As a treasure of the traditional culture of China, TCM can be developed in long-term, that need the inheritance and innovation of scholars. During the process, it is an important responsibility and obligation that the development of TCM hospital. The development and improve of the hospital scientific research are important aspects for the development of hospital. The construction of scientific research team is an important approach to promote the hospital scientific research strength. By analyzing the whole current situation of hospital scientific research team, we will discuss the measures to strengthen the construction of hospital scientific research team from several aspects. These aspects include the system of scientific research team, talented person echelon structure, management system and the team overall strength, etc. These measures are aimed to strengthen the team construction characteristics of TCM, promote the scientific research level of TCM, contribute to the development of the career and hospital.

Objective: To investigate the current situation and influencing factors of knowledge, attitude and practice (KAP) of fall prevention among the elderly in Huzhou City, Zhejiang Province, so as to provide the evidence for the development of fall intervention for the elderly. Methods: The permanent residents aged 60 years and over in Huzhou City were selected using multi-stratified cluster sampling method from March to April 2023. Demographic information, activity of daily living (ADL), fall risk, and KAP of fall prevention was collected using questionnaire surveys. Factors affecting KAP of fall prevention were identified using a multivariable logistic regression model. Results: Totally 2 160 questionnaires were allocated, and 2 104 valid questionnaires were recovered, with an effective recovery rate of 97.41%. There were 1 063 males (50.52%) and 1 041 females (49.48%), and 861 residents aged 60 to <70 years (40.92%). The awareness of fall prevention knowledge was 84.13%, the percentage of attitude towards fall prevention was 85.88%, and the percentage of practice of fall prevention was 14.59%. Multivariable logistic regression analysis showed that age, educational level, exercise duration and fall risk were associated with the awareness of fall prevention knowledge; age, educational level, marital status, exercise duration, ADL and fall risk were associated with the attitude towards fall prevention; gender, age, educational level, marital status, exercise duration, chronic diseases, ADL and fall risk were associated with the practice of fall prevention (all P<0.05). The desired access to fall prevention knowledge was mainly dominated by medical personnel, accounting for 75.51% (589/780). Conclusions The practice towards fall prevention among the elderly is relatively low in Huzhou City. The KAP of fall prevention is related to age, educational level, exercise duration and fall risk.

Objective To investigate the respiratory burst function of neutrophils in very low birth weight infants (VLBWI).Methods Twenty two VLBWI was divided into two groups:neonatal respiratory distress syndrome (NRDS) and non NRDS (11 in each).The respiratory burst function of neutrophils in the peripheral blood of VLBWI within 48 hours after birth was determined using the flow cytometrydihydrorhodamine 1,2,3 method before and after the chemical stimulation of phorbol-12-myrismte 14 acetate (PMA),and the gp91Phox was also measured in resting neutrophils by flow cytometry.Twenty healthy term neonates served as controls.Mann-Whitney U test was used for statistical analysis.Results Before the stimulation of PMA,the percentage of activated neutrophils of VLBWI [(49.10±20.19) ％] producing a respiratory burst was higher than that of term neonates [(18.73 ±6.81) ％] (Z--4.911,P=0.000),however,after the stimulation of PMA,the percentage of activated neutrophils of VLBWI [(96.58 ± 3.44) ％] was lower than that of term neonates [(99.20±0.62) ％] (Z--3.186,P=0.001),and the stimulation index (SI) of VLBWI (171.40 ± 103.35) was lower than that of term neonates (306.30 ± 138.47),with significant difference (Z=-3.413,P=0.001).The geometric mean of gp91Phox in VLBWI (21.66± 19.87) was higher compared with term neonates (19.60±8.03),however,the difference was not significant (P=0.350).The percentage of neutrophils that expressed gp91Phox [(56.11 ± 29.40) ％] was lower in VLBWI than that in term neonates [(80.14± 14.87) ％],with significant difference (Z=-2.374,P=0.018).Before the stimulation of PMA,the percentage of activated neutrophils of VLBWI with NRDS (63.40± 16.45) ％] was higher than that of VLBWI without NRDS [(34.80± 11.65) ％],with significant difference (Z=-3.382,P=0.001),the SI of VLBWI with NRDS (129.46 ± 75.36) was significantly lower than that of VLBWI without NRDS (213.35 ± 113.49) (Z=-2.331,P=0.020).Conclusions Neutrophils producing a respiratory burst in both VLBWI and term neonates are active without stimulation of PMA,while the phenomenon is more obvious in VLBWI.Neutrophils in VLBWI and term infants can be activated by the stimulation of PMA,and express gp91Phox.The activation and gp91Phox expression of neutrophils in VLBWI with NRDS tend to be lower than those in VLBWI without NRDS.

The clinical manifestations of acute poisoning in children were nonspecific,most of all,the initial symptoms were disturbance of consciousness or even coma.The critical treatment of acute poisoning is quickly identify life-threatening situation,remove the unabsorbed toxins,promote the removal of poison which has been absorbed of blood,timely application the detoxification and organ functional support.The treatment of blood purification and extracorporeal membrane oxygenation technique are important progresses in children's severe poisoning.

Objective:To explore the clinical characteristics and prognostic risk factors of accidental injuries in pediatric intensive care unit(PICU).Methods:The children with accidental injuries admitted to the PICU at Shanghai Children′s Hospital from January 2017 to December 2019 were analyzed retrospectively.The patients were divided into survival group and death group according to outcome.We collected the patients′ clinical data and laboratory indexes, and analyzed the differences between two groups.Multivariate Logistic regression was used to screen the risk factors of death and receiver-operating characteristic(ROC)curve was used to determine the threshold.Results:(1)A total of 253 children were included, accounting for 5.2% of PICU hospitalization during the same period.There were 137 males(54.2%)and 116 females(45.8%), with an average age of 45(19, 96)months.The top three causes of accidental injuries were fall injury in 82 cases(32.4%), traffic accident in 70 cases(27.7%)and foreign body in 39 cases(15.4%). There were 22 cases of deaths, with a fatality rate of 8.7%.(2)The mean arterial pressure at admission in the death group was lower than that in the survival group( P<0.05), and the total length of stay was longer( P<0.001). There were significant differences in Glasgow coma scale, Pediatric Risk of Mortality Scoring Ⅲ(PRISM Ⅲ)between the two groups( P<0.001). In the death group, and the blood lactic acid(LA) significantly increased( P<0.001), hemoglobin and fibrinogen were lower than those in the survival group, the activated partial thromboplastin time and prothrombin time(PT)were significantly prolonged( P<0.001). (3)Multivariate Logistic regression analysis showed that PRISM Ⅲ score, LA and PT were independent risk factors for the death of accidental injuries.The area under curve(AUC)of PRISM Ⅲ score was 0.987(95% CI 0.976-0.999, P<0.001)and the cut-off value was 11 with a sensitivity of 100% and a specificity of 95.7%.The AUC of LA was 0.886(95% CI 0.810-0.961, P<0.001)and the cut-off value was 3.1 mmol/L with a sensitivity of 85.7% and a specificity of 77.3%.The AUC of PT was 0.835(95% CI 0.730-0.941, P<0.001)and the cut-off value was 13.9 s with a sensitivity of 86.6% and a specificity of 72.7%. Conclusion:The main accidental injuries in PICU of our hospital in the past three years are falling injuries, traffic accidents and foreign body injuries.PRISM Ⅲ score, LA and PT at admission are independent risk factors for predicting death.

Objective To investigate the correlation of the expressions of P170,topoisomerase Ⅱ(TOPⅡ)and the proliferation in gliomas.Methods Ki-67 was used as the marker of the proliferation in gliomas.The expressions of P170,TOPⅡ and Ki-67 were tested by S-P immunohistochemical technique using monoclonal antibody to their protein in 54 cases of low-grade gliomas(WHO Ⅰ～Ⅱ grade)and 54 cases of high-grade gliomas(WHO Ⅲ～Ⅳ grade),analysis of the clinical and follow-up were performed.Results The expressions of P170,TOPⅡ and Ki-67 had significant differences between low-grade and high-grade gliomas(P<0.01).Correlation analysis showed that the expression of P170 was negatively related with Ki-67(r=-0.276,P=0.019);the expression of TOPⅡ was positively related with Ki-67(r= 0.637,P<0.001);there was no correlation between the expressions of P170 and TOPⅡ.Conclusion The expressions of P170 and TOPⅡ are associated with the malignant prognosis in gliomas.

This paper summarized the current ethical dilemmas of living will in our country including life ethical dilemmas, medical ethical dilemmas and family ethical dilemmas, and then proposed several suggestions for the promotion of living will in China:strengthening the theoretical research on related contents of living will, increasing the intensity of death education, carrying out related activities in the communities, strengthening the policy support and establishing hospital or regional pilots, to provide the feasible problems for the advancement of our country's living will.

Objective:To summarize the clinical features, imaging changes, treatment, and prognosis of children with severe autoimmune encephalitis (AE).Methods:A retrospective study was conducted on patients with severe AE admitted to PICU of Shanghai Children’s Hospital from June 2017 to May 2020. Clinical features, treatment protocols and follow-up data were collected.Results:A total of 27 children were included, among which 18 cases (66.7%) were girls. The on-set age was (7.9±3.2) years. Eighteen cases were diagnosed with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Fever (77.8%), headache (40.7%) and vomiting (44.4%) were most of prodromal symptoms in children with severe AE. Patients’ neurological symptoms showed seizures (88.9%), mental behavior abnormalities (81.5%), speech disorders (70.4%) and dyskinesia (70.4%). Moreover, epileptic discharge and slow wave activity were critical feature of electroencephalogram (EEG) abnormalities, and the abnormal signal changes on T2-weighted and FLAIR sequence of head MRI were in the posterior horn of the lateral ventricle. In addition, the main comorbidities included refractory status epilepticus (RSE), cardiovascular dysfunction, central hypoventilation syndrome and acute intracranial hypertension syndrome. For patients with central respiratory failure, the median duration of mechanical ventilation was 19.8 (14.8, 29.1) days. According to treatment protocol, the first-line immune treatment included the combination therapies of methylprednisolone, intravenous immunoglobulin (IVIG) and therapeutic plasma exchange (TPE). Eighteen cases were given with methylprednisolone [10-30 mg/(kg. d), 3-5 d] + IVIG (2 g/kg, within 2 d) + TPE, 1 case was treated with methylprednisolone [10-30 mg/(kg·d), 3-5 d] + TPE and 8 cases were given with[10-30 mg/(kg·d), 3-5 d] + IVIG (2 g/kg, within 2 d). Sequential therapy was given with methylprednisolone (1-2 mg/kg), gradually reduced from 3 to 6 months. Finally, 16 children (59.3%) had neurological damages at the first discharge, among which 8 cases (29.6%) were with dyskinesia, 5 cases (18.5%) were with speech disturbance, and 5 cases (18.5%) were with abnormal mental behaviors.Conclusions:The most of first clinical symptom is epileptic seizures in pediatric severe AE, and most of these patients are diagnosed with Anti-NMDA receptor encephalitis. RSE, cardiovascular dysfunction, central respiratory and acute intracranial hypertension syndrome constitute to main organ dysfunctions.

Objective:To investigate the tendency of bacterial distribution and drug resistance of clinically isolated pathogens in the pediatric intensive care unit (PICU), which provided references for the reasonable application of antibiotics.Methods:The distribution characteristics of all clinical isolates from PICU of Children′s Hospital of Shanghai Jiaotong University from January 2010 to December 2018 and their trend of drug resistance were retrospectively analyzed.Results:A total of 2 749 strains of bacteria were isolated, including 1 912 strains (69.6%) Gram-negative bacteria and 837 strains (30.4%) Gram-positive bacteria.The top 6 detected bacteria were Acinetobacter baumannii (749 stains, 27.2%), Klebsiella pneumoniae (289 stains, 10.5%), Staphylococcus aureus (214 stains, 7.8%), Stenotrophomonas maltophilia (207 stains, 7.5%), Escherichia coli (204 stains, 7.4%) and Pseudomonas aeruginosa (189 stains, 6.9%). Among them, the detective rate of Maltophilia Stenotrophomonasannually increased from 6 strains (2.8%) in 2010 to 39 strains (9.5%) in 2018.The resistance rates of Acinetobacter baumannii and Klebsiella pneumoniae to carbapenems increased year by year, which was up to 96.0% and 71.4% to Meropenem by 2018.Their resistance rates to the third-generation cephalosporins, aminoglycosides and sulfonamides were higher than 70.0%.The sensitivity rate to Tigecycline and Polymyxin was 100.0%.The detection rate of Methicillin-resistant Staphylococcus aureus (MRSA) significantly increased from 18.2% in 2010 to 50.0% in 2018 ( χ2=19.38, P=0.013). No Vancomycin-resistant strains were found. Conclusions:Gram-negative bacteria are the main clinical isolates of PICU.Acinetobacter baumannii, Klebsiella pneumoniae, and especially Pseudomonas maltophilus, have a significant growth trend in the detection rate. Acinetobacter baumannii and Klebsiella pneumoniae are highly resistant to carbapenems.MRSA annually grows, but it still maintains a high degree of sensitivity to Vancomycin.

Objective:To investigate the effects of therapeutic plasma exchange(TPE)as adjuvant therapy in children with myasthenia gravis(MG)in pediatric intensive care unit(PICU).Methods:A retrospective study was conducted in 7 children with MG admitted to PICU at Shanghai Children′s Hospital from January 2016 to December 2019.TPE was performed on unsatisfactory effect of acetylcholinesterase inhibitors, glucocorticoids or IVIG.The TPE dose was 50-70 mL/kg for 2 to 3 times for each case.The clinical symptoms, anti-acetylcholine antibody(AChR-Ab)level and prognosis were measured before and after TPE.Results:Seven children with myasthenia gravis admitted to PICU from January 2016 to December 2019, including 4 cases of systemic myasthenia gravis(1 case of myasthenia crisis with respiratory failure)and 3 cases of ocular myasthenia gravis.The AChR-Ab level decreased from 1.66(0.99, 3.33)nmol/L before TPE to 0.66(0.40, 10.97)nmol/L after TPE( Z=-2.545, P=0.011). The symptoms of muscle weakness and blepharoptosis were partially or completely relieved in 7 cases.There were no significantly changes in the levels of circulating immune complex, complement C3, CD4 + , CD8 + and NK cells before and after TPE(all P>0.05). During the process of TPE, 2 cases had mild rash, and 1 case had hypotensive shock, which were recovered after timely treatment.After TPE, the fibrin levelsdecreased from 1.90(1.40, 2.40)g/L to 1.10(1.00, 1.30)g/L( Z=-3.092, P=0.002). Conclusion:TPE reduce the AChR-Ab levels and improve the short-term symptoms in children with myasthenia gravis who have failed conventional treatment.TPE may be an optional therapy for pediatric severe MG.