Objective:To investigate the influencing factors for gastrointestinal leakage and its occurrence time after minimally invasive radical gastrectomy for gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 3 135 patients with gastric cancer who were admitted to The First Affiliated Hospital of Army Medical University from January 2004 to December 2022 were collected. There were 2 174 males and 961 females, aged (57±11)years. Gastrointestinal leakage occurring within 4 days after surgery was defined as early gastrointestinal leakage, and gastrointestinal leakage occuring more than 4 days after surgery was defined as late gastrointestinal leakage. Measurement data with normal distribution were represented as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were represented as M( Q1, Q3), and Mann-Whitney U test was used for comparison between groups. Count data were represented as absolute numbers, and chi-square test or Fisher exact pro-bability was used for comparison between groups. Comparison of ordinal data was conducted using the nonparameter rank sum test. Logistic regression model was used for univariate analysis, and Logistic forward stepwise regression model was used for multivariate analysis. Results:(1) Clinico-pathological characteristics of patients with and without postoperative gastrointestinal leakage. Of the 3 135 patients, there were 3 056 patients without gastrointestinal leakage and 79 patients with gastrointestinal leakage after operation, and there were significant differences in age, American Society of Anesthesiologists classification, neoadjuvant chemotherapy, surgical resection range, volume of intraoperative blood loss and surgeon′s experience between them ( P<0.05). (2) Postoperative gastro-intestinal leakage and treatment. Of the 79 patients with postoperative gastrointestinal leakage, there were 36 patients with esophagojejunal anastomotic leakage (2 patients combined with jejunal anastomotic leakage), 29 patients with duodenal stump leakage, 11 patients with gastrojejunal anas-tomotic leakage, 2 patients with esophagogastric anastomotic leakage and 1 patient with gastroduo-denal anastomotic leakage. The same patient could be combined with more than one kind of gastro-intestinal leakage. Thirty-four patients were improved after conservative treatment, 31 patients were improved after puncture drainage or endoscopic interventional therapy, and 14 patients were treated with secondary surgery. Among the patients who underwent secondary surgery, 5 patients died during perioperative period. The time to occurrence of postoperative gastrointestinal leakage of 79 patients was 5(4, 8)days, with the earliest occurrence at 1 day after operation, and the latest occurrence at 16 days after operation. (3) Analysis of influencing factors for the occurrence time of postopera-tive gastrointestinal leakage. Results of multivariate analysis showed that neoadjuvant chemotherapy, total gastrectomy and surgeon′s experience ≤50 patients were independent risk factors for early gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer ( odds ratio=4.262, 2.179, 5.015, 95% confidence interval as 1.386-13.110, 1.026-4.627, 2.378-10.537, P<0.05). Age>60 years, total gastrectomy, volume of intraoperative bleeding loss>200 mL were independent risk factors for late gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer ( odds ratio=3.031, 2.804, 2.223, 95% confidence interval as 1.631-5.631, 1.535-5.122, 1.190-4.151, P<0.05). Conclusions:Most patients with gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer can be cured by non-surgical methods. Neoadjuvant chemo-therapy and surgeon′s experience ≤ 50 patients are independent risk factors for early gastrointes-tinal leakage after minimally invasive radical gastrectomy. Age >60 years and volume of intraopera-tive blood loss >200 mL are independent risk factors for late gastrointestinal leakage after minimally invasive radical gastrectomy. Total gastrectomy is an independent risk factor for both early and late gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer.

Objective:To investigate the influencing factors for gastrointestinal leakage and its occurrence time after minimally invasive radical gastrectomy for gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 3 135 patients with gastric cancer who were admitted to The First Affiliated Hospital of Army Medical University from January 2004 to December 2022 were collected. There were 2 174 males and 961 females, aged (57±11)years. Gastrointestinal leakage occurring within 4 days after surgery was defined as early gastrointestinal leakage, and gastrointestinal leakage occuring more than 4 days after surgery was defined as late gastrointestinal leakage. Measurement data with normal distribution were represented as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were represented as M( Q1, Q3), and Mann-Whitney U test was used for comparison between groups. Count data were represented as absolute numbers, and chi-square test or Fisher exact pro-bability was used for comparison between groups. Comparison of ordinal data was conducted using the nonparameter rank sum test. Logistic regression model was used for univariate analysis, and Logistic forward stepwise regression model was used for multivariate analysis. Results:(1) Clinico-pathological characteristics of patients with and without postoperative gastrointestinal leakage. Of the 3 135 patients, there were 3 056 patients without gastrointestinal leakage and 79 patients with gastrointestinal leakage after operation, and there were significant differences in age, American Society of Anesthesiologists classification, neoadjuvant chemotherapy, surgical resection range, volume of intraoperative blood loss and surgeon′s experience between them ( P<0.05). (2) Postoperative gastro-intestinal leakage and treatment. Of the 79 patients with postoperative gastrointestinal leakage, there were 36 patients with esophagojejunal anastomotic leakage (2 patients combined with jejunal anastomotic leakage), 29 patients with duodenal stump leakage, 11 patients with gastrojejunal anas-tomotic leakage, 2 patients with esophagogastric anastomotic leakage and 1 patient with gastroduo-denal anastomotic leakage. The same patient could be combined with more than one kind of gastro-intestinal leakage. Thirty-four patients were improved after conservative treatment, 31 patients were improved after puncture drainage or endoscopic interventional therapy, and 14 patients were treated with secondary surgery. Among the patients who underwent secondary surgery, 5 patients died during perioperative period. The time to occurrence of postoperative gastrointestinal leakage of 79 patients was 5(4, 8)days, with the earliest occurrence at 1 day after operation, and the latest occurrence at 16 days after operation. (3) Analysis of influencing factors for the occurrence time of postopera-tive gastrointestinal leakage. Results of multivariate analysis showed that neoadjuvant chemotherapy, total gastrectomy and surgeon′s experience ≤50 patients were independent risk factors for early gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer ( odds ratio=4.262, 2.179, 5.015, 95% confidence interval as 1.386-13.110, 1.026-4.627, 2.378-10.537, P<0.05). Age>60 years, total gastrectomy, volume of intraoperative bleeding loss>200 mL were independent risk factors for late gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer ( odds ratio=3.031, 2.804, 2.223, 95% confidence interval as 1.631-5.631, 1.535-5.122, 1.190-4.151, P<0.05). Conclusions:Most patients with gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer can be cured by non-surgical methods. Neoadjuvant chemo-therapy and surgeon′s experience ≤ 50 patients are independent risk factors for early gastrointes-tinal leakage after minimally invasive radical gastrectomy. Age >60 years and volume of intraopera-tive blood loss >200 mL are independent risk factors for late gastrointestinal leakage after minimally invasive radical gastrectomy. Total gastrectomy is an independent risk factor for both early and late gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer.

China has classified the Corona Virus Disease 2019(COVID-19) as a statutory category B infectious disease and managed it according to Category B since January 8, 2023.In view that Omicron variant is currently the main epidemic strain in China, in order to guide the treatment of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection in children with the times, refer to the Diagnosis and Treatment Protocol for Novel Coronavirus Infection (Trial 10 th Edition), Expert Consensus on Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fourth Edition) and the Diagnosis and Treatment Strategy for Pediatric Related Viral Infections.The Expert Consensus on the Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fifth Edition) has been formulated and updated accordingly on related etiology, epidemiology, pathogenic mechanism, clinical manifestations, auxiliary examination, diagnosis and treatment, and added key points for the treatment of COVID-19 related encephalopathy, fulminating myocarditis and other serious complications for clinical reference.

Monkeypox is a zoonotic disease.Previous studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians′ understanding of monkeypox and achieve early detection, early diagnosis, early treatment and early disposal, the committee composed of more than 40 experts in the related fields of infectious diseases, pediatrics, infection control and public health formulate this expert consensus, on the basis of the latest clinical management and infection prevention and control for monkeypox released by the World Health Organization (WHO), the guidelines for diagnosis and treatment of monkeypox (version 2022) issued by National Health Commission of the People′s Republic of China and other relevant documents.During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis and differential diagnosis, treatment, discharge criteria, prevention, case management process and key points of prevention and control about monkeypox.

Since December 2019, severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infections have raged globally for more than 2 years.China has always adopted scientific and effective prevention and control measures to achieved some success.However, with the continuous variation of SARS-CoV-2 cases and imported cases from abroad, the prevention and control work has become more difficult and complex.With the variation of the mutant strain, the number of cases in children changed, and some new special symptoms and complications were found, which proposed a new topic for the prevention and treatment of SARS-CoV-2 infection in children in China.Based on the third edition, the present consensus according to the characteristics of the new strain, expounded the etiology, pathology, pathogenesis, and according to the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of effective prevention and treatment of SARS-CoV-2 infection in children in China.

At present, severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is still rampant worldwide.As of September 10, 2021, there were about 222 million confirmed cases of corona virus disease 2019(COVID-19)and more than 4.6 million deaths worldwide.With the development of COVID-19 vaccines and the gradual vaccination worldwide, the increasing number of cases in children and unvaccinated young people has drawn attention.According to World Health Organization surveillance data, the proportion of COVID-19 infection cases in children gradually increased, and the proportion of cases in the age groups of under 5 years and 5-14 years increased from 1.0% and 2.5% in January 2020 to 2.0% and 8.7% in July 2021, respectively.At present, billions of adults have been vaccinated with various COVID-19 vaccines worldwide, and their protective effects including reducing infection and transmission, reducing severe disease and hospitalization, and reducing death, as well as high safety have been confirmed.Canada, the United States, Europe and other countries have approved the emergency COVID-19 vaccination in children and adolescents aged 12 to 17 years, and China has also approved the phased vaccination of COVID-19 vaccination in children and adolescents aged 3 to 17 years. For smooth advancement and implementation of COVID-19 vaccination in children, academic institutions, including National Clinical Research Center for Respiratory Diseases, National Center for Children′s Health, and The Society of Pediatrics, Chinese Medical Association organized relevant experts to reach this consensus on COVID-19 vaccination in children.

Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is still worldwide.As a vulnerable group, severe and dead pediatric cases are also reported.Under this severe epidemic situation, children should be well protected.With the widespread vaccination of SARS-CoV-2 vaccine in adults, the infection rate have decreased.Therefore, SARS-CoV-2 vaccine inoculation for children groups step by step is of great significance to the protection of children and the prevention and control of corona virus disease 2019(COVID-19) as a whole.But the safety of children vaccinated with SARS-CoV-2 vaccine is a main concern of parents.Therefore, in order to ensure the safety of vaccination and the implementation of vaccination work, National Clinical Research Center for Respiratory Diseases, National Center for Children′s Health and the Society of Pediatrics, Chinese Medical Association organized experts to interpret the main issue of parents about SARS-CoV-2 vaccine for children, in order to answer the doubts of parents.

Objective: To evaluate the protective effect of granulocyte-colony stimulating factor(G-CSF) on neonatal rats after hypoxic-ischemic brain damage(HIBD)and its effect on endoplasmic reticulum (ER) stress. Methods: According to the random number table, a total of 54 Sprague-Dawley (SD) rats aged 7 days were divided into 3 groups(18 rats in each group): Sham group, HIBD group and G-CSF group, and the improved Rice method was used to establish a neonatal rat model of HIBD.A dose of 50 μg/kg of G-CSF was administered intraperitoneally 1 hour after HIBD (G-CSF group), while the rats in HIBD group and Sham group received saline only.At 24 hours of HIBD, pups were euthanized to quantify brain infarct volume by using 2, 3, 5-Triphenyltetrazolium chloride.Hematoxylin-Eosin (HE) staining was used to observe the changes of brain structure.Neuronal cell death was determined by using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL). Then the expressions of glucose-regulated protein 78 (GRP78), cysteinyl aspartate specific proteinase 12 (Caspase-12), CCAAT/enhancer binding-protein homologous protein (CHOP) were assessed by Western blot and immunofluorescence staining. Results: Twenty-four hours after operation, HE staining showed that no significant neuronal damage was observed in Sham group.The brain tissue structure of rats in the HIBD group was significantly damaged, while some improvement was observed in the G-CSF group.The infarction volume in HIBD group[(25.40±5.15)%] increased compared with that in the Sham group[(0.31±0.15)%] and the G-CSF group[(16.36±4.97)%], and the differences were statistically significant(all P<0.05). There was increased positive expression of GRP78 protein in HIBD group, compared with that in the Sham group and the G-CSF group[(49.38±10.06)% vs.(9.12±4.50)%, (30.61±6.35)%], and the differences were statistically significant (all P<0.05). The percentage of apoptosis in the hippocampal CA1 region and conex in HIBD group [(44.84±11.54)%, (48.23±14.07)%] were higher than those in the G-CSF group [(17.87±7.20)%, (26.18±9.96)%], and the differences were statistically significant (all P<0.05). The expression of GRP78, CHOP and Caspase-12 in the HIBD group (0.63±0.24, 0.72±0.21, 0.68±0.25) were higher than those in the Sham group (0.20±0.08, 0.28±0.08, 0.23±0.07), and the G-CSF group (0.39±0.13, 0.51±0.18, 0.48±0.16), and the differences were statistically significant (all P<0.05). Conclusions G-CSF exerts neuroprotective effect on the neonatal rats after HIBD.G-CSF may be an effective treatment of HIBD by reducing ER stress-induced neuronal apoptosis.

Objective: To investigate the role of granulocyte-colony stimulating factor (G-CSF) on the regulation of inflammatory cytokines in neonatal hypoxic-ischemic brain damage(HIBD) rat model, and to explore the possible mechanism involved in G-CSF neuroprotective effect via the mammalian target of Rapamycin/p70 ribosomal S6 protein kinase (mTOR/p70S6K) signaling pathway. Methods: A group of postnatal day 7 (P7) Sprague-Dawley rat pups (90 cases) were randomly divided into sham-operated group, hypoxia-ischemia(HI) group, G-CSF group, Rapamycin (RAP) group and control group, and the improved Rice method was used to establish a neonatal rat model of HIBD.One hour before HI induction, Rapamycin was administered intraperitoneally with a dose of 250 μg/kg, and the control group was given equal volume of ethanol injected intraperitoneally.One hour after HI, a dose of 50 μg/kg of G-CSF was injected intraperitoneally into the G-CSF group, Rapamycin group and control group.The same volume of normal saline was injected intraperitoneally into HI group and sham-operated group.Forty-eight hours after HI, Western blot was used to detect the protein levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-10, and the mTOR/p70S6K signaling pathway in brain tissue.Neuron injury of the hippocampal CA1 region and the cortex was assessed by Nissl staining, and infarct volume detected by 2, 3, 5-triphenyltetrazolium chloride staining. Results: The G-CSF group and control group were associated with significantly reduced infarction volume compared to the HI group [(12.87±1.54)%, (11.90±1.31)% vs.(24.21±3.28)%], and the differences were statistically significant(P<0.05). There was an increased positive neuron cell number in the ipsilateral hemispheres of the hippocampal CA1 region in the G-CSF group and the control group [(61.00±4.90) cell/field and (61.67±6.40) cell/field] and cortex [(92.67±6.68) cell/field and (90.17±4.45) cell/field] compared with those in HI group [(42.62±4.46) cell/field and (70.83±6.97) cell/field], and the differences were all statistically significant (all P<0.05). The expression levels of TNF-α and IL-1β were significantly decreased in the G-CSF group and the control group, compared with those in HI group(TNF-α: 0.67±0.07, 0.55±0.05 vs.0.86±0.05; IL-1β: 0.65±0.06, 0.52±0.10 vs.0.86±0.06), and the differences were all statistically significant (all P<0.05). There was increased expression levels of IL-10, p-mTOR/mTOR and p-p70S6K/p70S6K in the G-CSF group and the control group, compared with those in HI group (IL-10: 0.68±0.04, 0.62±0.05 vs.0.34±0.02; p-mTOR/mTOR: 0.53±0.02, 0.51±0.01 vs.0.26±0.01; p-p70S6K/p70S6K: 0.89±0.03, 0.90±0.03 vs.0.55±0.02), and the differences were all statistically significant(all P<0.05). There was an increased infarct volume in Rapamycin group [(25.70±1.50)%], compared with the G-CSF group and the control group, and there were decreased number of positive neuron cell count in the hippocampal CA1 region [(40.67±3.50) cell/field] and cortex [(68.33±8.17) cell/field], increased expression levels of TNF-α and IL-1β (0.97±0.06 and 0.98±0.10, respectively), decreased expression levels of IL-10, p-mTOR/mTOR and p-p70S6K/p70S6K (0.21±0.02, 0.30±0.01 and 0.55±0.01, respectively) in the Rapamycin group, and the differences were all statistically significant (all P<0.05). Conclusions G-CSF may inhibit inflammatory responses after HIBD by up-regulating the mTOR/p70S6K signaling pathway in neonatal HI encephalopathy.

Objective To reduce the incidence of peritoneal dialysis related peritonitis for patients in rural area and to improve management quality of peritoneal dialysis center.Methods We established multidisciplinary collaborative research group involving departments of nephrology,nutrition,infection,and quality control.Risk factors of peritoneal dialysis related peritonitis in rural patients were analyzed,and prevention measures were designed.The rate of peritoneal dialysis related peritonitis in 89 patients after implementation was analyzed.Results The rate of peritoneal dialysis related peritonitis was decreased from 43 patient·month per time to 67 patient ·month per time.Conclusion The compound pathway can effectively reduce the rate of peritonitis,improve patient satisfaction,and prolong dialysis age.