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 provide basis for the formation of acute exacerbation of chronic obstructive pulmonary disease(AECOPD-STES),the item weight of the syndrome therapeutic evaluation scale for AECOPD-STES was determined.Methods Based on the clinical survey data of 387 AECOPD patients,the random forest method was adopted,and the Spyder integrated development environment.Anaconda navigator software was used to call the"random forest Classifier"in the sklearn package to establish the initial random forest model and calculate the item weights.Factor analysis was used to extract common factors with cumulative variance contribution>80%,and the item weight was calculated according to the cumulative variance contribution and component score coefficient of common factors.The percentage weight method was used to calculate the item weight based on the importance score of each item by 29 experts.Finally,40%,30%and 30%of the above three methods were given respectively to determine the final weight of the items.Results The random forest method showed that the weights of wind cold syndrome,cold Yin syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.014-0.170,0.076-0.194,0.017-0.183,0.010-0.183 and 0.069-0.298,respectively.Factor analysis showed that the weights of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.030-0.111,0.100-0.182,0.037-0.095,0.022-0.141 and 0.054-0.185,respectively.The percentage weight method shows that the weight ranges of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.072-0.102,0.146-0.182,0.057-0.077,0.075-0.111 and 0.115-0.185,respectively.According to the three methods,the weights of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.050-0.121,0.117-0.174,0.040-0.117,0.056-0.130 and 0.092-0.188,respectively.Conclusion This study determined the weight of each item of AECOPD-STES,providing a basis for the calculation of syndrome score.

Objective: To investigate the effects of cranial electrotherapy stimulation(CES) with varying parameter configurations on sleep quality in patients diagnosed with chronic insomnia disorder. Methods: Seventy-two participants meeting diagnostic criteria for chronic insomnia disorder were randomly allocated to a four-arm parallel study design.The intervention protocol comprised:Group 1(G1) received CES at 0.5 Hz,300 μA;Group 2(G2) underwent CES treatment at 1.5 Hz,300 μA;Group 3(G3) administered 100 Hz,300 μA stimulation;and Group4(G4) received sham stimulation with identical device placement but no current delivery.Primary outcomes were quantified through polysomnography(PSG) recordings conducted at baseline and post-intervention,whereas secondary outcomes were assessed via standardized sleep questionnaires including the Pittsburgh sleep quality index(PSQI) and Insomnia Severity Index(ISI). Results: Following a 10-day intervention protocol,significant clinical improvements were observed across all active treatment groups(G1-G3) as evidenced by reductions in PSQI.Insomnia severity index(ISI) scores quantitative polysomnographic analysis revealed that both G2(1.5 Hz) and G3(100 Hz) cohorts demonstrated statistically significant enhancements in Flinders Fatigue Scale(FFS) scores,total sleep time(TST),and sleep efficiency(SE),accompanied by reduced sleep onset latency(SOL) compared to baseline measurements.However,no statistically significant differences were detected between the G2 and G3 intervention arms across all measured parameters.CES exerted no significant effect on sleep architecture. Conclusion CES can effectively improve the sleep of patients with chronic insomnia.Within a certain range,a higher frequency of CES leads to better sleep improvement effects.

Objective To investigate the effect of miR-29b-3p targeting insulin-like growth factor-1(IGF-1)on high glucose-induced injury in human retinal microvascular endothelial cells(HRMECs)and the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt)/mammalian target of rapamycin(mTOR)signaling pathway.Methods HRMECs were di-vided into the following groups:control group(normal culture),high glucose(HG)group(treated with 30.0 mmol·L-1 glucose for 48 h),inhibitor-NC group,miR-29b-3p inhibitor group,miR-29b-3p inhibitor+si-NC group,miR-29b-3p inhib-itor+si-IGF-1 group(all transfected with corresponding plasmids for 24 h after HG treatment),and LY294002 group(treated with 40 μmol·L-1 LY294002 for 24 h).The expression level of miR-29b-3p was detected by quantitative real-time PCR(qRT-PCR).Cell viability was assessed using the Cell Counting Kit-8(CCK-8)assay.Intracellular reactive oxygen species(ROS)levels were measured by immunofluorescence.The expression levels of malondialdehyde(MDA),superox-ide dismutase(SOD),and glutathione peroxidase(GSH-Px)were determined using enzyme-linked immunosorbent assay(ELISA).Cell apoptosis was analyzed by flow cytometry.Autophagosome formation was observed under a transmission electron microscope.The protein expression levels related to apoptosis,autophagy,IGF-1,and the PI3K/Akt/mTOR path-way were examined by Western blot.The targeting relationship between miR-29b-3p and IGF-1 was verified by a dual-lucif-erase reporter assay.Results Compared with the Control group,the HG group showed significant increases in the ex-pression levels of miR-29b-3p,ROS,MDA,Bax,Cleaved-caspase 3,p62,the p-PI3K/PI3K ratio,the p-Akt/Akt ratio,the p-mTOR/mTOR ratio,and the cell apoptosis rate;whereas the expression levels of IGF-1,SOD,GSH-Px,the LC3Ⅱ/LC3Ⅰ ratio,cell viability,and the number of autophagosomes were significantly decreased(all P＜0.05).Compared with the in-hibitor-NC group,the miR-29b-3p inhibitor group exhibited significant decreases in the expression levels of miR-29b-3p,ROS,MDA,Bax,Cleaved-caspase 3,p62,the p-PI3K/PI3K ratio,the p-Akt/Akt ratio,the p-mTOR/mTOR ratio,and the cell apoptosis rate;while the expression levels of IGF-1,SOD,GSH-Px,the LC3Ⅱ/LC3Ⅰ ratio,cell viability,and the num-ber of autophagosomes were significantly increased(all P＜0.05).Compared with the miR-29b-3p inhibitor+si-NC group,the miR-29b-3p inhibitor+si-IGF-1 group demonstrated significant increases in the expression levels of miR-29b-3p,ROS,MDA,Bax,Cleaved-caspase 3,p62,the p-PI3K/PI3K ratio,the p-Akt/Akt ratio,the p-mTOR/mTOR ratio,and the cell apoptosis rate;whereas the expression levels of IGF-1,SOD,GSH-Px,the LC3Ⅱ/LC3Ⅰ ratio,cell viability,and the number of autophagosomes were significantly decreased(all P＜0.05).Compared with the HG group,the LY294002 group showed significant decreases in the expression levels of miR-29b-3p,ROS,MDA,Bax,Cleaved-caspase 3,p62,the p-PI3K/PI3K ratio,the p-Akt/Akt ratio,the p-mTOR/mTOR ratio,and the cell apoptosis rate;while the expression levels of IGF-1,SOD,GSH-Px,the LC3Ⅱ/LC3Ⅰ ratio,cell viability,and the number of autophagosomes were significantly increased(all P＜0.05).The dual-luciferase activity was significantly lower in cells co-transfected with IGF-1-WT and miR-29b-3p mimic compared to miR-NC cells(P＜0.05).Conclusion Inhibition of miR-29b-3p can target upregulation of IGF-1 expression levels,thereby inhibiting the PI3K/Akt/mTOR pathway and improving high glucose induced cell damage in HRMECs.

Objective To provide basis for the formation of acute exacerbation of chronic obstructive pulmonary disease(AECOPD-STES),the item weight of the syndrome therapeutic evaluation scale for AECOPD-STES was determined.Methods Based on the clinical survey data of 387 AECOPD patients,the random forest method was adopted,and the Spyder integrated development environment.Anaconda navigator software was used to call the"random forest Classifier"in the sklearn package to establish the initial random forest model and calculate the item weights.Factor analysis was used to extract common factors with cumulative variance contribution>80%,and the item weight was calculated according to the cumulative variance contribution and component score coefficient of common factors.The percentage weight method was used to calculate the item weight based on the importance score of each item by 29 experts.Finally,40%,30%and 30%of the above three methods were given respectively to determine the final weight of the items.Results The random forest method showed that the weights of wind cold syndrome,cold Yin syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.014-0.170,0.076-0.194,0.017-0.183,0.010-0.183 and 0.069-0.298,respectively.Factor analysis showed that the weights of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.030-0.111,0.100-0.182,0.037-0.095,0.022-0.141 and 0.054-0.185,respectively.The percentage weight method shows that the weight ranges of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.072-0.102,0.146-0.182,0.057-0.077,0.075-0.111 and 0.115-0.185,respectively.According to the three methods,the weights of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.050-0.121,0.117-0.174,0.040-0.117,0.056-0.130 and 0.092-0.188,respectively.Conclusion This study determined the weight of each item of AECOPD-STES,providing a basis for the calculation of syndrome score.

Objective To investigate the effect of miR-29b-3p targeting insulin-like growth factor-1(IGF-1)on high glucose-induced injury in human retinal microvascular endothelial cells(HRMECs)and the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt)/mammalian target of rapamycin(mTOR)signaling pathway.Methods HRMECs were di-vided into the following groups:control group(normal culture),high glucose(HG)group(treated with 30.0 mmol·L-1 glucose for 48 h),inhibitor-NC group,miR-29b-3p inhibitor group,miR-29b-3p inhibitor+si-NC group,miR-29b-3p inhib-itor+si-IGF-1 group(all transfected with corresponding plasmids for 24 h after HG treatment),and LY294002 group(treated with 40 μmol·L-1 LY294002 for 24 h).The expression level of miR-29b-3p was detected by quantitative real-time PCR(qRT-PCR).Cell viability was assessed using the Cell Counting Kit-8(CCK-8)assay.Intracellular reactive oxygen species(ROS)levels were measured by immunofluorescence.The expression levels of malondialdehyde(MDA),superox-ide dismutase(SOD),and glutathione peroxidase(GSH-Px)were determined using enzyme-linked immunosorbent assay(ELISA).Cell apoptosis was analyzed by flow cytometry.Autophagosome formation was observed under a transmission electron microscope.The protein expression levels related to apoptosis,autophagy,IGF-1,and the PI3K/Akt/mTOR path-way were examined by Western blot.The targeting relationship between miR-29b-3p and IGF-1 was verified by a dual-lucif-erase reporter assay.Results Compared with the Control group,the HG group showed significant increases in the ex-pression levels of miR-29b-3p,ROS,MDA,Bax,Cleaved-caspase 3,p62,the p-PI3K/PI3K ratio,the p-Akt/Akt ratio,the p-mTOR/mTOR ratio,and the cell apoptosis rate;whereas the expression levels of IGF-1,SOD,GSH-Px,the LC3Ⅱ/LC3Ⅰ ratio,cell viability,and the number of autophagosomes were significantly decreased(all P＜0.05).Compared with the in-hibitor-NC group,the miR-29b-3p inhibitor group exhibited significant decreases in the expression levels of miR-29b-3p,ROS,MDA,Bax,Cleaved-caspase 3,p62,the p-PI3K/PI3K ratio,the p-Akt/Akt ratio,the p-mTOR/mTOR ratio,and the cell apoptosis rate;while the expression levels of IGF-1,SOD,GSH-Px,the LC3Ⅱ/LC3Ⅰ ratio,cell viability,and the num-ber of autophagosomes were significantly increased(all P＜0.05).Compared with the miR-29b-3p inhibitor+si-NC group,the miR-29b-3p inhibitor+si-IGF-1 group demonstrated significant increases in the expression levels of miR-29b-3p,ROS,MDA,Bax,Cleaved-caspase 3,p62,the p-PI3K/PI3K ratio,the p-Akt/Akt ratio,the p-mTOR/mTOR ratio,and the cell apoptosis rate;whereas the expression levels of IGF-1,SOD,GSH-Px,the LC3Ⅱ/LC3Ⅰ ratio,cell viability,and the number of autophagosomes were significantly decreased(all P＜0.05).Compared with the HG group,the LY294002 group showed significant decreases in the expression levels of miR-29b-3p,ROS,MDA,Bax,Cleaved-caspase 3,p62,the p-PI3K/PI3K ratio,the p-Akt/Akt ratio,the p-mTOR/mTOR ratio,and the cell apoptosis rate;while the expression levels of IGF-1,SOD,GSH-Px,the LC3Ⅱ/LC3Ⅰ ratio,cell viability,and the number of autophagosomes were significantly increased(all P＜0.05).The dual-luciferase activity was significantly lower in cells co-transfected with IGF-1-WT and miR-29b-3p mimic compared to miR-NC cells(P＜0.05).Conclusion Inhibition of miR-29b-3p can target upregulation of IGF-1 expression levels,thereby inhibiting the PI3K/Akt/mTOR pathway and improving high glucose induced cell damage in HRMECs.

Chronic obstructive pulmonary disease(COPD)poses a serious threat to human health and carries a heavy burden of disease.The disease burden mainly includes traditional epidemiological indicators such as morbidity,disability rate,and mortality rate,as well as economic burden evaluation indicators such as direct economic burden,indirect economic burden,and intangible economic burden,as well as social/health burden evaluation indicators such as potential years of life reduction,disability adjusted life years,and quality adjusted life years.It summarized the existing methods for evaluating the burden of COPD diseases and proposed the following suggestions:(1)enriching economic burden research methods to comprehensively and accurately evaluate direct economic burden;(2)expanding the scope of economic burden research and improve the economic burden research of COPD;(3)strengthening information management and enhance the accuracy of disease burden data;(4)exploring multidimensional indicators and establish a COPD disease burden evaluation system;(5)strengthening relevant research and highlight the health economics advantages of traditional Chinese medicine intervention in COPD.It can provide references for establishing a COPD disease burden evaluation system and policy formulation.

Objective:To summarize the best evidence for the use of ankle pump exercises in preventing perioperative lower limb deep vein thrombosis (DVT) in patients undergoing joint replacement surgery and to evaluate its clinical application.Methods:This study utilized an evidence-based continuous quality improvement model. A systematic search was conducted for relevant clinical practice guidelines, expert consensus, systematic reviews, and randomized controlled trials (RCTs) from both domestic and international sources. The best evidence was evaluated and summarized, and audit indicators were developed for baseline assessments. Facilitating and hindering factors were analyzed based on the baseline results. From December 2022 to April 2023, the evidence was applied in the Department of Orthopedics at Henan Provincial People's Hospital. The pre-evidence group for baseline assessments included 36 joint replacement patients and 18 nurses from the orthopedic unit between December 2022 and January 2023, while the post-evidence group included 36 joint replacement patients and the same 18 nurses between March and April 2023. The knowledge level of nurses, the effectiveness of ankle pump exercises, the execution rate, and patient compliance were compared before and after evidence-based practice.Results:A total of 12 articles were included in the study, comprising one clinical practice guideline, five expert consensus papers, one systematic review, and five RCTs. Ten best practices were summarized in terms of applicable populations, exercise assessment, exercise positions, timing, methods, frequency, and patient education. After implementing evidence-based practice, the knowledge scores of nurses on ankle pump exercises significantly improved from (70.56±9.98) to (82.78±8.26) ( P<0.01). The compliance rates of audit items 2, 3, 4, 5, and 6 among nurses increased from 0, 22.2%, 0, 27.8%, and 11.1% respectively, to 94.4%, 94.4%, 83.3%, 100.0%, and 100.0% respectively ( P<0.01). On the patient side, the compliance rates for audit items 7 and 8 increased from 5.6% and 0 to 86.1% and 94.4%, respectively ( P<0.01) . Conclusions:Implementing evidence-based ankle pump exercises to prevent DVT in joint replacement patients can significantly improve nurses' knowledge of evidence-based practice, standardize the practice of ankle pump exercises, and explore balanced educational strategies that enhance patient compliance, ensuring clinical practices are evidence-based.

The utilization of optimal orthodontic force is crucial to prevent undesirable side effects and ensure efficient tooth movement during orthodontic treatment.However,the sensitivity of existing detection techniques is not sufficient,and the criteria for evaluating optimal force have not been yet established.Here,by employing 3D finite element analysis methodology,we found that the apical distal region(A-D region)of mesial roots is particularly sensitive to orthodontic force in rats.Tartrate-resistant acidic phosphatase(TRAP)-positive osteoclasts began accumulating in the A-D region under the force of 40 grams(g),leading to alveolar bone resorption and tooth movement.When the force reached 80 g,TRAP-positive osteoclasts started appearing on the root surface in the A-D region.Additionally,micro-computed tomography revealed a significant root resorption at 80 g.Notably,the A-D region was identified as a major contributor to whole root resorption.It was determined that 40 g is the minimum effective force for tooth movement with minimal side effects according to the analysis of tooth movement,inclination,and hyalinization.These findings suggest that the A-D region with its changes on the root surface is an important consideration and sensitive indicator when evaluating orthodontic forces for a rat model.Collectively,our investigations into this region would aid in offering valuable implications for preventing and minimizing root resorption during patients'orthodontic treatment.

Objective:To investigate the features of the brain structural network in patients with postpartum depression (PPD).Methods:This cross-sectional study included PPD patients who visited the mental health counseling clinic after delivery at the Jiangsu University Affiliated Yixing Hospital from June 2013 to September 2022 (PPD group). Matched non-PPD postpartum women based on age, years of education, and body mass index who came for postpartum follow-up (non-PPD postpartum group), and non-pregnant women who visited the hospital or underwent physical examinations during the same period (non-pregnant group) were also included. Demographic data and diffusion tensor imaging (DTI) data were collected for all three groups. The brain was partitioned into 90 regions using an anatomical template to construct the brain structural network. Network-based statistics (NBS) were applied to further screen and construct subnetworks. The efficacy of the subnetworks in identifying PPD was evaluated through multivariable logistics regression models and receiver operating characteristic curves. A comparison of the connectivity strength of white matter tracts and topological attributes of brain structural network parameters was conducted using independent samples t-tests, and the results were corrected using the false discovery rate (FDR) method. Results:(1) A total of 116 subjects were included, with 40 in the non-pregnant group, 40 in the non-PPD postpartum group, and 36 in the PPD group. PPD group had higher Edinburgh Postnatal Depression Scale (EPDS) scores than the non-pregnant and non-PPD postpartum groups [(18.0±4.1) scores vs. (2.5±1.2) and (6.1±2.1) scores, F=340.40; t=24.65,10.60 and 16.16 in pairwise comparison; all P<0.001]. (2) Compared to the non-pregnant group, there was a decrease in the connectivity strength of nine white matter tracts within the brain structural network of the postpartum group (including left dorsolateral superior frontal gyrus-left anterior cingulate and paracingulate gyrus, left dorsolateral superior frontal gyrus-right amygdala, left dorsolateral superior frontal gyrus-left insula, left insula-left lentiform nucleus, left insula-left hippocampus, left hippocampus-right amygdala, left hippocampus-left precuneus, left anterior cingulate and paracingulate gyrus-right amygdala, and right amygdala-right hippocampus) (all P<0.05, FDR corrected). No increased connection strengths were observed. There were no significant differences in the connection strengths of these nine tracts between the non-PPD and PPD groups. (3) A characteristic subnetwork for the maternal group was successfully constructed based on the nine tracts, which exhibited typical small-world properties (σ>1). Compared to the non-PPD maternal group, the characteristic path length in the PPD group was increased [(3.904±0.328) vs. (4.130±0.433), t=－2.58], and global efficiency was decreased [(0.361±0.036) vs. (0.331±0.053), t=2.91] (both P<0.05). Local property comparisons showed that the node efficiency values for the left dorsolateral superior frontal gyrus, left insula, left anterior cingulate and paracingulate gyrus, left hippocampus, right hippocampus, right amygdala, left precuneus and left putamen in the PPD group were significantly reduced [(0.273±0.023) vs. (0.267±0.030), t=0.98; (0.299±0.035) vs. (0.276±0.041), t=2.64; (0.265±0.019) vs. (0.258±0.025), t=1.38; (0.318±0.028) vs. (0.305±0.031), t=1.92; (0.312±0.027) vs. (0.302±0.031), t=1.50; (0.322±0.030) vs. (0.298±0.026), t=3.71; (0.356±0.040) vs. (0.338±0.056), t=1.62; (0.346±0.028) vs. (0.331±0.036), t=1.74; all P<0.05]. However, only the differences in node efficiency values for the left insula and right amygdala remained significant after FDR correction (corrected P=0.041 and 0.003). (4) Global efficiency, as well as node efficiency for the left insula and right amygdala, demonstrated good value for identifying PPD [areas under the curve (AUC) and their 95% CI were 0.827 (0.732-0.922), 0.741 (0.628-0.854), and 0.761 (0.653-0.867), respectively], with even better performance when combined [0.897 (0.828-0.969)]. (5) In the PPD group, global efficiency ( r=－0.43, P=0.008), node efficiency for the left insula ( r=－0.39, P=0.019), and node efficiency for the right amygdala ( r=－0.42, P=0.011) were all negatively correlated with EPDS scores. Conclusion:Aberrations in global efficiency, node efficiency for the left insula, and node efficiency for the right amygdala may serve as characteristic neuroimaging biomarkers for PPD.