In order to further standardize the vaccination of kidney transplant candidates and recipients in China, the Branch of Organ Transplantation of Chinese Medical Association has organized experts in kidney transplantation and infectious diseases. Based on the "Vaccination of Solid Organ Transplant Candidates and Recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice", and in combination with the clinical reality of infectious diseases and vaccination after organ transplantation in China, as well as referring to relevant recommendations from home and abroad in recent years, these guidelines are formulated from aspects such as epidemiology, types of vaccines, vaccination principles, target population, and specific vaccine administration. The "Guidelines for Vaccination of Kidney Transplant Candidates and Recipients in China" aims to provide theoretical reference for medical workers in the field of kidney transplantation in China, regarding the vaccination of kidney transplant candidates and recipients. It is expected to better guide the vaccination of kidney transplant candidates and recipients, reduce the risk of postoperative infection, and improve survival outcomes.

Objective: To evaluate the clinical effect of blood transfusion treatment in elderly critically ill patients under different blood transfusion initiation thresholds. Methods: A total of 144 elderly critically ill patients aged >70 years who underwent red blood cell transfusion in the elderly intensive care unit (ICU) of our hospital from January 2021 to January 2023 were included. According to different blood transfusion initiation thresholds, the patients were divided into restrictive blood transfusion group (n=77, Hb<70 g/L before blood transfusion) and liberal blood transfusion group (n=67, Hb 70-100 g/L before blood transfusion). Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, estimated mortality and general data collection were performed when the two groups of patients entered the ICU. Blood transfusion details of these patients in the ICU were collected and documented, including pre-transfusion Hb levels, volume and number of red blood cell transfusion, and post- transfusion Hb levels. Propensity score matching (PSM) was used to match the baseline data of the two groups of patients, and the clinical outcomes were compared and analyzed after matching. Results: After PSM matching, 52 pairs of patients were successfully matched. The matched restrictive and liberal transfusion groups showed comparable characterists, including age, APACHE Ⅱ score, the number of cases with APACHE Ⅱ score >20, estimated mortality, incidence of comorbidities and primary diseases (P>0.05). The number of red blood cell transfusions and transfusion volume (U) in the ICU of the two groups were 7.77±4.73 vs 12.19±10.41, 11.64±7.65 vs 19.14±16.14 (all P<0.05), and the Hb levels (g/L) before and after red blood cell transfusion in the ICU was 59.92±5.98 vs 77.44±8.60,77.88±17.21 vs 87.56±15.23 (all P<0.05). In terms of clinical outcomes, there was no significant difference between the two groups (all P>0.05): ICU length of stay (d) 39.56±36.80 vs 40.10±49.29, three-week mortality rate (%) 21.2 vs 21.2, in-hospital mortality rate (%) 46.2 vs 53.9, mortality rate in subgroup with APACHE Ⅱ score ≤ 20 (%) 11.5 vs 1.9, the incidence of severe infection (%) 78.8 vs 73.1, the incidence of heart failure (%) 57.7 vs 44.2, and the incidence of pulmonary edema (%) 26.9 vs 19.2. Conclusion: Elderly ICU patients can tolerate lower blood transfusion thresholds. Therefore, the restrictive transfusion strategy can reduce the total amount of blood transfusion, save valuable blood resources, and achieve the same blood transfusion effect as the liberal transfusion strategy.

Objective To explore the changing trend in the disease burden of gout in China from 1990 to 2021, and analyze the incidence, prevalence, and disability-adjusted life years (DALYs) by age and gender, with comparisons to global patterns, and to predict the disease burden of gout in China in 2030. Methods Data from the Global Burden of Disease (GBD) database were used to analyze changes in gout burden. Joinpoint regression was used to estimate the average annual percentage change (AAPC) with 95% confidence intervals (CIs). Comparative analyses were conducted on data from China and the world, and an ARIMA model was used to project China's gout burden in 2030. Results From 1990 to 2021, China's age-standardized incidence rate (ASIR) rose from 122.52 to 151.61/100,000, exceeding the global rise from 93.09 to 109.07/100,000. The age-standardized prevalence rate (ASPR) in China increased from 640.67/100,000 to 810.35/100,000, compared to a global rise from 536.54/100,000 to 653.81/100,000. The age-standardized DALYs rate (ASDR) in China increased from 20.2/100,000 to 25.43/100,000, surpassing the global increase from 16.67/100,000 to 20.21/100,000. AAPCs for ASIR, ASPR, and ASDR in China were 0.70%, 0.77%, and 0.75%, respectively, all higher than global rates. Middle-aged and elderly men faced the highest burden. It was predicted that there will be a decline in China's ASIR and ASPR by 2030, while ASDR will remain stable. Conclusion The disease burden of gout in China has increased significantly, outpacing global trends. Targeted interventions for hyperuricemia, particularly in elderly men, are crucial to reduce the future disease burden.

Objective: To explore the association between mental health and muscle strength among Chinese adolescents aged 13- 18, providing a theoretical foundation and intervention strategies for mental health promotion. Methods: Data were obtained from the 2019 Chinese National Survey on Students Constitution and Health, including 98 631 Chinese adolescents aged 13- 18. Psychological distress was assessed by using the Kessler Psychological Distress Scale (K10), and mental well being was measured with the Warwick-Edinburgh Mental Well being Scale (WEMWBS). Based on the gender and age specific Z scores of various test items [grip strength, standing long jump, pull ups (for males), and sit ups (for females)], muscle strength index (MSI) was constructed to evaluate the comprehensive level of muscle strength in adolescents. According to the Dual factor Model (DFM) of mental health, participants were categorized into four groups:troubled, symptomatic but content, vulnerable, and complete mental health. Gender differences were analyzed by using Chi-square tests, trends were tested with Cochran-Armitage tests, and multinomial Logistic regression models were applied to assess associations between muscle strength and mental health among adolescents. Results: In 2019, 37.4% of Chinese adolescents aged 13-18 were reported of high mental distress, and 59.9% were reported of low mental well being. Boys had significantly lower rates of high mental distress (35.3%) and low mental well being (55.6%) compared to girls (39.4%, 64.3%), and the differences were of statistical significance ( χ 2=176.13, 780.42, both P <0.05). In 2019, the rate of complete mental health among adolescents showed a downward trend with increasing age ( χ 2 trend = 258.47) and a gradual upward trend with increasing muscle strength levels ( χ 2 trend =123.14)，and both boys and girls exhibited similar trends ( χ 2 trend =103.83, 168.46; 57.00 , 67.34) (all P <0.05). The results of the unordered multiclass Logistic regression model showed that after controlling for confounding factors such as age and gender, when the completely pathological group as a reference, for every 1 unit increase in MSI in adolescents, the likelihood of being in a completely mental health state increased by 29% ( OR = 1.29); for every unit increase in the Z-score for pull ups, the likelihood of being in a completely mental health state increased by 6% ( OR =1.06) among boys; for every 1 unit increase in sit up Z score, the likelihood of being in a completely mental health state increased by 19% ( OR =1.19) among girls (all P <0.05). Conclusions The mental health status of Chinese adolescents is not good enough. Muscle strength is positively associated with mental health.

Background::Very low birth weight (VLBW) infants are the key populations in neonatology, wherein morbidity and mortality remain major challenges. The study aimed to analyze the clinical characteristics of VLBW infants.Methods::A retrospective cohort study was conducted in West China Second Hospital between January 2016 and December 2021. Neonates with a birth weight of <1500 g were included. Mortality, care practices, and major morbidities were analyzed, and compared with those of previous 7 years (2009-2015).Results::Of the total 1750 VLBW, 1386 were infants born with birth weight between 1000-1499 g and 364 infants were born with weight below 1000 g; 42.9% (751/1750) required delivery room resuscitation; 53.9% (943/1750) received non-invasive ventilation only; 38.2% (669/1750) received invasive ventilation; 1517 VLBW infants received complete treatment. Among them, 60.1% (912/1517) of neonates had neonatal respiratory distress syndrome (NRDS), 28.7% (436/1517) had bronchopulmonary dysplasia (BPD), 22.0% (334/1517) had apnea, 11.1% (169/1517) had culture-confirmed sepsis, 8.4% (128/1517) had pulmonary hemorrhage, 7.6% (116/1517) had severe intraventricular hemorrhage (IVH)/periventricular leukomalacia (PVL), 5.7% (87/1517) had necrotizing enterocolitis (NEC), and 2.0% (31/1517) had severe retinopathy of prematurity. The total and in-hospital mortality rates were 9.7% (169/1750) and 3.0% (45/1517), respectively. The top three diagnoses of death among those who had received complete treatment were sepsis, NRDS, and NEC. In 2009-2015, 1146 VLBW were enrolled and 895 infants received complete treatment. The proportions of apnea, IVH, and IVH stage ≥3/PVL, were higher in 2009-2015 compared with those in 2016-2021, while the proportions of NRDS and BPD were characterized by significant increases in 2016-2021. The total and in-hospital mortality rates were 16.7% (191/1146) and 5.6% (50/895) respectively in 2009-2015.Conclusion::Among VLBW infants born in 2016-2021, the total and in-hospital mortality rates were lower than those of neonates born in 2009-2015. Incidences of NRDS and BPD increased in 2016-2021, which affected the survival rates and long-term prognosis of VLBW.

Objective To explore the clinical efficacy of high hip center technique total hip arthroplasty(THA)for CroweⅡ and Ⅲ developmental dysplasia of hip(DDH)and severe hip osteoarthritis(HOA).Methods From January 2018 to Jan-uary 2020,74 patients with Crowe type Ⅱ and Ⅲ DDH and severe HOA were admitted,and 37 cases of anatomical hip center reconstruction were taken as control group,including 7 males and 30 females,aged from 42 to 65 years old with an average of(58.40±4.98)years old,body mass index(BMI)ranged from 18 to 29 kg·m-2 with an average of(23.02±2.21)kg·m-2.Thirty-seven routine high hip center technical reconstruction were performed as study group,including 5 males and 32 females,aged from 41 to 65 years old with an average of(57.31±5.42)years old,BMI ranged from 18 to 29 kg·m-2 with an average of(23.14±2.07)kg·m-2.The patients presented with hip pain,limited function and range of motion,and gait instability before surgery.All patients underwent THA,the control group underwent intraoperative anatomical hip center reconstruction,and the study group underwent intraoperative high hip joint reconstruction.The perioperative indicators of the two groups were com-pared.The hip joint function,balance function and gait of the patients were evaluated before surgery,3 months,6 months,and 12 months after surgery.The length difference of both lower limbs,horizontal distance of rotation center,vertical distance of ro-tation center and femoral eccentricity were measured before operation and 1 year after operation.The incidence of complica-tions in the two groups during the operation and postoperative follow-up was counted.Results The operation time of the study group was shorter than that of the control group,and the intraoperative blood loss was less than that of the control group(P＜0.05).After 12-months follow-up,1 was lost to followvup in study group and 2 were lost to follow-up in control group.The Har-ris scores and Berg balance scale(BBS),pace,stride frequency and single step length in the study group were higher than those in the control group at 3 months and 6 months after operation(P＜0.05);there was no statistically significant difference between the two groups in the indexes 12 months after operation(P＞0.05).The vertical distance of the center of rotation of the study group was greater than that of the control group 12 months after operation(P＜0.05),and there was no significant difference in the length difference of the lower limbs,the horizontal distance of the center of rotation,and the femoral eccentricity between two groups(P＞0.05).There were no complications in either group.Conclusion The long-term effects of TH A in patients with DDH and severe HO A were similar between the two central hip reconstruction methods,and the safety was good,and the high hip central reconstruction technique could shorten the operation time and reduce the amount of intraoperative blood loss.At the same time,it has certain advantages in early recovery of hip joint function,balance function and walking function of patients.

Objective To explore clinical effect of the fifth metatarsal head excision and non-excision in rheumatoid arthritis(RA)forefoot deformity reconstruction.Methods Retrospective analysis was performed on 50 patients(76 feet)with moderate to severe forefoot deformity caused by RA treated from May 2015 to January 2019.According to degeneration of the fifth metatarsophalangeal joint,the fifth metatarsal head was retained or excised by wind-like forefoot reconstruction,and divid-ed into the fifth metatarsal head preservation group(preservation group)and the fifth metatarsal head resection group(resec-tion group).Twenty-four female patients in preservation group,aged from 47 to 81 years old with an average of(60.37±8.60)years old;the course of disease ranged from 13 to 22 years with an average of(19.00±3.06)years;body mass index(BMI)ranged from 21 to 28 kg·m-2 with an average of(23.53±2.47)kg·m-2;six patients(6 feet)with moderate hallux valgus defor-mity and 18 patients(30 feet)with severe hallux valgus deformity;treated with the first metatarsophalangeal joint fusion com-bined with the second th the fourth metatarsophalangeal joint arthroplasty and the fifth metatarsophalangeal joint cleanup.Twenty-six female patients in resection group were female,aged from 30 to 80 years old with an average of(58.53±13.70)years old;the course of disease ranged from 8 to 25 years with an average of(17.94±3.92)years;BMI raged from 20 to 28 kg·m-2 with an average of(24.60±2.03)kg·m-2;4 patients(4 feet)with moderate bunion valgus deformity and 22 patients(36 feet)with severe bunion valgus deformity;treated by the first metatarsophalangeal joint fusion combined with the second th the fifth metatarsophalangeal joint resection of the metatarsophalangeal head.Operation time and postoperative complications between two groups were observed,hallux valgus angle(HVA),intermetatarsal angles between the first and the second metatarsals(I-MAFS),intermetatarsal angles between the first and fifth metatarsals(IMAFF),Japanese Society for Surgery of Foot(JSSF)score before surgery and at the latest follow-up were compared.Results Fifty patients were followed-up from 14 to 46(25.30± 8.83)months in resection group and 12 to 48 with an average of(24.30±1 1.12)months in preservation group,while no signifi-cant difference between two groups(P＞0.05).There were no significant difference in operation time and postoperative compli-cations between two groups(P＞0.05).JSSF scores,HVA,IMAFS and IMAFF in fesection group were improved from(45.09± 3.35)points,(38.90±13.67)°,(12.88±1.72)°,(32.50±2.99)° before operation to(81.60±3.27)points,(15.40±0.90),(9.06±2.27)°,(22.20±1.98)° at the latest follow-up(P＜0.05);preservation group were improved from(47.09±3.96)points,(43.30±12.65)°,(13.99±3.13)°,(33.20±6.14)° to(83.10±3.66)points,(15.20±1.54)°,(8.99±1.02)°,(24.70±1.88)°,respectively.There were no significant difference in JSSF score,HVA,IMAFS and IMAFF between two groups before opera-tion and the latest follow-up(P＞0.05).At the latest follow-up,there were statistically significant differences in pain and defor-mity in JSSF scores between two groups(P＜0.05).Conclusion Both rheumatoid anterior foot reconstruction and anterior foot reconstruction fifth metatarsophalangeal joint debridement showed significant improvement in clinical efficacy and imaging re-sults.Compared with rheumatoid prefoot reconstruction,the fifth metatarsophalangeal joint reconstruction for the treatment of moderate and severe deformity of rheumatoid prefoot showed better improvement in pain,but worse improvement in deformity.For the moderate to severe deformity of the forefoot caused by rheumatoid disease,patients with mild to moderate degenerative deformity of the articular surface of the fifth metatarsal phalanges may be considered for use.

Objective:To analyze the genetic and molecular characteristics of H9N2 subtype avian influenza viruses from external environment and humans in Anhui Province from 2013 to 2022.Methods:Environmental samples and human samples were collected from Anhui influenza surveillance network laboratory. Sixty-three strains of virus were isolated in chicken embryos. RT-PCR was used to amplify the virus and whole genome sequencing was performed. To construct gene evolutionary tree and analyze its genetic characteristics and potential glycosylation sites.Results:The hemagglutinin (HA) gene belongs to the 9.2.4.5 clade, and the protein cleavage sites are mostly " PSRSSR\GL". The neuraminidase (NA) gene, basic protein-1(PB1) gene, acidic protein (PA) gene, non-structural protein (NS) gene and nucleoprotein (NP) gene belong to the F/98 clade, the matrix protein (MP) gene belongs to the G1/97 clade, and the basic protein-2 (PB2) gene belongs to the ST/7488 clade. Mutations of T155N, R164Q, H183N, T189D/V, A190V/T and Q226L occurred in HA protein, deletion of NA protein occurred at 62-64 sites, and mutations of T271A, I292V/M and E627V/L occurred in PB2 protein. At the same time, mutations of K356R and S409N occurred in the PA protein.Conclusions:The H9N2 subtype avian influenza viruses collected from external environment and human sources in Anhui province from 2013 to 2022 belong to the same evolutionary branch, and amino acid site mutations suggest that the virus shows a tendency to gradually adapt to the mammalian host environment. Therefore, further studies on the adaptive evolution of the virus and related monitoring work are needed.

Objective To explore the effects of preoperative anxiety on intraoperative body temperature,adverse reactions during recovery and incision healing in elderly patients undergoing radical mastectomy under general anesthesia.Methods A total of 139 elderly patients who underwent radical mastectomy under general anesthesia in the Fourth Affiliated Hospital of Nanjing Medical University from January 2020 to December 2022 were selected as the study objects,and they were divided into the non-anxiety group(87 cases)and the anxiety group(52 cases)according to whether they were complicated with anxiety before surgery.The nasopharyngeal temperature before surgery,after 30 minutes,60 minutes,90 minutes of surgery and at the end of surgery,the ratio of intraoperative nasopharyngeal temperature<36.0℃,the ratio of perioperative blood loss>300 mL,the occurrence of adverse reactions during the recovery period and the incision healing of patients in the two groups were compared.Results There was no statistically significant difference in the nasopharyngeal temperature before surgery and after 30 minutes of surgery of patients between the two groups(P>0.05).After 60 minutes,90 minutes of surgery and the end of surgery,the nasopharyngeal temperatures of patients in the anxiety group were lower than those in the non-anxietey group,and the differences were statistically significant(P<0.05).There were statistically significant differences in the nasopharyngeal temperature at different times of patients in the two groups(P<0.05).The ratios of patients with intraoperative nasopharyngeal temperature<36.0℃and perioperative blood loss>300 mL in the anxiety group were higher than those in the non-anxiety group,and the differences were statistically significant(P<0.05).The incidence of delayed awakening,shivering reaction,and poor postoperative incision healing in the anxiety group were higher than those in the non-anxiety group,with statistically significant differences(P<0.05).Conclusion Elderly patients undergoing radical mastectomy under general anesthesia combined with anxiety show obvious temperature drop after 60 minutes of surgery,and perioperative blood loss has significantly increased,with a higher incidence of intraoperative hypothermia,adverse reactions during recovery and poor postoperative incision healing,which should arouse clinical attention.

The spleen is the largest lymphoid organ of the body,which participates in the regulation of metabolic balance.High altitude hypoxia environment can affect lipid metabolism in spleen tissue,but the key mechanism of lipid metabolism is still unclear.We aimed to use lipidomic analysis to study the effect of high altitude hypoxia on lipid metabolism in mouse spleen tissue.C57BL/6 mice were placed at an altitude of 4 200 m and 400 m,respectively,and after 30 days the spleen tissues were harvested and lipidomic analysis was performed using an ultra-high performance liquid chromatography-Orbitrap mass spectrometry system.Under the high altitude hypoxia environment,the spleen index of mice and the white pulp decreased,and the germinal center expanded with other pathological changes.The results of lipidomic analysis showed that a total of 41 lipid subclasses and 2 473 lipid molecules were identified,and triacylglycerides(TGs)and phosphatidylcholines(PCs)were the two most identified lipid mole-cules.Using univariate and multivariate analysis,44 differentially expressed lipid molecules were identi-fied,which were mainly concentrated in phospholipid metabolism.Subsequently,RT-qPCR was per-formed on the key enzymes in the phospholipid metabolic pathway,and it was found that the mRNA ex-pression levels were different(P＜0.05).It suggested that high altitude hypoxia environment mainly af-fects the phospholipid metabolism of mouse spleen tissue via reducing the contents of PC and phosphatidic acid(PA),promoting their conversion to phosphatidylethanolamine(PE)and cardiolipin(CL)and fa-cilitating the PE production via the CDP-Etn pathway.This study provides a new experimental basis for the abnormal metabolism of phospholipids in spleen tissue under high altitude hypoxia environment.