Objective:To compare the epidemiological and clinical characteristics of hospitalized children with respiratory syncytial virus (RSV) infection in Kunming among the pre-and post-COVID-19 era, and to establish a prediction model for severe RSV infection in children during the post-COVID-19 period.Methods:This was a retrospective study. Clinical and laboratory data were collected from 959 children hospitalized with RSV infection in the Department of Pulmonary and Critical Care Medicine at Kunming Children′s Hospital during January to December 2019 and January to December 2023. Patients admitted in 2019 were defined as the pre-COVID-19 group, while those admitted in 2023 were classified as the post-COVID-19 group. Epidemiological and clinical characteristics were compared between the two groups. Subsequently, comparison of the clinical severity among the two groups was performed based on propensity score matching (PSM). Furthermore, the subjects in the post-COVID-19 group were divided into severe and non-severe groups based on clinical severity. Chi-square test and Mann-Whitney U test were used for pairwise comparison between groups, and multivariate Logistic regression was applied for the identification of independent risk factors and construction of the prediction model. The receiver operating characteristic (ROC) curve and calibration curve were employed to evaluate the predictive performance of this model. Results:Among the 959 children hospitalized with RSV infection, there were 555 males and 404 females, with an onset age of 15.4 (7.3, 28.5) months. Of which, there were 331 cases in the pre-COVID-19 group and 628 cases in the post-COVID-19 group. The peak period of RSV hospitalization in the post-COVID-19 group were from May to October 2023, and the monthly number of inpatients for each of these months were as follows: 72 cases (11.5%), 98 cases (15.6%), 128 cases (20.4%), 101 cases (16.1%), 65 cases (10.4%), and 61 cases (9.7%), respectively. After PSM for general data, 267 cases were matched in each group. The proportion of wheezing in the post-COVID-19 group was lower than that in the pre-COVID-19 group (109 cases (40.8%) vs. 161 cases (60.3%), χ2=20.26, P<0.001), while the incidences of fever, tachypnea, seizures, severe case, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein and interleukin-6 levels were all higher than those in the pre-COVID-19 group (146 cases (54.7%) vs. 119 cases (44.6%), 117 cases (43.8%) vs. 89 cases (33.3%), 37 cases (13.9%) vs. 14 cases (5.2%), 69 cases (25.8%) vs. 45 cases (16.9%), 3.6 (1.9, 6.4) vs. 2.3 (1.8, 4.6), 9.9 (7.1, 15.2) vs. 7.8 (4.5, 13.9) mg/L, 20.5 (15.7, 30.4) vs. 17.2 (11.0, 26.9) ng/L, χ2=5.46, 6.36, 11.47, 6.42, Z=4.13, 3.06, 2.96, all P<0.05). There were 252 cases and 107 cases with co-infection in the post-and pre-COVID-19 groups, respectively. The proportion of triple and quadruple infection in the post-COVID-19 group was higher than that in the pre-COVID-19 group (59 cases (23.4%) vs. 13 cases (12.1%), 30 cases (11.9%) vs. 5 cases (4.7%), χ2=5.94, 4.46, both P<0.05). Among the 252 cases with co-infection in post-COVID-19 group, the most prevalent pathogens involving in co-infections, in order, were Mycoplasma pneumoniae 56 cases (22.2%), Influenza A virus 53 cases (21.0%), Rhinovirus 48 cases (19.0%), Parainfluenza virus 35 cases (13.9%), and Adenovirus 28 cases (11.1%).The result of multivariate Logistic regression showed that age ( OR=0.70, 95% CI 0.62-0.78, P<0.001), underlying diseases ( OR=10.03, 95% CI 4.10-24.55, P<0.001), premature birth ( OR=6.78, 95% CI 3.53-13.04, P<0.001), NLR ( OR=1.85, 95% CI 1.09-3.15, P=0.023), and co-infection ( OR=1.28, 95% CI 1.18-1.38, P<0.001) were independently associated with the development of severe RSV infection in the post-COVID-19 group. The ROC curve of the prediction model integrating the above five factors indicated an area under the curve of 0.85 (95% CI 0.80-0.89, P<0.001), with an optimal cutoff of 0.21, a sensitivity of 0.83 and a specificity of 0.80. The calibration curve showed that the predicted probability in this model did not differ significantly from the actual probability ( P=0.319). Conclusions:In the post-COVID-19 era in Kunming, the peak in pediatric hospitalizations for RSV infection was from May to October, with declined incidence of wheezing and increased incidence of fever, tachypnea, seizures, severe cases, and rates of triple and quadruple co-infections. Age, underlying diseases, premature birth, NLR, and co-infection were identified as independent risk factors for severe RSV infection in the post-COVID-19 period. In this study, a risk prediction model for severe pediatric RSV infection was established, which had a good predictive performance.

Clinicopathological data of 15 patients with pyloric early cancer and precancerous lesions, who received endoscopic submucosal dissection (ESD) in Zhejiang Cancer Hospital from March 2011 to January 2020 were retrospectively analyzed. Postoperative pathology showed 7 cases of low-grade intraepithelial neoplasia, 3 cases of high-grade intraepithelial neoplasia, and 5 cases of early gastric cancer. R0 complete resection was achieved in all patients. The mean operation time was 55.2 min (35-78 min). One patient had delayed postoperative bleeding, and no other complications such as bleeding, perforation or abdominal pain occurred in other 14 patients. No recurrence, metastasis or pyloric stenosis was found during the follow-up of 31.3 months (1-106 months). ESD is safe and effective for early cancer and precancerous lesions in the pylorus.

Objective:To understand the status quo of self-stigma of diabetic patients in college students and analyze its influencing factors.Methods:This study was a cross-sectional study, and the convenient sampling was conducted online and offline from July 2017 to June 2020. College students with diabetes who were treated in outpatient or inpatient Departments of Endocrinology and Metabolism in 5 Class Ⅲ Grade A hospitals were selected as the research objects, and similar patients who followed 2 diabetes public accounts were selected as online supplements. General information questionnaire and China-Self Stigma Scale (C-SSS) were used for questionnaire surveys. Data were statistically processed by t-test, analysis of variance and multiple linear regression analysis. A total of 200 questionnaires were distributed, and 189 valid questionnaires were recovered, with an effective recovery rate of 94.50%. The self-stigma of 80.42% of college students with diabetes mellitus was at a medium-to-high level. The total average score of C-SSS was (2.34±0.49) , of which the mean scores of cognitive dimension, emotional dimension and behavioral dimension were respectively (2.33±0.50) , (2.41±0.57) and (2.19±0.64) . The results of univariate analysis showed that there were statistically significant differences in the stigma scores of diabetic patients with different genders, family locations, parental physical conditions, diabetes types, family history, diabetes complications and insulin treatment or not ( P<0.05) . The results of multiple linear regression analysis showed that gender and type of diabetes were factors affecting the self-stigma level of college students with diabetes mellitus ( P<0.05) . Conclusions:The level of self-stigma in college students with diabetes mellitus is generally high. Hospitals, schools and families should strengthen cooperation and pay attention to these with high level of self-stigma. Meanwhile, early prevention and control should be targeted through dynamic tracking, psychological counseling and other interventions.

Objective:To investigate the epidemiology and clinical characteristics of adenovirus (ADV)-caused acute respiratory tract infection among hospitalized children in Kunming, China.Methods:Clinical and laboratory data were collected from 467 children with adenovirus infection who were hospitalized from January 1, 2019 to December 31, 2019 in 6 grade A class Ⅲ hospitals in Kunming area. The basic characteristics, epidemiology, mixed infection and adenovirus genotypes of the patients were retrospectively analyzed. The patients diagnosed with adenovirus pneumonia (AP) were divided into two groups, severe AP (SAP) group and general AP(GAP) group according to the severity of illness. Mann-Whitney U test or χ 2 test was used for comparison between groups, while multivariate regression was applied to analyze the risk factors of SAP. Results:Among 15 635 hospitalized children with respiratory tract infection, 467 cases were adenovirus positive, with a detection rate of 2.99%. Of the 467 patients with adenovirus infection, 284 were male and 183 female, the age was 2.4 (1.1,3.9) years, including 44 cases (9.4%) < 0.5 years, 59 cases (12.6%) of 0.5 to<1.0 years, 176 cases (37.7%) of 1.0 to <3.0 years, 150 cases (32.1%) of 3.0 to <7.0 years, and 38 cases (8.1%) of 7.0 to 14.0 years. Adenovirus infection was common in autumn and winter, and the high incidence months were October to December, which accounted for 51.6% (241/467) of the whole year cases. Co-infection was detected in 226 cases (48.4%) out of 467 patients, in which one pathogen co-infection was the most frequent form (172 cases, 76.1%). Of the 262 pathogen detected 108 (41.2%) were Mycoplasma pneumoniae. In 144 of ADV-positve cases (30.8%) were taken geno-typing was done by PCR amplification, the results showed that 74 cases (51.4%) were ADV 3, 7 subtypes and 65 cases (45.1%) of ADV 1, 2,6 subtypes. Of the 467 cases of ADV infection, 320 (68.5%) were diagnosed with pneumonia, 82 (17.6%) with upper respiratory tract infection and pharyngeal tonsillitis, and 65 (13.9%) with bronchitis, laryngeal bronchitis, and asthmatic bronchitis. Among the 320 patients with AP, 56 cases were severe and 264 cases were general. Two cases (3.6%) in severe group died. Compared with the GAP group, the age was young [17 (11,42) months vs. 24 (14,44) months, Z=2.222, P=0.026], the fever duration was long [8 (5,14) days vs. 6 (3,9) days, Z=3.380, P<0.01], and the proportions of preterm birth and having underlying diseases were high [respectively 19.6% (11/56) vs. 6.1% (16/264), 26.8% (15/56) vs. 10.2% (27/264), χ 2=8.965,11.109, P<0.05] in SAP group. Referring to laboratory markers, white blood cell count, C-reactive protein, creatine kinase-MB and lactate dehydrogenase were significantly increased in SAP group as compared to GAP group(all P<0.05). Multivariate Logistic regression analysis showed that preterm birth ( OR=3.284, 95% CI 1.079-9.993, P=0.036), underlying disease ( OR=3.284, 95% CI 1.079-9.993, P=0.036), fever duration ≥10 d ( OR=2.523,95% CI 1.195-5.328, P=0.015) and C-reactive protein ≥50 mg/L ( OR=3.156, 95% CI 1.324-7.524, P=0.010) were positively correlated with the risk of SAP. Conclusions:The incidence of adenovirus infection among hospitalized children in Kunming was lower than the national level, and no outbreak occurred in 2019. Subtype 3 and 7 of ADV are the predominant strains for infection, which usually occurs in autumn and winter and mainly causes pneumonia. Premature birth, underlining diseases, long fever duration and markedly increased C-reactive protein are the risk factors for developing into severe pneumonia. This paper presents the prevalence and clinical characteristics of adenovirus infection in children at high altitude area.

Objective:To explore the safety and efficiency of a novel bipolar electric knife for endoscopic submucosal dissection.Methods:The thermal damage on tissue caused by the new bipolar knife and traditional monopolar knife were compared by finite element analysis. The vertical thermal damage to the porcine gastric wall caused by the two types of electric knife were analyzed in vitro animal experiments. In vivo animal experiments were used to compare operation related indexes of two types of electric knife, including en bloc resection rate and cutting efficiency in porcine digestive tract submucosal dissection. Results:Through overcoming deviation of experimental individuals and operator experience, the finite element model showed that the length, width and depth of thermal damage on tissue caused by the monopolar knife was 1.08 times, 1.12 times, and 1.23 times of that of the bipolar knife, respectively. Additionally, the bipolar knife caused less vertical thermal damage to the porcine gastric wall than the monopolar knife (433.25±42.58 μm VS 898.03±111.59 μm, t=6.740, P=0.003) in vitro animal experiments when charged for 1 s at the same power. Finally, in vivo animal experiments showed that the en bloc resection rates of the two kinds of electric knife systems were both 100.0%. In addition, the cutting area and cutting time of the bipolar knife was 229.58±185.29 mm 2 and 164.37±96.27 s, respectively. The corresponding indicators of the monopolar knife was 209.70±167.35 mm 2 and 162.65±69.97 s, respectively, and there was no significant difference (all P>0.05). Conclusion:The novel bipolar knife not only ensures the cutting efficiency but also reduces the thermal damage during endoscopic submucosal dissection in simulating experiment and animal experiment, which needs further verification in clinical trial.

Objective:To establish a method for the determination of aflatoxin( AF) B1,B2,G1and G2by HPLC in Xiao'er Fupi granule,and help manufacturers select safe raw materials for production through the analysis of test results of 31 batches of samples and the safety investigation of Xiao'er Fupi granule in terms of aflatoxin pollution. Methods: A post-column photochemical derivation HPLC method was used to detect the content of aflatoxin in Xiao'er Fupi granule. An Ecosil C18column(250 mm×4.6 mm,5 μm) was adopted with the mobile phase of acetonitrile-methanol-water (30: 10: 60)at the flow rate of 0.8 ml·min-1. The column tem-perature was maintained at 30 ℃. The sample size was 20 μl,The excitation wavelength was 360 nm and the emission wavelength was 450 nm in the fluorescence detection. Results:The linear range of aflatoxin B1,B2, G1and G2was 9.65-48.25 pg (r=0.999 1), 2.45-12.25 pg(r=0.999 8), 10.5-52.5 pg(r =0.995 6) and 2.55-12.75 pg (r =0.996 6), respectively. The recovery was 83.3%-95.6%. Totally 14 batches of samples contained aflatoxin,and the total content was 0.21 × 10 -3-0.54 ×10 -3μg·g-1. Conclusion:The method is convenient and accurate,which can be used for the quality control of Xiao'er Fupi granule.

Objectives: To explore the differences in signal pathway and gene expression related to the pathogenesis of congenital microtia by the in-depth analysis of DNA methylation profiling of auricular chondrocytes from congenital microtia patients. Methods: Genome wide methylation profile of congenital microtia was obtained by MeDIP chip technology, and analyzed by Gene ontology (GO) and Pathway analysis. The gene expression levels of Wnt1 and Wnt11 were evaluated by Real-time PCR in the auricular cartilage from the healthy side and affected side of the congenital microtia patients , and healthy controls. Results: The GO and Pathway assay showed that Wnt signal pathway was enriched in differential methylated levels. The Wnt1 and Wnt11 genes were with higher methylation in the promoter region and CpG islands in healthy control group than that in microtia group, in addition the methylation level in the affected side auricular cartilage was lower than that in the healthy side. There was no difference in Wnt1 and Wnt11 gene expression in microtia patients and healthy controls. The higher Wnt11 gene expression was detected in the affected side residual cartilage tissues than in the healthy side cartilage tissues of the same congenital microtia patient. Conclusions The over expression of Wnt11 during embryonic development might be associated with the pathogenesis of congenital microtia. The mechanism of the difference in methylation levles of Wnt11 affecting pathogenesis of congenital microtia needs further research.

Purpose To investigate the presence of perineural invasion (PNI) and the expression of human epidermal growth factor receptor 2 (HER-2) in patients with advanced gastric cancer.To discuss the correlation between PNI and the expression of HER-2 and their prognostic significance.Methods Paraffin sections of surgical specimens from 100 patients who underwent gastric resection were selected,and then PNI were detected by HE staining and the expression of HER-2 were detected by immunohistochemical (IHC).The correlation of perineural invasion with the clinicopathological features and HER-2 expression were performed.Results PNI was positive in 42 cases of 100 patients (PNI positive rate was 42％),the occurrence of PNI has significantly related with lymph node metastases,infiltrating depth,tumor emboli,TNM stage and expression of HER2.The difference was statistically significant (P ＜ 0.05).Univariate analysis showed that total survival rate of advanced gastric cancer was associated with T stage,tumor emboli,N stage,TNM stage,PNI and HER-2 expression (P ＜ 0.05).The overall survival of the PNI-negative patients was 45.3 months on average,much better than the PNI positive patients who was 15.4months in average (P ＜ 0.05).The overall survival of the HER2-negative patients was 43.2 months on average,much better than the HER-2-positive patients who was 22.7 months in average (P ＜ 0.05).By muhivariable Cox proportional hazards model of overall smvival,the positivity of PNI and HER-2 appeared to be new independent prognostic factors (P ＜ 0.05).Conclusion The detection of PNI and HER-2 expression maybe helpful for the prognosis of patients with advanced gastric cancer.In addition,HER-2 may be responsible for the presence of perineural invasion.

Objective:To establish a quantitative method for the determination of lysine hydrochloride in pediatric compound lysine granules. Methods:The quantitative determination was performed on an amino acids analyzer. The cationic resin column(150 mm × 4. 6 mm,7 μm)was used. The mobile phase was citrate buffer solution (pH 3. 45) and citrate buffer solution (pH 10. 85) with gradient elution at a flow rate of 0. 45 ml·min-1 . The detection wavelengths were set at 570 nm and 440 nm. Results:The linear range of lysine hydrochloride was 2. 692-21. 536 μg·ml-1(r=0. 999 5), and the average sample recovery was 98. 85% with RSD of 0. 63% (n=9). Conclusion:The method is sensitive, simple and reproducible. It can be used for the quality control of pediatric compound lysine gran-ules.

Objective To explore the risk factors of pulmonary infection in patients with basal ganglia hemorrhage . Methods A total of 152 patients with basal ganglia hemorrhage who received conservative treatment from March 2013 to Septem‐ber 2014 were enroled in the study ,while the incidence of pulmonary infections and and risk factors were retrospectively analyzed , and recorded the distribution of pathogenic bacteria .Results The pulmonary infections occured in 106 of 152 patients with the in‐fection rate of 69 .7% .The way of treatment ,history of smoke and consciousness were the independent risk factors for pulmonary infection(P<0 .05) .A total of 153 strains of pathogens were isolated from the patients of infection group ,in which there were 132 strains of gram negative bacteria ,10 strains of gram positive bacteria and 12 strains of fungi .Conclusion Basal ganglia hemorrhage associated with a greater incidence of pulmonary infection ,it should be noted the risk factors of pulmonary infection in basal ganglia hemorrhage patients to reduce the incidence of pulmonary infection .