BACKGROUND:Rheumatoid arthritis is widely prevalent worldwide,with its high incidence and universality that considerably affects patients' quality of life.Previous studies have focused on a few immune cells or cytokines,whereas this study comprehensively provides a more complete view of the immune mechanisms in rheumatoid arthritis.OBJECTIVE:To explore the causal relationship between 731 immune cell phenotypes and rheumatoid arthritis using the Mendelian randomization method,thereby providing evidence of causality.METHODS:The 731 immune cell phenotypes used in this study were sourced from the GWAScatalog database,jointly developed by the National Human Genome Research Institute(NHGRI)and the European Bioinformatics Institute(EBI).The rheumatoid arthritis data were from the Finngen database,developed by the Finnish Institute for Molecular Medicine(FIMM).The inverse variance weighting method was employed as the primary analytical approach.Additionally,multiple analytical methods,including MR-Egger,weighted mode,simple mode,and weighted median,were concurrently utilized to complement the final results.Sensitivity analyses(Cochran's Q test,MR-Egger regression,and MR-presso analysis)were also conducted to verify the stability and feasibility of the data.RESULTS AND CONCLUSION:(1)After excluding results through heterogeneity testing,the inverse variance weighting analysis indicated that 10 absolute cell counts,15 median fluorescence intensities of surface antigen levels,1 morphological characteristic,and 9 relative cell counts had a causal relationship with the occurrence of rheumatoid arthritis.(2)According to cell classification,this study found that seven types of B cells,seven types of classical dendritic cells,six types of mature T cells,four types of monocytes,three types of myeloid cells,three types of TBNK cells(lymphocyte subset T cells,B cells and natural killer cells),and five types of Tregs had a causal association with the occurrence of rheumatoid arthritis.(3)Through comprehensive bidirectional two-sample MR analysis,we demonstrated the complex causal relationships between multiple immune phenotypes and rheumatoid arthritis,highlighting the intricate interaction patterns between the immune system and rheumatoid arthritis.These results provide new biomarkers for the early screening and diagnosis of rheumatoid arthritis in China,and help to improve the diagnostic accuracy and sensitivity.

BACKGROUND:Rheumatoid arthritis is widely prevalent worldwide,with its high incidence and universality that considerably affects patients' quality of life.Previous studies have focused on a few immune cells or cytokines,whereas this study comprehensively provides a more complete view of the immune mechanisms in rheumatoid arthritis.OBJECTIVE:To explore the causal relationship between 731 immune cell phenotypes and rheumatoid arthritis using the Mendelian randomization method,thereby providing evidence of causality.METHODS:The 731 immune cell phenotypes used in this study were sourced from the GWAScatalog database,jointly developed by the National Human Genome Research Institute(NHGRI)and the European Bioinformatics Institute(EBI).The rheumatoid arthritis data were from the Finngen database,developed by the Finnish Institute for Molecular Medicine(FIMM).The inverse variance weighting method was employed as the primary analytical approach.Additionally,multiple analytical methods,including MR-Egger,weighted mode,simple mode,and weighted median,were concurrently utilized to complement the final results.Sensitivity analyses(Cochran's Q test,MR-Egger regression,and MR-presso analysis)were also conducted to verify the stability and feasibility of the data.RESULTS AND CONCLUSION:(1)After excluding results through heterogeneity testing,the inverse variance weighting analysis indicated that 10 absolute cell counts,15 median fluorescence intensities of surface antigen levels,1 morphological characteristic,and 9 relative cell counts had a causal relationship with the occurrence of rheumatoid arthritis.(2)According to cell classification,this study found that seven types of B cells,seven types of classical dendritic cells,six types of mature T cells,four types of monocytes,three types of myeloid cells,three types of TBNK cells(lymphocyte subset T cells,B cells and natural killer cells),and five types of Tregs had a causal association with the occurrence of rheumatoid arthritis.(3)Through comprehensive bidirectional two-sample MR analysis,we demonstrated the complex causal relationships between multiple immune phenotypes and rheumatoid arthritis,highlighting the intricate interaction patterns between the immune system and rheumatoid arthritis.These results provide new biomarkers for the early screening and diagnosis of rheumatoid arthritis in China,and help to improve the diagnostic accuracy and sensitivity.

Objective:To investigate the occurrence and influencing factors of oral frailty among the elderly in China.Methods:General information questionnaire,Oral Frailty Scale,Sarcopenia Screening Questionnaire(SARC-F),Social Network Scale-6(LSNS-6)and Subjective Cognitive Decline Questionnaire(SCD-Q9)were used to conduct a survey in Anhui Province.A survey was conducted among 3 063 elderly people to analyze their current status and influencing factors related to oral frailty.Results:The incidence of oral frailty among the elderly in Anhui Province was 46.82％(1434/3063).Binary logistic regression analysis showed sarcopenia(OR=8.742,95％CI:7.156-10.679),social isolation(OR=1.601,95％CI:1.313-1.953),and subjective cogni-tive decline(OR=2.424,95％CI:1.905-3.085),90 years old and above(OR=2.261,95％CI:1.304-3.922)and having disability(OR=1.341,95％CI:1.040～1.729)are risk factors for oral frailty in the elderly in Anhui Province.Conclusion:The incidence of oral frailty is high among the elderly in Anhui Province.Risk factors for oral frailty include sarcopenia,social isolation,subjective cognitive decline,advanced age,and disability.

Objective:To construct a home rehabilitation program for patients with rib fractures based on empowerment theory and to evaluate its application effects.Methods:Literature related to rehabilitation of rib fracture patients published between June 2013 and May 2023 was systematically retrieved. After literature screening, clinical investigation, and expert consultation, the final version of the home rehabilitation program based on empowerment theory was developed. A total of 102 rib fracture patients discharged from the Department of Thoracic and Cardiovascular Surgery, Beijing Friendship Hospital, Capital Medical University, between October 2023 and June 2024 were selected as research subjects. According to discharge sequence, 52 patients were assigned to the observation group and 50 patients to the control group. The control group received routine health education and discharge follow-up, while the observation group received the empowerment theory-based home rehabilitation program. Pain levels, pulmonary function [forced vital capacity (FVC) , forced expiratory volume in 1 second (FEV1) ] , and exercise compliance were assessed at discharge and at 2, 4, 8, and 12 weeks post-discharge. Complication incidence and readmission rates were recorded and compared at 12 weeks after discharge.Results:At 4, 8, and 12 weeks post-discharge, pain scores in the observation group were lower than those in the control group, whereas FVC and FEV1 were higher; the differences were all statistically significant ( P<0.05) . At 12 weeks post-discharge, the incidence of complications and unplanned readmission rates in the observation group were lower than those in the control group, the exercise compliance score was higher, and the differences were all statistically significant ( P<0.05) . Conclusions:The home rehabilitation program for rib fracture patients constructed based on empowerment theory can reduce pain during home rehabilitation, promote recovery of pulmonary function, improve exercise compliance, and decrease the incidence of complications and unplanned readmissions.

Objective:To explore the kinesiophobia-associated with dyspnea belief in patients with rib fractures and analyze its influencing factors.Methods:Convenience sampling was used to select 385 patients with rib fractures treated at Beijing Friendship Hospital, Capital Medical University, from January 2023 to December 2024 as study subjects. All patients were enrolled on day 5 after treatment, and the Breathlessness Beliefs Questionnaire (BBQ) was used to assess the dyspnea belief-associated kinesiophobia. Patients were divided into a negative group (BBQ score≤23) and a positive group (BBQ score≥24) for kinesiophobia. Logistic regression analysis was employed to investigate the factors influencing dyspnea belief-associated kinesiophobia.Results:The BBQ score for 385 patients was (29.47±7.33). A total of 218 patients experienced dyspnea belief-associated kinesiophobia, with an incidence of 56.62%. Patients in negative group and positive group for kinesiophobia showed statistically significant differences in gender, educational attainment, fracture time, fracture location, number of fractured ribs, presence of concomitant hemothorax/pneumothorax, pain, perceived burden, and post-traumatic stress disorder ( P<0.05). Logistic regression analysis showed that fracture time ( OR=0.640), fracture location ( OR=3.195), presence of concomitant hemothorax/pneumothorax ( OR=2.025), pain ( OR=2.498), self-perceived burden ( OR=1.202), and post-traumatic stress disorder ( OR=1.091) were the influencing factors of dyspnea belief-associated kinesiophobia ( P<0.05) . Conclusions:Patients with rib fractures exhibit high levels and incidence of dyspnea belief-associated kinesiophobia. Targeted management should be carried out for rib fracture patients with early-stage fractures, bilateral fractures, combined pneumothorax and pain, high levels of self-perceived burden and post-traumatic stress disorder.

Objective To develop a quality evaluation indicator system for"Internet+indwelling tubes home nursing services"for a standardised evaluation process.Methods Based on the structure-process-outcome(SPO)model,a quality assessment indicator system for"Internet+indwelling tubes home nursing services"was developed.This system was refined via a comprehensive literature review,semi-structured interviews,clinical expertise,and a two-round Delphi consultation involving 20 experts from clinical nursing,nursing management,human resource management,public health and information technology.Results The effective recovery rate from both rounds of Delphi consultation was 100.00%.The authority coefficients for two-rounds of expert consultation were both at 0.785.Kendall's W coefficients for secondary indicators were 0.201 and 0.280,and 0.214 and 0.226 for tertiary indicators,all were statistically significant(P<0.05).After 2 rounds of expert consultation,the system demonstrated strong reliability:mean importance weights for all indicators exceeded 4.0,coefficients of variation were below 0.2,and full score rates included or surpassed 20%.The finalised quality evaluation indicator system for"Internet+indwelling tubes home nursing services"included 3 primary indicators(allocation of pipeline nursing service resources,implementation of pipeline nursing service resources,and feedback on the effectiveness of pipeline nursing service resources),12 secondary indicators,and 70 tertiary indicators.Conclusion The quality evaluation indicator system for"Internet+indwelling tubes home nursing services"developed in this study is scientifically reliable,practical and applicable for evaluation of the quality of"Internet+"pipeline home nursing services.

Objective To develop a quality evaluation indicator system for"Internet+indwelling tubes home nursing services"for a standardised evaluation process.Methods Based on the structure-process-outcome(SPO)model,a quality assessment indicator system for"Internet+indwelling tubes home nursing services"was developed.This system was refined via a comprehensive literature review,semi-structured interviews,clinical expertise,and a two-round Delphi consultation involving 20 experts from clinical nursing,nursing management,human resource management,public health and information technology.Results The effective recovery rate from both rounds of Delphi consultation was 100.00%.The authority coefficients for two-rounds of expert consultation were both at 0.785.Kendall's W coefficients for secondary indicators were 0.201 and 0.280,and 0.214 and 0.226 for tertiary indicators,all were statistically significant(P<0.05).After 2 rounds of expert consultation,the system demonstrated strong reliability:mean importance weights for all indicators exceeded 4.0,coefficients of variation were below 0.2,and full score rates included or surpassed 20%.The finalised quality evaluation indicator system for"Internet+indwelling tubes home nursing services"included 3 primary indicators(allocation of pipeline nursing service resources,implementation of pipeline nursing service resources,and feedback on the effectiveness of pipeline nursing service resources),12 secondary indicators,and 70 tertiary indicators.Conclusion The quality evaluation indicator system for"Internet+indwelling tubes home nursing services"developed in this study is scientifically reliable,practical and applicable for evaluation of the quality of"Internet+"pipeline home nursing services.

Objective:To construct a home rehabilitation program for patients with rib fractures based on empowerment theory and to evaluate its application effects.Methods:Literature related to rehabilitation of rib fracture patients published between June 2013 and May 2023 was systematically retrieved. After literature screening, clinical investigation, and expert consultation, the final version of the home rehabilitation program based on empowerment theory was developed. A total of 102 rib fracture patients discharged from the Department of Thoracic and Cardiovascular Surgery, Beijing Friendship Hospital, Capital Medical University, between October 2023 and June 2024 were selected as research subjects. According to discharge sequence, 52 patients were assigned to the observation group and 50 patients to the control group. The control group received routine health education and discharge follow-up, while the observation group received the empowerment theory-based home rehabilitation program. Pain levels, pulmonary function [forced vital capacity (FVC) , forced expiratory volume in 1 second (FEV1) ] , and exercise compliance were assessed at discharge and at 2, 4, 8, and 12 weeks post-discharge. Complication incidence and readmission rates were recorded and compared at 12 weeks after discharge.Results:At 4, 8, and 12 weeks post-discharge, pain scores in the observation group were lower than those in the control group, whereas FVC and FEV1 were higher; the differences were all statistically significant ( P<0.05) . At 12 weeks post-discharge, the incidence of complications and unplanned readmission rates in the observation group were lower than those in the control group, the exercise compliance score was higher, and the differences were all statistically significant ( P<0.05) . Conclusions:The home rehabilitation program for rib fracture patients constructed based on empowerment theory can reduce pain during home rehabilitation, promote recovery of pulmonary function, improve exercise compliance, and decrease the incidence of complications and unplanned readmissions.

Objective:To explore the kinesiophobia-associated with dyspnea belief in patients with rib fractures and analyze its influencing factors.Methods:Convenience sampling was used to select 385 patients with rib fractures treated at Beijing Friendship Hospital, Capital Medical University, from January 2023 to December 2024 as study subjects. All patients were enrolled on day 5 after treatment, and the Breathlessness Beliefs Questionnaire (BBQ) was used to assess the dyspnea belief-associated kinesiophobia. Patients were divided into a negative group (BBQ score≤23) and a positive group (BBQ score≥24) for kinesiophobia. Logistic regression analysis was employed to investigate the factors influencing dyspnea belief-associated kinesiophobia.Results:The BBQ score for 385 patients was (29.47±7.33). A total of 218 patients experienced dyspnea belief-associated kinesiophobia, with an incidence of 56.62%. Patients in negative group and positive group for kinesiophobia showed statistically significant differences in gender, educational attainment, fracture time, fracture location, number of fractured ribs, presence of concomitant hemothorax/pneumothorax, pain, perceived burden, and post-traumatic stress disorder ( P<0.05). Logistic regression analysis showed that fracture time ( OR=0.640), fracture location ( OR=3.195), presence of concomitant hemothorax/pneumothorax ( OR=2.025), pain ( OR=2.498), self-perceived burden ( OR=1.202), and post-traumatic stress disorder ( OR=1.091) were the influencing factors of dyspnea belief-associated kinesiophobia ( P<0.05) . Conclusions:Patients with rib fractures exhibit high levels and incidence of dyspnea belief-associated kinesiophobia. Targeted management should be carried out for rib fracture patients with early-stage fractures, bilateral fractures, combined pneumothorax and pain, high levels of self-perceived burden and post-traumatic stress disorder.

Objective The aim of this study is to discuss the causal relationship between periodontal disease(PD)and prostate cancer(PCa).Methods A two-sample bidirectional Mendelian randomization(MR)analysis based on publicly statistical data from genome-wide association studies(GWAS)was conducted.MR Egger,weighted medium,simple mode and weighted mode were supplemented,while inverse variance weighted analysis(IVW)was the main method of analysis.Heterogeneity testing,pleiotropy testing and leave-one-out testing were used to assess the sensitivity and stabili-ty.Results The results of MR analysis showed that PD had no significant impact on the occurrence of PCa:East Asian(IVW,PD:OR=1.07,P=0.48);European(IVW,PD:OR=1.00,P=0.37,periodontitis:OR=1.03,P=0.14,chronic gingivitis:OR=0.99,P=0.37,chronic periodontitis:OR=1.03,P=0.22).The reverse MR analysis also did not show a causal relationship between PCa and PD:East Asian(IVW,PD:OR=0.97,P=0.22);European(IVW,PD:OR=0.84,P=0.44,periodontitis:OR=1.01,P=0.75,chronic gingivitis:OR=0.93,P=0.23,chronic periodontitis:OR=0.99,P=0.80).The results of other analysis were consistent with those of IVW analysis.Conclusions The results of our two-sample bidirectional MR analysis do not support a causal relationship between PD and PCa.