Objective:To analyze the distribution of clopidogrel metabolism-related gene variability in Kawasaki disease (KD) children with coronary artery lesions (CAL) across different age groups and the impact of genetic variability on the efficacy of clopidogrel antiplatelet therapy.Methods:A retrospective cohort study was conducted. Clinical data were collected from 46 KD children with CAL who were hospitalized in the Cardiovascular Center of Children′s Hospital of Fudan University between January 2021 and August 2022 and were treated with clopidogrel, including gender, age, body mass index, course of KD, CAL severity grade, and baseline platelet count. According to their age, the children were divided into ≥2-year-old group and <2-year-old group. Their platelet responsiveness was assessed by adenosine diphosphate-induced platelet inhibition rate (ADPi) calculated via thromboelastography, and children were categorized into high on-treatment platelet reactivity (HTPR) and normal on-treatment platelet reactivity (NTPR) groups. Genotypes of CYP2C19, PON1 and ABCB1 were detected. The t test, one-way analysis of variance and Chi-square test were used for intergroup comparison. Results:Among the 46 KD children with CAL, 34 were male and 12 were female; 37 were ≥2-year-old and 9 were <2-year-old; 25 cases were in the HTPR group and 21 cases were in the NTPR group, with 19 HTPR and 18 NTPR in the ≥2-year-old group, and 6 HTPR and 3 NTPR in the <2-year-old group. Genetic analysis showed that 92 alleles among the 46 children, with frequencies of CYP2C19*1, CYP2C19*2, CYP2C19*3, CYP2C19*17, PON1 192Q, PON1 192R, ABCB1 3435C, ABCB1 3435T at 59% (54/92), 32% (29/92), 9% (8/92), 1% (1/92), 36% (36/92), 64% (59/92), 63% (58/92) and 37% (34/92), respectively. Analysis of the impact of genotype on ADPi revealed that in children aged ≥2 years, those with CYP2C19*1/*3 genotype had significantly lower ADPi than those with CYP2C19*1/*1 genotype ((34±15)% vs. (61±29)%, t=2.18, P=0.036). There were also no significant difference in ADPi among children with PON1 192Q homozygous, PON1 192R heterozygote and PON1 192R homozygous genotypes ((40±22)% vs. (52±33)% vs. (65±27)%, F=2.17, P=0.130), or among those with ABCB1 3435C homozygous, ABCB1 3435T heterozygote and ABCB1 3435T homozygous genotypes ((55±34)% vs. (60±27)% vs. (49±24)%, F=0.33, P=0.719). In <2-year-old group, there were no significant differences in ADPi across CYP2C19*1/*1, CYP2C19*1/*2 and CYP2C19*2*2 genotypes ((40±20)% vs. (53±37)% vs. (34±16)%, F=0.37, P>0.05). There were no significant differences in ADPi across CYP2C19*1/*1 and CYP2C19*1/*3 genotypes ((44±27)% vs. (42±20)%, t=0.08, P>0.05). There were no significant differences in ADPi across PON1 192Q homozygous, PON1 192R heterozygote and PON1 192R homozygous genotypes (45% vs. (55±27)% vs. (24±5)%, F=1.83, P>0.05). There were no significant differences in ADPi across ABCB1 3435C homozygous, ABCB1 3435T heterozygote and ABCB1 3435T homozygous genotypes ((36±16)% vs. (50±35)% vs. 45%, F=0.29, P>0.05). The risk analysis of HTPR in different genotypes revealed that in children aged ≥2 years, carrying at least 1 or 2 loss-of-function alleles of CYP2C19 was a risk factor for HTPR ( OR=4.69, 10.00, 95% CI 1.11-19.83, 0.84-119.32, P=0.033, 0.046, respectively), and PON1 192R homozygosity and carrying at least one PON1 192R allele were protective factors against HTPR ( OR=0.08, 0.13, 95% CI 0.01-0.86, 0.01-1.19, P=0.019, 0.043, respectively). Conclusion:KD children aged ≥2 years carrying CYP2C19 loss-of-function alleles and PON1 192Q are more likely to develop HTPR.

Objective To investigate the epidemiological characteristics of Mycoplasma pneumoniae(MP)infection in children in Nanjing Integrated Traditional Chinese and Western Medicine Hospital before and after the COVID-19 outbreak,and provide an experi-mental basis for the prevention and treatment of MP infection.Methods The clinical data of 17 976 children visited Nanjing Integrated Traditional Chinese and Western Medicine Hospital from January 2019 to November 2023 due to respiratory tract infections were retro-spectively analyzed.The levels of serum specific MP-IgM in the children were detected by the direct luminescence immunoassay,and the detection rates of MP-IgM in different genders,seasons,and ages before and after the COVID-19 epidemic were analyzed using the chi square test to explore the epidemiological characteristics of MP infection.Results The total detection rate of serum MP-IgM in 17 976 children with respiratory tract infections was 28.45%(5 114/17 976).Among them,the total detection rate of serum MP-IgM in female children(31.69%,2 672/8 432)was significantly higher than that in male children(25.59%,2 442/9 544,χ2=81.89,P＜0.001).The detection rate of serum MP-IgM was highest in 2019(34.35%,1 415/4 119),followed by in 2023(30.11%,2 409/8 001)and in 2020-2022(22.03%,1 290/5 856),with statistically significant difference(χ2=19.95,P＜0.001).The detection rate of serum MP-IgM was highest in autumn(33.16%,1 683/5 075),followed by in summer(28.61%,1 053/3 681),winter(27.65%,1 826/6 604),and spring(21.10%,552/2 616),with statistically significant difference(χ2=126.90,P＜0.001).Among different age groups,the detection rate of serum MP-IgM was highest in the age group of 7-9 years old(35.83%,1 190/3 321),fol-lowed by 4-6 years old(28.06%,1 882/6 707),1-3 years old(26.55%,1 493/5 623),10-18 years old(23.64%,486/2 056),and＜1 year old(23.42%,63/269),with statistically significant difference(χ2=126.11,P＜0.001).Conclusion MP is a common pathogen of respiratory tract infections in children,especially in the age range of 7-9 years old,with female children having a higher in-cidence than male children,and the peak incidence in autumn.The effective prevention and control measures during the COVID-19 ep-idemic have reduced the detection rate of MP-IgM,which may provide certain experimental basis for the control and prevention of MP infection transmission and other respiratory diseases.

Abstract With the successive liberalization of the two child and three child policies in China, the issue of sibling relationships has been paid more and more attention by society. Severe sibling jealousy has a negative impact on the physical and mental health development of both young children and their siblings. The study reviewed the influencing factors of sibling jealousy, and analyzed the effect of applying six related intervention methods to the sibling jealousy intervention.The review aims to provide theoretical and empirical basis for children s sibling jealousy intervention, to reduce the level of sibling jealousy through the intervention, and to promote the physical and mental health of young children and their brothers and sisters.

A 28-year-old male patient presented with a 4-year history of a solitary brown mass, and a 1-year history of multiple small papules on the left chest. Skin examination showed a quasi-round brown firm mass measuring about 1.2 cm × 1.1 cm × 1.0 cm in size on the left chest, and several brown papules with diameters ranging from 3 to 5 mm on the right side of the mass; no enlarged lymph nodes were detected in the left axilla on palpation. The mass and papules were completely resected, and histopathological examination showed clustered nevus cells in the superficial dermis of the mass and small papules, and the diagnosis of intradermal nevus was considered. There was a desmoplastic nodule in the mass, nevus cells were scattered among the fibers in the nodule, and giant nevus cells were also observed; the nevus cells in the nodule were relatively larger, epithelioid or spindle-shaped with round or spindle-shaped nuclei, obvious nucleoli, and rare mitotic figures. Immunohistochemical study showed that the nevus cells in both the intradermal nevus and proliferative nodule were positive for S100; the nevus cells in the superficial dermis of the intradermal nevus were positive for Melan-A and HMB45, while the nevus cells in the proliferative nodule were negative for Melan-A and HMB45; both the intradermal nevus and proliferative nodule tissues showed a Ki-67 index of 1%, positive staining for CD34, but negative staining for P16 and P63. Finally, the patient was diagnosed with intradermal nevus associated with desmoplastic nodule.

Objective: To investigate the application of coronary angiography (CAG) in children with Kawasaki disease complicated with coronary artery lesion (CAL). Methods: A total of 139 patients (115 boys and 24 girls, age (48±42) months) with Kawasaki disease complicated with CAL underwent CAG between June 2006 and June 2018 in Children′s Hospital of Fudan University. CAL in all children were at grade Ⅲ and above assessed by echocardiography and underwent CAG under general anesthesia with parental consent. A retrospective analysis was performed to identify the safety and complication of CAG, degree of satisfaction of image, distribution of CAL, and the treatment and follow-up management according to the result of CAG. Results: All the 139 patients underwent CAG, and 17 patients received CAG twice. In these cases, there was a total of 309 CAL with an average of 2.22 CAL per patient. After CAG, children were re-graded as grade Ⅲ in 33 cases, grade Ⅳ in 56 cases, grade Ⅴa in 33 cases and grade Ⅴb in 17 cases according to the clinical severity. Ten patients (7.2%) had only aortic root angiography and 129 (92.8%) patients had selective left or right CAG. Among these, 27 cases (19.4%) showed thrombosis in coronary aneurysm, 23 cases (16.5%) showed coronary artery stenosis, 4 cases (2.9%) showed recanalization after occlusion in right coronary artery. All the patients obtained satisfied images, and no complication was found. Eight of the grade Ⅴb patients underwent coronary artery bypass grafting (CABG). One patient died during the surgery due to severe heart failure, and the other seven patients received CABG successfully and recovered well during a long-term follow up (18 to 108 months). Conclusions CAG is safe for children with Kawasaki disease with CAL, and the images of CAG are satisfied. Patients who were graded according to CAG and received the corresponding surgical treatment could get satisfied effect in the medium and long-term follow-up.

Objective To explore the current status of the stress and coping styles of emergency room nurses in Class Ⅲ Grade A hospitals, to discuss the correlation between stress and coping styles, and to provide a basis for formulating targeted training plans. Methods Totally 178 emergency room nurses from 9 Class ⅢGrade A hospitals in Hebei Province were randomly selected as the study subject from April to May 2016 and investigated with the General Information Questionnaire, Nurse's Working Stress Source Scale and Coping Style Questionnaire. Results The total average stress score of the nurses was (1.88±0.56); and the scores for each dimension of coping styles were: (0.84±0.12) for problem-solving, (0.71±0.20) for fantasy, (0.68±0.22) for rationalization, (0.67±0.24) for avoidance, (0.67±0.14) for asking for help, and (0.60±0.29) for self-accusation. Nursing and working stress was positively correlated with the coping styles such as fantasy and rationalization (P<0.05), and negatively correlated with self-accusation (P<0.05). Conclusions Emergency room nurses' stress generally remains at a medium and high level. Therefore, nursing managers should formulate proper nursing management measures and take necessary measures to alleviate nurses' stress.

Objective: Undiagnosed critical congenital heart disease (CCHD) was assessed before discharge from maternity hospital.Basic information was provided for screening CCHD in the early neonatal stage.Chi-squared test was used for comparison of categorical variables(detection rate of different types of CCHD). Method: A retrospective cohort study was conducted in neonates with CCHD who were admitted to Children′s Hospital of Fudan University between 1 January 2012 and 31 December 2015. For comparing with the previously reported undiagnosed rate of CCHD at discharge, CCHD was defined as all duct dependent congenital heart disease (DDCHD) and any cyanotic CHD that required early surgery. Result: A total of 1 036 infants with CCHD were included. The prenatal detection rate of CCHD was 14.04%(122/869). As a whole, 52.51% (544/1 036) of CCHD cases were undiagnosed at discharge, and 14.09%(146/1 036)were still missed after 6-week examination. The diagnoses most likely to be unrecognized at discharge included critical coarctation of the aorta (COA) (75.00%), total anomalous pulmonary venous connection (61.54%), pulmonary atresia (PA) with ventricle septal defect (VSD) (61.45%), single ventricle (SV) (60.10%) and critical aortic stenosis (52.94%). Among newborns diagnosed prior to discharge, 54.88% (270/492) due to symptom or prenatal ultrasonographic diagnosis, 45.12% (222/492) due to abnormal findings in routine examination. Among asymptomatic CCHD cases without prenatal diagnosis, 71.02% (544/766) were undiagnosed and the most common delayed diagnosis was SV (82.78%), interrupted aortic arch (81.82%), transposition of the great arteries with intact ventricular septum (79.63%), PA/VSD (79.07%), and critical COA (78.57%). Newborns with DDC were more likely to develop symptoms within the first few days after birth, in comparison with non-DDC cases. However, their detection rates were close to each other. Conclusion The rate of misdiagnosis of CCHD before discharge from maternity hospitals is high in China, indicates the importance of implementation of CCHD screening in Chinese maternity hospitals, so as to give timely diagnosis and proper treatment.

Objective To explore the effect of standing-sitting Baduanjin exercise in postoperative rehabilitation of breast cancer patients. Methods Totally 70 cases of patients with breast cancer postoperation were randomly assigned to the control group and the experimental group. Patients in the control group received routine postoperative nursing, while patients in the experimental group adopted standing-sitting Baduanjin exercise. Fatigue condition and functional recovery of ill limb were compared through evaluation by BFI and functional assessment of ill limb.Results The total BFI score of fatigue in the experimental group was (3.29± 0.42) points 1 month after operation, and was (3.28±0.45) points 3 months after operation. They were all superior than the score of control group (t=-4.007,-3.996;P<0.01). Limb function of 96.8% patients were completely recovered in the experimental group 1 month after operation, while just 75.8% patients in the control group. 3 months after operation, 100% patients were completely recovered in the experimental group, and in the control group, it was 81.8% (χ2=4.233,4.264;P<0.05).Conclusions Suitability standing-sitting Baduanjin exercise can relieve the fatigue symptom of patients with breast cancer postoperation, and delay the aggravation of symptoms during chemotherapy.

Objective To explore optimal suctioning negative pressure in endoscopic nasobiliary drainage (ENBD) after endoscopic retrograde cholangiopan-creatography (ERCP). Methods A total of 131 patients with extrahepatic bile duct stones complicated with infection, who were treated by ENBD after ERCP, were randomly divided into two groups according to intubation dates from September 2013 to December 2014. The patients of two groups were treated with the same medical and nursing care. The pressure of low suctioning negative pressure group (61 cases) was -1--5 kPa and the pressure of high suctioning negative pressure group (70 cases) was -5--8 kPa. The conditions of biliary bleeding, drainage volume, drainage tube obstruction and patient comfort in two groups were compared. Results There were 4 cases of bile occult blood in low suctioning negative pressure group and 9 cases in high suctioning negative pressure group (P>0. 05). The daily biliary drainage volume in low suctioning negative pressure group was (349. 79 ± 108. 26) ml, which was more than that in high suctioning negative pressure group (t=6. 76,P<0. 01). There were 8 cases of drainage tube obstruction in low suctioning negative pressure group, which was less than that of 25 cases in high suctioning negative pressure group (χ2 =8. 83,P<0. 01). There were 2 cases of postoperative vomiting and 4 cases of xiphoid under pain in low suctioning negative pressure group, which were less than those in high suctioning negative pressure group (χ2 =17. 27,3. 89;P<0. 05). Conclusions The optimal suctioning negative pressure in ENBD after ERCP is -1--5 kPa. It can be used in clinical nursing care in order to improve patient comfort and keep the drainage tube unobstructed.

ObjectiveTo assess whether intravenous contrast medium would result in acute kidney injury (AKI), and to determine the risk factors associated with contrast induced AKI (CI-AKI) and its outcome.Methods A retrospective observational study was conducted in intensive care unit (ICU) of Fuyang People's Hospital in Zhejiang Province from January 1st 2011 to December 31st 2014. All enrolled critically ill patients had accepted CT scan, and the hospital length of stay was longer than 48 hours, and the patients who needed renal replacement treatment were excluded. Patients were divided into contrast medium group and control group. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria (serum creatinine content over 26.4μmol/L or 50% increase of it from baseline within 48 hours). The incidence of AKI was compared between the two groups, and risk factors for CI-AKI were determined by multiple logistic regression analysis. The relationship of CI-AKI and outcomes were also analyzed. Results A total of 2 370 critically ill patients were enrolled during the period. 474 (20.0%) of the 2 370 patients received contrast medium, and 70 of them suffered from CI-AKI (14.8%). In 1 896 patients who did not receive contrast medium, 235 of them suffered from AKI (12.4%). There was no significant difference in the incidence of AKI between two groups (χ2= 1.905,P = 0.168). After several confounding factors were adjusted, multiple logistic regression analysis showed that contrast medium was not found to associate with AKI in critically ill patients [odds ratio (OR) = 1.66, 95% confidence interval (95%CI) = 0.72-3.90,P = 0.201], and high acute physiology and chronic health evaluationⅡ (APACHEⅡ) score (OR = 1.70, 95%CI = 1.33-2.40,P< 0.001), sepsis (OR= 8.06, 95%CI =3.28-17.80,P< 0.001), shock (OR= 3.57, 95%CI = 1.73-8.01,P< 0.001) and use of nephrotoxic agent (OR= 1.96, 95%CI = 1.25-2.63,P = 0.015) were risk factors of CI-AKI. Ten of 70 patients with CI-AKI died (14.3%), and 21 out of 404 patients without CI-AKI, died (5.2%). There was no significant difference in the mortality rate (χ2= 8.060, P = 0.005). It was shown by multiple logistic regression analysis that age (OR=1.30, 95%CI = 1.05-1.71,P = 0.027), male sex (OR = 1.13, 95%CI = 1.05-1.20,P = 0.039), APACHEⅡscore (OR = 1.07, 95%CI = 1.03-1.18,P< 0.001), and sepsis (OR = 3.29, 95%CI = 1.92-6.46,P< 0.001) were highly associated with mortality of critically ill patients in whom contrast medium was used. However, the occurrence of CI-AKI showed no influence on the mortality rate (OR = 1.70, 95%CI = 0.88-3.56,P = 0.227).Conclusions The use of contrast medium is not a risk factor of CI-AKI in critically ill patients. CI-AKI will not raise mortality rate in ICU patients.