Objective:To analyze the effect of montelukast combined with budesonide in the treatment of children with intermittent asthma, and the impact on airway remodeling and T helper type 1 (Th1)/T helper type 2 (Th1/Th2) related cytokines.Methods:A prospective study was conducted among 120 children with intermittent asthma admitted to Huanghua Municipal People′s Hospital from December 2021 to February 2023. The children were randomly divided into the control group (60 children treated with budesonide atomizationinhalation) and the observation group (60 children treated with montelukast on the basis of the treatment of control group). Clinical efficacy, airway remodeling indicators [total area of airway (Ao), outer diameter of airway (D) and wall area to total airway cross-sectional area (WA%)], pulmonary function [peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV 1)/forced vital capacity (FVC) and the maximum expiratory flow at 25% of vital capacity (MEF25%)], Th1/Th2 related cytokines, inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), interleukin-6 (IL-6) and interferon-gamma (IFN-γ)], recurrence, and the incidence of adverse reactions were compared between the two groups. Results:The total effective rate in the observation group was higher than that in the control group: 90.00% (54/60) vs. 75.00% (45/60) ( P<0.05). After treatment, Ao, D and WA% in the observation group were lower than those in the control group: (17.58 ± 1.89) mm 2 vs. (19.22 ± 1.94) mm 2, (4.25 ± 0.48) mm vs. (4.48 ± 0.49) mm, (63.75 ± 6.49)% vs. (69.22 ± 7.14)% ( P<0.05). PEF, FEV 1/FVC and MEF25% in the observation group were higher than those in the control group: (3.13 ± 0.34) L/s vs. (2.86 ± 0.35) L/s, (87.45 ± 8.86) % vs. (83.59 ± 8.42) %, (87.63 ± 8.86)% vs. (82.15 ± 8.43)% ( P<0.05). The levels of Th1 and Th1/Th2 in the observation group were higher than those in the control group: (14.13 ± 1.46) % vs. (10.27 ± 1.25) %, 3.46 ± 0.39 vs. 1.88 ± 0.25, and the level of Th2 was lower than that in the control group: (3.96 ± 0.45)% vs. (5.48 ± 0.56)% ( P<0.05). After treatment, the levels of TNF-α and IFN-γ in the observation group were higher than those in the control group: (76.15 ± 7.78) ng/L vs. (66.38 ± 6.47) ng/L, (7.15 ± 0.74) ng/L vs. (6.14 ± 0.66) ng/L. The levels of IL-4 and IL-6 were lower than those in the control group: (77.85 ± 7.96) ng/L vs. (86.42 ± 8.74) ng/L, (37.25 ± 3.89) mg/L vs. (44.23 ± 4.57) mg/L ( P<0.05). The recurrence rate in the observation group was lower than that in the control group: 3.33% (2/60) vs. 15.00% (9/60) ( P<0.05). The incidence rates of adverse reactions in the two groups were without statistically significant difference between the groups ( P>0.05). Conclusions:Montelukast combined with budesonide can reduce airway remodeling in children with intermittent asthma, improve their pulmonary function, Th1/Th2 related cytokines and inflammatory response indicators, and reduce recurrence rate, with good safety.

Objective: To understand the knowledge of disinfection and its influencing factors among caregivers in childcare centers in Huangpu District, Shanghai, in order to provide a basis for the future development of targeted training programs and the work plan to enhance the professional level of disinfection practitioners in childcare centers. Methods: A total of 423 caregivers from 62 childcare centers (including nursery schools) in Huangpu District were selected for a questionnaire about disinfection knowledge, influencing factors, and training needs in March 2023. Differences in disinfection knowledge among subjects with different characteristics were compared using χ 2 tests, and influencing factors were analyzed using a multi factor binary Logistic regression model. Results: The overall knowledge rate of disinfection among caregivers was 50.12%, and those in public kindergartens, private ones, and nursery schools were 51.35%, 46.18%, and 42.57%, respectively, with statistically significant differences ( χ 2=14.25, P < 0.05 ). The caregivers in the highest level kindergartens ( OR =4.50, 95% CI =1.97-10.29), in first level ones ( OR =4.29, 95% CI = 1.98-9.33), in the institutions had clusters of outbreaks ( OR =1.87, 95% CI =1.14-3.07), in which the number of children to caregivers ratio being less than 10∶1 ( OR =21.81, 95% CI =2.55-186.59), with 6-14 years of working experience ( OR =3.51, 95% CI = 1.59 -7.75) had better knowledge of disinfection( P <0.05). Conclusions Knowledge of disinfection among caregivers of childcare institutions is low in Huangpu District, Shanghai. Training of caregivers disinfection knowledge should be strengthened for caregivers with fewer years of experience, in childcare institutions, to improve caregivers disinfection expertise and skills.

ObjectiveTo introduce the Hr gene of spontaneously mutated SHJH^hr mice into BALB/cAShjh inbred mice with clear genetic background,and provide a basis for study on the molecular mechanism of Hr gene mutation-induced abnormal phenotype and the application of this model.Methods Using a backcross-intercross breeding method guided by phenotypic monitoring, mutant genes from SHJH^hr mice bred by spontaneous mutation were introduced into inbred BALB/cAShjh mice by homozygous mutation introgression, and the mice were bred into BALB/cA.Cg.SHJH^hr (abbreviated as C.Cg.SHJH^hr) mice after 10 generations. The genotypes of 90 single nucleotide polymorphism (SNP) detection sites were analyzed in C.Cg.SHJH^hr mice by multiplex PCR library construction followed by next generation sequencing. Then 14 biochemical locus marker genes were detected in C.Cg.SHJH^hr mice according to the method of GB/T 14927.1-2008. Finally, whole genome exon sequencing was utilized to detect the mutated genes in this mouse. ResultsFrom May 2018 to March 2022, a total of 10 generations of backcross-intercross were conducted to complete the construction of the C.Cg.SHJH^hr mouse line. Among the 90 SNPs loci detected, except for rs13484115 and rs13484116, all the other loci had the same genotype as the recipient mice BALB/cAShjh. The results of biochemical marker gene detection showed that all the 14 loci of the mouse were the same as those of the recipient mouse. Whole genome exon sequencing found that the mouse had 109 site mutations compared with the recipient mouse strain, including 71 synonymous mutations, 1 stopgain, 37 missense mutations, and 20 genes involved in protein sequence alterations (including the reported Hr gene). ConclusionC.Cg.SHJH^hr mice were created. Through exon sequencing and genetic analysis, three Hr mutated genes and associated mutated genes that mainly cause phenotypic variations were identified, which provides a basis for expanding the application of C.Cg.SHJH^hr mice in biomedical research.

Objective:To analyze the clinical manifestations and laboratory features of brucellosis patients in order to provide help for clinical diagnosis.Methods:The medical records of confirmed brucellosis patients ( n=81) in Kunming Third People's Hospital from 2015 to 2019 were collected. The occupation, contact history, clinical manifestations, laboratory examination characteristics and treatment of the patients were retrospectively analyzed. Results:The 81 cases of brucellosis were mainly farmers (64 cases), most of who had a history of raising sheep or contacting sheep manure or secretions (71 cases). The clinical manifestations were fever (68 cases), low back pain (42 cases), joint pain (22 cases), including 72 cases in acute stage and 9 cases in chronic stage. Laboratory examination showed that liver function index total bilirubin (TB) and direct bilirubin (DB) were generally normal, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyltransferase (GGT) were increased in about half of the patients; high sensitivity C-reactive protein (HsCRP), procalcitonin (PCT), interleukin-6 (IL-6) and serum amyloid A (SAA) were increased in more than 80% of the patients, and erythrocyte sedimentation rate (ESR) was increased in 64.6% (42/65) of the patients. Doxycycline plus rifampicin was the first-line treatment program.Conclusion:The clinical manifestations of patients with brucellosis are diverse and atypical, and patients with nonspecific clinical manifestations such as fever should be combined with their occupation, contact history, indicators of infection detection, timely blood culture examination to make a clear diagnosis, and patients with abnormal liver function should pay attention to asking about occupation and contact history, so as to reduce misdiagnosis and mistreatment of brucellosis.

Objective To investigate the expression and clinical significance of Bcl-2/adenovirus E1B19kDa interacting protein 3 (BNIP3) in serum and cerebrospinal fluid (CSF) of patients with severe hand, foot and mouth disease (HFMD). Methods Ninety children with HFMD were classified into three groups with 30 in each group:critical group (clinical stage 3), severe group (clinical stage 2) and common group (clinical stage 1, excluding encephalitis with CSF and other examinations). Another thirty healthy children were randomly selected as the control group. The levels of BNIP3 in serum and CSF were detected before and after treatment. Moreover, serum neuro-specific enolase ( NSE) and S100B protein were also measured to analyze their correlation with BNIP3. Receiver operating characteristic ( ROC) curve was used to evaluate the prediction efficiency of BNIP3 for the severity of HFMD. Results The levels of serum BNIP3, S100B protein and NSE in the critical group were higher than those in the other three groups ( P<0. 01). CSF BNIP3 level in the critical group were significantly higher than that in the common and severe groups (P<0. 01). Serum BNIP3, S100B protein and NSE were significantly higher in the severe group than in common and control groups (P<0. 01). CSF BNIP3 was significantly increased in the severe group as compared with that in the common group (P<0. 01). After treatment, the levels of BNIP3, S100B protein and NSE in serum and BNIP3 in CSF were decreased in both critical and severe groups (P<0. 01). The lev-els of BNIP3 in serum and CSF were positively correlated with the level of S100B protein and NSE ( P<0. 01). Serum BNIP3 had the highest Youden value at the cut-off value of 3. 015μg/L, with a sensitivity of 83. 33％ and a specificity of 90. 00％, in the prediction of severe HFMD. CSF BNIP3 had the highest Youden value at the cut-off value of 1. 735 μg/L, with a sensitivity of 73. 33％ and a specificity of 93.33％, in the prediction of severe HFMD. Conclusions BNIP3 is involved in the pathological process of brain injury in children with severe HFMD. Detection of BNIP3 helps evaluate the severity and prognosis of HFMD.

Objective: To investigate the expression and clinical significance of Bcl-2/adenovirus E1B19kDa interacting protein 3 (BNIP3) in serum and cerebrospinal fluid (CSF) of patients with severe hand, foot and mouth disease (HFMD). Methods: Ninety children with HFMD were classified into three groups with 30 in each group: critical group (clinical stage 3), severe group (clinical stage 2) and common group (clinical stage 1, excluding encephalitis with CSF and other examinations). Another thirty healthy children were randomly selected as the control group. The levels of BNIP3 in serum and CSF were detected before and after treatment. Moreover, serum neuro-specific enolase (NSE) and S100B protein were also measured to analyze their correlation with BNIP3. Receiver operating characteristic (ROC) curve was used to evaluate the prediction efficiency of BNIP3 for the severity of HFMD. Results: The levels of serum BNIP3, S100B protein and NSE in the critical group were higher than those in the other three groups (P<0.01). CSF BNIP3 level in the critical group were significantly higher than that in the common and severe groups (P<0.01). Serum BNIP3, S100B protein and NSE were significantly higher in the severe group than in common and control groups (P<0.01). CSF BNIP3 was significantly increased in the severe group as compared with that in the common group (P<0.01). After treatment, the levels of BNIP3, S100B protein and NSE in serum and BNIP3 in CSF were decreased in both critical and severe groups (P<0.01). The levels of BNIP3 in serum and CSF were positively correlated with the level of S100B protein and NSE (P<0.01). Serum BNIP3 had the highest Youden value at the cut-off value of 3.015 μg/L, with a sensitivity of 83.33% and a specificity of 90.00%, in the prediction of severe HFMD. CSF BNIP3 had the highest Youden value at the cut-off value of 1.735 μg/L, with a sensitivity of 73.33% and a specificity of 93.33%, in the prediction of severe HFMD. Conclusions BNIP3 is involved in the pathological process of brain injury in children with severe HFMD. Detection of BNIP3 helps evaluate the severity and prognosis of HFMD.

Objective:To explore the effects of different puberty development stages on thyroid morphology and function in women.Methods:From October to November 2017, a multi-stage cluster sampling method was used to select one junior high school in Minhang district of Shanghai, Haimen city of Jiangsu province, Yuhuan city of Zhejiang province and Deqing county of Zhejiang province respectively. A total of 491 girls in the first grade in 4 schools were included in the study. The subjects were examined with thyroid B-ultrasound and physical examination, and their morning random urine samples and fasting blood samples were collected to detect urinary iodine and thyroid function indexes. Puberty Development Self-rating Scale (PDS) was used to evaluate the stages of puberty; multiple linear regression models and logistic regression models were used to investigate the effects of different puberty stages on thyroid morphology and function.Results:There were differences in thyroid status among women at different stages of puberty. Thyroid volume, the rate of nodules and the level of FT4 were lowest in prepubertal period, followed by pubertal period and postpubertal period ( P<0.05). TT3 and FT3 levels were highest in prepubertal period, followed by pubertal period and postpubertal period ( P<0.001), and there was an opposite trend on the abnormal rate. TSH and TT4 levels were not affected by the stage of puberty ( P>0.05). Multiple linear regression analysis and multivariate logistic regression analysis showed consistent results. There was a negative correlation between puberty development and TT3 and FT3 levels. For each 1 point increase in PDS, TT3 and FT3 levels decreased by 0.067 nmol/L and 0.170 nmol/L in Model 1, respectively, and decreased by 0.065 nmol/L and 0.162 nmol/L in Model 2, respectively. Compared with the prepubertal period, the TT3 and FT3 levels were lower in postpubertal period (Model 1: OR=0.337, 95 %CI: 0.173-0.658; OR=0.283, 95 %CI: 0.144-0.557; Model 2: OR=0.306, 95 %CI: 0.155-0.605; OR=0.263, 95 %CI: 0.132-0.524). Conclusions:The process of puberty is related to the thyroid status in women. The better matured during the puberty, the larger volume the thyroid was, more likely the thyroid nodules appeared, and the levels of TT3 and FT3 was much lower.

Objective:To explore the clinical application effect of the self-designed collection room for 2019-nCOV nucleic acid test specimens during period of fighting against COVID-19 infections.Methods:The standard operating room and operating table of the collected 2019-nCOV nucleic acid test specimens were applied to the clinics, and the disinfection and sterilization system of the operating room and the requirements of the operators were formulated. The infection of medical staff during the anti-epidemic period was counted.Results:A total of 2 649 person-times of throat swabs were collected and none of the nurses were infected with COVID-19.Conclusions:The use of self-designed collection room for 2019-nCOV nucleic acid test specimens can effectively protect the first-line nurses from COVID-19, thereby ensuring the personal safety of medical staff.

Objective To evaluate the risk-benefit of aspirin discontinuation during the perioperative period in elderly patients undergoing laparoscopic surgery.Methods Eighty-eight patients of both sexes,aged ≥65 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective laparoscopic cholecystectomy,taking aspirin to prevent cardiovascular diseases,were divided into 2 groups (n =44 each) using a random number table method:non-discontinuation group (N group) and discontinuation group (D group).No aspirin was discontinued during the perioperative period in group N.Aspirin was discontinued at 7 days before surgery and resumed at 3 days after surgery.Venous blood samples were collected at 24 h before surgery (To) and 30 min and 24 h after surgery (T1.2) for measurement of blood coagulation by thromboelastography,and clot reaction time,coagulation time,angle oα,maximal amplitude,and coagulation index were recorded.The occurrence of TEG parameters below/above normal values of clinical significance was recorded.The intraoperative blood loss,postoperative drainage,reoperation due to hemorrhage within 48 h,perioperative blood transfusion and fluid infused,and adverse cardiovascular events (myocardial ischemia,venous thrombosis of lower extremity,pulmonary embolism,etc.)within 30 days after surgery were also recorded.Results Compared with group N,no significant change was found in the intraoperative blood loss,intraoperative fluid infused,postoperative drainage rate and drainage volume,reoperation due to hemorrhage within 48 h,or length of hospitalization (P＞0.05),angle α,maximal amplitude and coagulation index were increased,clot reaction time was shortened,the incidence of clot reaction time below normal values of clinical significance was increased in group D (P＜0.05).There was no significant difference in the incidence of adverse cardiovascular events between group D (7％) and group N (0) (P＞0.05).Conclusion Perioperative discontinuation of aspirin does not reduce the perioperative blood loss with no clinical benefit,induces blood hypercoagulation and increases the risk of adverse cardiovascular events,and thus it is recommended not to discontinue aspirin in the perioperative period in elderly patients undergoing laparoscopic surgery.

Objective: To investigate the effects of different developmental patterns on the increases of thyroid volume in children from different genders and periods, and to explore whether there is a synergistic effect on the initiation of puberty in girls, so as to provide a theoretical basis for reducing the risk of thyroid abnormalities in adulthood. Methods: A multi-stage cluster sampling was used to select a primary school in Minhang District of Shanghai, Haimen City of Jiangsu Province and Yuhuan city of Zhejiang Province. A total of 784 children aged 8-10 years old were included in "8-10 years school-aged children cohort". At the same time, a total of 491 girls aged 11-13 years were included in the "11-13 years adolescent girls cohort". The content of survey on follow-up was consistent with the one on baseline. B-ultrasonography was used to measure thyroid volume. The physical development indexes such as height (H), weight (W) and waist circumference (WC) were measured. The morning urine samples were collected and the urinary iodine content was detected. The changes of body mass index (BMI), waist circumference (WC), and thyroid volume (V) were calculated (d BMI, d WC, and d V, respectively). According to the changes of BMI and WC, the subjects were classified into four types of developmental changes, namely "B-LW-L (low d BMI, low d WC)" "B-LW-H (low d BMI, high d WC)" "B-HW-L (high d BMI, low d WC)" and "B-HW-H (high d BMI , high d WC)". Results In partial correlation analysis, thyroid volume was significantly correlated with BMI and WC at baseline or follow-up(P<0.05). The changes of thyroid volume in 8-10 years old boys were related to the changes of BMI and WC (P<0.05), the changes of thyroid volume in 8-10 year old girls were only associated with the changes of WC (P=0.03), and no association was found in 11-13 year old girls(P>0.05). In multivariate logistic regression analysis, after adjusting for baseline age, region, and differences of urinary iodine, the risk of thyroid volume increasing in B-HW-H was 2.70 times (95%CI=1.29-5.66) higher than that of B-LW-L in boys aged 8-10 years; among girls aged 11-13 years, the risk of thyroid volume increasing in B-LW-H, B-HW-L and B-HW-H were 2.46 times (95%CI=1.31-4.61), 2.16 times (95%CI=1.15-4.03) and 1.79 times (95%CI=1.07-2.99), respectively; there was no interaction between menarche age and developmental pattern on thyroid volume change trend (P=0.49). Conclusion The thyroid volume in children and adolescents increases with the development of physical development. Different developmental patterns and estrogens have certain effects on thyroid morphological changes. To avoid obesity in childhood (especially with central obesity), timely identify and effectively intervene thyroid morphological abnormalities in childhood，and to reduce the risk of thyroid diseases in adulthood.