ObjectiveTo identify the rate， population characteristics， and vaccination history of repeat infections among previously infected people in the current epidemic based on the rate of repeat infection and population characteristics of different mutant strains at different times in Pudong New Area of Shanghai， and to provide reference for the prevention and control strategies of novel coronavirus repeat infections. MethodsA total of 9 250 investigated subjects were randomly selected from the new cases of asymptomatic infection and confirmed cases reported by Pudong New Area from March to May 2022. The investigation mainly focused on demographic characteristics， nucleic acid or antigen test results， and symptoms after infection. The repeat infection rates among different populations were compared， and logistic regression was used to analyze the impact of gender， age， and vaccination status on repeat infections. ResultsThe survey sample of 9 250 people had a response rate of 81.85%. There were 4 043 males （53.40%） and 3 528 females （46.60%）， with a median age of 34 years old （P₂₅， P₇₅： 7， 61）. The overall vaccine uptake rate was 59.44% （4 500/7 571）. In December of 2022， there were 563 cases of repeat infection， with an infection rate of 7.44%. The lowest rate of repeat infection was seen in the 3‒ year-old group （2.86%） and the highest rate in the 30‒ year-old group （12.42%）， with significant differences between different age groups. The repeated infection rate for those who had completed their vaccinations was significantly lower （6.57%） compared to those who had not （7.11%）. The age groups of 3‒ years， 70‒79 years， as well as individuals who completed full vaccination and received booster shots were protective factors against repeat infections. ConclusionThe overall rate of reinfection among the infected in Shanghai during the spring of 2022 was low in the outbreak of the Omicron variant， and the rate of reinfection in the 3‒ year-old group was significantly lower than in other age groups. Completing the full course of vaccination significantly reduces the risk of reinfection. Although the reinfection rate is high in individuals who received booster shots， it remains a mitigating factor compared to those who do not receive the vaccine. It is recommended to continue monitoring reinfections in key populations and further strengthen immunization efforts.

Objective To analyze the efficacy and adverse reactions of donepezil in the treatment of patients with a continuous disease spectrum of Alzheimer's disease(AD)with pharmacogenomics.Methods Seventy-two patients who took donepezil therapy at the time of initial molecular pa-thology diagnosis of AD continuous disease spectrum in Chinese PLA General Hospital from Jan-uary 2022 to January 2023 were recruited.Cells from the oral buccal mucosa were collected,and MassARRAY nucleic acid mass spectrometry was applied to detect the genotypes of CYP2D6,the gene encoding cytochrome P450 2D6 enzyme,and CHAT,the gene encoding acetylcholine trans-ferase.After 9 months of follow-up,drug efficacy was indirectly determined by neurological func-tion scales,caregiver evaluations,and drug prescribing behaviors,and thus,the 50 patients on donepezil alone were divide into effective group(n=28)and ineffective group(n=22).Seventy-two patients were divided into adverse reaction group(n=12)and no adverse reaction group(n=60).Multivariate logistic regression analysis was used to analyze the correlation between donepezil efficacy and pharmacogenomics.Results The frequencies of CHAT rs3793790 locus carrying G allele and rs2177370 locus carrying A allele were significantly higher in the effective group than the ineffective group(35.71％vs 9.09％,P=0.029;42.86％vs 9.09％,P=0.008).Multivariate lo-gistic regression analysis showed that donepezil was more effective in those who carrying rs3793790 G allele and/or rs2177370 A allele in the CHAT gene than those who carrying neither of the alleles(95％CI:1.20-34.47,P=0.030).There were no statistical differences in the CYP2D6 gene-adjusted activity score and whether or not carrying*10 between the patients with and without adverse reactions(P＞0.0 5).Conclusion In patients with a continuous spectrum of AD,donepezil efficacy is associated with CHAT gene polymorphisms,but there is no correlation between donepezil adverse reactions and CYP2D6 genotype.

Objective: To investigate the recessive infection rate of healthy children and guardians in different epidemic periods of hand, foot and mouth disease (HFMD) in Qingdao, analyze the risk factors affecting recessive infection, so as to provide the basis for HFMD prevention and control. Methods: In the nonepidemic period of 2022, the random cluster sampling method was used to selected 546 children and guardians from 4 childcare institutions in Laoshan District and Pingdu City. In the epidemic period of 2023, 690 children and guardians were selected from 6 childcare institutions in Shibei District, Laoshan District and Pingdu District. A questionnair survey was conducted in the epidemic period. Logistic regression analysis was used to analyze the factors affecting the recessive infection. Dominance analysis was used to explore the relative importance of the risk factors affecting recessive infection. Results: The results showed that the recessive infection rates of healthy children and guardians in the epidemic period were 18.84% and 13.62%, respectively; the recessive infection rates were 9.09% and 4.44% in the nonepidemic period, respectively. The results of multivariate Logistic analysis showed that rural areas (OR=4.71, 95%CI=2.57-8.61) and recessive infection of guardians (OR=18.62, 95%CI=7.45-46.56) were positively correlated with recessive infection of HFMD in healthy children (P<0.05). Washing hands (OR=0.09, 95%CI=0.04-0.20), using towels alone (OR=0.17, 95%CI=0.07-0.40), and EV71 vaccination (OR=0.42, 95%CI=0.20-0.87) were negatively correlated with recessive infection of HFMD in healthy children (P<0.05). Public toilets (OR=3.02, 95%CI=1.50-6.09) and drying bedding once per quarter (OR=3.89, 95%CI=1.75-8.68) were positively correlated with recessive infection of HFMD in healthy guardians. Housing with good lighting (OR=0.31, 95%CI=0.12-0.79), and tableware disinfection (OR=0.31, 95%CI=0.15-0.65) were negatively correlated with recessive infection of HFMD in healthy guardians (P<0.05). The results showed that recessive infection of guardians was relatively the most important for healthy children (41.51%), and tableware disinfection was relatively the most important for recessive infection of guardians (28.87%). Conclusions The recessive infections of HFMD are common among healthy populations in Qingdao, and the recessive infection rate among children during the epidemic period is relatively higher. Guardians play an important role in the recessive infection of healthy children. Therefore, healthy education should be strengthened for key populations, especially to enhance parents awareness of prevention and control to reduce the occurrence of recessive infections of hand, foot and mouth disease in children and guardians.

Objective To investigate the effect and mechanism of galactose on the expression of sialic-acid-binding immunoglobulin-like lectin 9(Siglec-9)glycan ligand on human primarily cultured pulmonary artery endothelial cells.Methods The expression of Siglec-9 glycan ligand on the endothelial cell surface and the type of glycosidic bonds at the end of this ligand were identified by flow cytometry.Endothelial cells were treated with L-glucose,glucose,N-acetylglucose,mannose,N-acetylmannose,galactose,sialic acid and sucrose for 48 h,and the expression of Siglec-9 glycan ligand in endothelial cells was detected by flow cytometry.The endothelial cells were divided into the control group and the galactose group(n=3).Western blotting,flow cytometry,and immunofluorescence assay were employed to investigate the impact of galactose on the Siglec-9 glycan ligand in endothelial cells.After α2-3,6,8 sialidase treatment for endothelial cells,Western blotting was used to detected the effect of galactose on the recovery time of Siglec-9 glycan ligand in endothelial cells.Endothelial cells were treated with galactose,Western blotting was used to detect and analyze the expression levels of intracellular sialic acid synthetases(GNE,NANS,NANP,CMAS,NPL and ST3Gals),and the mRNA expression levels of the relevant proteins were verified by RT-qPCR.Western blotting was used to detect the changes of Siglec-9 glycan ligand level in endothelial cells after siRNA knockdown in NANP,CMAS and ST3Gal-Ⅲ.The effect of the increase of Siglec-9 ligand on apoptosis and phagocytosis of macrophages was analyzed by macrophage co-culture experiments.Results Endothelial cells showed the expression of Siglec-9 ligand and the ligand was a sialic acid glycoprotein linked to α 2-3 sialic acid at the end.Compared with the control group,the expression level of this ligand on endothelial cells in the galactose group was increased significantly(P＜0.01),but the addition of galactose had no effect on the self-recovery time of the ligand.Compared with the control group,the expression levels of NANP,CMAS and ST3Gal-Ⅲ in endothelial cells treated with galactose were increased(P＜0.05,P＜0.01),respectively.The results of RT-qPCR verification were consistent with those results.After the expression of NANP,CMAS or ST3Gal-Ⅲ was inhibited,the level of Siglec-9 glycan ligand in endothelial cells was decreased(P＜0.01).In the co-culture experiment,compared with the untreated group,galactose-treated endothelial cells promoted the apoptosis of macrophages(P＜0.01)and reduced their phagocytosis(P＜0.05).Conclusion Galactose up-regulates the level of Siglec-9 glycan ligand on endothelial cells through the NANP-CMAS-ST3Gal-Ⅲ pathway,thereby inhibiting the activity of macrophages.

Objective:To explore the current status of vicarious posttraumatic growth (VPTG) among emergency nurses, and analyze its influencing factors and pathways of action.Methods:From March to May 2022, convenience sampling was used to select 532 emergency nurses from 20 public general hospitals in Anhui Province as the research subject. A survey was conducted on emergency nurses using the General Information Questionnaire, Posttraumatic Growth Inventory, Chinese Version of the Interpersonal Reactivity Index, Connor-Davidson Resilience Scale, and the Multidimensional Scale of Perceived Social Support. AMOS 24.0 software was used to establish the structural equation model and analyze the path relationships between variables.Results:A total of 532 questionnaires were distributed, and 480 valid questionnaires were collected, with an effective response rate of 90.23% (480/532). The score of the Posttraumatic Growth Inventory for 480 emergency nurses was (49.35±15.82). Empathy, psychological resilience, and perceived social support all had a positive impact on VPTG, with total effect values of 0.503, 0.261, and 0.163, respectively. Empathy directly or indirectly affected VPTG through perceived social support and psychological resilience. Perceived social support indirectly affected VPTG through psychological resilience, and psychological resilience directly affected VPTG.Conclusions:VPTG of emergency nurses is directly and/or indirectly positively influenced by empathy, psychological resilience, and perceived social support. Nursing managers should pay attention to the interaction between factors, take effective measures based on the association between factors, and promote the positive transformation of emergency nurses after trauma.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To explore the regulatory role of hederagenin(HG)on glutamate(Glu)-in-duced ferroptosis and corresponding inflammatory responses in mouse hippocampal neuron HT22 cells and investigate its potential mechanisms.Methods HT22 cells were randomly divided into control,Glu and HG groups(n=3).The cells of the control group received no treatment,the cells of the Glu group were treated with 35 mmol/L Glu for 24 h to establish a cellular model of ferroptosis in Alzheimer's disease,and the cells of the HG group were treated with 0.5 μmol/L HG and 35 mmol/L Glu for 24 h simultaneously.FerroOrange fluorescent probe was used to de-tect intracellular Fe2+.The production of reactive oxygen species(ROS),mitochondrial membrane potential,and levels of inflammatory factors TNF-α,IL-1β and IL-6 in the cells were assessed.Finally,the expression of the key regulator of iron death,glutathione peroxidase 4(GPX4)was measured.Results Compared to the control group,the levels of intracellular Fe2+,ROS,TNF-α,IL-1β,and IL-6 were significantly elevated,while the mitochondrial membrane potential was obvi-ously reduced in the Glu group(P＜0.05,P＜0.01).The HG group had significantly decreased Fe2+,ROS,TNF-α,IL-1β,and IL-6 and enhanced mitochondrial membrane potential than the Glu group(P＜0.05,P＜0.01).The GPX4 expression was significantly lower in the Glu group than the control group(1.00±0.02 vs 0.46±0.04,P＜0.01),and was notably higher in the 0.5 and 1.0 μmol/L HG groups when compared to the Glu group(0.64±0.03 and 0.59±0.05 vs 0.46±0.04,P＜0.01).Conclusion HG inhibits ferroptosis by regulating GPX4 expression,and thereby effec-tively alleviates the inflammatory response.

Objective:To investigate the correlation between hearing loss and microvascular complications in diabetes.Methods:This cross-sectional study conducted the data from 572 patients with diabetes hospitalized in the Endocrinology Department of the General Hospital of Southern Theater Command from September 2022 to July 2023. All participants underwent electrical audiometry and acoustic immittance in the ENY department. Based on the audiometric results, participants were categorized into normal hearing group and hearing loss group. Additionally, 572 non-diabetic patients from the outpatient department were enrolled as the non-diabetic group. The general information and laboratory results were collected and compared using t test, rank sum test or χ2 test. Binary logistic regression analysis was used to evaluate the association of diabetic hearing loss with diabetic kidney disease(DKD), diabetic retinopathy (DR), and diabetic peripheral neuropathy (DPN). Results:Among 572 patients with diabetes, 429 suffered from hearing loss and 143 were normal. χ2 test showed significant differences in combined DKD and DPN between two groups, but not in DR. Multivariate binary logistic regression analysis identified DKD and DPN as risk factors for hearing loss, but no correlation was found with DR. Conclusion:Diabetic patients with DKD or DPN should be monitored for potential hearing loss. Early screening and treatment are crucial to prevent severe hearing impairment.

Objective To explore the application effect of ultrasound-guided long axis iliac fascia block through femoral nerve for pain management in elderly patients with hip fractures.Methods A total of 60 elderly patients with hip fractures admitted to the Second Affiliated Hospital of Jiaxing University from March to June 2023 were selected,and they were divided into S group and L group according to random number table method,with 30 cases in each group.Patients in S group underwent short axis iliac fascia block through femoral nerve by ultrasound,while patients in L group underwent long axis iliac fascia block through femoral nerve by ultrasound.The static numerical rating scale(NRS)scores,dynamic NRS scores of two groups were compared before nerve block(T0),and 10min(T1),2h(T2),6h(T3)and 12h(T4)after nerve block,effective cases of nerve branch block,and occurrence of adverse events related to nerve block were compared between two groups.Results The static and dynamic NRS scores of two groups decreased first and then increased slightly with the extension of time.At time points T2 and T3,the static and dynamic NRS scores of patients in L group were significantly lower than those in S group(P<0.05).The effective cases of lateral femoral cutaneous nerve block and obturator nerve block in L group were significantly higher than those in S group(P<0.05).No adverse events such as local anesthetic poisoning,peripheral nerve injury,and analgesia covering up the disease occurred in both groups.Conclusion Ultrasound-guided long axis iliac fascia block through femoral nerve can effectively reduce early pain in elderly patients with hip fracture,and it is safe.

A total of 231 patients aged>60 years who underwent orthopedic surgery in Department of Orthopedics of Emergency General Hospital from November 2019 to June 2022, were enrolled. All patients received a comprehensive geriatric assessment before surgery. The demographic characteristics, medical history of patients were collected, the geriatric syndrome, postoperative complications were analyzed. The risk factors of postoperative complications were analyzed with Logistic regression. The preoperative comprehensive geriatric assessment showed that the most common geriatric syndrome was cognitive impairment (29.9%, n=69), followed by frailty (14.3%, n=33), nutritional risk (10.4%, n=24), functional dependence (7.8%, n=18), depression and anxiety (3.9%, n=9). Postoperative complications occurred in 38 cases, including delirium in 18 cases (7.8%), respiratory infection in 15 cases (6.5%), heart failure in 9 cases (3.9%) and death in 1 case (0.4%). The Logistic regression analysis showed that anemia ( OR=5.278, 95% CI:1.237-22.518), frailty ( OR=2.865, 95% CI:1.049-7.829) and cognitive impairment ( OR=3.796, 95% CI:1.526-9.442) were independent risk factors for adverse postoperative outcomes ( P<0.05). The study indicates that incidence of preoperative geriatric syndrome in patients undergoing evaluation is common; and anemia, frailty and cognitive impairment may be related to adverse clinical outcomes in elderly patients after surgery.