Objective: To analyze epidemiological trends and changing characteristics of syphilis among students in Yunnan Province from 2005 to 2023, so as to provide evidence for the comprehensive prevention and control of syphilis in schools. Methods: The case data of syphilis among students in Yunnan Province from 2005 to 2023 were obtained from the China Information System for Disease Control and Prevention. The Joinpoint regression model was used to conduct a time trend analysis of the reported incidence rate of syphilis. Results: From 2005 to 2023, a cumulative total of 3 191 cases of syphilis were reported in schools in Yunnan Province(1 248 male cases and 1 943 female cases). The reported incidence rate rose continuously from 0.17/100 000 in 2005 to 8.26/100 000 in 2023, with an average annual percent change (AAPC) of 24.89%( Z =13.18, P <0.01). The reported incidence rate was higher in female students than in male students ( χ 2=229.48, P <0.05). The incidence rates in the primary school, junior high school, senior high school and higher education were 0.21/100 000, 2.42/100 000, 4.45/100 000 and 6.29/100 000 respectively, and the difference was statistically significant (χ 2=3 432.84, P <0.05). The average annual growth rate was the highest in the junior high school stage(AAPC= 30.68% , Z =7.57, P <0.05),followed by the senior high school stage (AAPC=24.28%, Z = 5.70 , P <0.05).The reported incidence rate of primary and secondary syphilis increased from 0.12/100 000 in 2005 to 2.06/ 100 000 in 2023, with an AAPC of 16.86% ( Z = 4.57, P <0.05). Conclusions The overall reported incidence rate of syphilis among students in schools in Yunnan Province shows a sustained upward trend, with the most rapid annual increase observed in junior high schools. Schools should prioritize syphilis education and expand awareness campaigns to curb transmission.

Objective:To understand and compare the clinical characteristics of children and adults infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant BA.5 and BA.2 subtypes in Shanghai City.Methods:The clinical data of 524 children hospitalized with coronavirus disease 2019(COVID-19) at the Children′s Hospital of Fudan University during the period of BA.5 predominance from December 1, 2022 to January 20, 2023 were collected, which included age, gender, clinical symptoms and laboratory examination results. And the clinical data of household close contacts were also collected. The clinical data of children and their household contacts infected with Omicron BA.2 subtypes during the period of BA.2 predominance from April 4 to April 30, 2022 were collected and compared.The clinical characteristic of critical and non-critical cases, child and adult cases during the period of BA.5 predominance were compared.Statistical analyses were conducted using independent samples t-test, Mann-Whitney U test, chi-square test or Fisher′s exact test. Results:The age of 524 hospitalized children was five days to 16 years old. Among them, 301(57.4%) were male and 223(42.6%) were female. Additionally, there were 29 critical cases (5.5%) and 495 non-critical cases (94.5%). Critical cases had significantly higher fever peak, more shortness of breath occurrence, more pneumonia and underlying diseases compared to non-critical cases, with statistically significant differences ( t=12.06, χ2=34.90, 10.04 and 31.10, respectively, all P<0.05). Regarding laboratory examinations, critical cases exhibited significantly higher frequencies of decreased lymphocyte count, elevated levels of C-reactive protein, procalcitonin and interleukin-6, abnormal liver function and kidney function, and abnormal creatine kinase isoenzyme compared to non-critical cases, with statistically significant differences ( χ2=8.18, Z=-4.61, Z=-4.28, Z=-5.13, χ2 =195.90, Fisher′s exact test and χ2=136.13, respectively, all P<0.05). Non-critical children cases infected with Omicron variant BA.5 subtype exhibited a higher proportion of symptomatic infections compared to adults. Among children, the occurrence rates of fever and gastrointestinal symptoms (nausea, vomiting, diarrhea) were higher, whereas among adults, the occurrence rate of cough was higher. The differences were statistically significant ( χ2=11.16, 11.83, 8.50 and 28.14, respectively, all P<0.05).From December 1, 2022 to January 20, 2023, a total of 588 children cases and 791 adult cases were collected, while from April 4 to April 30, 2022, a total of 355 children cases and 755 adult cases were collected.In the children group, the occurrence rates of cough, convulsions and critical cases were higher in BA.5 subtype-infected children compared to those infected with the BA.2 subtype, with statistically significant differences ( χ2=37.95, 40.78 and 15.54, respectively, all P<0.001).In the adult group, BA.5 subtype-infected individuals had higher fever peak, longer duration of fever, and higher occurrence of fever, cough and gastrointestinal symptoms, compared to those infected with the BA.2 subtype.The differences were statistically significant ( t=-4.40, Z=-9.64, χ2=47.29, 124.09 and 29.90, respectively, all P<0.001). Conclusions:During the peak periods of BA.5 subtype of the Omicron variant in Shanghai City, critical cases have severe systemic symptoms and a higher prevalence of underlying diseases compared to non-critical cases. Among non-critical cases infected with BA.5 subtype, the proportion of symptomatic infections in children is higher than adults, with fever and gastrointestinal symptoms more common than adults, while cough symptoms are more common seen in adults.The occurrence rate of convulsions and critical cases is higher in children infected with variant BA.5 subtype compared to those infected with BA.2 subtype.The systemic symptoms are more severe in adults infected with BA.5 subtype compared to those infected with BA.2 subtype.

Objective: To understand the attitudes and perceptions of traditional Chinese medicine (TCM) practitioners in Beijing TCM hospitals regarding the use of Ephedra sinica Stapf (E. sinica, Ma Huang). Methods: A two-stage cross-sectional study was conducted using a questionnaire survey of TCM practitioners in Beijing TCM hospitals between April 2023 and March 2024. The questionnaire included demographic information, the clinical background of TCM practitioners, and the clinical application of E. sinica. Logistic regression analysis was used to analyze the relevant influencing factors when using E. sinica. Results: Of the 465 questionnaires collected, 441 were valid. Among these, 84.81% (374/441) reported having used E. sinica in clinical practice at least once. The commonly used doses of E. sinica—excluding the pediatric department—were 10 g for high doses, 6 g for medium, and 3 g for low. The three most frequently used formulas for E. sinica included Maxing Shigan decoction, Mahuang decoction, and Xiao Qing Long decoction. The most common TCM patterns treated with a high dose of E. sinica were wind-cold exterior pattern, wind-cold invading the lung, and wind and water combat with meridians congealed by cold. The top three Western medical diagnoses when using E. sinica for treatment were common cold, pneumonia, and upper respiratory tract infections. Nearly half of the respondents reported experiencing adverse reactions from the oral administration of E. sinica, with the most common being palpitations, insomnia, and restlessness. Starting with a low dose and gradually increasing it as appropriate was identified as an effective approach. Conclusion This study investigated the attitudes and perceptions of TCM practitioners in Beijing TCM hospitals regarding the dose–efficacy–adverse reaction relationship of E. sinica, providing a reference for the safe and effective clinical use of E. sinica.

Objective:To investigate the clinicopathological features,differential diagnosis,treatment and prognosis of Burkitt-like lymphoma with 11q aberration (BLL-11q).Methods:The clinical manifestations,histological morphology,immunophenotype and molecular genetic changes of 2 cases of BLL-11q admitted to the department of pathology of The First People's Hospital of Lianyungang in 2020 and 2021 were analyzed retrospectively,and the relevant literatures were reviewed.Results:Patients were found with right neck masses inadvertently and grew rapidly. They presented with localized disease with Ann Arbor stages IA and IIA. Microscopically, the normal structure of the lymph node disappeared and was replaced by a diffuse proliferation of lymphocytes, with consistent morphology and medium size. And the presence of "star-sky" phenomenon was obvious, the morphological characteristics were similar to Burkitt lymphoma. Immunophenotypically, tumor cells were diffusely positive for CD20, CD79α, PAX5, CD10 and Bcl-6, partly moderately positive for C-MYC and MUM-1, however, CD3, Bcl-2, CD30 and TDT were negative,Ki-67 positive index was more than 95%, and EBER was negative. FISH detection showed that MYC, Bcl-2, and Bcl-6 were negative. Both cases had the 11q23.3 gain and 11q24.3 loss. Both patients were treated with chemotherapy and followed up for 10-22 months,and achieved complete remission and disease-free survival.Conclusion:BLL-11q is a rare germinal center B-cell lymphoma with abnormal long arm of chromosome 11 and lack of MYC gene rearrangement. It should be distinguished from Burkitt lymphoma, diffuse large B-cell lymphoma, B-lymphoblastic lymphoma, large B-cell lymphoma with IRF4 rearrangement and high-grade B-cell lymphoma. On the basis of morphology and immunophenotype, the diagnosis depends on genetic detection. There may be a better prognosis.

Objective:To summarize the best evidence for the prevention of medical device related pressure injuries in patients in ICU, and to provide a basis for clinical nursing practice.Methods:Using evidence-based method and computer 6S evidence model, the relevant literature was retrieved. The resource types included clinical guidelines, evidence summaries, systematic reviews and expert consensus. The retrieval time was from the establishment of the databases to January 2021. Three researchers who received evidence based nursing training independently evaluated various types of literature, and extracted evidence from literature that met inclusion criteria.Results:A total of 11 articles were included with 8 guidelines, 1 systematic review, 1 evidence summary, and 1 expert consensus. The 24 best evidences related to risk assessment, skin assessment and cleaning, selection and wearing of medical devices, preventive use of dressings, and education and training were summarized.Conclusions:This study summarized the clinical practice basis for the prevention of medical device related pressure injuries in patients in ICU, which can provide scientific and effective theoretical guidance for clinical nursing staff to implement changes in practice. And it is recommended that the evidence should be combined with the clinical reality when using evidence. Analyze the facilitating factors and obstacles in the process of using evidence and formulate reform strategies suitable for clinical transformation, and then apply them to daily clinical work to improve the quality of nursing work.

Objective:To explore the status of kinesiophobia in patients with heart failure during discharge transition period, and analyze its changing trend and influencing factors.Methods:The189 patients with heart failure treated in Henan Provincial People′s Hospital from February 2020 to April 2021 were conveniently selected as the research objects. The general situation questionnaire, the Tampa Scale for Kinesiophobia Heart, the Self-efficacy for Exercise Scale and the Control Attitudes Scale-Revised were used to investigate the patients 2-3 days before leaving the hospital, 1 month and 4 months after discharge.Results:The score of patients′ kinesiophobia deteriorated slightly from 2-3 days before discharge (48.62 ± 11.26) to 1 month after discharge (49.03 ± 11.24), and decreased with the extension of the transition time to 4 months after discharge (47.86 ± 11.11). The overall trend of improvement was statistically significant ( F = 17.92, P<0.01). The score of perceived disease control also showed the same change pattern, 2-3 days before discharge (27.34 ± 7.40), 1 month after discharge (26.18 ± 7.39), 4 months after discharge (27.76 ± 7.38), the difference was statistically significant ( F = 38.41, P<0.01). The score of the exercise self-efficacy of 4 months after discharge (35.63 ± 11.51) was higher than (34.00 ± 11.88) of 2-3 days before discharge and (34.20 ± 11.69) of 1 month after discharge ( F = 12.33, P<0.01). The generalized estimation equation showed that exercise self-efficacy ( B = -0.255, P<0.01) and perceived disease control ( B = -0.439, P<0.01) were protective factors of kinesiophobia in patients with heart failure. Path analysis showed that perceived disease control could not only directly predict patients′ kinesiophobia ( β = -0.461, P<0.01), but also indirectly affect patients′ kinesiophobia by acting on exercise self-efficacy (mediating effect = -0.21, 95% CI -0.293 - -0.136). The mediating effect accounted for 31% of the total effect. Conclusions:The kinesiophobia, perceived disease control and exercise self-efficacy in patients with heart failure during discharge transition were dynamic. Perceived disease control could not only directly predict patients′ kinesiophobia, but also indirectly affect it by acting on exercise self-efficacy. Nursing staff can develop nursing interventions based on perceived disease control or exercise self-efficacy to reducethe level of kinesiophobia inheart failure patients.

Objective:To describe the clinical features of liver involvement in children and adolescent with 2019-nCoV infection.Methods:The clinical data of 77 hospitalized cases admitted to the Children’s Hospital of Fudan University were collected from January 19 to November 28, 2020. The characteristics and risk factors of abnormal liver chemistries in children with laboratory-confirmed 2019-nCoV infection were analyzed.Results:Of the 77 cases, 44 were male (57.1%) and 33 were female (42.9%), with a median age of 10 years. 27(35.1%) were asymptomatic, 28(36.4%) had mild illness, 22(28.6%)had non-severe pneumonia. Hydroxychloroquine was used in 7 cases. Of the 75 children without underlying diseases, alanine aminotransferase was elevated in 1 case (1.5%, during hydroxychloroquine therapy), aspartate aminotransferase was elevated in 7 cases (10.3%), alkaline phosphatase was elevated in 7 cases (28%), and total bilirubin, direct bilirubin, albumin, international normalized ratio were in normal range. There was no statistical difference between the pneumonia group and the non-pneumonia group in term of liver chemistries ( P > 0.05), same as between the elevated erythrocyte sedimentation rate group and the normal group. There was no aggravation of liver injury in the child with biliary atresia. The child with epilepsy showed no abnormal liver chemistries after infection. Conclusion:Children with 2019-nCoV infection had mild clinical symptoms with few cases of liver injury. The abnormal liver chemistries in children with COVID-19 infection may be related to the underlying disease and the use of antiviral drugs.

Objective:To explore the methods and effects of high-frequency color Doppler ultrasound assisted reverse island flap of dorsal digital artery of ulnar thumb for repairing skin and soft tissue defects in the distal end of the same finger.Methods:The retrospective cohort study method was applied. From March 2014 to January 2020, 43 patients with skin and soft tissue defects in the distal end of thumb were hospitalized in the Department of Hand and Foot Surgery of Yidu Central Hospital of Weifang, including 28 males and 15 females, aged 19-58 years. The time from injury to operation was 4 to 10 hours, and the area of wound defect was 1.5 cm×1.0 cm-5.0 cm×3.0 cm. The type and course of dorsal digital artery of ulnar thumb were detected by high-frequency color Doppler ultrasound before operation, based on which the reverse transfer of the island flap of dorsal digital artery of ulnar thumb was designed to repair the skin and soft tissue defects in the distal end of the same finger. The patients with absence of the dorsal digital artery of ulnar thumb were repaired by the greater fish reverse island flap pedicled with the radial palmar artery. The area of the flap was 2.0 cm×1.5 cm-5.5 cm×3.5 cm. The donor site wound was directly closed by suturing or covered with split-thickness skin graft from the inner side of the upper arm in the same arm. The status of dorsal digital artery of ulnar thumb detected by high frequency color Doppler ultrasound before operation was recorded. The type, course, and distribution of the dorsal digital artery of ulnar thumb detected before operation were compared with those observed during the operation. The survival of the flap was observed after operation. During the last follow-up, the appearance of the donor and recipient area of flaps was observed, the thumb function was evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association, and the sensory function of the area transplanted with flap was evaluated with the sensory function evaluation standard.Results:The results of high-frequency color Doppler ultrasound showed that the dorsal digital artery of ulnar thumb was absent in 2 patients, while 41 patients had the dorsal digital artery of ulnar thumb, among which 20 cases were type 1 that started from the first dorsal metacarpal artery and ran on the surface of the first interosseous dorsal muscle; 16 cases were type 2 that started from the deep branch of the radial artery or the main artery of thumb and ran in the deep surface of the first interosseous dorsal muscle, including 10 cases of type 2a with the starting point in the basal region of the first metacarpal bone and 6 cases of type 2b with the starting point in the first metacarpal bone region; 5 cases were type 3 that started from the confluence of the first dorsal metacarpal artery and the main thumb artery in the region of the first metacarpophalangeal joint. The outer diameter of the vessel at the beginning of the dorsal digital artery of ulnar thumb was (1.12±0.31) mm, and the outer diameter of the vessel at the beginning of the accompany vein was (0.63±0.21) mm. The dorsal digital artery of ulnar thumb was concentrated in the ulnar side of the first metacarpophalangeal joint and snuff box region. The type, course, and distribution range of the dorsal digital artery of ulnar thumb observed during the operation were consistent with the results detected by high-frequency color Doppler ultrasound before operation. After the operation, the flaps survived in 43 patients. The patients were followed up for 6 months to 1 year. During the last follow-up, only linear scars were left in the donor area; there were no obvious pigmentation in the area transplanted with reverse island flap of dorsal digital artery of ulnar thumb, with good texture and elasticity, and beautiful appearance; the thumb function was evaluated as excellent in 23 cases, good in 17 cases, and fair in 3 cases; the sensory function of the area transplanted with flap was evaluated as S 4 level in 16 cases, S 3 level in 22 cases, and S 2 level in 5 cases. Conclusions:The reverse island flap of dorsal digital artery of ulnar thumb is one of the ideal methods to repair the skin and soft tissue defect in the distal end of the same finger, especially that beyond the distal interphalangeal joint. Preoperative detection with high-frequency color Doppler ultrasound can identify the type and distribution of dorsal digital artery of ulnar thumb, so as to design a personalized operation plan, resulting in good appearance of the donor and recipient area and thumb function after operation.

Objective:To investigate the clinical effect of repairing soft-tissue defect of foot weight-bearing area with the help of CT angiography (CTA) using medial plantar artery perforator (MPAP) flap.Methods:This was a retrospective study spanning over a period, from May 2011 to October 2019, conducted at the Yidu Central Hospital of Weifang. The data was focused on the cases of soft tissue defect in plantar bearing area repaired by fascial island skin flap containing a perforating branch of the medial plantar artery perforator. CTA of the foot was performed before procedure. The 3D digital model was reconstructed by computer software to explore the number, diameter, course, and distribution of perforating vessels in the donor site, and a personalized repair scheme was designed to match the shape and size of recipient site. The outcome of the flap repair, foot function, and sensory function were followed up. Pared-sample t-test was used to compare the difference of perforator vessel diameter and the distance from heel margin to perforator branch between preoperative and intraoperative actual measurement by CTA. Results:A total of 9 patients were enrolled, including 5 males and 4 females. The mode for age group were 41 (range, 16-65 years). The area of the wound defect was 2.0 cm×2.0 cm-4.0 cm×5.0 cm, and the size of perforator fascial skin flap was 6.0 cm × 4.0 cm -12.0 cm × 8.0 cm. All the 9 flaps were survived and followed up for half a year to 5 years. All the patients were satisfied with the outcomes, the satisfaction score of flap efficacy was 8.7±3.1. Outcomes were evaluated according to the foot function scoring criteria: 3 cases were excellent, 5 cases were good, and 1 case was medium. Sensory recovery reached S4 in 3 cases, S3 in 5 cases, and S2 in 1 case. There were 4 cases in R4, 4 cases in R3, and 1 case in R2. There was no significant difference between the preoperative measurement of perforator diameter and the distance between the heel edge and perforator ( P>0.05). Conclusions:The MPAP flap is simple, safe and easy to operate. It is one of the ideal methods to repair the soft tissue defects in small and medium-sized areas of the foot weight-bearing area.

Objective:To investigate the clinical effect of repairing soft-tissue defect of foot weight-bearing area with the help of CT angiography (CTA) using medial plantar artery perforator (MPAP) flap.Methods:This was a retrospective study spanning over a period, from May 2011 to October 2019, conducted at the Yidu Central Hospital of Weifang. The data was focused on the cases of soft tissue defect in plantar bearing area repaired by fascial island skin flap containing a perforating branch of the medial plantar artery perforator. CTA of the foot was performed before procedure. The 3D digital model was reconstructed by computer software to explore the number, diameter, course, and distribution of perforating vessels in the donor site, and a personalized repair scheme was designed to match the shape and size of recipient site. The outcome of the flap repair, foot function, and sensory function were followed up. Pared-sample t-test was used to compare the difference of perforator vessel diameter and the distance from heel margin to perforator branch between preoperative and intraoperative actual measurement by CTA. Results:A total of 9 patients were enrolled, including 5 males and 4 females. The mode for age group were 41 (range, 16-65 years). The area of the wound defect was 2.0 cm×2.0 cm-4.0 cm×5.0 cm, and the size of perforator fascial skin flap was 6.0 cm × 4.0 cm -12.0 cm × 8.0 cm. All the 9 flaps were survived and followed up for half a year to 5 years. All the patients were satisfied with the outcomes, the satisfaction score of flap efficacy was 8.7±3.1. Outcomes were evaluated according to the foot function scoring criteria: 3 cases were excellent, 5 cases were good, and 1 case was medium. Sensory recovery reached S4 in 3 cases, S3 in 5 cases, and S2 in 1 case. There were 4 cases in R4, 4 cases in R3, and 1 case in R2. There was no significant difference between the preoperative measurement of perforator diameter and the distance between the heel edge and perforator ( P>0.05). Conclusions:The MPAP flap is simple, safe and easy to operate. It is one of the ideal methods to repair the soft tissue defects in small and medium-sized areas of the foot weight-bearing area.