Objective To assess the effects of temperature and rainfall on the incidence of cardiovascular and cerebrovascular diseases (CVD) in Guiyang. Methods Using daily CVD incidence data and temperature and rainfall data in Guiyang City from September 2021 to August 2022, a distributed lag non-linear model was used to explore the nonlinear relationship between meteorological and environmental factors and CVD incidence. Results The risk of CVD was higher under cold (average, minimum, and maximum temperatures <2.1 ℃, 1.6 ℃, and 4.2 ℃, respectively) and hot (maximum temperature>32.5 ℃) effects, and the cumulative lag effect reached its maximum at 10 and 17 days, respectively. The risk of CVD increased sharply when there was a small diurnal temperature (<6.9 ℃), sudden drop in temperature (over 6.1 ℃), and heating (over 2.4 ℃ in 24 hours). The incidence risk of CVD was high when the daily rainfall exceeded 21.5 mm and the continuous rainy days exceed 5.7 days. The risk in rainstorm was 0.81 higher than that in heavy rain. Continuous absence of rain helped to prevent CVD patients from developing symptoms. Conclusion Meteorological environments such as hot and cold weather, dramatic change in temperature, significant rainfall and continuous rainfall have an impact on the incidence of CVD. It is necessary to consider the changes of the meteorological environment during the prevention and control of CVD.

Objective:To establish and validate a prediction model for the risk of major upper gastrointestinal bleeding in patients with varices of liver cirrhosis.Method:This study retrospectively collected the clinical data of patients with esophageal and gastric variceal bleeding who were admitted to the emergency department of Ningxia Medical University General Hospital from October 2019 to October 2022. The patients were divided into modeling group and validation group according to the ratio of 7:3 by random number table method. The observation index was whether the upper gastrointestinal bleeding occurred within 24 hours after admission. The predictors in the logistic regression model were used to construct a prediction model for the risk of major upper gastrointestinal bleeding in patients with varices with liver cirrhosis, and the area under the receiver operating characteristic curve (AUC), the correction curve and the decision curve were analyzed to evaluate the discriminatory ability, accuracy and clinical utility of the prediction model.Results:A total of 305 patients were included, including 215 and 90 in the modeling and validation groups, respectively, and the clinical data of the two groups were comparable. Multivariate logistic regression showed that systolic blood pressure ( OR=0.918, 95% CI: 0.860-0.980, P=0.010), MAP(ASH) score ( OR=1.993, 95% CI: 1.017-3.907, P=0.045), Child-Pugh score ( OR=1.999, 95% CI: 1.139-3.510, P=0.016) and model for end-stage liver disease (MELD) ( OR=1.398, 95% CI: 1.037-1.886, P=0.028) were independent influencing factors for the occurrence of upper gastrointestinal bleeding in patients with liver cirrhosis varices. The AUC of the prediction model in the modeling group was 0.936 (95% CI: 0.895-0.976), and that of the prediction model in the validation group was 0.891 (95% CI: 0.807-0.975), the prediction model had good identification, calibration, and clinical application value. Conclusions:Systolic blood pressure, MAP (ASH) score, Child-Pugh score, and prediction models constructed by end-stage liver disease models are helpful for early prediction of the risk of upper gastrointestinal bleeding in patients with cirrhosis varices in the emergency department.

Objective:To explore the prognostic factors of elderly patients with community-acquired pneumonia-related sepsis and to construct a prediction model.Methods:The clinical data of elderly patients with community-acquired pneumonia-associated sepsis from October 2020 to October 2022 in the General Hospital of Ningxia Medical University from October 2020 to October 2022 were retrospectively included, and the clinical data of the two groups were divided into the modeling population and the validation population in the ratio of 7:3 by random number table method, and the clinical data of the two groups were compared. According to the 30-day outcomes of admission, the patients were divided into survival group and death group, and the independent risk factors for the prognosis of elderly patients with community-acquired pneumonia-related sepsis were screened out by LASSO regression and multivariate logistic regression analysis, and the nomogram prediction model was constructed by R software. The area under the curve (AUC), calibration curve and decision curve of the receiver operating characteristic curve were used to validate the nomogram prediction model in the modeling population and the validation population to judge its discrimination, calibration and clinical practicability.Results:A total of 472 patients were included, with 331 and 141 models and validations, respectively, indicating that the clinical data were comparable between the modeled and validated populations. LASSO regression and multivariate logistic regression analysis showed that pneumonia severity index (PSI) score and sequential organ failure assessment (SOFA) score were independent risk factors for the prognosis of elderly patients with community-acquired pneumonia-associated sepsis. The AUC of the modeled population prediction model was 0.984 (95% CI: 0.975-0.994), and the AUC of the validated population prediction model was 0.961 (95% CI: 0.926-0.996). The nomogram prediction model has good discrimination, calibration and clinical practicability in both the modeled and validated populations. Conclusions:The nomogram prediction model established in the study has high accuracy for early identification and risk of sepsis in elderly patients with CAP and can guide for clinicians to formulate personalized interventions.

AIM: To analyze the effect of full-femtosecond small incision lenticule extraction(SMILE)on the treatment of high myopia based on propensity score matching.METHODS: A total of 48 cases(48 eyes)of high myopia patients who underwent SMILE surgery in our hospital from May 2019 to May 2021 were selected as the observation group, and 48 cases(48 eyes)of high myopia patients who underwent FS-LASIK surgery were matched using propensity score matching as the control group. Follow up for 6mo after surgery, the changes in cylindrical, central corneal thickness, uncorrected visual acuity(UCVA), corneal endothelial cell related indicators [percentage of hexagonal endothelial cells(6A), coefficient of variation(CV)of endothelial cell area, central corneal endothelial cell density(ECD)] and corneal biomechanical indicators [simulated Goldman intraocular pressure(IOPg), corneal hysteresis(CH), corneal resistance factor(CRF), corneal compensated intraocular pressure(IOPcc)] between the two groups were compared, and the incidence of complications in both groups of patients was recorded.RESULTS: Both groups of patients showed significant improvements in cylindrical and UCVA at 3 and 6mo after surgery, as well as decreased central corneal thickness, corneal endothelial cells, and corneal biomechanics related indicators. The changes in the observation group were more significant(all P<0.05). During the follow-up period, there was no significant difference in the incidence of complications between the observation group and the control group(8% vs. 17%, P>0.05).CONCLUSION: SMILE has a definite effect on patients with high myopia and is helpful to improve visual acuity.

Objective: To evaluate the value of next-generation sequencing (NGS) in the prevention and management of thalassemia. Methods: A systematic search was performed in eight databases including China Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journals Database, Wanfang database, PubMed, EMBASE, Web of Science, and Cochrane Library from the inception to 1 June 2022. Stata 17.0 and Review Manager 5.4 were used for the meta-analysis. Results: Nine studies containing 14794 participants were included in the meta-analysis. Compared with the routine genetic testing (including Gap-PCR and reverse dot blot), NGS had higher detection rates in screening thalassemia (RR 1.22, 95% CI 1.13-1.31, P<0.01), particularly for the α-thalassaemia mutation carriers (RR 1.24, 95% CI 1.07-1.44, P<0.01). However, no significant difference was found in the screening of β-thalassemia (RR 1.10, 95% CI 0.99-1.23, P>0.05). Conclusions: Compared with routine genetic testing, NGS had a higher detection rate in general, particularly in the detection of α-thalassemia.

In order to strengthen the management of disinfection quality of endoscopes, Quality Control Center of Digestive Endoscopy and Nosocomial Infection Control Center of Yunnan Province investigated the diagnosis, treatment, cleaning and disinfection conditions and disinfection quality of digestive endoscopes in some medical institutions of Yunnan Province by web questionnaire from April to May in 2019, and 277 valid questionnaires were finally obtained. SPSS 19.0 statistical software was used to analyze the influencing factors of cleaning and disinfection process and the infection control implementation of digestive endoscopes in 227 secondary and tertiary hospitals. The results showed that the number of decontamination people who had received systematic training in Yunnan Province was significantly lower than that in other areas of China. The hospital level, the number of decontamination personnel, and decontamination methods affected the implementation of cleaning and decontamination process and infection control, while the allocation of decontamination supplies had no effects. It is important to establish an effective mechanism for the normalized implementation of cleaning and disinfection of digestive endoscopes.

Objective:To compare short-term clinical efficacy between femoral neck system (FNS) and cannulated compression screws (CCS) in the treatment of femoral neck fractures in young adults.Methods:Retrospectively analyzed were the data of 94 patients with femoral neck fracture who had been admitted to Department of Orthopedics and Traumatology, The First Affiliated Hospital to University of Science and Technology of China, Department of Orthopaedics, The First Affiliated Hospital to Anhui Medical University and Department of Orthopaedics, The Second Affiliated Hospital to Anhui Medical University from October 2019 to October 2020. They were divided into 2 groups according to their modes of internal fixation: a FNS group ( n=47) and a CCS group ( n=47). In the FNS group there were 30 males and 17 females with a mean age of (47.8±9.8) years; in the CCS group there were 26 males and 21 females with a mean age of (43.7±13.1) years. The 2 groups were compared in terms of operation time, incision length, intraoperative blood loss, fracture healing time, weight-bearing time, Harris hip score and complications. Results:There was no significant difference in preoperative general data or follow-up duration between the 2 groups, showing comparability between groups ( P>0.05). In the FNS group, operation time [(47.7±9.4) min] was significantly shorter than that in the CCS group [(66.1±3.8) min], postoperative partial and full weight-bearing time [2.0 (2.0, 3.0) weeks, (6.4±2.1) weeks] significantly earlier than that in the CCS group [8.0 (3.0, 9.0), (10.1±3.4) weeks], fracture healing time [3.0(3.0, 4.0) months] significantly shorter than that in the CCS group [3.0(3.0, 4.0) months], Harris hip score at the last follow-up [95.0 (93.0, 95.0) points] significantly higher than that in the CCS group [90.0 (88.0, 95.0) points], incidence of lateral thigh irritation [0% (0/47)] significantly lower than that in the CCS group [31.9% (15/47)], and neck shortening length (4.3±3.9 mm) significantly shorter than that in the CCS group (6.9±4.5 mm) (all P<0.05). There was no significant difference in the rate of avascular necrosis of the femoral head or rate of internal fixation failure between the 2 groups ( P>0.05). Conclusion:In the treatment of femoral neck fractures in young adults, compared with CCS fixation, FNS fixation can shorten operation time and fracture healing time, allow patients to ambulate early after surgery, which is beneficial to maintenance of femoral neck length and to functional recovery of the hip.

Objective To evaluate the efficacy and safety of ilaprazole sodium for injection in the treatment of peptic ulcer bleeding.Methods It was designed as a multi-center,stratified randomized,double-blind,positive drug parallel controlled and non-inferiority study.From October 2014 to April 2015,at 40 hospitals,patients with peptic ulcer hemorrhage confirmed by gastroendoscopy were enrolled and divided into the ilaprazde sodium group (10 mg ilaprazole sodium for injection every 24 h,the first dose doubled) and the positive control group (40 mg of omeprazole sodium for injection every 12 h).The course of both treatment was 72 h.The hemostasis rate of overall group at 72 h,the clinical rebleeding rate at four to seven days,the blood transfusion rate,the incidence of switching to other treatments and the incidence of adverse reactions were compared between the two groups.A chi-square test or Fisher's exact probability method were performed for statistical analysis.Results A total of 533 patients with peptic ulcer bleeding were enrolled,355 patients in the ilaprazole sodium group and 178 patients in the positive control group.The hemostasis rates of ilaprazole sodium group and positive control group at 72 h were 97.69 ％ (339/347) and 97.14 ％ (170/175),respectively,and the difference was not statistically significant (P＞0.05).There were no rebleeding patients in both groups at four to seven days.The blood transfusion rates of ilaprazole sodium group and positive control group were 5.07 ％ (18/355) and 3.37 ％ (6/178).The incidence of switching to other treatments was 0.56％ (2/355) and 0.56％ (1/178),respectively,and the differences were not statistically significant (both P＞ 0.05).The incidence of adverse reactions in the ilaprazole sodium group was 3.94％ (14/355),which was lower than that of positive control group (8.43％,15/178).And the difference was statistically significant (Fisher's exact probability method,P=0.042).Conclusions The efficacy of ilaprazole sodium for injection in the treatment of peptic ulcer bleeding is similar to that of omeprazole sodium for injection.Moreover,the smaller the dose,the lower the frequency of administration and the better the safety.

This paper introduced the measures to construct the hierarchical medical system in Yichang city. The authors identified problems found and proposed the city to take the following countermeasures. Such steps included service capacity building at primary level, motivating primary medical workers, attracting patients to primary care, and improving policies of hierarchical medical system.

Hierarchical medical system empowers the current healthcare reform on the medical supply side in China, a key to resolving the contradictions in the healthcare sector. This study analyzed the necessity and obstacles for such a system with synergy between hospitals, insurance and pharmacy, putting forward suggestions for building a scientific and rational hierarchical system.