Objective: To explore the traditional Chinese medicine (TCM) diagnosis and treatment of type 2 diabetes in Tianjin urban population. Methods: A cross-sectional study was conducted on hospital patients with type 2 diabetes in TCM hospitals of different levels in Tianjin from 2003 to 2007. The multiphasic stratified cluster sampling method was adopted in selecting the target hospital. Finally 3 496 patients were selected as the survey sample. Then the constituent ratios of diabetes in different syndrome types were calculated. Results: In this study, the descending sort proportion of TCM syndrome types of type 2 diabetes in Tianjin urban population was deficiency of both qi and yin, stagnation of phlegm-dampness, exuberant heat due to yin deficiency, deficiency of both yin and yang, and blood stasis and qi stagnation. Most of the diabetes patients with deficiency of both qi and yin, deficiency of both yin and yang, and stagnation of phlegm-dampness were older than 60 years. Most of the diabetes patients with exuberant heat due to yin deficiency were 50 to 59 years old, while the diabetes patients with blood stasis and qi stagnation were 40 to 49 years old. The frequency of Danggui (Angelica sinensis) use was high in the diabetes patients with deficiency of both qi and yin; the frequency of Chenpi (Citrus reticulate Blanco) use was high in the diabetes patients with exuberant heat due to yin deficiency; the frequency of Baishao (Radix Paeoniae Alba) use was high in the diabetes patients with deficiency of both qi and yin; the frequency of Gancao (Radix Glycyrrhizae) use was high in the diabetes patients with stagnation of phlegm-dampness; and the frequency of Xingren (Semen Armeniacae) use was high in the diabetes patients with blood stasis and qi stagnation. Conclusion: The main syndrome types of diabetes patients in Tianjin urban area are deficiency of both qi and yin, stagnation of phlegm-dampness and exuberant heat due to yin deficiency. And the patients are mainly older than 50 years. The most frequently used herbs are Danggui (Angelica sinensis), Chenpi (Citrus reticulate Blanco), Baishao (Radix Paeoniae Alba), Gancao (Radix Glycyrrhizae) and Xingren (Semen Armeniacae).

BACKGROUND: The incidence of diabetic peripheral neuropathy (DPN) is affected by various related factors, which can manifeste in patients with simple diabetes mellitus. However, which of these factors are involved in the occurrence of DPN in diabetic patients?OBJECTIVE: To analyze the risk factors for DPN in patients with type 2 diabetes mellitus.DESIGN: A hospital-based one-to-one pair-matched case-controlled investigation.SETTING: School of Public Health, Tianjin Medical University.PARTICIPANTS: Totally 111 outpatients or inpatients with DPN (DPN group) were recruited from the Metabolic Disease Hospital of Tianjin Medical University from December 2002 to November 2003, including 53 males and 58 females. Inclusive criteria: Diagnosed according to the diagnostic standards for diabetes mellitus recommended by American Diabetes Association (ADA) in 1997; Typing for type 2 diabetes mellitus according to the program by ADA in 1997; Decline or disappearance of achilles tendon reflex, knee tendon reflex, etc.; Decline or disappearance of pain sensation and thalposis; Decline or disappearance of diapason vibration sense. Meanwhile, 111 outpatients or inpatients with simple diabetes mellitus were selected as the control group. Informed consents were obtained from all the subjects.METHODS: The patients were investigated at admission or in the outpatient department with self-designed questionnaires, including more than 80 items of general information, past history, family history, etc. The results of laboratory examinations were recorded. The data were catalogized and input into computer. Multivariate conditional logistic regression was used to establish main effect equation for analyzing the risk factors for DNP.MAIN OUTCOME MEASURES: Risk factors for DNP.RESULTS: All the 111 patients with DNP and 111 patients with simple diabetes mellitus were involved in the analysis of results. The protective factors for DNP included higher educational level, intensive treatment, coronary heart disease and tea drinking. The risk factors for DNP included longer duration of diabetes mellitus, poor situation of blood sugar control, treating with insulin, diabetic nephropathy, diabetic retinopathy, history of diabetic ketonemia, more meat intake before diabetes mellitus, vertigo, dryness of skin, hypertension, history of injury, history of smoking, higher waist-to-hip ratio, higher level of blood cholesterol. The results of multivariate Logistic regression analysis showed that the following factors were significantly associated with DPN: longer duration of diabetes mellitus, treating with insulin, vertigo, more meat intake before diabetes mellitus, alcohol drinking and history of injury (operation, frostbite, etc.).CONCLUSION: DPN is related to various risk factors, such as longer duration of diabetes mellitus, treating with insulin, vertigo, alcohol drinking, more meat intake before diabetes mellitus, history of injury, etc., which all can increase the risk of diabetic neuropathy in patients with type 2 diabetes mellitus. Patients and physicians should pay more attention to these risk factors during the course of prevention and treatment.

Objective To explore risk factors of type 2 diabetes mellitus in suburban of Tianjin.Methods A frequently matched community-based case-control study was conducted in Tianjin suburb.The multi-phasic stratified cluster sampling method was adopted.Finally 9 961 people were selected as study subjects.All of 585 patients with type 2 diabetes mellitus were recruited as cases,and 620 persons without type 2 diabetes mellitus were chosen as controls.The two groups were frequently matched by age and sex.Results Family history of diabetes mellitus(OR=2.671),depression(OR=3.759),higher level of BMI(OR=1.502) and WHR(OR=1.740),history of hypertension(OR=2.016),history of hyperlipoidemia(OR=1.867),were risk factors for type 2 diabetes mellitus while increased the risk of type 2 diabetes.And increasing intake of fruits(OR=0.736) was shown to be reversely associated with diabetes mellitus.Conclusions Family history of diabetes mellitus,depression,overweight,central obesity,history of hypertension,history of hyperlipoidemia were risk factors of type 2 diabetes mellitus in suburban of Tianjin,while increasing intake of fruits was shown to be a protective factor of diabetes mellitus.

Objective To evaluate the effects of a comprehensive intervention including regular aerobic exercise and health education on knowledge,attitude,belief,practice (KAP) scores,body mass index (BMI),waist circumferences,blood pressure,serum glucose and lipid levels in middle-aged and elderly people with overweight and obesity.Methods Three resident communities were chosen randomly from Wangdingdi community in Nankai district in Tianjin.Totally 125 overweight people were involved in this study,62 and 63 people were randomly assigned to intervention group and control group respectively.The members of intervention group were asked to participate in aerobic exercise and health education program 3 times per week within 6 months.And control group members received no intervention.Then to evaluate the effects of intervention of regular aerobic exercise and health education by physical examination and questionnaire.Comparison between intervention group and control group was performed using a repeatedmeasures analysis of variance.Results The comprehensive intervention resulted in significant improvement of the KAP scores [13.82 (95％CI:12.42-15.23)] and high-density lipoprotein cholesterol [0.22(95％ CI:0.17-0.28) mmol/L] and reductions in intervention group in body mass index [-0.47 (95％ CI:-0.58-0.36) kg/m2],waist circumference [-4.00 (95％ CI:-5.01--2.99) cm],systolic blood pressure [-11.69 (95％ CI:-13.84--9.55) mmHg] (1 mmHg=0.133 kPa),fasting plasma glucose [-1.21 (95％ CI:-1.55--0.88) mmol/L],triglyceride [-0.06 (95％ CI:-0.25-0.13) mmol/L],low-density lipoprotein cholesterol [-0.48 (95％ CI:-0.62--0.34) mmol/L].Conclusion Regular aerobic exercise and health education program in community can successfully reduce body mass index,waist circumference and some other risk factors related to overweight and obesity.It is effective to improve awareness,physical fitness,change lifestyle for middle-aged and elderly people in the community.

Objective: To study the distribution of sub-health and occupational stress as well as their correlation among middle school teachers in Tianjin, then provide evidences for prevention and control of the status of sub-health. Methods: A total of 3 522 middle school teachers from six districts of Tianjin were recruited with stratified cluster sampling strategy for the investigation of Sub-Health Measurement Scale version 1.0 (SHMS V1.0) and Occupational Stress Inventory-Revised Edition (OSI-R) . Results: Detection rate of sub-health status among Tianjin middle school teachers was 58.55%. Men had significantly lower sub-health detection rate (55.19%) than women (59.71%) . Sub-health detection rate increased with age (P<0.05) , the sub-health detection rate among middle school teachers more than 50 years old was the highest (66.84%) . The mean score of OSI-R was 403.18±41.80 with the scores of 176.00±21.05, 103.17±17.53, and 124.02±20.28 for ORQ, PSQ, PRQ, respectively, which showed significantly difference compared with the occupational stress norm of China (P<0.001) . The mean scores of OSI-R, ORQ, PSQ, PRQ in different health status were significantly different (P<0.001) . The partial correlation analysis between the scores of sub-health and occupational stress of middle school teachers showed that the scores of occupational role and personal strain were negatively correlated with the scores of sub-health state (P< 0.001) , while, there was significantly positive correlation between the scores of personal resource and the scores of sub-health state (P<0.001) . Conclusion Sub-health detection rate of middle school teachers in Tianjin is higher. Effective measures should be taken to appropriately mitigate the occupational stress level of middle school teachers, increase personal resources, and scientific and effective health guidance and education should be strengthened.

Objective:To use Meta analysis to understand the prevalence of the heritability of body mass index (BMI) in twins.Methods:All studies on the heritability of the twins' BMI published before December 31, 2020 were retrieved through the China National Knowledge Network, Wanfang, VIP, PubMed and Web of Science databases. The literature quality was evaluated by using Joanna Briggs Institute Critical Appraisal tools. Stata 16.0 was used to perform subgroup analysis on the outcome indicators (heritability, 95% CI) to explore the source of heterogeneity. The local weighted regression method was used to fit the trend of heritability with age. The publication bias test and the sensitivity analysis of included literatures were also performed by using Stata 16.0. Results:A total of 10 articles meeting the inclusion and exclusion criteria were included with 79 twins' independent estimates of heritability for BMI. Meta-analysis showed that the combined value of BMI heritability was 0.69 (95% CI: 0.65-0.71), the combined value of BMI (0.68, 95% CI: 0.65-0.70) in males was lower than that (0.70, 95% CI: 0.68-0.72) in females. The heritability of BMI (0.72, 95% CI: 0.68-0.76) in childhood and adolescence was higher than that (0.68, 95% CI: 0.66-0.70) in adulthood. The gender specific difference in BMI heritability in twins ≤18 years old was even greater, which was lower in males (0.68, 95% CI: 0.61-0.76) than in females (0.75, 95% CI: 0.69-0.81). The heritability increased with age in childhood, reached peak at about 18 years old, and then slowly decreased with age. Conclusions:The heritability of BMI varied with population characteristics, especially age and gender. In view of the high estimated value of BMI heritability in female children and adolescents, more attention should be paid to the start time of health intervention.

Objective:To explore the relationship between myopic refraction and near work in children and adolescents with different genetic risks.Methods:From September to December 2016, Nankai District and Hongqiao District of Tianjin were taken as the study sites. Using the method of stratified cluster random sampling, 533 children and adolescents aged 6-14 years from one primary school and one junior middle school in each of the two districts were included as the study subjects. Refraction measurements by an auto-kerato-refractor and questionnaire survey about near work were conducted. 11 single nucleotide polymorphisms in the selected myopia susceptibility genes were detected, and the genetic risk of each individual was scored. After grouping by genetic risk score, the relationship between myopia and near work was analyzed by the multivariate logistic regression, and the relationship between near work and refraction was analyzed by the multivariate linear regression.Results:The age of 553 subjects was (9.8±2.5) years, including 295 boys (53.3%). The overall detection rate of myopia was 62.0%. The spherical equivalent refraction (SER) was (-1.30±1.85) D. The results of the multivariate logistic regression showed that in the low risk group of GRS, compared with those with continuous near work time less than half an hour, those with continuous near work time no less than half an hour had a higher risk of myopia [ OR ( 95%CI) = 2.64 (1.07, 6.52)]. In the moderate risk group of GRS, the risk of myopia increased with the increase of daily computer use [ OR ( 95%CI) = 2.14 (1.03, 4.77)]. In the high risk group of GRS, the risk of myopia increased with the increase of the total daily reading and writing time [ OR ( 95%CI) = 1.27 (1.01, 1.59)]. The results of the multivariate linear regression showed that in the low risk group of GRS, with increase of 1 hour in the total daily reading and writing time and mobile phone time, the SER decreased by 0.18 D (95% CI:-0.30, -0.07) and 0.95 D (95% CI:-1.51, -0.39), respectively. In the moderate risk group of GRS, with increase of 1 hour in the total daily reading and writing time and computer use time, the SER decreased by 0.25 D (95% CI:-0.31, -0.18) and 0.57 D (95% CI:-0.97, -0.18), respectively. In the high risk group of GRS, with increase of 1 hour in the daily total reading and writing time, the SER decreased by 0.33 D (95% CI:-0.43, -0.22). Conclusion:Continuous near work time no less than half an hour, daily computer use time, the total daily reading and writing time, and daily mobile phone use time were associated with myopic refraction in children and adolescents.

Objective:To explore the relationship between myopic refraction and near work in children and adolescents with different genetic risks.Methods:From September to December 2016, Nankai District and Hongqiao District of Tianjin were taken as the study sites. Using the method of stratified cluster random sampling, 533 children and adolescents aged 6-14 years from one primary school and one junior middle school in each of the two districts were included as the study subjects. Refraction measurements by an auto-kerato-refractor and questionnaire survey about near work were conducted. 11 single nucleotide polymorphisms in the selected myopia susceptibility genes were detected, and the genetic risk of each individual was scored. After grouping by genetic risk score, the relationship between myopia and near work was analyzed by the multivariate logistic regression, and the relationship between near work and refraction was analyzed by the multivariate linear regression.Results:The age of 553 subjects was (9.8±2.5) years, including 295 boys (53.3%). The overall detection rate of myopia was 62.0%. The spherical equivalent refraction (SER) was (-1.30±1.85) D. The results of the multivariate logistic regression showed that in the low risk group of GRS, compared with those with continuous near work time less than half an hour, those with continuous near work time no less than half an hour had a higher risk of myopia [ OR ( 95%CI) = 2.64 (1.07, 6.52)]. In the moderate risk group of GRS, the risk of myopia increased with the increase of daily computer use [ OR ( 95%CI) = 2.14 (1.03, 4.77)]. In the high risk group of GRS, the risk of myopia increased with the increase of the total daily reading and writing time [ OR ( 95%CI) = 1.27 (1.01, 1.59)]. The results of the multivariate linear regression showed that in the low risk group of GRS, with increase of 1 hour in the total daily reading and writing time and mobile phone time, the SER decreased by 0.18 D (95% CI:-0.30, -0.07) and 0.95 D (95% CI:-1.51, -0.39), respectively. In the moderate risk group of GRS, with increase of 1 hour in the total daily reading and writing time and computer use time, the SER decreased by 0.25 D (95% CI:-0.31, -0.18) and 0.57 D (95% CI:-0.97, -0.18), respectively. In the high risk group of GRS, with increase of 1 hour in the daily total reading and writing time, the SER decreased by 0.33 D (95% CI:-0.43, -0.22). Conclusion:Continuous near work time no less than half an hour, daily computer use time, the total daily reading and writing time, and daily mobile phone use time were associated with myopic refraction in children and adolescents.

Objective To explore the effectiveness of clinical pharmacists participating in anti-infection treatment for severe infection patients in the intensive care unit.Methods A retrospective collection of severe infection patients admitted to the ICU of the Fourth People's Hospital of Jinan from January to June 2023 was conducted through the hospital information system.Among them,some patients with clinical pharmacists participating in anti-infection treatment throughout the process were in the intervention group,and other patients who did not participate in treatment were in the control group.Both groups of patients received routine treatment according to clinical diagnosis.We compared the cure rate,incidence of adverse reactions,cost of antibiotics,proportion of antibiotic costs,pathogen testing rate,duration of antibiotic treatment,and average length of hospital stay between two groups of patients,and conducted statistical analysis.Results A total of 147 patients were included,with 66 in the intervention group and 81 in the control group.The cure rate of patients in the intervention group was 65.15％,significantly higher than 46.91％in the control group(P＜0.05);The incidence of adverse reactions(7.58％)was significantly lower than that of the control group(19.75％)(P＜0.05).The usage rates of quinolone drugs and tigecycline were significantly reduced in the intervention group;The intervention group had significantly better indicators such as antibiotic costs,proportion of antibiotic costs,and patient pathogen testing rate than the control group(P＜0.05).There were no significant difference in the duration of antimicrobial treatment and average length of hospital stay between the two groups(P＞0.05).Conclusion The full participation of clinical pharmacists in the anti-infection treatment of ICU severe infection patients can help improve their clinical cure rate and medication safety,and reduce their medical burden.

Objective:To investigate the association between air pollutant exposure levels and the risk of atrial fibrillation and to evaluate the mediating role of serum uric acid levels in the association between air pollutant levels and atrial fibrillation risks.Methods:This study was a case-control study, and the data of the atrial fibrillation group was derived from atrial fibrillation patients diagnosed at the Zhongda Hospital, Affiliated to Southeast University, from January 2014 to April 2021, and data of control group was derived from those without atrial fibrillation at the screening in Qixia District, Nanjing City, in March to April 2019. A 1∶1 propensity score matching was performed with the matched variables of age and sex. Air pollutant exposure data were collected from 9 air quality monitoring stations in Nanjing from January 2014 to April 2021, including NO 2, CO, PM 2.5 and PM 10. Exposure to air pollutants was converted to respiratory exposure levels according to an approximate formula. Multivariate logistic regression models were used to analyze the association between air pollutants and the risk of atrial fibrillation. Mediation analysis was used to investigate the mediating role and magnitude of serum uric acid in the association pathway between the four air pollutants (PM 2.5, PM 10, NO 2, and CO) and atrial fibrillation. Results:The atrial fibrillation group was aged (68.7±11.3) years, with 544 (51.8%) males; the control group was aged (68.5±8.9) years, with 543 (51.7%) males. Multivariate logistic regression models suggested that individual exposure levels of all four air pollutants were associated with the increased risks of atrial fibrillation. Every 1 μg·kg -1·d -1 increased in NO 2 was associated 12.1% increased risk of atrial fibrillation among the individuals ( OR=1.121, 95% CI:1.098-1.144); For every 1 μg·kg -1·d -1 increased in CO, the individual risk of atrial fibrillation increased by 0.7% ( OR=1.007, 95% CI: 1.006-1.008). For each 1 μg·kg -1·d -1 increase in PM 2.5 exposure level, the individual risk of atrial fibrillation increased by 14.2% ( OR=1.142, 95% CI: 1.120-1.164). For each 1 μg·kg -1·d -1 increase in PM 10 exposure level, the individual risk of atrial fibrillation increased by 3.7% ( OR=1.037, 95% CI: 1.028-1.046). The results of the mediation analysis suggested that serum uric acid levels mediated 5.6% ( P=0.032) causal effects of PM 2.5 on atrial fibrillation risks and 7.5% ( P=0.010) mediated by CO. Conclusion:Air pollutant exposure was a risk factor for the development of atrial fibrillation and uric acid mediated the increased risk of atrial fibrillation by PM 2.5 and CO.