Random allocation is essential in randomized controlled trials (RCTs) to ensure impartial treatment allocation and minimize selection bias. Despite permuted block design (PBD) is used in approximately 75

Background:The Sustainable Development Goals (SDGs) aim to reduce the global maternal mortality ratio (MMR) to below 70 deaths per 100 000 live births by 2030. However, progress has been uneven, with regional disparities and new challenges. We aimed to report global trends in maternal disorder burdens from 1990 to 2021. Methods:Using the Global Burden of Disease (GBD) 2021 database, we systematically analysed trends in incidence, mortality, and disability-adjusted life-years (DALYs) associated with maternal disorders from 1990 to 2021 and employed age-period-cohort (APC) models to assess changes in these indicators. For selected age-specific analyses, we additionally expressed incidence and DALY rates per 100 000 live births using age-specific fertility rates. We used the Bayesian APC model to forecast trends in maternal disorder incidence and mortality from 2022 to 2036. Results:From 1990 to 2021, there was a decrease in global incidence (38.5%), mortality (43.2%), and DALYs (61.4%) of maternal disorders. However, significant regional disparities persist. The burden was considerably lower in higher-sociodemographic-index regions than in sub-Saharan Africa. Maternal haemorrhage and hypertensive disorders continue to represent the primary causes of mortality, with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-related deaths increasing, particularly among women aged 30-34 years and older. The APC model revealed that the age effect on maternal disorders initially decreased and then increased. The projected MMR of 136.5 (95% confidence interval = 100.2-172.7) per 100 000 live births by 2030 falls short of the SDG target of 70 maternal deaths per 100 000 live births, indicating a markedly insufficient annual reduction rate. Conclusions:Despite a decrease in the global burden of maternal disorders, regional disparities persist. Major challenges include haemorrhage, hypertensive disorders, and increasing HIV/AIDS-related deaths. Achieving SDG targets by 2030 requires universal access to quality maternal care.

Background and aims:Despite progress made under the United Nations Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs), inequalities in global health persist, particularly in the maternal health. Public health emergencies also affect health equity. This research examined long-term disease burden trends (1990-2021) of maternal hypertensive disorders (MHD), with a focus on the influence of age and socio-demographic index (SDI) differences, as well as short-term disruptions during the COVID-19 pandemic, to inform more equitable maternal health policies. Methods:Using the Global Burden of Disease database (2021), this study conducted a systematic examination of indicators of MHD: incidence, maternal mortality ratio (MMR), and disability-adjusted life years (DALYs). All analyses were standardized for age-specific fertility rates (ASFR). Analyses included frontier analysis to identify achievable health outcomes, decomposition analysis to identify key factors, and age-period-cohort (APC) model to assess independent effects. Health inequalities were measured using the slope index of inequality (SII) and concentration curve. The secular trends were characterized using the average annual percentage change (AAPC), while the impact of the COVID-19 pandemic was assessed through the estimated annual percentage change (EAPC). Results:The APC model revealed elevated risks for adolescent and older pregnancies, with incidence fluctuating over 32 years but MMR steadily declining. Disease burden generally decreased with higher SDI levels. Decomposition analysis suggested that demographic factors increased the burden, while epidemiology mitigated it. Frontier analysis indicated effective maternal health control in Canada but Cameroon required progress. While the SII in 2021 declined [-2003.35 (95% CI: -2184.75 to -1821.96)], concentration curves revealed increased relative inequality in lower-SDI populations. Over 32 years, the global MHD burden declined, with a reduction in low-SDI regions [AAPC: -29.46 (95% CI: -30.06 to -28.85)] approximately 24 times that of high-SDI regions. However, the pandemic significantly slowed the decline in low- and low-middle SDI regions. Conclusion:This study highlights marked disparities in the disease burden among age groups across diverse SDI regions. Public health emergencies have intensified existing health inequalities and exposed gaps in healthcare resource distribution. Implementing targeted interventions and reinforcing maternal care during emergencies are critical for enhancing maternal health and advancing health equity.

[Background]Anxiety and depression are common perinatal mental health issues that often occur together and can have serious negative effects on both maternal and infant health. [Objective]To examine the relationships between lifestyle factors and comorbid anxiety and de-pression(CAD)among pregnant women in Shanghai. [Methods]The study estimated the prevalence of CAD during the first,second,and third trimesters of pregnancy using the Self-rating Anxiety Scale(SAS)and Center for Epidemiological Studies-Depression(CES-D)based on data from the China National Birth Cohort(CNBC)embryonic-derived diseases with assisted reproductive technology(ART)sub-cohort.Infor-mation on demographics,sleep status,nutritional intake,and exercise during each trimester was collected through self-made question-naires,the Pittsburgh Sleep Quality Index(PSQI),and the Food Frequency Questionnaire(FFQ).Lifestyle factors(such as sleep status,nu-tritional intake,and exercise during each trimester)were analyzed using logistic regression and generalized linear mixed models(GLMM)to determine their impacts on the prevalence of CAD(yes or no)among pregnant women. [Results]A total of 2876 pregnant women were included in this study.The prevalence of CAD was 10.6%(305),3.6%(103),and 5.5%(159)in the first,second,and third trimesters of pregnancy,respectively.The logistic regression analysis revealed that poor sleep quality throughout the entire pregnancy were statistically associated with an increased prevalence of CAD,and the odds ratios(OR)with 95%confidence intervals(CI)were 2.817(1.845,4.301),2.840(1.855,4.347),and 9.316(5.835,14.876)for the first,second,and third trimesters,respectively,when compared to good sleep quality.Additionally,compared to an intake frequency of 7 times per week,the frequency of egg intake≤3 times per week in the first trimester(OR=2.025,95%CI:1.197,3.425)and the frequency of egg intake of 4-6 times per week(OR=1.896,95%CI:1.117,3.216)or≤3 times per week(OR=1.906,95%CI:1.082,3.357)in the third trimester were asso-ciated with an increased risk of CAD(P<0.05).Moreover,when compared to a frequency of exercise>3 times per week,never or almost never exercising in the second trimester(OR=2.218,95%CI:1.220,4.035)was associated with an increased risk of CAD(P<0.05).The GLMM analysis also demonstrated a significant association between poor sleep quality,lower exercise frequency,or lower intake frequency of vegetables,eggs,or milk and an increased risk of CAD(P<0.05). [Conclusion]The prevalence of CAD among pregnant women in Shanghai follows a U-shaped distribution,with the highest rate occurring in early pregnancy and the lowest rate in mid-pregnancy.Factors such as poor sleep quality,inadequate intake of vegetables,eggs,or milk,and lack of exercise during pregnancy may increase the risk of CAD.Implementing lifestyle interventions during pregnancy could potentially reduce the risk of mental health problems and improve the overall health of both mothers and babies.

OBJECTIVE:To investigate the contribution of longitudinal mean arterial pressure (MAP) measurement during the first, second, and third trimesters of twin pregnancies to the prediction of pre-eclampsia. METHODS:A retrospective cohort study was conducted on women with twin pregnancies. Historical data between 2019 and 2021 were analyzed, including maternal characteristics and mean artery pressure measurements were obtained at 11-13, 22-24, and 28-33 weeks of gestation. The outcome measures included pre-eclampsia with delivery <34 and ≥34 weeks of gestation. Models were developed using logistic regression, and predictive performance was evaluated using the area under the curve, detection rate at a given false-positive rate of 10%, and calibration plots. Internal validation was conducted via bootstrapping. RESULTS:A total of 943 twin pregnancies, including 36 (3.82%) women who experienced early-onset pre-eclampsia and 93 (9.86%) who developed late-onset pre-eclampsia, were included in this study. To forecast pre-eclampsia during the third trimester, the most accurate prediction for early-onset pre-eclampsia resulted from a combination of maternal factors and MAP measured during this trimester. The optimal predictive model for late-onset pre-eclampsia includes maternal factors and MAP data collected during the second and third trimesters. The areas under the curve were 0.937 (95% confidence interval [CI] 0.894-0.981) and 0.887 (95% CI 0.852-0.921), respectively. The corresponding detection rates were 83.33% (95% CI 66.53%-93.04%) for early-onset pre-eclampsia and 68.82% (95% CI 58.26%-77.80%) for late-onset pre-eclampsia. CONCLUSION:Repeated measurements of MAP during pregnancy significantly improved the accuracy of late-onset pre-eclampsia prediction in twin pregnancies. The integration of longitudinal data into pre-eclampsia screening may be an effective and valuable strategy.

Purpose: Surgical guide plates can improve the accuracy of surgery, although their design process is complex and time-consuming. This study aimed to use artificial intelligence (AI) to design standardized mandibular angle ostectomy guide plates and reduce clinician workload. Methods: An intelligence algorithm was designed and trained to design guide plates, with a safety-ensuring penalty factor added. A single-center retrospective cohort study was conducted to test the algorithm among patients who had visited our hospital between 2020 and 2021 for mandibular angle ostectomy. We included patients diagnosed with mandibular angle hypertrophy and excluded those combined with other facial malformations. The guide plate design method acted as the primary predictor, which was AI algorithm vs. experienced residents. Moreover, the symmetry of plate-guided ostectomy was chosen as the primary outcome. The safety, shape, location, effectiveness, and design duration of the guide plate were also recorded. The independent samples t-test and Pearson's chi-squared test were used and P-values < 0.05 were considered significant. Results: Fifty patients (7 men, 43 women; 27 +/- 4 years) were included. The two groups differed significantly in terms of safety (7.02 vs. 5.25, P < 0.05) and design duration (24.98 vs. 1685.08, P < 0.05). The ostectomy symmetry and shape, location, and effectiveness of the guide plates did not differ significantly between the two groups. Conclusions: The intelligent algorithm can improve safety and save time for guide plate design, ensuring other quality of the guide plates. It has good potential applicability in accurate mandibular angle ostectomy. (c) 2023 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Incidence of twin pregnancies increases significantly in recent years. Twin pregnancies are likely to have a higher risk of quicker progression and more severe preeclampsia (PE) than singletons, making the prediction and prevention of PE of twin pregnancies even more important. The prediction and screening for PE have evolved from guideline-based risk factor screening to simple models with maternal factors only, and then to complex models with a wider range of indicators. Besides, the modeling algorithms have expanded from logistic regression to complex algorithms such as competing risk models. Continuous improvements have been achieved in the prediction models. This paper presents a comprehensive overview of the applicability and the prospect of these models in this area in twin pregnancies and suggests that the prediction models should be improved by optimizing modeling strategies using localized indicators.

RESEARCH QUESTION:Is ART associated with adverse neurodevelopmental outcome in 12-month-old offspring compared with those conceived through natural conception?DESIGN:In this prospective cohort study, 488 infertile women undergoing ART and 1397 women with natural conception were recruited and followed until their offspring were 12 months old. The primary outcome was the neurodevelopment in the offspring. The association between exposure to ART and Gesell developmental scale scores was investigated using multiple linear regression models after adjusting for confounders. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to verify the results.RESULTS:In total, 18 (3.7%) and 40 (2.9%) children in the ART and natural conception groups, respectively, had been diagnosed with neurodevelopmental delay at 12 months of age. It was found that gross motor, adaptive behaviour, language and total development quotient scores were comparable between the groups. Following multivariate linear regression and IPTW, social behaviour development quotient scores were found to be slightly higher in the ART group than the natural conception group. Higher social behaviour development quotient scores in the ART group were also observed in the male and the singleton subgroups.CONCLUSIONS:At 12 months, offspring born after ART appeared to have similar motor, language and adaptive behaviour skills, and total development quotient scores, to those born after natural conception. However, social behaviour development in 12-month-old infants was slightly higher in those conceived using ART than in naturally conceived offspring, especially in male or singleton infants. These findings may provide new information in evaluating the potential benefits and risks of ART.

Objective To investigate the current situation and problems of the transformation of scientific and technological achievements in Shanghai public hospitals, and explore strategies for promoting the transformation of scientific and technological achievements in public hospitals in Shanghai. Methods Undstood the current situation of the transformation of scientific and technological achievements through indicators such as the number of patents applications/authorizations, the amount and the methods of transformation of 12 hospitals affiliated with a university in Shanghai from 2016 to 2020. Literature review and expert interviews were conducted to explore the problems and coping strategies for the technology transformation. Results The number of the technology achievements transformation in the 12 affiliated hospitals continued upward trend year by years. While, over the 5 years, the achievement transformation ratio of 1,599 authorized patents only was 4.3%,and there was still a significant gap in domestic and foreign medical institutions with high-level scientific and technological achievements transformation. There was a large gap in the number of technological achievements among the 12 affiliated hospitals.61.97% technological achievements transformation amount was less than 1 million yuan, and 91.67% of hospitals did not set up full-time service personnel for technological achievements transformation.97% of technological achievements had been transformed through licensing and transfer, and no conversion cases had been found in the form of pricing investment was found. Conclusions The transformation process of technological achievement transformation in Shanghai public hospitals mainly has many problems, such as too many patents but less transformation, low patent value, large proportion of small-projects in successful transformation projects, lack of professional scientific and technological achievements transformation service team, and limited transformation methods of pricing and investment. Therefore, recommendations include optimizing the scientific research evaluation system, formulating negative list for transformation through multi-department collaboration, establishing transformation service teams based on universities, and conducting a pilot of pricing and investment based on favorable policies.

目的 非固定区组长度可有效降低随机对照临床试验(RCT)中区组随机化分组的可预测性,为此编制全自动SAS宏程序实现变化区组随机化.方法 结合变化区组随机化的原理编制SAS宏程序,通过模拟实例演示程序的使用.结果 输入设定的宏变量参数,运行SAS宏程序即可生成变化区组随机化的受试者分配方案.此外,该SAS宏能实现多臂不等比RCT的分配问题,提供了受试者随机分配序列重现的功能.结论 多区组长度的设置和区组长度的随机选择能够降低分组可预测性,避免随机分组阶段选择偏倚的产生.本文的SAS宏为随机对照临床试验实现变化区组随机化提供了便利.

Nanomedicines for cancer treatment have been studied extensively over the last few decades. Yet, only five anticancer nanomedicines have received approvals from the United States Food and Drug Administration (FDA) for treating solid tumors. This drastic mismatch between effort and return calls into question the basic understanding of this field. Various viewpoints on nanomedicines have been presented regarding their potentials and inefficiencies. However, the underlying logics of nanomedicine research and its inadequate translation to the successful use in the clinic have not been thoroughly examined. Tumor-targeted drug delivery was used to understand the shortfalls of the nanomedicine field in general. The concept of tumor-targeted drug delivery by nanomedicine has been based on two conjectures: (i) increased drug delivery to tumors provides better efficacy, and (ii) decreased drug delivery to healthy organs results in fewer side effects. The clinical evidence gathered from the literature indicates that nanomedicines bearing classic chemotherapeutic drugs, such as Dox, cis-Pt, CPT and PTX, have already reached the maximum drug delivery limit to solid tumors in humans. Still, the anticancer efficacy and safety remain unchanged despite the increased tumor accumulation. Thus, it is understandable to see few nanomedicine-based formulations approved by the FDA. The examination of FDA-approved nanomedicine formulations indicates that their approvals were not based on the improved delivery to tumors but mostly on changes in dose-limiting toxicity unique to each drug. This comprehensive analysis of the fundamentals of anticancer nanomedicines is designed to provide an accurate picture of the field's underlying false conjectures, hopefully, thereby accelerating the future clinical translations of many formulations under research.

BackgroundPreeclampsia is a heterogeneous and complex disease with its pathogenesis mechanism not fully elucidated. A certain subset of patients with preeclampsia exhibit disturbances in lipid metabolism before clinical symptoms. Moreover, there is a tendency for preeclampsia to run in families. Whether genetic factors play a role in abnormal lipid metabolism during the incidence of preeclampsia has not been well investigated. MethodsPreeclampsia patients (n = 110) and healthy age- and gravidity-matched pregnant women (n = 110) were enrolled in this study. Peripheral blood specimens were used for genomic analysis (n = 10/group) or laboratory validation (n = 100/group). We retrospectively obtained the baseline clinical characteristics of 68 preeclampsia patients and 107 controls in early pregnancy (12-14 gestational weeks). Correlation analyses between differential genes and baseline lipid profiles were performed to identify candidate genes. In vitro and in vivo gain-of-function models were constructed with lentivirus and adeno-associated virus systems, respectively, to investigate the role of candidate genes in regulating lipid metabolism and the development of preeclampsia. ResultsWe observed that preeclampsia patients exhibited significantly elevated plasma TC (P = 0.037) and TG (P < 0.001) levels and increased body mass index (P = 0.006) before the disease onset. Within the region of 27 differential copy number variations, six genes potentially connected with lipid metabolism were identified. The aberrant copies of APOBEC3A, APOBEC3A_B, BTNL3, and LMF1 between preeclampsia patients and controls were verified by quantitative polymerase chain reaction. Especially, APOBEC3A showed a significant positive correlation with TC (P < 0.001) and LDL (P = 0.048) in early pregnancy. Then, our in vitro data revealed that overexpression of APOBEC3A disrupted lipid metabolism in HepG2 cells and affected both cholesterol and fatty acid metabolisms. Finally, in vivo study in a hepatic-specific overexpressed APOBEC3A mouse model revealed abnormal parameters related to lipid metabolism. Pregnant mice of the same model at the end of pregnancy showed changes related to preeclampsia-like symptoms, such as increases in sFlt-1 levels and sFlt-1/PLGF ratios in the placenta and decreases in fetal weight. ConclusionOur findings established a new link between genetics and lipid metabolism in the pathogenesis of preeclampsia and could contribute to a better understanding of the molecular mechanisms of preeclampsia.

Research question: What is the association between homocysteine (Hcy) and IVF/intracytoplasmic sperm injection (ICSI) outcomes, stratified by methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms? Design: This prospective cohort study recruited 1011 infertile women undergoing IVF/ICSI treatment for the first time at the International Peace Maternity and Child Health Hospital between June 2015 and March 2018. Results: The concentration of total serum Hcy was significantly negatively associated with clinical pregnancy and implantation rate. When adjusted for maternal and paternal age and educational level, maternal body mass index, and FSH and oestradiol concentrations, logistic regression analysis showed that women with higher Hcy had a higher risk of unsuccessful pregnancy. After stratification by MTHFR C677T polymorphisms and adjustment for confounding factors, a higher risk of unsuccessful pregnancy and a significantly lower implantation rate only existed in women with higher Hcy concentration in the MTHFR C677T TT genotype. There was no significant association between Hcy concentrations and other ovarian stimulation outcomes (oocytes retrieved, metaphase II stage oocytes, fertilization rate, cleavage rate, high-quality embryo rate) or neonatal outcomes (preterm birth, gestational age at delivery, Caesarean section, birthweight, small for gestational age, large for gestational age or birth defects). Conclusions: Hcy is highly negatively associated with clinical pregnancy and implantation rate during the first IVF/ ICSI cycle, especially in women carrying the MTHFR C677T TT genotype. Other factors with impacts on reproductive outcomes, such as stage of embryo transferred, other factors involved in folate metabolism, preimplantation genetic testing, etc., should be taken into account in further research.

目的·探讨妊娠早期血脂水平与子痫前期(preeclampsia,PE)发病风险的关系.方法·研究对象为2015年1月—2017年12月于上海交通大学医学院附属国际和平妇幼保健院行常规产检并住院分娩的孕妇,经筛选后纳入26230例,其中发生PE的孕妇(PE组)680例、未发生PE的孕妇(对照组)25550例.通过电子病历系统获取2组孕妇的一般临床资料和妊娠10～14周的血脂指标.采用多因素Logistic回归分析探讨妊娠早期血脂水平(四分位等级)与PE发病风险的关系.结果·与对照组相比,PE组孕妇妊娠早期的总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TAG)、低密度脂蛋白(low density lipoprotein,LDL)和载脂蛋白B(apolipoprotein B,ApoB)水平均较高(均P<0.05),而高密度脂蛋白(high density lipoprotein,HDL)水平较低(P=0.000).多因素Logistic回归分析显示,TAG(>1.45 mmol/L)、LDL(>3.26 mmol/L)和ApoB(>0.86 g/L)是PE发病的独立危险因素(均P<0.05),HDL(>1.99 mmol/L)是PE发病的独立保护因素(P=0.002).在调整了潜在的混杂因素后,随着TAG、LDL和ApoB水平的升高,PE的发病风险逐渐增加,而HDL反之(均趋势P<0.05).以最低四分位组为参考,TAG、LDL、ApoB和HDL在最高四分位组的调整OR值及95％CI分别为1.90(1.47～2.45)、1.39(1.08～1.78)、1.51(1.13～2.04)和0.66(0.50～0.86).结论·妊娠早期的血脂代谢异常预示孕期PE的发病风险增加,及早进行血脂水平的检测有助于PE的早期预测.

目的·探讨个体化营养示范餐对超重及肥胖孕妇的孕期体质量管理和妊娠糖尿病(gestational diabetes mellitus,GDM)预防的效果.方法·将2017年6月-2019年1月在上海健康医学院附属第六人民医院东院建卡并已知情同意的超重及肥胖孕妇随机分为干预组和对照组各100例,对照组进行孕期营养课堂集体健康教育,干预组在此基础上进行营养示范餐等个体化的营养干预.比较分析2组孕妇孕13?16、17?20、21～24周的体质量增长情况和GDM的发病率.结果·孕13～24周干预组增加的体质量小于对照组(t=4.207,P=0.000).2组体质量增长值的差异在不同孕周不同,孕17?20周时2组的差别最大(F=3.483,P=0.034).干预组GDM发病率(16.5％)低于对照组(38.5％)(x2= 11.773,P=0.001).结论·个体化营养示范餐的干预有助于超重及肥胖孕妇维持适宜的孕期体质量增长并降低GDM发病率.

目的·建立一种数据驱动的实用方法预测新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情的演变趋势、跟踪预判疫区适时风险分级,为精准防控策略提供量化依据.方法·基于移动平均法建立移动平均预测限(moving average prediction limit,MAPL)方法.采用既往严重急性呼吸综合征(severe acute respiratory syndrome,SARS)疫情数据验证MAPL方法对疫情趋势和风险预判的实用性.跟踪COVID-19疫情从2020年1月16日起的官方公布数据,建立相应MAPL进行适时疫情预判与风险评估.结果·基于MAPL方法分析显示,2020年2月初全国COVID-19疫情达到峰值.经过积极防控,2月中旬到3月中旬全国疫情整体呈下降趋势.与湖北地区相比,非湖北地区2月中旬新增病例数下降速度快,但之后又有小幅增长.3月以来境外输入性风险的分析提示,近阶段存在中高等疫情输入性风险,建议出入境口岸采取相应防控措施,避免境外输入病例引起疫情再次蔓延.结论·MAPL方法可以辅助判断新发传染病流行发展趋势并及时预测疫区风险水平.各疫区可结合当地实际与疫情风险分级,规划落实差异化精准防控策略.3月份以来应注重境外输入性风险的防控.

子痫前期(PE)是一种常见的产科疾病,是导致孕产妇和新生儿发病及死亡的主要原因之一.PE的发病机制不明,提升PE预测准确性有助于及时筛选出高危人群并进行临床干预.本综述回顾近年来PE孕早期预测的研究进展,预测因素主要包括母体因素、平均动脉压、遗传学标记物、生物化学指标和多普勒指标等.在所有类型的预测模型中,多因素联合预测模型效果最佳.目前的预测模型存在指标不易获取、模型缺乏验证等不足,限制了其在临床上的应用.亟需建立适用于国内妇幼保健真实产检情境的PE孕早期预测模型,注重指标采集符合当地产检实际及预测模型的本土化验证.

目的 建立一种数据驱动的实用方法预测突发全新传染性疾病的疫情趋势，通过动态预判疫情风险与分级为防控策略提供量化依据。方法 在移动平均法的基础上予以改进，提出一种移动平均预测限（Moving Average Prediction Limits, MAPL）方法，采用既往重症急性呼吸综合征（Severe Acute Respiratory Syndrome，SARS）疫情数据验证MAPL方法对疫情趋势和风险预判的实用性。追踪本次新型冠状病毒（COVID-19）感染疫情从2020年1月16日起的官方公布数据，采用MAPL方法预判疫情变动趋势与疫区适时风险分级。 结果 基于MAPL方法分析显示，2020年2月初全国COVID-19感染疫情达到峰值。经过前期积极防控，2月中旬起全国疫情整体呈下降趋势。到2月下旬各地疫情有明显的区域性差异。与湖北地区相比，非湖北地区新增病例数下降速度快且未来疫情加重的风险相对较小。在几个重要的疫情输入省份，新增确诊病例数和可疑病例数的发展趋势一致，但消减速度在各省份间存在差异。 结论 MAPL方法可以辅助判断疫情趋势并适时预判风险分级，各疫情输入区可结合当地实际与疫情风险分级规划落实差异化精准防控策略。

Objective: To investigate the sedation weaning strategies in critically ill patients with mechanical ventilation in pediatric intensive care unit (PICU) and to explore the effect of different sedative weaning patterns on withdrawal syndrome. Methods: A single-center prospective cohort study was conducted from April 1, 2016 to April 30, 2017. One hundred and twelve patients who required mechanical ventilation and benzodiazepines and (or) opioids for at least 5 consecutive days in PICU of Shanghai Children's Medical Center were enrolled. Twenty patients (17.9%) had an intermittent weaning pattern, defined as a 50% or greater increase in daily benzodiazepine and (or) opioid dose after the start of weaning, and the remaining 92 cases (82.1%) had a steady weaning pattern. The demographic and clinical features, duration and dose of sedative and analgesics, and the incidence of withdrawal syndrome were evaluated. Mann-Whitney U test was used for comparison about clinical features between different weaning pattern groups and children with withdrawal syndrome or not. Logistic regression was used to explore the risk factors of withdrawal syndrome. Results: Among the 112 patients, 46 (41.1%) had withdrawal syndrome. The patients with the intermittent weaning pattern had a high score of pediatric risk of mortality Ⅲ (PRISM-Ⅲ) (10.0 (3.5, 12.0) vs. 6.0 (2.0, 10.0), U=654.50, P=0.043) and were prone to re-intubation (35.0% (7/20) vs. 7.6% (7/92), P=0.003). The patients with withdrawal syndrome had longer duration of sedation (19.5 (16.8, 24.3) vs. 10.0 (7.0, 17.3) days, U=743.50, P<0.01), higher incidence of intermittent weaning pattern (32.6% (15/46) vs. 7.6% (5/66),χ(2)=11.58, P=0.001), longer PICU hospitalization (19.0 (15.8, 25.3) vs. 12.0 (8.8, 17.0) days, U=755.00, P<0.01) and higher cost (89 (57,109) vs. 53 (32, 79) thousand yuan, U=804.00, P<0.01). Logistic regression showed that intermittent weaning pattern (odds ratio (OR)=4.85, 95% confidence interval (CI) 1.39-16.91, P=0.013), perioperative period of liver transplantation (OR=6.97, 95%CI 1.25-39.04, P=0.027) and a cumulative dose of midazolam ≥ 34.7 mg/kg (OR=8.12, 95%CI 3.09-21.37, P<0.01) were risk factors of withdrawal syndrome. Conclusions: Withdrawal syndrome is more likely to occur in children who are intermittently weaned from sedation. Steady weaning strategy may help prevent iatrogenic withdrawal syndrome.

[ABSTRACT] A pneumonia outbreak caused by a novel coronavirus (COVID-19) occurred in Wuhan, China at the end of 2019 and then spread rapidly to the whole country. A total of 81,498 laboratory-confirmed cases, including 3,267 deaths (4.0%) had been reported in China by March 22, 2020, meanwhile, 210,644 laboratory-confirmed cases and 9,517 deaths (4.5%) were reported outside China. Common symptoms of COVID-19 pneumonia included fever, fatigue and dry cough. In face of such a sudden outbreak of emerging novel infectious diseases, we have no history to learn from and no evidence to count on. Traditional models often predict inconsistent results. There is an urgent need to establish a practical data-driven method to predict the evolutionary trend of the epidemic, track and prejudge the current epidemic situation after the COVID-19 outbreak. Here we propose a simple, directly and generally applicable index and we name it ‘epidemic evaluation index’ (EEI), which is constructed by 7-day moving average of the log-transformed daily new cases (LMA). EEI could be used to support the decision-making process and epidemic prevention and control strategies through the evaluation of the current epidemic situation. First, we used SARS epidemic data from Hong Kong in 2003 to verify the practicability of the new index, which shows that the index is acceptable. The EEI was then applied to the COVID-19 epidemic situation analysis. We found that the trend direction of different districts in China changed on different date during the epidemic. At the national level and at local Hubei Province level, the epidemic both peaked on February 9. While the peak occurred relatively earlier, i.e. on February 5 in other provinces. It demonstrated the effectiveness of decisive action and implementations of control measures made by Chinese governments. While local governments should adjust management measures based on local epidemic situation. Although the epidemic has eased since late February, continued efforts in epidemic control are still required to prevent transmission of imported cases in China. However, the global COVID-19 epidemic outside China continues to expand as indicated by the EEI we proposed. Currently, efforts have been made worldwide to combat the novel coronavirus pandemic. People all over the world should work together and governments of all countries should take efficient measures in the light of Chinas experience and according to national circumstances and local conditions.