ObjectiveTo investigate the current awareness and optimization recommendations on pneumonia with unknown etiology (PUE) surveillance among Shanghai healthcare professionals, and to provide evidence for the improvement of the surveillance system. MethodsIn December 2024, healthcare professional participants from diverse medical and health institutions were randomly selected within each stratum using a stratified cluster sampling method in all 16 districts of Shanghai for questionnaire surveys on their knowledge and suggestions for optimization of the PUE surveillance system. Descriptive statistics analyses, multivariate logistic regressions, and content analyses were used for data analyses. ResultsA total of 385 survey subjects were involved in the study, including 119 professional staffs from disease prevention and control centers and 266 from medical institutions. Those who understood the case definition for PUE correctly accounted for 67.01% (258/385). Multivariate regression model analyses showed that female gender (aOR=2.22, 95%CI: 1.36‒3.66), professionals from disease control institutions (aOR=2.02, 95%CI: 1.12‒3.72), and those who self-assessed as being familiar with the monitoring system (aOR=2.18, 95%CI:1.23‒3.89) had better understanding of the definition. Overall, 89.61% (345/385) of the survey subjects acknowledged the necessity of the surveillance system. Small number of cases meeting the case definition (54.46%, 214/379), insufficient diagnostic awareness (39.84%, 151/379), and lack of incentives for case reporting (29.29%, 111/379) were major problems for the current surveillance system, with variations observed across different types of institutions. Suggested segments for optimizing the surveillance system included monitoring purpose, case definition, form of monitoring and reporting procedure, organization mechanism, and epidemiological investigation and response. ConclusionThe necessity of PUE surveillance is commonly recognized among healthcare workers. However, the existing system falls short in terms of mastery of case definition and overall surveillance adaptability. There is an urgent need for optimization and improvement to enhance the capacity for preventing and controlling emerging and sudden respiratory infectious diseases.

AIM: To evaluate the effects of the myopia prevention and control guidance station(MPCGS)on axial elongation in school-age children.METHODS:This was a prospective cohort study.Students enrolled in Grades 1 to 3 of primary schools in Qingyang District, Chengdu, in the first half of 2022 who completed continuous follow-up from 2022 to 2025 were included in this study. Among them, three schools that implemented the MPCGS in 2023 were assigned to the intervention group, and another three schools in the same district without MPCGS served as the control group. The intervention group received the school-hospital-family integrated model for myopia prevention and control,while the control group only received routine vision screening without such intervention measures.Students were categorized into three groups based on their grade in 2022: Group A(Grade 1), Group B(Grade 2), and Group C(Grade 3). Comparisons were stratified by grade, with independent samples t-tests used for intergroup analyses of annual axial elongation(ΔAL)between the intervention and control groups, and repeated-measures ANOVA(Bonferroni-corrected post-hoc test)used for intervention group comparisons across different time points.RESULTS:Totally 3 404 students were enrolled in this study, including 1 709 in the intervention group(897 males and 812 females, aged 7.64±0.88 y)and 1 695 in the control group(902 males and 793 females, aged 7.75±0.97 y). In the intervention group, there were 537 students in subgroup A(293 males and 244 females, aged 7.08±0.28 y), 721 in subgroup B(369 males and 352 females, aged 8.03±0.29 y), and 451 in subgroup C(235 males and 216 females, aged 9.07±0.30 y). In the control group, there were 559 students in subgroup A(295 males and 264 females, aged 7.05±0.28 y), 497 in subgroup B(269 males and 228 females, aged 8.04±0.30 y), and 639 in subgroup C(338 males and 301 females, aged 9.08±0.30 y). No significant differences were observed between the intervention and control groups within each grade(A, B, and C)at baseline age, sex, SE, AL, ΔSE(2022-2023), and ΔAL(2022-2023)(all P>0.05). During the first intervention year(2023-2024), intergroup comparisons revealed no significant differences in ΔAL between the intervention and control groups within Groups A, B, and C(all P>0.05). During the second intervention year(2024-2025), the intervention group showed significantly lower ΔAL than the control group within Groups A and B(PSymbol|@@0.001 and P=0.017, respectively), while no significant difference in ΔAL was detected in Group C(P=0.419). In the intervention group, there were significant differences in ΔAL at different time points among Groups A, B and C(all P<0.001). Compared with the first year before intervention, the ΔAL of each subgroup significantly decreased in the second year of intervention(all P<0.0167).CONCLUSION:The implementation of the school-hospital-family integrated MPCGS model was associated with slowed axial elongation. This association exhibited a time-dependent cumulative effect and was more pronounced in lower-grade children(grades 1-2).

Objective:To analyze the efficacy of combination of peginterferon α-2b（Peg-IFN α-2b）with nucleos（t）ide analogues（NAs）on antiviral therapy in children with chronic hepatitis B（CHB）and to provide an optimized clinical treatment strategies for CHB children.Methods:A retrospective analysis was conducted on 30 CHB children treated in The First Affiliated Hospital of the Army Medical University（Southwest Hospital）from January 2022 to January 2025 with treatment duration at least 48 weeks. The enrolled children were aged between 2 and 17 years and divided into the NAs combined with Peg-IFN α-2b（NPI）group（n=13）and NAs group（n=17）by their therapy regimens. The characteristics of baseline，week 12，week 24，week 48 and week 96 were compared between groups，as well as the differences in response to biochemical，immune and viral indicators at each observation point. Logistic regression analysis and receiver operating characteristic（ROC）curve analysis were performed to identify factors influencing the HBsAg seroclearance. Results:At baseline of treatment，the proportion of HBeAg positivity in the NPI group and the NAs group was high（76.9% vs 86.6%， χ2=0.679， P=0.628），and the alanine aminotransferase（ALT）and aspartate aminotransferase（AST）in the NPI group were significantly lower than those in the NAs group（ P<0.001）. At 24 weeks，the decrease in HBsAg in the NPI group was also significantly higher than that in the NAs group（ Z=-3.161， P=0.002）. Finally，the cumulative seroclearance rate of HBsAg at 96 weeks in the NPI group was significantly higher than that in the NAs group（46.15% vs 5.88%， χ2=0.679， P=0.025）. Mulitivariate Logistic regression analysis showed that treatment regimen and gender were risk factors affecting the outcome of HBsAg（ P<0.05）. ROC curve analysis showed that the increase in ALT at 12 weeks compared with baseline（AUC=0.857，Cutoff value=3.615 IU/L），the decrease in ALT at 24 weeks（AUC=0.870，Cutoff value=47.85 IU/L），and the decrease in HBsAg at 12 weeks and especially at 24 weeks（AUC=0.885，Cutoff value=0.97log IU/ml）were effective predictors of HBsAg prognosis at 96 weeks. Conclusion:In CHB children，antiviral regimen Peg-IFN α-2b combined with NAs was more effective than NAs alone in improving the HBsAg seroclearance rate of CHB，and the effects in female were better than in male. The decline of HBsAg and the fluctuation of ALT in the early treatment period are valid predictors of HBsAg clearance.

Objective:To investigate the acute effects of persistent high exposure to atmospheric fine particulate matter (PM 2.5) on residents' outpatient visits for respiratory diseases. Methods:We collected daily outpatient records from 92 hospitals in 13 cities across the Beijing-Tianjin-Hebei region, along with daily PM 2.5, nitrogen dioxide (NO 2), and meteorological data from 2013 to 2018. Five persistent high PM 2.5 exposure scenarios were defined in terms of daily mean PM 2.5 concentrations (>75 μg/m 3 and >150 μg/m 3), duration (≥2 days and ≥3 days), and whether or not there was concurrent exposure to high levels of NO 2 (daily mean NO 2 concentration >50 μg/m 3). A two-stage statistical analysis strategy based on a generalized linear model was applied to conduct a time-series analysis to assess the exposure-response relationship between persistent high PM 2.5 exposure scenarios and residents' outpatient visits for a variety of respiratory diseases, and to estimate excess outpatient visits. Results:During the period, M ( Q1, Q3) PM 2.5 and NO 2 concentrations were 61.2 (42.3, 95.1) μg/m 3 and 40.2 (31.4, 54.4) μg/m 3, respectively, and the daily respiratory disease outpatient visits were 57 (52, 66) cases. When compared with non-permanent high PM 2.5 exposure periods, exposure scenarios with PM 2.5 >75 μg/m 3 and lasting for ≥2 days caused an increased risk of outpatient visits for respiratory diseases by 2.10% (95% CI: 1.44%-2.77%), and resulted in 43 787 (95% CI: 30 025-57 757) excess visits; in this scenario, the concurrent exposure to high levels of NO 2 had a greater acute effect on respiratory disease visits than the absence of exposure to high levels of NO 2 ( P<0.001). The risk of respiratory disease visits increased substantially by 4.41% (95% CI: 3.15%-5.68%) when the daily mean PM 2.5 concentration exceeded 150 μg/m 3 for ≥2 days. Subgroup disease analyses showed that scenarios with daily mean PM 2.5 concentrations exceeding 75 μg/m 3 for ≥3 days caused a significant increase in the risk of lower respiratory tract infections, chronic lower respiratory disease, and asthma visits. Conclusions:Sustained persistent high PM 2.5 exposure increases the risk of outpatient visits for various respiratory diseases; concurrent exposure to high concentrations of NO 2 leads to a greater risk of visiting the clinic, suggesting that the prevention and control of PM 2.5 pollution should be synchronized with the control of mobile source emissions, to synergistically manage the compound pollution of PM 2.5 and NO 2 in the atmosphere.

Objective:To study the effects of manual inspection and special equipment inspection for light guiding components of hard endoscope after cleaning and disinfection,so as to provide scientific data and evidence for the application of special inspection equipment of hard endoscope in Central Sterile Supply Department(CSSD).Methods:A total of 100 hard endoscopes after cleaning and disinfection,which were in CSSD of the Fifth Medical Center of Chinese PLA General Hospital during July and August 2024,were selected.Each light guiding components of hard endoscope was respectively inspected by manual method and special functional detector for endoscope(inspection method with equipment).The positive rates of fog,stains and glass shards,and overall failure rate of light guiding components of hard endoscope,as well as the difference with the effect of clinical use,between two kinds of inspection methods were compared.Results:In 100 hard endoscopes,the inspection method with equipment found 2 cases were overall failure,which fog,strains and glass shards were respectively 2,0 and 0.The overall failure rate,and the positive rates of fog,stains and glass shards of the inspection method with equipment were respectively 2%,2%,0 and 0,which all lower than overall failure rate(23%),and the positive rates of fog(17%),stains(2%)and glass shards(4%)of manual inspection.There was significant difference in overall failure rate and positive rat of fog between the two kinds of inspection methods(x2=18.286,11.399,P＜0.05).The overall failure rate that was reflected by clinical users was 3%,which was significant lower than 23%of manual inspection,and the difference of that between two methods was significant(x2=15.959,P＜0.05).Conclusion:The inspection for light guiding components of hard endoscopes after cleaning and disinfection can be carried out by manual inspection and special inspection equipment,and results of special inspection equipment is getting closer the usage effect of clinical users.It has a series of advantages include being intuitive,easy use,high accuracy,convenient observation,and archivable.

Objective:To explore the feasibility of joint screening of the two primary immunodeficiency diseases [severe combined immunodeficiency (SCID) and X-linked agammaglobulinemia(XLA)] and spinal muscular atrophy(SMA) in newborns by multiplex real-time quantitative PCR technology, and to provide evidence for early screening, diagnosis and treatment of children.Methods:Cross-sectional study. From July 2021 to January 2023, a total of 103 240 dry blood spots samples of newborns were collected which were delivered to Neonatal Disease Screening Center of Zhejiang by cold chain transportation. The concentrations of the T cell receptor excision ring (TREC), Kappa deletion of the recombinant excision loop (KREC), and exon 7 deletion of Survival Motor Neuron 1 (SMN1) gene in dry blood spots were simultaneously detected by multiplex real-time fluorescence quantitative PCR, taken ribonuclease P/MRP 30 000 subunits (RPP30) as an internal reference gene. The positive newborns were further diagnosed by other laboratory tests and gene sequencing was taken as gold standard. Children samples from 1 case of SCID, 3 cases of XLA and 2 cases of SMA were used for positive verification. The correlation between detected concentration of TREC/KREC and basic information in newborns were analyzed. The differences among groups for each factor were analyzed.Results:One case of SCID, 2 cases of XLA, 9 cases of SMA and 7 cases of other genetic diseases (4 cases of DiGeorge syndrome, 1 case of trisomy 21 syndrome, 1 case of Noonan syndrome and 1 case of super male syndrome) were identified by multiplex real-time fluorescence quantitative PCR. The positive predictive values of screening neonatal SCID, XLA and SMA were 2.44% (1/41), 2.78% (2/72) and 9/9 respectively. Taking the samples from clinically diagnosed 1 case of SCID, 3 cases of XLA and 2 cases of SMA as positive validation samples, which were all identified. The detected results of TREC/KREC correlated with time of blood collection, sex, weight, gestational age and delivery mode of newborns, whose r values were 0.162/0.187, 0.066/0.032, 0.045/0.042, ?0.015/?0.088 and 0.014/0.068 respectively (all P<0.05). Conclusions:Relying on current neonatal screening platform in Zhejiang, it is feasible to screen jointly two kinds of primary immunodeficiency diseases and spinal muscular atrophy in newborns by multiple real-time fluorescence quantitative PCR technology.

Objective:To investigate the brain iron status in the sensorimotor cortex of patients with chronic low back pain (CLBP) and its relationship with changes in resting-state functional connectivity (RS-FC).Methods:This was a cross-sectional study. Thirty-two patients with CLBP (CLBP group) who were treated at Wuxi People′s Hospital Affiliated to Nanjing Medical University from July 2023 to March 2024 and 30 age-and gender-matched healthy volunteers (control group) were prospectively included. All subjects underwent pain and neuropsychological assessments and head MRI examinations, including conventional sequences, quantitative susceptibility mapping (QSM), and blood oxygen level-dependent (BOLD) functional MRI. QSM values of the sensorimotor cortex and the left middle frontal gyrus, right inferior temporal gyrus, right olfactory cortex, and right posterior cingulate gyrus were extracted using the ANTs toolkit. The bilateral postcentral gyrus and posterior portion of the bilateral precentral gyrus in the sensorimotor cortex were selected as seed points using SPM software to extract the average time series of BOLD signals and evaluate the changes in RS-FC values with other brain regions. Two-sample t-tests were used to compare the differences in QSM values and RS-FC values between the two groups. Pearson correlation analysis was used to analyze the correlation between iron deposition in key brain regions and RS-FC values and clinical scale scores. Results:The QSM values in the posterior portion of the bilateral precentral gyrus and the left postcentral gyrus in the CLBP group were significantly higher than those in the control group ( t=2.17, P=0.009; t=4.44, P<0.001), and the QSM value in the left postcentral gyrus was positively correlated with pain-related scale scores ( P<0.05). Compared with the control group, the QSM values in the left orbital part of the middle frontal gyrus ( t=2.22, P=0.031) and the right inferior temporal gyrus ( t=2.98, P=0.004) were increased, while the QSM values in the right olfactory cortex ( t=2.54, P=0.014) and the right posterior cingulate gyrus ( t=2.70, P=0.009) were decreased in the CLBP group. Compared with the control group, the RS-FC values between the left postcentral gyrus, the posterior part of the bilateral precentral gyrus, and the left superior frontal gyrus were increased in the CLBP group ( P<0.001), the RS-FC value between the right postcentral gyrus and the right precuneus was increased ( P<0.001). The RS-FC of the bilateral motor cortex and the left dorsolateral superior frontal gyrus was positively correlated with the QSM values of the bilateral motor cortex ( r=0.444, P=0.015). Conclusion:Iron deposition in the sensorimotor cortex (posterior portion of the bilateral precentral gyrus and the left postcentral gyrus) is increased in CLBP patients and is correlated with abnormal functional connectivity within and between brain regions.

Objective To study the efficacy and safety of antiviral therapy in the patients with normal ALT chronic hepatitis B(CHB).Methods The clinical data of the patients with normal ALT CHB visiting in this hospital from December 2019 to December 2023 were collected.The patients were divided into the low vi-ral load group(HBV DNA＜2×106 IU/mL,n=76)and high viral load group(HBV DNA≥2×106 IU/mL,n=10).ETV,TDF and TAF were adopted to conduct the single drug antivirus therapy.The basic informa-tion,demographic characteristics,HBV DNA levels in initial treatment and after 12,24,36,48 weeks of treat-ment,estimated glomerular filtration rate(eGFR)were collected.The rate of complete virological response(CVR)at each time point conducted the statistics for evaluating the effect.The drug safety was evaluated by the eGFR level in 48 weeks of treatment.Results The CVR rates in 12,24,36 weeks of treatment in the low viral load group were 81.6％,94.7％,100.0％and 100.0％respectively,which in the high viral load group were 40.0％,80.0％,80.0％and 80.0％respectively.There was no significant change in eGFR level(109.41±170.57)mL·min-1·1.73 m-2 at 48 weeks of treatment compared with baseline(108.47±110.83)mL·min-1·1.73 m-2(P＞0.05).The ALT and creatinine levels during the treatment process in all the patients were not increased.There was no case of drug withdrawal and drug change due to the drug side effects.Conclusion The overall efficacy and safety of ETV,TDF and TAF monotherapy are good in CHB pa-tients with a family history of cirrhosis or liver cancer and normal ALT.The patients with high viral load at baseline are less likely to achieve CVR in 48 weeks of treatment.

OBJECTIVES: To explore the efficacy and adverse reactions of nusinersen combined with risdiplam in the treatment of spinal muscular atrophy (SMA). METHODS: A retrospective analysis was conducted on the clinical data of 10 pediatric SMA patients treated with nusinersen combined with risdiplam at the Children's Medical Center of Xiangya Hospital, Central South University. RESULTS: Among the 10 SMA patients, there were 4 with type I, 4 with type II, and 2 with type III. Nine patients initially received nusinersen monotherapy, while 1 patient received nusinersen combined with risdiplam. The median duration of combination therapy with nusinersen and risdiplam for the 10 patients was 10.5 months (range: 0.5-20.0 months), with 6 patients undergoing combination therapy for more than 6 months, showing improvements in motor and/or respiratory function. The remaining 4 patients had combination treatment durations of 0.5, 1.0, 1.3, and 4.0 months, respectively, with no significant overall improvement. After combined treatment, 5 patients experienced skin hyperpigmentation, 2 had lumbar puncture site pain, 1 experienced vomiting, 1 had increased sputum production, and 1 had reduced total sleep time. All adverse reactions were mild and did not require medical intervention. CONCLUSIONS Nusinersen combined with risdiplam demonstrates efficacy in the treatment of SMA, and no significant adverse reactions have been observed.
Humans ; Oligonucleotides/adverse effects* ; Male ; Female ; Child, Preschool ; Retrospective Studies ; Infant ; Muscular Atrophy, Spinal/drug therapy* ; Drug Therapy, Combination ; Child ; Azo Compounds ; Pyrimidines

OBJECTIVES: To investigate the predictive factors for plastic bronchitis (PB) in children with Mycoplasma pneumoniae pneumonia (MPP) and to establish a nomogram prediction model for PB occurrence. METHODS: A retrospective analysis was conducted on children with MPP hospitalized at The Affiliated Hospital of Xuzhou Medical University from January 2023 to June 2024. The patients were randomly divided into a training set (n=562) and a validation set (n=240) at a ratio of 7:3 using simple random sampling. In the training set, patients were categorized into a PB group (n=70) and a non-PB group (n=492) based on the occurrence of PB. Spearman correlation analysis was performed to exclude collinearity among variables, followed by univariate analysis and LASSO regression to identify predictive factors. A nomogram prediction model for PB in children with MPP was constructed. The discriminative ability of the model was assessed using receiver operating characteristic (ROC) curve analysis, model calibration was evaluated with calibration curves, and clinical utility was appraised through decision curve analysis. RESULTS: Compared with the non-PB group, the PB group exhibited significantly longer disease duration prior to bronchoscopy, prolonged fever duration, higher fever peaks, higher proportions of patients with a family history of allergy and personal allergy history, and a higher proportion of patients with pleural effusion, as well as significantly elevated levels of white blood cell count, neutrophil percentage, C-reactive protein, procalcitonin, fibrinogen, D-dimer, aspartate aminotransferase, alanine aminotransferase, creatine kinase, lactate dehydrogenase, immunoglobulin A, and interleukin-6, along with a significantly lower lymphocyte percentage (all P<0.05). LASSO regression analysis identified pleural effusion, procalcitonin, D-dimer, and lactate dehydrogenase as major predictive factors for PB occurrence in children with MPP. The nomogram model based on these factors demonstrated good discriminative ability (area under the ROC curve: 0.852 in the training set and 0.830 in the validation set), with satisfactory calibration and clinical benefit. CONCLUSIONS The nomogram prediction model based on pleural effusion, procalcitonin, D-dimer, and lactate dehydrogenase provides effective predictive performance for the occurrence of PB in children with MPP.
Humans ; Pneumonia, Mycoplasma/complications* ; Nomograms ; Male ; Female ; Child ; Child, Preschool ; Retrospective Studies ; Bronchitis/etiology* ; Infant ; ROC Curve ; Adolescent