The lung collaterals form a network that branches from the lung meridian, traversing the lung system and extending across the body′s surface. Lung collateral disease refers to the structural alterations or dysfunction in these collaterals caused by external or internal pathogens. Research into the structural and physiological functions of children′s lung collaterals, as well as the pathogenesis and syndrome differentiation for treating lung collateral diseases in children, holds significant value in guiding the prevention and treatment of pediatric respiratory conditions. Drawing on the theory of collateral disease, the clinical insights of both historical and contemporary physicians, and modern research findings—while considering the unique physiological and pathological characteristics of children′s respiratory systems—this study provides a foundational summary of the morphology and spatial distribution of children′s lung collaterals. The characteristics of these collaterals are highlighted as thin, sparse, short, narrow, brittle, and tender. From this structural understanding, the unique physiological functions of children′s lung collaterals are analyzed. The study further explores the interactions between pathogenic factors and lung collaterals, elucidating the pathogenesis and progression of children′s lung collateral diseases. It proposes treatment principles centered on "seeking treatment in the collaterals and employing the method of unblocking collaterals, "which align with the unique features of pediatric lung collaterals. Common treatment approaches, and relevant prescriptions for managing these diseases are summarized. This paper lays the foundation for a theoretical system encompassing the structure, function, pathogenesis, and syndrome differentiation for treating children′s lung collateral diseases. It offers valuable insights for the clinical diagnosis and management of pediatric respiratory diseases linked to collateral dysfunction and serves as a reference for the systematic development of a broader theoretical framework for children′s collateral diseases.

ObjectiveTo obtain the epidemiological characteristics of re-positive cases infected with SARS-CoV-2 in Pudong New Area from March to July 2022, including clinical manifestations, duration of a negative nucleic acid conversion after tested for re-positive, and length of time from the discharge of the initial infection to the most recent re-positivity, so as to provide a scientific basis for the prevention and control of COVID-19. MethodsA questionnaire survey was conducted among the re-positive cases infected with SARS-CoV-2 after discharged from hospital/quarantine facility in Pudong New Area, and descriptive epidemiological methods were used for characteristics analysis. ResultsA total of 2 422 re-positive cases met the inclusive and exclusive criteria, with males accounting for 61.02%. The age distribution mainly fell between 18 and <60 years old, accounting for 62.39%. Clinical manifestations were predominantly asymptomatic (72.15%), followed by cough (12.03%) and sore throat (6.58%). Among the stratified randomized sample of 416 individuals, there were statistically significant differences in symptoms (χ²=262.667, P<0.001), clinical typing (χ²=12.996, P=0.001), and duration of a negative nucleic acid conversion (χ²=142.578, P<0.001) between the initial positive and re-positive instances. Besides, statistically significant differences in symptoms (χ²=13.696, P=0.016) and self-perception of the severity of re-infection (χ²=7.923, P=0.048) between the initial and re-positive cases were observed by different genders. ConclusionAmong re-positive cases, males experienced milder symptoms compared to females, and the self-perception of symptoms during re-positivity is milder than that in the initial positive infection. The length of time for negative nucleic acid conversion during the initial positive period is shorter than that during the re-positive period.

Human beings are inevitably exposed to toxic substances as a result of influences of potential contamination factors in the environment,food and medicines,which poses a threat to human health.In order to effectively screen and prevent the exposure or intake of such substances,it is neces-sary to develop in vitro assays for the detection and toxicity evaluation of toxic substances.High content screening(HCS)has been recognized as an important tool for toxicity testing and risk assessment of compounds due to its high throughput and automation advantages,and has been widely used in in vitro toxicology research.In this review,we described the system components of HCS and its workflow in toxicity screening and toxicity evaluation by focusing on cases of their application in toxicity detection and evaluation studies,including the cytotoxicity,hepatotoxicity,nephrotoxicity,genotoxicity,neurotox-icity,cardiotoxicity,and developmental toxicity.In addition,the applications and developments of machine learning in HCS were explored,especially to the advantages of supervised and unsupervised machine learning strategies for high throughput image screening and data analysis.Finally,the future applications of HCS in toxicity screening and evaluation are outlined,especially in terms of binding new models and gene editing technology.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To develop a Behavioral Decision-making Scale for Glycemic Management in pregnant women with gestational diabetes and to test its reliability and validity.Methods Based on the trans-theoretical model and behavioral decision theory,the test version of the scale was formed through literature review,semi-structured interview,brainstorming,2 rounds of expert consultation and cognitive interview.A total of 560 pregnant women with gestational diabetes mellitus were recruited from 10 hospitals in Quanzhou,Fujian Province by convenience sampling method from 21 July to November 2023.The data were divided into 2 parts by random number method for exploratory factor analysis and confirmatory factor analysis.Results The scale included 4 dimensions of"behavioral decision-making motivation""behavioral decision-making influencing factors""behavioral decision-making intention"and"behavioral decision-making effectiveness"with 34 items.The Cronbach's αcoefficient of the total scale was 0.971;the split-half reliability was 0.919;the test-retest reliability was 0.863;the content validity index of the scale was 0.853.The exploratory factor analysis extracted 4 common factors,and the cumulative variance contribution rate was 78.28％.The confirmatory factor analysis showed that the factor structure of the scale was stable.Conclusion The scale has ideal reliability and validity,which can be used to measure the level of glycemic management behavior decision-making of pregnant women with gestational diabetes mellitus.

Objective:To evaluate the effect of small-dose esketamine on the learning and memory ability of chronic sleep-deprived rats and the role of hippocampal amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors (AMPARs).Methods:Forty healthy male Sprague-Dawley rats, aged 4 months, weighing 200-280 g, were divided into 4 groups ( n=10 each) using a random number table method: normal control group (N group), chronic sleep deprivation group (SD group), chronic sleep deprivation+ esketamine group (SDK group) and chronic sleep deprivation + esketamine + AMPAR antagonist CNQX group (SDKI group). The sleep deprivation model was prepared by the modified multi-platform water environment method. For 3 consecutive days after developing the model, ketamine 10 mg/kg was intraperitoneally injected in SDK group, and SDKI group received intraperitoneal injection of CNQX 1 mg/kg followed by ketamine 10 mg/kg. Morris water maze test was used to detect spatial learning and memory ability after the end of sleep deprivation or after administration. After the water maze test, rats were sacrificed, and the hippocampal tissue was obtained to detect the expression of hippocampal Homer1a mRNA (by quantitative polymerase chain reaction), Homer1a, metabotropic glutamate receptor 5 (mGluR5) and AMPAR (by Western blot). The density of dendritic spines in hippocampal CA1 region was determined by Golgi staining. Results:Compared with N group, the escape latency was significantly prolonged, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were decreased, the expression of Homer1a protein and mRNA and mGluR5 was up-regulated, the expression of AMPAR was down-regulated, and the density of dendritic spines in hippocampal CA1 region was decreased in SD group ( P<0.05). Compared with SD group, the escape latency was significantly shortened, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were increased, the expression of AMPAR was up-regulated, and the density of dendritic spines in hippocampal CA1 region was increased in SDK group ( P<0.05). Compared with SDK group, the escape latency was significantly prolonged, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were decreased, the expression of AMPAR was down-regulated, and the density of dendritic spines in hippocampal CA1 region was decreased in SDKI group ( P<0.05). There was no significant difference in the expression of Homer1a protein and mRNA and mGluR5 among SD group, SDK group and SDKI group ( P>0.05). Conclusions:Small-dose esketamine can improve the learning and memory ability of chronic sleep-deprived rats, and the mechanism may be related to up-regulation of the expression of hippocampal AMPARs.

Objective To investigate the prognostic value of red cell distribution width(RDW)on neurological prognosis in patients with cardiac arrest(CA).Methods Retrospective analysis the case data,RDW and biochemical indicators of 107 CA patients treated in our department(January 2020 to November 2023).According to cerebral performance category(CPC),patients were divided into good neurological prognosis group and bad neurological prognosis group.The differences in clinical data and RDW between the two groups were compared.Multivariate Logistic regression analysis was used to investigate the risk factors on neurological prognosis.Predictive effect of RDW on poor neurological prognosis in CA patients was assessed by receiver operating characteristic(ROC)curve.According to the optimal cut-off value of RDW,it was divided into high RDW group(≥ 13.45％)and low RDW group(＜13.45％)to compare the incidence of poor neurological prognosis.Results Totally 107 CA patients were included,34 patients in the good neurological prognosis group and 73 patients in the bad neurological prognosis group,the incidence of poor prognosis of neurological function was 68.22％.Compared with good neurological prognosis group,the acute physiology and chronic health evaluation Ⅱ score,RDW,cardiopulmonary resuscitation(CPR)time,age,serum sodium and glutamic-pyruvic transaminase in bad neurological prognosis group were significantly increased(P＜0.05).Multivariate Logistic regression analysis showed that RDW,age and CPR time were independent risk factors for poor prognosis of neurological function(P＜0.05).ROC curve analysis showed that the area under the curve of RDW to predict poor neural function prognosis in CA patients was 0.766.When the optimal threshold of RDW was 13.45％,the sensitivity was 73％and the specificity was 71％.The incidence of poor prognosis of neurological function in high RDW group was 84.13％,which was significantly higher than 45.45％in low RDW group(P＜0.05).Conclusion Elevated RDW is an independent risk factor for increased risk of poor neurological outcomes in patients with CA.It has certain predictive value for neurological outcomes in patients with CA.

Objective This investigation evaluates the effectiveness of ultrasound-guided erector spinae plane block,employing a combination of ropivacaine,methylprednisolone sodium succinate,mecobalamin,and an additional administration of dexmedetomidine(Dex),in the treatment of postherpetic neuralgia.Methods A tatol of 60 postherpetic neuralgia patients who underwent erector spinae plane block at Shangyu People's Hospital of Shaoxing City from May 2023 to March 2024 were selected.To divided patients into control group and Dex group using random number table method,30 cases in each group.Besides conventional medication therapy,both groups received the ultrasound-guided erector spinae plane block.The patients in control group were administered a mixed diluent of ropivacaine,mecobalamin,and methylprednisolone sodium succinate,while the patients in Dex group received an additional dosage of Dex at 1 μg/kg.The pain,depression,and anxiety scores were compared between two groups.Results Both groups reported a decrease in pain scores at the end of the first week and second weeks and two weeks after the completion of treatment,compared to pre-treatment levels.The decrease in pain scores in Dex group was significantly greater than that in control group,with a statistically significant difference(P＜0.05).After treatment,the depression and anxiety scores of both groups of patients decreased compared to pre-treatment.The scores of the patients in Dex group improved more significantly compared to the patients in control group,and the difference was statistically significant(P＜0.05).Conclusion The ultrasound-guided erector spinae plane block,augmented with dexmedetomidine,effectively reduces the intensity of pain in postherpetic neuralgia patients and alleviates their symptoms of anxiety and depression.

Objective:To further improve the understanding of paroxysmal nocturnal hemoglobinuria (PNH), we retrospectively analyzed and summarized the clinical characteristics, treatment status, and survival status of patients with PNH in Zhejiang Province.Methods:This study included 289 patients with PNH who visited 20 hospitals in Zhejiang Province. Their clinical characteristics, comorbidity, laboratory test results, and medications were analyzed and summarized.Results:Among the 289 patients with PNH, 148 males and 141 females, with a median onset age of 45 (16-87) years and a peak onset age of 20-49 years (57.8% ). The median lactic dehydrogenase (LDH) level was 1 142 (604-1 925) U/L. Classified by type, 70.9% (166/234) were classical, 24.4% (57/234) were PNH/bone marrow failure (BMF), and 4.7% (11/234) were subclinical. The main clinical manifestations included fatigue or weakness (80.8%, 235/289), dizziness (73.4%, 212/289), darkened urine color (66.2%, 179/272), and jaundice (46.2%, 126/270). Common comorbidities were hemoglobinuria (58.7% ), renal dysfunction (17.6% ), and thrombosis (15.0% ). Moreover, 82.3% of the patients received glucocorticoid therapy, 70.9% required blood transfusion, 30.7% used immunosuppressive agents, 13.8% received anticoagulant therapy, and 6.3% received allogeneic hematopoietic stem cell transplantation. The 10-year overall survival (OS) rate was 84.4% (95% CI 78.0% -91.3% ) . Conclusion:Patients with PNH are more common in young and middle-aged people, with a similar incidence rate between men and women. Common clinical manifestations include fatigue, hemoglobinuria, jaundice, renal dysfunction, and recurrent thrombosis. The 10-year OS of this group is similar to reports from other centers in China.

Objective To investigate the effect of orthokeratology combined with repeated low-level red-light(RL-RL)therapy on progressive myopia in adolescents.Methods A total of 106 adolescents(212 eyes)with progressive my-opia admitted to our hospital from March 2020 to September 2022 were selected and randomly classified into an observation group(n=57,114 eyes)and a control group(n=49,98 eyes).Patients in the observation group received orthokeratology and RLRL therapy,and patients in the control group received orthokeratology only.All patients were followed up for 1 year.The uncorrected visual acuity(UCVA),axial length(AL),diopter,tear film lipid layer thickness(LLT),break-up time(BUT),subfoveal choroidal thickness(SFChT),and the incidence of complications at different time points were compared between the two groups.Results Analysis of variance on the UCVA,diopter,LLT,BUT and SFChT at differ-ent time points before and after treatment revealed a significant time effect and time × group interaction effect(all P＜0.05),but no statistical group effect(all P＞0.05).For the AL,there was a significant time effect(P＜0.05),but no time x group interaction effect or group effect(all P＞0.05).Twelve months after treatment,the UCVA,LLT decrease and SFChT thickening were greater in the observation group compared to the control group,while the diopter progression and AL increase were milder in the observation group than in the control group(all P＜0.05).Changes in BUT yielded no sta-tistical difference between the two groups(P＞0.05).The complication rate demonstrated no statistical difference between the two groups(P＞0.05).Conclusion The application of RLRL therapy combined with orthokeratology for progressive myopia in adolescents can effectively improve the UCVA and control the growth of AL and diopter,with high safety.