Wild hedgehogs may act as carriers and/or hosts for bacterial,viral,and fungal pathogens with zoonotic potential,posing a significant threat to humans.Humans are increasingly invading hedgehog habitats,disrupting the coexistence between humans and animals.Hedgehogs are also increasingly being kept as pets,substantially increasing the probability of human zoonotic pathogen spillover from hedgehogs to humans.Herein,we review existing knowledge on bacterial,viral,and mycotic pathogens with zoonotic potential,evaluating the significance of hedgehogs as carriers or hosts.

ObjectiveTo perform a clinical comprehensive evaluation of Xianyu capsules in the treatment of epilepsy with wind-phlegm obstruction syndrome to provide methodological references for clinical rational medication and post-marketing research on Chinese medicine. MethodBased on evidence-based medicine，clinical epidemiology，clinical medicine，evidence-based pharmacy， and pharmacoeconomics，the clinical comprehensive evaluation was carried out from the "6 + 1" dimensions of safety，effectiveness，economy，innovation，suitability，and accessibility， as well as characteristics of traditional Chinese medicine （TCM） using public data，literature data，pharmaceutical research，questionnaire survey， and other information by qualitative and quantitative evaluation methods in combination. Multi-criteria decision analysis （MCDA） model and CSC software V2.0 were adopted to evaluate the clinical value of Xianyu capsules. The evaluation results of each dimension were divided into four grades， i.e.， A，B，C， and D. ResultMultiple sources of safety evidence such as spontaneous reporting system （SRS） monitoring data，literature reports， and clinical studies showed that the main adverse reactions of Xianyu capsules were dizziness，drowsiness， and nausea，and there were no serious adverse reactions. Due to the sufficient evidence and the controllable risk， they were graded B for the safety. Meta-analysis showed that Xianyu capsules combined with conventional western medicine in the treatment of epilepsy were better than conventional western medicine alone in reducing the frequency of seizures （times/month） and improving the total clinical effective rate，and they were graded B for the effectiveness. The results of pharmacoeconomic research showed that Xianyu capsules combined with conventional western medicine （magnesium valproate sustained-release tablets） had cost-effectiveness advantages over magnesium valproate sustained-release tablets alone in the treatment of epilepsy，but the level of incremental effect was not significant. Therefore， they were graded B for economy. Xianyu capsules are the only Chinese patent medicine that can treat epilepsy under the list of phlegm-eliminating and orifices-opening agents with aromatics in the current national medical insurance catalogue. They are designed for the syndrome of wind-phlegm obstruction with clear syndrome type. The company has insisted on inheritance and innovation based on the classic famous prescriptions by virtue of modern science and technology，and obtained a number of patents for invention. Hence， they were graded A for the innovation. The questionnaire results showed that the use of drugs could meet the medication needs of clinical doctors and patients，and the publicity materials such as instructions and labels were accurate and complete without exaggeration and misleading. The information service of drug instructions，labels， and packaging was normative. According to the comprehensive questionnaire and the information service results of Chinese patent medicine，they were graded A for the suitability. Compared with the price of similar drugs，the price of Xianyu capsules is moderate. The cost of treatment accounts for a high proportion of per capita disposable income and is generally affordable. Because of a wide sales scope， sustainable medicinal material resources， and good availability，they were graded B for the accessibility. Xianyu capsules are derived from the combination of the classic prescriptions Qianzhengsan and Tianma Goutengyin， which are designed for the syndrome of wind-phlegm obstruction with rich experience in human use. Hence， they were rated as grade B for TCM characteristics. Based on the evidence evaluation results of "6 + 1" dimensions of Xianyu capsules，the comprehensive evaluation of clinical value was B. ConclusionThe clinical value of Xianyu capsules in the treatment of epilepsy with wind-phlegm obstruction syndrome is high，and the TCM characteristics are prominent. It is suggested to convert into the relevant policy results of basic clinical medication management according to the procedure.

Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome (ROHHADS) is a rare multi-system disease, and delayed diagnosis and treatment may lead to catastrophic cardiopulmonary complications. As far as we know, no patient with ROHHADS has been reported in China, and this article reports a child with ROHHADS to improve the awareness of this disease among clinicians. A girl, aged 3 years, had the clinical manifestations of rapid weight gain, fever, disturbance of consciousness, and convulsion. The physical examination showed a body weight of 20 kg, somnolence, irregular breathing, and stiff neck. She had increased blood levels of prolactin and follicle-stimulating hormone and hyponatremia. The lumbar puncture showed an increased intracranial pressure. The brain MRI and magnetic resonance venography showed symmetrical lesions in the periventricular region and venous thrombosis in the right transverse sinus and the superior sagittal sinus. The sleep monitoring showed hypopnea. The girl was finally diagnosed with ROHHADS and intracranial venous thrombosis. She recovered after symptomatic treatment including decreasing intracranial pressure, anticoagulation, and respiratory support. The possibility of ROHHADS should be considered for patients with unexplained obesity, fever, and hypoventilation, with or without central nervous system symptoms. Early diagnosis and standardized follow-up can improve the prognosis of children with ROHHADS.
Child ; Child, Preschool ; China ; Consciousness ; Female ; Humans ; Hypothalamic Diseases ; Hypoventilation ; Obesity

OBJECTIVE: To evaluate the safety and effectiveness of Qishe Pill () on neck pain in real-world clinical practice. METHODS: A multi-center, prospective, observational surveillance in 8 hospitals across Shanghai was conducted. During patients receiving 4-week Qishe Pill medication, Visual Analogue Scale (VAS) and Neck Disability Index (NDI) assessments have been used to assess their pain and function, while safety monitoring have been observed after 2 and 4 weeks. RESULTS: Results from 2,023 patients (mean age 54.5 years) suggest that the drug exposure per unit of body mass was estimated at 3.41 ± 0.62 g/kg. About 8.5% (172/2,023) of all participants experienced adverse events (AEs), while 3.8% (78/2,023) of all participants experienced adverse reaction. The most common AEs were gastrointestinal events and respiratory events. The VAS score (pain) and NDI score (function) significantly decreased after 4-week treatment. An effect-quantitative analysis was also conducted to show that the normal clinical dosage may be consider as 3-4 g/kg, at which dosage the satisfactory pain-relief effect may achieve by 40-mm reduction in VAS. CONCLUSION These findings showed that patients with cervical radiculopathy who received Qishe Pill experienced significant improvement on pain and function. (Registration No. NCT01875562).

BACKGROUND: The current deep learning diagnosis of breast masses is mainly reflected by the diagnosis of benign and malignant lesions. In China, breast masses are divided into four categories according to the treatment method: inflammatory masses, adenosis, benign tumors, and malignant tumors. These categorizations are important for guiding clinical treatment. In this study, we aimed to develop a convolutional neural network (CNN) for classification of these four breast mass types using ultrasound (US) images. METHODS: Taking breast biopsy or pathological examinations as the reference standard, CNNs were used to establish models for the four-way classification of 3623 breast cancer patients from 13 centers. The patients were randomly divided into training and test groups (n = 1810 vs. n = 1813). Separate models were created for two-dimensional (2D) images only, 2D and color Doppler flow imaging (2D-CDFI), and 2D-CDFI and pulsed wave Doppler (2D-CDFI-PW) images. The performance of these three models was compared using sensitivity, specificity, area under receiver operating characteristic curve (AUC), positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR-), and the performance of the 2D model was further compared between masses of different sizes with above statistical indicators, between images from different hospitals with AUC, and with the performance of 37 radiologists. RESULTS: The accuracies of the 2D, 2D-CDFI, and 2D-CDFI-PW models on the test set were 87.9%, 89.2%, and 88.7%, respectively. The AUCs for classification of benign tumors, malignant tumors, inflammatory masses, and adenosis were 0.90, 0.91, 0.90, and 0.89, respectively (95% confidence intervals [CIs], 0.87-0.91, 0.89-0.92, 0.87-0.91, and 0.86-0.90). The 2D-CDFI model showed better accuracy (89.2%) on the test set than the 2D (87.9%) and 2D-CDFI-PW (88.7%) models. The 2D model showed accuracy of 81.7% on breast masses ≤1 cm and 82.3% on breast masses >1 cm; there was a significant difference between the two groups (P < 0.001). The accuracy of the CNN classifications for the test set (89.2%) was significantly higher than that of all the radiologists (30%). CONCLUSIONS: The CNN may have high accuracy for classification of US images of breast masses and perform significantly better than human radiologists. TRIAL REGISTRATION Chictr.org, ChiCTR1900021375; http://www.chictr.org.cn/showproj.aspx?proj=33139.
Area Under Curve ; Breast/diagnostic imaging* ; Breast Neoplasms/diagnostic imaging* ; China ; Deep Learning ; Humans ; ROC Curve ; Sensitivity and Specificity

Severe fever with Thrombocytopenia Syndrome(SFTS)is an emerging epidemic disease caused by a novel SFTS bunyavirus(SFTSV).It is widely spread in central and northeast of China,particularly in rural and hilly areas,posing a great threat to public health.Here we presented a SFTS case in Anhui Province with clinical symptoms of fever,leukopenia and thrombocytopenia which SFTSV was detected in serum,urine and throat swab samples by RT-qPCR.Two gene fragments of viral complementary DNA were obtained by RT-PCR and sequenced from the patient's body fluids.Phylogenetic analysis indicated that the sequences obtained were closely related to those from patients in other epidemic areas of China.To our knowledge,it was the first report on the simultaneous detection of SFTSV RNA from serum,throat swabs and urine in the same patient,which suggest to be alert to the possible ways of SFTSV transmission other than tick bite.

Hantavirus(HV)belongs to Seoul virus-S4 subtype(SEOV-4),which is the main epidemic subtype of HV in southeast coastal area.In this study,a rapid detection method for SEOV-S4 was established based on Enzymatic Probe Isothermal Amplification(EPIA)and primers and probes were designed to target the relatively conserved S sequence of SEOV-S4.The sensitivity and repeatability were verified by gradient dilution of target gene synthetic plasmid,and the specificity was verified by other human subtype HV.The results showed that the sensitivity of SEOV-S4 method based on EPIA could reach 10 copies/μL.There was no cross-reaction with other human subtypes of HV.The method established in this study has good sensitivity,specificity and repeatability,and can be used for the diagnosis and screening of relevant samples.

Aneurysm, False/therapy* ; Cardiac Catheterization ; Heart Aneurysm ; Heart Ventricles/surgery* ; Humans

Long duty hours have been associated with significant medical errors, adverse events, and physician “burn-out”. An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors’ perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician “burn-out” (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician “burn-out”.
After-Hours Care ; Asian Continental Ancestry Group ; Education, Medical ; Humans ; Internal Medicine ; Medical Errors ; Patient Safety ; Patient Satisfaction

Long duty hours have been associated with significant medical errors, adverse events, and physician “burn-out”. An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors’ perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician “burn-out” (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician “burn-out”.