The glycoproteins in the biological sample are low abundance and are susceptible to be inhibited and interfered by other non-glycoproteins.An enrichment step is usually required before the glycoprotein analysis, but the operation steps of conventional solid-phase-based glycoprotein enrichment methods are difficult to be compatible with the most classical enzyme-linked immune sorbent assay (ELISA) technique.In this study, a novel water-soluble dendrimer based boronic acid capture (DBC) material was developed using PAMAM 4.0 as the carrier and boronic acid as the affinity group.The method was applied to the detection of glycoproteins in human liver microsomes using ELISA.In this study, the DBC enrichment conditions were optimized by model glycoprotein, and then its sensitivity and anti-interference ability were investigated.This method was applied to the enrichment of glycoproteinsin human liver microsomal.The results showed that the enrichment selectivity of DBC for glycoprotein could be up to 100000 folds, and the enrichment signal of glycoprotein could be increased by 100 times.Therefore, the ELISA method using DBC as a novel enrichment material for glycoprotein had high sensitivity and selectivity in detection of biological samples with only one simple incubation step, which was useful for glycoproteins researches.

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.

Objective:In this study, the clinical data of biliary atresia(BA) and infant intrahepatic cholestasis(IHC) was reviewed, and the utility of gamma-glutamyl transpeptidase(GGT) and liver Young′s modulus in the differential diagnosis of BA and IHC in infants was discussed.Methods:Based on the clinical data of 120 infants with cholestasis treated in the Children′s Hospital Affiliated to Xi′an Jiaotong University, from September 2017 to December 2019, the infants were divided into two groups according to the results of intraoperative cholangiography and follow-up: BA group( n=50); IHC group( n=70). The age, clinical manifestations, laboratory examination results, gallbladder contraction rate, hepatobiliary scintigraphy, liver Young′s modulus, and medical treatment effects were compared between the two groups.The utility of GGT and liver Young′s modulus in the differential diagnosis of BA and IHC was analyzed. Results:The age, alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bile acid, fasting blood glucose, blood ammonia and splenomegaly between the two groups were compared and the results showed no statistical significance( P>0.05). In contrast, there were statistically significant differences( P<0.001) in stool color, liver size, total bilirubin(TB), direct bilirubin(DB), GGT, liver Young′s modulus, positive hepatobiliary scintigraphy, gallbladder contraction rate at 1 hour after meal, and medical treatment effect between the two groups.TB, DB, GGT, liver Young′s modulus and GGT combined with liver Young′s modulus were analyzed using ROC curves, and the area under the curve(AUC) were 0.820, 0.809, 0.906, 0.876 and 0.926, respectively.When GGT exceeded the cut-off value of 198.85 U/L, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BA were 82.0%, 84.3%, 78.8%, 86.8% and 83.3%, respectively.When liver Young′s modulus exceeded the cut-off value of 8.6 kPa, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BA were 88.0%, 80.0%, 75.9%, 90.3% and 83.3%, respectively.The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of GGT combined with liver Young′s modulus in diagnosing BA were 98.0%, 68.6%, 69.0%, 98.0% and 80.8%, respectively.Multivariate logistic regression analysis found that DB>115.55 μmol/L, GGT>198.85 U/L, and liver Young′s modulus>8.6 kPa were risk factors for BA( OR=9.510, P=0.001; OR=24.634, P<0.001; OR=21.469, P<0.001). Conclusion:GGT and liver Young′s modulus are useful in the differential diagnosis of BA and IHC.If GGT and liver Young′s modulu sexceed the threshold values of 198.85 U/L and 8.6 kPa respectively, it can effectively indicate that the child is BA.

Objective:To investigate the association of single nucleotide polymorphisms(SNPs)in the vitamin D receptor(VDR)gene with influenza susceptibility and severity of disease in children.Methods:Peripheral venous blood was collected from 172 children with influenza A (study group) and 88 healthy children (healthy control group) admitted to Xi ′an Children′s Hospital and Xi ′an Central Hospital from February 2019 to February 2021.Serum 25-hydroxyvitamin D(25-OH-D) level was detected by using 25-OH-D kit.The study group was divided into three groups according to clinical syndrome: mild group, severe group, and critical group.Four candidate loci in the VDR gene(ApaI, TaqI, FokI, and BSMI)were selected, and polymorphisms in the VDR gene of each group were determined by polymerase chain reaction restriction fragment length polymorphism and analyzed in relation to children with influenza.Results:Compared with the healthy control group[(109.65±4.35) nmol/L], the serum 25-OH-D levels in the study groups were lower[(73.55±2.46)nmol/L in the mild group, (45.59±4.62) nmol/L in the severe group, and (33.65±3.87) nmol/L in the critical group]( P<0.05); Genotypes AA, Aa and allele A of the ApaI locus(51.74%, 22.67%, and 63.08%, respectively)and genotypes FF, Ff and allele F of the FokI locus(41.86%, 34.88%, and 59.30%, respectively)accounted for a significantly higher proportion of cases in the study group than those in healthy control group(11.36%, 14.77%, 18.75%, 10.23%, 13.64%, and 17.05%, respectively)( P<0.05). The proportion of allele A at the ApaI locus and genotypes AA and Aa in severe group(63.70%, 43.84%, and 28.76%) were significantly higher than those in mild group(47.37%, 35.09%, and 24.56%)( P<0.05); The proportion of allele A and genotype AA and at the ApaI locus in critical group(92.86%, 88.10%, and 49.52%) were significantly higher than those in severe group( P<0.05). Serum 25-OH-D<50 nmol/L( OR=5.087, 95% CI 3.114-5.648), ApaI site genotypes AA ( OR=4.011, 95% CI 1.217-18.624)and Aa( OR=3.839, 95% CI 2.483-1.456), FokI site genotypes FF( OR=4.112, 95% CI 3.215-20.775)and Ff( OR=4.591, 95% CI 0.032-10.936)were risk factors for the onset of influenza in children. Conclusion:Serum 25-OH-D deficiency is associated with childhood influenza, and VDR gene genotype AA and Aa of ApaI locus, and FokI site genotype FF, Ff may increase the risk of childhood influenza susceptibility, and allele A of ApaI locus and genotypes AA and Aa are associated with the severity of influenza.

Objective:To explore the relationship of Vitamin A and Vitamin D with the incidence and severity of hand, foot and mouth disease(HFMD) as well as with the anti-viral immune index interferon-α(INF-α), and to investigate the role of Vitamin A and Vitamin D in HFMD.Methods:A total of 305 children with Coxsackie virus A6(CA6) HFMD admitted at Xi′an Children′s Hospital from January 2017 to December 2018 were enrolled in the study.One hundred healthy children whose gender and age matched with those of children in the case group were selected as the healthy control group.Serum Vitamin A levels were detected by high performance liquid chromatography.Enzyme-linked immunosorbent assay was used to detect the levels of Vitamin D and IFN-α, and the correlation of the levels of Vitamin A and Vitamin D with the severity of HFMD was analyzed.Results:The levels of serum Vitamin A[(0.96±0.39) mg/mol] and Vitamin D [(42.14±15.13) μg/L] in patients with CA6 HFMD were lower than those of the healthy control group[(1.26±0.29) mg/mol, (49.63±8.86) μg/L], and the differences were statistically significant(all P<0.05). Logistic multivariate regression analysis showed that WBC>15×10 9/L, blood sugar>8.3 mmol/L, the deficiency of Vitamin A level and Vitamin D level were all risk factors for severe CA6 HFMD in children( OR=2.303, 4.622, 7.346, 5.211; all P<0.05). According to the receiver operating characteristic curve analysis, the Youden index was the largest at a Vitamin A level of 0.725 mg/mol, and the corresponding sensitivity and specificity were 82.0% and 64.8%, respectively.When Vitamin D level was 32.88 μg/L, the Youden index was the highest, and the sensitivity and specificity were 84.5% and 61.9%, respectively.The serum IFN-α concentration of patients with CA6 HFMD [(84.44±26.28) ng/L] was higher than that of the healthy control group [(36.58±14.39) ng/L], and the difference was statistically significant( P<0.05). In addition, the serum IFN-α concentration in severe HFMD children [(71.48±18.34) ng/L] was significantly lower than that in the common HFMD children [(91.25±27.27) ng/L], and the difference was statistically significant( P<0.05). The results of correlation analysis showed that serum IFN-α concentration is positively correlated with Vitamin A and Vitamin D levels ( r=0.783, 0.239; all P<0.001). Conclusions:The levels of serum Vitamin A and Vitamin D decreased in children with HFMD.WBC>15×10 9/L, blood sugar>8.3 mmol/L, the deficiency of Vitamin A level and Vitamin D level are related to severe HFMD.The se-rum IFN-α concentration is positively correlated with the levels of Vitamin A and Vitamin D. The deficiency of Vitamin A and Vitamin D is one of the early warning factors of severe HFMD.

Objective To detect the plasma calcitonin gene-related peptide ( CGRP ) in children with enterovirus 71(EV71) infected hand foot and mouth disease(HFMD),and explore the relationship be-tween CGRP and the severity of EV71 infected HFMD. Methods Two hundred children with EV71 infected HFMD in Xi'an Children's Hospital from January 2017 to December 2017 were selected as the research group,and 50 healthy children were selected as control group in the same period. According to the severity of the disease,the research group was divided into the mild group (n=142) and the severe group (n=58). The level of plasma CGRP was detected by ELISA. Results In acute stage,the level of CGRP in children with EV71 infected HFMD was lower than that in control group, and the difference was statistically significant (t=4. 235,P<0. 001). The level of CGRP in acute stage in severe group[(29. 90 ± 5. 10)pg/ml] was sig-nificantly lower than that of the mild group[(35. 51 ± 5. 48)pg/ml],and the difference was statistically sig-nificant (t=6. 615,P=0. 001). The level of CGRP in mild group[(35. 51 ± 5. 48)pg/ml] was slightly low-er than that of the control group[(36. 63 ± 5. 65)pg/ml],but the difference was insignificant (t=1. 120, P=0. 086). In recovery stage,the level of CGRP in the severe group was obviously higher than that in the acute stage(t=5. 924,P=0. 003). According to the ROC curve of CGRP in mild and severe EV71 infected HFMD,the critical value of CGRP in mild and severe HFMD was 28. 12 pg/ml, and the sensitivity was 80. 0％ and the specificity was 50. 0％. Conclusion The CGRP is associated with the progression of EV71 HFMD,and when CGRP is lower than 28. 12 pg/ml,suggesting the possibility of severe HFMD. The decrease of plasma CGRP may be a risk factor for the progression of EV71 infected HFMD.

Based on the analysis of the existing problems and implementation dilemmas in family doctor contracting and first-return-visits faced by primary medical institutions in China, the authors propose countermeasures to provide reference for managers of primary health care institutions.

By sorting out the differences and connections between family doctor teams and specialized disease teams, role competency and mutual collaboration, and introducing the learning health system (LHS) mechanism, a comprehensive operating system for community general practice learning organizations based on LHS was constructed, focusing on five single disease types. The system includes a combination of general and specialized medicine that links three levels of medical institutions, thereby opening up the business cooperation process between professionals in different institutions, and establishing a sustainable collaboration mechanism. This allows medical institutions at three levels to continuously tap the potential of their disciplines, achieve their own ability growth and feel higher work value, and also bring better health solutions to residents, guided by the common goal of "health centered, patient centered".

Objective: To investigate the clinical value of plasma brain natriuretic peptide (BNP) levels in predicting the severity of hand, foot and mouth disease (HFMD) in children with coxsackie virus A6 (CV-A6) infection. Methods: A total of 305 children with CV-A6 type HFMD admitted to Xi′an Children′s Hospital from January 2017 to December 2018 were divided into general group (200 cases) and severe group (105 cases) according to the severity of the disease.The receiver operating characteristic curve was used to calculate the value of plasma BNP levels to predict the severe CV-A6 HFMD.Multivariate logistic regression analysis was used to analyze the correlation between the related factors and the severity of CV-A6 HFMD. Results: Compared with the normal group, children in the severe group had statistically significant differences in WBC level, BNP level, neurological symptoms, circulatory disorders, and blood glucose levels(all P<0.05). The optimal cut-off value of the receiver operating characteristic curve for BNP level to predict severe HFMD was 294.85 ng/L.Multivariate logistic regression analysis found that WBC>15×10⁹/L, blood glucose> 8.3 mmol/L, and BNP>294.85 ng/L were related to the severity of CV-A6 HFMD(OR=2.275, P=0.013; OR=6.057, P=0.028; OR=1.008, P<0.001). Conclusion BNP>294.85 ng/L is closely related to the severity of CV-A6 HFMD and has predictive value.It is an early warning factor for the severity of CV-A6 HFMD.

Objective: To understand the etiological and clinical characteristics of children with severe hand, foot and mouth disease (HFMD) in Xi′an in 2018, and to provide the evidence for clinical diagnosis and treatment. Methods: The children with severe HFMD admitted at Xi′an Children′s Hospital from January to December 2018 were selected as the research objects.Clinical data were collected, and the anal swab were detected by adopting real time(RT)-polymerase chain reaction(PCR). Results: Ninety-five cases of HFMD were treated in Xi′an Children′s Hospital in 2018, of which 92 cases were severe and 3 cases were critical.Eighty-seven cases were positive for enterovirus nucleic acid, 30 cases were enterovirus 71(EV71)(31.6%), 39 cases were coxsackievirus A6(CA6) (41.0%), 3 cases were CA16(3.2%), 2 cases were CA10(2.1%) and 13 cases were other enteroviruses (13.7%). Among 95 patients, the ratio of male to female was 1.1∶1.0; the peak period of incidence of HFMD was from May to July, and the main age of onset of severe HFMD was under 3 years old.The main clinical manifestations were mental retardation, vomiting, irritability, lethargy and convulsion.Severe cases of CA6 are prone to convulsion.The main form of rash in CA6 cases was bullous rash, and demethylation may occur in recovery period.The rash in EV71 cases was small, thick, hard and few.After active treatment, only one child with EV71 infection died because of severe cerebral dysfunction, frequent convulsions and neurogenic pulmonary edema.The other child was discharged with hemiplegia and language dysfunction.The other severe children were cured and discharged from hospital. Conclusions In 2018, CA6 was the main pathogen of severe HFMD in Xi′an, with bullae was the main manifestation of skin rash, and nail removal could occur during convalescence.Critical and death cases were still caused by EV71.