OBJECTIVE To analyze trends in the burden of disease associated with falls from 1990 to 2023， identify risk factors for falls， and provide a reference for the development of measures to reduce the burden of disease associated with falls and the formulation of public health policies. METHODS Based on the data of 2023 from the Global Burden of Disease （GBD） database， the changes in fall-related prevalence， mortality， disability-adjusted life years （DALYs） and incidence in China and globally from 1990 to 2023 were analyzed， and the stratified analyses by gender， age and socio-demographic index （SDI） were conducted. The risk factors related to falls in 2023 were systematically analyzed， and the impact of multimorbidity and polypharmacy on the occurrence of falls by combining relevant literature evidence was explored. RESULTS & CONCLUSIONS Globally， the percentage changes in age-standardized rates of fall-related prevalence， mortality， DALYs and incidence from 1990 to 2023 were －2.4% （95%UI： －4.8% to －0.3%）， －7.8% （95%UI： －20.5% to 10.9%）， －10.6% （95%UI： －16.5% to －4.3%）， and －4.6% （95%UI： －8.1% to －0.8%）， respectively. However， in some regions， the percentage changes in age-standardized rates for these indicators were greater than 0 （e.g.， prevalence， mortality and DALYs in Australasia， and incidence in Andean Latin America）. In China， the percentage changes in age-standardized rates of fall-related mortality and DALYs from 1990 to 2023 were －18.3% （95%UI： －56.7% to 32.3%） and 1.9% （95%UI： －10.1% to 12.4%）， while the percentage changes in age-standardized rates of prevalence and incidence were 25.9% （95%UI： 20.2% to 32.0%） and 35.7% （95%UI： 28.5% to 44.1%）， respectively. Globally， in regions with high and medium-to-high SDI levels， the percentage changes in age-standardized rates of fall-related prevalence and incidence showed an upward trend， while DALYs showed a downward trend； however， the trend in mortality was unclear. In regions with a middle SDI level， the percentage changes in age-standardized rates of fall-related prevalence and incidence both showed an upward trend， while the trends in mortality and DALYs were unclear. In regions with low-to-medium SDI level， the percentage changes in age-standardized rate of fall-related prevalence， DALYs and incidence all showed a downward trend， while the trend in mortality was unclear； in regions with low SDI level， the trends for all above indicators were unclear. Correlation analyses of the burden of fall-related diseases in China and globally indicated that the risk of fall-related diseases was higher among younger and middle-to-older adult male populations， while women were concentrated in older age groups. Meanwhile， as the SDI levels increase， the percentage change in age-standardized rate of DALYs for fall-related diseases showed a clear upward trend， and this trend was more pronounced in high-SDI regions. Tobacco use， alcohol consumption， low bone density， and occupational risks were risk factors for falls， with low bone density and occupational risks contributing significantly （exceeding 20% in some regions）； multimorbidity and polypharmacy could also significantly increase the risk of falls. It is recommended that clinical settings establish a list of fall-risk increasing drugs and a warning system， improve medication reviews， strengthen medication education and adherence management， foster multidisciplinary collaboration， and develop medication strategies for specific patient populations to reduce the incidence of falls and alleviate the burden of disease.

ObjectiveBased on non-targeted metabolomics， to analyze the regulation of endogenous differential metabolites in serum of type 2 diabetes mellitus（T2DM） rats by Fuling Yunhua granules， and to clarify the metabolic pathways through which this granules exerted its effect on improving T2DM. MethodSeventy SD rats， half male and half female， were randomly divided into the control group， model group， and high， medium， low dose groups of Fuling Yunhua granules（20.70， 10.35， 5.18 g·kg^-1 in raw drug amount） and the positive drug group（pioglitazone hydrochloride tablets， 8.1 mg·kg^-1）. Except for the control group， other groups were fed with high-sugar and high-fat diet combined with intraperitoneal injection of streptozotocin（STZ） to establish a T2DM rat model. After successful modeling， the treatment groups were administered the corresponding drugs by gavage， and the control group and model group were treated with an equal volume of saline by gavage， once/d， for 28 d. Fasting blood glucose（FBG） and glycosylated hemoglobin A1c（GHbA1c） levels were measured in all groups of rats during the administration period， and hematoxylin-eosin（HE） staining was used to observe the pathomorphological changes in the pancreatic tissues of rats at the end of the administration period. The endogenous metabolite levels in rat serum were detected by ultra-performance liquid chromatography-linear ion trap-electrostatic field orbitrap high-resolution mass spectrometry（UPLC-LTQ-Orbitrap MS）， and the data were processed using principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）. Differential metabolites were identified by the Human Metabolome Database（HMDB） and the Kyoto Encyclopedia of Genes and Genomes（KEGG）， and screened for differential metabolites with variable importance in the projection（VIP） value>1， P<0.05， and fold change（FC）<0.6 or FC>1. And the metabolic pathway enrichment analysis of the screened differential metabolites was performed by MetaboAnalyst 5.0， then the screened differential metabolites were diagnosed and evaluated by the receiver operating characteristic（ROC） curves. ResultCompared with the control group， the FBG level of rats in the model group increased significantly（P<0.01）， the GHbA1c content tended to increase， but the difference was not statistically significant， and the pancreatic tissue of rats was obviously damaged， the number of pancreatic islets decreased， and the pancreatic β-cells were obviously reduced， atrophied and enlarged. Compared with the model group， the FBG levels of rats in the high dose group of Fuling Yunhua granules and the positive drug group were significantly reduced after 2 weeks of administration（P<0.05， P<0.01）， the GHbA1c content of rats in the high dose group of Fuling Yunhua granules was significantly reduced（P<0.05）， and the pancreatic tissue lesions of rats in the different dose groups of Fuling Yunhua granules were reduced. The results of non-targeted metabolomics showed that 46 differential metabolites were significantly changed in the model group compared with the blank group. Pathway enrichment analysis found that T2DM mainly affected biological processes including biosynthesis of primary bile acid， D-amino acid metabolism， steroid hormone biosynthesis， and glycerophospholipid metabolism in rats. Compared with the model group， the levels of 8 differential metabolites in the high dose group of Fuling Yunhua granules were significantly adjusted， and the pathway enrichment analysis found that D-amino acid metabolism， retinol metabolism， glycine， serine and threonine metabolism， tryptophan metabolism and other metabolic pathways were mainly involved. ROC curves further analysis revealed that the four characteristic differential markers of 11-cis-retinol， D-piperidinic acid， D-serine， and p-cresol sulfate had high diagnostic value for the treatment of T2DM with Fuling Yunhua granules. ConclusionFuling Yunhua granules can improve the symptoms of T2DM rats by regulating the amino acid metabolic and retinol metabolic pathways through the modulation of endogenous differential metabolites.

Objective:To analyze the radiographic parameters of shoulder balance that affect the postoperative satisfaction of Lenke type 1 adolescent idiopathic scoliosis (AIS).Methods:A total of 98 patients with AIS who underwent posterior pedicle screw fusion in Xijing Hospital of Air Force Medical University from August 2017 to July 2020 were retrospectively analyzed. There were 26 males and 72 females, aged 15.2±5.3 years (range, 10-24 years). Distribution of upper instrumented vertebrae: T 2 58 cases (59%), T 3 25 cases (26%), T 4 15 cases (15%); Distribution of lower instrumented vertebrae: T 12 63 cases (64%), L 1 28 cases (29%), L 2 4 cases (4%), L 3 3 cases (3%). Clavicle angle (CA), radiographic shoulder height (RSH), and coracoid height difference (CHD), clavicle-rib cage intersection difference (CRID), T 1 tilt angle, first rib tilt angle, clavicle chest angle difference(CCAD) and Scoliosis Research Society-22 (SRS-22) scale were compared before and after operation. Binary logistic regression was used to analyze the radiographic indicators of shoulder balance that affected the postoperative satisfaction of Lenke type 1 AIS. The receiver operating characteristic (ROC) curve was drawn to determine the threshold value of the imaging index. Results:All operations were successfully completed. The operation time was 260±80 min (range, 220-320 min), and the intraoperative blood loss was 360±110 ml (range, 300-700 ml). There was no nerve, dural or vascular injury during operation. RSH, CHD, CRID, T 1 tilt angle, first rib tilt angle, and CCAD at the final follow-up were 4.0 (0, 13.9) mm, 7.0 (0, 12.9) mm, 4.0 (0, 10.0) mm, 4.8° (3.3°, 8.2°), 5.3°±3.9°, and 5.5° (3.0°, 8.9°), respectively, which were less than the preoperative 10.6 (2.0, 20.3) mm, 10.3 (2.5, 15.9) mm, 8.0 (1.0, 15.2) mm, 7.6° (3.5°, 12.2°), 7.5°±6.9°, 8.5° (3.6°, 18.3°), and the difference was statistically significant ( P<0.05). The SRS-22 function, pain, appearance, and psychological scores at the final follow-up were 4.6 (4.0, 4.9), 4.1±0.5, 4.1±0.7, and 4.2 (3.9, 4.8) points, respectively, which were greater than the preoperative scores of 4.2 (3.8, 4.6), 4.0±0.7, 3.5±0.7, and 4.0 (3.5, 4.4) points, the difference was statistically significant ( P<0.05). Binary logistic regression showed that CCAD was an independent radiographic indicator of shoulder balance that affected the satisfaction of AIS patients after orthopaedic surgery ( OR=0.826, P=0.040). ROC curve showed that the area under the curve and 95% CI was 0.726 (0.572, 0.865), and the threshold was 6.6°. Conclusion:CCAD is an independent radiographic parameter of shoulder balance that affects the postoperative satisfaction of AIS. Patients are more likely to achieve a satisfactory outcome when their postoperative CCAD is ≤6.6°, which can be used clinically as a radiographic parameter to assess the efficacy of orthopaedic spine surgery.

Bacterial cellulose(BC)is a type of extracellular polymeric nanomaterial secreted by microorganisms over the course of their growth.It has gained significant attention in the field of bone tissue engineering due to its unique structure of three-dimensional fibrous network,excellent biocompatibility,biodegradability,and exceptional mechanical properties.Nevertheless,BC still has some weaknesses,including low osteogenic activity,a lack of antimicrobial properties,small pore size,issues with the degradation rate,and a mismatch in bone tissue regeneration,limiting its standalone use in the field of bone tissue engineering.Therefore,the modification of BC and the preparation of BC composite materials have become a recent research focus.Herein,we summarized the relationships between the production,modification,and bone repair applications of BC.We introduced the methods for the preparation and the modification of BC.Additionally,we elaborated on the new advances in the application of BC composite materials in the field of bone tissue engineering.We also highlighted the existing challenges and future prospects of BC composite materials.

Objective:To explore the optimum time of ambulation of atrial fibrillation patients after radiofrequency ablation, to provide basis for patients' early postoperative rehabilitation.Methods:By convenient sampling method, a total of 120 patients with atrial fibrillation after radiofrequency ablation were collected at Yanghu Branch and City Branch of Changzhou Second People's Hospital from January 2020 to May 2021. They were divided into the early group, middle group and late group according to the random number table method, each group were 40 cases. All patients received routine postoperative intervention, the time of ambulation were 4, 6 and 12 h after operation in the early group, middle group and late group, respectively. The complication rate within 24 h after operation was compared among the three groups, and the comfort level of the three groups at 24, 48 and 72 h after operation was evaluated with Comfort Status Scale (GCQ).Results:Finally, 111 patients were included, including 37 in the early group, 38 in the middle group and 36 in the late group. There was no significant difference in the incidence of bleeding or hematoma, urinary retention, lumbago within 24 h after operation among the three groups ( P>0.05). The incidence of postural hypotension within 24 h after operation in the early group was 2.7% (1/37), which was lower than 21.1% (7/38) and 25.0% (9/36) in the middle and late groups, with a statistically significant difference ( χ2=4.86, 7.67, both P<0.05). At 48 and 72 h after operation, the scores of physiological dimension, psychological dimension and the total score of GCQ in the early group were (20.68 ± 3.07), (22.54 ± 3.35), (81.68 ± 6.11) and (22.54 ± 3.73), (24.38 ± 2.49), (84.92 ± 6.37), higher than those in the middle group (19.16 ± 2.19), (21.32 ± 2.27), (78.24 ± 5.58), (20.93 ± 2.85), (22.32 ± 2.04), (81.66 ± 6.56), and those in the late group (18.44 ± 1.50) (21.31 ± 1.99), (78.06 ± 4.32), (20.89 ± 2.25), (21.58 ± 1.86), (80.28 ± 6.44), the differences were statistically significant ( t values were 2.19-4.15, all P<0.05). Conclusions:Ambulation at 4 h after operation does not increase peripheral vascular complications, but can reduce the incidence of postural hypotension and improve the comfort of patients with atrial fibrillation after radiofrequency ablation.

Objective:To investigate the relationship between primary resection and KRAS gene mutation in the mild symptomatic patients with stage Ⅳ colorectal cancer,and to clarify its significance of prognosis.Methods:The clinical data of 46 mild symptomatic patients with stage Ⅳ colorectal cancer 2010 to December 2010 were collected.All the patients received primary resection.The KRAS gene mutation in the patients was detected by direct sequencing and the patients were followed up for 5 years.The influence of primary resection and KRAS gene mutation in prognosis of the patients with stage Ⅳ colorectal cancer was analyzed, and the clinical pathological features which might influence the prognosis were analyzed by survival analysis.Results:In 46 patients with colorectal cancer, KRAS gene mutation was found in 20 cases, the mutation rate was 43.4%, and most mutation was found at Codon 12. The KRAS mutation had relationship with the tumor site and multiple metastasis (P<0.05).The Kaplan-Meier survival curve and univariate analysis results showed that the median survival time of the patients with wild type of KRAS gene was 58.4 months, the median survival time of the patients with mutant type of KRAS gene was 42.2 months, and there was no significant difference (P>0.05).The median survival time of right colon cancer patients was 34.2 months, the median survival time of left colon cancer patients was 58.3 months, and there was sigificant difference (P<0.05).The cancer metastases including liver, lung and multiple metastasis were closely related to the poor prognosis of the colorectal cancer patients(P<0.05).The median survival time of the patients with stage Ⅳ colorectal cancer was 39.6 months after operation.Conclusion:After primary resection of the mild symptomatic patients with stage Ⅳ colorectal cancer,the median survival time of the patients with colorectal cancer in left colon site and right colon site were prolonged.Right colon cancer has more poorer prognosis than left colon cancer.KRAS gene mutation is associated with the tumor site and the multiple metastasis.The location of metastasis affect the prognosis.

Objective To observe the clinical efficacy of acupuncture plus rehabilitation training in treating post-stroke depression.Method Forty-one patients with post-stroke depression were randomized into a treatment group of 22 cases and a control group of 19 cases. In addition to the basic internal medicine treatment, the treatment group received acupuncture plus rehabilitation training, while the control group was intervened by rehabilitation training alone. The Hamilton Depression Scale (HAMD) and National Institutes of Health Stroke Scale (NIHSS) were observed and compared before and after treatment.Result The HAMD and NIHSS scores in the two groups were significantly changed respectively after 4-week and 8-week treatment (P<0.05,P<0.01). Respectively after 4-week and 8-week treatment, the HAMD and NIHSS scores in the treatment group were significantly different from that in the control group (P<0.05,P<0.01).Conclusion Acupuncture plus rehabilitation training is an effective approach in treating post-stroke depression.

Objective To study the effects of diet and exercise intervention on prognosis of nonalcoholic fatty liver disease (NAFLD).Methods Fifty two patients with NAFLD received diet and exercise intervention.The treatment effects before and after intervention were analyzed.Result The body mass index(BMI),triglyceride(TG),cholesterol(TC)were significantly lower than those in control group after three-month intervention(all P<0.05).Conclusions Diet and exercise intervention can effectively improve liver function and promote the prognosis of nonalcoholic fatty liver,thus promote their quality of life.

Objective To investigate the value of clinical care path in pregnant women with gestational diabetes .Methods Eighty pregnant women with gestational diabetes were selected and randomly divided into the observation group ( n =40 ) and the control group ( n =40 ) .The observation group was carried out the clinical nursing care path, while the control group used the conventional care method .The results were presented by comparing the health education , patients ’ satisfaction, child delivery mode , postpartum hemorrhage , breastfeeding , and blood glucose control status .Results The fasting blood glucose , thirty minutes before and two hours after meal glucose , and the midnight glucose in the observation group were (4.61 ±0.43), (4.21 ±0.89), (6.22 ±0.21) and (4.92 ±0.73) mmol/L, respectively.Those in the control group were (5.72 ±3.20), (5.85 ±2.42), (7.68 ±2.95) and (6.39 ±3.18) mmol/L.The glucose values were significantly reduced (t=2.1743,4.022 6,3.122 2,2.849 5,respectively;P <0.05).Thirteen patients (32.50%) in the observation group and twenty-four patients (60.00%) in the control group were undergone cesarean section.There was no significant difference (χ2 =2.205 2,P>0.05).In the observation group, two patients (5.00%) had postpartum hemorrhage and thirty-eight patients (95.00%) took breast feeding; while in the control group, twelve patients ( 30.00%) had postpartum hemorrhage and twenty-nine patients (72.50%) took breast feeding.The differences were significant (χ2 =8.658 0,7.439 7,respectively;P <0.05).The compliance in the observation group was significantly higher than that in the control group ( U=2.914 4,P<0.01).And the passing rate of health education (χ2 =23.809 5,P<0.01) and the re-visiting rate (U=2.835 3,P<0.01) in the observation group were also significantly higher than those in the control group.Conclusions Clinical care path can improve the nursing care treatment and patients ’ satisfaction, and it is worthy of promotion .

Objective To realize the actuality and analyze the problem of the hospital medicine preparation in Beijing,then to discuss its developing methods.Methods By summarizing questionnaire of the hospital medicine preparation and combining with the problem showed in daily supervision,we analyzed the main existing problems and reasons for hospital medicine preparation and put forward the developing methods.Results The main existing problems of hospital preparation are the decreasing variety of medicine preparation,insufficient infrastructure and software.Conclusion Therefore we should enhance the input on the infrastructure,set up the software,improve the quality of the staff,and consummate the regulation means and system.