OBJECTIVE: This study aimed to explore the association between body mass index (BMI) and mortality based on the 10-year population-based multicenter prospective study. METHODS: A general population-based multicenter prospective study was conducted at four sites in rural China between 2013 and 2023. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to assess the association between BMI and mortality. Stratified analyses were performed based on the individual characteristics of the participants. RESULTS: Overall, 19,107 participants with a sum of 163,095 person-years were included and 1,910 participants died. The underweight (< 18.5 kg/m ²) presented an increase in all-cause mortality (adjusted hazards ratio [ aHR] = 2.00, 95% confidence interval [ CI]: 1.66-2.41), while overweight (≥ 24.0 to < 28.0 kg/m ²) and obesity (≥ 28.0 kg/m ²) presented a decrease with an aHR of 0.61 (95% CI: 0.52-0.73) and 0.51 (95% CI: 0.37-0.70), respectively. Overweight ( aHR = 0.76, 95% CI: 0.67-0.86) and mild obesity ( aHR = 0.72, 95% CI: 0.59-0.87) had a positive impact on mortality in people older than 60 years. All-cause mortality decreased rapidly until reaching a BMI of 25.7 kg/m ² ( aHR = 0.95, 95% CI: 0.92-0.98) and increased slightly above that value, indicating a U-shaped association. The beneficial impact of being overweight on mortality was robust in most subgroups and sensitivity analyses. CONCLUSION This study provides additional evidence that overweight and mild obesity may be inversely related to the risk of death in individuals older than 60 years. Therefore, it is essential to consider age differences when formulating health and weight management strategies.
Humans ; Body Mass Index ; China/epidemiology* ; Male ; Female ; Middle Aged ; Prospective Studies ; Rural Population/statistics & numerical data* ; Aged ; Follow-Up Studies ; Adult ; Mortality ; Cause of Death ; Obesity/mortality* ; Overweight/mortality*

Soil cadmium (Cd) pollution is one of the major environmental problems globally. Ophiopogon japonicus, a multifunctional plant extensively used in traditional Chinese medicine, has demonstrated potential in environmental remediation. This study investigated the Cd accumulation pattern of O. japonicus under cadmium stress and identified the heavy metal ATPase (HMA) family members in this plant. Our results demonstrated that O. japonicus exhibited a Cd enrichment factor (EF) of 2.75, demonstrating strong potential for soil Cd pollution remediation. Nine heavy metal ATPase (HMA) members of P1B-ATPases were successfully identified from the transcriptome data of O. japonicus, with OjHMA1-OjHMA6 classified as the Zn/Co/Cd/Pb-ATPases and OjHMA7-OjHMA9 as the Cu/Ag-ATPases. The expression levels of OjHMA1, OjHMA2, OjHMA3, and OjHMA7 were significantly up-regulated under Cd stress, highlighting their crucial roles in cadmium ion absorption and transport. The topological analysis revealed that these proteins possessed characteristic transmembrane (TM) segments of the family, along with functional A, P, and N domains involved in regulating ion absorption and release. Metal ion-binding sites (M4, M5, and M6) existed on the TM segments. Based on the number of transmembrane domains and the residues at metal ion-binding sites, the plant HMA family members were categorized into three subgroups: P1B-1 ATPases, P1B-2 ATPases, and P1B-4 ATPases. Specifically, the P1B-1 ATPase subgroup included the motifs TM4(CPC), TM5(YN[X]₄P), and TM6(M[XX]SS); the P1B-2 ATPase subgroup featured the motifs TM4(CPC), TM5(K), and TM6(DKTGT); the P1B-4 ATPase subgroup contained the motifs TM4(SPC) and TM6(HE[X]GT), all of which were critical for protein functions. Molecular docking results revealed the importance of conserved sequences such as CPC/SPC, DKTGT, and HE[X]GT in metal ion coordination and stabilization. These findings provide potential molecular targets for enhancing Cd uptake and tolerance of O. japonicus by genetic engineering and lay a theoretical foundation for developing new cultivars with high Cd accumulation capacity.
Cadmium/metabolism* ; Adenosine Triphosphatases/metabolism* ; Ophiopogon/drug effects* ; Soil Pollutants/toxicity* ; Plant Proteins/metabolism* ; Stress, Physiological ; Multigene Family ; Gene Expression Regulation, Plant

Objective To investigate the key factors influencing the implementation of long-acting injection-promoting policies and propose effective improving paths.Methods Qualitative interviews were carried out for stakeholders involved in the promotion of long-acting injections,based on the consolidated framework for implementation research.Additionally,countermeasures for identified barriers were proposed based on expert recommendations for implementation changes.Results A total of 46 health administrators,healthcare workers,and patients in Beijing were interviewed.The study identified several barriers in the strength and quality of evidence,adaptability,relative advantage,complexity and cost,patient needs and resources,external collaboration,external policies and incentives,organizational structural characteristics,and self-efficacy.Conclusions From the perspectives and experiences of stakeholders,the promotion of long-acting injections has shown initial success but still faces multiple obstacles.It is recommended that efforts should be made to coordinate and adapt policies,improve and incentivize relative organizations,and continuously strengthen the advocacy and education for individuals.
Humans ; Beijing ; Delayed-Action Preparations ; Health Personnel ; Health Policy ; Injections

Objective To gain insights into the care service preferences and willingness of patients with severe mental disorders in Beijing,analyze the main factors affecting their participation in care services,and provide data support and decision-making reference for the optimal design of care services for patients with severe mental disorders and the improvement of relevant policies.Methods In July 2022,a questionnaire survey was conducted for a part of Beijing community patients with severe mental disorders selected by multi-stage stratified sampling,including the basic personal information and the preferences of discrete choice experiment.A mixed Logit model was used to perform regression analysis on the care service preferences,and the trade off between general and monetary attributes was quantified by willingness to pay(WTP).Results A total of 242 questionnaires were distributed,and 181 valid questionnaires were collected,with a response rate of 74.79%.The regression coefficients for the four attributes-service type,service content,service frequency,and service cost-all showed statistical significance(all P<0.05).Patients' most preferred attribute level was a service frequency covering about 90% of the time per month/year( β=1.059),while the least preferred was full-time residential care( β=-1.025).Increasing the service frequency from 30% to 90% corresponded to a WTP of 492.5 yuan,while changing the service type from home-based care to full-time residential care resulted in a WTP of -476.6 yuan.Moreover,there were differences in care service preferences and WTP among patient groups with different characteristics(all P<0.05).Conclusions Service type,service content,service frequency,and service cost all significantly affect the care service preferences of patients with severe mental disorders.There is heterogeneity in care service preferences among patient groups with different characteristics.
Humans ; Mental Disorders/therapy* ; Patient Preference ; Beijing ; Surveys and Questionnaires ; Male ; Female ; Choice Behavior ; Adult ; Middle Aged

Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Objective:To examine the effect of antidepressant treatment on the longitudinal depressive burden in patients with bipolar depression.Methods:Subjects were recruited from a national multicenter, naturalistic observational project: Comprehensive Assessment and Follow-up Descriptive Study on Bipolar Disorder study (CAFE-BD). A total of 110 patients with bipolar depression (51 males, 59 females; aged 18-64 years, mean age 34.4±11.1 years) were consecutively enrolled between January 2012 and December 2013 from outpatients and inpatients of nine medical institutions, including six psychiatric hospitals and three general hospitals. Based on the use of antidepressants as defined in this study, patients were classified into a medicated group (Ads, n=74) and a non-medicated group (nAds, n=36). Diagnosis of bipolar depression was confirmed using the MINI (Chinese version), and baseline and follow-up assessments were conducted using the Assessment of Mood Disorders Evaluation (ADE) and the Clinical Monitoring Form (CMF). Depression burden indicators, including aggregate depression scores (SUM-D), number of depressive symptoms (NUM-D), and total depression burden, were compared between the Ads group and nAds group at mid-term (the 6 th month) and endpoint (the 12 nd month). Longitudinal changes in these indicators were also analyzed. Results:The proportion of bipolar depressive patients on antidepressants was 67% (74/110). Among them, 85% (63/74) were taking antidepressants at baseline; this dropped to 76% (56/74) at mid-term, and 64% (47/74) at the endpoint. SUM-D were higher in the Ads group than in the nAds group at baseline (9 (6.5, 11) vs 7.38 (5.5, 9.0); W=1 712.00, P=0.015), and there was no statistically significant difference in NUM-D and total depressive burden between two groups at any time points ( P>0.05). Compared to baseline, the Ads group had significantly lower SUM-D (0.5 (0, 1), 1.33 (0.5, 2.5) vs. 9 (6.5, 11); W=2 770.00, 2 743.00), NUM-D (0 (0, 0), 0 (0, 1) vs. 7 (5, 8); W=2 621.00, 2 601.50) and total depressive burden (c 2=64.36, 59.00) at both mid-term and endpoint (all P<0.001); While SUM-D (0.59 (0.4, 0.7), 1 (0.8, 2.5) vs. 7.38 (5.5, 9.0); W=664.50, W=666.00), NUM-D (0 (0, 0), 0 (0, 1) vs. 6 (4, 7); W=527.00, 528.00) and total depression burden ( χ 2=31.00, 31.00) in the nAds group were also significantly decreased at both mid-term and endpoint (all P<0.001). There were no statistically significant differences in the changes in depression burden indicators between the two groups from baseline to mid-follow-up or endpoint, nor from mid-follow-up to endpoint ( P>0.05). Conclusion:In a 12-month real-world naturalistic follow-up study, both medicated and non-medicated bipolar depression groups experienced significant and similar reductions in depression burden.

Objective:To investigate the clinical characteristics and independent risk factors of severe disease in patients with anti-nuclear matrix protein (NXP) 2 antibody-positive juvenile dermatomyositis (JDM).Methods:A retrospective cohort study was conducted, including 219 anti-NXP2 antibody-positive JDM patients admitted to 23 children′s hospitals across China from July 2011 to July 2023. Patients were classified into severe and non-severe groups based on classification criteria for severe dermatomyositis. Demographic characteristics, clinical manifestations, and laboratory parameters were compared between the 2 groups using independent sample t-test, Mann-Whitney U test, or χ2 test. Univariate and multivariate Logistic regression analyses were performed to identify risk factors for severe disease. The receiver operating characteristic curve was employed to calculate optimal cut-off values. Results:Among the 219 patients, 108 were male and 111 were female, with an age at onset of 6.3 (3.5, 9.4) years. The severe group comprised 69 patients, and the non-severe group 150 patients. The severe group had significantly higher rates of fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, as well as elevated levels of ferritin-to-albumin ratio (FAR), creatine kinase (CK), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) (all P<0.05). Multivariate analysis identified anti-Ro52 antibody positivity ( OR=13.26, 95% CI 1.37-128.29) and elevated FAR ( OR=1.90, 95% CI 1.09-2.31) as independent risk factors for severe anti-NXP2 antibody-positive JDM (both P<0.05). Receiver operating characteristic curve analysis revealed that a FAR cutoff value of 6.82 predicted severe disease with an area under the curve of 0.87 (95% CI 0.81-0.94, P<0.001), sensitivity of 0.85, and specificity of 0.70. All patients received glucocorticoid therapy, and the severe group received higher proportions of steroid pulse therapy, cyclophosphamide, mycophenolate mofetil, intravenous immunoglobulin, biologics, and adjuvant treatments compared to the non-severe group (all P<0.05). In terms of outcomes, 2 patients (2.9%) in the severe group died (due to neurological involvement and intestinal perforation, respectively), while the remaining patients achieved complete clinical response or remission. All patients in the non-severe group achieved remission. Conclusions:The primary clinical features of anti-NXP2 antibody-positive JDM included fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, and elevated levels of CK, AST, LDH, and FAR. Furthermore, anti-Ro52 antibody positivity and a FAR>6.82 were identified as independent risk factors.

Objective:To compare the anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) in the sagittal plane reconstruction for unstable Hangman fractures.Methods:A retrospective study was conducted to analyze the clinical data of 43 patients who had been surgically treated at Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital for unstable Hangman fractures from January 2007 to December 2022. There were 32 males and 11 females aged (47.9±14.2) years. They were divided into 2 groups according to their surgical methods: an anterior group of 23 cases who were subjected to ACDF and a posterior group of 20 cases who were subjected to PCE. The 2 groups were compared in terms of operation time, intraoperative bleeding, hospitalization time, and the C 2 subluxation, occipitocervical angle, C 2-C 3 angle, cervical lordosis (CL), and cervical sagittal vertical axis (cSVA) measured on the lateral cervical spine X-rays over the time points of hospital admission, immediate postoperation, and the final follow-up, as well as in terms of the visual analog scale (VAS) for pain and neck disability index (NDI) over the time points of hospital admission and the final follow-up. The American Spinal Injury Association (ASIA) classification was used to assess the neurological status of the patients before surgery and at the final follow-up, and complications were documented. Results:The differences in preoperative general data between the 2 groups were not statistically significant, indicating comparability ( P>0.05). The operation time [(90.3±13.6) min] and hospitalization time [(13.1±2.4) d] in the anterior group were significantly shorter than those in the posterior group [(153.9±26.1) min and (18.5±1.9) d], and the intraoperative bleeding volume in the anterior group [(57.2±15.9) mL] was significantly less than that in the posterior group [(123.2±22.5) mL] ( P<0.05). Compared with the preoperative period in both groups, the C 2 subluxation and C 2-C 3 angle were significantly corrected at immediate postoperation, and well maintained at the final follow-up. The C 2-C 3 angle was significantly better corrected in the anterior group than in the posterior group at immediate postoperation and the final follow-up. The VAS scores and NDI at the final follow-up in both groups were significantly lower than those at admission ( P<0.05), while the differences between the 2 groups were not statistically significant ( P>0.05). Four cases in the anterior group and 2 cases in the posterior group all had their preoperative ASIA grade D improved to grade E at the final follow-up. Three patients in the anterior group developed postoperative hoarseness, which returned to normal at the 3-month follow-up. There was no hoarseness or dysphagia at the final follow-up. Both groups achieved fine fusion at the final follow-up, showing no complications like loosening or fracture of internal fixation. Conclusion:In the sagittal plane reconstruction for unstable Hangman fractures, both ACDF and PCF can lead to satisfactory clinical and radiological outcomes, but the former shows a significant advantage in reconstruction of C 2-C 3 lordosis.

With the rapid development of the healthcare industry and the deepening implementation of the Healthy China strategy,high-quality development has become the core goal of China's healthcare service system construction.As an important component of the healthcare service system,research-oriented hospitals undertake multiple missions such as technological innovation,clinical translation,and talent cultivation.A team of communication experts and lead authors jointly participated in the compilation of the expert group's related expert team to comprehensively analyze the current development status,existing problems,and future directions of research-oriented hospitals in China.After inviting well-known experts in hospital management from across the country to discuss and exchange ideas,it proposed a consensus on the construction mode and path of research-oriented hospitals in China under high-quality development,aiming to further guide and standardize the current construction work of research-oriented hospitals in China,and provide reference for the formulation and practice of relevant policies at the national and provincial levels.