Objective: To analyze the hospitalization expenditures and their temporal trends in patients with nasopharyngeal carcinoma (NPC), and evaluate the associated economic burden and influencing factors. Methods: A random sampling survey was conducted in newly diagnosed NPC patients undergoing curative therapy in a grade Ⅲ cancer hospital in Southern China from January 2019 to December 2023 to obtain their hospitalization cost data, the patients with recurrence, metastasis, severe complications or receiving no radical therapy were excluded. The collected data included basic demographics, tumor characteristic, treatment way, payment method, total hospitalization expenditure, and their composition. The primary outcome was the median hospitalization expenditure per case (adjusted to 2023 values using the Consumer Price Index). Univariate and multivariate generalized linear models were used to identify factors associated with hospitalization expenditures. The annual cost composition and temporal trends were analyzed. Results: A total of 788 NPC patients were finally included with an age of diagnosis of (47.0±11.7) years, in whom 598 (75.9%) were from Southern China, 584 (74.1%) were men, and 716 (90.9%) were at advanced stage. The M(Q1, Q3) hospitalization expenditure per case was 146 289 (125 083, 178 056) yuan. The median expenditures in 2019, 2020 and 2021 were 150 718, 151 811 and 157 463 yuan, respectively, and the median expenditures decreased to 139 696 yuan in 2022 and 134 621 yuan in 2023. Regarding cost composition, the expenditure for radiotherapy was highest (83 430 yuan, 59.7%), followed by the expenditure for medication (26 580 yuan, 19.0%). Multivariable generalized linear model analysis showed that the median hospitalization expenditure (150 045 yuan) was higher in patients with commercial insurance or public funding than in those with urban resident basic medical insurance (144 524 yuan) (aOR=1.11, 95%CI: 1.06-1.16, P<0.001). Patients in advanced stage had higher expenditures (149 342 yuan) compared with those in early stage (114 476 yuan) (aOR=1.11, 95%CI: 1.03-1.19, P=0.002). Patients receiving comprehensive treatment incurred higher expenditures (148 573 yuan) compared with those receiving radiotherapy alone (99 727 yuan) (aOR=1.33, 95%CI: 1.21-1.47, P<0.001). The median hospitalization expenditures of patients in 2022 (139 696 yuan) and 2023 (134 621 yuan) were lower than those in 2019 (150 718 yuan) (aOR=0.93, 95%CI: 0.88-0.99; aOR=0.87, 95%CI: 0.82-0.93, both P<0.05). Conclusions: The median hospitalization expenditure per case in NPC patients was high with a slight decreasing trend in recent years. Payment method, clinical stage, treatment way, year of hospitalization were the main factors influencing the hospitalization expenditure. 目的： 分析鼻咽癌病例的住院费用及变化趋势，评估其造成的经济负担及相关影响因素。 方法： 按年份随机抽取2019年1月至2023年12月在华南地区某三甲专科医院进行根治性治疗的初诊鼻咽癌病例（排除复发、转移、合并严重并发症及非根治性治疗病例），收集其住院费用及相关信息，包括基本信息、肿瘤特征、治疗方式、付费方式、住院总费用及其构成等。主要分析指标为每例病例的住院费用M（经居民消费价格指数调整至2023年值），采用单因素及多因素广义线性模型分析其影响因素。按年份分层分析费用的构成及其变化趋势。 结果： 最终共纳入788例鼻咽癌病例，确诊年龄为（47.0±11.7）岁，598例（75.9%）病例来自华南地区。男性584例（74.1%），716例（90.9%）病例为晚期。鼻咽癌病例住院费用M（Q1，Q3）为146 289（125 083，178 056）元。2019-2021年鼻咽癌病例住院费用M分别为150 718、151 811、157 463元，2022、2023年分别降至139 696元和134 621元。费用构成方面，住院费用以放疗费为主（83 430元，59.7%），其次是药物治疗费（26 580元，19.0%）。多因素广义线性模型分析结果显示，商业保险/公费付费方式病例的住院费用M（150 045元）高于城镇居民保险病例（144 524元）［aOR=1.11（95%CI：1.06~1.16），P<0.001］。鼻咽癌晚期病例的住院费用M（149 342元）高于早期病例（114 476元）［aOR=1.11（95%CI：1.03~1.19），P=0.002］；综合治疗病例的住院费用M（148 573元）高于单纯放疗组（99 727元）［aOR=1.33（95%CI：1.21~1.47），P<0.001］。2022年（139 696元）和2023年病例的住院费用M（134 621元）低于2019年（150 718元）［aOR=0.93（95%CI：0.88~0.99），aOR=0.87（95%CI：0.82~0.93），均P<0.05］。 结论： 鼻咽癌病例住院费用M较高，近年平稳中略有下降；付费方式、临床分期、治疗方式、住院年份是影响住院费用的主要因素。.
Objective: To explore the utilization patterns of HIV pre-exposure prophylaxis (PrEP) service and the influence path of medication compliance in male population, and to provide a reference for optimizing the PrEP medication service strategy in China. Methods: A cross-sectional study design was adopted. From June to October 2023, in the three provincial capital cities of Kunming, Zhengzhou and Guangzhou where PrEP was piloted, relying on the Center for Disease Control and Control, social organizations of men who had sex with men and designated hospitals of each city, a snowball sampling method was used to recruit male individuals aged 18 years and above with PrEP medication experience as the research subjects. The recruitment sample size was 306 people. The information such as their sociodemographic characteristics, PrEP service utilization patterns, medication compliance and influence paths were collected. The latent category analysis (LCA) was used to identify its PrEP service utilization patterns, and partial least squares path model was used to analyze the influence paths of PrEP medication compliance to calculate the path coefficient (β) and the moderating effect of PrEP medication compliance was analyzed using the multiple linear regression model [to calculate the slope (k)].The statistical analysis was performed using R 4.4.2 software. Results: A total of 290 subjects were included, with an age of (29.7±7.2) years. The majority of them were unmarried (89.7%) and had engaged in homosexual behavior (88.6%). Regarding the utilization patterns of PrEP medication services for the subjects, according to LCA, they were classified into three categories: category 1 (online initiation-loss to follow-up type), category 2 (health institution-full process management type), and category 3 (digital closed-loop-strong follow-up type), accounting for 31.3% (91/290), 37.7% (109/290), and 31.0% (90/290) respectively. The PrEP medication compliance was classified as poor, good, and moderate.The analysis of the influencing paths of PrEP medication adherence revealed that the positive influencing paths included different cities → different purchasing channels (β=0.599, 95%CI: 0.527-0.668), different purchasing channels → service satisfaction (β=0.482, 95%CI: 0.381-0.573), the frequency of safe sex use in the past 6 months → the risk motivation for unprotected sexual behavior (β=0.373, 95%CI: 0.263-0.482), liver and kidney function tests and follow-up service utilization → service satisfaction (β=0.337, 95%CI: 0.256-0.416). The analysis of moderating effects showed that category 2 (health institution-full process management type) had a strong moderating effect on the influence path from service satisfaction of the research subjects to PrEP medication adherence (k=1.483, P<0.001). Conclusions: The utilization pattern of PrEP medication services had a differentiated impact on the PrEP medication compliance of the male population. Different cities, different purchasing channels, service satisfaction, risk motives for sexual behavior, liver and kidney function tests, and follow-up services were the positive influencing variables of PrEP medication compliance. This study provided a reference basis for promoting PrEP services from standardization to personalized and precise intervention. 目的： 探讨男性人群HIV暴露前预防（PrEP）服务利用模式及其用药依从性的影响路径，为优化我国PrEP用药服务策略提供参考依据。 方法： 采用横断面研究设计，2023年6-10月在开展PrEP试点的昆明市、郑州市和广州市，依托CDC、MSM社会组织和定点医院，采用滚雪球抽样法招募≥18岁男性有PrEP用药经历者306人为研究对象，收集其社会人口学特征、PrEP服务利用模式和用药依从性及影响路径等信息。采用潜在类别分析（LCA）识别其PrEP服务利用模式，采用偏最小二乘路径模型分析其PrEP用药依从性的影响路径［计算路径系数（β）］，采用多元线性回归模型进行PrEP用药依从性的调节效应分析［计算斜率（k）］。应用R 4.4.2软件进行统计学分析。 结果： 纳入研究对象290人，年龄（29.7±7.2）岁，以未婚者（89.7%）和发生同性性行为者（88.6%）为主。研究对象的PrEP用药服务利用模式，按LCA分为3个类别：类别1（线上启动-失访型）、类别2（卫生机构-全程管理型）、类别3（数字闭环-强随访型），占比分别为31.3%（91/290）、37.7%（109/290）和31.0%（90/290），PrEP用药依从性分别为较差、较好和中等。PrEP用药依从性的影响路径分析发现，正向的影响路径包括不同城市→不同购药渠道（β=0.599，95%CI：0.527~0.668）、不同购药渠道→服务满意度（β=0.482，95%CI：0.381~0.573）、近6个月安全套使用频率→发生无保护性行为的风险动机（β=0.373，95%CI：0.263~0.482）、肝肾功能检测和随访的服务利用→服务满意度（β=0.337，95%CI：0.256~0.416）等。调节效应分析结果显示，类别2（卫生机构-全程管理型）在研究对象服务满意度至PrEP用药依从性的影响路径中调节作用较强（k=1.483，P<0.001）。 结论： PrEP用药服务利用模式对男性人群的PrEP用药依从性存在差异化影响，不同城市、不同购药渠道、服务满意度、发生性行为的风险动机、肝肾功能检测和随访的服务利用是PrEP用药依从性正向的影响路径变量。本研究为推动PrEP用药服务从标准化向个性化的精准干预提供参考依据。.
Objective: To understand the clinical and epidemiological characteristics of influenza virus and respiratory syncytial virus (RSV) infection in hospitalized children aged <5 years in Changzhou, Jiangsu Province, and compare their severity. Methods: Children aged <5 years and hospitalized for acute respiratory infections in Changzhou Children's Hospital from January 2024 to January 2025 were included, the information collection was conducted, multi-pathogen testing was carried out by fluorescent quantitative PCR, and χ2 test was used to compare the socio-demographic and clinical characteristics of children infected with influenza virus and RSV. Multivariate logistic regression analysis was then used to evaluate the association of severe acute respiratory infection (SARI) and severe respiratory infection with influenza virus and RSV. Results: A total of 1 946 cases were included, with 147 cases (7.6%) being infected with influenza virus and 371 cases(19.1%) being infected with RSV. The RSV infection rate (28.2%) was significantly higher than that of influenza virus infection (7.5%) in the children under 1 year old. Both influenza virus and RSV infection mainly occurred in winter and spring, with the incidence of RSV infection exhibiting greater fluctuation. Compared with influenza virus infection, children with RSV infection exhibited significantly higher proportions of wheezing and asthma, as well as difficulty of feeding, however, fever and rhinorrhoea occurred less frequently, the differences were significant (all P<0.05). After adjusting for age, multivariate logistic regression analyses revealed that RSV infection had higher risk for severe respiratory symptoms (aOR=2.7, 95%CI: 1.2-7.4) and SARI (aOR=2.7, 95%CI: 1.1-8.2)in age group <1 year. Furthermore, children infected with RSV were at a higher risk for severe respiratory infection in age group 1-4 years (aOR =2.9, 95%CI: 1.3-7.0). Conclusions: RSV-related respiratory infection was more severe than influenza virus infection in children under 5 years old. Children under 1 year old are at high risk for RSV infection, and further etiological surveillance is needed to reduce the risk for serious illness. 目的： 了解江苏省常州市<5岁住院儿童流感病毒和呼吸道合胞病毒（RSV）感染的临床和流行病学特征，对比2种病原体呼吸道感染严重程度。 方法： 收集2024年1月至2025年1月常州市儿童医院<5岁因急性呼吸道感染住院儿童，对纳入病例进行信息收集和采样，采用荧光定量PCR开展多病原检测。采用χ2检验比较流感病毒和RSV感染儿童社会人口学特征以及临床特征，采用多因素logistic回归模型分析严重急性呼吸道感染（SARI）及重症呼吸道感染与流感病毒和RSV关联程度。 结果： 共纳入病例1 946例，流感病毒感染147例（7.6%），RSV感染371例（19.1%），<1岁的RSV感染比例（28.2%）显著高于流感病毒（7.5%）。流感病毒和RSV感染均为冬春季高发，RSV波动幅度更大。与流感病毒感染相比，RSV感染儿童出现喘息/哮喘、喂养困难的比例较高，发热、流涕的出现比例更低，差异有统计学意义（均P<0.05）。调整年龄后，多因素logistic回归分析结果显示，相较于流感病毒，<1岁年龄组中，RSV会增加重症呼吸道感染（aOR=2.7，95%CI：1.2~7.4）以及SARI（aOR=2.7，95%CI：1.1~8.2）风险；1~4岁年龄组中，RSV感染增加儿童重症呼吸道感染风险（aOR=2.9，95%CI：1.3~7.0）。 结论： <5岁儿童RSV有关呼吸道感染严重程度高于流感病毒，<1岁儿童作为RSV感染的高危人群，需进一步加强病原学监测，降低重症发生风险。.
Objective: To analyze the contamination of avian influenza virus (AIV) in poultry related environment in Shaanxi Province, and provide reference for the improvement of local avian influenza prevention and control. Methods: The relevant environments in 10 prefecture-level cities in Shaanxi from 2020 to 2024 (including urban and rural live poultry markets, large-scale poultry breeding farms, areas with small-scale poultry breeding houses, and slaughter houses and processing plants, etc.), were selected as surveillance points. External environmental samples such as poultry manure, surface swabs of poultry cages, poultry drinking water, and swabs of chopping boards were collected monthly. The subtypes of AIV were detected by real-time fluorescence quantitative RT-PCR, and finally descriptive analysis was conducted according to the surveillance time, area, site and sample type. Statistical analysis was performed by using software SPSS 25.0. Results: The annual average positive rate of AIV in poultry related environments was 3.54% (466/13 152) in Shaanxi from 2020 to 2024. Exhibiting two distinct positive rate peaks, with slight variation with years. AIV was mainly detected in the Loess Plateau area in northern Shaanxi (8.10%, 221/2 728) and the Qinba Mountain area in southern Shaanxi (3.34%, 121/3 622). The surveillance sites with relatively high positive rates included urban and rural live poultry markets (7.50%, 219/2 920) and poultry slaughtering and processing houses (7.19%, 32/445). The sample types with relatively high positive rates included swabs of chopping boards (10.95%, 81/740) and poultry cleaning wastewater (7.39%, 37/501), the differences were significant (P<0.001). In the positive samples, H9N2 virus was detected in all years, indicating that it was the most common subtype (81.76%, 381/466). Conclusions: From 2020 to 2024, the contamination of H9N2 AIV existed widely in poultry related environments in Shaanxi. The urban and rural live poultry markets and poultry slaughtering and processing houses in the Loess Plateau area in northern Shaanxi and the southern Qinba Mountain area in southern Shaanxi were the key places for the prevention and control avian influenza. It is necessary to strengthen the surveillance for the contamination of AIV in the poultry related environments. In the areas with high incidences, active and effective intervention measures should be taken in the places at high risk to reduce the risk of avian influenza outbreaks in humans and poultry. 目的： 分析陕西省涉禽环境禽流感病毒（AIV）污染情况，为加强区域禽流感防控提供参考依据。 方法： 选取2020-2024年陕西省10个地市涉禽区县范围内的相关环境（城乡活禽市场、规模养殖场、散养户集中的地区和家禽屠宰加工厂等）作为监测点，按月采集禽类粪便、笼具物表擦拭物、禽类饮用水及宰杀或摆放禽肉案板擦拭物等外环境样本，采用实时荧光定量RT-PCR法进行AIV亚型检测，最后按照监测时间、地区、场所和样本类型进行描述性分析。采用SPSS 25.0软件进行统计学分析。 结果： 陕西省2020-2024年涉禽环境的AIV阳性率为3.54%（466/13 152）。历年均有检出，呈2个阳性高峰，不同年度的阳性高峰略有不同；地区分布主要集中在陕北黄土高原区（8.10%，221/2 728）和陕南秦巴山区（3.34%，121/3 622）；AIV阳性率较高的监测场所主要为城乡活禽市场（7.50%，219/2 920）和家禽屠宰加工厂（7.19%，32/445），AIV阳性率较高的样本类型主要为宰杀或摆放禽肉案板表面的擦拭样本（10.95%，81/740）和清洗禽类的污水（7.39%，37/501），差异有统计学意义（P<0.001）；AIV阳性样本病原谱以H9N2亚型为主（81.76%，381/466），且历年均有检出。 结论： 2020-2024年陕西省涉禽环境中持续存在H9N2亚型AIV污染，范围较广，陕北黄土高原区和陕南秦巴山区的城乡活禽市场和家禽屠宰加工厂为重点防控对象。在防控工作中，应持续监测涉禽环境的AIV污染情况，针对高发地区高发场所，采取积极有效的干预措施，降低人间及禽间的禽流感疫情的发生风险。.
Objective: To analyze the epidemiological characteristics of respiratory multi-pathogen co-detected in China during the 2023-2025 surveillance years based on influenza-like illness (ILI) surveillance data, and to characterize the distribution across populations, temporal periods, regions, and pathogen types. Methods: Data were obtained from the respiratory multi-pathogen surveillance of ILI outpatients and emergency department visits across 216 national sentinel hospitals within the National Acute Respiratory Infectious Disease Sentinel Surveillance Network from week 42 of 2023 to week 14 of 2025. Given that the surveillance spanned two distinct phases, the impact of adjustments to the surveillance protocol was evaluated. Descriptive epidemiological methods were employed to analyze the patterns of multi-pathogen co-detections. Results: A total of 175 131 ILI cases were tested during the 2023-2025 surveillance years, with an overall multi-pathogen co-detection rate of 17.99%. The predominant co-detection combination was "virus+bacteria" (66.64%), commonly involving influenza virus or rhinovirus paired with Streptococcus pneumoniae or Haemophilus influenzae. Significant differences in co-detection rates were observed across different age groups, genders, and occupations (all P<0.001). Regarding the population distribution, the highest rates were found in school-aged children (5-14 years, 26.62%) and infants/toddlers (0-4 years, 25.83%). Males (19.57%) exhibited a higher detection rate than females (16.39%). Temporally, the co-detection rate peaked during the winter and spring seasons. Spatially, South China exhibited the highest age-standardized co-detection rate (23.74%), while Northeast China reported the lowest (12.72%). Southern regions were characterized by prolonged circulation, whereas northern regions displayed short-term epidemic patterns. Conclusions: Multi-pathogen co-detections were prevalent in China during the 2023-2025 surveillance years, characterized by a distinct clustering in younger age groups and a "high in the south, low in the north" geographic trend. Synergistic co-detection of viruses and bacteria remains the primary manifestation. It is recommended to strengthen multi-pathogen surveillance and data analysis in high-prevalence regions and among school-aged populations, and to implement differentiated prevention and control strategies tailored to regional seasonal characteristics. 目的： 基于流感样病例（ILI）监测分析2023-2025监测年度我国呼吸道多病原共同检出的流行病学特征，了解不同人群、时间、地区和病原分布情况。 方法： 选取全国急性呼吸道传染病哨点监测网络2023年第42周至2025年第14周全国216家国家级哨点医院门急诊ILI的呼吸道多病原监测数据。考虑监测涵盖2个阶段，评估监测方案调整对数据的影响，并描述性分析不同人群、时间和地区呼吸道多病原共同检出的流行特征。 结果： 2023-2025监测年度共检测门急诊ILI 175 131例，呼吸道多病原共同检出率为17.99%。病原组合以病毒+细菌为主（66.64%），常见流感病毒或鼻病毒与肺炎链球菌、流感嗜血杆菌的共同检出。不同年龄、性别和职业人群的多病原共同检出率差异有统计学意义（均P<0.001）。人群分布上，5~14岁学龄儿童（26.62%）和0~4岁婴幼儿（25.83%）检出率最高，男性检出率（19.57%）高于女性（16.39%）。时间分布上，冬、春季共同检出率较高。地区分布上，华南地区的年龄标化检出率最高（23.74%），东北地区最低（12.72%）；南方地区流行持续时间长，北方地区则表现为短时流行模式。 结论： 2023-2025监测年度我国呼吸道多病原共同检出普遍存在，且呈现明显的低龄化聚集和“南高北低”的区域流行特征。病毒与细菌的协同感染是主要的共同检出形式。建议加强高发地区及学龄人群中的多病原监测和结果分析，并根据不同区域的季节性特征制定差异化的防控策略。.
In the context of increased prevalence of chronic diseases and associated risk factors in China, the "Healthy China 2030" plan requires the shift of the health focus to prevention and the integration of sports-exercise and medicine. Based on the research of related literatures published both at home and abroad, this consensus was developed by an expert panel led by the Sichuan Medical Association in collaboration with professionals from healthcare and sports sectors. The consensus aims to standardize the construction of exercise prescription service organization, promote the scientific application of exercise prescription in health promotion, disease prevention, and chronic disease management. The consensus specifies the requirement for exercise prescription service in terms of facility and equipment, human resource, service workflow, and quality control. The consensus emphasizes tailoring the scale of construction according to actual needs and the consensus is applicable to different institutions, including medical facilities, medical fitness center, health management organizations, exercise-based health promotion center, sports service providers, and fitness center. It also provides guidance for configuring and evaluating hardware and software conditions. 为应对我国慢性病及其风险流行态势的日趋严峻，落实《“健康中国2030”规划纲要》“健康关口前移、体医融合”发展的要求，研究组在循证近年来国内外相关文献的基础上，由四川省医学会牵头，联合医疗卫生、体育领域专业人员共同讨论完成本共识。本共识旨在规范运动处方执行服务机构的建设和服务，推动运动处方在健康促进、疾病预防和慢性病管理中的科学应用。共识就运动处方开具和执行服务机构在基本要求、设施设备、人员配置、服务流程、质量控制等方面的建设内容提供了规范意见。强调根据实际需求，选择建设规模，适用于各级医疗机构、医学运动健康中心、健康管理机构、运动健康促进中心、体育服务机构、健身房等，参考配置硬件和软件条件，并进行建设和评估。.
In oncology clinical trials, the duration of response (DOR) is limited by the inclusion of only responders, leading to selection bias and violating the principle of randomization. To address this limitation, this study introduces the restricted mean duration of response (RMDOR) as a novel composite efficacy endpoint. The definition, parameter estimation, and hypothesis testing procedures of RMDOR were systematically described, and an example analysis was conducted using data from a phase Ⅲ non-small cell lung cancer clinical trial with the package "PBIR". RMDOR integrates information from the objective response rate, time to response, and DOR at the intention-to-treat population level, effectively compensating for the limitations of single endpoints. The example analysis demonstrated that RMDOR provides a stable and rational quantification of treatment differences between therapeutic regimens. RMDOR offers a new methodological tool for oncology trials that preserves the advantages of randomization under the intention-to-treat principle while comprehensively reflecting treatment benefits. Its combined use with traditional endpoints is recommended in future clinical studies. 肿瘤临床试验中，缓解持续时间（DOR）因仅纳入缓解者分析，存在选择偏倚并违背了随机化原则。为克服这一局限，本文介绍了限制平均反应持续时间（RMDOR）这一新型复合疗效指标的应用价值。本文系统阐述了RMDOR的定义、参数估计及假设检验方法，并结合“PBIR”软件包对一项非小细胞肺癌Ⅲ期临床试验数据进行了实例分析。RMDOR能够在意向性分析人群层面同时整合客观缓解率、起效时间和DOR的信息，有效弥补单一终点的不足。实例分析结果显示，RMDOR可对不同治疗方案的疗效差异进行稳定而合理的量化评估。RMDOR为肿瘤临床试验提供了一种新的方法学工具，能够在保持意向性治疗随机化优势的同时，综合反映治疗获益，建议在实际研究中与传统终点联合应用。.
Objective: To explore the association between childhood sexual abuse (CSA) and HIV infection risk among men who have sex with men (MSM), and to examine the mediating role of intimate partner violence (IPV) in the relationship, thereby providing a reference basis for targeted interventions. Methods: A cross-sectional study design was adopted. From July 2023 to January 2024, with the assistance of social organizations for sexual minorities in Wuhan, a total of 1 321 MSM were recruited by convenient sampling and peer-driven sampling methods. The questionnaire designed by the mobile version of Wenjuanxing was used to collect information such as the sociodemographic characteristics, CSA, IPV and HIV high-risk behaviors of subjects. The HIV infection risk score was calculated using the comprehensive risk assessment tool. The effects of CSA and IPV on high-risk behaviors were analyzed by multiple linear regression, and the mediating effect of IPV was tested by the Bootstrap method. Subgroup analyses were conducted according to IPV types and different HIV high-risk behaviors. Results: Among the 1 054 subjects of MSM, the self-reporting rates of those who had experienced CSA and IPV were 22.8% (240/1 054) and 14.8% (158/1 054), respectively. Among high-risk behaviors of HIV, the self-reporting rates of having 2-5 homosexual sexual partners in the last 6 months, unprotected anal sex in the last 6 months, and having multiple sexual partners were 59.1% (623/1 054), 49.2% (519/1 054), and 26.3% (277/1 054), respectively.The multiple linear regression model analysis showed that MSM who had experienced CSA and IPV had a higher HIV infection risk score (β=0.437, 95%CI: 0.051-0.823; β=0.465, 95%CI: 0.008-0.920).Subgroup analysis of IPV types revealed that suffering IPV played a partial mediating role in the relationship between CSA and HIV infection risk score (β=0.045, 95%CI: 0.002-0.110), with the mediating effect accounting for 10.3% of the total effect. Subgroup analysis of high-risk behaviors for HIV revealed that in CSA and unprotected anal sex relationships, comprehensive, suffered and administered IPV (β=0.015, 95%CI: 0.002-0.030; β=0.014, 95%CI: 0.001-0.020; β=0.017, 95%CI: 0.002-0.030) all exerted a complete mediating effect. In the relationship between CSA and parallel multiple sexual partners, the comprehensive and implemented IPV (β=0.009, 95%CI: 0.000-0.020; β=0.011, 95%CI: 0.001-0.020) exert a complete mediating effect. Conclusions: MSM who have experienced CSA directly increase the risk of HIV infection, and can also indirectly increase the risk of HIV infection through IPV. Moreover, the mediating effect of IPV showed specificity in terms of type and behavior. 目的： 探讨MSM儿童期性虐待（CSA）与HIV感染风险的关联，并探索亲密性伴暴力（IPV）在两者关系中的中介作用，为针对性干预策略的制定提供参考依据。 方法： 采用横断面研究设计，2023年7月至2024年1月在武汉市性少数人群社会组织的协助下，采用方便抽样和同伴推动抽样法招募MSM共1 321人。采用问卷星手机版设计的调查问卷收集研究对象的社会人口学特征、CSA、IPV及HIV高危行为等信息。采用综合风险评估工具计算HIV感染风险评分，运用多元线性回归分析CSA与IPV对高危行为的影响，并采用Bootstrap法检验IPV的中介效应，按IPV类型、不同HIV高危行为进行亚组分析。 结果： 在MSM研究对象1 054人中，经历过CSA和IPV 的自我报告率分别为22.8%（240/1 054）和14.8%（158/1 054）。在HIV高危行为中，最近6个月有同性性伴数为2~5个、最近6个月发生无保护肛交、并行多性伴的自我报告率分别为59.1%（623/1 054）、49.2%（519/1 054）、26.3%（277/1 054）。多元线性回归模型分析结果显示，经历过CSA和IPV的MSM有更高的HIV感染风险评分（β=0.437，95%CI：0.051~0.823；β=0.465，95%CI：0.008~0.920）。IPV类型的亚组分析发现，遭受型IPV在CSA与HIV感染风险评分关系中发挥部分中介效应（β=0.045，95%CI：0.002~0.110），中介效应占总效应的10.3%。HIV高危行为的亚组分析发现，在CSA和无保护肛交关系中，综合型、遭受型和实施型IPV（β=0.015，95%CI：0.002~0.030；β=0.014，95%CI：0.001~0.020；β=0.017，95%CI：0.002~0.030）均发挥完全中介效应。在CSA与并行多性伴的关系中，综合型和实施型IPV（β=0.009，95%CI：0.000~0.020；β=0.011，95%CI：0.001~0.020）发挥完全中介效应。 结论： 经历过CSA的MSM直接增加了HIV感染风险，也可通过IPV间接增加HIV感染风险，并且IPV的中介效应呈现类型与行为的特异性。.
Objective: To analyze the association between hospital visit data and data of school absence due to illness in primary and secondary school students, and evaluate the performance of different monitoring data in early warning of infectious disease outbreaks. Methods: Thirteen primary and secondary schools in Dapeng New District, Shenzhen, were selected to conduct the study. Data of infectious disease-related hospital visits in local students from January 1, 2015 to December 31, 2019 were collected from Chinese Disease Prevention and Control Information System, and the monitoring data of school absence due to illness during the period were collected from Shenzhen Student Health Monitoring System. Spearman rank correlation analysis was used to evaluate the time-series correlation between the two types of data. An early warning strategy was established by using the moving average method combined with a fixed-threshold method. The performance of different early warning strategies were evaluated by using indicators such as positive predictive value (PPV) and sensitivity, the school outbreak data reported in Shenzhen Disease Cluster Surveillance System were used as the gold standard. Results: A total of 1 870 cases of school absence due to infectious diseases were found in local primary and secondary school students. The main diseases were influenza, varicella, and mumps, with fever, cough, and sore throat being the most common reasons for school absence. During the study period, 52 infectious disease outbreaks were reported in local primary and secondary schools, which were mainly caused by influenza and varicella. A lag correlation was observed between the hospital visit data and the school absence monitoring data (r=0.31, P<0.001), with the latter detecting outbreaks earlier. Hospital monitoring, school absence monitoring, serial monitoring and parallel monitoring triggered 385, 491, 298, and 876 early warning signals, respectively. The hospital monitoring alone achieved the highest positive prediction value (66.49%), the serial monitoring achieved the highest specificity (98.42%), and the parallel monitoring achieved the highest sensitivity (100.00%) and Youden index (80.52%). Conclusions: The information about infectious disease obtained from hospital visit data lags behind monitoring data of school absence due to illness in primary and secondary school students. A parallel early warning strategy combining both monitoring methods enables accurate and rapid outbreak detection, providing data support for epidemiological investigation and prevention and control resource allocation. 目的： 分析中小学生传染病就诊与因病缺勤监测数据之间的关联，评估不同监测数据在传染病疫情预警中的作用。 方法： 选取深圳市大鹏新区13所中小学校，收集2015年1月1日至2019年12月31日中国疾病预防控制信息系统中的中小学生传染病就诊监测数据，以及深圳市学生健康监测系统中的因病缺勤监测数据。采用Spearman秩相关分析比较监测数据的时间序列相关性，运用移动平均数法结合固定阈值法建立预警策略，并以深圳市聚集性疫情监测系统中报告的中小学校聚集性疫情数据作为验证基准，通过阳性预测值、灵敏度等指标评估不同预警策略的效能。 结果： 共收集1 870例因传染病导致缺勤的中小学生病例，以流感、水痘和流行性腮腺炎为主，缺勤原因主要为发热、咳嗽和咽痛。期间共报告52起中小学校聚集性疫情，主要为流感和水痘。传染病就诊与因病缺勤监测数据之间存在滞后相关性（r=0.31，P<0.001），后者能较早发现疫情。传染病就诊监测、因病缺勤监测、串联监测和并联监测分别触发预警385、491、298和876个预警信号。传染病就诊监测单独预警的阳性预测值最高（66.49%），串联监测预警的特异度最高（98.42%），而并联监测预警的灵敏度与约登指数均为最高（100.00%和80.52%）。 结论： 中小学生传染病就诊监测在时间上滞后于因病缺勤监测，采用两者并联监测预警策略能够实现疫情的准确、快速识别，为流行病学调查和防控资源配置提供数据支持。.
Objective: To clarify the incidence and influencing factors of spontaneous HBsAg seroclearance in community-based chronic HBV-infected individuals. Methods: A total of 5 649 individuals who had never received antiviral treatment were included in this long-term follow-up cohort study. A Fine-Gray competing risk model (F-G model) was used to estimate HBsAg seroclearance incidence and analyze the factors influencing spontaneous HBsAg seroclearance. Results: By the end of 2023 follow-up, a total of 707 participants had achieved spontaneous HBsAg seroclearance in 48 144 person-years of follow-up with the seroclearance rate of 1.47/100 person-years. Analysis using the F-G model demonstrated a higher likelihood of HBsAg seroclearance among: males [sub-distribution hazard ratio (sHR)=1.48, 95%CI: 1.21-1.81, P<0.001], individuals aged 60 years and above (sHR=2.19, 95%CI: 1.21-3.95, P=0.009), obese individuals (sHR=1.38, 95%CI: 1.09-1.74, P=0.007) and HBV DNA-negative individuals (sHR=7.42, 95%CI: 3.89-14.20, P<0.001). Participants with slow decline, slow increase, or significant increase in HBV DNA level had a lower likelihood of HBsAg seroclearance compared to those with significant decline (all P<0.05). Those with high-normal or fluctuating ALT had a lower likelihood of HBsAg seroclearance compared to those with persistently low-normal ALT (both P<0.001). Conclusions: The spontaneous HBsAg seroclearance rate in chronic HBV-infected individuals was relatively low. In the context of expanded antiviral treatment, more strict ALT treatment threshold can be adopted, and the ALT level and HBV DNA level should be continuously monitored to promote HBsAg seroclearance. 目的： 明确社区来源慢性HBV感染者中HBsAg自然阴转发生情况及影响因素。 方法： 通过对无抗病毒治疗史的慢性HBV感染者5 649人进行长期随访，观察其HBsAg自然阴转发生情况，采用Fine-Gray竞争风险模型（F-G模型）进行HBsAg自然阴转的影响因素分析。 结果： 截至2023年随访结束，队列共随访48 144人年，发生HBsAg阴转707人，HBsAg阴转率为1.47/100人年。F-G模型分析结果显示，男性［亚分布风险比（sHR）=1.48，95%CI：1.21~1.81，P<0.001］、年龄≥60岁（sHR=2.19，95%CI：1.21~3.95，P=0.009）、肥胖（sHR=1.38，95%CI：1.09~1.74，P=0.007）和HBV DNA阴性（sHR=7.42，95%CI：3.89~14.20，P<0.001）的慢性HBV感染者HBsAg阴转可能性较高。HBV DNA水平缓慢下降、缓慢升高、明显升高者HBsAg阴转可能性低于明显下降者（均P<0.05）。高正常ALT、反复波动者HBsAg阴转可能性低于持续低正常ALT者（均P<0.001）。 结论： 慢性HBV感染者的HBsAg自然阴转率较低。在扩大抗病毒治疗的趋势下，可采用更为严格的ALT治疗阈值，并持续监测感染者的ALT水平和HBV DNA水平，以促进HBsAg阴转。.
Objective: To investigate the association between CD4+T lymphocytes (CD4) counts test index and immunological failure among HIV-infected patients receiving antiretroviral therapy in Taizhou, Zhejiang Province. Methods: A retrospective cohort study was conducted. A total of 4 609 HIV-infected patients aged 18 and above who received antiretroviral therapy (ART)were derived from Chinese Disease Prevention and Control Information System from 2006 to 2024.The CD4 counts test index was defined as the ratio of actual CD4 counts test times to theoretical test times, and were divided into four groups: 0.00-0.30 (extremely low detection group), 0.31-0.80 (low detection group), 0.81-1.20 (regular detection group), and ≥1.21 (enhanced detection group). Immunological failure was defined as the last CD4 counts after ART that did not exceed the baseline level or persistently below 100 cells/μl. Restricted cubic splines (RCS) and piecewise Cox proportional hazards models were used to analyze the dose-response relationship between the CD4 counts testing index and immunological failure. Results: Among 4 609 cases of HIV-infected patients, a non-linear U-shaped association was observed between the CD4 counts testing index and immunological failure (P<0.001), with an inflection point at 0.93. Below 0.93, each 0.1-unit increase in the index was associated with a 29% reduction in the risk of immunological failure (aHR=0.71, 95%CI: 0.65-0.77). Above 0.93, each 0.1-unit increase was associated with a 13% increase in risk (aHR=1.13, 95%CI: 1.09-1.16). Compared with the regular detection group, the risk of immunological failure was significantly higher in the extremely low, low, and enhanced detection groups. (aHR=7.60, 1.49, and 1.37, respectively). Subgroup analyses indicated that the association between a high testing index and immunological failure was positively correlated among patients with low BMI, sexual transmission, and low baseline CD4 counts levels. Conclusions: Among HIV-infected patients in Taizhou City, Zhejiang Province from 2006 to 2024, insufficient frequency of CD4 count testing or intensive testing based on clinical indications were both associated with the risk of immunological failure of ART. In the follow-up management of HIV-infected patients, on the basis of evaluating individual clinical indications and the efficacy of ART, the frequency of CD4 count testing should be reasonably arranged to provide precise and personalized ART and follow-up management plans for HIV-infected patients. 目的： 探讨浙江省台州市HIV感染者CD4+T淋巴细胞（CD4）计数检测指数与抗病毒治疗（ART）免疫学失败的关联。 方法： 采用回顾性队列研究，研究对象来源于中国疾病预防控制信息系统，共纳入2006-2024年接受ART的≥18岁HIV感染者4 609例。CD4计数检测指数定义为实际CD4计数检测次数与理论应检测次数之比，CD4计数检测指数分为4组：0.00~0.30（极低检测组）、0.31~0.80（低检测组）、0.81~1.20（常规检测组）、≥1.21（强化检测组）；免疫学失败定义为ART后末次CD4计数未超过基线值或持续<100个/μl。采用限制性立方样条（RCS）和分段Cox比例风险回归模型分析CD4计数检测指数与免疫学失败的剂量-反应关系。 结果： 在HIV感染者4 609例中，HIV感染者CD4计数检测指数与ART免疫学失败呈非线性的U形关系（P<0.001），拐点为0.93。CD4计数检测指数<0.93时，每增加0.1单位，ART免疫学失败风险降低29%（aHR=0.71，95%CI：0.65~0.77）；CD4计数检测指数≥0.93时，每增加0.1单位，ART免疫学失败风险增加13%（aHR=1.13，95%CI：1.09~1.16）。与常规检测组相比，极低检测组、低检测组和强化检测组的ART免疫学失败风险均显著升高（aHR值分别为7.60、1.49和1.37）。亚组分析显示，在BMI偏低、性接触传播和基线CD4计数水平较低的HIV感染者中，CD4计数高检测指数与ART免疫学失败的关联有统计学意义。 结论： 在2006-2024年浙江省台州市HIV感染者中，CD4计数检测频次不足或基于临床指征的强化检测均与ART免疫学失败风险相关联。在HIV感染者的随访管理中，应在评估个体临床指征与ART效果的基础上，合理安排CD4计数检测频次，为HIV感染者提供精准化和个性化ART和随访管理方案。.
Objective: To analyze the epidemiological characteristics of typhoid/paratyphoid fever and the patient medical treatment flow in Guizhou Province from 2015 to 2024, and provide reference for the prevention and control of typhoid/paratyphoid fever. Methods: The incidence data of typhoid/paratyphoid fever in Guizhou from 2015 to 2024 were collected from the Infectious Disease Reporting Information Management System of the China Disease Prevention and Control Information System. The data of the epidemics were obtained from the Public Health Emergency Management Information System and the field investigation reports from local centers for disease control and prevention. Descriptive epidemiological methods were used to analyze the epidemiological characteristics of typhoid/paratyphoid fever and the patient medical-seeking flow. Results: From 2015 to 2024, a total of 4 476 cases, including 2 deaths, of typhoid/paratyphoid fever were reported in Guizhou, i.e. 3 294 cases of typhoid fever and 1 182 cases of paratyphoid fever. The annual average incidence rate was 1.22/100 000, and the case fatality rate was 0.044 7%. In the reported cases, 1 793 (40.06%) were confirmed, including 1 065 cases of typhoid fever and 728 cases of paratyphoid fever. The overall incidence rate showed a downward trend (average annual percentage change=-6.50%, P=0.005). The period with high-incidence was from June to October (2 415 cases, 53.95%). The average incidence rate was high in Qiannan Buyi and Miao Autonomous Prefecture (4.23/100 000), Liupanshui (1.63/100 000), and Tongren (1.38/100 000). The average incidence rate in rural area (1.69/100 000) was higher than that in urban area (0.76/100 000). The male to female ratio of the cases was 1.10∶1 (2 346∶2 130), and the majority of the cases were aged 5-69 years (3 917 cases, 83.09%). The majority of the cases were the jobless and unemployed (1 625 cases, 36.30%), home-cared children (695 cases, 15.53%), and students (654 cases, 14.61%). A total of 6 epidemics of typhoid/paratyphoid fever were reported with an attack rate of 0.43% (107/24 919). The epidemics occurred in 3 schools, 3 rural communities, and 3 urban-rural fringe communities. There were 5 waterborne transmission cases and 1 foodborne transmission case. In the 4 476 cases of typhoid/paratyphoid fever, 10.37% sought medical treatment in local areas, 85.30% sought medical treatment in the province, and 4.33% sought medical treatment in other provinces. In 33 counties (districts) in Guizhou, there were 1 572 typhoid/paratyphoid fever cases seeking medical treatment in the province, in whom 1 505 (95.74%) went to the provincial or prefectural capital cities for medical treatment. In the 194 cases seeking medical treatment in other province, 108 went to Yunnan (55.67%). In the 4 476 typhoid/paratyphoid fever cases reported in Guizhou, 2 081 were reported by county (district) level medical institutions (46.49%), and 29 were reported by township (community) level medical institutions (0.65%). The M (Q1, Q3) of interval between onset and diagnosis were 5 (3, 9) days, with 476 cases (10.63%), 529 cases (11.82%), 1 605 cases (35.85%), 1 275 cases (28.49%), 397 cases (8.87%), and 194 cases (4.34%) being diagnosed within 0, 1-2, 3-6, 7-13, 14-29 and ≥30 days respectively. Conclusions: From 2015 to 2024, the incidence of typhoid/paratyphoid fever decreased significantly to a historical low level in Guizhou. However, it was still high compared with others areas in China. The diagnosis of typhoid/paratyphoid fever needs to be improved. A notable proportion of cases seek medical care across regions, which increases the potential risks of transmission, endemic spread, and outbreaks. It is necessary to strengthen the performance of grassroots medical institutions and conduct joint prevention and control, integration of medical and prevention, surveillance and early warning, risk assessment, standardized diagnosis, and precise intervention. 目的： 分析2015-2024年贵州省伤寒/副伤寒的流行特征与病例就医流向网络模式，为伤寒/副伤寒防控提供参考依据。 方法： 资料来源于中国疾病预防控制信息系统传染病报告信息管理系统2015-2024年贵州省伤寒/副伤寒病例卡片数据，聚集性/暴发疫情数据来源于突发公共卫生事件管理信息系统和各级CDC现场调查报告。采用描述性流行病学方法分析伤寒/副伤寒的流行特征和就医流向网络模式。 结果： 2015-2024年贵州省伤寒/副伤寒累计报告病例4 476例（伤寒3 294例，副伤寒1 182例），死亡2例，年均发病率为1.22/10万，病死率为0.044 7%。其中确诊病例1 793例（伤寒1 065例，副伤寒728例）占40.06%。年发病率总体呈下降趋势（年平均变化百分比=-6.50%，P=0.005）。高发季节为6-10月（2 415例，53.95%）。年均发病率高于全省水平的地区有黔西南布依族苗族自治州（4.23/10万）、六盘水市（1.63/10万）和铜仁市（1.38/10万）。乡村年均发病率（1.69/10万）高于城镇（0.76/10万）。病例男女性别为1.10∶1（2 346∶2 130），发病年龄以5~69岁（3 917例，83.09%）为主，发病人群以家务及待业人员（1 625例，36.30%）、散居儿童（695例，15.53%）和学生（654例，14.61%）居多。共报告6起伤寒/副伤寒暴发疫情，罹患率为0.43%（107/24 919）。发生场所为学校3起，农村及城乡接合部3起。水型传播5起，食物型1起。4 476例病例中，10.37%为就近就医，85.30%为省内流动就医，4.33%为跨省流动就医。省内跨区域就医涉及33个县（市、区）1 572例，95.74%（1 505/1 572）流向省会及市州政府所在地。跨省就医55.67%（108/194）流向云南省。46.49%（2 081/4 476）由县（市、区）级医疗机构报告，0.65%（29/4 476）由乡镇（社区）级医疗机构报告。发病和诊断的时间间隔M（Q1，Q3）为5（3，9）d，其中，0、1~、3~、7~、14~和≥30 d者分别占10.63%（476例）、11.82%（529例）、35.85%（1 605例）、28.49%（1 275例）、8.87%（397例）和4.34%（194例）。 结论： 2015-2024年贵州省伤寒/副伤寒发病率显著下降，发病率处于全省历史低位，但仍位居全国前列，病例诊断能力和及时性有待提高，多数病例的跨区域流动就医，增加了潜在传播、流行和暴发风险，亟需加强基层医疗机构能力培训，强化联防联控、医防融合、监测预警、风险评估、规范诊疗和精细干预等防控措施。.
Children constitute a high-risk population for rabies exposure due to their physiological and psychological characteristics and limited self-protection abilities, making them particularly vulnerable to severe bites on the head, face, or multiple body parts, which significantly increases the risk of disease onset. Furthermore, rabies post-exposure prophylaxis in children exhibits distinct features in wound management, rabies vaccination, and the use of passive immunizing agents. To address the current challenges of inconsistent awareness and suboptimal practices in rabies exposure prevention for children in China, the Rabies Prevention and Control Committee of the Chinese Preventive Medicine Association, the Branch of Animal Injury Treatment, China Association for Disaster and Emergency Rescue Medicine, the Branch of Animal Injury and Prevention & Treatment of Acute Infectious Diseases, Beijing Association of Holistic Integrative Medicine have developed this consensus. Based on a comprehensive review and evaluation of the latest domestic and international research evidence, as well as relevant standards and guidelines, this consensus integrates clinical practice characteristics specific to rabies exposure prevention in Chinese children, aiming to systematically improve the standardization and quality of rabies exposure prevention management nationwide. 儿童属于狂犬病暴露的高风险人群。由于儿童的生理、心理特点以及自我防护能力较弱等原因，易出现头面部或全身多处严重咬伤，发病风险较高。而且儿童狂犬病暴露后预防在伤口处置、狂犬病疫苗和被动免疫制剂应用等方面存在自身特点。为应对当前我国儿童狂犬病暴露后预防实践中存在的认知不统一、处置欠规范等问题，中华预防医学会狂犬病预防控制工作委员会、中国医学救援协会动物伤害救治分会、北京整合医学会动物致伤与急性传染病防治分会组织国内相关领域专家，在全面检索和评价国内外最新研究证据的基础上，参考相关规范与指南，结合我国儿童狂犬病暴露后预防的临床经验制定本共识，以期全面提升我国儿童狂犬病暴露后预防的处置水平。.
Objective: To conduct precise health education about mpox in men who have sex with men (MSM) based on internet platforms and evaluate its performance on the improvement of the mpox related knowledge awareness level in this population. Methods: In January 2025, a randomized controlled study was conducted in MSM recruited through the "Sunshine Test" WeChat official account of the Hangzhou Coastal Public Welfare Social Organization. By using a random number table, the MSM were divided into education group and control group at ratio of 1∶1, and all of them completed a baseline electronic questionnaire. Based on the baseline survey results, the MSM in the education group were further divided into 3 awareness level groups, i.e. high awareness level group (≥12 correct answers), medium awareness level group (9-11 correct answers), and low awareness level group (≤8 correct answers). Tailored educational materials were delivered at different frequencies to conduct precise health education for one month. Finally, mpox knowledge awareness level were compared between the two groups. Results: A total of 360 MSM were included in data analysis, including 176 in the education group and 184 in the control group. In the baseline survey, the proportions of MSM with high awareness level in the education group and in control group were 46.0% and 46.7%, respectively, the difference was not significant. After the precise health education, the proportions of the MSM with high awareness levelin the education group and control group were 84.7% and 58.7%, respectively, the difference was significant (P<0.001). Conclusions: The awareness level of mpox related knowledge was relatively low in MSM. The internet-based precision health education can rapidly improve the awareness level of mpox related knowledge in MSM. 目的： 通过互联网平台实施精准宣教，并观察能否提升男男性行为人群（MSM）猴痘知识知晓水平。 方法： 采用随机对照研究设计。2025年1月，以杭州市海岸公益社会组织“阳光测”公众号为平台招募研究对象，使用随机数字表法将研究对象按1∶1分为宣教组和常规组，并完成基线电子问卷调查。根据基线调查结果，将宣教组研究对象分为高（回答正确的题目数≥12道）、中（回答正确的题目数9~11道）、低（回答正确的题目数≤8道）知晓水平组，并以不同频率推送针对性宣教材料，为期1个月。最终对宣教组和常规组研究对象的猴痘知识知晓水平进行评估。 结果： 共纳入360名研究对象进行分析，其中宣教组176名，常规组184名。基线调查中宣教组和常规组研究对象的猴痘知识高知晓水平组构成比分别为46.0%和46.7%，差异无统计学意义。经过精准宣教后，评估调查中宣教组和常规组研究对象的猴痘知识高知晓水平组构成比分别为84.7%和58.7%，差异有统计学意义（P<0.001）。 结论： MSM猴痘知识知晓水平较低，基于互联网平台的精准宣教模式短期内可以有效提高MSM猴痘知识知晓水平。.
Objective: To analyze characteristics and trends in the incidence of diabetes mellitus, type 2 (T2DM) in Tianjin, 2006-2024, and to provide scientific bases for formulating the priorities of diabetes prevention and control efforts. Methods: The data were sourced from the diabetes incidence surveillance dataset collected by Tianjin CDC. The gender- and age-standardized incidence rate was calculated, using the standard population from the 2010 Chinese population census. Using R 4.3.2 and Joinpoint 5.0 software, the annual percentage change (APC) and the average annual percentage change (AAPC), along with their trend changes, were calculated and analyzed. Furthermore, differences across genders, urban and rural areas, and age groups were compared. Results: From 2006 to 2024, there were a total of 462 951 T2DM-onset cases in Tianjin. The crude incidence rate rose from 99.17/100 000 to 351.71/100 000, and the standardized rate rose from 85.79/100 000 to 252.98/100 000, with the trend of the standardized rate increasing first (2006-2015 APC=13.66%, P<0.001) and then becoming stable (P=0.626). The standardized incidence rates in men were higher than those in women, and the upward trend of the standardized rate in men (AAPC=7.69%, P<0.001) was slightly greater than that in women (AAPC=5.98%, P<0.001). The standardized rates were higher in urban areas before 2010, and in rural areas after 2011, and the upward trend in urban areas (AAPC=4.87%, P<0.001) was slightly lower than that in rural areas (AAPC=6.28%, P=0.025). The crude rates of the age group aged ≥60 were much higher than those of the age groups aged 0-, 20-, and 40-. The trend of the former remained stable (P=0.138), while the trends of the latter three continued to rise, and the upward trend of the age group aged 20- (AAPC=10.57%, P<0.001) was slightly greater than that of the age groups aged 0- (AAPC=9.46%, P<0.001) and 40- (AAPC=7.58%, P<0.001). However, the differences in AAPC among genders, urban and rural areas, and age groups were not statistically significant (all P>0.05). Conclusions: The incidence trend of T2DM in Tianjin generally shows an initial increase followed by stabilization. The male, rural, and elderly groups are facing a higher risk of incidence, and the continuous increase in the incidence of early-onset T2DM among young people should be taken seriously. 目的： 分析天津市2006-2024年2型糖尿病（T2DM）的发病特征和变化趋势，为制定糖尿病防治工作重点提供科学依据。 方法： 数据来源于天津市CDC的糖尿病发病监测数据集，以2010年第六次全国人口普查结果为标准人口计算性别年龄别标化发病率，使用R 4.3.2和Joinpoint 5.0软件进行统计学分析，计算年变化百分比（APC）和平均年变化百分比（AAPC）并进行趋势分析，进一步对不同性别、城乡、年龄组的差异进行组间比较。 结果： 2006-2024年天津市新发T2DM共462 951例，粗发病率从99.17/10万上升至351.71/10万，标化发病率从85.79/10万上升至252.98/10万，标化发病率呈先上升（2006-2015年APC=13.66%，P<0.001）后平稳（P=0.626）的趋势。男性标化发病率高于女性，且男性标化发病率上升趋势（AAPC=7.69%，P<0.001）略大于女性（AAPC=5.98%，P<0.001）；2010年及以前城市标化发病率较高，2011年及以后农村较高，城市上升趋势（AAPC=4.87%，P<0.001）略小于农村（AAPC=6.28%，P=0.025）；≥60岁年龄组粗发病率远高于0~、20~、40~岁年龄组，但前者发病趋势较为平稳（P=0.138），而后三者发病率呈持续上升趋势，20~岁年龄组上升趋势（AAPC=10.57%，P<0.001）略大于0~岁年龄组（AAPC=9.46%，P<0.001）和40~岁年龄组（AAPC=7.58%，P<0.001）；性别、城乡、年龄组之间发病趋势的差异无统计学意义（均P>0.05）。 结论： 天津市T2DM发病水平总体呈先上升后稳定的趋势，其中男性、农村、老年群体面临较高的发病风险，早发T2DM发病率的持续上升应引起重视。.
Objective: To analyze the spatial clustering characteristics and spatiotemporal variation trends of newly reported HIV-infected men who have sex with men (MSM) in Zhengzhou, Henan Province, from 2015 to 2024, and provide evidence for the development of local AIDS prevention and control strategies in MSM. Methods: The incidence data of HIV infection in MSM in Zhengzhou from 2015 to 2024 were collected from Chinese Disease Prevention and Control Information System. Software Joinpoint 5.4.0 was used to analyze the change trend of the newly reported HIV infection in MSM. Software GeoDa 1.20 was used for spatial autocorrelation analysis, including local indicators of spatial association (LISA) analysis, to calculate the local Moran's I index and the relative length and curvature of the LISA time path analysis. Software SaTScan 10.2.5 was used for spatiotemporal scan analysis, and software ArcMap 10.8 was used for visualization of analysis results. Result: From 2015 to 2024, a total of 5 103 HIV infection cases were reported in MSM in Zhengzhou, in whom 2 778 (54.44%) had local residence in Zhengzhou. The change trend of HIV-infections reported in MSM in Zhengzhou was not obvious. At the scale of streets (townships), the HIV infections reported in MSM in Zhengzhou showed a spatial clustering from 2015 to 2024. The high-high clustering areas were mainly in southern part of Erqi and Guancheng Districts, northern part of Jinshui District, the eastern part of Zhongyuan District, and the adjacent areas of Xinmi and Xinzheng Cities, showing a trend from the main urban areas to the surrounding areas with the affected area expanding from 113.4 km² in 2015 to 595.67 km² in 2024. The LISA analysis indicated that the streets (townships) with a relative length of time path greater than the average value of Zhengzhou (Γi>1) were mainly distributed in main urban areas and their surrounding areas, such as Jinshui, Guancheng, Zhongyuan, Erqi and Huiji Districts, high-tech zone, economic development zone, and Zhengdong New District. The HIV infections newly reported in MSM in these areas changed significantly year by year, and the local spatial structure was more dynamic. The streets (townships) with curvature greater than the average value of Zhengzhou (Δi>14.145) were mainly distributed in the surrounding areas of these districts where the local spatial structure changed strongly over time and the trend of HIV infections newly reported in MSM was significantly different, showing an overflow or suction effect. The spatiotemporal scan analysis found that there was one type Ⅰ clustering area from 2015 to 2019 (log likelihood ratio=119.141, RR=2.09, P<0.001), with Mifengzhang Street in Erqi District as the center and a radiation radius of 7.35 km. Conclusions: From 2015 to 2024, there was a spatial clustering of newly reported HIV infection in MSM in Zhengzhou. The AIDS prevention and control in MSM in Zhengzhou should be strengthened in the main urban areas such as Jinshui, Guancheng, Zhongyuan, Erqi and Huiji Districts, high-tech zone, economic development zone, and Zhengdong New District, as well as the surrounding areas. The AIDS prevention and control strategies and measures should be improved in a timely manner according to the dynamic changes of the local spatial structure. 目的： 分析2015-2024年河南省郑州市新报告男男性行为人群HIV感染者（MSM感染者）的空间聚集特征及时空变化趋势，为制定MSM艾滋病区域化防治策略提供依据。 方法： 资料来源于中国疾病预防控制信息系统2015-2024年郑州市新报告MSM感染者数据，应用Joinpoint 5.4.0软件分析新报告MSM感染者数的变化趋势，应用GeoDa 1.20软件进行空间自相关分析，进行局部空间自相关（LISA）分析，计算局部Moran's I指数和LISA时间路径分析的相对长度和弯曲度。应用SaTScan 10.2.5软件进行时空扫描分析，应用ArcMap10.8软件对分析结果进行可视化。 结果： 2015-2024年郑州市新报告MSM感染者5 103例，其中，54.44%（2 778/5 103）为郑州市现住址。郑州市新报告MSM感染者数的变化趋势不明显；在街道（乡、镇）空间尺度上，2015-2024年郑州市新报告MSM感染者数存在空间聚集分布，高-高聚集区主要位于郑州市二七区南部、管城区南部、金水区北部和中原区东部等主城区内以及新密市、新郑市与以上区域的邻接区域，呈由主城区向周边转移和扩散的趋势，覆盖面积由2015年的113.4 km2扩大到2024年的595.67 km2。LISA分析的时间路径相对长度大于郑州市的全市平均值（相对长度>1）的街道（乡、镇）主要分布在金水区、管城区、中原区、二七区、惠济区、高新区、经开区、郑东新区等主城区及其周边区域，其新报告MSM感染者数年度变化幅度较大，局部空间结构变化更加动态；弯曲度高于全市平均值（弯曲度>14.145）的街道（乡、镇）主要分布在各区（县、市）交界区域，其局部空间结构时间变动性较强，报告病例数发展过程与周边区域差异较大，呈现溢出或虹吸效应。时空扫描分析发现，2015-2019年存在1个一类聚集区（对数似然比=119.141，RR=2.09，P<0.001），以二七区的蜜蜂张街道办事处为中心，辐射半径为7.35 km。 结论： 2015-2024年郑州市新报告MSM感染者数存在空间聚集性，郑州市MSM的艾滋病防控应重点关注金水区、管城区、中原区、二七区、惠济区、高新区、经开区、郑东新区等主城区及周边区域，并根据局部空间结构的动态变化特征及时调整和完善艾滋病防控策略和措施。.
Objective: To investigate the associations between alcohol intake and risks of chronic obstructive pulmonary disease (COPD) using self-reported alcohol intake and genetically predicted mean alcohol intake in adults in 10 areas of China. Methods: This study used baseline data collected in 2004-2008 from the China Kadoorie Biobank, and the COPD outcome was determined through long-term follow-up. After excluding participants with cancer, coronary heart disease, stroke or transient ischemic attack, asthma, tuberculosis, or COPD at baseline, 445 523 participants were included in the observational analysis. A total of 133 168 participants with complete genotyping data were included in the genetic analysis, after the same exclusion criteria were applied. Alcohol consumption patterns were obtained through a baseline questionnaire. The mean alcohol intake of male non-abstainers was calculated based on the combination of ALDH2-rs671 and ADH1B-rs1229984 genotypes and the study region, and all participants were divided into six groups (C1-C6) accordingly. Cox proportional hazards regression models were used to estimate the associations between exposure factors and risk of incident COPD. Results: In the observational analysis, 11 825 incident cases of COPD were identified during an average follow-up period of (11.8±2.1) years. After adjusting for potential confounders, occasional and current drinking was associated with lower risk of incident COPD in males, with HRs (95%CIs) of 0.80 (0.74-0.86), 0.75 (0.68-0.83), 0.84 (0.76-0.93), 0.86 (0.76-0.97) and 0.84 (0.75-0.94) for occasional and current drinkers consuming pure alcohol <140.0, 140.0-, 280.0-, ≥420.0 g/week respectively, while there was no significant association between abstainers and risk of COPD. In females, compared with non-drinkers, the risk of COPD reduced in all groups except for current drinkers consuming pure alcohol 70.0-139.9 g/week, with HRs (95%CIs) of 0.81 (0.68-0.96), 0.87 (0.82-0.93), 0.78 (0.62-0.99) and 0.77 (0.62-0.96) for abstainers, occasional and current drinkers consuming pure alcohol <70.0, 70.0-, ≥140.0 g/week respectively. In the genetic analysis, the risk of COPD in the C2-C6 groups was similar to that of males in the C1 group. In females, only the C4 group had a lower COPD risk compared to the C1 group (HR=0.79, 95% CI: 0.63-0.99). Conclusion: The study does not support a causal association between alcohol consumption and the risk of COPD. 目的： 评估中国10个地区成年人自报饮酒状况及基因预测的酒精摄入量与慢性阻塞性肺疾病（COPD）发病风险的关联。 方法： 利用中国慢性病前瞻性研究2004-2008年开展的基线调查数据，并通过长期随访确定COPD结局。观察性分析中剔除基线自报患有恶性肿瘤、冠心病、中风/小卒中发作、哮喘、肺结核或COPD的研究对象，最终纳入445 523例研究对象。在遗传分析中，采取相同的纳入排除标准，共纳入133 168例有完整基因分型数据的研究对象。饮酒信息通过基线问卷获取。按照ALDH2-rs671和ADH1B-rs1229984基因型组合及研究地区计算男性非戒酒者的平均纯酒精摄入量，并据此将所有研究对象分为6组（C1~C6）。采用Cox比例风险回归模型分析暴露因素与新发COPD结局风险间的关联。 结果： 观察性分析中，研究对象随访（11.8±2.1）年，共记录11 825例新发COPD事件。调整潜在的混杂因素后，男性中偶尔饮酒者及经常饮酒者COPD发病风险均有所降低，偶尔饮、经常饮<140.0、140.0~、280.0~和≥420.0 g/周的研究对象HR值（95%CI）分别为0.80（0.74~0.86）、0.75（0.68~0.83）、0.84（0.76~0.93）、0.86（0.76~0.97）和0.84（0.75~0.94），而戒酒与COPD发病风险无统计学关联；在女性中，与从不饮酒者相比，除经常饮酒70~ g/周与COPD发病风险无统计学关联外，其余各组发病风险均下降，已戒、偶尔饮、经常饮<70.0和≥140.0 g/周的研究对象HR值（95%CI）分别为0.81（0.68~0.96）、0.87（0.82~0.93）、0.78（0.62~0.99）和0.77（0.62~0.96）。遗传分析结果显示，与C1组研究对象相比，C2~C6组的男性COPD发病风险均无显著改变；在女性中，仅C4组COPD发病风险相较参照组有所降低（HR=0.79，95%CI：0.63~0.99）。 结论： 本研究结果不支持饮酒与COPD发病风险间的因果关联。.
Chronic kidney disease (CKD) is an irreversible progressive disease accompanied by multiple complications, and a cluster of chronic diseases caused by various complex factors such as hypertension and diabetes. Characterized by high prevalence and disability rates, it has been recognized as one of the important public health issues endangering human life and health worldwide. The etiology of CKD is complex and diverse; in addition to genetic factors, environmental factors also play a significant role in its development. With rapid industrialization and economic development in China, large amounts of metals are released into the environment, causing environmental pollution. After entering the human body, these metals are mainly excreted through the kidneys, where they tend to accumulate and exert adverse effects on renal structure and function. Among them, metals such as cadmium, arsenic, lead, and lithium can cause kidney damage. Therefore, this article summarizes the relationships between cadmium, arsenic, lead, lithium, other metals, and CKD, aiming to provide new insights for the prevention and control of CKD induced by metal exposure. 慢性肾脏病（CKD）是一种伴随多种并发症的不可逆进行性疾病，由高血压、糖尿病等多种复杂因素引起的一系列慢性疾病群。其具有高患病率和高致残率的特点，已被认为是在全球范围内危害人类生命健康的重要公共卫生问题之一。CKD的病因复杂多样，除遗传因素外，环境因素也是CKD的重要原因。随着工业化和经济的高速发展，大量金属被释放到环境中造成环境污染，而金属进入人体后主要经肾脏排泄，易在肾脏蓄积并对肾结构与功能产生影响，而镉、砷、铅、锂等金属会对肾脏造成损害。本文总结镉、砷、铅、锂和其他金属与CKD的关系，为预防和控制金属导致的CKD提供新思路。.
Objective: To investigate the associations between multiple non-invasive atherosclerotic indicators and the risk of cardiovascular disease (CVD) outcomes in Chinese adults. Methods: Based on data from the second resurvey (2013-2014) of the China Kadoorie Biobank (CKB), covering 25 239 adults across 10 regions, this study excluded 4 366 participants with missing key covariates and 3 386 with a prior history of coronary heart disease or stroke. A total of 17 487 adults were initially included to describe baseline characteristics. After further excluding participants with missing data on specific non-invasive atherosclerotic indicators, the final sample sizes for the association analyses were 17 456 for carotid intima-media thickness (cIMT), 17 456 for carotid plaque, 17 272 for ankle-brachial index (ABI), and 13 916 for arterial stiffness indicators. Cox proportional hazards regression models were used to analyze the associations of the four non-invasive atherosclerotic indicators [cIMT, carotid plaque, ABI, and arterial stiffness indices(reflection index and stiffness index)] with the risks of ischemic heart disease (IHD), ischemic stroke (IS), hemorrhagic stroke (HS), major adverse cardiovascular events (MACE), and total CVD. Results: During an average follow-up of 7.8 years, 3 975 incident CVD events were observed. cIMT thickening (HR=1.16-1.31) and the presence of carotid plaque (HR=1.21-1.43) were independent risk factors for IHD, IS, HS, MACE, and total CVD. Specifically, cIMT thickening increased the risk of total CVD by 21% (HR=1.21, 95%CI: 1.12-1.31), and the presence of carotid plaque increased the risk of total CVD by 27% (HR=1.27, 95%CI: 1.18-1.37). Both cIMT and plaque burden scores showed significant positive dose-response relationships with the risks of the aforementioned outcomes (P for trend <0.05): for every 1.0 mm increase in cIMT, the risk increased by 48%-74% (HR=1.48-1.74); for every 1.00-point increase in plaque burden score, the risk increased by 11%-17% (HR=1.11-1.17). ABI demonstrated a non-linear U-shaped association with CVD risk, with the lowest risk observed in the ABI range of 1.0-1.3. However, after adjustment for multiple testing, ABI showed no statistically significant associations with any cardiovascular endpoints. Similarly, arterial stiffness indices (reflection index and stiffness index) showed no statistically significant associations with cardiovascular endpoints. Conclusions: Both cIMT thickening and carotid plaque burden are significantly associated with an elevated risk of CVD, suggesting that incorporating non-invasive atherosclerotic indicators, particularly those derived from carotid ultrasound, into risk assessment may facilitate more comprehensive risk stratification and prevention for high-risk CVD populations in China. 目的： 探讨中国成年人多种无创动脉粥样硬化指标与心血管疾病（CVD）相关结局发生风险的关联。 方法： 基于中国慢性病前瞻性研究2013-2014年第二次重复调查的10个地区25 239例成年人的数据，剔除关键协变量缺失的成年人4 366例、既往患有冠心病或脑卒中的成年人3 386例，初步纳入17 487例成年人进行基线特征描述，进一步剔除无创动脉粥样硬化指标数据缺失的成年人后，最终纳入颈动脉内中膜厚度（cIMT）、颈动脉斑块、踝肱指数（ABI）和动脉僵硬度指标关联分析的样本量分别为17 456、17 456、17 272和13 916例。采用Cox比例风险回归模型，分析cIMT、颈动脉斑块、ABI和动脉僵硬度指标（反射指数和硬度指数）4种无创动脉粥样硬化指标与缺血性心脏病（IHD）、缺血性脑卒中（IS）、出血性脑卒中（HS）、主要不良心血管事件（MACE）和总CVD的风险关联。 结果： 在平均7.8年的随访期间，共观察到3 975例新发CVD事件。cIMT增厚（HR=1.16~1.31）和颈动脉斑块存在（HR=1.21~1.43）均是IHD、IS、HS、MACE和总CVD的独立危险因素；其中，cIMT增厚使总CVD风险增加21%（HR=1.21，95%CI：1.12~1.31），有颈动脉斑块使总CVD风险增加27%（HR=1.27，95%CI：1.18~1.37）。cIMT及斑块负担评分与上述结局风险呈显著正向剂量反应关系（趋势检验P<0.05）：cIMT每增加1.0 mm，各类结局风险增加48%~74%（HR=1.48~1.74）；斑块负担评分每增加1.00分，风险增加11%~17%（HR=1.11~1.17）。ABI与心血管病风险呈非线性U形关联，风险最低点位于1.0~1.3之间，但经多重检验校正后，ABI与各类心血管结局均无统计学关联。动脉僵硬度指标（反射指数和硬度指数）与心血管结局风险无统计学关联。 结论： cIMT增厚与颈动脉斑块负担增加与CVD发生风险升高显著相关，这提示将以颈动脉超声为主的无创动脉粥样硬化指标纳入风险评估，可能有助于对我国CVD高危人群进行更全面的风险分层与防控。.
Objective: To investigate the association between polycyclic aromatic hydrocarbons (PAHs) exposure and embryonic arrest, and the proportion of mediating effects of aryl hydrocarbon receptor (AHR) mRNA expression and 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels on this association. Methods: Using a 1∶2 matched case-control study, a total of 92 pregnant women diagnosed with embryonic arrest from April 2021 to April 2022 were selected as the case group, and 184 normal preganant women who voluntarily requested for abortion in the same hospital during the same period were usaed as the control group according to the match ratio of 1∶2. Abortion villus tissues were collected to detect the expression levels of PAH-DNA adducts, AHR mRNA expression and 8-OHdG levels. Conditional logistic regression was used to analyze the association of the three levels with embryonic arrest, and the mediating effects of AHR mRNA expression, and 8-OHdG levels were analyzed with R 4.3.3 software Mediation package. Results: The levels of PAH-DNA adducts, AHR mRNA expression, and 8-OHdG levels were higher in the embryonic arrest group than in the control group, and the differences were significant (all P<0.001). The results of mediating analysis showed that 8-OHdG levels partially mediated the association between PAHs exposure and embryonic arrest, with a mediating effect of 0.18 (95%CI:0.06-7.42), accounting for 16.07% of the total. And the expression of AHR mRNA mediated the levels of PAH-DNA adducts and 8-OHdG levels, with a mediation effect of 0.74 (95%CI:0.07-1.94), accounting for 27.11% of the total. Conclusion: PAHs exposure is a risk factor for embryonic arrest, which might cause DNA oxidative damage through increased AHR expression, further leading to embryonic arrest. 目的： 探讨多环芳烃（PAHs）暴露与胚胎停育的关联，分析芳香烃受体（AHR）mRNA表达及8-羟基脱氧鸟苷（8-OHdG）水平对该关联的中介效应。 方法： 采用1∶2匹配病例对照研究，于2021年4月至2022年4月纳入符合胚胎停育诊断标准的92例孕妇为病例组，按1∶2比例匹配同医院同期自愿要求人工流产的184例正常妊娠孕妇作对照组。采集流产绒毛组织检测PAH-DNA加合物、AHR mRNA表达及8-OHdG水平。采用条件logistic回归分析三者与胚胎停育的关联，用R 4.3.3软件Mediation包分析AHR mRNA表达、8-OHdG水平的中介效应。 结果： 病例组PAH-DNA加合物、AHR mRNA表达及8-OHdG水平均高于对照组，差异有统计学意义（均P<0.001）。中介效应分析显示，8-OHdG水平部分介导了PAHs暴露和胚胎停育的关联，中介效应为0.18（95%CI：0.06~7.42），占比为16.07%。AHR mRNA表达在PAH-DNA加合物与8-OHdG水平之间起中介作用，中介效应为0.74（95%CI：0.07~1.94），占比为27.11%。 结论： PAHs暴露是胚胎停育的危险因素，可能通过增加AHR表达引起DNA氧化损伤，进而导致胚胎停育。.