Objective To analyze the expression and detection significance of community acquired respiratory distress syndrome(CARDS)toxin in bronchoalveolar lavage fluid(BALF)in children with severe Mycoplasma pneumoniae pneumonia(SMPP).Methods The BALF samples of children diagnosed with Mycoplasma pneumoniae pneumonia(MPP)were collected from the Department of Pulmonology,Children's Hospital Affiliated to Capital Institute of Pediatrics from August 2021 to April 2022,the relative expression of CARDS toxins was determined by quantitative realtime polymerase chain reaction(qPCR).The patients were divided into SMPP group and non-SMPP group(control group).The relative expression of CARDS toxin and other clinical indicators were compared between the two groups.The risk factors of SMPP were analyzed.The predictive value of the indicators was analyzed using receiver operating characteristic(ROC)curves.Results ①The relative expression level of CARDS toxin(Z=-6.151),D-dimer(Z=-5.102)and lactate dehydrogenase(LDH)(Z=-6.337)in SMPP group were significantly higher than those in control group(P<0.001).The white blood cell(Z=-2.155),neutrophil ratio(t=2.988)and C-reactive protein(CRP)(Z=-3.360)were higher than those in control group(P<0.05).②The relative expression of CARDS toxin was positively correlated with serum LDH(r=0.258,P<0.05).③Binary Logistic regression analysis showed that fever time(OR=1.271,95% CI:1.079-1.497),LDH(OR=1.011,95% CI:1.005-1.017)and CARDS toxin(OR=6.210,95% CI:2.646-14.577)were risk factors for SMPP.Conclusion CARDS toxin was closely related to MPP disease,and was significantly increased in SMPP group.CARDS toxin was one of the independent risk factors for SMPP and positively correlated with serum LDH level.It can be used as a good indicator to evaluate the condition,combined with fever time and LDH has clinical significance.

Perineural invasion (PNI) in pancreatic cancer,as an important clinical pathological feature,not only participates in various biological processes such as development,growth,invasion,and metastasis of pancreatic cancer,but also is closely associated with poor prognosis in pancreatic cancer. This article systematically reviews the latest research advancements in the field of PNI in pancreatic cancer,providing a multidimensional analysis of its anatomical basis,cytokine regulatory networks,metabolic reprogramming mechanisms,vesicle-mediated molecular transport,immune-neural interactions,pain-inducing pathomechanism,quantitative assessment frameworks,experimental model construction,cutting-edge technological applications,and innovations in surgical strategies. In the surgical domain,precision techniques combining targeted nerve plexus resection with molecular-targeted probes have significantly improved the R0 resection rate,while surgical navigation strategies based on single-cell spatial transcriptomics offer novel insights for optimizing therapeutic paradigms. Future research should prioritize the discovery of PNI-specific molecular targets,multidimensional exploration of the neural-immune-metabolic axis,and addressing the challenges of integrating interdisciplinary technologies into clinical translation.

Objective To analyze the expression and detection significance of community acquired respiratory distress syndrome(CARDS)toxin in bronchoalveolar lavage fluid(BALF)in children with severe Mycoplasma pneumoniae pneumonia(SMPP).Methods The BALF samples of children diagnosed with Mycoplasma pneumoniae pneumonia(MPP)were collected from the Department of Pulmonology,Children's Hospital Affiliated to Capital Institute of Pediatrics from August 2021 to April 2022,the relative expression of CARDS toxins was determined by quantitative realtime polymerase chain reaction(qPCR).The patients were divided into SMPP group and non-SMPP group(control group).The relative expression of CARDS toxin and other clinical indicators were compared between the two groups.The risk factors of SMPP were analyzed.The predictive value of the indicators was analyzed using receiver operating characteristic(ROC)curves.Results ①The relative expression level of CARDS toxin(Z=-6.151),D-dimer(Z=-5.102)and lactate dehydrogenase(LDH)(Z=-6.337)in SMPP group were significantly higher than those in control group(P<0.001).The white blood cell(Z=-2.155),neutrophil ratio(t=2.988)and C-reactive protein(CRP)(Z=-3.360)were higher than those in control group(P<0.05).②The relative expression of CARDS toxin was positively correlated with serum LDH(r=0.258,P<0.05).③Binary Logistic regression analysis showed that fever time(OR=1.271,95% CI:1.079-1.497),LDH(OR=1.011,95% CI:1.005-1.017)and CARDS toxin(OR=6.210,95% CI:2.646-14.577)were risk factors for SMPP.Conclusion CARDS toxin was closely related to MPP disease,and was significantly increased in SMPP group.CARDS toxin was one of the independent risk factors for SMPP and positively correlated with serum LDH level.It can be used as a good indicator to evaluate the condition,combined with fever time and LDH has clinical significance.

Perineural invasion (PNI) in pancreatic cancer,as an important clinical pathological feature,not only participates in various biological processes such as development,growth,invasion,and metastasis of pancreatic cancer,but also is closely associated with poor prognosis in pancreatic cancer. This article systematically reviews the latest research advancements in the field of PNI in pancreatic cancer,providing a multidimensional analysis of its anatomical basis,cytokine regulatory networks,metabolic reprogramming mechanisms,vesicle-mediated molecular transport,immune-neural interactions,pain-inducing pathomechanism,quantitative assessment frameworks,experimental model construction,cutting-edge technological applications,and innovations in surgical strategies. In the surgical domain,precision techniques combining targeted nerve plexus resection with molecular-targeted probes have significantly improved the R0 resection rate,while surgical navigation strategies based on single-cell spatial transcriptomics offer novel insights for optimizing therapeutic paradigms. Future research should prioritize the discovery of PNI-specific molecular targets,multidimensional exploration of the neural-immune-metabolic axis,and addressing the challenges of integrating interdisciplinary technologies into clinical translation.

Objective:To develop the Clinical Nurse Extra Task Load Scale and test its reliability and validity.Methods:Based on the job demand-control model, a primary scale was formed through literature search and qualitative interviews, as well as Delphi consultation and pre-survey. In September 2023, 813 clinical nurses from First Affiliated Hospital of Xinxiang Medical University and Xinxiang Central Hospital were selected for reliability and validity testing. In October 2023, 1 050 clinical nurses from First Affiliated Hospital of Xinxiang Medical University and Xinxiang Central Hospital were selected for investigation, and the reliability and validity of the scale were tested.Results:The final Clinical Nurse Extra Task Load Scale included two dimensions and a total of 12 items. The item-level content validity index was 0.86 to 1.00, and the scale-level content validity index was 0.84. Exploratory factor analysis extracted two common factors, with a cumulative variance contribution rate of 74.55%. Confirmatory factor analysis showed that χ 2/ df was 1.613, GFI was 0.928, CFI was 0.971, NFI was 0.928, IFI was 0.971, and RMSEA was 0.024. Cronbach's α coefficient of the work environment demand dimension was 0.897, Cronbach's α coefficient of individual behavior restriction was 0.955, Cronbach's α coefficient of the total scale was 0.950, and the split-half reliability was 0.850. Conclusions:The Clinical Nurse Extra Task Load Scale developed has a good reliability and validity, and can be used to evaluate and quantify the extra task load for clinical nurses.

Objective:To investigate the value of community acquired respiratory distress syndrome (CARDS) toxin combined with IFN-γ in the early prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods:A total of 100 children diagnosed with Mycoplasma pneumoniae pneumonia (MPP) were selected as the study objects. Among them, 36 cases were diagnosed with RMPP and 64 cases without RMPP were set as control group. The general data, clinical symptoms, signs, laboratory tests and internal and external pulmonary complications were compared between the two groups. The independent risk factors for RMPP was analyzed by Binary Logistic regression, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of the indicators. Results:The fever time and hospital stay in RMPP group were significantly longer than those in control group, the relative expression of CARDS toxin, neutrophil ratio, C-reactive protein, D-dimer, lactate dehydrogenase, IL-6 and IFN-γ levels in RMPP group were higher than those in control group, and the differences were statistically significant. Binary Logistic regression analysis showed that long fever duration, increased expression of IFN-γ and CARDS toxin and extrapulmonary complications were independent risk factors for RMPP. ROC curves were drawn for the three continuous variables of fever time, IFN-γ, and relative expression of CARDS toxin, the sensitivity and specificity of the combined prediction of the three indexes were 86.1% and 73.4%, respectively.Conclusions:CARDS toxin is closely related to MPP. Fever duration, IFN-γ, relative expression of CARDS toxin and extrapulmonary complications are independent risk factors for RMPP. Especially when the fever time is more than 10.5 d, IFN-γ is more than 31.79 pg/ml, and the relative expression of CARDS toxin is more than 1.18, the possibility of RMPP should be noted.

Objective:To investigate the value of community acquired respiratory distress syndrome (CARDS) toxin combined with IFN-γ in the early prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods:A total of 100 children diagnosed with Mycoplasma pneumoniae pneumonia (MPP) were selected as the study objects. Among them, 36 cases were diagnosed with RMPP and 64 cases without RMPP were set as control group. The general data, clinical symptoms, signs, laboratory tests and internal and external pulmonary complications were compared between the two groups. The independent risk factors for RMPP was analyzed by Binary Logistic regression, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of the indicators. Results:The fever time and hospital stay in RMPP group were significantly longer than those in control group, the relative expression of CARDS toxin, neutrophil ratio, C-reactive protein, D-dimer, lactate dehydrogenase, IL-6 and IFN-γ levels in RMPP group were higher than those in control group, and the differences were statistically significant. Binary Logistic regression analysis showed that long fever duration, increased expression of IFN-γ and CARDS toxin and extrapulmonary complications were independent risk factors for RMPP. ROC curves were drawn for the three continuous variables of fever time, IFN-γ, and relative expression of CARDS toxin, the sensitivity and specificity of the combined prediction of the three indexes were 86.1% and 73.4%, respectively.Conclusions:CARDS toxin is closely related to MPP. Fever duration, IFN-γ, relative expression of CARDS toxin and extrapulmonary complications are independent risk factors for RMPP. Especially when the fever time is more than 10.5 d, IFN-γ is more than 31.79 pg/ml, and the relative expression of CARDS toxin is more than 1.18, the possibility of RMPP should be noted.

Objective:To evaluate the long-term outcome of Viabahn stent graft in the treatment of complex femoropopliteal occlusive lesions.Methods:From Sep 2013 to Mar 2020, clinical data of TASC C and D femoropopliteal lesions treated with Viabahn were retrospectively analyzed. Patency rates, the freedom rate from clinically-driven target lesion revascularization (F-TLR), limb salvage and survival after five years were calculated.Results:A total of 65 patients (67 lower limbs) were included. 20 limbs were TASC C lesions, 47 limbs were TASC D lesions. The mean lesion length was (29.1±9.4) cm, including 48 chronic total occlusion (CTO) lesions (71.6%) with mean lesion length of (26.1±10.4) cm. Technique success rate was 98.6%. Mean length of stent graft was (31.3±10.1) cm.Major amputation was performed in 4.2% cases within 5 years. All-cause mortality in 5 years was 23.1%. Primary patency rates at 1,3,and 5 years were 76.8%,59.4%,50.9%, Assisted primary patency rates were 88.4%, 83.4%, 83.4% and secondary patency rates were 88.4%, 85.8%, and 85.8% . F-TLR at 1, 3 and 5 year was 88.2%,76.9%,73.1% .Conclusion:Viabahn for complex and long femoropopliteal artery occlusions is an acceptable treatment with fair long-term outcome.

Objective:To analyze the effect of spine-pelvis sagittal parameters and sagittal orientation of facet joint on degeneration of cranial L 3,4 facet joint (facet joint degeneration, FJD) after L 4-S 1 posterior lumbar interbody fusion (PLIF). Methods:Patients with lumbar degenerative diseases who underwent L 4-S 1 PLIF from January 2012 to December 2016 were retrospectively investigated, there were 54 cases, including 28 males and 26 females. Age: 54.59±5.48 years (range, 45-60 years). X-ray, CT, MRI and Weishuapt grade was used to evaluate the degeneration of L 3,4 facet joint at the cranial adjacent segment. The general information and the sagittal parameters of spine pelvis at the last follow-up were compared between the two groups. The former included age, gender, body mass index (BMI), bone mineral density (BMD), follow-up time and preoperative diagnosis. The latter included lower lumbar lordosis angle (LLL), lumbar lordosis angle (LL), pelvis incidence (PI), pelvis tilt (PT), sacrum slope (SS), the height of the intervertebral space (HD), the angle of cranial facet joint, Oswestry disability index (ODI), Japanese Orthopedic Association (JOA) lumbar function score and improvement rate were compared at the same time. Independent sample t-test was used to compare continuous variables between groups; comparison of categorical variable components χ 2 test or Fisher's exact test. Multivariate logistic regression analysis was used to predict the risk factors of adjacent FJD. Results:Postoperative follow-up was 33.44±6.85 months (range, 24-36 months), there were 17 patients in the degenerative group and 37 patients in the non degenerative group. There were no significant differences in age, gender, BMI, BMD, follow-up time or preoperative diagnosis between the two groups. LLL, LL and SS also showed no significant difference. At the last follow-up, PI (56.28°±6.03° vs. 47.87°±8.30°, t=3.74, P=0.001), PT (17.90°±7.06° vs. 14.41°±5.51°, t=1.97, P=0.042) and the joint angle of the cephalic facet (58.48°±2.00° vs. 54.69°±3.01°, t=4.72, P=0.072) in the degenerative group were greater than those in the non-degenerative group. In the subgroup analysis of lumbar lordosis distribution, the difference between the two groups was statistically significant (χ 2=9.90, P=0.006). The HD in the degenerative group 7.50±3.60 mm was significantly lower than that in the non degenerative group 9.30±2.79 mm ( t=2.00, P=0.031). Multivariate logistic regression analysis showed that increase of PI ( OR=1.22, P=0.005) and magnified cephalic facet joint angle ( OR=2.04, P=0.008) were risk factors for adjacent segment facet degeneration. At the last follow-up, the ODI improvement rate in the degenerative group (58.14%±13.41% vs. 70.18%±8.03%, t=4.11, P<0.001) and the JOA score improvement rate (44.72%±9.53% vs. 68.86%±8.55%, t=0.43, P=0.001) were lower than those in the non degenerative group. Conclusion:The increase of PI and sagittal facet (increased joint angle of proximal facet) are risk factors of adjacent segment FJD after lumbar fusion; The abnormal distribution of lower lumbar lordosis and poor PT recovery in adjacent segment FJD patients after lumbar fusion are more obvious, which may be related to the increase of PI; After lumbar fusion, the orientation of adjacent facet joint tended to be sagittal.