Objective To understand the surveillance situation of poliovirus in Guangzhou from 2011 to 2024, and to further strengthen polio surveillance and ensure the continued maintenance of a polio-free status. Methods An analysis was conducted on the discovery and investigation results of six cases of vaccine-derived poliovirus (VDPV) detected in Guangzhou. Results A total of 6 VDPV incidents were reported in Guangzhou from 2011 to June 2024, among which 5 incidents were from sewage sample testing in the Liede Sewage Treatment Plant in Guangzhou, all of which were confirmed as VDPV, with 1 for type I, 1 for type II, and 3 for type III. In addition, one confirmed HFMD case was identified as a type VDPV II carrier. No presence of any wild poliovirus (WPV), VDPV cases, or circulating VDPV (cVDPV) was reported. Conclusion Guangzhou City has maintained a high level of vigilance and effectiveness in the monitoring and prevention of polio. Continuously strengthening the construction of the polio monitoring network, optimizing vaccination strategies, and comprehensively improving public health awareness are still the focus of the prevention and control work in the future.

OBJECTIVE: As an age-related neurodegenerative disease, the prevalence of mild cognitive impairment (MCI) increases with age. Within the framework of traditional Chinese medicine, spleen-kidney deficiency syndrome (SKDS) is recognized as the most frequent MCI subtype. Due to the covert and gradual onset of MCI, in community settings it poses a significant challenge for patients and their families to discern between typical aging and pathological changes. There exists an urgent need to devise a preliminary diagnostic tool designed for community-residing older adults with MCI attributed to SKDS (MCI-SKDS). METHODS: This investigation enrolled 312 elderly individuals diagnosed with MCI, who were randomly distributed into training and test datasets at a 3:1 ratio. Five machine learning methods, including logistic regression (LR), decision tree (DT), naive Bayes (NB), support vector machine (SVM), and gradient boosting (GB), were used to build a diagnostic prediction model for MCI-SKDS. Accuracy, sensitivity, specificity, precision, F1 score, and area under the curve were used to evaluate model performance. Furthermore, the clinical applicability of the model was evaluated through decision curve analysis (DCA). RESULTS: The accuracy, precision, specificity and F1 score of the DT model performed best in the training set (test set), with scores of 0.904 (0.845), 0.875 (0.795), 0.973 (0.875) and 0.973 (0.875). The sensitivity of the training set (test set) of the SVM model performed best among the five models with a score of 0.865 (0.821). The area under the curve of all five models was greater than 0.9 for the training dataset and greater than 0.8 for the test dataset. The DCA of all models showed good clinical application value. The study identified ten indicators that were significant predictors of MCI-SKDS. CONCLUSION The risk prediction index derived from machine learning for the MCI-SKDS prediction model is simple and practical; the model demonstrates good predictive value and clinical applicability, and the DT model had the best performance. Please cite this article as: Ai YT, Zhou S, Wang M, Zheng TY, Hu H, Wang YC, Li YC, Wang XT, Zhou PJ. Development of a machine learning-based risk prediction model for mild cognitive impairment with spleen-kidney deficiency syndrome in the elderly. J Integr Med. 2025; 23(4): 390-397.
Humans ; Cognitive Dysfunction/diagnosis* ; Aged ; Male ; Female ; Machine Learning ; Spleen ; Aged, 80 and over ; Kidney ; Medicine, Chinese Traditional

Objective:To investigate the clinical effects of free dorsal interosseous artery perforator flaps in repairing multi-finger skin and soft tissue defects.Methods:The study was a retrospective observational study. From April 2020 to June 2022, 7 patients with multi-finger skin and soft tissue defects were admitted to the Department of Hand Microsurgery of the Chongqing Great Wall Orthopaedic Hospital, including 4 males and 3 females, aged 27 to 54 years. A total of 18 fingers were injured in 7 patients, of which 4 fingers were involved in 1 case, 3 fingers were involved in 2 cases, and 2 fingers were involved in 4 cases. The area of skin and soft tissue defects after stage Ⅰ debridement ranged from 3.0 cm×2.0 cm to 7.5 cm×3.0 cm. All the patients underwent stage Ⅰ debridement, stage Ⅱ interosseous dorsal artery perforator flap transplantation to repair the wound, and stage Ⅲ flap pedicle division and finger-split. The incision area of the flap was 4.0 cm×2.5 cm to 10.5 cm×3.5 cm. The interosseous dorsal artery was anastomosed with the proper digital artery by end to end, and the concomitant veins of 2 interosseous dorsal arteries were anastomosed with 2 superficial subcutaneous veins of the fingers by end to end. The donor area was treated by subcutaneous suture after full reduction of tension. The survival of flap after stage Ⅲ was observed. Follow-up was conducted once every 3 months after the stage Ⅲ operation to observe the appearance, texture, sensation of the operative areas in fingers, the range of motion of the finger joint, and the wound healing of the donor area. At the last follow-up, the function of fingers was assessed according to the trial standard of upper limb partial function assessment of the Hand Surgery Society of Chinese Medical Association.Results:All the flaps in 7 patients survived after stage Ⅲ operation. During follow-up of 6 to 36 months after stage Ⅲ operation, only 3 patients with bloated flap underwent the flap volume reduction operation in 3 months and later, and the finger appearance in the other patients recovered well. Only linear scar remained in the donor areas of 6 patients; 1 patient had scar hyperplasia in the donor area, which was significantly improved after laser treatment. At the last follow-up, the finger function was evaluated as excellent in 5 cases and good in 2 cases.Conclusions:The flaps pedicled with multiple interosseous dorsal artery perforators were used to repair multi-finger skin and soft tissue defects, and only one set of blood vessel needs to be anastomosed during the operation without damaging the main vessels, which reduces the incidence of postoperative vascular crisis. Besides, the procedure of finger-splitting operation is simple and the appearance and function in the donor and recipient areas are good. This method is worthy of clinical promotion.

Objective To investigate the differences in clinical characteristics among children on prolonged mechanical ventilation(PMV)due to different primary diseases.Methods A retrospective analysis was performed on the clinical data of 59 pediatric patients requiring PMV from July 2017 to September 2022.According to the primary disease,they were divided into respiratory disease(RD)group,central nervous system(CNS)group,neuromuscular disease(NMD)group,and other disease group.The four groups were compared in terms of general information,treatment,and outcome.Results There were significant differences among the four groups in age,body weight,Pediatric Logistic Organ Dysfunction-2(PELOD-2)score,Pediatric Risk of Mortality Ⅲ(PRISM Ⅲ)score,analgesic and sedative treatment,nutrition supply,rehabilitation treatment,tracheotomy,successful ventilator weaning,and outcomes(P＜0.05).Compared with the RD group,the CNS group and the other disease group had a significantly higher age and a significantly higher proportion of children receiving rehabilitation treatment,and the CNS group had a significantly higher proportion of children receiving tracheotomy(P＜0.008).Compared with the other disease group,the CNS group and the NMD group had significantly lower PELOD-2 and PRISM Ⅲ scores,and the CNS group had a significantly higher proportion of children with successful ventilator weaning and a significantly higher proportion of children who were improved and discharged(P＜0.008).Conclusions There are differences in clinical characteristics among children receiving PMV due to different etiologies.Most children in the RD group have a younger age,and children in the CNS group have a relatively good prognosis.

Objective To explore the correlation of MPV,NLR,PT,APTT and FIB with early pro-gression of ACI in patients with BAD.Methods A total of 303 ACI patients with BAD admitted in our department of neurology from October 2021 to September 2023 were consecutively recrui-ted,and according to their progression within 7 d of onset,they were divided into progression group(89 cases)and un-progression group(214 cases).The general clinical data,blood routine re-lated indicators(MPV,NLR)and coagulation related indicators(PT,APTT,FIB)were compared between the two groups.Multivariate logistic regression analysis was applied to identify the rela-tionship of above indicators with early progression of ACI in BAD patients.ROC curve was plot-ted to analyze the predictive value of the indictors for disease progression in these patients.Results The progression group had significantly advanced age,larger proportions of diabetes,hyperlipi-demia and stroke history,and increased levels of uric acid,LDL-C,homocysteine,MPV,platelet distribution width,NLR,D-dimer and FIB,and shorter TT,PT and APTT when compared with the un-progressed group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that MPV,NLR,PT,APTT,and FIB were all independent influencing factors for early disease pro-gression of ACI in patients with BAD(P＜0.05,P＜0.01).ROC curve indicated that the AUC value of combined MPV,NLR,PT,APTT and FIB in detecting early disease progression was 0.859(95％CI:0.813-0.905).Conclusion Blood routine(MPV,NLR)and coagulation related indicators(PT,APTT,FIB)are closely associated with the early disease progression of ACI in BAD patients,and these indicators are of high value in predicting the early disease progression.

Objective To investigate the Gram-positive coccus resistance in nationwide's tertiary hospitals and understand the trend of antimicrobial resistance.Methods All the clinical isolates were collected from 19 hospitals and the minimal inhibitory concentrations(MICs)were tested using agar/broth dilution method recommended.Results A total of 1 974 pathogenic Gram-positive coccus from 19 tertiary hospitals in 19 cities nationwide over the period from July 2021 to June 2022 were studied.Based on the MIC results,the prevalence of methicillin resistant Stapylococcus aureus(MRSA)and methicillin resistant Stapylococcus epidermidis(MRSE)were 36.4％and 79.9％respectively.No vancomycin insensitivity Staphylococcus was detected.Staphylococcus aureus were 100％susceptibility to linezolid and teicoplanin.Antibiotic resistance rate of Enterococcus faecalis and Enterococcus faecium to ampicillin were 3.1％and 92.9％.The detectation rate of vancomycin resistant Enterococcus(VRE)was 1.6％.Nonsusceptibility rate of Enterococcus faecalis to linezolid was 32.2％,two consecutive monitoring rises and nonsusceptibility rate of Enterococcus faecium(12.5％)was also significantly increased.The prevalence of penicillin non-susceptible Streptococcus pneumoniae(PNSSP)was 0.8％based on non-meningitis and parenteral administration criterion,decrease of nearly 30 percentage points from the previous surveillance.While for cases of oral penicillin,the rate was 71.8％,showing similar to last time.The results indicated that the number of strains with higher MIC value of penicillin(MIC ≥4 mg·L-1)decreased significantly.There were no significant differences of resistance rates of Stapylococcus aureus,Stapylococcus epidermidis,Enterococcus faecalis,Enterococcus faecium and Streptococcus pneumoniae among various groups such as different department,age,or specimen source.Conclusion VRE detection ratio stablized at a relatively low level.The number of Streptococcus pneumoniae with higher MIC value of penicillin decreased significantly compared with the previous monitoring.The increase of linezolidin-insensitive Enterococcus was noteworthy.

Objective To investigate the Gram-negative bacteria resistance in nationwide's tertiary hospitals and understand the trend of antimicrobial resistance.Method All the clinical isolates were collected from 19 hospitals and the minimal inhibitory concentrations(MICs)were tested using agar/broth dilution method recommended.Results A total of 4 066 pathogenic isolates from 19 tertiary hospitals in 19 cities nationwide over the period from July 2021 to June 2022 were studied.Based on the MIC results,Escherichia coli and Klebsiella pneumoniae showed extended spectrum β-lactamase(ESBLs)phenotype rates of 55.0％and 21.0％,respectively,ESBLs phenotype rate of Klebsiella pneumoniae keep going down.The ratios of carbapenems resistance Klebsiella pneumoniae increased by 5 percentage points compared with the previous monitoring.Carbapenems,moxalactam,sitafloxacin,β-lactam combination agents,fosfomycin trometamol,and amikacin displayed desirable antibacterial activity against Enterbacterales,susceptibal rates were above 75％.In addition,tigacycline,omacycline,colistin and fluoxefin maintained good antibacterial activity against their respective effective bacteria/species,and the bacterial sensitivity rates by more than 80％.Resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannnii to imipenem were 26.3％and 72.1％and multidrug-resistant(MDR)detection rates were 41.1％and 77.3％,extensively drug-resistant(XDR)were 12.0％and 71.8％,respectively.Comparison of drug resistance rates from different wards,ages and specimen sources indicated that the proportion of resistance in Klebsiella pneumoniae and Acinetobacter baumannii isolated from intensive care unit(ICU)were significantly higher than non-ICU.Carbapenem resistance rates of Klebsiella pneumoniae isolated from ICU were more than 35％.Resistance rates of Haemophilus influenzae isolated in children to β-lactam,macrolide,clindamycin and ESBLs detection rate in Klebsiella pneumoniae isolated from children were more than those from adults and the old people,so bacterial resistance in children is an important problem in China.Conclusion ESBLs detection rate of Escherichia coli increased slightly after years of continuous decline.The proportion of carbapenem resistant Pseudomonas aeruginosa was stable,but the resistance rate of Klebsiella pneumoniae and Acinetobacter baumannii to carbapenems was still increased,which should be paid more attention.

Objective: To analyze the clinical features, efficacy and prognosis factors of core binding factor (CBF) acute myeloid leukemia (AML) children in South China. Methods: This was a retrospective cohort study. Clinical data of 584 AML patients from 9 hospitals between January 2015 to December 2020 was collected. According to fusion gene results, all patients were divided into two groups: CBF-AML group (189 cases) and non-CBF-AML group (395 cases). CBF-AML group were divided into AML1-ETO subgroup (154 cases) and CBFβ-MYH11 subgroup (35 cases). Patients in CBF-AML group chosen different induction scheme were divided into group A (fludarabine, cytarabine, granulocyte colony stimulating factor and idarubicin (FLAG-IDA) scheme, 134 cases) and group B (daunorubicin, cytarabine and etoposide (DAE) scheme, 55 cases). Age, gender, response rate, recurrence rate, mortality, molecular genetic characteristics and other clinical data were compared between groups. Kaplan-Meier method was used for survival analysis and survival curve was drawn. Cox regression model was used to analyze prognostic factors. Results: A total of 584 AML children were diagnosed, including 346 males and 238 females. And a total of 189 children with CBF-AML were included, including 117 males and 72 females. The age of diagnosis was 7.3 (4.5,10.0)years, and the white blood cell count at initial diagnosis was 21.4 (9.7, 47.7)×10⁹/L.The complete remission rate of the first course (CR1) of induction therapy, relapse rate, and mortality of children with CBF-AML were significantly different from those in the non-CBF-AML group (91.0% (172/189) vs. 78.0% (308/395); 10.1% (19/189) vs. 18.7% (74/395); 13.2% (25/189) vs. 25.6% (101/395), all P<0.05). In children with CBF-AML, the CBFβ-MYH11 subgroup had higher initial white blood cells and lower proportion of extramedullary invasion than the AML1-ETO subgroup, with statistical significance (65.7% (23/35) vs. 14.9% (23/154), 2.9% (1/35) vs. 16.9% (26/154), both P<0.05). AML1-ETO subgroup had more additional chromosome abnormalities (75/154), especially sex chromosome loss (53/154). Compared with group B, group A had more additional chromosome abnormalities and a higher proportion of tumor reduction regimen, with statistical significance (50.0% (67/134) vs. 29.1% (16/55), 34.3% (46/134) vs. 18.2% (10/55), both P<0.05). Significant differences were found in 5-years event free survival (EFS) rate and 5-year overall survival (OS) rate between CBF-AML group and non-CBF-AML group ((77.0±6.4)%vs. (61.9±6.7)%,(83.7±9.0)%vs. (67.3±7.2)%, both P<0.05).EFS and OS rates of AML1-ETO subgroup and CBFβ-MYH11 subgroup in children with CBF-AML were not significantly different (both P>0.05). Multivariate analysis showed in the AML1-ETO subgroup, CR1 rate and high white blood cell count (≥50×10⁹/L) were independent risk factors for EFS (HR=0.24, 95%CI 0.07-0.85,HR=1.01, 95%CI 1.00-1.02, both P<0.05) and OS (HR=0.24, 95%CI 0.06-0.87; HR=1.01, 95%CI 1.00-1.02; both P<0.05). Conclusions: In CBF-AML, AML1-ETO is more common which has a higher extramedullary involvement and additional chromosome abnormalities, especially sex chromosome loss. The prognosis of AML1-ETO was similar to that of CBFβ-MYH11. The selection of induction regimen group FLAG-IDA for high white blood cell count and additional chromosome abnormality can improve the prognosis.
Male ; Female ; Humans ; Child ; Retrospective Studies ; RUNX1 Translocation Partner 1 Protein/genetics* ; Core Binding Factor Alpha 2 Subunit/therapeutic use* ; Prognosis ; Leukemia, Myeloid, Acute/genetics* ; Cytarabine/therapeutic use* ; Oncogene Proteins, Fusion/genetics* ; Chromosome Aberrations

Objective : To investigate the expression of circular RNA ( circRNA) circPRKDC in serum of patients with new-onset type 2 diabetes and its protective effect on palmitic acid-induced islet cell injury and its mechanism. Methods : Fifty patients with new-onset type 2 diabetes and 50 healthy individuals who underwent physical examination during the same period were selected，and the expression of circPRKDC in serum was detected by real-time quantitative polymerase chain reaction ( qRT-PCR) ．The mouse pancreatic β cell line MIN6 was treated with 110 μmol / L palmitic acid for 24 h to establish cell injury model．Negative control lentivirus or circPRKDC overexpression lentivirus were transfected，namely control group and circPRKDC group，respectively．Flow cytometry was used to determine the apoptosis and intracellular reactive oxygen species ( ROS) levels of cells in each group．Bioinformatics software predicted miRNA with binding sites for circPRKDC．The dual-luciferase reporter gene experiment verified the direct binding of circPRKDC to downstream miRNA．The expression of miRNA in each group of cells was detected by qRT-PCR. Western blot was used to detect the expressions of apoptosis-related factors (Bax，Bcl-2， caspase 8 ) and inflammation-related proteins ( NF-κB，p65 ) in each group of cells. Results : Compared with healthy subjects，the expression of circPRKDC in serum of patients with type 2 diabetes was significantly lower (P < 0. 01) ．Compared with the control group，the expression of circPRKDC in the circPRKDC group increased (P < 0. 01) ，the level of apoptosis decreased (P＜0. 01) ，and the content of intracellular ROS decreased (P ＜0. 01) . circPRKDC directly bound miR-375 (P ＜0. 01 ) ．Compared with the control group，the expression of miR-375 in cells in the circPRKDC group decreased (P＜0. 01) ，the protein expression of Bcl-2 was up-regulated (P＜0. 01) ， and the protein expressions of Bax，caspase 8，NF-κB and p65 were down-regulated (all P＜0. 01) ． Conclusion The expression of circPRKDC is down-regulated in the serum of patients with new-onset type 2 diabetes，and it reduces palmitic acid-induced oxidative stress in islet cells by targeting miR-375，thereby inhibiting apoptosis and in- flammatory responses.

OBJECTIVE To systemically sort out the main practices of local drug online procurement， so as to provide reference for national and local governments to improve drug online procurement policies and drug price formation mechanism. METHODS By searching the official websites of 31 provincial medical security bureaus and drug-centralized procurement platforms in China， the classification methods and main goals of local drug online procurement were summarized， then the main practices of local drug online procurement were analyzed based on the main goals， and corresponding suggestion was put forward. RESULTS & CONCLUSIONS There were two classification methods of online drug procurement in each province， one is based on online or purchase methods， and the other is based on drug dimensions. Five main objectives of online drug procurement in each province are to ensure reasonable drug prices， meet clinical drug demand， ensure stable drug supply， cooperate with the implementation of drug policies， and standardize the behavior of transaction subjects. In order to achieve the five goals， each province has taken some targeted measures， but the severity of the policy varies greatly. In order to further improve the online drug procurement policy and improve the market-oriented online drug price formation mechanism， it is suggested to build the top-level design of online drug procurement， strengthen the management of the price comparison relationship of similar drugs， give full play to the monitoring function of the drug-centralized procurement platform and establish a national unified drug-centralized procurement platform.