Objective To investigate the relationship between the comorbidity of dyslipidemia, hypertension and diabetes and lifestyle of adult residents in Hebei Province in 2018, and to provide reference for the development of chronic diseases prevention measures. Methods Using data from the surveillance of chronic diseases and their risk factors among adults in Hebei in 2018, 7 711 permanent residents aged ≥18 years were selected as the research subjects. Multivariate logistic regression analysis was used to analyze the relationship between the comorbidity of dyslipidemia, hypertension, and diabetes and lifestyle in adult residents. Results A total of 7 711 subjects aged ≥18 years were included in 2018. The comorbidity rates of hypertension and dyslipidemia, diabetes and dyslipidemia, and hypertension and diabetes were 16.88%, 7.91%, and 8.13%, respectively. The comorbidity rate of hypertension, diabetes, and dyslipidemia was 22.65%. These comorbidity rates increased with age and BMI. Multivariate logistic regression results showed that male, age, overweight/obesity, physical inactivity, daily sedentary behavior time ≥5 hours, and sleep problems were risk factors for the comorbidity of the "three highs". Conclusion The prevalence of the "three highs" comorbidities is relatively high in Hebei Province, and there are multiple common risk factors. Maintaining a healthy lifestyle and implementing comprehensive prevention and control measures are the key to improving the health level of residents.

Objective To analyze the prevalence of hyperuricemia (HUA) among adults in Hebei Province and its influencing factors related to comorbidities with ^“three highs^”, and to provide a theoretical basis for the prevention and control of HUA and multi-disease co-management. Methods Data were derived from the 2018 China Chronic Disease and Risk Factors Surveillance program conducted in Hebei Province. A multi-stage stratified cluster random sampling method was used to select permanent residents aged ≥18 years. All statistical analyses were adjusted for complex weighting. Design-based logistic regression was employed to analyze factors influencing HUA prevalence, and ordinal logistic regression was used to analyze the influencing factors of HUA patients and their comorbidity with ^“three highs^”. Results The prevalence of HUA among adults in Hebei Province was 10.42%, with males showing higher rates than females (P<0.05). The highest prevalence of HUA was observed in the 18-39 age group, followed by a declining trend, and a resurgence in those aged ≥70 (P<0.05). Among HUA patients with comorbidities, isolated HUA, 1 comorbidity, 2 comorbidities, and 3 comorbidities accounted for 13.94%, 33.33%, 39.17%, and 13.56%, respectively. HUA combined with hypertension and dyslipidemia represented the highest proportion (31.07%). Analysis of the influencing factors of HUA revealed that higher education levels, obesity, central obesity, and dyslipidemia increased the risk of HUA (P<0.05). Ordinal logistic regression analysis of HUA combined with three highs showed that HUA patients aged ≥50 years, overweight individuals, and those with chronic kidney disease had a higher number of patients with three highs (P<0.05). Conclusion HUA exhibits insidious onset, and it is recommended to include uric acid testing in routine physical examinations. Targeted prevention measures, such as early uric acid testing and health education, should be implemented by Hebei authorities for populations with higher education levels, obesity, central obesity, and dyslipidemia to reduce HUA incidence. Additionally, health education and regular medical check-ups are recommended for overweight HUA patients and those with chronic kidney disease to prevent comorbidities and alleviate disease burden.

Coronary heart disease （CHD） has a distinct circadian rhythmicity in its onset， which is closely related to the waxing and waning of qi and blood in the channel passages of the human body. Grounded in the circadian rhythm theory of "correspondence between heaven and humankind"， this paper explores the pathogenic evolution rules of qi-blood disharmony， channel obstruction， interacting as cause and effect with circadian rhythm disorders in CHD. Clinically， CHD can be observed to attack in the early morning， at night， in the afternoon， and at fixed or unfixed circadian intervals. The pathogenesis rhythms at different time nodes can correspondingly reflect the susceptibility tendencies and pathological stress responses of the human body to core pathogeneses such as yang deficiency with cold congelation， yin deficiency with yang floating， qi and yin deficiency， and liver constraint with qi stagnation under specific temporal states. Treatment should be adapted to the season and time， regulating yin and yang in accordance with biological rhythms. It is recommended to regulate qi during the daytime by promoting ascending and dispersing to unblock the channel passages， and select the appropriate timing for administration to harness natural timing. At the Mao （卯） hour， yang ascends while yin descends， and taking medication at this time conforms to the ascending of yang qi. At the Wu （午） hour， the heart meridian is active， and taking medication at this time warms the channel passages and assists heart yang， which can be treated with modified Buzhong Yiqi Decoction （补中益气汤） or Shengyang Yiwei Decoction （升阳益胃汤）. At night， blood should be harmonized， when the channel passages are unblocked through nourishing， restraining， and searching， with Lianmei Decoction （连梅汤） combined with Dahuang Zhechong Pill （大黄䗪虫丸）. Following the temporal rhythm， the focus is put on the transitional time of day and night and the four seasons to treat disease before it arises， resonating and corresponding with the natural rhythm.

Objective:To explore the predictive value of human cartilage glycoprotein 39 (YKL-40) and growth differentiation factor 15 (GDF-15) for clinical outcomes of patients with Parkinson disease (PD).Methods:A total of 109 patients with PD admitted to Xinxiang Central Hospital from February 2021 to February 2023 were selected and treated with regular anti-PD medications for 4 weeks, with dosage appropriately adjusted according to clinical status and individual response.Clinical outcomes were evaluated after 2 months of treatment, and the predictive value of serum YKL-40 and GDF-15 at admission for clinical outcomes was analyzed.Data were analyzed by independent sample t-test, χ2 test and Logistic regression using SPSS 26.0. Results:PD patients with poor outcomes exhibited higher serum levels of YKL-40((3.18±0.67)mg/L, (2.34±0.41)mg/L) and GDF-15((457.82±142.83)pg/mL, (282.95±105.96)pg/mL) than those with good outcomes, and the differences were statistically significant ( t=8.082, 7.349, both P<0.05).Logistic regression analysis showed that elevated serum levels of YKL-40( B=0.664, OR=1.943, 95% CI=1.237-3.052) and GDF-15( B=0.185, OR=1.787, 95% CI=1.145-2.789) both influenced the clinical outcomes of PD patients(both P<0.05).Serum YKL-40 combined with GDF-15 demonstrated a predictive sensitivity of 87.23%, specificity of 90.32%, and AUC of 0.927(95% CI=0.861-0.968) for clinical outcomes in PD patients.The AUC was significantly higher than that achieved by either indicator alone (YKL-40: AUC (95% CI)=0.722 (0.628-0.804); GDF-15: AUC (95% CI)=0.797 (0.709-0.868)). Conclusion:The elevated levels of YKL-40 and GDF-15 in PD patients are associated with clinical outcomes, which may be the potential markers for predicting clinical outcomes of patients with PD.

Objective:To analyze the prevalence of chronic kidney disease (CKD) and influencing factors of adults in Hebei Province, and provide scientific evidence for the development of comprehensive CKD prevention and control strategies.Methods:In China Adult Chronic Disease and Nutrition Surveillance in Hebei in 2018, a total of 7 562 permanent residents aged ≥18 years were selected by multi-stage stratified cluster random sampling from 13 surveillance points in Hebei for questionnaire survey, medical examination and laboratory test.Results:A total of 1 067 CKD patients were detected in the adults aged ≥18 years in this survey, with a weighted prevalence rate of 12.10%. The results of multivariate analysis showed that the daily total static behavior time ( OR=1.07, 95% CI: 1.04-1.09), living in rural area ( OR=1.50, 95% CI: 1.14-1.97), coal use ( OR=1.37, 95% CI: 1.16-1.61), coal gas/liquefied gas/natural gas/biogas use ( OR=2.92, 95% CI: 2.40-3.54) and solar energy/electricity use ( OR=1.75, 95% CI: 1.36-2.25), insufficient fruit intake ( OR=1.39, 95% CI: 1.06-1.83), insufficient physical activity ( OR=1.35, 95% CI: 1.11-1.64), suffering from hypertension ( OR=1.80, 95% CI: 1.44-2.24) and suffering from diabetes ( OR=1.77, 95% CI: 1.27-2.45) were risk factors for CKD in adults in Hebei. High education level ( OR=0.41, 95% CI: 0.19-0.91), excessive drinking ( OR=0.53, 95% CI: 0.28-0.99), central obesity ( OR=0.75, 95% CI: 0.58-0.97), history of allergic diseases ( OR=0.44, 95% CI: 0.27-0.72) were protective factors for CKD. Conclusions:The prevalence of CKD in adults in Hebei was relatively high, especially in those who had too long average daily static behavior, lived in rural area, used coal, gas/liquefied gas/natural gas/biogas, solar energy/electricity, had inadequate intake of fruits, lacked physical activity and suffered from hypertension and diabetes. It is necessary to pay attention to the early prevention and treatment of CKD, strengthen the health education about healthy lifestyle and improve the management of patients with chronic disease, such as hypertension and diabetes, to further reduce the risk for CKD.

Objective:To analyze the effect of precipitation on road traffic injuries (RTI) in Zhejiang Province.Methods:The RTI surveillance and meteorological data from 2009 to 2022 in Zhejiang Province were collected. Based on the time-stratified case-crossover design, the precipitation of case day and control day was compared, and the distributed lag nonlinear model was applied to analyze the correlation of precipitation and RTI. Stratified analyses were conducted to analyze the effect modification of gender, age, injury location, and temperature. An attributable fraction was used to assess the burden of RTI caused by precipitation.Results:A total of 239 970 RTIs were monitored in Zhejiang Province from 2009 to 2022, averaging 46 daily cases. The distributed lag nonlinear model showed that compared with no rain, the risk of RTI increased first and then decreased with the increase of precipitation. The risk of RTI was the highest when the precipitation was 30.99 mm ( OR=1.08, 95% CI: 1.05-1.11). The adverse effects on RTI mainly occurred on the day of precipitation, and it showed insignificant or protective effects with the extension of lag days. 1.34%(95% CI: 1.31%-1.36%) of RTI could be attributed to precipitation. Stratified analysis showed that gender, age, injury location, and temperature may modify the effect of precipitation on RTI. Precipitation caused a heavier burden on RTI in subgroups aged 18-64, females, and occurring on roads and in low temperatures. Conclusions:Precipitation can increase the risk of RTI. People aged 18-64 or females are the key groups for RTI prevention, and prevention and control efforts of precipitation-related RTI should be increased in road and low-temperature environments.

Objective:To evaluate the influence of different positive end-expiratory pressure on the ventilation of laryngeal mask airway in pediatric patients undergoing laparoscopic surgery through ultrasound assessment.Methods:In this randomized controlled trial, 90 pediatric patients of both sexes, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, aged 2-10 yr, with a body mass index of 12-22 kg/m 2, scheduled for elective laparoscopic surgery, were divided into 3 groups ( n=30 each) by a random number table method: group P0, group P3, and group P5. Each group adopted the pressure-controlled mode with an inspiration/expiration ratio of 1∶2, a flow rate of 2 L/min, and a respiratory rate of 16-26 breaths/min. The positive end-expiratory pressure was set at 0, 3 and 5 cmH 2O(1 cmH 2O=0.098 kPa) in P0, P3 and P5 groups respectively. The ultrasonic scores and misalignment rate of the laryngeal mask airway were recorded every 5 min following the pneumoperitoneum, and the occurrence of intraoperative hypoxemia (SpO 2 < 92%) and P ETCO 2 ≥ 45 mmHg(1 mmHg=0.133 kPa) was recorded. The development of hypoxemia, blood staining on the laryngeal mask airway and hoarseness after laryngeal mask airway removal were also recorded. Results:Compared with P0 group, the ultrasound scores were significantly increased at 15 min of pneumoperitoneum in P3 group ( P<0.05), and the ultrasound scores and the laryngeal mask airway misplacement rate were significantly increased, and no significant change was found in the other parameters in P5 group ( P<0.05). There were no statistically significant differences in each parameter between P5 group and P3 group ( P>0.05). There was no statistically significant difference in the incidence of postoperative complications among the three groups ( P>0.05). Conclusions:The laryngeal mask airway provides better ventilatory effect in pediatric patients undergoing laparoscopic surgery when the PEEP is set at 3 cmH 2O.

Objective:To analyze the infiltration of immune cells in different molecular subtypes of endometrial cancer(EC)at the protein level and explore the correlation between immune infiltration and clinicopathological features.Methods:Clinical data from 75 mismatch repair-deficient(MMR-D)EC cases and 74 mismatch re-pair-proficient(MMR-P)EC cases with comparable differentiation levels,diagnosed at Sichuan Provincial People's Hospital between January 2013 and January 2021,were selected.Molecular classification of EC was con-ducted according to the ProMisE standard.Immunohistochemistry(IHC)staining and fluorescent multiplexed im-munohistochemistry(F-mIHC)techniques were used to quantify the distribution of CD8+T cells,regulatory T cells(Tregs),and macrophages.The clinicopathological features and immune infiltration characteristics of different subtypes were investigated.Results:Among 149 samples,75 were MMR-D,8 were POLE-mutated(POLEmut),13 were p53-mutated(p53abn),and 53 were p53 wild-type(p53wt).The infiltration characteristics of CD8+T cells,Tregs,and macrophages were no statistically significant differences correlated with age and pathological stage(P>0.05).Among the molecular subtypes of EC,MMR-D tumors demonstrated a significantly higher densi-ty of CD8+T cells and Tregs compared to MMR-P tumors(P<0.05).Further comparison across the four EC mo-lecular subtypes revealed that the MMR-D subtype,which had a favorable prognosis,displayed a significantly high density of CD8+T cells compared to the p53abn subtype and the p53wt subtype(P<0.05).Additionally,the Tregs density of the MMR-D tumors was significantly higher than that of the p53wt tumors,in both the tumor area(P<0.05)and the stroma area(P<0.05).The POLEmut type tumors,which had the best prognosis,showed a high infiltration of CD8+T cells and Tregs cells compared to the p53abn and p53wt types,although there was no signifi-cant statistical difference(P>0.05).The p53wt subtype,which had a moderate prognosis,exhibited low density of CD8+T cells(P<0.05)and Tregs(tumor area,P<0.01,stroma area,P<0.05)compared to MMR-D tumors.The p53abn subtype,which was associated with the worst prognosis,exhibited higher infiltration of M2-like macro-phages than the MMR-D subtype(P<0.05)and the p53wt subtype(P<0.05)in tumor region,and lower CD8+T cell density than the MMR-D subtype(P<0.05).No significant statistical difference was observed in the density of M1-like macrophages across the four molecular subtypes in either the tumor or stroma areae(P>0.05).Conclu-sions:There was no statistically significant relation found between infiltration characteristics of immune cells and clinicopathological features.The types and distribution of infiltrated immune cells were different across these EC molecular subtypes.This indicated that ECs with different molecular subtype exhibited different features of immune infiltration which is closely associated with patient prognosis.

Objective:To investigate the regulatory effect of follistatin-like 1 protein (FSTL1) on the differentiation of mesenchymal stem cells (MSCs) into myofibroblasts in renal tissue and on renal fibrosis induced by renal ischemia-reperfusion injury (IRI).Method:In animal experiments, a unilateral renal IRI-induced fibrosis model was established by clamping the left renal pedicle (IRI 7 d group, n=3), with a sham-operated group as control (Sham 7 d group, n=3). Twelve male C57BL/6 mice were randomly assigned to sham operation (Sham group, n=4), model (IRI group, n=4) and FSTL1 treatment (IRI+FSTL1 group, n=4) groups. The Sham group underwent laparotomy sham surgery, while the IRI group and IRI+FSTL1 group underwent unilateral renal IRI surgery. From 1 day before surgery to 7 days after surgery, mice received daily intraperitoneal injections of phosphate buffered saline (Sham group and IRI group) or recombinant FSTL1 protein (IRI+FSTL1 group). The mice were sacrificed 14 days after surgery. Renal histopathological damage was evaluated by hematoxylin-eosin (HE) staining. Collagen fiber deposition and fibronectin (FN) accumulation in renal interstitium were assessed by Sirius red staining, Masson’s trichrome staining and immunohistochemical staining. The co-expression level of stem cell antigen-1 (SCA-1) and α-smooth muscle actin (α-SMA) was detected by double immunofluorescence staining. The mRNA expression levels of fibrosis-related genes ( Col1a1, Col3a1, Fn1) and myofibroblast marker gene ( Acta2) were detected by real time quantitative polymerase chain reaction (RT-qPCR). In cell experiments, a differentiation model of mouse MSCs into myofibroblasts was established through TGF-β1 induction (MSC+TGF-β1 group, n=3), with a blank control group (MSC group, n=3) set up for comparison. Bone marrow MSCs from C57BL/6 mice were randomly divided into 4 groups: the TGF-β1 induction group (MSC+TGF-β1, n=6), the FSTL1 treatment group (MSC+TGF-β1+FSTL1, n=6), the negative control siRNA transfection group (MSC-siNC+TGF-β1, n=6), and the Fstl1-targeted siRNA transfection group (MSC-si Fstl1+TGF-β1, n=6). The mRNA and protein expression levels of Col1a1, Col3a1, Fn1 and Acta2 were detected by RT-qPCR and Western blot respectively. The concentration of FSTL1 protein in cell culture supernatant was measured by enzyme-linked immunosorbent assay. Result:The expression of Col1a1 and Acta2 mRNA in the kidney tissue of IRI 7 d group mice was higher than that of the Sham 7 d group (both P<0.05), successfully establishing a mouse model of renal fibrosis. The mRNA expression of Fstl1 in kidney tissues of the IRI 7 d group mice was upregulated ( P<0.01). Immunofluorescence double staining revealed increased co-expression of SCA-1/α-SMA and SCA-1/FSTL1 in the renal interstitium. At 14 days after surgery, HE staining results showed reduced pathological damage in kidney tissues of the IRI+FSTL1 group compared to the IRI group, and Sirius Red and Masson staining revealed decreased collagen fiber deposition in the renal interstitium, while immunohistochemical staining demonstrated reduced FN accumulation in the renal interstitium (all P<0.05). The mRNA expression levels of Col1a1, Col3a1, Fn1 and Acta2 in renal tissue of IRI+FSTL1 group were lower than IRI group (all P<0.05). Double immunofluorescence staining showed a decrease in the co-expression of SCA-1 and α-SMA in renal interstitium. In cell experiments, the mRNA expression levels of Col1a1, Col3a1, Fn1, and Acta2 in the MSC+TGF-β1 group were higher than those in the MSC group (all P<0.05), confirming successful TGF-β1-induced myofibroblast differentiation of MSCs. Additionally, both intracellular FSTL1 protein expression and FSTL1 protein concentration in the cell supernatant were elevated in the MSC+TGF-β1 group (both P<0.05). Compared with MSC+TGF-β1 group, the mRNA levels of Acta2 and Col1a1 in MSC+TGF-β1+FSTL1 group were decreased (both P<0.01), and the protein expression levels of collagen Ⅰ and α-SMA were significantly decreased (both P<0.001). Compared with MSC-siNC+TGF-β1 group, the protein level of FSTL1 in cell culture supernatant of MSC-si Fstl1+TGF-β1 group were decreased ( P<0.001), while the protein expression levels of FN and α-SMA were increased (both P<0.001), and the mRNA expression levels of Fn1 and Acta2 were increased (both P<0.05). Conclusions:During unilateral renal IRI-induced renal fibrosis, MSCs in renal interstitium may differentiate into myofibroblasts. FSTL1 may alleviate renal fibrosis after unilateral renal IRI by inhibiting the differentiation of MSCs into myofibroblasts.

Limb spasticity is a common complication after stroke,with clinical manifestations such as increased muscle tone,limb stiffness and pain,which reduces the quality of patients'daily life and increases the economic burden.Currently,scales,surface electromyography and biomechanical methods are mostly used to assess limb spasticity in clinical practice,but clinical scales rely on experience and are highly subjective;surface electromyography is prone to compensations and test errors;and biomechanical methods are more restrictive.Musculoskeletal ultrasound is not only capable of detecting muscle parameters and providing quantitative information such as muscle hardness and elasticity,but also has the unique advantages of high-resolution and real-time imag-ing,which has been increasingly used in clinical diagnosis and treatment.In this paper,we review the evidence related to musculoskeletal ultrasound and limb spasticity assessment,with the aim of exploring a simple and reasonable quantitative assessment method,which will provide some thoughts for the future clinical assessment of limb spasticity.