Objective To investigate the expression and clinical significance of serum microRNA-141-3p(miR-141-3p)and Kelch like epichlorohydrin associated protein 1(KEAP1)in neonatal acute respiratory dis-tress syndrome(NARDS).Methods A total of 121 children with NARDS admitted to the hospital from Janu-ary 2022 to March 2024(NARDS group)and 65 healthy neonates during the same period(control group)were selected.According to the degree of disease,the children with NARDS were divided into the mild NARDS group(4≤oxygen index<8,48 cases),the moderate NARDS group(8≤oxygen index<16,46 ca-ses),the severe NARDS group(oxygen index≥16,27 cases),and the children with NARDS were divided into the death group(18 cases)and the survival group(103 cases)according to the 28-day prognosis.Serum miR-141-3p and KEAP1 levels were detected by fluorescence quantitative polymerase chain reaction and enzyme-linked immunosorbent assay.The correlation between serum miR-141-3p and KEAP1 levels in children with NARDS was analyzed by Pearson correlation coefficient.The correlation between serum miR-141-3p and KEAP1 levels and oxygen index in children with NARDS was analyzed by Spearman correlation coefficient.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive efficacy of serum miR-141-3p and KEAP1 levels on the death in children with NARDS.Results Serum miR-141-3p level in the NARDS group was lower than that in the control group,and KEAP1 level in the NARDS group was higher than that in the control group(t=14.288,12.596,P<0.001).There was a binding site between miR-141-3p and KEAP1 at the 3'-untranslated region 131-138.Pearson correlation showed that serum miR-141-3p was negatively correlated with KEAP1 level in children with NARDS(r=-0.745,P<0.001).The levels of ser-um miR-141-3p increased sequentially in the severe NARDS group,moderate NARDS group,and mild NARDS group,while the level of KEAP1 decreased sequentially(F=185.469,113.126,P<0.001).Spearman correla-tion coefficient showed that oxygen index in children with NARDS was negatively correlated with serum miR-141-3p level(r=-0.815,P<0.001)and positively correlated with serum KEAP1 level(r=0.827,P<0.001).Serum miR-141-3p level in the dead group was lower than that in the survival group,and KEAP1 level was higher than that in the surviving group(t=4.213,4.495,P<0.001).The area under the curve of the combined prediction of serum miR-141-3p and KEAP1 levels for the death in children with NARDS was 0.878(95%CI:0.806-0.930),which was greater than 0.783(95%CI:0.699-0.853)and 0.786(95%CI:0.702-0.855)predicted by serum miR-141-3p and KEAP1 levels alone(Z=2.963,2.021,P<0.05).Conclu-sion The serum miR-141-3p level is decreased and the KEAP1 level is increased in children with NARDS,which is associated with worsening of the disease and poor prognosis.The combination of serum miR-141-3p and KEAP1 levels has high predictive efficacy for death in children with NARDS.

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 investigate the clinical efficacy and safety of two thrombus thrombectomy devices,AcoStream and AngioJet,in the treatment of acute iliofemoral vein thrombosis(AIFVT).Methods A total of 97 AIFVT patients were treated with different thrombus clearing devices according to their states of illness,and patients were divided into the AcoStream group(41 cases)and the AngioJet group(56 cases).The thrombus clearing status,degree of swelling reduction in affected limb,surgical time and intraoperative blood loss were compared between the two groups,and the need for assisted catheter contact thrombolysis(CDT)treatment,urokinase dosage,iliac vein stent placement,incidence of complications,length of hospital stay and hospitalization costs were also compared between the two groups.Regular follow-up was conducted to record for recurrence of thrombosis,the patency of the stent,deep vein thrombosis syndrome(PTS)and PTS degree were evaluated in lower limbs.Results There were no significant differences in age,gender,affected limb,time of illness,site of illness and causes of illness between the two groups(P＞0.05).The operation was successful in both groups and the thrombus removal effect was satisfactory.There were no significant differences in terms of thrombus clearance rate,the degree of swelling reduction in the limb 48 hours after surgery and assisted CDT rate between the two groups(P＞0.05).Compared with the AcoStream group,the AngioJet group had a longer surgical time,reduced intraoperative blood loss,increased hospitalization costs and higher rates of complications(P＜0.05).There was no significant difference in the recurrence rate of thrombosis between the two groups(P＞0.05),and there was no occurrence of iliac vein stent occlusion or PTS in either patients.Conclusion Two mechanical thrombus clearing devices of AcoStream and AngioJet are safe and effective for treating AIFVT.

Objective:To explore the potential categories of transformation shock levels among newly employed nurses and their influencing factors, in order to provide references for implementing targeted interventions.Methods:In March and April 2024, a convenience sampling method was used to select 208 nurses undergoing standardized training at Beijing Tiantan Hospital, Capital Medical University, as the study subjects. The Transformation Shock Evaluation Scale, the Chinese Registered Nurse Core Competency Scale, and the Work Confidence and Ability Scale were used for data collection. Latent profile analysis was employed to identify the potential categories of transformation shock levels among newly employed nurses, and multinomial Logistic regression was used to analyze the influencing factors for different categories.Results:A total of 208 questionnaires were distributed, with 195 valid ones returned, yielding an effective response rate of 93.75%. The overall transformation shock score of the 195 newly employed nurses was (2.10±0.84), the career core competency score was (179.30±35.32), and the work confidence and ability score was (80.01±10.64). The transformation shock levels of the newly employed nurses were divided into four categories: high transformation shock-negative coping group (22.56%, 44/195), moderate transformation shock-psychological barrier group (29.23%, 57/195), lower transformation shock-high communication effectiveness group (36.41%, 71/195), and low transformation shock-high coping ability group (11.79%, 23/195). Logistic regression analysis showed that education level, clinical nursing ability, leadership, communication, critical thinking and research ability were influencing factors for the different categories of transformation shock levels among newly employed nurses ( P<0.05) . Conclusions:The transformation shock levels among newly employed nurses exhibit distinct categorical characteristics. Nursing education and management personnel should provide targeted training based on the influencing factors of different categories to reduce the level of transformation shock.

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 investigate the clinical efficacy and safety of two thrombus thrombectomy devices,AcoStream and AngioJet,in the treatment of acute iliofemoral vein thrombosis(AIFVT).Methods A total of 97 AIFVT patients were treated with different thrombus clearing devices according to their states of illness,and patients were divided into the AcoStream group(41 cases)and the AngioJet group(56 cases).The thrombus clearing status,degree of swelling reduction in affected limb,surgical time and intraoperative blood loss were compared between the two groups,and the need for assisted catheter contact thrombolysis(CDT)treatment,urokinase dosage,iliac vein stent placement,incidence of complications,length of hospital stay and hospitalization costs were also compared between the two groups.Regular follow-up was conducted to record for recurrence of thrombosis,the patency of the stent,deep vein thrombosis syndrome(PTS)and PTS degree were evaluated in lower limbs.Results There were no significant differences in age,gender,affected limb,time of illness,site of illness and causes of illness between the two groups(P＞0.05).The operation was successful in both groups and the thrombus removal effect was satisfactory.There were no significant differences in terms of thrombus clearance rate,the degree of swelling reduction in the limb 48 hours after surgery and assisted CDT rate between the two groups(P＞0.05).Compared with the AcoStream group,the AngioJet group had a longer surgical time,reduced intraoperative blood loss,increased hospitalization costs and higher rates of complications(P＜0.05).There was no significant difference in the recurrence rate of thrombosis between the two groups(P＞0.05),and there was no occurrence of iliac vein stent occlusion or PTS in either patients.Conclusion Two mechanical thrombus clearing devices of AcoStream and AngioJet are safe and effective for treating AIFVT.

Objective:To explore the potential categories of transformation shock levels among newly employed nurses and their influencing factors, in order to provide references for implementing targeted interventions.Methods:In March and April 2024, a convenience sampling method was used to select 208 nurses undergoing standardized training at Beijing Tiantan Hospital, Capital Medical University, as the study subjects. The Transformation Shock Evaluation Scale, the Chinese Registered Nurse Core Competency Scale, and the Work Confidence and Ability Scale were used for data collection. Latent profile analysis was employed to identify the potential categories of transformation shock levels among newly employed nurses, and multinomial Logistic regression was used to analyze the influencing factors for different categories.Results:A total of 208 questionnaires were distributed, with 195 valid ones returned, yielding an effective response rate of 93.75%. The overall transformation shock score of the 195 newly employed nurses was (2.10±0.84), the career core competency score was (179.30±35.32), and the work confidence and ability score was (80.01±10.64). The transformation shock levels of the newly employed nurses were divided into four categories: high transformation shock-negative coping group (22.56%, 44/195), moderate transformation shock-psychological barrier group (29.23%, 57/195), lower transformation shock-high communication effectiveness group (36.41%, 71/195), and low transformation shock-high coping ability group (11.79%, 23/195). Logistic regression analysis showed that education level, clinical nursing ability, leadership, communication, critical thinking and research ability were influencing factors for the different categories of transformation shock levels among newly employed nurses ( P<0.05) . Conclusions:The transformation shock levels among newly employed nurses exhibit distinct categorical characteristics. Nursing education and management personnel should provide targeted training based on the influencing factors of different categories to reduce the level of transformation shock.

On February 5,2024,the American Heart Association(AHA)released a scientific statement on the pharmacological management of cardiac arrhythmias in the fetal and neonatal periods.The statement discussed the mechanisms of arrhythmias,medication regimens,and fetal and neonatal aspects of pharmacokinetics.The statement proposed a consensus on drug treatment for arrhythmias in fetuses and newborns.This article interpreted the drug treatment part,and summarized the recommended medication and drug characteristics for fetal and neonatal arrhythmias to provide a reference for the drug treatment of fetal and neonatal arrhythmias in China.

Purpose: This study aimed to determine the optimal cutoff points for age and tumor size of patients with intrahepatic cholangiocarcinoma (ICC) and to establish and verify a predictive nomogram of overall survival at 1, 3, and 5 years. Methods: From the SEER (Surveillance, Epidemiology, and End Results) database, 1,325 ICC patients were selected and randomly divided into training and testing cohorts at a 7:3 ratio. Using the X-tile software, age and tumor size were classified into 3 subgroups: ≤61, 62–74, and ≥75 years and ≤35, 36–55, and ≥56 mm. Subsequently, univariate and multivariate Cox regression analyses were performed using the R software in the training cohort to determine independent risk factors, compile the prediction nomogram, and verify it with the testing cohort findings. Results: The C-indexes of the new prediction nomograms in the training and testing cohorts were 0.738 (95% confidence interval [CI], 0.718–0.758) and 0.750 (95% CI, 0.72–0.78), respectively. Furthermore, the areas under the 1-, 3-, and 5-year receiver operating characteristic (ROC) curves based on the nomogram were 0.792, 0.853, and 0.838, respectively, higher than the ROC based on the 7th and 8th editions of the American Joint Cancer Commission (AJCC) staging system. Conclusion This study established and verified a prognostic nomogram that improved the accuracy of the 1-, 3-, and 5-year survival predictions for ICC patients, compared with that based on the 7th and 8th editions of the AJCC staging system, and can help clinicians make personalized survival predictions.

Abstract: Objective To express Mycobacterium tuberculosis Rv2626c protein in Escherichia coli (E. coli) and study the antigenicity of the purified recombinant Rv2626c protein. Methods The amino acid sequence of Rv2626c protein from Mycobacterium tuberculosis H37Rv strain (accession number: CCP45424.1) in GenBank was retrieved and converted into the corresponding DNA sequence according to the codon preference of E. coli. This DNA sequence was synthesized and cloned into pET24a(+) plasmid to construct pET24a(+)-Rv2626c recombinant plasmid. This plasmid was transformed into E. coli BL21(DE3) cells, and the expression of Rv2626c protein was induced under various conditions of isopropyl β-D-thiogalactopyranoside (IPTG) concentrations, temperature, and period. The recombinant Rv2626c protein was identified by SDS-PAGE and Western Blot. The recombinant Rv2626c protein was purified by nickel chelate affinity chromatography and used to immunize violet blue rabbits to prepare anti-Rv2626c anti-serum. The specificity and titer of the serum were respectively detected by Western Blot and enzyme-linked immunosorbent assay (ELISA). Results The recombinant plasmid pET24a(+)-Rv2626c was successfully constructed. SDS-PAGE analysis showed that recombinant Rv2626c was expressed in the recombinant plasmid transformed E. coli with IPTG induction, with a molecular weight of about 14 500, and the size was consistent with the expectation. The optimal expression condition for recombinant Rv2626c protein was at 31 ℃ with 1.0 mmol/L IPTG for 6 hours. The target protein was mainly present in a soluble form, which was consistent with the results of Western blot. The hyperimmunized serum with recombinant Rv2626c protein vaccination showed good specificity, with a titer of 1∶ 256 000 detected by ELISA. Conclusions Mycobacterium tuberculosis Rv2626c protein is successfully expressed in E. coli, and the purified protein has good purity and antigenic activity, laying the foundation for further reveals of its biological functions.