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*

OBJECTIVES: To explore the clinical value of endoscopic findings under white light gastroscopy in diagnosing Helicobacter pylori (Hp) infection in children. METHODS: A retrospective analysis was conducted on the clinical data of 340 children who underwent gastroscopy and gastric mucosa tissue Hp culture from July 2022 to June 2023 in the Department of Gastroenterology at Wuxi Children's Hospital due to upper gastrointestinal symptoms. Based on the results of Hp culture, the children were categorized into an Hp-infected group (146 cases) and a non-infected group (194 cases). The detection rates of various endoscopic findings in the gastric mucosa between the two groups were compared, and the association between each endoscopic finding and different Hp infection statuses was analyzed, as well as the diagnostic value of each endoscopic finding under different Hp infection statuses. RESULTS: The proportions of white mucus, diffuse redness, mucosal edema, enlarged folds, chicken skin-like changes, and ulcers in the Hp-infected group were higher than those in the non-infected group (P<0.05), while the proportions of regular arrangement of collecting venules (RAC) and ridge-like redness were lower in the Hp-infected group compared to the non-infected group (P<0.05). Multivariate logistic regression analysis showed that diffuse redness, enlarged folds, mucosal edema, and chicken skin-like changes were closely associated with Hp infection (P<0.05), while RAC and ridge-like redness were closely associated with the absence of Hp infection (P<0.05). Receiver operating characteristic curve analysis indicated that the area under the curve for diffuse redness, enlarged folds, mucosal edema, and chicken skin-like changes in predicting Hp infection was 0.798, 0.731, 0.782, and 0.760, respectively (P<0.05). The area under the curve for RAC and ridge-like redness in predicting the absence of Hp infection was 0.861 and 0.589, respectively (P<0.05). CONCLUSIONS Endoscopic findings under white light gastroscopy are associated with Hp infection in children, with diffuse redness, mucosal edema, chicken skin-like changes, and enlarged folds showing significant diagnostic value for Hp infection.
Humans ; Helicobacter Infections/diagnostic imaging* ; Female ; Male ; Gastroscopy/methods* ; Child ; Helicobacter pylori ; Retrospective Studies ; Child, Preschool ; Adolescent ; Gastric Mucosa/pathology* ; Infant ; Logistic Models

The chemical constituents in dried roots of Atractylodes macrocephala were investigated in this study. Through utilizing normal-phase silica gel and ODS column chromatography, TLC, and semi-preparative HPLC, 4 new sesquiterpenoids were purified from the ethyl acetate extract of A. macrocephala. By various spectroscopic techniques, such as 1D and 2D NMR, HR-ESI-MS, IR, UV, and CD, their structures were identified as atractylmacron A (1), 9β-hydroxyasterolide (2), atractylenolide H (3), atractylenolide J (4). Compound 1 possesses a rare 6/7 bicyclic skeleton.

As a serine protease,thrombin can convert soluble fibrinogen into insoluble fibrin and plays a pivotal role in the coagulation cascade.Therefore,the accurate quantitative assay of thrombin levels is of great value in the evaluation of coagulation function,clinical screening and prognostic monitoring of coagulation-related diseases,and screening of drugs for targeted therapy.Existing methods for thrombin detection can be divided into two categories,e.g.,the assay of concentration levels using nucleic acid aptamers as the affinity elements and the assay of activity levels based on the hydrolytic cleavage of substrate peptides.In recent years,electrochemical biosensors have attracted much attention in thrombin detection due to high sensitivity,high selectivity,simple instrument,fast response,and good portability.In this review,the latest research progress in methods for electrochemical detection of thrombin was summarized,focusing on the detection principles and the applied signal amplification strategies of related electrochemical biosensors.In addition,the challenges with respect to the practical use of electrochemical thrombin biosensors and the prospects were discussed.

Objective To retrieve the academic documents concerning vein of Marshall(VOM)published in the years of 2000-2023 from Web of Science database,to summarize the literature,to make visualization analysis,and to judge the development status of this field.Methods The core collection expansion database in Web of Science database was used as the data source,the VOM-related literature published in 2000-2023 was collected.the R software was used to make descriptive bibliometric analysis,and software tools such as CiteSpace,VOSviewer,etc.were used to make interpretation of the visualization results.Results A total of 145 documents were retrieved,which were published in 34 journals and were written by 816 researchers from 227 research institutions in 17 countries.The number of publications continued to increase since 2000,especially,the number of publications presented an explosive growth since 2019.The United States dominated in the number of published literature and the number of documents cited,besides,the University of California,Los Angeles was considered the most active research institution with the largest total number of citations(n=587).The《JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY》had the highest number of annual publications and the most total local citations.Duchateau was one of the most active researchers in this field in recent years,and Hwang was one of the earliest and most influential researchers in this field.The timeline analysis indicated that"mitral isthmus ablation"was the most important area of VOM research.In recent years,persistent atrial fibrillation and absolute ethanol perfusion ablation were the hottest research directions.Conclusion In this study,bibliometric analysis is used to analyze VOM-related literature,comprehensively and intuitively expounds the research hotspots and research directions in this field,providing effective reference information for further studies.

Objective:To investigate the clinical efficacy of cervical cerclage in singleton pregnancy with different degrees of short cervix.Methods:The clinical data of singleton pregnant women who underwent transvaginal ultrasound examination at 18-24 +6 weeks of gestation and found cervical dilation with cervical length (CL) ≤20 mm, and without history of spontaneous preterm delivery or late abortion in Women′s Hospital, Zhejiang University School of Medicine from January 2021 to September 2023 were collected and retrospectively analyzed. According to the case control matching, 78 pregnant women in the cerclage group and 78 women in the conservative treatment group were finally included. The pregnancy outcomes and neonatal prognosis of the two groups were compared. Meanwhile, the two groups of pregnant women were divided into three subgroups for stratification (CL≤10, 11-15, 16-20 mm). Multivariate logistic regression analysis and Kaplan-Meier curve were used to evaluate the effect of cervical cerclage on pregnancy outcomes in different subgroups. Results:(1) Compared with the conservative treatment group, the gestational age at delivery (median: 36 vs 37 weeks) and the duration of pregnancy extension (median: 90 vs 97 days) in the cerclage group were not significantly prolonged (all P>0.05). There was no significant difference in the cumulative non-delivery rate between the cerclage group and the conservative treatment group ( P=0.143). The rate of neonatal intensive care unit (NICU) admission in the cerclage group was significantly higher than that in the conservative treatment group (46.1% vs 31.2%, P<0.001), but there were no significant differences in other neonatal outcomes between the two groups (all P>0.05). (2) CL 16-20 mm subgroup: compared with the conservative treatment group (28 cases), the cerclage group (18 cases) had a significantly higher rate of preterm birth before 37 weeks of gestation (3.6% vs 6/18, P<0.001) and a significantly lower neonatal birth weight (median: 3 370 vs 2 925 g, P<0.001). There was no significant difference in the cumulative non-delivery rate between the cerclage group and the conservative treatment group ( P=0.168). (3) CL 11-15 mm subgroup: compared with the conservative treatment group (26 cases), the gestational age of delivery in the cerclage group (32 cases) was later (median: 36 and 37 weeks, respectively), and the difference was statistically significant ( P<0.05). The cumulative non-delivery rate in the cerclage group was significantly higher than that in the conservative treatment group ( P=0.001). (4) CL≤10 mm subgroup: compared with the conservative treatment group (24 cases), the pregnant women in the cerclage group (28 cases) had a later gestational age at delivery (median: 34 vs 37 weeks), a longer duration of pregnancy (median: 74 vs 97 days), and a larger newborn birth weight (median: 2 300 vs 3 165 g). The rates of preterm birth before 34 weeks of gestation (45.8% vs 14.3%) and before 37 weeks of gestation (83.3% vs 39.3%) were lower, and the differences were all statistically significant (all P<0.05). The cumulative non-delivery rate of pregnant women in the cerclage group was significantly higher than that in the conservative treatment group ( P<0.001). Conclusion:Cervical cerclage could significantly prolong the gestational weeks and improve the perinatal outcomes for singleton pregnant women with cervical internal orifice dilation and CL≤15 mm without a history of spontaneous preterm delivery or late abortion.

Objective:To investigate the relationship between different states of cardiac function and their changes during the course of diabetic foot ulcers(DFU), and to evaluate their impact on patient prognosis.Methods:A retrospective analysis was conducted on 194 DFU patients who were rehospitalized at approximately 3-month intervals. Basic clinical data and cardiac function-related indicators were collected at baseline and follow-up. Patients were followed until death or until November 10, 2024. Outcomes including ulcer healing, recurrence, minor amputation, and death were recorded. Logistic regression models were used to analyze the effects of cardiac function status and its changes on these four outcomes. Results:After treatment, the proportion of patients with NYHA class Ⅱ-Ⅲ decreased significantly from 33.5% at baseline to 21.6%( P=0.009). Serum N-terminal pro-B-type natriuretic peptide(NT-proBNP) level also decreased after treatment compared with baseline [635.85(59.83, 453.28) pg/mL vs 728.67(81.48, 696.15) pg/mL, P=0.055]. Serum NT-proBNP level was significantly higher in the death group compared to the survival group( P=0.002). The proportion of DFU patients with baseline NYHA class Ⅱ-Ⅲ was significantly higher than that in those with class Ⅰ( P=0.012). Regression analysis showed that an improvement in NT-proBNP levels was associated with a lower risk of DFU recurrence( OR=0.378, 95% CI 0.183-0.779, P=0.008), and improvement in NYHA class was associated with a lower mortality risk( OR=0.074, 95% CI 0.020-0.275, P<0.001). Conclusion:Cardiac function status and its changes during the treatment of DFU patients have strong prognostic implications, particularly in predicting the risk of recurrence and death outcomes.

Objective:To construct a clinical decision-making ability indicator system based on evidence-based practice for pediatric nursing interns, and to provide a scientific basis for clinical teaching and evaluation.Methods:A method combining literature analysis, Delphi expert consultation, and empirical research was used. Firstly, a systematic search of Chinese and English databases (2018-2023) was conducted. Literature was screened based on the PICO framework and evidence-based data were extracted, resulting in a preliminary system consisting of 4 primary indicators, 12 secondary indicators, and 39 tertiary indicators. Subsequently, the indicators were revised through two rounds of Delphi expert consultation (25 experts with 19-27 years of work experience). The expert authority coefficients (Cr) were 0.898-0.907 and the Kendall's concordance coefficients were 0.351-0.420 ( P<0.001). Finally, the analytic hierarchy process was used to determine the weights, and the reliability and validity were verified through a questionnaire survey (sample size: 30 participants in preliminary survey and 58 participants in formal survey). Results:The constructed indicator system included 4 primary indicators (weights), 13 secondary indicators, and 42 tertiary indicators. The weights of the primary indicators were as follows: knowledge integration ability (0.300), evidence-based practice ability (0.250), clinical judgment ability (0.280), and ethical decision-making ability (0.170). The importance scores of all items exceeded 4.0 points (out of 5 points), and the coefficients of variation were less than 0.20. The reliability and validity tests showed that the Cronbach's α of the overall scale was 0.89, and the intraclass correlation coefficient was 0.88. The cumulative variance contribution rate of exploratory factor analysis was 69.30%. The confirmatory factor analysis demonstrated a good model fit with a comparative fit index of 0.93 and a root mean square error of approximation of 0.05. Conclusions:This indicator system has high scientificity and practicality, and can provide a reference for the standardized cultivation and evaluation of clinical decision-making ability of pediatric nursing interns. In the future, it is necessary to strengthen advanced evidence-based skills training and long-term application effectiveness tracking.

Objective To explore the effect of project-based learning on the training of sharp injury prevention skills in the pre-job training for nursing interns and its impact on the incidence of sharp injuries during internship.Methods Two classes(class A and B),majoring in nursing at Medical College of Nanchang Institute of Technology in March 2023 were selected as the research subjects by convenience sampling method.Coin flipping method was used to designate class A as the routine group and class B as the intervention group.The routine group received rou-tine pre-job training which mainly focused on retrospective intensive training on nursing operation skills.On this ba-sis,the intervention group integrated project-based learning as compensation education on sharp injury prevention skills.Kirkpatrick's four level training evaluation model was adopted to comprehensively evaluate the educational effectiveness at the four progressive levels of"reaction,learning,behavior,and outcome"at corresponding stages.Results 56 nursing interns were included in the class A routine group and class B intervention group,respectively.The course evaluation score(128.67±4.39 vs 117.28±6.55),needlestick protection knowledge cognition score(109.11±4.38 vs 96.44±6.72),safe injection behavior score(38.45±4.91 vs 32.30±5.62),occupational iden-tity score(58.02±8.55 vs 51.77±15.86),and job competency score(82.59±13.35 vs 75.61±15.09)of nursing interns in the intervention group were all higher than those in the routine group,differences were all statistically sig-nificant(all P＜0.05).The incidence of sharp injuries(19.64％ vs 57.14％)and the average frequency of occu-rrence(1.45 vs 2.13)in nursing interns in the intervention group were both lower than those in the control group.The case intervention rate(87.50％ vs 45.59％)and case reporting rate(93.75％vs 32.35％)after sharp injury were both higher than those in the routine group,and the differences were both statistically significant(both P＜0.05).Conclusion Introducing project-based learning in pre-job training for nursing interns can effectively improve their mastery of protection skills,reduce the incidence of sharp injuries during internships,and have important prac-tical value in cultivating their occupational protection abilities.

Aim To investigate the effects of edaravone(EDA)on depression-like behaviors in a rat model of post-stroke depression(PSD)and to explore the un-derlying mechanisms.Methods SD rats were ran-domly divided into:sham operation group(Sham),cerebral ischemia group(CI),post-stroke depression(PSD),fluoxetine(10 mg·kg-1)group,and EDA(5,15 mg·kg-1)group.A PSD rat model was estab-lished using the suture method combined with 56 d of chronic unpredictable mild stimulation.Drug treatment was given once daily for 28 d after stimulation.Body weight and sucrose water preference were measured during the stimulation period,and serum TNF-α,IL-1 β,IL-6,MDA,SOD levels,and hippocampal tissue HO-1 and GPX4 protein expression were detected at the end of stimulation.Results Compared with the sham group,the rat neurological function scores of the remaining groups increased(P＜0.01).Compared with the PSD group,EDA increased the body weight and sucrose water preference of the rats(P＜0.01),significantly decreased the serum TNF-α,IL-1β and IL-6 levels,decreased the MDA level,increased the SOD level(P＜0.01),and up-regulated hippocampal HO-1 and GPX4 protein expression(P＜0.01).Con-clusions EDA improves depression-like behaviors and inhibits peripheral inflammation and oxidative stress in-jury in PSD rats,and its mechanism may be related to the activation of HO-1/GPX4 pathway to inhibit oxida-tive stress.