Objective: To understand the microclimate in primary and secondary school classrooms for the study period during the winter heating season, so as to provide a reference for the revision and improvement of relevant health standards. Methods: In December 2024, stratified random sampling was used to select 30 primary and secondary schools and 180 classrooms from the northern regions with centralized heating (Liaoning Province, Tianjin City) and the southern regions without centralized heating (Shanghai City, Anhui Province, and Jiangxi Province). Indoor temperature, relative humidity, wind speed, CO 2 and other indicators were measured on site. Variance analysis, t-test, Mann-Whitney U test and Kruskal-Wallis H test were used to analyze the differences in the microclimate of classrooms among regions and urban and rural differences. Results: The average temperature in the middle of the classrooms tested on site was (16.47±4.72)℃, and the variance analysis showed that the difference between the regions was statistically significant ( F=27.80, P <0.01). Among them, Tianjin had the highest average temperature of (20.43± 2.12 )℃, followed by Liaoning (19.03±2.23)℃, Shanghai (15.33±5.32)℃, Anhui (12.79±1.74)℃, and Jiangxi (11.69± 1.68 )℃. Horizontal temperature difference was 0.90 (0.50, 1.60)℃, the vertical temperature difference was 0.20 (0.10,0.60)℃, the average relative humidity was (44.39±16.16)%, the wind speed was 0.03(0.01,0.11)m/s, and the differences among different provinces and cities were statistically significant ( H/F =40.62, 82.69, 95.06, 55.28, all P <0.01). The average CO 2 volume concentration in urban areas of Tianjin, Liaoning, and Shanghai was 0.21(0.16,0.30)%, and there was no statistically significant difference ( H=4.65, P =0.10). There were grade differences in relative humidity ( F =3.71, 6.21) and CO 2 ( H =14.72, 12.92) in the north and the south (all P <0.05). In addition, the temperature, relative humidity, wind speed and CO 2 in the middle of the classroom were 42.8%, 67.8%, 100.0% and 22.2% respectively. Conclusions The temperature in the middle of the classroom in the non centralized heating area is lower than the standard, the relative humidity of classroom in the centralized heating area is lower than the standard，and the CO 2 in the classroom in winter is lower than the standard. It is recommended to install heating facilities in schools with low temperatures to increase the temperature and increase the frequency of ventilation in classrooms or adopt mechanical ventilation strategies to reduce CO 2 volume concentration.

Childhood simple obesity has become a significant public health issue in China. Modern medicine primarily relies on lifestyle interventions and often suffers from poor long-term compliance， while pharmacological options are limited and associated with potential adverse effects. Traditional Chinese Medicine （TCM） has a long history in the prevention and management of this condition， demonstrating eight distinct advantages， including systematic theoretical foundation， diversified therapeutic approaches， definite therapeutic efficacy， high safety profile， good patient compliance， comprehensive intervention strategies， emphasis on prevention， and stepwise treatment protocols. Additionally， TCM is characterized by six distinctive features： the use of natural medicinal substances， non-invasive external therapies， integration of medicinal dietetics， simple exercise regimens， precise syndrome differentiation， and diverse dosage forms. By combining internal and external treatments， TCM facilitates individualized regimen adjustment and holistic regulation， demonstrating remarkable effects in improving obesity-related metabolic indicators， regulating constitutional imbalance， and promoting healthy behaviors. However， challenges remain， such as inconsistent operational standards， insufficient high-quality clinical evidence， and a gap between basic research and clinical application. Future efforts should focus on accelerating the standardization of TCM diagnosis and treatment， conducting multicenter randomized controlled trials， and fostering interdisciplinary integration， so as to enhance the scientific validity and international recognition of TCM in the prevention and treatment of childhood obesity.

Objective:To evaluate the feasibility, safety, and short-term efficacy of robot-assisted unilateral axillary approach for partial or total thyroidectomy without inflation. Methods:A retrospective analysis was performed on the clinical data of 98 patients who underwent gasless unilateral axillary approach robot-assisted resection of bilateral thyroid lesions at Sun Yat-sen University Cancer Center between October 2022 and October 2024. Perioperative indicators were recorded and compared among patients undergoing different surgical approaches（total thyroidectomy vs. bilateral partial thyroidectomy） and with different body mass index（BMI） values, including operative time, intraoperative blood loss, number of lymph nodes dissected, incidence of postoperative hoarseness, incidence of postoperative hypocalcemia, and other postoperative complications. Results:A total of 98 patients were included, of whom 78.57% were female, with a median age of 39 years（interquartile range[IQR]: 35-49） and a median BMI of 24.08 kg/m²（IQR: 21.43-25.98）. The median intraoperative blood loss was 32.14 mL（IQR: 20.00-50.00）, the median operative time was 130.0 minutes（IQR: 104.80-150.30）, and the median hospital stay was 2.01 days（IQR: 1.00-2.00）. The most common postoperative complication was transient hypocalcemia, with an incidence of 16.32%. There were no cases of permanent recurrent laryngeal nerve palsy or conversion to open surgery. Compared with the non-total thyroidectomy group, the total thyroidectomy group had a significantly longer operative time（135.10±33.28 min vs 120.30±30.53 min, P=0.033）. Subgroup analysis based on BMI showed no statistically significant differences in operative time, hospital stay, drainage volume, or incidence of hypocalcemia between patients with BMI≥25 kg/m² and those with BMI<25 kg/m². Conclusion:The gasless unilateral axillary approach for robot-assisted partial or total thyroidectomy demonstrates favorable safety, cosmetic outcomes, and feasibility. Appropriate selection of surgical techniques and meticulous protection of critical structures during the procedure can further reduce the risk of complications and optimize therapeutic outcomes.
Humans ; Thyroidectomy/methods* ; Retrospective Studies ; Female ; Robotic Surgical Procedures/methods* ; Male ; Adult ; Middle Aged ; Axilla/surgery* ; Operative Time ; Postoperative Complications ; Thyroid Neoplasms/surgery* ; Thyroid Gland/surgery* ; Lymph Node Excision

In recent years, robot-assisted thyroid surgery has gained widespread adoption in major hospitals worldwide, offering advantages such as a shorter learning curve and superior cosmetic outcomes while overcoming the limitations of endoscopic surgery. Currently, the main surgical approaches include the transaxillary, bilateral axillo-breast（BABA）, retroauricular, and transoral vestibular routes. However, the widespread adoption of robotic thyroidectomy still faces several challenges, including technical complexity, prolonged operative time, a higher complication rate during the learning curve, and high costs. Nevertheless, when performed by experienced surgeons on carefully selected patients, robotic thyroidectomy can achieve outcomes comparable to those of conventional open transcervical thyroidectomy. This article provides a systematic review of the development and latest advances in robotic thyroid surgery.
Humans ; Robotic Surgical Procedures/methods* ; Thyroidectomy/methods* ; Thyroid Gland/surgery*

High mobility group box 1 (HMGB1), when released extracellularly, plays a pivotal role in the development of spinal cord synapses and exacerbates autoimmune diseases within the central nervous system. In experimental autoimmune encephalomyelitis (EAE), a condition that models multiple sclerosis, the levels of extracellular HMGB1 and interleukin-33 (IL-33) have been found to be inversely correlated. However, the mechanism by which IL-33 deficiency enhances HMGB1 release during EAE remains elusive. Our study elucidates a potential signaling pathway whereby the absence of IL-33 leads to increased binding of P300/CBP-associated factor with HMGB1 in the nuclei of astrocytes, upregulating HMGB1 acetylation and promoting its release from astrocyte nuclei in the spinal cord of EAE mice. Conversely, the addition of IL-33 counteracts the TNF-α-induced increase in HMGB1 and acetylated HMGB1 levels in primary astrocytes. These findings underscore the potential of IL-33-associated signaling pathways as a therapeutic target for EAE treatment.
Animals ; Encephalomyelitis, Autoimmune, Experimental/metabolism* ; Astrocytes/metabolism* ; Interleukin-33/metabolism* ; HMGB1 Protein/metabolism* ; Acetylation ; Mice, Knockout ; Mice, Inbred C57BL ; p300-CBP Transcription Factors/metabolism* ; Mice ; Spinal Cord/metabolism* ; Cells, Cultured ; Female ; Signal Transduction

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objectives:To investigate the association between the triglyceride-glucose(TyG)index and risk of non-alcoholic fatty liver disease(NAFLD)in young and middle-aged(<60 years)adults.Methods:From June 2006 to October 2007,47 675 employees of Kailuan Group with no liver disease were selected as the study objects.Based on the TyG index quartile,participants were divided into Q1 group(TyG index≤8.08,n=11 924),Q2 group(8.0836.46,n=11 919),the association between TyG index,cum-TyG and cumulative exposure time and the risk of NAFLD was analyzed.Results:The average age of the study population was(44.3±8.7)years,36 345 participants were males(76.23%).During a median follow-up period of 11.55(7.28,13.89)years,4 635(9.72%)participants developed new-onset NAFLD.After adjusting for confounders,cox regression analysis showed that compared with the Q1 group,the HR(95%CI)for NAFLD in the Q2 to Q4 groups were 1.328(1.191-1.480),1.591(1.430-1.770),and 2.106(1.861-2.384),respectively,Ptrend<0.001.Compared with the cum-Q1 group,the HR(95%CI)for NAFLD in the cum-Q2 to cum-Q4 groups were 1.571(1.426-1.730),2.123(1.935-2.330)and 2.593(2.367-2.840),respectively,Ptrend<0.001.Compared with the TyG index for 0 year,the HR(95%CI)of NAFLD for 2,4 and 6 years was 1.333(1.196-1.486),1.879(1.690-2.088)and 3.184(2.860-3.545),respectively,Ptrend<0.001.Conclusions:Increased TyG index is an independent risk factor for the new-onset NAFLD in young and middle-aged population.

Objective:To summarize the clinical characteristics, diagnostic and therapeutic approaches, and prognosis of posttransplant lymphoproliferative disease (PTLD) following kidney transplantation.Methods:A retrospective case series analysis was conducted on 7 PTLD patients after kidney transplantation treated in the Department of Transplant Oncology, Tianjin First Central Hospital between January 2018 and December 2023. Clinical features, laboratory findings, imaging and pathological characteristics, treatment modalities, and outcomes were analyzed.Results:Among 7 PTLD patients, there were 5 male and 2 females with a median age of 41 (17-65) years. The median time of onset after operation was 4 (0.5-11) years. Among them, 2 patients had early onset (<1 year post-transplantation) and 5 patients had late onset (>1 year). The clinical manifestations included abdominal mass in 4 cases, anemia in 4 cases, fever in 3 cases, lymphadenopathy in 4 cases, gastrointestinal bleeding in 1 case, abdominal pain in 2 cases, and intestinal obstruction in 2 cases. Pathological types included diffuse large B-cell lymphoma in 4 cases, Burkitt lymphoma in 1 case, marginal zone lymphoma in 1 case, and polymorphic PTLD in 1 case. Reducing the immunosuppressant level was the basal treatment plan, and rituximab, chemotherapy, surgery, radiotherapy and CD19-targeted chimeric antigen receptor therapy were given according to the pathological classification. Until the date of submission, 2 patients had died, 4 had a complete response, and 1 had a partial response. None of the patients had acute rejection, and 1 patient had chronic renal insufficiency.Conclusions:PTLD after kidney transplantation presents with nonspecific manifestations, necessitating prompt imaging and histopathological evaluation for definitive diagnosis. At the same time, a series of measures should be given to improve the prognosis, including discontinuous use of anti-metabolic drugs, dosage decline of calcitric phosphatase inhibitor by 50% or convert it to sirolimus treatment, and corresponding treatment according to the specific conditions of the recipient.

Objective To explore the value of CT-based radiomics and machine learning in predicting the severity of community acquired pneumonia(CAP)in children.Methods The clinical and imaging data of 158 patients diagnosed with CAP in children were analyzed retrospectively.All patients were randomly divided into training set(n=110)and validation set(n=48)in a ratio of 7︰3.Radiomics features were outlined and extracted using 3D Slicer software,and feature selection was achieved using maximum relevance and minimum redundancy(MRMR)and least absolute shrinkage and selection operator(LASSO)algorithms.The construction of the nomogram model and the machine learning combined model was performed by combining clinical features and Radiomics score(Radscore),and its performance was evaluated and validated.Results The area under the curve(AUC)of the clinical model,the radiomics model and the nomogram model in the validation set were classified as 0.82,0.86 and 0.91,respectively.The AUC of the combined multi-layer perceptron(MLP),random forest(RF),and adaptive boosting(ADB)models were 0.926,0.934 and 0.917,respectively in the validation set.Conclusion Radiomics combined with clinical data is expected to be a novel predictor of the severity of CAP in children.MLP,RF and ABD machine learning algorithms can further enable model performance.

Objective:To analyze the correlation between blood glucose index and peripheral neuropathy in type 2 diabetes patients under continuous blood glucose monitoring.Methods:A total of 110 patients with type 2 diabetes admitted to the Lu′an Hospital Affiliated to Anhui Medical University from November 2022 to January 2024 were retrospectively observed, and the blood glucose indexes of patients were monitored by continuous glucose meter [glucose time in range (TIR), mean blood glucose (MBG), estimated hemoglobin A 1c (eHbA 1c), blood glucose standard deviation (SD), coefficient of variation (CV), largest amplitude of glycemic excursions (LAGE), mean amplitude of glycemic excursions (MAGE), means of daily differences (MODD), etc ]. All patients with type 2 diabetes were grouped according to whether they had peripheral neuropathy or not, and were divided into the developing group and the non-developing group. General data and blood glucose indexes of the two groups were collected and sorted out. Receiver operating characteristic (ROC) curve was used to analyze the value of various blood glucose indicators in predicting peripheral neuropathy in patients with type 2 diabetes. Spearman correlation analysis was also used to evaluate the correlation between blood glucose index and peripheral neuropathy. Results:The disease course, TIR, MBG, eHbA 1c, SD, CV, LAGE, MAGE and MODD of the occurrence group were significantly different from those of the non-occurrence group (all P<0.05). By plotting the ROC curve, It was found that the area under the curve (AUC) of TIR, MBG, eHbA 1c, SD, CV, LAGE, MAGE and MODD predicting peripheral neuropathy in patients with type 2 diabetes were 0.942, 0.840, 0.705, 0.759, 0.819, 0.813, 0.857 and 0.677, respectively. The AUC of the combined prediction was 0.971(95% CI: 0.946-0.997), which was higher than that of the single indicator (all P<0.05). Spearman correlation assessment showed a negative correlation between TIR and peripheral neuropathy ( r=-0.738, P<0.05). MBG, eHbA 1c, SD, CV, LAGE, MAGE and MODD were positively correlated with peripheral neuropathy ( r=0.554, 0.376, 0.452, 0.490, 0.527, 0.625, 0.272, all P<0.05). Conclusions:Based on continuous blood glucose monitoring, the blood glucose index of type 2 diabetes patients is closely related to peripheral neuropathy, and the above blood glucose index can accurately predict peripheral neuropathy, providing a reference for reducing or preventing the occurrence of peripheral neuropathy.