Objective To investigate the exposure-response relationships and lag effects between air pollutants (PM_2.5, PM₁₀, O₃, and NO₂) and mortality in Jiading District, Shanghai, and to provide a scientific basis for the formulation of environmental health policies. Methods Using an individual-level time-stratified case-crossover design, conditional logistic regression models in conjunction with a distributed lag nonlinear model (DLNM) were employed to analyze the exposure-response relationship and temporal lag patterns of ambient air pollution on resident mortality in Jiading District (1994–2024). Results A total of 59 048 death cases were collected, including 18,701 deaths from cardiovascular diseases and 11 731 deaths from respiratory diseases. PM_2.5 and NO₂ had a significant impact on all-cause mortality, cardiovascular disease mortality, and respiratory disease mortality, with the most significant effects observed within a lag of 0–3 days. PM₁₀ also had some impact on these three types of mortality, but its effect was generally weaker than that of PM_2.5 and NO₂. The exposure-response curves showed that the risk of death increased rapidly with increasing concentrations of PM_2.5 and PM₁₀, while the effect of NO₂ plateaued at higher levels. No significant differences were found across age or gender subgroups. Conclusion Short-term exposure to PM_2.5, PM₁₀, and NO₂ significantly increases all-cause mortality risk in Jiading District, with effects persisting up to 7 days, highlighting the need for enhanced air pollution control measures, particularly targeting fine particulate matter.

Diabetic kidney disease（DKD） is a chronic kidney structural and functional disorder caused by diabetes. With the global prevalence of diabetes continuing to rise， DKD has gradually become a major cause of chronic kidney disease and end-stage renal disease（ESRD）， posing a serious threat to patients' quality of life and long-term health outcomes. Studies have shown that apoptosis plays a pivotal role in the development and progression of DKD， with its mechanisms involving abnormal activation of multiple signaling pathways such as Toll-like receptor 4（TLR4）/nuclear transcription factor-κB（NF-κB）/B-cell lymphoma-2（Bcl-2）/cysteinyl aspartate-specific proteinase（Caspase）-3， protein kinase R-like endoplasmic reticulum kinase（PERK）/eukaryotic initiation factor 2α（eIF2α）/activating transcript factor 4（ATF4）/CCAAT enhancer-binding protein homologous protein（CHOP）， phosphatidylinositol 3-kinase（PI3K）/protein kinase B（Akt）/glycogen synthase kinase-3β（GSK-3β）， Janus kinase 2（JAK2）/signal transducer and activator of transcription 3（STAT3）， adenosine monophosphate-activated protein kinase（AMPK）/mammalian target of rapamycin（mTOR） and silent information regulator 1（SIRT1）/tumor suppressor protein 53（p53）， thereby accelerating renal pathological damage in DKD. Extensive evidence-based medical studies have confirmed that traditional Chinese medicine（TCM）， leveraging its unique therapeutic advantages of multi-target， multi-component and multi-pathway approaches， has demonstrated remarkable efficacy and favorable safety profiles in treating DKD. Recent studies have demonstrated that active components of TCM can specifically target and modulate key effectors in apoptotic signaling pathways. Meanwhile， traditional compound formulations exert synergistic effects through multiple approaches such as replenishing deficiency and activating blood circulation， detoxifying and dredging collaterals， tonifying kidney essence， and removing stasis and purging turbidity， thereby comprehensively regulating critical pathological processes including endoplasmic reticulum stress and mitochondrial apoptosis pathways. This combined therapeutic approach of molecular targeting and holistic regulation provides novel strategies for delaying the progression of DKD. Based on this， this paper provides an in-depth analysis of key apoptotic signaling pathways and their regulatory mechanisms， while systematically summarizing recent research advances regarding the therapeutic effects of TCM active components， compound formulations， and proprietary Chinese medicines on DKD through modulation of these pathways， with particular emphasis on their underlying molecular mechanisms. These findings not only elucidate the modern scientific connotation and theoretical basis of TCM in treating DKD but also establish a solid theoretical and practical foundation for promoting the wider clinical application and further research of TCM in the field of DKD treatment.

ObjectiveTo investigate the effects of 7-dehydrocholesterol reductase （DHCR7） in promoting proliferation， migration， and invasion of lung adenocarcinoma cells and the underlying signaling mechanisms. MethodsThe expression level of DHCR7 in lung adenocarcinoma and its prognosis were analyzed by using public databases. DHCR7 protein expression levels in the lung adenocarcinoma cell lines H1299 and A549 were assessed by Western blot， using the normal lung epithelial cell line BEAS-2B as a control. Small interfering RNA （siRNA） was used to knock down DHCR7 expression in H1299 and A549 cells. Assays including colony formation， CCK-8， wound healing， and Transwell experiments were conducted to assess the proliferation， migration， and invasion of the knockdown cells. Next， Western blot was employed to assess the phosphorylation levels of key signaling molecules in the phosphoinositide 3-kinase/protein kinase B （PI3K/AKT）， janus kinase/signal transducer and activator of transcription 3 （JAK/STAT3），mitogen-activated protein kinase/extracellular signal-regulated kinase pathway （MAPK/ERK） （p-AKT， p-STAT3， p-ERK）. ResultsBioinformatics results indicated that both DHCR7 mRNA and protein were highly expressed in lung adenocarcinoma compared with normal tissues adjacent to cancer. Furthermore， higher DHCR7 mRNA level was associated with poor prognosis （P<0.001）. The expression levels of DHCR7 were significantly higher in both H1299 and A549 cells than that in BEAS-2B cells （P<0.05， P<0.01）. Compared with si-control， the proliferation， migration， and invasion abilities of si-DHCR7 H1299 and A549 cells significantly decreased. Among the phosphorylated signaling molecules detected， p-ERK was significantly downregulated （P<0.000 1， P<0.01） whereas p-AKT and p-STAT3 levels were not significantly changed. ConclusionDHCR7 has prominent effects in promoting the proliferation， migration， and invasion of lung adenocarcinoma cells， and the underlying mechanisms are related to the MAPK/ERK signaling pathway.

ObjectiveTo investigate the biological reparative effects of platelet-rich fibrin （PRF） extract on injured endometrial stromal cells （ESCs） induced by mifepristone and the underlying molecular mechanisms. MethodsAn ESCs injury model was established using mifepristone treatment. Cells were divided into four groups： untreated control （Con）， mifepristone-injured group （M）， mifepristone treatment+PRF extract group （M+P）， and mifepristone treatment+PRF extract+growth factor inhibitors treatment group， including M+P+T， M+P+Me， and M+P+CJ. Cell viability was detected using the CCK-8 assay， and migration ability was evaluated via the scratch wound healing assay. The release kinetics of growth factors， including vascular endothelial growth factor （VEGF）， platelet-derived growth factor-BB （PDGF-BB）， and transforming growth factor-beta 1 （TGF-β1） from PRF extract were measured by ELISA. The mRNA and protein expression levels of apoptosis-related factors （Bcl-2， Bax， and Caspase-3） were analyzed by RT-qPCR and Western blot， respectively. ResultsVEGF， PDGF-BB， and TGF-β1 were continuously released from the PRF extract over two weeks， with peak release observed on days 3-7. The extract significantly restored the proliferation and migration of mifepristone-injured ESCs （all P<0.000 1）. PRF extract up-regulated the mRNA and protein expression of the anti-apoptotic factor Bcl-2 （all P<0.000 1） and down-regulated that of the pro-apoptotic factors Bax and Caspase-3 （all P<0.000 1） in mifepristone-injured ESCs. Inhibitors of VEGF， PDGF-BB， and TGF-β1 （Tanshinone IIA， Methylnissolin， and CJJ300） significantly reversed the protective effects of PRF extract on mifepristone-injured ESCs （all P<0.05）. ConclusionPRF extract promotes the repair of injured ESCs by enhancing cell proliferation， attenuating apoptosis， and increasing migration capacity， which involve multiple growth factors， including VEGF， PDGF-BB， and TGF-β1.

ObjectiveTo observe the clinical efficacy and safety of Yishen Jiangtang decoction combined with conventional Western medicine treatment in managing stage G3A3 diabetic kidney disease （DKD） in the patients with the pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis， and to explore its mechanism of inhibiting the endoplasmic reticulum stress （ERS）-apoptosis axis and delaying renal fibrosis （RF）. MethodsA single-center， randomized， parallel-controlled clinical trial was conducted. A total of 78 patients diagnosed with stage G3A3 DKD and traditional Chinese medicine （TCM） pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis and treated in the Department of Nephrology and the Department of Endocrinology of the People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from March 2025 to February 2026 were enrolled. They were randomly assigned at a 1∶1 ratio into a control group （conventional Western medicine treatment） and an experimental group （Yishen Jiangtang decoction combined with conventional Western medicine treatment）， with 39 patients in each group. The treatment lasted for 12 weeks. Basic demographic data and medical history were collected before and after treatment. The two groups before and after treatment were compared in terms of the following parameters： Blood urea nitrogen （BUN）， serum creatinine （SCr）， estimated glomerular filtration rate （eGFR）， urinary albumin-to-creatinine ratio （UACR）， fasting blood glucose （FBG）， triglycerides （TG）， total cholesterol （TC）， and low-density lipoprotein cholesterol （LDL-C）. Enzyme-linked immunosorbent assay （ELISA） kits were used to measure serum glucose-regulated protein 78 （GRP78）， serum cysteinyl aspartate-specific protease-3 （Caspase-3）， and serum and urinary transforming growth factor-β₁ （TGF-β₁） levels before and after treatment. TCM symptom scores， TCM syndrome efficacy， and overall clinical efficacy were evaluated before and after treatment. Spearman correlation analysis was performed to explore the correlations of serum levels of GRP78 and Caspase-3， as well as serum and urinary levels of TGF-β1， with renal function， proteinuria， and glucose and lipid metabolism indicators in patients with DKD. In addition， safety indicators were also monitored. ResultsA total of 75 patients completed the study （38 in the control group and 37 in the experimental group）. ① Baseline data： The two groups were comparable in terms of sex and age， with no statistically significant difference. ② Efficacy outcomes： Compared with baseline levels， both groups showed reductions in BUN， SCr， UACR， FBG， TG， TC， LDL-C， and TCM symptom scores （P<0.01） and increases in eGFR level （P<0.01）. Moreover， the experimental group outperformed the control group in altering the indicators above （P<0.05）. Regarding TCM syndrome efficacy， the total response rate in the experimental group was 83.78%， which was higher than that （57.89%） in the control group （P<0.05）. Regarding overall clinical efficacy， the total response rate in the experimental group was 78.38%， which was higher than that （50.00%） in the control group （P<0.05）. ③ Mechanism outcomes： Compared with baseline levels， both groups showed declined serum levels of GRP78， Caspase-3， and TGF-β₁ and urinary level of TGF-β₁ after treatment （P<0.01）. Moreover， the experimental group showed greater declines than the control group （P<0.05）. The serum levels of GRP78， Caspase-3，and TGF-β₁ and the urinary level of TGF-β₁ in DKD patients showed positive correlations with BUN， SCr， UACR， and FBG and negative correlations with eGFR （P<0.05）. ④ Safety outcomes： Neither group showed drug-related adverse reactions， and laboratory safety parameters remained within normal ranges. ConclusionYishen Jiangtang decoction combined with conventional Western medicine treatment may safely and effectively alleviate clinical symptoms， correct glucose and lipid metabolism disorders， and protect the renal function in patients with stage G3A3 DKD and the pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis. The mechanism may be associated with inhibition of the ERS-apoptosis axis and delay of the RF process.

ObjectiveTo observe the clinical efficacy and safety of Yishen Jiangtang decoction combined with conventional Western medicine treatment in managing stage G3A3 diabetic kidney disease （DKD） in the patients with the pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis， and to explore its mechanism of inhibiting the endoplasmic reticulum stress （ERS）-apoptosis axis and delaying renal fibrosis （RF）. MethodsA single-center， randomized， parallel-controlled clinical trial was conducted. A total of 78 patients diagnosed with stage G3A3 DKD and traditional Chinese medicine （TCM） pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis and treated in the Department of Nephrology and the Department of Endocrinology of the People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from March 2025 to February 2026 were enrolled. They were randomly assigned at a 1∶1 ratio into a control group （conventional Western medicine treatment） and an experimental group （Yishen Jiangtang decoction combined with conventional Western medicine treatment）， with 39 patients in each group. The treatment lasted for 12 weeks. Basic demographic data and medical history were collected before and after treatment. The two groups before and after treatment were compared in terms of the following parameters： Blood urea nitrogen （BUN）， serum creatinine （SCr）， estimated glomerular filtration rate （eGFR）， urinary albumin-to-creatinine ratio （UACR）， fasting blood glucose （FBG）， triglycerides （TG）， total cholesterol （TC）， and low-density lipoprotein cholesterol （LDL-C）. Enzyme-linked immunosorbent assay （ELISA） kits were used to measure serum glucose-regulated protein 78 （GRP78）， serum cysteinyl aspartate-specific protease-3 （Caspase-3）， and serum and urinary transforming growth factor-β₁ （TGF-β₁） levels before and after treatment. TCM symptom scores， TCM syndrome efficacy， and overall clinical efficacy were evaluated before and after treatment. Spearman correlation analysis was performed to explore the correlations of serum levels of GRP78 and Caspase-3， as well as serum and urinary levels of TGF-β1， with renal function， proteinuria， and glucose and lipid metabolism indicators in patients with DKD. In addition， safety indicators were also monitored. ResultsA total of 75 patients completed the study （38 in the control group and 37 in the experimental group）. ① Baseline data： The two groups were comparable in terms of sex and age， with no statistically significant difference. ② Efficacy outcomes： Compared with baseline levels， both groups showed reductions in BUN， SCr， UACR， FBG， TG， TC， LDL-C， and TCM symptom scores （P<0.01） and increases in eGFR level （P<0.01）. Moreover， the experimental group outperformed the control group in altering the indicators above （P<0.05）. Regarding TCM syndrome efficacy， the total response rate in the experimental group was 83.78%， which was higher than that （57.89%） in the control group （P<0.05）. Regarding overall clinical efficacy， the total response rate in the experimental group was 78.38%， which was higher than that （50.00%） in the control group （P<0.05）. ③ Mechanism outcomes： Compared with baseline levels， both groups showed declined serum levels of GRP78， Caspase-3， and TGF-β₁ and urinary level of TGF-β₁ after treatment （P<0.01）. Moreover， the experimental group showed greater declines than the control group （P<0.05）. The serum levels of GRP78， Caspase-3，and TGF-β₁ and the urinary level of TGF-β₁ in DKD patients showed positive correlations with BUN， SCr， UACR， and FBG and negative correlations with eGFR （P<0.05）. ④ Safety outcomes： Neither group showed drug-related adverse reactions， and laboratory safety parameters remained within normal ranges. ConclusionYishen Jiangtang decoction combined with conventional Western medicine treatment may safely and effectively alleviate clinical symptoms， correct glucose and lipid metabolism disorders， and protect the renal function in patients with stage G3A3 DKD and the pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis. The mechanism may be associated with inhibition of the ERS-apoptosis axis and delay of the RF process.

Objective:To explore applications of adjusting timing of nebulization and analgesic usage in patients after lung cancer surgery, to provide reference for postoperative rehabilitation of lung cancer.Methods:Adopting a prospective randomized controlled study design, a total of 84 patients with lung cancer who underwent surgery in affiliated hospital of Jining Medical University from September 2020 to June 2023 were enrolled by a convenience sampling method, they were randomly divided into experimental group and control group according to random number table method. Two groups was given routine perioperative care, on this basis, the control group received lip and abdomen contraction breathing training according to the conventional process, and the experimental group adjusted timing of nebulization and analgesic usage and received respiratory function training when nebulization and analgesics were at the peak of blood drug concentration. Pain level and exercise self-efficacy of two groups were compared.Results:There were 27 males and 15 females in the control group, aged (54.52 ± 14.06) years; and 24 males and 18 females in the experimental group, aged (53.33 ± 12.02) years. At one day, two days and three days after operation, the scores of Numerical Rating Scale (NRS) were (5.07 ± 0.84), (3.40 ± 0.49), (2.93 ± 0.87) in the experimental group, lower than (5.86 ± 1.05), (4.09 ± 0.88), (3.33 ± 0.65) in the control group, the differences were statistically significant ( t=3.79, 4.44.2.42, all P<0.05), and for both groups, the differences in the time effect, between-group effect, and the interaction effect were all statistically significant ( F=582.92, 44.65, 3.82, all P<0.05). Three days after operation, the dimensions of efficacy expectation, outcome expectation and total self-efficacy scores were (28.62 ± 6.75), (33.71 ± 7.04) and (62.33 ± 9.07) in the experimental group, and (25.52 ± 6.66), (30.43 ± 6.80) and (55.95 ± 9.34) in the control group, the differences were statically significant ( t=2.12, 2.18, 3.18, all P<0.05). Conclusions:Adjusting timing of nebulization and analgesic usage and giving respiratory function training for lung cancer surgery when nebulization and analgesics at the peak of blood drug concentration can effectively alleviate the pain caused by respiratory exercise and improve training self-efficacy of patients after lung cancer surgery.

This study aimed to investigate the association between secondhand smoke exposure in different places and overweight/obesity among children and adolescents. Children and adolescents aged 7 to 18 years old in Hunan Province were recruited for questionnaire surveys and physical examinations using a multi-stage stratified cluster sampling method. Secondhand smoke exposure was evaluated according to the answer to the question, "Has someone smoked in front of you in the last 7 days?". Overweight and obesity were determined using BMI-for-age and BMI-for-sex according to the national standard WS/T586-2018. Multivariate logistic regression was used to explore the association between secondhand smoke exposure in different places and overweight/obesity among children and adolescents. A total of 187 863 participants were included in this study, with a prevalence of overweight and obesity of 28.4%. The prevalence of secondhand smoke exposure at home, school and other public places was 25.5%, 12.6% and 32.3%, respectively. Children and adolescents with secondhand smoke exposure at home, school and other public places had a higher prevalence of overweight and obesity than those without exposure. After adjusting for confounding factors, secondhand smoke exposure was positively associated with overweight and obesity among children and adolescents, and exposure at home showed the closest association ( OR=1.091; 95% CI: 1.066-1.117). In conclusion, secondhand smoke exposure, especially at home, significantly increases the risk of overweight and obesity among children and adolescents. Comprehensive strategies should be implemented to avoid secondhand smoke exposure and protect children and adolescents from overweight and obesity.

OBJECTIVE To build a Tibetan-language medication service platform based on"internet+"and evaluate its effect on improving medication compliance and safety of Tibetan patients with chronic disease.METHODS Medication guidance contents of commonly used drugs in the outpatient department were summarized,translated and recorded in Tibetan-language or video to form a"text-audio-video"multi-dimensional"internet+"Tibetan-language medication service platform.A total of 387 Tibetan outpatients with chronic disease in our hospital after the implementation of"internet+"Tibetan-language medication service platform(from January 2024 to June 2024)in our hospital were selected as the intervention group,and 387 Tibetan outpatients before the implementation(from January 2023 to June 2023)were selected as the control group.Patients in the control group received conventional window-based Chinese-language medication services,while patients in the intervention group received both conventional window-based Chinese-language medication service and"internet+"Tibetan-language medication service.The medication compliance of patients was evaluated using the 12-item Medication Compliance Scale.A six-level causality assessment was conducted as the principles for analyzing adverse drug reactions(ADR)set by the National Center for ADR Monitoring.Additionally,statistics were compiled on the occurrence of ADR that were assessed as"definite""probable"or"possible"in the causality assessment.RESULTS The proportion(31.0%)of patients with good medication compliance and compliance scores[39.0(37.0,42.0)]of patients in the intervention group were significantly better than control group[7.0%,21.0(19.0,23.0)](P＜0.05).There were no statistically significant differences in the incidence of various types of ADR or the overall incidence between the two groups(P＞0.05).CONCLUSIONS The"internet+"Tibetan-language medication service platform is constructed successfully;the service can effectively improve the medication compliance of Tibetan-language patients,but its effect on improving the medication safety of patients is limited.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.