BACKGROUND: Previous evidence showed that ambient air pollution and cardiovascular mortality are related. However, there is a lack of evidence towards the modification effect of long-term lifestyle on the association between short-term ambient air pollution and death from cardiovascular events. METHOD: A total of 14,609 death from major adverse cardiovascular events (MACE) were identified among the China Kadoorie Biobank participants from 2013 to 2018. Ambient air pollution exposure including particulate matter 2.5 (PM_2.5), SO₂, NO₂, CO, and O₃ from the same period were obtained from space-time model reconstructions based on remote sensing data. Case-crossover design and conditional logistic regression was applied to estimate the effect of short-term exposure to air pollutants on MACE mortality. RESULTS: We found MACE mortality was significantly associated with PM_2.5 (relative percent increase 2.91% per 10 µg/m³ increase, 95% CI 1.32-4.53), NO₂ (5.37% per 10 µg/m³ increase, 95% CI 1.56-9.33), SO₂ (6.82% per 10 µg/m³ increase, 95% CI 2.99-10.80), and CO (2.24% per 0.1 mg/m³ increase, 95% CI 1.02-3.48). Stratified analyses indicated that drinking was associated with elevated risk of MACE mortality with NO₂ and SO₂ exposure; physical inactivity was associated with higher risk of death from MACE when exposed to PM_2.5; and people who had balanced diet had lower risk of MACE mortality when exposed to CO and NO₂. CONCLUSIONS The study results showed that short-term exposure to ambient PM_2.5, NO₂, SO₂, and CO would aggravate the risk of cardiovascular mortality, yet healthy lifestyle conduct might mitigate such negative impact to some extent.
Humans ; Cardiovascular Diseases/epidemiology* ; China/epidemiology* ; Male ; Female ; Air Pollution/adverse effects* ; Middle Aged ; Air Pollutants/analysis* ; Particulate Matter/analysis* ; Environmental Exposure/adverse effects* ; Life Style ; Aged ; Adult ; Risk Factors ; Cross-Over Studies ; East Asian People

Standardised emergency management protocols for hand injury in microsurgery is critical, as it directly determines ultimate clinical outcomes. This consensus consolidates expert insights regarding diagnostic and treatment procedure for hand injury in microsurgery, emergency support protocols and key points of emergency workflow optimisation. It summarises the opinions of experts and puts forward standardised recommendations to guide clinical practice in microsurgical treatment process, so as to further improve the quality of treatment for hand injury in microsurgery and maximise the protection of limb function and quality of life of patients.

Objective:To observe the effects of acupuncture on intestinal flora and inflammatory factor interleukin(IL)-6 in ulcerative colitis(UC)model rats and to explore the related mechanism of acupuncture in treating UC.Methods:Thirty-two Sprague-Dawley rats were randomly divided into a normal control(NC)group,a model(MO)group,a mesalazine(ME)group,and an acupuncture(AC)group,with 8 rats in each group.Rats,except those in the NC group,were given a 2.5%sodium dextran sulfate solution to establish UC models.After successful modeling,rats in the ME group were treated with mesalazine by gavage twice a day for 7 continuous days;rats in the AC group received acupuncture at bilateral Tianshu(ST25)and Zusanli(ST36)with needles retained for 20 min each time,once a day for 7 consecutive days.After intervention,changes in the intestinal flora diversity,colon tissue damage degree,and inflammatory factor expression in each group of rats were evaluated.Results:The body mass increased slowly in the MO group compared to the NC group.After intervention,the body mass increased more significantly,colon injuries recovered,and intestinal flora diversity improved in the ME and AC groups compared to the MO group(P<0.05).The IL-6 expression level was higher in the MO group compared to the NC group(P<0.05).The IL-6 expression level decreased in the AC group compared to the MO group(P<0.05).Conclusion:Acupuncture at Tianshu(ST25)and Zusanli(ST36)improves body mass loss and colon injuries,regulates intestinal flora diversity,and reduces the expression of inflammatory factor IL-6 in the colon tissue of UC rats,therefore alleviating the disease severity of UC.

Objective:To observe the effects of acupuncture on intestinal flora and inflammatory factor interleukin(IL)-6 in ulcerative colitis(UC)model rats and to explore the related mechanism of acupuncture in treating UC.Methods:Thirty-two Sprague-Dawley rats were randomly divided into a normal control(NC)group,a model(MO)group,a mesalazine(ME)group,and an acupuncture(AC)group,with 8 rats in each group.Rats,except those in the NC group,were given a 2.5%sodium dextran sulfate solution to establish UC models.After successful modeling,rats in the ME group were treated with mesalazine by gavage twice a day for 7 continuous days;rats in the AC group received acupuncture at bilateral Tianshu(ST25)and Zusanli(ST36)with needles retained for 20 min each time,once a day for 7 consecutive days.After intervention,changes in the intestinal flora diversity,colon tissue damage degree,and inflammatory factor expression in each group of rats were evaluated.Results:The body mass increased slowly in the MO group compared to the NC group.After intervention,the body mass increased more significantly,colon injuries recovered,and intestinal flora diversity improved in the ME and AC groups compared to the MO group(P<0.05).The IL-6 expression level was higher in the MO group compared to the NC group(P<0.05).The IL-6 expression level decreased in the AC group compared to the MO group(P<0.05).Conclusion:Acupuncture at Tianshu(ST25)and Zusanli(ST36)improves body mass loss and colon injuries,regulates intestinal flora diversity,and reduces the expression of inflammatory factor IL-6 in the colon tissue of UC rats,therefore alleviating the disease severity of UC.

Standardised emergency management protocols for hand injury in microsurgery is critical, as it directly determines ultimate clinical outcomes. This consensus consolidates expert insights regarding diagnostic and treatment procedure for hand injury in microsurgery, emergency support protocols and key points of emergency workflow optimisation. It summarises the opinions of experts and puts forward standardised recommendations to guide clinical practice in microsurgical treatment process, so as to further improve the quality of treatment for hand injury in microsurgery and maximise the protection of limb function and quality of life of patients.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To analyze and compare the clinical effects of upper brachial plexus repair with nerve root stumps and each type of power source nerves,determine the availability of nerve root stumps and the effectiveness and rationality of clinical use.Methods Retrospective analysis was performed for the patients admit-ted to our department from January 2007 to December 2015.The patients were diagnosed with partial or total bra-chial plexus injury.Case data were collected including gender,age,diagnosis,cause of injury,interval between injury and operation,follow-up time,injury type,operation method,gap length between donor and recipient nerve,graft type and length,and complications.In addition,we also examine the adverse events in the donor site.The British Medical Research Council(BMRC)muscle strength evaluation criteria were used to evaluate the patients'deltoid muscle and biceps muscle strength and we also performed disabilities of arm,shoulder and hand(DASH)score.Results A total of 136 patients received brachial plexus repair,112 cases included in the study after 24 cases were excluded.The patients were divided into four groups:22 cases in modified Oberlin surgery group,45 cases in CC7 transfer comebined with huamn acellular nerve allograft group,27 cases in CC7 transfer and direct suture group.There were 14 cases of nerve root stumps repair upper trunk directly or combined with huamn acellular nerve allografting,which including 10 cases of BPAI and 4 cases of stab wound.The effective rate of deltoid muscle strength was 68.2%,71.2%,88.9%and 78.6%,respectively.The muscle strength and effective rate of biceps were 81.8%,60.0%,85.2%and 64.3%,respectively.Subgroup analysis:(1)operative methods for upper brachial plexus injuries:4 cases with stab wounds in the nerve root stump repair group;in the modified Oberlin surgery group,22 cases were avulsion injury.The results showed that there were no statistically significant differences between the two groups in the ROM,deltoid muscle strength,biceps muscle strength and DASH score.For the comparison of C5-C8 or TBAI:there is no statistical difference in ROM of shoulder abduction between the nerve root stump repair group and CC7 transfer and direct suture group;the evaluation indexes include angle of elbow flexion,biceps muscle strength and DASH score in CC7 transfer and direct suture group were better than the other two groups,followed by CC7 transfer combined with shenqiao group and nerve root stump repair group.Conclusions This part evaluated and analyzed the clinical effects of various kinds of power sources nerve on the recovery of elbow flexion and shoulder abduction after upper brachial plexus repairing,and determined the avail-ability of nerve root stump and the validity and rationality of its clinical use.Protecting the nerve stump roots may improve the clinical effect of nerve stump utilization and increase the power source nerve in the future.

Objective To analyze and compare the clinical effects of upper brachial plexus repair with nerve root stumps and each type of power source nerves,determine the availability of nerve root stumps and the effectiveness and rationality of clinical use.Methods Retrospective analysis was performed for the patients admit-ted to our department from January 2007 to December 2015.The patients were diagnosed with partial or total bra-chial plexus injury.Case data were collected including gender,age,diagnosis,cause of injury,interval between injury and operation,follow-up time,injury type,operation method,gap length between donor and recipient nerve,graft type and length,and complications.In addition,we also examine the adverse events in the donor site.The British Medical Research Council(BMRC)muscle strength evaluation criteria were used to evaluate the patients'deltoid muscle and biceps muscle strength and we also performed disabilities of arm,shoulder and hand(DASH)score.Results A total of 136 patients received brachial plexus repair,112 cases included in the study after 24 cases were excluded.The patients were divided into four groups:22 cases in modified Oberlin surgery group,45 cases in CC7 transfer comebined with huamn acellular nerve allograft group,27 cases in CC7 transfer and direct suture group.There were 14 cases of nerve root stumps repair upper trunk directly or combined with huamn acellular nerve allografting,which including 10 cases of BPAI and 4 cases of stab wound.The effective rate of deltoid muscle strength was 68.2%,71.2%,88.9%and 78.6%,respectively.The muscle strength and effective rate of biceps were 81.8%,60.0%,85.2%and 64.3%,respectively.Subgroup analysis:(1)operative methods for upper brachial plexus injuries:4 cases with stab wounds in the nerve root stump repair group;in the modified Oberlin surgery group,22 cases were avulsion injury.The results showed that there were no statistically significant differences between the two groups in the ROM,deltoid muscle strength,biceps muscle strength and DASH score.For the comparison of C5-C8 or TBAI:there is no statistical difference in ROM of shoulder abduction between the nerve root stump repair group and CC7 transfer and direct suture group;the evaluation indexes include angle of elbow flexion,biceps muscle strength and DASH score in CC7 transfer and direct suture group were better than the other two groups,followed by CC7 transfer combined with shenqiao group and nerve root stump repair group.Conclusions This part evaluated and analyzed the clinical effects of various kinds of power sources nerve on the recovery of elbow flexion and shoulder abduction after upper brachial plexus repairing,and determined the avail-ability of nerve root stump and the validity and rationality of its clinical use.Protecting the nerve stump roots may improve the clinical effect of nerve stump utilization and increase the power source nerve in the future.

Objective:To analyze the effects of chronic obstructive pulmonary disease (COPD) combined with obstructive sleep apnea hypopnea syndrome (OSAHS) on hypercapnia and its related factors.Methods:In this cross-sectional study, patients with stable COPD were continuously recruited from July 2016 to December 2018 in the Respiratory Department of Peking University Third Hospital. General clinical data of patients were collected, and lung function test, arterial blood gas analysis and portable sleep monitoring were also conducted. Patients with COPD complicated with apnea hypopnea index (AHI)≥10 times/h and apnea events being mainly blockage-type events, accompanied by snoring, sleep apnea, daytime sleepiness and other symptoms were defined as overlapping group, patients with COPD complicated with AHI<10 times/h were defined as simple COPD group. Correlation analysis and logistic regression model were used to explore the determinants of daytime hypercapnia in patients with COPD.Results:Compared with simple COPD group, the median arterial partial pressure of carbon dioxide (PaCO 2) was significantly higher in the overlapping group (42.00 vs 38.95 mmHg (1 mmHg=0.133 kPa), P<0.001), and the rate of daytime hypercapnia was significantly higher (23.3% vs 3.3%, P=0.002). PaCO 2 was correlated with forced vital capacity (FVC), percent predicted forced expiratory volume in one second (FEV 1%pred), the ratio of residual volume (RV) to total lung capacity (TLC), AHI, nocturnal average transcutaneous oxygen saturation (SpO 2), nocturnal minimum SpO 2 and the total sleep time spent with SpO 2≤90% (T90) (all P<0.05). In logistic regression analysis, after adjusting for age, sex, and body mass index (BMI), only severe OSAHS, GOLD Ⅲ-Ⅳ grade (FEV 1%pred<50%), and T90>1% were independent risk factors for hypercapnia. Conclusions:OSAHS can increase the risk of hypercapnia in patients with COPD. AHI, lung function injury and T90 are closely related to hypercapnia.

Objective: Based on physical activity (PA) and sedentary behavior (SB) variables on weekdays and weekends, the study aims to cluster the physical activities inside and outside kindergartens and to explore the cluster characteristics of different children using physical fitness indicators, so as to provide new strategies and methods for early childhood education and health. Methods: From March to June 2019, 291 children aged 3-6 years from 6 kindergartens in Nanchang were recruited by a stratified cluster random sampling method. The ActiGraph GT3X-BT triaxial accelerometer was used to measure and analyze the PA and SB levels inside and outside the kindergarten. A twostep clustering algorithm model was employed for cluster analysis. Physical fitness were measured and evaluated according to the "National Physical Fitness Measurement Standard Manual (Preschool Section)". Differences in physical fitness among different clusters of children were compared, and the cluster characteristics of different children were analyzed. Results: The clustering algorithm model indicated that based on six indicators, including PA and SB inside the kindergarten on weekdays, and PA and SB outside the kindergarten on both weekdays and weekends, children could be divided into three categories:active inside (high PA, low SB inside), active outside (high PA outside), and inactive (low PA, high SB both inside and outside). The average silhouette coefficient of the model was 0.3, indicating good clustering results. Both the active inside and active outside children showed significantly higher PA inside on weekdays, PA outside on weekdays and weekends, daily low intensity physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) than the inactive children ( F=157.91, 80.79 , 95.86, 95.52, 124.74, P <0.05). After adjusting for gender and age, the physical fitness scores of both active outside ( 19.03 ±0.47) and active inside (19.11±0.40) were significantly higher than those of the inactive children (17.94±0.31). Additionally, active inside children (3.91±0.14) also showed significantly better performance in continuous double-leg jumps, compared to inactive children (3.45±0.11) ( P <0.05). Conclusion Children active inside and those active outside perform well in PA. Future research should focus on the proportion of structured and unstructured PA time to enhance the overall physical fitness of children.