OBJECTIVE: To investigate the clinical features and risk factors associated with cutaneous chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children. METHODS: A retrospective analysis was conducted on the clinical data of children who underwent allo-HSCT in the Wuhan Children's Hospital from August 1, 2016, to December 31, 2023, and were regularly followed up for 1 year or more. The differences in clinical features between children with and without cutaneous cGVHD were compared, and the risk factors affecting the occurrence of cutaneous cGVHD were analyzed. RESULTS: During the study period, 296 children received allo-HSCT. Until December 31, 2024, follow-up showed that 20 children (6.8%) developed cutaneous cGVHD, which manifested as cutaneous lichenification, hyperpigmentation, keratosis pilaris, sclerotic changes, and hair or nail involvement. According to their skin lesion area and degree of grading, 5 cases were mild, 10 cases were moderate, and 5 cases were severe. Multivariate logistic regression analysis revealed that female donors and previous acute GVHD were risk factors for the development of cutaneous cGVHD after allo-HSCT. All 20 children were treated with glucocorticoid ± calcineurin inhibitors (tacrolimus/cyclosporine) as first-line therapeutic agents. Only 1 child improved after first-line treatment. The remaining 19 children treated with a second-line regimen of combination interventions based on individualized status, including 10 children who could not tolerate hormonotherapy or first-line treatment, and showed no significant improvement after 3 months, as well as 9 children with multi-organ cGVHD. After comprehensive second-line treatment, 17 children showed improvement in cutaneous symptoms. There were 3 deaths, including 1 due to primary disease recurrence and 2 due to pulmonary infections. CONCLUSION The skin is the first manifestation and most common organ involved in cGVHD in children. Cutaneous cGVHD severely affects the daily activities of transplanted children and requires prolonged immunosuppressive therapy, but has a favorable prognosis. First-line treatments for adults are not applicable to children who usually require a combination treatment with multiple drugs.
Humans ; Graft vs Host Disease/etiology* ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Retrospective Studies ; Risk Factors ; Female ; Child ; Skin Diseases/etiology* ; Chronic Disease ; Transplantation, Homologous ; Male ; Child, Preschool ; Adolescent

Objective:To systematically evaluate the clinical outcomes of hemihepatic inflow occlusion(HHO)and total hepatic inflow occlusion(THO)in liver resection surgery.Method:Re-trieve the Cochrane Library,PubMed,EMbase,Ovid,Web of Science,CNKI,and WanFang Data databases,and search for journal articles published from January 1,2000 to January 31,2023,on randomized controlled trials(RCTs)comparing the effects of HHO and THO in liver resection.At the same time,two researchers independently screened literature based on inclusion and exclusion cri-teria,conducted meta-analysis using RevMan 5.4 and State17PM software.Result:Fifteen RCTs were ultimately included,including 624 patients.The meta-analysis results showed that HHO re-duced serum AST(MD=-104.75,95％CI:-134.45-75.06,P＜0.05),ALT(MD=-155.37,95％CI:-182.90-127.85,P＜0.05),and TBIL(MD=-6.28,95％CI:-8.07-4.48,P＜0.05)on postoperative days 1,3,and 7 Compared to THO,the elevation of blood levels and reduction of intraoperative bleeding(MD=-66.21,95％CI:-116.49-15.94,P＜0.05)were superior.THO is superior to HHO in shortening surgical time(MD=13.94,95％CI:4.77-23.12,P＜0.05).There was no significant differ-ence between the two methods in hospital stay,hospital death rate and complication rate(P＞0.05).Conclusion:compared with THO,the application of HHO in hepatectomy has less damage to liver function and less intraoperative bleeding,but the two methods have the similar effect in terms of hospitalization time,hospital mortality rate and complication rate.

Objective To predict and verify the mechanism of Naoan capsules(NAC)in treatment of ischemic stroke(IS)by network pharmacology,Gene Expression Omnibus(GEO)database,and molecular docking technology.Methods The active components in NAC were collected using the Traditional Chinese Medicine System Pharmacological Analysis Platform,and the disease-related differential genes were screened using GEO database.After screening and obtaining the common targets of the two,the compound disease network was constructed by Cytoscape 3.8.2 software.At the same time,protein-protein interaction networks were created to identify candidate targets for NAC treatment of IS,and gene ontology and Kyoto encyclopedia of genes and genomes enrichment analyses were performed.Finally,core targets were verified by molecular docking technology.Results A total of 56 candidate compounds and 18 544 disease-related differential genes were screened.Further,quercetin,kaempferol,luteolin and baicalein were found to be the key active compounds of NAC in the treatment of IS through the compound disease network.In the search of PPI network core,eight key targets for NAC treatment of IS were screened,including mitogen-activated protein kinase 1(MAPK1),B-cell lymphoma factor 2(Bcl-2),cysteinylaspartate specific protease 3(CASP3),etc.In addition,the key pathways of NAC treatment of IS are mainly concentrated in lipid and atherosclerosis,advanced glycation end products and receptor for advanced glycation end products(AGE-RAGE),tumor necrosis factor(TNF),interleukin17(IL-17),C-type lectin receptor,apoptosis,hypoxia-inducing factor-1(HIF-1),MAPK and other signaling pathways.Finally,the molecular docking results showed that the key active compounds(quercetin,kaempferol,luteolin and baicalein)had good binding force with the 8 key targets,which initially verified the results of network pharmacology.Conclusion NAC plays a role in the treatment of IS through multi-component,multi-target and multi-pathway.

Objective To evaluate the management and indicators of pathogen detection before antimicrobial treat-ment for inpatients in second level and above medical institutions(MIs)in Guangdong Province,and provide direc-tion and decision-making basis for the improvement of pathogen detection quality in the region.Methods The ma-nagement status,information system functions,and pathogen detection rate indicators of secondary and above MIs in 21 cities in Guangdong Province was surveyed through online questionnaire surveys and system submission.A baseline survey on sentinel monitoring MIs was conducted from July 15th to August 8th,2023.From November 7th to 30th,a baseline survey on non-sentinel monitoring MIs was launched.Surveys on indicator information of all MIs were completed from January 15th to 30th,2024.Results A total of 265 MIs were surveyed,and the proportions of establishing special working groups(83.98％),developing special action improvement plans(79.01％),estab-lishing pathogen detection rate management systems(91.71％),and developing management assessment plans(76.80％)of tertiary MIs were all higher than that of secondary MIs,differences were all statistically significant(all P＜0.05).The proportion of tertiary MIs with various information system functions was higher than that of secondary MIs(all P＜0.05).The pathogen detection rate(61.07％)before antimicrobial treatment and health-care-associated infection(HAI)diagnosis-related pathogen detection rate(88.00％)of inpatients in tertiary MIs were both higher than those in secondary MIs(both P＜0.05).Among different types of MIs,pathogen detection rate before antimicrobial treatment of inpatients in maternal and child health MIs was higher than that in other types of MIs.HAI diagnosis-related pathogen detection rate in other specialized hospitals was the highest,and pathogen detection rate before combined use of key antimicrobial treatment in traditional Chinese medicine hospitals was the lowest,differences were all statistically significant(all P＜0.05).Conclusion Tertiary MIs have more advantages in management strategies and information technology construction than secondary MIs,secondary MIs need more guidance and support.Monitoring and analysis of pathogen detection rate indicators in MIs of different levels and types should be strengthened through special actions.

Objective To use mendelian randomization(MR)study to explore the causal relationship between cholelithiasis,cholecystectomy,and gastroesophageal reflux disease(GERD).Methods Based on large-scale genome-wide association studies(GW AS),genetic variants closely associated with cholelithiasis and cholecystectomy were selected as instrumental variables.Mendelian randomization pleiotropy residual sum and outlier(MR-PRESSO)was used to eliminate outliers.Inverse variance weighting(IVW)was used as the main analysis method and MR-Egger,Weighted median,Simple mode and Weighted mode were used as supplementary analysis methods for causal effect evaluation.Meanwhile,Cochran's Q was used for heterogeneity test.The MR Egger intercept test was used to analyze the level of horizontal pleiotropy,and the leave-one-out method was used to ensure the robustness of the results.Results Inverse variance weighted results showed that cholelithiasis(odds ratio:1.05,95％confidence interval:1.03-1.07,P＜0.01)and cholecystectomy(odds ratio:2.56,95％confidence interval:1.76-3.73,P＜0.01)were significantly associated with an increased risk of GERD.Cochran's Q test showed that there was heterogeneity in the genetic variants of cholelithiasis(P＜0.05),but no significant heterogeneity in the genetic variants of cholecystectomy(P＞0.05).MR-Egger intercept analysis did not detect potential horizontal pleiotropy(P＞0.05),and the leave-one-out analyses showed that the results were robust.Conclusion Genetically predicted cholelithiasis and cholecystectomy are causally associated with GERD,suggesting that the prevention of GERD should be strengthened in patients with cholelithiasis and after cholecystectomy.

Objective To evaluate the management and indicators of pathogen detection before antimicrobial treat-ment for inpatients in second level and above medical institutions(MIs)in Guangdong Province,and provide direc-tion and decision-making basis for the improvement of pathogen detection quality in the region.Methods The ma-nagement status,information system functions,and pathogen detection rate indicators of secondary and above MIs in 21 cities in Guangdong Province was surveyed through online questionnaire surveys and system submission.A baseline survey on sentinel monitoring MIs was conducted from July 15th to August 8th,2023.From November 7th to 30th,a baseline survey on non-sentinel monitoring MIs was launched.Surveys on indicator information of all MIs were completed from January 15th to 30th,2024.Results A total of 265 MIs were surveyed,and the proportions of establishing special working groups(83.98％),developing special action improvement plans(79.01％),estab-lishing pathogen detection rate management systems(91.71％),and developing management assessment plans(76.80％)of tertiary MIs were all higher than that of secondary MIs,differences were all statistically significant(all P＜0.05).The proportion of tertiary MIs with various information system functions was higher than that of secondary MIs(all P＜0.05).The pathogen detection rate(61.07％)before antimicrobial treatment and health-care-associated infection(HAI)diagnosis-related pathogen detection rate(88.00％)of inpatients in tertiary MIs were both higher than those in secondary MIs(both P＜0.05).Among different types of MIs,pathogen detection rate before antimicrobial treatment of inpatients in maternal and child health MIs was higher than that in other types of MIs.HAI diagnosis-related pathogen detection rate in other specialized hospitals was the highest,and pathogen detection rate before combined use of key antimicrobial treatment in traditional Chinese medicine hospitals was the lowest,differences were all statistically significant(all P＜0.05).Conclusion Tertiary MIs have more advantages in management strategies and information technology construction than secondary MIs,secondary MIs need more guidance and support.Monitoring and analysis of pathogen detection rate indicators in MIs of different levels and types should be strengthened through special actions.

Objective To use mendelian randomization(MR)study to explore the causal relationship between cholelithiasis,cholecystectomy,and gastroesophageal reflux disease(GERD).Methods Based on large-scale genome-wide association studies(GW AS),genetic variants closely associated with cholelithiasis and cholecystectomy were selected as instrumental variables.Mendelian randomization pleiotropy residual sum and outlier(MR-PRESSO)was used to eliminate outliers.Inverse variance weighting(IVW)was used as the main analysis method and MR-Egger,Weighted median,Simple mode and Weighted mode were used as supplementary analysis methods for causal effect evaluation.Meanwhile,Cochran's Q was used for heterogeneity test.The MR Egger intercept test was used to analyze the level of horizontal pleiotropy,and the leave-one-out method was used to ensure the robustness of the results.Results Inverse variance weighted results showed that cholelithiasis(odds ratio:1.05,95％confidence interval:1.03-1.07,P＜0.01)and cholecystectomy(odds ratio:2.56,95％confidence interval:1.76-3.73,P＜0.01)were significantly associated with an increased risk of GERD.Cochran's Q test showed that there was heterogeneity in the genetic variants of cholelithiasis(P＜0.05),but no significant heterogeneity in the genetic variants of cholecystectomy(P＞0.05).MR-Egger intercept analysis did not detect potential horizontal pleiotropy(P＞0.05),and the leave-one-out analyses showed that the results were robust.Conclusion Genetically predicted cholelithiasis and cholecystectomy are causally associated with GERD,suggesting that the prevention of GERD should be strengthened in patients with cholelithiasis and after cholecystectomy.

Objective:To systematically evaluate the clinical outcomes of hemihepatic inflow occlusion(HHO)and total hepatic inflow occlusion(THO)in liver resection surgery.Method:Re-trieve the Cochrane Library,PubMed,EMbase,Ovid,Web of Science,CNKI,and WanFang Data databases,and search for journal articles published from January 1,2000 to January 31,2023,on randomized controlled trials(RCTs)comparing the effects of HHO and THO in liver resection.At the same time,two researchers independently screened literature based on inclusion and exclusion cri-teria,conducted meta-analysis using RevMan 5.4 and State17PM software.Result:Fifteen RCTs were ultimately included,including 624 patients.The meta-analysis results showed that HHO re-duced serum AST(MD=-104.75,95％CI:-134.45-75.06,P＜0.05),ALT(MD=-155.37,95％CI:-182.90-127.85,P＜0.05),and TBIL(MD=-6.28,95％CI:-8.07-4.48,P＜0.05)on postoperative days 1,3,and 7 Compared to THO,the elevation of blood levels and reduction of intraoperative bleeding(MD=-66.21,95％CI:-116.49-15.94,P＜0.05)were superior.THO is superior to HHO in shortening surgical time(MD=13.94,95％CI:4.77-23.12,P＜0.05).There was no significant differ-ence between the two methods in hospital stay,hospital death rate and complication rate(P＞0.05).Conclusion:compared with THO,the application of HHO in hepatectomy has less damage to liver function and less intraoperative bleeding,but the two methods have the similar effect in terms of hospitalization time,hospital mortality rate and complication rate.

Objective: To explore the utility of stool-based DNA test of methylated SDC2 (mSDC2) for colorectal cancer (CRC) screening in residents of Shipai Town, Dongguan City. Methods: This was a cross-sectional study. Using a cluster sampling method, residents of 18 villages in Shipai Town, Dongguan City were screened for CRC from May 2021 to February 2022. In this study, mSDC2 testing was employed as a preliminary screening method. Colonoscopy examination was recommended for individuals identified as high-risk based on the positive mSDC2 tests. The final screening results, including the rate of positive mSDC2 tests, the rate of colonoscopy compliance, the rate of lesions detection, and the cost-effectiveness of screening, were analyzed to explore the benefits of this screening strategy. Results: A total of 10 708 residents were enrolled and completed mSDC2 testing, giving a participation rate of 54.99% (10 708/19 474) and a pass rate of 97.87% (10 708/10 941). These individuals included 4 713 men (44.01%) and 5 995 women (55.99%) with a mean age of (54.52±9.64) years. The participants were allocated to four age groups (40-49, 50-59, 60-69, and 70-74 years), comprising 35.21%(3770/10 708), 36.25% (3882/10 708), 18.84% (2017/10 708), and 9.70% (1039/10 708) of all participants, respectively. mSDC2 testing was positive in 821/10 708 (7.67%) participants, 521 of whom underwent colonoscopy, resulting in a compliance rate of 63.46% (521/821). After eliminating of 8 individuals without pathology results, data from 513 individuals were finally analyzed. Colonoscopy detection rate differed significantly between age groups (χ²=23.155, P<0.001),ranging from a low of 60.74% in the 40-49 year age group to a high of 86.11% in the 70-74 year age group. Colonoscopies resulted in the diagnosis of 25 (4.87%) CRCs, 192 (37.43%) advanced adenomas, 67 (13.06%) early adenomas, 15 (2.92%) serrated polyps, and 86 (16.76%) non- adenomatous polyps. The 25 CRCs were Stage 0 in 14 (56.0%) individuals, stage I in 4 (16.0%), and Stage II in 7(28.0%). Thus, 18 of the detected CRCs were at an early stage. The early detection rate of CRCs and advanced adenomas was 96.77% (210/217). The rate of mSDC2 testing for all intestinal lesions was 75.05% (385/513). In particular, the financial benefit of this screening was 32.64 million yuan, and the benefit-cost ratio was 6.0. Conclusion: Screening for CRCs using stool-based mSDC2 testing combined with colonoscopy has a high lesion detection rate and a high cost-effectiveness ratio. This is a CRC screening strategy that deserves to be promoted in China.
Male ; Humans ; Female ; Adult ; Middle Aged ; Cross-Sectional Studies ; Early Detection of Cancer/methods* ; Colorectal Neoplasms/pathology* ; Colonoscopy/methods* ; Mass Screening/methods* ; Adenoma/diagnosis* ; DNA ; Syndecan-2/genetics*

Objective: This cross-sectional investigation aimed to determine the incidence, clinical characteristics, prognosis, and related risk factors of olfactory and gustatory dysfunctions related to infection with the SARS-CoV-2 Omicron strain in mainland China. Methods: Data of patients with SARS-CoV-2 from December 28, 2022, to February 21, 2023, were collected through online and offline questionnaires from 45 tertiary hospitals and one center for disease control and prevention in mainland China. The questionnaire included demographic information, previous health history, smoking and alcohol drinking, SARS-CoV-2 vaccination, olfactory and gustatory function before and after infection, other symptoms after infection, as well as the duration and improvement of olfactory and gustatory dysfunction. The self-reported olfactory and gustatory functions of patients were evaluated using the Olfactory VAS scale and Gustatory VAS scale. Results: A total of 35 566 valid questionnaires were obtained, revealing a high incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain (67.75%). Females(χ2=367.013, P<0.001) and young people(χ2=120.210, P<0.001) were more likely to develop these dysfunctions. Gender(OR=1.564, 95%CI: 1.487-1.645), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), oral health status (OR=0.881, 95%CI: 0.839-0.926), smoking history (OR=1.152, 95%CI=1.080-1.229), and drinking history (OR=0.854, 95%CI: 0.785-0.928) were correlated with the occurrence of olfactory and taste dysfunctions related to SARS-CoV-2(above P<0.001). 44.62% (4 391/9 840) of the patients who had not recovered their sense of smell and taste also suffered from nasal congestion, runny nose, and 32.62% (3 210/9 840) suffered from dry mouth and sore throat. The improvement of olfactory and taste functions was correlated with the persistence of accompanying symptoms(χ2=10.873, P=0.001). The average score of olfactory and taste VAS scale was 8.41 and 8.51 respectively before SARS-CoV-2 infection, but decreased to3.69 and 4.29 respectively after SARS-CoV-2 infection, and recovered to 5.83and 6.55 respectively at the time of the survey. The median duration of olfactory and gustatory dysfunctions was 15 days and 12 days, respectively, with 0.5% (121/24 096) of patients experiencing these dysfunctions for more than 28 days. The overall self-reported improvement rate of smell and taste dysfunctions was 59.16% (14 256/24 096). Gender(OR=0.893, 95%CI: 0.839-0.951), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), history of head and facial trauma(OR=1.180, 95%CI: 1.036-1.344, P=0.013), nose (OR=1.104, 95%CI: 1.042-1.171, P=0.001) and oral (OR=1.162, 95%CI: 1.096-1.233) health status, smoking history(OR=0.765, 95%CI: 0.709-0.825), and the persistence of accompanying symptoms (OR=0.359, 95%CI: 0.332-0.388) were correlated with the recovery of olfactory and taste dysfunctions related to SARS-CoV-2 (above P<0.001 except for the indicated values). Conclusion: The incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain is high in mainland China, with females and young people more likely to develop these dysfunctions. Active and effective intervention measures may be required for cases that persist for a long time. The recovery of olfactory and taste functions is influenced by several factors, including gender, SARS-CoV-2 vaccination status, history of head and facial trauma, nasal and oral health status, smoking history, and persistence of accompanying symptoms.
Female ; Humans ; Adolescent ; SARS-CoV-2 ; Smell ; COVID-19/complications* ; Cross-Sectional Studies ; COVID-19 Vaccines ; Incidence ; Olfaction Disorders/etiology* ; Taste Disorders/etiology* ; Prognosis