Objective:To explore the clinical effect of vitamin A in the adjuvant treatment of bronchial asthma in children and its influence on serum transforming growth factor-β1 (TGF-β1), eosinophils (EOS) and interleukin-17 (IL-17) levels.Methods:A prospective study was conducted on 110 children with bronchial asthma who received treatment in Department of Pediatrics, Xi'an Central Hospital from January 2022 to December 2023. Based on the principle of balanced and comparable baseline characteristics between groups, they were randomly divided into a control group and an observation group, with 55 cases in each group, using a random number table method. The control group was treated with routine pediatric bronchial asthma therapy, while the observation group was added with vitamin A adjuvant therapy on the basis of the control group. After 15 days of continuous treatment, the scores of asthma control condition (Childhood-Asthma Control Test (C-ACT), Asthma Control Questionnaire (ACQ)) in the two groups were evaluated. The pulmonary ventilation function (forced expiratory volume in one second (FEV 1), forced expiratory volume in one second/forced vital capacity (FEV 1/FVC), peak expiratory flow (PEF)), serum inflammatory factors (TGF-β1, EOS, IL-17) and immune function indicators (T helper 17 cell (Th17), T helper 2 cell (Th2), regulatory T cell (Treg) ) were compared between groups of children before treatment and after 15 days of treatment. Measurement data with normal or approximate distribution were expressed as xˉ± s, and independent sample t test was used for comparison between groups. Enumeration data were expressed as percentage, and chi-square test was adopted for between-group comparison. Results:After 15 days of treatment, the C-ACT score with (16.20±3.14) points in observation group was higher than (14.80±2.62) points in control group while the ACQ score with (30.30±4.14) points was lower than (34.60±6.23) points in control group, with statistical differences between groups (t values were 2.54 and 4.26; P values were 0.012 and <0.001). The pulmonary ventilation function indicators in observation group and control group after 15 days of treatment (FEV 1: (1.76±0.34) L与(1.54±0.32) L, FEV 1/FVC:(76.89±5.76)%与(70.25±6.42)%, PEF(2.89±0.35) L/s与(2.68±0.39) L/s) were higher than those before treatment (FEV 1:(1.12±0.31) L与(1.20±0.33) L, FEV 1/FVC:(56.96±4.35)%与(58.12±3.48)%, PEF(2.15±0.66) L/s与(2.34±0.56) L/s), and the differences were statistically significant ( t values were 10.32, 5.49, 20.48, 10.43, 7.35, 3.70, respectively; all P<0.001), and the indicators in observation group were higher compared to control group, the differences were statistically significant ( t values were 3.49, 5.71, and 2.97; P values were 0.001, <0.001, and 0.004). After 15 days of treatment, the levels of serum inflammatory factors (TGF-β1:(6.32±1.36) ng/L与(8.75±1.81) ng/L, EOS:(3.56±0.65)%与(4.28±0.82)%, IL-17:(5.53±1.22) ng/L与(6.42±1.51) ng/L) and CD4 + T lymphocyte immune function indicators (Th17:(0.97±0.26) ng/L与(1.23±0.35) ng/L, Th2:(2.32±0.64) ng/L与(3.15±0.52) ng/L, Treg:(5.41±0.76) ng/L与(5.86±0.23) ng/L ) were lower in observation group and control group than those before treatment (TGF-β1: (14.35±2.23)与(15.26±3.05) ng/L, EOS: (6.32±1.33)%与(6.41±1.27)%, IL-17:(8.86±1.68)与(9.03±1.89) ng/L, Th17:(1.82±0.75)与(1.67±0.68) ng/L, Th2:(4.15±1.49)与(3.98±1.28) ng/L, Treg: (7.26±1.35)与(6.92±1.72) ng/L), and the differences were statistically significant ( t values were 22.80, 13.61, 13.83, 10.45, 11.90, 8.08, 7.94, 4.27, 8.37, 4.46, 8.86, 4.58, respectively; all P<0.001). However, the above indicators in the observation group were lower than those in the control group ( t values were 7.96, 5.10, 3.40, 4.42, 7.47, 4.20, and P-values were <0.001, <0.001, 0.001, <0.001, <0.001, and <0.001 respectively). Conclusion:Vitamin A adjuvant therapy is helpful to the control of bronchial asthma, and it can effectively improve the pulmonary function, reduce the inflammatory reaction and enhance the body's immunity.

To construct a recombinant fowl adenovirus 4(FAdV-4)expressing the Cap protein of goose astrovirus genotype 2(GoAstV-2),the expression cassette of Cap gene was inserted into the natural 1 966 bp deletion region of the FAdV-4 genome in the infectious clone p15A-cm-FAdV4-HNJZ.The resulted recombinant plasmid p15A-cm-FAdV4-HNJZ-Cap/GoAstV-2 was linearized with restriction enzyme and transfected into chicken hepatoma cell line(LMH)to rescue the recombinant FAdV-4 expressing the Cap protein of GoAstV-2,rF Ad V4-Cap/GoAstV-2.After 15 passages in LMH cells,the recombinant rFAdV4-Cap/GoAstV-2 was identified by PCR using primers flanking the insertion site of the Cap gene expression cassette and using viral genome DNA extracted from rFAdV4-Cap/GoAstV-2 infected LMH cells as template.LMH cells were in-fected with 15th passage rFAdV4-Cap/GoAstV-2 and indirect immunofluorescence was performed with a polyclonal antibody against Cap protein as the primary antibody.Western blot was carried out with lysates of rFAdV4-Cap/GoAstV-2 infected LMH cells.The in vitro replication dynamic of the 15th passage of the rFAdV4-Cap/GoAstV-2 was also investigated in LMH cells.The results demonstrated that the Cap gene of GoAstV-2 was presented in the genome of the recombinant vi-rus rF AdV4-Cap/Go Ast V-2,and could be expressed stably.The prepared recombinant virus in this study will lay a foundation for developing inactivated bivalent vaccine candidate against co-in-fection of FAdV-4 and GoAstV-2 in goose.

Objective To summarize the experience in carotid endarterectomy(CEA)for the treatment of carotid artery stenosis,in order to decrease postoperative complications and enhance clinical efficacy.Methods The clinical data of 64 cases receiving surgical treatment for carotid artery stenosis from January 2022 to December 2024 were analyzed retrospectively.Clinical data including age,gender,condition of underlying diseases,degree of carotid artery stenosis,degree of coronary artery stenosis,cerebral blood flow before operation,characteristics of carotid plaques before operation,usage of antiplatelet drugs during perioperative period,usage of carotid shunt during operation,intraoperative carotid artery occlusion time,operation time,postoperative complications and follow-up results were collected.Results All 64 patients underwent CEA successfully.Among them,14 cases underwent shunt during operation,48 cases received single antiplatelet therapy during perioperative period and 16 cases received dual antiplatelet therapy.The median operation time was 161.50(138.00,186.50)min,the clamping time was(28.42±10.72)min.The incidence of postoperative complications included 1 case of incisional infection(1.56%),1 case of incisional hematoma(1.56%),1 case of internal carotid artery occlusion(1.56%),1 case of cerebral hypoperfusion(1.56%).There were no cerebral infarction,no cerebral hyperperfusion,no cardiac events and no brain nerve injury.There was no one case of postoperative complications in the patients who underwent shunt during operation.All patients were followed up for 3～38 months.Among them,there were 2 cases of stroke and there was no death during the fellow-up period.The clamping time was significantly shorter in shunting group than in non-shunting group[(18.43±6.64)min vs.(31.22±9.98)min,P<0.05)],there were no significant differences in remaining clinical data between two groups(P>0.05).The degree of carotid artery stenosis was more severe in the dual antiplatelet group than in the single antiplatelet group[on operation side(χ2=-2.377,P<0.05),on contralaternal side(χ2=-2.261,P<0.05)],there were no significant differences in remaining clinical data between two groups(P>0.05).Conclusions CEA is an effective treatment for carotid artery stenosis,shunting during CEA is safe.Meticulous perioperative management and operative procedures could help to reduce the rate of postoperative complications.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective:To evaluate the value of preoperative triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio in predicting postoperative delirium (POD) following internal fixation for lower limb fracture in geriatric patients.Methods:In this retrospective case-control study, the medical records of patients, aged ≥ 65 yr, with American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, who underwent internal fixation for lower limb fracture under general anesthesia or spinal-epidural anes-thesia at Hebei General Hospital from January 2023 to July 2024, with the postoperative length of hospital stay of at least 3 days, were collected. The baseline characteristics, preoperative length of hospital stay, parameters of the last preoperative laboratory tests, type of surgery, anesthesia method, duration of surgery and anesthesia, and intraoperative hypotension and fluid intake and output were collected, and the ratio of TG to HDL-C was calculated. Patients were stratified into POD group and non-POD group based on whether POD developed. The logistic regression was carried out to identify influencing factors for POD. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive accuracy of preoperative TG/HDL-C ratio in predicting POD.Results:A total of 234 patients were finally included, of whom 30 developed POD, with an incidence of 12.8%. The results of multivariate logistic regression indicated that the elevated preoperative TG/HDL-C ratio, increased WBC count and a history of cerebrovascular disease were independent risk factors for POD, and the increased albumin concentration was an independent protective factor for POD ( P<0.05). The area under the curve of preoperative TG/HDL-C ratio in predicting POD was 0.758, with a specificity of 0.809 and sensitivity of 0.633, and the optimal cut-off value was 3.285 ( P<0.001). Conclusions:Elevated preoperative TG/HDL-C ratio is an independent risk factor for POD and may have a certain predictive value for POD in geriatric patients undergoing internal fixation for lower limb fracture.

Objective:To explore the mediating role of coping strategies in the relationship between disease uncertainty and post-discharge coping difficulties in mothers of preterm infants.Methods:A convenience sampling method was used to select 255 mothers of preterm infants from Shandong Provincial Hospital Affiliated to Shandong First Medical University, Linyi People 's Hospital, Weifang Maternal and Child Health Hospital, Maternal and Child Care Center of Dezhou, Dongying People 's Hospital between March and May 2023. General information surveys, the Parents ' Perception of Uncertainty Scale, the Simple Coping Style Questionnaire, and Post-Discharge Coping Difficulty Scale-Parent Form were administered on the day of discharge and 3 weeks post-discharge. Structural equation modeling was constructed using AMOS 23.0 software, and the mediating effect was tested using the Bootstrap method. Results:The disease uncertainty score for the 255 mothers of preterm infants was 66.00 (53.00, 77.00), the active coping score was 23.00 (17.00, 27.00), the passive coping score was 10.00 (7.00, 13.00), and the post-discharge coping difficulties score was 42.00 (26.00, 55.00). Mediating effect analysis showed that active and passive coping partially mediated the relationship between disease uncertainty and post-discharge coping difficulties, with mediating effects of 18.73% and 17.06%, respectively.Conclusions:Disease uncertainty can indirectly affect post-discharge coping difficulties through active and passive coping strategies. Healthcare providers should assist mothers of preterm infants in appropriately managing disease uncertainty and actively coping with challenges.

Influenza virus pneumonia （IVP） is an acute inflammatory disease of the lung with high incidence rate and infectivity caused by invading of the virus into the lower respiratory tract. At present, the treatment of IVP is mainly based on anti-influenza virus infection strategies, including the use of influenza vaccines and anti-influenza virus drugs. Due to the strong variability of viral antigens, it is difficult to obtain long-lasting immunity through vaccination. Commonly used chemical//biological antiviral drugs usually target a single specific viral protein. The mutation and evolution of the virus can reduce its efficacy or render it ineffective, which may lead to drug resistance, limiting the clinical application of these treatment options. Traditional Chinese Medicines （TCMs） have a long history in the prevention and treatment of IVP and are widely used in clinical practice due to their unique advantages and clear therapeutic effects. The research progress on the pathogenesis of IVP, effective prevention and treatment of TCMs for IVP, and the mechanism of action of its active ingredients were reviewed, which could provide new ideas for the treatment of IVP and reference for the development of new multi-target and low toxicity drugs.

Objective To externally validate a prediction model based on clinical and CT imaging features for the preoperative identification of high-grade patterns (HGP), such as micropapillary and solid subtypes, in early-stage lung adenocarcinoma, in order to guide clinical treatment decisions. Methods This study conducted an external validation of a previously developed prediction model using a cohort of patients with clinical stage ⅠA lung adenocarcinoma from the Fourth Hospital of Hebei Medical University. The model, which incorporated factors including tumor size, density, and lobulation, was assessed for its discrimination, calibration performance, and clinical impact. Results A total of 650 patients (293 males, 357 females; age range: 30-82 years) were included. The validation showed that the model demonstrated good performance in discriminating HGP (area under the curve>0.7). After recalibration, the model's calibration performance was improved. Decision curve analysis (DCA) indicated that at a threshold probability>0.6, the number of HGP patients predicted by the model closely approximated the actual number of cases. Conclusion This study confirms the effectiveness of a clinical and imaging feature-based prediction model for identifying HGP in stage ⅠA lung adenocarcinoma in a clinical setting. Successful application of this model may be significant for determining surgical strategies and improving patients' prognosis. Despite certain limitations, these findings provide new directions for future research.

Objective:To evaluate the value of preoperative triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio in predicting postoperative delirium (POD) following internal fixation for lower limb fracture in geriatric patients.Methods:In this retrospective case-control study, the medical records of patients, aged ≥ 65 yr, with American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, who underwent internal fixation for lower limb fracture under general anesthesia or spinal-epidural anes-thesia at Hebei General Hospital from January 2023 to July 2024, with the postoperative length of hospital stay of at least 3 days, were collected. The baseline characteristics, preoperative length of hospital stay, parameters of the last preoperative laboratory tests, type of surgery, anesthesia method, duration of surgery and anesthesia, and intraoperative hypotension and fluid intake and output were collected, and the ratio of TG to HDL-C was calculated. Patients were stratified into POD group and non-POD group based on whether POD developed. The logistic regression was carried out to identify influencing factors for POD. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive accuracy of preoperative TG/HDL-C ratio in predicting POD.Results:A total of 234 patients were finally included, of whom 30 developed POD, with an incidence of 12.8%. The results of multivariate logistic regression indicated that the elevated preoperative TG/HDL-C ratio, increased WBC count and a history of cerebrovascular disease were independent risk factors for POD, and the increased albumin concentration was an independent protective factor for POD ( P<0.05). The area under the curve of preoperative TG/HDL-C ratio in predicting POD was 0.758, with a specificity of 0.809 and sensitivity of 0.633, and the optimal cut-off value was 3.285 ( P<0.001). Conclusions:Elevated preoperative TG/HDL-C ratio is an independent risk factor for POD and may have a certain predictive value for POD in geriatric patients undergoing internal fixation for lower limb fracture.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.