Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO₂, NO₂, CO, PM_2.5, PM₁₀, and maximum 8 h O₃ concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM_2.5, NO₂, SO₂, and O₃ were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM_2.5, NO₂, SO₂ and O₃ were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.

Objective To explore the application and effectiveness of the combination of bilabial /Φ/and inter-dental /θ/to the training of pronouncing fricatives after cleft palate operations .Methods Seventy children aged four to eight years with abnormal fricatives after cleft palate operations over one month were enrolled in the study . They were randomly allocated into the experimental group (35 cases) and the control group (35 cases) .The chil-dren in the experimental group received the combined training of bilabial /Φ/and inter-dental /θ/while those in the control group received routine rehabilitation training .Results After 6 to 10 times of speech training ,the number of erroneous words of the experimental group decreased to 1 .20 ± 0 .35 from 70 .80 ± 0 .52 before the training .The difference was statistically significant (Z= -5 .215 , P= 0 .001) .The number of incorrect words of the control group decreased to 7 .17 ± 0 .45 from 70 .86 ± 0 .50 of the baseline .The difference was statistically significant (Z=-5 .237 ,P=0 .001) .The number of erroneous words of the two groups had no statistical differences before train-ing (t= -0 .079 ,P=0 .937) .The number of wrong words of the experimental group was significantly lower than the control group after training (Z= -7 .023 ,P=0 .001) .Conclusion The application of the combination of bilabi-al /Φ/and inter-dental /θ/to the training of pronouncing fricatives after cleft palate operations can decrease dis-tinctly the number of erroneous words .

Objective The purpose of this study was to explore common complications and their clinicopathological features in pediatric liver transplantation.Methods Clinical and pathological data of 240 liver biopsies from 168 children that conducted liver puncture from January 2015 to May 2018 in Tianjin First Central Hospital was retrospectively analyzed.We comprehensively analyzed incidence rate and pathological features of various complications,and correlations between acute rejection and C4d staining result or Banff score.Results A total of 86.67％ (208/240) liver biopsies could be definitely diagnosed with incidence rate of main complications in descending order as follows:T cell mediated rejection (TCMR) 60.57％ (126/208),drug-induced liver injury (DILI) 17.31％ (36/208),biliary complication 8.17％ (17/208),vascular complication 3.37％ (7/208),ischemia/reperfusion injury (IRI) 2.88％ (6/208),antibody mediated acute rejection (AMR) 1.92％ (4/208),HBV infection 1.92％ (4/208),non-alcoholic fatty liver disease (NAFLD) 1.44％ (3/208),chronic rejection (CR) 0.96 ％ (2/208) and HCV infection 0.48 ％ (1/208).TCMR and AMR in acute rejection (AR) accounted for 96.92％ (126/130) and 3.08％ (4/160),and into(portal-based,PB)type TCMR accounted for 96.03％(121/126) with the detectable rate of BP type subtype TCMR of 26.45％(32/121)within 30 d.There were 65.87％ (83/126)、25.40％ (32/126) 和4.76％ (6/126) of BP TCMR samples with "Banff ACR RAI" score within 3-5,6-7 and 8-9,and RAI score was negatively correlated with postoperative time (r =0.127,P =0.084).The incidence rate of central perivenulitis (CP) and portal eosinophils infiltration (PEI) in BP TCMR was 63.63％ (77/121) 和43.80％ (53/ 121),respectively,additionally,the PEI level was positively correlate with RAI score (P＜0.05).CP TCMR and AMR occurred within 30d-365 d and 8 d-180 d,respectively postoperative,while,the two CR occurred at 1095 d and 1335 d postoperative,and significant correlation was strikingly observed between rejection subtype and postoperative time (Z =9.231,P =0.026).C4d positive rate was 10％ (24/240),which was associated with Banff score and postoperative time,besides,C4d score was also correlated with rejection subtype and RAI score.The occurrence of DILI was mainly at time of ＜90 d or ＞180 d postoperative,and the detectable rate of biliary complication within 180 d postoperative was 82.35％ (14/17),IRI Appear in ＜30d.Hepatic artery complication account for nearly 57.14％ (4/7),occurrence time is ≤90 d.Occurrence of HBV infection,CMV infection and NAFLD were mainly at ＞365 d,＜90 d and ＜365 d,respectively.Conclusion There were lots of differences in clinical and pathological features among multi pediatric liver transplantation complications.Liver puncture plays an important role in rejection subtype classification and grading,as well as in non-rejection complications identification.

Objective:To explore the effects of humanized nursing and personalized service in operating room nursing.Methods:A total of 300 patients who underwent surgical surgery in our hospital from April 2016 to June 2016 were randomly divided into the intervention group (n =150) and control group (n =150).Patients in the control group were treated with routine nursing care.On this basis,patients in the intervention group were provided with integral perioperative nursing of humanized nursing and personalized service.The fear,anxiety,blood pressure and heart rate fluctuations of both two groups before and after entering operating room were statistically analyzed.Results:Before entering operating room,the fear and anxiety scores of the patients in the intervention group were (32.67 ± 12.27),the blood pressure was (97.5 ± 12.8) mmHg,and the heart rate was (93.7 ± 11.8).The fear and anxiety scores in the control group were (36.94 ± 12.78),the blood pressure was (99.8 ± 12.5) mmHg,and the heart rate was (105.4 ± 10.6).The intervention group was significantly lower than the control group (P ＜ 0.05).Conclusion:The implementation of humanized nursing and personalized service can effectively reduce the patient's fear and anxiety to make the heart rate,blood pressure and other vital signs be in a relatively stable state;can make patients calm,positive and optimistic to undergo the surgery and actively cooperate with doctors and ward nursing,thus to get well soon.

Objective To study the phonetic characteristics of patients with abnormal plosive consonant of functional articulation disorders (FAD) and the possible treatment approaches.Methods A total of patients of 4~26 years old with abnormal plosive consonant of FAD received speech assessment and the phonetic characteristics.Incorrect articulation patterns and forms of plosive consonant /b/,/p/,/d/,/t/,/g/ and /k/ were analysed.The targeted speech treatment was established to correct the erroneous places and types of pronunciation.Results The error rate of /t/ (82/87)was the highest,followed by /k/(77/87),/d/(67/87),/g/(60/87),/p/(59/87) and /b/(3/87) which was the lowest.The error rate of fricative was 65.52% as the highest among all the erroneous patterns,followed by unaspiration(63.22%),forward movement of the tongue(54.02%),distortion(33.33%),bilabial(32.18%),and backward movement of the tongue(18.39%).Seventy-one cases were completely cured,and 16 cases partially cured after 2 to 10 times of treatment.The number of incorrect words of plosives decreased to 4.03±2.71 after the speech therapy from 67.97±18.56 prior to that.The differences were statistically significant (t =34.301,P<0.001).Conclusion The articulation errors of plosives occur mainly on /t/,/k/,/d/,/g/and /p/,/b/.The incorrect types of pronunciation are fricatives,unaspiration,distortion and omission.The incorrect places of articulation are forward movement of the tongue,bilabial and backward movement of the tongue.The targeted speech therapy established according to the erroneous places and types of articulation is significantly effective.

Objective: To investigate the clinical features and genetic characteristics of patients with ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) gene variants. Method: The clinical data of a patient with ENPP1 homozygous variants from Capital Institute of Pediatrics was collected, the related literature was searched from China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, National Center from Biotechnology Information and PubMed by using search term "ENPP1" , "hypophosphatemic rickets" . The literature retrieval was confined from 1980 to February 2017. The clinical manifestations, bone metabolism examinations, X-RAY and genotypes were reviewed. Result: Our patient was an 11 years old girl, with 7 years history of lower limb malformation. She showed significant valgus deformity of the knee (genu valgum). Metabolic examination revealed reduced level of plasma phosphate (0.86 mmol/L), a normal level of plasma calcium (2.30 mmol/L) and an elevated alkaline phosphatase level of 688 IU/L. The calcium-phosphorus product was 25.9. A homozygous nonsense variants of ENPP1 gene, c.783C>G (p.Tyr261X) in exon 7 was identified in the patient. Both parents were heterozygous carriers. Literature review identified 3 Chinese patients from one publication and 17 cases from twenty one publications around the world. None of the patients was found PHEX variants which is the most common variants among hypophosphatemic rickets patients. The disease onset age was 11 months to 10 years. Eight patients had short stature, five patients had the history of generalized arterial calcification of infancy. Four suffered from deafness, three showed localized calcifications of arteries, three patients manifested pseudoxanthoma elasticum and two suffered from ossification of posterior longitudinal ligament. Nine missense variants, six splicing variants and 4 nonsense variants were reported among these twenty patients. c.783C>G was found in two Chinese patients. Conclusion ENPP1 gene mutation was a cause of patient with hypophosphatemic rickets. Comorbid features included generalized arterial calcification of infancy, early onset hearing loss, pseudoxanthoma and ossification of posterior longitudinal ligament. ENPP1 gene testing should be performed on hypophosphatemic rickets patients without PHEX gene variants. Long-term follow up is recommended. The most common types of ENPP1 gene variants were nonsense/splicing variants. The gene c.783C>G was the most common variants in Chinese patients.

Objective To explore the clinical characteristics of consonant errors in adults with functional ar-ticulation disorders (FAD) .Methods Speech evaluations were carried out on 42 adult subjects with FAD .Then the articulation patterns and types of erroneous consonants were classified and analyzed .Results The main erroneous articulation patterns of the adults were substitution ,distortion ,followed by omission .The abnormal consonants which were classified according to the place of articulation were found as follows :blade-palatal(39 cases) ,supra-dental(31 cases) ,lingua-palatal(22 cases) ,velar(19 cases) ,blade-alveolar(18 cases) ,labiodental(6 cases) and bi-labial consonant(6 cases) .Erroneous consonants which were sorted according to the error frequency by descending order lied in/sh/,/zh/,/ch/,/r/,/z/,/c/,/s/,/q/,/x/,/j/,/g/,/k/,/h/,/t/,/l/,/d/,/f/ and /p/.The error types were fronting of tongue(22 cases) ,unaspiration(12 cases) ,lateralization(12 cases) ,omission(9 cases) ,back-ing of tongue (8 cases) ,replacement by lingua-palatal(4 cases) ,bilabial(4 cases) and labiodental consonant(3 ca-ses) .Conclusion The main erroneous articulation patterns of adults with FAD are substitution and distortion .The erroneous consonants are blade -palatal ,supradental ,lingua-palatal ,velar and blade-alveolar .The error types are fronting of tongue ,unaspiration ,lateralization and omission .

Objective To explore the clinical characteristics of adults with functional articulation disorders (FADs) and suitable speech training methods.Methods Phonological evaluation was carried out for 37 adults with functional articulation disorders whose clinical characteristics were analyzed,then targeted speech training was established.Results The main erroneous articulation patterns of the adults were substitution,followed by distortion and omission.The erroneous articulation types included forward movement of the tongue (19 cases),insufficient aspiration (11 cases),lateralization (10 cases),backward movement of the tongue (7 cases),omission of consonants (7 cases),conprehensive errors (4 cases),and replacement by labiodental and lingua-palatal phonemes (3 and 2 cases respectively).Twenty-eight adults were cured,8 adults were improved,and 1 adult showed unsatisfactory effects after 1 to 5 courses of speech training.The average speech intelligibility score increased significantly from (56.03±14.71)％ before speech training to (91.22±10.10)％ afterward.Conclusion The main erroneous patterns of adults with functional articulation disorders are substitution and distortion.Targeted speech training was shown to be significantly effective.

Objective To explore the phonological characteristics of lateral misarticulation in children with functional articulation disor-ders and the rehabilitation approaches for them. Methods From June, 2013 to December, 2014, 44 children with lateral misarticulation were assessed and the phonological characteristics of lateral misarticulation were analyzed. They accepted targeted rehabilitation training. The cor-relation was analyzed between lateral misarticulation and age as well as severity of disorder. Results The frequency of lateral misarticulation was the most in Blade-palatals (75.00%), and then the dentals (65.91%), lingua-palatals (56.82%) and blade-alveolar consonant (20.45%). Thirty-eight cases were cured and 4 cases improved after 1 to 5 courses of rehabilitation. The overall cure rate was 86.36%(38/44), and it was 100%(11/11), 86.67%(13/15), 77.78%(14/18) in those with mild, moderate and severe disorder, respectively. There was no significant correlation between lateral misarticulation and age (r=0.100, P=0.752) as well as severity (r=0.257, P=0.092). Conclusion Lateral misarticu-lation in children with functional articulation disorders mainly occurs on blade-palatals, dentals and lingua-palatals. The targeted speech re-habilitation training is beneficial.

This study investigated the anti-angiogenic activities of two diarylheptanoids, together with a structure analogue, curcumin. The activity and toxicity of these three compounds were compared using transgenic zebrafish as in vivo model and human umbilical vein endothelial cell(HUVEC)as in vitro model. Anti-angiogenic index(AI)was used as the ratio between LC50 and EC50. The results suggested that in both in vitro and in vivo assay, curcumin exerted the most potent anti-angiogenic effect but with lowest toxicity among these compounds; Yakuchinone A was the second potent; Yakuchinone B has the lowest activity but with the highest toxicity in all three compounds. Taken together, curcumin was the best angiogenic inhibitor in these three diarylheptanoids.