Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.

Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.

Objective: To understand the current situation and regulatory effectiveness of daylighting and artificial lighting in primary and secondary school classrooms in Shanghai, so as to provide a basis for enhancing the visual environment of school classrooms. Methods: From April 2021 to December 2023, the daylighting and artificial lighting conditions of classrooms in 1 735 regular primary and secondary schools currently in operation in Shanghai were monitored, and the qualified rate of each indicator was calculated. The Chisquare test or Fisher exact probability method were used to compare the differences in qualification rates across different educational stages, regions, school type, both before and after the implementation of regulatory measures. The regulatory measures included convene interview, propaganda and education, supervision order, supervisory opinion paper, rectification requests and offenses and punishment. Results: The qualified rate of daylighting and artificial lighting in primary and secondary school classrooms was 30.1%, with a qualified daylighting rate of 85.6% and a qualified artificial lighting rate of 32.9%. There was no statistically significant differences in the qualified rate of daylighting and artificial lighting in primary and secondary schools (32.4%，28.1%；χ2=3.76，P＞0.05). However, statistically significant differences were found in the qualified rate of daylighting and artificial lighting in urban and rural school classrooms (32.6%，26.7%), as well as in public and private schools (31.4%, 20.6%) (χ2=6.99，9.92，P＜0.05). Following the implementation of regulatory measures, the qualified rate of classroom daylighting and artificial lighting improved from 30.1% to 83.2%, while the respective qualified rates of daylighting and artificial lighting increased from 85.6% to 91.1% and 32.9% to 90.5%. Compared to the preimplementation period, the qualified rate of classroom daylighting and artificial lighting, as well as the respective rates of daylighting and artificial lighting, all showed statistically significant differences after the implementation of regulatory measures (χ2=995.29，25.34，1 219.87，P<0.01). Conclusions Effective regulatory measures can promote enhanced classroom daylighting and artificial lighting. Attention should be paid to improving classroom artificial lighting, in order to provide students with enhanced visual environment.

There are still multiple challenges in China during the malaria post-elimination phase, including a large number of imported malaria cases with widespread distribution, low awareness of timely healthcare seeking, insufficient malaria diagnosis and treatment capacity of medical institutions and insufficient malaria surveillance and response capability of disease control and prevention institutions. As the core technical institutions for preventing the re-establishment of malaria transmission, both medical institutions and disease control and prevention institutions are required to enhance the collaboration between clinical and public health services, improve the malaria diagnosis and quality management system, intensify case identification and epidemiological investigations, and improve the management mechanism of antimalarial drug reserves. In addition, doctors are encouraged to become the main force in the health education and promotion of malaria prevention to improve the public health literacy. These approaches are recommended to improve the overall capability of timely identification, standardized treatment and effective response of imported malaria cases, so as to continuously consolidate the malaria elimination achievements in China.

Objective　To analyze the characteristics of the malaria epidemic and the indicators for "1-3-7" from 2021 to 2023 in China, understand the effectiveness and challenges in preventing re-establishment malaria in China, propose response strategies, and provide references for consolidating the achievements of malaria elimination. Methods　The individual malaria case data and focus data from 2021 to 2023 in the "Information System for Infectious Disease Surveillance" and the "Information System for Parasitic Diseases Prevention and Control" were collected, and epidemiological characteristics and indicators for “1-3-7” were analyzed. Results　From 2021 to 2023, a total of 4 132 malaria cases were reported in 31 provinces and Xinjiang Production and Construction Corps, with mainly falciparum malaria (59.2%, 2 445/4 132). The national malaria epidemic reached a historical low of 799 cases in 2021, before rebounding significantly to 2 488 cases in 2023. The top five provinces for malaria cases were Yunnan, Guangdong, Henan, Sichuan, and Shandong, accounting for 49.4% of the total (2 043/4 132) cases. Except for two long incubation cases infected with P. malariae and one non-mosquito-transmitted case, the remaining cases were imported from abroad, mainly from African countries (81.7%, 3 374/4 129), with P. vivax malaria mainly coming from Myanmar (63.7%, 638/1 001). Malaria cases mainly occur in middle-aged men and migrant overseas workers. 142 severe cases and 21 deaths of malaria were reported. 81.8% (3 378/4 132) of malaria cases sought medical attention within 3 days of symptom onset, and the initial diagnosis institutions were mainly county-level, municipal, and provincial hospitals(77.2%), with an accuracy malaria diagnosis rate of above 80.0%. The completion rates of the malaria indicators for "1-3-7" were all above 90.0%. Conclusions　Since the malaria elimination in China, there has been no re-establishment of malaria, and the surveillance response capability has been maintained at a high level. However, the epidemic of imported malaria continued to rise, severely endangering public health in China, especially in areas such as the China-Myanmar border where the risk of re-establishment was high. Currently, it is necessary to further enhance the awareness of the key populations about timely medical consultation for malaria, as well as healthcare workers' vigilance, diagnostic capabilities, and awareness of timely referrals. Efforts should be maintained to investigate and manage epidemics, strengthen prevention and control in key areas such as the China-Myanmar border in Yunnan, and continuously consolidate elimination achievements.

Humans ; Abdomen ; Dantrolene ; East Asian People ; Malignant Hyperthermia

Malaria remains a global health challenge, although an increasing number of countries will enter pre-elimination and elimination stages. The prompt and precise diagnosis of symptomatic and asymptomatic carriers of Plasmodium parasites is the key aspect of malaria elimination. Since the launch of the China Malaria Elimination Action Plan in 2010, China has formulated clear goals for malaria diagnosis and has established a network of malaria diagnostic laboratories within medical and health institutions at all levels. Various external quality assessments were implemented, and a national malaria diagnosis reference laboratory network was established to strengthen the quality assurance in malaria diagnosis. Notably, no indigenous malaria cases have been reported since 2017, but the risk of re-establishment of malaria transmission cannot be ignored. This review summarizes the lessons about malaria diagnosis in the elimination phase, primarily including the establishments of laboratory networks and quality control in China, to better improve malaria diagnosis and maintain a malaria-free status. A reference is also provided for countries experiencing malaria elimination.
China/epidemiology* ; Clinical Laboratory Techniques ; Global Health ; Humans ; Laboratories ; Malaria/prevention & control*

Objective:To explore the application and choice of trunk perforator flaps in chest wound repair.Methods:From May 2015 to December 2019, clinical data of 14 patients using trunk perforator flap for chest soft tissue defect repair were reviewed. They were 8 males and 6 females, aged from 17 to 74 years. 5 patients had wound after scar surgery. 6 patients had benign lesions, and 3 patients had malignant tumors. The size of tissue defects ranged from 6.0 cm×8.0 cm-20.0 cm×21.0 cm. The perforator flaps were designed to repair different wounds. Preoperatively, the perforators are identified by ultrasound or CTA, and the flap scope and surgical approach are designed according to the perforator alignment and the perforated muscle point. Postoperatively, the survival of the flap was observed and followed up for at least 6 months.Results:All 17 flaps of 14 patients survived. The flap area was 7.0 cm × 8.0 cm-22.0 cm × 22.0 cm, and the length of the pedicle was 2.0-6.0 cm. All patients were followed up for 6 to 26 months with satisfied result . Recurrence occurred in one of the patients with thoracic dermatofibrosarcoma protuberans.Conclusions:The perforator artery of the trunk is densely and easy to obtain. The combined flaps could be used to repair large chest defects. The first-stage suture of the donor area, so it meets the organization transplantation principle of "the repair is perfect, the damage is small" .

Objective:To assess the efficacy and safety of common medication treatments on Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA).Methods:PubMed, Embase, Web of Science, CNKI and Wanfang database were searched to find out the observational studies on medication treatment of KHE and TA. R-3.6.2 was used for calculate the pooled response rate and pooled adverse events rate. Meta analyses were performed according to KHE and TA with and without Kasabach-Merritt phenomenon (KMP) respectively. SPSS 22.0 was used to compare the pooled rates among each therapy.Results:A total of 30 studies regarding the medication treatment of KHE and TA were identified in this meta-analysis. Analyzed medicines included glucocorticoid, vincristine, sirolimus, propranolol, combination therapy of vincristine and glucocorticoid. The pooled results indicated that when referring therapy on KHE and TA with KMP, the pooled response rate of combination therapy (98.34%) and sirolimus (96.43%) was higher than that of other therapies, and the difference was statistically significant. The pooled adverse events rate of sirolimus (5.53%) was relatively higher than other modalities, with no statistically significance. As for therapy on KHE and TA without KMP, sirolimus (94.23%) had higher pooled response rate than glucocorticoid (31.25%), vincristine (46.15%) and propranolol (22.86%), with statistically significant differences. The pooled adverse events rate of sirolimus was 23.81%.Conclusions:Our findings indicate that for KHE and TA with KMP, combination therapy (sirolimus + glucocorticoid) and vincristine have the best efficacy, while the adverse events rate of sirolimus is relatively high. For KHE and TA without KMP, sirolimus has the highest response rate, but there is also a risk of serious adverse events. Glucocorticoid and vincristine have comparable response rate, which both inferior to sirolimus.

Objective:To assess the efficacy and safety of common medication treatments on Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA).Methods:PubMed, Embase, Web of Science, CNKI and Wanfang database were searched to find out the observational studies on medication treatment of KHE and TA. R-3.6.2 was used for calculate the pooled response rate and pooled adverse events rate. Meta analyses were performed according to KHE and TA with and without Kasabach-Merritt phenomenon (KMP) respectively. SPSS 22.0 was used to compare the pooled rates among each therapy.Results:A total of 30 studies regarding the medication treatment of KHE and TA were identified in this meta-analysis. Analyzed medicines included glucocorticoid, vincristine, sirolimus, propranolol, combination therapy of vincristine and glucocorticoid. The pooled results indicated that when referring therapy on KHE and TA with KMP, the pooled response rate of combination therapy (98.34%) and sirolimus (96.43%) was higher than that of other therapies, and the difference was statistically significant. The pooled adverse events rate of sirolimus (5.53%) was relatively higher than other modalities, with no statistically significance. As for therapy on KHE and TA without KMP, sirolimus (94.23%) had higher pooled response rate than glucocorticoid (31.25%), vincristine (46.15%) and propranolol (22.86%), with statistically significant differences. The pooled adverse events rate of sirolimus was 23.81%.Conclusions:Our findings indicate that for KHE and TA with KMP, combination therapy (sirolimus + glucocorticoid) and vincristine have the best efficacy, while the adverse events rate of sirolimus is relatively high. For KHE and TA without KMP, sirolimus has the highest response rate, but there is also a risk of serious adverse events. Glucocorticoid and vincristine have comparable response rate, which both inferior to sirolimus.