Objective To explore the relationship between education level and the risk of all-cause mortality in the middle-aged and elderly (≥45 years old) population in China. Methods Using data from five surveys from 2011-2020, years of education, age, gender, marital status, type of household, alcohol consumption status, smoking status, physical activity, limited ability to perform activities of daily living (ADLs), chronic disease status, and body mass index were collected. According to the survival status，the study participants were divided into a survival group (n=8625) and an all-cause mortality group (n=1735). Cox proportional risk regression model was used to analyze the relationship between years of education and the risk of all-cause mortality in middle-aged and elderly people with stratified analysis. Results The survey was conducted on 10360 research subjects, including 4 983 males and 5 377 females, with an age M(Q_R) of 59(8) years old. A total of 88 187 person years (average 8.512 person years) were followed up, and a total of 1735 deaths were reported over 9 years. The all-cause mortality rate was 19.674 ‰, with an education period M(Q_R) of 5(8) years and a survival time M(Q_R) of 9 (0) years. After adjusting for confounding factors, for every 1 year increase in education, the risk of all-cause mortality decreased by 2.60% [HR=0.974, 95% CI (0.960-0.988)]. The stratified analysis results showed that in the population aged 45-59, for every 1 year increase in education, the risk of all-cause mortality decreased by 1.00% [HR=0.990, 95% CI (0.959,1.021)]; In the population aged 60-74 and over 75, for every 1 year increase in education, the risk of all-cause mortality decreased by 2.70% [HR=0.973, 95% CI (0.948, 0.999)] and 3.50% [HR=0.965, 95% CI (0.929, 1.003)], respectively. Conclusion Improving the education level of middle-aged and elderly people (≥ 45 years old) in China can reduce the risk of all-cause mortality, and elderly education should be vigorously promoted.

BACKGROUND:Spleen has the functions of blood storage,hematopoiesis,and immunity.With the increase of age,the structural degeneration and functional decline of spleen lead to the impairment of immune system function,thus accelerating the aging process of the body.The treatment of spleen aging in tree shrews with highly active umbilical cord mesenchymal stem cells has not been reported. OBJECTIVE:To explore the intervention effect and mechanism of highly active umbilical cord mesenchymal stem cells on spleen aging in tree shrews. METHODS:Highly active umbilical cord mesenchymal stem cells were isolated,cultured,and obtained from the umbilical cord tissue of newborn tree shrews by caesarean section.The differentiation abilities of adipogenesis,osteogenesis,and chondrogenesis were detected by three-line differentiation kit.Cell cycle and surface markers were detected by flow cytometry.The second generation of highly active umbilical cord mesenchymal stem cells were transfected with Genechem Green Fluorescent Protein with infection complex values of 100,120,140,160,180,and 200,respectively,to screen the best transfection conditions.After transfection,the fourth generation of highly active umbilical cord mesenchymal stem cells was injected into the tail vein of tree shrews in the elderly treatment group.The young control group and the aged model group were not given special treatment.After 4 months of treatment,the spleen tissue was taken and the structure of the spleen was observed by hematoxylin-eosin staining.β-Galactosidase staining was used to detect the activity of aging-related galactosidase.Immunohistochemical staining was used to detect the expression levels of p21 and p53 proteins.Ki67 and PCNA immunofluorescence staining was used to detect cell proliferation activity.Immunofluorescence staining was used to detect the expression levels of spleen autophagy protein molecules Beclin 1 and APG5L/ATG5.Reactive oxygen species fluorescence staining was used to detect the content of reactive oxygen species in spleen tissue.CD3 immunofluorescence staining was used to detect the change of the proportion of total T lymphocytes.The secretion levels of interleukin 1β and transforming growth factor β1 in spleen were detected by enzyme linked immunosorbent assay.The distribution of highly active umbilical cord mesenchymal stem cells labeled with green fluorescent protein in spleen tissue was observed by DAPI double staining of nucleus. RESULTS AND CONCLUSION:(1)Highly active umbilical cord mesenchymal stem cells grew in a short spindle shape with fish-like growth,with a large proportion of G0/G1 phase,and had the potential to differentiate into adipogenesis,osteogenesis,and chondrogenesis.(2)Multiplicity of infection=140 and transfection for 72 hours were the best conditions for labeling tree shrews highly active umbilical cord mesenchymal stem cells with Genechem Green Fluorescent Protein.(3)Compared with the aged model group,in the aged treatment group,the spleen tissue cells of tree shrews were arranged closely,and the area of white pulp was increased(P<0.01);the boundary between red pulp and white pulp was clear;the proportion of germinal centers did not show statistically significant difference(P>0.05).The activity level of galactosidase related to spleen tissue aging was decreased(P<0.001),and the expression levels of aging protein molecules p21 and p53 were down-regulated(P<0.001).The expression levels of proliferation-related molecules Ki67 and PCNA were up-regulated(P<0.001,P<0.05);expression levels of autophagy-related molecules Beclin 1 and APG5L/ATG5 were up-regulated(P<0.001),and the content of reactive oxygen species decreased(P<0.001),and the proportion of CD3+T cells increased(P<0.05).The secretion level of interleukin 1β in the aging-related secretion phenotype decreased(P<0.001);no significant difference was found in transforming growth factor β1 level(P>0.05).Compared with the young control group,the above indexes were significantly different in the elderly treatment group(P<0.05).(4)Green fluorescent cells labeled with green fluorescent protein were observed in spleen tissue of tree shrews the elderly treatment group by frozen tissue section observation.The results show that intravenous infusion of highly active umbilical cord mesenchymal stem cells can migrate to spleen tissue,inhibit the production of reactive oxygen species,down-regulate the expression of aging-related proteins,induce autophagy,promote cell proliferation,reduce chronic inflammation,and then improve the structure and function of spleen tissue.

Objective:To investigate the effect of continuous renal replacement therapy (CRRT) on energy metabolism and thermal balance in ICU patients with acute kidney injury (AKI).Methods:This study was a prospective observational study, which included AKI patients who underwent CRRT in ICU of the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from May 2020 to December 2023. The patients' general clinical characteristics, comorbidities, body temperature, disease severity score, CRRT treatment time and filter lifespan were recorded. The concentrations of glucose and lactate in blood and ultrafiltrate, and the citrate level in the ultrafiltrate when regional citrate anticoagulation adopted were analyzed regularly. Subgroup analysis was carried out according to different anticoagulation modes and whether the patients with diabetes or shock. The changes of energy metabolism and thermal balance corresponding to the changes in glucose, lactate, citrate and body temperature induced by CRRT were calculated daily.Results:This study included 420 AKI patients undergoing CRRT. When the blood lactate was between 14-18 mmol/L, there was a loss of approximately 200-250 kcal of energy per day, while the blood lactate was between 6.5-11.5 mmol/L, the daily corresponding energy loss was about 100-150 kcal. During CRRT on the first day, the patients with diabetes or shock had a mild decrease of blood glucose, while patients without diabetes and shock had mild increase of blood glucose. When the target of blood glucose was gradually achieved, the mean daily increase of energy corresponding to blood glucose intake was about 100-130 kcal in patients undergoing CRRT. The mean daily increase of energy corresponding to citrate intake was approximately 330 kcal, when the patient was undertaken by CRRT with regional citrate anticoagulation. For every 1℃ decrease in body temperature, the mean daily heat loss caused by extracorporeal thermal radiation during CRRT was about 200 kcal.Conclusions:When conducting nutritional assessment and prescription for AKI patients supported by CRRT in the ICU, it is essential to fully consider the impact of CRRT on the patient's energy metabolism and heat balance. This includes the clearance of lactate, the balance of blood glucose, the intake of citrate, and the reduction in body temperature. Additionally, the type and stage of the disease, as well as individual differences, must be taken into account to achieve personalized nutritional assessment and precise implementation.

Objective: To analyze the association of participation in non-sports extracurricular tutoring classes with the prevalence of screening myopia, axial length (AL) and axial length to corneal radius ratio (AL/CR) among primary school students, so as to provide evidences for formulating myopia prevention and control policies. Methods: In December 2024, combination of convenience and cluster sampling method was used to select 2 273 students from two primary schools in Hefei City, Anhui Province. Ophthalmic examinations and questionnaire surveys were conducted to obtain information on myopia, AL, AL/CR and participation in various types of extracurricular tutoring. A binary Logistic regression model was used to analyze the association between non-sports tutoring and screening myopia, and multiple linear regression models were used to examine the associations between non-sports tutoring and AL and AL/CR. Results: Among the surveyed students, the participation rate in non-sports extracurricular tutoring classes was 64.9% , and the overall prevalence of screening myopia was 39.1%. The average AL and AL/CR were (23.60± 1.01 ) mm and (3.00±0.12), respectively. Univariate analysis showed that students who attended non-sports, music, or academic tutoring classes for ≥2 h per week had higher risks of screening myopia and greater AL/CR values than non-participants (screening myopia: OR =1.38, 1.82, 1.55; AL/CR: β =0.01, 0.03, 0.03; all P <0.05). After adjusting for sex, grade, and participation in sports tutoring, multivariate analysis indicated that participation in non-sports and musical instrument tutoring classes for ≥2 h per week remained significantly associated with higher risks of screening myopia ( OR =1.26, 1.49, both P <0.05). Multiple linear regression showed that participation in musical instrument tutoring for ≥2 h per week was positively correlated with AL ( β=0.14, P < 0.05). Conclusions Participation in non-sports extracurricular tutoring is common among primary school students. Attending non-sports tutoring classes for ≥2 h per week increases the risk of screening myopia.

OBJECTIVE To investigate the bactericidal effect of levulinic acid-sodium dodecyl sulfate(LVA-SDS)on the strains of Mycobacterium abscessus,Mycobacterium chelonae and Mycobacterium fortuitum,and to provide a new method for the prevention of common pathogenic rapidly growing non-tuberculous mycobacteria(NTM)dis-ease.METHODS The minimum inhibitory concentration(MIC)and minimal bactericidal concentration(MBC)of LVA-SDS were detected by microculture method and suspension quantitative bactericidal test,respectively.Using 1000 mg/L chlorine-containing disinfectant(sodium hypochlorite)as the control,the killing effect of LVA-SDS at different times and concentrations on M.abscessus,M.chelonae and M.fortuitum were detected.RESULTS The MIC values of LVA-SDS against M.abscessus,M.chelonae and M.fortuitum were 0.0625%LVA+0.00625%SDS,0.03125%LVA+0.003125%SDS and 0.125%LVA+0.0125%SDS,respectively.The MBC values were 0.25%LVA+0.025%SDS,0.25%LVA+0.025%SDS,and 1%LVA+0.1%SDS,repectively.Within a cer-tain range,with the increase in LVA-SDS concentration and the extension of time(1-30 min),the bactericidal effect on M.abscessus,M.chelonae and M.fortuitum gradually enhanced.The killing rates of the 18%LVA+1.8%SDS for 5 minutes and the 6%LVA+0.6%SDS for 20 minutes to M.abscessus reached 100.00%;the kill-ing rates of the 18%LVA+1.8%SDS for 10 minutes and the 10%LVA+1%SDS for 25 minutes to M.chelo-nae reached 100.00%;while the killing rates of the 18%LVA+1.8%SDS for 5 minutes and the 6%LVA+0.6%SDS for 30 minutes to M.fortuitum reached 100.00%.Compared with 1000 mg/L chlorine-containing disin-fectant(sodium hypochlorite),LVA-SDS has equivalent bactericidal effects against M.abscessus and M.chelo-nae,and a better bactericidal effect against M.fortuitum.CONCLUSION LVA-SDS has a good bactericidal effect on M.abscessus,M.chelonae and M.fortuitum,and may be used in the disinfection of NTM in the future.

Objective To explore the therapeutic effect and potential mechanism of CA330 and OXIRIS adsorbent columns in septic shock.Methods Patients who met the diagnostic criteria for septic shock and admitted to the De-partment of Critical Care Medicine of Shenzhen Third People's Hospital from February 2022 to June 2024 were se-lected.They were randomly divided into an OXIRIS group and a CA330 group according to the random number table method.The CA330 group received hemoperfusion combined with hemodiafiltration using CA330 adsorbent co-lumn,while the OXIRIS group was treated with OXIRIS adsorbent column.Relevant markers of the two groups of patients before and after treatment were collected and compared,including inflammatory markers,bilirubin(total bilirubin[TBil],direct bilirubin[DBil]),coagulation functions(prothrombin time[PT],activated partial throm-boplastin time[APTT],etc),endotoxin(ETX),organ function scores(acute physiology and chronic health score Ⅱ[APACHE Ⅱ],sequential organ failure assessment[SOFA],etc).Molecular biology techniques were adopted to detect changes in inflammation-related gene expression(nuclear factor kappa B[NF-κB],toll-like receptor 4[TLR4],myeloid differentiation factor 88[MyD88]),and oxidative stress factors(glutathione peroxidase[GSH-Px],superoxide dismutase[SOD])in the blood of patients before and after treatment.The safety and effectiveness of two types of adsorbent columns during the treatment process was evaluated.Results A total of 92 patients were included and randomly divided into the OXIRIS group and the CA330 group,with 46 cases in each group.After treatment,the levels of TBil,DBil,and ETX in two groups of patients all showed significant decreases compared with before treatment(all P＜0.01),the levels of TBil,DBil,and ETX in patients in the OXIRIS group after treat-ment were all lower than those in the CA330 group during the same period(all P＜0.05);PT and APTT in both groups shortened significantly compared with before treatment(both P＜0.01),PT and APTT in the OXIRIS group after treatment were both shorter than those in the CA330 group during the same period(both P＜0.05);The APACHE Ⅱ score and SOFA score in patients in the OXIRIS group after treatment were both lower than those in the CA330 group during the same period(both P＜0.05);The levels of serum high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-5,and IL-8 in patients in both groups showed significant decreases compared with before treatment(all P＜0.05),and the levels of these serum markers in the CA330 group after treatment were all lower than those in the OXIRIS group during the same period(all P＜0.05).The gene expression levels of NF-κB,TLR4,and MyD88 in patients in the CA330 group after treatment were all lower than those in the OXIRIS group during the same period(all P＜0.05);The levels of GSH-Px and SOD in pa-tients in the OXIRIS group after treatment were both higher than those in the CA330 group(both P＜0.01).No serious adverse event occurred in patients in the CA330 group and the OXIRIS group during the treatment process.Conclusion OXIRIS may be better in clearing bilirubin and endotoxin,improving coagulation function,protecting organ function,and regulating oxidative stress response in patients,while CA330 may be more prominent in clearing inflammatory markers and regulating inflammation-related gene expression in patients.

Diabetic retinopathy(DR)is a kind of microvascular disease caused by the long-term influence of diabetes mellitus(DM),and it is one of the main cause of global visual impairment and blindness.Its typical characteristics include microaneurysms,hard exudates,macular edema(DME)and neovascularization.Its pathogenesis is diverse,and the root cause is oxidative stress and advanced glycosylation end products.The nuclear red blood cell related factor 2(Nrf2)signa-ling pathway plays an important role in preventing various diseases.As one of the characteristics of DM,hyperglycemia will activate the generation of reactive oxygen species(ROS)in mitochondria.These oxidative stress factors activate the nucle-ar transcription factor κB pathway,becoming the main inducement of various complications of DM.This pathway will in-duce increased transcription of proinflammatory cytokines,including tumor necrosis factor-alpha,transforming growth fac-tor-beta and interleukin-1.The active ingredients of traditional Chinese medicine have significant antioxidant,anti-inflam-matory,anti-apoptotic and angiogenesis-promoting effects,and can block the progression of DR through various mecha-nisms.In this article,the research status of traditional Chinese medicine targeting the Nrf2 signaling pathway in the preven-tion and treatment of DR is reviewed to guide clinical and scientific research.

Objective:To detect the expression levels of long non-coding RNAs(lncRNA)in elderly patients with pulmonary tuberculosis(PTB)and those with non-tuberculous lung diseases(non-TB), and to assess the performance of these lncRNA in the differential diagnosis of PTB.Methods:A total of 300 elderly patients with suspected PTB were recruited from Beijing Chest Hospital between January 2024 and September 2024, and were further divided into the PTB group and the non-TB lung disease group based on the results of mycobacterium tuberculosis(MTB)pathogenicity testing.Peripheral blood mononuclear cells were isolated using a lymphocyte separation solution, and RNA was extracted using the TRIzol method.Nine lncRNAs, previously identified as differentially expressed in PTB through our group's microarray analysis, were selected and detected by real-time fluorescence quantitative polymerase chain reaction to evaluate the expression levels of these lncRNAs between the PTB and non-TB lung disease groups.The overall patients were randomly divided into training and validation sets in a 7∶3 ratio.Lasso regression was employed to select the characteristic variables, and a random forest algorithm was then used to construct the lncRNA diagnostic portfolio.Receiver operating characteristic(ROC)curves were generated to evaluate the diagnostic performance of individual lncRNAs and the combined panel in differentiating elderly patients with PTB from those with other non-TB lung diseases.Results:A total of 201 cases were included, with 105 confirmed elderly patients diagnosed with PTB(52.2%)and 96 elderly patients suffering from non-TB lung disease(47.8%).Compared to the elderly patients with non-TB lung disease, the expression levels of ENST00000417346.1, ENST00000620744.1, lncRNA PWP1, ENST00000583184.1, lncRNA ABHD17B, ENST00000607464.1, ENST00000516057.1, and NR_003000 were significantly downregulated in the PTB patients, whereas the expression level of lncRNA BCL2L10 was significantly upregulated in the PTB patients.ROC analysis revealed that the area under the curve(AUC)for each lncRNA ranged from 0.659 to 0.848.The diagnostic panel, which included NR_003000, ENST00000607464.1, ENST00000583184.1, and ENST00000620744.1 as determined by Lasso analysis, exhibited AUC values of 0.917 and 0.906 in the training and validation sets, respectively.The performance of this panel was superior to that of each individual lncRNA.Conclusions:The random forest model, which incorporates NR_003000, ENST00000607464.1, ENST00000583184.1, and ENST00000620744.1, demonstrates potential in differentiating between PTB and non-TB lung diseases.

This study was aimed at exploring the epidemic characteristics and spatio-temporal evolution patterns of severe fever with thrombocytopenia syndrome(SFTS)in Henan Province from 2011 to 2022,to provide a reference for prevention and control ef-forts.Data on SFTS in Henan Province from 2011 to 2022 were collected from the Information Management System for Infectious Dis-ease Reporting,and epidemiological characteristics and spatio-temporal evolution patterns were investigated through spatial autocorre-lation analysis,standard deviation ellipse analysis,and spatial-centered transfer curves,on a district-county basis.From 2011 to 2022,a total of 5 471 SFTS cases associated with 81 deaths were reported in Henan Province.The incidence rate showed an increasing trend(χ2trend=23.24,P<0.001),and the average annual incidence was 0.4 677/100 000.The case-fatality rate showed a decreasing trend from 2011 to 2019(χ2trend=8.86,P=0.003),but an increasing trend from 2020 to 2022(χ2trend=12.93,P<0.001).The average an-nual case-fatality rate was 1.48%.The peak incidence period was from May to July;this period accounted for 58.75%of the total cases.Females(59.39%),individuals 60-80 years old(55.40%),and farmers(96.64%)were the high prevalence groups.The disease was distributed primarily in Xinyang City,and Shangcheng County had the highest incidence rate(27.411 8/100 000).Spatial aggregation was observed in the southeastern region(Moran's I>0,P<0.001),and the disease centers were all located in Guangshan County,Xin-yang City,and showed southeast-northwest-southeast-northwest-southeast-northeast-southwest movement during the 12-year pe-riod.In conclusion,from 2011 to 2022,SFTS in Henan Province had a high incidence in May to July,and females,older people,and farmers were the high-risk groups.Spatial aggregation was observed in the southeastern region,along with spread to surrounding areas.Xinyang City is therefore a key area for the prevention and control of SFTS.

Acute respiratory distress syndrome(ARDS)is a common respiratory emergency,but current clinical treatment remains at the level of symptomatic support and there is a lack of effective targeted treatment measures.Our previous study confirmed that inhalation of hydrogen gas can reduce the acute lung injury of ARDS,but the application of hydrogen has flammable and explosive safety concerns.Drinking hydrogen-rich liquid or inhaling hydrogen gas has been shown to play an important role in scavenging reactive oxygen species and maintaining mitochondrial quality control balance,thus improving ARDS in patients and animal models.Coral calcium hydrogenation(CCH)is a new solid molecular hydrogen carrier prepared from coral calcium(CC).Whether and how CCH affects acute lung injury in ARDS re-mains unstudied.In this study,we observed the therapeutic effect of CCH on lipopolysaccharide(LPS)induced acute lung injury in ARDS mice.The survival rate of mice treated with CCH and hydrogen inhalation was found to be comparable,demonstrating a significant improvement compared to the untreated ARDS model group.CCH treatment significantly reduced pulmonary hemorrhage and edema,and improved pulmonary function and local microcirculation in ARDS mice.CCH promoted mitochon-drial peripheral division in the early course of ARDS by activating mitochondrial thioredoxin 2(Trx2),improved lung mitochondrial dysfunction induced by LPS,and reduced oxidative stress damage.The results indicate that CCH is a highly efficient hydrogen-rich agent that can attenuate acute lung injury of ARDS by improving the mitochondrial function through Trx2 activation.