Objective To analyze the epidemiological and clinical characteristics of scrub typhus in Liuyang People's Hospital Hunan Province for better diagnosis,treatment,prevention and control of scrub typhus.Methods A retrospective study was conducted on 159 confirmed cases of scrub typhus.The demographic data of patients,clinical manifestations of scrub typhus,laboratory tests,and chest CT findings,complications,treatment,and outcomes were analyzed.Results The 159 patients with scrub typhus included 142 males and 17 females.The average age of patients was(53.8±11.9)(18-82)years old.The peak incidence of scrub typhus was in the period from July to September(87.42％).The common clinical manifestations included fever(97.48％),headache(41.51％),and fatigue(23.90％).The most common signs were eschar(92.45％)on the lower limbs(25.16％),scrotum(15.72％),and buttocks(11.32％).Laboratory test results upon admission showed decreased platelet count(64.15％),elevated creatinine(38.36％),elevated AST(90.57％),ALT(80.50％),and LDH(90.57％).Pulmonary imaging study revealed pulmonary inflammation(22.64％),pleural effusion(13.21％),and pericardial effusion(6.29％).The common complications included liver impairment(69.81％)and decreased platelet count(50.94％),as well as other complications such as renal dysfunction,myocardial injury,sepsis,respiratory failure,and disseminated intravascular coagulation(DIC).Doxycycline-based therapies resulted in cure rate of 98.11％(156/159).Three patients died due to severe complications.Conclusions The peak incidence of scrub typhus was in the period from July to September in Hunan Province.Eschar is a key feature for clinical diagnosis.Scrub typhus can affect multiple organ systems,leading to various systemic complications.The cure rate is high with doxycycline treatment,but some patients may die from severe complications due to delayed medical treatment.

Background and Aims:Pancreatic ductal adenocarcinoma(PDAC)is a highly malignant digestive system tumor with an inferior prognosis,and its early diagnosis and treatment remain significant challenges.In recent years,RNA methylation modifications(such as m6A and m5C)have attracted considerable attention for their roles in tumor development;however,their regulatory mechanisms and clinical significance in PDAC remain unclear.This study was conducted to identify prognosis-related long noncoding RNAs(lncRNAs)associated with m6A and m5C in PDAC,construct a reliable prognostic prediction model,and explore their relationship with the tumor immune microenvironment.Methods:Based on RNA-seq data from the TCGA-PDAC cohort,differentially expressed lncRNAs(DElncRNAs)related to m6A and m5C were identified through differential expression analysis and Pearson correlation analysis.The samples were randomly divided into a training set(n=89)and a validation set(n=89).Key DElncRNAs were selected using LASSO-Cox regression to construct a prognostic model,and patients were categorized into high-and low-risk groups based on risk scores.Kaplan-Meier survival analysis,ROC curves,and multivariate Cox regression were used to evaluate the model's predictive performance.Furthermore,CIBERSORT and ESTIMATE scores were used to analyze immune cell infiltration characteristics and tumor microenvironment(TME)differences between the high-and low-risk groups.Results:To construct the prognostic model,four m6A-and m5C-related DElncRNAs(LINC00857,LINC02038,TSPOAP1-AS1,and TRPC7-AS1)were identified.Patients in the high-risk group had significantly lower overall survival than those in the low-risk group(P<0.05),and the risk score was an independent prognostic factor for PDAC(HR=1.551,95%CI=1.297-1.854,P<0.001).ROC curve analysis showed that the risk score model exhibited high predictive efficiency in both the training and validation sets(AUC values for 1,3,and 5 years:0.766,0.875,0.879;0.685,0.711,0.792,respectively).Immune analysis revealed increased infiltration of M0 macrophages with lower TME scores in the high-risk group(all P<0.05),suggesting an immunosuppressive microenvironment.Conclusion:This study successfully established a PDAC prognostic model based on m6A-and m5C-related DElncRNAs and confirmed its independent predictive value.High-risk patients exhibited M0 macrophage enrichment and immunosuppressive microenvironment characteristics,possibly contributing to poor prognosis.

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Objective To investigate the impact of mitophagy,mediated by the long non-coding RNA SNHG16(LncRNA SNHG16)on diabetes-associated cognitive impairment(DCI).Methods 29 male C57BL/J mice were randomly divided into normal control(NC)group,DCI group and DCI+mitochondrial autophagy inhibitor(DCI+Mdivi-1)group.Morris water maze and new object recognition test were used to detect the cognitive function of mice,qRT-CPR was used to detect the expression of LncRNA SNHG16 and mitochondrial autophagy marker mRNA.Western blot were used to detect the expression of related protein.The mouse hippocampal neurons HT22 were divided into control(Con)group,high glucose(HG)group,HG+SNHG16 silencing(HG+sh-SNHG16)group and HG+no-load control(HG+sh-NC)group.CCK8 method and lactate dehydrogenase(LDH)method were used to detect neuronal damage.JC-1 method was used to detect mitochondrial membrane potential.Results Compared with NC group,the expression of LncRNA SNHG16 and the expression of autophagy-related gene 5,PTEN-induced putative kinase 1(PINK1),Parkin and microtubule associated protein light chain 3(LC3)Ⅱ/Ⅰ increased(P<0.05),while the expression of mitochondrial autophagy-related proteins P62 and mitochondrial outer membrane transposase 20(TOMM20)decreased in T2DM group.Compared with DCI group,the cognitive dysfunction of mice improved,and the expression level of LncRNA SNHG16 decreased in the DCI+Mdivi-1 group(P<0.05).The expressions of LncRNA SNHG16,LC3 Ⅱ/Ⅰ,PINK1 and Parkin were higher in HG group than in Con group(P<0.05),while the cell survival rate and TOMM20 protein expression were lower in HG group than in Con group(P<0.05).Silence of LncRNA SNHG16 can restore the activity of HT22 cells and mitochondrial membrane potential,and reduce the level of mitochondrial autophagy under HG condition.Conclusions The expression level of LncRNA SNHG16 was up-regulated in the hippocampus brain region of mice with diabetic cognitive dysfunction,and mitophagy was overactivated.Silencing of LncRNA SNHG16 inhibits mitophagy in hippocampal neurons and alleviates HG induced hippocampal neuronal damage.

Objective To investigate and analyze the epidemiological characteristics and the causes of a suspected outbreak of carbapenem-resistant Acinetobacter baumannii(CRAB)infection,and provide basis for healthcare-asso-ciated infection(HAI)prevention and control.Methods Information of 3 patients with CRAB positive culture from the respiratory intensive care unit(RICU)of a hospital in May 2024 was collected.Microbiological sampling was performed in patients' ward environment,and the specimens were cultured and strains were identified.CRAB strains detected from the environment and patients were performed whole genome sequencing(WGS).Multiple de-partments jointly formulated and implemented comprehensive infection control measures,and the effectiveness were evaluated.Results CRAB was cultured from specimens of sputum and bedside office mice of 3 patients.WGS de-tection showed that ST2158 and ST1791 resistance genes were detected from both sputum and bedside office mice of 2 patients.After comprehensive assessment,2 patients were confirmed with HAI and 1 patient was confirmed with colonization,ruling out an outbreak of HAI.A total of 24 environmental specimens were taken for environmental hygiene monitoring,with a CRAB detection rate of 58.33％.CRAB detected from bedside mice and patients' spu-tum specimen had consistent CRAB drug susceptibility testing results.After implementing measures such as in-creasing the frequency of cleaning and disinfection of ward environment,strengthening the implementation of hand hygiene,and enhancing the supervision of department personnel as well as HAI prevention and control training,HAI was effectively controlled.Conclusion The possible transmission route of this suspected CRAB outbreak in RICU is the contamination of office mice,which caused healthcare workers carrying CRAB in their hands,leading to cross infection due to poor hand hygiene implementation of healthcare workers.Strengthening the cleaning and dis-infection of environmental surface and the management of hand hygiene of healthcare workers are key measures to prevent CRAB HAI.

Objective To investigate and analyze the epidemiological characteristics and the causes of a suspected outbreak of carbapenem-resistant Acinetobacter baumannii(CRAB)infection,and provide basis for healthcare-asso-ciated infection(HAI)prevention and control.Methods Information of 3 patients with CRAB positive culture from the respiratory intensive care unit(RICU)of a hospital in May 2024 was collected.Microbiological sampling was performed in patients' ward environment,and the specimens were cultured and strains were identified.CRAB strains detected from the environment and patients were performed whole genome sequencing(WGS).Multiple de-partments jointly formulated and implemented comprehensive infection control measures,and the effectiveness were evaluated.Results CRAB was cultured from specimens of sputum and bedside office mice of 3 patients.WGS de-tection showed that ST2158 and ST1791 resistance genes were detected from both sputum and bedside office mice of 2 patients.After comprehensive assessment,2 patients were confirmed with HAI and 1 patient was confirmed with colonization,ruling out an outbreak of HAI.A total of 24 environmental specimens were taken for environmental hygiene monitoring,with a CRAB detection rate of 58.33％.CRAB detected from bedside mice and patients' spu-tum specimen had consistent CRAB drug susceptibility testing results.After implementing measures such as in-creasing the frequency of cleaning and disinfection of ward environment,strengthening the implementation of hand hygiene,and enhancing the supervision of department personnel as well as HAI prevention and control training,HAI was effectively controlled.Conclusion The possible transmission route of this suspected CRAB outbreak in RICU is the contamination of office mice,which caused healthcare workers carrying CRAB in their hands,leading to cross infection due to poor hand hygiene implementation of healthcare workers.Strengthening the cleaning and dis-infection of environmental surface and the management of hand hygiene of healthcare workers are key measures to prevent CRAB HAI.

Objective To investigate the impact of mitophagy,mediated by the long non-coding RNA SNHG16(LncRNA SNHG16)on diabetes-associated cognitive impairment(DCI).Methods 29 male C57BL/J mice were randomly divided into normal control(NC)group,DCI group and DCI+mitochondrial autophagy inhibitor(DCI+Mdivi-1)group.Morris water maze and new object recognition test were used to detect the cognitive function of mice,qRT-CPR was used to detect the expression of LncRNA SNHG16 and mitochondrial autophagy marker mRNA.Western blot were used to detect the expression of related protein.The mouse hippocampal neurons HT22 were divided into control(Con)group,high glucose(HG)group,HG+SNHG16 silencing(HG+sh-SNHG16)group and HG+no-load control(HG+sh-NC)group.CCK8 method and lactate dehydrogenase(LDH)method were used to detect neuronal damage.JC-1 method was used to detect mitochondrial membrane potential.Results Compared with NC group,the expression of LncRNA SNHG16 and the expression of autophagy-related gene 5,PTEN-induced putative kinase 1(PINK1),Parkin and microtubule associated protein light chain 3(LC3)Ⅱ/Ⅰ increased(P<0.05),while the expression of mitochondrial autophagy-related proteins P62 and mitochondrial outer membrane transposase 20(TOMM20)decreased in T2DM group.Compared with DCI group,the cognitive dysfunction of mice improved,and the expression level of LncRNA SNHG16 decreased in the DCI+Mdivi-1 group(P<0.05).The expressions of LncRNA SNHG16,LC3 Ⅱ/Ⅰ,PINK1 and Parkin were higher in HG group than in Con group(P<0.05),while the cell survival rate and TOMM20 protein expression were lower in HG group than in Con group(P<0.05).Silence of LncRNA SNHG16 can restore the activity of HT22 cells and mitochondrial membrane potential,and reduce the level of mitochondrial autophagy under HG condition.Conclusions The expression level of LncRNA SNHG16 was up-regulated in the hippocampus brain region of mice with diabetic cognitive dysfunction,and mitophagy was overactivated.Silencing of LncRNA SNHG16 inhibits mitophagy in hippocampal neurons and alleviates HG induced hippocampal neuronal damage.

Objective:To explore the diagnostic value of conventional computed tomography(CT)combined with enhanced CT scan in bone metastases.Methods:This study was a retrospective observational study,84 suspected bone metastases patients admitted to our hospital from January 2022 to August 2024 were selected,All patients underwent conventional CT and enhanced CT scan and pathological examination,Using pathological examination results as the"gold standard"for diagnosis.The imaging manifestations of bone metastases using conventional CT combined with enhanced CT scan examination were observed;The detection rate and bone metastases types of conventional CT and enhanced CT scan were analyzed;The bone metastases location in different types of malignant tumors were analyzed;The detection results of bone metastases between conventional CT and enhanced CT scan were compared;the diagnostic efficacy of conventional CT and enhanced CT scan alone and in combination for bone metastases were analyzed by Receiver operating characteristic(ROC)curve.Results:The detection rate of osteogenic,osteolytic,cystic and mixed bone metastases by conventional CT combined with enhanced CT scan was supered to that of conventional CT and enhanced CT scan alone(P＜0.05).Bone metastases from lung cancer,breast cancer and other tumors mainly occur in the spine,limbs and ribs,while esophageal cancer,gastric cancer,liver cancer,prostate cancer,thyroid cancer,renal cancer,and nasopharyngeal cancer had relatively fewer bone metastases.The positive detection cases of bone metastases used conventional CT combined with enhanced CT scan were supered to those used conventional CT and enhanced CT scan alone.The sensitivity,specificity and accuracy of conventional CT combined with enhanced CT scan for the diagnosis of bone metastases were 94.00％,94.11％and 94.04％,respectively,and the positive/negative predictive values were 95.91％and 91.42％,respectively.The sensitivity,specificity and accuracy of conventional CT scan were 84.00％,78.78％and 80.95％,respectively,and the positive/negative predictive values were 85.71％and 74.28％,respectively.The sensitivity,specificity and accuracy of enhanced CT were 89.79％,85.71％and 88.09％,respectively.and the positive and negative predictive values were 89.79％and 85.71％,respectively.The diagnostic efficacy of conventional CT combined with enhanced CT scan for bone metastases was significantly better than that of conventional CT and enhanced CT scan alone.Conclusions:Conventional CT combined with enhanced CT scan can significantly improve the diagnostic efficiency of bone metastases,and provide an important basis for clinical treatment.

Objective: To explore glymphatic impairment in pediatric refractory epilepsy (RE) using multi-parameter magnetic resonance imaging (MRI), assess its relationship with white-matter (WM) abnormalities and clinical indicators, and preliminarily evaluate the performance of multi-parameter MRI in discriminating RE from drug-sensitive epilepsy (DSE). Materials and Methods: We retrospectively included 70 patients with DSE (mean age, 9.7 ± 3.5 years; male:female, 37:33) and 26 patients with RE (9.0 ± 2.9 years; male:female, 12:14). The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index as well as fractional anisotropy (FA), mean diffusivity (MD), and nodal efficiency values were measured and compared between patients with RE and DSE. With sex and age as covariables, differences in the FA and MD values were analyzed using tract-based spatial statistics, and nodal efficiency was analyzed using a linear model. Pearson’s partial correlation was analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the discrimination performance of the MRI-based machine-learning models through five-fold cross-validation. Results: In the RE group, FA decreased and MD increased in comparison with the corresponding values in the DSE group, and these differences mainly involved the callosum, right and left corona radiata, inferior and superior longitudinal fasciculus, and posterior thalamic radiation (threshold-free cluster enhancement, P < 0.05). The RE group also showed reduced nodal efficiency, which mainly involved the limbic system, default mode network, and visual network (false discovery rate, P < 0.05), and significantly lower DTI-ALPS index (F = 2.0, P = 0.049). The DTI-ALPS index was positively correlated with FA (0.25 ≤ r ≤ 0.32) and nodal efficiency (0.22 ≤ r ≤ 0.37), and was negatively correlated with the MD (-0.24 ≤ r≤ -0.34) and seizure frequency (r = -0.47). A machine-learning model combining DTI-ALPS, FA, MD, and nodal efficiency achieved a cross-validated ROC curve area of 0.83 (sensitivity, 78.2%; specificity, 84.8%). Conclusion Pediatric patients with RE showed impaired glymphatic function in comparison with patients with DSE, which was correlated with WM abnormalities and seizure frequency. Multi-parameter MRI may be feasible for distinguishing RE from DSE.

This study analyzed the practical experience of the World Health Organization,the European Union,the United States,and Japan,to reveal the characteristics of health emergency drills in terms of institutional construction,technological integration,and international collaboration.The health emergency drills present three major development trends:paradigm shift driven by social demand,efficiency improvement empowered by intelligent technology,and deepening international cooperation under the global governance framework.In response to the construction needs of China's public health emergency system,policy recommendations were proposed to establish a hierarchical classification system,a full-cycle training strategy for major infectious diseases,a dual wheel drive mechanism by both techniques and qualified personnel,and a path for global governance participation.