BACKGROUND: There is growing evidence that the occurrence and severity of respiratory diseases in children are related to the concentration of air pollutants. Nonetheless, evidence regarding the association between short-term exposure to air pollution and outpatient visits for respiratory diseases in children remains limited. Outpatients cover a wide range of disease severity, including both severe and mild cases, some of which may need to be transferred to inpatient treatment. This study aimed to quantitatively evaluate the impact of short-term ambient air pollution exposure on outpatient visits for respiratory conditions in children. METHODS: This study employed data of the Second People's Hospital of Yichang from January 1, 2016 to December 31, 2023, to conduct a time series analysis. The DLNM approach was integrated with a generalized additive model to examine the daily outpatient visits of pediatric patients with respiratory illnesses in hospital, alongside air pollution data obtained from monitoring stations. Adjustments were made for long-term trends, meteorological variables, and other influencing factors. RESULTS: A nonlinear association was identified between PM_2.5, PM₁₀, O₃, NO₂, SO₂, CO levels and the daily outpatient visits for respiratory diseases among children. All six pollutants exhibit a hysteresis impact, with varying durations ranging from 4 to 6 days. The risks associated with air pollutants differ across various categories of children's respiratory diseases; notably, O₃ and CO do not show statistical significance concerning the risk of chronic respiratory conditions. Furthermore, the results of infectious respiratory diseases were similar with those of respiratory diseases. CONCLUSIONS Our results indicated that short-term exposure to air pollutants may contribute to an increased incidence of outpatient visits for respiratory illnesses among children, and controlling air pollution is important to protect children's health.
Humans ; China/epidemiology* ; Air Pollutants/analysis* ; Respiratory Tract Diseases/chemically induced* ; Child ; Child, Preschool ; Environmental Exposure/adverse effects* ; Air Pollution/analysis* ; Infant ; Male ; Particulate Matter/adverse effects* ; Female ; Ambulatory Care/statistics & numerical data* ; Outpatients/statistics & numerical data* ; Adolescent ; Infant, Newborn

To detect interleukin-33(IL-33)level and investigate the effect of IL-33 signaling pathway on monocytes in patients with hepatitis B virus(HBV)-associated hepatocellular carcinoma(HCC),total of 31 HBV-HCC patients,33 chronic hepatitis B(CHB)patients and 21 normal controls were enrolled in the study.Peripheral blood was collected to isolate plasma and peripheral blood mononuclear cells(PBMC),then CD14+monocytes were purified by magnetic-activated cell sorting.Intrahepatic lymphocytes(IHL)were isolated from para-tumor tissues and tumor tissues of 11 HBV-HCC patients.IL-33 and soluble suppressor of tumorigenicity 2(sST2)levels in plasma were measured by enzyme-linked immunosorbent assay;ST2 expression in CD14+monocytes was investigated by flow cytometry.Recombinant human IL-33 was used to stimulate CD14+monocytes,then the cytokine secretion and HLA-DR proportion in CD14+monocytes were assessed.Furthermore,cytotoxicity of monocytes was also investigated.Data showed that plasma IL-33 level in CHB patients and HBV-HCC patients were lower than that in controls(P<0.01).Plasma sST2 level of HBV-HCC patients was higher than those of CHB patients and controls(P<0.01).ST2+CD14+proportion in PBMC from HBV-HCC patients was lower than those of from CHB patients and controls(P<0.000 1).ST2 mean fluorescence intensity(MFI)in PBC from HBV-HCC patients was lower than those from CHB patients and controls(P<0.0001).ST2+CD14+proportion in IHL was also lower in tumor tissues than that in para-tumor tissues(P<0.05);ST2 MFI in IHL was lower in tumor tissues than that in para-tumor tissues(P<0.05).As compared with controls,monocytes activity of HBV-HCC and CHB patients were lower,especially in tumor tissues,which was presented as downregulation of HLA-DR proportion,TNF-α,IL-6,IL-1β and granzyme B secretion(P<0.05).IL-33 stimulation did not affect ST2 level in CD14+monocytes(P>0.05).Both 0.1 ng/ml and 1 ng/ml of IL-33 stimulation elevated cytokine production and HLA-DR+CD14+monocytes percentage in CD14+monocytes from HBV-HCC patients(P<0.05).However,only 1 ng/ml of IL-33 stimulation promoted monocytes-induced target cell death(P<0.000 1).Taken together,monocytes activity is down-regulated in HBV-HCC patients,and IL-33 signaling pathway could enhance monocytes function in HBV-HCC patients.

Objective:To investigate the effect of a participatory ergonomics intervention program on the willingness to re-turn to work in patients with back injuries. Method:A total of 64 patients with lumbar&back injury were randomly divided into control group(n=33)and experimental group(n=31).The experimental group was given the participatory ergonomics intervention,and both group were given the conventional vocational rehabilitation training.Patients in the two groups were evaluated by spinal function sort(SFS),Lam assessment of stages of employment readiness(LASER),fear-avoidance belief questionnaire(FABQ)before and after intervention. Result:There were no statistically significant differences between the two groups in FABQ score,SFS score and LASER score before invention(P＞0.05).There were statistically significant differences in SFS scores and LASER scores in both groups before and after treatment(P＜0.05),and the evaluation index of the experimen-tal group was significantly better than that of the control group(P＜0.05).In the experimental group,FABQ scores decreased significantly(P＜0.05),no significant decrease in control group(P＞0.05). Conclusion:Participatory ergonomics intervention combined with vocational rehabilitation training can improve the self-perception of spinal function,and improve the willingness to work of patients with low back pain.

Objective:To analyze the patterns of antibacterial agents in Chinese children surveyed by the China multi-center monitoring network for the application of antibacterial agents in children and neonates in 2019 by using World Health Organization (WHO) Access, Watch, Reserve and Not-recommended (AWaRe) and typical anatomical/therapeutic/chemical (ATC) in this study.Methods:The cross-sectional method was adopted.A multi-center cross-sectional survey was conducted on one day from September to December 2019.The information of all inpatients taking antibiotics was uploaded to the network-based data collection system (https: //garpec-31.mobilemd.cn/login.aspx? relogin=true). This study covered 13 hospitals from 10 provinces and cities in China.All hospitalized children in the Respiratory Department, Infectious Disease Department, General Surgery Department, Pediatric Intensive Care Units, Neonatal Intensive Care Units and Neonatology joined in this survey.The clinically used antibacterial agents were classified by AWaRe and ATC, and the AWaRe and ATC distributions of antibacterial agents prescribed for Chinese children and neonates were described.Results:Of the 2 644 antibiotic prescriptions included from 13 hospitals, 2 134 (80.71%) were for children and 510 (19.29%) were for neonates.Of all antibiotic prescriptions, there were 368 (13.92%) Access antibiotics prescriptions, 1 973 (74.62%) Watch prescriptions, 60 (2.27%) Reserve prescriptions and 243 (9.19%) Not-recommended prescriptions.The top-five antibiotics prescribed for children and neonates were third-generation cephalosporins (1 056, 39.94%), macrolides (492, 18.61%), carbapenems (275, 10.40%), beta lactam-beta lactamase inhibitors (246, 9.30%), and second-generation cephalosporins (136, 5.14%). The use ratios of Access, Watch, Reserve and Not-recommended antibiotics in each center ranged from 0 to 30.00%, 36.67% to 97.20%, 0 to 17.02% and 0 to 33.33%, respectively.In 1 360 antibiotic prescriptions for children and neonates with pneumonia, there were 152 (11.18%) Access antibiotics, 1 051 (77.28%) Watch antibiotics, 37 (2.72%) Reserve antibiotics, and 120 (8.82%) Not-recommended antibiotics.The top-five antibiotics prescribed for children with pneumonia were third-generation cephalosporins (522, 38.38%), macrolides (388, 28.53%), beta lactam-beta lactamase inhibitors (141, 10.37%), carbapenems (117, 8.6%) and penicillins (49, 3.60%).Conclusions:Watch antibiotics and broad spectrum antibiotics such as third-generation cephalosporins and macrolides prone to induce resistance are the main antibacterial agents used in Chinese children and neonates with pneumonia.Broad-spectrum antibiotics may be overused in Chinese children and neonates.

Objective:To investigate the changes in peripheral blood and liver-infiltrating natural killer-like B (NKB) cells in patients with primary hepatocellular carcinoma (HCC), and to assess the influence of IL-18 on NKB cells in vitro and the underlying mechanism. Methods:Forty-three HCC patients and 21 normal controls (NC) were enrolled in the study. Peripheral blood samples were collected to isolate plasma and peripheral blood mononuclear cells (PBMC). Intrahepatic lymphocytes (IHL) were isolated from tumor tissues and para-tumor tissues obtained from 16 HCC patients who received surgery. IL-12, IL-18 and IL-18 binding protein (IL-18BP) levels in plasma were measured by enzyme linked immunosorbent assay. The percentages of CD3 -NKp46 + CD19 + NKB cells and IL-18 + NKB cells in PBMC and IHL were analyzed by flow cytometry. Changes in the percentages of NKB cells and IL-18 + NKB cells were measured after stimulating PBMC and IHL with recombinant human IL-18 (1 ng/ml and 10 ng/ml). Changes in IL-18BP levels in the culture supernatants and phosphorylated nuclear factor-κB (NF-κB) in NKB cells were also assessed. Student′s t test, one-way analysis of variance or LSD-t test was used for statistical analysis. Results:There was no significant difference in plasma IL-12 level between HCC patients and NC ( P=0.245). Compared with NC, HCC patients had decreased IL-18 level in plasma [(224.3±58.89) pg/ml vs (327.0±52.27) pg/ml, P<0.000 1], but increased IL-18BP level [(4.421±0.97) ng/ml vs (0.92±0.18) ng/ml, P<0.000 1]. The percentages of peripheral blood NKB cells and IL-18 + NKB cells were lower in HCC patients than in NC [(2.68±1.23)% vs (8.88±2.95)% and (54.42±12.60)% vs (69.74±12.65)%, both P<0.000 1]. The percentage of NKB cells in IHL was reduced in tumor tissues as compared with that in para-tumor tissues [(2.89±0.86)% vs (4.66±1.17)%, P<0.000 1]. Moreover, the percentage of IL-18 + NKB cell was also down-regulated in tumor tissues as compared with that in para-tumor tissues [(51.50±13.18)% vs (62.13±9.24)%, P=0.013]. Recombinant human IL-18 stimulation reduced the IL-18BP level in the culture supernatants ( P<0.05). IL-18 stimulation at 1 ng/ml did not affect NKB cell percentage, IL-18 + NKB cell percentage or NF-κB phosphorylation in NKB cells from PBMC or IHL ( P>0.05), while 10 ng/ml of IL-18 not only elevated NKB cell percentage and IL-18+ NKB cell percentage, but also promoted NF-κB phosphorylation in NKB cells ( P<0.01). Conclusions:In vitro stimulation with high concentration of IL-18 might promote NF-κB phosphorylation by inhibition of IL-18BP expression. This process might play a positive feedback role to induce the activation of NKB cells and IL-18 secretion.

To analyze the clinical data of 2 neonates with Langerhans cell histiocytosis (LCH). The rashes appeared in both cases shortly after birth.Case 1 had both rashes and neonatal sepsis, and no other tissues and organs were involved.After anti-infective treatment, the rashes gradually disappeared.Case 2 had secondary pneumonia, abnormal coagulation function and gastrointestinal bleeding.Both cases were positive for CD1a and S-100 by immunohistochemical staining of skin biopsy, and they were diagnosed as multi system-LCH.The early diagnosis of LCH is particularly important.The detection methods of skin or lymph node biopsy like immunohistochemistry, need to be performed as early as possible.Because the course of the disease is not clear, a close monitoring and follow-up are needed.

Objective:To explore the therapeutic effect of drug ion implantation on viral or bacterial keratitis.Methods:A total of 200 patients with viral keratitis and another 200 patients with bacterial keratitis who were admitted to our hospital for ophthalmic treatment from April 2018 to April 2019 were selected as research subjects, through double-blind, prospective, randomized controlled method patients were divided into two groups, namely the control group given routine treatment, and drug treatment group cases were treated on the basis of the routine treatment with drug iontophoresis technology. The effective rate, visual acuity, length of stay, complication rate, half-year recurrence rate and nursing satisfaction were observed.Results:The treatment effective rate of the experimental group was 100%, the effective rate of vision treatment was 100%, and the nursing satisfaction rate was 93%, which was significantly higher than that of the control group, ( χ2=4.082, P=0.043; χ2=4.082, P=0.043; χ2=59.282, P<0.001). The duration of hospitalization of the patients in the experimental group (8.93±1.69)d, the cost of hospitalization (5627.12±482.34) yuan, the recurrence rate of half a year was 2%, and the incidence of complications was 4%, which was significantly lower than that of the control group ( t=6.522, P=0.000; t=10.985, P<0.001; χ2=5.674, P=0.017; χ2=10.010, P=0.002). Conclusions:Drug ion implantation technology wasbetter than conventional drug treatment in the treatment of viral and bacterial keratitis, and the treatment operation is more convenient, did not produce adverse reactions, is worth promoting in ophthalmic treatment as an optional treatment method .

Objective:To explore the effects of targeted nursing interventions on the quality of life in patients with diabetic retinopathy (DR) after panretinal photocoagulation (PRP) .Methods:Totally 92 DR patients who received PRP in the People's Hospital of Hechi from May 2016 to May 2018 were selected using convenient sampling and divided into control ( n=46) and observation ( n=46) groups. Patients in the control group received routine nursing care postoperatively, while patients in the observation group received targeted nursing interventions on this basis. Patients in both groups received follow-up visits for 3 months. The 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) was used to evaluate the patients' quality of life postoperatively and at the last follow-up visit. Results:There was no statistically significant difference in NEI-VFQ-25 scores between the two groups before intervention ( P>0.05) . Single item scores and total NEI-VFQ-25 scores of the observation group were increased after intervention than before intervention, and the differences were statistically significant ( P<0.05) . There was no statistically significant difference in the score of driving between the observation and control groups after intervention ( P>0.05) . The scores of another 11 items and total NEI-VFQ-25 scores of the observation group were higher than those of the control group, and there were statistically significant differences between the two groups ( P<0.05) . Conclusions:Targeted nursing interventions have significant effects on the quality of life in DR patients after PRP, which can improve their quality of life.

Objective: To analyze the clinical features and factors associated with osteonecrosis in children with systemic lupus erythematosus (SLE). Methods: A retrospective analysis of 15 SLE patients with osteonecrosis in Department of Pediatrics, Renji Hospital Affiliated to School of Medicine of Shanghai Jiaotong University from January 2013 to May 2017 was carried out.Forty-two SLE patients without osteonecrosis were selected as control group.The clinical, laboratory variables and the treatment were compared among SLE patients who were with and without osteonecrosis. Results: (1) Fifteen patients developed osteonecrosis that constituted 8.6% of all the 175 hospitalized SLE patients during the same period.(2) Of 15 patients, 2 patients were male, 13 patients were female, who developed osteonecrosis with an average age of (13.9±2.7) years (range: 10-18 years old). The duration of SLE before the diagnosis of osteonecrosis ranged from 6 days to 141 months, the median was 10 months, and 80.0% (12/15 cases) was diagnosed with osteonecrosis within 2 years of SLE diagnosis.There were 36 joints involved in 15 patients, all of which were detected by magnetic resonance imaging(MRI). The knees were the most commonly involved joints(14/15 cases, 93.3%), followed by hip and ankle joints.(3) Univariate analysis revealed that the level of Triglyceride [(2.080±1.500) mmol/L vs.(1.350±0.945) mmol/L], maximum daily dose of glucocorticoid[(1.25±0.33) mg/kg vs.(1.07±0.22) mg/kg], positive rate of gene associated with glucocorticoid-induced osteonecrosis of femoral head(100.0% vs.54.8%)were significantly higher in SLE with osteonecrosis than those in controls(all P<0.05). While the level of 25(OH)D₃[(21.37±11.29) μg/L vs.(31.45±17.73) μg/L] was significantly lower than that of controls(P<0.05). Multiple factor Logistic regression analysis showed that hypertriglyceridemia and daily maximum dose of glucocorticoid were the risk factors for osteonecrosis. Conclusions Osteonecrosis mostly occurred in children over 10 years old, knee joint involvement is the most common.The high-risk time of osteonecrosis is within 2 years of SLE diagnosis.Hypertriglyceridemia and daily ma-ximum dose of glucocorticoid are risk factors associated with osteonecrosis in children with SLE.

Objective To analyze the relevant risk factors of recurrent wheezing(≥3 attacks) in the first 3 years of life in Shanghai Pujiang.Methods A case-control study was conducted.Two hundred and sixty-two research children were chosen for clinical visits (＜ 3 years old) with wheezing at the Pediatric Department of Shanghai Renji Hospital (South Campus),School of Medicine,Shanghai Jiaotong University,from January to December 2014.According to the frequency of wheezing,the subjects were divided into 75 cases of recurrent wheezing group (≥ 3 attacks),110 cases of occasional wheezing group(1-2 attacks) and 77 cases of no wheezing group.Probable risk factors were inquired by using face-to-face questionnaire.The passive agglutination method was used to detect the Mycoplasma pneumoniae antibody immunoglobulin M (IgM).The indirect immunofluorescence was used to detect the respiratory pathogens.The Western blot was used to detect 20 items of serum allergen.Chi-square test was firstly used for univariate analysis,and then the multivariate stepwise Logistic regression was used to analyze the independent risk factors associated with infant recurrent wheezing.Results A total of 20 factors were found relevant to infant recurrent wheezing by univariate analysis,which included boys (OR =4.030,95％ CI:1.937-8.388),personal atopy (OR =13.125,95％ CI:5.951-28.946),allergic dermatitis (OR =9.833,95％ CI:4.663-20.737),allergic rhinitis (OR =40.327,95％ CI:5.300-306.842),like rubbing eyes or nose(OR =6.487,95％ CI:3.190-13.191),food allergy (OR =6.689,95 ％ CI:1.860-24.051),premature birth (OR =3.795,95 ％ CI:1.001-14.385),low birth weight (OR =9.075,95％ CI:1.106-74.450),parental atopy (OR =10.667,95％ CI:4.824-23.587),parental allergic dermatitis (OR =8.072,95 ％ CI:2.634-24.734),parental allergic rhinitis (OR =6.524,95 ％ CI:2.920-14.577),parental allergic conjunctivitis (OR =1.087,95％ CI:1.017-1.162),parental asthma history (OR =1.119,95％ CI:1.035-1.210),colds ＞ 6 times (OR =9.111,95％ CI:3.970-20.909),history of bronchopneumonia(OR =7.554,95％ CI:3.588-15.903),age at first time use of antibiotics less than 6 months (OR =2.388,95％ CI:1.129-5.052),exposure to cigarette smoking (OR =1.922,95 ％ CI:1.004-3.681),maternal passive smoking during pregnancy (OR =2.508,95 ％ CI:1.298-4.848),living close to wood stove (OR =3.342,95 ％ CI:1.427-7.827) and positive results of inhaled allergens (OR =1.821,95 ％ CI:1.420-2.336).Keeping cats was the protective factor(OR =0.922,95％ CI:0.864-0.984).The forward Logistic regression analysis showed that personal atopy (OR =10.278,95 ％ CI:2.503-42.202),like rubbing eyes or nose (OR =1 0.316,95 ％ CI:2.722-39.101),food allergy (OR =10.370,95％ CI:1.248-86.145),parental atopy (OR =5.402,95％ CI:1.340-21.778),colds ＞ 6 times (OR =7.048,95 ％ CI:1.688-29.423),history of bronchopneumonia (OR =7.876,95 ％ CI:2.040-30.407) and maternaal passive smoking (OR =3.696,95 ％ CI:1.013-13.494) during pregnancy were the independent risk factors of infants recurrent wheezing.Conclusion Personal atopy,like rubbing eyes or nose,food allergy,parental atopy,colds ＞ 6 times,history of bronchopneumonia,maternal passive smoking are the independent risk factors of recurrent wheezing in infants less than 3 years old.