Objective To explore the sleep quality and mental fatigue level in elderly patients with cerebrovascular small disease(CSVD).Methods A total of 222 patients aged over 65 years old hospitalized due to chronic diseases in Department of Neurology of the Affiliated Jiangning Hospi-tal of Nanjing Medical University from August 2022 to June 2024 were recruited prospectively and continuously.According to the CSVD score,they were divided into a CSVD group(CSVD score≥1,148 cases)and a non-CSVD group(CSVD score=0,74 cases).All the patients were evaluated by sleep quality,fatigue and neuropsychological scale when they were fully cooperated and in good condition.Subsequently,the patients in the CSVD group were further assigned into a good sleep subgroup(117 cases)and a poor sleep subgroup(31 patients).Results The CSVD group had significantly higher total score of Pittsburgh sleep quality index(PSQI),sleep quality score,sleep disturbance score,total score of self-rating fatigue,and mental fatigue score than the non-CSVD group(P＜0.01).The sleep quality score,sleep disturbance score,and mental fatigue score were risk factors for CSVD(P＜0.05).The mental fatigue score was significantly higher in the CSVD patients with poor sleep than those with good sleep(4.13±1.15 vs 2.50±1.92,P＜0.01).Conclusion Elderly CSVD patients were more likely to have decreased sleep quality and mental fatigue,and among them,those with poor sleep quality are prone to having mental fatigue than those with good sleep.

Objective:To systematically analyze the promoting and hindering factors of physical activity during chemotherapy for children with cancer by Meta-synthesis method, so as to provide a basis for the subsequent formulation of scientific and standardized physical activity strategies.Methods:Databases of PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, China National Knowledge Infrastructure, Wanfang Database, VIP database and China Biomedical Literature Database were retrieved on qualitative research about the experiences of physical activity in children with cancer during chemotherapy and the caregivers′ perceptions of the factors influencing physical activity in children with cancer. The retrieval period is from the establishment of the databases to January 31, 2024. The quality of the literature was evaluated according to Joanna Briggs Institute Evidence Based Healthcare Center Critical for qualitative studies in Australia. The pooled integration method was used to Meta-synthesis the research results such as research topic, implicit meaning and classification.Results:A total of 7 studies were included, and 26 research results were obtained through Meta-synthesis, similar research results were classified into 7 new categories, and finally 2 integrated results were formed:the hindering factors of physical activity in children with cancer during chemotherapy; the promoting factors of physical activity in children with cancer during chemotherapy.Conclusions:During hospitalization for chemotherapy in children with cancer, health care professionals should pay attention to the positive impact of physical activity on children, strive to overcome the obstacles to physical activity, and formulate a scientific and personalized physical activity strategy in combination with each child′s unique condition and personal needs.

Programmed cell death is an important defense mechanism of the body, which monitors internal lesions and defends external infections to maintain the stability of the body.In the past, there were two main types of cell death: apoptosis and necrosis.With the development of scientific research, new cell death modes, such as pyroptosis and ferroptosis, have attracted much attention and are involved in the occurrence and development of diabetic retinopathy (DR).Many pathogenic factors, such as oxidative stress, hyperglycemia and inflammation, lead to the death of retinal cells in different ways, such as apoptosis, pyroptosis and ferroptosis.Apoptosis is the earliest pathological response of DR, which occurs at the initial stage of oxidative stress, and the integrity of cell membranes is maintained at the early stage of apoptosis.Apoptotic cells are cleared by phagocytes in the tissue before dissolution, which avoids unnecessary inflammation.Pyroptosis is activated by Caspase-1, then cleaves GSDMD, which can lead to pore formation and osmotic cell lysis, resulting in inflammation and immune response.Ferroptosis involves lipid peroxidation and abnormal iron homeostasis.Lipid peroxidation and glutathione depletion are the main markers of ferroptosis.The three cell death modes are independent and interrelated, and play a role in the occurrence and development of diseases together with other cell death modes.This article reviews the current status of cell apoptosis, pyroptosis and ferroptosis in DR.

Objective:To conduct a systematic review of reported cases of autosomal dominant tubulointerstitial kidney disease (ADTKD) caused by uromodulin ( UMOD) gene mutations (ADTKD- UMOD) in China, summarize the clinical, pathological and genetic variation characteristics, and analyze the genotype-phenotype correlation. Methods:It was a retrospective systematic analysis study. The search terms "UMOD", "ADTKD-UMOD", "uric acid kidney disease (UAKD)", "medullary cystic kidney disease type 2 (MCKD2)", and "familial juvenile hyperuricemic nephropathy type 1 (FJHN1)" were used, and relevant literature on ADTKD- UMOD cases in China were retrieved from PubMed, CNKI, Wanfang Data and Chinese Medical Journal Full-text Database. The data of the cases involved in the literature were collected and summarized, and the clinical and pathological characteristics and genetic variation features of Chinese ADTKD- UMOD patients were analyzed. The patients were divided into exon 3 mutation group and non-exon 3 mutation group based on the mutation sites, and the differences of clinical phenotypes between the two groups were compared. The patients were also divided into domain 8 cysteine (D8C) mutation group and non-D8C mutation group based on the mutation regions, and the differences of clinical phenotypes between the two groups were compared. Results:A total of 17 relevant articles on ADTKD- UMOD cases in China were retrieved, involving 57 patients from 34 families. The age at first diagnosis was 24.0 (20.0, 39.5) years. Fifty-three patients (93.0%) had a family history of nephropathy or hyperuricemia. Among the 48 patients with recorded blood uric acid levels, 36 patients (75.0%) had hyperuricemia, with age of 24.0 (20.3, 37.3) years. Fifty-four patients had chronic kidney disease assessment records, among which 46 patients (85.2%) developed chronic kidney disease, and 21 patients (38.9%) developed end-stage renal disease. The age of end-stage renal disease was 39.0 (24.0, 46.0) years, with age of 33.0 (21.0, 46.5) years in males and 39.5 (25.5, 45.5) years in females ( Z=-0.649, P=0.516). Twenty patients underwent renal biopsies, and 19/20 patients had tubular or interstitial lesions, and 9/20 patients had glomerular lesions, mainly manifested as focal segmental or global glomerulosclerosis. Forty patients had renal ultrasound examination records, among which 36 patients (90.0%) had abnormal results, with renal cysts being the most common type (12 patients, 30.0%). Among the 34 family cases, no ADTKD- UMOD hotspot mutation was found in the UMOD gene mutations. Thirty-two families (94.1%) were missense mutations, 26 families (76.5%) had mutation sites in exon 3, and 16 families (47.1%) had mutation regions in D8C. The proportion of hypertension in the non-exon 3 mutation group was higher than that in the exon 3 mutation group ( χ2=9.84, P=0.002). The proportion of males in the non-D8C mutation group was higher than that in the D8C mutation group ( χ2=4.97, P=0.026). Conclusions:The main clinical manifestations of Chinese ADTKD- UMOD patients are hyperuricemia, and the main renal histopathological changes are tubular and interstitial lesions. Some patients have glomerular lesions, which need to be differentiated from focal segmental glomerulosclerosis. Renal cysts detected by renal ultrasound can suggest the diagnosis of the disease. Missense mutation is the main type of UMOD gene mutations. The gene mutation region may be correlated with hypertension and gender.

Objective To explore the sleep quality and mental fatigue level in elderly patients with cerebrovascular small disease(CSVD).Methods A total of 222 patients aged over 65 years old hospitalized due to chronic diseases in Department of Neurology of the Affiliated Jiangning Hospi-tal of Nanjing Medical University from August 2022 to June 2024 were recruited prospectively and continuously.According to the CSVD score,they were divided into a CSVD group(CSVD score≥1,148 cases)and a non-CSVD group(CSVD score=0,74 cases).All the patients were evaluated by sleep quality,fatigue and neuropsychological scale when they were fully cooperated and in good condition.Subsequently,the patients in the CSVD group were further assigned into a good sleep subgroup(117 cases)and a poor sleep subgroup(31 patients).Results The CSVD group had significantly higher total score of Pittsburgh sleep quality index(PSQI),sleep quality score,sleep disturbance score,total score of self-rating fatigue,and mental fatigue score than the non-CSVD group(P＜0.01).The sleep quality score,sleep disturbance score,and mental fatigue score were risk factors for CSVD(P＜0.05).The mental fatigue score was significantly higher in the CSVD patients with poor sleep than those with good sleep(4.13±1.15 vs 2.50±1.92,P＜0.01).Conclusion Elderly CSVD patients were more likely to have decreased sleep quality and mental fatigue,and among them,those with poor sleep quality are prone to having mental fatigue than those with good sleep.

Objective:To summarize and analyze the clinical and genetic characteristics of children with nephronophthisis (NPHP) so as to improve clinicians′ understanding of this disease and provide reference for its early diagnosis.Methods:Retrospective case series study.The clinical and genetic data of 15 children with NPHP diagnosed by gene detection in the Department of Nephrology, Beijing Children′s Hospital, Capital Medical University from January 2016 to June 2024 were retrospectively analyzed.Non-normal distribution measurement data were expressed as median (range) and analyzed by rank sum test.Results:There were 10 boys and 5 girls in the 15 patients included, with a median age of onset of 6.85 years (1.16-14.00 years).The initial clinical manifestations were lack of specificity, and most patients presented non-specific symptoms such as fatigue, growth retardation, polydipsia and polyuria initially.At the first visit, 14 children had renal function damage, and 5 of them had end-stage renal disease (ESRD).Another 4 children progressed to ESRD during the follow-up, and 2 children died during the follow-up.The median age of ESRD or death was 12.25 years (1.87-15.00 years).Renal ultrasound changes were observed in all 15 children, including parenchymal echo enhancement in 14 cases, unclear medullary boundary in 10 cases, renal cysts in 7 cases, and renal volume reduction in 2 cases.Renal histopathological examination was performed in 2 cases, and their results were consistent with the pathological manifestations of early and late NPHP, respectively.NPHP can be complicated with renal, intracranial, cardiac and other extrarenal manifestations. NPHP1, NPHP4, NPHP2, NPHP3, NPHP11, NPHP13 and NPHP18 mutations were detected in 5, 4, 2, 1, 1, 1, and 1 patient, respectively.Previously unreported mutation sites were revealed, including c. 594-3C>G, c.1415T>C, c.37553769delTTCGGGGGACACAGA, c.4067A>C, c.1196A>G, c.4140+ 3G>C, c.1196A>G, c.2101-20A>C, c.643C>T and c. 2087T>C. Conclusions:The onset of NPHP is insidious and it often presents with non-specific manifestations.Laboratory and imaging examinations lack specificity.Generally, renal insufficiency is an early symptom of NPHP, and it progresses rapidly, resulting in poor prognosis.Most patients lose the opportunity for kidney biopsy.NPHP should be considered in children with early onset and unexplained renal insufficiency, and genetic testing is helpful for early diagnosis.

Objective To analyze the influencing factors of health behaviors in stroke patients,and explore the chain mediating effects of self-efficacy and e-health literacy between the perception of stroke recurrence risk and health behaviors in stroke patients,providing a reference for strengthening the health behavior and reducing recurrence risk in stroke patients.Methods 249 stroke patients were selected as the research objects from March to September 2024 in a tertiary hospital in Shanghai,China.Patients were surveyed using General Information Questionnaire,Stroke Recurrence Risk Perception Scale,Stroke Health Behavior Scale(HBS-SP),Chronic Disease Self-Efficacy Scale(CDSES),and the e-health Literacy Scale(e-HEALS).Pearson correlation analysis was used to explore the correlations among various variables,and SPSS 26.0 software macro program Process Model 6 was used to conduct chain mediation model test.Results The scores of Recurrence Risk Perception,HBS-SP,CDSES and e-HEALS of stroke patients were(42.88±6.48)scores,(68.32±14.13)scores,(6.87±1.55)scores and(27.76±6.06)scores,and all the variables were positively correlated(P<0.01).The mediating effect model showed that self-efficacy and e-health literacy played a chain mediating role in the recurrence risk perception and health behavior in stroke patients,with an effect size of 0.488,accounting for 37.22%of the total effect.Conclusions The recurrence risk perception and health behavior of stroke patients are both at a moderate level.In the future,we can establish a mobile management platform to provide comprehensive health management for stroke patients.Further exploration of strategies to enhance stroke patients'self-efficacy and channels for online health education could be pursued to improve their health behaviors.

BACKGROUND:Titanium surface micro-nano structure modification is a hot research field in titanium implant surface treatment.The diabetic hyperglycemia environment will affect the stable bonding between titanium implant and bone tissue,so it is necessary to explore the surface micro-nano structure modification to improve the osteogenic activity of titanium implant in high glucose environment.OBJECTIVE:To investigate the effect of gold nanoparticle@mesoporous silica nanoparticles(AuNPs@MSNs)coating on osteogenic activity of osteoblasts under high glucose in vitro.METHODS:Gold nanoparticle suspension and mesoporous silica were prepared respectively,and the two were mixed in deionized water in a certain proportion to prepare gold nanoparticle@mesoporous silica suspension.Titanium sheets were taken and divided into three groups for treatment:the smooth group was treated with water sandpaper;the nanotube group was treated with water sandpaper and then anodized to prepare titanium dioxide nanotube coating,and the experimental group prepared titanium dioxide nanotube coating and then immersed in gold nanoparticle@mesoporous silica suspension to prepare gold nanoparticle@mesoporous silica nanoparticles coating.The microscopic morphology and hydrophilicity of the surface of the three groups of titanium sheets were characterized.Rat bone marrow mesenchymal stem cells were inoculated on the surface of the three groups of titanium sheets.Cell proliferation was detected by cell live/dead fluorescence staining and CCK-8 assay.Cell adhesion was detected by DAPI/phalloidin staining.Rat bone marrow mesenchymal stem cells were inoculated on the surface of the three groups of titanium sheets,and high-glucose osteogenic induction medium was added for culture.Osteogenic differentiation was detected by alkaline phosphatase and Alizarin Red S staining.RESULTS AND CONCLUSION:(1)Scanning electron microscopy showed that the surface of the titanium sheet in the smooth group was uniform and flat.The titanium dioxide nanotube arrays in the nanotube group were closely arranged on the surface,and the titanium sheet in the experimental group was loaded with gold nanoparticle@mesoporous silica on the surface and inside of the titanium dioxide nanotubes.The hydrophilicity of the titanium sheets in the nanotube group and the experimental group was better than that in the smooth group.(2)The results of cell live/dead fluorescence staining exhibited that the cell viability on the surface of the three groups of titanium sheets was higher than 90%.The results of CCK-8 assay show that the cell proliferation rate in the experimental group was higher than that in the smooth group and the nanotube group.The results of DAPI/phalloidin staining showed that the titanium dioxide nanotube coating and the gold nanoparticle@mesoporous silica nanoparticles coating were more conducive to cell adhesion.(3)The results of alkaline phosphatase and Alizarin Red S staining showed that the alkaline phosphatase activity and extracellular matrix mineralization of the cells on the titanium sheet surface in the experimental group were higher than those in the smooth group and the nanotube group.(4)The results show that the gold nanoparticle@mesoporous silica nanoparticles coating can enhance the biological activity of the titanium surface and promote osteogenic differentiation in a high glucose environment.

Objective:To conduct a systematic review of reported cases of autosomal dominant tubulointerstitial kidney disease (ADTKD) caused by uromodulin ( UMOD) gene mutations (ADTKD- UMOD) in China, summarize the clinical, pathological and genetic variation characteristics, and analyze the genotype-phenotype correlation. Methods:It was a retrospective systematic analysis study. The search terms "UMOD", "ADTKD-UMOD", "uric acid kidney disease (UAKD)", "medullary cystic kidney disease type 2 (MCKD2)", and "familial juvenile hyperuricemic nephropathy type 1 (FJHN1)" were used, and relevant literature on ADTKD- UMOD cases in China were retrieved from PubMed, CNKI, Wanfang Data and Chinese Medical Journal Full-text Database. The data of the cases involved in the literature were collected and summarized, and the clinical and pathological characteristics and genetic variation features of Chinese ADTKD- UMOD patients were analyzed. The patients were divided into exon 3 mutation group and non-exon 3 mutation group based on the mutation sites, and the differences of clinical phenotypes between the two groups were compared. The patients were also divided into domain 8 cysteine (D8C) mutation group and non-D8C mutation group based on the mutation regions, and the differences of clinical phenotypes between the two groups were compared. Results:A total of 17 relevant articles on ADTKD- UMOD cases in China were retrieved, involving 57 patients from 34 families. The age at first diagnosis was 24.0 (20.0, 39.5) years. Fifty-three patients (93.0%) had a family history of nephropathy or hyperuricemia. Among the 48 patients with recorded blood uric acid levels, 36 patients (75.0%) had hyperuricemia, with age of 24.0 (20.3, 37.3) years. Fifty-four patients had chronic kidney disease assessment records, among which 46 patients (85.2%) developed chronic kidney disease, and 21 patients (38.9%) developed end-stage renal disease. The age of end-stage renal disease was 39.0 (24.0, 46.0) years, with age of 33.0 (21.0, 46.5) years in males and 39.5 (25.5, 45.5) years in females ( Z=-0.649, P=0.516). Twenty patients underwent renal biopsies, and 19/20 patients had tubular or interstitial lesions, and 9/20 patients had glomerular lesions, mainly manifested as focal segmental or global glomerulosclerosis. Forty patients had renal ultrasound examination records, among which 36 patients (90.0%) had abnormal results, with renal cysts being the most common type (12 patients, 30.0%). Among the 34 family cases, no ADTKD- UMOD hotspot mutation was found in the UMOD gene mutations. Thirty-two families (94.1%) were missense mutations, 26 families (76.5%) had mutation sites in exon 3, and 16 families (47.1%) had mutation regions in D8C. The proportion of hypertension in the non-exon 3 mutation group was higher than that in the exon 3 mutation group ( χ2=9.84, P=0.002). The proportion of males in the non-D8C mutation group was higher than that in the D8C mutation group ( χ2=4.97, P=0.026). Conclusions:The main clinical manifestations of Chinese ADTKD- UMOD patients are hyperuricemia, and the main renal histopathological changes are tubular and interstitial lesions. Some patients have glomerular lesions, which need to be differentiated from focal segmental glomerulosclerosis. Renal cysts detected by renal ultrasound can suggest the diagnosis of the disease. Missense mutation is the main type of UMOD gene mutations. The gene mutation region may be correlated with hypertension and gender.

Objective:To investigate the association of monocyte-to-high-density lipoprotein cholesterol ratio (MHR) with the severity of white matter hyperintensities (WMHs) and its spatial distribution.Methods:Patients admitted to the Department of Neurology, Jiangning Hospital Affiliated to Nanjing Medical University due to various chronic diseases or physical examinations between January 2023 and December 2024 were included retrospectively. Past medical history, clinical and imaging data were collected. The Fazekas scale was used to assess the severity of WMHs. According to the scoring results of periventricular WMHs (PVWMHs) and deep WMHs (DWMHs), WMHs were divided into no/mild group (0-1 points) and moderate/severe group (2-3 points). Multivariate logistic regression analysis was used to determine independent correlation factors for the severity of WMHs, PVWMHs, and DWMHs. Results:A total of 357 patients were included, aged 65.42±9.95 years, with 198 males (55.5%). There were 193 patients (54.1%) in the no/mild group and 164 (45.9%) in the moderate/severe group. Univariate analysis showed that the proportion of patients with hypertension, diabetes, history of cerebral infarction and cerebral hemorrhage, carotid plaque, and age, serum creatinine, monocyte count and MHR in the moderate/severe group were significantly higher than those in the no/mild group (all P<0.05). Multivariate logistic regression analysis showed a significant positive correlation between MHR and the severity of WMHs (odds ratio 3.138, 95% confidence interval 1.042-9.451; P=0.042). Further analysis showed a significant positive correlation between MHR and PVWMHs (odds ratio 3.384, 95% confidence interval 1.111-10.305; P=0.032), but no independent correlation with DWMHs. In addition, age and hypertension, diabetes, history of cerebral infarction and cerebral hemorrhage were significantly positively correlated with the severity of WMHs, PVWMHs and DWMHs. Conclusion:MHR is correlated with the severity of WMHs, and higher MHR is significantly associated with PVWMHs, but not with DWMHs.