Background Frailty serves as a significant precursor to falls, disability, and mortality. Epidemiological evidence examining the impact of working hours on frailty remains scarce. Objective To explore the prevalence of frailty and the relationship between frailty and working hours among full-time middle-aged and older workers in China. Methods Data were derived from the 2020 China Health and Retirement Longitudinal Study (CHARLS). The study included full-time workers aged 45 years and above with a weekly working duration exceeding 35 h. Frailty was assessed using the Frailty Index (FI). First, the dose-response relationship between working hours and FI was explored using a generalized additive model (GAM). Second, univariate analyses were performed using t-tests, χ² tests, and the Jonckheere–Terpstra trend test. Restricted cubic splines (RCS) were introduced for modeling. Based on ordinal logistic regression models, covariates were adjusted sequentially to examine whether differences in frailty prevalence existed across different weekly working hour categories. Finally, subgroup analyses were performed. Results Among the 5504 included participants, the mean age was (56.41±7.30) years, with 2304 being female (41.86%). A total of 807 participants (14.66%) were identified as frail, and 2 686 participants (48.80%) were pre-frail. After standardization for gender and age according to the seventh national census data, the standardized prevalence of frailty and prefrailty were 18.89% and 47.25%, respectively. Significant higher proportions of frail individuals were found among those in non-managerial (73.73%), agricultural (64.06%), and non-employed (65.68%) occupations. Long working hours were prevalent: 2596 (47.17%) workers worked 41–60 h per week, 1649 (29.96%) worked >60 h per week, and only 1259 (22.87%) worked 35–40 h per week. GAM analysis showed a non-linear relationship between weekly working hours and FI. Restricted cubic spline analysis showed a statistically significant association between weekly working hours and frailty status (P=0.022). Logistic regression analysis revealed that individuals working more than 60 h per week had a 23% higher odds of frailty compared to those working 41–60 h (OR=1.23, 95%CI: 1.09, 1.38, P<0.01), while those working 35–40 h per week showed a 15% higher odds of frailty (OR=1.15, 95%CI: 1.01, 1.31, P=0.034). The subgroup analysis revealed that the positive association between working more than 60 h per week and frailty remained generally consistent across sex, age, urban/rural residence, occupational attributes, industry, or employment type, although the association did not reach statistical significance among non-rural residents and individuals aged 60 years and older. Conclusion The prevalence of frailty among full-time middle-aged and older labor force in China is relatively high, and the odds of frailty increases significantly among those who work more than 60 h per week. It is recommended to implement frailty prevention and management strategies targeting long-working-hour workers and to prioritize the impact of working duration on frailty.

Objective To summarize and analyze the efficacy and influencing factors of second allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute leukemia relapsing after the first allo-HSCT. Methods Clinical data of 17 patients with acute leukemia who underwent second allo-HSCT at Peking University First Hospital from January 2005 to December 2024 were retrospectively analyzed. Results Among the 17 patients, 7 achieved long-term disease-free survival after second transplantation. The median progression-free survival after successful second transplantation was 7 months (range 8 days to 69 months). The relapse fatality was 24%, and the transplant-related fatality was 35%. Conclusions Second transplantation is an effective treatment for relapsed and refractory acute leukemia, but the relapse fatality and transplant-related fatality remain high. Patient age, time of relapse after the first transplantation and disease status before second transplantation are all factors that affect the efficacy of second transplantation. Younger age, late relapse and complete remission of disease before second transplantation are all beneficial for long-term disease-free survival after second transplantation.

Objective: To investigate the status and influencing factors of influenza vaccination among the elderly, so as to provide insights into improving the strategies for influenza vaccination among the elderly. Methods: Elderly people aged 60 years and above were recruited from one community each in five sub-districts of Shihezi City, Xinjiang Uygur Autonomous Region using a random sampling method. Demographic information, knowledge about influenza and influenza vaccines, vaccine literacy and influenza vaccination status in the past year were collected through questionnaire surveys. Factors affecting influenza vaccination among the elderly were analyzed using a multivariable logistic regression model. Results: Totally 1 121 valid questionnaires were recovered, with an effective recovery rate of 95.08%. There were 417 males (37.20%) and 704 females (62.80%). The majority were aged 60-<81 years, accounting for 80.37% (901 individuals). The awareness of knowledge about influenza and influenza vaccines was 78.86%. Low vaccine literacy was observed in 786 individuals, representing 70.12%. The influenza vaccination rate was 20.96%. Multivariable logistic regression analysis showed that age (71-<81 years, OR=1.607, 95%CI: 1.041-2.479; ≥81 years, OR=1.719, 95%CI: 1.040-2.842), educational level (middle school/technical secondary school, OR=0.616, 95%CI: 0.416-0.911), medical expense payment (employee medical insurance, OR=6.531, 95%CI: 2.030-21.010; resident medical insurance, OR=3.385, 95%CI: 1.095-10.466; public expense, OR=4.828, 95%CI: 1.700-13.712), vaccination willingness (yes, OR=6.237, 95%CI: 3.277-11.871), influenza vaccination history (yes, OR=14.600, 95%CI: 8.733-24.408) and vaccine literacy (medium and above, OR=2.412, 95%CI: 1.636-3.555) were associated with influenza vaccination among the elderly. Conclusion The influenza vaccination rate among the elderly was relatively low, and was mainly affected by age, educational level, medical expense payment, vaccination willingness, influenza vaccination history and vaccine literacy.

This study systematically analyzed the clinical applications of photobiomodulation(PBM)therapy in Parkinson disease(PD)patients using a scoping review methodology,with the aim of summarizing treatment protocols,outcome measures,and therapeutic effects to provide references for subsequent clinical research and treatment.A comprehensive search was conducted across Web of Science,PubMed,Embase,Cochrane Library,CNKI,and Wanfang,ultimately including 13 studies.The results indicate that PBM therapy can effectively improve motor symptoms,non-motor symptoms,and brain structure in PD patients,serving as a beneficial supplement to conventional treatments.However,there remains a scarcity of large-sample randomized controlled trials(RCTs),along with significant variations in the selected treatment parameters.Therefore,further investigations with larger sample sizes and extended durations are required to validate its therapeutic efficacy.

Objective·To explore the relationship between abdominal fat area and the first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes,and to establish predictive models of nomogram.Methods·From October 2020 to February 2024,a total of 120 patients with type 2 diabetes,who were hospitalized in the Department of Endocrinology,Zhongshan Hospital,Fudan University,and underwent the arginine stimulation test,were recruited for the study.Patients were categorized into an insulin secretion function-preserved group(i.e.preserved group)and a depleted group according to the results of the arginine stimulation test.General information and laboratory parameters were collected.Subcutaneous fat area(SFA)and visceral fat area(VFA)were non-invasively measured by abdominal fat detector.The variables were screened by univariate analysis,and multivariate Logistic regression was used to identify the influencing factors,followed by the establishment of predictive models of nomogram.The area under the receiver operating characteristic curve(ROC curve)and concordance index(C-index)were used to evaluate the predictive performance of the models.Results·Seventy-four patients(61.7%)were assigned to the preserved group,and 46 patients(38.3%)to the depleted group.Patients in the depleted group had a longer diabetes duration,lower waist circumference,hip circumference,body mass index(BMI),uric acid,free triiodothyronine(FT3),adipose tissue insulin resistance(Adipo-IR),ankle brachial index(ABI),SFA and VFA,and higher brachial ankle pulse wave velocity(baPWV).Multivariate Logistic regression showed that SFA,VFA,FT3,baPWV,and ABI were independent risk factors for the depleted insulin secretion function.Nomogram models were constructed based on the above risk factors.Among them,the model comprising VFA,FT3,ABI,and baPWV showed the best predictive performance with a C-index of 0.81.Conclusion·SFA and VFA are lower in patients with depleted first-phase insulin secretion function of pancreatic β-cells.The nomogram model,including SFA or VFA,can be used to predict first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes.

Objective:To investigate the predictive value of cardiac MR (CMR)-derived left ventricular end-systolic wall stress (LVESWS) and biventricular strain parameters for different types of heart failure in patients with myocardial infarction.Methods:This retrospective cohort study included 231 patients diagnosed with myocardial infarction by clinical and CMR criteria at the Second Affiliated Hospital of Kunming Medical University between January 2015 and July 2023. The endpoint was the occurrence of heart failure, and patients were divided into 3 groups: no heart failure ( n=85), heart failure with preserved ejection fraction (HFpEF, n=74), and heart failure with reduced ejection fraction (HFrEF, n=72). Clinical indicators such as age and infarct size were collected. CMR parameters analysis included LVESWS, left ventricular global radial strain (LVGRS), left ventricular global circumferential strain (LVGCS), left ventricular global longitudinal strain (LVGLS), right ventricular global radial strain (RVGRS), right ventricular global circumferential strain (RVGCS), right ventricular global longitudinal strain (RVGLS), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI). Differences in clinical baseline data and CMR parameters among the 3 groups were tested. Univariate Cox regression analysis was performed, followed by multivariate Cox modeling of statistically significant factors. Receiver operating characteristic (ROC) analysis was conducted for the influencing factors identified in the multivariate Cox model, and Kaplan-Meier survival curves for survival time were plotted. Results:Significant differences were observed in biventricular strain parameters (LVGRS, LVGCS, LVGLS, RVGRS, RVGCS, RVGLS), LVESWS, LVEDVI, and LVESVI among the 3 groups (all P<0.05). Univariate and multivariate Cox regression analyses showed that RVGCS, age, and infarct size were independent influencing factors for HFpEF after myocardial infarction (all P<0.01), while LVESWS and LVGLS were independent influencing factors for HFrEF after myocardial infarction (all P<0.001). Further ROC analysis revealed that the areas under the curve (AUC) for RVGCS, infarct size, age, RVGCS combined with age, and RVGCS combined with age and infarct size in predicting HFpEF were 0.771, 0.607, 0.615, 0.793, and 0.805, respectively. The AUCs for LVESWS, LVGLS, and LVESWS combined with LVGLS in predicting HFrEF were 0.943, 0.925, and 0.971, respectively. Kaplan-Meier survival curves based on optimal cutoff values showed statistically significant differences in survival time between HFpEF and non-heart failure patients when grouped by RVGCS and age (all P<0.05), but no significant difference when grouped by infarct size ( P=0.400). Statistically significant differences in survival time were observed between HFrEF and non-heart failure patients when grouped by LVESWS and LVGLS (all P<0.001). Conclusion:CMR-derived LVESWS and biventricular strain parameters demonstrate significant predictive value for different types of heart failure after myocardial infarction and can serve as valuable imaging markers for heart failure management and risk stratification in patients with myocardial infarction.

Objective:To investigate the predictive value of cardiac MR (CMR)-derived left ventricular end-systolic wall stress (LVESWS) and biventricular strain parameters for different types of heart failure in patients with myocardial infarction.Methods:This retrospective cohort study included 231 patients diagnosed with myocardial infarction by clinical and CMR criteria at the Second Affiliated Hospital of Kunming Medical University between January 2015 and July 2023. The endpoint was the occurrence of heart failure, and patients were divided into 3 groups: no heart failure ( n=85), heart failure with preserved ejection fraction (HFpEF, n=74), and heart failure with reduced ejection fraction (HFrEF, n=72). Clinical indicators such as age and infarct size were collected. CMR parameters analysis included LVESWS, left ventricular global radial strain (LVGRS), left ventricular global circumferential strain (LVGCS), left ventricular global longitudinal strain (LVGLS), right ventricular global radial strain (RVGRS), right ventricular global circumferential strain (RVGCS), right ventricular global longitudinal strain (RVGLS), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI). Differences in clinical baseline data and CMR parameters among the 3 groups were tested. Univariate Cox regression analysis was performed, followed by multivariate Cox modeling of statistically significant factors. Receiver operating characteristic (ROC) analysis was conducted for the influencing factors identified in the multivariate Cox model, and Kaplan-Meier survival curves for survival time were plotted. Results:Significant differences were observed in biventricular strain parameters (LVGRS, LVGCS, LVGLS, RVGRS, RVGCS, RVGLS), LVESWS, LVEDVI, and LVESVI among the 3 groups (all P<0.05). Univariate and multivariate Cox regression analyses showed that RVGCS, age, and infarct size were independent influencing factors for HFpEF after myocardial infarction (all P<0.01), while LVESWS and LVGLS were independent influencing factors for HFrEF after myocardial infarction (all P<0.001). Further ROC analysis revealed that the areas under the curve (AUC) for RVGCS, infarct size, age, RVGCS combined with age, and RVGCS combined with age and infarct size in predicting HFpEF were 0.771, 0.607, 0.615, 0.793, and 0.805, respectively. The AUCs for LVESWS, LVGLS, and LVESWS combined with LVGLS in predicting HFrEF were 0.943, 0.925, and 0.971, respectively. Kaplan-Meier survival curves based on optimal cutoff values showed statistically significant differences in survival time between HFpEF and non-heart failure patients when grouped by RVGCS and age (all P<0.05), but no significant difference when grouped by infarct size ( P=0.400). Statistically significant differences in survival time were observed between HFrEF and non-heart failure patients when grouped by LVESWS and LVGLS (all P<0.001). Conclusion:CMR-derived LVESWS and biventricular strain parameters demonstrate significant predictive value for different types of heart failure after myocardial infarction and can serve as valuable imaging markers for heart failure management and risk stratification in patients with myocardial infarction.

OBJECTIVE To evaluate the potential of nanopore sequencing technology for rapid diagnosis of Talaro-myces marneffei(TM)infection.METHODS Nine patients with TM infection admitted to the Fourth People's Hospital of Nanning from May 13,2022 to Aug.3,2023 were retrospectively analyzed.Rapid diagnosis was con-ducted by nanopore sequencing technology,and a comprehensive analysis of their clinical characteristics and treat-ment processes was performed.RESULTS The 9 patients included in the study had infections in various sites such as the lungs,buttocks,blood and cervical lymph nodes.Comorbidities included AIDS,secondary pulmonary tuberculosis,non-tuberculous mycobacterial disease and adult-onset immune deficiency.Patients generally exhibited elevated C-reactive protein levels and erythrocyte sedimentation rates,along with increased neutrophil counts.Some patients had abnormal lymphocyte counts and CD4+/CD8+ratios.Microbiological tests showed positive cultures in 3 cases,positive smears in 2 cases and positive targeted detection in 6 cases.Nanopore sequencing detected various pathogens in the 9 patients.The treatment results indicated that 8 patients improved after medication,with 6 patients having medication regimens adjusted based on nanopore sequencing results.CONCLUSION Nanopore sequencing technology has shown potentials in the auxiliary diagnosis of TM infection,providing timely etiological diagnostic evidence for clinical practice.

Objective To investigate the relationship between quantitative parameters of the histogram of global fat fraction(FF)in the infrapatellar fat pad(IPFP)and the severity of knee osteoarthritis(KOA).Methods A total of 120 patients were prospectively selected and divided into the non-KOA group(KL grade 0-1),the mild KOA group(KL grade 2),and the severe KOA group(KL grade 3-4)based on the Kellgren-Lawrence(KL)classification criteria of knee X-rays.The FF maps of the IPFP were obtained based on the mDIXON-Quant technique.The region of interest(ROI)was delineated using 3D Slicer software,and global histogram analysis was performed to obtain quantitative parameters,including mean,median,10th percentile(10th),90th percentile(90th),skewness,kurtosis,and entropy.Pearson or Spearman correlation analysis was used to evaluate the correlation between each quanti-tative parameter and the severity of KOA.The diagnostic efficacy was analyzed using the receiver operating characteristic(ROC)curves.Results As the progression of KL classification,the mean,median,percentiles,and kurtosis of the global FF histogram quantitative parameters in the IPFP decreased,while skewness and entropy increased,with statistically significant among the three groups(P＜0.001).The mean,median,10th,90th,and kurtosis showed negative correlations with the KL classification(r=-0.563,-0.448,-0.614,-0.294,-0.450),while skewness and entropy showed positive correlations with the KL classification(r=0.385,0.637),all of which were statistically significant(P＜0.05).The area under the curve(AUC)for diagnosing KOA were 0.799,0.725,0.828,0.636,0.741,0.688,and 0.830,respectively.The sensitivity of the 10th and entropy were 74.4％and 77.9％,respectively,and the specificity were 85.3％and 88.2％,respectively.Conclusion The quantitative parameters of the histogram of global FF in the IPFP are correlated with the severity of KOA and can reflect the pathophysiological changes in the IPFP.They can serve as objective indicators for diagnosing KOA and assessing its severity.

Tuberculosis is a zoonotic disease posing a substantial public health threat.Immunological diagnosis and vaccine im-munization are both necessary to control tuberculosis prevalence.However,the identical antigenic components in diagnostic reagents and vaccines hinder the use of animal vaccines and limit the specificity of clinical diagnosis in humans.Differentiating infected from vaccinated animals can overcome these problems.This article reviews the progress in differential diagnosis research from three as-pects:the diagnostic effects of antigens,methods for discovering new antigens,and screening of new host immune markers,to provide a theoretical basis for future research.