ObjectiveTo observe the clinical effectiveness and safety of Xuandi Ziyin Mixture （玄地滋阴合剂） for central precocious puberty （CPP） in girls with syndrome of yin deficiency and fire exuberance， and to analyse the effect of body mass index （BMI） on the effectiveness. MethodsA total of 236 girls with CPP of yin deficiency and fire exuberance syndrome were included， and all of them were given Xuandi Ziyin Mixture， 30 ml each time， twice a day， for a total treatment period of 6 months. Before and after treatment， children's weight， height and bone age were measured， BMI and BMI Z-score （BMI Z） and the difference between bone age and actual age were calculated； ultrasound was used to detect uterine and ovarian sizes， and to calculate uterine volume （V_uterus）， bilateral ovarian volume （V_{left ovary}， V_{right ovary}）， and bilateral maximal follicle diameters （r_{left follicle} and r_{right follicle}）； and serum sex hormones were measured， including follicle-stimulating hormone （FSH）， luteinising hormone （LH）， prolactin （PRL）， estradiol （E₂）， and testosterone （T）， and were scored for traditional Chinese medicine （TCM） syndrome. Multiple linear regression was used to analyse the influence factors of the difference between bone age and actual age， and changes in uterine volume. The children were divided into the normal weight group and the overweight/obesity group according to baseline BMI， and the bone age， the difference between bone age and actual age， V_uterus and BMI Z scores before and after treatment were compared between the two groups. ResultsFinally， 199 children entered the statistical analysis. Compared with pre-treatment， the bone age， BMI and BMI Z scores of the children increased after treatment， and the difference between bone age and actual age， TCM syndrome scores， V_uterus， V_{left ovary}， V_{right ovary}， r_{left follicle} and r_{right follicle} decreased； and the levels of serum FSH， LH， E₂， and T significantly decreased （P＜0.05 or P＜0.01）. The difference between bone age and actual age was negatively correlated with LH and V_uterus （P＜0.05）， and changes in uterine volume were positively correlated with LH （P＜0.01）. Comparing between the groups before and after treatment， the bone age， difference between bone age and actual age， and BMI Z scores of children in the normal weight group （100 cases） were significantly smaller than those in the overweight/obesity group （99 cases） （P＜0.01）. Compared with pre-treatment， the bone age of the children in both groups increased， but the difference between bone age and actual age and V_uterus were significantly smaller （P＜0.01）. Further comparison of Δ bone age and actual age difference and ΔV_uterus （Δ = post-treatment value - pre-treatment value） between the two groups showed no statistically significant difference （P＞0.05）. ConclusionsXuandi Ziyin Mixture can reduce bone age， sex hormone level， ovary and uterus size， and improve clinical symptoms in girls with yin deficiency and fire exuberance syndrome of CPP. It is also effective in overweight/obese children， and the inhibitory effect on bone age in girls with CPP is not affected by BMI， with good safety.

Following the principles of evidence-based medicine,in accordance with the structure and drafting rules of standardized documents,based on literature research,according to the characteristics of chronic cough in children and issues that need to form a consensus,the TCM Guidelines for Diagnosis and Treatment of Chronic Cough in Children was formulated based on the Delphi method,expert discussion meetings,and public solicitation of opinions.The guideline includes scope of application,terms and definitions,eti-ology and diagnosis,auxiliary examination,treatment,prevention and care.The aim is to clarify the optimal treatment plan of Chinese medicine in the diagnosis and treatment of this disease,and to provide guidance for improving the clinical diagnosis and treatment of chronic cough in children with Chinese medicine.

Non-pharmaceutical interventions (NPIs) implemented during the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) epidemic have been proven to be effective in blocking the spread of the epidemic.While reducing SARS-CoV-2 transmission, NPIs also reduce children exposure to other pathogens, leading to a decline in the incidence of many viral and bacterial infections.The reduction in contact with viruses and bacteria and the delay or interruption of routine immunization during SARS-CoV-2 epidemic have resulted in insufficient immune stimulation of pathogens on the population, leading to an increase in susceptible populations and a decline in herd immunity, forming the immune debt during SARS-CoV-2 epidemic.After reducing or lifting NPIs, the incidence of some viral or bacterial infectious diseases was significantly higher than pre-epidemic.In this review, the definition, source, impact and strategies of immune debt during epidemic period were expounded, inorder to improve clinicians′ attention and understanding of immune debt and optimize the prevention of children′s infectious diseases.

Objective:To construct an "Internet+nursing service" model for elderly patients at home led by the continuing care service center from the perspective of the Internet, and to provide reference for different types of professional home care services for elderly patients.Methods:From March 2019 to December 2021, relying on the continuing care service center, six links of "discharge preparation, discharge follow-up service, home care service, online diagnosis and treatment, institutional return visit, health guidance" in Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology were interconnected to construct a closed-loop "Internet+nursing service" model for elderly patients at home. Summarized the workload after the implementation of "Internet+nursing service", and investigated the satisfaction of 149 patients and 112 home sevice nurses.Results:After 2 years and 9 months of implementation, the team provided 11 home care services for elderly patients with diabetes foot dressing change, PICC catheter maintenance, replacement of catheter, wound stoma care and home membrane dialysis etc, and provided 452 home care services for 149 patients. Patient satisfaction was (94.47 ± 3.07) points; the approval of this model by 112 home service nurses was (4.69 ± 0.43) points.Conclusions:The "Internet+nursing service" model for elderly patients at home, which is dominated by the continuous nursing service center, can meet the continuous nursing needs of elderly patients at home. At the same time, expanding nurses′ practice space and enhancing nurses′ professional value will play a positive role in promoting the development of nursing service industry.

It is a common problem for all mentors to cultivate the capacity for scientific research of master degree candidates in plastic surgery under the current training program of "double-track in one" and "four-certificate in one". This study introduces the "COME" training mode that includes clinical study, off-hour, multiple modalities, and efficient feedback. This study elaborates the composition and method of this training mode, and compares the number and quality of published papers and thesis before and after its implementation. Results show that the "COME" training mode can significantly improve the capacity for scientific research of master degree candidates in plastic surgery.

It is a common problem for all mentors to cultivate the capacity for scientific research of master degree candidates in plastic surgery under the current training program of "double-track in one" and "four-certificate in one". This study introduces the "COME" training mode that includes clinical study, off-hour, multiple modalities, and efficient feedback. This study elaborates the composition and method of this training mode, and compares the number and quality of published papers and thesis before and after its implementation. Results show that the "COME" training mode can significantly improve the capacity for scientific research of master degree candidates in plastic surgery.

Hypoxemia is a common complication of pneumonia, asthma, and bronchopulmonary dysplasia in children.Rapid identification of hypoxemia is of great significance for the disposal and management of critical children.Pulse oximetry is recognized by the World Health Organization as the best way to monitor hypoxemia in children, and it can monitor pulse oxygen saturation noninvasively and continuously.Based on the related literature at home and abroad, combined with the clinical needs of pediatrics, the " Expert consensus on clinical application of pulse oximetry in children" is formulated to improve the understanding of pediatricians and nurses on the application in pediatric clinical practice, principle, operation techniques, and limitations of pulse oximetry.

Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.

Objective:To evaluate the application effect of virtual reality in labor pain management by Meta analysis.Methods:The randomized controlled trials on the impact of virtual reality on labor pain was searched by PubMed (Medline), Web of Science, The Cochrane Library, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang database, Chinese biomedical database, and VIP database from their inception until July 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bais of included studies. Meta-analysis was performed using the Comprehensive Meta-Analysis (CMA) software Version 3.Results:Totally, 658 pregnant women were identified in the search, which were narrowed down to 8 studies. The results of Meta-analysis showed that the virtual reality group decreased the labor pain compared with the normal nursing group ( MD=-1.13, 95% CI-1.59 to -0.67, P<0.01), especially during the active phase of labor ( MD=-1.20, 95% CI-1.96 to -0.45, P<0.01). Besides, compared with the normal nursing group, the virtual reality group had a shorter first stage duration of labor ( MD=-0.93, 95% CI-1.51 to -0.34, P<0.01) and a lower level of anxiety ( SMD=-1.54, 95% CI-2.22 to -0.85, P<0.01). However, there was no significant difference between two groups in the pain scores during the latent phase of labor ( MD=-0.41, 95% CI-1.30 to 0.47, P>0.05) and the second stage duration of labor ( MD=-0.37, 95% CI-3.27 to 2.53, P>0.05). Conclusions:The findings of this Meta-analysis showed that the virtual reality significantly reduced the labor pain, shorted the first stage labor duration and lowered anxiety level. However, due to the limited quantity and quality of the included studies, its conclusions need to be verified by more large sample multicenter randomized controlled trials with rigorous design in the future.

Objective:To evaluate clinical efficacy and safety of topical compound oleum lithospermi in the treatment of mild to moderate diaper dermatitis.Methods:A multicenter, randomized, positive-drug parallel-controlled clinical trial was conducted in 19 hospitals from July 2019 to August 2020. Children aged 0 - 12 months with mild to moderate diaper dermatitis were enrolled and randomly divided into 2 groups using a random number table: test group topically treated with compound oleum lithospermi, and control group topically treated with zinc oxide cream. The treatment was carried out 6 - 8 times a day for 7 days. Visits were scheduled on days 0 and 7, and total response rate and clinical healing time were evaluated. Changes in the dermatitis family impact (DFI) score were compared between the test group and control group, and adverse events were recorded. Statistical analysis was carried out by using independent-sample t test for normally distributed continuous data, Wilcoxon rank sum test for non-normally distributed continuous data, and chi-square test or Fisher′s exact test for unordered categorical data; survival curves were drawn, and log-rank test was used for comparisons between two groups. Results:A total of 343 children with diaper dermatitis were enrolled in this study. Among them, 31 children violated the protocol, so 312 were included in the per protocol set, including 157 in the test group and 155 in the control group, and all completed the visits on days 0 and 7. The total response rate was significantly higher in the test group (87.26%, 137/157) than in the control group (78.71%, 122/155; χ2 = 4.04, P = 0.044) . The clinical healing time was significantly shorter in the test group (5.33 days) than in the control group (6.13 days; χ2 = 4.67, P = 0.025) . After 7-day treatment, the DFI score significantly decreased in both the 2 groups compared with that before the treatment, but there was no significant difference in the DFI score between the 2 groups (test group: 4.02 ± 6.96, control group: 3.58 ± 5.90, Z = -0.39, P = 0.686) . The incidence of adverse events was 2.92% (5/171) and 5.45% (9/165) in the test group and control group respectively, and there was no significant difference between the 2 groups ( χ2 = 0.03, P = 0.865) . Conclusion:Compound oleum lithospermi can markedly reduce the clinical severity of diaper dermatitis, improve the total response rate, shorten the clinical treatment period, and improve the quality of life of children′s families with a favorable safety profile.