ObjectiveTo analyze the epidemiological and etiological characteristics of a cluster of human metapneumovirus (HMPV) infection in a kindergarten in Gongshu District of Hangzhou City in May 2024, and to provide reference for the prevention and control of similar outbreaks. MethodsAn on-site investigation was conducted using an epidemiological case investigation form. Throat swab specimens collected from cases were screened for 13 respiratory pathogens using real-time fluorescent polymerase chain reaction (PCR). For HMPV nucleic acid positive specimens, the F gene of HMPV was used as the target gene for amplification and sequencing. The sequencing results were then compared with sequences in GenBank database to determine the virus subtypes and perform phylogenetic analyses. ResultsThe outbreak occurred in a kindergarter junior class with a total of 28 preschoolers and 3 teachers and childcare workers. A total of 11 cases (10 preschoolers and 1 teacher) were identified, including 8 male cases and 3 female cases. Clinical manifestations included fever in all 11 cases (100.00%), cough in 8 cases (72.72%), catarrhal symptoms in 4 cases (36.36%), and headache in 3 cases (27.27%). All symptoms were mild, and no severe cases were observed. A total of 11 throat swab samples were collected. Real-time fluorescent PCR test results showed that 3 samples were positive for HMPV nucleic acid, 2 samples were positive for both HMPV and Streptococcus pneumoniae, and 1 sample was positive for both HMPV and rhinovirus. The sequences of the 6 HMPV nucleic acid positive specimens were amplified and analyzed using specific primers, and all were determined to be HMPV subtype A2b. The F gene fragment sequence showed the highest similarity to PV081665.1/Brazil/2024 (99.65%), and also exhibited high similarity to PP683455.1/Indonesia/2021 (99.48%), PV016275.1/Beijing/2024 (99.31%), and PV052230.1/USA/2024 (99.13%). ConclusionThis cluster of acute respiratory tract infection was caused by HMPV subtype A2b, with co-infection of rhinovirus and Streptococcus pneumoniae. The F gene fragment sequences of the HMPV in this outbreak were highly homologous to those of the A2b strains isolated from Brazil, Beijing, Indonesia, and the the United States.

Objective:To study and establish the UPLC fingerprint and multi-index content determination methods of Hedyotidis chrysotricahae Herba; To provide a reference for the quality control of Hedyotidis chrysotricahae Herba.Methods:The chromatographic column was ACQUITY UPLC HSS T3 (100 mm×2.1 mm,1.8 μm). The mobile phase was acetonitrile-0.1% phosphoric acid solution with gradient elution; the detection wavelength was 254 nm; the flow rate was 0.30 ml/min and column temperature was 35 ℃. The method could determine content and fingerprint of rutin, Kaempferol-3-O-rutinoside, Narcissoside, Neochlorogenic aci, Chlorogenic Acid, Cryptochlorogenic acid and have quality analysis to 17 batches of Hedyotidis chrysotricahae Herba based on the variance of fingerprint, similarity evaluation, clustering analysis along with principal component analysis (PCA) at the same time.Results:The common pattern of UPLC specific chromatogram of Hedyotidis chrysotricahae Herba was established. The 11 common peaks were marked out, among which 7 peaks were identified. 17 batches Hedyotidis chrysotricahae Herba could be divided into 4 categories according to different origins. Quality content of six indicators of Hedyotidis chrysotricahae Herba was in slight difference between different origins, among which the content quality of Hedyotidis chrysotricahae Herba from Duyun in Guizhou Province was the highest.Conclusion:The established UPLC fingerprint and content determination method of 6 indicators from the study can be used for the quality control of Hedyotidis chrysotricahae Herba, which can also provide a theoretical basis for the standard improvement of Hedyotidis chrysotricahae Herba.

On the premise of respecting the objective law of the occurrence and development of traditional Chinese medicine（TCM） dispensing granules， relevant national departments have gradually formed the research and formulation ideas of national drug standards for dispensing granules based on the experiences and lessons learned in the development process of quality standards， as well as the formation mechanism of national standards for dispensing granules. This has certain reference significance for the formulation path of TCM quality standards. Combined with the general situation of the published standards and specific cases， the research concepts of the national standards for dispensing granules were analyzed and summarized in this paper， and the analysis of the technical characteristics of the issued national standards was focused， including the introduction of standard decoction， the overall quality control of TCM， the whole process quality control and other research ideas. At the same time， it summarized the industry common problems in the research and development process of national standards for dispensing granules， such as the source and process control of medicinal materials， and strived to solve them together， encouraging the demonstration and application of new technological means in the field of TCM dispensing granules. Finally， based on the literature analysis， the shortcomings of the current national standards were discussed， and relevant suggestions were put forward to further improve the national standards for dispensing granules. Through the overall analysis， it is helpful to comprehensively understand the technical characteristics of the national standards for TCM dispensing granules， and provide reference for the scientific exploration and practice of quality control methods for TCM.

Objective To investigate the expression of dihydrolipoamide S-acetyltransferase(DLAT)in hepatocellular carcinoma(HCC)tissues and its impact on immunotherapy efficacy,aiming to identify a new biomarker for prognosis assessment and immunotherapy response prediction.Methods Bioinformatics methods were used to analyze the transcriptomic data,clinical pathological characteristics and survival information of HCC patients from TCGA database.The expression of DLAT in HCC and its correlation with clinical features were evaluated,along with its relationship with immune infiltration,immune checkpoint-related genes,and immunotherapy response.Results DLAT was highly expressed in HCC tissues and associated with poor prognosis(HR=1.63,P=0.006).The proportion of R1&R2 residual tumors were significantly higher in the DLAT high-expression group(4.1％vs 1.2％,P=0.011).Immune infiltration analysis revealed that high DLAT expression was negatively correlated with Th 17,DC cells,B cells and T cells,while positively correlated with T helper cells,Tcm and Tem cells.Furthermore,DLAT expression showed significant positive correlations with key immune checkpoint genes(PDCD1LG2,HAVCR2,TIGIT,and PVR),and TIDE algorithm predicted poor response to immune checkpoint inhibitor therapy in the DLAT high-expression group.Conclusion High expression of DLAT in HCC tissues is a risk factor for poor prognosis and may serve as a potential biomarker for prognostic assessment and immunotherapy response prediction in HCC patients.

Objective To conduct a multidimensional and multi-level evaluation of the comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus.Methods Based on the National Essential Medicines List(2018 Edition),dapagliflozin was selected as the control.A comprehensive clinical evaluation index system was established through literature review,focus group interviews and in-depth expert interviews,encompassing six dimensions:safety,efficacy,economy,suitability,innovation,and accessibility.The Delphi method and hierarchical direct weighting method were used to screen indicators and determine their weights.Evidence for each indicator was collected and integrated both qualitatively and quantitatively through literature research,real-world studies,and pharmacoeconomic evaluations.Experts scored the indicators based on the collected evidence,and a total score for the comprehensive clinical evaluation of empagliflozin was calculated by combining these scores with indicator weights,followed by a comparative analysis with dapagliflozin.Results A comprehensive clinical evaluation of empagliflozin in the treatment of type 2 diabetes mellitus was successfully established,consisting of 6 primary indicators,14 secondary indicators,and 41 tertiary indicators.The overall evaluation score for empagliflozin was 90.35,and 89.47 for dapagliflozin.Conclusion The comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus is slightly higher than that of dapagliflozin.This finding can serve as a reference for rational clinical drug use and related decision-making.

Objective: To investigate the knowledge, attitude and practice of infectious disease prevention and control among primary and middle school students in Gongshu District, Hangzhou City, so as to provide the evidence for implementing health education on infectious disease prevention and control in schools. Methods: Students from 12 primary and middle schools in Gongshu District were selected using a random cluster sampling method. Basic information, knowledge, attitude and practice of infectious disease middle and control were collected through questionnaire surveys. Influencing factors of practice of primary and middle school students' infectious disease prevention and control were analyzed using multivariable logistic regression model. Results: A total of 3 439 primary and middle school students were surveyed, including 1 717 boys (49.93%) and 1 722 girls (50.07%). There were 1 237 primary school students (35.97%), 1 092 junior high school students (31.75%), and 1 110 senior high school students (32.28%). The awareness of infectious disease prevention and control knowledge, the percentage of attitude towards infectious disease prevention and control, and the percentage of practice towards infectious disease prevention and control were 73.22%, 96.83%, and 60.19%, respectively. Multivariable logistic regression analysis revealed that girls (OR=1.460, 95%CI: 1.265-1.685), those who had received health education on infectious disease prevention (OR=2.088, 95%CI: 1.656-2.632), those with adequate knowledge (OR=2.129, 95%CI: 1.816-2.496), and those with positive attitude (OR=4.320, 95%CI: 2.683-6.957) were more likely to form practice for the prevention and control of infectious disease. Conversely, senior high school students (OR=0.667, 95%CI: 0.561-0.794) and those with poor self-rated health status (OR=0.678, 95%CI: 0.495-0.930) were less likely to form practice for the prevention and control of infectious disease. Conclusions The attitude towards infectious disease prevention and control among primary and middle school students in Gongshu District is relatively high, but their awareness and practice are low. It is recommended to strengthen health education on infectious disease prevention and control knowledge in a targeted manner to promote the formation of prevention and control practice among senior high school students and primary and middle school students who self-assess their health status as poor.

Objective To investigate the effect of tirofiban combined with oxiracetam on acute anterior circulation progressive cerebral infarction.Methods A total of 171 patients with acute anteri-or circulation progressive cerebral infarction from October 2022 to January 2024 were enrolled and ran-domly divided into three groups using a random number table.The control group of 57 patients re-ceived conventional treatment,the observation group A received tirofiban in addition to conventional treatment,and the observation group B received oxiracetam on the basis of observation group A's treat-ment.The effectiveness indicators[including the rates of neurological improvement and neurological deterioration at 14 days after treatment,the rate of good prognosis and modified Rankin Scale(MRS)scores at 90 days after treatment,as well as the National Institutes of Health Stroke Scale(NIHSS)scores at 7 and 14 days after treatment and their differences from baseline],cognitive function[as-sessed using the Montreal Cognitive Assessment(MOCA)],and safety indicators(incidence rates of symptomatic intracranial hemorrhage,fatal intracranial hemorrhage,and mortality at 90 days after treat-ment)were compared among the three groups.Results There were no statistically significant differ-ences in the rates of neurological improvement and neurological deterioration at 14 days after treatment,the rate of good prognosis,and MRS scores at 90 days after treatment among the three groups(P＞0.05).There were statistically significant differences in NIHSS scores between baseline and 7 and 14 days after treatment in all three groups(P＜0.05),and the differences in NIHSS scores from baseline at the above time points were higher in observation group B than in observation group A and the control group(P＜0.05).There were no statistically significant differences in MOCA scores among the three groups before treatment(P＞0.05);however,the MOCA scores in the observation group B were higher than those in observation group A and the control group at 14,30,and 90 days after treatment(P＜0.05).There were no statistically significant differences in the incidence rates of symptomatic intracranial hemorrhage,fatal intracranial hemorrhage,and mortality at 90 days after treatment among the three groups(P＞0.05).Conclusion Tirofiban combined with oxiracetam can improve cognitive function in patients with acute anterior circulation progressive cerebral infarc-tion without increasing the risk of hemorrhage,and has better prognosis.

Objective To investigate the expression of dihydrolipoamide S-acetyltransferase(DLAT)in hepatocellular carcinoma(HCC)tissues and its impact on immunotherapy efficacy,aiming to identify a new biomarker for prognosis assessment and immunotherapy response prediction.Methods Bioinformatics methods were used to analyze the transcriptomic data,clinical pathological characteristics and survival information of HCC patients from TCGA database.The expression of DLAT in HCC and its correlation with clinical features were evaluated,along with its relationship with immune infiltration,immune checkpoint-related genes,and immunotherapy response.Results DLAT was highly expressed in HCC tissues and associated with poor prognosis(HR=1.63,P=0.006).The proportion of R1&R2 residual tumors were significantly higher in the DLAT high-expression group(4.1％vs 1.2％,P=0.011).Immune infiltration analysis revealed that high DLAT expression was negatively correlated with Th 17,DC cells,B cells and T cells,while positively correlated with T helper cells,Tcm and Tem cells.Furthermore,DLAT expression showed significant positive correlations with key immune checkpoint genes(PDCD1LG2,HAVCR2,TIGIT,and PVR),and TIDE algorithm predicted poor response to immune checkpoint inhibitor therapy in the DLAT high-expression group.Conclusion High expression of DLAT in HCC tissues is a risk factor for poor prognosis and may serve as a potential biomarker for prognostic assessment and immunotherapy response prediction in HCC patients.

Objective To conduct a multidimensional and multi-level evaluation of the comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus.Methods Based on the National Essential Medicines List(2018 Edition),dapagliflozin was selected as the control.A comprehensive clinical evaluation index system was established through literature review,focus group interviews and in-depth expert interviews,encompassing six dimensions:safety,efficacy,economy,suitability,innovation,and accessibility.The Delphi method and hierarchical direct weighting method were used to screen indicators and determine their weights.Evidence for each indicator was collected and integrated both qualitatively and quantitatively through literature research,real-world studies,and pharmacoeconomic evaluations.Experts scored the indicators based on the collected evidence,and a total score for the comprehensive clinical evaluation of empagliflozin was calculated by combining these scores with indicator weights,followed by a comparative analysis with dapagliflozin.Results A comprehensive clinical evaluation of empagliflozin in the treatment of type 2 diabetes mellitus was successfully established,consisting of 6 primary indicators,14 secondary indicators,and 41 tertiary indicators.The overall evaluation score for empagliflozin was 90.35,and 89.47 for dapagliflozin.Conclusion The comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus is slightly higher than that of dapagliflozin.This finding can serve as a reference for rational clinical drug use and related decision-making.

Higher doses of radiation from computed tomography (CT) scans can cause health problems. The radiation dose should be as low as possible while still meeting diagnostic needs. However, low-dose computed tomography (LDCT) increases image noise, reduces image quality and compromises diagnostic accuracy. Researchers have focused on the denoising technology for LDCT image. In this review, the research progress of projection domain pre-processing denoising, image reconstruction denoising, image domain post-processing denoising and dual-domain processing denoising algorithm based on deep learning for LDCT image were reviewed. The current problems of LDCT denoising were also summarized to promote the application of deep learning in LDCT image denoising.