Background Ozone (O₃), a key air pollutant, significantly contributes to cardiovascular disease (CVD)-related mortality, with particularly pronounced effects in the elderly. Objective To explore the association between acute O₃ exposure and mortality from CVD and its subtypes in the elderly population in Jinan, and to investigate the modifying effects of gender,age, and seasonal factors on O₃-related effects, as well as to clarify the interaction with other air pollutants. Methods Daily mortality data for CVD, air pollutants, and meteorological parameters were collected in Jinan from 2015 to 2023. Generalized additive models (GAM) combined with distributed lag nonlinear models (DLNM) were used to analyze the lag effects of acute O₃ exposure on mortalities from CVD, ischemic heart disease (IHD), and stroke in elderly individuals aged ≥60 years. Subgroup analyses were conducted to explore effect differences by gender (male vs. female), age (non-high-aged elderly<80 years vs. high-aged elderly ≥80 years), and season (warm season: April–September vs. cold season: October–March of the following year). Relative excess risk due to interaction (RERI), attributable proportion of interaction (API), and Synergy index (SI) were used to assess the interactions of O₃ with PM_2.5 and NO₂. Results During the study period, the mean daily concentration of ozone reached (105.01 ± 54.18) μg·m⁻³, exceeding the Grade I limit value specified in Ambient Air Quality Standard (GB 3095–2012). Among the 203834 CVD deaths, IHD (53.07%) and stroke (33.33%) were the predominant mortality subtypes. The single-day lag analysis revealed peak excess risk (ER) for CVD mortality at lag0 (ER=0.64%, 95%CI: 0.29%, 1.00%) per 10 μg·m⁻³ O₃ increase. The cumulative effects peaked at lag04 (ER=1.61%, 95%CI: 0.77%, 2.46%). The subtype-specific analyses showed the maximal single-day effects at lag0 were identified for both IHD (ER=0.61%, 95%CI: 0.20%, 1.03%) and stroke (ER=0.65%, 95%CI: 0.19%, 1.11%), while the cumulative risks peaked at lag04 for IHD (ER=1.54%, 95%CI: 0.56%, 2.54%) and lag03 for stroke (ER=1.74%, 95%CI: 0.76%, 2.73%). The gender subgroup analyses suggested that both male and female subgroups showed the most significant impact on CVD mortality at lag0, with ER values of 0.53% (95%CI: 0.11%, 0.95%) and 0.75% (95%CI: 0.33%, 1.18%), respectively, but the differences were not statistically significant (P>0.05). No statistically significant difference in effect values was found between high-aged and non-high-aged elderly (P>0.05) after age subgroup analyses. The seasonal subgroup analyses indicated that the effects of O₃ on CVD and its subtypes in the warm season were significantly higher than those in the cold season (P<0.05). At lag0 in the warm season, the ER values for CVD, IHD, and stroke mortality were 0.86% (95%CI: 0.57%, 1.14%), 0.84% (95%CI: 0.49%, 1.19%), and 0.84% (95%CI: 0.43%, 1.26%), respectively. The interaction analyses revealed an antagonistic effect between O₃ and PM_2.5 on stroke mortality in the elderly [RERI=−4.64% (95%CI: −9.27%, −0.01%), API=−4.39% (95%CI: −8.77%, −0.01%), SI=0.55 (95%CI: 0.26, 0.84)]. The O₃ effect remained robust in the multi-pollutant models (P<0.05). Conclusion Acute O₃ exposure increases the risk of mortality from CVD and its subtypes in the elderly, and this effect is amplified in the warm season. Additionally, O₃ and PM_2.5 have an antagonistic effect on stroke mortality in the elderly.

Objective:To further improve the understanding of paroxysmal nocturnal hemoglobinuria (PNH), we retrospectively analyzed and summarized the clinical characteristics, treatment status, and survival status of patients with PNH in Zhejiang Province.Methods:This study included 289 patients with PNH who visited 20 hospitals in Zhejiang Province. Their clinical characteristics, comorbidity, laboratory test results, and medications were analyzed and summarized.Results:Among the 289 patients with PNH, 148 males and 141 females, with a median onset age of 45 (16-87) years and a peak onset age of 20-49 years (57.8% ). The median lactic dehydrogenase (LDH) level was 1 142 (604-1 925) U/L. Classified by type, 70.9% (166/234) were classical, 24.4% (57/234) were PNH/bone marrow failure (BMF), and 4.7% (11/234) were subclinical. The main clinical manifestations included fatigue or weakness (80.8%, 235/289), dizziness (73.4%, 212/289), darkened urine color (66.2%, 179/272), and jaundice (46.2%, 126/270). Common comorbidities were hemoglobinuria (58.7% ), renal dysfunction (17.6% ), and thrombosis (15.0% ). Moreover, 82.3% of the patients received glucocorticoid therapy, 70.9% required blood transfusion, 30.7% used immunosuppressive agents, 13.8% received anticoagulant therapy, and 6.3% received allogeneic hematopoietic stem cell transplantation. The 10-year overall survival (OS) rate was 84.4% (95% CI 78.0% -91.3% ) . Conclusion:Patients with PNH are more common in young and middle-aged people, with a similar incidence rate between men and women. Common clinical manifestations include fatigue, hemoglobinuria, jaundice, renal dysfunction, and recurrent thrombosis. The 10-year OS of this group is similar to reports from other centers in China.

The information construction and information sharing in Shenzhen public hospitals were investigated with their achievements and problems summarized .Suggestions were put forward for perfecting their information construction, improving their information sharing level, and realizing their regional medical information sharing for the reference in working out their information development program and making health information policies.

OBJECTIVETo investigate the changes in hemodynamics and depth of anesthesia under monitored anesthesia care (MAC) in patients undergoing percutaneous dilatational tracheostomy (PDT).

METHODSForty-six patients with oral cancer were divided into two groups with 23 cases each: Local anesthesia group (group L) and MAC group (group M). Local and intratracheal surface anesthesia were performed with 2% lidocaine in group L. Midazolam, propofol and fentanyl were added to group M after local and intratracheal surface anesthesia, then PDT was carried out. During the induction, observer's assessment of alertness/sedation(OAA/S) scale was used to assess the depth of sedation. Mean arterial blood pressure (MAP), heart rate (HR), state entropy (SE) and response entropy (RE) were recorded before anesthesia (basal value, T1), after local anesthesia (T2), after intravenous administration/before incision (T3), during incision (T4), during dilating with stretching pliers (T5) and endotracheal intubation (T6). A postoperative follow-up was taken in group M.

RESULTSMAP and HR increased significantly at T4-T6 in group L and decreased at T3 (P < 0.05) with no change at T4-T6 in group M compared with those in T1. MAP and HR at T3-T6 in group M were obviously lower than those in group L. SE and RE at T3-T6 in group M were obviously lower than those at T1 or in group L (P < 0.01) and decreased significantly with the reduction of OAA/S scale (P < 0.05) during the induction. Intraoperative awareness in group M was not found through postoperative follow-up.

CONCLUSIONPatients undergoing PDT under MAC has more comfortability, more stable hemodynamics and no memory, so MAC is a better anesthesia for PDT than local anesthesia.

Anesthesia ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Propofol ; Tracheostomy

Objective To investigate the effect of family nursing intervention on life satisfaction in patients with hemodialysis.Methods 128 patients with hemodialysis in our hospital were randomly divided into experimental group and control group,64 cases in each group.Traditional health nursing methods were used in control group and home nursing intervention was carried out in experimental group.Patients' life satisfaction in the two groups was investigated by Neugarten' life satisfaction scale,the life satisfaction,nutrition and kidney function were compared between the two groups.Results The life satisfaction score,blood urea nitrogen,Creatinine,Albumin,hemoglobin in the two groups before intervention were similar ( P ＞ 0.05 ).After intervention,the life satisfaction score,life satisfaction index A,life satisfaction index B were (20.07 ± 1.39),( 17.35 ± 1.04) and ( 18.49 ± 1.10) in experimental group,but ( 14.71 ± 0.81 ),( 15.00 ± 0.75 ) and (15.49 ±0.85) in sequence in control group,there were statistically significant differences between the two groups(t =22.43,2.10,10.30; P ＜ 0.05 ),blood urea nitrogen,Creatinine,Albumin,hemoglobin in experimental group after intervention were better than that in control group ( P ＜ 0.05 ).Conclusions Home nursing intervention can improve life satisfaction of patients with hemodialysis in community then it can improve the quality of life.