With the continuous intensification of aging， chronic diseases among the elderly have become a widely concerned public health issue. In the terminal stage， they often lose the ability to express their medical care wishes autonomously， leading to a disconnect between medical decision-making and the actual needs of the patients and increasing their physical and psychological suffering. With the rapid aging process in China， the incidence of chronic diseases in the elderly is continuously rising， which has become a serious public health problem. Studies have shown that advance care planning （ACP） has achieved remarkable results in maintaining the dignity of life for terminal chronic disease patients， improving patients’ quality of life， as well as alleviating the physical， mental， and economic burdens on their families. Therefore， the implementation of ACP is crucial for elderly patients with chronic diseases. This paper reviewed the concept of ACP， as well as application effects， challenges and limitations， and corresponding recommendations and countermeasures of ACP in elderly patients with chronic diseases， with a view to providing a solid theoretical and practical basis for the application of ACP in elderly population with chronic diseases in China.

Objective: To explore the longitudinal relationships between sleep problems and non suicidal self injury (NSSI) behaviors in college students, so as to provide a theoretical basis for the prevention and intervention of NSSI. Methods: In October 2023 (T1), a total of 1 009 college students from two provincial colleges in Guangdong were selected by using a combination of convenience sampling and stratified cluster random sampling for a 1 year follow up survey (October 2024, T2). The students were assessed by using the Insomnia Severity Index(ISI), Non restorative Sleep Scale(NRSS), Epworth Sleepiness Scale (ESS), and Adolescent Non suicidal Self injury Assessment Questionnaire(ANSAQ). Data analysis was performed using McNemar’s test and Logistic regression. Results: The detection rate of NSSI behaviors was 18.83% at T1 and decreased to 7.73% at T2, with a statistically significant difference ( χ 2=66.24, P <0.01). The trajectories of NSSI behaviors were divided into persistent group (4.06%), new onset group (3.67%), remission group (14.77%), and resistance group (77.50%). Logistic regression analysis showed that sleep less than 7 hours per day at night, insomnia (mild, moderate to severe), non restorative sleep (moderate, severe), daytime sleepiness, and weekly nightmare frequency (1-2, ≥3 times) were associated with NSSI behaviors at T1 ( OR =5.02, 2.39, 5.51, 3.47, 9.70, 2.36, 2.63, 4.74, all P <0.01). Insomnia (mild, moderate to severe), severe non restorative sleep, daytime sleepiness, and weekly nightmares ≥3 times at T1 all increased the risk of NSSI behaviors at T2 ( OR =1.76, 4.15, 4.05, 1.88, 5.63, all P < 0.05 ). Moderate to severe insomnia, severe non restorative sleep, daytime sleepiness, and weekly nightmares ≥3 times at T1 increased the risk of belong to the new onset NSSI group ( OR =5.05, 3.37, 2.08, 5.86, all P <0.05). Conclusions Insomnia, non restorative sleep, daytime sleepiness, and frequent nightmares are important risk factors for NSSI behaviors among college students. Early assessment and intervention of sleep problems may be an important strategy for the prevention and treatment of NSSI.

Objective:To investigate the differences and prognostic value of serum myeloid-related proteins 8 and 14 (Mrp 8/14) in patients with acute respiratory distress syndrome (ARDS) induced by pulmonary and extrapulmonary sepsis.Methods:A retrospective cohort study was conducted to collect the general clinical data of septic ARDS patients admitted to the intensive care unit (ICU) of Nanjing Hospital of Nanjing Medical University from August 2021 to February 2024. The serum levels of Mrp 8/14 were detected within 24 hours after admission. According to whether the patients died during ICU stay, the patients with pulmonary ARDS and extrapulmonary ARDS induced by sepsis were divided into survival and death groups, respectively. The differences of Mrp 8/14 and other clinical data between the two groups were compared. Logistic regression analysis was used to analyze the prognostic factors of septic patients with pulmonary ARDS and extrapulmonary ARDS. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of serum Mrp 8/14 for the prognosis of patients with pulmonary ARDS and extrapulmonary ARDS.Results:A total of 138 patients with sepsis-induced ARDS were enrolled in this study, including 79 patients with pulmonary ARDS and 59 patients with extrapulmonary ARDS. Compared to the death group, the level of serum Mrp 8/14 was significantly lower [Mrp 8/14: 22.90 (17.91, 30.88) μg/mL vs. 10.73 (7.15, 17.20) μg/mL, P<0.05]. Multivariate logistic regression analysis demonstrated that the serum Mrp 8/14 level was an independent risk factor for the prognosis of pulmonary ARDS patients only during the ICU stay ( OR=1.253, 95% CI: 1.110-1.414, P<0.05). ROC curve analysis showed that the area under the curve of serum Mrp 8/14 for the prediction of death in ARDS patients with pulmonary sepsis during ICU stay was 0.855 (95% CI: 0.773-0.938, P<0.05), the cut-off value was 19.230 μg/mL, the sensitivity was 0.718, the specificity was 0.925, and the Yonden index was 0.405. Conclusion:Serum Mrp 8/14 is an effective prognostic indicator for the mortality of ARDS patients with pulmonary sepsis during ICU hospitalization.

Objective:This study investigated the awareness and consumption of Trogia venenata among populations in regions affected by Yunnan unexplained sudden death (YUSD). The findings aim to support etiological research on YUSD and contribute to the formulation of preventive measures against Trogia venenata poisoning. Methods:This study was a case-control study. From 2018 to 2021, surveys were conducted in 90 villages across 25 counties within YUSD-affected areas in Yunnan Province. Households with YUSD cases were designated as case households, whereas households without YUSD cases served as controls, ande were selected through convenience sampling at a 3:1 ratio. An enhanced questionnaire was designed to collect information on the consumption of Trogia venenata, and symptoms following consumption. Frequency data were presented as percentages, and group comparisons were conducted using χ 2 tests or Fisher’s exact tests. Results:A total of 711 questionnaires were collected (response rate: 100%), comprising 175 case households and 536 control households. Trogia venenata was present in 80.82% of the villages surveyed. Among the 711 households, 15.89% reported consuming Trogia venenata, primarily through stir-frying (53.10%), followed by boiling (29.20%), boiling and stir-frying (15.93%), and steaming (1.77%). Most households (94.69%) consumed fresh fruiting bodies, with 69.02% consuming them fewer than three times annually. The consumption rates were higher among the case households than among the control households. Of the 113 households with a history of Trogia venenata consumption, 35.40% reported symptoms such as nausea, vomiting, and limb soreness. The proportions of affected families in each group were compared according to their source, cooking method, fruiting body status and consumption frequency. The proportion of affected families with high consumption frequency (≥3 times/year) was higher than that with low consumption frequency (<3 times/year). Among 421 YUSD cases, 63 cases (14.96%) had a history of Trogia venenata consumption before death, with 43 cases showing symptoms within the longest known latency period (14 d) for poisoning by this mushroom. Conclusions:Trogia venenata is prevalent in 80.82% of YUSD-affected regions, with 16.67% of the population reporting its consumption, predominantly as fresh fruiting bodies prepared by stir-frying or boiling. Confirmed Trogia venenata consumption was identified in 14.96% of YUSD cases, suggesting that mushroom poisoning is a significant risk factor for YUSD. Ongoing health education and interventions are critical for mitigating the risk of Trogia venenata poisoning.

Objective:To understand the electrocardiogram and echocardiography examination results of population in key areas of unexplained sudden death in Yunnan Province (referred to as Yunnan sudden death).Methods:From 2014 to 2022, electrocardiogram examination was performed on population (including same incident cases, relatives of the cases, villagers of the affected villages, and control individuals) in key areas of Yunnan sudden death from May to October each year. Echocardiography examination was performed on relatives of the cases and villagers of the affected villages, and the types of electrocardiogram and echocardiography changes were sorted out and analyzed.Results:Electrocardiogram examination was conducted on 1 same incident case, 241 relatives of the cases, 464 villagers of the affected villages, and 99 control individuals, respectively. The types of electrocardiogram changes in the same incident case were Q-T interval prolongation and sinus tachycardia. A total of 17 types of electrocardiogram changes were detected in the relatives of the cases, mainly including sinus arrhythmia (12.45%, 30/241), sinus bradycardia (11.20%, 27/241), and left axis deviation (8.30%, 20/241). A total of 21 types of electrocardiogram changes were detected in the villagers of the affected villages, mainly including left axis deviation (9.48%, 44/464), sinus bradycardia (8.19%, 38/464), and T-wave abnormalities (7.76%, 36/464). A total of 10 types of electrocardiogram changes were detected in the control individuals, mainly including sinus arrhythmia (12.12%, 12/99), T-wave abnormalities (9.09%, 9/99), and sinus bradycardia (7.07%, 7/99). Echocardiography examination was conducted on 49 relatives of the cases and 365 villagers of the affected villages, respectively. A total of 12 types of echocardiography changes were detected in the relatives of the cases, mainly including tricuspid regurgitation (18.37%, 9/49), decreased right ventricular diastolic function (8.16%, 4/49), aortic regurgitation (6.12%, 3/49), and atrial septal defect (6.12%, 3/49). A total of 15 types of echocardiography changes were detected in the villagers of the affected villages, mainly including tricuspid regurgitation (8.77%, 32/365), aortic regurgitation (6.85%, 25/365), and decreased left ventricular diastolic function (6.58%, 24/365).Conclusion:There are many types of changes in electrocardiogram and echocardiography in the population of key areas of Yunnan sudden death.

BACKGROUND:It has been shown that neural stem cells can differentiate into neurons,astrocytes,and oligodendrocytes.Mesenchymal stem cells-derived extracellular vesicles have also been shown to cross the blood-brain barrier to reach sites of central nervous injury and promote neural repair.However,it is not clear whether neuron-derived extracellular vesicles promote the differentiation of neural stem cells in a direction that is beneficial for neurogenesis. OBJECTIVE:To investigate whether neuron-derived extracellular vesicles facilitate neural stem cell differentiation towards neurogenesis. METHODS:Neurons and neural stem cells were extracted from neonatal SD rat cerebral cortex by trypsin digestion.Cell supernatants of neurons were collected.Neuron-derived extracellular vesicles were extracted.Neural stem cells cultured for 10 days were co-cultured with neuron-derived extracellular vesicles or PBS for 7 days.Immunoblotting,immunofluorescence,and RT-qPCR were used to detect proteins specifically expressed by neurons,neural stem cells,oligodendrocytes,and astrocytes. RESULTS AND CONCLUSION:The neural stem cells co-cultured with neuron-derived extracellular vesicles showed high expression of neuron-specific proteins and oligodendrocyte-specific proteins including β3-tubulin,neurofilament 200 and myelin basic protein,and low expression of astrocyte-specific protein glial fibrillary acidic protein.These results suggest that neuron-derived extracellular vesicles can promote the differentiation of neural stem cells into neurons and oligodendrocytes and prevent the differentiation of neural stem cells into astrocytes.

Objective To evaluate the clinical effect of 3D printing-assisted percutaneous screw fixation in treating unstable pelvic fracture.Methods A total of 80 patients with unstable pelvic fractures,who received treatment at the Lianyungang Municipal First People's Hospital of China from January 2022 to January 2023,were enrolled in this study.According to the surgical methods,the patients were divided into percutaneous screw fixation group(n=47,receiving 3D printing-assisted percutaneous screw fixation)and open reduction group(n=33,receiving open reduction with steel plate internal fixation).The intraoperative blood loss,time spent for surgery,total hospitalization time,fracture healing time,levels of serum creatine kinase(CK),myoglobin(Myo),lactate dehydrogenase(LDH)levels,and incidence of surgical complications were compared between the two groups.Results In the percutaneous screw fixation group,the time spent for surgery[(62.96±19.31)min vs(100.07±26.71)min],intraoperative blood loss[(112.71±25.43)mL vs(230.65±30.29)mL],total hospitalization time[(11.04±2.35)days vs(15.16±2.58)days]and fracture healing time[(102.18±9.74)days vs(113.42±11.52)days]were remarkably higher than those in the open reduction group(all P＜0.01);the postoperative 3-month total effective rate was 95.74％,which was significantly higher than 80.00％in the open reduction group(P＜0.05);and the excellent rate of fracture reduction quality was higher than that in the open reduction group(P＜0.05).The postoperative one-,3-and 6-month Majeed scores in the percutaneous screw fixation group were strikingly higher than those in the open reduction group(all P＜0.05).No statistically significant differences in the preoperative levels of CK,Myo and LHD existed between the two groups(all P＞0.05),while the postoperative levels of CK,Myo and LHD in the percutaneous screw fixation group were prominently lower than those in the open reduction group(all P＜0.05).The difference in the incidence of postoperative complications between the two groups was not statistically significant(P＞0.05).Conclusion For the treatment of unstable pelvic fracture,3D printing-assisted percutaneous screw fixation is superior to open reduction with plate internal fixation in achieving better clinical results,reducing surgical injury,and shortening postoperative recovery time.

Objective:To evaluate the effect of comprehensive intervention measures on Yunnan unexplained sudden death (YUSD) in Dali Prefecture, Yunnan Province, and to provide scientific basis for improving the prevention and control measures.Methods:Since 2010, Yunnan Province had implemented comprehensive intervention measures in ward areas according to the etiological pattern of YUSD. In July 2019, 47 families with YUSD were selected as case families and 23 families without YUSD were selected as control families in 31 natural villages of Heqing, Xiangyun, Yunlong, Eryuan, Jianchuan, Binchuan and Nanjian counties of Dali Prefecture. A unified questionnaire was used to investigate the basic information, economic status, dietary structure, and health literacy of the families during the two periods of "the first sudden death case" and "the present".Results:The annual household income of the case families at present (median, 20 492.6 yuan) was significantly higher than that of the first sudden death case (3 883.4 yuan), and the difference was statistically significant ( Z = - 5.27, P < 0.001). At present, rice (76.6%, 36/47) was the main diet of the case families; at the time of the first sudden death case, 23.4% (11/47) of the case families could not eat enough, and there was no such situation in the case families at present. Compared with the time of the first sudden death case, the dietary habits of the case families at present were as follows: the proportion of eating Trogia venenata decreased from 19.0% (39/205) to 0 (0/190), the proportion of eating wild fruit decreased from 17.1% (35/205) to 9.5% (18/190), and the proportion of drinking raw water decreased from 55.1% (113/205) to 42.1% (80/190), and the differences were statistically significant (χ 2 = 22.37, 4.90, 6.86, P < 0.05). Lifestyle and health awareness: the proportion of those who washed their hands before meals and after using the toilet increased from 9.8% (20/205) to 41.6% (79/190), those who did not overwork increased from 16.6% (34/205) to 34.2% (65/190), and those who took good protection when spraying pesticides increased from 7.3% (15/205) to 21.6% (41/190), and the differences were statistically significant (χ 2 = 53.17, 33.94, 16.48, P < 0.001). Toilet habits: the proportion of using outdoor toilet decreased from 75.6% (155/205) to 9.5% (18/190), the difference was statistically significant (χ 2 = 175.21, P < 0.001). When the first sudden death case occurred, the proportions of eating Trogia venenata and using outdoor toilet in the case families were higher than those in the control families (χ 2 = 22.37, 23.70, P < 0.001), the proportions of those who washed their hands before meals and after using the toilet and those who did not overwork in the case families were lower than those in the control families (χ 2 = 7.38, 4.93, P < 0.05). Conclusions:The economic conditions, production and living conditions of YUSD areas in Dali Prefecture have been significantly improved, and the health literacy and health prevention awareness of the population have been greatly improved. Economic conditions and living standard, dietary structure and health literacy may be related factors of YUSD.

Objective:To explore the mediating effects of mindfulness and perceived stress between childhood trauma and psychotic-like experiences.Methods:In October 2021, 602 freshmen from a university in Guangdong Province were tested by childhood trauma questionnaire(CTQ), mindful attention awareness scale(MAAS), perceived stress scale(PSS), and community assessment of psychic experiences(CAPE). SPSS 21.0 and Mplus 8.3 were used for data analysis. Mann-Whitney U test was used to compare the differences between groups, and Spearman correlation analysis was used to investigate the correlation among childhood trauma, mindfulness, perceived stress and psychotic-like experiences. Bias-corrected nonparametric percentile Bootstrap method was used to examine the mediating roles of mindfulness and perceived stress between childhood trauma and psychotic-like experiences. Results:(1) In the past one month, 59.5% of the freshmen had psychotic-like experiences, and 8.5% of them experienced the distress. (2)Childhood trauma was positively correlated with perceived stress( r=0.29, P<0.01), frequency ( r=0.14, P<0.01)and distress( r=0.17, P<0.01) of psychotic-like experiences, and was negatively correlated with mindfulness( r=-0.28, P<0.01). (2)Mindfulness and perceived stress played individual mediating effects and chain mediating effect between childhood trauma and frequency of psychotic-like experiences, with effect size of 0.08, 0.04, 0.03, accounting for 53.33%, 26.67%, 20.00% of the total indirect effect(effect size=0.15), respectively. Mindfulness and perceived stress played individual mediating effects and chain mediating effect between childhood trauma and distress of psychotic-like experiences, with effect size of 0.07, 0.04, 0.03, accounting for 50.00%, 28.57%, 21.43% of the total indirect effect(effect size=0.14), respectively. Conclusion:Childhood trauma can affect psychotic-like experiences and distress through the indirect effects of mindfulness and perceived stress, or through the chain mediating effect of mindfulness-perceived stress.

Osteoarthritis (OA) is a prevalent degenerative joint disease characterized by cartilage loss and accounts for a major source of pain and disability worldwide. However, effective strategies for cartilage repair are lacking, and patients with advanced OA usually need joint replacement. Better comprehending OA pathogenesis may lead to transformative therapeutics. Recently studies have reported that exosomes act as a new means of cell-to-cell communication by delivering multiple bioactive molecules to create a particular microenvironment that tunes cartilage behavior. Specifically, exosome cargos, such as noncoding RNAs (ncRNAs) and proteins, play a crucial role in OA progression by regulating the proliferation, apoptosis, autophagy, and inflammatory response of joint cells, rendering them promising candidates for OA monitoring and treatment. This review systematically summarizes the current insight regarding the biogenesis and function of exosomes and their potential as therapeutic tools targeting cell-to-cell communication in OA, suggesting new realms to improve OA management.
Apoptosis ; Cartilage/pathology* ; Cartilage, Articular/metabolism* ; Cell Communication ; Chondrocytes/metabolism* ; Exosomes/pathology* ; Humans ; Osteoarthritis/therapy*