OBJECTIVE To re-evaluate the use of systematic evaluation/meta-analysis of anti-VEGF drugs in the treatment of diabetic macular oedema （DME）， aiming to provide evidence-based support for the clinical application of this medication. METHODS A comprehensive search was conducted across a range of databases， including CNKI， Wanfang data， VIP， CBM， PubMed， Web of Science， Embase， and Cochrane Library. The objective was to identify systematic evaluation/meta-analysis of anti- VEGF drugs for DME， with search time from the inception of the databases to March 2024. The report quality， methodological quality， and evidence quality were assessed by using PRISMA2020 statement， AMSTAR2 scale and GRADE tool. A comprehensive analysis of systematic evaluation/meta-analysis results was also conducted. RESULTS A total of 22 articles were included. According to the PRISMA2020 statement evaluation， 13 studies provided relatively complete information （≥21 points）， while 9 studies had information deficiencies （18-＜21 points）. The AMSTAR 2 scale evaluation revealed that 21 studies had very low methodological quality， and one study had low methodological quality. The GRADE tool evaluation showed that out of 89 outcome indicators， 28（ 31.46%） were classified as high-quality evidence， 34（ 38.20%） as moderate-quality evidence， 24（ 26.97%） as low- quality evidence， and 3 （3.37%） as very low-quality evidence. The comprehensive quality analysis results demonstrated that， compared with laser photocoagulation， anti-VEGF drugs significantly enhanced the improvement in best-corrected visual acuity （BCVA）， as well as significant change in retinal thickness at 1 and 6 months， and 1 and 2 years post-treatment， and also in BCVA and retinal thickness at 1， 3， and 6 months post-treatment （P＜0.05）. Compared with placebo， patients treated with anti-VEGF drugs showed significant improvement in BCVA after 1 year of treatment （P＜0.05）. However， when compared with corticosteroid drugs， patients treated with anti-VEGF drugs exhibited a significant increase in retinal thickness after 6 months of treatment （P＜0.05）. Compared with corticosteroid drugs， the incidence of adverse events related to the eyes， cataract formation and intraocular pressure were significantly decreased in patients treated with anti-VEGF drugs （P＜0.05）. Compared with laser photocoagulation， the incidence of ocular adverse events was significantly decreased in patients treated with anti-VEGF drugs， while the incidence of fatal adverse events was significantly increased （P＜0.05）. CONCLUSIONS Anti-VEGF therapy for DME may possess certain advantages in terms of efficacy and safety， but it is associated with a higher risk of fatal adverse events； the evidence included in systematic reviews/meta-analyses is of moderate to high quality.

Objective To investigate the prevalence of work-related musculoskeletal disorders (WMSDs) in passenger drivers and its influencing factors. Methods A total of 951 passenger drivers in Guangdong Province were selected as the research subjects using the judgmental sampling method. A Musculoskeletal Injury Questionnaire was employed to assess the prevalence of WMSDs in the past year. Results The prevalence of WMSDs in passenger drivers was 41.11%. The result of multivariable logistic regression analysis showed that married drivers had a higher risk of WMSDs than single drivers (P<0.05). The lower the frequency of physical exercise, the longer the driving time per week, the longer the continuous driving time, the more restricted the driving working space, the poorer the foot comfort during driving, and the more affected the normal meal, the higher the risk of WMSDs (all P<0.05). The risk of WMSDs in drivers with sleep time ≤ 8.0 h/d was higher than that in drivers with sleep time > 8.0 h/d (P<0.01), and the risk of WMSDs in drivers with the same posture for a long time on the shoulder was higher than that in drivers without this poor working posture (P<0.01). Conclusion WMSDs were prevalent among passenger drivers, which was associated with demographic and adverse ergonomic factors. Intervention on lifestyle and adverse ergonomic factors could further reduce the risk of WMSDs of passenger drivers.

Background Pesticides like organophosphorus and pyrethroids are extensively utilized, and associated potential human health risks arising from multi-route exposure, including environmental sources and dietary intake, cannot be overlooked. Conducting human exposure studies using pesticide exposure biomarkers is essential for an objective evaluation of human pesticide exposure levels. Objective To develop a rapid and precise liquid chromatography-tandem mass spectrometry method for the detection of 12 pesticide metabolites in urine, including 5 metabolites of organophosphorus pesticide, 4 metabolites of pyrethroid pesticide, 2 metabolites of herbicides, and 1 metabolite of insecticide. Methods After overnight enzymatic hydrolysis, urine samples were subjected to extraction and purification using Oasis HLB 96-well solid-phase extraction. Subsequently, the samples were analyzed by liquid chromatography-tandem mass spectrometry and quantified using the isotope internal standard method. The developed method was employed to analyze 143 urine samples from a general population to assess its effectiveness and to evaluate pesticide exposure levels. Results All 12 target compounds exhibited good linear ranges, with their correlation coefficients of calibration curves exceeding 0.999. The limits of detection (LOD) ranged from 0.02 to 0.19 μg·L⁻¹, while the limits of quantitation (LOQ) ranged from 0.06 to 0.27 μg·L⁻¹. The recoveries at three spiked levels ranged from 84% to 112%, and the inter- and intra- day precisions of targeted analystes were 0.43%-9.6% and 1.6%-9.7% respectively. Using this method, 143 urine samples from residents in Jiangsu region were analyzed, and 11 pesticides were detected except N,N-diethyl-m-toluamide (DEET). Conclusion The established method of solid-phase extraction combined with liquid chromatography-tandem mass spectrometry has the characteristics of low detection limit, good repeatability, and high throughput, which is suitable for quantitative detection of selected 12 pesticides in large batches of human urine samples, and provides technical support for pesticide internal exposure monitoring and health risk assessment.

Objective:To explore the application effect of a multidisciplinary collaborative model led by stomatognathic therapists, utilizing a combination of platelet-rich plasma (PRP) and moist wound dressings in the comprehensive treatment of postoperative chronic wounds, and to provide references and guidance for improving the clinical practice and management level of patients with chronic wounds.Methods:This was a prospective randomized controlled trial. Eighty-eight patients with postoperative non-healing chronic wounds who visited the Chronic Wound Care Clinic of the Third Affiliated Hospital of Guangzhou Medical University from October 2018 to February 2023 were conveniently sampled. They were randomly divided into two groups using a coin toss method: the control group ( n = 41) received standard moist wound dressing therapy, while the experimental group ( n = 47) received comprehensive treatment based on PRP combined with moist wound dressings. This treatment, led by enterostoml therpist, involved the innovative nursing technique of simultaneous injection of PRP and coagulant mixture via a three-way connector and covering with ultra-thin foam dressing. The Pressure Ulcer Scale for Healing (PUSH) score, wound area healing index (WSHI), pain level during dressing change, wound healing time, and treatment satisfaction rate were observed in both groups. Results:Among 88 cases, there were 25 females and 16 males in the control group, aged 58.00 (37.00 ± 79.00) years old. There were 31 females and 16 males in the experimental group, aged 57.00 (35.00 ± 72.00) years old. The median PUSH scores of the experimental group on the 7th, 14th, and 21th day after wound treatment were 11.00, 9.00, and 7.00, respectively, which were better than those of the control group, which were 13.00, 11.00, and 9.00. The median WSHI scores were 0.35, 0.58, and 0.84 for the experimental group, respectively, which were better than those of the control group, which were 0.09, 0.30, and 0.50. The differences between the two groups were statistically significant ( Z values ranged from 4.08 to 8.20, all P<0.01). On the 7th, 14th, and 21st day of treatment, the pain scores of the experimental group were 3.00 (2.00,3.00), 2.00 (1.00, 2.00), 0.00 (0.00,1.00) points, respectively, which were lower than the 3.00 (3.00,3.50), 2.00 (2.00,3.00), and 2.00 (1.00, 2.00) points of the control group, and the differences were statistically significant ( Z values were 2.16, 3.38, 6.14, all P<0.05). The healing time in the experimental group was (37.04 ± 25.33) days, which was shorter than that in the control group, (52.88 ± 36.58) days, and the difference was statistically significant ( t = 5.53, P<0.05). The satisfaction rate in the experimental group was 97.87% (46/47), significantly higher than 87.80% (36/41) in the control group ( χ2 = 3.13, P<0.05). Conclusions:Under the leadership of stomatognathic therapists, the multidisciplinary collaborative model, employing comprehensive treatment techniques centered around PRP combined with moist wound dressings, demonstrated significant therapeutic efficacy for postoperative chronic wounds including shortening healing time, accelerating healing speed, reducing wound pain, and improving patient satisfaction, indicating high clinical application value and social benefits.

An improved U-Net model(channel attention module U-Net,CAMU-Net)is proposed to achieve precise segmentation of retinal vessels.CAMU-Net model enhances its understanding of regional features by employing residual enhancement convolution to extract important information from the regions,improves the global feature acquisition capability by introducing feature refinement module to promote feature extraction,realizes precise segmentation by adding channel attention module to capture image features accurately,and enhances its capability to perceive target boundaries and details through a multi-scale feature fusion structure.The ablation study on the DRIVE dataset validates the role of each module in retinal vessel segmentation.The comparison with other mainstream network models on DRIVE and STARE datasets verify that CAMU-Net model is superior to other models.

Objective : To analyze the epidemiological characteristics and pathogen spectrum of hand，foot mouth disease (HFMD) in Anhui province from 2015 to 2022，and to provide scientific evidence for prevention and control measures of HFMD． Methods : The surveillance data of hand，foot and mouth disease in Anhui province from 2015 to 2022 were analyzed by descriptive epidemiology. Real-time PCR was used to detect and classify HFMD samples. Results : A total of 650 590 HFMD cases were reported in Anhui province from 2015 to 2022，including 1 406 se- vere cases and 17 deaths．The annual reported incidence was 131. 45 /100 000．The epidemic features of“low incidence in odd years and high incidence in even years”were presented from 2015 to 2019．The incidence showed a continuous decline from 2020 to 2022．The monthly distribution showed the characteristics of bimodal epidemic，and the main peak was not obvious in 2020．Hefei，Fuyang，Bozhou，Chuzhou and Suzhou ranked the top five cities in terms of cumulative incidence．The age of onset was mainly distributed in children aged 5 years and below，accounting for 89. 26% of the total cases．The male to female ratio was 1. 48 ∶ 1．A total of 28 657 laboratory-confirmed cases had been reported from 2015 to 2022．EV71 cases accounted for 10. 57% ，Cox A16 cases accounted for 24. 90% ，and other enterovirus cases accounted for 64. 53%．The dominant pathogens showed dynamic changes in different years．Since 2018，the proportion of EV71 decreased significantly，and the proportion of other enteroviruses gradually increased to become the dominant pathogens．Among other enteroviruses，Cox A6 strain was dominant (80. 48% ) ． Conclusion This study suggests that the prevention and control of HFMD in Anhui province should be paid more attention from April to July and from October to December．The focus areas are the cities in northern Anhui and Hefei where the floating population is large．The focus of prevention and control is on children aged 5 years and below．Other enteroviruses have become the dominant pathogens of hand-foot-mouth disease in Anhui province，Cox A6 strain is dominant.

Objective:To explore the effects of intense pulsed light and carbon dioxide fractional laser sequential treatment of early hypertrophic scar after deep burn.Methods:A retrospective cohort study was used. The patients with early hypertrophic scar after deep burn who were admitted to the First People’s Hospital of Zhengzhou from May 2019 to January 2021 and met the inclusion criteria were selected as the study subjects. All patients began to receive sequential laser treatment 4-8 weeks after complete healing of wounds. The treatment method was selected according to the Vancouver scar scale (VSS) score before each treatment. If the blood vessel distribution ≥ 2 points and the thickness<2 points, they were treated with intense pulsed light. If the blood vessel distribution ≥2 points and the thickness ≥ 2 points, they were treated with intense pulsed light combined with carbon dioxide laser. If the blood vessel distribution <2 points and the thickness ≥ 2 points, they were treated with carbon dioxide laser. If the blood vessel distribution < 2 points and the thickness < 2 points, the treatment was ended. Intense pulsed light therapy was performed once a month, and carbon dioxide laser therapy was performed once every 3 months. Before and after treatment, patients were evaluated with VSS, observer scar assessment scale (OSAS) and patient scar assessment scale (PSAS), while higher scores indicated more severe scars. The number of intense pulsed light and carbon dioxide laser treatment during the treatment period, the time of scar formation and the occurrence of complications at the end of the treatment were recorded. SPSS 22.0 software was used for statistical analysis. Measurement data were expressed as Mean±SD, and paired sample t-test was used to compare patients before and after treatment. Results:A total of 28 patients were included, including 16 males and 12 females, aged 12-54 years. After the sequential treatment, the VSS scores of color, thickness, vascular distribution, softness and total score were significantly lower than those before the treatment ( t=15.00, 11.90, 15.59, 9.46, 39.24, P<0.001); OSAS scores of vascular distribution, color, thickness, roughness, softness, surface area, overall evaluation and total score were significantly lower than those before treatment ( t=14.89, 10.82, 9.54, 7.23, 16.97, 8.60, 16.42, 25.08, P<0.001); PSAS scores of pain, itching, color, hardness, thickness, irregularity, overall evaluation and total score were significantly lower than those before treatment ( t=26.40, 24.53, 16.54, 12.18, 12.25, 21.04, 22.00, 29.38, P<0.001). During the treatment, the patients were treated with intense pulsed light for (4.00±1.22) times (2-6 times), carbon dioxide laser for (2.54±1.00) times (0-5 times). At the end of the treatment, the scar formation time was (13.82±2.98) months (8-20 months). Complications occurred in 5 cases during treatment and follow-up, including 4 cases of skin blisters and 1 case of infection. No immediate skin lesions, pigmentation, depigmentation, scar aggravation and other adverse reactions occurred. Conclusion:The combination of sequential therapy of intense pulsed light and carbon dioxide laser can significantly improve the appearance and texture of early hypertrophic scar after deep burn, which has good safety.

Objective:To understand the status quo of social alienation in young adults undergoing radioactive iodine (RAI) therapy for papillary thyroid carcinoma (PTC) , analyze its influencing factors, and provide references for the formulation of clinical nursing interventions.Methods:Totally 206 young adults with PTC who underwent RAI therapy at the First Affiliated Hospital of Zhengzhou University from January 2021 to May 2022 were selected by convenience sampling. These patients were surveyed using a general information questionnaire, General Alienation Scale (GAS) , Social Support Rating Scale (SSRS) , and Hospital Anxiety and Depression Scale (HADS) . Multiple linear regression analysis was utilized to analyze the influencing factors of social alienation in young adults undergoing RAI therapy for PTC.Results:The score of social alienation in the young adults undergoing RAI therapy for PTC was (39.39±4.93) . Univariate analysis results indicated that there was a statistically significant difference in the scores of social alienation among the young PTC patients with different marital statuses, levels of disease awareness, employment statuses, family per capita monthly incomes, and tumor stages ( P<0.05) . Multiple linear regression analysis revealed that the influencing factors of social alienation included the level of disease awareness, family per capita monthly income, tumor staging, social support score, and anxiety and depression score ( P<0.05) . Conclusions:The overall level of social alienation in young adults undergoing RAI therapy for PTC is moderate. Healthcare providers should timely assess and adopt targeted intervention measures to enhance patients' sense of social participation.

Objective:To explore the effects of intense pulsed light and carbon dioxide fractional laser sequential treatment of early hypertrophic scar after deep burn.Methods:A retrospective cohort study was used. The patients with early hypertrophic scar after deep burn who were admitted to the First People’s Hospital of Zhengzhou from May 2019 to January 2021 and met the inclusion criteria were selected as the study subjects. All patients began to receive sequential laser treatment 4-8 weeks after complete healing of wounds. The treatment method was selected according to the Vancouver scar scale (VSS) score before each treatment. If the blood vessel distribution ≥ 2 points and the thickness<2 points, they were treated with intense pulsed light. If the blood vessel distribution ≥2 points and the thickness ≥ 2 points, they were treated with intense pulsed light combined with carbon dioxide laser. If the blood vessel distribution <2 points and the thickness ≥ 2 points, they were treated with carbon dioxide laser. If the blood vessel distribution < 2 points and the thickness < 2 points, the treatment was ended. Intense pulsed light therapy was performed once a month, and carbon dioxide laser therapy was performed once every 3 months. Before and after treatment, patients were evaluated with VSS, observer scar assessment scale (OSAS) and patient scar assessment scale (PSAS), while higher scores indicated more severe scars. The number of intense pulsed light and carbon dioxide laser treatment during the treatment period, the time of scar formation and the occurrence of complications at the end of the treatment were recorded. SPSS 22.0 software was used for statistical analysis. Measurement data were expressed as Mean±SD, and paired sample t-test was used to compare patients before and after treatment. Results:A total of 28 patients were included, including 16 males and 12 females, aged 12-54 years. After the sequential treatment, the VSS scores of color, thickness, vascular distribution, softness and total score were significantly lower than those before the treatment ( t=15.00, 11.90, 15.59, 9.46, 39.24, P<0.001); OSAS scores of vascular distribution, color, thickness, roughness, softness, surface area, overall evaluation and total score were significantly lower than those before treatment ( t=14.89, 10.82, 9.54, 7.23, 16.97, 8.60, 16.42, 25.08, P<0.001); PSAS scores of pain, itching, color, hardness, thickness, irregularity, overall evaluation and total score were significantly lower than those before treatment ( t=26.40, 24.53, 16.54, 12.18, 12.25, 21.04, 22.00, 29.38, P<0.001). During the treatment, the patients were treated with intense pulsed light for (4.00±1.22) times (2-6 times), carbon dioxide laser for (2.54±1.00) times (0-5 times). At the end of the treatment, the scar formation time was (13.82±2.98) months (8-20 months). Complications occurred in 5 cases during treatment and follow-up, including 4 cases of skin blisters and 1 case of infection. No immediate skin lesions, pigmentation, depigmentation, scar aggravation and other adverse reactions occurred. Conclusion:The combination of sequential therapy of intense pulsed light and carbon dioxide laser can significantly improve the appearance and texture of early hypertrophic scar after deep burn, which has good safety.

Objective:To investigate the effect of gene polymorphism of β1 adrenergic receptor (β1-AR) G1165C and A145G locus on myocardial hypertrophy and the efficacy in patients with hypertension.Methods:Two hundred and twenty-seven cases of patients with hypertension admitted to Binhai County People′s Hospital from January to December 2019 were enrolled. Among them, there were 113 cases of hypertension with myocardial hypertrophy and 114 cases of hypertension without myocardial hypertrophy. In addition, 115 patients with normal physical examination during the same period were selected as the control group. DNA in the peripheral blood leukocytes was extracted, polymerase chain reaction-restriction fragment length polymorphism method was used to detect β1-AR G1165C and A145G locus gene polymorphism, and the differences in the efficacy of β blockers in hypertensive patients with different genotypes were compared.Results:There was no statistically significant differences in the distribution of β1-AR A145G genotypes among the three groups ( P>0.05). Compared with the healthy control group, the frequency of Gly/Gly genotype carrying β1-AR G1165C locus was higher in hypertension with myocardial hypertrophy group, and the frequency of Gly/Arg and Arg/Arg gene were lower; compared with hypertension without myocardial hypertrophy group, the frequency of Gly/Arg+Gly/Gly gene in hypertension with myocardial hypertrophy group was higher; taking Arg/Arg genotype as the control group, carrying Gly/Gly genotype could increase the risk of cardiac hypertrophy in hypertensive patients by 3.159 times ( OR = 3.159, 95% CI 1.240 - 7.412, P<0.05).The frequency of G1165C allele Arg in the hypertension with myocardial hypertrophy group was significantly lower than that in the control group and the hypertension without myocardial hypertrophy group ( P<0.05); the frequency of G1165C allele Gly was significantly higher than that in the control group and the hypertension without myocardial hypertrophy group ( P<0.05); taking Arg/Arg genotype as the control, carrying Gly/Gly genotype could increase the risk of cardiac hypertrophy in hypertensive ( OR = 3.417, 95% CI 1.357 - 7.965, P<0.05). The left ventricular mass index of Gly/Gly genotype patients was (120.38 ± 28.41) g/m 2, which was significantly higher than (99.76 ± 25.16) g/m 2 and (90.30 ± 19.54) g/m 2 of Gly/Arg and Arg/Arg, with statistically significant differences ( F = 10.89, P<0.01). After the treatment, the resting heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure of patients with G1165C allele Arg hypertension with myocardial hypertrophy were lower than those with G1165C allele Gly, with statistically significant differences ( P<0.05). Conclusions:β1-AR G1165C gene polymorphism is related to the risk of myocardial hypertrophy in hypertensive patients. Carrying the G1165C allele Gly may increase the risk of susceptibility to cardiac hypertrophy, and β-blockers are more effective in hypertensive patients with myocardial hypertrophy who carry the G1165C allele Arg.