ObjectiveTo explore the central neuroregulation mechanism of heat-sensitive moxibustion for knee osteoarthritis on pain relief. MethodsThirty patients who did not have experience of Deqi （得气） during heat-sensitive moxibustion treatment were assigned to the "non-Deqi group"， while another 30 patients who had experience of Deqi were assigned to the "Deqi group". Both groups received moxibustion at the left Heding （EX-LE2） acupoint. In the Deqi group， after the patients experienced sensation of Deqi at the acupoint， moxibustion was applied at approximately 3 cm from the skin for 10 minutes； in the non-Deqi group， moxibustion was also applied at approximately 3 cm from the skin for 10 minutes. Both groups received treatment once daily for 10 consecutive days. Knee joint pain was assessed before and after treatment using the visual analog scale （VAS）. Resting-state functional magnetic resonance imaging （rs-fMRI） scans were performed on all participants before the first treatment session and after the final session on the 10th day. The fractional amplitude of low-frequency fluctuations （fALFF） maps before and after treatment were processed using the SPM12 module by MATLAB. ResultsAfter treatment， VAS scores in both groups were significantly lower than before treatment （P＜0.05 or P＜0.01）， with the Deqi group showing significantly lower VAS scores than the non-Deqi group （P＜0.01）. Compared to before treatment， the Deqi group exhibited significant activation in the prefrontal cortex （t = 6.28）， white matter （t = 6.36）， and left temporal lobe （t = 9.33）， while significant inhibition was observed in the occipital lobe （t = -9.86） and right cerebrum （t = -4.54， P＜0.01）； in the non-Deqi group， significant changes after treatment were observed in the left occipital lobe （t = -6.42）， left medial frontal gyrus （t = -4.35）， left middle frontal gyrus （t = -4.74）， right superior frontal gyrus （t = -4.82）， right superior temporal gyrus （t = -6.61）， and right cerebellar posterior lobe （t = -8.64）， all of which were in inhibited states （P＜0.01）. Compared to the non-Deqi group， the Deqi group exhibited significant activation after treatment in the external nucleus （t = 5.77）， white matter （t = 3.58）， right cerebrum （t = 5.84）， left cerebellum （t = 5.35）， and left cerebrum （t = 4.32）， while significant inhibition was observed in the prefrontal cortex （t = -4.16）， occipital lobe （t = -4.87）， and precentral gyrus （t = -4.46， P＜0.01）. ConclusionsHeat-sensitive moxibustion provides better analgesic effects for knee osteoarthritis under state of Deqi. Its central neuroregulation mechanism may be related to the involvement of the frontal lobe， temporal lobe， occipital lobe， external nucleus， white matter， right cerebrum， left cerebellum， left cerebrum， and precentral gyrus in modulating pain signals.

OBJECTIVES: Whether vortioxetine has a utility as an adjuvant drug in the treatment of bipolar depression remains controversial. This study aimed to validate the efficacy and safety of vortioxetine in bipolar depression. METHODS: Patients with bipolar Ⅱ depression were enrolled in this prospective, two-center, randomized, 12-week pilot trial. The main indicator for assessing treatment effectiveness was a Montgomery-Asberg Depression Rating Scale (MADRS) of ≥50%. All eligible patients initially received four weeks of lurasidone monotherapy. Patients who responded well continued to receive this kind of monotherapy. However, no-response patients were randomly assigned to either valproate or vortioxetine treatment for eight weeks. By comprehensively comparing the results of MADRS over a period of 4‍‒‍12 weeks, a systematic analysis was conducted to determine whether vortioxetine could be used as an adjuvant drug for treating bipolar depression. RESULTS: Thirty-seven patients responded to lurasidone monotherapy, and 60 patients were randomly assigned to the valproate or vortioxetine group for eight weeks. After two weeks of combined valproate or vortioxetine treatment, the MADRS score in the vortioxetine group was significantly lower than that in the valproate group. There was no difference in the MADRS scores between the two groups at 8 and 12 weeks. The incidence of side effects did not significantly differ between the valproate and vortioxetine groups. Importantly, three patients in the vortioxetine group appeared to switch to mania or hypomania. CONCLUSIONS This study suggested that lurasidone combination with vortioxetine might have potential benefits to bipolar II depression in the early stage, while disease progression should be monitored closely for the risk of switching to mania.
Humans ; Bipolar Disorder/drug therapy* ; Vortioxetine/therapeutic use* ; Male ; Female ; Middle Aged ; Adult ; Valproic Acid/administration & dosage* ; Lurasidone Hydrochloride/administration & dosage* ; Prospective Studies ; Treatment Outcome ; Pilot Projects ; Drug Therapy, Combination ; Sulfides/therapeutic use* ; Antidepressive Agents/therapeutic use*

ObjectiveTo understand the epidemiological distribution and gene evolutionary variation of influenza A (H3N2) viruses in Fengxian District, Shanghai, in the surveillance year of 2023, and to provide a reference basis for influenza prevention and control. MethodsThe prevalence of influenza virus in Fengxian District in the 2023 influenza surveillance year (April 2023‒March 2024) was analyzed. The hemagglutinin (HA) gene, neuraminidase (NA) gene, and amino acid sequences of 75 strains of H3N2 influenza viruses were compared with the vaccine reference strain for similarity matching and phylogenetic evolutionary analysis, in addition to an analysis of gene characterization and variation. ResultsIn Fengxian District, there was a mixed epidemic of H3N2 and H1N1 in the spring of 2023, with H3N2 being the predominant subtype in the second half of the year, and Victoria B becoming the predominant subtype in the spring of 2024. A total of 75 influenza strains of H3N2 with HA and NA genes were distributed in the 3C.2a1b.2a.2a.2a.3a.1 and B.4 branches, with overall similarity to the reference strain of the 2024 vaccine higher than that of the reference strain of the 2022 and 2023 vaccine. Compared with the 2023 vaccine reference strain, three antigenic sites and one receptor binding site were changed in HA, with three glycosylation sites reduced and two glycosylation sites added; where as in NA seven antigenic sites and the 222nd resistance site changed with two glycosylation sites reduced. ConclusionThe risk of antigenic variation and drug resistance of H3N2 in this region is high, and it is necessary to strengthen the publicity and education on the 2024 influenza vaccine and long-term monitoring of influenza virus prevalence and variation levels.

Objective To observe the value of ultrasound combined with hematologic tests for diagnosing acute complicated appendicitis.Methods Data of 225 patients with acute appendicitis confirmed by surgery and postoperative pathology were retrospectively analyzed.The patients were divided into acute complicated appendicitis group(complicated group,n=33)and acute uncomplicated appendicitis group(uncomplicated group,n=192)based on operational and post operation pathological findings.Clinical data,hematologic test results and ultrasound findings before operation were compared between groups.Multivariate logistic regression was used to construct a combination model for diagnosing acute complicated appendicitis.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the diagnostic value of predictive factor alone and their combination for diagnosing acute complicated appendicitis,which were then compared with DeLong test.Results Compared with uncomplicated group,patients in complicated group were older,with higher proportion of fever and vomiting,higher level of C reactive protein(CRP)and of neutrophil-to-lymphocyte ratio(NLR),larger external diameters of appendix,also higher proportion of appendiceal intracavitary fecalith and periappendiceal abscess(all P＜0.05).Multivariate logistic regression analysis showed that elevated serum CRP and NLR,increased external diameter of appendix and periappendiceal abscess were all predictive factors of acute complicated appendicitis(all P＜0.05).The diagnostic efficiency of logistic regression model constructed based on the above factors(AUC=0.854)was higher than that of each single predictive factor alone(Z=2.548-4.527,all P＜0.05).Conclusion Ultrasound combined with hematologic tests had high value for diagnosing acute complicated appendicitis.

ObjectiveTo investigate the pathogenic spectrum and epidemiological characteristics of diarrheal disease in Fengxian District of Shanghai, and to provide scientific basis for the prevention and control of diarrheal diseases. MethodsBasic information of the initial adult cases visited diarrheal disease surveillance sentinel hospital in Fengxian District, Shanghai, was collected from August 2013 to 2023, and fecal samples were collected at 1∶5 sampling intervals to isolate and identify 5 kinds of diarrheagenic Escherichia coli (DEC), Salmonella (SAL), Vibrio parahaemolyticus, Campylobacter, Vibrio cholerae, Shigella and Yersinia enterocolitica (YE). Simultaneously, nucleic acid detection was performed for 3 kinds of rotavirus, 2 kinds of norovirus, intestinal adenovirus, astrovirus and sapovirus. ResultsA total of 1 861 cases of newly diagnosed diarrheal disease were reported, with the peak in July to August. Additionally, 704 surveillance samples were detected, with a total positive detection rate of 50.57%. The detection rates of bacterial, viral and mixed infection were 25.14%, 21.02% and 4.40%, respectively. Among the pathogens detected, DEC accounted for the highest (17.61%, 124/704), followed by norovirus (16.48%, 116/704), rotavirus (6.39%, 45/704), SAL (5.97%, 42/704) and Campylobacter (3.84%, 27/704). DEC detected were mainly enteroaggregative Escherichia coli and enterotoxigenic Escherichia coli, with no detection of Vibrio cholerae, Shigella and YE. The highest total pathogen detection rate was observed from June to September, and the detection peaks of norovirus were from March to June and from October to December, whereas that of DEC was from June to October. The detection rate of rotavirus peaked from January to February, but which was not detected between 2020‒2023. The SAL positive rate peak was in September, whereas that of Campylobacter was from July to September. ConclusionThe main pathogens detected in Fengxian District from 2013‒2019 are DEC, norovirus, rotavirus, SAL and Campylobacter. Different pathogens have different detection peaks, with bacteria predominating in summer and viruses in winter and spring. Prevention and control measures should be carried out according to the epidemiological characteristics of different seasons.

Objective To observe the value of ultrasound combined with hematologic tests for diagnosing acute complicated appendicitis.Methods Data of 225 patients with acute appendicitis confirmed by surgery and postoperative pathology were retrospectively analyzed.The patients were divided into acute complicated appendicitis group(complicated group,n=33)and acute uncomplicated appendicitis group(uncomplicated group,n=192)based on operational and post operation pathological findings.Clinical data,hematologic test results and ultrasound findings before operation were compared between groups.Multivariate logistic regression was used to construct a combination model for diagnosing acute complicated appendicitis.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the diagnostic value of predictive factor alone and their combination for diagnosing acute complicated appendicitis,which were then compared with DeLong test.Results Compared with uncomplicated group,patients in complicated group were older,with higher proportion of fever and vomiting,higher level of C reactive protein(CRP)and of neutrophil-to-lymphocyte ratio(NLR),larger external diameters of appendix,also higher proportion of appendiceal intracavitary fecalith and periappendiceal abscess(all P＜0.05).Multivariate logistic regression analysis showed that elevated serum CRP and NLR,increased external diameter of appendix and periappendiceal abscess were all predictive factors of acute complicated appendicitis(all P＜0.05).The diagnostic efficiency of logistic regression model constructed based on the above factors(AUC=0.854)was higher than that of each single predictive factor alone(Z=2.548-4.527,all P＜0.05).Conclusion Ultrasound combined with hematologic tests had high value for diagnosing acute complicated appendicitis.

ObjectiveWe conducted a drug resistance and homology analysis of diarrheagenic Escherichia coli （DEC） in Fengxian District of Shanghai in order to provide a basis for clinical rational drug use， risk monitoring and early warning. MethodsDEC were isolated from diarrheal patients in Fengxian District， Shanghai from 2019 to 2022. The minimum inhibitory concentrations （MIC） of 21 drugs to the DEC were determined. Genotyping and homology analysis were conducted with pulsed-field gel electrophoresis （PFGE）. ResultsThe DEC detection rate of diarrhea cases was 18.99% （131/690）， including enteroaggregative E.coli （EAEC） 64.89% （85/131）， enterotoxigenic E.coli （ETEC） 22.14% （29/131）， enteropathogenic E.coli （EPEC） 12.21% （16/131）， and enterohemorrhagic E.coli （EHEC） 0.76%（1/131）. The DEC detection showed obvious seasonal characteristics with a high incidence in summer. The DEC multidrug resistance rate was 66.41% with a total of 65 drug resistance profiles. The five antimicrobial drugs with the highest resistance rate were ampicillin （60.31%）， nalidixic acid （51.91%）， cefazolin （50.38%）， tetracycline （44.27%）， and cotrimoxazole （35.11%）. The rate of DEC resistance to levofloxacin was significantly increased from 2019 to 2022. Cluster analysis showed that the similarity of 85 EAEC cluster was 58.4%‒100.0%， and 69 band patterns were obtained. The similarity of 29 ETEC cluster was 58.5%‒100.0%， and 13 band patterns were obtained， including 2 dominant band types. The similarity of 16 EAEC clusters was 53.9%‒100.0%， and 15 band patterns were obtained. Five groups of homologous strains were found， consistent with the resistance phenotypes. ConclusionAmong the diarrhea cases， the DEC epidemic intensity is high， the drug resistance situation is severe， and the risk of outbreak infection is high in Fengxian District， Shanghai. Therefore， health monitoring and prevention need to be strengthened.

ObjectiveTo analyze the surveillance status of acute respiratory tract infection pathogens in Fengxian District of Shanghai, and to determine the pathogen spectrum and epidemiological characteristics of acute respiratory tract infection in the district. MethodsCase surveillance data from Fengxian Central Hospital were collected through the Shanghai Integrated Surveillance System for Acute Respiratory Infections, and respiratory specimens were collected from the 50^th week of 2022 to the 49^th week of 2023 for nucleic acid detection of 25 pathogens and bacterial culture testing. Case surveillance data from Fengxian Central Hospital were collected through the National Influenza Sentinel Surveillance System, and respiratory specimens were collected for nucleic acid detection of 5 pathogens. ResultsThe percentage seeking for medical visits of influenza-like illness (ILI) and severe acute respiratory infection (SARI) were 4.74% and 0.81%, respectively, with epidemic peaks in winter and spring. A total of 1 610 samples were detected, among which 354 were SARI cases, whose age of P₂₅ and P₇₅ quartiles were 44 years and 71 years, respectively, with a positive detection rate of 48.31%. Among the 1 256 ILI cases, the age of P₂₅ and P₇₅ quartiles were 21 years and 39 years, respectively. The positive detection rate of pathogens was 65.04% in 123 ILI cases under comprehensive surveillance of respiratory tract infection and 66.11% in 1 133 ILI cases under influenza surveillance. The positive rates of influenza andSARS-CoV-2 in SARI samples were 12.99% and 29.66%, respectively. The positive rates of influenza and SARS-CoV-2 in ILI case samples were 33.20% and 31.53%, respectively. Influenza virus concentrated in the winter and spring. The ILI and SARI cases had the highest positivity rates in the 6‒14 years old group and 15‒24 years old group, respectively. ConclusionThe main pathogens of respiratory tract infection in Fengxian District of Shanghai were SARS-CoV-2 and influenza virus. Special efforts should be made to monitor respiratory disease pathogens in the population under 24 years old, and surveillance of SARI cases aged ≥60 years should be strengthened. The influenza virus and SARS-CoV-2 are alternating, which is different from the past and requires a change in the previous prevention and control strategies.

Objective:To investigate the clinical efficacy and safety of amlodipine besylate and benazepril hydrochloride tablets (II) in the treatment of primary hypertension.Methods:A total of 280 patients with primary hypertension who were treated at Shougang Shuigang Hospital between June 2022 and June 2023 were selected as study subjects. A clinical case-control study was conducted, and the RAND function method was utilized to randomly allocate the subjects into four groups, each receiving a different treatment: amlodipine besylate group (Group A, n = 70), benazepril hydrochloride group (Group B, n = 70), compound formulation amlodipine besylate and benazepril hydrochloride tablets group (Group C, n = 71), and amlodipine besylate plus benazepril hydrochloride group (Group D, n = 69). Relevant therapeutic indicators (blood pressure compliance rate, changes in blood pressure values) and safety indicators (adverse reactions, medication adherence) were observed. Results:The blood pressure compliance rates of Group C and Group D were 91.5% (65/71) and 89.9% (62/69), respectively. There was no statistically significant difference between the two groups ( χ2 = 1.24, P = 0.143), but both were higher than the rates of 77.1% (54/70) and 74.3% (52/70) in Group A and Group B, respectively ( χ2 = 5.68, 4.86, P = 0.004, 0.012). Before treatment, there was no statistically significant difference in systolic and diastolic blood pressure among the four groups of patients (all P > 0.05). After treatment, there was a statistically significant decrease in both systolic and diastolic blood pressure among the four groups compared with their pre-treatment levels (all P < 0.05). Specifically, Group C and Group D exhibited significant reductions in blood pressure following treatment ( t = 4.35, 5.12, 7.25, 5.86, all P < 0.05). Meanwhile, there was no statistically significant difference in systolic blood pressure between Group C and Group D after treatment ( P > 0.05), while diastolic blood pressure was lower in Group C than Group D after treatment ( t = 6.01, P < 0.05). There was a significant downward trend observed in total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels (all P < 0.05). Notably, Group B and Group D reported higher incidences of dry cough, with 15 and 10 cases, respectively, compared with Group A and Group C, which had 1 and 3 cases, respectively. These differences were statistically significant ( χ2 = 4.25, 5.04, both P < 0.05). Furthermore, the treatment compliance rates for Group A, Group B, and Group C were 72.9% (51/70), 71.4% (50/70), and 74.6% (53/71), respectively, all exceeding the 46.4% (32/69) compliance rate of Group D. These differences were also statistically significant ( χ2 = 4.68, 5.24, 4.98, all P < 0.05). Conclusion:The clinical efficacy and safety of the compound formulation amlodipine besylate and benazepril hydrochloride tablets (II) in the treatment of primary hypertension are superior to those of single tablets and combination therapy.

Objective:To analyze the mutation types and distribution characteristics of thalassemia gene among high-risk populations in Sanya City, and to evaluate the effectiveness of blood routine screening, in order to provide scientific basis for formulating measures for prevention and control of thalassemia in Sanya City.Methods:Retrospective analysis was used to collect detection results and clinical data from high-risk individuals who completed genetic screening for thalassemia at Sanya Materal and Child Health Hospital from January 2019 to August 2021. Mutation types and distribution characteristics of thalassemia gene were analyzed, and the missed detection rate and sensitivity of blood routine indicators [mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH)] were evaluated based on the results of genetic screening for thalassemia.Results:A total of 5 760 high-risk individuals were included in the screening results of thalassemia genes, and 3 868 samples of thalassemia gene mutations were detected, with a detection rate of 67.15%. Among them, there were 2 979 samples with α-thalassemia genetic mutations, with a detection rate of 51.72%; including 2 966 common genotype samples (99.56%), the main genotype was αα/-α 3.7 (20.14%, 600/2 979); 13 rare genotype samples (0.44%), 4 cases of αα/-- THAI, 3 cases of α CD40(AAG>AA-)α/αα, 2 cases of α PPα/αα, and 1 case of Fusion gene/αα, Fusion gene/α WSα, α WSα/α PPα, and α CD40(AAG>AA-)α/α WSα each. There were 340 samples with β-thalassemia gene mutations, with a detection rate of 5.90%; including 336 common genotype samples (98.82%). The β CD41/42/β N genotype was dominant (57.65%, 196/340); 4 rare genotype samples (1.18%), β CD5(-CT)/β N, β IVS-Ⅱ-2(-T)/β N, β IVS-Ⅱ-761(-T)/β N and β Initiation(ATG>AGG)/β N 1 case each. There were 549 samples of αβ-compound type thalassemia, with a detection rate of 9.53%. The α missing recombination β CD41/42 genotype was dominant (61.02%, 335/549). There were a total of 4 226 samples that could be traced back to MCV and MCH. Among them, 3 007 samples were found to have mutations in thalassemia genes through screening, 2 584 cases were found to have abnormalities in the combination of MCV and MCH indicators, and 423 samples were missed in blood routine screening, with a missed detection rate of 14.07% (423/3 007). The missed samples were mainly α static type, accounting for 89.13% (377/423) of the total missed samples. The screening sensitivity of MCV combined with MCH for α-, β- and αβ-compound type thalassemia was 82.65%, 98.07% and 98.15%, respectively. Conclusion:The types of genetic mutations in thalassemia in Sanya City are complex and diverse, and there are certain omissions in the blood routine screening of MCV combined with MCH.