Objective: To analyze the epidemiological characteristics and influencing factors of severe fever with thrombocytopenia syndrome (SFTS) in Zhejiang Province from 2019 to 2023, so as to provide the reference for strengthening SFTS prevention and control. Methods: Data on laboratory-confirmed SFTS cases in Zhejiang Province from 2019 to 2023 were collected through the Infectious Disease Reporting Information System of Chinese Disease Prevention and Control Information System. Meteorological data, geographic environment and socioeconomic factors during the same period were collected from the fifth-generation European Centre for Medium-Range Weather Forecasts, Geospatial Data Cloud, and Zhejiang Statistical Yearbook, respectively. Descriptive epidemiological methods were used to analyze the epidemiological characteristics of SFTS from 2019 to 2023, and a Bayesian spatio-temporal model was constructed to analyze the influencing factors of SFTS incidence. Results: A total of 578 SFTS cases were reported in Zhejiang Province from 2019 to 2023, with an annual average incidence of 0.23/105. The peak period was from May to July, accounting for 52.60%. There were 309 males and 269 females, with a male-to-female ratio of 1.15∶1. The cases were mainly aged 50-<80 years, farmers, and in rural areas, accounting for 82.53%, 77.34%, and 75.43%, respectively. Taizhou City and Shaoxing City reported more SFTS cases, while Shaoxing City and Zhoushan City had higher annual average incidences of SFTS. The Bayesian spatio-temporal interaction model showed good goodness of fit. The results showed that mean temperature (RR=1.626, 95%CI: 1.111-2.378) and mean wind speed (RR=1.814, 95%CI: 1.321-2.492) were positively correlated with SFTS risk, while altitude (RR=0.432, 95%CI: 0.230-0.829) and population density (RR=0.443, 95%CI: 0.207-0.964) were negatively correlated with SFTS risk. Conclusions SFTS in Zhejiang Province peaks from May to July. Middle-aged and elderly people and farmers are high-risk populations. Taizhou City, Shaoxing City, and Zhoushan City are high-incidence areas. Mean temperature, mean wind speed, altitude, and population density can all affect the risk of SFTS incidence.

In the context of the modernization of traditional Chinese medicine （TCM）， the inheritance of the experiences of famous doctors faces significant challenges due to its complex nonlinear characteristics and dynamic evolution. There are still issues in the current inheritance system， such as the homogenization of talent cultivation models， lack of standardized mentoring practices， and monotonous evaluation method， which hinder the systematic inheritance and innovative development of famous doctors' experiences. Based on a systematic review of the current state of artificial intelligence （AI）-assisted inheritance of famous doctors' experiences， this study explores innovative pathways for deep integration of modern information technologies with famous doctors' experiences from key dimensions， including data authenticity assurance， interdisciplinary collaboration mechanisms， and the establishment of dynamic inheritance standards. It proposes a paradigm shift in the inheritance of TCM famous doctors' experiences in the AI era， aiming to build a new TCM inheritance system of "digital intelligence empowerment and cross-disciplinary innovation"， providing theoretical support and practical pathways for the inheritance of famous doctors' experiences in TCM.

The abnormal accumulation of neutrophil extracellular traps （NETs） can promote the initiation and progression of pancreatic cancer， which is considered a potential therapeutic target for this disease. The Miraculous Pivot·Inquiry About Statement （《灵枢·口问》） have recorded the concept of "defensive qi stagnation". Based on the recognition that the function of defensive qi is similar to the immune function of neutrophils， and combining traditional Chinese medicine theory with clinical practice， it is proposed that the abnormal accumulation of NETs may be a pathological product of "defensive qi stagnation"， with the spleen being the critical site of pathology. Further exploring the application strategy of cleaning spleen and restoring defensive qi method in pancreatic cancer treatment， it is proposed to employ three approaches such as dredging method to eliminate spleen stagnation and inhibit pancreatic cancer proliferation， cleaning method to remove spleen dampness and suppress the inflammatory micro-environment， and tonifying method to strengthen Weiqi and to improve the immune microenvironment， which aims to provide new insights for the clinical treatment of pancreatic cancer with traditional Chinese medicine.

Objective: To explore the prospective association between multidimensional sleep indicators and the risk of newlyonset dental caries, providing a reference for childrens oral healthrelated sleep intervention. Methods: In October 2021, 1 417 students in grades 1 to 4 (aged 6 to 11) from two elementary schools in Bengbu, Anhui Province, were selected by cluster sampling method. Surveys and followup visits were conducted at baseline (T1), November 2022 (T2), May 2023 (T3), and November 2023 (T4), respectively, including parental questionnaires, oral health and physical examination. Bedtime, sleep duration, sleep midpoint, social jet lag, weekend catchup sleep, and sleep habits were collected and calculated. A multifactorial Cox proportional risk regression model was used to analyze the association between multidimensional sleep indicators and newlyonset caries in schoolaged children after 2 years. Results: The prevalence of dental caries in children was 65.1% at baseline, and the prevalence was 59.0% at the end of the 2year followup. Cox proportional risk regression model showed that for every 1point increase in the childrens bedtime resistance, nocturnal awakenings, parasomnias, and daytime sleepiness scores, the risk of newlyonset caries increased by 12% (HR=1.12, 95%CI=1.08-1.15), 22% (HR=1.22, 95%CI=1.15-1.29), 12% (HR=1.12, 95%CI=1.08-1.17), and 15% (HR=1.15, 95%CI=1.12-1.19), respectively; the risk of newlyonset caries increased by 23% for each 1 h increase in the length of weekend catchup sleep (HR=1.23, 95%CI=1.14 -1.33); compared with children who went to bed before 21:00 on school days, those who went to bed later than 22:00 had a 57% higher risk of newlyonset caries (HR=1.57, 95%CI=1.22-2.03). Compared to children who slept adequately (≥9 h/d), those with insufficient sleep had a 67% higher risk of new caries (HR=1.67, 95%CI=1.43-1.95) (P<0.01). Conclusions These findings suggest a significant association between sleep patterns/sleep disorders and the development of childhood dental caries. Incorporating sleep behavior optimization and sleep quality improvement into comprehensive caries prevention and oral health management protocols may represent a promising intervention strategy to enhance childrens oral health outcomes.

Objective: To investigate the impact of temperature changes between neighboring days (TCN) on the mortality risk of respiratory diseases, so as to provide the evidence for the study of deaths from respiratory diseases caused by climate change. Methods: The monitoring data of deaths from respiratory diseases in Zibo City from 2015 to 2019 were collected from Shandong Provincial Management Information System for Chronic Diseases and Cause of Death Surveillance. The meteorological and air pollutant data of the same period were collected from China Meteorological Data Website and ChinaHighAirPollutants dataset. The effect of TCN on the risk of deaths from respiratory diseases was examined using a generalized additive model combined with a distributed lag non-linear model, and subgroup analyses for gender and age were conducted. The disease burden attributed to TCN at different intervals was assessed by calculating attributable fraction. Results: Totally 11 767 deaths from respiratory diseases were reported in Zibo City from 2015 to 2019, including 6 648 males (56.50%) and 5 119 females (43.50%). There were 1 307 deaths aged <65 years (11.11%), and 10 460 deaths aged 65 years and older (88.89%). A monotonically increasing exposure-response relationship was observed between TCN and deaths from respiratory diseases in the general population, females, and the population aged 65 years and older. The 95th percentile of TCN (P95, 3.84 ℃) reached the peak at a cumulative lagged of day 11 (RR=2.063, 95%CI: 1.261-3.376). The results of subgroup analyses showed greater impacts on females and the population aged 65 years and older, with cumulative lagged effects peaking at day 12 (RR=3.119, 95%CI: 1.476-6.589) and day 11 (RR=2.107, 95%CI: 1.260-3.523). The results of attributional risk analysis showed that next-day warming might increase the attributable risk of deaths from respiratory diseases, and next-day cooling might decrease the attributable risk. Conclusion Next-day warming may increase the mortality risk of respiratory diseases, and has greater impacts on females and the population aged 65 years and older.

Objective:To explore the predictive value of nutrition risk screening score 2002 (NRS-2002) and L3 skeletal muscle index (L3-SMI) for mortality within 90 days in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF).Methods:A retrospective analysis was conducted on 162 cases with HBV-ACLF who were diagnosed and treated at the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2023. Patients were divided into a survival and death group according to the 90-day survival status following diagnosis, and the clinical data between the two groups were compared. Binary logistic regression analysis was used to screen out the influencing factors related to the occurrence of mortality events. The receiver operating characteristic (ROC) curve was plotted to compare the predictive value of NRS-2002 and L3-SMI for mortality within 90 days in patients with HBV-ACLF.Results:There were statistically significant differences in lymphocyte count (LY), platelet (PLT), total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, international normalized ratio (INR), total bilirubin (TBil), urea, model for end-stage liver disease (MELD) score, NRS-2002 score, and L3-SMI between the death and the survival group ( P<0.05). Multivariate analysis showed that higher levels of INR [odds ratio ( OR)=4.412, 95% confidence interval ( CI): 1.974-9.959, P<0.001], TBil ( OR=1.004, 95% CI: 1.001-1.007, P<0.05), MELD score ( OR=1.148, 95% CI: 1.071-1.232, P<0.001), NRS-2002 score ( OR=1.526, 95% CI: 1.194-1.950, P<0.05), and lower levels of LY ( OR=0.351, 95% CI: 0.103-0.755, P<0.01), and L3-SMI ( OR=0.902, 95% CI: 0.854-0.953, P<0.001) were independent risk factors for 90-day mortality in patients with HBV-ACLF. The ROC curve showed that AUCL3-SMI was 0.706 and AUCNRS-2002 was 0.712. Multivariate logistic analysis showed that the optimal cutoff point for the prediction of 90-day mortality was 0.5. The area under the ROC curve was 0.841 (95% CI: 0.763-0.926), which was significantly higher than the single application of the MELD, NRS-2002, and L3-SMI indicators. Conclusion:The 90-day mortality risk has a correlation with low L3-SMI and high NRS-2002 scores in patients with HBV-ACLF. The SNM model has a certain predictive value for mortality within 90 days in patients with HBV-ACLF.

Objective:To explore the predictive value of nutrition risk screening score 2002 (NRS-2002) and L3 skeletal muscle index (L3-SMI) for mortality within 90 days in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF).Methods:A retrospective analysis was conducted on 162 cases with HBV-ACLF who were diagnosed and treated at the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2023. Patients were divided into a survival and death group according to the 90-day survival status following diagnosis, and the clinical data between the two groups were compared. Binary logistic regression analysis was used to screen out the influencing factors related to the occurrence of mortality events. The receiver operating characteristic (ROC) curve was plotted to compare the predictive value of NRS-2002 and L3-SMI for mortality within 90 days in patients with HBV-ACLF.Results:There were statistically significant differences in lymphocyte count (LY), platelet (PLT), total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, international normalized ratio (INR), total bilirubin (TBil), urea, model for end-stage liver disease (MELD) score, NRS-2002 score, and L3-SMI between the death and the survival group ( P<0.05). Multivariate analysis showed that higher levels of INR [odds ratio ( OR)=4.412, 95% confidence interval ( CI): 1.974-9.959, P<0.001], TBil ( OR=1.004, 95% CI: 1.001-1.007, P<0.05), MELD score ( OR=1.148, 95% CI: 1.071-1.232, P<0.001), NRS-2002 score ( OR=1.526, 95% CI: 1.194-1.950, P<0.05), and lower levels of LY ( OR=0.351, 95% CI: 0.103-0.755, P<0.01), and L3-SMI ( OR=0.902, 95% CI: 0.854-0.953, P<0.001) were independent risk factors for 90-day mortality in patients with HBV-ACLF. The ROC curve showed that AUCL3-SMI was 0.706 and AUCNRS-2002 was 0.712. Multivariate logistic analysis showed that the optimal cutoff point for the prediction of 90-day mortality was 0.5. The area under the ROC curve was 0.841 (95% CI: 0.763-0.926), which was significantly higher than the single application of the MELD, NRS-2002, and L3-SMI indicators. Conclusion:The 90-day mortality risk has a correlation with low L3-SMI and high NRS-2002 scores in patients with HBV-ACLF. The SNM model has a certain predictive value for mortality within 90 days in patients with HBV-ACLF.

Endothelial cells in the inner wall of blood vessels respond to physical and chemical signals of the body by regulating vascular homeostasis， vascular tension， cell adhesion， cell proliferation， coagulation resistance and inflammatory factors， to maintain the stability of blood vessels. Angiogenesis is the key condition for tumor evolution， and the pathological mode of tumor angiogenesis provides nutrients and oxygen for tumor growth and promotes its proliferation. In recent years， endothelial cells have participated in tumor vascular infiltration and driven angiogenesis， which is considered to be the point link in tumor metastasis. By regulating metabolic remodeling， vascular endothelial cells provide the materials and energy needed in the process of tumor angiogenesis， and their abnormal metabolic characteristics facilitate their adaption to the changes of tumor microenvironment， which is often regarded as an important basis for tumor angiogenesis. The ''Yin fire'' theory in traditional Chinese medicine， originating from Huangdi's Internal Classic （Huang Di Nei Jing）， originally meant Yin deficiency generates internal heat， and belonged to the category of fire of internal injury. After the deduction and changes by physicians over the ages， the pathogenesis of ''spleen and stomach Qi deficiency-Yin fire rising-Qi and fire disharmony'' was gradually formed. The pathogenesis of metabolic remodeling of endothelial cells manifests the pathological characterization of Yin fire in an objective way， which is consistent with the disease state of uncontrolled and hyperactive tumor neovascularization. Changes in spleen and stomach Qi deficiency as well as imbalance of Qi movement lead to the failure of water and food in distribution， and thus metabolic disorders occur. Long term retention turns in phlegm and blood stasis， which combat with blood vessels， and result in abnormal local environment （formation of tumor microenvironment）， adverse pulse channel （imbalance of endothelial cell metabolism）， and tumor neovascularization. Under the guidance of ''Yin fire'' syndrome elements and by focusing on the correlation between Qi and fire， prescriptions are made based on the treatment method of ''strengthening the body and regulating Qi'' to regulate the metabolic function of endothelial cells， thus achieving a relatively balanced state of the body and inhibiting tumor angiogenesis. As a result， this study， centering on the metabolic remodeling of endothelial cells and ''Yin fire'' theory， elucidated the academic ideas， with the purpose of providing some theoretical support for the intervention of tumor vascularization by Chinese medicine.

Objective To evaluate the migration of plutonium aerosol caused by α recoil. Methods In this paper, the recoil deposition and Brownian motion of plutonium-containing nanoaerosols were simulated by Monte Carlo method. The recoil angle and the vertical first landing time of Brownian motion in the process of settling were sampled, and then the lateral displacements of Brownian motion were sampled to determine the final settling position of aerosol. Results For aerosols with particle sizes of 10-50 nm, the maximum migration distance of a single recoil settling was 1.39 μm. Brownian motion increased the migration capacity. Although there was a high likelihood that aerosols settled within 100 μm, there remained a slight probability of long-term suspension in the air. Conclusion The α recoil is one of the mechanisms of plutonium aerosol migration. An important mechanism for long-distance migration of nanoaerosols is that Brownian motion after recoil may cause them to suspend for a long time.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.