Objective To analyze the diagnostic values of H2FPEF and HFA-PEFF scores for heart failure with preserved ejection fraction(HFpEF)and HFpEF complicated with atrial fibrillation(HFpEF-AF)in Chinese patients and explore the related factors.Methods A cross-sectional study was conducted.A total of 835 consecutive HFpEF patients treated in the Department of Geriatric Cardiology,the First Hospital of Lanzhou Uni-versity from 2009 to 2020 were selected and assigned to a HFpEF-AF group(n =267)and a HFpEF group(n = 568)according to the presence of AF or not.HFA-PEFF and H2FPEF scores were used for retrospective diagnosis and the diagnostic consistency of the two scores was assessed.One hundred and thirty-six healthy volunteers with age and sex matching the patients during the same period were selected as healthy controls.The receiver operating characteristic(ROC)curves were established for H2FPEF and HFA-PEFF scores in diagnosing HFpEF-AF and HFpEF,on the basis of which the diagnostic performance of the two scores was evaluated.Results There was no difference in the HFA-PEFF score between the two groups(P =0.070).However,the HFpEF-AF group had higher mean H2FPEF score and higher proportion of patients with the score no less than 6 than the HFpEF group(P<0.001).According to the ROC curves,HFA-PEFF and H2FPEF scores demonstrated high perform-ance in diagnosing all HFpEF patients,with the area under the curve(AUC)of 0.892 and 0.922 and the opti-mal cut-offs of 4 and 4,respectively.The HFA-PEFF score showed similar performance in diagnosing HFpEF and HFpEF-AF,with the AUC of 0.899 and 0.911,respectively.The H2FPEF score had higher performance in di-agnosing HFpEF-AF(AUC of approximately 1.000)and low performance in diagnosing HFpEF(AUC of 0.885).Conclusions The HFA-PEFF score is applicable in the diagnosis of both HFpEF and HFpEF-AF.The H2FPEF score may underestimate HFpEF in Chinese patients,and its applicability in the Chinese patients with HFpEF alone remains to be investigated.

Objective Taking three-dimensional (3D) motion capture system (MoCap) as the gold standard, a deep learning fusion model based on bi-lateral long short-term memory (BiLSTM) recurrent neural network and linear regression algorithm was developed to reduce system error of the Kinect sensor in lower limb kinematics measurement. Methods Ten healthy male college students were recruited for gait analysis. The 3D coordinates of the reflective markers and the lower limb joint centers were simultaneously collected using the MoCap system and the Kinect V2 sensor, respectively. The joint angles of lower limbs were calculated using the Cleveland clinic kinematic model and the Kinect kinematic model, respectively. The dataset was constructed using the MoCap system as the target and the angles via the Kinect system as the input. A BiLSTM network and a linear regression model for all lower limb angles were developed to obtain the refined angles. A leave-one subject-out cross-validation method was employed to study the performance of the models. The coefficient of multiple correlations (CMC) and root mean square error (RMSE) were used to investigate the similarity and the mean deviation between the joint angle waveforms via the MoCap and the Kinect system. ResultsIn comparison with the linear regression algorithm, the BiLSTM had better performance in the aspect of dealing highly nonlinear regression problems, especially for hip flexion/extension, hip adduction/abduction, and ankle dorsi/plantar flexion angles. The deep learning refined model significantly reduced the system error of Kinect. The mean RMSEs for all joint angles were mainly smaller than 10°, and the RMSEs of the hip joint were smaller than 5°. The joint angle waveforms presented very good similarity with the golden standard. The CMCs of joint angles were greater than 0.7 except for hip rotation angle. Conclusions The markerless gait analysis system based on deep learning fusion model developed in this study can accurately assess lower limb kinematics, joint mobility, walking functions, and has good prospect to be applied in clinical and home rehabilitation.

Objective:To explore the role of hierarchical teaching based on the "competency-based" concept in the standardized training of respiratory nursing interns.Methods:A total of 70 nursing interns who came to the Department of Respiratory Medicine in Beijing Jishuitan Hospital for standardized training from September 2019 to August 2020 were selected as the study subjects. They were randomly divided into the study group and the control group by coin tossing method, 35 in each group. The study group used hierarchical teaching based on the "competency-based" concept, while the control group adopted conventional hierarchical teaching. The nursing ability and teaching quality of the two groups of nurses were compared. SPSS 23.0 was used for t-test and Chi-square test. Results:The theoretical knowledge scores of the nurses in the two groups after the standardized training [(95.29±3.13), (86.29±5.13)] were higher than those before the training [(78.22±4.48), (77.29±5.13)]. The scores of theoretical knowledges, operation skills, medical record reporting, and the comprehensive quality scores of the study group after the standardized training were higher than those of the control group, and the differences were statistically significant ( P<0.05). The satisfaction of teaching quality in study group was higher than that in control group, and the difference was statistically significant ( P<0.05). Conclusion:The hierarchical teaching based on the "competency-based" concept can significantly improve the teaching quality in the standardized training and the comprehensive quality of respiratory nursing interns, which is worthy of application.

Objective:To investigate the risk factors for axial deviation in the treatment of tibial defect susing Orthofix unilateral external fixator and proximal tibial osteotomy for bone transport.Methods:A retrospective study was performed to analyze the clinical data of 90 patients who had been treated for tibial bone defects by the Orthofix unilateral external fixator at Department of Microrepair and Reconstruction, The First Hospital Affiliated to Xinjiang Medical University from May 2012 to June 2019. There were 77 males and 13 females with a mean age of 41.2 years (from 17 to 63 years).The bone defects ranged from 4 to 13 cm in length. According to the Paley criteria for axial deviation, the 90 patients were divided into 2 groups: a deviation-free group with no axial deviation or an axial deviation ≤5° and a deviation group with an axial deviation>5°. The 2 groups were compared in terms of age, number of prior surgery, defect length, placement angle of Schanz screws, external fixation time, external fixation index and bending degree of Schanz screws at the last follow-up.The factors with P<0.05 were analyzed by multivariate logistic regression to find the risk factors for coronal axial deviation. Results:The 90 patients were followed up for an average of 23 months (from 12 to 40 months). The incidence of axial deviation in this cohort was 36.7% (33/90).The deviation group had a significantly larger number of prior surgery [5 (3, 6) times], a significantly longer defect length [8 (8, 9) cm], a significantly longer external fixation time [400.0 (341.8, 426.3) d], and a significantly greater bending degree of Schanz screws at the last follow-up [1.2° (0.4°, 3.5°)] than the deviation-free group [3 (2, 3) times, 6 (5, 8) cm, 340.8 (226.5, 422.8) d, and 0.8° (0.2°, 3.7°)] (all P<0.05). Multivariate logistic regression analysis showed that the number of prior surgery ( OR=2.581, 95% CI: 1.496-4.450, P=0.001) and the defect length ( OR=5.310, 95% CI: 1.952-14.442, P=0.001) were the risk factors for the axial deviation. Conclusion:In the treatment of tibial defect susing Orthofix unilateral external fixator and proximal tibial osteotomy for bone transport, the more prior surgeries and the longer a bone defect, the higher the risk for axial deviation.

Objective To investigate the osteogenic differentiation potency of ligament cells in thoracic ossification of the ligamentum flavum (TOLF) and analyze further by using transcriptome high-throughput sequencing.Methods Clinically,the patients with non-TOLF and TOLF (n=10 in each group) who underwent surgery in our hospital from October 2015 to April 2016 were included in this study.The primary ligament cells that derived from the two groups were separately cultured and induced osteogenesis with 15％ strength of cyclic mechanical stress for 12h and 24h using a device called Flexcell FX-4000.The ALP activity was determined to evaluate the osteogenesis using quantitative analysis and ALP staining assay.Real-time PCR and westernblotting were used to detect the mRNA and protein expression of osteogenic-related genes including ALP,BMP-2 and Osteocalcin.Then,three patients in each group were included in the study of transcriptome high-throughput sequencing and bioinformatics analysis using Illumina HiSeqTM 2500 sequencing platform to compare further.Results The morphology of the cells that derived from two groups was basically similar,all presented an elongate spindle-shape.To evaluate the ostogenesis,ALP activity assays including quantitative and staining assays were performed.Under microscope,the ALP staining in the TOLF group was higher than non-TOLF group and increased with the longer duration of stress induction.The result of semi-quantitative analysis showed the stained area and positive cells in TOLF group were more than non-TOLF group significantly at 0 h,and were increased with the induction.The results of quantitative analysis showed ALP activity in the TOLF group was significantly higher than non-TOLF group and were increased with the induction significantly all the time.But no significant change in ALP staining or quantitative analysis was found in non-TOLF.The results of real-time PCR indicated that the expression of ostegenic markers above in the TOLF group was more than non-TOLF group significantly except the expression of OCN at 0 h.The expression of the three ostegenic markers in TOLF group was increased with the stress induction for 12 h and 24 h significantly except the expression of BMP-2 and OCN at 12 h.The results of western-blotting indicated that the expression of the three ostegenic markers above in the TOLF group was more than non-TOLF group significantly except the expression of ALP at 0 h.The expression of the three ostegenic markers in TOLF group was increased with the stress induction for 12 h and 24 h,but only the expression of ALP at 24 h was significant.And no significant change in the expression of mRNA and protein was found in non-TOLF group.In the transcriptome analysis,671 genes of TOLF group were up-regulated and 314 genes were found to be down-regulated compared to the control group.In addition,22 significant GO terms associated with upregulated genes were found to be closely related to ossification.Conclusion TOLF ligament cells have high osteogenic differentiation potency,which could express obvious osteogenesis-related gene spectrum,and differentially expressed genes including L1RL1 、PTHLH、DKK1 、BMP6、SPP1 and FGF1 may be related with the osteogenic potency of ligament cells in thoracic ossification.

Aim To investigate the effect of curcumin against high-fat-diet induced C57BL/6J mice bone changes and the correlation between the expression of cathepsin K and curcumin.Methods Curcumin treated C57BL/6J mice had been on high fat diet for 12 weeks.The HE, Alizarin red S staining and Safranin O/fast green staining of femur were employed to evaluate bone microstructure, bone metabolism and bone development.The expressions of cathepsin K were assessed by Western blot and immunohistochemical staining.Results Histopathological results showed that curcumin could improve the destruction of trabecular bone structure, cartilage development and bone calcification.Biomechanical results proved that curcumin could improve the bone strength of the type 2 diabetic mice induced by high fat.The results of immunohistochemistry and Western blot assay indicated that curcumin could significantly inhibit the expression of cathepsin K in bone tissues of mice.Conclusion Curcumin can increase bone strength, improve bone microstructure, and enhance the degree of bone calcification, which may be achieved by inhibiting the expression of cathepsin K.

Objective: To investigate the clinical significance of low-dose CT (LDCT) in coal mine workers with relatively long working years. Methods: A total of 907 coal mine workers with ≥20 working years were enrolled, among whom there were 863 male and 44 female workers with a mean age of 49.5 years. Digital radiography (DR) was performed for these workers in 2013, and LDCT was performed for three consecutive years from 2014 to 2016. Results: A total of 32 workers were found to have lung nodules by DR in 2013, while in 2014, 269 workers were found to have non-calcified lung nodules by LDCT, and there was a significant difference in the number of workers with lung nodules (χ²=233.73, P<0.005) . There was also a significant difference in the detection rate of nodules between the workers with different working years of dust exposure (χ²=6.648, P=0.00) . The male workers had a significantly higher detection rate of nodules than the female workers (χ²=5.690, P=0.017) . There was no significant difference in the number of nodules between workers with different types of work (χ²=16.985, P=0.05) . There were 443 lung nodules in total, among which 71.56% were solid nodules and 55.75% had a size of ≤4mm; malignant nodules were confirmed by surgery in 6 (0.66%) of the 907 workers after baseline LDCT. LDCT reexamination in 2015 and 2016 found new nodules in 8 workers and enlarged nodules in 3 workers, and there was no significant change in the number of nodules with a size of ≤4 mm. Conclusions It is necessary to perform high-risk population screening for coal mine workers by LDCT. The follow-up strategies for nodules with a size of ≤4mm are the same as those for negative results; annual reexamination is recommended for nodules with a size of >4-8 mm, and clinical treatment should be considered for nodules with a size of >8 mm.

Osteoporosis is a progressive metabolic disease. In traditional Chinese medicine (TCM), deficiency of the liver, spleen and kidney and blood stasis can induce osteoporosis. The main etiology was kidney deficiency which harmed the liver and spleen and causeqi-blood deficiency and blood stasis. The insufficiency of natural endowment and postnatal malnutrition caused poor nutrition of tendons and vessels, which induced debility of bone. This article discussed the etiology and pathogenesis of TCM understanding on osteoporosis in details. Opportunities and challenges of TCM in osteoporosis treatment were explored. The homology of Chinese medicine and food as well as the long-term of osteoporosis showed that TCM had incomparable superiority in osteoporosis treatment. While, the scientific research methods and reasonable evaluation of TCM safety were important to display its advantages in osteoporosis treatment.

Objective To master the serum nickel change rule of acute nickel carbonyl poisoning in rats,and to provide laboratory support for clinical treatment of acute nickel carbonyl poisoning patients.Methods SPF rats were given nickel carbonyl (250mg/m3,500mg/m3) in static inhalation for 30min.Rats were anesthetized by ether for 15 seconds after exposure for 30min,2h,4h,8h,12h,24h,48h,72h and 7d respectively.Anatomized rats,kept blood collection 2-3mL,and separated serum 0.5-1mL.Serum nickel was detected by AA800 (American PE company).Results The average serum nickel levels of 250mg/m3 dose group at 30min,2h,4h,8h,12h,24h,48h,72h,7d were (33.69 ±2.59),(24.61 ±3.03),(27.83 ±5.69),(21.36 ±4.14),(20.39 ±4.14),(18.80 ±7.02),(14.51 ±8.21),(13.58 ± 5.78) and (12.83 ± 4.41)μg/L.30 minutes reached the peak,and was 5.30-fold of those in normal controls.There had significant differences compared with normal control(t =5.959,5.958,5.990,5.998,5.997,5.994,5.990,4.317,4.347,all P ＜ 0.01).The average serum nickel levels of 500mg/m3 dose group at 30min,2h,4h,8h,12h,24h,48h,72h,7d were (72.22 ± 1.62),(57.78 ± 12.99),(42.25 ± 7.25),(103.77 ± 11.11),(79.04 ±12.26),(26.35 ±6.56),(18.58 ±4.92),(17.22 ±9.73),(14.59 ±5.27) μg/L.8h reached the peak,and was 16.33-fold of normal controls.The differences were significant (t =5.960,5.947,5.978,5.927,5.948,5.959,3.143,2.447,2.440,all P ＜ 0.05).Meanwhile,there were significant differences between two groups of 30min,2h,4h,8h,12h(t =5.208,2.447,2.449,5.959,5.959,P =0.001,0.049,0.042,0.000,0.000),but there was no significant difference after 24h.Conclusion There was significant doses-effect relationship between serum nickel content of acute nickel carbonyl poisoning rats and the dosage.Nickel carbonyl or its metabolites were excreted mainly within 24h.