BACKGROUND: The mechanisms distinguishing metabolically healthy from unhealthy phenotypes within the same BMI categories remain unclear. This study aimed to investigate the associations between regional fat distribution and metabolically unhealthy phenotypes in Chinese adults across different BMI categories. METHODS: This cross-sectional study involving 11833 Chinese adults aged 20 years and older. Covariance analysis, adjusted for age, compared the percentage of regional fat (trunk, leg, or arm fat divided by whole-body fat) between metabolically healthy and unhealthy participants. Trends in regional fat percentage with the number of metabolic abnormalities were assessed by the Jonckheere-Terpstra test. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated by logistic regression models. All analyses were performed separately by sex. RESULTS: In non-obese individuals, metabolically unhealthy participants exhibited higher percent trunk fat and lower percent leg fat compared to healthy participants. Additionally, percent trunk fat increased and percent leg fat decreased with the number of metabolic abnormalities. After adjustment for demographic and lifestyle factors, as well as BMI, higher percent trunk fat was associated with increased odds of being metabolically unhealthy [highest vs. lowest quartile: ORs (95%CI) of 1.64 (1.35, 2.00) for men and 2.00 (1.63, 2.46) for women]. Conversely, compared with the lowest quartile, the ORs (95%CI) of metabolically unhealthy phenotype in the highest quartile for percent arm and leg fat were 0.64 (0.53, 0.78) and 0.60 (0.49, 0.74) for men, and 0.72 (0.56, 0.93) and 0.46 (0.36, 0.59) for women, respectively. Significant interactions between BMI and percentage of trunk and leg fat were observed in both sexes, with stronger associations found in individuals with normal weight and overweight. CONCLUSIONS Trunk fat is associated with a higher risk of metabolically unhealthy phenotype, while leg and arm fat are protective factors. Regional fat distribution assessments are crucial for identifying metabolically unhealthy phenotypes, particularly in non-obese individuals.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Adipose Tissue ; Body Fat Distribution ; Body Mass Index ; China/epidemiology* ; Cross-Sectional Studies ; Health Surveys ; Phenotype

Objective To develop a risk management system for complications associated with peripheral venous indwelling needles and to evaluate its application effect in order to reduce the risk of related complications.Methods We designed a comprehensive risk management system for peripheral intravenous indwelling needle complications,integrating specialized evidence-based guidelines with clinical practice insights,including 5 modules:intelligent assessment and decision support,intelligent inspection reminders,educational modules,collaborative case management procedures,and a knowledge base.Patients admitted to the neurology and internal classification metabolism departments of a tertiary hospital in Jilin Province were conveniently selected as the research subjects.Patients were assigned to a control group(from May to July 2022,before the implementation of the system)and an experimental group(from September to December 2022,after the implementation of the system).The incidence of complications,duration of indwelling needle,compliance rate of core indicators for nursing quality and number of nursing consultations were compared between the groups.Additionally,a self-administered questionnaire was used to assess clinical nurses'evaluations of the system.Results A total of 189 patients were included in the experimental group and 177 patients in the control group.The incidence of complications associated with peripheral intravenous indwelling needles was lower than that in the control group.The duration of indwelling peripheral intravenous needles was longer than that in the control group.The quality compliance rate of peripheral venous indwelling needle care in the experimental group was higher than that in the control group,and the number of consultation cases in the experimental group was higher than that in the control group.Comparisons between the 2 groups showed statistically significant differences for all indicators(P＜0.05).The nurses'recognition rates for the system's user-friendliness,professional guidance,and patient benefit were 77.78％,81.74％,and 82.13％,respectively.Conclusion The application of a peripheral vein indwelling needle complication risk management system can reduce the incidence of complications,prolong the duration of indwelling,and improve nursing quality.Nurses have a high recognition of this system.

Objective To develop a risk management system for complications associated with peripheral venous indwelling needles and to evaluate its application effect in order to reduce the risk of related complications.Methods We designed a comprehensive risk management system for peripheral intravenous indwelling needle complications,integrating specialized evidence-based guidelines with clinical practice insights,including 5 modules:intelligent assessment and decision support,intelligent inspection reminders,educational modules,collaborative case management procedures,and a knowledge base.Patients admitted to the neurology and internal classification metabolism departments of a tertiary hospital in Jilin Province were conveniently selected as the research subjects.Patients were assigned to a control group(from May to July 2022,before the implementation of the system)and an experimental group(from September to December 2022,after the implementation of the system).The incidence of complications,duration of indwelling needle,compliance rate of core indicators for nursing quality and number of nursing consultations were compared between the groups.Additionally,a self-administered questionnaire was used to assess clinical nurses'evaluations of the system.Results A total of 189 patients were included in the experimental group and 177 patients in the control group.The incidence of complications associated with peripheral intravenous indwelling needles was lower than that in the control group.The duration of indwelling peripheral intravenous needles was longer than that in the control group.The quality compliance rate of peripheral venous indwelling needle care in the experimental group was higher than that in the control group,and the number of consultation cases in the experimental group was higher than that in the control group.Comparisons between the 2 groups showed statistically significant differences for all indicators(P＜0.05).The nurses'recognition rates for the system's user-friendliness,professional guidance,and patient benefit were 77.78％,81.74％,and 82.13％,respectively.Conclusion The application of a peripheral vein indwelling needle complication risk management system can reduce the incidence of complications,prolong the duration of indwelling,and improve nursing quality.Nurses have a high recognition of this system.

This study aims to explore possible effect of RNA polymerase I subunit D (POLR1D) on proliferation and angiogenesis ability of colorectal cancer (CRC) cells and mechanism herein. The correlation of POLR1D and Yin Yang 1 (YY1) expressions with prognosis of CRC patients in TCGA database was analyzed. Quantitative realtime polymerase chain reaction (qRT-PCR) and Western blot were applied to detect expression levels of POLR1D and YY1 in CRC cell lines and CRC tissues. SW480 and HT-29 cells were transfected with si-POLR1D or pcDNA3.1-POLR1D to achieve POLR1D suppression or overexpression before cell migration, angiogenesis of human umbilical vein endothelial cells were assessed. Western blot was used to detect expressions of p38 MAPK signal pathway related proteins and interaction of YY1 with POLR1D was confirmed by dual luciferase reporter gene assay and chromatin immunoprecipitation (ChIP). TCGA data showed that both POLR1D and YY1 expressions were up-regulated in CRC patients. High expression of POLR1D was associated with poor prognosis of CRC patients. The results showed that POLR1D and YY1 were highly expressed in CRC cell lines. Inhibition or overexpression of POLR1D can respectively suppress or enhance proliferation and angiogenesis of CRC cells. YY1 inhibition can suppress CRC progression and deactivate p38 MAPK signal pathway, which can be counteracted by POLR1D overexpression. JASPAR predicted YY1 can bind with POLR1D promoter, which was confirmed by dual luciferase reporter gene assay and ChIP. YY1 transcription can up-regulate POLR1D expression to activate p38 MAPK signal pathway, thus promoting proliferation and angiogenesis ability of CRC cells.

Enzalutamide (ENZ) is a second-generation androgen receptor (AR) antagonist used for the treatment of castration-resistant prostate cancer (CRPC) and reportedly prolongs survival time within a year of starting therapy. However, CRPC patients can develop ENZ resistance (ENZR), mainly driven by abnormal reactivation of AR signaling, involving increased expression of the full-length AR (ARfl) or dominantly active androgen receptor splice variant 7 (ARv7) and ARfl/ARv7 heterodimers. There is currently no efficient treatment for ENZR in CRPC. Herein, a small molecule LLU-206 was rationally designed based on the ENZ structure and exhibited potent inhibition of both ARfl and constitutively active ARv7 to inhibit PCa proliferation and suppress ENZR in CRPC. Mechanically, LLU-206 promoted ARfl/ARv7 protein degradation and decreased ARfl/ARv7 heterodimers through mouse double minute 2-mediated ubiquitination. Finally, LLU-206 exhibited favorable pharmacokinetic properties with poor permeability across the blood-brain barrier, leading to a lower prevalence of adverse effects, including seizure and neurotoxicity, than ENZ-based therapies. In a nutshell, our findings demonstrated that LLU-206 could effectively inhibit ARfl/ARv7-driven CRPC by dual-targeting of ARfl/ARv7 heterodimers and protein degradation, providing new insights for the design of new-generation AR inhibitors to overcome ARfl/ARv7-driven CRPC.

Objective:To construct the Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes and evaluate its reliability and validity so as to provide a scientific assessment scale for clinical practice.Methods:The literature review, group discussion, expert consultation method and questionnaire survey method were used to construct the Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes. Based on the theory of knowledge, attitude and practice, the initial scale was developed through literature review. The Delphi method was used to conduct two rounds expert consultation to develop the pre-test scale. From August to October 2020, a total of 230 pre-discharge patients from China-Japan Union Hospital of Jilin University were selected as the research subjects. The reliability and validity of the scale were tested.Results:The formal scale included 32 items and 4 dimensions. The scale-level content validity index was 0.79-1.00, unanimity scale-level content validity index ( S- CVI/ UA) was 0.81, and average scale-level content validity ( S- CVI/ Ave) was 0.95. The Cronbach's α coefficient of the scale was 0.955, and the half-reliability was 0.846. Conclusions:The Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes has good reliability and validity, which can provide a scientific and effective assessment tool for clinical practice.

Objective:To explore the value and threshold of steady-state trough plasma concentration (trough concentration) of imatinib mesylate (IM) and its active metabolite N-desmethyl imatinib (NDI) in predicting the risk of moderate to severe adverse reactions in patients with gastrointestinal stromal tumors (GIST).Methods:The subjects were selected from GIST outpatient who received IM treatment and re-visited doctor in the First Affiliated Hospital of Soochow University form July 2020 to March 2021. On the day of re-visiting, the relevant clinical information and occurrence of IM-related adverse reactions within 28 d prior to the trial of selected patients was asked and recorded and blood were collected (22 to 24 hours after the last medication) to determine IM and NDI trough concentration. Twenty-eight days after blood collection, telephone follow-up was conducted to record IM-related adverse reactions occurrence. Blood routine and blood biochemical examination results within 28 days before and after blood collection were collected through the hospital information system. After evaluating causality for adverse reactions and grading their severity, patients without or with grade I adverse reactions were regarded as the no/mild group and those with grade Ⅱ~Ⅴadverse reactions were regarded as the moderate-severe group. The risk factors of moderate-severe adverse reactions were analyzed by comparing the main clinical characteristics of patients in the 2 groups, and the value and threshold of IM and NDI trough concentrations in predicting the risk of moderate-severe adverse reactions were analyzed by receiver operating characteristic (ROC) curve.Results:A total of 119 patients were recruited in this study and 113 (95.0%) had adverse reactions. There were 65 patients in the no/mild group and 54 in the moderate-severe group. The differences in the gender and dose distribution of patients in the 2 groups were statistically significant ( χ2=19.772, P<0.001; χ2=9.817, P=0.020); proportions of females, patients at dose of 300 mg/d, and patients at dose of 600 mg/d in the moderate-severe group were greater than those in the no/mild group. The trough concentration of IM and NDI of patients in the moderate-severe group were significantly higher than those of patients in the no/mild group[1 695 (1 258, 2 261) μg/L vs. 1 360 (938, 1 643) μg/L, P<0.001; 324(223, 379) μg/L vs. 264(217, 338) μg/L, P=0.042]. ROC curve analysis results showed that the breakpoints of IM and NDI trough concentrations for moderate-severe adverse reactions in patients with GIST were 1 539 μg/L (sensitivity 62.3%, specificity 70.3%) and 303 μg/L (sensitivity 56.6%, specificity 68.7%) respectively. The 119 patients were grouped according to the breakpoint concentrations. The incidences of moderate-severe adverse reactions were 63.0% (34/54) and 30.8% (20/65) in patients with IM trough concentration >1 539 μg/L and ≤1 539 μg/L, respectively and 59.6% (31/52) and 34.3% (23/67) in patients with NDI trough concentration >303 μg/L and ≤303 μg/L, respectively. The differences were statistically significant ( P<0.001, P=0.006). Conclusions:The trough concentrations of IM and NDI are of some value in predicting the risk of moderate-severe adverse reactions in patients with GIST. Drug monitoring should be strengthened in patients with IM trough concentration >1 539 μg/L and NDI trough concentration >303 μg/L to ensure the safety of IM use.

Objective:To explore the value and threshold of steady-state trough plasma concentration (trough concentration) of imatinib mesylate (IM) and its active metabolite N-desmethyl imatinib (NDI) in predicting the risk of moderate to severe adverse reactions in patients with gastrointestinal stromal tumors (GIST).Methods:The subjects were selected from GIST outpatient who received IM treatment and re-visited doctor in the First Affiliated Hospital of Soochow University form July 2020 to March 2021. On the day of re-visiting, the relevant clinical information and occurrence of IM-related adverse reactions within 28 d prior to the trial of selected patients was asked and recorded and blood were collected (22 to 24 hours after the last medication) to determine IM and NDI trough concentration. Twenty-eight days after blood collection, telephone follow-up was conducted to record IM-related adverse reactions occurrence. Blood routine and blood biochemical examination results within 28 days before and after blood collection were collected through the hospital information system. After evaluating causality for adverse reactions and grading their severity, patients without or with grade I adverse reactions were regarded as the no/mild group and those with grade Ⅱ~Ⅴadverse reactions were regarded as the moderate-severe group. The risk factors of moderate-severe adverse reactions were analyzed by comparing the main clinical characteristics of patients in the 2 groups, and the value and threshold of IM and NDI trough concentrations in predicting the risk of moderate-severe adverse reactions were analyzed by receiver operating characteristic (ROC) curve.Results:A total of 119 patients were recruited in this study and 113 (95.0%) had adverse reactions. There were 65 patients in the no/mild group and 54 in the moderate-severe group. The differences in the gender and dose distribution of patients in the 2 groups were statistically significant ( χ2=19.772, P<0.001; χ2=9.817, P=0.020); proportions of females, patients at dose of 300 mg/d, and patients at dose of 600 mg/d in the moderate-severe group were greater than those in the no/mild group. The trough concentration of IM and NDI of patients in the moderate-severe group were significantly higher than those of patients in the no/mild group[1 695 (1 258, 2 261) μg/L vs. 1 360 (938, 1 643) μg/L, P<0.001; 324(223, 379) μg/L vs. 264(217, 338) μg/L, P=0.042]. ROC curve analysis results showed that the breakpoints of IM and NDI trough concentrations for moderate-severe adverse reactions in patients with GIST were 1 539 μg/L (sensitivity 62.3%, specificity 70.3%) and 303 μg/L (sensitivity 56.6%, specificity 68.7%) respectively. The 119 patients were grouped according to the breakpoint concentrations. The incidences of moderate-severe adverse reactions were 63.0% (34/54) and 30.8% (20/65) in patients with IM trough concentration >1 539 μg/L and ≤1 539 μg/L, respectively and 59.6% (31/52) and 34.3% (23/67) in patients with NDI trough concentration >303 μg/L and ≤303 μg/L, respectively. The differences were statistically significant ( P<0.001, P=0.006). Conclusions:The trough concentrations of IM and NDI are of some value in predicting the risk of moderate-severe adverse reactions in patients with GIST. Drug monitoring should be strengthened in patients with IM trough concentration >1 539 μg/L and NDI trough concentration >303 μg/L to ensure the safety of IM use.

Objective : To understand the spatial distribution of multidrug resistant/rifampicin resistant pulmonary tuberculosis（MDR/RR PTB）in Wenzhou from 2014 to 2017,and to provide the scientific basis for MDR/RR TB control and prevention. Methods : The data of MDR/RR PTB cases in Wenzhou from 2014 to 2017 were collected from the Tuberculosis Management Information System of the Chinese Disease Prevention and Control Information System,and was associated with the geographic information database of Wenzhou Survey and Mapping Research Institute. The global spatial autocorrelation analysis was carried out by ArcGIS 10.1 to determine if there was spatial clustering of MDR/RR PTB cases in Wenzhou. The specific clustering areas of the MDR/RR PTB in Wenzhou was analyzed by SaTScan 9.3 and presented by ArcGIS. Results : There were 452 MDR/RR PTB cases reported in Wenzhou from 2014 to 2017,with a total registration rate of 4.74/100 000. The incidence rate of MDR/RR PTB in Wenzhou was unevenly distributed;the areas with registration rates of more than 7.45/100 000 were the north-central parts of Yongjia,the south-central parts of Yueqing and the east-central parts of Wencheng. The results of global spatial autocorrelation analysis showed that there were obvious clustering for MDR/RR PTB in Wenzhou（Moran's I=0.321,Z=7.352,P<0.001）. The spatial scanning found two clusters：20 towns/streets in the southeastern part of Yongjia and the south of Yueqing were the primary clustering areas（RR=2.213,LLR=22.353,P<0.001）;Yangyi Street and Shuangyu Street in Lucheng were the secondary clustering areas（RR=2.488,LLR=9.889,P=0.004）. Conclusion The MDR/RR PTB cases reported from 2014 to 2017 in Wenzhou had spatial clustering. The high-incidence areas were in the southeast of Yongjia,south of Yueqing,Yangyi Street and Shuangyu Street of Lucheng.