Objective To explore the relationship and internal path between activities of daily living(ADL),sleep quality and mental health of community elderly people in Shanghai.Methods A questionnaire survey was conducted among community residents aged 60 years and older seeing doctors in community health care center of five streets in Shanghai during Sept to Dec,2021 using convenience sampling.Activities of Daily Living(ADL),Pittsburgh Sleep Quality Index(PSQI)and 10-item Kessler Psychological Distress Scale(K10)were adopted in the survey.Single factor analysis,correlation analysis and multiple linear regression were used to analyze the data.The effect relationship between the variables was tested using Bootstrap's mediated effects test.Results A total of 1 864 participants were included in the study.The average score was 15.53±4.47 for ADL,5.60±3.71 for PSQI and 15.50±6.28 for K10.The rate of ADL impairment,poor sleep quality,poor and very poor mental health of the elderly were 23.6%,27.3%,11.9%and 4.9%,respectively.ADL and sleep quality were all positively correlated with mental health(r=0.321,P＜0.001;r=0.466,P＜0.001);ADL was positively correlated with sleep quality(r=0.294,P＜0.001).Multiple linear results of factors influencing mental health showed that ADL(β= 0.457,95%CI:0.341-0.573),sleep quality(β =0.667,95%CI:0.598-0.737)and mental health were positively correlated(P＜0.001).Sleep quality partially mediated the relationship between ADL and mental health(95%CI:0.078-0.124)with an effect size of 33.0%.Conclusion Sleep quality is a mediator between ADL and mental health among community elderly people.Improving ADL and sleep quality may improve mental health in the population.

Objective:To evaluate the relationship between preoperative serum bilirubin concentrations and postoperative delirium (POD) in the patients undergoing knee or hip replacement.Methods:Medical records from 413 patients undergoing knee or hip arthroplasty were selected from August 2020 to October 2023 at Qingdao Municipal Hospital using a nested case-control design based on the PNDABLE study cohort. The patients were divided into POD group ( n=77) and non-POD group ( n=336) according to whether POD occurred. Univariate analysis was used to analyze the influencing factors. Logistic regression was used to identify the risk factors for POD. The significance of mediation effect was tested. The receiver operating characteristic curve was drawn to evaluate the accuracy of risk factors in predicting POD. Results:There were significant differences in age, education time, ratio of diabetes history, Memorial Delirium Assessment Scale score, total bilirubin concentration, direct bilirubin concentration, indirect bilirubin concentration, Aβ 42 concentration, p-tau concentration, t-tau concentration, Aβ 42/p-tau ratio and Aβ 42/t-tau ratio between POD group and non-POD group ( P<0.05). The results of logistic regression analysis showed that preoperative serum total bilirubin, direct bilirubin and indirect bilirubin were risk factors for POD ( P<0.05). The results of mediation effects showed that the concentration of total tau protein in CSF partly mediated the relationship between high serum total bilirubin, direct bilirubin and indirect bilirubin concentrations and POD. The area under the receiver operating characteristic curve of total bilirubin, direct bilirubin and indirect bilirubin combined with CSF biomarker concentrations in predicting POD was 0.83 ( P<0.001). Conclusions:Preoperative elevated concentrations of total bilirubin, direct bilirubin and indirect bilirubin are risk factors for POD in the patients undergoing knee or hip replacement. CSF t-tau concentration has a partly mediating role in the association between serum total bilirubin, direct bilirubin and indirect bilirubin concentrations and the development of POD.

Objective To investigate the effects of trigonelline combined with aerobic exercise on hyperlipidemia rats and its mechanism.Methods SD rats were randomly divided into control group(normal diet),model group(hyperlipidemia rat model was established by feeding high fat diet),experimental-L,-H groups(high fat diet+15,45 mg·kg-1 trigonelline)and combine group(high fat diet+45 mg·kg-1 trigonelline+aerobic exercise).Each group had 11 rats.Serum lipid metabolism related indexes were detected by automatic biochemical analyzer.Serum levels of 6 ketone prostaglandin F1a(6-keto-PGF1a);the levels of glutamic oxaloacetic transaminase(GOT)in liver tissue were detected by enzyme-linked immunosorbent assay;the mRNA levels of interleukin-1β(IL-1β)in liver tissue were detected by real-time fluorescence quantitative polymerase chain reaction(RT-qPCR);Western blot assay was used to detect the expression of proprotein convertase subtilin/kexin 9 type(PCSK9)and low density lipoprotein receptor(LDLR)protein in liver tissue.Results The serum TC levels in control group,model group,experimental-L group,experimental-H group and combine group were(1.81±0.10),(6.68±0.77),(5.10±0.44),(3.57±0.47)and(2.40±0.35)mmol·L-1;the levels of 6-keto-PGF1a were(841.47±86.74),(536.03±36.50),(664.06±52.44),(759.19±52.30)and(824.45±67.62)pg·mL-1;GOT levels were(11.95±0.88),(18.20±1.81),(15.05±1.10),(13.32±0.98)and(12.47±0.83)U·L-1;IL-1β mRNA expression levels were 1.00±0.09,2.21±0.17,1.57±0.10,1.26±0.16 and 1.14±0.09;the expression of PCSK9 protein were 0.39±0.07,0.88±0.08,0.71±0.08,0.60±0.04 and 0.52±0.07;LDLR protein levels were 1.12±0.13,0.52±0.07,0.74±0.11,0.84±0.08 and 0.96±0.11,respectively.Model group was compared with the control group,experimental-L group and experimental-H group were compared with model group respectively,combine group was compared with the experimental-H group,the differences of the above indexes were statistically significant(all P＜0.05).Conclusion Trigonelline combined with aerobic exercise may inhibit the expression of PCSK9 and up-regulate the expression of LDLR to improve lipid metabolism,so as to play a lipid-lowering role in hyperlipidemia rats.

Objective To investigate the effect and mechanism of rosuvastatin on liver injury induced by high fat diet in hyperlipidemia rats.Methods All rats were randomly divided into control group,model group and experimental group,with 10 rats in each group.Except the control group,hyperlipidiosis model rats were fed with high-fat diet combined with alcohol to construct hyperlipidiosis model rats.The experimental group was given 10 mg·kg-1 rosuvastatin by gavage,control group and model group were given gavage with 10 mL·kg-1 distilled water,once a day for 4 weeks.Serum lipids and liver function were measured by enzyme-linked immunosorbent assay(ELISA).Quantitative real-time polymerase chain reaction(qRT-PCR)was used to analyze the expression of microRNA(miR)-185-3p and mastermind like transcription coactivator 1(MAML1);the expression levels of MAML1 and inducible nitric oxide synthase(iNOS)were detected by Western blot.Results The liver tissue injury scores of control group,model group and experimental group were 0.32±0.15,4.03±1.62 and 2.36±1.14;the TG levels were(4.95±0.86),(6.75±1.42)and(5.51±0.91)mmol·L-1;the TC were(2.36±0.48),(5.11±2.05)and(3.24±1.39)mmol·L-1;the LDL-C were(0.67±0.16),(1.73±0.42)and(1.03±0.25)mmol·L-1;the HDL-C were(0.72±0.23),(0.51±0.14)and(0.64±0.11)mmol·L-1;the GOT were(158.31±32.46),(253.19±49.27)and(187.52±53.46)U·L-1;the GPT values were(53.17±6.81),(79.64±13.92)and(55.63±9.11)U·L-1.Compared with the control group,the expression of miR-185-3p in the model group was significantly down-regulated,the expression of MAML1 and iNOS was significantly increased.Compared with the model group,the expression of miR-185-3p in the liver tissue of experimental group was significantly up-regulated,while the expression of MAML1 and iNOS was significantly decreased(all P＜0.05).There were statistically significant differences in the above indexes between the control group and the model group(P＜0.05);the above data in the model group were statistically significant compared with the experimental group(P＜0.05).Conclusion Rosuvastatin inhibits the expression of MAML1 and iNOS by regulating miR-185-3p,thereby improving the liver injury induced by hyperlipidemia in rats.

Objective To investigate the effect of naringin on hyperlipidemia in mice and to elucidate its mechanism.Methods C57BL/6 mice were randomly divided into control group,hyperlipidemia group and naringin group.Mice in hyperlipidemia group and naringin group were fed high-fat diet for 4 weeks,and hyperlipidemia model was established.The control group was fed normal diet.After successful modeling,naringin group mice were intragastric with 200 mg·kg-1 naringin per day,and mice in control group and hyperlipemia group were intragastric with 0.9％NaCl per day for 5 weeks.The blood of mice was collected for lipid detection.The activities of superoxide dismutase(SOD)and catalase(CAT)and the contents of malondialdehyde(MDA)and glutathione(GSH)were detected by biochemical method.Western blot was used to detect the protein expression.Results The activity of SOD in liver tissue of mice in control group,hyperlipidemia group and naringin group were(58.43±6.27),(37.16±4.10)and(51.23±4.81)U·mg prot-1,respectively;CAT activities were(176.11±13.59),(112.65±10.02)and(158.46±14.37)U·mg prot-1,respectively;the contents of MDA were(3.15±0.74),(12.62±2.07)and(5.76±1.83)U·mg prot-1;the contents of GSH were(91.52±11.47),(34.16±4.62)and(71.64±8.79)U·mg prot-1,respectively;the relative protein expression levels of induced nitric oxide synthase(iNOS)were 0.28±0.05,4.26±1.13 and 0.94±0.19;the relative protein expression levels of adenosine 5'-monophosphate activated protein kinase(AMPK)were 1.32±0.18,0.84±0.11 and 1.49±0.16,respectively;the relative protein expression levels of cholesterol regulatory element binding protein(SREBP)were 1.76±0.24,5.78±1.21 and 2.93±0.42;the relative protein expression levels of 3-hydroxy-3-methyl glutaryl coenzyme A reductase(HMGCR)were 1.69±0.18,6.13±1.38 and 3.26±0.43,respectively.The above indexes in the control group and the naringin group were significantly different from those in the hyperlipidemia group(P＜0.05,P＜0.01,P＜0.001).Conclusion Naringin can effectively regulate the level of blood lipids,inhibit oxidative stress and apoptosis in hyperlipidemia mice,and its mechanism may be related to the regulation of AMPK/HMGCR/SREBP signaling pathway.

Objective To investigate the effect and mechanism of hypericin on osteoporosis(OP)in rats with chronic obstructive pulmonary disease(COPD).Methods COPD combined with OP rat model was established by cigarette combined with bacteria.The rats were randomly divided into control group,model group(COPD combined with OP model was constructed),experimental-L group(50 mg·kg-1 hypericin was given by intragastric administration after constructing COPD combined with OP model),experimental-H group(100 mg·kg-1 hypericin was given intragastric administration after constructing COPD combined with OP model),positive group(subcutaneous injection of 16 U·kg-1 salmon calcitonin after constructing COPD combined with OP model);each group was given 12 rats for 90 days.The lung function of rats was detected by pulmonary function apparatus;bone mineral density(BMD)was detected by micro-computed tomography(CT);serum bone metabolism and inflammatory factors were detected by enzyme-linked immunosorbent assay(ELISA);Western blot assay was used to detect the relevant indicators of the pathway.Results The levels of forced vital capacity(FVC)in control group,model group,experimental-H group and positive group were(10.42±1.40),(4.10±0.60),(6.75±0.37),(4.18±0.33)mL,respectively;BMD levels were(0.31±0.04),(0.12±0.02),(0.28±0.03),(0.29±0.04)g·mm-3,respectively;bone alkaline phosphatase(BALP)levels were(200.04±20.03),(80.80±6.00),(148.16±14.23),(173.97±23.55)U·L1,respectively;interleukin-1β(IL-1β)levels were(122.60±8.70),(695.59±74.84),(422.41±44.86),(527.90±39.36)pg·mL-1,respectively;phosphorylated p38 mitogen-activated protein kinase(p-P38)protein expression levels were 0.99±0.11,0.36±0.05,0.79±0.08,0.36±0.04,respectively.Compared with the control group,the above indexes in the model group had statistical significance(all P＜0.05);the above indexes in experimental-H group were significantly different from those in model group(all P＜0.05).Conclusion Hypericin can inhibit inflammatory response,improve bone metabolism and biomechanics.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

Objective To analyze the clinical efficacy and safety of glecaprevir/pibrentasvir in the treatment of pa-tients with hepatitis C virus(HCV)and human immunodeficiency virus(HIV)co-infection,and provide scientific basis for clinical treatment.Methods 89 initially treated non-cirrhotic patients with HCV/HIV co-infection in a hospital of Butuo County of Liangshan Prefecture from January 2021 to January 2022 were selected.All patients re-ceived glecaprevir/pibrentasvir treatment for 8 weeks and were followed up for 12 weeks.Virological response rate at the end-of-treatment and sustained virological response rate after 12 weeks(SVR12)of treatment as well as oc-currence of adverse reaction were recorded.Results Among 89 initially treated non-cirrhotic patients with HCV/HIV co-infection,most were middle-aged and young married men(n=79,88.8％).HIV was mainly transmitted through sexual contact(n=62,69.7％)and intravenous drug use(n=27,30.3％).The most common HCV geno-types were genotype 1b(n=33,37.1％)and genotype 3b(n=25,28.1％).All patients completed 8 weeks of treatment successfully and HCV RNA load at the end of treatment was below the detection limit(＜25 IU/mL).Eight patients failed to complete the follow-up,and the remaining 81(100％)patients achieved a sustained virologic re-sponse.There were no serious adverse reactions during the observation period,but 11 patients had mild adverse re-actions.Conclusion The 8-week treatment regimen of glecaprevir/pibrentasvir for non-cirrhotic patients with geno-type 1,3,and 6 HCV/HIV co-infection can achieve 100％SVR12,with high safety and tolerability,which can be used as a good choice for clinical treatment of these patients.

Objective To compare the clinical efficacy of intraoperative slide rail CT combined with C-arm X-ray assis-tance and just C-arm for percutaneous screw in the treatment of pelvic posterior ring injury.Methods A retrospective analysis was performed on the patient data of 76 patients with posterior pelvic ring injury admitted to the Department of Orthopedic Trauma from December 2018 to February 2022.Among them,39 patients in the CT group were treated with C-arm combined with slide rail CT-assisted inline fixation including 23 males and 16 females with an average age of(44.98±7.33)years old;and the other 37 patients in the C-arm group were treated with intraline fixation treatment under only C-arm fluoroscopy in-cluding 24 males and 13 females with an average age of(44.37±10.82)years old.Among them,42 patients with anterior ring fractures were treated with percutaneous inferior iliac spines with internal fixation(INFIX)or suprapubic support screws to fix the anterior pelvic ring.Postoperative follow-up time,operation time,complications of the two groups were compared.Results of Matta reduction criteria,Majed efficacy evaluation,the CT grading and the rate of secondary surgical revision were com-pared.Results The nailing time of(32.63±7.33)min in CT group was shorter than that of(52.95±10.64)min in C-arm group(t=-9.739,P＜0.05).The follow-up time between CT group(11.97±1.86)months and C-arm group(12.03±1.71)months were not statistically significant(P＞0.05).The postoperative complication rates between two groups were not statistically significant(x2=0.159,P＞0.05).Results of Matta reduction criteria(Z=2.79,P＜0.05),Majeed efficacy evaluation(Z=2.79,P＜0.05),CT grading(Z=2.83,P＜0.05)in CT group were better than those in C-arm group(P＜0.05);the secondary surgical revision rate in the CT group was significantly lower than that in the C-arm group(x2=5.641,P＜0.05).Conclusion Compared with traditional C-arm fluoroscopy,intraoperative slide rail CT combined with C-arm assisted percutaneous sacroiliac joint screw placement surgery has the characteristics of short operation time,high accuracy and safety,and significant decrease in postoperative sec-ondary revision rate,and is one of the effective methods for re-establishing the stability of the posterior ring of pelvic fracture.

Objective To examine the changing antimicrobial resistance profile of Enterobacter spp.isolates in 53 hospitals across China from 2015 t0 2021.Methods The clinical isolates of Enterobacter spp.were collected from 53 hospitals across China during 2015-2021 and tested for antimicrobial susceptibility using Kirby-Bauer method or automated testing systems according to the CHINET unified protocol.The results were interpreted according to the breakpoints issued by the Clinical & Laboratory Standards Institute(CLSI)in 2021(M100 31st edition)and analyzed with WHONET 5.6 software.Results A total of 37 966 Enterobacter strains were isolated from 2015 to 2021.The proportion of Enterobacter isolates among all clinical isolates showed a fluctuating trend over the 7-year period,overall 2.5％in all clinical isolates amd 5.7％in Enterobacterale strains.The most frequently isolated Enterobacter species was Enterobacter cloacae,accounting for 93.7％(35 571/37 966).The strains were mainly isolated from respiratory specimens(44.4±4.6)％,followed by secretions/pus(16.4±2.3)％and urine(16.0±0.9)％.The strains from respiratory samples decreased slightly,while those from sterile body fluids increased over the 7-year period.The Enterobacter strains were mainly isolated from inpatients(92.9％),and only(7.1±0.8)％of the strains were isolated from outpatients and emergency patients.The patients in surgical wards contributed the highest number of isolates(24.4±2.9)％compared to the inpatients in any other departement.Overall,≤ 7.9％of the E.cloacae strains were resistant to amikacin,tigecycline,polymyxin B,imipenem or meropenem,while ≤5.6％of the Enterobacter asburiae strains were resistant to these antimicrobial agents.E.asburiae showed higher resistance rate to polymyxin B than E.cloacae(19.7％vs 3.9％).Overall,≤8.1％of the Enterobacter gergoviae strains were resistant to tigecycline,amikacin,meropenem,or imipenem,while 10.5％of these strains were resistant to polycolistin B.The overall prevalence of carbapenem-resistant Enterobacter was 10.0％over the 7-year period,but showing an upward trend.The resistance profiles of Enterobacter isolates varied with the department from which they were isolated and whether the patient is an adult or a child.The prevalence of carbapenem-resistant E.cloacae was the highest in the E.cloacae isolates from ICU patients.Conclusions The results of the CHINET Antimicrobial Resistance Surveillance Program indicate that the proportion of Enterobacter strains in all clinical isolates fluctuates slightly over the 7-year period from 2015 to 2021.The Enterobacter strains showed increasing resistance to multiple antimicrobial drugs,especially carbapenems over the 7-year period.