分类归档 hanzhen

　　CCTV News:The National Immigration Bureau recently released the national entry and exit data for the first quarter, showing that in the first quarter, the number of national ports exceeded 141 million, showing a rapid growth trend, and the number of foreigners coming to China increased significantly. Driven by a series of policies and measures to promote the exchange of Chinese and foreign personnel, the traffic of large airport ports such as Shanghai Pudong and Guangzhou Baiyun has also increased rapidly.

　　With the gradual implementation of a series of visa-free agreements and other entry and exit policies in 2024, China, Singapore, Malaysia, Thailand and other countries have entered the "visa-free era", and at the same time, many countries and regions have granted convenience to China citizens such as landing visa.

　　At the entry and exit site of Shanghai Pudong Airport Port, there is an endless stream of travelers. According to the data, in the first quarter, the number of mainland residents who chose to enter and leave through Pudong Airport Port reached 4.85 million, about 3.7 times that of the same period in 2023, exceeding 70% of the total number of entry and exit personnel at this port, and it is the main force of entry and exit passenger flow at this port.

　　In the first quarter of 2024, more than 170,000 foreigners entered the country visa-free through Pudong Airport Port, an increase of 23.6% over the same period in 2023. Among them, more than 70% visa-free personnel come to China for tourism or business, which further shows that the visa-free policy has greatly promoted the economic and trade tourism of foreigners in China and enhanced the confidence of the international community in investing in China.

　　In the past few days, at the Baiyun Airport Port in Guangzhou, foreign merchants who came to attend the 135th Canton Fair came in an endless stream. Since the beginning of April, the inbound and outbound traffic of Guangzhou Baiyun Airport has increased significantly, with more than 720,000 people entering and leaving the port. Compared with the same period in 2023, the number of foreigners entering the port has increased significantly, with a year-on-year increase of 160%.

　　At the same time, affected by the favorable visa-free policy, the number of Singapore and Malaysian inbound passengers at Baiyun Airport Port continued to grow, reaching more than 23,000 and 63,000, up 3.6 times and 4.8 times respectively compared with 2023. Thanks to the continuous release of the "visa-free+visa-free" policy bonus of the National Immigration Administration, in the first quarter, more than 110,000 foreigners entered the country visa-free at Baiyun Airport.

　　The popularity of cross-border tourism has gradually increased.

　　With the continuous optimization of entry and exit policies, a "cross-border tour" has become the first choice for many people’s holidays, and the popularity of cross-border and border tours has gradually increased.

　　On April 13th, 2023, China-Laos Railway International Passenger Train was officially launched. This economical, convenient and comfortable mode of travel has quickly become the first transportation choice for many Chinese and foreign people to travel, study, do business and communicate with each other.

　　The data shows that in the first quarter of 2024, the daily average number of entry and exit personnel at Mohan Port reached more than 5,300, and the highest number of entry and exit personnel exceeded 8,000. A total of nearly 500,000 entry and exit personnel from 71 countries and regions entered and exited Mohan Port, a year-on-year increase of 51.8%.

　　Similarly, at the Khorgos port in Xinjiang, the number of passengers coming and going is also one after another. At about 10: 30 every morning, it is the most intensive time for cross-border tourism and business exchanges between the two countries in the entry and exit hall of the port.

　　With the proposal of "Kazakhstan Tourism Year" in China, more and more citizens of China and Kazakhstan come and go for sightseeing. In order to cope with the peak of inbound and outbound passengers, Horgos entry-exit frontier inspection station has also taken relevant measures.

Import tariffs on a series of commodities that involve the innovation and development of advanced manufacturing industries and protect people’s lives and health will fall. The State Council Customs Tariff Commission recently issued the latest announcement, starting from January 1, 2024, China will implement a provisional import tariff rate lower than the MFN tariff rate for 1010 commodities.

Provisional tariff rate is a tariff rate for some import and export goods within a certain period of time. Usually, it is lower than MFN tariff rate and has priority. It is a common way to adjust tariffs independently. It is reported that this adjustment was deliberated and adopted at the first plenary session of the Eighth the State Council Customs Tariff Commission and submitted to the State Council for approval, aiming at continuing to play the supporting role of import and export in the economy, better fulfilling the important function of tariffs in coordinating the domestic and international markets, and maintaining the stability and smoothness of China’s industrial chain supply chain.

"Overall, this tariff adjustment plan fully embodies the characteristics of striving for progress in stability, showing a series of highlights such as benefiting people’s livelihood, strengthening resilience and promoting upgrading." Gao Lingyun, a researcher at the Institute of World Economics and Politics of the Chinese Academy of Social Sciences, said.

First, accelerate the innovation and development of advanced manufacturing industries, and reduce import tariffs on domestic scarce resources, key equipment and parts such as lithium chloride, low arsenic fluorite and gas diffusion layer for fuel cells.

The second is to protect people’s lives and health, meet the consumption needs of residents with high-quality supply, implement zero tariffs on some anticancer drugs, medicines and raw materials for rare diseases, and reduce import tariffs on formula foods for special medical purposes. Chen Wei, chief physician of the Clinical Nutrition Department of Peking Union Medical College Hospital, said that formula food for special medical use refers to formula food specially processed and prepared to meet the special needs of people with food restriction, digestive and absorption disorders, metabolic disorders or specific disease states for nutrients or meals. "Reducing import tariffs on formula foods for special medical purposes will help reduce the phenomenon of’ sky-high nutritional products’ and many patients will benefit." Chen Wei said.

The third is to reduce import tariffs on sweet corn, coriander and burdock seeds. In addition, in order to promote the development of new materials industry and reduce the export tariff of high-purity aluminum. "Reducing import tariffs on key raw materials, agricultural seeds and other commodities will help strengthen the supply capacity of resources, enhance the resilience of the supply chain of the industrial chain, and accelerate industrial transformation and upgrading and high-quality development." Gao Lingyun said.

In addition, from January 1, 2024, according to the development of domestic industries and changes in supply and demand, import tariffs on some commodities such as ethylene, propylene and LCD glass substrates below generation 6 will be increased within the scope of China’s commitment to join the World Trade Organization.

In order to expand the global network of high-standard free trade zones, continue to promote high-level opening to the outside world, and promote the construction of an open world economy, in 2024, according to the free trade agreements and preferential trade arrangements signed between China and relevant countries or regions, some commodities under 20 agreements and originating in 30 countries or regions will be subject to agreed tax rates. The China-Nicaragua Free Trade Agreement came into effect on January 1, 2024 and implemented tax reduction.

In order to support and help the least developed countries to accelerate their development, preferential tax rates will continue to be applied to the least developed countries that have established diplomatic relations with China and completed the exchange of letters in 2024, and the preferential tax rates will be adjusted according to the United Nations list of least developed countries and China’s transitional arrangements.

In order to promote China’s superior products to better participate in the international market competition, in 2024, China’s subheads will be appropriately adjusted to add tax items such as decorative base paper and high-end steel products. After adjustment, the total number of tariff items is 8957.

"The adjustment of import and export tariffs on some commodities reflects China’s determination to expand opening up independently, share the booming China market with the world and promote high-level opening up. At the same time, it is conducive to supporting the construction of a modern industrial system, promoting the continuous enhancement of endogenous power, and better coordinating development and safety. " Tu Xinquan, dean of the World Trade Organization Research Institute in China, university of international business and economics, said. (Reporter Zeng Jinhua)

　　Recently, the networking commissioning ceremony of Fuyan Expressway New Energy Exchange Power Station was held in Nasa Water Station in Guangnan County, and the first inter-provincial high-speed heavy truck exchange trunk line was put into operation in Fuyan Expressway.

　　The power exchange station is equipped with the newly developed power exchange technology, and the robot is matched with the mechanical telescopic arm to realize collaborative power exchange. The power exchange can be completed in about 5 minutes at the earliest, and the vehicle can start from full power, which improves the operation efficiency of electric heavy trucks and can meet the power exchange demand of up to 168 trips per day. In addition to changing the power station at Nasa Water Station, four expressway power stations, namely Babao Service Area Power Station, Babao Water Station Power Station and Liuzhao Water Station Power Station, were put into operation this time, providing green energy services for electric heavy trucks travelling from Wenshan, Yunnan to Guangxi Beibu Gulf Economic Zone, and realizing the electrification of the entire inter-provincial high-speed freight line from Yunnan to Guangxi.

　　"On this line, each car runs about 100,000 to 150,000 kilometers a year, and consumes about 400 tons of oil every year. After the four expressway power stations are put into operation, millions of tons of fuel consumption and carbon dioxide emissions will be reduced every year. " According to the relevant person in charge, this line will strengthen the layout of power stations in the future to promote the greening and energy saving of passenger travel and cargo transportation.　　

[Editor: Yu Qian]

CCTV News:Recently, from home and abroad, from finance to science and technology, from "mobility" to real estate, many fields in China have shown a new atmosphere of leaping forward, with steady progress in high-quality development and confidence and motivation for development.

The China-US Economic Working Group held its fourth meeting.　

On April 16, China and the United States conducted intensive dialogue and communication in various fields, involving military, financial and economic aspects. On April 16, the China-US Economic Working Group held its fourth meeting. The two sides conducted in-depth, pragmatic and constructive communication on the global and China-US macroeconomic situation, balanced growth, and communication arrangements for the next step. China expressed concern about the US economic and trade restrictions on China, and further responded to the issue of production capacity. The two sides agreed to continue to maintain communication.　

China-US Financial Working Group held its fourth meeting.

On the same day, the China-US Financial Working Group also held its fourth meeting in Washington, DC. The two sides exchanged views on monetary policy and financial stability, financial supervision and cooperation, institutional arrangement of financial markets, cross-border payment and data. The meeting also heard reports from the technical expert groups of the two sides on the financial regulatory framework of the two countries. The two sides agreed to continue to communicate.

The General Administration of Financial Supervision and other three departments jointly issued a notice to promote the high-quality development of financial support manufacturing industry

The General Administration of Financial Supervision, the Ministry of Industry and Information Technology and the National Development and Reform Commission jointly issued a notice a few days ago, demanding that the proportion of medium and long-term loans in the manufacturing industry be continuously increased and financial support for the development of the manufacturing industry be promoted.

The three departments proposed that efforts should be made to support the security and stability of the industrial chain supply chain and increase financial support for weak areas such as basic parts, basic materials, basic software and industrial software. Efforts will be made to support the innovative development of business entities such as small and medium-sized scientific and technological enterprises, high-tech enterprises, "specialized and innovative" small and medium-sized enterprises, and single champion enterprises in manufacturing. It is necessary to strengthen medium-and long-term financial support for equipment renewal and technological transformation of traditional manufacturing industries, help cultivate and expand strategic emerging industries, and optimize the financial supply of foreign trade in manufacturing industries.

In addition, it is necessary to strengthen financial services in the fields of smart equipment, digital infrastructure, and new industrial Internet formats, and vigorously promote the development of green finance.

The three departments require financial institutions to make separate manufacturing credit plans, strengthen the support of medium and long-term loans and credit loans in the manufacturing industry, and develop credit products and services adapted to the characteristics of the manufacturing industry. The notice also made it clear that financial institutions are not allowed to borrow and tie in, collect fees in violation of regulations, and it is strictly forbidden to attach unreasonable conditions to the loan.

Shanghai Futures Exchange: The price limit of gold and silver futures contracts is adjusted to 8%

Shanghai Futures Exchange has adjusted the price limit of gold and silver futures contracts from 6% and 7% to 8%, the margin ratio of hedging transactions from 7% and 8% to 9%, and the margin ratio of speculative transactions from 8% and 9% to 10% from April 17th.

Experts pointed out that raising the price limit and margin level of gold and silver futures contracts is conducive to preventing the risk of large price fluctuations, promoting the rational and prudent participation of all parties and promoting the long-term healthy development of varieties.　

The review of the first batch of "white list" projects of real estate was completed: more than 2,100 projects were approved, and the amount exceeded 520 billion yuan.

The reporter learned from the relevant departments that by the end of March, commercial banks had completed the review of all the first batch of "white list" projects pushed by the coordination mechanism, of which the number of approved projects exceeded 2,100, with a total amount exceeding 520 billion yuan, and some unqualified projects had been fed back to the coordination mechanism.

In the next step, the General Administration of Financial Supervision will work with the Ministry of Housing and Urban-Rural Development to further promote the effectiveness of the coordination mechanism for urban real estate financing, and urge financial institutions to actively support and meet the reasonable financing needs of real estate projects and enterprises on the premise of effectively preventing risks.

Five-hundred-meter Aperture Spherical Radio Telescope (FAST) discovered that the number of new pulsars exceeded 900.

According to the FAST Operation and Development Center of the National Astronomical Observatory of Chinese Academy of Sciences, the number of new pulsars discovered by the 500-meter spherical radio telescope (FAST), which is known as the "Five-hundred-meter Aperture Spherical Radio Telescope (FAST)", has exceeded 900.

Not only that, Five-hundred-meter Aperture Spherical Radio Telescope (FAST) has also expanded the observation range of the radiation intensity of pulsars. Most of the more than 900 new pulsars discovered are faint pulsars that are difficult to find by other telescopes in the world. Pulsar is a rapidly rotating neutron star, which is a celestial body, named after constantly sending out electromagnetic pulse signals. Five-hundred-meter Aperture Spherical Radio Telescope (FAST), located in Pingtang County, Guizhou Province, is the largest and most sensitive single-aperture spherical radio telescope in the world.

On the first day of "May 1" holiday, train tickets for popular routes are on sale.

According to the regulation that Railway 12306 sells tickets 15 days in advance, on April 17th, the train tickets will be sold on the first day of the May Day holiday. The reporter found on the 12306 website that tickets from Beijing to Zhengzhou, Wuhan, Taiyuan, Changsha and other popular directions are very tight, and many of them have been sold out, and there are a large number of candidates. The high-speed rail ticket from Beijing to Tianshui, Gansu for more than 7 hours has also been "second light".

The railway department reminds that passengers who have not bought their favorite tickets can pay close attention to buying tickets through the standby. Select several combinations of "date, train number and seats" to submit the standby order, so as to increase the standby success rate. In addition, the railway department will also increase the capacity according to the ticket sales.

General Administration of Market Supervision: The main quality indicators of cotton in Xinjiang have reached the best level in the past five years.

According to the General Administration of Market Supervision, as a national high-quality cotton base, Xinjiang’s cotton production accounts for more than 90% of the country. From the inspection results, the main quality indicators of cotton in Xinjiang in 2023 are the best in the past five years.

The dual terminal of Wuhan Tianhe Airport in Hubei Province was officially opened.

After two years’ renovation, the T2 terminal of Wuhan Tianhe Airport in Hubei Province was officially reopened a few days ago. The reconstructed T2 terminal of Wuhan Tianhe Airport adopts the departure and arrival diversion mode, which will form a joint force with T3 terminal, with a passenger handling capacity of 50 million passengers per year.

Linyi, Shandong Province opens direct passenger flights to Hong Kong.

On April 16th, flight MU6091, which was operated by China Eastern Airlines, left Linyi International Airport, marking the official opening of scheduled passenger flights between Linyi and Hong Kong. It is understood that the flight schedule of this route is every Tuesday and Friday, and the flight time is about 3 hours.

Mianyang, Sichuan: Wild pandas go down the mountain to drink water and relax.

In the Laohegou area of Pingwu, Mianyang, Sichuan, the patrolman recently met a wild giant panda on the way to patrol. It was in a mountain forest at an altitude of 2150 meters, and the giant panda was climbing down the mountain. It is strong and agile. When it comes to the river, the giant panda finds a suitable place and sits down to drink water like no one’s watching. According to the monitoring data, at present, there are 418 wild giant pandas in Mianyang.

Wang Zhongjun, Chairman of Huayi Brothers (right) and Ma Yun, founder of Alibaba (data map)

　 　 1905 movie network news On the evening of November 18th, Huayi Brothers announced that it had raised no more than 3.6 billion yuan from four issuers, including Hangzhou Ali Venture Capital Co., Ltd. (hereinafter referred to as Ali) and Shenzhen Tencent Computer System Co., Ltd. (hereinafter referred to as Tencent), through non-public issuance of A shares. Among them, 3.1 billion will be directly used to invest in film and television projects, and Huayi Brothers promised to use this fund to complete the production of 31 films within the specified three years.

　 　 In addition to the simple private placement cooperation, Huayi Brothers also revealed in two announcements on strategic cooperation that the company will carry out mutual and deep cooperation with Ali and Tencent respectively, including Taobao, Entertainment Treasure, tencent games and other platforms. In addition, Huayi also reached an agreement with these two issuers to release a certain amount of investment in "Huayi Film Works" for their participation.

　 　 So far, Huayi Brothers has completed the largest financing business in the film industry in 2014. With this issuance, Huayi successfully joined hands with companies such as Ali and Tencent, further promoting the company’s layout in the Internet field.

Huayi financing 3.1 billion: 31 films completed in 3 years.

Ali and Tencent each received 10% of the shares.

　 　 For some time, the discussion about Huayi’s "de-filmization" strategy has continued to ferment. Some people are optimistic about using this method to expand the territory and realize industrial integration; Some people think that Huayi is "doing nothing", which leads to a decline in performance. Now it is announced that it has reached strategic cooperation with Internet companies Ali, Tencent, Ping An Asset Management Co., Ltd. and CITIC Construction Securities Co., Ltd. from the financial industry. Huayi’s move can be described as "killing two birds with one stone": not only did it not neglect the original multi-layout plan, it successfully broadened the company’s resource channels in film and television, games, e-commerce, finance and other fields, but also raised 3.1 billion yuan for film and television project production, which provided a solid guarantee for the company’s next big move in film and television. According to the analysis report on the use of raised funds issued by Huayi, the company promised to use this fund to invest and produce movies and TV series in the three years from January 2015 to December 2017. Among them, there are 31 films, and the investment will account for nearly 60% of the total, including 12 super-large films, 12 large-scale films and 7 small and medium-sized films.

　 　 Among the four companies participating in this non-public offering subscription, the cooperation between Ali and Tencent, two companies from the Internet industry, and Huayi is far from simple private placement. In addition to the deep cooperation with the superior resource "new media" platform, Huayi also reached an agreement with them to release 5%-10% of total investment of the project’s "Huayi Film Works" for Ali and Tencent to participate in the project, and completed the production and distribution of five films with the two companies within three years from the effective date of the agreement.

Join hands with Ali: Entertainment Bao participates in the operation of 10 Huayi projects.

Taobao takes the lead in derivatives promotion platform.

　 　 Ali plans to subscribe for Huayi shares this time for 1.533 billion yuan, accounting for 42.5% of the total amount raised. It is not difficult to see from the strategic cooperation announcement that the cooperation between the two parties involves many aspects of the company’s business. First of all, Huayi’s film works will officially enter Ali’s "Entertainment Treasure" in the next three years, and the two companies will jointly select 10 films and adopt this product model for production and distribution. Undoubtedly, the highly targeted business attributes and a large number of user data resources of "Entertainment Bao" will make Huayi, which has just set up a new media interactive platform and is focusing on developing a "fan economy", even more powerful.

　 　 Another cooperation is related to Ali’s most popular "Taobao". As early as 2012, Huayi began to test the water film derivative model and regarded it as a powerful performance growth point. According to statistics, in the last three years, Huayi’s movie and TV drama business and its derived income totaled more than two-thirds of the total revenue. In order to continue to focus on creating a brand-new interactive system that combines traditional media with Internet finance and e-commerce, Huayi will give priority to the cooperation of e-commerce platform with Ali on its derivatives with relevant rights. For the cooperative film [Note 4], Huayi will give priority to Taobao for online ticketing sales cooperation. The ticket sales and O2O business of Huayi’s real-life entertainment theme park will also be promoted on this platform.

Cooperation with Tencent: the priority of star IP adaptation is shared by both parties

Realize the common content of movies, literature and online games.

　 　 Compared with the multi-point cooperation with Ali, the purpose of cooperation between Huayi and Tencent is much simpler and more direct, that is, sharing the star IP resources of both parties. In the next five years, under the same conditions, Tencent must give priority to Huayi’s online games or literary works for which it enjoys relevant rights. In return, all the online games, online literature and animation adaptation rights of Huayi’s film and television works will also be given priority to Tencent. For Huayi, this seemingly independent content cooperation project also undertakes the important task of exploring new ways of cooperation between Huayi’s game business and tencent games platform, and provides help for the company’s game business that needs to be developed urgently.

　 　 Huayi has been trying to deploy its interactive entertainment business group. This time, the establishment of a priority cooperation mechanism between movie IP and Tencent literature and game IP, and the opening of IP rights circulation channels between the two sides to achieve common content will help to bring into play the synergy between the company’s businesses, provide great impetus for the company to establish an internet entertainment network ecosystem, and help enterprises further improve the industrial chain layout.

[Note 1] Private placement: that is, non-public offering, offering shares to specific investors, which is also commonly known as private placement.

[Note 2] Huayi’s film works refer to film projects which are developed and produced by Huayi, controlled by Huayi, and which enjoy the decision-making power of investment arrangement.

[Note 3] Derivatives of which Huayi enjoys relevant rights: including the related derivatives of its contracted artists developed by Huayi and enjoying relevant rights, and the derivatives of which Huayi enjoys the right to develop related derivatives.

[Note 4] Huayi and Ali co-produced films: namely, 10 entertainment treasure co-produced films, 5 co-produced and distributed films and Ali participated in the film.

Original pediatric doctor Yan, pediatric doctor Yan

When I meet a baby with cough and wheezing, the first thing I think of is bronchiolitis (also called bronchiolitis), especially in winter and spring clinics.

Although bronchiolitis is not strictly pneumonia, it is difficult to manage, which is mainly related to its special lesion location and pathogenic pathogens.

01

bronchiolitis

The bronchioles are located at the end of the bronchi (below ⑤, close to the alveolar ducts), and then down are the alveolar ducts and alveoli.

The respiratory tract of young children (especially infants under one year old) is relatively narrow, and local inflammation and exudation of bronchioles can easily cause lumen blockage, hinder air from entering and leaving alveoli, and even lead to hypoxia and dyspnea in severe cases.

The symptoms of children with bronchiolitis have their own characteristics, so that clinical diagnosis can be made through symptoms and signs.

Early symptoms are mild, such as runny nose, stuffy nose, cough, and some have low fever, just like the common cold.

Different from the common cold, children with bronchiolitis have frequent cough and asthma in about 2-3 days, some have shortness of breath and inspiratory depression, and some have severe dyspnea.

Then there is a long recovery period.

Although most children can recover by themselves (the course of disease is self-limited), some need hospitalization management and even use ventilator because of severe respiratory distress.

Bronchiolitis is mostly caused by virus infection, and there is usually no targeted antiviral drug, so it can only be treated symptomatically, and then the child can carry it by himself.

The main management measures include cleaning nasal secretions, ensuring liquid intake, high-flow oxygen inhalation and auxiliary ventilation when necessary.

Aerosol inhalation of bronchodilators (salbutamol, bricanyl) and corticosteroids (budesonide) has no obvious effect on bronchiolitis, and it is usually not routinely used continuously. Unless it is observed that the symptoms of cough and asthma in children are obviously relieved after atomization inhalation, they can continue, otherwise it is recommended to stop.

It is precisely because the drug treatment of bronchiolitis is limited, so the focus of management is not how to give drugs to children, but to guide parents.

For example, guide parents to care at home, observe the progress of the disease, identify severe cases, and let parents know that the next course of disease may be longer, so they must be psychologically prepared. Otherwise, children will face excessive intervention.

02

Significance of pathogen detection

Respiratory syncytial virus (RSV) is the most common pathogen causing bronchiolitis. In addition, rhinovirus, human metapneumovirus, parainfluenza virus, adenovirus and mycoplasma pneumoniae infection can all cause bronchiolitis.

If the child has typical bronchiolitis symptoms, it is unnecessary to check the pathogen. Because even if the pathogen is known, there is usually no antiviral method. But many times, I will choose to check.

Why check? Mainly to facilitate communication with parents.

For example, cough and asthma in children with bronchiolitis lasts for a long time, which may be several weeks, and has no obvious expected effect on many treatment methods including atomized inhalation. In this case, parents are inevitably anxious.

Parents are anxious and will try their best to control their children’s symptoms. They may take their children to see a doctor repeatedly, and the children will face more medication. In addition, repeated exposure to medical institutions will increase the risk of nosocomial infection.

And a clear result of pathogenic examination (such as detecting a virus) can alleviate parents’ anxiety to a certain extent and facilitate communication between doctors and patients.

Therefore, in the clinic, when a child is suspected of bronchiolitis, I usually suggest a rapid antigen test for nasopharyngeal swab RSV first (RSV is chosen because it is the most likely and the rapid antigen test is very convenient).

If it is positive, inform the parents of the main points of home management, the possibility of facing a longer course of disease, and avoiding the abuse of antibiotics during this period, so that parents can be mentally prepared.

You see, proper auxiliary examination is actually to protect children.

However, RSV is only the most common virus that causes bronchiolitis. At work, children with typical bronchiolitis symptoms will also be encountered, but RSV is negative. How to manage it?

03

A case

Next, share a case. Before sharing, as usual, I would like to thank my parents for their permission.

This 11-month-old baby was the last patient on the afternoon of December 1st. Before coming to my clinic, the course of cough was nearly ten days, and I have been treated twice in other hospitals. In the clinic, the child coughed violently and vomited several times, with obvious asthma, shortness of breath and inspiratory depression, and fever.

Hormones and bronchodilators have been atomized and inhaled at home, and the symptoms are not obviously relieved.

I did a rapid RSV antigen test first, and the result was negative.

Although the child has shortness of breath and inspiratory depression, the degree is not serious and the oxygen saturation is still in the normal range.

Although coughing leads to vomiting and affects eating, there is no dehydration;

Although low fever, but the overall state is not bad, willing to interact with others, no symptoms of infection and poisoning;

Most importantly, my mother has a certain ability to observe the changes of diseases. Although she is anxious, she is not particularly anxious.

I evaluate that the child has not reached the indication of hospitalization at present, and there is no clear manifestation of bacterial infection. The high probability is still viral infection. After taking a throat swab sample and doing targeted sequencing, he didn’t prescribe medicine, so he was told to go home for observation and follow up online. I also repeatedly reminded that if the symptoms get worse, I need to be hospitalized.

To tell the truth, when the patient’s family was ready to leave the clinic after the visit, I was really sorry when my mother asked the children to wave goodbye to me. Coming from other places, the total cost of consultation and laboratory test is more than 1,500 yuan. I didn’t prescribe any medicine, and I didn’t know the pathogen. I went home empty-handed, and the future course of my illness is still unclear, which is really worrying.

On the second day, I contacted my parents by phone. The parents reported that they still coughed and vomited, but the frequency was less, my temperature was normal, I could eat something, and my urine volume was normal.

On the afternoon of the third day, targeted sequencing showed that the sample contained high concentration of human metapneumovirus, and cytomegalovirus was detected.

Combined with the symptoms of the child, I think the child is bronchiolitis caused by human metapneumovirus infection. As for the detected cytomegalovirus, it is considered to be carried in the pharynx (previous infection).

Because my home is out of town, I didn’t ask my parents to take her back to the clinic for follow-up, and I kept in touch by phone all the time.

Fortunately, the symptoms behind this child gradually eased, and it was not until mid-December that there was basically no cough, but there was phlegm in the throat from time to time. The total course of disease is more than 3 weeks, which accords with the characteristics of classic bronchiolitis.

04

Human metapneumovirus

Everyone should be unfamiliar with human metapneumovirus, and the doctor’s knowledge is likely to stay at the textbook level, because this pathogen is not checked at ordinary times and there is a lack of perceptual knowledge.

With the targeted sequencing in our outpatient department, many children were found to be infected with this virus. I thought it was a little strange at first, but if you look up the relevant information, you will find that you are rare and strange. I didn’t know it before, but I just didn’t have the ability to test it.

In 2001, Dutch virologist Bernadette G. van den Hoogen and his colleagues isolated a new virus from the respiratory secretions of 28 young children, named human metapneumovirus, hMPV).

HMPV belongs to pneumoviridae. Pneumoviridae is named because its viruses are related to respiratory diseases of people or other animals, and the most famous one is RSV.

HMPV is distributed all over the world, and is often prevalent in winter/spring in temperate regions, overlapping with RSV and flu seasons.

Serological studies show that hMPV has spread for at least 60 years. By the age of five, almost all children in the world have been infected, which is considered to be the common cause of lower respiratory tract infection in children (second only to RSV in some areas).

Although infection is common in early life, reinfection is also common in older children and adults. Reinfection is mostly mild infection, such as common cold symptoms, but the risk of serious diseases will increase when reinfection occurs in immunocompromised people or the elderly.

HMPV may be transmitted by contact with virus-containing secretions, droplets, large aerosol particles or pollutants.

05

Symptom

The symptom characteristics and severity of hMPV are similar to RSV, so I often mistake hMPV infection in children for RSV infection.

Like RSV, the common symptoms of children infected with hMPV are fever, cough, runny nose and stuffy nose, and nearly half of young children may have asthma. A few patients may have acute laryngitis.

If hMPV only affects the upper respiratory tract, the symptoms are like common cold, such as mild fever, runny nose, stuffy nose, sore throat, cough and headache, which usually disappear in about a week.

However, hMPV is not very friendly to children and the elderly, and may spread to the lower respiratory tract. Infants infected with hMPV are prone to bronchiolitis, and the symptoms described in the first part of this paper, "Bronchiolitis", appear.

Some children with hMPV infection need hospitalization because of severe respiratory distress or inability to eat effectively with dehydration.

06

Severe risk

The risk of severe illness and hospitalization is significantly increased in the following groups:

Premature infants (gestational age ≤36 weeks)

Low birth weight infants (birth weight less than 2500g)

Infants under 1 year old

Chronic lung diseases (especially bronchopulmonary dysplasia)

Abnormal anatomical structure of airway

Congenital heart disease (with significant hemodynamic abnormalities)

Immune hypofunction

Nervous system diseases

Children with these high-risk factors need special attention, because their risk of adverse outcomes is significantly increased.

07

Treatment

Symptomatic treatment.

Use antipyretics to relieve discomfort caused by fever.

Clean nasal secretions to make children more comfortable and easy to eat and sleep.

Ensure liquid and energy intake and avoid dehydration.

Respiratory support: oxygen, assisted breathing.

Antiviral treatment.

Ribavirin and other antiviral drugs have been shown to be active against hMPV in vitro. However, there is no clinical data about the effect of ribavirin or other antiviral drugs on hMPV infection.

Therefore, antiviral drugs are not recommended for people infected with hMPV.

08

Epidemic vaccine

At present, there is no approved hMPV vaccine.

Moderna, an American pharmaceutical company, has developed a candidate vaccine against hMPV and conducted clinical trials.

As of October 2019, the candidate vaccine has passed the first phase of clinical trials. It is reported that the vaccine is well tolerated at all dosage levels within two months, and it stimulates immune response and produces neutralizing antibodies.

09

Total knot

Whether it is RSV, hMPV, or bronchiolitis caused by Boca virus, rhinovirus and parainfluenza virus, there is no difference in our management principles.

If you have the conditions to check, you can check the cause and find out hMPV, so don’t worry too much; If there is no condition to check, it can be diagnosed by symptoms and managed according to bronchiolitis.

The focus of management is still home care and observing the progress of the disease.

Original title: "Cough, asthma and fever, thought it was RSV infection, the result was human metapneumovirus, what should I do?" 》

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