Objective To construct and apply a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients.Methods Based on evidence summaries and expert consultation,a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients was constructed,consisting of 19 items covering 7 aspects including identification of risk factors,position management,tube and cuff selection,cuff management,mechanical ventilation management,pain and sedation management,removal of oropharyngeal and subglottic secretions,and oral care.Convenience sampling was used to select 141 ICU intubated patients from a tertiary A comprehensive hospital in Suzhou from June,2022 to September,2023.Patients were divided into an experimental group(n=72)and a control group(n=69)according to the wards.The experimental group received the management plan for microaspiration of oropharyngeal secretions in ICU intubated patients.The control group received the nursing bundle for ventilator associated pneumonia(VAP).The incidence and time from intubation to microaspiration and VAP,duration of mechanical ventilation,ICU length of stay,and disease outcome were compared between the 2 groups.Results The incidence of microaspiration of oropharyngeal secretions,the duration of mechanical ventilation,time from intubation to microaspiration showed significant differences between the 2 groups(P<0.05).There were no significant differences in the incidence of ventilator associated pneumonia,ICU length of stay,and disease outcome between the 2 groups(P>0.05).The time from intubation to VAP in the experimental group was 7.5 days,and that in the control group was 3.8 days.Conclusion The application of the management plan for microaspiration of orophaiyngeal secretions in ICU intubated patients is beneficial for reducing the incidence of microaspiration,delaying the time from intubation to microaspiration and VAP,and shortening the duration of mechanical ventilation.

Objective:To analyze the level and influencing factors of nurses′ proactive career behavior, problem-solving coping strategies and organizational identification, and to explore the relationship among them.Methods:This was a cross-sectional survey. A total of 536 nurses from Cangzhou Central Hospital, Luanzhou People′s Hospital, the Second Affiliated Hospital of Xingtai Medical College, People′s Hospital of Qiu County, Hebei Province in November 2023 were selected by convenience sampling method and investigated by general data questionnaire, Proactive Career Behavior Scale, Career Coping Strategies Scale and Organizational Identification Scale. The mediation effect was analyzed by AMOS 24.0 structural equation model.Results:Finally, 495 valid questionnaires were collected. There were 432 females and 63 males, 170 cases aged<31 years old, 256 cases aged 31-40 years old, and 69 cases aged>40 years old. The score of nurses′ proactive career behavior was (51.28 ± 9.86) points, problem-solving coping strategies was (16.25 ± 2.81) points, and organizational identification was (19.00 ± 4.84) points. The results of single factor analysis showed that nurses′ proactive career behavior was affected by age, title, department and salary satisfaction( F values were 2.20-24.44, all P<0.05), problem-solving coping strategies was affected by title, department and salary satisfaction ( F=5.72, 2.75, 21.30, all P<0.01), organizational identification was affected by salary satisfaction ( F=23.22, P<0.01). Problem-solving coping strategies, organizational identification were positively associated with proactive career behavior( r=0.786, 0.722, both P<0.01). Problem-solving coping strategies had a partial mediating effect between organizational identification and proactive career behavior( β=0.432, P<0.01), and the mediating effect accounted for 64.48% of the total effect. Conclusions:There is still room for improvement of nurses′ proactive career behavior, problem-solving strategies, and organizational identification. Nursing managers should pay attention to nurses′ job advantage of different age, title and department, and improve salary satisfaction to stimulate their work potential, and improve their organizational identification, guide them to adopt problem-solving strategies in coping with occupational stress, so as to promote the development of proactive career behavior.

Objective:To explore the clinical and genetic characteristics of two children with mental retardation and microcephaly.Methods:Two children who had visited the Anhui Children′s Hospital respectively on March 12 and June 22, 2021 were selected as the study subjects. Peripheral venous blood samples were collected from them and their parents, and subjected to chromosomal karyotyping and whole exome sequencing analyses. Candidate variants were verified by Sanger sequencing and pathogenicity analysis. This study was approved by the Anhui Children′s Hospital (Ethics No. EYLL-2018-008).Results:Chromosomal karyotyping and copy number detection of the two children had found no abnormality. Whole exome sequencing revealed that child 1 has harbored a c. 471delT (p.Pro157Profs*9) frameshifting variant of the CASK gene, whilst child 2 has harbored a c. 1259_1269delCTGAGAATAAC (p.Pro420fs*27) frameshifting variant of the CASK gene. Sanger sequencing confirmed that both variants were de novo in origin. Based on the guidelines from the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG-AMP), both variants were rated as pathogenic (PVS1+ PS2+ PP3). Conclusion:The de novo variants of the CASK gene probably underlay the pathogenesis of mental retardation and microcephaly in both children.

Objective:To analyze the changing trends of the epidemic characteristics of human brucellosis in Hangzhou City, and to provide a basis for further formulating prevention and control measures.Methods:The epidemic data of brucellosis in Hangzhou City from 2004 to 2021 were collected from the "China Disease Control and Prevention Information System" and the annual reports, compilations and summaries of prevention and control work of brucellosis in Hangzhou City, and the epidemiological characteristics and trends of brucellosis cases in Hangzhou City from 2004 to 2009, 2010 to 2015, and 2016 to 2021 were compared and analyzed.Results:A total of 186 cases of brucellosis were diagnosed in Hangzhou City from 2004 to 2021, with an average annual incidence rate of 0.151/100 000, ranging from 0.016/100 000 to 0.286/100 000. The incidence rate showed a stage-by-stage upward trend from 2004 to 2009, 2010 to 2015, and 2016 to 2021 ( Z = 3.15, P = 0.002). The age of onset of brucellosis cases was predominantly 18 - 60 years old, accounting for 78.49% (146/186). The male-to-female ratio was 2.10∶1.00 (126∶60). The occupational and non-occupational populations accounted for 62.90% (117/186) and 37.10% (69/186), respectively, with the proportion of non-occupational cases in the three stages being 28.57%, 23.29% and 51.76%, showing an increasing trend (χ 2trend = 9.85, P = 0.002). The regional distribution was dominated by Yuhang District, accounting for 55.91% (104/186), followed by Jianggan District (9.14%, 17/186) and Fuyang District (7.53%, 14/186). The number of brucellosis epidemic counties (cities, districts) increased from 6 to 9. The seasonal analysis showed that the proportion of cases from January to June decreased from 84.93% (23/28) from 2004 to 2009 to 54.12% (46/85) from 2016 to 2021. The proportion of infection from outside the province in the three stages was 0, 10.96% and 27.38%, respectively, showing an upward trend (χ 2trend = 18.16, P < 0.001), the main infected areas were Henan Province, Heilongjiang Province, and Inner Mongolia Autonomous Region. In clinical symptoms and signs, the incidence of muscle and joint pain and low back pain increased from 60.71% (17/28) and 10.71% (3/28) from 2004 to 2009, respectively, to 83.53% (71/85) and 25.88% (22/85) from 2016 to 2021, both showing an upward trend (χ 2trend = 9.92, 4.67, P = 0.002, 0.031). Conclusions:The incidence of human brucellosis in Hangzhou City is on the rise, and the number of cases of non-occupational population has increased significantly in recent years. The sheep breeding places have gradually become the high incidence areas of brucellosis in Hangzhou City. It is recommended to strengthen the promotion and education of knowledge on brucellosis prevention among the general public, and focus on actively monitoring human brucellosis in high-risk areas.

ObjectiveThis study aimed to investigate the HIV genotypic subtypes and molecular transmission clusters among men who have sex with men （MSM） with newly reported HIV infections in Dehong Dai and Jingpo Autonomous Prefecture （Dehong Prefecture）， Yunnan Province， China， between 2010 and 2019. The study aimed to identify potential high-risk transmitters and provide reference data for screening， management， and intervention of infection sources. MethodsPlasma samples from newly reported HIV-positive MSM individuals in Dehong Prefecture between 2010 and 2019 were collected. The viral pol gene fragments were amplified， sequenced， and genotyped. Genetic distances （GD） between pairwise sequences were analyzed and calculated. MEGA 7.0 and Gephi were used for phylogenetic and molecular transmission network analysis. ResultsA total of 159 newly reported HIV infections among MSM were included in the study， with successful genotyping of 100 cases. Nine HIV-1 subtypes were identified， with the most prevalent being CRF01_AE subtype （52%）， followed by CRF07_BC subtype （31%）， CRF55_01B subtype （10%）， and others （7%）. Cluster analysis revealed a total network access rate of 67%， forming three transmission clusters. CRF01_AE subtype formed two transmission clusters with 38 and 3 infected individuals， while CRF07_BC subtypes formed one transmission cluster with 26 infected individuals. The transmission network within the CRF01_AE clusters exhibited a more complex relationship. Significant differences in educational level were observed between the two main transmission clusters. ConclusionThe predominant HIV subtypes among newly reported MSM cases in Dehong Prefecture between 2010 and 2019 were CRF01_AE and CRF07_BC. Significant cultural differences are observed between the main transmission clusters. Continued monitoring of genotypic subtypes and targeted interventions within transmission clusters are warranted.

Objective:To investigate the effect of volatile organic compounds (VOCs) exposure in the atmosphere on the risk of daily death from stroke in Guangzhou.Methods:Daily average concentrations of twelve atmospheric VOCs, meteorological factors, and daily deaths for stroke and its subtypes (including ischemic and hemorrhagic stroke) in Guangzhou from 2020 to 2021 were collected. The time-series Poisson generalized additive model was established to analyze the relationship between daily average concentrations of atmospheric VOCs and daily mortality from a stroke on different lag days. The season, gender, and age group further performed stratification analysis.Results:Toluene and n-pentane were associated with a higher mortality risk from stroke and its subtypes. For each interquartile range ( IQR) increment in toluene concentration at lag0- 1 days, the RRs for mortality from stroke and hemorrhagic stroke were 1.060 (95% CI: 1.036-1.085) and 1.071 (95% CI: 1.030-1.113), respectively. For each IQR increment in n-pentane concentration, the RR for mortality from ischemic stroke was 1.064 (95% CI: 1.030-1.099). The effect estimates of VOCs may be higher during the cold season and among women and people aged ≥75 years. For each IQR increment in toluene concentration, the RRs for mortality risk of stroke in the cold season and women were 1.099 (95% CI: 1.056-1.143) and 1.085 (95% CI: 1.050-1.120), respectively. For n-pentane, the RR for death risk of stroke in people aged ≥75 years old was 1.072 (95% CI: 1.036-1.109). Results of sensitivity analysis showed that the effect estimates fluctuated less when PM 2.5 and O 3 were separately introduced for the two-pollutant model, as well as changing the degrees of freedom for covariates. Conclusions:This study suggests that VOCs may be an independent risk factor for daily mortality from stroke. Moreover, Toluene presented the most significant health impact.

Objective: To investigate the epidemiological characteristics of malaria in Hangzhou City from 2004 to 2021, so as to provide the evidence for formulating the post-elimination control strategy for malaria in Hangzhou City. Methods: The epidemic situation of malaria in Hangzhou City from 2004 to 2021 were collected from the National Information System for Disease Control and Prevention in China, and the temporal, spatial and human distributions of malaria cases and the source of malaria infections were analyzed in Hangzhou City during the pre-elimination stage (2004 to 2009), the elimination stage (2010 to 2015) and the post-elimination stage (2016 to 2021). Results: Totally 602 malaria cases were reported in Hangzhou City from 2004 to 2021,and the annual mean incidence of malaria was 0.22/105, 0.20/105 and 0.18/105 during the pre-elimination, elimination and post-elimination stages, appearing a tendency towards a decline. Men accounted for 63.96%, 85.07% and 93.75% of all malaria cases and there were 67.86%, 82.84% and 80.00% of cases at ages of 18 to 50 years during the pre-elimination, elimination and post-elimination stages, both appearing a tendency towards a decline (χ2trend=56.748, P<0.001; χ2trend=39.971, P<0.001). The predominant occupation of malaria cases shifted from farmers or migrant workers to multiple occupations, and the proportion of commercial servants increased from 4.87% during the pre-elimination stage to 24.38% during the post-elimination stage (χ2trend=73.308, P<0.001). The proportion of Plasmodium vivax malaria cases reduced from 96.43% during the pre-elimination stage to 7.50% during the post-elimination stage, and the proportion of P. falciparum malaria cases increased from 3.57% to 71.25%, while P. ovale, P. malariae and mixed infections were identified since 2010. There was a significant season-specific incidence of P. vivax malaria during the pre-elimination stage, and the period between May and October was an epidemic season; however, there was no season-specific incidence of P. vivax malaria during the elimination and post-elimination stages. The regional distribution of malaria cases presented a tendency towards a shift from suburb and rural areas to urban areas (χ2trend=74.229, P<0.001). No local cases were detected in Hangzhou City since 2010, and 94.22% of malaria cases were overseas imported cases after malaria elimination, including 90.61% from Africa. Conclusions oung and middle-aged men were high-risk populations for malaria in Hangzhou City from 2004 to 2021, and overseas commercial servants gradually became the predominant source of malaria infections, with malaria parasite species tending to be diverse. Improving the management of overseas imported cases and timely identification and treatment of cases are major interventions to consolidate malaria elimination achievements in Hangzhou City.

ObjectiveTo determine the trend and influencing factors of HIV subtypes in newly reported HIV/AIDS cases in Dehong Dai and Jingpo Autonomous Prefecture （Dehong Prefecture） from 2017 to 2019. MethodsRNA extraction was conducted among newly reported HIV/AIDS cases in Dehong Prefecture from 2017 to 2019 whose plasma volume was more than 200 μL. The gag， env and pol genes were amplified by using RT-PCR and then sequenced to determine the subtypes. ResultsA total of 3 287 HIV-infected cases were newly reported in Dehong from 2017 to 2019. The HIV gag， env and pol genotypes were determined in 1 813 cases. The major subtypes were subtype C （28.4%，515/1 813）， recombination form BC （22.0%，398/1 813） and CRF_01AE （18.1%，329/1 813）. Furthermore， the proportion of subtype B， subtype C and CRF01_AE decreased over years， whereas 01/BC， CRF07_BC and CRF08_BC increased over years in both Chinese and Burmese patients （χ²=75.212，P<0.001）. There were significant differences in gender， age， marital status， ethnicity， educational level and transmission route among Chinese and Burmese HIV-infected cases with diverse HIV genotypes （all P<0.05）. ConclusionHIV subtypes in Dehong change over time， which demonstrates that the proportion of BC recombinant subtypes and unique recombinant subtypes increased significantly.

OBJECTIVE To explore the discrimination of processing degree of Zingiber officinale charcoal and the correlation between color and component content based on machine vision system， and provide reference for quality evaluation and processing degree control of Z. officinale charcoal. METHODS High-performance liquid chromatography method was used to determine the contents of 5 components in Z. officinale charcoal and its different processed products， such as 6-gingerol， 8-gingerol， 10-gingerol， 6-shogaol， gingerone. Machine vision system was used to obtain the image of the decoction pieces and extract the color features of the decoction pieces in RGB， L*a*b* and HSV color spaces. Machine learning methods， such as principal component analysis （PCA）， linear discriminant analysis （LDA）， partial least squares-discriminant analysis （PLS-DA） and support vector machine （SVM）， were used to establish qualitative identification model for Z. officinale charcoal processed products of different processing degree. The correlation between the color eigenvalues and the contents of measured 5 components were analyzed， and the color- component content prediction model was established.RESULTS With the deepening of processing， gingerone was produced after processing and the content firstly increased and then decreased， and the content of gingerone in standard carbon was the highest； the contents of 6-gingerol， 8-gingerol and 10-gingerol decreased gradually； the content of 6-shogaol increased firstly and then decreased. The prediction accuracy of qualitative discriminant model， which was established on the basis of objective quantization of image and color combined with LDA and SVM of supervised discriminant pattern recognition method， reached 100% in cross-validation training and 95.83% in the external validation. Content prediction model of 5 components was established on the basis of objective quantization of image and color combined with SVM， the RPD values were all greater than 2， the R2P and R2C values of gingerone were 0.633 9 and 0.683 3， and the values of other components were all greater than 0.75， indicating SVM had good prediction ability for the contents of 4 components except for gingerone. CONCLUSIONS The machine vision system is excellent for the discrimination of the processing degree of Z. officinale charcoal and the content prediction， which can provide a reference for the quality control of Z. officinale charcoal decoction pieces and the judgment of the processing degree.

Objective:To investigate the distributions of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) genotypes among newly reported HIV/HCV co-infected Burmese patients in Dehong Dai and Jingpo Autonomous Prefecture, Yunnan Province from 2016 to 2019.Methods:A total of 1 289 newly reported HIV/HCV co-infected Burmese patients in Dehong Dai and Jingpo Autonomous Prefecture were collected through the National Acquired Immunodeficiency Syndrome Comprehensive Prevention and Control Data Information System From January 2016 to December 2019. Among them, 996 subjects with a plasma volume of ≥200 μL were selected to perform HIV and HCV genotyping. The HIV pol gene, the HCV core protein-binding envelope protein ( CE1) gene and non-structural protein 5B ( NS5 B) gene were amplified using the nested polymerase chain reaction.The phylogenetic tree was constructed by MEGA 7.0 software to classify the genotypes. Chi-square test was used for statistical analysis. Trend chi-square test was used to analyze the trend of HIV and HCV genotypes. Results:Among the 996 cases with HIV/HCV co-infection, HIV and HCV sequences from a total of 554 subjects (55.6%, 554/996) were successfully obtained, and the genotypes of HIV and HCV were diverse. HIV genotype C (40.3%, 223/554) and BC recombinant (33.6%, 186/554) were the most prevalent, followed by genotype B (6.5%, 36/554) and circulating recombinant form (CRF)01_AE (3.6%, 20/554). HCV genotype 3b was the most prevalent (31.2%, 173/554), followed by genotype 6u (19.5%, 108/554), 1a (17.5%, 97/554), 6n (11.4%, 63/554), 3a (8.7%, 48/554) and 6xg (6.3%, 35/554). The prevalence of HIV genotype C showed a downward trend ( χtrend2=7.23, P<0.001), while the prevalence of BC recombinant showed an upward trend ( χtrend2=5.97, P<0.001), and the proportion of BC recombinant was higher than genotype C in 2019 (54.9%(101/184) vs 21.7%(40/184)). However, there were no statistically significant differences in the proportions of genotype 3b, 6u and 1a from 2016 to 2019 ( χtrend2=1.43, 1.79 and 0.39, respectively, P=0.152, 0.074 and 0.695, respectively). The HIV genotype distribution among patients with different ethnic groups were significantly different ( χ2=22.06, P=0.037). Conclusions:The diversity of HIV and HCV genotypes is high and complex among HIV/HCV co-infected Burmese patients in Dehong Dai and Jingpo Autonomous Prefecture. BC recombinant shows a trend of becoming the predominant HIV genotype among these co-infected patients. Therefore, surveillance of the prevalence of HCV and HIV genotypes in Burmese population needs to be further strengthened.