Objective To analyze the main epidemiological characteristics of fungal infection in this hospital in the past 7 years,and to provide reference for clinical treatment and prevention and control strategies of fun-gal infection.Methods The fungal data and clinical data of related patients isolated from clinical samples in Peking Union Medical College Hospital from early January 2018 to the end of May 2024 were selected,and the main epidemiological characteristics of fungal infection in this hospital were identified and described through multi-angle statistical analysis.Results A total of 4 479 patients with filamentous fungal infection were en-rolled.The proportion of male patients[57.5％(2 576/4 479)]was higher than that of female patients[42.5％(1 903/4 143)],mainly distributed in internal medicine,Intensive Care Unit(ICU)and emergency de-partment,among which internal medicine accounted for the highest proportion[50.0％(2 241/4 479)].About 90.0％of the specimens were from the lower respiratory tract,in addition to specimens from skin and soft tis-sue,tissue,ear and blood culture.In terms of seasonal distribution,there are more patients in winter.The fun-gi were mainly composed of Aspergillus,Mucor,Cerdosporium,Fusarium and Penicillium,among which As-pergillus was the most abundant,accounting for 74.6％of the total.Aspergillus fumigatus was the most a-bundant Aspergillus,accounting for 42.5％of the total Aspergillus(1 418/3 340).Among the related infec-tions caused by mold,Aspergillus was the most common in the lower respiratory tract,accounting for 76.8％.Among them,Aspergillus fumigatus accounted for the highest proportion(33.6％).98.6％of the molds infected the ear were Aspergillus,of which Aspergillus niger and Aspergillus terreus were the most common.Skin infections are mainly caused by Sporothrix schenckii,Trichophyton rubrum,Microsporum ca-nis.The results of in vitro drug sensitivity test showed that the four common Aspergillus isolated in this hos-pital were sensitive to voriconazole,and amphotericin B had better antifungal activity against Mucorales in vitro.Conclusion Based on the main epidemiological characteristics of fungal infections in this hospital,it is recommended that special attention be paid to the admission of patients in the respiratory department during the peak infection period in autumn and winter.In the treatment of fungal infections in different regions and on different body parts,attention should be paid to the differences in the distribution of bacterial species.

OBJECTIVE To systematically evaluate medication risk prediction models for hospitalized adult patients and provide references for their development and clinical application. METHODS Databases including PubMed， Embase， Web of Science， CNKI， Wanfang data， VIP and CBM were searched for studies on medication risk prediction models from their inception to May 2024. After screening the literature， extracting data， and evaluating the quality of the literature， descriptive analysis was performed on the results of the included studies. RESULTS A total of 13 studies were included， involving 12 models. Nine studies used Logistic regression algorithm for modeling， and the number of included predictive factors ranged from 3 to 11； the area under the receiver operating characteristic curve ranged from 0.65 to 0.865. The literature quality evaluation results showed that 10 studies had high risk of bias； 10 studies had high applicability risk. A total of 31 predictive factors were extracted， including 15 items of basic patient information， 3 test indicators， and 5 items of medication information， and 8 others. CONCLUSIONS The existing medication risk prediction models for hospitalized adult inpatients are mainly Logistic regression algorithm， with predictive factors mainly focusing on basic indicators such as demographics. The overall prediction performance of the models needs to be improved， and the overall risk of bias is relatively high.

Objective To develop a value evaluation index system for health management and logistics positions in pub-lic hospitals,providing a research tool for future performance evaluations and salary reform.Methods Literature review,focus group interviews,and the point-factor method were employed to establish an initial index pool.A public hospital in Guangzhou was selected as a case study.Delphi expert consultation was then utilized to refine and finalize the indicators for the evaluation system.Results For the two rounds of Delphi expert consultation,the response rates were 87.5％and 100.0％,with the expert authority coefficient of 0.812.The Kendall's W coordination coefficients were 0.796 and 0.624 for the first round,and 0.747 and 0.918 for the second,(all＜0.001).The coefficients of variation ranged from 0.157 to 0.265 for the first round and from 0.108 to 0.230 for the second round.Experts provided four suggestions,leading to the removal of one secondary indicator and modifications to the definitions of three others.Finally,the evaluation system consists of 4 primary indicators and 12 secondary indicators.Conclusion This system can provide a research tool and reference for the follow-up performance evaluation,improve the salary reform of public hospitals,and promote the high-quality development of public hospitals.

Objective To develop a value evaluation index system for health management and logistics positions in pub-lic hospitals,providing a research tool for future performance evaluations and salary reform.Methods Literature review,focus group interviews,and the point-factor method were employed to establish an initial index pool.A public hospital in Guangzhou was selected as a case study.Delphi expert consultation was then utilized to refine and finalize the indicators for the evaluation system.Results For the two rounds of Delphi expert consultation,the response rates were 87.5％and 100.0％,with the expert authority coefficient of 0.812.The Kendall's W coordination coefficients were 0.796 and 0.624 for the first round,and 0.747 and 0.918 for the second,(all＜0.001).The coefficients of variation ranged from 0.157 to 0.265 for the first round and from 0.108 to 0.230 for the second round.Experts provided four suggestions,leading to the removal of one secondary indicator and modifications to the definitions of three others.Finally,the evaluation system consists of 4 primary indicators and 12 secondary indicators.Conclusion This system can provide a research tool and reference for the follow-up performance evaluation,improve the salary reform of public hospitals,and promote the high-quality development of public hospitals.

We report a case of a male patient who developed persistent fever and central nervous system symptoms after eating raw snails for 10 days. The patient was diagnosed with Angiostrongyliasis depended on the clinical presentation, epidemiological history, and etiological results. The patient recovered after receiving albendazole anthelmintic and dexamethasone anti-inflammatory therapy. This article incorporates literature review to sort out the diagnosis and treatment of this patient, in order to provide feasible reference for clinicians.

We report a case of a male patient who developed persistent fever and central nervous system symptoms after eating raw snails for 10 days. The patient was diagnosed with Angiostrongyliasis depended on the clinical presentation, epidemiological history, and etiological results. The patient recovered after receiving albendazole anthelmintic and dexamethasone anti-inflammatory therapy. This article incorporates literature review to sort out the diagnosis and treatment of this patient, in order to provide feasible reference for clinicians.

Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P＞0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P＜0.001;12 months,93.80±2.52 vs.89.94±2.39,P＜0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P＜0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.

Objective:To investigate the effect of combination of infrared thermography (IRT) and high frequency colour Doppler ultrasound (HFCDU) in location of superficial fascia perforating vessels and to guide the design and harvest of super-thin anterolateral thigh flap (ALTF) .Methods:A total of 15 patients who received medical treatment in the Department of Orthopaedics, Zhoushan Hospital and Department of Foot and Ankle Surgery, Wuxi No.9 People’s Hospital from January 2022 to July 2023 were selected to participate the study. The patients were 11 males and 4 females, aged 26 to 64 years with an average age of 48.3 years. A total of 14 wounds of foot, 1 of hand, 1 of forearm and 1 of ankle were reconstructed with 17 free super-thin ALTFs. The sizes of soft tissue defect were 5 cm×3 cm-23 cm×7 cm. The flaps were 6 cm×4 cm to 25 cm×8 cm in size. The donor sites were directly pulled together and sutured. Before surgery, HFCDU was applied to locate the perforator vessels across deep fascia into superficial fascia of the ALTF. IRT was further employed to locate the superficial perforator vessels on the superficial fascia in operating room. The running course of a perforating branch in the superficial fascia was determined by the running courses of the perforating branch located by the two location methods. Super-thin ALTFs were harvested and the precise locations of the perforating vessels were verified in surgery. SPSS 23.0 software was used for data analysis. Rank sum test was performed on the location data of superficial fascial perforating branches found by IRT and the data in surgery. P<0.05 was considered a statistically significant difference. All patients were included in the postoperative follow-up by means of visit of outpatient clinic and via WeChat reviews, where the survival and functional recovery of the flaps were observed. Results:A total of 30 perforating vessels had been located by HFCDU and 30 by IRT, and a total of 31 perforating vessels were found in superficial fascia in surgery. The true positive rate was 93.3%, with a false positive rate at 6.7% and a false negative rate at 9.7%. The rank sum test calculated P=0.853 for the number of perforating vessels located by the IRT and those found from surgery. There was no significant difference between the 2 detecting methods. No postoperative complication occurred in all 14 flaps. Partial necrosis occurred in 1 flap but healed after dressing changes. Venous occlusion had occurred in 1 flap, it was rectified after surgical exploration. Superficial infection happened in 1 flap and it was improved after anti-infection treatment. Postoperative follow-up was conducted for 3-12 months. The flaps were in good texture with satisfactory appearance and function of limbs. All donor sites healed well without scar hyperplasia. Conclusion:IRT combined with HFCDU is a reliable method in location of perforator vessels of ALTF, and it is an ideal technique in the exploration of perforator vessels and in the harvest of a super-thin flap.

Objective:To analyze the epidemiological and etiological characteristics of a death case of meningococcal meningitis in Hengyang city, Hunan Province in 2024.Methods:Epidemiological investigation of the death case was performed, and samples from the patient and close contacts were collected. Following cultivation and isolation, Neisseria meningitidis ( Nm) strains were analyzed by antimicrobial susceptibility testing, pulsed field gel electrophoresis (PFGE), and whole-genome sequencing for analyzing epidemiological and etiological characteristics. Phylogenetic analysis was carried out using core genomic multilocus sequence typing (cgMLST). Results:The case was a 16-year-old high school boarding student with fulminant meningococcal meningitis. He had shock symptoms, and died within 24 h of the onset of symptoms. Six Nm strains were isolated from the patient and his roommates, belonging to two distinct clades. Isolate 144569 from the patient was highly homologous to isolate 144572 from a close contact, both belonging to the highly pathogenic sublineage L44.1 of CC4821. The typical molecular features was C: P1.7-2, 14: F5-101: ST4821 (CC4821). The two strains carried the antimicrobial resistance genes of gyrA-71 and penA-552, indicating reduced susceptibility to quinolone and penicillin, which was with their resistance phenotype. The isolates from four close contacts clustered within the same clade, characterized by the molecular features of B: P1.18-25, 9-18: ST5829 (UA). Conclusions:The death case is caused by Nm serogroup C from highly pathogenic sublineage L44.1 of CC4821. The spread of this isolate has the potential risk of outbreaks of invasive meningococcal disease. It is necessary to enhanced the molecular epidemiological surveillance, particularly focusing on the transmission of multiple serogroups of Nm among adolescents and the increasing exposure risk.

Objective:To investigate the effect of combination of infrared thermography (IRT) and high frequency colour Doppler ultrasound (HFCDU) in location of superficial fascia perforating vessels and to guide the design and harvest of super-thin anterolateral thigh flap (ALTF) .Methods:A total of 15 patients who received medical treatment in the Department of Orthopaedics, Zhoushan Hospital and Department of Foot and Ankle Surgery, Wuxi No.9 People’s Hospital from January 2022 to July 2023 were selected to participate the study. The patients were 11 males and 4 females, aged 26 to 64 years with an average age of 48.3 years. A total of 14 wounds of foot, 1 of hand, 1 of forearm and 1 of ankle were reconstructed with 17 free super-thin ALTFs. The sizes of soft tissue defect were 5 cm×3 cm-23 cm×7 cm. The flaps were 6 cm×4 cm to 25 cm×8 cm in size. The donor sites were directly pulled together and sutured. Before surgery, HFCDU was applied to locate the perforator vessels across deep fascia into superficial fascia of the ALTF. IRT was further employed to locate the superficial perforator vessels on the superficial fascia in operating room. The running course of a perforating branch in the superficial fascia was determined by the running courses of the perforating branch located by the two location methods. Super-thin ALTFs were harvested and the precise locations of the perforating vessels were verified in surgery. SPSS 23.0 software was used for data analysis. Rank sum test was performed on the location data of superficial fascial perforating branches found by IRT and the data in surgery. P<0.05 was considered a statistically significant difference. All patients were included in the postoperative follow-up by means of visit of outpatient clinic and via WeChat reviews, where the survival and functional recovery of the flaps were observed. Results:A total of 30 perforating vessels had been located by HFCDU and 30 by IRT, and a total of 31 perforating vessels were found in superficial fascia in surgery. The true positive rate was 93.3%, with a false positive rate at 6.7% and a false negative rate at 9.7%. The rank sum test calculated P=0.853 for the number of perforating vessels located by the IRT and those found from surgery. There was no significant difference between the 2 detecting methods. No postoperative complication occurred in all 14 flaps. Partial necrosis occurred in 1 flap but healed after dressing changes. Venous occlusion had occurred in 1 flap, it was rectified after surgical exploration. Superficial infection happened in 1 flap and it was improved after anti-infection treatment. Postoperative follow-up was conducted for 3-12 months. The flaps were in good texture with satisfactory appearance and function of limbs. All donor sites healed well without scar hyperplasia. Conclusion:IRT combined with HFCDU is a reliable method in location of perforator vessels of ALTF, and it is an ideal technique in the exploration of perforator vessels and in the harvest of a super-thin flap.