1.Connotation of Xiao Chaihu Decoction combined with Maxing Shigan Decoction based on severe cases and modern pathophysiological mechanism and application for severe pulmonary infection and acute exacerbation of chronic obstructive pulmonary disease in critical care medicine.
China Journal of Chinese Materia Medica 2023;48(10):2606-2612
		                        		
		                        			
		                        			Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic herbal formula. All of them are derived from Treatise on Cold Damage(Shang Han Lun) by ZHANG Zhong-jing. This combination has the effects of harmonizing lesser yang, relieving exterior syndrome, clearing lung heat, and relieving panting. It is mainly used for treating the disease involving the triple-Yang combination of diseases and accumulation of pathogenic heat in the lung. Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic combination for the treatment of exogenous diseases involving the triple-Yang combination. They are commonly used in exogenous diseases, especially in the north of China. This combination is also the main treatment strategy for coronavirus disease 2019(COVID-19) accompanied by fever and cough. Maxing Shigan Decoction is a classical herbal formula for treating the syndrome of phlegm-heat obstructing the lung. "Dyspnea after sweating" suggests the accumulation of pathogenic heat in the lung. Patients with mild symptoms may develop cough and asthma along with forehead sweating, and those in critical severe may develop whole-body sweating, especially the front chest. Modern medicine believes that the above situation is related to lung infection. "Mild fever" refers to syndromes rather than pathogenesis. It does not mean that the heat syndrome is not heavy, instead, it suggests that severe heat and inflammation have occurred. The indications of Xiao Chaihu Decoction combined with Maxing Shigan Decoction are as follows.(1) In terms of diseases, it is suitable for the treatment of viral pneumonia, bronchopneumonia, lobar pneumonia, mycoplasma pneumonia, COVID-19 infection, measles with pneumonia, severe acute respiratory syndrome(SARS), avian influenza, H1N1 influenza, chronic obstructive pulmonary disease with acute exacerbation, pertussis, and other influenza and pneumonia.(2) In terms of syndromes, it can be used for the syndromes of bitter mouth, dry pharynx, vertigo, loss of appetite, vexation, vomiting, and fullness and discomfort in the chest and hypochondrium. It can also be used to treat alternate attacks of chill and fever and different degrees of fever, as well as chest tightness, cough, asthma, expectoration, dry mouth, wanting cold drinks, feeling agitated, sweating, yellow urine, dry stool, red tongue, yellow or white fur, and floating, smooth, and powerful pulse, especially the right wrist pulse.
		                        		
		                        		
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Cough
		                        			;
		                        		
		                        			Syndrome
		                        			;
		                        		
		                        			Influenza A Virus, H1N1 Subtype
		                        			;
		                        		
		                        			Influenza, Human
		                        			;
		                        		
		                        			COVID-19
		                        			;
		                        		
		                        			Drugs, Chinese Herbal/pharmacology*
		                        			;
		                        		
		                        			Lung
		                        			;
		                        		
		                        			Pulmonary Disease, Chronic Obstructive/drug therapy*
		                        			;
		                        		
		                        			Asthma
		                        			;
		                        		
		                        			Critical Care
		                        			;
		                        		
		                        			Medicine, Chinese Traditional
		                        			
		                        		
		                        	
2.Epidemiologic characteristics and influencing factors of influenza outbreaks in Guangdong Province, 2015-2022.
Ya Li ZHUANG ; Jie LU ; Shu Kai WU ; Zhan Hui ZHANG ; Zhi Mei WEI ; Yi Hong LI ; Ting HU ; Min KANG ; Ai Ping DENG
Chinese Journal of Epidemiology 2023;44(6):942-948
		                        		
		                        			
		                        			Objective: To grasp the epidemiological characteristics of influenza outbreaks in Guangdong Province by analyzing the outbreaks of influenza-like cases reported in Guangdong Province from January 2015 to the end of August 2022. Methods: In response to the outbreak of epidemics in Guangdong Province from 2015 to 2022, information on on-site epidemic control was collected, and epidemiological analysis was conducted to describe the characteristics of the epidemics. The factors that influence the intensity and duration of the outbreak were determined through a logistic regression model. Results: A total of 1 901 influenza outbreaks were reported in Guangdong Province, with an overall incidence of 2.05%. Most outbreak reports occurred from November to January of the following year (50.24%, 955/1 901) and from April to June (29.88%, 568/1 901). A total of 59.23% (1 126/1 901) of the outbreaks were reported in the Pearl River Delta region, and primary and secondary schools were the main places where outbreaks occurred (88.01%, 1 673/1 901). Outbreaks with 10-29 cases were the most common (66.18%, 1 258/1 901), and most outbreaks lasted less than seven days (50.93%,906/1 779). The size of the outbreak was related to the nursery school (aOR=0.38, 95%CI:0.15-0.93), the Pearl River Delta region (aOR=0.60, 95%CI:0.44-0.83), the time interval between the onset of the first case and the time of report (>7 days compared with ≤3 days: aOR=3.01, 95%CI:1.84-4.90), the influenza A(H1N1) (aOR=2.02, 95%CI:1.15-3.55) and the influenza B (Yamagata) (aOR=2.94, 95%CI: 1.50-5.76). The duration of outbreaks was related to school closures (aOR=0.65, 95%CI: 0.47-0.89), the Pearl River Delta region (aOR=0.65, 95%CI: 0.50-0.83) and the time interval between the onset of the first case and the time of report (>7 days compared with ≤3 days: aOR=13.33, 95%CI: 8.80-20.19; 4-7 days compared with ≤3 days: aOR=2.56, 95%CI: 1.81-3.61). Conclusions: An influenza outbreak in Guangdong Province exhibits two peaks, one in the winter and spring seasons and the other in the summer. Primary and secondary schools are high-risk areas, and early reporting of outbreaks is critical for controlling influenza outbreaks in schools. Furthermore, comprehensive measures should be taken to prevent the spread of the epidemic.
		                        		
		                        		
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Influenza A Virus, H1N1 Subtype
		                        			;
		                        		
		                        			Influenza, Human/epidemiology*
		                        			;
		                        		
		                        			Disease Outbreaks
		                        			;
		                        		
		                        			Epidemics
		                        			;
		                        		
		                        			China/epidemiology*
		                        			
		                        		
		                        	
3.Structural characterization of PCP-Ⅰ from Poria as vaccine adjuvant and its hydrolytic oligosaccharide.
Jia-Nan GU ; Gui-Xin LIU ; Shuai LI ; Hao MA ; Jun-Jie SHAN
China Journal of Chinese Materia Medica 2023;48(16):4429-4437
		                        		
		                        			
		                        			Poria is an important medical herb in clinic. The authors isolated a polysaccharide(PCP-Ⅰ) from Poria in previous studies, which is composed of galactose, mannose, fucose and glucose. PCP-Ⅰ exhibited significant adjuvant effects on H1N1 influenza vaccine, hepatitis B surface antigen and anthrax protective antigen, and its adjuvant activity was stronger than aluminium adjuvant. However, little is known about the chemical structure of PCP-Ⅰ at present. In this study, weak acid hydrolysis was used to obtain the backbone oligosaccharide of PCP-Ⅰ. Then periodate oxidation, Smith degradation, methylation analysis, Fourier transform infrared spectroscopy(FT-IR), nuclear magnetic resonance(NMR) and gas chromatography-mass spectrometry(GC-MS) were performed to investigate the chemical structural features of PCP-Ⅰ and its hydrolytic oligosaccharide(PCP-Ⅰ-hy-1). These results suggested that the backbone of PCP-Ⅰ was composed of galactose with α anomeric carbon and β anomeric carbon. The linking residues of galactan are(1→),(l→6) and(1→2,6).
		                        		
		                        		
		                        		
		                        			Adjuvants, Vaccine
		                        			;
		                        		
		                        			Poria
		                        			;
		                        		
		                        			Hydrolysis
		                        			;
		                        		
		                        			Spectroscopy, Fourier Transform Infrared
		                        			;
		                        		
		                        			Galactose
		                        			;
		                        		
		                        			Influenza A Virus, H1N1 Subtype
		                        			;
		                        		
		                        			Polysaccharides/chemistry*
		                        			;
		                        		
		                        			Oligosaccharides
		                        			;
		                        		
		                        			Carbon
		                        			
		                        		
		                        	
4.Genetic characteristics of the first human infection with the G4 genotype eurasian avian-like H1N1 swine influenza virus in Shaanxi Province,China.
Long QIN ; Jun Jun ZHANG ; Bin CHEN ; Shi Feng WANG ; Peng Bo YU
Chinese Journal of Preventive Medicine 2023;57(9):1434-1439
		                        		
		                        			
		                        			Objective: To analyze the genetic characteristics of the first human infection with the G4 genotype of Eurasian avian H1N1 swine influenza virus (EA H1N1 SIV) in Shaanxi Province. Methods: The patient's throat swab samples were collected, and MDCK cells were inoculated for virus isolation to obtain the virus strain. The whole genome deep sequencing method was used to obtain the eight gene segments of the isolated strain. The nucleotide homology analysis was conducted through the Blast program in the GenBank database, and a phylogenetic tree was constructed to analyze the genetic characteristics of the virus. Results: The throat swab specimens of the case were confirmed as EA H1N1 SIV in the laboratory, and the isolated strain was named A/Shaanxi-Weicheng/1351/2022(H1N1v). Homology analysis found that the PB2, NP, HA, NA, and M genes of this isolate had the highest nucleotide homology with A/swing/Beijing/0301/2018 (H1N1), about 98.29%, 98.73%, 97.41%, 97.52%, and 99.08%, respectively. The phylogenetic tree showed that the isolate belonged to G4 genotype EA H1N1 SIV, with PB2, PB1, PA, NP and M genes from pdm/09 H1N1, HA and NA genes from EA H1N1, and NS gene from Triple-reassortant H1N1. The cleavage site of the HA protein was IPSIQSR↓G, which was the molecular characteristic of the low pathogenic influenza virus. No amino acid mutations associated with neuraminidase inhibitors were found in the NA protein. PB2 protein 701N mutation, PA protein P224S mutation, NP protein Q357K mutation, M protein P41A mutation, and NS protein 92D all indicated its enhanced adaptability to mammals. Conclusion: The patient is the first human infection with G4 genotype EA H1N1 SIV in Shaanxi province. The virus is low pathogenic, but its adaptability to mammals is enhanced. Therefore, it is necessary to strengthen the monitoring of such SIVs.
		                        		
		                        		
		                        		
		                        			Swine
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Influenza A Virus, H1N1 Subtype/genetics*
		                        			;
		                        		
		                        			Phylogeny
		                        			;
		                        		
		                        			Genotype
		                        			;
		                        		
		                        			Influenza A virus
		                        			;
		                        		
		                        			China
		                        			;
		                        		
		                        			Birds
		                        			;
		                        		
		                        			Mammals
		                        			
		                        		
		                        	
5.Technical guidelines for seasonal influenza vaccination in China (2023-2024).
Chinese Journal of Epidemiology 2023;44(10):1507-1530
		                        		
		                        			
		                        			Influenza is an acute respiratory infectious disease that is caused by the influenza virus, which seriously affects human health. The influenza virus has frequent antigenic drifts that can facilitate escape from pre-existing population immunity and lead to the rapid spread and annual seasonal epidemics. Influenza outbreaks occur in crowded settings, such as schools, kindergartens, and nursing homes. Seasonal influenza epidemics can cause 3-5 million severe cases and 290 000-650 000 respiratory disease-related deaths worldwide every year. Pregnant women, infants, adults aged 60 years and older, and individuals with comorbidities or underlying medical conditions are at the highest risk of severe illness and death from influenza. China has experienced a influenza epidemic season dominated by A (H1N1) pdm09 subtype from mid-February to the end of April 2023, and the intensity was slightly higher than the epidemic year before the COVID-19. We may face the risk of interaction or co-circulation of respiratory infectious diseases such as COVID-19 and influenza during the coming season. Annual influenza vaccination is an effective way to prevent influenza, reduce influenza-related severe illness and death, and reduce the harm caused by influenza-related diseases and the use of medical resources. The currently approved influenza vaccines in China include trivalent inactivated influenza vaccine (IIV3), quadrivalent inactivated influenza vaccine (IIV4), and trivalent live attenuated influenza vaccine (LAIV3). IIV3 and IIV4 are produced as a split virus vaccine and subunit vaccine; LAIV3 is a live, attenuated virus vaccine. The influenza vaccine is a non-immunization program vaccine, which means that residents are voluntarily vaccinated. China CDC has issued "Technical guidelines for seasonal influenza vaccination in China" every year from 2018 to 2022. Over the past year, new research evidence has been published at home and abroad, and new influenza vaccines have been approved for marketing in China. To better guide the prevention and control of influenza and vaccination in China, the National Immunization Advisory Committee (NIAC) Technical Working Group (TWG), Influenza Vaccination TWG updated and revised the 2022-2023 technical guidelines with the latest research progress into the "Technical guidelines for seasonal influenza vaccination in China (2023-2024)." The new version has updated five key areas: (1) new research evidence-especially research conducted in China-has been added, including new estimates of the burden of influenza disease, assessments of influenza vaccine effectiveness and safety, and analyses of the cost-effectiveness of influenza vaccination; (2) policies and measures for influenza prevention and control were issued by the National Health Commission of the People's Republic of China and National Disease Control and Prevention Administrationy over the past year; (3) influenza vaccines approved for marketing in China this year; (4) composition of trivalent and quadrivalent influenza vaccines for the 2023-2024 northern hemisphere influenza season; and (5) recommendations for influenza vaccination during the 2023-2024 influenza season. The 2023-2024 guidelines recommend that all people aged 6 months and above who have no contraindications should get the influenza vaccination. For adults aged ≥18 years, co-administration of inactivated SARS-CoV-2 and influenza vaccines in separate arms is acceptable regarding immunogenicity and reactogenicity. For people under 18 years of age, there should be at least 14 days between influenza vaccination and COVID-19 vaccination. The guidelines express no preference for influenza vaccine type or manufacturer-any approved, age-appropriate influenza vaccines can be used. Combining the influenza epidemic tendency and the prevention and control strategy of multiple diseases, the technical guidelines recommend priority vaccination of the following high-risk groups during the upcoming 2023-2024 influenza season to minimize harm from influenza: (1) healthcare workers, including clinical doctors and nurses, public health professionals, and quarantine professionals; (2) adults ≥60 years of age; (3) individuals with comorbidities; (4) people living in nursing homes or welfare homes and staff who take care of vulnerable, at-risk individuals; (5) pregnant women; (6) children 6-59 months of age; (7) family members and caregivers of infants under 6 months of age; and (8) people who work in nursery institutions, primary and secondary schools, and supervision places. Children 6 months to 8 years of age who receive inactivated influenza vaccine for the first time should receive two doses, with an inter-dose interval of 4 or more weeks. Children who previously received the influenza vaccine and anyone aged 9 years or older need only one dose. LAIV is recommended only for a single dose regardless of the previous influenza vaccination. Vaccination should begin as soon as influenza vaccines become available, and preferably should be completed before the onset of the local influenza season. Repeated influenza vaccination during a single influenza season is not recommended. Vaccination clinics should provide immunization services throughout the epidemic season. Pregnant women can receive inactivated influenza vaccine at any stage of pregnancy. These guidelines are intended for use by staff of CDCs, healthcare workers, maternity and child care institutions and immunization clinic staff members who work on influenza control and prevention. The guidelines will be updated periodically as new evidence becomes available.
		                        		
		                        		
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Infant
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Pregnancy
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Adolescent
		                        			;
		                        		
		                        			Infant, Newborn
		                        			;
		                        		
		                        			Influenza Vaccines
		                        			;
		                        		
		                        			Influenza, Human/drug therapy*
		                        			;
		                        		
		                        			Seasons
		                        			;
		                        		
		                        			COVID-19 Vaccines
		                        			;
		                        		
		                        			Influenza A Virus, H1N1 Subtype
		                        			;
		                        		
		                        			Vaccination
		                        			;
		                        		
		                        			COVID-19
		                        			;
		                        		
		                        			China/epidemiology*
		                        			;
		                        		
		                        			Vaccines, Attenuated
		                        			
		                        		
		                        	
6.Genetic characteristics of the first human infection with the G4 genotype eurasian avian-like H1N1 swine influenza virus in Shaanxi Province,China.
Long QIN ; Jun Jun ZHANG ; Bin CHEN ; Shi Feng WANG ; Peng Bo YU
Chinese Journal of Preventive Medicine 2023;57(9):1434-1439
		                        		
		                        			
		                        			Objective: To analyze the genetic characteristics of the first human infection with the G4 genotype of Eurasian avian H1N1 swine influenza virus (EA H1N1 SIV) in Shaanxi Province. Methods: The patient's throat swab samples were collected, and MDCK cells were inoculated for virus isolation to obtain the virus strain. The whole genome deep sequencing method was used to obtain the eight gene segments of the isolated strain. The nucleotide homology analysis was conducted through the Blast program in the GenBank database, and a phylogenetic tree was constructed to analyze the genetic characteristics of the virus. Results: The throat swab specimens of the case were confirmed as EA H1N1 SIV in the laboratory, and the isolated strain was named A/Shaanxi-Weicheng/1351/2022(H1N1v). Homology analysis found that the PB2, NP, HA, NA, and M genes of this isolate had the highest nucleotide homology with A/swing/Beijing/0301/2018 (H1N1), about 98.29%, 98.73%, 97.41%, 97.52%, and 99.08%, respectively. The phylogenetic tree showed that the isolate belonged to G4 genotype EA H1N1 SIV, with PB2, PB1, PA, NP and M genes from pdm/09 H1N1, HA and NA genes from EA H1N1, and NS gene from Triple-reassortant H1N1. The cleavage site of the HA protein was IPSIQSR↓G, which was the molecular characteristic of the low pathogenic influenza virus. No amino acid mutations associated with neuraminidase inhibitors were found in the NA protein. PB2 protein 701N mutation, PA protein P224S mutation, NP protein Q357K mutation, M protein P41A mutation, and NS protein 92D all indicated its enhanced adaptability to mammals. Conclusion: The patient is the first human infection with G4 genotype EA H1N1 SIV in Shaanxi province. The virus is low pathogenic, but its adaptability to mammals is enhanced. Therefore, it is necessary to strengthen the monitoring of such SIVs.
		                        		
		                        		
		                        		
		                        			Swine
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Influenza A Virus, H1N1 Subtype/genetics*
		                        			;
		                        		
		                        			Phylogeny
		                        			;
		                        		
		                        			Genotype
		                        			;
		                        		
		                        			Influenza A virus
		                        			;
		                        		
		                        			China
		                        			;
		                        		
		                        			Birds
		                        			;
		                        		
		                        			Mammals
		                        			
		                        		
		                        	
7.Analysis of non-bacterial respiratory pathogens in children in Ningbo City from 2019 to 2021.
Cheng Bo ZHOU ; Wen Bo LU ; Yi Zhi ZHANG ; Wen Yuan LIU ; Yi Bo CHEN ; Yan Qiao QIAN ; Li Hua ZHU
Chinese Journal of Preventive Medicine 2022;56(12):1751-1758
		                        		
		                        			
		                        			Objective: To investigate the distribution characteristics of respiratory non-bacterial pathogens in children in Ningbo from 2019 to 2021. Methods: A retrospective analysis was performed on 23 733 children with respiratory tract infection who visited the department of pediatrics of Ningbo Women and Children's Hospital from July 2019 to December 2021. There were 13 509 males (56.92%) and 10 224 females (43.08%), with an age range of 1 day to 18 years old. There were 981 cases in the neonatal group (younger than 1 month old), 5 880 cases in the infant group (1 month to younger than 1 year old), 6 552 cases in the toddler group (1 to younger than 3 years old), 7 638 cases in the preschool group (3 to younger than 7 years old), and 2 682 cases in the school-age group (7 to 18 years old). Thirteen respiratory pathogens were detected by multiple polymerase chain reaction (PCR) based on capillary electrophoresis, and SPSS 23.0 software was used for statistical analysis of the results, the count data were expressed as percentages, and the χ2 test was used for comparison between groups. Results: Of the 23 733 specimens, 13 330 were positive for respiratory pathogens, with a total positive rate of 56.17%. The positive rates of human rhinovirus (HRV) 24.05% (5 707/23 733), human respiratory syncytial virus (HRSV) 10.45% (2 480/2 3733) and mycoplasma pneumoniae (Mp) 7.03% (1 668/23 733) were in the first three. The positive rates of pathogens in the male and female children were 57.47% (7 763/13 509) and 54.45% (5 567/10 224), respectively, and the difference was statistically significant (χ2=21.488, P<0.001). The positive rates in the neonatal group, infant group, toddler group, preschool group, and school-age group were 31.80% (312/981), 54.71% (3 217/5 880), 63.23% (4 143/6 552), 59.83% (4 570/7 638), 40.57% (1 088/2 682), respectively, and the difference among the groups was statistically significant (χ2=681.225, P<0.001). The single infection rate was 47.43% (11 256/23 733), the mixed infection rate of two or more pathogens was 8.74% (2 074/23 733), most of which were mixed infections of two pathogens. HRV, HADV, HCOV, Ch disseminated in the whole year. HRSV, HMPV, Boca, HPIV occurred mostly in fall and winter. The positive rates of FluA, FluB, Mp were at a low level after the corona virus disease 2019 (COVID-19) epidemic (2020 and 2021). The positive rates of FluA, H1N1, H3N2, FluB, HADV, Mp in 2020 were significantly lower than in 2019 (P<0.05). The positive rates of HPIV, HRV, HCOV, Ch in 2020 were significantly higher than in 2019 (P<0.05). The positive rates of FluA, H1N1, H3N2, HPIV, HCOV, Mp, Ch in 2021 were significantly lower than in 2020 (P<0.05). The positive rates of Boca, HMPV, HRSV in 2021 were significantly higher than in 2020 (P<0.05). Conclusion: From 2019 to 2021, the main non-bacterial respiratory pathogens of children in Ningbo City were Mp and HRV, and the detection rates of respiratory pathogens varied among different ages, seasons and genders.
		                        		
		                        		
		                        		
		                        			Infant
		                        			;
		                        		
		                        			Infant, Newborn
		                        			;
		                        		
		                        			Child
		                        			;
		                        		
		                        			Child, Preschool
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Adolescent
		                        			;
		                        		
		                        			Influenza A Virus, H1N1 Subtype
		                        			;
		                        		
		                        			Influenza A Virus, H3N2 Subtype
		                        			;
		                        		
		                        			Retrospective Studies
		                        			;
		                        		
		                        			COVID-19
		                        			;
		                        		
		                        			Respiratory Tract Infections/epidemiology*
		                        			;
		                        		
		                        			Respiratory Syncytial Virus, Human
		                        			;
		                        		
		                        			Mycoplasma pneumoniae
		                        			;
		                        		
		                        			Coinfection
		                        			
		                        		
		                        	
8.Effect and mechanism of acupoint injection on influenza A virus induced pneumonia in mice.
Ming-Jiang LIU ; Zi-Yi HAN ; Hui-Wen WANG ; Cheng-Long YU ; Xiao-Long XU ; Tao QIN ; Jin-Gui LI ; Qing-Quan LIU
Chinese Acupuncture & Moxibustion 2022;42(9):1017-1023
		                        		
		                        			OBJECTIVE:
		                        			To investigate the effect and mechanism of acupoint injection with 0.1% vitamin C+vitamin B complex solution (VC+VBCo) at "Tiantu" (CV 22), "Quchi" (LI 11) and "Zusanli" (ST 36) in mouse model of pneumonia induced by influenza A virus (A/PR/8/34 [H1N1], PR8).
		                        		
		                        			METHODS:
		                        			Sixty male ICR mice were randomized into 6 groups, i.e. control group, model group, acupoint injection group, intraperitoneal injection group, non-target point group and ribavirin group, 10 mice in each one. Except the control group, the pneumonia models were induced by slow nasal dripping PR8 virus in the other groups. On the 2nd day of experiment, VC+VBCo solution, 40 μL was injected at "Tiantu" (CV 22), "Quchi" (LI 11, left) and "Zusanli" (ST 36, left) in the acupoint injection group; VC+VBCo solution, 120 μL was injected intraperitoneally in the intraperitoneal injection group; VC+VBCo solution, 40 μL was injected at non-target acupoints (0.5 cm away from "Tiantu" [CV 22] to the left side, "Quchi" [LI 11, left] and "Zusanli" [ST 36, left]) in the non-target point group; and ribavirin solution, 120 μL was injected intraperitoneally in the ribavirin group. The intervention was delivered once daily, for consecutive 7 days. Three parallel experiments were undertaken. The mean death rate and survival time were assessed in each group, the body mass and lung index were compared among groups. Using HE staining, the morphology of lung tissue was observed; and with real-time fluorescence quantitative PCR, viral load in lung tissue was detected. The concentrations of inflammatory factors (tumor necrosis factor α [TNF-α], interleukin [IL]-1β, IL-10) were detected in lung tissue of each group using ELISA; and those of oxidative stress markers (superoxide dismutase [SOD], glutathione peroxidase [GSH-Px], malondialdehyde [MDA]) were detected with chemiluminescence method.
		                        		
		                        			RESULTS:
		                        			Compared with the control group, the body mass was decreased and lung index was increased in the model group (P<0.01). In comparison with the model group, body mass was increased in the acupoint injection group (P<0.05), lung index was reduced in the acupoint injection group the and ribavirin group (P<0.05); the mean death rate was decreased and the mean survival time prolonged in the mice of the acupoint injection group (P<0.01, P<0.05); and the mean death rate was reduced in the mice of the ribavirin group (P<0.05). In the model group, the alveolar structure was not integral, the alveolar septum was thickened, inflammatory cells were infiltrated and red blood cells exudated seriously (P<0.01). Compared with the model group, in the acupoint injection group and the ribavirin group, the alveolar structure was integral, the thickened alveolar septum was alleviated; and the infiltration of inflammatory cells and the exudation of red blood cells were reduced remarkably. The viral load was reduced in the mice of the ribavirin group when compared with the model group (P<0.01). Compared with the control group, the concentrations of TNF-α, IL-1β and MDA in lung tissue were increased and those of IL-10, SOD and GSH-Px were reduced in the model group (P<0.01). In the acupoint injection group and the ribavirin group, the concentrations of TNF-α, IL-1β and MDA were reduced in lung tissue and those of IL-10, SOD and GSH-Px were increased (P<0.05, P<0.01) when compared with the model group.
		                        		
		                        			CONCLUSION
		                        			Acupoint injection with VC+VBCo solution may alleviate inflammatory responses and oxidative stress in lung tissue of the PR8-induced pneumonia mice, improve survival rate and prolong the survival time in the case of no effect of the viral load.
		                        		
		                        		
		                        		
		                        			Acupuncture Points
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Influenza A Virus, H1N1 Subtype
		                        			;
		                        		
		                        			Influenza A virus
		                        			;
		                        		
		                        			Interleukin-10
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Mice
		                        			;
		                        		
		                        			Mice, Inbred ICR
		                        			;
		                        		
		                        			Pneumonia
		                        			;
		                        		
		                        			Ribavirin/therapeutic use*
		                        			;
		                        		
		                        			Superoxide Dismutase
		                        			;
		                        		
		                        			Tumor Necrosis Factor-alpha
		                        			
		                        		
		                        	
9.Perceived stress and associated factors among healthcare workers in a primary healthcare setting: the Psychological Readiness and Occupational Training Enhancement during COVID-19 Time (PROTECT) study.
Eng Sing LEE ; Shu Yun TAN ; Poay Sian Sabrina LEE ; Hui Li KOH ; Shok Wen Winnie SOON ; Kang SIM ; Wern Ee TANG ; Phui-Nah CHONG
Singapore medical journal 2022;63(1):20-27
		                        		
		                        			INTRODUCTION:
		                        			Disease outbreaks such as the COVID-19 pandemic significantly heighten the psychological stress of healthcare workers (HCWs). The objective of this study was to understand the factors contributing to the perceived stress levels of HCWs in a public primary care setting during the COVID-19 pandemic, including their training, protection and support (TPS), job stress (JS), and perceived stigma and interpersonal avoidance.
		                        		
		                        			METHODS:
		                        			This cross-sectional study using an electronic self-administered questionnaire was conducted at the National Healthcare Group Polyclinics in March 2020. Data was collected anonymously. Analysis was performed using regression modelling.
		                        		
		                        			RESULTS:
		                        			The response rate was 69.7% (n = 1,040). The mean perceived stress level of HCWs in various departments ranged from 17.2 to 20.3. Respondents who reported higher perceived stress were those who made alternative living arrangements, were more affected by the current pandemic, reported higher JS and were Muslims. Respondents who reported lower perceived stress were those who had been through the severe acute respiratory syndrome epidemic in 2003 and H1N1 pandemic in 2009 as HCWs, and those who had higher confidence in the organisation's TPS.
		                        		
		                        			CONCLUSION
		                        			All HCWs, regardless of their scope of work, were similarly stressed by the current pandemic compared to the general population. Improving the confidence of HCWs in their training, protection and the support of personal protective equipment, and retaining experienced HCWs who can provide advice and emotional support to younger colleagues are important. Adequate psychological support for HCWs in the pandemic can be transformed into reserves of psychological resilience for future disease outbreaks.
		                        		
		                        		
		                        		
		                        			COVID-19/epidemiology*
		                        			;
		                        		
		                        			Cross-Sectional Studies
		                        			;
		                        		
		                        			Health Personnel/psychology*
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Influenza A Virus, H1N1 Subtype
		                        			;
		                        		
		                        			Pandemics
		                        			;
		                        		
		                        			Primary Health Care
		                        			;
		                        		
		                        			SARS-CoV-2
		                        			;
		                        		
		                        			Stress, Psychological
		                        			
		                        		
		                        	
10.A broadly neutralizing human monoclonal antibody against the hemagglutinin of avian influenza virus H7N9.
Jingxin LI ; Li ZHANG ; Linlin BAO ; Yuxiao WANG ; Lin QIU ; Jialei HU ; Rong TANG ; Huiyan YU ; Jun SHAN ; Yan LI ; Chuan QIN ; Fengcai ZHU
Chinese Medical Journal 2022;135(7):799-805
		                        		
		                        			BACKGROUND:
		                        			The new emerging avian influenza A H7N9 virus, causing severe human infection with a mortality rate of around 41%. This study aims to provide a novel treatment option for the prevention and control of H7N9.
		                        		
		                        			METHODS:
		                        			H7 hemagglutinin (HA)-specific B cells were isolated from peripheral blood plasma cells of the patients previously infected by H7N9 in Jiangsu Province, China. The human monoclonal antibodies (mAbs) were generated by amplification and cloning of these HA-specific B cells. First, all human mAbs were screened for binding activity by enzyme-linked immunosorbent assay. Then, those mAbs, exhibiting potent affinity to recognize H7 HAs were further evaluated by hemagglutination-inhibiting (HAI) and microneutralization in vitro assays. Finally, the lead mAb candidate was selected and tested against the lethal challenge of the H7N9 virus using murine models.
		                        		
		                        			RESULTS:
		                        			The mAb 6-137 was able to recognize a panel of H7 HAs with high affinity but not HA of other subtypes, including H1N1 and H3N2. The mAb 6-137 can efficiently inhibit the HA activity in the inactivated H7N9 virus and neutralize 100 tissue culture infectious dose 50 (TCID50) of H7N9 virus (influenza A/Nanjing/1/2013) in vitro, with neutralizing activity as low as 78 ng/mL. In addition, the mAb 6-137 protected the mice against the lethal challenge of H7N9 prophylactically and therapeutically.
		                        		
		                        			CONCLUSION
		                        			The mAb 6-137 could be an effective antibody as a prophylactic or therapeutic biological treatment for the H7N9 exposure or infection.
		                        		
		                        		
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Antibodies, Monoclonal/therapeutic use*
		                        			;
		                        		
		                        			Antibodies, Neutralizing/therapeutic use*
		                        			;
		                        		
		                        			Antibodies, Viral
		                        			;
		                        		
		                        			Hemagglutinins
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Influenza A Virus, H1N1 Subtype
		                        			;
		                        		
		                        			Influenza A Virus, H3N2 Subtype
		                        			;
		                        		
		                        			Influenza A Virus, H7N9 Subtype
		                        			;
		                        		
		                        			Influenza Vaccines
		                        			;
		                        		
		                        			Influenza in Birds
		                        			;
		                        		
		                        			Influenza, Human/prevention & control*
		                        			;
		                        		
		                        			Mice
		                        			
		                        		
		                        	
            
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