Objective: To investigate the influencing factors for delay in healthcare-seeking, definitive diagnosis and identification in patients with pulmonary tuberculosis (PTB) in Minhang District, Shanghai Municipality, so as to provide the basis for effectively reducing delay in PTB patients. Methods: Data of PTB patients in Minhang District from 2017 to 2022 were collected from the Infectious Disease Reporting Information System of Chinese Disease Prevention and Control Information System. The prevalence rates of delay in healthcare-seeking, definitive diagnosis and identification were analyzed, and factors affecting delay in healthcare-seeking, definitive diagnosis and identification were identified using multivariable logistic regression models. Results: A total of 4 214 PTB patients were reported in Minhang District from 2017 to 2022, including 2 802 males and 1 412 females, with a male-to-female ratio of 1.98∶1. The majority of patients were aged 25 to <45 years (1 664 cases, 39.49%). The prevalence rates of delay in healthcare-seeking, definitive diagnosis and identification were 36.81%, 30.21% and 38.09%, respectively. Delay in healthcare-seeking was associated with the year (2018, OR=0.708; 2019, OR=0.549; 2020, OR=0.670; 2021, OR=0.682), gender (female, OR=1.199), occupation (worker, OR=1.379; housekeeping service/housework/unemployed, OR=1.481), case identification route (symptom-based consultation, OR=11.159), and level of the first-diagnosed hospital (city-level, OR=1.528). Delay in definitive diagnosis was associated with age (45 to <65 years, OR=1.476), occupation (commercial service, OR=0.687; housekeeping service/housework/unemployed, OR=0.672), household registration (non-local, OR=0.820), case identification route (symptom-based consultation, OR=0.616), pathogen test result (negative/not tested, OR=1.903), and the level of the first-diagnosed hospital (city-level, OR=0.311). Delay in identification was associated with the year (2018, OR=0.785; 2019, OR=0.647; 2020, OR=0.790; 2021, OR=0.710), occupation (commercial service, OR=0.687), household registration (non-local, OR=0.848) and level of the first-diagnosed hospital (city-level, OR=0.560) Conclusions Year, gender, occupation, case identification route and level of the first-diagnosed hospital are influencing factors for delay in healthcare-seeking in PTB patients. Age, occupation, household registration, case identification route, pathogen test result and level of the first-diagnosed hospital are influencing factors for delay in definitive diagnosis. Year, occupation, household registration and level of the first-diagnosed hospital are influencing factors for delay in identification.

Objective: To investigate the epidemiological characteristics of human brucellosis in Jiande City, Zhejiang Province from 2005 to 2024, so as to provide the evidence for strengthening the prevention and control of brucellosis. Methods: Data on brucellosis cases and surveillance in Jiande City from 2005 to 2024 were collected through the Chinese Disease Prevention and Control Information System, the annual brucellosis surveillance reports from the Jiande Center for Disease Control and Prevention, and the annual summaries of brucellosis prevention and control efforts. The epidemiological characteristics of human brucellosis were analyzed using a descriptive epidemiological method. Results: A total of 1 125 individuals were monitored in Jiande City from 2005 to 2024, with 18 seropositive cases identified and the seropositivity rate of 1.60%. The average annual seropositivity rate from 2015 to 2024 was 3.35%, which was significantly higher than that of 0.57% from 2005 to 2014 (P<0.05). There were 10 confirmed brucellosis cases and 8 asymptomatic infections, with no reported deaths. The peak incidence occurred between March and August. Among the 16 towns (streets) in Jiande City, 8 reported brucellosis cases. Of the brucellosis cases, 14 were male and 4 were female, with a male-to-female ratio of 3.5∶1. The majority of cases (13 cases) were aged between 40 and 60 years. Occupational exposure was identified in 16 cases, all of whom were infected through direct hand contact with the excreta, secretions, or animal products of infected sheep or cattle. The primary source of infection was sheep, followed by cattle. Five strains of Brucella were isolated and cultured, all identified as Brucella melitensis biovar 3. Conclusions The brucellosis epidemic in Jiande City remained at a sporadic and low prevalence level from 2005 to 2024, with an increasing trend observed from 2015 to 2024. Male occupational groups aged 40 to 60 years were the key population for brucellosis prevention and control, and sheep were the primary source of infection.

Cardiomyopathy is a group of heterogeneous myocardial diseases with a variety of specific phenotypes that can lead to cardiovascular death or progressive heart failure in severe cases.Because of the severity and complexity of these diseases,the search for new regulatory mechanisms to prevent and treat cardiomyopathy is particularly urgent.Iron death is a form of programmed cell death that differs from other forms of iron dependence and is characterized by the accumulation of iron-dependent lipid peroxides.Studies have shown that iron death can be involved in the occurrence and progression of cardiomyopathy through different signaling pathways.Therefore,targeted regulation of iron death is a new strategy to prevent cardiomyopathy.In this paper,the mechanism of iron death and its important role in cardiomyopathy were reviewed to find the potential relationship between iron death and cardiomyopathy and provide more ideas for the treatment of various cardiomyopathies in the future.

Objective To explore the feasibility and effectiveness of the artificial intelligence(AI)diagnostic model for bone age imaging in the radiology information system-picture archiving and communication system(RIS-PACS)environment operation.Methods The optimized bone age AI model was integrated into the RIS-PACS platform.The bone age imaging data of 88 038 patients aged 0-18 years old were automatically evaluated.The reference bone age was determined by the consensus of two experienced radi-ologists based on GP map,with an error of±1.0 year old.The success rate,accuracy,system compatibility,stability,and influen-cing factors of results were further analyzed.Results The time for bone age AI evaluation of each case did not exceed 3 seconds,and the success rate of automatic evaluation reached 100%.AI model of bone age and RIS-PACS in hospital could be well integrated.Accord-ing to the readings evaluated by pediatric radiologists based on GP maps,the accuracy rate was 93.05%for girls and 89.53%for boys,with a mean absolute error(MAE)of(0.42±0.54)years old for girls and(0.45±0.60)years old for boys,respectively.The AI model could run efficiency in the RIS-PACS,which significantly reduced the burden of radiologists.The factors that affect the accuracy of the model were image position,exposures,multiple images in a single sequence and hand deformity,etc.Conclusion The bone age imaging AI diagnostic model can be seamlessly embedded into RIS-PACS in hospital,achieving one click bone age imaging diagnosis.

Objective:To explore the effects of multi-disciplinary nutrition support team on nutritional status and quality of life in lung cancer patients undergoing chemotherapy, so as to provide reference for the formulation of nutritional intervention plans for lung cancer patients undergoing chemotherapy.Methods:This was a quasi experimental study. A total of 74 patients with lung cancer undergoing chemotherapy in Jinshan Hospital of Fudan University from February 2021 to July 2022 were selected as the research object by convenient sampling method. They were divided into two groups according to their admission time, 37 cases of patients from February to August 2021 for the control group, using conventional nursing interventions, 37 cases of patients from September 2021 to July 2022 for the observation group, with multi-disciplinary nutrition support team. A follow-up was conducted for three chemotherapy cycles, serum nutrition indicators and quality of life were compared between the two groups.Results:There were 27 males and 10 females in the control group, aged (68.14 ± 6.82) years old. There were 30 males and 7 females in the observation group, aged (65.92 ± 9.17) years old. There was no significant difference in the serum nutrition indicators and quality of life before intervention between the two groups (all P>0.05). The serum total protein, albumin and prealbumin levels in the observation group were (69.41 ± 5.87), (38.11 ± 4.04) g/L, and (243.57 ± 67.58) mg/L, which were higher than those in the control group (65.54 ± 8.33), (35.78 ± 5.39) g/L, and (200.84 ± 60.84) mg/L, the differences were statistically significant ( t=-2.31, -2.10, -2.86, all P<0.05). After intervention, the observation group showed higher scores for emotional function and overall health/life quality, with (88.29 ± 16.72), (60.36 ± 13.24) points, compared to the control group with (76.80 ± 17.58), (46.40 ± 16.38) points. The scores for fatigue, nausea/vomiting, insomnia, and loss of appetite were (34.53 ± 22.19), (11.26 ± 8.83), (20.72 ± 16.39), (24.32 ± 18.67) points in the observation group, which were lower than the scores in the control group (45.65 ± 22.95), (25.68 ± 18.67), (36.94 ± 23.29), (40.54 ± 22.41) points, all the differences were statistically significant ( t values were -4.03-4.24, all P<0.05). Conclusions:During chemotherapy in lung cancer patients, the multidisciplinary nutrition support team has been shown to significantly improve the patients′ nutritional status and enhance their quality of life.

OBJECTIVE:To systematically evaluate the efficacy of transcranial direct current stimulation on the motor function of patients with Parkinson's disease,and to compare the efficacy of transcranial direct current stimulation at different targets on the motor function of patients with Parkinson's disease,so as to provide a theoretical basis for the target selection of transcranial direct current stimulation in clinical practice. METHODS:Cochrane Library,PubMed,Web of Science,CNKI,VIP,WanFang Data were retrieved for randomized controlled trials on the improvement of motor function in patients with Parkinson's disease by transcranial direct current stimulation published from the database inception to January 2023.The keywords were"Parkinson,transcranial direct current stimulation"in English and Chinese.The quality of the included studies was evaluated using the Cochrane 5.1.0 risk of bias assessment tool and the PEDro scale.Meta-analysis of outcome indicators was performed using RevMan 5.4 and Stata 17.0 software. RESULTS:Fifteen randomized controlled trials were finally included,and the PEDro scale showed that all were high-quality or very high-quality studies.Meta-analysis showed that transcranial direct current stimulation significantly improved Unified-Parkinson Disease Rating Scale part III score[mean difference(MD)=-2.49,95%confidence interval(CI):-4.42 to-0.55,P<0.05),step frequency score(MD=0.07,95%CI:0.03-0.11,P<0.05)and step speed score(MD=0.02,95%CI:0.00-0.05,P<0.05),but not for Berg Balance Scale scores(MD=2.57,95%CI:-0.74 to 5.87,P>0.05).Network Meta-analysis probability ranking:In terms of Unified-Parkinson Disease Rating Scale part III scores,the probability ranking results of target stimulation efficacy were dorsal lateral prefrontal cortex(52.4%)>primary motor cortex(45.8%)>central point of the brain(1.8%)>conventional rehabilitation(0%);in terms of gait frequency scores,the probability probability ranking results of target stimulation efficacy were cerebellum(50.1%)>central point of the brain(45.8%)>dorsal lateral prefrontal cortex(3.9%)>primary motor cortex(0.2%)>conventional rehabilitation(0%);in terms of gait speed scores,the probability ranking results of target stimulation efficacy were cerebellum(64.8%)>dorsal lateral prefrontal cortex(23.8%)>central point of the brain(9.4%)>primary motor cortex(1.7%)>conventional rehabilitation(0.4%);in terms of Berg Balance Scale scores,the probability ranking results of target stimulation efficacy were cerebellum(77.4%)>dorsal lateral prefrontal cortex(20.7%)>central point of the brain(0.7%)>conventional rehabilitation(0.2%). CONCLUSION:Transcranial direct current stimulation significantly improves motor function of patients with Parkinson's disease,with better motor coordination in the dorsolateral prefrontal cortex and better walking and balance in the cerebellum.

Objective:To study the effects of endoplasmic reticulum stress (ERS) and autophagy mechanisms in the pathogenesis of necrotizing enterocolitis (NEC).Methods:A total of 39 newborn SD rats were randomly assigned into 3 groups: the NEC group (NEC model: artificial feeding+hypoxic stimulation+intragastric injection of lipopolysaccharides), the ERS antagonist group (NEC model+intraperitoneal injection of 4-phenylbutyric acid) and the ERS inducer group (NEC model+intraperitoneal injection of tunicamycin). After successful modeling, the rats were sacrificed and intestinal tissues were obtained. The intestinal pathology was observed using electronic microscope. Intestinal fatty acid binding protein (I-FABP) was detected using ELISA. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to examine mRNA levels of glucose-regulated protein 78 (GRP78) and oxygen-regulated protein 150 (ORP150). Western-blot was used to detect p62 and autophagy-related proteins (microtubule-associated protein 1 light chain 3 (LC3)Ⅱ and LC3Ⅰ) and LC3Ⅱ/LC3Ⅰ ratio was calculated.Results:(1) For all 3 groups, the pathological scores of rat intestines were≥2. (2) The ERS inducer group showed significantly higher clinical score, pathological score, I-FABP level, GRP78 and ORP150 mRNA levels and LC3Ⅱ/ LC3Ⅰ ratio than the NEC group and ERS antagonist group, and the NEC group higher than the ERS antagonist group ( P<0.05). The p62 level in the ERS inducer group was significantly lower than the NEC group and the ERS antagonist group, and the NEC group lower than the ERS antagonist group ( P<0.05). (3) The LC3Ⅱ/ LC3Ⅰ ratio was positively correlated with clinical score, pathological score and I-FABP level ( P<0.05). The p62 level was negatively correlated with clinical score, pathological score and I-FABP level ( P<0.05). The mRNA levels of GRP78 and ORP150 were positively correlated with clinical score, pathological score and I-FABP level ( P<0.05). LC3Ⅱ/ LC3Ⅰ ratio was positively correlated with the mRNA levels of GRP78 and ORP150 ( P<0.05). The p62 level was negatively correlated with the mRNA levels of GRP78 and ORP150 ( P<0.05). Conclusions:ERS is associated with the pathogenesis of NEC. Inhibition of ERS can reduce autophagy and improve intestinal barrier function and clinical symptoms of NEC.

Objective To explore the protection effect and mechanism of preoperative ultrasound-guided stellate ganglion block(SGB)on lung in patients undergoing one-lung ventilation(OLV)during thoracoscopic surgery.Methods Eighty-four patients who underwent OLV during thoracoscopic lobectomy at the Affiliated Suzhou Hospital of Nanjing Medical University from January 2021 to April 2022 were selected as research subjects,and the patients were divided into the observation group and control group by using a random number table,with 42 patients in each group.Patients in the observation group received ultrasound-guided SGB before anesthesia induction,while patients in the control group did not undergo puncture procedures.Patients in both groups received the same anesthesia induction and maintenance protocols.Hemodynamic,respiratory and arterial blood gas parameters were recorded at various time points:upon entering the operating room(T0),before OLV(T1),30 minutes after OLV initiation(T2),60 minutes after OLV initiation(T3),completion of surgery(T4),and 30 minutes after extubation(T5).Oxygenation index(OI),intrapulmonary shunt rate(Qs/Qt)and pH values of patients in the two groups were compared at these time points.Venous blood were collected from patients in both groups at T0,T3 and T5,and enzyme-linked immunosorbent assay was employed to measure the levels of surfactant protein-A(SP-A),superoxide dismutase(SOD),malondialdehyde(MDA),interleukin-6(IL-6)and interleukin-10(IL-10).Postoperative SGB-related complications and pulmonary complications within 72 hours were recorded.Results The mean arterial pressure(MAP)and heart rate(HR)in both groups were significantly lower at T,,T2,and T3 compared to T0(P＜0.05);the MAP and HR at T4 and T5 had no statis-tically significant difference compared to those at T0(P＞0.05);there was no significant difference in MAP and HR at other time points(P＞0.05).MAP in the observation group at T1,T2 and T3 was significantly lower than that in the control group(P＜0.05),and HR in the observation group at T2 and T3 was significantly lower than that in the control group(P＜0.05);there were no significant differences in MAP and HR between the two groups at other time points(P＞0.05).There were no significant differences in pulse oxygen saturation(SpO2)between the two groups at T0-T5(P＞0.05).At T2 and T3,peak airway pressure(Ppeak)and respiratory rate(RR)were significantly higher than those at T,and T4,and tidal volume(TV)was significantly lower than that at T,and T4 in both groups(P＜0.05).Ppeak and TV in the observation group at T2 and T3 were significantly lower than those in the control group(P＜0.05);there were no significant differences in Ppeak and TV between the two groups at T1 and T4(P＞0.05).RR and partial pressure of end-tidal carbon dioxide(PetCO2)at T1-T4 showed no significant differences between the two groups(P＞0.05).The pH values at T0-T5 showed no significant differences between the two groups(all P＞0.05).The OI at T,had no significant difference compared to that at T0 in both groups(P＞0.05);OI at T2-T5 in both groups was significantly lower than that at T0(P＜0.05);OI in the observation group at T2-T5 was significantly higher than that in the control group(P＜0.05).Qs/Qt at T2-T5 was significantly higher than that at T0 and T1 in both groups(all P＜0.05);Qs/Qt in the observation group at T2-T5 was significantly lower than that in the control group(P＜0.05).At T3 and T5,serum SP-A and IL-6 levels in both groups were significantly higher than those at T0(P＜0.05);serum SP-A and IL-6 levels in the observation group at T3 and T5 were significantly lower than those in the control group(P＜0.05).At T3 and T5,serum IL-10 level in the control group were significantly lower than that at T0,while serum IL-10 level in the observation group were significantly higher than that at T0(P＜0.05).Serum IL-10 level in the observation group at T3 and T5 were higher than that in the control group(P＜0.05).At T3 and T5,serum MDA level in the control group was significantly higher than that at T0(P＜0.05);serum MDA level in the observation group showed no significant difference compared to that at T0(P＞0.05);serum MDA level in the observation group was significantly lower than that in the control group(P＜0.05).At T3 and T5,serum SOD level in the control group was significantly lower than that at T0,while serum SOD level in the observation group was significantly higher than that at T0(P＜0.05);serum SOD level in the observation group was significantly higher than that in the control group(P＜0.05).Four patients in the observation group experienced symptoms of unilateral recurrent laryngeal nerve block,and one patient experienced brachial plexus nerve block,but all improved within 24 hours after surgery.No other adverse reactions were observed during follow-up.Within 72 hours postoperatively,one patient in the control group experienced hypoxemia.Conclusion Preoperative ultrasound-guided SGB has lung-protective effects on patients undergoing OLV in thoracoscopic surgery,which significantly improves OI,reduces intrapulmonary shunts,and inhibits inflammatory response and oxidative stress.

Objective To investigate the effect of inhibiting autophagy induced by endoplasmic reticulum stress(ERS)on necrotiz-ing enterocolitis(NEC)in neonatal rats.Methods First,the NEC model of neonatal rats was established.Then,the intestinal epitheli-al cells were isolated and divided into three groups:control group,inhibition group and induction group.The control group was cultured normally,the inhibition group was added with 4-phenylbutyric acid,and the induction group was added with tunicamycin for 24hours.Enzyme-linked immunosorbent assay(ELISA)was used to detect the expression of the cellular inflammatory cytokines tumor necrosis factor-α(TNF-α)and intestinal fatty acid binding protein(I-FABP)in each group.Real-time quantitative polymerase chain reac-tion(RT-qPCR)was used to detect the mRNA expression level of the markers of ERS glucose regulated protein 78(GRP78)and oxy-gen-regulated protein 150(ORP150).Western blot was used to detect the expression of autophagy related proteins LC3 Ⅱ/Ⅰ and p62.Results Compared with the control group,the expression of p62 in the inhibition group increased significantly,the expression of TNF-α,I-FABP,GRP78,ORP150,LC3 Ⅱ/Ⅰ in the inhibition group was significantly decreased,while the expression of p62 in the induc-tion group was significantly decreased,the expressions of TNF-α,Ⅰ-FABP,GRP78,ORP150,LC3 Ⅱ/Ⅰ were significantly increased,and the differences were statistically significant(P＜0.05).Conclusion Inhibition of ERS induced autophagy activation can alleviate intestinal mucosal injury and inflammatory response in neonatal rats with NEC and improve intestinal barrier function.

Objective To analyze and compare the clinical manifestations and imaging features of children with secondary massive cerebral infarction after acute subdural hematoma(ASDH),and to evaluate its potential risk factors in order to provide evidence for the prevention,early diagnosis and early treatment of secondary massive cerebral infarction after ASDH.Methods The clinical data of children with ASDH aged 4～12 years were retrospectively studied.All the children received routine operation.The diagnosis of post-traumatic secondary massive cerebral infarction(MCI)was based on low-density areas on CT images and clinical signs.Clinical and radiographic findings related to patient outcomes were reviewed and statistically compared.Univariate and multifactor Cox regression analysis was used to evaluate the MCI after operation to obtain the factors affecting MCI.Results A total of 67 cases were included in the study,with 32 cases included in the MCI group and 35 cases included in the non-MCI group.There were significant differences between MCI and non-MCI groups in age(t=2.016,P= 0.048),body mass(t=2.389,P=0.020),multiple injuries(χ2=11.121,P=0.001),GCS(Z=-4.730,P＜0.001),hematoma volume(χ2=12.890,P=0.002),MLS(χ2=12.261,P=0.002)and perioperative shock(χ2= 14.417,P＜0.001).GCS(OR=0.322,P=0.002),perioperative shock(OR=10.992,P=0.007),multiple injury(OR= 6.547,P=0.046)and MLS score(OR= 46.974,P=0.025)were major risk factors for MCI in children with ASDH.Conclusion Perioperative shock,multiple injuries,low GCS and MLS greater than 10mm are risk factors for MCI.The incidence of MCI is significantly increased in children with multiple risk factors.