Objective: To evaluate the efficacy of the left spermatic vein transposition to the great saphenous vein in treating left varicocele (VC) secondary to nutcracker syndrome (NCS). Methods: Clinical data of 8 patients treated during Feb.2020 and Feb.2023 in our hospital were retrospectively analyzed.A meticulous preoperative evaluation of the vascular status of the spermatic vein and the great saphenous vein was performed using color Doppler ultrasound.A spermatic vein-great saphenous vein shunt surgery was performed in patients who were strictly selected.The clinical symptoms and hemodynamics of renal vein were compared before and after operation. Results: The median age of patients was 23.5(18-33) years.There was a notable reduction in post-exercise scrotal and lower back pain in all patients，and the score of scrotal pain decreased to 0 in 7 patients. The median quantification of urinary protein was 352.8(54.4-687.3) mg prior to surgical intervention，which significantly diminished to 125.5(25.9-255.1) mg 6 months after operation.Notably，3 cases of preoperative positive urine occult blood tests were undetectable in the subsequent postoperative assessments.The median peak blood flow velocity at the site of stenosis in the left renal vein measured at 74.4(48.7-117.6) cm/s preoperatively，subsequently reduced to 45.1(25.5-61.2) cm/s postoperatively.During the 6-month follow-up，no recurrence of varicocele，vascular anastomotic stenosis or thrombosis were observed. Conclusion: Our research indicates that spermatic vein to great saphenous vein bypass is safe and feasible in the treatment of left varicocele secondary to nutcracker syndrome for strictly selected patients，which can effectively alleviate renal vein congestion without significant complications.

Objective: To establish a nomogram prediction model for Alzheimer's disease (AD) among the elderly in community, so as to provide the evidence for early screening and prevention of AD. Methods: Based on the Zhejiang Healthy Aging Cohort Study, the elderly aged 60-90 years who completed the baseline survey were selected as the study subjects. Follow-up surveys were conducted from 2015 to 2016 and from 2019 to 2021. Sociodemographic characteristics, lifestyle factors, medical history, and waist circumference were collected through questionnaire surveys and physical examinations. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), and a diagnosis of AD was made based on the Alzheimer's Disease Assessment Scale-Cognitive Subscale and medical history. The participants were randomly divided into training and validation sets at 8∶2 ratio. LASSO regression was used to screen for predictive factors. Multivariable logistic regression model was used to analyze predictive factors and construct a nomogram. The model was analyzed and evaluated using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results: A total of 6 988 elderly were included at baseline, with a mean age of (68.19±6.63) years. There were 3 438 males (49.20%), and 3 550 females (50.80%). The median follow-up duration was 4.90 (interquartile range, 3.80) years, with 817 new cases of AD were identified, yielding an incidence of 11.69%. LASSO regression and multivariable logistic regression showed that age (OR=1.017, 95%CI: 1.005-1.030), gender (female, OR=1.820, 95%CI: 1.533-2.165), educational level (primary school, OR=0.813, 95%CI: 0.673-0.980), physical exercise (not active, OR=1.572, 95%CI: 1.260-1.980), dining companions (spouse and children, OR=0.771, 95%CI: 0.598-0.995), baseline MMSE score (OR=0.843, 95%CI: 0.821-0.866), and waist circumference (OR=0.981, 95%CI: 0.973-0.989) were risk predictors for AD among the elderly in community. The prediction model demonstrated an area under the ROC curve of 0.740 (95%CI: 0.698-0.783) in the validation set, with a sensitivity of 0.731 and a specificity of 0.667. DCA indicated that when the probability threshold was 0.060 to 0.325, the clinical net benefit was relatively high. Conclusion The AD risk prediction model constructed in this study has good discrimination and clinical practicability, can be used for early screening of AD among the elderly in the community.

BACKGROUND: Disease-modifying therapies have been approved for the treatment of relapsing multiple sclerosis (RMS). The present study aims to examine the safety of teriflunomide in Chinese patients with RMS. METHODS: This non-randomized, multi-center, 24-week, prospective study enrolled RMS patients with variant (c.421C>A) or wild type ABCG2 who received once-daily oral teriflunomide 14 mg. The primary endpoint was the relationship between ABCG2 polymorphisms and teriflunomide exposure over 24 weeks. Safety was assessed over the 24-week treatment with teriflunomide. RESULTS: Eighty-two patients were assigned to variant ( n  = 42) and wild type groups ( n  = 40), respectively. Geometric mean and geometric standard deviation (SD) of pre-dose concentration (variant, 54.9 [38.0] μg/mL; wild type, 49.1 [32.0] μg/mL) and area under plasma concentration-time curve over a dosing interval (AUC tau ) (variant, 1731.3 [769.0] μg∙h/mL; wild type, 1564.5 [1053.0] μg∙h/mL) values at steady state were approximately similar between the two groups. Safety profile was similar and well tolerated across variant and wild type groups in terms of rates of treatment emergent adverse events (TEAE), treatment-related TEAE, grade ≥3 TEAE, and serious adverse events (AEs). No new specific safety concerns or deaths were reported in the study. CONCLUSION: ABCG2 polymorphisms did not affect the steady-state exposure of teriflunomide, suggesting a similar efficacy and safety profile between variant and wild type RMS patients. REGISTRATION NCT04410965, https://clinicaltrials.gov .
Humans ; Crotonates/adverse effects* ; Toluidines/adverse effects* ; Nitriles ; Hydroxybutyrates ; Female ; Male ; Adult ; ATP Binding Cassette Transporter, Subfamily G, Member 2/genetics* ; Middle Aged ; Multiple Sclerosis, Relapsing-Remitting/genetics* ; Prospective Studies ; Young Adult ; Neoplasm Proteins/genetics* ; East Asian People

To achieve early warning of dengue fever from multiple sources and improve the ability to detect and identify dengue fever outbreaks timely, we took Hangzhou as an example and proposed the possibility of early warning of dengue fever. This study divided early warning of dengue fever into three stages: early warning of epidemic source, epidemic symptom, and epidemic. The early warning of epidemic source and epidemic symptom were emphasized to provide reference for other similar studies. Our findings showed that the staged warning of dengue fever was meaningful. Combining the source early warning with the symptom early warning could improve the sensitivity of the warning. Monthly warning can be used as a supplement to weekly warning.

Objective:To explore the application effect of the goal-oriented and task checklist-driven method based on higher-order thinking in operating room nursing teaching.Methods:We assigned 240 nursing students who interned in the operating room of China-Japan Union Hospital of Jilin University from March 2019 to January 2023 were into control group and observation group according to the order of admission. The control group received traditional teaching, while the observation group received goal-oriented and task checklist-driven teaching based on higher-order thinking. At the end of the internship, the two groups were compared in terms of theory and skill assessment scores, comprehensive teaching feedback, and nursing quality assessment scores. SPSS 22.0 was used to perform the t-test and χ2 test. Results:In the observation group, the scores of basic theory assessment, surgical nursing assessment, basic nursing skill assessment, and operating room nursing skill assessment were (92.69±7.90) points, (93.42±7.62) points, (92.05±7.41) points, and (94.14±7.53) points, respectively, while in the control group, the scores were (85.63±7.71) points, (84.41±6.16) points, (83.86±7.53) points, and (85.05±8.13) points, respectively, showing significant differences between the two groups ( P<0.001). The observation group had significantly higher percentages of positive teaching feedback than the control group ( P<0.05). The total score and the scores of individual domains of nursing quality were significantly higher in the observation group than in the control group ( P<0.001). Conclusions:The application of the goal-oriented and task checklist-driven learning model based on higher-order thinking in operating room nursing teaching can effectively enhance the core professional competencies and higher-order clinical thinking ability of student nurse interns, thereby improving nursing quality.

To achieve early warning of dengue fever from multiple sources and improve the ability to detect and identify dengue fever outbreaks timely, we took Hangzhou as an example and proposed the possibility of early warning of dengue fever. This study divided early warning of dengue fever into three stages: early warning of epidemic source, epidemic symptom, and epidemic. The early warning of epidemic source and epidemic symptom were emphasized to provide reference for other similar studies. Our findings showed that the staged warning of dengue fever was meaningful. Combining the source early warning with the symptom early warning could improve the sensitivity of the warning. Monthly warning can be used as a supplement to weekly warning.

Objective To explore the possible mechanisms of myocardial injury induced by simulated weightlessness in space flight and the recovery of myocardium in rats by aerobic exercise intervention.Methods The body weight of rats was weighed using an electronic balance;the cardiac function indexes of rats in each group were detected using echocardiography and isolated cardiac perfusion;and the expression of proteins related to the AMPK/ULK1/Beclin1 pathway in the myocardial tissues of rats in each group was detected using Western Blot.Results(1)When compared with the C1 group,the T1 group not statistically significant in body weight(P?>?0.05),and the wet weight of the flounder muscle,the wet weight-to-weight ratio of the flounder muscle,and the heart weight were all significantly decreased(P??0.05).After 4 weeks of aerobic exercise,when compared to group C2,group R showed a significant rise in the expression of AMPK and ULK1(P??0.05),and a rise in the expression of Beclin1,but not statistically significant(P?>?0.05);and group A showed a slight increase in the expression of AMPK,ULK1 and Beclin1 expression decreased slightly but not statistically significant(P?>?0.05),p-AMPK expression decreased significantly(P??0.05),and a significant decrease in the expression of ULK1(P??0.05);the expression of p-ULK1 decreased significantly(P?

Objective: To investigate the trend of hepatitis B incidence among children under 10 years in Zhejiang Province from 2004 to 2020 with age, period and birth cohort, so as to provide the basis for evaluating the implementation of hepatitis B prevention and control measures for children in Zhejiang Province. Methods: Data of hepatitis B incidence among children under 10 years in Zhejiang Province from 2004 to 2020 were collected through the Infectious Disease Reporting Information System of Chinese Disease Prevention and Control Information System. The trend in hepatitis B incidence was analyzed using an age-period-cohort model. Results: The incidence of hepatitis B among children under 10 years in Zhejiang Province decreased from 12.91/105 in 2004 to 0.61/105 in 2020, with a reduction of 95.24%. The incidence showed an decreasing trend with the increase of age. Compared with 2012, the risk of hepatitis B incidence among children under 10 years appeared a tendency towards a decline with time, with the period rate ratio decreased from 4.546 (95%CI: 3.322-6.220) in 2004 to 0.277 (95%CI: 0.161-0.478) in 2020. Compared with the 2008 cohort, the risk of hepatitis B incidence appeared a tendency towards a decline with cohort, with the cohort rate ratio decreased from 25.535 (95%CI: 15.105-43.166) in 1995 to 0.135 (95%CI: 0.038-0.475) in 2020. Conclusions The incidence of hepatitis B among children aged under 10 years in Zhejiang Province from 2004 to 2020 showed a downward trend. The risk of hepatitis B incidence decreased with increasing age and advancing birth cohort.

Ying and wei qi is derived from the essence of water and grain， and is the basic material to maintain the normal life activities of the body. Ying and wei qi has the difference of nature of yin and yang or the clear and the turbid. When the relationship between ying and wei qi is out of order and in reverse disorder， it will lead to the occurrence of various diseases. Based on the analysis of the theory of "ying-wei disorder" in The Inner Canon of Yellow Emperor （《黄帝内经》）， this paper started from the perspective of the exuberance and debilitation， circulation and function of ying qi and wei qi， focused on the theoretical understanding that the change of deficiency and excess （"fall"） and the change of circulation （"move"）， and refined the core mechanism of "ying-wei disorder"， which is the depletion of ying qi and wei qi， stagnation of ying qi and wei qi， and disharmony of ying qi and wei qi， and finally summarized the syndrome identification and treatment method of supporting ying qi and assisting wei qi， promoting ying qi and moving wei qi， regulating ying qi and wei qi， and constructed the syndrome identification and treatment system for ying-wei disorder of malignant tumor in clinic.

Objective To analyze the influencing factors of unstable ventilation pressure during nasal continuous positive airway pressure(NCPAP)treatment in neonates with hyaline membrane dis-ease(HMD)and construct a nomogram model.Methods A retrospective analysis was conducted in 157 HMD neonates who underwent NCPAP treatment.The patients were divided into unstable group(n=49)and stable group(n=108)based on the occurrence of unstable ventilation pressure during treatment.Logistic regression analysis was used to identify influencing factors of unstable ventilation pressure during NCPAP treatment in HMD neonates.A nomogram model was constructed using R software,and its predictive performance was evaluated using receiver operating characteristic(ROC)curves,calibration curves,and the Hosmer-Lemeshow goodness-of-fit test.Results Unstable venti-lation pressure occurred in 49 HMD neonates during NCPAP treatment,with an incidence rate of 31.21％(49/157).Univariate analysis showed that unstable ventilation pressure during NCPAP treatment had no relation to gestational age,gender,birth weight,delivery mode,neonatal Apgar score,catheter distortion,or excessive condensation in the tube(P＞0.05).However,NCPAP treatment duration,nasal mucosa damage,secretion blockage in the airway,and restlessness were identified as influencing factors for unstable ventilation pressure during NCPAP treatment in HMD neonates(P＜0.05).Multivariate Logistic regression analysis revealed that NCPAP treatment duration ≥72 h,nasal mucosa damage,secretion blockage in the airway,and restlessness were independent risk fac-tors for unstable ventilation pressure during NCPAP treatment in HMD neonates(P＜0.05).A no-mogram model was constructed based on these four independent risk factors.The ROC curve demon-strated good discrimination for the nomogram model,with an area under the curve of 0.801(95％CI,0.730 to 0.861).The Hosmer-Lemeshow goodness-of-fit test showed a chi-square value of 3.550 with a P-value of 0.470,and the calibration curve had a slope close to 1,indicating good fit validity for the nomogram prediction model.Conclusion The nomogram model constructed based on NC-PAP treatment duration,nasal mucosa damage,secretion blockage in the airway,and restlessness has good predictive value for the occurrence of unstable ventilation pressure during NCPAP treatment in HMD neonates.