Objective:To analyze the genetic characteristics of hemagglutinin（HA）and neuraminidase（NA）of influenza A（H1N1）pdm09 viruses in Kunming during the 2022-2023 influenza season.Methods:A total of 15 strains of A（H1N1）pdm09 influenza virus isolated from sentinel hospital surveillance and from outbreaks from April 2022 to March 2023 in Kunming were chosen for sequencing. The genetic analysis，which included sequence alignment，homology analysis，construction of phylogenetic tree and amino-acid mutations analysis，was carried out using MAFFT version 7，MegAlign and MEGA 11.Results:Fourteen strains isolated during the 2022-2023 influenza season in Kunming belong to clade 6B.1A.5a.2a，and A/Kunming/284/2023 belonged to clade 6B.1A.5a.2a.1. They all diverged from the northern hemisphere vaccine strain A/Wisconsin/588/2019 in clade 6B.1A.5a.2 recommended by WHO during the 2022-2023 influenza season. Comparing with the HA of the vaccine strain：A186T and Q189E，which might cause the reduction of vaccine protection，were identified in Sb of 14 strains；P137S，K142R in Ca and A186T，Q189E in Sb were identified in A/Kunming/284/2023 and two strains isolated from Thailand. The four mutations at tow antigenic sites identified immune escape at the molecular level. Q189E in the 190-helix and E224A in the 220-loop，which might change the pathogenicity of A（H1N1）pdm09 viruses，were identified in 15 strains. Comparing with NA of the vaccine strain：S200N in 14 strains and S339L in 1 strain were identified in antigenic sites. The two mutations might reduce the protection of antibodies induced by NA.Conclusion:Strengthening influenza surveillance and timely detecting new variants in Kunming contributes to preventing the importation of foreign strains and issuing early warnings for influenza outbreaks.

Objective To explore the clinical effectiveness of a locally trained and re-optimized RapidPlan model in lung stereotactic body radiation therapy (SBRT). Methods A total of 132 lung SBRT cases were retrospectively collected as a training group for the establishment of an initial RapidPlan model (RP-1) in the Eclipse 15.5 treatment planning system. RP-1 was then used to optimize the training group plans to generate the first-generation RapidPlans, which were used as a new training group to generate the upgraded RapidPlan model (RP-Plus). Additional 40 lung SBRT cases were selected to verify the quality and efficiency of RP-Plus plans, which were further assessed through clinical quality assurance (QA). Results The RP-Plus reduced the average number of optimization cycles by 2.1 times and 0.3 times compared to manual and RP-1 methods, respectively, and reduced the optimization time by 57.6% and 18.8%. The conformity index met clinical requirements, and the gradient index and Max_2cm(%) were improved compared to RP-1 (both P < 0.05). The RP-Plus plans showed lower dosimetric parameters of organs at risk, including lung V_20Gy, spinal cord D_max, and heart \begin{document}$D_{0.1{\mathrm{cm}}^3} $\end{document} The clinical QA pass rate of the RP-Plus plans was 100%. Conclusion The locally trained and re-optimized lung SBRT RapidPlan model can further improve plan quality and efficiency, and meet clinical QA requirements, showing feasibility for clinical application.

Objective:To analyze the genetic characteristics of hemagglutinin（HA）and neuraminidase（NA）of influenza A（H1N1）pdm09 viruses in Kunming during the 2022-2023 influenza season.Methods:A total of 15 strains of A（H1N1）pdm09 influenza virus isolated from sentinel hospital surveillance and from outbreaks from April 2022 to March 2023 in Kunming were chosen for sequencing. The genetic analysis，which included sequence alignment，homology analysis，construction of phylogenetic tree and amino-acid mutations analysis，was carried out using MAFFT version 7，MegAlign and MEGA 11.Results:Fourteen strains isolated during the 2022-2023 influenza season in Kunming belong to clade 6B.1A.5a.2a，and A/Kunming/284/2023 belonged to clade 6B.1A.5a.2a.1. They all diverged from the northern hemisphere vaccine strain A/Wisconsin/588/2019 in clade 6B.1A.5a.2 recommended by WHO during the 2022-2023 influenza season. Comparing with the HA of the vaccine strain：A186T and Q189E，which might cause the reduction of vaccine protection，were identified in Sb of 14 strains；P137S，K142R in Ca and A186T，Q189E in Sb were identified in A/Kunming/284/2023 and two strains isolated from Thailand. The four mutations at tow antigenic sites identified immune escape at the molecular level. Q189E in the 190-helix and E224A in the 220-loop，which might change the pathogenicity of A（H1N1）pdm09 viruses，were identified in 15 strains. Comparing with NA of the vaccine strain：S200N in 14 strains and S339L in 1 strain were identified in antigenic sites. The two mutations might reduce the protection of antibodies induced by NA.Conclusion:Strengthening influenza surveillance and timely detecting new variants in Kunming contributes to preventing the importation of foreign strains and issuing early warnings for influenza outbreaks.

Purpose: The aim of this study was to understand the experience of social alienation in elderly lung cancer patients, to explore its causes, and to propose targeted intervention strategies. Methods: From July to August 2023, 16 elderly lung cancer patients attending the respiratory department of a tertiary hospital in Changsha City, Hunan Province, were selected for semi-structured interviews using a purposive sampling method. The Colaizzi 7-step method was used to analyze the data. Results: A total of four themes were distilled: the experience of social alienation in elderly lung cancer patients (pessimistic feelings, inferiority complex, and heavy psychological burden), subjective causes (disease-included shame, avoidant social behavior, and stigmatized labels), objective causes (isolated social states, and reduced amount of socialization), and rehabilitation support. Conclusion The causes of social alienation in elderly lung cancer patients include multiple aspects of personal, family, and social support, and symptom management and psychological guidance should be strengthened for this population to construct a hospitalesocietyefamily triple-linkage care program to help patients recover.

Purpose: The aim of this study was to understand the experience of social alienation in elderly lung cancer patients, to explore its causes, and to propose targeted intervention strategies. Methods: From July to August 2023, 16 elderly lung cancer patients attending the respiratory department of a tertiary hospital in Changsha City, Hunan Province, were selected for semi-structured interviews using a purposive sampling method. The Colaizzi 7-step method was used to analyze the data. Results: A total of four themes were distilled: the experience of social alienation in elderly lung cancer patients (pessimistic feelings, inferiority complex, and heavy psychological burden), subjective causes (disease-included shame, avoidant social behavior, and stigmatized labels), objective causes (isolated social states, and reduced amount of socialization), and rehabilitation support. Conclusion The causes of social alienation in elderly lung cancer patients include multiple aspects of personal, family, and social support, and symptom management and psychological guidance should be strengthened for this population to construct a hospitalesocietyefamily triple-linkage care program to help patients recover.

Purpose: The aim of this study was to understand the experience of social alienation in elderly lung cancer patients, to explore its causes, and to propose targeted intervention strategies. Methods: From July to August 2023, 16 elderly lung cancer patients attending the respiratory department of a tertiary hospital in Changsha City, Hunan Province, were selected for semi-structured interviews using a purposive sampling method. The Colaizzi 7-step method was used to analyze the data. Results: A total of four themes were distilled: the experience of social alienation in elderly lung cancer patients (pessimistic feelings, inferiority complex, and heavy psychological burden), subjective causes (disease-included shame, avoidant social behavior, and stigmatized labels), objective causes (isolated social states, and reduced amount of socialization), and rehabilitation support. Conclusion The causes of social alienation in elderly lung cancer patients include multiple aspects of personal, family, and social support, and symptom management and psychological guidance should be strengthened for this population to construct a hospitalesocietyefamily triple-linkage care program to help patients recover.

Objective:To investigate the characteristic of mild cognitive impairment (MCI) in the adults aged 48 years and over in a coal mine community, and to analyze its associated risk factors.Methods:From July to October 2019, a questionnaire survey for basic information was conducted among 180 middle-aged and elderly adults who met the inclusion criteria in the Datong coal mine community. The cognitive function was evaluated by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The effects of gender, age, years of education, sleep, living alone, physical exercise, social activities, smoking and drinking status, body mass index and chronic diseases on cognitive level were analyzed by single factor stratification and multiple linear regression.Results:There was no significant difference in the positive rate of MCI screened by MMSE and MoCA in the age groups of 48-<64, 64-<72 and 72-90 (original and corrected P>0.05); The positive rate of MCI in MoCA screening (64.4%, 66.7%, 60.9%) was significantly higher than that in MMSE (35.6%, 45.6%, 28.1%) (all P<0.05); MMSE was positively correlated with MoCA score ( r=0.762, P<0.001). With the increase of age, the scores of memory, execution and visual space detected by MoCA decreased significantly (all P<0.05), while the scores of attention, language and orientation did not change significantly (all P>0.05). Univariate stratification showed that the significant influencing factors of MMSE or MoCA scores were gender, age, years of education and sleep status (all P<0.05). Multiple linear regression analysis showed that gender ( βMMSE=-0.192; βMoCA=-0.140), years of education ( βMMSE=0.209; βMoCA=0.328) and sleep status( βMMSE=-0.162; βMoCA=-0.136) were risk factors affecting MMSE and MoCA scores ( P<0.05). Conclusions:More middle-aged and elderly adults with MCI might be observed in a coal mine community, and the main characteristics of MCI are impaired memory, executive function and visual space. To prevent and reduce the occurrence of dementia, early interventions of MCI should be carried out among the adults with female, old age, low years of education and poor sleep quality.

Objective:To investigate the application value of three-dimensional (3D) printing technology assisted laparoscopic anatomic liver resection of segment 8 (Lap-S8).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 8 liver cancer patients including 7 cases with hepatocellular carcinoma and 1 case with intrahepatic cholangio-carcinoma who underwent 3D printing technology assisted Lap-S8 in the Hunan Provincial People′s Hospital from January 2019 to December 2020 were collected. There were 7 males and 1 female, aged from 49.0 to 80.0 years, with a median age of 56.5 years. Of the 8 patients, 6 cases underwent laparoscopic anatomic liver resection of the entire segment 8, 1 case underwent laparoscopic anatomic liver resection of ventral subsegmental of the segment 8 and 1 case underwent laparoscopic anatomic liver resection of dorsal subsegmental of the segment 8. 3D printing technology was used to assist preoperative evaluation and intraoperative navigation for all 8 patients. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination, internet or telephone interview to detect survival and tumor recurrence of patients after operation up to March 2021. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations: all the 8 patients underwent 3D printing technology assisted Lap-S8 successfully, without conversion to open surgery. The operation time, hepatic portal occlusion time and volume of intraoperative blood loss of the 8 patients were (216±41)minutes, (56±11)minutes and 75 mL(range, 50 to 300 mL), respectively. There was no intraoperative blood transfusion in 8 patients, and the surgical margin of the 8 patients was negative. (2) Postoperative situations: the duration of postoperative hospital stay of the 8 patients were (9±3)days. There was no complication such as postoperative hemorrhage, biliary fistula, liver abscess or abdominal infection occurred. (3) Follow-up: all the 8 patients were followed up for 3.0?24.0 months, with a median follow-up time of 12.5 months. During the follow-up, 1 of 8 patients with preoperative diagnosis of recurrent hepatocellular carcinoma developed tumor recurrence at 5 months after operation. The patient underwent laparoscopic surgery followed with the transcatheter arterial chemoembolization and target therapy, and survived with tumor. There was no tumor recurrence in the other 7 patients.Conclusion:3D printing technology assisted Lap-S8 is safe and feasible.

ABSTRACT OBJECTIVE：To systematically evaluate the efficacy and safety of echinococcins in the prevention of invasive candidiasis，and to provide evidence-based reference for clinical treatment. METHODS：Retrieved from PubMed，Embase， Medline，Cochrane library，CJFD，VIP and Wanfang database，randomized controlled trials（RCTs）about the effectiveness and safety of echinococcins （trial group） versus conventional fungal drugs （amphotericin B and triazole antifungal agents，control group）in the prevention of invasive candidiasis were collected during database establishment to Jul. 2019. After data extraction of clinical studies met inclusion criteria and quality evaluation with Cochrane system evaluator manual 5.0.2，Meta-analysis was performed for breakthrough invasive fungal infection rate，fungal infection mortality rate，all-cause mortality rate and the incidence of drug withdrawal due to adverse reactions by using Rev Man 5.2 statistical software. RESULTS：Totally 7 RCTs were included， involving 3 219 patients. Results of Meta-analyses indicated that the incidence of breakthrough invasive fungal infection [OR＝0.58， 95％CI（0.40，0.85），P＝0.004]，fungal infection mortality rate[OR＝0.68，95％CI（0.51，0.92），P＝0.01] and the incidence of drug withdrawal due to adverse reactions [OR＝0.52，95％CI（0.40，0.67），P＜0.001] in trial groups were significantly lower than control group，with statistical significance. There was no statistical significance in the all-cause mortality rate [OR＝0.84，95％CI（0.67， 1.05），P＝0.13]. CONCLUSIONS：Compared with amphotericin B and triazole antifungal agents，echinococcins used for the prevention of invasive candidiasis can reduce the incidence of breakthrough invasive fungal infection，fungal infection mortality rate and the incidence of drug withdrawal due to adverse reactions

Objective: To explore the safety and feasibility of laparoscopic liver resection in the treatment of intrahepatic cholangiocarcinoma (ICC). Methods: The retrospective study was adopted. The clinical data of 58 patients with ICC who underwent laparoscopic liver resection in the Department of Hepatobiliary Minimally Invasive Surgery of the First Affiliated Hospital of Hu′nan Normal University were collected From January 2016 to December 2018. Among them, 34 patients were males and 24 were females, aged from 34 to 71 years with a median age of 54 years. Observation indicators: (1) Surgical treatment: surgical methods, operation time, intraoperative blood loss, intraoperative blood transfusion rate, intraoperative hepatic portal blocking time, conversion rate, postoperative complications, postoperative hospital stay. (2) Postoperative pathological conditions. (3) Follow-up.Follow-up visits were conducted using an outpatient clinic and telephone to understand patient survival after surgery. The follow-up period was until June 2019. Measurement data with normal distribution were expressed as (Mean±SD), count data was expressed as frequency and percentage. Results: A total of 58 patients were included in this study, of which 48 patients underwent laparoscopic radical surgical resection of intrahepatic cholangiocarcinoma and 10 patients underwent laparoscopic conversion to laparotomy. (1) Surgical treatment: laparoscopic resection of the left liver (segments Ⅱ, Ⅲ and Ⅳ), laparoscopic resection of the right liver (segments Ⅴ, Ⅵ, Ⅶ and Ⅷ), laparoscopic resection of the right posterior lobe (segments Ⅵ and Ⅶ), laparoscopic extended resection of the right posterior lobe, laparoscopic resection of the middle lobe (Ⅳ, Ⅴ and Ⅷ), laparoscopic resection of the V and Ⅵ, laparoscopic resection of the left liver (segments Ⅱ, Ⅲ and Ⅳ) combined with the caudate lobe (segments I and Ⅸ), laparoscopic extended left hemihepatectomy, laparoscopic resection of the VI, laparoscopic resection of the Ⅶ and Ⅷ, laparoscopic resection of the left lateral lobe (segments Ⅱ and Ⅲ) and laparoscopic resection of the right hepatic mass; operation time: (320.38±107.68) min; intraoperative blood loss: (262.34±76.06); intraoperative blood loss: 0 (0/58); Intraoperative hepatic portal occlusion time: (48±15) min, the conversion rate was 17.2% (10/58); the incidence of postoperative biliary fistula was 6.8% (4/58), and the patient was discharged after conservative treatment and unobstructed drainage (T-tube vacuum suction); the postoperative gastrointestinal recovery time was (1.84±0.57) d; no other serious complications occurred.Postoperative hospital stay: (9.34±3.39) d; there were no deaths and unplanned surgeries during the perioperative period. (2) Pathological conditions: 32 cases received lymph node dissection during the operation, and 26 cases showed cholangiocarcinoma without lymph node dissection; pathological examination showed that the pathological reports of all tumor margins were negative, and 4 cases showed lymph node dissection and positive lymph node metastasis. (3) Follow-up results: of the 58 patients with ICC, 49 were followed up for 6 to 36 months. The tumor survival time was (4 to 36) months. 28 patients survived without tumor. 17 patients had intrahepatic metastasis with multiple lymph node metastasis. 4 patients were treated with microwave ablation after intrahepatic metastasis was found. 9 patients were lost to follow-up. Conclusion Laparoscopic treatment of intrahepatic cholangiocarcinoma is safe and feasible in experienced centers.