Objective: To analyze the etiological surveillance results of influenza-like illness (ILI) cases in Jiangsu Province, and investigate the distribution characteristics of different influenza virus types, so as to provide the evidence for improving influenza prevention and control measures. Methods: Influenza laboratory testing data for sentinel surveillance of ILI cases in Jiangsu Province from 2019 to 2024 were collected through the China Influenza Surveillance Information System. The positive detection rate of influenza virus was calculated, and descriptive analysis was performed to characterize the distribution of different influenza virus types. Using the farthest neighbor linkage method, influenza virus positive detection rates clustering was analyzed by year and week. Clusters were defined based on inter-cluster distance, and the intensity of the positive detection rate was visualized through color gradients in the clustering heatmap. Results: From 2019 to 2024, a total of 183 878 ILI specimens were collected in Jiangsu Province. Among them, 20 059 specimens tested positive for influenza virus, corresponding to an overall positive detection rate of 10.91%, and an average annual positive detection rate of 10.89%. The primary circulating influenza virus types were influenza A H3N2 subtype, accounting for 40.92%, followed by influenza B Victoria linage at 34.00%, and influenza A H1N1 subtype at 24.80%. Influenza B Yamagata linage was not detected throughout the five-year period. Influenza A H3N2 subtype predominated during two distinct periods: from January to March 2019, and from June 2022 to December 2023. Influenz B Victoria linage was the dominant type from April 2019 to May 2022 and again from January to April 2024. Influenza A H1N1 subtype emerged as the primary type from May to December 2024. Year-based clustering analysis grouped the annual positive detection rates from 2019 to 2024 into three clusters. The closest cluster distance was observed between 2019 and 2024. The highest annual positive detection rate occurred in 2023. Both influenza A H3N2 and H1N1 subtype each formed a single cluster, with their peak positive detection rates also recorded in 2023. Influenza B Victoria lineage was separated into two clusters, with its highest positive detection rate occurring in 2020. Week-based clustering analysis revealed that influenza virus detection was concentrated in weeks 47 to 52 and weeks 1 to 15. More specifically, the positive detection rates for influenza A H3N2 subtype peaked during weeks 30 to 34 and weeks 42 to 52; for influenza A H1N1 subtype, during weeks 9 to 15 and weeks 51 to 52; and for influenza B Victoria lineage, during weeks 1 to 11 and weeks 50 to 52. Conclusions From 2019 to 2024, the average annual positive detection rate of influenza virus in Jiangsu Province remained relatively low. Influenza activity characterized by the alternating circulation of influenza A H1N1 subtype, influenza A H3N2 subtype, and influenza B Victoria linage. It is necessary to maintain the surveillance sensitivity for the influenza B Yamagata lineage.

The construction of a training system for visiting physicians in the department of rare diseases in China is an important measure to improve the overall diagnosis and treatment capacity for rare diseases and address the critical challenge of insufficient knowledge and skills among clinicians in practice. This article systematically describes the visiting physician training system established by the Department of Rare Diseases at Peking Union Medical College Hospital. It summarizes the training objectives and positioning, design logic, and learning modules of the system, aiming to provide a reference for the construction of the specialized talent team for rare diseases in China.

ObjectiveTo clearly identify the difference between rescue injuries and agonal injuries and to avoid duplicate identifications and misidentifications. MethodsBased on the forensic pathological data of 5 923 cases of death cause identification from 2013 to 2022 in Sun Yat-sen University Forensic Identification Center and Guangzhou Tianhe District Branch of Guangzhou Public Security Bureau， this study retrospectively studied the characteristics of rescue injuries and agonal injuries seen in cause of death identification and their influence on cause of death identification. ResultsAmong all the 5 923 cases， 640 cases were found to have rescue injuries or agonal injuries， and 624 cases received treatment， of which 609 cases were found to have rescue injuries （97.60%）， 44 cases were found to have agonal injuries， and 13 cases were found to have both types of injuries. Among the 640 cases， 441 were male and 199 were female. The age of death was discontinuously distributed from 0 to 95 years old. The leading cause of death was disease， followed by mechanical injury and asphyxia. The main manifestations of rescue injuries were rib and sternum fractures， soft tissue injuries in the prechest area or face， and pericardial rupture. The most common injuries in agonal stage were falling after unconsciousness， inhalation of foreign body in respiratory tract or multiple violent injuries. Among the 640 cases， 19 cases were repeatedly identified， including 15 cases of rescue injuries， 6 cases of agonal injuries， and 2 cases of both types of injuries. Compared with the cases where neither type of injuries was detected， the repeated identification rate of treatment injuries and agonal injuries was significantly increased （χ²=4.04， P=0.044； χ²=43.49， P<0.001）. Among the 640 cases， 11 cases （1.72%） were misidentified as the initial injuries in the first identification， and 13 cases had combined rescue injuries or agonal injuries that were involved in death. ConclusionsBy elucidating the epidemiological characteristics of the two types of injuries， this study proved that the two types of injuries were associated with higher rates of repeated identification and misidentification， which provided a reference for reducing repeated identification and misidentification and improving the accuracy of cause of death identification.

ObjectiveTo analyze the prevalence and influencing factors of overweight and obesity among primary school students in a community of Fengxian District, Shanghai, and to provide references for formulating prevention and control strategies against overweight and obesity. MethodsData on height and weight of all primary school students in a community in Fengxian District, Shanghai, in 2023 were obtained by physical examination, and 1 759 primary school students were included according to the entry criteria. Overweight and obesity were determined using body mass index (BMI). Additionally, a questionnaire survey was performed to 1 045 students to collect their demographic characteristics, dietary behaviors, dietary habits, sleep and physical activity information. Chi-square test and logistic regression analysis were used to analyze the influencing factors of overweight and obesity. ResultsIn 2023, among the 1 759 primary school students in the community in Fengxian District, 923 (52.47%) were male and 836 (47.53%) were female, with an overweight/obesity detection rate of 28.08%. The detection rate of overweight and obesity was 33.37% in males and 22.25% in females, which was significantly higher in males than that in females (χ²=26.845, P<0.001). Students aged 10‒12 years had a higher overweight/obesity detection rate (32.55%) than those aged 6‒<10 years (26.53%), and the difference was statistically significant (χ²=10.925, P<0.001). Logistic regression analysis revealed that being female, with young age, parental education level of bachelor’s degree and above, a high global dietary recommendation healthy (GDR-healthy) score, preference for vegetables and sweeter home-cooked meals, and a slow eating speed were negatively correlated with overweight/obesity. Whereas, parental overweight and obesity, binge eating, and a faster eating pace than same-age, same-gender peers may be positively correlated with overweight/obesity. ConclusionThe detection rate of overweight and obesity among primary school students in the community in Fengxian District of Shanghai is higher than the national level. Gender, age, parental BMI, parental education level, dietary behaviors and habits are the main influencing factors of overweight/obesity among primary school students.

BACKGROUND: Generalized pustular psoriasis (GPP), a rare and recurrent autoinflammatory disease, imposes a substantial burden on patients and society. Awareness of GPP in China remains limited. METHODS: This cross-sectional survey, conducted between September 2021 and May 2023 across 14 hospitals in China, included GPP patients of all ages and disease phases. Data collected encompassed demographics, clinical characteristics, economic impact, disease severity, quality of life, and treatment-related complications. Risk factors for GPP recurrence were analyzed. RESULTS: Among 127 patients (female/male ratio = 1.35:1), the mean age of disease onset was 25 years (1st quartile [Q1]-3rd quartile [Q3]: 11-44 years); 29.2% had experienced GPP for more than 10 years. Recurrence occurred in 75.6% of patients, and nearly half reported no identifiable triggers. Younger age at disease onset ( P  = 0.021) and transitioning to plaque psoriasis ( P  = 0.022) were associated with higher recurrence rates. The median diagnostic delay was 8 months (Q1-Q3: 2-41 months), and 32.3% of patients reported misdiagnoses. Comorbidities were present in 53.5% of patients, whereas 51.1% experienced systemic complications during treatment. Depression and anxiety affected 84.5% and 95.6% of patients, respectively. During GPP flares, the median Dermatology Life Quality Index score was 19.0 (Q1-Q3: 13.0-23.5). This score showed significant differences between patients with and without systemic symptoms; it demonstrated correlations with both depression and anxiety scores. Treatment costs caused financial hardship in 55.9% of patients, underscoring the burden associated with GPP. CONCLUSIONS The substantial disease and economic burdens among Chinese GPP patients warrant increased attention. Patients with early onset disease and those transitioning to plaque psoriasis require targeted interventions to mitigate the high recurrence risk.
Humans ; Male ; Female ; Psoriasis/pathology* ; Adult ; Cross-Sectional Studies ; Adolescent ; Child ; Young Adult ; Quality of Life ; Middle Aged ; China/epidemiology* ; Recurrence ; Risk Factors ; Surveys and Questionnaires ; East Asian People

Objective To investigate the effect of ATP synthase inhibitory factor 1 (ATPIF1) on the antitumor activity of chimeric antigen receptor (CAR)-NK92 cells. Methods HER2-targeted CAR-NK92 cells with ATPIF1 overexpression or knockdown were constructed. CAR-positive expression rate was detected by flow cytometry. Cell proliferation capacity was measured using CCK-8 assay. Glycolytic capacity was analyzed by Seahorse metabolic analyzer. Mitochondrial membrane potential levels were detected using JC-1 probe. Target cell lysis rate was evaluated by firefly luciferase reporter assay. Expression levels of CD107a, natural-killer group 2 member D (NKG2D), granzyme B (GzmB), perforin, and interleukin 2 (IL-2) were detected via flow cytometry. Quantitative real-time PCR was used to measure the expression of interferon-induced protein with tetratricopeptide repeats 1 (IFIT1), tumor necrosis factor α (TNF-α), ATPIF1, and hexokinase 1 (HK1). The impact of glycolytic inhibition by 2-Deoxy-D-glucose (2-DG) on CAR-NK92 antitumor capacity was examined. Results Successfully generated HER2-targeting control CAR-NK92 cells, as well as ATPIF1-overexpressing and ATPIF1 knockdown CAR-NK92 cells. The ATPIF1-overexpressing CAR-NK92 cells showed significantly enhanced target cell lysis rate, elevated expression levels of NKG2D and CD107a, increased secretion capacities of Granzyme B (GzmB) and IL-2, and upregulated mRNA expression levels of IFIT1 and TNF-α, while ATPIF1-knockdown cells exhibited opposite effects. ATPIF1 overexpression induced metabolic reprogramming in CAR-NK92 cells, manifested by significantly decreased mitochondrial membrane potential (δpsim), markedly upregulated HK1 mRNA expression, and enhanced basal glycolysis and glycolytic capacity. After glycolysis inhibition with 2-DG (5 μmol/L), both ATPIF1-overexpressing and knockdown CAR-NK92 cells showed no significant differences in NKG2D and CD107a expression levels compared to control cells. Conclusion ATPIF1 regulates the antitumor activity of CAR-NK92 cells through modulating glycolytic metabolism. Overexpression of ATPIF1 can enhance the antitumor efficacy of CAR-NK92 cells.
Humans ; Glycolysis ; Killer Cells, Natural/metabolism* ; Receptors, Chimeric Antigen/immunology* ; Granzymes/genetics* ; Hexokinase/metabolism* ; Cell Line, Tumor ; Interleukin-2/genetics* ; Cell Proliferation ; NK Cell Lectin-Like Receptor Subfamily K/genetics* ; Membrane Potential, Mitochondrial

Natural killer cells(NK)are important innate immune cells that do not require prior antigen exposure and can directly recognize and attack virus-infected cells and tumor cells.The activation and effector functions of NK cells are regulated by a balance of signals delivered through their surface activating receptors and inhibitory re-ceptors,which bind to ligands on target cells to achieve cytotoxicity via"induced self"and"missing self"recogni-tion models.The killing mechanisms of NK cells primarily include release of cytotoxic granules such as perforin and granzymes to induce target cell lysis,death receptor-mediated apoptosis,secretion of various cytokines,chemokines and growth factors to coordinate with other immune cells in killing tumor cells,thereby generating secondary im-mune responses and antibody-dependent cellular cytotoxicity(ADCC).

Objective To explore the influencing factors of cognitive impairment in non-dialysis patients with chronic kidney disease(CKD).Methods A total of 60 hospitalized non-dialysis patients with CKD in the Department of Nephrology of Northern Jiangsu People's Hospital Affiliated to Yangzhou University from September 2022 to September 2023 were enrolled as research objects.According to the estimated glomerular filtration rate(eGFR),they were divided into stage 1 to 2 of CKD group[eGFR ≥60 mL/(min·1.73 m2)]with 23 cases,the stage 3 of CKD group[eGFR 30～＜60 mL/(min·1.73 m2)]with 20 cases,and stage 4 to 5 of CKD group[eGFR＜30 mL/(min·1.73 m2)]with 17 cases.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate the cognitive function of the patients.Basic data and common clinical laboratory in-dicators on hospital admission were collected to analyze the differences in cognitive function levels under different renal function statuses and to explore the influencing factors of cognitive impairment.Results The incidence rates of cognitive impairment in the stage 1 to 2 of CKD group,stage 3 of CKD group,and stage 4 to 5 of CKD group were 47.8％,85.0％,and 94.1％respectively,the median MoCA scored 26,24 and 20 respectively,with statistically significant between-group differ-ences(P＜0.05).Cognitive function was significantly negatively correlated with age(r=-0.634,P＜0.001),blood urea nitrogen(BUN)(r=-0.574,P＜0.001),serum creatinine(Cr)(r=-0.417,P＜0.001),cystatin C(Cys-C)(r=-0.327,P=0.011),serum β2-microglobulin(β2-MG)(r=-0.259,P=0.046),and N-terminal pro-brain natriuretic peptide(NT-proBNP)(r=-0.474,P＜0.001),and was significantly positively correlated with hemoglobin(HB)(r=0.401,P=0.001)and eGFR(r=0.485,P＜0.001).Multivariate Logistic regression analysis showed that age(P=0.006)and NT-proBNP(P=0.041)were influencing factors of cognitive im-pairment in non-dialysis patients with CKD.Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC),sensitivity,and specificity of age for prediction were 0.860,0.864 and 0.812 respectively,the AUC,sensitivity,and specificity of NT-proBNP for pre-diction were 0.808,0.795 and 0.875 respectively,and the combined prediction of age and NT-proBNP had an AUC,sensitivity,and specificity of 0.893,0.955,and 0.750,respectively.Conclusion As renal function deteriorates,the incidence rate and severity of cognitive impairment in non-dialysis patients with CKD tend to increase.Advanced age,renal function deterioration,high NT-proBNP level,and anemia are associated with the occurrence of cognitive impairment in non-di-alysis patients with CKD,among which age and NT-proBNP are influencing factors for cognitive im-pairment.

Objective:To evaluate the clinical outcomes of arthroscopic debridement combined with in situ ulnar nerve release in patients with osteoarthritic elbow stiffness complicated by tardy ulnar neuritis.Methods:A retrospective chart review was conducted on 36 patients with osteoarthritic elbow stiffness and tardy ulnar neuritis who underwent arthroscopic debridement and in situ ulnar nerve release between January 2018 and October 2022. The mean patient age was 51.3±6.5 years (range: 40-62 years), with 29 males and 7 females. The procedure was performed on 28 right and 8 left elbows, all on the dominant side. Radiographic classification of elbow osteoarthritis (OA) revealed 16 cases of Kellgren-Lawrence grade II, 15 cases of grade III, and 5 cases of grade IV. The duration of OA was 4.2±1.8 years (range: 2-8 years), and the duration of ulnar nerve compression symptoms was 4.6±3.2 months (range: 2 months-1 year). Elbow function and pain were assessed preoperatively and 12 months postoperatively using flexion-extension range of motion, the Mayo Elbow Performance Index (MEPI), and the Visual Analogue Scale (VAS) for pain. Ulnar nerve function was evaluated through grip strength, pinch strength, two-point discrimination of the little finger, and motor and sensory nerve conduction velocities (MNCV and SNCV).Results:The mean operation time was 151.4±16.2 minutes (range: 125-180 minutes), with an average hospital stay of 6.5±1.0 days (range: 5-8 days). One patient (2.8%) experienced skin necrosis at the ulnar nerve release incision, while all other incisions healed at the first stage. At the 12-month follow-up, significant improvements were observed in elbow extension [26.00° (20.00°, 30.00°) vs. 6.00° (5.00°, 10.00°), Z=-5.235, P<0.001], flexion range of motion [98.00° (88.25°, 100.00°) vs. 120.50° (109.00°, 128.00°), Z=-5.234, P<0.001], VAS pain scores (7.5±0.9 vs. 1.8±0.8, t=32.788, P<0.001), and MEPI [32.50 (26.25, 43.75) vs. 85.00 (80.00, 85.00), Z=-5.269, P<0.001]. Improvements in grip strength (24.1±2.4 N vs. 35.0±2.7 N, t=30.745, P<0.001), pinch strength (16.2±1.3 N vs. 23.8±1.7 N, t=40.239, P<0.001), two-point discrimination [16.00 (14.00, 18.00) mm vs. 5.00 (3.00, 7.00) mm, Z=-5.270, P<0.001], and MNCV (27.5±3.0 m/s vs. 41.6±3.0 m/s, t=53.673, P<0.001) / SNCV (25.1±2.7 m/s vs. 35.0±2.9 m/s, t=47.538, P<0.001) were also noted. At the 12-month follow-up, 5 patients (13.9%) had an elbow extension lag greater than 15° (range: 18°-20°), though elbow flexion recovered to at least 100°, sufficient for daily activities. One patient (2.8%) had incomplete relief of ulnar nerve symptoms postoperatively, but was generally satisfied with the outcome. Three patients (8.3%) experienced temporary worsening of ulnar nerve symptoms during rehabilitation, which improved with adjusted exercise routines, and the symptoms resolved by the 1-year follow-up. Conclusion:Arthroscopic debridement combined with in situ ulnar nerve release is a safe and effective treatment for osteoarthritic elbow stiffness complicated by tardy ulnar neuritis. This minimally invasive procedure is associated with a low complication rate and yields significant functional improvements.

Objective:To investigate the clinical efficacy of unicompartmental knee arthroplasty (UKA) in the treatment of medial compartment knee osteoarthritis (OA) with concomitant lateral discoid meniscus.Methods:A retrospective analysis was conducted on 13 patients (16 knees) who underwent UKA for medial compartment OA of the knee associated with lateral discoid meniscus at Central Hospital of Cangzhou between January 2016 and July 2021. The mean age of the patients was 59.1±7.7 years (range, 49-74 years), with a mean body mass index (BMI) of 28.9±1.7 kg/m 2 (range, 25.2-31.3 kg/m 2). Of the 13 patients, 7 were male (9 knees) and 6 were female (7 knees). The procedure was performed on 10 knees of the left leg and 6 knees of the right leg. Preoperative radiographic assessment showed that all patients had Kellgren-Lawrence grade 3-4 knee OA (9 knees with grade 3, 7 knees with grade 4). The average duration of knee pain was 6.0±1.5 years (range, 3-8 years). No surgical intervention was performed on the lateral discoid meniscus during the UKA procedure. The alignment of the lower limbs was assessed by measuring the hip-knee-ankle (HKA) angle using full-length weight-bearing X-rays. Functional outcomes were evaluated using the Hospital for Special Surgery (HSS) score, Oxford knee score (OKS), and American Knee Society (AKS) knee and function scores. The presence of lateral knee pain or tenderness along the lateral joint line was used to assess symptoms related to lateral meniscus injury. Results:The average surgical time for the 16 knees was 55.9±4.5 min (range, 48-62 min), and the mean length of hospital stay was 10.2±3.2 days (range, 7-15 days). The mean follow-up duration was 53.2±11.1 months (range, 36-68 months). At 6 months, 1 year, and the final follow-up, significant improvements were observed in HSS scores [57.00(54.25, 58.00) vs. 91.00 (89.25, 92.00) vs. 95.50(92.00, 97.00) vs. 96.50 (95.00, 97.75)], OKS [37.00(36.00, 39.00) vs. 15.00(15.00, 16.00) vs. 14.00(13.00, 14.00) vs. 13.00(12.25, 13.00)], AKS knee scores [52.00(50.00, 53.75) vs. 91.50(91.00, 92.00) vs. 95.00(95.00, 97.00) vs. 96.50 (95.00, 97.00)], and AKS function scores [53.00(45.00, 55.00) vs. 90.00(90.00, 90.00) vs. 95.00(92.00, 99.25) vs. 95.00(95.00, 100.00)] compared to preoperative values ( P<0.001). Statistically significant differences were found between the 6-month follow-up and the 1-year or final follow-up ( P<0.05), but no significant differences were observed between the 1-year and final follow-up ( P>0.05). Preoperative HKA angle was 8.00°(6.25°, 9.75°) of varus, whereas the postoperative HKA angle was 3.00° (3.00°, 3.75°) of varus. The postoperative alignment showed a significant reduction in varus deformity, with a statistically significant difference compared to preoperative values ( Z=-3.419, P=0.001). One knee developed symptomatic intra-articular loose body at 5 years postoperatively, which was successfully treated with arthroscopic removal. At the final follow-up, all prostheses were well-positioned, with no signs of loosening, subsidence, periprosthetic infection, or the need for revision surgery. No symptoms were indicative of lateral discoid meniscus injury were observed. Conclusion:UKA for the treatment of medial compartment knee OA in patients with lateral discoid meniscus yields favorable clinical outcomes, with significant improvements in knee function and pain relief, as well as stable midterm prosthesis performance.