Objective Many environmental epidemiological studies have shown the associations between short-term exposure of air pollution and daily deaths.However,the generally available population data only contain a small number of measured confounding factors,which is faced with the problem that a large number of unobserved confounding factors are not included in the model,resulting in biased estimates.The instrumental variable method can solve the problem of estimating the effects caused by unobserved confounders.In this paper,We used the instrumental variable method to estimate the effects of PM2.5 on daily mortality.Methods We collected daily PM2.5 concentrations,meteorological data,and nonaccidental daily deaths in a Chinese city from 2016 to 2019.We used boundary layer height and wind speed as instrumental variables to estimate the effects of PM2.5 on nonaccidental daily mortality.Negative exposure control was used to test the hypothesis of instrumental variables.Meanwhile time series bootstrap method was used to estimate confidence interval.We compared the results of the generalized additive model and instrumental variable method.Results The instrumental variable method showed that PM2.5 was significantly related to daily deaths.For every 10 μg/m3 increase of PM2.5 concentrations,the nonaccidental daily deaths increased by 0.94%(95%CI:0.39%～1.55%).Negative exposure control results showed no correlation between negative exposure and nonaccidental deaths(P=0.19),indicated that the aforementioned instrumental variable model was not affected by unmeasured and uncontrolled confounders.The traditional generalized additive model estimated that for every 10 μg/m3 increase in PM2.5 concentrations,the nonaccidental deaths would increase by 0.24%(95%CI:0.01%～0.47%).Conclusion The instrumental variable method estimated that PM2.5 concentrations were significantly correlated with the nonaccidental daily deaths.Boundary layer height and wind speed can be used as instrumental variables to estimate the effects of PM2.5 concentrations on nonaccidental deaths.

To develop a new type of moxibustion treatment equipment based on moxibustion heat,light and smoke factors.It was composed of three parts:upper cylinder,middle cylinder and lower cylinder,which integrated multiple functions such as temperature control,ash collection,adsorption,and anti-scalding,and all parts could be disassembled.It is convenient to use,convenient for clinical treatment and health care,can overcome the problem of not being able to adjust the temperature of moxibustion therapy and easy to burn in the process of moxibustion,reduce the irritation and pollution of moxa smoke smell and smoke dust on doctors,patients and the diagnosis and treatment environment,and make moxibustion therapy more convenient,efficient and safe.

Objective:To explore the application and value of metagenomic next-generation sequencing (mNGS) in refractory infection after organ transplantation.Methods:A case report discussed about a patient with lumbar spine infection after kidney transplantation and the relevant literature was reviewed. The recipient was a 63-year-old man with low back pain after kidney transplantation. Lumbar spine magnetic resonance imaging showed lumbar spine infection. Multiple operations plus antibacterial and antituberculosis treatments were ineffective. Before and after treatment, numerous tests of traditional pathogenic microorganisms failed to detect any positive bacteria.Results:The detection of lumbar secretion by mNGS suggested aspergillus infection. The symptoms improved after dosing of voriconazole.Conclusions:The incidence of fungal infection of lumbar spine is low. The imaging manifestations are non-typical so that it is easy to misdiagnose. mNGS helps to timely diagnose and guide treatment. With a review of the literature, mNGS has some application value for some difficult and rare infectious diseases.

Objective:To construct the clinical management model of a new type of smoke-purifying temperature-controlled moxibustion device based on the whole life cycle theory,and to explore its management effect on the new type of smoke-purifying temperature-controlled moxibustion device.Methods:The clinical management model of a new type of smoke purification and temperature-controlled moxibustion device was constructed based on the whole life cycle theory with the architecture of the basic layer,access layer,service layer,data layer and application layer.Eighteen new type of smoke purification and temperature-controlled moxibustion devices in clinical use in the Shijiazhuang Pingan Hospital from 2021 to 2022 were selected,and the conventional new smoke-purifying temperature-controlled moxibustion device management scheme(referred to as the conventional management mode)and the new smoke purification and temperature-controlled whole life cycle management model(referred to as the whole life cycle management mode)were adopted respectively according to different management modes.The management effect of the new smoke-purifying temperature-controlled moxibustion therapy device and the satisfaction of the relevant management personnel were compared between the two management modes.Results:The average scores of the management quality,temperature control effect,smoke control effect and moxa smoke purification effect of the new smoke purification moxibustion device using the whole life cycle management mode were(89.37±3.48)points,(93.53±4.26)points,(0.13±0.04)points and(0.11±0.03)points,respectively,the average scores of management quality and temperature control effect were higher those of the conventional management mode,and the average scores of smoke control effect and moxa smoke purification effect were lower than those of the conventional management mode,the difference was statistically significant(t=11.744,14.850,11.266,24.593,P<0.05).The satisfaction scores of engineers,medical staff and patients in the use of the new smoke purification and temperature control moxibustion therapy device adopting the whole life cycle management model were(95.69±6.62)points,(96.82±5.87)points and(95.34±5.14)points,respectively,which were higher than those of conventional management mode,the difference was statistically significant(t=9.334,19.549,33.694,P<0.05).Conclusion:The application of the clinical management model of a new type of smoke-purifying temperature-controlled moxibustion device based on the whole life cycle theory to new type of smoke purification and temperature control moxibustion therapy device can effectively improve the quality of equipment management,improve the temperature control effect of the new smoke and temperature control moxibustion device,and improve the satisfaction of relevant users.