Objective: To investigate the epidemiological characteristics and spatial-temporal clustering of severe fever with thrombocytopenia syndrome (SFTS) in Huai'an City, Jiangsu Province from 2011 to 2024, so as to provide a basis for optimizing local SFTS prevention and control strategies, and identifying high-risk areas and key populations. Methods: Data on SFTS incidence and deaths in Huai'an City from 2011 to 2024 were collected from the Infectious Disease Reporting Information System of the Chinese Disease Prevention and Control Information System. The reported incidence, mortality, and fatality rates were calculated. Descriptive analysis was performed on temporal, population, and regional distribution. The average annual percent change (AAPC) was used to analyze the trend in the reported incidence of SFTS. Global and local spatial autocorrelation analyses were employed to examine the spatial distribution patterns and spatial association patterns of SFTS incidence while spatio-temporal scanning analyses was used to assess the spatial-temporal clustering of SFTS. Results: A total of 337 SFTS cases were reported in Huai'an City from 2011 to 2024, with the reported incidence rising from 0.17/100 000 to 1.88/100 000. There were 20 deaths, with an average annual mortality of 0.03/100 000, and a fatality rate of 5.93%. The incidence showed obvious seasonality, with a peak in May and June (148 cases, accounting for 43.92%). Spring and summer accounted for 107 cases (31.75%) and 159 cases (47.18%), respectively. The reported SFTS cases were mainly male, farmers, and individuals aged ≥41 years, accounting for 56.38%, 79.23%, and 96.74%, respectively. The population distribution of death cases was basically consistent with that of incident cases. Xuyi County was a high-incidence area, with a total of 332 reported cases, accounting for 98.52%. All death cases were reported in this county. Spatial autocorrelation analyses revealed a positive spatial correlation in SFTS incidence from 2019 to 2024, with Moran's I values ranging from 0.214 to 0.336 (all P<0.05). Heqiao Town, Tianquanhu Town, and Guiwu Town in Xuyi County were identified as high-high clustering areas. Spatio-temporal scanning analyses showed that cluster 1 was consistent with the high-high clustering areas, with an aggregation time from the second quarter of 2019 to the second quarter of 2022. Conclusions From 2011 to 2024, the reported incidence of SFTS in Huai'an City showed an upward trend, with a high incidence in spring and summer. Males, farmers, and the middle-aged and elderly population were the key populations for prevention and control. Xuyi County was the key area for prevention and control.

Background Lung cancer, one of the most common malignant tumors worldwide, has long ranked first in cancer incidence and mortality, posing a severe challenge to public health systems. Objective To analyze the trends in incidence, mortality, and disability-adjusted life years (DALYs) of lung cancer among residents in Jing'an District, Shanghai, from 2002 to 2021, explore the impacts of population aging, population growth, and age-specific prevalence on disease burden, and provide a scientific basis for optimizing regional lung cancer prevention and control strategies. Methods Based on the cancer registration and cause-of-death surveillance data of registered residents in Jing'an District, Shanghai, from 2002 to 2021, Joinpoint regression models were used to analyze the annual change trends (APC) and average annual change trends (AAPC) of lung cancer incidence, mortality, DALY rate, and their age-standardized rates. Decomposition analysis was applied to quantify the contribution of population aging, population growth, and age-specific prevalence to changes in the number of new cases, deaths, and DALYs. Results From 2002 to 2021, the crude incidence rate of lung cancer in Jing'an District increased from 68.00 per 100000 to 144.36 per 100000 (AAPC=4.86%, P<0.001), and the age-standardized incidence rate rose from 43.09 per 100000 to 61.46 per 100000 (AAPC=2.89%, P<0.001). The growth rate of incidence was significantly higher in females (AAPC=6.73%) than in males (AAPC=3.62%). The crude mortality rate increased from 58.08 per 100000 to 66.11 per 100000 (AAPC=1.10%, P<0.001), while the age-standardized mortality rate decreased (AAPC=−1.54%, P<0.001). The crude DALY rate showed an upward trend (AAPC=0.94%, P=0.002), whereas the age-standardized DALY rate declined (AAPC=−1.63%, P<0.001). Significant differences were observed across genders and age groups: the mortality and DALY rates increased in males aged 60-64 years, while the fastest incidence growth occurred in females aged 45-64 years. The results of decomposition analysis indicated that the increase in new cases was primarily attributed to age-specific incidence (38.15%) and aging (37.31%); the growth in deaths and DALYs was driven by aging, while age-specific mortality and population growth showed offsetting effects. From 2002 to 2021, the probability of premature death from lung cancer among males (2.04%-2.52%) in Jing'an District showed no statistically significant trend (AAPC=−0.28%, P=0.440), while it presented a decreasing trend in the total population (1.37%-1.89%) and females (0.72%-1.26%) (AAPC=−0.80% and −2.23%, respectively; P=0.029 and <0.001, respectively). Conclusion From 2002 to 2021, the risk of lung cancer incidence in Jing’an District, Shanghai, continue to increase, with a disease burden exhibiting significant heterogeneity by gender and age: key features include a rapid increase in new cases and a trend toward younger onset among females, alongside rising mortality risk among males aged 60–64 years. Population aging and increasing age-specific incidence rates are primary drivers of the growing number of cases, while declining age-specific mortality rates mitigate the rise in mortality burden.

Objective To describe and analyze the epidemiological characteristics of scrub typhus in Huai'an, Jiangsu Province from 2006 to 2024 and explore the long-term incidence trend and distribution of high-risk areas, and to formulate targeted prevention and control strategies. Methods The scrub typhus case report data of Huai'an from 2006 to 2024 in the Chinese Disease Prevention and Control Information System were extracted for descriptive analysis. Results A total of 898 cases of scrub typhus were reported in Huai'an, with an average annual incidence rate of 0.96 per 100 000 from 2006 to 2024. There was a turning point in the incidence trend of scrub typhus in 2011. From 2006 to 2011, the annual percentage change (APC) was 47.09% (95% CI: 7.53 - 859.39), and the upward trend was statistically significant (P < 0.05). From 2012 to 2024, the APC was -2.12% (95% CI: -29.09 - 3.75), and the downward trend was not statistically significant. October and November were the high-incidence months, and the total concentration from 2006 to 2024 was 0.93, indicating that scrub typhus had strict seasonality. The circular distribution method estimated that the peak period of the epidemic was from October 11th to November 25th, and the peak day of incidence was November 3rd. Jinhu County was a high-incidence area. The ratio of male to female cases was 1.03. The age group with the highest reported incidence was 40 to < 80 years old. The occupation with the highest proportion was farmers, accounting for 78.03%. Conclusion From 2006 to 2024, scrub typhus in Huai'an shows a peak every 3 - 4 years. Middle-aged and elderly farmers are the key population at risk, and Jinhu County is a key area. In the future, targeted health education should be carried out to effectively control the prevalence of scrub typhus.

Objective To investigate the experience of ICU nurses in communication with the patients under mechanical ventilation,therefore to provide a reference for establishing and improving effective strategies in communication with the patients.Methods Using qualitative research,semi-structured interviews were conducted on 14 ICU nurses in a Tire-IIIA hospital.Data were analysed using Colaizzi's seven-step method to extract themes.Results A total of 4 themes were extracted with 11 sub-themes,they were:emotional stress in non-verbal communication(frustration and feeling of defeat,emotional exhaustion and burnout),difficulty and challenge in ineffective communication(difficulty in establishing an equal and trusting communication quickly,difficulty in accurately understanding communication requirement of patients,and difficulty in achieving effective communication and cooperation),active promotion of effective communication(use of assistive communication tools,actively seek external collaboration,early assessment and prevention of delirium),and enhancement of communication skills and a sense of professional benefit(improvement of professional communication skills and enhancement of cultural communication literacy).Conclusion ICU nurses face various emotional pressures and communication challenges.It is important to actively provide psychological support to the nurses and optimise the communication environment in order to reduce the work stress and enhance the sense of achievement and values.

Phototherapy plays a significant role in vitiligo treatment.Narrow-band ultraviolet B(NB-UVB)remains the first-line phototherapy for non-segmental vitiligo in clinical practice.In recent years,visible light has emerged as a novel therapeutic approach for vitiligo.Studies indicate that helium-neon laser demonstrates superior efficacy in segmental vitiligo,blue light is more effective for localized vitiligo,and NB-UVB is better suited for generalized or extensive vitiligo.Different phototherapy modalities exhibit distinct mechanisms of action,involving multiple biological proteins and signaling pathways in melanocyte activation and repigmentation.This review sum-marizes recent advances in phototherapy for vitiligo treatment.

Sodium-glucose cotransporter 2 inhibitor was initially developed and marketed as a novel oral hypoglycemic agent.Currently,it has been recommended as one of the main therapeu-tic agents for chronic heart failure by national and international guidelines,and it has a significant cardioprotective effect on heart failure with reduced ejection fraction,heart failure with im-proved ejection fraction,heart failure with mildly reduced ejec-tion fraction,and heart failure with preserved ejection fraction.However,cardiac tissues do not express sodium-glucose cotrans-porter 2,and the underlying mechanisms of clinical cardiovascu-lar benefits of sodium-glucose cotransporter 2 inhibitors remain unclear.This review intends to summarize the cardiovascular benefits of sodium-glucose cotransporter 2 inhibitors in clinical trials and the recommendations suggested by national and inter-national heart failure guidelines and to elucidate further the po-tential mechanisms of sodium-glucose cotransporter 2 inhibitor-mediated cardioprotective effects.

Objective To investigate the mechanism by which Erdong Xiaoke Formula(EDXKF)regulates lacrimal gland autophagy in type 2 diabetes-induced dry eye rats through the peroxisome proliferator-activated receptor γ(PPARγ)/mammalian target of rapamycin(mTOR)signal pathway.Methods Healthy male SD rats were fed with high-sugar and high-fat chow and then injected intraperitoneally 30 mg·kg-1 streptozotocin to construct type 2 diabetes-induced dry eye rat models.Healthy male SD rats were selected as a blank group.Type 2 diabetes rats were randomly divided into a model group,a Traditional Chinese Medicine(TCM)group(given 11 g·kg-1 of EDXKF through gavage),an antagonist group(given 2 mg·kg-1 PPARγ antagonist through intraperitoneal injection),and a TCM plus antagonist group(given 11 g·kg-1 EDXKF through gavage and 2 mg·kg-1 PPARγ antagonist through intraperitoneal injection).Fasting blood glucose(FBG),corneal fluorescein(FL)staining,tear film break-up time(BUT)and phenol red cotton thread test(Prtt)were examined before modeling,after modeling,and after intervention.The weight of the lacrimal gland was compared among different groups after sampling.Hematoxylin and eosin(HE)staining was performed to analyze lacrimal gland hismorphol-ogy.The expression of microtubule-associated protein 1 light chain 3(LC3)and Sequestosome-1(p62)in the lacrimal gland was examined by immunofluorescence.Western blot was used to detect the expression of PPARγ,p62,LC3 Ⅱ,LC3 I,mTOR and p-mTOR in the lacrimal gland.Results FBG levels in the antagonist group were significantly increased after intervention,compared with those in the TCM group(P＜0.01).Ocular surface examination showed that compared with the model group,the TCM group had increased BUT and Prtt scores and decreased FL scores,the antagonist group had de-creased BUT and Prtt scores and increased FL scores(all P＜0.05).Compared with the antagonist group,the TCM plus antagonist group showed increased BUT and Prtt scores and decreased FL scores(all P＜0.05).The weight analysis of lac-rimal glands revealed that the lacrimal gland weight increased in the TCM group and decreased in the antagonist group,compared with that in the model group(all P＜0.01).The lacrimal gland weight in the TCM plus antagonist group was higher than that in the antagonist group(P＜0.01).HE staining of the lacrimal gland showed atrophy of glandular lobules,increased fusion and expansion of follicles,and dense distribution of nuclei in model and antagonist groups.These symp-toms were more obvious in the antagonist group.Compared with antagonist and TCM plus antagonist groups,the TCM group showed improved symptoms,with tightly arranged follicles,partial atrophy and fusion,and a small amount of expan-sion.Immunofluorescence staining for detecting the average fluorescence intensity of LC3 and p62 showed that compared with the model group,the TCM group had increased LC3 levels and decreased p62 levels,and the antagonist group had de-creased LC3 levels and increased p62 levels(all P＜0.01).Compared with those in the antagonist group,LC3 levels were increased and p62 levels were decreased in the TCM plus antagonist group(both P＜0.01).Western blot results showed that compared with the model group,the TCM group had increased PPARγ and LC3 levels and decreased p62 and p-mTOR/mTOR levels.PPARγ and LC3 levels were decreased and p62 and p-mTOR/mTOR levels were increased in the antagonist group,compared with those in the model group.The TCM plus antagonist group had higher PPARγ and LC3 levels and low-er p62 and p-mTOR/mTOR levels than the antagonist group(all P＜0.05).Conclusion EDXKF can regulate the PPARy/mTOR signal pathway to promote lacrimal gland autophagy and thus alleviate dry eyes in type 2 diabetes rats.

Objective:To explore the clinical characteristics and treatment methods of patients with small bowel obstruction secondary to mesenteric ischemia (MI).Methods:The clinical data of 24 patients with small intestinal obstruction secondary to MI from December 2021 to December 2024 in the Fourth Affiliated Hospital of Nanjing Medical University were retrospectively analyzed, including the clinical characteristics and surgical treatment.Results:Among the 24 patients with small intestinal obstruction secondary to MI, 19 were male and 5 were female, with ages ranging from 21 to 65 years old, and the disease course was 0.5 (1.0, 5.5) months. There were 8 cases of deep vein thrombosis, 6 cases of hypertension, 6 cases of atrial fibrillation, 5 cases of short bowel syndrome, 4 cases of abdominal trauma and 23 cases with a history of abdominal surgery. There were 4 cases of acute onset, presenting with full abdominal pain, elevated D-dimer and hematogenous intestinal obstruction. There were 20 cases of chronic onset, presenting with recurrent abdominal pain, weight loss and mechanical intestinal obstruction. The pathogenic factors were superior mesenteric vein thrombosis in 7 cases, superior mesenteric arteriosclerosis in 6 cases, mesenteric injury repair in 4 cases, superior mesenteric artery embolism in 3 cases, superior mesenteric aneurysm in 2 cases, superior mesenteric artery dissection in 1 case, and ileocolic aneurysm in 1 case. Three patients underwent surgical operations after the failure of interventional surgeries, and 20 patients were directly treated with surgery. The small intestinal obstruction was completely relieved in all cases. Another case was treated conservatively, but the small intestinal obstruction was not completely relieved.Conclusions:Small bowel obstruction secondary to MI is often atypical. CT angiography should be performed to identify the cause of obstruction due to deep vein thrombosis, atrial fibrillation, abdominal trauma or abdominal surgery. Surgery is the preferred treatment.

Objective:To construct a risk warning model for severe mycoplasma pneumoniae pneumonia(SMPP)children based on clinical data,laboratory indicators and imaging indicators.Methods:162 Mycoplasma pneumoniae pneumonia(MPP)children who were admitted in Foshan Women and Children Hospital from January 2021 to December 2023 were selected,64 SMPP children were included in severe group,the remaining 98 children were included in mild group.The general data,laboratory indicators and imaging indicators of the children were collected.The influencing factors for the occurrence of SMPP were analyzed by univariate and multivariate logistic regression models,and a risk warning model for the occurrence of SMPP children was constructed based on multivariate logistic regression model.The predictive value of the risk warning model for the occurrence of SMPP were analyzed by receiver operating characteristic(ROC)curve.Results:The proportion of 3 years old ≤ age＜6 years old,course of disease,body temperature,fever course,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),lactate dehydrogenase(LDH),cyanosis of lips,positive triconcave sign,pleural effusion,lesion site was the lower lobe,abnormal electrocardiogram and extrapulmonary manifestations in severe group were significantly higher than those in mild group(P＜0.05),there were no significant differences in gender,white blood cell count(WBC),neutrophil ratio and procalcitonin(PCT)between the two groups(P＞0.05).Multivariate logistic regression analysis model showed that,3 years old ≤age＜6 years old,high body temperature,long fever course,CRP elevated,ESR elevated,LDH elevated,cyanosis of lips,positive triconcave sign,pleural effusion,lesion site was the lower lobe,abnormal electrocardiogram and extrapulmonary manifestations were risk factors for the occurrence of SMPP(P＜0.05).ROC curve analysis showed that,the area under the curve(AUC)of the risk warning model was 0.829,the sensitivity was 84.82％,and the specificity was 78.15％,the actual prediction curve of the risk warning model was in good agreement with the prediction curve,the decision curve showed that,the threshold probability range of the model was 4.61％～88.14％.Conclusion:The risk warning model based on clinical multi parameters such as general data,laboratory indicators and imaging indicators has certain predictive value for the occurrence of SMPP.

Objective:To explore the application effect of different doses of dexmedetomidine combined with propofol in elderly patients undergoing radical thyroidectomy for thyroid cancer.Methods:This study was a prospective study,102 elderly patients undergoing radical thyroidectomy for thyroid cancer at Shayang County People's Hospital of Jingmen from April 2022 to April 2024 were selected,they were randomly divided into low-dose group and high-dose group used random number table method,with 51 patients in each group.Low-dose group received propofol(2.0 mg/kg)combined with dexmedetomidine(loading dose 0.3 μg/kg)for anesthesia induction,while high-dose group received propofol(1.0 mg/kg)combined with dexmedetomidine(loading dose 0.6 μg/kg)for anesthesia induction.The postoperative recovery indicators,pain level,cognitive function,hemodynamic indicators[mean arterial pressure(MAP)and heart rate(HR)],and adverse reactions between two groups were compared.Results:Compared with high-dose group,low-dose group had shorter awakening time,spontaneous breathing recovery time,tracheal extubation time,and lower incidence of adverse reactions(P＜0.05).Compared with high-dose group at 6 h,12 h,and 24 h after surgery,low-dose group had lower pain visual analog scale(VAS)scores and higher mini-mental state examination(MMSE)scores(P＜0.05).Compared with high-dose group at separation of thyroid gland(T2)to completion of surgery(T3),low-dose group had lower MAP and HR(P＜0.05).Conclusion:Loading dose 0.3 μg/kg dexmedetomidine combined with propofol has a good analgesic effect in elderly patients undergoing radical surgery for thyroid cancer,it can also maintain hemodynamic stability,reduce the impact on cognitive function,and lower the incidence of adverse reactions.