Objective To describe and analyze the epidemiological characteristics of scrub typhus in Huai'an, Jiangsu Province from 2006 to 2024 and explore the long-term incidence trend and distribution of high-risk areas, and to formulate targeted prevention and control strategies. Methods The scrub typhus case report data of Huai'an from 2006 to 2024 in the Chinese Disease Prevention and Control Information System were extracted for descriptive analysis. Results A total of 898 cases of scrub typhus were reported in Huai'an, with an average annual incidence rate of 0.96 per 100 000 from 2006 to 2024. There was a turning point in the incidence trend of scrub typhus in 2011. From 2006 to 2011, the annual percentage change (APC) was 47.09% (95% CI: 7.53 - 859.39), and the upward trend was statistically significant (P < 0.05). From 2012 to 2024, the APC was -2.12% (95% CI: -29.09 - 3.75), and the downward trend was not statistically significant. October and November were the high-incidence months, and the total concentration from 2006 to 2024 was 0.93, indicating that scrub typhus had strict seasonality. The circular distribution method estimated that the peak period of the epidemic was from October 11th to November 25th, and the peak day of incidence was November 3rd. Jinhu County was a high-incidence area. The ratio of male to female cases was 1.03. The age group with the highest reported incidence was 40 to < 80 years old. The occupation with the highest proportion was farmers, accounting for 78.03%. Conclusion From 2006 to 2024, scrub typhus in Huai'an shows a peak every 3 - 4 years. Middle-aged and elderly farmers are the key population at risk, and Jinhu County is a key area. In the future, targeted health education should be carried out to effectively control the prevalence of scrub typhus.

Objective:To clarify the morphological relationship between the upper airway and TMJ in patients with normal-angle skeletal Ⅱ and skeletal Ⅰ malocclusion.Methods:30 skeletal class Ⅰ and 22 skeletal class Ⅱ patients with normal-angle were included.CBCT examination was performed,and Mimics 21.0 software was used to conduct 3D reconstruction and measurements of the samples.Data was analyzed by using independent t-test and the Pearson correlation test.Results:12 measurements,including the sagittal diameter of nasopharyngeal segment,the sagittal,coronal diameter,minimum cross-sectional area,the volume of palato-pharyngeal segment and glossopharyngeum segment,the total volume of upper airway,posterior oblique slope of the articular eminence and the length of the condylar showed significant differences between skeletal Ⅱ and skeletal Ⅰ subjects with normal-angle(P＜0.05).The posterior oblique slope of the articular eminence showed a positive correlation with the sagittal diameter of the palatopharyngeal segment,volume and minimum cross-sectional area of glossopharyngeum lingual segment(P＜0.05).The liner ratio showed a negative correction with the coronal diameter of palatopharyngeal and glossapharyngeal segment as well as minimum cross-section area of glos-sapharyngeal segment(P＜0.05).Conclusion:The structure of upper airway is correlated with that of TMJ.Differences in the upper airway are statistically significant between skeletal Ⅱ and skeletal Ⅰ malocclusion with normal-angle(P＜0.05).

Objective:To explore the value of paediatric age-adjusted shock index（SIPA）in early identification of septic shock in children，and to evaluate the relationship between SIPA and disease severity and prognosis.Methods:The infected children admitted to the department of critical care medicine of the Children's Hospital Affiliated to Capital Institute of Pediatrics from May 2023 to July 2024 were collected. Dynamic assessment was performed 0 to 6 hours after admission. Patients diagnosed with sepsis without septic shock were classified as the sepsis group and those diagnosed with sepsis with septic shock were classified as the septic shock group. According to whether the blood pressure of the children decreased，they were divided into two groups：compensated septic shock group and decompensated septic shock group. The difference of SIPA among the three groups was analyzed，and the predictive value of SIPA on case fatality rate，lactate level，pediatric critical illness score，ventilator utilization rate and length of hospital stay were analyzed.Results:Among 203 children with sepsis，112 were males and 91 were females. There were 146 cases in the sepsis group，37 cases in the compensated septic shock group and 20 cases in the decompensated septic shock group. There was no significant difference between the three groups in gender（ P>0.05），but there was a statistically significant difference in age（ χ 2=32.905， P<0.001）. There was no significant difference in age between the sepsis group and the compensated septic shock group（ P>0.05）. The age of sepsis group and decompensated septic shock group，compensated septic shock group and decompensated septic shock group were statistically significant（ χ 2=29.431， P<0.001； χ 2=19.764， P=0.001）. The proportion of increased SIPA was statistically different among the three groups，with both the compensated septic shock group and the decompensated septic shock group being higher than the sepsis group（ χ2=20.383， P<0.001； χ2=33.600， P<0.001）. The decompensated septic shock group was higher than the compensated septic shock group（ χ2=6.555， P=0.01）. SIPA was correlated with case fatality rate，lactate level，pediatric critical illness score，ventilator use rate and length of stay of the children，with statistically significant differences（ P<0.05）. Conclusion:The increase of SIPA can be used for the early identification of septic shock in children，and it has a certain early warning value for the prognosis assessment of sepsis and septic shock.

Objective:To summarize and analyze the clinical characteristics of pediatric pulmonary hypertension (PH) and the related factors affecting the prognosis，to provide a basis for the early diagnosis and treatment of the disease.Methods:The clinical data of 80 PH children hospitalized in the intensive care department of Children's Hospital of Capital Pediatric Research Institute from January 1,2019 to December 31,2022 were retrospectively analyzed,and general data,clinical symptoms, echocardiography, laboratory examination and treatment indicators were collected. According to survival death groups, multivariate Logistic regression was applied to analyze independent associated risk factors for PH death.Results:（1）Clinical characteristics of childhood PH: more common in infants, the average age of treatment was 0.9(0.3-5.3)years, the male to female ratio was 1.3∶1, and the average time from first symptoms to first diagnosis was 6.5 (2,14) days. The etiology of PH in children was complex, with arterial PH (PAH) (40%), pulmonary disease and(or) hypoxia (33.8%) being the most common. The main clinical manifestations were dyspnea, decreased activity endurance, poor appetite, and positive heart examination. Severe PH accounted for 53.8%, 30% of pulmonary hypertensive crisis.（2）Factors affecting the prognosis of childhood PH: childhood PH mortality was 20.8%, compared with the survival group, ICU length of stay, loss of appetite, decreased urine volume, cardiac function classification, right heart size, main pulmonary artery diameter/ascending aorta diameter ratio(MPAD/MAD), vasoactive inotropic score(VIS), use of invasive ventilator treatment had statistical significance (all P<0.05). A Logistic regression analysis of death-related factors showed that right heart enlargement ( OR=0.193,95% CI 0.040-0.919, P=0.039), higher MPAD/MAD value ( OR =11.883,95% CI 1.347-104.869, P=0.026), and higher VIS score ( OR= 1.029,95% CI 1.003-1.056, P=0.028) were independent risk factors for poor prognosis. Conclusion:（1）Children PH is mainly infants, the causes of PAH and pulmonary diseases, severe PH accounted for 53.8%, 30% of which have pulmonary hypertensive crisis.（2）An enlarged right heart, higher MPAD/MAD values, and higher VIS score are independent risk factors for death in children with PH.

Objective To analyze the clinical characteristics,laboratory test,imaging examination,and treatment outcome of invasive Klebsiella pneumoniae liver abscess syndrome(IKPLAS)in the elderly,and improve clinicians' understanding on this disease.Methods Clinical data of 7 elderly patients who were diagnosed with IKPLAS in a hospital from January 2020 to February 2024 were analyzed retrospectively.Results Among the 7 elderly patients with IKPLAS,there were 3 males and 4 females,ranging in age from 60 to 78 years old.All 7 patients were with community-acquired infection.The main clinical symptoms were fever(n=7),chills(n=6),upper abdominal pain(n=4),fatigue and poor appetite(n=3),cough and expectoration(n=5),vomiting(n=3),vision decrease(n=2),and disturbance of consciousness(n=1).All 7 patients had pathogenic evidence of Klebsiella pneumoniae(KP),including 4 cases with KP isolated from liver puncture pus,3 from blood culture,and 1 from both liver puncture pus and intraocular pus.Among the 7 patients,there were 5,2,1,3,1,1 cases combined with pulmonary abscess,endophthalmitis,brain abscess,bloodstream infection,urinary system infection,and pelvic infection,re-spectively.Conclusion Elderly patients with IKPLAS have a variety of underlying diseases and diverse clinical symptoms,showing no specificity.Once IKPLAS was suspected,timely testing for pathogen and screening for other metastatic infection sites outside the liver should be performed.Timely drainage of liver abscess and selection of ap-propriate antimicrobial agents for treatment based on antimicrobial susceptibility testing result can improve patients' survival rate.

Objective To explore the value of cranial CT perfusion imaging(CTP)parameters combined with head and neck CT angiography(CTA)in assessing collateral circulation status and predicting prognosis in acute ischemic stroke(AIS).Methods A retrospective analysis was carried out on 83 AIS patients who were treated in Taikang Xianlin Drum Tower Hospital from June 2018 to June 2023.CTP and head and neck CTA examinations were performed within 24 hours after admission.Digital subtraction angiography is the gold standard for assessing collateral circulation status in AIS patients.The general information of these patients was collected,and the patient's prognosis was evaluated using the modified Rankin scale through telephone or outpatient follow-up 90 days after the occurrence of AIS.Pearson or Spearman correlation was used to analyze the correlation between collateral circulation assessment and CTP parameters and head and neck CTA scores.The value of CTP parameters and head and neck CTA scores in predicting the prognosis of AIS patients was discussed using multivariate Logistic regression.Moreover,the receiver operating characteristic(ROC)curve was used to analyze the predictive value of CTP parameters,head and neck CTA,and the combination for the prognosis of AIS patients.Results The cerebral blood volume(CBV),cerebral blood flow(CBF),and CTA score were higher,while mean transit time(MTT)and time to peak(TTP)were shorter in the good collateral circulation group than in poor collateral circulation group(P<0.05).The collateral circulation status in AIS patients was negatively correlated with CBV,CBF,and CTA score,while positively correlated with MTT and TTP(P<0.05).Compared with poor prognosis group,good prognosis group had higher CBV,CBF,CTA,and shorter MTT and TTP(P<0.05).Multivariate Logistic regression analysis identified MTT and TTP as risk factors for poor prognosis,and CBV,CBF,and CTA scores as protective factors for poor prognosis in AIS patients(P<0.05).The ROC results showed that the area under the curve(AUC)of CBV,MTT,CBF,TTP,CTA score and the combination to predict the prognosis of AIS patients were 0.897,0.864,0.835,0.920,0.918,and 0.979,respectively,showing better predictive performance of the combination than single index alone(Z=2.194,2.910,2.521,2.229,2.171;P<0.05).Conclusion CTP parameters combined with CTA may effectively assess collateral circulation in patients with AIS and is significant for prognosis prediction.

Objective:To explore the differences in early clinical features between Kawasaki disease shock syndrome (KDSS) and septic shock (SS).Methods:A retrospective case-control study was conducted. Clinical data was collected from 64 children who were diagnosed with KDSS or SS and admitted to the Department of Critical Care Medicine of Capital Center for Children′s Health, Capital Medical University from January 2018 to February 2025. Mann-Whitney U test, χ2 test, or Fisher′s exact test were used to compare the differences in clinical features, treatment, and outcomes between children with KDSS and SS. Lasso regression was applied to screen predictive variables, and multivariable logistic regression analysis was performed to identify factors associated with KDSS. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of parameters for KDSS. Results:Among the 64 children (30 males and 34 females), the age was 3.6 (1.2, 6.5) years. There were 51 cases in the SS group and 13 cases in the KDSS group. Compared to children with SS, children with KDSS had a longer pre-shock fever duration, lower lactate levels and serum albumin levels, and higher soluble interleukin-2 receptor (sIL-2R) levels (all P<0.05). Additionally, they exhibited a higher incidence of coronary involvement, pericardial effusion, and ascites, a higher utilization rate of intravenous immunoglobulin, and a lower utilization rate of invasive mechanical ventilation (all P<0.05). There was no significant difference in in-hospital mortality between KDSS and SS ( P=0.574). Multivariate logistic regression analysis identified pre-shock fever duration and sIL-2R as independent factors associated with KDSS ( OR=1.52 and 1.54 per 1 000 U increase, 95% CI 1.12-2.05 and 1.06-2.24, respectively; both P<0.05). ROC curve analysis showed that the areas under the curve for pre-shock fever duration and sIL-2R in identifying KDSS were 0.83 (95% CI 0.73-0.94, P=0.001) and 0.70 (95% CI 0.53-0.87, P=0.042), respectively. The optimal cutoff values were 3.5 d and 3.8×10 6 U/L, with sensitivities of 0.91 and 0.82, and specificities of 0.71 and 0.62, respectively. Conclusions:Children with KDSS have higher incidences of coronary involvement, pericardial effusion, and ascites compared to those with SS. Pre-shock fever duration and sIL-2R may serve as potential early indicators for distinguishing KDSS from SS.

Objective To explore the current situation and experience of the development of multi-hospital areas in foreign medical institutions,and to analyze its enlightenment to the construction of"one hospital with multiple campuses"in public hospitals in China.Methods Through the combing of relevant literature,it systematically analyzes the development status of multi-hospital construction of medical institutions in typical countries such as the United States,the United Kingdom,and Germany,summarizes the relevant experience of different countries,and analyzes the current situation of the construction of"one hospital with multiple campuses"in China's public hospitals.Results At present,the orderly development of multiple hospitals of foreign medical institutions mainly depends on the homogenization of medical care,the scientific management of human resources and the improvement of information construction.China can learn from its experience and technical means to build a development pattern of"one hospital with multiple campuses"suitable for China's national conditions.Conclusion In the future,the construction of"one hospital with multiple campuses"in China's public hospitals should focus on"rationalization of human resource allocation,homogenization of medical service quality,and intelligent information system construction",improve"human resource allocation",establish and improve"information sharing mechanism",differentiate the layout of"hospital functions",and strengthen"quality supervision and patient feedback",aiming to improve the construction effect of"one hospital with multiple campuses"in China's public hospitals.

Objective:To investigate the changes in thyroid hormone levels and inflammatory markers in critically ill children，analyze their correlation with disease severity，and explore their potential impact on prognosis,providing references for clinical management and prognosis assessment in critical illness.Methods:A retrospective cohort study was conducted involving 394 pediatric patients admitted to the ICU of the Capital Pediatric Institute Affiliated Children's Hospital from 2019 to 2023.Based on the pediatric critical illness score,patients were divided into three groups:the extremely critical group (score ≤ 70, n=81),the critical group (score 71–80, n=150),and the non-critical group (score>80, n=163).Data collected included thyroid function indicators，inflammatory markers[C-reactive protein（CRP)，procalcitonin(PCT),tumor necrosis factor(TNF)-α，interleukin (IL)，etc.]，clinical information，and outcomes.The correlation between thyroid function indicators and inflammatory markers were analyzed.The predictive value of thyroid function indicators and inflammatory markers for prognosis in critically ill pediatric patients was assessed. Results:Of the 394 children,non-thyroidal disease syndrome occurred in 321 cases,with an overall incidence of 81.5%,which increased with disease severity.Thyroid hormone [total triiodothyronine (TT3),free triiodothyronine (FT3),and total tetraiodothyronine (TT4)] levels were significantly lower in the extremely critical group than in the other groups ( P<0.05).Inflammatory markers such as CRP,PCT,TNF-α,IL-6,IL-8,and IL-10 were significantly higher in the extremely critical group than in the other groups ( P<0.05).Thyroid hormones were negatively correlated with inflammatory markers,and the receivor operating characteristic curves analysis indicated that TT3,FT3,IL-6 and IL-8 levels,could effectively differentiate disease prognosis.Univariate regression model showed significant associations between TT3,FT3,TT4,PCT,IL-8,and IL-10 and disease prognosis.The multivariate Logistic regression model showed IL-6 and IL-8 were independent predictors of disease prognosis. Conclusion:Significant reductions in thyroid hormone levels are closely related to disease severity and poor prognosis.Changes in inflammatory markers reflect the inflammatory state and severity of the disease and impact prognosis.Monitoring thyroid function and inflammatory status is important in clinical management，which provids new insights into prognosis assessment and treatment strategies for critically ill children.

Objective To explore the value of cranial CT perfusion imaging(CTP)parameters combined with head and neck CT angiography(CTA)in assessing collateral circulation status and predicting prognosis in acute ischemic stroke(AIS).Methods A retrospective analysis was carried out on 83 AIS patients who were treated in Taikang Xianlin Drum Tower Hospital from June 2018 to June 2023.CTP and head and neck CTA examinations were performed within 24 hours after admission.Digital subtraction angiography is the gold standard for assessing collateral circulation status in AIS patients.The general information of these patients was collected,and the patient's prognosis was evaluated using the modified Rankin scale through telephone or outpatient follow-up 90 days after the occurrence of AIS.Pearson or Spearman correlation was used to analyze the correlation between collateral circulation assessment and CTP parameters and head and neck CTA scores.The value of CTP parameters and head and neck CTA scores in predicting the prognosis of AIS patients was discussed using multivariate Logistic regression.Moreover,the receiver operating characteristic(ROC)curve was used to analyze the predictive value of CTP parameters,head and neck CTA,and the combination for the prognosis of AIS patients.Results The cerebral blood volume(CBV),cerebral blood flow(CBF),and CTA score were higher,while mean transit time(MTT)and time to peak(TTP)were shorter in the good collateral circulation group than in poor collateral circulation group(P<0.05).The collateral circulation status in AIS patients was negatively correlated with CBV,CBF,and CTA score,while positively correlated with MTT and TTP(P<0.05).Compared with poor prognosis group,good prognosis group had higher CBV,CBF,CTA,and shorter MTT and TTP(P<0.05).Multivariate Logistic regression analysis identified MTT and TTP as risk factors for poor prognosis,and CBV,CBF,and CTA scores as protective factors for poor prognosis in AIS patients(P<0.05).The ROC results showed that the area under the curve(AUC)of CBV,MTT,CBF,TTP,CTA score and the combination to predict the prognosis of AIS patients were 0.897,0.864,0.835,0.920,0.918,and 0.979,respectively,showing better predictive performance of the combination than single index alone(Z=2.194,2.910,2.521,2.229,2.171;P<0.05).Conclusion CTP parameters combined with CTA may effectively assess collateral circulation in patients with AIS and is significant for prognosis prediction.