To evaluate the modification of allergic dermatitis on the association between PM exposure and allergic rhinitis in preschool children. This cross-sectional study was based on a questionnaire conducted between June 2019 and June 2020 to caregivers of children aged 3 to 6 years in the kindergartens of 7 Chinese cities to collect information on allergic rhinitis and allergic dermatitis. A mature machine learning-based space-time extremely randomized trees model was applied to estimate early-life, prenatal, and first-year exposure of PM 1, PM 2.5 and PM 10 at 1 km×1 km resolution. A combination of multilevel logistic regression and restricted cubic spline functions was used to quantitatively assess whether allergic dermatitis modifies the associations between size-specific PM exposure and the risk of childhood allergic rhinitis. The results showed that out of 28 408 children, 14 803 (52.1%) were boys and 13 605 (47.9%) were girls; the age of children ranged from 3.1 to 6.8 years, with a mean age of (4.9±0.9) years, of which 3 586 (12.6%) were diagnosed with allergic rhinitis. Among all children, 17 832 (62.8%) were breastfed for more than 6 months and 769 (2.7%) had parental history of atopy. A total of 21 548 children (75.9%) had a mother with an educational level of university or above and 7 338 (29.6%) had passive household cigarette smoke exposure. The adjusted ORs for childhood allergic rhinitis among the children with allergic dermatitis as per interquartile range (IQR) increase in early-life PM 1(9.8 μg/m 3), PM 2.5 (14.9 μg/m 3) and PM 10 (37.7 μg/m 3) were significantly higher than the corresponding ORs among the children without allergic dermatitis [ OR: 1.45, 95% CI (1.26, 1.66) vs. 1.33, 95% CI (1.20, 1.47), for PM 1; OR: 1.38, 95% CI (1.23, 1.56) vs. 1.32, 95% CI (1.21, 1.45), for PM 2.5; OR: 1.56, 95% CI (1.31, 1.86) vs. 1.46, 95% CI (1.28, 1.67), for PM 10]. The interactions between allergic dermatitis and size-specific PM exposure on childhood allergic rhinitis were statistically significant ( Z value=19.4, all P for interaction<0.001). The similar patterns were observed for both prenatal and first-year size-specific PM exposure and the results of the dose-response relationship were consistent with those of the logistic regression. In conclusion, allergic dermatitis, as an important part of the allergic disease progression, may modify the association between ambient PM exposure and the risk of childhood allergic rhinitis. Children with allergic dermatitis should pay more attention to minimize outdoor air pollutants exposure to prevent the further progression of allergic diseases.

To evaluate the modification of allergic dermatitis on the association between PM exposure and allergic rhinitis in preschool children. This cross-sectional study was based on a questionnaire conducted between June 2019 and June 2020 to caregivers of children aged 3 to 6 years in the kindergartens of 7 Chinese cities to collect information on allergic rhinitis and allergic dermatitis. A mature machine learning-based space-time extremely randomized trees model was applied to estimate early-life, prenatal, and first-year exposure of PM 1, PM 2.5 and PM 10 at 1 km×1 km resolution. A combination of multilevel logistic regression and restricted cubic spline functions was used to quantitatively assess whether allergic dermatitis modifies the associations between size-specific PM exposure and the risk of childhood allergic rhinitis. The results showed that out of 28 408 children, 14 803 (52.1%) were boys and 13 605 (47.9%) were girls; the age of children ranged from 3.1 to 6.8 years, with a mean age of (4.9±0.9) years, of which 3 586 (12.6%) were diagnosed with allergic rhinitis. Among all children, 17 832 (62.8%) were breastfed for more than 6 months and 769 (2.7%) had parental history of atopy. A total of 21 548 children (75.9%) had a mother with an educational level of university or above and 7 338 (29.6%) had passive household cigarette smoke exposure. The adjusted ORs for childhood allergic rhinitis among the children with allergic dermatitis as per interquartile range (IQR) increase in early-life PM 1(9.8 μg/m 3), PM 2.5 (14.9 μg/m 3) and PM 10 (37.7 μg/m 3) were significantly higher than the corresponding ORs among the children without allergic dermatitis [ OR: 1.45, 95% CI (1.26, 1.66) vs. 1.33, 95% CI (1.20, 1.47), for PM 1; OR: 1.38, 95% CI (1.23, 1.56) vs. 1.32, 95% CI (1.21, 1.45), for PM 2.5; OR: 1.56, 95% CI (1.31, 1.86) vs. 1.46, 95% CI (1.28, 1.67), for PM 10]. The interactions between allergic dermatitis and size-specific PM exposure on childhood allergic rhinitis were statistically significant ( Z value=19.4, all P for interaction<0.001). The similar patterns were observed for both prenatal and first-year size-specific PM exposure and the results of the dose-response relationship were consistent with those of the logistic regression. In conclusion, allergic dermatitis, as an important part of the allergic disease progression, may modify the association between ambient PM exposure and the risk of childhood allergic rhinitis. Children with allergic dermatitis should pay more attention to minimize outdoor air pollutants exposure to prevent the further progression of allergic diseases.

Objective To analyze the preoperative related factors of early weaning of infants with congenital heart disease after operation. Methods From January ,2014 to January ,2017 in Pediatric Cardiology CICU , infants with congenital heart disease were selected as research objects. The clinical data were retrospectively collect ed and the relationship between preoperative influencing factors and postoperative early weaning were analyzed. Early weaning meant mechanical ventilation time was shorter than 24 h and late weaning meant longer than 24 h. Results Single factor analysis showed that early weaning success rate was related to preoperative cardiac function grade 1,NNIS grade 0~1,ASA grade 1,no lung infection and no or mild pulmonary hypertension(average P<0.05). Non conditional logistic regression analysis showed that preoperative heart function grade 1 was an indepen-dent influencing factor,with OR value(95%CI)of 3.9(1.9~7.7). Conclusions In infants with congenital heart disease,preoperative heart function grade 1,NNIS grade 0 ~ 1 ,ASA grade 1,no lung infection and no or mild pulmonary hypertension benefit early withdrawing of ventilator and preoperative cardiac function grade 1 is an inde-pendent factor for early weaning.

Objective To assess the acute effects of daily mean temperature,cold spells,and heat waves on stroke mortality in 12 counties across Hubei province,China.Methods Data related to daily mortality from stroke and meteorology in 12 counties across Hubei province during 2009-2012,were gathered.Distributed lag nonlinear model (DLNM) was first used,to estimate the county-specific associations between daily mean temperature,cold spells,heat waves and stroke mortality.Multivariate Meta-analysis was then applied to pool the community-specific relationships between temperature and stroke mortality (exposure-response relationship) as well as both cold-and-heatassociated risks on mortality at different lag days (lag-response relationship).Results During 2009-2012,a total population of 6.7 million was included in this study with 42 739 persons died of stroke.An average of 2.7 (from 0.5 to 6.0) stroke deaths occurred daily in each county,with annual average mean temperature as 16.6 ℃ (from 14.7 ℃ to 17.4 ℃)during the study period.An inverse J-shaped association between temperature and stroke mortality was observed at the provincial level.Pooled mortality effect of cold spells showed a 2-3-day delay and lasted about 10 days,while effect of heat waves appeared acute but attenuated within a few days.The mortality risks on cold-spell days ranged from 0.968 to 1.523 in 12 counties at lag 3-14,with pooled effect as 1.180 (95％ CI:1.043-1.336).The pooled mortality risk (ranged from 0.675 to 2.066) on heat-wave days at lag 0-2 was 1.114 (95％CI:1.012-1.227).Conclusions An inverse J-shaped association between temperature and stroke mortality was observed in Hubei province,China.Both cold spells and heat waves were associated with increased stroke mortality,while different lag patterns were observed in the mortality effects of heat waves and cold spells.

Objective To explore the morphologic features of the biceps reflection pulley through the comparative study of the thin sec -tional anatomy based on the Chinese Visible Human ( CVH) and MRI sectional anatomy of the biceps reflection pulley ,and to provide ima-ging anatomic data for the diagnosis of lesions .Methods The thin slices of sagittal oblique plane and coronal oblique plane by visualization -al reconstruction based on 5 data set of the Chinese visible human ( CVH) were compared with the corresponding MR images from 20 shoulder joints of the normal volunteer individuals with routine MRI ,5 shoulders without abnormalities with MR arthrography .The detailed sectional a-natomy structure of the the biceps reflection pulley was marked from the CVH ,routine MRI and MR arthrography one by one with Photoshop CS2 software.Results The main three components of the biceps reflection pulley including the coracohumeral ligament (CHL),the superior glenohumeral ligament ( SGHL) ,and the long head of the biceps tendon ( LBT) were markedly displayed on the CVH and MRI .The CHL was markedly displayed on the sagittal oblique , using plain MRI .The SGHL was markedly displayed on the CVH , especially in the transverse plane.The LBT was markedly displayed on the CVH ,especially in the coronal oblique plane parallel to the LBT .The biceps reflection pulley was markedly displayed on the sagittal oblique plane with CVH and MR arthrography .The SGHL was perpendicular to the CHL , with T-shaped link anterior to the LBT on the sagittal oblique plane .Conclusion It is complementary for MRI and CVH displaying the components of the biceps reflection pulley .The sagittal oblique plane is the best position for displaying the components and adjacent structures of the bi -ceps reflection pulley ,which provide helpful position mark for the diagnosis of the lesions in the rotator interval .

Objective To evaluate the diagnosis of frozen shoulder with the coracohumeral ligament on the coronal oblique plane with MRI.Methods There were 60 patients(120 shoulder joints)in control group,with 30 males and 30 females,the mean age was 50.5 years old.There were 72 shoulder joints in 72 patients of frozen shoulder group(50 femles and 22 males with a mean age of 53.5 years)with clini-cal evidence and MR imaging evidence of frozen shoulder.These were prospectively analyzed to identify the CHL visualization rate and meas-ure the maximum thickness of the CHL.Results The CHL visualization rate on the coronal oblique plane in the control group was 86.7%(104 /120),and the frozen shoulder group was 87.5%(63 /72),the difference was not significant(P >0.05).The CHL visualization rate on the axial view in the frozen shoulder group was 19.4%(14 /72)and the control group was 24.2%(29 /120),the difference was not signifi-cant(P >0.05).The CHL thickness on the coronal oblique plane (n =63)in the patients with frozen shoulder was (4.37 ±1.71)mm, which was significantly greater than (2.84 ±0.79)mm ofpatients in the control group(n =104),the difference was significant(P <0.001). The CHL thickness on the axial plane(n =14)in the patients with frozen shoulder was (3.93 ±1.49)mm,which was significantly greater than (2.29 ±0.65)mm of patients in the control group(n =29),the difference was significant(P <0.001).Conclusion A thickened CHL is highly suggestive of frozen shoulder,which is 4.37 mm on the coronal oblique plane.

OBJECTIVE:To detect the contents of chlorogenic acid and rutoside in Saussurea involucrate,and to optimize the decoction and extraction technology of S. involucrate from different producing areas. METHODS:The contents of chlorogenic acid and rutoside in 10 batches of S. involucrate from different producing areas were determined by HPLC. L9(34)orthogonal experiment was used to optimize the water amount,decoction times and decoction time using comprehensive score of extraction transport rate of chlorogenic acid and rutoside as index. The verification test was also conducted. RESULTS:The contents of chlorogenic acid and rutoside in 10 batches of S. involucrate were 0.380%-0.546% and 0.334%-0.617%;the optimal decoction technology was as follows as the amout of crude material of S. involucrate 100 g,soaking for 20 min,decocting for 3 times,12,10 and 10 fold of water,decocting 45,30 and 30 min,respectively. The extraction transfer rates of chlorogenic acid and rutoside were 96.2%(RSD=2.66%,n=3)and 89.3%(RSD=3.31%,n=3)in verification test. CONCLUSIONS:For S. involucrate from different producing areas,the contents of effective components are different;optimized decoction and extraction technology is stable and feasible.

Objective To evaluate the association between cold spells and nonaccidental mortality from 2001 to 2011 in the Jiang'an District of Wuhan, China. Methods We collected mortality data for December 2001 to 2010 and January to March 2002 to 2011 in the study area. According to the International Classification of Diseases, we stratified the mortality data into three cause-specific categories:nonaccidental mortality, cardiovascular mortality, and respiratory mortality. We also obtained meteorological data (from the China Meteorological Administration) and ambient pollution data (from the Wuhan Environmental Monitoring Center) during the same periods. In the present study, a cold spell was defined as 5 or more consecutive days with daily average temperatures below the 5th percentile of daily mean temperatures (2.58℃) from January to December in 2001-2011. A distributed lag nonlinear model (DLNM) was applied to assess the acute effect of cold spells on daily nonaccidental mortality. Results During the study period, the total number of nonaccidental deaths was 17 119, including 9 403 (75.5%) among individuals aged over 65 years; 7 968 (46.5%) people died of cardiovascular disease. According to this definition, there were a total of 13 cold spell events and 111 days of duration in Wuhan during the study period. Study days were divided into three periods: non-cold spell days, 2008 cold spell days, and cold spell days in other years. Average daily mean temperatures of the above three periods were(8.2±4.5),(-0.7±1.4), and(0.8±1.2)℃, respectively, corresponding to average daily deaths of 14.0 ± 4.2, 18.2 ± 4.5, and 14.9 ± 4.9 for nonaccidental mortality. After adjusting for long-term trends, seasonal trends, weekdays, holidays, and relative humidity, analysis by the DLNM revealed that cold spells were associated with increased mortality risk, with a cumulative relative risk (RR) of 1.56 (95%CI:1.36-1.79) at lag 0-27 days in 2008, higher than that in other years with 1.23 (95%CI:1.08-1.41). Cold spells were not significantly associated with respiratory mortality and people under 65 years of age;however, during the 2008 cold spell RR increased to 1.96 (95%CI:1.62-2.37) and 1.67 (95%CI: 1.43-1.95) for cardiovascular mortality and older adults (≥65 years old), respectively;both males and females had high mortality risk, with RRs of 1.60 (95%CI:1.33-1.92) and 1.50 (95%CI: 1.23-1.84), respectively. The association between cold spells and mortality remained nearly unchanged with and without adjustment for ambient pollutants (PM10, SO2, and NO2) in the DLNMs. Conclusion In Wuhan, both the 2008 cold spell and cold spells in other years were significantly associated with increased nonaccidental mortality. People with cardiovascular disease and elderly adults may be more susceptible to the impact of cold spells on mortality.

Objective To evaluate the acute effects of daily mean temperature on ischemic heart disease (IHD) mortality in 12 counties across Hubei Province,China.Methods We obtained the daily IHD mortality data and meteorological data of the 12 counties for 2009-2012.The distributed lag nonlinear model (DLNM) was used to estimate the community-specific association between mean temperature and IHD mortality.A multivariate meta-analysis was then applied to pool the community-specific relationship between temperature and IHD mortality,and the effects of cold and heat on mortality risk.Results In 2009-2012,of the 6 702 012 people included in this study,19 688 died of IHD.A daily average of 1.2 IHD deaths occurred in each community.The annual average mean temperature was 16.6 ℃ during the study period.A nonlinear temperature-IHD mortality relationship was observed for different cumulative lag days at the provincial level.The pooled heat effect was acute but attenuated within 2 days.In contrast,the cold effect was delayed and persisted for more than 2 weeks.Compared with a reference temperature (25th percentile of mean temperature during the study period,P25),the cold effect for P10 of mean temperature was associated with IHD mortality,the RR(95％CI) was 1.084 (1.008-1.167) at lag 0-14,and 1.149 (1.053-1.253) at lag 0-21.For the P1 cold temperature,the mortality RR (95％ CI) values were 1.116 (0.975-1.276)and 1.220 (1.04-1.428),respectively.We found no significant association between high temperatures and IHD mortality in the present study at different lag days.Conclusion In Hubei Province,low temperature was associated with increased IHD mortality risk,and cold effects lasted for several days;no significant effect of high temperature was observed.

Objective To evaluate the association between cold spells and nonaccidental mortality from 2001 to 2011 in the Jiang'an District of Wuhan, China. Methods We collected mortality data for December 2001 to 2010 and January to March 2002 to 2011 in the study area. According to the International Classification of Diseases, we stratified the mortality data into three cause-specific categories:nonaccidental mortality, cardiovascular mortality, and respiratory mortality. We also obtained meteorological data (from the China Meteorological Administration) and ambient pollution data (from the Wuhan Environmental Monitoring Center) during the same periods. In the present study, a cold spell was defined as 5 or more consecutive days with daily average temperatures below the 5th percentile of daily mean temperatures (2.58℃) from January to December in 2001-2011. A distributed lag nonlinear model (DLNM) was applied to assess the acute effect of cold spells on daily nonaccidental mortality. Results During the study period, the total number of nonaccidental deaths was 17 119, including 9 403 (75.5%) among individuals aged over 65 years; 7 968 (46.5%) people died of cardiovascular disease. According to this definition, there were a total of 13 cold spell events and 111 days of duration in Wuhan during the study period. Study days were divided into three periods: non-cold spell days, 2008 cold spell days, and cold spell days in other years. Average daily mean temperatures of the above three periods were(8.2±4.5),(-0.7±1.4), and(0.8±1.2)℃, respectively, corresponding to average daily deaths of 14.0 ± 4.2, 18.2 ± 4.5, and 14.9 ± 4.9 for nonaccidental mortality. After adjusting for long-term trends, seasonal trends, weekdays, holidays, and relative humidity, analysis by the DLNM revealed that cold spells were associated with increased mortality risk, with a cumulative relative risk (RR) of 1.56 (95%CI:1.36-1.79) at lag 0-27 days in 2008, higher than that in other years with 1.23 (95%CI:1.08-1.41). Cold spells were not significantly associated with respiratory mortality and people under 65 years of age;however, during the 2008 cold spell RR increased to 1.96 (95%CI:1.62-2.37) and 1.67 (95%CI: 1.43-1.95) for cardiovascular mortality and older adults (≥65 years old), respectively;both males and females had high mortality risk, with RRs of 1.60 (95%CI:1.33-1.92) and 1.50 (95%CI: 1.23-1.84), respectively. The association between cold spells and mortality remained nearly unchanged with and without adjustment for ambient pollutants (PM10, SO2, and NO2) in the DLNMs. Conclusion In Wuhan, both the 2008 cold spell and cold spells in other years were significantly associated with increased nonaccidental mortality. People with cardiovascular disease and elderly adults may be more susceptible to the impact of cold spells on mortality.