Objective:To observe the preventive and treatment effects of warming needle therapy on peripheral neuropathy after albumin-bound paclitaxel plus cisplatin chemotherapy.Methods:Eighty patients who received albumin-bound paclitaxel plus cisplatin chemotherapy after being diagnosed with cancer were divided into an observation group and a control group using the simple random allocation table method,with 40 cases in each group.The control group received methylcobalamin dispersible tablets via oral administration,and the observation group received warming needle therapy.They were observed for the incidence of chemotherapy-induced peripheral neuropathy(CIPN),Levi's specific sensory neurotoxicity grading,brief pain inventory(BPI)score,nerve conduction velocities of the limbs,and traditional Chinese medicine(TCM)symptom scores before treatment,at the 21st day of the first cycle of chemotherapy(D1),and the 21st day of the second chemotherapy cycle(D2).The clinical efficacy was assessed at D2.Results:The incidence of CIPN was 92.5%in the control group,higher than 75.0%in the observation group(P<0.05).At D2,the number of people graded 0 on Levi's specific sensory neurotoxicity grading was larger in the observation group than in the control group,and the number of those graded 2 was smaller in the observation group(P<0.05);the observation group had a higher markedly effective rate than the control group(P<0.05).At D2,the BPI general score,BPI pain intensity score,and BPI pain interference score significantly dropped in the observation group compared to those before treatment(P<0.05).At D1,the motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)of the limbs decreased in both groups compared to those before treatment;at D2,the MNCV and SNCV increased in the two groups compared to D1 and were higher in the observation group than in the control group(P<0.05).At D1,the TCM symptom scores increased in both groups compared to those before treatment,and the observation group was lower than the control group in comparing the scores of numbness in the extremities and poor appetite(P<0.05).At D2,the observation group showed decreases in all TCM symptom scores compared to D1 except for the scores of nausea and vomiting and poor appetite(P<0.05),while the control group had no significant changes in the TCM symptom scores compared to D1(P>0.05);the observation group was lower than the control group in comparing each symptom score(P<0.05).There were no significant adverse reactions in either group over the study period.Conclusion:Compared to oral administration of methylcobalamin dispersible tablets,warming needle therapy shows certain strengths in managing CIPN after albumin-bound paclitaxel plus cisplatin chemotherapy,and it can better improve chemotherapy-induced gastrointestinal reactions.

Sepsis is a life-threatening organ dysfunction caused by dysregulated host responses to infection and remains a leading cause of mortality in intensive care unit（ICU）. In China，the incidence and mortality rate of sepsis are relatively high，with children and the elderly being more susceptible. The pathogenesis of sepsis is complex，primarily involving gram-negative bacteria and multidrug-resistant strains. Traditional blood culture，regarded as the "gold standard" for diagnosis，has limitations in terms of sensitivity and time consumption，whereas next-generation sequencing technology，characterized by its rapidity and high sensitivity，shows potential value in pathogen detection and treatment optimization. To effectively reduce the disease burden of sepsis in China，future research should focus on elucidating the immunological mechanisms of sepsis and developing precise strategies for classification and personalized treatment. Additionally，enhancing healthcare resource allocation and ICU accessibility are also crucial. This article summarizes the epidemiological characteristics of sepsis and systematically reviews the advances in pathogen diagnostic techniques and stratified treatment for sepsis，aiming to provide a reference for the precision diagnosis and treatment of sepsis.

Objective:To build an internet hospital cost-benefit evaluation index system based on a large public tertiary hospital, for references for improving the operation and management of internet hospitals.Methods:From May to October 2024, this study identified the elements of cost-benefit through on-site investigation, literature analysis and expert discussion, and built an initial evaluation index system of cost-benefit of internet hospitals; Delphi method and Pareto chart method were used to determine indicators and their weights; This evaluation index system was used to quantitatively evaluate an internet hospital since its operation for two years (from May 2022 to April 2024).Results:Five profit entities and 26 cost-benefit components had been identified; The expert authority coefficient of the two rounds of Delphi method was 0.73, and the Kendall coefficient was 0.80 ( P<0.001). The costs and benefits of an internet hospital since its operation for two years were 14.06 million yuan and 134.95 million yuan, respectively, with a benefit cost ratio of 9.60. Conclusions:The cost-benefit evaluation index system of internet hospitals built in this study was suitable for these relying on physical hospitals. This system was scientific and practical, and could provide references for cost-benefit evaluation of other Internet hospitals.

Objective To analyze the detrimental effects of exposure to environmental noise alone and combined with carbon monoxide(CO)on spermatogenesis in male rats,investigate the underlying mechanisms involved in such damage,and evaluate the protective role of pterostilbene(PTE)against these adverse effects.Methods Sixty male SD rats(6～8 weeks old,weighing 200±10 g)were randomly divided normal control group(standard housing),sham-exposure control group(restraint stress only),noise exposure(85 dB),CO exposure(460 mg/m3),combined exposure(simultaneous exposure),and PTE intervention(80 mg/kg pretreatment),with 10 animals in each group.The rats were exposed daily for 2 h via a nose-only inhalation exposure system within a multifactorial environmental simulation chamber for 60 consecutive days.Sperm count and viability were measured after exposure.Histopathological changes of testicular tissues were observed with HE staining.qRT-PCR was used to measure stage-specific mRNA levels in germ cells.Serum sex hormone levels and adenosine triphosphate(ATP)concentrations in testes and sperm were detected.Transmission electron microscopy(TEM)was applied to observe the ultrastructural damage in the spermatocytes.Additionally,transcriptome sequencing was performed on testicular tissue,followed by bioinformatics analysis.Results Compared with the negative control group,the combined exposure group exhibited significant reductions in sperm viability and count(P<0.05),and developmental arrest of immature germ cells in the testicular tissue,with obviously less spermatogonia,spermatocytes,and round/elongated spermatids(P<0.01).Additionally,significantly reduced levels of reproductive-related hormones,such as gonadotropin-releasing hormone,follicle-stimulating hormone,luteinizing hormone and testosterone,and ATP levels in testes and sperm were observed in the mice after combined exposure(P<0.01),accompanied by mitochondrial rupture and cristae disruption in spermatocytes.Conversely,the PTE intervention group showed marked alleviation of these impairments,with parameters recovering almost to normal levels.Transcriptome sequencing identified biological processes related to reproductive development and ATP-dependent pathways as potential contributors to testicular injury induced by noise and CO exposure,with key genes including Nppa,Adm,Gnrh1,Ptafr,Atp13a5,Atp8b1,and LOC102555469.Conclusion Noise and CO exposure induce spermatogenic damage in rats,which may be related with energy metabolism and hormonal regulation,while PTE demonstrates significant protective effects against such reproductive impairments.

Objective To investigate the transgenerational effects of paternal PM2.5 exposure on offspring growth and development,and to preliminarily elucidate the role of sperm DNA methylation modifications in mediating these effects.Methods Eight-week-old male C57BL/6 mice were randomly divided into filtered air(FA),unfiltered air(UA),and concentrated PM2.5(CAP)groups,with 10 animals in each group.The exposure was conducted from November 2019 to April 2020,and then,these male mice were mated with unexposed females to generate F1 offspring,which were bred successively to produce F2 and F3 generations.All the offspring were living in PM2.5-free environment.The birth body weight,birth number,and sex ratio of the offspring were recorded,body weight growth was monitored,and organ coefficients of the heart,liver,lung,and brain were calculated.Whole-genome methylation sequencing was performed on the sperm DNA of the CAP group,FA group,and their F1 generation offspring to screen for differentially methylated regions,and the genes and pathways associated with these regions were analyzed.Results When compared with the F1～F3 offspring of the FA group,the CAP group had significantly reduced birth body weight in the F1 generation(P<0.05),no statistical differences were observed in the birth body weight in the F2 and F3 generations(P>0.05),or either in the sex ratio and birth number among the F1,F2 and F3 generations.Compared with the FA group offspring,the F1～F3 offspring of CAP group exhibited delayed body weight gain,especially in the males(P<0.05),the CAP-F1 male generation had obviously elevated liver organ coefficient(P<0.01),but no statistical changes were observed in the heart,lung,or brain coefficients among the F1～F3 generations.Between the FA group and the CAP group,37 997 differentially methylated regions were detected,with a reduction of approximately 50%in the number of differentially methylated regions in the F1 generation.Differentially methylated genes in F0 and F1 sperm were potentially related to developmental processes,including imprinting genes(Gnas,Igf2)and metabolic genes(Ppard,Rps6kb1).Conclusion Paternal exposure to PM2.5 leads to reduced birth weight and intergenerational growth retardation in offspring.Its impact on phenotypic effects is gradually weakened during intergenerational transmission.Changes in the methylation of development-related genes in sperm may be one of the mechanisms mediating this intergenerational effect.

Objective:To observe the preventive and treatment effects of warming needle therapy on peripheral neuropathy after albumin-bound paclitaxel plus cisplatin chemotherapy.Methods:Eighty patients who received albumin-bound paclitaxel plus cisplatin chemotherapy after being diagnosed with cancer were divided into an observation group and a control group using the simple random allocation table method,with 40 cases in each group.The control group received methylcobalamin dispersible tablets via oral administration,and the observation group received warming needle therapy.They were observed for the incidence of chemotherapy-induced peripheral neuropathy(CIPN),Levi's specific sensory neurotoxicity grading,brief pain inventory(BPI)score,nerve conduction velocities of the limbs,and traditional Chinese medicine(TCM)symptom scores before treatment,at the 21st day of the first cycle of chemotherapy(D1),and the 21st day of the second chemotherapy cycle(D2).The clinical efficacy was assessed at D2.Results:The incidence of CIPN was 92.5%in the control group,higher than 75.0%in the observation group(P<0.05).At D2,the number of people graded 0 on Levi's specific sensory neurotoxicity grading was larger in the observation group than in the control group,and the number of those graded 2 was smaller in the observation group(P<0.05);the observation group had a higher markedly effective rate than the control group(P<0.05).At D2,the BPI general score,BPI pain intensity score,and BPI pain interference score significantly dropped in the observation group compared to those before treatment(P<0.05).At D1,the motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)of the limbs decreased in both groups compared to those before treatment;at D2,the MNCV and SNCV increased in the two groups compared to D1 and were higher in the observation group than in the control group(P<0.05).At D1,the TCM symptom scores increased in both groups compared to those before treatment,and the observation group was lower than the control group in comparing the scores of numbness in the extremities and poor appetite(P<0.05).At D2,the observation group showed decreases in all TCM symptom scores compared to D1 except for the scores of nausea and vomiting and poor appetite(P<0.05),while the control group had no significant changes in the TCM symptom scores compared to D1(P>0.05);the observation group was lower than the control group in comparing each symptom score(P<0.05).There were no significant adverse reactions in either group over the study period.Conclusion:Compared to oral administration of methylcobalamin dispersible tablets,warming needle therapy shows certain strengths in managing CIPN after albumin-bound paclitaxel plus cisplatin chemotherapy,and it can better improve chemotherapy-induced gastrointestinal reactions.

Sepsis is a life-threatening organ dysfunction caused by dysregulated host responses to infection and remains a leading cause of mortality in intensive care unit（ICU）. In China，the incidence and mortality rate of sepsis are relatively high，with children and the elderly being more susceptible. The pathogenesis of sepsis is complex，primarily involving gram-negative bacteria and multidrug-resistant strains. Traditional blood culture，regarded as the "gold standard" for diagnosis，has limitations in terms of sensitivity and time consumption，whereas next-generation sequencing technology，characterized by its rapidity and high sensitivity，shows potential value in pathogen detection and treatment optimization. To effectively reduce the disease burden of sepsis in China，future research should focus on elucidating the immunological mechanisms of sepsis and developing precise strategies for classification and personalized treatment. Additionally，enhancing healthcare resource allocation and ICU accessibility are also crucial. This article summarizes the epidemiological characteristics of sepsis and systematically reviews the advances in pathogen diagnostic techniques and stratified treatment for sepsis，aiming to provide a reference for the precision diagnosis and treatment of sepsis.

Objective:To build an internet hospital cost-benefit evaluation index system based on a large public tertiary hospital, for references for improving the operation and management of internet hospitals.Methods:From May to October 2024, this study identified the elements of cost-benefit through on-site investigation, literature analysis and expert discussion, and built an initial evaluation index system of cost-benefit of internet hospitals; Delphi method and Pareto chart method were used to determine indicators and their weights; This evaluation index system was used to quantitatively evaluate an internet hospital since its operation for two years (from May 2022 to April 2024).Results:Five profit entities and 26 cost-benefit components had been identified; The expert authority coefficient of the two rounds of Delphi method was 0.73, and the Kendall coefficient was 0.80 ( P<0.001). The costs and benefits of an internet hospital since its operation for two years were 14.06 million yuan and 134.95 million yuan, respectively, with a benefit cost ratio of 9.60. Conclusions:The cost-benefit evaluation index system of internet hospitals built in this study was suitable for these relying on physical hospitals. This system was scientific and practical, and could provide references for cost-benefit evaluation of other Internet hospitals.

Objective:To analyze the epidemiological characteristics of respiratory virus infections in Sichuan from 2017 to 2023, and investigate the changes in detection rates of various viruses in different periods and age groups.Methods:The study included 41 516 patients with acute respiratory infections. Clinical laboratory results of these patients were retrospectively collected to calculate the detection rates of various viruses. The epidemiological characteristics of respiratory virus infections before, during, and after the COVID-19 pandemic, the prevalence of mixed infections, and the detection rates in different seasons and age groups were analyzed.Results:The overall detection rate of respiratory viruses was 23.35% (9 696/41 516), with influenza A virus (8.47%, 3 515/41 516), rhinovirus (7.13%, 2 961/41 516), and influenza B virus (2.04%, 846/41 516) being the most prevalent. The highest detection rate was observed in children aged 0-14 years (48.62%, 1 429/2 939), while the detection rates in young, middle-aged, and elderly individuals were similar [21.00% (1 482/7 057), 22.06% (3 828/17 350), 20.33% (2 685/13 205)]. The detection rate of influenza A virus dropped to 1.35% (253/18 717) during the COVID-19 pandemic, and rebounded to 13.05% (1 560/11 953) after the pandemic. A similar pattern was observed in other viruses such as human metapneumovirus, influenza B virus, coronavirus, and respiratory syncytial virus, with significant reductions during the COVID-19 pandemic and subsequent increases that even exceeded pre-pandemic levels. The detection rates of adenovirus, bocavirus, and rhinovirus gradually decreased over time, while the prevalence of parainfluenza virus remained stable, indicating a less significant impact of COVID-19 on these viruses. Higher detection rates were observed in autumn (28.90%, 2 324/8 041) and winter (26.52%, 4 093/15 433) as compared to that in spring (17.61%, 1 848/10 494) and summer (18.96%, 1 431/7 548), suggesting significant seasonal impacts on virus detection rates ( P<0.001). This study identified 8 666 cases of single-virus infections, 948 double infections, 77 triple infections, and five quadruple infections. Co-infection of bocavirus and rhinovirus was the most common type of double infections (17.41%, 165/948), and 59.60% (565/948) of double infections involved rhinovirus. Conclusions:The overall detection rate of respiratory viruses is higher in autumn and winter than in spring and summer. The prevalence of some respiratory viruses such as influenza viruses decreases during the COVID-19 pandemic. People of different ages can develop multiple infections with rhinovirus being the most common in double infections.

Objective:To analyze the new value of gastroscopy in the diagnosis of esophageal hiatal hernia(EHH).Methods:From March 7 to September 24 in 2019, 194 patients with gastroesophageal reflux disease who received endoscopy and high resolution esophageal manometry (HREM) at the Department of Gastroesophageal Surgery, the PLA Rocket Force Medical Center were selected. The transverse diameter of esophageal hiatus and the upward length of esophagogastric junction (EGJ) were measured under endoscopy, and the relevant data of reflux esophagitis (RE) and length and pressure of lower esophageal sphincter (LES) were collected. The value of traditional method under endoscopy and esophageal hiatus transverse diameter (EHTD) method under endoscopy in the diagnosis of EHH was compared. Independent sample- t test, rank sum test and chi-square test were used for statistical analysis. Results:The detection rate of EHH by EHTD method under endescopy was higher than that by traditional method under endoscopy and HREM method (60.8%, 118/194 vs. 14.9%, 29/194 and 37.1%, 72/194), and the detection rate of EHH by HREM method was higher than that by traditional method under endoscopy, and the differences were statistically significant ( χ2=86.75, 21.82, and 24.75; all P<0.001). The proportion of RE, the upward length of EGJ and the transverse diameter of esophageal hiatus of EHH patients diagnosed by traditional method under endoscopy and EHTD method under endoscopy were all higher than those of non-EHH patients (79.3%, 23/29 vs. 28.5%, 47/165; 49.2%, 58/118 vs. 15.8%, 12/76; 2.0 (2.0, 3.0) cm vs. 0.4(0, 0.7) cm, 0.7(0, 1.6) cm vs. 0(0, 0.6) cm; (2.60±0.71) cm vs. (1.88±0.44) cm, (2.30±0.45) cm vs. (1.51±0.29) cm); the minimum resting pressure of LES and resting pressure of LES were both lower than those of non-EHH patients(3.7(0.3, 12.1) mmHg (1 mmHg=0.133 kPa) vs. 9.1(3.3, 14.2) mmHg, 6.4(2.2, 12.5) mmHg vs. 10.8 (4.7, 15.5) mmHg; (9.70±7.92) mmHg vs. (14.92±10.30) mmHg, (11.36±7.79) mmHg vs. (18.44±11.78) mmHg); the length of intraperitoneal LES were shorter than that of non-EHH patients (0(0, 1.4) cm vs. 1.1(0, 1.7) cm, 0.3(0, 1.5) cm vs. 1.3(0.4, 1.8) cm); the length of LES of EHH patients diagnosed by EHTD method under endoscopy was shorter than that of non-EHH patients ((2.83±0.63) cm vs. (3.10±0.66) cm), and the differences were statistically significant ( χ2=26.53 and 22.31, Z=-8.26 and-5.04, t=5.26 and 13.67, Z=-2.14 and-2.71, t=-2.59 and-4.63, Z=-2.58 and-3.60, t=-2.96; all P<0.05). There were no significant differences in gender, LES length, intraperitoneal LES length, minimum resting pressure of LES, resting pressure of LES and residual pressure of LES between EHH patients diagnosed by EHTD method and traditional method under endoscopy (all P>0.05). Conclusions:Endoscopy plays a significant role in the diagnosis of EHH. EHTD method under endoscopy is more accurate in the diagnosis of sliding EHH, which is worthy of clinical reference.