With the rapid advancement of vaccines, the research and application of vaccine adjuvants have garnered significant attention. Despite the development of numerous vaccine adjuvants, their applications in human vaccines remain limited due to either insufficient efficacy or severe side effects. Consequently, there is growing interest in developing bioactive compounds derived from traditional Chinese medicines (TCMs) as vaccine adjuvants, owing to their natural biocompatibility, diversity, and safety. Here, we systematically review the current application status and potential value of TCM-based bioactive compounds in vaccine adjuvants. Firstly, we elaborate on the types and characteristics of active ingredients, such as polysaccharides, saponins, flavonoids, acids, and alkaloids. The mechanisms by which these compounds function as vaccine adjuvants are then discussed, including their roles in enhancing humoral immunity, cellular immunity, and relieving the immune suppression in the microenvironment. Additionally, we summarize the current strategies for structural modification and platform optimization to adapt to different application scenarios. Finally, we offer insights into the future development directions for these potential adjuvants, highlighting research priorities, technical approaches, and application prospects. In conclusion, natural vaccine adjuvants derived from TCMs present broad application prospects and hold promise for future vaccine development.

Objective·To investigate the therapeutic effect of combined vitamin D and docosahexaenoic acid(DHA)supplementation on preschool children with attention deficit hyperactivity disorder(ADHD).Methods·From April 2021 to May 2021,a total of 1 412 children aged 4 to 6 years from eight kindergartens in Pudong New Area of Shanghai,including Tangqiao Street,Chuansha Town,and Heqing Town,were randomly selected by stratified cluster random sampling method.Attention and hyperactivity symptom assessment was performed using the Conner's Scale,Diagnosis and Statistical Manual of Mental Disorders(fifth edition,DSM-Ⅴ),and Swanson,Nolan,and Pelham(version Ⅳ,SNAP-Ⅳ)Scale,and other neurodevelopmental disorders were excluded using the Wechsler Intelligence Scale.A total of 82 preschool children with ADHD were enrolled,and after fully informing them of the intervention measures,they were divided into an intervention group(n=64)and a control group(n=18)based on their parents' choice.The control group received routine health education.In addition to routine health education,the intervention group received daily supplementation of Vitamin D(800 IU)and DHA(400 mg).Venous blood samples were collected from both groups at baseline,3 months,and 12 months for the measurement of serum 25 hydroxy vitamin D[25(OH)D]and DHA levels.ADHD symptoms were evaluated using Conner's Scale,SNAP-Ⅳ Scale,and DSM-Ⅴ.Results·After 3 and 12 months of intervention in the intervention group,serum 25(OH)D levels and DHA levels were significantly higher(P<0.05),the ADHD symptom scores,including impulsivity-hyperactivity and hyperactivity index scores in Conner's Scale,the attention and hyperactivity/impulsivity scores in SNAP-Ⅳ Scale,and the attention and hyperactivity/impulsivity scores in DSM-Ⅴ,were significantly reduced compared with the scores before the intervention(P<0.05).There was no significant difference in serum 25(OH)D and DHA levels,or ADHD symptom scores,at the 3-and 12-month follow-ups compared to baseline.After 3 months of nutritional intervention in the intervention group,the hyperactivity/impulsivity scores in SNAP-Ⅳ Scale and DSM-Ⅴ were significantly improved compared to the control group(P<0.05).After 12 months of intervention,conduct problems,impulsive-hyperactivity and hyperactivity index scores in Conner's Scale,and hyperactivity/impulsivity scores in SNAP-Ⅳ Scale and DSM-Ⅴ showed significant improvement compared to the control group(P<0.05).Conclusion·Combined supplementation with vitamin D and DHA significantly improves serum 25(OH)D and DHA levels and alleviates ADHD symptoms in preschool children.

Objective·To investigate the therapeutic effect of combined vitamin D and docosahexaenoic acid(DHA)supplementation on preschool children with attention deficit hyperactivity disorder(ADHD).Methods·From April 2021 to May 2021,a total of 1 412 children aged 4 to 6 years from eight kindergartens in Pudong New Area of Shanghai,including Tangqiao Street,Chuansha Town,and Heqing Town,were randomly selected by stratified cluster random sampling method.Attention and hyperactivity symptom assessment was performed using the Conner's Scale,Diagnosis and Statistical Manual of Mental Disorders(fifth edition,DSM-Ⅴ),and Swanson,Nolan,and Pelham(version Ⅳ,SNAP-Ⅳ)Scale,and other neurodevelopmental disorders were excluded using the Wechsler Intelligence Scale.A total of 82 preschool children with ADHD were enrolled,and after fully informing them of the intervention measures,they were divided into an intervention group(n=64)and a control group(n=18)based on their parents' choice.The control group received routine health education.In addition to routine health education,the intervention group received daily supplementation of Vitamin D(800 IU)and DHA(400 mg).Venous blood samples were collected from both groups at baseline,3 months,and 12 months for the measurement of serum 25 hydroxy vitamin D[25(OH)D]and DHA levels.ADHD symptoms were evaluated using Conner's Scale,SNAP-Ⅳ Scale,and DSM-Ⅴ.Results·After 3 and 12 months of intervention in the intervention group,serum 25(OH)D levels and DHA levels were significantly higher(P<0.05),the ADHD symptom scores,including impulsivity-hyperactivity and hyperactivity index scores in Conner's Scale,the attention and hyperactivity/impulsivity scores in SNAP-Ⅳ Scale,and the attention and hyperactivity/impulsivity scores in DSM-Ⅴ,were significantly reduced compared with the scores before the intervention(P<0.05).There was no significant difference in serum 25(OH)D and DHA levels,or ADHD symptom scores,at the 3-and 12-month follow-ups compared to baseline.After 3 months of nutritional intervention in the intervention group,the hyperactivity/impulsivity scores in SNAP-Ⅳ Scale and DSM-Ⅴ were significantly improved compared to the control group(P<0.05).After 12 months of intervention,conduct problems,impulsive-hyperactivity and hyperactivity index scores in Conner's Scale,and hyperactivity/impulsivity scores in SNAP-Ⅳ Scale and DSM-Ⅴ showed significant improvement compared to the control group(P<0.05).Conclusion·Combined supplementation with vitamin D and DHA significantly improves serum 25(OH)D and DHA levels and alleviates ADHD symptoms in preschool children.

Objective Aiming to develop a distance-adaptive visual function self-examination system based on tablet computers and evaluate its accuracy.Methods Utilizing ArUco technology on a tablet device equipped with the camera,a system was developed to assess visual functions by identifying QR codes within a 2-meters range for real-time ranging.This system integrates various visual function tests,including visual acuity test(conventional visual acuity test and high-pass visual acuity test with varying contrasts),accommodative amplitude test,and visual field test at the foveal(5°).A total of 22 healthy subjects(44 eyes)participated in visual function assessments,with 6 subjects undergoing visual acuity tests at varying distances(1 m,1.25 m,1.6 m,2 m)and accommodative amplitude tests under both refractive correction and simulated undercorrection of-3.00D.The program distance and actual distance were compared,the consistency of visual acuity outcomes for identical optotype at different distances were assessed,the accommodative amplitude under refractive correction and undercorrection were analyzed,the repeatability of accommodative amplitude outcomes was evaluated using Intraclass Correlation Coefficient(ICC),and the contrast threshold and efficacy of visual field test outcomes were analyzed.Results The program distance and actual distance showed good agreement.High-pass visual acuity tests with the same contrast showed no significant differences at different distances(P?>?0.05),while conventional visual acuity tests showed significant differences at distances of 0.9 to 1.1 meters compared to other distances(P?

Enterotoxigenic Escherichia coli（ETEC）infection can induce watery diarrhea，leading to dehydration，electrolyte disturbance，and even death in severe cases. Recombinant B subunit/inactivated whole-cell cholera（rBS/WC）vaccine is effective in preventing ETEC infectious diarrhea. On the basis of the latest evidence on etiology and epidemiology of ETEC，as well as the effectiveness，safety，and health economics of rBS/WC vaccine，National Clinical Research Center for Child Health（The Children’s Hospital，Zhejiang University School of Medicine）and Zhejiang Provincial Center for Disease Control and Prevention invited experts to develop expert consensus on rBS/WC vaccine in prevention of ETEC infectious diarrhea. It aims to provide the clinicians and vaccination professionals with guidelines on using rBS/WC vaccine to reduce the incidence of ETEC infectious diarrhea.

Objective:To explore the feasibility and effectiveness of early ambulation program for patients after pancreaticoduodenectomy.Methods:From December 2020 to July 2021, convenience sampling was used to select 134 patients after pancreaticoduodenectomy in the First Medical Center of People's Liberation Army General Hospital as the research object. The patients in Ward A were set as the experimental group, and the patients in Ward B were set as the control group, with 67 cases in each group. The patients in the control group were given routine perioperative nursing, and the patients in the experimental group were given an early ambulation program after pancreaticoduodenectomy on the basis of routine perioperative nursing. The completion of the activity goals of the patients in the experimental group was observed. The completion rate of ambulation on the first day after operation, activity distance one to three days after operation, pain and dizziness during activity, time of first exhaust and defecation after operation, abdominal distention and activity-associated adverse events three days after operation were observed in the two groups of patients.Results:The compliance rates of ambulation on the first to third days in the experimental group were 100.00%, 88.06%, and 92.54%, respectively, and there was no statistical difference in the daily ambulation compliance rate between laparoscopic surgery patients and laparotomy patients ( P>0.05) . In the experimental group, the completion rate of ambulation of the patients on the first day after operation was higher than that in the control group. On the second, third and first to third days after operation, the activity distances were more than those of the control group. The time of first exhaust and defecation after operation were lower than those of the control group, and the abdominal distension score three days after operation was lower than that of the control group, the above differences were statistically significant ( P<0.05) . The pain and dizziness scores of the experimental group when ambulation for the first time were lower than those of the control group, but the difference was not statistical ( P>0.05) . There were no adverse events in the two groups of patients during the early postoperative ambulation. Conclusions:The early ambulation program for patients after pancreaticoduodenectomy is feasible and effective, which provides a basis and method for medical and nursing staff to evaluate and guide patients with early ambulation after pancreaticoduodenectomy.

This paper summarizes the development trend and characteristics of public opinion on health protection and disinfection strategies in the COVID-19 epidemic. The experience and deficiency of the strategies are discussed from the perspective of public opinion, and suggestions on how health protection and disinfection can help prevent and control infectious diseases are also put forward: to strengthen health protection and disinfection in key places and units; to evaluate health protection and disinfection effects as well as the transmission mechanism of virus in the environment; to establish a professional health protection and disinfection emergency science popularization mechanism and information release channel; to speed up the formulation and revision of health protection and disinfection standards related to the epidemic.

This paper summarizes the development trend and characteristics of public opinion on health protection and disinfection strategies in the COVID-19 epidemic. The experience and deficiency of the strategies are discussed from the perspective of public opinion, and suggestions on how health protection and disinfection can help prevent and control infectious diseases are also put forward: to strengthen health protection and disinfection in key places and units; to evaluate health protection and disinfection effects as well as the transmission mechanism of virus in the environment; to establish a professional health protection and disinfection emergency science popularization mechanism and information release channel; to speed up the formulation and revision of health protection and disinfection standards related to the epidemic.

Objective To detect the levels of procalcitonin in multiple genes autoinflammatory disease (adult Still disease,systemic juvenile idiopathic arthritis,crohn's Crohn's disease),and to explore the relationship between erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),ESR/CRP and disease or complicated infection combined disease.Methods One hundred and fifty-three patients were en-rolled,88 patients with multiple genes autoinflammatory disease,including 32 cases of adult Still disease,27 cases of systemic juvenile idiopathic arthritis,29 cases of Crohn's disease.In addition,30 cases of healthy controls,35 patients with systemic lupus erythematosus (SLE) were included into this study.Electroche-miluminescence was used to test the value of serum PCT,erythrocyte sedimentation rate was tested by blood sedimentation instrument method,the CRP level was tested by lmmunoturbidimetry,and the data was handed managed and analysised by matlab software and One-way analysis of variance (ANOVA) was used to compare the differences of PCTs between groups.Results ① In the non-infection condition,the PCT value of the autoimmune inflammatory diseases [(0.36±0.74) μg/L,95％confidence interval (CI) (0.174 9,0.550 9) μg/L)] was signifieantly higher than that of the healthy control group [(0.06±0.06) μg/L,95％CI (0.035 1,0.081 7 μg/L)],the difference was statistically significant (F=5.03,P=0.027 4),but there was no statistically significant (F=1.03,P=0.475 5) when comparing with SLE group.② The PCT level of the non-infected inflammatory enteric arthritis [(0.20±0.32),95％CI(0.042 7,0.364 3) μg/L] was different compared with the healthy group,the difference was statistically significant (F=5.77,P=0.020 4),at the same time,the difference was not statistically significant when comparing with the SLE group (F=0.22,P=0.647 6).When the PCT value in non-infected adults Still disease [(0.60±1.02) 95％CI(0.048 4,1.153 6) μg/L] compared with the healthy group,the difference was statistically significant (F=7.22,P=0.01) but the difference was not statistically different when compared with the SLE group (F=2.65,P=0.114 3).The PCT level difference was statistically significant (F=2.23,P＜0.01)when comparing infection-free juvenile idiopathic arthritis [(1.52±2.02) μg/L,95％CI(0.054 8,4.591 9) μg/L] and the healthy group,the difference was statistically significantly different (F=8.34,P=0.004 7) when compared with the PCT of the non-infected SLE group.③ In the case of autoinflammatory diseases without infection,the 95％CI of ESR/CRP ratio was between 1.121 2 and 3.589 4.In the case of co-infection,the 95％ CI of ESR/CRP ratio was between 1.502 2 and 8.718 8,so we considered autoimmune inflammatory diseases might had a high possibility of co-infection when the ESR/CRP ratio was higher than 3.5.Conclusion ① The multiple genes autoinflammatory disease group has a higher value of PCT level than healthy controls even without infection.② The mean and 95％CI range of PCT of the inflammatory bowel disease arthritis,adult Still disease and the juvenile id-iopathic arthritis is significantly higher than the healthy controls,partially higher than SLE group.In addition,the PCT level in the juvenile idiopathic arthritis is the highest.③ In clinical,to estimate whether the multiple genes autoinflammatory disease has bacterial infection,we can't just simply rely on PCT to estimate whether the multiple genes autoinflammatory disease has bacterial infection,we may consider the ratio of the ESR/CRP,when the value is higher than 3.5,we may consider patients has strong probability with infection.

Objective To investigate the relationship between nutritional risk status and implementation of nutrition therapy in mechanical ventilated (MV) chronic obstructive pulmonary disease (COPD) patients, so as to provide evidence for individualized nutrition therapy. Methods A prospective multicenter observational study was conducted. MV COPD patients admitted to Department of Intensive Care Units (ICU) of 10 County Hospitals in Zhejiang Province from January 2015 to January 2016 were enrolled, and according to nutrition risk screening 2002 (NRS2002) score, they were divided into nutritional high risk group (NRS2002 3-5) and nutritional extremely high risk group (NRS2002 6-7). Nutrition therapy situation and hospital mortality were compared between the two groups; multivariate Cox regression analysis was used to analyze the risk factors affecting the prognosis of patients with COPD under mechanical ventilation. Kaplan-Meier curve was used to analyze the prognosis at 30 days; receiver operating characteristic (ROC) curve was used to test the robustness of multivariable regression analysis. Results ① One hundred and six COPD patients with MV were analyzed; among them, 90 patients were in the nutritional high risk group, and 16 were in the nutritional extremely high risk group. There were no significant differences in age, gender and body mass index (BMI) between the two groups (all P > 0.05); the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, NRS2002 score in patients of nutrition risk extremely high group were obviously higher than that in patients with nutrition high risk group (APACHEⅡ: 24.9±6.1 vs. 20.3±5.8, NRS2002 score: 6.3±0.5 vs. 4.2±0.8, both P < 0.05). ② Patients in both groups received early enteral nutrition (EN) therapy, the proportion of patients in nutritional extremely high risk group received early EN was lower than that of patients in the nutritional high risk group [12.5% (2/16) vs. 17.7% (16/90)], along with the prolongation of hospital stay, the proportions of patients beginning to receive the EN were gradually increased in the nutrition extremely high risk group and high risk group, after 2 days the EN increased significantly, and reached the highest value on day 6 after entering ICU [100.0% (16/16), 98.9% (89/90), respectively]; within 3 days after admission into ICU, the proportion of EN in nutrition extremely high risk group was obviously lower than that in nutrition high risk group, and from day 4, there was no statistical significant difference in proportion of EN between the two groups (all P > 0.05). The time to start parenteral nutrition (PN) treatment was relatively early admission to the ICU on day 1 and the proportion of this therapy was high in the two groups [56.2% (9/16), 27.7% (25/90), respectively], the PN proportion did not decrease with the length of hospitalization and the increase of EN. The proportion of patients in the nutrition extremely high risk group who started PN treatment was higher, which reached 56.2% admission to the ICU on day 1.③ With extension of hospital stay, the calories of EN were gradually increased in the nutritional high risk group, the highest calories in nutritional high risk groups was 4 318 (3 912, 4 812) kJ/d at day 7; while the highest calories in nutritional extremely high risk groups was 3 602 (2 167, 4 615) kJ/d at day 6 and a slight decreased at day 7; the difference of calories within the first week between the two groups had no significance (all P > 0.05). The calorific value of PN therapy remained at a constant level during hospitalization within 7 days, and after admission into ICU for 4-5 days, the target range of calories was achieved. ④ Kaplan-Meier survival curve analysis showed that the mortality at 30 days in the extremely high risk group was significantly higher than that in the high risk group [62.5% (10/16) vs. 11.1% (10/90), χ2 = 15.4, P < 0.01]. ⑤ Multiple cox-regression analysis showed that NRS2002 scoring was the independent risk factor affecting the mortality of patients in hospital [odds ratio (OR) = 2.08, 95% confidence interval (95%CI) = 1.39-3.12, P = 0.005]. ⑥ ROC curve analysis: according to ROC curve analysis of the effectiveness of multi-factor regression model, area under ROC curve (AUC) was 0.79, sensitivity was 70.00%, specificity was 74.42%, positive likelihood ratio was 2.74, negative likelihood ratio was 0.40, 95% confidence interval (95%CI) was 0.702-0.864, P = 0.001, and it showed that the regression model had a good prediction effect. Conclusions MV COPD patients have significant nutritional risk and all receive early EN therapy. The proportion of beginning to use PN treatment in patients with nutritional extremely high risk is relatively high. Initial nutritional status is the independent risk factor of poor prognosis in MV patients with COPD.