Background In 2021, chronic obstructive pulmonary disease (COPD) emerged as the forth leading cause of death in the world. However, the impact of air pollutants on COPD is still inconsistent across current studies. Objective To analyze the relationship between ambient sulfur dioxide (SO₂) exposure and hospital admissions for COPD in Lanzhou, and to examine the modified effects of SO₂ across different genders, age groups, and seasons. Methods A total of 20718 hospital admission records for COPD were collected from Lanzhou between 2016 and 2020, alongside synchronized data on SO₂ concentration and meteorological variables. A generalized additive model integrated with a distributed lag nonlinear model was used to assess the relationship and the lag effects between SO₂ exposure and COPD admissions. Potential confounders, including meteorological factors, day-of-the-week effect, and holidays, were controlled for, with a maximum lag period set at 7 d. Two-pollutant models and sensitivity analyses were conducted to ensure robustness. Results are expressed as relative risks (RR) with 95% confidence intervals (95%CI). Results During the study period, the average daily number of COPD admissions was 11.34±7.03. The average mass concentration of SO₂ was (23.72±12.35) μg·m⁻³. SO₂ exposure was positively correlated with COPD admissions; specifically, each 10 μg·m⁻³ increase in SO₂ concentration was associated with an RR of 1.440 (95%CI: 1.317, 1.573). Stratified analyses found that at a cumulative lag of 7 d, the RRs were higher among females, individuals aged ≥65 years, and during the cold season. Conversely, no significant increase in COPD admission risk related to SO₂ was observed during the warm season. For every 10 μg·m⁻³ increase in SO₂ concentration, the RR was 1.483 (95%CI: 1.311, 1.678) for females, 1.441 (95%CI: 1.311, 1.583) for those aged > 65 years， and 1.595 (95%CI: 1.313, 1.937) during the cold season. Conclusion Short-term exposure to ambient SO₂ exposure in Lanzhou is associated with an increased risk of COPD admission. The association is more pronounced among females, the elderly (aged> 65 years) and during the cold season.

ObjectiveThe widespread adoption of portable fundus cameras for primary care and community screening is hindered by limitations in current autofocus(AF) technologies. Image-based methods relying on sharpness evaluation require iterative searches, resulting in slow convergence, while projection-based techniques are susceptible to optical artifacts and calibration errors. To address these challenges, this study introduces a novel AF system based on direct wavefront sensing, designed to deliver simultaneous high speed, high precision, and operational robustness within the compact form factor essential for portable ophthalmic devices. MethodsOur approach fundamentally reimagines the AF process by directly measuring the ocular wavefront aberration. We developed a custom portable fundus camera integrating a miniaturized Shack-Hartmann wavefront sensor (SHWS) into the optical path. An 850 nm laser diode projects a point source onto the retina via oblique illumination to minimize corneal reflections. Light scattered from this spot carries the eye’s refractive error through the imaging optics and is directed to the SHWS, positioned at a plane optically conjugate to the primary color CMOS imaging sensor. A microlens array within the SHWS samples the incident wavefront, generating a pattern of focal spots on a CCD. Real-time centroid analysis of these spots provides a map of local wavefront slopes. These measurements are processed through a singular value decomposition (SVD) algorithm to fit a Zernike polynomial basis set, enabling real-time reconstruction of the wavefront phase. The defocus component (S) is extracted from the second-order Zernike coefficients, providing a direct, quantitative measure of the refractive error in diopters. This value serves as a precise error signal in a closed-loop control system, which commands a voice-coil actuated focusing lens to its null position in a single, deterministic step, eliminating the need for iterative search algorithms. ResultsComprehensive evaluation demonstrated the system’s high performance. Testing on a calibrated model eye (OEMI-7) established a highly linear relationship between the computed defocus S and the focusing lens position across a ±20 Diopter (D) compensation range, achievable within a 5 mm mechanical travel. The system achieved a focusing precision of 0.08 D, corresponding to an 18-fold improvement over a conventional projection spot-size method tested under identical conditions. The total focus acquisition time, encompassing wavefront measurement, computation, and lens actuation, averaged under 0.5 s. Clinical validation with 25 human volunteers (50 eyes, refractive range -15 D to +10 D) confirmed practical efficacy. The wavefront-sensing AF succeeded in 92% of attempts with a mean time of 0.5 s, substantially outperforming a projection-based benchmark which achieved only a 32% success rate with an average time of 4.25 s. The system provided instantaneous directional guidance and maintained stability during minor ocular movements. Objective assessment of image quality, via amplitude contrast of retinal vasculature, showed consistent and significant enhancement following AF correction across the entire tested diopter range. ConclusionThis work successfully implements and validates a direct wavefront-sensing autofocus paradigm for portable fundus cameras. By directly quantifying and compensating for the optical defocus aberration, this method bypasses the fundamental limitations of image-processing and projection-based techniques, enabling rapid, precise, and deterministic diopter compensation. The developed system delivers an exceptional combination of a wide operational range (±20 D), high accuracy (0.08 D), fast convergence (0.5 s), and a compact physical footprint. This technology provides a practical and high-performance focusing solution capable of enhancing the reliability, throughput, and diagnostic utility of portable retinal imaging in large-scale screening applications. Future efforts will be directed towards system cost optimization and performance adaptation for diverse ocular conditions.

OBJECTIVE To evaluate the quality of Euscaphis japonica from different habitats. METHODS The relative correction factors of gallic acid， protocatechuic acid， ellagic acid， isoquercitrin， astragalin and apigenin were calculated with quercetin as the internal reference； the relative correction factors of euscaphic acid， oleanolic acid， stigmasterol and β-sitosterol were also calculated with ursolic acid as the internal reference. The contents of 12 components in 18 batches of samples were calculated by QAMS method and were compared with external standard method. At the same time， the contents of water-soluble extract， alcohol-soluble extract， total ash and acid-insoluble ash were detected. The quality of E. japonica was evaluated by principal component analysis （PCA）， orthogonal partial least squares-discriminant analysis （OPLS-DA）， and weighted technique for order preference by similarity to ideal solution （TOPSIS） method. RESULTS There was no significant difference between the results of QAMS method and external standard method for the 12 components in the 18 batches of samples. However， notable content variations were observed among different batches of samples. The results of PCA and OPLS-DA showed that S1-S7， S8- S12， and S13-S18 were clustered into one category respectively. Seven key characteristic components variable importance in projection values ＞1， euscaphic acid， ursolic acid， protocatechuic acid， apigenin， β-sitosterol， isoquercitrin， and oleanolic acid， respectively. The analysis results of the weighted TOPSIS method revealed that the relative closeness for evaluating the quality of 18 batches of samples ranged from 0.283 5 to 0.644 1， with the samples of E. japonica from Fengjie， Chongqing， demonstrating the highest quality. CONCLUSIONS The established method is accurate and feasible， which can be used for the quality evaluation of E. japonica combined with chemometrics and weighted TOPSIS model.

Objective To investigate the efficacy of leaflet augmentation technique to repair the recurrent mitral valve (MV) regurgitation after mitral repair in children. Methods A retrospective analysis was conducted on the clinical data of children who underwent redo MV repair for recurrent regurgitation after initial MV repair, using a leaflet augmentation technique combined with a standardized repair strategy at Fuwai Hospital, Chinese Academy of Medical Sciences, from 2018 to 2022. The pathological features of the MV, key intraoperative procedures, and short- to mid-term follow-up outcomes were analyzed. Results A total of 24 patients (12 male, 12 female) were included, with a median age of 37.6 (range, 16.5–120.0) months. The mean interval from the initial surgery was (24.9±17.0) months. All children had severe mitral regurgitation preoperatively. The cardiopulmonary bypass time was (150.1±49.5) min, and the aortic cross-clamp time was (94.0±24.2) min. There were no early postoperative deaths. During a mean follow-up of (20.3±9.1) months, 3 (12.5%) patients developed moderate or severe mitral regurgitation (2 severe, 1 moderate). One (4.2%) patient died during follow-up, and one (4.2%) patient underwent a second MV reoperation. The left ventricular end-diastolic diameter was significantly reduced postoperatively compared to preoperatively [ (43.5±8.6) mm vs. (35.8±7.8)mm, P<0.001]. Conclusion The leaflet augmentation technique combined with a standardized repair strategy can achieve satisfactory short- to mid-term outcomes for the redo mitral repair after previous MV repair. It can be considered a safe and feasible technical option for cases with complex valvular lesions and severe pathological changes.

Objective To observe the ultrasonic manifestations of local recurrence(LR)of breast cancer after surgery.Methods Totally 82 female breast cancer patients with local hypoechoic in surgical area who underwent ultrasound follow-up were enrolled and divided into LR group(n=18)and non LR group(n=64)according to the local hypoechoic was LR or not.Clinical data and ultrasonic manifestations of primary lesion before operation and postoperative local hypoechoic were observed and compared between groups.Results Significant differences of surgical resection type,molecular subtype,status of smooth muscle actin,Calponin status,Ki-67 status,clinical staging,the maximum diameter and posterior echo of the primary lesion,as well as of involved tissue layer,location,long axis parallel to the skin or not,edge,internal echo,posterior echo,skin change and Adler blood flow grading of local hypoechoic in resection area were found between groups(all P＜0.05).Conclusion Ultrasonic manifestations of LR of breast cancer after surgery had certain characteristics.

Objective To study the current situation and influencing factors of the digitalized medical and health service space for the elderly,it provides a reference for solving the dilemma of digital medical treatment for the elderly,sharing the dividend of digital medical development,and achieving the goal of healthy aging.Methods Using stratified cluster sampling method,a questionnaire survey was conducted among the elderly in Jiamusi City and Daqing City of Heilongjiang Province in August 2024,and 800 valid questionnaires were collected.Multiple linear regression was used to analyze the influencing factors of the spatial level of digitalized medical and health services for the elderly.Results The score of digitalized medical and health service space for the elderly was(2.05±1.90).The results of multiple linear regression analysis showed that digital health literacy,long-term residence and digital literacy were the main influencing factors of digitalized medical and health service space for the elderly the differences were statistically significant(P＜0.05).Conclusion The government,hospitals,enterprises,society,families and other multi-subjects should pay attention to the integration of digitalized medical and health service space for the elderly,and cooperate with the improvement of the digital ability of the elderly by creating an external digital medical environment,so as to reduce the occurrence of adverse outcomes in the digitalized medical and health service space of the elderly,eliminate the dilemma of digital medical treatment for the elderly,improve the medical well-being of the elderly in the digital society,and promote healthy aging.

BACKGROUND:Mechanical alignment is the"gold standard"alignment technique in total knee arthroplasty,but regardless of advances in prosthetic materials and robotic-assisted navigation,mechanical alignment-total knee arthroplasty still has a patient dissatisfaction rate of about 20％.OBJECTIVE:To evaluate the early efficacy of navigation-assisted total knee arthroplasty using functional alignment.METHODS:A total of 44 consecutive cases(50 knees)that underwent computer navigation-assisted total knee arthroplasty with functional alignment from October 2019 to June 2023 were retrospectively analyzed,including 12 males(14 knees)and 32 females(36 knees).A total of 46 consecutive cases(50 knees)that underwent navigation-assisted total knee arthroplasty with mechanical axis alignment by the same surgical team during the same period were selected as controls,including 5 males(5 knees)and 41 females(45 knees).The tibial osteotomy angle,tibial plateau osteotomy amount,femoral osteotomy angle,distal femoral,posterior and anterior osteotomy amount,and joint line movement were observed in the two groups of patients.Preoperative and postoperative flexion and extension gap internal and external laxity,hip-knee-ankle angle,mechanical lateral distal femoral angle,mechanical medial proximal tibial angle,joint line convergence angle,sagittal femoral component angle,posterior tibial slope,arithmetic hip-knee-ankle angle,joint line obliquity,coronal plane alignment of the knee classification,Western Ontario and McMaster Universities Osteoarthritis Index,and Hospital for Special Surgery score and forgotten joint score were compared between the two groups.RESULTS AND CONCLUSION:(1)The intraoperative tibial plateau osteotomy angle in the functional alignment group was greater than that in the mechanical axis alignment group,and the proportion of gap imbalance(2％)was smaller than that in the mechanical axis alignment group(18％).The differences were all significant(P＜0.05).(2)The hip-knee-ankle angle,mechanical medial proximal tibial angle,arithmetic hip-knee-ankle angle,and joint line obliquity in the functional alignment group were smaller than those in the mechanical axis alignment group postoperatively,and the differences were significant(P＜0.05).(3)The most common coronal plane alignment of the knee classification before surgery was type Ⅰ(80％in the functional alignment group and 42％in the mechanical axis alignment group).(4)The proportion of joint line obliquity＜177°(44％)in the functional alignment group was greater than that in the mechanical axis alignment group(14％)postoperatively.(5)Hospital for Special Surgery score at 1 month,6 months,and last follow-up after surgery was higher in the functional alignment group than that in the mechanical axis alignment group;the differences were statistically significant(P＜0.05).The Western Ontario and McMaster Universities Osteoarthritis Index 1 month after surgery was lower in the functional alignment group than that in the mechanical axis alignment group;the difference was statistically significant(t=-2.85,P=0.005).There was no significant difference in postoperative range of motion and forgotten joint score between the two groups(P＞0.05).(6)It is indicated that navigation-assisted total knee arthroplasty using functional alignment optimizes early clinical efficacy.The functional alignment technique has advantages in restoration of constitutional alignment and joint line obliquity and avoids soft tissue release compared to mechanical alignment technique.

Aim To investigate the effects of rosavin on hepatocellular steatosis and its mechanism of action.Methods AML-12 and HepG2 cells were induced to undergo hepatocellular steatosis by free fatty acids(FFA),and the optimal inducing concentration was determined by oil red O staining and CCK-8 assay.The cell activity was detected by CCK-8 assay after ro-savin treatment,and the lipid droplet accumulation was observed by oil red O staining.The levels of triglycer-ide(TG),total cholesterol(TC),glutamic oxalacetic transaminase(AST),glutamic pyruvic transaminase(ALT),superoxide dismutase(SOD),glutathione per-oxidase(GSH-Px),and malondialdehyde(MDA)were detected by kits.The potential targets of rosavin in non-alcoholic fatty liver disease(NAFLD)were ana-lyzedby network pharmacology and molecular docking,and the expression of core candidate targets before and after the rosavin intervention was detected by real-time fluorescence quantitative PCR.Results Hepatocyte steatosis was induced by FFA,and the intervention of rosavin(25,50 μmol·L-1)reduced the number of intracellular lipid droplets in hepatocytes in a dose-de-pendent manner,also lowered the cellular levels of TG,TC,AST,ALT,elevated the levels of SOD and GSH-Px,and reduced the levels of MDA.Network pharma-cological analysis and molecular docking yielded five core candidate targets:NOS3,MAPK14,PPARG,TNF-α,and IGF-1,and real-time fluorescence quantitative PCR showed that the action of loxavir significantly re-duced the gene expression of TNF-α and PPARG in hepatocytes after FFA induction.Conclusions Rosa-vin can attenuate the inflammatory response,oxidative stress level,and lipid accumulation in hepatocytes by modulating TNF-α and PPARG,thereby ameliorating FFA-induced hepatocellular steatosis.

Objective To simulate modern social stress using a pre-pregnancy chronic mild stress(CMS)model and to explore the mechanisms of emotional,behavioral,and neurodevelopmental changes in male offspring of pre-pregnancy liver qi stagnation female mice through corticosterone(CORT)-brain-derived neurotrophic factor(BDNF)extracellular signal-regulated kinase(ERK)1/2 signaling cascade-mediated hippocampal injury.This study aimed to elucidate the impact of negative life events on offspring and the interventional mechanism of Shuyu Capsules.Methods CMS stress was used to induce pre-pregnancy depression in female rats(liver qi stagnation state),followed by intervention with Shuyu and fluoxetine capsules.After screening,male rats were mated and 12 male offspring from each group were selected for behavioral testing and detection of serum CORT levels by enzyme-linked immunosorbent assay.BDNF,ERK1/2,phospho(p)-ERK1/2,cAMP-response element binding protein(CREB),and p-CREB protein levels in the hippocampus were detected by Western Blot,and BDNF,ERK1,ERK2,and CREB mRNA levels in the hippocampus were detected by reverse transcription-polymerase chain reaction(RT-PCR),to verify the effects of pre-pregnancy CMS on the BDNF-ERK1/2-CREB signaling pathway and to investigate the key micro-mechanisms of Shuyu Capsules on emotional and learning memory-related behaviors of male offspring of females with pre-pregnancy liver qi stagnation syndrome.Results The distance,number of entries,and duration of stay in the central area in open-field experiments were significantly reduced in offspring in the model group(all P＜0.05).The escape latency during the exploration period of the water-maze experiment was significantly prolonged(P＜0.05)and the swimming distance,duration of the target quadrant,and number of platform crossings were significantly reduced(P＜0.05,P＜0.05,P＜0.01),the suspension time and frequency in the forced-swimming experiment were increased(P＜0.05,P＜0.01),and the incubation period was shortened(P＜0.05)in offspring in the model group.Prophylactic treatment with Shuyu Capsules and fluoxetine improved the depression-like behavior and cognitive impairment in the offspring in the model group.Biochemical tests showed that CORT levels were increased in the CMS model group(P＜0.05),BDNF,p-ERK1/2,and p-CREB protein levels in the hippocampus were decreased(all P＜0.05),and BDNF,ERK1,ERK2,and CREB mRNA levels were significantly reduced(P＜0.01,P＜0.05,P＜0.01,P＜0.05).Treatment with Shuyu Capsules and fluoxetine increased the CORT content and BDNF,ERK1/2,and CREB protein and mRNA levels in male offspring to varying degrees.Conclusions High levels of CORT in offspring act selectively on the hippocampus,exerting adverse effects on the emotional and learning memory functions of rats by downregulating the BDNF-ERK1/2 signaling cascade.The Chinese medicine Shuyu Capsules can reduce the impact of an adverse intrauterine environment on offspring development by correcting abnormal levels and pathways of glucocorticoids.

Objective:To analyze and explore the selection of secondary intervention strategies for residual issues following congenital aortic valve disease surgery in children, as well as to evaluate their prognostic efficacy.Methods:A retrospective analysis was conducted on the clinical data of 41 children with residual issues after congenital aortic valve disease surgery, who were treated at the Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, between January 2013 and August 2024. Among them, 25 were male and 16 were female, with a mean age of(116.8±45.1)months and a mean weight of(40.0±20.2)kg. The mean interval for secondary intervention was(60.0±36.4)months. The residual issues included aortic valve insufficiency(20 cases), aortic valve stenosis(11 cases), and combined aortic valve insufficiency and stenosis(10 cases).Results:Secondary interventions included aortic valve repair(7 cases), mechanical valve replacement(20 cases), Ross procedure(13 cases), and Ozaki procedure(1 case). Additionally, 5 cases with left ventricular outflow tract stenosis underwent concomitant Konno surgery.One case of early postoperative in-hospital death occurred, with a mortality rate of 2.4%, primarily due to acute left heart failure and multiple organ dysfunction. The average follow-up period for surviving children was( 64.6±34.5) months(5-147 months), with no mid- to long-term mortality. Follow-up results showed that In surviving children, the left heart showed significant reduction in size postoperatively, with the LVEDD Z-score decreasing from 1.24±2.23 before surgery to -0.97±1.48( P=0.001). Postoperative LVEF 0.66±0.06 showed no significant difference compared to pre-reintervention 0.68±0.10( P=0.140). In aortic stenosis(AS) patients, the peak transvalvular pressure gradient decreased from(69.5±19.8) mmHg(1 mmHg=0.133 kPa) preoperatively to(25.1±10.9) mmHg postoperatively( P=0.003). In aortic insufficiency(AI) patients, the width of the aortic regurgitation jet decreased from(5.8±1.1) mm preoperatively to(2.7±1.1) mm postoperatively( P=0.012). 97.5% of children maintained mild-to-moderate aortic regurgitation(jet width <4 mm), with only 1 case of moderate regurgitation(jet width 4.4 mm)remaining under close observation.Two children underwent reoperation on the aortic valve, with a tertiary intervention rate of 5.0%. One case underwent redo commissurotomy 21 months after aortic valve repair due to recurrent stenosis, and the other underwent mechanical valve replacement 34 months after the Ozaki procedure due to leaflet calcification and infective endocarditis. Mid-term follow-up revealed good cardiac function recovery in surviving children, with 87.5% achieving NYHA functional class Ⅰ/Ⅱ. Conclusion:Due to the demands of growth and development and the degenerative nature of valve tissue, residual issues are inevitable in the mid- to long-term following congenital aortic valve disease surgery in children, often necessitating secondary intervention. Given the lack of suitable autologous valve tissue, the use of aortic valve replacement has significantly increased in secondary interventions. The Ross procedure, as an ideal secondary intervention, demonstrates satisfactory mid-term follow-up outcomes. For children with high-risk factors for the Ross procedure, mechanical valve replacement also yields favorable prognoses.