Objective To explore the predictive value of growth differentiation factor 15(GDF-15)for atrial fibrillation(AF)in patients with coronary heart disease(CHD).Methods A prospective observation cohort of 1261 elderly CHD patients was randomly sampled from the First Medical Center of Chinese PLA General Hospital from January 2012 to December 2015.ELISA was used to detect GDF-15 level in all the subjects,and their baseline data were collected.Until March 2023,93 patients were lost during the follow-up period,and finally 1168 patients completed the follow-up,with a median time of 9.4 years.According to AF occurred or not during the period,the eligible patients were divided into an AF group(197 cases)and a non-AF group(971 cases),and based on their medical history,also assigned into a stable angina pectoris(SAP,n=304)and an acute coronary syndrome group(ACS,n=864).Logistic regression analysis was used to determine whether GDF-15 is a risk factor for AF in elderly CHD patients.ROC curve was plotted to assess the predictive value of GDF-15,guideline recommended CHARGE-AF scoring model,and their combination for AF events in the patients.Results The AF group had significantly advanced age,larger proportions of smoking history,type 2 diabetes,hypertension,old myocardial infarction,stroke,ACS and administration of statins,higher ratio of angiotensin converting enzyme inhibi-tor/angiotensin receptor blocker,and elevated levels of GDF-15 and N-terminal pro-B-type natri-uretic peptide,and lower left ventricular ejection fraction,SAP incidence,and low-density lipopro-tein cholesterol,total cholesterol and triglycerides levels when compared with the non-AF group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that GDF-15 was not a risk factor for AF in elderly CHD patients(OR=0.92,95％CI:0.74-1.16,P=0.489),but was a risk factor for AF in SAP patients(OR=1.38,95％CI:1.07-2.79,P=0.015),and in ACS patients,still not a risk factor for AF(OR=0.81,95％CI:0.63-1.05,P=0.814).ROC curve analysis showed that the AUC value of GDF-15 combined with the CHARGE-AF scoring model in predic-ting AF was 0.682 in the elderly CHD patients,0.746 in the SAP patients,and 0.680 in the ACS patients.Conclusion Elevated GDF-15 level is an independent risk factor and predictor of AF in elderly SAP patients.In SAP patients,the combination of GDF-15 and CHARGE-AF scoring model further improves the predictive performance of AF occurrence.

Objective:To comprehensively evaluate the medical service capacity of 50 first batch county medical sub-centers in Guizhou Province,it provides the basis and references for further research on the construction of county medical sub-centers in Guizhou province and improvement of the medical service capacity of township health centers(community health service centers)in Guizhou Province.Methods:Through TOPSIS method,RSR method and the fuzzy combination method,the medical service capacity of the primary medical institutions in the county medical sub-center was evaluated.Results:Among the first batch of 50 county-level secondary medical centers,the top three in terms of medical service capabilities were G18,G6,and G36,while the last three were G27,G15,and G22.Conclusion:There were significant differences in the medical and health service capacity among the 50 sub-centers.It is suggested to continue to increase the support for sub-centers,formulate relevant policies according to local conditions and time conditions,and improve the medical service capacity of sub-centers.

Objective:To comprehensively evaluate the medical service capacity of 50 first batch county medical sub-centers in Guizhou Province,it provides the basis and references for further research on the construction of county medical sub-centers in Guizhou province and improvement of the medical service capacity of township health centers(community health service centers)in Guizhou Province.Methods:Through TOPSIS method,RSR method and the fuzzy combination method,the medical service capacity of the primary medical institutions in the county medical sub-center was evaluated.Results:Among the first batch of 50 county-level secondary medical centers,the top three in terms of medical service capabilities were G18,G6,and G36,while the last three were G27,G15,and G22.Conclusion:There were significant differences in the medical and health service capacity among the 50 sub-centers.It is suggested to continue to increase the support for sub-centers,formulate relevant policies according to local conditions and time conditions,and improve the medical service capacity of sub-centers.

Objective To explore the predictive value of growth differentiation factor 15(GDF-15)for atrial fibrillation(AF)in patients with coronary heart disease(CHD).Methods A prospective observation cohort of 1261 elderly CHD patients was randomly sampled from the First Medical Center of Chinese PLA General Hospital from January 2012 to December 2015.ELISA was used to detect GDF-15 level in all the subjects,and their baseline data were collected.Until March 2023,93 patients were lost during the follow-up period,and finally 1168 patients completed the follow-up,with a median time of 9.4 years.According to AF occurred or not during the period,the eligible patients were divided into an AF group(197 cases)and a non-AF group(971 cases),and based on their medical history,also assigned into a stable angina pectoris(SAP,n=304)and an acute coronary syndrome group(ACS,n=864).Logistic regression analysis was used to determine whether GDF-15 is a risk factor for AF in elderly CHD patients.ROC curve was plotted to assess the predictive value of GDF-15,guideline recommended CHARGE-AF scoring model,and their combination for AF events in the patients.Results The AF group had significantly advanced age,larger proportions of smoking history,type 2 diabetes,hypertension,old myocardial infarction,stroke,ACS and administration of statins,higher ratio of angiotensin converting enzyme inhibi-tor/angiotensin receptor blocker,and elevated levels of GDF-15 and N-terminal pro-B-type natri-uretic peptide,and lower left ventricular ejection fraction,SAP incidence,and low-density lipopro-tein cholesterol,total cholesterol and triglycerides levels when compared with the non-AF group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that GDF-15 was not a risk factor for AF in elderly CHD patients(OR=0.92,95％CI:0.74-1.16,P=0.489),but was a risk factor for AF in SAP patients(OR=1.38,95％CI:1.07-2.79,P=0.015),and in ACS patients,still not a risk factor for AF(OR=0.81,95％CI:0.63-1.05,P=0.814).ROC curve analysis showed that the AUC value of GDF-15 combined with the CHARGE-AF scoring model in predic-ting AF was 0.682 in the elderly CHD patients,0.746 in the SAP patients,and 0.680 in the ACS patients.Conclusion Elevated GDF-15 level is an independent risk factor and predictor of AF in elderly SAP patients.In SAP patients,the combination of GDF-15 and CHARGE-AF scoring model further improves the predictive performance of AF occurrence.

Polyurethane (PUR) plastics is widely used because of its unique physical and chemical properties. However, unreasonable disposal of the vast amount of used PUR plastics has caused serious environmental pollution. The efficient degradation and utilization of used PUR plastics by means of microorganisms has become one of the current research hotspots, and efficient PUR degrading microbes are the key to the biological treatment of PUR plastics. In this study, an Impranil DLN-degrading bacteria G-11 was isolated from used PUR plastic samples collected from landfill, and its PUR-degrading characteristics were studied. Strain G-11 was identified as Amycolatopsis sp. through 16S rRNA gene sequence alignment. PUR degradation experiment showed that the weight loss rate of the commercial PUR plastics upon treatment of strain G-11 was 4.67%. Scanning electron microscope (SEM) showed that the surface structure of G-11-treated PUR plastics was destroyed with an eroded morphology. Contact angle and thermogravimetry analysis (TGA) showed that the hydrophilicity of PUR plastics increased along with decreased thermal stability upon treatment by strain G-11, which were consistent with the weight loss and morphological observation. These results indicated that strain G-11 isolated from landfill has potential application in biodegradation of waste PUR plastics.
Plastics/metabolism* ; Polyurethanes/chemistry* ; RNA, Ribosomal, 16S ; Bacteria/genetics* ; Biodegradation, Environmental

Objective:To observe the multimodal imaging characteristics of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE).Methods:A cross-sectional study was conducted.Sixteen eyes of 16 patients with CHRRPE were enrolled in Second People's Hospital of Yunnan Province from March 2013 to July 2019.Fundus color photography, fundus autofluorescence (FAF), fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and multicolor imaging were performed in all patients.The multimodal imaging characteristics were analyzed.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Second People's Hospital of Yunnan Province (No.20130106). Written informed consent was obtained from patients or their guardians prior to any medical examination.Results:Tumors were located in the posterior optic disc, and translucent glial lesions with unclear borders and slight elevations were observed.The surface of the lesions was attached by different degrees of fibroproliferative membrane, and the adjacent vessels were twisted and dilated.The tumors presented flat bulging green reflexes on the retina at the posterior pole by multicolor imaging, and OCT image showed thickened optic disc and retina near the optic disc, structural disorder, high reflectance of the surface, and low reflectance of the deep retina below the periretinal membrane.OCTA showed irregular blood flow signals, and the signal of retinal blood vessels was twisted and dilated.FAF showed that the autofluorescence intensity of tumors was weakened to different degrees.Early lesions presented different degrees of blocked fluorescence in FFA.Deformed and tortuous blood vessels were found in the eyes, and telangiectasia showing needle-like punctate strong fluorescence leakage was observed in severe eyes by FFA.ICGA showed no abnormal choroidal vessels.Conclusions:The main imaging features of CHRRPE include abnormal retinal blood vessels in the tumor area and fibrous proliferative membranes on the surface in color image; OCT shows that the retina and the retinal pigment epithelium are involved, and the retina in the tumor is thickened with disordered structure; high reflection OCTA shows irregular internal blood flow signals inside the tumor; FFA examination shows fluorescence obscuration and obviously tortuous retinal blood vessels.Multimodal imaging examinations are helpful for the diagnosis of CHRRPE.

OBJECTIVE To pr ovide theoretic support for Guiyang to scientifically guide the development of drug retail industry and implement national health policies . METHODS The data were collected through statistical yearbook ，data cloud ， coordinate acquisition device of Application Programming Interface of Baidu map and so on. The spatial distribution characteristics and accessibility of medical insurance designated retail pharmacies （shorted for “designated pharmacies ”）in Guiyang were analyzed by spatial analysis based on Geographic Information System. The related factors for the distribution of designated pharmacies in Guiyang were analyzed by statistical method. RESULTS The number of designated pharmacies ，designated pharmacies per thousand people and designated pharmacies per 10 km2 in Guiyang increased from 2 018，0.41 and 2.51 in 2020 to 2 500，0.42 and 3.11 in 2021，with growth rates of 23.89％，2.44％ and 23.90％ respectively. The service area of the designated pharmacies that residents of Guiyang reached within 15 minutes on foot was 10.27％ of the total service area of designated pharmacies in Guiyang. The results of correlation analysis showed that the correlation coefficients between the regional gross regional production ，total retail sales of consumer goods ，population，urban per capita disposable income and the number of designated pharmacies in Guiyang were 0.999，0.999，0.977 and 0.992，respectively （all P＜0.05）. CONCLUSIONS The distribution of designated pharmacies is insufficient in Guiyang ，the development of designated pharmacies in various administrative regions is uneven ，and the layout of pharmacies is significantly affected by economic and demographic factors. It is suggested that the local government should explore the strategy of scientifically and reasonably expanding the coverage of designated pharmacies in urban and rural areas，promote the rational layout of pharmacies with appropriate economic and demographic policies ，and pay attention to improving the service capacity of designated pharmacies ，so as to improve the quality of life of the people and guide the healthy and high-quality development of drug retail industry.

Objective:To explore the relationship between sleep duration and depressive symptoms in middle-aged and elderly people.Methods:A total of 11 931 middle-aged and elderly people aged ≥55 years who participated in the baseline survey of the "Community Cohort Study of Specialized Nervous System Diseases" in China from 2018 to 2019 were selected to obtain basic information about their lifestyle, food intake frequency, disease history, sleep duration. The body height and weight were measured, and body mass index (BMI) were calculated. The subjects with depressive symptoms were screened with the Geriatric Depression Scale (GDS-30). Restricted cubic spline model and multivariate logistic regression model were used to analyze the relationship between sleep duration and depressive symptoms.Results:Among the middle-aged and elderly people aged ≥55 years, 17.79% reported sleep duration less than 7 hours, 16.84% reported that their sleep duration ≥9 hours, and the detection rate of depression symptoms was 7.95%. After adjusting for factors such as region, age, gender, the restricted cubic spline results showed the U-shaped relationship between sleep duration and the risk for depressive symptoms, the results of multivariate logistic regression analysis showed that the risk for depressive symptom in middle-aged and elderly people aged ≥55 years with sleep duration ≤5 hours, 6 hours, and ≥9 hours were 1.749(95% CI:1.279-2.392), 1.284(95% CI:1.021-1.615) and 1.260(95% CI:1.033-1.538) times higher compared with the counterparts with sleep duration 7-8 hours, the risk for depressive symptom in women with sleep duration ≤5 hours, 6 hours and ≥9 hours were 2.115 (95% CI:1.473-3.038), 1.605(95% CI:1.213-2.123) and 1.313(95% CI:1.011-1.705) times higher, respectively, compared with counterparts with sleep duration 7-8 hours, the risk for depressive symptoms in 55-64-year-old middle-aged and elderly people with sleep duration ≤5 hours and ≥9 hours were 1.806 (95% CI:1.014-3.217) and 1.478 (95% CI:1.060-2.061) times higher compared with counterparts with sleep duration 7-8 hours, and the risk for depressive symptoms in elderly people aged 65-74 years with sleep duration ≤5 hours was 2.112 (95% CI:1.327-3.361)times higher compared with counterparts with sleep duration 7-8 hours, the differences were all significant ( P<0.05). There was no statistically significant association between sleep duration and depressive symptoms in men and in elderly people aged ≥75 years ( P>0.05). Conclusion:Insufficient or prolonged sleep was independently associated with depressive symptoms in middle-aged and elderly people, showing a U-shaped relationship, especially in women and in middle-aged and elderly people aged 55-64 years.

OBJECTIVETo analyze the ultra microstructures and the expression of platelet peroxidase (PPO) of megakaryocytes from bone marrow, their clinical manifestations and laboratory characteristics in patients with acute megakaryoblastic leukemia (AMKL).

METHODSKaryocytes from bone marrow of 22 AMKL patients were divided into two parts by lymphocyte separation liquid, one part was used to prepare the ordinary transmission electron microscope specimens to observe the morphological structures of megakaryocytes, the other was used to prepare the histochemical specimens of platelet peroxidase to analyze the positive reaction of PPO in AMKL, which were coupled with the patients' data of with bone marrow morphology, cell chemistry, and chromosome karyotype examination.

RESULTSMegakaryocytes from 17 of 22 patients were in the first stage, less than 20 µm in diameter, the nucleis were round, the cytoplasm contained microtubules, membranous vesicles and minute dense granules, no demarcation membrane system and surface-connected canalicular system, less dense granules and α-granules; Megakaryocytes in 5 cases were mainly in the first stage, while containing second and third stage megakaryocytes; the positive rate of PPO in megakaryocytes of 22 patients was 0-80%. The primitive and naive megakaryocytes were found in bone marrow smears of 22 cases, CD41 staining of the megakaryocytes was detected in the primitive and naive megakaryocytes, and more complex chromosome karyotype anomalies were observed.

CONCLUSIONThe majority of megakaryocytes in AMKL patients were the first stage ones, the rest were second and third stage ones, and the positive PPO reaction was significantly different. CD41 staining of the megakaryocytes was specific with complex chromosome karyotypeswere.

Blood Platelets ; enzymology ; Bone Marrow ; pathology ; Cell Count ; Chromosome Aberrations ; Chromosome Disorders ; Humans ; Karyotyping ; Leukemia, Megakaryoblastic, Acute ; diagnosis ; pathology ; Megakaryocytes ; pathology ; Peroxidase ; metabolism ; Staining and Labeling

Objective To investigate the distribution of the prevalence of albuminuria in elderly population of a community in Tianjin and analyze the situation of their early renal injury and its clinical and environmental risk factors.Methods The morning spot urine sample and the clinical data from 2 050 old population (aged ≥ 60 years)who took part in healthy examination were collected.The concentration of urine albumin and creatinine were tested,and the albumin/creatinine ratio(ACR)was calculated.We analyzed the prevalence of albuminuria,and used logistic regression to analyze the odd ratio(OR) of risk factors.Results In the 2 050 participants,the prevalence was 1162 cases (56.69％) for hypertension,264 cases (12.86％) for diabetes and 568 cases (27.71％) for albuminuria.The prevalence of ACR ＞ 30 mg/g was lower in men than in women (21.61％ vs.32.55％,P＜0.001).The OR for increased ACR was 1.45 in 70-79y subjects as compared with 60-69y subjects,and the OR was 1.89 in ＞80y old people.The OR of increased ACR was 2.03 in ＞80y old people after adjusting gender.Body mass index and waist circumference were not the risk factors of increased ACR after adjusting confounding factors.There was an association between the prevalence of albuminuria and triglycerides(OR=1.19),hypertension(OR=1.68),diabetes(OR=1.95).ACR value was increased along with increased number of cigarettes,however,there was also no association between smoking and albuminuria(P＞ 0.05).Physical activity could reduce the risk of albuminuria,the OR of ACR＞30 mg/g in those undertaking a activity once daily was 0.52 (P =0.027) Conclusions There is a high prevalence of albuminuria in elderly population(higher in female than in male) in a community of Tianjin.Hypertension and diabetes have the greatest influence on ACR.Additionally,the physical activity once daily can reduce the risk of albuminuria.