Objective : To analyze the epidemiological characteristics of pertussis among the population aged ≤18 years in Zhejiang Province from 2016 to 2023, so as to provide a basis for optimizing pertussis prevention and control measures as well as immunization strategies. Methods: Data on pertussis cases among individuals aged ≤18 years in Zhejiang Province from 2016 to 2023 were collected through the Infectious Disease Reporting Information System of Chinese Disease Prevention and Control Information System. Vaccination records were obtained from the specialized pertussis epidemiological survey conducted in Zhejiang Province. The descriptive epidemiological method was employed to analyze the epidemiological characteristics of pertussis among the population aged ≤18 years, as well as the interval between disease onset and the last immunization among breakthrough cases. Results: A total of 7 431 pertussis cases aged ≤18 years were reported in Zhejiang Province from 2016 to 2023, with an average annual reported incidence of 8.68/105. The overall trend showed no statistical significance (P>0.05). The reported incidence remained relatively low from 2016 to 2021, consistently below 10.00/105. In contrast, the incidence rose to 33.98/105 in 2022 and 13.39/105 in 2023. The peak incidence period was from April to August, during which 4 024 cases were reported, accounting for 54.15%. Hangzhou City, Wenzhou City, and Ningbo City reported the highest number of cases, with 3 844, 1 581, and 646 cases, representing 51.73%, 21.28%, and 8.69%, respectively. In terms of average annual incidence, Hangzhou City, Wenzhou City, and Huzhou City ranked the highest, with rates of 33.98/105, 12.38/105, and 12.27/105, respectively. Among age groups, the highest reported incidence was observed in children aged 0-<1 years, at 48.87/105. From 2016 to 2023, the incidence in the 5-<10 years and 10-18 years age groups showed upward trends (AAPC=108.193%, 106.709%, both P<0.05). The proportion of cases in the 5-<10 years age group also increased during this period (P<0.05). A total of 109 breakthrough pertussis cases were identified. The median interval between disease onset and the last immunization was 4.00 (interquartile range, 4.00) years. The numbers of cases with intervals of 1-<2 years and ≥6 years were both relatively high, comprising 25 cases and 37 cases, which accounted for 22.94% and 33.94%, respectively. Conclusions From 2016 to 2021, the reported incidence of pertussis in Zhejiang Province remained relatively stable. However, a sharp increase was observed in 2022. The disease peaked during spring and summer. Key populations for targeted prevention and control included children aged 0-<1 year, 5-<10 years, and 10-18 years. The interval between disease onset and the last immunization among breakthrough pertussis cases exhibited a bimodal distribution.

The incidence of gestational diabetes mellitus (GDM) is gradually increasing and has become a significant public health issue. Endocrine disrupting chemicals (EDCs) are a ubiquitous class of exogenous chemical substances that can interfere with hormone synthesis, metabolism, and activity, and subsequently affect endocrine homeostasis. Humans are extensively and continuously exposed to various EDCs originating from food packaging, plastic products, textiles, electronic goods, as well as cleaning agents and cosmetics in daily life, leading to endocrine and metabolic disorders, such as obesity, insulin resistance, impaired glucose tolerance, and diabetes. Previous studies indicated a close association between EDCs exposure and the occurrence of GDM. This review summarized the correlation between daily life exposure to EDCs and GDM, along with their potential biological mechanisms, including bisphenols, phthalates, per- and polyfluoroalkyl substances, organophosphate esters, parabens, and triclosan, aiming to provide scientific evidence for supporting the effective implementation of public health intervention measures to alleviate and prevent GDM.

Objective:To determine the prevalence, risk factors, and longitudinal associations of loneliness during mid- to late pregnancy with anxiety and depressive symptoms in late pregnancy.Methods:In this prospective cohort study, 1 107 pregnant women at 24-28 weeks' gestation were enrolled between June 2021 and December 2022. Psychological status was assessed during mid-pregnancy (24-28 weeks) and late pregnancy (≥32 weeks) using standardized electronic questionnaires, including the Revised University of California Los Angeles Loneliness Scale (UCLA) Loneliness Scale-Short Form (Cronbach's α=0.82), Patient Health Questionnaire-9 ( α=0.86), and Generalized Anxiety Disorder-7 ( α=0.88). Multivariate logistic regression identified independent risk factors for loneliness. Cross-lagged path models analyzed the longitudinal predictions between loneliness and anxiety/depressive symptoms. Results:The prevalence of loneliness decreased significantly from 10.8% (120/1 107) in mid-pregnancy to 4.8% (37/777) in late pregnancy ( χ2=21.81, P<0.001). Multivariate analysis identified independent risk factors for loneliness: age <30 years ( OR=1.70, 95% CI: 1.15-2.50), annual household income <50 000 CNY ( OR=2.53, 95% CI: 1.28-5.02), unemployment during pregnancy ( OR=1.57, 95% CI: 1.03-2.39), history of alcohol consumption ( OR=1.63, 95% CI: 1.03-2.56), and the presence of mid-pregnancy depressive ( OR=2.76, 95% CI: 1.51-5.04) and anxiety symptoms ( OR=1.65, 95% CI: 1.01-2.71) (all P<0.05). Cross-lagged path models indicated bidirectional associations between loneliness and both anxiety ( β=0.32, P<0.01) and depressive symptoms ( β=0.28, P<0.01). However, the predictive effect of loneliness on subsequent depressive and anxiety symptoms ( β=0.28-0.32) was substantially stronger than the reverse prediction (mid-pregnancy anxiety on late-pregnancy loneliness: β=0.12; mid-pregnancy depression on late-pregnancy loneliness: β=0.11). Loneliness demonstrated high temporal stability (autoregressive effects β=0.29-0.32). Conclusion:Loneliness in mid-pregnancy exhibits a symmetric bidirectional association with anxiety and depressive symptoms in late pregnancy, suggesting it may be a core driver in the development of these emotional symptoms. Younger maternal age (<30 years), low household income (<50 000 CNY/year), unemployment during pregnancy, and a history of alcohol consumption were associated with a higher risk of loneliness and should be prioritized for psychological screening and intervention.

During the progression of ischemic stroke,cells experience oxidative stress and intracellular energy depletion,triggering the dynamic assembly and disassembly of stress granules.Stress granules may have a dual role in ischemic stroke.In the ultra-early reperfusion period(6-36 h),under acute stress,the stress granules may inhibit neuronal apoptosis and exert neuroprotective effects through reversible liquid-liquid phase separation.In contrast,in the acute reperfusion period(36 h to 2 weeks),under prolonged stress,pathological stress granules may accumulate through liquid-solid phase transition,leading to neuronal dysfunction and inducing ischemic stroke sequelae such as motor and cognitive impairments.This article reviewed the mechanisms of stress granules dynamic phase transitions during ischemic stroke and their effects on neurons,aiming to provide references and insights for future stress granule-targeted interventions for ischemic stroke and its sequelae.

Objective·To retrieve and evaluate evidence related to weight management during endocrine therapy for prostate cancer patients,and summarize the best evidence available.Methods·The PIPOST model was adopted to construct evidence-based questions.Following the"6S"model of evidence resources,a systematic computer-based search was conducted to retrieve relevant evidence on weight management during prostate cancer endocrine therapy from various databases and websites,including Guidelines International Network,BMJ Best Practice,UpToDate,JBI Evidence-Based Healthcare Center Database,American Guidelines Network,Medlive,Cochrane Library,PubMed,CINAHL,Web of Science,Embase,CNKI,Chinese Biomedical Literature Database,Wanfang Database,and VIP Database,as well as the websites of the American Urological Association,European Urological Association,and Urological Branch of Chinese Medical Association.The evidence retrieved included guidelines,clinical decisions,recommended practices,expert consensuses,evidence summaries,systematic reviews,and original studies.The search period spanned from database establishment to December 2023.Two researchers independently evaluated the quality of the included literature.The included articles were read one by one and summarized according to themes.Priority was given to high-level,high-quality,and newly published authoritative literature during evidence screening and extraction.The included and extracted evidence was uniformly classified into levels 1?5 according to the JBI evidence pre-classification and evidence recommendation level system,and the evidence recommendations were divided into strongly recommended(Grade A)and weakly recommended(Grade B).Results·A total of 12 articles were retrieved,consisting of 4 guidelines,3 expert consensuses,2 evidence summaries,2 randomized controlled trials,and 1 quasi-experimental study.All 12 articles were rated as high quality and were included.The best evidence was summarized into 8 aspects:weight management assessment and monitoring,multidisciplinary collaboration,personalized support,family involvement strategies,nutrition management strategies,exercise management strategies,health education,and follow-up management.Conclusion·The best evidence for weight management during endocrine therapy for prostate cancer is summarized into eight aspects.In clinical application,specific clinical situations and patient characteristics should also be considered to improve the effectiveness of clinical interventions and the quality of care.

AIM:This study aims to investigate the therapeutic impact of bone marrow mesenchymal stem cell(MSC)-derived exosomes(MSC-Exos)on septic lung injury by targeting Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway.METHODS:MSC-Exos were isolated from bone marrow MSCs using ultracentrifugation.The exosomes were characterized by transmission electron microscopy(TEM),nanoparticle tracking analysis(NTA),and Western blot.A septic lung injury model was established via cecal ligation and puncture(CLP).MSC-Exos were adminis-tered intraperitoneally 3 h after CLP.Blood and lung tissue samples were collected at 6,12,24,and 72 h after CLP.Con-centrations of interleukin-10(IL-10),IL-6,IL-1β,and tumor necrosis factor-α(TNF-α)were measured by ELISA.The lung tissue damage in mice was assessed by HE staining.Expression levels of TLR4 and NF-κB were detected by RT-qP-CR and Western blot.RESULTS:The results of TEM revealed typical round and oval exosome-like structures of MSC-Exos.Western blot showed positive expression of CD63,TSG101 and HSP-70.The results of NTA indicated that the parti-cle size of MSC-Exos was(107.5±16.6)nm.Septic lung injury began to manifest 12 h after CLP and progressively worsened,peaking at 72 h after CLP.At 6 h after CLP,the level of TNF-α was markedly elevated compared to the control group,reaching its peak at 72 h after CLP.At 12 h after CLP,the levels of IL-1β,IL-10,and IL-6 were elevated com-pared to the control group,and they reached their maximum point 72 h post-CLP.The MSC-Exos intervention group ex-hibited significantly reduced lung injury compared to the CLP group,as indicated by the lung pathology scoring.In the MSC-Exos intervention group,concentrations of IL-10,IL-1β,IL-6,and TNF-α peaked at 12 h after CLP,gradually de-clined,and returned to baseline levels by 72 h.TLR4 and NF-κB expression levels were significantly increased at 6 h af-ter CLP in the CLP group,peaking at 72 h.In contrast,MSC-Exos treatment normalized TLR4 and NF-κB expression levels at 72 h after CLP.CONCLUSION:Early intervention with bone marrow MSC-Exos significantly alleviated septic lung injury by reducing the inflammatory cytokine storm,likely through downregulation of the TLR4/NF-κB signaling path-way.

Objective To investigate the correlation between cognitive function and medication compliance in patients with type 2 diabetes mellitus(T2DM).Methods Patients with T2DM who were admitted to the Department of Endocrinology,Drum Tower Hospital,Nanjing University School of Medicine from July 2023 to December 2023 were selected.The clinical data and laboratory results of the patients were collected.The medication compliance of the patients was evaluated by Adherence to Refills and Medications Scales(ARMS).And the overall cognitive function and independent cognitive domain tests were performed.According to the diagnostic criteria of mild cognitive impairment(MCI),patients were divided into normal cognitive group and MCI group.Linear regression analysis was used to evaluate the correlation between cognitive function and medication compliance in T2DM patients.Multivariate logistic regression analysis was used to explore the relationship between cognitive dysfunction and poor medication compliance in T2DM patients.Results A total of 216 patients with T2DM were enrolled,including 113 patients with normal cognitive function and 103 patients with MCI.The ARMS score(16.4±4.1 vs.15.1±2.8)and the rate of poor medication compliance(54.4%vs.31.0%)in the MCI group were higher than those in the normal cognitive group(all P<0.05).After adjusting for gender,age,years of education and glycosylated hemoglobin,ARMS scores were significantly negatively correlated with immediate memory,attention and delayed memory scores(all P<0.05).Multivariate logistic regression analysis showed that patients with MCI had a higher risk of poor medication adherence[OR=2.645,95%CI=(1.414,4.946),P<0.001].Conclusions Poor cognitive function,especially memory and concentration,is associated with reduced medication compliance in patients with T2DM.Patients with memory and attention problems should be given appropriate medication advice to improve their compliance in clinical practice.

Objective To investigate the correlation between cognitive function and medication compliance in patients with type 2 diabetes mellitus(T2DM).Methods Patients with T2DM who were admitted to the Department of Endocrinology,Drum Tower Hospital,Nanjing University School of Medicine from July 2023 to December 2023 were selected.The clinical data and laboratory results of the patients were collected.The medication compliance of the patients was evaluated by Adherence to Refills and Medications Scales(ARMS).And the overall cognitive function and independent cognitive domain tests were performed.According to the diagnostic criteria of mild cognitive impairment(MCI),patients were divided into normal cognitive group and MCI group.Linear regression analysis was used to evaluate the correlation between cognitive function and medication compliance in T2DM patients.Multivariate logistic regression analysis was used to explore the relationship between cognitive dysfunction and poor medication compliance in T2DM patients.Results A total of 216 patients with T2DM were enrolled,including 113 patients with normal cognitive function and 103 patients with MCI.The ARMS score(16.4±4.1 vs.15.1±2.8)and the rate of poor medication compliance(54.4%vs.31.0%)in the MCI group were higher than those in the normal cognitive group(all P<0.05).After adjusting for gender,age,years of education and glycosylated hemoglobin,ARMS scores were significantly negatively correlated with immediate memory,attention and delayed memory scores(all P<0.05).Multivariate logistic regression analysis showed that patients with MCI had a higher risk of poor medication adherence[OR=2.645,95%CI=(1.414,4.946),P<0.001].Conclusions Poor cognitive function,especially memory and concentration,is associated with reduced medication compliance in patients with T2DM.Patients with memory and attention problems should be given appropriate medication advice to improve their compliance in clinical practice.

Objective:To investigate the application effect of propofol combined with remifentanil for anesthesia in children undergoing plasma adenoidectomy.Methods:Clinical data of 103 children who underwent plasma adenoidectomy in our hospital from Apr 2023 to Apr 2024 were retrospectively analyzed.Children were divided into two groups according to different anesthesia schemes.Children who received propofol+ketamine anesthesia were enrolled in the control group(n=52)and children who received propofol+remifentanil anesthesia were enrolled in the study group(n=51).Hemodynamic parameters were compared between the two groups at four time points:before anesthesia(T0),immediately after extubation(T1),5 minutes after extubation(T2),and 10 minutes after extubation(T3).The pain scores(CHIPPS)of the two groups were compared at 10,20,and 30 min after extubation.Post-anesthesia evaluation of discomfort(PAED)and incidence of restlessness during recovery in children were compared.The indicators of stress response(cortisol and epinephrine)were measured preoperatively and 1 day postoperatively.Total perioperative adverse events were analyzed.Results:The recovery times for spontaneous breathing,eye-opening,and extubation in the study group were shorter than those in the control group(P＜0.05).The heart rate and mean arterial pressure level in the study group at T1-T3 were lower than those in the control group(P＜0.05).The CHIPPS scores at 10,20,and 30 min after extubation and PAED scores during the recovery period in the study group were lower than those in the control group(P＜0.05).The incidence of restlessness during the recovery period in the study group was lower than that in the control group(P＜0.05).The levels of cortisol and epinephrine in the study group were lower than those in the control group on day 1 after surgery(P＜0.05).There was no significant difference in the overall incidence of adverse reactions between the two groups(P＞0.05).Conclusion:The use of propofol combined with remifentanil in plasma adenoidectomy can effectively shorten the recovery time of anesthesia in children,enhance analgesic effects,reduce blood circulation fluctuations and stress reactions,and reduce the incidence of restlessness,with reliable safety.

Objective:To investigate the clinical effect of local injection of triamcinolone acetonide acetate combined with ultra-pulsed CO 2 fractional laser in the treatment of hypertrophic scars in children. Methods:A randomized controlled study method was used. According to the inclusion and exclusion criteria, the subjects were selected from children with hypertrophic scars admitted to the Children’s Hospital Affiliated to Shandong University from January 2022 to September 2023, and were divided into control group and experimental group using random number table method. The control group was treated with ultra-pulsed CO 2 fractional laser. The experimental group was injected with triamcinolone acetonide acetate injection at multiple points into the scar (the ratio of triamcinolone acetonide acetate injection to 2% lidocoin hydrochloride injection was 1∶1), with a distance between the points as 1 cm, and the injection dose was about 0.1 to 0.2 ml/cm 2 according to the degree of scar protrusion. The maximum dose each time was ≤40 mg. CO 2 fractional laser treatment was performed after 10 minutes of cold compress with ice bag. Scars in both groups were treated 3 times, with an interval of 2 to 3 months. Before the treatment and 6 months after the last treatment, the Vancouver scar scale (VSS) was performed on both groups of scars score, the total score was 0 - 15. The higher the score, the more serious the scar hyperplasia was. Six months after the last treatment, the scar treatment effects of the two groups were comprehensively evaluated and divided into 3 levels: markedly effective, effective and ineffective. The total effective rate =(markedly effective + effective) number of cases/total number of cases ×100%. Patient satisfaction was investigated 6 months after the last treatment and divided into 5 levels: very satisfied, satisfied, average, dissatisfied, and very dissatisfied. Satisfaction rate =(very satisfied + satisfied) number of cases/total number of cases ×100%. The occurrence of adverse reactions was recorded throughout the treatment process. Analysis was performed using SPSS 19.0 software. Measurement data were expressed as Mean±SD, inter-group comparisons were performed using independent samples t-test, intra-group comparisons were performed using paired t-test, counting data were expressed as examples and percentages, and comparisons between the two groups were performed using χ2 test. P<0.05 indicated that the difference was statistically significant. Results:A total of 82 children with hypertrophic scars were included, 33 males and 49 females, aged 1 to 15 years old, with an area of 5 to 45 cm 2. The pathogenic factors were trauma, burns, and surgery. The course of disease was 2 to 30 months. Among them, 41 patients in the control group, 16 males and 25 females; the age was (5.8±1.6) years; 41 patients in the experimental group, 17 males and 24 females, the age was (5.6±1.5) years. There were no significant differences in age, gender, scar area, pathogenic factors and course of disease between the two groups ( P>0.05). There was no significant difference in VSS scores between the experimental group and the control group before the treatment [(9.42±1.35) points vs. (9.06±1.57) points, P>0.05]. Six months after the last treatment, there was a significant difference in VSS scores between the experimental group and the control group [(4.12±0.56) points vs. (5.50±0.75) points, P<0.01]. The VSS scores of children in both groups were significantly lower than those before the treatment ( P<0.01). Six months after the last treatment, the comprehensive evaluation result showed that the total effective rate in the experimental group was higher than that in the control group [92.7%(38/41) vs. 75.6%(31/41), P<0.05]. Six months after the last treatment, the patient satisfaction survey showed that the satisfaction rate in the experimental group was higher than that in the control group [87.8%(36/41) vs. 58.5%(24/41), P<0.01]. The main adverse reactions during treatment included edema erythema, skin ruptures, skin atrophy, and vigorous hair growth. There was no significant difference in the incidence of adverse reactions between the experimental group and the control group [12.2%(5/41) vs. 7.3%(3/41), P>0.05]. Conclusion:Local injection of triamcinolone acetonide acetate combined with ultra-pulsed CO 2 fractional laser is more effective in treating children’s hypertrophic scars. It can significantly improve the appearance of scars, reduce clinical symptoms, with fewer adverse reactions, and high patient satisfaction.