Objective: To investigate the characteristics and risk factors of an outbreak of acute hemorrhagic conjunctivitis (AHC) in a boarding middle school in Guangdong Province, in order to provide a scientific evidence for effective prevention and control of campus AHC outbreaks. Methods: From September 1st to 28th 2023, case identification was conducted among 559 students and 60 faculty members using standardized definition. Descriptive analysis was conducted on the three distrubution patterns of the outbreak. Questionnaires were designed, and a case-control study was adopted to analyze the possible risk factors of the disease transmission. The propensity score matching (PSM) method was used to control the difference of baseline data. Results: A total of 269 cases of AHC were identified, with an attack rate of 43.46%. The pathogen was confirmed as Coxsackie virus A24 variant (CA24v). Among these, 264 cases were students (attack rate of 47.23%) and 5 were staff (attack rate of 8.33%). A total of 153 pairs of PSM were successfully matched. After PSM matching, there were no statistically significant differences in gender, grade and class between the case group and the control group ( χ 2=0.12, 5.41, 11.24, P >0.05). The results of multivariate Logistic regression analysis showed that middle school students whose towels contacted with others ( OR =1.81), and direct contact with other AHC cases recently ( OR =4.89) were more likely to have AHC; while wearing glasses ( OR =0.43) and frequent use of hand sanitizer ( OR = 0.37 ) were less likely to have AHC ( P <0.05). Conclusion The outbreak of AHC is caused by CA24v, demonstrating rapid spread and extensive impact within the school setting.

Objective To explore whether 5/6 nephrectomy can establish a rat model of chronic renal failure-in-duced sarcopenia.Methods The rats were randomly divided into control group,sham operation group and 5/6 ne-phrectomy model group.Chronic renal failure and sarcopenia were further verified.Results Compared with the sham group:① In the model group,the qualitative analysis of urinary protein,serum creatinine,blood urea nitrogen and serum uric acid levels were increased(P＜0.05);② In the model group,the degree of renal fibrosis and the rate of apoptosis were high(P＜0.05);③ In the model group,the muscle strength and function declined(P＜0.05);④ In the model group,the degree of muscle fibrosis was obvious(P＜0.05).Conclusion Through the 5/6 nephrectomy method,an animal model of chronic renal failure-induced sarcopenia can be established,which provides an experimental basis for further prevention and treatment of this disease.

This paper took the"see your life story"-volunteer service project of the cancer patient care program of the First Affiliated Hospital of Guangzhou Medical University as an example,and explored the application of life narrative in the care service of cancer patients.The project adopted the multi-dimensional volunteer service model of"doctors and nurses+volunteers+social workers+patient friends",used the life narrative method,and guided the three groups of cancer patients,patient caregivers,and oncology medical staff to tell their life stories through medical volunteers.Finally,these life stories were delivered in diversified ways,such as physical picture books,interview stories,and sharing meetings.The connection between patients can be promoted in the form of sharing,so that patients and caregivers can get support,and truly achieve to impact life with life.This paper selected the cases in life story books,deeply analyzed the important role of life narrative in promoting the physical and mental recovery of cancer patients,as well as provided reference suggestions for improving patients'medical experience and promoting the cultural development of public hospitals.

Objective:To investigate the factors contributing to frailty in very elderly patients with multimorbidity.Methods:This cross-sectional study enrolled 119 very elderly patients with multimorbidity who were hospitalized in the Department of Geriatrics of Huadong Hospital Affiliated to Fudan University from August 2022 to March 2023.The study aimed to understand the basic status of multimorbidity by collecting general information, the number and types of diseases, and frailty status.The subjects were divided into frail and non-frail groups through comprehensive geriatric assessment.Various factors including gender, age, Tinetti balance gait score, risk of sarcopenia, dementia, depression, risk of deep vein thrombosis, dysphagia, comorbidity index, medication count, Basic Activities of Daily Living(BADL)score, Instrumental Activities of Daily Living(IADL)score, Nutritional Risk Screening 2002(NRS-2002)score, Norton pressure injury risk assessment score, and Social Support Rating Scale(SSRS)score were compared.The correlation between each factor and the occurrence of frailty was analyzed using univariate analysis and multivariate Logistic regression analysis.Results:A total of 119 elderly inpatients with multimorbidity, with an average age of 90.8±5.9 years old, were included in the study.The incidence of frailty was 68.9%(82 cases).Univariate analysis revealed significant statistical differences between the frail group and the non-frail group in various factors including age( t=-3.131, P=0.002), Tinetti score( Z=-5.544, P<0.001), risk of sarcopenia( χ2=39.205, P<0.001), dysphagia( χ2=5.937, P=0.015), Charlson comorbidity index( Z=-2.565, P=0.010), medication count( Z=-3.325, P<0.001), BADL( Z=-5.871, P<0.001), IADL( Z=-5.062, P<0.001), Norton score( Z=-5.922, P<0.001), and SSRS social support( Z=-2.637, P=0.008).Multivariate logistic regression analysis showed that the Tinetti score( OR=0.843, 95% CI: 0.737-0.966, P=0.014), decreased muscle strength( OR=11.226, 95% CI: 2.157-58.432, P=0.004), sarcopenia( OR=18.084, 95% CI: 2.041-106.211, P=0.009), Norton score( OR=0.462, 95% CI: 0.254-0.838, P=0.011), and medication count( OR=1.153, 95% CI: 1.000-1.329, P=0.049)were independently associated with frailty. Conclusions:In very elderly patients with multimorbidities, the occurrence of frailty is notably increased.Frailty is linked to multiple risks including falls, muscle weakness/sarcopenia, pressure ulcer risk, and polypharmacy, and these risks are independent of other factors.

Objective To observe the clinical efficacy of compound Wufengcao liquid combined with negative pressure wound therapy with instillation(NPWTi)for the treatment of stage Ⅲ-Ⅳ pressure injury(PI),and to preliminarily explore its action mechanism.Methods(1)Clinical research:from January 2019 to October 2022,60 PI patients who were admitted to the Scrofula Department and Wound Care Clinic at Nanjing Municipal Hospital of Traditional Chinese and Western Medicine were randomly divided into normal saline NPWTi group and compound Wufengcao liquid NPWTi group,with 30 cases in each group.Both groups underwent NPWTi under the premise of systemic basic treatment,before treatment,after removing the negative pressure device in the 1st,2nd and 3rd weeks of treatment,the pressure ulcer scale for healing(PUSH)score,the wound bacterial culture detection rate and the wound healing time were counted,and the vascular endothelial growth factor(VEGF)content of wound tissue was detected by ELISA method.(2)Animal experiments:24 SD rats were randomly divided into blank group,model group,normal saline NPWTi group and compound Wufengcao liquid NPWTi group,6 rats in each group.PI rat model was established by local tissue ischemia/reperfusion injury method,and the negative pressure device was removed at the end of each day of treatment.Before treatment and 3,7 and 10 days after treatment,the wound morphology of each group of rats was observed,the wound histopathology was observed by HE staining,the CD34 positive cells rate of wound tissue was detected by immunohistochemistry,and the expressions of p38 mitogen-activated protein kinase(p38 MAPK),nuclear factor-κB p65(NF-κB p65),inducible nitric oxide synthase(iNOS),tumor necrosis factor-α(TNF-α),arginase-1(Arg-1)and transforming growth factor-β(TGF-β)in rat blood and wound tissue were detected by ELISA and RT-qPCR.Results(1)Clinical research:Both groups could effectively reduce the PUSH score and the wound bacterial culture detection rate,shorten the wound healing time,and promote the expression of VEGF in wound tissue,the compound Wufengcao liquid NPWTi group was better than the normal saline NPWTi group(P<0.05).(2)Animal experiments:Compared with blank group,the rats in the model group showed obvious wound inflammatory response and tissue damage,and the CD34 positive cells rate,blood and wound tissue p38 MAPK,NF-κB p65,iNOS and TNF-α levels were significantly increased,Arg-1 and TGF-β level was significantly reduced(P<0.05);Compared with model group,after 7 days of treatment,the normal saline NPWTi group and the compound Wufengcao liquid NPWTi group significantly decreased the wound morphology score,the histopathological morphology was significantly improved,the CD34 positive cells rate was significantly increased(P<0.05),the levels of blood and wound tissue p38 MAPK,NF-κB p65,iNOS,and TNF-α were significantly reduced,and the levels of Arg-1 and TGF-β were significantly increased(P<0.05),and the compound Wufengcao liquid NPWTi group was better than that of the normal saline NPWTi group(P<0.05).Conclusion Compound Wufengcao liquid combined with NPWTi can effectively promote the healing of PI wounds,and its mechanism of action may be by inhibiting the activation and expression of p38 MAPK/NF-κB signaling pathway,thereby regulating the polarization balance of M1/M2 macrophages.

Objective To compare clinical effect between open reduction and fixation with cannulated screw and threaded rivet via posteromedial approach versus arthroscopic Endobutton plate fixation in treating posterior cruciate ligament avulsion fractures.Methods Clinical data of 38 patients with posterior cruciate ligament avulsion fractures from July 2020 to December 2021 were analyzed retrospectively,and divided into open reduction and internal fixation group(posterior medial approach hollow anchor system fixation)and arthroscopic fixation group(Endobutton with loop plate fixation under arthroscopy).There were 20 patients in open reduction and internal fixation group,including 16 males and 4 females,aged from 26 to 74 years old with an average of(42.9±18.8)years old;13 patients on the left side and 7 patients on the right side;12 patients were classi-fied to type Ⅱ and 8 patiens with type Ⅲ according to Meyers-McKeever fractures classification;14 patients were grade Ⅱ and 6 patients were grade Ⅲ in back drawer test.There were 18 patients in arthroscopic fixation group,including 11 males and 7 fe-males;aged from 24 to 70 years old with an average of(53.5±13.4)years old;11 patients on the left side and 7 patients on the right side;10 patients were classified to type Ⅱ and 8 patiens with type Ⅲ according to Meyers-McKeever fractures classifica-tion;11 patients were grade Ⅱ and 7 patients were grade Ⅲ in back drawer test.Operation time,blood loss,and quality of im-mediate reduction were compared between two groups.Knee range of motion,knee back drawer test,and International Knee Documentation Committee(IKDC)grading,KT2000 stability evaluation and Lysholm function score of knee joint were com-pared at 6 months after operation.Results All patients were followed up for 8 to 16 months with an average of(12.3±1.9)months.There were no complications such as incision infection,fracture malunion or non-union,and internal fixation loosening occurred.The avulsion fractures of knee joint were reached to imaging healing standard at 6 months after operation.Operation time and blood loss in open reduction and internal fixation group were(56.4±7.1)min and(63.2±10.2)ml,while(89.9±7.4)min and(27.7±8.7)ml in arthroscopic fixation group,respectively,and had significant difference between two groups(P＜0.05).There were no differences in immediate reduction quality(x2=0.257,P=0.612),knee joint range of motion at 6 months after opertaion(t=0.492,P=0.626),knee joint rear drawer test(x2=0.320,P=0.572),IKDC classification of knee joint(x2=0.127,P=0.938),KT2000stability evaluation(x2=0.070,P=0.791),and knee Lysholmfunction score(t=0.092,P=0.282)between two groups.Conclusion Posterior medial approach with hollow anchoring system fixation and arthroscopic Endobutton with loop plate fixa-tion for the treatment of posterior cruciate ligament tibial occlusion avulsion fracture could achieve satisfactory clinical results,and arthroscopic surgery has less bleeding,but also has a longer learning curve and longer operation time than traditional inci-sion surgery.The surgeon needs to make a choice according to clinical situation of patient and their own surgical inclination.

Objective:To evaluate the effect of low-dose recombinant interleukin-2(rIL-2)therapy on immunocyte subsets and its side effects in children with solid tumor.Methods:A total of 22 children(11 males and 11 females)with solid tumor in our department from December 2012 to November 2017 were selected,with a median age of 9(3-16)years old when starting IL-2 therapy.ALL surgeries and chemotherapy of children had been completed before low-dose rIL-2 therapy,and 17 cases achieved complete remission(CR)and 5 cases achieved partial remission(PR).A low-dose rIL-2 therapy was given 1 month after chemotherapy for 1 year:4 × 105 IU/(m2·d),s.c.for every other day,3 times per week.The immunocyte subsets were detected every 3 months until the end of treatment,meanwhile,disease condition and therapy-related side effects were followed up.Results:After low-dose rIL-2 therapy in 22 children,the absolute values of CD3+T cells,CD3-CD56+natural killer cells,CD3+CD4+helper T cells(Th)and CD3+CD8+cytotoxic T cells were up-regulated remarkably,as well as Th/suppressor T cells(all P＜0.05).While,there were no significant differences in absolute value and proportion of CD4+CD25+CD127-Treg cells during therapy.Among the 17 children who achieved CR before rIL-2 therapy,14 cases continued to maintain CR after therapy,while 3 cases relapsed,and with 2 died after treatment abandonment.The 5 children who achieved PR before low-dose rIL-2 therapy were evaluated CR by PET/CT scan after treatment.In the early stage of low-dose rIL-2 therapy,1 child developed skin rashes at the injection sites,and 2 children ran a slight to mild transient fever.Their symptoms disappeared without any organ damage after symptomatic treatment.Conclusion:Low-dose rIL-2 therapy has good drug tolerance,and changes the distribution of anti-tumor immune-cell subgroup in peripheral blood of children with solid tumor remarkably without up-regulation of absolute value and ratio of Treg cells.

Objective:To screen interleukin(IL)-1β secretion-related membrane transporters by macrophage experiment in vitro and conventional knockout mice.Methods:THP-1 cell line was differentiated to obtain human THP-1-derived macrophages,and the primary macrophages were obtained from human peripheral blood.FVB wild-type mice with the same sex and age were used as the controls of MRP1 knockout mice.The macrophages in abdominal cavity and bone marrow of mice were cultivated.The cells were treated with ABCC1/MRP1,ABCG2/BCRP,ABCB1/P-gp,OATP1B1,and MATE transporter inhibitors,then stimulated by lipopolysaccharide and adenosine triphosphate.The secretion level of IL-iβ was detected by ELISA,Western blot,and immunofluorescence.Results:After inhibiting ABCC1/MRP1 transporter,the secretion of IL-1β decreased significantly,while inhibition of the other 4 transporters had no effect.In animal experiment,the level of IL-1 β secreted by macrophages in bone marrow of MRP1 knockout mice was significantly lower than control group(P＜0.05).Conclusion:ABCC1/MRP1 transporter is a newly discovered IL-1β secretion pathway,which is expected to become a new target for solving clinical problems such as cytokine release syndrome.

Objective:To explore risk factors of early acute kidney injury (AKI) after pediatric living donor liver transplantation (LT) and examine the effects on the prognosis of recipients.Methods:From January 2018 to December 2019, the relevant clinical data were retrospectively reviewed for 201 pediatric recipients of elective living donor LT. Post-LT AKI recipients were diagnosed and categorized according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria (2012). Based upon the presence or absence of AKI within 7 days post-LT, they were assigned into two groups of AKI (64 cases) and non-AKI (137 cases). Baseline profiles, preoperative results of major laboratory tests and operation-related parameters were compared between two groups. Univariate variables with statistical differences were included into binary Logistic regression model for multivariate analysis to identify the independent risk factors of early AKI post-LT. Prognostic data of recipients such as postoperative mechanical ventilation time, intensive care unit (ICU) stay time, total hospitalization stay, in-hospital mortality and 3-year postoperative mortality were compared between two groups. Survival analysis was conducted for pediatric recipients with different AKI grades.Results:The incidence of AKI within 7 days post-LT was 31.8% (64/201). Univariate analysis revealed significant inter-group differences in age, preoperative PELD score, diagnosis of biliary atresia, total bilirubin, cystatin C, operative duration and volume of blood loss ( P<0.001, P<0.001, P=0.002, P<0.001, P<0.001, P<0.001& P<0.001). Multi-factorial analysis showed that total bilirubin ( OR=1.154, 95% CI: 1.068-1.248, P<0.001), cystatin C ( OR=2.532, 95 % CI: 1. 627-3.939, P<0.001), operative duration ( OR=1.174, 95% CI : 1.064-1.295, P=0.001) and volume of blood loss ( OR=1.210, 95% CI : 1. 095-1.337, P<0.001) were independent risk factors of AKI within 7 days post-LT. As compared with non-AKI group, postoperative mechanical ventilation time and ICU stay time became markedly extended (178 vs 389 min, P<0.001 ; 2 vs 3 day, P<0.001) and mortality during hospitalization rose sharply (0.7% vs 7.8%, P=0.002) in AKI group. The survival rates of recipients during hospitalization in group non-AKI/AKI were 99.3% (136/137) and 96.8% (30/31, grade 1), 92.9 % (13/14, grade 2), 78.9% (15/19, grade 3 ). The survival rates of recipients 3 years post-LT in group non-AKI/AKI were 94.2% (129/137) and 96.8% (30/31, grade 1), 78.6% (11/14, grade 2), 73.7% (14/19, grade 3). Results of survival analysis indicated that, in group non-AKI and AKI (geade 1, 2, 3), survival rate of recipients during hospitalization and 3 years post-LT declined gradually ( χ2=21.102, P<0.001 ; χ2=13.316, P=0.004) . Conclusion:As one common complication after pediatric living donor LT, AKI adversely affects the prognosis of recipients. Elevated preoperative levels of total bilirubin and cystatin C, prolonged operative duration and greater volume of intraoperative blood loss may boost the postoperative risk of early AKI in pediatric recipients.

Objective:To construct a prediction model for the emergency volume of the psychiatric hospital, and analyze the changes of psychiatric emergency visits, so as to provide references for optimizing the allocation of emergency service resources.Methods:This study extracted data of the visit time of emergency patients, etc from the information system of a certain psychiatric hospital from 2018 to 2023. The monthly emergency visits (emergency volume) from 2018 to 2022 were used to construct the autoregressive integrated moving average model (ARIMA), and the monthly emergency volume from 2023 was used to validate the predictive performance of the model.Results:After model construction and screening, seasonal ARIMA (0, 1, 0) (1, 1, 1) 12 was determined as the optimal model. The predicted values of the model were in good agreement with the actual values, with an average relative error fluctuation of 1.6% to 26.8% and an average absolute error fluctuation of 9 to 159 person-time. Conclusions:The seasonal ARIMA model could accurately predict the emergency volume of a certain psychiatric hospital and provide references for human resource allocation and emergency response. However, this prediction model was suitable for short-term forecasting. If long-term forecasting was needed, continuous data fitting was necessary to ensure the effectiveness of the prediction.