Objective:The obesity rate among middle-aged and young adults in China is increasing annually,and the incidence of cardiovascular diseases is becoming more prevalent in younger populations.However,it has not yet been reported whether obesity is associated with early vascular aging(EVA).This study aims to explore the correlation between obesity and EVA in middle-aged and young adult health check-up populations,providing a reference for the prevention of cardiovascular diseases. Methods:A total of 15 464 middle-aged and young adults aged 18-59 who completed brachial-ankle pulse wave velocity(baPWV)test in the Third Xiangya Hospital of Central South University from January to December 2020 were included.Among them,1 965 individuals with normal blood pressure and no cardiovascular risk factors were selected as the healthy population.The baPWV thresholds for determining EVA in each age group for males and females were calculated based on the baPWV values of the healthy population.The number and percentage of individuals meeting the EVA criteria in the middle-aged and young adult health check-up populations were statistically analyzed by age and gender.The differences in obesity indicators[visceral adiposity index(VAI),body mass index(BMI),waist circumference(WC)]between the EVA and non-EVA groups for males and females were compared.Using EVA as the dependent variable,VAI,BMI,and WC were included as independent variables in a Logistic model to analyze the correlation between each obesity indicator and EVA before and after adjusting for other influencing factors.Furthermore,the correlation between each obesity indicator and EVA in each age group was analyzed. Results:In the health check-up populations,the detection rate of EVA in different age groups was 1.65%-10.92%for males,and 1.16%-10.50%for females,the detection rate of EVA increased with age in both males and females.Except for the 40-<50 age group,the EVA detection rate was higher in males than in females in all other age groups.Regardless of gender,obesity indicators VAI,BMI,and WC were significantly higher in the EVA group than in the non-EVA group(all P<0.01).Before and after adjusting for other influencing factors,VAI and WC were both correlated with EVA(both P<0.05).BMI was a risk factor for EVA before adjusting for other influencing factors(P<0.01),but after adjustment,the correlation between BMI and EVA was not statistically significant(P=0.05).After adjusting for other influencing factors,the correlation between VAI and EVA was statistically significant in the 18-<40 and 50-<60 age groups(both P<0.05),while the correlation between BMI and WC with EVA was not statistically significant(both P>0.05).In the 40-<50 age group,the correlation between VAI and BMI with EVA was not statistically significant(both P>0.05),but the correlation between WC and EVA was statistically significant(P<0.01). Conclusion:VAI is closely related to the occurrence of EVA in middle-aged and young adults aged 18-<40 and 50-<60 years,while WC is closely related to the occurrence of EVA in those aged 40-<50 years.

Objective: This study aimed to determine the predictive performance of non-contrast CT (NCCT) signs for hemorrhagic growth after intracerebral hemorrhage (ICH) when stratified by onset-to-imaging time (OIT). Materials and Methods: 1488 supratentorial ICH within 6 h of onset were consecutively recruited from six centers between January 2018 and August 2022. NCCT signs were classified according to density (hypodensities, swirl sign, black hole sign, blend sign, fluid level, and heterogeneous density) and shape (island sign, satellite sign, and irregular shape) features. Multivariable logistic regression was used to evaluate the association between NCCT signs and three types of hemorrhagic growth: hematoma expansion (HE), intraventricular hemorrhage growth (IVHG), and revised HE (RHE). The performance of the NCCT signs was evaluated using the positive predictive value (PPV) stratified by OIT. Results: Multivariable analysis showed that hypodensities were an independent predictor of HE (adjusted odds ratio [95% confidence interval] of 7.99 [4.87–13.40]), IVHG (3.64 [2.15–6.24]), and RHE (7.90 [4.93–12.90]). Similarly, OIT (for a 1-h increase) was an independent inverse predictor of HE (0.59 [0.52–0.66]), IVHG (0.72 [0.64–0.81]), and RHE (0.61 [0.54– 0.67]). Blend and island signs were independently associated with HE and RHE (10.60 [7.36–15.30] and 10.10 [7.10–14.60], respectively, for the blend sign and 2.75 [1.64–4.67] and 2.62 [1.60–4.30], respectively, for the island sign). Hypodensities demonstrated low PPVs of 0.41 (110/269) or lower for IVHG when stratified by OIT. When OIT was ≤ 2 h, the PPVs of hypodensities, blend sign, and island sign for RHE were 0.80 (215/269), 0.90 (142/157), and 0.83 (103/124), respectively. Conclusion Hypodensities, blend sign, and island sign were the best NCCT predictors of RHE when OIT was ≤ 2 h. NCCT signs may assist in earlier recognition of the risk of hemorrhagic growth and guide early intervention to prevent neurological deterioration resulting from hemorrhagic growth.

Objective:To find the preferences of nursing staff when they provide " Internet + nursing service" for elderly patients.Methods:By means of the discrete choice experiment, a questionnaire was designed to investigate the preferences of nursing staff when they provide " Internet + nursing services" for elderly patients. In-service nursing staff from 8 medical and health institutions in Ningbo city and Wenzhou city were selected by random sampling, for an online questionnaire survey conducted from May to June 2022. The preferences of nursing staff on their service income, service content, service distance, service continuity and residence status of elderly patients when providing " Internet + nursing service" were analyzed by mixed logit regression.Results:A total of 420 valid questionnaires were collected. Compared to 50 yuan/order, nursing staff preferred to a price of 150 yuan/order ( β= 1.22, P<0.001) nursing services; Compared to specialized nursing services, nursing staff preferred to the routine care ( β= 0.86, P<0.001) and health promotion ( β= 0.86, P<0.05) service; Compared to<5 km, nursing staff were unwilling to provide nursing services for elderly patients at distances of 5-10 km and 11-15 km ( β=-0.66, P<0.05; β=-0.95, P<0.001) ; Compared to 1-2 visits per month, nursing staff preferred not to provide continuing care services ( β=-0.70, P<0.05); Compared to homestay with the patient family, nursing staff preferred to provide nursing services for elderly patients residing in nursing homes ( β= 1.21, P<0.001) . Conclusions:Considering the preference of nursing staff tend to provide " Internet + nursing service" for the elderly patients with services featuring appropriate price, non-specialist care, close distance, low continuity (moderate intensity used as the reference) and security assurance for practice.

Objective:To investigate the current situation and analyze the influencing factors of job satisfaction of infectious disease physicians in Jiangsu Province.Methods:From April to May 2021, a stratified random sampling method was used to select 10 municipal level infectious disease hospitals in Jiangsu province. An electronic questionnaire survey was conducted on the infectious disease physicians of these hospitals using an online questionnaire platform. The questionnaire mainly included the job satisfaction scale developed by Greenhaus and Wormley, and a self-designed job satisfaction influencing factor scale based on resource conservation theory. At the same time, semi-structured interviews were made with relevant insiders on such issues as salary and benefits, and career development among others. Descriptive analysis was conducted on the questionnaire data, while single factor analysis and multiple linear regression analysis were used to identify the factors that affect their job satisfaction, and the results of the interviews were studied with Colaizzi 7-step analysis.Results:A total of 457 valid questionnaires were recovered. The job satisfaction score of infectious disease physicians was (3.38±0.76). The results of univariate analysis showed significant differences in job satisfaction scores among infectious disease physicians of different ages, educational backgrounds, professional titles, and positions. The results of multiple linear regression analysis showed that salary and benefits ( B=0.141, P<0.001), work environment ( B=0.128, P<0.001), leadership support ( B=0.112, P=0.014), development security ( B=0.117, P<0.001), self-efficacy ( B=0.084, P=0.045) and social support ( B=0.285, P<0.001) were both influencing factors of their job satisfaction. The interview results identified such problems as low salary, insufficient salary security, large gap in social security levels between in-staff and off-staff physicians, and insufficient career development potential. Conclusions:The job satisfaction of infectious disease physicians in Jiangsu Province was found at an average level. It is recommended that the government increase the investment in personnel expenses for infectious disease physicians, optimize the salary and benefits structure, pay attention to the career development needs of middle-aged and young physicians, and care about the social relationship needs of infectious disease physicians to improve their job satisfaction.

Objective:To investigate the role of modification level of lysine trimethylation at position 27 of histone 3 (H3K27me3) on expression of anti-apoptotic protein B lymphocyte tumor-2 gene (BCL2) during arsenic-induced hepatocyte apoptosis.Methods:Rat liver BRL-3A cells were cultured in vitro. According to the arsenic treatment factor, the experiment was divided into two parts, in the first part arsenic was not added, the experiment was divided into normal, transfection reagent, negative transfection, H3K27me3 specific demethylase (JMJD3) small interfering RNA (siRNA) transfection and H3K27me3 methyltransferase (EZH2) siRNA transfection groups. In the second part arsenic was added, the experiment was divided into control, arsenic treatment, arsenic + negative transfection, arsenic + JMJD3siRNA transfection and arsenic + EZH2siRNA transfection groups. When arsenic was not added, the corresponding siRNA and transfection reagent was used to transfect cells at a ratio of 100 pmol : 7.5 μl for 6 h [the normal group was treated with phosphate buffer solution (PBS) of the same volume as transfection reagent], then the medium was changed and the cells were incubated for a total of 48 h. After 24 h of treatment with the above transfection and culture method in arsenic added group, a final concentration of 30 μmol/L sodium arsenite (NaAsO 2) was added and the cells were incubated for 24 h (the control group was treated with PBS with the same volume of NaAsO 2 for 24 h). Real-time cell analysis (RTCA) was used to measure the proliferation of BRL-3A cells in arsenic added group. Apoptosis of BRL-3A cells was analyzed by flow cytometry in arsenic added group. Western blotting was used to detect JMJD3, EZH2, H3K27me3 and BCL2 in no-arsenic and arsenic-added BRL-3A cells. The modification levels of H3K27me3 in BCL2 gene promoter regions were detected by chromatin immunoprecipitation of the cells exposed to arsenic. Results:There were statistically significant differences of the proliferation rates [control, arsenic treatment, arsenic + negative transfection, arsenic + JMJD3siRNA transfection and arsenic + EZH2siRNA transfection groups: (100.00 ± 10.43)%, (12.19 ± 3.37)%, (31.86 ± 1.95)%, (24.58 ± 3.64)%, (11.53 ± 1.11)%] and the apoptosis rates [(1.15 ± 0.04)%, (13.06 ± 1.33)%, (17.39 ± 0.22)%, (23.90 ± 1.66)%, (15.07 ± 0.88)%] between groups ( F = 146.50, 194.30, P < 0.001), correspondingly. The protein expression level of H3K27me3 in JMJD3siRNA transfection group was higher than that of normal, transfection reagent and negative transfection groups, while EZH2siRNA transfection group had an opposite result ( P < 0.05). The protein expression level of BCL2 in JMJD3siRNA transfection group was lower than that of normal, transfection reagent and negative transfection groups, while EZH2siRNA transfection group had an opposite result ( P < 0.05). The protein expression levels of H3K27me3 and BCL2 were not statistically significant differences between normal, transfection reagent and negative transfection groups ( P > 0.05). The protein expression levels of JMJD3, EZH2, H3K27me3 and BCL2 among control, arsenic treatment, arsenic + negative transfection, arsenic + JMJD3siRNA transfection and arsenic + EZH2siRNA transfection groups were compared, and the differences were statistically significant ( F = 26.56, 7.82, 9.81, 31.19, P < 0.05). Compared with control group, the protein expression levels of JMJD3 and EZH2 in arsenic treatment group were significantly reduced ( P < 0.05), and the protein expression level of H3K27me3 was higher ( P < 0.05), meanwhile the protein expression level of BCL2 was lower ( P < 0.05). Compared with arsenic + negative transfection group, the protein expression level of JMJD3 was significantly reduced in arsenic + JMJD3siRNA group, and the protein expression level of EZH2 was significantly reduced in arsenic + EZH2siRNA group ( P < 0.05). In addition, arsenic + JMJD3siRNA increased the level of H3K27me3 modification while reducing the protein expression of BCL2, while arsenic + EZH2siRNA had an opposite result ( P < 0.05). Compared with control group, the enrichment levels of H3K27me3 in BCL2 gene promoter regions (CHIP1 and CHIP2) in arsenic treatment group were significantly higher ( P < 0.05). Conclusion:Arsenic may inhibit the expression of BCL2 by increasing the enrichment level of H3K27me3 in the promoter regions of BCL2 gene, and promoting hepatocyte apoptosis.

Objective:To study the clinical characteristics and etiological distribution characteristics of plastic bronchitis in children, analyze its early warning indicators, and evaluate the clinical diagnosis and treatment effect of flexible bronchoscopy.Methods:The clinical data of 232 children with severe pneumonia admitted to Guiyang Maternal and Child Health Hospital from January 2019 to February 2021 were retrospectively analyzed.The children were divided into the plastic bronchitis group and non-plastic bronchitis group according to bronchoscopic results.The gender, age, clinical manifestations, auxiliary examinations, imaging features, bronchoscopy findings and treatment of the children were collected, compared and analyzed, comparison between two groups by t test and χ2 test. Results:A total of 232 children were included in this study, including 98 cases in the plastic bronchitis group and 134 cases in the non-plastic bronchitis group.The main symptoms of both groups were fever, cough and shortness of breath.The age of onset in the plastic bronchitis group was (54.640±37.085) months, and the age of onset in the non-plastic bronchitis group was (14.870±19.813) months.The difference in the age of onset between the two groups was statistically significant ( t=9.656, P<0.001). The average hospitalization days of the plastic and non-plastic bronchitis groups were (16.133±6.227) d and (12.690±4.287) d, respectively.Significant difference was found in the average hospitalization days between the two groups ( t=4.721, P<0.001). The average fever days of the plastic bronchitis group were (10.090±3.473) d, and the average fever days of the non-plastic bronchitis group were (6.030±4.850) d. There was significant difference in the average fever days between the two groups ( t=5.654, P<0.001). The age of onset, hospitalization days, and fever days of the plastic bronchitis group were larger than those of the non-plastic bronchitis group (all P<0.001). The physical examination suggested that 40% (39/98) of patients in the plastic bronchitis group had reduced the breath sounds, and this percentage was significantly higher than that in the non-plastic bronchitis group[6%(8/134)]. The plastic bronchitis group had lower partial pressure of blood oxygen (PO 2) and oxygen saturation (SO 2) levels than the non-plastic bronchitis group (all P<0.01). The plastic bronchitis group had a higher percentage of neutrophils (N), C-reactive protein (CRP) level, procalcitonin (PCT) level, lactate dehydrogenase (LDH) level and D-dimer level than the non-plastic bronchitis group (all P<0.01). According to the imaging results, in the plastic bronchitis group, lung consolidation was found in 72 cases (73%, 72/98), atelectasis in 32 cases (33%, 32/98), and pleural effusion in 33 cases (34%, 33/98). In the non-plastic bronchitis group, 65%(87/134) cases had lung consolidation, 5%(7/134) cases had atelectasis, 3.7% (5/134) cases had pleural effusion.The first pathogen detected in 46.9% of the patients in the plastic bronchitis group was Mycoplasma pneumoniae (MP), and the percentage was significantly higher that in the non-plastic bronchitis group (11.1%). Flexible bronchoscopy was performed on both groups at their admission.The plastic bronchitis group received the flexible bronchoscopy check for (2.960±1.157) times on average, and the non-plastic bronchitis group was tested for (1.140±0.371) times on average.Of 98 children in the plastic bronchitis group, 95 cases were improved and discharged, 2 cases were transferred, and 1 case died.All 134 children in the non-plastic bronchitis group were improved and discharged. Conclusions:Preschool and school-age children, fever ≥10 d, PCT, CRP, LDH, D-dimer levels are early warning signs of plastic bronchitis clinically.MP is still the primary pathogen causing plastic bronchitis.Flexible bronchoscopy technique is a key measure for timely diagnosis and effective treatment of plastic bronchitis.

Objective:To examine the influencing factors of endothelial injury using the structural equation model (SEM).Methods:A total of 6 861 asymptomatic individuals free of cardiovascular disease underwent health examinations at the health management center of the third Xiangya hospital, Central South University from May 2015 to August 2020. And collected their questionnaire and checkup data. Spearman′s rank correlation coefficient was used to analyze metabolic factors and brachial artery flow-mediated dilatation (FMD). Exploratory factor analysis (3 430/6 861) and confirmatory factor analysis (3 431/6 861) were conducted on the diet items. An SEM was constructed using the diet pattern data, cardiovascular risk factors and FMD, and using multi-path regression analysis to determine the correlation between the indicators.Results:Based on the factor analysis, diet items were divided into three patterns: healthy food, meat, and supplementary food. The SEM indicated that age ( β=0.27) and blood pressure ( β=0.12) had obvious effects on low FMD. Triglyceride ( β=0.03), fasting blood glucose ( β=0.04), and body mass index ( β=0.08) were positively correlated with low FMD. On the upstream, healthy food was negatively correlated with blood pressure ( β=-0.04) and body mass index ( β=-0.04), meat was positively correlated with triglyceride ( β=0.33), blood pressure ( β=0.06), fasting blood glucose ( β=0.20), and body mass index ( β=0.16), and supplementary food was negatively correlated with fasting blood glucose ( β=-0.30). This was the only pattern that was directly correlated with FMD ( β=0.05). Conclusions:SEM is an effective method to analyze the influence of various risk factors on the population and the relationship between individual indicators. This study revealed direct and indirect correlations between age, diet pattern, cardiovascular-metabolic risk, and FMD impairment. Comprehensive control of dietary patterns and metabolic indicators could prevent and improve early cardiovascular injury.

Objective:To investigate the current situation of the " Internet plus nursing services" for the elderly in Ningbo, and evaluate the promotion effect of the pilot policy, for reference to further optimize such service policy of China nationwide.Methods:The data came from the orders for " Internet plus nursing services" by elderly users over 60 years on the " cloud hospital" platform in Ningbo from 2016 to 2021. Descriptive analysis was used to study major demographic information, types of service items and number of person-times of the elderly users; The promotion effect of the pilot policy on " Internet plus nursing services" for the elderly in 2019 was analysed by Chow test.Results:The number of elderly users increased from 76 person-times in 2016 to 5 923 person-times in 2021, accumulating up to 12 209 person-times. The number of nursing service items increased from 18 in 2016 to 36 in 2021. The person-times of users of common clinical nursing and specialized nursing service items were 11 850 and 359 respectively. After the pilot policy was issued, the number of service items and the number of users were significantly increased in 2020( P<0.05). Conclusions:The development of " Internet plus nursing services" for the elderly in Ningbo had achieved certain results, especially with the promotion of the pilot policy in 2019, the types of service items and the number of elderly users had increased year by year. In the future, we should continue to focus on the elderly living alone and other special elderly groups with the support of relevant policies, further expand the scale of elderly users, improve the types of service items, and optimize the charging standards to help China′s healthy aging process.

Objective: To understand physical development of children aged 7 to 12 in the oroqen autonomous banner experimental primary school in the oroqen settlement area from 2013 to 2018, and to provide scientific basis for their physical fitness and health. Methods: According to the standards of "National Student Physical Health Standards (2014 Revised Edition)" and the standards of "Overweight and Obesity Screening for School age Children and Adolescents" issued by the National Health and Family Planning Commission in 2018, the Oroqen Autonomous Banner Experimental Primary School was 7-12 years old. The average value and growth rate of children s height, weight and BMI in the past 6 years. Results: From 2013 to 2018, the height and weight of boys and girls aged 7 to 12 showed an increasing trend, with height growth values of boys were 1.8,1.7,1.9,2.6,5.7,5.9 cm,girls were 2.8,4.5,1.9,1.8,3.6,2.9 cm.And the weight groups values of boys were 2.2,2.5,5.1,6.3,6.4,7.2 kg,girls were 2.4,3.6,3.1,1.3,4.6,3.0 kg. The growth rate of girls aged 7 to 8 was higher than that of boys, and the growth rate of boys aged 9 to 12 was higher than that of girls. With the increase of age, the average BMI of boys and girls aged 7 to 12 showed an upward trend, and the BMI of boys of the same age was always higher than that of girls. Among them, the average BMI of boys aged 7 to 12 in 2018 exceeded the critical value of overweight BMI. Conclusion The physical shape of children aged 7-12 years increases with age, but the development tends to be overweight and obese, which is related to the natural environment of life, lifestyle, and reduction in physical activity.

Objective:To investigate the current situation of students' academic procrastination behavior in medical colleges and universities and its influencing factors, and to put forward suggestions to reduce the academic procrastination of medical students.Methods:A total of 1 327 undergraduate students from three medical colleges and universities in Heilongjiang Province were randomly selected to receive questionnaire investigation on life satisfaction, anxiety, and academic procrastination. SPSS 23.0 was used for data analysis.Results:①The total procrastination scores of medical students were (35.00±8.92) points. ②There were statistical differences in the academic procrastination of medical students with different genders, whether the only children, the reasons for choosing the major, and the level of achievement ( P < 0.05). There was no statistical difference in academic procrastination among medical students of different ages and grades ( P > 0.05). ③Medical students' procrastination was positively correlated with their anxiety level ( r = 0.102, P < 0.01), and negatively correlated with life satisfaction ( r = -0.117, P < 0.01). ④Regression analysis showed that the following six predictive variables including the level of achievement, gender, life satisfaction, anxiety, reasons for choosing the major, and whether the only children could effectively explain the variance of 14.2% academic procrastination of medical students. Conclusion:The overall degree of academic procrastination of medical students is higher than that of non-medical students. And the students' achievement level, gender, life satisfaction, anxiety, the reasons for choosing this major and whether the only child are the influencing factors of academic procrastination.