Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

Due to the difference of cultural background, the psychological, social and spiritual needs of dying people are very different, so there are great differences in the care and nursing concept of dying people in different countries and nationalities. In order to construct the modern hospice care, we should actively learn from the western experience, but more important is to dig the local ideological resources from the traditional culture, build a set of caring care theory and practice rooted in China and originated from the concept of a good end of Chinese traditional culture, with the characteristics of the times and the cultural confidence of the Chinese nation, serving the Chinese people, and with Chinese characteristics.

Objective:To investigate the expression of serum microRNA (miR)-92 in patients with liver cancer and its relationship with poor prognosis.Methods:The clinical data of 70 patients with liver cancer in the First People′s Hospital of Huzhou City, Zhejiang Province and the Central Hospital of Huzhou City, Zhejiang Province from May 2015 to May 2018 were retrospectively analyzed. The miR-92 expression level was detected by real-time quantitative polymerase chain reaction method and compared with that of 80 healthy subjects. Receiver operating characteristic (ROC) curve was drawn to evaluate the efficacy of serum miR-92 in diagnosing liver cancer and early stage (stage Ⅰ to Ⅱ) liver cancer. The relationship between serum miR-92 expression level and clinicopathological characteristic was analyzed. Independent risk factors affecting the prognosis in patients with liver cancer were analyzed by multivariate Cox regression model.Results:The expression level of serum miR-92 in patients with liver cancer was significantly higher than that in healthy subjects (4.10 ± 1.74 vs 1.88 ± 0.78), and there was statistical difference ( P<0.05). ROC curve analysis result showed that the area under curve (AUC) of serum miR-92 for the diagnosis liver cancer was 0.874, the best cut-off value was 2.43, the sensitivity was82.86%, and the specificity was 86.25%; the AUC of serum miR-92 for the diagnosis early liver cancer was 0.755, the best cutoff value was 2.38, the sensitivity was 68.57%, and the specificity was 84.42%. The serum miR-92 expression level was related to TNM stage and lymph node metastasis ( P<0.01), but not related to gender, age, tumor diameter, history of hepatitis, liver cirrhosis, degree of differentiation and portal vein tumor thrombus ( P>0.05). The 5-year overall survival rate in liver cancer patients with high serum miR-92 expression was significantly lower than that in liver cancer patients with low serum miR-92 expression (17.1% vs. 31.5%), and there was statistical difference ( χ2 = 5.561, P<0.05). Multivariate Cox regression analysis result showed that miR-92 was an independent risk factor affecting the prognosis in patients with liver cancer ( HR = 0.282, 95% CI 1.179 to 3.562, P<0.05). Conclusions:The expression level of serum miR-92 in patients with liver cancer is significantly increased, which plays an important role in the progression of the disease. Serum miR-92 can be used as an indicator for early diagnosis and prognosis evaluation of liver cancer.

Objective:To observe the effects of continuous light exposure on skeletal muscle fiber type transformation and lipid metabolism, and to explore its internal relationship.Methods:Mice were randomly divided into normal light group and 24-hour continuous light group by random number table. The serum and skeletal muscle lipid content and urine 6-sulfatoxymelatonin(6-SML)level were detected by ELISA. The expression of circadian clock and lipid metabolism related genes mRNA were observed by realtime PCR. The muscle fiber type and lipid deposition were evaluated by tissue immunofluorescence as well as oil red O staining.Results:Compared with the normal light group, the level of 6-SML in urine at night decreased( P<0.05), and the expression level and rhythm of brain and muscle ARNT-like protein 1(Bmal1), circadian locomotor output cycles protein kaput(Clock), and period 2(Per2)mRNA in the skeletal muscle changed in continuous light group. In addition, the body weight, blood lipid, free fatty acid, and triglyceride contents of skeletal muscle in continuous light group increased significantly( P<0.05 or P<0.01), the expression of carnitine palmitoyltransferase 1b (Cpt1b)mRNA, the key enzyme of fatty acid oxidation, decreased significantly( P<0.05), while the expression of stearoyl-CoA desaturase(Scd1)mRNA, a lipid synthesis related gene, increased significantly( P<0.01). Further immunofluorescence analysis showed that the proportion of slow muscle fibers decreased and that of fast muscle fibers increased in continuous light group(both P<0.05). Conclusion:The process of ectopic deposition of lipid in skeletal muscle in mice induced by continuous light exposure may be related to the remodeling of skeletal muscle fibers.

Objective:To identify anti-dipeptidyl-peptidase-like protein 6 (DPPX) antibody in patients with encephalitis of unknown etiology and describe the clinical features of anti-DPPX antibody-associated encephalitis in Chinese patients.Methods:For patients registered in the Peking Union Medical College Hospital Encephalitis and Paraneoplastic Syndrome Registration Project from 2016 to 2019 with negative findings in autoimmune encephalitis routine antibody profile and paraneoplastic antibody profile, but with positive tissue-based assay (TBA) results, further tests for rare antibodies, including cell-based assay (CBA) of anti-DPPX antibody, were performed. Patients positive for anti-DPPX antibody were enrolled and the clinical data were collected.Results:Two patients with anti-DPPX antibody-associated encephalitis were found from 2016 to 2019 among about 15 000 patients. Both were females, aged 46 and 75 years. One patient had diarrhea, cachexia, cognitive dysfunction, agitation, myoclonus, tremor, and seizures. The other had cognitive impairment, restlessness, memory loss, disorientation, and sleep disturbance. The second patient had medical history of systemic lupus erythematosus and secondary Sj?gren′s syndrome.Conclusions:TBA should be combined with CBA in identification of anti-DPPX antibody to confirm the diagnosis. Anti-DPPX antibody-associated encephalitis has clinical manifestations of encephalopathy with diarrhea and cachexia, and can coexist with systemic lupus erythematosus.

Objective:To explore the effect of physical-medical integration training on the rehabilitation of inpatients with schizophrenia and metabolic syndrome.Methods:From January 2019 to January 2020, convenience sampling was used to select 105 patients with schizophrenia and metabolic syndrome who received treatment in Beijing Huilongguan Hospital as the research object. Patients were divided into research group ( n=53) and control group ( n=52) . Control group conducted psychiatric routine nursing, and research group implemented physical-medical integration training model (doctor-nurse-technician participation) on the basis of routine nursing. We compared the body mass index (BMI) , blood glucose, blood pressure and social function score of the two groups of patients after three months of training. Results:Finally, 50 patients in each group completed the study. After three months of training, the BMI, fasting blood glucose, systolic blood pressure and diastolic blood pressure of research group were lower than those of control group, and the total score and all dimension scores of social function were higher than those of control group with statistical differences ( P<0.05) . Conclusions:Physical-medical integration training can directly affect the BMI, blood pressure, and blood glucose of patients with schizophrenia and metabolic syndrome, and can improve the social function of the patient and increase the patient's sense of satisfaction.

Objective:To compare the early diagnostic value of the indicators of endothelial injury, renal injury, inflammation and coagulation in patients with sepsis-induced acute kidney injury (AKI).Methods:A retrospective study was performed on 119 patients with sepsis from February 2017 to March 2018. Lab tests were performed on patients at admission, which included:ing soluble thrombomodulin (sTM), tissue plasminogen activators and inhibitors (t-PAI-C), antithrombin III (AT-III), thrombin-antithrombin (TAT) complex, plasmin-alpha 2, plasmin inhibitor complex (PIC), fibrin degradation product (FDP), fibrinogen (FIB), D-Dimer, prothrombin time (PT), prothrombin time international normalized ratio (PT-INR), procalcitoni (PCT), white blood cell (WBC), neutrophil (Neu), and platelet count (PLT). The receiver-operating characteristic curve was used to analyze the predictive value of the above indicators, and logistic regression analysis was used to analyze the risk factors of sepsis-induced AKI. A prospective study was conducted from April 2018 to September 2018 and 46 patients were enrolled. The lab tests results retrieved including sTM, t-PAI-C, FDP, AT-III, TAT, PIC, FIB, D-Dimer, PT, PCT, serum cystatin C (Cys C), urine albumin (microalbumin) and albumin to creatinine ratio (ACR), urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary N-acetyl-beta-glucosaminidase (uNAG), and urinary retinol-binding protein (uRBP). As same with the previous group, the receiver-operating characteristic curve was used to analyze the diagnostic value of the above indicators, and logistic regression Was used to analyze the risk factors of sepsis-induced AKI.Results:(1) In the retrospective study: sTM, D-Dimer, PCT, PT, and PT-INR were statistically different. sTM, D-Dimer, PCT, PT, and PT-INR had a good diagnostic value for septis-induced AKI, among which, sTM had a highest diagnostic value (AUC: 0.857; 95% CI: 0.790, 0.924), better sensitivity (64.4%) and specificity (91.8%). The high expression of sTM and history of chronic kidney disease were independent risk factors for septis-induced AKI.(2) In the prospective study: PCT, sTM , Cys C, and uNGAL were statistically different. PCT, sTM, Cys C, uNGAL showed good predictive features for septis-induced AKI. sTM had the highest sensitivity (>0.999) while uNGAL had the highest specificity (0.800). The high expression of sTM was an independent risk factor for septis-induced AKI. Conclusions:sTM and uNGAL represent endothelial injury and renal tubular injury respectively. sTM is an independent risk factor of sepsis-induced AKI.

As a pandemic metabolic disease, obesity has become a worldwide problem, which endangering human health. The change in body weight reflects the energy imbalance. And the homeostasis regulation of the central and peripheral melanocortin system may maintain the energy balance and then affect the body weight. Recent studies have found that melanocortin receptor-4 ( MC4R) plays an important role in energy homeostasis and body weight changes, but its specific mechanism needs further elucidation. In this paper, we reviewed the research progress of MC4R in body weight and energy regulation, so as to provide a theoretical basis for further exploring the potential role of MC4R in improving energy metabolism imbalance and obesity.

Forty three patients with L5-S1 spondylolisthesis undergoing surgical treatment from April 2012 to November 2014 were included for analysis,including 20 cases received transforaminal lumbar interbody fusion (TLIF group) and 23 cased received posterior lumbar interbody fusion (PLIF group).The incision length,operative time were shorter and blood loss was less in TLIF group than those in PLIF group [(9.6±0.9) vs.(16.1±1.5) cm,(125.6±13.0) vs.(156.4±11.8) minand (218.7±22.5)ml vs.(326.5 ±20.1) ml,respectively,all P =0.000].There was no statistical difference in the S1 pedicle screw (S1PS) insertion point between two approaches[(29.4 ± 1.9) vs.(28.5 ± 1.0) mm,P =0.069],but the distance from the midline to the lateral edge of the screw (12.9 ±3.6) mm,S1PS angle (23.3 ±2.1) ° and length of S1PS length with the sacral body (40.9 ± 2.6) mm in the TLIF group were better than those in PLIF group (P =0.000).Our results demonstrate that the paraspinal muscle approach for the treatment of L5-S1 spondylolisthesis may be superior with less trauma,better functional recovery and stable screw placement.