Objective To investigate the correlation between insulin resistance and interleukin-6 (IL-6), chemerin, total cholesterol (TC)/high density lipoprotein cholesterol (HDL-C) ratio, triglyceride (TG)/HDL-C ratio, low density lipoprotein cholesterol (LDL-C)/HDL-C ratio and insulin resistance in obese patients with type 2 diabetes mellitus (T2DM), and to provide scientific basis for T2DM prevention and control. Methods A total of 355 obese T2DM patients in Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine were selected from January 2021 to December 2023. IL-6, chemerin and lipids were detected, and the assessment of insulin resistance was conducted through the homeostasis model assessment of insulin resistance (HOMA-IR). Results Among the 355 obese T2DM patients, there were 280 cases of insulin resistance, with the incidence rate of 78.87%. The BMI, IL-6, chemerin, TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C in the insulin resistance group were higher than those in the non-insulin resistance group (P<0.05). The above insulin resistant patients were divided into 4 subgroups by means of insulin resistance, and there were significant differences in BMI, IL-6, chemerin, and TG/HDL-C among the subgroups (P<0.05). IL-6, chemerin, and TG/HDL-C were positively correlated with HOMA-IR in obese T2DM patients (P<0.05), while TC/HDL-C and LDL-C/HDL-C had no significant correlation with HOMA-IR (P>0.05). BMI, IL-6, chemerin, and TG/HDL-C were all influencing factors of insulin resistance in obese T2DM patients (P<0.05). Conclusion IL-6, chemerin and TG/HDL-C are correlated with insulin resistance in obese patients with T2DM and are influencing factors for the occurrence of insulin resistance.

Objective: To investigate the vitamin D levels in children aged 1 year in Shaoxing City, Zhejiang Province, so as to provide the basis for prevention and treatment of vitamin D deficiency in children and promoting their health. Methods: The 1-year-old children who underwent health examinations at the Department of Child Health Care of Shaoxing Maternal and Child Health Care Hospital from September 2023 to August 2024 were selected. Basic information of the children was collected through the medical record information system, and their length and weight were measured. The length, weight and nutritional status were evaluated according to the Technical Specifications for the Management of Nutritional Diseases in Children. Serum 25-hydroxyvitamin D [25- (OH) D] levels were measured using electrochemiluminescence assay, and vitamin D levels were assessed based on the fifth edition of Child Health Care. The vitamin D levels were analyzed among the children with different genders, testing months, and growth status. Results: A total of 2 245 children were recruited, including 1 189 boys (52.96%) and 1 056 girls (47.04%). The median serum 25- (OH) D level was 39.98 (interquartile range, 16.63) ng/mL. Vitamin D insufficiency was observed in 279 children, with an insufficiency rate of 12.43%. The median serum 25- (OH) D level in boys was 39.26 (interquartile range, 17.75) ng/mL, which was lower than that in girls at 41.39 (17.75) ng/mL (P<0.05). The vitamin D insufficiency rate was 13.04% in boys and 11.74% in girls, with no statistically significant difference (P>0.05). The lowest vitamin D insufficiency rate was observed in August at 4.95%, while the highest rate was in September at 23.89%, showing the statistically significant difference across testing months (P<0.05). The children with above-average length ratings, higher weight ratings and obesity had higher vitamin D insufficiency rates, at 17.29%, 20.86% and 20.88%, respectively. The vitamin D insufficiency rate increased with higher weight and nutritional status ratings (both P<0.05), but no significant change was observed with higher length ratings (P>0.05). Conclusions The vitamin D insufficiency rate among 1-year-old children in Shaoxing City was 12.43%, with variations observed in different testing months, weight and nutritional status. Targeted prevention and intervention measures should be implemented to address these differences.

Objective:To evaluate the clinical efficacy of a novel reduction device in the treatment of A3N0/1 thoracolumbar fracture using navigation-assisted techniques.Methods:A retrospective analysis was conducted on 45 patients (29 males, 16 females; mean age 40.67±16.11 years, range 24-57) with thoracolumbar fractures who underwent fracture reduction and pedicle screw fixation via the Wiltse approach at Zhengzhou Orthopaedic Hospital between January 2022 and January 2023. Injury levels included: T 10 in 2 cases, T 11 in 5 cases, T 12 in 13 cases, L 1 in 20 cases, L 2 in 3 cases, L 3 in 2 cases. All patients underwent fracture reduction via the Wiltse approach using the spinal fracture reduction instrument for vertebral body reduction. Among them, 20 patients received O-arm navigation-assisted internal fixation and vertebral reduction (O-arm group), while 25 received C-arm fluoroscopy-guided internal fixation and vertebral reduction (C-arm group). Operative time, intraoperative blood loss, vertebral reduction time using the instrument, first-time screw placement success rate, screw placement accuracy, and complications were compared. Mid-vertebral body height ratio (MVBHr), local Cobb angle of the fractured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) were compared preoperatively, at 1 week postoperatively, 3 months postoperatively, and final follow-up. Results:All surgeries were successfully completed in both groups. Operative time was significantly shorter in the O-arm group (106.8±14.4 min) than in the C-arm group (119.1±16.4 min, P<0.05). All patients were followed up for a mean duration of 15.9±3.9 months (range 12-20 months). Vertebral reduction time was significantly shorter in the O-arm group (11.0±2.2 min) than in the C-arm group (20.4±5.7 min, P<0.05). The first-time screw placement success rate was significantly higher in the O-arm group (100%) than in the C-arm group (95.3%, P<0.05). Screw placement accuracy (Grade I) was significantly higher in the O-arm group (117 screws, 97.5%) than in the C-arm group (136 screws, 90.7%, P<0.05). No cases of wrong-level surgery, infection, or spinal cord/nerve injury occurred. Both groups showed significant improvements in MVBHr, Cobb angle, VAS, and ODI at all postoperative time points compared to preoperative values ( P<0.05). At final follow-up, the O-arm group demonstrated significantly better outcomes than the C-arm group in MVBHr (90.6%±4.5% vs. 86.4%±6.9%, P<0.05), Cobb angle (7.6°±1.8° vs. 10.1°±3.2°, P<0.05), VAS (1.3±0.4 vs. 1.7±0.6, P<0.05), and ODI (4.6%±1.9% vs. 7.7%±2.0%, P<0.01). Conclusion:O-arm navigation-assisted intrasegmental push reduction for A3N0/1 type thoracolumbar fractures demonstrates advantages including faster and more accurate screw placement, precise reduction with improved outcomes, and significant postoperative pain relief.

Objective To explore the facilitators and barriers of palliative care volunteering,and to provide references for further advancement of palliative care volunteering.Methods Purposeful sampling was used to select 12 volunteers from a palliative care ward in Hangzhou,Zhejiang Province,between April and September 2024.Semi-structured interviews were conducted,and directed content analysis was applied to organize and analyze the data,followed by theme analysis.Results Facilitators and barriers for volunteers' participation in palliative care volunteering were extracted.The 5 sub-themes of facilitators include motivating factors and perceived benefits,support and collaboration among volunteers,professional training and healthcare recognition,increased social awareness and public acceptance,and government support and institutional safeguards.The 5 sub-themes of barriers include limitations in individual capacity,challenges in collaboration with patients,families and healthcare workers,inadequate management and service mechanisms,uneven development of palliative care and insufficient public attention to psychological problems,and inadequate relevant laws and incentives.Conclusion There are more factors affecting the development of palliative care volunteering,and healthcare professionals should adopt targeted strategies to promote the active participation of volunteers in order to promote the sustainable development of palliative care volunteering.

Objective:To explore the efficacy of percutaneous vertebroplasty (PVP) using the partition injection technique in the treatment of Kümmell’s disease of stages Ⅰ and Ⅱ.Methods:A retrospective study was conducted of the 30 patients with stage Ⅰ or Ⅱ Kümmell’s disease (the partition group) who had been treated by PVP using the partition injection technique at Department of Spinal Surgery, Zhengzhou Orthopedic Hospital from January 2020 to January 2022. The data of another 30 patients who had been treated at the same department and the same period using conventional PVP for stage Ⅰ or Ⅱ Kümmell's disease were selected as the conventional group. In the partition group, there were 13 males and 17 females, with an age of (72.3±10.1) years and disease duration of (3.1±1.5) months. Seventeen thoracic and 13 lumbar vertebrae were affected. In the conventional group, there were 11 males and 19 females, with an age of (75.5±12.7) years and disease duration of (3.5±1.8) months. Eighteen thoracic and 12 lumbar vertebrae were affected. Surgical time, volume of bone cement injected, bone cement leakage, and bone cement distribution were compared between the 2 groups. The heights of the anterior and middle vertebral bodies, kyphotic Cobb angle, visual analog scale (VAS) pain score, and Oswestry disability index (ODI) were assessed postoperatively at 1 day, 6 months, and the last follow-up and compared between the 2 groups.Results:No significant differences were found in the baseline data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (17.3±3.1) months. There were no significant differences in the surgical time or bone cement leakage between the 2 groups ( P>0.05). The volume of bone cement injected in the partition group was significantly higher [(6.3±1.5) mL] than that in the conventional group [(4.9±1.0) mL] ( P<0.05). Bone cement distribution was significantly better in the partition group than that in the conventional group ( P<0.05). At postoperative 1 day, 6 months, and the last follow-up, the partition group was significantly better than the conventional group in anterior vertebral body height, middle vertebral body height, and kyphotic Cobb angle ( P<0.05). At the 6-month and the last follow-ups, the partition group was also significantly better than the conventional group in VAS pain score and ODI ( P<0.05). Conclusion:In the treatment of Kümmell’s disease of stages Ⅰ and Ⅱ, compared with conventional PVP, PVP using the partition injection technique may lead to better long-term outcomes due to its better bone cement distribution, more adequate cement injection, and better restoration of vertebral body heights and correction of local deformity.

ObjectiveTo explore the characteristics of traditional Chinese medicine （TCM） syndromes in the patients with concurrent knee osteoarthritis （KOA） and postmenopausal osteoporosis （PMOP） and provide a scientific basis for precise TCM syndrome differentiation， diagnosis， and treatment of such concurrent diseases. MethodsA prospective， multicenter， cross-sectional clinical survey was conducted to analyze the characteristics of TCM syndromes in the patients with concurrent PMOP and KOA. Excel 2021 was used to statistically analyze the general characteristics of the included patients. Continuous variables were reported as x¯±s， and binary variables were reported as percentages. UCINET and Gephi were used to construct a complex "isease-syndrome-symptom" network for in-depth mining. Topological structure indicators， edge connection information between nodes， and weighted adjacency matrices were calculated by UCINET and Python. Gephi was used for complex network visualization. ResultsA total of 157 patients with concurrent PMOP and KOA from 12 TCM hospitals or community health service centers were selected for the collection of TCM syndrome and symptom information. A total of 4 main TCM syndromes were obtained， which were kidney-Yang deficiency （47.13%）， liver-kidney Yin deficiency （36.94%）， spleen-kidney Yang deficiency （8.92%）， and kidney Yin-Yang deficiency （7.01%）. In addition， 10 concurrent syndromes （mainly Qi stagnation and blood stasis， Qi and blood deficiency， spleen Yang deficiency， and cold-dampness） were identified. Based on the results of comprehensive frequency statistics and complex network analysis， as well as TCM theoretical knowledge and relevant guidelines， the general characteristics of concurrent PMOP and KOA and the main TCM syndromes in the dimensions of physical symptoms， pain， tongue and pulse manifestations， and defecation and urination were obtained. ConclusionThe main TCM syndromes in the patients with concurrent PMOP and KOA may be kidney Yang deficiency， liver-kidney Yin deficiency， spleen-kidney Yang deficiency， and kidney Yin-Yang deficiency， among which kidney Yang deficiency and liver-kidney Yin deficiency are the core TCM syndromes.

ObjectiveTo explore the characteristics of traditional Chinese medicine （TCM） syndromes in the patients with concurrent knee osteoarthritis （KOA） and postmenopausal osteoporosis （PMOP） and provide a scientific basis for precise TCM syndrome differentiation， diagnosis， and treatment of such concurrent diseases. MethodsA prospective， multicenter， cross-sectional clinical survey was conducted to analyze the characteristics of TCM syndromes in the patients with concurrent PMOP and KOA. Excel 2021 was used to statistically analyze the general characteristics of the included patients. Continuous variables were reported as x¯±s， and binary variables were reported as percentages. UCINET and Gephi were used to construct a complex "isease-syndrome-symptom" network for in-depth mining. Topological structure indicators， edge connection information between nodes， and weighted adjacency matrices were calculated by UCINET and Python. Gephi was used for complex network visualization. ResultsA total of 157 patients with concurrent PMOP and KOA from 12 TCM hospitals or community health service centers were selected for the collection of TCM syndrome and symptom information. A total of 4 main TCM syndromes were obtained， which were kidney-Yang deficiency （47.13%）， liver-kidney Yin deficiency （36.94%）， spleen-kidney Yang deficiency （8.92%）， and kidney Yin-Yang deficiency （7.01%）. In addition， 10 concurrent syndromes （mainly Qi stagnation and blood stasis， Qi and blood deficiency， spleen Yang deficiency， and cold-dampness） were identified. Based on the results of comprehensive frequency statistics and complex network analysis， as well as TCM theoretical knowledge and relevant guidelines， the general characteristics of concurrent PMOP and KOA and the main TCM syndromes in the dimensions of physical symptoms， pain， tongue and pulse manifestations， and defecation and urination were obtained. ConclusionThe main TCM syndromes in the patients with concurrent PMOP and KOA may be kidney Yang deficiency， liver-kidney Yin deficiency， spleen-kidney Yang deficiency， and kidney Yin-Yang deficiency， among which kidney Yang deficiency and liver-kidney Yin deficiency are the core TCM syndromes.

Objective: To explore the factors affecting language development delay among children aged <3 years, so as to provide a basis for the prevention and early intervention of children's language development problems. Methods: Eighty-one children aged <3 years with language development delay who visited the children's language development clinic of Shaoxing Maternal and Child Health Hospital from January to December 2024 as the case group. Meanwhile, 118 children who underwent routine physical examinations at the children's health clinic during the same period, had normal language development were randomly selected as the control group. Data on children's basic information, parenting environment, and screen exposure were collected through questionnaire surveys. Language development delay was assessed using the Early Language Milestone Scale and the Gesell Developmental Diagnosis Scale. The factors for language development delay were analyzed using a multivariable logistic regression model. Results: The case group comprised 81 children, including 56 boys (69.14%) and 25 girls (30.86%), with a mean age of (23.14±4.84) months. The control group consisted of 118 children, including 81 boys (68.64%) and 37 girls (31.36%), with a mean age of (23.81±4.60) months. Multivariable logistic regression analysis showed that daily parental companionship time of ≥2 hours (OR=0.121, 95%CI: 0.040-0.367), attending childcare institutions (OR=0.103, 95%CI: 0.030-0.352), the average daily screen exposure time <1 hour (OR=0.614, 95%CI: 0.400-0.942), interactive parental accompaniment during screen exposure (OR=0.350, 95%CI: 0.157-0.779), and restricting screen exposure time (OR=0.162, 95%CI: 0.056-0.470) were associated with a lower risk of language development delay among children aged <3 years. Conclusion Daily paternal companionship of 2 hours or more, attending childcare institutions, daily screen exposure time of less than 1 hour, interactive parental companionship during screen time, and limiting screen exposure time can reduce the risk of language developmental delay among children aged under 3 years.

Objective:To compare the clinical efficacy of O-arm navigation-assisted percutaneous vertebroplasty (PVP) versus C-arm-guided PVP in the treatment of postoperative recurrent vertebral fractures following Kümmell′s disease.Methods:A retrospective cohort study was conducted to analyze the clinical data of 48 patients with postoperative recurrent vertebral fractures following Kümmell′s disease who were admitted to Zhengzhou Orthopedic Hospital from January 2021 to September 2024, including 16 males and 32 females, aged 51-85 years [(69.8±6.6)years]. Among them, 21 patients had stage I Kümmell′s disease and 27 stage II. Fractured vertebrae involved T 8-T 10 in 4 patients, T 11-L 2 in 29, and L 3-L 5 in 15. Twenty-five patients underwent O-arm navigation-assisted PVP (O-arm-assisted group) and 23 underwent C-arm-guided PVP (C-arm-guided group). The two groups were compared in terms of the operative time, intraoperative blood loss, bone cement volume, and bone cement filling saturation rate in the injured vertebral body. The visual analogue scale (VAS) scores and Oswestry disability index (ODI) values were also compared before operation, at 1 day, 1 month, 6 months after operation, and at the last follow-up. The excellent-good rate based on the MacNab criteria at the last follow-up and incidence of postoperative complications were detected. Results:All the patients were followed up for 6-24 months [(13.3±3.5)months]. There were no significant differences in the operative time, operative blood loss or bone cement volume between the two groups ( P>0.05). The O-arm-assisted group demonstrated a bone cement filling saturation rate of 96% (24/25) in the fractured vertebrae, significantly higher than 65% (15/23) in the C-arm-guided group ( P<0.05). The VAS scores before operation, at 1 day, and 1 month after operation were (8.4±1.0)points, (1.9±0.7)points, and (1.8±0.6)points, respectively in the O-arm-assisted group, while they were (8.3±0.8)points, (2.0±0.6)points, and (1.9±0.5)points, respectively in the C-arm-guided group ( P>0.05). The ODI values before operation, at 1 day, and 1 month after operation were 76.6±8.2, 20.4±4.5, and 19.8±4.1, respectively in the O-arm-assisted group, and 74.9±9.1, 21.3±3.6, and 20.9±3.2, respectively in the O-arm-assisted group ( P>0.05). At 6 months after operation and at the last follow-up, the VAS scores were (1.4±0.5)points and (1.5±0.5)points in the O-arm-assisted group, with significant improvement compared to (1.8±0.4)points and (1.9±0.3)points in the C-arm-guided group ( P<0.01); the ODI values were 17.8±3.2 and 18.2±3.5 in the O-arm-assisted group, with significant improvement compared to 19.9±3.1 and 21.3±4.0 in the C-arm-guided group ( P<0.05). Both groups demonstrated significant improvements in VAS scores and ODI values at 1 day, 1 month, 6 months after operation, and at the last follow-up, compared to those preoperatively ( P<0.05), while no statistically significant differences were found in VAS scores or ODI values at any postoperative timepoints ( P>0.05). According to the MacNab criteria, the O-arm-assisted group had a 100% (25/25) excellent-good rate, compared to 74% (17/23) in the C-arm-guided group ( P<0.05). The complication rate was 4% (1/25) in the O-arm-assisted group, significantly lower than 35% (8/23) in the C-arm-guided group ( P<0.05). Conclusion:O-arm navigation-assisted PVP for postoperative recurrent vertebral fractures following Kümmell′s disease offers advantages in precise cement delivery with sufficient dispersion, enhanced pain relief, functional recovery, improved quality of life, and reduced complication rates when compared to C-arm navigation-assisted PVP.