OBJECTIVE To explore the implementation and standardized management of infection control core ele-ments in grass-roots medical institutions within county-level medical communities.METHODS From Mar.2024 to Apr.2024,the current status of implementation of infection control core elements in the grass-roots medical institu-tions within county-level medical communities was investigated by means of questionnaire survey and qualita-tive interview,and the implementation strategies were further explored.RESULTS The infection management or-ganizational system and functions of the two county-level medical institutions within the county medical communi-ties were completed,there is no independent hospital infection management department in the primary medical in-stitutions.The infection management personnel in the 16 grass-roots medical institutions were part-time person-nel,the personnel with the educational background below junior college accounted for 84.21％,the personnel with the professional background of nursing accounted for 100.00％,the personnel with less than 5 years of working experience accounted for 78.95％,none of them had an on-the-job training certificate.The monitoring programs of the county-level medical institutions within the county medical communities were completed,there was no infec-tion management monitoring information platform in the grass-roots medical institutions.The infection cases,hand hygiene,environmental health and occupational exposures were monitored by people.The grass-roots medi-cal institutions had the highest requirements for various professional trainings and increase of training contents of prevention and control of public health infectious diseases(100.00％).The county-level medical institutions had inadequate capabilities of professional examination of medical equipment replacement and construction of medi-cal architecture.CONCLUSION It is necessary for the country and local levels of governments to attach great importance to the implementation of the infection control core elements in the grass-roots medical institutions within the county-lev-el medical communities,establish the county-level regional information platform,formulate the corresponding surveil-lance indexes and homogenized management systems,complete the cultivation of talents,and offer financial support.

Continuous care can effectively improve the quality of life, self-management ability and health outcomes of lung transplant recipients, and is important for reducing readmission rates and medical costs, but there are no standardized criteria for evaluating the quality of continuous care for lung transplant recipients. Based on the Donabedian three-dimensional quality evaluation model, this paper presents a review of the indicators for evaluating the quality of continuous care for lung transplant recipients, and analyses the current state of the art of assessing the quality of care in the current literature, in order to provide reference for the development of a multi-dimensional, highly sensitive and specific evaluation index system for lung transplant recipients′ continuous care, as well as providing a direction for future research and clinical application.

OBJECTIVE To explore the implementation and standardized management of infection control core ele-ments in grass-roots medical institutions within county-level medical communities.METHODS From Mar.2024 to Apr.2024,the current status of implementation of infection control core elements in the grass-roots medical institu-tions within county-level medical communities was investigated by means of questionnaire survey and qualita-tive interview,and the implementation strategies were further explored.RESULTS The infection management or-ganizational system and functions of the two county-level medical institutions within the county medical communi-ties were completed,there is no independent hospital infection management department in the primary medical in-stitutions.The infection management personnel in the 16 grass-roots medical institutions were part-time person-nel,the personnel with the educational background below junior college accounted for 84.21％,the personnel with the professional background of nursing accounted for 100.00％,the personnel with less than 5 years of working experience accounted for 78.95％,none of them had an on-the-job training certificate.The monitoring programs of the county-level medical institutions within the county medical communities were completed,there was no infec-tion management monitoring information platform in the grass-roots medical institutions.The infection cases,hand hygiene,environmental health and occupational exposures were monitored by people.The grass-roots medi-cal institutions had the highest requirements for various professional trainings and increase of training contents of prevention and control of public health infectious diseases(100.00％).The county-level medical institutions had inadequate capabilities of professional examination of medical equipment replacement and construction of medi-cal architecture.CONCLUSION It is necessary for the country and local levels of governments to attach great importance to the implementation of the infection control core elements in the grass-roots medical institutions within the county-lev-el medical communities,establish the county-level regional information platform,formulate the corresponding surveil-lance indexes and homogenized management systems,complete the cultivation of talents,and offer financial support.

Objective:To reassess the pathogenicity of copy number variants (CNVs) involving chromosomal microdeletions and microduplications classified as variants of uncertain significance (VUS).Methods:This retrospective study analyzed 1 882 pregnant women who underwent invasive prenatal diagnosis for chromosomal microarray analysis (CMA) at the First Medical Center, Chinese PLA General Hospital between January 1, 2018, and December 31, 2022. The results were classified according to the American College of Medical Genetics and Genomics guidelines, with 82 fetuses rated as VUS selected for the study. We analyzed invasive prenatal diagnostic indications, followed up on fetal ultrasound findings, parental origin identification results, and pregnancy outcomes, and reclassified VUS CNVs based on the latest evidence. Descriptive statistical analysis was applied to the data.Results:(1) Among the 82 fetuses with VUS CNVs, prenatal diagnostic indications included fetal structural abnormalities detected by ultrasound (21 cases, 25.6%), abnormal non-invasive prenatal testing (NIPT) results (12 cases, 14.6%), high-risk serum screening (seven cases, 8.5%), advanced maternal age (≥35 years at expected delivery, 28 cases, 34.1%), and other indications (14 cases, 17.1%). Sixteen cases (19.5%) exhibited abnormal phenotypes, with seven pregnancies terminated due to severe structural abnormalities detected by prenatal ultrasound. Seventy-five live births were followed up for 25 (13-66) months. (2) Among the 82 cases, five fetuses had two VUS CNVs detected by CMA, while the remaining 77 had only one, totaling 87 VUS CNVs. Of these, 63 (72.4%) were chromosomal microduplications and 24 (27.6%) were chromosomal microdeletions. The size of the CNV segments ranged from 0.85 (0.05-5.61) Mb, with 82 segments less than 2 Mb. Parental origin identification was refused by 44 cases (53.7%), while 38 (46.3%) underwent the test, revealing eight (21.0%) de novo variants and 30 (78.9%) inherited from either parent (12 maternal and 18 paternal). (3) Among the 87 VUS CNVs, the ratings of 11 CNVs (12.6%) changed after re-evaluation. This included one 4p16.2 microdeletion and two 15q11.2 microdeletions being upgraded to pathogenic, one 16p13.11 microduplication being upgraded to likely pathogenic, one Xp22.31 microduplication and two 2q13 microdeletions being downgraded to likely benign, and four Xp22.31 microduplications being downgraded to benign. (4) Among the 16 fetuses with abnormal phenotypes, seven with prenatal abnormalities terminated pregnancies, including six with structural abnormalities and one with severe fetal growth restriction. After re-evaluation, one case was upgraded to pathogenic, while six remained VUS. Nine live births with postnatal abnormal phenotypes showed no change in classification after re-evaluation. Among the 66 cases (80.5%) without abnormal phenotypes, 10 had their classifications changed after re-evaluation. Conclusions:Fetuses with VUS CNVs often exhibit no significant abnormal phenotypes and have a relatively favorable prognosis, however, further floow-up is still needed. Parental origin identification can provide valuable insights for genetic counseling.

Objective:To analyze the clinical characteristics of children hospitalized with acute lower respiratory tract infections (ALRTI) caused by respiratory syncytial virus (RSV) in Kunming area in 2023.Methods:The clinical data of children with RSV-ALRTI admitted to Kunming Children's Hospital from January to December 2023 were retrospectively analyzed.According to the severity of the disease and whether the children developed severe pneumonia,they were divided into common group and severe group.The general data,clinical manifestations,laboratory indexes,imaging results,treatment and outcomes of the children between the two groups were compared.Multinomial Logistic regression analysis was used to study the risk factors for severe RSV-ALRTI.Results:A total of 696 children with RSV-ALRTI were included,including 432 males (62.1%) and 264 females (37.9%),with a median age of 1.30 (0.40,3.38) years.The onset of RSV-ALRTI occured throughout the year,with a peak incidence in May to August (60.6%).One hundred and seventy-one of 696 samples were tested RSV gene sequence,and two genotypes of RSV A-ON1(60.8%) and RSV B-BA9(39.2%) were detected.Among the 696 children,480 (69.0%) were in the common group and 216 (31.0%) were in the severe group.The age of the children in the severe group was lower than that of the common group,and the proportions of age <1 year,preterm birth,congenital diseases (congenital anomalies of airway development,congenital heart disease),combined Mycoplasma pneumoniae infections,and combined bacterial infections were higher than those of the common group ( P<0.05).There was no statistically significant differences in fever and cough symptoms between the two groups ( P>0.05),but the proportions of children in the severe group with wheezing,shortness of breath,dyspnea,vomiting,and diarrhea were significantly higher than those in the common group ( P<0.05),and the proportions of moist rales and wheezing heard by lung auscultation were significantly higher than those in the common group ( P<0.05).The levels of leukocytes,neutrophils,neutrophil percentage,platelets,procalcitonin,lactate dehydrogenase,alanine aminotransferase,aspartate aminotransferase,creatine kinase isoenzyme,and ferritin in the severe group were higher than those in the common group,while the levels of hemoglobin,lymphocyte percentage,albumin,creatinine,IgG,IgM,IgA,interleukin 6,D-dimer,and fibrin were lower than those in the common group ( P<0.05).The proportions of pulmonary consolidation and pleural effusion in the severe group were higher than those in the common group,and the severe group was more likely to have bilateral pulmonary consolidation ( P<0.05).Both groups of children were given interferon aerosol inhalation for antiviral treatment,and actively symptomatic and supportive treatment.One case in the severe group died during hospitalization,and the remaining 695 cases were cured and discharged.The proportions of children in the severe group using antibiotics,dual antibiotics,intravenous hormones,intravenous immunoglobulin,complications,transfer to PICU,use of invasive mechanical ventilation,length of hospital stay,and treatment costs were significantly higher than those in the common group ( P<0.001).Multinomial Logistic regression analysis showed that low age ( OR=0.878,95% CI 0.800~0.963, P=0.006),congenital diseases (congenital anomalies of airway development,congenital heart disease) ( OR=2.892,95% CI 1.977~4.233, P<0.001),and co-infection with bacteria ( OR=1.846,95% CI 1.268~2.686, P=0.001) were risk factors for the development of severe pneumonia in RSV-infected children. Conclusions:In 2023,RSV-ALRTI in children in Kunming area had an incidence throughout the year,and the peak age group of incidence was predominantly <1 year old,and the main genotype of infection was RSV A-ON1.Children with RSV-ALRTI who are young,suffering from congenital diseases (congenital anomalies of airway development,congenital heart disease) and complicated with bacterial infection are more likely to develop into severe diseases,and should be paid close attention and active intervention to reduce the incidence of critical illness.

Objective:To analyze the gene mutation spectrum of children with T-acute lymphoblastic leukemia (T-ALL) using next generation sequencing technology and to evaluate the value of gene mutations in prognosis stratification.Methods:A case series analysis was made.The clinical data of newly diagnosed pediatric T-ALL patients in the First Affiliated Hospital of Zhengzhou University from January 1, 2019 to February 29, 2024 were analyzed retrospectively.T-ALL gene mutations were analyzed.The relationships of gene mutations with clinical features and induction of responses to therapy were studied.The effects of gene mutations on overall survival (OS) and event-free survival (EFS) were examined by the Kaplan-Meier method and COX regression model.Results:A total of 80 newly diagnosed pediatric T-ALL patients were enrolled in the study, with a male-to-female ratio of 3.4∶1.0 and a median age of 8 (range, 2-17) years.A total of 57 mutations were detected in 74 patients, 46.2% (37/74) of whom showed 3 or more gene mutations.The coexistence of mutated genes was obvious. PTEN mutations were more prevalent in male patients ( P=0.018).Initial leukocyte counts were higher in patients with PTEN mutations ( P=0.038) and lower in patients with JAK3 mutations ( P=0.002).Patients with NOTCH1 mutations had a higher positive rate of fusion genes ( P=0.043).Patients with PTEN mutations had a higher rate of minimal residual disease(MRD) remission after 15/19 d of treatment with induction therapy, respectively ( P=0.013).The rate of MRD remission after 33/46 d of treatment with induction therapy was higher in patients with the FBXW7 mutation ( P=0.004) and lower in patients with JAK3 mutations ( P=0.003).Multifactorial COX regression analysis showed that IL7R mutation and three or more gene mutations were independent risk factors for OS and EFS in T-ALL patients(OS: HR=3.252, 7.357, 95% CI: 1.020-10.372, 1.646-32.882; EFS: HR=3.372, 3.009, 95% CI: 1.234-9.214, 1.174-7.708; all P<0.05). Conclusions:Gene mutations are prevalent in T-ALL children and correlate with clinical manifestations and prognosis.The coexistence of mutated genes is obvious.Pediatric T-ALL patients with IL7R mutations and three or more gene mutations have a poorer prognosis.

Objective:To investigate the clinical experience and efficacy of unrelated umbilical cord blood hematopoietic stem cell transplantation (HSCT) for the treatment of congenital amegakaryocytic thrombocytopenia (CAMT).Methods:A case summary was conducted.The clinical data of 2 children with CAMT who were finally cured by unrelated umbilical cord blood HSCT in the Department of Pediatric Medicine, the First Affiliated Hospital of Zhengzhou University from March 2020 to August 2023 were retrospectively analyzed.Related studies were retrieved from databases CNKI, Wanfang and PubMed using search terms including " congenital amegakaryocytic thrombocytopenia" and " hematopoietic stem cell transplantation" from the inception to July 2024.The clinical characteristics, diagnosis and treatment processes, and prognosis of CAMT patients treated by HSCT were then summarized.Results:Both cases exhibited scattered skin haemorrhages throughout the body and carried 2 compound heterozygous mutations with pathogenicity in the MPL gene.Both patients were finally diagnosed with CAMT.Case 1 was a girl aged 3 at the time of transplantation, and case 2 was also a girl, who aged 5 at the time of transplantation.Both of them received unrelated umbilical cord blood HSCT and hematopoietic reconstruction was achieved.The time of neutrophil and platelet implantation was 21 and 40 days after transplantation in case 1, and 20 and 31 days in case 2, respectively.The chimerism rate of neutrophil implantation in both children was complete chimerism of donor cells.Implantation syndrome was detected in case 1 following transplantation.Case 2 suffered implantation syndrome, hypertensive encephalopathy, and cytomegalovirus infection following transplantation.Both children showed no graft-versus-host disease (GVHD).Both children had hematopoietic and immune reconstruction after transplantation and their primary diseases were cured.Cases 1 and 2 were followed up for more than 14 and 17 months, respectively.Both of them achieved disease-free survival during the follow up.Literature review of 26 cases with CAMT treated by HSCT, including the above-mentioned 2 cases was conducted, with an overall disease-free survival rate of 92.3%(24/26).Of 12 cases with CAMT typing, 10 were type Ⅰ and 2 were type Ⅱ.Of the 26 cases treated by HSCT, 17 had bone marrow HSCT, with an overall survival rate of 88.2%(15/17), and 2 had peripheral blood HSCT.Seven cases had umbilical cord blood HSCT (6 cases receiving unrelated umbilical cord blood HSCT and 1 case receiving related umbilical cord blood HSCT), with an overall survival rate of 100%.Unlike bone marrow and peripheral blood HSCT, unrelated umbilical cord blood HSCT did not result in 3-4 grade GVHD. Conclusions:Unrelated umbilical cord blood HSCT can achieve good therapeutic effects in CAMT patients when there is no suitable donor.Myeloablative pretreatment is conducive to CAMT patients.

The clinical features and SFTPA2 gene mutation in a female child with interstitial lung disease, who was admitted to the Pediatric Intensive Care Unit of Kunming Children′s Hospital in September 2022, were retrospectively analyzed, supplemented by a literature review.The 8-year-and-11-month-old patient presented with pneumonia, dyspnea, and persistent hypoxemia.High-resolution computed tomography revealed pneumomediastinum, subcutaneous emphysema, pneumothorax, and bilateral diffuse lung lesions.Pulmonary function tests demonstrated restrictive ventilatory impairment.Whole-exome sequencing identified a novel heterozygous SFTPA2 variant (c.736T>C) in the patient, potentially associated with interstitial lung disease.To date, 18 SFTPA2 variants have been globally linked to interstitial lung disease.The variant detected in this case is previously unreported, expanding both the phenotypic and mutational spectra of this disorder.

Objective:To analyze the clinical characteristics of children hospitalized with acute lower respiratory tract infections (ALRTI) caused by respiratory syncytial virus (RSV) in Kunming area in 2023.Methods:The clinical data of children with RSV-ALRTI admitted to Kunming Children's Hospital from January to December 2023 were retrospectively analyzed.According to the severity of the disease and whether the children developed severe pneumonia,they were divided into common group and severe group.The general data,clinical manifestations,laboratory indexes,imaging results,treatment and outcomes of the children between the two groups were compared.Multinomial Logistic regression analysis was used to study the risk factors for severe RSV-ALRTI.Results:A total of 696 children with RSV-ALRTI were included,including 432 males (62.1%) and 264 females (37.9%),with a median age of 1.30 (0.40,3.38) years.The onset of RSV-ALRTI occured throughout the year,with a peak incidence in May to August (60.6%).One hundred and seventy-one of 696 samples were tested RSV gene sequence,and two genotypes of RSV A-ON1(60.8%) and RSV B-BA9(39.2%) were detected.Among the 696 children,480 (69.0%) were in the common group and 216 (31.0%) were in the severe group.The age of the children in the severe group was lower than that of the common group,and the proportions of age <1 year,preterm birth,congenital diseases (congenital anomalies of airway development,congenital heart disease),combined Mycoplasma pneumoniae infections,and combined bacterial infections were higher than those of the common group ( P<0.05).There was no statistically significant differences in fever and cough symptoms between the two groups ( P>0.05),but the proportions of children in the severe group with wheezing,shortness of breath,dyspnea,vomiting,and diarrhea were significantly higher than those in the common group ( P<0.05),and the proportions of moist rales and wheezing heard by lung auscultation were significantly higher than those in the common group ( P<0.05).The levels of leukocytes,neutrophils,neutrophil percentage,platelets,procalcitonin,lactate dehydrogenase,alanine aminotransferase,aspartate aminotransferase,creatine kinase isoenzyme,and ferritin in the severe group were higher than those in the common group,while the levels of hemoglobin,lymphocyte percentage,albumin,creatinine,IgG,IgM,IgA,interleukin 6,D-dimer,and fibrin were lower than those in the common group ( P<0.05).The proportions of pulmonary consolidation and pleural effusion in the severe group were higher than those in the common group,and the severe group was more likely to have bilateral pulmonary consolidation ( P<0.05).Both groups of children were given interferon aerosol inhalation for antiviral treatment,and actively symptomatic and supportive treatment.One case in the severe group died during hospitalization,and the remaining 695 cases were cured and discharged.The proportions of children in the severe group using antibiotics,dual antibiotics,intravenous hormones,intravenous immunoglobulin,complications,transfer to PICU,use of invasive mechanical ventilation,length of hospital stay,and treatment costs were significantly higher than those in the common group ( P<0.001).Multinomial Logistic regression analysis showed that low age ( OR=0.878,95% CI 0.800~0.963, P=0.006),congenital diseases (congenital anomalies of airway development,congenital heart disease) ( OR=2.892,95% CI 1.977~4.233, P<0.001),and co-infection with bacteria ( OR=1.846,95% CI 1.268~2.686, P=0.001) were risk factors for the development of severe pneumonia in RSV-infected children. Conclusions:In 2023,RSV-ALRTI in children in Kunming area had an incidence throughout the year,and the peak age group of incidence was predominantly <1 year old,and the main genotype of infection was RSV A-ON1.Children with RSV-ALRTI who are young,suffering from congenital diseases (congenital anomalies of airway development,congenital heart disease) and complicated with bacterial infection are more likely to develop into severe diseases,and should be paid close attention and active intervention to reduce the incidence of critical illness.

The triple energizer is the pathway for the transportation and metabolism of qi,blood and body fluid in the body,and the xuanfu(sweat pores)is the way for the ascending,descending,exiting,and entering of qi movement in the muscular striae and the exterior.Professor Li Huilin believes that the pathogenesis of acne is usually due to the dysfunction of triple energizer and the stagnation of depressed yang-heat,which result into the abnormal opening and closing of the xuanfu and the accumulation of heat-toxin in the muscular striae.For the treatment of acne with traditional Chinese medicine,it is necessary to pay attention to the regulation of triple energizer-xuanfu.The treatment should be based on unblocking therapy,and the therapeutic principle of unblocking triple energizer and opening xuanfu should be taken into account.In clinical practice,it is necessary to identify the syndromes of upper energizer,middle energizer and lower energizer.The syndrome of the upper energizer is often due to fire-heat,which results from the wind-heat in lung meridian or the exuberance of heart fire.The upper-energizer syndrome can be treated by the therapy of relieving and clearing the pathogens with light and mild drugs,expelling fire-heat to open sweat pores,and through the modified use of Mahuang Lianqiao Chixiaodou Decoction,Ma Xing Shi Gan Decoction,or Puji Xiaodu Decoction.The syndrome of the middle energizer is usually due to the qi stagnation,which results from intense stomach-heat,damp-heat in the spleen and stomach,liver depression and qi stagnation,or spleen deficiency with dampness accumulation.The middle-energizer syndrome can be treated by the therapy of regulating qi movement to relieve stagnation and open sweat pores,and through the modified use of Qingwei san,Sanren Decoction,Huanglian Wendan Decoction,Chaihu Shugan Powder,or Heqi Powder.The syndrome of the lower energizer is often due to healthy-qi deficiency,which results from yin deficiency of liver and kidney,or deficiency-cold in lower energizer.The lower-energizer syndrome can be treated by the therapy of cultivating the vital essence and consolidating vital base,supplementing deficiency to open sweat pores,and through the modified use of Liuwei Dihuang Pills or Yanghe Decoction.