Objective: To evaluate the effect of community comprehensive management model intervention among patients with dyslipidemia, so as to provide the reference for optimizing community management strategies and improving the target achievement rate for blood lipids among this population. Methods: From May to June 2023, a multi-stage stratified random sampling method was employed to select patients with dyslipidemia from primary healthcare institutions in Jiaxing City, Zhejiang Province. Eligible participants were randomly assigned to either a control group or an intervention group. The control group received routine management, while the intervention group was subjected to a community comprehensive management model in addition to the routine care. Both groups were followed up for 24 months. Data on demographic characteristics, lifestyle behaviors, physical examination indices, and blood biochemical indicators were collected at baseline and after the intervention through questionnaires, physical examinations, and laboratory tests. Changes in obesity rate, central obesity rate, target achievement rates for blood lipids, blood pressure, and blood glucose, as well as lifestyle modifications, were analyzed. Differences between the two groups before and after the intervention were assessed using generalized estimating equations (GEE). Results: The control group consisted of 560 patients, including 303 females (54.11%) and 430 individuals aged ≥65 years (76.79%). The intervention group also included 560 patients, with 300 females (53.57%) and 431 individuals aged ≥65 years (76.96%). Before the intervention, no statistically significant differences were observed between the two groups in terms of gender, age, educational level, history of chronic diseases, and atherosclerotic cardiovascular disease risk stratification (all P>0.05). After 24 months of intervention, interaction effects between group and time were observed for obesity rate, central obesity rate, target achievement rate for blood lipids, target achievement rate for blood glucose, composite target achievement rate, physical activity rate, and medication adherence (all P<0.05). Specifically, the intervention group demonstrated lower rates of obesity and central obesity, and higher target achievement rate of blood lipids, target achievement rate of blood glucose, composite target achievement rate, physical activity rate, and medication adherence compared to the control group. Conclusion The community comprehensive management model contributed to improvements in multiple metabolic parameters (including body weight, waist circumference, blood lipids, and blood glucose) among patients with dyslipidemia, and was associated with increased physical activity rate and medication adherence.

Objective:To investigate the effect of bone morphogenetic protein-9(BMP9)overexpression on inflammatory response and apoptosis of alveolar epithelial cells induced by lipopolysaccharide(LPS).Methods:A549 cells were stimulated with 0.1 μg/ml LPS,expressions and changes of BMP9 protein at different time points(LPS stimulation for 0 h,6 h,12 h,24 h)were detected by Western blot.Expression of BMP9 in A549 cells was up-regulated by transfection of BMP9 plasmid,and the transfection efficiency was verified by Western blot and qPCR.After 12 h of LPS stimulation,levels of inflammatory factors TNF-α,IL-6,IL-1β in cell supernatant were detected by ELISA,expressions of anti-apoptotic protein(Bcl-2)and pro-apoptotic protein(Bax)were detected by Western blot,and apoptosis of cells was detected by TUNEL staining.Results:With the extension of LPS stimulation time,expression of BMP9 was down-regulated.Overexpression of BMP9 successfully up-regulated expression of BMP9 in A549 cells.LPS stimulation promoted secretions of TNF-α,IL-6 and IL-1β from A549 cells,increased apoptosis,promoted Bcl-2 expression while inhibited Bax expression.Overexpression of BMP9 inhibited TNF-α,IL-6 and IL-1β releasing,decreased apoptosis,inhibited Bcl-2 expression,while promoted Bax expression.Conclusion:In LPS-stimulated A549 cells,BMP9 expression is gradually decreased at a time-depen-dent manner.Overexpression of BMP9 can inhibit LPS-induced inflammatory response and apoptosis in A549 cells.

BACKGROUND:Defective outgrowth of chondrocyte mitophagy causes degenerative chondrocyte pathological changes such as apoptosis and matrix loss.OBJECTIVE:To investigate the effects and possible mechanism of Juanbi Decoction-containing serum on interleukin-1β-induced inflammatory response and apoptosis of rat knee joint chondrocytes.METHODS:Fifty male Sprague-Dawley rats were randomly given saline,Juanbi Decoction in low,medium and high doses(1.24,2.48 and 4.96 g/kg),and celecoxib(positive drug)group.Drug-containing serum was obtained by continuous gavage for 2 weeks.(1)Chondrocytes were isolated and randomly divided into control group,interleukin-1β group,Juanbi Decoction low,medium and high dose containing serum groups and positive drug serum group.Cell counting kit-8 assay was used to detect cell viability;immunofluorescence double staining was used to detect mitophagy level;immunofluorescence was used to detect the phosphorylated AMP-activated protein kinase level;western blot was used to detect the expression of PTEN induced putative kinase 1/Parkin pathway-related protein and cleaved caspase-3;and ELISA was used to detect inflammatory factor level.(2)PTEN induced putative kinase 1 siRNA and Compound C were used for intervention to explore the role of AMP-activated protein kinase/PTEN induced putative kinase 1/Parkin pathway in the regulation of mitophagy by Juanbi Decoction-containing serum.RESULTS AND CONCLUSION:(1)Compared with the control group,chondrocyte survival,type II collagen,phosphorylated AMP-activated protein kinase,PTEN induced putative kinase 1,Parkin,and microtubule-associated proteins 1 light chain 3 protein levels,and mitophagy levels were significantly lower in the interleukin-1β group(P<0.05),while cleaved caspase-3 protein levels,interleukin-6,interleukin-8 and tumor necrosis factor-α levels were significantly higher(P<0.05).Compared with the interleukin-1β group,opposite changes in all the above indexes were observed in Juanbi Decoction low,medium and high dose containing serum groups and positive drug serum group(P<0.05).(2)PTEN induced putative kinase 1 siRNA significantly inhibited the effect of Juanbi Decoction-containing serum on mitophagy in interleukin-1β-treated chondrocytes and reduced the protective effect of Juanbi Decoction-containing serum on interleukin-1β-induced inflammation and apoptosis in chondrocytes;Compound C reversed the effect of Juanbi Decoction-containing serum on the PTEN induced putative kinase 1/Parkin signaling pathway in interleukin-1β-treated chondrocytes.To conclude,Juanbi Decoction-containing serum inhibits chondrocyte inflammation and apoptosis by affecting the level of mitochondrial autophagy,thereby attenuating interleukin-1β-induced chondrocyte degradation by a mechanism that may be related to the regulation of the AMP-activated protein kinase/PTEN induced putative kinase 1/Parkin pathway.

BACKGROUND:Some research has suggested that regulation of gut microbiota may influence the course of intervertebral disc degeneration.However,the causal relationship of gut microbiota on intervertebral disc degeneration is unknown.OBJECTIVE:To assess the potential causal relationship between gut microbiota and intervertebral disc degeneration using a Mendelian randomization method.METHODS:Genome-wide association analysis summary statistics for 473 gut microbiota and genome-wide association analysis summary data for intervertebral disc degeneration from the R11 of the FinnGen database(46 205 cases of intervertebral disc degeneration and 322 314 controls)from the most recent publicly available publication were applied.Inverse variance weighting,MR-Egger regression,weighted median,weighted modeling,and simple modeling were used to investigate the causal relationship between gut microbiota and intervertebral disc degeneration.Sensitivity analyses were used to test whether the results of Mendelian randomization analyses were reliable.Reverse Mendelian randomization was performed with all gut microbiota as the outcomes for effect analysis and sensitivity analysis.RESULTS AND CONCLUSION:(1)The results of the inverse variance weighting method of the forward Mendelian randomization method showed that the order Trichosporonaceae,the family UBA-6960,the family Anaerobes thermophilus,the family Salmonellaceae,the genus Pseudomonas tufts,the species Gordonella and the species Euclidia showed a positive correlation with intervertebral disc degeneration.The order Spirochaetes,the order Pseudomonas,the family Spirochaetaceae,the genus CAG-776,the genus Helicobacter,the species CAG-448 sp003150135,the species CAG-776 sp000438195,the species Brautella-A sp000285855 and the species Hanson's Brautella showed a negative correlation with intervertebral disc degeneration.(2)The results of reverse Mendelian randomization showed that intervertebral disc degeneration was positively correlated with the genus Bartonella rosea,the genus Geobacillus C,the species Escherichia fumigatus,the species Propionibacterium fumigatus,the species UBA-1777 sp900319835,the species Pseudomonas aeruginosa and the species Bacillus subtilis,while negatively correlated with the species Streptomyces mingoldii,the species Prevotella sp000434975,the species Brault's A sp000285855,the species CAG-194 sp002441865 and the species CAG-590 sp000431135.(3)No heterogeneity or horizontal pleiotropy was found in the two-way sensitivity analysis.(4)The results described above indicate that the causal relationship between gut microbiota and intervertebral disc degeneration based on the Finnish database contributes to the exploration on new biomarkers for the early prediction and treatment of intervertebral disc degeneration in clinical practice.In addition,the establishment of a large database and the integration of medical data from multiple centers can be drawn upon in biomedical research in China to provide a solid foundation for studying the relationship between gut microbiota and intervertebral disc degeneration.We will strengthen communication and cooperation with research teams in other countries to jointly promote the research on the relationship between gut microbiota and diseases and contribute to the development of global medicine.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

AIM:To observe the role of enoyl-coenzyme A hydratase/L-3-hydroxyacyl-coenzyme A dehydroge-nase(Ehhadh)in renal tubulointerstitial inflammation in high-fat diet(HFD)fed mice,and to explore its molecular mecha-nism.METHODS:Twenty-four C57BL/6N mice were randomly divided into 4 groups:standard diet(SD)group,HFD group,HFD with Ehhadh overexpression(HFD+Ehh)group and HFD with blank vector(HFD+Vec)group.Each group consisted of 6 mice.The HFD mice were fed with a diet containing 60%fat,20%protein,and 20%carbohydrates for 16 weeks.Briefly,at the end of 8 weeks,the mice in HFD+Ehh or HFD+Vec group were injected with adeno-associated virus 9(AAV9)-Ehhadh or AAV9-vector via the tail vein,and then continued another 8-week HFD feeding.At the end of the experiments,the renal function and morphological changes were observed.The protein expression levels of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),caspase-1 p10,interleukin-1β(IL-1β)and IL-18 in the kidney were detected by Western blot and immunohistochemistry.Immunofluorescence staining was used to detect the colocalization of Ehhadh and peroxisomal biogenesis factor 14(Pex14).ELISA was used to detect the content of IL-1β and IL-18 in the urine.Lipid droplet formation in renal tissues was detected by Nile red staining.Absolute quantitative lip-idomic analysis were used to detect the differential lipid species in renal cortices of the mice in SD,HFD and HFD+Ehh groups.RESULTS:Compared with SD group,the expression of Ehhadh protein was significantly decreased in the peroxi-some of renal tubular epithelium cells in HFD-fed mice(P<0.01).Overexpression of Ehhadh significantly improved renal function(P<0.01)and alleviated the morphological changes of renal tubular epithelial cells in HFD group.Moreover,it significantly inhibited the expression of inflammatory cytokines IL-1β and IL-18 and macrophage infiltration in renal tu-bule interstitium of HFD-fed mice(P<0.01).At the same time,Ehhadh overexpression inhibited HFD-induced NLRP3 inflammasome activation(P<0.01).It also attenuated lipid deposition in renal tubular epithelium cells(P<0.01)and promoted the β-oxidation of long-chain fatty acid such as cholesterol and phospholipids in peroxisomes.CONCLUSION:The Ehhadh inhibits tubulointerstitial inflammation by promoting long-chain fatty acid β-oxidation in peroxisomes and in-hibiting the activation of NLRP3 inflammasome in HFD-fed mice.

Objective:To investigate the efficacy and safety of a self-controlled chain ring combined with tissue clip traction-assisted technique for endoscopic submucosal dissection (ESD) of early colorectal tumors.Methods:Data of patients with early colorectal tumors in technically challenging locations who underwent ESD at the Digestive Endoscopy Center of Jiangsu Province Hospital of Chinese Medicine from January 2021 to April 2024 were enrolled in the retrospective cohort study. According to the treatment methods, they were divided into the traction-assisted ESD group (a self-controlled chain ring combined with tissue clip traction-assisted) and the traditional ESD group (without traction). Clinical endoscopic data, treatment conditions, and complications were compared between the two groups.Results:A total of 61 patients were enrolled, including 29 patients in the traction-assisted ESD group and 32 patients in the traditional ESD group. There were no significant differences in age, gender, tumor size, shape, location, pit pattern, pathological type, depth of invasion, one-time complete resection, or curative resection between the two groups ( P>0.05). The traction-assisted group demonstrated significantly shorter dissection times (37.55±20.44 min VS 60.78±29.34 min, t=-3.552, P<0.001) and lower complication rates [3.4% (1/29) VS 25.0% (8/32), χ2=4.035, P=0.045]. Complications in the traction-assisted ESD group included 1 muscularis propria superficial injury (no perforation/uncontrollable bleeding), versus 6 muscularis injuries and 2 micro-perforations in controls. Conclusion:The combined traction technique improves dissection efficiency and reduces procedural risks for challenging colorectal ESD.

Objective: To investigate the trend in mortality of injury in Jiaxing City, Zhejiang Province, from 2010 to 2022, so as to provide the evidence for developing injury prevention and intervention strategies. Methods: Data on injury mortality in Jiaxing City from 2010 to 2022 were obtained from the Jiaxing Chronic Disease Monitoring Information Management System. Crude mortality was calculated, and standardized mortality was computed using data of the Sixth National Population Census in 2010. Descriptive analysis of injury mortality and cause of injury death was conducted by gender and age. The average annual percent change (AAPC) was used to analyze the trend in mortality of injury from 2010 to 2022. Results: From 2010 to 2022, the crude injury mortality in Jiaxing City was 79.24/100 000, and the standardized mortality was 47.08/105. The crude injury mortality was higher in males than in females (80.51/100 000 vs. 78.01/100 000, P<0.05). The standardized injury mortality for the total population, males, and females showed significant declining trends (AAPC=-2.011%, -2.373% and -1.542%, all P<0.05). The crude injury mortality increased with age (P<0.05), peaking in the age group of ≥85 years (1 806.46/100 000). Decreasing trends were observed in the age groups of 0-<15 years, 15-<45 years, and 45-<65 years (AAPC=-7.794%, -4.698% and -4.521%, all P<0.05), while no significant trend was found in the age group of ≥65 years. The top five causes of injury death were falls (29.96/100 000), motor vehicle traffic accidents (17.81/100 000), drowning (6.50/100 000), suicide (5.40/100 000), and poisoning (0.69/100 000). Drowning was the leading cause of injury death in the age group of 0-<15 years, while falls were the primary cause in the age group of ≥65 years. Motor vehicle traffic accidents were the top cause of injury death in age groups of 15-<45 years and 45-<65 years. From 2010 to 2022, the standardized mortality of falls showed an upward trend (AAPC=1.094%, P<0.05), while the standardized mortality of motor vehicle traffic accidents, drowning, and suicide demonstrated downward trends (AAPC=-7.576%, -2.745% and -2.786%, all P<0.05). Conclusions The standardized injury mortality in Jiaxing City showed an overall downward trend from 2010 to 2022. Falls were the leading cause of injury death, and particular attention should be paid to the prevention and control of falls among the elderly aged ≥65 years.

Objective: To investigate the current status and influencing factors of overweight and obesity among adults in Jiaxing City, Zhejiang Province, so as to provide a basis for developing targeted weight management measures. Methods: In 2024, a multistage stratified random cluster sampling method was employed to recruit permanent residents aged ≥18 years from Jiaxing City for questionnaire surveys. Data on basic information, lifestyle behaviors, and history of chronic diseases were collected. Height and body weight were measured, and overweight and obesity were determined based on body mass index (BMI). The influencing factors of overweight and obesity among adults were analyzed by a multivariable logistic regression model. Results: Totally 10 509 questionnaires were allocated, and 9 802 valid questionnaires were recovered, with an effective recovery rate of 93.27%. Among the respondents, 4 808 (49.05%) were males and 4 994 (50.95%) were females, with a mean age of (51.27±17.26) years. A total of 4 884 overweight and obesity individuals were identified, with a detection rate of 49.83%. Multivariable logistic regression analysis showed that gender (male, OR=1.719, 95%CI: 1.578-1.873), age (≥60 years, OR=0.802, 95%CI: 0.652-0.986), educational level (bachelor and above, OR=0.640, 95%CI: 0.518-0.791), marital status (being married/cohabiting, OR=1.224, 95%CI: 1.009-1.486), adequate nut intake (OR=0.910, 95%CI: 0.832-0.995), hypertension (OR=2.462, 95%CI: 2.219-2.732), and dyslipidemia (OR=1.629, 95%CI: 1.444-1.837) were statistically associated with overweight and obesity among adults. Conclusion The detected rate of overweight and obesity among adults in Jiaxing City was relatively high, and was mainly associated with gender, age, education level, marital status, nut intake, hypertension, and dyslipidemia.

ObjectiveTo investigate the risk factors for pyogenic liver abscess （PLA） comorbid with sepsis by analyzing clinical features， and to construct a predictive model. MethodsA retrospective analysis was performed for 489 patients who were hospitalized and diagnosed with PLA in The Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2023， and according to the presence or absence of sepsis， they were divided into sepsis group with 306 patients and non-sepsis group with 183 patients. Related data were collected， including general information， laboratory markers， and outcome measures. The patients were further divided into a training set of 342 patients and a validation set of 147 patients at a ratio of 7∶3， and the training set was used for screening of variables and construction of a predictive model， while the validation set was used to test the performance of the model. An LASSO regression analysis was used for the screening of variables， and a multivariate Logistic regression analysis was used to construct the predictive model and plot a nomogram. The calibration curve， the receiver operating characteristic （ROC） curve， and the decision curve analysis were used for the validation of the model， and internal validation was performed for assessment. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical variables between groups. ResultsThere were significant differences between the sepsis group and the non-sepsis group in pulse rate， mean arterial pressure， duration pf symptoms， comorbidity of liver cirrhosis or malignant tumor， leukocyte count， neutrophil count， lymphocyte count， platelet count （PLT）， activated partial thromboplastin time， fibrinogen， C-reactive protein， aspartate aminotransferase， alanine aminotransferase， albumin， total bilirubin （TBil）， creatinine， potassium， and prognostic nutritional index （PNI） （all P<0.05）. In the training set， the LASSO regression analysis identified four predictive factors of pulse rate， PLT， TBil and PNI， and the multivariate Logistic regression analysis showed that pulse rate （odds ratio ［OR］=1.033， 95% confidence interval ［CI］： 1.006‍ ‍—‍ ‍1.061， P=0.018）， PLT （OR=0.981， 95%CI： 0.975‍ ‍—‍ ‍0.987， P<0.001）， TBil （OR=1.086， 95%CI： 1.053‍ ‍—‍ ‍1.125， P<0.001）， and PNI （OR=0.935， 95%CI： 0.882‍ ‍—‍ ‍0.988， P=0.019） were independent influencing factors for the risk of sepsis in patients with PLA. The model constructed based on these factors showed a good predictive ability， with an area under the ROC curve of 0.948 （95%CI： 0.923‍ ‍—‍ ‍0.973） in the training set and 0.912 （95%CI： 0.848‍ ‍—‍ ‍0.976） in the validation set. The decision curve analysis showed that the model has a good net benefit within the range of 0.3‍ ‍—‍ ‍0.9 for threshold probability. ConclusionThe nomogram prediction model constructed based on pulse rate， PLT， TBil， and PNI has a certain clinical value and can well predict the risk of sepsis in patients with PLA.