Background Emerging evidence posits repetitive non-suicidal self-injury (NSSI) shares behavioral and neurobiological parallels with addiction. However, the neural mechanisms underlying NSSI, particularly within the framework of “sensation of pain” addiction, remain poorly understood. This study combines the effective connectivity (EC) and transcriptomic profiling to explore addiction-related neural circuit and their potential genetic substrates of NSSI. Method A total of 76 medication-free adolescents with depression were included in the study, comprising 36 with NSSI (NSSI group) and 40 without NSSI (non-NSSI group). The addictive subscale of the Ottawa Self-Injury Inventory (OSI) was used to assess the addictive features of NSSI in the NSSI group. Resting-state functional magnetic resonance imaging were analyzed using Spectral dynamic causal modeling to explore the directed neural interactions within predefined circuits of “sensation of pain” addiction. Correlation analyses were performed between the EC and clinical data. Spatial transcriptomic mapping integrated with Allen Human Brain Atlas further detect alterations in connectivity-associated gene expression signatures. Results Compared with the non-NSSI group, the NSSI group exhibited four distinct EC alterations from the ventral tegmental area (VTA) to left amygdala (AMYG), from the right medial prefrontal cortex (mPFC) to right AMYG, from the left ventral striatum (VS) to right insula (INS) and from the right VS to left AMYG. Crucially, EC values from the VTA to left AMYG and from the right VS to left AMYG are associated with the addictive characteristics and the NSSI frequency, respectively. Genes associated with altered connectivity patterns primarily focus on the brain development, axon, dendrite, oligodendrocytes, D1+ spiny neurons, D2+ spiny neurons, and cholinergic neurons of habenula. Conclusion Our findings yield empirical support for reconceptualizing the NSSI within behavioral addiction frameworks, revealing underlying neurobiological pathways and genetic basis driving repeated NSSI. Notably, EC from the VTA to the left AMYG was positively associated with the addictive features of NSSI, highlighting a potentially important neural pathway underlying its addictive nature. The identified EC dysfunction and associated genetic markers could offer novel potential targets for therapeutic interventions.

Background:Internet addiction (IA), childhood maltreatment (CM), and bullying are prevalent psychosocial stressors among adolescents and have each been associated with suicidal ideation (SI). However, existing research often treats these factors in isolation, overlooking their potential interrelationships and joint associations with SI. Objective:This study aimed to examine how CM, IA, and bullying are jointly related to SI at both the scale and symptom levels and identify key symptoms within the CM-IA-bullying-SI network that may serve as intervention targets to disrupt maladaptive associations across the network. Methods:A total of 6573 adolescents were recruited through cluster sampling. Mediation analyses were conducted to assess direct and indirect effects of CM on SI via IA and bullying. Network analysis was conducted to examine symptom-level associations among CM, IA, bullying, and SI and identify core and bridge symptoms within the network. Network comparison tests were conducted to assess differences in network structure by gender and history of nonsuicidal self-injury. Results:Mediation analyses revealed that both IA and bullying partially mediated the association between CM and SI, with significant indirect effects via IA (c'=0.010, 95% CI 0.008-0.011; P<.001) and bullying (c'=0.004, 95% CI 0.002-0.005; P<.001). In the network, tolerance, time management, and compulsive internet use were identified as central symptoms, whereas SI, emotional abuse, and traditional bullying victimization served as bridge symptoms. Emotional abuse and cyberbullying victimization were most strongly linked to SI. Among individuals with a history of nonsuicidal self-injury, emotional abuse and emotional neglect showed stronger associations with SI. Sex subgroup analysis showed no significant difference in global strength (S=0.095; P=.69) but a significant difference in network structure (M=0.174; P=.01). Conclusions:This study revealed how CM, bullying, and IA are jointly related to SI among adolescents at both the scale and symptom levels. Key symptoms, including tolerance and time management, played central roles within the symptom network, with SI bridging multiple psychosocial domains. These findings underscore the need for multilevel, targeted interventions to disrupt maladaptive links and reduce suicide risk in adolescents.

BACKGROUND:Depression is a leading global health challenge, yet the role of Social Determinants of Health (SDH) in shaping depression risk - particularly through underlying biological mechanisms - remains insufficiently understood. This study leverages a multi-omics approach to explore how unfavorable social conditions influence depression through neural, and physiological pathways. METHODS:Drawing on data from 257,698 participants in the UK Biobank. Cox proportional hazards regression models were used to examine the relationship between SDH, polygenic risk scores (PRS), and depression. Correlation analyses were conducted to explore associations between SDH, biomarkers, brain structure, and depression. Two-sample mendelian randomization (MR) was applied to investigate causal relationships, while structural equation modeling (SEM) was used to examine interactions among SDH, depression, brain structure, PRS, and immune-metabolic biomarkers. RESULTS:Depression was significantly associated with SDH. Multivariable Cox regression showed that unfavorable SDH increased depression risk (HR = 1.916), and higher PRS was also linked to increased risk (HR = 1.288). The combination of unfavorable SDH and high PRS yielded the highest depression risk (HR = 2.578). MR analysis further emphasized the causal relationship between unfavorable SDH and depression. SDH was also linked to brain structural changes and metabolic markers, with smaller brain volumes in regions like the hippocampus and insula in the unfavorable SDH group, along with associations with biomarkers such as triglycerides and C-reactive protein. SEM analysis revealed that SDH influenced depression through immune-metabolic and brain structural pathways. CONCLUSIONS:These findings underscore the multifaceted nature of depression, highlighting how social disadvantage becomes biologically embedded through genetic and physiological mechanisms. Addressing key modifiable components of SDH may represent a powerful strategy for targeted prevention, especially in genetically at-risk populations.

Background: Aggression has been reported to be associated with insomnia in adolescents. However, the impact of aggression and different levels of aggression on insomnia needs further exploration. This study aimed to explore the association of aggression, as well as different profiles of aggression, with insomnia in Chinese adolescents. Method: This was a prospective cohort study with an 8-month follow-up period. The Short-Form Buss-Perry Aggression Questionnaire (BPAQ-SF) was used to assess the aggression; the Insomnia Severity Index (ISI) was used to assess the symptoms of insomnia. Latent profile analysis (LPA) was conducted to identify profiles of aggression. The association between different profiles of aggression and insomnia was assessed using logistic regression analysis. We also used the restricted cubic spline model to investigate the pattern of the association. Results: A total of 1124 students completed the questionnaire. The aggression was classified into three profiles: low aggression (n = 931, 82.8%), moderate aggression (n = 153, 13.6%), and high aggression (n = 40, 3.6%). A follow-up survey after 8 months found 228 (20.3%) new cases of insomnia. Moreover, high aggression was associated with a significantly increased risk of insomnia after adjustment for age, sex, ethnicity, anxiety state, and depressive state (odds ratio [OR]: 9.98, 95%CI: 4.94-20.15). The relationship between aggression and the risk of insomnia was linear in the restricted cubic spline regression analysis. Conclusion: High levels of aggression were significantly associated with insomnia among Chinese adolescents. Therefore, targeted interventions aimed at addressing insomnia among adolescents with high levels of aggression are needed to improve their mental well-being.

Objective To explore the mediating role of mindful attention and awareness in depressive symptoms and insomnia severity among patients with comorbid depression and insomnia.Methods A cross-sectional study was conducted,enrolling 267 patients with comorbid depression and insomnia who were treated in the outpatient Department of Medical Psychology of Second Affiliated Hospital of Army Medical University,from March to May 2024.Basic demographic and clinical data were collected using a general information questionnaire.Depressive symptom severity was measured via the Patient Health Questionnaire-9(PHQ-9),insomnia severity via the Insomnia Severity Index(ISI),perceived stress via the Perceived Stress Scale-10(PSS-10),and mindful attention and awareness via the Mindful Attention Awareness Scale(MAAS).Pearson correlation analysis was used to examine the correlations between depressive severity,insomnia severity,perceived stress,and mindful attention and awareness.Mediation analysis was performed using Process 4.1.Results The PHQ-9 score was(13.80±5.98)and the ISI score was(17.10±5.56)in the 267 patients.Pearson correlation analysis showed that depressive severity and insomnia severity were positively correlated with perceived stress(r=0.531,0.351,P<0.001)and negatively correlated with mindful attention and awareness(r=-0.373,-0.350,P<0.001).Mediation analysis using Process 4.1 indicated that the combined mediating effect of mindful attention and awareness and insomnia between perceived stress level and depressive level was 0.157,with a 95%confidence interval(CI)of 0.102～0.217,and the total mediating effect was significant(P<0.001).Conclusion Perceived stress directly positively affects depression and indirectly exacerbates depression through insomnia as a mediator,and mindful attention and awareness can weaken the promoting effect of perceived stress on insomnia.

Objective: The purpose of this study was to explore how the congruence between academic pressure and psychological imbalance affects depressive symptoms in adolescents and to further explore grade-level differences in these effects among high school students. Methods: The study population consisted of 29,975 high school students from 20 schools in Liuyang City, Hunan Province. The Mental Health Scale for Secondary School Students (MSSMHS) and Self-Depression Scale (SDS) were used to assess academic pressure, psychological imbalance and depressive symptoms. The effects of academic pressure and psychological imbalance were examined by polynomial regression and response surface analysis. Results: The results showed that the lowest level of academic pressure (F = 35.99, p < 0.001), psychological imbalance (F = 54.50, p < 0.001), and depressive symptoms (F = 9.36, p < 0.001) was found in repeaters, while the highest level was found in twelfth graders. Academic pressure was positively associated with psychological disequilibrium, and both were positively associated with adolescent depressive symptoms. Furthermore, when academic pressure and psychological imbalance are aligned, adolescent depressive symptoms increase with the first two. In addition, adolescent depressive symptoms decreased as the difference between academic pressure and psychological imbalance increased. Conclusion: This study elucidates the non-linear relationship between academic pressure, psychological imbalance and depressive symptoms, and that adopting appropriate strategies to reduce academic pressure and adjust psychological balance is crucial for the prevention of depression in adolescents.

Adolescent Self-Injurious Behavior (SIB) is a significant global public health issue, with a lifetime prevalence rate of approximately 13.7%. As awareness of SIB rises, there is an urgent need for effective prediction mechanisms to enable early identification and intervention, reducing the risk of suicide and self-harm attempts. This study, grounded in Psychopathological Network Theory, uses machine learning and network analysis to explore the multidimensional structure of risk factors for adolescent SIB. A survey of 2047 adolescents aged 11 to 17 years in China analyzed 19 variables across physiological, psychological, and social domains. The Entropy Weight Method (EWM) was applied to combine network analysis and machine learning outcomes for a comprehensive risk evaluation. The study identified key risk factors for SIB, including loneliness, ADHD symptoms, Internet addiction, anxiety, depression, affinity for solitude, autistic traits, being bullied. These factors interact within a complex network structure, influencing the occurrence of SIB both directly and indirectly. The integration of EWM, network analysis, and machine learning provides a more precise risk assessment approach for adolescent SIB. The findings offer valuable insights into the causal mechanisms of SIB and emphasize the importance of targeted prevention and intervention strategies.

Schizophrenia (SZ) is associated with an increased risk of violence, with clinical diagnosis primarily relies on symptomatology. The niacin skin flushing response (NSFR) is proposed as a potential biomarker for SZ, but its effectiveness in violent offenders with schizophrenia (VOSZ) remains unevaluated. This study investigates whether the diagnostic model differentiating general SZ patients (GSZ) from healthy controls (HCs) using NSFR can also distinguish VOSZ from HCs. SZ patients were continuously sampled based on the International Classification of Diseases, 10th Edition, and categorized into VOSZ (with a history of violent crimes), and GSZ (without such history). HCs had no psychiatric illnesses or violent crime history. A total of 315 VOSZ, 296 GSZ, and 281 HCs were recruited. Least absolute shrinkage and selection operator regression was used to select variables and construct diagnostic models based on NSFR. No significant differences in age, sex or BMI were observed among groups. Both VOSZ and GSZ exhibited similar blunted NSFR compared to HCs. The diagnostic model constructed by 14 NSFR variables distinguishing GSZ from HCs was successfully transferred to distinguish VOSZ from HCs, with areas under the curve of 0.796 (specificity = 81.6%, sensitivity = 64.2%) and 0.798 (specificity = 80.0%, sensitivity = 70.2%), respectively. Moreover, NSFR was unrelated to illness severity, violence, or antipsychotic dosage in VOSZ, suggesting it is a trait indicator of SZ. This study supports the NSFR as an objective diagnostic biomarker for distinguishing VOSZ from HCs, expanding its applicability, although it may not specifically identify violent offenders among SZ patients.

This study was to investigate the differences between young older adults with and without vision impairment on neuropsychological and psychiatric outcomes following falls during the past year and to identify predictors of cognitive decline or mental distress. A secondary analysis of 668 young older Chinese adults aged 65 ∼ 79 years old with a history of falls was conducted from the cross-sectional survey data in the 2018 wave of the Chinese Longitudinal Health Longevity Survey (CLHLS). Participants with vision impairment scored significantly higher on anxiety and depression and lower on cognitive function and SWB than those without vision impairment. And vision impairment was a significant predictor of adverse outcomes for all four neuropsychological and psychiatric measures. Neurocognitive deficits, psychological problems, and decreased self-sufficiency are quite common among community-dwelling older adults with visual impairment who have a history of falls within a year.

Background: Childhood trauma was known to increase risks of social isolation, loneliness and self-injurious thoughts and behaviors in adulthood. The aim of this study was to examine the protect and risk factors of social health, self-injurious thoughts and behaviors between adults with or without childhood trauma. Method: This was a cross-sectional study comprising of 145,043 participants enrolled in the UK Biobank. Childhood trauma was determined by the Childhood Trauma Screener. Social health included social isolation, loneliness and emotional support. Outcomes of self-injurious thoughts and behaviors included suicide ideation, suicide attempt and non-suicidal self-injury (NSSI). Demographic data, self-reported morbidities and other confounding variables were covariates. Stata 17.0 and SPSS 27.0 was used to analysis data. Results: Compared with participants without childhood trauma, there was no protective effect of emotional support for NSSI in participants with childhood trauma (beta-value difference = 0.334, p = 0.008). The risk effect of loneliness for suicide ideation, suicide attempt and NSSI were also weaker in participants experiencing childhood trauma (p<0.05). Social isolation was no longer a risk factor for NSSI in all participants, while loneliness remained as a threat (p < 0.05). Limitations: Many variables were measured using core items of the scale in UK Biobank, meanwhile, the childhood trauma data collected in adulthood may have recall bias. Conclusions: Adults reported childhood trauma were less vulnerable to self-injurious thoughts and behaviors when experiencing loneliness, but they could also not be protected from NSSI through emotional support. Emotional dysregulation caused by childhood trauma may contribute to this.

Objective: This study aimed to develop and validate the Chinese Short Version of the Adult ADHD Self-Report Scale (ASRS-CSV), addressing the need for culturally appropriate diagnostic tools for Attention-Deficit Hyperactivity Disorder (ADHD) in the Chinese adult population.Methods: Utilizing a combination of intergroup difference analysis, factor analysis, and network analysis, we identified core ADHD symptoms pertinent to the Chinese cultural context. The study involved two samples: a vocational and technical school sample (N=1144) and an internet sample (N=1654), comprising adults aged 16-25 years. Reliability, validity, and diagnostic efficacy of the ASRS-CSV were assessed through psychometric testing.Results: The ASRS-CSV demonstrated high internal consistency (Cronbach’s alpha > 0.9) and robust convergent validity (AVE > 0.7). The scale’s diagnostic cutoff points were optimized, revealing high sensitivity and specificity for ADHD screening. Cross-cultural analysis highlighted differences in core ADHD symptoms between Chinese and Western populations, underscoring the scale’s cultural sensitivity.Conclusion: The ASRS-CSV is a reliable, valid, and efficient tool for screening ADHD in Chinese adults, reflecting the socio-cultural nuances of ADHD symptomatology. Its development marks a significant advancement in the field of psychiatry, offering a tailored approach for ADHD assessment in China and contributing to the global discourse on cross-cultural psychiatric diagnosis.

BACKGROUND: Vascular endothelial injury, a key factor in diabetic foot ulcers (DFUs) pathogenesis, is linked to the impaired proliferation and migration of vascular endothelial cells, modulated by hypoxia-inducible factor, growth factors, and inflammatory elements. OBJECTIVE: The present study assesses the role of SIKVAV (Ser-Ile-Lys-Val-Ala-Val), a peptide shown to enhance cell proliferation and migration, on mouse aortic endothelial cell (MAEC) and the corresponding molecular mechanisms. METHODS: MAEC were treated with SIKVAV at 0, 100, 200, 400, and 600 μg/mL for 0, 24, 48, and 72 h. Cell viability was tested using the CCK-8 assay. Proliferating cell nuclear antigen (PCNA), extracellular signal-regulated kinase 1/2 (ERK1/2), and protein kinase B (Akt) levels were measured by qRT-PCR and western blot. RESULTS: SIKVAV augmented PCNA mRNA expression and stimulated vascular endothelial cell proliferation in a concentration and time-dependent fashion. Furthermore, it amplified the expression of p-ERK1/2 and p-Akt, pivotal components of the mitogen-activated protein kinase (MAPK)/ERK1/2 and phosphatidylinositol-3-kinase (PI3K)/Akt signaling pathways. The inhibition of these pathways suppressed PCNA mRNA expression, cell proliferation rate, and decreased p-ERK1/2 and p-Akt levels, highlighting SIKVAV’s role in promoting vascular endothelial cell proliferation via these pathways. CONCLUSION: The results of this study confirmed that SIKVAV grafted onto scaffolds can accelerate the proliferation of vascular endothelial cells for the therapy of skin wounds, and provide a theoretical basis for its application in ischemic disease as synthesized biomaterials scaffolds of tissue engineering.

Objective: The concept of intrinsic capacity (IC) revolves around healthy aging and active aging. Since the Introduction of the concept by the World Health Organization in 2015, a series of studies have been conducted by scholars from multiple fields. However, no bibliometric analysis has systematically investigated this issue. We aim to identify the current landscape and frontier trends of scientific achievements on IC in older adults through bibliometric approaches. Methods: Quantitative analysis of publications relating to IC in older adults from 2015 to 2023 was interpreted and graphed through the Web of Science Core Collection database on December 5, 2023. A variety of quantitative variables was analyzed, including publication and citation counts, H-index, and journal citation reports. Co-authorship, citation, co-citation, and co-occurrence analyses were performed for countries/regions, institutions, authors, and keywords using the VOSviewer and CiteSpace. Results: A total of 952 original and review articles in English were identified. The European countries possessed an absolute advantage in this field. The most contributive institution was the University of S & atilde;o Paulo. The most productive author is Cesari Matteo from France, followed by Qaisar Rizwan from the United Arab Emirates. However, a relatively low level of research cooperation existed between institutions and authors. Important topics mainly include the connotations, theoretical framework models, evaluation, screening tools, and application scenarios of IC. Among the promising hotspots, "biological aging", "ICOPE", "Covid-19", "prevention", "inflammation", "caf22", "prevalence", and "randomized controlled trial" displayed relatively latest average appearing year. Conclusion: Global trends indicate a growing scientific output on IC in older adults, and developed countries are leading the way. There is still room for improvement in research team collaboration. The focus gradually shifts from theoretical research to empirical research. It is recommended to pay attention to the latest hot spots, such as "biological aging", "ICOPE implementation", "postCOVID-19 syndrome", and "biomarkers".

The concept of intrinsic capacity (IC) was introduced to define healthy aging and active aging based on functional capacity, yet there is limited understanding of the risk of IC decline at a population level. To consolidate existing evidence for rates of IC decline and risk factors among community-dwelling adults 60 years or older. According to the PRISMA guidelines, the literature search was independently conducted by two researchers in 8 databases from inception to January 2024 without language restrictions using combinations of free words and subject words. Qualities of included studies were assessed using Joanna Briggs Institute’s (JBI’s) critical appraisal checklist for prevalence studies. To pool the data, a random-effect meta-analysis was performed, followed by subgroup analysis and sensitivity analysis. All analyses were performed by Stata14.0. From 1594 records, 15 studies were extracted with 33,070 participants for meta-analysis. The pooled prevalence of IC decline in community settings was 67.8

Previous studies have revealed morphologic alterations in patients with major depressive disorder (MDD) with experiences of childhood trauma. However, the underlying neural mechanisms remain largely unknown. This study aims to explore the brain structural changes and their possible mediation role in the relationship between childhood maltreatment and psychological resilience in drug-naïve adolescents with first-episode MDD. A total of 57 adolescents with first-episode MDD and 36 healthy controls (HCs) completed the T1-weighted magnetic resonance imaging scan. The adverse childhood experiences and current psychological resilience were assessed using the Childhood Trauma Questionnaire-Short Form and the Connor Davidson Resilience Scale, respectively. The voxel-based morphometry approach was applied to examine changes in the gray matter volume (GMV). Compared with the HCs, adolescents with MDD had significantly reduced GMV volumes in the left fusiform gyrus, right orbitofrontal gyrus, right superior temporal gyrus, right calcarine cortex, right middle frontal gyrus, left angular gyrus, right precuneus, right posterior cingulate gyrus, and right posterior central gyrus, as well as significantly increased GMV volumes in the left lenticular putamen and right lenticular pallidum. The GMV of the right calcarine cortex was found to be negatively correlated with the severity of emotional abuse and positively correlated with the level of psychological resilience. Moreover, the GMV of the right calcarine cortex might partially mediate the relationship between childhood maltreatment and psychological resilience. The present study provided further evidence for structural impairments in adolescents with MDD. Our findings also confirmed the important role of depression-related GMV changes in childhood growth experiences and psychological resilience characteristics during adolescent brain maturation.

Following the COVID-19 pandemic, a significant subset of previously infected individuals experience enduring multisystem symptoms, designated as “long COVID”. Sleep disturbances are frequently reported in this population, yet comprehensive data elucidating COVID-19’s impact on sleep architecture remains scarce. This study aims to conduct an expansive cross-sectional analysis delineating the effects of COVID-19 on sleep quality, while accounting for associated psychological and socioeconomic factors. We distributed validated questionnaires assessing sleep quality (PSQI), depression (PHQ-9), anxiety (GAD-7) and other parameters among 1062 Chinese participants. Descriptive analyses examined infected (n=857) vs. uninfected (n=205) groups, with subsequentanalyses of those with persistent symptoms (“long COVID”, n=273) vs. without (n=789). Acute COVID-19 infection modestly increased sleep latency and PSQI scores vs. uninfected individuals (P<.05) but did not affect most other sleep metrics. However, those with long COVID showed substantially impaired sleep across all domains (P<.01). Multivariable regression revealed that socioeconomic, health, and psychosocial factors strongly predicted sleep quality amongst COVID-19 patients beyond direct viral effects. While acute COVID-19 mildly affects sleep, long COVID profoundly disrupt sleep quality. A complex interplay of demographic, medical, and behavioral factors influence sleep outcomes. These insights highlight priorities for screening and targeted interventions to improve sleep amongst COVID-19 survivors.

ObjectiveRelevant research focusing on young adults with Unipolar Depression (UD) and Bipolar Depression (BD) is limited. The current research aims to investigate childhood trauma and personality traits in young adults with UD and BD.MethodsTwo hundred and thirty-five patients in a first depressive episode (diagnosed UD and BD), 16–25 years old, were recruited from Second Xiangya Hospital. And 79 healthy controls (HC) were recruited from the community to form the comparison group. Patients' childhood trauma was measured by the Childhood Trauma Questionnaire (CTQ), and personality was measured by Eysenck Personality Inventory (EPI). The Kruskal-Wallis test was used to compare depression, anxiety, CTQ, and EPI scores between the HC (n = 79), UD (n = 131), and BD (n = 104) groups. Factors independently associated with mood disorders and BD were determined using binary logistic regression analyses.ResultsCompared with HC, mood disorders had more severe anxiety and depression symptoms, and higher CTQ. Emotional abuse (OR = 1.47; 95% CI = 1.08–2.01), emotional neglect (OR = 1.24; 95% CI = 1.05–1.46), and neuroticism (OR = 1.25; 95% CI = 1.16–1.35) were associated with significantly increased odds of mood disorders. Whereas, higher extraversion scores were a protective factor for mood disorders. Compared with UD, BD had more severe anxiety symptoms, and higher CTQ, than extraversion and neuroticism personality scores. Anxiety (OR = 1.06; 95% CI = 1.02–1.08) and extraversion (OR = 1.05; 95% CI = 1.03–1.09) were associated with significantly increased odds of BD.ConclusionInterventions to prevent childhood trauma may improve young adults' mental health. Using childhood trauma and personality to anticipate BD and UD creates more accurate treatment for young adults with first depression.

目的 比较清醒俯卧位(APP)联合标准护理与标准护理防治老年髋部骨折患者早期术后肺部并发症(PPCs)的效果.方法 采用回顾性队列研究分析2021年2月至2021年8月东南大学附属中大医院收治的84例老年髋部骨折患者的临床资料,其中男31例,女53例;年龄67～96岁[(82.3±6.3)岁].骨折类型:股骨颈骨折45例,股骨转子间骨折39例.手术方式:闭合复位内固定术39例,人工股骨头置换术35例,全髋关节置换术10例.42例术后仅接受标准化护理(标准护理组),42例术后接受标准化护理和APP干预(APP联合标准护理组).比较两组术后30 d内PPCs(包括肺炎、呼吸衰竭、胸腔积液、肺不张和肺水肿)发生率、术后第4天动脉血氧分压(Pa02)和动脉血二氧化碳分压(PaCO2)及动脉血氧饱和度(SaO2)、术后第4天与急诊就诊时PaO2的差值、术后第4天临床肺部感染评分(CPIS)、APP相关不良事件数目.结果 患者均获随访30～90 d[(86.1±16.5)d]o APP联合标准护理组术后30 d内PPCs发生率为16.7％(7/42),I型呼吸衰竭发生率为4.8％(2/42);标准护理组分别为35.7％(15/42)、21.4％(9/42)(P均＜0.05).APP联合标准护理组术后第4天PaO2为(82.0±8.8)mmHg,SaO2为0.96±0.01,术后第4天与急诊就诊时PaO2的差值为3.2(-1.9,8.0)mmHg;标准护理组分别为(74.3±12.1)mmHg、0.94±0.03、-7.6(-17.2,1.1)mmHg(P均＜0.01).APP联合标准护理组术后第4天CPIS为2.0(1.0,3.0)分,标准护理组为4.0(1.0,7.0)分(P＜0.05).两组术后30 d内肺炎、Ⅱ型呼吸衰竭、胸腔积液、肺不张和肺水肿发生率及术后第4天PaCO2差异无统计学意义(P均＞0.05).两组均未发生APP相关不良事件.结论 与标准护理比较,APP联合标准护理可显著降低老年髋部骨折患者早期PPCs,尤其是Ⅰ型呼吸衰竭的发生率,提高术后氧合.

Objective:To evaluate the radiological and clinical outcomes of the aged patients with unstable proximal humeral fracture (UPHF) treated with a locking plate and an intramedullary titanium mesh.Methods:A retrospective study was conducted to analyze the 43 aged patients with UPHF who had been admitted to Department of Orthopedics, Zhongda Hospital Affiliated to Southeast University from January 2017 to July 2019. There were 13 males and 30 females with an age of (71.3±10.3) years (from 60 to 83 years). All patients were treated with a locking plate and an intramedullary titanium mesh to support. The postoperative imaging measurements included changes in humeral head height (HHH) and neck-shaft angle (NSA) (the difference between 3 years after surgery and the second day after surgery, taken as an absolute value); the postoperative clinical measurements included visual analogue scale (VAS), range of shoulder motion, Constant-Murley shoulder functional score (Constant score), American Shoulder and Elbow Surgeons (ASES) score, and incidence of complications.Results:All patients were followed up for (39.2±2.3) months after surgery. The change in HHH at 3 years after surgery was (1.5±1.1) mm, and the change in NSA at 3 years after surgery 3.3°±2.6°. At 3 years after surgery, the VAS score was (2.2±1.3) points, the Constant score (79.2±9.1) points, and the ASES score (78.9±9.2) points; the range of forward extension was 143.2°±20.8°, the range of outward extension 139.3°±23.1°, and the range of outward rotation 55.1°±4.7°. Complications after surgery were found in 6 patients, including humeral head necrosis in 2 cases, ectopic ossification in 1 case, and infection in 3 cases.Conclusion:In the treatment of the aged patients with UPHF, a locking plate combined with an intramedullary titanium mesh can help to restore the medial column support, leading to fine radiological and clinical outcomes.

Background: Sleep problems are common among older adults worldwide. The present study aims to determine the prevalence of poor sleep quality and its independent factors among retired people in health check-ups population in China.Method: In this multicenter, cross-sectional survey in 2017, a group of retired people was invited to participate in an online survey of health status, and their data, including socio-demographic information, lifestyle, and medical characteristics, were recorded. Binary logistic regression was used to analyze the independent factors responsible for poor sleep quality.Results: Data from 17,408 responders who met the inclusion criteria were analyzed; among them, 53.04 % (95 % CI = 52 %-54 %) reported poor sleep quality. Binary logistic regression showed that poor sleep quality was associated with a number of factors, including being female (OR = 1.42, 95 % CI = 1.32-1.53), being single (OR = 1.35, 95 % CI = 1.18-1.54), non-smoker (OR = 1.12, 95 % CI = 1.03-1.22), physical inactivity (OR = 1.14, 95 % CI = 1.05-1.23), poor self-rated health status (OR = 1.69, 95 % CI = 1.43-2.00), long-term medication use (OR = 1.05, 95 % CI = 1.07-1.23), chronic pain (OR = 1.33, 95 % CI = 1.22-1.45), comorbidity (OR = 1.16, 95 % CI = 1.07-1.25), and depressive symptoms (mild depression: OR = 2.14, 95 % CI = 1.96-2.34; moderate depression: OR = 4.00, 95 % CI = 3.49-4.58, moderately severe depression: OR = 4.15, 95 % CI = 3.47-4.97, severe depression: OR = 4.27, 95 % CI = 2.93-6.22); while age (OR = 0.99, 95 % CI = 0.99-1.00) was negatively related to poor sleep quality.Conclusion: The prevalence of poor sleep quality in the studied population is relatively high (53.04 %). Sleep problems are common among Chinese retirees, especially older females, and have a great impact on their quality of life. People living with depression, chronic diseases, and chronic pain were at a higher risk of developing sleep disorders. Therefore, it is critical to formulate effective management strategies for Chinese retirees with poor sleep quality in the context of healthy aging.