Objective The Hybrid Education Competence Instrument(HybridEduCom)was sinicized,and its reliability and validity were tested.Methods The translation,cultural adjustment and pre-investigation of HybridEduCom were followed by the Brislin translation model.The reliability and validity of the HybridEduCom was tested by surveying 553 educators in medical and nursing related fields by convenience sampling from March to April 2024.Results The Chinese version of HybridEduCom consisted of 46 items in 5 dimensions:planning and resourcing competence,technology competence,interaction competence,digital pedagogy competence,and ethical competence in the hybrid education.The confirmatory factor analysis resulted in the second-order five-factor model,with the chi-square and degree of freedom ratio being 1.274,approximate root mean square error being 0.022,goodness of fit index being 0.913,and standard fit index(NFI)being 0.934,and Tucker-Lewis and comparative fit index being 0.985.All main evaluation indexes were within the acceptable range of the judgment criteria.The item-content validity index was 0.833-1.000,and the scale-content validity index was 0.968.The Cronbach's α for the whole scale was 0.982,while varied from 0.892 to 0.936 for each dimension.The test-retest reliability of the scale was 0.978.Conclusion The reliability and validity of the Chinese version of HybridEduCom were satisfactory,and it can serve as a valid assessment instrument for the implementation of hybrid education competence of Chinese higher medical and nursing educators.

Objective:To study the resistance of Aedes albopictus to commonly used insecticides in Hangzhou, and to investigate the polymorphism distribution characteristics of voltage-gated sodium channel (VGSC) and acetylcholinesterase (AchE) 1 (Ace-1) genes in Aedes albopictus in the region, providing a scientific basis for control of Aedes albopictus in Hangzhou. Methods:From May to June 2023, Aedes albopictus larvae and pupae were collected from residential areas across divided different urban areas by directions in Hangzhou. They were reared in the laboratory, and their resistance to malathion, propoxur, pyrethroid insecticides (permethrin, deltamethrin, and beta-cypermethrin) was evaluated using the World Health Organization-recommended adult mosquito contact tube method. The 24 h mortality rates of adult mosquito of 98% - 100% was susceptible, 80% - < 98% was suspected resistance, < 80% was resistant. Genomic DNA was extracted from adult Aedes albopictus, and mutations in the VGSC and Ace-1 genes were detected through PCR amplification and Sanger sequencing. Results:The 24 h mortality rates of adult Aedes albopictus exposed to 0.5% malathion, 0.05% propoxur, 0.4% permethrin, 0.03% deltamethrin, and 0.08% beta-cypermethrin in Hangzhou were 100% (75/75), 96.00% (72/75), 41.43% (29/70), 17.33% (13/75), and 32.86% (23/70), respectively. A total of 146 surviving Aedes albopictus were tested for VGSC gene mutations at diagnostic doses of pyrethroid insecticides. Among them, 6 Aedes albopictus (4.11%) had a gene mutation at position V1016, and 146 Aedes albopictus (100%) had a gene mutation at position F1534. A total of 63 Aedes albopictus that died at diagnostic doses of pyrethroid insecticides were analyzed for VGSC gene mutations. No gene mutation was detected at position V1016, while 63 Aedes albopictus (100%) had a gene mutation at position F1534. One non synonymous mutation was detected at position V1016 of the VGSC gene, which was a heterozygous mutation of V1016V to V1016V/G. Two non synonymous mutations were detected at position F1534 of the VGSC gene, namely F1534F to F1534S or a F1534F/S heterozygous mutation. No Ace-1 gene mutation was detected in all Aedes albopictus exposed to 0.05% propoxur ( n = 75). Conclusions:The Aedes albopictus in Hangzhou has developed resistance to permethrin, deltamethrin, and beta-cypermethrin. It shows suspected resistance to propoxur and sensitivity to malathion. Moreover, a high frequency of mutations in the VGSC gene has been observed in these mosquitoes. It is crucial to enhance resistance monitoring in Aedes albopictus populations in Hangzhou and to implement the rational rotation of chemical insecticides to slow down the progress of drug resistance.

Acute lung injury (ALI) has been a kind of acute and severe disease that is mainly characterized by systemic uncontrolled inflammatory response to the production of huge amounts of reactive oxygen species (ROS) in the lung tissue. Given the critical role of ROS in ALI, a Fe₃O₄ loaded bovine serum albumin (BSA) nanocluster (BF) was developed to act as a nanomedicine for the treatment of ALI. Combining with NIR irradiation, it exhibited excellent ROS scavenging capacity. Significantly, it also displayed the excellent antioxidant and anti-inflammatory functions for lipopolysaccharides (LPS) induced macrophages (RAW264.7), and Sprague Dawley rats via lowering intracellular ROS levels, reducing inflammatory factors expression levels, inducing macrophage M2 polarization, inhibiting NF-κB signaling pathway, increasing CD4⁺/CD8⁺ T cell ratios, as well as upregulating HSP70 and CD31 expression levels to reprogram redox homeostasis, reduce systemic inflammation, activate immunoregulation, and accelerate lung tissue repair, finally achieving the synergistic enhancement of ALI immunotherapy. It finally provides an effective therapeutic strategy of BF + NIR for the management of inflammation related diseases.

Objective The Hybrid Education Competence Instrument(HybridEduCom)was sinicized,and its reliability and validity were tested.Methods The translation,cultural adjustment and pre-investigation of HybridEduCom were followed by the Brislin translation model.The reliability and validity of the HybridEduCom was tested by surveying 553 educators in medical and nursing related fields by convenience sampling from March to April 2024.Results The Chinese version of HybridEduCom consisted of 46 items in 5 dimensions:planning and resourcing competence,technology competence,interaction competence,digital pedagogy competence,and ethical competence in the hybrid education.The confirmatory factor analysis resulted in the second-order five-factor model,with the chi-square and degree of freedom ratio being 1.274,approximate root mean square error being 0.022,goodness of fit index being 0.913,and standard fit index(NFI)being 0.934,and Tucker-Lewis and comparative fit index being 0.985.All main evaluation indexes were within the acceptable range of the judgment criteria.The item-content validity index was 0.833-1.000,and the scale-content validity index was 0.968.The Cronbach's α for the whole scale was 0.982,while varied from 0.892 to 0.936 for each dimension.The test-retest reliability of the scale was 0.978.Conclusion The reliability and validity of the Chinese version of HybridEduCom were satisfactory,and it can serve as a valid assessment instrument for the implementation of hybrid education competence of Chinese higher medical and nursing educators.

Objective To investigate the effect of early closed reduction and percutaneous Kirschner wire pinning for Gartland type Ⅱ and Ⅲ pediatric supracondylar humerus fractures.Methods Clinical data of 123 children with Gartland type Ⅱ and Ⅲsupracondylar humerus fractures admitted to our hospital from January 2021 to December 2022 were retrospectively analyzed.According to the time from injury to operation,they were divided into early group(≤ 24 h)and delayed group(＞24 h).The perioperative conditions,postoperative complications,fracture healing,and elbow joint functional recovery were compared between the two groups.Results Compared to the delayed group,the early group had less operation time[(22.9±11.3)min vs.(40.3±17.5)min,t=-6.116,P=0.000],less number of intraoperative fluoroscopy[(10.6±4.5)times vs.(17.4±5.5)times,t=-7.471,P=0.000],shorter hospital stay[(3.3±1.0)d vs.(4.2±1.3)d,t=-3.866,P=0.000],and less hospitalization cost[(10 555.0±971.2)yuan vs.(10 972.4±938.9)yuan,t=-2.345,P=0.021].The rate of anatomical reduction in the early group was higher than that in the delayed group[79.0％(60/76)vs.59.6％(28/47),x2=5.354,P=0.021].No serious complications such as vascular and nerve injury,compartment syndrome,ischemic myosclerosis,myositis ossificans,or cubitus varus and valgus occurred in both group after surgery.The incidences of tension blisters[6.6％(5/76)vs.23.4％(11/47),x2=7.265,P=0.007],plaster loosening[22.4％(17/76)vs.40.4％(19/47),x2=4.574,P=0.032],and pin tract infection[2.6％(2/76)vs.14.9％(7/47),x2=4.757,P=0.029]in the early group were lower than those in the delayed group.The fracture union time,and the time to start active and full weight-bearing activities in the early group were earlier than those in the delayed group(P＜0.05).The Flynn elbow joint scores at 3 and 6 months after surgery in the early group were better than those in the delayed group(Z=-3.469,P=0.001;Z=-2.961,P=0.003).Conclusion Early closed reduction and percutaneous Kirschner wire pinning is effective in the treatment of pediatric supracondylar humerus fractures,which can shorten the operation time and hospital stay,reduce the hospitalization cost,lower the incidence of complications,and restore elbow joint function in early stage.

Objective To investigate the effect of early closed reduction and percutaneous Kirschner wire pinning for Gartland type Ⅱ and Ⅲ pediatric supracondylar humerus fractures.Methods Clinical data of 123 children with Gartland type Ⅱ and Ⅲsupracondylar humerus fractures admitted to our hospital from January 2021 to December 2022 were retrospectively analyzed.According to the time from injury to operation,they were divided into early group(≤ 24 h)and delayed group(＞24 h).The perioperative conditions,postoperative complications,fracture healing,and elbow joint functional recovery were compared between the two groups.Results Compared to the delayed group,the early group had less operation time[(22.9±11.3)min vs.(40.3±17.5)min,t=-6.116,P=0.000],less number of intraoperative fluoroscopy[(10.6±4.5)times vs.(17.4±5.5)times,t=-7.471,P=0.000],shorter hospital stay[(3.3±1.0)d vs.(4.2±1.3)d,t=-3.866,P=0.000],and less hospitalization cost[(10 555.0±971.2)yuan vs.(10 972.4±938.9)yuan,t=-2.345,P=0.021].The rate of anatomical reduction in the early group was higher than that in the delayed group[79.0％(60/76)vs.59.6％(28/47),x2=5.354,P=0.021].No serious complications such as vascular and nerve injury,compartment syndrome,ischemic myosclerosis,myositis ossificans,or cubitus varus and valgus occurred in both group after surgery.The incidences of tension blisters[6.6％(5/76)vs.23.4％(11/47),x2=7.265,P=0.007],plaster loosening[22.4％(17/76)vs.40.4％(19/47),x2=4.574,P=0.032],and pin tract infection[2.6％(2/76)vs.14.9％(7/47),x2=4.757,P=0.029]in the early group were lower than those in the delayed group.The fracture union time,and the time to start active and full weight-bearing activities in the early group were earlier than those in the delayed group(P＜0.05).The Flynn elbow joint scores at 3 and 6 months after surgery in the early group were better than those in the delayed group(Z=-3.469,P=0.001;Z=-2.961,P=0.003).Conclusion Early closed reduction and percutaneous Kirschner wire pinning is effective in the treatment of pediatric supracondylar humerus fractures,which can shorten the operation time and hospital stay,reduce the hospitalization cost,lower the incidence of complications,and restore elbow joint function in early stage.

Objective:To study the resistance of Aedes albopictus to commonly used insecticides in Hangzhou, and to investigate the polymorphism distribution characteristics of voltage-gated sodium channel (VGSC) and acetylcholinesterase (AchE) 1 (Ace-1) genes in Aedes albopictus in the region, providing a scientific basis for control of Aedes albopictus in Hangzhou. Methods:From May to June 2023, Aedes albopictus larvae and pupae were collected from residential areas across divided different urban areas by directions in Hangzhou. They were reared in the laboratory, and their resistance to malathion, propoxur, pyrethroid insecticides (permethrin, deltamethrin, and beta-cypermethrin) was evaluated using the World Health Organization-recommended adult mosquito contact tube method. The 24 h mortality rates of adult mosquito of 98% - 100% was susceptible, 80% - < 98% was suspected resistance, < 80% was resistant. Genomic DNA was extracted from adult Aedes albopictus, and mutations in the VGSC and Ace-1 genes were detected through PCR amplification and Sanger sequencing. Results:The 24 h mortality rates of adult Aedes albopictus exposed to 0.5% malathion, 0.05% propoxur, 0.4% permethrin, 0.03% deltamethrin, and 0.08% beta-cypermethrin in Hangzhou were 100% (75/75), 96.00% (72/75), 41.43% (29/70), 17.33% (13/75), and 32.86% (23/70), respectively. A total of 146 surviving Aedes albopictus were tested for VGSC gene mutations at diagnostic doses of pyrethroid insecticides. Among them, 6 Aedes albopictus (4.11%) had a gene mutation at position V1016, and 146 Aedes albopictus (100%) had a gene mutation at position F1534. A total of 63 Aedes albopictus that died at diagnostic doses of pyrethroid insecticides were analyzed for VGSC gene mutations. No gene mutation was detected at position V1016, while 63 Aedes albopictus (100%) had a gene mutation at position F1534. One non synonymous mutation was detected at position V1016 of the VGSC gene, which was a heterozygous mutation of V1016V to V1016V/G. Two non synonymous mutations were detected at position F1534 of the VGSC gene, namely F1534F to F1534S or a F1534F/S heterozygous mutation. No Ace-1 gene mutation was detected in all Aedes albopictus exposed to 0.05% propoxur ( n = 75). Conclusions:The Aedes albopictus in Hangzhou has developed resistance to permethrin, deltamethrin, and beta-cypermethrin. It shows suspected resistance to propoxur and sensitivity to malathion. Moreover, a high frequency of mutations in the VGSC gene has been observed in these mosquitoes. It is crucial to enhance resistance monitoring in Aedes albopictus populations in Hangzhou and to implement the rational rotation of chemical insecticides to slow down the progress of drug resistance.

Objective:To investigate the clinical effects of modified automatic hemorrhoidal ligation using elastic string (RPH-4) combined with Xiaozhilling injection for grade Ⅲ hemorrhoids.Methods:The prospective randomized controlled study was conducted. The clinical data of patients with grade Ⅲ hemorrhoids who underwent modified RPH-4 combined with Xiaozhiling injection in Traditional Chinese Medicine Hospital of Chongqing Shapingba District from July 2021 to December 2022 were selected. Patients with grade Ⅲ hemorrhoids who meeting the inclusion criteria were randomly divided into the experimental group and the control group using a random number table method. Patients in the experiment group underwent submucosal injection of the Xiaozhilling injec-tion followed by modified RPH-4, and patients in the control group underwent submucosal injection of the 0.9% sodium chloride solution followed by modified RPH-4. Observation indicators: (1) grouping of enrolled patients; (2) postoperative situations; (3) short-term efficacy; (4) long-term efficacy. Com-parison of measurement data with normal distribution between groups was conducted using the inde-pendent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the nonparameter test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Grouping of enrolled patients. A total of 120 patients were selected. There were 72 males and 48 females, aged 48(range, 18-69)years, including 60 cases in the experiment group and 60 cases in the control group, respectively. There was no significant difference in gender, age, type of hemorrhoids, time to hemorrhoid prolapsis, stool blood, symptom score and Wexner score between the two groups ( P>0.05), confounding bias ensured comparability. At the end of the study, there were 59 cases in the experimental group and 58 cases in the control group. (2) Postoperative situations. There were 5 cases of secondary bleeding after modified RPH-4 in the experiment group and 15 cases of secondary bleeding after modified RPH-4 in the control group, showing a significant difference between the two groups ( χ2=6.239, P<0.05). The post-operative hemorrhoidal shedding time was (6.9±1.4)days in the experiment group, versus (8.1±2.2)days in the control group, showing a significant difference between the two groups ( t=-3.566, P<0.05). (3) Short-term efficacy. There were 59 cases in the experiment group and 58 cases in the control group completing short-term follow-up. The cure rate was 88.14%(52/59) in the experiment group, versus 84.48%(49/58) in the control group, showing no significant difference in short-term efficacy between the two groups ( χ2=0.331, P>0.05). The wound healing time was (24±5)days in the experi-ment group, versus (25±5)days in the control group, showing no significant difference between the two groups ( t=-1.082, P>0.05). (4) Long-term efficacy. There were 59 cases in the experiment group and 58 cases in the control group completing long-term follow-up. None of patient in the two groups had anal incontinence. Cases of hemorrhoid recurrence (blood stool or prolapse) and cases of rectal hard segment in the experiment group were 2 and 1, respectively, and there was no anorectal stenosis. Cases of hemorrhoid recurrence (blood stool or prolapse) and cases of anorectal stenosis were 8 and 1, respectively, and there was no rectal hard segment. There was no significant difference of above situations between the two groups ( P>0.05). Conclusion:The modified RPH-4 combined with Xiaozhiling injection for grade Ⅲ hemorrhoids can achieve double solid and hemorrhoidal removal efficacy, which can further reduce the risk of complications after severe hemorrhoids modified RPH-4 alone treatment.

Objective:To investigate the resistance of Culex pipiens pallens to pyrethroid insecticides in Hangzhou City, and explore the mutation of knock down resistance (kdr) gene of Culex pipiens pallens, providing scientific basis for control of Culex pipiens pallens in the region. Methods:In September 2022, larvae and pupae of Culex pipiens pallens were collected from various locations at national monitoring sites in Shangcheng District and Gongshu District of Hangzhou City. They were bred in the laboratory and their resistance to three commonly used pyrethroid insecticides (permethrin, deltamethrin and beta-cypermethrin) was determined using the adult mosquito contact tube method and larval immersion method recommended by the World Health Organization. The genomic DNA was extracted from individual adult mosquito, and kdr gene mutation was detected via PCR amplification and Sanger sequencing. Results:The 24-hour mortality rates of adult mosquitoes of Culex pipiens pallens exposed to 0.25% permethrin, 0.025% deltamethrin, and 0.025% beta-cypermethrin were 20.00% (15/75), 17.33% (13/75), and 18.67% (14/75), respectively, indicating resistance. The resistance ratios of Culex pipiens pallens larvae to permethrin, deltamethrin, and beta-cypermethrin were 27.08, 341.00, and 15.88, respectively. Among 183 adult mosquitoes that survived under the diagnostic doses of pyrethroid insecticides, 180 mosquitoes (98.36%) had mutation at the L1014 site of the kdr gene. Among 42 adult mosquitoes that died under the diagnostic doses of pyrethroid insecticides, 5 mosquitoes (11.90%) had L1014 mutation in the kdr gene. Conclusions:Culex pipiens pallens in Hangzhou City has developed varying degrees of resistance to permethrin, deltamethrin and beta-cypermethrin, with a high frequency of kdr gene mutation in resistant mosquitoes. We should strengthen the monitoring of the resistance of Culex pipiens pallens in Hangzhou City and use chemical insecticides reasonably.

Objective:To investigate the distribution and seasonal fluctuations of flies in Hangzhou, study the resistance of Musca domestica ( M. domestica) to five commonly used sanitary insecticides and changing patterns in Hangzhou and provide a basis for scientific control of flies. Methods:From April to November 2023, the cage trap method was used for ecological monitoring of flies. From May to June 2023, the swing net method was used to collect M. domestica from various districts (counties and cities) in Hangzhou. After indoor breeding, the resistance of F1 generation female adult flies to five commonly used sanitary insecticides was determined using the micro-drop method. Probit regression model was used to calculate the median lethal dose (LD 50), 95% confidence interval ( CI) and virulence regression equation. Results:In 2023, the fly density in Hangzhou was 5.99 flies/cage, with a higher density of flies belonging to the Sarcophagus family (2.39 flies/cage), making it the dominant fly species in Hangzhou. Among different monitoring points, the fly density in Linping District was relatively high (20.97 flies/cage). In different habitats, the fly density in agricultural markets was relatively high (fly density from April to November: 2.86, 5.39, 8.86, 16.86, 31.32, 6.39, 3.75 and 1.89 flies/cage). The seasonal fluctuation of fly density showed a unimodal pattern, with the higher density in August (13.45 flies/cage). The M. domestica population in Hangzhou was sensitive to dichlorvos [resistance ratio ( RR): 3.08 times]. Different degrees of resistance were developed to propoxur, deltamethrin, beta-cypermethrin, and beta-cyhalothrin. The degree of resistance from high to low was propoxur (> 336.36 times), beta-cypermethrin (906.61 times), beta-cyhalothrin (432.29 times), and deltamethrin (72.56 times). Based on the monitoring results from 2003 to 2023, the RR of dichlorvos reached the higher level in 2008 (33.47 times) and gradually decreased to a sensitive level. The resistance level of propoxur had been at an extremely high level over the years. Three types of pyrethroid insecticides all had high resistance. Conclusions:The species of flies in the Sarcophagus family are the dominant population in Hangzhou, and M. domestica has developed high resistance to four commonly used insecticides except for dichlorvos. The use of physical control techniques is advocated to reduce the use of chemical pesticides, and prevent the continuous increase of resistance in M. domestica.