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BackgroundPneumonia is quite common in people with chronic bedridden, severe malnutrition and underlying diseases of cerebral palsy. Although poor oral hygiene and inadequate airway protection are risk factors, case reports of childhood pneumonia caused by oral obligate anaerobes are rare.IntroductionWe reported 4 cases of oral anaerobic pneumonia and empyema diagnosed by the pediatric intensive care unit (PICU) of our hospital.DiscussionNo bacteria were detected in sputum bacterial culture, pleural water bacterial culture and blood culture of the four children. Considering that multiple sputum cultures were negative, the pleural effusion and bronchoalveolar lavage fluid were subjected to next-generation sequencing (NGS) to identify the pathogen causing pneumonia. The results found oral obligate anaerobes represented by Parvimonas micra and Porphyromonas gingivalis. After identifying the pathogenic bacteria, we changed to piperacillin tazobactam combined with metronidazole for anti-infection treatment, and the pneumonia in the above patients was improved. In addition, all four patients had different basic medical histories, and long-term bed rest, severe malnutrition, poor oral hygiene and insufficient airway protection were all high risk factors for oral anaerobic pneumonia in these children.ConclusionOral obligate anaerobes are one of the pathogens to consider for pneumonia in the elderly, but they may be easily overlooked in pediatric groups. Therefore, when receiving children with high-risk factors, we should be alert to the possibility of oral obligate anaerobic bacteria infection. Educating family members to pay attention to children's oral hygiene plays an important role in preventing oral obligatory anaerobic bacteria pneumonia. NGS can be used as a rapid diagnostic method when sputum culture cannot distinguish between pathogens.

Background: Self-rated health (SRH) has been frequently used in population health surveys. However, most of these studies only focus on specific factors that might directly affect SRH, so only partial or confounding information about the determinants of SRH is potentially obtained. Conducted in an older Tibetan population in a Chinese plateau area, the aim of our study is to assess interrelationships between various factors affecting SRH based on the conceptual framework for determinants of health.Methods: Between May 2018 and September 2019, 2707 Tibetans aged 50 years or older were recruited as part of the China Multi-Ethnic Cohort Study (CMEC) from the Chengguan District of Lhasa city in Tibet. The information included SRH and variables based on the conceptual framework for determinants of health (i.e., socioeconomic status, health behaviors, physical health, mental health, and chronic diseases). Structural equation modeling (SEM) was used to estimate the direct and indirect effects of multiple factors in the conceptual framework.Results: Among all participants, 5.54% rated their health excellent, 51.16% very good, 33.58% good, 9.12% fairly poor and 0.59% poor. Physical health (β = - 0.23, P <  0.001), health behaviors (β = - 0.44, P <  0.001), socioeconomic status (β = - 0.29, P <  0.001), chronic diseases (β = - 0.32, P <  0.001) and gender (β = 0.19, P <  0.001) were directly associated with SRH. Socioeconomic status, physical health and gender affected SRH both directly and indirectly. In addition, there are potential complete mediator effects in which age and mental health affect SRH through mediators, such as physical health, health behaviors and chronic diseases.Conclusions: The findings suggested that interventions targeting behavioral changes, health and chronic disease management should be attached to improve SRH among older populations in plateau areas without ignoring gender and socioeconomic disparities. [ABSTRACT FROM AUTHOR]

The increasing complexity and diversity of the human immunodeficiency virus-1 (HIV-1) infections challenge the disease control and anti-retrovirus treatment in China. The infection stages and molecular characteristics of HIV-1 from infected Chinese blood donors were examined to shed light on the HIV genotype distribution and the status of drug resistance mutations (DRMs) in the changing HIV epidemic in China. Western blot (WB) confirmed HIV-1 positive plasma samples were collected from blood donors at five Chinese blood centers from April 16, 2012, through June 30, 2014. The HIV infection stages were determined using the Lag-avidity assay. HIV Pol regions including whole protease and partial reverse transcriptase (RT) were amplified and sequenced to establish the profile of genotype distribution and drug resistance mutations (DRMs). Viral loads were determined using the ROCHE COBAS system. Of the 259 HIV-1 positive samples tested by the Lag-avidity assay, 23.6% (61/259) were identified as recent infections. A total of 205 amplified sequences displayed the following genotype distributions: circulating recombinant form (CRF) 07_BC (61.5%), CRF08_BC (8.3%), CRF01_AE (20%), B (6.3%), and 01B (3.9%). There was no significant difference in genotype distribution between recent and long-term infections. 31 DRMs were identified from 27 samples including four protease inhibitors (PIs) accessory DRMs, two PIs major DRMs (M46I), two nucleoside RT inhibitors DRMs (K219R and K70Q), and 23 nonnucleoside RT inhibitors DRMs. 27 samples had DRMs, yielding a drug resistance prevalence of 13.2% (27/205). Our findings provide important information for developing strategies for comprehensive HIV control and improving anti-retroviral treatment in China. [ABSTRACT FROM AUTHOR]

HIV-1 subtypes and drug resistance are routinely tested by many international surveillance groups. However, results from different sites often vary. A systematic comparison of results from multiple sites is needed to determine whether a standardized protocol is required for consistent and accurate data analysis. A panel of well-characterized HIV-1 isolates (N = 50) from the External Quality Assurance Program Oversight Laboratory (EQAPOL) was assembled for evaluation at seven international sites. This virus panel included seven subtypes, six circulating recombinant forms (CRFs), nine unique recombinant forms (URFs) and three group O viruses. Seven viruses contained 10 major drug resistance mutations (DRMs). HIV-1 isolates were prepared at a concentration of 107 copies/ml and compiled into blinded panels. Subtypes and DRMs were determined with partial or full pol gene sequences by conventional Sanger sequencing and/or Next Generation Sequencing (NGS). Subtype and DRM results were reported and decoded for comparison with full-length genome sequences generated by EQAPOL. The partial pol gene was amplified by RT-PCR and sequenced for 89.4%-100% of group M viruses at six sites. Subtyping results of majority of the viruses (83%-97.9%) were correctly determined for the partial pol sequences. All 10 major DRMs in seven isolates were detected at these six sites. The complete pol gene sequence was also obtained by NGS at one site. However, this method missed six group M viruses and sequences contained host chromosome fragments. Three group O viruses were only characterized with additional group O-specific RT-PCR primers employed by one site. These results indicate that PCR protocols and subtyping tools should be standardized to efficiently amplify diverse viruses and more consistently assign virus genotypes, which is critical for accurate global subtype and drug resistance surveillance. Targeted NGS analysis of partial pol sequences can serve as an alternative approach, especially for detection of low-abundance DRMs. [ABSTRACT FROM AUTHOR]

Background In Western developed countries, food-based dietary patterns have been associated with the risk of cardiometabolic diseases, but little is known about such associations in less developed ethnic minority regions (LEMRs), where the cardiometabolic disease burden is growing rapidly and food patterns differ substantially. Methods Between May 2018 and September 2019, we recruited 99556 participants aged 30-79 years from the China Multi-Ethnic Cohort (CMEC) Study. We measured habitual dietary intake with validated food frequency questionnaire (FFQ) and then calculated dietary pattern scores for two of the most studied a priori dietary patterns, i.e., Dietary Approaches to Stop Hypertension (DASH) and alternative Mediterranean (aMED) style diets, and three a posteriori dietary patterns. Four cardiometabolic risks, including hypertension, diabetes, dyslipidaemia and metabolic syndrome (MetS), were newly diagnosed by medical examination and blood tests. We estimated adjusted odds ratios (OR) relating various dietary pattern scores to cardiometabolic risks using marginal structural models under the guidance of directed acyclic graphs. For the above associations, we further calculated the proportion mediated by overweight (PM) using regression-based mediation analysis for better public health implications. Findings The final study sample consisted of 68834 participants. Among them, we newly diagnosed 12803 hypertension, 3527 diabetes, 16342 hyperlipidaemia, and 8198 MetS cases. Overall, all 5 dietary patterns showed considerable associations with risks of hypertension and MetS. Comparing the highest with the lowest quintiles, the DASH score showed the strongest inverse associations with risks of hypertension (OR=0.74, 95% CI:0.70-0.79; PM=10%) and MetS (OR=0.79, 95% CI:0.74-0.85; PM=35%); conversely, scores of the localized a posteriori Yunnan-Guizhou plateau dietary pattern in LEMRs showed the strongest positive associations with risks of hypertension (OR=1.44, 95% CI:1.35-1.52; PM=10%) and MetS (OR=1.35, 95% CI:1.26-1.46; PM=33%), with all P values for trend <0.001. These associations were consistent in various subgroups defined by sex, age, smoking and physical activity, but with magnitudes that differed substantially across different ethnic regions and urbanicity. By investigating the single-component effects of dietary patterns, the dairy intake component contributed a major proportion to the beneficial effects of DASH (41.9% for hypertension and 100.5% for MetS). Interpretation Substantial socioeconomic status and ethnic disparities in diet quality and related cardiometabolic risks were seen in LEMRs, with hypertension being the top diet-related cardiometabolic risk. Our findings support that DASH provides superior dietary guidance compared to aMED for reducing cardiometabolic risks in LEMRs. In particular, the dairy intake encouraged by DASH may produce considerable beneficial effects. Funding This study was funded by the National Key R&D Program of China; full funding sources listed in the acknowledgements., Competing Interests: All authors declared no competing interest.The authors declare no conflict of interest., (© 2021 The Author(s). Published by Elsevier Ltd.)

The increasing complexity and diversity of the human immunodeficiency virus-1 (HIV-1) infections challenge the disease control and anti-retrovirus treatment in China. The infection stages and molecular characteristics of HIV-1 from infected Chinese blood donors were examined to shed light on the HIV genotype distribution and the status of drug resistance mutations (DRMs) in the changing HIV epidemic in China. Western blot (WB) confirmed HIV-1 positive plasma samples were collected from blood donors at five Chinese blood centers from April 16, 2012, through June 30, 2014. The HIV infection stages were determined using the Lag-avidity assay. HIV Pol regions including whole protease and partial reverse transcriptase (RT) were amplified and sequenced to establish the profile of genotype distribution and drug resistance mutations (DRMs). Viral loads were determined using the ROCHE COBAS system. Of the 259 HIV-1 positive samples tested by the Lag-avidity assay, 23.6% (61/259) were identified as recent infections. A total of 205 amplified sequences displayed the following genotype distributions: circulating recombinant form (CRF) 07&#95;BC (61.5%), CRF08&#95;BC (8.3%), CRF01&#95;AE (20%), B (6.3%), and 01B (3.9%). There was no significant difference in genotype distribution between recent and long-term infections. 31 DRMs were identified from 27 samples including four protease inhibitors (PIs) accessory DRMs, two PIs major DRMs (M46I), two nucleoside RT inhibitors DRMs (K219R and K70Q), and 23 nonnucleoside RT inhibitors DRMs. 27 samples had DRMs, yielding a drug resistance prevalence of 13.2% (27/205). Our findings provide important information for developing strategies for comprehensive HIV control and improving anti-retroviral treatment in China.