OBJECTIVE: To compare the efficacy and safety of intravenous colistin sulfate combined with nebulized inhalation versus intravenous monotherapy for pulmonary infections caused by carbapenem-resistant organism (CRO). METHODS: A multicenter retrospective cohort study was conducted. Clinical data were collected from patients admitted to the intensive care unit (ICU) of 10 tertiary class-A hospitals in Henan Province between July 2021 and May 2023, who received colistin sulfate for CRO pulmonary infections. Data included baseline characteristics, inflammatory markers [white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), C-reactive protein (CRP)], renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN)], life support measures, anti-infection regimens, clinical efficacy, microbiological clearance rate, and prognostic outcomes. Patients were divided into two groups: intravenous group (colistin sulfate monotherapy via intravenous infusion) and combination group ((intravenous infusion combined with nebulized inhalation of colistin sulfate). Changes in parameters before and after treatment were analyzed. RESULTS: A total of 137 patients with CRO pulmonary infections were enrolled, including 89 in the intravenous group and 48 in the combination group. Baseline characteristics, life support measures, daily colistin dose, and combination regimens (most commonly colistin sulfate plus carbapenems in both groups) showed no significant differences between two groups. The combination group exhibited higher clinical efficacy [77.1% (37/48) vs. 59.6% (52/89)] and microbiological clearance rate [60.4% (29/48) vs. 39.3% (35/89)], both P < 0.05. Pre-treatment inflammatory and renal parameters showed no significant differences between two groups. Post-treatment, the combination group showed significantly lower WBC and CRP [WBC (×10⁹/L): 8.2±0.5 vs. 10.9±0.6, CRP (mg/L): 14.0 (5.7, 26.6) vs. 52.1 (24.4, 109.6), both P < 0.05], whereas NEU, PCT, SCr, and BUN levels showed no significant between two groups. ICU length of stay was shorter in the combination group [days: 16 (10, 25) vs. 21 (14, 29), P < 0.05], although mechanical ventilation duration and total hospitalization showed no significant differences between two groups. CONCLUSIONS Intravenous colistin sulfate combined with nebulized inhalation improved clinical efficacy and microbiological clearance in CRO pulmonary infections with an acceptable safety profile.
Humans ; Colistin/therapeutic use* ; Retrospective Studies ; Administration, Inhalation ; Anti-Bacterial Agents/therapeutic use* ; Carbapenems/pharmacology* ; Male ; Female ; Middle Aged ; Gram-Negative Bacteria/drug effects* ; Aged ; Treatment Outcome ; Respiratory Tract Infections/drug therapy*

Objective To explore the effects of warming-yang and tonifying-qi needling combined with electromyographic biofeedback therapy(EMGBFT)on brain image structure,surface myoelectric characteristics and neurotransmitters in patients with stroke rehabilitation.Methods A prospective research method was conducted in which 200 stroke rehabilitation patients admitted to the Third Hospital of Xingtai City from February 2021 to February 2022 were selected as the study subjects.According to the random principle,the patients were divided into a control group and an study group,with 100 cases in each group.Both groups received routine treatment for stroke,while the control group received a combination of EMGBFT.The study group received a combination of warming-yang and tonifying-qi acupuncture based on the control group,and both groups continued to receive treatment for 9 weeks.Observe the clinical efficacy of two groups of patients and compare the differences in National Institutes of Health Stroke Scale(NIHSS)scores,traditional Chinese medicine symptom scores,brain image structures,serum neurotransmitter levels,and surface electromyography levels before and after treatment,and observe the occurrence of adverse reactions.Results The effective rate of treatment in the study group was significantly higher than that in the control group(97.00％ vs.87.00％,P<0.05).After treatment,NIHSS score,traditional Chinese medicine symptom score,root-mean-square(RMS)of biceps and triceps,and synergistic contraction rate(SCR)were significantly lower than those before treatment in both groups,and the levels of cerebral blood flow(CBF)in the thalamus and frontal lobe,fractional anisotropy(FA),norepinephrine(NE),5-hydroxytryptamine(5-TH),and dopamine(DA)were significantly higher than those before treatment.After treatment,the NIHSS score(4.18±1.09 vs.6.89±1.54),traditional Chinese medicine symptom score(5.41±1.08 vs.9.46±1.55),and biceps RMS(μV:9.76±3.51 vs.16.36±3.44),triceps brachii RMS(μV:6.79±1.83 vs.10.61±2.87),and SCR[(28.08±8.73)％ vs.33.08±9.31)％]were significantly lower than those control group(all P<0.05),the CBF of the thalamus(mL·kg-1·min-1:278.97±86.32 vs.233.63±84.62),and the CBF of the frontal lobe(mL·kg-1·min-1:299.31±75.54 vs.262.81±87.18),FA(0.57±0.18 vs.0.48±0.14),serum 5-HT(ng/L:352.83±38.93 vs.306.71±32.54),NE(ng/L:160.83±17.25 vs.122.81±12.41),DA(μg/L:9.23±0.92 vs.7.36±0.71)were significantly higher than those of the control group(all P<0.05).The incidence of adverse reactions in the study group was significantly lower than that in the control group(3.00％ vs.14.00％,P<0.05).Conclusion Based on EMGBFT,the combination of warming-yang and tonifying-qi acupuncture can synergistically improve the clinical symptoms and brain image structure in stroke rehabilitation patients,and increase their serum neurotransmitter levels,with fewer adverse reactions,which is worthy of promotion.

Objective:To investigate the effect of biological maternal sounds on blood gas analysis index, mechanical ventilation time, oxygen therapy time and hospital stay in mechanically ventilated children with severe pneumonia.Methods:This study was a randomized controlled trial. From June 2020 to November 2020, 128 mechanically ventilated children with severe pneumonia in Hunan Children′s Hospital were selected by convenient sampling method and divided into four groups with 32 cases in each group by random number table method. Group A was given routine nursing care, group B was given mother sounds, group C was given mother cardiotone, group D was given biological maternal sounds. Data of blood gas analysis index, mechanical ventilation duration, oxygen therapy duration, hospital stays were collected for comparative analysis.Results:Finally, group A, B, C, and D included 28, 30, 28 and 28 cases, respectively. There was no statistically significant difference in PaO 2 among the four groups on the 1st to 2nd day after intervention ( P>0.05), but PaO 2 on the 3rd to 7th day after intervention were (75.57 ± 12.88), (77.71 ± 15.81), (78.21 ± 14.51), (78.64 ± 17.71), (79.04 ± 11.57) mmHg (1 mmHg=0.133 kPa), (81.71 ± 17.89), (82.93 ± 18.36), (82.68 ± 15.47), (83.25 ± 14.24), (83.77 ± 13.90) mmHg, (80.89 ± 18.78) (82.11 ± 13.34), (82.96 ± 14.20), (83.43 ± 14.37), (83.68 ± 12.64) mmHg, (84.54 ± 18.77), (86.29 ± 10.94), (86.96 ± 10.53), (87.46 ± 12.64), (89.08 ± 12.21) mmHg, with statistically significant differences ( F values were 41.17 - 332.68, all P<0.01). Further pairwise comparison revealed that PaO 2 in group B and group C were higher than those in group A on the 3rd to 7th day after intervention, while those in group D were higher on the 3rd to 7th day after intervention than those in group A, B, and C, with statistically significant differences( t values were 3.35- 4.75, all P<0.01). There was no statistically significant difference in PaCO 2 among the four groups on the 1st to 4th day after intervention ( P>0.05), but PaCO 2 on the 5th to 7th day after intervention was (47.31 ± 2.89), (46.18 ± 2.06), (41.94 ± 2.09) mmHg, (44.73 ± 1.76), (41.38 ± 1.30), (38.33 ± 1.16) mmHg, (44.81 ± 1.24), (41.23 ± 1.89), (38.73 ± 2.55) mmHg, (40.83 ± 1.78), (37.87 ± 1.43), (34.78 ± 2.05) mmHg, with statistically significant differences ( F=29.48, 36.12, 34.52, all P<0.05). Further pairwise comparison revealed that PaCO 2 in group B and group C were lower than those in group A on the 5th to 7th day after intervention, while PaCO 2 in group D were lower than those in groups A, B, and C, with statistically significant differences ( t values were 3.37-4.85, all P<0.01). During the analysis of PaO 2 and PaCO 2 in the four groups at different time points, the interaction effects were not statistically significant ( P>0.05). There was no significant difference in invasive mechanical ventilation duration, non-invasive mechanical ventilation duration and hospital stay among the four groups after intervention ( P>0.05). The oxygen therapy time of the four groups were (8.61 ± 6.40), (6.17 ± 4.80), (6.23 ± 2.75), and (3.75 ± 2.10) days, with statistically significant differences ( F=17.27, P<0.01). Further pairwise comparison revealed that the oxygen therapy time in group B and group C was shorter than that in group A, while group D was significantly shorter than that in groups A, B, and C, with statistically significant differences ( t values were 4.02-4.74, all P<0.01). Conclusions:Biological maternal sounds is superior to maternal sound and mother cardiotone in improve the blood gas analysis index, shorten the oxygen treatment time, which is worthy of clinical promotion in neonatal unaccompanied ward.

Objective:To summarize the situation of dead newborns and their parents after parents gave up treatment, and analyze the reasons and emotional needs of parents who gave up treatment, so as to provide reference for reducing neonatal mortality and negative emotions of parents.Methods:A retrospective study was conducted to collect the data of neonates and mothers who died after giving up treatment reported in Hunan Children′s Hospital from January 2019 to December 2021. The general information, perinatal risk factors, and the incidence of in-hospital diseases were analyzed. Then, semi-structured interviews were conducted with parents of newborns who died after giving up treatment from February to December 2021. Understand why parents give up treatment and their emotional needs.Results:A total of 172 newborns died after giving up were included in the analysis, including 103 males (59.88%) and 74 premature infants (43.02%); Umbilical cord, placenta and amniotic fluid abnormalities were 21 cases (12.21%), 39 cases (22.67%) and 25 cases (14.53%), respectively. Birth asphyxia was 31 cases (18.02%), including severe asphyxia in 18 cases (10.46%); There were 21 (12.21%), 35 (20.35%) and 30 (17.44%) cases of maternal infection in the third trimester, hypertension in pregnancy and diabetes in pregnancy, respectively. The top three causes of death were septicemia (18.02%), congenital malformation (16.86%) and severe pneumonia (10.47%). The main reason why parents give up treatment was that the child′s disease was critical and irreversible, and parents had strong emotional needs for hospice care in their hearts.Conclusions:There are many high risk factors of perinatal death of newborns after giving up treatment. Sepsis is the primary cause of death, and strengthening perinatal health care is fundamental. Parents have a strong demand for hospice care, so it is of practical significance to implement family-centered hospice care model for such special newborns.

Objective: This study is designed to compare the changes of intestinal microflora and cytokine levels in patients with schizophrenia in different periods, analyze the correlation between intestinal microflora and disease symptoms, and explore the influence of intestinal microflora changes on the symptoms of patients with schizophrenia. Methods: 40 schizophrenic patients in different periods were included in the study, with their demographic data of age, body mass index(BMI), sex and course of disease collected. For each subject, serum was first collected for the levels of cytokines to be determined by an Meso Scale Discovery. The severity of schizophrenia was then assessed using negative and positive symptom scales. Finally macrofactor sequencing of intestinal flora was performed using MetaGeneMark. Results: Serum levels of interleukin-6(IL-6), interleukin-10(IL-10), interleukin-17(IL-17), interleukin-23(IL-23), and tumor necrosis factor-α(TNF-α) in the acute stage were higher than those in remission stage, and the results were statistically significant(P<0.05). Negative and positive symptom Scale(PANSS) positive factor scores were negatively correlated with TNF-α and IL-17(R=-0.312,P<0.05;R=-0.399,P<0.05); IL-23 was positively correlated with the negative factor score of the scale(R=-0.344,P<0.05). IL-6 was positively correlated with scale cognitive factor score(R=-0.339,P<0.05). IL-23 was positively correlated with the total score of the scale(R=-0.370,P<0.05). The microbial diversity detected in stool samples of patients with acute schizophrenia was lower than that of patients with remission, and certain difference was detected in the intestinal flora species composition between patients in the acute stage and in the remission stage. Conclusion The level of serum cytokines in the acute stage of schizophrenia is higher than that in the remission stage, and some cytokines levels are correlated with clinical symptoms.

Objective:To investigate the normal range of fetal ventricles and posterior cranial fossa development in the second and third trimesters and their variations with gestational age using quantitative MRI analysis.Methods:This retrospective study enrolled 675 pregnant women who underwent prenatal MRI examination with an average gestational week of 29.0±8.5 in the Third Affiliated Hospital of Guangzhou Medical University from January 2016 to January 2020. MRI data of all the subjects were collected and analyzed, including left lateral ventricle trigonometric width (LLVTW) and right lateral ventricle trigonometric width (RLVTW), third ventricle width (TVW), fourth ventricle width (FVW), the anterior-posterior diameter of the fourth ventricle (APDFV), cavum septum pellucidum width (CSPW), cisterna magna width (CMW), etc. Spearman, Pearson correlation analysis, and t-test were used for the statistical analysis. Results:(1) Totally 675 fetuses were recruited, including 392 female and 283 male fetuses. No statistical difference of gestational weeks at MRI was found between male and female fetuses. (2)The mean value of TVW and CMW of the female fetuses were significantly higher than those of male fetuses [(0.60±0.05) vs (0.63±0.04) cm, t=－5.059; (0.57±0.14) vs (0.67±0.15) cm, t=－7.445; both P<0.001]. Spearman correlation analysis showed that TVW and CMW were negatively correlated with fetal gender ( r=－0.179 and－0.312, both P<0.001). (3)Pearson correlation analysis showed that LLVTW, RLVTW, TVW, FVW, APDFV, CSPW, and CMW were all positively correlated with gestational weeks ( r=0.310, 0.267, 0.205, 0.801, 0.829, 0.216 and 0.284, all P<0.001). FVW and APDFV were significantly linearly correlated with gestational weeks (r=0.801 and 0.829, both P<0.001). (4) There was no significant change in LLVTW and RLVTW in the second trimester, but a slight increase was found in the third trimester. TVW showed a scattered distribution in the second and third trimesters and increased slightly with the gestational week at 26 to 27 +6 gestational weeks. FVW and APDFV increased linearly while. CSPW increased slowly with gestational weeks in the second and third trimesters. CMW increased slightly with gestational weeks in the second and third trimesters but showed little change in the third trimester. Conclusions:The development of fetal ventricles and posterior cranial fossa in the second and third trimesters show a growth trend of varying degrees with the increase of gestational weeks. TVW and CMW are significantly negatively correlated with the fetal gender.

Objective:To explore whether the inequality of economic development in different provinces in China leads to differences in pediatric nurses ′ health education literacy and to analyze related factors affecting pediatric nurses ′ health education literacy. Methods:Self-designed and tested online questionnaire of competencies in health education (scoring scale 10-50) were distributed to pediatric nurses in China in October 2018. We examined the influencing factors of competencies in health education and its relationship with the province-level data on gross domestic product (GDP) per capita.Results:A total of 15 443 pediatric nurses from 31 provinces were eligible for the analysis. At the regional of GDP per capital over than 20 000 US dollars, 15 000 to 20 000 US dollars, 10 000 to 14 900 US dollars and less than 10 000 US dollars, the health education literacy scores were 40.76±4.52, 40.66±4.08, 40.50± 4.02 and 39.69±4.32 respectively. Significant difference was found between the competencies in health education of pediatric nurses and provinces with different GDP per capita ( F value was 9.21, P<0.001). Regression and hierarchical analysis models based on GDP per capita showed that: nurses with senior professional titles, bachelor degrees or above, aged over 40, and those working in emergency rooms have higher competencies in health education ( OR value was 0.296-4.766, P<0.05) . Lower competencies in health education were demonstrated on nurses who have been working less than 5 years ( OR value was 0.319, P<0.05). Conclusions:Economic development is one of the main factors that affect the competencies in health education of pediatric nurses in China. Pediatric nurses who were young, had limited working experience, with low office titles, with low education background, and who working at non-emergency rooms require more training.

Objective To investigate the distribution of urinary iodine level and its relationship with thyroid function in Tibetan adults in Lhasa. Methods Tibetan residents living in Lhasa and its surrounding countryside were recruited by the method of multistage randomized cluster sampling. Their salt iodine, drinking water iodine, urinary iodine, and thyroid function levels were detected. According to the urinary iodine level, these subjects were divided into the iodine deficiency group ( urinary iodine<100μg/L) , the iodine enough group ( urine iodine 100-199μg/L) , the iodine adequate group ( urine iodine 200-299 μg/L ) and the iodine excessive group ( urine iodine≥300μg/L) . The differences in thyroid function among various groups were compared. Results A total of 2235 subjects were included in the study. The overall level of urinary iodine was in skewed distribution, with a median ( upper and lower quartiles) of 154 (99, 229) μg/L. The proportion of subjects with insufficient iodine intake was 25.7％, while those of the enough, adequate, and excessive groups were 41. 5％, 21. 3％, and 11. 5％, respectively. There was no significant difference in urine iodine level between males and females [152(95,219)μg/L vs 155(100,232)μg/L P>0.05]. The urinary iodine levels in residents of urban were higher than those in rural residents [157(101,232)μg/L vs 140(92,200)μg/L, P<0.05]. The urinary iodine levels in the young, middle-aged, and elderly groups were 175 ( 116,256) , 136 ( 91, 200) , and 116 ( 68, 164)μg/L respectively, showing a gradual decrease in urine iodine level with aging (P<0.05). The average salt iodine content of Tibetan adults in Lhasa was 23.16 mg/kg, and that in drinking water was 4.33μg/L. There were no significant differences in TSH levels among various iodine intake groups ( P>0.05) . The levels of thyroid peroxidase antibody ( TPOAb) and thyroglobulin antibody ( TGAb) were gradually decreased with the increase of urinary iodine level (P<0.05). Conclusion More than 50％ of Tibetans are at the status of low iodine and high iodine intakes in Lhasa. Although the salt iodine content meets national standards, the drinking water iodine content is lower than that standard.

Objective To investigate the distribution of diarrhea pathogens in infants without rotavirus-detection in Hangzhou. Methods 605 stool samples of children with rotavirus-negative diarrhea were collected from Hangzhou First People's Hospital of Zhejiang University, Children's Hospital of Zhejiang University and Hangzhou Children's Hospital from March 2017 to June 2018. The routine test results were analyzed retrospectively and Bristol score was used for the characteristics of stool samples. DNA and/or RNA were extracted from fecal samples with DNA and RNA extraction kit. The extracted DNA and RNA-reversed cDNA were used as templates. 7 common pathogens DNA and/or RNA were amplified by polymerase chain reaction (PCR). The amplified products were detected by agarose gel electrophoresis. The positive rates of pathogens were analyzed by chi-square test. Results Among 605 children, 375 were male (28±11) months and 230 were female (29±10) months. Bristol score of stool samples was mainly in type 6 (496, 82％), followed by type 7 (85, 14％) and type 5 (24, 4％). Among 605 results 97 cases were occult blood positive (positive rate 16％) and 170 cases were white blood cell positive (positive rate 28％).452 of 605 stool samples were positive for pathogen target genes. The positive rate was 74.7％. 319 cases detected single pathogen gene fragments. 127 cases detected two pathogen genes and 6 cases detected three pathogen gene fragments. The positive rate of Clostridium difficile toxin B (48.9％, 296/605)was the highest than the others, followed by Salmonella (20.0％, 121/605) and Norovirus (10.9％, 66/605). The positive rate of Clostridium difficile toxin A was 1.0％ (6/605). The positive rates of pathogens in male and female children were 86.7％(325 / 375) and 86.5％ (199 / 230) respectively, with (χ2 =0.002, P=0.959). Conclusions Salmonella and Norovirus were the main pathogens in children with diarrhea who were negative for rotavirus detection in Hangzhou. The high positive rate of Clostridium difficile toxin B may be related to the colonization of Clostridium difficile in the gastrointestinal tract of infants rather than the pathogen of diarrhea because of the low positive rate of Clostridium difficile toxin A. There was no gender difference in the detection rate of diarrhea pathogens.

Objective To investigate the relationship between intelligence impairment and interictal epileptiform discharges spreading in mesial temporal lobe epilepsy(mTLE)patients. Method We assessed 145 patients diagnosed as mTLE and their general materials, analyzed the relationship between intelligence impairment and interictal epileptiform discharges spreading. Results ①Patients with mTLE with longer disease course and higher frequencies of epilepsy tended to have a severe impairment in the total intelligence quotient (IQ), verbal intelligence quotient (vIQ) and performance intelligence quotient (pIQ). ② IQ of was negatively correlated with the condition that interictal epileptiform discharges spreading to the ipsilateral central and parietal region in patients with left lesion; pIQ was negatively correlated with the condition that interictal epileptiform discharges spreading to the ipsilateral frontal region, while positively correlated with the condition that interictal epileptiform discharges spreading to the ipsilateral occipital region in patients with right lesion. Conclusion ①Intelligence impairment of mTLE patients is related with courses and frequencies.②Total IQ is more severely impaired by interictal epileptiform discharges spreading to the ipsilateral central and parietal region in left mTLE patients, and the pIQ is more severely impaired by interictal epileptiform discharges spreading to the ipsilateral frontal region in right mTLE patients.