ObjectiveTo investigate the triglyceride-glucose (TyG) index and the level of serum homocysteine (Hcy) in association with the incidence of stroke in type 2 diabetes mellitus (T2DM) patients. MethodsBased on the chronic disease risk factor surveillance cohort in Pudong New Area, Shanghai, excluding those with stroke in baseline survey, T2DM patients who joined the cohort from January 2016 to October 2020 were selected as the research subjects. During the follow-up period, a total of 318 new-onset ischemic stroke patients were selected as the case group, and a total of 318 individuals matched by gender without stroke were selected as the control group. The Cox proportional hazards regression model was used to adjust for confounding factors and explore the serum TyG index and the Hcy biochemical indicator in association with the risk of stroke. ResultsThe Cox proportional hazards regression results showed that after adjusting for confounding factors, the risk of stroke in T2DM patients with 10 μmol·L⁻¹-¹ and Hcy>15 μmol·L⁻¹ was 1.532 times (95%CI: 1.017‒2.309 times, P=0.041) and 1.738 times (95%CI: 1.119‒2.699 times, P=0.014) higher respectively, compared to T2DM patients with Hcy≤10 μmol·L⁻¹. T2DM patients with TyG>9.074 had 1.396 times higher risk of stroke (95%CI: 1.091‒1.787, P=0.008) compared to those with TyG≤9.074. The study found that urea and α1-antitrypsin (α1-AT) were independent risk factors for the incidence of stroke in T2DM patients. For every unit increase in urea andα1-AT, the risk of stroke in T2DM patients increased by 233.6% (HR=3.336, 95%CI: 1.588‒7.009, P=0.001) and 11.3% (HR=1.113, 95%CI: 1.028‒1.205, P=0.008), respectively. Cumulative risk curves showed that Hcy>10 μmol·L⁻¹ and TyG>9.074 accelerated the time to stroke occurrence in T2DM patients. ConclusionElevated levels of Hcy>10 μmol·L⁻¹ and a higher TyG index are risk factors for stroke in T2DM patients. Effective interventions for Hcy and TyG should be conducted for diabetic patients to reduce the incidence of stroke.

ObjectiveTo examine the protective mechanism of wogonin in SH-SY5Y cells cultured in the conditioned media with lipopolysaccharide （LPS）-induced BV-2 microglia. MethodBV-2 microglia were divided into the blank group， LPS group， low concentration group of wogonin （4 μmol∙L^-1）， medium concentration group of wogonin （8 μmol∙L^-1）， and high concentration group of wogonin （16 μmol∙L^-1）. The LPS group was given 1 mg·L^-1 LPS， and the other three groups were treated with the corresponding concentration of wogonin for 4 h and then given 1 mg·L^-1 LPS. The conditioned media from these groups were used to cultivate SH-SY5Y cells. Cell counting kit-8 （CCK-8） was used to assess the vitality of BV-2 cells in the above groups. The contents of interleukin-6 （IL-6） and tumor necrosis factor-alpha （TNF-α） in the supernatant of BV-2 cells were determined by enzyme-linked immunosorbent assay （ELISA）. The expression of tyrosine hydroxylase （TH） and α-Synuclein （α-Syn） in SH-SY5Y cells was detected by immunohistochemical staining （IHC）. The nuclear transfer and fluorescence expression intensity of nuclear transcription factor-κB p65 （NF-κB p65） protein in SH-SY5Y cells were detected by immunofluorescence staining （IF）. Western blot was used to detect the expression of Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/NF-κB pathway-related proteins in SH-SY5Y cells. ResultThe levels of IL-6 and TNF-α in the supernatant of BV-2 cells in the LPS group were significantly higher than those in the blank group （P<0.01）. Compared with those in the LPS group， the IL-6 content of BV-2 cells in the low concentration group of wogonin was statistically significantly lower （P<0.05）， whereas the IL-6 and TNF-α contents of the medium and high concentration groups of wogonin were statistically lower （P<0.05，P<0.01）. The IL-6 and TNF-α contents in the high concentration group of wogonin decreased most significantly （P<0.01）， and the intervention effect was the best. Compared with that in the blank group， the expression of α-Syn protein in SH-SY5Y cells cultured with conditioned media in the LPS group was significantly increased， and the expression of TH protein was significantly decreased （P<0.05）. Compared with that in the LPS group， α-Syn protein expression in the medium and high concentration groups of wogonin showed a decreasing trend （P<0.05， P<0.01）. TH protein expression was increased in the low， medium， and high concentration groups of wogonin （P<0.05， P<0.01）. Compared with the blank group， NF-κB p65 protein gradually accumulated into the nucleus， and the fluorescence expression intensity was significantly enhanced （P<0.01）. Compared with the LPS group， the NF-κB p65 protein was gradually dispersed outside the nucleus， and the fluorescence expression intensity was gradually weakened in all concentration groups of wogonin. The fluorescence intensity in the high concentration group of wogonin was significantly reduced （P<0.01）. Compared with those in the blank group， the expression levels of TLR4 protein， phosphorylated（p）-NF-κB p65 protein， and MyD88 protein in the LPS group were significantly increased （P<0.05， P<0.01）. Compared with those in the LPS group， the expressions of TLR4 protein， p-NF-κB p65 protein， and MyD88 protein in the medium concentration group of wogonin were all significantly decreased （P<0.05， P<0.01）. The expressions of TLR4 protein， and MyD88 protein in the high concentration group of wogonin were significantly decreased （P<0.05， P<0.01）. ConclusionWogonin may regulate the TLR4/MyD88/NF-κB signaling pathway to inhibit the release of LPS-induced inflammatory factors in BV-2 microglia and protect SH-SY5Y cells， thereby reducing inflammation and achieving neuroprotective effects.

Objective To explore the relationship between baseline urinary protein levels and the onset of chronic obstructive pulmonary disease (COPD). Methods A questionnaire survey, blood and urine sample collection, physical examination, and pulmonary function test were conducted among permanent residents over 40 years old in Pudong New Area, Shanghai. The subjects were divided into four groups based on the baseline urine albumin-to-creatinine ratio (ACR) quartiles (0~1.65 mg/g, 1.65~4.89 mg/g, 4.89~10.78 mg/g, and ≥10.78 mg/g). Cox regression analysis was used to explore the relationship between ACR levels and the incidence of COPD in middle-aged and elderly people. Results Among the 3 105 subjects, the median follow-up time was 3.212 years (P25~P75：3.102~3.473). 116 new cases of COPD were observed, with an incidence density of 10.423 per 1000 person-years. The incidence densities for COPD at four ACR levels were 7.922 per 1 000 person-years, 8.300 per 1 000 person-years , 11.419 per 1 000 person-years, and 13.843 per 1 000 person-years, respectively. Cox regression analysis revealed that as the ACR level increased, there was a rising trend in the incidence rate of COPD (χ²=4.396, P=0.036). After adjusting for gender, age, education level, occupational exposure to dust, history of childhood pneumonia, smoking, family history of COPD, central obesity, and hypertension, the risk of developing COPD was 2.499 times higher (95% CI: 1.460~4.276) for ACR levels ≥10.78 mg/g compared to the reference group with a baseline ACR level of 0~1.65 mg/g. Conclusion Elevated ACR levels in middle-aged and elderly population may increase the risk of COPD, and early monitoring of urine protein levels is beneficial for COPD prevention.

Objective:To explore any effect of intermittent theta burst stimulation (iTBS) and of different sequencing of rehabilitation training on upper limb dysfunction after a stroke.Methods:Thirty-six patients with upper limb motor dysfunction after subacute subcortical cerebral infarction were divided at random into a control group, an experimental group 1, and an experimental group 2, each of 12. The control group was given prosthetic stimulation and upper limb function rehabilitation training. Experimental group l received focal iTBS stimulation on M1 immediately followed by upper limb rehabilitation training. Experimental group 2 received the same treatment but in reverse order. The experiment lasted four weeks. Upper limb functioning and ability in the activities of daily living (ADL) were quantified before and after the interventions using the Fugl-Meyer upper extremity assessment (FMA-UE) and the modified Barthel index (MBI). Cortical latency (CL) was also recorded.Results:Before the treatment there were no significant differences among the three groups, but afterward a significant increase was observed in the average FMA-UE and MBI scores of both experimental groups accompanied by a significant decrease in CL. There was no significant difference between the two experimental groups′ results, on average.Conclusion:Supplementing upper limb rehabilitation training with iTBS can significantly improve the upper limb functioning of ischemic stroke survivors, and the sequencing of the training has no effect on the therapeutic results.

【Objective】 To investigate the characteristics of HIV-1 infection among voluntary blood donors in Huzhou City from 2016 to 2022. 【Methods】 A total of 233 552 voluntary blood donors in Huzhou, Zhejiang from January 2016 to December 2022 were retrospectively analyzed. Blood donors who were qualified for health examination were required to take EDTA-K2 anticoagulant blood samples by bypass during blood donation. Enzyme-linked immunosorbent assay (ELISA) was used for initial screening and re-examination of HIV antigen / antibody. The results were determined in strict accordance with the criteria in National AIDS Testing Technical Specification(2015 Revision). HIV-1 antibody-positive samples were detected by HIV-1 new infection enzyme immunoassay kit, and the restricted antigen affinity method was used to detect whether the samples were new infections. Samples with CD4 cells > 200 / L and the viral load > 1 000 copies / mL were defined as new infection. The positive rate of HIV-1 antibody in each year was compared. With the positive rate of HIV-1 antibody used as the base, the incidence of new HIV-1 infections among subgroups of HIV-1 antibody positive patients of different types (gender, age, occupation, etc.) was compared. 【Results】 From 2016 to 2022, there were 233 552 blood samples from voluntary blood donors in Huzhou, including 15 HIV-1 antibody positive samples, with infection rate of 6.42/100 000, among which 40.00% were newly infected and 60.00% were previously infected. From 2016 to 2022, the HIV-1 infection rate showed a downward trend year by year as 1.62%, 1.24%, 0.63%, 0.31%, 0.30%, 0.28% and 0.27%, respectively. The comparision of new infection rate of HIV-1 in different subgroups of 15 HIV-1 antibody positive patients showed that the new infection rate of HIV-1 in repeated blood donation subgroup was higher than that in the first-time blood donation subgroup, with no statistical difference(P>0.05). The incidence of new HIV-1 infections in males was higher than that in females, but there was no statistically significant difference between groups (P>0.05). Among HIV-1 antibody positive blood donors with different educational backgrounds, the proportion of newly infected individuals with junior high school or below was relatively high, but there was no difference compared to other educational subgroups (P>0.05). There was no statistically significant difference in the incidence of new HIV-1 infections among different occupational subgroups (P>0.05). 【Conclusion】 In recent years, the incidence of HIV-1 new infections in Huzhou has decreased year by year, and there is no obvious distribution characteristics of new infections in the subgroups of first-time blood donation and repeated blood donation subgroups, as well as subgroups of different genders, educational backgrounds and occupations.

ObjectiveTo evaluate the intervention effect of meteorological risk forecasting service on acute onset and medical expenses of chronic obstructive pulmonary disease（COPD） patients， and to provide scientific basis for the establishment of health management model for chronic obstructive pulmonary disease（COPD） patients. MethodsStudy subjects were recruited from chronic obstructive pulmonary patients aged ≥40 in Pudong New Area. Propensity score matching method was used to determine the intervention group and the control group. The control group received regular health education and follow-up management， and the intervention group was provided with meteorological and environmental risk forecasting services through WeChat， mobile phone short message service（SMS）and telephone. Finally， a total of2 589 subjects were included in the analysis， including 1 300 in the intervention group and 1 289 in the control group. General demographic data， past medical history and family history of COPD， COPD related knowledge and practice survey， COPD related symptom assessment， acute onset， health service utilization and medical expenses before and after intervention were collected through questionnaire survey. The differences of acute attack， health service utilization and related medical expenses between the two groups before and after intervention were compared to evaluate the intervention effect. ResultsIn terms of acute attacks， after intervention， the incidence of acute attacks in the intervention group was lower than that before intervention（χ²=52.901， P<0.001）， and the incidence of acute attacks in the groups with different intervention methods was lower than that before intervention （P<0.001）. WeChat had the best effect， decreasing the incidence by 14.4%， followed by mobile phone SMS SMS decreasing by 12.3%. In terms of utilization of health services， the outpatient rate due to acute attack was lower in the intervention group after intervention than that before intervention （χ²=7.129， P=0.008）， and the outpatient rate due to acute attack was lower in the subjects who received the forecast service through mobile phone SMS than that before intervention （χ²=4.675， P<0.001）. In terms of medical expenses， there was no significant difference between control group and intervention group with different intervention methods before intervention （P>0.05）. After intervention， the difference between the control group and the intervention group with different intervention methods was statistically significant （H=11.864， P<0.05）. The results of multiple comparisons showed that compared with the control group， the average annual medical expenses of patients receiving mobile phone SMS and telephone forecasting services after intervention were lower than those of the control group， and the difference was statistically significant （P<0.05）. ConclusionMeteorological risk forecasting service can reduce the acute onset of COPD， reduce the rate of consultation and medical expenses due to acute onset， and provide scientific basis for the basic COPD health management model.

Objective To compare H_p(3) calibration with a homemade (A) thermoluminescent dosimeter (TLD) and an imported (B) TLD in a standard X-ray RQR radiation field, to explore the different responses of A and B, and to provide foundation for the calibration of H_p(3). Methods A column mode was selected. H_p(3) calibration was performed using A and B in a standard X-ray RQR radiation field in the Secondary Standard Dosimetry Laboratory, National Institute for Radiological Protection, China Center for Disease Control and Prevention. Angle response, energy response, and linear response were calibrated with RQR4 (60 kV), RQR7 (90 kV), and RQR9 (120 kV), respectively. Results In terms of angle response, the calibration results of A were relatively high, while the calibration results of B were relatively low. In terms of energy response, the calibration results showed a similar pattern to angle response. In terms of linear response, the calibration results of both A and B were satisfactory. Conclusion Both A and B can be used for normal calibration of H_p(3) in a standard X-ray RQR radiation field. However, in actual monitoring, attention should be paid to the energy and angle response values of TLDs.

Objective·To explore the correlation among perceived social support,rehabilitation self-efficacy and rehabilitation exercise adherence of in-patients after hip/knee arthroplasty,and examine the mediating role of rehabilitation self-efficacy in the correlation between perceived social support and rehabilitation exercise adherence.Methods·A convenience sampling method was used,and 141 post-total hip/knee arthroplasty inpatients in the bone and joint ward of the First Affiliated Hospital of Naval Medical University(Shanghai Changhai Hospital)from October 2021 to February 2023 were selected as the study subjects.The general demographic data,such as age and gender,and the information of disease and operation were assessed by using General Data Questionnaire.The adherence to rehabilitation exercise in patients after hip/knee arthroplasty was assessed by using the Rehabilitation Exercise Adherence Scale(REAS);the self-efficacy of rehabilitation exercise was assessed by using the Self-Efficacy for Rehabilitation Outcome Scale(SER);the social support level of individual subjective feelings of the patients was assessed by using the Perceived Social Support Scale(PSSS).Pearson's correlation analysis was used to test the correlation between the variables,and Bootstrap method was used to investigate the mediating role of rehabilitation self-efficacy in the correlation between perceived social support and rehabilitation exercise adherence.Results·A total of 167 questionnaires were distributed and 141 valid questionnaires were recovered,with a valid recovery rate of 84.4%.The age range of the 141 patients after hip/knee arthroplasty was 26?84 years old,and the average age was(64.75±10.74)years old.The total score of SER of the patients after hip/knee arthroplasty was(100.45±21.71),the total score of PSSS was(68.29±10.89),and the total score of REAS was(11.93±2.29).Pearson's correlation analysis results showed that there was a significant correlation between SER score and PSSS score,SER score and REAS score,and PSSS score and REAS score in patients after hip/knee arthroplasty.The mediation effect analysis showed that the indirect effect of perceived social support on rehabilitation exercise adherence was significant(effect value 0.033,95%CI 0.017?0.058,P<0.05),and the direct effect of perceived social support on rehabilitation exercise adherence was not significant(effect value 0.027,95%CI-0.008 ? 0.065,P>0.05).Conclusion·Perceived social support positively predicts rehabilitation exercise adherence,and rehabilitation self-efficacy fully mediates the correlation.Direct intervention in rehabilitation self-efficacy is superior to moderating the level of perceived social support.

Objective To evaluate the degree of brain atrophy in spinocerebellar ataxia type 3(SCA3)patients based on artificial intelligence(AI)technology,and to explore the correlation between the degree of brain atrophy and the severity of the disease.Methods The clinical and imaging data of 23 SCA3 patients(SCA3 group)and 24 healthy controls(HC)(HC group)were collected.The International Cooperative Ataxia Rating Scale(ICARS)was used to evaluate the severity of ataxia in patients with SCA3.AI technology was used to process the 3D-T1 WI MR image data of the SCA3 and HC groups to segment and measure the volume and volume percentage of brain,followed by correlation analyses between brain structural alterations and the severity of ataxia in SCA3 patients.Results There were no significant differences in gender and age between the two groups(P＞0.05).The SCA3 group had a significant reduction in the volume and volume percentage of various brain regions,such as the frontal,temporal,parietal,occipital,limbic,right cerebral white mat-ter,subcortical gray matter,cerebellum and brainstem,compared to the HC group(multiple hypothesis testing adjusted P＜0.01).In the SCA3 group,the ICARS showed positive correlation with patient age(r=0.571,P=0.004)and negative correlation with the vol-ume of the left cerebellar white matter,vermis,medulla oblongata,and the volume percentages of bilateral cerebellar white matter,vermis,pons,medulla oblongata(P＜0.05).Conclusion The significant atrophy of the supratentorial and subtentorial regions of the brain in SCA3 patients.The globus pallidus exhibits the most substantial atrophy,suggesting its potential as an imaging diagnostic marker of SC A3.

Objective To investigate the relationship between protein SUMOylation level and the prognosis of papillary thyroid carcinoma(PTC)in males.Methods Protein SUMOylation levels in PTC was analyzed by bioinformatics based on GTEx and TCGA databases and validated by immunohistochemical staining and Western blotting in our clinical pairs specimens.The mRNA expression of the protein SUMOylation associated genes were measured by fluorescent quantitative real-time polymerase chain reaction(qRT-PCR)in surgical pairs specimens.Results The expression level of SUMOylation in the tumor tissues of PTC showed an elevated trend(P＜0.05),and was associated with poor prognosis of the patients by TCGA and GTEx databases analysis(P=0.021).In the clinical samples of our hospital,it was verified that the level of SUMOylation in tumor tissues was higher than that of the paired non-tumor tissues(P＜0.05).However,qRT-PCR showed no significant changes in the transcriptional level of the protein SUMOylation associated genes in most cases.Conclusions Protein SUMOylation in thyroid tumor tissues were higher than that in paired non-tumor tissues,and the higher SUMOylation levels levels in tumor tissues were,the shorter overall survival time of the patients was.