Objective:To determine incidence of seasonal influenza virus infection in the community and to analyze the factors influencing seasonal influenza virus infection.Methods:This study recruited residents aged 6-59 years to build a cohort in 15 villages/streets in Macheng city in November 2019. Meanwhile, a cross-sectional baseline survey was conducted immediately to collect sera, information on demographics and child protection knowledge, behaviors, as well as attitudes using a questionnaire from the participants enrolled in the cohort (i.e., before the influenza epidemic season). In July 2020, a cross-sectional follow-up survey was conducted to collect sera once again (i.e., after the influenza season). Paired sera from the two cross-sectional surveys were tested for influenza virus-specific antibodies by hemagglutination inhibition (HI) test or micro-neutralization (MN) test using a circulating representative strain of each subtype/lineage of influenza virus as the test antigen. The infections with influenza virus subtype/lineage was confirmed if there was a four-fold or more increase in titers of antibodies against circulating representative strain of the subtype/lineage of influenza virus. Factors influencing infection with influenza A (H3N2) and B/Victoria viruses were analyzed using univariable and multivariable logistic regression.Results:In November 2019, 800 study participants were enrolled in the cohort, including 340 children aged 6-17 years and 460 adults aged 18-59 years; 605 study participants (including 224 children and 381 adults) were followed up in July 2020 and their paired sera were obtained before and after the influenza season. 25.3% (153/605) of the participants were confirmed to be infected with at least one subtype/lineage of seasonal influenza virus by HI and MN tests. The overall incidence of influenza viruses of all subtypes/lineages in children was 44.2% (95% CI: 37.6%-50.8%) which was significantly higher than the incidence of 14.1% in adults (95% CI: 10.7%-17.7%). Children had the highest incidence of influenza A (H3N2) virus infection, followed by B/Victoria. MN or HI antibody titers in A (H3N2)[ OR=0.88 (95% CI: 0.84-0.93)] and B/Victoria[ OR=0.97 (95% CI: 0.95-0.99)] before the influenza season were significantly associated with whether children were infected with that subtype/lineage of influenza virus. Conclusions:The residents aged 6-59 years in Macheng city had a substantial incidence of seasonal influenza virus infection during the influenza season from winter 2019 to spring 2020. Notably, almost half of children aged 6-17 years have been infected with seasonal influenza virus. Higher titers of HI/MN antibodies against seasonal influenza virus before the influenza season would be likely to reduce the risk of infection with influenza A (H3N2) and B/Victoria.

Objective To observe the value of dual-energy CT(DECT)radiomics combined with clinical and CT features for predicting differentiation degree of gastric adenocarcinoma(GAC).Methods Totally 254 patients with GAC were prospectively analyzed and divided into high-grade group(low differentiation GAC,n=88)and low-grade group(middle-high differentiation GAC,n=166)according to pathological results.The patients were also divided into training set(n=203,including 70 high-grade and 133 low-grade GAC)and verification set(n=51,including 18 high-grade and 33 low-grade GAC)at the ratio of 8∶2.Radiomics features were extracted and screened based on venous phase single-level(40,70,100 and 140 keV)DECT,and a multi-energy radiomics model was constructed to predict GAC classification.Univariate analysis and multivariate logistic regression were used to analyze clinical and CT features as well as DECT parameters in training set to construct a clinic-CT model.Then a combined model was constructed through combining clinic-CT model with radiomics model.The predictive efficacy of the models were evaluated,and the calibration degree of the combined model was assessed.Results The area under the curve(AUC)of clinic-CT model,multi-energy radiomics model and combined model was 0.74,0.75 and 0.78 in training set,and 0.73,0.77 and 0.78 in verification set,respectively.Except for AUC of combined model was higher than that of clinic-CT model in training set(P＜0.05),no significant difference of AUC was found among models in training set nor verification set(all P＞0.05).The calibration degree of combined model was good in both training set and verification set(both P＞0.05).Conclusion DECT radiomics combined with clinical and CT features could effectively predict differentiation degree of GAC.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To assess the quality of low-keV monoenergetic images using deep learning image reconstruction (DLIR) algorithm combined with dual energy CT (DECT) in gastric cancer and to compare them with images from the conventional adaptive statistical iterative reconstruction (ASiR-V) algorithm.Methods:In this cross-sectional study, DECT images of 31 gastric cancer patients in the First Affiliated Hospital of Zhengzhou University were prospectively collected from September 2022 to March 2023. The 55 keV monoenergy images were reconstructed using the DLIR algorithm at low-, medium-, and high-intensity levels (DLIR-L, DLIR-M, and DLIR-H) based on arterial phase and venous phase images, respectively. The 70 keV 40% mixing coefficient (ASiR-V40%) images were reconstructed using the ASiR-V algorithm. In the objective evaluation of images, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for both lesions and muscle were calculated across four sets of reconstructed images. In the subjective evaluation of images, scores were assigned to the overall image quality, lesion visibility, and diagnostic confidence for each set of reconstructed images. Comparisons of SNR and CNR between the 4 groups were made by One-way repeated-measures ANOVA or Friedman′s test. Comparisons of scores were made by Friedman′s test. The P value of pairwise comparison was adjusted using Bonferroni correction methods. Results:In the objective evaluations, CNR lesion, SNR lesion and SNR muscle were highest on the 55 keV DLIR-H images in the arterial and venous phases, and showed a gradually increasing trend on the 70 keV ASiR-V40%, 55 keV DLIR-L, DLIR-M, DLIR-H images ( P<0.05). In subjective evaluations, compared to the 70 keV ASiR-V40% images, overall image quality scores were numerically higher for the 55 keV DLIR-H ( P>0.05), similar or slightly worse for the 55 keV DLIR-M, and significantly lower for the 55 keV DLIR-L ( P<0.05). The lesion visibility and diagnostic confidence on the 55 keV DLIR reconstruction images were higher in both arterial and venous phases than 70 keV ASiR-V40% images ( P<0.05). Conclusions:Compared to the conventional 70 keV ASiR-V40% images, the 55 keV DLIR-H images had higher lesion contrast and diagnostic confidence with lower image noise. The 55 keV DLIR-M images had comparable overall image quality to 70 keV ASiR-V40% images, but the former had higher lesion contrast and diagnostic confidence. The 55 keV DLIR-L was unable to improve image quality to the level of 70 keV ASiR-V40%.

Objective:To investigate the application of virtual reality (VR) technology on intraoperative pain in patients undergoing peritoneal dialysis (PD)-related procedures with local infiltration anesthesia and the satisfaction.Methods:It was a single-center, prospective, concurrent controlled study. Patients were divided into two groups: VR group and control group. In the VR group, patients wore a VR headset to watch soothing audio and video content during surgery, while the control group underwent routine procedures. Intraoperative pain and satisfaction were assessed using the visual analog scale (VAS) and a 5-point satisfaction scale within 30 minutes of surgery. In addition, tolerance of the VR experience in the VR group was assessed using the VR sickness questionnaire.Results:A total of 43 patients were included in the study, including 25 males (58.1%). Chronic glomerulonephritis [17 cases (39.5%)] and diabetic nephropathy [6 cases (14.0%)] were the main primary diseases. There were 23 cases in the control group and 20 cases in the VR group. There were no significant differences between the two groups in age, sex ratio, proportion of primary disease, diabetes, hypertension, distribution of operation methods, preoperative vital signs and operation time (all P>0.05). VAS pain score was significantly lower in the VR group than that in the control group (5.90±2.38 vs. 7.43±1.67, t=2.469, P=0.018). The percentage of patients who were satisfied was 89.5% (17/19) in the VR group and 78.3% (18/23) in the control group, but there was no significant difference (chi-square test for continuity correction, χ2=0.308, P=0.579). Three patients in the VR group withdrew from the study due to severe discomfort, while the remaining participants found the VR experience to be tolerable. Common adverse effects included fatigue and blurred vision. Conclusions:The application of VR technology in PD-related procedures has been effective in reducing intraoperative pain when combined with local infiltration anesthesia. Furthermore, the utilization of VR technology in PD-related procedures is associated with a safe and tolerable outcome, despite the observation of some adverse effects.

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.

Abstract: Objective　To investigate the expression level and clinical significance of serum liver fibrosis-associated lncRNA1 (lnc-LFAR1) in patients with chronic hepatitis B cirrhosis, aiming to analyze its correlation with interleukin-6 (IL-6), interleukin-1β (IL-1β), and liver function. Methods　Patients with chronic hepatitis B (CHB) cirrhosis and CHB diagnosed and treated in Dongguan City People's Hospital from March 2016 to December 2019 were selected and divided into the liver cirrhosis group (n=80) and the CHB group (n=80), and 80 healthy people with physical examination during the same period were selected as healthy group. The serum levels of lnc-LFAR1, interleukin-6 (IL-6), albumin (ALB), interleukin-1β (IL-1β) and liver function indicators, including albumin (ALB) and alanine aminotransferase (ALT) were measured and analyzed. The correlation between serum lnc-LFAR1 expression level and IL-6, IL-1β was assessed, and the levels of lnc-LFAR1, IL-6, IL-1β, ALB and ALT were compared among patients with CHB cirrhosis of different Child-Pugh grades. Results The serum levels of lnc-LFAR1, IL-6, IL-1β and ALT in the patients with liver cirrhosis [(1.85± 0.62), (41.76±13.92) ng/mL, (7.78±1.95) pg/mL, (148.37±29.67) U/L] were higher than those in the CHB group [(1.42±0.47), (23.56± 7.85) ng/mL, (5.42±1.41) pg/mL, (87.59±17.52) U/L] and the healthy group [(1.01±0.34), (6.70±2.23) ng/mL, (3.13± 0.78) pg/mL, (15.44±3.10) U/L] (P<0.05), while the ALB levels (30.54±3.82) g/L were lower than those in the CHB group (37.27±4.34) g/L and the healthy group (45.26±5.66) g/L (P<0.05). Serum lnc-LFAR1, IL-6, IL-1β and ALT levels in the CHB group were higher than those in the healthy group (P<0.05), and ALB levels were lower than those in the healthy group (P<0.05); the serum levels of lnc-LFAR1, IL-6, IL-1β in patients with CHB cirrhosis were negatively correlated with ALB (P<0.05), and positively correlated with ALT (P<0.05); the serum expression level of lnc-LFAR1 in patients with CHB cirrhosis was positively correlated with IL-6 and IL-1β (r=0.598, 0.571, P<0.05); with the increase of Child-Pugh grade, the serum levels of lnc-LFAR1, IL-6, IL-1β, and ALT in patients with CHB cirrhosis gradually increased (P<0.05), and the level of ALB gradually decreased (P<0.05). Conclusions Serum lnc-LFAR1 expression level is higher in patients with CHB cirrhosis, which is obviously related to IL-6, IL-1β, ALB and ALT. Therefore, the evaluation of serum lnc-LFAR1 expression level is helpful in the clinical assessment of the condition of CHB cirrhosis patients.

Objective:To investigate the clinical characteristics and prognosis of duodenal neuroendocrine neoplasms.Methods:The clinical data of 35 patients with duodenal neuroendocrine neoplasms admitted to Union Hospital, Tongji Medical College, Huazhong University of Science & Technology from Jan 2012 to Dec 2021 were retrospectively analyzed. The differences of clinical characteristics between periampullary and non-periampullary duodenal neuroendocrine neoplasms were analyzed. Kaplan-Meier curve was used for survival analysis, and the clinical factors affecting the prognosis were analyzed.Results:Of the 35 patients, 30 underwent tumor resection, 7 (23%) developed different degree of complications after operation and were improved and discharged after intervention. A total of 5 patients died during the follow-up period. Only 1 of 30 patients who underwent tumor resection died 30 months after operation due to disease progression, and the others had no recurrence or metastasis. Univariate analysis showed that tumor size, tumor grade, and tumor location were associated with the prognosis of patients (all P<0.05), and multivariate analysis showed that patients with tumors located.Away from the ampulla had a significantly better prognosis than those located around the duodenal ampulla ( P<0.01). Conclusions:Patients with duodenal neuroendocrine neoplasms have a good prognosis after complete resection; patients with duodenal neuroendocrine neoplasms located around the ampulla of Vater have a relatively poor prognosis compared with those away from the area of ampulla.

Objective    To evaluate the quality of life (QOL) in patients with primary palmar hyperhidrosis (PPH) after endoscopic thoracic sympathicotomy (ETS) and analyze the influencing factors. Methods    A total of 243 patients (118 males and 125 females, with an average age of 21.99±6.31 years) with PPH who were successfully treated with ETS (only T3 level thoracic sympathicotomy) in our hospital from January 2017 to January 2018 were enrolled, and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) was used to assess the QOL scores before and after ETS. By establishing a linear regression model of gender, age, body mass index, compensatory hyperhidrosis (CH) and palm dryness, and the relationship between the changes of the QOL scores and various factors was studied. Results    The total QOL score after surgery was higher than that before surgery (63.01±4.58 vs. 48.11±1.95, P<0.05). Compared with the negative group of CH, the QOL score decreased by 4.662 in the postoperative CH patients. For every grade of CH severity increasing, the QOL score decreased by 3.449. Compared with the negative group, the QOL scores decreased by 1.804 and 2.400 respectively for every grade of CH severity increasing in the patients with postoperative chest and back CH. Conclusion    ETS can not only improve the symptoms of abnormal palmar hyperhidrosis, but also significantly improve the QOL. Severe chest and back CH is an important factor affecting the QOL of patients.

Objective:To explore the clinical features, diagnosis, treatment and prognosis of rectal neuroendocrine tumor with lymphatic metastasis.Method:There were 153 case who were diagnosed with RNET, among them, there were 10 patients(6.5%) with lymphatic metastasis in Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science & Technology from January 2012 to December 2020, including 4 males and 6 females, aged from 32 to 71 years old, and the median age was 56.5 years.Results:Of the 10 patients, 3 had tumors < 1 cm in diameter, 4 had 1 to 2 cm, and 3 had > 2 cm. Preoperative CT examination was performed in 10 patients, of which 9 suggested lymphatic metastasis; preoperative MRI examination was performed in 7 patients, of which 6 suggested lymphatic metastasis. All patients were received radical resection, in which Miles operation was performed in 2 cases, Dixon operation in 6 cases, and additional Dixon operation after endoscopic submucosal dissection in 2 cases.All patients were followed up for 51 months (ranged from 14 to 118 months). Nine patients had no recurrence or metastasis, and one patient had abdominal metastasis 40 months after surgery and died after 31 months of comprehensive treatment.Conclusions:Lymphatic metastasis is rare in rectal neuroendocrine tumor. Imaging examination has important reference value for judging the status of lymphatic metastasis. For rectal neuroendocrine tumor with lymphatic metastasis, radical resection is effective.