Objective To explore the effect of influenza vaccination on the prevention of respiratory tract infection in preschool children. Methods The clinical data of 400 preschool children (1-6 years old) who were diagnosed with respiratory tract infection for the first time in department of pediatrics of Xi'an Third Hospital and second department of respiratory medicine of Xi'an Children's Hospital were retrospectively analyzed from January 2023 to December 2023, including acute bronchitis, upper respiratory tract infection and pneumonia. According to the actual influenza vaccination status, the patients were divided into vaccination group (n=210) and non-vaccination group (n=190). The incidence of respiratory tract infection was compared between both groups. The fever duration, average course of disease, hospitalization rate, clinical symptoms scores (fever, cough, nasal congestion, sore throat), inflammation indicators [C-reactive protein (CRP), white blood cell count (WBC), neutrophil percentage (NE%)] and recurrence rate after 6 months of follow-up were compared. Results The incidence of respiratory tract infection in the vaccination group was significantly lower than that in the non-vaccination group (21.43% vs 43.16%, P<0.05), and the hospitalization rate was significantly lower compared with that in the non-vaccination group (P<0.05). The scores of fever, cough, nasal congestion and sore throat were lower in the vaccination group than those in the non-vaccination group (P<0.05), and the CRP, WBC and NE% were significantly lower compared to the non-vaccination group (P<0.05). After 6 months of follow-up, the recurrence rate in the vaccination group was 11.11% (5/45), which was significantly lower than 26.83% (22/82) in the non-vaccination group (χ²=0.038, P=4.288<0.05). Conclusion Influenza vaccination can effectively reduce the incidence of respiratory tract infection in preschool children, relieve the symptoms and shorten the disease course after infection. Its preventive effect on influenza is particularly significant, suggesting the importance of strengthening influenza vaccination in preschool children.

Objective:To understand the impact of diet on glycemic control in community-managed patients with type 2 diabetes mellitus (T2DM) and provide evidence for implementing prevention strategies and measures for diabetes patients.Methods:Eight communities were randomly selected from Changshu and Wuhan in 2015, and T2DM patients managed in the community were selected to conduct questionnaire surveys, physical measurements, and blood glucose testing. Factor analysis was used to obtain dietary patterns. A binary logistic regression model was used to analyze the factors affecting glycemic control.Results:Finally, 1 818 T2DM patients were included, and the control rate of FPG was 57.59% (95% CI: 55.30%-59.86%), and the control rate of 2 h postprandial blood glucose (2 h PBG) was 24.90% (95% CI: 22.93%- 26.91%). Five dietary patterns were obtained by factor analysis: animal food pattern, fruit-aquatic products-potato patterns, vegetable-grain pattern, egg-milk-bean pattern, and oil-salt patterns. No-conditional multivariate logistic regression analysis showed that after adjusting for confounding factors, the reduced probability of FPG control was related to animal food pattern ( OR=0.71, 95% CI: 0.52-0.98) and fruit-aquatic products-potato patterns ( OR=0.71, 95% CI: 0.51-0.97). The decrease in the 2 h PBG control probability was related to fruit-aquatic products-potato patterns ( OR=0.60, 95% CI: 0.40-0.90). The increased probability of FPG and 2 h postprandial glucose control were both related to vegetable-grain pattern ( OR=1.41, 95% CI: 1.03-1.94; OR=1.68, 95% CI: 1.13-2.51) and egg-milk-bean pattern ( OR=1.75, 95% CI: 1.25-2.46; OR=1.56, 95% CI: 1.00-2.42). Compared with the Q4 group of egg-milk-bean pattern, the FPG control rate of the combination of "fruit-aquatic products-potato pattern ( Q4 group), vegetable-grain pattern ( Q2 group), egg-milk-bean pattern ( Q3 group)" was higher ( OR=6.79, 95% CI: 1.15-40.23, P=0.035). Compared with the Q4 group of vegetable-grain pattern, the combination of "fruit-aquatic products-potato pattern ( Q4 group), vegetable-grain pattern ( Q3 group), egg-milk-bean pattern ( Q2 group), oil-salt pattern ( Q2 group)" had higher control rate of 2 h PBG ( OR=12.78, 95% CI: 1.26-130.05, P=0.031). Conclusions:A proper combination of dietary patterns and dietary patterns are more conducive to the control of FPG and 2 h PBG in T2DM patients managed in the communities of Wuhan and Changshu. Patient nutrition education should be strengthened, and the food-matching ability of patients should be improved.

Objective:To describe the prevalence of food allergy among children aged 0-5 years in China and to explore related influencing factors.Methods:Multistage stratified random sampling method was used to collect data from 275 surveillance sites of the China National Nutrition and Health Survey of Chinese children and lactating mothers programs in 31 provinces (autonomous regions and municipalities) of China in 2016-2017. A total of 70 107 participants aged 0-5 years were included in this study. The study collected information of participants' demographic characteristics and food allergies by face-to-face questionnaire. The prevalence of food allergy was analyzed, using the complex data weighting method. The logistic regression models were used to analyze the influencing factors related to food allergy.Results:The overall prevalence of self-reported food allergy among children aged 0-5 years was 4.81%. Prevalence rates in infants aged 0-5 months, and 6-23 months and preschool children aged 2-5 years were 0.81%, 4.68% and 5.26%, respectively. The results of logistic analysis showed that there was a significantly positive correlation between factors including children from 6 months to 5 years old, urban area, southwest area, first-born, mothers with college education or above, and the prevalence of food allergy in children. Shrimp, poultry eggs, crab shellfish, fruit, milk and fish appeared the common allergic foods in children aged 0-5 years, with prevalence rates of self-reported food allergy as 1.55%, 1.25%, 0.99%, 0.97%, 0.87% and 0.86%, respectively. The proportion of single food allergy in children with allergies was 69.85%.Conclusions:Among children aged 0-5 years, the prevalence of self-reported food allergy increases with age, in China. Foods that is prone to allergies include fish, shrimp, crab, shellfish, poultry eggs, milk and fruits, etc. Most allergies were only caused by single food in children, under observation.

Objective To investigate the regulatory effects of exosome microRNA-3614-5p(miR-3614-5p)derived from mesenchymal stem cells on the progression of preeclampsia(PE)in model rats and its related mechanisms.Methods Thirty-six SD rats(24 females and 12 males)were housed in cages at a female-to-male ratio of 2∶1 for natural conception.Twenty-four pregnant rats were randomly divided into sham group(sham group),PE model group(PE group)and exosome miR-3614-5p group(PE+exo group),with 8 rats in each group.The PE model was established by subcutaneous injection of 100 mg/kg NG-nitro-L-arginine methyl ester in PE group.PE model was constructed in PE+exo group.Meanwhile,160 μ g/ml exosome suspension(0.5 ml/individual/day)was intraperitoneally injected on the 14th day for 6 consecutive days,and the experiment lasted for 21 days.Sham group was given an equal amount of normal saline.Blood pressure and urinary protein concentration were measured on days 0,7,14 and 21 of pregnancy.The levels of miR-3614-5p,B lymphoblastoma-2(Bcl-2)and Bcl-associated X protein(Bax)mRNA were detected by RT-qPCR.The activity of Caspase-3,the levels of reactive oxygen species(ROS)and the content of malondialdehyde(MDA),glutathione(GSH)and ferrous ion(Fe2+)were detected by ELISA.Western blot was used to analyze the protein levels of the iron death-related protein glutathione peroxidase 4(GPx4)and solute carrier family 7 member 11(SLC7A11).Results Compared with the sham group,the expression of miR-3614-5p in the placental tissues(0.43±0.05 vs 1.01±0.07)and peripheral blood(0.51±0.07 vs 1.01±0.12)of rats in the PE group was down-regulated,with significant differences(t=19.070,10.180,all P＜0.01).Compared with supernatant liquid phase,miR-3614-5p in exosomes derived from MSCs was enriched.Compared with sham group,the diastolic blood pressure(175.43±6.02 mmHg vs 113.26±5.11 mmHg),systolic blood pressure(123.57±5.63 mmHg vs 82.63±5.26 mmHg)and urinary protein content(175.48±13.21 mg/ml vs 67.65±5.76 mg/ml)of rats in PE group were increased on the 21st day with statistical significante between groups(t=22.606,16.440,23.168,all P＜0.01).Compared with PE group,diastolic blood pressure(124.57±5.33 mmHg vs 175.43±6.02 mmHg),systolic blood pressure(89.76±3.88 mmHg vs 123.57±5.63 mmHg)and urinary protein content(97.69±7.23 mg/ml vs 175.48±13.21 mg/ml)in PE+exo group were decreased,and the differences between groups were significant(t=18.493,13.557,16.713,all P＜0.01).Compared with sham group,Caspase-3 activity(238.56％±13.22％vs 100.12％±5.93％),Bax level(3.18±0.71 vs 1.01±0.11),ROS level(387.65％±25.98％vs 100.51％±5.89％),MDA content(33.21±3.17 nmol/mg vs 14.83±2.69 nmol/mg)and Fe2+concentration(38.77±6.53 nmol/ml vs 17.51±3.15 nmol/ml)in placenta tissue of PE group were increased,while Bcl-2 level(0.47±0.08 vs 1.01±0.12),GSH content(4.12±1.22 nmol/mg vs 9.76±0.93 nmol/mg),GPX4 protein(0.48±0.06 vs 1.01±0.24)and SLC7A11 protein(0.51±0.11 vs 1.01±0.11)levels were decreased(t=6.459～32.863,all P＜0.01);Caspase-3 activity(117.35％±8.67％vs 238.56％±13.22％),Bax level(1.13±0.45 vs 3.18±0.71),ROS level(128.73％±14.37％vs 387.65％±25.98％),MDA content(18.13±3.89 nmol/mg vs 33.21±3.17 nmol/mg)and Fe2+concentration(19.05±3.45 nmol/ml vs 38.77±6.53 nmol/ml)in placental tissues of PE+exo group were decreased,while Bcl-2 level(1.04±0.11 vs 0.47±0.08),GSH content(7.86±1.07 nmol/mg vs 4.12±1.22 nmol/mg),GPX4 protein(0.98±0.14 vs 0.48±0.06)and SLC7A11 protein(1.11±0.09 vs 0.51±0.11)levels were increased compared with PE group,with significant differences between groups(t=6.093～29.633,all P＜0.01).Conclusion In the placental tissues and peripheral blood of PE rats,miR-3614-5p was down-regulated.Exosomes overexpressing miR-3614-5p derived from MSCs suppressed PE progression in rats by inhibiting ferroptosis.These results suggested that exosomes miR-3614-5p derived from MSCs may be a novel potential biomarker for PE treatment.

Objective The long-term epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) in Huai’an, Jiangsu were analyzed to provide scientific evidence for the prevention of HFMD. Methods The data of HFMD reports, etiological diagnosis and in Huai’an from 2009 to 2022 were described and analyzed. Results A total of 78 535 cases were reported from 2009 to 2022 , with 14-year average annual incidence rate of 114.71/100 000. Before 2020, the incidence rate of HFMD in Huai’an showed the epidemic intensity increased every other year on the whole, and the average annual incidence rate during the COVID-19 pandemic (2020-2022) (55.69/100 000) was significantly lower than that in previous years (2009-2019) (129.95/100 000). The joinpoint regression analysis showed that the best fitting model from 2009 to 2022 had no joinpoints, APC=AAPC=-1.24%. The overall trend showed a monotonously decreasing trend, but the trend was not statistically significant. The male-to-female distribution ratio was 1.53:1, and the age distribution was mainly under 5 years old, especially in scattered children. The epidemic season was from April to July. The results of etiological surveillance showed that the co-epidemic of Coxsackievirus A16 (CV-A16) and Enterovirus A71 (EV-A71) during the early stages had changed to the co-epidemic of CV-A16 and CV-A6 in the current period. Conclusion The burden of HFMD in Huai’an was large, and the epidemic intensity increased every other year was affected by the COVID-19 pandemic. The epidemiological features after the COVID-19 pandemic should be further monitored.

Objective To evaluate the efficacy and safety of Huanglian Wendan Decoction (黄连温胆汤, HLWDD) alone or combined with western medicine in treating insomnia caused by phlegm-heat internal disturbance in recent 10 years. Methods The randomized controlled trials of HLWDD alone or combined with western medicine in treating insomnia caused by phlegm-heat internal disturbance from January 1, 2012 to April 1, 2022 were searched in China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, China BioMedical Literature Database (CBM), PubMed, Web of Science, Embase, and Cochrane Library databases. After being screening, the included literature was analyzed to evaluate the effective rate, Pittsburgh Sleep Quality Index (PSQI) score, traditional Chinese medicine (TCM) syndrome score, and adverse reactions of HLWDD on insomnia caused by phlegm-heat internal disturbance. The subgroup analyzed the effect of HLWDD after different treatment courses, and compared the therapeutic effects of HLWDD alone and HLWDD combined with western medicine. Results Twenty-seven randomized controlled trials were finally included, with a total of 2 395 patients. The results of the meta-analysis showed that the curative effect of HLWDD alone or combined with the western medicine group was better than that of the western medicine group [RR = 1.14, 95% CI (1.06, 1.22), P = 0.000]. The PSQI score [SMD = – 0.31, 95% CI (– 0.42, – 0.20), P = 0.000], TCM syndrome score [SMD = – 0.40, 95% CI (– 0.67, – 0.12), P = 0.005], and adverse reaction rate [RR = 0.21, 95% CI (0.15, 0.29), P = 0.000] of HLWDD alone or combined with western medicine group were significantly reduced compared with the western medicine group. The subgroup’s analysis showed that the curative effect of HLWDD alone or combined with western medicine group of 4 weeks treatment course was better than that of the western medicine group [RR = 1.14, 95% CI (1.03, 1.26), P < 0.05]. The TCM syndrome score of HLWDD alone or combined with the western medicine group of 4 weeks treatment course decreased more obviously than that of the western medicine group [SMD = – 0.60, 95% CI (– 0.96, – 0.25), P < 0.05]. There were no significant differences between HLWDD alone or combined with western medicine group and western medicine group with different treatment courses based on PSQI score and adverse reaction rate. Based on the effective rate, the comparison between the HLWDD alone group and the western medicine group [RR = 1.09, 95% CI (1.00, – 1.20) P < 0.05], and between the HLWDD combined with western medicine group and the western medicine group [RR = 1.15, 95% CI (1.03, 1.29), P < 0.05] was the same. PSQI score [SMD = – 0.44, 95% CI (– 0.59, – 0.30), P < 0.05] and TCM syndrome score [SMD = – 1.10, 95% CI (– 1.59, – 0.61), P < 0.05] of HLWDD combined with western medicine group were significantly lower than those of the western medicine group. There were no significant differences of adverse reaction rate between HLWDD alone group [RR = 0.08, 95% CI (0.04, 0.17), P < 0.05] and HLWDD combined with western medicine group [RR = 0.36, 95% CI (0.24, 0.53), P < 0.05]. Conclusion HLWDD alone or combined with western medicine is an effective treatment for insomnia caused by phlegm-heat internal disturbance, which has a high effective rate, significantly reduced PSQI score and TCM syndrome score, and favorable safety. The best course of treatment is 4 weeks.

Objective:To investigate the efficacy and safety of programmed death-1 (PD1) inhibitor combined with transcatheter arterial chemoembolization (TACE) in the treatment of huge primary liver cancer.Methods:From June 2016 to December 2019, the clinical data of 31 patients with huge primary liver cancer enrolled in the Central Hospital of Lishui were retrospectively collected and analyzed. The tumor size ranged from 10.1 to 18.8 cm, with an average of (14.2±2.3) cm. The patients were divided into TACE group (TACE treatment, 18 cases) and combined group (one week after TACE, patients receiving a dose of 200 mg PD1 inhibitor administration every 21 days, 13 cases), according to whether patients receiving PD1 inhibitors. The patients were followed up. The disease control rate (DCR) were compared between the two groups using Mann-Whitney U test. The median overall survival (OS) and progression free survival (PFS) were calculated by Kaplan-Meier method. Results:The DCR in combined group (53.8%, 7/13) was higher than that in TACE group (22.2%, 4/18), and the difference was statistically significant ( Z=-2.13, P=0.04). The median PFS (5.0 months) in combined group was longer than that in TACE group (3.0 months), the difference was statistically significant (χ2=4.39, P=0.04). The median OS (15 months) in combined group was longer than that in control group (9 months), and the difference was statistically significant (χ2=5.51, P=0.02). Conclusion:The combine PD1 inhibitors with TACE is an effective and safe therapy for huge primary liver cancer.

【Objective】 To investigate the diagnostic value of neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte (MLR), and lymphocyte (LYM) count in children with infectious mononucleosis (IM). 【Methods】 Clinical and laboratory data of 134 IM children hospitalized between September 2017 and March 2020 were collected. A total of 60 healthy children during the same period were selected as the control group. The subjects’ NLR, MLR, and LYM were calculated according to the results of peripheral blood. The values of NLR, MLR, and LYM in diagnosing and predicting IM were analyzed with ROC. 【Results】 The MLR and LYM values of IM children were significantly higher than those of the control group (P<0.01), while the NLR values of the two groups were not statistically significant (P>0.05). ROC results showed that the area under the ROC curve (AUC) of NLR was 0.397, AUC of MLR was 0.648, and LYM's AUC was 0.680. The ROC curve AUC of MLR+LYM was 0.878, the optimal threshold was 0.59, the sensitivity was 82.09%, and the specificity was 85.00%. 【Conclusion】 MLR and LYM are independent biomarkers for the prediction of IM in children.

OBJECTIVE: To assess the value of non-invasive prenatal testing (NIPT) for the diagnosis of fetal chromosomal aneuploidies among women with advanced gestational age. METHODS: 14 047 pregnant women have voluntarily accepted the NIPT test. The results of NIPT and amniocytic karyotyping analysis were compared, and the outcome of pregnancy was followed up. RESULTS: NIPT has identified 104 cases with a high risk for trisomies 21, 18 and 13, and 44 cases with a high risk for sex chromosome abnormalities. After genetic consultation, 87 of 104 cases have accepted amniocyte chromosomal karyotyping. 63 cases of fetal chromosome abnormality were confirmed, including 46 cases of 21 trisomy, 11 cases of 18 trisomy and 6 cases of 13 trisomy. The positive predictive value was 83.64% (46/55), 61.11% (11/18), and 42.86% (6/14), the specificity was 99.93%, 99.95%, 99.94%, and the sensitivity was 100%. Among the 44 cases, 34 received amniocytic chromosomal karyotyping analysis, 11 cases were confirmed, the positive predictive value was only 32.35%. No aneuploidy was found in the low-risk cases. The negative predictive value was 100%. CONCLUSION As a prenatal screening method for women with advanced gestational age, NIPT has the highest positive predictive value for trisomy 21 and trisomy 18, but a lower positive predictive value for sex chromosome abnormalities. NIPT has a very low rate of missed diagnosis of trisomies 21, 18 and 13, which can significantly reduce the number of women undergoing invasive prenatal diagnosis.

Cardiopulmonary resuscitation (CPR) training plays an important role in improving the survival rate of patients with out-of-hospital cardiac arrest, and attention should be paid to the knowledge education and skill training of CPR for the public. This article reviews the current situation of CPR training at home and abroad, and puts forward suggestions for CPR training in China, particularly emphasizes that CPR training should be included in the compulsory education and that general practitioners should play a leading role in public CPR training.