Background Sleep is a crucial physiological activity for the human body, and research has shown that air pollution can affect sleep quality. However, the association between polycyclic aromatic hydrocarbons (PAHs) exposure, neurotoxic compounds in air pollutants, and sleep quality remains uncertain. Objective To evaluate the association of PAHs exposure with sleep quality, and to provide evidence for improving sleep quality. Methods This study used a cross-sectional design. We selected 632 workers from a coking plant of a large state-owned enterprise as the exposure group, and 477 workers from the energy and power plant of the same enterprise as the control group. All workers worked in three shifts. A questionnaire survey was conducted to collect basic information including gender, years of service, age, educational level, smoking, alcohol consumption, consumption of fried foods, cooking frequency, types of cooking fuels. Worker's post-shift morning midstream urine was sampled to determine the concentrations of eight PAHs metabolites (OH-PAHs) using gas chromatography-tandem mass spectrometry (GC-MS). Worker's sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI). A higher PSQI score indicated a lower sleep quality. Associations of urinary OH-PAHs levels with sleep quality in the workers were analyzed using linear regression, Bayesian kernel-machine regression (BKMR), and quantile g-computation. Results The median (P₂₅, P₇₅) concentration of total OH-PAHs in the exposure group [88.84 (46.27, 151.96) μg·L⁻¹] was higher than that in the control group [54.33 (24.86, 97.97) μg·L⁻¹]. Additionally, the PSQI score (\begin{document}$ \overline{x}\pm {s} $\end{document}) in the exposure group (5.16±3.84) was higher than that in the control group (4.60±3.17). The multiple linear regression revealed that an increase in the sum of the concentrations of eight OH-PAHs after natural logarithmic transformation (lnΣ₈OH-PAHs) was associated with an increase of 0.3646 (95%CI: 0.1337, 0.5955) in PSQI score, and an increase in lnΣlow-ring OH-PAHs was associated with an increase of 0.2954 (95%CI: 0.0941, 0.4967) in PSQI score. The BKMR analysis demonstrated that PSQI score was gradually increased as the increasing of lnΣ₈OH-PAHs concentration. The quantile g-computation analysis indicated that a quantile increase in lnΣ₈OH-PAHs concentration was associated with an increase of 0.4062% (95%CI: 0.1176%, 0.6949%) in PSQI score. Conclusion Compared to the controls, the coking workers show a higher concentration of urinary OH-PAHs and report worse sleep quality. The concentration of OH-PAHs is significantly negatively associated with sleep quality.

Objective To use the high-speed fluorescence photography to investigate the regulatory effect of nitric oxide(NO)on calcium transient state in skeletal muscle cells of adult zebrafish.Methods The skeletal muscle cells were separated and extracted from adult zebrafish and then incubated with Fluo-4 and AM fluorescent probe.The fluorescence change of calcium transient state in zebrafish free skeletal muscle cells after single electrical stimulation was recorded by a high-speed fluorescence camera,and the biophysical pa-rameters related to the intracellular calcium transient state were quantitatively calculated.The experimental groups were divided into the control group,S-nitroso-n-acetyl-DL-penicillamine(SNAP)group and n-nitroso-L-arginine methyl ester(L-NAME)group.NO donor SNAP and non-specific nitric oxide synthase(NOS)in-hibitor L-NAME were used to investigate the regulatory effect of NO on calcium transient state in adult skele-tal muscle cells of zebrafish.The experimental groups were redivided into the control group,N-ethylmaleimide(NEM)group,1H-[1,2,4]dioxalin and[4,3-a]quinoxalin-1-one(ODQ)group,SNAP group and SNAP+ODQ group.The regulatory mechanism of NO on calcium transients state in adult zebrafish skeletal muscle cells was investigated by using sGC-cGMP-PKG pathway inhibitor ODQ and S-nitrosation inhibitor NEM.Re-sults The fluorescence changes of calcium transient state in adult zebrafish skeletal muscle cells could be re-corded by high speed fluorescence photography and the biophysical parameters related to intracellular calcium transients state were calculated.Compared to the control group,the calcium transient state of skeletal muscle cells in the SNAP group was significantly decreased,while the calcium transient state of skeletal muscle cells in the L-NAME group was significantly enhanced compared to the control group.The calcium transient state of skeletal muscle cells in the ODQ group was significantly stronger than that in the control group,while there was no statistical difference in the related parameters of calcium transient state between the NEM group and control group.The calcium transient state of skeletal muscle cells in the SNAP+ODQ group was also signifi-cantly stronger than that in the SNAP group.Conclusion NO could negatively regulate the process of calcium transient state in adult zebrafish skeletal myocytes by the sGC-cGMP-PKG pathway.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:To evaluate the role of ecto-5′-nucleotidase (CD73) in endogenous protective mechanism of hepatic ischemia-reperfusion (I/R) injury in mice and the relationship with transforming growth factor beta1 (TGF-β 1)/Smad3 signaling pathway. Methods:Twenty-four SPF healthy male C57BL/6 mice, aged 8-10 weeks, weighing 20-23 g, were divided into 3 groups ( n=8 each) by the random number table method: sham operation group (S group), hepatic I/R group (IR group) and hepatic I/R plus CD73 specific inhibitor group (APCP group). The hepatic hilum was only exposed but not occluded in group S. The hepatic portal was occluded for 30 min followed by reperfusion to develop the model of hepatic I/R in anesthetized animals in group IR.CD73-specific inhibitor APCP 40 mg/kg was intraperitoneally injected, and 10 min later hepatic I/R was performed.Orbital venous blood samples were collected at 6 h of reperfusion for determination of serum alanine transaminase (ALT) and aspartate transaminase (AST) concentrations.Then the mice were sacrificed, and liver tissues were obtained for determination of the expression of CD73, TGF-β 1 and phosphorylated Smad3 (p-Smad3) (by Western blot), contents of interleukin-1β (IL-1β) and tumor necrosis factor-alpha (TNF-α) (by enzyme-linked immunosorbent assay), and content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) (with a visible spectrophotometer) and for microscopic examination of the pathological changes of liver tissues (with a light microscope). Results:Compared with group S, the concentrations of AST and ALT in serum and contents of IL-1β, TNF-α and MDA in liver tissues were significantly increased, the activity of SOD was decreased, and the expression of CD73, TGF-β 1 and p-Smad3 was up-regulated in IR and APCP groups ( P<0.05). Compared with group IR, the concentrations of AST and ALT in serum and contents of IL-1β, TNF-α and MDA in liver tissues were significantly increased, the activity of SOD was decreased, and the expression of CD73, TGF-β 1 and p-Smad3 in liver tissues was down-regulated in group APCP ( P<0.05). The pathological changes of liver tissues were accentuated in group APCP as compared with group IR. Conclusions:CD73 is involved in the process of endogenous protective mechanism of hepatic I/R injury in mice, which may be related to the regulation of TGF-β 1/Smad3 signaling pathway.

Objective:To evaluate the role of microRNA-10a (miRNA-10a) in renal ischemia-reperfusion (I/R) injury in mice and the relationship with transforming growth factor beta1 (TGF-β 1)/Smad2 signaling pathway. Methods:Twenty-four SPF healthy male adult C57BL/6 mice, aged 8-10 weeks, weighing 20-25 g, were divided into 4 groups ( n=6 each) by the random number table method: sham operation group (S group), renal I/R group (IR group), renal I/R plus miRNA-10a antagonist group (I group), and renal I/R+ miRNA-10a agonist group (M group). The mouse model of renal I/R was developed by clamping the left renal pedicle for 45 min followed by reperfusion in anesthetized animals.miRNA-10a antagonist and agonist 20 nmol were injected via the tail vein once every 24 h for 3 consecutive days starting from 72 h before surgery in group M and group I, respectively, while the equal volume of normal saline was given instead in S and IR groups.Blood samples were collected from the orbital vein at 24 h of reperfusion to determine the concentrations of the serum creatinine (Scr) and blood urea nitrogen (BUN). Then the mice were sacrificed, and the kidney tissues were taken for determination of the malondialdehyde (MDA) content and superoxide dismutase (SOD) activity, contents of interleukin-1 beta (IL-β) and tumor necrosis factor-alpha (TNF-α) (by enzyme-linked immunosorbent assay), and expression of TGF-β 1 and phosphorylated Smad2 (p-Smad2) (by Western blot) and for microscopic examination of the pathological changes.The damage to the renal tubules was scored. Results:Compared with group S, the concentrations of Scr and BUN, contents of MDA, IL-1β and TNF-α in renal tissues and renal tubular damage score were significantly increased in IR, I and M groups, and the activity of SOD was significantly decreased, and the expression of TGF-β 1 and p-Smad2 was up-regulated in IR and M groups ( P<0.05). Compared with group IR, the concentrations of Scr and BUN, contents of MDA, IL-1β and TNF-α in renal tissues and renal tubular damage score were significantly decreased, the activity of SOD was increased, and the expression of TGF-β 1 and p-Smad2 was down-regulated in group I, and the concentrations of Scr and BUN, contents of MDA, IL-1β and TNF-α in renal tissues and renal tubular damage score were significantly increased, the activity of SOD was decreased, and the expression of TGF-β 1 and p-Smad2 was up-regulated in group M ( P<0.05). Compared with group I, the concentrations of Scr and BUN, contents of MDA, IL-1β and TNF-α in renal tissues and renal tubular damage score were significantly increased, the activity of SOD was decreased, and the expression of TGF-β 1 and p-Smad2 was up-regulated in group M ( P<0.05). Conclusions:miRNA-10a is involved in the process of renal I/R injury and is related to activation of TGF-β 1/Smad2 signaling pathway in mice.

Background Long-term occupational polycyclic aromatic hydrocarbons (PAHs) exposure is an important risk factor for cognitive impairment. At the same time, it can also cause a decrease of brain-derived neurotrophic factor (BDNF). However, it is not clear whether BDNF plays a key role in the cognitive impairment of workers caused by occupational PAHs exposure. Objective To analyze the correlation between the levels of PAHs in the plasma of coke oven workers and cognitive impairment, and to explore the possible mediating effect of plasma BDNF level on the relationship between PAHs and cognitive impairment. Methods A cross-sectional survey was carried out to select 138 pairs of workers from a coking plant (exposure group) and an energy plant (control group) in a large enterprise in Taiyuan, and the matching variables included age, education level and smoking status. The basic data of the workers were collected by questionnaire. The cognitive function of the workers was assessed by the Montreal Cognitive Assessment (MoCA) scale. Fasting elbow venous blood was collected, the plasma concentrations of 16 PAHs were determined by high performance gas chromatography-mass spectrometry (GC-MS), and the plasma concentration of BDNF was detected by enzyme-linked immunosorbent assay (ELISA). Multiple linear regression model was used to analyze the relationship between 12 PAHs levels in plasma and MoCA scores, and Bootstrap method was used to analyze the mediating effect of BDNF in the relationship between these two indicators. Results The average (\begin{document}$\bar x \pm s $\end{document}) age of workers in the two groups was (48.46±5.04) years, the length of service was (21.45±9.78) years, and 58.7% of the participants reported their education level at secondary vocational school, high school, and above. The median level (25th and 75th percentiles) [M(P₂₅, P₇₅)] of plasma Σ₁₂PAHs concentration of workers in the exposure group [20.937 (9.454, 38.387) μg·L⁻¹] was significantly higher than that of the control group [9.997 (4.952, 23.770)μg·L⁻¹] and the MoCA score (22.82±2.38) of the exposure group was significantly lower than that of the control group (24.60±5.67) (P<0.05). The plasma BDNF showed no significant difference between the exposure group [(29.99±9.80) μg·L⁻¹] and the control group [(31.48±9.09) μg·L⁻¹](P>0.05). Taking plasma PAHs as independent variable and MoCA score as dependent variable, after adjusting selected covariates, the results of multiple linear regression model showed that the MoCA score changed by −0.020 (95%CI: −0.035 - −0.005) for every 1 μg·L⁻¹ increase of plasma Σ₁₂PAHs. Low (<P₃₃), medium ( P₃₃~P₆₆) and high (>P₆₆) dummy variables were set according to the intertertile boundaries (8.31, 23.76) μg·L⁻¹ of the plasma level of Σ₁₂PAH of the workers. The change of MoCA score in the high concentration group versus the low concentration group was −1.167 (95%CI: −1.866 - −0.467). The MoCA score changed by 0.066 (95%CI: 0.012 - 0.119) for each 1 μg·L⁻¹ increase in plasma BDNF level. The results of dichotomous logistic regression analysis showed that the risk of cognitive impairment in the high concentration group was 2.635 (95% CI: 1.085 - 6.398) times higher than that in the low concentration group. The results of mediating effect analysis showed that plasma BDNF level was an intermediate variable between PAHs and cognitive impairment, and 45.50% of PAHs-induced cognitive impairment risk was mediated by reduced BDNF level. Conclusion The level of plasma PAHs in coke oven workers is negatively correlated with MoCA score, and PAHs may mediate cognitive impairment by reducing plasma BDNF level.

Polytrauma represents severe injuries to multiple body regions, which is associated with high risk of complications and mortality. The definition of polytrauma relies on the basic concept of a combination of injuries that cause a life-threatening condition. The authors strongly call on the healthcare community to list polytrauma as a single disease in the international classification of diseases, rather than "disease combination". Because polytrauma has definite etiology and unique pathophysiological changes after polytrauma, treatment models are different from single trauma. Polytrauma can certainly fulfil any practical and nosological criteria of a single disease according to Berlin definition. The authors explore the importance of polytrauma as a single disease in preventive intervention strategies, therapeutic measures and traumatology development in the future.

Objective:To explore the relationship between polycyclic aromatic hydrocarbons (PAHs) exposure and sleep quality in workers from a coking plant.Methods:From April to June 2019. Selected 632 employed workers in the coking plant of a large state-owned enterprise in Shanxi Province as the exposed group, and 477 employed workers in the water-pump plant belonged to the same enterprise as the control group. We used self-designed questionnaires to collect the basic information of subjects. We measured the concentrations of 12 PAHs in the peripheral blood of workers using gas chromatography-mass spectrometry (GC-MS) ; Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality of workers; The relationship between plasma PAHs concentration and sleep quality was analyzed using multiple linear regression model, restricted cubic spline (RCS) regression and logistic regression.Results:The concentration of 12 polycyclic aromatic hydrocarbons in the peripheral blood of the exposure group was (2.36±1.46) ng/ml, which was significantly higher than that of the control group (2.19±1.21) ng/ml. The detection rate of sleep disorder in the exposure group (18.0%) was higher than that in the control group (16.8%) , which was manifested by the significantly increased scores in subjective sleep quality, sleep latency, sleep disorders, daytime dysfunction, and PSQI. Multiple linear regression analysis showed that the PSQI score of workers in the high exposure group decreased by 0.80 (95% CI: -1.40~-0.19) points compared with the low exposure group, with a statistically significant difference ( P<0.05) . RCS analysis showed a non-linear dose-response relationship of PSQI score with PAHs cumulative exposure (plasma PAHs concentration multiplied by length of service) . The results of logistic regression showed that compared with the low level group, the risk of somnipathy in the middle level group of PAHs cumulative exposure decreased by 44%, among which the risk of sleep disorder in the drinkers decreased by 40%, while the risk of somnipathy in the high level group increased by 96% compared with the low level group. Stratified analysis of alcohol drinking habit showed non-significant difference in PSQI score with low, medium, and high levels of PAHs cumulative exposure in non-drinkers ( P>0.05) , and that the PSQI score was significantly increased in alcohol drinkers with high level of PAHs cumulative exposure compared to those with low and medium levels of PAHs cumulative exposure. Conclusion:The workers in the coking plant had high levels of PAHs in plasma and poor sleep quality, Higher level of PAHs cumulative exposure (>1396.56ng/ml) is a risk factor of poor sleep quality.

Objective:To explore the relationship between polycyclic aromatic hydrocarbons (PAHs) exposure and sleep quality in workers from a coking plant.Methods:From April to June 2019. Selected 632 employed workers in the coking plant of a large state-owned enterprise in Shanxi Province as the exposed group, and 477 employed workers in the water-pump plant belonged to the same enterprise as the control group. We used self-designed questionnaires to collect the basic information of subjects. We measured the concentrations of 12 PAHs in the peripheral blood of workers using gas chromatography-mass spectrometry (GC-MS) ; Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality of workers; The relationship between plasma PAHs concentration and sleep quality was analyzed using multiple linear regression model, restricted cubic spline (RCS) regression and logistic regression.Results:The concentration of 12 polycyclic aromatic hydrocarbons in the peripheral blood of the exposure group was (2.36±1.46) ng/ml, which was significantly higher than that of the control group (2.19±1.21) ng/ml. The detection rate of sleep disorder in the exposure group (18.0%) was higher than that in the control group (16.8%) , which was manifested by the significantly increased scores in subjective sleep quality, sleep latency, sleep disorders, daytime dysfunction, and PSQI. Multiple linear regression analysis showed that the PSQI score of workers in the high exposure group decreased by 0.80 (95% CI: -1.40~-0.19) points compared with the low exposure group, with a statistically significant difference ( P<0.05) . RCS analysis showed a non-linear dose-response relationship of PSQI score with PAHs cumulative exposure (plasma PAHs concentration multiplied by length of service) . The results of logistic regression showed that compared with the low level group, the risk of somnipathy in the middle level group of PAHs cumulative exposure decreased by 44%, among which the risk of sleep disorder in the drinkers decreased by 40%, while the risk of somnipathy in the high level group increased by 96% compared with the low level group. Stratified analysis of alcohol drinking habit showed non-significant difference in PSQI score with low, medium, and high levels of PAHs cumulative exposure in non-drinkers ( P>0.05) , and that the PSQI score was significantly increased in alcohol drinkers with high level of PAHs cumulative exposure compared to those with low and medium levels of PAHs cumulative exposure. Conclusion:The workers in the coking plant had high levels of PAHs in plasma and poor sleep quality, Higher level of PAHs cumulative exposure (>1396.56ng/ml) is a risk factor of poor sleep quality.

Objective:To observe the effect of repeated, bilateral administration of high-frequency transcranial magnetic stimulation (rTMS) in treating post-stroke dysphagia.Methods:Forty-five persons with post-stroke dysphagia were randomly divided into a bilateral group ( n=14 after one dropout), an affected group ( n=15) and a healthy group ( n=15). All received 30 minutes of conventional swallowing rehabilitation training 5 times a week for 2 weeks from a speech therapist. Those in the affected group also received 5Hz rTMS applied to the motor cortex controlling the suprachyoid muscle group. The bilateral group received the same stimulation bilaterally with the same duration and treatment course. Videofluoroscopy was used to assess their swallowing before and after the 2 weeks of treatment. It was rated using the penetration-aspiration scale (PAS) and the functional swallowing disorder scale (FDS). Surface electromyography was employed to evaluate suprachyoid muscle function. Cortical excitability was assessed by measuring the resting motor threshold (RMT) of the unaffected hemisphere. Results:After the treatment, the average PAS, FDS and muscle function values had improved significantly for all three groups, but significant RMT differences were observed only between the bilateral and the unaffected group. Significant differences in the average FDS and PAS scores were observed after the treatment, as well as significant changes in FDS and muscle function between the affected group and the other two groups. The average FDS scores before and after treatment were significantly different between the unaffected and bilateral group, with the former scoring significantly better than the latter. But no significant differences in the average PAS scores were observed after the treatment.Conclusions:5Hz rTMS of either the unaffected or affected cerebral cortex (or bilateral) can effectively improve the swallowing function of persons with post-stroke dysphagia. Bilateral stimulation has the greatest therapeutic effect, followed by stimulation of the unaffected cerebral cortex.