Background Industrial emissions are a well-established major source of urban fine particulate matter (PM_2.5) and associated heavy metals. To improve local air quality, Shanghai No. 1 Iron and Steel Plant in Baoshan District was entirely relocated, with all production lines successively shut down in 2018. Objective To evaluate the trends in PM_2.5 and three heavy metal concentrations - chromium (Cr), mercury (Hg), and thallium (Tl) —in the local atmosphere pre- and post- relocation of the steel plant. Methods Taking the steel plant relocation in 2019 as the intervention cutoff point, this study was divided into two phases: pre-intervention (January 2017 to December 2018) and post-intervention (January 2019 to December 2021). Monthly mean pollutant concentrations were used to construct an interrupted time series (ITS) model, followed by segmented linear regression to assess the pre- and post-intervention trends in ambient PM_2.5 and three heavy metals surrounding thesteel plant. Results The ITS regression analysis revealed that the change in PM_2.5 concentration (b₂) after the intervention was −7.16 μg·m⁻³, while the changes in Cr, Hg, and Tl concentrations (b₂) were −0.46, −0.03, and −0.06 ng·m⁻³, respectively. Prior to the intervention, PM_2.5 mass concentrations exhibited a temporal decline with a slope of b₁ = –0.69 (P<0.05); seasonal adjustment further strengthened the overall significance of the model. Before the intervention, the concentration of Cr increased over time, with a slope of b₁=0.12 (P<0.05). After the intervention, the concentration of Cr showed a gradual downward trend over time, with a slope (b₁ + b₃) of −0.04, and significant seasonal variations were observed. The concentration of Hg decreased over time before the intervention, with a slope of b₁=−0.0029 (P<0.05). After the intervention, the slope was −0.0003, showing a further slow decline in Hg concentration over time. However, no significant seasonal trend was observed for Hg. The mass concentration of Tl decreased after the intervention, and the difference before and after the intervention was statistically significant (P<0.05). PM_2.5, Cr, and Tl better fit to the seasonal model, whereas Hg showed a better fit to the non-seasonal model. Conclusion The steel plant relocation intervention has markedly improved local air quality.

ObjectiveTo explore the association between air pollutants and hospital outpatient visits in a district of Shanghai. MethodsDaily meteorological data， environmental data， data of outpatient visits to two secondary hospitals and two tertiary hospitals in this district from January 1， 2015 to December 31， 2019 were collected. A Poisson regression generalized linear model was used to analyze the exposure-response relationship between the air pollutants and hospital outpatient visits in this area. ResultsDuring the study period， the total number of outpatient visits in the included hospitals was 17 802 634， with an average daily total of （9 750±4 191） outpatient visits，and an average daily of （761±341） respiratory outpatient visits. In the lag effect of single pollutant model， when the concentration of air pollutant increased by 10 μg·m^-3， PM_2.5， SO₂， NO₂ had the maximum lag effect on the number of outpatient visits in the department of internal medicine for respiratory diseases on lag day 4， day 5 and day 7， respectively. And the RR values and 95%CI were 1.002 0（1.001 3‒1.002 6）， 1.0154（1.012 3‒1.018 5）， and 1.006 1（1.005 3‒1.006 9）， respectively. ConclusionThere is a exposure-response relationship between air pollutants and the number of outpatient visits in each department of the hospitals， and different pollutants have different degrees of lag effects.

ObjectiveTo understand the health information needs of chronic disease inpatients and the current utilization of community health resources， and to analyze the influencing factors， so as to provide basis for personalized and high-quality health education for chronic disease inpatients and to guide them to make full use of community health resources. MethodsFrom November 2020 to February 2021， we conducted a face-to-face multi-center clinical epidemiological survey with paper questionnaire in three general hospitals of Shanghai. The study included 404 inpatients with diabetes， hypertension， coronary heart disease， chronic respiratory diseases， cancer and other chronic diseases. Results94.01% of the 404 respondents had different needs for disease or health related information， and there was no significant difference between patients of different ages， genders and educational backgrounds in their needs for health knowledge. Among these patients， only 39.11% of them participated in the establishment of a card for chronic disease management in the community or signed for a family doctor. The participation rate of male patients was lower than that of female patients （P<0.05）. ConclusionPatients with chronic diseases have a high demand for health related information， and we need to provide health information in multiple ways. We should increase investment in community health resources， improve service quality， and guide residents with chronic diseases to make full use of community health resources.

OBJECTIVE: Rheumatoid arthritis (RA) progression is associated with the balance of T-regulatory (Treg) and T-helper 17 (Th17) cells, while the role of microRNAs (miRs) in regulating Treg/Th17 cell balance has not been clarified. This study aimed to assess whether moxibustion could regulate Treg/Th17 cell balance by modulating the miR-221/suppressor of cytokine signaling 3 (SOCS3) axis in the RA mouse model. METHODS: A mouse model of collagen-induced arthritis (CIA) was established in male DBA/1J mice. Twenty-two days after CIA induction, the mice received daily treatment with moxibustion for 12 times. Pathological scores were assessed according to the levels of synovial hyperplasia. The expression levels of cytokines interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), IL-17 and IL-10 were analyzed in serum by enzyme-linked immunosorbent assay. The cluster of differentiation 4 (CD4⁺) splenocytes was analyzed by fluorescence-activated cell sorting. The expression levels of RA-related miRs and target genes were subsequently detected, and the target of miR-221 was confirmed by the dual-luciferase reporter assay. RESULTS: It was revealed that moxibustion treatment decreased the pathological scores and downregulated the expression levels of IL-1β, IL-6, TNF-α, IFN-γ and IL-17, while upregulated the expression level of IL-10. The Treg/Th17 cell balance was regulated by moxibustion treatment. The expression level of miR-221 was suppressed by moxibustion treatment. Furthermore, SOCS3 was found as the direct target of miR-221, which mediated the function of moxibustion by regulating the Treg/Th17 cell balance. CONCLUSION Moxibustion therapy regulated the Treg/Th17 cell balance by modulating the miR-221/SOCS3 axis in the RA mouse model.
Animals ; Arthritis, Experimental/therapy* ; Arthritis, Rheumatoid/therapy* ; Cytokines ; Disease Models, Animal ; Interleukin-10 ; Interleukin-17 ; Interleukin-6 ; Male ; Mice ; Mice, Inbred DBA ; MicroRNAs/genetics* ; Moxibustion ; T-Lymphocytes, Regulatory ; Th17 Cells/pathology* ; Tumor Necrosis Factor-alpha

Alzheimer Disease/genetics* ; Animals ; Apolipoprotein E4/metabolism* ; Gene-Environment Interaction ; Hippocampus/metabolism* ; Male ; Noise/adverse effects* ; Rats

Objective:To evaluate the safety and validity of enriched autologous bone marrow mesenchymal stem cells (BMSCs) and annular suture for repairing defect after lumbar discectomy.Methods:Enrichment of autologous BMSCs: autologous bone marrow blood was collected from 5 patients undergoing lumbar surgery, and nucleated cells were enriched on gelatin sponge particles by selective cell retention technique. From October 2016 to March 2019, 109 patients with lumbar disc herniation underwent discectomy with mobile microendoscopic discectomy technique, including 61 males and 48 females, aged 24-59 years. Discectomy group: 26 cases received simple discectomy. Suture group: 39 cases received annular suture after discectomy. BMSCs+suture group: 44 cases received intradisc transplantation of gelatin sponge particles enriched with autologous BMSCs and annular suture after discectomy. The perioperative conditions were recorded, with visual analogue scale (VAS), Oswestry dysfunction index (ODI), Pfirrmann grade of disc degeneration, disc height and degree of herniationevaluated after operation.Results:In enrichment test with flow cytometry, the enrichment multiple of nucleated cells and target cells was 6.4±0.9 and 4.2±0.6 respectively, and BMSCs grew well in vitro. The operation time was 35-55 mins. 7 cases in the suture group were transferred to the discectomy group and 10 cases in the BMSCs+suture group were transferred to BMSCs group due to unsuccessful suture. There were no significant differences in VAS, ODI, Pfirrmann grade of disc degeneration, disc height and degree of herniation among the groups. There was no significant difference in intraoperative bleeding, postoperative drainage and length of hospital stay. The incision was healed without redness and swelling. 18 patients were followed up for 6 months, and 91 cases were followed up for 1-3 years (25.0±5.6 months). There was no interbody fusion, heterotopic ossification or infection during follow-up. VAS and ODI decreased significantly after operation in all patients. At final follow-up, the VAS improvement rate of BMSCs+suture group (81.7%±7.9%) was higher than discectomy group (73.0%±8.9%), suture group (74.0%±6.9%) and BMSCs group (75.3%±8.4%); the ODI improvement rate of BMSCs+suture group (91.9%±8.8%) was higher than discectomy group (86.2%±8.1%) and suture group (86.4%±5.5%). According to MRI, the Pfirrmann grade of disc increased 0.7 in discectomy group, 0.6 in suture group, while it did not increased significantly in BMSCs+suture group and BMSCs group, and the progress of Pfirrmann grade in BMSCs+suture group and BMSCs group were lighter than discectomy group and suture group.The disc height decreased in each group, the loss rate of disc height in BMSCs+suture group (17.2%±4.3%) was less than discectomy group (29.3%± 6.3%) and suture group (20.6%±5.7%); and suture group was less than discectomy group. The degree of herniation was reduced by more than 50% in all groups, while 1 case in discectomy group had herniation without clinical symptoms.Conclusion:Autologous BMSCs and annulus suture are safe and effective in repairing the defect after lumbar discectomy, which may help to slow down the degeneration of intervertebral disc.

Objective:To investigate the application value of transversus abdominis muscle release technique in giant ventral hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 72 patients with giant ventral hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2017 to January 2020 were collected. There were 47 males and 25 females, aged from 29 to 79 years, with a median age of 56 years. All patients underwent ventral hernia repair with transversus abdominis muscle release technique and preperitoneal/retro-muscular polypropylene mesh reinforcement. Observation indicators: (1) surgical situations; (2) postoperative complications; (3) hernia-related quality of life. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative complications at postoperative 1, 6 and 12 months. Follow-up was up to January 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison within groups was analyzed using the paired t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical situations: all 72 patients underwent ventral hernia repair with transversus abdominis muscle release technique and preperitoneal/retro-muscular polypropylene mesh reinforcement successfully. The operation time, volume of intraoperative blood loss and mesh size of the 72 patients were (105±46)minutes, (55±15)mL and (680±225)cm 2, respectively. (2) Postoperative complications: 72 patients were followed up for 12 to 48 months, with a median follow-up time of 16 months. During the follow-up, 7 of the 72 patients were diagnosed with seroma by abdominal computed tomography (CT) scan at postoperative 1 week, the size of which was (460±130)mm 2. The 7 patients with seroma were followed up and results of abdominal CT scan at postoperative 6 months showed that the seroma was completely absorbed. Two of the 72 patients had postoperative intestinal obstruction, which was considered as postoperative paralytic ileus. After conservative treatment, the 2 patients were improved 2 weeks after operation. None of the 72 patients had surgical site infection, intestinal fistula or hernia recurrence. (3) Hernia-related quality of life: the score of hernia-related quality of life of 72 patients before operation and at postoperative 12 months were 40±12 and 73±17, respectively, showing a significant difference ( t=12.527, P<0.05). Conclusion:Transversus abdominis muscle release technique in the giant ventral hernia repair is safe and effective, which can improve hernia-related quality of life of patients.

Atrial Fibrillation/surgery* ; Catheter Ablation ; Heart Conduction System/surgery* ; Humans ; Syncope, Vasovagal/surgery*

Objective To explore the composition and distribution of metal and metalloids in fine particulate metter in a certain area of Shanghai through four consecutive years of dynamic monitoring. Methods The sampling point was on the roof of a community health service center in Shanghai, with a height of 12.5 meters.In the four winters of 2014-2017 from Dec. to Feb. next year, samples were continuously collected for 7 days(from 10^th to 16^th) a month and 22 hours for each day.Inductively coupled plasma-mass spectrometry (ICP-MS) was used for the determination of metals and metalloids in collected samples. Results The pairwise comparisons between the total metals, Al, Be, Cr, Hg, Pb, Mn, Ni, Se and Tl in any two years were statistically different through the rank sum test.In the Cochran-Armitage trend test, Al showed an upward trend in the whole periods, while Cr, Pb and Ni was on a downward trend.In factor analysis, factor 1 in each year had relatively stable component elements (As, Cd, Pb, Mn, Se), while the internal components of the remaining factors were relatively unstable. Conclusions There may be relatively stable sources of pollution locally.Al, Cr, Pb and Ni have a significant tendency to increase or decrease.

Objective　To investigate the relationship between serum uric acid（SUA） level and red cell distribution width in patients with acute ischemic stroke（AIS） and its clinical significance. Methods　The clinical and biochemical data were retrospectively analyzed in 481 patients with AIS in the department of neurology at Renji Hospital Baoshan branch affiliated to Shanghai Jiao Tong University from January 2018 to June 2019.Included patients were divided into normal SUA group and high SUA group according to the SUA levels，and the clinical and biochemical characteristics between the two groups were compared. The correlation between SUA level and red cell distribution width was analyzed. Results　There were no significant difference in gender，age，previous medical history（hypertension，diabetes mellitus，coronary heart disease etc.），total cholesterol，low density lipoprotein，red blood cell count，hemoglobin，erythrocyte aggregation index，mean corpuscular hemoglobin，erythrocyte rigidity index，glutamic-oxiracetam transaminase，cysteine level，erythrocyte sedimentation rate，D-dimer，white blood cell，antiplatelet，hypoglycemic，antihypertensive drugs between normal serum uric acid level group and high serum uric acid level group（P>0.05）. There was significant difference in uric acid，creatinine，urea，triglyceride，high density lipoprotein level，erythrocyte hemoglobin distribution width and mean corpuscular volume，red cell distribution width（P<0.05）. The relationship between the serum uric acid level and the red cell distribution width was u-shape. When SUA levels were within the normal range，serum uric acid levels were negatively correlated with red cell distribution width（r=-0.113，P=0.023）. When serum uric acid levels were high，the SUA were positively correlated with red cell distribution width（r=0.380，P<0.001）. Conclusion　The red cell distribution width was increased with high SUA level in patients with AIS. The above findings were helpful to explore the possible mechanism of high SUA in promoting AIS by influencing the red blood cell deformation function.