Background Climate change poses a significant threat to public health. In China, relevant health intervention research is still in its early stages, and evidence for evaluating the effectiveness of regional climate change health adaptation strategies and measures is scarce. Objective To investigate the level of climate change-related health literacy among residents in Shenzhen, implement targeted health interventions, and assess the intervention effects as well as their influencing factors. Methods From July 2023 to January 2024, 4 communities were randomly selected in Shenzhen, and a total of 896 community residents were enrolled and divided into an intervention group (444 participants) and a control group (452 participants). Baseline and follow-up surveys on climate change-related health literacy were conducted among residents for both groups. During the period between the two surveys, the intervention group received targeted health interventions. Health literacy—comprising 3 dimensions: basic health knowledge and concepts, basic health skills, and healthy lifestyles—was defined as achieving ≥80% of the total score. A differences-in-differences model was adopted to analyze the impact of the intervention, and multiple linear regression was used to explore the factors influencing the intervention effect. Results The baseline survey showed that 240 out of the 896 surveyed residents (26.79%) possessed climate change health literacy. For the 3 dimensions, the number of residents and the proportions with corresponding literacy in descending order were: basic health skills (521, 58.15%), healthy lifestyles (345, 38.50%), and basic health knowledge and concepts (44, 4.91%). After the intervention, the intervention group showed a 3.19% increase in the total health literacy score, a 3.55% increase in basic health knowledge and concepts, and a 4.24% increase in basic health skills (t=2.79, 2.77, and 2.47 respectively) (P<0.05). No significant change was observed in healthy lifestyle scores (t=0.70, P>0.05). Further analysis showed that awareness of the “dual carbon goals” and occupation were significantly associated with the intervention effect on overall health literacy (P<0.05). For basic health knowledge and concepts, occupation, history of chronic diseases, and awareness of the “dual carbon goals” had statistically significant effects on the intervention outcomes (P<0.05). Regarding basic health skills, awareness of the “dual carbon goals” significantly influenced the intervention effect (P<0.001). In terms of healthy lifestyles, gender, educational level, occupation, and awareness of climate change were significantly associated with the intervention effect (P<0.05). Conclusion The climate change-related health literacy among community residents in Shenzhen is in urgent need of improvement. Health interventions can effectively enhance residents' basic health knowledge and concepts, basic health skills, and overall literacy level. In the future, it is necessary to strengthen the popularization of climate change health knowledge based on different population characteristics and further optimize intervention strategies, to comprehensively improve residents' health adaptation capacity to climate change.

Objective:To investigate the impacts of the radiosensitivity of cell lines on a microdosimetric kinetic model (MKM) used in carbon-ion radiotherapy.Methods:The saturation-corrected specific energy ( ) of monoenergetic carbon ions was calculated using the Kiefer-Chatterjee (K-C) track structure model. Correction curve f(LET) was derived from experimental data on relative biological effectiveness (RBE) (RBE DSB-LET) defined based on the double-strand DNA break of the Chinese hamster ovary (CHO) and Fibroblast cell lines irradiated using carbon ions with varying linear energy transfer (LET) values. Then, based on the MKM, the D10-LET curves, as well as α and β databases, of the CHO and Fibroblast cell lines with varying radiosensitivity were determined. Results:Compared to the clinically applied MKM, the predicted D10 after correction while accounting for cell line radiosensitivity agreed better with experimental D10 values of the CHO and Fibroblast cell lines. Specifically, compared to experimental values in the literature, the D10 values calculated in the study and determined using the MKM showed mean squared errors (MSEs) of 0.04 and 0.71, for the CHO cell line and 0.35 and 0.55, respectively, for the Fibroblast cell line. For monoenergetic carbon ions with varying LET values, the calculated α and β values generally increased with cellular radiosensitivity. Conclusions:Incorporating cellular radiosensitivity into the MKM framework serves as a more specific method for RBE assessment while also providing a reference for advancing MKM applications and achieving the fine-scale calculations of RBE in carbon-ion radiotherapy.

The patients with skeletal class Ⅱ malocclusion are often accompanied by structural and functional abnormalities of the upper airway,and obstructive sleep apnea hypopnea syndrome(OSAHS)may occur in severe cases.The morphologic and fluid dynamic changes of the upper airway in one patient with skeletal class Ⅱ malocclusion accompanied by OSAHS after maxillomandibular advancement(MMA)surgery were observed.The patient was a 27-year-old male with skeletal class Ⅱ malocclusion and moderate OSAHS.Combined orthodontic and orthognathic treatment was conducted,involving the anterior movement of the maxilla and mandible.After surgery,the patient's facial and intraoral features showed a satisfactory occlusion relationship with normal overbite,overjet and canine-molar relationships.There was also a significant improvement in the upper airway flow field.Two years after surgery,the cross-sectional area of the nasopharyngeal airway increased by 10.76％with a 55.36％reduction in pressure.The oropharyngeal airway showed a 108.25％increase in cross-sectional area with a 98.14％pressure reduction.The hypopharyngeal airway exhibited a 97.51％increase in cross-sectional area with a 351.03％pressure reduction.The laryngopharyngeal airway demonstrated a 27.54％increase in cross-sectional area with a 95.62％pressure reduction.The apnea-hypopnea index(AHI)decreased by 55.45％,achieving the treatment goal.Morphological measurements combined with fluid dynamic analysis can comprehensively evaluate the condition of the upper airway.The approximate value of the critical closing pressure(Pcrit)obtained from computational fluid dynamics(CFD)analysis may serve as a simple quantitative indicator for assessing the upper airway condition.

Objective To explore potential association between sedentary time and the risk of all-cause mortality and cardiovascular disease(CVD)in Chinese population using data from the Prospective Urban Rural Epidemiology(PURE-China)cohort study.Methods Baseline data were collected,from 2022 standardized questionnaires and physical examinations,with follow-up until August 31,2022.The primary endpoints were all-cause mortality and cardiovascular events(non-fatal myocardial infarction,stroke or heart failure).Multivariable Cox shared frailty model was used to analyze the association between sedentary time and the risks of all-cause mortality and CVD in the target population,and to compare differences across subgroups based on gender,age and geographic location.Results A total of 47 931 participants were recruited,and 43 367 were included in the final analysis.Over a me-dian follow-up of 11.9±3.0 years,2 277 participants experienced all-cause mortality,3 551 experienced cardiovas-cular events.The Cox model indicated that,compared to individuals with less than 4 h of sedentary time per day,those with 6-8 h had a 23％increased in risk of all-cause mortality(HR=1.23,95％CI:1.06-1.44)and an 18％increased risk of CVD(HR=1.18,95％CI:1.04-1.33).For individuals with more than 8 h of sedentary time,the risk increased by 50％for all-cause mortality(HR=1.50,95％CI:1.16-1.94)and 44％for CVD(HR=1.44,95％CI:1.16-1.79).These associations were more pronounced in men and individuals aged 50 years and older.Conclusions Sedentary behavior is associated with an increased risk of all-cause mortality and cardiovascular disease in Chinese population,especially in the population with sedentary time of 6 hrs or more per day.Reducing sedentary time and increasing physical activity is an important strategy to mitigate the disease burden of cardiovascular disease and premature death.

Objective:To investigate the impacts of the radiosensitivity of cell lines on a microdosimetric kinetic model (MKM) used in carbon-ion radiotherapy.Methods:The saturation-corrected specific energy ( ) of monoenergetic carbon ions was calculated using the Kiefer-Chatterjee (K-C) track structure model. Correction curve f(LET) was derived from experimental data on relative biological effectiveness (RBE) (RBE DSB-LET) defined based on the double-strand DNA break of the Chinese hamster ovary (CHO) and Fibroblast cell lines irradiated using carbon ions with varying linear energy transfer (LET) values. Then, based on the MKM, the D10-LET curves, as well as α and β databases, of the CHO and Fibroblast cell lines with varying radiosensitivity were determined. Results:Compared to the clinically applied MKM, the predicted D10 after correction while accounting for cell line radiosensitivity agreed better with experimental D10 values of the CHO and Fibroblast cell lines. Specifically, compared to experimental values in the literature, the D10 values calculated in the study and determined using the MKM showed mean squared errors (MSEs) of 0.04 and 0.71, for the CHO cell line and 0.35 and 0.55, respectively, for the Fibroblast cell line. For monoenergetic carbon ions with varying LET values, the calculated α and β values generally increased with cellular radiosensitivity. Conclusions:Incorporating cellular radiosensitivity into the MKM framework serves as a more specific method for RBE assessment while also providing a reference for advancing MKM applications and achieving the fine-scale calculations of RBE in carbon-ion radiotherapy.

[摘 要] 目的：探讨免疫检查点抑制剂（ICI）治疗非小细胞肺癌（NSCLC）患者发生免疫检查点抑制剂相关性肺炎（CIP）的发生情况和免疫治疗疗效的关系，分析接受ICI治疗的NSCLC患者的预后相关因素。方法：回顾性分析2020年3月至2023年3月在新疆医科大学附属肿瘤医院接受ICI治疗145例NSCLC患者的临床资料，将患者分为CIP组和非CIP组，随后将发生CIP的患者分为轻度（1、2级）CIP和重度（3、4级）CIP两个亚组，通过Kaplan-Meier法比较生存曲线，分析CIP的发生及严重程度对于患者PFS及OS的影响。通过单因素及多因素COX风险比例回归模型分析与PFS和OS相关的预后因素。结果：145例患者中有26例患者出现CIP，发生率为17.93％，重度CIP发生率为3.45%。CIP组患者PFS明显长于非CIP组患者（12.3 vs 7.6个月，P<0.05），CIP组与非CIP组的OS比较差异无统计学意义（16.2 vs 15.8个月，P>0.05)。亚组分析显示，轻度CIP和重度CIP相比，PFS（12.2 vs 12.9个月）及OS（16.1 vs 17.8个月）均无统计学意义（均P>0.05）。多因素COX回归分析显示，CIP[HR=0.55，95%CI（0.33, 0.90），P=0.02]、免疫疗程>6个[HR=0.51，95%CI（0.31, 0.85），P=0.01]是影响患者PFS的有利预后因素，免疫疗程>6个[HR=0.4，95%CI（0.18, 0.88），P=0.02]是影响OS的有利预后因素。结论：CIP的发生率为17.93％，CIP的发生与PFS的延长密切相关。免疫疗程>6个是影响NSCLC患者PFS、OS的有利预后因素。

Objective:To evaluate the effect of hyperthermia on radiation pneumonitis (RP) in elderly patients with esophageal cancer undergoing intensity-modulated radiotherapy (IMRT).Methods:Clinical data of 177 elderly esophageal cancer patients (aged ≥60 years) receiving IMRT in the First Affiliated Hospital of Soochow University and Yixing Cancer Hospital from August 1, 2017 to February 6, 2023 were retrospectively analyzed. Patients were divided into the hyperthermia and non-hyperthermia groups based on whether they received hyperthermia treatment. Patients in two groups received IMRT with 6 MV X-rays. Patients in the hyperthermia group underwent high-frequency hyperthermia within 1 h before radiation using the external thermotherapy device HG-2000Ⅲ (heating temperature: 41-43 ℃ for 40 min, twice a week). After adjusting for confounding factors between two groups using propensity score matching (PSM), the short-term effective rates between two groups were compared using Chi-square test. Univariate analysis and logistic multivariate analysis were employed to compare the incidence of RP between two groups. Results:After applying PSM, 42 pairs were successfully matched, and the baseline data and radiotherapy parameters showed no statistically significant differences between two groups (all P>0.05). The objective response rate (ORR) in the hyperthermia group was significantly higher than that in the non-hyperthermia group (83.3% vs. 64.3%, P=0.047). Univariate analysis revealed that the incidence of RP and symptomatic RP (≥ grade 2) in the hyperthermia group was significantly lower than that in the non-hyperthermia group (61.9% vs. 85.7%, P=0.013; 21.4% vs. 47.6%, P=0.012). Logistic multivariate analysis indicated that hyperthermia was an independent protective factor for symptomatic RP ( P=0.011). Conclusions:The incidence and severity of RP in elderly esophageal cancer patients receiving IMRT can be reduced by hyperthermia. Hyperthermia, as a clinically beneficial green treatment, improves efficacy and reduces toxicity for patients with esophageal cancer.

Objective:To systematically evaluate the qualitative research on experience of fear of falling in the elderly, so as to provide theoretical basis for nursing practice.Methods:Qualitative researches on the fear of falling among the elderly were systematically searched in PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biology Medicine disc. The search period was from database establishment to November 5, 2023. The quality of literature was evaluated using the quality evaluation criteria for qualitative research of the Australia Joanna Briggs Institute Evidence-Based Health Care Center, and the results were integrated using the Meta-synthesis.Results:A total of 13 articles were included, 44 themes were extracted, categorized into 12 categories, and refined into four integrated results, namely perception of fear of falling, influencing factors of fear of falling, coping strategies in attitude and behavior, and multidimensional needs for rehabilitation nursing.Conclusions:Medical and nursing staff should pay attention to and understand the fear of falling among the elderly, evaluate their fear of falling from multiple dimensions and dynamically, provide personalized guidance based on coping behaviors, create support systems to alleviate their fear of falling and meet their multidimensional needs, so as to improve their quality of life.

Objective To explore the relationship between lactate dehydrogenase to albumin ratio(LAR)and short-term prognosis in patients with sepsis-associated acute kidney injury(AKI).Methods A retrospective analysis was conducted on 463 sepsis patients treated in the intensive care unit(ICU)of Beijing Shijitan Hospital,Capital Medical University,from January 2018 to June 2022.The patients were divided into two groups:a group with secondary AKI(AKI group)and the one without acute kidney injury(non-AKI group).Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ),Sequential Organ Failure Assessment(SOFA),and levels of procalcitonin(PCT),C-reactive protein(CRP),serum creatinine(SCr),lactate dehydrogenase(LDH),and albumin(ALB)were compared between the two groups.Multivariate logistic regression analysis was used to determine prognostic factors for sepsis-associated acute kidney injury,and Receiver Operating Characteristic(ROC)analysis was performed to assess the predictive value of APACHE Ⅱ score,SOFA score,PCT,SCr,and lactate dehydrogenase to albumin ratio(LAR)for short-term prognosis of sepsis-associated acute kidney injury.Results The 28-day mortality rate in the non-AKI group was lower than that in the AKI group,and the length of stay in ICU was shorter in the non-AKI group than in the AKI group(P<0.05).APACHE Ⅱ score,SOFA score,PCT,SCr and LAR were independent influencing factors for 28-days death in patients with sepsis-associated acute kidney injury.The ROC curve analysis showed that LAR level had a higher predictive value for short-term prognosis in patients with sepsis-associated AKI as compared with APACHE Ⅱ score,SOFA score,PCT,and SCr.Conclusions LAR is an independent risk factor for sepsis-associated AKI and is associated with 28-day mortality in patients.

Objective:To discuss the effect of concentrated growth factor(CGF)on the performance of bone marrow mesenchymal stem cells(BMSCs)sheets,and to clarify the role of CGF-containing composite cell sheets(CS)in the bone defect repairment.Methods:In in vitro experiments,the BMSCs were isolated and cultured from two 3-week-old SD rats;Alizarin Red S and Oil Red O staining were used to identify the osteogenic and adipogenic capabilities of BMSCs;CGF liquid extracts(CGFe)was prepared from three 3-week-old SD rats.The cells were divided into control group,traditional CS(BMSC-CS)group,and CGF-containing composite CS(CGF/BMSC-CS)group.The morphology of the CS in two groups was observed by HE staining.Alizarin Red and alkaline phosphatase(ALP)staining were used to detect the osteogenic differentiation of the CS in various groups;cell scratch assay was used to detect the migration abilities of the cells in various groups;real-time fluorescence quantitative PCR(RT-qPCR)method was used to detect the mRNA expression levels of ALP,collagen are type 1(COL-1),Runt-related transcription factor 2(RUNX2),and osteocalcin(OCN)in the cells in various groups.In in vivo experiments,15 SD rats were randomly divided into control group,BMSC-CS group,and CGF/BMSC-CS group;micro computed tomography(Micro-CT)was used to detect the bone formation parameters in skull defects of the rats in various groups;HE staining and Masson staining were used to observe the morphology of skull defect tissue of the rats in various groups.Results:The third-generation BMSCs were spindle-shaped,closely arranged,and grew in a vortex cluster.The Alizarin red staining results showed obvious calcium nodules,and the Oil red O staining showed red lipid droplets,confirming the cells'ability to undergo osteogenic and adipogenic differentiation.The CS were white and semi-transparent,with slightly curled edges.The peeled CS were irregularly curled and wrinkled.Compared with BMSC-CS group,the CS in CGF/BMSC-CS group were whiter,less transparent,significantly increased in thickness and extensibility,less prone to breakage,and had a certain degree of stickiness and plasticity.The HE staining results showed that compared with BMSC-CS group,the number of the cells of CS in CGF/BMSC-CS group was increased,with denser arrangement and more abundant extracellular matrix(ECM),which wrapped and connected the cells to form an integral sheet-like structure.The Alizarin red and ALP staining results showed that compared with control group,the ALP activity and mineralization uplift value of CS in BMSC-CS group were significantly increased(P<0.05);compared with control group and BMSC-CS group,the number of osteoblasts and red mineralized nodules in the CS in CGF/BMSC-CS group was significantly increased,with obvious deepening of the staining,increased positive area,and the ALP activity and mineralization uplift value were significantly increased(P<0.05).Compared with BMSC-CS group,the ALP activity and mineralization uplif value of the CS in CGF/DMSC-CS group were increased(P<0.05).The cell scratch assay results showed that after 24 of culture,compared with control group,the migration rates of the cells in BMSC-CS group and CGF/BMSC-CS group were significantly increased(P<0.05).Compared with BMSC-CS group,the migration rate of the cells in CGF/BMSC-CS group was significantly increased(P<0.01).After 48 h of culture,compared with control group,the migration rate of the cells in CGF/BMSC-CS group was significantly increased(P<0.05).The RT-qPCR results showed that compared with control group,the expression levels of COL-1 and OCN mRNA in the cells in BMSC-CS group were significantly increased(P<0.01),and the expression levels of ALP,COL-1,OCN,and RUNX2 mRNA in the cells in CGF/BMSC-CS group were significantly increased(P<0.01).Compared with BMSC-CS group,the expression levels of ALP,COL-1,and OCN mRNA in the cells in CGF/BMSC-CS group were significantly increased(P<0.01).The Micro-CT detection results showed that in control group,the boundary of the rat skull defect area was clear,with almost no new bone formation.In BMSC-CS group,a small amount of new bone formed only at the edge of the bone defect in skull of the rats,with a significant gap in the central area of the defect.In CGF/BMSC-CS group,new bone formed along the edge of the bone defect towards the central area in skull of the rats,repairing most of the bone defect.Compared with control group,the bone volume(BV)and trabecular number(Tb.N)of the rats in BMSC-CS group were significantly increased(P<0.05);the bone volume(BV),bone volume fraction[BV/tissue volume(TV)],trabecular thickness(Tb.Th),and trabecular number(Tb.N)in skull of the rats in CGF/BMSC-CS group,were significantly increased(P<0.05).Compared with BMSC-CS group,the BV,BV/TV,Tb.Th,and Tb.N in skull of the rats in CGF/BMSC-CS group were significantly increased(P<0.01).The HE and Masson staining observation showed that in control group,almost no new bone formed in the skull defect tissue of the rats,with only a large amount of collagen fibers connecting the two sides of the bone ends.In BMSC-CS group,a small amount of new bone formed only at the edge of the bone defect in skull tissue of the rats,with the central area of the defect containing dense collagen fibers connected to the newly formed bone at the defect edge.In CGF/BMSC-CS group,new bone tissue could be seen at the edge of the bone defect,and bone islands formed in the central area of the defect,surrounded by osteocytes and a large amount of collagen fibers.The Masson staining observation results showed that the cytoplasm and osteoid were red,and the collagen was blue.In CGF/BMSC-CS group,newly formed osteoid was observed in skull defect tissue of the rats,with the highest amount of new bone formation.Conclusion:CGF can promote the osteogenic differentiation and increase the richness of ECM in BMSCs sheets.CGF-containing composite CS can efficiently repair skull defects of the rats and serve as an ideal and safe material for promoting the bone regeneration.