Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.

Objective: To investigate the predictive value of EZH2 expression for malignant transformation in oral leukoplakia (OLK) and to provide a reference for clinical practice. Methods: This study was approved by the institutional ethics committee, and informed consent was obtained from all participants. A total of 114 patients diagnosed with OLK by pathological examination and treated at our hospital between November 2020 and July 2022 were initially enrolled. After excluding those with incomplete data or follow-up, 105 participants were included in the final analysis, comprising 14 in the high EZH2 expression group and 91 in the low EZH2 expression group. Histopathological examination of oral mucosa and immunohistochemical detection of EZH2 protein expression were performed. The follow-up period was 30 months; participants were followed until malignant transformation occurred or until the end of follow-up, at which point they were withdrawn from the study. The exposure factor was the level of EZH2 protein expression, and the outcome was the malignant transformation rate of OLK. Differences in EZH2 expression levels and transformation outcomes were analyzed. Results: There were no statistically significant differences between the high and low EZH2 expression groups in terms of age, sex, history of systemic disease, lifestyle habits, psychological status, diet, and sleep conditions (P > 0.05). Lesions in the high EZH2 expression group were mainly located on the ventral tongue, while in the low EZH2 expression group, they were more commonly found on the dorsal tongue and buccal mucosa. The malignant transformation rate was 28.6% (4/14) in the high expression group and 8.8% (8/91) in the low expression group; these differences were not statistically significant (P=0.053). In univariate Cox regression analysis, the risk of malignant transformation in the high EZH2 expression group was 3.647 times that of the low EZH2 expression group (HR = 3.647, 95% CI: 1.097-12.120, P<0.05). Kaplan-Meier survival analysis showed that over the 30-month follow-up period, the cancer-free survival rate in the high EZH2 expression group was 19.8% lower than in the low expression group, and the difference was statistically significant (P<0.05). In multivariate Cox regression analysis, only moderate and severe epithelial dysplasia were identified as independent risk factors for malignant transformation. The risk of malignant transformation in the moderate and severe dysplasia groups was 10.695 and 13.623 times higher, respectively, than in the mild dysplasia group (HR = 10.695, 95% CI: 2.270-50.396, P<0.05; HR=13.623, 95% CI: 1.918-96.774, P<0.05). EZH2 high expression was not an independent risk factor in the multivariate model (HR= 2.528, 95% CI: 0.752-8.500, P = 0.134). Conclusion High EZH2 protein expression is a risk factor for the malignant transformation of OLK but does not have independent predictive value.

Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.

Objective:To investigate the value of artificial intelligence (AI) cytomorphologic analysis system in the cytomorphological diagnosis and therapeutic evaluation of acute myeloid leukemia (AML).Methods:Bone marrow smear samples were collected from 150 patients with newly diagnosed and treated acute myeloid leukemia who were inpatients and outpatients at the Department of Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from June 1, 2021 to July 31, 2022 for retrospective analysis. Among them, there were 50 patients in the newly diagnosed group, including 28 males and 22 females, with the onset age of 43.5(32.3,58.8)years. There were 100 patients in the post-treatment group, including 36 males and 64 females, with the onset age of 34.5(23.0,47.0)years. The results from cytomorphology expert were used as the gold standard and the Python 3.6.7 was used for analysis to evaluate the accuracy, sensitivity, and specificity of the AI cytomorphologic analysis system for blast cell recognition in AML diagnosis and treatment.Results:The proportion of blasts in AI analysis of 50 samples in the newly diagnosed group was&ge;20%, which met the diagnostic criteria of AML. AI analysis of blasts had an accuracy of 90.3%, sensitivity of 85.5%, and specificity of 98.0%. The correlation coefficient between AI and the proportion of blasts analyzed by experts was positively correlated( r=0.882, P<0.001). Meanwhile, in the post-treatment group, the sensitivity and specificity of AI analysis of blasts were 89.7% and 99.2%, respectively. The correlation coefficient between AI and the proportion of blasts analyzed by experts was positively correlated( r=0.957, P<0.001). According to AI analysis data, there are 8 samples in this group whose AI efficacy evaluation results on AML are inconsistent with expert analysis. Conclusion:AI cytomorphologic analysis system has high accuracy, sensitivity and specificity for blast cell recognition in AML morphological diagnosis and therapeutic evaluation.

Sympathetic cues via the adrenergic signaling critically regulate bone homeostasis and contribute to neurostress-induced bone loss, but the mechanisms and therapeutics remain incompletely elucidated. Here, we reveal an osteoclastogenesis-centered functionally important osteopenic pathogenesis under sympatho-adrenergic activation with characterized microRNA response and efficient therapeutics. We discovered that osteoclastic miR-21 was tightly regulated by sympatho-adrenergic cues downstream the β2-adrenergic receptor (β₂AR) signaling, critically modulated osteoclastogenesis in vivo by inhibiting programmed cell death 4 (Pdcd4), and mediated detrimental effects of both isoproterenol (ISO) and chronic variable stress (CVS) on bone. Intriguingly, without affecting osteoblastic bone formation, bone protection against ISO and CVS was sufficiently achieved by a (D-Asp₈)-lipid nanoparticle-mediated targeted inhibition of osteoclastic miR-21 or by clinically relevant drugs to suppress osteoclastogenesis. Collectively, these results unravel a previously underdetermined molecular and functional paradigm that osteoclastogenesis crucially contributes to sympatho-adrenergic regulation of bone and establish multiple targeted therapeutic strategies to counteract osteopenias under stresses.
Adrenergic Agents/pharmacology* ; Apoptosis Regulatory Proteins/pharmacology* ; Bone Diseases, Metabolic/metabolism* ; Humans ; Liposomes ; MicroRNAs/genetics* ; Nanoparticles ; Osteoclasts ; Osteogenesis/physiology* ; RNA-Binding Proteins/pharmacology*

Mild cognitive impairment is a transitional state between normal aging and dementia, which is the best intervention window to delay cognitive decline.As one of the adjustable risk factors affecting cognitive function, perceived stress significantly increases the risk of cognitive impairment by causing hypothalamic-pituitary-adrenal axis dysfunction and psychological disorders.Therefore, perceived stress management will become a new hot spot in the research and practice of non-drug intervention techniques for cognitive impairment.This paper reviews the current situation of perceived stress in MCI population, the relationship between perceived stress and cognitive function, and the evaluation techniques of MCI individual perceived stress.Further more, this paper summarizes the relevant influencing factors of perceived stress based on stress attribution model, and comments on the action mechanism and practical enlightenment of perceived stress intervention program on cognitive function management, in order to provide theoretical reference for cognitive function management of MCI population.

Objective:To test the reliability and validity of the Chinese version of the Rowland Universal Dementia Assessment Scale (RUDAS) among patients with dementia in China.Methods:All participants were recruited from a psychiatric hospital, two old people′s homes and three community mental health centers in Huzhou city. Convenience sampling method was used. All participants were tested by the Chinese version of RUDAS and The Mini-Mental State Examination (MMSE). Cronbach α coefficient and retest reliability were used for reliability test. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for validity test. The criterion validity of MMSE and Chinese version of RUDAS was tested by Pearson correlation analysis.Results:EFA extracted 6 factors and factor loadings of each item ranged from 0.594 to 0.960, which contributed to 62.584% variance totally. Six factors were identified, namely, visual-spatial orientation, imitation and judgment, visual structure, delayed recall, linguistic accuracy, and linguistic fluency. Compared with the original scale, the dimension of verbal communication showed reduced dimension. In the CFA, χ 2/ df=1.031, GFI=0.882, AGFI=0.853, CFI=0.996, TLI=0.996, RMSEA=0.014, all the indicators were in adaption standard range. The Cronbach α coefficient was 0.793, and the Cronbach α coefficients for six dimensions ranged from 0.503 to 0. 930.The test-retest reliability for the Chinese version of RUDAS was 0.91. Conclusion:The Chinese version of RUDAS showed satisfactory psychometric properties in dementia screening, which can provide guidance and reference for further diagnostic research and application practice of this scale.

Objective:To test the reliability and validity of the Chinese version of the Rowland Universal Dementia Assessment Scale (RUDAS) among patients with dementia in China.Methods:All participants were recruited from a psychiatric hospital, two old people′s homes and three community mental health centers in Huzhou city. Convenience sampling method was used. All participants were tested by the Chinese version of RUDAS and The Mini-Mental State Examination (MMSE). Cronbach α coefficient and retest reliability were used for reliability test. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for validity test. The criterion validity of MMSE and Chinese version of RUDAS was tested by Pearson correlation analysis.Results:EFA extracted 6 factors and factor loadings of each item ranged from 0.594 to 0.960, which contributed to 62.584% variance totally. Six factors were identified, namely, visual-spatial orientation, imitation and judgment, visual structure, delayed recall, linguistic accuracy, and linguistic fluency. Compared with the original scale, the dimension of verbal communication showed reduced dimension. In the CFA, χ 2/ df=1.031, GFI=0.882, AGFI=0.853, CFI=0.996, TLI=0.996, RMSEA=0.014, all the indicators were in adaption standard range. The Cronbach α coefficient was 0.793, and the Cronbach α coefficients for six dimensions ranged from 0.503 to 0. 930.The test-retest reliability for the Chinese version of RUDAS was 0.91. Conclusion:The Chinese version of RUDAS showed satisfactory psychometric properties in dementia screening, which can provide guidance and reference for further diagnostic research and application practice of this scale.

Objective:To explore the action path and the potential mediating effects of depression and physical diseases on the influencing factors of mild cognitive impairment(MCI) in community, and provide the theoretical basis for the construction of the strategy of cognitive regulation.Methods:A convenient sample survey was conducted on 252 mild cognitive impairment patients in the community undergoing screening using the general information questionnaire, Montreal cognitive assessment scale(MoCA) and geriatric depression scale(GDS-15)from January 2018 to June 2019. SPSS 22.0 and AMOS 22.0 softwares were used to conduct descriptive analysis, correlation analysis, structural equation model and confirmatory factor analysis.Results:The score of MoCA was 19.66±3.90 for all MCI patients. There were significant correlations among age, education, social frequency, physical exercise frequency and depression degree, the number of physical disease and MoCA( r=-0.440-0.487, P<0.01). The structural equation model fits well(χ 2/ df=2.476, TLI=0.885, CFI=0.916, GFI=0.919, AGFI=0.871, RMSEA=0.077). Mediation modeling analysis showed that age, education, social frequency physical exereise frequency had a direct effect on cognitive function(effect value was -0.183, 0.458, 0.237, 0.174, P<0.01). There were partly mediating effect of the number of physical disease between age, education, physical exercise frequency and cognitive function(effect value was -0.106, 0.078, 0.075, P<0.01), and there were partly mediating effect of depression degree between age, social frequency, physical exercise frequency and cognitive function(effect value was -0.075, 0.080, 0.050, P<0.01), and there were chain mediating effect of the number of physical disease-depression degree between age, education, physical exercise(effect value was -0.028, 0.031, 0.019, P<0.01). Conclusion:The cognitive management of MCI among community should focus on the elderly, low education level groups.In the implementation of exercise intervention to improve cognitive function of health management strategy, while to strengthen the effective management of physical diseases and negative emotion evaluation and dredging, to increase the effect of exercise intervention on cognitive function improvement.

Objective:To evaluate the direct and sustained effects of multitask-process cognitive training program on cognitive function in the community elderly with mild cognitive impairment(MCI).Methods:Ninety-two participants with MCI who met the inclusion criteria were randomly selected from Huzhou community of Zhejiang province.According to the allocation ratio of 1∶1, the MCI participants were randomly divided into the cognitive training group and the control group, with 46 cases in each group.The participants in control group were received a cognitive function-health education program, and the participants in cognitive training group received an additional 10 weeks of multitask-process cognitive training.Respectively in three-time points of at baseline, after 10 weeks of training, and a 3-month follow-up to evaluate all participants with MCI executive function tested by trail making test A-B and Stroop color-word test, overall cognitive function tested by MoCA scale.Repeated measure ANOVA was used to compare the between-group variation, time effect and interaction effect of two groups at 3 time points.Results:The MoCA score of intervention group at T0, T1, T2 were 19.09±1.98, 21.09±1.41, 21.11±1.27 respectively, and the MoCA score of the control group were 18.24±2.22, 18.57±1.86, 18.07±1.90 respectively.Compared with the control group, the score of MoCA in the intervention group was significantly improved at T1 and T2 ( P< 0.05). Compared with control group, the Trail making test A-B, Stroop color-word interference test of intervention group were improved at T1, T2 ( P<0.05). Repeated measurement ANOVA shows that there were significant differences in Trail making test A-B, Stroop color-word interference test and MoCA between the two groups in terms of between-group effect, time effect and group-time interaction effect ( F=9.245~196.457, P<0.05). Simple effects analysis shows that compared with the control group, the multitask-process cognitive training had a positive direct effect on the Trail making test A-B, Stroop color-word interference test and MoCA, and these improvements maintained until the end of a 3-month follow-up ( F=2.757~201.829, P<0.05). During the research period, the compliance rate of the cognitive training group was 87.4%, and no adverse events occurred. Conclusion:The multitask-process cognitive training program positively promote the cognitive function of participants with MCI and provide a set of standardized and procedural nursing intervention program for the cognitive management of community participants with MCI.