To evaluate the design and implementation effects of the "Rapid Recognition and Management of Critically Ill Patients" course, and to provide a reference for the improvement of situational simulation teaching in emergency and critical care settings.

Objective: To analyze the trends in mortality and life lost among residents in Jinshan District, Shanghai Municipality from 2003 to 2023, so as to provide the evidence for developing injury prevention and control strategies and optimizing public health resource allocation. Methods: Data on injury mortality in Jinshan District from 2003 to 2023 were collected through Jinshan District Death Cause Registration System. Crude mortality was calculated, and standardized by the Sixth National Population Census in 2010. Potential years of life lost (PYLL), potential years of life lost rate (PYLLR), and average years of life lost (AYLL) were used to analyze life loss. Annual percent change (APC) was used to analyze the trends of injury mortality and life lost Results: From 2003 to 2023, the standardized mortality of injury in the total population, males, and females in Jinshan District were 34.39/105, 43.01/105, and 25.52/105, respectively, showing downward trends (APC=-3.270%, -3.913%, and -2.108%, all P<0.05). The standardized mortality of injury in males was higher than that in females (P<0.05). The crude mortalities of injury in age groups of 0-<15, 15-<30, 30-<45, 45-<60, and ≥60 years were 8.45/105, 16.94/105, 23.59/105, 39.05/105, and 127.70/105, respectively, showing an upward trend with increasing age (P<0.05). From 2003 to 2023, except for the ≥60 years group, the crude mortalities of injury in other age groups showed downward trends (APC=-6.539%, -4.426%, -7.846%, and -5.185%, all P<0.05). From 2003 to 2023, the top two causes of injury death in the total population were traffic accidents and falls, with crude mortalities of 17.88/105 and 15.81/105, respectively. Among them, the crude mortality of traffic accidents showed a downward trend (APC=-4.478%, P<0.05), while the crude mortality of falls showed an upward trend (APC=5.467%, P<0.05). From 2003 to 2023, PYLL, PYLLR, and AYLL of injury in the total population showed downward trends (APC=-6.685%, -6.710%, and -7.225%, all P<0.05). Conclusions From 2003 to 2023, the injury mortality and life lost in Jinshan District showed downward trends. Males and the elderly are the key populations for prevention and control, and falls are the key cause of death for prevention and control.

[Purpose]To analyze the trends of mortality and probability of premature mortality caused by colorectal cancer in Jinshan District of Shanghai from 1980 to 2023.[Methods]The death database of Jinshan District from 1980 to 2023 were established based on the death reports from the medical institutions and public security bureau at all levels.The crude mortality rate,age-standardized mortality rate by Chinese standard population and world standard population(ASRC and ASRW),age-specific mortality rate,probability of premature mortality,annual percentage change(APC)and average annual percentage change(AAPC)of colorectal cancer were calculated.[Results]The crude mortality rate of colorectal cancer increased from 1980 to 2023(AAPC=2.36％,P＜0.001)and the ASRW of colorectal cancer decreased at the same period(AAPC=-1.02％,P=0.003).The ASRW of colorectal cancer in male and female showed a decreasing trend from 1990 to 1999(APC=-5.08％,-7.85％,P=0.007,0.011),but there was no significant change in other periods.The age-specific mortality rate increased with age and reached the peak at the age group of 70～74 years old during 1980-1989,75～79 years old during 1990-1999,80～84 years old during 2000-2009 and 2010-2019,85 years old and above during 2020-2023(109.22/105,77.56/105,113.78/105,172.82/105 and 236.58/105,respectively).The probability of premature mortality of colorectal cancer decreased in male and female(AAPC=-1.10％,-2.41％,P=0.047,＜0.001),but there was no change after the year of 2000.[Conclusion]The overall mortality rate of colorectal cancer in Jinshan District showed a decreasing trend from 1980 to 2023,but the standardized mortality rate and the probability of premature mortality had not shown a significant downward trend since 2000.

[Purpose]To analyze the trends of mortality and probability of premature mortality caused by colorectal cancer in Jinshan District of Shanghai from 1980 to 2023.[Methods]The death database of Jinshan District from 1980 to 2023 were established based on the death reports from the medical institutions and public security bureau at all levels.The crude mortality rate,age-standardized mortality rate by Chinese standard population and world standard population(ASRC and ASRW),age-specific mortality rate,probability of premature mortality,annual percentage change(APC)and average annual percentage change(AAPC)of colorectal cancer were calculated.[Results]The crude mortality rate of colorectal cancer increased from 1980 to 2023(AAPC=2.36％,P＜0.001)and the ASRW of colorectal cancer decreased at the same period(AAPC=-1.02％,P=0.003).The ASRW of colorectal cancer in male and female showed a decreasing trend from 1990 to 1999(APC=-5.08％,-7.85％,P=0.007,0.011),but there was no significant change in other periods.The age-specific mortality rate increased with age and reached the peak at the age group of 70～74 years old during 1980-1989,75～79 years old during 1990-1999,80～84 years old during 2000-2009 and 2010-2019,85 years old and above during 2020-2023(109.22/105,77.56/105,113.78/105,172.82/105 and 236.58/105,respectively).The probability of premature mortality of colorectal cancer decreased in male and female(AAPC=-1.10％,-2.41％,P=0.047,＜0.001),but there was no change after the year of 2000.[Conclusion]The overall mortality rate of colorectal cancer in Jinshan District showed a decreasing trend from 1980 to 2023,but the standardized mortality rate and the probability of premature mortality had not shown a significant downward trend since 2000.

Objective:To explore the efficacy and its related factors of rituximab (RTX) in the treatment of children with frequently relapsing nephrotic syndrome/steroid-dependent nephrotic syndrome (FRNS/SDNS).Methods:It was a single-center retrospective study. The clinical data of FRNS/SDNS children first treated with RTX in the First Affiliated Hospital of Sun Yat-sen University from November 1, 2016 to September 1, 2023 were collected. The number of relapse within 1 year before and after RTX treatment, the time to first relapse after RTX treatment, and the time to B-cell reconstitution were analyzed. At the first treatment, a single dose of RTX was given at 375 mg/m 2, with a maximum dose of 500 mg, once a week, for 1 to 4 doses. The count of CD19 + lymphocytes in the peripheral blood of the children was continuously monitored. If B-cell reconstruction was performed, the decision on whether to proceed to the next course of RTX treatment was made based on clinical manifestations. Kaplan-Meier method was used to analyze relapse-free survival rate after receiving RTX. Cox proportional hazards regression model was used to analyze the related factors of relapse after RTX treatment. Results:A total of 98 FRNS/SDNS children receiving RTX treatment were enrolled, including 75 males (76.5%). The age at onset was 4.0 (1.9, 7.1) years and age of receiving RTX was 11.3 (8.5, 13.5) years. There were 90 children (91.8%) achieving complete remission, while 8 patients (8.2%) did not respond to RTX treatment, and 3 patients (3.1%) progressed to end-stage kidney disease after receiving RTX. The relapse-free survival rates at 6 months and 1 year after RTX treatment were 83.3% (75/90) and 57.9% (22/38), respectively. The frequency of relapse 1 year after RTX treatment decreased compared to 1 year before RTX treatment ( Z=-7.398, P<0.001). Compared with children without relapse during the period of B-cell depletion, relapsed children had a higher number of relapse within one year after RTX treatment ( Z=5.246, P<0.001). The time to first relapse after RTX treatment was 8.3 (4.6, 13.9) months in 51 relapse patients. Compared with children receiving 1 dose of RTX in the first course, those receiving 2 or more doses had a longer time to the first relapse ( Z=2.983, P=0.003). There was no statistically significant difference in time to the first relapse between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). The reconstruction time of B cells after the first course of RTX was 6.9 (5.3, 9.0) months. Compared to children receiving one dose of RTX in the first course, those receiving two or more doses had a longer B-cell reconstitution time ( Z=2.739, P=0.006). There was no statistically significant difference in B-cell reconstitution time between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). Univariate Cox regression analysis showed that recurrence after calcineurin inhibitor (CNI) treatment before RTX treatment and the number of recurrence in one year before RTX treatment were correlated factors of recurrence after RTX treatment (both P<0.05). Multivariate Cox regression analysis showed that recurrence after CNI treatment before RTX treatment was an independent correlated factor of relapse after RTX therapy ( HR=3.496, 95% CI 1.245-9.818, P=0.018). Infusion reactions occurred in 10 patients (10.2%) and infections were observed in 24 patients (24.5%) during B cell depletion. No serious adverse events occurred. Conclusions:RTX is well tolerated and effective in treating FRNS/SDNS. Recurrence after CNI treatment before RTX treatment may be an independent related factor of relapse after RTX treatment.

Objective:To explore the molecular epidemiological characteristics of human metapneumovirus (HMPV) in children with acute respiratory infection (ARI) in Beijing from 2023 to 2024.Methods:In the longitudinal study, 9 834 children with ARI were enrolled from August 2023 to December 2024, including the influenza-like illness (ILI) group from emergency and outpatient department receiving influenza virus (Flu) and HMPV test and the ARI inpatient group for 13 common respiratory pathogen screening test including HMPV, Flu, respiratory syncytial virus, and so on. All respiratory samples positive with HMPV were genotyped by amplifying and sequencing of G gene and further phylogenetic analysis. The χ2 test and Wilcoxon rank-sum test were used to compare the positive rate and basic clinical data of the 2 groups. Results:Among 9 834 enrolled patient, there were 5 276 male and 4 558 female children, with age 5.4 (1.9, 8.2) years. In ILI group of 1 460 patients, there were 83 cases (5.7%) positive for HMPV, with the age 4.9 (3.6, 6.6) years and children under 6.0 years old 59 cases (71.1%). Among 8 374 ARI inpatients, there were 256 cases (3.1%) positive for HMPV, with age 3.5 (1.3, 6.4) years and children under 6.0 years old 188 cases (73.4%). The HMPV positive rate and the age of children positive for HMPV in ARI inpatient group were significantly lower than that in ILI group (both P<0.001). In December, 2024, the HMPV positive rates of ILI and ARI inpatient group (21.3% (17/80), 15.0% (47/314)) were significantly higher than the total positive rates of each group (both P<0.001). Among 279 subtyped specimens, there were 155 cases (55.6%) belonging to genotype A and 124 cases (44.4%) belonging to genotype B. Sub-lineage A2.2.2 containing 111nt-insertions was predominate one in 2023 with positive ratio 89.2% (91/102), and B2 was predominate in 2024 with positive ratio 64.4% (114/177). Conclusions:From 2023 to 2024, the positive rate of HMPV in the ILI group was higher than that in the ARI inpatient group, suggesting a common epidemic of HMPV infection. Children positive for HMPV in the ARI inpatient group were younger than that in the ILI group. A severe epidemic of HMPV was observed in the winter of 2024, which requires attention. Sub-lineage A2.2.2 with 111nt-duplicate insertions and B2 were the predominant epidemic strains in 2023 and 2024, respectively.

Airway management is a critical component of critical patient care.Although traditional methods of airway management are effective to some extent,they still face many challenges,such as difficult airways,delayed endotracheal intubation,endotracheal tube migration,unpredictable airway complications and failure to mechanical ventilation weaning.Artificial intelligence(AI),a technological tool with advanced algorithms,offers important innovations to improve the safety and efficiency of airway management with its multimodal data integration and real-time decision support capabilities.For example,AI can be used in areas such as real-time monitoring of patients′ vital signs,dynamic adjustment of ventilator parameters,monitoring and assessment of airway complications,and assisted robotic tracheal intubation.In addition,AI is able to build predictive models based on big data to help reduce the risk of injury in mechanically ventilated patients and assist clinicians in making timely decisions.This paper reviews the research progress of AI in airway management and discusses issues of privacy and security,ethics,model performance and interpretability that may be faced during the use of AI,and looks forward to a more active role for AI in airway management in future.

OBJECTIVE To explore the protective effect of Jianpi Shengqing Jiangzhuo Recipe on db/db mice with diabetic kid-ney disease(DKD)and its possible mechanism.METHODS Thirty-two 8-week-old male db/db mice were randomly divided into four groups(n=8),including the model group,the Western medicine group[Dapagliflozin(1.0 mg·kg-1·d-1)],low-dose Jianpi Shengqing Jiangzhuo group(19.63 g·kg-1·d-1),and high-dose Jianpi Shengqing Jiangzhuo group(58.89 g·kg-1·d-1).Addi-tionally,8 db/m mice were used as the normal group.The mice were orally administered once a day for 10 consecutive weeks.The general survival status of the mice was observed,and the body weight,fasting blood glucose(FBG),and urine volume of the mice were dynamically monitored;urine creatinine and urine microalbumin were detected,and urine microalbumin excretion(UAE)and protein-creatinine ratio(ACR)were calculated.After the last intervention,mice were fasted for 12 h,blood was collected under anesthesia,and kidney tissue was separated;blood creatinine(Scr),serum urea nitrogen(BUN),triglycerides(TG),total cholesterol(TC),low-density lipoprotein(LDL-C),and high-density lipoprotein(HDL-C)were tested;HE and Masson staining were used to observe pathological changes in renal tissue;Oil Red O staining was used to observe the deposition of lipid droplets in the kidneys,and Image J was used for quantitative analysis;ELISA was used to detect the levels of TNF-α and IL-1β in renal tissue;Western blot was used to detect the expression of SIRT1,SREBP-1,and PPAR-α proteins in renal tissue.RESULTS Compared with the normal group mice,the body weight,FBG,Scr,TG,TC,HDL-C,LDL-C,urine volume,UAE,and ACR of the model group mice were signifi-cantly increased(P<0.05,P<0.01);the glomerular volume was significantly increased,renal fibrosis was altered,and renal lipid droplet deposition increased(P<0.01);renal TNF-α,IL-1β,SREBP-1 expression increased(P<0.01),and SIRT1 and PPAR-α expression decreased(P<0.01).Compared with the model group,the FBG levels in the Western medicine group was significantly de-creased at the 5th and 10th weeks of intervention(P<0.05,P<0.01);after the intervention,the Scr,UAE and ACR in the Western medicine group and high-dose Jianpi Shengqing Jiangzhuo group were significantly decreased(P<0.05,P<0.01),and the serum TG level in the high-dose Jianpi Shengqing Jiangzhuo group was also significantly decreased(P<0.01);the Western medicine group and the high-dose group of Jianpi Shengqing Jiangzhuo group improved renal pathological changes and lipid deposition(P<0.05,P<0.01),with decreased levels of TNF-α and IL-1β and increased expression of SIRT1 and PPAR-α proteins(P<0.05,P<0.01);high-dose group of Jianpi Shengqing Jiangzhuo decreased the expression of SREBP-1(P<0.01).CONCLUSION Jianpi Shengqing Jiangzhuo Recipe can improve proteinuria,kidney injury,renal lipid deposition as well as inflammatory reaction in DKD,which may be related to the activation of the SIRT1/SREBP-1/PPAR-α pathway to regulate lipid homeostasis.

Objective To develop a predictive model integrating clinical features,deep learning(DL),and radiomics based on T2-weighted imaging for prenatal assessment of postpartum hemorrhage(PPH)risk in high-risk pregnant women.Methods A total of 538 pregnant women with ultrasound-reported high-risk placenta accrete were retrospectively enrolled and divided into training,internal test,and external test cohorts.A nnUNet model was trained for automatic placental segmentation.Univariate and multivariate analyses were conducted on clinical features to identify those associated with PPH.Quantitative radiomic features were extracted from the placental region,and a random forest model was developed to predict estimated blood loss(EBL)and PPH risk.A DenseNet-based multi-task DL model was trained to predict PPH risk,EBL,and placenta previa status.Finally,a DL-radiomics ensemble(DRE)model was constructed by integrating clinical features,DL outputs,and radiomics scores.Diagnostic performance was evaluated using the area under the receiver operating characteristic curve(AUC)and DeLong test.Results The DRE model achieved AUC values of 0.874(95%CI:0.792-0.951)and 0.836(95%CI:0.648-0.974)in the internal and external test cohorts,respectively,significantly outperforming the standalone clinical,DL,and radiomics models.Incorporation of EBL regression improved the performance of the PPH classification model,with the external test AUC increasing from 0.261-0.788 to 0.836.Conclusion The DRE model integrating DL and radiomics can efficiently predict PPH risk and assist in the clinical management of high-risk pregnancies.

Objective: To systematically analyze the revisions content and technological development trends of microbiological standards in the Chinese Pharmacopoeia (ChP) 2025 Edition, and explore its novel requirements in risk-based pharmaceutical product lifecycle management.
Methods: A comprehensive review was conducted on 26 microbiological-related standards to summarize the revision directions and scientific implications from perspectives including the revision overview, international harmonization of microbiological standards, risk-based quality management system, and novel tools and methods with Chinese characteristics.
Results: The ChP 2025 edition demonstrates three prominent features in microbiological-related standards: enhanced international harmonization, introduced emerging molecular biological technologies, and established a risk-based microbiological quality control system.
Conclusion: The new edition of the Pharmacopoeia has systematically constructed a microbiological standard system, which significantly improves the scientificity, standardization and applicability of the standards, providing a crucial support for advancing the microbiological quality control in pharmaceutical industries of China.