Objective:To investigate the current situation of knowledge, attitude and practice of medical personnel in areas with high incidence of fever with thrombocytopenia syndrome (SFTS) in Anhui Province, in order to provide a scientific basis for conducting systematic training for medical personnel.Methods:From July to August 2024, a multi-stage random sampling method was used to select medical personnel from village, township, county, and city level medical institutions in high incidence areas of SFTS in Anhui Province (Hefei City, Liu'an City, Chuzhou City, Xuancheng City) for an online questionnaire survey on their knowledge, attitude, and practice status. The survey included demographic data, knowledge, attitude, and practice related to SFTS, and a binary logistic regression model was used to analyze the influencing factors of SFTS knowledge qualification rate.Results:A total of 2 718 valid questionnaires were collected, with an effective response rate of 99.60% (2 718/2 729). Among them, 1 384 were males, accounting for 50.92%. The majority were medical personnel aged 41 to 50 years old, with undergraduate degrees, junior professional titles, working in township health centers or community health service centers, as clinical physicians, and with a working experience of no more than 10 years. They accounted for 31.97% (869/2 718), 50.48% (1 372/2 718), 35.54% (966/2 718), 38.52% (1 047/2 718), 62.33% (1 694/2 718), and 30.61% (832/2 718), respectively. The overall correct rates of medical personnel's relevant knowledge, attitude and practice were 77.52% (31 605/40 770), 94.53% (12 847/13 590) and 89.73% (12 194/13 590), respectively. There were statistically significant differences in the knowledge qualification of medical personnel of different genders, ages, education levels, professional titles, hospital levels, job positions, and years of work experience ( P < 0.05). The results of binary logistic regression analysis showed that professional title, hospital level, work position, and work experience were the influencing factors of knowledge qualification rate ( P < 0.05). Conclusions:Medical personnel have a relatively positive attitude and high level of practice towards SFTS, but their knowledge level still needs to be improved. It is recommended to provide targeted knowledge training for medical personnel in different positions to promote early detection, diagnosis, and treatment of SFTS.

Objective:To compare the infection status of severe fever with thrombocytopenia syndrome (SFTS) between the non-endemic area (Yixian county, Huangshan city) and the endemic area (Qianshan city, Anqing city) in Anhui province, and to explore the possibility of Yixian county being a natural focus of SFTS, thereby providing a scientific basis for the formulation of prevention and control strategies.Methods:In Xidi town, Yixian county, and Shuihou town, Qianshan city, one administrative village with the highest number of reported cases in the past three years was selected as the study village in each area, along with one control village with no reported cases. The study investigated the total antibody positivity rates of SFTS virus (SFTSV) in natural populations and host animals, as well as the density and virus-carrying rate of the vector ticks. Differences in total antibody positivity rates between the two regions were compared.Results:The total SFTSV antibody positivity rates in the natural population and host animals in the surveyed villages (control villages) of Qianshan city and Yi county were 8.7% and 8.0% (3.3%, 4.1%) and 0.0%, 9.1% (50.0%, 66.7%), respectively. There was no statistically significant difference in the infection rates of the natural population and host animals between the surveyed villages (control villages) in different endemic regions (all P>0.05). In the surveyed villages of Qianshan city and Yi county, the free-living tick densities were 1.4 ticks/hour per flag and 1.7 ticks/hour per flag, respectively; the parasitic tick densities were 0.4 ticks/host and 2.5 ticks/host, respectively; the tick infestation rates were 33.3% and 35.3%, respectively; and the tick density indices were 1.3 ticks/host and 7.2 ticks/host, respectively. Conclusions:The natural populations and host animals in some areas of Yixian county exhibit high SFTSV infection rates, and the tick density is also high, suggesting that the region may have become a natural focus of SFTS. Therefore, it is necessary to further strengthen capabilities in surveillance, diagnosis, and clinical treatment to address the potential risk of SFTS outbreaks.

Objective:To investigate the current situation of knowledge, attitude and practice of medical personnel in areas with high incidence of fever with thrombocytopenia syndrome (SFTS) in Anhui Province, in order to provide a scientific basis for conducting systematic training for medical personnel.Methods:From July to August 2024, a multi-stage random sampling method was used to select medical personnel from village, township, county, and city level medical institutions in high incidence areas of SFTS in Anhui Province (Hefei City, Liu'an City, Chuzhou City, Xuancheng City) for an online questionnaire survey on their knowledge, attitude, and practice status. The survey included demographic data, knowledge, attitude, and practice related to SFTS, and a binary logistic regression model was used to analyze the influencing factors of SFTS knowledge qualification rate.Results:A total of 2 718 valid questionnaires were collected, with an effective response rate of 99.60% (2 718/2 729). Among them, 1 384 were males, accounting for 50.92%. The majority were medical personnel aged 41 to 50 years old, with undergraduate degrees, junior professional titles, working in township health centers or community health service centers, as clinical physicians, and with a working experience of no more than 10 years. They accounted for 31.97% (869/2 718), 50.48% (1 372/2 718), 35.54% (966/2 718), 38.52% (1 047/2 718), 62.33% (1 694/2 718), and 30.61% (832/2 718), respectively. The overall correct rates of medical personnel's relevant knowledge, attitude and practice were 77.52% (31 605/40 770), 94.53% (12 847/13 590) and 89.73% (12 194/13 590), respectively. There were statistically significant differences in the knowledge qualification of medical personnel of different genders, ages, education levels, professional titles, hospital levels, job positions, and years of work experience ( P < 0.05). The results of binary logistic regression analysis showed that professional title, hospital level, work position, and work experience were the influencing factors of knowledge qualification rate ( P < 0.05). Conclusions:Medical personnel have a relatively positive attitude and high level of practice towards SFTS, but their knowledge level still needs to be improved. It is recommended to provide targeted knowledge training for medical personnel in different positions to promote early detection, diagnosis, and treatment of SFTS.

Objective:To compare the infection status of severe fever with thrombocytopenia syndrome (SFTS) between the non-endemic area (Yixian county, Huangshan city) and the endemic area (Qianshan city, Anqing city) in Anhui province, and to explore the possibility of Yixian county being a natural focus of SFTS, thereby providing a scientific basis for the formulation of prevention and control strategies.Methods:In Xidi town, Yixian county, and Shuihou town, Qianshan city, one administrative village with the highest number of reported cases in the past three years was selected as the study village in each area, along with one control village with no reported cases. The study investigated the total antibody positivity rates of SFTS virus (SFTSV) in natural populations and host animals, as well as the density and virus-carrying rate of the vector ticks. Differences in total antibody positivity rates between the two regions were compared.Results:The total SFTSV antibody positivity rates in the natural population and host animals in the surveyed villages (control villages) of Qianshan city and Yi county were 8.7% and 8.0% (3.3%, 4.1%) and 0.0%, 9.1% (50.0%, 66.7%), respectively. There was no statistically significant difference in the infection rates of the natural population and host animals between the surveyed villages (control villages) in different endemic regions (all P>0.05). In the surveyed villages of Qianshan city and Yi county, the free-living tick densities were 1.4 ticks/hour per flag and 1.7 ticks/hour per flag, respectively; the parasitic tick densities were 0.4 ticks/host and 2.5 ticks/host, respectively; the tick infestation rates were 33.3% and 35.3%, respectively; and the tick density indices were 1.3 ticks/host and 7.2 ticks/host, respectively. Conclusions:The natural populations and host animals in some areas of Yixian county exhibit high SFTSV infection rates, and the tick density is also high, suggesting that the region may have become a natural focus of SFTS. Therefore, it is necessary to further strengthen capabilities in surveillance, diagnosis, and clinical treatment to address the potential risk of SFTS outbreaks.

Objective To investigate the feasibility of low-voltage,automatic tube current adjustment(ATCM)and low contrast agent concentration,dose and injection rate combined with full-model iterative re-construction(IMR)in vertebral artery V3-segment three-dimensional CT angiography(3DCTA).Methods A total of 60 patients with suspected upper cervical spine,craniocervical junction lesions undergoing cervical vertebral artery V3 segment 3DCTA in this hospital from November 2019 to May 2020 were selected and divided into the group A and B by adopting the random number table method,30 cases in each group.The group A adopted the ATCM technology of 80 kV,average tube current of 50 mAs,25 mL of contrast agent io-hexol(iodine content 300 mg/mL)combined IMR technology with an injection rate of 3 mL/s,while the group B adopted 120 kV,150 mAs fixed tube current,50 mL injection rate of 5 mL/s contrast agent iopamidol(iodine content 370 mg/mL)combined filter back projection(FBP)reconstruction technology.CT value,noise,signal-to-noise ratio(SNR),contrast noise ratio(CNR)and image sensitivity(FOM)were measured and compared between the two groups and the quality of the resulting images was evaluated.The CT volumet-ric dose index(CTDIvol)and dose-length product(DLP)were recorded,and the effective dose(ED)was cal-culated.Results There was no statistically significant difference in the vertebral arterial CT value between the two groups(P＞0.05),but the noise of the group A was lower than that of the group B(P＜0.05),SNR,CNR and FOM of the group A were greater than those of the group B(P＜0.05).The image quality of the two groups met the requirements of clinical diagnosis[(4.78±0.41)points vs.(4.85±0.35)points],and there was no statistically significant difference in the subjective evaluation of image quality(P＞0.05).The CTDIvol,DLP and ED levels in the group A were lower than those in the group B(P＜0.05).The iodine in-takes of contrast medium in the group A and group B were 7.5 g and 18.5 g,respectively,and the iodine flow rates of contrast agent were 0.9 and 1.85 mg/s,respectively,and compared with group B,the iodine intake and iodine flow rate of the group A were decreased by 59.5％and 51.4％,respectively.Conclusion Low tube voltage ATCM and low contrast concentration,dose and injection rate combined with IMR technology can not only ensure the 3DCTA image quality of vertebral artery V3 segment,but also reduce the radiation dose re-ceived by the patients,and reduce the iodine intake and iodine flow rate of contrast agent.

Purpose: This study aims to elucidate the longitudinal alterations in frailty and health-related quality of life experienced by elderly patients undergoing surgical treatment for esophageal cancer. Additionally, it seeks to ascertain the impact of preoperative frailty on postoperative health-related quality of life over time. Methods: 131 patients were included in the prospective study. Patients' frailty and health-related quality-of-life were assessed utilizing the Tilburg and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at preoperative, 1 week, 1 month, and 3 months, postoperatively. Statistical analyses were performed using generalized estimating equations, repeated-measures analysis of variance, and linear mixed models (LMMs). Results: Out of 131 patients, 28.2% had frailty before surgery, and the prevalence of frailty consistently higher after surgery compared with baseline (67.9%, 51.9%, and 39.7%). There was no significant change in frailty scores in preoperative frail patients within 3 months following surgery (p = .496, p < .999, p < .999); whereas in preoperative non-frail patients, the frailty scores increased at 1 week (p < .001) and then decreased at 1 month (p = .014), followed by no change at 3 months. In addition, preoperative frail patients had significantly worse global quality-of-life (β = −4.24 (−8.31; −.18), p = .041), physical functioning (β = −9.87 (−14.59; −5.16), p < .001), role functioning (β = −10.04 (−15.76; −4.33), p = .001), and social functioning (β = −8.58 (−15.49; −1.68), p = .015), compared with non-frail patients. Conclusions A significant proportion of participants exhibited a high prevalence of preoperative frailty. These patients, who were preoperatively frail, exhibited a marked reduction in health-related quality-of-life, a more gradual recovery across various functional domains, and an increased symptom burden during the follow-up period. Therefore, it is crucial to meticulously identify and closely monitor patients with preoperative frailty for any changes in their postoperative physiology, role, and social functioning.

The cross regional loose medical alliance is an important carrier in the current integrated development process of medical services in the Yangtze River Delta region. Smith policy implementation process model was used to analyze the development difficulties of cross regional loose medical alliances from idealized policies, policy implementation institutions, policy target groups, and policy implementation environment. Such medical alliances were formed under the background of integrated development in the Yangtze River Delta, with Shanghai′s tertiary public hospitals as leading units and medical institutions in Jiangsu, Zhejiang, and Anhui provinces as member units. Analysis showed that the policies for such medical alliances development had not yet clearly defined the organizational management mode, operational mechanism, and implementation path, and the corporate governance structure of medical alliance was immature; The policy implementation agencies were relatively lagging behind in the support of special funds and the formulation of related supporting policies; Participation of policy target groups was insufficient and their incentive mechanisms was imperfect; There were problems in the policy implementation environment, namely inconsistent medical and health service regulations and systems in different regions, different health financing capabilities of local governments, insufficient coordination of medical institution management concepts, and a lack of unified standards in information systems. Based on the above difficulties, this study proposed to strengthen the development planning and layout of cross regional loose medical alliances, and improve the corporate governance structure; To strengthen the government′s main responsibility and improving policy implementation capabilities; To improve the internal cooperation and operation mechanism of cross regional loose medical alliances, and enhance the sense of identity of the target group; To optimize the policy implementation environment and implement various support measures, so as to provide references for further promoting the coordinated development of high-quality medical resources in the Yangtze River Delta region.

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.

Objective:To apply the best evidence of pre-examination and triage management of patients with non-traumatic acute abdomen to clinical practice and evaluate its effects.Methods:Using convenience sampling method, 15 nurses and 237 patients with non-traumatic acute abdomen admitted in the emergency department of Shanxi Provincial People ′s Hospital from January to May 2021 were selected as the research objects, 114 cases as the baseline review group and 123 cases as the after-effect evaluation group. Following the clinical evidence practice application of JBI Evidence-Based Nursing Center Systematic standard procedures, using self before-after control study to compare the knowledge and behavior of triage nurses before and after evidence application, and compliance with each review index; using a non-contemporaneous controlled trial to compare the changes of pre-examination and triage time and triage accuracy between two groups. Results:After the application of evidence, the score of the triage nurses on the pre-examination and triage of non-traumatic acute abdomen increased from 98.00±6.56 in the after-effect evaluation group to 114.20±3.88 in the base-line review group, and the difference was statistically significant ( t=8.62, P<0.05); after the application of evidence, the compliance with indicators 1-9,12,13,15-17 was significantly improved and the difference was significant ( χ2 values were 11.46-123.06, all P <0.05). After the application of evidence, the compliance rate of those indicators <80% increased to more than 80% except indicator 6, the accuracy of patient triage rose from 84.21%(96/114) to 93.50%(115/123) with a statistically significant difference ( χ2=5.22, P<0.05); after the application of the evidence, the triage time was 2.00(1.00,4.00) min, shorter than 3.00(2.00,4.63) min in the base-line review group, and the difference was statistically significant ( Z=-3.18, P<0.05). Conclusions:The application of the best evidence of pre-examination and triage for non-traumatic acute abdomen can improve the nursing practice of non-traumatic acute abdomen triage, improve the accuracy of non-traumatic acute abdomen triage, and shorten the triage time.

OBJECTIVE：To provide reference for the identification of Chebulae Fructus and Chebulae Fructus Immaturus . METHODS：UPLC method was adopted. The determination was performed on Waters Cortecs T 3 C18 column with mobile phase consisted of acetonitrile- 0.2％ phosphoric acid solution （gradient elution ）at the flow rate of 0.35 mL/min. The column temperature was 30 ℃，and the detection wavelength was set at 270 nm. The sample size was 1 μL. Using gallic acid as reference，UPLC fingerprints of 17 batches of Chebulae Fructus and 14 batches of Chebulae Fructus Immaturus were established and their similarity was evaluated by TCM Chromatographic Fingerprint Similarity Evaluation System （2012 edition）. By comparing substance control ， UV absorption spectrum and related literaturs ，common peaks were identified. PCA and PLS-DA were performed by using SPSS 20.0 and SIMCA 14.1 software. The contents of main difference components in Chebulae Fructus and Chebulae Fructus Immaturus were determined by above UPLC method and compared. RESULTS ：There were 8 common peaks in UPLC fingerprint of Chebulae Fructus and Chebulae Fructus Immaturus ，i.e. chebulic acid （peak 1），gallic acid （peak 2），punicalagin A （peak 3），punicalagin B （peak 4），corilagin（peak 6），chebulagic acid （peak 7）and chebulinic acid （peak 8）. The similarities of 17 batches of Chebulae Fructus were from 0.92 to 0.99，while 14 batches of Chebulae Fructus Immaturus were all above 0.99. The similarity of control fingerprint between Chebulae Fructus and Chebulae Fructus Immaturus was 0.909. PCA demonstrated the differences between Chebulae Fructus and Chebulae Fructus Immaturus . The results of PLS-DA were consistent with those of PCA ，and the variable importance in projection （VIP）values of peak 5，4，7，3 and 2 were above 1 in the PLS-DA model. In 31 batches of samples ，the contents of gallic acid （peak 2），punicalagin A（peak 3），punicalagin B （peak 4）and chebulagic acid （peak 7）were 2.63-10.31， 5.37-44.63，8.02-60.77，44.07-162.98 mg/g；RSDs were 40.14％， 47.91％ ，53.97％ ，36.22％（n＝31）. There was statistical significance in the differences of the mentioned 4 components between Chebulae Fructus and Chebulae Fructus Immaturus 719412818@qq.com （P＜0.05）. CONCLUSIONS ：There are significant differences between Chebulae Fructus and Chebulae Fructus Immaturus gallic acid ，punicalagin A ，punicalagin B and chebulagic acid are the main difference components for identification.