ObjectiveTo analyze the epidemiological and clinical characteristics of pertussis in Baoshan District, Shanghai from 2017 to 2024, so as to provide an evidence-based reference for optimizing prevention and control strategies. MethodsData on pertussis cases were collected from the China Disease Prevention and Control Information System, Shanghai Integrated Management and Immunization Service Information System, and follow-up epidemiological investigations. Descriptive epidemiological analyses were performed to analyze the epidemiological characteristics, clinical manifestations, and vaccine effectiveness. Joinpoint regression analyses were used to examine the temporal trends in incidence rates, and a Poisson model was constructed for spatiotemporal scan analyses. ResultsA total of 1 634 pertussis cases were reported in Baoshan District from 2017 to 2024, with a male-to-female ratio of 1.08∶1. More cases were observed in males than in females, with the age ranged from 20 days to 81 years. Among them, 59.92% were in the 6‒<11 years age group, and 63.34% were students. Low-level sporadic incidence persisted during 2017‒2023, followed by a sharp increase in 2024 (71.37/100 000). Starting in January 2024, the incidence rate showed an upward trend, peaking in May before declining. The majority of cases occurred between April and June. The trend in reported pertussis incidence rates in Baoshan District from 2017 to 2023 showed no statistically significant change (APC=10.039%, t=2.586, P=0.150). Incidence rate rose from January 2024, peaked in May (APC=133.641%, t=3.841, P=0.006), then declined significantly (APC=-47.816%, t=2.586, P<0.001). The 12 subdistricts of Baoshan District were divided into low, medium, and high population density areas, with an average annual reported incidence rate of 6.09/100 000, 8.19/100 000 and 11.96/100 000, respectively. The reported incidence rate increased with an increase in population density. Spatiotemporal scan analyses showed that cases clustered in the southwest and northeast of Baoshan District. Epidemiological follow-up investigations of 1 520 cases revealed that the main clinical symptoms were cough (97.63%) and sputum production (41.58%), and 98.13% of the cases were confirmed by positive nucleic-acid test results. Among the 1 475 cases with immunization records, 83.53% had completed the four-dose pertussis vaccine before onset. The complication incidence rates, from high to low, were in the 0-dose vaccination group, 1‒3-dose vaccination group and 4-dose vaccination group. The duration of cough, from long to short, was observed in the the 0-dose vaccination group, 1‒3-dose vaccination group and 4-dose vaccination group, correspondingly. ConclusionIt is recommended to improve the pertussis surveillance system in medical institutions and establish an active monitoring network, prioritizing deployment in school settings and areas with high population density. Enhancing diphtheria-tetanus-pertussis (DTP) vaccination coverage among 6-year-old children and further optimizing the pertussis immunization strategies are essential to prevent and reduce the risk of pertussis among school-aged children.

Objective To investigate the correlation between the manual compression on injection point and the incidence of subcutaneous bleeding after subcutaneous injection of low molecular weight heparin(LMWH)in elderly patients with coronary artery disease.Methods A total of 131 elderly patients with coronary artery disease,who received subcutaneous injection of LMWH after percutaneous coronary intervention(PCI)at the Affiliated Nanjing Hospital of Nanjing Medical University of China between January 2019 and December 2021,were enrolled in this study.According to whether the manual compression on the injection point was employed or not after the injection of LMWH,the patients were divided into the study group(n=67)and the control group(n=64).The operation process of subcutaneous injection of LMWH was carried out in accordance with the"Supervision Standard for Nursing Quality of Hypodermic Injection of Low Molecular Weight Heparin"which was included in the norms formulated by authors'hospital.For the patients of the study group,the injection point was manually pressed for 3-5 min after the injection of LMWH,the manually-used force was to press the skin down for 1cm deep.The incidence of subcutaneous bleeding was compared between the two groups.Results In the study group and the control group,the incidence of subcutaneous ecchymosis was 9.0%and 7.8%respectively,the incidence of subcutaneous hard tubercle was 4.5%and 1.6%respectively,the differences between the two groups were not statistically significant(both P＞0.05).The patient's age,gender,abdominal circumference and body mass index(BMI)carried no obvious correlation with the subcutaneous bleeding after LMWH injection(P＞0.05),while a statistically significant correlation existed between the abdominal wall fat thickness and the subcutaneous bleeding(P＜0.05),which could be used as an independent predictor for the occurrence of subcutaneous bleeding after LMWH injection.Conclusion No obvious correlation exists between the manual compression on injection point and the incidence of subcutaneous bleeding in elderly patients with coronary artery disease after subcutaneous injection of LMWH,therefore,no compression manipulation,used as a hemostatic measure,is required after subcutaneous injection of LMWH.The abdominal wall fat thickness is an independent predictor for subcutaneous bleeding after injection of LMWH.Standard operation procedures should be strictly followed so as to avoid the occurrence of subcutaneous bleeding after injection of LMWH.(J Intervent Radiol,2024,32:77-81)

Objective To explore the predictive value of lung ultrasound score on the severity of neonatal respiratory distress syndrome(NRDS).Methods The clinical data of 65 children with NRDS in our NICU from July 2021 to July 2022 were retrospectively analyzed,and 65 children were included in the NRDS group,while 40 children with other common pulmonary diseases(neonatal wet lung and infectious pneumonia)were selected as the other pulmonary disease group during the same period,and all children were examined by pulmonary ultrasound and X-ray to observe the children in both groups.The lung conditions of the two groups of children were observed:abnormal pleural line,disappearance of A line,isolated B line,fused B line,diffuse B line,lung consolidation,with or without bronchial inflation sign,and other lung ultrasound manifestations.The lung ultrasound scores of the two groups of children were compared,and the X-ray grading distribution of children in the NRDS group was analyzed,correlation between lung ultrasound scoring and X-ray grading was used by Pearson correlation analysis.The clinical value of lung ultrasound score in the differential diagnosis of NRDS and the severity of the disease was analyzed by receiver operator characteristic(ROC)curve.Results The proportion of solid lung,abnormal pleural line,disappearance of A-line,white lung detection,fused B-line,and bronchial inflation sign was significantly higher in the NRDS group than in the other lung disease groups,and the proportion of isolated B-line and double lung point detection was significantly lower than in the other lung disease groups,with statistically significant differences(P<0.05).The lung ultrasound scores of both lungs,left lung,right lung,bilateral lung,and base of both lungs were significantly higher in the NRDS group than in the other lung disease groups(P<0.05).With the increase of X-ray grading,the lung ultrasound score gradually increased,and there was a statistically significant difference between groups at each grade(P<0.05).Pearson correlation analysis showed that there was a significant positive correlation between lung ultrasound score and X-ray grade(r=0.704,P<0.05).The area under curve(AUC)of lung ultrasound score in differentiating NRDS from common lung diseases was 0.907,with sensitivity and specificity of 89.0%and 92.5%,respectively;the AUC of mild and moderate,moderate and severe NRDS in the differential diagnosis by lung ultrasound score was 0.914 and 0.933,respectively,which had high clinical value.Conclusion The lung ultrasound score has certain value in identifying NRDS.The lung ultrasound score can quantitatively assess the changes in the condition of NRDS,and the lung ultrasound and X-ray grading have good consistency,it has the advantages of radiation free,fast,and intuitive,and can be used as an effective method for early diagnosis of NRDS and evaluation of the severity of the disease.

Objective To explore the application efficacy and safety of oblique ultrasound-guided techniques in PICC puncture,in order to provide guidance and references for clinical application.Methods Through convenient sampling,654 patients from a tertiary A hospital in Zhejiang Province from March to December 2022 were selected as the study subjects.The random numbers were generated through Excel table functions and they were randomly grouped into 3 groups:A,B,and C.The ultrasound short axis method,long axis method,and oblique axis method were employed to guide PICC puncture catheterization,respectively.The success rate of PICC puncture,the number of subcutaneous adjustments of the puncture needle,puncture time,and the occurrence of puncture complications(such as hematoma,puncture of the posterior wall of blood vessels,accidental injury to arteries,and accidental injury to nerves)were recorded during the catheterization process in 3 groups.Results A total of 654 patients completed the study,including 215 in group A,219 in group B,and 220 in group C.The success rate of first-time puncture in the group C(86.36％)was higher than that in group A(73.95％)and group B(63.93％),and there was a statistically significant difference among 3 groups(P＜0.001).The subcutaneous adjustment frequency of the puncture needle was 1(1,1)in group C,1(1,2)in group A,and 1(1,2)in group B.The difference between 3 groups was statistically significant(P＜0.001);the puncture time of group C was shorter than that of group A and group B,and the difference was statistically significant(P＜0.001).There was a statistically significant difference in the puncture time between 3 groups(P＜0.017);the pairwise comparison of the number of subcutaneous needle adjustments and the success rate of a puncture between 3 groups showed that there was a statistical difference between group C and group A,and between group C and group B(P＜0.017),while there was no statistical difference between group A and group B(P＞0.017).There was statistical significance(P＜0.05)among 3 groups in terms of complications such as accidental nerve injury and puncture of the contralateral vascular wall by puncture needle,but there was no statistical significance in terms of accidental arterial injury and hematoma occurrence among 3 groups.Conclusion Compared with the short axis approach and the long axis approach,the ultrasound oblique axis approach guided PICC puncture has statistical differences in the success rate of a puncture and the incidence of puncture complications,etc.It is recommended to use the ultrasound oblique axis approach during PICC puncture.

Objective To use the cognitive reinforcement comprehensive intervention program constructed by our team to intervene in patients with spinal cord injury and evaluate its clinical application effect.Methods A non-randomized trial design was adopted to select 97 patients with spinal cord injury from November 2021 to September 2022.Forty-four patients from March to September 2022 in a Grade A hospital in Hefei City were included in the experimental group,and 53 patients from November 2021 to February 2022 were included in the control group.The cognitive reinforcement comprehensive intervention program was used to intervene in the experimental group,and the conventional rehabilitation nursing was used to intervene in the control group.The intervention lasted for 12 weeks in both groups.The Changsha Montreal Scale,Social Support Rating Scale,Rehabilitation Exercise Self-efficacy Scale,Spinal Cord Injury Independence Rating Scale and Hamilton Anxiety Scale were used to measure the two groups before intervention,1 month after intervention and 3 months after intervention.Results 40 cases in the experimental group and 48 cases in the control group completed the study.Repeated measurement ANOVA showed that the temporal,interactive and intergroup effects of cognitive function scores and anxiety scores were statistically significant(P＜0.05).The time effect and interaction effect of the subjective support dimension score,coping self-efficacy dimension score of the two groups were statistically significant(P＜0.05).One month after the intervention,the cognitive function scores of test group were higher than before intervention and control group,and the anxiety scores were lower than before intervention and control group(P＜0.05).Three months after the intervention,the scores of cognitive function,subjective support dimension and coping self-efficacy dimension of experimental group were higher than those before intervention and control group,and the scores of anxiety level were lower than those before intervention and control group(P＜0.05).Conclusion Comprehensive intervention of cognitive reinforcement can improve the cognitive function of patients with spinal cord injury,delay the process of cognitive impairment,enhance self-confidence,relieve anxiety,and promote physical and mental rehabilitation of patients.

Objective:To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2016 to December 2017. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute (CLSI) 2019. WHONET 5.6 was used to analyze data.Results:During the study period, 8 154 bacterial strains were collected from 33 hospitals, of which 2 325 (28.5%) were Gram-positive bacteria and 5 829 (71.5%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (34.7%), Klebsiella pneumoniae (15.8%), Staphylococcus aureus (11.3%), coagulase-negative Staphylococci (7.4%), Acinetobacter baumannii (4.6%), Pseudomonas aeruginosa (3.9%), Enterococcus faecium (3.8%), Streptococci (2.9%), Enterobacter cloacae (2.7%) and Enterococcus faecalis (2.5%). Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) accounted for 34.2%(315/922) and 77.7%(470/605), respectively. No vancomycin-resistant Staphylococcus was detected. The resistance rate of Enterococcus faecium to vancomycin was 0.6%(2/312), and no vancomycin-resistant Enterococcus faecium was detected. The ESBLs-producing rates in Escherichia coli, Klebsiella pneumoniae and Proteus were 55.7%(1 576/2 831), 29.9%(386/1 289) and 38.5%(15/39), respectively. The incidences of carbapenem-resistance in Escherichia coli, Klebsiella pneumoniae were 1.2%(33/2 831), 17.5%(226/1 289), respectively. The resistance rates of Acinetobacter baumannii to polymyxin and tigecycline were 14.8%(55/372) and 5.9%(22/372) respectively, and those of Pseudomonas aeruginosa to polymyxin and carbapenem were 1.3%(4/315) and 18.7%(59/315), respectively. Conclusion:The surveillance results from 2016 to 2017 showed that the main pathogens of blood stream infection in China were gram-negative bacteria, while Escherichia coli was the most common pathogen; the MRSA incidence was lower than other surveillance data in the same period in China; carbapenem-resistant Escherichia coli was at a low level during this surveillance, while carbapenem-resistant Klebsiella pneumoniae is on the rise.

The widespread application of next generation sequencing (NGS) in clinical settings has enabled testing, diagnosis, treatment and prevention of genetic diseases. However, many issues have arisen in the meanwhile. One of the most pressing issues is the lack of standards for reporting genetic test results across different service providers. The First Forum on Standards and Specifications for Clinical Genetic Testing was held to address the issue in Shenzhen, China, on October 28, 2017. Participants, including geneticists, clinicians, and representatives of genetic testing service providers, discussed problems of clinical genetic testing services across in China and shared opinions on principles, challenges, and standards for reporting clinical genetic test results. Here we summarize expert opinions presented at the seminar and report the consensus, which will serve as a basis for the development of standards and guidelines for reporting of clinical genetic testing results, in order to promote the standardization and regulation of genetic testing services in China.

Objective To analyze the epidemiology and clinical characteristics of acquired immunodeficiency syndrome (AIDS) and pulmonary tuberculosis (TB) co-infection.Methods A retrospective study was conducted with the clinical data of patients diagnosed with AIDS and TB in Shanghai Public Health Clinical Center during the period from 2011 to 2015.The outcome of the patients were evaluated by outpatient and telephone follow-up.The data were analyzed by descriptive analysis using SPSS 22.0 software package.Results A total of 359 patients with AIDS/TB co-infection were included in this analysis,including 325 males and 34 females,the highest proportion in 30-44 age group.The diagnosis was delayed in about 42.6％ of the patients.The clinical symptoms were mainly fever,cough and weight loss,but hemoptysis uncommon.Both lungs were affected in most cases,with lesions in at least 3 lung fields,but rare pulmonary cavity.T-SPOT.TB test showed lower positive rate.CD4+T lymphocyte count was 50 cells/μL or less in 50.7％ of the patients at their first test.About 43.5％ of the 69 patients with antimicrobial susceptibility data showed resistance to therapy.Majority (93.2％) of the patients with known viral status received antiretroviral treatment.Extra-pulmonary tuberculosis was identified in 282 cases.The complication and opportunistic infection included central nervous system infection,syphilis,hepatitis B virus infection,hepatitis C virus infection,pulmonary infection,and drug-induced liver injury.Of the 333 patients with known outcome,53 died,most (79.2％,42/53) within 6 months.Conclusions The patients with AIDS/TB co-infection showed higher proportion of young people.The CT finding was atypical.The patients showed lower positive rate for T-SPOT TB test and lower CD4+T lymphocyte count at their first test.Most patients had extra-pulmonary tuberculosis and other complications or opportunistic infections.

Objective To explore the effect of transitional care model on health recovery in discharged elderly patients with angiocardiopathy.Methods A group of transitional care of geriatric department was formed by physicians and nurses of geriatric department, physicians and therapists of rehabilitation department and so on. A total of 81 discharged patients with angiocardiopathy of geriatric department in the Second People's Hospital of Nantong were selected as research group from July 2015 to February 2016 using purposive sampling. They accepted transitional care. A total of 85 elderly patients with angiocardiopathy were recruited as control between December 2015 to June 2016 with routine health education. The effect and the patients' satisfaction were compared between two groups.Results The compliance rate of medication of patients was 93.6% in research group and 65.8% in control group in the second week after leaving hospital with a significant difference (χ2=20.447,P<0.05). There was a statistically significant difference in satisfaction between research group [(95.21±1.98)%] and control group [(88.34±1.84)%] (t=32.7470,P<0.05).Conclusions The transitional care can improve the medication compliance in discharged elderly patients with angiocardiopathy, help them build up health lifestyle and improve the quality of life of patients.

Objective To investigate the clinical characteristics and treatment strategies of arachnoid cyst combined with chronic subdural hematoma.Methods Seventeen patients with arachnoid cyst combined with chronic subdural hematoma,who received treatment in our hospital from February 2008 to March 2016,were chosen in our study;13 of them were performed burr hole irrigation and drainage,2 received craniotomy for removing hematoma and cystectomy,and 2 received endoscopic cyst excision and hematoma removal surgery.A retrospectively analysis of clinical characteristics and treatment strategies of these patients was performed.Results Follow up for 0.5-2 years was performed in the 13 patients performed burr hole irrigation and drainage,and no hematoma relapse was noted;one was found rebleeding in the cyst associated with a small amount of subdural hematoma on the 5th d of surgery,and the subdural hematoma was absorbed during the follow-up observation;one was found that the cyst and subdural hematoma both disappeared in the postoperative check,while the cyst reappeared 40 days after surgery,and during the follow-up observation,the cyst was not enlarged and the chronic subdural hematoma was not relapsed.Two patients recovered after receiving the craniotomy for removing hematoma and cystectomy;two patients recovered after receiving the endoscopic cyst excision andhematoma removal surgery.Conclusion For patients with arachnoid cyst associated with chronic subdural haematoma,burr-hole irrigation and drainage are generally selected;for patients with reappeared cyst or hematoma,there is no need to burr hole again or perform the surgery aiming at the cyst in a haste,and follow-up observation is suggested;for patients whose symptoms in the cyst have appeared before hemorrhage or whose hemorrhage appeared recurrently in the cyst,surgery of hematoma removal and cyst excision can be chosen at the same time.