Background Metals and metalloids in fine particulate matter (PM_2.5) may cause damage to the respiratory and circulatory systems of the human body, and long-term exposure is prone to causing chronic poisoning, cancer, and other adverse effects. Objective To assess the distribution characteristics of metals and metalloids in outdoor PM_2.5 in a southern city of China, conduct source apportionment, and evaluate the associated health risks, thereby providing theoretical support for further pollution control measures. Methods PM_2.5 samples were collected in districts A, B, and C of a southern China city, and the concentrations of 17 metals and metalloids were detected by inductively coupled plasma-mass spectrometry (ICP-MS). Pollution sources were assessed through enrichment factor and principal components analysis, and the main pollution sources were quantified using absolute principal component scores-multivariate linear regression (APCS-MLR). Health risks were evaluated based on the Technical guide for environmental health risk assessment of chemical exposure (WS/T777—2021). Results The ambient air PM_2.5 concentrations in the city were higher in winter and spring, and lower in summer and autumn. The annual average concentrations of ambient PM_2.5 in districts A, B, and C were 36.7, 31.9, and 24.4 μg·m⁻³, respectively. The ambient PM_2.5 levels in districts B and C were below the second-grade limit set by the Ambient air quality standards (GB 3095—2012). The enrichment factors of cadmium (Cd), aluminum (Al), and antimony (Sb) were greater than 10, those of copper (Cu), lead (Pb), arsenic (As), nickel (Ni), mercury (Hg), and molybdenum (Mo) fell between 1 and 10, and those of manganese (Mn), vanadium (V), chromium (Cr), cobalt (Co), barium (Ba), beryllium (Be), and uranium (U) were below or equal to 1. The comprehensive evaluation of source analysis showed that the main pollution sources in districts A and C and the whole city were coal-burning. In district B, the main pollution source was also coal combustion, followed by industrial process sources and dust sources. The carcinogenic risks of As and Cr were between 1×10⁻⁶ and 1×10⁻⁴. However, the hazard quotients for 15 metals and metalloids in terms of non-carcinogenic risk were below 1. Conclusion Cr and As in the atmospheric PM_2.5 of the city present a certain risk of cancer and should be paid attention to. In addition, preventive control measures should be taken against relevant pollution sources such as industrial emission, dust, and coal burning.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To explore the relationship between plasma insulin-like growth factor-binding protein 2(IGFBP2),secreted modular calcium-binding protein 2(SMOC2)levels and cardiac function and prognosis in patients with chronic heart failure(CHF).Methods A total of 120 CHF patients(the CHF group)and 60 healthy volunteers undergoing physical examination during the same period(the control group)were enrolled.CHF patients were classified according to the New York Heart Association(NYHA)functional classification into the class Ⅱ(46 cases)group,the class Ⅲ group(42 cases)and the class Ⅳ group(32 cases).Based on the 6-month prognosis,patients were further divided into the poor prognosis group(42 cases)and the good prognosis group(78 cases).Plasma IGFBP2 and SMOC2 levels were measured using enzyme-linked immunosorbent assay.The correlation between plasma IGFBP2 and SMOC2 levels with NYHA functional classification was analyzed using Spearman rank correlation.Multivariate unconditional Logistic regression was used to analyze the relationship between plasma IGFBP2 and SMOC2 levels and poor prognosis in CHF patients.The predictive efficacy of plasma IGFBP2 and SMOC2 levels for CHF prognosis was evaluated using receiver operating characteristic(ROC)curve analysis.Results Compared with the control group,plasma IGFBP2 and SMOC2 levels were significantly higher in the CHF group(P＜0.05).Plasma IGFBP2 and SMOC2 levels increased progressively in the class Ⅱ group,the class Ⅲgroup and the class Ⅳ group(P＜0.05).Plasma IGFBP2 and SMOC2 levels were positively correlated with NYHA classification of CHF patients(P＜0.05).The 6-month poor prognosis rate for the 120 CHF patients was 35.00%(42/120).Compared with the good prognosis group,the plasma IGFBP2 and SMOC2 levels were significantly higher in the poor prognosis group(P＜0.05).After adjusting for confounding factors,high levels of IGFBP2 and SMOC2 were independent risk factors for poor prognosis in CHF patients(P＜0.05).The area under the curve(AUC)for the combined prediction of poor prognosis in CHF patients by plasma IGFBP2 and SMOC2 levels was 0.899,which was higher than that of plasma IGFBP2(0.800)and SMOC2(0.782)alone(P＜0.05).Conclusion The plasma levels of IGFBP2 and SMOC2 in CHF patients are increased,which is related to the decrease of cardiac function and poor prognosis.The combination of plasma IGFBP2 and SMOC2 levels has a high predictive efficiency for the prognosis of CHF patients.

Objective The aim of this study was to explore the effects of changes in the estrogen receptor alpha 36(ER-α36)expression on the proliferation and membrane-initiated estrogen signaling in glioblastoma U251 cells.Methods The expression and localization of ER-α36 and EGFR glioblastoma U87 cells and U251 cells were determined by immunofluorescence,qRT-PCR and Western blot.The effect of upregulating ER-α 36 on U251 cell proliferation and estrogen signaling pathway activity by low con-centrations of 100 pmol/L icariin isomer(SNG162)was detected by MTT assay and Western blot.Results ER-α36 and EGFR were co-expressed in the cell membrane of glioblastoma.Compared with DMSO(control group),the expression ER-α36(P<0.01)and EG-FR increased in U251 cells treated with SNG162(P<0.05);Further experments also found that low concentrations of SNG162 in-creased the expression of cycle related proteins-cyclin D1,cyclin B,cyclin E and CDK4(P<0.01),and enhanced the proliferative a-bility of U251 cells(P<0.05).Conclusion The low concentration of SNG162 upregulates the expression of ER-α36,activates the estrogen-mediated ERK1/2 MAPK,p38 MAPK,and EGFR/Src signaling pathways,promotes glioblastoma proliferation,and activates the membrane initialized estrogen signaling pathway.

Objective To explore the biological mechanism of radiation resistance in esophageal squamous cell carcinoma(ESCC)and search for effective sensitization targets.Methods We retrieved 186 signaling pathways and related gene information from the MSigDB database.We also obtained RNA transcriptome data of ESCC patients using the Cancer Genome Atlas(TCGA)and Gene Expression Omnibus(GEO)databases.We collected clinical pathological characteristics and tissue samples of 97 ESCC patients in our hospital from 2013 to 2020.Gene set variation analysis(GSVA)was made to calculate KEGG signaling pathway score,radiotherapy resistance related signaling pathways were screened through random forest algorithm,key genes in the pathway were screened using DESeq2,and a radiotherapy efficacy prediction model was constructed based on support vector machine-recursive feature elimination(SVM-RFE).The results were validated through experiments such as Western blotting and clonogenic assay.Results Based on the KEGG signaling pathway and GSVA enrichment score,random forest analysis showed that in the TCGA and GSE45670 cohorts,the contribution of tryptophan metabolism pathway enrichment values to radiation resistance in ESCC was significantly better than that of the other pathways.DESeq2 analysis revealed that key molecules in the tryptophan metabolism pathway,namely,IDO1,ALDH1B1,AOC1,INMT,AFMID and ALDH7A1,were significantly differentially expressed in the resistant and sensitive groups of ESCC.Based on the SVM-RFE algorithm,the AUC was 0.77,which could accurately predict the radiotherapy efficacy of ESCC.Western blotting experiments showed that IDO1 was highly expressed in ESCC cells,and IDO1 inhibitor treatment significantly inhibited the survival ability and radiosensitivity of KYSE-410 cells.In the enrolled patients of our hospital,immunohistochemical studies showed that IDO1 was highly expressed in the radiotherapy resistant group of ESCC and was associated with poor radiotherapy prognosis in ESCC patients.In addition,further testing showed that the expression of IDO1 in patient samples from our hospital was positively correlated with its PD-L1 expression,but negatively correlated with the infiltration ratio of CD3/CD8 immune cells.Conclusion Tryptophan catabolism is associated with radiation resistance in ESCC,and the key enzyme IDO1 in tryptophan metabolism can be used as a therapeutic target for radiosensitization in ESCC.

Objective To compare the differences of endoscopic ultrasound (EUS)-guided non-invasive measurement of portal venous pressure and EUS-guided portal pressure gradient(EUS-PPG) in measurement of portal venous pressure on animals and their correlation. Methods Twenty-four miniature pigs were selected and fed with carbon tetrachloride and phenobarbital sodium combined with high-fat,low-protein and low-choline diet for 16 weeks to establish a liver cirrhotic portal hypertension model. The changes of biochemical indexes of liver function and liver pathology in the experimental pigs were observed to evaluate whether the model was successful. After the model was successfully established,the hemodynamic parameters of the portal venous trunk were measured non-invasively under EUS guidance,including portal venous blood flow and splenic artery pulsatility index,thereby calculating portal venous pressure. Then,taking EUS-PPG,the portal vein,hepatic vein,and inferior vena cava were punctured with an 18G puncture needle under general anesthesia guided by the translinear endoscopic ultrasound,and the PPG was calculated through the central venous pressure monitoring system.The Pearson correlation analysis,Kappa test,ICC intraclass correlation coefficient and Bland-Altman plot were used for consistency analysis. Results All the 24 pigs survived 16 weeks after modeling.The serum levels of alanine transaminase (ALT),aspartate transaminase (AST),albumin (ALB),globulin (GLB),total bilirubin (TBIL) and indirect bilirubin (IBIL)after modeling were higher than those before modeling(P<0.05). HE staining and Sirius red staining showed abnormal liver morphology and increased collagen fibers after modeling,suggesting that the experimental pig model of liver cirrhotic portal hypertension was successfully established. The results of EUS-guided non-invasive measurement of portal venous pressure showed that the mean splenic artery pulsatility index was (2.03±0.68),the mean portal vein flow was (17.27±4.31)cm/s,and the mean portal venous pressure was (15.97±3.65)mmHg. The measurement results of the mean portal venous pressure,hepatic venous pres-sure and PPG of EUS-PPG were (20.68±4.71)mmHg,(4.07±2.14)mmHg and (16.38±4.28)mmHg respectively. Pearson correlation analysis showed that there was a significant positive correlation between the portal venous pressures measured by the two methods (r=0.902,P<0.001);the consistency tests of Kappa test and ICC intraclass correlation coefficient showed that the measurement results of the two methods were highly consistent (Kappa=0.699,P<0.001;ICC=0.945);Bland-Altman plot analysis showed that most of the points fell within 95％ limits of agreement. Conclusion EUS-guided non-invasive measurement of portal venous pressure has a high correlation and consistency with the measurement results by EUS-PPG,which has high success rate,and accurate reflection of portal venous pressure,with low cost and good safety.

Objective To analyze the medication rules of traditional Chinese medicine in treating breast cancer based on real-world data mining.Methods Inpatients with breast cancer who received traditional Chinese medicine treatment at the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from January 2017 to December 2021 were selected.Python 3.10 software was used to mine traditional Chinese medicine prescription data;SPSS 23.0 software was applied for descriptive analysis,and systematic cluster analysis was performed on high-frequency drugs.Results A total of 3026 consultation records of inpatients with breast cancer were collected.The main traditional Chinese medicine syndrome diagnosis of"predominantly liver depression and Qi stagnation"accounted for 60.94％of the total consultations.A total of 240 kinds of traditional Chinese medicine were used,with a cumulative frequency of 35 462 times.Among them,29 kinds of traditional Chinese medicine such as Danggui,Fuling,Baizhu,Chaihu had a cumulative usage frequency exceeding 300 times.Regarding the four natures of drugs,cold-natured(43.55％),warm-natured(30.05％),and neutral-natured(23.34％)drugs were predominant;In terms of five flavors,sweet(46.12％),bitter(30.91％),and pungent(20.02％)were the main ones.The most frequently used drugs were tonifying herbs(32.77％),followed by heat-clearing herbs(15.96％)and phlegm-resolving herbs(14.71％).Systematic cluster analysis yielded 7 groups of drug combinations.Conclusion In real-world clinical practice,traditional Chinese medicine for breast cancer mainly uses tonifying herbs,reflecting the traditional Chinese medicine principle of"strengthening healthy Qi and cultivating the root"in treating tumors.The four natures and five flavors of drugs follow syndrome differentiation and the combination of cold and heat.The clustered drug combinations have extensive therapeutic effects,covering various syndromes of breast cancer at different stages,which can provide a reference for clinical medication.

Objective:To identify and trace the origin of the Francisella tularensis subsp. novicida strain SJCS-979 isolated from the blood of a patient, so as to provide a reference for the traceability investigation of such infection events. Methods:Hot spring water samples that the patient had recently bathed in were collected to culture the causative agent, combined with the pathogenic characteristics and the patient′s activity before the bloodstream infection. The water samples were concentrated, acid-treated, and then the isolation of the causative agent was performed, following the method for Legionella detection in circulating cooling water. Suspected strains detected from the hot spring water were subjected to classical phenotypic identification, API ZYM and API NH strips tests, drug sensitivity testing, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) identification, and the obtained data were compared with those of strain SJCS-979 isolated from the patient′s blood. A phylogenetic tree was constructed based on genomic analysis to determine the taxonomic status of strain SJCS-979 and related strains. Epidemiological data of Francisella tularensis subsp. novicida were collected and analyzed by integrating the global genetic and genomic data on GenBank database. Core single nucleotide polymorphism(SNP) comparisons were obtained using Snippy 3.2 software, and then an evolutionary tree was built to determine its population structure based on BAPS analysis. Results:Strain CC-2, isolated from the hot spring water, shared the same biochemical and drug sensitivity phenotype, and had a nearly consistent mass spectrometric profile with strain SJCS-979 isolated from the blood of a patient. Genomic phylogenetic tree analysis based on 120 core protein sequences showed that strains SJCS-979 and CC-2 fell on the same branch with known Francisella tularensis subsp. novicida strains. Bayesian genotyping showed that the global Francisella tularensis subsp. novicida strains with genomic data could be divided into six different sequence clusters. Strains SJCS-979 and CC-2 were located in the same taxonomic group with only 4 SNP differences, indicating that they might be the same clone. Conclusions:This study reports a case of bacteremia caused by Francisella tularensis subsp. novicida, and natural hot spring water may be the environmental source of this infection event.

ObjectiveTo investigate the anti-inflammatory, antioxidant, and goblet cell-stimulating effects of a suspension of Ophiopogon japonicus (L. f.) Ker Gawl. (O. japonicus, Mai Dong) extract combined with hyaluronic acid (HA) in the mouse model with dry eye disease (DED).MethodsA DED mouse model was induced using benzalkonium chloride (BAK), followed by treatment with O. japonicus extract-containing eye drops at varying concentrations. Experimental groups included a normal control, a DED model control, a positive control, and an O. japonicus extract-treated group. Corneal fluorescein staining and tear break-up time (TBUT) were used to assess tear film stability and ocular surface integrity. Enzyme-linked immunosorbent assay (ELISA) measured inflammatory factor levels in corneal and conjunctival tissues, whereas Western blot (WB) analyzed key antioxidant and inflammatory markers, including nuclear factor erythroid 2-related factor (2Nrf2) and heme oxygenase 1 (HO-1). Periodic acid-schiff (PAS) staining and immunofluorescence were used to evaluate goblet cell density and mucin secretion.ResultsO. japonicus extract significantly improved corneal damage, reduced fluorescein staining scores, prolonged TBUT, and increased tear secretion. It downregulated inflammatory markers, including interleukin-8 (IL-8), interleukin-1β (IL-1β), and interferon-γ (IFN-γ) while upregulating Nrf2, HO-1, and the interleukin-13 (IL-13)/IFN-γ ratio, alleviating oxidative stress and inflammation. PAS staining showed increased conjunctival goblet cell density and restored mucin secretion, enhancing tear film stability.ConclusionO. japonicus extract demonstrated significant anti-inflammatory, antioxidant, and goblet cell-stimulating effects in a DED model, with good biocompatibility and promising therapeutic potential. Future research should optimize extraction processes and validate their efficacy and safety in clinical settings.

Objective To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application.Methods and Results Recommendations were formulated based on literature review and expert group discussion,and consensus was reached following expert consultation.The consensus recommendations are comprehensive,covering the entire treatment procedures from preoperative assessment and preparation,surgical operation process,postoperative management and traditional Chinese medicine treatment to individualized treatment planning.The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain,reduced the use of opioid drugs,and significantly improved the quality of life and enhanced immune function of the patients.Postoperative follow-up suggested good treatment tolerance among the patients without serious complications.Conclusion The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy.The combined treatment has a high clinical value with a good safety profile for management of cancer pain.