Infants cholestasis is a common disorder of hepatobiliary system which is caused by abnormal cholestasis of hepatocytes or substances accumulation in the liver, blood and extrahepatic tissue due to the disorder of the intrahepatic or extrahepatic bile ducts.Serum Gamma-glutamyl transpeptidase(GGT) was widely distributed in one side of the capillary bile duct and the whole bile duct system of hepatocytes.When hypersynthesis in the liver or disorder of cholorrhagia, serum GGT increased.This review summarized the changes of GGT cholestasis of different causes in infants and its significance in differential diagnosis, for better understand the disease and provide references for clinical practice.

Objective:To explore the whole genome sequencing of carbapenem resistant Klebsiella pneumoniae (CRKP), reveal the prevalence of drug-resistance in CRKP, and guide the prevention and control of nosocomial infection. Methods:The CRKP isolates in Bengbu Third People′s Hospital from November 2018 to March 2019 was collected, and the strain identification and drug susceptibility testing were carried out using VITEK-2 Compact analyzer. The whole genome of selected CRKP was sequenced by Illumina Hiseq 2500 platform, spliced with spades-2.0 sequence, analyzed and extracted the core gene and drug-resistant genotype by cgMLST, and constructed the bacterial association map and transmission map by Scotti software.Results:Among the 19 CRKP strains, 13 were CT3176 genotype, 2 were CT1313 and 2 were CT1689, and 2 were other CRKP strains. CT3176 was distributed mainly in the Department of critical care medicine and was in epidemic status. The strains mainly carried blaKPC-2 (19/19), blaCTX-M-65 (19/19), blaSHV-11 (16/19), blaTEM-1B (14/19), and aminoglycosides. Among them, aadA2 (14/19), rmtB (14/19), AAC(3)-Ⅱd (12/19), armA (11/19), mph (E) (11/19), msr (E) (11/19), mph (A) (10/19), fosA6 (19/19) and other resistant genes were detected. Software analysis showed that the strains numbered 7 and 29, and strains numbered 12 and 17 had 42% and 37% transmission rate repectively, but that of the other strains remain low.Conclusions:By using the whole genome sequencing of microorganisms, strain typing, drug resistance genes, and the homology of strains can be determined, strain association map and transmission map can be built. That can effectively guide the development of nosocomial infection prevention and control in hospitals.

Inflammatory bowel disease is a chronic recurrent inflammatory disease of the intestine of unknown origin.It is currently thought to be mediated by a combination of susceptibility genes, intestinal microecology and immune involvement, with all three interacting and influencing each other.This leads to a disruption of the intestinal microenvironment, which affects the host′s immune tolerance, and ultimately induces intestinal inflammation.In this review, we summarized the mechanisms of intestinal microbiota in children with inflammatory bowel disease and discussed new ideas of microecological agents for individualized treatment of children with inflammatory bowel disease.

Pediatric acute liver failure(PALF)is a severe liver damage caused by multiple factors, resulting in severe impairment of hepatic synthesis, excretion, detoxification and biotransformation.It was thought that PALF patients had coagulation disorders that predisposed them to bleeding.Now it is noted that due to the simultaneous reduction of anticoagulant and procoagulant factors, the body is in a state of rebalanced hemostasis.The risk of thrombosis is nearly equal to hemorrhage.Appropriate laboratory tests can better assess the coagulation status of children with PALF and guide appropriate blood product transfusions to improve coagulation and reduce the risk of transfusion-related fluid overload and other adverse prognosis.

Objective:To analyze the use of antibiotics in the department of pediatric gastroenterology, and improve the standardization and rationality of drug use.Methods:The relevant indicators of antibiotics use in hospitalized children from 2015 to 2021 in the Department of Pediatric Gastroenterology at Shengjing Hospital of China Medical University were collected with statistical analysis, including the proportion of drugs, the proportion of antibiotics expenses, the utilization rate of antibiotics expenses, and the intensity of antibiotics use (AUD).Results:From 2015 to 2021, the proportion of drugs, the proportion of antibiotics expenses and the average annual utilization rate of antibiotics for hospitalized children showed a fluctuating decline.The proportion of drugs decreased from 32.01 % in 2015 to 26.29 % in 2021.The proportion of antibiotics expenses decreased from 15.28 % in 2015 to 2.55 % in 2021.The average annual utilization rate of antibiotics decreased from 51.21 % in 2015 to 34.26 % in 2021.From 2018 to 2021, the AUD showed a fluctuating decline, from 16.15 in 2018 to 15.73 in 2021.The average utilization rate and average AUD in different seasons did not fluctuate significantly.Conclusion:The proportion of drugs, the proportion of antibiotics expenses, the annual average utilization rate of antibiotics, and the annual average AUD in the department of pediatric gastroenterology in a single center show a fluctuating decline.There is no significant difference in the utilization rate and AUD in different seasons.

Objective:To explore the effect of nursing intervention based on the health action process approach (HAPA) theory on follow-up compliance and blood glucose management of patients with diabetes retinopathy (DR) .Methods:From October 2022 to May 2023, 102 DR patients who visited the Diabetes Fundus Clinic of Shanxi Eye Hospital were selected by convenience sampling as participants. A total of 51 patients who visited from October 2022 to January 2023 were selected as control group, and 51 patients who visited from February to May 2023 were selected as observation group. Control group received routine nursing, while observation group received nursing intervention based on HAPA theory on this basis. The follow-up compliance, Chinese version of the Compliance with Annual Diabetic Eye Exams Survey (CADEES-C) score, fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG) and glycosylated hemoglobin (HbA1c) were compared between the two groups.Results:The compliance of DR patients in observation group after six months of follow-up was higher than that in control group, and the difference was statistically significant ( P<0.05). After six months, the CADEES-C dimension scores and total score of DR patients in observation group were higher than those in control group, and the differences were statistically significant ( P<0.05). FBG and 2hPG of DR patients in observation group were lower than those in control group after three and six months, and the differences were statistically significant ( P<0.05). After six months of intervention, there was no statistically significant difference in HbA1c between observation group and control group ( P>0.05) . Conclusions:Nursing interventions based on HAPA theory can effectively improve the follow-up compliance of DR patients, enhance their health beliefs during follow-up, and improve their blood glucose.

OBJECTIVE:The main clinical manifestations of knee osteoarthritis are pain,swelling,stiffness,and limited activity,which have a serious impact on the life of patients.Exercise therapy can effectively improve the related symptoms of patients with knee osteoarthritis.This paper uses the method of network meta-analysis to compare the efficacy of different exercise types in the treatment of knee osteoarthritis. METHODS:CNKI,WanFang,PubMed,Embase,Cochrane Library,Web of Science,Scopus,Ebsco,SinoMed,and UpToDate were searched with Chinese search terms"knee osteoarthritis,exercise therapy"and English search terms"knee osteoarthritis,exercise".Randomized controlled trials on the application of different exercise types in patients with knee osteoarthritis from October 2013 to October 2023 were collected.The outcome measures included visual analog scale,Western Ontario and McMaster Universities Osteoarthritis Index score,Timed Up and Go test,and 36-item short form health survey.Literature quality analysis was performed using the Cochrane Manual recommended tool for risk assessment of bias in randomized controlled trials.Two researchers independently completed the data collection,collation,extraction and analysis.RevMan 5.4 and Stata 18.0 software were used to analyze and plot the obtained data. RESULTS:A total of 29 articles with acceptable quality were included,involving 1 633 patients with knee osteoarthritis.The studies involved four types of exercise:aerobic training,strength training,flexibility/skill training,and mindfulness relaxation training.(1)The results of network meta-analysis showed that compared with routine care/health education,aerobic training could significantly improve pain symptoms(SMD=-3.26,95%CI:-6.33 to-0.19,P<0.05);strength training(SMD=-0.79,95%CI:-1.34 to-0.23,P<0.05)and mindfulness relaxation training(SMD=-0.79,95%CI:-1.23 to-0.34,P<0.05)could significantly improve the function of patients.Aerobic training(SMD=-1.37,95%CI:-2.24 to-0.51,P<0.05)and mindfulness relaxation training(SMD=-0.41,95%CI:-0.80 to-0.02,P<0.05)could significantly improve the functional mobility of patients.Mindfulness relaxation training(SMD=0.70,95%CI:0.21-1.18,P<0.05)and strength training(SMD=0.42,95%CI:0.03-0.81,P<0.05)could significantly improve the quality of life of patients.(2)The cumulative probability ranking results were as follows:pain:aerobic training(86.6%)>flexibility/skill training(60.1%)>strength training(56.8%)>mindfulness relaxation training(34.7%)>routine care/health education(11.7%);Knee function:strength training(73.7%)>mindfulness relaxation training(73.1%)>flexibility/skill training(56.1%)>aerobic training(39.9%)>usual care/health education(7.6%);Functional mobility:aerobic training(94.7%)>mindfulness relaxation training(65.5%)>strength training(45.1%)>flexibility/skill training(41.6%)>routine care/health education(3.2%);Quality of life:mindfulness relaxation training(91.3%)>strength training(68.0%)>flexibility/skill training(44.3%)>aerobic training(34.0%)>usual care/health education(12.3%). CONCLUSION:(1)Exercise therapy is effective in the treatment of knee osteoarthritis,among which aerobic training has the best effect on relieving pain and improving functional mobility.Strength training and mindfulness relaxation training has the best effect on improving patients'function.Mindfulness relaxation training has the best effect on improving the quality of life of patients.(2)Limited by the quality and quantity of the included literature,more high-quality studies are needed to verify it.

Bacillus spp. are probiotics and can secrete a variety of natural antimicrobiol active substances, of which lipopeptides are an important class. Up to now, about 90 lipopeptides have been identified, and most of them are cyclic lipopeptides. surfactin, iturin, fengycin, bacillomycin and polymyxins are widely studied, and the first three have huge potential for application due to their properties of surfactants and anti-fungal, anti-bacterial, anti-viral, anti-tumor and anti-inflammatory functions. In this paper, the research progress in the structure, function, synthesis regulation, separation, purification and production of surfactin, iturin and fengycin was reviewed. Synthetic biology is a vital means to increase the yield of lipopeptides, and in the future, lipopeptides can be used in crop cultivation, animal farming, food, medicine and petroleum industries as well as environmental protection. Future research should be strengthened on the discovery of new lipopeptides, synthesis of high-activity lipopeptides, economical production of lipopeptides on a large scale and their safety evaluation.
Anti-Bacterial Agents ; Anti-Infective Agents/pharmacology* ; Bacillus ; Bacillus subtilis ; Lipopeptides/pharmacology* ; Peptides, Cyclic/pharmacology*