Acute necrotizing encephalopathy (ANE) is a rare but deadly complication with an unclear pathogenesis. We aimed to elucidate the immune characteristics of H1N1 influenza virusassociated ANE (IANE) and provide a potential therapeutic approach for IANE. Seven pediatric cases from a concentrated outbreak of H1N1 influenza were included in this study. The patients’ CD4+T cells from peripheral blood decreased sharply in number but highly expressed Eomesodermin (Eomes), CD69 and PD-1, companied with extremely high levels of IL-6, IL-8 in the cerebrospinal fluid and plasma. Patient 2, who showed high fever and seizures and was admitted to the hospital very early in the disease course, received intravenous tocilizumab and subsequently showed a reduction in temperature and a stable conscious state 24 h later. In conclusion, a proinflammatory cytokine storm associated with activated CD4+T cells may cause severe brain pathology in IANE. Tocilizumab may be helpful in treating IANE.

Objective:To dynamically study the iodine nutritional status of pregnant women in Guangxi Zhuang Autonomous Region (referred to as Guangxi), providing a basis for timely implementation of targeted prevention and control measures and scientific adjustment of intervention strategies.Methods:From 2015 to 2022, a survey was conducted in Guangxi on a county-by-county basis. One township/street was selected from each county based on the east, west, south, north, and center directions, and 20 pregnant women were selected from each township/street. Salt and urine samples were collected from the homes of pregnant women to detect salt and urine iodine levels.Results:A total of 78 034 pregnant women were surveyed from 2015 to 2022, with a median salt iodine concentration of 24.4 mg/kg. The overall coverage rate of iodized salt, qualification rate of iodized salt, consumption rate of qualified iodized salt, and the rate of non-iodized salt were 99.0% (77 250/78 034), 95.9% (74 105/77 250), 95.0% (74 105/78 034), and 1.0% (784/78 034), respectively. The comparison of qualified iodized salt consumption rates in different regions (cities) showed statistically significant difference (χ 2 = 3 801.28, P < 0.001), with Baise City had the highest (98.1%, 8 328/8 488) and Beihai City had the lowest (70.7%, 1 909/2 700); except for Beihai City, the consumption rate of qualified iodized salt in all other cities was over 90%. The median urinary iodine level among pregnant was 148 μg/L. The difference in urinary iodine levels among pregnant women between different years was statistically significant ( H = 2 516.52, P < 0.001), with the highest level in 2020 (169 μg/L) and the lowest level in 2015 (126 μg/L). From 2020 to 2022, the median urinary iodine level for pregnant women was ≥150 μg/L, while from 2015 to 2019, it was < 150 μg/L. There were statistically significant difference in urinary iodine levels among pregnant women in different regions (cities, H = 495.69, P < 0.001), with Liuzhou City and Guilin City had the highest levels (both at 156 μg/L), and Beihai City had the lowest level (132 μg/L). The median urinary iodine levels of pregnant women in the early, middle, and late stages of pregnancy were 154, 147, and 154 μg/L, respectively. There were statistically significant differences in urine iodine levels among pregnant women in different pregnancy stages ( H = 158.64, P < 0.001), with mid pregnancy being lower than early and late pregnancy ( P < 0.017). Conclusions:The overall iodine nutrition level of pregnant women in Guangxi is slightly insufficient, especially in coastal cities such as Beihai City. We should continue to adhere to the strategy of using iodized salt to prevent and control iodine deficiency disorders. At the same time, we should strengthen health education for pregnant women, and adopt targeted and precise iodine supplementation measures for pregnant women in different regions and during pregnancy.

Objective:To investigate the awareness and behavior of iodine deficiency disorders prevention and control knowledge among pregnant women in Guangxi Zhuang Autonomous Region (referred to as Guangxi), and provide a basis for further targeted health education.Methods:From June to August 2023, a cross-sectional study method was used conduct a questionnaire survey about the awareness and behavior of iodine deficiency disorders prevention and control knowledge on 819 pregnant women who underwent prenatal or inpatient examinations at county people's hospitals, maternal and child health centers, and township health centers in 14 counties of 7 cities in Guangxi.Results:A total of 819 valid questionnaires were collected in this survey. The score of iodine deficiency disorders prevention and control knowledge among pregnant women was (6.1 ± 2.8) points, with an awareness rate of 62.4% (511/819). There were statistically significant differences in the awareness rate of iodine deficiency disorders prevention and control knowledge among pregnant women of different ages, residence areas, fertility status, educational level, employmnet status, occupation, and per capita monthly income(χ 2 = 9.17, 37.51, 5.15, 87.12, 54.22, 50.17, 67.623, P < 0.05). There were statistically significant differences in various behaviors related to salt consumption habits, home salt packaging, awareness of which salt to eat, choices made when buying salt, salt preservation habits, whether or not the subject had eaten iodine-rich foods in the week before the survey, how often they had eaten iodine-rich foods in the year before the survey, and whether or not they had actively learned about iodine knowledge during pregnancy or before pregnancy between pregnant women with different levels of knowledge (χ 2 = 21.64, 12.81, 101.79, 123.20, 36.78, 59.76, 109.14, 98.10, P < 0.05). The main ways to obtain knowledge on prevention and control of iodine deficiency disorders were medical workers(71.3%, 381/534), traditional media(54.5%, 291/534), community advocacy(53.4%, 285/534), news client and new media(50.2%, 268/534). Conclusions:The overall awareness rate of iodine deficiency disorders prevention and control knowledge among pregnant women in Guangxi is not high. We should strengthen health education for pregnant women, especially young and multiparous women, those with low education and low income.

Objective:To learn about the status of iodine deficiency disorders in children and pregnant women in coastal areas of Guangxi Zhuang Autonomous Region (Guangxi for short).Methods:From January 2017 to December 2020, 12 counties (cities, districts) in Beihai City, Qinzhou City and Fangchenggang City in coastal areas of Guangxi were selected as the survey sites to carry out iodine deficiency disorders monitoring. Each county (city, district) was divided into five areas according to administrative regions: East, West, South, North and Middle. One township (town) was selected from each area, and 40 non-boarding children aged 8 to 10 (age balanced, half male and half female) and 20 pregnant women were selected from each township (town) as the survey subjects. Edible salt samples and urine samples were collected from children and pregnant women to detect salt iodine and urinary iodine levels; thyroid volume of children was determined and the rate of goiter was calculated.Results:From 2017 to 2020, a total of 8 905 children were monitored, and the median salt iodine of children was 23.4 mg/kg, and the medians salt iodine in each year were 23.7, 22.8, 23.5, 23.6 mg/kg, respectively; the median urinary iodine of children was 164.7 μg/L, and the medians urinary iodine in each year were 161.2, 169.7, 156.0, 171.1 μg/L, respectively; 30 of them had goiter, the rate of goiter of children was 0.34% (30/8 905). A total of 6 626 pregnant women were monitored, and the median salt iodine of pregnant women was 23.5 mg/kg, and the medians salt iodine in each year were 23.7, 22.5, 24.3, 23.8 mg/kg, respectively; the median urinary iodine of pregnant women was 139.6 μg/L, and the medians urinary iodine in each year were 129.6, 131.6, 134.4, 175.0 μg/L, respectively.Conclusions:The iodine nutrition of children in coastal areas of Guangxi is at an appropriate level (100 - 199 μg/L), and the rate of goiter has reached the national iodine deficiency disorders elimination standard (< 5%). But pregnant women are at risk of iodine deficiency (urinary iodine < 150 μg/L).

Objective:To analyze the causes of postoperative stricture of biliary-enteric anastomotic for congenital choledochal cysts.Methods:These 28 patients underwent salvage operation on an average 15 years (0.2-25 years) after initial surgeries at the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital from Jan 2014 to Jun 2018.Results:In 26 patients the biliary-enteric anastomotic stenosis was benign, and in 2 the stricture was caused by cancerration. In 26 cases the Roux-en-Y hepaticojejunostomy was redone,among them 8 cases underwent concurrent hepatectomy for a better exposure of the intrahepatic bile duct. In 2 cases the anastomotic stenosis was found to be caused by canceration with extensive intraabdominal metastasis ,an external drainage was adopted. There were no inhospital deaths, and no serious complications. The postoperative follow-up time was 6-67 months. Two cancerated patients died within half a year, and the remaining patients had no long-term complications.Conclusions:Biliary-enteric anastomotic stenosis is one of the serious complications in postoperative patients for congenital choledochal cysts. Hence a wide, tension free biliary-enteric anastomosis performed by a experienced hand is necessary.

ObjectiveTo analyze the epidemiological characteristics and trends of influenza‑like illness (ILI) in Jiading District from 2013 to 2023, to explore the prevalence patterns, so as to provide a scientific basis for a better prevention and control of influenza. MethodsData of ILI cases, pathogenetic surveillance results and pathogen detection data from influenza surveillance network laboratories in Jiading District from 2013 to 2023 were collected for statistical analysis. ResultsFrom 2013 to 2023, the overall proportion of medical visits for ILI cases in Jiading District was 2.70%. ILI cases were mainly distributed in the age group of ≥25 years, with a seasonal prevalence characteristic, mainly concentrated in the winter and spring, with an occasional small peak in the summer. A total of 12 423 specimens were tested for pathogenetic surveillance and monitoring, 3 651 of which were tested positive for nucleic acid detection, with a positive rate of 29.39%. The dominant strain was influenza A (H3N2) virus, accounting for 55.05%. There were statistical significant differences in the positive detection rates by different streets and townships(χ²=24.73，P<0.05）. The influenza network laboratory isolated and cultured influenza viruses from 3 154 nucleic acid‑positive samples sent by national influenza sentinel surveillance hospitals using 2 methodsMadin‑Darby canine kidney (MDCK) cells and specific pathogen free (SPF) chicken embryos, respectively, with a total isolation rate of 39.51%, and the isolation rate of MDCK cells (35.45%) was higher than that of SPF chicken embryos (5.36%). From 2013 to 2023, a total of 14 ILI outbreaks were reported in Jiading District, mainly in primary schools, kindergartens and secondary schools. ConclusionInfluenza in Jiading District, Shanghai, is mainly prevalent in the winter and spring, with different subtypes of influenza viruses alternating or co⁃circulating in different monitoring year. It is recommended to promote influenza vaccination, further improve influenza prevention and control measures, enhance health promotion to the age group of ≥25 years in winter and spring, and strengthen surveillance and monitoring on ILI outbreaks in collective units such as primary schools and childcare institutions, so as to reduce the disease burden.