Objective:To evaluate the association between heatwaves and fall-related mortality.Methods:A total of 61 421 fall-related mortality from 2013 to 2022 in 7 provinces of China were included in a time-stratified case-crossover design, with daily meteorological data derived from the fifth generation European Reanalysis dataset produced by the European Centre for Medium-Range Weather Forecasts. Conditional logistic regression chimeric distributed lag nonlinear model was used to analyze the association between heatwaves and fall-related mortality and stratified analysis was conducted according to gender and age.Results:Heatwaves were associated with an increased risk of fall-related morality. The risk of fall-related mortality during heatwaves was higher than during non-heatwave periods ( OR=1.11, 95% CI: 1.05-1.18). The attributable fraction of fall-related motality due to heatwaves was 10.25% (95% CI: 4.49%-15.36%). For each 1 ℃ increase above the heatwave threshold, the risk of fall-related mortality increased by 34% ( OR=1.34, 95% CI: 1.02-1.76). The effect of heatwave duration on fall-related mortality was not statistically significant. Stratified analyses indicated that women experienced a higher risk of fall-related mortality during heatwaves ( OR=1.13, 95% CI: 1.04-1.22) compared to man ( OR=1.10, 95% CI: 1.04-1.17). Conclusions:Heatwave increases the risk of fall-related mortality, and the intensity of heatwaves modify this risk. Women are vulnerable populations.

Osteosarcoma is a highly aggressive bone tumor that primarily affects children and adolescents. It is characterized by high rates of recurrence and metastasis, with the tumor microenvironment playing a pivotal role in disease progression. Exosomes, small extracellular vesicles secreted by various cell types, exert dual roles in osteosarcoma. On one hand, exosomes derived from osteosarcoma cells remodel the microenvironment to facilitate tumor progression. For instance, they carry miR-501-3p to activate the PTEN/PI3K/Akt signaling pathway, promoting osteoclastogenesis and bone destruction; TGF-β1/3 stimulates bone marrow-derived mesenchymal stem cells (BMSCs) to secrete IL-6 and IL-8, enhancing the inflammatory microenvironment; and miR-25-3p suppresses DKK3, thereby promoting angiogenesis and invasion. Moreover, exosomes contribute to the formation of a pre-metastatic niche by transporting miR-21 and miR-675, which promote lung metastasis, activate cancer-associated fibroblasts, and enhance invasiveness via the linc00881/miR-29c-3p/MMP2 axis. Conversely, exosomes derived from mesenchymal stem cells deliver tumor-suppressive miRNAs such as miR-1913, miR-150, and miR-206, which target NRSN2, IGF2BP1, and TRA2B, thereby inhibiting tumor growth. In the context of drug resistance, osteosarcoma-derived exosomes transport MDR-1 mRNA and circRNA_103801, contributing to chemotherapy resistance. Additionally, TGF-β-induced IL-6 activates the STAT3 pathway, further enhancing resistance. In terms of immune modulation, these exosomes suppress T cell and NK cell activity and upregulate PDL1 expression, promoting immune evasion. Exosomes also hold therapeutic potential. They can serve as drug delivery vehicles, for example, carrying doxorubicin or kanamycin, to achieve targeted cytotoxicity via ferroptosis or apoptosis. Engineered exosomes enriched with miR-101 or MEG3 have been shown to inhibit metastasis, while plant-derived exosome-like nanoparticles activate the P38/JNK pathway to induce apoptosis. These approaches aim to improve therapeutic efficacy while minimizing adverse effects. In summary, exosomes play multifaceted roles in the pathogenesis of osteosarcoma and offer promising avenues for early diagnosis, prognostic assessment, and precision therapy, including pathway-targeted strategies. However, challenges remain in optimizing exosome isolation, standardizing large-scale production, and validating clinical applications. Addressing these issues is essential for translating laboratory findings into effective clinical treatments.

Objective:To evaluate the association between heatwaves and fall-related mortality.Methods:A total of 61 421 fall-related mortality from 2013 to 2022 in 7 provinces of China were included in a time-stratified case-crossover design, with daily meteorological data derived from the fifth generation European Reanalysis dataset produced by the European Centre for Medium-Range Weather Forecasts. Conditional logistic regression chimeric distributed lag nonlinear model was used to analyze the association between heatwaves and fall-related mortality and stratified analysis was conducted according to gender and age.Results:Heatwaves were associated with an increased risk of fall-related morality. The risk of fall-related mortality during heatwaves was higher than during non-heatwave periods ( OR=1.11, 95% CI: 1.05-1.18). The attributable fraction of fall-related motality due to heatwaves was 10.25% (95% CI: 4.49%-15.36%). For each 1 ℃ increase above the heatwave threshold, the risk of fall-related mortality increased by 34% ( OR=1.34, 95% CI: 1.02-1.76). The effect of heatwave duration on fall-related mortality was not statistically significant. Stratified analyses indicated that women experienced a higher risk of fall-related mortality during heatwaves ( OR=1.13, 95% CI: 1.04-1.22) compared to man ( OR=1.10, 95% CI: 1.04-1.17). Conclusions:Heatwave increases the risk of fall-related mortality, and the intensity of heatwaves modify this risk. Women are vulnerable populations.

Osteosarcoma is a highly aggressive bone tumor that primarily affects children and adolescents. It is characterized by high rates of recurrence and metastasis, with the tumor microenvironment playing a pivotal role in disease progression. Exosomes, small extracellular vesicles secreted by various cell types, exert dual roles in osteosarcoma. On one hand, exosomes derived from osteosarcoma cells remodel the microenvironment to facilitate tumor progression. For instance, they carry miR-501-3p to activate the PTEN/PI3K/Akt signaling pathway, promoting osteoclastogenesis and bone destruction; TGF-β1/3 stimulates bone marrow-derived mesenchymal stem cells (BMSCs) to secrete IL-6 and IL-8, enhancing the inflammatory microenvironment; and miR-25-3p suppresses DKK3, thereby promoting angiogenesis and invasion. Moreover, exosomes contribute to the formation of a pre-metastatic niche by transporting miR-21 and miR-675, which promote lung metastasis, activate cancer-associated fibroblasts, and enhance invasiveness via the linc00881/miR-29c-3p/MMP2 axis. Conversely, exosomes derived from mesenchymal stem cells deliver tumor-suppressive miRNAs such as miR-1913, miR-150, and miR-206, which target NRSN2, IGF2BP1, and TRA2B, thereby inhibiting tumor growth. In the context of drug resistance, osteosarcoma-derived exosomes transport MDR-1 mRNA and circRNA_103801, contributing to chemotherapy resistance. Additionally, TGF-β-induced IL-6 activates the STAT3 pathway, further enhancing resistance. In terms of immune modulation, these exosomes suppress T cell and NK cell activity and upregulate PDL1 expression, promoting immune evasion. Exosomes also hold therapeutic potential. They can serve as drug delivery vehicles, for example, carrying doxorubicin or kanamycin, to achieve targeted cytotoxicity via ferroptosis or apoptosis. Engineered exosomes enriched with miR-101 or MEG3 have been shown to inhibit metastasis, while plant-derived exosome-like nanoparticles activate the P38/JNK pathway to induce apoptosis. These approaches aim to improve therapeutic efficacy while minimizing adverse effects. In summary, exosomes play multifaceted roles in the pathogenesis of osteosarcoma and offer promising avenues for early diagnosis, prognostic assessment, and precision therapy, including pathway-targeted strategies. However, challenges remain in optimizing exosome isolation, standardizing large-scale production, and validating clinical applications. Addressing these issues is essential for translating laboratory findings into effective clinical treatments.

OBJECTIVETo compare the efficacy difference between acupotomy and acupuncture in the treatment of avascular necrosis of femoral head at the early and middle stages.

METHODSThe randomized controlled prospective study method was adopted. Sixty cases of avascular necrosis of femoral head at Ficat-ArletⅠto Ⅱ stages were randomized into an acupotomy group (32 cases) and an acupuncture group (28 cases) by the third part. In the acupotomy group, the acupotomy was adopted for the loose solution at the treatment sites of hip joint, once every two weeks, totally for 3 times. In the acupuncture group,points around the hip joint were selected and stimulated with warm acupuncture therapy, once every day, for 6 weeks. Harris hip score was observed before and after treatment. The efficacy was evaluated in the two groups.

RESULTSHarris hip score was improved significantly after treatment in the two groups (both<0.05). The result in acupotomy group was better than that in the acupuncture group (<0.05). The effective rate was 90.6% (29/32) in the acupotomy group, better than 75.0% (21/28) in the acupuncture group after treatment (<0.05).

CONCLUSIONSHarris hip score and the effective rate in the acupotomy group are better than those in the treatment with routine acupuncture for avascular necrosis of femoral head at the early and middle stages.

Objective To explore the dynamic changes of endothelial barrier antigen (EBA) and vascular endothelial growth factor (VEGF) expressions in cerebral cortex under the condition of blood-brain barrier damage in rats following radi?ation-induced brain injury, which provided clinical references. Methods Forty-eight clean grade male SD rats were divid?ed into the control group and 7 d, 14 d, 28 d after brain irradiation group (n=12 for each group) by using stochastic indicator method. The radiation-induced brain injury model was established by using electronic computer X-ray tomography tech?nique. The 3%Evans blue (EB) was injected into rats according to the dose of 3 mL/kg via the tail vein, then the blood ves?sels of cerebral cortex were exposed after having a craniotomy. EB extravasation was detected by microcirculation micro?scope. The permeability of blood-brain barrier was evaluated by using microscope vascular camera device. The expressions of EBA and VEGF in the cerebral cortex were measured by immunohistochemistry staining in each group. Results Both of EB extravasation and VEGF expression in rat cerebral cortex were significantly increased in injury group at day 7, 14 and 28 after brain irradiation compared with those of control group (P<0.05), and which were gradually decreased from day 7 to day 28 after brain irradiation. There were significant differences in EB extravasation and VEGF expression between the injury subgroups (P<0.05). There was a positive correlation between EB extravasation and VEGF expression (r=0.898, P<0.001). The expression levels of EBA were decreased at different time points in injury groups compared with those of control group (P<0.05), and gradually increased from day 7 to 28 after injury. There were significant differences in expression levels of EBA between injury subgroups (P<0.05). The expression of EBA was negatively correlated with EB extravasation (r=-0.866, P<0.001). Conclusion The increases of blood-brain barrier permeability have important relation to the decreases of EBA expression and the increases of VEGF expression after radiation-induced brain injury.

Aiming at the single treatment and the design separation between treatment and assessment in electrotherapy equipment, a kind of system including low-intermediate frequency treatment and efficacy evaluation was developed. With C8051F020 single-chip microcomputer as the core and the circuit design and software programming used, the system realized the random switch of therapeutic parameters, the collection, display and data storage of pressure pain threshold in the assessment. Experiment results showed that the stimulus waveform, current intensity, frequency, duty ratio of the system output were adjustable, accurate and reliable. The obtained pressure pain threshold had a higher accuracy (< 0.3 N) and better stability, guiding the parameter choice in the precise electrical stimulation. It, therefore, provides a reliable technical support for the treatment and curative effect assessment.
Electric Stimulation Therapy ; instrumentation ; Equipment Design ; Microcomputers ; Pain Measurement ; instrumentation ; Software