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.

Objective To investigate the prevalence of Schistosoma japonicum infections in wild rodents in schistosomiasis-endemic areas of China, so as to provide insights into formulation of technical guidelines for monitoring of and the precise control strategy for S. japonicum infections in wild rodents during the elimination phase. Methods Two administrative villages where schistosomiasis was historically highly prevalent were selected each from Dongzhi County, Anhui Province, and Duchang County, Jiangxi Province as study villages. Wild rodents were captured from study villages with baited traps or cages at night in June and September, 2021. The number of rodents captured was recorded, and the rodent species was characterized based on morphologi-cal characteristics. Liver tissues were sampled from captured rodents for macroscopical observation of the presence of egg granu- lomas, and S. japonicum infection was detected simultaneously using liver tissue homogenate microscopy, examinations of mesenteric tissues for parasites, and modified Kato-Katz thick smear technique (Kato-Katz technique). A positive S. japonicum infection was defined as detection of S. japonicum eggs or adult worms by any of these methods. The rate of wild rodent capture and prevalence of S. japonicum infections in wild rodents were compared in different study villages and at different time periods, and the detection of S. japonicum infections in wild rodents was compared by different assays. Results The overall rate of wild ro- dent capture was 8.28% (237/2 861) in Dongzhi County, and the wild rodent capture rates were 9.24% (133/1 439) and 7.31% (104/1 422) in two study villages (χ² = 3.503, P = 0.061), and were 8.59% (121/1 409) and 7.99% (116/1 452) in June and September, 2021, respectively (χ² = 0.337, P = 0.561). The overall rate of wild rodent capture was 3.72% (77/2 072) in Duchang County, and the wild rodent capture rates were 6.91% (67/970) and 0.91% (10/1 102) in two study villages (χ² = 51.901, P < 0.001), and were 4.13% (39/945) and 3.37% (38/1 127) in June and September, 2021, respectively (χ² = 0.815, P = 0.365). Rattus norvegicus was the predominant rodent species captured in both counties, accounting for 70.04% (166/237) of all captured wild rodents in Dongzhi County and 88.31% (68/77) in Duchang County. No S. japonicum infection was detected in wild rodents captured in Duchang County. Nevertheless, the overall prevalence of S. japonicum infections was 51.05% (121/237) in wild rodents captured in Dongzhi County, with prevalence rates of 50.38% (67/133) and 51.92% (54/104) in two study villages (χ² = 0.098, P = 0.755), and 54.31% (63/116) and 47.93% (58/121) in September and June, 2021, respectively (χ² = 0.964, P = 0.326). Of 237 wild rodents captured in Dongzhi County, there were 140 (59.07%) rodents with visible hepatic egg granulomas, 117 (49.47%) tested positive for S. japonicum eggs by liver tissue homogenate microscopy, 34 (14.35%) tested positive for S. japonicum eggs with Kato-Katz technique; however, no adult S. japonicum worms were detected in mesenteric tissues. In addition, hepatic egg granulomas were found in all wild rodents tested positive for S. japonicum eggs with liver tissue homogenate microscopy. Conclusions The rate of wild rodent capture and prevalence of S. japonicum infection in wild rodents vary greatly in schistosomiasis-endemic areas of China, and the prevalence of S. japonicum infection is slightly higher in wild rodents captured in autumn than in summer. Liver tissue is recommended as the preferred sample for surveillance of S. japonicum infection in wild rodents, and a combination of macroscopical observation of hepatic egg granulomas and liver tissue homogenate microscopy may be a standard method for surveillance of S. japonicum infection in wild rodents.

Objective:To analyze the influencing factors of postoperative frailty in elderly patients with gastrointestinal tumors, establish a nomogram model for predicting postoperative frailty and evaluate its efficacy, so as to provide reference basis for formulating perioperative frailty management plans for elderly gastrointestinal tumor patients in the later stage.Methods:Convenience sampling method was used to select 376 elderly patients with gastrointestinal tumors who underwent surgical treatment in the First Affiliated Hospital of Anhui Medical University from December 2021 to August 2022 as the study objects. On the 5th day after surgery according to Tilburg Frailty Indicator, the patients were diagnosed whether they developed postoperative frailty and were divided into postoperative frailty group and postoperative non-frailty group. General data, laboratory indicators and clinical data of patients were collected. Univariate analysis and multivariate Logistic regression analysis were used to screen the independent influencing factors of postoperative frailty in elderly patients with gastrointestinal tumors. R software was used to establish a nomogram prediction model and conduct internal validation to evaluate the differentiation, calibration and clinical applicability of the model.Results:A total of 265 males and 111 females included aged (70.04 ± 5.89) years old, with 222 (59.0%) patients experienced postoperative frailty in this study. Multivariate analysis showed that low Barthel Index score ( OR=0.941, 95% CI 0.903-0.980), low hemoglobin ( OR=0.976, 95% CI 0.963-0.989), high Charison Comorbid Index score ( OR=1.457, 95% CI 1.128-1.882), preoperative frailty ( OR=4.369, 95% CI 1.486-12.841), and pathological stage Ⅲ-Ⅳ ( OR=2.053, 95% CI 1.253-3.364) were independent influencing factors for postoperative frailty of elderly gastrointestinal tumors (all P<0.05). The AUC before and after internal validation of the nomogram model was 0.811 (95% CI 0.768-0.854) and 0.803 (95% CI 0.762-0.856) respectively. The results of Hosmer-Lemeshow test showed good goodness of fit ( χ2=4.09, P>0.05). Decision curve analysis showed that the model had certain clinical applicability. Conclusions:Based on the risk factors of postoperative frailty in elderly patients with gastrointestinal tumors, the nomogram prediction model was established, which has good differentiation, consistency and clinical applicability, and can provide reference for clinical staff to make perioperative frailty management plan.

Objective: To analyze the safety and effectiveness of different types of stents with the treatment of vertebraebasilar artery dissection aneurysms(VBADA). Methods : The clinical data of 80 patients with VBADA treated by intravascular intervention in the First Hospital of University of Science and Technology of China(Anhui Provincial Hospital) from February 2018 to November 2023 were retrospectively analyzed. Patients were divided into laser engraved stent group(n=34) and braided stent group(n=46) based on the type of stent used. O′Kelly-Marotta(OKM) grade was used to evaluate the embolization effect of aneurysms in DSA images, and a modified Rankin Scale(mRS) score was used to evaluate the clinical prognosis of patients. The baseline data, aneurysm characteristics, intraoperative and perioperative treatment details and postoperative follow-up details between the two groups were compared. Results : There was no significant difference in baseline data, mRS score, ischemic and hemorrhage complications and mortality between the two groups(allP>0.05). Compared with the laser engraved stent group, the mean diameter of aneurysms was larger(P<0.000 1) and the proportion of ruptured aneurysm(P<0.01), parent artery stenosis and beaded vascular lesions(P<0.05) and branch artery dissecting aneurysm were higher(P<0.01) in the braided stent group. Conversely, the proportion of coil-assisted embolization(P<0.000 1) and the immediate aneurysm occlusion rate(OKM C and D)(P<0.000 1) were lower. Finally, 21 patients were obtained by controlling for maximum diameter of aneurysms and whether coil-assisted embolization, the aneurysm occlusion rate half a year later in the braided stent group was higher than that in the laser engraved stent group(P<0.05), but the recurrence rate of postoperative aneurysm was lower than that of laser engraved stent group(P<0.05). It was worth noting that the cure rate and vascular remodeling rate of middle-large size VBADA which the maximum diameter being over 15 mm in the braided stent group reached 72.2%, and the whole effect was ideal. Conclusion Braided stents are relatively safe and effective in the treatment of VBADA and are significantly better than laser engraved stents in reducing VBADA recurrence and remodeling lesion vessels without increasing postoperative complication.

Objective To investigate the effect of continuous intraoperative insulin infusion on my-ocardial blood perfusion after cardiac surgery under cardiopulmonary bypass(CPB).Methods Forty-eight patients,21 males and 27 females,aged 55-80 years,BMI 18-28 kg/m2,ASA physical status Ⅱ-Ⅳ,who underwent elective cardiac surgery with CPB were selected and randomly divided into two groups:the insulin group(group I,n = 25)and the control group(group C,n = 23).The same anesthesia protocol was implemented in both groups.After induction of anesthesia,group Ⅰ received intravenously infusion of in-sulin 30 mU·kg-1·h-1,glucose 0.12 g·kg-1·h-1,and potassium chloride 0.06 mmol·kg-1·h-1,and group C received saline 10 ml/h,all of which were infused until the end of surgery.The targeted blood glucose range for both groups was set at 6.1-11.1 mmol/L.Transesophageal echocardiography(TEE)was performed 10 minutes after induction of general anesthesia(T2)and before the end of surgery(T6)to ex-amine the coronary sinus(CS)flow spectrum and diameter,pulmonary venous flow spectrum,and calculate CS net antegrade flow velocity time integral(VTI).Femoral mean arterial pressure(MAP),central venous pressure(CVP),stroke volume(SV),cardiac index(CI)and peripheral vascular resistance index(SVRI)were recorded at T2,2 minutes before CPB(T3),the end of CPB(T5),and T6.The concentra-tions of blood glucose and lactate 5 minutes before anesthesia induction(T1),T3,30 minutes after CPB(T4),T5,T6,6 hours after surgery(T7),12 hours after surgery(T8),and 24 hours after surgery(T9)were recorded.The levels of high-sensitivity C-reactive protein(hs-CRP),high-sensitivity troponin I(hs-TnI),and creatine kinase isoenzyme(CK-MB)were recorded 1 day preoperatively,1 and 2 days post-operatively.Results Compared with group C,in group I,CS net antegrade flow VTI and blood flow per minute were significantly increased(P<0.05),and pulmonary venous peak atrial reversal wave velocity(ARp)was significantly reduced at T6(P<0.05),SV and CI were significantly increased and SVRI was significantly decreased at T5 and T6(P<0.05),lactate concentration was significantly decreased at T7 and T8(P<0.05),hs-CRP and CKMB were significantly decreased 1 and 2 days postoperatively(P<0.05),hs-TnI was significantly reduced 2 days postoperatively(P<0.05).Conclusion Continuous insulin admin-istration during cardiac surgery with CPB while maintaining blood glucose at 6.1-11.1 mmol/L can enhance myocardial blood perfusion,mitigate postoperative inflammatory response,and reduce myocardial injury.

Objective To investigate the effect of intraoperative renal artery resistance index(RI)in predicting postoperative acute kidney injury(AKI)in patients undergoing cardiac surgery with cardiopul-monary bypass(CPB).Methods Forty-four patients undergoing elective cardiac surgery with CPB,21 males and 23 females,aged ≥18 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅰ-Ⅲ,were select-ed.Left renal artery peak systolic velocity(PSV)and end-diastolic velocity(EDV)were measured by transesophageal echocardiography(TEE)20 minutes after general anesthesia induction(T1)and 30 minutes after CPB cessation(T2).RI was calculated as(PSV-EDV)/PSV.Patients were divided into two groups:the AKI group and the non-AKI group,according to whether occurred AKI by the diagnostic criteria of the kidney disease:improving global outcomes organization(KDIGO).Logistic multivariate regression analysis was performed to identify the risk factors for AKI occurrence.Results Sixteen patients(36％)oc-curred AKI.Compared with the non-AKI group,the CPB duration and aortic cross-clamp duration were sig-nificantly prolonged(P＜0.05),the renal artery RI at T,and T2 were significantly increased in the AKI group(P＜0.05).Multivariate logstic analysis showed that RI at T2 was an independent risk factor for AKI occurrence after cardiac surgery,the AUC was 0.893(95％CI 0.794-0.991,P＜0.010),the sensitivity and specificity were 84.5％and 78.6％,respectively,and the cut-off value was 0.720.Conclusion Intra-operative renal artery RI in patients undergoing cardiac surgery is an independent risk factor for AKI after cardiac surgery,and renal artery RI＞0.720 at 30 minutes after CPB cessation can serve as a predictive in-dicator for AKI after cardiac surgery.

Objective To explore whether the capacity of decision-making under ambiguity in adult patients with moyamoya disease(MMD)is impaired and its association with executive function.Methods Neuropsychological scales were used to measure the executive function of forty-one adult patients with MMD and forty-one healthy con-trols(HC),The Iowa Gambling Task(IGT)was utilized to study the capacity of decision-making under ambiguity of the two groups.Correlation analysis was performed between the two types of data.Results ① The total number of favorable choices in the MMD group was significantly lower than that in the HC group,with a statistically signifi-cant difference(Z=-2.782,P＜0.01),and the total number of unfavorable choices was significantly higher than that of the controls,with a statistically significant difference(Z=-2.782,P＜0.01).The results of ANOVA showed that the net residual value of Block4 and Block5 in MMD group was lower than that of Block4 and Block5 in HC group,respectively,and the differences were statistically significant(t=-3.433,P=0.001;t=-5.271,P＜0.001),the net residual value of Block 1 was higher than that of Block 1 in HC group,the difference was statisti-cally significant(t=2.715,P=0.008).② Spearman correlation analysis revealed no association between the net score of IGT,the total number of favorable choices,the total number of unfavorable choices,and executive func-tion.Conclusion The capacity of decision-making under ambiguity in adult patients with MMD is impaired possi-bly,which is not correlated with executive cognition.

Objective:To explore the effect of intravascular sodium nitroprusside (SNP) combined with hyaluronidase (HAase) plus urokinase (UK) in treating rat abdominal wall skin flap ischemia caused by HA induced artery embolism, and to compare the difference between thrombolysis with and without addition of sodium nitroprusside.Methods:Forty male Sprague-Dawley rats were injected with 10 μl of hyaluronic acid (HA) into the left inferior epigastric arteries, constructing the superficial epigastricl artery skin flap ischemic model in rats. The rats were randomly divided into four groups: a control group, and experimental groups A, B and C. Control and experimental groups A, B and C were treated with the following solutions 45 minutes after hyaluronic acid injection: physiological saline plus glucose was injected into the rats (control group); hyaluronidase (HAase) plus glucose injection was injected into the rats (experimental group A), hyaluronidase (HAase) plus urokinase (UK) was injected into the rats (experimental group B), hyaluronidase (HAase), urokinase (UK) plus sodium nitroprusside were injected into the rats (experimental group C). The changes of flaps were observed at 0 min, 3 days, 5 days and 7 days after operation. The difference of the area percentage of unperfused flap in the four groups was compared 7 days after operation. This study was carried out from July 2020 to March 2021 in the Medical Laboratory Animal Center of Weifang Medical University.Results:The unperfused area of flaps for the control group, experimental groups A, B and C were (100.00±0.00) %, (44.68±7.90)%, (34.01±8.77)% and (24.12±4.58)%, respectively. In the experimental group C, the scabby necrosis area was smaller than that of the experimental group A ( P<0.05); in the experimental group C, the scabby necrosis area was smaller than that of the experimental group B ( P<0.05); in the experimental group B, the scabby necrosis area was smaller than that of the experimental group A ( P<0.05). HE staining revealed that size and density of the embolus was significantly decreased after the addition of sodium nitroprusside. Conclusions:Sodium nitroprusside combined with hyaluronidase and urokinase can effectively improve the ischemia of the flap caused by HA induced artery embolism, increase the tissue perfusion, and reduce the necrotic area of the flap.

Objective:To investigate the efficacy of continuous intravenous injection of hyaluronidase (HAase) combined with urokinase (UK) in the treatment of ischemia of hyaluronic acid (HA) arterial embolized skin flap.Methods:(1)Establish an animal model of superficial abdominal artery embolization with HA: 24 SD rats were used to make a square island flap (2 cm×2 cm, the width of the pedicle is 2 mm) on the left and right sides of the abdominal white line with superficial epigastric artery as feeding artery. The left and right flaps of rats were used as experimental group and control group. After the preparation of the experimental skin flap, HA 10 μl was injected into the superficial abdominal artery, while the self-control flap was only made and the vessels were peeled off without embolization.(2)The rats were randomly divided into A, B, C and D groups by drawing lots with 6 rats in each group, After the successful establishment of embolic animal model of 45 min, HAase(2 000 IU/kg)+ UK(50 000 IU/kg), HAase(2 000 IU/kg), UK(50 000 IU/kg) and normal saline were continuously infused through caudal vein with microinjection pump. The volume of solution in each group was 6 ml in 12 minutes. The general condition of rats and the skin color, edema, congestion and skin necrosis in the operation area of rats were observed, which were photographed and compared immediately, and at 3 days, 5 days and 7 days after embolization. The images were analyzed by Photoshop software, and the percentage of survival area of the flap after operation 7 days, was measured by pixel method. The percentage of survival area was compared by single factor analysis of variance (ANOVA) and head-to-head comparison by LSD- t test. Results:Immediately after operation, all the flaps in the four groups were pale and there was no obvious swelling. All the flaps showed different degrees of swelling within 3 days after operation, and the swelling basically disappeared within 3-5 days after operation, and gradually changed from dark red ecchymosis to dark purple or black. Seven days after operation, the necrotic area flap gradually hardened and its boundary was obvious. The skin flaps of the 4 groups showed different degrees of necrosis. The postoperative reaction of the flap was the slightest in group A, the performance of group B and C was similar, which were both between group A and group D, and there was the heaviest postoperative reaction in group D. At 7 days after operation, the percentage of survival area of flaps in groups A, B, C and D was 90.30%±5.95%, 52.63%±6.90%, 51.14%±5.95% and 7.70%±2.18%, respectively. The percentage of survival area of skin flap in group A was significantly higher than that in groups B, C and D (analysis of ANOVA: P<0.01; LSD- t test: P<0.01). Conclusions:Continuous intravenous infusion of HAase combined with UK can effectively alleviate the flap ischemia caused by HA artery embolism, increase tissue perfusion and increase the survival area of the flap.