Objective: To analyze the mediating effects of self-efficacy and self-management behaviors on the relationship between depression symptoms and glycemic control among elderly patients with type 2 diabetes mellitus (T2DM), so as to provide references for optimizing health management of elderly T2DM patients. Methods: T2DM patients aged ≥60 years from 8 community health service centers in Nanjing City were selected using a convenience sampling method. Basic information such as gender and age was collected through questionnaires. Depressive symptoms, self-efficacy, and self-management behaviors were assessed using the Patient Health Questionnaire, the Diabetes Self-Efficacy Scale, and the Diabetes Self-Management Behavior Scale, respectively. Glycated hemoglobin (HbA1c) was measured to evaluate glycemic control. A mediating effect model was constructed to analyze the mediating effects of self-efficacy and self-management behaviors on the relationship between depressive symptoms and glycemic control. Results: A total of 567 elderly T2DM patients were included, with a median age of 70.00 (interquartile range, 7.50) years. There were 248 males (43.74%) and 319 females (56.26%). The median scores of self-efficacy, self-management behaviors, depressive symptoms, and HbA1c were 3.89 (interquartile range, 0.78), 4.45 (interquartile range, 1.55), 4.00 (interquartile range, 6.00), and 6.80% (interquartile range, 1.40%), respectively. The mediating effect analysis showed that depressive symptoms indirectly affected glycemic control among elderly T2DM patients through the independent mediating effects of self-efficacy (β=0.028, 95%CI: 0.016-0.043) and self-management behaviors (β=0.009, 95%CI: 0.003-0.016), as well as the chain mediating effect of both (β=0.025, 95%CI: 0.017-0.035). The mediating effects of self-efficacy and self-management behaviors accounted for 36.66% and 11.35% of the total effect, respectively, while the chain mediating effect accounted for 32.15% of the total effect. Conclusion Self-efficacy and self-management behaviors play mediating roles in the relationship between depressive symptoms and glycemic control among elderly T2DM patients.

To explore the differentially expressed genes (DEGs) related to biosynthesis of active ingredients in wolfberry fruits of different varieties of Lycium barbarum L. and reveal the molecular mechanism of the differences of active ingredients, we utilized Illumina NovaSeq 6000 high-throughput sequencing technology to conduct transcriptome sequencing on the fruits of 'Ningqi No.1' and 'Ningqi No.7' during the green fruit stage, color turning stage and maturity stage. Subsequently, we compared the profiles of related gene expression in the fruits of the two varieties at different development stages. The results showed that a total of 811 818 178 clean reads were obtained, resulting in 121.76 Gb of valid data. There were 2 827, 2 552 and 2 311 DEGs obtained during the green fruit stage, color turning stage and maturity stage of 'Ningqi No. 1' and 'Ningqi No. 7', respectively, among which 2 153, 2 050 and 1 825 genes were annotated in six databases, including gene ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG) and clusters of orthologous groups of proteins (KOG). In GO database, 1 307, 865 and 624 DEGs of green fruit stage, color turning stage and maturity stage were found to be enriched in biological processes, cell components and molecular functions, respectively. In the KEGG database, the DEGs at three developmental stages were mainly concentrated in metabolic pathways, biosynthesis of secondary metabolites and plant-pathogen interaction. In KOG database, 1 775, 1 751 and 1 541 DEGs were annotated at three developmental stages, respectively. Searching the annotated genes against the PubMed database revealed 18, 26 and 24 DEGs related to the synthesis of active ingredients were mined at the green fruit stage, color turning stage and maturity stage, respectively. These genes are involved in carotenoid, flavonoid, terpenoid, alkaloid, vitamin metabolic pathways, etc. Seven DEGs were verified by RT-qPCR, which showed consistent results with transcriptome sequencing. This study provides preliminary evidences for the differences in the content of active ingredients in different Lycium barbarum L. varieties from the transcriptional level. These evidences may facilitate further exploring the key genes for active ingredients biosynthesis in Lycium barbarum L. and analyzing their expression regulation mechanism.
Flavonoids/metabolism* ; Fruit/genetics* ; Gene Expression Profiling/methods* ; Gene Expression Regulation, Plant ; Lycium/metabolism* ; Metabolic Networks and Pathways ; Transcriptome

OBJECTIVE To explore dianhydrogalactitol(DAG)-induced neurodevelopmental toxicity and mechanisms in zebrafish embryos and larvae. METHODS On the basis of general toxicity evaluation, zebrafish embryos were exposed to DAG in groups, and the effects of DAG on zebrafish nerves and behaviors were observed by means of autonomic locomotor response and light stimulation response of juvenile fish; the effects of DAG on zebrafish brain tissues were observed by means of histopathological examination of brain and acridine orange staining. The relative expression of dopamine neuron-related genes(DAT, TH, GCH1) and neural inhibition/promotion of apoptosis-related genes(Bax, Bcl-2) was determined by real-time fluorescence quantitative PCR in zebrafish larvae. RESULTS DAG inhibited the voluntary movement of zebrafish under the 20, 40, 75 mg·L-1, and the inhibition rate of voluntary movement showed obvious concentration correlation; DAG inhibited the reaction speed of zebrafish under the 20, 40, 75 mg·L-1, and the rate of decrease of reaction ability showed concentration correlation; the brain tissue became smaller, but the tissue structure of zebrafish did not show any significant abnormality in the various concentration groups of DAG; acridine orange staining was used to detect the apoptosis of the overall embryonic cells of zebrafish, and it was found that the administration of DAG inhibited the apoptosis of zebrafish. Acridine orange staining was used to detect apoptosis in the whole embryonic cells of zebrafish, and it was found that the green fluorescence in the head of the administered group was more obvious than that in the control group, indicating that apoptosis increased, and apoptosis increased in a dose-dependent manner, which was in accordance with the apparent observation; DAG in 75, 150, 300, 425, 600 mg·L-1 of the experimental condition could lead to a downward regulation of the relative expression of mRNA of the genes related to the zebrafish juvenile dopaminergic neuron, DAT, TH and GCH1. The Bax/Bcl-2 relative mRNA expression was up-regulated with increasing drug concentration. CONCLUSION The neurodevelopmental toxicity of DAG in zebrafish embryos and juveniles may be related to the inhibition of dopaminergic neurons.

Objective: To investigate the prevalence and influencing factors of dyslipidemia among adult residents in Hefei City, so as to provide the evidence for formulating the dyslipidemia control strategy. Methods: A total of 10 812 permanent residents at ages of 18 years were randomly sampled from 5 counties (districts) in Hefei City using a multi-stage stratified cluster random sampling method. Participants' demographic features, dietary behaviors and development of chronic diseases were collected using questionnaire surveys, and the height, body weight, waist circumference and blood lipids were measured. The prevalence of dyslipidemia was analyzed, and the factors affecting the development of dyslipidemia were identified using a multivariable logistic regression model. Results: Totally 10 812 valid questionnaires were recovered, with an effective recovery rate of 92.02%. The participants had a male to female ratio of 0.85∶1, a mean age of (51.89±12.56) years. The prevalence of dyslipidemia was 25.20%, and hypertriglyceridemia and low high-density lipoprotein cholesterol (HDL-C) were predominant types of dyslipidemia, with prevalence of 12.70% and 10.20%, respectively. Multivariable logistic regression analysis showed that urban areas (OR=1.340, 95%CI: 1.219-1.474), age of 40 years and older (40 to 59 years, OR=1.181, 95%CI: 1.047-1.333; 60 to 88 years, OR=1.321, 95%CI: 1.154-1.513), alcohol consumption (OR=1.205, 95%CI: 1.093-1.329), insufficient physical activity (OR=1.217, 95%CI: 1.111-1.332), static behavior duration of 3 h/d and longer (OR=1.126, 95%CI: 1.027-1.234), overweight (OR=1.162, 95%CI: 1.045-1.291), obesity (OR=1.310, 95%CI: 1.097-1.564), central pre-obesity (OR=1.236, 95%CI: 1.102-1.387), central obesity (OR=1.414, 95%CI: 1.247-1.603), hypertension (OR=1.279, 95%CI: 1.107-1.477), diabetes (OR=2.192, 95%CI: 1.820-2.640), medical insurance (OR=0.594, 95%CI: 0.395-0.893) and self-rated “very good/good” oral health (OR=0.731, 95%CI: 0.576-0.927) were factors affecting the development of dyslipidemia. Conclusion The risk of dyslipidemia is high among adult residents living in urban areas, middle-aged and elderly residents, residents with alcohol consumption, insufficient physical activity, overweight, obesity, central pre-obesity, central obesity, hypertension and diabetes.

Objective: This study aims to investigate the epidemiological distribution of HFMD and quantify the association of temperature with the incidence of children’s HFMD in Nanjing, China. Methods: Daily counts of HFMD in children under 5 years and daily meteorological variables during 2011-2016 were obtained. Descriptive statistics were used to describe the epidemiological characteristics and distributed lag non linear model (DLNM) was used to assess the associations of temperature on HFMD cases. Results: A total of 104 977 HFMD cases aged 0-5 years were reported in Nanjing during the study period and the male to female sex ratio was 1.49∶1. The average annual incidence was 213.5 per 100 000. A bimodal seasonal pattern was observed and the south and west were found to be the high incidence areas in the city. Of these laboratory confirmed enteroviruses positive cases, 32.5% cases were positive for EV-A71 infections, 29.1% cases were positive for CV-A16 infections and 38.4% cases were positive of other enteroviruses infections. The temperature HFMD relationships were non linear and showed obvious lag effects. The cumulative relative risk presented as an approximately inverted U shape over 14 days and peaked at 25.7 ℃ with value of 2.71(95%CI=1.93-3.81). Subgroup analyses revealed that males and children aged <1 year were more vulnerable to temperature variations. Conclusion Epidemiological characteristics of HFMD among children aged 0-5 years old in Nanjing presented temporal and regional distribution. The temperature has significant impact on children’s HFMD occurrence.

OBJECTIVE: To explore the influence of work pressure and psychological capital on job burnout of college teachers. METHODS: A total of 287 teachers from 7 universities in Nanjing City were selected as the research subjects using the convenient sampling method. The Maslach Burnout Inventory, Job Stress Scale for University Teachers and Psychological Capital Questionnaire were used to investigate their job burnout, job stress and psychological capital. RESULTS: The total scores of job burnout and job stress were(42.9±12.5) and(48.5±12.4) respectively, and the occurrence of job burnout was 64.1%. The total scores of psychological capital was(106.7±14.7), and the scores of the four dimensions including self-efficacy, hope, resilience and optimism were(27.6±4.6),(26.7±4.8),(27.0±4.2) and(25.4±3.8) respectively. The total score of job stress was positively correlated with the total score of job burnout [correlation coefficient(r)=0.41, P<0.01]. The total score of psychological capital, self-efficacy, hope, resilience and optimism were negatively correlated with the total score of job burnout(r values were-0.42,-0.28,-0.36,-0.36 and-0.42, respectively, P<0.01). The results of multiple linear regression analysis showed that after adjusting the influence of confounding factors and excluding other confounding factors, the higher the job stress, the higher the job burnout level(P<0.01), the higher the psychological capital optimism dimension score, the lower the job burnout level(P<0.01). CONCLUSION: The job stress and psychological capital of college teachers can independently affect their job burnout level, with a dose-effect relationship.

Objective: To evaluate the safety and efficacy of oblique lateral interbody fusion (OLIF) in the surgical treatment of lumbar degenerative diseases. Methods: All literatures of OLIF performed in lumbar degenerative diseases were searched in recognized databases including Pubmed, OVID, Embase, Cochrane Library, Science Direct, springer, CNKI, Wanfang and VIP databases. Methodological Indexfor Non-randomized Studies (MINORS) was used to evaluate the quality of the literatures. The meta-analysis was performed using Review Manager 5.3 and Stata 15.0 statistical software. Results: A total of 35 literatures were included, including 22 English literatures and 13 Chinese literatures. There were 3 630 patients with 45.2% of males, aged from 14 to 89 years old (mean, 62.6 years). The average of length of stay (LOS), operation time (OT) and blood loss (BL) of OLIF procedure were 6.7 days, 117 minutes, and 128 ml, respectively. The VAS scores of low back pain of postoperative and final follow-up decreased by 4.33 and 4.70, respectively. The VAS scores of leg pain decreased by 4.57 points and 5.31, respectively. Compared with preoperative, the postoperative JOA score increased by 7.58 and the postoperative ODI were also improved by 33.89%. All the postoperative imaging data were significantly different from those before surgery. The surgical level intervertebral heightincreased 4.14 mm, and the intervertebral foramen height and intervertebral foramen area increased by 3.54 mm, 53.96 mm², while the dura sac cross-sectional area increased by 36.61 mm², and the overall lumbar lordosis increased by 13.78° with the local segmental lordosis increased by 4.62°. The overall incidence of complications of OLIF was 32%, with a 95% confidence interval of 25%-38%. Conclusion OLIF is a minimally invasive procedure for the treatment of lumbar degenerative diseases. OLIF has a simply procedure and short learning curve, with short LOS and operation time, less blood loss. OLIF can effectively open the narrow intervertebral space and increase the spinal canal and nerve root canal, significantly improve the symptoms, while the complication rate is low, so OLIF is worthy of widespread clinical application.

Objective To compare the impact of permissive underfeeding versus standard enteral feeding on outcomes in critical patients requiring mechanical ventilation (MV). Methods A prospective randomized controlled study was conducted. Eighty-two patients requiring MV admitted to intensive care unit (ICU) of Anji People's Hospital from January 2015 to March 2017 were enrolled, and they were randomly divided into the permissive underfeeding group (n = 40, non-protein heat was 52.3-62.8 kJ·kg-1·d-1, protein was 1.2-1.5 g·kg-1·d-1) and standard enteral feeding group (n = 42, non-protein heat was 104.6-125.5 kJ·kg-1·d-1, protein was 1.2-1.5 g·kg-1·d-1). Permissive underfeeding group received 50% of their daily energy expenditure via enteral nutrition (EN) and standard enteral feeding group received 100% of their daily energy expenditure via EN in 24-48 hours after admitted to ICU. Nutritional status [pro-albumin (PA), serum albumin (ALB)], inflammation state [procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP)] were detected before treatment and 7 days after treatment. Duration of MV, length of ICU stay, daily insulin dosage, 28-day mortality, hospital acquired pneumonia (HAP), urinary tract infection, septic shock and other secondary infection, and the nutrition related complications were recorded. Results Compared with before treatment, the levels of serum PA (mg/L) and ALB (g/L) were significantly increased, the levels of PCT (ng/L) and hs-CRP (mg/L) were significantly decreased at 7 days after treatment in both groups [permissive underfeeding group: PA was 127.42±65.83 vs. 80.92±60.14, ALB was 30.16±4.32 vs. 25.36±6.21, PCT was 375.8±227.2 vs. 762.3±314.5, hs-CRP was 32.19±7.53 vs. 120.48±60.24; standard enteral feeding group: PA was 132.56±61.32 vs. 86.78±47.06, ALB was 31.25±4.63 vs. 26.71±5.48, PCT was 412.1±323.4 vs. 821.7±408.6, hs-CRP was 35.86±5.69 vs. 116.38±72.16, all 1 < 0.05], but there was no significant difference in PA, ALB, PCT or hs-CRP at 7 days after treatment between two groups (all 1 > 0.05). There was no significant difference in the duration of MV, length of ICU stay, 28-day mortality or ICU-associated infection between two groups [duration of MV (hours): 162.35±20.37 vs. 153.48±18.65, length of ICU stay (days): 7.52±1.61 vs. 6.34±1.87, 28-day mortality: 17.5% vs. 19.0%, ICU-associated infection: 45.0% vs. 47.6%, all 1 > 0.05]. Compared with standard enteral feeding, insulin demand was significantly decreased (U/d: 13.68±10.36 vs. 26.24±18.53), and gastrointestinal intolerance was less frequent (32.5% vs. 54.8%) in the permissive underfeeding group (both 1 < 0.05). Kaplan-Meier survival curve analysis showed that there was no significant difference between the two groups (χ2= 3.216, 1 = 0.068). Conclusion The curative effect and prognosis of MV severe patients receiving permissive underfeeding are similar to those of standard enteral feeding, but it can reduce the dosage of insulin with better gastrointestinal tolerance.

Objective To investigate the effects of fresh lumbar osteoporotic vertebral compression fracture (OVCF) on spinopelvic sagittal parameters and distribution of Roussouly types.Methods One hundred and eight patients with one-level fresh lumbar OVCF and 110 patients with simple osteoporosis (OP) were diagnosed and treated at Department of Orthopedic Surgery,Shougang Hospital from January 2016 to August 2017.The basic clinical data of all the patients were documented and their lumber spines were classified by Roussouly types.The 2 groups were compared in terms of spinopelvic sagittal parameters such as pelvic incidence (PI),pelvic tilt (PT),sacral slope (SS),and lumbar lordosis (LL) and Roussouly types.The correlation between Roussouly types and fracture segments was observed in OVCF group.Results There was no significant different in PI between OVCF and OP groups (50.35° ± 11.00° versus 51.96° ± 11.73°) (P ＞ 0.05).PT in OVCF group (18.79°± 9.51°) was significantly larger than that (16.19°± 9.03°) in OP group while SS (31.56° ± 7.88°) and LL (40.22°± 12.29°) in the former significantly smaller than those in the latter (35.77° ± 8.82° and 47.89° ± 13.20°,respectively) (P ＜ 0.05).Roussouly types Ⅰ,Ⅱ,Ⅲ and Ⅳ in OVCF group were 35,40,28 and 5 cases,respectively,with types Ⅰ and Ⅱ accounting for 69.5％;Roussouly types Ⅰ,Ⅱ,Ⅲ and Ⅳ in OP group were 17,30,49 and 14 cases,respectively,with type Ⅲ being predominant (44.5％).There was a significant difference between the 2 groups in distribution of Roussouly types (P ＜03.05).In OVCF group,fractures of L1 and L2 vertebrae accounted for 82.4％.There was a significant correlation between fracture segments and lumbar Roussouly types (P =0.034).Conclusions Patients with fresh lumbar OVCF tend to have a forward gravity and sagittal disequilibrium,leading to posterior pelvic rotation,increased PT,decreased SS,and downward shift of the apex of the lumbar curve.Their Roussouly classification is mainly type Ⅰ or type Ⅱ.

Objective By comparing clinical efficacy of percutaneous vertebroplasty with high viscosity bone cement and percutaneous kyphoplasty with conventional low viscosity bone cement for osteoporotic vertebral compression fractures,to explore the clinical value of treatment of osteoporotic vertebral compression fractures with high viscosity bone cement.Methods In this prospective study,100 patients with one-level OVCF and older than 70 years were diagnosed and treated in our hospital from June 2014 to December 2015,which were randomly divided into 2 groups (50 patients in each),applied unilateral percutaneous vertebroplasty with high viscosity bone cement and bilateral percutaneous kyphoplasty with conventional low viscosity bone cement,respectively.Collected data of basic clinical informations (including age,gender,body mass index,etc.),preoperative and postoperative visual analog scales (VAS),Oswestry disability questionnaire (ODI),operative time,intraoperative X-ray times,the amount of bone cement injection,leakage of bone cement,anterior vertebral height and kyphosis (Cobb angle) of preoperative and postoperative,and statistical analysis.Results There were significant improvement of both VAS and ODI scores of the postoperative 1 day,3 months and 12 months compared with preoperative,but there was no significant difference between two groups;The operative time,intraoperative fluoroscopy times,bone cement injection amount and intraoperative bone cement leakage of high viscosity bone cement PVP group were significantly less than those of low viscosity bone cement PKP group (P＜0.05);the anterior vertebral height and kyphosis improved,and there was a significant difference between preoperative and postoperative of low viscosity bone cement PKP group (P＜0.05).Conclusion The efficacies of unilateral PVP with high viscosity bone cement and bilateral PKP with conventional low viscosity bone cement for osteoporotic vertebral compression fractures are the same,which can relieve pain and improve function of life significantly.However,the high viscosity bone cement PVP is simpler surgical procedure,with shorter operative time,less intraoperative radiation,less bone cement leakage rate.The domestic bone cement injection device can significantly reduce the cost of surgery,it worth to be widely used for clinical application.