The rapid development of artificial intelligence (AI), especially generative AI (GenAI), has already brought, and will continue to bring, revolutionary changes to our daily production and life, as well as create new opportunities and challenges for diagnostic and therapeutic practices in the medical field. Haihe Hospital of Tianjin University collaborates with the National Supercomputer Center in Tianjin, Tianjin University, and other institutions to carry out research in areas such as smart healthcare, smart services, and smart management. We have conducted research and development of a full-process disease diagnosis and treatment assistance system based on GenAI in the field of smart healthcare. The development of this project is of great significance. The first goal is to upgrade and transform the hospital's information center, organically integrate it with existing information systems, and provide the necessary computing power storage support for intelligent services within the hospital. We have implemented the localized deployment of three models: Tianhe "Tianyuan", WiNGPT, and DeepSeek. The second is to create a digital avatar of the chief physician/chief physician's voice and image by integrating multimodal intelligent interaction technology. With generative intelligence as the core, this solution provides patients with a visual medical interaction solution. The third is to achieve deep adaptation between generative intelligence and the entire process of patient medical treatment. In this project, we have developed assistant tools such as intelligent inquiry, intelligent diagnosis and recognition, intelligent treatment plan generation, and intelligent assisted medical record generation to improve the safety, quality, and efficiency of the diagnosis and treatment process. This study introduces the content of a full-process disease diagnosis and treatment assistance system, aiming to provide references and insights for the digital transformation of the healthcare industry.
Artificial Intelligence ; Humans ; Delivery of Health Care ; Generative Artificial Intelligence

Community acquired pneumonia(CAP)has a high morbidity and mortality rate, and can bring a heavy social and economic burden.Its etiology is complex.How to identify high-risk children, early diagnosis, prognosis prediction are the focus of clinical research.Early identification and active intervention of high-risk children who need hospitalization or admission to pediatric intensive care unit by using score scales and biomarkers are crucial to improve the survival rate.This review summarized the assessment of severity and prognosis of CAP in children by different score scales and biomarkers.

Objective:To explore the relationship between different admission sources and outcomes at children in pediatric intensive care unit(PICU).Methods:The clinical data of children admitted to PICU of Henan Provincial People′s Hospital from January 1, 2021 to December 31, 2021 were collected.The children were divided into emergency group, outpatient group, ward transfer group and out-hospital transfer group according to different admission sources, and the influence of different admission sources on the outcome of children was analyzed.Results:A total of 413 children were included in the study.There were 141 cases(34.14%)in emergency group, 14 cases(3.39%)in outpatient group, 115 cases(27.85%)in ward transfer group and 143 cases(34.62%)in out-hospital transfer group.There were significant differences among the four groups in terms of age, length of hospital stay, PCIS score, type of disease, duration of mechanical ventilation and outcome of children( P<0.05). There was no significant difference in gender among the four groups( P=0.328). Among the 143 children of out-hospital transfer group, 92 cases(64.3%)were admitted during the day and 51 cases(35.7%)were admitted in the night.There was no significant difference in age, gender, duration of mechanical ventilation, PCIS score, length of hospital stay and outcome of children between two groups( P>0.05). The independent risk factors for mortality of children in out-hospital transfer group were length of hospital stay( OR=0.717, 95% CI 0.582-0.883, P=0.002), gender( OR=13.185, 95% CI 2.044-85.061, P=0.007), duration of mechanical ventilation>1 day( OR=23.524, 95% CI 3.294-168.026, P=0.002)and PCIS score≤80( OR=6.000, 95% CI 1.637-21.985, P=0.007). Conclusion:PICU children in our hospital mainly come from emergency, ward transfer and out-hospital transfer.The patients transferred from other hospitals were the most critically ill and had the worst outcome, suggesting that we need to develop and popularize referral standards for critically ill children and establish a transport system so that children can receive timely referral and effective treatment, so as to reduce the risk of death of referred children as far as possible.

Objective:To measure the predictive value of miR-424 on the risk of sepsis complicated with acute respiratory distress syndrome(ARDS), and to explore its correlation with the prognosis of ARDS children.Methods:A prospective study was conducted.The data of children with sepsis (some complicated with ARDS), who were treated in Henan Provincial People′s Hospital (People′s Hospital, Zhengzhou University) were collected from February 2020 to February 2021.The incidence of ARDS and the fatality rate of ARDS children were recorded.Children were divided into survival group and death group according to whether death or not.The expression of miR-424 in peripheral blood mononuclear cells was detected by quantitative reverse transcription polymerase chain reaction (RT-qPCR). Pearson correlation analysis was made to investigate the relationship between the expression level of miR-424 and Pediatric Critical Illness Score(PCIS), Sequential Organ Failure Assessment(SOFA) score, oxygenation index(P/F ratio), C-reactive protein(CRP), procalcitonin (PCT), interleukin 6 (IL-6) and interleukin 8 (IL-8). The factors affecting the prognosis of ARDS children were analyzed by multivariate Logistic regression.Receiver operating characteristic curve(ROC)was used to assess the accuracy of miR-424 in early diagnosis of sepsis complicated with ARDS, and to measure the predicative value of miR-424 on the risk of death in sepsis patients with ARDS. Results:A total of 121 sepsis patients were included in this study, and 36 cases of them were complicated with ARDS.The expression level of miR-424(0.56±0.17)in the blood of sepsis patients complicated with ARDS was significantly lower than that of sepsis patients without ARDS (0.98±0.26)( t=8.776, P<0.001). The expression of miR-424 was negatively co-rrelated with IL-6( r=-0.627, P<0.01), IL-8 ( r=-0.651, P<0.01) and CRP( r=-0.472, P<0.05)in sepsis patients with ARDS.The expression of miR-424 was positively correlated with PCIS score( r=0.330, P<0.05), P/F ratio ( r=0.592, P<0.001) and albumin ( r=0.496, P<0.05) in sepsis patients with ARDS.The ROC showed that miR-424 [area under curve(AUC)=0.908, 95% CI: 0.856-0.960] could differentiate sepsis patients with ARDS from those without ARDS.Compared with that of the survival group(0.63±0.15), miR-424 of the death group decreased significantly(0.42±0.14)( t=3.890, P<0.05). The decreased miR-424 (AUC=0.845, 95% CI: 0.696-0.995)indicated an increased risk of death in children with ARDS.Multivariate Logistic regression analysis showed that miR-424( OR=0.001, P=0.033)and albumin ( OR=0.553, P=0.040) were independent risk factors for death in ARDS children. Conclusions:miR-424 can help with early diagnosis of sepsis complicated with ARDS, and can be used as a predictor of the prognosis of sepsis children complicated with ARDS.

Objective:To analyze clinical factors related to nosocomial infection in children with extracorporeal membrane oxygenation(ECMO)support.Methods:General data, infection data and relevant factors in children with ECMO support in Bayi Children′s Hospital, the 7 th Medical Center of People′s Liberation Army General Hospital and Henan Provincial People′s Hospital from September 2012 to February 2020 were reviewed.Relevant factors of nosocomial infection in them were analyzed. Results:Among 163 cases, 36(22.1%) children supported with ECMO had infections during the period of ECMO, and 72 pathogenic microorganisms were detected, including 67 bacteria (33 Acinetobacter baumannii, 21 Klebsiella pneumoniae, and 6 Pseudomonas aeruginosa) and 5 fungi.Pathogens from the respiratory system, blood system, urinary tract and abdominal cavity were detected in 45 cases(62.5%), 25 cases (34.7%), 1 case (1.4%), and 1 case (1.4%), respectively.Drug sensitivity analysis of the Acinetobacter baumannii showed that it was the extensively resistant strain.Compared with uninfected children supported with ECMO, ECMO support time[(10.0±6.7) d], hospitalization[(34.0±25.3) d], hospitalization cost[(234 368±113 234) yuan], preoperative oxygenation index(52.8±23.0) and lactate value[(9.6±5.9) mmol/L]were significantly higher in nosocomial infection ones[(4.6±3.2) d, (24.3±19.8) d, (161 416±65 847) yuan, 35.6±10.4, (5.6±5.4) mmol/L] supported with ECMO (all P<0.05). There was no significant difference in the mortality between 2 groups ( P>0.05). In addition, lactate level (9.8 mmol/L) and oxygenation index (36.0±12.7) were significantly higher in died children(2.7 mmol/L, 22.1±10.4) with nosocomial infection during the period of ECMO support than those of survivors (all P<0.05). Multivariate Logistic regression analysis showed that ECMO support time( OR=7.054, 95% CI: 2.206-25.525) and preoperative lactate value( OR=2.250, 95% CI: 1.378-4.611) were independent risk factors of nosocomial infection. Conclusions:Correcting underlying diseases of ECMO supporting and shortening the duration of ECMO can reduce the incidence and mortality of nosocomial infection in children who are supported with ECMO.

Regulatory B cells(Breg) are a subgroup of B lymphocytes and characterized by their immunosuppressive capacity. The regulation of immune response by Breg plays a critical role in the mouse and human immune systems. Previous studies on Breg mainly focus on autoimmune diseases and tumors, but in recent years, the role of Breg in chronic infectious diseases has attracted attention. This review summarized the phenotypes, modes of action and the role of Breg in the process of chronic infectious diseases aiming to provide a new sight for research on immunotherapy for chronic infectious diseases.

Objective:To explore the risk factors for mortality in pediatric acute respiratory distress syndrome (PARDS) requiring extracorporeal membrane oxygenation (ECMO) support.Methods:Clinical data of 109 patients with severe PARDS supported by ECMO, who were hospitalized in 6 ECMO centers in China from September 2012 to February 2020, were retrospectively analyzed. They were divided into survival group and death group according to the prognosis. Chi-square test and rank sum test were used to compare the variables between the two groups, including the demographic data, laboratory examination results, clinical data before and after ECMO, and other supportive treatment. Univariate and multivariate Logistic regression models were used to analyze the prognostic risk factors.Results:In these 109 cases, 54 died and 55 survived. Compared with the survival group, the death group had higher incidences of acute kidney injury (AKI) (48.1% (26/54) vs. 21.8% (12/55) , χ2=8.318, P=0.004) and coagulation dysfunction (22.2% (12/54) vs. 7.3% (4/55) , χ2=4.862, P=0.027), and higher rate of renal replacement therapy (48.1% (26/54) vs. 21.8% (12/55) , χ2=9.694, P=0.008) during ECMO support. Logistic regression analysis showed that continuous renal replacement therapy (CRRT) and AKI were independent risk factors for death in patients with severe PARDS requiring ECMO support ( HR=3.88,95% CI 1.04-14.52, HR=4.84,95% CI 1.21-19.46, both P<0.05). Conclusion:AKI and CRRT are independent risk factors for predicting mortality in patients with severe PARDS requiring ECMO support.

Objective:To investigate the relationship between the biochemical parameters, the pulmonary pathologic injury and the immune mechanism of severe sepsis in infant porcine, and the intervention effect of Shenfu injection.Methods:Panamanian infant porcine (2-3 months old) were divided into sham operation group (Sham group; intravenous injection of normal saline), lipopolysaccharide (LPS) induced severe sepsis model group (LPS group; intravenous injection of LPS 1 mg/kg, and continuing at 0.5 mg·kg -1·h -1 for 12 hours), and Shenfu injection intervention group (SF group; intravenous injection of Shenfu injection 10 mL/kg at the same time of modeling, twice a day) according to the random number table method, with 5 in each group. Forty-eight hours after the challenge, the changes of C-reactive protein (CRP), procalcitonin (PCT), oxygenation index (PaO 2/FiO 2), base excess (BE), blood lactate (Lac) and other biochemical indexes were detected with blood sampling; the number of neutrophils [myeloperoxidase positive (MPO +)] and their activated subsets CD11b + CD64 +, M1 macrophages (CD80 + CD64 +), CD4 + and CD8 + T cells were analyzed in peripheral blood by flow cytometry. The levels of plasma cytokines were detected by enzyme linked immunosorbent assay (ELISA). The pathological damage of lung tissue was observed by hematoxylin-eosin (HE) staining. The mRNA expression of lung injury related molecules and their receptors, chemokines, cytokines, vascular endothelial related molecules and tight junction protein were detected by reverse transcription-polymerase chain reaction (RT-PCR). Results:Compared with Sham group, the levels of CRP, PCT and Lac in LPS group significantly increased, and PaO 2/FiO 2 and BE significantly decreased. In the peripheral blood, CD80 + CD64 + macrophages, CD11b + CD64 + and MPO + neutrophils, CD4 +, CD8 + T cells and tumor necrosis factor-α (TNF-α) significantly decreased, but interleukin-10 (IL-10) and vascular endothelial cell growth factor (VEGF) significantly increased; the mRNA expressions of high mobility group protein B1 (HMGB1), receptor for advanced glycation end products (RAGE), angiopoietin 2/angiopoietin 1 (Ang2/Ang1) significantly increased, Toll like receptor 9 (TLR9), chemokines (CXCL9 and CXCL10), TNF-α, IL-27, Tek tyrosine kinase 2 (TIE2), vascular endothelial cadherin (VE-CAD) and Occludin significantly decreased in lung tissue. HE staining showed inflammatory cell infiltration and exudation in the alveolar cavity, alveoli consolidation, thickening of the alveolar interstitial layer and emphysema. Compared with LPS group, Lac in SF group significantly decreased (mmol/L: 4.2±1.0 vs. 6.3±1.1, P < 0.05), while BE and PaO 2/FiO 2 significantly increased [BE (mmol/L): -6.4±2.6 vs. -11.6±2.5, PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): 180±36 vs. 105±35, both P < 0.05]; the percentage of CD80 + CD64 + macrophages, CD11b + CD64 + and MPO + neutrophils significantly increased [CD80 + CD64 +: (7.13±2.01)% vs. (3.80±0.46)%, CD11b + CD64 +: (8.33±2.55)% vs. (2.15±0.47)%, MPO +: (21.22±2.33)% vs. (8.31±0.46)%, all P < 0.05]; the mRNA expressions of HMGB1 and RAGE decreased to some extent [HMGB1 mRNA (2 -ΔΔCT): 1.81±0.45 vs. 2.23±0.85, RAGE mRNA (2 -ΔΔCT): 6.69±3.48 vs. 11.60±6.91, both P < 0.05], the mRNA expressions of CXCL9 and TIE2 increased to a certain extent [CXCL9 mRNA (2 -ΔΔCT): 1.06±0.63 vs. 0.50±0.12, TIE2 mRNA (2 -ΔΔCT): 1.42±0.68 vs. 0.27±0.16, both P < 0.05]; the pathological damage of lung tissue were significantly alleviated. Conclusions:The increased abnormality of BE, Lac, and PaO 2/FiO 2, the immune exhausting and paralysis may be important factors leading to the fatal lung injury in infant porcine with severe sepsis. The possible mechanism is that the excessive activation of HMGB1 and its receptor RAGE, the suppression of TLR9 and corresponding chemokine and inflammatory factors lead to increased endothelial damage and decreased tight connection, which in turn induces capillary leakage. The intervention of immune disorders by Shenfu injection in the severe pneumonia accompanied by sepsis may be related to elevated M1 macrophages and activated neutrophils in the peripheral blood, inhibition of HMGB1 and its receptor RAGE mRNA expression, and elevated CXCL9 and TIE2 expression.

Objective:To investigate the relationship between the serum high mobility group box 1 (HMGB1) level and children with febrile convulsion(FC) and epileptic seizures in the future.Methods:A total of 359 children with first-episode FC occurring in January 2014 to January 2017 admitted to the Department of Pediatrics, Henan Provincial People′s Hospital, were enrolled in the FC group.One hundred children without FC were enrolled in the fever control group, and 100 healthy children were enrolled in the healthy control group.Children with FC were followed for 18 months and their seizures were recorded.Serum HMGB1 and inflammatory response indexes were measured in all subjects, and the diagnostic value of HMGB1 for FC was analyzed.Other data were used to analyze the correlation between HMGB1 and the conversion of FC into epilepsy.Results:The level of serum HMGB1 in the FC group were hig-her than those in the healthy control group and the fever control group, and the differences were statistically significant [(3.04±1.01) μg/L, (5.09±1.45) μg/L vs.(8.32±2.27) μg/L, all P<0.01]. serum HMGB1 level in children with FC was positively correlated with interleukin(IL)-1β, IL-6, tumor necrosis factor (TNF)-α, C-reactive protein (CRP) and white blood cell (WBC) ( r=0.364, 0.173, 0.227, 0.235, 0.247, all P<0.05). There were significant differences in HMGB1 levels between groups with different duration and types of convulsions [(8.11±2.15) μg/L vs.(10.19±2.51) μg/L, (7.63±1.93) μg/L vs.(9.83±2.25) μg/L, all P<0.05]; HMGB1 level diagnosis of FC was better [area under the receiver′s operating characteristic curve (AUC)=0.843 (95% CI: 0.811-0.873)]; Serum HMGB1 in children with epilepsy with FC was higher than that without conversion to epilepsy, and the difference was statistically significant [(8.18±2.14) μg/L vs.(8.95±2.73) μg/L, P<0.05]; However, its performance in predicting the conversion of FC to epilepsy was not high [AUC=0.596 (95% CI: 0.544-0.691)]; Multivariate regression analysis showed that it was not an independent influencing factor of FC to epilepsy [odd ratio( OR)=1.929, P=0.222]. Conclusions:Serum HMGB1 levels in children with FC are related to the onset, severity and type of fever, and are one of the influencing factors affecting the conversion of FC to epilepsy, but not the independent factors.

Objective: To investigate application and safety of pediatric interfacility-transport with extracorporeal membrane oxygenation (ECMO) in China. Methods: The data of 48 patients transported inter-hospital from February 2016 to May 2018 were collected from the following 4 centers: pediatric intensive care unit (PICU) of Bayi Children′s Hospital Affiliated to the 7th Medical Center of PLA General Hospital, Pediatric Hospital of Fudan University, Henan Provincial People′s Hospital and Children′s Hospital of Zhejiang University School of Medicine. The data of patients′ characteristics, ECMO mode and wean rate, and mortality were reviewed, which was further compared with the data of 57 compatible inner-hospital ECMO cases with t test, Rank sum test or chi-square test. Results: All the 48 interfacility-transports were accomplished by ambulance on land, with an average transfer distance of (435±422) km. The incidence of ECMO complications was 13% (6 case), without death. There were no significant differences in lactic acid, PaO₂ or SaO₂ before and after transport (4.0 (2.0, 7.5) vs. 3.0 (1.5, 6.0) mmol/L, Z=-1.579, P>0.05; 112(47, 405) vs. 166(122, 240) mmHg (1 mmHg=0.133 kPa), Z=-0.104, P>0.05; 0.97±0.02 vs. 0.96±0.03, t=1.570, P>0.05). Instead, PaCO₂ and pH were significantly different ((47±8) vs. (42±5) mmHg, t=2.687, P<0.05; 7.3±0.2 vs. 7.5±0.2, t=3.379, P<0.05). The total ECMO weaned rate was 73% (35/48) and the survival rate was 67% (32/48). No significant differences in demographic characteristics, ECMO mode or duration, transport distance or duration, or complications existed between the survival group and the death group (7/25 vs. 2/14, χ²=0.615, P>0.05; 4/28 vs. 2/14, χ²=0, P>0.05; (405±404) vs. (493±465) km, t=0.525, P>0.05; (5±4) vs. (5±5) h, t=0.388, P>0.05; 166 (128, 239) vs. 187(52, 405) h, Z=-0.104, P>0.05; 3/32 vs. 3/16, χ²=0.734, P>0.05). The lowest lactate value in survival group before ECMO transport was significantly lower than that in the death group ((5±5) vs. (8±6) mmol/L, t=2.151, P<0.05). There were neither significant differences in age, ECMO mode or support pattern (9/39 vs. 15/42, χ²=0.845, P>0.05; 6/42 vs. 7/50, χ²=0.001, P>0.05; 29/19 vs. 38/19, χ²=0.441, P>0.05), nor in ECMO weaned rate, survival rate or complications between interfacility-transport group and inner-hospital group (35/48 vs. 37/57, χ²=0.775, P>0.05; 32/48 vs. 35/57, χ²=0.313, P>0.05; 20/48 vs. 22/57, χ²=0.102, P>0.05). Conclusion With appropriate transport equipment and mature teams who handle problems timely during the transport, critically ill children could be safely transported to the destination with ECMO.