Objective: To explore the correlation and lag effects of environmental factors on pediatric respiratory disease visits at hospital, so as to provide scientific basis for disease prediction and optimizing clinical diagnosis and treatment. Methods: Data from 503 889 pediatric respiratory disease outpatient and emergency visits a central hospital in Minhang District of Shanghai between 2017 and 2019, along with concurrent meteorological data were collected. A distributed lag non-linear models (DLNM) was constructed to explore the specific relationship between pediatric respiratory disease consultations and various environmental factors and to quantify the cumulative lag effects of environmental factors on respiratory disease consultations. Results: Among the environmental factors, temperature, fine particulate matter (PM 2.5 ), inhalable particulate matter (PM 10 ), nitrogen dioxide (NO 2), and sulfur dioxide (SO 2) were associated with pediatric respiratory disease visits. After adjusting for temperature, PM 2.5 and PM 10 concentrations did not show significant immediate or lag effects. The relative risk (RR) of pediatric respiratory disease visits increased with rising NO 2 concentrations. When NO 2 concentration ≥55 μg/m 3, significant immediate and lagged effects (lag 3, 5, and 7 days) were observed. The RR values were 1.05, 1.13, 1.17, and 1.21( P <0.05). The RR values showed an inverted “U” shaped relationship with SO 2 concentrations. When SO 2 concentration ≥5 μg/m 3, significant lagged effects (lag 3, 5, and 7 days) were observed. The RR values were 1.03 , 1.03, and 1.04 ( P <0.05). Conclusion High concentrations of NO 2 and SO 2 increase the risk of pediatric respiratory disease visits, with observable lag effects.

ObjectiveTo evaluate the clinical efficacy and safety of Baoshen prescription in the treatment of stage Ⅳ diabetic nephropathy （DN） in the patients with syndromes of Qi-Yin deficiency and kidney collateral stasis and obstruction， and to explore the mechanism of this prescription delaying the disease progression. MethodsA randomized， controlled， double-blind， multicenter clinical trial was conducted， in which 94 stage Ⅳ DN patients with syndromes of Qi-Yin deficiency and kidney collateral stasis and obstruction were randomly assigned into Baoshen prescription and control groups （47 cases）. The treatment lasted for 12 weeks. The primary efficacy indicators were mainly renal function indexes， including urine albumin-to-creatinine ratio （UACR）， 24-hour urine total protein （24 h-UTP）， serum creatinine （SCr）， and estimated glomerular filtration rate （eGFR）. The secondary efficacy indicators were metabolic memory of hyperglycemia， podocyte epithelial-to-mesenchymal transdifferentiation-related indexes， and TCM syndrome score. ResultsAfter 12 weeks of treatment， the Baoshen prescription group showed lowered levels of advanced glycation end products （lgAGEs）， connective tissue growth factor （CTGF）， type Ⅳ collagen （Col-Ⅳ）， receptor of AGEs （RAGE）， urinary fibroblast-specific protein-1 （FSP-1）， UACR， 24 h-UTP， and glycated hemoglobin （HbAlc） （P<0.05）， and an upward trend of miR-21 mRNA. The control group showed elevated levels of SCr and UREA and lowered levels of urinary FSP-1， eGFR， and HbAlc （P<0.05）. After treatment， the Baoshen prescription group had lower levels of lgAGEs， CTGF， urinary FSP-1， SCr， UACR， and 24 h-UTP and higher levels of Col-Ⅳ and eGFR than the control group （P<0.05）. In addition， the Baoshen prescription group showed statistically significant differences in SCr， eGFR， UACR， and 24 h-UTP before and after treatment （P<0.05）. ConclusionBaoshen prescription can effectively improve the renal function， reduce the urinary protein level， and alleviate clinical symptoms in stage Ⅳ DN patients with syndromes of Qi-Yin deficiency and kidney collateral stasis and obstruction. The mechanism may be related to the metabolic memory of hyperglycemia and epithelial-to-mesenchymal transdifferentiation of podocytes.

An animal biosafety level-3 laboratory(ABSL-3)is a high-level biosafety installation that can conduct experiments on animals infected with highly pathogenic microorganisms.In recent years,with the continuous characterization of emerging and re-emerging infectious diseases,high-level biosafety laboratories have played increasingly important roles in pathogenic mechanism and drug and vaccine research and development.The demand for ABSL-3 is increasing year by year.At the same time,there is also a growing demand for personnel who are competent in working in ABSL-3.The systematization,normalization,and standardization of pre-service training have become important to guarantee a reduction in the risks to personnel working in ABSL-3.Training of ABSL-3 staff needs to be carried out in specific simulated laboratories.Therefore,it is necessary to construct simulated ABSL-3 and establish scientific and effective operating standards and mechanisms.This paper comprehensively introduces the design,construction,operation,and functions of a simulated ABSL-3 installation.

Objective Based on the limited time theory,taking tonsillectomy day operation as an example,the whole process nursing list of day operation was constructed,and its application effect was evaluated.Methods The nursing service list of tonsillectomy was constructed based on literature research,field observation and expert correspondence.A total of 197 patients who underwent tonsillectomy in the day ward of a tertiary A general hospital in Hangzhou,Zhejiang Province were selected.Among them,98 patients from April to June 2023 were taken as an experimental group and treated with the whole-process nursing list of daytime tonsillectomy constructed in this study,and 99 patients from January to March 2023 were taken as a control group and routine nursing was adopted.The anxiety degree,postoperative pain score,postoperative complication rate and patients'satisfaction with nursing service were compared between the 2 groups.Results Anxiety scores before operation and at discharge,pain scores at 6 h,12 h and 24 h after operation,and incidence of complications such as infection and gastrointestinal reaction within 14 days after operation in the experimental group were lower than those in the control group,with statistical significance(P＜0.05).The satisfaction of nursing service in the experimental group(99.40±0.69)score was significantly higher than that in the control group(90.36±1.04)score,and the difference was statistically significant(P＜0.001).Conclusion The use of tonsillectomy day whole-process nursing list can improve perioperative anxiety,relieve postoperative pain and reduce the incidence of postoperative complications,and improve patient satisfaction.

To summarize the nursing experience of a patient with cardiac resynchronization therapy defibrillator(CRT-D)implantation who was about to deplete battery due to repeated discharge after implantation and underwent left ventricular assist device implantation combined with cryoablation.Key points of care were as follows.To begin with,we actively managed arrhythmias and electric storm.Secondly,we carried refined capacity management to avoid water and sodium retention.Thirdly,we formulated personalized anticoagulation programs to reduce the risk of bleeding and thrombosis.Then,the pump line infection should be prevented as early as possible.At the whole stage,we provided psychological counseling to improve emotional state.After discharge,regular follow-up was carried out through online and offline method to ensure quality of life in the long term.After careful treatment and nursing care,23 days after surgery,the patient was discharged smoothly,and good follow-up after discharge.

To report 7 Chinese children with characteristic hyperpigmented macules on the forehead and temples. Among the 7 cases, there were 2 males and 5 females, with the age at onset ranging from 9 to 24 months (12.43 ± 5.32 months), and the disease duration being 1 - 4 months (2.57 ± 1.27 months). Skin examination revealed that the children presented with varying numbers of irregular brown macules and patches scattered on their foreheads and temples, without obvious desquamation. Dermoscopic examination revealed multiple yellowish-brown patches with irregular borders, and linear vessels were observable in some skin lesions. A diagnosis of acquired facial hyperpigmented macules was made in these children. The children received no treatment. After 2 years of follow-up, hyperpigmented macules completely subsided in 2 cases and regressed to varying degrees in 4 cases, while 1 case exhibited no changes in the skin lesions. Considering the literature and the cases discussed in this article, it is hypothesized that acquired facial hyperpigmented macules in young children may represent an independent condition.

Objective:To investigate the status quo of psychological contracts and influencing factors among members of the "1+N" family doctor teams in Shenzhen and to explore the impact of psychological contracts on job burnout.Methods:This cross-sectional study was conducted from September 30 to October 31, 2022 among 361 members of 92 family doctor teams from 92 community health service centers which provided family doctor team service in Shenzhen city. A self-designed general information questionnaire, an employee psychological contract questionnaire (including organizational responsibility and personal responsibility dimensions), and a job burnout scale (including emotional exhaustion, depersonalization, and personal accomplishment dimensions) were used in the study. T-tests, one-way ANOVA, Pearson correlation analysis, and multiple linear regression analysis were used to analyze the influencing factors of psychological contracts and job burnout.Results:Among 361 respondents, there were 299 females (82.8%) and 62 males (17.2%), and a higher proportion of general practitioners (37.5%, 129/361) and nurses (41.8%, 151/361). The total score of psychological contracts among the 361 respondents was (141.6±19.5), with organizational responsibility scoring (70.6±11.2) and personal responsibility scoring (71.0±9.3). On the job burnout scale, emotional exhaustion scored (17.89±6.82), depersonalization scored (6.51±2.54), and personal accomplishment scored (30.95±5.70). General practitioners scored lower in organizational responsibility and personal responsibility compared to other members ( F=7.341,3.119, all P<0.05), and higher in emotional exhaustion and depersonalization ( F=7.637, 2.415, all P<0.05). Members with≤5 years of work experience scored lower in personal responsibility and personal accomplishment ( F=3.656, 4.205, all P<0.05). Correlation analysis showed that scores of organizational responsibility and personal responsibility were negatively correlated with levels of emotional exhaustion and depersonalization ( r=-0.618, -0.526, all P<0.01), ( r=-0.404, -0.393, all P<0.01), and positively correlated with personal accomplishment ( r=0.500, 0.558, all P<0.01). Multiple linear regression analysis indicated that organizational responsibility negatively affected emotional exhaustion and depersonalization ( β=-0.554, -0.274, all P<0.01), and positively affected personal accomplishment ( β=0.172, P<0.05). Personal responsibility positively affected personal accomplishment ( β=0.404, P<0.01). Conclusions:The study demonstrates that general practitioners in family doctor teams in Shenzhen city have lower psychological contract levels and are more prone to emotional exhaustion and depersonalization; members with≤5 years of work experience have lower personal responsibility and accomplishment. The results indicate that enhancing organizational responsibility can reduce job burnout of members in family doctor teams.

Objective To investigate the clinical features,treatment and prognosis of children with histiocytic necrotizing lymphadenitis(HNL).Methods The clinical data of 72 children with HNL diagnosed and treated in the Department of Infectious Diseases,Children's Hospital Affiliated to Shandong University from January 2019 to December 2023 were reviewed.The clinical symptoms,laboratory examination,imaging examination,pathological findings,treatment and follow-up were retrospectively analyzed.Results Among the 72 children,49 were males and 23 were females.The age was 3 to 15 years old,of which 55 cases(76.4％)ranged from 8 to 13 years.The duration of the first onset was 2-60 days,with an average of 15 days.All the children had fever and lymph node enlargement.Only abdominal lymph node lesions were present in 1 case,and cervical lymph nodes were involved in the rest.In the course of the disease,a few of the children had rash,joint swelling and pain and aseptic meningitis.One patient had coronary artery and jugular dilatation.In the acute stage of the disease,most children had decreased white blood cells and hemoglobin,increased erythrocyte sedimentation rate and lactate dehydrogenase.71 cases were treated with glucocorticoid,and 69 cases were treated for 8-12 weeks.The longest follow-up of the newly diagnosed cases has been nearly 5 years,except for one patient who developed cutaneous lupus,no case has recurred or progressed to other immune diseases.Conclusion Children HNL is more common in school-age children.The overall incidence is higher in boys than girls.Most children with HNL present with cervical lymph node enlargement,and very few patients only involve deep lymph nodes.It can also cause vascular lesions.Treatment with glucocorticoids for 2 to 3 months after diagnosis may reduce recurrence and prevent disease progression.

AIM:To investigate the effects of Shaoyao-Gancao decoction(SGD)on inflammation and mucosal barrier damage in rats with 2,4,6-trinitrobenzenesulfonic acid(TNBS)-induced inflammatory bowel disease(IBD).METHODS:Forty-eight male SD rats were randomly divided into normal group,model group,high-dose(500 mg/kg),medium-dose(250 mg/kg)and low-dose(125 mg/kg)SGD groups,and balsalazide sodium(1 g/kg)group.All rats were pre-administered for 3 d,and on the 4th day of the experiment,they were fasted for 24 h.Except for the normal group,the rats in the other 5 groups were given enema mixed with TNBS(100 mg/kg)and 50％ethanol,and continued to be adminis-tered for 5 d after modeling.After modeling,the disease activity index(DAI)was evaluated.After the experiment,the levels of nitric oxide(NO)and myeloperoxidase(MPO)in serum and colonic tissues of rats were determined.RT-qPCR and Western blot were used to determine tumor necrosis factor-α(TNF-α),cyclooxygenase-2(COX-2),inducible nitric oxide synthase(iNOS)and nuclear factor-κB(NF-κB)in the colon of rats.The expression of tight junction proteins zonu-la occludens-1(ZO-1)and claudin 2 in rat colon tissues was determined by immunofluorescence staining.RESULTS:Compared with normal group,the weight of rats in model group was decreased,the colon was shortened,DAI and colon tissue macroscopic scores were significantly increased(P<0.05),colon pathological injury was serious,and NO and MPO levels in serum and colon tissues of the rats in model group were significantly increased(P<0.05).The mRNA and pro-tein expression levels of TNF-α,COX-2,iNOS and NF-κB in colon tissues were significantly increased(P<0.01),while the expression levels of ZO-1 and claudin 2 were significantly decreased(P<0.01).Compared with model group,the body weight and colon shortening of rats in SGD groups were alleviated,DAI and macroscopic scores of colon tissues were significantly decreased(P<0.05),the pathological damage of colon was improved,and the levels of NO and MPO in se-rum and colon tissues of rats were significantly decreased(P<0.05).The mRNA and protein expression levels of TNF-α,COX-2,iNOS and NF-κB in colon tissues were significantly decreased(P<0.05),while the expression levels of ZO-1 and claudin 2 were significantly increased(P<0.05).CONCLUSION:Treatment with SGD effectively attenuates the inflam-matory response and intestinal mucosal barrier damage caused by TNBS-induced IBD in rats.

Objective:To explore and compare the image quality and radiation dose between the spiral scanning and the axial scanning for skull phantom based on specific conditions.Methods:The position of the orbitomeatal base line(OBL)of the skull phantom was marked,and the different angles of elevation of skull were adjusted.The angles between OBL and bed surface were respectively set as 90°,100°,110° and 120°.The axial scanning and spiral scanning were respective adopted to conduct 24 times of image acquisition when the computed tomography dose index(CTDIvol)of fixed volume were respectively 40,50 and 60 mGy.The cross section of axial scanning was vertical to OBL,and the images of spiral scanning used the reconstructed technique of image quality enhancement(IQE)of removing spiral artifacts to conduct reconstruction along the OBL direction.The CT value(HU)and standard deviation(SD)of the bilateral cerebellum,temporal lobe,frontal lobe and parietal lobe of the phantom were measured,and the signal-to-noise ratio(SNR)of each lobe of the phantom was calculated.The CTDIvol and dose-length product(DLP)were recorded,and the effective dose(ED)of lens was calculated.Results:The differences of the SNR values of cerebellum and occipital lobe(R),cerebellum and occipital lobe(L),temporal lobe(R),temporal lobe(L),frontal lobe(R),frontal lobe(L),parietal lobe(R)and parietal lobe(L)between two kinds of scanning models were significant(F=6.48,5.83,7.00,6.20,7.30,8.26,5.72,5.83,P<0.05),respectively.There was significant difference in lens DLP between the two kinds of scanning models(F=10.96,P<0.05).The spiral scanning and IQE reconstructed technique were used to conduct image acquisition and processing.The SNR value of spiral scanning imaging was better than that of axial scanning,and the reconstructions of coronal and sagittal positions could be conducted,and the radiation doses of lens were similar,but the DLP value of spiral scanning was slightly higher than that of axial scanning at the same CTDIvol.Conclusion:Using the IQE reconstruction technique of spiral scanning can obtain satisfactory CT sectional images of skull under the situations that machine cannot change scanning angle or the scanning of axial position is unable to conduct cooperation.