ObjectiveTo analyze the epidemiological and etiological characteristics of a cluster of human metapneumovirus (HMPV) infection in a kindergarten in Gongshu District of Hangzhou City in May 2024, and to provide reference for the prevention and control of similar outbreaks. MethodsAn on-site investigation was conducted using an epidemiological case investigation form. Throat swab specimens collected from cases were screened for 13 respiratory pathogens using real-time fluorescent polymerase chain reaction (PCR). For HMPV nucleic acid positive specimens, the F gene of HMPV was used as the target gene for amplification and sequencing. The sequencing results were then compared with sequences in GenBank database to determine the virus subtypes and perform phylogenetic analyses. ResultsThe outbreak occurred in a kindergarter junior class with a total of 28 preschoolers and 3 teachers and childcare workers. A total of 11 cases (10 preschoolers and 1 teacher) were identified, including 8 male cases and 3 female cases. Clinical manifestations included fever in all 11 cases (100.00%), cough in 8 cases (72.72%), catarrhal symptoms in 4 cases (36.36%), and headache in 3 cases (27.27%). All symptoms were mild, and no severe cases were observed. A total of 11 throat swab samples were collected. Real-time fluorescent PCR test results showed that 3 samples were positive for HMPV nucleic acid, 2 samples were positive for both HMPV and Streptococcus pneumoniae, and 1 sample was positive for both HMPV and rhinovirus. The sequences of the 6 HMPV nucleic acid positive specimens were amplified and analyzed using specific primers, and all were determined to be HMPV subtype A2b. The F gene fragment sequence showed the highest similarity to PV081665.1/Brazil/2024 (99.65%), and also exhibited high similarity to PP683455.1/Indonesia/2021 (99.48%), PV016275.1/Beijing/2024 (99.31%), and PV052230.1/USA/2024 (99.13%). ConclusionThis cluster of acute respiratory tract infection was caused by HMPV subtype A2b, with co-infection of rhinovirus and Streptococcus pneumoniae. The F gene fragment sequences of the HMPV in this outbreak were highly homologous to those of the A2b strains isolated from Brazil, Beijing, Indonesia, and the the United States.

Background Coal workers' pneumoconiosis is a serious occupational disease in China. Exhaled volatile organic compounds (VOCs) can serve as the "breath fingerprint" of internal pathological processes, which provides a theoretical basis for exhaled VOCs to be used as potential non-invasive biomarkers for early diagnosis of coal workers' pneumoconiosis. Objective To screen out the characteristic VOCs and important characteristic VOCs of exhaled air in patients with coal workers' pneumoconiosis, and to explore the potential of these VOCs as biomarkers for early non-invasive diagnosis of the disease. Methods In this study, 27 VOCs in the exhaled breath of 22 patients with stage I coal workers' pneumoconiosis, 77 workers exposed to dust, and 92 healthy controls were quantitatively detected by thermal desorption gas chromatography-mass spectrometry (TD-GC-MS). Substances with P<0.05 in univariate analysis and variable importance projection (VIP) >1 in supervised orthogonal partial least squares discriminant analysis (OPLS-DA) model were selected as the characteristic VOCs for early diagnosis of coal workers' pneumoconiosis. Age was included in the LASSO regression model as a covariate to screen out important characteristic VOCs, and the diagnostic performance was evaluated by receiver operating characteristic (ROC) curve. Spearman correlation was further used to explore the correlation between important characteristic VOCs and clinical lung function indicators. Results Through univariate analysis and OPLS-DA modeling, 8 VOCs were selected, including 2-methylpentane, 3-methylpentane, n-hexane, methylcyclopentane, n-heptane, methylcyclohexane, 4-methyl-2-pentanone, and 2-hexanone, in exhaled breath of patients with coal workers' pneumoconiosis. The concentrations of 4 VOCs, including 3-methylpentane, n-hexane, 4-methyl-2-pentanone, and 2-hexanone, showed a decreasing trend with the increase of dust exposure years. By LASSO regression, the important characteristic VOCs of the coal workers' pneumoconiosis group and the dust exposure group were n-hexane, methylcyclohexane and 4-methyl-2-pentanone, and the important characteristic VOCs of the coal workers' pneumoconiosis group and the healthy group were 2-methyl-pentane and 4-methyl-2-pentanone. The ROC analysis showed that the area under the curve (AUC) of n-hexane, methylcyclohexane, and 4-methyl-2-pentanone were 0.969, 0.909, and 0.956, respectively, and the AUC of combined diagnosis was 0.988 and its Youden index was 0.961, suggesting that these results can serve as a valuable reference for further research on early diagnosis. The Correlation analysis found that there was a positive correlation between n-hexane and lung function indicators in the important characteristic VOCs, indicating that it could indirectly reflect the obstruction of lung function ventilation, further proving that important characteristic VOCs have the potential to monitor lung function decline. Conclusion Three important characteristic VOCs selected in this study have the potential to be used as non-invasive biomarkers for early diagnosis and disease monitoring of coal workers' pneumoconiosis, and are worthy of further study and verification.

Objective To investigate the effect of acupuncture at Hegu(LI4)on neural activity in the visual cortex of healthy volunteers using functional near-infrared spectroscopy(fNIRS).Methods Each healthy volunteer underwent three sets of trials in a resting state:the LI4 group received acupuncture stimulation at the right Hegu(LI4)acupoint;the negative control was the sham acupoint group(SHAM group);and the positive control was the visual stimulation group(VISUAL group).fNIRS was used to simultaneously monitor changes in oxygenated hemoglobin(Oxy-Hb)levels in the vis-ual cortex during various stages of acupuncture or visual tasks,thereby reflecting the activation level of the visual cortex.The entire acupuncture procedure was performed with the subjects' eyes closed.fNIRS recorded the raw optical density values of hemodynamics in the region of interest(ROI)of the visual cortex during each task phase.The relative coefficientβ value for oxygenated hemoglobin was obtained via Matlab analysis,and the coefficient difference Δβ value between the task period and the baseline period was calculated,representing the degree of change in oxygenated hemoglobin content in-duced by the stimulus,which reflected the change in activation level of the visual cortex after acupuncture or visual stimu-lation.A larger Δβ value indicates a higher degree of visual cortex activation.Generalized estimating equations(GEE)were applied to analyze the differences in visual cortex activation levels among the LI4,SHAM,and VISUAL groups.Results In channels 15 and 17 of the striate area and channels 10 and 13 of the extrastriate area,the Δβ values of sub-jects in the LI4 group during the needle manipulation and withdrawal phases were significantly higher than those in the SHAM group(all P＜0.01).When comparing the Δβ values of the LI4 group during the needle manipulation and withdrawal phases with those of the VISUAL group,under the current sample size,the differences were not statistically significant(all P＞0.05).The Δβ values in both the striate and extrastriate areas of the LI4 group peaked during the needle manipulation phase.Conclusion Acupuncture at Hegu(LI4)can effectively activate the visual cortex in healthy volunteers,with the most significant increase in activation observed during the needle manipulation phase.

Signaling lymphocyte activation molecule family 6(SLAMF6)is widely expressed in T,B lymphocytes,NK cells and other immune cells.As a self-binding receptor for homotypic interactions,SLAMF6 is a type Ⅰ transmembrane protein belonging to the immunoglobulin superfamily,composed of the proximal IgC2 domain and distal IgV domain,the extracellular membrane,and three unique tyrosine cytoplasmic signaling motifs.This article summarizes the structure,expression,function and implication for au-toimmunity and tumor immunity of SLAMF6.

Objective To investigate the effect of acupuncture at Hegu(LI4)on neural activity in the visual cortex of healthy volunteers using functional near-infrared spectroscopy(fNIRS).Methods Each healthy volunteer underwent three sets of trials in a resting state:the LI4 group received acupuncture stimulation at the right Hegu(LI4)acupoint;the negative control was the sham acupoint group(SHAM group);and the positive control was the visual stimulation group(VISUAL group).fNIRS was used to simultaneously monitor changes in oxygenated hemoglobin(Oxy-Hb)levels in the vis-ual cortex during various stages of acupuncture or visual tasks,thereby reflecting the activation level of the visual cortex.The entire acupuncture procedure was performed with the subjects' eyes closed.fNIRS recorded the raw optical density values of hemodynamics in the region of interest(ROI)of the visual cortex during each task phase.The relative coefficientβ value for oxygenated hemoglobin was obtained via Matlab analysis,and the coefficient difference Δβ value between the task period and the baseline period was calculated,representing the degree of change in oxygenated hemoglobin content in-duced by the stimulus,which reflected the change in activation level of the visual cortex after acupuncture or visual stimu-lation.A larger Δβ value indicates a higher degree of visual cortex activation.Generalized estimating equations(GEE)were applied to analyze the differences in visual cortex activation levels among the LI4,SHAM,and VISUAL groups.Results In channels 15 and 17 of the striate area and channels 10 and 13 of the extrastriate area,the Δβ values of sub-jects in the LI4 group during the needle manipulation and withdrawal phases were significantly higher than those in the SHAM group(all P＜0.01).When comparing the Δβ values of the LI4 group during the needle manipulation and withdrawal phases with those of the VISUAL group,under the current sample size,the differences were not statistically significant(all P＞0.05).The Δβ values in both the striate and extrastriate areas of the LI4 group peaked during the needle manipulation phase.Conclusion Acupuncture at Hegu(LI4)can effectively activate the visual cortex in healthy volunteers,with the most significant increase in activation observed during the needle manipulation phase.

Type 2 inflammation（T2 inflammation）is an immune response mediated by Th2 cells，eosinophils，type 2 innate lymphocytes，and other cells. Its pathological characteristics are manifested by the abnormally high expression of type 2 cytokines such as IL-4，IL-5，and IL-13，and it widely involves allergic diseases including asthma，allergic rhinitis，and atopic dermatitis. Ginsenosides are the core active ingredients of ginseng and the key substances for ginseng to exert its pharmacological effects. It has anti-inflammatory and immunomodulatory effects. This article reviews the mechanism of action，experimental research progress，and clinical application prospects of ginsenosides in T2 inflammation，explores the therapeutic potential and clinical challenges of ginsenosides，and proposes future research directions.

Objective To investigate the mid- to long-term follow-up results of ascending aorta (AAO)-descending thoracic aorta (DTA) bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation. Methods A retrospective analysis was conducted on the clinical data of patients with complex aortic arch coarctation who underwent AAO-DTA bypass grafting via median sternotomy incision at the First Hospital of Tsinghua University from August 2004 to May 2017. Results A total of 7 patients were enrolled, including 4 males and 3 females, aged (13.3±4.6) years, and weighted (40.2±12.2) kg. Six (85.7%) patients had concomitant upper limb hypertension. Four patients were aortic arch coarctation combined with intracardiac malformations, two were post-operative restenosis, and 1 was post-operative restenosis combined with intracardiac malformation. All patients underwent surgery under cardiopulmonary bypass. There were no perioperative deaths or major complications. The pre-operative upper-lower limb pressure difference was (39.3±19.2) mm Hg, which decreased to (2.9±2.7) mm Hg post-operatively (P<0.01). The follow-up period was (14.9±5.9) years. There were no long-term deaths or artificial graft-related complications. Except for one patient who still had mild hypertension, the blood pressure of the remaining patients returned to normal. Conclusion AAO-DTA bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation can effectively reduce upper limb blood pressure and the upper-lower limb arterial pressure difference, has fewer complications, and demonstrates satisfactory mid- to long-term efficacy.

Pristimerin, which is one of the compounds present in Celastraceae and Hippocrateaceae, has antitumor effects. However, its mechanism of action in esophageal squamous cell carcinoma (ESCC) remains unclear. This study aims to investigate the efficacy and mechanism of pristimerin on ESCC in vitro and in vivo. The inhibitory effect of pristimerin on cell growth was assessed using trypan blue exclusion and colony formation assays. Cell apoptosis was evaluated by flow cytometry. Gene and protein expressions were analyzed through quantitative reverse transcription-polymerase chain reaction (qRT-PCR), Western blotting, and immunohistochemistry. RNA sequencing (RNA-Seq) was employed to identify significantly differentially expressed genes (DEGs). Cell transfection and RNA interference assays were utilized to examine the role of key proteins in pristimerin?s effect. Xenograft models were established to evaluate the antitumor efficiency of pristimerin in vivo. Pristimerin inhibited cell growth and induced apoptosis in ESCC cells. Upregulation of Noxa was crucial for pristimerin-induced apoptosis. Pristimerin activated the Forkhead box O3a (FoxO3a) signaling pathway and triggered FoxO3a recruitment to the Noxa promoter, leading to Noxa transcription. Blocking FoxO3a reversed pristimerin-induced Noxa upregulation and cell apoptosis. Pristimerin treatment suppressed xenograft tumors in nude mice, but these effects were largely negated in Noxa-KO tumors. Furthermore, the chemosensitization effects of pristimerin in vitro and in vivo were mediated by Noxa. This study demonstrates that pristimerin exerts an antitumor effect on ESCC by inducing AKT/FoxO3a-mediated Noxa upregulation. These findings suggest that pristimerin may serve as a potent anticancer agent for ESCC treatment.
Forkhead Box Protein O3/genetics* ; Humans ; Apoptosis/drug effects* ; Esophageal Squamous Cell Carcinoma/physiopathology* ; Esophageal Neoplasms/physiopathology* ; Pentacyclic Triterpenes ; Animals ; Cell Line, Tumor ; Proto-Oncogene Proteins c-bcl-2/genetics* ; Mice ; Signal Transduction/drug effects* ; Mice, Nude ; Cell Proliferation/drug effects* ; Triterpenes/pharmacology* ; Xenograft Model Antitumor Assays ; Mice, Inbred BALB C ; Male ; Gene Expression Regulation, Neoplastic/drug effects*

Dental treatments for children and adolescents have unique clinical characteristics that differ from dental care for adults in terms of children's physiology, psychology, and behavior. These differences impose specific requirements on the application of local anesthesia in pediatric dental procedures. This article presents expert consensus on the principles of local anesthesia techniques in pediatric dental therapies, including the use of common anesthetic drugs and dosage control, safety and efficacy evaluation, and prevention and management of complications. The aim is to improve the safety and quality of pediatric dental treatments and offer guidance for clinical application by dentists.
Humans ; Child ; Anesthesia, Local/methods* ; Consensus ; Anesthesia, Dental/methods* ; Adolescent ; Anesthetics, Local/administration & dosage* ; Dental Care for Children

Objective:To evaluate the diagnostic performance of resting echocardiography in detecting severe coronary artery stenosis.Methods:A total of 136 patients with suspected coronary artery disease（CAD）who presented to Sichuan Provincial People's Hospital between January 2021 and December 2024 were prospectively enrolled. All patients underwent both coronary computed tomography angiography（CCTA）and transthoracic echocardiography within one week. Based on CCTA results，the patients were divided into non-severe stenosis group（ n=78）and severe stenosis group（ n=58）. Echocardiographic parameters including left atrial maximum volume（LAVmax），left ventricular global longitudinal strain（GLS），left ventricular longitudinal strain of endo-myocardium，mid-myocardium，epi-myocardium（LSendo，LSmid，LSepi），early diastolic mitral inflow velocity（E），early diastolic mitral annular velocity of the lateral and septal walls（e'），and E/e' were measured. Predictive factors for severe coronary stenosis were identified using LASSO regression，and a nomogram model was developed via multivariate Logistic regression. Model performance was evaluated using ROC curves，calibration curves，and decision curve analysis. Results:Multivariate Logistic regression analysis revealed LSendo，LAVmax，and E/e' as independent predictors of severe coronary artery stenosis. The nomogram constructed based on these predictors achieved an area under the curve of 0.798（95% CI=0.723-0.873），with sensitivity and specificity of 0.756 and 0.759，respectively. Conclusions:The resting echocardiography-based nomogram model demonstrates good diagnostic efficacy for severe coronary artery stenosis. It may serve as a noninvasive tool to assist in risk stratification and clinical decision-making in patients with suspected CAD.