Objective:To investigate the association between frailty and prognosis of elderly patients in the emergency department, and to validate frailty screening tools suitable for the emergency department.Methods:This was a prospective cohort study. Clinical data of elderly patients over 60 years old treated in the emergency department of Beijing Bo'Ai Hospital from January to December 2021 were collected. The Frailty Screening Questionnaire (FSQ), FRAIL Scale (FRAIL) and Clinical Frailty Scale (CFS) were used to score patients, and patients were divided into frail or non-frail group according to the criteria of the above three scales. Twelve-month all-cause mortality was the primary endpoint, dependence and re-admission to the emergency department within 12 months were secondary outcomes. Receiver operating characteristic curves were used to evaluate the ability of the FSQ, FRAIL and CFS scores to predict the primary and secondary endpoints, and the areas under the curve (AUC) were calculated and compared. Survival analysis was performed using Cox hazard proportional regression model, and relative risk was expressed as hazard ratio ( HR) and 95% CI. Results:A total of 406 patients were included in the study. The AUCs (95% CI) of FSQ, FRAIL and CFS scores for predicting 12-month all-cause mortality were 0.879 (0.844-0.909), 0.838 (0.798-0.872), 0.906 (0.873-0.933), respectively (all P<0.001). The AUCs of 3 scores for predicting secondary endpoints ranged from 0.820 to 0.889 (all P<0.001). Pairwise comparisons of the AUCs showed that the CFS was superior to one or both of the other frailty screening scales in predicting 12-month all-cause mortality and dependence except for re-admission to emergency room within 12 months after discharge (all P<0.05). Cox regression analysis revealed that, after adjusting for sex, age, body mass index and comorbidities, frailty as defined by the FSQ, FRAIL, and CFS scales was independently associated with 12-month all-cause mortality, with the HRadj of 3.267 (95% CI: 2.406-4.435), 2.465 (95% CI: 1.819-3.341), 3.523 (95% CI: 2.648-4.687), respectively (all P<0.001). Conclusions:FSQ, FRAIL and CFS scores can predict adverse outcomes, the CFS is a practical frailty screening tool in the emergency department, and frailty screening can improve the risk stratification of older patients.

A sandglass ladder residual network(SLRN)is proposed for multi-label chest X-ray classification,thereby improving the accuracy of clinical diagnosis.SLRN consists of 3 key modules:(1)a sandglass convolutional module to simultaneously extract inter-channel and spatial information;(2)a ladder self attention block to achieve different window divisions through shift operations,expand the receptive field,and realize multi-scale feature extraction and fusion;(3)class specific residual attention in the multi-label classification stage to capture the correlation between different labels and the importance of features for accomplishing more accurate classification by adjusting the weights of different features.The proposed model is validated using the IU X-Ray dataset collected by Indiana University and the publicly available Chest X-Ray14 dataset collected by the National Institutes of Health in the United States;and the results demonstrate that SLRN which combines the advantages of convolutional neural network and vision transformer enables the capture of local features and global correlations in images,better handles long-distance dependencies,and assists doctors in clinical diagnosis.

Objective The aim of this study was to analyze the incidence,mortality,and epidemiological trends of malignant tumors in the cancer registration areas of Qinghai Province and provide a reference for the prevention and control strategies and meas-ures of malignant tumors.Methods According to the quality control standards for cancer registration,the data on malignant tumor in-cidence and mortality from 8 national cancer registration areas in Qinghai Province from 2014 to 2021 were collated.The crude inci-dence/mortality,age-standardized incidence/mortality rate by Chinese standard population(ASIRC/ASMRC)and World standard population(ASIRW/ASMRW),the cumulative rates(0-74 years old),and the age-specific incidence/mortality of malignant tumors were calculated for different sexes and regions.The Joinpoint 4.9.0.0 software was used to calculate the average annual percentage change(AAPC)and conduct trend analysis.Results The crude incidence of malignant tumors in the cancer registration areas of Qinghai Province from 2014 to 2021 was 221.25/100,000(243.31/100,000 for males and 198.68/100,000 for females),the ASIRC was 199.48/100,000(229.13/100,000 for males and 173.34/100,000 for females),the ASIRW was 196.38/100,000(228.32/100,000 for males and 167.97/100,000 for females).The cumulative rate for those aged 0-74 years was 21.57％;the crude mortali-ty of malignant tumors was 131.90/100,000(163.86/100,000 for males and 99.20/100,000 for females),the ASMRC was 121.07/100,000(157.33/100,000 for males and 87.45/100,000 for females),the ASMRW was 120.53/100,000(157.54/100,000 for males and 86.31/100,000 for females),and the cumulative rate for those aged 0-74 years was 12.79％.The crude incidence,ASIRC,ASIRW,crude mortality,ASMRC and ASMRW were all higher in males than those in females.Both the crude incidence and mortality of malignant tumors increased with age.The crude incidence rate increased rapidly after age 45,peaked in the 80-84 age group(2,352.29 per 100,000),and declined slightly in the 85+age group.The crude mortality increased rapidly after age 50,peaked in the 85+age group(2,305.44 per 100,000).The crude incidence(AAPC=5.68％,95％CI:3.48％-7.93％,P＜0.05)and erude mortality(AAPC=3.67％,95％CI:2.44％-4.91％,P＜0.05)of malignant tumors showed an overall upward trend from 2014 to 2021.The ASIRC(AAPC=-0.12％,95％CI:-3.70％-3.59％,P＞0.05)remained stable,while the ASMRC(AAPC=-2.81％,95％CI:-3.28％--2.03％,P＜0.05)showed a downward trend.The top five malignant tumors in terms of crude incidence were stom-ach cancer,lung cancer,liver cancer,female breast cancer,and cervical cancer,respectively;the top five malignant tumors in terms of crude mortality were stomach cancer,lung cancer,liver cancer,esophagus cancer,and colorectal cancer,respectively.Conclusion From 2014 to 2021,the incidence and mortality of malignant tumors in the Qinghai Province cancerregistration areas showed an in-creasing trend,with higher rates in males than those in females.It is recommended that targeted prevention and control measures should be implemented for people aged 45 and older,with stomach cancer,liver cancer,and cervical cancer as key cancers.

Objective The aim of this study was to analyze the incidence,mortality,and epidemiological trends of malignant tumors in the cancer registration areas of Qinghai Province and provide a reference for the prevention and control strategies and meas-ures of malignant tumors.Methods According to the quality control standards for cancer registration,the data on malignant tumor in-cidence and mortality from 8 national cancer registration areas in Qinghai Province from 2014 to 2021 were collated.The crude inci-dence/mortality,age-standardized incidence/mortality rate by Chinese standard population(ASIRC/ASMRC)and World standard population(ASIRW/ASMRW),the cumulative rates(0-74 years old),and the age-specific incidence/mortality of malignant tumors were calculated for different sexes and regions.The Joinpoint 4.9.0.0 software was used to calculate the average annual percentage change(AAPC)and conduct trend analysis.Results The crude incidence of malignant tumors in the cancer registration areas of Qinghai Province from 2014 to 2021 was 221.25/100,000(243.31/100,000 for males and 198.68/100,000 for females),the ASIRC was 199.48/100,000(229.13/100,000 for males and 173.34/100,000 for females),the ASIRW was 196.38/100,000(228.32/100,000 for males and 167.97/100,000 for females).The cumulative rate for those aged 0-74 years was 21.57％;the crude mortali-ty of malignant tumors was 131.90/100,000(163.86/100,000 for males and 99.20/100,000 for females),the ASMRC was 121.07/100,000(157.33/100,000 for males and 87.45/100,000 for females),the ASMRW was 120.53/100,000(157.54/100,000 for males and 86.31/100,000 for females),and the cumulative rate for those aged 0-74 years was 12.79％.The crude incidence,ASIRC,ASIRW,crude mortality,ASMRC and ASMRW were all higher in males than those in females.Both the crude incidence and mortality of malignant tumors increased with age.The crude incidence rate increased rapidly after age 45,peaked in the 80-84 age group(2,352.29 per 100,000),and declined slightly in the 85+age group.The crude mortality increased rapidly after age 50,peaked in the 85+age group(2,305.44 per 100,000).The crude incidence(AAPC=5.68％,95％CI:3.48％-7.93％,P＜0.05)and erude mortality(AAPC=3.67％,95％CI:2.44％-4.91％,P＜0.05)of malignant tumors showed an overall upward trend from 2014 to 2021.The ASIRC(AAPC=-0.12％,95％CI:-3.70％-3.59％,P＞0.05)remained stable,while the ASMRC(AAPC=-2.81％,95％CI:-3.28％--2.03％,P＜0.05)showed a downward trend.The top five malignant tumors in terms of crude incidence were stom-ach cancer,lung cancer,liver cancer,female breast cancer,and cervical cancer,respectively;the top five malignant tumors in terms of crude mortality were stomach cancer,lung cancer,liver cancer,esophagus cancer,and colorectal cancer,respectively.Conclusion From 2014 to 2021,the incidence and mortality of malignant tumors in the Qinghai Province cancerregistration areas showed an in-creasing trend,with higher rates in males than those in females.It is recommended that targeted prevention and control measures should be implemented for people aged 45 and older,with stomach cancer,liver cancer,and cervical cancer as key cancers.

A sandglass ladder residual network(SLRN)is proposed for multi-label chest X-ray classification,thereby improving the accuracy of clinical diagnosis.SLRN consists of 3 key modules:(1)a sandglass convolutional module to simultaneously extract inter-channel and spatial information;(2)a ladder self attention block to achieve different window divisions through shift operations,expand the receptive field,and realize multi-scale feature extraction and fusion;(3)class specific residual attention in the multi-label classification stage to capture the correlation between different labels and the importance of features for accomplishing more accurate classification by adjusting the weights of different features.The proposed model is validated using the IU X-Ray dataset collected by Indiana University and the publicly available Chest X-Ray14 dataset collected by the National Institutes of Health in the United States;and the results demonstrate that SLRN which combines the advantages of convolutional neural network and vision transformer enables the capture of local features and global correlations in images,better handles long-distance dependencies,and assists doctors in clinical diagnosis.

Objective:To analyze the epidemiological characteristics of respiratory syncytial virus (RSV) among children in Hebei from 2019 to 2023.Methods:A total of 46 576 lower respiratory tract specimens were collected from hospitalized children in the Children′s Hospital of Hebei Province from 2019 to 2023. Multiple RT-PCR and capillary electrophoresis were used to detect 13 common respiratory pathogens in the specimens, and the results were statistically analyzed.Results:The overall positive rate of RSV was 18.76%(8 739/46 576). The overall positive rates of RSV in male and female children were 18.84%(5 174/27 462) and 18.65%(3 565/19 114), respectively, showing no statistically significant difference between genders (χ 2=0.916, P=0.339). A linear relationship was found between the positive rate of RSV and age ( P<0.01). There was a significant difference in the positive rates of RSV in different years (χ 2=723.71, P<0.01). The positive rate of RSV peaked in the period from December to February from 2019 to 2021. In 2019 and 2020, the positive rates of RSV were very low from May to October, while the positive rate of RSV was above 10% throughout the whole year of 2021 and small off-season epidemics occurred in May and August. The positive rate of RSV was low in 2022, and no significant seasonal change was observed. The rate of RSV infections peaked from April to June in 2023. There were significant differences in the rates of RSV infections before, during and after the COVID-19 epidemic in each age group ( P<0.01). The rate of mixed infections was 29.20%(2 522/8 739), and the most common other respiratory pathogen was human rhinovirus (52.29%, 1 342/2 552 ). Conclusions:RSV is a common pathogen causing respiratory tract infections in children in Hebei, especially in children under 3 years old. After the COVID-19 epidemic, there are off-season RSV epidemics. Given the variations in the epidemiological features of RSV, it is necessary to carry out continuous monitoring of RSV to provide scientific data for the prevention and control of related diseases.

Objective:To investigate the epidemiological characteristics of human parainfluenza virus (HPIV) in hospitalized children with acute respiratory tract infection in Hebei region, providing reference for the diagnosis and prevention of children with respiratory tract infection.Methods:A retrospective analysis was performed on 20 577 children hospitalized with acute respiratory tract infection in Hebei Children′s Hospital from January 2022 to September 2023. Multiple PCR and capillary electrophoresis were used to detect HPIV and 12 other common respiratory viruses and atypical pathogens. The data from January to September 2022 were taken as the normalized epidemic prevention and control period, and the data from January to September 2023 were taken as the normalized epidemic control period. The epidemiological characteristics of HPIV were analyzed.Results:The overall HPIV-positive rate was 13.65% (2 808/20 577). There was no statistical difference in the total detection rate of HPIV [14.24%(1 236/8 679) and 14.35%(1 447/10 087)] at the same time before and after the novel coronavirus normalization prevention and control was lifted(χ 2= 0.041, P=0.839), while the detection rate of single infection [8.96%(778/8 679) and 7.58%(765/10 087)] decreased, while mixed infection [5.28%(458/8 679) and 6.76%(682/10 087)] increased, with statistically significant differences(χ 2= 11.776 and 18.008, P<0.01). The HPIV positive rate in the <1 year [18.53%(378/2 040) and 17.08%(369/2 161)] decreased after the release of normalized prevention and control, and the difference was statistically significant(χ 2= 5.932, P<0.05). The HPIV positive rate [13.03%(382/2 932) and 14.82%(529/3 570)] in the 3-5 years increased after the normalized prevention and control was lifted, and the difference was statistically significant(χ 2= 7.177, P<0.05). The rate of mixed infection of HPIV with other respiratory pathogens was 43.13% (1 211/2 808), among which double infection was 34.40% (966/2 808), triple infection was 7.55% (212/2 808), and quadruple infection was 1.18% (33/2 808). Mixed detection of HPIV and HRV (38.65%, 468/1 211) was the most common. Conclusions:HPIV is one of the respiratory pathogens in children in Hebei region and more prevalent in spring and summer. The susceptible population of HPIV is mainly children under the age of 3 years old. After the normal prevention and control of novel coronavirus was lifted, the detection rate of HPIV combined with other pathogens increased.

Objective:To investigate the epidemiological characteristics of human parainfluenza virus (HPIV) in hospitalized children with acute respiratory tract infection in Hebei region, providing reference for the diagnosis and prevention of children with respiratory tract infection.Methods:A retrospective analysis was performed on 20 577 children hospitalized with acute respiratory tract infection in Hebei Children′s Hospital from January 2022 to September 2023. Multiple PCR and capillary electrophoresis were used to detect HPIV and 12 other common respiratory viruses and atypical pathogens. The data from January to September 2022 were taken as the normalized epidemic prevention and control period, and the data from January to September 2023 were taken as the normalized epidemic control period. The epidemiological characteristics of HPIV were analyzed.Results:The overall HPIV-positive rate was 13.65% (2 808/20 577). There was no statistical difference in the total detection rate of HPIV [14.24%(1 236/8 679) and 14.35%(1 447/10 087)] at the same time before and after the novel coronavirus normalization prevention and control was lifted(χ 2= 0.041, P=0.839), while the detection rate of single infection [8.96%(778/8 679) and 7.58%(765/10 087)] decreased, while mixed infection [5.28%(458/8 679) and 6.76%(682/10 087)] increased, with statistically significant differences(χ 2= 11.776 and 18.008, P<0.01). The HPIV positive rate in the <1 year [18.53%(378/2 040) and 17.08%(369/2 161)] decreased after the release of normalized prevention and control, and the difference was statistically significant(χ 2= 5.932, P<0.05). The HPIV positive rate [13.03%(382/2 932) and 14.82%(529/3 570)] in the 3-5 years increased after the normalized prevention and control was lifted, and the difference was statistically significant(χ 2= 7.177, P<0.05). The rate of mixed infection of HPIV with other respiratory pathogens was 43.13% (1 211/2 808), among which double infection was 34.40% (966/2 808), triple infection was 7.55% (212/2 808), and quadruple infection was 1.18% (33/2 808). Mixed detection of HPIV and HRV (38.65%, 468/1 211) was the most common. Conclusions:HPIV is one of the respiratory pathogens in children in Hebei region and more prevalent in spring and summer. The susceptible population of HPIV is mainly children under the age of 3 years old. After the normal prevention and control of novel coronavirus was lifted, the detection rate of HPIV combined with other pathogens increased.

With the rapid development of imaging and percutaneous coronary intervention, the application of contrast media has become more and more widespread, and contrast-associated AKI has become one of the most common causes of acute kidney injury. Contrast-associated AKI seriously threatens patients' health and brings greater economic burden to patients, so it is particularly important to prevent the contrast-associated AKI. Nicorandil is a common vasodilator drug in clinical practice, widely used in the treatment of angina pectoris, with the effects of anti-oxidative stress, anti-apoptosis, anti-inflammatory and vasodilation, and is considered to be effective in preventing contrast - associated AKI. However, there is still a lack of further research on the efficacy of nicorandil in preventing contrast-associated AKI.

Objective:To analyze the clinical characteristics of pertussis cases diagnosed by two pathological detection methods: bacterial culture and real-time polymerase chain reaction (RT-PCR), and to explore the applicable value of two pathological detection methods in the diagnosis of pertussis.Methods:Bilateral nasopharyngeal swabs and clinical information of 165 children suspected of pertussis were collected by Hebei Children′s Hospital from April 2019 to January 2020. The bacterial culture and RT-PCR for nasopharyngeal swab specimens were performed in all cases. Chi-square test was used to analyze the cases of pertussis diagnosed by the above two methods.Results:Based on clinical diagnosis, the sensitivity of bacterial culture and RT-PCR for the diagnosis of pertussis was 61.70% (58/94) and 86.17% (81/94), and the specificity was 92.96% (66/71) and 71.83% (51/71), respectively. The positive rate of RT-PCR in children of all ages, seasons and cough courses is higher than that of bacterial culture. Children with pertussis diagnosed by bacterial culture and RT-PCR were basically similar in age, season, and cough course distribution, with the most common cases ≤3 months old, a high incidence trend in summer and autumn, and the course of coughing in children was mostly within 15-21days. The positive rate of bacterial culture in the diagnosis of pertussis in children is affected by the age of the children, and there are statistical differences between children in different age groups (χ2= 11.929, P=0.036). The positive rate of bacterial culture was the highest in children with >3 years old (51.85% [14/27]), followed by children with ≤3 months old (48.72% [19/39]), and the lowest in children with >6-12 months old (15.00% [3/20]). Moreover, the positive rate of bacterial culture in the diagnosis of pertussis in children is also affected by the cough course of the children, and there are statistical differences between children in different cough course groups (χ2=9.841, P=0.020). The positive rate of bacterial culture was the highest in children with cough course 15-21 days (49.23% [32/65]), followed by 43.59% (17/39) in children with cough course 8-14 days, and the lowest in children with cough course of less than 7 days (22.86% [8/35]). Conclusions:Compared with RT-PCR, bacterial culture has lower sensitivity and higher specificity in the detection of pertussis. These two detection methods have their own advantages and limitations. Medical institutions at all levels should comprehensively analyze different laboratory detection methods. Only by combining the two methods can the diagnostic value and level be effectively improved.