Objective To investigate the influencing factors of antibiotic-associated diarrhea(AAD)following congenital heart disease(CHD)surgery in pediatric patients,develop a nomogram-based predictive model,and validate its efficacy.Methods A retrospective analysis was conducted on the clinical data of pediatric patients who underwent CHD surgery in the Pediatric Intensive Care Unit(PICU)of a tertiary hospital in Guang-dong Province from July 2022 to July 2024.Patients were categorized into an AAD group and a non-AAD group.Univariate and multivariate logistic regression analyses were performed to identify risk factors for AAD occurrence following CHD surgery.A risk prediction model was developed,and a nomogram was constructed.The predictive performance of the model was evaluated using the Receiver Operating Characteristic(ROC)curve to calculate the area under the curve(AUC),the Hosmer-Lemeshow goodness-of-fit test,calibration curves,and clinical decision curve analysis.External validation of the model was conducted using data from patients in the Surgical Intensive Care Unit(SICU).Results The incidence of AAD following CHD surgery was 48.52%(229 out of 472 cases).Risk factors for AAD included the combined use of antibiotics,mechanical ventilation,elevated C-reactive protein levels,prolonged surgical duration,and extended antibiotic usage time(all with OR>1,P<0.05).Conversely,probiotic administration was identified as a protective factor(OR<1,P<0.05).The predictive model demon-strated excellent discrimination,as evidenced by the ROC curve areas:0.922(95%CI:0.894～0.951)in the modeling group,0.886(95%CI:0.838～0.915)in the internal validation group,and 0.862(95%CI:0.784～0.941)in the external validation group.Additionally,the model exhibited satisfactory calibration,as indicated by the Hosmer-Lemeshow test results:χ2=7.96,P=0.538 in the modeling group;χ2=4.24,P=0.895 in the inter-nal validation group;and χ2=9.923,P=0.270 in the external validation group.Furthermore,the model provided significant clinical utility.Conclusions Combined antibiotic use,duration of antibiotic therapy,mechanical ventilation,surgical duration,C-reactive protein(CRP)levels,and probiotic administration are key factors influ-encing the occurrence of AAD.The risk prediction model developed based on these variables demonstrates robust predictive performance and can serve as a valuable reference for the development and implementation of preventive and therapeutic strategies in clinical practice.

Objective To investigate the influencing factors of antibiotic-associated diarrhea(AAD)following congenital heart disease(CHD)surgery in pediatric patients,develop a nomogram-based predictive model,and validate its efficacy.Methods A retrospective analysis was conducted on the clinical data of pediatric patients who underwent CHD surgery in the Pediatric Intensive Care Unit(PICU)of a tertiary hospital in Guang-dong Province from July 2022 to July 2024.Patients were categorized into an AAD group and a non-AAD group.Univariate and multivariate logistic regression analyses were performed to identify risk factors for AAD occurrence following CHD surgery.A risk prediction model was developed,and a nomogram was constructed.The predictive performance of the model was evaluated using the Receiver Operating Characteristic(ROC)curve to calculate the area under the curve(AUC),the Hosmer-Lemeshow goodness-of-fit test,calibration curves,and clinical decision curve analysis.External validation of the model was conducted using data from patients in the Surgical Intensive Care Unit(SICU).Results The incidence of AAD following CHD surgery was 48.52%(229 out of 472 cases).Risk factors for AAD included the combined use of antibiotics,mechanical ventilation,elevated C-reactive protein levels,prolonged surgical duration,and extended antibiotic usage time(all with OR>1,P<0.05).Conversely,probiotic administration was identified as a protective factor(OR<1,P<0.05).The predictive model demon-strated excellent discrimination,as evidenced by the ROC curve areas:0.922(95%CI:0.894～0.951)in the modeling group,0.886(95%CI:0.838～0.915)in the internal validation group,and 0.862(95%CI:0.784～0.941)in the external validation group.Additionally,the model exhibited satisfactory calibration,as indicated by the Hosmer-Lemeshow test results:χ2=7.96,P=0.538 in the modeling group;χ2=4.24,P=0.895 in the inter-nal validation group;and χ2=9.923,P=0.270 in the external validation group.Furthermore,the model provided significant clinical utility.Conclusions Combined antibiotic use,duration of antibiotic therapy,mechanical ventilation,surgical duration,C-reactive protein(CRP)levels,and probiotic administration are key factors influ-encing the occurrence of AAD.The risk prediction model developed based on these variables demonstrates robust predictive performance and can serve as a valuable reference for the development and implementation of preventive and therapeutic strategies in clinical practice.

Objective:To investigate the effect of protein tyrosine kinase 6(PTK6) on TNF-α induced human airway epithelial barrier dysfunction and mechamism.Methods: After cultivating 16HBE cells in vitro,the recombined PTK6 and PTK6 siRNA was respectively transfected into the cells,with empty vector and scramble siRNA as control.The cells were incubated with exogenous TNF-α.Cell viability was detected by MTT assay.Cells TER and permeability were detected.ZO-1 and Occludin mRNA were analyzed by RT-PCR.PTK6,ZO-1,Occludin,p-ERK1/2,p-JNK1/2 and p-p38MAPK protein were assayed by Western blot.Results: TNF-α remarkably decreased ZO-1 and Occludin mRNA and protein and TER;increased cells permeability,as well as p-ERK1/2,p-JNK1/2 and p-p38 protein(P<0.05).Upregulation of PTK6 further decreased ZO-1 and Occludin mRNA and protein and TER,enhanced cells permeability and p-JNK1/2 and p-p38 protein(P<0.05),and downregulated PTK6 ,the changes of these indices were opposite(P<0.05).Whereas upregulation or downregulation of PTK6 had no effect on p-ERK1/2.Conclusion: Downregulation of PTK6 inhibits the phosphorylation of JNK1/2 and p38MAPK,thus improving TNF-α-induced human airway epithelial barrier dysfunction.

Objective: To explore the effect of caveolin-1 ( Cav-1 ) on lipopolysaccharide ( LPS )-induced airway mucous hypersecretion.Methods:16HBE human airway epithelial cells with Toll-like receptor 4(TLR4) inhibitor,nuclear factor-kappa B(NF-κB) inhibitor,Cav-1 siRNA or plasmid pr-treated,further stimulated with LPS.The cells were divided into 8 groups:the control group, the LPS group,the LPS+Cav-1 expression group,the LPS+Cav-1 siRNA group,the LPS +negative siRNA group,the LPS +empty vector group,the LPS +E5564 group, the LPS +PDTC group.Cell survival rate was detected by MTT assay.Transcription level of mucin(MUC)5AC was evaluated with RT-PCR.The level of MUC5AC protein was measured by ELISA.The expression of TLR4,Cav-1 and phosphorylated IκBα( p-IκBα) were measured by Western blot.MUC5AC protein changes were observed by immunofluorescence and confocal laser technology.Results:LPS remarkably increased MUC5AC,as well as TLR4,p-IκBα(P<0.05).These effects were prevented by E5564 and PDTC.We found that the overexpression of Cav-1 further enhanced the expression of TLR4, p-IκBαand MUC5AC.However,downregulation of Cav-1 inhibited the expression of TLR4,p-IκBα,MUC5AC.Conclusion: Cav-1 enhances LPS-induced MUC5AC hypersecretion through TLR4/NF-κB signaling pathway.

Objective To explore the effects of Xingnaojing injection on plasma MMP-9 and TIMP-1 levels for patients with cerebral hemorrhage. Methods A total of 60 patients with acute cerebral hemorrhage from February 2014 to May 2015 were selected as research subjects and randomly divided into the research group and the control group, with 30 patients in each group. The research group was given Xingnaojing injection on the basis of regular treatment, and the control group was given regular treatment. The plasma MMP-9 and TIMP-1 levels of the two groups of patients were compared, and the correlation between MMP-9 and TIMP-1 levels in the patients and their correlation with cere-bral edema were analyzed. Results On the fifth day of onset of the disease in the two groups of patients, MMP-9 and TIMP-1 levels were significantly increased, and the levels were reduced on the 14th day. On the fifth day and 14th day of onset of the disease in the research group, MMP-9 level was significantly lower than that in the control group, and TIMP-1 level was significantly higher than that in the control group. The differences were statistically significant (P<0.01). In 24 h, the volume of cerebral edema in the two groups was positively correlated to MMP-9 (r=0.682, P=0.761), and was significantly negatively correlated to TIMP-1(r=-0.489, P=-0.619); on the 14th day, the volume of cerebral edema was positively correlated to MMP-9 (r=0.516, P=0.835). Conclusion Xingnaojing is able to significantly reduce the increasing degree of MMP-1 in the patients with cerebral hemorrhage, enhance the increasing degree of TIMP-1, and improve patients' cerebral edema.