Background Chronic non-communicable diseases, including hypertension, have become major threats to urban public health. The built environment has been linked to blood pressure. Objective To examine joint exposure patterns of built environment factors in relation to residents' blood pressure status and to identify environmental profiles of neighborhoods that may be favorable or unfavorable to hypertension prevention. Methods (1) A cross-sectional study was conducted among 1910 residents in Longzihu District, Bengbu City. Demographic characteristics, clinical indicators (including blood pressure), and lifestyle behavioral data were collected. Nine built environment indicators were derived within a 500-meter buffer zone surrounding each participant's residential address. (2) Using elevated blood pressure status as a binary outcome (all residents) and grade of elevated blood pressure as an ordinal multi-class outcome (residents with elevated blood pressure), the predictive performance of four binary classification models and nine multi-class classification models was compared, respectively. Feature importance was ranked based on the best-performing model. Multi-variable logistic regression with stepwise adjustment was then used to identify key environmental factors. (3) Using partial dependence plots, a joint exposure analysis was conducted in the target population of residents with elevated blood pressure (high-normal blood pressure and hypertension grades 1–3), with the 25th and 75th percentiles of key environmental factors as the low- and high-level thresholds, respectively. The 95% confidence intervals were estimated using the Bootstrap method. Results (1) Among the study participants, 863 had elevated blood pressure: 349 (40.4%) had high-normal blood pressure, and 398 (46.1%), 93 (10.8%), and 23 (2.7%) had hypertension grades 1, 2, and 3, respectively. (2) Logistic regression showed the best performance in analyzing the association between built environment factors and elevated blood pressure status (n=1910), whereas random forest showed the best performance in analyzing the association between built environment factors and grade of elevated blood pressure (n=863). Road density, bus stop density, and hospital/clinic density were key environmental factors. (3) Pairwise joint exposure patterns were observed among the three key environmental factors: When any two were both below the low-level thresholds (road ≤0.54 km·km⁻², bus stop ≤0.51 points·km⁻², hospital ≤5.99 points·km⁻²), the risk of a higher grade of elevated blood pressure was greater than the overall sample average (relative predicted odds 1.29–1.31, 95% confidence interval lower bound >1); when any two were both above the high-level thresholds (road ≥0.75 km·km⁻², bus stop ≥1.25 points·km⁻², hospital ≥15.00 points·km⁻²), the risk was lower than the overall sample average (relative predicted odds 0.54–0.61, 95% confidence interval upper bound <1); low-high and high-low combinations did not differ significantly from the overall sample average (P > 0.05). Conclusion Joint exposure profiles characterized by road density, bus stop density, and hospital/clinic density are associated with elevated blood pressure among residents: Simultaneously low levels of any two of these environmental indicators are associated with a higher predicted risk of a more severe grade, whereas simultaneously high levels are associated with a lower predicted risk. These findings suggest that coordinated configurations of road networks, public transit accessibility, and medical service facilities may represent important environmental feature of neighborhoods favorable to hypertension prevention and control.

Objective: To investigate the influencing factors for sarcopenia among the elderly, so as to provide the evidence for developing prevention and control strategies for sarcopenia among the elderly. Methods: From April 2023 to October 2025, a multi-stage stratified cluster sampling method was used to select elderly individuals aged ≥60 years in Shaoxing City, Zhejiang Province as survey participants. Demographic information, lifestyle behaviors, and indicators including height, weight, and waist circumference were collected through questionnaire surveys and physical examinations, and body mass index (BMI) was calculated. Appendicular skeletal muscle mass was measured using bioelectrical impedance analysis, and the appendicular skeletal muscle mass index was calculated. Muscle strength and physical function were assessed using handgrip strength test and 6-meter gait speed test. Sarcopenia was diagnosed according to the 2019 Asian Working Group for Sarcopenia Consensus on Diagnosis and Treatment. Factors affecting sarcopenia among the elderly were analyzed using a multivariable logistic regression model. Results: A total of 4 095 elderly individuals were surveyed, with a mean age of (71.17±6.89) years. There were 1 773 males (43.30%) and 2 322 females (56.70%). Sarcopenia was detected in 539 cases, with a prevalence of 13.16% (95%CI: 12.13%-14.20%). Multivariable logistic regression analysis showed that elderly individuals aged ≥70 years (70-<80 years, OR=2.709, 95%CI: 2.069-3.547; 80-<90 years, OR=10.574, 95%CI: 7.615-14.681; ≥90 years, OR=16.729, 95%CI: 6.681-41.887), those with underweight (OR=5.239, 95%CI: 3.394-8.807), and those who did not consume meat and poultry daily (OR=7.739, 95%CI: 5.871-10.202) had a higher risk of sarcopenia. Conversely, the elderly with overweight or obesity (OR=0.071, 95%CI: 0.050-0.100) had a lower risk of sarcopenia. Conclusions The risk of sarcopenia among the elderly was associated with age, BMI, and meat and poultry intake. For the elderly with advanced age or low BMI, optimizing dietary patterns and promoting appropriate physical activity are recommended.

The present study aims to screen and evaluate the early clinical predictors for type 2 diabetes mellitus (T2DM) patients with mild cognitive impairment (MCI) and dementia in Hunan province. A cross-sectional study was conducted from May 2023 to October 2023 to collect data on long-term T2DM patients who settled in Hunan province and were treated in the Department of Geriatrology at Xiangya Hospital of Central South University. The patients were grouped according to the Montreal Cognitive Assessment (MoCA) scale. Basic patient information and multiple serum markers were collected, and differences between groups were compared using one-way ANOVA or Kruskal-Wallis (KW) tests. The multivariate logistic regression analysis was utilized to assess risk factors and Nomogram models were constructed. The logistic regression analysis showed that years of education and serum levels of 1, 5-AG were related factors for the progression of T2DM to T2DM with MCI, and body weight, years of education and FPN levels affected the progression of T2DM with MCI to T2DM with dementia. Based on this, two Nomogram risk prediction models were established. The area under the curve (AUC) of the Nomogram model predicting T2DM progression to T2DM combined with MCI was 0.741, and the AUC of the Nomogram model predicting T2DM combined with MCI progression to T2DM combined with dementia was 0.734. The calibration curves (DCA) of the two models in the training and validation sets were symmetrically distributed near the diagonal line, indicating that the models in the training and validation sets could match each other. In summary, body weight, years of education, and serum HDL-3, FPN, and 1, 5-AG levels are associated with the development of MCI and dementia in T2DM patients. The Nomogram models constructed based on these factors can predict the risk of MCI and dementia in T2DM patients, providing a basis for clinical decision-making.

The present study aims to screen and evaluate the early clinical predictors for type 2 diabetes mellitus (T2DM) patients with mild cognitive impairment (MCI) and dementia in Hunan province. A cross-sectional study was conducted from May 2023 to October 2023 to collect data on long-term T2DM patients who settled in Hunan province and were treated in the Department of Geriatrology at Xiangya Hospital of Central South University. The patients were grouped according to the Montreal Cognitive Assessment (MoCA) scale. Basic patient information and multiple serum markers were collected, and differences between groups were compared using one-way ANOVA or Kruskal-Wallis (KW) tests. The multivariate logistic regression analysis was utilized to assess risk factors and Nomogram models were constructed. The logistic regression analysis showed that years of education and serum levels of 1, 5-AG were related factors for the progression of T2DM to T2DM with MCI, and body weight, years of education and FPN levels affected the progression of T2DM with MCI to T2DM with dementia. Based on this, two Nomogram risk prediction models were established. The area under the curve (AUC) of the Nomogram model predicting T2DM progression to T2DM combined with MCI was 0.741, and the AUC of the Nomogram model predicting T2DM combined with MCI progression to T2DM combined with dementia was 0.734. The calibration curves (DCA) of the two models in the training and validation sets were symmetrically distributed near the diagonal line, indicating that the models in the training and validation sets could match each other. In summary, body weight, years of education, and serum HDL-3, FPN, and 1, 5-AG levels are associated with the development of MCI and dementia in T2DM patients. The Nomogram models constructed based on these factors can predict the risk of MCI and dementia in T2DM patients, providing a basis for clinical decision-making.

Objective: To investigate the situation of road traffic injuries (RTIs) among middle school students in Shaoxing City, Zhejiang Province, so as to provide the basis for implementation of interventions against RTIs among students. Methods: From 2021 to 2023, a multi-stage stratified cluster sampling method was used to select 82 junior high school classes and 89 senior high school classes in Shaoxing City as the survey population. Data on basic information, commuting travel, road safety behaviors and road safety knowledge awareness were collected through questionnaires, and the prevalence of RTIs in the past year was analyzed. Results: A total of 6 287 middle school students were surveyed, and 971 cases of RTIs were reported, with a reporting rate of 15.44%. The reporting rate of RTIs was higher in males than in females (17.68% vs. 13.34%, P<0.05). The reporting rate of RTIs was higher in high school students than in junior high school students (17.70% vs. 12.66%, P<0.05). The students who mainly walked to school (18.00%), walked 5 days a week (17.82%) and traveled with classmates (17.58%) had higher reporting rates of RTIs. Among those who walked for ≥20 minutes, the reporting rate of RTIs was higher in males than in females (P<0.05). Among different road safety behaviors, the reporting rate of RTIs was higher in males than in females who used electronic devices (P<0.05). The reporting rates of RTIs were relatively high among students who played for ≥10 minutes on the way (32.92%), crossed traffic lights directly when being late for school (41.54%) and crossed traffic barriers directly (30.67%). The reporting rate of RTIs among middle school students decreased with the increase of road safety knowledge scores (P<0.05). Conclusions Male students, high school students, students with road risky behaviors and with low awareness of road safety knowledge have higher reporting rates of RTIs. It is necessary to strengthen road safety knowledge education for students.

Objective: To investigate sleep quality among patients with hypertension and diabetes, so as to provide the basis for improving the health of patients with chronic diseases. Methods: From May to August 2022, patients with hypertension and diabetes under the community management in 4 counties and cities (districts) of Shaoxing City, Zhejiang Province were recruited using a multi-stage stratified cluster random sampling method. Demographic information, disease history, smoking, alcohol consumption, physical activity and sleep quality were collected by questionnaire surveys, and blood pressure, fasting blood glucose and glycosylated hemoglobin were collected through physical examination and laboratory testing. The incidence of poor sleep quality symptoms (snoring/asphyxia/suffocation, difficulty falling asleep, night awakening, taking sleeping pills and early morning awakening) in patients with diabetes and hypertension was descriptively analyzed, and sleep quality was evaluated. Results: A total of 1 539 patients with hypertension and diabetes were surveyed, including 715 males (46.46%) and 824 females (53.54%). The patients had a mean age of (68.68±7.62) years. The proportions of night awakening, early morning awakening, snoring/asphyxia/suffocation, difficulty falling asleep and taking sleeping pills were 29.82%, 28.53%, 20.73%, 15.79% and 4.29%, respectively. The proportion of poor sleep quality was 66.54%. Employment status, smoking status, moderate/high intensity physical activity and blood pressure control were related to poor sleep quality (all P<0.05). Conclusion Poor sleep quality is common in patients with hypertension and diabetes, with the main symptoms being night awakening, early morning awakening, difficulty falling asleep and snoring/asphyxia/suffocation.

Objective: To investigate the clustering of risk factors among populations at high risk of cardiovascular diseases in Shaoxing City, Zhejiang Province, so as to provide the evidence for formulating the cardiovascular disease control measures among populations at high risk of cardiovascular diseases. Methods: The populations with hypertension, diabetes, dyslipidemia and a history of cardio-cerebrovascular disease at ages of 35 to 70 years were sampled from 6 districts (counties) of Shaoxing City using a multi-stage cluster random sampling method from May to July 2021. Participants' demographics, history of disease, smoking, alcohol consumption and drug use were collected through questionnaires, and height, body weight and blood lipid were measured. The participants at high risk of cardiovascular diseases were enrolled, and the prevalence and clustering of five risk factors were investigated, including current smoking, current alcohol consumption, overweight/obesity, never exercise and daily sedentary duration of 3 hours and longer. Factors affecting the clustering of risk factors were identified with an ordinal logistic regression model. Results: Totally 1 695 participants were enrolled, including 940 men (55.46%) and 755 women (44.54%), with a mean age of (62.56±6.08) years old. There were 213 participants with a history of cardio-cerebrovascular disease (12.57%), and the prevalence of hypertension, diabetes and dyslipidemia was 78.53%, 61.95% and 46.78%, respectively, and there were 32.63% of participants with current smoking, 35.99% with current alcohol consumption, 49.38% with overweight/obesity, 62.12% with never exercise and 61.24% with daily sedentary duration of 3 hours and longer, respectively. There were 28.85% of participants with two risk factors, and 46.90% with three to five risk factors. Ordinal logistic regression analysis showed that male (OR=5.430, 95%CI: 4.389-6.726), and development of hypertension (OR=1.655, 95%CI: 1.313-2.090) led to present more numbers of clustering of risk factors, and annual household income of 20 000 to 50 000 Yuan (OR=0.620, 95%CI: 0.473-0.812), a history of cardio-cerebrovascular diseases (OR=0.430, 95%CI: 0.324-0.572), presence of diabetes (OR=0.592, 95%CI: 0.476-0.736) led to less numbers of clustering of risk factors among populations at high risk of cardiovascular diseases. Conclusions There is clustering of risk factors among populations at high risk of cardiovascular diseases in Shaoxing City. Men, income, history of cardio-cerebrovascular diseases, hypertension and diabetes are factors affecting the clustering of risk factors.

Objective To compare the biomechanical effects of contiguous three-level cervical Hybrid surgery[anterior cervical discectomy and fusion (ACDF) + cervical disc arthroplasty ( CDA)] and three-level ACDF. Methods The finite element model of C1-T1 cervical-thoracic spine was developed based on CT data. Three models were simulated by the implantation of Prestige LP and Zero-P prostheses, including two Hybrid models (AFA, Prestige LP implanted at C3-4 and C5-6 segments and Zero-P implanted at C4-5 segment; FAF, Zero-P implanted at C3-4 and C5-6 segments and Prestige LP implanted at C4-5 segment) and three-level ACDF model(FFF). The changes in range of motion (ROM) of adjacent levels during flexion, extension, lateral bending and axial rotation, the overall ROM, as well as the intradiscal pressure ( IDP) and facet contact force ( FCF) of adjacent levels were compared. Results The ROM in adjacent levels and the overall ROM of the AFA modelwere closer to the intact model, and the maximum increases in the ROM of the adjacent levels for the FAF and FFF models were 15. 0% and 23. 4% , respectively. For AFA, FAF and FFF models, the maximum increases in the maximum IDP of adjacent levels were 19. 0% , 66. 7% , 147. 6% , and the maximum increases in FCF were 17. 4% , 55. 7% , 80. 1% , respectively. Conclusions This study provides biomechanical basis for three-level cervical Hybrid surgery in treating patients with the contiguous three-level cervical degenerative disc disease.

Objective:To investigate the effects of myeloid differentiation protein-2 (MD-2) on paclitaxel resistance cells in triple negative breast cancer (TNBC) through EGFR signaling pathway.Methods:Immunohistochemical method was used to detect the expression of MD-2 in cancer tissue and adjacent tissue of TNBC patients, and the relationship between MD-2 expression and clinicopathological parameters of patients was analyzed. The TNBC paclitaxel-resistant cell line was constructed and MD-2 expression in cells was interfered. Cell invasion was detected by Transwell, and cell apoptosis was detected by flow cytometry. The signaling pathways regulated by MD-2 were screened by transcriptome sequencing and verified by Western blot.Results:The expression of MD-2 was significantly enhanced in cancer tissues relative to adjacent tissues. High expression of MD-2 was closely related to clinical stage, tumor size, tumor recurrence and metastasis ( χ2=4.50, P=0.032; χ2=2.55, P=0.011; χ2=4.40, P=0.036). In cell experiments, compared with normal breast cells, the expression of MD-2 in TNBC cell lines was significantly enhanced. Compared with sh-NC group (100±11.52) (6.81±0.57), knockdown of MD-2 could inhibit the invasion (61.44±6.78) ( t=4.99, P=0.008) but promote apoptosis (15.19±1.06) ( t=12.06, P<0.001) of paclitaxel resistant TNBC cells. Transcriptome sequencing and Western blot results showed that MD-2 mainly affects the biological behavior of TNBC cells by regulating the EGFR signaling pathway. Conclusions:MD-2 promoted TNBC cell invasion and paclitaxel resistance, which may be achieved by affecting the EGFR signaling pathway. MD-2 is expected to become an effective target in TNBC treatment.

Objective:To investigate the effect of single-port laparoscopy and conventional laparoscopic surgery in ovarian cystectomy.Methods:The clinical data of 139 patients with laparoscopic surgery for ovarian cyst admitted to the same department of gynecology from December 2016 to December 2019 in Suzhou Hospital Affiliated of Anhui Medical University were retrospectively analyzed, and they were divided into single-port laparoscopic surgery group (62 cases) and conventional laparoscopic surgery group (77 cases) according to different surgical methods. The clinical indictors, the levels of estrogen, T lymphocyte subgroups, the complications rate and incision satisfaction rate between two groups were compared.Results:The operation in both groups was smooth and there was no conversion to open surgery. Compared with the conventional laparoscopic surgery group, the surgery time, intraoperative blood loss in single-port laparoscopic surgery group were higher, the hospital stays in single-port laparoscopic surgery group was shorter, but there were no significant differences ( P>0.05). The levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E 2) in two groups before operation had no significant differences ( P>0.05). At 30 d after operation, the levels of FSH, LH and E 2 in single-port laparoscopic surgery group were higher than those in conventional laparoscopic surgery group, but the differences were no statistically significant ( P>0.05). Before operation, the levels of CD 4+, CD 8+ and CD 4+/CD 8+ in two groups has no significant differences ( P>0.05). At 3 d after operation, the levels of CD 4+, CD 8+ and CD 4+/CD 8+ in single-port laparoscopic surgery group were higher than those in conventional laparoscopic surgery group: 0.51 ± 0.03 vs. 0.47 ± 0.02, 0.41 ± 0.23 vs. 0.39 ± 0.05, 1.36 ± 0.02 vs. 1.24 ± 0.02, and the differences were statistically significant ( P<0.05). The rate of complication in two groups had no significant difference ( P>0.05). At 3 d after operation, the scores of visual analogue scale (VAS) of pain in single-port laparoscopic surgery group were lower than that in conventional laparoscopic surgery group: (1.12 ± 0.21) scores vs. (3.56 ± 0.65) scores, and the difference was statistically significant ( P<0.05). The incision satisfaction rate in single-port laparoscopic surgery group was significantly higher than that in conventional laparoscopic surgery group: 90.32%(56/62) vs. 72.73%(56/77), and the difference was statistically significant ( P<0.05). Conclusions:Single-port laparoscopy can be safely and smoothly implemented in ovarian cystectomy, and can reduce postoperative pain, improve cell immunity, and have better cosmetic result.