Objective The aim of this study was to investigate the prospective association between physical activity (PA),independently or in conjunction with other contributing factors,and osteoporosis (OP) outcomes. Methods The Physical Activity in Osteoporosis Outcomes (PAOPO) study was a community-based cohort investigation. A structured questionnaire was used to gather the participants' sociodemographic characteristics. Bone mineral density (BMD) measurements were performed to assess OP outcomes,and the relationship between BMD and OP was evaluated within this cohort. Results From 2013 to 2014,8,471 participants aged 18 years and older were recruited from Tangshan,China's Jidong community. Based on their PA level,participants were categorized as inactive,moderately active,or very active. Men showed higher physical exercise levels than women across the activity groups. BMD was significantly higher in the very active group than in the moderately active and inactive groups. Individuals aged>50 years are at a higher risk of developing OP and osteopenia. Conclusion The PAOPO study offers promising insights into the relationship between PA and OP outcomes,encouraging the implementation of PA in preventing and managing OP.

Objective To investigate the Oncomelania hupensis snails spread and its spatio-temporal clustering characteristics in Suzhou City, Jiangsu Province from 2016 to 2023, so as to provide insights into precision control of O. hupensis snails in the City. Methods O. hupensis snail surveillance data in Suzhou City from 2016 to 2023 were collected, and the areas of O. hupensis snail spread and areas of emerging and re-emerging snail habitats were retrieved. The spatial distribution characteristics and clustering types and locations of environments with O. hupensis snail spread were investigated using global and local spatial auto correlation analyses with the software ArcGIS 10.7, and the clustering and cluster areas of O. hupensis snail spread were identified in Suzhou City using spatio-temporal scans with the software SaTScan 10.0.2. Results O. hupensis snail spread covered an area of 677 171 m² in Suzhou City from 2016 to 2023, including 376 230 m² emerging snail habitats and 300 941 m² re-emerging snail habitats. Global spatial autocorrelation analysis showed overall clustering of O. hupensis snail spread in Suzhou City from 2016 to 2023 (Moran’s I = 0.066, P = 0.007), and there were spatial clustering of areas with O. hupensis snail spread in 2019 (Moran’s I = 0.086, P = 0.001) and 2021 (Moran’s I = 0.045, P = 0.003). Local spatial autocorrelation analysis showed clusters of O. hupensis snail spread in Suzhou City from 2016 to 2023, with high-high clusters in Guangfu Township and Dongzhu Street, and the high-high clusters of O. hupensis snail spread were mainly distributed in southwestern Suzhou City. Spatio-temporal scans identified two clusters of areas with O. hupensis snail spread and areas of re-emerging snail habitats in Suzhou City from 2016 to 2023, with large clustering areas found in Guangfu Township, Dongzhu Street, Tong’an Township and Wangting Township [relative risk (RR) = 22.34, log likelihood ratio (LLR) = 163 295.32, P < 0.001] and small clustering areas in Xukou Township, Mudu Township and Xiangshan Street (RR = 2.73, LLR = 921.92, P < 0.001). Conclusions There was spatial clustering of O. hupensis snail spread in Suzhou City from 2016 to 2023. Improved quality of O. hupensis snail control and intensified management of environments at a high risk of O. hupensis snail spread are recommended in Suzhou City.

To reveal the effects of N-carbamylglutamic(NCG)on growth performance,blood pa-rameters and meat quality of meat rabbits,192 Hyla rabbits at 35 days of age were assigned to four groups randomly with 0.00％,0.05％,0.10％,and 0.20％NCG added to the basal diet,with six replicates of eight rabbits in each group and one replicate of eight rabbits.The results indicated that:compared to the control group,the body weight of the 0.20％NCG group at d 35(P＜0.01),the BW at d 14 and the average daily gain(ADG)from d 1 to 14 in the 0.05％NCG group(P＜0.05)were significantly elevated;the ADG of the control group from d 1 to 35 was significantly lower than the 0.10％and 0.20％NCG groups(P＜0.05).The levels of total superoxide dismutase(T-SOD)in the 0.10％NCG group(P＜0.01),total antioxidant capacity(T-AOC)and urea nitro-gen(BUN)in the 0.20％NCG group(P＜0.05)were significantly higher compared to the control group;the levels of T-SOD in the 0.10％NCG group were significantly elevated compared to the 0.05％NCG group(P＜0.05).NCG significantly increased polyunsaturated fatty acids(PUFA)and PUFA/SFA(P＜0.05).The cooked meat rate of the longissimus lumborum in the 0.20％NCG group was significantly increased compared to the control group(P＜0.01),while the water holding rate of the longissimus lumborum increased significantly in the 0.10％NCG groups(P＜0.01)and the control group(P＜0.05)and 0.05％NCG group(P＜0.05)than the 0.20％NCG group.NCG significantly reduced the crypts depth(P＜0.01)and had the tendency to in-crease the V/C value(P=0.067),while the villi height of jejunal in the 0.20％NCG group was significantly elevated compared to the control group(P＜0.05).In conclusion,NCG could promote the growth performance,enhance the antioxidant capacity,and improve the intestinal morphology and meat quality of meat rabbits.The appropriate amount of NCG added to meat rabbit diet is 0.10％.

Hypoprothrombinemia-lupus anticoagulant syndrome(HLAS)is a rare disease in which patients present with varying degrees of bleeding and positive lupus anticoagulant with reduced prothrombin on laboratory tests.This article reports a case of HLAS in a middle-aged woman with recurrent gingival bleeding and epistaxis as the first presentation.After admission,tests revealed prolonged prothrombin time(PT),activated partial thromboplastin time(APTT),and reduced coagulation factor Ⅱ activity,and positive lupus anticoagulant(LA).Meanwhile,the patient had symptoms of dry mouth and dry eyes for a long time,and the examination of autoantibodies,tear secretion test and salivary gland emission computed tomography(ECT)were consistent with the diagnosis of Sjogren's syndrome.The final diagnosis was HLAS secondary to Sjogren's syndrome.After treatment with methylprednisolone and cyclophosphamide,the coagulation disorder gradually improved,and no recurrent bleeding occurred.HLAS is a rare clinical case,which reminds medical staff to be alert to the possibility of HLAS when encountering patients with unexplained prolonged APTT and PT and positive lupus anticoagulant.

Objective:To investigate the clinicopathological characteristics and survival of patients with lymphoplasmacytic lymphoma (LPL).Methods:The data of 33 newly diagnosed LPL patients in the First Affiliated Hospital of Dalian Medical University from July 2003 to May 2021 were retrospectively analyzed. The clinical characteristics, bone marrow cell morphology, immunophenotyping, chromosomal karyotype, gene mutation, treatment response and prognosis were analyzed, and Kaplan-Meier method was used to analyze the survival of patients.Results:The median age of onset of 33 patients was 66 years old (55-84 years old). There were 26 males (78.8%) and 7 females (21.2%). The common clinical manifestations were anemia (31 cases, 93.9%), enlarged lymph nodes (16 cases, 48.5%) and B symptoms (8 cases, 24.2%). All patients had bone marrow involvement and M protein, 23 of them (69.7%) were type IgM-κ, 8 cases (24.2%) were type IgM-λ, 1 case (3.0%) was type IgG-κ, and 1 case (3.0%) was type IgA-κ. Lymphocytes, lymphoplasmacytes or plasma cells was increased in bone marrow smear; 22 patients underwent immunophenotyping of bone marrow by flow cytometry, and all patients expressed B cell surface antigens (CD19 and CD20), 16 patients (72.7%) lost the expression of CD5 and CD10, 13 patients (59.1%) expressed or weakly expressed CD138 and 5 patients (22.7%) expressed CD38. Seven out of 23 cases (30.4%) who received chromosome examination had abnormal chromosomal karyotype. Fourteen out of 16 cases (87.5%) who received MYD88 L265P mutation detection harbored the mutation. Among 21 patients with evaluable efficacy, 18 patients (85.7%) responded to treatment, achieving partial remission or stable disease, but the rate of complete remission was low (14.3%, 3/21). The median follow-up time was 34 months (2-102 months), 1 case was lost. The median overall survival time was not reached, and the 3-year and 5-year overall survival rates were 79.2% and 67.9%, respectively.Conclusions:LPL is a rare indolent small B-cell lymphoma with a long course and a variety of manifestations, which is commonly seen in elderly men.Serological examination, bone marrow cell morphology and biopsy, immunophenotyping and MYD88 L265P mutation detection are important for the diagnosis and differential diagnosis.

BACKGROUND: Coronary artery disease (CAD) is the commonest cause of heart failure (HF), whereas pulmonary hypertension (PH) has not been established or reported in this patient population. Therefore, we assessed the prevalence, risk factors, and survival in CAD-associated HF (CAD-HF) complicated with PH. METHODS: Symptomatic CAD-HF patients were continuously enrolled in this prospective, multicenter registry study. Echocardiography, coronary arteriography, left and right heart catheterization (RHC), and other baseline clinical data were recorded. Patients were followed up and their survival was recorded. RESULTS: One hundred and eighty-two CAD-HF patients were enrolled, including 142 with HF with a preserved ejection fraction (heart failure with preserved ejection fraction [HFpEF]; left ventricular ejection fraction [LVEF] ≥50%) and 40 with a reduced ejection fraction (heart failure with reduced ejection fraction [HFrEF]; LVEF < 50%). PH was diagnosed with RHC in 77.5% of patients. Patients with PH showed worse hemodynamic parameters and higher mortality. HFrEF-PH patients had worse survival than HFpEF-PH patients. CAD-HF patients with an enlarged left ventricular end-diastolic diameter and reduced hemoglobin were at higher risk of PH. Nitrate treatment reduced the risk of PH. Elevated creatinine and mean pulmonary arterial pressure (mPAP), diastolic pressure gradient (DPG) ≥7 mmHg, and previous myocardial infarction (MI) entailed a higher risk of mortality in CAD-HF patients with PH. CONCLUSIONS: PH is common in CAD-HF and worsens the hemodynamics and survival in these patients. Left ventricle enlargement and anemia increase the risk of PH in CAD-HF. Patients may benefit from nitrate medications. Renal impairment, elevated mPAP, DPG ≥7 mmHg, and previous MI are strong predictors of mortality in CAD-HF-PH patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT02164526.
Coronary Artery Disease/epidemiology* ; Creatinine ; Heart Failure/complications* ; Humans ; Hypertension, Pulmonary/complications* ; Nitrates ; Prevalence ; Prognosis ; Prospective Studies ; Registries ; Risk Factors ; Stroke Volume ; Ventricular Function, Left

Objective To understand the current situation of patients with advanced schistosomiasis in Suzhou, and to provide a basis for scientific management, medical assistance, and improvement of patients' quality of life. Methods Questionnaire survey, physical examination and B-ultrasound examination were performed on the registered patients with advanced schistosomiasis. The diagnosis and classification were carried out according to the “Schistosomiasis Control Manual”. The epidemiological and clinical characteristics, disease classification, and medical and financial assistance of all existing patients were analyzed. Results There were 2 420 cases of advanced schistosomiasis in Suzhou. Their distribution was highly correlated with the cumulative area of oncomelania snails and the cumulative number of schistosomiasis patients in each district (county) (r=0.949, P<0.01; r=0.946, P<0.01). There were 845 males and 1 575 females. The highest proportion of male patients was found in Suzhou Industrial Park and the lowest in Kunshan (χ²=26.591, P<0.001). The average age of patients was (76.80±7.55) years old, and the age of female patients were higher that of male patients (F=72.01, P<0.001). The splenomegaly type was the most common (2 165), ascites type was the second (198), colonic proliferative type was the third (55), and pygmy type was the least (2). A total of 895 patients were cured and 1 337 patients were improved, while 188 patients were not cured. The condition of advanced schistosomiasis patients with different clinical types was different (χ² =226.034, P<0.001), and the condition of patients with ascites was the worst. 1 438 patients' labor level was reduced, and 540 patients lost their labor ability, while only 442 patients were normal. Age increase (β=0.012，P<0.001), clinical classification being ascites type (β=0.346，P<0.001) and need for treatment (β=0.298，P<0.001) were risk factors for the loss of labor ability in patients with late schistosomiasis. The stable condition of the disease (β= -0.089，P=0.001) was a protective factor. Conclusion There are a large number of advanced schistosomiasis cases in Suzhou, and the epidemiological characteristics of advanced schistosomiasis patients in different districts (cities) are different. The relief work of advanced schistosomiasis in Suzhou should focus on the historical heavy epidemic areas, strengthen the nursing care of the elderly patients, and pay attention to the quality of life of patients with ascites. It is also important to strengthen the follow-up nursing of patients with splenomegaly to avoid turning into ascites. All districts and counties should be guided by the characteristics of local patients and formulate targeted scientific management methods and rescue policies to improve the quality of life of patients.

Objective To construct a motivation goal framework for changes in transcultural self-management health behaviors among senile patients with chronic heart failure (CHF). Methods Totally 15 experts were selected to participate in Delphi consultancy from September 2016 to September 2017. Two rounds of questionnaire consultancy were conducted in terms of the proposed items for the motivation goal framework for changes in transcultural self-management health behaviors among senile CHF patients, with an unanimous understanding among the experts attained. Finally, the motivation goal framework for changes in transcultural self-management health behaviors among senile CHF patients was preliminarily constructed. Results The preliminarily constructed motivation goal framework for changes in transcultural self-management health behaviors among senile CHF patients included 3 primary items, 9 secondary items and 52 tertiary items. The authority coefficient, judgement coefficient and degree of familiarity of these experts were 0.930, 0.950 and 0.910, respectively. The return rate of valid questionnaires in the two rounds of expert consultancy reached 100%. Conclusions The motivation goal framework for changes in transcultural self-management health behaviors among senile CHF patients constructed under the transcultural nursing theory and the cross-theoretical model is scientific and practical, which provides reference for personalized, precise and normalized self-management education.

Objective: To analyze the clinical value of real-time PCR for virus detection in the diagnosis and treatment of patients after allo-HSCT who had no infection evidence of pneumonia using routine pathogen detection panel. Methods: The clinical data of 71 episodes with acute lung injury from May 2015 to March 2017 after allo-HSCT in hematology department of Peking University People’s Hospital (PKUPH) were retrospectively analyzed. PCR for virus detection and other routine pathogen detection tests were performed on bronchoalveolar lavage fluid (BALF) samples. Results: Among 71 episodes with acute lung injury, a total of 15 patients were diagnosed as lower respiratory tract disease merely associated with virus (detection rate of 21.13%) , 19 episodes were absent of lower respiratory tract infection. The median time from allo-HSCT to the occurrence of lung injury were 176 (49-1 376) d and 196 (57-457) d respectively (z=-0.191, P=0.864) . There were no statistical differences for baseline characteristics and clinical features between two groups. The 100-day attributable mortalities were 13.3% (2/15) and 26.3% (5/19) (χ²=0.864, P=0.426) . Patients with low-dose steroids treatment had favorable outcome than those with high-dose steroids treatment (the dose of methylprednisolone ≥250 mg/d as standard) [4.2% (1/24) vs 60.0% (6/10) ]. In patients with detectable virus in BALF, 2 patients died with early high-dose steroids treatment, while 11 patients survived with no steroids treatment or late application. Conclusions Virus infection should be considered in post-HSCT pneumonia patient with negative result using routine pathogen detection panel. Expanding virus detection panel by PCR in BALF could increase diagnostic precision and might be instructive to treatment.

[The differential diagnoses of reactive arthritis presenting as arthralgia should be considered as diverse disorders , especially when the symptoms cannot be fully explained by some definite diseases.Do not ignore the indication of bone marrow aspiration .We reported a 50-year-old woman who complained of arthralgia , recurrent fever and rash 9 months ago.Laboratory exams showed mild leukopenia , anemia, thrombocytopenia and increased lymphocyte proportion .She was treated with glucocorticoid after the diagnosis of connective tissue disease was suspected .Until platelet count abruptly decreased to very low level, the final diagnosis of acute lymphoblastic leukemia was made through bone marrow morphology , flow cytometry, and chromosome examination .Therefore, a small number of leukemia is not easily diagnosed by routine operations .Thus when diagnoses are not determined with recurrent symptoms , cautious observation and further examination are required to avoid misdiagnoses or missed diagnoses of acute leukemia .