Objective: To evaluate the current situation of thermal environment in primary and secondary school classrooms during winter, and to analyze students thermal comfort needs, so as to provide a basis for improving classroom thermal environment. Methods: From December 16 to 26, 2024, a stratified cluster random sampling method was used to select 90 classrooms from 15 primary and secondary schools in centralized/air conditioned heating areas(Liaoning Province, Tianjin City, Shanghai City) and naturally ventilated areas(Anhui Province and Jiangxi Province)for on site environmental measurement. A questionnaire survey was conducted among 743 students. The differences between groups using the χ 2 test were compared. Based on actual measurement data, a predicted mean vote prepared percentage of dissatisfied (PMV-PPD) model for centralized/air conditioned classrooms and an adaptive model for naturally ventilated classrooms were established, and the thermal neutral temperature and comfort interval were calculated. Results: The average outdoor temperature during on site measurement was 4.00(0.20，7.00)℃. In classrooms with centralized or air conditioned heating systems, the measured average temperature was (19.33±2.59)℃, with a thermal comfort range of 20.35-25.35 ℃ and a thermal neutral temperature of 22.85 ℃. And 13.92% of students reported feeling cold, while 80.80% felt comfortable. In classrooms with natural ventilation, the measured average temperature was (12.26±1.83)℃, with a thermal neutral temperature of 19.67 ℃ and a thermal comfort range of 16.17-23.17 ℃. About 48.33% of students reported feeling cold, and 49.81 % felt comfortable.The results of univariate analysis showed that there were statistically significant differences in shoe thickness, temperature sensation, relative humidity sensation and wind speed sensation between centralized/air conditioned heating areas ( χ 2= 7.01 , 31.47, 13.57, 13.80,all P <0.05). There were also statistically significant differences in school stage for primary and secondary school students, body mass index, classroom location for seat, temperature sensation, relative humidity sensation and wind speed sensation between naturally ventilated areas ( χ 2=42.13, 11.13, 11.04, 60.39, 29.27, 38.46,all P <0.05). Conclusions There are differences in thermal environment and students subjective thermal comfort in primary and secondary schools under different ventilation modes in winter. The temperature standards for heated classrooms should be revised, and differentiated environmental regulation strategies should be adopted based on different ventilation methods to improve students health and comfort levels.

AIM:To investigate the prevalence of visual impairment and its correction status among junior high school students in Xi'an, so as to provide evidence for the development of targeted myopia prevention and control strategies.METHODS: A stratified cluster sampling design was adopted. From March to May 2025, students in grades 7-9 were recruited from three schools in Xi'an, Shaanxi Province, China: Dongfang Middle School, the Middle School Attached to Xi'an University of Technology, and the Xingqing Campus of the High School Affiliated to Xi'an Jiaotong University. In total, 3 974 students were invited, including 1 726 in grade 7, 1 206 in grade 8, and 1 042 in grade 9. The visual acuity was measured monocularly using a 5 m standard logarithmic visual acuity chart, with the fellow eye occluded; the line corresponding to the smallest optotype that could be correctly identified was recorded as the visual acuity value. Non-cycloplegic autorefraction was performed with a desktop autorefractor to obtain spherical equivalent(SE)values for refractive error screening.RESULTS: This study initially included 3 974 students, of whom 32 did not participate in the vision test, resulting in 3 942 students being included in the final analysis. Among them, 3 067(77.80%)were identified with poor vision. The prevalence of myopia was 81.47%(1 746)in males and 87.55%(1 575)in females(P<0.01). A stratified analysis by grade showed myopia rates of 81.72%(1 386)in junior grade one, 84.47%(1 017)in junior grade two, and 88.10%(918)in junior grade three, demonstrating a significant upward trend with increasing grade level(χ2=19.8484, P<0.01). Among the 3 321 myopic students, 2 287 adopted corrective measures. The rates of full correction, under-correction, and non-correction among all myopic students were 48.15%(1 599), 20.71%(688), and 31.14%(1 034), respectively. The rate of non-correction was significantly higher in male students than in females(32.70% vs 29.40%, χ2=4.2222, P<0.05).CONCLUSION: The findings indicate a high prevalence of visual impairment among junior high school students in Xi'an, coupled with suboptimal spectacle-wearing and full-correction rates. There is an urgent need for collaborative efforts across society, schools, and families to implement effective interventions to slow the onset and progression of myopia in this population.

Knee osteoarthritis (KOA) is a common chronic degenerative disease that not only causes pain and reduces the quality of life for patients but also imposes a significant societal burden. Clinical pathways can be developed by referencing recommendations from clinical practice guidelines to localize guidelines within the context of integrated traditional Chinese and western medical systems. However, existing clinical pathways suffer from shortcomings such as deficiencies in integrated traditional Chinese and western medical diagnosis and treatment, inadequate shared decision-making between healthcare providers and patients, and suboptimal visualization of clinical pathways. This study aimed to address and optimize the clinical pathway of KOA by comprehensively organizing and localizing the recommended guidelines. The concept of integrated traditional Chinese and western medicine was reflected through the construction of a path of joint decision-making between doctors and patients, emphasizing the coexistence of diagnosis and screening, the combination of clinical and imaging staging, joint decision-making between doctors and patients, and treatment stages. This pathway emphasizes patient-centered approach, with pain relief and functional rehabilitation running parallel, achieving the implementation of evidence-based concepts in practical medical practice. It provides a concrete basis for joint decision-making between doctors and patients in the integrated treatment of KOA with traditional Chinese and western medicine, which helps to improve diagnosis and treatment efficiency and patient quality of life.

Objective To investigate the application value of different doses of remifentanil combined with sevoflurane under pain threshold index(PTi)monitoring in ambulatory laparoscopic cholecystectomy.Methods 152 patients undergoing laparoscopic cholecystectomy under general anesthesia were selected from December 2023 to June 2024 at the Second Affiliated Hospital of Kunming Medical University.Patients were randomly divided into R1 group(n=38),R2 group(n=38),R3 group(n=38),and R4 group(n=38)using a random number table.On the basis of sevoflurane at 0.7 minimum alveolar concentration(MAC),patients in R1～R4 groups were combined with 0.1,0.2,0.3,and 0.4 μg/kg·min remifentanil,respectively.The changes in PTi at different time points,pre-and post-operative blood stress indicators[cortisol(Cor),norepinephrine(NE),and blood glucose(Glu)concentrations]were compared,and the incidence of intraoperative hypertension,hypotension,tachycardia,bradycardia,and postoperative nausea and vomiting were recorded.Results Compared with R1 group,PTi in R2,R3,and R4 groups decreased from the start of surgery(T3)to 5 min after extubation(T11)(P<0.05);compared with R2 group,PTi in R3 and R4 groups was lower at T3～T11(P<0.05);no statistically significant difference was found in PTi changes between R3 and R4 groups at different time points(P>0.05).Postoperative Cor,NE,and Glu concentrations showed statistically significant differences among the four groups(P<0.001),but no significant difference was found preoperatively(P>0.05).Compared with preoperative values,Cor,NE,and Glu levels significantly increased in all groups(P<0.001),with R1 group>R2 group>R4 group>R3 group.The incidence of intraoperative hypertension,hypotension,bradycardia,and tachycardia showed statistically significant differences(P<0.001),with R4>R1>R2=R3.The incidence of postoperative nausea and vomiting also showed statistically significant differences(P<0.001),with R1 group>R4 group>R2 group>R3 group.Conclusion Sevoflurane at 0.7 MAC combined with 0.3 μg/kg·min remifentanil provides good analgesic effects for patients undergoing ambulatory laparoscopic cholecystectomy,reduces stress response,and has high safety,making it worthy of clinical promotion.

The amino acid sequences of the OmpA protein isolated from Escherichia coli QML2206-1(E.coli QML2206-1)in our laboratory were analyzed for homology with different strains of OmpA proteins using bioinformatics software,and the OmpA protein was analyzed for its physicochemical properties,transmembrane structure and signal peptide prediction,B-cell anti-genic epitope prediction,secondary and tertiary structure prediction.The OmpA gene fragment was ligated with pET-32a vector to construct a prokaryotic expression vector,which was purified by a nickel column affinity purification system after prokaryotic expression and optimization of ex-pression conditions in BL21(DE3).The purified recombinant protein was fully mixed with Freund's adjuvant to immunize mice,and the levels of mouse-specific IgG antibody and the expression levels of cytokines CD4,CD8 and IL-4 in mouse serum were detected by ELISA,and the immuno-protective effect was evaluated by mouse attack protection test.OmpA protein is a hydrophilic protein with no transmembrane structural domains and a secondary structure consisting mainly of irregular coils(47.98％)and α-helices(29.77％),with 12 antigenic epitopes that can bind to anti-bodies produced by B cells.The recombinant protein OmpA with a relative molecular mass of a-bout 55 kDa was successfully obtained by prokaryotic expression,and the highest expression was induced by IPTG concentration of 0.000 4 mmol/L for 6 h at 37 ℃.The serum-specific IgG anti-body potency of recombinant protein immunized mice was up to 1∶32 000;the expression levels of CD4,CD8 and IL-4 in the serum of immunized mice were elevated compared with those of the con-trol group.The survival rate of mice was 80％and 40％after attack with minimum lethal dose(MLD)and 2 times minimum lethal dose(2MLD),respectively.OmpA recombinant protein has good antigenicity and certain immunoprotective effects,and this study provides a technical basis for the next step in the development of a genetically engineered subunit vaccine against yak-appli-cable E.coli based on OmpA protein.

Objective:To review the current research on mechanisms for bone and muscle loss among astronauts in a microgravity environment and predict progress in prevention and treatment. Literature resource and selection Related literature retrieved from CNKI, Wanfang Data, PubMed and other Chinese and English databases that was published as of December 2023. Such key words as weightless, microgravity, bone, muscle and osteoporosis were used. Literature quotation Fifty seven related articles that had been published at home and abroad were included. Literature synthesis The loss of bone and muscle in a microgravity environment was receiving increasing attention in the field of aerospace medicine, but the process of bone and muscle loss was influenced by a range of factors. The microgravity environment altered the function and expression of osteoblasts, osteocytes and osteoclasts, thus impacting bone formation, mineralization and absorption. In addition, the microgravity environment led to muscle cell atrophy, apoptosis, functional decline and degradation of muscle proteins. Complex signaling pathways and molecular regulatory mechanisms existed between bone and muscle cells, and these interactions were disrupted in the microgravity environment. Conclusions:Current strategies for prevention and treatment of bone and muscle loss in a microgravity environment include mechanical stimulation, pharmacologic interventions and nutritional supplementation. More effort is needed to study the related mechanisms and targets.

Objective:This study aims to investigate the differences in emotional status and cognitive function among patients with vestibular migraine (VM), Meniere′s disease (MD), and their comorbidity (VMMD), and to analyze key factors influencing cognitive function.Methods:This cross-sectional study included 96 outpatients (32 males, 64 females, aged 21-73 years) from the Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between December 2022 and December 2023. The study population consisted of 31 VM patients (VM group), 36 MD patients (MD group), and 29 VMMD patients (VMMD group), along with 32 healthy controls (16 males, 16 females, aged 19-74 years). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), while emotional status and somatization symptoms were evaluated through the Generalized Anxiety Disorder scale, Patient Health Questionnaire Depression scale, Symptom Checklist-90, and the Self-rating Somatization Symptom scale. Multiple linear regression analysis was conducted to explore the influence of different variables on cognitive function.Results:The total MoCA score in the VMMD group (26.0 [24.5, 28.0]) was significantly lower than that in the control group (28.0 [27.0, 29.0]) and the MD group (28.0 [26.0, 30.0]) ( P=0.006). VMMD patients exhibited significant impairments in specific cognitive domains, including visuospatial/executive function, delayed recall, and orientation ( P<0.05). Patients with VM, MD, and VMMD showed higher rates of anxiety, depression, and somatization symptoms compared to the control group ( P<0.05), with the VMMD group experiencing the most severe emotional distress. Multiple linear regression analysis identified education level and vestibular disease type as key factors affecting cognitive function, with a university-level education predicting higher MoCA scores ( P<0.001), while VMMD was associated with cognitive decline ( P<0.01). Conclusions:Patients with VM and MD, particularly those with comorbid VMMD, exhibit significant emotional distress. Cognitive impairments are present in VM and VMMD patients, affecting different cognitive domains. These factors should be comprehensively considered in clinical assessments to develop more effective treatment strategies.

Objective:To explore the clinical application value of magnetic resonance imaging (MRI)-guided wire localization to the non-palpable breast lesions (NPBL) identified on MRI only.Methods:A retrospective case series study was conducted. A total of 171 patients with NPBL identified on MRI only who underwent MRI-guided wire localization from April 2017 to May 2024 in Shaanxi Provincial Cancer Hospital were collected. All patients had breast MRI Breast Imaging Report and Data System (BI-RADS) 4a and above lesions, and underwent MRI-guided wire localization within the same menstrual cycle within 2 days to 2 months after diagnostic MRI examination. Based on postoperative pathological results, the MRI characteristics of benign and malignant lesions were compared, and the clinical application value of MRI-guided wire localization was evaluated.Results:There were 179 lesions in 171 patients, including 54 malignant lesions (30.17%) and 125 benign lesions (69.83%). There was no statistically significant difference in the enhancement morphology between pathological benign and malignant NPBL lesions ( χ2 = 0.04, P = 0.982), while there were statistically significant differences in breast background parenchymal enhancement, lesion time-signal intensity curve and BI-RADS classification ( χ2 values were 32.03, 20.72 and 37.60, respectively, all P < 0.05). Conclusions:For NPBL that is identified on MRI only and evaluated as BI-RDADS 4a or above, MRI-guided wire localization can improve the accuracy of diagnosis and treatment of intraductal carcinoma, early invasive cancer and high-risk lesions.

Objective:To investigate the expression of cellular repressor of E1A-stimulated gene 2 (CREG2) in colon adenocarcinoma (COAD) and its relationship with prognosis and tumor immune microenvironment.Methods:CREG2 mRNA expression data and survival data of patients were collected from 23 pan-cancer cohorts including COAD in the University of California, Santa Cruz (UCSC) database. The difference of CREG2 mRNA expression levels in cancer tissues and paracancerous tissues was compared. Univariate Cox proportional risk model was used to analyze the correlation of high and low expressions of CREG2 mRNA in pan-cancer tissues with the overall survival (OS) of patients; taking the pathological results as the gold standard, the optimal cut-off value of CREG2 mRNA expression level in cancerous and paracancerous tissues obtained by receiver operating characteristic (ROC) curve was used to group the high and low expressions. Kaplan-Meier method was used to draw the OS curve of pan-cancer CREG2 mRNA high and low expression groups, and log-rank test was used for comparison between groups. The data of patients with complete clinical data of the COAD cohort were further extracted from the UCSC database. The distribution of patients with high and low CREG2 mRNA expressions stratified by different clinicopathological characteristics of different groups was compared. Kaplan-Meier method was used to analyze the OS of patients with high and low CREG2 mRNA expressions as well as the OS of patients stratified by different clinicopathological characteristics, and log-rank test was used for comparison between groups; multivariate Cox proportional risk model was used to screen the independent factors influencing the OS of COAD patients. The chips of cancer tissues and the corresponding paracancerous tissues from 58 COAD patients were collected for immunohistochemical staining. CREG2 protein expression level between the cancer tissues and paracancerous tissues was compared. The product of the proportion of positive cells and the staining intensity score was treated as the CREG2 protein expression level in the tissues; taking pathological results as the gold standard, the ROC curve was used to analyze the therapeutic efficacy of CREG2 protein level in judging cancer tissues and paracancerous tissues. Based on the tumor immune assessment resource (TIMER) database, Pearson function was used to analyze the correlation between the CREG2 mRNA expression and the degree of immune cell infiltration in COAD tissues. ESTIMATE algorithm was used to obtain each immune infiltration score, and the immune infiltration score was compared between the CREG2 mRNA high and low expression groups.Results:In the 23 pan-cancer cohorts of UCSC database, the CREG2 mRNA expression level in 17 cohort cancer tissues including COAD was higher than that in paracancerous tissues, and the CREG2 mRNA expression level in 3 cohort cancer tissues including glioma was lower than that in paracancerous tissues, and the differences were statistically significant (all P < 0.05). Univariate Cox regression analysis showed that the OS of patients with high CREG2 mRNA expression was worse than that in those with low CREG2 mRNA expression in 5 cohort cancer tissues including COAD (236 cases, HR = 1.13, 95% CI: 1.01-1.26, P = 0.030), and in glioma cohorts (553 cases, HR = 0.90, 95% CI: 0.85-0.95, P < 0.001), the OS of patients with low CREG2 mRNA expression was worse than that in those with high CREG2 mRNA expression. Kaplan-Meier analysis also showed that the OS of COAD, lung adenocarcinoma, renal papillary cell carcinoma, and hepatocellular carcinoma patients with high CREG2 mRNA expression was worse than that of those with low CREG2 mRNA expression, and the OS of glioma patients with high CREG2 mRNA expression was better than that of those with low CREG2 mRNA expression. In the UCSC database, CREG2 mRNA expression level in 222 COAD patients with complete clinical data was higher than that in paracancerous normal tissues. The proportion of patients with high CREG2 mRNA expression in mismatch repair deficient patients with COAD was higher than that in mismatch repair normal patients [87.2% (34/39) vs. 69.4% (127/183)], and the difference was statistically significant ( P = 0.024). There were no statistically significant differences in the proportion of patients with high CREG2 mRNA expression among patients stratified by age, gender and pathological stage (all P > 0.05). Kaplan-Meier analysis showed that patients with pathological stage Ⅲ-Ⅳ, stage T 4, lymph node metastasis, distant metastasis, and high CREG2 mRNA expression had poor OS, and the differences were statistically significant (all P < 0.05); and multivariate Cox regression analysis showed that distant metastasis ( HR = 3.61, 95% CI: 1.81-7.23, P < 0.01) and high CREG2 mRNA expression ( HR = 4.29, 95% CI: 1.69-10.93, P < 0.01) were independent risk factors for poor OS in COAD patients. The result of immunohistochemistry method detection of clinical samples showed that in cancer and paracancerous tissues, CREG2 protein was mainly expressed in the cytoplasm, and the expression level of CREG2 protein in COAD tissues was higher than that in corresponding paracancerous tissues (164±23 vs. 146±24, P < 0.001). ROC curve analysis showed that CREG2 protein expression in COAD tissues could be used to judge cancer and paracancerous tissues (the area under the curve = 0.720, 95% CI: 0.628-0.814, P < 0.001). The analysis of the data in TIMER database showed that CREG2 expression level in COAD tissues was correlated with infiltration levels of CD8 + T cells ( R = 0.158, P = 0.001), CD4 + T cells ( R = 0.125, P = 0.012), macrophages ( R = 0.202, P < 0.001), neutrophils ( R = 0.248, P < 0.001), and dentritic cells ( R = 0.265, P < 0.001). The matrix score and estimated score in the high CREG2 expression group were higher than those in the low expression group, and the differences were statistically significant (all P < 0.05). Conclusions:CREG2 gene is highly expressed in COAD tissues, and its high expression may be related to the poor prognosis of COAD patients. The microenvironment of COAD with high CREG2 expression has a higher abundance of stromal cells, and CREG2 may be involved in immune regulation and immune response.

To review the randomized controlled trials (RCTs) at home and abroad on digital intelligence (DI)-driven rehabilitation in patients of neuromuscular disease, compare the effects of DI-driven rehabilitation with traditional rehabilitation, summarize the special needs and challenges faced by patients in rehabilitation of rare neuromuscular diseases, and provide evidence for the development and quality improvement of rehabilitation for rare neuromuscular diseases.