ObjectiveTo understand the epidemiological distribution and gene evolutionary variation of influenza A (H3N2) viruses in Fengxian District, Shanghai, in the surveillance year of 2023, and to provide a reference basis for influenza prevention and control. MethodsThe prevalence of influenza virus in Fengxian District in the 2023 influenza surveillance year (April 2023‒March 2024) was analyzed. The hemagglutinin (HA) gene, neuraminidase (NA) gene, and amino acid sequences of 75 strains of H3N2 influenza viruses were compared with the vaccine reference strain for similarity matching and phylogenetic evolutionary analysis, in addition to an analysis of gene characterization and variation. ResultsIn Fengxian District, there was a mixed epidemic of H3N2 and H1N1 in the spring of 2023, with H3N2 being the predominant subtype in the second half of the year, and Victoria B becoming the predominant subtype in the spring of 2024. A total of 75 influenza strains of H3N2 with HA and NA genes were distributed in the 3C.2a1b.2a.2a.2a.3a.1 and B.4 branches, with overall similarity to the reference strain of the 2024 vaccine higher than that of the reference strain of the 2022 and 2023 vaccine. Compared with the 2023 vaccine reference strain, three antigenic sites and one receptor binding site were changed in HA, with three glycosylation sites reduced and two glycosylation sites added; where as in NA seven antigenic sites and the 222nd resistance site changed with two glycosylation sites reduced. ConclusionThe risk of antigenic variation and drug resistance of H3N2 in this region is high, and it is necessary to strengthen the publicity and education on the 2024 influenza vaccine and long-term monitoring of influenza virus prevalence and variation levels.

ObjectiveTo investigate the pathogenic spectrum and epidemiological characteristics of diarrheal disease in Fengxian District of Shanghai, and to provide scientific basis for the prevention and control of diarrheal diseases. MethodsBasic information of the initial adult cases visited diarrheal disease surveillance sentinel hospital in Fengxian District, Shanghai, was collected from August 2013 to 2023, and fecal samples were collected at 1∶5 sampling intervals to isolate and identify 5 kinds of diarrheagenic Escherichia coli (DEC), Salmonella (SAL), Vibrio parahaemolyticus, Campylobacter, Vibrio cholerae, Shigella and Yersinia enterocolitica (YE). Simultaneously, nucleic acid detection was performed for 3 kinds of rotavirus, 2 kinds of norovirus, intestinal adenovirus, astrovirus and sapovirus. ResultsA total of 1 861 cases of newly diagnosed diarrheal disease were reported, with the peak in July to August. Additionally, 704 surveillance samples were detected, with a total positive detection rate of 50.57%. The detection rates of bacterial, viral and mixed infection were 25.14%, 21.02% and 4.40%, respectively. Among the pathogens detected, DEC accounted for the highest (17.61%, 124/704), followed by norovirus (16.48%, 116/704), rotavirus (6.39%, 45/704), SAL (5.97%, 42/704) and Campylobacter (3.84%, 27/704). DEC detected were mainly enteroaggregative Escherichia coli and enterotoxigenic Escherichia coli, with no detection of Vibrio cholerae, Shigella and YE. The highest total pathogen detection rate was observed from June to September, and the detection peaks of norovirus were from March to June and from October to December, whereas that of DEC was from June to October. The detection rate of rotavirus peaked from January to February, but which was not detected between 2020‒2023. The SAL positive rate peak was in September, whereas that of Campylobacter was from July to September. ConclusionThe main pathogens detected in Fengxian District from 2013‒2019 are DEC, norovirus, rotavirus, SAL and Campylobacter. Different pathogens have different detection peaks, with bacteria predominating in summer and viruses in winter and spring. Prevention and control measures should be carried out according to the epidemiological characteristics of different seasons.

ObjectiveTo analyze the surveillance status of acute respiratory tract infection pathogens in Fengxian District of Shanghai, and to determine the pathogen spectrum and epidemiological characteristics of acute respiratory tract infection in the district. MethodsCase surveillance data from Fengxian Central Hospital were collected through the Shanghai Integrated Surveillance System for Acute Respiratory Infections, and respiratory specimens were collected from the 50^th week of 2022 to the 49^th week of 2023 for nucleic acid detection of 25 pathogens and bacterial culture testing. Case surveillance data from Fengxian Central Hospital were collected through the National Influenza Sentinel Surveillance System, and respiratory specimens were collected for nucleic acid detection of 5 pathogens. ResultsThe percentage seeking for medical visits of influenza-like illness (ILI) and severe acute respiratory infection (SARI) were 4.74% and 0.81%, respectively, with epidemic peaks in winter and spring. A total of 1 610 samples were detected, among which 354 were SARI cases, whose age of P₂₅ and P₇₅ quartiles were 44 years and 71 years, respectively, with a positive detection rate of 48.31%. Among the 1 256 ILI cases, the age of P₂₅ and P₇₅ quartiles were 21 years and 39 years, respectively. The positive detection rate of pathogens was 65.04% in 123 ILI cases under comprehensive surveillance of respiratory tract infection and 66.11% in 1 133 ILI cases under influenza surveillance. The positive rates of influenza andSARS-CoV-2 in SARI samples were 12.99% and 29.66%, respectively. The positive rates of influenza and SARS-CoV-2 in ILI case samples were 33.20% and 31.53%, respectively. Influenza virus concentrated in the winter and spring. The ILI and SARI cases had the highest positivity rates in the 6‒14 years old group and 15‒24 years old group, respectively. ConclusionThe main pathogens of respiratory tract infection in Fengxian District of Shanghai were SARS-CoV-2 and influenza virus. Special efforts should be made to monitor respiratory disease pathogens in the population under 24 years old, and surveillance of SARI cases aged ≥60 years should be strengthened. The influenza virus and SARS-CoV-2 are alternating, which is different from the past and requires a change in the previous prevention and control strategies.

Objective:To explore the effect of intravenous infusion of remifentanil and remifentanil combined with esketamine on blood glucose during gastrointestinal surgery.Methods:A prospective selection of 160 patients who underwent elective gastrointestinal surgery at Nanjing Hospital and the Fourth Affiliated Hospital of Nanjing Medical University from July 2023 to October 2023 was conducted. The patients were randomly divided into a control group (remifentanil group) and an observation group (remifentanil combined with esketamine group) using a random number table method, with 80 patients in each group. Both groups were anesthetized with remifentanil. The observation group received intravenous injection of 0.5 mg/kg of esketamine during anesthesia induction, followed by maintenance at a dose of 0.12 mg/(kg·h) until the sutured skin. The control group received an equal amount of physiological saline, and the anesthesia induction and maintenance plans were the same for both groups. Two groups of intraoperative and postoperative blood glucose and insulin usage, as well as intraoperative atropine and ephedrine usage, anesthesia time, extubation time, and post anesthesia care unit (PACU) retention time were recorded. Visual Analog Scale (VAS) scores were also recorded at 6, 12, and 24 hours post surgery, as well as the incidence of complications.Results:The intraoperative blood glucose levels in the observation group were lower than those in the control group, and the blood glucose levels at 6, 12, and 24 hours postoperatively were higher than those before and during surgery. The blood glucose levels at 6 and 12 hours postoperatively were higher than those at 24 hours postoperatively, and the differences were statistically significant (all P<0.05). The proportion of patients with intraoperative and postoperative blood glucose>7 mmol/L in the observation group was significantly lower than that in the control group, and the difference was statistically significant (all P<0.05). There was no statistically significant difference in the proportion of insulin use between the two groups during surgery ( P>0.05). The postoperative insulin use in both groups was significantly higher than that during surgery, and the difference was statistically significant (all P<0.05). There was no statistically significant difference in anesthesia time between the two groups of patients ( P>0.05). The observation group had shorter extubation time and PACU retention time than the control group, and the difference was statistically significant (all P<0.05). The incidence of intraoperative heart rate (HR)<60 beats/min and mean arterial pressure (MAP)<60 mmHg in the observation group were significantly lower than those in the control group, and the differences were statistically significant (all P<0.05). The maintenance dose of propofol and remifentanil in the observation group were both lower than those in the control group, and the difference was statistically significant (all P<0.05). The proportion of additional remifentanil, the dosage of hydroxycodone used within 24 hours, and the proportion of atropine and ephedrine used in the observation group were all lower than those in the control group, and the differences were statistically significant (all P<0.05). The VAS scores of the observation group at rest and activity 12 hours after surgery were significantly lower than those of the control group, with a statistically significant difference ( P<0.05). There was no statistically significant difference in VAS scores between the two groups at other time points (all P>0.05). Conclusions:Intraoperative infusion of 0.1-0.4 μ g/(kg·min) remifentanil combined with 0.12 mg/(kg·h) esketamine can inhibit intraoperative stress induced blood glucose elevation, maintain good heart rate and mean arterial pressure, and prevent postoperative remifentanil induced hyperalgesia.

Objective:To evaluate the teaching effects of a comprehensive LPC model (combining lecture-based learning, problem-based learning, and case-based learning) in the observership of basic surgery for pediatric medical students of the five-year program.Methods:We divided 69 students of grades 2019 and 2020 majoring in pediatrics of the five-year program of Capital Medical University who were in the observership of basic surgery at Beijing Friendship Hospital into experimental group ( n=33, adopting the LPC teaching mode) and control group ( n=36, using the LBL teaching mode). Teaching and assessment were completed in stages. The two groups were compared in terms of clinical skill practice score, clinical thinking score, observership enthusiasm, and satisfaction with observership teaching. SPSS 25.0 was used for the t test, chi-square test, or rank sum test. Results:The LPC group showed significantly higher scores in clinical skill practice [(99.91±0.29) vs. (84.72±10.21), P<0.05] and clinical thinking [(91.06±5.93) vs. (84.31±7.98), P<0.05] and significantly better enthusiasm for observership ( P<0.05) compared with the LBL group. The LPC group was superior to the LBL group with respect to the proportion of students with proficiency in surgical skills (100.0% vs. 63.9%, P<0.05), the proportion of students with good literacy in aseptic surgical principles (100.0% vs. 69.4%, P<0.05), the proportion of improvement in clinical competency (97.0% vs. 66.7%, P<0.05), the proportion of improvement in communication ability (93.9% vs. 72.2%, P<0.05), the proportion of increase in interest in literature search and review (90.9% vs. 63.9%, P<0.05), the proportion of increase in interest in scientific research (93.9% vs. 69.4%, P<0.05), the proportion of satisfaction with learning atmosphere (100.0% vs. 72.2%, P<0.05), and the proportion of satisfaction with teaching methods (100.0% vs. 63.9%, P<0.05). Conclusions:The LPC teaching model shows better effects than LBL in basic surgery observership teaching for pediatric medical students of the five-year program, which is worth promotion.

Objective:To the investigate the predictive value of preoperative systemic inflammatory response index (SIRI) for postoperative clinical outcome in patients with spontaneous intracerebral hemorrhage (ICH) in basal ganglia region.Methods:Patients with ICH in basal ganglia region underwent surgical treatment at the Department of Neurosurgery, the Affiliated Hospital of Qingdao University from January 2015 to December 2021 were retrospectively included. At 3 months after surgery, the modified Rankin Scale was used to evaluate the clinical outcome, with a score of 0-2 defined as good outcome and >2 defined as poor outcome. Multivariate logistic regression analysis was used to identify the independent correlation between SIRI and poor outcome in patients with ICH. Receiver operating characteristic (ROC) curve analysis was used to identify the predictive value of SIRI. Results:A total of 258 patients with ICH in basal ganglia region underwent surgical treatment were enrolled, including 176 males (68.22%), aged 57.00 years (interquartile range, 49.00-65.25 years); median hematoma volume was 50.00 ml (interquartile range, 40.00-70.00 ml), and median SIRI was 4.12 (interquartile range, 2.28-7.30); 143 patients (55.43%) had poor outcome. Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.070, 95% confidence interval [ CI] 1.030-1.111; P<0.001), lower Glasgow Coma Scale score ( OR 0.669, 95% CI 0.575-0.779; P<0.001), higher platelet count ( OR 1.010, 95% CI 1.003-1.017; P=0.004), and higher SIRI ( OR 1.434, 95% CI 1.255-1.638; P<0.001) were the independent predictors of poor outcome. ROC curve analysis showed that the area under the curve for predicting poor outcome by SIRI was 0.791 (95% CI 0.737-0.845; P<0.001), with an optimal cutoff value of 4.53. The predictive sensitivity and specificity were 67.8% and 81.7%, respectively. Conclusion:Preoperative SIRI can effectively predict the clinical outcome of patients with ICH in basal ganglia area at 3 months after surgery, and SIRI >4.53 indicates poor outcome.

Objective To compare the clinical safety and efficacy of CT-guided hook-wire localization of≤10mm pulmonary ground-glass nodule(GGN)via different path ways before video-assisted thoracoscopic surgery(VATS).Methods The clinical data of a total of 128 patients with 10 mm pulmonary GGN,who received CT-guided hook wire localization before VATS at The Third Hospital of Mianyang of China between July 2018 and March 2023,were retrospectively analyzed.According to the puncturing localization path way mode,the patients were divided into vertical puncturing group(n=88)and non-vertical puncturing group(n=40).The number of puncturing times,the time spent for puncturing localization,the success rate of puncture,the operation time of VATS,and puncture-related complications of the two groups were recorded.Results No statistically significant differences in the gender,age,smoking history,GGN location,puncture position,nodule size,density characteristics of GGN,emphysema,and nodules-pleura distance existed between the two groups(all P＞0.05).Compared with non-vertical puncturing group,in vertical puncturing group the number of puncturing times was smaller,the time spent for localization was shorter,the incidence of pneumothorax was lower,and the operation time of VATS was shorter,the differences in all the above indexes between the two groups were statistically significant(all P＜0.05);and the subgroup analysis of patients whose GGN was overlapped with rib shadow obtained the same results.Binary logistic regression analysis revealed that non-vertical puncturing and the number of puncturing times were the independent risk factors for the occurrence of pneumothorax.Conclusion CT-guided hook-wire localization of≤10mm pulmonary GGN before VATS is clinically safe and effective.Under the condition when the lesion can be localized within the range of 2.0cm and the shadow overlapping of GGN with the rib and blood vessel can be effectively avoided,vertical puncturing path way mode should be preferred,which can effectively reduce the incidence of pneumothorax and shorten the operation time of VATS.

ObjectiveWe conducted a drug resistance and homology analysis of diarrheagenic Escherichia coli （DEC） in Fengxian District of Shanghai in order to provide a basis for clinical rational drug use， risk monitoring and early warning. MethodsDEC were isolated from diarrheal patients in Fengxian District， Shanghai from 2019 to 2022. The minimum inhibitory concentrations （MIC） of 21 drugs to the DEC were determined. Genotyping and homology analysis were conducted with pulsed-field gel electrophoresis （PFGE）. ResultsThe DEC detection rate of diarrhea cases was 18.99% （131/690）， including enteroaggregative E.coli （EAEC） 64.89% （85/131）， enterotoxigenic E.coli （ETEC） 22.14% （29/131）， enteropathogenic E.coli （EPEC） 12.21% （16/131）， and enterohemorrhagic E.coli （EHEC） 0.76%（1/131）. The DEC detection showed obvious seasonal characteristics with a high incidence in summer. The DEC multidrug resistance rate was 66.41% with a total of 65 drug resistance profiles. The five antimicrobial drugs with the highest resistance rate were ampicillin （60.31%）， nalidixic acid （51.91%）， cefazolin （50.38%）， tetracycline （44.27%）， and cotrimoxazole （35.11%）. The rate of DEC resistance to levofloxacin was significantly increased from 2019 to 2022. Cluster analysis showed that the similarity of 85 EAEC cluster was 58.4%‒100.0%， and 69 band patterns were obtained. The similarity of 29 ETEC cluster was 58.5%‒100.0%， and 13 band patterns were obtained， including 2 dominant band types. The similarity of 16 EAEC clusters was 53.9%‒100.0%， and 15 band patterns were obtained. Five groups of homologous strains were found， consistent with the resistance phenotypes. ConclusionAmong the diarrhea cases， the DEC epidemic intensity is high， the drug resistance situation is severe， and the risk of outbreak infection is high in Fengxian District， Shanghai. Therefore， health monitoring and prevention need to be strengthened.