Background Hypertension is one of the chronic diseases with the highest prevalence in China, and a history of hypertension may potentially exacerbate hearing loss. Investigating the association between long-term blood pressure trends and hearing thresholds could contribute to hearing protection efforts for occupationally noise-exposed populations. Objective By investigating hearing thresholds and blood pressure levels among occupationally noise-exposed workers in an urban rail transit enterprise, and conducting a comprehensive analysis of the association between long-term blood pressure changes and hearing thresholds, to provide data references for health management strategies targeting occupationally noise-exposed workers. Methods Workers exposed to occupational noise at a rail transit enterprise were enrolled as study subjects and underwent pure-tone audiometry. Group-based trajectory modeling was employed to identify blood pressure trajectories. Categorical data were compared using chi-square tests, while normally distributed continuous variables were analyzed via t-tests and analysis of variance (ANOVA). Generalized linear mixed models (GLMMs) were subsequently applied toexamine associations between these trajectory groups and high-frequency hearing thresholds. Results Among 2 002 occupationally noise-exposed workers, the median (P₂₅, P₇₅) age was 32 (28, 35) years, with a median (P₂₅, P₇₅) working tenure of 7 (3, 10) years. In 2019, the positive hypertension rate was 9.04%, with a mean systolic blood pressure (SBP) of (122.97±11.60) mmHg and a mean diastolic blood pressure (DBP) of (76.37±9.02) mmHg. The hearing loss prevalence was 10.1%, showing bilateral high-frequency average hearing thresholds of (17.18±8.71) dB and speech-frequency average thresholds of (13.79±3.46) dB. Three distinct trajectory groups were identified for both SBP and DBP. Compared with other trajectory groups, the high-stable DBP group exhibited significantly higher hearing loss prevalence (χ²=6.34, P=0.042) and elevated high-frequency hearing thresholds (all Ps<0.05). Specifically, within the 30-39 age subgroup, the moderate-stable DBP group demonstrated 1.96 dB lower high-frequency thresholds than the high-stable group [β(95%CI): −1.96 (−3.61, −0.32), P=0.020]. Conclusion Among occupationally noise-exposed workers in a municipal rail transit enterprise, DBP trajectories demonstrated a positive association with high-frequency hearing thresholds. Notably, in young and middle-aged occupationally noise-exposed populations, DBP may exert a more critical influence than SBP on the progression of hearing loss.

Senile chronic heart failure(CHF)complicated with sarcopenia can further degrade patients'quality of life,and increase the occurrence of falls,disability and mortality.Currently,western medicine preventive and treatment for sarcopenia mainly depend on nutritional support and exercise therapy,but their efficacy remained uncertain.Traditional Chinese medicine(TCM)therapy has the advantages of holism and syndrome differentiation and treatment,and its application in senile CHF complicated with sarcopenia is worthy of further exploration.This paper sorted out the relevant statements in the Treatise on Exogenous Febrile and Miscellaneous Diseases,and concluded that the clinical manifestations of senile CHF complicated with sarcopenia are similar to those of heart water and consumptive disease in the Treatise on Exogenous Febrile and Miscellaneous Diseases.The statements in Treatise on Exogenous Febrile and Miscellaneous Diseases will guide the identification of etiology and pathogenesis as well as the diagnosis and treatment for senile CHF complicated with sarcopenia.The analysis of the pathogenesis indicated that heart water and consumptive disease were induced by deficiency of heart and spleen and kidney,five kinds of overstrain and seven types of impairment,water pathogen insulting heart,and internal stagnation of blood stasis.Therefore,it is proposed that the core pathogenesis of senile CHF complicated with sarcopenia is due to the deficiency of heart,spleen and kidney yang,and water blended with blood stasis.The classical prescriptions such as Ling Gui Zhu Gan Tang,Zhenwu Tang,Sini Tang,Shenqi Pills,Jianzhong Tang and Wuling Powder can be used by modification or combination based on syndrome differentiation in treating senile CHF complicated with sarcopenia.For both of the congenital and acquired origin(spleen and kidney)of elderly patients with CHF complicated with sarcopenia are deficient,the utilization of herbs for invigorating spleen and boosting kidney on the basis of syndrome differentiation may achieve good efficacy.

Objective To analyze the correlation between venous thromboembolism(VTE)and traditional Chinese medicine(TCM)constitution types in elderly frail patients.Methods A retrospective study was conducted on 1 428 elderly frail patients admitted to the Second Comprehensive Department of Guangdong Provincial Hospital of Chinese Medicine from January 2019 to June 2023.Patients were divided into a venous thrombsis(VT)group(n=187)and a non-VT group(n=1 241)based on VTE occurrence.Baseline data,including age distribution,Padua scores,Wells scores,and TCM constitution types,were compared between the two groups.Multivariate logistic regression analysis was performed to identify factors for influencing VTE in elderly frail patients.Results(1)Compared with the non-VT group,the VT group had significantly higher total hospitalization costs,length of stay,age,Fried scores,Padua scores,and Wells scores,with statistically significance(P＜0.001).(2)Compared with the non-VT group,the VT group had a higher proportion of high VTE-risk individuals and those with Wells scores of 2 points,with statistically significance(P＜0.001).(3)The age distribution of VTE patients showed an increasing trend in the age groups of 60-69,70-79,80-89,and ≥90-year-old,with a significant difference compared to the non-VT group(P＜0.001).(4)The VT group had a higher proportion of qi-deficiency,blood-stasis,and qi-depression constitutions than the non-VT group(P＜0.05 or P＜0.001).(5)Multivariate logistic regression analysis(after adjusting age,gender,frailty,and other scores)showed that qi-deficiency and yang-deficiency constitutions were non-susceptible,while damp-heat,blood-stasis,and qi-depression constitutions were susceptible to VTE in elderly frail patients(P＜0.05 or P＜0.01).Conclusion VTE in elderly frail patients is significantly correlated with TCM constitution types.Deviated constitutions are characteristic of TCM constitution types in elderly frail patients,and damp-heat,blood-stasis,and qi-depression constitutions are risk factors for VTE in this population.

Objective:To explore the correlation between right atrial function parameters and prognosis in patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary hypertension.Methods:Eighty-four patients with COPD combined with pulmonary arterial hypertension treated with bosentan combined with milrinone admitted to the First Affiliated Hospital of Xinjiang Medical University during the period of February 2020 to June 2022 were selected as the study subjects, and they were divided into the effective group (63 cases) and the ineffective group (21 cases) according to the treatment effect. Right cardiac function parameters were measured by Philips iE33 color ultrasonography before treatment and 72 h after treatment. Logistic regression was used to analyze the risk factors affecting the treatment outcome of patients, and receiver operating characteristics (ROC) curve was used to analyze the predictive value of right atrial function parameters in the poor prognosis of patients with COPD complicated with pulmonary hypertension.Results:The main pulmonary artery diameter (MPA), right ventricular base transverse diameter (RVd1), right ventricular middle transverse diameter (RVd2), right atrial diameter (RAd) and right ventricular free wall thickness (RVWT) in the effective group were lower than those in the ineffective group: (2.65 ± 0.23) cm vs. (2.90 ± 0.44) cm, (3.46 ± 0.43) cm vs. (3.76 ± 0.72) cm, (3.48 ± 0.42) cm vs. (3.88 ± 0.69) cm, (3.53 ± 0.81) cm vs. (4.03 ± 1.20) cm, (0.63 ± 0.12) cm vs. (0.72 ± 0.21) cm; end-diastolic to end-systolic tricuspid ring displacement (TAPSE) was higher than that in the ineffective group: (2.08 ± 0.32) cm vs. (1.82 ± 0.46) cm, there were statistical differences( P<0.05). Logistic regression analysis showed that RVd1 increased ( OR = 3.717, P<0.05), RVd2 increased ( OR = 2.162, P<0.05), RAd increased ( OR = 2.838, P<0.05) and TAPSE reduction ( OR = 1.704, P<0.05) were risk factors for treatment failure in patients. The results of ROC curve showed that the area under the curve of RVd1, RVd2, RAd, TAPSE in predicting the therapeutic effect of COPD patients with pulmonary hypertension were 0.820, 0.831, 0.872, 0.909, respectively. Conclusions:The independent influencing factors of ineffective patients with COPD combined with pulmonary arterial hypertension treated with bosentan combined with milrinone are the increase of structural parameters of the right heart and the decrease of systolic function parameters. The therapeutic effect of patients can be evaluated clinically according to the level of each parameter.

Personalized medicine emphasizes individualized and dynamic treatment decisions. There is an urgent need for a new efficacy evaluation system that can adapt to this approach. By reviewing past clinical research practices， this article pointed out the innovative needs of traditional Chinese medicine （TCM） efficacy evaluation from the perspective of personalized medicine in terms of ethical review， trial design， data management， and statistical analysis. Focusing on these needs， the article has proposed a strategic framework using syndrome differentiation and treatment in TCM as an example. The framework includes a method based on subgroup dynamic-static parallel group design and analysis， a safeguard mechanism of continuous review， dynamic informed consent， and multicenter ethical review， a technological support platform for personalized clinical efficacy evaluation and evidence support， and a statistical strategy integrating Bayesian and traditional analysis methods， aiming to promote the development of personalized TCM diagnosis and treatment.

Objective: To examine the mediating effect of nighttime sleep duration on pain and frailty among elderly patients with comorbidity of chronic diseases, so as to provide insights into frailty control among the elderly. Methods: Demographic information, pain and nighttime sleep duration of the elderly at ages of 60 years and older were collected from the China Health and Retirement Longitudinal Study 2020. Frailty were evaluated using frailty index. The mediating effect of sleep duration for pain and frailty was analyzed using the Process program compiled by HAYSS and colleagues, and the significance of the mediating role was tested using the Bootstrap test. Results: A total of 2 246 elderly patients with comorbidity of chronic diseases were enrolled, including 1 195 males (53.21%) and 1 051 females (46.79%), with a median age of 65.00 (interquartile range, 8.00) years. There were 504 cases with frailty (22.44%), with a median pain score of 0 (interquartile range, 1.00) points, and a mean nighttime sleep duration of (6.44±1.55) hours. Mediating analysis showed that pain affected frailty directly and positively with the effect value of 0.089 (95%CI: 0.066-0.112), and also affected frailty by nighttime sleep duration directly and positively with the effect value of 0.047 (95%CI: 0.036-0.058), with the mediating effect contributed 34.56% of the total effect. Conclusion Pain can directly or indirectly affect frailty among elderly patients with comorbidity of chronic diseases through nighttime sleep duration.

BACKGROUND:Reducing the rate of abnormal fertilization is an effective approach to improving the efficacy of in vitro fertilization and reducing patients'financial strain.However,the current research on abnormal fertilization has focused on exploring the types of prokaryotic nuclei and their generation mechanisms,as well as analyzing embryos formed by abnormal fertilization,chromosomal ploidy and utilization value.There is a lack of clinical prediction models for abnormal fertilization based on retrospective studies. OBJECTIVE:To construct a nomogram model to predict abnormal female factors in in vitro fertilization. METHODS:A total of 5 075 patients undergoing treatment for conventional in vitro fertilization at Nanxishan Hospital of Guangxi Zhuang Autonomous Region from March 2017 to March 2022 were retrospectively analyzed.The male confounders were calibrated on a 1:1 propensity score with a match tolerance of 0.02,and 1 672 cases were successfully matched.According to the Vienna Consensus,patients with≥60%normal fertilization capacity were included in the normal fertilization group(n=836)and those with<60%normal fertilization capacity were included in the abnormal fertilization group(n=836).The model and validation groups were obtained by random sampling at a ratio of 7:3.Factors related to the occurrence of abnormal fertilization following conventional in vitro fertilization in the model group were screened using univariate analysis and the best matching factors were selected using the Least Absolute Shrinkage and Selection Operator(LASSO)and included in a multifactorial forward stepwise Logistic regression to identify their independent influencing factors and plot a nomogram.Finally,the prediction model was validated for discrimination,accuracy and clinical application efficacy using receiver operating characteristic curves,calibration curves,clinical decision curves and clinical impact curves. RESULTS AND CONCLUSION:The univariate analysis indicated the factors influencing the occurrence of abnormal fertilization were age,controlled ovarian hyperstimulation protocol,number of assisted pregnancies,years of infertility,infertility factors,anti-mullerian hormone,sinus follicle count,basal luteinizing hormone,luteinizing hormone concentration on the human chorionic gonadotropin day,and estradiol level on human chorionic gonadotropin injection day(P<0.05).LASSO regression further identified the best matching factors,including age,microstimulation protocol,number of assisted pregnancies,years of infertility,anti-mullerian hormone,luteinizing hormone level on human chorionic gonadotropin injection day,and estradiol level on human chorionic gonadotropin injection day(P<0.05).Multifactorial forward stepwise Logistic regression results showed that age,microstimulation protocol,number of assisted conceptions,years of infertility,anti-mullerian hormone,and estradiol level on human chorionic gonadotropin injection day were independent influencing factors for the occurrence of abnormal fertilization following conventional in vitro fertilization.The receiver operating characteristic curves showed an area under the curve of 0.761(0.746,0.777)for the model group and 0.767(0.733,0.801)for the validation group,indicating that the model has good discrimination.The mean absolute error of the calibration curve was 0.044,and the Hosmer-Lemeshow test indicated that there was no significant difference between the predicted probability of abnormal fertilization and the actual probability of abnormal fertilization(P>0.05),indicating the prediction model has good consistency and accuracy.The clinical decision curves and clinical impact curves showed that the model and validation groups had the maximum net clinical benefit at valve probability values of 0.00-0.52 and 0.00-0.48,respectively,and there was a good clinical application efficacy in this valve probability range.To conclude,the nomogram model has good discrimination and accuracy as well as clinical application efficacy for predicting the occurrence of abnormal fertilization in women undergoing conventional in vitro fertilization based on age,microstimulation protocol,number of assisted conceptions,years of infertility,anti-mullerian hormone,and estradiol level on human chorionic gonadotropin injection day.

Objective The occurrence of chickenpox in rapidly developing areas poses substantial seasonal risk to children.However,certain factors influencing local chickenpox outbreaks have not been studied.Here,we examined the relationship between spatial clustering,heterogeneity of chickenpox outbreaks,and socioeconomic factors in Southern China. Methods We assessed chickenpox outbreak data from Southern China between 2006 and 2021,comprising both relatively fast-growing parts and slower sub-regions,and provides a representative sample of many developing regions.We analyzed the spatial clustering attributes associated with chickenpox outbreaks using Moran's I and local indicators of spatial association and quantified their socioeconomic determinants using Geodetector q statistics. Results There were significant spatial heterogeneity in the risk of chickenpox outbreaks,with strong correlations between chickenpox risk and various factors,particularly demographics and living environment.Furthermore,interactive effects among specific are factors,such as population density and per capita residential building area,percentage of households with toilets,percentage of rental housing,exhibited q statistics of 0.28,0.25,and 0.24,respectively. Conclusion This study provides valuable insights into the spatial dynamics of chickenpox outbreaks in rapidly developing regions,revealing the socioeconomic factors affecting disease transmission.These implications extend the formulation of effective public health strategies and interventions to prevent and control chickenpox outbreaks in similar global contexts.

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Objective To investigate Furin,tumor growth factor-β(TGF-β),vascular endothelial growth factor(VEGF),neuron towards axon guidance factor-1(netrin-1)level expressions and polymorphism of Furin gene P1 promoter r2071410 locus C/T in endometriosis(EMT)patients with different r-AFS stages,and explore the correlation with the incidence of EMT in Shenzhen.Methods A total of 102 patients diagnosed with EMT from May 2021 to January 2023 in the People's Hospital of Longhua,Shenzhen were selected as EMT group,and the EMT group was divided into stage Ⅰ to Ⅱ group and stageⅢ to Ⅳ group according to r-AFS staging method.At the same time,78 non-EMT patients were collected as control group.The levels of serum Furin,TGF-β,VEGF and netrin-1 were detected by enzyme-linked immunosorbent assay(ELISA),and the polymorphism of the r2071410 C/T locus in the P1 promoter region of Furin gene was analyzed by reverse transcription-real time quantitative polymerase chain reaction(RT-qPCR).Results The levels of Furin(140.84±47.02pg/ml),TGF-β(376.46±82.36ng/L)and VEGF(167.67±53.02ng/L)in EMT group were higher than those in control group(55.49±13.67pg/ml,216.37±15.04ng/L,102.27±8.45ng/L),while the level of netrin-1(48.37±15.20pg/ml)was lower than that of the control group(165.85±15.63pg/ml),with significant differences(t=28.409,20.347,16.915,36.653,all P＜0.05).The levels of Furin(192.41±20.62pg/ml),TGF-β(452.61±72.03ng/L)and VEGF(201.84±28.01ng/L)in patients with stage Ⅲ to Ⅳ were higher than those in patients with stage Ⅰ to Ⅱ(78.05±16.54pg/ml,283.75±56.92ng/L,126.07±19.35ng/L),while the level of netrin-1(37.95±11.34pg/ml)was lower than that of stage Ⅰ to Ⅱ(61.05±9.52pg/ml),with significant differences(t=31.071,18.054,19.183,21.625,all P＜0.05).Pearson/Spearman correlation analysis showed that Furin was positively correlated with levels of TGF-β and VEGF and clinical stage(r=0.614 9,0.752 6,0.790 5,均 P＜0.05),but negatively correlated with netrin-1 level(r=-0.670 1,all P＜0.05).The TT genotype and T allele frequencies at r2071410 C/T locus of Furin gene P1 promoter in EMT group(42.16％,55.39％)were higher than those in control group(7.69％,19.87％),while the TT genotype and T allele frequencies at stages Ⅲ to Ⅳ(51.79％,65.18％)were higher than those at stage Ⅰ to Ⅱ(30.43％,43.48％),and the differences were statistically significant(x2=26.500,46.472,4.721,9.626,all P＜0.05).The Furin level of patients with different genotypes in EMT group was different(F=51.286,P＜0.001),in which the Furin level of TT genotype(216.29±68.53pg/ml)was higher than that of CC(83.04±21.37pg/ml)and CT genotype,(89.18±20.95pg/ml),and the differences were statistically significant(t=27.146,25.719,all P＜0.01),but there was no significant difference between CC and CT genotypes(t=1.326,P＞0.05).Conclusion The level of Furin in EMT patients was increased,and it was certainly correlated with the levels of TGF-β,VEGF,netrin-1 and clinical stage.Meanwhile,the r2071410 C/T locus in the promoter region of Furin gene P1 showed a polymorphic distribution,in which the Furin level increased more significantly in patients with TT genotype,which may be related to the incidence of EMT in Shenzhen area.