Search

Background: The rebound of influenza A (H1N1) infection in post-COVID-19 era recently attracted enormous attention due the rapidly increased number of pediatric hospitalizations and the changed characteristics compared to classical H1N1 infection in pre-COVID-19 era. This study aimed to evaluate the clinical characteristics and severity of children hospitalized with H1N1 infection during post-COVID-19 period, and to construct a novel prediction model for severe H1N1 infection. Methods: A total of 757 pediatric H1N1 inpatients from nine tertiary public hospitals in Yunnan and Shanghai, China, were retrospectively included, of which 431 patients diagnosed between February 2023 and July 2023 were divided into post-COVID-19 group, while the remaining 326 patients diagnosed between November 2018 and April 2019 were divided into pre-COVID-19 group. A 1:1 propensity-score matching (PSM) was adopted to balance demographic differences between pre- and post-COVID-19 groups, and then compared the severity across these two groups based on clinical and laboratory indicators. Additionally, a subgroup analysis in the original post-COVID-19 group (without PSM) was performed to investigate the independent risk factors for severe H1N1 infection in post-COIVD-19 era. Specifically, Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to select candidate predictors, and logistic regression was used to further identify independent risk factors, thus establishing a prediction model. Receiver operating characteristic (ROC) curve and calibration curve were utilized to assess discriminative capability and accuracy of the model, while decision curve analysis (DCA) was used to determine the clinical usefulness of the model. Results: After PSM, the post-COVID-19 group showed longer fever duration, higher fever peak, more frequent cough and seizures, as well as higher levels of C-reactive protein (CRP), interleukin 6 (IL-6), IL-10, creatine kinase-MB (CK-MB) and fibrinogen, higher mechanical ventilation rate, longer length of hospital stay (LOS), as well as higher proportion of severe H1N1 infection (all P < 0.05), compared to the pre-COVID-19 group. Moreover, age, BMI, fever duration, leucocyte count, lymphocyte proportion, proportion of CD3+ T cells, tumor necrosis factor α (TNF-α), and IL-10 were confirmed to be independently associated with severe H1N1 infection in post-COVID-19 era. A prediction model integrating these above eight variables was established, and this model had good discrimination, accuracy, and clinical practicability. Conclusions: Pediatric H1N1 infection during post-COVID-19 era showed a higher overall disease severity than the classical H1N1 infection in pre-COVID-19 period. Meanwhile, cough and seizures were more prominent in children with H1N1 infection during post-COVID-19 era. Clinicians should be aware of these changes in such patients in clinical work. Furthermore, a simple and practical prediction model was constructed and internally validated here, which showed a good performance for predicting severe H1N1 infection in post-COVID-19 era. [ABSTRACT FROM AUTHOR]

Traditionally, the strata of the Luonie Valley, Dechang County, SW Sichuan, China, are considered to contain a suite of felsic volcanic rocks (the Huili Group) that erupted after c. 1050 Ma. However, we report here new age constraints, elemental and Lu–Hf isotope geochemistry for a different suite of older basaltic agglomerate lava, basaltic tuff lava and basalt from the same area, which we name the Luonie Formation. New dating results show that the basaltic volcanic suite of the upper part of the Luonie Formation formed at 1126.1 ± 9.9 Ma, significantly earlier than deposition of the Huili Group, but comparable in age to the 1142 ± 16 Ma Laowushan Formation in central Yunnan Province. Granite intrusion into the Luonie Formation dated 1050.7 ± 12.7 Ma provides crucial supporting evidence for this earlier depositional age. We also report a maximum sedimentary age of c. 1158 Ma for the underlying arkose, implying stratigraphic conformity with the basaltic volcanic rock suite. The ϵHf(t) values of the basaltic volcanic rocks are mainly positive, indicating that the rocks are mainly derived from the depleted mantle and slightly stained by crustal materials. The characteristics of P*, Nb* and Zr* anomalies also support this view. The distribution patterns of trace and rare earth elements indicate that the basaltic volcanic rocks formed in an extensional setting. The Zr/4–Y–2Nb and Th–Nb/16–Zr/117 discrimination diagrams also provide evidence for this understanding. Lithofacies analysis shows that basaltic volcanic wrocks with the characteristics of both continental and marine facies should be formed in a littoral–neritic environment. We propose here that the evidence is consistent with a phase of continental extension that preceded the convergence of the SW Yangtze Block to form part of Rodinia. [ABSTRACT FROM AUTHOR]