Objective Performing physical tasks in the low-pressure environment of space poses a significant physiological challenge for astronauts.This study investigates the localized thermophysiological effects of typical physical tasks on different body segments and analyzes the mechanisms by which low-pressure environments influence human task performance.The findings aim to provide a theoretical basis for the thermal control design of spacesuits,focusing on both localized thermoregulation and overall task performance.Methods Two typical physical tasks—15 kg weighted walking and 25 kg load-carrying—were conducted in a simulated low-pressure composite environment chamber.The chamber was set to an altitude-equivalent pressure of 57 kPa(4500 m),with a temperature of 26℃and humidity of 40％.Six non-acclimatized adult male participants were recruited.After environmental stabilization,12-point skin temperatures were recorded throughout the tasks,and localized temperature data were statistically analyzed.Results Under low-pressure conditions,different body regions exhibited distinct thermal responses over time depending on the task type,while the same body region showed varied responses under different task conditions.During walking,temperatures in the primary active regions(thighs and calves)decreased,with most other body regions(except the pelvis and feet)gradually cooling as the task progressed.In contrast,during load-carrying,temperatures in the primary active regions(back and upper arm muscles)increased significantly.Conclusion Astronauts performing different tasks in low-pressure environments experience distinct localized thermophysiological effects.Therefore,spacesuit thermal control systems should not only account for task intensity and metabolic differences but also adapt localized heating/cooling based on task-specific thermal profiles.This approach enables targeted intelligent thermal regulation,enhancing operational support in specific mission scenarios.

Objective To develop and validate risk prediction models utilizing five machine learning algorithms for assessing postoperative pulmonary infection(PPI)risk in lung cancer patients undergoing grade Ⅳ thoracoscopic surgery.Methods A retrospective cohort study included 2,380 lung cancer patients who underwent grade Ⅳ thoracoscopic surgery at a tertiary hospital in Shanghai(January 2022 to June 2024).Patients were stratified into training(n=1,665)and validation(n=715)cohorts.Five machine learning algorithms—Logistic regression(LR),artificial neural network(ANN),support vector machine(S VM),random forest(RF),and extreme gradient boosting(XGB)—were employed to construct predictive models.A nomogram was developed for clinical utility.Results Among 2,380 patients,226(9.5％)developed PPI.The Least Absolute Shrinkage and Se-lection Operator(LASSO)regression identified eight predictive variables:daily cigarette consumption,diabetes history,preoperative diffusing capacity,maximal tumor diameter,24-hour postoperative chest drainage volume,perioperative oral nutritional supplementation(ONS),postoperative urinary cathe-terization,and intraoperative pleural adhesion severity.All models demonstrated robust discrimina-tion,with area under the curve(AUC)values ranging from 0.862 to 0.947.The XGB model a-chieved superior performance(AUC=0.947,95％CI,0.937 to 0.962),followed closely by the LR model(AUC=0.926,95％CI,0.918 to 0.933).Conclusion Machine learning-based algo-rithms models effectively stratify PPI risk in lung cancer patients following grade Ⅳ thoracoscopic surgery.The derived nomogram provides a practical tool for perioperative risk management by healthcare providers.

Background::Risk assessment and treatment stratification for three-vessel coronary disease (TVD) remain challenging. This study aimed to investigate the prognostic value of left atrial volume index (LAVI) with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score II, and its association with the long-term prognosis after three strategies (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], and medical therapy [MT]) in patients with TVD.Methods::This study was a post hoc analysis of a large, prospective cohort of patients with TVD in China, that aimed to determine the long-term outcomes after PCI, CABG, or optimal MT alone. A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital. A total of 7818 patients with available baseline LAVI data were included in the study. Baseline, procedural, and follow-up data were collected. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), which was a composite of all-cause death, myocardial infarction (MI), and stroke. Secondary endpoints included all-cause death, cardiac death, MI, revascularization, and stroke. Long-term outcomes were evaluated among LAVI quartile groups. Results::During a median follow-up of 6.6 years, a higher LAVI was strongly associated with increased risk of MACCE (Q3: hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.06-1.37, P = 0.005; Q4: HR 1.85, 95%CI 1.64-2.09, P <0.001), all-cause death (Q3: HR 1.41, 95% CI 1.17-1.69, P <0.001; Q4: HR 2.54, 95%CI 2.16-3.00, P <0.001), and cardiac death (Q3: HR 1.81, 95% CI 1.39-2.37, P <0.001; Q4: HR 3.47, 95%CI 2.71-4.43, P <0.001). Moreover, LAVI significantly improved discrimination and reclassification of the SYNTAX score II. Notably, there was a significant interaction between LAVI quartiles and treatment strategies for MACCE. CABG was associated with lower risk of MACCE than MT alone, regardless of LAVI quartiles. Among patients in the fourth quartile, PCI was associated with significantly increased risk of cardiac death compared with CABG (HR: 5.25, 95% CI: 1.97-14.03, P = 0.001). Conclusions::LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease. CABG is associated with improved long-term outcomes compared with MT alone, regardless of LAVI quartiles. When LAVI is severely elevated, PCI is associated with higher risk of cardiac death than CABG.

Objective:To explore the differences in postoperative recovery, economic effects, and discharge readiness between the day surgical ward mode and the traditional hospitalization mode for lung cancer patients based on propensity score matching analysis.Methods:From August to December 2022, 320 lung cancer patients who underwent thoracoscopy in the Department of Thoracic Surgery and Day Surgery Ward of the Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine were selected as the study subject by convenience sampling. The patients were surveyed using the General Information Questionnaire and the Readiness for Hospital Discharge Scale (RHDS) . The differences in postoperative recovery indicators, economic indicators, and discharge readiness between the day surgical ward mode and the traditional hospitalization mode for lung cancer patients were compared. A total of 320 questionnaires were distributed, and 308 valid questionnaires were collected, with an effective response rate of 96.25% (308/320) .Results:Among 308 lung cancer patients, there were 161 in the day surgical ward mode group and 147 in the traditional hospitalization mode group. Through propensity matching, a total of 160 cases were successfully matched, with 80 cases in each group. The first time out of bed, chest tube retention time, and postoperative hospitalization time in the day surgical ward mode group were all shorter than those in the traditional hospitalization mode group, with statistically significant differences ( P<0.05) . There was no statistically significant difference in the incidence of postoperative complications, adverse reactions, and pain scores between the two groups on the first and second postoperative days ( P>0.05) . The laboratory expenses, Western medicine expenses, and total postoperative hospitalization expenses of the day surgical ward mode group were all lower than those of the traditional hospitalization mode group, and the differences were statistically significant ( P<0.05) . The individual status, adaptability, and discharge readiness scores of the day surgical ward mode group were lower than those of the traditional hospitalization mode group, with statistically significant differences ( P<0.05) . Conclusions:The daytime surgical ward mode based on enhanced recovery after surgery for lung cancer can ensure the safety of patients during the perioperative period, promote early recovery, shorten hospitalization time, and improve economic effects. Compared to the traditional hospitalization mode, there is still room for improvement in the discharge readiness of the day surgical ward mode. It is necessary to strengthen the evaluation of patient discharge readiness and implement targeted interventions.

Objective:To explore the curative effect of Penumbra retrograde semi-retrieval Solitaire stents technique in the treatment of acute basilar artery occlusion.Methods:The clinical data of 15 patients with acute basilar artery occlusion in Shengjing Hospital of China Medical University from January 2017 to December 2019 were analyzed retrospectively. All patients were treated with Penumbra retrograde semi-retrieval Solitaire stents technique. The modified thrombolysis in cerebral infarction (mTICI) was used to evaluate the therapeutic effect.Results:Fifteen patients achieved vascular recanalization of occluded basilar artery, and mTICI 2b grade was in 3 cases, 3 grade in 12 cases. One operation completed vascular recanalization in 11 cases, 2 times in 3 cases,3 times in 1 case. CT images 24 to 48 h after operative showed no intracranial hemorrhage. The National Institutes of Health stroke scale (NIHSS) score at discharge was significantly lower than that before surgery: (4.8 ± 2.1) scores vs. (16.1 ± 5.7) scores, and there was statistical difference ( P<0.01). Conclusions:Penumbra retrograde semi-retrieval Solitaire stents technique can improve the efficiency of thrombus grasping and significantly improve patient symptoms.

Objective:To investigate the long-term effects of metabolically healthy obesity on the risks of type 2 diabetes, cardiovascular disease events, and its mortality over a 23-year follow-up.Methods:Based on the results of an oral glucose tolerance test, there were 519 participants with normal glucose tolerance and 630 with newly diagnosed type 2 diabetes enrolled in 1986 and then given to assess the long-term clinical outcomes during the 23-year follow-up in Daqing. Metabolically healthy obesity was defined as the overweight and obese individuals with no metabolic abnormalities (diabetes, hypertension, hyperlipidemia). Finally, we identified 682 participants (350 with normal glucose tolerance and 332 with newly diagnosed diabetes). They were divided into five groups: 211 individuals with metabolically healthy normal weight (MHNW group), 58 with metabolically healthy overweight and obesity (MHO group), 81, 109, 223 were metabolically unhealthy overweight and obesity with hypertension (MUHO group), type 2 diabetes (MUDO group), hypertension and diabetes (MUHDO group). Incidences of type 2 diabetes, morbidity and mortality of cardiovascular disease were compared among these groups.Results:Over 23 years, instead of the morbidity and mortality of cardiovascular disease, the incidence of type 2 diabetes in MHO group was two times higher than in MHNW group ( 24.1%, 12.5/1 000 person years vs 10.9%, 5.2/1 000 person years, P=0.01), with an age, sex, and smoking history-adjusted hazard ratio ( HR) of 2.42 (95% CI 1.24-4.74, P=0.01). The morbidity and mortality of cardiovascular disease in the groups of overweight and obesity with metabolically unhealthy were higher than in MHNW group, and increased across the subjects with MUHO, MUDO, MUHDO ( P<0.05). Conclusion:Compared with metabolically healthy normal weight participants, the metabolically healthy obese group was at increased risk of type 2 diabetes but not cardiovascular disease events and its mortality. On the contrary, the overweight and obese groups with metabolic abnormalities had significant higher incidence of type 2 diabetes, morbidity and mortality of cardiovascular diseases.

Objective To study the association between transforming growth factor-β1 (TGF-β1) polymorphism and type 2 diabetes mellitus in Han population of Shanghai. Methods In this case-control study , 1 234 cases of T2DM patients were recruited and 1 272 healthy individuals were selected as control. Five ml of blood sample was collected from each subject ,from which the whole genomic DNA was extracted.The polymorphism was detected by the Taqman technology. Result Significant association was observed in TGF-β1 T896C genotypes and alleles with T2DM (P = 0.0001 and P = 0.004, OR = 1.18 [1.05 ~ 1.33], respectively). Conclusion The polymorphism of T896C in TGF-β1 gene may be associated with T2DM in Han population from Shanghai.

Objectives: To evaluate the effect and safety of 14-day continuous subcutaneous insulin infusion (CSII) in type 2 diabetes patients with heart diseases.
Methods: A total of 22 consecutive type 2 diabetes patients (history ≤ 5 years) with heart diseases treated in our hospital from 2011-03 to 2013-08 were studied. There were 20 male, and the with the mean age of patieuts (48.15 ± 9.80) years, all patients without standard hypoglycemic treatment before admission. The patients received 14-day CSII for enhanced treatment and the blood glucose level, insulin function and insulin sensitivity were compared before and after the treatment.
Results: After CSII treatment, the blood glucose level was obviously decreased, fasting blood glucose (FBG) and postprandial blood glucose at 30, 60 and 120 min were improved, all P<0.001. The C peptide level was higher at 60 and 120 min alter treatweut as 2.73 (1.05-7.05)ng/ml vs 3.84 (1.22-63.39)ng/ml, P=0.004 and 3.34 (1.42-9.61)ng/ml vs 6.27 (0.93-47.39)ng/ml, P=0.004. The insulin sensitivity was improved as -1.89 ± 0.29 vs -1.70±0.31, P=0.008. With CSII treatment, there were 22.73% patients (5/22) at remission by controlling the diet and excise and 77.27% (17/22) with continuing medication. The patients were followed-up for (12.4 ± 8.5) months, there were 4/5 patients with euglycemia, 1/5 with increase blood sugar and received medication at 2 months after discharge, the rest 17 patients remained oral hypoglycemic medication.
Conclusion: CSII may quickly relieve glucotoxicity and improve insulin sensitivity in type 2 diabetes patients with heart diseases. Some patients may alleviate drug burden in clinical practice.

OBJECTIVETo identify the casual mutation of a Chinese pedigree with hypertrophic cardiomyopathy (HCM), and to analyze the genotype-phenotype relationship.

METHODSThe coding exons of 26 reported disease genes were sequenced by targeted resequencing in the proband and the identified mutation were detected with bi-directional Sanger sequencing in all family members and 307 healthy controls. The genotype-phenotype correlation was analyzed in the family.

RESULTSA missense mutation (c.2191C > T, p. Pro731Ser) in the 20th exon of MYH7 gene was identified. This mutation was absent in 307 healthy controls and predicted to be pathogenic by PolyPhen-HCM. Totally 13 family members carried this mutation, including 10 patients with HCM and 3 asymptomatic mutation carriers. The proband manifested severe congestive heart failure and 8 patients expressed various clinical manifestations of heart failure, including dyspnea, palpitations, chest pain, amaurosis or syncope. Five patients were diagnosed as HCM at the age of 16 or younger. One family member suffered sudden cardiac death.

CONCLUSIONSThe Pro731Ser of MYH7 gene mutation is a causal and malignant mutation linked with familiar HCM.

Adolescent ; Asian Continental Ancestry Group ; Base Sequence ; Cardiomyopathy, Hypertrophic ; ethnology ; genetics ; Death, Sudden, Cardiac ; Exons ; Humans ; Mutation, Missense ; Myosin Heavy Chains ; genetics ; Pedigree ; Phenotype ; Research Design ; Ventricular Myosins

Objective To identify the casual mutation of a Chinese pedigree with hypertrophic cardiomyopathy (HCM),and to analyze the genotype-phenotype relationship.Methods The coding exons of 26 reported disease genes were sequenced by targeted resequencing in the proband and the identified mutation were detected with bi-directional Sanger sequencing in all family members and 307 healthy controls.The genotype-phenotype correlation was analyzed in the family.Results A missense mutation (c.2191C>T, p.Pro731Ser) in the 20th exon of MYH7 gene was identified.This mutation was absent in 307 healthy controls and predicted to be pathogenic by PolyPhen-HCM.Totally 13 family members carried this mutation , including 10 patients with HCM and 3 asymptomatic mutation carriers.The proband manifested severe congestive heart failure and 8 patients expressed various clinical manifestations of heart failure , including dyspnea , palpitations , chest pain , amaurosis or syncope.Five patients were diagnosed as HCM at the age of 16 or younger.One family member suffered sudden cardiac death.Conclusions The Pro731Ser of MYH7 gene mutation is a causal and malignant mutation linked with familiar HCM.