Objective To analyze the characteristics of viral hepatitis mortality and life loss among residents in Pudong New Area from 2003 to 2023, and to provide a basis for related prevention and control work. Methods Viral hepatitis mortality data were obtained from the Pudong New Area mortality monitoring system. The crude mortality rate (CMR), standardized mortality rate (SMR), potential years of life lost (PYLL), average years of life lost (AYLL), and standardized potential years of life lost (SPYLL) were calculated to analyze viral hepatitis deaths. The average annual change (AAPC) and annual percentage change (APC) of the mortality rate were calculated by Joinpoint regression analysis to analyze the trend of mortality. Results The CMR and SMR of viral hepatitis among residents in Pudong New Area from 2003 to 2023 were 3.89/100000 and 1.98/100000, respectively. Both CMR and SMR of viral hepatitis showed a decreasing trend over time (CMR:APC=-5.476, t=-13.581, P<0.001; SMR:APC=- 7.624, t= -21.253, P<0.001). The CMR for males was 4.75/100000 and the SMR for males was 2.65/100000; the CMR for females was 3.04/100000 and the SMR for females was 1.32/100000, with a higher mortality rate for males than for females（Z_CME=12.094，P<0.001; Z_SMR=-14.718，P<0.001). Deaths were concentrated in the age groups of 45-64 years old and 65 years old and above, accounting for 91.62% of the total deaths. The PYLL of deaths due to viral hepatitis among residents in Pudong New Area from 2003 to 2023 was 26912 person-years, with a PYLLR of 0.45% and an AYLL of 8.88 years per person. Conclusion The mortality rate of viral hepatitis among the residents of Pudong New Area in 2003-2023 shows a decreasing trend over time. The mortality rate of males is higher than that of females, and the deaths of middle-aged and elderly people account for a large proportion of the total deaths. Chronic hepatitis B is the main cause of death.

Background The crude mortality rate of sudden death has shown a steady upward trend. Pudong New Area, Shanghai, is a highly urbanized and densely populated district that is substantially affected by the urban heat island effect and has experienced frequent extreme temperature events in recent years. However, evidence on the association between ambient temperatures and sudden death among local residents remains limited. Objective To examine the association between daily mean temperature and sudden death in Pudong New Area, and to provide evidence for reducing temperature-related risks of sudden death. Methods Data on sudden death, meteorological factors (daily average temperature, daily average relative humidity, and daily average air pressure), and air pollutants [inhalable particulate matter (PM₁₀), sulfur dioxide (SO₂), and nitrogen dioxide (NO₂)] in Pudong New Area from 2016 to 2021 were collected. A distributed lag non-linear model was used to examine the associations of daily mean temperature with total sudden death and sudden death due to cardiovascular and cerebrovascular diseases, including lagged and cumulative effects (lag0, 0-3, 0-7, 0-14, and 0-21 d). Stratified analyses were performed by sex, age, and education level to identify vulnerable populations. The temperature attributable burden of sudden death was assessed by calculating attributable number (AN) and attribute fraction (AF). Results A total of 19458 sudden deaths were reported in Pudong New Area from 2016 to 2021, of which 11082 (56.95%) were due to cardiovascular and cerebrovascular diseases. Both low (P₅, 4.6 ℃) and high (P₉₅, 30.2 ℃) temperatures were associated with increased risks of sudden death. The cumulative risks associated with low temperature peaked at lag 0-21 d for both total sudden death and sudden death due to cardiovascular and cerebrovascular diseases. In contrast, the cumulative risks associated with high temperature peaked at lag 0-7 d for total sudden death and at lag 0-3 d for sudden death due to cardiovascular and cerebrovascular diseases. Stratified analyses showed that females, individuals aged ≥65 years, and those with primary school education or below were more sensitive to low temperature; whereas females, individuals aged <65 years, and those with secondary school education or above were more sensitive to high temperature. Using 21.5 ℃ as the minimum mortality temperature, the AN of total sudden deaths attributable to non-optimal temperature was 3791 (95%CI: 1853, 5587), with an AF of 20.41% (95%CI: 9.47%, 28.94%); the AN attributable to low temperature was 3358 (95%CI: 1087, 5062), with an AF of 17.26% (95%CI: 5.89%, 26.01%), whereas the AN attributable to high temperature was 225 (95%CI: −274, 655), with an AF of 2.03% (95%CI: −2.53%, 5.78%). For sudden deaths due to cardiovascular and cerebrovascular diseases, the AN attributable to non-optimal temperature was 2721 (95%CI: 1747, 5575), with an AF of 24.55% (95%CI: 9.59%, 28.65%); the AN attributable to low temperature was 2496 (95%CI: 988, 3562), with an AF of 22.53% (95%CI: 8.97%, 32.41%), whereas the AN attributable to high temperature was 614 (95%CI: −15, 1176), with an AF of 3.15% (95%CI: −0.08%, 6.02%). Conclusions Both low (P₅, 4.6 ℃) and high (P₉₅, 30.2 ℃) temperatures are associated with increased risks of sudden death in Pudong New Area, Shanghai. High temperature shows a relative short-term effect, whereas low temperature shows a stronger cumulative effect. Females, people ≥65 years, and individuals with primary school educational attainment or below are more vulnerable to low temperature, while females, people <65 years, and those with secondary school educational attainment or above are more vulnerable to high temperature. The attributable burden of low temperature is greater than that of high temperature. Targeted health protection measures should be strengthened for vulnerable populations during extreme temperature events.

With technological advancement and the growing demand for renewable energy, research and applications of new energy materials are becoming increasingly widespread. Typical new energy materials include lithium-ion battery materials, nanomaterials, nuclear energy materials and magnetic materials, etc., each of which has special toxicological characteristics. These materials may pose potential toxicological risks in the process of resource exploitation, production, transportation, usage, recycling or disposal, which have negatively impact on human health and the ecological environment. Occupational exposure is the main route of energy materials exposure, with potential health hazards on workers during the processes of production, transportation, recycling, and disposal. Among them, the disassembled batteries in the recycling or waste disposal process requires quality control, which is the high-risk position of occupational hazards. At present, the toxicology study of typical new energy materials mainly focuses on the potential impact of lithium-ion battery materials and nanomaterials on human health and the environment, but there are still limitations and challenges. In the future, it is necessary to further strengthen the human health risk management and prevention and control of new energy materials to protect human health and sustainable development.

[Purpose]To analyze the trends in pancreatic cancer mortality and disease burden among residents in Shanghai Pudong New Area from 2002 to 2022,and to investigate the effects of age,period,and birth cohort on mortality risk.[Methods]Data on pancreatic cancer deaths among residents of Pudong New Area from 2002 to 2022 were collected through the Shanghai Population Cause of Death Registration System.The crude mortality rate,age-standardized mortality rate by Chinese standard population(ASMRC),potential years of life lost(PYLL),potential years of life lost rate(PYLLR),and average years of life lost(AYLL)were calculated.Joinpoint regression was applied to calculate the average annual percentage change(AAPC)for analyzing the changing trend of the mortality rate of pancreatic cancer.The age-period-cohort model was applied with R 4.4.1 to analyze the age,period,and cohort effects on the mortality risk of pancreatic cancer.[Results]The crude mortality rate of pancreatic cancer among residents in Pudong New Area increased from 10.42/105 in 2002 to 18.73/105 in 2022,showing a significant upward trend(AAPC=2.90％,P＜0.001);the ASMRC was generally stable(AAPC=-0.05％,P=0.775).The crude mortality rate of males(17.09/105)was higher than that of females(13.75/105),and both showed an upward trend(AAPC=3.05％and 2.75％respectively,both P＜0.001).After the age of 40,the mortality rate of pancreatic cancer increased significantly with the growth of age in both sexes.The PYLL was 31 347 person-years,showing an upward trend(AAPC=1.83％,P＜0.001),and the AYLL was 3.59 years,showing a downward trend(AAPC=-2.45％,P＜0.001).The age effect showed that the mortality risk of pan-creatic cancer was increased with age;the period effect showed that the mortality risk decreased from 2002 to 2016 and then increased;the cohort effect showed that the mortality risk increased with the advancement of the birth cohort.[Conclusion]From 2002 to 2022,the crude mortality rate of pancreatic cancer in Pudong New Area showed an upward trend,and the mortality rate of males was higher than that of females.The mortality risk of pancreatic cancer increases with age,and the later the birth year of the residents,the higher the mortality risk.Early screening should be strengthened for men and the elderly,environmental and lifestyle risk factors should be paid attention to in combination with the characteristics of cohort effect,and the prevention and control strategy for the whole population should be optimized.

Objective:To analyze the clinical characteristics and treatment of patients with acute Q fever in Dali Bai Autonomous Prefecture, Yunnan Province.Methods:A total of 26 patients with acute Q fever admitted to People′s Hospital of Yunnan Dali Bai Autonomous Prefecture from October 2022 to December 2023 were enrolled. A retrospective cross-sectional study analysis was performed to analyze the demographic characteristics, epidemiology, clinical manifestations, laboratory tests and pathogen detection of these patients.Results:Of the 26 patients, 25 were male and one was female. The age ranged from 18 to 82 years with an average age of (45.6±17.2) years. All of them were sporadic cases. The neighbors of eight patients had sheep and cattle, 11 cases had a history of field work, and four cases had a history of field trip. Coxiella burnetii was detected in 26 patients by different molecular diagnostic techniques, including 21 cases by blood quantitative polymerase chain reaction (qPCR), three cases by sputum multi-pathogen targeted next-generation sequencing (tNGS), one case by alveolar lavage fluid tNGS, and one case by cerebrospinal fluid metagenomic next-generation sequencing (mNGS). Routine blood cultures of 19 cases were negative. All 26 patients presented with chills and fever, 21 cases (80.8%) with headache, 19 cases (73.1%) with fatigue, 14 cases (53.8%) with generalized aches and pains, 12 cases (46.2%) with poor appetite, and 14 cases (53.8%) with cough. Twenty-four cases had concurrent hepatitis, 12 cases had pneumonia, one had encephalitis, and 19 cases had myocardial damage. The laboratory tests showed that 23 cases (88.5%) had normal white blood cell count, eight cases (30.8%) had decreased platelet count, 25 cases (96.2%) had C-reactive protein elevated, 24 cases (92.3%) had procalcitonin elevated, 14 out of 17 cases had elevated erythrocyte sedimentation rate, and 19 cases had elevated D-dimer levels. Liver function tests showed that alanine aminotransferase increased in 24 cases (92.3%) (all less than 10 times of upper limit of normal (ULN)), aspartate aminotransferase increased in 23 cases (88.5%) (all less than 10 times of ULN), alkaline phosphatase increased in 10 cases (38.5%)(all less than two times of ULN), and γ-glutamyl transpeptidase increased in 19 cases (73.1%), which were all less than 10 times of ULN. Myocardial enzymes were detected in 21 cases, of which seven cases (33.3%) had elevated lactate dehydrogenase and 12 cases (57.1%) had elevated hydroxybutyrate dehydrogenase (all less than three times of ULN). In terms of treatment, 16 cases were treated with doxycycline alone, and nine cases were treated with doxycycline combined with azithromycin or quinolones or rifampicin, and one with tigecycline. After treatment, the conditions of patients improved. The overall length of hospital stay was (7.7±5.0) d, and that of eight patients treated with doxycycline combined with quinolones or azithromycin was 4.8 to 6.0 days. Conclusions:Acute Q fever often has no clear epidemiological history, and the clinical manifestations and laboratory tests are lack of specificity. qPCR, tNGS, mNGS can provide pathogenic diagnostic evidence for suspected cases. In terms of treatment, doxycycline is the first choice for treatment of acute Q fever, and combined treatment with azithromycin or quinolones could result in a shorter hospital stay.

Objective To evaluate the applicability and guideline concordance of the Chinese Society of Clinical Oncology(CSCO)arti-ficial intelligence(AI)system in clinical decision-making for colorectal cancer(CRC)patients,and to explore its feasibility in real-world clinical applications.Methods A total of 972 CRC patients diagnosed and treated at the Second Affiliated Hospital,Zhejiang University School of Medicine,from January 2010 to December 2021,were included.Patient data were analyzed by the CSCO AI system to gener-ate treatment decisions,and decision concordance was assessed by a blinded independent central review(BICR)panel.The applicability and guideline concordance rates of the CSCO AI system were calculated for different treatment stages,and a logistic regression model was used to analyze factors influencing the system's decision discrepancies with actual treatments.Results The overall applicability rate of the CSCO AI system was 96.2%,and the overall guideline concordance rate was 94.9%.In the adjuvant and palliative treatment stages,the system's applicability rates were 95.8%and 96.7%,respectively,and the guideline concordance rates were 95.0%and 94.9%,respective-ly.Multivariate logistic regression analysis showed that age≥65 years and high-risk stage Ⅱ treatment were significant factors affecting guideline concordance in the adjuvant treatment stage(both P<0.05).Conclusions The CSCO AI system demonstrated high applicability and guideline concordance in the adjuvant and palliative treatment stages for CRC.The system's clinical decision-making potential is sig-nificant,and it can be further optimized for specific clinical scenarios and promoted for use across various medical institutions.

Objective To evaluate the applicability and guideline concordance of the Chinese Society of Clinical Oncology(CSCO)arti-ficial intelligence(AI)system in clinical decision-making for colorectal cancer(CRC)patients,and to explore its feasibility in real-world clinical applications.Methods A total of 972 CRC patients diagnosed and treated at the Second Affiliated Hospital,Zhejiang University School of Medicine,from January 2010 to December 2021,were included.Patient data were analyzed by the CSCO AI system to gener-ate treatment decisions,and decision concordance was assessed by a blinded independent central review(BICR)panel.The applicability and guideline concordance rates of the CSCO AI system were calculated for different treatment stages,and a logistic regression model was used to analyze factors influencing the system's decision discrepancies with actual treatments.Results The overall applicability rate of the CSCO AI system was 96.2%,and the overall guideline concordance rate was 94.9%.In the adjuvant and palliative treatment stages,the system's applicability rates were 95.8%and 96.7%,respectively,and the guideline concordance rates were 95.0%and 94.9%,respective-ly.Multivariate logistic regression analysis showed that age≥65 years and high-risk stage Ⅱ treatment were significant factors affecting guideline concordance in the adjuvant treatment stage(both P<0.05).Conclusions The CSCO AI system demonstrated high applicability and guideline concordance in the adjuvant and palliative treatment stages for CRC.The system's clinical decision-making potential is sig-nificant,and it can be further optimized for specific clinical scenarios and promoted for use across various medical institutions.

[Purpose]To analyze the trends in pancreatic cancer mortality and disease burden among residents in Shanghai Pudong New Area from 2002 to 2022,and to investigate the effects of age,period,and birth cohort on mortality risk.[Methods]Data on pancreatic cancer deaths among residents of Pudong New Area from 2002 to 2022 were collected through the Shanghai Population Cause of Death Registration System.The crude mortality rate,age-standardized mortality rate by Chinese standard population(ASMRC),potential years of life lost(PYLL),potential years of life lost rate(PYLLR),and average years of life lost(AYLL)were calculated.Joinpoint regression was applied to calculate the average annual percentage change(AAPC)for analyzing the changing trend of the mortality rate of pancreatic cancer.The age-period-cohort model was applied with R 4.4.1 to analyze the age,period,and cohort effects on the mortality risk of pancreatic cancer.[Results]The crude mortality rate of pancreatic cancer among residents in Pudong New Area increased from 10.42/105 in 2002 to 18.73/105 in 2022,showing a significant upward trend(AAPC=2.90％,P＜0.001);the ASMRC was generally stable(AAPC=-0.05％,P=0.775).The crude mortality rate of males(17.09/105)was higher than that of females(13.75/105),and both showed an upward trend(AAPC=3.05％and 2.75％respectively,both P＜0.001).After the age of 40,the mortality rate of pancreatic cancer increased significantly with the growth of age in both sexes.The PYLL was 31 347 person-years,showing an upward trend(AAPC=1.83％,P＜0.001),and the AYLL was 3.59 years,showing a downward trend(AAPC=-2.45％,P＜0.001).The age effect showed that the mortality risk of pan-creatic cancer was increased with age;the period effect showed that the mortality risk decreased from 2002 to 2016 and then increased;the cohort effect showed that the mortality risk increased with the advancement of the birth cohort.[Conclusion]From 2002 to 2022,the crude mortality rate of pancreatic cancer in Pudong New Area showed an upward trend,and the mortality rate of males was higher than that of females.The mortality risk of pancreatic cancer increases with age,and the later the birth year of the residents,the higher the mortality risk.Early screening should be strengthened for men and the elderly,environmental and lifestyle risk factors should be paid attention to in combination with the characteristics of cohort effect,and the prevention and control strategy for the whole population should be optimized.

Objective:To analyze the clinical characteristics and treatment of patients with acute Q fever in Dali Bai Autonomous Prefecture, Yunnan Province.Methods:A total of 26 patients with acute Q fever admitted to People′s Hospital of Yunnan Dali Bai Autonomous Prefecture from October 2022 to December 2023 were enrolled. A retrospective cross-sectional study analysis was performed to analyze the demographic characteristics, epidemiology, clinical manifestations, laboratory tests and pathogen detection of these patients.Results:Of the 26 patients, 25 were male and one was female. The age ranged from 18 to 82 years with an average age of (45.6±17.2) years. All of them were sporadic cases. The neighbors of eight patients had sheep and cattle, 11 cases had a history of field work, and four cases had a history of field trip. Coxiella burnetii was detected in 26 patients by different molecular diagnostic techniques, including 21 cases by blood quantitative polymerase chain reaction (qPCR), three cases by sputum multi-pathogen targeted next-generation sequencing (tNGS), one case by alveolar lavage fluid tNGS, and one case by cerebrospinal fluid metagenomic next-generation sequencing (mNGS). Routine blood cultures of 19 cases were negative. All 26 patients presented with chills and fever, 21 cases (80.8%) with headache, 19 cases (73.1%) with fatigue, 14 cases (53.8%) with generalized aches and pains, 12 cases (46.2%) with poor appetite, and 14 cases (53.8%) with cough. Twenty-four cases had concurrent hepatitis, 12 cases had pneumonia, one had encephalitis, and 19 cases had myocardial damage. The laboratory tests showed that 23 cases (88.5%) had normal white blood cell count, eight cases (30.8%) had decreased platelet count, 25 cases (96.2%) had C-reactive protein elevated, 24 cases (92.3%) had procalcitonin elevated, 14 out of 17 cases had elevated erythrocyte sedimentation rate, and 19 cases had elevated D-dimer levels. Liver function tests showed that alanine aminotransferase increased in 24 cases (92.3%) (all less than 10 times of upper limit of normal (ULN)), aspartate aminotransferase increased in 23 cases (88.5%) (all less than 10 times of ULN), alkaline phosphatase increased in 10 cases (38.5%)(all less than two times of ULN), and γ-glutamyl transpeptidase increased in 19 cases (73.1%), which were all less than 10 times of ULN. Myocardial enzymes were detected in 21 cases, of which seven cases (33.3%) had elevated lactate dehydrogenase and 12 cases (57.1%) had elevated hydroxybutyrate dehydrogenase (all less than three times of ULN). In terms of treatment, 16 cases were treated with doxycycline alone, and nine cases were treated with doxycycline combined with azithromycin or quinolones or rifampicin, and one with tigecycline. After treatment, the conditions of patients improved. The overall length of hospital stay was (7.7±5.0) d, and that of eight patients treated with doxycycline combined with quinolones or azithromycin was 4.8 to 6.0 days. Conclusions:Acute Q fever often has no clear epidemiological history, and the clinical manifestations and laboratory tests are lack of specificity. qPCR, tNGS, mNGS can provide pathogenic diagnostic evidence for suspected cases. In terms of treatment, doxycycline is the first choice for treatment of acute Q fever, and combined treatment with azithromycin or quinolones could result in a shorter hospital stay.

Objective:To investigate the clinical practicability of positive end-expiratory pressure (PEEP) titrated by lung stretch index (SI) in patients with acute respiratory distress syndrome (ARDS).Methods:A parallel randomized controlled trial was conducted. Patients with moderate to severe ARDS who required mechanical ventilation admitted to the department of critical care medicine of General Hospital of the Yangtze River Shipping from August 2022 to February 2023 were enrolled. They were randomly divide into SI guided PEEP titration group (SI group) and pressure-volume curve (P-V curve) inspiratory low inflection point (LIP) guided PEEP titration group (LIP group). All patients were ventilated in a supine position after admission, with the head of the bed raised by 30°. The primary disease was actively treated, prone position ventilation for 12 h/d, and lung protective ventilation strategies such as controlled lung expansion were used for lung recruitment. On this basis, mechanical ventilation parameters were titrated with SI in the SI group; the LIP group titrated mechanical ventilation parameters with P-V curve inspiratory LIP+2 cmH 2O (1 cmH 2O ≈ 0.098 kPa). The oxygenation index (PaO 2/FiO 2), and respiratory mechanics indicators such as lung dynamic compliance (Cdyn), peak airway pressure (Pip) were monitored before recruitment maneuver and after 1, 3, and 5 days of treatment. The therapeutic effect of the two groups was compared. Results:There were 41 patients in the SI group and 40 patients in the LIP group. There was no significant difference in general information such as gender, age, and disease type between the two groups. The mechanical ventilation time and the length of intensive care unit (ICU) stay in the SI group were significantly shorter than those in the LIP group (days: 9.47±3.36 vs. 14.68±5.52, 22.27±4.68 vs. 27.57±9.52, both P < 0.05). Although the 28-day mortality of the SI group was lower than that of the LIP group, the difference was not statistically significant [19.5% (8/41) vs. 35.0% (14/40), P > 0.05]. On the fifth day, the PaO 2/FiO 2 was higher in SI group [mmHg (1 mmHg≈0.133 kPa): 225.57±47.85 vs. 198.32±31.59, P < 0.05], the Cdyn was higher in SI group (mL/cmH 2O: 47.39±6.71 vs. 35.88±5.35, P < 0.01), the Pip was lower in SI group (mmHg: 35.85±5.77 vs. 43.87±6.68, P < 0.05). The Kaplan-Meier survival curve showed no statistically significant difference in the 28 days cumulative survival rate between the two groups (Log-Rank: χ2 = 2.348, P = 0.125). Conclusion:The application of SI titration with PEEP in the treatment of ARDS patients may improve their prognosis.