In the context of rapid global aging, the number of vulnerable elderly individuals who are sensitive to climate change and air pollution is increasing rapidly, potentially augmenting the burden of related diseases. The intrinsic capacity (IC) of the elderly refers to the comprehensive ability of individuals in physical, cognitive, and mental health aspects, typically encompassing 5 dimensions: cognitive status, motor ability, mental health, sensory function, and vitality. This article reviewed the advancements in epidemiological research on the effects of air pollution and climate change (including meteorological factors) on the overall intrinsic capacity of the elderly and its various dimensions. The results indicated that pollutants such as fine particulate matter (PM_2.5) and ozone (O₃) are most significantly associated with the decline in the cognitive function and vitality dimensions, and extreme meteorological events like high temperatures are also related to the functional deterioration of each dimension of IC. Nevertheless, the current studies mostly focus on the impact of atmospheric environmental factors on a specific dimension of IC rather than on overall IC, and research on the combined exposure to multiple atmospheric factors is even rarer, and the exploration of associated mechanisms is insufficient. Future research should enhance the investigation of the influence and mechanism of the combined exposure to air pollution and climate change on the dynamic changes of IC, and promote multi-center research and transnational cooperation. This review is conducive to clarifying the potential impact of atmospheric environmental factors on the IC of the elderly, providing a scientific basis for formulating health intervention policies to address climate change and air pollution.

Objective:To retrieve, evaluate, and integrate the best practice evidence for targeted temperature management in neurocritically ill patients.Methods:PIPOST tool was used to identify evidence-based issues; the Chinese and English terms were chosen as "Traumatic brain injuries", "Craniocerebral trauma/Cerebral hemorrhage/Stroke/Subarachnoid hemorrhage/Cerebral vascular disease", and "Mild hypothermia therapy/Target body temperature/Cyotherapy". According to top-down design of the "6S" evidence model, databases such as French guideline network, US guideline network, UpToDate, Chinese Biomedical Literature Database, China Yimaitong Guide network, CNKI, and Wanfang Medical Network were searched. Two researchers independently evaluated the quality of the included literature, and extracted and summarized the evidences of the literature that met the quality standards.Results:A total of 10 articles were included, including 1 clinical decision, 4 guidelines, 1 evidence summary, and 4 expert consensuses. Finally, 27 pieces of best evidences were summarized, including 6 aspects as evaluation, preparation before implementation, targeted body temperature selection, intervention duration, chill management, and other complication prevention.Conclusion:Best evidence for temperature management in neurocritically ill patients can provide evidence-based evidence for healthcare professionals.

ObjectiveThis study aimed to investigate the HIV genotypic subtypes and molecular transmission clusters among men who have sex with men （MSM） with newly reported HIV infections in Dehong Dai and Jingpo Autonomous Prefecture （Dehong Prefecture）， Yunnan Province， China， between 2010 and 2019. The study aimed to identify potential high-risk transmitters and provide reference data for screening， management， and intervention of infection sources. MethodsPlasma samples from newly reported HIV-positive MSM individuals in Dehong Prefecture between 2010 and 2019 were collected. The viral pol gene fragments were amplified， sequenced， and genotyped. Genetic distances （GD） between pairwise sequences were analyzed and calculated. MEGA 7.0 and Gephi were used for phylogenetic and molecular transmission network analysis. ResultsA total of 159 newly reported HIV infections among MSM were included in the study， with successful genotyping of 100 cases. Nine HIV-1 subtypes were identified， with the most prevalent being CRF01_AE subtype （52%）， followed by CRF07_BC subtype （31%）， CRF55_01B subtype （10%）， and others （7%）. Cluster analysis revealed a total network access rate of 67%， forming three transmission clusters. CRF01_AE subtype formed two transmission clusters with 38 and 3 infected individuals， while CRF07_BC subtypes formed one transmission cluster with 26 infected individuals. The transmission network within the CRF01_AE clusters exhibited a more complex relationship. Significant differences in educational level were observed between the two main transmission clusters. ConclusionThe predominant HIV subtypes among newly reported MSM cases in Dehong Prefecture between 2010 and 2019 were CRF01_AE and CRF07_BC. Significant cultural differences are observed between the main transmission clusters. Continued monitoring of genotypic subtypes and targeted interventions within transmission clusters are warranted.

Objective　To explore independent risk factors for early neurological deterioration in first-ever minor ischemic stroke without reperfusion therapy,and to achieve individualized prediction by constructing a nomogram model.Methods　We enrolled first-ever minor ischemic stroke patients of non-reperfusion therapy from January 1,2017 to December 31,2019 in the Zhaoqing First People’s Hospital.The clinical and imaging data of the Neurological deterioration group(END group) and the non-END group were analyzed.The independent related factors were screened and the nomogram model was constructed.Results　A total of 384 cases were enrolled,including 66 cases (17.19%) in the END group and 318 cases (82.81%) in the non-END group.Logistic regression analysis showed that diabetes mellitus,TOAST typing,albumin levels,and cerebral atherosclerosis score (CAS) were independent influencing factors (P<0.05).The nomogram model is constructed and the ROC curve is generated,and the area under the curve is 0.859［95%CI(0.758,0.864)］.Model consistency can be hinted at by the calibration curve and the Hoster-Lemeshow test.Finally,the clinical decision curve indicates that the model has clinical application value.Conclusion　This study explores the nomogram model for END in first-ever minor ischemic stroke without reperfusion therapy,which has some clinical application value,is composed of four major factors:diabetes mellitus,TOAST typing,albumin level and CAS.

Objective:To investigate the standardization of implementing enteral nutrition in patients with stroke among nurses in Guangdong province.Methods:The results of 175 valid questionnaires submitted by 175 nurses from 60 hospitals in Guangdong province from June to July 2022 were analyzed. Contents of the questionnaires included status of enteral nutrition management of stroke patients (facility, staffing, risk screening, and formulation, implementation and quality control of the plans), nurses' knowledge of enteral nutrition monitoring and complication prevention, follow-up status of enteral nutrition in stroke patients, and nurses' willingness in participating in special training of enteral nutrition.Results:(1) In terms of enteral nutrition facilities and staffing, only 76% and 36% used enteral infusion pumps and heating infusion devices, and only 3% had multidisciplinary team configuration; in terms of risk screening, only 63% had all-patient-screen for enteral nutrition risk; in terms of plan formulation, the proportion of no enteral nutrition process reached to 44%; in terms of plan implementation, the implementation rate of enteral nutrition≤48 h and gastrointestinal function evaluation using gastrointestinal function evaluation scale was less than 50%; in terms of plan quality control, less than 50% Departments had sensitive indexes of enteral nutrition nursing. (2) Among 14 risk management problems of enteral nutrition monitoring and complication prevention, only 3 had accuracy rate higher than 70%. (3) 78% nurses mentioned that patients had experienced enteral nutrition complications, and 77% nurses mentioned that patients/family members had consulted about enteral nutrition related issues; 81% nurses wanted to participate in training or refresher courses related to enteral nutrition, and 88% nurses wanted to join the enteral nutrition Nursing Alliance for stroke patients to serve patients after referral and discharge.Conclusion:The current situation of enteral nutrition management of stroke patients in Guangdong province is not optimistic; nurses lack knowledge of enteral nutrition monitoring and complication prevention, but are strongly willing to participate in the special training of enteral nutrition; relevant measures to further improve the standardized management of enteral nutrition of stroke patients is suggested.

Objective:To search and summarize the best evidence for blood pressure management in patients with intracerebral hemorrhage to provide evidence for blood pressure management in these patients.Methods:PIPOST model was used to establish evidence-based questions; with "intracerebral hemorrhage/cerebral hemorrhage/ICH/HICH/stroke" AND "blood pressure/hypertension" as English search terms, and with "脑出血/颅内出血/脑卒中"+"血压" as Chinese search terms, the official websites of related associations and domestic and foreign databases, such as GUIDE.com, UpToDate, Cochrane Library, CNKI, VIP Chinese journal Service platform, and Wanfang Data Knowledge Service platform, were searched. Two researchers independently evaluated the quality of the literature, including guidelines, systematic reviews, and expert consensus, and extracted the evidence.Results:A total of 17 articles were selected; 2 were clinical decision type, 7 were guideline type, 7 were systematic review type, and 1 was expert consensus type. Twenty-six pieces of evidence were summarized into 5 aspects: timing and methods of lowering blood pressure, benefits and risks of lowering blood pressure, drug selection and selection methods, recurrence prevention of stroke, and matters for attention.Conclusion:It is necessary to pay attention to blood pressure management in patients with intracerebral hemorrhage; in the process of evidence application, it's suggested to make an appropriate blood pressure management plan for the patients according to clinical situation.

OBJECTIVETo investigate the role of miR-199a-3p in cardiac fibrosis and the potential target of miR-199a-3p.

METHODSCardiac fibroblasts were isolated from C57BL/6 mice and cultured. The miR-199a-3p mimic and Smad1 siRNA were transiently transfected into the cardiac fibroblasts via liposome. Dual luciferase reporter assay was performed to confirm the interaction between miR-199a-3p and the 3'-UTR of Smad1. The expressions of Smad1 and fibrosis-related genes at the mRNA and protein levels in the cells after miR-199a-3p mimic transfection were determined using RT-qPCR and Western blotting, respectively. The expressions of Smad1, Smad3 and fibrosis-related genes at the protein level in cells transfected with miR-199a-3p mimic and Smad1 siRNA were detected using Western blotting.

RESULTSOver-expression of miR-199a-3p significantly increased the expression of cardiac fibrosis-related genes in cultured mouse cardiac fibroblasts. Dual luciferase reporter assay revealed the interaction of miR-199a-3p with the 3'-UTR of Smad1. The results of RT-qPCR and Western blotting confirmed that miR-199a-3p inhibited Smad1 expression at the post- transcriptional level. Transfection with miR-199a-3p mimic and siRNA-mediated Smad1 silencing consistently activated the Smad3 signaling pathway and enhanced the expressions of cardiac fibrosis-related genes in the cardiac fibroblasts.

CONCLUSIONSAs the target gene of miR-199a-3p, Smad1 mediates the pro-fibrotic effect of miR-199a-3p by activating the Smad3 signaling in cultured mouse cardiac fibroblasts.

Objective To observe the effects of Wenyang Baidu Yin on the serum liver DeRitis ratio [aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio] and the level of renal neutrophil gelatinase-associated lipocalin (NGAL) in septic rats. Methods One hundred and twenty healthy male sprague-dawley (SD) rats were divided into normal control group, model group, western medicine treatment group, traditional Chinese medicine (TCM) treatment group and combined medicine group by random number table method, with 24 rats in each group. Rat sepsis model was established by intra-peritoneal injection of E.coli endotoxin; after modeling for 2 hours, normal control group and model group were given normal saline intragastric administration, western medicine treatment group was given dexamethasone 2.5 mg/kg intra-gastric administration, TCM treatment group was given Wenyang Baidu Yin intragastric administration (honeysuckle 30 g, dandelion 30 g, aconite 30 g, mixed with water and after two times of boiling, the obtained liquid was concentrated and made into dry ointment for reserve, when the ointment was used, it was dissolved in warm water to 8 g/kg, administered by gavage, twice a day), the combined medicine group was given both the above TCM decoction and dexamethasone dosages by gavage. After modeling for 24, 48 and 72 hours, the differences of DeRitis ratio and NGAL levels were compared among various groups. Results The DeRitis ratio and NGAL level in the model group were significantly higher than those in the normal control group at 24, 48, 72 hours after modeling (DeRitis ratio: 4.14±0.53 vs. 2.08±0.37, 4.78±0.07 vs. 1.73±0.61, 4.83±0.31 vs. 1.05±0.20 respectively, NGAL was 2 412.73±368.03 vs. 837.52±142.98, 1 735.16±290.76 vs. 817.38±102.08, 1 838.43±295.44 vs. 847.82±140.14 respectively, all P < 0.05). The DeRitis ratios and NGAL levels of western medicine treatment group, TCM treatment group and combined medicine group were significantly lower than those of model group at each time point, and the decrease degree of combined medicine group was more significant, there were statistical differences 48 hours after modeling between combined medicine group and Western medicine treatment group and between combined group and TCM treatment group [DeRitis ratio: 3.09±0.15 vs. 3.68±0.44, 3.27±0.62, NGAL (ng/L):1 105.32±270.27 vs. 1 206.35±143.82, 1 526.53±289.02], and reached the lowest level until 72 hours [DeRitis ratio: 2.27±0.26 vs. 2.93±0.38, 2.61±0.54, NGAL (ng/L): 903.47±105.37 vs. 9 316.05±116.23, 1 025.14±152.68, all P < 0.05], showing the usage of combined therapeutic method in the aspect of improving DeRitis ratio and NGAL of septic rats was prominently superior than using either western medicine or TCM decoction alone. Conclusion Wenyang Baidu Yin can effectively reduce the liver DeRitis ratio and the kidney NGAL level in endotoxin-induced septic rats.

Background and objective It is very diffcult to deal with the comprehensive central airway diseases, especially the malignant airway obstruction. The aim of this study is to explore the clinical effects of multiple interventional bronchoscopies for the treatment of 112 cases with comprehensive malignant central airway diseases so as to evaluate the clini-cal applications of thermoablation and cryosurgery.Methods The 112 cases with malignant airway diseases retrospectively reviewed for bronchoscopic interventions performed in more than two lesions of carina and/or bifurcation. hTe age was from 22 to 90 years, which including 55 cases with squamous carcinoma (SQ), 16 adenocarcinoma (AD), 15 adenocystic carcinoma (ACC), 10 metastasis tumor (MT), 8 small cell lung carcinoma (SCLC) and 8 mixed carcinoma (MC). All bronchoscopic interventions such as argon plasma coagulation (APC), cryosurgery, electronic snare and stenting were performed under rigid bronchoscopy combined with electric bronchoscopy in general anesthesia.Results hTe 460 bronchoscopic procedures were successfully performed in 112 cases. Cryosurgery and APC were the most used in every group. Stent was more common in patients with MT, balloon dilation was more common in patients with ACC and AD. Electric snare and radioactive seeds im-plantation were frequently used in cases with SCLC. Trachea stricture is more severe in MT than that in others, while bronchus stricture is more severe than that of trachea in SQ and ACC group. Karnofsky performance score (KPS) is lower and shortness of breath score (SBS) is higher in MC, MT and SCLC group. Trachea and bronchus stricture is improved atfer comprehensive treatment in 5 groups except of mixed group. KPS increased and SS decreased signiifcantly in 5 groups except of adenocarci-noma. In follow-up, the overall survival time (OS) is 15 months and median survival time is 10 months, especially OS is 28.4 months in ACC and 21.7 months in AD, 8.9 months in SCLC and 7.4 months in mixed group.Conclusion APC combination with Cryosurgery and other bronchoscopic interventions are indicated for the treatment of complex or diffcult airway diseases whether they are located in trachea or bronchus. It is a safe and rapid during procedure.

Objective To optimize the preparative procedure for stachydrine in Fructus Leonuri. Methods The preparation was screened by orthogonal experiment, and a mathematical model of relationship of extraction time, methanol concentration, and solid-liquid ratio with the content of stachydrine hydrochloride was established by using back-propagation (BP) neural network. And the process parameters were optimized with genetic algorithm (GA) . Results The optimum process parameters were as follows: extraction with 69% of methanol concentration and with solid-liquid ratio being 11 times for 62 min. The content of stachydrine obtained by BP neural network modeling and GA was higher than that achieved by orthogonal experiment. Conclusion The optimum preparative procedure could be achieved by combining BP modeling with GA. The model developed in this study was proved to be predictable and feasible for the optimization of process parameters of multi-dimension nonlinear system.