Background The global number of type 2 diabetes (T2D) cases has been steadily increasing over the past few decades, becoming a major public health issue. Available toxicological research has indicated that ozone (O₃) can lead to oxidative stress and inflammatory responses, thereby causing metabolic changes and the development of T2D. Existing cohort studies on the impact of long-term O₃ exposure on the risk of developing T2D have reached contradictory conclusions, and the results have shown significant heterogeneity. Objective To summarize cohort studies on long-term O₃ exposure and T2D risk, and investigate heterogeneity sources in the association between O₃ and T2D. Methods Cohort studies on O₃ and T2D were searched through PubMed, Embase, and the Web of Science, with the search deadline set for 25 April, 2025. After two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies, meta-analysis was conducted using Stata 18.0 software. We used a random effects model to calculate the overall relative risk (RR) of the standardized risk estimates and its 95% confidence interval (CI). Additionally, sensitivity analysis, subgroup analysis, meta-regression, and publication bias testing were performed to explore the sources of heterogeneity in the association between O₃ and T2D. Results In the 8 articles meeting predetermined inclusion criteria, a total of 11 cohort studies involving 54887070 participants were finally included. The results of the meta-analysis indicated that long-term exposure to O₃ was associated with a higher incidence of type 2 diabetes [standardized RR=1.04 (95%CI: 1.01, 1.07), P<0.001, I²=97.3%], and significant heterogeneity existed. The subgroup analysis showed that females (standardized RR=1.08, 95%CI: 1.03, 1.13) and the Asian population (standardized RR=1.09, 95%CI: 1.06, 1.11) were are more susceptible to O₃. The meta-regression model that included study region and average O₃ concentration variables explained 60.33% of the heterogeneity between studies. No significant evidence of publication bias was observed after the funnel plot test, Egger's test (P=0.437), Begg's test (P=0.640), and the trim-and-fill method. Conclusion Long-term exposure to O₃ could increase the risk of developing T2D, with females and Asian populations being particularly sensitive. The heterogeneity in the association between O₃ and T2D can be partly explained by factors such as average O₃ concentration and geographic location.

Objective To analyze the innovative model and effectiveness of the four-level prevention of stroke in Nantong Medical and Prevention Collaborative Center for Cardiovascular and Cerebrovascular Disease,so as to provide new practical experience for the prevention and treatment of cerebrovascular disease.Methods In practice,Nantong city has explored the"53343"mode of collaborative treatment and prevention of cardiovascular and cerebrovascular diseases,and innovatively integrated this mode into four-level prevention to form a practice mode of zero-level guidance,first-level monitoring,second-level coordination and three-level leading.Data from the China Health Statistics Yearbook from 2011 to 2022 and the monitoring data of cardiovascular and cerebrovascular events in Nantong City on the Jiangsu Provincial Chronic Disease Management Information Platform from 2017 to 2023 were collected and processed by using Excel and SPSS 24.0,to analyze the changes of stroke surveillance data and effectiveness in Nantong City after applying the model.Results According to the monitoring data of cardiovascular and cerebrovascular events in Nantong City from the Jiangsu Provincial Chronic Disease Management Information Platform,despite the continuous increase in the number of monitored individuals over five years,the monitoring data for stroke from the Nantong Medical and Prevention Collaborative Center for Cardiovascular and Cerebrovascular Disease witnessed a decline in the number of monitored individuals for the first time in 2022.The stroke monitoring data from the same monitoring agency showed a more stable fluctuation trend compared to the number of national stroke patients discharged from 2017 to 2021.We established a coherent health service operation mechanism,cultivated 14 interdisciplinary talents,held a special continuing education class on stroke,strengthened the in-depth collaboration between clinical and public health,and provided a practical and innovative model for effective prevention and treatment of stroke.Conclusions The four-level prevention based on the medical and preventive collaboration center for cardiovascular and cerebrovascular diseases can achieve process and cycle health management,effectively slow down the upward trend of stroke,and improve the ability and level of scientific research and teaching.

Objective:To assess performance advantages of voxel-less optimization(VoLO)algorithm of CyberKnife-based S7 treatment plan system for the optimization of stereotactic body radiation therapy(SBRT)for liver cancer.Methods:The case data of 20 patients with hepatocellular carcinoma from Chinese PLA General Hospital during June 2022 and April 2023 were retrospectively selected,which included 10 patients with large hepatocellular carcinoma and 10 patients with small hepatocellular carcinoma.All patients adopted respectively sequential optimization(SO)and VoLO to conduct optimization for plan.The optimized quality of plan and execution efficiency of two kinds of algorithms were assessed,and the influences of different tumor volumes also were considered.The planed quality assessment included dosimetric parameters of the target region and organ at risk(OAR).The assessment parameters of execution efficiency included the numbers of monitor units(MUs),nodes and beams,and estimated treatment time.Paired t-test method was adopted to analyze quality of plan and treatment efficiency.Results:On the aspect of the dose of target region,for small hepatocellular carcinoma,the conformity index(CI)value(1.08±0.05)of target region of VoLO algorithm was significantly better than(1.17±0.06)of SO algorithm(t=4.631,P<0.05).The gradient index(GI),coverage rate and dose by 95%(D95%)of VoLO algorithm were better than those of SO algorithm,while the differences were not significant(P>0.05).According to the defined standards of liver surgery,for large hepatocellular carcinoma,the differences in CI,GI,coverage rate and D95%of target region between two kinds of algorithms were significant(t=3.337,4.238,-3.359,-3.311,P<0.05),respectively.On the aspect of dosimetry for OAR,for the target region of large hepatocellular carcinoma,the differences of liver Dmean and D700 cm3 between two kinds of algorithms were significant(t=4.114,3.415,P<0.05).However,for small hepatocellular carcinoma,there was no significant statistical difference in dosimetry parameters of OAR between two kinds of algorithms(P>0.05).The execution efficiency of the plan of VoLO group was obviously higher than that of SO group,and the differences of MU number,node number,beam number and estimated treatment time between two groups were significant(t=12.661,4.423,5.024,9.487,P<0.05).Conclusion:The quality of VoLO plan is significantly better than that of SO,which has a significant improvement in execution efficiency of treatment.For the cases of large hepatocellular carcinoma with more complexity,the VoLO optimization shows better advantages on the aspect of dose on target region,and protection for normal liver.

Objective:To assess performance advantages of voxel-less optimization(VoLO)algorithm of CyberKnife-based S7 treatment plan system for the optimization of stereotactic body radiation therapy(SBRT)for liver cancer.Methods:The case data of 20 patients with hepatocellular carcinoma from Chinese PLA General Hospital during June 2022 and April 2023 were retrospectively selected,which included 10 patients with large hepatocellular carcinoma and 10 patients with small hepatocellular carcinoma.All patients adopted respectively sequential optimization(SO)and VoLO to conduct optimization for plan.The optimized quality of plan and execution efficiency of two kinds of algorithms were assessed,and the influences of different tumor volumes also were considered.The planed quality assessment included dosimetric parameters of the target region and organ at risk(OAR).The assessment parameters of execution efficiency included the numbers of monitor units(MUs),nodes and beams,and estimated treatment time.Paired t-test method was adopted to analyze quality of plan and treatment efficiency.Results:On the aspect of the dose of target region,for small hepatocellular carcinoma,the conformity index(CI)value(1.08±0.05)of target region of VoLO algorithm was significantly better than(1.17±0.06)of SO algorithm(t=4.631,P<0.05).The gradient index(GI),coverage rate and dose by 95%(D95%)of VoLO algorithm were better than those of SO algorithm,while the differences were not significant(P>0.05).According to the defined standards of liver surgery,for large hepatocellular carcinoma,the differences in CI,GI,coverage rate and D95%of target region between two kinds of algorithms were significant(t=3.337,4.238,-3.359,-3.311,P<0.05),respectively.On the aspect of dosimetry for OAR,for the target region of large hepatocellular carcinoma,the differences of liver Dmean and D700 cm3 between two kinds of algorithms were significant(t=4.114,3.415,P<0.05).However,for small hepatocellular carcinoma,there was no significant statistical difference in dosimetry parameters of OAR between two kinds of algorithms(P>0.05).The execution efficiency of the plan of VoLO group was obviously higher than that of SO group,and the differences of MU number,node number,beam number and estimated treatment time between two groups were significant(t=12.661,4.423,5.024,9.487,P<0.05).Conclusion:The quality of VoLO plan is significantly better than that of SO,which has a significant improvement in execution efficiency of treatment.For the cases of large hepatocellular carcinoma with more complexity,the VoLO optimization shows better advantages on the aspect of dose on target region,and protection for normal liver.

Objective To analyze the innovative model and effectiveness of the four-level prevention of stroke in Nantong Medical and Prevention Collaborative Center for Cardiovascular and Cerebrovascular Disease,so as to provide new practical experience for the prevention and treatment of cerebrovascular disease.Methods In practice,Nantong city has explored the"53343"mode of collaborative treatment and prevention of cardiovascular and cerebrovascular diseases,and innovatively integrated this mode into four-level prevention to form a practice mode of zero-level guidance,first-level monitoring,second-level coordination and three-level leading.Data from the China Health Statistics Yearbook from 2011 to 2022 and the monitoring data of cardiovascular and cerebrovascular events in Nantong City on the Jiangsu Provincial Chronic Disease Management Information Platform from 2017 to 2023 were collected and processed by using Excel and SPSS 24.0,to analyze the changes of stroke surveillance data and effectiveness in Nantong City after applying the model.Results According to the monitoring data of cardiovascular and cerebrovascular events in Nantong City from the Jiangsu Provincial Chronic Disease Management Information Platform,despite the continuous increase in the number of monitored individuals over five years,the monitoring data for stroke from the Nantong Medical and Prevention Collaborative Center for Cardiovascular and Cerebrovascular Disease witnessed a decline in the number of monitored individuals for the first time in 2022.The stroke monitoring data from the same monitoring agency showed a more stable fluctuation trend compared to the number of national stroke patients discharged from 2017 to 2021.We established a coherent health service operation mechanism,cultivated 14 interdisciplinary talents,held a special continuing education class on stroke,strengthened the in-depth collaboration between clinical and public health,and provided a practical and innovative model for effective prevention and treatment of stroke.Conclusions The four-level prevention based on the medical and preventive collaboration center for cardiovascular and cerebrovascular diseases can achieve process and cycle health management,effectively slow down the upward trend of stroke,and improve the ability and level of scientific research and teaching.

Objective To analyze the quality of 19 batches of Ginseng Formula Granules from 11 different manufacturers by using Ginseng water Extract reference substance(GWERS)as references.Methods Thin layer chromatography(TLC)identification and feature map detection were carried out according to the identification items and characteristic maps of Ginseng Formula Granules standard(YBZ-PFKL-2021186)issued by the National Medical Products Administration.Results The results of TLC analysis showed that the 19 batches of Ginseng Formula Granules-labeled samples could be divided into three categories.The overall pattern of the first type of samples was consistent with that of GWERS,and the similarity was high.Pseudoginsenoside F11,a unique component of American ginseng,was detected in the second type of samples.Four blue fluorescent spots were observed in the third type of samples compared to GWERS.HPLC results indicated that all 19 batches of Ginseng Formula Granules showed eight characteristic peaks at the same retention time as that of GWERS chromatogram.Two more chromatographic peaks were found in the chromatogram of three batches of samples from one manufacturer compared to the chromatogram of other samples,whose similarity to the GWERS chromatogram was less than 0.65.The similarity between the chromatogram of the remaining 16 sample and GWERS chromatogram was higher than 0.94.Conclusion At present,the quality of Ginseng Formula Granules on the market varies greatly.It was suspected that American ginseng might appear among them.The application of GWERS for quality analysis of Ginseng Formula Granules has better applicability to the control medicinal materials.

Objective:A dose verification system of two-dimensional semiconductor matrix(SRS MapCHECK)was used to verify the dose of the clinical treatment plan of patients who underwent CyberKnife(CK),which realized rapid verification for individualization of radiotherapy plans of patients through analyzed the γ-passing rates of them.Methods:A total of 253 patients with tumor who received CK clinical treatment in the First Medical Center of Chinese PLA General Hospital from March 2021 to May 2023 were selected.Among of them,121 cases received CK treatment on head,and 30 cases received that on lung,and 102 cases received CK treatment on abdomen and other metastatic tumor.In the MultiPlan treatment plan system,the plan of patient was mapped to the integrated model composed of StereoPHAN model and SRS MapCHECK matrix dose verification system by the means of the plan image center overlap.The dose verification was conducted on the plan of each patient on the basis of ensuring the consistency of the number of beam,direction of beam and the monitor unit.The different γ analysis standards(1%/1 mm,2%/1 mm,3%/1 mm,1%/2 mm,2%/2 mm,3%/2 mm,1%/3 mm,2%/3 mm and 3%/3 mm)were adopted to conduct global analysis of absolute dose for each verification plan,and the threshold(TH)of low dose was set as 10%.Results:The γ passing rates of phantom verification plans of 253 patients were respectively(88.64±5.91)%,(95.43±3.40)%,(97.90±2.06)%,(96.51±2.35)%,(98.15±1.68)%,(99.06±1.12)%,(98.30±1.39)%,(99.09±0.97)%and(99.52±0.63)%under different analysis standards.The γ passing rates of other standards of patients with tumor on different parts were larger than 95%except the analysis result of 1%1 mm standard.The overall analysis result of the deviation of central point dose was(-1.30±2.17)%,among of which the tumor of head,abdominal tumors and other metastatic tumor were about approximately-2%,while that of lung tumors were approximately-3%.The deviation of abdominal and other metastatic tumor was the minimum.The correlation analysis showed that the target volume and the size of the minimum collimator were respectively correlated to the dose deviation of the center.Conclusion:SRS MapCHECK dose verification system can conveniently and quickly realize the individualized verification for the plan of patients who receive CK treatment.

Objective To explore the grading of acute gastrointestinal injury(AGI)events in patients with different severities of acute ischemic stroke(AIS)and correlation of short-term prognosis.Methods AIS patients admitted from the Advanced Stroke Center of the Eighth Clinical Medical College of Guangzhou University of Chinese Medicine from January 2023 to November 2023 were retrospectively selected,and depending on the degree of nerve function defect(NIHSS)scores.AIS patients were divided into two groups:NIHSS ≤ 14 group and NIHSS＞14 group.The National Institute of Health Stroke Scale(NIHSS)score,general baseline data,clinical test indicators,AGI event classification and short-term prognosis were collected at admission.Results A total of 270 patients were included,with an average age of(64.95±13.65)years,70.0％males and 30.0％females.The proportion of AIS patients with AGI incident accounted for 66.30％.AIS patients after AGI incidents,90 days after the onset of the modified Rankin rating scale(mRS)score＞2 points of 83 people,accounting for 30.7％;The poor clinical outcomes of 270 AIS patients with different AGI event grades were significantly different(P＜0.05),among which AGI grade 0 and AGI grade Ⅰ were significantly different from AGI grade Ⅲ and AGI grade Ⅳ,respectively.The incidence of poor prognosis of AGI grade Ⅲ and AGI grade Ⅳ is significantly higher than that of AGI grade 0 and AGI grade Ⅰ.In AIS patients with NIHSS＞14 group,there were significant differences in the adverse clinical outcomes between AGI grade 0,AGI grade Ⅰ and AGI grade Ⅲ(P＜0.05),and the incidence of poor prognosis of AGI grade Ⅲ was significantly higher than that of AGI grade 0 and AGI grade Ⅰ.Multivariate Logistic regression analysis showed that NIHSS score was an independent risk factor for AGI events in AIS patients(P＜0.05).The higher the NIHSS score,the higher the risk of AGI events in AIS patients.And age,NIHSS score,systolic blood pressure is 90 days after AGI events affect AIS patients independent risk factors of poor prognosis(P＜0.05),the higher the age,the greater the NIHSS score,the higher systolic blood pressure of patients with AIS 90 days after AGI events are at higher risk of poor prognosis.Conclusion AGI event grading in patients with AIS of different severity is associated with short-term prognosis.

Objective To explore the grading of acute gastrointestinal injury(AGI)events in patients with different severities of acute ischemic stroke(AIS)and correlation of short-term prognosis.Methods AIS patients admitted from the Advanced Stroke Center of the Eighth Clinical Medical College of Guangzhou University of Chinese Medicine from January 2023 to November 2023 were retrospectively selected,and depending on the degree of nerve function defect(NIHSS)scores.AIS patients were divided into two groups:NIHSS ≤ 14 group and NIHSS＞14 group.The National Institute of Health Stroke Scale(NIHSS)score,general baseline data,clinical test indicators,AGI event classification and short-term prognosis were collected at admission.Results A total of 270 patients were included,with an average age of(64.95±13.65)years,70.0％males and 30.0％females.The proportion of AIS patients with AGI incident accounted for 66.30％.AIS patients after AGI incidents,90 days after the onset of the modified Rankin rating scale(mRS)score＞2 points of 83 people,accounting for 30.7％;The poor clinical outcomes of 270 AIS patients with different AGI event grades were significantly different(P＜0.05),among which AGI grade 0 and AGI grade Ⅰ were significantly different from AGI grade Ⅲ and AGI grade Ⅳ,respectively.The incidence of poor prognosis of AGI grade Ⅲ and AGI grade Ⅳ is significantly higher than that of AGI grade 0 and AGI grade Ⅰ.In AIS patients with NIHSS＞14 group,there were significant differences in the adverse clinical outcomes between AGI grade 0,AGI grade Ⅰ and AGI grade Ⅲ(P＜0.05),and the incidence of poor prognosis of AGI grade Ⅲ was significantly higher than that of AGI grade 0 and AGI grade Ⅰ.Multivariate Logistic regression analysis showed that NIHSS score was an independent risk factor for AGI events in AIS patients(P＜0.05).The higher the NIHSS score,the higher the risk of AGI events in AIS patients.And age,NIHSS score,systolic blood pressure is 90 days after AGI events affect AIS patients independent risk factors of poor prognosis(P＜0.05),the higher the age,the greater the NIHSS score,the higher systolic blood pressure of patients with AIS 90 days after AGI events are at higher risk of poor prognosis.Conclusion AGI event grading in patients with AIS of different severity is associated with short-term prognosis.

Objective To analyze the effects of different supplements on anemia related indexes in rural children. Methods A stratified method was adopted, and six villages (towns) in and around Qinghai Province were selected as intervention sits for the present study. A total of 304 children from 2 to 6 years old at each intervention site meeting the inclusion criteria were screened and divided into three groups (A, B, and C), who were intervened for 3 months. Serum vitamin A, vitamin D and hemoglobin levels were measured before and after the intervention. Results The hemoglobin level of 304 children before intervention was (118.65±16.07) g /L, and the prevalence of anemia was 9.54%. The vitamin A value, vitamin D value and hemoglobin value were increased after three months of the intervention. The changes of vitamin A value, vitamin D value and hemoglobin value in rural children in group C were significantly higher than those in groups A and B. The increase in vitamin A value in rural children aged 3 years was significantly higher than that in other age groups, and the increase in hemoglobin in rural children of 1 year old was significantly higher than that in other age groups. The increase in vitamin A value of rural children of other ethnic groups (mainly Tibetans) was significantly higher than that of Han and Hui nationalities, and the increase of hemoglobin value in Hui rural children was significantly higher than that in Han and other ethnic groups. Conclusion Vitamin A combined with iron dextran tablets was effective in preventing anemia in rural children.