Objective To explore the pulse diagram parameter changes of chronic renal insufficiency patients with five symptoms types(spleen kidney qi deficiency ,spleen kidney Yang deficiency ,kidney liver Yin deficiency and the deficiency of Yin and Yang ) , and to establish the differentiation mode of each symptoms type for assisting the clinical diagnosis .Methods The DS01-C pulse manifestation instrument made by the Shanghai Daosh company was adopted to detect and analyze the pulse manifestations in the healthy control group and the chronic renal insufficiency group .Results The healthy control group was dominated by the normal pulse manifestation .The chronic renal insufficiency group was dominated by the taut pulse and its concurrent pulse .Along with the progress of the disease ,the pulse manifestations also appeared the corresponding changes .The patients with spleen kidney qi defi-ciency and spleen kidney Yang deficiency were dominated by the taut pulse .Comparing the patients with liver kidney Yin deficiency and Qi Yin deficiency ,the taut pulse and concurrent rapid pulse were common ,in addition ,the former also had the deep pulse .The patients with Yin and Yang deficiency showed the slow pulse and the taut pulse or the taut pulse and rapid pulse .Conclusion The pulse manifestation change in the patients with chronic renal insufficiency is dominated by the taut pulse and the concurrent pulse , the pulse manifestation change of various symptoms types are complex .

Objective : To examine the association between acute exposure to traffic-related air pollutants (TRAP) NOX and NO2 and outpatient visits of pediatric respiratory diseases. Methods : Data regarding outpatient visits to Department of Respiratory Diseases of Beijing Children's Hospital from 2015 to 2020 were collected, and the concentrations of nitrogen oxides (NOX), nitrogen dioxide (NO2) and other TRAP were collected from the surveillance sites assigned by the Peking University Health Science Center. A time-stratified case-crossover design was employed, and a conditional logistic regression model was created to examine the association between NOX and NO2 acute exposure and outpatient visits of pediatric respiratory diseases. Results : The daily mean outpatient visits of pediatric respiratory diseases were 571 (interquartile range, 554) person-times among children at ages of 0 to 14 years in Beijing Children's Hospital from 2015 to 2020, and the daily mean outpatient visits for upper respiratory tract infections (URI), bronchitis, and pneumonia were 265 (interquartile range, 282), 143 (interquartile range, 178) and 128 (interquartile range, 120) person-times, respectively. The daily mean concentrations of atmospheric NOX and NO2 were 67.8 (interquartile range, 50.7) and 49.3 (interquartile range, 30.7) μg/m3, respectively. Conditional logistic regression analysis showed the largest lagged effect of NOX and NO2 on pediatric respiratory diseases at cumulative lags of 0 to 7 days. An increase in NOX concentrations by an interquartile range resulted in the excess risks of URI, bronchitis and pneumonia by 6.87% (95%CI: 6.37%-7.38%), 7.25% (95%CI: 6.51%-7.99%), and 5.51% (95%CI: 4.69%-6.33%), and an increase in NO2 concentrations by an interquartile range resulted in excess risks of URI, bronchitis and pneumonia by 5.71% (95%CI: 5.12%-6.31%), 5.32% (95%CI: 4.51%-6.14%), and 4.83% (95%CI: 3.91%-5.75%), respectively. NOX and NO2 presented a more remarkable effect on outpatient visits of pediatric respiratory diseases among children at ages of over 5 years. Conclusion NOx and NO2 acute exposure may increase the outpatient visits of pediatric respiratory diseases.

Objective: To investigate the efficacy and safety of Rivaroxaban for elderly patients with thrombotic diseases. Methods: This was a retrospective study.A total of 301 elderly patients taking Rivaroxaban from October 2012 to November 2017 at the Second Medical Center of the Chinese PLA General Hospital were consecutively selected.The ages ranged from 60 to 102 years, with an average age of(86.5±8.4)years.Anticoagulation regimens were developed based on comprehensive evaluation of indications, creatinine clearance, ischemia and bleeding risk.Patients were divided into a Rivaroxaban 2.5-5.0 mg/d group(n=72), a 10.0 mg/d group(n=205), and a 15.0-20.0 mg/d group(n=24). Hepatic function, renal function, and coagulation indexes were measured before and after the administration of Rivaroxaban.Fatal bleeding, cardiovascular deaths, all-cause deaths, non-fatal bleeding and thromboembolic events were recorded during the follow-up period. Results: The average dose of Rivaroxaban was(9.3±3.0)mg/d, and the minimum dose was 2.5 mg/d.The average follow-up time was(14.9± 13.9)months and the longest follow-up time was 48 months.One patient had intracranial bleeding.Twenty patients(6.6%)died with a cumulative incidence of 25.2%, three(1.0%)died of cardiac events, and 55.0% died of pneumonia and multiple organ failure.Forty patients(13.3%)had non-fatal hemorrhagic events with a cumulative incidence of 42.4%.Seven patients(2.3%)had thromboembolic events with a cumulative incidence of 16.0%, including 2 cases of non-fatal myocardial infarction, 3 cases of cerebral infarction and 2 cases of deep vein thrombosis.After treatment, levels of prothrombin time and fibrinogen significantly increased while levels of D-dimer significantly deceased(P<0.05). Conclusions Compared with previous reports, low-dose Rivaroxaban is safe and effective for elderly patients with thrombotic diseases.However, the risk of bleeding and ischemia should be comprehensively evaluated, and appropriate doses of Rivaroxaban should be selected individually.

Objective:To investigate the clinical value of neuroendoscopic resection in recurrent or residual sellar and clivus tumors and the prevention and treatment of operative complications.Methods:A retrospective study was performed. Clinical data of 49 patients with residual or recurrent sellar and clivus tumors after neuroendoscopic resection in Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University from November 2021 to October 2023 were collected; 45 patients were with pituitary adenoma, 3 were with craniopharyngioma, and 1 patient was with clivus chordoma; their surgical efficacy and complications were summarized and analyzed.Results:Total resection was achieved in 29 patients (59.2%), subtotal resection in 12 (24.5%), and partial resection in 8 (16.3%). Two patients (4.1%) had intraoperative internal carotid artery rupture and were given emergency laminar stenting, discharging with good recovery, but one of them left with unilateral motor nerve palsy. During 1-24 months of follow-up, 97.2% patients (35/36) had headache relief and visual acuity improvement, and no patient had permanent diabetes insipidus or cerebrospinal fluid rhinorrhea. Residual tumors increased in 3 patients (6.1%); no tumor recurrence after total resection was noted.Conclusion:Endoscopic resection of recurrent or residual sellar and clivus tumors is safe and effective; attention should be paid to the internal carotid artery during the operation.

Objective:Evidence on potential cardiovascular benefits of personal-level intervention among the elderly exposed to high levels of particulate matter(PM)remains limited.We aimed to assess improvements in surrogate markers of cardiovascular injury in vulnerable populations at risks by using indoor air filtration units.Methods:We conducted a randomized crossover trial for 2 separate 2-week air filtration interventions in 20 households of patients with stable chronic obstructive pulmonary disease and their partners in the winter of 2013,with concurrent measurements of indoor PM.The changes in biomarkers indicative of cardiac injury,atherosclerosis progression and systemic inflammation following intervention were evaluated using linear mixed-effect models.Results:In the analysis,average levels of indoor PM with aerodynamic diameters＜2.5 μm(PM2.5)decreased significantly by 59.2％(from 59.6 to 24.3 μg/m3,P＜0.001)during the active air filtration.The reduction was accompanied by improvements in levels of high-sensitivity cardiac troponin I by-84.6％(95％confidence interval[CI]:-90.7 to-78.6),growth differentiation factor-15 by-48.1％(95％CI:-31.2 to-25.6),osteoprotegerin by-65.4％(95％CI:-56.5 to-18.7),interleukin-4 by-46.6％(95％CI:-62.3 to-31.0)and myeloperoxidase by-60.3％(95％CI:-83.7 to-3.0),respectively.Conclusion:Indoor air filtration intervention may provide potential cardiovascular benefits in vulnerable popu-lations at risks.

Objective To explore risk factors of poor early prognosis in the treatment of COVID-19 by nematevir and ritonavir tablets Paxlovid and establish the prediction model to provide reference for improving the effect of such patients. Methods 92 inpatients of COVID-19 treated with Paxlovid in three military tertiary hospital in southern Fujian from January 2023 to March 2023 were retrospectively analyzed. The clinical indicators of 92 inpatients were collected for univariate and multivariate analysis by single factor and multiple factors and the independent risk factors of poor early prognosis in Paxlovid were screened out. Logistic model equation was transformed to construct the combined predictors, and ROC curve was used to determine the area under the curve (AUC) and the optimal critical value of the combined predictors. Results Among 92 patients, 31 (33.70%) developed poor early prognosis, including 11 deaths (35.48%), 17 critical cases (54.84%) and 3 severe cases (9.68%). Multi-factor Logistic regression analysis showed that the disease days, lymphocyte count, aspartate aminotransferase(AST), C reactive protein(CRP) and ventilator-assisted ventilation were independent risk factors for poor early prognosis in Paxlovid. A formula for calculating the combined predictors (Y) was established as Y_{combinedpredictors}=7.875X_{disease days}+126.188X_{lymphocyte count}+1.438X_AST+X_CRP+220.500X_{ventilator-assisted ventilation} based on the above independent risk factors, and the ROC curve was drawn. With the maximum area under the ROC curve of the combined predictors being 0.939, the prediction value was best, and the optimal critical value of the ROC curve corresponding to the maximum Youden index (0.756) was 447.920.Theoretical accuracy of the model was 89.10%. Conclusion The disease days, lymphocyte count, AST, CRP and ventilator-assisted ventilation were independent risk factors for poor early prognosis in Paxlovid. Combined predictors could be calculated by the above risk factors before medication. The efficiency should be improved by taking more active treatment, including combining with other anti-COVID-19 drugs when the prediction result exceeds 447.920.

Background The increasing threats of air pollution and extreme weather have been widely recognized in recent years in China, but their individual and joint effects on cardio-cerebrovascular mortality are unclear. Objective This study aims to investigate the individual effects of and potential interactions between oxidant pollutants and ambient temperature on cardio-cerebrovascular mortality risks. Methods We collected daily data on death counts of cardio-cerebrovascular diseases, concentrations of ambient air pollutants, and meteorological parameters in Guangzhou, Chinabetween 1 January 2006 and 31 December 2016. A generalized additive model with a Poisson distribution was conducted to assess the associations of oxidant pollutants and ambient temperature with cardio-cerebrovascular mortality risks. Bivariate response surface models and stratified analyses were further adopted to qualitatively and quantitatively examine the potential interactions between oxidant pollutants and ambient temperature on cardio-cerebrovascular mortality risks. Results During the study period, the daily averages were 60.3 μg·m⁻³ for ozone (O₃), 50.9 μg·m⁻³ for combined atmospheric oxidant capacity (O_x), 32.5 μg·m⁻³ for nitrogen dioxide (NO₂), and 22.3℃ for ambient temperature. The average daily death counts of coronary and stroke diseases were 20 and 15, respectively. Per 10 μg·m⁻³ increment in O₃, O_x, and NO₂ were associated with increased coronary mortality risks (excess risk, ER) of 1.26% (95%CI: 0.79%-1.74%), 1.61% (95%CI: 0.99%-2.23%), and 1.33% (95%CI: 0.59%-2.07%), and with increased stroke mortality risks of 1.56% (95%CI: 1.04%-2.09%), 2.30% (95%CI: 1.60%-3.01%), and 2.93% (95%CI: 2.07%-3.79%) over cumulative lags of 2-5 days, respectively. The exposure-response relationships between ambient temperature and coronary and stroke mortality risks exhibited an inverse "J" shape, with the minimum mortality at temperatures of 25.7℃ for coronary disease and 27.3℃ for stroke. Our results further showed potentially synergic effects of higher temperatures and higher levels of O₃ and O_x exposures on coronary mortality risks, and the relative ER due to interactions was 0.103 (95%CI: 0.028-0.178) for O₃ and 0.079 (95%CI: 0.004-0.154) for O_x. We didn't find evidence of an interaction between oxidant pollutants and low temperature. Conclusion Short-term exposures to oxidant pollutants are associated with increased cardio-cerebrovascular mortality risks, and the interactive effects of high temperature and oxidant pollutants are synergistic in relation to cardio-cerebrovascular mortality risks.