Objective To analyze the pollution characteristics of PM_2.5-bound polycyclic aromatic hydrocarbons (PAHs) during the non-heating period, heating period, and haze period in Harbin, and infer their possible sources, and to evaluate their impact on population carcinogenesis. Methods From 2020 to 2022, sampling points were set up in different districts of Harbin. PM_2.5 samples were regularly collected every month to analyze the contents of 10 types of PM_2.5-bound 4-6 rings PAHs. The pollution characteristics of PAHs were analyzed during different monitoring periods (non-heating period, heating period, and haze period). The excess carcinogenesis risks of PM_2.5-bound PAHs were assessed according to the Technical Specifications for Health Risk Assessment of Ambient Air Pollution and the U. S. Environmental Protection Agency (US EPA) risk assessment method. The characteristic ratio method and the positive matrix factorization (PMF) model were used to infer the sources of PAHs. Results The median mass concentrations of ambient PM_2.5-bound 4-6 rings PAHs (ΣPAHs) during the non-heating period, heating period, and haze period were 6.44 ng/m³, 37.85 ng/m³, and 106.79 ng/m³, respectively. During the heating season and haze period, the concentrations of benzo[a]anthracene, benzo[k]fluoranthene, pyrene and fluoranthene were relatively high. The excess carcinogenic risks for ASF_>16, ASF_2-16 and ASF_<2 caused by exposure to PM_2.5-bound 4-6rings PAHs during the heating season were 2.34×10^-6, 1.82×10^-6, and 0.88×10^-6, respectively, while the excess carcinogenic risks for the whole population during the heating season and haze period were 5.05×10^-6 and 1.75×10^-6, respectively. The results of the two source methods showed that the main characteristic elements during the heating season were fluoranthene, pyrene, benzo[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, and benzo[a]pyrene. According to the emission source standards, it was determined that the sources were mainly coal and biomass combustion, accompanied by traffic source emissions. Conclusion In Harbin, the PM_2.5-bound 4-6 rings PAHs during the haze period is significantly higher than that during the heating period. The pollution is mainly from coal combustion emissions, accompanied by continuous traffic source pollution. The exposure to PAHs during the heating period poses a potential carcinogenic risk to the population.

OBJECTIVES: Papular dermatoses commonly affecting the female vulva, such as molluscum contagiosum, syringoma, lymphangioma, folliculitis, verruca vulgaris, ectopic sebaceous glands, and bowenoid papulosis, often present with similar clinical appearances and are frequently misdiagnosed. This study aims to explore the clinical diagnostic value of reflectance confocal microscopy (RCM) in differentiating these conditions. METHODS: A retrospective analysis was conducted on RCM imaging and histopathological findings from lesion sites in 172 female patients with vulval papular dermatoses. RCM characteristics confirmed by biopsy were summarized and diagnostic clues were explored. RESULTS: RCM diagnosis was consistent with histopathological diagnosis in 147 out of 172 cases (85.47%). Molluscum contagiosum, syringoma, lymphangioma, and folliculitis all exhibited cystic-like structures under RCM, differing in the location of the structures, wall characteristics, internal contents, and reflectivity. Verruca vulgaris, ectopic sebaceous glands, and bowenoid papulosis lacked such structures. Verruca vulgaris showed distinctive low-refractive vacuolated cells in the spinous layer; bowenoid papulosis exhibited mild cytologic atypia in the spinous layer; ectopic sebaceous glands were characterized by moderately to low-refractive, fish roe-like sebaceous lobules within the dermis. CONCLUSIONS RCM enables noninvasive, real-time, and dynamic visualization of key diagnostic and differential features of common vulvar papular dermatoses in women, offering high diagnostic value.
Humans ; Female ; Microscopy, Confocal/methods* ; Retrospective Studies ; Adult ; Vulvar Diseases/diagnosis* ; Middle Aged ; Young Adult ; Aged ; Adolescent ; Diagnosis, Differential ; Child ; Skin Diseases/pathology* ; Molluscum Contagiosum/diagnosis*

OBJECTIVE: To construct and validate a prognostic prediction model for children with sepsis using the Phoenix sepsis score (PSS). METHODS: A retrospective case series study was conducted to collect clinical data of children with sepsis admitted to the pediatric intensive care unit (PICU) of the Affiliated Hospital of Guizhou Medical University from January 2022 to April 2024. The data included general information, the worst values of laboratory indicators within the first 24 hours of PICU admission, PSS score, pediatric critical illness score (PCIS), and the survival status of the children within 30 days of admission. The statistically significant indicators in univariate Logistic regression analysis were included in multivariate Logistic regression analysis to screen the risk factors affecting the prognosis of children with sepsis and construct a nomogram model. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive performance of the model. The Bootstrap method was used to perform 1 000 repeated sampling internal verification and draw the calibration curve of the model. RESULTS: A total of 199 children with sepsis were included, of which 32 died and 167 survived 30 days after admission. In the univariate Logistic regression analysis, shock, white blood cell count (WBC), international normalized ratio (INR), lactic acid (Lac), PSS score, and PCIS score were identified as statistically significant predictors. These variables were then included in the multivariate Logistic regression analysis, which demonstrated that shock [odds ratio (OR) = 4.258, 95% confidence interval (95%CI) was 1.049-17.288], WBC (OR = 1.124, 95%CI was 1.052-1.210), and PSS score (OR = 1.977, 95%CI was 1.298-3.012) were independent risk factors for mortality in pediatric patients with sepsis (all P < 0.05). A nomogram model was constructed based on these three risk factors, with the model equation as follows: -4.809+1.449×shock+0.682×PSS score+0.117×WBC. The calibration curve results showed that the model's predictions were highly consistent with the actual observations. The ROC curve showed that when the Youden index of the prediction model was 0.792, the sensitivity and specificity were 90.6% and 88.6%, respectively, and the area under the curve (AUC) was 0.957 (95%CI was 0.930-0.984), which was higher than the AUC of shock, WBC, and PSS score alone (0.808, 0.667, 0.908, respectively). CONCLUSIONS Shock, WBC, and PSS score have demonstrated certain predictive value for mortality in children with sepsis. The nomogram model based on the above indicators has important clinical significance for evaluating the prognosis and guiding treatment of children with sepsis.
Humans ; Sepsis/diagnosis* ; Prognosis ; Retrospective Studies ; Logistic Models ; Intensive Care Units, Pediatric ; Nomograms ; Child ; ROC Curve ; Risk Factors ; Male ; Female ; Child, Preschool ; Infant

Objective To analyze the sleep problems and temperament characteristics of children aged 12-35 months so as to understand the relationship between the sleep problems and temperament in early childhood.Methods 129 toddlers with sleep problems and 129 normal controls were selected.The brief infant sleep questionnaire(BISQ)was used to investigate children's sleep problems and the temperament questionnaire was used to investigate their temperament characteristics.The influence of temperament on sleep problems was analyzed by Logistic regression analysis.Results The temperament types of children aged 12 to 35 months with sleep problems were mainly easy to cultivate and moderately easy to cultivate.There was a statistically significant difference(P<0.05)in the comparison of easily cultivating temperament types between the children with the sleep problems and the control group;Compared with the control group,there were statistically significant differences(P<0.05)in the five dimensions of avoidance,adaptability,emotional essence,persistence,and attention dispersion among children with sleep problems.Compared with the temperament type of easy to cultivate,the proportion of sleep problems in children intermediately easy to cultivate and slow to start was higher(both P<0.05)Conclusion There is a certain relationship between the sleep problems and temperament types in children aged 12 to 35 months.Early understanding of sleep problems and temperament characteristics of toddlers can guide parents to adjust their education methods in time,give parents"individualized"sleep guidance and intervention,reduce the occurrence of long-term development problems and promote the healthy physical and mental development of toddlers.

Objective To explore the effects of different CO2 pneumoperitoneum pressures during surgery on overweight or obese patients with laparoscopic panhysterectomy in Trendelenburg position.Methods A total of 88 overweight or obese patients who underwent laparoscopic panhysterectomy were selected and randomly divided into the low-pressure group and the high-pressure group according to random number table method,with 44 patients in each group.All patients used CO2 as the pneumoperitoneum medium during surgery,with 10 mmHg of CO2 pneumoperitoneum pressure in the low-pressure group and 15 mmHg of CO2 pneumoperitoneum pressure in the high-pressure group.The operation-related indexes,respiratory indicators,nasopharyngeal temperature and adverse reactions of patients were compared between the two groups.Results There was no significant difference in the surgical time,blood loss,intraoperative infusion volume,incidence of organ injury,and laparotomy rate between the two groups(P>0.05).The recovery time of anesthesia of patients in the low-pressure group was shorter than that in the high-pressure group(P<0.05).At 30 minutes after the establishment of pneumoperitoneum,the peak airway pressure(Ppeak)and plateau pressure(Pplat)of patients in the high-pressure group were significantly higher than those in the low-pressure group(P<0.05),while the dynamic lung compliance(Cdyn)of patients in the high-pressure group was significantly lower than that in the low-pressure group(P<0.05).At 60 minutes after the establishment of pneumoperitoneum and the end of pneumoperitoneum,the nasopharyngeal temperature of patients in the high-pressure group were significantly lower than those in the low-pressure group(P<0.05).The incidences of intraoperative hypothermia and shivering in the high-pressure group were significantly higher than those in the low-pressure group(P<0.05).Conclusion Compared with 15 mmHg of CO2 pneumoperitoneum pressure,10 mmHg of CO2 pneumoperitoneum pressure on overweight or obese patients with laparoscopic panhysterectomy in Trendelenburg position does not increase surgical difficulty,and the patients has lower airway pressure,better lung compliance,fewer adverse reactions,and faster recovery,which can also avoid intraoperative hypothermia.

Objective:The purpose of this study is to explore the mediating effect of 25-hydroxyvitamin D3[25(OH)D3]on the relationship between psychological status and cognitive function in elderly obese patients.Methods:130 elderly obese patients who visited Hongdu Traditional Chinese Medicine Hospital in Nanchang from January 2023 to June 2024 were selected,they were divided into cognitive impairment group(n=27)and cognitive normal group(n=103)based on the Mini Mental State Examination(MMSE)score.General information were prospectively collected,their psychological status used Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA)to evaluated,25(OH)D3 levels were detected by enzyme-linked immunosorbent assay.General information,psychological status scores,and 25(OH)D3 levels were compare between two groups.Analysis of the correlation between 25(OH)D3 and psychological status and cognitive function by Pearson method.Analysis of the mediating effect of 25-hydroxyvitamin D3[25(OH)D3]on the relationship between psychological status and cognitive function in elderly obese patients.Results:Compared with cognitive normal group,cognitive impairment group had higher age and lower years of education(P＜0.05).HAMA and HAMD scores in the cognitive impairment group were significantly higher than those in the cognitive normal group(P＜0.05),and the 25(OH)D3 level was significantly lower than that in the cognitive normal group(P＜0.05).Pearson correlation analysis showed that,25(OH)D3 was negatively correlated with HAMA score and HAMD score,and positively correlated with MMSE score(P＜0.05);HAMA score,HAMD score,and MMSE score were all negatively correlated(P＜0.05).The structural equation model shows good fit[x2/df=1.87,root mean square error approximate=0.062,comparative fit index=0.945,Tucker-Lewis index=0.931].The direct effect of psychological status(HAMA+HAMD)on cognitive function was-0.325(95％confidence Interval(CI):-0.454～-0.216,P＜0.05),and the mediating effect through 25(OH)D3 was-0.182(95％CI:-0.271～-0.112,P＜0.05),accounting for 36.00％of the total effect.Conclusion:In elderly obese patients,25(OH)D3 is positively correlated with cognitive function and negatively correlated with psychological status,moreover,25(OH)D3 plays a significant mediating role in the relationship between psychological status and cognitive function,and is an important mediating factor affecting the relationship between the two.

Objective:The purpose of this study is to explore the mediating effect of 25-hydroxyvitamin D3[25(OH)D3]on the relationship between psychological status and cognitive function in elderly obese patients.Methods:130 elderly obese patients who visited Hongdu Traditional Chinese Medicine Hospital in Nanchang from January 2023 to June 2024 were selected,they were divided into cognitive impairment group(n=27)and cognitive normal group(n=103)based on the Mini Mental State Examination(MMSE)score.General information were prospectively collected,their psychological status used Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA)to evaluated,25(OH)D3 levels were detected by enzyme-linked immunosorbent assay.General information,psychological status scores,and 25(OH)D3 levels were compare between two groups.Analysis of the correlation between 25(OH)D3 and psychological status and cognitive function by Pearson method.Analysis of the mediating effect of 25-hydroxyvitamin D3[25(OH)D3]on the relationship between psychological status and cognitive function in elderly obese patients.Results:Compared with cognitive normal group,cognitive impairment group had higher age and lower years of education(P＜0.05).HAMA and HAMD scores in the cognitive impairment group were significantly higher than those in the cognitive normal group(P＜0.05),and the 25(OH)D3 level was significantly lower than that in the cognitive normal group(P＜0.05).Pearson correlation analysis showed that,25(OH)D3 was negatively correlated with HAMA score and HAMD score,and positively correlated with MMSE score(P＜0.05);HAMA score,HAMD score,and MMSE score were all negatively correlated(P＜0.05).The structural equation model shows good fit[x2/df=1.87,root mean square error approximate=0.062,comparative fit index=0.945,Tucker-Lewis index=0.931].The direct effect of psychological status(HAMA+HAMD)on cognitive function was-0.325(95％confidence Interval(CI):-0.454～-0.216,P＜0.05),and the mediating effect through 25(OH)D3 was-0.182(95％CI:-0.271～-0.112,P＜0.05),accounting for 36.00％of the total effect.Conclusion:In elderly obese patients,25(OH)D3 is positively correlated with cognitive function and negatively correlated with psychological status,moreover,25(OH)D3 plays a significant mediating role in the relationship between psychological status and cognitive function,and is an important mediating factor affecting the relationship between the two.

Objective To explore the effects of different CO2 pneumoperitoneum pressures during surgery on overweight or obese patients with laparoscopic panhysterectomy in Trendelenburg position.Methods A total of 88 overweight or obese patients who underwent laparoscopic panhysterectomy were selected and randomly divided into the low-pressure group and the high-pressure group according to random number table method,with 44 patients in each group.All patients used CO2 as the pneumoperitoneum medium during surgery,with 10 mmHg of CO2 pneumoperitoneum pressure in the low-pressure group and 15 mmHg of CO2 pneumoperitoneum pressure in the high-pressure group.The operation-related indexes,respiratory indicators,nasopharyngeal temperature and adverse reactions of patients were compared between the two groups.Results There was no significant difference in the surgical time,blood loss,intraoperative infusion volume,incidence of organ injury,and laparotomy rate between the two groups(P>0.05).The recovery time of anesthesia of patients in the low-pressure group was shorter than that in the high-pressure group(P<0.05).At 30 minutes after the establishment of pneumoperitoneum,the peak airway pressure(Ppeak)and plateau pressure(Pplat)of patients in the high-pressure group were significantly higher than those in the low-pressure group(P<0.05),while the dynamic lung compliance(Cdyn)of patients in the high-pressure group was significantly lower than that in the low-pressure group(P<0.05).At 60 minutes after the establishment of pneumoperitoneum and the end of pneumoperitoneum,the nasopharyngeal temperature of patients in the high-pressure group were significantly lower than those in the low-pressure group(P<0.05).The incidences of intraoperative hypothermia and shivering in the high-pressure group were significantly higher than those in the low-pressure group(P<0.05).Conclusion Compared with 15 mmHg of CO2 pneumoperitoneum pressure,10 mmHg of CO2 pneumoperitoneum pressure on overweight or obese patients with laparoscopic panhysterectomy in Trendelenburg position does not increase surgical difficulty,and the patients has lower airway pressure,better lung compliance,fewer adverse reactions,and faster recovery,which can also avoid intraoperative hypothermia.

Objective To explore the feasibility and operability in identifying the therapeutic dominant stages of traditional Chinese medicine(TCM)based on subdivision model of disease course.Methods The hierarchical Bayesian model was used to differentiate the disease course of 125 cases of premature ovarian failure(POF),and the disease course of POF were divided into the occult stage,diminished ovarian reserve(DOR)stage,premature ovarian insufficiency(POI)stage,and POF stage.An then the paired sample t-test,Pearson correlation analysis and expert in-depth interview were used for the analysis of the therapeutic effects of TCM for POF at various stages.Results(1)Compared with POF stage,DOR and POI stages were frequently intervened by Chinese patent medicine.(2)In DOR(complicated with POI)stage and POF stage,there was significant difference between the degree of TCM intervention and the therapeutic effect(t =-3.70,P＜0.001).(3)The degree of TCM intervention was positively correlated with treatment outcomes in the DOR stage(r = 0.679,P＜0.001),so did in the POF stage(r = 0.432,P＜0.001),but the correlation in the POF stage was slightly lower than that in the DOR stage.(4)The results of in-depth interviews with experts of TCM gynecology showed that in the concealed phase of POF,the prognosis would be most favorable if TCM regulation and intervention were performed.In the DOR stage and POI stage,treatment with Chinese medicine prescriptions usually brought about better curative effect and prognosis.For the patients at POF stage,the therapeutic effect of TCM depended on the patients'compliance and the treatment course,and the effect was relatively not as good as that of the previous stages.Conclusion In the DOR stage and POF stage,the higher the degree of TCM intervention,the better the prognosis will be achieved for the patients treated with western medicine.In the POF stage,the efficacy of TCM intervention is reduced to a certain extent compared with the DOR stage.The results indicated that it is feasible and operable to identify the TCM therapeutic dominant stages based on the subdivision model of disease course.

Tuberculosis （TB） and human immunodeficiency virus infection / acquired immune deficiency syndrome （HIV/AIDS） are both serious global public health threats. Early detection of infected persons and/or patients through TB/HIV bi-directional screening is crucial for prevention and control strategy in China and globally. In recent years， with the promotion and application of new TB and HIV detection technologies worldwide， TB/HIV bi-directional screening technologies and strategies have made remarkable changes. This expert consensus introduces the significance and challenges of TB/HIV bi-directional screening， summarizes important progress of research and applications， and makes recommendations on screening measures and procedures to further strengthen TB/HIV bi-directional screening in China.