BACKGROUND:The pathogenesis of nontraumatic necrosis of the femoral head is still unclear.Among them,the lipid metabolism disorder is an important hypothesis of the cause of nontraumatic necrosis of the femoral head.Regulating blood lipid metabolism to inhibit the progression of femoral head necrosis has become an important method for the treatment of nontraumatic femoral head necrosis.OBJECTIVE:To review the research progress in the relationship between nontraumatic necrosis of the femoral head and lipid metabolism disorder and the treatment of nontraumatic necrosis of the femoral head.METHODS:Using"osteonecrosis of femoral head,nontraumatic osteonecrosis of femoral head,femoral head necrosis,osteonecrosis and lipid,lipid metabolism osteonecrosis,polymorphisms osteonecrosis of femoral head,pathway osteonecrosis of femoral head,steroid-induced osteonecrosis of the femoral head,alcohol-induced osteonecrosis of femoral head"as Chinese and English search terms,relevant articles were searched on CNKI,WanFang databases,Yiigle,and PubMed databases.Finally,104 articles were included for summarization.RESULTS AND CONCLUSION:(1)Patients with femoral head necrosis are often accompanied by dyslipidemia.It was found that high total cholesterol,high triglyceride,high low-density lipoprotein cholesterol,high apolipoprotein B,low low-density lipoprotein cholesterol and low apolipoprotein were the risk factors causing necrosis of the femoral head.In patients with different triggers of femoral head necrosis,blood lipid levels are usually different.(2)Hormone and alcohol,as the two major causes of nontraumatic necrosis of the femoral head,can induce adipogenic differentiation of bone marrow mesenchymal stem cells,increase the number of fat cells in the bone marrow cavity,and accumulate fat droplets,ultimately leading to necrosis of the femoral head.(3)Many adipokines and molecules related to lipid metabolism,such as adiponectin,leptin,lipid carrier protein 2,etc.have been confirmed to be related to femoral head necrosis.(4)Some signaling pathways,such as peroxisome proliferator-activated receptor γ,wnt/β-catenin and adenosine activated protein kinase,can change the osteogenic and adipogenic differentiation potential of bone marrow mesenchymal stem cells,and thus participate in the occurrence and development of necrosis of the femoral head.Lipid metabolism signaling pathways,such as phosphatidylinositol 3 kinase/protein kinase Band bone morphogenetic protein 2,are also related to necrosis of the femoral head,which may affect the progression of femoral head necrosis through the regulation of lipid metabolism.(5)Studies have found that cordycepin,Panax notoginseng saponins,gushiling capsule and other Chinese medicines,as well as statins can achieve the therapeutic effect on nontraumatic necrosis of the femoral head by improving lipid metabolism disorder.

BACKGROUND:The pathogenesis of nontraumatic necrosis of the femoral head is still unclear.Among them,the lipid metabolism disorder is an important hypothesis of the cause of nontraumatic necrosis of the femoral head.Regulating blood lipid metabolism to inhibit the progression of femoral head necrosis has become an important method for the treatment of nontraumatic femoral head necrosis.OBJECTIVE:To review the research progress in the relationship between nontraumatic necrosis of the femoral head and lipid metabolism disorder and the treatment of nontraumatic necrosis of the femoral head.METHODS:Using"osteonecrosis of femoral head,nontraumatic osteonecrosis of femoral head,femoral head necrosis,osteonecrosis and lipid,lipid metabolism osteonecrosis,polymorphisms osteonecrosis of femoral head,pathway osteonecrosis of femoral head,steroid-induced osteonecrosis of the femoral head,alcohol-induced osteonecrosis of femoral head"as Chinese and English search terms,relevant articles were searched on CNKI,WanFang databases,Yiigle,and PubMed databases.Finally,104 articles were included for summarization.RESULTS AND CONCLUSION:(1)Patients with femoral head necrosis are often accompanied by dyslipidemia.It was found that high total cholesterol,high triglyceride,high low-density lipoprotein cholesterol,high apolipoprotein B,low low-density lipoprotein cholesterol and low apolipoprotein were the risk factors causing necrosis of the femoral head.In patients with different triggers of femoral head necrosis,blood lipid levels are usually different.(2)Hormone and alcohol,as the two major causes of nontraumatic necrosis of the femoral head,can induce adipogenic differentiation of bone marrow mesenchymal stem cells,increase the number of fat cells in the bone marrow cavity,and accumulate fat droplets,ultimately leading to necrosis of the femoral head.(3)Many adipokines and molecules related to lipid metabolism,such as adiponectin,leptin,lipid carrier protein 2,etc.have been confirmed to be related to femoral head necrosis.(4)Some signaling pathways,such as peroxisome proliferator-activated receptor γ,wnt/β-catenin and adenosine activated protein kinase,can change the osteogenic and adipogenic differentiation potential of bone marrow mesenchymal stem cells,and thus participate in the occurrence and development of necrosis of the femoral head.Lipid metabolism signaling pathways,such as phosphatidylinositol 3 kinase/protein kinase Band bone morphogenetic protein 2,are also related to necrosis of the femoral head,which may affect the progression of femoral head necrosis through the regulation of lipid metabolism.(5)Studies have found that cordycepin,Panax notoginseng saponins,gushiling capsule and other Chinese medicines,as well as statins can achieve the therapeutic effect on nontraumatic necrosis of the femoral head by improving lipid metabolism disorder.

Objective:To systematically evaluate the service capacity of Traditional Chinese Medicine(TCM)in secondary and above general hospitals in Jiangsu Province and to uncover differences in service capacity across economic types,hospital grades,and re-gions.Methods:The entropy weight method was employed to conduct a comprehensive evaluation of the TCM service capacity of 579 sec-ondary and above general hospitals in Jiangsu Province.Additionally,T-tests were used to compare these four dimensions of human re-sources,financial resources,material resources,and resource utilization efficiency across different types of hospitals.Results:The TCM service capacities in Nanjing,Suzhou,and Wuxi ranked among the highest in Jiangsu,with comprehensive scores of 0.810,0.676,and 0.426,respectively.In contrast,Taizhou and Zhenjiang exhibited relatively weaker service capacities,with scores of only 0.067 and 0.049.The service levels in other regions were moderate.Furthermore,the results of T-tests and entropy weight method indicated significant differences(P＜0.05)in TCM service capacity across hospital grades and economic types for most dimensions,while regional differences were not statistically significant(P＞0.05).Conclusion:There is significant imbalance in the TCM ser-vice capacity across Jiangsu Province.Economically developed cities(e.g.,Nanjing,Suzhou,and Wuxi)demonstrate strong service capacities,while certain regions(e.g.,Taizhou and Zhenjiang)are relatively weak.The service capacity of public and tertiary hospi-tals is significantly higher than that of private and secondary hospitals;however,regional differences are not significant.Future efforts should focus on policy support for regions with lower resource utilization efficiency and weaker hospitals,aiming to promote a more bal-anced and efficient development of TCM services to better meet the growing demand for TCM across different areas and populations.

Objective:To systematically evaluate the service capacity of Traditional Chinese Medicine(TCM)in secondary and above general hospitals in Jiangsu Province and to uncover differences in service capacity across economic types,hospital grades,and re-gions.Methods:The entropy weight method was employed to conduct a comprehensive evaluation of the TCM service capacity of 579 sec-ondary and above general hospitals in Jiangsu Province.Additionally,T-tests were used to compare these four dimensions of human re-sources,financial resources,material resources,and resource utilization efficiency across different types of hospitals.Results:The TCM service capacities in Nanjing,Suzhou,and Wuxi ranked among the highest in Jiangsu,with comprehensive scores of 0.810,0.676,and 0.426,respectively.In contrast,Taizhou and Zhenjiang exhibited relatively weaker service capacities,with scores of only 0.067 and 0.049.The service levels in other regions were moderate.Furthermore,the results of T-tests and entropy weight method indicated significant differences(P＜0.05)in TCM service capacity across hospital grades and economic types for most dimensions,while regional differences were not statistically significant(P＞0.05).Conclusion:There is significant imbalance in the TCM ser-vice capacity across Jiangsu Province.Economically developed cities(e.g.,Nanjing,Suzhou,and Wuxi)demonstrate strong service capacities,while certain regions(e.g.,Taizhou and Zhenjiang)are relatively weak.The service capacity of public and tertiary hospi-tals is significantly higher than that of private and secondary hospitals;however,regional differences are not significant.Future efforts should focus on policy support for regions with lower resource utilization efficiency and weaker hospitals,aiming to promote a more bal-anced and efficient development of TCM services to better meet the growing demand for TCM across different areas and populations.

Objective: To explore the associations of physical activity and sleep quality with anxiety and depressive symptoms in college students, in order to provide empirical support and theoretical guidance for mental health intervention among college students. Methods: From March to April 2023, 2 099 college students from universities in 6 different provinces were selected by a convenient sampling method. Physical activity, sleep quality, anxiety and depressive symptoms were evaluated by the International Physical Activity Questionnaire Short Form (IPAQSF), the Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies Depression Scale (CESD) and the Anxiety SelfRating Scale (SAS), respectively. Descriptive statistics and Logistic regression models were used to analyze the data. Results: The reporting rates of lowintensity, moderateintensity, and highintensity physical activity among college students were 30.3%, 45.3%, and 24.4%, respectively. Moreover, among the participants, anxiety was detected in 21.6% and depressive symptoms in 39.9%, while 62.3% experienced poor sleep quality. Compared with males, females exhibited a lower proportion of highintensity physical activity (22.3% vs 42.8%), while reported higher proportions of moderateintensity (48.1% vs 40.8%) and lowintensity physical activity (29.5% vs 16.4%). Additionally, the proportion of females reporting poor sleep quality (65.0%) was higher than that of males (58.0%) (χ2=110.15, 10.70, P<0.05). The proportion of girls (43.8%) with depressive sypmtoms was higher than that of boys (33.9%) (χ2=20.48, P<0.05). Logistic regression analysis showed that high physical activity was negatively correlated with anxiety and depression (OR=0.45, 0.33), poor sleep quality was positively correlated with anxiety and depressive symptoms (OR=3.89, 3.94) (P<0.01).The interaction effect between high physical activity and good sleep quality was associated with the reduction of anxiety and depression among college students (OR=0.14, 0.08, P<0.01). Conclusions Physical activity and sleep quality are associated with anxiety and depressive symptoms among college students. The interventions for mental health problems such as depression and anxiety among college students should aim to improve physical activity and sleep quality.

Objective:To investigate the current smoking status and smoking abstinence self-efficacy of stroke smoking patients, to clarify the factors associated with the smoking abstinence self-efficacy in stroke patients, and to provide a theoretical basis for subsequent targeted interventions and guidance for smoking cessation.Methods:A total of 196 stroke patients admitted to the Neurology Department of Tianjin Huanhu Hospital from September to December in 2021 were surveyed adopted cross-sectional survey method by the General Information Questionnaire, the Fagerstrom Test for Nicotine Dependence, the Tobacco Hazard Perception Score, and the Smoking Abstinence Self Efficacy Scale. Multiple linear regression was used to analyze the factors associated with patients' smoking abstinence self-efficacy.Results:The overall score of self-efficacy for smoking in stroke patients was (20.78 ± 6.47), and the scores of each dimension in descending order were habit/addiction, negative/emotional and positive/social situations. Multiple linear regression analysis showed that occupation, nicotine dependence score and cognition score of tobacco harm were the influencing factors of smoking abstinence self-efficacy, which could explain 37.4% variation of smoking abstinence self-efficacy.Conclusions:The self-efficacy level of smoking patients with stroke needs to be improved, and helping patients to improve their perception of tobacco harm and reduce their nicotine dependence can improve their self-efficacy level to increase the success rate of smoking cessation, thus reducing or even quitting the health risks caused by smoking behavior.

Objective:To investigate the correlation between hyperuricemia and hypertension in hospital employees.Methods:A cohort was constructed from staff participating health checkups at the Xiangya Hospital of Central South University, baseline health examinations and questionnaires were conducted from February 1, 2011, to January 29, 2012; 502 participants were excluded according to the nadir criteria, and 3 525 participants were followed-up from February 1, 2012, to December 31, 2018, according to the results of annual employee checkups. The participants were divided into the normal uric acid (3 232 cases) and hyperuricemia groups (293 cases) according to the baseline examination results. The presence of hyperuricemia was used as an observation index and occurrence of hypertension within 7 years was used as an outcome indicator. Age, sex, body mass index, creatinine, LDL cholesterol, triacylglycerol, HDL cholesterol, fasting glucose, marriage, education, job position, smoking, alcohol consumption, and exercise status were used as confounding factors to construct five Cox regression models and calculate their HR values, adjusted HR values, and 95% CI to analyze the relationship between hyperuricemia and the occurrence of hypertension in the overall population and female and male populations. Results:The follow-up of the study participants was conducted for a period of (6.19±1.25) years, with a total of 21 831 person-years of follow-up. The 7-year cumulative prevalence of hypertension was 16.5% in the total population, 12.5% in the female population, 30.1% in the male population, 14.1% in the normal uric acid group, and 42.0% in the hyperuricemia group. The prevalence density of hypertension was 26.6, 19.6, 53.8, and 22.4 per 1 000 person-years in the total, female, male, and normouricemic groups, respectively. Without adjusting for any confounding variables, the risk of hypertension was higher in the total population, female population, and male population in the hyperuricemia group than in the normal uric acid group [ HR=3.86, 5.69, 1.60, (95% CI: 3.17-4.72, 4.36-7.43, 1.18-2.16)] (all P<0.05); after gradually adjusting for confounders, this correlation was only manifested in the female population [adjusted HR=1.91 (95% CI: 1.08-3.36)] (all P<0.05), and the difference was not statistically significant in the male population ( P>0.05). Conclusion:Among female hospital employees, hyperuricemia is an independent risk factor for the development of hypertension.

Objective:To investigate the relationship between waist circumference and hyperuricemia in occupational population in Changsha city.Methods:Based on a retrospective cohort design, a total of 1 197 employees from 70 organizations who received 4 or more years of continuous physical examinations in Xiangya hospital from January 1, 2014 to December 31, 2018 were included in this study. The physical examination data of the year 2014 were set as baseline data, while the data between January 1, 2015 and December 31, 2018 were used as follow-up data. According to interquartile range of the waist circumference, the subjects was divided into four groups: the first quartile ( Q1),<77 cm for men and <68 cm for women; the second quartile ( Q2), 77 cm ≤ and<82 cm for men, 68 cm ≤ and <73 cm for women; the third quartile ( Q3), 82 cm ≤ and <87 cm for men, 73 cm ≤and <78 cm for women; the fourth quartile ( Q4), ≥87 cm for men, ≥78 cm for women. Among them, Q1 was set as the control group, and Q2, Q3 and Q4 as the exposed groups. Three models were established for the total population, men and women, respectively. The confounding factors were not adjusted in model Ⅰ. The model Ⅱ was adjusted for age, gender and body mass index (the male or female population were not adjusted for sex). Confounders including age, gender, body mass index, hypertension, fasting glucose, blood creatinine, triacylglycerol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were adjusted for model Ⅲ. Cox regression analysis was used to compare the hazard ratio ( HR), adjusted hazardratio (a HR) and their 95% CIs for the development of hyperuricemia in the subjects with different waist circumference over the 4 years. Results:Total of 1 197 subjects were followed-up for (2.05±1.18) years and 2 448 person-years. A total of 208 cases of hyperuricemia were identified in the total population during the 4 years (45 women/163 men), with a cumulative incidence of 17.4% (6.4% in women/33.3% in men) and an incidence density of 84.9/1 000 person-years (31.8/1 000 person-years in women, 157.6/1 000 person-years in men). And 626, 609, 629, and 584 person-years were followed-up in the 4 groups, respectively; with 15, 30, 59, and 104 cases of hyperuricemia occurred during 4 years, respectively. The cumulative incidence rates of hyperuricemia in the 4 yearswas 5.5%, 9.2%, 20.8% and 32.8%, respectively; and the incidence densities was 24.0/1 000 person-years, 49.3/1 000 person-years, 93.8/1 000 person-years and 178.1/1 000 person-years, respectively. Compared with that in the Q1 group, the risk of hyperuricemia was increased in the Q4 group, with a HR (95% CI) of 2.70 (1.81 to 4.04), P<0.05. After adjusted for confounding factors in the total population, the a HR (95% CI) of hyperuricemia was 2.12 (1.39 to 3.24), P<0.05. This risk remained when stratified by gender and adjusted for confounding factors. Compared with the Q1 group, the a HR (95% CI) of hyperuricemia in the Q4 group was 1.91 (1.18 to 3.09) for the male population and 2.93 (1.14 to 7.56) for the female population, respectively (both P<0.05). Conclusion:Among the occupational population, the risk of hyperuricemia increases with increase of waist circumference.

Objective:To investigate the correlation between serum uric acid level and hyperglycemia.Methods:A medical examination cohort of the staff of our hospital was constructed. From February 1 st, 2011, to December 31 st, 2011, 3 937 staff members without hyperglycemia were selected, and baseline data were collected through a questionnaire survey, physical examination, measurement of blood lipid and blood glucose, assessment of kidney function, and other laboratory tests. The subjects were followed up during the annual physical examination for 7 years, from January 1 st, 2012, to December 31 st, 2018. They were divided into four groups according to serum uric acid level: uric acid<360 μmol/L, 360≤uric acid<420 μmol/L, 420≤uric acid<480 μmol/L, and uric acid≥ 480 μmol/L. With the occurrence of hyperglycemia as the outcome indicator; uric acid level as the observation index; uric acid<360 μmol/L as the control group; and gender, age, body mass index, smoking, hypertension, dyslipidemia as confounding factors, Cox regression was performed before and after adjusting confounding factors to analyze the relationship between different uric acid levels and the incidence of hyperglycemia in the entire sample, in the male staff, and in the female staff. Results:The 7-year cumulative incidence of hyperglycemia in the four groups were 15.7%, 34.0%, 38.8%, and 43.8%, respectively ( Z=148.94, P<0.01). In the male staff, the 7-year cumulative incidence rates in the four groups were 23.4%, 29.9%, 34.7%, and 35.8%, respectively ( Z=11.17, P<0.01). In the female staff, the 7-year cumulative incidence rates in the four groups were 14.2%, 42.5%, 52.2%, and 65.0%, respectively ( Z=141.84, P<0.01. After adjusting for gender, age, body mass index, smoking, hypertension, and dyslipidemia, the risk of hyperglycemia in the 360≤uric acid<420 μmol/L, 420≤uric acid<480 μmol/L, and uric acid≥ 480 μmol/L groups were 1.73 (1.39-2.15), 1.86 (1.42-2.45), and 1.95 (1.34-2.85) times higher than that in the control group (all P<0.05). Among female staff, the risk of hyperglycemia in the 360≤uric acid<420 μmol/L, 420≤uric acid<480 μmol/L, and uric acid≥ 480 μmol/L groups were 2.18 (1.62-2.94), 3.41 (2.24-5.20), and 3.02 (1.69-5.40) times, respectively, and were also higher than those in the control group (all P<0.01). Conclusion:With the increase of serum uric acid level, the risk of hyperglycemia in medical staff increases, which is mainly manifested in female staff.

Objective:To investigate the correlation between serum uric acid level and non-alcoholic liver disease (NAFLD).Methods:A medical examination cohort of our hospital′s staff was constructed. From February 1, 2012 to January 29, 2013, a total of 3, 479 staff without NAFLD were selected as research subjects, and baseline data were collected through a questionnaire survey, physical examination, abdominal ultrasound examination, blood lipid, blood glucose, liver and kidney function, and other laboratory tests. From February 1, 2013 to December 31, 2018, the patients were followed up during the annual physical examination for six years. The serum uric acid level was used as the observation index and divided into four groups from A to D according to the quartile. With the occurrence of NAFLD as the outcome indicator; the four groups of uric acid as the observation indicator; and age, body mass index, hyperlipidemia, hyperglycemia, hypertension, creatinine, and alanine aminotrans ferase as confounding factors; four Cox regression analysis models were constructed to explore the relationship between groups of different blood uric acid levels and NAFLD. Stratified by gender, three Cox regression analysis models were constructed to investigate the relationship between blood uric acid level grouping and NAFLD between different genders.Results:The six-year cumulative incidence of NAFLD in groups A, B, C, and D was 1.2%, 3.1%, 4.9%, and 12%, respectively (χ 2=114.710, P<0.05). Among the female workers, the six-year cumulative incidence rates in groups A, B, C, and D were 1.0%, 2.9%, 4.1% and 10.9%, respectively (χ 2=71.241, P<0.05). The incidence risk of NAFLD in groups B, C, and D was 2.04 (1.01-4.11), 2.24 (1.13-4.44), and 3.89 (1.94-7.80) times that of group A, P<0.05, respectively. The incidence risk of NAFLD in groups B, C, and D was 2.21 (1.02-4.77), 2.39 (1.10-5.19), and 4.49 (1.99-10.15) times that of group A, all P<0.05, respectively. Conclusion:The risk of NAFLD increased with the increase of serum uric acid level, and this trend was mainly manifested in female employees.