AIM: To investigate the effect of the timing of satisfactory sedation with preoperative oral midazolam on anesthesia induction and recovery in children undergoing adenotonsillectomy. METHODS: A total of 147 children undergoing elective adenotonsillectomy, with ASA physical status orⅡ, aged 2-7 years were selected from November 2022 to June 2023 in the Second Affiliated Hospital of Wenzhou Medical University. The children were orally administered 0.5 mg/kg midazolam in preoperative waiting area and were divided into 10-20 min (rapid onset, M1 group) and 21-30 min (slow onset, M2 group) based on the satisfactory sedation time, or equal volume of sugar pear drink orally (blank control group, C group). Children in all three groups received a general anesthesia method of propofol+fentanyl combined with sevoflurane induction and sevoflurane maintenance. The primary outcome measures were the induction compliance checklist (ICC) score and the pediatric anesthesia emergence delirium (PAED) score in the post-anesthesia care unit (PACU) to assess the occurrence of emergence agitation (EA), and the secondary outcome measures included the parental separation anxiety scale (PSAS), sedation Ramsay score, surgery duration, recovery time, PACU stay time, discharge time, the incidence of perioperative respiratory adverse events (PRAE) and other adverse events in the ward. RESULTS: 147 children were included in the result analysis, with 49 cases in each group. The proportion of perfect induction (ICC=0) were significantly higher in two M groups than that in group C (95.9% vs. 91.8% vs. 61.2%, P=0.001). The maximum and average PAED score in PACU in group M1 showed a significantly higher (6.4±5.0 vs. 4.4 ± 4.1, P=0.029; 5.2 ± 4.5 vs. 3.4 ± 3.6, P=0.030), and the incidence of EA was significantly higher than those in group C (10.2% vs. 30.6%, P=0.022), and increased compared to the group M2 (OR= 0.581, 95%CI 0.231-1.463, P=0.354). There was no statistically significant difference in the maximum and average PAED scores, incidence of EA between group M2 and group C (P>0.05). The Ramsay score and PSAS score in two M groups were higher, PACU stay time and recovery time was longer than those in group C (P<0.05). The pain scores in PACU in group M1 was higher than that of group C (P<0.05). There was no statistically significant difference in the surgical time, discharge time, the incidence of PRAE and other adverse events in the ward among three groups (P>0.05). CONCLUSION: Preoperative oral midazolam can improve the ICC and PSAS scores of children during induction, but it also leads to prolonged recovery time and PACU retention time. The rapid onset of midazolam did not result in better induction and recovery quality, but instead increased the incidence of EA and postoperative pain score.

Objective To explore the mechanisms of circadian rhythm disorder(CRD)on behavior and testicular spermatogenic capacity in adolescent mice.Methods Thirty SPF grade C57 mice were selected and randomly di-vided into the control and CRD groups with 15 mice in each group.The control group kept 12 h dark/12 h bright circulating light,and the CRD group kept 24 h light.The trial lasted for 61 days.The growth curves of mice in each group were counted;the elevated plus maze test and open field test were performed to detect mice behavior;neuronal morphology was visualized by Nissl staining.The distribution of ionized calcium-binding adapter molecule 1(Iba1)and neuron-specific nuclear protein(NeuN)in the hypothalamus were detected by immunofluorescence and Western blot.Expression of testosterone synthesis-related genes steroidogenic acute regulatory protein(StAR)and hydroxy-delta-5-steroid dehydrogenase,3 beta-and steroid delta-isomerase 1(HSD3B1)and spermatogenesis-related genes gametogenetin binding protein 2(GGNBP2)and deleted in azoospermia-like(DAZL)were deter-mined by RT-qPCR.Results The weight of the CRD group was significantly higher than that of control group at 61 days;in the elevated plus maze test,the time,frequency,and percentage of time in the open arm of the CRD group were significantly less than those of the control group;in the open field test,there was no significant differ-ence in movement distance between the two groups;however,the residence time of the central area in the CRD group was significantly less than that in the control group;the frequency of entering the central area in the CRD group was significantly less than that in the control group.Nissl staining results showed that the positive cells in the CRD group were significantly lower than the control group.Immunofluorescence and Western blot results showed that Iba1 protein expression was up-regulated and NeuN protein expression was down-regulated in the hypothalamus of the CRD group.In the RT-qPCR experiment,the expression of HSD3B1 in the CRD group was significantly low-er than that of the control group;the expression of GGNBP2 and DAZL in the CRD group was significantly lower than that in the control group.Conclusion The CRD treatment can not only lead to depressive behavior in adoles-cent mice but also reduce the development of reproductive system in male adolescent mice.

Objective:To understand the epidemiology of rubella and the genetic characteristics of the virus circulating during the period 2021-2022, providing basic scientific data for rubella prevention and control in China.Methods:National rubella incidence data for the period 2021-2022 were obtained from the Infectious Disease Surveillance System module and the Surveillance Report Management module of the China′s Disease Prevention and Control Information System. Positive rubella virus(RuV)isolates were obtained from the National Measles/Rubella Laboratory Network. Two nucleotide (nt) fragments [F1-480 (8 633-9 112 nt) and F2-633 (8 945-9 577 nt)] located in the E1 gene were amplified and determined by reverse transcription polymerase chain reaction (RT-PCR), and the target gene (E1-739) was obtained after collating and splicing. The sequences obtained in this study were used to construct a phylogenetic tree with the reported reference strains for genotype and lineage identification. Additionally, the phylogenetic analysis was performed to assess their genetic relatedness of RuV strains prevalent in China during 2018-2020 from GenBank database.Results:In 2021-2022, the rubella incidence in China was 0.06/100, 000 (2021: 840 cases; 2022: 784 cases), with cases primarily concentrated in the western and southern provinces. Age distribution analysis showed that rubella cases in 2021-2022 was mainly in children under 5 years of age (2021: 34.17%, 287/840; 2022: 42.09%, 330/784), with the highest proportion in children aged 0-2 years. Further analysis of the immunization history of cases revealed that in the 8-23 months age group, a significant proportion of cases had received only one dose of rubella containing vaccine (RCV); cases in the 2-14 years age group were mainly among children who had received two or more doses of RCV; however, cases over 15 years of age were primarily found in individuals who had not received RCV or had unknown immunization history. National virological surveillance data showed that totally 22 RuV virus isolates were obtained, from 6 provinces in China during 2021-2022, which belonged to lineage 1E-L2 (11 strains) and 2B-L2c (11 strains). And these viruses displayed high genetic homology with RuV prevalent from 2018 to 2020.Conclusions:The incidence of rubella in China was maintained at a low level during 2021-2022, and the prevalent RuV strains were lineage 1E-L2 and 2B-L2c.

ObjectiveTo evaluate the caries prevention effect of different fluoride application frequencies in 3-year-old children with active caries. MethodsA total of 337 3-year-old children with dental caries from 12 kindergartens in Changning District of Shanghai were divided into three groups： group 1 received fluoride application once every three months， group 2 received fluoride application once every six months， and the control group received no fluoride application. At baseline， parents completed a questionnaire survey， and oral examinations were conducted at baseline， 7 months， and 16 months after the fluoride intervention to assess the incidence of new dental caries， new dmft， and new dmfs of children. Multivariate logistic regression analysis was used to analyze the relationship between fluoride application and new dental caries， with new dental caries as the dependent variable and local fluoride application， child's gender， age in months， parents' highest education level， frequency of sugary intake （desserts， candies， sweet beverages）， age of toothbrushing initiation， frequency of daily toothbrushing， use of fluoride toothpaste， parental assistance in child’s toothbrushing， and daily use of dental floss as the independent variables. ResultsThere were no significant differences in baseline general conditions and oral health behaviors among group 1 （121 cases）， group 2 （123 cases） and the control group （93 cases） （all P>0.05）. After 16 months' intervention， three children were lost to follow-up due to transferring schools. The new caries rates of group 1 （120 cases）， group 2 （121 cases） and the control group （93 cases） were 5.83%， 24.79% and 52.69%， respectively. The incidence of new caries was significantly lower in group 1 compared to group 2 and the control group （P<0.001）， and it was also significantly lower in group 2 compared to the control group （P<0.001）. The newly-increased caries of group 1， group 2 and the non-fluoride control group were all 0.12 0.52， 0.36 0.68 and 1.16 1.39， respectively. The mean increment of new caries was lower in group 1 compared to group 2 （P=0.040） and the non-fluoride control group （P<0.001）， and it was lower in group 2 compared to the non-fluoride control group （P<0.001）. After adjusting for factors such as gender， parents' education level and child's oral health behaviors by multivariate logistic regression， the results showed that fluoride application once every three months could significantly reduce the risk of dental caries （OR=0.04， P<0.001）. ConclusionLocal use of fluoride has a certain effect on the prevention and treatment of dental caries in children with active caries. Fluoride application once every three months effectively reduces the incidence of new caries and slows down the progression of caries lesions. It is suggested that local application of fluoride should be implemented once every three months for children with active caries.

Objective:To summarise the effect of free perforator flap of radial collateral artery on reconstruction of first web contracture after hand injury.Methods:Retrospective analysis was conducted based on the clinical data of patients with first web contracture after hand injury in the Department of Hand and Foot Surgery and Rehabilitation, Guangdong Work Injury Rehabilitation Hospital from November 2019 to June 2022. Ten patients, 8 males and 2 females aged between 27 and 51 years old with an average of 40.5 years old were included. There were 6 left hands and 4 right hands. Width and the included angle of first web were measured before surgery. Four hands were classified as severe first web contracture, and the rest of 6 hands had moderate first web contracture. After release scars of the first web, the areas of wound were 5.5 cm × 2.0 cm - 10.5 cm × 3.0 cm. The flaps sized were 6.0 cm×2.5 cm - 11.0 cm × 3.5 cm. All of flaps carried the posterior cutaneous nerve of forearm. Donor sites were closed directly. All patients were included in postoperative follow-up regularly through outpatient clinic or via WeChat reviews. The colour, texture, process in change of the transferred flaps, donor and recipient sites healing and complications were observed.Results:All 10 flaps survived and the wound healed by first intention. The patients received 7 to 15 months (10.5 months in average) of postoperative follow-up. The flaps were not bulky, texture and colour were satisfactory and without pigmentation. Protective sensations restored in 6 patients. At the last follow-up, average included angle of the first webs was 47.14°±1.68°, in comparison with 35.43°±3.60° before surgery. The average width of first webs was 5.34 cm±0.52 cm, in comparison with 3.17 cm±0.75 cm before surgery, the differences were statistically significant ( P<0.01). Eight hands were rated excellent, and 2 were good. There were only linear scars left at the donor sites, without sign of radial nerve injury. Conclusion:The free perforator flap of radial collateral artery is a safe and effective method for repair of first web contracture after hand injury.

Objective:To compare the efficacy and safety between WangShiBaoChiWan and mosapride in the treatment of functional dyspepsia (FD).Methods:From September 2019 to September 2020, patients with postprandial fullness and early satiation who met the Rome Ⅳ criteria for FD diagnosis were enrolled from 15 hospitals, including the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical College. The subjects were randomly divided into WangShiBaoChiWan (experimental) group and mosapride (control) group in the ratio of 1∶1. The treatment regimens were WangShiBaoChiWan+ mosapride simulator, WangShiBaoChiWan simulator+ mosapride, respectively with a treatment period of 2 weeks. The primary efficacy outcome was the improvement rates of main symptoms before and after treatment, the secondary efficacy primary efficacy outcome was the total clinical effective rate and the change of the single symptom score. And the safety indicator included adverse events. Independent sample t-test, paired t-test and chi-square test were used for statistical analysis. Results:A total of 251 FD patients were enrolled in the full analysis set, including 124 in the experimental group and 127 in the control group; 241 FD patients were in the per-protocol analysis set, including 117 in the experimental group and 124 in the control group. The analysis of per-protocol analysis set showed that the improvement rates of the main symptoms of the experimental group and the control group were (66±29)% and (60±30)%, respectively, and the difference was not statistically significant ( P>0.05). The improvement rate of the main symptoms of the experimental group reached 117% of that of the control group, which exceeded the expected non-inferiority standard of 80%. The total clinical effective rates of the experimental group and the control group were 76.07% (89/117) and 75.81% (94/124), respectively, and the difference was not statistically significant ( P>0.05). The results of full analysis set showed that the incidence of adverse events of the experimental group and the control group was 1.62% (2/124) and 1.57% (2/127), respectively, and the difference was not statistically significant ( P>0.05). There were no serious adverse events in the two groups. Conclusion:The improvement rate of the main symptoms of WangShiBaoChiWan is not inferior to that of mosapride in the treatment of FD, and it has good safety.

Neurodegenerative diseases(NDs)are closely related to the central nervous system and characterized by morphological abnormalities and progressive loss of function in specific neuron groups.The main NDs include Alzheimer's disease,Parkinson's disease,amyotrophic lateral sclerosis,multiple sclerosis and Huntington's disease.However,no direct therapies for NDs exist.In recent years,single cell RNA-sequencing(scRNA-seq)has been widely used in various NDs.The pathogenesis of NDs is closely related to morphology of immune cells,and the pathogenesis mainly involves mitochondrial function,glucose metabolism,inflammation,and synaptic transmission.Induced pluripotent stem cells are a potential therapy for NDs.Ultimately,we review the application of scRNA-seq to various NDs and provide a reference for prevention and treatment of NDs.

Objective:To understand the genetic characteristics of human adenovirus (HAdV) in severe acute respiratory infection (SARI) cases in Luohe city, Henan province, China.Methods:After viral isolation of HAdV-positive specimens identified in SARI cases from October 2017 to February 2019, the Loop2 region of the Hexon gene was amplified and determined to initially identify the virus type. Then, based on the preliminary screening result, the full length of the sequences of the three target genes (Penton base, Hexon and Fiber) of the viral strains were amplified using specific primers for each HAdV type, and phylogenetic and sequence homology analyses were performed with the prototype strains and the representative strains of the corresponding types at home and abroad to identify the types of viral strains and understand their genetic characteristics.Results:A total of 18 viral isolates were obtained from 27 HAdV-positive throat swab specimens from 783 SARI cases in Luohe city, Henan province, and the molecular typing result showed that these strains belonged to species B (HAdV-3, HAdV-7 and HAdV-55), species C (HAdV-1, P1H2F2, Px1/Ps3H5F5, P89H5F5 and HAdV-6) and species E (HAdV-4). Among them, the highest positive detection rate was found for species C HAdV-1 isolates (33.3%), followed by species B HAdV-3 (22.2%) and species C P1H2F2 (11.1%). The four HAdV strains in this study (HAdV-3, HAdV-4, HAdV-7 and HAdV-55) were characterized by significantly conserved and stable in time and space; while three patterns of genetic recombination (P1H2F2, Px1/Ps3H5F5 and P89H5F5) were identified for HAdV-C strains in this study, and their potential public health significance needed to be confirmed by further studies.Conclusions:The HAdV infection of SARI cases in Luohe city, Henan province during 2017-2019 was dominated by species C, followed by species B and species E. These data provided a scientific basis for the prevention and control of local adenovirus-associated infectious diseases.

Objective:To evaluate the effect of synthetic CpG oligodeoxynucleotide (CpG-ODN) as adjuvant on immune response induced by inactivated human adenovirus (HAdV)-55 antigen in BALB/c mice.Methods:HAdV-55 virus QS prototype strain was purified by plaque to construct a seed bank of vaccine candidate strain. The amplified product of vaccine candidate strain was inactivated by 0.05%β-propiolactone, and purified to prepare perfect virus particle antigen. The purified HAdV-55 antigen was mixed with the same volume CPG-ODN and aluminum hydroxide adjuvant in low-dose group (0.2 mg/ml) and high-dose group (1 mg/ml), respectively, and inoculated BALB/c mice after emulsification. Meanwhile, the control group was set with PBS, and the immunization was enhanced once every 21 days. Respectively on primary immune 21 and 35 days after collecting venous blood in mice and separation of serum, serum was collected at the end of the time of separating spleen lymphocytes in mice. The levels of HAdV-55 specific IgG antibody and neutralization antibody in serum of immunized mice were observed by ELISA and micro-neutralization test, and the levels of lymphocytes secreting IL-4 and IFN-γ cytokines were detected by ELISpot.Results:No matter with or without adjuvant, along with the increase of the number of immunization and vaccination dose of inactivated HAdV-55 antigen induced BALB/c mice virus specific IgG antibody was also significantly increased. However, neutralizing antibody can reach detectable level only after enhanced immunity, and the geometric mean titer (GMT) of neutralizing antibody is between 1: 11 and 1: 23. Different adjuvants have significant effects on the immune response of mice. Low dose antigen combined with CPG-ODN and aluminum hydroxide mixed adjuvant can induce higher humoral and cellular immune responses in mice, and the levels of specific IgG antibody and neutralizing antibody are 2.2 and 1.8 times higher than those in the aluminum hydroxide adjuvant group, respectively. The number of lymphocytes secreting IFN-γ was 2.3 times that of the group immunized with aluminum hydroxide adjuvant.Conclusions:The novel CPG-ODN adjuvant significantly increased the immunogenicity of the inactivated HAdV-55 whole virus antigen in BALB/c mice and directed the cellular immune response toward Th1 type.

Objective: To evaluate the value of computed tomography (CT) multi-planner reconstruction (MPR)in the treatment of lung cancer with percutaneous argon-helium cryoablation.Method:A total of 66 patients with stage T2 or T3 non-small cell lung can-cer who had complete follow-up data were treated with percutaneous argon-helium cryoablation with conventional axial CT(conven-tional group)or MPR guidance(MPR group)between January 2013 and 2016.There were 31 patients in the conventional group and 35 in the MPR group.The total number of punctures,the total time of operation,and the incidence of complications,tumor residual rates,and local control rates were compared between the two groups.Results:When the number of needles was the same,the aver-age number of punctures and puncture errors in the two groups were significantly lower in the MPR group than in the conventional group(P<0.05).Comparing the average operation time,there was no statistical difference between the MPR group and the conven-tional scan group(P>0.05).The incidence of postoperative complications was significantly lower in the MPR group than in the conven-tional scan group.Among them,the incidence of puncture combined hemorrhage was 1.52% vs.13.64%,and pneumothorax second-ary to puncture was 3.03% vs.19.70%(P<0.05).During the follow-up period to 12 months after surgery,the therapeutic benefit indica-tors such as local residual rate and total effective rate in the MPR group were also significantly better than those in the conventional group,which were 1.52% vs.10.61 and 51.52% vs.36.36%(P<0.05),respectively.Conclusions:Using MPR technology to guide percuta-neous argon-helium cryoablation treatment for lung cancer confers a small puncture error,low incidence of complications,and signifi-cant treatment benefits.This method is worthy of clinical promotion.