Objective To explore the correlation between serum vitamin D(VD3)level differences and immune inflammatory markers in elderly sepsis patients.Methods A total of 103 elderly patients with sepsis(aged 65-99 years)in the ICU of the First Affiliated Hospital of Kunming Medical University from January 2020 to December 2022 were collected and divided into two groups according to the diagnostic criteria for VD3 deficiency:VD3 deficiency group(n=32)and VD3 severe deficiency group(n=71).Correlation analysis was conducted by comparing the differences in serum 25-(OH)-D3(VD3)levels,immune function-related indicators upon admission(blood routine,infection-related proteins,combined detection of 12 cytokines,absolute count analysis of lymphocytes and subgroups,quantitative determination of infection-related immune cells,immunoglobulin,and complement),illness severity,and prognostic indicators(APACHE-II score,SOFA score,duration of ICU stay,and 28-day mortality rate).Result(1)Serum VD3 levels were lower in elderly patients with sepsis.No patient was in the VD3 normal or insufficient group.Patients with severe VD3 deficiency had higher APACHE-II scores,SOFA scores,and 28-day mortality rates than those with VD3 deficiency,and these scores were negatively correlated with serum VD3 levels(P<0.001),while the difference in ICU stay duration between the two groups was not statistically significant(P>0.05);(2)WBC,PCT,CRP,and CD4/CD8 in the VD3 deficiency group were all lower than those in the VD3 severe deficiency group(P<0.05),while IL-6,IL-10,CD45+,CD3+/CD45+,and CD19+Abs were all higher than those in the VD3 severe deficiency group(P<0.05);In the VD3 deficiency group,VD3 levels were positively correlated with CD45+(P<0.05 for all),while negatively correlated with IL-6,IL-10,PCT,and CRP(P<0.05 for all);In the VD3 severe deficiency group,there were fewer corre-lation indicators and the correlation strength was not as strong as that in the VD3 deficiency group.Conclusion(1)Elderly patients with sepsis generally have lower levels of VD3,with lower levels associated with more severe illness and poorer prognosis;(2)In elderly sepsis patients,compared to patients with severe VD3 deficiency,patients with VD3 deficiency have lower levels of inflammation,stronger cellular immune response,and stronger correlation,suggesting that the effects of different VD3 levels on immune inflammatory responses may vary in elderly sepsis patients.

Objective To investigate the recognition efficiency of AI model based on deep learning for cardiac conduction system(CCS).Methods HE staining sections of cardiac muscle and CCS of 17 cases of non-sudden death were selected,and the gold standard was unanimous recognition by 2 forensic pathologists with more than 20 years of CCS diagnosis experience.Inception V3 algorithm was used to establish AI model and complete CCS identification training and testing.Confusion matrix,accuracy,precision,recall,F1 score,ROC curve and AUC value were used to evaluate the effectiveness of AI model,and accuracy,sensitivity and specificity were used to evaluate the efficiency of manual independent and AI-assisted manual recognition for CCS.Results The accuracy of AI model was 87.3%,the precision was 91.9%,the recall was 81.9%,the F1 score was 86.6%,and the AUC value was 95.3%.The accuracy of AI model was higher than that of senior forensic pathologists.There was no statistical significance in the accuracy of AI-assisted senior forensic pathologists in identifying CCS compared with manual independent detection(P>0.05),while the accuracy of AI-assisted intermediate and junior forensic pathologists in identifying CCS was increased by 8%and 14.33%,respectively,with statistical significance(P<0.05).The accuracy rate of AI-assisted junior forensic pathologists to identify CCS was higher than that of intermediate forensic pathologists in self-diagnosis.Conclusion The AI model could be used for the automatic recognition of CCS,and could improve the diagnostic efficiency of CCS and narrow the gap between the forensic pathologists with low experience and that with high experience.

Objective:To investigate the application of cromolyn sodium combined with diclofenac sodium eye drops in allergic conjunctivitis (AC) and its effect on tear film function, interleukin-10 (IL-10), interleukin-17 (IL-17) and immunoglobulin E(IgE).Methods:From April 2018 to May 2020, 78 patients with AC collected in Liaoning Armed Police Crops Hospital were divided into control group and observation group according to the random number table method (39 cases in each group). The control group was given cromolyn sodium eye drops, and the observation group was given cromolyn sodium combined with diclofenac sodium eye drops. The efficacy, clinical symptoms, changes of signs, tear film function [tear film rupture time (BUT), Schirmer I test (SIt)], tear inflammation indicators [interleukin-4 (IL-4), tumor necrosis factor-α (TNF-α), IL-10, IL-17], tear allergy mediators [eosinophil cationic protein (ECP), hyaluronic acid (HA), IgE] and safety.Results:The total effective rate of observation group was 100.00%, which was higher than that of control group (84.62%), with statistically significant difference ( P<0.05). After treatment, the scores of eye itching, tearing, photophobia, eye secretion, conjunctival hyperemia, conjunctival edema and blepharoconjunctival papillary follicular hyperplasia in the two groups were significantly lower than those before treatment, and the observation group was lower than the control group, with statistically significant difference (all P<0.05). The BUT in the observation group was higher than that in the control group after treatment, with statistically significant difference ( P<0.05). After treatment, the tear levels of IL-4, TNF-α, IL-10 and IL-17 in the observation group were lower than those in the control group, with statistically significant difference (all P<0.05). After treatment, the tear ECP, HA and IgE level in the observation group were lower than those in the control group, with statistically significant difference (all P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05). Conclusions:Cromolyn sodium combined with diclofenac sodium eye drops is effective in the treatment of AC, which can effectively improve the clinical symptoms and signs, promote stable tear film function, alleviate local metamorphosis and inflammation, and has good safety.

Objective: To investigate the effects of bone trauma therapy instrument combined with Guyuling capsule in the treatment of traumatic fractures and the effects on the levels of serum epidermal growth factor (EGF), transforming growth factor-1 (TGF-β1) and vascular endothelial growth factor (VEGF). Methods: The clinical data of 168 patients with traumatic fractures admitted to our hospital from January 2015 to December 2017 were retrospectively analyzed. According to different treatment methods, the patients were divided into the bone trauma treatment instrument group (54 cases), the bone Guyuling capsule group (52 cases) and the combined group (62 cases). All patients were treated with open internal fixation and routine anti-infection, detumescence, analgesic and other symptomatic treatment. The bone trauma therapeutic instrument group was given auxiliary treatment with bone trauma therapeutic instrument on the basis of conventional treatment, the bone healing capsule group was added with bone healing capsule treatment on the basis of conventional treatment, and the bone trauma therapeutic instrument and bone healing capsule combined treatment were given in the combined group at the same time. The clinical efficacy was compared and the serum levels of EGF, TGF-β1 and VEGF in the three groups were detected. Results: The detumescence time (8.37 ± 2.84 d vs. 10.76 ± 4.17 d, 11.64 ± 3.98 d, F=12.329) and the healing time (11.73 ± 3.44 week vs. 14.23 ± 4.62 week, 14.76 ± 5.17 week, F=7.835) of the combined group were significantly shorter than those of the bone trauma therapy group and the Guyuling capsule group (P<0.01). After treatment, the serum EGF (0.60 ± 0.27 μg/L vs. 0.75 ± 0.35 μg/L, 0.72 ± 0.37 μg/L, F=3.406), TGF-β1 (9.28 ± 4.19 μg/L vs. 12.36 ± 4.21 μg/L, 12.86 ± 4.69 µg/L, F=11.568), VEGF (92.58 ± 26.01 pg/ml vs. 132.69 ± 28.01 pg/ml, 127.63 ± 29.85 pg/ml, F=36.053) were significantly lower than those in the bone trauma therapy group and the Guyuling capsule group (P<0.01). Three months after operation, the cure rate was 35.2% (19/54) and the total effective rate was 81.5% (44/54) in all three groups. The cure rate and total effective rate in the combined group were better than those in the bone trauma therapy group and the Guyuling capsule group (χ²=6.373, 4.669, P=0.041, 0.031). Conclusions The treatment of traumatic fractures with bone trauma therapy instrument combined with Guyuling capsule can promote the healing of fractures, reduce the stress response caused by fractures, and improve the clinical efficacy.

Objective: To explore the effect of fine particulate matters (PM_2.5) exposure on emergency visits and outpatient visits of 5 hospitals in Beijing, Shanghai and Guangzhou from 2013 to 2015. Methods: Using convenient sampling method, 5 general hospitals in Beijing, Shanghai and Guangzhou were selected which included Beijing hospital, China-Japan friendship hospital, Xinhua hospital affiliated to Shanghai jiaotong University School of Medicine, the liwan hospital of the third affiliated hospital and the first affiliated hospital of Guangzhou Medical University. The emergency and outpatient data, air pollution monitoring data and meteorological data were collected from January 1, 2013 to December 31, 2015. A generalized additive model was used to analyze the effect of PM_2.5 exposure on daily hospital emergency and outpatient visits, and Meta analysis was used to obtain the combined effect value. Results: The number of emergency and outpatient visits of 5 hospitals was 1 378 501 and 18 139 779 in total, respectively. The mean±SD of PM_2.5 exposures in Beijing hospital, China-Japan friendship hospital, Xinhua hospital affiliated to Shanghai jiaotong University School of Medicine, the liwan hospital of the third affiliated hospital and the first affiliated hospital of Guangzhou Medical University were (81.8±68.7), (83.2±69.7), (54.4±34.1), (43.5±24.8) μg/m³, respectively. Results of single pollutant model analysis showed that 0-1 day lag concentrations of PM_2.5 had the largest effect on emergency visits and outpatient visits. For a 10 μg/m³ increase of PM₂.5 concentration, excess risk (ER) (95%CI) of emergency and outpatient visits was 0.56% (0.14%, 0.99%) and0.63% (0.07%, 1.19%), respectively. After adjusting for O₃, NO₂, SO₂, and CO, for a 10 μg/m³ increase of PM_2.5 concentrations, the ER (95%CI) of emergency visits was 0.50% (0.10%, 0.90%), 0.34% (-0.02%, 0.69%), 0.36% (0.02%, 0.69%) and 0.56% (0.10%, 1.03%), respectively and the ER (95% CI) of outpatient visits was 0.65% (0.08%, 1.21%), 0.29% (-0.17%, 0.75%), 0.48% (-0.06%, 1.03%) and 0.48%(-0.02%, 0.99%), respectively. Conclusion Our results suggested that PM_2.5 exposure can increase emergency and outpatient visits of 5 hospitals in Beijing, Shanghai and Guangzhou.

OBJECTIVETo quantitatively evaluate the effects of daily mean temperature on respiratory diseases.

METHODSBased on the data of daily hospital admissions for respiratory diseases, meteorological parameters and air pollution in Shanghai between January 2006 and December 2011, we used a generalized additive model (GAM) to explore the effects of daily mean temperature on hospital admissions on respiratory diseases adjusted for the secular trend, seasonal trend, day of week and other confounders.

RESULTSA J-shaped relationship was found between daily mean temperature and respiratory disease and the optimum temperature (OT) corresponding to low risk of respiratory hospital admissions was about 25 °C. For cold effects over lag 0-30 days, the overall excess risk (ER) of hospital admission associated with 1 °C below the OT was 3.00% (95% CI: 2.54%-3.45%), 3.00% (95% CI: 2.55%-3.45%) and 3.02% (95% CI:2.51%-3.49%) for overall, males and females, respectively. For hot effects over lag 0-30 days, the overall excess risk (ER) was 2.15% (95% CI: 0.67%-3.66%), 1.86% (95% CI: 0.39%-3.34%) and 2.57% (95% CI: 0.82%-4.36%) for overall, males and females, respectively. The optimum temperature between daily mean temperature and respiratory disease were 14 °C, 20 °C, 25 °C and 28 °C in different age groups. The effect of low temperature increased with age for the people above 45 years old; however the effect of high temperature was significant for the people under 65 years old.

CONCLUSIONSBoth of higher temperature and lower temperature resulted in ER of respiratory hospital admissions increase with lag effects. The effects of lower temperature lagged longer and stronger than higher temperature. Different age group and gender shows different effects.

Age Factors ; Air Pollution ; China ; Cold Temperature ; Female ; Hospitalization ; Hot Temperature ; Humans ; Male ; Models, Theoretical ; Respiratory Tract Diseases ; Sex Factors ; Temperature

Objective To quantitatively evaluate the effects of daily mean temperature on respiratory diseases.Methods Based on the data of daily hospital admissions for respiratory diseases , meteorological parameters and air pollution in Shanghai between January 2006 and December 2011, we used a generalized additive model ( GAM) to explore the effects of daily mean temperature on hospital admissions on respiratory diseases adjusted for the secular trend , seasonal trend , day of week and other confounders.Results A J-shaped relationship was found between daily mean temperature and respiratory disease and the optimum temperature ( OT) corresponding to low risk of respiratory hospital admissions was about 25 ℃.For cold effects over lag 0-30 days, the overall excess risk ( ER ) of hospital admission associated with 1 ℃ below the OT was 3.00% ( 95%CI:2.54%-3.45%) , 3.00% ( 95%CI: 2.55%-3.45%) and 3.02% (95%CI:2.51%-3.49%) for overall, males and females, respectively.For hot effects over lag 0-30 days, the overall excess risk (ER) was 2.15% (95%CI:0.67%-3.66%), 1.86%(95%CI: 0.39%-3.34%) and 2.57% ( 95%CI: 0.82%-4.36%) for overall, males and females, respectively.The optimum temperature between daily mean temperature and respiratory disease were 14℃, 20 ℃, 25 ℃and 28 ℃ in different age groups.The effect of low temperature increased with age for the people above 45 years old; however the effect of high temperature was significant for the people under 65 years old.Conclusions Both of higher temperature and lower temperature resulted in ER of respiratory hospital admissions increase with lag effects.The effects of lower temperature lagged longer and stronger than higher temperature.Different age group and gender shows different effects.

Objective To quantitatively evaluate the effects of daily mean temperature on respiratory diseases.Methods Based on the data of daily hospital admissions for respiratory diseases , meteorological parameters and air pollution in Shanghai between January 2006 and December 2011, we used a generalized additive model ( GAM) to explore the effects of daily mean temperature on hospital admissions on respiratory diseases adjusted for the secular trend , seasonal trend , day of week and other confounders.Results A J-shaped relationship was found between daily mean temperature and respiratory disease and the optimum temperature ( OT) corresponding to low risk of respiratory hospital admissions was about 25 ℃.For cold effects over lag 0-30 days, the overall excess risk ( ER ) of hospital admission associated with 1 ℃ below the OT was 3.00% ( 95%CI:2.54%-3.45%) , 3.00% ( 95%CI: 2.55%-3.45%) and 3.02% (95%CI:2.51%-3.49%) for overall, males and females, respectively.For hot effects over lag 0-30 days, the overall excess risk (ER) was 2.15% (95%CI:0.67%-3.66%), 1.86%(95%CI: 0.39%-3.34%) and 2.57% ( 95%CI: 0.82%-4.36%) for overall, males and females, respectively.The optimum temperature between daily mean temperature and respiratory disease were 14℃, 20 ℃, 25 ℃and 28 ℃ in different age groups.The effect of low temperature increased with age for the people above 45 years old; however the effect of high temperature was significant for the people under 65 years old.Conclusions Both of higher temperature and lower temperature resulted in ER of respiratory hospital admissions increase with lag effects.The effects of lower temperature lagged longer and stronger than higher temperature.Different age group and gender shows different effects.

Objective To investigate the effects of sevoflurane pretreatment on renal ischemia-reperfusion (I/R)-induced apoptosis in kidney in rats. Methods Thirty pathogen-free male SD rats weighing 220-260 g were randomized into 3 groups (n=10 each):group control (group C);group I/R and group sevoflurane(group S). Renal I/R was induced by clamping the left renal pedicle for 45 min in I/R and S groups. In group S inhalation of 2.2% sevoflurane in O2 was started at 30 min before operation and maintained throughout the experiment.Venous blood samples were taken at 3 h of reperfusion for determination of serum BUN and Cr concentrations. The animals were then sacrificed and the left kidneys were removed for microscopic examination, detection of apoptosis(by TUNEL)and determination of heme oxygenase-1(HO-1) mRNA and protein expression (by RT-PCR and Western blot).Results Renal I/R significantly increased serum BUN and Cr concentrations, apoptotic index(percentage of apoptotic cells) and the severity of necrosis of renal proximal convoluted tubules (0=normal,4=necrosis of whole segment of proximal convoluted tubules).Sevoflurane inhalation attenuated the I/R-induced changes mentioned above.HO-1 mRNA and protein expression was up-regulated by I/R and HO-1 mRNA expression was further up-regulated by sevoflurane inhalation.Conclusion Sevoflurane pretreatment can protect kidney against I/R injury by attenuating cell apoptosis.Up-regulation of HO-1 mRNA expression may be involved in the mechanism.

Objective To investigate the effects of ischemic preconditioning on pneumocyte apoptosis and the expression of HSFT0 after lung isehemia-reperfusion(I/R) in rats and discuss its possible mechanism of extenu-ating ischemia-repedusion injury. Method Thirtysix male Sprague-Dawley rats were randomly divided into three groups [ sham operation(SO ) group, ischemia-teperfusion(L/R) group, and ischemic preconditioning(IP) group],twelve in each group. Lung croas-clamping was used to build the L/R model. In IP group, three cycles of 5-minute-ischemia + 5-minute-reperfusion were given to the pulmonary artery before the procedure. Sham operation rats had a thoracotomy only. Two hours(or five hours) reperfusion was given to both L/R and IP group. Tenninal-deoxynucleotidyl Transferase Mediated d-UTP Nick End Labeiing(TUNEL) was used to evaluate apoptosis. Expression of HSP/0 in lung was observed by immunohistochemical stain and image analysis. Index of quantitative assessment of histologic lung injury(IQA), wet to dry weight ratio(W/D) were measured. The pathological change of lung tissue was observed under both hght and electron microscopy. Statistical analysis was carried out by One-way Anova. Scheffe test was used for intragroup comparison. Results The apoptosis index and expression of HSP70、W/D,IQA of hng tissue in I/R group were higher than those in the sham operation group (P<0.01). Compared with the L/R group, the apoptosis index and expression of HSP70, W/D, IQA of lung tissue significantly decreased (P<0.01), the levels of expression of HSPTO increased significantly in IP group ( P<0.01 ). The pathological and ultrastructure change of lung tissue was better in IP group than those in I/R group. Condusions Ischemic preconditioning can extenuate lung I/R injury by the possible mechanism of increasing the expression of HSPT0 which inhibits the apoptosis during lung I/R injury.