Objective:This study aimed to explore the clinical value of myostatin(MST) and follistatin(FST) as biological biomarkers in evaluating sarcopenia in elderly women.Methods:This was a retrospective cross-sectional study that enrolled 350 females aged 20-89 years who underwent physical examinations in Shanghai Huadong Hospital in 2021. Demographic characteristics, muscle mass, fat mass, bone mineral density, hand grip strength, gait speed, and serum indices of MST and FST were collected.Results:The serum levels of MST did not change significantly with age. However, the serum levels of FST increased with age. In women aged≥60 years, MST was positively correlated with total lean mass and appendicular skeletal muscle index(ASMI; r=0.236, P=0.041; r=0.289, P=0.014), while FST was negatively correlated with ASMI( r=-0.265, P=0.030). In multivariate stepwise regression analysis, after adjusting for age, body mass index, hip bone mineral density, and total fat mass, only FST was independently correlated with ASMI( β=-0.238, P=0.006), while MST was not correlated with ASMI. The receiver operating characteristic curve was plotted using muscle mass reduction as the state variable and serum FST level as the test variable. The area under the curve was 0.753. And when the FST cutoff value was 17.49 ng/mL, the maximum Jordan index was 0.46, with a sensitivity of 77.3% and a specificity of 68.7%. Women aged ≥60 years were divided into three groups based on serum FST levels. Compared to the upper third of the serum FST level group, the low third of the FST level group had a significantly reduced risk of suffering from sarcopenia( OR=0.098, P =0.036). Conclusions:Serum FST lever has a better correlation with muscle mass among elderly women, making it a promising biomarker for evaluating muscle mass.

Objective:To conduct meta analysis to compare the effect of complete resection with or without postoperative radiotherapy (PORT) on survival in stage Ⅲ(N 2) non-small cell lung cancer (NSCLC). Methods:Relevant studies of the efficacy of PORT for stage Ⅲ(N 2) NSCLC were searched from Wanfang Data, PubMed, and Cochrane Library from January 2006 to January 2022. Literature screening, extraction of information and assessment of the risk of bias of the included literature was carried out by two independent researchers. Meta analysis was performed using R4.0.3 software. Results:A total of 12 publications consisting of 2992 patients were included, 1479 cases in the PORT group and 1513 cases in the control group. PORT improved the overall survival (OS) and disease free survival (DFS) compared to the control group. Fixed-effects model meta analysis of 6 randomized controlled trials showed that PORT did not significantly reduce the risk of death ( HR=0.98, 95% CI: 0.80-1.20). Fixed-effects model meta analysis of 6 retrospective studies showed that PORT improved prognosis ( HR=0.68, 95% CI: 0.59-0.79). PORT could improve OS of patients with multiple (station) metastasis of ipsilateral mediastinum and / or submandibular lymph nodes ( HR=0.89, 95% CI: 0.80-0.99). Conclusions:PORT could improve OS and DFS in stage Ⅲ(N 2) NSCLC. A trend towards benefit can be observed in the subgroup with multiple/multi-station N2 metastasis.

Objective:To analyze the prevalence of malnutrition among human immunodeficiency virus-exposed uninfected (HEU) children and to identify the associated factors in Hunan Province.Methods:All children born to human immunodeficiency virus (HIV)-infected mothers retrieved from Information System of Prevention of Mother-to-Child Transmission of human immunodeficiency virus Management (IPMTCT) in Hunan Province between July 2013 and June 2019 were included. Information including maternal demographic characteristic, maternal comorbidities/complications, anti-retroviral therapy during pregnancy, anti-retroviral prophylaxis for children, birth weight, and disease during follow-up was collected. The length and weight of children at one, three, six, nine, 12 and 18 months of follow-up time points were detected, and the prevalences of stunting, underweight, wasting and malnutrition among HEU children were evaluated. The generalized estimating equation was used to fit the logistic regression model to analyze the associated factors for malnutrition.Results:A total of 656 HEU children were finally included. The prevalences of stunting, underweight, wasting, and malnutrition among HEU children were highest at one month of age, which were 11.9%(78/656), 9.1%(60/656), 7.0%(45/656) and 21.0%(138/656), respectively. Maternal comorbidities/complications (adjusted odds ratio (a OR)=2.30, 95% confidence interval ( CI) 1.48 to 3.58), mono/dual anti-retroviral therapy during pregnancy (a OR=2.38, 95% CI 1.54 to 3.68), birth weight <2 500 g (a OR=2.66, 95% CI 1.69 to 4.21) and disease during follow-up (a OR=1.73, 95% CI 1.10 to 2.70) were the risk factors for malnutrition among HEU children (all P<0.050). Both taking zidovudine (a OR=0.60, 95% CI 0.38 to 0.94) and nevirapine (a OR=0.31, 95% CI 0.18 to 0.52) for anti-retroviral prophylaxis were the protective factors for malnutrition among HEU children (both P<0.050). Conclusions:The prevalence of malnutrition among HEU children is high. The prevalence of malnutrition is affected by maternal comorbidities/complications, anti-retroviral therapy during pregnancy, and birth weight, diseases during follow-up and anti-retroviral prophylaxis for children.

Objective To set up and apply a standardized communication system of adolescents and young adults (AYAs) cancer patients,in order to improve AYAs cancer patients' psychological distress and other negative emotions,as well as promote social support and quality of life of patients.Methods A AYAs cancer patients standardized communication system,suitable for China's national conditions,was preliminarily built.Using randomized controlled trials,a total of 171 subjects,selected from 486 cases of AYAs cancer patients,in the Third Xiangya Hospital of Central South University and Hunan Cancer Hospital from August to September in 2016,were intervened with a set of standardized communication system.The Mental Distress Thermometer (DT),Hospital Anxiety and Depression Scale (HADS),Social Support Rating Scale (SSRS) and Concise Health Status Questionnaire (SF-36) were used as evaluation indexes to observe the psychological distress,emotion,social support and quality of life of the three groups of subjects before intervention,immediately after intervention,1 month after intervention and 3 months after intervention.Results At the follow-up of 3 months after intervention,38 cases were lost,14 cases in communication group (final n =43),11 cases in music therapy group (final n =46),and 13 cases in routine group (final n =44)..There was no significant difference in the evaluation indexes between the communication group,music treatment group and the routine group before intervention (P ＞ 0.05).There were statistically significant differences in scores of psychological pain,anxiety and depression,and social support in the 3 groups,before and immediately after intervention,1 month and 3 months after intervention (P ＜ 0.05).The scores of psychological pain,anxiety and depression,social support and quality of life in the communication group 1 month after intervention were statistically significant compared with those in the music group and the routine group (P ＜ 0.05).Conclusions Compared to music therapy and regular care,the standardized communication system has significant effect on improving the psychological distress of AYAs with cancer,and can also improve their social support level and quality of life.The clinical validation of the standardized communication system can provide reference for psychological rehabilitation of cancer survivors.

Objective To examine the association between maternal syphilis treatmentand the adverse pregnancy outcomes.Methods Syphilis-infected pregnant women retrieved from Information System of Prevention Mother-to-child Transmission of Human Immunodeficiency Virus (HIV),Syphilis,and Hepatitis B Management in Hu'nan Province between January 2012 and December 2017 were retrospectively studied.Information of demographic characteristics,pregnancy history,and syphilis infection/treatment history among these syphilis-infected pregnant women were collected and analyzed.According to the anti-syphilis treatment situation during pregnancy,syphilis-infected pregnant women were divided into three groups:non-treatment group,non-standardized treatment group and standardized treatment group.The incidences of adverse pregnancy outcomes among the three groups were calculated.Multivariate logistic regression was used to control confounding factors and analyze the association between maternal syphilis treatment and the adverse pregnancy outcomes.The adjusted odds ratios (aOR) and 95％ confidence interval (CI) were calculated.Results Among 9 059 syphilis-infected pregnant women,13.9％ (1 262),31.3％ (2 834),and 54.8％ (4 963)were untreated,non-standardized treated and standardized treated patients,respectively.The incidences of total adverse pregnancy outcomes in the non-treatment,non-standardized treatment and standardized treatment groups were 25.5％ (322),20.8％ (589),and 16.2％ (806),respectively.The incidences of stillbirth in the three groups were 2.3％ (29),1.3％ (38),and 0.6％ (28),respectively;those of preterm birth were 12.6％(159),10.5％ (297),and 6.0％ (299),respectively;those of low birth weight were 6.4％ (81),6.2％(175),and 3.3 ％ (162),respectively;those of small for gestational age were 10.9％ (138),8.4％ (237),and 8.0％ (399),respectively;those of neonatal death were 1.3％ (17),1.0％ (28) and 0.3％ (15),respectively;those of neonatal asphyxia were 1.9％ (24),0.9％ (25),and 0.9％ (46),respectively;those of neonatal pneumonia were 0.6％ (8),0.9％ (26),and 0.6％ (32),respectively;those of birth defects were 2.8％(35),1.3％ (37),and 1.1％ (57),respectively;those of neonatal congenital syphilis were 2.5％ (31),2.4％ (69),and 0.8％ (42),respectively.Compared with standardized treatment group,maternal syphilis without treatment was associated with increased risks of total adverse pregnancy outcomes (aOR =1.73),stillbirth (aOR =4.82),preterm birth (aOR =2.52),low birth weight (aOR =1.88),neonatal death (aOR =3.29),neonatal asphyxia (aOR =2.42) and birth defects (aOR =3.26) all P ＜ 0.01;maternal syphilis with non-standardized treatment was associated with increased risks of total adverse pregnancy outcomes (aOR =1.34),stillbirth (aOR =2.54),preterm birth (aOR =1.98),low birth weight (aOR =1.84),neonatal death (aOR =2.49) and neonatal congenital syphilis (aOR =1.70,P ＜ 0.05 or 0.01).Conclusions Maternal syphilis without treatment or with non-standardized treatment would increase the risks of adverse pregnancy outcomes.It is necessary to further strengthen the early screening and early treatment for syphilis-infected pregnant women,and improve the rate of standardized treatment to reduce the occurrence of adverse pregnancy outcomes.

Cancer is the most cause death of among adolescents and young adults (AYAs).Psychological distress caused by cancer affects AYAs' effective coping abilities of disease,physical symptoms and treatment.This paper mainly introduces the related concepts,screening tools and intervention progress of psychological distress of AYAs cancer patients to deepen the understanding of these among clinical professionals and provide reference for implement effective interventions to patients.

Objective To translate and revise the Individualized Care Scale-Patient Version(ICS-P) into Chinese,then to assess the reliability and validity of the Chinese version of the Individualized Care Scale-Patient Version (C-ICS-P).Methods Standard forward-back translation techniques were used in the translation of the ICS-P according to the Brislin translation model.Cross-cultural revision of the translated ICS-P was carried out through group discussion and pretesting.Totally 223 patients were recruited through convenience sampling method from a tertiary hospital in Changsha and investigated using general information questionnaire and the C-ICS-P,and its reliability and validity were assessed.Results The C-ICS-P contained two subscales,and both C-ICS-P-A and C-ICS-P-B contained 3 factors explaining 61.330％ and 65.263％ of the total variance.The dimensions of C-ICS-P-A were clinical characteristics (6 items),personal life characteristics (4 items) and participation willingness (5 items);the dimensions of C-ICS-P-B were clinical care (6 items),personal life care (4 items) and decisional control over care (5 items).The Cronbach's α coefficients of C-ICS-P-A and its dimensions were 0.897,and 0.730～0.774;the Cronbach's α coefficients of C-ICS-P-B and its dimensions were 0.909,and 0.688～0.754.Split-half reliability was 0.856 for C-ICS-P-A and 0.688～0.754 for its dimensions;split-half reliability was 0.889 for C-ICS-P-B and 0.750～0.758 for its dimensions.Analysis of content validity of the C-ICS-P indicated that I-CVI was at least 0.83,S-CVI was 0.943.Conclusion The reliability and validity of C-ICS-P are satisfactory and well meet the requirements of psychological measurement,indicating C-ICS-P is a reliable and valid instrument in the context of Chinese culture.

Objective:To explore the effect and mechanism of AMPK on apoptosis of alveolar epithelial cells induced by endoplasmic reticulum stress in COPD rats.Methods:the rats were divided into three groups:control group,model group,AICAR intervention group,establishment of rat model of chronic obstructive pulmonary disease by smoking smoke inhalation and intratracheal instillation of lipopolysaccharide.The HE staining of rat lung tissue pathological observation,immunohistochemical detection of p-AMPK /AMPK,western blot the expression of Caspase-3,ORP 150,and CHOP.Apoptosis were detected by TUNEL method.Results:the HE staining showed that the model group of pulmonary bullae formation,inflammatory cell infiltration,inflammatory ceils in AICAR group was lower than that of model group.Compared with the normal control group,immunohistochemistry and Western blot showed that p-AMPK/AMPK and ORP150 protein expression decreased in the model group,the difference was statistically significant (P＜0.05),and AICAR in the intervention group p-AMPK/AMPK and ORP150 protein expression were significantly increased compared with the model group,the difference was statistically significant (P＜0.05).Endoplasmic reticulum stress related apoptosis The expression of CHOP and caspase-3 apoptosis index increased significantly in the model group,there was significant difference compared with normal group (P＜0.05),while in group AICAR,apoptosis index down significantly compared with the model group.Conclusion:AMPK can protect alveolar epithelial cells from cigarette smoke induced endoplasmic reticulum stress and apoptosis,it was possible to achieve its protective effect the increase of ORP150.

Aim To investigate the effects of celecoxib on cyclooxygenase-2(COX-2) and caspase-9 expression and motor function after traumatic brain injury in rats.Methods The rats were divided into control group, sham operation group, trauma group and treatment group.The model of closed craniocerebral trauma was established by Marmarou method, the gene expression of COX-2 and Caspase-9 was detected by real-time quantitative PCR(qPCR), the protein expressions of COX-2 and Caspase-9 were detected by immunohistochemical staining, and the motor function of the rats was evaluated by the neurological impairment score(NSS).Results The gene and protein expression of COX-2 and Caspase-9 in traumatic group was significantly higher than in other three groups (P<0.05), the expression of COX-2 and Caspase-9 in treatment group was significantly lower than in traumatic group(P<0.05), but still higher than the sham operation group and the normal group(P<0.05);compared with the trauma group, the motor function of the treatment group could be effectively improve (P<0.05), but compared with the control group and the sham operation group, the difference was statistically significant(P<0.05).Conclusion Celecoxib can reduce the inflammatory response after craniocerebral injury by specific inhibition of COX-2, and further reduce the expression of Caspase-9, thereby reducing the apoptosis of nerve cells, and improving motor function after traumatic brain injury in rats.

Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treating hepatocellular carcinoma (HCC) under liver capsular. Methods Forty three patients with 62 lesions of HCC under liver capsular received TACE followed by CT?guided percutaneous RFA after 1 to 2 weeks were analyzed retrospectively. The subjects were observed and follow?up imaging with enhanced MRI was performed to evaluate the therapeutic efficacy after combined treatment. The patients were followed up for 10 to 69 months. The patients with residual lesions received a second RFA, the patients with recurrence or new lesions received another TACE combined with RFA. The overall survival rates, median survival time and median time to progression were calculated by using Kaplan?Meier. Results A total of 55 TACE and 68 ablations were performed in 43 patients with 62 lesions. The procedure was successfully accomplished in all patients. The complete ablation rate after the first ablation was 90.3%(56/62). The 1, 3, 5?year overall survival rates were 95.3%, 78.1%and 43.9%, the median survival time was 58 months and the median time to progression was 32 months. Conclution For the treatment of hepatocellular carcinoma under liver capsular, TACE combined with RFA is safe and effective.