Objective To analyze the epidemic characteristics of scarlet fever in Pudong New Area, Shanghai from 2010 to 2023, and to grasp the incidence of scarlet fever in time. Methods The information on the registration of scarlet fever in Pudong New Area, Shanghai from January 1, 2010 to December 31, 2023 was collected through the China Disease Prevention and Control Information System, and descriptive epidemiological methods and Joinpoint regression model were used for data analysis. Results From 2010 to 2023, a total of 5 669 cases of scarlet fever were reported in Pudong New Area, Shanghai, and no deaths were reported. The annual reported incidence rate was 7.2/100 000, and the overall trend was decreasing year by year. In terms of time distribution, the incidence peaks were in spring and winter. The incidence rate in males was higher than that in females, and it mainly affected children, especially those aged 2 to 10 years. Joinpoint regression model analysis showed that the annual percentage change (APC) and average annual percentage change (AAPC) of the reported incidence rate of scarlet fever from 2010 to 2023 showed that the incidence rate was fluctuating, and the incidence rate decreased significantly from 2019 to 2023 (APC was -53.7%). Conclusion The reported incidence rate of scarlet fever in Pudong New Area in Shanghai has decreased year by year from 2010 to 2023, and children remain the focus of prevention and control.

Objective To explore the global and loci-specific genetic correlations and bidirectional causal relationships between spinal stenosis(SS)and constipation.Methods Utilizing the publicly available genome-wide association study data from the European population,linkage disequilibrium score regression and local analysis of variant association were used for quantifying genetic correlation at both global(genome-wide)and local(genomic regions)levels,and a two-sample Mendelian randomization(TSMR)analysis was conducted:Four distinct methods,namely the inverse variance weighting method,MR-Egger regression method,weighted median method,and weighted mode,were utilized for analysis and evaluation of the results;Cochran's Q test,leave-one-out method,MR-Egger intercept test,Mendelian randomization polymorphic residuals,and outlier tests were applied to examine the stability and reliability of the results.Results The analysis of linkage disequilibrium score regression and local analysis of variant association revealed that a total of 71 regions had at least one pair of traits with local genetic correlations.The TSMR analysis,with SS as the exposure and constipation as the outcome,based on the results of the inverse variance weighting method,suggested a causal relationship between two(OR=1.077,95％CI:1.034-1.122,P=0.000);Cochran's Q test and MR-Egger intercept test indicated the absence of heterogeneity or pleiotropy,and were verified by the analysis of Mendelian randomization polymorphic residuals,and outlier tests,demonstrating that the results of this study did not exhibit horizontal pleiotropy;The sensitivity analysis using the leave-one-out method indicated that the research results were stable.With constipation as the exposure factor and SS as the outcome,no eligible instrumental variables were found.Conclusion There are significant global and loci-specific genetic correlations between SS and constipation,and SS may be a risk factor for the occurrence of constipation.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To explore the global and loci-specific genetic correlations and bidirectional causal relationships between spinal stenosis(SS)and constipation.Methods Utilizing the publicly available genome-wide association study data from the European population,linkage disequilibrium score regression and local analysis of variant association were used for quantifying genetic correlation at both global(genome-wide)and local(genomic regions)levels,and a two-sample Mendelian randomization(TSMR)analysis was conducted:Four distinct methods,namely the inverse variance weighting method,MR-Egger regression method,weighted median method,and weighted mode,were utilized for analysis and evaluation of the results;Cochran's Q test,leave-one-out method,MR-Egger intercept test,Mendelian randomization polymorphic residuals,and outlier tests were applied to examine the stability and reliability of the results.Results The analysis of linkage disequilibrium score regression and local analysis of variant association revealed that a total of 71 regions had at least one pair of traits with local genetic correlations.The TSMR analysis,with SS as the exposure and constipation as the outcome,based on the results of the inverse variance weighting method,suggested a causal relationship between two(OR=1.077,95％CI:1.034-1.122,P=0.000);Cochran's Q test and MR-Egger intercept test indicated the absence of heterogeneity or pleiotropy,and were verified by the analysis of Mendelian randomization polymorphic residuals,and outlier tests,demonstrating that the results of this study did not exhibit horizontal pleiotropy;The sensitivity analysis using the leave-one-out method indicated that the research results were stable.With constipation as the exposure factor and SS as the outcome,no eligible instrumental variables were found.Conclusion There are significant global and loci-specific genetic correlations between SS and constipation,and SS may be a risk factor for the occurrence of constipation.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To explore the protective effect and mechanism of Tongfu Lifei decoction (TFL) on human monocytic leukemia cell THP-1 induced by lipopolysaccharide (LPS).Methods:① THP-1 cells were cultured in vitro, and incubated with 1 mg/L LPS for 18 hours to construct an in vitro THP-1 cell inflammation model. Other THP-1 cells were taken as blank control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) secreted by cells. ② THP-1 cells were divided into seven groups and treated with 0, 0.005, 0.01, 0.02, 0.04, 0.08, and 0.16 mL/mL TFL for 24 hours (added different dosages of TFL solution per milliliter of culture medium, with a crude drug content of 1 kg/L). The cell survival rate was detected using methyl thiazolyl tetrazolium (MTT) colorimetric method, and the intervention dosage of TFL for its non-toxic effect on THP-1 cells was screened. ③ Another THP-1 cells were divide into inflammatory model group and 0.01, 0.02, and 0.04 mL/mL TFL groups according to the intervention dosage of TFL screened by MTT colorimetry. After 24 hours of intervention, the levels of TNF-α and IL-6 secreted by cells were measured using ELISA. Western blotting was used to detect the expressions of programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) signaling pathway proteins in cells. Real time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expressions of microRNAs (miR-146a, miR-146b, miR-155) in cells. ④ The maximum non-toxic concentration of TFL (0.04 mL/mL) on the THP-1 cell was selected as the intervention dose. THP-1 cells were divided into inflammation model group, TFL group, TFL+miR-146a inhibitor group, TFL+miR-146b inhibitor group, and TFL+miR-155 inhibitor group. The inflammation model group was not given any drug intervention. The other inhibitor groups were added 100 nmol/L corresponding inhibitor. After 24 hours of intervention, the levels of TNF-α and IL-6 secreted by cells were measured using ELISA. Western blotting was used to detect the expressions of PD-1/PD-L1 signaling pathway proteins in cells. Results:① Compared with the blank control group, the levels of TNF-α and IL-6 secreted by cells in the inflammatory model group were significantly increased, indicating the successful construction of the THP-1 inflammatory cell model in vitro. ② 0-0.04 mL/mL TFL had no toxic effect on THP-1 cells. However, the survival rates of cells in the 0.08 mL/mL and 0.16 mL/mL TFL groups were significantly lower than those in the inflammation model group, indicating that TFL dosages exceeding 0.04 mL/mL had toxic effects on THP-1 cells. ③ Compared with the inflammation model group, 0.01 mL/mL TFL had no significant effect on the levels of TNF-α and IL-6 secreted by THP-1 cells, while intervention with 0.02 mL/mL and 0.04 mL/mL TFL significantly reduced the levels of TNF-α and IL-6 secreted by cells [TNF-α(ng/L): 95.89±8.55, 70.73±11.70 vs. 137.10±7.19, IL-6 (ng/L): 23.03±2.55, 16.58±1.72 vs. 32.60±2.55, all P < 0.01]. Compared with the inflammation model group, the expressions of PD-1/PD-L1 signaling pathway proteins in THP-1 cells in different dosages of TFL groups were significantly reduced, and showed a certain dosage dependence. The expressions of the pathway proteins in the 0.04 mL/mL TFL group were significantly lower than those in the inflammation model group [PD-1 protein (PD-1/β-actin): 0.28±0.04 vs. 1.00±0.10, PD-L1 protein (PD-L1/β-actin): 0.54±0.05 vs. 1.00±0.08, phosphoinositide 3-kinase (PI3K) protein (PI3K/β-actin): 0.28±0.03 vs. 1.00±0.08, phosphorylated protein kinase B (p-Akt) protein (p-Akt/Akt): 0.38±0.04 vs. 1.00±0.10, all P < 0.01]. Compared with the inflammation model group, the expression of miR-146a in THP-1 cells in the 0.01, 0.02, and 0.04 mL/mL TFL groups was significantly reduced (2 -ΔΔCt: 0.46±0.11, 0.31±0.13, 0.23±0.14 vs. 1.01±0.18, all P < 0.01), while there was no significant change in the expressions of miR-146b and miR-155. ④ Compared with the inflammation model group, the TFL group showed a significant decrease in the levels of TNF-α and IL-6 secreted by THP-1 cells. The miR-146a inhibitor could significantly reverse the inhibitory effect of TFL on inflammatory factors, and the difference was statistically significant as compared with the TFL group [TNF-α (ng/L): 138.55±10.30 vs. 72.33±10.59, IL-6 (ng/L): 31.35±3.98 vs. 15.75±3.76, both P < 0.01]. Compared with the inflammation model group, the expressions of PD-1/PD-L1 signaling pathway proteins in THP-1 cells in the TFL group were significantly reduced. The expressions of pathway proteins in cells in the TFL+miR-146a inhibitor group were significantly higher than those in the TFL group [PD-1 protein (PD-1/β-actin): 0.85±0.09 vs. 0.37±0.04, PD-L1 protein (PD-L1/β-actin): 0.83±0.08 vs. 0.55±0.06, PI3K protein (PI3K/β-actin): 0.85±0.09 vs. 0.63±0.06, p-Akt protein (p-Akt/Akt): 0.98±0.10 vs. 0.75±0.07, all P < 0.05]. Conclusion:TFL regulates the expression of miR-146a to inhibit the PD-1/PD-L1 signaling pathway in THP-1 cells, regulates the immune barrier of sepsis induced in cell inflammation model in vitro, and thus protects LPS induced THP-1 cells.

ObjectiveTo analyze the epidemic characteristics of measles and rubella in Pudong New Area of Shanghai from 2013 to 2022， and to provide data support for the elimination of measles and rubella. MethodsEnzyme linked immunosorbent assay was used to detect IgM antibodies in serum samples. The sequence of 630 nucleotides at the C-terminal of N gene of measles virus was amplified by reverse transcription-polymerase chain reaction and the phylogenic tree was constructed. ResultsA total of 1 529 suspected cases of measles were detected from 2013 to 2022， among which the positive rate of measles IgM antibody was 33.55% （513/1 529）. The highest positive rate （20.73%） was from March to May ， and the positive rate of rubella IgM antibody was 6.80% （104/1 529）. The positive rate of both IgM was higher in males than that in females （P<0.05）. The IgM against measles was mainly detected in 0‒ years old （63.16%， 96/152） and 20‒ years old （45.61%， 161/353）. The IgM against rubella was mainly detected in 10‒20 years old （27.27%， 18/66）. The IgM antibody could be detected more easily from 4 to 28 days after eruption， and the IgM antibody positive rate of measles/rubella from 2020 to 2022 was significantly lower than previous years （2013‒2019）. There were 2 D8 genotype strains， and the rest were H1a gene subtypes. ConclusionThe positive rate of IgM antibodies against measles/rubella in Pudong New Area of Shanghai decreased significantly. People aged 0‒ years and 20‒ years old are more susceptible to measles， and rubella is concentrated in 10‒ years old. It is necessary to strengthen the vaccination of school-age children， in order to achieve the goal of eliminating measles. The age group with high risk of exposure should be checked for vaccination status to ensure the enhanced immunization， and the surveillance of imported measles cases should be strengthened.

ObjectiveTo identify the rate， population characteristics， and vaccination history of repeat infections among previously infected people in the current epidemic based on the rate of repeat infection and population characteristics of different mutant strains at different times in Pudong New Area of Shanghai， and to provide reference for the prevention and control strategies of novel coronavirus repeat infections. MethodsA total of 9 250 investigated subjects were randomly selected from the new cases of asymptomatic infection and confirmed cases reported by Pudong New Area from March to May 2022. The investigation mainly focused on demographic characteristics， nucleic acid or antigen test results， and symptoms after infection. The repeat infection rates among different populations were compared， and logistic regression was used to analyze the impact of gender， age， and vaccination status on repeat infections. ResultsThe survey sample of 9 250 people had a response rate of 81.85%. There were 4 043 males （53.40%） and 3 528 females （46.60%）， with a median age of 34 years old （P₂₅， P₇₅： 7， 61）. The overall vaccine uptake rate was 59.44% （4 500/7 571）. In December of 2022， there were 563 cases of repeat infection， with an infection rate of 7.44%. The lowest rate of repeat infection was seen in the 3‒ year-old group （2.86%） and the highest rate in the 30‒ year-old group （12.42%）， with significant differences between different age groups. The repeated infection rate for those who had completed their vaccinations was significantly lower （6.57%） compared to those who had not （7.11%）. The age groups of 3‒ years， 70‒79 years， as well as individuals who completed full vaccination and received booster shots were protective factors against repeat infections. ConclusionThe overall rate of reinfection among the infected in Shanghai during the spring of 2022 was low in the outbreak of the Omicron variant， and the rate of reinfection in the 3‒ year-old group was significantly lower than in other age groups. Completing the full course of vaccination significantly reduces the risk of reinfection. Although the reinfection rate is high in individuals who received booster shots， it remains a mitigating factor compared to those who do not receive the vaccine. It is recommended to continue monitoring reinfections in key populations and further strengthen immunization efforts.

BACKGROUND:As a routine method after lumbar spine surgery,a drainage tube is convenient for postoperative bleeding drainage and management,and there is still no consensus on the choice of postoperative removal time for short-segment lumbar spine surgery with less risk. OBJECTIVE:To explore the effect of different drainage times on early clinical efficacy after short-segment lumbar fusion. METHODS:A prospective randomized controlled study was performed on 220 patients in the Affiliated Hospital of Southwest Medical University who underwent posterior lumbar interbody fusion for lumbar degenerative diseases from March 2017 to April 2021.According to the different drainage times,the patients were randomly divided into removal on the second day after operation(group A),removal on the third day after operation(group B),and removal after the observation method 24-hour drainage volume<30 mL(group C).The perioperative indicators and follow-up results of the three groups of patients were observed and compared. RESULTS AND CONCLUSION:(1)Because 7 patients were lost to follow-up,2 patients were excluded,and 211 patients were finally included(72 patients in group A,71 patients in group B,and 68 patients in group C).(2)The average drainage time of group C was 2.91 days.The postoperative drainage volume in group A was significantly less than that in groups B and C,and the difference was statistically significant(P<0.05).On day 3 after operation,the hematocrit value of group C was lower than that of group A and group B,and the difference was statistically significant(P<0.05).Postoperative activity time and hospital stay in group A were shorter than those in groups B and C,and the difference was statistically significant(P<0.05).(3)Four patients in group A,two patients in group B and three patients in group C received an allogeneic blood transfusion.There was no significant difference among the groups(P>0.05).(4)In terms of postoperative complications,there were no statistical differences in postoperative wound leakage and surgical site infection in all three groups(P>0.05).(5)All patients were followed up for more than 12 months.Visual analog scale score and Oswestry dysfunction index of the three groups of patients before discharge and at the last follow-up were significantly improved compared with those before surgery(P<0.05).There was no statistical significance among the groups(P>0.05).(6)It is indicated that the removal of the drainage tube on the second day after a posterior lumbar fusion can effectively reduce the time to get out of bed and hospital stay,without increasing the postoperative blood loss and the risk of complications.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.