中华预防医学杂志最新文献

Respiratory syncytial virus (RSV) is a common pathogen that causes acute respiratory infections, especially in infants and young children. There are currently no RSV-specific antiviral drugs, and there are no approved vaccines for infants and young children. With the widespread use of RSV passive immunizations in infants and young children in 2022 and the effective reduction of the burden of RSV infection-related diseases, passive immune-prophylaxis of RSV infection has attracted more and more attention. This paper summarizes the implementation experience and real-world application effect of passive immune-prophylaxis for RSV infection at home and abroad, to provide reference for the immune-prophylaxis practice of passive immune-prophylaxis for RSV infection in infants and young children in China.

Objective: To develop and validate a clinical warning model for severe pediatric community-acquired pneumonia (CAP) using electronic health records. Methods: A retrospective cohort study was conducted, analyzing clinical data of 15 750 children hospitalized for CAP at Wuhan Children's Hospital between January 1, 2019, and December 31, 2023. Patient data were randomly split into training and testing sets at a 7∶3 ratio. Six supervised machine learning models were constructed in the training set, optimized using five-fold cross-validation, and evaluated in the testing set. Model performance was assessed using ROC-AUC, sensitivity, specificity, positive predictive value, negative predictive value, calibration curves, and clinical decision curve analysis at optimal thresholds. The best-performing model was selected, and SHapley Additive exPlanations (SHAP) were used to interpret feature importance. A program interface was developed based on the model results, enabling integration into clinical decision support systems for automated early warning. Results: A total of 15 750 participants, ranging in age from 28 days to 18 years, were included in the study. The median age was 2 years [interquartile range (IQR): 0-4 years], with 9 555 males (60.67%) and 6 195 females (39.33%). Among them, 2 211 (14.04%) developed severe pneumonia. In the prediction models, XGB outperformed other models with an ROC-AUC of 0.884 (95%CI: 0.870-0.898), sensitivity (0.803, 95%CI: 0.772-0.832), specificity (0.828, 95%CI: 0.816-0.839). Calibration analysis showed strong agreement between predicted and observed risks (Brier score: 0.081, 95%CI: 0.075-0.086). The analysis based on the SHAP method revealed that respiratory rate, heart rate, T-lymphocyte subsets, and red blood cell volume distribution width-SD are predictive factors for severe progression of community-acquired pneumonia (CAP) in children. Conclusion: An interpretable machine learning model was developed for the early detection and personalized treatment planning of severe CAP in children, providing valuable support to clinicians.

Human papillomavirus (HPV) infection not only causes cervical cancer in women but also leads to HPV-related cancers and genital warts in men. Globally, 82 countries have adopted a gender-neutral HPV vaccination strategy to prevent and control related diseases. In China, HPV vaccination for men has now been implemented. Based on the global and domestic burden of male HPV-related diseases, evidence on the safety and efficacy of HPV vaccines in males, and lessons from international male HPV prevention efforts, a panel of experts has developed the Expert Initiative for the Prevention and Control of HPV Infection and related diseases among Chinese males after multi-round discussions. The initiative proposes: Develop comprehensive strategies for the prevention and control of male HPV infection and related diseases; prioritize and enhance public education and awareness campaigns; promote joint prevention for both men and women and advance gender-inclusive vaccination; innovate financing mechanisms to reduce the economic burden; strengthen research on male HPV infection and vaccination to facilitate the development of new vaccines; and adopt innovative immunization models to improve the quality of vaccination services.

Objective: To establish a three-dimensional U-shaped residual coordinated attention network (URCA-Net) based on enhanced CT images for small bowel polyp detection and analyze its application effectiveness in intelligent detection of small bowel polyps. Methods: Abdominal CT data of patients with small bowel polyps were collected from the Air Force Medical Center between June 2019 and July 2023. All patients underwent bowel preparation followed by thin-slice spiral CT scanning to obtain enhanced CT arterial phase images. The data were randomly divided into training, validation and test sets in an 8∶1∶1 ratio. The URCA-Net deep learning model was used for small bowel polyp segmentation. The training set was used for model parameter training, the validation set for hyperparameter adjustment and monitoring of model generalization performance and the test set for final unbiased evaluation of the model. An early intelligent detection model for small bowel polyps was constructed, and its performance was evaluated. Evaluation metrics included pixel-level metrics for the segmentation task [Dice Similarity Coefficient (DSC)], as well as sensitivity and precision for polyp detection. A two-stage segmentation strategy was adopted: the first stage segmented the small bowel region to remove external interference, and the second stage performed polyp segmentation within the small bowel region. Results: A total of 78 subjects were included in the study, with an average age of (54±7) years. A total of 23 400 scan images were extracted, including 136 hyperplastic polyps, 298 hamartomatous polyps, 14 adenomatous polyps, and 4 cancerous polyps. On the test set, the average DSC for the first stage (small bowel segmentation) and the second stage (polyp segmentation) was 0.790 and 0.314, respectively. In the second stage task (polyp segmentation based on small bowel region), the polyp segmentation DSC increased to 0.701, with a precision of 0.836 (95%CI: 0.700-0.972) and a sensitivity of 0.759 (95%CI: 0.631-0.888) for polyp detection. Conclusion: The URCA-Net deep learning technique demonstrates good auxiliary diagnostic effectiveness in small bowel polyp detection and can provide a reference for screening and detection of small bowel polyps. The model is capable of generating high-quality segmentation results, which could facilitate evaluating polyp lesion morphology and provide support for downstream tasks such as preoperative navigation and risk prediction.

Cat allergens are among the most significant environmental factors contributing to the onset of allergic diseases. The increasing global prevalence of pet cat ownership in recent years has been associated with a rise in the incidence of allergic diseases linked to cat allergens. Research has demonstrated that pet cats can trigger type I hypersensitivity-related conditions, such as allergic rhinitis, asthma, and atopic dermatitis, in atopic individuals through allergens found in their dander, saliva, urine, and other substances. The precise mechanism by which cat allergens induce immune tolerance remains incompletely understood. Furthermore, due to the complexities of multiple sensitizations and cross-reactivity, the interactions between cat allergens and other pet allergens (e.g., dog allergens) and air pollutants in the development of allergic diseases are not yet fully elucidated. Consequently, this article reviews recent advancements in the epidemiology of cat allergen sensitization, the underlying mechanisms, exposure and sensitization risks, component-resolved diagnostics, treatment, and prevention, with the aim of providing references for clinical strategies in the prevention, diagnosis, and management of these conditions.

To analyze the prevalence, drug resistance and whole genome characteristics of Mycoplasma pneumoniae (MP) in respiratory throat swab samples of hospitalized children with pneumonia in Suzhou City from 2023 to 2024. Throat swab samples of hospitalized children aged 0-14 years old with pneumonia in Suzhou were collected from September 2023 to September 2024. Real-time fluorenscence quantitative PCR technology was used to detect MP nucleic acid. The results showed that the positive rate of MP in 3 235 samples was 22.44% (726/3 235), with a rate of 55.00% in week 47 of 2023. The positive rate of MP increased with age (χ²=45.842, P<0.001). The study selected MP nucleic acid test positive samples from week 20 (5.13-5.19) to week 23 (6.3-6.9) of 2024 for isolation, culture and resistance phenotype detection. About 31 MP strains were successfully isolated and cultured, all of which were resistant to macrolides. The next-generation sequencing technology and nanopore sequencing technology were used for genome sequencing. All 31 strains carried the A2063G mutation, with the main prevalent genotype being the P1-1, and the main mlST type being the ST3. Despite the overall genomic similarity between strains being over 99%, there were significant differences between the P1-1 and P1-2 strains in the P1 gene region. In summary, from 2023 to 2024, the main MP type prevalent in Suzhou City is the P1-1 genotype. All isolated MP strains carry an A2063G resistance site mutation and are resistant to macrolides, requiring continuous monitoring and further research.

Objective: To investigate the clinical demand for subcutaneous immunotherapy (SCIT) with pet allergens and explore the sensitization characteristics of patients undergoing pet SCIT. Methods: A cross-sectional retrospective analysis was conducted on patients diagnosed with pet allergies and treated with pet allergen SCIT in our outpatient clinic from January 2019 to December 2023. Patients were categorized into three groups based on the type of SCIT received: single-cat SCIT group, single-dog SCIT group, and combined cat-dog SCIT group. Results: A total of 931 patients were included, the age range was 5-65 years (median age of 30 years), with 283 male and 648 female. Among them, 67.7%(n=630) received single-cat SCIT, 10.9% (n=102)received single-dog SCIT, and 21.4% (n=199) received combined cat-dog SCIT. The number of patients receiving pet allergen SCIT increased annually. Patients in the single-dog SCIT group were significantly older than those in the other two groups (H=41.329,P<0.001) and had a lower prevalence of allergic rhinitis (91.2% vs. 96.5% and 98.5%; χ²=10.400,P=0.006). In the combined cat-dog SCIT group, the allergy rate to mold allergens was significantly higher than in the single-cat SCIT group (12.6% vs. 4.9%, χ²=13.965,P=0.001). In the single-dog SCIT group, the allergy rate to spring pollen allergens was significantly higher than in the other two groups (χ²=15.731,P<0.001), and the allergy rate to autumn pollen allergens was significantly higher than in the single-cat SCIT group (χ²=13.459,P=0.001). There was no significant difference in the dust mite allergy rate among the three groups(χ²=4.117,P=0.129). In the single-dog SCIT group, patients with asthma were significantly older than those without asthma (41.2 vs. 35.2 years old,t=-2.073,P=0.041). In both the single-cat and single-dog SCIT groups, the proportion of allergic rhinitis in the asthma group(91.2%,78.3%) was significantly lower than that in the non-asthma group(97.4%,94.9%) (χ²=8.863,6.158;P=0.008,0.026). In the single-cat SCIT group, non-asthmatic patients were significantly more likely to receive SCIT combined with spring pollen allergens compared to asthmatic patients (23.9% vs. 11.0%, χ²=7.586,P=0.006). Conclusions: The demand for pet allergen SCIT has steadily increased over the years, with a predominance of female patients. Sensitization profiles varied among patients receiving SCIT for different pet allergens. This study comprehensively elucidates the clinical demand and sensitization characteristics of patients undergoing pet allergen SCIT, providing valuable reference data for clinical diagnosis and treatment.

To satisfy the growing healthcare demands of the public, it is essential to develop a public service platform for vaccination. This initiative aligns with national policies, optimizes resource allocation, innovates service models, enhances service efficiency, and reduces service costs. Drawing on relevant national policies and regulatory requirements, as well as the notable achievements and practical experiences gained through the exploration and innovation of vaccination service models across various regions, this paper proposes expert recommendations. It defines the essential components and functional specifications for public service platforms, focusing on public needs such as electronic vaccination record management, appointment management, the promotion of electronic vaccination certificates, vaccination certificate verification for school enrollment, vaccination site navigation, and science communication and public engagement. The recommendations aim to serve as a reference for the development of vaccination public service platforms nationwide.

Skin aging is a complex physiological process that is associated with various skin diseases and affects appearance.Vitamin D, a fat-soluble vitamin synthesized after exposure of the skin to ultraviolet B radiation, has been found to regulate skin aging by modulating the physiological functions of skin cells, regulating the immune system, inducing antioxidative responses, inhibiting DNA damage, and promoting its repair. This article elucidates the multi-target mechanism of vitamin D in delaying skin aging, providing a new theoretical foundation for preventive medicine to retard aging and related diseases through nutritional intervention.