ObjectiveTo understand the seropositivity of neutralizing antibodies (NAb) and low-level NAb against SARS-CoV-2 infection in the community residents, and to explore the impact of COVID-19 vaccination and SARS-CoV-2 infection on the levels of NAb in human serum. MethodsOn the ground of surveillance cohort for acute infectious diseases in community populations in Shanghai, a proportional stratified sampling method was used to enroll the subjects at a 20% proportion for each age group (0‒14, 15‒24, 25‒59, and ≥60 years old). Blood samples collection and serum SARS-CoV-2 NAb concentration testing were conducted from March to April 2023. Low-level NAb were defined as below the 25^th percentile of NAb. ResultsA total of 2 230 participants were included, the positive rate of NAb was 97.58%, and the proportion of low-level NAb was 25.02% (558/2 230). Multivariate logistic regression analysis indicated that age, infection history and vaccination status were correlated with low-level NAb (all P<0.05). Individuals aged 60 years and above had the highest risk of low-level NAb. There was a statistically significant interaction between booster vaccination and one single infection (aOR=0.38, 95%CI: 0.19‒0.77). Compared to individuals without vaccination, among individuals infected with SARS-CoV-2 once, both primary immunization (aOR=0.23, 95%CI: 0.16‒0.35) and booster immunization (aOR=0.12, 95%CI: 0.08‒0.17) significantly reduced the risk of low-level NAb; among individuals without infections, only booster immunization (aOR=0.28, 95%CI: 0.14‒0.52) showed a negative correlation with the risk of low-level NAb. ConclusionsThe population aged 60 and above had the highest risk of low-level NAb. Regardless of infection history, a booster immunization could reduce the risk of low-level NAb. It is recommended that eligible individuals , especially the elderly, should get vaccinated in a timely manner to exert the protective role of NAb.

Objective:To acquire the implementation effect of the neonatal Phenylketonuria(PKU)Screening Project in Dong-guan,and evaluate its economic effectiveness,so as to provide references for the prevention and control policies of genetic defects in newborns.Methods:Choosing PKU children born in Dongguan from January 2012 to December 2021(excluding BH4 deficien-cy)as the subjects,conduct the cost-benefit and cost-effectiveness analysis on the prevention and treatment of PKU.The relevant data was gained from questionnaire surveys,statistical data,medical service prices of non-profit medical institutions in Dongguan,and relevant literature materials.Results:In the past 10 years,1 245 243 newboms were screened for PKU in Dongguan,the average screening rate is 93.32％.Among them,29 were diagnosed with PKU,with a positive rate of 1:42939.During continuous follow-up,23 cases were diagnosed.Among the 23 follow-up cases,only 1 had intelligence at the critical value,while the rest were normal.The total cost of screening is 29.728 7 million,and the total benefit is 14.239 9 million.The cost-effectiveness ratio is 102.51:1,the cost-benefit ratio is 1:4.79.Conclusion:Neonatal phenylketonuria(PKU)screening in Dongguan has significant social and economic benefits.It's necessary to continue and improve the screening work,especially the policy which can benefit the PKU's full life.

Objective:To analyze the features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infected with other common respiratory pathogens among coronavirus disease 2019 (COVID-19) patients in Shanghai City, and to provide a reference for scientific prevention and control of COVID-19 and other respiratory infectious diseases.Methods:Descriptive epidemiological approaches were used to analyze the data of COVID-19 reported cases in Shanghai City from January 2020 to February 2021 in the information system of Chinese Disease Prevention and Control. Clinical data of the participants were collected, and their SARS-CoV-2 nucleic acid-positive respiratory specimens were collected at the time of illness onset or admission. Multiplex reverse transcription-polymerase chain reaction (RT-PCR) was performed to detect the 22 respiratory pathogens. Independent-samples t test was used for statistical analysis. Results:Of the 272 patients with COVID-19, 15(5.5%) had co-infection of SARS-CoV-2 with other respiratory pathogens, all of which were double infection. There were three cases infected with enterovirus/rhinovirus, two of each with adenovirus, human metapneumovirus and coronavirus NL63/HKU1, and one of each with coronavirus 229E, influenza A virus H1N1, parainfluenza virus 1 and respiratory syncytial virus B. Two cases infected with Mycoplasma pneumoniae. Among the 272 COVID-19 patients, 212(77.9%) had fever, 117(43.0%) had cough, 46(16.9%) had fatigue, and 35(12.9%) had sore throat. The white blood cell count of co-infection cases was higher than that of non-co-infection cases ((6.8±1.7)×10 9/L vs (5.3±1.6)×10 9/L), and the difference was statistically significant ( t=3.09, P=0.008). Conclusions:There is a certain proportion of co-infection of SARS-CoV-2 with other respiratory pathogens among the COVID-19 cases in Shanghai City, mainly viral pathogens, especially enterovirus/rhinovirus. A rational combination of drugs was recommended to improve the cure rate. Surveillance of acute respiratory infection should be further strengthened as well.

The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea

Humans ; Benzodiazepines ; Hypnotics and Sedatives/therapeutic use* ; Intensive Care Units ; Midazolam

Enteral nutrition plays an irreplaceable role in the nutritional treatment of critically ill patients. In order to help clinical medical staff to manage the common complications during the implementations of enteral nutrition for critically ill patients, the consensus writing team carried out literature retrieval, literature quality evaluation, evidence synthesis. Several topics such as diarrhea, aspiration, high gastric residual volume, abdominal distension, etc. were assessed by evidence-based methodology and Delphi method. After two rounds of expert investigations, Expert consensus on prevention and management of enteral nutrition therapy complications for critically ill patients in China (2021 edition) developed, and provided guidance for clinical medical staff.

Objective:To evaluate the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area.Methods:According to the principle of proximity, children aged 6 months-17 years who were diagnosed with bronchial asthma at Shanghai Children′s Medical Center from July 2016 to May 2017 were divided into two cohorts: the specialized hospital group and the community hospital group.Twelve months of treatment and follow-up were conducted.The asthma control level, Childhood Asthma Control Test (C-ACT) score, medication adherence and health economic indicators were collected.Results:A total of 524 children were included for data analysis and divided into the specialized hospital group (300 cases) and the community hospital group (224 cases). According to the Global Initiative for Asthma(GINA) criteria, there was no statistical difference in monthly asthma control level between the two groups (all P>0.05). In the 12 th month, the well-controlled rate of the specialized hospital group increased by 12.4% ( P<0.01), and that of the community hospital group increased by 22.9% ( P= 0.015). According to the C-ACT criteria, there was no statistical difference in the monthly well-controlled rate between the two groups (all P>0.05), and the rate maintained an upward trend.The rates of patients with good compliance in the specialized hospital group and the community hospital group at the 12 th month of hierarchical diagnosis and treatment were 78.3%(235/300 cases) and 75.0%(168/224 cases), respectively, and the difference was not statistically significant ( P=0.370). After 12 months of hierarchical diagnosis and treatment, the number of asthma attacks were 1.0 and 2.0 ( P=0.269), and the hospitalization rates for asthma were 3.0%(9/300 cases) and 4.9%(11/224 cases), respectively in the specialized hospital group and the community hospital group, and the diffe-rence was not statistically significant ( P=0.259); the number of respiratory infections in the specialized hospital group (2.0 times) was lower than that in the community hospital group (3.0 times), and the total cost of treatment in the community hospital group (2 471.5 Yuan) was lower than that in the specialized hospital group (3 445.5 Yuan), and the difference was statistically significant ( Z=-3.308, -3.336, all P<0.01). Twelve months after hierarchical diagnosis and treatment, the number of asthma attacks, the number of respiratory infections and the hospitalization rate for asthma in the two groups were all lower than those in the first 12 months of hierarchical diagnosis and treatment, and the difference was statistically significant (all P<0.01). Conclusions:Hierarchical diagnosis and treatment model of childhood asthma in Shanghai Pudong New Area can improve asthma control level, C-ACT score and asthma medication adherence, and enhance health economic benefits, thus it′s an effective way to manage childhood asthma.

Transmembrane 6 superfamily member 2 (TM6SF2) is a recently discovered gene,which is located on the chromosome 19 (19p12) and encodes a protein consisting of 351 amino acids.Presently,many studies have reported that the single-nucleotide polymorphism of TM6SF2 rs58542926 and plasma lipids are closely related to the incidence and development of diseases,such as non-alcoholic fatty liver disease (NAFLD),cardiovascular disease (CVD),liver cancer,and hepatitis C.This review will summarize the research progress conducted in these areas.

Objective To compare the clinical evaluation in diagnosis of thyroid nodules between fine needle aspiration(FNA) and core needle biopsy(CNB).Methods 82 cases with thyroid nodules undergoing FNA and 33 cases with thyroid nodules undergoing CNB were selected.Cytology,histopathology,and postoperative results were compared with postoperative pathology as the gold standard.Results The accuracy,sensitivity,specificity,positive predictive value,negative predictive value,false positive rate,false negative rate of FNA and CNB were 91.5％ vs 87.9％,93.2％ vs 87.5％,87.0％ vs 88.9％,94.8％ vs 95.5％,83.3％ vs 72.7％,13.0％ vs 11.1％,6.8％ vs 12.5％,respectively.There was no significant difference between FNA and CNB (P＞0.05).Conclusion Both of FNA and CNB examination show high accuracy,sensitivity and specificity in diagnosis of benign and malignant thyroid nodules,but FNA is more economical,safe,convenient and thus has more extensive clinical application.For lymphoma or borderline tumor,CNB examination combined with immunohistochemistry is of more advantages.

Objective To investigate the antibiotic resistance in clinical isolates in the Second Hospital of Hebei Medical University from 2015 to 2016.Methods A total of 16 292 strains of non-duplicate bacterial strains were collected.The isolates were subjected to identification and antimicrobial susceptibility testing on VITEK 2-Compact system.The data were processed and analyzed using WHONET 5.6 software.Results Specifically,7 961 and 8 331 strains of pathogens were collected in 2015,2016,respectively.Gram-negative bacteria accounted for 62.0％ in 2015 and 66.9％ in 2016,respectively.The top five pathogens isolated in these two years were still Klebsiella pneumoniae,Escherichia coli,Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus.The proportion of K.pneumoniae increased to the first place in 2016 which accounted for 16.1％.Coagulase negative Staphylococcus in blood samples decreased from 42.6％ in 2015 to 30.0％ in 2016.Vancomycin resistant strains were not found in Staphylococcus.In 2015 and 2016,the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 56.2％ and 51.3％,respectively.The prevalence of methicillinresistant coagulase negative Staphylococcus (MRCNS)was 79.3％ and 63.1％,respectively.Enterococcus faecalis and Enterococcus faecium accounted for 25.2％ and 73.2％ respectively in the 911 strains of Enterococcus.In 2015 and 2016,3.1％ and 2.9％ of the E.faecium strains were resistant to vancomycin,respectively.In 2016,the prevalence of carbapenemresistant strains increased in K.pneumoniae,E.coli and E.cloacae.K.pneumoniae showed increasing resistance rate to all the antimicrobial agents tested except for gentamicin and amikacin.The percentage of the K.pneumoniae strains resistant to imipenem and meropenem increased from 19.3％,18.5％ in 2015 to 24.2％,23.1％,respectively.A.baumannii isolates were still highly resistant to the commonly used antibiotics in these two years,but relatively susceptible to polymyxin B,tigecycline,cefoperazone-sulbactam and minocycline (＜30％ resistant).P.aeruginosa isolates showed lower resistance rate to amikacin (11.7％),cefoperazonesulbactam (15.5％),piperacillin-tazobactam (18.7％),ceftazidime (20.1％),cefepime (21.9％).P.aeruginosa presented a trend of declining resistance to all the antimicrobial agents tested from 2015 to 2016,except aztreonam,to which the resistant P.aeruginosa strains increased from 27.0％ in 2015 to 34.7％ in 2016.Conclusions The antimicrobial susceptibility profile of clinical bacterial isolates has been changing constantly.We need to adopt effective infection prevention and control measures in hospital and further standardize and control the use of antibacterial agents.