Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

This paper summarized the experience of Professor FANG Dingya in staged treatment of Sjögren's syndrome from the perspective of dryness toxin. It is believed that the cause of Sjögren's syndrome is externally-contracted dryness， consumption of essence and fluid， congenital and acquired essence deficiency， depleted essence and insufficient blood， and the core mechanism is internal accumulation of dryness toxin. The treatment can be divided into three stages， that is dryness toxin transforming into fire-heat， damp-heat and phlegm-stasis， from the perspective of dryness metal qi transformation. It is emphasized to dispel pathogen mainly， to clear and moisten with yin-nourishing medicinals in supplementation， and to treat by stages based on syndrome differentiation. For dryness toxin with fire-heat， it is suggested to moisten dryness， resolve toxins and subdue fire， with self-made Runzao Jiedu Decoction （润燥解毒汤） in modification. For dryness toxin with damp-heat， the method of nourishing yin， clearing heat and draining dampness should be used， and Chunze Decoction （春泽汤） in modification is suggested. For dryness toxin with phlegm-stasis， it is recommended to unblock collaterals， disperse phlegm and dissipate stasis， with self-made Sanyu Xiaotan Decoction （散瘀消痰汤） in modification.

Polymyxin B, which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections, became available in China in Dec. 2017. As dose adjustments are based solely on clinical experience of risk toxicity, treatment failure, and emergence of resistance, there is an urgent clinical need to perform therapeutic drug monitoring (TDM) to optimize the use of polymyxin B. It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use. We report a consensus on TDM guidelines for polymyxin B, as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society. The consensus panel was composed of clinicians, pharmacists, and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations, sample collection, reporting, and explanation of TDM results. The guidelines provide the first-ever consensus on conducting TDM of polymyxin B, and are intended to guide optimal clinical use.
Humans ; Anti-Bacterial Agents/therapeutic use* ; China ; Drug Monitoring/methods* ; Polymyxin B ; Practice Guidelines as Topic

Objective: To understand the current situation of suicidal ideation among middle school students in Taiyuan City and its correlation with exposure to social ecological risk factors, so as to provide a reference basis for exploring the causes of suicidal ideation among middle and high school students and formulating effective preventive measures. Methods: A questionnaire survey was conducted among 2 639 middle school students in urban and rural areas of Taiyuan City by multistage stratified random cluster sampling, including general demography characteristics, social ecological risk factors and suicidal ideation. SPSS 26.0 software was used for Chi squared test and binary Logistic regression analysis. Results: The overall detection rate of suicidal ideation was 24.7 %. There were statistically significant differences in the detection rate of suicidal ideation among middle school students in different gender, grade, family residence, maternal education level, perceived family economic conditions, number of close friends, self-perceived academic burden ( χ 2=38.17, 13.44, 10.77, 8.15, 19.76, 18.95, 59.75, P <0.05). After adjusting the general demography characteristics, the binary Logistic regression showed that moderate and high risk in the individual, family and cultural dimension, and high risk in the school dimension of the social ecology were all positively correlated with suicidal ideation among middle school students ( OR=1.38, 2.28, 1.97, 3.28, 1.48, 2.15, 1.71, P <0.05). Conclusion The suicidal ideation among middle school students is related to individuals, families, and schools in the social ecological microsystem, as well as the cultural environment in the macro system. It is necessary to conduct intervention in suicidal ideation at the individual, family, and school levels, meanwhile, strengthening social and cultural construction to reduce the impact of adverse factors on the mental health among adolescents.

Objective:To investigate the prognosis of severe hyperbilirubinemia in full-term infants who met the exchange transfusion criteria and were treated by blood exchange transfusion and phototherapy.Methods:A total of 168 full-term infants with severe hyperbilirubinemia who met the criteria for exchange transfusion and were hospitalized in the Neonatology Department of seven tertiary hospitals in Hebei Province from June 2017 to December 2018 were retrospectively included. According to the treatment protocol, they were divided into two groups: exchange transfusion group (38 cases) and phototherapy group (130 cases). Two independent sample t-test and Chi-square test were used to compare the clinical manifestations and follow-up results between the two groups. Multivariate logistic regression was used to analyze the risk factors for poor prognosis. Results:Neonatal severe hyperbilirubinemia in the exchange transfusion and phototherapy group were both mainly caused by hemolytic disease [42.1%(16/38) and 29.2%(38/130)], sepsis [28.9%(11/38) and 11.5%(15/130)] and early-onset breastfeeding jaundice [15.8%(6/38) and 11.5%(15/130)]. Total serum bilirubin level on admission in the exchange transfusion group was significantly higher than that in the phototherapy group [(531.7±141.3) vs (440.0±67.4) μmol/L, t=3.870, P<0.001]. Moreover, the percentage of patients with mild, moderate and severe acute bilirubin encephalopathy in the exchange transfusion group were higher than those in the phototherapy group [15.8%(6/38) vs 3.8%(5/130), 7.9%(3/38) vs 0.8%(1/130), 13.2%(5/38) vs 0.0%(0/130); χ2=29.119, P<0.001]. Among the 168 patients, 135 were followed up to 18-36 months of age and 12 showed poor prognosis (developmental retardation or hearing impairment) with four in the exchange transfusion group (12.9%, 4/31) and eight in the phototherapy group (7.7%, 8/104). Multivariate logistic regression analysis showed that for full-term infants with severe hyperbilirubinemia who met the exchange transfusion criteria, phototherapy alone without blood exchange transfusion as well as severe ABE were risk factors for poor prognosis ( OR=14.407, 95% CI: 1.101-88.528, P=0.042; OR=16.561, 95% CI: 4.042-67.850, P<0.001). Conclusions:Full-term infants who have severe hyperbilirubinemia and meet the exchange transfusion criteria should be actively treated with blood exchange transfusion, especially for those with severe ABE, so as to improve the prognosis.

Since microdroplets are able to be generated rapidly in large amount and each droplet can be well controlled as an independent micro-cultivator, droplet microfluidic technology can be potentially used in the culture of microorganisms, and provide the microbial culture with high throughput manner. But its application mostly stays in the laboratory-level building and using for scientific research, and the wide use of droplet microfluidics in microbial technology has been limited by the key problems that the operation for microdroplets needs high technical requirements with wide affecting factors and the difficulties in integration of automatic microdroplet instrumentation. In this study, by realizing and integrating the complicated operations of droplet generation, cultivation, detection, splitting, fusion and sorting, we design a miniaturized, fully automated and high-throughput microbial microdroplet culture system (MMC). The MMC can be widely used in microbial growth curve test, laboratory adaptive evolution, single factor and multi-level analysis of microbial culture, metabolite detection and so on, and provide a powerful instrument platform for customized microbial evolution and screening aiming at efficient strain engineering.
Industrial Development ; Microfluidics

Objective:To explore whether the limit of "before the equal-diameter period" is reasonable in the current criteria for "Diagnosis of Kashin-Beck Disease" (WS/T 207-2010) in children, and to provide basic data and technical support for revision of the criteria for "Diagnosis of Kashin-Beck Disease" (WS/T 207-2010).Methods:In 2018, the historical Kashin-Beck disease (KBD) areas in Heilongjiang Province were selected as the investigation sites. The right-hand X-ray films of all children aged 7-12 years old were taken. According to the different X-ray manifestations of the growth and development of the phalangeal epiphysis, they were divided into five periods: before the equal-diameter period, equal-diameter period, ultra-diameter period, pre-closure period and closure period. Firstly, after stratifying by basic data such as age and gender, the data were standardized and analyzed. Secondly, the detection rates of metaphysis-epiphysis (CRME) in each period were calculated and compared. Finally, based on the mean value of the detection rate of metaphyseal change in Linkou and Fuyu counties of Heilongjiang Province in 1990, the rates of expected detection and missed diagnosis of metaphyseal changes of KBD among investigated children were calculated and compared under the limitation of before the equal-diameter period, before the ultra-diameter period or age range reduction.Results:A total of 5 019 children were investigated. The proportion of children before the equal-diameter period was 53.94% (2 707/5 019), and that of before the ultra-diameter period was 77.92% (3 911/5 019). The results showed that the equal-diameter period mainly appeared in 7-10 years old, and showed a decreasing trend with the increase of age (χ 2trend = 390.10, P<0.05); the ultra-diameter period mainly occurred in 10-12 years old, showing a decreasing trend with the increase of age (χ 2trend = 65.39, P < 0.05); the pre-closure period mainly occurred in 10-12 years old, with an increasing trend with the increase of age (χ 2trend = 51.86, P<0.05); the closure period mainly occurred in 11-12 years old and increased with age (χ 2trend = 7.58, P<0.05). The CRME of children in ultra-diameter period was 14.78% (158/1 069), however CRME did not occur in children with equal-diameter period. Among children before equal-diameter period, before ultar-diameter period and aged 7-10 years old, the expected detection rates of metaphyseal changes of KBD were 5.90%, 8.53% and 7.42%, respectively. The expected missed diagnosis rates of metaphyseal changes of KBD were 5.06%, 2.45% and 3.52%, respectively. Conclusion:In order to improve the rate of expected detection and lower the rate of missed diagnosis of metaphyseal changes of KBD, children in "equal-diameter period" should be included in X-ray diagnosis and disease monitoring of KBD.

Objective:To investigate the expression of microRNA (miR) -26a in human skin fibroblasts during photoaging induced by ultraviolet A (UVA) , and to evaluate the effect of up-or down-regulation of miR-26a expression on the methylation level of the whole genome, the target gene enhancer of zeste homolog 2 (EZH2) and cell aging.Methods:Some human skin fibroblasts were irradiated with 10 J/cm 2 UVA once a day for 7 consecutive days, RNA was extracted on days 0, 3 and 7, and real-time quantitative reverse PCR (RT-PCR) was performed to determine the expression of miR-26a; miR-26a mimics and inhibitors were transfected into fibroblasts to up-or down-regulate the expression of miR-26a respectively, and fluorescence microscopy and RT-PCR were performed to determine the expression of miR-26a and evaluate the transfection efficiency. Some human skin fibroblasts were divided into 6 groups: blank control group receiving no treatment, UVA group treated with UVA irradiation according to the above method, miR-26a mimic group transfected with miR-26a-mimics, UVA+miR-26a mimic group transfected with miR-26a-mimics followed by UVA irradiation, miR-26a inhibitor group transfected with miR-26a inhibitors, UVA+miR-26a inhibitor group transfected with miR-26a inhibitors followed by UVA irradiation. On day 7, cells in each group were collected after the end of UVA irradiation. Then, flow cytometry was performed to detect cell cycle, DNA methylation quantitative detection kit was used to detect the methylation level of whole genome, RT-PCR was conducted to determine the mRNA expression of EZH2 (a histone-lysine N-methyltransferase enzyme) , DNA methyltransferase 1 (DNMT1) and miR-26a, and Western blot analysis was performed to determine the protein expression of EZH2 and DNMT1. Statistical analysis was carried out by using one-way analysis of variance and least significant difference- t test. Results:Compared with the unirradiated control group, the expression of miR-26a gradually increased in the UVA irradiation group over time during the culture, and there was a significant difference in the expression of miR-26a between the two groups after 7 days of UVA irradiation ( t=5.295, P < 0.05) . Strong fluorescence signals were observed in the miR-26a mimic-or miR-26a inhibitor-transfected fibroblasts, suggesting a high transfection efficiency. Flow cytometry showed that the proportion of cells at G1 phase significantly differed among the blank control group, UVA group, miR-26a mimic group, UVA+miR-26a mimic group, miR-26a inhibitor group, and UVA+miR-26a inhibitor group (52.82% ± 2.56%, 78.56% ± 4.34%, 53.63% ± 3.13%, 89.52% ± 4.17%, 54.39% ± 3.86%, 65.34% ± 4.78%, respectively; F=46.728, P < 0.01) , and significantly higher in the UVA group than in the blank control group ( t=8.848, P < 0.01) , higher in the UVA+miR-26a mimic group than in the miR-26a mimic group and UVA group ( t=11.922, 3.154, P < 0.01, < 0.05, respectively) , and higher in the UVA+miR-26a inhibitor group than in the miR-26a-inhibitor group ( t=3.087, P < 0.05) , but significantly lower in the UVA+miR-26a inhibitor group than in the UVA group ( t=3.547, P < 0.05) . Detection of the genome-wide methylation level showed that the methylation level ( A450 value) significantly differed among the above groups (0.676 ± 0.024, 0.323 ± 0.043, 0.506 ± 0.035, 0.169 ± 0.024, 0.602 ± 0.036, 0.422 ± 0.029, respectively, F=97.402, P < 0.01) , and significantly lower in the UVA group than in the blank control group ( P < 0.01) , lower in the UVA+miR-26a mimic group than in the miR-26a mimic group and UVA group (both P < 0.01) , and lower in the UVA+miR-26a inhibitor group than in the miR-26a inhibitor group ( P < 0.01) , but significantly higher in the UVA+miR-26a inhibitor group than in the UVA group ( P < 0.05) . RT-PCR and Western blot analysis showed significant differences in the mRNA and protein expression of EZH2 and DNMT1 respectively among the 6 groups (both P < 0.05) , which were significantly lower in the UVA group than in the blank control group ( P < 0.05) , lower in the UVA+miR-26a mimic group than in the miR-26a mimic group and UVA group (both P < 0.05) , and lower in the UVA+miR-26a inhibitor group than in the miR-26a inhibitor group ( P < 0.05) , but significantly higher in the UVA+miR-26a inhibitor group than in the UVA group ( P < 0.05) . Conclusion:In the UVA irradiation-induced photoaging of skin fibroblasts, miR-26a expression was up-regulated, cellular proliferative activity and genome-wide methylation level decreased; up-regulation of miR-26a expression could down-regulate the expression of its target gene EZH2 and methylation-related gene DNM1, and promote cell photoaging, while down-regulation of miR-26a expression could up-regulate the expression of EZH2 and DNMT1, and inhibit cell photoaging.

Objective:To analyze the willingness of post-exposure prophylaxis (PEP) to prevent HIV transmission and related factors in men who have sex with men (MSM).Methods:Cross sectional survey design was used in this study. After informed consent, MSM aged 18 years or above and having had homosexual anal or oral sex in the past 6 months were recruited through "i WeChat" official account between September and November, 2019.Results:Of 1 517 MSM were surveyed, the proportion of MSM who had ever heard of PEP were 72.5% (1 100/1 517) and 87.9%(1 333/1 517) of the MSM said they would like to use PEP if it is needed.Multivariate logistic regression analysis suggested that aged above 25 year ( OR=1.807, 95% CI: 1.090-2.995), HIV test history ( OR=1.953, 95% CI: 1.171-3.256) and being aware of PEP ( OR=2.163, 95% CI: 1.468-3.186) were the positive factors for PEP use, but an aware of the HIV status of sexual partner was the negative factor for PEP ( OR=0.602, 95% CI: 0.407-0.890). Among MSM who had ever heard of PEP, the positive factors for PEP use included living in Zhejiang ( OR=1.942, 95% CI: 1.097-3.438), aged above 25 years ( OR=2.431, 95% CI: 1.331-4.439), being aware of PEP ( OR=3.714, 95% CI: 1.532-9.007) obtaining information about PEP service from MSM organization/volunteer/health organization. Conclusions:MSM's willingness to use PEP services was relatively high. Age, awareness of PEP related knowledge, and awareness of sexual partner's HIV infection status were the related factors. MSM organization/volunteer/health organization were the main forces for PEP promotion in MSM.

OBJECTIVE： To improve the quality of antitumor drug dispensing in pharmacy intravenous admixture services （PIVAS）， reduce dispensing error and occupational exposure to dispensers by antitumor drugs. METHODS： The composition and functions of automatic injection dispensing system were introduced， and the system was applied in antitumor drug dispensing in PIVAS. Various work indexes were compared 1 month before and after the application of the system. RESULTS： The system included information processing software， equipment control software and drug dispensing machine hardware， and had functions such as automatic counting of medicines， automatic entry into basket， automatic drug dispensing and automatic printing of labels. After applying automatic injection dispensing system， the operation of infusion label printing， basket dividing and dispensing in dispensing process was changed from manual to automatic. It could save human resources， as for each label， the average time of drug dispensing decreased from （33.00±3.31） s to （15.55±1.41） s while no mistakes and damaged label was found. CONCLUSIONS： The application of automatic injection dispensing system achieves automatic operation of antitumor drug dispensing in PIVAS， reduce dispensing error reduces staff’s exposure to antitumor drugs and occupational exposure.