To analyze the factors affecting the cost of hospitalization for patients and provide insights using the intrauterine lesion surgery group (DRG code NE19) as an example.

Influenza imposes a significant disease burden on society and individuals annually, and influenza vaccination is considered a significant public health measure to prevent influenza and reduce influenza-related severe disease and death. The low influenza vaccination rate in China is partly due to certain factors affecting the willingness and behavior of individuals to receive them. Scientific research and targeted interventions on these factors can effectively improve the vaccination situation. Commonly used individual-level theoretical models for influenza vaccination behavior include the health belief model, protection motivation theory, and theory of planned behavior. This study reviews theoretical models commonly employed in researching influenza vaccination willingness and behavior. An overview of these practical applications and challenges models is presented to provide references for relevant research and intervention programs in China.

Objective:To compare the efficacy of ulnar Z-shaped shortening osteotomy combined with arthroscopic deep suture anchor repair of the triangular fibrocartilage complex (TFCC) and ulnar Z-shaped shortening osteotomy alone in the treatment of ulnar impaction syndrome with moderate or severe distal radioulnar joint instability.Methods:A retrospective cohort study was conducted to analyze the clinical data of 30 patients with ulnar impaction syndrome accompanied by moderate or severe distal radioulnar joint instability, who were admitted to Affiliated Hospital of Qingdao University from January 2016 to June 2023, including 16 males and 14 females, aged 27-58 years [(42.4±9.9)years]. All the patients presented with positive ulnar variance and TFCC type IB injury, with the deep layer of TFCC affected. Fifteen patients were treated with Z-shaped shortening osteotomy of the ulna alone (osteotomy alone group), while the other 15 patients received Z-shaped shortening osteotomy of the ulna combined with arthroscopic suture anchor repair of the deep layer of TFCC (osteotomy combined with repair group). The operation time, intraoperative blood loss, and length of ulnar shortening were compared between the two groups. The forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, visual analogue scale (VAS), patient-rated wrist evaluation (PRWE) score, modified Mayo wrist score, and disabilities of the arm, shoulder, and hand (DASH) questionnaire score were assessed preoperatively, at 6 and 12 months postoperatively, and at the last follow-up. The incidence of postoperative complications was recorded.Results:The patients were followed up for 6-24 months [(15.8±4.9)months]. The operation time in the osteotomy combined with repair group was 3.0 (2.3, 3.0)hours, longer than 1.5 (1.3, 2.0)hours in the osteotomy alone group ( P<0.01). There were no significant differences in intraoperative blood loss and the length of ulnar shortening between the two groups ( P>0.05). There were no significant differences in forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, VAS, PRWE score, modified Mayo wrist score, and DASH score between the two groups preoperatively ( P>0.05). At 6 and 12 months postoperatively, and at the last follow-up, the forearm rotation degrees in the osteotomy combined with repair group were (130.3±8.8)°, (135.2±7.9)°, and (141.9±6.9)°, greater than (120.5±9.4)°, (123.7±10.2)°, and (130.9±8.5)° in the osteotomy alone group; the ulnar-radial deviation angles in the osteotomy combined with repair group were 23.0 (23.0, 26.5)°, 33.0 (30.0, 36.0)°, and 36.0 (32.5, 41.5)°, greater than 22.0 (20.0, 23.0)°, 23.0 (23.0, 28.0)°, and 25.0 (23.0, 33.5)° in the osteotomy alone group ( P<0.05 or 0.01). In the osteotomy combined with repair group, the palmar-dorsal flexion angles at 12 months postoperatively and at the last follow-up were (125.8±10.8)° and (132.9±16.8)°, greater than those in the osteotomy alone group [(99.1±15.7)° and (121.2±17.4)°] ( P<0.01), while there was no significant difference in the palmar-dorsal flexion angle between the two groups at 6 months postoperatively ( P>0.05). In the osteotomy combined with repair group, the grip strength at 6 months postoperatively was (14.6±1.0)N, greater than (12.8±1.8)N in the osteotomy alone group ( P<0.05), while there was no significant difference in grip strength between the two groups at 12 months postoperatively and at the last follow-up ( P>0.05). At 6, 12 months postoperatively, and at the last follow-up, the VAS scores in the osteotomy combined with repair group were (4.3±1.9)points, (2.7±1.1)points, and (2.1±0.7)points, lower than (6.5±2.5)points, (4.7±1.4)points, and (4.3±0.9)points in the osteotomy alone group; the PREW scores were (57.6±4.1)points, (47.3±2.4)points, and (35.0±3.4)points, lower than (67.8±4.5)points, (53.1±4.4)points, and (43.5±4.1)points in the osteotomy alone group ( P<0.05 or 0.01). The modified Mayo wrist scores in the osteotomy combined with repair group at 6, 12 months postoperatively, and at the last follow-up were (78.3±2.9)points, (80.1±3.0)points, and (83.5±3.9)points, higher than those in the osteotomy alone group [(69.0±4.3)points, (75.5±2.9)points, (78.8±2.4)points] ( P<0.01). The DASH scores in the osteotomy combined with repair group at 12 months postoperatively and at the last follow-up were (35.8±4.6)points and (28.4±5.4)points, lower than (43.3±5.0)points and (34.2±4.4)points in the osteotomy alone group ( P<0.01), while there was no significant difference in DASH scores between the two groups at 6 months postoperatively ( P>0.05). In both groups, forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, and modified Mayo wrist scores at all time points postoperatively were all higher than the preoperative values ( P<0.05), while the postoperative VAS, PREW, and DASH scores were lower than the preoperative values ( P<0.05), with statistically significant differences among different time points postoperatively ( P<0.01). The incidence of postoperative complications in the osteotomy combined with repair group was 6.7% (1/15), lower than 46.7% (7/15) in the osteotomy alone group ( P<0.05). Conclusion:Compared with the ulnar Z-shaped shortening osteotomy alone, ulnar Z-shaped shortening osteotomy with arthroscopic suture anchor deep repair of TFCC has the advantages of increased wrist range of motion, reduced pain, improved function, and lower incidence of complications, etc in treating ulnar impaction syndrome with moderate or severe instability of the distal radioulnar joint.

Diabetic retinopathy (DR) is the main cause of blindness in diabetic patients. Early diagnosis and intervention are essential to improve the quality of life of patients with DR. Choroidal vascularity index (CVI) is the ratio of choroidal luminal area to total area, which can reflect the structure and blood flow of the choroid, and has been used to evaluate the choroidal condition in various eye diseases. CVI has shown great potential in the prediction, early intervention, disease assessment, and prognosis of DR. The relationship between CVI and photoreceptors needs more research, and CVI may be used as a predictive indicator of photoreceptor health and visual prognosis. In addition, the study of CVI at different layers of the choroid is limited by the accuracy of stratification and the repeatability of measurement. Artificial intelligence and other technologies may provide solutions for this. In the future, through more comprehensive study and the help of artificial intelligence, the value of CVI will be further enriched, which is of great significance for the elucidation of the pathogenesis of DR and serving the clinic.

Objective:To analyze the epidemiological characteristics of indigenous 2019-nCoV infection in population under 18 years old in 31 provinces of China, and provide evidence for the prevention and control of COVID-19.Method:Demographic and epidemiologic information of children and adolescents with 2019-nCoV infection reported in China between April 29, 2020 and May 31, 2022 were collected from China's Disease Prevention and Control Information System. We analyzed the epidemiological characteristics of the 2019-nCoV infection in children and adolescents and compared the epidemiological characteristics of the cases at different epidemic stages.Result:A total of 63 916 indigenous 2019-nCoV infection cases in children and adolescents were reported in China from April 29, 2020 to May 31, 2022, in which 14 777 (23.12%) were confirmed cases and 49 139 (76.88%) were asymptomatic cases. An obvious incidence peak (40 864 cases) was observed in April, 2022, and two sub-peaks were observed in January, 2020 and January, 2021, respectively. The 2019-nCoV infection cases occurred in 187 cities above prefecture level in 30 provinces, the cases reported in Shanghai (41 562 cases), Changchun (5 753 cases) and Jilin (3 888 cases) accounted for 80.11% of the total cases (51 203/63 916). The proportion of the cases in males was 54.34%. The age of the cases, M ( Q1, Q3) was 10 (5, 14) years, and 57.73% of the cases were 6 - 15 years old. The cases in students accounted for the highest proportion (56.14%). The interval between illness onset and diagnosis of confirmed cases, M ( Q1, Q3) was 1 (0, 2) days. Among the 2019-nCoV infection cases in children and adolescents, 76.88% were asymptomatic, 21.78% were mild ones, 1.32% were moderately severe ones, 0.02% were severe ones, and there were no critical cases and deaths. Compared with other age groups, the proportion of severe or critical cases was higher in children aged <1 year (0.12%). The proportion of asymptomatic infections was highest in Omicron variant epidemic (78.43%). Conclusion:The 2019-nCoV infection cases in children and adolescents aged <18 years in 31 provinces in China were mainly primary and secondary school students aged 6-15 years. Most cases were asymptomatic and mild ones with low clinical severity. It is still necessary to strengthen the surveillance for 2019-nCoV infection in children and adolescents to improve the prevention and control of COVID-19 in school age children.

To report a typical case of Morvan syndrome with positive anti-leucine rich glioma-inactivated 1(LGI1) and contactin-associated protein 2 (CASPR2) antibodies in serum and cerebrospinal fluid. A 39-years-old female initially presented weakness of extremeties. The main symptoms included paroxysmal limb pain, wheezing, itching, muscle twitching, epilepsy, hypomnesia, dysphoria, apathy, intractable insomnia, salivation and sweating. Tests of electrolytes found hypokalemia (2.7-3.1 mmol/L) and hyponatremia (130-136 mmol/L). Arterial blood gas analysis showed hypoxemia (oxygen saturation 50%-70%). Total thyroxine (TT4) was elevated to 207 nmol/L with positive thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (TG-Ab). LGI1and CASPR2 antibodies (CBA method) were positive in both serum and cerebrospinal fluid, and the remaining antibodies related to autoimmune encephalitis and paraneoplastic syndrome were negative. Head MRI was almost normal, while mild abnormalities were found in electroencephalogram. Electromyography showed slightly increased voltage of left quadriceps motor unit potential. After treated with corticosteroids, IVIG and mycophenolate mofetil, the patient completely improved. Cognitive function scores recovered from MoCA/MMSE (16/24) to MoCA/MMSE (26/29). Positivity of LGI1/CASPR2 antibodies both in serum/cerebrospinal fluid are rarely seen in patients with Morvan syndrome. Steroids and immunosuppressants are suggested for treatment as early as possible.

There is a certain relationship between chemotherapy and stroke in cancer patients. Its mechanism may be associated with the increase of the prevalence of traditional vascular factors, the promotion of coagulation dysfunction, the induction of anemia, the impairment of cardiac function, and vascular inflammation. The pathophysiological mechanism of chemotherapy-associated stroke is still in the exploratory stage. This article reviews the pathophysiological mechanism, monitoring indicators, and diagnosis and treatment progress of stroke in cancer patients during chemotherapy.

COVID-19 ; Coronavirus Nucleocapsid Proteins ; Humans ; Nucleocapsid Proteins ; Phosphoproteins ; SARS-CoV-2

Domestic and foreign literatures related to the persistence of SARS-CoV-2 and the re-positive cases infected with SARS-CoV-2 were reviewed, and the characteristics and infectivity of the re-positive cases were analyzed to provide scientific evidence for the improvement of case management and the development of measures to stop the spread of SARS-CoV-2. Existing studies have shown that re-positive rate of SARS-CoV-2 ranged from 2.4% to 19.8%, the median of interval between re-positive detection and discharge was 4-15 days. Following the second course of the disease, the anti-SARS-CoV-2 IgM, IgG and IgA positive rates of the cases were 11.11%-86.08%, 52.00%-100.00% and 61.54%-100.00% respectively, the total antibody and neutralizing antibody positive rates were 98.72% and 88.46%. The viral load of the re-positive cases was lower than that in the initial infection. At least 3 380 re-positive cases have been reported globally. SARS-CoV-2 strains were isolated from the samples of 3 re-positive cases (1 immunodeficiency case and 2 cases with abnormal pulmonary imaging). There were close contacts that were infected by an asymptomatic case taking immunosuppressive agents. In conclusion, the infectivity of re-positive cases infected with SARS-CoV-2 is generally very low. Rare re-positive cases infected with SARS-CoV-2 might cause further transmission. The management approach for the re-positive cases can be based on the assessment of the individual transmission risk according to the pathogen detection results.
Antibodies, Neutralizing ; Antibodies, Viral ; COVID-19 ; Humans ; Immunoglobulin M ; SARS-CoV-2

COVID-19 is an emerging infectious disease caused by SARS-CoV-2. After the infection of the virus, the host immune system is stimulated to produce multifarious specific antibodies to decrease or eliminate effects of the pathogen. Study of the specific antibodies dynamic characteristics in patients with COVID-19 is very important for the understanding and diagnosis of the disease, research and development of vaccine, and planning of prevention and control strategy. This paper reviews and summarizes the domestic and oversea research on dynamic characteristics of specific antibodies of COVID-19 patients, including the antibody producing, duration and level, and its possible influencing factors in order to improve the understanding of the immunological characteristics of COVID-19.