Objective:To investigate the association between air pollutant exposure levels and the risk of atrial fibrillation and to evaluate the mediating role of serum uric acid levels in the association between air pollutant levels and atrial fibrillation risks.Methods:This study was a case-control study, and the data of the atrial fibrillation group was derived from atrial fibrillation patients diagnosed at the Zhongda Hospital, Affiliated to Southeast University, from January 2014 to April 2021, and data of control group was derived from those without atrial fibrillation at the screening in Qixia District, Nanjing City, in March to April 2019. A 1∶1 propensity score matching was performed with the matched variables of age and sex. Air pollutant exposure data were collected from 9 air quality monitoring stations in Nanjing from January 2014 to April 2021, including NO 2, CO, PM 2.5 and PM 10. Exposure to air pollutants was converted to respiratory exposure levels according to an approximate formula. Multivariate logistic regression models were used to analyze the association between air pollutants and the risk of atrial fibrillation. Mediation analysis was used to investigate the mediating role and magnitude of serum uric acid in the association pathway between the four air pollutants (PM 2.5, PM 10, NO 2, and CO) and atrial fibrillation. Results:The atrial fibrillation group was aged (68.7±11.3) years, with 544 (51.8%) males; the control group was aged (68.5±8.9) years, with 543 (51.7%) males. Multivariate logistic regression models suggested that individual exposure levels of all four air pollutants were associated with the increased risks of atrial fibrillation. Every 1 μg·kg -1·d -1 increased in NO 2 was associated 12.1% increased risk of atrial fibrillation among the individuals ( OR=1.121, 95% CI:1.098-1.144); For every 1 μg·kg -1·d -1 increased in CO, the individual risk of atrial fibrillation increased by 0.7% ( OR=1.007, 95% CI: 1.006-1.008). For each 1 μg·kg -1·d -1 increase in PM 2.5 exposure level, the individual risk of atrial fibrillation increased by 14.2% ( OR=1.142, 95% CI: 1.120-1.164). For each 1 μg·kg -1·d -1 increase in PM 10 exposure level, the individual risk of atrial fibrillation increased by 3.7% ( OR=1.037, 95% CI: 1.028-1.046). The results of the mediation analysis suggested that serum uric acid levels mediated 5.6% ( P=0.032) causal effects of PM 2.5 on atrial fibrillation risks and 7.5% ( P=0.010) mediated by CO. Conclusion:Air pollutant exposure was a risk factor for the development of atrial fibrillation and uric acid mediated the increased risk of atrial fibrillation by PM 2.5 and CO.

The European Society of Endodontology published the S3-level clinical practice guideline for the treatment of pulpal and apical disease in October 2023, which provides best current therapeutic strategies supported by scientific evidences. The guideline was divided into four parts: the diagnosis and treatment of pulpitis, diagnosis and nonsurgical treatment of apical periodontitis, surgical treatment of apical periodontitis, and regenerative treatment. This article aims to introduce and interpret the guideline, and to better manage patients with pulpitis and apical periodontitis for preserving teeth over a patient′s lifetime in China.

Objective To explore the effectiveness of clinical pharmacists participating in anti-infection treatment for severe infection patients in the intensive care unit.Methods A retrospective collection of severe infection patients admitted to the ICU of the Fourth People's Hospital of Jinan from January to June 2023 was conducted through the hospital information system.Among them,some patients with clinical pharmacists participating in anti-infection treatment throughout the process were in the intervention group,and other patients who did not participate in treatment were in the control group.Both groups of patients received routine treatment according to clinical diagnosis.We compared the cure rate,incidence of adverse reactions,cost of antibiotics,proportion of antibiotic costs,pathogen testing rate,duration of antibiotic treatment,and average length of hospital stay between two groups of patients,and conducted statistical analysis.Results A total of 147 patients were included,with 66 in the intervention group and 81 in the control group.The cure rate of patients in the intervention group was 65.15％,significantly higher than 46.91％in the control group(P＜0.05);The incidence of adverse reactions(7.58％)was significantly lower than that of the control group(19.75％)(P＜0.05).The usage rates of quinolone drugs and tigecycline were significantly reduced in the intervention group;The intervention group had significantly better indicators such as antibiotic costs,proportion of antibiotic costs,and patient pathogen testing rate than the control group(P＜0.05).There were no significant difference in the duration of antimicrobial treatment and average length of hospital stay between the two groups(P＞0.05).Conclusion The full participation of clinical pharmacists in the anti-infection treatment of ICU severe infection patients can help improve their clinical cure rate and medication safety,and reduce their medical burden.

Objective To investigate the prenatal diagnosis and perinatal outcomes between anterior pla-centa accreta and non-anterior placenta.Methods A retrospective analysis was done for 560 pregnant women who were diagnosed with placenta accreta and delivered in the Third Affiliated Hospital of Guangzhou Medical Uni-versity.According to the location of the placenta,the group was dividing into anterior placenta accreta group(319 cases)and non-anterior placenta accreta group(241 cases).The general characteristics,maternal and infant out-comes of the two groups were analyzed.The non-anterior placenta accrete group(241 cases)then were dividing into two groups according to the time of clear diagnosis.Those who were firstly diagnosed with placenta accrete dur-ing or after the operation was the intrapartum diagnosis group(missed diagnosis)(70 cases),and those who were diagnosed with clear placenta accreta before the delivery was prenatal diagnosis group(171 cases).The general characteristics,maternal and infant outcomes of the two groups were also analyzed.Results There were statisti-cally significant differences in the parity,history of cesarean section,delivery mode,degree of placenta accreta,missed diagnosis rate,neonatal birth weight,and hysterectomy rate between the non-anterior placenta accrete group and the anterior placenta accreta group.In the case of prenatal diagnosis of different degrees of placenta accreta,the prenatal diagnosis rate of placental adhesion in the non-anterior placenta accreta group was lower than that of the anterior placenta accreta group,which was statistically significant.In the non-anterior placenta accrete group,there were statistically significant differences in the age,cesarean section history,placenta previa status,mode of delivery,degree of implantation,24-hour bleeding volume,blood transfusions,NICU transfer rate,uterine loss rate between the intrapartum diagnosis group(missed diagnosis)and the prenatal diagnosis group.Conclusions The high-risk factors of patients with non-anterior placenta accreta are different from those of patients with anterior placenta accreta.Multiple births and a history of cesarean section are high-risk factors for anterior placenta accreta patients.Non-anterior placenta accreta are more likely to be missed diagnosed,especially the placental adhesion.For pregnant women with non-anterior placenta accreta missed diagnosis,there is a high rate of adverse birth out-comes,especially in the rate of neonatal transfer to the NICU.

Objective:To quantitatively analyze the effects of population aging and other risk factors on the burden of atherosclerosis cardiovascular disease (ASCVD) in China from 1990 to 2019.Methods:Disability adjusted life years (DALY) and age-standardized rates obtained from the Global Burden of Disease Study 2019 (GBD2019) were used to describe the temporal trend of a burden on ASCVD. And a decomposition method established by Gupta was applied to quantify the burden related to population growth, aging, age-specific prevalence, and the severity of the disease.Results:In 2019, 61.00% of the burden of cardiovascular disease in China was caused by ASCVD. The DALY of ischemic heart disease increased by 133.66% compared with that in 1990, with 29.57% of the increase attributed to population growth, 108.74% due to population aging, and 8.87% due to the rise of age-specific prevalence and -13.53% benefited from changes in disease severity. The DALY of ischemic stroke increased by 138.64% compared with 1990, and the proportions attributable to the above four parts were 30.95%, 123.38%, 55.80%, and -71.49%, respectively. Hypertension remained the leading risk factor for ASCVD in 2019, followed by high LDL cholesterol. The age-standardized DALY rate attributable to drinking had the most significant increase (486.01%) from 1990, with an average annual growth of 10.93%.Conclusions:Aging population seems responsible for the main reason for the considerable increase in the burden of ASCVD in China. Still, the adverse trends of other avoidable risk factors, especially metabolic risk factors, can not be ignored.

Objective:To use Meta analysis to understand the prevalence of the heritability of body mass index (BMI) in twins.Methods:All studies on the heritability of the twins' BMI published before December 31, 2020 were retrieved through the China National Knowledge Network, Wanfang, VIP, PubMed and Web of Science databases. The literature quality was evaluated by using Joanna Briggs Institute Critical Appraisal tools. Stata 16.0 was used to perform subgroup analysis on the outcome indicators (heritability, 95% CI) to explore the source of heterogeneity. The local weighted regression method was used to fit the trend of heritability with age. The publication bias test and the sensitivity analysis of included literatures were also performed by using Stata 16.0. Results:A total of 10 articles meeting the inclusion and exclusion criteria were included with 79 twins' independent estimates of heritability for BMI. Meta-analysis showed that the combined value of BMI heritability was 0.69 (95% CI: 0.65-0.71), the combined value of BMI (0.68, 95% CI: 0.65-0.70) in males was lower than that (0.70, 95% CI: 0.68-0.72) in females. The heritability of BMI (0.72, 95% CI: 0.68-0.76) in childhood and adolescence was higher than that (0.68, 95% CI: 0.66-0.70) in adulthood. The gender specific difference in BMI heritability in twins ≤18 years old was even greater, which was lower in males (0.68, 95% CI: 0.61-0.76) than in females (0.75, 95% CI: 0.69-0.81). The heritability increased with age in childhood, reached peak at about 18 years old, and then slowly decreased with age. Conclusions:The heritability of BMI varied with population characteristics, especially age and gender. In view of the high estimated value of BMI heritability in female children and adolescents, more attention should be paid to the start time of health intervention.

Objective:To explore the relationship between myopic refraction and near work in children and adolescents with different genetic risks.Methods:From September to December 2016, Nankai District and Hongqiao District of Tianjin were taken as the study sites. Using the method of stratified cluster random sampling, 533 children and adolescents aged 6-14 years from one primary school and one junior middle school in each of the two districts were included as the study subjects. Refraction measurements by an auto-kerato-refractor and questionnaire survey about near work were conducted. 11 single nucleotide polymorphisms in the selected myopia susceptibility genes were detected, and the genetic risk of each individual was scored. After grouping by genetic risk score, the relationship between myopia and near work was analyzed by the multivariate logistic regression, and the relationship between near work and refraction was analyzed by the multivariate linear regression.Results:The age of 553 subjects was (9.8±2.5) years, including 295 boys (53.3%). The overall detection rate of myopia was 62.0%. The spherical equivalent refraction (SER) was (-1.30±1.85) D. The results of the multivariate logistic regression showed that in the low risk group of GRS, compared with those with continuous near work time less than half an hour, those with continuous near work time no less than half an hour had a higher risk of myopia [ OR ( 95%CI) = 2.64 (1.07, 6.52)]. In the moderate risk group of GRS, the risk of myopia increased with the increase of daily computer use [ OR ( 95%CI) = 2.14 (1.03, 4.77)]. In the high risk group of GRS, the risk of myopia increased with the increase of the total daily reading and writing time [ OR ( 95%CI) = 1.27 (1.01, 1.59)]. The results of the multivariate linear regression showed that in the low risk group of GRS, with increase of 1 hour in the total daily reading and writing time and mobile phone time, the SER decreased by 0.18 D (95% CI:-0.30, -0.07) and 0.95 D (95% CI:-1.51, -0.39), respectively. In the moderate risk group of GRS, with increase of 1 hour in the total daily reading and writing time and computer use time, the SER decreased by 0.25 D (95% CI:-0.31, -0.18) and 0.57 D (95% CI:-0.97, -0.18), respectively. In the high risk group of GRS, with increase of 1 hour in the daily total reading and writing time, the SER decreased by 0.33 D (95% CI:-0.43, -0.22). Conclusion:Continuous near work time no less than half an hour, daily computer use time, the total daily reading and writing time, and daily mobile phone use time were associated with myopic refraction in children and adolescents.

Objective:To explore the relationship between myopic refraction and near work in children and adolescents with different genetic risks.Methods:From September to December 2016, Nankai District and Hongqiao District of Tianjin were taken as the study sites. Using the method of stratified cluster random sampling, 533 children and adolescents aged 6-14 years from one primary school and one junior middle school in each of the two districts were included as the study subjects. Refraction measurements by an auto-kerato-refractor and questionnaire survey about near work were conducted. 11 single nucleotide polymorphisms in the selected myopia susceptibility genes were detected, and the genetic risk of each individual was scored. After grouping by genetic risk score, the relationship between myopia and near work was analyzed by the multivariate logistic regression, and the relationship between near work and refraction was analyzed by the multivariate linear regression.Results:The age of 553 subjects was (9.8±2.5) years, including 295 boys (53.3%). The overall detection rate of myopia was 62.0%. The spherical equivalent refraction (SER) was (-1.30±1.85) D. The results of the multivariate logistic regression showed that in the low risk group of GRS, compared with those with continuous near work time less than half an hour, those with continuous near work time no less than half an hour had a higher risk of myopia [ OR ( 95%CI) = 2.64 (1.07, 6.52)]. In the moderate risk group of GRS, the risk of myopia increased with the increase of daily computer use [ OR ( 95%CI) = 2.14 (1.03, 4.77)]. In the high risk group of GRS, the risk of myopia increased with the increase of the total daily reading and writing time [ OR ( 95%CI) = 1.27 (1.01, 1.59)]. The results of the multivariate linear regression showed that in the low risk group of GRS, with increase of 1 hour in the total daily reading and writing time and mobile phone time, the SER decreased by 0.18 D (95% CI:-0.30, -0.07) and 0.95 D (95% CI:-1.51, -0.39), respectively. In the moderate risk group of GRS, with increase of 1 hour in the total daily reading and writing time and computer use time, the SER decreased by 0.25 D (95% CI:-0.31, -0.18) and 0.57 D (95% CI:-0.97, -0.18), respectively. In the high risk group of GRS, with increase of 1 hour in the daily total reading and writing time, the SER decreased by 0.33 D (95% CI:-0.43, -0.22). Conclusion:Continuous near work time no less than half an hour, daily computer use time, the total daily reading and writing time, and daily mobile phone use time were associated with myopic refraction in children and adolescents.

Objective: To study the distribution of sub-health and occupational stress as well as their correlation among middle school teachers in Tianjin, then provide evidences for prevention and control of the status of sub-health. Methods: A total of 3 522 middle school teachers from six districts of Tianjin were recruited with stratified cluster sampling strategy for the investigation of Sub-Health Measurement Scale version 1.0 (SHMS V1.0) and Occupational Stress Inventory-Revised Edition (OSI-R) . Results: Detection rate of sub-health status among Tianjin middle school teachers was 58.55%. Men had significantly lower sub-health detection rate (55.19%) than women (59.71%) . Sub-health detection rate increased with age (P<0.05) , the sub-health detection rate among middle school teachers more than 50 years old was the highest (66.84%) . The mean score of OSI-R was 403.18±41.80 with the scores of 176.00±21.05, 103.17±17.53, and 124.02±20.28 for ORQ, PSQ, PRQ, respectively, which showed significantly difference compared with the occupational stress norm of China (P<0.001) . The mean scores of OSI-R, ORQ, PSQ, PRQ in different health status were significantly different (P<0.001) . The partial correlation analysis between the scores of sub-health and occupational stress of middle school teachers showed that the scores of occupational role and personal strain were negatively correlated with the scores of sub-health state (P< 0.001) , while, there was significantly positive correlation between the scores of personal resource and the scores of sub-health state (P<0.001) . Conclusion Sub-health detection rate of middle school teachers in Tianjin is higher. Effective measures should be taken to appropriately mitigate the occupational stress level of middle school teachers, increase personal resources, and scientific and effective health guidance and education should be strengthened.

Objective To evaluate the effects of a comprehensive intervention including regular aerobic exercise and health education on knowledge,attitude,belief,practice (KAP) scores,body mass index (BMI),waist circumferences,blood pressure,serum glucose and lipid levels in middle-aged and elderly people with overweight and obesity.Methods Three resident communities were chosen randomly from Wangdingdi community in Nankai district in Tianjin.Totally 125 overweight people were involved in this study,62 and 63 people were randomly assigned to intervention group and control group respectively.The members of intervention group were asked to participate in aerobic exercise and health education program 3 times per week within 6 months.And control group members received no intervention.Then to evaluate the effects of intervention of regular aerobic exercise and health education by physical examination and questionnaire.Comparison between intervention group and control group was performed using a repeatedmeasures analysis of variance.Results The comprehensive intervention resulted in significant improvement of the KAP scores [13.82 (95％CI:12.42-15.23)] and high-density lipoprotein cholesterol [0.22(95％ CI:0.17-0.28) mmol/L] and reductions in intervention group in body mass index [-0.47 (95％ CI:-0.58-0.36) kg/m2],waist circumference [-4.00 (95％ CI:-5.01--2.99) cm],systolic blood pressure [-11.69 (95％ CI:-13.84--9.55) mmHg] (1 mmHg=0.133 kPa),fasting plasma glucose [-1.21 (95％ CI:-1.55--0.88) mmol/L],triglyceride [-0.06 (95％ CI:-0.25-0.13) mmol/L],low-density lipoprotein cholesterol [-0.48 (95％ CI:-0.62--0.34) mmol/L].Conclusion Regular aerobic exercise and health education program in community can successfully reduce body mass index,waist circumference and some other risk factors related to overweight and obesity.It is effective to improve awareness,physical fitness,change lifestyle for middle-aged and elderly people in the community.