A multivariate linear regression analysis using finite mixtures of t distributions

Objective To analyze the influencing factors of serum fibroblast growth factor 23 (FGF23) level in maintenance hemodialysis (MHD) patients, and to explore its relationship with mineral bone metabolism disorders and vascular calcification. Methods From January to February of 2018, a total of 380 patients who had undergone MHD for more than 3 months in our hospital were enrolled for this study. Clinical parameters were recorded, including gender, age, dialysis age, dialysis adequacy, and use of phosphorus-reducing drugs. Before dialysis, blood was drawn for detection of serum calcium, phosphorus, intact parathyroid hormone (iPTH), and alkaline phosphatase as mineral bone metabolism indicators, as well as hemoglobin, albumin, blood glucose, blood lipids, high-sensitivity C-reactive protein (hs-CRP), and β2 microglobulin, etc. The serum level of FGF23 was determined with enzyme-linked immunosorbent assay (ELISA), while multislice spiral CT (MSCT) was used to evaluate coronary artery calcification scores. The t-test and chi-square test were applied to analyze the influencing factors of FGF23 in the MHD patients. Multivariate linear regression analysis was performed for multivariate analysis. The chi-square test was also used to analyze the correlation between parathyroid hormone and coronary artery calcification scores in the MHD patients with different FGF23 levels. Results The median level of serum FGF23 in the MHD was 8 905.3 pg/ml. According to 50% of the FGF23 median level, the patients were divided into high-level group and low-level group. Univariate analysis showed that dialysis age, dialysis duration, dialysis ultrafiltration volume, and dialysis frequency were the influencing factors of serum FGF23 level. The level of FGF23 was higher in patients with larger age, longer duration of dialysis, more frequent dialysis, and greater volume of dialysis ultrafiltration (P<0.05). In the FGF23 high-level group, blood urea nitrogen, serum creatinine, and serum β2 microglobulin levels were higher than in the FGF23 low-level group (P<0.05). Multivariate linear regression analysis showed that dialysis age and serum creatinine were risk factors for the increase of FGF23 (P<0.001). And high FGF23 level was associated with the levels of serum calcium, serum phosphorus, iPTH, and high coronary artery calcification scores. Conclusions Dialysis age, dialysis duration, dialysis ultrafiltration volume, dialysis frequency, blood urea nitrogen, serum creatinine, serum β2 microglobulin, were related to the maintenance of FGF23 elevation in MHD patients. Dialysis AGE and serum creatinine were risk factors for FGF23 elevation. FGF23 was significantly associated with mineral-bone metabolism and coronary artery calcification in MHD patients. Key words: Hemodialysis; Fibroblast growth factor 23; Vascular calcification; Mineral-bone metabolism disorder; Cardiovascular disease

Objective To explore whether human adipose-derived stem cells (ADSCs) express PD-L1 and Gal-9 and its potential influence factors. Methods ADSCs isolated from 28 healthy female donors who underwent liposuction of the abdomen or breast tissue were cultured and characterized. The expression of PD-L1 and Gal-9 were detected using flow cytometry. The impact of donor age, body mass index (BMI), donor site and interferon-γ (IFN-γ) on the expression of PD-L1 and Gal-9 was analyzed using multivariate linear regression analysis. Results The cultured cells fulfilled the criteria for defining MSCs according to the international standards and expressed PD-L1 and Gal-9. Breast-derived ADSCs had higher expression levels of PD-L1 (37.24%±8.20%) and Gal-9 ( 4.41%±2.65%) than those in abdomen-derived ADSCs (28.80%±8.59% and 2.51%±1.39%, respectively) (P=0.018, P=0.039). Multivariate linear regression analysis showed that donor age and site were independent risk factors affecting PD-L1 expression (P=0.009, P=0.006). The expression of PD-L1 decreased by 0.385% for every one year of age increase, and it was 8.58% higher in the breast-derived ADSCs than in the abdomen-derived ADSCs. Donor site was an independent risk factor for Gal-9 expression (P=0.041). Gal-9 positive expression rate in the breast-derived ADSCs was 1.898% higher than that in the abdomen-derived ADSCs. BMI was not a risk factor affecting PD-L1 or Gal-9 expression on ADSCs. The expression of PD-L1 and Gal-9 on ADSCs were significantly upregulated after 48 hours stimulation with 20 ng/ml IFN-γ in vitro. Conclusions Human ADSCs expressed PD-L1 and Gal-9. Donor age, site and IFN-γ treatment were independent risk factors affecting the expression of PD-L1 and Gal-9 on ADSCs. Key words: Adipose-derived stem cells; Programmed cell death ligand 1; Galectin 9; Interferon-γ

Objective To investigate the characteristics of cognitive impairment and psychotic symptoms in general paresis of insane (GPI) before and after penicillin therapy, and explore factors that may predict the clinical outcomes. Methods Thirty patients with GPI were recruited. All GPI patients underwent a comprehensive neuropsychological assessment before receiving penicillin therapy, and returned for follow-up visits after 7 months. The severity of dementia was determined by Clinical Dementia Rating Scale (CDR), cognitive functions were assessed by Mini Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog), ability of daily living was assessed by Instrumental Activities of Daily Living Scale (IALD) and Physical Self maintenance Scale(PSMS), behavioral and psychological symptoms were assessed by Neuropsychiatric Inventory (NPI). Aqueous crystalline penicillin G 24 million units per day was administered as continuous infusion for 14 days, followed by benzathine penicillin 2.4 million units IM once per week for 3 weeks. Patients returned for follow-up visits after 7 months. Clinical outcomes were determined by the improvement of neuropsychological test scores at the end of the treatment. Grouped by CDR scores, changes in neuropsychological tests scores among different GPI groups were used to explore the correlation between severity of dementia and clinical outcomes. Univariate analysis and multivariate linear regression analysis were used to identify factors that may predict the clinical outcomes. Results (1)After penicillin therapy, GPI patients' MMSE scores (14.4±6.9 vs.17.1±9.1) and IADL scores (4.0 (2.0, 5.0) vs.6.0 (2.0, 7.3) ) both improved significantly (t=5.820, Z=3.710, P 1,significant change was found only in total scores of NPI (t=-3.772,P<0.05) . (3) Univariate analysis and multivariate linear regression analysis showed that improvement of MMSE scores after the treatment was significantly correlated with IADL scores and MMSE scores at baseline (β=0.541, P=0.004; β=0.364, P=0.044) . Conclusions After penicillin treatment, GPI patients may improve in both cognitive function and psychotic symptoms but not in all the domains. Symptoms of anxiety, sleep/nigh-time behavior change, and apathy, as well as moderate to severe GPI patients may not benefit much from the treatment. Key words: Neurosyphilis; Cognition disorders; Neurobehavioral manifestations; Therapy; Prognosis

Objective To investigate the relationship of tumor-associated macrophage (TAM) infiltration in lesions with clinicopathologic features of cutaneous malignant melanoma (CMM) and epithelial-mesenchymal transition (EMT) -related indicators. Methods Fifty-four CMM and 15 benign melanocytic nevus paraffin-embedded tissue samples were collected. An immunohistochemical study was performed to determine the expression pattern and intensity of the TAM marker CD163 as well as EMT indicators epithelial cadherin (E-cadherin) , neurologic cadherin (N-cadherin) and vimentin in these tissue samples. Count data were expressed as mean ± standard deviation. Statistical analysis was carried out using t test, one-way analysis of variance (ANOVA) and multivariate linear regression analysis with the software SPSS 17.0. Results CD163-positive TAMs were detected in CMM samples, but not in benign melanocytic nevus samples. The mean TAM count per high power field in tissue samples was significantly different between invasive and in situ CMM (35.08 ± 13.78 vs. 16.97 ± 8.74, P 0.05) . No significant difference was observed in TAM count between patients of different gender or age groups, between acral and non-acral melanoma, or between ulcerated and non-ulcerated melanoma (all P ≥ 0.05) . Multivariate linear regression analysis showed that TAM count in CMM was associated with five factors: Clark level, ulceration, tumor progression, N-cadherin and vimentin. Conclusion TAMs may accelerate tumor progression and increase tumor malignancy by promoting EMT in CMM. Key words: Melanoma; Nevi and melanomas; Macrophages; Epithelial-mesenchymal transition; Pathology

The clinical data of 239 inpatients with type 2 diabetes in Endocrinology Department of Henan Provincial People′s Hospital from January to February 2017 were collected. A total of 170 subjects were included in the final analysis. One diabetes-specific vertebral facture risk estimation called risk score for vertebral fracture was used to estimate the risk of vertebral fracture. Multivariate linear regression analysis was used to calculate the association of serum uric acid with risk of vertebral fracture. The mean age of subjects in final analysis was 56.5±26.4 years old, with the duration of diabetes 8.6±7.1 years and the vertebral fracture risk score 5.6±4.0. Additionally, there was a negative linear correlation between serum uric acid and vertebral fracture risk score in patients with type 2 diabetes(Ptrend=0.021) independent of age, gender, systolic blood pressure, HbA1C, course of diabetes, obesity status, total cholesterol, and estimated glomerular filtration rate(P=0.033). Multivariate linear regression indicated that age, course of diabetes, blood pressure, total cholesterol, serum albumin, T score at femoral neck were related to the vertebral fracture risk score. Key words: Uric acid; Diabetes mellitus, type 2; Fracture

Objective To investigate the relationship between plasma fibroblast growth factor 21 (FGF-21) levels and body mass index(BMI), plasma glucose, plasma insulin levels, as well as other factors in newly diagnosed type 2 diabetes mellitus (T2DM). Methods 180 subjects who visited Department of endocrinology, Chaoyang Hospital, Capital Medical University from January to July in 2013 were enrolledand divided into newly diagnosed T2DM group (DM group, n=136) and Impaired glucose tolerance (IGR group, n=44). We selected 52 healthy volunteer as control group (NCM group). Plasma FGF-21 levels were determined by ELISA. The association between plasma FGF-21 levels and BMI, plasma glucose, blood lipids, plasma insulin levels, homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of insulin sensitivity index(HOMA-ISI) and other factors were also analyzed. We use independent-samples t test, Pearson's correlations, multivariate linear regression analysis. Results Plasma FGF-21 levels in newly diagnosed T2DM patients were significantly higher than those of healthy individuals (319.2±2.5 vs 223.09±1.43, t=2.804, P<0.05). Plasma FGF-21 levels positively correlated with triglyceride (TG) in newly diagnosed T2DM patients and healthy individuals (r=0.26, 0.38, respectively, P< 0.05 all above). Plasma FGF-21 levels positively correlated with BMI in IGR group (r=0.33, P<0.05). Multiple regression analysis suggested that HOMA-ISI was an independent related factor influencing plasma FGF-21 levels. Conclusion FGF-21 in newly diagnosed T2DM patients is associated with triglyceride levels, insulin resistance. Key words: Diabetes mellitus, type 2; Insulin resistance; Fibroblast growth factor 21

Objective To evaluate the structure and stiffness of the common carotid artery (CCA) in patients with obstructive sleep apnea syndrome (OSAS) by RFQIMT and RFQAS technology and analyze the relationships between the parameters of CCA and cardiovascular risk factors.Methods 113 participants with habitual snoring suspected OSAS were divided into control group,mild,moderate and severe OSAS groups according to apnea hypopnea index(AHI)＜5,5-20,20-40,＞40 event/hour respectively.Carotid parameters included intima-media thickness (IMT),diameter (D),distension (Dis),distensibility coefficient (DC),compliance coefficient (CC),pulse wave velocity (PWV),stiffness index α and β were collected by RFQIMT and RFQAS.Multivariate linear regression analysis was applied to analyze the relationships between CCA parameters and cardiovascular risk factors.Results ①The clinical characteristics:blood pressure had significant difference among the four groups (P ＜0.05).SO2,SO2 min decreased and T90,ODI increased significantly in mild,moderate and severe group (P ＜0.05).②The structure parameters of CCA:IMT,D and plaques had no significant difference among the four groups (P ＞0.05).③The elasticity parameters of CCA:Compared with control group,Dis increased significantly in mild group (P ＜0.05).PWV,α,β increased significantly in moderate group (P ＜ 0.05).Compared with mild group,PWV,α,β increased significantly in moderate group (P ＜0.05).Compared with moderate group,α,β increased significantly in severe group (P ＜0.05).④By multivariate linear regression analysis,age was an independent predictor of IMT,Dis,D,CC,PWV,α,β(P ＜0.05).A blunted nocturnal fall was an independent predictor of D,DC,CC,PWV (P ＜0.05),SBP,DBP and PP of daytime had an important effect on D (P ＜0.05).SO2 was independently correlated with PWV (P ＜0.05).PP was an independent predictor of PWV,α,β (P ＜0.05).Smoking was an independent predictor of plaque (P ＜0.05).Conclusions ①Stiffness is damaged earlier than morphology of CCA in patient with OSAS.②PP,a blunted nocturnal fall and SO2 are correlated with stiffness of CCA significantly.It indicates that abnormal circadian blood pressure rhythm and hypoxia are associated significantly with stiffness of CCA in patient with OSAS. Key words: Ultrasonography; Sleep Apnea, obstructive; Carotid arteries; Stiffness; Intima-media thickness

Objective To analysis the distribution of HOMA-IR, and explore the diagnostic value of leptin/adiponectin ratio (LEP/APN) on insulin sensitivity in Beijing children and adolescents. Methods A total of 3506 schoolchildren, selected from the Beijing Child and Adolescent Metabolic Syndrome Study(BCAM study), were included in the current study, among them 659 were overweight and 1219 were obese. Age- and sex-specific body mass index (BMI) percentiles, developed by the Working Group for Obesity in China, were used to classify participants as normal weight (BMI <85%), overweight (BMI ≥85% but <95%), or obese (BMI ≥ 95%). Examination included anthropometry, pubertal development, and levels of fasting lipid profile, insulin, LEP and APN. Insulin resistance (IR) was evaluated by HOMA-IR. Correlation analysis and receiver operating characteristic curve (ROC) were used in the statistical analysis. Results According to the distribution of HOMA-IR in healthy children and adolescents, the cutoff value for IR was ≥2 .6 in pre-pubertal stage and ≥3.4 in pubertal phase, respectively. The prevalence of IR was 22.2% and 42.9% respectively in overweight and obese children and adolescences. The LEP/APN ratio was progressively increased from normal group to overweight group and to obesity group, and correlated with HOMA-IR significantly (Pearson correlation coefficient was 0.51 and partial correlation coefficient was 0.40). After adjusting for age, sex, puberty and other confounding factors, the LEP/APN ratio is an independent predicator for HOMA-IR by multivariate linear regression analysis (unstandardized coefficient was 0.273 and standardized coefficient was 0.467, P<0.01). Area under the ROC curve of LEP/APN ratio for diagnosing of IR was larger than those of LEP, APN, BMI, waist circumference and FAT%. Conclusions Evaluation of IR needs to consider puberty status and prevalence of IR is obvious in overweight and obese children and adolescents. The LEP/APN ratio is expected to be early biomarker of IR state, and an early potent predicator of metabolic disorders. Key words: Children and adolescents; Obesity; Insulin resistance; Leptin/adiponectin ratio

Objective To explore the status quo of information needs in pancreatic tumor patients and analyze the influencing factors. Methods Totally 120 pancreatic tumor patients who were hospitalized and treated in a ClassⅢ Grade A hospital in Changchun from June 2015 to October 2017 were selected and investigated with the general information questionnaire, Information Need Assessment Scale (INAS) and Numerical Rating Scale (NRS) . The univariate and multivariate linear regression analysis was used to analyze the influencing factors. Results The average score of information needs in these pancreatic tumor patients was (123.63±18.05) . The influencing factors included age, educational level, treatment protocol and pain level (P<0.05) . Conclusions Pancreatic tumor patients show higher needs for information. Medical workers shall pay attention to their information needs and provide targeted and individualized information support based on their actual situation. Key words: Pancreatic neoplasms; Information needs; Influencing factors

Objective To explore the relationship between depression and anxiety and peripheral blood cell counts (white blood cell (WBC), neutrophil (NEU), lymphocyte (LYM), red blood cell (RBC) and hemoglobin (HGB)) of heroin-dependent patients receiving methadone maintenance treatment (MMT). Methods Two hundred and fifty-two MMT heroin addicts, who had received peripheral blood tests within the week prior to the study, were administered with a general information questionnaire, SDS and SAS. The results of blood tests of these patients were compared with those of 109 healthy people in physical examination. Multiple linear regression was used to analyze associations between indicators of peripheral blood cell counts and depressive and anxiety symptoms. Results Compared with healthy controls, MMT patients had significantly higher proportions of elevated WBC(14.7% vs 3.7%), NEU(12.7% vs 2.8%) and LYM(9.9% vs 2.8%) counts (all P<0.05), and low RBC(10.3% vs 4.6%) counts and HGB(11.5% vs 4.6%) concentration (both P<0.05). Multivariate linear regression analysis showed that blood cell counts of WBC (β=0.261, P<0.01), NEU (β=0.264, P<0.01), LYM (β=0.196, P=0.003) and RBC (β=-0.144, P=0.021) were independently associated with depression; and blood cell counts of WBC (β=0.298, P<0.01) and LYM (β=0.269, P<0.01) were independently associated with anxiety. Conclusion Improving the inflammatory and malnutrition status may be helpful for reducing depressive and anxiety symptoms of MMT heroin addicts. Key words: Methadone maintenance treatment; Heroin dependence; Blood cell count; Depression; Anxiety

Objective: To investigate the influence factors and differences of abnormal posterior corneal elevation by Pentacam system and Corvis ST. Methods: This retrospective case series study included 227 eyes of 144 patients (90 males, 139 eyes; 54 females, 88 eyes) from December 2017 to October 2018 who were going to receive corneal refractive surgery at the Corneal Refraction Department of Qingdao Eye Hospital. The general data of the patients including gender, age, refractive parameters, optimal correction of spherical and cylindrical diopters were collected. All patients underwent Pentacam system and Corvis ST measurement. According to the back difference (BD) of Pentacam parameters, BD<12 μm was set as the control group (59 patients, 118 eyes) and BD≥12 μm as the high BD group (85 patients, 109 eyes). In the high BD group, BD≤16 μm was set as the suspicious group (44 patients, 53 eyes), while BD>16 μm was set as the abnormal group (41 patients, 56 eyes). Seven parameters of Pentacam and 15 parameters of Corvis ST were selected. The Pentacam parameters included BD, anterior surface keratometry (ASK), posterior surface keratometry (PSK), anterior surface astigmatism (AAstig), posterior surface astigmatism (PAstig), central corneal thickness (CCT), and corneal diameter (W-W). The parameters of Corvis ST included the first applanation time (AT(1)), the first applanation length (AL(1)), the first applanation velocity (AV(1)), the second applanation time (AT(2)), the second applanation length (AL(2)), the second applanation velocity (AV(2)), highest concavity time (HCT), highest concavity peak distance (HC-PD), highest concavity deformation amplitude (HC-DA), highest concavity radius (HC-R), the ratio of deformation amplitude (DA ratio), Integr. Radius, corneal thickness thinnest/pachymetric progression (ARTh), SPA1 (resultant pressure divided by deflection amplitude at the first applanation), and the Corvis Biomechanical Index (CBI). The comparison between the groups was analyzed with Independent sample t test, Kruskal-Wallis H test, and Bonferroni test. Spearman rank correlation analysis was used to explore the correlation factors of BD, and the main factors affecting BD were found through multiple linear regression. Results: There were no statistically significant differences between the control group and the high BD group in age, spherical diopters, and cylindrical diopters (t=-3.311, -1.808, -2.359; P=0.071, 0.072, 0.121, respectively). In Pentacam parameters, ASK, PSK, PAstig, and W-W showed significant differences among groups (Z=18.492, 31.547, 10.773, 70.167; P<0.05). AAstig and CCT showed no statistical difference between groups (P>0.05). Compared with the control group [42.80 (41.98, 44.00)], ASK increased in the abnormal group [43.40 (42.20, 44.40)] significantly (t=-4.292; P<0.05). PSK of the suspicious group [-6.50 (-6.60, -6.35)] and the abnormal group [-6.50 (-6.70, -6.33)] increased significantly compared with the control group [-6.30 (-6.50, -6.20)] (t=4.492, 4.618; P<0.05). Compared with the control group [0.40 (0.30, 0.50)], PAstig of the suspicious group [0.40 (0.30, 0.40)] and the abnormal group [0.40 (0.30, 0.40)] increased significantly (t=2.796, 2.515; P=0.016, 0.036). Compared with the control group [11.50 (11.40, 11.80)], W-W of the suspicious group [11.40 (11.00, 11.60)] and the abnormal group [11.10 (10.90, 11.30)] decreased, and W-W of the abnormal group also decreased significantly compared with the suspicious group (t=3.235, 8.353, 4.282; P<0.05). The correlation analysis between BD and Pentacam parameters of patients in each group showed that BD was negatively correlated with W-W (r=-0.614, -0.304, -0.396, -0.661, P<0.05) in the control group, the suspicious group, the abnormal group, and all patients, while BD had a low correlation with other parameters or no significant correlation. The correlation analysis of BD and Corvis ST parameters in patients showed that only in the suspicious group, BD was positively correlated with AV(1), HCT, and HC-DA (r=0.332, 0.361, 0.382, P<0.05), while no significant correlation was found between BD and other Corvis ST parameters in each group. In order to further explore the main factors affecting BD, Pentacam parameters and Corvis ST parameters were selected as independent variables with BD as the dependent variable to establish a multivariate linear regression analysis model. There was no collinearity between variables W-W, ASK, PSK, HC-PD, SPA1, and CCT (tolerance<0.100). The equation test result was F=37.221, P<0.001, adjusted r(2)=0.504, and the fitting was good. Conclusions: Among the Pentacam parameters, W-W, ASK, and PSK are the main factors affecting the change of BD. HC-PD and SPA1 in the Corvis ST parameters may also have some influence on BD. The Pentacam system combined with Corvis ST is a very useful differential diagnosis system for patients with abnormal BD. (Chin J Ophthalmol, 2020, 56:110-117).

The plaque imaging findings associated with the stent expansion rate (SER) of the carotid artery are not well known. The purpose of this study was to investigate the imaging findings associated with SER. It was a retrospective investigation. Based on the kind of carotid stents used, retrospective data from 89 patients who had carotid artery stenting (CAS) for atherosclerotic carotid stenosis were gathered and divided into two groups: open-cell stents and closed-cell stents. Patients underwent preoperative carotid high-resolution magnetic resonance vessel wall imaging (HR-VWI). Use HR-VWI to quantitatively evaluate carotid wall thickness and plaque components. Calculate SER using digital subtraction angiography (DSA). All patients' baseline and HR-VWI imaging features were retrospectively analyzed. Simple and multivariable linear regression analysis was used to determine the imaging findings associated with SER of open-cell and closed-cell stents. A total of 89 patients (mean age, 70±8 years; 69 men) were included in the final analysis. Among 89 patients, 35 patients were treated with open-cell stents. Fifty-four patients were treated with closed-cell stents. In the open-cell stents group, the Maximum single-slice calcification circumference score, maximum wall thickness (WTmax), and total calcification location score with P<0.10 in the simple linear regression analysis were included in the multivariable linear regression analysis. The results of the multivariable linear regression revealed that only the Maximum single-slice calcification circumference score (β=-9.35; 95% CI: -18.15 to -0.56; P=0.03) was associated with SER of open-cell stents. In the closed-cell stents group, the Maximum single-slice calcification circumference score, WTmax, maximum area percentage of calcification, calcification volume, and total calcification location score with P<0.10 in the simple linear regression analysis were included in the multivariable linear regression analysis. The results of the multivariable linear regression revealed that the Maximum area percentage of calcification (β=-0.67; 95% CI: -1.29 to -0.05; P=0.03), Maximum single-slice calcification circumference score (β=-8.43; 95% CI: -13.36 to -3.49; P=0.001) and total calcification location score (β=-0.37; 95% CI: -1.08 to 0.09; P=0.02) were associated with SER of closed-cell stents. Calcified plaques are associated with SER of the carotid artery. Calcification circumference correlates with SER of open-cell stents. Calcification circumference, calcification area, and calcification location are related to SER of closed-cell stents, which may provide a new consideration for clinicians when choosing carotid artery stents.

Objective To investigate effects of changes in body composition and pancreas islet β-cell function on bone mineral density(BMD)in obese women with normal glucose metabolism at child-bearing age.Methods Ninety-five obese women with normal blood glucose at child-bearing age were recruited for the study,20 in non-obese group with body mass index(BMI)less than 23,20 in overweightgroup with BMI equal to or more than 23 and less than 25.28 in obesity Ⅰ group with BMI equal to or more than 25 and less than 30.and 27 in obesity Ⅱ group with BMI equal to or more than 30.Their BMD,body fat and lean mass were measured with by dual energy X-ray absorptiometer(DEXA),and intravenous -glucose tolerance test(IVGTT)was performed.Area under the Curve of insulin(AUCins)and acute jnsulin response(AIR)phase were calculated to assess their early insulin secretion.Homeostasis model assessment β-cell function index(HOMA2-%B)and homeostasis model insulin resistance index(HOMA2-IR)were used to assess their β-cell function and insulin resistance.Results Fat and lean mass in the upper and lower extremities.trunk and whole body and BMD in those women increased with increasing of their BMI(P＜0.05),particularly in fat mass.as well as their otller parameters including plasma insulin level at zerominute of IVGTT(IVGTTins0),AUCins.HOMA2-%B and HOMA2.IR(all P＜0.01).BMD in the upper and lower extremities,trunk and whole body showed a positive correlation with BMI,FPG,lean mass and/or fat mass.respectively(P＜0.05).BMD of the trunk and whole body also had a positive correlation with TVGTTins0,AIR,AUCins and HOMA2-IR.respectively(P＜0.05).Results of multivariate linear regression analysis showed that HOMA2-%B and HOMA2-IR correlated with BMD in a linear pattern.As the vailable body composition was added to the regression model.HOMA2 parameters would be removed from the model.Results of partial correlation analysis showed that islet β-cell function did not correlate with BMD after controlling body composition factors.Conclusions Insulin resistance or islet β-cell function compensation accompanied in obese women with main increase in fat mass have little benefit for their BMD,which may reflect indirectly their change in body compositions.Body composition,especially lean nlass,is the most important determinants of BMD in obese women. Key words: Obesity; β-cell function; Body composition; Bone mineral density

Objective To investigate the status of knowledge, attitude, practice of preventing professional exposure to body fluid splash in the medical staff of ENT Department in 6 ClassⅢ Grade A hospitals in Shanxi Province so as to provide evidence for the formulation of prevention and protection measures. Methods By convenience sampling, a total of 300 medical staff in ENT Department in 6 Class Ⅲ Grade A hospitals in Shanxi Province from July to September in 2018 were selected as the research objects. The Questionnaire of Knowledge, Belief and Practice of Occupational Protection Among Medical Staff in Otorhinolaryngology Department was used to investigate them. A total of 300 questionnaires were distributed and 265 valid ones were retrieved. Results The 265 medical staff in ENT Department scored (43.86±6.05) points in knowledge, (34.67±4.79) points in attitude and (32.95±4.98) points in practice, with a total score of (111.48±14.84) . Knowledge, attitude and practice were positively correlated (P<0.05) . Multivariate linear regression analysis showed that professional title, length of service and exposure history were the influencing factors of occupational protection behavior of medical staff in ENT Department (P<0.05) . Conclusions The protection of occupational exposure to body fluid splashing of medical staff should start with improving the attitude, and constantly strengthen the attitude in practical work, so as to achieve the purpose of improving the protection behavior. Key words: Ear-Nose-Throat; Medical staff; Occupational exposure; Knowledge, attitude, practice

Objective To explore the chief nurses' integrity leadership, the nurses' work environment, the current status of the new job nurses' adaptation level, and analyze the relevance, to provide a basis for targeted new nurse training. Methods The newly recruited nurses from totally 4 Class Ⅲ hospitals in Wenzhou were selected by convenient sampling and investigated with the general information questionnaire, Chief Nurses' Integrity Leadership Scale, Nurse Work Environment Scale and Chinese Work Adjustment Scale between June and September 2018. Totally 296 questionnaires were distributed, and 282 of them were collected, with a successful collection rate of 95.27%. Results The work adjustment, chief nurses' integrity leadership and work environment in the 282 newly recruited nurses totaled (61.36±8.95) , (40.09±9.53) and (100.50±12.35) , respectively. Chief nurses' integrity leadership behavior and work environmental scores were positively correlated with work adjustment scores (P<0.05) . Multivariate linear regression analysis showed that chief nurses' leadership behavior and nurses' work environment and educational background were the influencing factors to the work adjustment of the newly recruited nurses (P<0.01) . Conclusions The work adjustment scores of newly recruited nurses are at low levels. Chief nurses' leadership behavior and nurses' work environment and educational background were the influencing factors to the work adjustment of newly recruited nurses, indicating that clinical nursing managers should take measures to improve chief nurses' integrity leadership behavior as well as nurses' work environment in order to improve the work adjustment of newly recruited nurses and ensure the quality of clinical nursing service. Key words: Nurses; Newly recruited nurses; Integrity leadership; Work environment; Work adjustment