Herbal Textual Research on Asteris Radix et Rhizoma in Famous Classical Formulas / 中国实验方剂学杂志

By reviewing the ancient and modern literature， the name， origin， scientific name evolution， place of origin， quality， harvesting， processing， efficacy and toxicity of Asteris Radix et Rhizoma（ARR） were systematically sorted out， so as to provide reference for the development and utilization of the relevant famous classical formulas. According to textual research， ARR was first contained in Shennong Bencaojing， all generations are Ziwan for its proper name， and there are still aliases such as Ziyuan， Ziqian and Xiaobianer. Its mainstream origin in successive generations was Aster tataricus， and there are also Ligularia fischeri and others in local area of use. The medicinal parts of ARR are root and rhizome， but in modern times， the rhizome is mostly used for propagation and cultivation， so some of ARR medicinal materials only have the root without the rhizome. The earliest recorded ancient origin of ARR was now Fangxian（Hubei）， Zhengding and Handan（Heibei）， then the range of production areas gradually expanded， the mainstream production areas from the Song dynasty to the Ming and Qing dynasties included Hebei， Jiangsu， Anhui， Henan and other places， since modern times， two major producing areas have been formed in Anguo， Hebei province and Bozhou， Anhui province. From the quality evaluation， it is clear that from ancient times， flexible roots and purple color are the best. The ancient harvesting was mainly in lunar February or March， and then dried in the shade， and the modern harvesting is mostly in spring and autumn， and the roots are braided into pigtails and then dried in the sun or dried in the sun after 1-2 d. The ancient and modern processing method of ARR are basically the same， mainly honey processing， there are still methods of frying， steaming， vinegar sizzling， etc. Based on the results， it is recommended that the dried roots and rhizomes of A. tataricus should be used in clinical and the development of related famous classical formulas， and those whose original formulas specify the processing requirements can be processed according to the relevant requirements， while whose processing requirements are not specified should be used in the form of raw products.

Progress of group B streptococcus meningitis in children / 国际儿科学杂志

Group B streptococcus(GBS), also known as streptococcus agalactis, is a Gram-positive conditionally causative coccus that can colonize healthy humans.GBS is a common pathogen of bacterial meningitis in infants under 3 months of age.GBS serotype Ⅲ and sequence type 17(ST 17)are the most common and virulent, and there is a significant correlation between serotype Ⅲ and ST 17, and erythromycin resistance is high.Penicillin or ampicillin is the first-line drug in China.Children with GBS meningitis are at high risk of poor prognosis.Intrapartum antibiotic prophylaxis(IAP)may be given in the presence of specific risk factors for GBS invasion in newborns. IAP reduced the incidence of early-onset GBS, but did not significantly reduce early-onset mortality and late-onset morbidity.

Pharmacodynamic mechanism study on Modified sanhuang ointment in the treatment of anal ulcers and swelling in rats / 中国药房

OBJECTIVE To explore the improvement mechanism of Modified sanhuang ointment on anal ulcers and swelling model rats. METHODS The anal ulcer model of the rat was induced by using glacial acetic acid； the effects of Modified sanhuang ointment low-dose， medium-dose and high-dose groups （185， 370， 740 mg/kg）， western medicine positive control group （Compound carraghenates cream， 1 g/kg） and TCM positive control group （Mayinglong shexiang zhichuang ointments， 1 g/kg） on body weight， area of anal ulcer， grade of anal ulcer were investigated. The other groups of rats were used to induce rectal swelling models with croton oil； the effects of Modified sanhuang ointment low-dose， medium-dose and high-dose groups （185， 370， 740 mg/kg）， western medicine positive control group （Compound carraghenates cream， 1 g/kg） and TCM positive control group （Mayinglong shexiang zhichuang ointments， 1 g/kg） on the rate of rectal and anal swelling， serum contents of inflammatory factors [interleukin 2 （IL-2）， IL-4， tumor necrosis factor （TNF-α）]， pathological morphology of rectal tissue， the expression of transient receptor potential channel V1 （TRPV1） and substance P in rectal tissue and rectal vascular permeability were investigated. RESULTS In Modified sanhuang ointment， the increase in body weight was enhanced， and the area of anal ulcers， as well as the grade of anal ulcers in rats with anal ulcer models， were reduced to varying degrees； rectal tissue damage in rectal swelling model rats was improved； the rate of rectal and anal swelling， the serum contents of inflammatory factors， the expressions of TRPV1 and substance P in rectal tissue， and rectal vascular permeability were all decreased （P＜0.05 or P＜0.01）. The effect of Modified sanhuang ointment was better than that of western medicine positive control and TCM positive control.Modified sanhuang ointment can improve anal ulcers and swelling in rats by reducing the release of inflammatory factors， inhibiting the expression of TRPV1 and substance P.

Preliminary Construction of Evaluation Index System for Traditional Chinese Medicine Medicated Diet based on Delphi Method and Analytic Hierarchy Process / 中医杂志

ObjectiveTo build an evaluation index system for traditional Chinese medicine （TCM） medicated diet， promoting the scientific and standardized development of medicated diet in TCM. MethodsThe framework of the evaluation index system was constructed through literature review and Delphi expert consultation method. The analytic hierarchy process was used to construct a hierarchical structure model. Pairwise comparisons between the indicators were conducted using the Saaty 1-9 scale method， and the weight of each indicator was calculated using Yaahp 10.3. ResultsThe response rates for the two rounds of expert consultation were 93.33% and 100%， respectively. The Kendall's W coefficients for the first-level and second-level indicators in the second round were 0.270 and 0.281， respectively （both P＜0.001）. Finally， an evaluation index system for TCM medicated diet therapy was constructed， consisting of 6 primary indicators and 27 secondary indicators. The weightings of the primary indicators were as follows： sensory appearance （0.1843）， health value （0.3569）， ingredient compatibility （0.1271）， packaging （0.0370）， production and preparation （0.1005）， and reliability （0.1940）. ConclusionA comprehensive and universally applicable evaluation index system for TCM medicated diet has been developed， taking into conside-rations of color， taste， appearance， efficacy， preparation， quality and others. This system can provide valuable reference for the evaluation of the value of medicated diet as well as its development.

Impeding the combination of astrocytic ASCT2 and NLRP3 by talniflumate alleviates neuroinflammation in experimental models of Parkinson's disease

Alanine-serine-cysteine transporter 2 (ASCT2) is reported to participate in the progression of tumors and metabolic diseases. It is also considered to play a crucial role in the glutamate-glutamine shuttle of neuroglial network. However, it remains unclear the involvement of ASCT2 in neurological diseases such as Parkinson's disease (PD). In this study, we demonstrated that high expression of ASCT2 in the plasma samples of PD patients and the midbrain of MPTP mouse models is positively correlated with dyskinesia. We further illustrated that ASCT2 expressed in astrocytes rather than neurons significantly upregulated in response to either MPP+ or LPS/ATP challenge. Genetic ablation of astrocytic ASCT2 alleviated the neuroinflammation and rescued dopaminergic (DA) neuron damage in PD models in vitro and in vivo. Notably, the binding of ASCT2 to NLRP3 aggravates astrocytic inflammasome-triggered neuroinflammation. Then a panel of 2513 FDA-approved drugs were performed via virtual molecular screening based on the target ASCT2 and we succeed in getting the drug talniflumate. It is validated talniflumate impedes astrocytic inflammation and prevents degeneration of DA neurons in PD models. Collectively, these findings reveal the role of astrocytic ASCT2 in the pathogenesis of PD, broaden the therapeutic strategy and provide a promising candidate drug for PD treatment.

Multi-disciplinary treatment of severe palatal radicular groove of maxillary lateral incisor: A case report and literature review / 中南大学学报(医学版)

Palatal radicular groove is a developmental malformation of maxillary incisors, lateral incisors in particular, which often causes periodontal destruction. This paper reports a case of combined periodontal-endodontic lesions induced by palatal radicular groove, which was initially misdiagnosed as a simple periapical cyst. After root canal therapy and periapical cyst curettage, the course of disease was prolonged, resulting in the absence of buccal and maxillary bone plates in the affected tooth area. After the etiology was determined, the affected tooth was extracted and guide bone tissue regeneration was performed at the same time, followed by implantation and restoration at the later stage, leading to clinical cure. The palatal radicular groove is highly occult, and the clinical symptoms are not typical. If the abscess of the maxillary lateral incisor occurs repeatedly, and the abscess of the maxillary lateral incisor has not been cured after periodontal and root canal treatment, cone-beam computed tomographic and periodontal flap surgery should be considered.

The synthesis of an amended membrane coated with graphene oxide and dopamine and guanidyl-based modifier and its antifouling properties.

The membrane fouling issue has aroused great concern. To improve their antifouling properties, surface grafting with oxidative deposition were employed to amend a polyvinylidene fluoride (PVDF) membrane. The modifiers were amino-modified graphene oxide (AMGO), dopamine (DPA) and 1,3-diaminoguanidine hydrochloride (DAGH). To take bovine serum albumin (BSA, 1 g/l) as an example of organic materials, BSA interception rate and pure water flux recovery rate increased to 93.65% and 66.74%, respectively, while the corresponding values for the original membrane were much lower (72.82% and 31.72%). The optimum synthesis conditions were found to be 1.5 mg/ml of DPA, 1 wt% of DAGH, 2 mg/ml of AMGO, 4 h of DPA oxidation deposition time and 1 h of AMGO grafting time. Many functional groups like C = N, -NH2, C = O and -OH improved the membrane surface hydrophilicity leading to a higher resistance to organic pollution. Dopamine and guanidyl facilitated the antimicrobial performance of the modified membrane, whose antimicrobial rate was up to 96%, while the raw membrane had no antimicrobial activity. The amended membrane possessed 40% higher mechanical strength than the initial one. It could withstand a high pumping suction force. The noteworthy property was that the irreversible fouling rate decreased by 55%. Therefore, the amended membrane could restore its flux much more easily.

Advances in pediatric solid tumor immunotherapy based on chimeric antigen receptor T cell / 国际儿科学杂志

Chimeric antigen receptor T cell immunotherapy(CAR-T)has achieved a significant breakthrough in hematologic malignancies.On the contrary, the application of CAR-T in solid tumor, including pediatric solid tumor, is confronted with numerous barriers.Pre-clinical experiments and clinical trials point out that several reasons account for the consequence: rare and heterogeneous targets; limited lifetime of CAR-T in vivo as a result of T cell exhaustion; inadequate infiltration of tumor sites due to steric hindrance; side effects of treatment.Based on the above problems, this review will summarize the research progression of different targets, the choice of immune cells, inhibitory tumor microenvironment, and countermeasures for side effects, so as to provide several new explorable directions for improving the treatment effect.

Comparative molecular analysis of oral submucous fibrosis and other organ fibrosis based on weighted gene co-expression network analysis / 中南大学学报(医学版)

OBJECTIVES@#There is currently a lack of economic and suitable animal models that can accurately recapitulate the oral submucous fibrosis (OSF) disease state for indepth study. This is one of the primary reasons for the limited therapeutic methods available for OSF. Based on the underlying logic of pan-cancer analysis, this study systematically compares OSF and the other four types of organ fibrosis from the aspects of molecules, signaling pathways, biological processes, etc. A comprehensive analysis of the similarities and differences between OSF and other organ fibrosis is helpful for researchers to discover some general rules of fibrosis disease and may provide new ideas for studying OSF.@*METHODS@#Microarray data of the GSE64216, GSE76882, GSE171294, GSE92592, and GSE90051 datasets were downloaded from GEO. Differentially expressed mRNAs (DEmRNAs) of each type of fibrosis were identified by Limma package. Weighted gene co-expression network analysis (WGCNA) was used to identify each type of fibrosis-related module. The similarities and differences of each fibrosis-related-module genes were analyzed by function and pathway enrichment analysis.@*RESULTS@#A total of 6 057, 10 910, 27 990, 10 480, and 4 801 DEmRNAs were identified in OSF, kidney intestinal fibrosis (KIF), liver fibrosis (LF), idiopathic pulmonary fibrosis (IPF), and skin fibrosis (SF), respectively. By using WGCNA, each type of fibrosis-related module was identified. The co-expression networks for each type of fibrosis were constructed respectively. Except that KIF and LF have 5 common hub genes, other fibrotic diseases have no common hub genes with each other. The common pathways of OSF, KIF, LF, IPF, and SF mainly focus on immune-related pathways.@*CONCLUSIONS@#OSF and the other 4 types of fibrotic diseases are tissue- and organ-specific at the molecular level, but they share many common signaling pathways and biological processes, mainly in inflammation and immunity.

The expression of constitutively active CPK3 impairs potassium uptake and transport in Arabidopsis under low K+ stress.

Potassium (K+) is a vital cation and is involved in multiple physiological functions in plants. K+ uptake from outer medium by roots is a tightly regulated process and is mainly carried out by two high affinity K+ transport proteins AKT1 and HAK5. It has been shown that calcium (Ca2+) signaling plays important roles in the regulation of K+ transport in plants. Ca2+-dependent protein kinases (CPKs) are involved in regulation of multiple K+ channels in different tissues. However, it remains to be studied whether CPKs are involved in the regulation of AKT1 and, thereby, K+ transport. Here, we have shown that constitutively active version of CPK3 (CPK3CA) is involved in K+ transport in Arabidopsis via regulating AKT1 under low K+ conditions. The constitutively active version of CPK3 (CPK3CA), as well as CPK21 (CPK21CA), inhibited K+ currents of AKT1 in Xenopus oocytes. CPK3CA inhibited only channel conductance but had no effect on channel open probability. Further, CPK3 in vivo interacted with AKT1. Under low K+ conditions, cpk3 knock-out mutants had no distinct phenotype, while the seedlings of 35S-CPK3CA overexpressing lines died even at normal K+ concentration. Further, the transgenic lines expressing CPK3CA under AKT1 promoter (ProAKT1-CPK3CA) exhibited the same phenotype as akt1 mutant with a defective root growth and leaf chlorosis. Moreover, ProAKT1-CPK3CA transgenic lines had lower root and shoot K+ contents than Col. Overall, the data reported here demonstrate that the expression of constitutively active of CPK3 impairs potassium uptake and transports in Arabidopsis under low K+ stress by inhibiting the activity of AKT1.

Genomic epidemiology of SARS-CoV-2 in Pakistan

Pakistan has been severely affected by the COVID-19 pandemic. To investigate the initial introductions and transmissions of the SARS-CoV-2 in the country, we performed the largest genomic epidemiology study of COVID-19 in Pakistan and generated 150 complete SARS-CoV-2 genome sequences from samples collected before June 1, 2020. We identified a total of 347 variants, 29 of which were over-represented in Pakistan. Meanwhile, we found over one thousand intra-host single-nucleotide variants. Several of them occurred concurrently, indicating possible interactions among them. Some of the hypermutable positions were not observed in the polymorphism data, suggesting strong purifying selections. The genomic epidemiology revealed five distinctive spreading clusters. The largest cluster consisted of 74 viruses which were derived from different geographic locations and formed a deep hierarchical structure, indicating an extensive and persistent nation-wide transmission of the virus that was probably contributed by a signature mutation of this cluster. Twenty-eight putative international introductions were identified, several of which were consistent with the epidemiological investigations. No progenies of any of these 150 viruses have been found outside of Pakistan, most likely due to the nonphmarcological intervention to control the virus. This study has inferred the introductions and transmissions of SARS-CoV-2 in Pakistan, which could provide a guidance for an effective strategy for disease control.

Audio-visual Emotion Regulation System Based on TGAM Module / 中国医疗器械杂志

OBJECTIVE@#Based on the TGAM PCB module, a system of emotion control using audio-visual feedback is designed.@*METHODS@#TGAM collects EEG information through the electrode in contact with the forehead skin. The system analyzes the user's emotion through the STM32F103ZET6 of the main control chip, and finally controls the control end of the system to regulate the user's emotion.@*RESULTS@#It can be seen from the test results that the system can precisely recognize the user's emotions, and at the same time effectively adjust the user's emotions from both audio-visual aspects.@*CONCLUSIONS@#The system has high recognition accuracy and good adjustment effect.

Application of Nuclear Imaging Probes in PD-L1 Immunotherapy of Tumor / 肿瘤防治研究

Immunotherapy strategies of targeting PD-1 and its ligand PD-L1 are widely administered in varied types of cancer. Patient benefitting from PD-L1 targeted immunotherapy mainly depends on the expression level of PD-L1 in tumor tissues. Currently, the expression level of PD-L1 is primarily detected through the invasive method of biopsy in clinic, which is severely limited by the temporal and spatial heterogeneity of PD-L1 expression. Nuclear medicine probe can realize the noninvasive as well as in vivo detection of PD-L1 at the molecular level, which has important clinical significance for the guidance of patient screening and the prediction of patient's response to immunotherapy. This article reviews PD-L1 targeting nuclear imaging probes and their applications in tumor PD-L1 imaging.

High Expression of GADD45B Induced by Acid and Bile Acid is A Potential Prognostic Marker for Barrett's Esophagus-associated Adenocarcinoma / 胃肠病学

Background: Esophageal mucosal injury induced by gastroesophageal reflux is a key link to the development of Barrett's esophagus-associated adenocarcinoma. However, the molecular mechanism is still not elucidated. Aims: To investigate the role of differentially expressed genes (DEGs) after stimulating esophageal cells with acid and bile acid in the development of esophageal adenocarcinoma (EAC). Methods: The DEGs were obtained through bioinformatics methods after stimulating esophageal cells with low pH and deoxycholic acid, and GO, KEGG enrichment analysis were performed. Protein-protein interaction (PPI) network was performed to screen the hub genes, and their relationships with prognosis and tumor stage of EAC patients were analyzed. The role of co-expressed genes of GADD45B in EAC was also analyzed. Results: Thirty-one overlapping DEGs were obtained after stimulating esophageal cells with low pH and deoxycholic acid, which mainly enriched in the cytokine-cytokine receptor interaction, transcription factors activity, and regulation of cell proliferation and apoptotic process. High expression of GADD45B was correlated with the survival prognosis and tumor stage of EAC patients. GADD45B and its co-expressed genes were involved in the production of tumor necrosis factor. Conclusions: The high expression of GADD45B induced by acid and bile acid is correlated with the prognosis and tumor stage of EAC patients, and is a potential diagnosis and treatment target for Barrett's esophagus-associated adenocarcinoma.

Efficacy of Nicorandil in the treatment of unstable angina pectoris in 30 patients / 中国基层医药

Objective:To investigate the efficacy of Nicorandil in the treatment of unstable angina pectoris.Methods:Sixty patients with unstable angina pectoris who received treatment in Department of Cardiovascular Disease, Suixi Hospital of Traditional Chinese Medicine, China during January-July 2020 were included in this study. They were randomly assigned to receive either conventional treatment including antiplatelet, increasing coronal blood flow velocity, lipid-lowering treatment and stabilization of atherosclerotic plaque (control group, n = 30) or Nicorandil treatment and conventional treatment (observation group, n = 30). Clinical efficacy was compared between the two groups. Angina attack, electrocardiogram changes and adverse reactions in each group were analyzed before and after treatment. Results:Total effective rate in the observation group was significantly higher than that in the control group [88.67% (26/30) vs. 53.33% (16/30), χ2 = 7.937, P = 0.005]. The frequency and duration of angina pectoris in the observation group were (1.53 ± 0.62) times/week, (1.93 ± 0.78) minutes, which were significantly lower or shorter than those in the control group [(1.97 ± 0.71) times /week, (2.60 ± 1.00) minutes, t = -2.359, -3.162, P = 0.025, 0.004). The total effective rate of electrocardiogram in the observation group was significantly higher than that in the control group [70.00% (22/30) vs. 43.34% (13/30), χ2 = 5.554, P = 0.018]. There was no significant difference in the incidence of adverse drug reactions such as nausea, dizziness and palpitation between the two groups (all P > 0.05). Conclusion:Based on conventional treatment, Nicorandil treatment for unstable angina pectoris can improve the clinical symptoms and electrocardiogram changes, exhibit remarkable efficacy, and therefore deserve clinical promotion.

Oral lichen planus induced by long-term use of antimicrobials for recurrent aphthous ulcer:A case report and literature review / 中南大学学报(医学版)

The precise etiology of oral lichen planus(OLP)is still unclear,but the existing evidence suggests that drug intake,virus infection,fungal infection,psychological disorders,and immunodeficiency are closely associated with the pathogenesis of OLP.We report a case of OLP accompanied with candidiasis induced by long-term use of antimicrobials for recurrent aphthous ulcer(RAU)and update the literature,to discuss the possible association between OLP and misuse of antimicrobials,and to inform general dentists and pharmacists the importance for practice with optimal antimicrobial stewardship.In this case,a 42-year-old man presented to Xiangya Stomatological Hospital with white reticular patterns spreading in the oral cavity for almost 1 year.He was diagnosed with OLP via histopathological examination.He had a 5-year history of RAU which occurred every 1-2 months,and he was given antimicrobials ingested or injected whenever the ulcers came up.Satisfactory treatment results were obtained by stopping the abuse of antimicrobials and local antifungal therapy.Meanwhile,the exacerbation and alleviation of OLP was closely related to the administration of antimicrobials.Combined with literature review,antimicrobial might contribute to the development of OLP by inducing candidiasis,a common side-effect of misuse of antimicrobials.Considering the seriousness of antimicrobial resistance and opportunistic infection,dentists should prescribe antimicrobials judiciously according to guidelines and evidence-based indications.Appropriate prescribing of antimicrobials is a professional responsibility to all dentists.

Determination of active ingredients and prediction of targetin Sanhua Decoction for cerebral ischemia based on HPLC and network pharmacology methods / 国际中医中药杂志

Objective:To determinate the active ingredients and predicte action targets in Sanhua Decoction for treating cerebral ischemia based on HPLC and network pharmacology methods. Methods:The HPLC analysis was performed on HC-C18 (250 mm × 4.6 mm, 5 μm) with the mobile phase of methanolacetonitrile-0.05% phosphoric acid with gradient elution at the flow rate of 1.0 ml/min and 0.8 ml/min. The detection wavelength was set at 254 nm, the column temperature was at 30 ℃, and the injection volume was 10 μl. TCMIP v2.0 platform was used to search the action targets of rhein, emodin, chrysophanol, hesperidin, magnolol and notopterygiol. We used Cerebral ischemia as a keyword searching the databases such as Genecards, OMIM, TTD, and Disgenet to screen six potential targets for the treatment of cerebral ischemia by active ingredients, construct a protein interaction (PPI) network and a disease-component-target-pathway integration network.Results:The literature search determined that rhein, emodin, chrysophanol, hesperidin, magnolol and qianhuol were the index components for the determination of Sanhua Decoction. Their linear ranges were 0.080 4-0.804 0 μg, 0.015 3-0.382 0 μg, 0.041 8-0.626 4 μg, 0.312 6-3.908 0 μg, 0.037 9-0.568 8 μg, 0.045 3-1.359 6 μg, respectively. The correlation coefficient R 2 is greater than 0.999 0. The content ranges of the above six components in seven samples were 0.887-0.971 mg/g, 0.094-0.101 mg/g, 0.110-0.119 mg/g, 1.494-1.669 mg/g, 0.126-0.145 mg/g and 0.153-0.167 mg/g, respectively. Network pharmacology analysis found that the targets of the six components for the treatment of cerebral ischemia may be TNF, TP53, MAPK14, JUN, IL1B, MYC, ESR1, ICAM1, PTGS2, PPARG and so on. Conclusions:A quality control method forthe six active ingredients in Sanhua Decoction treating cerebral ischemia was established. This method is simple and repeatable. The ten potential targets of the six active ingredients in Sanhua Decoction for the treatment of cerebral ischemia have been clarified, laying a foundation for further research on the action mechanism.

Progress of immunotherapy in pediatric lymphocyte malignancies / 国际儿科学杂志

In the last half-century, the multi-cooperation of conventional therapies including chemotherapy, radiotherapy and bone marrow hematopoietic stem cell transplantation has saved a lot of children with lymphocyte malignancies, but the outcomes of relapsed and/or refractory diseases remain dismal.Thus, it is in urgent need of novel approaches to improve clinical efficiency.After decades of rapid development, immunotherapy has achieved remarkable results from the treatment of pediatric lymphocyte malignancies, especially chimeric antigen receptors T(CAR-T), bi-specific T cell engager(BiTE), and immune checkpoint blockader(ICB). However, a part of patients is still resistant to immunotherapy.The review will focus on CAR-T, BiTE and ICB to elucidate the pre-clinical studies and clinical trials that have been intensively conducted in pediatric leukemia and lymphoma, as well as the brief introduction of their limitations and probably optimal strategies.

Prolonged presence of SARS-CoV-2 in feces of pediatric patients during the convalescent phase

BackgroundSevere acute respiratory coronavirus 2 (SARS-CoV-2) is a newly identified virus which mainly spreads from person-to-person. Presence of SARS-CoV-2 has been constantly reported in stools of patients with coronavirus disease 2019 (COVID-19). However, there is a paucity of data concerning fecal shedding of the virus in pediatric patients. ObjectiveTo investigate dynamic changes of SARS-CoV-2 in respiratory and fecal specimens in children with COVID-19. MethodsFrom January 17, 2020 to February 23, 2020, three pediatric cases of COVID-19 were reported in Qingdao, Shandong Province, China. Epidemiological, clinical, laboratory, and radiological characteristics and treatment data of these children were collected. Real-time fluorescence reverse-transcriptase-polymerase-chain reaction (RT-PCR) was performed to detect SARS-CoV-2 RNA in throat swabs and fecal specimens. Patients were followed up to March 10, 2020, the final date of follow-up, and dynamic profiles of RT-PCR results were closely monitored. ResultsAll the three pediatric cases were household contacts of adults whose symptoms developed earlier. Severity of disease was mild to moderate and fever was the most consistent and predominant symptom at onset of illness of these children (two cases had body temperature higher than 38.5{degrees}C). All children showed increased lymphocytes (>4.4x109 /L) with normal white blood cell counts on admission. Radiological changes were not typical for COVID-19. All children showed good response to supportive treatment. Clearance of SARS-CoV-2 in respiratory tract occurred within two weeks after abatement of fever, whereas viral RNA remained positive in stools of pediatric patients for longer than 4 weeks. Two children had fecal SARS-CoV-2 turned negative 20 days after throat swabs showing negative, while that of another child lagged behind for 8 days. InterpretationSARS-CoV-2 may exist in gastrointestinal tract for a longer time than respiratory system. Persistent shedding of SARS-CoV-2 in stools of infected children indicates the potential for the virus to be transmitted through fecal excretion. Massive efforts should be made at all levels to prevent spreading of the infection among children after reopening of kindergartens and schools.

Precautions are Needed for COVID-19 Patients with Coinfection of Common Respiratory Pathogens

BackgroundWith the ongoing outbreak of Coronavirus Disease 2019 (COVID-19), infected patients within and beyond the epidemic area, Wuhan, China, showed different epidemiological and clinical characteristics. There is a paucity of data concerning coinfection with other common respiratory pathogens in COVID-19 patients outside of Wuhan. MethodsWe conducted a double-centre study recruiting 68 patients with severe acute respiratory coronavirus 2 (SARS-CoV-2) infection confirmed by nucleic acid testing in Qingdao and Wuhan from January 17 to February 16, 2020. Indirect immunofluorescence was performed to detect the specific IgM antibody against common respiratory pathogens in collected acute phase serum. ResultsOf the 68 patients with SARS-CoV-2 infection, 30 (44.12%) were from Qingdao. The median age of Qingdao and Wuhan patients were 50 (IQR: 37-59) and 31 (IQR: 28-38) years, respectively, and the majority of patients were female in Qingdao (60.00%) and Wuhan (55.26%). Among COVID-19 patients in Qingdao, 24 (80.00%) of them had IgM antibodies against at least one respiratory pathogen, whereas only one (2.63%) of the patients in Wuhan had positive results for serum IgM antibody detection (P<0.0001). The most common respiratory pathogens detected in Qingdao COVID-19 patients were influenza virus A (60.00%) and influenza virus B (53.33%), followed by mycoplasma pneumoniae (23.33%) and legionella pneumophila (20.00%). While the pattern for coinfection in patients with community-acquired pneumonia in Qingdao was quite different, with a positive rate of only 20.90%. InterpretationWe reported a large proportion of COVID-19 patients with coinfection of seasonal respiratory pathogens in Qingdao, northeast China, which differed greatly from the patients in Wuhan, central China. Precautions are needed when dealing with COVID-19 patients beyond the epidemic centre who have coinfection with other respiratory pathogens. We highly recommend adding SARS-CoV-2 to routine diagnostic testing in capable hospitals to prevent misdetection of the virus.