Objective: To assess the current status of knowledge, attitude, and practice (KAP) regarding health protection against air pollution among primary school students in China, and to analyze the impacts of fine particulate matter (PM 2.5 ) exposure, family, and individual factors on KAP levels, so as to provide empirical basis for implementing targeted interventions. Methods: Using stratified cluster random sampling method, a questionnaire survey was conducted among 19 297 primary school students from third to fifth grade across 30 provinces (autonomous regions and municipalities directly under the central government) in China in 2024. The questionnaire was developed based on the Technical Guidelines for the Assessment of Civic Environmental and Health Literacy (Trial), and encompasses three dimensions:knowledge, attitude, and practice. Spearman correlation analysis, Chi-square test, multivariate Logistic regression, and Bootstrap mediation effect test was applied for data analysis. Results: The overall mean KAP score for health protection against air pollution among primary school students was (79.73±13.53), with an adequacy rate of 80.47% ( n =15 528). The dimension scores for knowledge, attitude, and practice were (41.34±8.01, 16.43± 2.61 ), and (21.97±5.71), respectively. Knowledge was positively correlated with attitude and practice, and attitude was positively correlated with practice ( r =0.51, 0.35, 0.32, all P <0.01). Multivariate Logistic regression showed that the northeast region ( OR =2.36, 95% CI =2.02-2.75), having parents with a bachelor s degree or higher ( OR =4.76, 95% CI =2.71-8.37), living with both parents ( OR =1.33, 95% CI =1.15-1.55), being in the fifth grade ( OR =1.22, 95% CI =1.11-1.33), outdoor PM 2.5 level exceeding standard limits at the survey site ( OR =1.25, 95% CI =1.16-1.34), history of allergy ( OR =1.47, 95% CI =1.31-1.64), and wearing masks during heavily polluted weather ( OR =1.19, 95% CI =1.07-1.31) were promoting factors for KAP adequacy rate (all P <0.05). Conversely, obesity was a detrimental factor ( OR =0.78, 95% CI =0.69-0.88, all P <0.05). Conclusions Primary school students in China exhibit a favorable KAP level regarding health protection against air pollution, though regional, familial, and individual disparities persist. Exposure to PM 2.5 levels exceeding standard limits exerts a direct positive effect on enhancing health protection literacy. Future efforts should focus on the western region, families with lower educational attainment children to implement tailored, stratified interventions.

Objective:To evaluate the level of first morning voided(FMV)urinary luteinizing hor-mone(LH)in girls with breast development,and to determine the value of FMV urine LH in the evalua-tion of central precocious puberty(CPP).Methods:From September 2018 to April 2021,among the patients who were admitted to the Department of Pediatrics of Peking University Third Hospital for"pre-cocious puberty"and underwent gonadotropin-releasing hormone(GnRH)stimulation test,a total of 108 girls were enrolled.According to CPP diagnostic criteria,they were divided into CPP group(n=45)and non-CPP group(n=63).The clinical characteristics and hormone levels of the two groups were com-pared.Receiver operating characteristic(ROC)curve was used to analyze the cut-off value of FMV uri-nary LH in the diagnosis of CPP in girls.Further analyses were done to evaluate the value of FMV urinary LH in the diagnosis of CPP using correlation analysis between urinary LH level and common clinical cha-racteristics.Results:ROC curve analysis showed that FMV urine LH level was significant for the diagno-sis of CPP.The cut-off value of FMV urine LH was 0.69 IU/L(specificity 56.9％,sensitivity 85.0％,area under curve 0.804,P＜0.001).The basic clinical characteristics without GnRH stimulation test were analyzed by binary Logistic regression analysis,indicating that the level of FMV urine LH,uterine volume,ovarian volume and advanced T-bone age had predictive significance for CPP diagnosis in girls(OR values were 2.125,1.961,1.564 and 2.672,respectively).The prediction model was established and the area under the ROC curve was 0.904,P＜0.001.The level of FMV urine LH was positively cor-related with the levels of serum LH,FSH and estrogen before GnRH stimulation test,the peak value of blood LH after GnRH stimulation test,T bone age and uterine volume,with r values of 0.462,0.373,0.242,0.360,0.373 and 0.263,respectively,and P values were＜0.001,＜0.001,0.013,＜0.001,＜0.001 and 0.007,respectively.Conclusion:FMV urine LH can provide a good indication for the diagnosis of CPP.Combining with bone age advanced level and pelvic ultrasound measurement,the pre-dictive value of FMV urine LH can be further improved for the diagnosis of CPP in girls.

Chronic obstructive pulmonary disease （COPD） is a chronic heterogeneous airway disease characterized by persistent and progressive airflow restriction， which can be divided into stable COPD and acute exacerbations of COPD （AECOPD）. Its morbidity and mortality remain high， posing a serious threat to human health. Traditional Chinese Medicine （TCM） believes that COPD belongs to the categories of "cough"， "dyspnea syndrome"， "lung distension"， etc. And its basic pathogenesis is intermingled phlegm and stasis with deficiency in origin and excess in superficiality. Qianjin Weijingtang， derived from the Records of Proved Prescriptions， Ancient and Modern （古今录验方）， consists of Phragmitis Caulis， Persicae Semen， Coicis Semen， and Benincasae Semen， with remarkable functions in clearing the lung， resolving phlegm and eliminating blood stasis， and has definite clinical efficacy in treating COPD and its syndromes. At present， in clinical studies， Qianjin Weijingtang has been used to treat COPD with modifications. It can be used alone or in combination with other prescriptions/western medicines to treat stable COPD， AECOPD， COPD complications， and other TCM syndromes of COPD such as phlegm-heat-stagnation obstructing the lung syndrome. It can significantly improve clinical symptoms， lung function， and blood gas indexes， and inhibit inflammatory response. Animal experiments mainly explored the mechanism of COPD from the level of pathological changes. Specifically， the underlying mechanism may be related to regulating T helper 17 （Th17）/regulatory T cells （Treg） balance， up-regulating single immunoglobulin IL-1-related receptor （SIGIRR） for resisting inflammation， up-regulating hyperplasia suppressor gene （HSG） and inhibiting Wnt signaling pathway activation to inhibit airway remodeling. It was found that there were many problems， such as low quality of clinical research， failure in sharing research standards， and the lack of mechanism research. This article systematically reviewed clinical studies of Qianjin Weijingtang in the treatment of COPD and its mechanism based on animal experiments in recent years， and put forward thoughts and suggestions according to the existing problems to provide references for the clinical application and further research on Qianjin Weijingtang.

Objective:To investigate the maternal and fetal immune tolerance effect mediated by human leukocyte antigen-G (HLA-G) in the early threatened abortion patients given by Zishen-Yutai pills.Methods:The current study was a single-blind randomized controlled trial. Totally 150 early threatened abortion patients were enrolled into this study, who had received outpatient and inpatient treatment in the Second Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from January 2018 to December 2019. Randomization was used according to a randomized number which was generated by computer. Patients were divided into the Zishen-Yutai Pills group ( n=50), Bushen-Jianpi Recipe group ( n=50) and Dydrogesterone Tablets group ( n=50). They were treated until 12 weeks of gestation. Primary indicators were serum HLA-G and pregnancy outcome; minor indicators were: 1) level of CD4, CD8, CD4/CD8, natural killer (NK) cells; 2) level of serum oestradiol, progesterone, human chorionic hormone (hCG); 3) ultrasound situation of pelvic; 4) symptom scores of Traditional Chinese Medicine. Results:1) The HLA-G levels of the three groups were all increased after the treatment (all P<0.05), which were higher in Zishen-Yutai Pills group [(352.54±102.40) IU/mL] and Bushen-Jianpi Recipe group [(353.76±98.92) IU/mL] than in Dydrogesterone Tablets group [(306.90±60.74) IU/mL; P=0.024, P=0.016)]. There was no statistical significant difference between Zishen-Yutai Pills group and Bushen-Jianpi Recipe group ( P>0.05). 2) The CD4 levels of the Zishen-Yutai Pills group (34.82%±6.99%) and the Bushen-Jianpi Recipe group (36.10%±6.44%) were decreased after the treatment (37.66%±7.43%, P=0.004; 39.72%±7.07%, P<0.001). The CD8 levels of the three groups were all decreased after the treatment (all P<0.05),which decreased obviously in Zishen-Yutai Pills group (20.40%±4.12%) and Bushen-Jianpi Recipe group (19.92%±4.68%) compared with Dydrogesterone Tablets group (24.06%±5.29%; P<0.001, P<0.001). The CD4/CD8 levels of the three groups were all increased ( P<0.001, P<0.001, P=0.001), which were statisticaly higher in Bushen-Jianpi Recipe group (1.94±0.65) than in Dydrogesterone Tablets group (1.64±0.50) after the treatment ( P=0.044). The NK cell levels of Zishen-Yutai Pills group (10.78%±2.79%) and Bushen-Jianpi Recipe group (10.70%±3.22%) were all decreased after the treatment (14.36%±3.73%, 15.12%±6.06%; all P<0.001), which were significantly lower than that in Dydrogesterone Tablets group (14.03%±5.48%; P=0.001 , P=0.001). 3) The serum estradiol, progesterone, hCG levels of the three groups were all increased after the treatment (all P<0.001), the progesterone level of Zishen-Yutai Pills group [(33.20±6.19) ng/L] and Bushen-Jianpi Recipe group [(33.92±7.83) ng/L] was statistically significantly different from that of Dydrogesterone Tablets group [(25.56±6.06) ng/L; P<0.001, P<0.001]. 4) The TCM symptoms′ scores of the three groups were all decreased after the treatment (all P<0.001), while it was lower in Zishen-Yutai Pills group [2.00(1.25)] than that in Bushen-Jianpi Recipe group [3.00(2.00)] and Dydrogesterone Tablets group [9.00(2.00)] ( P=0.002, P<0.001). 5) The clinical pregnancy outcome of the three groups had no significant difference ( P>0.05). Conclusion:The Zishen-Yutai pills can mediate maternal and fetal immune tolerance by upregulating HLA-G level, and improve the pregnancy outcome. Its clinical effect was similar to that of the Bushen-Jianpi Recipe, and better than that of the Dydrogesterone Tablets. It is worth popularizing in the treatment of early threatened abortion because of its definite clinical effect, convenient to carry and take.

Objective:To investigate the maternal and fetal immune tolerance effect mediated by human leukocyte antigen-G (HLA-G) in the early threatened abortion patients given by Zishen-Yutai pills.Methods:The current study was a single-blind randomized controlled trial. Totally 150 early threatened abortion patients were enrolled into this study, who had received outpatient and inpatient treatment in the Second Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from January 2018 to December 2019. Randomization was used according to a randomized number which was generated by computer. Patients were divided into the Zishen-Yutai Pills group ( n=50), Bushen-Jianpi Recipe group ( n=50) and Dydrogesterone Tablets group ( n=50). They were treated until 12 weeks of gestation. Primary indicators were serum HLA-G and pregnancy outcome; minor indicators were: 1) level of CD4, CD8, CD4/CD8, natural killer (NK) cells; 2) level of serum oestradiol, progesterone, human chorionic hormone (hCG); 3) ultrasound situation of pelvic; 4) symptom scores of Traditional Chinese Medicine. Results:1) The HLA-G levels of the three groups were all increased after the treatment (all P<0.05), which were higher in Zishen-Yutai Pills group [(352.54±102.40) IU/mL] and Bushen-Jianpi Recipe group [(353.76±98.92) IU/mL] than in Dydrogesterone Tablets group [(306.90±60.74) IU/mL; P=0.024, P=0.016)]. There was no statistical significant difference between Zishen-Yutai Pills group and Bushen-Jianpi Recipe group ( P>0.05). 2) The CD4 levels of the Zishen-Yutai Pills group (34.82%±6.99%) and the Bushen-Jianpi Recipe group (36.10%±6.44%) were decreased after the treatment (37.66%±7.43%, P=0.004; 39.72%±7.07%, P<0.001). The CD8 levels of the three groups were all decreased after the treatment (all P<0.05),which decreased obviously in Zishen-Yutai Pills group (20.40%±4.12%) and Bushen-Jianpi Recipe group (19.92%±4.68%) compared with Dydrogesterone Tablets group (24.06%±5.29%; P<0.001, P<0.001). The CD4/CD8 levels of the three groups were all increased ( P<0.001, P<0.001, P=0.001), which were statisticaly higher in Bushen-Jianpi Recipe group (1.94±0.65) than in Dydrogesterone Tablets group (1.64±0.50) after the treatment ( P=0.044). The NK cell levels of Zishen-Yutai Pills group (10.78%±2.79%) and Bushen-Jianpi Recipe group (10.70%±3.22%) were all decreased after the treatment (14.36%±3.73%, 15.12%±6.06%; all P<0.001), which were significantly lower than that in Dydrogesterone Tablets group (14.03%±5.48%; P=0.001 , P=0.001). 3) The serum estradiol, progesterone, hCG levels of the three groups were all increased after the treatment (all P<0.001), the progesterone level of Zishen-Yutai Pills group [(33.20±6.19) ng/L] and Bushen-Jianpi Recipe group [(33.92±7.83) ng/L] was statistically significantly different from that of Dydrogesterone Tablets group [(25.56±6.06) ng/L; P<0.001, P<0.001]. 4) The TCM symptoms′ scores of the three groups were all decreased after the treatment (all P<0.001), while it was lower in Zishen-Yutai Pills group [2.00(1.25)] than that in Bushen-Jianpi Recipe group [3.00(2.00)] and Dydrogesterone Tablets group [9.00(2.00)] ( P=0.002, P<0.001). 5) The clinical pregnancy outcome of the three groups had no significant difference ( P>0.05). Conclusion:The Zishen-Yutai pills can mediate maternal and fetal immune tolerance by upregulating HLA-G level, and improve the pregnancy outcome. Its clinical effect was similar to that of the Bushen-Jianpi Recipe, and better than that of the Dydrogesterone Tablets. It is worth popularizing in the treatment of early threatened abortion because of its definite clinical effect, convenient to carry and take.

Objective: To explore the effect of ambient fine particulate matters (PM_2.5) exposure on nasal oxidative stress level in patients with allergic rhinitis (AR). Methods: A panel of sixty AR patients was recruited as subjects. Four repeated measurements were carried out from June 2017 to January 2018. Nasal irrigation solution was collected and examined for malondialdehyde (MDA) and superoxide dismutase (SOD). Monitoring data of atmospheric pollutants and meteorological factors during measurement periods were also collected. Time activity pattern combined with micro-environment monitoring method was used to evaluate PM_2.5 exposure. Mixed effect model was applied to analyze the relationship between PM_2.5 exposure concentration and oxidative stress level. Results: 49 subjects accomplished the four repeated measurements, and the mean±SD of their age was (36.7±8.4) years old. The median of MDA and SOD in four measurement periods was 3.70, 3.70, 5.58, 6.24 nmol/ml, and 105.50, 102.50, 95.00, 96.50 U/ml. The concentration of PM_2.5 exposure in four measurement periods was (40.0±2.7), (41.5±2.5), (52.3±5.9) and (74.7±4.9) μg/m³, respectively. Results of single pollutant mixed effect model analysis showed that 0-, 1-, 2-, 3-day lag concentrations of PM_2.5 was significantly positively associated with MDA, about β (95%CI) estimated as 0.24 (0.17, 0.30), 0.34 (0.27, 0.41), 0.32 (0.20, 0.44) and 0.33 (0.23, 0.43), respectively. 0-, 1-, 2-day concentrations of PM_2.5 was significantly negatively associated with SOD, about β (95%CI) estimated as -0.99 (-1.66, -0.31), -1.35 (-2.08, -0.62) and -0.94 (-1.80, -0.07), respectively. Multivariate analysis found that lag 1-day concentration of PM_2.5 was still significantly associated with MDA and SOD after controlling for temperature, age and other influencing factors. For a 10 μg/m³ increase of PM_2.5 concentration, MDA increased 0.26 (95%CI: 0.18, 0.33) nmol/ml, and SOD decreased 0.87 (95%CI: 0.21, 1.53) U/ml. Conclusion Our results suggested that PM_2.5 exposure can aggravate the nasal oxidative stress response of AR patients.

Objective: To compare diary-reported trips and Global Positioning System (GPS) recording trips and identify the reasons for the discrepancies between two methods. Methods: The survey was conducted in Jiangning district in Nanjing city during July to September and November to December, 2015. Both the diary records and GPS method were used to investigate the travel behavior of 33 retired adults for 5 consecutive days. The GPS traces were display in Google Earth and then split into trips to compare with the diary records according to time and location. χ² test was used to analyze the influence of trip characteristics on misreporting rates of each method. Results: A total of 1 087 trips in the survey can be compared between the diary (n=909) and the GPS method (n=912). 7.3% (79/1 087) of the trips were only recorded by GPS method, and 11.8% (128/1 087) were only reported in the diary. Of the remaining 880 trips recorded by the both methods, 86.7% (763/880) matched each other, while 13.3% (117/880) did not. For the matched trips, the difference between the trip durations recorded by diary and GPS method was 2.0 (quartile was 6.0) minutes and the diary method overestimated about 25.0% trip durations when compared with the GPS method. The accuracy rates were 84.8%(903/1 065) and 86.9%(925/1 065) for diary and GPS method, respectively. Both methods were more likely to misreport the trip under 5 minutes. The misreporting rates of diary method for trips under 5 minutes were 6.8 times higher than trips over 30 minutes (21.7% vs 3.2%). The reporting accuracy was also significantly different among trips by different travel mode (P<0.05) for both methods, diary method had the lowest accuracy in reporting vehicles recorders (69.3%, 133/192), while GPS method was more accuracy in both biking (91.9%, 136/148) and vehicles recorders(89.6%, 172/192). The main reasons for misreporting by diary method were forgetting or unwilling to record and failing to record trips according to travel mode, while forgetting to carry GPS device, bad GPS signal and failing to locate the position were the main reasons for misreporting by GPS method. Conclusion The majority of the trips reported in diary and GPS method are well consistent with each other. Both of the methods should be used simultaneously in the survey of time-activity pattern to improve the data quality.

Objective To investigate the relationship between the expression of imprinted gene CDKN1C in placenta and the birth weight of neonates.Methods Twenty-nine term small for gestational age (SGA) neonates admitted to Peking University Third Hospital from January 1,2014 to December 31,2014 were recruited,and 29 appropriate for gestational age (AGA) neonates with a difference of not more than one week in gestational age served as controls.Fresh placental tissue was collected and the expression of imprinted gene CDKN1C mRNA in the placenta were detected by real-time fluorescence quantitative-polymerase chain reaction,and its protein expression was estimated by Western-blot.Chi-square test,independent-sample t test,Pearson's correlation analysis were used for statistical analysis.Results The CDKN1C mRNA expression level in SGA was significantly higher than that in AGA (0.133± 0.059 vs 0.100±0.046,t=2.401,P=0.020),so was the CDKN1C protein expression (0.280±0.043 vs 0.190±0.041,t=8.410,P=0.000).The CDKN1C mRNA expression levels were negatively correlated with birth weight in both groups (SGA group,r=-0.587,P=0.001;AGA group,r=-0.569,P=0.001),and the correlation was slightly stronger in SGA (r2=0.344) than in AGA (r2=0.324).The CDKN1C protein expression levels of the two groups were negatively correlated with birth weight (SGA group,r=-0.579,P=0.001;AGA group,r=-0.497,P=0.006),the correlation being stronger in SGA group (r2=0.335) than in AGA group (r2=0.247).The CDKN1C mRNA and protein expression levels of the two groups were negatively correlated with birth weight for gender,especially in males [mRNA:r2=0.293(male)vs r2=0.185(female);protein:r2=0.730 (male) vs r2=0.601(female)].Neither CDKN1C mRNA nor protein expression level was correlated to the placenta weight (mRNA:SGA group,r=0.119,P=0.540;AGA group,r=-0.069,P=0.722;protein:SGA group,r=0.126,P=0.515;AGA group,r=-0.247,P=0.196).Conclusions The expressions of CDKN1C mRNA and protein may be related to birth weight of term SGA neonates,especially in male infants.

Objective To investigate the regular pattern of dynamic changes of insulin sensitivity in fetal growth restriction (FGR) rats. Methods Twenty pregnant female rats were randomly divided into two groups as normal-protein group (NP) and low-protein group (LP), which respectively received normal protein diet (20% protein) and low protein diet (8% protein) during pregnancy. Weights of newborns were measured within 6 hours after birth, and the LP offspring whose birth weights were at least 2 standard deviations below the mean of NP offspring (≤2 standard deviations) were defined as FGR rats. At day 3, 7, 14, 30, 60 and 90 after birth, rats were fasted for 12 hours and then angular vein blood was collected to measure fasting plasma glucose (FPG) and fasting serum insulin (FINS) level. At 90 days of age, intraperitoneal glucose tolerance test (IPGTT)was performed; and blood triglyceride ( TG ), low-density lipoprotein cholesterol ( LDL-C ),high-density lipoprotein cholesterol (HDL-C) and glycosylated hemoglobin Alc (HbAlc) were measured. Insulin sensitivity was evaluated by FINS, insulin resistance index (HOMA-IR), insulin sensitivity index (ISI) and IPGTT. Results (1) Birth weights of LP offspring [(4. 92 ± 0. 36) g]were significantly lower than those of NP ones [(6. 43 ± 0. 59) g] (t = 14. 73, P＜0. 05). The incidence of FGR in LP was 88. 2% ; and for the male and female rats, the FGR rate was 94. 1% and 83. 1%, respectively. (2) FPG levels in the male FGR rats were significantly higher than in the NP from the age of 60 days [(9.38 ± 1.57) mmol/L vs (5. 58 ± 1.24) mmol/L] to 90 days [(8. 95 ±1.83) mmol/L vs (6. 21± 1.14) mmol/L] (t=-3. 291, P＜0. 05), while FPG levels in female FGR rats increased significantly only at 90 days of age [(9. 08±1.65) mmol/L vs (6.73±0. 67) mmol/L](t=-3. 226,P＜0. 05). FINS levels were significantly higher in FGR rats than in the NP from the age of 30 days (male FGR rats) or 60 days (female FGR rats) to 90 days (P＜0. 05, respectively).Similarly, HOMA-IR was significantly higher in FGR rats than in the NP at the age of 30 days (male FGR rats) or 60 days (female FGR rats) to 90 days (P＜0. 05, respectively). ISI in male FGR rats showed a reduction in comparison with the NP from the age of 30 to 90 days, while as to the female FGR rats it was significantly lower than in the NP only at 60 days of age and continued to 90 days (P＜0. 05, respectively). IPGTT showed that after injection of glucose, blood glucose at all four points (from 0 min to 120 min) in both male and female FGR rats were higher than that in the NP (P＜0. 05). (3) No significant difference was observed in TG, LDL-C and HDL-C at 90 days of age between the FGR rats and NP ones, while HbA1c in the male FGR rats was significantly higher than that in the NP [(7. 03±0. 54) % vs (4. 37±0. 64)%,t= -8. 028, P＜0. 05]. Conclusions FGR rats are able to maintain glucose balance and normal insulin levels during their earlier age, while insulin sensitivity decreased from adolescence to adulthood. The change of insulin sensitivity is different between male and female FGR rats, and male FGR rats are more likely to develop insulin resistance.

Objective To investigation the relation of leptin to birth weight and insulin in preterm and term neonates and to explore whether a functional “adipoinsular axis” might exist in preterm and term neonates. Methods A total of 264 preterm and term newborns were recruited and categorised according to gestation length. Anthropometric measurements were performed at birth. Leptin, fasting glucose and insulin were measured at 3 days of life. Results Serum leptin was significantly higher in term than in preterm. The relation between serum leptin and gestation followed a non-linear pattern; The slope of the curve began to increase after 34 weeks gestation. Serum leptin was associated with birth weight and insulin in newborn more than 32 weeks gestation(r=0.240, 0.227, P