Objective To quantitatively assess the association of short-term exposure to polycyclic aromatic hydrocarbons (PAHs) in ambient fine particulate matter (PM2.5) with residents mortality. Methods A time-stratified case-crossover study was conducted from 2020 to 2022 among 10606 non-accidental residents by using the Guangzhou Cause of Death Surveillance System in Conghua District, Guangzhou. Exposure levels of PAHs in PM_2.5 and meteorological data during the study period were obtained from the Center for Disease Control and Prevention in Conghua District and the China Meteorological Administration Land Data Assimilation System (CLDAS-V2.0), respectively. Conditional Poisson regression model was used to estimate the exposure-response association between PAHs and the mortality risk. Results Fluoranthene, chrysene, benzo[k]fluoranthene, benzo[a]pyrene, and indeno[1,2,3-cd]pyrene were significantly associated with an increased risk of mortality. For every one interquartile range increase in exposure levels, the non-accidental mortality risks increased by 8.33% (95% CI: 1.80%, 15.27%), 4.67% (95% CI: 1.86%, 7.57%), 6.07% (95% CI: 2.08%, 10.21%), 4.62% (95% CI: 1.85%, 7.47%), and 4.70% (95% CI: 0.53%, 9.03%), respectively. The estimated non accidental deaths attributable to exposure to fluoranthene, chrysene, benzo[k]fluorine, benzo[a]pyrene and indine[1,2,3-cd]pyrene were 5.91%, 6.08%, 6.51%, 6.46%, and 4.21%, respectively. Conclusions Short-term exposure to PAHs in PM_2.5, including fluoranthene, chrysene, benzo[k]fluoranthene, benzo[a]pyrene and indine[1,2,3-cd]pyrene, was significantly associated with an increased risk of mortality among residents.

Objective: To investigate the epidemiological characteristics of varicella outbreaks in primary and middle schools, and to establish a risk predictive model, so as to provide scientific guidance for the prevention of varicella outbreaks in schools. Methods: Based on a nested case-control study, primary and middle schools in 4 districts of Shanghai (Yangpu District and Jingan District) and Hangzhou (Xiaoshan District and Linping District) from January to December 2023 were selected to observe the status of varicella outbreaks. Associated factors of varicella outbreaks were investigated and used for establishing the predictive model, which was evaluated by the Hosmer-Lemeshow(H-L) goodness of fit test, receiver operating characteristic (ROC) curve, Calibration curve, decision curve analysis (DCA). Results: A total of 98 varicella outbreaks were included, with 195 schools without varicella outbreaks during the same period as controls. Eight factors, including the availability of warm water in restroom, availability of hand soap in restroom, average class size, duration of student attendance at school per day, presence of a fulltime school doctor, hesitancy of the school principal towards varicella vaccination, and rates of first and second doses of varicella vaccination, were identified as potential factors for school varicella outbreaks, with statistically significant differences (χ2/Z=10.01, 20.49, 17.43, 9.74, 32.17, 6.60, 2.20, 3.39, P<0.05). The 8 variables above were employed to construct a risk predictive model, and Hosmer-Lemeshow goodness of fit test yielded a χ2 value of 5.863 (P>0.05); the area under the ROC curve (AUC) was 0.846 (95%CI=0.799-0.893); Calibration curve analysis indicated good consistency between predicted and actual values of the model. DCA demonstrated favorable predictive performance of the model over a wide range. Conclusions The predictive model for school varicella outbreaks demonstrates satisfactory accuracy and efficacy. It suggested to make good use of this prediction model and take relevant measures to reduce the risk of varicella transmission in schools.

Myotonic dystrophy type 1(DM1)is a multisystem trinucleotide repeat expansion disorder usually referred to the department of neurology with complaints of progressive muscle weakness and myotonia.This article reported a 33-year-old female patient with DM1 presenting with acute respiratory failure.Muscle bi-opsy in vastus lateralis showed significantly increased internal nuclei.Genetic test show CTG repeat expansions with the size of(847±76)in dystrophia myotonica protein kinase(DMPK)gene on chromosome 19.This case report broadens the clinician's understanding of the atypical clinical manifestations of DM1,so as to avoid missed diagnosis and misdiagnosis.

Objective To investigate the mechanism of mikanolide derivative LY19380b in inhibiting the growth of human leukemia cell HEL.Methods Methyl thiazolyl tetrazolium(MTT)assay was used to detect the effect of compound LY19380b on the proliferation of human tumor cells,flow cytometry was used to determine cell cycle,Annexin V-FITC/PI double staining and Hoechst 33258 staining were used to determine apoptosis.Western blot was used to analyze effects of LY19380b on cell cycle and apoptosis-related proteins.Results LY19380b had anti-proliferative activity on different human tumor cells,and significantly inhibited the growth of human leukemia cell HEL.It can also induce apoptosis and affect the cell cycle of HEL.In addition,LY19380b could significantly increase the expressions of P53,BIM,BID,BAD,BAX,FLIP,P21 and Cyclin B1 proteins,while decreased the expressions of Bcl-2,p-CDC25C,p-AKT,p-STAT3 and p-ERK proteins.Conclusion By increasing the expressions of pro-apoptotic proteins BIM,BID,BAD and BAX,decreasing the expression of anti-apoptotic protein Bcl-2,LY19380b induced the apoptosis of human leukemia cell HEL,and upregulated the expressions of P21 and Cyclin B1,thus leading to cell cycle arrest in HEL.

Objective: To investigate the trends in incidence of stroke in Jindong District, Jinhua City, Zhejiang Province from 2016 to 2022, so as to provide to the evidence for improving the stroke control strategy. Methods: The incidence of stroke in Jindong District from 2016 to 2022 was collected through the Zhejiang Chronic Disease Monitoring Information System, and standardized by the data of the Chinese National Population Census in 2010. The gender-, age- and subtype-specific incidence of stroke was calculated, and the trends in stroke incidence were investigated with average annual percent change (AAPC). Results: A total of 9 159 stroke cases were reported in Jindong District from 2016 to 2022, with crude incidence of 386.52/105 and standardized incidence of 276.75/105. The crude incidence of stroke appeared a tendency towards a rise (AAPC=3.704%, 95%CI: 0.792%-6.700%, P<0.05), while the standardized incidence showed no significant changing patterns (P>0.05). The crude incidence of stroke was significantly higher among men than among women (438.69/105 vs. 334.66/105; χ2=14.028, P<0.05), and the standardized incidence of stroke was significantly higher among men than among women (316.58/105 vs. 237.31/105; χ2=6.985, P<0.05). The crude incidence of stroke appeared a tendency towards a rise with age（χ2=5 290.180, P<0.05), and the crude incidence of stroke appeared a tendency towards a decline with age among residents at ages of 45 to 64 years (AAPC=-9.135%, 95%CI: -15.003% to -2.861%, P<0.05), while no significant changing patterns were found in the crude incidence of stroke among residents at other age groups (P>0.05). The crude incidence of ischemic stroke was significantly higher than that of hemorrhagic stroke (306.08/105 vs. 76.89/105; χ2=137.184, P<0.05). Conclusions The incidence of stroke appeared a tendency towards a rise in Jindong District from 2016 to 2022, with ischemic stroke as the predominant subtype. Male and middle-aged and elderly populations should be given a high priority for stroke control.

Humans ; Nitric Oxide ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Lung Neoplasms ; Lung ; Nitric Oxide Synthase ; Macrophages, Alveolar ; Pulmonary Alveoli

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To explore the effects of multidimensional pain intervention model on postoperative pain in patients with perianal abscess.Methods:Totally 106 patients with perianal abscess who were admitted to the China-Japan Friendship Hospital from March 2020 to March 2022 were selected by convenience sampling and divided into observation group and routine group according to the admission time, with 53 patients in each group. Patients in the routine group received routine nursing care, while patients in the observation group were treated with a multidimensional pain intervention model based on the care provided to the routine group. The postoperative Numerical Rating Scale (NRS) and Depression-Anxiety-Stress Scale 21 (DASS-21) scores were compared between the two groups.Results:The NRS scores of the observation group at 1, 3, 5 and 7 days after surgery were all lower than those of the routine group, and the differences were statistically significant ( P<0.05) ; the DASS-21 scores of the observation group were lower than those of the routine group at 1 and 7 days after surgery, with statistically significant differences ( P<0.05) . Conclusions:The multidimensional pain intervention model can ameliorate postoperative pain and negative emotions of patients with perianal abscess.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

Post-stroke depression (PSD) is one of the common complications of stroke, which can seriously affect the functional rehabilitation of patients with stroke and increase their mortality and disability rate. As for the pathogenesis of PSD, endogenous theory emphasizes that it is closely associated with biological mechanism, while reactive theory believes that it is associated with psychosocial factors. At present, the research on the pathogenesis and treatment of PSD focuses on inflammation, immune response, stress, nerve regeneration, brain network, biological rhythm disorder, sleep disorder, melatonin and so on. This article reviews the research progress on the neurobiological mechanism of PSD and the related treatment for the pathogenesis.