OBJECTIVE: To study the clinical features of coronavirus disease 2019 (COVID-19) in children aged <18 years. METHODS: A retrospective analysis was performed from the medical data of 23 children, aged from 3 months to 17 years and 8 months, who were diagnosed with COVID-19 in Jiangxi, China from January 21 to February 29, 2020. RESULTS: Of the 23 children with COVID-19, 17 had family aggregation. Three children (13%) had asymptomatic infection, 6 (26%) had mild type, and 14 (61%) had common type. Among these 23 children, 16 (70%) had fever, 11 (48%) had cough, 8 (35%) had fever and cough, and 8 (35%) had wet rales in the lungs. The period from disease onset or the first nucleic acid-positive detection of SARS-CoV-2 to the virus nucleic acid negative conversion was 6-24 days (median 12 days). Of the 23 children, 3 had a reduction in total leukocyte count, 2 had a reduction in lymphocytes, 2 had an increase in C-reactive protein, and 2 had an increase in D-dimer. Abnormal pulmonary CT findings were observed in 12 children, among whom 9 had patchy ground-glass opacities in both lungs. All 23 children received antiviral therapy and were recovered. CONCLUSIONS COVID-19 in children aged <18 years often occurs with family aggregation, with no specific clinical manifestation and laboratory examination results. Most of these children have mild symptoms and a good prognosis. Epidemiological history is of particular importance in the diagnosis of COVID-19 in children aged <18 years.
Adolescent ; Betacoronavirus ; Child ; Child, Preschool ; China ; Coronavirus Infections ; Humans ; Infant ; Pandemics ; Pneumonia, Viral ; Retrospective Studies

Objective: To calculate the number of pregnant women who receive standardized prevention of mother-to-child transmission (PMTCT) services for HIV annually. Methods: HIV-positive pregnant women in six counties of Liangshan Prefecture in 2017 were selected as study subjects. The entire process, from when the subjects first received the PMTCT of HIV services to the end, was divided into four stages, which were further divided into 25 phases. The equivalent coefficient was used to indicate the weight of workload in each phase. Seven experts were invited to score the equivalent coefficient; the number of pregnant women who received standardized services to prevent the transmission of HIV was calculated. Results: A total of 663 HIV-positive pregnant women were registered in six Liangshan Prefecture counties in 2017. This figure was converted into 7,780 person-months devoted to HIV-positive pregnant women, with 260 person-months (3.34%) spent on the first antenatal care, 1,510 person-months (19.41%) during pregnancy, 378 person-months (4.86%) on delivery, and 5,632 person-months (72.39%) on post-partum period. The equivalent coefficient calculation showed that 314 HIV-positive pregnant women received standardized PMTCT services. Conclusion The number of pregnant women receiving standardized services for the PMTCT of HIV can be calculated accurately using the equivalent method to identify the gap between the level of PMTCT of HIV intervention services needed and the actual workload.
Anti-HIV Agents/therapeutic use* ; Female ; HIV Infections/virology* ; Humans ; Infectious Disease Transmission, Vertical/prevention & control* ; Pregnancy ; Pregnant Women

Adolescent ; Adult ; Child ; Decision Trees ; Female ; HIV Infections ; economics ; transmission ; Humans ; Infectious Disease Transmission, Vertical ; economics ; prevention & control ; Kenya ; Middle Aged ; Mothers ; South Africa ; Vietnam ; Young Adult

OBJECTIVE: To explore the clinical effect of acupuncture and the potential effect mechanism in patients with premature ovarian failure. METHODS: A total of 104 patients with premature ovarian failure were randomized into an acupuncture group and a western medication group, 52 cases in each one. In the western medication group, the conjugated estrogens tablets were prescribed for oral administration, 0.625 mg each time, once a day, consecutively for 21 days. On the 16th day of medication with conjugated estrogens tablets, the oral administration of medroxyprogesterone acetate tablets were supplemented, 10 mg each time, once a day, consecutively for 5 days, and then, these two kinds of western medication were discontinued for 1 week. A total of 3 cycles were required in treatment with 28 days as an artificial cycle. In the acupuncture group, acupuncture was applied. Two groups of acupoints were selected. The first group of acupoints were stimulated before ovulation and the acupoints were Guanyuan (CV 4), Guilai (ST 29), Taichong (LR 3), Taixi (KI 3), Xuehai (SP 10), Sanyinjiao (SP 6), Zigong (EX-CA 1), Yinlingquan (SP 9), Zusanli (ST 36), Shuidao (ST 28), Dahe (KI 12) and Tianshu (ST 25). The second group of acupoints were stimulated after ovulation and the acupoints included Ciliao (BL 32), Shiqizhui (EX-B 8), Ganshu (BL 18), Shenshu (BL 23), Geshu (BL 17) and Pishu (BL 20). The therapeutic effect was observed and compared in the patients between the two groups, as well as the expressions of interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) and the levels of serum luteinizing hormone (LH), follicule stimulating hormone (FSH) and estradiol (E) before and after treatment. RESULTS: The total effective rate was 90.4% (47/52) in the acupuncture group, higher than 67.3% (35/62) in the western medication group (<0.05). After treatment, the expressions of IFN-γ and TNF-α in the acupuncture group were obviously lower than the western medication group (<0.05). Except for serum LH after treatment, at the end of treatment and in 30 days and 90 days after treatment, the levels of serum E in the acupuncture group were higher obviously than the western medication group and the levels of serum LH and FSH were lower obviously than the western medication group (all <0.05). CONCLUSION Acupuncture promotes the regular menstruation, effectively regulates the levels of serum LH, FSH and E and improves the pituitary gland and the ovary endocrine in the patients with premature ovarian failure. Such effect may be related to the the improvements in the expressions of IFN-γ and TNF-α, the inhibition of the apoptosis of ovarian granulosa cells, the recovery of ovarian function and the enhancement of reserve capacity.
Acupuncture Points ; Acupuncture Therapy ; Female ; Humans ; Interferon-gamma ; blood ; Primary Ovarian Insufficiency ; blood ; therapy ; Tumor Necrosis Factor-alpha ; blood

Objective:To investigate the effect of bedside ultrasound in measuring the gastric residual volume in postoperative patients with rheumatic heart disease complicated with cachexia with enteral nutrition support.Method:From June 2015 to May 2017,60 patients with rheumatic heart disease complicated with cachexia who admitted in ICU were randomly divided into two groups,group A (routine enteral nutrition plan plus ultrasound monitoring GRV)and group B (routine enteral nutrition plan plus withdraw every 4h to monitor the GRV),to guide the implementation of enteral nutrition.Results:There was significant difference in Hb,TP and ALB levels between the two groups (P ＜0.05).The nutritional status of group A was better than that of group B.The incidence of gastric retention and pulmonary infection in group A was significant lower than group B (P ＜0.05).The length of target feeding time and ICU stay had a statistically difference in group A and group B [(3.02 ± 0.78) d vs (4.89 ± 0.69) d,t=2.278,P=0.019] and [(10.41 ± 1.98) d vs (11.39 ± 1.75) d,t=2.384,P=0.015].Conclusion:The application of bedside ultrasound to monitor the gastric residual volume can be an accurate method to guide enteral nutrition in postoperative patients with rheumatic heart disease complicated with cachexia,which can improve the nutrition status,shorten the length of target feeding time and ICU stay and reduce enteral nutrition-related complications.

Objective To investigate the prevalence of main chronic diseases and explore its influencing factors among urban residents in Liaoning Province. Methods Using multistage stratified and cluster random sampling method, 30 953 urban residents of 14 districts were investigated with a standard questionnaire and physical examination. The logistic regression was applied to explore the influencing factors of main chronic diseases. Results The prevalence rate of chronic diseases was 39.25% and the standardized prevalence rate was 32.29%. The top three chronic diseases were hypertension, diabetes mellitus, and dyslipidemia, and the standardized prevalence rates were 21.13%, 9.48% and 5.25%. The results of the logistic regression analysis showed that the three chronic diseases shared older age(OR: 1.266-7.325)and overweight or obesity(OR:1.107-2.982)as the risk factors .In addition, there existed certain interactions among hypertension, diabetes mellitus and dyslipidemia(OR: 2.424-3.121). Conclusion Hypertension, diabetes mellitus and dyslipidemia which shared older age, overweight and obesity as the risk factors are the main chronic diseases to damage the health of urban residents in Liaoning. The corresponding prevention and treatment strategies should be taken based on the key groups and related influencing factors.

Objective To explore the current status of the prenatal care quality and the influencing factors in Hangzhou City. Methods We used sociodemographic characteristics questionnaire and the Chinese version of QPCQ to investigate 383 pregnancy women who were at 36 weeks' gestation or greater by convenient sampling method from September to December in 2016. Results A total of 350 questionnaires were valid. The average age of 350 samples was (29.71±3.67) years old. There were 231 primiparas which accounted for 66.00％. Among them, 196 (56.00％) were satisfied with the prenatal care they received, and 153 (43.70％) think general, and only 1 (0.30％) felt unsatisfied. The score of the Chinese version of QPCQ was 3.61±0.50. The item "My prenatal care professional (s) always answered my questions honestly" had the highest scores of 4.10±0.62, while "My prenatal care professional (s) did things hastily" had the lowest scores of 2.44±0.96 . By multiple linear regression analysis, those people who had more visiting time (β' = 0.21, P<0.01), less waiting time (β' = -0.18, P<0.01) and the cognition of the essentiality of pregnancy school (β' = 0.12, P=0.02) were more likely to give higher regards for the quality of prenatal care. Conclusion Sufficient time scored relative lower in the whole questionnaire. So, hospitals could take efforts to shorten the waiting time by promoting the hospital process optimization, making good use of this period time and other strategies, so as to improve the quality of prenatal care.

BACKGROUNDPropofol is increasingly used during partial support mechanical ventilation such as pressure support ventilation (PSV) in postoperative patients. However, breathing pattern, respiratory drive, and patient-ventilator synchrony are affected by the sedative used and the sedation depth. The present study aimed to evaluate the physiologic effects of varying depths of propofol sedation on respiratory drive and patient-ventilator synchrony during PSV in postoperative patients.

METHODSEight postoperative patients receiving PSV for <24 h were enrolled. Propofol was administered to achieve and maintain a Ramsay score of 4, and the inspiratory pressure support was titrated to obtain a tidal volume (VT) of 6-8 ml/kg. Then, the propofol dose was reduced to achieve and maintain a Ramsay score of 3 and then 2. At each Ramsay level, the patient underwent 30-min trials of PSV. We measured the electrical activity of the diaphragm, flow, airway pressure, neuro-ventilatory efficiency (NVE), and patient-ventilator synchrony.

RESULTSIncreasing the depth of sedation reduced the peak and mean electrical activity of the diaphragm, which suggested a decrease in respiratory drive, while VT remained unchanged. The NVE increased with an increase in the depth of sedation. Minute ventilation and inspiratory duty cycle decreased with an increase in the depth of sedation, but this only achieved statistical significance between Ramsay 2 and both Ramsay 4 and 3 (P < 0.05). The ineffective triggering index increased with increasing sedation depth (9.5 ± 4.0%, 6.7 ± 2.0%, and 4.2 ± 2.1% for Ramsay 4, 3, and 2, respectively) and achieved statistical significance between each pair of depth of sedation (P < 0.05). The depth of sedation did not affect gas exchange.

CONCLUSIONSPropofol inhibits respiratory drive and deteriorates patient-ventilator synchrony to the extent that varies with the depth of sedation. Propofol has less effect on breathing pattern and has no effect on VT and gas exchange in postoperative patients with PSV.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Pressure ; drug effects ; physiology ; Female ; Hemodynamics ; drug effects ; physiology ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Positive-Pressure Respiration ; methods ; Propofol ; therapeutic use ; Prospective Studies ; Respiration, Artificial ; methods ; Tidal Volume ; drug effects ; physiology ; Young Adult

Objective To analysis the clinical efficacy of alteplase com-bined with butylphthalide sodium chloride injection on patients with acute cerebral infarction and its effect on the expression of serum stress factors. Methods A total of 142 patients with acute cerebral infarction were ran-domly divided into treatment group and control group, with 71 cases each.Patients in two groups were all treated with butylphthalide sodium chloride injection100 mL each time, twice a day, with over 6 h interval, injection time was 50-70 min.Alteplase was added in treatment group on the basis of control group, 5 mg alteplase was dissolved in 10 mL 0.9%NaCl for intravenous injection within 10 seconds.The remaining 45 mg was dissolved 0.9% NaCl in 100 mL for intravenous injection within 60 min, the injections were proceeded once a day.The course was 2 weeks of the two groups.The clinical efficacy and the changes of neu-rological function and expression of stress factor of the 2 groups were compared.Results The total effective rate in treatment group was 95.8%, and 83.1% in control group ( P<0.05 ) .Cerebral infarction volume and US National institutes of health stroke scale ( NHISS ) significantly reduced at 1 and 2 weeks after treatment in both groups, Barthel index ( BI) significantly increased ( P<0.05).The improvement in the treatment group was more obvious (P<0.05).Interleukin -6 (IL-6), IL-8, IL-10, C-reaction protein significantly decreased (P<0.05) after 1 and 2 weeks treatment in both groups, treat-ment group obviously decreased( P<0.05).Conclusion Alteplase combined with butylphthalide sodium chloride in-jection could reduce the expression of serum stress factor in patients with acute cerebral infarction, and could control the volume of cerebral infarction and improve the neural function.

OBJECTIVETo investigate the changes of plasma gelsolin level in patients with critical illness and its application in prognostic evaluation.

METHODSNinety six critically ill patients admitted in ICU of Sichuan Provincial People's Hospital from February 2012 to December 2013 were enrolled in the prospective cohort study. Plasma gelsolin levels were detected with enzyme linked immunosorbent assay (ELISA) at admission (d1), d2, d4 and d8 after admission, and also detected in blood samples of 186 healthy subjects as controls. Logistic regression model was used to analyze the relationship between the level of plasma gelsolin and prognosis of patients.

RESULTSThe average levels of plasma gelsolin were significantly lower in critically ill patients than those in control subjects (F=1986.37, P<0.01). There was significant difference in overall level of gelsolin between survival patients and fatal patients (F=16.691, P<0.01). APACHE Ⅱ score was associated with survival outcomes (r=0.489, P=0.009); the APACHE Ⅱ score was significantly higher in fatal patients than that in survival patients (29.5±7.7 vs 22.1±5.7, t=5.375, P<0.01). There was a negative correlation between plasma gelsolin levels and fatal outcomes (r=-0.512, P<0.01). Logistic regression analysis showed that the overall plasma gelsolin levels and the last measured level was a prognostic factor for critically ill patients (P<0.05).

CONCLUSIONPlasma gelsolin levels are correlated with the severity of critically ill patients, and plasma gelsolin can be used as indicator of prognosis.

APACHE ; Case-Control Studies ; Critical Illness ; Enzyme-Linked Immunosorbent Assay ; Gelsolin ; blood ; Humans ; Logistic Models ; Plasma ; Prognosis ; Prospective Studies