Objective:To summarize the experience of the precise prevention and control strategy of novel coronavirus infection in the pediatric intensive care unit(PICU)during the epidemic of the Omicron variant.Methods:A retrospective analysis was performed on the strategies and management experience of precise prevention and control of novel coronavirus infection in PICU at Pediatric Hospital of Fudan University from March 1 to May 10, 2022.Results:According to the national and Shanghai novel coronavirus infection prevention and control standards, the PICU in our hospital, in accordance with the specialty characteristics of PICU, cooperated with the hospital′s department of infection and medical department to jointly construct a precise ward management strategy for the outbreak of the omicron mutants infection.Precise prevention and control management strategies were formulated from four aspects: the admission process of critically ill children, the division of PICU ward areas and nosocomial infection protection, the reception management system for children′s family members, and the " bubble management" system for PICU staff, and run them for 3 months.During the epidemic, there was no nosocomial infection of novel coronavirus infection in children or medical staff.During the period, a total of 140 critically ill children were admitted, including 87 cases transferred from the general ward in the hospital, 48 cases from the emergency department(non-febrile, 3 cases transferred by the transfer team), four cases from fever clinic, and one case from control ward.Four of the critically ill children had no emergency nucleic acid test report when they were admitted to the PICU.Among the 140 critically ill children, 54 patients received mechanical ventilation, 18 patients received blood purification, and two patients were monitored after liver transplantation.Seventy-eight (55.7%) children had underlying diseases.Conclusion:During the current round of novel coronavirus epidemic in Shanghai, PICU in our hospital formulated the admission and ward management procedures for critically ill children, which ensured the prevention and control of nosocomial infection of novel coronavirus, and at the same time ensured the treatment of critically ill children to the greatest extent.

[摘 要] 目的：探讨在靶向HER2的CAR的CD3ζ链胞内区引入YRHQ基序对CAR-T细胞的特异性杀伤活性及免疫记忆形成的影响。方法：通过DNA合成获得包含靶向HER2的编码抗原受体H28ζ或H28ζ(YRHQ)的DNA片段，通过慢病毒载体将不同CAR的DNA片段分别转导健康人外周血T细胞，制备靶向HER2的H28ζ-CAR-T及H28ζ(YRHQ)-CAR-T细胞。扩增过程中对不同CAR-T细胞进行计数，FCM检测CAR的表达率。将CAR-T细胞分别与HER2阳性的SKOV3、MDA-MB-453或HER2阴性的MCF-7细胞共培养，LDH释放法检测其杀伤活性，ELISA法检测IL-2、IFN-γ和颗粒酶B的水平，WB法检测STAT3磷酸化水平及免疫检查点分子TIM-3和PD-1的表达，通过FCM检测CCR7、CD45RO的表达，分析CAR-T细胞的表型。结果：H28ζ-CAR-T和H28ζ(YRHQ)-CAR-T细胞扩增能力较好，体外培养7 d时扩增4~5倍。H28ζ-CAR和H28ζ(YRHQ)-CAR表达率分别为（33.3±2.85）%和（28.30±3.2）%。H28ξ(YRHQ)-CAR-T细胞的杀伤活性较H28ζ-CAR-T细胞更高（P<0.05）。经HER2抗原刺激后，与T细胞或H28z-CAR-T细胞比较，H28ξ(YRHQ)-CAR-T细胞的STAT3磷酸化水平较H28ξ-CAR-T细胞明显升高（P<0.01）；而两者间PD-1和TIM-3的表达无明显差异。未经抗原刺激的CAR-T细胞CCR7和CD45RO表达与正常T细胞比较差异无统计学意义（均P>0.05），与SKOV3细胞共培养后，与T细胞或H28z-CAR-T细胞比较，H28ξ(YRHQ)-CAR-T细胞中TEM细胞比例明显增加、TCM细胞比例明显减少（均P<0.05）。结论：在CD3胞内区引入YRHQ基序可在一定程度上提高CAR-T细胞的杀伤潜力。

Objective:To construct a color assessment tool for continuous bladder irrigation (CBI) drainage fluid and to explore its clinical value.Methods:The color assessment tool for CBI drainage fluid (tentative version) was constructed through literature review, expert meetings and practical development, and its consistency was tested and the tool was improved to form a color assessment tool for CBI drainage fluid. Convenience sampling was used to select patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate (TURP) in the First Affiliated Hospital of Soochow University from April to May 2020. According to the assessment method of the tool, the patient's drainage fluid color was evaluated and recorded.Results:The color assessment tool for CBI drainage fluid included 6 color scales, and the corresponding Pantone color card codes were 503C, 3519C, 701C, 702C, 710C, 1807C respectively, and the blood concentration was 0.125%, 0.5%, 1.0%, 2.0%, 4.0% and 8.0% respectively. The tool was used to evaluate the drainage fluid color in 29 patients after TURP. Each evaluation took (5.12±2.41) s; when the color scale was greater than number two, complications such as the bladder spasm and blood clot blockage occurred.Conclusions:The construction method of color assessment tool for CBI drainage fluid is scientific and reliable, which can provide a basis for evaluating the CBI drainage fluid color, and can assist medical and nursing staff to quickly evaluate the drainage fluid color and find abnormal color scales.

Objective:To explore correlation between RoSCo score and postoperative absolute bed rest time in patients undergoing laparoscopic partial nephrectomy (LPN) .Methods:The imaging data and clinical data of patients undergoing LPN from January 2018 to July 2019 in a Class ⅢGrade A hospital in Suzhou were retrospectively analyzed. RoSCo score was calculated by RENAL score, body mass index (BMI) and Charlson comorbidity index. According to the score, patients were divided into low-risk group (RoSCo score≤4 points) , medium-risk group (RoSCo score of 5 to 6 points) , high-risk group (RoSCo score≥7 points) , and postoperative absolute bed rest time of patients in three groups were collected. The kruskal-Wallis H test of non-parametric test was used to compare the absolute bed rest time of patients in the three groups, and Spearman correlation method was used to analyze the correlation between RoSCo score and postoperative absolute bed rest time. Results:A total of 164 LPN patients were included in the study, including 82 cases in the low-risk group, 65 cases in the medium-risk group and 17 cases in the high-risk group. The median and quartile of absolute bed rest time of all patients was 7 (6, 8) d, including 6 (5, 6) d in the low-risk group, 8 (7, 8) d in the medium-risk group and 11 (11, 12) d in the high-risk group. Postoperative absolute bed rest time of low-risk group, medium-risk group and high-risk group classified by RoSCo score were different, and the differences were statistically significant ( H=112.9, P<0.001) . The pairwise test after using Bonferroni method to correct the significance level found that pairwise comparison of the three groups showed statistically significant differences (all adjusted P<0.001) . RoSCo score was positively correlated with postoperative absolute bed rest time ( r=0.815, P<0.001) . Conclusions:RoSCo score of patients undergoing LPN has a significant positive correlation with postoperative absolute bed rest time. The higher the RoSCo score is, the longer the absolute bed rest time is. Therefore, nursing staff can predict the postoperative absolute bed rest time of LPN patients based on RoSCo score so as to provide a basis for clinical nursing decision.

Objective: To explore the application and choice of latissimus dorsi musculocutaneous flap and thoracodorsal artery perforator flap in different wound repair. Methods: From March 2012 to February 2018, 8 cases of different wounds were repaired with island latissimus dorsi myocutaneous flap pedicled with dorsal thoracic artery, free latissimus dorsi myocutaneous flap, or thoracodorsal artery perforator flap combined with scapular flap. The patients includes 4 cases of trauma, 2 cases of tumor and 2 cases of osteomyelitis. Among them, 5 cases received pedicled grafting, 2 cases had anastomotic vascular free grafting combined with antibiotic bone cement chain bead, 1 case had thoracodorsal artery perforator flap combined with scapular flap. Results: All 9 flaps of 8 patients survived. The size of the flaps ranged from 22.0 cm×7.5 cm to 28.0 cm×21.0 cm. All the donor and recipient areas healed well. After 2 months to 2 years follow up, all flaps have good blood supply, and the limbs′ function was normal. The appearance of flaps were satisfactory, with fully treated osteomyelitis, and no recurrence of the tumor was observed. Conclusions According to wound characteristics, selective application of thoracodorsal artery perforator flap, pedicled or free latissimus dorsi myocutaneous flap is effective for the repair of muscle, skin and soft tissue defects, as well as osteomyelitis, after tumor resection.

Objective To investigate the needs of nursing-based continuing home care in old patients with chronic diseases in communi-ty. Methods From June to August, 2016, 14 old patients with chronic diseases were purposively sampled, and interviewed with semi-struc-ture. The data were collected and refined with phenomenological analysis. Results The patients were very positive in nursing-based continu-ing home care. The main requirements included the knowledge about chronic diseases, psychological comforts, rehabilitation nursing, daily security help and medical insurance support. Conclusion It is necessary to support the continuing home care for old patients with chronic diseases, and strengthen the profesional nursing team building in community.

Objective To determine the epidemiology of death in PICU in the past ten years.Meth-ods Retrospective cohort study was conducted in the PICU of Childrne ′s Hosip tal of Fud an University from January2005 to December 2014.Resulst The overall mortality rate of PICU was 8.5%overa 10-year peri-od for m January 2005 toD ecember 2014.Compared wti h the period from 2005 to 2009,the mortalti y rate in PICU decreasedf rom 9.7%to 8.0%during ht e period of 2010 to 2014.A totalo f 736 patients died over a 10-year pre iod,including 329(44.7%) infants,191(26.0%) toddlers,118(16.0%) preschoolers,and 98 (13.3%) school-age and adolsec ence.From 2005 to 2009,there were 269 deaths,of which 65.4% were infants and toddlers.From 2010 to 2014,there were 467 deaths,of which 73.7% were infants and toddlers. Among the diseases causing death,the severe pneumonia was the most common disease(21.6%),followed by malignant tumors ( 16.3%) , sepsis ( 15.4%) , accidental injury ( 13.7%) , and severe encephla itis (8.0%).In different age groups,the distribution of the diseases causing death was different,such as infants mainly with sevre e pneum onia(34.3%),t oddlers mainly with accidental injury(16.8%),preschoolers main-ly with accidental injury and malignant tumors(23.7%),school-age and adolescence mainly with malignant tumor(28.6%).From 2005 to 2009,77.5%deaths were critically and very critically ill patients,and the sep sis was the most common cause of death ( 27.6%) especially in very critically ill patients.From 2010 to 2014,83.0%deaths were critically and very critically ill patients,and the accidental injury was the most com-mon cause of death( 23.2%) especially in very critically ill patients, followed by sepsis ( 17.9%).There were 345 deaths ( 46.9%) occurred within the first week of admission, mainly with accidental injury (20.9%).There we re 391 deaths(53.1%) with the PICU stay for 7 or more days,and severe pneumonia (24.3%) was the most common cause of death.Modes of death were categorized as failed cardiopulmonary resuscitation(54.6%) adn forgoing life-sustaining treatme nt(45.4 %).Conclu sion Compared with the pe-riod from 2005 to 2009,the mortality rate in PICU decreaseds gi nificantly during the periodo f 2010 to 2014. The younger the patine t,the higher the mortality rate.Most deaths were attributed to severe pneumonia,fol-lowed by malignant tumors and sepsis.The causes of death also had relations with severity of diseases and lne gth of PICU stay.Failed cardiopulmonary resuscitation and forgoing life-sustaining treatment were still the mostc ommon mode of deaths.

OBJECTIVETo observe the clinical safety and efficacy of decitabine in patients of acute myeloid leukemia and myelodysplastic syndromes (MDS/AML).

METHODSTotally 79 patients with MDS/AML were divided into three groups: (1)Treated with decitabine alone (20 mg/m² for 5 days). (2) Combination of decitabine with half dose CAG chemotherapy (Acla 20 mg qod×3 d, Ara-C 10 mg/m² q12 h×7 d, G-CSF 300 μg/d, the dose of G-CSF adjust to the amount of blood routine). (3)Combination of decitabine with CAG chemotherapy (Acla 20 mg qod×4 d, Ara-C 10 mg/m² q12 h×14 d, G-CSF 300 μg/d, the dose of G-CSF adjust to the amount of blood routine). We observed complete remission (CR) rate, overall response rate (ORR) and overall survival (OS) of the three groups; meanwhile, we analyzed the factors relevant to decitabine efficacy and the prognosis.

RESULTSORR in the three groups were 53.3%, 56.5% and 69.2% respectively, with no statistically significant differences (P>0.05). Due to the last follow-up at 2014.04.01, 20 patients still survived, 45 died, 14 were lost to follow-up. The 5-year cumulative survival rate of 79 patients was 25.3%, the 2-year survival were of the three groups were 34.8%, 24.8 and 29.2% respectively with no statistically significant differences (P>0.05). Adverse events of infection and bleeding were mainly caused by decitabine. Grade 3 to 4 hematological toxicities were observed in 72 cases with the average time for the lack of granulocytes as 14.8 days. 59 patients experienced infectious events, including grade 3 or 4 infections in 14 cases, grade 1 or 2 infections in 45 cases. There were no statistically significant differences (P>0.05) among the three groups in terms of infection rates, bleeding rates, duration of neutrophenia, mean MAP transfusion and mean platelet transfusion. 79 patients were safely through bone marrow suppression by anti-infective and supportive treatment without treatment-related deaths.

CONCLUSIONTreating MDS/AML with decitabine alone, in combination with half or one course CAG regimen produced high efficacy. ORR of the combination of decitabine with one course CAG regimen was relatively higher. Three groups of patients were all well tolerated.

Aclarubicin ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Azacitidine ; analogs & derivatives ; Cytarabine ; Granulocyte Colony-Stimulating Factor ; Humans ; Leukemia, Myeloid, Acute ; drug therapy ; Myelodysplastic Syndromes ; drug therapy

Objective To evaluate the effects of known-to-have health management on diabetes patients.Methods A total of 585 diabetic patients from Desheng Community of Beijing received an intensive health management for 3 months,including diet intervention,physical exercises,medication,health education and individual health guidance.Body weight (BW),body mass index (BMI),waist circumference (WC),blood pressure (BP),fasting blood glucose (FBG),2-h postprandial blood glucose (PBG),glycated hemoglobin A1C (HbA1 c),total cholesterol (TC),triglycerides (TG),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),total physical exercises,effective physical exercises,effective physical exercise ratio to BW and dietary intake were compared before and after the intervention.Results Of 585 patients with type 2 diabetes mellitus,240 were male and 345 were female (average age (64.4 ± 9.1) years old).BW,BMI,WC,systolic blood pressure,diastolic blood pressure,FBG,2-h PBG,HbA1c,TC,TG,HDL-C,LDL-C,amount and time or frequency of effective physical exercises,effective physical exercise ratio to BW and total dietary intake were significantly improved after intensive health management (t values were 20.35,20.34,23.74,14.06,12.35,13.35,16.50,9.90,7.53,6.37,-3.74,4.91,-7.44,-7.91,-5.60,-8.41 and 5.21,respectively ; all P ＜ 0.05).More healthy eating habits were found in 321 subjects (54.8％).Those having normal FBG were increased from 54.2％ to 80.1％ following known-to-have health management,with 2-h PBG from 60.4％ to 87.8％ and HbA1c from 58.9％ to 77.9％ (x2 values were 88.21,109.31 and 39.97,respectively; all P ＜ 0.05).Conclusion Known-to-have management may provide an effective tool for community diabetics.

Objective To explore the influence of the killer cell immunoglobulin like receptor (KIR) gene polymorphism on cytomegalovirus (CMV) infection and pathogenesis after hematopoietic stem cell transplantation (HSCT).Methods The KIR genotype was determined by sequence-specific primer polymerase chain reaction (PCR-SSP) in 138 pairs of donors and recipients before HSCT during October,2005 and May,2011.Posttransplant monitoring for CMVpp65 antigen was performed by indirect immune histochemically assays since week 2 after transplantation.The differences between CMV positive group and negative group,inhibitive and active KIR of donors and recipients,and KIR haplotype frequency of donors and recipients were analyzed.Results There were no significant differences in frequency of KIR gene and haplotype AA,AB,BB between the donors and recipients.The frequencies of 2DS2 and 2DS4 * 003-007 of donors in CMV positive group were obviously lower than those in CMV negative group with significant differences(8％ vs 16％,P =0.0420;3％ vs 13％,P =0.0050).There was no significant difference in KIR gene between CMV positive group and CMV negative group.The CMV infection rates of haplotype AA,BB,AB donors were 64.38％,36.84％ and 50.00％,while CMV infection rates of haplotype AA,BB,AB recipients were 53.73％,46.15％ and 51.72％,respectively.The CMV infection rate was higher in the patients received KIR haplotype AA donor than in those received KIR haplotype BB donor (36.84％ vs 64.38％,P =0.0299).2DS4 * 003-007 and haplotype BB of donor were found associated with CMV infection in multifactor analysis.Conclusion KIR genotypes of donors are associated with CMV infection after HSCT.