ObjectiveTo investigate the characteristics of injury deaths and its disease burden in Taizhou City from 2009 to 2022, and to provide a basis for the prevention and control of injury. MethodsBased on the injury death surveillance data of Taizhou City from 2009 to 2022, the age-specific and sex-specific mortality rates, as well as the standardized mortality rates after adjusting China’s standardized population age of residents in Taizhou City were calculated. The crude mortality rate, standardized mortality rate, average years of life lost(AYLL), potential years of life lost (PYLL) and potential years of life lost rate (PYLLR) were calculated using Excel 2013 software. Joinpoint 4.2 software was used to estimate the annual percentage change (APC) and analyze the trends of injury mortality and PYLLR from 2009 to 2022. ResultsFrom 2009 to 2022, the standardized mortality rate of injuries in Taizhou City showed a decreasing trend (APC=-4.876%, P<0.001), with a mortality rate of 64.38/100 000 and a standardized mortality rate of 66.68/100 000. There was a statistically significant difference in injury deaths by genders (χ²=7 520.153, P<0.001). From 2009 to 2022, the PYLL and AYLL caused by injuries in Taizhou City were 587 518 person years and 21.91 years, respectively, with a PYLLR of 7.72%. The PYLLR of injuries showed a decreasing trend (APC=-7.454%, P<0.001), in addition, the PYLLR in urban(APC=-7.123%), rural areas (APC=-10.193%), males (APC=-7.595%) and females (APC=-7.046%) all showed a decreasing trend, all differences were statistically significant(all P<0.001). The top five causes of injury deaths leading to PYLL were traffic accident, drowning, accidental fall, suicide and accidental poisoning. ConclusionIn the last decade, injury has been a major cause leading to premature death among residents in Taizhou, with a higher mortality rate in males than that in females, and different injury characteristics caused by different types of injuries. It is necessary to take targeted injury prevention and intervention measures for different key population groups to effectively reduce the disease burden caused by injury deaths.

Objective:To study the early predictors of refractory septic shock (RSS) in neonates.Methods:From July 2020 to December 2021, clinical data of neonates with septic shock admitted to the Neonatal Department of our hospital were retrospectively reviewed. According to the maximum septic shock score (SSS) during clinical course, the neonates were assigned into RSS group and non-RSS group. Perinatal data, laboratory results and hemodynamic parameters at diagnosis were compared between the two groups. Multiple logistic regression analysis was used to identify independent risk factors of RSS and septic shock-related death. Receiver operating characteristic (ROC) curve was constructed to evaluate the early predictors of poor prognosis.Results:A total of 130 neonates were enrolled, including 54 in RSS group and 76 in non-RSS group. Compared with the non-RSS group, the RSS group had significantly lower pH, base excess (BE), stroke volume index (SVI), cardiac output (CO) and cardiac index (CI).Meanwhile, the RSS group had significantly higher mean arterial pressure (MAP) to CI ratio (MAP/CI) and SSS [including bedside SSS (bSSS), computed SSS (cSSS) and modified version of cSSS (mcSSS)] (all P<0.05). Multiple logistic regression analysis showed that increased MAP/CI was an independent predictor of RSS. The cut-off value of MAP/CI was 11.6 [sensitivity 62%, specificity 87%, positive predictive value (PPV) 79% and negative predictive value (NPV) 77%], with an area under the curve (AUC) of 0.734. Increased mcSSS was an independent predictor of septic shock-related death. The cut-off value of mcSSS was 5.8 (sensitivity 83%, specificity 72%, PPV 21% and NPV 97%), with an AUC of 0.845. Conclusions:Increased MAP/CI (≥11.6) and mcSSS (≥5.8) may be early predictors of RSS and septic shock-related death in neonates.

Objective:The electroencephalogram(EEG)signals were collected for analysis to define the differences in dy-namic functional connectivity of the brain network of related nodes in the primary motor area(M1)and pre-motor area(PMA)during motor imagination and motor execution.The relationship between muscle synergy and isolated movement was also explored. Method:Ten stroke patients with right hemiplegia and nineteen healthy adults participated in this study.All participants performed motor imagination(MI)and motor execution(ME)tasks according to visual instruc-tions.We recorded and analyzed the EEG signals at 12 sites located in Ml and PMA areas.The chosen EEG signals were filtered and analyzed based on the modified S-transform(MST).All data were normalized to avoid individual differences.Then we analyzed the data with Pearson correlation to identify the dynamic func-tional connectivity(FC)and the differences with Fisher's exact test for node degrees. Result:All the distribution trend of correlation degree of chosen node about left or right MI and ME of stroke patients was similar to that of healthy participants.Compared with the motion execution,the function connection strength and density of each node were elevated at MI,which was also consistent with healthy par-ticipants.When healthy adults underwent left hand MI,the degree of the C4 node in the Ml area was signifi-cantly higher than that of C3 on the opposite side(P＜0.05),while at right hand MI,the sum of the node de-grees of FC3 and FC1 in the left PMA area was significantly higher than that of the lateral symmetric chan-nel FC4 and FC2(P＜0.05).When the right upper limb isolated movement was performed,the node degree of C3 decreased significantly(P＜0.05). Conclusion:The major region of function connectivity of the right hand MI was in the left PMA area,and the node degree at MI was higher than ME.The functional connectivity of each node at the left hand MI was dispersed.The main channels activated by the muscle synergy are different from the isolated movement.

ObjectiveTo analyze the mortality rate and the changing trends of injury in Taizhou City from 2009 to 2022, so as to provide a reference for developing injury intervention strategies. MethodsSurveillance data on injury deaths of the registered residents in Taizhou from 2009 to 2022 were used, and descriptive statistics and χ² test were employed to analyze the mortality rates and differences by age group, gender, and region. Joinpoint regression analysis was used to analyze the trends and calculate the annual percentage change(APC). ResultsFrom 2009 to 2022, a total of 53 707 injury deaths were recorded in Taizhou, with a mortality rate of 64.38/10⁵ and a standardized mortality rate of 66.68/10⁵. The injury mortality rate showed a decreasing trend (APC=-1.30%, P<0.05). The top five causes of death were accidental falls, traffic accidents, drowning, suicide, and accidental poisoning, all showing a decreasing trend (APC=-3.30%, -7.65%, -2.77%, -5.78%, and -7.82%, respectively, all P <0.05). The leading causes of death for those under 15 years old, 15‒64 years old, and 65 years old and above were drowning, traffic accidents, and accidental falls, respectively. There was no statistical difference in the mortality rate between urban and rural areas (χ²=3.81, P=0.05), but there was a statistical difference between genders (χ²=7 520.15, P<0.01). ConclusionIn recent years, injury deaths among the residents in Taizhou have been decreasing. Efforts should be made to strengthen the prevention and control of injuries such as drowning in children, traffic accidents in middle-aged and young people, and accidental falls in the elderly.

Objective: To understand the mortality and probability of premature death due to malignant tumors, cardio-cerebrovascular diseases, diabetes and chronic respiratory diseases in Taizhou City, Zhejiang Province, so as to provide the basis for the improvement of chronic diseases prevention and control strategies. Methods: The death data of the four chronic diseases among local residents in Taizhou City from 2019 to 2022 were collected through Taizhou Chronic Disease Information Management System, and the crude mortality, standardized mortality (standardized by the data of the seventh national population census in 2020) and probability of premature death were calculated. The trends in mortality and probability of premature death were analyzed using annual percent change (APC). The attainment of probability of premature death due to the four chronic diseases were evaluated using the target values and predicted values in 2025 and 2030. Results: There were 119 899 deaths from the four chronic diseases in Taizhou City from 2019 to 2022, with the crude mortality of 494.48/105 and the standardized mortality of 410.68/105, which was no significant changing trend (APC=4.680% and -2.795%, both P>0.05). The probability of premature death decreased from 10.39% to 8.69% (APC=-6.027%, P<0.05). The crude mortality and standardized mortality in males were higher than those in females (562.13/105 vs. 424.08/105; 461.67/105 vs. 353.81/105; both P<0.05). The crude mortality and standardized mortality in rural areas were higher than those in urban areas (499.65/105 vs. 480.52/105; 429.20/105 vs. 365.68/105; both P<0.05). The probability of premature death in women and rural residents showed downward trends (APC=-8.210% and -7.558%, both P<0.05) from 2019 to 2022. The standardized mortality and probability of premature death due to malignant tumors showed downward trends (APC=-6.090% and -8.019%, both P<0.05). The crude mortality of diabetes showed an upward trend (APC=18.654%, P<0.05). The predicted values for probability of premature death due to due to the four chronic diseases in 2025 and 2030 were 7.27% and 5.40%, respectively, and were lower than the target values of 10.02% and 8.77%. Conclusions From 2019 to 2022, there was no significant trends in the mortality of four chronic diseases in Taizhou City, with rural men being the key population for prevention and control. The probability of premature death showed a downward trend, and it was expected to achieve the target in 2025 and 2030.

Objective:To explore the effect of quality improvement of hemodynamic monitoring on fluid overload (FO) and outcome in newborns with septic shock.Methods:Non-invasive cardiac output monitoring and functional cardiac ultrasound quality improvement program was started during January 2020 in our hospital. Neonates with septic shock admitted before and after the program were retrospectively analyzed. From January 2018 to December 2019 was pre-improvement period when fluid resuscitation was routinely performed and vasoactive drugs was selected empirically. From January 2020 to December 2021 was post-improvement period when fluid resuscitation and/or use and adjustment of vasoactive drugs were guided by hemodynamic parameters. The 24 h, 48 h, 72 h FO, duration of invasive respiratory support, vasoactive-inotropic score, septic shock score, incidences of complications and all-cause mortality were compared between the two groups.Results:A total of 284 eligible cases were enrolled, including 136 cases in pre-improvement group and 148 cases in post-improvement group. Post-improvement group had significantly lower gestational age (GA), birth weight (BW) and body weight at disease onset than pre-improvement group ( P<0.05). Incidences of 48 h and 72 h FO, fluid resuscitation volume within 72 h, pulmonary hemorrhage and periventricular leukomalacia (PVL) were significantly lower in the post-improvement group ( P<0.05). No significant differences existed in 24 h FO, other complications and all-cause mortality between the two groups ( P>0.05). No significant differences existed in GA and BW for neonates with pulmonary hemorrhage and PVL between the two groups ( P>0.05). Conclusions:Quality improvement of hemodynamic monitoring can effectively improve FO and reduce the incidences of pulmonary hemorrhage and PVL.

Objective:To study the predictive value of vasoactive-inotropic score (VIS), fluid overload (FO) and lactate level for the outcome of preterm infants with refractory septic shock.Methods:Preterm infants diagnosed with refractory septic shock and required hydrocortisone treatment in our Department from January 2016 to December 2021 were analyzed retrospectively. Preterm infants were assigned into three gestational age groups (<28 weeks, 28-31 weeks, 32-36 weeks). According to the outcome of the disease, the children were further divided into good prognosis group and poor prognosis group. The relationship between the maximum VIS, FO and the mean lactic acid before hydrocortisone and the outcome of refractory septic shock was analyzed by receiver operating characteristic (ROC) curve, the cut-off point of ROC curve was calculated to obtain the predictive efficacy of the three indicators for the outcome of refractory septic shock in preterm infants.Results:A total of 50 preterm infants with refractory septic shock and received hydrocortisone treatment were enrolled, including 20 in the good prognosis group and 30 in the poor prognosis group. There were no significant differences in the maximum VIS, FO and mean lactic acid before hydrocortisone treatment between the two groups of gestational age of <32 weeks ( P> 0.05). The maximum VIS, FO and mean lactic acid of gestational age of 32-36 weeks in the poor prognosis group were higher than those in the good prognosis group, VIS: 56.1±15.7 vs. 37.1±12.9, FO (%): 108.2 (78.6,137.7) vs. 55.5 (10.3, 100.7), and mean lactic acid (mmol/L): 8.3 (4.6, 12.0) vs. 4.8 (-0.8, 10.5), all P<0.05. The area under the ROC curve of the mean lactic acid was the largest, the cut-off value was 4.1 mmol/L, and the Youden index was 1.732. Conclusions:VIS, FO and lactate level are difficult to be used for determining the outcome of refractory septic shock in preterm infants of <32 weeks. While the mean lactic acid has the best predictive performance in preterm infants of 32-36 weeks.

ObjectiveTo analyze the characteristics of death and premature death of 4 major chronic diseases （cardiovascular and cerebrovascular diseases， malignant tumors， chronic respiratory diseases and diabetes） in Taizhou City from 2011 to 2018，and provide data basis for the government to formulate chronic disease prevention planning. MethodsThe death data of household registration residents in Taizhou City from 2011 to 2018 were derived from the Chronic Disease Surveillance Information Management System in Zhejiang Province. The death toll ratio of chronic diseases， the mortality rate of chronic diseases， the probability of premature death of chronic diseases were analyzed. The standardization rate was calculated six times in 2010. Population composition of the census. The Joinpoint Regression Program 4.2 software was used for calculating annual percent change （APC） and its statistical test results. ResultsFrom 2011 to 2018， there were 231 724 chronic disease deaths in Taizhou City， with a mortality rate of 486.52/10⁵ and a standardized mortality rate of 381.55/10⁵. The proportion of chronic disease deaths to total deaths was 79.89%， of which males were higher than females and rural areas were higher than urban areas.From 2011 to 2018， the standardized mortality and early death probability of cardiovascular and cerebrovascular diseases， malignant tumors and chronic respiratory diseases in Taizhou showed a downward trend （P<0.05）， the standardized mortality of diabetes （P=0.46） and the early death probability （P=0.22） did not decline， and the mortality of all age groups of the above four types of chronic diseases in rural areas was higher than that in urban areas. The mortality of the four types of chronic diseases from high to low are cardiovascular and cerebrovascular diseases， malignant tumors， chronic respiratory diseases and diabetes， and the mortality tends to increase with age. From 2011 to 2018， the probability of premature death from four types of chronic diseases in Taizhou City showed a downward trend， from 13.49% in 2011 to 10.49% in 2018， with an average annual decrease of 2.97%. The difference was statistically significant （t=‒5.83，P<0.05）. ConclusionChronic disease death is the main cause of death in Taizhou City. In order to reduce the mortality rate of chronic diseases， effective prevention and control measures for chronic diseases should be carried out， especially the prevention and control of diabetes and male chronic diseases.

Objective:To study the predictive value of vasoactive-inotropic score (VIS), shock score and lactate level for the outcome of term infants with septic shock.Methods:From January 2019 to October 2020, clinical data of term infants with septic shock admitted to our department were reviewed. According to their clinical outcome, the infants were assigned into the survival group and the deceased group and the differences of the two groups were compared. Logistic regression was used to determine the risk factors of mortality in term infants with septic shock. Receiver operating characteristic curve was used to compare the predictive efficacy of VIS, shock score and lactate level for the outcome of septic shock.Results:Significant differences existed between the survival group and the deceased group in the following: maximum VIS, maximum shock score, maximum lactate level, the mean value of VIS during the second 24 h, the mean value of lactate during the first and second 24 h ( P < 0.05). Meanwhile, maximum VIS ( OR = 1.038, 95% CI 1.014~1.063), maximum shock score ( OR = 2.372, 95% CI 1.126~4.999) and the mean value of lactate during the first 24h ( OR = 2.983, 95% CI 1.132~7.862) were correlated with mortality in the infants ( P < 0.05). The area under the curve of maximum VIS was the most prominent, with 58.5 as cut-off. Conclusions:Among the three indicators, VIS has the best predictive value for mortality outcome in term infants with septic shock, followed by shock score and lactate level.

Objective:To study the threshold of fluid overload (FO) and its risk factors in neonatal septic shock.Methods:From January 2019 to November 2020, clinical data of infants with septic shock hospitalized in the neonatal department of our hospital were reviewed. With poor prognosis as the outcome, ROC curve was drawn based on 24 h (from the beginning of septic shock), 48 h and 72 h FO value. FO cutoff value was determined as area under curve (AUC) reached maximum. Risk factors of FO were analyzed between FO