Background Diurnal temperature range (DTR) is closely associated with cardiovascular health in the elderly, but there is a lack of research on the relationship between DTR and ischemic heart disease (IHD) in the elderly. Objective To investigate the effect of DTR on daily hospital admissions for IHD in people 65 years and older in Wuhan. Methods The study obtained data on elderly inpatients with IHD from all secondary and tertiary hospitals in Wuhan between January 1, 2017 and December 31, 2018, along with synchronous meteorological and air pollution data. Daily DTR was calculated as the difference between the maximum and minimum temperatures in a day. We employed distributed lag nonlinear models based on quasi-Poisson distribution to analyze the association between DTR and hospitalization risk in individuals aged 60 years and above. We assessed the extreme effects of DTR by selected DTR percentiles (the 1st percentile, P₁: 1.8 ℃; the 5th percentile, P₅: 2.9 ℃; the 95th percentile, P₉₅: 14.3 ℃; and the 99th percentile, P₉₉: 16.2 ℃) on hospitalization for IHD in the elderly population. Additionally, we conducted stratified analyses by gender, age (60-74 years and ≥75 years) and different subtypes (acute IHD and chronic IHD) to investigate the effects of DTR on hospitalizations for IHD across different genders, ages, and subtypes. Results This study included a total of 64212 first-time IHD hospitalizations among individuals aged 65 years and above in Wuhan from 2017 to 2018. The results showed a "J"-shaped exposure-response relationship between DTR and the cumulative risk of IHD hospitalization with a lag of 7 d; the optimal DTR was 5.0 ℃, and as DTR increased or the lag time lengthened, the risk of hospitalization for IHD in the elderly population increased. Extremely high DTR (P₉₉: 16.2 ℃) had a significant impact on the day of exposure (lag 0), with a cumulative RR of 1.58 (95%CI: 1.25, 1.99) at a lag of 7 d. The overall effects of DTR on IHD for different genders, ages, and subtypes of IHD exhibited similar patterns to the effects for overall population. High DTR had a significantly higher impact on hospitalization for chronic IHD (RR=1.46, 95%CI: 1.20, 1.79), compared to acute IHD (RR=1.29, 95%CI: 1.04, 1.61). At a cumulative lag of 7 d, elderly individuals aged 60-74 (RR=1.78, 95% CI: 1.30, 2.42) were more affected by high DTR in terms of IHD hospitalizations compared to those aged ≥75 (RR=1.35, 95% CI: 1.08, 1.70). Conclusion High DTR significantly increases the risk of hospitalization for IHD among elderly individuals. The effect of high DTR is particularly pronounced in patients with chronic IHD and elderly individuals aged 60–74 years.

Objective To analyze the research hotspot and development trend of tiered health care system of type 2 diabetes in China. Methods The relevant research in the field of the tiered health care system of type 2 diabetes in China was sorted out and summarized by using CNKI, WangFang, VIP and Web of Science databases as search objects, and the relevant literature collected between January 1, 2009, and September 28, 2022, was searched. CiteSpace was used to describe the number of articles published, high-frequency keywords, emerging words, and trends. Results A total of 147 valid papers were included. The overall volume of related articles published showed an upward trend. After visual analysis, nine clusters were obtained, including family doctors, tiered health care system, health service system, and primary care. In the past two years, the research trends were mainly focused on primary care, general practitioners, specialist nurses, and quality of survival. Conclusion Research hotspots are focused on the areas of hierarchical diagnosis and treatment, primary care, family doctors, and community health services, with the words ^“medical association^” and ^“specialist nurse^” emerging in the past two years. In the future, research should be devoted to improving the tiered health care system of type 2 diabetes and opening up a multi-level cooperative research model, so as to effectively bring into play the advantages and effects of the tiered health care system.

Objective To explore the association of (cardiometabolic index , CMI ) and ( lipid accumulation product , LAP ) with the prevalence of hypertension in adults in Pingshan District, Shenzhen, and to evaluate the predictive value of CMI and LAP for the prevalence of hypertension. Methods A cross-sectional survey was conducted, in which 1000 permanent residents aged 18-69 years in Pingshan District, Shenzhen were randomly selected as survey subjects. The data were collected using questionnaires, physical measurements and blood tests, and the relationship between CMI, LAP and hypertension prevalence was analyzed using logistic regression models. Results A total of 987 subjects were included in the analysis, including 471 (47.72%) males and 516 (52.28%) females, with an average age of 40.9 ± 11.1 years. Subjects of different genders were divided into groups Q1 to Q4 according to quartiles of CMI and LAP, and the prevalence of hypertension increased with increasing levels of CMI and LAP in both men and women (P for trend < 0.001). Logistic regression analysis revealed that after adjusting for variables such as age and occupation, the OR for hypertension was 1.251 (1.025-1.526) and 1.685 (1.001-2.836) for men and women, respectively, for each standard deviation increase in CMI; the OR for hypertension was 3.519 (1.343-9.222) for men in the Q4 group, compared to the CMI subgroup Q1. For each standard deviation increase in LAP, the ORs for hypertension were 1.355 (1.089-1.686) and 1.825 (1.023-3.254) for men and women, respectively; compared to LAP subgroup Q1, the ORs for hypertension in the male Q3 and Q4 groups were 2.554 (1.103-5.909) and 5.322 (2.393-11.834), while the OR for hypertension in the female Q4 group was 2.906 (1.096-7.703). ROC analysis revealed that the area under the curve (AUC) for CMI, LAP, and BMI was 0.671, 0.704, and 0.702 for males, and 0.660, 0.722, and 0.697 for females, respectively. The AUC for LAP was greater than that for CMI for different genders (P < 0.01). Conclusion The greater the CMI and LAP values in adults in Pingshan District, Shenzhen , the higher the prevalence of hypertension. CMI and LAP have certain values in predicting the prevalence of hypertension.

【Objective】 To investigate the molecular mechanism of long non-coding RNA (lncRNA) TDRG1 in facilitating the malignant progression and poor prognosis of patients with cervical cancer. 【Methods】 Cervical cancer cell lines and normal cervical cell Ect1/E6E7 were collected. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the expression of TDRG1. Cervical cancer cell lines were transfected with TDRG1-siRNA, and the proliferation of cancer cells was detected by CCK-8 method and cell plate cloning experiment. The invasion and migration of cancer cells were measured by Transwell experiment. The apoptosis of cancer cells was examined by flow cytometry, and the expressions of relevant proteins were tested by Western blot. 【Results】 Compared with Ect1/E6E7, cervical cancer cell lines showed relatively increased expression of TDRG1. Downregulation of TDRG1 expression inhibited the proliferation and colony formation (162±21 vs. 411±33, P<0.05), as well as the invasion and migration (invasion: 86±13 vs. 315±38, P<0.01; migration: 177±22 vs. 406±41, P<0.01) of Hela cells. Meanwhile, the apoptosis of Hela cells increased [(28±1.5)% vs. (16±1.2)%, P<0.05] and the expression of Bcl-2 protein reduced. In addition, TDRG1 knockdown also decreased the activity of autophagy in Hela cells. 【Conclusion】 TDRG1 facilitates the malignant biological progression of cervical cancer by inhibiting the apoptosis and providing a protective autophagy in cervical cells.

As the life expectancy of the population increases and traditional indexes are flawed in reflecting the health level, the concept of the healthy life expectancy has emerged, which integrates the length of the life and quality, more comprehensively reflects the health level of the population. This article has summarized the emergence and development of health life expectancy, classification of indexes, and commonly used measurement methods, as well as domestic and international application examples, and domestic research status. It proposes to establish a unified national measurement method, and make full use of big data resources in health care to comprehensively assess the health life expectancy of the population.

Objective: To assess the pollution characteristics and risk assessment of carcinogenicity or non-carcinogenicity on heavy metals in PM_2.5 in Shenzhen. Methods: PM_2.5 samples were collected monthly from the year of 2014 to 2015, and analyzed by seasons. 12 heavy metal elements (Pb, Hg, Mn, Sb, Al, As, Be, Cd, Cr, Ni, Se, Tl) in PM_2.5 were detected by ICP-MS spectrometry. Health risk assessment was conducted using the recommended United States Environmental Protection Agency (USA EPA) model. Results: The median of PM_2.5 concentration was 45.10 μg/m³ in Longgang district of Shenzhen. The non-carcinogenecity risks of the metals in PM_2.5 existed in spring, autumn and winter (HQ>1). Three metal elements including As, Mn and Cd have higher HQ levels. The carcinogenecity risk levels in four seasons were winter, autumn, spring and summer, respectively. The carcinogenecity risks in four seasons were between 10^-6 to 10^-4. As, Cr and Cd have higher carcinogenicityrisks. Conclusion The heavy metals in PM_2.5 have both carcinogenecity risk and non-carcinogenecity risk to residents in Longgang district of Shenzhen, the occupational health management must be continuously strengthened, the further research and the measures for prevention and control should be considered.

Objective To evaluate the efficacy of double-balloon dilation in percutaneous kyphoplasty for severe osteoporotic vertebral compression fracture (OVCF) in the elderly. Methods Sixty patients with severe OVCF were randomly divided into two groups, a double- and a single-balloon dilatation group,with 30 cases in each group. Regular follow-up was conducted at 3,6,and 12 months after operation. The operation time,blood loss volume,bone cement injection rate,and bone cement leakage rate were recorded. The visual analog score (VAS),Oswestry disability index (ODI),vertebral anterior height,and kyphosis Cobb angle were used to evaluate efficacy. Results No significant differences in operation time and bleeding volume were found between the 2 groups (P > 0.05). The amount of bone cement injection in the double-balloon dilatation group was more than that in the single-balloon dilatation group (P < 0.05). The bone cement leakage rate was lower in the double-balloon dilatation group,but the difference was not statistically significant (P > 0.05). No significant differences in VAS score and ODI were found between the 2 groups at 1 day and 3,6,and 12 months after operation (P >0.05),but with significant differences in the anterior vertebral height and kyphosis Cobb angle (P < 0.05). During the follow-up,2 cases of complication occurred in the double-balloon dilatation group,but 6 cases of complication occurred in the single-balloon dilatation group. Conclusion Double-balloon dilation in percutaneous kyphoplasty for elderly patients with severe OVCF can effectively alleviate clinical symptoms and reduce complications,which is an effective method for the treatment of severe OVCF.

Objective To explore the influence of high flux hemodialysis (HFHD) and hemodialysis filtration (HDF) on the dialysis effect and patients mortality in the patients with end-stage renal disease(ESRD).Methods One hundred and twenty-two patients with ESRD in our hospitals were selected and respectively adopted HFHD (HFHD group,62 cases) and HDF (HDF group,60 cases) for conducting the dialysis therapy.The serum indexes before and after treatment were detected and compared between the two groups.Results Compared with before treatment,the level of blood urea nitrogen (BUN),blood uric acid (BUA),serum creatinine (Scr),blood phosphorus (P),parathyroid hormone (PTH),β2 microglobulin (β2-MG) and cysteine protease inhibitors (Cys-C) after treatment in the two groups were significantly decreased(P＜0.05).The clearance rates of P,PTH and Cys-C in the HFHD group were significantly higher than those in the HDF group(t=2.479,t=1.834,t=1.512,P＜0.05).The mortality after an average follow-up of (12.2 ± 3.7) months had statistical difference between the two groups,the mortality rate in the HDF group was significantly higher than that in the HFHD group (P＜ 0.05).The multivariate Cox regression analysis results showed that the HFHD was an important factor affecting death in ESRD patient (HR =0.50,95 ％ CI:0.33-0.84,P =0.009).Conclusion HFHD has more significant effect for clearing P,PTH,β2-MG and Cys-C than HDF in ESRD patients,moreover can reduces their mortality.

Objective To compare the effect of cisplatin or nedaplatin combined with paclitaxel as an adjuvant chemotherapy for cervical cancer.Methods Total 160 patients with cervical cancer in Ningqiang County Tianjin Hospital from February 2011 to December 2015 were divided into two groups according to different treatments.Cisplatin group was treated with TP chemotherapy,nedaplatin group was treated with TN chemotherapy,the curative effect,adverse reaction of chemotherapy,hospitalization time and treatment costs were compared between the two groups.Results The effective rate of cisplatin group was 79.26％ and nedaplatin group's was 82.05％,the two groups had no significant difference;The incidence of Ⅰ-Ⅳ grade hemoglobin,leukocyte of nedaplatin group were significantly higher than those in the cisplatin group (P ＜ 0.05),but between the two groups Ⅲ and Ⅳ grade had no significant difference,the incidence of Ⅰ-Ⅳ grade and Ⅲ-Ⅳ grade nausea,vomiting of nedaplatin group were significantly lower than cisplatin group (P ＜ 0.05);The hospitalization time of nedaplatin group was significantly shorter than cisplatin group (P ＜ 0.05),The cost of treatment between nedaplatin group and cisplatin group had no significant difference.Conclusion Cisplatin or nedaplatin combined with paclitaxel has similar efficacy in the neoadjuvant chemotherapy for cervical cancer,gastrointestinal adverse reactions of nedaplatin are lower than cisptatin,bone marrow suppression increase but still can be controlled,nedaplatin chemotherapy can shorten the duration of hospitalization,and hospitalization expenses were not significantly increased,which makes it more easily accepted by patients.

Objective:To explore the rational mode of hospital management under the trusteeship mode through the case study of a county-level hospital entrusted by a large general public hospital.Methods:Based on the system construction,the complete sinking of quality medical resources,the cultivation of talents and cultural integration,this paper analyzed the current situation of medical technology and service quality in hospitals before and after trusteeship by a retrospective control study.Results:The medical technology,quality and patient satisfaction of the hospital were improved significantly after trusteeship.Conclusions:The effective measures in the process of trusteeship of county-level hospitals are conducive to improve the level of medical technology and service of county -level hospitals,which can ensure the quality and safety of medical treatment,provide valuable suggestions for decision-making,and promote the development of hierarchical diagnosis and treatment.