The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea

Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. The existing treatment of postoperative AF mainly focuses on preoperative prevention, intraoperative protection and postoperative treatment for factors prone to AF before, during and after surgery, but the postoperative treatment in various areas and hospitals is different. This article combines the latest literature published in Europace about the practice guidance of cardioversion of AF and atrial flutter, and summarizes the treatment of electrical cardioversion, in order to provide clinical guidance for electrical cardioversion of AF after cardiac surgery.

Model informed precision dosing for warfarin is to provide individualized dosing by integrating information related to patient characteristics, disease status and pharmacokinetics /pharmacodynamics of warfarin, through mathematical modeling and simulation techniques based on the quantitative pharmacology. Compared with empirical dosing, it can improve the safety, effectiveness, economy, and adherence of pharmacotherapy of warfarin. This consensus report describes the commonly used modeling and simulation techniques for warfarin, their application in developing and adjusting dosing regimens, medication adherence and economy. Moreover, this consensus also elaborates the detailed procedures for the implementation in the warfarin pharmacy service pathway to facilitate the development and application of model informed precision dosing for warfarin.

The facultative anaerobic and strict anaerobic microorganisms enriched and acclimated during the anaerobic digestion process are crucial for the efficiency of the anaerobic digestion system. Most of the problems encountered during running anaerobic digestion processes could be effectively improved via stimulation of microbial metabolic activity. Benefited from the rapid development of microbiome techniques, deeper insights into the microbial diversity in anaerobic digestion systems, e.g. the microbe-microbe interactions and microbe-environment interactions, have been gained. A complex and intricate metabolic network exists in the anaerobic digestion system of solid organic wastes. However, little is known about these interactions and the underlying mechanisms. This review briefly summarized the representative interactions between microbial communities during anaerobic digestion process discovered to date. In addition, typical issues encountered during the anaerobic digestion of solid organic wastes and how microbes can tackle and alleviate these issues were discussed. Finally, future priorities on microbiome research were proposed based on present contribution of microbiome analysis in anaerobic digestion system.
Anaerobiosis ; Bioreactors ; Methane ; Microbial Interactions ; Microbiota ; Solid Waste

Objective To estimate the key epidemiological parameters, including the serial interval (SI), basic reproduction numbers (R₀), and time-dependent reproduction numbers (R_t) based on the case data of COVID-19 published on the official website of Shaanxi Provincial Health Commission. Methods The method of maximum likelihood estimation was used to fit the probability distribution of SI, and three parametric models including Gamma, Weibull, and Lognormal distributions were adopted to estimate the distribution of SI. The optimal model was selected by the corrected Akaike information criterion (AICc). Based on nonlinear regression model the cumulative number of confirmed cases was fit to the growth rate r of the Richard growth model to estimate R₀. The R_t was calculated based on the Bayesian framework. Results A total of 49 transmission chains were discovered from 245 local confirmed cases in Shaanxi Province. The Gamma distribution was the optimal model to fit the SI here by AICc. Using the Gamma distribution, the mean SI was estimated to be 6.3 days (95%CI:5.98 - 6.43) with a standard deviation (SD) of 3.94 days (95%CI: 3.01 - 5.03). Using the Richard growth model, the growth rate was estimated to be 0.23 (95% CI: 0.21 - 0.24) and the basic reproduction number in Shaanxi to be 3.11 (95%CI: 2.91 - 3.40). R_t showed an overall downward trend, and fell below 1 on February 10 (R_t=0.95（95%CI: 0.76-1.16)), and stabilized at around 0.35 on February 18. Conclusion The SI of COVID-19 is relatively shorter than that of MERS and SARS, while the R₀ is relatively larger, and R_t is on a downward trend, which suggests COVID-19 is a highly transmissible infectious disease. The control measures including the isolation and treatment of confirmed patients, quarantine and observation of suspected cases, contact tracing, improvement of public awareness, and adoption of self-protection measures can effectively reduce the COVID-19 outbreak.

Objective: To understand the current status of health related quality of life among primary and middle school students aged 9 to 15 years old in Henan Province, and to explore its relationship with negative emotions and social support. Methods: Between January and June 2016, 24 primary and middle schools were selected from 6 cities of Henan Province, and 5 867 primary and middle school students were included and completed the Pediatric Quality of Life Inventory Measurement, Stress Anxiety Depression Scale, Perceived Social Support Scale. Hierarchical linear regression analysis was used to examine the moderating effect of social support. Results: The total score of health related quality of life of primary and middle school students in Henan was (81.21±12.49). There were statistically significant differences in the quality of life among primary and middle school students with different gender, study period, family monthly income, subjective parental relationship and parental education ( P <0.05). Negative emotions were negatively correlated with quality of life ( r =-0.51, P <0.01) and social support ( r =-0.30, P <0.01), while social support was positively correlated with quality of life ( r =0.29, P <0.01). Regression analysis showed that negative emotional was negatively associated with quality of life ( β =-0.23, P <0.01), while social support was positively associated with quality of life ( β =0.16, P <0.01). The interaction of negative emotions and social support was negatively associated with quality of life ( β =-0.18, P <0.01). Conclusion Health related quality of life among 9-15 year old primary and middle school students in Henan province is satisfactory. Social support might buffer the negative impact of negative emotions including depression, anxiety and stress on quality of life of primary and secondary school students.

Objective:To investigate the clinical characteristics, treatment and prognosis of QARS1 gene related glutaminyl-tRNA synthetase deficiency.Methods:To summarize and analyze the clinical manifestations, imaging, laboratory examination, genetic variant characteristics and treatment of three patients from the Fujian Medical University Affiliated Union Hospital, the 900th Hospital of People's Liberation Army, the First Medical Center of People's Liberation Army General Hsopital carrying compound heterozygous variations in QARS1 gene with a long-term follow-up in China. A literature search was conducted using Wanfang, Weipu, China National Knowledge Infrastructure (CNKI) and Pubmed databases with the keywords "QARS", "QARS1" and "glutaminyl-tRNA Synthetase"(up to December 2019). Results:Case 1, a female 53 days of age, was admitted to the Fujian Medical University Affiliated Union Hospital for treatment because of the complaint of repetitive seizures for one month after birth and fever for one day. The seizure occurred within the first 2 hours of life with multiple forms and often had a status as persisted from hours to days. The seizures were resistant to many anti-epilepsy drugs (AED) and ketogenic diet but later controlled by clonazepam. However, she died at the age of seven years. Case 2 (younger brother of case 1), a one-hour-old boy, was hospitalized because of seizures after birth for 1 hour. Intrauterine growth retardation was discovered during late-pregnancy. The boy presented seizures and microcephaly immediately after birth, and his epilepsy was pharmacoresisitant. Case 3, an 8-month-old girl, was admitted due to recurrent convulsions for nearly two months. The girl had mild developmental retardation and hypotonia after birth. The infantile spasm was observed at her age of 6 months and disappeared under treatment with Vitamin B6, vigabatrin combined with adreno-cortico-tropic-hormone and magnesium sulfate. However, the seizure pattern turned to tonic seizures later. She was seizures free now with clobazam and zonisamide treatment. All of them manifested as a syndrome composed of severe global developmental retardation, progressive microcephaly, hypotonia from the very beginning, mild hypoproteinemia and diffuse brain atrophy. Genetic studies revealed compound heterozygous variations of QARS1 gene which were not reported previously . A review of the literature reported a total of 22 patients from 18 unrelated families all over the world. Except for 5 cases without epilepsy,all the patients shared very similar clinical manifestations as classic pentalogy. The recommended effective treatment for epilepsy has not been reported yet. Conclusions:Glutaminyl-tRNA synthetase deficiency caused by QARS1 gene variations manifested as a clinical syndrome′s pentalogy, characterized by microcephaly, cerebral atrophy, intractable early-onset epileptic encephalopathy, global developmental retardation and severe muscle hypotonia.

Objective To explore the levels of water channel protein 4 (aquaporin-4,AQP-4) in the serum and the cerebrospinal fluid of patients with severe hand-foot-mouth disease (HFMD) and its clinical significance.Methods Children with the critical HFMD (clinical stage 3) admitted to Xuzhou Children's Hospital from February 2017 to November 2017 were recruited(critical group).In the same period,another 25 cases of common HFMD (central nervous system infection excluded in cerebrospinal fluid examination,common group),the other 25 cases of severe HFMD (clinical stage 2,severe group) were taken as the controls.The levels of AQP-4 in the serum and and cerebrospinal fluid were measured in all children and the levels of AQP-4 in cerebrospinal fluid were checked again in the critical and severe cases after treatment.The levels of interleukin-6 (IL-6),norepinephrine (NE) and neuron-specific enolase (NSE) in the serum were examined simultaneously and the correlation between them was analyzed.Results Before treatment,the levels of AQP-4 in the serum of critical group were (54.42 ± 19.86) μg/L,which were significantly higher than common group[(8.02 ± 1.59) μg/L] and severe group[(22.04 ± 8.14) μg/L] (F =36.684,P ＜0.01).Compared with before treatment,the levels of AQP-4 in the serum of critical and severe group were significantly lower after treatment (P ＜ 0.05).Before treatment,the levels of AQP-4 in the cerebrospinal fluid of critical and severe cases were respectively (9.81 ±2.27) μg/L and (8.58 ± 1.92) μg/L,which were significantly higher than common group (6.56 ± 1.79) μg/L (F =6.713,P ＜ 0.05).After treatment,the levels of AQP-4 in the cerebrospinal fluid of critical and severe cases were (8.41 ± 1.63) μg/L and (7.14 ± 1.69) μg/ L separately,which were significantly lower than before treatment (t =6.340,5.073,all P ＜ 0.01).The levels of IL-6,NE and NSE in serum were significantly different among the three groups (P ＜ 0.01).The above indicators were positively correlated with the levels of AQP-4 in the serum(r =0.734,0.810,0.729,all P ＜ 0.01)and were also positively correlated with AQP-4 in the cerebrospinal fluid (r =0.299,0.431,0.363,all P ＜ 0.05).Conclusion AQP-4 may participate in pathophysiological processes of HFMD.The levels of AQP-4 in serum can be used as an indicator for judging the severity and monitor prognosis of HFMD.

Objective To analyze the effects of Hual qi huang granules on children with mycoplasma pneumoniae pneumonia.Methods A randomized,multicenter parallel controlled clinical trial was carried out.A total of 3 000 cases of hospitalized children with mycoplasma pneumoniae pneumonia were selected.All of them were given treatment for mycoplasma pneumoniae pneumonia with macrolide antibiotics and symptomatic treatment.They were randomly divided into 2 groups:research group and control group.The children of research group were give oral Huai qi huang granules for three months.According to the classification of pneumonia,these two groups were divided into:lobar pneumonia research group,lobar pneumonia control group,lobular pneumonia research group,lobular pneumonia control group.The hospitalization duration of fever,length of hospital stay,the absorption area of lung inflammation and pneumonia severity sores were observed.The frequency of upper respiratory infections,bronchitis,pneumonia were observed in 3 months after discharge.Results 2 378 cases were investigated.The hospitalization duration of fever,length of hospital stay of research group were significantly shorter than that of in control group (P ＜ 0.001).The children with lobar pneumonia,2 weeks after treatment,the absorption of consolidation of the lobar pneumonia research group is significantly better than lobar pneumonia control group (P ＜0.001).After two weeks treatment,the pneumonia scores of lobar pneumonia research group is lower than lobar pneumonia control group (P ＜ 0.05).Followup of 3 months after hospital discharge,frequency of upper respiratory infection and bronchitis of research group,were significantly lower than that of control.In addition,appetite increased significantly in research group than control (P ＜ 0.001).There are 21 cases with drug associated adverse reactions (mild diarrhea),including 12 cases of research group,9 cases of control group,and there was no statistical significance (P ＞0.05).Conclusion Standard treatment combined with oral Huai qi huang granules in the treatment of mycoplasma pneumoniae pneumonia,can significantly shorten hospitalization duration of fever,length of hospital stay and reduce the severity score of pneumonia.Three months oral Huai qi huang granules can significant reduce the frequency of respiratory infections and bronchitis,also can increase patients appetite,and be safe.

Animals ; Base Pairing ; Binding Sites ; CCCTC-Binding Factor ; metabolism ; Consensus Sequence ; Humans ; Mutation ; Nucleotide Motifs