Objective:To evaluate the effect of lung recruitment maneuvers combined with individualized positive end-expiratory pressure(PEEP) on the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.Methods:One hundred and forty-three elderly patients, aged ≥65 yr, with body mass index of 18.5-30.0 kg/m 2, scheduled for elective laparoscopic surgery, were assigned to either individualized PEEP combined with recruitment maneuvers (group Ⅱ) or fixed PEEP (group Ⅰ) using a random number table method. PEEP was maintained at 6 cmH 2O starting from the beginning of procedure until the end of the procedure in group I. Individualized PEEP titration was performed after induction of anesthesia in group Ⅱ. The primary outcome measure was the 12-zone lung ultrasound score at 15 min after tracheal extubation. Other outcome measures were the occurrence of postoperative pulmonary complications within 7 days after surgery, Quality of Recovery-15 scale score on 3rd day after surgery, rate of unplanned admission to intensive care units, length of hospital stay, incidence of intraoperative hypoxemia, usage rate of intraoperative vasoactive drugs, and incidence of postoperative hypotension. Results:Compared with group Ⅰ, the lung ultrasound score, driving pressure and postoperative pulmonary complications were significantly decreased, the dynamic lung compliance was increased ( P<0.05 or 0.01), and no significant changes were found in the other parameters in group Ⅱ ( P>0.05). Conclusions:Individualized PEEP combined with recruitment maneuvers can reduce the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.

Objective:To understand the temporal and spatial characteristics of fluoride in rural drinking water in Jinan City.Methods:From 2015 to 2018, the factory water and terminal water samples of centralized rural water supply system were collected from all townships (streets) in 7 agriculture-related districts (counties) in Jinan City during dry season and high water season. Water samples were collected, stored, transported and tested in accordance with the "Standard Examination Methods for Drinking Water" (GB/T 5750-2006). The time, region, endemic areas (Zhangqiu, Jiyang, Shanghe, Licheng, Changqing) and non-endemic areas (Pingyin, Tianqiao) of drinking water type fluorosis, water periods (dry season and high water season), water samples (factory water and terminal water), water sources (shallow well water, deep well water, river water and reservoir water) of water fluorine were analyzed descriptively.Results:A total of 1 638 water samples were collected from 2015 to 2018, the median of water fluorine was 0.400 mg/L, ranging from 0.002 to 2.700 mg/L. The differences in water fluorine of different year (0.400, 0.430, 0.490, 0.360 mg/L) were statistically significant ( H = 33.907, P < 0.01). Total water fluorine excess rate was 5.49% (90/1 638), there were 3 districts with water fluorine excess, namely Jiyang [26.11% (59/226)], Zhangqiu [6.12% (30/490)] and Licheng [0.53% (1/188)]. The median of water fluorine in endemic areas (1 398 samples) was 0.420 mg/L, the non-endemic areas (240 samples) was 0.320 mg/L, and the water fluorine in endemic areas was significantly higher than that in non-endemic areas ( Z =-6.490, P < 0.01). The water fluorine excess rate in endemic areas was 6.44% (90/1 398), and there was no water fluorine excess in non-endemic areas. The median of water fluorine in both dry season (819 samples) and high water season (819 samples) was 0.400 mg/L. The median of water fluorine of factory water (392 samples) was 0.320 mg/L, the terminal water (1 246 samples) was 0.450 mg/L, and the water fluorine of terminal water was significantly higher than that of factory water ( Z =-6.881, P < 0.01). The water fluorine excess rates of shallow well water and deep well water were 31.76% (47/148) and 3.82% (43/1 126), respectively, and there were no water fluorine excess in river water and reservoir water. Conclusions:Fluoride of drinking water in rural areas of Jinan City exceeds the standard, mainly concentrated in Jiyang District. The water fluorine in endemic areas is higher than that in non-endemic areas, water fluorine of terminal water is higher than that of factory water, shallow well water and deep well water as the sources of water has excessive water fluoride, and the general survey and detection of fluoride content in residents' drinking water should be continuously carried out.

Background In recent years, regional high-temperature weather in summer occurs frequently in China. Heat stroke is the most representative meteorological disease caused by high temperature. In order to improve monitoring, early warning, prevention, and control of heat stroke, it is of great significance to understand the epidemiological characteristics of heat stroke and the associated impact of heatwave. Objective To understand the epidemiological characteristics of heat stroke cases in Jinan City, and to explore the effects of heatwave exposure on heat stroke. Methods Case reports of heat stroke and daily data of meteorological factors in Jinan City from 2017 to 2022 were collected. We described the temporal, population, and regional distribution characteristics of heat stroke cases in Jinan City, and used a time-stratified case-crossover design combined with conditional logistic regression model to explore the effects of heatwave exposure on heat stroke under 12 heatwave definitions (different combinations of intensity and duration). The cut-off percentiles used for heatwave definitions were the 90th (P₉₀), 95th (P₉₅), 97.5th (P_97.5), and 99th (P₉₉) percentiles of daily mean temperature; the durations were ≥ 2 d, ≥ 3 d, and ≥ 4 d, respectively. P_i(k), where i is temperature threshold, and k is duration. For example, the definition of a heatwave was notated as P₉₀(2), indicating that the daily mean temperature is ≥ P₉₀ and lasts for ≥ 2 d. Alternatively, lag01 denotes the cumulative lag effect with a 1 d lag, and so on. Results A total of 1394 cases of heat stroke were reported in Jinan City from 2017 to 2022, including 581 mild cases and 813 severe cases, and 85 deaths were reported, with a cumulative fatality rate of 6.10%. The cases of heat stroke reported each year during the study period were concentrated from June to August and peaked in July (665 cases, 47.70%). The sex ratio of males to females in heat stroke cases was 2.02:1. A high incidence of heat stroke was in 50-89 years, with a smaller peak occurring in the age group of 50-59 years and a larger peak in the age group of 70-79 years, respectively. The high-incidence areas of heat stroke were distributed in the western part of Jinan City where city centers situated (Tianqiao District, 274 cases, 19.66%; Huaiyin District, 223 cases, 16.00%) and in the surrounding rural areas (Pingyin County, 254 cases, 18.22%). The effect of heatwave exposure on heat stroke was statistically significant during the study period. The largest effect estimates for the effect on heat stroke occurred under the heatwave definitions of P₉₉(2), P_97.5(3), and P_97.5(4) at lag04, lag03, and lag04, where corresponding OR (95%CI) values were 9.27 (4.71, 14.24), 8.95 (6.17, 12.98), and 8.22 (4.91, 13.78), respectively. The exposure-response curve showed that the risk of heat stroke tended to increase with the increase of average daily temperature. Conclusion July is the key period for the occurrence of heat stroke among Jinan City residents, while male cases are predominant, more serious cases, age concentration in the 50-89 years. The occurrence of heatwave can further increase the risk of heat stroke with a significant lag effect.

Objective To explore the effect of Wuwei Xiaoke Formula on intestinal flora and inflammatory factors in patients with type 2 diabetes mellitus.Methods A total of 92 cases of type 2 diabetes patients with Qi-Yin deficiency syndrome were selected and randomly divided into treatment group(n=46)and control group(n=46).The control group was treated with basic treatment + metformin,and the treatment group was treated with Wuwei Xiaoke formula on the basis of the control group.The clinical efficacy,intestinal flora and inflammatory factor levels of the two groups were observed and compared.Results The two groups of patients were evenly distributed,with good baseline status and strong comparability.After treatment,the total effective rate of 91.30%in the treatment group was higher than that of 78.26%in the control group(P<0.05).After treatment,the number of Bacteroides,Lactobacillus and bifidobacterium groups in treatment group was higher than that in control group(P<0.05).The numbers of enterococcus,enterobacter and yeast were lower than those in control group(P<0.05).After treatment,the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)in the treatment group were decreased more significantly than those in the control group(P<0.05).Conclusion Wuwei Xiaoke formula is helpful to improve the clinical symptoms of type 2 diabetes patients,regulate the disorder of intestinal flora in patients,reduce the level of inflammatory factors,and has good safety.

Idiopathic pulmonary fibrosis (IPF) is a progressive disease with unknown etiology and limited therapeutic options. Activation of fibroblasts is a prominent feature of pulmonary fibrosis. Here we report that lncRNA DACH1 (dachshund homolog 1) is downregulated in the lungs of IPF patients and in an experimental mouse model of lung fibrosis. LncDACH1 knockout mice develop spontaneous pulmonary fibrosis, whereas overexpression of LncDACH1 attenuated TGF-β1-induced aberrant activation, collagen deposition and differentiation of mouse lung fibroblasts. Similarly, forced expression of LncDACH1 not only prevented bleomycin (BLM)-induced lung fibrosis, but also reversed established lung fibrosis in a BLM model. Mechanistically, LncDACH1 binding to the serine/arginine-rich splicing factor 1 (SRSF1) protein decreases its activity and inhibits the accumulation of Ctnnb1. Enhanced expression of SRSF1 blocked the anti-fibrotic effect of LncDACH1 in lung fibroblasts. Furthermore, loss of LncDACH1 promoted proliferation, differentiation, and extracellular matrix (ECM) deposition in mouse lung fibroblasts, whereas such effects were abolished by silencing of Ctnnb1. In addition, a conserved fragment of LncDACH1 alleviated hyperproliferation, ECM deposition and differentiation of MRC-5 cells driven by TGF-β1. Collectively, LncDACH1 inhibits lung fibrosis by interacting with SRSF1 to suppress CTNNB1 accumulation, suggesting that LncDACH1 might be a potential therapeutic target for pulmonary fibrosis.