Objective:To analyse the clinical characteristics of 214 cases of paediatric high altitude pulmonary edema（HAPE）and the efficacy of dexamethasone in adjunctive therapy.Methods:This retrospective study analyzed 214 pediatric cases of HAPE admitted to the Department of Paediatrics of the General Hospital of Tibetan Military between June 2015 to June 2017 and June 2019 to June 2021.Patients were divided into dexamethasone-treated group and dexamethasone-untreated group.Baseline data，clinical characteristics were collected to evaluate the treatment efficacy and drug side effects.Results:There were 107 children in each of the two groups with a median age of 8（5，11）years. The median age of the dexamethasone-treated group was 9（6，12）years and the mean age of the dexamethasone-untreated group was 7（3，10）years. The proportion of male children was 69.60%（149/214）；the onset of illness was mostly concentrated within 72 hours，accounting for 97.20%（208/214）of the cases；83.18%（178/214）of the cases had symptoms of combined upper respiratory tract infection before entering the plateau. The most important clinical symptoms of the children were cough（86.92%，186/214），cyanosis（70.09%，150/214），and shortness of breath（66.36%，142/214）. The proportion of auscultatory rhonchi was 83.18%（178/214），and all cases showed positive findings on chest radiography. After the dexamethasone regimen，the overall cure rate of the children was 94.39%，the average disappearance time of the symptoms and signs was（40.52±7.85）h，and the average hospital stay was（3.60±1.90）d. After treatment with the dexamethasone-free regimen，the overall cure rate was 92.52%，the mean time to disappearance of symptoms and signs was（42.10±7.62）h，and the mean length of stay in the hospital was(3.84±2.08)d. There was no significant difference in the cure rate，the disappearance time of symptoms and signs，and the average hospitalisation days between the two groups（ P>0.05），but a total of 11 children in the dexamethasone-treated group experienced adverse drug reactions，and no children in the dexamethasone-untreated group experienced adverse drug reactions. Conclusion:Han Chinese male children，particularly those with upper respiratory infections，should be closely monitored for HAPE risk within three days of ascending to high altitudes. This study does not recommend the use of dexamethasone for pediatric HAPE due to the lack of therapeutic benefits and potential adverse effects.

Objective To analyze the research hotspots and trends of invasive fungal infections(IFIs)in China over the past 24 years,and provide references and suggestions for future research.Methods Literatures on IFIs re-search in China from 2000 to 2024 were retrieved from China National Knowledge Infrastructure(CNKI)and Web of Science(WOS).CiteSpace software was employed to conduct collaboration network analysis on authors' institu-tions,and co-occurrence,clustering,and burst analyses were conducted on key words.Results A total of 2 479 li-teratures retrieved from CNKI and 1 149 from WOS were included in the analysis,involving 295 research institu-tions,with no core research team identified having a intermediary centrality＞0.1.Institutions with intermediary centrality＞0.1 included Chinese Academy of Sciences,Peking University,Fudan University,Sun Yat-sen Univer-sity and Zhejiang University.Key words with high centrality included"diagnosis""risk factor""voriconazole"and"Candida albicans".Clustering analysis grouped the co-occurrence network of key words into 6 clusters,mainly covering fungal diagnosis,treatment,and susceptible factors.Since 2020,focuses on the safety of antifungal treat-ment agents and primary prevention have emerged,with hot topics including pharmacokinetics,children,clinical features,and risk factors.Conclusion Currently,research teams are dispersed with insufficient interdisciplinary collaboration.Research topics are relatively simple.It is necessary to strengthen research on fungal resistance and healthcare-associated infection prevention and control.Risk factors and prevention measures for IFIs may be the fo-cus of future research.

ObjectiveTo explore the regulatory effects and mechanisms of Astragali Radix polysaccharide （APS） on inhibitor of differentiation1 （ID1） and protein kinase B （Akt） in gastric cancer. MethodsImmunohistochemical staining was used to detect the expression of ID1 and Akt in 61 gastric cancer tissue samples and 20 adjacent normal gastric tissue samples. Immunofluorescence was used to detect the localization of ID1 and Akt. The effects of APS at the concentrations of 0.625， 1.25， 2.5， 5， 10， 20 mg·L^-1 on the proliferation of gastric cancer MGC-803 cells were examined by the cell counting kit-8（CCK-8） method and the colony formation assay. The target information of APS was retrieved from the Traditional Chinese Medicine Systems Pharmacology and Analysis Platform and Swiss Target Prediction. Keywords such as gastric cancer， gastric tumor， and stomach cancer were searched against GeneCards， UniProt， DisGeNET， and Online Mendelian Inheritance in Man （OMIM） for the screening of gastric cancer-related targets. The online tool jvenn was used to create the Venn diagram to identify the common targets， and STRING and Cytoscape were used to construct the protein-protein interaction network. Gene Ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analyses were conducted via R 4.2.2 to predict the potential roles of APS in the development of gastric cancer. The cell scratch assay was employed to assess the effect of APS on the migration of MGC-803 cells. The protein and mRNA levels of ID1 and Akt in the cells treated with APS were determined by Western blot and Real-time PCR， respectively. ResultsCompared with the adjacent normal gastric tissue， the gastric adenocarcinoma tissue showed increased positive expression of ID1 （χ² =81.00， P<0.01）. Immunofluorescence detection showed that ID1 and Akt were mainly located in the cytoplasm of gastric adenocarcinoma cells. Bioinformatics analysis identified 14 common genes shared between APS and gastric cancer. The average degree of protein-protein interaction network nodes was 14.29. GO and KEGG pathway enrichment results showed that ID1 and Akt were significantly enriched in the Rap1 and phosphatidylinositol-3-kinase （PI3K） /Akt signaling pathways. Cell experiments demonstrated that 5-fluorouracil （0.1 mg·L^-1） and APS （10， 20 mg·L^-1） groups showed decreased cell proliferation， migration， and colony formation. Compared with the control group， 10， 20 mg·L^-1 APS inhibited the proliferation of MGC-803 cells （P<0.01）， with 10 mg·L^-1 APS demonstrating stronger inhibitory effect. In addition， APS at 10， 20 mg·L^-1 inhibited the migration （P<0.01） and colony formation （P<0.05， P<0.01） of MGC-803 cells. Compared with the control group， APS at 10， 20 mg·L^-1 down-regulated the protein levels of ID1 （P<0.01） and Akt （P<0.05） and the mRNA levels of ID1 （P<0.05， P<0.01） and Akt （P<0.05， P<0.01） in MGC-803 cells. ConclusionID1 and Akt are highly expressed in the gastric adenocarcinoma tissue， which may be related to the development of gastric cancer. APS can down-regulate the protein and mRNA levels of ID1 and Akt to exert anti-tumor effects， which is expected to provide new therapeutic targets for gastric cancer treatment.

Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.
Humans ; Chemoradiotherapy/adverse effects* ; Consensus ; Risk Factors ; Stomatitis/etiology*

Type 2 diabetes mellitus(T2DM) is a prevalent metabolic and endocrine disorder. Long-term hyperglycemia can lead to severe chronic complications, imposing substantial economic burdens on both society and patients. Despite the availability of various hypoglycemic agents for clinical use, these agents often fail to meet the therapeutic needs of T2DM and its complications. Consequently, there is an urgent need for novel therapeutic strategies and drugs. Lithocarpus litseifolius(L. litseifolius), commonly referred to as "cordyceps on trees", has a long history of use in traditional medicine and can be applied in tea, sugar, and medicine. Research indicates that L. litseifolius extracts are rich in dihydrochalcones, including trilobatin, phloridzin, and phloretin, which exhibit a range of pharmacological activities, such as anti-inflammatory, antioxidant, hypoglycemic, hypolipidemic, hepatoprotective, and cardioprotective effects. These properties suggest potential applications in the treatment of T2DM and its complications. This review systematically compiled and organized the relevant literature from the past decade on dihydrochalcones(trilobatin, phloridzin, and phloretin) from L. litseifolius extracts. It highlighted recent research progress regarding their role in treating T2DM and its complications through mechanisms such as reducing insulin resistance, regulating glucose transport, improving glucose and lipid metabolism, modulating enzyme activity, regulating gut microbiota, and alleviating inflammation and oxidative damage. The purpose of this review is to provide a reference and basis for future research on the prevention and treatment of T2DM and its complications using dihydrochalcones(trilobatin, phloridzin, and phloretin) from L. litseifolius extracts.
Chalcones/chemistry* ; Diabetes Mellitus, Type 2/metabolism* ; Humans ; Animals ; Elaeocarpaceae/chemistry* ; Drugs, Chinese Herbal/therapeutic use* ; Hypoglycemic Agents/chemistry* ; Plant Extracts/chemistry*

Targeting drug delivery systems mediated by nanoparticles has shown great potential in the diagnosis and treatment of cancer. However, influences of different tumor progressions on the accumulation of nanoparticles, especially the ligand-modified active targeting nanoparticles are seldom exploited. In this work, the accumulation and penetration of RGD-modified gold nanoparticles (active AuNPs) with different sizes were investigated in orthotopic breast cancer with different tumor progressions. The results showed that the smallest active AuNPs had better accumulation and permeation effects in early tumor tissues with the relatively looser extracellular matrix, larger gaps, lower interstitial fluid pressure, and less receptor expression, which was due to size effects. However, the larger active AuNPs had better accumulation and penetration effects in late tumor tissues with highly expressed target receptors integrin α _v β ₃ because of the multivalent interactions between larger active nanoparticles and integrin α _v β ₃. In the midterm, tumor accumulation of active AuNPs was equally influenced by size effects and multivalent interactions. Therefore, RGD-modified nanoparticles with sizes of 7 and 90 nm accumulated more in tumors. This study will guide a rational design of active targeting nanoparticles for enhancing the diagnosis and treatment of tumors based on their progressions.

Objective To analyze the research hotspots and trends of invasive fungal infections(IFIs)in China over the past 24 years,and provide references and suggestions for future research.Methods Literatures on IFIs re-search in China from 2000 to 2024 were retrieved from China National Knowledge Infrastructure(CNKI)and Web of Science(WOS).CiteSpace software was employed to conduct collaboration network analysis on authors' institu-tions,and co-occurrence,clustering,and burst analyses were conducted on key words.Results A total of 2 479 li-teratures retrieved from CNKI and 1 149 from WOS were included in the analysis,involving 295 research institu-tions,with no core research team identified having a intermediary centrality＞0.1.Institutions with intermediary centrality＞0.1 included Chinese Academy of Sciences,Peking University,Fudan University,Sun Yat-sen Univer-sity and Zhejiang University.Key words with high centrality included"diagnosis""risk factor""voriconazole"and"Candida albicans".Clustering analysis grouped the co-occurrence network of key words into 6 clusters,mainly covering fungal diagnosis,treatment,and susceptible factors.Since 2020,focuses on the safety of antifungal treat-ment agents and primary prevention have emerged,with hot topics including pharmacokinetics,children,clinical features,and risk factors.Conclusion Currently,research teams are dispersed with insufficient interdisciplinary collaboration.Research topics are relatively simple.It is necessary to strengthen research on fungal resistance and healthcare-associated infection prevention and control.Risk factors and prevention measures for IFIs may be the fo-cus of future research.

Objective:To analyse the clinical characteristics of 214 cases of paediatric high altitude pulmonary edema（HAPE）and the efficacy of dexamethasone in adjunctive therapy.Methods:This retrospective study analyzed 214 pediatric cases of HAPE admitted to the Department of Paediatrics of the General Hospital of Tibetan Military between June 2015 to June 2017 and June 2019 to June 2021.Patients were divided into dexamethasone-treated group and dexamethasone-untreated group.Baseline data，clinical characteristics were collected to evaluate the treatment efficacy and drug side effects.Results:There were 107 children in each of the two groups with a median age of 8（5，11）years. The median age of the dexamethasone-treated group was 9（6，12）years and the mean age of the dexamethasone-untreated group was 7（3，10）years. The proportion of male children was 69.60%（149/214）；the onset of illness was mostly concentrated within 72 hours，accounting for 97.20%（208/214）of the cases；83.18%（178/214）of the cases had symptoms of combined upper respiratory tract infection before entering the plateau. The most important clinical symptoms of the children were cough（86.92%，186/214），cyanosis（70.09%，150/214），and shortness of breath（66.36%，142/214）. The proportion of auscultatory rhonchi was 83.18%（178/214），and all cases showed positive findings on chest radiography. After the dexamethasone regimen，the overall cure rate of the children was 94.39%，the average disappearance time of the symptoms and signs was（40.52±7.85）h，and the average hospital stay was（3.60±1.90）d. After treatment with the dexamethasone-free regimen，the overall cure rate was 92.52%，the mean time to disappearance of symptoms and signs was（42.10±7.62）h，and the mean length of stay in the hospital was(3.84±2.08)d. There was no significant difference in the cure rate，the disappearance time of symptoms and signs，and the average hospitalisation days between the two groups（ P>0.05），but a total of 11 children in the dexamethasone-treated group experienced adverse drug reactions，and no children in the dexamethasone-untreated group experienced adverse drug reactions. Conclusion:Han Chinese male children，particularly those with upper respiratory infections，should be closely monitored for HAPE risk within three days of ascending to high altitudes. This study does not recommend the use of dexamethasone for pediatric HAPE due to the lack of therapeutic benefits and potential adverse effects.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the causes of a cluster of suspected neonatal carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection(BSI)in the neonatal department of a hospital,and provide references for the effective control of the occurrence of healthcare-associated infection(HAI).Methods Epidemiological in-vestigation on 3 neonates with CRKP BSI in the neonatal department from January 31 to February 6,2023 was per-formed.Specimens from environmental object surfaces were taken for environmental hygiene monitoring,and effec-tive control measures were taken according to the risk factors.Results From January 31 to February 6,2023,a to-tal of 60 neonates were admitted in the neonatal department,including 16 with peripherally inserted central venous catheter(PICC).Three neonates had CRKP BSI,with a incidence of 5.00％.There were 33 hospitalized neonates on the day(February 7)when the cluster of HAI was reported,with a prevalence rate of 9.09％(3/33).CRKP BSI rate in the neonatal department of this hospital from January 31 to February 6,2023 was higher than that in 2022(P＜0.001).The incubators of the 3 neonates with CRKP BSI were in the same ward and adjacent to each other.The first neonate with CRKP BSI(who developed BSI on January 31)underwent PICC maintenance on Feb-ruary 4,and the other 2 neonates with PICC maintenance immediately following the first one also developed CRKP BSI.CRKP were isolated from blood culture of all 3 neonates,and antimicrobial susceptibility testing results were consistent.Conclusion The occurrence of the cluster event of neonatal CRKP BSI may be related to the failure of strict implementation of aseptic procedures during PICC maintenance and cross contamination among items.