Objective To explore the risk factors of hip fracture in elderly patients from Yongkang.Methods From August 2014 to August 2016,468 elderly patients with hip fracture admitted to Department of Orthopedics, Orthopedics Hospital of Yongkang were prospectively collected as study group,and 150 elderly people admitted to Orthopedics Hospital of Yongkang and Community Health Service Center for health examination were randomly selected as control group.The complications,daily living habits,bone density and menstruation of the female were observed between the two groups.Results Compared with the control group,the incidence rate of diabetes in the study group increased significantly(28.63% vs.12.67%,χ2 =15.544,P =0.000),the rate of height decreased more than 3cm increased significantly (16.88% vs.8.00%,χ2 =7.134,P =0.008),the proportion of long -term use of hormone significantly increased (18.59% vs.10.00%,χ2 =6.082,P =0.014),the rate of physical exercise decreased signif-icantly (14.32% vs.22.67%,χ2 =5.793,P =0.016),the rate of bed ridden increased significantly (5.34% vs 1.33%,χ2 =4.369,P =0.037),the bone density of femoral neck decreased significantly[(0.99 ±0.12)g/cm2 vs. (1.10 ±0.12)g/cm2 ,t =10.139,P =0.000].When it came to the females,the rate of menopause before the age of 45 years in the study group was higher than that in the control group (33.23% vs.22.22%,χ2 =4.299,P =0.038).Conclusion Diabetes,height decrease >3 cm,long -term use of hormones,lack of physical exercise,bed ridden and bone density decrease are risk factors of hip fracture in elderly people from Yongkang,and menopause before the age of 45 is a risk factor for hip fracture in elderly women.

Objective: To analyze epidemiological characteristics of brucellosis in Shaoxing City, Zhejiang Province from 2005 to 2023, so as to provide the basis for developing targeted control measures. Methods: Data of brucellosis cases and epidemiological investigation in Shaoxing City from 2005 to 2023 were collected from the Monitoring and Reporting Management System of the Chinese Disease Prevention and Control Information System. The epidemiological characteristics of brucellosis were descriptively analyzed, the trend in incidence of brucellosis was analyzed using average annual percent change (AAPC). Results: A total of 270 cases of brucellosis were reported in Shaoxing City from 2005 to 2023, with an average annual incidence of 0.29/105. The AAPC was 0.812%, with no significant changing trend (P>0.05). The incidence of brucellosis peaked from February to March, with 80 cases (29.63%). The reported cases were mainly distributed in Shangyu District (139 cases, 51.48%) and Shengzhou City (74 cases, 27.41%). There were 188 male cases and 82 female cases, with a male-to-female ratio of 2.29∶1. The cases were primarily concentrated in the age group of 40 to <70 years, with 205 cases accounting for 75.93%. Among these, 86 cases were reported in the 50 to <60 years of age group, accounting for 41.95%. The majority of the cases were farmers, with 187 cases accounting for 69.26%. The median interval from onset to diagnosis was 22.73 (interquartile range, 39.97) days, with a delayed diagnosis rate of 62.96%. Infections through breeding, selling and transporting cattle and sheep resulted in 164 cases (60.74%), and through buying and slaughtering resulted in 36 cases (13.33%). An outbreak of brucellosis was reported in Xinchang County in 2018, with three confirmed cases. Conclusions The incidence of brucellosis in Shaoxing City had no significant change from 2005 to 2023. The peak period was from February to March. The cases were mainly distributed in Shangyu District and Shengzhou City. People aged 50 to <60 years, males, and farmers were the key groups for prevention and control.

Objective To explore anti-EV71 effects of Ganlu Xiaodudan in vitro. Methods Ribavirin was taken as control drug, with the help of cell culture to observe anti-EV71 inhibition rate of Ganlu Xiaodudan in inhibiting-virus-directly experiment, therapeutic-inhibiting-virus experiment, preventive-inhibiting-virus experiment and preventive-therapeutic-inhibiting-virus experiment. Results In inhibiting-virus-directly experiment, therapeutic-inhibiting-virus experiment and preventive-therapeutic-inhibiting-virus experiment, virus inhibition rate of Ganlu Xiaodudan was higher than ribavirin. In preventive-inhibiting-virus experiment, virus inhibition rates of Ganlu Xiaodudan and ribavirin both were almost zero. Conclusion Ganlu Xiaodudan has better antiviral effects on EV71 than ribavirin, and it can affect more than one link of multiplication of EV71.

Objective To observe the effects of Ganlu Xiaodu Dan and its incomplete prescription on expressions of MiR-146a and TLR4 mRNA in RD cells infected by EV71. Methods With technique of cell culturing, Ganlu Xiaodu Dan therapy group, incomplete Qing prescription therapy group, incomplete Li prescription therapy group, normal cells control group, model control group and ribavirin control group were set, and tests for virus toxicity and medicine toxicity in cells were taken, then expressions of miRNA-146a and TLR4 mRNA in these RD cells 24 hours after intervention with medicine were detected. Results Compared with normal cells control group, miR-146a in mRNA model control group decreased and TLR4 mRNA increased. Compared with model control group, miR-146a mRNA in Ganlu Xiaodu Dan therapy group, incomplete Qing prescription therapy group and incomplete Li prescription therapy group all increased while TLR4 mRNA decreased, and differences between ribavirin control group and model control group were not significant. Compared with Ganlu Xiaodu Dan therapy group, both expressions of miR-146a and TLR4 mRNA in incomplete Qing prescription therapy group were lower; miR-146a increased and TLR4 mRNA decreased in incomplete Li prescription therapy group. Compared with incomplete Qing prescription therapy group, miR-146a mRNA in incomplete Li prescription therapy group increased, but expression of TLR4mRNA between them was not significant. Conclusion Ganlu Xiaodu Dan can regulate the immune reactions caused by infection of EV71 by increasing expression of miR-146a mRNA and reducing expression of TLR4 mRNA. There may be antagonism effect between incomplete Qing prescription and incomplete Li prescription.

Objective: To investigate the epidemiological characteristics of hemorrhagic fever with renal syndrome (HFRS) in Shaoxing City from 2006 to 2022, so as provide insights into improvements of the HFRS control strategy. Methods: Data pertaining to HFRS cases in Shaoxing City from 2006 to 2022 were captured from the Surveillance System of China Information System for Disease Control and Prevention. The temporal, population and regional distributions of HFRS were analyzed using the descriptive epidemiological method, and the trends in incidence of HFRS were evaluated using annual percent change (APC). Results: Totally 1 022 HFRS cases were reported in Shaoxing City from 2006 to 2022, with annual average incidence of 1.22/105 and three deaths. The incidence of HFRS appeared a tendency towards a decline in Shaoxing City from 2006 to 2022 (APC=-11.101%, t=-9.930, P<0.001), and the incidence of HFRS peaked from May to June and from November to January of the next year. A higher incidence of HFRS was seen in men than in women (1.76/105 vs. 0.68/105; χ2=201.361, P<0.001). There were 714 HFRS cases at ages of 30 to 59 years (69.86%), and farmers were the predominant occupation (78.18%). The three counties with the largest number of HFRS cases included Zhuji (366 cases), Xinchang (263 cases) and Shengzhou (134 cases). The incidence of HFRS was lower in urban districts (Yuecheng, Keqiao and Shangyu) than in counties (Zhuji, Shengzhou and Xinchang) (0.58/105 vs. 1.96/105; χ2=326.880, P<0.001). Conclusion The incidence of HFRS appeared a tendency towards a decline in Shaoxing City from 2006 to 2022, and the incidence was high in late spring, early summer and winter. The HFRS cases were mainly males, young and middle-aged people, and farmers, and predominantly distributed in counties. Targeted control measures are needed.

As the second largest vector of infectious diseases, ticks carry and transmit various pathogens that cause human infections and pose a serious public health hazard. In recent years, there has been an ongoing epidemic of tick-borne fever with thrombocytopenia syndrome virus (SFTSV), as well as the occurrence of human infections by brand-new viruses such as Jingmen tick virus (JMTV) and Alongshan virus (ALSV) in China. This paper will review the advancement of disease clinical characteristics, laboratory methods of virus isolation, immunology and molecular biology of these emerging tick-borne viral diseases in China.

Autoimmune diseases refer to clinical diseases caused by the body′s autoimmune tolerance state being broken or autoimmune cells being abnormally regulated, and the immune system produces autoantibodies, causing self-tissue damage or abnormal function. Most of the causes are unknown and easy to repeat, causing a huge burden on the quality of life of patients. Infectious pathogens have a potential role in initiating autoimmune processes and exacerbating disease progression, and conversely, some pathogens can suppress autoimmune responses. This paper summarizes the relationship between different types of infection and autoimmune diseases. Possible mechanisms of action include molecular mimicry of pathogen antigens, activation of bystander T or B cells, modification of autoantigens, and epitope diffusion.

Objective To explore the impact of diagnosis related groups (DRGs) payment and drug zero plus on the management of intensive care medicine department. Methods The clinical data of patients in one year from 2016 to 2017 admitted into the Department of ICU in Liuzhou Worker's Hospital concerning their numbers of discharged patients, transferred patients, bed utilization rate, number of bed turnover, average length of stay of discharged patients, cure and improvement rates, admission and discharge diagnostic coincidence rate, 3-day definite diagnosis rate, clinicopathological diagnosis coincidence rate, rescue success rate, total income, drug proportion, consumable proportion, DRGs payment and settlement data, etc were retrospectively analyzed to explore the dual challenges, DRGs payment and drug zero plus, facing the department and how to respond and deal with them. Results In 2016 and 2017, the total incomes of the department of critical care medicine in our hospital were 42.107 0 million yuan and 41.371 3 million yuan respectively, and the medical insurance incomes were 15.03 million yuan and 16.69 million yuan respectively;in 2016 and 2017, 2 693 patients and 2 922 patients were admitted and treated respectively; 595 patients and 577 patients were discharged respectively, with 2 071 patients and 2 334 patients transferred respectively; the balances of the department were 15.48 million yuan and 29.11 million yuan, respectively. From July to December 2017, the medical insurance DRGs payment data suggested that the proportion of loss of the department be 7.02%. Accelerating the Grade 6 electronic medical records and informationization construction, adopting the severe disease information solution program and fine quality control management in the department of critical care medicine can reduce the cost of manpower. Conclusion Our future development direction in the Department of Intensive Care Medicine includes the following aspects: Open source and reduce expenditure, strictly control the proportions of drugs and consumables, improve the balance of the department, and actively respond and deal with the medical insurance DRGs payment.

Objective To explore the effective strategies of clinical pathway construction in intensive care unit (ICU).Methods From January 2016 to July 2018,1 488 patients were discharged from ICU of Liuzhou Worker's Hospital of Guangxi Zhuang Autonomous Region.The pilot project of "postoperative monitoring of heart disease" with simpler route and less variation was selected first,and then the pilot project was promoted to "post-operative monitoring" after its success.The implementation of the clinical pathway was divided into three stages:the first stage,January 2016 to May 2017,for the pilot phase,a total of 87 patients were enrolled in the clinical pathway trial;the second stage,June 2017 to December 2017,surgical ICU "postoperative monitoring of heart disease" was put into the pathway 111 times;the third stage,January 2018 to July 2018,surgical ICU "postoperative monitoring of heart disease" was entered in the path 116 times;comprehensive ICU "postoperative care" was put into the path 96 times.After carefully analyzed the reasons and sum up the experience,internet+medical treatment (Liuzhou Worker's Hospital became the fifih deep partner of Tencent Inc in the internct+medical field,and carried out the plan and practice of "WeChat wisdom hospital 3.0" in 2017) was used,four aspects of connection,payment,security and ecological cooperation were upgraded,and the construction of 6 level of electronic medical record (EMR) was accelerated.At the same time,through diagnosis related groups system (DRGs),the concept of evidence-based medicine,quality management and continuous improvement as the leading factor,and combined with the construction status of hospital information system (HIS) and EMR system,step by step implementation and design of information management platform for clinical pathway were formulated.The completion rate of clinical pathway,average length of hospital stay,average cost,cure rate and improvement rate were the main observation parameters.Results In the first stage,none of the 87 patients who entered the clinical pathway completed the clinical pathway.In the second stage,the completion rate of surgical ICU clinical pathway was increased from 33.33％ in June 2017 to 94.44％ in December 2017,and up to 100％ in October 2017,and the average completion rate from January to July 2018 was 94.00％.The completion rate of ICU clinical pathway was increased from 81.82％ in January 2008 to 92.86％ in July 2008.There was a significant difference in the overall clinical pathway completion rate from 2016 to 2018 (x2 =204.300,P =0.000).After the effective implementation of clinical pathway in June 2017,the length of hospital stay of patients was significantly shortened as compared with that before implementation (days:2.96 ± 0.43 vs.6.66 ± 0.75,P ＜ 0.01),and the daily cost was significantly reduced (Yuan:3 550.92 ± 755.51 vs.6 171.48 ± 377.29,P ＜ 0.01).The average length of hospital stay was shortened by about 3.84 days (P ＜ 0.01),and the average daily cost was reduced by about 2 108.39 Yuan (P ＜ 0.01) after the implementation of clinical pathway by surgical ICU "postoperative monitoring of heart disease" as compared with those before implementation.The average length of hospital stay was shortened by about 2.98 days (P ＜ 0.01) and the average daily cost was reduced by 5 094.13 Yuan (P ＜ 0.01) after the implementation of clinical pathway by comprehensive ICU "post-operative monitoring" as compared with those before implementation.At the same time,the cure rate was increased from 1.16％ (7/603) to 42.26％ (105/227),and the improvement rate was decreased from 94.36％ (569/603) to 52.86％ (120/227,both P ＜ 0.01) after the implementation of surgical ICU clinical pathway,but there was no significant difference in the cure rate or the improvement rate after the implementation of comprehensive ICU [2.77％ (33/1 193) vs.2.22％ (2/90),79.21％ (945/1 193) vs.97.78％ (88/90),both P ＞ 0.05].Conclusions Application of clinical pathway to control ICU quality and guide diagnosis and treatment,more refined diagnosis and treatment schemes including clinical guidelines,average length of stay,average cost of hospitalization,cost-efficiency ratio and so on were completed,which confirmed that the improvement of clinical pathway management strategy originated from clinical were needed.Informatization,intellectualization,standardization and effective control of medical cost of clinical pathway could improve medical quality and accurate management.The integration of ICU clinical pathway construction and HIS could promote the development of digital hospitals.