Objective:To explore the structural relationship between WMSDs in the upper limbs and various risk factors in the occupational population in China, based on a large sample epidemiological survey and structural equation analysis, and to establish a structural equation model, so as to lay a foundation for the prevention and control of such diseases.Methods:The Chinese version of the Musculoskeletal Disorders Electronic Questionnaire was used to conduct a nationwide survey on the prevalence of WMSDs in the upper extremity. Six factors related to WMSDs in the upper extremity were extracted by the classification standard of adverse ergonomic factors and their source and confirmatory factor analysis, including work organization, work type, upper extremity work posture, individual factors, upper extremity fatigue and upper extremity WMSDs. The structural equation analysis was carried out and the structural equation model was established.Results:The incidence of WMSDs and fatigue in the upper limbs was 24.44% and 43.76%, respectively. The adjusted structural equation model fitting indicators were generally up to the standard (GFI=1.000, AGFI=1.000, RMSEA=0.043, NFI=0.808, TLI=0.784) . The four exogenous latent variables of work organization, work type, upper limb work posture and individual factors were correlated. There was a strong positive correlation between job type and upper limb work posture ( r=0.865) , a moderate positive correlation between work organization and job type and upper limb work posture ( r=0.570, 0.490) , and a weak negative correlation between individual factors and the other three exogenous latent variables. Upper limb work posture and individual factors had direct effects on upper limb WMSDs, and the effect coefficients were 0.10 and 0.06, respectively. Upper limb fatigue played a mediating role between work organization, work type, upper limb work posture and upper limb WMSDs. The effect coefficient was 0.46, and the composition ratios of indirect effects were 100.0%, 100.0%, and 38.3%, respectively. The direct path effect of upper limb work posture, individual factors and upper limb WMSDs was weaker than the mediating path through upper limb fatigue. Conclusion:When carrying out the prevention and control of upper limbWMSDs, it is necessary to comprehensively consider the pathogenesis path of upper limb muscle fatigue and upper limb WMSDs caused by work organization, work type, and upper limb work posture, so as to provide theoretical reference for improving the prevention and control level of such diseases.

Objective To investigate the potential value of nobiletin(NOB)in the treatment of dry eyes in type 2 di-abetes mellitus(T2DM-DE)and its effect on the expression of cystic fibrosis transmembrane conductance regulators(CFTRs).Methods The T2DM mouse model was established by a high-fat diet combined with streptozotocin,and then the T2DM-DE mouse model was induced by benzalkonium chloride.These mice were divided into 6 groups:the NC group,the T2DM-DE group,the L-NOB group,the M-NOB group,the H-NOB group,and the CFTR inhibitor group.Mice in the NC and T2DM-DE groups were provided with phosphate buffer saline(PBS)containing 0.5％Tween80 through oral ga-vage;those in the L-NOB,M-NOB,and H-NOB groups were provided with 50,100,and 200 mg?kg-1?d-1 NOB solu-tions,respectively,through oral gavage;those in the CFTR inhibitor group were provided with 200 mg?kg-1?d-1 NOB solution through oral gavage and intraperitoneally injected with 1 mg?kg-1?d-1 CFTR(inh)-172.The intervention in these groups was provided for 4 weeks.The fasting blood glucose(FPG),tear secretion,tear film break-up time(BUT),corne-al fluorescein sodium staining grade,and interleukin-1 β(IL-1 β),IL-6,IL-8,and tumor necrosis factor-α(TNF-α)levels in tears of mice were detected.Besides,the periodic acid-Schiff(PAS)staining of conjunctival goblet cells and the terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)staining of the cornea were performed respectively.The mRNA and protein expression levels of CFTRs,Bax,and Bcl-2 in the cornea were measured by the real-time quantitative polymerase chain reaction(RT-qPCR)and Western blot.Results Compared with the NC group,the FPG of mice in the T2DM-DE group increased;the level of IL-1β,IL-6,IL-8,and TNF-α in tears increased;the corneal fluorescein sodium staining grade and TUNEL positive rate increased(all P＜0.05);the tear secretion,BUT,and the number of conjunctival goblet cells decreased;the mRNA and protein expression levels of CFTRs decreased(all P＜0.05).Compared with the T2DM-DE group,the FPG of mice in the L-NOB,M-NOB,and H-NOB groups decreased;the levels of IL-1β,IL-6,IL-8,and TNF-α in tears decreased;the corneal fluorescein sodium staining grade and TUNEL positive rate decreased(all P＜0.05),the tear secretion,BUT,and the number of conjunctival goblet cells increased;the mRNA and protein expression levels of CFTRs increased(all P＜0.05).Compared with the H-NOB group,the FPG of mice in the CFTR inhibitor group increased;the levels of IL-1 β,IL-6,IL-8,and TNF-α in tear increased;the corneal fluorescein sodium staining grade and TUNEL positive rate increased(all P＜0.05);the tear secretion,BUT,and the number of conjunctival goblet cells de-creased;the mRNA and protein expression levels of CFTRs decreased(all P＜0.05).Conclusion NOB can reduce the blood glucose level by activating CFTRs,inhibit inflammation,and promote the survival of conjunctival goblet cells and cor-neal cells in T2DM-DE mice,thus playing a role in the treatment of T2DM-DE.

Objective To explore the brain damage of SD rats under different time points of hypobaric hypoxia exposure.Methods A rat high-altitube cerebral edema(HACE)model was constructed by simulating an altitude of 6 000 m in a hypobaric hypoxia animal experimental chamber.Thirty-six SD male rats were randomly divided into the control group and the hypobaric hypoxia exposure 3,7 and 14 d groups,with 9 rats in each group.Except for the control group,the rats in each group were continuously exposed to hypobaric hypoxia for 3,7,and 14 d.At the end of the modeling period,serum was collected by blood sampling via the abdominal aorta,and brain tissue samples were taken.The wet-to-dry ratio(W/D)of brain tissue was calculated,and the levels of relevant oxidative enzymes in serum and brain tissue were measured.The expression levels of hypoxia-inducible factor-1α(HIF-1α)and aquaporin 4(AQP4)mRNAs in brain tissue were detected by real-time fluorescence quantitative polymerase chain reaction.Results The W/D of brain tissues in the control group and the group exposed to hypobaric hypoxia for 3,7 and 14 d were 4.46±0.12,4.98±0.16,5.07±0.18 and 4.95±0.07;the superoxide dismutase contents were(111.86±2.45),(90.73±1.48),(79.64±2.56)and(55.33±1.45)U·g-1;the glutathione contents were(126.91±5.18),(125.26±1.53),(56.20±2.17)and(122.73±1.78)μg·mL-1;the malondialdehyde contents were(230.94±2.00),(362.65±3.28),(407.34±3.47)and(237.50±1.59)nmol·g-1;the relative expression levels of HIF-1 α mRNA were 1.00±0,2.99±0.49,4.72±0.49 and 1.91±0.28;the relative expression levels of AQP4 mRNA were 1.00±0,2.62±0.34,8.38±0.84 and 5.27±0.42,respectively.Statistically significant differences were found between the above indexes in the 3,7 and 14 d of hypobaric hypoxia exposure group compared with the control group(P＜0.05,P＜0.01).Conclusion Different time of hypobaric hypoxia exposure can up-regulate the expression of AQPs proteins in HACE rats and cause the disruption of the blood-brain barrier,and the HACE model constructed in the hypobaric hypoxia chamber with 6 000 m intervention for 7 d was more stable.

Objective To explore the brain damage of SD rats under different time points of hypobaric hypoxia exposure.Methods A rat high-altitube cerebral edema(HACE)model was constructed by simulating an altitude of 6 000 m in a hypobaric hypoxia animal experimental chamber.Thirty-six SD male rats were randomly divided into the control group and the hypobaric hypoxia exposure 3,7 and 14 d groups,with 9 rats in each group.Except for the control group,the rats in each group were continuously exposed to hypobaric hypoxia for 3,7,and 14 d.At the end of the modeling period,serum was collected by blood sampling via the abdominal aorta,and brain tissue samples were taken.The wet-to-dry ratio(W/D)of brain tissue was calculated,and the levels of relevant oxidative enzymes in serum and brain tissue were measured.The expression levels of hypoxia-inducible factor-1α(HIF-1α)and aquaporin 4(AQP4)mRNAs in brain tissue were detected by real-time fluorescence quantitative polymerase chain reaction.Results The W/D of brain tissues in the control group and the group exposed to hypobaric hypoxia for 3,7 and 14 d were 4.46±0.12,4.98±0.16,5.07±0.18 and 4.95±0.07;the superoxide dismutase contents were(111.86±2.45),(90.73±1.48),(79.64±2.56)and(55.33±1.45)U·g-1;the glutathione contents were(126.91±5.18),(125.26±1.53),(56.20±2.17)and(122.73±1.78)μg·mL-1;the malondialdehyde contents were(230.94±2.00),(362.65±3.28),(407.34±3.47)and(237.50±1.59)nmol·g-1;the relative expression levels of HIF-1 α mRNA were 1.00±0,2.99±0.49,4.72±0.49 and 1.91±0.28;the relative expression levels of AQP4 mRNA were 1.00±0,2.62±0.34,8.38±0.84 and 5.27±0.42,respectively.Statistically significant differences were found between the above indexes in the 3,7 and 14 d of hypobaric hypoxia exposure group compared with the control group(P＜0.05,P＜0.01).Conclusion Different time of hypobaric hypoxia exposure can up-regulate the expression of AQPs proteins in HACE rats and cause the disruption of the blood-brain barrier,and the HACE model constructed in the hypobaric hypoxia chamber with 6 000 m intervention for 7 d was more stable.

Objective To investigate the potential value of nobiletin(NOB)in the treatment of dry eyes in type 2 di-abetes mellitus(T2DM-DE)and its effect on the expression of cystic fibrosis transmembrane conductance regulators(CFTRs).Methods The T2DM mouse model was established by a high-fat diet combined with streptozotocin,and then the T2DM-DE mouse model was induced by benzalkonium chloride.These mice were divided into 6 groups:the NC group,the T2DM-DE group,the L-NOB group,the M-NOB group,the H-NOB group,and the CFTR inhibitor group.Mice in the NC and T2DM-DE groups were provided with phosphate buffer saline(PBS)containing 0.5％Tween80 through oral ga-vage;those in the L-NOB,M-NOB,and H-NOB groups were provided with 50,100,and 200 mg?kg-1?d-1 NOB solu-tions,respectively,through oral gavage;those in the CFTR inhibitor group were provided with 200 mg?kg-1?d-1 NOB solution through oral gavage and intraperitoneally injected with 1 mg?kg-1?d-1 CFTR(inh)-172.The intervention in these groups was provided for 4 weeks.The fasting blood glucose(FPG),tear secretion,tear film break-up time(BUT),corne-al fluorescein sodium staining grade,and interleukin-1 β(IL-1 β),IL-6,IL-8,and tumor necrosis factor-α(TNF-α)levels in tears of mice were detected.Besides,the periodic acid-Schiff(PAS)staining of conjunctival goblet cells and the terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)staining of the cornea were performed respectively.The mRNA and protein expression levels of CFTRs,Bax,and Bcl-2 in the cornea were measured by the real-time quantitative polymerase chain reaction(RT-qPCR)and Western blot.Results Compared with the NC group,the FPG of mice in the T2DM-DE group increased;the level of IL-1β,IL-6,IL-8,and TNF-α in tears increased;the corneal fluorescein sodium staining grade and TUNEL positive rate increased(all P＜0.05);the tear secretion,BUT,and the number of conjunctival goblet cells decreased;the mRNA and protein expression levels of CFTRs decreased(all P＜0.05).Compared with the T2DM-DE group,the FPG of mice in the L-NOB,M-NOB,and H-NOB groups decreased;the levels of IL-1β,IL-6,IL-8,and TNF-α in tears decreased;the corneal fluorescein sodium staining grade and TUNEL positive rate decreased(all P＜0.05),the tear secretion,BUT,and the number of conjunctival goblet cells increased;the mRNA and protein expression levels of CFTRs increased(all P＜0.05).Compared with the H-NOB group,the FPG of mice in the CFTR inhibitor group increased;the levels of IL-1 β,IL-6,IL-8,and TNF-α in tear increased;the corneal fluorescein sodium staining grade and TUNEL positive rate increased(all P＜0.05);the tear secretion,BUT,and the number of conjunctival goblet cells de-creased;the mRNA and protein expression levels of CFTRs decreased(all P＜0.05).Conclusion NOB can reduce the blood glucose level by activating CFTRs,inhibit inflammation,and promote the survival of conjunctival goblet cells and cor-neal cells in T2DM-DE mice,thus playing a role in the treatment of T2DM-DE.

Objective:To explore the structural relationship between WMSDs in the upper limbs and various risk factors in the occupational population in China, based on a large sample epidemiological survey and structural equation analysis, and to establish a structural equation model, so as to lay a foundation for the prevention and control of such diseases.Methods:The Chinese version of the Musculoskeletal Disorders Electronic Questionnaire was used to conduct a nationwide survey on the prevalence of WMSDs in the upper extremity. Six factors related to WMSDs in the upper extremity were extracted by the classification standard of adverse ergonomic factors and their source and confirmatory factor analysis, including work organization, work type, upper extremity work posture, individual factors, upper extremity fatigue and upper extremity WMSDs. The structural equation analysis was carried out and the structural equation model was established.Results:The incidence of WMSDs and fatigue in the upper limbs was 24.44% and 43.76%, respectively. The adjusted structural equation model fitting indicators were generally up to the standard (GFI=1.000, AGFI=1.000, RMSEA=0.043, NFI=0.808, TLI=0.784) . The four exogenous latent variables of work organization, work type, upper limb work posture and individual factors were correlated. There was a strong positive correlation between job type and upper limb work posture ( r=0.865) , a moderate positive correlation between work organization and job type and upper limb work posture ( r=0.570, 0.490) , and a weak negative correlation between individual factors and the other three exogenous latent variables. Upper limb work posture and individual factors had direct effects on upper limb WMSDs, and the effect coefficients were 0.10 and 0.06, respectively. Upper limb fatigue played a mediating role between work organization, work type, upper limb work posture and upper limb WMSDs. The effect coefficient was 0.46, and the composition ratios of indirect effects were 100.0%, 100.0%, and 38.3%, respectively. The direct path effect of upper limb work posture, individual factors and upper limb WMSDs was weaker than the mediating path through upper limb fatigue. Conclusion:When carrying out the prevention and control of upper limbWMSDs, it is necessary to comprehensively consider the pathogenesis path of upper limb muscle fatigue and upper limb WMSDs caused by work organization, work type, and upper limb work posture, so as to provide theoretical reference for improving the prevention and control level of such diseases.

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.

ObjectiveTo explore the molecular mechanism implicated in the treatment of primary myelofibrosis （PMF） using Chinese medicinal herbs （CMH） by bioinformatics and molecular dynamics. MethodsData mining was performed to find the high-frequency CMH in treating PMF between the year of 1985 and 2024 by searching CNKI， Chinese Science and Technology Journal Database （CCD）， and China Academic Journal Database （CSPD）. TCMSP， SwissTargetPrediction and related reports were used to collect the main active ingredients of high-frequency CMH and their targets. The PMF datasets GSE44426 and GSE124281 were downloaded from GEO database， and R software was used for data normalization and differentially expressed genes （DEGs） screening. Key module hub genes were obtained by weighted gene co-expression network analysis （WGCNA） analysis. The common intersection genes of active ingredient targets， DEGs and key module hub genes of CMH were selected， and the target network was generated using Cytoscape 3.9.2 software. The core target network was generated by topological analysis， while key pathways were selected by GO and KEGG pathway enrichment analysis， and protein interaction relationships were obtained from the String database， so as to construct drug-ingredient-target network and protein interaction network （PPI） relationship diagrams. Discovery Studio 2020 software was used to perform molecular docking， and the GROMACS program was used to perform molecular dynamics simulation. ResultsA total of 21 prescriptions were collected involving 121 herbs. There were 9 herbs with a frequency ≥10 times， which were Danshen （Radix et Rhizoma Salviae Miltiorrhizae）， Huangqi （Radix Astragali）， Baizhu （Rhizoma Atractylodis Macrocephalae）， Danggui （Radix Angelicae Sinensis）， Dangshen （Radix Codonopsis）， Gancao （Radix et Rhizoma Glycyrrhizae）， Baishao （Radix Paeoniae Alba）， Fuling （Poria） and Shudihuang （Radix Rehmanniae Praeparata） from high- to low-frequency. A total of 98 active ingredients and 1125 potential targets were obtained from 9 high-frequency CMH. GSE44426 and GSE124281 data sets screened out 24 gene samples， including 14 of the healthy control group and 10 of the PMF group， and identified 319 DEGs between the two groups， including 122 up-regulated genes and 197 down-regulated genes. WGCNA screened out 24 co-expression module genes and found that the five modules closely related to the onset of PMF were MEpink， MEdarkred， MEblack， MEgrey， and MEturquoise， involving 7112 key module hub genes. The GO and KEGG enrichment analyses indicated that lipids and the atherosclerosis pathways were mainly involved in the mechanism of above high-frequency CMH in treating PMF， which included six hub protein targets： HSP90AA1， HSP90AB1， SRC， MAPK1， IL1B and IL10. From the drug-ingredient-target network， seven active ingredients of CMH targeting at these six hub targets were found， including verbascoside， verbascos isoflavone， kaempferol， luteolin， naringenin， quercetin and pachymic acid. The molecular docking and molecular dynamics analyses showed that the key CMH were Shudihuang， Huangqi， Baishao， Danshen， Gancao and Fuling， and among the seven active ingredients， calycosin had the highest binding affinity with HSP90AB1. ConclusionThe main CMH for the treatment of PMF may be Shudihuang， Huangqi， Baishao， Danshen， Gancao and Fuling， and the active ingredients include verbascoside， verbascos isoflavones， kaempferol， luteolin， naringenin， quercetin and pachymic acid. The relevant targets are HSP90AA1， HSP90AB1， SRC， MAPK1， IL-10， and IL-1β， and the most critical pathways are lipid and atherosclerosis pathways.

Objective:To analyze the distribution characteristics of work-related musculoskeletal disorders (WMSDs) among the occupational population in China's key industries during the period from 2018 to 2023, and to provide data support for the formulation of targeted prevention strategies.Methods:Between January 1, 2018, and December 31, 2023, a cross-sectional epidemiological survey and a retrospective investigation were conducted in seven geographical regions of North China, East China, Central China, South China, Southwest China, Northwest China, and Northeast China, using a combination of epidemiological cross-sectional and retrospective surveys. The industries were stratified according to the degree of closeness to WMSDs, the size of the occupational population, and the importance of the national economy, and then cluster sampling was conducted according to the size of the enterprises (large, medium, and small) within each stratum. Representative enterprises were selected, and workers who had been employed for more than one year and met the inclusion criteria were selected as the study subjects. The survey subjects completed the Chinese version of the Musculoskeletal Disorders Survey Questionnaire online by scanning a QR code. A total of 88, 609 valid questionnaires were collected. Continuous data were described by means and standard deviations, and the standardized incidence rates of WMSDs were evaluated using chi-square tests to compare the standardized incidence rates of different body parts.Results:The standardized prevalence rate of WMSDs among the frontline working population in China was 36.7%, with the top three being the neck (21.37%), shoulders (18.23%), and lower back (14.92%). There was a statistically significant difference in the standardized prevalence rate of WMSDs between different body parts (χ 2=47577.82, P<0.05). The lowest standardized prevalence rate of WMSDs was found in the southeast coastal region of China (32.54%), while the highest was in the northwest (49.70%) and northeast regions (46.16%). The standardized prevalence rate of WMSDs decreased from 42.88% in 2018 to 29.94% in 2023. The micro-enterprise observation group had a higher concentration of WMSDs in the neck (20.66%), lower back (17.95%), and shoulders (17.79%), while the large enterprise observation group had a higher concentration in the neck (20.54%), shoulders (17.52%), and lower back (14.65%). Among the industries surveyed, the highest standardized prevalence rate of WMSDs was found in the healthcare industry (53.18%), followed by the toy manufacturing industry (50.54%), the automotive manufacturing industry (43.39%), general aviation services (42.71%), and the ship and related equipment manufacturing industry (40.56%). The standardized prevalence rate of WMSDs among women was significantly higher than that of men ( OR value=1.44, P<0.05). In addition, the standardized prevalence rate of WMSDs with multiple affected body parts (four or more body parts affected simultaneously) was higher, and the risk of WMSDs increased with subjective fatigue, showing a significant "S-shaped" trend (the OR value was 2.19, 3.16, 4.71, 5.49, and 3.97 when the RPE was 13, 15, 17, 19, and 20, respectively. χ 2trend=17.23, P<0.001) . Conclusion:The distribution characteristics of WMSDs in key industries in China show obvious differences in different parts, regions, time, enterprise scale, industry and population attributes. Agriculture, pharmaceutical manufacturing, packaging and decoration and other printing industries have a high proportion of WMSDs in multiple parts at the same time and in a single site. It is necessary to study and implement precise preventive measures according to specific regions, industries and enterprise scales, as well as the characteristics of multi-site WMSDs, so as to effectively protect the health and well-being of the working population.

Objective:To explore the occupational contact characteristics of work-related musculoskeletal disorders (WMSDs) among key occupational groups in China, assess the impact of occupational factors on the occurrence of WMSDs, and propose corresponding preventive strategies.Methods:Between January 1, 2018, and December 31, 2023, a cross-sectional epidemiological survey method was employed to retrospectively investigate the occurrence of WMSDs and related occupational factors. Valid questionnaire data from 88609 on-the-job workers in 441 enterprises across 29 industries or job types in seven regions of China were collected, and the relationship between WMSDs and various occupational factors was discussed using multifactorial logistic regression analysis. Odds ratios ( OR) and their 95% confidence intervals ( CI) were calculated to assess the impact of different factors on the risk of WMSDs occurrence, with all statistical tests performed as two-tailed tests, using P<0.05 as the criterion for statistical significance. Results:Among the surveyed subjects, 59989 were male, accounting for 67.7% (59989/88609) ; 28620 women, accounting for 32.3% (28620/88609). The standardized incidence rate of work related musculoskeletal disorders (WMSDs) in 9 parts of the body was statistically significant ( P<0.05) among different working age groups without considering specific parts. The average length of service for onset of WMSDs (regardless of location) is (4.52±2.67) years, and there is a statistically significant difference in the length of service for onset of WMSDs in different locations ( P<0.05). As the frequency of heavy object handling increases, the standardization rate and OR value of WMSDs in various parts show a significant increase trend. The incidence of WMSDs is significantly correlated with maintaining poor work posture for a long time, frequent repetitive operations, and heavy object handling ( OR=1.52, 1.45, 1.63, P<0.01) . Conclusion:This study reveals that the risk of WMSDs in China's occupational population shows a non-linear change with increasing length of service, especially with a significant increase in 10 to 25 years of service. Poor work posture, frequent repetitive operations, and heavy object handling are significantly correlated with WMSDs, providing a scientific basis for developing more accurate and effective prevention strategies for WMSDs.