Objective: To understand the microclimate in primary and secondary school classrooms for the study period during the winter heating season, so as to provide a reference for the revision and improvement of relevant health standards. Methods: In December 2024, stratified random sampling was used to select 30 primary and secondary schools and 180 classrooms from the northern regions with centralized heating (Liaoning Province, Tianjin City) and the southern regions without centralized heating (Shanghai City, Anhui Province, and Jiangxi Province). Indoor temperature, relative humidity, wind speed, CO 2 and other indicators were measured on site. Variance analysis, t-test, Mann-Whitney U test and Kruskal-Wallis H test were used to analyze the differences in the microclimate of classrooms among regions and urban and rural differences. Results: The average temperature in the middle of the classrooms tested on site was (16.47±4.72)℃, and the variance analysis showed that the difference between the regions was statistically significant ( F=27.80, P <0.01). Among them, Tianjin had the highest average temperature of (20.43± 2.12 )℃, followed by Liaoning (19.03±2.23)℃, Shanghai (15.33±5.32)℃, Anhui (12.79±1.74)℃, and Jiangxi (11.69± 1.68 )℃. Horizontal temperature difference was 0.90 (0.50, 1.60)℃, the vertical temperature difference was 0.20 (0.10,0.60)℃, the average relative humidity was (44.39±16.16)%, the wind speed was 0.03(0.01,0.11)m/s, and the differences among different provinces and cities were statistically significant ( H/F =40.62, 82.69, 95.06, 55.28, all P <0.01). The average CO 2 volume concentration in urban areas of Tianjin, Liaoning, and Shanghai was 0.21(0.16,0.30)%, and there was no statistically significant difference ( H=4.65, P =0.10). There were grade differences in relative humidity ( F =3.71, 6.21) and CO 2 ( H =14.72, 12.92) in the north and the south (all P <0.05). In addition, the temperature, relative humidity, wind speed and CO 2 in the middle of the classroom were 42.8%, 67.8%, 100.0% and 22.2% respectively. Conclusions The temperature in the middle of the classroom in the non centralized heating area is lower than the standard, the relative humidity of classroom in the centralized heating area is lower than the standard，and the CO 2 in the classroom in winter is lower than the standard. It is recommended to install heating facilities in schools with low temperatures to increase the temperature and increase the frequency of ventilation in classrooms or adopt mechanical ventilation strategies to reduce CO 2 volume concentration.

Objective To explore the relationship between uric acid, visceral fat thickness and insulin resistance in elderly patients with hypertriglyceridemia (HTG). Methods A total of 347 elderly patients with HTG admitted to the hospital from January 2021 to January 2025 were retrospectively selected, and the related factors of insulin resistance in elderly HTG were analyzed. Results Among the 347 elderly patients with HTG, 218 cases had insulin resistance and 129 cases did not develop insulin resistance, and were included in the insulin resistance group (n=218) and the non-insulin resistance group (n=129) respectively. Compared with the non-insulin resistance group, patients in the insulin resistance group had higher proportions of severe HTG and concurrent fatty liver, higher levels of IL-6, TNF- α, FFA and uric acid, and thicker visceral fat thickness (P<0.05). After logistic regression analysis, it was found that the related factors for insulin resistance in elderly patients with HTG included the severity of HTG, IL-6, FFA, uric acid, and visceral fat thickness (P<0.05). Conclusion The severity of HTG, IL-6, FFA, uric acid, and visceral fat thickness are related to insulin resistance in elderly HTG patients. Clinically, it is necessary to pay attention to targeted interventions for uric acid control and visceral fat reduction in elderly patients with HTG so as to improve the insulin resistance status.

Background: Malignant pleural effusion (MPE), a common complication of advanced cancers, is associated with poor prognosis and reduced quality of life. Although host–tumor interactions are known to drive MPE development, the associated immune dynamics during disease progression remain unclear. Using a Lewis lung carcinoma-induced MPE model in C57BL/6JNidfc mice, we systematically evaluated general parameters and immune cell changes at two-day intervals throughout disease progression. Results: The day of Lewis lung carcinoma cell injection into the pleural space was designated as day 0. By day 10 post-injection (p.i.), MPE-bearing mice exhibited ~ 10% body weight loss, marking the experimental endpoint. Pleural tumor mass and pleural effusion volume were minimal up to day 4 p.i. but increased sharply from day 6 onward.CD45⁺ immune cell counts rose over time, and days 6, 8, and 10 p.i. marked key stages of MPE progression. On day 6, B cells, T cells, and natural killer cells, but not macrophages and neutrophils, increased significantly compared to earlier timepoints. By day 8, all immune cell subsets except T cells exceeded day 6 levels, and at day 10, natural killer cell numbers declined while others continued to increase. Besides, the numbers of CD8⁺ T cells, Th1 cells, regulatory T cells, and M2 macrophages progressively increased from day 6 to 10. Based on these data, days 6 and 10 were defined as early and advanced MPE stages, respectively, with distinct immune phenotypes. In advanced MPE, CD8⁺ T cells displayed reduced IFN-γ, TNF-α, Granzyme B, Perforin, FasL, and Ki-67, but upregulated PD-1 and CTLA-4 relative to early stage. Similarly, Th1 cells showed decreased IFN-γ, TNF-α, and IL-2 production along with reduced Ki-67 expression. Advanced-stage M2 macrophages exhibited lower MHC-II levels and impaired phagocytosis, but higher PD-L1 and IL-10 production, while neutrophils showed reduced TNF-α release and phagocytic activity. Conclusions Our findings characterize the temporal immune dynamics associated with MPE progression in a mouse model, revealing a transition from an early immunostimulatory state to a late immunosuppressive state. This study enhances our understanding of MPE immunopathogenesis and provides a foundation for developing precise, stagespecific therapeutic strategies.

Background: and Purpose Vertebrobasilar fusiform aneurysms (VBFAs) carry substantial morbidity and mortality, but optimal management for unruptured VBFAs remains unclear. We compared the safety and efficacy of conservative management (CM), stent-assisted coiling (SAC), and flow diverters (FDs) in patients with unruptured VBFAs, focusing on long-term prognosis. Methods: This study included data from a nationwide Chinese cohort of patients with vertebrobasilar dissecting aneurysms. Inverse probability of treatment weighting (IPTW) balanced confounders across groups. The primary outcome was poor prognosis (modified Rankin Scale score >2). Secondary outcomes included aneurysm rupture, ischemic stroke, compression symptoms, and VBFA-related deaths. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Among 1,115 patients with unruptured VBFAs, 838 (median age, 54 years; 655 men) were included. After IPTW, baseline characteristics were balanced. Median follow-up was 54 months. FD was associated with a lower risk of poor prognosis than CM (OR, 0.48 [95% CI, 0.30 to 0.77]; p=0.002), with no difference between CM and SAC. FD also reduced aneurysm rupture (OR, 0.20 [95% CI, 0.07 to 0.60]; p=0.004) and compression symptoms (OR, 0.30 [95% CI, 0.13 to 0.68]; p=0.004) versus CM. Time-to-event analyses further revealed significant differences in vertebral artery lesions and Type I–II VBFAs, whereas no significant differences were observed in basilar or vertebrobasilar junction lesions or in Type III–IV VBFAs. Conclusions Compared with CM, FD was associated with improved long-term outcomes in unruptured VBFAs, particularly in vertebral artery lesions and Type I–II VBFAs, although residual confounding cannot be excluded.

Post-stroke depression(PSD),a common stroke complication characterized by depressed mood and diminished interest,severely affects patients'recovery and quality of life.Microglial abnormal activation and polarization play key roles in PSD pathogenesis,closely associated with neuroinflammation and imbalance in neu-rotransmitter metabolism.In contrast,traditional Chinese medicine(TCM)demonstrates unique multi-target and multi-level mechanisms:regulating microglial function,ameliorating post-stroke neuroinflammatory environments,and promoting neuroplasticity,thereby potentially alleviating PSD symptoms.This review summarizes TCM's effects on microglial activation/polarization states and its therapeutic advances in PSD,providing novel perspectives and strategies for clinical management.

Cannabidiol(CBD),a natural,non-toxic,non-psy-choactive cannabinoid extracted from Cannabis sativa L,has a wide range of pharmacological activities,including anti-inflam-matory,antioxidant,immunomodulatory,analgesic,anti-tumor,anti-convulsant,anxiolytic effects.Recent studies have indica-ted that CBD may have potential neuroprotective effects in vari-ous models of central nervous system diseases.This paper re-views the experimental research progress of CBD in central nerv-ous system diseases and its possible neuroprotective mecha-nisms,aiming to provide references for its clinical application and new drug development.

Methodological quality assessment is a pivotal link between primary studies and reliable evidence-based practice,and an essential pathway for operationalizing the core principles of the Guide on Methodological Standards in Pharmacoepidemiology(2nd edition).A prevalent challenge in practice,however,is the conflation of appraising methodological robustness(risk of bias assessment)with verifying reporting transparency(adherence to reporting guidelines).This paper systematically addresses this fundamental challenge,beginning with a clear distinction between the essence and boundaries of these two concepts.On this basis,the article provides a comprehensive review of mainstream quality assessment tools,covering the methodological features and evolutionary trajectory of numerous instruments for interventional(e.g.,RoB 2,ROBINS-I),observational(e.g.,NOS,the JBI/SIGN/NIH series),secondary(e.g.,AMSTAR 2),and other specific types of studies such as health economic evaluations.Furthermore,a complete case study is used to illustrate the practical application of the ROBINS-I tool.The paper's central thesis advocates for an"appraisal-informed design"philosophy,urging a conceptual shift from the retrospective critique of existing literature to the prospective quality control of new research by internalizing appraisal standards as design principles,while also exploring the emerging paradigm of artificial intelligence in assisting assessment.This paper provides a comprehensive methodological reference for researchers and practitioners to prudently select appropriate assessment tools and to conduct rigorous critical appraisals of pharmacoepidemiological evidence.

Background and Aims:Acute pancreatitis(AP)accompanied by intestinal injury and intestinal barrier dysfunction can significantly worsen AP prognosis.Currently,there is no effective clinical treatment for AP-related intestinal dysfunction.Ulinastatin(UTI)is a conventional drug used for AP treatment due to its ability to inhibit trypsin activity and exert anti-inflammatory effects.However,whether UTI directly improves AP-related intestinal injury remains unclear.Therefore,this study was conducted to investigate the therapeutic effects and potential mechanisms of UTI in AP-related intestinal dysfunction.Methods:Thirty rats were equally randomized into three groups and received intraperitoneal injections of PBS(control group),20%L-arginine(AP group),or 20%L-arginine+UTI(UTI group).Tail vein blood samples were collected at 0,24,and 48 h after the initial injection of L-arginine(or PBS),and the rats were euthanized after the final blood collection to obtain pancreatic and terminal ileum tissues.Serum levels of amylase,lipase,intestinal fatty acid-binding protein(I-FABP),and diamine oxidase(DAO)were measured using ELISA.Histopathological examinations of the pancreas and terminal ileum were conducted.Western blot was used to detect the protein expression levels of tumor necrosis factor α(TNF-α),interleukin 6(IL-6),interleukin 1β(IL-1β),and interleukin 10(IL-10)in terminal ileum tissue.Western blot and qRT-PCR were used to assess the protein and mRNA expression levels of Toll-like receptor 4(TLR4)and nuclear factor κB(NF-κB)p-p65 in the terminal ileum.Results:Compared with the control group,both the AP and UTI groups exhibited significant AP changes(elevated serum amylase and lipase levels,pancreatic histopathological damage)and AP-related intestinal injury(decreased I-FABP and DAO levels,ileal histopathological damage).However,these alterations were significantly less severe in the UTI group compared to the AP group(all P<0.01).Compared with the control group,both the AP and UTI groups showed significantly increased protein expression of pro-inflammatory factors(TNF-α,IL-1β,IL-6)and the anti-inflammatory factor IL-10 in the ileal tissue;however,the UTI group exhibited significantly lower levels of pro-inflammatory factors and higher levels of IL-10 compared to the AP group(all P<0.01).Additionally,compared with the control group,both the AP and UTI groups displayed significant upregulation of TLR4 and NF-κB p-p65 protein and mRNA expressions in ileal tissue,but the upregulations were significantly lower in the UTI group compared to the AP group(all P<0.01).Conclusion:UTI can inhibit the activation of the TLR4/NF-κB signaling pathway in the ileal tissue of AP rats,thereby reducing pro-inflammatory cytokine levels and increasing anti-inflammatory cytokine levels.Therefore,in addition to its anti-pancreatitis effects,UTI may have a direct therapeutic effect on AP-related intestinal dysfunction.

Background and Aims:Acute pancreatitis(AP)accompanied by intestinal injury and intestinal barrier dysfunction can significantly worsen AP prognosis.Currently,there is no effective clinical treatment for AP-related intestinal dysfunction.Ulinastatin(UTI)is a conventional drug used for AP treatment due to its ability to inhibit trypsin activity and exert anti-inflammatory effects.However,whether UTI directly improves AP-related intestinal injury remains unclear.Therefore,this study was conducted to investigate the therapeutic effects and potential mechanisms of UTI in AP-related intestinal dysfunction.Methods:Thirty rats were equally randomized into three groups and received intraperitoneal injections of PBS(control group),20%L-arginine(AP group),or 20%L-arginine+UTI(UTI group).Tail vein blood samples were collected at 0,24,and 48 h after the initial injection of L-arginine(or PBS),and the rats were euthanized after the final blood collection to obtain pancreatic and terminal ileum tissues.Serum levels of amylase,lipase,intestinal fatty acid-binding protein(I-FABP),and diamine oxidase(DAO)were measured using ELISA.Histopathological examinations of the pancreas and terminal ileum were conducted.Western blot was used to detect the protein expression levels of tumor necrosis factor α(TNF-α),interleukin 6(IL-6),interleukin 1β(IL-1β),and interleukin 10(IL-10)in terminal ileum tissue.Western blot and qRT-PCR were used to assess the protein and mRNA expression levels of Toll-like receptor 4(TLR4)and nuclear factor κB(NF-κB)p-p65 in the terminal ileum.Results:Compared with the control group,both the AP and UTI groups exhibited significant AP changes(elevated serum amylase and lipase levels,pancreatic histopathological damage)and AP-related intestinal injury(decreased I-FABP and DAO levels,ileal histopathological damage).However,these alterations were significantly less severe in the UTI group compared to the AP group(all P<0.01).Compared with the control group,both the AP and UTI groups showed significantly increased protein expression of pro-inflammatory factors(TNF-α,IL-1β,IL-6)and the anti-inflammatory factor IL-10 in the ileal tissue;however,the UTI group exhibited significantly lower levels of pro-inflammatory factors and higher levels of IL-10 compared to the AP group(all P<0.01).Additionally,compared with the control group,both the AP and UTI groups displayed significant upregulation of TLR4 and NF-κB p-p65 protein and mRNA expressions in ileal tissue,but the upregulations were significantly lower in the UTI group compared to the AP group(all P<0.01).Conclusion:UTI can inhibit the activation of the TLR4/NF-κB signaling pathway in the ileal tissue of AP rats,thereby reducing pro-inflammatory cytokine levels and increasing anti-inflammatory cytokine levels.Therefore,in addition to its anti-pancreatitis effects,UTI may have a direct therapeutic effect on AP-related intestinal dysfunction.