Idiopathic pulmonary fibrosis （IPF） can be classified as pulmonary collateral disease，and its pathogenesis is mainly characterized by the loss of Qi meridian nourishment，the loss of Yin meridian nourishment，and the formation of blood stasis in the blood vessels. Qi Yin deficiency is the pathological basis that runs through IPF，and obstruction of meridians and collaterals is a key element in the development of the disease. The dysfunction of "spleen being in charge of the defensive function" is closely related to the formation of the pathological pattern of "lung deficiency and collateral stasis" in IPF. The term "spleen being in charge of the defensive function" originated from the Yellow Emperor's Inner Canon. If the spleen is healthy，the Qi will be filled with vitality. Positive energy is stored inside，evil cannot be dried up. Its concept is quite similar to the immune defense function in modern medicine. If the principle of "spleen being in charge of the defensive function" is lost，the key structure and function of the IPF alveolar epithelial barrier may be abnormal，and it can interact with various innate immune cells to promote inflammation and fibrosis processes. Therefore，this article explains the imbalance of immune homeostasis in IPF alveolar epithelium from two aspects：the barrier function of alveolar epithelial cells（AECs） and their interaction with innate immune cells. And based on the theory of "spleen being in charge of the defensive function"，using traditional Chinese medicine for strengthening the spleen and nourishing Qi to treat IPF from the perspective of the spleen. This not only strengthens the scientific connotation of "spleen being in charge of the defensive function" in the pathogenesis of IPF，but also provides new research directions and ideas for its future clinical prevention and treatment.

Acute ST-segment elevation myocardial infarction with multivessel disease is one of the high-risk types of coronary heart disease.Early opening of infarct-related artery and reperfusion of myocardium could significantly reduce the mortality in acute phase.However,the presence of non-culprit lesions in non-infarct-related arteries is still at risk and has an important impact on the long-term prognosis of patients.It remains controversial on how to precisely evaluate the clinical significance and revascularization value of non-culprit lesions.This article aims to review the research status and progress of guidance strategies of non-culprit lesion revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease.

Objectives:Present study analyzed the efficacy and safety of percutaneous coronary intervention(PCI)using the distal transradial access(dTRA)for patients with complex coronary lesions. Methods:A total of 10 033 patients with complex coronary artery lesions(type B2 and type C lesions)who underwent percutaneous coronary intervention(PCI)via dTRA or conventional transradial access(TRA)at Fuwai Hospital between June 2021 and May 2022 were included(9 625 patients in the TRA group and 408 patients in the dTRA group).After propensity score matching,391 patients were included in each group.Baseline data,PCI intraoperative data(including lesion characteristics,intervention success rate,etc.),and incidence of major bleeding related to the access were compared between the two groups before and after propensity score matching. Results:Before propensity score matching,the proportions of patients with hypertension,hyperlipidemia,family history of coronary heart disease,history of myocardial infarction,and history of coronary artery bypass grafting were significantly higher in the dTRA group than in the TRA group(all P<0.05).After propensity score matching,the baseline data of the two groups were similar(all P>0.05).Before propensity score matching,compared with the TRA group,patients in the dTRA group had a higher proportion of patients with type B2 lesions,while the proportions of patients with type C lesions and those using intravascular ultrasound(IVUS)were lower(all P<0.05).The proportion of patients with chronic complete occlusion was similar between the two groups(P>0.05).After propensity score matching,compared with the TRA group,patients in the dTRA group had a lower proportion using IVUS and had a higher percent of stent implantation(both P<0.05).There was no statistically significant difference between the two groups in terms of SYNTAX score,guide catheter size,target lesion distribution,proportion of patients using intra-aortic balloon counterpulsation,success rate of intervention procedures,and incidence of major bleeding events related to the access(all P>0.05). Conclusions:Compared with the conventional TRA,interventional treatment of complex lesions through dTRA is equally safe and effective for patients with complex coronary lesions.

Humans ; Cohort Studies ; Body Mass Index ; Percutaneous Coronary Intervention ; Coronary Artery Disease ; Inflammation ; Treatment Outcome ; Risk Factors

Objective To investigate the epidemiological characteristics of Salmonella infection in foodborne diseases in Shanxi Province, and to provide a scientific basis for the prevention and control of Salmonella infection. Methods Automatic microbial biochemical identification system was used to identify Salmonella , and descriptive epidemiological methods were used to analyze the characteristics of Salmonella infections in foodborne diseases in Shanxi Province from 2016 to 2021. Results The basic information of 10 037 cases of foodborne diseases and their Salmonella detection results were analyzed. The detection rate of Salmonella was 5.25%, and the main serotype was Salmonella enteritidis (209/522). The positive detection rate of Salmonella in the 0-10 years old age group was the highest (6.04%), and the difference was statistically significant (χ²= 19.23, P = 0.01). The positive detection rate of Salmonella in kindergarteners was the highest at 10.71%, and there was a significant difference in the positive detection rate among different occupations (χ²= 43.31, P < 0.05). The detection rate of bulk foods (5.16%) was higher than that of pre-packaged foods (3.70%), and the difference was statistically significant (χ²= 4.43, P = 0.04). Cases involving food stores had a higher Salmonella detection rate (9.54%), and the peak period of Salmonella infection was from May 24 to August 23. Conclusion The incidence of Salmonella infection in foodborne diseases is high in summer and autumn. Foods in food stores and bulk foods are more likely to cause Salmonella infection. Supervision and management of food stores should be strengthened, and special attention should be paid to children in kindergartens during the epidemic peak.

Objective:To investigate the correlation between atmospheric particulate matter 2.5 (PM 2.5) concentration and the number of chronic kidney disease (CKD) hospital admissions in the elderly in Taiyuan city. Methods:The atmospheric PM 2.5 concentration in Taiyuan city during 2019—2021 was used as the environmental exposure data, and the number of CKD admission of the elderly patients (> 60 years old) in Taiyuan city at the same time was used as the disease progression index. The distributed lag nonlinear model was used to analyze overall and lag effects of PM 2.5 average daily concentration on the elderly patients admitted to CKD. Results:A total of 6 037 cases elderly patients with CKD admitted to hospital were included, with a male-to-female ratio of 1.36∶1. The average daily concentration of PM 2.5 was 52.80 μg/m 3, which did not exceed China's air quality standard (75 μg/m3); But in autumn and winter, the average daily concentration of PM 2.5 significantly exceeded the normal reference value, with the highest value reaching 302 μg/m 3. The relationship between the average daily concentration of PM 2.5 and the number of elderly patients admitted to CKD was nonlinear and there was a lag effect. The relative risk ( RR) value reached the maximum when PM 2.5 average daily concentration was 87 μg/m 3 with lag time of 11 days [1.074(95% CI 1.018-1.321)]. The subgroup analysis results showed that the risk of admission of elderly female CKD patients was higher than that of male patients with lag time of 10 days, and the RR was 1.073(95% CI 1.001-1.151). Elderly CKD patients with hypertension (PM 2.5 87 μg/m 3) and diabetes (PM 2.5 88 μg/m 3) had a higher risk of admission when exposed to PM 2.5, with maximum RR values of 1.067(95% CI 1.002-1.136) and 1.162(95% CI 1.021-1.320), respectively. Conclusions:High atmospheric PM 2.5 concentration in Taiyuan city can increase the risk of admission in elderly patients with CKD, especially in women and patients with hypertension or diabetes.

Background Individual lead or cadmium exposure can cause abnormal blood glucose level and changes in telomere length, and the role of telomere length in the relationship between heavy metal joint exposure and blood glucose level is still unclear. Objective To explore the role of telomere length in the relationship between lead and cadmium coexposure and blood glucose. Methods A cross-sectional study was conducted. By convenient sampling method, 600 residents living in two communities in a city in North China were selected as participants from April to June 2016. Face-to-face interviews were performed to collect general demographics and lifestyles of the participants. The peripheral blood samples of the participants were collected for blood glucose and telomere length detection, the urine samples were collected for urinary cadmium, urinary lead, and urinary creatinine measurement, and both urinary cadmium and urinary lead were corrected by urinary creatinine. The included participants were divided into a control group, a high-cadmium and low-lead group, a high-lead and low-cadmium group, and a high-lead and high-cadmium group, according to the median levels of urinary cadmium and urinary lead. A restricted cubic spline model was constructed to analyze the relationship between urinary lead/cadmium levels and blood glucose concentrations in the four groups and the relationship between cadmium exposure and telomere length in the high-lead and high-cadmium group. Intermediary model test was conducted to analyze the effect of telomere length on the relationship between exposures to lead and cadmium and blood glucose. Results The included participants were divided into the control group (n=99), the high-cadmium and low-lead group (n=91), the high-lead and low-cadmium group (n=145), and the high-lead and high-cadmium group (n=265). The differences in age, education level, per capita monthly household income, smoking, blood glucose, and telomere length were statistically significant among the four groups (P＜0.05). The high-lead and high-cadmium group had the highest blood glucose concentration, (5.63±1.68) mmol·L⁻¹, and the shortest telomere length, (2.63±1.05) Kb. The restricted cubic spline results showed that urinary cadmium level was correlated with blood glucose concentration in the high-lead and high-cadmium group (F=3.45, P=0.037), and there was a non-linear association (F=6.91, P=0.002); the association between urinary cadmium level and telomere length was also non-linear (F=5.93, P=0.043). The intermediary model test results showed that telomere length was a mediating variable between urinary cadmium level and blood glucose concentration, and the mediating effect size was 0.0192 (95%CI: 0.0007-0.0563), with a mediation ratio of 15.57%. Conclusion Correlations between urinary cadmium and blood glucose and between urinary cadmium and telomere length were observed in the high-lead and high-cadmium coexposure group, and telomere length may play a mediating role in the relationship between them.

Background Environmental pollutants can affect N⁶-methyladenosine (m⁶A) level in the body, but the change of m⁶A level in kidney after being exposed to cadmium (Cd) and the molecular mechanism of renal injury need to be further studied. Objective To analyze the associations of m⁶A modification and methyltransferases/demethylases with microRNA-21 (miR-21) and transforming growth factor- β1 (TGF - β1) in kidney of rats exposed to Cd. Methods Twenty-four SPF male SD rats were divided into 4 groups, with 6 rats in each group, and were exposed to Cd by subcutaneous injection of 2.0, 1.0, and 0.5 mg·kg⁻¹ cadmium chloride (CdCl₂) and equal volume of normal saline for 2 weeks, 7 d a week, respectively. The levels of N-acetyl-β-D-glucosidase (UNAG) and albumin (UALB) in urine, and the levels of m⁶A methylation and TGF-β1 in kidney were detected by enzyme-linked immunosorbent assay (ELISA). The level of blood urea nitrogen (BUN) was measured by urease method. The levels of renal oxidative stress indicators such as malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were detected by total bile acid method, water-soluble tetrazolium asssay, and colorimetric method respectively. The relative levels of TGF-β1, methyltransferases, and demethylases in kidney were measured by reverse transcription-polymerase chain reaction. The expression of miR-21 in kidney was detected by fluorescent quantitative polymerase chain reaction. Results After 2 weeks of exposure to Cd, the body weights of rats in the 2.0 and 1.0 mg·kg⁻¹ cadmium chloride groups decreased, and the ratio of kidney/body weight and the levels of BUN, UNAG, and TGF-β1 mRNA and protein increased in the 2.0 mg·kg⁻¹ cadmium chloride group (P<0.05). The expression levels of m⁶A modification, methyltransferases METTL3, METTL14, Wilms’ tumor 1-associated protein (WTAP), and miR-21 were increased both in the 2.0 and 1.0 mg·kg⁻¹ cadmium chloride groups, with significant differences compared with the control group (P<0.05). The results of correlation analysis showed that the m⁶A modification level was negatively correlated with SOD (r=−0.4489, P<0.05) and GSH-Px (r=−0.4874, P<0.05), METTL3 was negatively correlated with MDA (r=−0.5158, P<0.05), while there was a positive correlation between FTO and GSH-Px (r=0.4802, P<0.05). In addition, miR-21 was positively correlated with METTL3 (r=0.7491), METTL14 (r=0.6157), and WTAP (r=0.6660) (P<0.05), TGF-β1 was positively correlated with METTL3 (r=0.5025, P<0.05) but negatively correlated with FTO (r=−0.5634, P<0.05) . Conclusion Cd can induce m⁶A methylation and up-regulation of METTL3, METTL14, WTAP, and miR-21 expression levels in rat kidney tissues, indicating that m⁶A and miR-21 may be associated with Cd-induced renal fibrosis.

Objective:To explore the modulatory effects of GSK-3β/β-catenin signaling pathway on anxiety- and depression-like behavior of mice induced by chronic sleep deprivation (CSD).Methods:Forty-eight 10-week-old C57BL/6J male mice were selected and randomly divided into four groups(with 12 mice in each group): control group, inhibitor-only group (LiCl), chronic sleep deprivation group (CSD) and inhibitor with CSD group (LiCl+ CSD). Elevated plus maze (EPM) and forced swimming test (FST) were used to evaluate the behavior of mice, HE staining was used to observe the pathological morphological changes of hippocampal neurons, and Western blot was used to detect the protein expressions of β-catenin, GSK-3β and p-GSK-3β in hippocampal tissues. SPSS 22.0 software was used for independent sample t-test and one way ANOVA. Results:After modeling, the body weight of mice in the CSD group ((26.53±0.76)g) was significantly lower than that of the control group ((28.00±0.37)g) ( q=4.119, P=0.041), and the body weight in the LiCl+ CSD group ((28.04±0.86)g) was improved compared with CSD group ( q=4.240, P=0.036). In EPM, the ratio of the entering times and the proportion of the staying time in the open arm in the CSD group ((48.44±9.16)%) and ((16.47±10.42)%) were significantly lower than those in the control group ((68.92±11.71)% and (42.93±15.89)%) ( q=4.660, P=0.018, q=4.346, P=0.029), but the staying time in the open arm in the LiCl+ CSD group ((32.92±12.05)%) was significantly higher than that in the CSD group ( q=2.432, P=0.038). In FST, the percentage of floating immobility time of the mice in the CSD group ((55.00±5.36)%) was significantly longer than that of the control group ((39.95±2.87)%) ( P=0.023), which was decreased significantly in the LiCl+ CSD group ((42.00±7.92)%) than that in the CSD group ( P=0.040). Western blot results showed that, the expressions of p-GSK-3β and β-catenin in the hippocampus of CSD group were decreased significantly ( P=0.040, P=0.008), while the expression of GSK-3β was significantly increased than that of the control group ( P<0.001). Both p-GSK-3β and β-catenin were significantly reversed in CSD+ LiCl group than that in CSD ( P=0.034, P=0.038). Conclusion:The GSK-3β/β-catenin signaling pathway may be involved in the regulation of CSD-induced anxiety and depression-like behaviors in mice.

Background Exposure to environmental lead can cause kidney damage and telomere wear. However, the relationship among lead, peripheral blood telomere length, and glomerular filtration rate (eGFR) are unclear. Objective This study is conducted to investigate the relationships of urinary lead level with peripheral blood telomere length and renal function index eGFR, and further explore whether peripheral blood telomere length plays an intermediary role in the relationship between urinary lead level and eGFR. Methods A case-control study was conducted to select 497 residents from two communities in a city, including 230 in the control group (eGFR≥80 mL·min⁻¹) and 267 in the abnormal eGFR group (eGFR<80 mL·min⁻¹). Basic information and health information of the subjects were collected through a face-to-face questionnaire survey. Fasting morning urine was collected, and urinary lead and urinary creatinine (UCr) were detected. Fasting peripheral venous blood was collected to detect telomere length and serum creatinine (SCr) in peripheral blood leukocytes. eGFR was estimated by the Levey formula. After further adjusting for age, gender, education level, family per capita monthly income, smoking, and drinking the relationship among urinary lead level, peripheral blood telomere length, and renal function index eGFR was evaluated by mediating effect analysis. Results The overall level of creatinine-adjusted urinary lead [M (P₂₅, P₇₅)] in the abnormal eGFR group was 3.85 (1.56, 7.34) μg·g⁻¹ which was higher than that in the control group, 1.57 (0.60, 3.62) μg·g⁻¹(P<0.001). In addition, the overall level of peripheral blood telomere length in the abnormal eGFR group was 2.42 (1.89, 3.10) Kb, lower than that in the control group, 2.69 (2.09, 3.64) Kb (P<0.001). The results of mediating effect analysis showed that the magnitude of mediating effect by peripheral blood telomere length was −0.276 (95%CI: −0.708-−0.001) and it contributed 3.35% to the relationship between urinary lead level and eGFR. In women, the magnitude of mediating effect by peripheral blood telomere length was −0.484 (95%CI: −1.160-−0.023) between urinary lead level and eGFR, and the proportion of the mediating effect was 5.34%. In men, no mediating role of peripheral blood telomere length was found between urinary lead and eGFR. Conclusion Urinary lead level is closely related to renal function index eGFR and telomere length in peripheral blood. Peripheral blood telomere length plays a mediating role in the relationship between female urinary lead and eGFR in women.