Objective:To investigate the mediating role of frailty in the relationship between sedentary behavior and quality of life in patients with stable chronic obstructive pulmonary disease (COPD), so as to provide empirical evidence for improving the quality of life in COPD patients.Methods:This was a cross-sectional survey. Two hundred and twenty-eight patients with stable COPD attending outpatient clinic in Chongming Branch of Shanghai Tenth People′s Hospital from January 2022 to February 2023 were selected by convenience sampling method. The General Information Questionnaire, the International Physical Activity Questionnaire, the Tilburg Frailty Indicator, and the COPD Assessment Test Questionnaire were investigated. Structural equation modeling was used to analyze the mediating role of frailty between sedentary behavior and quality of life, and Bootstrap method was used to analyze the mediating effect values.Results:Finally, 219 valid questionnaires were collected. The effective recovery rate was 96.05%(219/228). There were 168 males and 51 females, aged 69(62, 74) years old. The sedentary time of stable COPD patients was 6(5, 8) h/d, the frailty score was 5(3, 7) points, and the quality of life score was (13.56 ± 2.56) points. Pearson correlation analysis showed that the sedentary time, frailty in stable COPD were positively correlated with quality of life( r=0.420, 0.582, both P<0.01), and the sedentary time was also positively correlated with frailty ( r=0.698, P<0.01). Bootstrap method test results showed that the direct effect of sedentary time was 0.228 (95% CI 0.082-0.374), the indirect effect mediated by frailty was 0.169 (95% CI 0.080-0.215), and the total effect was 0.397, and the 95% CI of both the direct effect and the mediated effect did not contain 0. This model was partially mediated model with a 42.57% mediated effect. Conclusions:The quality of life of patients with stable COPD is at an intermediate level, and sedentary behavior can not only directly affect quality of life, but also indirectly affect quality of life by causing or aggravating debilitation. In clinical work, patients should be encouraged to avoid causing or aggravating debilitation due to prolonged sedentary behavior by standing, changing position frequently or performing light physical activities to promote the improvement of quality of life in the stable phase.

Objective:To evaluate the application of 3D printed osteotomy template in total knee arthroplasty (TKA) for valgus knee.Methods:A retrospective analysis was performed of the 21 patients with valgus knee who had undergone TKA at Department Ⅰ of Joint Surgery, Orthopaedics Hospital of Zhengzhou from March 2016 to February 2018. They were 5 males and 16 females, aged from 62 to 78 years (average, 66.7 years). TKA was performed with the assistance of a 3D printed personalized osteotomy template for each patient. The efficacy of the personalized osteotomy templates was evaluated by comparing the femorotibial angle, knee range of motion, Hospital for Special Surgery (HSS) knee scores of the patients between preoperation and postoperation.Results:The 21 patients were followed up for a mean duration of 16.3 months(range, from 10 months to 4 years). All incisions healed by the first intention. The last follow-ups showed that their preoperative femorotibial angle 17.6°±5.7° was improved significantly to 6.3°±1.2°, their preoperative knee range of motion 71.3°±5.8° increased significantly to 102.4°±7.5°, and their preoperative HSS scores 38.2±5.7 increased significantly to 87.5±3.5 ( P<0.001). Their radiographic evaluation at the last follow-up showed stable prosthetic components with no implant loosing or osteolysis. Conclusion:A personalized 3D printed osteotomy template can be used in TKA for valgus knee, leading to accurate osteotomy, effective correction of mechanical alignment and satisfactory clinical outcomes.

Objective To analyze the main practices of capitation payment system reform in the case areas and put forward enlightenments and suggestions in this regard. Methods The implementation practices of the case areas were summarized, and descriptive statistical analysis was carried out on the implementation effects. Results By analyzing the effectiveness of the case areas′reform, it was found that the case areas are curbing the excessive growth of medical expenses (for example, outpatient fees per visit of Dingyuan county-level hospitals decreased from 245.11 yuan in 2015 to 218.40 yuan in 2017), increasing the actual compensation ratio of residents ( for example, the actual compensation ratio of Funan increased from 59.80% in 2015 to 63.28% in 2017), forming a medical treatment pattern within the county (for example, out-of-county compensation ratio in Dingyuan decreased from 37.38% in 2015 to 31.13% in 2017), achieving double-way referrals (for example, the number of referrals to superior hospitals of Jimo increased from 98 in 2015 to 328 in 2017), improving the subsidence of quality services, and controlling the risks of medical insurance funds. Conclusions At present, the reform of the case areas has been implemented steadily and achieved results. It is recommended to further improve such aspects as reform coordination, insurance standard setting, incentive mechanism establishment, and leadership to ensure the reform progress.

Pilot areas have achieved initial success in capitation reform. On the other hand, challenges remain unsolved in terms of practical pathways, change of national medical insurance management system, related measures, incentives and allocative mechanism for implement of the reform. With the concerning on progress, practice, effects and challenges of typical areas, this article established an institutional framework. On such basis, we propose to design and refine a scheme in terms of 5 aspects, namely strengthening the basic medical care packages′financing, setting contents and standard of the basic medical care packages rationally, establishing effective evaluation system and formulating supporting measures.

Objective To study the changes of transforming growth factor-β (TGF-β),connective tissue growth factor (CTGF) and collagen 1 (COL1) in newborn rat's lung tissue and the expressions of 4EBP1 (eukaryotic promoter) and P7OS6K (mammalian target of rapamyein pathway downstream target protein) after rapamycin and hyperoxia intervention,and to study the influence of mammalian target of rapamyein (mTOR) pathway on hyperoxic lung injury and the possible intervention methods.Method A total of 48 21-day-old neonatal rats were assigned into 8 groups (n =6),including air control group,3 d group (3 days after hyperoxic exposure),7 d group (7 days after hyperoxic exposure),14 d group (14 days after hyperoxic exposure),air + RAPA group (air + rapamycin),3 d + RAPA group (3 days after hyperoxic exposure + rapamycin),7 d + RAPA group (7 days after hyperoxic exposure + rapamycin) and 14 d + RAPA group (14 days after hyperoxic exposure + rapamycin).In the hyperoxic group,newborn rats were exposed to 90％ oxygen for 3,7,14 days respectively.The rats in the hyperoxia + rapamycin intervention groups received intraperitoneal injection of rapamycin and inhaled high concentrations of oxygen for 3,7,14 days respectively.Air ± rapamycin group received intraperitoneal injection of rapamycin for 3 days.To study the pathological changes of lung tissures after hyperoxia and rapamycin intervention,we used ELISA to detect the changes of TGF-β,CTGF and COL1 and Western blot to detect the variations of mTORC1,P70S6K and 4EBP1 expression.Result TGF-β,CTGF,COL1 levels at 3 days,7 days and 14 days after hyperoxic exposure (TGF-[β:33.7±2.8 vs.58.6 ±3.1 vs.98.8 ±1.5 ng/mg,CTGF:50.1 ±1.8 vs.68.7 ± 2.2 vs.94.4 ±2.5 ng/mg,COL1:471.9 ±5.7 vs.529.7 ±7.0 vs.556.4 ±8.5 ng/mg) were significantly higher than the air control group (TGF-β:25.5 ± 1.9 ng/mg,CTGF:41.7 ± 1.4 ng/mg,COL1:414.4 ± 8.9 ng/mg) (P ＜ 0.01).While the levels in rapamycin intervention group were significantly lower than all the hyperoxia + rapamycin intervention groups (P ＜ 0.01).The lung tissue pathological grades in 3 d + RAPA group and 7 d + RAPAgroup were significantly lower than those in the 3 d group and 7 d group (3.5 ± 0.8 vs.6.3 ± 2.3 and 9.7 ± 2.0 vs.14.0 ± 2.4) (P ＜ 0.01).The mTORC1,P70S6K,4EBP1 expressions in 3 d + RAPA group were lower than 3 d group (mTORC1:0.26 ± 0.04 vs.0.29±0.08,P70S6K:0.29±0.01 vs.0.31 ±0.08,4EBP1:0.31 ±0.06 vs.0.33 ±0.06) (P＜0.05),while the expressions in 7 d + RAPA and 14 d + RAPA groups were significantly lower than 3 d + RAPAgroup (P ＜0.01).Conclusion mTOR signal pathway may be involved in the repairing process of hyperoxic-induced lung fibrosis.Rapamycin can reduce the levels of TGF-β,CTGF and COL1 and inhibit the expressions of mTOR pathway downstream target protein P70S6K and 4EBP1,thus reduce lung injury atearly stage.

OBJECTIVE To explore the expression of long non-coding RNA (LncRNA) HOTAIR, enhancer of Zeste homolog 2 (EZH2) and vascular endothelial growth factor (VEGF) in nasopharyngeal carcinoma (NPC) and their relationship between HOTAIR and prognosis. METHODS We examined the expression of HOTAIR, EZH2 and VEGF in NPC tissues, and analyzed the clinical significance of HOTAIR expression in patients with NPC. RESULTS We found that the expression of HOTAIR, EZH2 and VEGF in the NPC tissues were significantly higher than those in the chronic nasopharyngitis tissues in the gene and protein levels (U=955,P<0.05). The HOTAIR was positively correlated with VEGF (r=0.599,P<0.001), VEGF was positively correlated with EZH2 (r=0.369, P=0.012), and HOTAIR had no significant correlation with EZH2 (r=0.139,P=0.357). Moreover, HOTAIR expression levels increased with clinical stage progression. CONCLUSION The expression of HOTAIR, EZH2 and VEGF were significantly increased in the NPC tissues, and the expression of HOTAIR was related with the TNM stage, the clinical stage and the short term therapeutic effect of the NPC patients, which indicated that the HOTAIR might be used as a biological indicator to determine the prognosis of the NPC.

mTOR signaling pathway is a highly conserved intracellular signaling pathway,which partici-pates in several signaling pathways, such as PI3K/AKT/mTOR, AKT/TSC1-TSC2/Rheb/mTOR, LKB1-AMPK-TSC-mTOR and FGF-10-Spry2-mTORC1-STAT3/HIF-1α-VEGF-A. mTOR signaling implicate in the regulation of the development of lung and many pulmonary diseases in many aspects,may be connected to bron-chopulmonary dysplasia. Bronchopulmonary dysplasia is one of the very common chronic lung diseases in pre-term,physical and chemical factors have been shown to induce acute lung injury, aberrant wound healing and lung fibrosis in the immature lung. This review summarizes relationship of mTOR signaling among lung develop-ment,acute lung injury and lung fibrosis,to explore the role of mTOR signaling in the development of bronchop-ulmonary dysplasia,in hope of providing novel method in the prevention and treatment of bronchopulmonary dysplasia.

Objective:To discuss the factors for affecting image quality of flat panel detector on modified DR and the solution.Methods: We observed disturbed condition of image on display by changing spatial resolution of flat panel detector, grid and display under a certain exposure condition, and observed improvement condition of image quality by changing exposure condition.Results: The variation of spatial resolution of flat panel detector, grid and display could affect image quality directly in DR. The variation of exposure dose could also affect resolution and contrast of image within limits.Conclusion: When taking radiography by flat panel detector, if the spatial resolution of image sections were close, the image would form wave-shape- stripe disturbance with strong regularity and high distinguishability; if the deviation of spatial frequency was large or be in multiple relationship, there would be no wave-shape- stripe on image, or the disturbance was inconspicuous. At the same time, choosing suitable radiography condition also showed certain effect to improve image quality.

Objective To explore the correlation between the psychological resilience levelwith the emotional regulation modeand personality characteristicin the patientwith gastricarcinomto provide the theoretical reference fothe intervention measure.MethodOne hundred and forty-seven patientwith gastricancewere selected athe research subject(gastricancegroup) and contemporaneou150 individualwith healthy physical examination in the outpatiendepartmenwere selected athe control group .The Connoand Davidson Resilience Scale(CD-RISC) ,Eysenck Personality Questionnaire(EPQ) and Emotion Regu-lation Scale were adopted to perform the investigation .The correlation between the psychological resilience levelwith the emotional regulation modeand personality characteristicwaanalyzed .ResultThe overall CD-RISscore in the gastricancegroup wa(59 .12 ± 9 .19) point,which belonged to the poorescope ;the personality characteristic,emotional regulation modeand psycho-logical resilience had statistical differencebetween the gastricancegroup and the control group (P＜0 .05);the multivariate Lo-gistiregression analysiresultshowed thathe introversion ,extroversion ,neuroticism ,catharsiregulation and depression regula-tion had largeinfluence on the lowepsychological resilience level in the patientwith gastricance(P＜0 .05);the psychological resilience in the patientwith gastricancewapositively correlated with the catharsiregulation and the depression regulation (r=0 .287 ,0 .136 ,P＜0 .05) and negatively correlated with the introversion ,extroversion and neuroticism (r= -0 .232 ,-0 .789 , P＜0 .05) .Conclusion The introversion ,extroversion ,neuroticism ,catharsiregulation and depression regulation are the importanfactorinfluencing the psychological resilience level .The multi-angle interventional measureshould be taken to improve the psy-chological resilience level in the patientwith gastricance.

To lay a foundation for the type selection of the ambulance helicopter. The type selection was explored from the aspects of platform selection, rescue environment and service requirements, analyzing the rescue in the helicopter and the tendency of the ambulance helicopter in foreign countries and China. The types of the am-bulance helicopter were determined as the specific and modified ambulances, with the considerations such as operation environment, flight performance, cabin structure, onboard equipment, cabin configuration, fixation device and protection. Specific ambulance helicopter is supposed to be based on small- or mediate-sized platform, while the modi-fied ambulance helicopter is supposed to be based on large or heavy platform.