ObjectiveTo analyze the risk factors for long-term cardiovascular events in patients undergoing long-term peritoneal dialysis （PD）， and to construct and validate a visual nomogram prediction model based on multiple parameters. MethodsA prospective cohort study was conducted， consecutively enrolling 248 maintenance PD patients （dialysis duration ≥ 3 months）. Demographic characteristics， clinical indicators， laboratory parameters， and echocardiographic indices （including left ventricular ejection fraction ［LVEF］， ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity （E/e’）， etc.） were collected. The composite endpoint was defined as the occurrence of cardiovascular events or cardiovascular death， with non-cardiovascular death as the competing risk and loss to follow-up or the end of follow-up as censoring events. Fine-Gray competing risks model was used to screen independent predictors， based on which a nomogram model was constructed. Internal validation was performed using the Bootstrap method （1 000 resamplings）， and the concordance index （C-index） and time-dependent receiver operating characteristic （time-dependent ROC） curve were calculated to evaluate the model performance. ResultsWith a median follow-up of 29 months （interquartile range： 24–35 months）， 88 patients （35.48%） reached the composite endpoint， including 80 cases of cardiovascular events and 8 cases of cardiovascular death， and 4 patients died of non-cardiovascular causes. Multivariate Fine-Gray analysis revealed that age， diabetes mellitus， hemoglobin （HGB） level and E/e' ratio were independent influencing factors of the composite endpoint. Specifically， each 1-year increase in age was associated with a 3.0% increase in the risk of the composite endpoint （HR=1.030， P=0.006）； patients with diabetes mellitus had a 167.9% higher risk compared with non-diabetic patients （HR=2.679， P=0.007）； each 1g/L increase in HGB level contributed to a 1.5% reduction in the risk （HR=0.985， P=0.003）； and each 0.1 increase in E/e' ratio led to a 7.2% increase in the risk （HR=1.072， P=0.045）. The nomogram model had a C-index of 0.76 （95% CI： 0.698–0.820）， and the AUC of the time-dependent ROC curve reached 0.849 at 23 months of follow-up. ConclusionIncreased age， complicated with diabetes mellitus， decreased HGB， and elevated E/e' ratio are independent risk factors of long-term occurrence of cardiovascular events and cardiovascular death in patients undergoing long-term PD. The nomogram model constructed based on the above variables has good predictive value and clinical applicability， which can provide a reference for cardiovascular risk stratification and individualized intervention in long-term PD patients.

Objective: To analyze the dynamic changes and influencing factors of latent tuberculosis infection (LTBI) among junior and senior high school students, so as to provide evidence based references for precise tuberculosis prevention and control on campus. Methods: A retrospective cohort study was conducted among 11 206 junior and senior high school students in Yuhang District, Hangzhou, who underwent tuberculin skin test (TST) at baseline in 2023 (T0). Participants were followed up for two consecutive years (T1 in 2024, T2 in 2025), and TST results were analyzed. Cox proportional hazards regression model was used to identify influencing factors of LTBI, and generalized estimating equations (GEE) were applied to examine the sex-baseline grade-time interaction effects. Results: The cumulative incidence of LTBI among enrolled students was 10.01%, showed a distinct grade related gradient: the grade 7 cohort had the highest cumulative incidence of 12.62%, which decreased significantly with increasing grade level ( χ 2=109.12, P <0.01). Multivariate Cox regression analysis indicated that, compared with the grade 7 cohort, the grade 8 cohort ( aHR =0.60) and the grade 9 cohort ( aHR =0.43) had lower risks of LTBI (both P <0.01). Boarding school students had a 62% lower risk of LTBI than non boarding school students ( aHR =0.38, P <0.01). GEE analysis showed that, with grade 7 girls at T1 as the reference group, LTBI risk significantly increased among grade 7 girls at T2 ( β =0.23), whereas the most prominent risk reduction was observed among grade 9 boys ( β =-1.69) (both P <0.05). Conclusions LTBI risk among junior and senior high school students exhibits significant population heterogeneity and temporal dynamics. The grade 7 academic year represents a critical window for tuberculosis prevention. Girls advancing to the grade 8 should be prioritized as the key population for targeted interventions. The boarding school campus management model exerts a protective effect against LTBI among junior and senior high school students.

Abstract Surveillance and early warning systems are fundamental to the prevention and control of infectious diseases. However, existing systems are constrained by limitations such as single-source data, making it difficult to achieve early detection and timely response to infectious diseases. Real world data (RWD), characterized by diverse sources and extensive coverage, combined with technologies such as big data and artificial intelligence, offer significant advantages in constructing intelligent, multi-trigger surveillance and early warning systems for infectious diseases. This article systematically reviews relevant literature published over the past two decades, outlines the current status of infectious disease surveillance and early warning systems both domestically and internationally, analyzes the main sources of RWD and their applications in signal detection, cross-validation, and risk assessment, and introduces practical case studies and implementation pathways. At present, the use of RWD for intelligent infectious disease surveillance and early warning still faces challenges, including variable data quality, relatively limited algorithms, and insufficient cross-sectoral collaboration. Recommendations include promoting deep integration of multi-source data, establishing standardized data-sharing mechanisms, and strengthening interdisciplinary and cross-sectoral cooperation, so as to progressively build an efficient intelligent surveillance and early warning system and further enhance the early identification and rapid response capabilities for infectious diseases.

Objective: To explore the current situation and influencing factors of latent tuberculosis infection (LTBI) among middle school students in Yuhang District, Hangzhou City, so as to provide evidence for optimizing targeted school tuberculosis prevention and control strategies. Methods: The study targeted students in grades 7 through 11 in Yuhang District from 2023 to 2025. LTBI screening was conducted annually from September to November using the tuberculin skin test. Basic data, such as the year of screening and gender, were collected through the Yuhang District Public Health Emergency Intelligent Control System, while information on school type and boarding status was gathered from the schools themselves. A multivariable logistic regression model was used to analyze the influencing factors for LTBI among middle school students. Results: A total of 102 092 person-tims middle school students were screened, including 54 015 person-tims of boys (52.91%) and 48 077 person-tims of girls (47.09%). LTBI was detected in 6 913 person-tims, with a detection rate of 6.77%. Multivariable logistic regression analysis showed that screenings conducted in 2024-2025 (2024, OR=1.123, 95%CI: 1.055-1.196; 2025, OR=1.255, 95%CI: 1.181-1.334), girls (OR=1.146, 95%CI: 1.092-1.204), and students in grades 8 through 11 (grade 8, OR=1.707, 95%CI: 1.588-1.836; grade 9, OR=1.634, 95%CI: 1.515-1.762; grade 10, OR=1.713, 95%CI: 1.574-1.864; grade 11, OR=1.691, 95%CI: 1.549-1.846) had a higher risk of LTBI; students in boarding schools (OR=0.619, 95%CI: 0.575-0.666) had a lower risk of LTBI. Conclusion The prevalence of LTBI among middle school students in Yuhang District is relatively high, primarily due to the year of screening, gender, grade level, and boarding school.

Objective:To investigate the prevalence of enterovirus 71 (EV71) and the genetic characteristics of VP1 region in common hand, foot and mouth disease (HFMD) cases in Shenzhen from 2016 to 2022.Methods:Throat swabs from mild HFMD in Shenzhen sentinel hospitals were collected from 2016 to 2022. A total of 38 EV71-positive samples were screened from these throat swabs and were sequenced. Then, the VP1 sequence of these EV71-positive samples were analyzed for their phylogenetic evolution by bioimformatics software DNAStar and MEGA 6.Results:From 2016 to 2022, the number of EV71 infections among HFMD patients in Shenzhen sentinel hospitals decreased from 136 in 2016 to 0 in 2022. The mumber of EV71 infections in 2018 and 2019 decreased by 96.3%(257/267) compared to that in 2016 and 2017. From 2020 to 2022, the number of EV71 infections decreased to 0. During this period, the EV71 vaccination rate among HFMD patients increased from 6.4% to 39.6%; Evolutionary analysis showed that the nucleotide homology and amino acid homology between 38 EV71 sample strains in Shenzhen from 2016 to 2022 were 91.8%-99.9% and 98.3%-100.0%, all belonging to the C4a subgenotype; Among them, 26 strains wene local epidemic strains, and 11 strains were imported from other provinces, with a close genetic relationship with epidemic strains in Hainan, Yunnan, Sichuan, Tianjin, Henan, Jilin, and other places. One strain from 2017 had the closest genetic relationship with the US epidemic strain OP207969-USA-2017. Further comparing the EV71 epidemic strains in Shenzhen from 2016 to 2022 and EV71 severe strains, it was found that the EV71 strains in Shenzhen carried four amino acid mutation sites related to severe condition, named R22H, K43R, I249V and T289A.Conclusions:The EV71 epidemic strains in Shenzhen from 2016 to 2022 all belong to the C4a subgenotype, and the number of EV71 infection shows a downward trend with the increase of vaccine coverage rate. At the same time, the distribution of EV71 virus strains in Shenzhen shows a significant decrease in local strains and a predominance of imported strains. There are a total of four amino acid mutation sites associated with severe cases in the EV71 sample strains in Shenzhen from 2016 to 2022. Among them, 22R and 289T are located at the N and C ends of VP1, which are related to EV71 adsorption and targeting cells. The 43R site is associated with binding ability to Annexin2 protein, which enhances cell binding ability.

Objective : To employ the EQ-5D-5L questionnaire to evaluate HRQOL in patients on peritoneal dialysis ( PD) and investigate the related risk factors to provide suggestions for improving quality of life． Methods : PD patients who were followed up regularly in the department of nephrology were recruited in this study． Demographic characteristics and laboratory data were collected．Exercise capacity was assessed by the 6-MWT．PHQ-9 was con- ducted to screen depression status．The EQ-5D-5L questionnaire was used to evaluate HRQOL．Multivariate linear regression analysis was used to examine the potential influencing factors of EQ-5D-5L health utility value. Results : The highest health utility value of EQ-5D-5L was 1 point，while the lowest was －0. 01 points．The mean EQ-5D-5L score was (0. 92 ± 0. 15 ) ． The multivariate linear regression analyses showed that increased bilirubin level ( β = - 0. 009，P = 0. 018 ) ，increased CRP level ( β = －0. 005 ，P ＜0. 001 ) ，and increased PHQ-9 score ( β = - 0. 008，P = 0. 014) were negatively correlated with the EQ-5D-5L health utility value．Increased 6-MWD ( β = 0. 005，P = 0. 018) was positively correlated with the EQ-5D-5L health utility value． Conclusion The bilirubin and CRP levels，depression status，and exercise capacity are considered the main factors influencing HRQOL in PD patients.

Objective To explore the correlation between serum fibroblast growth factor-23 (FGF23) concentration and heart failure and all-cause death in patients with end-stage renal disease (ESRD).Methods The prospective cohort study design was used in the present study.The ESRD patients who were admitted to the department of ne-phropathy in the Hospital and without heart failure symptoms were recruited in this study.The data of patients was collected through baseline questionnaires, physical examinations, echocardiography, and laboratory examinations.The serum FGF23 levels were measured by enzyme-linked immunosorbent assay (ELISA) .The follow-up time was 2 years.The onset of heart failure (ACC/AHA stage C-D) and all-cause death were composite endpoint events.The Cox proportional risk model was used to explore the risk factors of outcome events.Through subgroup analyses and interaction analyses, further exploration was conducted to determine whether there was heterogeneity in the as-sociation between FGF23 and outcome events in different subgroups.Results Ultimately,107 ESRD patients were included in this study, with an average age of (52.00 ± 12.51) years.There were 39 males (36.45％), and the median follow-up time was 23 months (21, 25 months).There were 32 (29.9％) outcome events, of which 22 (20.6％) onset of heart failure and 10 (9.3％) all-cause of deaths.The results of this study showed that the con-centration of FGF23 in the outcome event group was significantly higher than that in the non-event group [ (4.40 ± 1.16) pmol/ml vs (3.85 ± 0.82) pmol/ml,P<0.05].The Cox proportional risk model showed that the elevated FGF23 was associated with increased risk of the composite endpoint events in ESRD patients (HR=1.730 , 95％CI:1.164-2.570 , P=0.007) .Subgroup analyses showed that there was an interactive effect between FGF23 levels and gender on the risk of cardiovascular outcome events.Especially in male ESRD patients, the increased FGF23 level was correlated with a higher risk of cardiovascular events (P-interaction <0.05).Conclusion Elevated serum FGF23 is an independent risk factor for the onset of heart failure and all-cause of mortality in ESRD patients, especially in male patients.

Objective: To investigate the epidemiological characteristics of influenza in Yuhang District, Hangzhou City from 2019 to 2023, so as to provide the reference for formulating influenza prevention and control measures. Methods: Influenza case data with current address in Yuhang District was collected through the Chinese Disease Prevention and Control Information System from 2019 to 2023. Influenza-like illness data was collected through the Hangzhou Epidemiological Investigation System. Time distribution, population distribution and pathogen detection of influenza-like illness were descriptively analyzed. Results: There were 118 319 influenza cases reported in Yuhang District from 2019 to 2023, with an average annual reported incidence rate of 2 316.80/105. The highest incidence rate was seen in 2023, with a reported incidence rate of 5 736.82/105. The peak incidence of influenza occurred from November to March of the following year, presenting the winter and spring epidemic. The cases were mainly distributed in the age groups of 7 to 14 years and 25 to 59 years, with 31 310 and 34 470 cases, accounting for 26.46% and 29.13%, respectively. Influenza cases were reported in all 12 towns (streets) in Yuhang District, with the top two being Wuchang Street and Liangzhu Street, with the average annual incidence rates of 17 346.08/105 and 14 945.80/105, respectively. From 2019 to 2023, there were 103 868 cases of influenza-like illness, and 1 482 throat swab samples were collected. Among them, 260 positive samples of influenza virus were detected, with a positive rate of 17.54%. The peak detection period for positive specimens was from November to March of the following year, with 222 influenza virus positive specimens detected. The influenza virus types included H1N1, H3N2, and Victoria B, accounting for 25.77%, 38.85% and 35.38%, respectively. Conclusions The peak of influenza outbreak in Yuhang District from 2019 to 2023 was in winter and spring, with children and adolescents being the main affected objectives. H1N1, H3N2 and Victoria B were alternately prevalent. Prevention and control measures such as influenza vaccination should be strengthened.

Objective:To understand the status quo of primary medical and health services for home aged dementia patients in Weifang from the perspective of medical service providers. And to provide suggestions for improving the primary medical services and community care for home aged dementia patients.Methods:A semi-structured in-depth interview was conducted with 26 primary medical and health care workers in the primary medical and health services of home patients with senile dementia, and the interview data were summarized and extracted by content analysis method.Results:Four themes were extracted according to the primary medical and health services for home aged dementia patients. Theme 1: less chance to contact with dementia patients, and the understanding of the disease is biased. Theme 2: limited medical services and no targeted services. Theme 3: receive less relevant training and need professional technical support. Theme 4: there is no system of medical support, and an effective model needs to be established.Conclusion:There are few primary medical and health services for home patients with senile dementia, and there are regional differences. It is necessary to increase the understanding of home patients with senile dementia by various means and increase the primary medical services for home patients.

Objective To analyze the genetic characteristics of VP1-VP4 genes carried by cox-sackievirus A6 (CVA6) strains isolated from severe cases of hand, foot, and mouth disease (HFMD) in Shenzhen during 2012 to 2015. -ethods The VP1-VP4 genes of CVA6 strains isolated from severe HFMD cases in Shenzhen during 2012 to 2015 were amplified and sequenced. Phylogenetic analysis was performed to analyze the VP1-VP4 genes of CVA6 isolates and sequences downloaded from GenBank by using DNASTAR6. 0 and MEGA6. 02 software packages. Results Four cases of severe HFMD were caused by CVA6 in Shenzhen during 2012 to 2015. All of the patients had the symptom of fever, skin rash and aseptic encephalitis. The CVA6 strain causing severe HFMD in 2013 shared 98. 8％-98. 9％ homology in nucleotide sequences and 99. 3％-99. 8％ in amino acid sequences with the strains isolated in 2012. Two amino acid mutations were found in the CVA6 strain isolated in 2013, which were G73E in VP2 region and S13G in VP1 region. However, the CVA6 strain isolated in 2015 only shared 95. 0％ homology in nucleotide sequences and 99. 3％ homology in amino acid sequences with the strain isolated in 2013. Six amino acid mutations were identified including E73G in VP2 region and T5A, S27N, A30V, N137S and V242I in VP1 region. The phylogenetic analysis revealed that the four CVA6 strains belong to D3 sub-genotype. The CVA6 strains causing severe cases in 2012 had the nearest genetic relationship with the strain isolated in Changsha in 2012 (KJ156349). The CVA6 strain isolated in Shenzhen in 2013 had the nearest genetic relationship with the strain isolated in Shanghai in 2013 (KJ612513). The Shenzhen CVA6 isolate in 2015 showed high similarity to Weifang CVA6 isolate in 2014 (KX752785). Conclusions All CVA6 strains causing severe HFMD ca-ses in Shenzhen during 2012 to 2015 belongs to D3 sub-genotype. Mutations of S27N and A30V in the VP1 region of the CVA6 isolate in 2015 are located in the B cell epitopes. In addition, the VP1-V242I mutation in the CVA6 strain isolated in 2015 is located in the binding site of PSGL-1 receptor. These mutations may affect the binding of CVA6 strains to the cellular receptors and their infectivity to people.