Neonatal diabetes mellitus （NDM） is a rare monogenic disorder primarily caused by insufficient insulin secretion resulting from mutations in the KCNJ11 and ABCC8 genes. Sulfonylureas， represented by glibenclamide， have become the standard therapy for this type of NDM by precisely closing the mutated ATP-sensitive potassium channels in pancreatic β cells， thereby restoring insulin secretion. Clinical studies confirm that sulfonylureas enable over 90% of patients to successfully transition from insulin to oral treatment， achieving long-term stable glycemic control and improving neurological outcomes to a certain extent. In terms of safety， severe hypoglycemia induced by sulfonylureas is relatively rare and gastrointestinal reactions are mild； moreover， sulfonylureas show good long-term tolerability， and have no adverse effects on child growth and development. In the future， by further refining the full-chain management pathway of “rapid genetic diagnosis-early intervention-specialized dosage forms-long-term follow-up”， the clinical application of sulfonylureas is expected to provide NDM patients with an optimized treatment regimen and maximize their health benefits.

Objective: To investigate the relationship between physical development indicators and the onset and progression of myopia among children and adolescents, so as to provide theoretical support for coordinated vision and physical health management. Methods: A prospective cohort study was conducted. In September 2022, 3 102 students from grade one in primary school to grade three in junior high school (five year primary school and four year junior high school) from six schools in Huantai County, Shandong Province, were selected using multistage cluster random sampling method to participate in an epidemiological survey on myopia, with follow up completed in September 2023. Follow up value minus baseline value( d ) was used to assess changes in physical development and vision indicators. Multivariate Logistic regression analysis was used to examine the relationship between physical development indicators and the incidence of myopia. Generalized linear models were established to analyze the relationship between physical development indicators and changes in d spherical equivalent (SE) and d axial length (AL) . Results: Multivariate Logistic regression analysis showed that, after adjusting for factors such as gender, age, and baseline body mass index, the third ( Q 3)and fourth ( Q 4)quartiles of d height showed increased risks of myopia onset within one year compared to the first quartile( Q 1) ( OR =1.85,95% CI =1.18-2.88; OR =1.74,95% CI =1.09-2.78,both P ＜0.05). Results from the generalized linear model indicated that, after adjusting for confounding factors such as gender, age, and baseline SE, d SE was negatively correlated with d height and d weight in children and adolescents ( β =-0.024, 95% CI =-0.031 to -0.018; β =-0.006, 95% CI =-0.011 to -0.001), d AL was positively correlated with d height and d weight in children and adolescents ( β =0.011, 95% CI =0.008-0.013; β =0.005, 95% CI =0.003-0.007) (all P ＜0.05). Conclusions Physical development indicators in children and adolescents were associated with the onset and progression of myopia. Dynamic monitoring and early intervention of myopia should be strengthened for children and adolescents with rapid height and weight gain to achieve coordinated management of myopia and physical development.

ObjectiveTo explore the effect and mechanism of Qigui Didang decoction， formulated based on the principle of Tonifying Deficiency and Unblocking Collaterals， on improving metabolic memory of db/db mice with diabetic nephropathy （DN） through silent information regulator 1 signal regulator 1 （Sirt1）/p53/nuclear factor kappa-B （NF-κB） p65 pathway. MethodsFifteen db/db mice were randomly divided into model group （10 mL·kg^-1·d^-1）， resveratrol group （20 mg·kg^-1·d^-1）， and Qigui Didang decoction group （3.34 g·kg^-1·d^-1） Another five db/m mice were selected as the normal group （10 mL·kg^-1·d^-1）. After the intervention， the kidney weight of each group was measured， and the kidney index （KI） was calculated. Fasting blood glucose （FBG）， creatinine （CRE）， β2-microglobulin （β2-MG）， blood urea nitrogen （BUN）， and cystatin C （CysC） were measured. Renal pathology was observed by hematoxylin-eosin （HE） staining and Masson staining. The mRNA and protein expression levels of Sirt1， NF-κB， tumor suppressor gene p53， interleukin-1β （IL-1β）， and cysteine aspartate protease-3 （Caspase-3） were detected using real-time quantitative polymerase chain reaction （Real-time PCR） and Western blot. ResultsCompared with the normal group， the model group showed disordered renal structure， obvious renal damage， and markedly elevated levels of renal function indexes （CRE， β2-MG， BUN， and CysC） （P<0.01）. The KI and blood glucose were significantly increased （P<0.01）， while Sirt1 expression was markedly decreased （P<0.01）. Expression levels of NF-κB p65， p53， IL-1β， and Caspase-3 were increased significantly （P<0.05）. Compared with those in the model group， DN mice treated with Qigui Didang decoction exhibited significantly decreased FBG， improved renal function， and markedly decreased KI （P<0.01）， along with reduced CRE， β2-MG， BUN， and CysC levels （P<0.05）. Protein expression of Sirt1 was significantly upregulated （P<0.05）， while that of NF-κB p65， p53， IL-1β， and Caspase-3 was markedly decreased （P<0.05）. The mRNA expression levels of NF-κB p65， p53， IL-1β， and Caspase-3 were significantly decreased （P<0.05）. The staining results indicate improved renal fibrosis， significantly decreased fiber deposition （P<0.05）， and less inflammatory infiltration in the Qigui Didang decoction group. ConclusionThe findings suggest that Qigui Didang decoction can alleviate the metabolic memory effect of DN， thereby inhibiting renal cell apoptosis and inflammatory response in mice， and improving renal function. The mechanism of action is closely related to the Sirt1/p53/NF-κB p65 signaling pathway.

Anti-CD20 monoclonal antibodies for the treatment of refractory nephrotic syndrome （RNS） in children. The first- generation rituximab is the most widely used in clinical practice； it shows definite efficacy in children with RNS， is recommended by guidelines， particularly for achieving a high remission rate in minimal change nephrosis， and can significantly reduce the cumulative use of glucocorticoids and immunosuppressants. The second-generation ofatumumab has potential as an alternative treatment for patients who are intolerant or resistant to rituximab， while the third-generation obinutuzumab has shown efficacy in complex cases such as rituximab resistance or post-transplant recurrence. However， there is still controversy regarding the optimization of rituximab treatment dosage and whether ofatumumab and obinutuzumab offer greater advantages than rituximab for the treatment of RNS in children. The most common adverse reaction induced by anti-CD20 monoclonal antibodies is infusion reactions， and long-term adverse events mainly include increased risks of sustained immunosuppression and infections. Rituximab has significant economic advantages for the treatment of RNS， but additional pharmacoeconomic research based on China’s healthcare environment is needed to evaluate the cost-effectiveness of ofatumumab and obinutuzumab in this population. Given that the current use of ofatumumab and obinutuzumab in this field is considered off-label use， clinical application should only proceed after a rigorous evaluation of the patient’s benefits and risks.

Objective: To investigate the prevalence of human T-lymphotropic virus (HTLV) infection among blood donors in Hunan Province from 2022 to 2024. Methods: A total of 1 830 342 blood donors from 14 prefecture-level blood centers in Hunan Province over the past three years were screened for anti-HTLV-Ⅰ/Ⅱ using enzyme-linked immunosorbent assay (ELISA). Initially reactive samples were further tested with Line Immunoassay (LIA )/MP-Western blot and RT-PCR nucleic acid test for confirmation. Blood donors confirmed positive for HTLV were tracked and followed up. Results: From 2022 to 2024, the initial ELISA reactive rate for anti-HTLV-I/II among blood donors in Hunan Province was 1.36 per 10 000 (249/1 830 342). The confirmed positive rate was 0.20 per 10 000 (37/1 830 342), accounting for 14.86% of the initially reactive donors. The follow-up success rate for confirmed HTLV-positive blood donors was only 18.92%, while that for HTLV-indeterminate donors was 54.17%. Conclusion: The confirmed HTLV infection rates in Yueyang, Loudi, Shaoyang, Yiyang, and Zhuzhou cities were higher than the provincial (0.20 per 10 000). Chenzhou, Yongzhou, Zhangjiajie, and Xiangxi were identified as low prevalence areas, with an infection rate of 0. The overall follow-up success rate was low, indicating significant difficulties and bottlenecks in follow-up work. The comprehensive screening for HTLV and follow-up studies in Hunan provide valuable data to further improve blood safety testing strategies and risk warning mechanisms.

Objective: To evaluate the effects of problem-oriented respiratory rehabilitation nursing on lung function, activity ability, length of hospital stay, and retention time of closed chest drainage tube in patients undergoing thoracoscopic radical resection for lung cancer, so as to provide a basis for improving the prognosis of patients with lung cancer surgery. Methods: A total of 119 patients with lung cancer who underwent thoracoscopic radical resection for lung cancer in the First Affiliated Hospital of Anhui Medical University from October 2023 to June 2024 were selected and randomly divided into the intervention group (n=59) and the control group (n=60). The control group received routine respiratory rehabilitation nursing of thoracic surgery. On the basis of the treatment and guidance received by the control group, the intervention group implemented problem-oriented respiratory rehabilitation nursing. First second expiratory volume (FEV1) and forced vital capacity (FVC) were used to evaluate pulmonary function at 1 day before surgery and 3 days after surgery, and the 6-minute walk distance (6MWD) was used to evaluate physical activity. The incidence of pulmonary complications, length of hospital stay and retention time of closed chest drainage tube were collected through the hospital's electronic medical records system. The intervention effects between the two groups were compared using variance analysis of repeated-measures analysis of variance and log-rank test. Results: The mean age of the control group was (60.77±9.31) years, with 28 males and 32 females. There were 4 cases of squamous cell carcinoma, 55 cases of adenocarcinoma, and 1 case of small cell carcinoma. The tumors were located in the right lobe in 41 cases. The mean age of the intervention group was (58.71±10.01) years, with 23 males and 36 females. There were 2 cases of squamous cell carcinoma, 56 cases of adenocarcinoma, and 1 case of small cell carcinoma. The tumors were located in the right lobe in 37 cases. There were no statistically significant differences in age, gender, education level, pathological type, and tumor location between the two groups (all P>0.05). Three days after surgery, there was an interaction effect between the group and the time in FEV1, FVC, and 6MWD between the two groups. The FEV1 and 6MWD in the intervention group were higher than those in the control group (both P<0.05). There was no statistically significant difference in FVC between the groups (P>0.05). There were 3 cases of postoperative complications in the control group, and no cases in the intervention group. Log-rank test showed that the length of hospital stay and retention time of closed chest drainage tube after surgery in the intervention group were shorter than those in the control group (both P<0.05). Conclusion The problem-oriented respiratory rehabilitation nursing can improve the lung function and activity ability of patients with lung cancer after surgery, shorten the length of hospital stay and retention time of closed chest drainage tube, and improve the quality of life.

Objective: To analyze the timeliness of antir-etroviral therapy (ART) and its influencing factors among newly reported HIV/AIDS cases in Wenzhou City, Zhejiang Province from 2016 to 2023, so as to provide a reference for improving the ART effect of HIV/AIDS cases. Methods: Newly reported HIV/AIDS cases in Wenzhou City from 2016 to 2023 were selected as the research subjects. Demographic information, the situation of the first CD4+ T lymphocyte (CD4 cell) test, baseline CD4 cell count, and ART situation were collected through the Chinese Disease Prevention and Control Information System. The timely rate of ART was analyzed, and the influencing factors for timely ART among HIV/AIDS cases were analyzed using a multivariable logistic regression model. Results: A total of 4 500 newly reported HIV/AIDS cases in Wenzhou City from 2016 to 2023 were included, among which 3 679 were males, accounting for 81.76%, and 821 were females, accounting for 18.24%. The median age was 46.24 (interquartile range, 26.23) years. Among these cases, 3 606 received timely ART, with a timely rate of 80.13%. The timely rate of ART increased from 57.54% in 2016 to 91.97% in 2023 (P<0.05). Multivariable logistic regression analysis showed that unmarried/divorced/widowed (OR=0.769, 95%CI: 0.641-0.922), detainees (OR=0.492, 95%CI: 0.269-0.900), untimely first CD4 cell test (OR=0.278, 95%CI: 0.234-0.330), baseline CD4 cell count ≥200 cells/µL (OR=0.709, 95%CI: 0.595-0.843) or undetected (OR=0.131, 95%CI: 0.080-0.213) were associated with a lower timeliness for ART among HIV/AIDS cases. Conclusion From 2016 to 2023, the timely rate of ART among newly reported HIV/AIDS cases in Wenzhou City showed an upward trend, which was mainly affected by marital status, case source, timeliness of the first CD4 cell test, and baseline CD4 cell count.

Objective: To analyze the epidemiological characteristics of hepatitis C in Wenzhou City, Zhejiang Province from 2005 to 2023, so as to provide the evidence for improving hepatitis C prevention and control measures. Methods: The data of hepatitis C cases in Wenzhou City from 2005 to 2023 were collected from the China Disease Prevention and Control Information System. Descriptive epidemiological methods were used to describe the incidence of hepatitis C by gender and age in Wenzhou City from 2005 to 2023. Average annual percent change (AAPC) was used to analyze the trend of hepatitis C incidence. Results: A total of 15 707 hepatitis C cases were reported in Wenzhou City from 2005 to 2023, with an average annual reported incidence of 9.17/100 000. The reported incidence showed an overall upward trend (AAPC=2.401%, P<0.05). In terms of occupation, farmers/migrant workers and workers accounted for 34.26% (5 382 cases), followed by domestic workers, those engaged in housework and unemployed people, accounting for 19.39% (3 045 cases). Lucheng District, Pingyang County, and Yongjia County had relatively high average annual reported incidences of hepatitis C, which were 18.12/100 000, 13.53/100 000 and 9.88/100 000, respectively. There were 10 816 males and 4 891 females, with a male-to-female ratio of 2.21∶1. The average annual reported incidence of hepatitis C in males was higher than in females (12.06/100 000 vs. 6.00/100 000, P<0.05). The reported incidence of hepatitis C in males showed an overall upward trend (AAPC=3.011%, P<0.05), but there was no significant change in females (AAPC=1.803%, P>0.05). The case was mainly aged 25-<55 years (12 659 cases, 80.59%). There was no significant change in incidence of hepatitis C in 0-<10 years old group and 10-<20 years old group (AAPC=2.103%, 1.126%, both P>0.05), while the incidence of hepatitis C in 20-<30 years old group and 30-<40 years old group showed downward trends (AAPC=>-13.160%, -7.159%, both P<0.05). There were upward trends in the 40-<50 years old group and 50-<60 years old group (AAPC=10.457%, 11.831%, both P<0.05), but no significant change in the ≥60 years old group (AAPC=2.867%, P>0.05). Conclusions The reported incidence of hepatitis C in Wenzhou City showed an overall upward trend from 2005 to 2023. Lucheng District, Pingyang County, and Yongjia County were high risk areas. Farmers/migrant workers, workers, males, and people aged 40-<60 years were the key population for prevention and control of hepatitis C.

Esophagectomy is an effective treatment for esophageal cancer,and there has been growing attention on the importance of postoperative pain management in patients undergoing the surgery.Epidural analgesia is the preferred analgesic approach for open esophagectomy.With the development of surgical technology,minimally invasive esophagectomy(MIE)has become the mainstream surgical approach.However,no conclusion has been reached concerning whether epidural analgesia is still the preferred analgesic approach for MIE.Herein,we analyzed the relevant literature published in recent years and found that epidural analgesia continued to be an important analgesic approach for MIE,offering the best analgesic effect.Epidural analgesia can reduce postoperative pulmonary complications,improve the quality of life,and reduce the stress response.Adverse effects can be minimized through accurate selection of epidural puncture segments,individualized medication,and multimodal analgesia strategies.In the future,precision-based multimodal analgesia can be achieved using emerging technologies such as big data analytics and artificial intelligence.

Objective To explore the mediating effect of hope between self-perceived burden and quality of life in patients with recurrent malignant tumors.Methods A cross-sectional survey was conducted using convenience sampling,selecting 204 patients with recurrent malignant tumors from the Oncology Department of Xiangyang Central Hospital in Hubei Province from September to December 2023.A general information questionnaire,Self-Perceived Burden Scale(SPBS),hope level(HHI),and EORTC QLQ-C30 quality of life questionnaire were utilized for the investigation.Results The SPBS score for patients with recurrent malignant tumors was(28.28±8.92),the HHI score was(35.83±4.30)and the quality of life score was(59.68±23.96).Self-perceived burden was negatively correlated with hope and quality of life(P<0.05;P<0.01),while hope was positively correlated with quality of life(P<0.01).The mediating effect of hope between the burden of self-perception and quality of life is reflected,with the indirect effect accounting for 21.18%of the total effect.Conclusion Patients with recurrent malignant tumors generally have a low quality of life and moderate levels of hope,both of which require improvement.The self-perceived burden of patients is at a mild to moderate level.Healthcare professionals should take effective measures to enhance patients'levels of hope and reduce their self-perceived burden,thereby improving the quality of life for patients with recurrent malignant tumors.