To investigate the prevalence and epidemiological characteristics of diabetic retinopathy (DR) in Yunnan Province, explore its risk factors, and provide a basis for the prevention and treatment of chronic complications of diabetes mellitus (DM). This is a large cross-sectional study, in all, 1 524 DM patients in 16 communities and villages of Yunnan Province who were registered in health service centers were included in this study from August to November 2019. All patients completed a uniform questionnaire, anthropometric measurements, biochemical measurements, and auxiliary examinations. Logistic regression analysis was used to screen the risk factors of DR. The prevalence rates of DR, mild non-proliferative DR (mild-NPDR), and referable DR (RDR) were 16.0% (244/1 524), 4.5% (69/1 524), and 11.5% (175/1 524), respectively. Glycated hemoglobin A 1c (HbA 1c)≥7.0% was the risk factor of mild-NPDR ( OR=1.872, 95% CI 1.055-3.323) and RDR ( OR=4.821, 95% CI 2.917-7.969). Blood pressure≥130/80 mmHg (1 mmHg=0.133 kPa) was the risk factor of mild-NPDR ( OR=1.933, 95% CI 1.112-3.358) and RDR ( OR=1.505, 95% CI 1.063-2.130). In Yunnan Province, 16.0% DM patients had accompanying DR, wherein about 71.7% of them required an ophthalmology referral, and the high incidence of RDR in DM patients was associated with poor control of blood glucose and blood pressure.

Objective:To evaluate the incidence of arrhythmias and electrocardiographic (ECG) characteristics in cancer patients treated with immune checkpoint inhibitors (ICIs).Methods:This was a cohort study conducted in the Fourth Hospital of Hebei Medical University. Cancer patients initiating ICIs treatments from November 2020 to September 2022 were included in this study. Baseline 12-leads ECG before ICIs initiation and post-treatment ECG were analyzed. An abnormal ECG was defined as the presence of any of the following changes: sinus arrhythmias, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, ventricular tachycardia, premature contractions, conduction disorder, and ST-T changes.Results:A total of 87 patients were enrolled, aged 63 (57, 68) years, with 66 (75.9%) males. And 44.8% (39/87) of patients presented with at least one confirmed cardiovascular disease or cardiovascular risk factor at baseline. The incidence of abnormal ECG increased from 31.0% (27/87) at baseline to 65.5% (57/87) after receiving (5.0±2.7) cycles of ICIs treatment ( P<0.001). The incidence of sinus arrhythmias was significantly increased after ICIs treatment (23.0% (20/87) vs. 9.2% (8/87), P=0.023), of which only the incidence of sinus tachycardia was significantly increased (11.5% (10/87) vs. 2.3% (2/87), P=0.039). There was also a significantly increased incidence of ST-T changes after ICIs treatment (31.0% (27/87) vs. 17.2% (15/87), P=0.012), which mainly attributed to the T wave changes (29.9% (26/87) vs. 13.8% (12/87), P=0.001). The incidence of premature contractions was also significantly increased after ICIs treatment (9.2% (8/87) vs. 0, P=0.008). Additionally, compared with baseline, the P wave axis was significantly increased after ICIs treatment ((56.94±21.01)° vs. (52.00±22.69)°, P=0.043). After ICIs treatment, the heart rate was significantly increased ((79.07±15.37) beats/min vs. (75.64±13.37) beats/min, P=0.029). Sokolow-Lyon index ((2.21±0.81)mV vs. (2.33±0.75)mV, P=0.138), QTc interval ((431.44±36.04)ms vs. (428.00±30.05)ms, P=0.415) all showed signs of change after treatment, but did not reach the traditional significant level. Conclusions:The incidence of abnormal ECG is significantly increased after ICIs treatment, especially for sinus tachycardia, premature contractions and T wave changes; the P wave axis and heart rate is also significantly increased after treatment. It is important to perform regular ECG monitoring in patients receiving ICIs treatment.

Objective:To explore the correlation between changing trajectories of serum uric acid and the onset of nonalcoholic fatty liver disease (NAFLD).Methods:A longitudinal cohort study. Total of 3 353 subjects who had routine health examination every year from January 2017 to December 2019 in the Health Management Center of the Second Affiliated Hospital of Dalian Medical University and met the inclusion criteria were selected as the research subjects. Four different serum uric acid trajectory groups were determined by using the group-based trajectory model: the low stability group, medium stability group, medium-high stability group and high stability group. During the follow-up to December 2021, the differences in cumulative incidence of NAFLD in different serum uric acid trajectory groups were calculated and compared. Cox proportional hazard regression model was used to evaluate the hazard ratio ( HR) and 95% confidence interval ( CI) of the NAFLD onset in different serum uric acid trajectory groups. The dose-response relationship between baseline serum uric acid and NAFLD was evaluated by a restricted cubic spline regression model. Results:The cumulative incidence of NAFLD in two years was 10.77%, and the cumulative incidence increased with the rising trajectory of serum uric acid, it was the highestin the high stability group ( P<0.05). Compared that in the low stability group, the risk of NAFLD in the other three groups was as follows: 2.24 (95% CI: 1.59-3.14) in the medium stability group, 2.89 (95% CI: 1.92-4.33) in the medium-high stability group and 4.55 (95% CI:2.83-7.31) in the high stability group (all P<0.05). The risk of NAFLD gradually increased with the rising of serum uric acid level, and the cut-off value of serum uric acid for women and men was 260.32 μmol/L and 365.09 μmol/L, respectively. Conclusions:Long-term moderate and high levels of serum uric acid are independent risk factors for the occurrence of NAFLD. With the rising of serum uric acid trajectory, the risk of NAFLD increases. Attention should be paid to the longitudinal change trend of serum uric acid level in the prevention of NAFLD, and it should be controlled within lower level of the normal range.

Objective:To analyze the research hotspots and frontiers in the training of health management talents in China based on knowledge mapping.Methods:The literature related to talent training in health management was retrieved from the databases of CNKI, Wanfang Data, and VIP Journals from 2007 to 2022. The keywords used for retrieval included “health management” “curriculum system” “health manager” “evaluation system” “health service and management” and “talent training”. The time distribution of the literature was analyzed using Excel. Bibliometric analysis was conducted to visually analyze the research in health management talent training, focusing on authorship and collaboration, research institutions, high-frequency keywords, and research hotspots. A knowledge map was created to outline the research framework.Results:A total of 378 journal articles were retrieved. Over the past decade, there has been an overall increasing trend in the number of research publications related to health management talent training. The highest number of articles was published in 2021 (63 articles). In terms of spatial distribution, highly productive authors were relatively concentrated, and research institutions were mostly universities, with Hangzhou Normal University having the highest number of publications (14 articles). The research hotspots included health managers, practice teaching modes, cross-cultivation, and discipline construction. The research frontiers concentrated on talent training modes, health service and management professions, talent demand, and curriculum system construction.Conclusions:In the past decade, health management talents training in China has received more attention and importance. However, there is limited exchange and cooperation among authors and research institutions, and the research hotspots continue to extend in the direction of specialization and diversification. The transformation from vocational education to academic education and strengthening professional construction are the frontiers of the research.

Objective To investigate the expression level of soluble Programmed cell death ligand2 (sPD-L2) in the peripheral blood of patients with Brucella infection and their correlation with helper T cells (Th) subsets. Methods Data from eighty-three patients with confirmed Brucella infection, including 37 patients with acute phase Brucella infection and 46 patients with chronic phase Brucella infection, collected from the People's Hospital of Xinjiang Uygur Autonomous Region between January 2019 and December 2021, were analyzed. Fifty healthy individuals undergoing regular medical check-ups during the same period were included as the Healthy Control (HC) group. Flow cytometry was used to detect the percentage of Th1 and Th2 cells as CD4+ T cells in the peripheral blood of the three groups of samples. Quantitative real-time fluorescence PCR (qRT-PCR) was performed to measure the mRNA expression levels of Th1 and Th2 cell-associated transcription factors T-bet and GATA-3 in the peripheral blood of the three samples. The expression levels of cytokines sPD-L2, IFN-γ, and IL-4 in the serum of the three groups of samples were measured by the cytometric bead array (CBA) technique. Results Th1 cells in the acute phase brucellosis infection group (45.33±4.96)%, mRNA expression levels of T-bet (1.91±0.41), and IFN-γ expression levels (74.42±13.95) pg/mL were significantly higher in the acute phase Brucella disease group compared to the chronic phase group (21.78±4.42)%, (0.65±0.24), and (10.64±3.04) pg/mL, as well as the HC group (28.87±6.67)%, (1.12±0.25), and (7.48±2.92) pg/mL, respectively (P<0.05). Th2 cells (59.80±10.09)%, GATA-3 mRNA expression level (1.50±0.44), and IL-4 level (8.76±2.06) pg/mL were significantly higher in the chronic phase brucellosis infection group compared to the acute phase brucellosis patient group (40.61±9.32)%, (1.02±0.23), and (2.08±0.50) pg/mL, as well as the HC group (46.06±8.84)%, (1.18±0.28), and (2.70±0.75) pg/mL, respectively (P<0.05). Compared to the HC group (91.61±11.44) pg/mL, the sPD-L2 levels were significantly higher in the acute phase brucellosis patient group (156.77±24.69) pg/mL and slightly higher in the chronic phase brucellosis patient group (110.99±29.44) pg/mL, with a statistically significant difference between the acute and chronic phase brucellosis patient groups (P<0.05). Correlation analysis of the brucellosis patient group showed that sPD-L2 levels were positively correlated with the percentage of Th1 cells (r=0.540, P<0.01) and the levels of IFN-γ (r=0.692, P<0.01), and negatively correlated with the percentage of Th2 cells (r=-0.565, P<0.01) and the levels of IL-4 (r=-0.528, P<0.01). Conclusions In patients with acute brucellosis, sPD-L2 levels are significantly increased, which may resist brucellosis by promoting Th1 cells to secrete more pro-inflammatory factors to defend against Brucella infection. In chronic Brucella disease patients, the tilting of immune response types from Th1 to Th2 may be due to a decrease in sPD-L2 expression, which reduces the inhibitory effect of Th2, leading to incomplete clearance of Brucella and thus immune escape. Brucella may affect the conversion of Th1 to Th2 through the sPD-L2 pathway, exerting negative regulatory effects and resulting in difficulty in complete Brucella clearance, thus turning into a chronic phase.

Objective:To explore the application status and trends of the health examination data.Methods:Relevant literatures on health examination data were retrieved from Web of Science from 1 January 2007 to 30 June 2022 and China Knowledge Network Infrastructure from 1 January 1992 to 30 June 2022; and the literature and research contents were visually analyzed by using CiteSpace 6.1 bibliometrics software.Results:Total of 5 517 Chinese articles and 18 563 English articles were selected. The publication volume of health examination data in China increased year by year since 1992, and the international publication volume also showed an increasing trend. The Chinese literature focused on health management, osteoporosis, overweight, and physical examination subjects such as pilots, while the English literature focused on the study of obesity, care and functional cognition after the formation of a cohort of physical examination data. More co-citation papers related to health examination data were published in the journals from developed countries mainly in the United States and the United Kingdom, and the contents of the co-cited journals highly covered disease research on chronic diseases, such as cardiovascular disease, functional cognition and rehabilitation.Conclusions:The number of articles published on health examination data is increasing year by year, and in the future, more studies will use big data algorithms such as machine learning to measure the association between the risk of chronic diseases and related influencing factors.

Objective:To explore the value of the logistic regression model with three-dimensional CT quantitative parameters in combination with qualitative parameters in predicting the invasiveness of pure ground glass nodules (pGGN).Methods:The clinical data and image features of 191 patients (196 lesions) with pGGN on CT confirmed as lung adenocarcinoma by pathology from April 2019 to December 2019 in Anhui Chest Hospital were retrospectively analyzed. Totally, 196 lesions were divided into atypical adenomatous hyperplasia (AAH)+adenocarcinoma in situ (AIS)+minimally invasive adenocarcinoma (MIA) group ( n=128) and invasive adenocarcinoma (IAC) group ( n=68). CT quantitative parameters included the maximum diameter, volume, average CT value and quality of pGGN, and the qualitative parameters included the intrinsic vascular changes, abnormal air-bronchogram, lobulated signs, bubble-like sign, pleura-traction sign, and fuzzy tumor-lung interface sign. The Mann-Whitney U test was used to compare the quantitative parameters and the Pearson χ 2 test was used to compare the qualitative parameters between two groups. The independent predictors of IAC and predictive probability value were screened by univariate analysis in combination with multivariate logistic regression analysis. The ROC curves were drawn to compare the diagnostic probability of logistic regression prediction probability and each single parameter. Results:There were statistically significant differences in maximum diameter [0.92(0.77,1.14) cm vs. 1.41(1.12, 1.93) cm, Z=-7.366, P<0.001], volume[0.31(0.20, 0.53) cm 3 vs. 0.88(0.41, 2.00) cm 3, Z=-6.254, P<0.001], average CT value[-571.5(-637.2, -477.0) HU vs. -418.1(-532.4, -338.5) HU, Z=-5.882, P<0.001], quality[0.14(0.09, 0.25) g vs. 0.42(0.26, 1.21) g, Z=-7.438, P<0.001], intrinsic vascular changes(23 vs. 49, χ2=55.906, P<0.001), abnormal air-bronchogram(13 vs. 30, χ2=29.908, P<0.001) and pleura-traction sign(39 vs. 32, χ2=5.291, P=0.021) between the two groups. The logistic regression analysis showed that the maximum diameter, average CT value, intrinsic vascular changes and abnormal air-bronchogram were the independent risk factors of IAC, and the odds ratio value(95%CI) were 10.624(1.275-88.522), 1.004(1.000-1.008), 3.424(1.458-8.043) and 2.993(1.114-8.043), respectively. The ROC curve demonstrated that the area under the curve, sensitivity and specificity of the logistic regression model were 0.899, 0.912, and 0.711 respectively, which were better than separate analysis results from each single parameter. Conclusion:The logistic regression model with a combination of three-dimensional CT quantitative and qualitative parameters can predict the invasiveness of pGGN better.

Objective:To investigate the present situation of unintended pregnancy within two years postpartum and its influencing factors in China.Methods:Participants who delivered a live birth at 60 hospitals in 15 provinces in the eastern, central and western regions of China during July 2015 to June 2016 were interviewed by using structured questionnaire. Information on occurrence of unintended pregnancy within 2 years after delivery, postpartum contraceptive use, sexual resumption, breastfeeding, and women′s socio-demographic characteristics, and so on, were collected. Life-table analysis, cluster log-rank tests and a 2-level Cox regression model were used for data analysis.Results:A total of 18 045 postpartum women were investigated. The cumulative 1- and 2-year unintended pregnancy rates after delivery were 5.3% (95% CI: 4.5%－6.1%) and 13.1% (95% CI: 11.3%－14.8%), respectively. Cox regression model analysis showed that the risk of unintended pregnancy within 2 years postpartum were increased in younger women, ethnic minorities, women with abortion history, and those who had a vaginal delivery with short lactation time and late postpartum contraceptive initiation (all P<0.01). The risk of postpartum unintended pregnancy was not associated with geographic regions and hospitals where women gave a birth (all P>0.05). Conclusions:In China, the risk of unintended pregnancy within 2 years after delivery is relatively high. Service institutions and service providers should improve the quality of postpartum family planning services, promote the use of high effect contraceptive methods, and educate women to use a method at the time of their sexual resumption or even before.

Objective To analyze the perfusion status of lung cancer before radiotherapy and the relationship between changes in CT perfusion parameters after radiotherapy and the efficacy of radiotherapy.Methods Twenty-eight patients clinically and pathologically diagnosed with lung cancer were enrolled as subjects.Those patients received CT perfusion imaging scan and perfusion parameters including blood flow (BF),blood volume (BV),mean transit time (MTT),and permeability surface (PS) were calculated.We use linear correlation analysis for relation between value of CT perfusion imaging and the target volume of lung cancer before radiotherapy,t-test for difference between the remission groups and non-remission groups,compared paired sample t-test for value of CT perfusion imaging before and after radiotherapy.Results According to the efficacy of radiotherapy,28 patients with lung cancer were divided into response group (n=16) and non-response group (n=12).The response group had significantly smaller tumor sizes before and after radiotherapy than the non-response group (58.72±22.95 cm3 vs.24.53±13.79 cm3,P=0.000).However,there was no significant correlation of target volume before radiotherapy with any perfusion parameter (P=0.628).The response group had significantly larger BF and BV than the non-response group before radiotherapy (1.23±1.36 vs.6.42±2.57,P=0.024 and 1.23±0.31 vs.0.59±0.18,=0.041),suggesting a low perfusion state of tumor tissue in the non-response group.However,there were no significant differences in MTT and PS between the two groups (0.93±0.58 vs.0.93±0.66,P=0.851 and 1.46±0.83 vs.1.17±0.56,P=0.141).All the 28 patients had significantly smaller BF,BV,MTT,and PS after radiotherapy (9.81±3.56 vs.7.48±3.31,P=0.006;0.96±0.41 vs.0.64±0.38,P=0.003;0.93±0.60 vs.0.53±0.30,P=0.007;1.34±0.73 vs.0.74±0.44,P=0.001).Conclusions CT perfusion imaging can predict the efficacy of radiotherapy for lung cancer,which may guide the planning and implementation of precise radiotherapy for lung cancer.

Objective To observe the effects of AMPK activation on cancer cell apoptosis and to investigate the underlying mechanism and its significance to cancer therapy.Methods Human cervical cancer HeLa-S3 cells were divided into six groups:DMSO control,5 μmol/L CD437,CD437+Compound C,CD437+AICAR,Compound C,AICAR.Apoptosis rates in every groups induced by CD437 and other factors were determined by FACS and confirmed with clave Caspase-3 expression by Western blot analysis.Finally,apoptosis rates were detected in HeLa-S3 cells induced by the above factors after wt-LKB1 reintroduction by plasmid transfection.Results FACS results showed that treatment with 5 μmol/L CD437 for 8 hours could induce Hela-S3 cells apoptosis by (87.42±5.95) ％.Co-incubation with 20 μmol/L compound C enhanced apoptotic effect of CD437 by (86.42±5.95) ％,while co-incubation with 2 mmol/L AICAR markedly reduced cell apoptosis induced by CD437 [(51.04±8.26) ％] (P ＜ 0.05).Re-introduction of wt-LKB1 by plasmid transfection attenuated the protective effect of AICAR in CD437 induced apoptosis.Conclusion Endogeneous AMPK activation exerts a protective effect in HeLa-S3 ceils.This effect could be attenuated by re-introduction of wt-LKB1.