ObjectiveTo analyze scarlet fever surveillance data in Harbin City from 2010 to 2024, to preliminarily understand its incidence level and epidemiological characteristics, and to provide a scientific basis for the further formulation of effective prevention and control strategies. MethodsScarlet fever surveillance data for Harbin City from January 1, 2010 to December 31, 2024 were collected through the China Disease Prevention and Control Information System. Descriptive epidemiological analyses were conducted using incidence rates and constituent ratios. ResultsFrom 2010 to 2024, a total of 11 052 scarlet fever cases were reported in Harbin City, during the 15-year period, with an average annual reported incidence of 7.65/100 000. The overall annual incidence rate showed a fluctuating downward trend, with epidemic peaks occurring from April to July each year and from November to January of the following year. The age group of 0 to 9 years had the highest incidence rate at 6.47/100 000. The majority of cases were students (4 707 cases, 42.59%), children in nurseries and kindergartens(3 289 cases, 29.76%) and scattered children (2 941 cases, 26.61%), together accounting for 98.96% of all cases. The incidence ratio of male to female was 1.53∶1. The average annual incidence rate was 9.23/100 000 for males and 6.07/100 000 for females. Over the 15-year period, all 18 districts (counties) in Harbin City had reported cases. The top five areas with the highest average annual reported incidence of scarlet fever were Acheng District (14.45/100 000), Xiangfang District (12.73/100 000), Pingfang District (12.10/100 000), Bin County (10.29/100 000) and Daowai District (10.08/100 000). ConclusionFrom 2010 to 2024, the overall incidence of scarlet fever in Harbin City presented a downward trend. The disease prevailed mainly in spring-summer and autumn-winter, rather than year-round, with cases concentrated in densely populated districts and counties. Children and adolescents constituted the major affected population. The incidence was slightly higher in males, and school-age children accounted for a larger proportion than other age groups. Comprehensive preventive measures should focus on health education in key endemic areas, strengthen targeted protection for high-risk groups, and enhance epidemic surveillance and early warning.

Objective To investigate the effects of different inspired oxygen concentrations on periop-erative cerebrovascular function in patients with a history of ischemic stroke.Methods A total of 150 patients scheduled for elective surgery with a history of ischemic stroke were enrolled from Renji Hospital,Shanghai Jiao Tong University School of Medicine,between June 2020 and March 2024.Using a random number table,patients were allocated into two groups:F30 group(intraoperative fraction of inspired oxygen,FiO2=30%)and F80 group(FiO2=80%),with 75 patients in each group.Bilateral middle cerebral artery(MCA)blood flow was continu-ously monitored using transcranial Doppler(TCD),including mean flow velocity(Vm),resistance index(RI),and pulsatility index(PI).Cerebral oxygen saturation(rScO2)was measured using a FORE-SIGHT oximeter.Arterial blood gas analysis was performed preoperatively,1 hour after induction,and before extubation to assess pH,partial pressure of arterial carbon dioxide(PaCO2),oxygenation index(OI),base excess(BE),hematocrit(Hct),and lactate(Lac).Peripheral blood samples were collected 24 hours postoperatively to measure thrombox-ane A2(TXA2)and prostacyclin(PGI2)levels.At 1 month postoperatively,telephone follow-up was conducted to evaluate the risk of recurrent cerebral ischemic events using the ABCD2 score and Essen Stroke Risk Score(ESRS).Results No significant differences were observed in baseline characteristics between the two groups.Perioperative arterial blood gas parameters did not differ significantly between groups(P>0.05).Compared with the F30 group,the F80 group exhibited a smaller reduction in mean flow velocity(Vm)of the affected MCA at the end of surgery(8.18%±3.34%vs.13.57%±5.32%,P<0.05),while no significant intergroup differences were found in RI or PI.At 1 hour after induction and before extubation,rScO2 of the affected hemisphere was signifi-cantly increased in the F80 group as compared with the F30 group(P<0.05),whereas no significant difference was observed in the contralateral hemisphere.Before extubation and on postoperative day 1,TXA2 levels were significantly lower and PGI2 levels higher in F80 group compared with F30 group(P<0.05).The proportion of patients at high risk of cerebral ischemia by ABCD2 and ESRS at 1 month postoperatively did not differ between groups(P>0.05).Conclusion In patients with a history of stroke,intraoperative administration of 80%FiO2under general anesthesia better maintains perioperative cerebral hemodynamic stability and cerebral oxygen satura-tion,improves cerebrovascular endothelial function,but does not significantly affect the short-term incidence of postoperative cerebrovascular events compared with 30%FiO2.

Objective:To evaluate the clinical efficacy of free anterolateral thigh perforator flap (ALTPF) for reconstruction of soft tissue defects in lower extremity in elderly patient.Methods:From February 2018 to August 2024, 24 elderly patients (14 males, 10 females. Age range: 70-89 years, mean age: 73.47 years) with soft tissue defects in lower extremity were treated with free ALTPFs in the Department of Hand Microsurgery, Sichuan Modern Hospital. All patients had comorbidities including chronic pulmonary diseases (10 cases), anaemia in various severity (15 cases), atherosclerosis (9 cases), diabetes mellitus (6 cases), hypertension (5 cases) and great saphenous varicose veins (4 cases). Fourteen patients were admitted to hospital though emergency department due to trauma. Of these patients, 2 underwent emergency flap transfer surgery, 12 had temporary wound coverage with negative pressure wound therapy (NPWT) or bone cement, followed by flap surgery at 3-7 days later. Ten patients with chronic wounds were admitted through outpatient clinic and underwent flap surgery at approximately 7 days after multidisciplinary team consultation and completion of preoperative preparation. A total of 15 patients received blood transfusion: 3 before the surgery, 10 in the surgery and 2 after the surgery. Defect locations were: right calf and ankle (6 cases), right foot (5 cases), left calf and ankle (10 cases) and left foot (3 cases). Defect sizes ranged from 5.0 cm×7.0 cm to 9.0 cm×30.0 cm, with exposure of tendon, bone or internal fixation. The size of ALTPFs ranged from 6.0 cm×8.0 cm to 10.0 cm×40.0 cm. All artery of flaps was end-to-end anastomosed with the recipient artery, and the vein of flaps was anastomosed with the accompanying vein by recipient artery. Donor sites were either closed directly or reconstructed with skin grafts. All patients were included in postoperative follow-up via visit of outpatient clinic or WeChat for evaluation of flap and donor sites.Results:All 24 flaps survived. Two cases presented with venous occlusion after surgery and surgical exploration discovered: 1 patient had a long-segment venous thrombosis in the recipient vein and was treated with great saphenous vein transposition for re-anastomosis; the other had a deep haematoma compressing of the flap, which was removed surgically with haemostasis. Follow-up lasted for 3 to 24 months. All donor sites healed well without local tenderness, leaving only linear or skin graft scars. The flap survived well, without infection, ulceration or necrosis. All ankle function was preserved.Conclusion:Transfer of free ALTPF is a valuable technique for treatment of soft tissue defects in lower extremity in elderly patients. Despite higher risks, satisfactory outcome can be achieved with thorough preoperative evaluation and surgical intervention, especially when the condition of a patient is stable, an early ambulation for functional recovery should be started.

Objective To investigate the effects of different inspired oxygen concentrations on periop-erative cerebrovascular function in patients with a history of ischemic stroke.Methods A total of 150 patients scheduled for elective surgery with a history of ischemic stroke were enrolled from Renji Hospital,Shanghai Jiao Tong University School of Medicine,between June 2020 and March 2024.Using a random number table,patients were allocated into two groups:F30 group(intraoperative fraction of inspired oxygen,FiO2=30%)and F80 group(FiO2=80%),with 75 patients in each group.Bilateral middle cerebral artery(MCA)blood flow was continu-ously monitored using transcranial Doppler(TCD),including mean flow velocity(Vm),resistance index(RI),and pulsatility index(PI).Cerebral oxygen saturation(rScO2)was measured using a FORE-SIGHT oximeter.Arterial blood gas analysis was performed preoperatively,1 hour after induction,and before extubation to assess pH,partial pressure of arterial carbon dioxide(PaCO2),oxygenation index(OI),base excess(BE),hematocrit(Hct),and lactate(Lac).Peripheral blood samples were collected 24 hours postoperatively to measure thrombox-ane A2(TXA2)and prostacyclin(PGI2)levels.At 1 month postoperatively,telephone follow-up was conducted to evaluate the risk of recurrent cerebral ischemic events using the ABCD2 score and Essen Stroke Risk Score(ESRS).Results No significant differences were observed in baseline characteristics between the two groups.Perioperative arterial blood gas parameters did not differ significantly between groups(P>0.05).Compared with the F30 group,the F80 group exhibited a smaller reduction in mean flow velocity(Vm)of the affected MCA at the end of surgery(8.18%±3.34%vs.13.57%±5.32%,P<0.05),while no significant intergroup differences were found in RI or PI.At 1 hour after induction and before extubation,rScO2 of the affected hemisphere was signifi-cantly increased in the F80 group as compared with the F30 group(P<0.05),whereas no significant difference was observed in the contralateral hemisphere.Before extubation and on postoperative day 1,TXA2 levels were significantly lower and PGI2 levels higher in F80 group compared with F30 group(P<0.05).The proportion of patients at high risk of cerebral ischemia by ABCD2 and ESRS at 1 month postoperatively did not differ between groups(P>0.05).Conclusion In patients with a history of stroke,intraoperative administration of 80%FiO2under general anesthesia better maintains perioperative cerebral hemodynamic stability and cerebral oxygen satura-tion,improves cerebrovascular endothelial function,but does not significantly affect the short-term incidence of postoperative cerebrovascular events compared with 30%FiO2.

Objective:To evaluate the clinical efficacy of free anterolateral thigh perforator flap (ALTPF) for reconstruction of soft tissue defects in lower extremity in elderly patient.Methods:From February 2018 to August 2024, 24 elderly patients (14 males, 10 females. Age range: 70-89 years, mean age: 73.47 years) with soft tissue defects in lower extremity were treated with free ALTPFs in the Department of Hand Microsurgery, Sichuan Modern Hospital. All patients had comorbidities including chronic pulmonary diseases (10 cases), anaemia in various severity (15 cases), atherosclerosis (9 cases), diabetes mellitus (6 cases), hypertension (5 cases) and great saphenous varicose veins (4 cases). Fourteen patients were admitted to hospital though emergency department due to trauma. Of these patients, 2 underwent emergency flap transfer surgery, 12 had temporary wound coverage with negative pressure wound therapy (NPWT) or bone cement, followed by flap surgery at 3-7 days later. Ten patients with chronic wounds were admitted through outpatient clinic and underwent flap surgery at approximately 7 days after multidisciplinary team consultation and completion of preoperative preparation. A total of 15 patients received blood transfusion: 3 before the surgery, 10 in the surgery and 2 after the surgery. Defect locations were: right calf and ankle (6 cases), right foot (5 cases), left calf and ankle (10 cases) and left foot (3 cases). Defect sizes ranged from 5.0 cm×7.0 cm to 9.0 cm×30.0 cm, with exposure of tendon, bone or internal fixation. The size of ALTPFs ranged from 6.0 cm×8.0 cm to 10.0 cm×40.0 cm. All artery of flaps was end-to-end anastomosed with the recipient artery, and the vein of flaps was anastomosed with the accompanying vein by recipient artery. Donor sites were either closed directly or reconstructed with skin grafts. All patients were included in postoperative follow-up via visit of outpatient clinic or WeChat for evaluation of flap and donor sites.Results:All 24 flaps survived. Two cases presented with venous occlusion after surgery and surgical exploration discovered: 1 patient had a long-segment venous thrombosis in the recipient vein and was treated with great saphenous vein transposition for re-anastomosis; the other had a deep haematoma compressing of the flap, which was removed surgically with haemostasis. Follow-up lasted for 3 to 24 months. All donor sites healed well without local tenderness, leaving only linear or skin graft scars. The flap survived well, without infection, ulceration or necrosis. All ankle function was preserved.Conclusion:Transfer of free ALTPF is a valuable technique for treatment of soft tissue defects in lower extremity in elderly patients. Despite higher risks, satisfactory outcome can be achieved with thorough preoperative evaluation and surgical intervention, especially when the condition of a patient is stable, an early ambulation for functional recovery should be started.

Objective To establish a quality control mechanism based on the Poisson distribution for monitoring con-tamination in nucleic acid testing(NAT)laboratories.Methods The study collected NAT single-reactivity rates and dis-criminatory test reactivity rates from the Grifols Panther NAT system from 2022 to 2023.The Poisson distribution probability method was used to calculate the daily probability of nucleic acid single reactivity.Sensitivity and specificity of the quality control model were further validated using single-reactivity rates,discriminatory reactivity rates and ROC curve analysis,fol-lowed by proposing corresponding multi-rule quality control strategies.Results Using P=0.05 as the threshold for out-of-control,the Poisson distribution probability quality control model identified 40 out-of-control points with P<0.05.After man-ual verification using discriminatory reactivity rates,20 out-of-control points were confirmed.The sensitivity of determining out-of-control was 60.0%,and the specificity was 95.6%.Due to the high number of out-of-control points,it is recommen-ded to combine discriminatory reactivity rates and employ multi-rule quality control methods for quality monitoring.Under the multi-rule quality control,there were 18 warning points and 2 out-of-control points for NAT single reactivity from 2022 to 2023.Conclusion The multi-rule NAT single-reactivity monitoring mechanism based on the Poisson distribution probability is more suitable for nucleic acid laboratories to monitor and warn of laboratory contamination,thereby enhancing the manage-ment capabilities and detection quality of nucleic acid laboratories.

Objective To form the in vitro diagnostic reagents(IVD)selection and optimization management plan and management database,and optimize the IVD management work.Methods Through the analysis of the policy background and the current management status of the IVD clinical laboratory in Beijing Hospital,the selection and optimization management plan for existing and newly applied laboratory IVD was formulated based on clinical needs.The IVD of the whole hospital was selected and optimized by combing projects,open bidding,innovative quotation methods,on-site review and other steps.The IVD management database and qualification database of Beijing Hospital was formed,and the effect from the aspects of compliance,work efficiency and cost control was evaluated.Results The selection and optimization of 1 737 IVDs in the whole hospital were completed according to the formulated IVD selection and optimization management plan.The implementation of management plan improved the work efficiency.The content of review in an average meeting was increased by more than 10 times,and the frequency of new applications for IVD access was accelerated,while the IVD cost was reduced,and the average purchase amount of the whole hospital was reduced by about 15％.The prices of key IVD products were lower after selection than before selection,and the difference was significant(t=2.493,P=0.034).Conclusion The management scheme of IVD selection and optimization was feasible,and it could achieve the goal of ensuring compliance,improving efficiency and reducing costs.

Objective:To investigate the risk factors for aneurysm rupture and post-intervention complications in intracranial arterial stenosis patients with intracranial aneurysms.Methods:A retrospective analysis was performed; 238 intracranial arterial stenosis patients with intracranial aneurysms (306 intracranial aneurysms) admitted to Cerebrovascular Disease Department, Neurosurgery Center, Zhujiang Hospital, Southern Medical University from January 2018 to August 2022 were chosen. Ruptured group and unruptured group were divided according to the rupture of intracranial aneurysms. Additionally, 139 patients who underwent interventional therapy and had complete follow-up data were divided into 2 groups according to occurrence of post-intervention complications. Univariate and multivariate Logistic regression analyses were used to identify the risk factors for aneurysm rupture and post-intervention complications.Results:(1) Of 238 patients, 269 unruptured aneurysms and 37 ruptured aneurysms were noted. Univariate regression analysis showed that significant difference was noted between the ruptured group and unruptured group in female ratio, aneurysm distribution, proportion of irregular shaped aneurysms, percentages of patients with increased white blood cell count, neutrophil count, total cholesterol and D-2 polymer, and percentage of patients with decreased blood lymphocyte count ( P<0.05). Multivariate Logistic regression analysis showed that irregular shaped aneurysms ( OR=12.393, 95% CI: 4.114-37.332, P<0.001), elevated neutrophil count ( OR=18.753, 95% CI: 6.555-53.648, P<0.001), and increased D-2 polymer ( OR=4.410, 95% CI: 1.758-11.065, P=0.002) were independent risk factors for aneurysm rupture in intracranial arterial stenosis patients with intracranial aneurysms. (2) Of the 139 patients, 57 had complications and 82 had no complications. Univariate regression analysis showed that the proportion of patients with hypertension history, distribution of arterial stenosis, and proportion of patients with elevated blood D-2 polymer were significantly different between patients with and without complications ( P<0.05); while multivariate Logistic regression analysis did not identify these 3 indexes as independent risk factors for post-intervention complications ( P>0.05). Conclusion:Patients with irregular shaped aneurysms, elevated blood neutrophil count and D-2 polymer trend to have aneurysm rupture; hypertension history, arterial stenosis, and elevated D-2 polymer have impact on postoperative complications in intracranial arterial stenosis patients with intracranial aneurysms.

Objective:To construct a physical restraint reduction scheme based on eCASH concept (that is early Comfort using Analgesia, minimal Sedatives and maximal Human care for adult patients after cardiac surgery, and intervene, and to evaluate its effectiveness.Methods:A non-synchronous case-control study was conducted. A total of 486 patients after cardiac surgery admitted to the cardiac surgery intensive care Unit (ICU) of Shandong Provincial Hospital Affiliated to Shandong First Medical University from July to October 2022 were enrolled as subjects. According to the implementation time node of the physical restraint reduction scheme, 250 patients admitted from July to August were served as the control group, and 236 patients admitted from September to October were served as the observation group. The control group adopted the routine physical restraint nursing process, including selecting the appropriate restraint device according to the patient's condition and consciousness and following the doctor's advice, and checking on time to prevent adverse reactions. The observation group implemented the physical restraint reduction scheme based on eCASH concept, including preoperative visit, postoperative assessment of whether patients needed physical restraint according to the restraint decision wheel and the physical restraint flow, and adopted personalized nursing programs. The restraint rate, restraint duration, incidence of restraint-related complication (edema of the limbs, redness and swelling of the skin in the restricted area, skin rupture, etc.), restraint device application standard rate, delirium rate and incidence of unplanned extubation event were compared between the two groups.Results:There was no significant difference in age, gender, cardiopulmonary bypass, endotracheal catheter retention duration and operation type between the two groups with comparability. The restraint rate in the observation group was significantly lower than that in the control group [16.95% (40/236) vs. 84.40% (211/250), P < 0.01], and the restraint duration was significantly shorter than that in the control group [hours: 0 (0, 1.0) vs. 7.0 (5.5, 10.0), P < 0.01], the incidence of restraint-related complication and delirium were significantly lower than those in the control group [restraint-related complication: 0.85% (2/236) vs. 1.60% (4/250), delirium: 0% (0/236) vs. 2.80% (7/250), both P < 0.05], and the restraint device application standard rate was significantly higher than that in the control group [100.00% (40/40) vs. 90.52% (191/211), P < 0.05]. No unplanned extubation event occurred in both groups. Conclusion:The physical restraint reduction scheme based on eCASH concept in adult patients after cardiac surgery can effectively reduce the restraint rate and the incidence of restraint-related complication, shorten the restraint duration, reduce the incidence of delirium, improve the standardization of restraint device application, without increasing the incidence of unplanned extubation events.

Objective To retrospectively analyze the efficacy and safety of abatacept(ABA)in anti citrullinated peptide antibody(ACPA)positive rheumatoid arthritis(RA).Methods Clinical data from ACPA positive RA patients who visited the Department of Rheumatology and Immunology at the Second Hospital of Hebei Medical University from May 2020 to January 2023 and were treated with ABA were retrospectively collected and analyzed,to evaluate the efficacy and safety of ABA at 12 weeks and 24 weeks of treatment.Efficacy evaluation measures included RA disease activity score-28(DAS-28),clinical disease activity index(CDAI),and remission criteria of RA of American College of Rheumatology(ACR).Results A total of 35 ACPA-positive RA patients were included in the final analysis.The DAS-28,CDAI,ACR20,ACR50,and ACR70 remission rates at 12 weeks after treatment were 34.29%,31.43%,60.00%,28.57%,and 14.29%,respectively;the DAS-28,CDAI,ACR20,ACR50,and ACR70 remission rates at 24 weeks after treatment were 74.29%,82.86%,85.71%,54.29%,and 31.43%,respectively;in addition,the remission rate at 24 weeks was significantly higher than that at 12 weeks(P﹤0.05).Among the 35 patients included in the analysis,4 patients experienced respiratory tract infections,3 patients experienced transient creatinine elevation,and 4 patients experienced elevated blood uric acid.Conclusion In the real world,ABA's clinical remission rate is consistent with expectations,and clinical combination drug regimens are flexible and diverse,with high drug safety.