Objective To explore the mediating role of activities of daily living (ADL) in pain and depressive symptoms in the elderly in China. Methods Utilizing the data from 2020 China Health and Retirement Longitudinal Study, 4403 Chinese elderly individuals aged ≥ 60 years old were selected as the research subjects. Depression Scale (CES-D 10) of the Center for Epidemiological Survey and ADL scale were used in the study. The PROCESS4.1 macro was used to test the mediating effect of daily living activities between pain and depressive symptoms, and the Bootstrap method was applied for verification of the mediating variables. Results A total of 2368 cases of depressive symptoms were detected in the elderly in China, with a detection rate of 53.78%. Pain was positively correlated with depressive symptoms (r=0.27, P<0.01), and activities of daily living were negatively correlated with pain and depressive symptoms (r=-0.27, -0.337, P<0.01). The results showed that the total effect value of pain on depressive symptoms was 0.33, the direct effect value was 0.24, and the mediating effect value of daily living activities was 0.09, accounting for 27.27%. Conclusion Pain and activities of daily living are important factors influencing depressive symptoms in the elderly, and activities of daily living play a partial mediating role in the relationship between pain and depressive symptoms in the elderly.

OBJECTIVE To evaluate the influence of pharmaceutical quality control on the efficiency and outcomes of standardized medication therapy management （MTM） services for patients with coronary heart disease by using Economic， Clinical and Humanistic Outcomes （ECHO） model. METHODS This study collected case data of coronary heart disease patients who received MTM services during January-March 2023 （pre-quality control implementation group， n＝96） and June-August 2023 （post-quality control implementation group， n＝164）. Using propensity score matching analysis， 80 patients were selected from each group. The study subsequently compared the economic， clinical， and humanistic outcome indicators of pharmaceutical services between the two matched groups. RESULTS There were no statistically significant differences in baseline data between the two groups after matching （P＞0.05）. Compared with pre-quality control implementation group， the daily treatment cost （16.26 yuan vs. 24.40 yuan， P＜0.001）， cost-effectiveness ratio [23.12 yuan/quality-adjusted life year （QALY） vs. 32.32 yuan/QALY， P＜0.001]， and the incidence of general adverse drug reactions （2.50% vs. 10.00%， P＝0.049） of post-quality control implementation group were decreased significantly； the utility value of the EuroQol Five-Dimensional Questionnaire （0.74± 0.06 vs. 0.71±0.07， P＝0.003）， the reduction in the number of medication related problems （1.0 vs. 0.5， P＜0.001）， the medication adherence score （[ 6.32±0.48） points vs. （6.10±0.37） points， P＝0.001]， and the satisfaction score （[ 92.56±1.52） points vs. （91.95±1.56） points， P＝0.013] all showed significant improvements. Neither group experienced serious adverse drug reactions. There was no statistically significant difference in the incidence of new adverse reactions between the two groups （1.25% vs. 3.75%， P＝0.310）. CONCLUSIONS Pharmaceutical quality control can improve the quality of pharmaceutical care， and the ECHO model can quantitatively evaluate the effect of MTM services， making pharmaceutical care better priced and more adaptable to social needs， thus being worthy of promotion.

Aim To explore the potential targets and related signaling pathways of Agaricus blazei Murill (AbM ) extract in the treatment of chronic myeloid leukemia (CML) based on liquid chromatography mass spectrometry ( LC-MS ), network pharmacology, molecular docking, and were further verified by experiments in vitro. Methods The active components of AbM extract were retrieved from LC-MS, Swiss Target Prediction database was used to predict related targets, and CML disease target genes were obtained from Gen- eCards and DisGeNET databases. After screening the common targets of drug and CML, the protein-protein interaction network of the common targets was performed by STRING, and GO and KEGG enrichment a- nalysis were done by DAVID database. Cytoscape software was used to construct the network of target protein. Molecular docking was carried out by DockThor, and the Pymol software was used to make a visual picture. The inhibitory effect of AbM extract on leukemia cells K562 was determined by CCK-8 experiment, and the effect of AbM extract on the expression and phosphorylation level of related proteins was verified by Western blot. Results The prediction results showed that 126 active components of AbM extract, and 172 common targets were collected. KEGG pathway analysis results showed that PI3K/Akt/mTOR signaling pathway might play an important role in the treatment of CML disease. The IC

Objective　To explore the mediating role of cognitive function in the association between literacy level and depressive symptoms in middle-aged and elderly people in China. Methods　 Using the fourth national follow-up data of the China Health and Elderly Care Tracking Survey 2018, 8 124 middle-aged and elderly people aged 45 years and above were included as the study subjects. The PROCESS 4.0 program was used to test the mediating effect of cognitive function between literacy level and depressive symptoms, and the Bootstrap method was used for the mediator variable validation. Results The detection rate of depressive symptoms among middle-aged and elderly people in China was 38.10%. After controlling for gender, place of residence, marital status, smoking, alcohol consumption, and exercise, literacy level was a negative predictor of depressive symptoms in middle-aged and elderly people (β =－0.480, t =－11.248, P<0.001). Cognitive function accounted for 58.75% of the amount of mediating effect between literacy level and depressive symptoms. Conclusion 　Literacy level and cognitive function are associated with depressive symptoms in middle-aged and elderly people. Literacy level can influence depressive symptoms directly or indirectly through the mediation of cognitive dysfunction.

Objective To investigate the changing trend and epidemiological characteristics of the incidence and mortality of chronic kidney disease (CKD) with age, period and birth cohort in Chinese population. Methods Based on the data of incidence and mortality of CKD in Chinese population aged 20-80 years from 1990 to 2019 in GHDx database, joinpoint regression model was used to analyze the incidence and mortality trend of CKD. An age-period-cohort model was constructed to analyze the effects of age, period, and birth cohort on the trend of CKD incidence and mortality. Results Joinpoint regression analysis showed that the standardized incidence rate of chronic kidney disease in Chinese population increased from 146.37/100 000 in 1990 to 161.52/100 000 in 2019, while the standardized mortality rate decreased from 12.98/100 000 in 1990 to 11.23/100 000 in 2019. The APC model analysis showed that the risk of CKD incidence and death in the Chinese population increased with age, while the risk of CKD incidence increased with the increase of period. The risk of death did not change significantly with the increase of period. The cohort born later had a lower risk of CKD incidence and death compared to the cohort born earlier. Conclusion At present, the age effect and period effect of the incidence and death risk of chronic kidney disease in China are dominant. It is important to take effective measures and intervene in a timely manner, especially to strengthen the protection of older high-risk groups born earlier.

Objective Data mining technology was used to mine the medication rules of the prescriptions used in the treatment of pediatric atopic dermatitis by Chinese medical master XUAN Guo-Wei.Methods The medical records of effective cases of pediatric atopic dermatitis treated by Professor XUAN Guo-Wei at outpatient clinic were collected,and then the medical data were statistically analyzed using frequency statistics,association rule analysis and cluster analysis.Results A total of 242 prescriptions were included,involving 101 Chinese medicinals.There were 23 commonly-used herbs,and the 16 high-frequency herbs(frequency＞100 times)were Glycyrrhizae Radix et Rhizoma,Saposhnikoviae Radix,Glehniae Radix,Perillae Folium,Ophiopogonis Radix,Cynanchi Paniculati Radix et Rhizoma,Microctis Folium,Dictamni Cortex,Scrophulariae Radix,Coicis Semen,Cicadae Periostracum,Lilii Bulbus,Rehmanniae Radix,Kochiae Fructus,Sclerotium Poriae Pararadicis,and Euryales Semen.The analysis of the medicinal properties showed that most of the herbs were sweet and cold,and mainly had the meridian tropism of the spleen,stomach and liver meridians.The association rule analysis yielded 24 commonly-used drug combinations and 20 association rules.Cluster analysis yielded 2 core drug combinations.Conclusion For the treatment of pediatric atopic dermatitis,Professor XUAN Guo-Wei focuses on the clearing,supplementing and harmonizing therapies,and the medication principle of"supporting the healthy-qi to eliminate the pathogen,and balancing the yin and yang"is applied throughout the treatment.

BACKGROUND:Many studies have shown that total hip arthroplasty will improve low back pain in patients with hip-spine syndrome.However,there are few studies on the relationship between postoperative low back pain improvement and changes in spinal-pelvic sagittal parameters.This study aims to reveal their connections between the two. OBJECTIVE:To explore the relationship between the improvement of low back pain and changes in the spinal-pelvic sagittal parameters in patients with hip-spine syndrome after total hip arthroplasty. METHODS:A retrospective analysis was performed on the clinical and imaging data of 93 end-stage hip disease patients who underwent primary total hip arthroplasty and combined with low back pain and were admitted to Affiliated Hospital of Xuzhou Medical University from January 2019 to January 2022.Spinal-pelvic sagittal parameters were measured on lateral lumbar X-rays before surgery and 1 year at the last follow-up:pelvic incidence,pelvic tilt,sacral slope,lumbar lordosis,pelvic incidence-lumbar lordosis(difference between pelvic incident angle and lumbar lordosis angle).Visual analog scale score,Oswestry disability index,and hip Harris score were recorded before and 1 year after arthroplasty.The patients were divided into two groups according to whether the change in visual analog scale scores 1 year after surgery reached the minimal clinically important difference for low back pain treatment,including 45 cases in the low back pain unimproved group and 48 cases in the low back pain improved group.The preoperative general data of patients,differences in spinal-pelvic sagittal parameters,Oswestry Disability Index and hip Harris score before and after surgery were compared between the two groups. RESULTS AND CONCLUSION:(1)There was no significant difference in age,gender,surgical side,body mass index,and etiology between the two groups(P>0.05),and they were comparable.(2)There was no significant difference in visual analog scale scores before surgery(P>0.05).The visual analog scale scores of the low back pain improved group were lower than those of the low back pain unimproved group 1 year after surgery(P<0.01).(3)At 1 year after surgery,the lumbar lordosis of the low back pain unimproved group was significantly smaller than that before surgery,while the lumbar lordosis of the low back pain improved group was significantly smaller than that before surgery(P<0.01).At the same time,the pelvic incidence-lumbar lordosis mismatch in the low back pain unimproved group was greater than before surgery,while the pelvic incidence-lumbar lordosis mismatch in the low back pain improved group was smaller than before surgery,with significant differences between the two groups(P<0.01).There was no significant difference in the changes of other spinal-pelvic sagittal parameters between the two groups(P>0.05).(4)Preoperative lumbar Oswestry disability index and hip Harris score were not significantly different between the two groups(P>0.05).At 1 year after surgery,Oswestry disability index of the low back pain improved group was lower than that of the low back pain unimproved group and the hip Harris score was higher than that of the low back pain unimproved group(P<0.05).(5)The results showed that the improvement of low back pain was related to changes in spinal-pelvic sagittal parameters in patients with hip-spine syndrome after total hip arthroplasty,showing reduced lumbar lordosis and pelvic incidence-lumbar lordosis mismatch.Moreover,patients with improved low back pain after surgery had better functional scores,indicating that total hip arthroplasty improved spinal alignment and spinal-pelvic sagittal balance.For patients with hip-spine syndrome,a total hip arthroplasty performed before the onset of lumbar disease can have a favorable effect on the lumbar spine.

Objective To understand the consumption of hand hygiene(HH)products and HH compliance in in-tensive care units(ICUs)of secondary and higher grade medical institutions(MIs)in Shanghai,and provide basis for further monitoring of HH among health care workers(HCWs).Methods Through healthcare-associated infec-tion surveillance system,the consumption of HH products and HH compliance in ICUs from secondary and higher grade MIs in Shanghai in 2017-2021 were analyzed.Results 105 ICUs from 74 MIs were included in analysis,the average consumption of HH products was 79.24(44.88-258.63)mL/(bed·day),with statistically significant difference among different types of ICUs(P＜0.001).The average consumption of HH products increased from 65.75 mL/(bed·day)in 2017 to 87.55 mL/(bed·day)in 2021,showing an increasing trend year by year(P＜0.001).HCWs'HH compliance rate was 82.13％,with the highest in nurses(86.59％)and the lowest(48.90％)in medical technicians,HH compliance rates of HCWs of different occupations were statistically significant different(P＜0.001).Among the implementation modes of HH,39.86％used running water for hand washing,42.27％used alcohol-based hand rub to wipe hands,13.22％didn't take HH measures,and 4.65％didn't take HH mea-sures when wearing gloves,with statistically significant differences among different HH implementation modes of HCWs(P＜0.001).There was a positive correlation between the average consumption of HH products per bed·day and HCWs'HH compliance rate(r=0.703,P＜0.05).Conclusion The average consumption of HH products per bed·day and HH compliance rate of HCWs in ICUs in Shanghai presents an increasing trend year by year.There are differences in the average consumption of HH products per bed·day and HH compliance rate among different types of ICUs.The implementation of HH can be evaluated by continuously surveillance on the average consumption of HH products per bed·day.

Objectives:To explore the influencing factors of inter-arm systolic blood pressure difference(sIAD)in young hypertensive population. Methods:A total of 12 895 young Kailuan employees aged≤40 years,who participated in the physical examination from 2010 to 2020,were enrolled in this study.All of them underwent blood pressure measurements of four limbs in supine position.Young hypertensive group(n=3 584)and young non-hypertensive group(n=3 584)were 1∶1 matched by sex and age(±1 year),and participants were further divided into sIAD＜10 mmHg(1 mmHg=0.133 kPa)and sIAD&ge;10 mmHg subgroups.A stepwise multivariate logistic regression model was established to analyze the determinants of sIAD&ge;10 mmHg. Results:The detection rate of sIAD&ge;10 mmHg was significantly higher in the young hypertensive group than in the young non-hypertensive group(31.72%vs.27.76%,P＜0.001).Stepwise multivariate logistic regression analysis showed that in young hypertensive population,ankle-brachial index(ABI)＜0.9,male,obesity,overweight,elevated low density lipoprotein cholesterol(LDL-C)level,and systolic blood pressure were positively associated with sIAD&ge;10 mmHg,while college education or above,physical exercise were negatively correlated with sIAD&ge;10 mmHg(all P＜0.05).In the young non-hypertensive population,ABI＜0.9,systolic blood pressure were positively correlated with sIAD&ge;10 mmHg,while age was negatively associated with sIAD&ge;10 mmHg(all P＜0.05). Conclusions:The detection rate of sIAD&ge;10 mmHg is higher in young hypertensive population than in young non-hypertensive population.Decreased ABI,male sex,obesity,overweight,increased LDL-C level,systolic blood pressure,college education and above,and physical exercise are the influencing factors of sIAD&ge;10 mmHg in young hypertensive population.

BACKGROUND:Anterior cruciate ligament avulsion fracture at tibial insertion is a special type of intra-articular fracture,which is mostly seen in sports injuries.At present,there are relatively few anatomical studies on this disease,but a large number of studies focus on the injury of the anterior cruciate ligament.It is generally believed that the increase in the posterior slope of the tibial plateau,the decrease of the depth of the medial tibial plateau,and the decrease in the width index of the femoral intercondylar notch are the risk factors for the injury of the anterior cruciate ligament.It is unclear whether avulsion fractures of the anterior cruciate ligament at the tibial insertion point are also related to it. OBJECTIVE:To investigate the correlation between the avulsion fracture of the anterior cruciate ligament at the tibial insertion and the posterior tibial slope,the medial tibial depth,the notch width index of the femoral intercondylar fossa,and the coronal slope angle of the tibial plateau. METHODS:A retrospective analysis was made on 101 patients who were admitted to the Department of Orthopedics of Affiliated Hospital of Xuzhou Medical University due to anterior knee pain from January 2019 to December 2022.Totally 51 patients with tibial insertion avulsion fracture of anterior cruciate ligament who received arthroscopy treatment were taken as the observation group,and 50 patients with anterior knee pain but no knee joint injury confirmed by physical examination and imaging examination were taken as the control group in the same period.The posterior tibial slope,anatomical parameters such as the medial tibial depth,and the notch width index of the femoral intercondylar fossa,were statistically analyzed for the anatomical risk factors leading to the tibial insertion avulsion fracture of the anterior cruciate ligament. RESULTS AND CONCLUSION:(1)There was no significant difference between the two groups in the comparison of the lateral posterior tibial slope,the posterior slope ratio of the lateral/medial tibial plateau,the notch width index of the femoral intercondylar fossa,and the coronary slope angle of the tibial plateau(P>0.05).The medial posterior tibial slope in the observation group was significantly higher than that in the control group(P<0.05).The medial tibial depth in the observation group was significantly lower than that in the control group(P<0.05).(2)Multifactor logistic regression analysis showed that the medial posterior tibial slope and the medial tibial depth were independent risk factors for tibial insertion avulsion fracture of anterior cruciate ligament(P<0.05).(3)The receiver operating characteristic curve shows that the medial posterior tibial slope and the medial tibial depth had certain predictive values for the tibial insertion avulsion fracture of the anterior cruciate ligament.(4)It is indicated that the increased medial posterior tibial slope and the shallower medial tibial depth are the anatomical risk factors for the avulsion fracture of the tibial insertion of the anterior cruciate ligament.