Objective:To analyze the epidemiological and clinical characteristics of leptospirosis in Wenzhou City, and to provide a scientific basis for formulating prevention and control strategies of leptospirosis in Wenzhou City.Methods:Information on leptospirosis case from 2019 to 2023 was collected from the China Information System for Disease Control and Prevention. Descriptive epidemiological methods were used to analyze the three-dimensional distribution and clinical manifestations of leptospirosis.Results:From 2019 to 2023, the annual average incidence rate of leptospirosis in Wenzhou City was 0.43/100 000, and the annual average mortality was 0.01/100 000. The incidence rate was the highest in 2021 (0.74/100 000), and there was a statistically significant difference in the incidence rate over the five years ( χ2 = 35.48, P < 0.001). Cases were reported in all regions in Wenzhou City except for Dongtou District and Longgang City, with Yongjia County had the highest number of cases (114 cases). The impact rate of streets/townships was 35.14% (65/185), among them Yongjia County had the highest impact rate of steets/townships (86.36%, 19/22). The onset season was from August to October (88.83%, 159/179), with a male to female ratio of 4.97 ∶ 1.00 (149/30). The age group of 61 - 70 years old was the most affected (39.66%, 71/179), and farmers were the main occupation (70.95%, 127/179). Twenty-six point eighty-two per cent (48/179) of the cases had a clear history of animal contact within one month before onset, and 68.16% (122/179) had a history of contact with contaminated water. The main clinical type was influenza-typhoid type (23.46%, 42/179), with the main clinical manifestations being fever (84.92%, 152/179), chills (55.87%, 100/179), and fatigue (62.57%, 112/179). Twelve point twenty-nine per cent 12.29% (22/179), 8.38% (15/179), and 22.91% (41/179) of cases showed conjunctival congestion, lymph node enlargement, and gastrocnemius muscle tenderness, respectively. Clinical outcomes showed that 73.74% (132/179) of the cases recovered or improved, and 3 cases died. Conclusions:From 2019 to 2023, the overall prevalence of leptospirosis in Wenzhou City is at a low level, but there are deaths that need to be taken seriously. In order to control the disease, continuous monitoring should be carried out, health education for relevant populations should be strengthened, and the risk of leptospirosis should be reduced.

Objective To investigate the risk factors influencing the prolonged length of hospital stay after transjugular intrahepatic portosystemic shunt(TIPS)in patients with ruptured esophagogastric variceal bleeding(EGVB)and to construct a risk prediction model.Methods The clinical data of 215 patients with EGVB,who received TIPS at a certain grade ⅢA hospital in Nanjing of China from January 1,2020 to January 30,2023,were retrospectively analyzed.According to whether the postoperative hospitalization stay was prolonged or not,the patients were divided into prolonged group(n=67)and normal group(n=148).Multivariate logistic regression analysis was sued to analyze the independent risk factors for prolonged postoperative hospitalization stay,and the risk factors were used as predictors for constructing the nomogram model.Results Multivariate logistic regression analysis showed that history of splenectomy,early TIPS performance,NRS 2002 Nutritional Risk Screening Score ≥3 points,and Barthel index score≤40 points were the independent risk factors for prolonged postoperative hospitalization stay in patients with cirrhotic EGVB after receiving TIPS(P＜0.05).The area under receiver operating characteristic(ROC)curve of the model constructed on the basis of independent risk factors was 0.743,which was higher than that of early TIPS performance,history of splenectomy,NRS 2002 score,and Barthel index score.The Hosmer-Lemeshow test obtained P=0.723,indicating that this model had a good fit degree.Conclusion The prediction model established in this study can be used for cirrhotic EGVB patients to predict the risk of prolonged postoperative hospitalization stay,and this model has good discrimination and calibration,besides,it can bring some clinical benefits to patients.

AIM: To explore the clinical effect of high dacryocystorhinostomy(DCR)combined with RS lacrimal duct recanalization on the treatment of chronic dacryocystitis.METHODS: Retrospective study. From January 2021 to January 2023, 110 patients(110 eyes)with chronic dacryocystitis treated in our hospital were collected and grouped according to the treatment method. The 55 eyes in the control group were treated with high DCR combined with suction cotton, and the 55 eyes in the monitored group were treated with high DCR combined with RS lacrimal duct recanalization. Follow-up for 6 mo, the clinical efficacy, quality of life, and complications were compared.RESULTS:At 6 mo after surgery, the monitored group had higher anatomical success rate than the control group(96.4% vs 83.6%), and had higher total effective rate than the control group(98.2% vs 78.2%; both P<0.05). At 6 mo after surgery, both groups had increased the Shot-Form Health Status Survey-36(SF-36)scores, with the monitored group having higher scores than the control group(all P<0.05); there was no statistical difference in complications between two groups(10.9% vs 20.0%, P>0.05).CONCLUSION:High DCR combined with RS lacrimal duct recanalization is safe and effective in treating patients with chronic dacryocystitis.

Objective:To compare the clinical efficacy of direct versus double-balloon occlusion in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for benign and malignant gastric outlet obstruction (GOO).Methods:Clinical data of patients with GOO who underwent EUS-GE at Nanjing Drum Tower Hospital between April 2017 and July 2024 were analyzed in a retrospectively cohort study. The patients were divided into the direct technique group ( n=36) and the double-balloon occlusion technique group ( n=105). The technical success rate, clinical success rate, procedure time, postoperative stay, stent replacement rate, and incidence of adverse events were compared between the two groups. Results:The technical success rates of the two groups were comparable, 97.2% (35/36) and 94.3% (99/105) ( χ2=0.065, P=0.798), so were the clinical success rates, 94.4% (34/36) and 86.7% (91/105) ( χ2=0.932, P=0.334). However, the direct technique group demonstrated significantly shorter procedure time and postoperative stay compared to the double-balloon occlusion group [33.4 (23.2, 42.3) min VS 43.4 (31.7, 63.1) min, Z=-3.057, P=0.002; 4.0 (3.00, 5.75) days VS 6.0 (5.00, 9.00) days, Z=-4.031, P<0.001]. Adverse event rates [11.1% (4/36) VS 11.4% (12/105), χ2<0.001, P=1.000] and stent replacement rates [5.6% (2/36) VS 9.5% (10/105), χ2=0.152, P=0.696] showed no significant differences. Conclusion:Both EUS-GE techniques achieve comparable efficacy and safety for GOO. However, the direct technique showed significant advantages over the double-balloon occlusion technique in terms of shorter procedure time and reduced postoperative hospital stay.

Objective:To analyze the epidemiological and clinical characteristics of leptospirosis in Wenzhou City, and to provide a scientific basis for formulating prevention and control strategies of leptospirosis in Wenzhou City.Methods:Information on leptospirosis case from 2019 to 2023 was collected from the China Information System for Disease Control and Prevention. Descriptive epidemiological methods were used to analyze the three-dimensional distribution and clinical manifestations of leptospirosis.Results:From 2019 to 2023, the annual average incidence rate of leptospirosis in Wenzhou City was 0.43/100 000, and the annual average mortality was 0.01/100 000. The incidence rate was the highest in 2021 (0.74/100 000), and there was a statistically significant difference in the incidence rate over the five years ( χ2 = 35.48, P < 0.001). Cases were reported in all regions in Wenzhou City except for Dongtou District and Longgang City, with Yongjia County had the highest number of cases (114 cases). The impact rate of streets/townships was 35.14% (65/185), among them Yongjia County had the highest impact rate of steets/townships (86.36%, 19/22). The onset season was from August to October (88.83%, 159/179), with a male to female ratio of 4.97 ∶ 1.00 (149/30). The age group of 61 - 70 years old was the most affected (39.66%, 71/179), and farmers were the main occupation (70.95%, 127/179). Twenty-six point eighty-two per cent (48/179) of the cases had a clear history of animal contact within one month before onset, and 68.16% (122/179) had a history of contact with contaminated water. The main clinical type was influenza-typhoid type (23.46%, 42/179), with the main clinical manifestations being fever (84.92%, 152/179), chills (55.87%, 100/179), and fatigue (62.57%, 112/179). Twelve point twenty-nine per cent 12.29% (22/179), 8.38% (15/179), and 22.91% (41/179) of cases showed conjunctival congestion, lymph node enlargement, and gastrocnemius muscle tenderness, respectively. Clinical outcomes showed that 73.74% (132/179) of the cases recovered or improved, and 3 cases died. Conclusions:From 2019 to 2023, the overall prevalence of leptospirosis in Wenzhou City is at a low level, but there are deaths that need to be taken seriously. In order to control the disease, continuous monitoring should be carried out, health education for relevant populations should be strengthened, and the risk of leptospirosis should be reduced.

Objective:To compare the clinical efficacy of direct versus double-balloon occlusion in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for benign and malignant gastric outlet obstruction (GOO).Methods:Clinical data of patients with GOO who underwent EUS-GE at Nanjing Drum Tower Hospital between April 2017 and July 2024 were analyzed in a retrospectively cohort study. The patients were divided into the direct technique group ( n=36) and the double-balloon occlusion technique group ( n=105). The technical success rate, clinical success rate, procedure time, postoperative stay, stent replacement rate, and incidence of adverse events were compared between the two groups. Results:The technical success rates of the two groups were comparable, 97.2% (35/36) and 94.3% (99/105) ( χ2=0.065, P=0.798), so were the clinical success rates, 94.4% (34/36) and 86.7% (91/105) ( χ2=0.932, P=0.334). However, the direct technique group demonstrated significantly shorter procedure time and postoperative stay compared to the double-balloon occlusion group [33.4 (23.2, 42.3) min VS 43.4 (31.7, 63.1) min, Z=-3.057, P=0.002; 4.0 (3.00, 5.75) days VS 6.0 (5.00, 9.00) days, Z=-4.031, P<0.001]. Adverse event rates [11.1% (4/36) VS 11.4% (12/105), χ2<0.001, P=1.000] and stent replacement rates [5.6% (2/36) VS 9.5% (10/105), χ2=0.152, P=0.696] showed no significant differences. Conclusion:Both EUS-GE techniques achieve comparable efficacy and safety for GOO. However, the direct technique showed significant advantages over the double-balloon occlusion technique in terms of shorter procedure time and reduced postoperative hospital stay.

Objective:To explore the effect of different posture angles on the pain and comfort in patients with early esophageal cancer after endoscopic submucosal dissection (ESD), so as to provide a basis for patients to choose the best position after ESD.Methods:This study was a randomized controlled trial. One hundred and twenty patients with early esophageal cancer who underwent ESD in the Department of Gastroenterology, Nanjing Drum Tower Hospital from March 2021 to March 2022 were selected as the study subjects, and they were randomly divided into 4 groups of 30 patients each according to the randomized numerical method. Group A was the conventional group, which was in the free position after the operation, and groups B, C, and D were the experimental groups, with group B in the head-high-feet-low 30° position, group C in the head-high-feet-low 45° position, and group D in the head-high-feet-low 60° position. The pain scores after returning to the room after the operation, at 8, 16, 24 h after the operation and comfort scores at 24 h after the operation of the patients in the four groups were evaluated by Numeric Rating Scale (NRS) and General Comfort Questionnaire (GCQ).Results:There were 17 males and 13 females in group A; there were 20 males and 10 females in group B; there were 22 males and 8 females in group C; there were 19 males and 11 females in group D. All patients were aged 30-85 years old. The time main effect, grouping main effect, and interaction effect of postoperative pain NRS score among four groups of patients were all statistically significant ( F=618.13, 12.14, 6.75, all P<0.01). There was no significant difference in the NRS scores of patients after returning to the room after the operation among the four groups ( P>0.05). The NRS scores in group D at 8 and 16 h after the operation were (1.93 ± 0.64), (0.60 ± 0.47) points, lower than the (2.87 ± 1.14), (1.97 ± 1.22) points, (2.17 ± 0.83), (1.97 ± 1.61) points, (2.30 ± 0.75), (0.80 ± 0.61) points in groups A, B, and C, the differences were statistically significant ( t values were 0.79-4.72, all P<0.05). The NRS scores in group B at 24 h after the operation was (0.23 ± 0.18) points, lower than the (1.53 ± 1.08), (0.30 ± 0.21), (0.46 ± 0.25) points in groups A, C, and D, the differences were statistically significant ( t= 5.32, 1.34, 1.37, all P<0.05). The GCQ total scores at 24 h after the operation were (96.96 ± 3.05), (99.77 ± 3.21), (93.53 ± 3.76), (92.20 ± 3.69) points in group A, B, C, D, the difference was statistically significant ( F= 29.59, P<0.05). Moreover, the GCQ total scores at 24 h after the operation in group B were higher than those in groups A, C, and D, and the differences were statistically significant ( t=3.15, 7.01, 8.52, all P<0.05). Conclusions:Targeted body position management can effectively reduce postoperative pain and improve patient comfort in early esophageal cancer patients undergoing ESD.

Periodontitis is a chronic inflammatory disease that destroys the integrity of tooth-supporting tissue. Periodontitis is listed as a major oral disease by the World Health Organization and is a public-health problem affecting global oral and systemic health. The fourth national oral health epidemiological survey has revealed that periodontitis is one of the most common oral problems in China. With the development of science and medicine, increased attention is being paid to the importance of oral health and its influence on general health. Accordingly, stomatologists are required to master more relevant information on clinical diagnosis and treatment, as well as to pay more attention to the diagnosis and treatment methods of patients with different systemic diseases. This article expounds the diagnosis and treatment strategy of patients with systemic disease periodontitis. We aimed to help stomatologists make more reasonable diagnosis and treatment decisions.
Humans ; Periodontitis/therapy* ; Mouth Diseases ; Oral Health ; China

Objective:To compare and observe the curative effect of different body positions after pars plana vitrectomy (PPV) combined with inert gas filling for rhegmatogenous retinal detachment (RRD).Methods:A retrospective clinical study. From October 2019 to September 2021, 192 eyes of 192 RRD patients who were diagnosed and received PPV combined with inert gas filling in Qingdao Eye Hospital of Shandong First Medical University were included in the study. Best corrected visual acuity (BCVA), intraocular pressure, ultra-wide-angle fundus photography, optical coherence tomography, and B-mode ultrasonography were performed in all affected eyes. The BCVA examination was performed using a standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. According to the post-operative position requirements, the affected eyes were divided into the face-down positioning group and the adjustable positioning group, with 97 eyes in 97 patients and 95 eyes in 95 patients, respectively. Age ( Z=0.804), course of disease ( Z=-0.490), eye type ( χ2=0.175), logMAR BCVA( Z=-0.895), intraocular pressure ( Z=0.178), lens status ( χ2=1.090), number of detached clocks ( Z=0.301) and macular involvement ( χ2=0.219), number of holes ( Z=-1.051) and number of lower holes ( χ2=0.619) were compared, there was no significant difference ( P>0.05). The gender composition ratio was compared, and the difference was statistically significant ( χ2=5.341, P<0.05). The follow-up time after surgery was more than 3 months. The retinal reattachment rate in one operation, the improvement of BCVA and the incidence of complications were observed. The independent sample Mann-Whitney test was used for the comparison of continuous variables between groups; the χ2 test was used for the comparison of categorical variables. Results:In the face-down positioning group and the adjustable positioning group, retinal reattachment in one operation was performed in 92 (94.8%, 92/97) and 89 (93.7%, 89/95) eyes, respectively; logMAR BCVA was 0.45±0.34, 0.41±0.21. There was no significant difference in the retinal reattachment rate in one operation ( χ2=0.120, P=0.729) and logMAR BCVA ( Z=-0.815, P=0.416) between the two groups. After surgery, the intraocular pressure increased in 11 (11.3%, 11/97) and 5 (5.3%, 5/95) eyes in the face-down positioning group and the adjustable positioning group, respectively; the secondary epimacular membrane was 2 (2.1%, 2/97), 3 (3.2%, 3/95) eyes. There was no significant difference in the incidence of elevated intraocular pressure and secondary epimacular membrane between the two groups after surgery ( χ2=2.320, 0.227; P=0.128, 0.634). Conclusion:It is safe and effective to adopt adjustable positioning after PPV combined with inert gas filling for RRD, which is equivalent to the effect of face-down positioning.

AIM: To explore the effect of lienal polypeptide injection (LPI) on platelet production in ITP model mice with primary immune thrombocytopenia. METHODS: SPF Kunming mice were divided into groups by random number table method, and the ITP model of mice was induced by intraperitoneally injected of rabbit anti-mouse platelet serum APS every other day. At the set time, blood was collected through caudal vein to detect the changes in the number of platelets, red blood cells and white blood cells in each group. Meanwhile, the thymus and spleen indexes were calculated. Megakaryocytes were classified and counted by means of bone marrow smear. Finally, the expression levels of TPO, SCF, IL-3, IL-6, IL-11, β-TG, TGF-β1 and PF-4 in serum were detected by ELISA. RESULTS: LPI significantly increased platelets count in ITP model mice, but had no effect on red blood cells and white blood cells. Thymus and spleen index decreased significantly. The number of megakaryoblasts and thrombocytopenia megakaryocytes in the bone marrow of mice increased, but the number of promegakaryocytes, granular megakaryocytes and naked megakaryocyte did not change significantly. Serum sytokines SCF, IL-3 and IL-6 were significantly increased, while PF-4 was decreased significantly. CONCLUSION: LPI may increase the platelet count in ITP mice by up regulating the levels of IL-3, IL-6, SCF and down regulating the level of PF-4, which has guiding significance for clinical promotion application of LPI.