Objective To investigate the exposure-response relationships and lag effects between air pollutants (PM_2.5, PM₁₀, O₃, and NO₂) and mortality in Jiading District, Shanghai, and to provide a scientific basis for the formulation of environmental health policies. Methods Using an individual-level time-stratified case-crossover design, conditional logistic regression models in conjunction with a distributed lag nonlinear model (DLNM) were employed to analyze the exposure-response relationship and temporal lag patterns of ambient air pollution on resident mortality in Jiading District (1994–2024). Results A total of 59 048 death cases were collected, including 18,701 deaths from cardiovascular diseases and 11 731 deaths from respiratory diseases. PM_2.5 and NO₂ had a significant impact on all-cause mortality, cardiovascular disease mortality, and respiratory disease mortality, with the most significant effects observed within a lag of 0–3 days. PM₁₀ also had some impact on these three types of mortality, but its effect was generally weaker than that of PM_2.5 and NO₂. The exposure-response curves showed that the risk of death increased rapidly with increasing concentrations of PM_2.5 and PM₁₀, while the effect of NO₂ plateaued at higher levels. No significant differences were found across age or gender subgroups. Conclusion Short-term exposure to PM_2.5, PM₁₀, and NO₂ significantly increases all-cause mortality risk in Jiading District, with effects persisting up to 7 days, highlighting the need for enhanced air pollution control measures, particularly targeting fine particulate matter.

Objective: To understand health literacy and associated factors of freshmen from Jiangsu Province, and to provide reference for youth health education. Methods: From 2017 October to 2018 October, a total of 15 602 college freshman were randomly selected from 20 universities in Jiangsu Province via stratified cluster sampling method. Structural questionnaires were used to investigate the status of health literacy. The χ 2 test and multivariate Logistic regression model were used to analyze the influencing factors of health literacy. Results: The health literacy level of college freshmen from Jiangsu Province was 20.2%, among which the literacy levels of knowledge, behavior and skills were 23.0%, 30.7% and 31.5% respectively. The literacy levels of the six public health issues, including safety and first aid, scientific health attitude, knowledge of prevention and treatment of infectious diseases, health information, basic health care, and prevention and treatment of chronic diseases, from high to low, were 72.8%, 58.7%, 28.5%, 28.2%, 20.3% and 15.9%, respectively. Multivariate Logistic regression analysis has showed that students from undergraduate colleges(OR=2.77, 95%CI=2.47-3.11), urban areas(OR=1.20, 95%CI=1.07-1.34), or southern Jiangsu regions(OR=1.10, 95%CI=1.00-1.22), being the only child(OR=1.13, 95%CI=1.03-1.25), higher maternal education level (OR=1.53, 95%CI=1.30-1.79), having both parents(OR=1.16, 95%CI=1.00-1.34), reported higher level of health literacy. Conclusion The three aspects and six dimensions of health literacy of college freshmen were unbalanced. Health literacy is a shared function of multiple factors including society, family, and individuals. It is essential to promote health education through more efforts on key issues, in order to effectively elevate the health literacy level of adolescent students.

Objective:To review the imaging characteristics and evaluate the diagnostic value of Doppler echocardiography for congenitally malposition of septum primum(MSP).Methods:Images of Doppler echocardiography were retrospectirely rewiewed and compared with CTA, operative and necropsy findings in 8 cases with MSP in Xinhua Hospital, and Shanghai Children′s Medical Center, Shanghai Jiaotong University School of Medicine from January 2009 to October 2019.Results:MSP was characterized by the absent of superior limbic band of septum secundum and different degrees of the leftward deviation of septum primum, and the pulmonary veins which connected with the posterior wall of the anatomical left atrium incorporated intothe right atrium. The associated malformations included totally anomalous (7 cases) and partially anomalous (1 case) pulmonary venous drainage directly to the right atrium. Six of 8 cases were diagnosed correctly. In the remaining 2 cases, 1 case misdiagnosed as single atrium, and the other case misdiagnosed as cor triatriatum.Conclusions:MSP could be diagnosed accurately by Doppler echocardiography. This malformation should be distinguished from single atrium and cor triatriatum.

Objective: To investigate the efficacy and safety of CD19 chimeric antigen receptor T (CAR-T) lymphocytes for the treatment of B cell lymphoma. Methods: A total of 22 patients with B-cell lymphoma from February 1, 2017 to July 1, 2018 were reviewed to evaluate the efficacy and adverse reactions of CD19 CAR-T. Results: Of 22 patients with B-cell lymphoma received CD19 CAR-T cells, the median dose of CAR-T cells was 7.2 (2.0-12.0) ×10⁶/kg. Nine of 12 cases of relapse refractory patients were overall response. Complete remission (CR) occurred in 2 of 12 patients, partial remission (PR) in 7 of 12 patients. The overall response in minor residual disease positive (MRD) group was 8 of 10 patients. CD19 CAR-T cells proliferated in vivo and were detectable in the blood of patients. The peak timepoints of CAR-T cells proliferated in the relapsed refractory and MRD positive groups were 12 (5-19) and 4.5 (1-12) days after treatment respectively, and among peripheral blood cells, CAR-T cells accounted for 10.10% (3.55%-24.74%) and 4.02% (2.23%-28.60%) of T lymphocytes respectively. The MRD positive patients achieved sustained remissions during a median follow-up of 8 months (rang 3-18 months) . None of all the patients relapsed during a median follow-up time of 10 months (3-18 months) . However, 7 PR responders of the relapsed refractory patients maintained a good condition for 1.5-6.0 months. One patient bridged to hematopoietic stem cell transplantation, another one sustained remission for 12 months. Cytokine-release syndrome (CRS) occurred in 14 patients with grade 1-2 CRS in MRD positive group and grade 3 CRS in relapsed refractory group. Conclusions CAR-T cell therapy not only played a role in the rescue treatment of relapsed and refractory patients, but also produced a surprising effect in the consolidation and maintenance of B-cell lymphoma. CD19 CAR-T cells might be more effective in the treatment of MRD positive B-cell lymphoma patients than in the refractory or relapsed cases. High response rate was observed with fewer adverse reactions.

To review the imaging characteristics and evaluate the diagnostic value of echocardiography for congenital double‐chambered left ventricle ( DCLV ) in children , and improve the diagnostic accuracy of initial echocardiography . Methods Doppler echocardiography was performed and these images were compared retrospectively with operative and computed tomography angiography findings in 8 children with DCLV . Results DCLV was characterized by the presence of a main left ventricular chamber and an auxiliary chamber seperated by abnormally hypertrophic muscle and/or fiber bundles . Six cases were diagnosed with type A ,and 2 cases with type B by Li Jun′s classification . T he associated malformations included ventricular septal defect ( 3 cases ) ,mitral regurgitation ( 2 cases ) ,mitral valve stenosis ( 1 case) . Six of 8 cases( 75 .0% ) were diagnosed correctly using Doppler echocardiography ,in the remaining 2 cases ( 25 .0% ) ,1 case was missed ,1 case misdiagnosed as left ventricular diverticulum . Conclusions DCLV could be correctedly diagnosed by Doppler echocardiography . This malformation should be differentiated from left ventricular diverticulum , left ventricular aneurysm , left ventricular non‐compaction ,and ventricular septal defect .

Recent years,chimeric antigen receptor T-cell(CAR-T)therapy has made great strides in enabling better treatment of malig-nant tumors,especially hematological tumors,as well as increasing the research prospects of potential solid tumor therapies.Conse-quently,CAR-T therapy is expected to become the selected treatment for patients with relapsed and refractory tumors.Immune check-point inhibitors also have certain curative effects in the treatment of cancers,such as liver cancer,refractory Hodgkin's lymphoma,and other malignant tumors,which brings promise to patients with advanced cancer.However,both treatments have different degrees of limitations.Recent clinical trials suggest that combined immune checkpoint inhibitors impair the immunosuppressive effects of the tu-mor microenvironment,increase the efficacy of CAR-T therapy,and prolong the survival.This article will review the research progress on the combination of CAR-T immunotherapy and immune checkpoint inhibitors in malignancies theray.

ObjectiveTo investigate the correlation between serum C-reactive protein(CRP),tumor necrosis factor-alpha(TNF-α) and atherosclerosis in patients with subclinical hypothyroidism.Methods Seventy-five patients with subclinical hypothyroidism were divided into two groups according to the level of TSH:mild group (42 cases) with TSH between 5.5 and 10.0 mU/L and severe group (33 cases) with TSH ＞10.0 mU/L.Thirty healthy physical examinees or volunteers were selected as control group.TG,LDL-C,HDL-C,TSH,FT4,FT3,CRP,TNF-α and carotid intima-media thickness(CIMT) of all cases were detected and measured.ResultsCIMT of mild,severe and control groups were(0.88 ± 0.20),( 1.12 ±0.21 ),(0.62 ±0.21 ) mm,respectively.CIMT of mild and severe groups were both significantly higher than that of control group,CIMT of severe group was significantly higher than that of mild group (P ＜ 0.01 ).There were no significant differences of CRP and TNF- α among three groups (P ＞ 0.05 ).LDL-C of mild and severe groups were significantly higher than that of control group [ (3.22 ± 0.37),(3.49 ± 0.38 ) mmol/L vs.(2.48 ±0.41 )mmol/L,P ＜0.01 ].HDL-C and TG between mild and control groups had no statistical significance (P ＞0.05).Compared with control and mild groups,HDL-C of severe group decreased [(0.92 ±0.10)mmol/L vs.( 1.21 ± 0.14),( 1.17 ± 0.11 ) mmol/L] and TG increased [ ( 1.50 ± 0.49) mmol/L vs.( 1.11 ±0.53),(1.27 ±0.47) mmol/L](P＜ 0.01 or ＜ 0.05).The levels of TG,LDL-C,TSH,CRP and TNF-α had positive correlation with CIMT (r =0.52,0.37,0.48,0.39,0.45;P ＜0.05 or ＜0.01 ).FT4 was negatively correlated with CIMT (r=-0.24,P＜0.05).HDL-C had no relation with CIMT (r =0.06,P ＞0.05).ConclusionsThere are many abnormalities such as metabolism disorder of blood lipid in patients with subclinical hypothyroidism.The risk of atherosclerosis increases in these patients and inflammatory reaction may not be an important factor of subclinical hypothyroidism complicated with atherosclerosis.

Objective To investigate the relationship of lacunar infarction (LI) and white matter lesion with cognitive impairment in patients with subcortical ischemic vascular disease (SIVD) Methods Fifty-three patients were diagnosed as SIVD according to the criteria of Erkinjuntti. The symptoms and signs were recorded by an interview and examination, and neuropsychological assessment and magnetic resonance imaging (MRI) were performed. A semi-automated MRI quantitative method was used to measure the volume of white matter hyperintensity (WMH) and the number of LI was counted. Correlation and the partial correlation analysis were performed to examine the relationship of general cognitive function with the volume of WMH and the number of LI. Results The pseudobulbar paralysis symptom and the upper motoneuron injury sign were the most common in these patients (18.9% and 37.7%). Correlation analysis showed that there was positive correlation between the volume of WMH and age (r = 0. 518, P < 0. 05), and there was negative correlcction between mini-metal state examination (MMSE) scures and the volume of WMH (r=-0.514, P<0. 05), After controlling confounding factors, only age was positively correlated with the volume of WMH (r=0. 400, P=0. 004). There were negative correlation between the number of LI, the volume of WMH and MMSE scores(r=-0. 456,-0. 514,-0. 385,-0. 382;all P<0. 05), and the years of education was positively correlated with MMSE scores (r= 0. 518, P< 0. 001). Conclusions Age may not be the main risk factor for cognitive impairment in patients with SIVD. The volume of WMH and the number of LI are independent risk factors for cognitive impairment in patients with SIVD. Patients with severer SIVD or more LI show poorer performance on cognitive function.

OBJECTIVE To investigate the affinity of 20 Klebsiella pneumoniae(KPN)strains.METHODS Twenty nine genes were detected from 20 KPN strains.They were sixteen kinds of beta-lactamase genes,six kinds of aminoglycosides modification enzyme genes,chlorhexidine-sulphanilamide drug resistance genes,TMP drug resistance genes;three kinds of integrase genes and Tn21/Tn501 transposon genetic mark were detected.And they were used as molecule marker for the sample clustering analysis and assay of the detected results.RESULTS The beta-lactamase genes,aminoglycosides modification enzyme genes,chlorhexidine-sulphanilamide drug resistance gene,TMP drug resistance gene,integrase genes and Tn21/Tn501 transposon genetic mark were all detectable.Clone transmission was shown through the sample clustering analysis.CONCLUSIONS The resistance to the beta-lactam and aminoglycoside antibiotics of the 20 KPN strains is intimately correlated to the generation of beta-lactamases and amino glycosides modification enzymes,which could be clone transmitted.