ObjectiveTo examine the influencing mechanisms and regional differences in accessible facility utilization behavior among residents in eastern and central-western China. MethodsData were collected through the online questionnaire administered to residents across China using snowball sampling. Descriptive analysis and chi-square tests were conducted to compare the basic characteristics of respondents between the two regions. Welch's t test was used to compare accessible facility utilization behavior and its influencing factors. Multigroup structural equation modeling (SEM) was applied to compare the influencing mechanisms of accessible facility utilization behavior between eastern and central-western China. ResultsA total of 1 039 valid responses were obtained, including 604 from the eastern region and 435 from the central-western region. Residents in eastern regions scored significantly higher than those in central-western regions on both facility-seeking (t = 4.057, P < 0.001) and actual-using (t = 4.551, P < 0.001) behavior. The structural equation models for both regions showed identical and satisfactory goodness-of-fit indices (GFI = 0.950, AGFI = 0.932, IFI = 0.947, CFI = 0.947, RMSEA = 0.028), and all measurement and structural invariance tests met the recommended criteria. Facility configuration showed no significant direct effect on utilization behavior in eastern China, whereas a negative direct effect was observed in central-western China (β = -0.171, P = 0.047), with its influence mainly exerted indirectly through social cognition and user experience. Social cognition and user experience had significant positive effects on utilization behavior (P < 0.001). Meanwhile, social cognition indirectly influences utilization behavior through the mediating path of usage experience. The direct effects of social cognition (β = 0.406) and user experience (β = 0.510) in central-western China were greater than those in eastern China (β = 0.369 and β = 0.335, respectively). The chain mediation effect of "configuration-cognition-experience-behavior" was statistically significant in both regions (P < 0.05), with larger indirect effects observed in central-western China. ConclusionFacility configuration has a limited direct effect on accessible facility utilization, whereas social cognition and user experience play a central role, particularly in central-western China. It is recommended that the construction and renovation of accessible facility be guided by population needs, accompanied by strengthened promotion of accessibility concepts and policies, and that a transition from hardware-oriented construction to service- and management-oriented governance of accessible environments should be promoted in central-western China.

Objective:To analyze the transition patterns of anal sex and unprotected anal intercourse (UAI), estimate the transition intensity and probability, and identify factors influencing the transition patterns in men who have sex with men (MSM) in Shandong Province.Methods:In August 2019, MSM aged ≥18 years old were recruited as subjects from 11 cities in Shandong Province. The baseline survey were completed in December 2019, and followup surveys were conducted once every 3 mouths from June 2020 to March 2021. Time-continuous, state-discrete multi-state reversible Markov model was constructed based on the status of MSM's sexual behaviors with different types of sexual partners [anal sex occurred or not (S1=No, S2=Yes) and UAI occurred or not (S1=No,S2=Yes)] to analyze the transition patterns and the influencing factors.Results:A total of 735 MSM were included. The transition intensity of starting anal sex with stable and casual partners was 1.935 times and 0.595 times higher than that of discontinuing this behavior, respectively. While the transition intensity to start UAI with stable and casual partners was 0.430 times and 0.169 times higher than that of discontinuing it, respectively. During the follow-up, the transition probabilities of anal sex and UAI with both stable and casual partners increased first and then stabilized. For stable partners, the transition probability of starting anal sex was higher than that of discontinuing it at the same period, for casual partners, it was just the reverse. For both stable and casual partners, the transition probabilities of discontinuing UAI were higher than starting it at the same time. The results of multivariate analysis showed that participants who received intervention materials ( HR=1.47), had an associate degree ( HR=1.77) or a bachelor's degree and above ( HR=1.47) were at higher risk of starting anal sex with stable partners. Those who received intervention materials ( HR=1.39) were at higher risk of discontinuing anal sex with stable partners, while participants identified themselves as non-male gender ( HR=0.49) were at lower risk of discontinuing anal sex with stable partners. Participants received intervention materials ( HR=1.75) were at higher risk of starting UAI with stable partners. Those who lived apart, divorced, or widowed ( HR=3.22) were at higher risk of starting UAI with casual partners, whereas had a bachelor's degree and above ( HR=0.58) were at lower risk of starting UAI with casual partners. Participants identified themselves as non-male gender ( HR=0.45) at lower risk of discounting UAI with casual partners. Conclusions:The transition patterns of homosexual behavior in MSM are different. Marital status, gender identity, educational level and other factors are the influencing factors of sexual behavior status transitions. Future researches should develop targeted interventions for different types of sexual partners and characteristics of MSM.

Objective:To analyze the transition patterns of anal sex and unprotected anal intercourse (UAI), estimate the transition intensity and probability, and identify factors influencing the transition patterns in men who have sex with men (MSM) in Shandong Province.Methods:In August 2019, MSM aged ≥18 years old were recruited as subjects from 11 cities in Shandong Province. The baseline survey were completed in December 2019, and followup surveys were conducted once every 3 mouths from June 2020 to March 2021. Time-continuous, state-discrete multi-state reversible Markov model was constructed based on the status of MSM's sexual behaviors with different types of sexual partners [anal sex occurred or not (S1=No, S2=Yes) and UAI occurred or not (S1=No,S2=Yes)] to analyze the transition patterns and the influencing factors.Results:A total of 735 MSM were included. The transition intensity of starting anal sex with stable and casual partners was 1.935 times and 0.595 times higher than that of discontinuing this behavior, respectively. While the transition intensity to start UAI with stable and casual partners was 0.430 times and 0.169 times higher than that of discontinuing it, respectively. During the follow-up, the transition probabilities of anal sex and UAI with both stable and casual partners increased first and then stabilized. For stable partners, the transition probability of starting anal sex was higher than that of discontinuing it at the same period, for casual partners, it was just the reverse. For both stable and casual partners, the transition probabilities of discontinuing UAI were higher than starting it at the same time. The results of multivariate analysis showed that participants who received intervention materials ( HR=1.47), had an associate degree ( HR=1.77) or a bachelor's degree and above ( HR=1.47) were at higher risk of starting anal sex with stable partners. Those who received intervention materials ( HR=1.39) were at higher risk of discontinuing anal sex with stable partners, while participants identified themselves as non-male gender ( HR=0.49) were at lower risk of discontinuing anal sex with stable partners. Participants received intervention materials ( HR=1.75) were at higher risk of starting UAI with stable partners. Those who lived apart, divorced, or widowed ( HR=3.22) were at higher risk of starting UAI with casual partners, whereas had a bachelor's degree and above ( HR=0.58) were at lower risk of starting UAI with casual partners. Participants identified themselves as non-male gender ( HR=0.45) at lower risk of discounting UAI with casual partners. Conclusions:The transition patterns of homosexual behavior in MSM are different. Marital status, gender identity, educational level and other factors are the influencing factors of sexual behavior status transitions. Future researches should develop targeted interventions for different types of sexual partners and characteristics of MSM.

Objective To investigate the correlation between coagulation system biomarkers and bone mineral den-sity(BMD)in patients with spinal degenerative diseases.Methods A total of 251 patients who underwent surgical treatment for spinal degenerative diseases at the Department of Spinal Surgery,Beijing Jishuitan Hospital,from March to October 2019,were enrolled in this study.These patients had both BMD data and coag-ulation system test results available.The distribution of coagulation indicators,including prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),and thrombin time(TT),was analyzed across different gender and BMD groups.Results A retrospective analysis of laboratory coagulation indicators revealed that in male patients,only fibrinogen levels were significantly increased with the reduction of BMD(P＜0.05).PT and APTT did't show significant differences in female patients across BMD groups,but fibrinogen levels increased with the decrease in BMD(P＜0.05).Patients were classified into osteoporosis and non-osteoporosis groups based on their BMD results.Pearson correlation analysis was performed between the binary variable of BMD grouping and patients'coagulation indicators.The results showed a significant negative correlation between BMD grouping and fi-brinogen levels in both genders(P＜0.05).Conclusions Fibrinogen level in patients with spinal degenerative dis-eases significantly increases as BMD decreases,suggesting that fibrinogen may serve as a predictive biomarker for BMD stratification in these patients.

Objective To explore the therapeutic mechanism of maggot for psoriasis-like lesions in mice from the perspective of immune stress and complement activation regulation.Methods Thirty-six male C57BL/6 mice were randomly divided into control group,model group,maggot(1.25%,2.5%,and 5%)groups,and Benvitimod(1%)group.Psoriasis-like lesions were induced by application of imiquimod cream,and the severity of skin lesions was assessed using the modified Psoriasis Area and Severity Index(MPASI)score.Auricular swelling of the mice was observed,and histopathological changes of the skin lesions were examined with HE staining.Scratching behavior of the mice was observed and the spleen index was calculated.Toluidine blue staining was used to detect mast cells in the skin lesions,and serum levels of IgG,IgM,the complements CH50,C1s,C3,C3a,C5 and C5a,and the inflammatory factors IL-23,IL-17A and TNF-α were determined with ELISA.Results In mice with imiquimod-induced psoriasis-like skin lesions,treatment with the maggot at the 3 doses significantly decreased MPASI score,alleviated auricular swelling and pathologies in the skin lesions,reduced scratching behaviors,spleen index,and the number of mast cells in the lesions.Treatment with high-dose maggot significantly lowered serum levels of IgG,C1s,C3a,C5a,IL-23,IL-17A and TNF-α and the levels of C1s,C3,C3a,C5 and C5a in the lesion tissue,and increased serum levels of CH50,C3,and C5.The therapeutic effect of maggot showed a dose-effect dependence.Conclusion Maggot can alleviate psoriasis-like skin lesions in mice by inhibiting immune stress and complement activation.

Objective To explore the therapeutic mechanism of maggot for psoriasis-like lesions in mice from the perspective of immune stress and complement activation regulation.Methods Thirty-six male C57BL/6 mice were randomly divided into control group,model group,maggot(1.25%,2.5%,and 5%)groups,and Benvitimod(1%)group.Psoriasis-like lesions were induced by application of imiquimod cream,and the severity of skin lesions was assessed using the modified Psoriasis Area and Severity Index(MPASI)score.Auricular swelling of the mice was observed,and histopathological changes of the skin lesions were examined with HE staining.Scratching behavior of the mice was observed and the spleen index was calculated.Toluidine blue staining was used to detect mast cells in the skin lesions,and serum levels of IgG,IgM,the complements CH50,C1s,C3,C3a,C5 and C5a,and the inflammatory factors IL-23,IL-17A and TNF-α were determined with ELISA.Results In mice with imiquimod-induced psoriasis-like skin lesions,treatment with the maggot at the 3 doses significantly decreased MPASI score,alleviated auricular swelling and pathologies in the skin lesions,reduced scratching behaviors,spleen index,and the number of mast cells in the lesions.Treatment with high-dose maggot significantly lowered serum levels of IgG,C1s,C3a,C5a,IL-23,IL-17A and TNF-α and the levels of C1s,C3,C3a,C5 and C5a in the lesion tissue,and increased serum levels of CH50,C3,and C5.The therapeutic effect of maggot showed a dose-effect dependence.Conclusion Maggot can alleviate psoriasis-like skin lesions in mice by inhibiting immune stress and complement activation.

Objective To investigate the expression of serum CC chemokine ligand 2(CCL2),CX3C chemokine ligand 1(CX3CL1)and CXC chemokine ligand 10(CXCL10)in postmenopausal osteoporosis(PMOP)patients and the value of combination with fracture risk assessment tool(FRAX)in predicting fracture occurrence.Methods A total of 120 patients with PMOP admitted to Hainan West Central Hospital from January 2022 to June 2023 were selected,and they were divided into fracture group(n=52)and non-fracture group(n=68).According to the FRAX score examination,they were divided into a high-risk fracture group(n=73)and a low-risk fracture group(n=47).The levels of serum CCL2,CX3CL1 and CXCL10 in each group were compared.Multivariate Logistic regression was used to analyze the fracture risk factors in PMOP patients.ROC curve was drawn to analyze the value of CCL2,CX3CL1 and CXCL10 combined with FRAX score in predicting fracture of PMOP.Results The levels of serum CCL2(134.98±32.24 pg/ml),CX3CL1(186.25±41.60 pg/ml)and CXCL10(223.47±56.43 pg/ml)in the fracture group were higher than those in the non-fracture group(82.26±17.30 pg/ml,105.23±23.78 pg/ml,151.47±43.14 pg/ml),and the differences were statistically significant(t=11.503,13.452,7.923,all P＜0.001).The levels of serum CCL2(119.70±37.56 pg/ml),CX3CL1(161.43±53.79 pg/ml)and CXCL10(204.06±61.41pg/ml)in the high-risk group for fractures were higher than those in the low-risk group(82.43±17.23 pg/ml,107.55±24.75 pg/ml,149.45±42.50pg/ml),and the differences were statistically significant(t=6.377,6.436,5.327,all P＜0.001).Multivariate Logistic regression analysis showed that elevated levels of serum CCL2,CX3CL1 and CXCL10 were risk factors for fractures in PMOP patients.The ROC curve showed that the combination of CCL2,CX3CL1 and CXCL10 combined with FRAX scores predicted the highest AUC(95％CI)for PMOP fractures[0.951(0.892～0.993)],with sensitivity and specificity of 98.2％and 85.6％,respectively.Conclusion The increased levels of serum CCL2,CX3CL1 and CXCL10 are risk factors for fracture in PMOP patients,and the combination with FRAX score has a good predictive value for fracture.

Objective:To investigate the diagnostic value of serum CircRNA_0048211 expression level in postmenopausal osteoporosis (PMOP) and its correlation with bone-specific alkaline phosphatase (BALP), osteopontin (OPN), procollagen type I N-terminal propeptide (PINP) and β-crosslaps (β-CTX). Methods:Data of postmenopausal women who underwent physical examination in our hospital from January 2019 to December 2021 were collected. All subjects were measured bone mineral density (BMD) by dual-energy X-ray absorptiometry and divided into PMOP group, decreased bone mass group and normal bone mass group according to BMD level. The serum CircRNA_0048211, BALP, OPN, PINP and β-CTX levels were compared in each group. Binary logistic regression was used to analyze the risk factors of PMOP, the receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic value of CircRNA_0048211, BALP, OPN, PINP and β-CTX on PMOP. The correlation between CircRNA_0048211 expression level and BALP, OPN, PINP and β-CTX was analyzed by Pearson correlation analysis. Results:A total of 218 patients were included in this study. Age is 60.52±6.83 years (range, 47-76 years), body mass index is 24.27±2.28 kg/m 2 (range, 22.18-25.73 kg/m 2) and menopausal time is 10.16±4.25 years (range, 2.30-21.80 years). There were 40 cases in PMOP group, 97 cases in osteopenia group and 81 cases in normal bone mass group. The serum CircRNA_ 0048211, BALP, OPN, PINP and β-CTX was significantly different between PMOP group, osteopenia group and normal group ( F=21.15, P<0.001; F=12.52, P<0.001; F=17.86, P<0.001; F=14.32, P<0.001; F=15.52, P<0.001). The serum CircRNA_0048211 level in PMOP group (0.37±0.08) were significantly lower than that of osteopenia group (1.05±0.46) and normal bone mass group (1.73±0.81), the difference was statistically significant ( P<0.05). The levels of BALP (28.42±7.35 μg/L), OPN (17.28±7.30 ng/ml), PINP (58.40±14.37 ng/ml) and β-CTX (1.52±0.28 μg/L) in PMOP group were significantly higher than those in osteopenia group (22.61±5.93 μg/L, 11.95±5.64 ng/ml, 49.16±11.24 ng/ml, 0.81±0.17 μg/L) and normal bone mass group (16.30±4.18 μg/L, 7.62±3.25 ng/ml, 35.48±7.12 ng/ml, 0.37±0.10 μg/L), the difference was statistically significant ( P<0.05). Binary logistic regression analysis showed that decreased CircRNA_0048211 expression level [ OR=3.53, 95% CI (2.73, 10.32)] was a risk factor for the occurrence of PMOP ( P<0.001). ROC curve showed that CircRNA_0048211≤0.76 has a diagnostic significance on PMOP, and its combination of BALP, OPN, PINP and β-CTX has the highest AUC [0.95, 95% CI (0.89, 1.00)] in diagnosing PMOP. Correlation analysis showed that CircRNA_0048211 expression level were negatively correlated with BALP, OPN, PINP and β-CTX ( r=-0.46, P<0.001; r=-0.80, P<0.001; r=-0.81, P<0.001; r=-0.69, P<0.001). Conclusion:The CircRNA_0048211 showed low expression in PMOP, which was negatively correlated with BALP, OPN, PINP and β-CTX. The combination of these five factors has certain clinical value in the diagnosis of PMOP.

Objective:To evaluate the effect of individualized blood pressure management on postoperative delirium in elderly hypertensive patients undergoing radical resection for gastrointestinal tumor.Methods:One hundred and sixty elderly hypertensive patients of both sexes, aged 60-80 yr, with body mass index of 19-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective radical resection for gastrointestinal tumor under general anesthesia, were divided into 2 groups ( n=80 each) using a random number table method: standardized blood pressure management group (group S) and individualized blood pressure management group (group I). Combined intravenous-inhalational anesthesia was performed, and BIS values were maintained at 40-60 and heart rate at 50-100 times/min during surgery in both groups. In group S, intraoperative systolic blood pressure was maintained above 90 mmHg with a decrease of less than 30% of the baseline value, while intraoperative fluctuation of systolic blood pressure was maintained less than 10% of the baseline value in group I. The use of vasoactive agents, numerical rating scale scores within 3 days after operation, and length of hospital stay were recorded. Postoperative delirium was evaluated by Confusion Assessment Method within 5 days after surgery. Results:Compared with group S, the intraoperative usage rate of norepinephrine was significantly increased, the incidence of postoperative delirium was reduced( P<0.05), and no significant change was found in the numerical rating scale scores and length of hospital stay in group I ( P>0.05). Conclusions:Individualized blood pressure management can reduce the development of postoperative delirium in elderly hypertensive patients undergoing radical resection for gastrointestinal tumor.

Objective: To investigate the diagnostic value of serum complement level and lipid metabolism level detection in senile osteoporosis. Methods: A total of 215 elderly people who underwent physical examination and bone mineral density test in Beijing Jishuitan Hospital from January 2016 to June 2016 were divided into osteoporotic group(74) and non-osteoporotic group (141) according to bone mineral density classification. The relationship between serum complement C3, complement C4, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), triglyceride (TG), total cholesterol (CHO) and bone mineral density were analyzed. The data were analyzed by t-test, non-parametric test, binary Logistic regression and the receiver operating characteristic (ROC) curve. Results: The age and CHO,LDL, HDL, complement C3 and C4 in the osteoporosis group[(80.6±8.2)years, (4.43±1.25)mmol/L, (2.27±0.73) mmol/L, (1.33±0.39) mmol/L, (1.12±0.22) g/L, (0.29±0.09)g/L], were significantly higher than those in the non-osteoporosis group[(77.5±8.3)years,(4.04±1.02)mmol/L,(1.97±0.59)mmol/L,(1.19±0.32)mmol/L,(0.86±0.25)g/L,(0.21±0.06)g/L,t-value were 2.571,-3.848,-4.483,-3.951,-1.249,-1.185,P<0.05], and the the BMI bone mineral density T-Score value of DXA and in the osteoporosis group were significantly lower than those in the non-osteoporosis group[(22.33±3.8)kg/m², -2.74±0.78 and (25.03±4.2)kg/m², 0.14±0.9, while the t value was 6.151 and 4.624, respectively, P<0.05]. The level of TG in osteoporotic group was significantly lower than that in non-osteoporotic group[the median (quartile) was 1.21(0.67,1.44)mmol/L and 1.37(0.86,1.67)mmol/L, respectively, Z=-2.51, P<0.01].Gender and serum levels of HDL, LDL, C3 and C4 were independent risk factors for senile osteoporosis(OR=2.476,P=0.004;OR=1.305,P=0.038;OR=1.564,P=0.028; OR=1.018, P=0.025; OR=1.023, P=0.015, respectively). The risk of osteoporosis in women was 2.476 times higher than that in men of the same age. The corresponding risk of osteoporosis increased by1.305,1.564, 1.018 and 1.023 times as HDL, LDL, C3 and C4 increased by one unit. The areas under the ROC curve detected separately by HDL, LDL, C3 and C4 were 0.623,0.595,0.673 and 0.731 respectively, and the area under the ROC curve of the four items was 0.864. Conclusions The levels of blood lipids and complements play a great role in bone metabolism. The combined detection of blood lipid metabolism and complement can improve the diagnostic efficacy of senile osteoporosis.