Objective:To construct multimorbidity patterns among elderly individuals with chronic diseases and to explore the relationship between these patterns and frailty.Methods:A cross-sectional study was conducted involving 4, 706 elderly participants aged 60 years and older from selected prefecture-level cities in Shaanxi Province.Data were collected on general information, chronic diseases, and frailty status.The average age of the participants was 69.9±6.7 years, with males comprising 47.3%(2, 255 cases)and females comprising 52.7%(2, 481 cases)of the sample.Latent class analysis(LCA)was employed to identify multimorbidity patterns, while multivariate logistic regression analysis was utilized to examine the associations between these patterns and frailty.Results:The prevalence of multimorbidity within the study population was found to be 43.6%(2, 052 cases out of 4, 706 cases).The highest rates of multimorbidity were observed in anxiety and depression(100%, 23 cases out of 23 cases), dementia(100%, 6 cases out of 6 cases), and Parkinson's disease(100%, 11 cases out of 11 cases).Stroke followed closely with a rate of 96.8%(597 cases out of 617 cases), while rheumatoid arthritis exhibited the lowest rate of multimorbidity with other chronic diseases at 50%(4 cases out of 8 cases).Five distinct multimorbidity patterns were identified through LCA: the complex multimorbidity class(123 cases), the stroke-respiratory class(546 cases), the sleep disorders-osteoarticular class(488 cases), the cardiovascular-metabolic class(987 cases), and the relatively healthy class(2, 562 cases).When compared to the relatively healthy class, the complex multimorbidity class( OR=2.317, 95% CI: 1.573-3.412), stroke-respiratory class( OR=2.279, 95% CI: 1.862-2.788), sleep disorders-osteoarticular class( OR=1.370, 95% CI: 1.111-1.691), and cardiovascular-metabolic class( OR=1.185, 95% CI: 1.003-1.400)were all found to be significantly associated with frailty. Conclusions:The cardiovascular-metabolic class is the most prevalent among elderly individuals.Various patterns exhibit distinct associations with frailty, with the complex multimorbidity class and the stroke-respiratory class being the most significant, as they markedly elevate the risk of frailty.

Objective : To explore the association between serum γ-aminobutyric acid ( GABA) levels and the risk of developing type 2 diabetes( T2DM) ． Methods : 187 cases of T2DM patients attending the hospital were selected as the T2DM group，and 187 cases of non-T2DM population attending the same period of time were selected as the control group according to age ( ± 3 years) and gender 1 ∶ 1．On-site questionnaires and physical examination were conducted for the study subjects，and serum levels of GABA，Malondialdehyde ( MDA) and activities of superoxide dismutase ( SOD) and Glutathione peroxidase ( GSH-Px) were detected by using ELISA kits．The differences in the levels of GABA and oxidative stress indicators ( SOD，GSH-Px，MDA) between the two groups were compared， and the correlation between GABA and oxidative stress indicators was analyzed by Spearman's method; GABA and oxidative stress indicators were divided into three groups according to their control quartiles，respectively ［low level group ( Q1: ＜P25) ，medium level group ( Q2: P25 －P75) ，high level group ( Q3: ＞P75) ］，and conditional logistic regression was applied to analyze the relationship between GABA，oxidative stress indicators and the risk of develo- ping T2DM; the dose-response relationship between GABA，oxidative stress indicators and the risk of developing T2DM was analyzed by using restricted cubic spline ( RCS) ． Results : T2DM group ( P＜0. 05) ．Spearman's correlation analysis showed that GABA level was positively correlated with SOD and GSH-Px activities and negatively correlated with MDA level ( P＜0. 001) ．Conditional logistic regression analysis showed that medium levels of SOD and GSH-Px as well as medium and high levels of GABA were protective factors for T2DM compared with low levels in each group ( P＜0. 05) ．RCS results showed that a negative dose-response relationship between GABA，GSH-Px and the risk of developing T2DM，and SOD showed a trend of decreasing and then increasing the risk of developing T2DM ( P＜0. 05) ． Conclusion Serum GABA levels have been associated with the risk of developing T2DM．As serum GABA levels increase，the risk of developing T2DM may decrease．

Objective:To construct multimorbidity patterns among elderly individuals with chronic diseases and to explore the relationship between these patterns and frailty.Methods:A cross-sectional study was conducted involving 4, 706 elderly participants aged 60 years and older from selected prefecture-level cities in Shaanxi Province.Data were collected on general information, chronic diseases, and frailty status.The average age of the participants was 69.9±6.7 years, with males comprising 47.3%(2, 255 cases)and females comprising 52.7%(2, 481 cases)of the sample.Latent class analysis(LCA)was employed to identify multimorbidity patterns, while multivariate logistic regression analysis was utilized to examine the associations between these patterns and frailty.Results:The prevalence of multimorbidity within the study population was found to be 43.6%(2, 052 cases out of 4, 706 cases).The highest rates of multimorbidity were observed in anxiety and depression(100%, 23 cases out of 23 cases), dementia(100%, 6 cases out of 6 cases), and Parkinson's disease(100%, 11 cases out of 11 cases).Stroke followed closely with a rate of 96.8%(597 cases out of 617 cases), while rheumatoid arthritis exhibited the lowest rate of multimorbidity with other chronic diseases at 50%(4 cases out of 8 cases).Five distinct multimorbidity patterns were identified through LCA: the complex multimorbidity class(123 cases), the stroke-respiratory class(546 cases), the sleep disorders-osteoarticular class(488 cases), the cardiovascular-metabolic class(987 cases), and the relatively healthy class(2, 562 cases).When compared to the relatively healthy class, the complex multimorbidity class( OR=2.317, 95% CI: 1.573-3.412), stroke-respiratory class( OR=2.279, 95% CI: 1.862-2.788), sleep disorders-osteoarticular class( OR=1.370, 95% CI: 1.111-1.691), and cardiovascular-metabolic class( OR=1.185, 95% CI: 1.003-1.400)were all found to be significantly associated with frailty. Conclusions:The cardiovascular-metabolic class is the most prevalent among elderly individuals.Various patterns exhibit distinct associations with frailty, with the complex multimorbidity class and the stroke-respiratory class being the most significant, as they markedly elevate the risk of frailty.

BACKGROUND:In recent years,the incidence of hyperuricemia caused by purine metabolism disorders has been increasing,which can induce inflammatory responses and lead to renal injury. OBJECTIVE:To explore the role and mechanism of solute carrier family 2 member 12(SLC2A12)in hyperuricemia-related renal injury. METHODS:Renal tubular cells(HK2 cells)were divided into five groups:HK2 group,HK2+uric acid group,HK2+uric acid+NC group,HK2+uric acid+siSLC2A12 group,and HK2+uric acid+siSLC2A12+MK-2206 group.HK2 cells were treated with uric acid and transfected with siRNA SLC2A12,followed by MK-2206 treatment to inhibit AKT expression.Cell proliferation was detected by CCK-8 assay.Apoptosis was detected by TUNEL assay.qRT-PCR and western blot assay were used to detect fibrogenic factors as well as activation of the AKT/FOXO3a pathway.The concentrations of inflammatory cytokines were measured by enzyme-linked immunosorbent assay. RESULTS AND CONCLUSION:(1)Uric acid treatment inhibited cell proliferation and promoted cell apoptosis in the HK2+uric acid group compared with the HK2 group.The proliferative ability of cells in the HK2+uric acid+siSLC2A12 group was further decreased and apoptotic cells were further increased compared with the HK2 group.Compared with the HK2+uric acid+siSLC2A12 group,the HK2+uric acid+siSLC2A12+MK-2206 group showed an increase in cell proliferation and a decrease in apoptotic cells.(2)Compared with the HK2 group,the connective tissue growth factor(CTGF),α-smooth muscle actin(α-SMA)and transforming growth factor beta(TGF-β)expressions increased in the HK2+uric acid group;CTGF,α-SMA and TGF-β expression further increased in the HK2+uric acid+siSLC2A12 group.Compared with the HK2+uric acid+siSLC2A12 group,the CTGF,α-SMA and TGF-β expressions decreased.(3)Compared with the HK2 group,the expression of p-AKT,FOXO3a,and p-FOXO3a elevated in the HK2+uric acid group;the expression of p-AKT further increased,while the expression of FOXO3a and p-FOXO3a decreased in the HK2+uric acid+siSLC2A12 group.Compared with the HK2+uric acid+siSLC2A12 group,p-AKT expression decreased;FOXO3a and p-FOXO3a expression increased in the HK2+uric acid+siSLC2A12+MK-2206 group.(4)Compared with the HK2 group,interleukin-6,interleukin-1 β,and tumor necrosis factor α levels increased in the HK2+uric acid group;interleukin-6,interleukin-1 β,and tumor necrosis factor α levels further increased in the HK2+uric acid+siSLC2A12 group.Compared with the HK2+uric acid+siSLC2A12 group,interleukin-6,interleukin-1 β,and tumor necrosis factor α levels diminished in the HK2+uric acid+siSLC2A12+MK-2206 group.(5)These findings indicate that SLC2A12 may protect against hyperuricemia-induced renal injury by counteracting uric acid-induced tubular fibrosis and inflammation through activation of the FOXO3a pathway.

BACKGROUND:Heterotopic ossification of skeletal muscle is a clinically serious complication.For heterotopic ossification of skeletal muscles,the cells involved in the process of heterotopic ossification remain unclear. OBJECTIVE:To investigate the involvement of myocytes,fascia cells,and endothelial cells in the process of heterotopic ossification in skeletal muscle and to observe the cell origin of heterotopic ossification in skeletal muscle induced by bone morphogenetic protein 4. METHODS:Both C2C12 cells and the myotubes formed by the C2C12 cells in the induction medium were cultured,and 500 ng/mL bone morphogenetic protein 4 was added to the medium respectively,and whether the C2C12 cells and myotubes continued to proliferate within 10 days under the treatment were observed under a microscope.Myogenic cells(L6,derived from rats)and fibroblast-derived cells(derived from human)were co-cultured.After treatment with 500 ng/mL bone morphogenetic protein 4 and 10 ng/mL transforming growth factor-β,osteogenic and chondrogenic differentiation potential within 21 days were observed using Safranine O staining and Alcian blue staining.Using transgenic animal FVB/N-TgN(TIE2-LacZ)182Sato mice,15 μL of adeno-associated virus-bone morphogenetic protein 4(5×1010 PFU/mL)were implanted in the thigh muscle space of genetic mice for 10 and 14 days.X-gal staining was used to observe the formation of new blood vessel endothelium in the differentiated bone. RESULTS AND CONCLUSION:(1)Bone morphogenetic protein 4 caused myotube breakdown and increased C2C12 cell proliferation.Compared with other groups,the pure fibroblast-derived cell group had a higher area of positive alcian blue and safarin O staining(P<0.05)and a lower area of alkaline phosphatase staining(P<0.05),while the pure L6 group had a bigger area of alkaline phosphatase staining(P<0.05)but a smaller area of positive alcian blue and safarin O staining(P<0.05).(2)Transplantation of adeno-associated virus-bone morphogenetic protein 4-adsorbed gelatin sponge into FVB/N-TgN(TIE2-LacZ)182Sato mice resulted in heterotopic ossification.(3)X-gal staining results demonstrated that there was no obvious staining in chondrocytes and differentiated bones and Tie2+ endothelial cells did not participate in the formation of the alienated bone.(4)These findings verify that fibroblasts are the primary source of osteoblasts during the adeno-associated virus-bone morphogenetic protein 4-induced ectopic endochondral ossification in skeletal muscle,but myogenic cells are the main source of osteoblasts.Tie2+ endothelial cells might not be the cell source for cartilage and bone.

Excessive gestational weight gain has already become a global clinical and public health problem that seriously affects maternal health. Excessive gestational weight gain not only increases the cesarean section rate and induces adverse pregnant outcomes, but also affects offspring development and health. This article reviews the effects of excessive weight gain during pregnancy on offspring health and its underlying mechanisms. Excessive gestational weight gain may increase the risk of obesity, cardiovascular diseases, infectious diseases of the respiratory tract, diabetes, polycystic ovary syndrome, mental or psychological illness among offspring, and the pathophysiological mechanisms include inflammatory response, intestinal flora dysbiosis and epigenetics theory. However, further studies are required to validate these hypotheses and to evaluate the effect of excessive weight gain at different gestational stages on offspring health, so as to provide insights into reasonable management of weight gain during pregnancy and improvements of offspring health.

Objective:This paper is to propose a calibration model based on sine function which enables more choices to determine the functional relationship between the absorbance and the concentration of the tested substance.Methods:This paper uses Taylor series expansion and Levenberg-Marquardt to obtain the optimal parameters for the Sine model and then summarizes the characters of the Sine model. On the basis of these characters, this paper compares and evaluates the experimental data processed by the Sine model from four aspects: correctness, precision, linearity and correlation.Results:The generated sine function calibration model achieved deviations within ±3% of the national standard substance, precision ( CV%) less than 2%, and a linear correlation coefficient greater than 0.990 within the measurement range of 32-710 mg/L. The correlation coefficients between the sine model and other well-performing linear calibration models for 104 clinical samples were all greater than 0.990. Conclusions:The performance evaluation of the prealbumin assay kit using the sine function calibration model meets industry standards and shows good correlation with the results of clinical sample measurements. This indicates that the sine function calibration model can serve as a new calibration model for in vitro diagnostic research and clinical applications.

Objective:To explore the clinical value of coronary artery calcification (CAC) detected by chest CT in early screening of coronary atherosclerotic heart disease (CAHD) in civil pilots.Methods:The physical examination data of 2 899 civil pilots were retrospectively analyzed. Pilots were divided into CAHD group and control group based on the results of coronary angiography (CAG). The health data were compared between 2 groups and the clinical value of CAC in the diagnosis of CAHD was analyzed by using binary Logistic regression model and receiver operating characteristic (ROC) curve.Results:Thirty-eight CAHD cases were diagnosed, and the remaining 2 861 were in the control group. Comparing to that of control group, the average age of the pilots in CAHD group was greater ( t=12.09, P<0.001), and the average total flying hours were longer ( Z=-7.68, P<0.001). The proportions of smoking, hyperlipidemia, diabetes, hypertension, fatty liver, obesity, carotid plaques, positive or suspiciously positive in submaximal treadmill exercise test, CAC, as well as the proportions of taking further requested coronary CT angiography and CAG were significantly higher in the CAHD group ( χ2=5.42-1 430.25, P<0.01 or <0.05). Logistic regression model showed that smoking ( OR=2.800, 95% CI: 1.074-7.301, P=0.035), obesity ( OR=3.336,95% CI:1.243-8.956, P=0.017), positive or suspiciously positive in submaximal treadmill exercise test ( OR=17.669, 95% CI: 2.923-106.756, P=0.002) and CAC ( OR=96.039, 95% CI: 11.439-806.396, P<0.001) were the independent risk factors for diagnosing CAHD. The ROC curve results suggested that the sensitivity and specificity of CAC for predicting CAHD was 97.4% and 93.1%, respectively, and the area under the ROC curve was 0.952 ( P<0.001). Conclusions:CAC detected by chest CT in physical examination is helpful for early screening of asymptomatic or atypical CAHD in civil pilots.

Objective:To explore the clinical value of coronary artery calcification (CAC) detected by chest CT in early screening of coronary atherosclerotic heart disease (CAHD) in civil pilots.Methods:The physical examination data of 2 899 civil pilots were retrospectively analyzed. Pilots were divided into CAHD group and control group based on the results of coronary angiography (CAG). The health data were compared between 2 groups and the clinical value of CAC in the diagnosis of CAHD was analyzed by using binary Logistic regression model and receiver operating characteristic (ROC) curve.Results:Thirty-eight CAHD cases were diagnosed, and the remaining 2 861 were in the control group. Comparing to that of control group, the average age of the pilots in CAHD group was greater ( t=12.09, P<0.001), and the average total flying hours were longer ( Z=-7.68, P<0.001). The proportions of smoking, hyperlipidemia, diabetes, hypertension, fatty liver, obesity, carotid plaques, positive or suspiciously positive in submaximal treadmill exercise test, CAC, as well as the proportions of taking further requested coronary CT angiography and CAG were significantly higher in the CAHD group ( χ2=5.42-1 430.25, P<0.01 or <0.05). Logistic regression model showed that smoking ( OR=2.800, 95% CI: 1.074-7.301, P=0.035), obesity ( OR=3.336,95% CI:1.243-8.956, P=0.017), positive or suspiciously positive in submaximal treadmill exercise test ( OR=17.669, 95% CI: 2.923-106.756, P=0.002) and CAC ( OR=96.039, 95% CI: 11.439-806.396, P<0.001) were the independent risk factors for diagnosing CAHD. The ROC curve results suggested that the sensitivity and specificity of CAC for predicting CAHD was 97.4% and 93.1%, respectively, and the area under the ROC curve was 0.952 ( P<0.001). Conclusions:CAC detected by chest CT in physical examination is helpful for early screening of asymptomatic or atypical CAHD in civil pilots.

Kidney transplantation is the most fundamental treatment for patients with end-stage renal disease. However, due to the long-term malnutrition of the patient before transplantation, coupled with the use of stress stimulation, immunosuppressive agents, and high-dose hormones after kidney transplantation, the patient is in a hypermetabolic state, and malnutrition is aggravated. The nutrition status of patients has a significant impact on the prognosis and development of kidney transplantation. Therefore, this article reviews the current status of nutrition intervention, the assessment of malnutrition, the related factors of malnutrition, and nutrition management in kidney transplantation recipients, so as to provide a reference for the nutrition and diet management of kidney transplantation recipients.