Objective To explore the diagnosis and treatment strategies for elderly patients with ground-glass opacity (GGO). Methods The imaging features and postoperative pathological findings of the elderly patients with pulmonary GGO receiving surgery in our hospital from 2017 to 2019 were retrospectively analyzed. The patients were divided into an elderly patient group and a non-elderly patient group based on their age. Results Finally 575 patients were included in the study. There were 281 elderly patients, including 83 males and 198 females, with an average age of (67.0±5.3) years. There were 294 non-elderly patients, including 88 males and 206 females, with an average age of (49.1±7.3) years. Compared with the non-elderly patients, elderly GGO patients showed the following distinct clinical features: long observation time for lesions (P=0.001), high proportion of rough edges of GGO (P<0.001), significant pleural signs (P＜0.001) and bronchial signs (P＜0.001), and high proportion of type Ⅱ-Ⅳ GGO (P<0.001), lobectomy type (P=0.013), and invasive lesions reported in postoperative pathology (P<0.001). There was no statistical difference in the average hospital stay between the two groups (P=0.106). Multivariate logistic regression analysis showed that GGO diameter and GGO type were the main factors affecting the operation. Observation time, GGO diameter, GGO type and pleural signs were the main influencing factors for postoperative pathological infiltrative lesions. The cut-off value of GGO diameter in predicting infiltrating lesions was 10.5 mm in the elderly patients group. Conclusion The size and type of GGO are important factors in predicting invasive lesions and selecting surgical methods. Elderly patients with radiographic manifestations of type Ⅱ-Ⅳ GGO lesions with a diameter greater than 10.5 mm should be closely followed up.

Objective: To investigate the spatio-temporal clustering characteristics of influenza in Ningxia Hui Autonomous Region from 2014 to 2023, so as to provide the basis for strengthening influenza prevention and control. Methods: Data pertaining to influenza cases reported in Ningxia Hui Autonomous Region from 2014 to 2023 were retrieved from the Infectious Disease Surveillance System of the Chinese Disease Prevention and Control Information System, including age, sex, current residence, onset date, and reporting date. The seasonal incidence of influenza was analyzed using seasonal index. The spatio-temporal clustering characteristics of influenza were identified using spatial autocorrelation analysis and spatio-temporal scan analysis. Results: A total of 20 377 influenza cases were reported in Ningxia Hui Autonomous Region from 2014 to 2023, with a male-to-female ratio of 1.15∶1. The majority were children under 15 years, with 10 950 cases accounting for 53.74%. Influenza was highly prevalent in January, February, March, and December, with seasonal indices of 219.06%, 111.00%, 246.65%, and 366.24%, respectively. The average annual reported incidence was 29.55/100 000, among which Pengyang County, Jinfeng District, Dawukou District, Xiji County, and Litong District had higher average annual reported incidence, at 63.99/100 000, 55.71/100 000, 55.70/100 000, 49.49/100 000, and 49.04/100 000, respectively. Spatial autocorrelation analysis showed that in 2023, there was spatial clustering of influenza cases in Ningxia Hui Autonomous Region (Moran's I=0.333, P<0.05), with a high-high cluster in Jingyuan County, while in other years, the distribution of influenza cases was random (all P>0.05). Spatio-temporal scan analysis showed that from 2014 to 2023, there were four space-time clusters in Ningxia Hui Autonomous Region, including one type Ⅰ cluster in Hongsibao District of Wuzhong City, with the clustering period from January 20 to 26, 2014; and three type Ⅱ clusters, mainly in January, February, March and December, covering one area in Shizuishan City, five areas in Guyuan City, one area in Zhongwei City, three areas in Wuzhong City, and four areas in Yinchuan City. Conclusions From 2014 to 2023, children under 15 years were the primary population affected by influenza in Ningxia Hui Autonomous Region, with distinct spatio-temporal distribution characteristics. The peak incidence occurred during the winter and spring seasons, and the main clustering areas were in the southern regions.

Objective: To investigate the awareness of air pollution protection knowledge and its influencing factors among primary school students in Shennongjia Forest District, Hubei Province, so as to provide insights into targeting implementation of health education on air pollution protection knowledge. Methods: Students in Grade 3 to 5 in Shennongjia Shiyan primary school were enrolled by stratified cluster sampling method, and students' demographic features and awareness of air pollution protection knowledge were investigated using the Investigation on the Effects of Air Pollution Health Protection of Pupils (Volume A). Factors affecting the awareness of air pollution protection knowledge among primary school students were identified using a multivariable logistic regression model. Results: A total of 897 questionnaires were allocated, and 877 valid questionnaires were recovered, with an effective rate of 97.77%. The respondents included 446 men (50.86%) and 431 women (49.14%), 301 third grade students (34.32%), 284 fourth grade students (32.38%), and 292 fifth grade students (33.30%), and had a mean age of (10.32±0.93) years. The overall awareness of air pollution protection was 55.76%, and the awareness rates of basic concepts, basic knowledge, and basic behaviors and skills were 42.99%, 53.48% and 57.24%, respectively. Multivariable logistic regression analysis identified age (OR=1.453, 95%CI: 1.053-2.005), living with parents (OR=2.638, 95%CI: 1.571-4.429), mother's educational level (below primary school, OR=0.270, 95%CI: 0.084-0.862; primary school, OR=0.169, 95%CI: 0.069-0.416; junior high school, OR=0.309, 95%CI: 0.138-0.691; high school, OR=0.352, 95%CI: 0.160-0.773) and average annual family income (50 000 to 100 000 Yuan, OR=1.629, 95%CI: 1.162-2.282; 100 000 to 150 000 Yuan, OR=1.802, 95%CI: 1.101-2.948; ≥150 000 Yuan, OR=1.939, 95%CI: 1.065-3.529) as factors affecting the awareness of air pollution protection knowledge among primary school students. Conclusion The awareness of air pollution protection knowledge is 55.76% among primary school students in Shennongjia Forest District, and is affected by age, mother's educational level, average annual family income and living with parents.

Objective To explore the effect of ropivacaine combined with dexmedetomidine in transversus abdominis plane block(TAPB)on postoperative stress hormones and cognitive function in patients undergoing laparoscopic radical gastrectomy.Methods A total of 80 patients undergoing laparoscopic radical gastrectomy at the First Affiliated Hospital of Xinxiang Medical University from April to October 2023 were selected as the research subjects.According to different anesthesia methods,the patients were divided into the observation group and the control group,with 40 patients in each group.Patients in the observation group were injected bilaterally with 2.5 g·L-1 ropivacaine and 0.5 μg·kg-1 dexmedetomidine for TAPB,with 20 mL injection on each side.Patients in the control group were injected bilaterally with 2.5 g·L-1 ropivacaine for TAPB,with 20 mL injection on each side.Mean arterial pressure(MAP)and heart rate(HR)were recorded at the time of admission to the operating room(T1),immediately after endotracheal intubation(T2),40 minutes after pneumoperitoneum(T3),and 15 minutes after extubation(T4).Radioimmunoprecipitation was used to detect serum cortisol(COR)level,and enzyme-linked immunosorbent assay was used to measure serum norepinephrine(NE)and epinephrine(E)levels at 1,6,12,and 24 hours after surgery.Visual analog scale(VAS)was used to assess pain at rest,and Ramsay sedation scale(RSS)was used to evaluate sedation depth.The doses of propofol and sufentanil were compared between the two groups.Serum β-amyloid(Aβ)and S100β protein levels at 1 day before surgery,1 and 3 days after surgery were detected by using the enzyme-linked immunosorbent assay,and cognitive function was assessed at the same time points by using the mini-mental state examination(MMSE).Results At T,and T2,there was no significant difference in MAP and HR between the control group and the observation group(P＞0.05).At T3 and T4,MAP and HR in the observation group were significantly lower than those in the control group(P＜0.05).At 1,6,and 12 hours postoperatively,VAS score in the observation group was significantly lower than that in the control group(P＜0.05).At 24 hours postoperatively,there was no significant difference in VAS score between the control group and observation group(P＞0.05).At 1 and 6 hours postoperatively,RSS score in the observation group was significantly higher than that in the control group(P＜0.05).At 12 and 24 hours postoperatively,there was no significant difference in RSS score between the control group and observation group(P＞0.05).At 1,6,and 12 hours postoperatively,COR,NE,and E levels in the observation group were significantly lower than those in the control group(P＜0.05).At 24 hours postoperatively,there was no significant difference in COR,NE,and E levels between the control group and observation group(P＞0.05).The doses of propofol and sufentanil in the observation group were significantly lower than those in the control group(P＜0.05).One day before surgery,there was no significant difference in MMSE score between the control group and observation group(P＞0.05).At 1 and 3 days postoperatively,MMSE score in the observation group was significantly higher than that in the control group(P＜0.05).One day before surgery,there was no significant difference in serum Aβ and S100β protein levels between the control group and observation group(P＞0.05).At 1 and 3 days postoperatively,serum Aβ and S100β protein levels in the observation group were significantly lower than those in the control group(P＜0.05).Conclusion Ropivacaine combined with dexmedetomidine in TAPB in radical gastrectomy can significantly reduce postoperative pain,increase sedative effect,prolong the duration of TAPB,and benefit patients'postoperative recovery with reduced cognitive impairment.

Objective To compare the effects of the left and right stellate ganglion resection on myocardial injury in rats with acute myocardial infarction(AMI).Methods According to the random number table method,30 healthy male Sprague Dawley rats were divided into the AMI group,left stellate ganglionectomy group,and right stellate ganglionectomy group,with 10 rats in each group.AMI models were prepared by ligation of the left anterior descending branch of the coronary artery in all the three groups.In the AMI group,the stellate ganglion was isolated(randomly left or right)without excision.The rats in the left and right stellate ganglionectomy groups underwent the left and right stellate ganglionectomy,respectively.At 24 hours after modeling,2 mL of subclavian venous blood was extracted from the three groups of rats.The serum levels of cardiac troponin Ⅰ(cTnⅠ),noradrenaline(NE),interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α),malondialdehyde(MDA),and superoxide dismutase(SOD)were detected by enzyme-linked immunosorbent assay.The left ventricular fractional shortening(LVFS),left ventricular ejection fraction(LVEF)and cardiac output(CO)of rats in the three groups were measured by echocardiography one week after modeling.Results The serum levels of NE,cTnⅠ and MDA in the left and right stellate ganglionectomy groups were significantly lower than those in the AMI group,and SOD level was significantly higher than that in the AMI group(P＜0.05);the serum levels of NE,cTnⅠ and MDA in the right stellate ganglionectomy group were significantly lower than those in the left stellate ganglionectomy group,and SOD level was significantly higher than that in the left stellate ganglionectomy group(P＜0.05).The levels of serum IL-1β,IL-6 and TNF-α in the left and right stellate ganglionectomy groups were significantly lower than those in the AMI group(P＜0.05);the levels of serum IL-1β,IL-6 and TNF-αin the right stellate ganglionectomy group were significantly lower than those in the left stellate ganglionectomy group(P＜0.05).LVEF,LVFS and CO in the left and right stellate ganglionectomy groups were significantly higher than those in the AMI group,and LVEF and LVFS in the right stellate ganglionectomy group were significantly higher than those in the left stellate ganglionectomy group(P＜0.05);there was no significant difference in CO between the left and right stellate ganglionectomy groups(P＞0.05).Conclusion Stellate ganglionectomy has a protective effect on AMI induced by ligation of the left anterior descending branch of the coronary artery,which may be related to reducing inflammatory reaction and oxidative stress damage.The right stellate ganglion resection has more protective effects on cardiac function than the left stellate ganglion resection.

Objective To investigate the effects of lumbar epidural block of renal sympathetic nerve on cardiac function and serum inflammatory factors in rats with myocardial infarction.Methods Thirty healthy male Sprague Dawley rats were divided into asham operation group,myocardial infarction group and sympathetic nerve block group according to the random number table method,with 10 rats in each group.Lumbar epidural catheterization was applied in all rats in the 3 groups.After catheter insertion,myocardial infarction was induced by ligation of the anterior descending branch of the left coronary artery of rats in the myocardial infarction group and the sympathetic nerve block group,while the left anterior descending branch of rats in the sham operation group was not ligated.After myocardial infarction,the rats in the sympathetic nerve block group were injected with 50 μL of ropivacaine(volume fraction:0.2％)via a lumbar epidural catheteronce every 24 hours,and the injection lasted until 14 days after surgery.In the myocardial infarction group,50 μL of 9 g·L-1sodium chloride was injected into the rats through a lumbar epidural catheteronce every 24 hours,and the injection lasted until 14 days after surgery.Rats in the sham group did not receive the injection of any drugs.At 14 days after operation,echocardiography was performed on rats in the 3 groups to measure ejection fraction(EF),left ventricular short-axis shortening rate(FS)and cardiac output(CO).A total of 1 mL of cervical venous blood was extracted from each rat in the 3 groups at 24 h after surgery,and 5 mL of abdominal aortic blood was extracted from rats in the 3 groups at 14 days after surgery.Serum levels of norepinephrine(NE),cardiac troponin I(cTnl),interleukin-18(IL-18),interleukin-1β(IL-1 β)and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay.At 14 days after surgery,the rats in the 3 groups were anesthetized by intraperitoneal injection of 100 g·L-1 chloral hydrate(300 mg·kg-1),and the thoracic cavity of the rats was opened to remove the heart.The myocardial infarction area of the rats was detected by 2,3,5-triphenyltetrazolium chloride staining,and the proportion of the myocardial infarction area was calculated.Results On the 14th day after surgery,EF,FS and CO of rats in the myocardial infarction group and sympathetic nerve block group were significantly lower than those in the sham operation group,while EF,FS and CO of rats in the sympathetic nerve block group were significantly higher than those in the myocardial infarction group(P＜0.05).The serum cTnI level of rats in the myocardial infarction group and sympathetic nerve block group was significantly higher than that in the sham operation group(t=68.260,15.110;P＜0.05),and the serum cTnI level of rats in the myocardial infarction group was significantly higher than that in the sympathetic nerve block group(t=27.920,P＜0.05).The proportion of the myocardial infarction area of rats in the sympathetic nerve block group was significantly lower than that in the myocardial infarction group(t=14.182,P＜0.001).There was no significant difference in the serum NE,IL-18,IL-1 β and TNF-α levels of rats between 24 hours and 14 days after surgery in the sham operation group(P＞0.05).The serum NE,IL-1 β and TNF-αlevels of rats at 14 days after surgery were significantly higher than those at 24 hours after surgery,and the IL-18 level of rats was significantly lower than that at 24 hours after surgery in the myocardial infarction group(P＜0.05).The serum NE,IL-18 and TNF-α levels of rats at 14 days after surgery were significantly lower than those at 24 hours after surgery,and the IL-1 βlevel of rats was significantly higher than that at 24 hours after surgery in the sympathetic nerve block group(P＜0.05).At 24 hours and 14 days after surgery,the serum NE,IL-18,1L-1 β and TNF-α levels of rats in the myocardial infarction group and sympathetic nerve block group were significantly higher than those in the sham operation group,while the serum NE,IL-18,IL-1 β and TNF-α levels of rats in the sympathetic nerve block group were significantly lower than those in the myocardial infarction group(P＜0.05).Conclusion Lumbar epidural block of renal sympathetic nerve in rats can significantly reduce the levels of serum inflammatory factors and NE,and improve cardiac function.

Objective To establish the analysis method of 13 Paralytic shellfish toxins(PSTs)in human whole blood by high-performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS).Methods 13 kinds of PSTs were extracted from the whole blood using acetonitrile with 1%acetate(1︰3,v︰v)solution,and separated by UPLC BEH Amide chromatographic column(100mm×2.1mm,1.7μm).The samples were detected by an electrospray ionization source(ESI)and positive and negative ion multiple reaction monitoring(MRM)mode,and quantified by matrix matching curve external standard method.Results The results showed that 13 kinds of PSTs in blood samples were linear well in the ranges of 1～100 ng/mL,with the correlation coefficient(r2)>0.995.The limit of detection(LODs)of the method were 0.5～2 ng/mL,the limit of quantitation(LOQs)were 1～4 ng/mL,and the recoveries of the method were 65.55%～114.12%.Conclusion The method is highly sensitive,reproducible,and can qualify and quantify thirteen toxins at the same time,which is suitable for the rapid detection of PSTs in whole blood samples.

Objective To explore and implement a differentiated management strategy for multi-campus hospitals to improve patient experience and satisfaction,and achieve the goal of homogenized management.Methods In December 2021,the Picker Patient Experience Questionnaire was used to survey the patient experience at 3 campuses of a tertiary A hospital in Hangzhou,and the reasons for the differences were analyzed.Based on policy document reviews,special group discussions,and expert meetings,differentiated management strategy for multi-campus hospitals was formulated.The patient experience and satisfaction before(December 2021)and after(December 2023)the implementation were compared.Results After the application of the one-hospital multi-campus difference management strategy,the overall medical experience score of the patients in the 3 campus was(58.54±2.36)points,which was higher than(58.13±3.24)points before the application(t=-3.223,P=0.001),and there was no statistically significant differences among the patients in the 3 campuses(F=0.781,P=0.458).After the application of the management strategy,the overall satisfaction score of the patients in the 3 campus was(98.44±6.22)points,which was higher than(97.98±6.87)points before the application of the management strategy(t=-2.490,P=0.013),and there was no statistical significance among the patients in the 3 campus(F=1.128,P=0.324).The number of banners and letters of commendation received by the 3 campuses increased from 1 661 before the application to 2 190 after the application,with a growth rate of 31.85％.Conclusion Differentiated management in a multi-campus hospital,aiming at homogenized quality through differentiated strategies,is practicable and can significantly improve the patient experience and satisfaction across different campuses.

Objective This study aims to develop and validate a dynamic web-based nomogram for predicting kinetophobia in patients following percutaneous coronary intervention(PCI).Methods A prospective design was employed to selectively enroll 330 PCI patients admitted to a hospital in Hangzhou from December 2022 to July 2023.Single-factor analysis and Lasso regression were utilized to identify independent risk factors for kinesophobia post-PCI.Logistic regression was performed using R software,and a nomogram was constructed.The model was assessed through the area under the receiver operating characteristic curve(AUC)and Hosmer-Lemeshow tests.Results There were 206 cases of kinesiophobia in 330 patients after PCI,and the incidence was 62.4％.Logistic regression analysis identified combined heart failure,emergency surgery,NYHA cardiac function grade,ADL level,sedentary behavior,Chinese version of PROMIS Physical Function Summary Table score,and Chinese version of Perceptive Social Support Scale score as independent influencing factors for kinesophobia after PCI(P＜0.05).The AUC value of the model was 0.821,with a sensitivity of 70.4％and specificity of 82.0％.The Hosmer-Lemeshow fit test yielded a non-significant result(x2=9.350,P=0.314).Calibration and decision curves demonstrated the model's favorable calibration and clinical practicability.The C-index of the nomogram prediction model was 0.778,0.774,and 0.800,respectively,by 5-fold cross-validation,10-fold cross-validation,and the Bootstrap method.Conclusion The dynamic nomogram model developed in this study effectively predicts kinesophobia in patients after PCI.It provides valuable references and support for clinical staff in early identification of high-risk patients,enabling the formulation of individualized health education strategies and exercise rehabilitation plans.

Objective:To evaluate the immunogenicity and protective effect of a multicomponent recombinant protein vaccine EPRHP014 constructed independently and provide a scientific basis for developing new tuberculosis (TB) vaccine and effective prevention and control of TB.Methods:Three full-length Mycobacterium ( M.) tuberculosis protein antigens (EsxH, Rv2628, and HspX) and two epitope-predicted and optimized epitope-dominant protein antigens (nPPE18 and nPstS1) were selected, from which five protein antigens were used to construct a protein antigen composition EPRHP014, including a fusion expression multi-component protein antigen (EPRHP014f) and a multi-component mixed protein antigen (EPRHP014m) formed with the five single protein using clone, purification, and purification respectively. Multicomponent protein vaccines EPRHP014f and EPRHP014m were prepared with aluminum adjuvant, and the BCG vaccine was used as a control. ELISA detected the titer of serum-specific antibodies, the secretion of various cytokines was detected by ELISpot and Luminex, and immune protection was observed by the M.tuberculosis growth inhibition test in vitro. The results were statistically analyzed by t-test or rank sum test, and P<0.05 was considered a statistically significant difference. Results:Mice Immunized with EPRHP014m and EPRHP014f could produce highly effective IgG antibodies and their subtypes IgG1 and IgG2a, and the antibody titers were similar to those of mice immunized with BCG, with no statistical significance ( P>0.05). The number of spot-forming cells (SFC) secreting IFN-γ and IL-4 induced by EPRHP014f group was significantly higher than those by EPRHP014m group and BCG group ( P<0.05), but there was no significant difference in the number of SFC for IFN-γ and IL-4 induced between EPRHP014m group and BCG group ( P>0.05). The secretion levels of GM-CSF and IL-12p70 induced by the EPRHP014m group were higher than those of the BCG group ( P<0.05), but there was no significant difference in the levels of IL-6 and IL-10 induced between EPRHP014m group and BCG group ( P>0.05). There was no significant difference in the secretions of IL-6, IL-10, IL-12, and GM-CSF between the EPRHP014f and BCG groups ( P>0.05). EPRHP014m group, EPRHP014f group, and BCG group had obvious antibacterial effects in vitro, and the difference was insignificant ( P>0.05). Conclusion:Both EPRHP014f and EPRHP014m can induce strong humoral and cellular immune responses in mice after immunization, and have a strong ability to inhibit the growth of M. tuberculosis in vitro, indicating that the antigen composition EPRHP014 has good potential in the development and application of TB vaccine.