Objective To investigate the transition intensity and transition probabilities of fall states among middle-aged and older adults in China,and to assess the impact of potential risk factors on falls.Methods We utilized in the study data from the China Health and Retirement Longitudinal Study(CHARLS)and employed a multi-state Markov model(MSM)to analyze the transition intensity and probabilities between states of no falls or falls without treatment,falls requiring treatment,and death.Results A total of 14722 participants were enrolled,with a mean age of(59.4 years±9.7 years),and 47.9％were male.The median follow-up period was 9 years(interquartile range[IQR].7-9 years).At baseline,12381 participants(84.1％)reported no falls or falls without treatment,while 2341(15.9％)reported falls requiring treatment.Participants who experienced falls requiring treatment within one follow-up cycle had a 55.2％probability of not falling again or only falling without treatment in the subsequent two years,a 37.6％probability of continuing to experience falls requiring treatment,and a 7.2％probability of death.The risk of transitioning from a state of no falls or falls without treatment to falls requiring treatment increased by 8.6％for every 5-year increase in age.The risk was 35.1％higher for females compared to males.Rural residents had a 10.1％higher risk.Those who were divorced,separated,widowed,or never married had a 20.7％higher risk.Higher degrees of physical function impairment were associated with an increased risk.Depressive symptoms increased the risk by 31.6％.Having one chronic disease raised the risk by 9.6％,while multimorbidity led to a 28.8％increase in risk.Conclusion According to the findings of the study,falls are a dynamic process and emphasis should be given to fall prevention for older adults,individuals with a history of fall-related medical visits,those living alone,those with impaired physical function,and those with depressive symptoms.

Objective To explore the effect of hypoxic exercise on Irisin secretion of obese rats with a palmitic acid-induced lipid accumulation in L6 myotubes and a high-fat diet-induced model.Methods L6 myotubes were treated with 750 μmol/L palmitic acid to induce lipid accumulation and subsequently divided into four groups of normoxia(N),exercise(E),hypoxia(H),and hypoxic exer-cise(HE).Hypoxic conditions(1%O2)were used to simulate a low-oxygen environment,while AICAR stimulation was applied to the E and HE groups to mimic exercise.Eighty 3-week-old Sprague-Dawley rats were fed a high-fat diet for 16 weeks to establish an obesity model.Fifty obese rats that met the criteria were then selected and randomly assigned according to their body weight into five groups of normoxia-sedentary(NC),normoxia-exercise(NE),hypoxia-sedentary(HC),high-liv-ing high-training(HH),and low-living high-training(LH),each of 10.The hypoxic environment was set at 13.6%O2(simulating 3,500 m altitude).Then the NE,HH and LH groups performed daily one-hour treadmill training(NE:20 m/min;HH and LH:16 m/min),5 days/week for 4 weeks.After the intervention,the body composition was measured using dual-energy X-ray absorptiometry(DEXA),while Irisin concentrations in cell culture media and rat serum were determined by using the enzyme-linked immunosorbent assay.Moreover,fibronectin type Ⅲ domain-containing 5(FNDC5)mRNA expression in L6 cells and rat skeletal muscle was measured by quantitative polymerase chain reaction(qPCR),while FNDC5 and silent information regulator 1-peroxisome proliferators-activated re-ceptor γ coactivator lalpha(SIRT1-PGC-1α)pathway proteins were analyzed using Western blotting.Results(1)Cell experiments:①Compared with the N group,there were significantly higher Irisin lev-els in the culture medium of the E,H,and HE groups(P<0.01,P<0.05),as well as elevated FNDC5 mRNA and protein expression in the E and HE groups(P<0.05,P<0.01).Moreover,the Iri-sin concentration and FNDC5 protein levels of group HE were significantly higher than group E(P<0.05).②Compared with group N,significantly increased SIRT1 and PGC-1α protein expression was observed in groups E and HE(P<0.05,P<0.01).(2)Animal experiments:①Compared with the NC group,body weight and fat mass were significantly lower in the NE,LH,and HH groups(P<0.01),with further reductions observed in the HH group compared with the NE group(P<0.05).② Com-pared with group NC,groups NE,LH,and HH exhibited higher serum Irisin levels and increased FNDC5 mRNA and protein expression in skeletal muscle(P<0.05,P<0.01).Furthermore,FNDC5 pro-tein expression of the HH group was significantly higher than the NE group(P<0.05).③ Compared with the NC group,SIRT1 and PGC-1α protein levels were significantly upregulated in the NE,LH,and HH groups(P<0.05,P<0.01).Conclusion Hypoxic exercise effectively alleviates obesity,reduces body weight and fat accumulation in high-fat diet-induced obese rats,and enhances FNDC5 expres-sion and Irisin secretion,which may be mediated through activation of the SIRT1-PGC-1α signaling pathway.Moreover,among the different hypoxic exercise modalities,the"high-living high-training"protocol appears to have greater benefits in promoting FNDC5/Irisin expression and facilitating weight and fat reduction in obese rats.

Objective To explore the effect of hypoxic exercise on Irisin secretion of obese rats with a palmitic acid-induced lipid accumulation in L6 myotubes and a high-fat diet-induced model.Methods L6 myotubes were treated with 750 μmol/L palmitic acid to induce lipid accumulation and subsequently divided into four groups of normoxia(N),exercise(E),hypoxia(H),and hypoxic exer-cise(HE).Hypoxic conditions(1%O2)were used to simulate a low-oxygen environment,while AICAR stimulation was applied to the E and HE groups to mimic exercise.Eighty 3-week-old Sprague-Dawley rats were fed a high-fat diet for 16 weeks to establish an obesity model.Fifty obese rats that met the criteria were then selected and randomly assigned according to their body weight into five groups of normoxia-sedentary(NC),normoxia-exercise(NE),hypoxia-sedentary(HC),high-liv-ing high-training(HH),and low-living high-training(LH),each of 10.The hypoxic environment was set at 13.6%O2(simulating 3,500 m altitude).Then the NE,HH and LH groups performed daily one-hour treadmill training(NE:20 m/min;HH and LH:16 m/min),5 days/week for 4 weeks.After the intervention,the body composition was measured using dual-energy X-ray absorptiometry(DEXA),while Irisin concentrations in cell culture media and rat serum were determined by using the enzyme-linked immunosorbent assay.Moreover,fibronectin type Ⅲ domain-containing 5(FNDC5)mRNA expression in L6 cells and rat skeletal muscle was measured by quantitative polymerase chain reaction(qPCR),while FNDC5 and silent information regulator 1-peroxisome proliferators-activated re-ceptor γ coactivator lalpha(SIRT1-PGC-1α)pathway proteins were analyzed using Western blotting.Results(1)Cell experiments:①Compared with the N group,there were significantly higher Irisin lev-els in the culture medium of the E,H,and HE groups(P<0.01,P<0.05),as well as elevated FNDC5 mRNA and protein expression in the E and HE groups(P<0.05,P<0.01).Moreover,the Iri-sin concentration and FNDC5 protein levels of group HE were significantly higher than group E(P<0.05).②Compared with group N,significantly increased SIRT1 and PGC-1α protein expression was observed in groups E and HE(P<0.05,P<0.01).(2)Animal experiments:①Compared with the NC group,body weight and fat mass were significantly lower in the NE,LH,and HH groups(P<0.01),with further reductions observed in the HH group compared with the NE group(P<0.05).② Com-pared with group NC,groups NE,LH,and HH exhibited higher serum Irisin levels and increased FNDC5 mRNA and protein expression in skeletal muscle(P<0.05,P<0.01).Furthermore,FNDC5 pro-tein expression of the HH group was significantly higher than the NE group(P<0.05).③ Compared with the NC group,SIRT1 and PGC-1α protein levels were significantly upregulated in the NE,LH,and HH groups(P<0.05,P<0.01).Conclusion Hypoxic exercise effectively alleviates obesity,reduces body weight and fat accumulation in high-fat diet-induced obese rats,and enhances FNDC5 expres-sion and Irisin secretion,which may be mediated through activation of the SIRT1-PGC-1α signaling pathway.Moreover,among the different hypoxic exercise modalities,the"high-living high-training"protocol appears to have greater benefits in promoting FNDC5/Irisin expression and facilitating weight and fat reduction in obese rats.

Objective To explore the relationship between hearing loss and cognitive function in the elderly population through propensity score matching method.Methods We analyzed the data of 7605 participants aged 60 and above who were included in the 2018 China Health and Retirement Longitudinal Study(CHARLS).The non-substitutable 1∶1 nearest neighbor matching method without caliper value was used for propensity score matching and G-computation was used to estimate the average treatment effect(ATE)of hearing loss on all dimensions of cognitive function.Results Before matching,there were 3626(47.68%)women,with 1409(18.53%)of whom suffering from hearing loss and 3031(39.86%)of whom suffering from cognitive impairment.After matching,1409 subjects were included in the hearing loss group and 1409,in the normal hearing group,with both groups sharing similar distribution of basic demographic characteristics.The results for the average treatment effect of the population indicated that the cognitive function scores of the hearing loss group were lower than those of the normal hearing group,with the overall cognitive function being 0.593 points lower(95%confidence intervel[CI]:-0.916--0.257,P<0.001),orientation being 0.183 points lower(95%CI:-0.302--0.055,P=0.004),immediate memory being 0.150 points lower(95%CI:-0.218--0.085,P<0.001),and language skills being 0.178 points lower(95%CI:-0.303--0.058,P=0.006).The prevalence of cognitive impairment of the hearing loss group was 4.2%higher than that of the normal hearing group(95%CI:0.007-0.077,P=0.020).Conclusion Hearing loss adversely affects the orientation,memory,and language skills of the elderly population and forms a potential risk factor for cognitive impairment in the elderly population.

ObjectiveTo analyze the feasibility， reliability and validity of the disability assessment for dementia scale for the elderly. MethodsA total of 290 dementia patients from 17 survey sites in 13 districts and counties of Chengdu were enrolled by convenient sampling method， and they were assessed using demographic data inventory， Mini-Mental State Examination （MMSE）， Neuropsychiatric Inventory （NPI）， Physical Self-Maintenance Scale （PSMS） and disability assessment for dementia scale for the elderly. Cronbach's α coefficient， Spearman-Brown coefficient， Guttman split-half coefficient and test-retest reliability were used to evaluate the internal consistency of above scales. Criterion-related validity of the scale was analyzed based on MMSE， NPI and PSMS. ResultsA total of 276 patients （95.17%） completed valid questionnaires. The intraclass correlation coefficient of the total score and each dimension were between 0.828~0.976， the Spearman-Brown coefficient were between 0.790~0.917， the Guttman split-half coefficient were between 0.812~0.857， and the Cronbach’s α coefficient were between 0.737~0.886. The cognitive function dimension score was positively correlated with the MMSE score （r=0.948， P<0.01）， the mental behavior symptom dimension score was positively correlated with the NPI score （r=0.893， P<0.01）， and the daily living ability dimension score was positively correlated with the PSMS score （r=0.997， P<0.01）. The dimensions scores were positively correlated with the total score of the scale （r=0.634~0.841， P<0.05）. ConclusionDisability of dementia assessment scale has good feasibility， reliability and validity， which is a reliable tool to assess senile dementia and disability.

OBJECTIVE:To provide reference for the reform of the postgraduate training mode of pharmaceutical professional degree. METHODS:Domestic literatures about postgraduate training mode of pharmaceutical professional degree from 2010 to 2013 were searched and combined with the current education situation in China to conclude and summarize the existing problems and reform strategy. RESULTS:Postgraduate education mode of pharmaceutical professional degree in China was still in the explor-atory stage,with shortage of teachers,unreasonable courses,unsound educational structure,nonsupport of the students,imperfec-tion evaluation systems,and so on. Further promoting the reform of postgraduate education mode needs to strengthen teacher teams ’construction,implement cooperative training;improve training program and teaching courses;strengthen dissertation applica-tion-oriented and practice base construction;fully mobilize the enthusiasm and motivation of students;promote the connection of pharmaceutical professional training and vocational qualifications;and improve the quality assurance systems. CONCLUSIONS:Further implementation of postgraduate training mode of pharmaceutical professional degree and postgraduate education of pharma-ceutical professional degree can train the applied talents that meet social needs,improve employment rate of postgraduates and re-duce waste of educational resources.

Objective:To examine factors that may have impact on the Mini-Mental State Examination ( MMSE) screening validity, which could lead to further establishing the general model of the MMSE score in Chinese health elderly and to improve the screening accuracy of the existing MMSE reference. Methods:Based on the data of the Chinese Longitudinal Healthy Longevity Survey ( CLHLS ) , the MMSE scores of 19 117 normal elderly and 137 dementia patients who met the inclusion criteria were used for the analysis. The area under the curve ( AUC) and validity indexes were used to compare the screening accuracy of various criteria. Multiple linear regression was used to identify factors that had impact on the MMSE score for both the normal and dementia elderly. Descriptive analysis was performed for differences in the MMSE scores by age trends and gender between the normal and dementia elderly. Results:The AUC of MMSE was≥0 . 75 ( P<0 . 05 ) . The MMSE score of the normal elderly declined nonlinearly as the age grew older(male:R2 =0. 924, P<0. 05; female: R2 =0. 951, P<0. 05), and increased nonlinearly as the education level rose(male: R2 =0. 948, P <0. 05; female: R2 =0. 859, P<0. 05). The females had significantly lower MMSE scores than the males, with a faster decline trend with age than the males (95%CI of female partial regression coefficient was not overlapped with 95%CI of male partial regression coefficient) . The dementia elderly showed a much lower MMSE score ( male:difference of Z score:-1 . 573 , P<0 . 05;female:difference of Z score:-1 . 222 , P<0 . 05 ) and ten-ded to with a faster decline speed than that of the normal elderly (95%CI of dementia partial regression coefficient included 95%CI of normal partial regression coefficient) . Conclusion:The screening validity of MMSE in CLHLS is not affected by educational level. The analysis of factors that may impact on the MMSE screening validity are gender, age, vision and residence which with validity identification. These four fac-tors can be used as assist tool of MMSE in the screening of dementia to improve the screening accuracy.

Objective: To study the incidence of catastrophic health expenditure of rural families in Xiaochang County of Hubei province, in order to explore the influential factors of catastrophic health expenditure. Methods: By using a multi-stage stratified cluster sampling to conduct a household survey, this paper randomly selects a total of a-bout 1,222 households of 4,673 people from 9 villages of 3 different towns in Xiaochang county of Hubei province, in order to compare the rate and severity of catastrophic health expenditure before and after joining the New Rural Coop-erative Medical Scheme ( NRCMS) , and it uses binary logistic regression model to analyze the influential factors of catastrophic health expenditure. Results: After joining the NRCMS, the rate, average gap and relative gap of cata-strophic health expenditure have all declined within the sampled areas; the influential factors of catastrophic health expenditure are household income, the number of working family members, the number of hospitalizations in family members, and the number of chronic patients among family members. Conclusion: With the increase of household in-come in the rural areas of Xiaochang County, both the rate and severity of catastrophic health expenditure have de-creased. In order to significantly reduce the catastrophic health expenditure in the rural areas of Xiaochang County, the government should perfectly improve the NRCMS's compensation mechanism for chronic outpatients' costs and re-duce the proportion of self-pay patients from low-income families.

This paper is to evaluate the biocompatibility and cytotoxicity of a new Ni-free Zr-based bulk metallic glass (BMG), Zr60.14 Cu22.31 Fe4.85 Al9.7 Ag3, by comparing it with conventional Ti6Al4V alloy. According to ISO 10993-5: 1999 and GB/T 16886.5-1997 standards, Zr60.14 Cu22.31 Fe4.85 Al9.7 Ag3, pure Zr and Ti6Al4V materials were extracted with surface area of sample/volume of medium ratio being 1 cm2/mL and 0.5 cm2/mL, respectively. The viabilities of MG-63 cells (Human osteosarcoma cell line) cultured in the BMG medium extracts for 1, 3 and 5 days were determined by CCK-8 assay. The cellular morphology of MG-63 cells cultured on the surface of samples for 3 days was tested through laser scanning confocal microscopy (LSCM) and scanning electron microscopy (SEM). The relative growth rate (RGR) of MG-63 cells cultured in Zr60.14 Cu22.31 Fe4.85 Al9.7 Ag3 and pure Zr were both more than 85%, indicating that the cytotoxicity of BMG was relatively low and met the national biomedical material eligibility standard. There was insignificant difference in the morphology of MG-63 cells cultured in the BMG medium extracts and the control group through LSCM and SEM, which showed the BMG had excellent biological compatibility. The Zr-based bulk metallic glass Zr60.14 Cu22.31 Fe4.85 Al9.7 Ag3 and the conventional Ti6Al4V alloy both had no obvious cytotoxicity to MG-63 cells. These results provided evidence that the new Zr-based bulk metallic glass could be potential replacement material for the orthopedic surgical implant.
Alloys ; Biocompatible Materials ; Cell Line ; Glass ; Humans ; Microscopy, Electron, Scanning ; Nickel ; Titanium ; Zirconium

ObjectiveTo investigate the influence of cobalt chloride ( CoCl2 )-mimetic hypoxia on theproliferation,apoptosis and migration of human pancreatic cancer cell fine PANC1.MethodsPANC1 cells were treated with 0(control),100,200,400,800 μmol/L CoCl2 respectively for 24 h.Real-time RT-PCR and Western blot were used to determine hypoxia induced factor ( HIF)-1o mRNA and protein expression respectively,and cell counting kit-8(CCK-8) assays,flow cytometry and cell scratch test were used to examine the proliferation,apoptosis and migration of PANC1 cells,respectively.ResultsIn the control group and 100,200,400 and 800 μmol/L CoCl-2 groups,the expressions of HIF-1t mRNA were 1,1.08 ±0.12,1.12 ± 0.09,1.04±0.11,0.66 ±0.07,and the expressions of VEGF mRNA were 1,2.69±0.35,4.81 ±0.54,2.19 ± 0.21,0.79 ± 0.08,while the expressions of HIF-1 α protein were 0.23 ± 0.03,0.36 ± 0.04,1.15 ± 0.11,1.08 ± 0.09,0.44 ± 0.04; and the expressions of VEGF protein were 0.14 ± 0.02,0.12 ± 0.01,0.95 ±0.09,0.87 ±0.09,0.55 ±0.06; and cell viability rates were 100％,(98.43 ±2.88)％,(76.15 ± 0.70)％,(53.87 ±0.77)％,(35.23 ±0.67)％ ; while cell apoptotic rates were (5.2 ±1.12)％,(5.74 ± 1.07)％,(6.82 ± 1.85)％,(12.09 ±3.53)％,(31.88 ±6.95)％ ; the cell migration distance of PANC1 cells were (43.24 ±3.67)％,(59.46 ±5.39)％,(80.56 ±8.05)％,(63.89 ±5.96)％,(9.09 ± 1.59 ) ％.Compared with those of control group,the expressions of VEGF mRNA,VEGF and HIF-1 α protein,cell migration distance showed a two-way variation ( ascending first and descending later) (P ＜0.05 ),and the expression of HIF-1α mRNA and cell proliferation rate was decreased in a dose-dependent manner,while the cell apoptosis was increased in a dose-dependent manner.Conclusions CoCl2 significantly inhibits the proliferation and promotes apoptosis of PANC1 cells at certain level.CoCl2 has a two-way effect on the migration of PANC1 cells,and it may be related to the direct injury of high concentration of CoCl2 on cells.