Objective:To understand the current knowledge, attitude, and practice (KAP) on influenza and influenza vaccine among pregnant women in Suzhou and to analyze its influencing factors to provide technical support data for public health strategies for promoting influenza vaccination in pregnant women.Methods:A questionnaire was designed, and a stratified sampling method was used to conduct a face-to-face survey among pregnant women at different stages of pregnancy who received antenatal examinations at different levels of medical institutions in Suzhou, Jiangsu Province, in 2023. KAP status and influencing factors were analyzed by χ2 test and logistic regression analysis. Results:A total of 2 195 valid questionnaires were collected in this survey. The M( Q1, Q3) of knowledge about influenza and influenza vaccine among pregnant women in Suzhou was 7.60 (5.23, 9.80) points, and the score range was 0.20-14.71 points, the passing rate was 34.12%, the awareness rate of influenza vaccine was 57.45%, and the vaccination rate of influenza vaccine was 1.91% within one year before the survey. The willingness to receive influenza vaccine during pregnancy was only 3.57%. Multivariate analysis of influenza and influenza vaccine-related knowledge scores showed that the passing rate was positively correlated with education level and gestational age. In contrast, family income was negatively correlated with living in rural areas, working as migrant workers, and having no medical insurance. Multivariate analysis of vaccination intention showed that decreased effectiveness of influenza vaccine and increased adverse reactions decreased vaccination intention during pregnancy. Conclusions:The pregnant women in Suzhou pay more attention to influenza, and vaccination rates and intentions are generally low. Pregnant women with early and second trimester of pregnancy, low education, living in rural areas, working as migrant workers, and not purchasing medical insurance are the key groups to popularize the knowledge about influenza and influenza vaccine.

Objective To explore the clinical characteristics and death factors of elderly male with type 2 diabetes mellitus(T2DM)complicated with coronavirus infectious disease 2019(COVID-19).Methods A total of 55 hospitalized elderly male T2DM patients with COVID-19 were enrolled in this study from December 2022 to February 2023.All the patients were divided into survival group(n=32)and death group(n=23).The clinical indicators were compared between the two groups and evaluated by multifactor analysis to clarify their clinical characteristics and death risk factors.Results Age,T2DM duration,C-RP,procalcitonin,serum creatinine,creatine kinase,myoglobin,BNP,troponin,D-dimer,FPG and HbA1c were higher(P＜0.05 or(P＜0.01),while lymphocyte count and PaO2 were lower(P＜0.05)in death group than in survival group.The advanced age,C-RP,procalcitonin,serum creatinine,troponin,BNP,D-dimer,increase of FPG and HbA1c,and the reduction of lymphocyte count and PaO2 were risk factors for death(P＜0.05).Conclusion Age,blood glucose control,cardiac renal and pulmonary functions,and risk of thrombosis in elderly male T2DM with COVID-19 have important significance inevalu-ating the prognosis.

Objective:To identify the pathogens isolated in the subperiosteal abscesses from the pediatric patients with acute osteomyelitis and to investigate the characteristics of bacterial drug resistance.Methods:A retrospective study was conducted on children with acute septic osteomyelitis who were hospitalized in the Children's Hospital, Zhejiang University School of Medicine from January 1, 2011 to March 1, 2018. The results of bacterial cultures isolated from the subperiosteal abscesses or bone marrow fluid were collected. The Merier automatic bacterial identification system (i.e., Vitek) was used to identify the bacteria and to assess the drug sensitivity.Results:(1) A total of 104 pediatric patients were included and 60 (57.7%) were male. Sixty-six strains of pathogens were isolated from 65 patients (62.5%). Among them, 53 strains (51.0%) were Staphylococcus aureus; 3 strains were Escherichia coli; 2 strains (1.9%) were Pseudomonas aeruginosa; 2 strains (1.9%) were Streptococcus pneumoniae, 2 strains (1.9%) were Ochrobactrum anthropi, and 4 strains (3.8%) were other bacteria. Pathogens were not found in 39 patients (37.5%). (2) Staphylococcus aureus accounted for 81.5% (53/65) of the pathogen-positive cases. Among them, 23 strains (43.4%) were methicillin-resistant Staphylococcus aureus (MRSA). Aureus-positive children were statistically significantly older ( P=0.028), heavier ( P=0.040) and had higher C-reactive protein (CRP) level ( P=0.038) than the aureus-negative children. (3) All the 53 Staphylococcus aureus strains were resistant to penicillin and 56.6% of them were only sensitive to benzocillin. The resistance rates to compound sulfamethoxazole, tetracycline, clindamycin and erythromycin were 11.3%, 30.2%, 67.9% and 69.8%, respectively. The sensitivity rate of the strains to furantoin was 90.2%. All strains were sensitive to quinupristin/dalfopristin, linezolid, rifampicin, tigecycline, levofloxacin, moxifloxacin, ciprofloxacin and vancomycin. There was 69.8% of the strains resistant to three or more different types of antibiotics. Conclusions:Staphylococcus aureus is the most common pathogen that causes the acute septic osteomyelitis in children, and the resistance rate to Benzocillin is relatively high. Therefore, Benzocillin and Clindamycin, as the traditionally-used drugs, should not be considered as the first choice when empirically using intravenous antibiotics. In the present study, pathogens in 39 patients (37.5%) were not detected in their subperiosteal abscesses or bone marrow fluid, so further effort should be made to investigate the etiology of these patients.

Objective:To explore the clinical efficacy of disease-modifying drug nusinersen on children with spinal muscular atrophy.Methods:The baseline and longitudinal clinical data of 15 children who were treated with nusinersen in the Children′s Hospital, Zhejiang University School of Medicine from October 2019 to October 2021 were retrospectively collected. The general data (gender, age, genotype, and clinical classification, etc.), motor function, nutritional status, scoliosis and respiratory function were analyzed. Wilcoxon rank-sum test was used for comparing multi-system conditions before and after treatment.Results:The age of 15 cases (7 males, 8 females) was 6.8 (2.8, 8.3) years, with 2 cases of type 1, 6 cases of type 2, and 7 cases of type 3 respectively, and the course of disease was 55.0 (21.0, 69.0) months. After 9.0 (9.0, 24.0) months of treatment, the motor function scale evaluations of the Hammersmith neurological examination section 2 (13.0 (7.0, 23.0) vs. 18.0 (10.0, 25.0) scores, Z=-2.67, P=0.018) of 15 children, the Hammersmith functional motor scale expanded (38.0 (18.5, 45.5) vs. 42.0 (23.0, 51.0) scores, Z=-2.38, P=0.018), and the revised upper limb module (27.0 (19.5, 32.0) vs. 33.0 (22.5, 35.5) scores, Z=-2.52, P=0.012) of children with type 2 and 3 had significantly improved. Thirteen patients achieved clinically significant motor function improvement, and 2 of them had kept stable scale scores. Subjective reports also indicated that the muscle strength and daily exercise ability of these children improved after treatment, and no serious adverse reactions were reported. Supplemented by the multi-disciplinary team management, the levels of some indicators such as Cobbs angle of scoliosis and forced vital capacity all had significantly improved (all P<0.05). Conclusions:Nusinersen can improve the motor function of patients with 5q spinal muscular atrophy, which is also proved safe to be used in children. The drug treatment supplemented by the multi-disciplinary team management is helpful to improve the multi-system function of the children with spinal muscular atrophy.

OBJECTIVE：To study the co rrelation of the chro maticity value of Schizonepeta tenuifolia charcoal of different processing time（0-40 min，similarly herein after）with multiple indicators ，and to reveal the quality change law of S. tenuifolia charcoal during processing and confirm the terminal time. METHODS ：The contents of ethanol-soluble extracts from S. tenuifolia charcoal decoction pieces of different processing time were determined. UPLC fingerprint of S. tenuifolia decoction pieces and S. tenuifolia charcoal decoction pieces of different processing time were established ，and the similarity evaluation was also conducted. The chromatographic peaks were confirmed by comparison with substance control. The same UPLC conditions were used to determine the contents of index components （hesperidin，rosmarinic acid ，menthone）in S. tenuifolia charcoal decoction pieces of different processing time. The colorimetric method was used to measure the chromaticity value of S. tenuifolia charcoal decoction pieces of different processing time. Meanwhile ，sample of processing 0 min was used as a control to calculate the total color value （E）and the total color difference value （ΔE）. Pearson correlation analysis ，cluster analysis and orthogonal partial least squares discriminant analysis （OPLS-DA）were performed on the ethanol-soluble extracts ，index component contents ，chromatographic peak area and chromaticity value. The terminal time of processing S. tenuifolia charcoal was conf irmed，and validation test was also conducted. RESULTS ：With the extension of processing time ， the content of ethanol-soluble extract in S. tenuifolia charcoal qq.com decoction pieces gradually decreased. A total of 17 chromato- graphic peaks were identified in 12 batches of S. tenuifolia decoction piece ，and its si milarity with the control fingerprint was greater than 0.9. 21 chromatographic peaks were identified in S. tenuifolia charcoal decoction pieces of different processing time，and its similarity with the chromatogram of sample of processing 0 min decreased with the processing time ，and the similarity after 18 min was lower than 0.9. The chromatographic peak 9 was hesperidin ，peak 10 was rosmarinic acid and peak 17 was menthone. The determination of content and chromaticity value showed that with the extension of processing time ，the contents of hesperidin ，rosmarinic acid and menthone decreased gradually ；the color L，b and E values of S. tenuifolia charcoal decoction piece powder decreased gradually ，and the a and ΔE values increased gradually. Pearson correlation analysis showed that the contents of ethanol-soluble extract ，hesperidin，rosmarinic acid and menthone ，the peak areas of 15 chromatographic peaks （peak 2，7-15，17-21）were significantly positively correlated with E value（P＜0.01）；the peak areas of 5 chromatographic peaks （peak 1，3-6）were significantly negatively correlated with E value（P＜0.01），but peak area of peak 16 was not related to E value（P＞ 0.05）. Results of cluster analysis showed that S. tenuifolia charcoal decoction pieces of different processing time were divided into 2 categories；the first category was processed for 0-16 min，and the second category was processed for 18-40 min. The results of OPLS-DA showed that the VIP values of peak 6 area（2.800 75），L value（2.327 54），peak 3 area（1.793 39），b value（1.735 78） and peak 5 area（1.244 04）were greater than 1. The final processing time of S. tenuifolia charcoal was 18 min. The results of validation experiment showed that the L，a and b values of S. tenuifolia charcoal decoction piece were 20.22-22.00，4.44-7.67， 9.78-13.00，and ΔE were 13.50-14.12，respectively. CONCLUSIONS ：The chromaticity value of S. tenuifolia charcoal decoction pieces of different processing time is closely related to the contents of ethanol-soluble extract ，hesperidin，rosmarinic acid ， menthone and the area of 20 chromatographic peaks. It is suggested that the terminal time of processing S. tenuifolia is 18 min.

Solar energy, which is essential for the origin and evolution of all life forms on Earth, can be objectively recorded through attributes such as climatic ambient temperature (CAT), ultraviolet radiation (UVR), and sunlight duration (SD). These attributes have specific geographical variations and may cause different adaptation traits. However, the adaptation profile of each attribute and the selective role of solar energy as a whole during human evolution remain elusive. Here, we performed a genome-wide adaptation study with respect to CAT, UVR, and SD using the Human Genome Diversity Project-Centre Etude Polymorphism Humain (HGDP-CEPH) panel data. We singled out CAT as the most important driving force with the highest number of adaptive loci (6 SNPs at the genome-wide 1 × 10-7 level;401 at the suggestive 1 × 10-5 level). Five of the six genome-wide significant adaptation SNPs were successfully replicated in an independent Chinese population (N = 1395). The corresponding 316 CAT adaptation genes were mostly involved in development and immunity. In addition, 265 (84％) genes were related to at least one genome-wide associationstudy (GWAS)-mapped human trait, being significantly enriched in anthropometric loci such as those associated with body mass index (x2;P<0.005), immunity, metabolic syndrome, and cancer (x2;P<0.05). For these adaptive SNPs, balancing selection was evident in Euro-Asians, whereas obvious positive and/or purifying selection was observed in Africans. Taken together, our study indicates that CAT is the most important attribute of solar energy that has driven genetic adaptation in development and immunity among global human populations. It also supports the non-neutral hypothesis for the origin of disease-predisposition alleles in common diseases.

Objective To investigate the effect of SVV guided fluid therapy on blood gas and lipopolysaccharide (LPS),procalcitonin (PCT) in patients undergoing resection of gastrointestinal tumor.Methods Sixty patients aged 60 85 years from Jan,2016 to Feb,2017 falling into ASA physical status Ⅱ or Ⅲ,scheduled for elective radical operations for gastrointestinal cancers,were includ ed and randomly divided into two groups (n =30 each) using a random number table:ScvO2 guided fluid therapy (group C),SVV guided fluid therapy (group G).MAP,HR and CVP of patients were recorded at the same time before anesthesia (T0),tumor removal (T1) and the end of surgery (T2)respectively.PH,BE,HCO3-and Lac of venous blood samples and artery blood samples at T0-T2,6 hours after surgery(T3) were recorded.Venous blood samples were collected at T0,T3 to detect LPS and PCT.Crystalloid requirements,colloid requirements,total volume,bleeding volume,peritoneal fluid volume and the use of dopamine were recorded.The time of PACU,time when the patients first exhausted and was fed after operation,length of hospital stay after operation were recorded.Results Compared with group C,BE of artery blood was obviously increased at T2,T3 in group G (P＜0.05);the Lac of artery at T2 and the Lac of artery and venous blood at T3 in group G was obvi ously decreased.LPS and PCT were decreased at T3 in group G (P＜0.05).Compared with group C,the needed colloid was increased in group G,the needed crystalloid and total volume of fluid infused were decreased in group G (P＜0.05).Compared with group C,the time of PACU starting to exhaust and feed,length of hospital was shortened in group G (P＜0.05).Conclusion SW guided goal directed fluid therapy is more conductive to maintain the acid base and reduce the incidence of in fection for the patients with gastrointestinal tumor operation,promote the recovery of gastrointestinal function and decrease the length of hopital after operations.

Objective To analyze the imaging features of ground-glass opacity (GGO) and provide advice for early diagnosis and treatment of malignant lung lesions.Methods The imaging findings of 56 GGOs scanned by MSCT on thin layer scanning were analyzed by χ2 test.Multivariate Logistic regression analysis was performed of the statistically significant variables for univariate analysis.Results Smoothness of the boundary, uniformity of the internal density, and spiculated margin of the GGO lesions were closely related to the diagnosis of malignant lesions.However,size,shape and distribution of the lesions were limited.Conclusion The distribution of GGO(internal, middle and outer band), border, internal density and spiculation are playing important role in early diagnosis of benign and malignant GGO.

Objective To investigate the risk factors of nosocomial infections in patients with head and neck cancer during radiotherapy .Methods Clinical data of 189 patients with head and neck cancer receiving radiotherapy in Huzhou Central Hospital during August 2011 and December 2014 were retrospectively studied .Chi-square test and multivariate Logistic regression analysis were performed to explore the risk factors of nosocomial infections in patients during radiotherapy .Results Among 189 patients with head and neck cancer receiving radiotherapy , nosocomial infection was observed in 64 (33.86%) patients.Univariate analysis showed that radiation-induced oral mucositis (χ2 =11.47, P<0.01), underlying disease (χ2 =6.59, P<0.05), stage of tumor Ⅲ-Ⅳ (χ2 =4.36, P<0.05), whole-neck radiation (χ2 =7.64, P <0.05), dose of radiation ≥50 Gy(χ2 =8.92, P <0.05), combined chemotherapy (χ2 =6.53, P<0.01), invasive operation (χ2 =4.21, P<0.05), PS score=1 (χ2 =3.58, P<0.05) and low body mass index (χ2 =9.56, P <0.05) were risk factors of nosocomial infections . Multivariate Logistic regression analysis indicated that radiation-induced oral mucositis ( OR=3.46, χ2 =8.72, P<0.01),underlying disease (OR=1.91, χ2 =4.66, P<0.05), stage of tumor Ⅲ-Ⅳ (OR=2.01,χ2 =5.22, P<0.05), whole-neck radiation (OR=1.78,χ2 =4.89, P<0.05), dose of radiation ≥50 Gy (OR=1.69,χ2 =3.25, P<0.05), combined chemotherapy (OR=1.84, χ2 =6.91, P<0.05) and low body mass index (OR=1.53, χ2 =2.59, P<0.05) were independent risk factors of nosocomial infection.Conclusions Nosocomial infections are popular in patients with head and neck cancer during radiotherapy.Radiation-induced oral mucositis, underlying disease, stage of tumor, radiation field, dose of radiation, combined chemotherapy and body mass index are associated with the occurrence of nosocomial infections in these patients .

Post competency is a kind of necessary ability for professional working.In order to train the students' excellent professional skills,we have conducted exploration and reform in post competency oriented experiment teaching,through reforming experimental courses,changing teaching methods and means of examination,constructing the laboratory etc.,so that we have built a new professional training model in pathological diagnosis and technology specialty experimental teaching.The experimental teaching reform results have improved the experimental teaching quality and the talents capability.