Objective: To investigate the prevalence of sleep quality among the elderly in nursing homes in Changning District, Shanghai Municipality, so as to provide insights into prevention and intervention strategies for improving sleep quality and overall quality of life for the elderly. Methods: The elderly from 25 nursing homes in Changning District were selected using a two-stage sampling method. Basic information including gender, age and types of medication were collected. Sleep quality was assessed using the Athens Insomnia Scale, and depressive symptoms were measured using the Geriatric Depression Scale. Factors affecting sleep quality among the elderly in nursing homes were analyzed using a multivariable logistic regression model. Results: A total of 739 participants were surveyed, including 516 males (69.82%) and 223 females (30.18%). The majority of participants were aged 80 to <90 years (478, 64.68%). Among them, 432 participants (58.46%) had normal sleep, 144 (19.49%) had suspected insomnia, and 163 (22.06%) had insomnia. Multivariable logistic regression analysis showed that older age (OR=1.030, 95%CI: 1.005-1.055), more medication types (OR=1.971, 95%CI: 1.381-2.812), frequent nighttime bathroom visits (OR=2.921, 95%CI: 1.853-4.605) and depressive symptoms (OR=3.295, 95%CI: 2.440-4.449) were associated with a higher risk of insomnia among the elderly in nursing homes. Conclusions Insomnia was reported in 22.06% of the elderly in nursing homes in Changning District. Age, the number of medication types, frequency of nighttime bathroom visits, and depressive symptoms are the main influencing factors for their sleep quality.

Objective To investigate the current situation of home environment safety of the elderly in Changning District, identify the risk factors related to the fall of the home environment of the elderly, and take targeted rectification measures, so as to create a safer environment for the elderly. Methods A phased random sampling method was used to select 201 elderly households from 10 streets in Changning District. Community doctors conducted on-the-spot investigation and assessment to collect information, and Epidata3.1 was used to input data and SAS 9.2 was used for statistical analysis. Results The incidence of falls in the past year was 19.90%, and the score of environmental risk factors/the number of environmental risk factors in each family ranged from 0 to 25, with an average of 9 items (standard deviation of 4.71). The results of multivariate logistic regression analysis show that the high level of falling environment (the number of falling risk factors in home environment ≥12) is still an independent risk factor for falls of the elderly, except for the influence of age and the number of drugs taken (OR=3.835, 95% CI:1.718-8.561). Conclusion The environmental risk factors causing falls are common in the home environment of the elderly in the community. It is necessary to focus on improving the home environment, reducing the risk of falls for the elderly, and creating a safe and comfortable home environment for the elderly.

Gorham-Stout disease(GSD)is a sporadic chronic disease characterized by progressive bone dissolution,absorption,and disappearance along with lymphatic vessel infiltration in bone-marrow cavities.Although the osteolytic mechanism of GSD has been widely studied,the cause of lymphatic hyperplasia in GSD is rarely investigated.In this study,by comparing the RNA expression profile of osteoclasts(OCs)with that of OC precursors(OCPs)by RNA sequencing,we identified a new factor,semaphorin 3A(Sema3A),which is an osteoprotective factor involved in the lymphatic expansion of GSD.Compared to OCPs,OCs enhanced the growth,migration,and tube formation of lymphatic endothelial cells(LECs),in which the expression of Sema3A is low compared to that in OCPs.In the presence of recombinant Sema3A,the growth,migration,and tube formation of LECs were inhibited,further confirming the inhibitory effect of Sema3A on LECs in vitro.Using an LEC-induced GSD mouse model,the effect of Sema3A was examined by injecting lentivirus-expressing Sema3A into the tibiae in vivo.We found that the overexpression of Sema3A in tibiae suppressed the expansion of LECs and alleviated bone loss,whereas the injection of lentivirus expressing Sema3A short hairpin RNA(shRNA)into the tibiae caused GSD-like phenotypes.Histological staining further demonstrated that OCs decreased and osteocalcin increased after Sema3A lentiviral treatment,compared with the control.Based on the above results,we propose that reduced Sema3A in OCs is one of the mechanisms contributing to the pathogeneses of GSD and that expressing Sema3A represents a new approach for the treatment of GSD.

Background::Pancreatic ductal adenocarcinoma (PDAC) is one of the main types of malignant tumor of the digestive system, and patient prognosis is affected by difficulties in early diagnosis, poor treatment response, and a high postoperative recurrence rate. Carbohydrate antigen 19-9 (CA19-9) has been widely used as a biomarker for the diagnosis and postoperative follow-up of PDAC patients. Nevertheless, the production mechanism and potential role of CA19-9 in PDAC progression have not yet been elucidated.Methods::We performed single-cell RNA sequencing on six samples pathologically diagnosed as PDAC (three CA19-9-positive and three CA19-9-negative PDAC samples) and two paracarcinoma samples. We also downloaded and integrated PDAC samples (each from three CA19-9-positive and CA19-9-negative patients) from an online database. The dynamics of the proportion and potential function of each cell type were verified through immunofluorescence. Moreover, we built an in vitro coculture cellular model to confirm the potential function of CA19-9. Results::Three subtypes of cancer cells with a high ability to produce CA19-9 were identified by the markers TOP2A, AQP5, and MUC5AC. CA19-9 production bypass was discovered on antigen-presenting cancer-associated fibroblasts (apCAFs). Importantly, the proportion of immature ficolin-1 positive (FCN1+) macrophages was high in the CA19-9-negative group, and the proportion of mature M2-like macrophages was high in the CA19-9-positive group. High proportions of these two macrophage subtypes were associated with an unfavourable clinical prognosis. Further experiments indicated that CA19-9 could facilitate the transformation of M0 macrophages into M2 macrophages in the tumor microenvironment. Conclusions::Our study described CA19-9 production at single-cell resolution and the dynamics of the immune atlas in CA19-9-positive and CA19-9-negative PDAC. CA19-9 could promote M2 polarization of macrophage in the pancreatic tumor microenvironment.

Objective To observe the expression and forewarning effect of MiR-155-5p in the chronicity process of herpes zoster neuralgia (HZN).Methods A total of 88 patients with herpes zoster neuralgia (HZN group) and 20 healthy subjects undergoing physical examination (HA group) were selected.The expression level of serum miR-155-5p was measured by reverse transcription real-time fluorescence quantification poly-merase chain reaction (RT-qPCR).The patients with pain after 3-month follow up served as herpes zoster neuralgia (PHN group) and those with pain disappearance served as the cure group (RC group).The expres-sion levels of miR-155-5p were compared between the HZN group and HA group and between the PHN group and RC group.The area under receiver operating characteristic (ROC) curve (AUC) and 95％ confidence in-terval (CI) were calculated for evaluating the efficiency of miR-155-5p in predicting the chronicity of HZN. Results Compared with the HA group,the expression level of miR-155-5p in the HZN group was significant-ly up-regulated,and the difference was statistically significant (P<0.05);compare with the RC group,the ex-pression level of serum miR-155-5p in the PHN group was significantly up-regulated,and the difference was statistically significant (P<0.05);AUC of miR-155-5p for predicting the chronicity of HZN was 0.878 (95％CI:0.808-0.948).Conclusion The expression level of serum miR-155-5p in herpes zoster period of the pa-tients with PHN is significantly up-regulated compared with the cure patients and miR-155-5p could serve as an important predictive indicator of HZN chronicity.

Objective:To compare the effectiveness of the Cancer Fatigue Scale (CFS) and the Revised Piper Fatigue Scale (PFS-R) in screening cancer-related fatigue (CRF) in lung cancer patients with chemotherapy.Methods:This study was a cross-sectional study. From June 2022 to March 2023, convenience sampling was used to select 162 lung cancer patients who underwent chemotherapy in the Oncology Department of Jiangsu Cancer Hospital as the study subject. CFS and PFS-R were used for CRF screening, using the diagnostic criteria proposed in the Clinical Practice Guidelines for Cancer-related Fatigue in China as the gold standard. The area under the receiver operating characteristic ( AUC), sensitivity, specificity, and Youden index of the two screening tools were compared. Results:The incidence of CRF in lung cancer chemotherapy patients was 61.1% (99/162). According to the presence of CRF, the patients were divided into CRF group ( n=99) and non-CRF group ( n=63). The CFS score and PFS-R score of patients in the CRF group were higher than those in the non-CRF group, and the differences were statistically significant ( P<0.05). The AUC of CFS was 0.840 with an optimal cutoff value of 2.470, and the sensitivity, specificity, and Youden index were 0.758, 0.873, and 0.631, respectively. The AUC of PFS-R was 0.918 with an optimal cutoff value of 4.500, and the sensitivity, specificity, and Youden index were 0.899, 0.937, and 0.836, respectively. The AUC of PFS-R was higher than that of CFS, and the difference was statistically significant ( Z=2.232, P<0.05) . Conclusions:Compared with CFS, PFS-R has a better evaluation effect and is more suitable as a screening tool for CRF in lung cancer patients with chemotherapy.

Objective:To construct the nursing quality evaluation index system for radionuclide wards, so as to provide scientific basis for monitoring the quality of nursing work in radionuclide wards.Methods:With Donabedian's "structure-process-outcome" three-dimensional quality evaluation model as the theoretical framework, literature review, Delphi method and analytic hierarchy process were used to determine the contents and weights of the evaluation index system of nursing quality in radionuclide wards. The enthusiasm of experts was expressed by the effective recovery rate of the questionnaire, the authority coefficient of experts was expressed by the authority coefficient, and the coordination degree of expert opinions was expressed by the coefficient of variation and the Kendall's harmony coefficient.Results:The effective recovery rates of the two rounds of expert correspondence questionnaires were 100.00% (15/15), the expert authority coefficients were 0.880 and 0.900, the coefficient of variation were 0.10-0.26 and 0-0.16 and the Kendall's harmony coefficients were 0.131 and 0.187 ( P<0.01). The final constructed nursing quality evaluation index system for radionuclide wards included three primary indicators, 12 secondary indicators and 56 tertiary indicators. Conclusions:The constructed nursing quality evaluation index system for radionuclide wards is scientific, reliable, practical and specialized, which is close to clinical nursing work and can provide a good evaluation method for nursing quality evaluation in radionuclide wards.

Purpose To examine the clinicopathologic,immunohistochemical,and molecular genetic characteristics and differential diagnosis of low-grade oncocytic tumor(LOT)of kidney with CK7 positive and CD117 negative,so as to enhance the understanding of this tumor among pathologists.Methods A total of five cases of renal LOT from the First Affiliated Hospi-tal of Soochow University between December 2016 and February 2023 were included in this analysis.The clinicopathological fea-tures,immunophenotype,genetic characteristics,and prognosis were evaluated using HE staing,immunohistochemical staining,and Sanger sequencing.Additionally,relevant literature was re-viewed to supplement the findings.Results Among the cohort of five patients,four were female and one was male,aged 57-70 years with a median age of 65 years and an average age of 64.8 years.Clinical presentation revealed that only the first case exhibited frequent urination accompanied by intermittent lumba-go,while the remaining cases were asymptomatic and incidental-ly discovered.Imaging studies demonstrated space-occupying le-sions with clear boundaries and even internal echoes on B-ultra-sonography,and patchy low-density shadows in the center with obvious edge enhancement on CT.Grossly,the tumor was nodu-lar,with a maximum diameter ranging from 2.1 to 7.6 cm,and an average diameter of 4.04 cm,with a solid section.Micro-scopically,the boundary of LOT was consistently well-defined,with a thick capsule.The arrangement of tumor cells was ob-served to be both dense and sparse,accompanied by fresh bleed-ing foci and proteinoid secretions.Focal lymphocyte aggrega-tion,hepatic plate like and hepatic sinusoid like structures,thick-walled blood vessels,false nodules of tumor cells,and old hemorrhage were also noted.The tumor cells exhibited uniformi-ty in shape,appearing round or polygonal,with eosinophilic and fine granular cytoplasm.The nuclei were of similar size and shape,appearing round or oval with a clear nuclear membrane.The histological features of the tumor included 2-grade small nu-cleoli,perinuclear halos,binuclear cells,and nuclear shrink-age,but no mitotic figures were detected.The immunophenotyp-ic analysis revealed strongly diffuse expression of CK7 in the tumor cells,while CD117 was negative.The Ki67 proliferation index was low.Sanger sequencing identified mutations in mTORC1 pathway genes in four cases,including three mutations in MTOR and one mutation in RHEB.The patients underwent either local or radical nephrectomy,and were followed up for a period ranging from 2 to 52 months,during which all patients re-mained free of recurrence.Conclusion The low-grade,eosino-philic,and rare renal tumor known as LOT exhibits inert behav-ior.At present,the follow-up results show that complete resec-tion of local operation is sufficient,and the prognosis is good.It is important to distinguish this lesion from other eosinophilic re-nal tumors.

Objectives:To report the sexual functional outcomes of vaginal dilation therapy in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome patients.Methods:From March 2020 to February 2023, 97 MRKH syndrome patients performed vaginal dilation therapy with guidance from Peking Union Medical College Hospital, and 45 of them engaged in penetrative intercourse and were included in this prospective cohort study. The Chinese version of female sexual function index (FSFI) was used to assess sexual function. Functional success was defined as FSFI>23.45. Forty age-matched healthy women were selected as controls. Kaplan-Meier survival analysis was used to calculate the median time to success. Pearson correlation analysis was used to explore the relationship between neovagina length and sexual function. Complications were collected using follow-up questionnaires.Results:The functional success rate of vaginal dilation therapy was 89% (40/45) with a median time to success of 4.3 months (95% CI: 3.0-6.1 months). Compared to controls, MRKH syndrome patients had significantly lower scores in the orgasm domain (4.72±1.01 vs 4.09±1.20; P=0.013) and pain domain (5.03±0.96 vs 4.26±0.83; P<0.001). However, there were no significant differences in the FSFI total score (26.77±2.70 vs 26.70±2.33; P=0.912), arousal domain (4.43±0.77 vs 4.56±0.63; P=0.422) and satisfaction domain (4.88±0.98 vs 4.65±0.86; P=0.269) between MRKH syndrome patients and controls. MRKH syndrome patients had significantly higher scores in the desire domain (3.33±0.85 vs 3.95±0.73; P<0.001) and lubrication domain (4.37±0.56 vs 5.20±0.67; P<0.001). The prevalence of sexual dysfunction in MRKH patients was non-inferior to controls: low desire [3% (1/40) vs 23% (9/40); P=0.007], arousal disorder [3% (1/40) vs 3% (1/40); P>0.999], lubrication disorder [5% (2/40) vs 25% (10/40); P=0.012], orgasm disorder [40% (16/40) vs 20% (8/40); P=0.051], sexual pain [30% (12/40) vs 15% (6/40); P=0.108]. Conclusions:MRKH syndrome patients undergoing non-invasive vaginal dilation therapy could achieve satisfactory sexual life. Given its high functional success rate and slight complication, vaginal dilation therapy should be recommended as the first-line option, reducing the need for unnecessary surgeries.

OBJECTIVE: To assess the value of copy number variation sequencing (CNV-seq) for revealing the genetic etiology of fetuses with isolated ventricular septal defect (VSD). METHODS: From December 2017 to December 2020, 69 fetuses with isolated VSD were identified at the First Affiliated Hospital of Zhengzhou University. Meanwhile, 839 similar prenatal cases were selected from public databases including Wanfang data, Wanfang Medicine, and China National Knowledge Infrastructure (CNKI) by using keywords such as "Ventricular septal defect", "Copy number variation", and "Prenatal". A total of 908 fetuses with isolated VSD were analyzed. CNV-seq was carried out for 69 fetuses. RESULTS: Among the 908 fetuses, 33 (3.63%) were found to harbor pathogenic CNVs, which included 11 chromosomal aneuploidies (1.21%) and 22 pathogenic CNVs (2.42%). The pathogenic CNVs have involved 12 genetic syndromes, with those known to involve the heart development including 5 cases of 22q11.21 deletion syndrome, 2 cases of 4q terminal deletion syndrome, and 1 case of 9q subtelomere deletion syndrome. The outcome of pregnancies for 15 fetuses with pathogenic CNVs was known, of which 12 were terminated, and 3 had spontaneous closure of the ventricular septum after birth, but 1 of them had other abnormalities. CONCLUSION Fetuses with isolated VSD have a relatively high risk for chromosomal abnormalities, for which CNV-seq should be recommended.
Female ; Pregnancy ; Humans ; DNA Copy Number Variations ; Heart Septal Defects, Ventricular/genetics* ; 22q11 Deletion Syndrome ; Fetus