简介：AbstractThe rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades. The antimicrobial stewardship program (ASP) is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use. ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance. Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization, decreasing drug resistance and treatment failure, minimization of adverse clinical outcomes, decreasing healthcare costs and hospital length of stay, and optimization of diagnostic strategies. However, some barriers in pediatric ASP still exist. This narrative review describes core elements of ASP, the impact of implemented ASPs on pediatric healthcare, and challenges of pediatric ASP as seen by the authors.

简介：AbstractThe demand for acquiring different languages has increased with increasing globalization. However, knowledge of the modification of the new language in the neural language network remains insufficient. Although many details of language function have been detected based on the awake intra-operative mapping results, the language neural network of the bilingual or multilingual remains unclear, which raises difficulties in clinical practice to preserve patients’ full language ability in neurosurgery. In this review, we present a summary of the current findings regarding the structure of the language network and its evolution as the number of acquired languages increased in glioma patients. We then discuss a new insight into the awake intra-operative mapping protocol to reduce surgical risks during the preservation of language function in multilingual patients with glioma.

简介：AbstractObjective:No ideal training system exists for pancreaticoduodenectomy (PD). We developed an educational system that uses an objective structured assessment of technical skills.Methods:This retrospective observational study was conducted using the data of consecutive trainees and patients who underwent PD from 2007 to 2013 in Kansai Medical University Hospital. The total score on the task checklist (21 parameters) for measuring technical performance during PD by self assessment and instructor assessment was compared between junior (JN) and hepatobiliary pancreatic (HBP) trainees at a university hospital. Surgical outcomes of 303 PDs (2007-2013) were also compared among JN trainees, HBP trainees, and instructors, and the present position of the trainees was investigated. This study was approved by the institutional review board of Kansai Medical University on May 26, 2020.Results:The self-assessment score on the task checklist was significantly higher for the HBP trainees than for the JN trainees on all parts of PD (P <.001). The discrepancy between self-assessment and instructor assessment improved in 3 JN trainees after experience with the first 5 PDs. Although total score curves rose to the right in the JN group, scores in the HBP group were stable, at 70 or higher, which correlated with the instructor assessment. The 90-day and 30-day mortality rates were 1.6% and 0.3%, respectively. Mortality and morbidity after PD did not differ between the JN and HBP trainees or between the instructors and the trainees. Four of 10 trainees became board-certified expert surgeons of the Japanese Society of Hepatobiliary Pancreatic Surgery.Conclusion:These results indicated good construct validity of the task checklist system. This program was safely and effectively implemented in terms of surgical outcomes and final outcomes of trainees becoming board-certified expert surgeons.

简介：AbstractTuberculosis (TB) is on the rise in Pakistan and there could be multiple reasons including poverty, difficulty in access to TB treatment services, non-compliance with treatment, social stigma etc. According to the TB program managers, limited treatment and testing sites for tuberculosis and lack of trained human resources play a major role in compromising TB management. A major lacuna in the TB control program is the absence of active contact tracing strategy. This is essential for a disease where positive cases are known to be able to infect a further 10-15 individuals in a year. Tackling tuberculosis in Pakistan has been beleaguered by funding challenges and other systems’ bottlenecks such as lack of skilled human resources and insufficient supply of medicines, despite the fact that disease burden is one of the highest in the world. Although it is a notifiable disease, active case finding, contact tracing and reporting is notoriously low throughout the country. Access to diagnostics and treatment facilities has been limited and stigma attached to the disease remains deeply entrenched among the communities. Researchers have shown that enhanced and active approaches to contact investigation effectively identifies additional patients with TB among household contacts at a relatively modest cost. USAID’s Integrated Health Systems Strengthening and Service Delivery Activity extended support to the Health Departments of Sindh and Khyber Pakhtunkhwa provinces. In collaboration with the two provincial TB programs, community based active contact tracing was conducted on 17,696 individuals, based on the index cases. Among the contacts traced, 243 cases were diagnosed as drug sensitive or drug resistant TB. Awareness sessions were conducted to sensitize people on the various aspects of disease and importance of getting tested. The project also supported establishing three satellite Programmatic Management of Drug Resistant Tuberculosis (PMDT) sites for drug resistant TB treatment, enhancing the programs’diagnostic and testing capacity.

简介：AbstractBiosafety equipment is the key barrier enabling high containment laboratories to handle high risk agents that may cause serious and potentially lethal infections. This perspective thoroughly analyzes the development of many kinds of key biosafety technologies, and equipment for protection of laboratory workers and for high containment laboratory facilities in China. Over more than ten years of rapid development, China has had remarkable achievements in key biosafety technologies and equipment in high containment laboratories. These technologies basically meet the needs of high containment laboratories construction in China. Furthermore, according to the current global situation regarding the prevention and control of infectious diseases and the technical development level of biosafety equipment, this paper proposes targeted suggestions and notes that China still needs to increase investment in scientific research to provide further technical and equipment support enabling us to build a community with a bright future in terms of human biosafety.

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简介：AbstractImportance:There are a variety of musculoskeletal malformations and injuries that can occur in newborns. These can be a significant cause of perinatal death or a reason for miscarriage and can lead to long-term functional issues if not managed appropriately. There is no systematic and well-established screening program for neonatal musculoskeletal malformations and injuries in China now.Objective:To report the incidence and types of congenital musculoskeletal malformations in two hospitals in Shenzhen City, to explore and discuss the details of the screening procedure and improve future prevention and treatment.Methods:From October 2013 to May 2014, 2564 one-day-old newborns were screened by a pediatric orthopedic physical examination, in combination with ultrasonography when required, and the incidence and variety of diseases were recorded statistically.Results:Among 2564 screened newborns, the following musculoskeletal conditions were identified: congenital muscular torticollis (CMT) (seven cases, 0.27%), hip subluxation (four cases, 0.16%), hip dysplasia (47 cases, 1.83%), congenital talipes equinovarus (CTEV) (two cases, 0.08%), congenital talipes calcaneovalgus (15 cases, 0.58%), polydactyly (nine cases, 0.35%), syndactyly (one case, 0.04%), and spinal hemivertebra (one case, 0.04%). Additionally, there were five (0.19%) neonates with birth injuries.Interpretation:It is feasible to carry out neonatal screening and identification of musculoskeletal malformations and birth injuries in China. This is helpful as timely detection and early intervention for many of these conditions can avoid permanent functional impairment in these children.

简介：AbstractObjective:Medical data mining and sharing is an important process in E-Health applications. However, because these data consist of a large amount of personal private information of patients, there is the risk of privacy disclosure when sharing and mining. Therefore, ensuring the security of medical big data in the process of publishing, sharing, and mining has become the focus of current research. The objective of our study is to design a framework based on a differential privacy protection mechanism to ensure the secure sharing of medical data. We developed a privacy protection query language (PQL) that integrates multiple data mining methods and provides a secure sharing function.Methods:This study is mainly performed in Xuzhou Medical University, China and designs three sub-modules: a parsing module, mining module, and noising module. Each module encapsulates different computing methods, such as a composite parser and a noise theory. In the PQL framework, we apply the differential privacy theory to the results of the computing between modules to guarantee the security of various mining algorithms. These computing devices operate independently, but the mining results depend on their cooperation. In addition, PQL is encapsulated in MNSSp3 that is a data mining and security sharing platform and the data comes from public data sets, such as UCBI. The public data set (NCBI database) was used as the experimental data, and the data collection time was January 2020.Results:We designed and developed a query language that provides functions for medical data mining, sharing, and privacy preservation. We theoretically proved the performance of the PQL framework. The experimental results show that the PQL framework can ensure the security of each mining result and the availability of the output results is above 97%.Conclusion:Our framework enables medical data providers to securely share health data or treatment data and develops a usable query language, based on a differential privacy mechanism, that enables researchers to mine information securely using data mining algorithms.

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简介：AbstractBackground:Non-smokers account for a large proportion of lung cancer patients, especially in Asia, but the attention paid to them is limited compared with smokers. In non-smokers, males display a risk for lung cancer incidence distinct from the females—even after excluding the influence of smoking; but the knowledge regarding the factors causing the difference is sparse. Based on a large multicenter prospective cancer screening cohort in China, we aimed to elucidate the interpretable sex differences caused by known factors and provide clues for primary and secondary prevention.Methods:Risk factors including demographic characteristics, lifestyle factors, family history of cancer, and baseline comorbidity were obtained from 796,283 Chinese non-smoking participants by the baseline risk assessment completed in 2013 to 2018. Cox regression analysis was performed to assess the sex difference in the risk of lung cancer, and the hazard ratios (HRs) that were adjusted for different known factors were calculated and compared to determine the proportion of excess risk and to explain the existing risk factors.Results:With a median follow-up of 4.80 years, 3351 subjects who were diagnosed with lung cancer were selected in the analysis. The lung cancer risk of males was significantly higher than that of females; the HRs in all male non-smokers were 1.29 (95% confidence interval [CI]: 1.20-1.38) after adjusting for the age and 1.38 (95% CI: 1.28-1.50) after adjusting for all factors, which suggested that known factors could not explain the sex difference in the risk of lung cancer in non-smokers. Known factors were 7% (|1.29-1.38|/1.29) more harmful in women than in men. For adenocarcinoma, women showed excess risk higher than men, contrary to squamous cell carcinoma; after adjusting for all factors, 47% ([1.30-1.16]/[1.30-1]) and 4% ([7.02-6.75]/[7.02-1])) of the excess risk was explainable in adenocarcinoma and squamous cell carcinoma. The main causes of gender differences in lung cancer risk were lifestyle factors, baseline comorbidity, and family history.Conclusions:Significant gender differences in the risk of lung cancer were discovered in China non-smokers. Existing risk factors did not explain the excess lung cancer risk of all non-smoking men, and the internal causes for the excess risk still need to be explored; most known risk factors were more harmful to non-smoking women; further exploring the causes of the sex difference would help to improve the prevention and screening programs and protect the non-smoking males from lung cancers.

简介：AbstractBackground:Sepsis, a serious condition with high mortality, usually causes sepsis associated encephalopathy (SAE) that involves neuronal cell death. However, the cell death programs involved and their underlying mechanisms are not clear. This study aimed to explore the regulatory mechanisms of different cell death programs in SAE.Methods:A neonatal rat model of SAE was established by cecal ligation and perforation. Survival rate and vital signs (mean arterial pressure and heart rate) were monitored, nerve reflexes were evaluated, and cortical pathological changes were observed by hematoxylin and eosin staining. The expression of pyroptosis, apoptosis, and necroptosis (PANoptosis)-related proteins, mitogen-activated protein kinase (MAPK), and its upstream regulator toll-like receptor 9 (TLR9) were detected. The expression of TLR9 in neurons was observed by immunofluorescence staining. The ultrastructure of neurons was observed by transmission electron microscope.Results:First, PANoptosis was found in cortical nerve cells of the SAE rats. Meanwhile, the subunits of MAPKs, p38 MAPK, Jun N-terminal kinase, and extracellular signal-regulated kinase (ERK) were activated. After pharmacologically inhibiting each of the subunits, only p38 MAPK was found to be associated with PANoptosis. Furthermore, blocking the p38 MAPK signaling pathway activated necroptosis but inhibited apoptosis and pyroptosis. When necroptosis was pharmacologically inhibited, apoptosis and pyroptosis were reactivated. Finally, we found that the expression of TLR9, a regulator of MAPKs, was significantly increased in this model. After down-regulation of TLR9, p38 MAPK, and ERK signaling pathways were inhibited, which led to the inhibition of PANoptosis. Further analysis found that down-regulation of TLR9 improved the survival rate and reduced the pathological changes in SAE rats.Conclusions:Our study showed that the programs comprising PANoptosis are activated simultaneously in SAE rats. TLR9 activated PANoptosis through the p38 MAPK signaling pathway. TLR9 may work as a potential target for SAE treatment.