Coronavirus Disease 2019 (COVID-19) is caused by 2019 novel coronavirus (2019-nCoV). Type I and type III interferons, as important available clinically used broad-spectrum antiviral drugs, have been considered as promising candidate drugs for the treatment and prevention of COVID-19. In early 2020, more than 40 clinical trials, including the World Health Organization (WHO) SOLIDARITY study, have been launched in the world to explore the clinical efficacy and application method of interferons in the treatment of COVID-19. Meanwhile, animal models and human clinical specimens were used in many laboratories to explore the immunologic role and mechanistic function of interferons in COVID-19. However, the conclusion of the studies in the past three years were not consistent and even contradictory albeit numerous data were accumulated by the scientific community, which reflects the complexity of the role and function of interferons in COVID-19. Recently, the results of four large high-quality randomized controlled phase III clinical trials were reported. In this review, we systematically summarize and analyze the complicated and contradictory data from the level of immunopathological mechanism and clinical trials. We clarify that the heterogeneous clinical outcome of 2019-nCoV infection is closely related to the level and production time of interferons and that interferons are protective in the early stage of COVID-19 but may cause immunological damages in the late stage which may exacerbate inflammation. Further high-quality prospective clinical trials that strictly control confounding factors are still warranted to finally elucidate the precise role and clinical application of interferons in COVID-19.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Objective To conduct a scoping review of research on the application of mobile health(mHealth)in the management of home enteral tube feeding,so as to provide references for future research and clinical practice.Methods A literature search was performed in the PubMed,Cochrane Library,Embase,Web of Science,CINAHL,CNKI,Wanfang,and CMB databases to identify relevant studies.The search period spanned from the establishment of databases until February 18,2024.According to the scoping review framework,2 researchers independently screened the studies,extracted the data of the included studies,and collaborated on the final analysis.Results A total of 24 studies were included.9 studies were conducted with interventions based on nursing models such as discharge planning model,"Hospital to Home"nutrition management model,guided care nursing model.The management forms included application,network communication software,and website.The content elements included education,assessment,consultation,referral,self-management,electronic health archive,appointment service,peer support.The outcome indicators included patients'physical and mental health,self-management ability,caregiver competence,family burden and user assessment.Conclusion The mHealth has played a positive role in the management of home enteral tube feeding.In the future,it is recommended to establish a multidisciplinary team to conduct high-quality research and continuously improve the form and content of mHealth management.

Objective To analyze the influencing factors of frailty in elderly patients with lower extremity osteoarthritis,and to construct and validate the risk assessment model.Methods Convenient sampling method was used to select 535 elderly patients with lower extremity osteoarthritis from tertiary hospitals and community health service centers in Hangzhou from January to September 2022 as the survey subjects including 357 in the modeling group and 178 in the validation group.Univariate and multivariate logistic regression analysis were used to determine the risk factors of frailty,construct a risk assessment model and draw a nomogram.The discrimination and calibration of the model were evaluated by the area under the receiver operating characteristic curve and the Hosmer-Lemeshow test.The Bootstrap method was used for intemal validation of the model,and the time verification method was used for external validation.Results The model variables included the number of affected joints,age-adjusted Charlson comorbidity index,pain,nutritional status,sedentary time,activity of daily living,osteoarthritis index,lower limb muscle strength,and Social Support Rating Scale score.The Hosmer-Lemeshow test results of the model showed that P=0.202,the area under the receiver operating characteristic curve was 0.942,the optimal critical value was 0.392,the sensitivity was 0.914,the specificity was 0.893,and the accuracy rate was 0.902.The internal and external validation showed that the C-statistics were 0.935 and 0.919,respectively,and the calibration curve showed good fitting.Conclusion The risk assessment model has a good degree of discrimination and calibration,which can more intuitively and easily screen elderly patients with lower extremity osteoarthritis at high risk of frailty,and provide references for early monitoring,identification,prevention and control.

Objective To explore the diagnostic value of video head impulse test(vHIT)combined with serum calcitonin gene related peptide(CGRP)and Ficolin-3 in patients with vestibular neuritis(VN).Methods A total of 92 VN patients treated in the hospital from March 2021 to September 2023 were assigned as the VN group,92 vestibular migraines(VM)patients treated in the hospital during the same period were assigned as the VM group,and another 92 healthy individuals who underwent physical examination in the hospital were assigned as the control group.The levels of CGRP and Ficolin-3 in serum were compared in three groups.Multivariate Logistic regression was applied to analyze the influencing factors of VN occurrence.Receiver operating charac-teristic curve was applied to analyze the diagnostic value of vHIT combined with serum CGRP and Ficolin-3 levels for VN.Results Compared with the control group,the serum CGRP levels in the VN group and the VM group were obviously increased(P＜0.05),while the Ficolin-3 levels were obviously reduced(P＜0.05).Compared with the VM group,the serum CGRP level and 3 pairs of vestibular ocular reflex(VOR)gain a-symmetry values in the VN group were obviously increased(P＜0.05),while the Ficolin-3 level was obvious-ly reduced(P＜0.05).Horizontal semicircular canal(HC)asymmetry value,superior semicircular canal(AC)asymmetry value,posterior semicircular canal(PC)asymmetry value,and CGRP were independent risk factors for VN occurrence(P＜0.05),while Ficolin-3 was an independent protective factor for VN occurrence(P＜0.05).The area under the curve(AUC)of combined detection of AC asymmetry value,HC asymmetry value and PC asymmetry was 0.872,which was better than that of AC asymmetry value and HC asymmetry value alone(Z three combination-AC asymmetry value=2.506,Z three combination-HC asymmetry value-2.329,P=0.012,0.020).The AUC of HC asymmetry value,AC asymmetry value,PC asymmetry value,serum CGRP and Ficolin-3 for diagnosing VN was 0.782,0.787,0.856,0.857,and 0.881,respectively.The AUC of the combined diagnosis of the five was 0.948,which was better than those of the individual diagnosis(Z five combination-HC asymmetry value=4.578,five combination-AC asymmetry value-4.908,Zfive combination-PC asymmetry value 3.085,Z five combination-CGRP=3.559,Z five combination-Ficolin-32.867,P＜0.05).Conclusion Serum CGRP level is increased and Ficolin-3 level is decreased in VN patients.CGRP is an independent risk factor for VN occurrence,and Ficolin-3 is an independent protective factor for VN occurrence.The combination of vHIT,CGRP,and Ficolin-3 has high diagnostic value for VN.

Objective:To observe the effect of preoperative application of butorphanol tartrate on postoperative recovery quality in patients undergoing thoracoscopic lobectomy.Methods:A prospective selection was conducted on 96 lung cancer patients who underwent thoracoscopic lobectomy and were admitted to Linyi People′s Hospital from May 2021 to September 2021. They were randomly divided into observation group and control group using a random table number method, with 48 patients in each group. The observation group received intravenous injection of 0.02 mg/kg butorphanol tartrate 15 minutes before anesthesia induction; The control group was given an equal volume of physiological saline. The operation site, operation time, remifentanil dosage during operation, heart rate (HR) and mean arterial pressure (MAP) at each time point of admission (T 0), intubation (T 1), 5 min after intubation (T 2), extubation (T 3), 5 min after extubation (T 4), and 15 min into post-anaesthesia care unit (PACU) (T 5) were recorded; The awakening Restlessness score (RS), Ramsay score, Visual Analogue Scale (VAS) score at T 4 and T 5, the time required from completion to extubation, and postoperative anesthesia related adverse reactions were evaluated. Results:There was no significant difference in the operation site, operation time and remifentanil dosage between the two groups (all P>0.05). Compared with T 0, the HR at T 2, T 3 and T 4, MAP at T 1, T 2, T 3 and T 4 in the two groups decreased significantly (all P<0.05). The HR of the observation group at T 1 and T 3 was significantly lower than that of the control group, and the difference was statistically significant (all P<0.05). The VAS scores of T 4 and T 5 in the observation group were lower than those in the control group after surgery, while the Ramsay score were higher than those in the control group (all P<0.001). The incidence of postoperative restlessness, nausea and vomiting in the observation group was lower than that in the control group ( P<0.05). Conclusions:Administering 0.02 mg/kg butorphanol tartrate 15 minutes before anesthesia induction can improve the quality of recovery in patients undergoing thoracoscopic lobectomy, reduce restlessness and related adverse reactions during recovery.

China/epidemiology* ; Humans ; Pemphigoid, Bullous/epidemiology* ; Retrospective Studies

Objective:To explore the mechanism underlying microRNA (miR) -125a-mediated inhibition of proliferation of keratinocytes.Methods:After 24-hour pretreatment with interleukin (IL) -23, human HaCaT keratinocytes were divided into miR-125a group and miR-NC group transfected with a miR-125a overexpression plasmid and a control plasmid, respectively. Cell counting kit-8 (CCK8) assay was performed to evaluate the proliferative ability of HaCaT cells in the two groups at 0, 24, 48 and 72 hours after transfection, real-time fluorescence-based quantitative PCR to determine the mRNA expression of miR-125a and IL-23 receptors (IL-23R) in the two groups 24 hours after transfection, and Western blot analysis to determine the protein expression of IL-23R, Janus kinase 2 (JAK2) , protein kinase B (AKT) and phosphorylated AKT (p-AKT) in the two groups 48 hours after transfection. Dual-luciferase reporter assay was performed to verify the targeting relationship between miR-125a and IL-23R. Comparison of means between two groups was carried out by using t test, and changes in the proliferative ability of HaCaT cells over time were evaluated by using repeated measures analysis of variance. Results:After plasmid transfection, the relative expression of miR-125a was significantly higher in the miR-125a group (6.377 ± 0.745) than in the miR-NC group (0.700 ± 0.222; t=7.305, P=0.002) . At 0, 24 and 48 hours after transfection, there was no significant difference in cellular proliferative ability between the miR-125a group and the miR-NC group ( t=0.663, 0.623 and 1.930, respectively, all P > 0.05) ; at 72 hours after transfection, the cellular proliferative ability was significantly lower in the miR-125a group than in the miR-NC group ( t=4.407, P < 0.05) . The IL-23R mRNA expression was significantly lower in the miR-125a group than in the miR-NC group ( t=3.082, P < 0.05) . Compared with the miR-NC group, the miR-125a group showed significantly decreased protein expression of IL-23R, JAK2 and p-AKT ( t=11.715, 6.996, 12.424, P < 0.001,=0.002, < 0.001, respectively) . Dual-luciferase reporter assay showed targeted binding of miR-125a to IL-23R. Conclusion:MiR-125a may inhibit the proliferation of keratinocytes by negatively regulating the IL-23R/JAK2/AKT signaling pathway.

Objective:To explore the clinical effect of a modified aponeurosis-resection surgery.Methods:From June 2017 to January 2018, a total of 34 patients (66 eyes) with mild to moderate congenital ptosis were treated in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, including 2 males and 32 females, (26.6 ± 7.6) aged, with mild 49 eyes and moderate 17 eyes. All patients underwent a modified aponeurosis-resection surgery by buried guiding suture. During the operation, guided sutures were run on the deep surface of the levator-Muller’s muscle complex, and the complex was sutured and fixed on the tarsal plate. Follow-up of the postoperative outcome was performed. The distance between the upper eyelid margin covering the upper edge of the cornea was recorded before operation, 3 months, 6 months, and 12 months after operation. The correction of ptosis was analyzed by the analysis of variance.Results:For the 34 patients (66 eyes), the distance between the upper eyelid margin covering the cornea before surgery, 3 months, 6 months, and 12 months was (3.84 ± 0.79) mm, (1.64 ± 0.13) mm, (1.67±0.14) mm, and (1.68 ± 0.14) mm. The difference between the initial value and the preoperative value was statistically significant ( P<0.01). During the follow-up period, no significant complications, such as infection, trichiasis, blepharoplasty, exposed keratitis, eyelid appearance, and conjunctival prolapse, were observed in all 34 patients. 1 case of blepharoplasty suture was lost and then repaired. The remaining 33 patients had satisfactory correction of the upper eyelid, good apperance, and bilateral symmetry. Two of them (4 eyes) had a slight decrease in the upper eyelid margin height, but still normal range, all patients were satisfied with the surgical result. Conclusions:The modified aponeurosis-resection surgery is effective in treating mild and moderate ptosis, with simple procedure, stable adhesion formation, and long-term eyelid function and appearance.

Objective:To explore the clinical effect of a modified aponeurosis-resection surgery.Methods:From June 2017 to January 2018, a total of 34 patients (66 eyes) with mild to moderate congenital ptosis were treated in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, including 2 males and 32 females, (26.6 ± 7.6) aged, with mild 49 eyes and moderate 17 eyes. All patients underwent a modified aponeurosis-resection surgery by buried guiding suture. During the operation, guided sutures were run on the deep surface of the levator-Muller’s muscle complex, and the complex was sutured and fixed on the tarsal plate. Follow-up of the postoperative outcome was performed. The distance between the upper eyelid margin covering the upper edge of the cornea was recorded before operation, 3 months, 6 months, and 12 months after operation. The correction of ptosis was analyzed by the analysis of variance.Results:For the 34 patients (66 eyes), the distance between the upper eyelid margin covering the cornea before surgery, 3 months, 6 months, and 12 months was (3.84 ± 0.79) mm, (1.64 ± 0.13) mm, (1.67±0.14) mm, and (1.68 ± 0.14) mm. The difference between the initial value and the preoperative value was statistically significant ( P<0.01). During the follow-up period, no significant complications, such as infection, trichiasis, blepharoplasty, exposed keratitis, eyelid appearance, and conjunctival prolapse, were observed in all 34 patients. 1 case of blepharoplasty suture was lost and then repaired. The remaining 33 patients had satisfactory correction of the upper eyelid, good apperance, and bilateral symmetry. Two of them (4 eyes) had a slight decrease in the upper eyelid margin height, but still normal range, all patients were satisfied with the surgical result. Conclusions:The modified aponeurosis-resection surgery is effective in treating mild and moderate ptosis, with simple procedure, stable adhesion formation, and long-term eyelid function and appearance.