To investigate the association between sleep-related phenotypes and the risk of malignancy in pulmonary nodules, and to provide complementary evidence from a general population cohort and genetic analyses.

Objective:To evaluate the protective effectiveness (VE) of the acellular pertussis vaccine (aPV) against pertussis in children aged 2 months to 6 years.Methods:A test-negative case-control study was conducted among children aged 2 months to 6 years who sought medical care for cough and underwent pertussis nucleic acid testing at sentinel surveillance hospitals in Zhejiang Province in 2024. Cases were defined as those with positive pertussis nucleic acid test results, while controls were test-negative individuals matched 1∶1 based on propensity scores using the caliper matching method. Conditional logistic regression models were used to calculate odds ratios ( ORs) and VEs. Results:Among the 658 participants, 31.76% (209 cases) tested positive for pertussis. After propensity score matching, 203 cases and 203 controls were included in the analysis. The VE of 1-2, 3, and 4 doses of aPV against pertussis was 52.46% (95% CI:-39.82%-83.84%), 65.22% (95% CI: 6.86%-87.02%), and 72.21% (95% CI: 34.33%-88.24%), respectively. For pertussis-related hospitalization, the VE of 1-3 and 4 doses was 80.95% (95% CI:31.38%-94.71%) and 86.79% (95% CI: 51.89%-96.37%). The VE for those who completed 4 doses of vaccination and had intervals of less than 2 years, 2 years, 3 years, and 4 years or more after vaccination were 91.15% (95% CI: 67.61%-97.58%), 84.70% (95% CI: 43.71%-95.84%),56.23% (95% CI:-47.58%-87.02%), and 49.92% (95% CI:-83.74%-86.35%), respectively. Conclusion:The VE of aPV against pertussis in children aged 2 months to 6 years increases with the number of doses administered, and it is more effective in preventing hospitalization due to pertussis. The VE declines rapidly over time after the last dose. It is recommended to follow the new pertussis immunization program for timely and full vaccination.

The morbidity and mortality associated with diphtheria have been effectively managed through mass immunization strategies. Nevertheless, recent outbreaks of diphtheria have been reported in various regions of Africa and Asia. In addition to infections among children, there has been a notable increase in cases among middle-aged and elderly individuals, underscoring the necessity of continued vigilance in the control of diphtheria. This paper reviewed the epidemiology of diphtheria, the current application of vaccines, and immunization strategies, with the aim of providing evidence for the prevention and control of this disease.

Objective To investigate the relationship of serum levels of neurofilament light chain protein(NFL)and chemerin with cerebral ischemia after interventional therapy in elderly patients with unruptured intracranial aneurysms.Methods A total of 258 patients with unruptured in-tracranial aneurysms undergoing stent-assisted coil embolization in our hospital from January 2020 to January 2024 were enrolled.They were divided into a cerebral ischemia group(52 cases)and a non-cerebral ischemia group(206 cases).The serum NFL and chemerin levels were detected.Multivariate logistic regression analysis was conducted to analyze the risk factors for cerebral is-chemia in the patients after interventional surgery.Results The cerebral ischemia group had sig-nificantly higher ratio of implantation of 3 stents,larger diameter of aneurysms,increased levels of NFL and chemerin before operation,10 min from the start of operation and 24 h after operation,and longer operation time than the non-cerebral ischemia group(P＜0.05,P＜0.01).Larger aneu-rysm diameter,longer operation time,and higher NFL and chemerin levels were the risk factors for cerebral ischemia in patients with unruptured intracranial aneurysm after interventional sur-gery(P＜0.05,P＜0.01).The AUC value of aneurysm diameter,operation time,NFL and chemerin,and combination of these indicators in predicting cerebral ischemia in patients with un-ruptured intracranial aneurysm after interventional surgery was 0.772,0.794,0.826,0.837,and 0.920,respectively,with that of the combination higher than that of each indicator alone(P＜0.05).Conclusion For the elderly patients with unruptured intracranial aneurysms,the increases of serum NFL and chemerin levels are associated with cerebral ischemia after stent-assisted coil embolization,which can predict the risk of cerebral ischemia after interventional therapy.

Objective To investigate the relationship of serum levels of neurofilament light chain protein(NFL)and chemerin with cerebral ischemia after interventional therapy in elderly patients with unruptured intracranial aneurysms.Methods A total of 258 patients with unruptured in-tracranial aneurysms undergoing stent-assisted coil embolization in our hospital from January 2020 to January 2024 were enrolled.They were divided into a cerebral ischemia group(52 cases)and a non-cerebral ischemia group(206 cases).The serum NFL and chemerin levels were detected.Multivariate logistic regression analysis was conducted to analyze the risk factors for cerebral is-chemia in the patients after interventional surgery.Results The cerebral ischemia group had sig-nificantly higher ratio of implantation of 3 stents,larger diameter of aneurysms,increased levels of NFL and chemerin before operation,10 min from the start of operation and 24 h after operation,and longer operation time than the non-cerebral ischemia group(P＜0.05,P＜0.01).Larger aneu-rysm diameter,longer operation time,and higher NFL and chemerin levels were the risk factors for cerebral ischemia in patients with unruptured intracranial aneurysm after interventional sur-gery(P＜0.05,P＜0.01).The AUC value of aneurysm diameter,operation time,NFL and chemerin,and combination of these indicators in predicting cerebral ischemia in patients with un-ruptured intracranial aneurysm after interventional surgery was 0.772,0.794,0.826,0.837,and 0.920,respectively,with that of the combination higher than that of each indicator alone(P＜0.05).Conclusion For the elderly patients with unruptured intracranial aneurysms,the increases of serum NFL and chemerin levels are associated with cerebral ischemia after stent-assisted coil embolization,which can predict the risk of cerebral ischemia after interventional therapy.

The morbidity and mortality associated with diphtheria have been effectively managed through mass immunization strategies. Nevertheless, recent outbreaks of diphtheria have been reported in various regions of Africa and Asia. In addition to infections among children, there has been a notable increase in cases among middle-aged and elderly individuals, underscoring the necessity of continued vigilance in the control of diphtheria. This paper reviewed the epidemiology of diphtheria, the current application of vaccines, and immunization strategies, with the aim of providing evidence for the prevention and control of this disease.

Objective:To evaluate the protective effectiveness (VE) of the acellular pertussis vaccine (aPV) against pertussis in children aged 2 months to 6 years.Methods:A test-negative case-control study was conducted among children aged 2 months to 6 years who sought medical care for cough and underwent pertussis nucleic acid testing at sentinel surveillance hospitals in Zhejiang Province in 2024. Cases were defined as those with positive pertussis nucleic acid test results, while controls were test-negative individuals matched 1∶1 based on propensity scores using the caliper matching method. Conditional logistic regression models were used to calculate odds ratios ( ORs) and VEs. Results:Among the 658 participants, 31.76% (209 cases) tested positive for pertussis. After propensity score matching, 203 cases and 203 controls were included in the analysis. The VE of 1-2, 3, and 4 doses of aPV against pertussis was 52.46% (95% CI:-39.82%-83.84%), 65.22% (95% CI: 6.86%-87.02%), and 72.21% (95% CI: 34.33%-88.24%), respectively. For pertussis-related hospitalization, the VE of 1-3 and 4 doses was 80.95% (95% CI:31.38%-94.71%) and 86.79% (95% CI: 51.89%-96.37%). The VE for those who completed 4 doses of vaccination and had intervals of less than 2 years, 2 years, 3 years, and 4 years or more after vaccination were 91.15% (95% CI: 67.61%-97.58%), 84.70% (95% CI: 43.71%-95.84%),56.23% (95% CI:-47.58%-87.02%), and 49.92% (95% CI:-83.74%-86.35%), respectively. Conclusion:The VE of aPV against pertussis in children aged 2 months to 6 years increases with the number of doses administered, and it is more effective in preventing hospitalization due to pertussis. The VE declines rapidly over time after the last dose. It is recommended to follow the new pertussis immunization program for timely and full vaccination.

Objective:To investigate the clinical efficacy of radical resection of rectal cancer with different surgical approaches and influencing factors of postoperative complications.Methods:The retrospective study was conducted. The clinicopathological data of 3 418 patients who underwent radical resection of rectal cancer in the Second Affiliated Hospital of Harbin Medical University from July 2011 to September 2020 were collected. There were 2 060 males and 1 358 females, aged (61±11)years. Patients meeting the requirements of radical resection and surgical indications underwent surgeries choosing from open radical colorectal cancer surgery, laparoscopic radical colorectal cancer surgery, and natural orifice specimen extraction surgery (NOSES). Observation indicators: (1) intraoperative and postoperative conditions of patients undergoing different surgical approaches; (2) comparison of preoperative clinical characteristics in patients undergoing different surgical approaches; (3) comparison of postoperative histopathological characteristics in patients undergoing different surgical approaches; (4) postoperative complications of patients undergoing different surgical approaches; (5) analysis of influencing factors of postoperative complications. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and comparisons between groups was analyzed using the Kruskal-Wallis rank test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Intraoperative and postoperative conditions of patients undergoing different surgical approaches. Of the 3 418 patients, 1 978 cases underwent open radical colorectal cancer sur-gery, 1 028 cases underwent laparoscopic radical colorectal cancer surgery and 412 cases underwent NOSES, respectively. The operation time, volume of intraoperative blood loss, cases with permanent stoma, preventive stoma or without fistula, time to postoperative first flatus, time to postoperative liquid food intake, cases transferred to intensive care unit after surgery, duration of postoperative hospital stay were 145(range, 55?460)minutes, 100(range, 30?1 000)mL, 435, 88, 1 455, 72(range, 10?220)hours, 96(range, 16?296)hours, 158, 10(range, 6?60)days, respectively, in patients undergoing open radical colorectal cancer surgery. The above indicators were 175(range, 80?450)minutes, 50(range, 10?800)mL, 172, 112, 744, 48(range, 14?120)hours, 72(range, 38?140)hours, 17, 9(range, 4?40)days, respectively, in patients undergoing laparoscopic radical colorectal cancer surgery and 180(range, 80?400)minutes, 30(range, 5?500)mL, 0, 45, 367, 48 (range, 14?144)hours, 72(range, 15?148)hours, 1, 6(range, 3?30)days, respectively, in patients undergoing NOSES. There were significant differences in the above indicators among the patients undergoing different surgical approaches ( H=291.38, 518.56, χ2=153.82, H=408.86, 282.97, χ2=78.66, H=332.30, P<0.05). (2) Com-parison of preoperative clinical characteristics in patients undergoing different surgical approaches. The gender, age, body mass index, cases with diabetes, cases with hypertension, cases with coronary heart disease, cases with anemia, cases with hypoproteinemia, cases with intestinal obstruction, tumor location, preoperative carcinoembryonic antigen, preoperative CA19-9 showed significant differences among patients undergoing open radical colorectal cancer surgery, laparoscopic radical colorectal cancer surgery and NOSES ( P<0.05). (3) Comparison of postoperative histopathological characteris-tics in patients undergoing different surgical approaches. Tumor histological type, tumor differentiation degree, tumor diameter, number of lymph node detected, nerve invasion, vascular invasion, lymph node invasion, tumor T staging, tumor N staging, tumor M staging, tumor TNM staging showed significant differences among patients undergoing open radical colorectal cancer surgery, laparos-copic radical colorectal cancer surgery and NOSES ( P<0.05). (4) Postoperative complications of patients undergoing different surgical approaches. Cases with postoperative complications as anastomotic leakage, abdominal infection, intestinal obstruction, anastomotic bleeding, incision complications, pulmonary infection, other complications were 52, 21, 309, 8, 130, 51, 59, respectively, in patients undergoing open radical colorectal cancer surgery. The above indicators were 33, 17, 75, 3, 45, 58, 9, respectively, in patients undergoing laparoscopic radical colorectal cancer surgery and 13, 4, 8, 0, 11, 10, 15, respectively, in patients undergoing NOSES. There were significant differences in the intes-tinal obstruction, incision complications, pulmonary infection, other complications among patients undergoing different surgical approaches ( χ2=122.56, 13.33, 20.44, 15.59, P<0.05) and there was no significant difference in the anastomotic leakage, abdominal infection, anastomotic bleeding among patients undergoing different surgical approaches ( χ2=0.96, 2.21, 3.08, P>0.05). (5) Analysis of influencing factors of postoperative complications. ① Analysis of influencing factors of intestinal obstruction in patients with radical resection of rectal cancer. Age as 20?39 years and 40?59 years, surgical approach as laparoscopic radical colorectal cancer surgery and NOSES were independent protective factors of intestinal obstruction in patients with radical resection of rectal cancer ( odds ratio=0.46, 0.59, 0.43, 0.13, 95% confidence interval as 0.21?1.00, 0.36?0.96, 0.33?0.56, 0.06?0.27, P<0.05). ② Analysis of influencing factors of incision complications in patients with radical resection of rectal cancer. Body mass index as 24.0?26.9 kg/m 2, surgical approach as laparoscopic radical colorectal cancer surgery and NOSES were independent protective factors of incision complications in patients with radical resection of rectal cancer ( odds ratio=0.24, 0.63, 0.46, 95% confidence interval as 0.11?0.51, 0.44?0.89, 0.24?0.87, P<0.05). ③ Analysis of influencing factors of pulmonary infection in patients with radical resection of rectal cancer. The surgical approach as laparoscopic radical colorectal cancer surgery was an independent risk factor of pulmonary infection in patients with radical resection of rectal cancer ( odds ratio=2.15, 95% confidence interval as 1.46?3.18, P<0.05), and tumor TNM staging as 0?Ⅰ stage was an independent protective factor ( odds ratio=0.10, 95% confidence interval as 0.01?0.88, P<0.05). ④ Analysis of influencing factors of other complica-tions in patients with radical resection of rectal cancer. Age as 20?39 years, 40?59 years, 60?79 years, body mass index as <18.5 kg/m 2, 18.5?23.9 kg/m 2, 24.0?26.9 kg/m 2, 27.0?29.9 kg/m 2, surgical approach as laparoscopic radical colorectal cancer surgery were independent protective factors of other complications in patients with radical resection of rectal cancer ( odds ratio=0.10, 0.29, 0.37, 0.08, 0.22, 0.35, 0.32, 0.29, 95% confidence interval as 0.01?0.81, 0.13?0.64, 0.17?0.78, 0.02?0.40, 0.09?0.52, 0.15?0.83, 0.12?0.89, 0.14?0.59, P<0.05). Conclusions:Compared to laparoscopic radical colorectal cancer surgery and NOSES, open radical colorectal cancer surgery has wide indication and short operation time, but less perioperative treatment effect. Laparoscopic radical colorectal cancer surgery and NOSES can achieve better surgical result and less postoperative complication when patients meeting surgical indications.

Objective:To analyze the composition differences of intestinal microbiota in patients with colon cancer and rectal cancer.Methods:The fecal samples of 72 patients in the Second Affiliated Hospital of Harbin Medical University from July 2018 to January 2019 were collected, and they were divided into colon cancer group and rectal cancer group, 36 cases in each group. DNA from fecal samples was extracted, and then high-throughput sequencing was performed on DNA. Bioinformatics was used to analyze the diversity and composition differences of intestinal microbiota between the two groups, and the potential cancer-promoting mechanisms of the differential flora were also discussed.Results:From high-throughput sequencing, 2 356 560 original sequences and 32 730 high-quality sequences were obtained from 72 samples. The average length of the sample sequence was mainly in the interval of 401-460 bp. And 1 409 operational taxonomic units (OTU) were acquired after OTU species taxonomy annotation of all the sequences. Alpha diversity analysis showed that Shannon index of the rectal cancer group and the colon cancer group was 2.61±0.56 and 2.43±0.67, respectively, and the difference was statistically significant ( t = 1.229, P = 0.223); Simpson index of the rectal cancer group and the colon cancer group was 0.17±0.09 and 0.21±0.16, respectively, and the difference was statistically significant ( t = 1.449, P = 0.151). Differences analysis of both groups and linear discriminant analysis (LDA) showed at the phylum level, Firmicutes were more abundant in the intestine of patients with rectal cancer (LDA = 4.67, P = 0.014), while Proteobacteria were more abundant in the gut of colon cancer patients (LDA = 4.49, P = 0.042). From the perspective of class level, the abundance of Gammaproteobacteria was higher in the intestine of patients with colon cancer (LDA = 4.50, P = 0.033), while the abundance of Erysipelotrichia was higher in the intestine of patients with rectal cancer (LDA = 3.50, P = 0.035). At the order level, the abundance of Erysipelotrichales was higher in the intestine of patients with rectal cancer (LDA = 3.50, P = 0.035); at the family level, the abundance of Porphyromonadaceae was higher in the intestine of patients with rectal cancer (LDA = 3.97, P = 0.033). Conclusion:The compositions of intestinal microbiota in patients with colon cancer and rectal cancer are significantly different, indicating that the different floras may contribute to the progression of colon cancer and rectal cancer.

Objective To study the effects of low calcium dialysate on bone mineral density (BMD) in old patients with low turnover renal osteodystrophy under maintenance hemodialysis.Methods Totally 72 elderly patients aged≥ 60 years under MHD for 6 months or more with parathyroid hormone(iPTH)＜100 ng/L were selected and randomly divided into treatment group(n=36,calcium 1.25 mmol/L in dialysate)and a control group(n =36,calcium 1.5 mmol/L in dialysate),for 12 months of treatment.The changes of albumin-corrected calcium and phosphorus,calciumphosphorus product,iPTH level,bone mineral density,and other indicators as well as related adverse events were observed before and 12 months after the study.Results There was no statistically significant difference in general conditions and the correlated laboratory examinations between the two groups before and after treatment (P ＞ 0.05).After dialytic treatments with dialysate containing calcium 1.25 mmol/L for 12 months,the therapy group versus pre-therapy and control group showed statistically significant decrease in parameters of mean arterial pressure(MAP) [(88.6 ± 9.2) vs.(92.6±10.4)and(93.7±8.8)mmHg],serum calcium[(2.4±0.1)vs.(2.6±0.3)and(2.6±0.2)mmol/L,t =5.061,5.074],phosphorus[(2.0±0.2)vs.(2.1 ±0.2)and(2.1±0.3)mmol/L,t=2.276,2.271],calcium-phosphorus product[(4.7 ± 0.5) vs.(5.3 ± 0.6) and (5.4 ± 0.7) mmol2 / L2,t =4.682,4.627](all P＜0.05),and showed statistically significant increase in parameters of iPTH levels[(132.6 ±37.8) vs.(71.3 ± 11.48) and (69.7 ± 16.0) ng/L;t value 8.824 and 9.048,respectively],bone mineral density values(Lumbar:0.8±0.9 vs.-1.2±1.1 and-1.2±1.1;t value 2.170 and 2.170,respectivly.Femoral neck:-0.8± 1.0 vs.1.3±1.2 and-1.3±1.3;t value 2.258 and 2.243,respectively) (all P＜0.05).In the control group after 12 months of treatment with calcium 1.5mmol/L dialysate,there was no significant difference in related parameters (P＞ 0.05).There was no significant difference in the adverse reactions between study and control groups (P ＞ 0.05).Conclusions The low calcium dialysate(calcium 1.25 mmol/L)used in elderly patients with iPTH＜100 ng/L under MHD can effectively improve the excessive depression of parathyroid function and the decreased BMD,and better control the albumin corrected calcium,phosphorus,calcium-phosphorus product level,and has a good security.