Background The decline of physical activity in the elderly due to aging may increase the risk of sarcopenia. Currently, there is a lack of evidence from large natural populations on the relationship between PA and sarcopenia. Objective To explore the relationship between PA and sarcopenia in the elderly aged 60 years and above in 10 provinces (autonomous regions) of China. Methods Data were retrieved from the 2022—2023 round of the China Development and Nutrition Health Impact Cohort. Personal basic information and PA data were collected by questionnaire survey. Skeletal muscle mass was measured by bio-electrical impedance analysis, muscle strength was measured using a grip dynamometer, and physical performance was reflected by 6-meter walk speed. The Asian Working Group for Sarcopenia (AWGS) 2019 criteria were used to diagnose sarcopenia. Light physical activity (LPA) duration, moderate-to-vigorous physical activity (MVPA) duration, and total physical activity volume were calculated. A total of 3326 residents aged ≥60 years with complete data were selected as the survey participants. Multiple logistic regression models and restricted cubic splines (RCS) were used to assess the association between PA duration/volume and sarcopenia. Results In 10 provinces (autonomous regions) of China, the prevalence of sarcopenia in the elderly aged 60 years and above was 5.5% (95%CI: 4.7%, 6.2%). The logistic regression analysis showed that compared with the elderly reporting 0-7.0 h·week⁻¹ in LPA duration, the risk of sarcopenia in the elderly with LPA duration of >14.0-21.0 h·week⁻¹ was reduced by 51% (OR=0.49, 95%CI: 0.26, 0.96). Compared with the elderly with total physical activity ≥15.0 metabolic equivalent of task (MET)-h·week⁻¹, those with <7.5 MET-h·week⁻¹ had a 2.24-fold increased risk of sarcopenia (OR=2.24, 95%CI: 1.17, 4.29). The RCS results found that LPA duration and total physical activity volume each showed a nonlinear dose-response relationship with the risk of sarcopenia (P_overall<0.05, P_non-linear<0.05). Compared with the elderly with an LPA duration of 0 h· week⁻¹, the risk of sarcopenia in the elderly with an LPA duration of 12.6 h· week⁻¹ was the lowest (OR=0.42, 95%CI: 0.21, 0.83). Compared with the elderly with a total physical activity volume of 15.0 MET-h· week⁻¹, the elderly with a total physical activity volume of 46.0 MET-h· week⁻¹ had the lowest risk of sarcopenia (OR=0.57, 95%CI: 0.38, 0.84). There was no statistically significant association between weekly MVPA duration and the risk of sarcopenia (P>0.05). Conclusion Increasing weekly LPA duration and total physical activity volume would help to reduce the risk of sarcopenia.

Thymocyte selection-associated high mobility group box (TOX), a member of the high mobility group protein super-family, plays an important role in T cell development, functional maintenance, and exhaustion. It has been recently found that TOX exerts critical immunoregulatory functions during pathogen infections, and TOX expression is strongly associated with the intensity and tolerance of host immune responses. This review systematically summarizes the structural and functional features of TOX and focuses on its expression dynamics, mechanisms of action, and immunomodulatory effects during viral, bacterial, and parasitic infections, which provides a theoretical support to better understanding of the role of TOX in infectious diseases and provides new insights into development of potential immunotherapeutic strategies targeting TOX.

Objective:To analyze the predictive value of four scoring systems,Pediatric Clinical Illness Score (PCIS),Pediatric Logistic Organ Dysfunction Score 2 (PELOD-2),Pediatric Risk of Mortality Ⅲ (PRISM Ⅲ),and Pediatric Sequential Organ Failure Assessment (pSOFA),in the severity and prognosis in pediatric sepsis.Methods:The medical records of 159 children with sepsis who admitted to PICU at the First Hospital of Jilin University between August 2015 and December 2020 were retrospectively analyzed.The PCIS,PELOD-2,PRISM Ⅲ and pSOFA scores were calculated according to the worst value of each index within 24 h of admission.The children were divided into survival group and death group based on clinical outcomes during hospitalization.The children were stratified according to the severity of sepsis into sepsis (no organ dysfunction) group ( n=18) and severe sepsis group ( n=141).The receiver operator characteristic (ROC) curve was used to evaluate the value of PCIS,PELOD-2,PRISM Ⅲ and pSOFA scores in predicting the severity and prognosis in pediatric sepsis. Results:There were 97 (61.01%) cases in the survival group and 62(38.99%) cases in the death group.There were 141(88.68%) children with severe sepsis.The areas under curve (AUCs) of PCIS,PELOD-2,PRISM Ⅲ and pSOFA scores for predicting severe sepsis in children with sepsis were 0.869,0.875,0.672 and 0.933,respectively (all P <0.05).The AUCs of PCIS,PELOD-2,PRISM Ⅲ and pSOFA scores for predicting the death of children with sepsis in PICU were 0.687,0.697,0.716 and 0.656,respectively (all P<0.05). Conclusion:Among the four scoring systems,the pSOFA scoring system had the highest predictive power for the severity of sepsis.The PRISM Ⅲ score had higher value in assessing the risk of death in all patients with sepsis.

Objective:To investigate the distribution characteristics of body height, body weight and body mass index (BMI) in children aged 3-17 years in China.Methods:Data were obtained from the National Nutrition and Health Systematic Survey in 0-18 years old children in China. The study selected 70 853 children aged 3-17 years from 28 urban and rural survey sites in 14 provinces (autonomous regions and municipalities) in 7 regions of China with multi-stage stratified cluster random sampling. M ( Q1, Q3) was used to describe the region, age and gender specific body height, body weight and BMI in the children aged 3-17 years. Wilcoxon rank sum test was used to compare the body height, body weight, and BMI between boys and girls in same age group. Kruskal-Wallis H rank sum test was used to compare the body height, body weight and BMI among boys in different age groups and among girls in different age groups, as well as among boys in same age group and among girls in same age group from different regions, and DSCF method was used for further pairwise comparisons. Results:In this study, the median body height and body weight were 172.0 cm and 62.9 kg in 17-year-old boys and 160.0 cm and 53.7 kg in 17-year-old girls. The median for children's body height, body weight, and BMI in most age groups were higher in northeastern and northern China than in southern China, and the differences could be observed until age 17 years. The differences in body weight and BMI in children in northeastern and northern China were greater in Q3 than in Q1 compared with southern China. Conclusions:The body height of children aged 3-17 years continues to increase in China. Northeastern and northern China have more children with higher bodyweight, showing an obvious body weight increase trend, to which close attention needs to be paid.

Relativity between prescription and syndrome is a theory of clinical syndrome differentiation by exploring the inherent laws between prescriptions and diseases， and it is also a unique syndrome differentiation thoughts， which is the core and essence of syndrome differentiation and treatment. Relativity between prescription and syndrome was initially recorded in Treatise on Febrile Diseases（《伤寒论》）. Prescriptions include empirical prescription， classic prescription， and current prescription. Syndrome is symptom， but also pathogenesis. Relativity between prescription and syndrome means that the prescription corresponds to pathogenesis. The disease manifests itself differently in different patients， meanwhile the symptom changes at different stages. Therefore， simply applying the original classic prescription cannot better reflect the syndrome differentiation principle of “changing treatment with syndromes”， nor does it solve complex clinical problems. Mastering the principle of relativity between prescription and syndrome can improve the accuracy of the syndrome differentiation and understand the constant changes， thus grasping the core and essence of the syndrome differentiation. The classic prescription and its syndrome have the most fixed relationship， so that the classic prescription can be used as a typical representative to explore the relativity between prescription and syndrome. Based on Treatise on Febrile Diseases， this paper summarized the relativity between prescription and syndrome into nine principles， including using medical classics to classify syndromes， using prescriptions to classify syndromes， focusing on the main syndromes， changing prescriptions when the main syndromes change， changing medicines with syndrome changing， modifying prescriptions according to syndromes， changing dosage according to syndromes， syndrome differentiation according to pulse， and syndrome differentiation according to time. Through analyzing the content in Treatise on Febrile Diseases， this paper described the application of the nine principles to explore the scientific connotation and improve the accuracy of syndrome differentiation， thereby expanding the range of classic prescription applications and providing references for the flexibly application of classic prescriptions and improvement of clinical efficacy.

Objective: To explore the indoor air quality of Harbin and its suburbs, and analyze the influence of indoor air quality on the pulmonary function indexes of schoolchildren, and to provide a reference for preventing the related respiratory diseases. Methods: The concentration of CO 2, formaldehyde, benzene, PM 10 and total bacterial count in indoor of 80 residents in Harbin and its suburb were monitored. The IAAH model was used to evaluate the indoor air quality, and the correlation between the indoor air quality and the pulmonary function indexes of schoolchildren was analyzed. Results: The levels of indoor air pollutant in suburb was higher than that in the urban of Harbin, and the concentration of CO 2, PM 10 and total bacteria count in the suburb of Harbin increase significantly during the heating season(t=5.86，4.92，21.16, P<0.05). Among the 40 households monitored by IAAH model in suburb during heating season, 37.5% had moderate air pollution, and 20.0% had severe air pollution. The IAAH was correlated with FVC, FEF75% and FEF25% after excluding the confounding factors by multiple linear regression(β=-0.17, -0.34, -0.43, P<0.05). Conclusion Indoor air pollution is very serious in the suburb of Harbin during heating season, which should be paid attention to by parents to prevent related respiratory diseases of schoolchildren.

Objective:To explore the application of group sandbox game intervention on emotional state and coping style in patients with gastric cancer.Methods:A total of 92 patients with gastric cancer treated with chemotherapy in the First People′s Hospital of Lianyungang from March 2018 to March 2019 were selected by convenient sampling method, they were divided into two groups according to admission time, 46 patients in the control group received conventional care after chemotherapy, and 46 patients in the observation group received group sandplay therapy for three months which was performed after chemotherapy. The Distress Thermometer(DT), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Medical Copingmodes Questionnaire (MCMQ) were used to assess the emotional status and coping style of the patients before and after intervention.Results:After intervention, the DT, HAMA and HAMD scores of the observation group were 2.26±2.09, 13.52±2.50 and 16.47±3.61 respectively, and the DT, HAMA and HAMD scores of the control group were 3.36±2.23 and 20.85±4.53, 23.63±4.82, respectively. The DT, HAMA, HAMD scores in observation group were significantly lower than those in the control group, the difference between the two groups was statistically significant ( t value was 2.441, 9.608, 8.064, P<0.05). The dimensional score of the MCMQ measurement surface of the observation group after intervention was 18.35±3.19, and 14.25±3.04 in the control group. MCMQ scale escape and yield dimension scores in the observation group were 15.26±3.14, 10.24±2.56, and 17.81±2.59 and 12.84±2.64 in the control group. After the intervention, the observation group′s MCMQ surface score was higher than the control group, and the escape and yield dimension score was lower than that of the control group ( t value was 6.311, 4.249, 4.795, P<0.05). Conclusions:Group sandplay therapy can relieve negative emotion in patients with gastric cancer undergoing chemotherapy, and improve their coping style.

Objective:To explore the application of failure mode and effects analysis (FMEA) in low-energy X-ray intraoperative radiotherapy (IORT), analyze its potential risks in IORT, and preliminarily explore the feasibility of FMEA in optimizing IORT management and reducing the occurrence of potential risks.Methods:An FMEA working group was established by the IORT team (1 radiologist, 1 radiology physicist, 2 surgeons, and 2 nurses) to apply the FMEA methodology to conduct a systematic risk assessment. The process modules were established, the potential failure modes and causes for each module were analyzed, the severity (SR), frequency of occurrence (OR) and likelihood of detection (DR) of failure modes were scored and the risk priority number (RPN) was calculated: RPN= SR × OR × DR. The possible errors and potential clinical impact of each part of the radiotherapy process were prospectively analyzed and understood, the causes and current measures were analyzed for each failure mode and preventive measures were proposed and risk management measures were taken accordingly.Results:The IORT process was divided into 8 modules with 14 failure modes. The highest OR value was unsatisfactory target area confirmation (7 points), the highest SR value was equipment failure to discharge the beam (10 points), the highest DR value was wrong key entry after dose calculation (7 points), the highest RPN values were unsatisfactory target area confirmation (210 points) and ineffective protection of endangered organs (180 points). Weaknesses were corrected according to priorities, workflows were optimized and more effective management methods were developed.Conclusion:FMEA is an effective method of IORT management and contributes to reducing the occurrence of potential risks.

Objective:To explore the application value of nutritional support comprehensive nursing in patients with advanced gynecological tumor and analyze its impact on patients' quality of life.Methods:From May 2016 to August 2019, 110 patients with advanced gynecological tumors were enrolled in the First People′s Hospital of Lianyungang City. According to the random number table method, they were divided into control group and observation group with 55 cases in each group. The control group received standard nutritional nursing and the observation group received nutrition support comprehensive nursing. Three milliliters of fasting venous blood were collected at the time of admission and discharge for centrifugation. The serum albumin (ALB) and prealbumin (PA) levels of the two groups were measured. The body mass index (BMI) of the patients was calculated and the changes of their nutritional status were analyzed.The quality of life of cancer patients was evaluated by the European Cancer Research and Treatment Organization Quality of Life Questionnaire-Core 30 at the time of admission and discharge.Results:There was no significant difference in the serum ALB, PA and quality of life at the time of admission between the two groups( P>0.05). There was no significant difference in BMI at the time of admission and discharge in the two groups( P>0.05). The serum ALB and PA were (36.92±2.68), (0.26±0.07) g/L at discharge in the observation group, significantly higher than (35.42±2.71), (0.23±0.06) g/L in the control group ( t values were 2.918, 2.413, P<0.05). The scores of social function, emotional function, role function, physical function and total life quality score were 63.42±4.18,62.83±6.24,63.19±6.12,64.43±4.31,70.42±6.91 at discharge in the observation group,significantly higher than 57.34±5.06,56.39±7.37,60.45±5.99,61.46±5.08,66.35±5.96 in the control group ( t values were 2.373-6.870, P<0.05). The scores of diarrhea, constipation, insomnia, anorexia, nausea, fatigue in the observation group were 36.42±5.06,34.54±6.23,34.49±5.56,36.41±4.57,40.38±7.24,37.94±4.65,significantly lower than 40.83±4.81,38.74±5.12,38.43±4.97,40.43±6.24,43.29±5.12,40.19±3.97 in the control group ( t values were 2.434-4.685, P<0.05). Conclusions:Nutrition support comprehensive nursing for patients with advanced gynecological tumor can further improve their nutritional status and improve their quality of life.

Objective:To explore the relationship between cardiac discomfort symptoms, fear of disease progress and post-traumatic stress disorder (PTSD) in patients with acute myocardial infarction(AMI) after discharge, and to clarify main intervention direction of PTSD in patients with AMI.Methods:Patients with AMI who were discharged from Tangshan Gongren Hospital between 1 month and 1 year were selected from November 2019 to November 2020.The cardiac discomfort symptoms scale, fear of progress questionnaire(FoP-Q-SF) and post-traumatic stress disorder self-rating scale(PTSD-SS) were used to investigate cardiac discomfort symptoms, fear of disease progress level and post-traumatic stress disorder status.Spearman rank correlation analysis was used to analyze the relationship between cardiac discomfort symptoms, fear of disease progress and post-traumatic stress disorder by SPSS 24.0 software. The mediating effect of fear of disease progress was analyzed by AMOS 24.0 software.Results:The PTSD score was (32.78±12.38) of patients with AMI discharged from hospital for 1 month to 1 year and the incidence of PTSD was 12.3%.Spearman correlation test showed cardiac discomfort symptoms and fear of disease progress were positively correlated with PTSD( r=0.530, 0.723, both P<0.01) and cardiac discomfort symptoms was positively correlated with fear of disease progress( r=0.518, P<0.01). Mediating effect test showed that fear of disease progress was a complete mediator between cardiac discomfort symptoms and PTSD. Conclusion:Cardiac discomfort symptoms can affect PTSD through a complete mediator of fear of disease progress.