Obesity is a significant risk factor for cancer and is associated with breast cancer metastasis. Nevertheless, the mechanism by which alterations in systemic metabolism affect tumor microenvironment (TME) and consequently influence tumor metastasis remains inadequately understood. Herein, we found that perturbations in circulating metabolites induced by obesity promote metastasis-like phenotypes in breast cancer. Oleoylcarnitine (OLCarn) concentrations were elevated in the serum of obese mice and humans. Administration of exogenous OLCarn induces metastasis-like characteristics in breast cancer cells. Mechanistically, OLCarn directly interacts with the Arg176 site of adenylate cyclase 10 (ADCY10), leading to the activation of ADCY10 and enhancement of cAMP production. Mutations at Arg176 prevent OLCarn from binding to ADCY10, disrupting the ADCY10-mediated activation of cyclic adenosine monophosphate (cAMP) signaling pathway. This activation promotes transcription factor 4 (TCF4)-dependent kinesin family member C1 (KIFC1) transcription, thereby driving breast cancer metastasis. Conversely, the neutralization of both ADCY10 and KIFC1 through knockdown or pharmacological inhibition abrogates the oncogenic effects mediated by OLCarn. Hence, obesity-induced systemic environmental changes lead to the aberrant accumulation of OLCarn within the TME, making it a potential therapeutic target and biomarker for breast cancer.

Objective:To investigate the clinical effects of free posterior interosseous artery perforator flap on reconstruction of the soft tissue defects of multiple fingers in one hand.Methods:Clinical data of 9 patients with soft tissue defect of multiple fingers in one hand admitted to the Department of Hand Surgery, Yongkang Orthopedic Hospital between January 2021 and August 2023 were retrospectively studied. The patients were 7 males and 2 females, aged between 19 and 55 years old. The soft tissue defects of 2 patients with 3 fingers injury and 7 patients with 2 fingers injury were reconstructed with free posterior interosseous artery perforator flaps. The size of defects in single finger was 1.5 cm×2.5 cm-3.0 cm×4.5 cm. The size of flap was 2.5 cm×7.0 cm-3.5 cm×13.0 cm. The posterior cutaneous nerve of the forearm were sutured to the intrinsic nerve of palmar side of the 14 fingers. Donor sites in forearm were directly sutured. After discharge, regular follow-up at outpatient clinic and through WeChat interviews were conducted to observe the appearance and texture of the flaps, finger fullness, donor site function and appearance, as well as patient satisfaction. For the flaps with anastomosis of cutaneous nerve, the recovery of TPD of the flap was tested. Sensory recovery was assessed according to the British Medical Research Council (BMRC) sensory function assessment criteria. Hand functions were evaluated using the Total Active Movement (TAM) of fingers of the Hand Surgery of the Chinese Medical Association.Results:All of the 20 flaps survived and were evaluated through follow-up visits, which ranged from 6 to 25 months with an average of 13 months. The flaps were soft, unbloated and without obvious pigmentation. The protective sensations were recovered with an average static TPD of 14 flaps anastomosed with cutaneous nerve was of 9.7 (7-13) mm. Among them, S 3+ 10 fingers, S 3 4 fingers; 6 fingers of flap without sutured cutaneous nerve, S 2 5 fingers, S 1 1 finger. According to the TAM of Hand Surgery of Chinese Medical Association, the results were excellent for 15 fingers and good for 5 fingers. There was no scar contracture in the forearm donor sites and motor function was not affected. Conclusion:Posterior interosseous artery perforator flap has the advantages of thin flap, similar texture to the hand, good recovery in sensory, and minimal damage to the donor site. Therefore, it is a good option in reconstruction of soft tissue defects of multiple fingers in one hand.

Objective:To summarize the assessment tools for fear of falling in the elderly both domestically and internationally, providing a reference for medical and nursing staff to assess their fear of falling.Methods:The literature on assessment tools for fear of falling in the elderly was systematically searched on China National Knowledge Infrastructure, WanFang Data, China Biology Medicine disc, VIP, Embase, PubMed, Web of Science, and Cochrane Library. The search period was from database establishment to July 4, 2023. This study extracted and analyzed the content of assessment tools for fear of falling.Results:A total of 45 articles were included, involving 16 assessment tools for fear of falling.Conclusions:The 16 assessment tools for fear of falling included in the analysis are mainly self-assessment. The reliability of the assessment tool for fear of falling is good, but its validity still needs further verification. It is recommended to consider multiple factors when choosing an assessment tool for fear of falling, and combine it with quantitative objective indicators measured by professional instruments to accurately assess the fear of falling of the elderly.

Objective:To systematically review the risk prediction model of retinopathy in type 2 diabetes patients.Methods:Research on the prediction model of retinopathy in patients with type 2 diabetes was retrieved in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biology Medicine. The search period was from database establishment to March 17, 2023. Two researchers independently screened the literature and extracted data, and used the prediction model risk of bias assessment tool to analyze the bias risk and applicability of the included literature.Results:A total of 18 articles were included, of which nine studies used Logistic regression, four studies used Cox proportional hazards regression, two studies used Lasso regression, one study used semi-parametric regression, and two studies used machine learning methods. Two studies simultaneously conducted internal and external validation, three studies conducted internal validation, and one study conducted external validation. A total of 12 studies mentioned that the area under the curve ( AUC) of predictive models ranged from 0.715 to 0.966, and all AUCs were greater than 0.7. Four studies mentioned the C index, which was 0.770 to 0.848, while two studies did not mention the predictive performance of the model. Age, course of type 2 diabetes, urinary protein, glycosylated hemoglobin, insulin use, hypertension, and time of hospital admissions were independent predictors of repeated reporting in the multivariate model. All studies had a certain risk of bias, but their applicability was good. Conclusions:The existing prediction models for retinopathy in type 2 diabetes patients have good prediction performance, but the overall risk of bias is high. Further validation of the performance of each model is needed, while further development of risk prediction models suitable for different populations (such as elderly patients, women, different races or regions) is still needed.

Objective:To understand the current situation of nurses in 52 hospitals in China on mastery of knowledge about skin injury in the elderly based on the background of mixed-mode homogenization training.Methods:Using the convenient sampling method, a total of 1 067 nurses from 52 hospitals in China were selected as the research objects in January 2021. A self-designed questionnaire on knowledge of skin injury in the elderly was used to investigate the nurses through the questionnaire star and univariate analysis was used to analyze the influencing factors. A total of 1 067 questionnaires were distributed and 1 067 valid questionnaires were recovered, and the effective recovery rate was 100%.Results:The knowledge scores of pressure injury, incontinence-associated dermatitis, skin tear and xerosis cutis among 1067 nurses were (95.66±7.37) , (95.65±9.15) , (91.37±15.45) and (87.67±15.91) , respectively. The results of univariate analysis showed that hospital grade was the influencing factor of nurses' knowledge score of pressure injury, skin tear and incontinence-associated dermatitis ( P<0.05) , educational background was the influencing factor of nurses' knowledge score of skin tear ( P<0.05) , professional title was the influencing factor of nurses' knowledge scores of pressure injury, incontinence-associated dermatitis and xerosis cutis ( P<0.05) . Conclusions:Hospitals at all levels need to strengthen the theoretical and practical knowledge training for nurses on skin xerosis and skin tear in the elderly, especially for nurses with primary titles and lower education in grassroots hospitals.

Objective To understand the colonization status of Streptococcus pneumoniae and Haemophilus influenzae in nasopharynx of healthy infants in Wuhan. Methods Six vaccination clinics were randomly selected, and the nasopharyngeal specimens of healthy infants were collected and cultured for Streptococcus pneumoniae and Haemophilus influenza. Results The carrying rate of Streptococcus pneumoniae and Haemophilus influenzae in 998 healthy infants was 18.84% and 17.54%, respectively. The carrying rate of Streptococcus pneumoniae and Haemophilus influenzae within 6 months of age was 15.79% and 14.39%, and the carrying rate of Streptococcus pneumoniae and Haemophilus influenzae at 7-12 months old was 22.90% and 21.73%, respectively. The difference was statistically significant (Sp: χ²=5.60 P=0.02; Hi：χ²=8.98　P=0.00); The carrying rate of Streptococcus pneumoniae in urban and suburban areas was 18.08% and 19.78%, respectively, and the Haemophilus influenzae carrying rate was 17.18% and 17.98%, respectively. The differences were not statistically significant (Sp：χ²=0.47　P=0.50; Hi：χ²=0.11　P=0.74). The correlation coefficient (r value) of the age of the month and the carrying rate of sp and hi was 0.98 and 0.96, respectively. Conclusion The age of healthy infants in Wuhan was highly linearly and positively correlated with the carrying rate of Streptococcus pneumoniae and Haemophilus influenza.

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.

As the rapid development of minimally invasive techniques,anesthesia,and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow?up, for the convenience of various medical centers.

As the rapid development of minimally invasive techniques,anesthesia,and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow?up, for the convenience of various medical centers.

BACKGROUND:Transforming growth factor β1 (TGF-β1) and interleukin 1β (IL-1β) have been reported to play an important role in the occurrence and development of primary osteoarthritis. OBJECTIVE:To investigate the association between gene polymorphisms of TGF-β1 and IL-1β and primary knee osteoarthritis. METHODS: Han and Uyghur elderly populations in Xinjiang Uygur Autonomous Region, China were surveyed on the prevalence of osteoarthritis, followed by allotted to osteoarthritis and health groups according the symptoms and radiography. Genotyping TGF-β1-509C/T and -1348C/T and IL-1β-511C/T was performed to analyze the relationship between the gene polymorphisms of TGF-β1 and IL-1β and osteoarthritis. RESULTS AND CONCLUSION:Alleles T and C with genotypes CC, CT and TT were detected in both two groups. In the Uygur population, the genotype frequency of TGF-β1-509C/T and IL-1β-511C/T showed significant difference between osteoarthritis and health groups (P < 0.05). In the Han population, the genotype frequency of TGF-β1-1348C/T showed significant difference between two groups (P < 0.05). These results suggest that the Uygur individuals carrying TT genotype of TGF-β1-509C/T and IL-1β-511C/T, and Han people carrying the TT genotype of TGF-β -1348T are more susceptible to osteoarthritis.