BACKGROUND:Kidney deficiency is the main pathogenesis of osteoporosis.To study the relationship between the two major syndrome types of kidney deficiency,Kidney-Yang deficiency and Kidney-Yin deficiency,is beneficial for the development of clinical diagnosis and treatments based on the combination of disease and syndrome. OBJECTIVE:To evaluate the biomechanical differences of the rat femurs with Kidney-Yang deficiency and Kidney-Yin deficiency caused by Yougui pills,and to demonstrate the scientific efficacy of medication based on the combination of disease and syndrome in osteoporosis from a biomechanical perspective. METHODS:The bilateral ovaries of 60 female Sprague-Dawley rats were surgically removed to establish an ovariectomized osteoporosis model.At 10 weeks after modeling,all the rats were randomly divided into a Kidney-Yang deficiency group(n=30)and a Kidney-Yin deficiency group(n=30).Rats with Kidney-Yang deficiency were given gluteal intramuscular injection of hydrocortisone,while rats with Kidney-Yin deficiency were orally administered with thyroid tablet suspension,once a day,for 14 consecutive days.After successful modeling,20 rats in each group were given a suspension of Yougui pills by gavage once a day for 12 consecutive weeks and the remaining 10 rats were used as the control group without intervention.After gavage,the microstructural parameters of the bone were measured using Micro-CT scanning.Three-point bending,finite element simulation,femoral head compression,and surface indentation distribution experiments of the femurs were performed on a mechanical testing machine. RESULTS AND CONCLUSION:Micro-CT revealed that the femoral bone density,bone volume fraction,bone surface density,trabecular number,and trabecular separation were improved in the Kidney-Yin deficiency+Yougui pills group compared with the Kidney-Yin deficiency group(P＜0.05);the femoral bone volume fraction,bone surface density,trabecular number,and trabecular thickness were improved in the Kidney-Yang deficiency+Yougui pills group compared with the Kidney-Yang deficiency group(P＜0.05).The three-point bending experiment showed that the femur elastic modulus,maximum bending strength and bending fracture strength were decreased(P＜0.05)and toughness was increased(P＜0.05)in the Kidney-Yang deficiency+Yougui pills group compared with the Kidney-Yang deficiency group.Finite element simulation showed that Yougui pills could significantly improve the bending resistance of the femurs in the Kidney-Yang deficiency group,but had no significant effect on the Kidney-Yin deficiency group.The femoral head compression experiments showed that Yougui pills could enhance the ability of the femoral head to resist deformation in the Kidney-Yang deficiency group,but there was no significant difference in the effect of Yougui pills on the surface properties of the femoral head in the Kidney-Yin deficiency group and the Kidney-Yang deficiency group.To conclude,Yougui pills can significantly enhance the biomechanical properties of the osteoporotic bones with Kidney-Yang deficiency,but have no significant effect on the osteoporotic bone with Kidney-Yin deficiency.

Abstract: Acute viral respiratory tract infections, particularly acute viral lower respiratory tract infections, are a prevalent etiology of severe pediatric respiratory illness. In addition to the harm caused by viral replication itself, excessive inflammatory responses and immune homeostasis imbalances in the body can trigger cytokine storms, resulting in severe tissue and organ damage, and leading to multiple organ dysfunction or even mortality. With the continuous promotion and application of various etiological detection techniques in clinical practice, early and accurate diagnosis of the virus can be achieved. Reasonable selection of antiviral drugs, standardized implementation of non-drug intervention measures, and active immunization are helpful to prevent and control infection.

Objective:To investigate the relationship between cerebral small vessel disease and thyroid hormones in the elderly.Methods:A total of 314 subjects aged ≥60 years with records of head magnetic resonance image(MRI), serum thyroid function tests and physical examinations collected in the Department of Health Care Neurology of Beijing Hospital from May 2019 to November 2020 were consecutively included for this cross-sectional study.Participants were assigned into the cerebral small vessel disease group if their head MRI presentations met the following standards: the Fazekas score ≥3 points; the Fazekas score ≥2 points, with 1 cavity; new subcortical infarcts; or cerebral microhemorrhage.Differences in thyroid function were compared between the cerebrovascular disease group(n=129)and the group without cerebrovascular disease(control group, n=185).Results:A total of 314 subjects were enrolled, of whom 129 met the head MRI standards for cerebrovascular disease, and 185 who did not meet the standards entered the control group.Comparison of thyroid function found a statistically significant difference in FT3( t=3.270, P=0.001)between the two groups.As for the association of a specific type of cerebral small vessel disease with thyroid function, there was a statistically significant difference in the FT3 level between the lacunar infarction group and the non-lacunar infarction group( t=3.106, P=0.002)and between the cerebral microhemorrhage group and the non-cerebral microhemorrhage group( t=2.125, P=0.034). Groups with different Fazekas scores in white matter hyperintensity showed statistically significant differences in rT3( F=3.092, P=0.027), FT3( F=5.427, P=0.001)and FT4( F=2.646, P=0.049). After correction for hyperlipidemia, rT3 and FT4, it was found that age( OR=1.044, 95% CI: 1.022-1.067, P=0.000), hypertension( OR=0.533, 95% CI: 0.294-0.963, P=0.037)and FT3( OR=0.276, 95% CI: 0.159-0.478, P=0.000)were related to cerebral small vessel disease. Conclusions:FT3 levels at the lower end of the normal range are associated with cerebral small vessel disease in the elderly.

The importance of structural variants(SVs)for human phenotypes and diseases is now recognized.Although a variety of SV detection platforms and strategies that vary in sensitivity and specificity have been developed,few benchmarking procedures are available to confidently assess their performances in biological and clinical research.To facilitate the validation and application of these SV detection approaches,we established an Asian reference material by characterizing the genome of an Epstein-Barr virus(EBV)-immortalized B lymphocyte line along with identified benchmark regions and high-confidence SV calls.We established a high-confidence SV callset with 8938 SVs by integrating four alignment-based SV callers,including 109x Pacific Biosciences(PacBio)continuous long reads(CLRs),22 x PacBio circular consensus sequencing(CCS)reads,104x Oxford Nanopore Technologies(ONT)long reads,and 114×Bionano optical mapping plat-form,and one de novo assembly-based SV caller using CCS reads.A total of 544 randomly selected SVs were validated by PCR amplification and Sanger sequencing,demonstrating the robustness of our SV calls.Combining trio-binning-based haplotype assemblies,we established an SV benchmark for identifying false negatives and false positives by constructing the continuous high-confidence regions(CHCRs),which covered 1.46 gigabase pairs(Gb)and 6882 SVs supported by at least one diploid haplotype assembly.Establishing high-confidence SV calls for a benchmark sample that has been characterized by multiple technologies provides a valuable resource for investigating SVs in human biology,disease,and clinical research.

Objective:To investigate the treatment and prognosis of children with propionic acidemia (PA).Methods:This study involved 82 children with PA treated in the Department of Pediatric Endocrinol-ogy and Genetic Metabolism, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from December 2002 to June 2020. Clinical data, including manifestations, laboratory test results, treatment strategy, and follow-up data, were summarized and analyzed using t-test or Mann-Whitney U test. Results:(1) Among the 82 cases consisting of 50 (61.0%) boys and 32 (39.0%) girls, 59 (72.0%) were diagnosed after clinical onset; 22 (26.8%) were diagnosed by newborn screening, including eight asymptomatic ones; the other one (1.2%) was asymptomatic but confirmed after the diagnosis of PA in the patient's sibling. The average age at first onset was 4.5 months (2 d-5 years) in 73 subjects, of which 28 (38.4%) were early-onset PA (within three months after birth). (2) Cranial MRI was performed on 26 cases, and abnormality was identified in 19 (73.1%) cases. (3) Hyperlactatemia was found in 16 cases among 30(53.3%) who underwent relevant examination with the average lactic acid level of 3.5 (2.1-4.3) μmol/L, while 35 out of 40 patients (87.5%) had hyperammonemia with an average blood ammonia level of 105.4 (34-907) μmol/L. (4) Among the 28 early-onset PA cases, 16 (57.1%) died, and 12 (42.9%) survived. There was no significant difference in the serum propionylcarnitine level, propionylcarnitine to acetylcarnitine ratio, urine 3-hydroxypropionic acid, or methylcitrate level between the survival and death cases. (5) Genetic mutations were detected in 75 patients (91.5%), among which 26 (34.7%) carried PCCA gene mutations and 48 (64%) with PCCB gene mutations. One patient (1.3%) harbored one known pathogenic mutation in each of the PCCA and PCCB genes. All mutations were inherited from the parents. (6) Followed up to June 2020, 57 (69.5%) patients survived, and 25 (30.5%) died from multiple organ failure secondary to severe acidosis, including 16 early-onset and nine late-onset cases. Conclusions:The primary treatment of PA is dietary control. Most PA patients are diagnosed after clinical onset, but symptoms may recur and even have developmental retardation despite treatment. Some of those diagnosed through newborn screening are asymptomatic after treatment. Newborn screening using tandem mass spectrometry is recommended for early diagnosis and treatment of PA.

Objective:To explore the relationship between learning motivation and professional identity of nursing students.Methods:A total of 1 538 undergraduate and specialized nursing students from a medical college in Shandong Province were investigated with general information questionnaire, occupational identity scale and learning motivation scale.Results:The total score of professional identity and learning motivation of nursing students was 57.54±12.89 and 119.92 ±22.03 all of which were at the middle level. There was a positive correlation between the total score and each dimension ( r=0.225-0.614, P<0.01). Conclusions:Nursing students' professional identity is positively correlated with their learning motivation. The stronger their learning motivation is, the higher their level of professional identity is. It suggests that nursing education and managers should pay attention to improving their learning motivation and establish a stable professional concept.

Objective To explore the role of genetic factors in development of esophageal cancer by studying the association of XRCC1,P53 and COX-2 genetic polymorphisms with susceptibility of esophageal cancer in Hakka population. Methods A case-control study was performed with molecular epidemiological methods. A total of 122 patients with esophageal cancer(esophageal cancer group)and 123 healthy people(control group) were randomly selected from Hakka people in Meizhou area. The genotypes and alleles of XRCC1 rs25487,P53 rs1042522,and COX-2 rs689466 in both groups were detected,and the distribution characteristics were analyzed. Results The polymorphisms of XRCC1 rs25487(A/G),P53 rs1042522(C/G)and COX-2 rs689466(A/G)were found in Hakkan people in Meizhou area ,but there were no significant differences in the genotype and allele fre-quencies between the two groups. And after such as sex,age,stratified analysis showed also no significant results. Conclusions The study shows that the genetic polymorphisms of XRCC1 gene rs25487,P53 gene rs1042522 and COX-2 gene rs689466 are possibly not related with the susceptibility of esophageal cancer in Hakka population in Meizhou area.

Objective The purpose of this research is to use modern statistical methods,to analyze the rules of cointment by Prof.Yang Zhimin treating yang deficiency and fatigue state patients,to increase the pertinence and to improve the clinical efficacy.Methods This paper analyzed 62 cases of Prof.Yang Zhimin in the treatment of the patients with yang deficiency and fatigue state from October 2010 to January 2013.The analyses were frequency analysis and association rules.Results Among the patients with yang-deficiency and fatigue,193 Chinese medicine were used.The monkshood was the highest frequency.Dampness-transforming medicine accounts for about 22.2％ in the top 36 frequency of medicine.Based on analyzing association rules,we found that the compatibility of medicine which were used more frequently came from Sini decoction,Danggui Sini decoction and Jinkui Shenqi pills,such as "monkshood and dried ginger","monkshood and roasted liquorice","dried ginger and roasted liquorice","monkshood and angelica","monkshood and comel","monkshood and prepared rehmannia root" and "monkshood and yam".Futhermore,we found two new core prescription.One was Qian Yang Dan combined with Sini decoction consist of "monkshood,roasted liquorice,dried ginger,fructus amomi".The other one was Tu Si Jian consist of "yam,semen cuscutae,angelica,roasted liquorice".Conclusions "Invigorating spleen and kidney","warming yang and dissipating dampness" and "hiding yang and Seeking Yang in Yin" are the habits and rules of the ointment medication by Prof.Yang Zhimin treatingyang deficiency and fatigue state patients.

Objective To develop a framework and indicators system for disability-related service data in China. Methods Using International Classification of Functioning, Disability and Health (ICF) framework and approach, the framework and indicators system were developed using content analysis, logical reasoning and expert consultation. Results A system with nine aspects, 35 dimensions and 115 indicators was established. Eleven experts with disability-related background all accepted the system, and satisfied in the importance and operability.Conclusion A data framework and indicators system with nine aspects, 35 dimensions and 115 indicators has been established for disability-related service, which can be used in further data collection.

Objective To investigate the effects of miR-155/miR-21 on the expression of TLR4 in patients with Kawasaki disease (KD).Methods Forty-five children with acute KD were enrolled into the study.Children were divided into the group with coronary artery lesions (KD-CAL+) and the group without coronary artery lesions (KD-CAL-).The age-matched twenty healthy children were included as the control group.The levels of TLR4 expression were analyzed by flow cytometry.The CD14+ monocytes in the peripheral blood were separated by CD14+ immunomagnetic beads.Real-time polymerase chain reaction (PCR) were performed to evaluate the expression of miR-155,miR-21 and interleukin (IL)-10,tumor necrosis factor (TNF)-α,IL-6,IL-1β in CD14+ monocytes at mRNA level.The concentration of matixmetalloproteinase (MMP)-9,HSP60,high mobility group box-1 protein (HMGB1) were measured by enzyme-linked immunosorbentassay (ELISA).T test was used to compare the differences between groups and P＜0.05 was considered to be statistically significant.Results The levels of Toll-like receptor 4 (TLR4) expression in children with acute KD were significantly higher than those in the control group [(12.4±5.1)％ vs (4.6±1.6)％,t=5.55,P＜0.05],and the levels of TLR4 expression in the KD-CAL+ group were remarkably elevated compared with the KD-CAL+group [(17.1±4.6)％ vs (9.6±2.7)％,t=5.89,P＜0.05].The plasma concentrations of HMGB11 [(10.2±7.6 vs 3.2±1.0) ng/ml,t=3.55,P＜0.05] and HSP60 [(56±23 vs 18±7) ng/ml,t=4.90,P＜0.05] in the KD group were increased(P＜0.05),but significantly decreased aftcr treatment with IVIG (P＜0.05).The levels of miR-155 [(21.0±27.0)×10 vs (4.6±3.1)×10-3,t=2.57,P＜0.05] and miR-21 (11.6±4.0 vs 8.7±2.2,t=2.78,P＜0.05)expression in the KD group were significantly higher than those in the controls (P＜0.05).The level of miR-155 expression in the KD-CAL+ group was apparently higher than that in the KD-CAL-group [(4.2±3.0)×10 vs (11.0±1.5)×104,t=4.07,P＜0.05] and the expression of miR-21 was lower than that in the KD-CAL-group (8.8±2.5 vs 12.8±4.0,t=3.46,P＜0.05).Compared with the controls,the levels of IL-10 mRNA expression in the KD group were significantly increased [(34.9 ±17.5)×10 vs (1.0±9.4)×10 4,t =5.62,P＜0.05),and IL-10 expression in the KD-CAL-group was higher than that in the KD-CAL+ group [(26.6±13.4)×104 vs (39.5±1.8)×10,t=2.36,P＜0.05].The plasma concentrations of MMP-9 in the KD group were remarkably higher than those in the controls [(1 141±541) pg/ml vs (304±94) pg/ml,t=4.83,P＜0.05],the concentration of MMP-9 in the KD-CAL+ group was higher than that in the KD-CAL-group [(1 350±625) pg/ml vs (945±370) pg/ml,t=2.21,P＜0.05].Conclusion The dysregulation of miR-155 and miR-21 may be one of the reasons that result in over-expression of TLR4 in patients with acute KD,and the persistently increased HSP60 and HMGB1 may trigger or amplify TLR4 expression.