Objective: To explore the association between takeout fast foods and sugar sweetened beverage consumption with co-occurrence of anxiety and depressive symptoms among first year junior high school students in Yunnan Province, so as to provide theoretical basis for the prevention of anxiety and depressive symptoms co-occurrence among adolescents. Methods: A random cluster sampling involving 8 500 first year junior high school students in 11 counties in Yunnan Province was conducted by a questionnaire survey from October to December 2022. The Depression Anxiety Stress Scale-21 (DASS-21) was applied to assess anxiety and depressive symptoms in first year junior high school students. Chi-square test was used to compare the anxiety-depression co-occurrence symptoms of first year junior high school students with different demographic characteristics. The association between takeout fast foods and sugar sweetened beverage consumption with co-occurrence of anxiety and depressive symptoms of adolescents was analyzed by binary Logistic regression models. Results: The detection rate of co-occurrence of anxiety and depression symptoms among first year junior high school students in Yunnan Province was 26.92%. After controlling for demographic variables and other confounders, takeout fast foods and sugar sweetened beverage consumption( OR=1.50, 95%CI =1.27-1.77) was associated with anxiety-depression co-occurrence symptoms among first year junior high school students in Yunnan Province ( P <0.01). Stratified analysis showed that both Han ( OR=1.37, 95%CI =1.07-1.77) and ethnic minorities ( OR=1.60, 95%CI =1.29-2.00) exhibited statistically significant associations between takeout fast foods and sugar sweetened beverage consumption with co-occurrence of anxiety and depressive symptoms(both P <0.05). Conclusions Takeout fast foods and sugar sweetened beverage consumption increases the risk of co-occurrence of anxiety and depressive symptoms among first year junior high school students in Yunnan Province. It is recommended to strengthen guidance on the consumption of such products among junior high school students to prevent co-occurrence of anxiety and depressive symptoms.

Objective To explore the differences of coronary computed tomography-derived fractional flow reserve(CT-FFR)and dynamic stress computed tomography myocardial perfusion imaging(CT-MPI)parameters in obstructive coronary artery disease(CAD),and their correlation with coronary computed tomography angiography(CCTA)vessel stenosis.Methods A retrospective analysis was conducted on 37 patients with obstructive CAD who underwent combined CCTA and dynamic stress CT-MPI scans.Based on the CCTA results,the patients were divided into moderate CAD group(22 cases)and severe CAD group(15 cases).The lowest CT-FFR value and perfusion parameter values between the two groups were analyzed.A total of 111 vessels including the left anterior descending branch(LAD),left circumflex branch(LCX),and right coronary artery(RCA)were classified into the mild vessel stenosis group(＜25％)with 42 vessels,moderate vessel stenosis group(25％-69％)with 49 vessels,and severe vessel stenosis group(≥70％)with 20 vessels.The lowest CT-FFR value and lowest perfusion parameter value among these three groups were analyzed.The correlation between CT-FFR value and CT-MPI perfusion parameter values and their diagnostic efficacy were analyzed.Results At the patient level,the relative myocardial blood flow(rMBF),myocardial blood flow(MBF),myocardial blood volume(MBV),flow extraction product(FEP)in the severe CAD group were significantly lower than those in the moderate CAD group(P＜0.05),while there was no significance in CT-FFR and perfusion capillary blood volume(PCBV)between these two groups(P=0.061,0.098).At the vascular level,there were significant differences in rMBF and MBV among mild,moderate,and severe vessel stenosis groups(P＜0.05).CT-FFR showed significant difference between mild vs moderate vessel stenosis groups and mild vs severe vessel stenosis groups(P＜0.001),and no significant difference between moderate and severe vessel stenosis groups(P=0.355).rMBF had the highest correlation with the degree of vessel stenosis(r=-0.674).CT-MPI combined with CT-FFR had a high efficacy in diagnosing CCTA vessel stenosis,area under the curve(AUC)≥0.90.Conclusion rMBF is more effective than CT-FFR in evaluating the degree of vessel stenosis in CCTA.CT-FFR combined with CT-MPI is helpful to evaluate functional vascular stenosis.

Objective:To investigate the clinical characteristics of children with severe human metapneumovirus (HMPV) infection and identify the risk factors associated with critical illness.Methods:A retrospective cohort study was conducted, enrolling 157 hospitalized children with severe HMPV infection, who tested positive for HMPV nucleic acid via PCR-capillary electrophoresis fragment analysis of nasopharyngeal secretions at Shanghai Children′s Hospital from January 2021 to December 2023.Clinical features, co-infections, treatment, and outcomes were collected. Based on the diagnostic criteria for severe HMPV infection, the patients were categorized into a critical illness group and a non-critical illness group. Intergroup comparisons were performed using the χ2 test or the Mann-Whitney U test. Multivariate Logistic regression analysis was employed to identify risk factors for critical HMPV infection and to establish a predictive model.The performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis and calibration curves. Results:Among the 157 cases of severe HMPV infection, there were 67 males and 90 females, with an onset age of 39.0 (20.0, 55.5) months. Single-pathogen infection was observed in 125 cases (79.6%), while mixed infections accounted for 32 cases (20.4%).Severe pneumonia was diagnosed in 136 cases (86.6%).The predominant manifestations of severe HMPV infection included fever 152 cases (96.8%), cough 151 cases (96.2%), and wheezing 94 cases (59.9%).Sixty-eight patients (43.3%) required non-invasive respiratory support, 58 cases (36.9%) were admitted to the intensive care unit, and 22 cases (14.0%) underwent mechanical ventilation. Of the total, 149 cases (94.9%) were discharged with improvement, 8 cases (5.1%) were discharged against medical advice, and there were no fatal cases. The cohort was further stratified into a critical illness group 31 cases and a non-critical illness group 126 cases. Compared to the non-critical illness group, the critical illness group exhibited significantly higher rates of respiratory distress, lethargy, and intercostal retractions, along with a higher proportion of underlying comorbidities, and elevated levels of C-reactive protein and procalcitonin (all P<0.05).Conversely, albumin and hemoglobin levels were significantly lower in the critical illness group (both P<0.05). ROC curve analysis revealed that the optimal cutoff value for the duration of fever in predicting severe HMPV infection was 4.5 days.The multivariate binary Logistic regression analysis revealed that prolonged fever duration (>4.5 days) ( OR=28.00, 95% CI 5.09-153.93, P<0.001), anorexia ( OR=11.72, 95% CI 1.26-108.75, P=0.030), and immune dysfunction ( OR=36.71, 95% CI 1.55-867.31, P=0.026) were independent risk factors for severe HMPV infection. A predictive model for critical illness was constructed based on these independent risk factors. ROC curve analysis demonstrated excellent discriminative ability, with an area under the curve of 0.96 (95% CI 0.92-1.00, P<0.001). The optimal predictive probability threshold was 0.17, yielding a sensitivity of 0.93 and specificity of 0.92. The calibration curve closely approximated the ideal curve, indicating good model calibration ( P=0.157). Conclusions:Severe HMPV infection is predominantly observed as a single infection and is prone to progress to severe pneumonia, with fever, cough, and wheezing as the main clinical manifestations. A subset of cases progresses to critical illness, though the overall prognosis is favorable. Prolonged fever duration (>4.5 days), anorexia, and immune dysfunction were independent risk factors for critical illness.The risk prediction model constructed for pediatric critical HMPV infection demonstrated robust discriminative ability with excellent calibration.

Objective:To analyze the distribution and epidemiological characteristics of non-bacterial pathogens in hospitalized children with acute respiratory infections at a tertiary pediatric hospital in Shanghai during 2023.Methods:A retrospective study was conducted on 10 591 children with acute respiratory tract infections who were hospitalized in Shanghai Children's Hospital from January to December 2023. A multiplex PCR combined with capillary electrophoresis platform was used to detect 11 common non-bacterial respiratory pathogens（including viruses and atypical pathogens）. Statistical analysis was carried out using SPSS 29.0 software. Qualitative data were presented as numbers and percentages，and the Chi-square test was employed to make comparisons between groups，aiming to analyze the differences in the distribution of different pathogens according to gender，age group，and season. Additionally，based on the severity of the disease，patients were calssified into a severe pneumonia group and a non-severe pneumonia group to further explore the characteristics of the pathogen spectrum of severe pneumonia.Results:The total detection rate of pathogens was 54.39%（5 760/10 591），and the proportion of mixed infections was 12.76%（735/5 760）. The dominant pathogens and their proportions were as follows： Mycoplasma pneumoniae（19.20%，2 034/10 591），human rhinovirus（12.16%，1 288/10 591），influenza A virus（8.31%，880/10 591），and respiratory syncytial virus（8.14%，862/10 591）. Epidemiological characteristics showed that：（1）In terms of age： Mycoplasma pneumoniae was more common in older children（29.55%，901/3 049，in the school-age group，χ 2 = 653.67， P<0.001）. Influenza A virus had a high incidence in the adolescent group（11.34%，45/397，χ 2=48.69， P<0.001）. Respiratory syncytial virus was most susceptible in the infant group（20.94%，280/1 337，χ 2=739.92， P<0.001）. Human rhinovirus showed the characteristic of general susceptibility across all ages.（2）Monthly and seasonal distribution： Mycoplasma pneumoniae had a seasonal epidemic in summer and autumn（it began to rise in May and peaked in October at 34.22%，439/1 283）；influenza A virus had a bimodal distribution in spring and winter（the peak was 37.15% in March，315/848）；respiratory syncytial virus had a dominant epidemic in spring and summer（the detection rate was 21.24% in May，206/970），and human rhinovirus was prevalent throughout the year.（3）Clinical correlation：The detection rate of pathogens in the severe pneumonia group was significantly higher than that in the non-severe group：84.19%（426/506） vs 2.89%（5 334/10 085），χ 2=56.23， P<0.001. Conclusions:In 2023，the pathogen spectrum of hospitalized children with acute respiratory infections in the Shanghai area exhibits an epidemic pattern dominated by Mycoplasma pneumoniae，and its transmission dynamics are significantly age-dependent. This study delineates the pathogen-host-environment tripartite interactions，establishing an evidence-based foundation for formulating precision diagnostic-therapeutic algorithms and seasonal nosocomial infection prevention frameworks.

Objective:To analyze the distribution and epidemiological characteristics of non-bacterial pathogens in hospitalized children with acute respiratory infections at a tertiary pediatric hospital in Shanghai during 2023.Methods:A retrospective study was conducted on 10 591 children with acute respiratory tract infections who were hospitalized in Shanghai Children's Hospital from January to December 2023. A multiplex PCR combined with capillary electrophoresis platform was used to detect 11 common non-bacterial respiratory pathogens（including viruses and atypical pathogens）. Statistical analysis was carried out using SPSS 29.0 software. Qualitative data were presented as numbers and percentages，and the Chi-square test was employed to make comparisons between groups，aiming to analyze the differences in the distribution of different pathogens according to gender，age group，and season. Additionally，based on the severity of the disease，patients were calssified into a severe pneumonia group and a non-severe pneumonia group to further explore the characteristics of the pathogen spectrum of severe pneumonia.Results:The total detection rate of pathogens was 54.39%（5 760/10 591），and the proportion of mixed infections was 12.76%（735/5 760）. The dominant pathogens and their proportions were as follows： Mycoplasma pneumoniae（19.20%，2 034/10 591），human rhinovirus（12.16%，1 288/10 591），influenza A virus（8.31%，880/10 591），and respiratory syncytial virus（8.14%，862/10 591）. Epidemiological characteristics showed that：（1）In terms of age： Mycoplasma pneumoniae was more common in older children（29.55%，901/3 049，in the school-age group，χ 2 = 653.67， P<0.001）. Influenza A virus had a high incidence in the adolescent group（11.34%，45/397，χ 2=48.69， P<0.001）. Respiratory syncytial virus was most susceptible in the infant group（20.94%，280/1 337，χ 2=739.92， P<0.001）. Human rhinovirus showed the characteristic of general susceptibility across all ages.（2）Monthly and seasonal distribution： Mycoplasma pneumoniae had a seasonal epidemic in summer and autumn（it began to rise in May and peaked in October at 34.22%，439/1 283）；influenza A virus had a bimodal distribution in spring and winter（the peak was 37.15% in March，315/848）；respiratory syncytial virus had a dominant epidemic in spring and summer（the detection rate was 21.24% in May，206/970），and human rhinovirus was prevalent throughout the year.（3）Clinical correlation：The detection rate of pathogens in the severe pneumonia group was significantly higher than that in the non-severe group：84.19%（426/506） vs 2.89%（5 334/10 085），χ 2=56.23， P<0.001. Conclusions:In 2023，the pathogen spectrum of hospitalized children with acute respiratory infections in the Shanghai area exhibits an epidemic pattern dominated by Mycoplasma pneumoniae，and its transmission dynamics are significantly age-dependent. This study delineates the pathogen-host-environment tripartite interactions，establishing an evidence-based foundation for formulating precision diagnostic-therapeutic algorithms and seasonal nosocomial infection prevention frameworks.

Objective To explore the differences of coronary computed tomography-derived fractional flow reserve(CT-FFR)and dynamic stress computed tomography myocardial perfusion imaging(CT-MPI)parameters in obstructive coronary artery disease(CAD),and their correlation with coronary computed tomography angiography(CCTA)vessel stenosis.Methods A retrospective analysis was conducted on 37 patients with obstructive CAD who underwent combined CCTA and dynamic stress CT-MPI scans.Based on the CCTA results,the patients were divided into moderate CAD group(22 cases)and severe CAD group(15 cases).The lowest CT-FFR value and perfusion parameter values between the two groups were analyzed.A total of 111 vessels including the left anterior descending branch(LAD),left circumflex branch(LCX),and right coronary artery(RCA)were classified into the mild vessel stenosis group(＜25％)with 42 vessels,moderate vessel stenosis group(25％-69％)with 49 vessels,and severe vessel stenosis group(≥70％)with 20 vessels.The lowest CT-FFR value and lowest perfusion parameter value among these three groups were analyzed.The correlation between CT-FFR value and CT-MPI perfusion parameter values and their diagnostic efficacy were analyzed.Results At the patient level,the relative myocardial blood flow(rMBF),myocardial blood flow(MBF),myocardial blood volume(MBV),flow extraction product(FEP)in the severe CAD group were significantly lower than those in the moderate CAD group(P＜0.05),while there was no significance in CT-FFR and perfusion capillary blood volume(PCBV)between these two groups(P=0.061,0.098).At the vascular level,there were significant differences in rMBF and MBV among mild,moderate,and severe vessel stenosis groups(P＜0.05).CT-FFR showed significant difference between mild vs moderate vessel stenosis groups and mild vs severe vessel stenosis groups(P＜0.001),and no significant difference between moderate and severe vessel stenosis groups(P=0.355).rMBF had the highest correlation with the degree of vessel stenosis(r=-0.674).CT-MPI combined with CT-FFR had a high efficacy in diagnosing CCTA vessel stenosis,area under the curve(AUC)≥0.90.Conclusion rMBF is more effective than CT-FFR in evaluating the degree of vessel stenosis in CCTA.CT-FFR combined with CT-MPI is helpful to evaluate functional vascular stenosis.

Objective:To investigate the clinical characteristics of children with severe human metapneumovirus (HMPV) infection and identify the risk factors associated with critical illness.Methods:A retrospective cohort study was conducted, enrolling 157 hospitalized children with severe HMPV infection, who tested positive for HMPV nucleic acid via PCR-capillary electrophoresis fragment analysis of nasopharyngeal secretions at Shanghai Children′s Hospital from January 2021 to December 2023.Clinical features, co-infections, treatment, and outcomes were collected. Based on the diagnostic criteria for severe HMPV infection, the patients were categorized into a critical illness group and a non-critical illness group. Intergroup comparisons were performed using the χ2 test or the Mann-Whitney U test. Multivariate Logistic regression analysis was employed to identify risk factors for critical HMPV infection and to establish a predictive model.The performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis and calibration curves. Results:Among the 157 cases of severe HMPV infection, there were 67 males and 90 females, with an onset age of 39.0 (20.0, 55.5) months. Single-pathogen infection was observed in 125 cases (79.6%), while mixed infections accounted for 32 cases (20.4%).Severe pneumonia was diagnosed in 136 cases (86.6%).The predominant manifestations of severe HMPV infection included fever 152 cases (96.8%), cough 151 cases (96.2%), and wheezing 94 cases (59.9%).Sixty-eight patients (43.3%) required non-invasive respiratory support, 58 cases (36.9%) were admitted to the intensive care unit, and 22 cases (14.0%) underwent mechanical ventilation. Of the total, 149 cases (94.9%) were discharged with improvement, 8 cases (5.1%) were discharged against medical advice, and there were no fatal cases. The cohort was further stratified into a critical illness group 31 cases and a non-critical illness group 126 cases. Compared to the non-critical illness group, the critical illness group exhibited significantly higher rates of respiratory distress, lethargy, and intercostal retractions, along with a higher proportion of underlying comorbidities, and elevated levels of C-reactive protein and procalcitonin (all P<0.05).Conversely, albumin and hemoglobin levels were significantly lower in the critical illness group (both P<0.05). ROC curve analysis revealed that the optimal cutoff value for the duration of fever in predicting severe HMPV infection was 4.5 days.The multivariate binary Logistic regression analysis revealed that prolonged fever duration (>4.5 days) ( OR=28.00, 95% CI 5.09-153.93, P<0.001), anorexia ( OR=11.72, 95% CI 1.26-108.75, P=0.030), and immune dysfunction ( OR=36.71, 95% CI 1.55-867.31, P=0.026) were independent risk factors for severe HMPV infection. A predictive model for critical illness was constructed based on these independent risk factors. ROC curve analysis demonstrated excellent discriminative ability, with an area under the curve of 0.96 (95% CI 0.92-1.00, P<0.001). The optimal predictive probability threshold was 0.17, yielding a sensitivity of 0.93 and specificity of 0.92. The calibration curve closely approximated the ideal curve, indicating good model calibration ( P=0.157). Conclusions:Severe HMPV infection is predominantly observed as a single infection and is prone to progress to severe pneumonia, with fever, cough, and wheezing as the main clinical manifestations. A subset of cases progresses to critical illness, though the overall prognosis is favorable. Prolonged fever duration (>4.5 days), anorexia, and immune dysfunction were independent risk factors for critical illness.The risk prediction model constructed for pediatric critical HMPV infection demonstrated robust discriminative ability with excellent calibration.

Objective:To evaluate the effects of photodynamic therapy (PDT) in extraction sockets of periodontally compromised molars on soft tissue healing, postoperative pain, bone density and bone height changes.Methods:This study is a single-center, single-blind, randomized controlled superiority clinical trial. Thirty-eight periodontally compromised molars requiring extraction in patients attending the Department of Periodontology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, from December 2022 to September 2023 were included, and randomly assigned to PDT group and control group. The control group received routine debridement after extraction, while PDT group received routine debridement followed by PDT. The bucco-lingual and mesio-distal wound distances at 7 and 14 d after extraction were measured, and then the wound closure rates were calculated. Evaluating the soft tissue healing indexes at 7 and 14 d after extraction. The visual analogue scale was used to assess the pain level at 6 h, 1 d, 2 d, and 3 d after tooth extraction. Apical radiographs were taken immediately and 2 months after extraction in order to compare the changes of the bone density and height.Results:The wound closure rate at 1 week was (78.08±5.45)% in PDT group and (71.03±6.82)% in control group, with significant differences ( P<0.01). The wound closure rate at 2 weeks in PDT group [(85.88±3.84) %] was significantly higher than that in the control group [(81.66±3.79) %] ( P<0.01), but did not reach the superiority value of the superiority test (superiority value=10%, 95% CI at 1 week: 3.00%-11.12%, 95% CI at 2 weeks: 1.71%-6.73%). The soft tissue healing index of PDT group at 1 week was significantly better than the control group ( P<0.05), but there was no significant difference between the two groups at 2 weeks ( P>0.05). There was no significant difference between the two groups in terms of postoperative pain at 6 h, 1 d, 2 d and 3 d as well as in bone density and height changes at 2 months after tooth extraction ( P>0.05). Conclusions:PDT could promote soft tissues healing to some extent, but did not provide additional assistance in the healing of extraction sockets of periodontally compromised teeth. PDT did not show benefits on postoperative pain, changes of the bone density and bone height after tooth extraction.

Volume loss caused by aging process, diseases, trauma and surgical treatments, could lead to facial depressions, profoundly affecting appearance. Injectable fillers could help to correct this type of disfigurements and are preferred by plastic surgeons and patients due to their quality of minimal invasiveness and better delicateness. Among these fillers, collagen stimulators such as poly-L-lactic acid(PLLA) and polycaprolactone(PCL) are biodegradable synthetic polymers that can stimulate collagen formation and thus gradually restore tissue volume. These polymers have been used worldwide to treat facial aging changes and human immunodeficiency virus-associated facial fat lipoatrophy, demonstrating ideal results in volume enhancement and facial rejuvenation. The progress and clinical applications of compound injectables based on biodegradable collagen stimulators are summarized.

Volume loss caused by aging process, diseases, trauma and surgical treatments, could lead to facial depressions, profoundly affecting appearance. Injectable fillers could help to correct this type of disfigurements and are preferred by plastic surgeons and patients due to their quality of minimal invasiveness and better delicateness. Among these fillers, collagen stimulators such as poly-L-lactic acid(PLLA) and polycaprolactone(PCL) are biodegradable synthetic polymers that can stimulate collagen formation and thus gradually restore tissue volume. These polymers have been used worldwide to treat facial aging changes and human immunodeficiency virus-associated facial fat lipoatrophy, demonstrating ideal results in volume enhancement and facial rejuvenation. The progress and clinical applications of compound injectables based on biodegradable collagen stimulators are summarized.