Zhonghua yi xue za zhi最新文献

Objective: Comparison of the epidemiological profile, clinical characteristics, and disease-related factors in vitiligo patients between 2001-2011 and 2022-2024. Methods: Clinical data from the inital visits of patients diagnosed with vitiligo at the Dermatology Department of Xijing Hospital were retrospectively collected during the periods of 2001-2011 and 2022-2024. The distribution of demographic and clinical characteristics, including age at the first visit, onset age, and disease duration, were compared between the 2001-2011 group and the 2022-2024 group. Results: The 2001-2011 group included 8 053 patients (4 284 males and 3 769 females), while the 2022-2024 group included 1 041 patients (581 males and 460 females). No significant difference was found in the gender distribution between the two groups (P=0.119). Compared to the 2001-2011 group, the 2022-2024 group was significantly older at the first visit [median 29 (IQR 16-39) years vs 21 (11-31) years] and at onset [22 (11-33) years vs 17 (9-26) years], with a higher proportion of patients with disease onset at ≥50 years of age [7.5% (78/1 041) vs 3.8% (305/8 053)]. The proportion of mild cases was significantly increased in 2022-2024 group [73.8% (768/1 041) vs 66.3% (5 341/8 053)], while the proportion of extremely severe cases was lower [0.4% (4/1 041) vs 1.9% (157/8 053)] (all P<0.05). Additionally, the 2022-2024 group showed a higher proportion of cases with onset in winter [14.2% (148/1 041) vs 4.4% (353/8 053)] and a lower proportion with onset in summer [15.3% (159/1 041) vs 18.6% (1 495/8 053)] (all P<0.05). Conclusion: Compared with the 2001-2011 period, patients in the 2022-2024 period exhibit important shifts in disease characteristics, including an older age at onset and a higher propensity for onset in winter.

Objective: To explore the value of model based on the stress hyperglycemia ratio (SHR) in predicting acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Methods: This was a retrospective cross-sectional study. Patients diagnosed with AMI from the MIMIC-Ⅳ 3.0 database in the United States between 2008 and 2022 were included and randomly divided into a training set (1 861 cases) and an internal validation set (799 cases) at a 7∶3 ratio. Additionally, eligible AMI patients from Qingdao Municipal Hospital between January 1, 2021, and February 1, 2025, were included as an external test set (316 cases). Key factors were screened using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Univariate and multivariate logistic regression models were used to identify factors influencing the occurrence of CS in AMI patients, and a nomogram prediction model based on SHR was established. The predictive performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision analysis (DCA) curve. Results: In the training set, patients had a median age of 69 (61, 77) years, with 1 293 males, and 16.7% (310/1 861) had concurrent CS. In the internal validation set, patients had a median age of 69 (61, 77) years, with 550 males, and 18.3% (146/799) had concurrent CS. In the external test set, patients had a median age of 72 (64, 80) years, with 199 males, and 11.1% (35/316) had concurrent CS. Multivariate logistic regression analysis indicated that systolic blood pressure (SBP), SHR, white blood cell (WBC) count, hematocrit (HCT), aspartate aminotransferase (AST), anion gap (AG), activated partial thromboplastin time (APTT), heart failure (HF), and acute kidney injury (AKI) were all influencing factors for the occurrence of CS in AMI patients (all P<0.05). A nomogram model based on these nine variables demonstrated an AUC of 0.82 (95%CI: 0.80-0.84), a sensitivity of 0.68 and a specificity of 0.82 in the training set for predicting CS in AMI patients; an AUC of 0.79 (95%CI: 0.75-0.83), a sensitivity of 0.64 and a specificity of 0.77 in the internal validation set; and an AUC of 0.84 (95%CI: 0.77-0.92), a sensitivity of 0.77 and a specificity of 0.80 in the external test set. Calibration curves indicated good consistency across all datasets, and DCA curve demonstrated that the nomogram model had excellent clinical applicability. Conclusions: SHR is an influencing factor for CS in AMI patients. The nomogram model developed using SBP, SHR, WBC, HCT, AST, AG, APTT, HF and AKI provides a more intuitive method for identifying the risk of CS in AMI patients.

Amid frequent global population mobility, rapid socioeconomic development, accelerated climate change and population aging process, the coexistence of multiple infectious disease threats and the complex interplay of various health determinants have made the co-circulation of multiple infectious diseases a new challenge for public health. Multi-disease prevention targets infectious diseases that share commonalities in clinical manifestations, modes of transmission, risk factors, as well as prevention and control strategies and measures. It integrates the planning, surveillance, testing, prevention, control, and management of such diseases to enhance the quality and efficiency of public health responses. The feasibility of multi-disease prevention lies in its scientific approach to identifying common patterns in the epidemiological characteristics, transmission mechanisms, and control logic of various infectious diseases, thereby enabling highly coordinated and efficient prevention and control efforts. Multi-disease prevention is an urgent practical response to the co-circulation of multiple diseases, a vital means of optimizing resource allocation and improving control efficiency, and an inevitable pathway toward modernizing the public health system. It is recommended to improve the institutional mechanisms for multi-disease prevention. Guided by the principle of"integrated planning, integrated surveillance, integrated testing, integrated prevention and control, and integrated assessment", scientific approaches should be adopted to advance multi-disease prevention efforts.

Objective: To analyze the molecular epidemiological features of the mcr-1 gene among intestinal Escherichia coli (E. coli) isolates from healthy individuals during 2016 and 2024. Methods: This cross-sectional study included 362 mcr-1-positive E. coli isolates recovered from the intestinal flora of healthy individuals across six provinces (6 475 participants) in 2016, 2019, 2022, and 2024. Strain identification was conducted using MALDI-TOF/MS, and mcr-1 gene was screened by PCR. Antibiotic susceptibility testing was performed to determine the resistance phenotypes of the strains. Whole-genome sequencing was employed to analyze the genetic environment of mcr-1 and the phylogenetic relationships of the host strains. Differences in the epidemiological patterns, resistance phenotypes, and genetic characteristics of mcr-1-positive E. coli isolates were analyzed across sampling years. Results: Among 362 participants, the mean age was (49±20) years; 194 were male. The carriage rate of the mcr-1 in E. coli showed a significant downgrade trend, decreasing from 13.3% (91/684) in 2016 to 0.4% (5/1 250) in 2024 (P=0.029). Among mcr-1-positive isolates, resistance was highest to cefotaxime (51.9%, 118/362), followed by ciprofloxacin (46.9%, 170/362) and aztreonam (31.2%, 113/362), while high susceptibility was retained to amikacin, cefoperazone/sulbactam, carbapenems, and tigecycline. Compared to 2016, the resistance of mcr-1-positive isolates to aztreonam, cefotaxime and ciprofloxacin all increased in 2019 (all P<0.05). Compared to 2022, the resistance to seven antimicrobial agents showed varying degrees of decline in 2024 (except for ciprofloxacin and meropenem, all P<0.05). Plasmid analysis identified nine plasmid incompatibility types among mcr-1-positive isolates, with IncI2 being most frequent (40.1%, 145/362), followed by IncX4 (15.5%, 56/362), IncHI2 (6.4%, 23/362), IncHI2A (2.8%, 10/362), IncP (2.2%, 8/362), IncF (1.4%, 5/362), and IncY (1.1%, 4/362). The genetic environment analysis of the mcr-1 gene showed that the IncI2 plasmid retained the mcr-1-pap2 structure of transposon Tn6330 during evolution. Conclusions: The plasmids carrying mcr-1 were more concentrated, with IncI2 plasmids becoming the dominant plasmid.

Objective: To evaluate the efficacy and safety of the Janus kinase (JAK) inhibitors ritlecitinib and baricitinib in the treatment of alopecia totalis and alopecia universalis. Methods: The clinical data of alopecia totalis and alopecia universalis patients with a Severity of Alopecia Tool (SALT) score≥95 who received baricitinib or ritlecitinib therapy in the Department of Dermatology, Xiangya Hospital, Central South University from December 2022 to April 2025 were retrospectively analyzed. Assessment was performed at baseline and at weeks 12, 24, and 36 post-treatment using the SALT, Eyebrow Assessment (EBA), and Eyelash Assessment (ELA). Safety was evaluated based on adverse events observed during the treatment period. The primary efficacy endpoint was the proportion of patients achieving a SALT score of≤20 after treatment. The secondary efficacy endpoints included the eyebrow response rate and the eyelash response rate. Results: A total of 30 patients were enrolled, comprising 12 males and 18 females, with a median age of 16.5 years (IQR 13.0, 27.0). Among them, 90.0% (27/30) had alopecia totalis, 86.7% (26/30) had eyebrow involvement, and 60.0% (18/30) had eyelash involvement. Twenty-two patients were treated with ritlecitinib, while 8 received baricitinib. The median SALT scores at baseline, week 12, and week 24 were 100.0 (IQR 98.0, 100.0) score, 76.5 (IQR 53.0, 100.0) score, and 28.0 (IQR 4.3, 91.3) score, respectively. Efficacy analysis revealed that at week 12, the SALT response rates were 3/22 for ritlecitinib and 2/8 for baricitinib. At week 24, the response rates were 12/22 for ritlecitinib and 2/8 for baricitinib. Additionally, at week 12, the overall eyebrow and eyelash response rates were 7/19 and 7/12, respectively. At week 24, these rates were 13/19 for eyebrows and 9/12 for eyelashes. A total of 15 adverse events were reported, all of which were mild to moderate, with folliculitis (9/15) being the most common. Conclusion: Baricitinib and ritlecitinib are both effective and well-tolerated in treating alopecia totalis and universalis, demonstrating a manageable safety profile.

Acute respiratory tract infection (ARTI) is a common and prevalent disease in children. Defining its etiology is essential for precise and standardized prevention and treatment. There exists a disparity in the understanding of pathogen detection and clinical management of childhood ARTI among pediatricians at all levels, particularly regarding the lack of a unified definition and diagnostic and therapeutic pathway for ARTI of unknown etiology in children. To improve the rationality of etiological detection for ARTI, optimize treatment strategies and management processes, the Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association developed this expert consensus. It addresses initial etiological assessment, diagnostic workflow, selection of diagnostic methods, clinical guidance based on next-generation sequencing results, severity evaluation, empirical treatment and management, as well as early identification and management of emerging and re-emerging infectious respiratory diseases. Based on relevant domestic and international literature and clinical experience, this consensus provides recommendations on the etiological diagnosis and management of childhood ARTI, aiming to uniformly improve the overall level of medical services as well as improve the outcome and prognosis of ARTI in children.

This study evaluated the application of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) for apneic oxygenation during anesthesia in pediatric surgery for juvenile-onset recurrent respiratory papillomatosis (JORRP). A retrospective analysis included 55 pediatric patients (27 males, 28 females) aged under 12 years who underwent JORRP surgery with THRIVE at Beijing Tongren Hospital between January 2023 and December 2024. Data on patient demographics, surgical details, lowest intraoperative SpO₂, heart rate and mean arterial pressure (MAP) at various time points (before and after anesthesia induction, at the start of surgery, at 5, 10, 20, and 30 minutes after surgery began, at the end of surgery, and upon leaving the operating room), number of extubations, and apnea duration were collected. The median age was 7 (IQR 6-10) years, with preoperative laryngeal obstruction grades ranging from Ⅰ to Ⅲ, including 35 patients (63.6%) with grade II or above. Median apnea time was 9 (IQR 8-12) minutes, and 50 patients (90.9%) required only one intraoperative extubation. The lowest SpO₂ was≥90% in 52 patients (94.6%), including 44 (80.0%) maintaining SpO₂ at 95%-100%. Intraoperative hypoxemia (SpO₂<92%) occurred in 5 patients (9.1%), with no serious THRIVE-related cardiopulmonary complications. Heart rate and MAP showed statistically significant variations across time points (all P<0.001). THRIVE effectively maintained oxygenation and circulation during apnea in pediatric patients with grade Ⅰ to Ⅲ laryngeal obstruction due to JORRP, reducing the need for repeated intubation and proving to be a safe and effective ventilatory support method.

Bone trabeculae are key components of bone microstructure, and their complex three-dimensional interconnected microarchitecture is closely related to bone mechanical properties. Traditional imaging studies have been mostly limited to two-dimensional morphological analysis of bone trabeculae, with insufficient attention paid to their interconnected topology, making it difficult to comprehensively reflect bone quality characteristics. The development of ultra-high resolution CT (U-HRCT) technology has brought revolutionary breakthroughs to three-dimensional imaging of bone microstructure. Its spatial resolution can reach up to 50 μm, enabling clear visualization of the three-dimensional structure of bone trabeculae and providing a technical foundation for in vivo assessment of the interconnected trabecular network. Placing emphasis on imaging assessment of bone quality based on three-dimensional interconnected bone microstructure is of great significance for innovating the diagnosis and treatment paradigm of osteoporosis and improving the accuracy of fracture risk prediction. On the basis of systematically reviewing research progress on the three-dimensional interconnected microarchitecture of bone trabeculae, this article focuses on commenting on the technical advantages of U-HRCT in bone microstructure imaging, analyzes the equipment and technical feasibility of evaluation based on the three-dimensional interconnected trabecular network, proposes developing new pathways for bone quality imaging assessment, constructs novel imaging parameters that reflect interconnected topological features, and establishes new bone quality assessment models by integrating multi-level information. It also points out current challenges, including lack of standardization, lengthy imaging durations, and complex data processing, and emphasizes that clinical translation still requires multidisciplinary integration and collaborative advancement across endocrinology, orthopedics, radiomics, biomechanics, and AI.