Objective:To systematically evaluate the prevalence of malnutrition in elderly patients with diabetes.Methods:A total of eight databases, namely PubMed, Embase, Web of Science, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), and VIP Database, were systematically searched for cross-sectional studies on malnutrition in elderly diabetic patients published from the inception of the databases to September 13, 2023. Two researchers independently conducted literature screening, data extraction, and quality assessment. Data analysis was performed using Stata 16.0 software.Results:A total of 22 studies were included, involving 6 349 elderly diabetic patients. Results of the meta-analysis showed that the overall prevalence of malnutrition in elderly patients with diabetes was 32.3% (95% CI: 0.21 to 0.43), and the prevalence of at-risk of malnutrition was 49.0% (95% CI: 0.31 to 0.67). Subgroup analysis showed that the prevalence of malnutrition in elderly diabetic patients with chronic complications (56.8%) was significantly higher than those without chronic complications (21.9%). Inpatients also showed a higher prevalence compared with outpatients and community (44.4%, 29.0%, and 18.5%, respectively). The prevalence of malnutrition as per mini-nutritional assessment scale was higher than that as per mini-nutritional assessment short-form scale (35.8% vs. 23.3%, P<0.05). There was no significant difference in the prevalence of malnutrition in elderly diabetic patients of different genders ( P>0.05). Conclusions:The prevalence of malnutrition and at-risk of malnutrition in elderly diabetic patients is high. In clinical practice, we should not only strengthen the early diagnosis of malnutrition in patients, but also emphasize the screening of malnutrition risk, implement timely corresponding interventions, and promote patient education on nutrition and health, to improve the prognosis and quality of life in elderly diabetes patients.

Objective: To analyze the second hand smoke exposure and related factors of nonsmoking junior middle school students in Beijing, so as to provide a data support for formulating tobacco control measures. Methods: The multistage cluster random sampling method was used to select junior middle school students in Beijing. The valid data of 4 494, 4 915 and 3 792 nonsmoking middle school students were obtained from three waves of youth tobacco epidemic surveillance in 2013 (September to October), 2019 (August to November) and 2021 (September to December) wave, respectively. The information was collected by the national youth tobacco epidemic surveillance questionnaire. The complex sampling data analysis module of SPSS 21.0 was used to descriptive analysis and multivariate Logistic regression. Results: The proportions of secondhand smoke exposure of nonsmoking junior middle school students in the four types of places in the past 7 days in 2013, 2019 and 2021 in Beijing were 76.4%, 71.4% and 65.7%, respectively, with statistically significant differences (χ2=126.10, P<0.01). The proportions of that found someone smoking in the campus in the three waves of survey were 34.7%, 27.9% and 21.1% (χ2=209.78), the proportion of that found teachers smoking daily were 2.7%, 1.8% and 1.3% (χ2=22.14) (P<0.01), respectively. Multivariate Logistic regression analysis showed both parents smoking (OR=8.47, 95%CI=4.36-16.48), father smoking (OR=3.51, 95%CI=2.75-4.49), and friends smoking (OR=1.88, 95%CI=1.39-2.55) were the influencing factors of secondhand smoke exposure in four types of places of nonsmoking junior middle school students in 2013. Both parents smoking (OR=2.37, 95%CI=1.33-4.22), father smoking (OR=2.80, 95%CI=2.33-3.37), friends smoking (OR=2.24, 95%CI=1.71-2.92), and teaching the tobacco hazards in class (OR=0.77, 95%CI=0.64-0.93) were the influencing factors of secondhand smoke exposure in four types of places for nonsmoking middle school students in 2019. Both parents smoking (OR=3.93, 95%CI=2.29-6.75), fathers smoking (OR=3.30, 95%CI=2.72-3.99), and teaching the tobacco hazards in the class (OR=0.81, 95%CI=0.68-0.97) were the influential factor of secondhand smoke exposure in four types of places of nonsmoking junior middle school students in 2021 (P<0.05). Conclusions The secondhand smoke exposure of nonsmoking middle school students in Beijing has improved, but still is a high level. It is necessary to take corresponding measures to effectively protect nonsmoking junior middle school students from the harm of secondhand smoke.

Objective:To investigate the diagnosis of dual-energy X-ray absorptiometry(DXA)for osteoporosis(OP)of postmenopausal patients with rheumatoid arthritis(RA)in Qinghai region and the risk factors of them.Methods:A total of 200 postmenopausal female RA patients who admitted to Qinghai Hospital of Traditional Chinese Medicine from May 2022 to April 2023 were selected.All patients were tested for bone mineral density(BMD)after admission,and lumbar spines L1-L4,whole lumbar,large trochanter,Ward's triangle area,whole body and whole forearm were measured by DXA.According to the results of BMD test,patients whose BMD T values of all body parts-2.5 SD were less or equal to-2.5 were included in the OP group(121 cases),and patients whose BMD T value of all body parts were larger than-2.5 SD were included in the non-OP group(79 cases).The BMD T value of different body parts between two groups of RA patients were compared and analyzed.The area under curve(AUC)of receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of BMD T value for OP.The logistic regression method was adopted to analyze the risk factors that postmenopausal RA patients of Qinghai region occurred OP.Results:The BMD T values of L1,L2,L3,L4,whole lumbar,large trochanter,Ward's triangular area,whole body and whole forearm of OP group were obviously lower than those of the non-OP group.In analysis of ROC curve,the sensitivities of BMD T values of L1,L2,L3,L4,whole lumbar,large trochanter,Ward's triangle area,whole body and forearm were respectively 96.20%,95.22%,90.16%,96.03%,92.01%,89.36%,99.26%,90.02% and 96.03% in diagnosing OP,and the specificities of them were respectively 81.00%,82.19%,85.22%,83.06%,83.06%,90.22%,80.06%,86.23%,83.09%,and the AUC values of them were respectively 0.908,0.905,0.896,0.906,0.903,0.879,0.918,0.901 and 0.906.The results of the logistic-regression analysis showed that advanced age,long disease course,rheumatic activity scores of 28 joints,erythrocyte sedimentation rate and Calcium supplementation were the risk factors of occurring OP in postmenopausal RA patients in Qinghai region.Conclusion:The DXA method that detects BMD of RA patients who occur OP can be used as gold standard to assess OP,and there are many risk factors that affect the occurrence of OP in postmenopausal RA patients of Qinghai region.The clinical work should combine with relative factors to formulate reasonable measure so as to reduce the incidence of OP.

Objective:To assess the radiation dose and clinical value of "one-stop" whole-brain CT perfusion (CTP) imaging in the evaluation of collateral circulation for patients with acute ischemic stroke (AIS), regarding the digital subtraction angiography (DSA) as the reference.Methods:This retrospective study included 32 AIS patients, for whom both CTP and DSA were obtained <24 h since onset. All CTP scans were acquired in whole-brain volume perfusion mode using a 320-row CT with the phase-specific settings of tube currents to optimize the image quality of CTA images, where multiple-phase (mp) CTA images were extracted from the CTP data in post-processing. The volume CT dose index (CTDI vol), dose length product (DLP), and effective dose were compared to those reported in previous studies. The perfusion parameters of the infarct lesions and their contralateral regions were compared using the paired t-tests. One radiologist scored the collateral circulation with only the CTP and with the CTP plus mp-CTA using a 5-point scale. Another radiologist performed the same evaluation on the DSA. The diagnostic accuracy was calculated referring to the result based on DSA. The scores were analyzed using the Pearson correlation coefficient. The agreement of scores was quantified with the Kappa test. Results:The mean CTDI vol was 184.18 mGy, which was comparable to the result of a previous study (184.19 mGy), and the mean effective dose was reduced 39% compared to that reported in the literature for combined CTP and CTA scanning (6.1 vs 10 mSv). There were statistically significant differences in cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), transit time to peak (TTP), and time-to-maximum (Tmax) between the infarct lesions and their contralateral regions ( P<0.01). The scores between CTP and DSA were significantly correlated ( r=0.95, P<0.01), as well as the scores between CTP plus mp-CTA and DSA ( r=0.98, P<0.01). The Kappa value was 0.64 ( t=7.53, P<0.01) between CTP and DSA, while it increased to 0.88 ( t=9.99, P<0.01) for CTP plus mp-CTA. With the result of DSA as a reference, the diagnostic accuracy was 71.9% and 90.6% for CTP and CTP plus mp-CTA, respectively. Conclusions:The "one-stop" whole-brain CTP imaging with phase-specific settings of tube currents can provide reliable CTP and multiple-phase CTA images simultaneously, which could reasonably reduce the radiation dose. Combined use of multi-phase CTA and CT perfusion improves the diagnostic accuracy of collateral circulation in AIS patients.

Objective To conduct a network meta-analysis on the effectiveness of first-line immunotherapy on patients with brain metastases from advanced non-small cell lung cancer(NSCLC).Methods Two investigators conducted a computerized search of Pubmed,Embase,Cochrane,and other databases to screen the literature,extract the information,and assess the risk of bias of the included studies.The included clinical trials were statistically analyzed using R(4.1.3)software.For the study outcome indicators OS and PFS,the risk ratios(HRs),and the 95%confidence intervals(CIs)were extracted from the included studies and logarithmically transformed into effect analysis statistics.Results Six randomized controlled trials were finally included,including 327 patients with non-excludable NSCLC brain metastases.Network meta-analysis suggested that PD-1 inhibitor+CTLA-4 was more advantageous than the conventional chemotherapy for enhancing patients'OS(HR:0.13,95%CI:0.03-0.71),followed by PD-L1 inhibitor(HR:0.17,95%CI:0.04-0.74)and PD-1 inhibitor+chemotherapy(HR:0.36,95%CI:0.2-0.63).PD-1 inhibitor+CTLA-4 was also more advantageous(HR:0.37,95%CI:0.15-0.93)than the conventional chemotherapy for boosting patients'PFS,followed by PD-L1 inhibitor+chemotherapy(HR:0.44,95%CI:0.29-0.66)and PD-1 inhibitor(HR:0.48,95%CI:0.27-0.86).Conclusion Immune checkpoint inhibitor therapy improves the survival of patients with brain metastases from advanced NSCLC.In particular,the combination of PD-1 inhibitor and CTLA-4 inhibitor show excellent survival benefit.

Objective:To assess the influence of extreme temperature events on the mortality risk of nervous system diseases in residents of Jiangsu Province and identify patients with nervous system diseases who are susceptible to extreme temperature events.Methods:Acase-crossover design was used to investigate the cumulative lagged effects of extreme temperature events on the mortality risk of nervous system disease in local residents by using the data on causes of death from nervous system diseases in Jiangsu from 2014 to 2020 with conditional logistic regression model. The final definition of extreme temperature events was established using Akaike information criterion. The heat wave was defined as 4 or more consecutive days with daily mean temperatures above the 92.5 th percentile of annual daily mean temperatures, and the cold spell was defined as 2 or more consecutive days with daily mean temperatures below the 10 th percentile of annual daily mean temperatures. Furthermore, stratified analyses was conducted to compare the effects of extreme temperature events on mortality risk in populations in different gender, age and marital status groups to identify susceptible populations to extreme temperature event. Results:Statistical results showed that the effect values of heat wave and cold spell on the mortality risk of nervous system diseases all peaked at the 7 th day of the cumulative lag, with OR of 1.60 (95% CI: 1.44-1.76) and 1.33 (95% CI: 1.13-1.56), respectively. Heat wave exposure increased mortality risk for individuals with Alzheimer's and Parkinson's diseases, while cold spell exposure increased the mortality risk for those with Alzheimer's disease. Stratified analyses showed that the mortality risk for nervous system disease and Alzheimer's disease was higher in partnerless population after heat wave exposure. Conclusions:Heat wave and cold spell were associated with increased mortality risks for nervous system disease, highlighting the need for improved early warning systems for extreme temperature event. In the context of heat wave, interventions to protect individuals with nervous system disease should prioritize partnerless population.

Objective To explore and compare the efficacy of open reduction Kirschner-wire internal fixation and closed reduction Herbert screw internal fixation in the treatment of fresh unstable scaphoid lumbar fracture.Methods 72 patients with fresh unstable scaphoid lumbar fracture admitted to our hospital from January 2020 to January 2022 were selected and randomly divided into the experimental group(36 cases,open reduction Kirschberg wire internal fixation)and the control group(36 cases,closed reduction Herbert screw internal fixation).The operation time,fracture healing time,healing rate at 12 weeks,complication rate,scaphoid osteonecrosis rate,wrist functional recovery 6 months and 1 year after surgery were observed and compared within 2 groups,including wrist range of motion,improved Mayo wrist function score,pain index using visual analog scale(VAS).Results There were no significant differences in operation time,fracture healing time,healing rate and complication rate in 2 groups(P＞0.05).6 months after surgery,the wrist motion of ulnar deviation,radial deviation,dorsalis extension and palmaris flexion in 2 groups were significantly improved compared with before surgery(P＜0.05).There was no significant difference in wrist motion in 2 groups after surgery(P＞0.05).Compared with 6 months after surgery,Mayo score of experimental group was significantly improved at 12 months after surgery(95.36± 3.34)vs.(78.52±5.62)(P＜0.05),and VAS was significantly decreased(1.04±2.24)vs.(3.25± 1.62)(P＜0.05),but there was no significant difference in Mayo score and VAS between 2 groups(P＞0.05).Conclusions Compared with closed reduction and Herbert screw internal fixation,open reduction and Kirschner wire internal fixation can also achieve satisfactory results.However,the operation cost and difficulty of Kirschner wire internal fixation are relatively low.

Objective:To compare the differences of event-related potential P300 and serum fibroblast growth factor 22 (FGF22) levels in cognitive impairment patients with first-episode and recurrent depression, and analyze the relations of each index with cognitive function and serum inflammatory factors.Methods:From June 2020 to April 2021, 45 cognitive impairment patients with first-episode depression (first-episode group) and 42 cognitive impairment patients with recurrent depression (recurrence group) were selected from our hospital. P300 examination was performed and serum FGF22, interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) levels were measured by enzyme-linked immunosorbent experiment (ELISA). The differences in clinical data, P300 examination results, and serum FGF22, IL-6 and TNF-α levels were compared between the two groups. The correlations of P300 amplitude and latency and serum FGF22 level with Montreal Cognitive Assessment (MoCA) scores and IL-6 and TNF-α levels were analyzed.Results:As compared with the first-episode group, the recurrence group had significantly decreased MoCA scores, P300 amplitude and serum FGF22 level, and statistically increased P300 latency and IL-6 and TNF-α levels ( P<0.05). Correlation analysis showed that P300 amplitude and serum FGF22 level were positively correlated with MoCA scores, and negatively correlated with IL-6 and TNF-α levels ( P<0.05); P300 latency was negatively correlated with MoCA scores, and positively correlated with IL-6 and TNF-α levels ( P<0.05). Conclusion:P300 amplitude and latency and serum FGF22 level are different between cognitive impairment patients with first-episode and recurrent depression, and they are correlated with the cognitive function and serum inflammatory factors.

The National Medical Insurance Administration launched a national pilot project based on diagnosis-related group (DRG) payment across the country in 2019. It optimizes and reuses limited resources from a clinical perspective, controls hospitalization expenses and medical costs, and reduces average hospital stays based on DRG payment. This article expounds the concept and application of DRG payment, from the perspective of clinical nursing, expounds the research progress of DRG payment at home and abroad, attempts to analyze the relationship between DRG payment and nursing, and further proposes the impact on the development of clinical nursing.

Objective: To understand the dynamic change rule and trend of the vital capacity of students in Tongzhou district, and to provide data support for the development of targeted physical exercise intervention mode. Methods: According to the routine physical examination data of students in Tongzhou District in the academic year 2011-2019, the physical examination data of 3 197 students with complete physical examination information were selected according to the proportion of students in urban areas and towns and gender differences. SPSS 17.0 was used for statistical analysis of the screening data. Results: The mean vital capacity of 3 197 students increased with the increase of grades. Except for grade 2 to grade 5 of primary school and grade 2 to grade 3 of junior high school, the mean vital capacity of urban students was higher than that of rural students ( P <0.05). The mean vital capacity of male students was higher than that of female students in all grades ( P <0.05). The vital capacity of male students and female students increased rapidly twice in grade 5 of primary school and grade 3 of junior high school( P <0.05), the growth rate of male students in two stages was larger than that of female students, the increase rates were 277.21 and 400.20 mL. The mean vital capacity was shown in this way:obese>overweight>normal weight>malnutrition ( P <0.05). The excellent rate of vital capacity evaluation in girls was higher than that in boys from grade 3 of primary school to grade 2 of junior middle school ( P <0.05). Except for grade 1 and 2 of primary school, the excellent rate of vital capacity evaluation in other grades was found as follows:obese>overweight>normal weight>malnutrition. The failure rate of boys was higher than that of girls ( P <0.05), except grade 3 of primary school. The failure rate from grade 5 to grade 3 showed the trend:malnutrition>normal weight>overweight>obesity ( P <0.05). In different groups, the failure rate of grade 1 of primary school and grade 1 of junior high school were the two peaks, which basically showed a decreasing trend followed by decreasing one. Conclusion The level of vital capacity of students in Tongzhou District is relatively low, so the school, family and society should focus on students vital capacity level. It should be one of the key tasks to enhance the physical quality of the students to increase the vital capacity of the boys and the students with abnormal weight.