This study analyzed the epidemic characteristics and spatial and temporal clustering of leptospirosis in Wenzhou from 2014 to 2023,to provide a scientific basis for prevention and control.Data for leptospirosis cases reported in Wenzhou from 2014 to 2023 were collected.Descriptive epidemiological approaches were used to analyze the cases'prevalence character-istics.Spatial autocorrelation analysis was performed in ArcGIS 10.2 software,and spatiotemporal clusters were scanned with SaTScan 10.1 software.From 2014 to 2023,189 leptospirosis cases were reported in Wenzhou,and the average annual inci-dence rate was 0.23/100 000.Relatively fewer cases occurred in 2014-2018,whereas significantly more cases occurred after 2019,and the largest number of reported cases was reported in 2021(62 cases).The peak incidence was from August to Octo-ber,accounting for 88.36％of the total incidence.The cases were mainly in males,and the sex ratio was 5.30∶1 male:female.Moreover,the cases were mainly in people in their 60s,accounting for 59.26％of total cases,and in people who were farmers,accounting for 72.49％of total cases.Global spatial autocorrelation analysis indicated that cases were randomly distributed from 2014 to 2018,and the incidence showed spatial clustering from 2019 to 2023(Moran's I＞0,P＜0.05).Local spatial autocor-relation and spatiotemporal scanning analysis revealed that leptospirosis cases were concentrated primarily in northern hilly areas of Yongjia County and other inland areas rich in vegetation from 2019 to 2023.In the past 5 years,the number of lepto-spirosis cases in Wenzhou increased,and the incidence of leptospirosis showed clear seasonal and spatial clustering.Cases were mainly in middle-aged and older farmers.Recommendations in-clude expanding the monitoring scope of leptospirosis,and per-forming prevention and control measures such as health education for key groups in key areas before the high-incidence season.

OBJECTIVE: To analyze the intellectual landscape and emerging research trends of Chinese medicine (CM) in the management of pediatric asthma through a scientometric study. METHODS: Publications related to CM in the management of pediatric asthma were retrieved from the Web of Science Core Collection using relevant keywords. A scientometric study was performed using CiteSpace and VOSviewer. RESULTS: A total of 1,673 original articles and reviews from 1991 to 2019 were included in the analysis. The amount of annual publications had a gradual increase with time. USA was the major contributor both in country and institution analyses. Based on the co-citation, the published journals were grouped into 4 clusters. Keyword analysis indicated that the main hotspots were: (1) comprehensive management; (2) risk factors, mechanism, and prevalence; (3) prevention and treatment; (4) inflammation; and (5) environmental research. Lastly, we predicted that three emerging trends were quality of life promotion, immune response, and combination therapy. CONCLUSIONS CM research in the management of pediatric asthma will maintain the current trend of steady growth. This scientometric analysis may help scientists to identify the areas of interests and future directions in the field.
Asthma/drug therapy* ; Bibliometrics ; Child ; Humans ; Medicine, Chinese Traditional ; Publications ; Quality of Life

In February, 2019, a patient with a defect of open dorsal cartilage and bone in the first metatarsal head, including the defects of soft tissue, tendon and joint capsule, was treated in our department. After multiple debridement, the vascularised medial femoral condyle osteochondral chimeric tissue flap was transferred to repair the composite tissue defect in the metatarsal head at the second stage. After 18 months of follow-up, the patient felt no pain in the foot and walking, and there was no sign of lameness and discomfort at donor sites. The postoperative functional recovery was satisfactory.

In recent years， with the change in life style， social environment， and national childbearing policy， the proportion of high-risk pregnant women has increased significantly， triggering the spectrum of obstetric diseases to constantly change， which has brought new challenges to the diagnosis and treatment of obstetrics. Traditional Chinese medicine （TCM） has been proved effective in dealing with a variety of obstetric diseases， and various treatment methods are available， which can serve as alternative means for solving refractory obstetric diseases. However， most obstetric clinicians are currently less aware of the therapeutic effects of TCM， which has significantly hindered its participation in clinical treatment. Therefore， the China Association of Chinese Medicine （CACM） organized the outstanding young obstetricians of TCM and western medicine to discuss 15 obstetric diseases responding specifically to TCM or integrated TCM and western medicine， including hyperemesis gravidarum， threatened abortion， ectopic gestation， cough during pregnancy， pregnancy-induced hypertension syndrome， maternal-fetal ABO incompatibility， postpartum hypogalactia， residual pregnancy tissue in uterine cavity， puerperal infection， pantalgia after childbirth， hematoma/undesirable healing after caesarean section， postpartum urinary retention， ileus after cesarean section， pelvic floor dysfunction， and postnatal depression. The suggestions for their treatment with TCM or integrated TCM and western medicine were also proposed， aiming to provide patients with effective and personalized treatments in clinical practice and improve the diagnosis and treatment effects of obstetric diseases， thus benefiting the public. At the same time， more obstetrical clinicians are expected to understand the therapeutic effects and advantages of TCM and draw on the strengths of both TCM and western， thereby promoting the establishment of an obstetric diagnosis and treatment system with Chinese characteristics.

This research aimed at the key issue that chemical drugs and Chinese medicine hydrophilic small molecule anti-tumor drugs were difficult to break through the dense interstitial permeability barrier of pancreatic cancer to achieve the key problem of drug efficacy in the deep part of tumor tissue. To solve this problem, the lipophilic molecule squalene (SQ) and the hydrophilic anti-tumor drug chidamide (CHI) were linked by a trypsin responsive bond to form a prodrug (SQ-CHI) and a folic acid modified prodrug self-assembled nanoparticles (FA-SQ-CHI NPs) were further developed. The feature of prodrug molecules and nanoparticles were characterized. The in vitro release characteristics and cytotoxicity of blank vector were investigated. The efficacy and permeability of the prodrug nanoparticles in the PSN-1 monolayer cell and PSN-1/HSPC co-cultured tumor spheroids model was evaluated. The results showed that SQ-CHI prodrug molecules and FA-SQ-CHI NPs were successfully developed. The nanoparticles were regular spherical, well-dispersed, with a particle size of (173.3 ± 1.5) nm, a drug load of (59.02 ± 0.8) % and showed trypsin responsive release ability. The prodrug nanoparticles can significantly enhance the penetration and anti-proliferation effects of CHI in the PSN-1/HSPC tumor spheroids. In conclusion, the construction of folic acid-modified SQ-CHI prodrug self-assembled nanoparticles can significantly enhance the penetration of CHI in the pancreatic cancer microenvironment in vitro. This research would provide a new idea for the construction of targeted drug delivery system for chemical drugs and Chinese medicine hydrophilic small molecule drugs in the application of anti-pancreatic cancer.

Objective The nursing treatment ability scale of patients with nuclear radiation damagein the hospital was developed to provide an evaluation basis for improving the nursing ability of nurses with nuclear radiation damage. Methods The scale was prepared by literature review, expert interview and expert consultation, and a total of 330 clinical nurses from a third-class hospital was randomly selected as the research objects. The scales were issued for item analysis and reliability and validity test. Results The scales were divided into 6 dimensions, including basic knowledge of nuclear radiation damage, specialized equipment use ability, specialized ward management ability, basic nursing ability, specialized nursing ability and self-ability recognition, with 51 items. After exploratory factor analysis, there were 6 principal components, and the cumulative interpreted variance was 70.757%. The χ², df, χ²/df, CFI, IFI, TLI, NFI, PNFI, PCFI, RMSEA fitting indexes of confirmatory factor analysis were all acceptable. Cronbach's α coefficient was 0.976, the retest reliability was 0.823, and the S-CVI (S-CVI/UA) was 0.84. The evaluation content validityS-CVI (S-CVI/AVE) was 0.98, and the content validity I-CVI of the item level was 0.78～1.00. Conclusion The items and dimension Settings of this scale have been tested, and all indicators met the requirements. The reliability and validity test results were good. It can be used as a scale for preliminary evaluation of hospital nursing ability of patients with nuclear radiation damage.

Objective Through determination of selenium content in liver and urine of selenium-induced mice, direct sampling atomic fluorescence spectrometry was established to provide a more accurate and convenient determination method for detection of selenium-related biological samples. Methods Selenium in the sample was released by the electrically heated quartz tube,the selenium in the atomic state was captured by the quartz tube,and the selenium released by the heating quartz tube was carried by the argon-hydrogen mixed gas into the argon-argon flame atomic fluorescence detector for determination; standard curve was established based on selenium content and fluorescence area, and then the content of selenium in the sample was calculated. Results The detection limit of selenium in samples by direct sampling atomic fluorescence spectrometry was 0.28 μg/kg, the correlation coefficient of standard curve was 0.999 3, and the relative standard deviation range was 1.82% - 4.19%. The adding standard recovery of the liver in mice was 87.30%- 100.20%; meanwhile the adding standard recovery of the urine in mice was 93.10% - 96.60%. Conclusions Direct sampling atomic fluorescence method is simple and easy to operate, accuracy and precision are better, the linear range is wide. The samples need not be processed by complex pretreatment,such as acid,etc.,elements loss is avoided and efficiency of detection is improved.The method can be used in a variety of samples for rapid detection of trace selenium.

Objective To investigate the clinical significance and difference in the expression of endostatin and vascular endothelial growth factor (VEGF) in non-small cell lung cancer (NSCLC) patients with different response to recombinant human endostatin (rh-endostatin) combined with chemotherapy.Methods Serum levels of endostatin and VEGF in peripheral blood of 30 patients with stage Ⅳ NSCLC (NSCLC group) and 30 healthy controls (control group) were determined by enzyme-linked immunosorbent assay.Two cycles of chemotherapy combined with rh-endostatin were provided to NSCLC patients to evaluate the efficacy of the regimen.Simultaneously,serum levels of endostatin and VEGF were measured before and after treatment.Results The level of serum endostatin was (37.96 ± 9.01) ng/ml and (40.12 ± 12.11)ng/ml in NSCLC patients and healthy controls,respectively,which was lower in the former than that of the latter,without statistical difference (P ＞ 0.05).Furthermore,the level of serum VEGF was (127.98 ± 33.88) pg/ml and (36.33 ± 15.43) pg/ml in NSCLC patients and healthy controls,respectively,which was higher in the former than that of the latter,with statistical difference (t =13.48,P ＜ 0.05).Besides,levels of endostatin and VEGF in serum were not correlated with the sex,age,tumor pathological type and differentiation of NSCLC patients (P ＞ 0.05).After two cycles of chemotherapy combined with rh-endostatin treatment,the level of serum endostatin in partial response (PR) or stable disease (SD) patients was (76.22 ± 20.41) ng/ml,higher than that of progressive disease (PD) patients,which was (31.24 ± 13.09) ng/ml (t =7.143,P ＜ 0.05).In addition,the level of serum VEGF in PR or SD patients was (93.28 ± 21.33) pg/ml,which was lower than (155.81 ± 48.38) pg/ml of the PD patients (t =3.503,P ＜ 0.05).Conclusions The levels of endostatin and VEGF are associated with the efficacy of anti-angiogenesis combined with chemotherapy in NSCLC patients.

Objective To explore the effect of newly developed XSTAT 30 hemostatic apparatus for US army TCCC. Methods The characteristics and application effects of XSTAT 30 were described from the aspects of design, indication and contraindication, operation and precautions, application safety and etc. Results In tactical echelons XSTAT 30 could be used for the hemostasis of penetrating fragment injuries at groin, armpit and etc. Conclusion XSTAT 30 behaves well in the hemostasis at the junction sites, and is worthy referencing for designing likely devices of the PLA.

Objective To explore the impact of cognitive training on cognitive function of the elderly in a community. Methods Ninety elderly people at and above sixty years old in a community of Shanghai were recruited in the study, and were divided into two groups: the cognitive training group and the control group.The cognitive training group conducted cognitive training for 12 weeks (24 times), a comprehensive training method incorporating cognitive training courses with Lumosity ( a brain functional exercise software) .The two groups were evaluated before and after the intervention with the Montreal Cognitive Assessment Scale ( MoCA) . Results Before the intervention, the scores of four fields ( i.e. visual space and executive function, naming, delayed recall, and directional force) and the total score for the cognitive training group were higher than the control group ( P <0 .05 );there was no statistically significant difference in other three fields ( i.e.attention, language ability and abstract ability) between the two groups (P>0.05).After the intervention, the scores of four fields (i.e.visual space and execu-tive function, attention, abstract, delayed recall) and the total score for the cognitive group improved, compared with the control group ( P<0 .05 ) . Conclusion Cognitive training could improve or maintain cognitive function for the elderly in the community.