis group after 1 month of treatment and before treatment was (-28.47±10.09) and (-20.57±14.48) pmol/L ( t=7.01, P<0.001), and the difference of FT4 was (-47.06±20.57) and (-30.17±20.54) pmol/L ( t=3.91, P<0.001) between the Graves disease group and the Hashimoto toxin group. The difference between one month after treatment and before treatment was (-13.10(-34.10,-2.60)) and (-10.50(-27.5,-0.20)) cm/s ( Z=2.63, P=0.009), respectively. The difference between 3 months and before treatment was (-31.40(-53.20,-12.70)) and (-19.90(-46.00,-4.70)cm/s ( Z=4.40, P<0.001)) between the Graves disease group and the Hashimoto's thyroiditis group, and the difference was statistically significant. Conclusion:Thyroid hormone levels were decreased after treatment with methimazole in patients with diffuse toxic goiter and Hashimoto toxemia, but the difference was not statistically significant. The PSV level of superior thyroid artery in patients with diffuse toxic goiter was significantly lower than that in patients with Hashimoto's thyrotoxicosis.

Objective:To compare the clinical efficacy of anatomical reconstruction of coracoclavicular ligament at the original insertion point and clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation.Methods:Retrospective analysis was made on the data of 67 patients with acromioclavicular joint dislocation who received surgical treatment in the Department of Orthopaedics of the First Affiliated Hospital of Nanjing Medical University from June 2015 to January 2021. According to the surgical method, they were divided into reconstruction group (using the technique of anatomical reconstruction of coracoclavicular ligament at the original insertion point) and hook plate group (using the clavicular hook plate). There were 37 cases in the reconstruction group, including 26 males and 11 females, aged 47.2±9.6 years (range, 18-65 years), 13 cases on the left and 24 cases on the right. Among the 37 patients, 8 were sports injuries, 14 were falls, 11 were traffic accidents, and 4 were external force injuries. The average time from injury to surgery was 8.3±2.3 days. There were 30 cases in the hook plate group, including 24 males and 6 females, aged 47.4±9.7 years (range, 18-67 years), 12 cases on the left and 18 cases on the right. Among the 30 patients, 7 were sports injuries, 11 were falls, 9 were traffic accidents, and 3 were external force injuries. The average time from injury to surgery was 7.9±2.6 days. The surgical time, incision length, intraoperative bleeding, hospital stay, postoperative coracoclavicular separation ratio, and postoperative complications were compared between the two groups. Constant-Murley score and visual analog scale (VAS) were used to assess the shoulder joint function and pain degree of patients.Results:Both groups of patients were followed up, with a follow-up time of 12.3±0.4 months for the reconstruction group and 12.2±0.5 months for the hook plate group. The operation time (105.8±10.0 min), incision length [12.0 (11.0, 13.0) cm] and hospitalization time (6.8±2.1 d) in the reconstruction group were longer than those in the hook plate group [48.3±4.9 min, 10.0 (10.0, 11.0) cm, and 5.5±2.7 d], while the intraoperative blood loss (75.1±3.9 ml) was less than that in the hook plate group (90.3±6.3 ml), the differences were statistically significant ( P<0.05). The VAS [4.0 (3.0, 5.0), 3.0 (3.0, 3.0), 2.0 (1.0, 2.0) points] and Constant-Murley score (65.4±4.5, 84.9±2.5, 90.1±2.5 points) of the reconstruction group at 3 days, 3 months, and 12 months after surgery were better than those of the hook plate group [5.0 (4.0, 5.0), 4.0 (4.0, 4.0), 3.0 (3.0, 4.0) and 56.9±3.5, 79.6±4.0, 86.8±2.4 points], the difference was statistically significant ( P<0.05). At the last follow-up, there was a statistically significant difference in the separation ratio of coracoclavicular distance between the reconstruction group (0.12±0.08) and the hook plate group 0.22±0.15 ( t=3.25, P=0.002). There was no significant difference ( Z=-0.52, P=0.605) in the separation ratio of acromioclavicular distance [0.16 (0.05, 0.25) and 0.16 (0.04, 0.40)]. In the hook plate group, 6 cases had shoulder joint foreign body sensation and 2 cases had acromioclavicular joint redislocation (both Rockwood type III). Because the shoulder joint function did not affect their daily life, neither patient underwent secondary surgery. And no case of acromioclavicular joint redislocation occurred in the reconstruction group. Conclusion:Compared with the clavicular hook plate fixation, anatomic reconstruction of coracoclavicular ligament at the original insertion point in the treatment of acromioclavicular joint dislocation can reduce the pain of the shoulder joint earlier, which has the characteristics of small trauma, good effect, and reduces the steps of internal fixation removal, and has good clinical curative effect.

Abstract Cognitive behavior therapy (CBT) is one of the main psychotherapeutic methods used to treat anxiety disorders in children and adolescents. Art therapy, based on psychotherapy theory and methods, is rising in popularity abroad. At present, foreign scholars have started to apply cognitive behavioral art therapy (CBAT) for patients with anxiety disorders. Based on the current findings, children and adolescents with developing cognitive functions may also benefit from this therapy. This article summarizes the application status of CBAT in the treatment of anxiety disorder in patients at home and abroad, and innovatively explores its therapeutic potential for anxiety disorders in children and adolescents in China, thus providing a novel perspective that can address the shortcomings of CBT.

Patients with lung cancer at the same stage may have markedly different overall outcome and a lack of specific biomarker to predict lung cancer outcome. Heat-shock protein 90 β (HSP90β) is overexpressed in various tumor cells. In this study, the ELISA results of HSP90β combined with CEA, CA125, and CYFRA21-1 were used to construct a recursive partitioning decision tree model to establish a four-protein diagnostic model and predict the survival of patients with lung cancer. Survival analysis showed that the recursive partitioning decision tree could distinguish the prognosis between high- and low-risk groups. Results suggested that the joint detection of HSP90β, CEA, CA125, and CYFRA21-1 in the peripheral blood of patients with lung cancer is plausible for early diagnosis and prognosis prediction of lung cancer.
Antigens, Neoplasm ; Biomarkers, Tumor ; CA-125 Antigen ; Carcinoembryonic Antigen ; Carcinoma, Non-Small-Cell Lung/pathology* ; Humans ; Keratin-19 ; Lung Neoplasms ; Prognosis

Objective : To systematically evaluate the incidence of suicide ideation among HIV/AIDS patients in China, so as to provide insights into prevention of suicidal behaviors among HIV/AIDS patients. Methods : All publications pertaining to suicide ideation were jointly retrieved in electronic databases from database creation to May 22, 2022, including CNKI, CMB, Wanfang Data, VIP, PubMed and Web of Science. The quality of literatures was evaluated using the 11 quality indicators for cross-sectional studies recommended by the United States Agency for Healthcare Research and Quality (AHRQ), and a meta-analysis was performed using the software Stata 16.0. The stability of the study results was evaluated using sensitivity analysis, and the publication bias was evaluated using Begg's test. Results : A total of 1 557 publications were screened and 32 literatures covering 12 917 HIV/AIDS patients were included in the final analysis, including 21 Chinese publications and 11 English publications, and 19 high-quality publications and 13 moderate-quality publications. Meta-analysis showed that the incidence of suicide ideation was 30.3% (95%CI: 23.2%-37.4%) among HIV/AIDS patients in China, and subgroup analysis showed higher incidence of suicide ideation in unemployed HIV/AIDS patients than in employed patients (P<0.05). Sensitivity analysis showed stable study results, and Begg's test revealed no significant publication bias. Conclusions The incidence of suicide ideation is 23.2% to 37.4% among HIV/AIDS patients in China. High attention paid to psychological health and early psychological interventions are required to prevent the development of suicide ideation.

Objective:To analyze the clinicopathological characteristics, treatment responses and kidney outcomes of patients with atypical membranous nephropathy (MN), and to provide information for the clinical practice.Methods:The clinical data of patients with atypical MN and synchronous primary MN who were diagnosed, treated and followed up in Peking University First Hospital from January 2008 to June 2020 were retrospectively collected and analyzed. Clinicopathological features, treatment responses and kidney prognosis were compared between the two groups. The expression of phospholipase A2 receptor (PLA2R) in kidney tissues was detected by immunofluorescence. Serum anti-PLA2R antibody was detected by enzyme-linked immunosorbent assay. Clinicopathological indexes were compared between PLA2R-related MN group and non-PLA2R-related MN group. Kaplan-Meier (Log-rank test) survival curve and multivariate Cox regression analysis methods were used to analyze the influencing factors of kidney prognosis in patients with atypical MN. The primary endpoint of renal adverse outcome was renal insufficiency, defined as end-stage renal disease or estimated glomerular filtration rate (eGFR) decline>30% baseline and<60 ml·min -1·(1.73 m 2) -1. Results:A total of 65 atypical MN patients were enrolled in this study. Compared with primary MN ( n=324), patients with atypical MN had younger age ( Z=-4.229, P<0.001), higher proportion of hematuria ( χ2=5.555, P=0.018), higher level of urinary protein ( Z=2.228, P=0.026) and lower level of eGFR ( t=-5.108, P<0.001); the proportion of IgG4 deposition in kidneys was lower ( χ2=8.081, P=0.004), and the proportions of IgA ( χ2=16.969, P<0.001) and IgM ( χ2=9.281, P=0.002) deposition were higher. There was no significant difference on gender, serum albumin, positive proportion of anti-PLA2R antibody, anti-PLA2R antibody level and kidney C3/C1q deposition between the two groups (all P>0.05). The proportions of atypical MN patients receiving renin-angiotensin aldosterone system inhibitors (49.3% vs 57.1%), calcineurin inhibitors (27.7% vs 19.1%) and cyclophosphamide (21.5% vs 23.8%) were comparable to those of primary MN patients (all P>0.05). The rates of clinical remission (80.0% vs 77.2%), partial remission (44.6% vs 44.1%), complete remission (35.4% vs 33.1%), spontaneous remission (36.9% vs 42.6%), response to cyclophosphamide (85.7% vs 81.8%), response to calcineurin inhibitor (88.9% vs 79.0%), and relapse (30.8% vs 26.8%) in atypical MN patients were comparable to those in primary MN patients (all P>0.05). During the follow-up 30.0(21.5, 61.5) months, 15 atypical MN patients (23.1%) had eGFR reduction>30%, among whom 7 patients (10.8%) had eGFR reduction>50% and 3 patients (4.6%) had end-stage kidney disease. There was no significant difference on poor kidney prognosis between the two groups (all P>0.05). Kaplan-Meier survival curve showed that patients with age>39 years old ( χ2=10.092, P=0.001), eGFR≤100 ml·min -1·(1.73 m 2) -1( χ2=5.491, P=0.019), tubular interstitial lesion ( χ2=6.999, P=0.008) and no nephropathy remission ( χ2=22.952, P<0.001) had earlier poor renal prognosis. Multivariate Cox regression analysis showed that no nephropathy remission ( HR=12.604, 95% CI 2.691-59.037, P=0.001) was an independent influencing factor for poor renal prognosis in atypical MN patients. Conclusion:No significant difference is found between atypical MN and primary MN on treatment responses and kidney prognosis, which implies that clinical practice of atypical MN can be performed by referring to the guidelines and experience of primary MN.

Adult ; Cyclosporine ; Glomerulosclerosis, Focal Segmental/drug therapy* ; Humans ; Leflunomide/therapeutic use* ; Nephrosis, Lipoid/drug therapy* ; Nephrotic Syndrome ; Steroids

Objective:To explore the application value of artificial intelligence (AI) model based on deep learning in breast nodules classification of Breast Imaging Reporting and Data System of ultrasound (BI-RADS-US).Methods:The ultrasound images of 2 426 breast nodules from 1 558 female patients with breast diseases at Beijing Tongren Hospital, Capital Medical University between December 2006 and December 2019 were collected . The image data sets were divided into training (63%), verification (7%), and test (30%) subsets for the construction of AI model. The diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were analyzed by using receiver operating characteristic (ROC) curve. The Cohen weighted Kappa statistic was used to compare the consistency of BI-RADS-US classification among 5 ultrasound doctors' diagnosis with or without AI model assistance. And the changes of BI-RADS-US classification were analyzed before and after each doctor adopted AI model assistance.Results:The differences in diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were statistically significant (all P > 0.05). The consistency among 5 ultrasound doctors was improved due to AI model assistance and Kappa value was increased from 0.433 (category 3), 0.600 (category 4a), 0.614 (category 4b), 0.570 (category 4c) and 0.495 (category 5) to 0.812, 0.704, 0.823, 0.690 and 0.509 (all P < 0.05), respectively. The upgrade and downgrade of BI-RADS-US classification occurred in 5 doctors after the classification of AI model assistance. Downgrade from category 4 to 3 in benign nodules of 56.6% (47/76) and upgrade from category 4 to 5 in malignant nodules of 69.4% (34/49) were mostly observed. Conclusions:AI-assisted BI-RADS-US classification can effectively improve the consistency of classification among the doctors without reducing the diagnostic efficiency. AI model shows clinical values in reducing unnecessary biopsy of partial benign lesions and increasing diagnostic accuracy of partial malignant lesions through the adjustment of breast nodule classification.