Objective: To understand the epidemiological characteristics and disease burden of influenza like illness (ILI) among student populations, so as to provide data support for policy formulation and optimal allocation of health resources. Methods: From January 2024 to February 2025, a questionnaire survey was conducted among parents of kindergarten, primary school, junior and senior high school students in 9 districts of Shenzhen, including Longhua, Futian, Bao an, Longgang, Luohu, Nanshan, Guangming, Pingshan and Yantian. Parents were asked to complete the questionnaire based on whether their children had fever, cough, vomiting, diarrhea, rash and other common symptoms in 2024. A total of 3 537 parents were investigated, and 444 ILI cases were included as study subjects. The epidemiological burden, including incidence rate of influenza, visitation rate, years lived with disability (YLDs) and economic burden (including direct economic burden, indirect economic burden and intangible burden) were analyzed. Results: The incidence rate of influenza among students in Shenzhen in 2024 was 12.55%. The ILI incidence rates in kindergarten, primary school, junior and senior high school were 14.01%, 11.69% and 5.23%, respectively, with a statistically significant difference ( χ 2= 45.20, P <0.01). The ILI consultation rate among students was 85.36%, and the consultation rates in kindergarten (87.36%) and primary school students (84.62%) were higher than those in junior and senior high school students ( 56.52 %) ( χ 2=16.47, P <0.01). A total of 78.88% of cases did not receive etiological detection.The median total economic burden per ILI case was 2 354.62 yuan, including direct medical costs of 300.00 yuan, direct non medical costs of 212.50 yuan, indirect costs of 1 000.00 yuan, and intangible burden of 500.00 yuan. Conclusions Schools are high risk environment for influenza, and younger students are a high risk group for ILI. The disease burden caused by student ILI remains substantial.

Chronic heart failure is the terminal stage of various cardiovascular diseases， and its occurrence and progression are closely associated with impaired myocardial energy metabolism and mitochondrial dysfunction. Mitochondrial dynamics maintain cardiomyocyte energy homeostasis through fusion， fission， and quality control. Disruption of mitochondrial dynamics may lead to mitochondrial network fragmentation， insufficient adenosine triphosphate （ATP） production， enhanced oxidative stress， and activation of ferroptosis. The theory of Yin at peace and Yang being compact originates from the Chapter Discussion on Interrelationship between Life and Nature in the Plain Questions， and emphasizes that the dynamic balance between Yin and Yang is fundamental to normal life activities. According to this theory and mitochondrial dynamics， this paper explores the pathogenic connotations of Yang failing to remain compact and Yin failing to remain at peace in chronic heart failure. In traditional Chinese medicine （TCM）， chronic heart failure is characterized by deficiency in origin and excess in manifestation. Deficiency of heart Qi and Yang is the root， often accompanied by Yang deficiency or Yin deficiency， while blood stasis， phlegm turbidity， and water retention constitute the manifestations. When Yang fails to remain compact， cardiac propulsion becomes weakened and Qi transformation is impaired. When Yin fails to remain at peace， Yin pathogens are generated and Yin essence is consumed. At the microscopic level， imbalance of mitochondrial dynamics is manifested as insufficient mitochondrial fusion， excessive fission， reduced energy production， excessive ROS generation， expansion of the labile iron pool， and accumulation of lipid peroxidation products， which contribute to Yin-Yang imbalance in chronic heart failure. Furthermore， by integrating formula-pattern correspondence and the approach of inferring patterns from formula effects， this paper summarizes the possible molecular phenotypes corresponding to different syndrome elements and syndrome patterns. It further proposes keeping Yang compact and keeping Yin at peace as therapeutic principle for chronic heart failure， aiming to restore energy metabolism homeostasis by regulating mitochondrial dynamics with TCM and to provide new perspectives and ideas for the treatment of chronic heart failure.

OBJECTIVE To explore the effect of failure mode and effect analysis(FMEA)on management of hospi-tal-associated infections(HAIs)in hemodialysis center.METHODS In Nov.2023,the risk priority number(RPN)integrated with action priority(AP)was adopted to identify,analyze and evaluate the risk factors in man-agement of HAIs in hemodialysis center of Tongji Hospital Affiliated to Tongji Medical College,Huazhong Uni-versity of Science and Technology by FMEA method.The high risk points that needed to be taken interventions were screened out,and the targeted measures were formulated to control the risks.At the end of the intervention period,a second round of risk assessment was carried out for improvement status of the high-risk points in Nov.2024,and the effect on the management of HAIs was evaluated.RESULTS The risk assessment was carried out for 48 risk points covering eight aspects,including organizational structure,self-inspection and supervision,staff management,environmental layout,cleaning and disinfection,surveillance,operation procedures and i-tem management.There were 9 risk points with the RPN values greater than 125,3 of which were with the AP value of"H".There were 8 risk points with the RPN value less than 125 and 6 risk points with the AP value drop-ping down to L after the targeted intervention measures were taken,indicating that the risk management has a-chieved favorable effect.CONCLUSIONS The RPN and AP integrated with FMEA can accurately identify the high-risk points in the quality management of the hemodialysis center.It is necessary to take targeted interven-tion measures so as to boost the effect on prevention and control of HAIs in the hemodialysis center and reduce the risk of HAIs in the hemodialysis patients.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective To explore the effectiveness of risk assessment in the prevention and control of central line associated-bloodstream infection(CLABSI),identify high-risk departments and processes,and develop targeted measures to reduce the risk.Methods Healthcare-associated infection control risk assessment form designed by American Association for Professionals in Infection Control and Epidemiology(APIC)was applied to assess the risk factors for CLABSI in 13 intensive care units(ICUs)in a hospital.Each risk indicator was identified,analyzed,and evaluated from three dimensions:the likelihood of risk occurrence,severity of consequences,and integrity of the current management system.Results The risk assessment results found that the general ICU and respiratory ICU had extremely high risk,cardiac surgery ICU and organ transplant ICU had high risk.Through one-year continuous intervention,the incidence of CLABSI decreased significantly,the awareness rate of CLABSI prevention and control measures and the implementation rate of partial measures increased significantly(all P＜0.05).Conclusion The application of risk assessment can screen high-risk departments,focus efforts on the intervention,and enhance the effectiveness of CLABSI risk prevention and control.

Objective To explore the mechanism of the intervention effect of Qizhu Xiaozheng Fang(QZXZF),a representative prescription of Yiqi Jianpi Jiedu(replenishing qi,strengthening spleen,and removing toxicity),in treating HBx-mediated liver cancer stem cells(LCSCs).Methods The Kaplan-Meier survival analysis was used to investigate the effects of Yiqi Jianpi Jiedu on the prognosis of patients with HBV-HCC.The network pharmacology method was utilized to predict the targets and pathways of QZXZF in treating HBx-related LCSCs(HBx-LCSCs).HBx-LCSCs cells were screened by stably transfecting HBx and serum-free culture.The therapeutic effect of QZXZF on HBx-LCSCs was tested in vitro,and its effect on stemness markers and PI3K/Akt pathway was verified by qRT-PCR and Western blot.Results Yiqi Jianpi Jiedu could improve the overall survival time of HBV-HCC patients.Combined with the results of network pharmacology,the mechanism of action of QZXZF against HBx-LCSCs was explored from the PI3K/Akt pathway.Compared with the blank vector group,HBx can promote the expression of stemness markers in HBx-LCSCs cells;compared with the HBx-LCSCs control group,QZXZF could significantly inhibit the proliferation and colony formation of HBx-LCSCs cells(in a concentration-dependent manner),and could reduce the expression of stemness markers(EpCAM,NANOG,SOX2,and OCT4),phosphorylated PI3K(p-PI3K)and phosphorylated AKT(p-AKT)proteins.Conclusion QZXZF may regulate HBx-mediated LCSCs through PI3K/AKT pathways,providing a reference for the mechanism of TCM intervention in LCSCs.

Alzheimer's disease(AD),a progressive dementia,is one of the most common neurodegenerative dis-eases.Clinical trial results of amyloid-β(Aβ)and tau regulators based on the pretext of straightforward amyloid and tau immunotherapy were disappointing.There are currently no effective strategies for slowing the progression of AD.Herein,we spotlight the dysregulation of lipid metabolism,particularly the elevation of ceramides(Cers),as a critical yet underexplored facet of AD pathogenesis.Our study delineates the role of Cers in promoting microglial pyroptosis,a form of programmed cell death distinct from apoptosis and necroptosis,characterized by cellular swelling,and membrane rupture mediated by the NLRP3 inflammasome pathway.Utilizing both in vivo experiments with amyloid precursor protein(APP)/presenilin 1(PS1)transgenic mice and in vitro assays with BV-2 microglial cells,we investigate the activation of microglial pyroptosis by Cers and its inhibition by icariin(ICA),a flavonoid with known antioxidant and anti-inflammatory properties.Our findings reveal a significant increase in Cers levels and pyroptosis markers(NOD-like receptor family,pyrin domain containing 3(NLRP3),apoptosis-associated speck-like protein containing a caspase recruitment domain,caspase-1,gasdermin D(GSDMD),and interleukin-18(IL-18))in the brains of AD model mice,indicating a direct involvement of Cers in AD pathology through the induction of microglial pyroptosis.Conversely,ICA treatment effec-tively reduces these pyroptotic markers and Cer levels,thereby attenuating microglial pyroptosis and suggesting a novel therapeutic mechanism of action against AD.This study not only advances our un-derstanding of the pathogenic role of Cers in AD but also introduces ICA as a promising candidate for AD therapy,capable of mitigating neuroinflammation and pyroptosis through the cyclooxygenase-2(COX-2)-NLRP3 inflammasome-gasdermin D(GSDMD)axis.Our results pave the way for further exploration of Cer metabolism disorders in neurodegenerative diseases and highlight the therapeutic potential of tar-geting microglial pyroptosis in AD.

Background and purpose:With the increasing use of medical imaging examinations,Computed tomography(CT)scans have become one of the primary sources of effective dose.This study analyzed the correlation between radiation dose,image quality and body composition in thyroid CT to provide a data foundation for better control of radiation dose and image quality in the future.Methods:A retrospective analysis was conducted on patients who underwent thyroid CT scans at Fudan University Shanghai Cancer Center from January 2015 to December 2019.CT values and standard deviations(SD)of the homogeneous parenchyma of the thyroid were collected,and CT values and SD values of adjacent subcutaneous fat tissue were measured with the same region of interest(ROI)size.All data were measured three times to obtain the average value,and the volume CT dose index(CTDIvol)and dose-length product(DLP)were recorded.Effective dose values and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)for various parts were calculated.All patients underwent bone density examinations,and patient height,weight,body mass index(BMI),body surface area(BSA),and the percentage of muscle and fat in the spine and thighs were recorded.Results:A total of 104 patients were enrolled in this study.The SNR of thyroid CT images and the percentage of spinal muscle(r=0.284,P=0.004),CNR of thyroid CT images and the percentage of spinal fat(r=0.197,P=0.045),and the effective dose of thyroid CT images and age,weight,BMI,thigh fat percentage,and body surface area(r=0.221,0.247,0.260,0.262,and 0.222;P=0.024,0.011,0.008,0.007 and 0.024)were positively correlated.While,SNR and age,weight,BMI,and the percentage of spinal fat(r=-0.292,-0.198,-0.207,and-0.284;P=0.003,0.044,0.035,0.004),CNR and the percentage of spinal muscle(r=-0.197,P=0.045),and the effective dose and the percentage of thigh muscle(r=-0.262,P=0.007)were negatively correlated.Conclusion:The radiation dose in thyroid CT is correlated with female body composition.The image quality is related to female body composition,providing a data foundation for better control of radiation dose and image quality in the future.

Alzheimer's disease (AD), a progressive dementia, is one of the most common neurodegenerative diseases. Clinical trial results of amyloid-β (Aβ) and tau regulators based on the pretext of straightforward amyloid and tau immunotherapy were disappointing. There are currently no effective strategies for slowing the progression of AD. Herein, we spotlight the dysregulation of lipid metabolism, particularly the elevation of ceramides (Cers), as a critical yet underexplored facet of AD pathogenesis. Our study delineates the role of Cers in promoting microglial pyroptosis, a form of programmed cell death distinct from apoptosis and necroptosis, characterized by cellular swelling, and membrane rupture mediated by the NLRP3 inflammasome pathway. Utilizing both in vivo experiments with amyloid precursor protein (APP)/presenilin 1 (PS1) transgenic mice and in vitro assays with BV-2 microglial cells, we investigate the activation of microglial pyroptosis by Cers and its inhibition by icariin (ICA), a flavonoid with known antioxidant and anti-inflammatory properties. Our findings reveal a significant increase in Cers levels and pyroptosis markers (NOD-like receptor family, pyrin domain containing 3 (NLRP3), apoptosis-associated speck-like protein containing a caspase recruitment domain, caspase-1, gasdermin D (gasdermin D (GSDMD)), and interleukin-18 (IL-18)) in the brains of AD model mice, indicating a direct involvement of Cers in AD pathology through the induction of microglial pyroptosis. Conversely, ICA treatment effectively reduces these pyroptotic markers and Cer levels, thereby attenuating microglial pyroptosis and suggesting a novel therapeutic mechanism of action against AD. This study not only advances our understanding of the pathogenic role of Cers in AD but also introduces ICA as a promising candidate for AD therapy, capable of mitigating neuroinflammation and pyroptosis through the cyclooxygenase-2 (COX-2)-NLRP3 inflammasome-gasdermin D (GSDMD) axis. Our results pave the way for further exploration of Cer metabolism disorders in neurodegenerative diseases and highlight the therapeutic potential of targeting microglial pyroptosis in AD.

OBJECTIVE To investigate the current status of cleaning and disinfection of digestive endoscopes in vari-ous grades of hospitals of Hubei Province so as to improve the quality of cleaning and disinfection of the digestive endoscopes.METHODS A survey was conducted by the hospital infection management department of Tongji Hos-pital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from Mar.25,2024 to Mar.29,2024.A questionnaire was formulated by brainstorming and literature review.The electronic question-naire was distributed through the"Wenjuanxing"platform.The questionnaire survey aimed to investigate the per-sonnel,training,equipment and facilities,cleaning and disinfection operations,monitoring and recording of the digestive endoscopy centers of the medical institutions in the province.RESULTS Totally 185 medical institutions were finally included,113 of which were tertiary hospitals,and 72 were secondary and lower-grade hospitals.The tertiary hospitals were superior to the secondary and lower-grade hospitals in the quantity of endoscopes,daily di-agnosis and treatment volume of patients,participation in external training(including continuous training,further education,hospital-level training),provision of some facilities and equipment(ultrasonic cleaners,full pipeline perfusion devices,cleaning brushes,high-pressure water guns,transport containers),some cleaning and disinfec-tion operations(changing the cleaning enzyme solution one time for one endoscope,disinfecting the cleaning brush one time after one-time use),implementation of surveillance of cleaning quality and preservation of surveil-lance records(P＜0.05).However,the tertiary hospital were inferior to the secondary and lower-grade hospitals in standardized use of transferring containers(65.49％)and drying time of air guns(57.52％)(P＜0.05).CONCLUSIONS The quality of cleaning and disinfection of the digestive endoscopes remains large room to be im-proved in the medical institutions of Hubei Province.It is necessary for the medical institutions to strengthen the supervision and training of personnel based on the their actual condition,complete the provision of facilities and e-quipment,standardize the cleaning and disinfection operations,and complete the surveillance and recordings.