Osteosarcopenia(OS) is the coexistence of sarcopenia(SP) and osteoporosis(OP). SP is a decrease in the number and strength of muscle fibers, causing impaired skeletal muscle function, and OP manifests itself as bone loss, decreased density, and degradation of bone microarchitecture. Mechanical loading is an important factor in maintaining the skeletal muscle-skeletal units in the interaction between skeletal muscle and bone. Increased muscle mass promotes bone growth and development and improves bone density and strength. As we age, skeletal muscle mass progressively decreases, leading to reduced skeletal loading which triggers wasting atrophy of the skeleton. Hormonal imbalance, chronic inflammation, oxidative stress, imbalance between protein degradation and synthesis, decreased physical activity and malnutrition are all closely associated with the development of OS. Interleukin(IL)-6 and tumor necrosis factor α(TNF-α)are important regulators of bone metabolism, and their elevated levels are negatively correlated with bone mineral density. IL-6 and TNF-α also inhibit protein synthesis in muscle by interfering with PI3K/Akt signaling pathways. NOD-like receptor protein 3(NLRP3) causes up-regulation of the NF-κB(nuclear factor-kappa B) pathway by activating damage-related molecules, and NLRP3 recruits pro-Caspase-1 to promote the release of IL-1β and IL-18, leading to increased chronic inflammation and inducing OS. The interdependence between skeletal muscle and bone and the interaction of multiple biological factors combine to contribute to the development of OS. As global aging increases, the incidence of OS will continue to rise, and in-depth investigation of its mechanisms is urgently needed to provide a theoretical basis for OS prevention and treatment.

Objective:To explore the value of machine learning models based on multiple structural MRI features for diagnosis of Parkinson disease (PD).Methods:The clinical and imaging data of 60 PD patients (PD group) diagnosed in the Neurology Department of the Second Affiliated Hospital of Soochow University from November 2017 to August 2019 and 56 normal elderly people (NC group) recruited from the community were retrospectively analyzed. All subjects underwent brain MR imaging. Multiple structural MRI features were extracted from cerebellum, deep nuclei and of brain cortex based on different partition templates. The Mann-Whitney U test, as well as least absolute shrinkage and selection operator regression were used to select the most discriminating features. Finally, logistic regression (LR) and linear discriminant analysis (LDA) classifier combined with the 5-fold cross-validation scheme were used to construct the models based on structural features of cerebellum, deep nuclei and cortex, and a combined model based on all features. The receiver operating characteristic curves were drawn, and the diagnostic performance and clinical net benefit of each model were evaluated by the area under curve (AUC) and the decision curve analysis (DCA). Results:In total, four cerebellum (asymmetry index of Lobule Ⅵ volume, asymmetry index of Lobule ⅦB cortical thickness, asymmetry index of total gray matter volume and absolute value of right Lobule Ⅵ gray matter volume), 3 deep nuclei (absolute value of right nucleus accumbens volume, absolute and relative value of total nucleus accumbens volume) and 3 cortex features (local gyration index of left PFm, local fractal dimension of right superior frontal gyrus and sulcal depth of left superior occipital gyrus) were selected as the most discriminating features, and the related models were constructed. In validation set, the AUC of cerebellum, deep nuclei, cortex and combined models for diagnosis of PD based on LR classifier were 0.692, 0.641, 0.747 and 0.816; the AUC of cerebellum, deep nuclei, cortex and combined models for diagnosis of PD based on LDA classifier were 0.726, 0.610, 0.752 and 0.818. The diagnostic efficiency of the combined models based on LR and LDA classifiers were significantly better than those of other models ( P<0.05). The DCA curve demonstrated that the combined models based on LR and LDA classifiers showed the highest clinical net benefit. Conclusion:The combined models with all structural features of cerebellum, deep nuclei and cortex included based on LR and LDA classifiers showed favorable performance and clinical net benefit for diagnosis of PD, which have the potential application value in clinical diagnosis.

OBJECTIVES: The aims of this study were to update the latest data on the prevalence of hypertension (HTN) in the elderly Chinese population and to assess relationships between new anthropometric indices and HTN. METHODS: Data were obtained from the Basic Public Health Service (BPHS) survey for Jiangsu Province, China. A total of 944,760 people aged 65 years and older were included in this study. Blood pressure was measured by trained investigators. Body weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), conicity index (COI), body roundness index (BRI), and a body shape index (ABSI) were included in the analysis as anthropometric indices. Logistic regression analysis and restricted cubic splines were used to evaluate the association of anthropometric indices with HTN. RESULTS: The prevalence of HTN among elderly residents of Jiangsu Province was 64.7% (95% confidence interval, 64.6 to 64.8). After adjusting for multiple covariates, all anthropometric indices except ABSI showed significant non-linear positive dose-response associations with HTN across sex (pnonlinear<0.001). Among participants with BMI <28 kg/m2, abnormal weight, WC, WtHR, BRI, COI, and ABSI were positively associated with HTN. CONCLUSIONS The prevalence of HTN in the elderly in Jiangsu Province is gradually increasing. It is necessary to consider the combination of ABSI and COI with BMI for screening elderly individuals for HTN in follow-up prospective studies.

Objective:To construct a plasmid for expression Mycobacterium tuberculosis ( Mtb) Rv3133c and to evaluate the immunogenicity of Rv3133c through population and mice experiments. Methods:The recombinant expression plasmid pPROEX-Rv3133c was constructed. The transformed E. coli BL21 (DE3) carrying expression plasmid was induced by IPTG to express the recombinant Rv3133c (rRv3133c). Western blot was used to identify the expressed protein. Whole-blood IFN-γ release assay (WBIA) was preformed to assess the immunogenicity of rRv3133c in Mtb-infected population. Antigen-specific antibodies in serum, Th1 type cytokines in splenocytes, functional T cell subset responses in splenocytes and the expression of cytokines at mRNA level in lung tissues were detected after immunizing mice subcutaneously with rRv3133c and adjuvant DC. Results:The rRv3133c was constructed and expressed successfully. Stimulation with rRv3133c promoted the production of IFN-γ in Mtb-infected population, especially in patients with latent tuberculosis infections. After immunizing mice with rRv3133c+ DC, the levels of IFN-γ, TNF-α and IL-2, the number of IFN-γ + TNF-α + CD4 + T cells in spleen and the expression of antigen-specific IFN-γ, TNF-α and iNOS at mRNA level in lung tissues were higher than those in BCG-immunized mice, but lower than those in BCG+ rRv3133c+ DC group. The serum IgG2a/IgG1 ratios in the rRv3133c+ DC group and the BCG+ rRv3133c+ DC group were greater than 1, and significantly higher than that of the BCG group. Conclusions:The rRv3133c had good immunogenicity and could induce strong Th1 immune response, suggesting that it was a potential candidate antigen for subunit vaccine against tuberculosis.

Objective:To evaluate the effect of electroacupuncture (EA) on lung injury caused by extremity ischemia-reperfusion.Methods:Forty-five American Society of Anesthesilogists physical status ⅠorⅡpatients, aged 20-60 yr, with body mass index of 18-28 kg/m 2, undergoing unilateral lower extremity operation requiring tourniquet with neuraxial anesthesia were divided into 3 groups ( n=15 each) using a random number table method: control group (C group), EA group and EA at non-acupoint group (group N). Bilateral acupoints Feshu and Zusanli were stimulated with disperse-dense waves, frequency 2/15 Hz, the current intensity the maximum current that patients could tolerant until the end of surgery in group EA.EA was performed at the points 1 cm lateral to the acupoints of Feshu and Zusanli in group N. Before anesthesia (T 1) and at 10, 30 and 60 min after tourniquet loosening (T 2-4), blood samples were collected from the radial artery for blood gas analysis, the partial pressure of arterial oxygen(PaO 2) and arterial carbon dioxide partial pressure (PaCO 2) were recorded, alveolar-arterial oxygen partial pressure difference (P A-aDO 2), oxygenation index (OI) and respiratory index (RI) were calculated, the malondialdehyde (MDA) content was measured by thiobarbituric acid method, the concentration of serum nitric oxide (NO) was determined by nitrate reductase method, and the concentrations of serum endothelin-1 (ET-1) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay. Results:Compared with the baseline at T 1, OI and RI were significantly decreased, P A-aO 2 was increased, and serum MDA, IL-6, ET-1 and NO levels were increased at T 2-4 in three groups ( P<0.05). Compared with group C, OI was significantly increased, P A-aO 2 and RI were decreased, serum MDA, IL-6, ET-1 and NO levels were decreased at T 2-4 in group EA ( P<0.05). Conclusion:EA can reduce lung injury caused by extremity ischemia-reperfusion, and the mechanism may be related to maintaining NO/ET-1 balance.

Objective: To explore the psychological vulnerability in the relationship between stressful life events and psychological crisis, and to provide basis for psychological crisis prevention among college students. Methods: With stratified cluster sampling，3584 students in Weifang Medical University and Weifang University were selected for a crosssectional selfadministrated questionnaire survey in December 2017. A selfdesigned general questionnaire, Adolescent SelfRating Life Events Check List(ASLEC), psychological vulnerability scale, and psychological crisis performance questionnaire for college students were applied in the survey. Mediating effect was tested by using SPSS 23.0 and AMOS 23.0. Results: The average score was 36.53±8.58 for life events(ASLEC), 54.21±11.80 for psychological vulnerability,and 26.33±39.72 for psychological crisis performance. The life events score was positively correlated with psychological crisis score (r=0.54, P<0.05) and positively correlated with psychological vulnerability score(r=0.30, P<0.05); psychological vulnerability score was positively correlated with psychological crisis score(r=0.37, P<0.05). Psychological vulnerability played a partial intermediary role on the relationship between life events and psychological among undergraduates,the effect was 0.10 accounting for 15.13% of the total effect. Conclusion Life events have made a direct influence and an indirect influence mediated by psychological crisis vulnerability on psychological crisis among undergraduates.

Objective To compare the efficacy and safety of humidified high-flow nasal cannula (HHFNC)and nasal continuous positive airway pressure (nCPAP) for moderate and severe bronchiolitis treatment in infants.Methods Thirty-two infants who were diagnosed as moderate and severe bronchiolitis admitted to Department of Pediatric Critical Care Medicine,the Affiliated Hospital of Qingdao University from September 2016 to May 2017 were selected,and they were randomly assigned into HHFNC group(17 cases) and nCPAP group(15 cases).The heart rate,breathing,oxygen saturation (SpO2),arterial partial pressure of oxygen [Pa (O2)],partial pressure of carbon dioxide [Pa (CO2)],pH value after treatment for 12 h,the duration of non-invasive ventilation and the incidence rates of invasive ventilation use,complications were compared between the 2 groups.Results After the treatment for 12 h,in HHFNC group,the heart rate was (130.88 ± 2.87) times/min,respiratory rate was (37.35 ± 3.55) times/min,SpO2 was(97.06 ± 1.43)％,pa(O2) was (99.65-±8.07) mmHg,pa(CO2) was (35.88 ±4.27) mmHg,pH was 7.42 ± 0.03;while in the nCPAP group,the heart rate was (135.73 ± 6.29) times/min,respiratory rate was (41.40 ± 4.40)times/min,SpO2 was (96.00 ± 1.13) ％,Pa (O2) was (91.33 ± 9.45) mmHg,pa (CO2) was (40.13 ± 3.72)mmHg,pH was 7.39 ± 0.03.The breathing,heart rate,oxygen saturation and arterial blood gas in both groups after treatment were improved significantly compared with those before treament,and the differences were statistically significant (all P ＜ 0.05);after treatment for 12 h,the heart rate,breathing,oxygen saturation and arterial blood gas of HHFNC group were improved more than those of the nCPAP group,and the differences had statistical significance (all P ＜ 0.05).The duration of non-invasive ventilation was (45.88-± 6.49) hours in HHFNC group,and (49.33 ± 8.99) hours in nCPAP group,so there was no difference between the 2 groups (t =1.254,P =0.219).There was 12 cases (80.0％) of mild complication in nCPAP group and 5 cases(29.4％) in HHFNC group,while the incidence rate of invasive ventilation use was 3 cases(20.0％) in nCPAP group and 1 case (5.9％) in HHFNC group.Conclusion The efficacy and security of HHFNC on moderate and severe bronchiolitis are better than those of nCPAP,and it is recommended for clinical application widely.

OBJECTIVEAicardi-Goutières syndrome (AGS) is a rare early-onset genetic encephalopathy. The aim of this study was to explore the clinical, imaging and genetic features of a family with AGS, which may contribute to definite diagnosis, genetic counseling and prenatal diagnosis of this rare disease in China. We summarized the characteristics of AGS through reviewing related references.

METHODInformation of the proband and other family members as well as their DNA samples were collected. All the exons and exon-intron boundaries of pathogenic genes were amplified with PCR and were directly sequenced for genomic DNA. And we reviewed the reports of 252 cases.

RESULT(1) The proband was a 6 years plus 7 months old boy. He presented with severe developmental delay and abnormal posture mainly as torsion of limbs. By physical examination he was found to have some chilblain-like skin lesions at the end of limbs and microcephaly. The CT scan of his head displayed multiple calcification, especially in the basal ganglia. The MRI of his head displayed a hypointense signal in T1-weighted (T1W) images and a hyperintense signal in T2-weighted (T2W) in cerebral white matter and cystic lesions in temporal white matter. The younger sister of the proband presented with chilblain-like skin lesions on her face and the end of limbs had no developmental delay. The CT of her head showed multiple calcification, especially in the basal ganglia. (2) Two mutations were identified in TREX1, one was a novel nonsense mutation (c.294_295insA), and the other was a known pathogenic mutation (c.868_885del). (3) The common performances of AGS included mental retardation [92% (231/252) ], dystonia [75% (189/252)], microcephaly [63% (159/252) ], chilblain [42% (106/252) ], basal ganglia calcification [100% (252/252)], brain atrophy[88% (222/252)] and cerebral white matter lesions [86% (217/252)]. TREX1 [38% (96/252) ] and RNASEH2B [23% (58/252)]are the most common pathogenic genes.

CONCLUSIONWe determined pathogenic gene of these patients which is the basis of genetic counseling for this family. c.294_295insA mutation is a novel mutation not reported around the world yet.

Atrophy ; Autoimmune Diseases of the Nervous System ; diagnosis ; genetics ; Calcinosis ; Child ; China ; Exodeoxyribonucleases ; genetics ; Exons ; genetics ; Genetic Testing ; Humans ; Magnetic Resonance Imaging ; Male ; Mutation ; Nervous System Malformations ; diagnosis ; genetics ; Pedigree ; Phosphoproteins ; genetics

Objective To observe the application of the mini-mental status examination (MMSE)cognitive assessment in the patients with brain glioma before and after surgery. Methods Using MMSE,36 pastients with primary brain glioma were subjected to the cognitive assessment before surgery, after surgery,and 3 monthsr after surgery. Results The quantitative cognitive assessments with MMSE before surgery revealed the hidden cognitive dysfunction patients.The quantitative cognitive assessments after surgery showed that surgeons might need to protect the non-function area and to form the idea of cognitive function in patients with glioma.Conclusion MMSE assessment is a simple,understandably,and convenient method having good compliance of patient. It may be effectively used to assess cognitive impairment for patients with glioma and worth being studied continuously and used widely in the clinic practice.

0.05).Conclusion The chest low-dose computed radiography is valuable in the field of clinical diagnosis.