Objective To quantitatively assess the exposure-response association between exposure to heatwave and sudden death, estimate the attributable excess deaths, and identify potential vulnerable subgroups. Methods A time-stratified case-crossover study was conducted among residents who died from sudden death in Jiangsu Province, China between 2015 and 2021. Heatwave events in Jiangsu Province, defined using varying relative temperature thresholds and durations, were identified using temperature data from the China Meteorological Administration Land Data Assimilation System (CLDAS V2.0). Individual heatwave exposure was assessed based on each subject's residential address. The exposure-response association between heatwave and sudden death was evaluated using conditional logistic regression model combined with a Distributed Lag Nonlinear Model(DLNM). Heatwave-attributable excess deaths were estimated. Stratified analyses by sex and age were performed to assess potential effect modifications. Results Under all definitions, exposure to heatwave was significantly associated with an increased risk of sudden death, and the risk increased with the intensity of heatwave. Using the P95_3d definition (temperature exceeding the 95th percentile for ≥3 consecutive days), heatwave was significantlyassociated with a 56% increased risk of sudden death (95% CI: 31%, 86%). The population-attributable fraction of sudden death due to heatwave exposure was 1.45% (95% CI: 0.97%, 1.90%). Stratified analyses indicated no statistically significant differences in the association between heatwave exposure and sudden death across age or sex subgroups. Conclusion Heatwave exposure was associated with an increased risk of sudden death. Reducing heatwave exposure during summer may help lower the occurrence of sudden death.

AIM: To investigate the changes in serum levels of platelet-derived growth factor A(PDGFA), heme oxygenase 1(HMOX1)and suppressor of cytokine signaling 6(SOCS6)in patients with diabetic retinopathy(DR)at different stages, and their predictive value for prognosis. METHODS: Patients diagnosed with DR in Zibo No.148 Hospital from April 2023 to April 2024 were included as the study group, and patients with simple type 2 diabetes mellitus(T2DM)during the same period were included as the control group. DR patients were separated into non proliferative DR group(NPDR group)and proliferative DR group(PDR group)based on DR staging, and into good prognosis group and poor prognosis group based on prognosis. Enzyme-linked immunosorbent assay(ELISA)method was used to detect serum levels of PDGFA, HMOX1, and SOCS6, and Pearson method was performed to analyze their correlation with laboratory indicators. Multivariate logistic regression was used to explore the risk factors affecting poor prognosis in DR patients. Receiver operating characteristic(ROC)curves were plotted to explore the prognostic value of serum PDGFA, HMOX1, and SOCS6 levels for DR patients. RESULTS: Totally 128 DR patients(67 males and 61 females)with the mean age 50.65±8.57 y were included. The control group consisted of 120 T2DM patients(63 males, 57 females)with the mean age of 50.32±8.65 y. The NPDR group comprised 74 patients(39 males, 35 females)with mean age of 50.42±8.71 y; the PDR group included 54 patients(28 males, 26 females)with the mean age of 50.96±8.40 y; The good prognosis group comprised 81 patients(43 males, 38 females)with the mean age of 50.51±8.62 y; the poor prognosis group included 47 patients(24 males, 23 females)with the mean age of 50.89±8.48 y. Compared with the control group, the study group had significantly higher serum levels of PDGFA, HMOX1, and SOCS6(all P<0.05). The PDR group had significantly higher serum levels of PDGFA, HMOX1, and SOCS6 than the NPDR group(all P<0.05). The poor prognosis group had significantly higher serum levels of FBG, HbA1c, SOD, MDA, IL-6, TNF-α, PDGFA, HMOX1, and SOCS6 than the good prognosis group(all P<0.05). The serum PDGFA of DR patients was positively related to FBG, HbA1c, IL-6, and TNF-α levels(all P<0.05), HMOX1 was positively related to FBG, HbA1c, SOD, MDA, IL-6, and TNF-α levels(all P<0.05), and SOCS6 was positively related to FBG, IL-6, and TNF-α levels(all P<0.05). Elevated levels of serum PDGFA, HMOX1, SOCS6, and HbA1c were risk factors for the prognosis of DR patients(all P<0.05). The AUC values of serum PDGFA, HMOX1, and SOCS6 alone in predicting the prognosis of DR patients were 0.806, 0.822, and 0.826, respectively. The AUC of their joint prediction was 0.912, and the joint prediction was superior to individual prediction(Z joint-PDGFA=2.183, P=0.029; Z joint-HMOX1=2.308, P=0.021; Z joint-SOCS6=2.620, P=0.009). CONCLUSION: Serum PDGFA, HMOX1, SOCS6 are significantly correlated with DR staging and prognosis, all showing high predictive efficiency for the prognosis of DR patients, with certain clinical value.

AIM:To investigating the predictive value of serum delta-like ligand 4(DLL4), complement C1q/tumor necrosis factor-related protein 5(CTRP5)levels for the severity of diabetic retinopathy(DR)and visual disability.METHODS:Patients with DR admitted to Tangshan Central Hospital between January 2022 and January 2024 were enrolled. Based on disease severity, patients were divided into a proliferative DR group and a non-proliferative DR group. After one year of follow-up, patients were further categorized into a vision disability group and a non-visual disability group based on visual impairment status. Enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of DLL4 and CTRP5. The data and serum levels of DLL4 and CTRP5 were compared among patients with different medical conditions and visual disabilities. Pearson method was used to explore the correlation between serum levels of DLL4, CTRP5 and glucose and lipid metabolism indicators. Multivariate Logistic regression was performed to explore the influencing factors of visual disability in DR Receiver operating characteristic(ROC)curve was performed to explore the value of serum levels of DLL4 and CTRP5 in predicting visual disability in DR.RESULTS: This study included 245 DR patients.Ninety-five patients were in the proliferative DR group(mean age 51.61±3.44 y, 51 men and 44 women), and 150 patients were in the non-proliferative DR group(mean age 51.22±3.11 y, 86 men and 64 women). The visually disability group consisted of 39 participants(mean age 51.64±3.87 y; 21 men and 18 women), while the non-visually disability group consisted of 206 participants(mean age 51.32±3.12 y; 116 men and 90 women). Patients in the proliferative DR group exhibited longer DR duration, higher levels of FPG, TG, TC, LDL-C, and serum DLL4 and CTRP5, and lower HDL-C levels compared to the non-proliferative DR group(all P<0.05). The serum levels of DLL4 were positively correlated with FPG(P<0.001), while the serum levels of CTRP5 were prominently positively correlated with FPG, TG, TC, LDL-C, and prominently negatively correlated with HDL-C(all P<0.001). The visual disability group had longer duration of DR and higher serum levels of DLL4 and CTRP5 than the non-visual disability group(all P<0.001). The duration of DR and serum levels of DLL4 and CTRP5 were influencing factors for visual disability in DR patients(all P<0.001). The joint detection of serum levels of DLL4 and CTRP5 had a higher value in predicting visual disability in DR patients than the single indicator prediction(ZDLL4-joint=3.018, PDLL4-joint=0.003; ZCTRP5-joint=2.784, PCTRP5-joint=0.005). CONCLUSION: Serum levels of DLL4 and CTRP5 are elevated in DR patients, and are closely related to the disease condition. The joint detection of serum levels of DLL4 and CTRP5 has high value in predicting visual disability in DR patients.

Objective To evaluate the clinical efficacy of Dangui Siwei Yin cell-wall broken powder in the treatment of degenerative lumbar spinal stenosis(DLSS)with qi deficiency and blood stasis syndrome.Methods A randomized controlled trial was conducted on 72 patients with qi deficiency and blood stasis-typed DLSS admitted to Guangdong Second Traditional Chinese Medicine Hospital(Huangpu Hospital)from November 2023 to January 2025.Patients were randomly divided into a cell-wall broken powder group and a traditional midicinal slice group(36 cases each)using a random number table method.Both groups received conventional western treatment(oral administration of Etoricoxib Tablets and Mecobalamin Tablets).Additionally,the cell-wall broken powder group was treated with Dangui Siwei Yin cell-wall broken powder,while the traditional midicinal slice group received traditional decoction of Dangui Siwei Yin.Both groups underwent a 1-week treatment course.Changes in Visual Analogue Scale(VAS)of pain scores,Oswestry Disability Index(ODI)scores,and Japanese Orthopaedic Association(JOA)lumbar function scores were observed before and after treatment.Clinical efficacy and medication safety were evaluated.Results(1)After one week of treatment,the total effective rate was 88.89％(32/36)in the cell-wall broken powder group and 75.00％(27/36)in the traditional midicinal slice group.The intergroup comparison(by chi-square test)showed that the efficacy in the cell-wall broken powder group was superior to the traditional midicinal slice group(P＜0.05).(2)After treatment,VAS and ODI scores were significantly decreased in both groups(P＜0.05),while JOA scores significantly increased(P＜0.05).The cell-wall broken powder group demonstrated superior improvements in VAS and ODI reduction and JOA elevation compared to the traditional midicinal slice group(P＜0.05).(3)The adverse reaction rate was 8.33％(3/36)in the cell-wall broken powder group and 11.11％(4/36)in the traditional midicinal slice group,with no statistically significant difference(P＞0.05).Conclusion Compared with traditional midicinal slice,Dangui Siwei Yin cell-wall broken powder exhibit better efficacy in alleviating low back and leg pain and improving lumbar function in qi deficiency and blood stasis-typed DLSS patients.This study provides evidence-based medical support for the clinical application and further development of cell-wall broken powder formulations in traditional Chinese medicine.

Objective: To analyze epidemiological trends and changing characteristics of syphilis among students in Yunnan Province from 2005 to 2023, so as to provide evidence for the comprehensive prevention and control of syphilis in schools. Methods: The case data of syphilis among students in Yunnan Province from 2005 to 2023 were obtained from the China Information System for Disease Control and Prevention. The Joinpoint regression model was used to conduct a time trend analysis of the reported incidence rate of syphilis. Results: From 2005 to 2023, a cumulative total of 3 191 cases of syphilis were reported in schools in Yunnan Province(1 248 male cases and 1 943 female cases). The reported incidence rate rose continuously from 0.17/100 000 in 2005 to 8.26/100 000 in 2023, with an average annual percent change (AAPC) of 24.89%( Z =13.18, P <0.01). The reported incidence rate was higher in female students than in male students ( χ 2=229.48, P <0.05). The incidence rates in the primary school, junior high school, senior high school and higher education were 0.21/100 000, 2.42/100 000, 4.45/100 000 and 6.29/100 000 respectively, and the difference was statistically significant (χ 2=3 432.84, P <0.05). The average annual growth rate was the highest in the junior high school stage(AAPC= 30.68% , Z =7.57, P <0.05),followed by the senior high school stage (AAPC=24.28%, Z = 5.70 , P <0.05).The reported incidence rate of primary and secondary syphilis increased from 0.12/100 000 in 2005 to 2.06/ 100 000 in 2023, with an AAPC of 16.86% ( Z = 4.57, P <0.05). Conclusions The overall reported incidence rate of syphilis among students in schools in Yunnan Province shows a sustained upward trend, with the most rapid annual increase observed in junior high schools. Schools should prioritize syphilis education and expand awareness campaigns to curb transmission.

Objective:To investigate the long-term efficacy, safety and prognostic factors of intraoperative radiotherapy (IORT) for narrow-margin (resection margin < 1 cm) hepatectomy in patients with hepatocellular carcinoma (HCC) during radical surgery.Methods:A retrospective cohort study was conducted. The data of primary HCC patients undergoing radical surgery and narrow-margin hepatectomy IORT in the Cancer Hospital of the Chinese Academy of Medical Sciences from November 2009 to February 2019 were collected. IORT applied 6 MeV or 9 MeV electron beams and a single irradiation was given to the margin. Kaplan-Meier method was used for the overall survival (OS) and disease-free survival (DFS) analysis; log-rank test was used for survival comparison among subgroups. The recurrence patterns and adverse reactions were recorded. Univariate and multivariate Cox proportional hazards models were used to analyze the factors influencing the OS and DFS.Results:A total of 64 patients were enrolled, with the median age [ M ( Q1, Q3)] of 57 years (49, 63) years. All patients included 55 males (85.9%) and 9 females (14.1%). The median dose of IORT was 15 Gy (range: 12-17 Gy). The median follow-up time was 83.3 (64.4, 91.9) months. The 1-year, 3-year, 5-year, 7-year, 10-year OS rates were 90.4%, 80.6%, 75.5%, 71.4% and 47.6%, respectively; the 1-year, 3-year, 5-year, 7-year,10-year DFS rates were 77.8%, 68.1%, 59.6%, 57.6% and 38.4%, respectively. Univariate Cox regression analysis indicated that preoperative serum alpha-fetoprotein (AFP) > 400 ng/ml was an independent risk factor for poor OS (> 400 ng/ml vs. ≤ 400 ng/ml: HR = 6.57, 95% CI: 2.16-19.96, P < 0.001), while not the independent influencing factor of poor DFS ( HR = 1.71, 95% CI: 0.65-4.52, P = 0.277). The age ≤ 60 years or not, gender, viral hepatitis or not, American Joint Committee on Cancer stage, tumor diameter (> 5 cm or not), tumor number, degree of tumor differentiation, microvascular invasion or not, microsatellite nodules or not, anatomical liver resection or not, and the dose of IORT ≤15 Gy or not were not the independent influencing factors of poor OS and DFS (all P > 0.05). Kaplan-Meier method analysis showed that patients with preoperative serum AFP ≤ 400 ng/ml (48 cases) had better OS compared with those with preoperative serum AFP>400 ng/ml (16 cases) (5-year OS rate: 84.8% vs. 44.9%; 7-year OS rate: 79.9% vs.37.4%), and the difference was statistically significant ( P = 0.002). There was no statistically significant difference in the DFS between the 2 groups ( P = 0.134). During the follow-up, 28 patients (43.8%) relapsed, including 17 cases (26.6%) of early recurrence and 11 cases (17.2%) of late recurrence. No marginal recurrence was observed. There were 22 cases (34.4%) of intrahepatic recurrence alone, 2 cases (3.1%) of extrahepatic recurrence and 4 cases (6.3%) of stimutaneous recurrence inside and outside the liver. The 1-, 3-, 5- and 7-year cumulative recurrence rates inside the liver were 19.0%, 27.2%, 37.4% and 39.3% respectively, and the cumulative recurrence rates outside the liver were 6.4%, 8.0%, 9.6% and 9.6% respectively. There were no adverse reactions above grade 3 in the entire group. There were no surgery-related deaths within 30 d after the operation, and no radiation-induced liver disease occurred. Conclusions:Narrow-margin IORT helps HCC patients receiving hepatectomy to achieve favorable long-term survival and adverse reactions are tolerable. It can be used as a safe and effective adjuvant therapy alternative.

Objective:To find out the distribution of water iodine in Jinzhong City, Shanxi Province, and provide scientific basis for scientifically delimiting the distribution range of different water iodine level areas.Methods:From March to August 2024, by using a cross-sectional survey method, the administrative villages (communities, abbreviated as administrative villages) were used as units in 11 counties (districts, cities, abbreviated as counties) of the city to verify the changes in the names and administrative divisions of counties, townships, and administrative villages based on the survey results of iodine content in drinking water in the city in 2017. Population data, water source information, and water supply project operation were investigated, and 10% sampling method was used to collect drinking water samples. Cerium sulfate catalytic spectrophotometry was used to test water iodine level.Results:A total of 2 402 centralized water supply projects in 2 181 administrative villages were investigated and all were operating normally. The median iodine concentration in the city's water was 2.43 μg/L, ranging from 0.15 to 556.45 μg/L. The number of villages and population covered by water iodine level of < 40, 40 - 100, and > 100 μg/L was 1 990 villages and 2 841 752, 153 villages and 372 085, 38 villages and 75 493, respectively.Conclusions:According to the classification of water iodine standards, Jinzhong City presents a coexistence of iodine deficiency, adequate iodine, and high iodine areas, with iodine deficiency areas still being the main focus. Therefore, it is necessary to continue implementing salt iodization measures. Areas with high iodine levels need to continue to promote the implementation of measures to improve water quality, reduce iodine levels, and supply non iodized salt. Efforts should be made to promote disease prevention knowledge among key areas and populations, guide the public to scientifically supplement iodine, and effectively control the hazards of high iodine.

Pulpitis is an inflammatory response of dental pulp tissue triggered by external stimuli such as bacterial infection, mechanical trauma, and iatrogenic injury. Accurate diagnosis of pulpitis is essential for the success of minimally invasive endodontic treatments. However, the current diagnostic framework lacks objective indicators capable of precisely assessing the severity of pulp inflammation. Recent studies have revealed that biomarkers such as matrix metalloproteinases, cytokines, chemokines, non-coding RNAs, growth factors, and signaling molecules are closely associated with the degree of pulp inflammation. These findings suggested that biomarker-based molecular diagnostics held significant promise for advancing precision and minimally invasive approaches in endodontics. This review systematically discusses the current research progress, challenges, and future directions of biomarkers in the diagnosis and treatment of pulpitis.

Objective To measure radiation filed distribution in the treatment room of the Varian Halcyon medical linear accelerator, and to provide a basis for shielding design and potential exposure analysis of treatment rooms for this type of accelerator. Methods Under the 6 MV X-ray (FFF) mode at a maximum dose rate of 800 MU/min and a maximum irradiation field of 28.00 cm × 28.00 cm, a total of 540 MU was delivered during gantry rotation. Radiation field distribution was measured using thermoluminescence dosimeters located at multiple points in the room. The measured data were then applied to shielding calculations, and the results were compared with those obtained using empirical formulas. Results The overall radiation levels in the treatment room were in the range of 12.2 µGy/540 MU to 5.520 Gy/540 MU, with the highest dose (5.520 Gy/540 MU) observed at the isocenter, and the lowest dose (12.2 µGy/540 MU) recorded at approximately 6.5 m from the gantry head. The radiation levels at most points were within the range of 100-1000 µGy/540 MU. At heights of 0.5, 1.1, and 1.7 m, the radiation field exhibited a rapid attenuation from the beam center outward, with a faster decay along the treatment couch direction (Y-axis) than along the perpendicular direction (X-axis). Shielding calculations based on the measured radiation field yielded required wall thicknesses of 1219 mm (east wall), 949 mm (south wall), 1235 mm (west wall), and 1252 mm (north wall), all of which were smaller than those calculated using empirical formulas. Conclusion Thermoluminescence dosimeter is suitable for multi-point in situ measurement of radiation field distribution in Halcyon accelerator treatment rooms. The measurement results can be used to optimize the shielding design of Halcyon accelerator treatment rooms.

Objective:By analyzing peripheral blood indicators, we constructed and validated a novel lung cancer prediction model using machine learning algorithms for riskassessment of lung cancer.Methods:A retrospective case-control design was conducted on the clinical data of 194 newly diagnosed lung cancer patients [mean age: (66.80±9.09) years, 126 males and 68 females] admitted to Qilu Second Hospital of Shandong University between January 9, 2020, and December 31, 2024, serving as the case group. During the same period, 290 healthy individuals undergoing physical examinations [mean age: (61.18±14.31) years, 155 males and 135 females J were enrolled as the control group. A total of 46 peripheral blood indicators-including routine blood tests, coagulation parameters, liver function markers, and tumor-related indices-along with two basic characteristics (age and sex) were included in the analysis. Eleven machinelearning algorithms including logistic regression, randomforest, support vector classifier, extreme gradient boosting, gradient boosting decision tree, decision tree, multilayer perceptron, linear discriminant analysis, adaptive boosting, Gaussian naive Bayes and light gradient-boosting machine-were trained for early diagnosis of lung-cancer.Model performance was evaluated by the area under the ROC, accuracy, positive predictive value, negative predictive value, F1-score and 95% confidence interval (95% CI). The best performing algorithm was selected, and feature importance was ranked with Shapley Additive Planation(SHAP) values. Results:The support-vector classifier achieved the best performance for predicting lung-cancer risk (AUC=0.974; 95 % CI 0.951-0.989) and was retained for final model establishment. After 20 rounds of stratified 10-fold cross-validation the mean AUC was 0.950; learning-curve, decision-curve and calibration analyses confirmed its superior generalizability, clinical utility and calibration.SHAPley additive explanations and decision-tree feature importance consistently identified neuron-specific enolase, carcinoembryonic antigen, and squamous-cell carcinoma antigen as the three most critical predictors of lung-cancer risk. Conclusion:An SVM-based lung cancer prediction model was successfully established to determine the risk of developing lung cancer.