ObjectiveTo analyze the epidemiological characteristics of patients with hepatitis C in Jinhua City, Zhejiang Province from 2005 to 2023, so as to provide a scientific basis for the prevention and control of hepatitis C. MethodsThe data on patients with hepatitis C, as well as whose current address is in Jinhua City, from 2005 to 2023 were collected from the infectious disease surveillance system of the China Disease Control and Prevention Information Management System. Descriptive epidemiological methods were used to analyze the temporal, spatial and demographic distribution characteristics of hepatitis C. ResultsA total of 2 326 cases of hepatitis C were reported in Jinhua from 2005 to 2023, including 2 death cases, with an average annual incidence rate of 2.19/100 000, showing a trend which rose first and then declined and then rose again. Hepatitis C was reported all the year round without significant seasonal pattern. In terms of the number of reported cases and the average annual incidence rate, Yiwu City ranked the first place. From 2005 to 2023, a total of 1 438 (61.82%) male cases and 888 (38.18%) female cases were reported, and the reported incidence rate was higher for males (2.62/100 000) than that for females (1.74/100 000), showing a statistically significant difference (χ²=92.937, P<0.001). Most cases aged between 30 to <50 years old (1 175, 50.52%), and the incidence rate of hepatitis C among the age group of 40‒<50, 50‒<60, 60‒<70 years old was showing an upward trend, with farmers (1 024, 44.02%) as the main occupation . ConclusionThe prevalence of hepatitis C in Jinhua City is generally at a low level, with an incidence rate of increasing and then decreasing, but rise up again after 2019. Therefore, epidemic surveillance and health education among the male, middle-aged and elderly people and farmers, as well as the key regions where the migrant workers flows in should be enhanced.

BACKGROUND: Preclinical studies have indicated that Angong Niuhuang Pills (ANP) reduce cerebral infarct and edema volumes. This study aimed to investigate whether ANP safely reduces cerebral infarct and edema volumes in patients with moderate to severe acute ischemic stroke. METHODS: This randomized, double-blind, placebo-controlled pilot trial included patients with acute ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores ranging from 10 to 20 in 17 centers in China between April 2021 and July 2022. Patients were allocated within 36 h after onset via block randomization to receive ANP or placebo (3 g/day for 5 days). The primary outcomes were changes in cerebral infarct and edema volumes after 14 days of treatment. The primary safety outcome was severe adverse events (SAEs) for 90 days. RESULTS: There were 57 and 60 patients finally included in the ANP and placebo groups, respectively for modified intention-to-treat analysis. The median age was 66.0 years, and the median NIHSS score at baseline was 12.0. The changes in cerebral infarct volume at day 14 were 0.3 mL and 0.4 mL in the ANP and placebo groups, respectively (median difference: -7.1 mL; interquartile range [IQR]: -18.3 to 2.3 mL, P = 0.30). The changes in cerebral edema volume of the ANP and placebo groups on day 14 were 11.4 mL and 4.0 mL, respectively ( median difference: 3.0 mL, IQR: -1.3 to 9.9 mL, P = 0.15). The rates of SAE within 90 days were similar in the ANP (3/57, 5%) and placebo (7/60, 12%) groups ( P = 0.36). Changes in serum mercury and arsenic concentrations were comparable. In patients with large artery atherosclerosis, ANP reduced the cerebral infarct volume at 14 days (median difference: -12.3 mL; IQR: -27.7 to -0.3 mL, P = 0.03). CONCLUSIONS: ANP showed a similar safety profile to placebo and non-significant tendency to reduce cerebral infarct volume in patients with moderate-to-severe stroke. Further studies are warranted to assess the efficacy of ANP in reducing cerebral infarcts and improving clinical prognosis. TRAIL REGISTRATION Clinicaltrials.gov , No. NCT04475328.
Aged ; Female ; Humans ; Male ; Middle Aged ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Ischemic Stroke/drug therapy* ; Pilot Projects ; Stroke/drug therapy* ; Treatment Outcome

Objective:To explore the correlation between clinical phenotypes and genotypes among 46 children with SCN1A-related developmental epileptic encephalopathy (DEE). Methods:Clinical data of 46 children with DEE and SCN1A variants identified at the Guangzhou Women and Children′s Medical Center between January 2018 and June 2022 were collected. The children were grouped based on their age of onset, clinical manifestations, neurodevelopmental status, and results of genetic testing. The correlation between SCN1A genotypes and clinical phenotypes was analyzed. Results:Among the 46 patients, 2 children (4.35%) had developed the symptoms before 3 months of age, 42 (91.30%) were between 3 to 9 months, and 2 cases (4.35%) were after 10 months. Two cases (4.35%) presented with epilepsy of infancy with migrating focal seizures (EIMFS), while 44 (95.7%) had presented with Dravet syndrome (DS), including 28 cases (63.6%) with focal onset (DS-F), 13 cases (29.5%) with myoclonic type (DS-M), 1 case (2.27%) with generalized type (DS-G), and 2 cases (4.55%) with status epilepticus type (DS-SE). Both of the two EIMFS children had severe developmental delay, and among the DS patients, 7 cases had normal development, while the remaining had developmental delay. A total of 44 variants were identified through genetic sequencing, which included 16 missense variants and 28 truncating variants. All EIMFS children had carried the c. 677C>T (p.Thr226Met) missense variant. In the DS group, there was a significant difference in the age of onset between the missense variants group and the truncating variants group ( P < 0.05). Missense variants were more common in D1 (7/15, 46.7%) and pore regions (8/15, 53.3%), while truncating variants were more common in D1 (12/28, 42.9%). Children with variants outside the pore region were more likely to develop myoclonic seizures. Conclusion:The clinical phenotypes of DEE are diverse. There is a difference in the age of onset between individuals with truncating and missense variants in the SCN1A gene. Missense variants outside the pore region are associated with a higher incidence of myoclonic seizures.

Objective:To analyze the results of serum IgM antibody and viral nucleic acid testing in measles and rubella cases in China from 2014 to 2023.Methods:Surveillance data on measles and rubella during 2014-2023 were obtained from the Chinese Disease Prevention and Control Information System, and cases that underwent measles/rubella IgM antibody testing and viral nucleic acid testing were included in the study. Information on the number of cases, vaccination status, and laboratory test results was collected, and laboratory test results were compared among cases with different times of rash or onset and different doses of vaccination.Results:From 2014 to 2023, the total number of measles and rubella surveillance cases was 581 746, and the number of measles and rubella cases that underwent both IgM antibody and viral nucleic acid testing was 39 124 and 21 766, respectively, with a double-positive rate of IgM antibody and viral nucleic acid testing of 63.73% (for measles) and 41.68% (for rubella). The single-positive rate for IgM antibody was 21.12% (for measles) and 27.15% (for rubella). The single-positive rate for viral nucleic acid tests was 13.84% (for measles) and 28.19% (for rubella). According to different days of rash or onset (0-3, 4-5, 6-10 and >10), samples of 24 629 (62.95%) measles cases and 15 785 (72.52%) rubella cases were from within 3 days of rash or onset, and the single positive rate of viral nucleic acid detection was 16.90% (for measles) and 32.07% (for rubella). The single positive rate of IgM antibody increased gradually with the time of onset (measles: χ 2trend=314.098, P<0.001, rubella: χ 2trend=763.846, P<0.001), and reached 31.66% (for measles) and 53.12% (for rubella) after 10 days of rash or onset. Depending on the number of vaccination doses (1, 2,≥3), the single positive rate of viral nucleic acid detection ranged from 12.93% to 20.29% (for measles) and from 25.30% to 27.88% (for rubella). The single positive rate of IgM antibody detection ranged from 36.89% to 47.47% (for measles) and from 22.81 to 41.15% (for rubella). Conclusions:Combined testing of serum IgM antibody and viral nucleic acids could facilitate laboratory confirmation of measles and rubella cases and was also important for measles and rubella elimination efforts.

Objective:To analyze the results of serum IgM antibody and viral nucleic acid testing in measles and rubella cases in China from 2014 to 2023.Methods:Surveillance data on measles and rubella during 2014-2023 were obtained from the Chinese Disease Prevention and Control Information System, and cases that underwent measles/rubella IgM antibody testing and viral nucleic acid testing were included in the study. Information on the number of cases, vaccination status, and laboratory test results was collected, and laboratory test results were compared among cases with different times of rash or onset and different doses of vaccination.Results:From 2014 to 2023, the total number of measles and rubella surveillance cases was 581 746, and the number of measles and rubella cases that underwent both IgM antibody and viral nucleic acid testing was 39 124 and 21 766, respectively, with a double-positive rate of IgM antibody and viral nucleic acid testing of 63.73% (for measles) and 41.68% (for rubella). The single-positive rate for IgM antibody was 21.12% (for measles) and 27.15% (for rubella). The single-positive rate for viral nucleic acid tests was 13.84% (for measles) and 28.19% (for rubella). According to different days of rash or onset (0-3, 4-5, 6-10 and >10), samples of 24 629 (62.95%) measles cases and 15 785 (72.52%) rubella cases were from within 3 days of rash or onset, and the single positive rate of viral nucleic acid detection was 16.90% (for measles) and 32.07% (for rubella). The single positive rate of IgM antibody increased gradually with the time of onset (measles: χ 2trend=314.098, P<0.001, rubella: χ 2trend=763.846, P<0.001), and reached 31.66% (for measles) and 53.12% (for rubella) after 10 days of rash or onset. Depending on the number of vaccination doses (1, 2,≥3), the single positive rate of viral nucleic acid detection ranged from 12.93% to 20.29% (for measles) and from 25.30% to 27.88% (for rubella). The single positive rate of IgM antibody detection ranged from 36.89% to 47.47% (for measles) and from 22.81 to 41.15% (for rubella). Conclusions:Combined testing of serum IgM antibody and viral nucleic acids could facilitate laboratory confirmation of measles and rubella cases and was also important for measles and rubella elimination efforts.

ObjectiveTo understand the human immunodeficiency virus（HIV） infection status and related factors by using the HIV/AIDS sentinel surveillance data of men who have sex with men（MSM） in Jinhua City， Zhejiang Province. MethodsSnowball sampling method was used to recruit MSM receiving HIV sentinel surveillance from 2016 to 2021.The inclusion criteria were aged 18 years old and above， reported having anal sex with man in recent 6 months. Questionnaire-based interviews were conducted on a one-on-one basis. Data including the characteristics of demography and ethology were collected. Five milliliter of blood samples were taken after the questionnaire. HIV and syphilis was screened. The time trend was analyzed with χ² test. Multivariate logistic regression model was used to analyze the factors associated with HIV infection status among MSM. ResultsThe positive rate of HIV was 8.0% （127/1 597）， with an increasing trend （P=0.002）， but the linear correlation was weak（r=0.075）. The positive rate of syphilis was 5.2% （83/1 597）， with no significant difference （P=0.661）.The constituent ratios showed an increasing trend （P<0.05） in using condoms consistently， finding male sexual partners through Internet or dating software， having anal sex in the past week， using condoms every time during anal sex in the past 6 months， accepting prevention services of AIDS in the last year， and the overall awareness of AIDS related knowledge. Multivariate logistic regression analysis showed that who was from national minority （OR=2.27， 95%CI： 1.08‒4.73） and from other provinces （OR=1.68， 95%CI： 1.08‒2.62）， who failed to consistently use condoms every time during anal sex in the past six months （OR=3.03， 95%CI： 2.02‒4.54）， who never accepted prevention services of AIDS in the last year （OR=2.17，95%CI：1.44‒3.27）， who don’t know the knowledge of AIDS （OR=1.86， 95%CI： 1.12‒3.07）， and who was infected with syphilis （OR=2.35， 95%CI： 1.20‒4.61） were at higher risk for HIV infection among MSM. ConclusionThe positive rate of HIV remains at a certain level among MSM in Jinhua. High-risk groups such as the patients with syphilis infections and floating population from other provinces need to be paid close attention. It is suggested to further strengthen the promotion of the use of condoms， awareness of AIDS and syphilis， warning education and comprehensive intervention services.

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

【Objective】 To explore the application value of different language assessment tools in the assessment of language development of 12-month-old high-risk infants, and to screen out simple and valid language assessment tools. 【Methods】 A total of 217 11- to 13-month-old high-risk infants who were followed up at the outpatient service for high-risk infants at the child health clinic of Guiyang Maternal and Child Health Hospital from March 2022 to May 2023 were selected as the study subjects. Their language was evaluated by Early Language Milestone Scale (ELMS), Putonghua Communicative Development Inventory (PCDI) and Ages and Stages Questionnaire-Third Edition (ASQ-3). With Gesell as the gold standard for the assessment of language, the area under receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value, negative predictive value, Youden index and Kappa value of the three tools were calculated. Spearman correlation analysis was used to analyze the correlation between the different language assessment scales. The Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was used to evaluate the three tools. 【Results】 1)Among 217 high-risk infants, 78 preterm infants was the most (35.94%). The rate of delayed language development detected by Gesell, ELMS, PCDI-comprehension, PCDI-expression, ASQ-3 were 5.5%, 7.8%, 36.4%, 30.0% and 11.5%, respectively. 2)ASQ-3 had the strongest correlation with Gesell language region (rs=0.607, P<0.01) and it had the most AUC (AUC=0.812, P<0.05). The consistency between ASQ-3 and Gesell was moderate (Kappa=0.56, P<0.01). ASQ-3 had the highest sensitivity(91.7%), accuracy(93.1%), negative predictive value(99.5%) and Youden index(0.85), and ELMS had the highest specificity(94.6%). 3) Comprehensive evaluation of three tools by the TOPSIS indicated that ASQ-3 was the best, followed by ELMS and PCDI-comprehension was the worse. 【Conclusion】 Among the three assessment tools, ASQ-3 has the highest value in assessing the language development of 11- to 13-month-old high risk infants, and it may be necessary to expand the age range and establish a national norm of ELMS and PCDI in the future.

Frailty, which predicts high dependency and mortality, is a major challenge for healthcare systems in nations that are rapidly aging and is receiving increasing attention. Cirrhosis is often combined with frailty, which has a significant impact on patient health outcomes. Understanding the risk factors for frailty, elucidating the mechanism of cirrhosis combined with frailty, and early recognition and slowing down the occurrence and development of frailty are of great significance for the prognosis of cirrhotic patients. This article reviews the current research status of cirrhosis combined with frailty, including the definition and risk factors, mechanism, correlation, and intervention measures, in order to improve understanding and provide assistance for strengthening early identification, management, and intervention.

Objective To investigate the value of total bilirubin rebound rate (TBRR), total bilirubin clearance rate (TBCR), and TBCR after 1 week of treatment (ΔTBCR) in evaluating the short-term prognosis of patients with severe drug-induced liver injury (DILI) after artificial liver support therapy. Methods A retrospective analysis was performed for 203 patients with severe DILI who received artificial liver support therapy in Tianjin Third Central Hospital from September 2013 to December 2021, and general information, biochemical parameters, and clinical classification were collected. The patients were divided into improved group and unhealed group according to the prognosis at discharge, and Model for End-Stage Liver Disease (MELD) score, TBRR, TBCR, and ΔTBCR were calculated. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was plotted to investigate the value of assessment indices in predicting the prognosis of patients, and the Kaplan-Meier method was used to investigate the difference in the length of hospital stay in the context of different assessment indices. Results Compared with the unhealed group, the improved group had significantly lower age ( t =-2.762, P < 0.05), white blood cell count ( Z =-3.184, P < 0.05), total bilirubin ( t =-2.809, P < 0.05), conjugated bilirubin ( t =-2.739, P < 0.05), international normalized ratio ( Z =-2.357, P < 0.05), MELD score ( t =-3.090, P < 0.05), and TBRR ( t =-4.749, P < 0.05), as well as significantly higher albumin ( t =2.198, P < 0.05), prothrombin time activity ( t =2.018, P < 0.05), TBCR ( t =2.166, P < 0.05), and ΔTBCR ( t =9.549, P < 0.05). MELD score, TBRR, TBCR, and ΔTBCR had an area under the ROC curve (AUC) of 0.656, 0.727, 0.611, and 0.879, respectively, and ΔTBCR had a better predictive value than TBRR ( Z =3.169, P =0.001 5). The optimal cut-off value was 22.5% for TBRR (with a sensitivity of 94.6% and a specificity of 45.2%) and 27.4% for ΔTBCR (with a sensitivity of 77.7% and a specificity of 86.5%). ΔTBCR showed a good predictive value in different clinicopathological types, with extremely high sensitivity (91.4%) and specificity (100.0%) in evaluating the treatment outcome of patients with mixed-type DILI after artificial liver support therapy. Conclusion TBRR and ΔTBCR have a higher value than MELD score in evaluating the short-term prognosis of patients with severe DILI after artificial liver support therapy, among which ΔTBCR has a higher predictive value.