Objective To compare TyG index between the patients with CHF and ADHF to eluci-date the metabolic difference between these two stages.Methods A total of 1156 HF patients ad-mitted in Taizhou People's Hospital between January 2020 and December 2022 were enrolled,and according to 2021 ESC Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Fail-ure,they were divided into CHF group(365 cases)and ADHF group(791 cases).The clinical da-ta,results of laboratory tests,and cardiovascular history were collected,and TyG index was calcu-lated.All-cause death outcome was observed in ADHF patients during a follow-up of 1 year.Results The TyG index was significantly lower in the ADHF group than the CHF group[8.27(7.99,8.62)vs 8.35(8.04,8.75),P=0.001].In the ADHF group,the TyG index was positively correlated with SBP,DBP,TC,TG,LDL-C,FPG,HbA1c,BMI,and LVEF,and negatively with age(P＜0.01).In the CHF group,the index was positively correlated with DBP,TC,TG,LDL-C,FPG,BMI,and HbA1c,and negatively with age(P＜0.05,P＜0.01).Both univariate and multiva-riate logistic regression analyses indicated that the TyG index was a protective factor for ADHF(OR=0.647,95％CI:0.503～0.832,P=0.001;OR=0.694,95％CI:0.536～0.898,P=0.005).Multivariate logistic regression analysis showed that the index in ADHF patients was a protective factor for one-year all-cause mortality(OR=0.483,95％CI:0.254-0.916;P=0.026).Conclusion TyG index might be regarded as an important marker for assessing the metabolic status in HF patients and predicting the prognosis in ADHF patients.

A 55-year-old male patient received immunotherapy combined with chemotherapy regimen(intravenous infusions of tislelizumab 200 mg on day 1, paclitaxel protein-bound 470 mg, and carboplatin 500 mg on day 1) after surgery for left upper lung squamous cell carcinoma, with 21 days as a treatment cycle. After more than half a month of medication in the 1st cycle, the patient developed multiple symmetrical purple red bruises on both lower limbs, which did not fade when pressed. The purple red bruising disappeared the next day after treatment with anti-allergic drugs. After 3 days of medication in the 3rd cycle, the patient developed a large number of scattered red papules on both lower limbs, protruding from the surface of the skin and accompanied by itching, a small number of red papules were scattered on both upper limbs and the face; after 15 days, the patient felt poor appetite; after 16 days, the patient experienced abdominal pain accompanied by vomiting and loose yellow stool. Laboratory tests showed a blood creatinine level of 204 μmol/L and occult blood in urine (+++). Pathological examination of skin tissue at the lesion site of the patient suggested IgA vasculitis (IgAV). After excluding other factors such as primary disease and infection, it was considered that the IgAV was probably related to tislelizumab. Tislelizumab was discontinued, anti-allergic and anti-inflammatory drugs, and glucocorticoid were given. After 2 weeks of treatments, the skin purpura gradually disappeared, and the abdominal pain and renal function indicators were improved. After fully aware of the risks, the patient was restarted tislelizumab immunotherapy combined with chemotherapy, and anti-allergic drugs were add at the same time. IgVA did not recur.

Objective To compare TyG index between the patients with CHF and ADHF to eluci-date the metabolic difference between these two stages.Methods A total of 1156 HF patients ad-mitted in Taizhou People's Hospital between January 2020 and December 2022 were enrolled,and according to 2021 ESC Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Fail-ure,they were divided into CHF group(365 cases)and ADHF group(791 cases).The clinical da-ta,results of laboratory tests,and cardiovascular history were collected,and TyG index was calcu-lated.All-cause death outcome was observed in ADHF patients during a follow-up of 1 year.Results The TyG index was significantly lower in the ADHF group than the CHF group[8.27(7.99,8.62)vs 8.35(8.04,8.75),P=0.001].In the ADHF group,the TyG index was positively correlated with SBP,DBP,TC,TG,LDL-C,FPG,HbA1c,BMI,and LVEF,and negatively with age(P＜0.01).In the CHF group,the index was positively correlated with DBP,TC,TG,LDL-C,FPG,BMI,and HbA1c,and negatively with age(P＜0.05,P＜0.01).Both univariate and multiva-riate logistic regression analyses indicated that the TyG index was a protective factor for ADHF(OR=0.647,95％CI:0.503～0.832,P=0.001;OR=0.694,95％CI:0.536～0.898,P=0.005).Multivariate logistic regression analysis showed that the index in ADHF patients was a protective factor for one-year all-cause mortality(OR=0.483,95％CI:0.254-0.916;P=0.026).Conclusion TyG index might be regarded as an important marker for assessing the metabolic status in HF patients and predicting the prognosis in ADHF patients.

A 55-year-old male patient received immunotherapy combined with chemotherapy regimen(intravenous infusions of tislelizumab 200 mg on day 1, paclitaxel protein-bound 470 mg, and carboplatin 500 mg on day 1) after surgery for left upper lung squamous cell carcinoma, with 21 days as a treatment cycle. After more than half a month of medication in the 1st cycle, the patient developed multiple symmetrical purple red bruises on both lower limbs, which did not fade when pressed. The purple red bruising disappeared the next day after treatment with anti-allergic drugs. After 3 days of medication in the 3rd cycle, the patient developed a large number of scattered red papules on both lower limbs, protruding from the surface of the skin and accompanied by itching, a small number of red papules were scattered on both upper limbs and the face; after 15 days, the patient felt poor appetite; after 16 days, the patient experienced abdominal pain accompanied by vomiting and loose yellow stool. Laboratory tests showed a blood creatinine level of 204 μmol/L and occult blood in urine (+++). Pathological examination of skin tissue at the lesion site of the patient suggested IgA vasculitis (IgAV). After excluding other factors such as primary disease and infection, it was considered that the IgAV was probably related to tislelizumab. Tislelizumab was discontinued, anti-allergic and anti-inflammatory drugs, and glucocorticoid were given. After 2 weeks of treatments, the skin purpura gradually disappeared, and the abdominal pain and renal function indicators were improved. After fully aware of the risks, the patient was restarted tislelizumab immunotherapy combined with chemotherapy, and anti-allergic drugs were add at the same time. IgVA did not recur.

Objective:To clarify the transitional components in the blood of compound Banlangen Granules; To explore the mechanism of drugs in the treatment of epidemic encephalitis B, hepatitis and parotitis.Methods:The transitional components in blood of compound Banlangen Granules were analyzed by ultra-high performance liquid chromatography-mass spectrometry (UPLC-MS/MS). The regulatory targets and pathways of compound Banlangen Granules in the treatment of epidemic encephalitis B, hepatitis and parotitis were analyzed based on UPLC-MS/MS and network pharmacology.Results:A total of 9 blood components were identified, of which 8 were prototype components, including sucrose, o-aminobenzoic acid, uridine, adenosine, guanosine, indole-3-acetonitrile-2 murine-S-β-D-glucopyranoside and salicylic acid. Through network pharmacological analysis, it was concluded that compound Banlangen Granules may treat epidemic encephalitis B, hepatitis and parotitis by regulating lipid and atherosclerosis, insulin resistance, IL-17 and other signal pathways.Conclusion:The 9 blood components of compound Banlangen Granules may treat epidemic encephalitis B, hepatitis and parotitis by regulating lipid and atherosclerosis, insulin resistance, IL-17 and other signal pathways.

Objective:To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes.Methods:The clinical data of children with septic shock in children′s PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results:A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs ( OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions:The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.

Objective:To investigate the clinical features, pathogen composition, and prognosis of septic shock in pediatric intensive care units (PICU) in China.Methods:A multicenter retrospective cohort study. A retrospective analysis was conducted on the clinical data of children with septic shock from 10 hospitals in China between January 2018 and December 2021. The clinical features, pathogen composition, and outcomes were collected. Patients were categorized into malignant tumor and non-malignant tumor groups, as well as survival and mortality groups. T test, Mann Whitney U test or Chi square test were used respectively for comparing clinical characteristics and prognosis between 2 groups. Multiple Logistic regression was used to identify risk factors for mortality. Results:A total of 1 247 children with septic shock were included, with 748 males (59.9%) and the age of 3.1 (0.9, 8.8) years. The in-patient mortality rate was 23.2% (289 cases). The overall pathogen positive rate was 68.2% (851 cases), with 1 229 pathogens identified. Bacterial accounted for 61.4% (754 strains) and virus for 24.8% (305 strains). Among all bacterium, Gram negative bacteria constituted 64.2% (484 strains), with Pseudomonas aeruginosa and Enterobacter being the most common; Gram positive bacteria comprised 35.8% (270 strains), primarily Streptococcus and Staphylococcus species. Influenza virus (86 strains (28.2%)), Epstein-Barr virus (53 strains (17.4%)), and respiratory syncytial virus (46 strains (17.1%)) were the top three viruses. Children with malignant tumors were older and had higher pediatric risk of mortality (PRISM) Ⅲ score, paediatric sequential organ failure assessment (pSOFA) score (7.9 (4.3, 11.8) vs. 2.3 (0.8, 7.5) years old, 22 (16, 26) vs. 16 (10, 24) points, 10 (5, 14) vs. 8 (4, 12) points, Z=11.32, 0.87, 4.00, all P<0.05), and higher pathogen positive rate, and in-hospital mortality (77.7% (240/309) vs. 65.1% (611/938), 29.7% (92/309) vs. 21.0% (197/938), χ2=16.84, 10.04, both P<0.05) compared to the non-tumor group. In the death group, the score of PRISM Ⅲ, pSOFA (16 (22, 29) vs. 14 (10, 20) points, 8 (12, 15) vs. 6 (3, 9) points, Z=4.92, 11.88, both P<0.05) were all higher, and presence of neoplastic disease, positive rate of pathogen and proportion of invasive mechanical ventilation in death group were also all higher than those in survival group (29.7% (87/289) vs. 23.2% (222/958), 77.8% (225/289) vs. 65.4% (626/958), 73.7% (213/289) vs. 50.6% (485/958), χ2=5.72, 16.03, 49.98, all P<0.05). Multiple Logistic regression showed that PRISM Ⅲ, pSOFA, and malignant tumor were the independent risk factors for mortality ( OR=1.04, 1.09, 0.67, 95% CI 1.01-1.05, 1.04-1.12, 0.47-0.94, all P<0.05). Conclusions:Bacterial infection are predominant in pediatric septic shock, but viral infection are also significant. Children with malignancies are more severe and resource consumptive. The overall mortality rate for pediatric septic shock remains high, and mortality are associated with malignant tumor, PRISM Ⅲ and pSOFA scores.

Objective:To compare the application value of the Braden-QD scale and the Braden-Q scale in assessing the risk of pressure injuries in pediatric intensive care unit (PICU) patients.Methods:A convenient sampling method was used to select 205 pediatric patients admitted to the First People’s Hospital of Lianyungang from December 2021 to September 2022 as the research subjects.The Braden-QD scale and the Braden-Q scale were used to evaluate the risk of pressure injuries.SPSS 25.0 and Python 2.7 softwares were used for statistical analysis. Inter-rater reliability of the scales was evaluated using intraclass correlation coefficient (ICC), internal consistency was evaluated using Cronbach's α, and the predictive power was compared using receiver operator characteristic curve (ROC), positive predictive value, negative predictive value, sensitivity, specificity and area under the ROC curve (AUC).Results:(1) A total of 24 (11.7%) out of 205 patients had pressure injury, predominantly in stage 1 (20 cases, 83.3%). (2)The ICC of Braden-QD scale and Braden-Q scale were 0.890 and 0.862, while the Cronbach's α were 0.891 and 0.710.(3) The AUC of the Braden-QD scale was 0.936. The optimal diagnostic cutoff value was 9.5, with a Youden index, sensitivity, specificity, positive predictive value and negative predictive value of 0.765, 0.875, 0.890, 0.512, 0.982, respectively.The AUC of the Braden-Q scale was 0.881. The optimal diagnostic cutoff value was 18.5, with a Youden index, sensitivity, specificity, positive predictive value, and negative predictive value of 0.626, 0.792, 0.834, 0.388, 0.968, respectively.Conclusion:Compared with the Braden-Q scale, the Braden-QD scale is more suitable for assessing the risk of pressure injuries in PICU children.

Objective:To evaluate the relationship between the Panton-Valentine leukocidin (pvl) strain and clinical characteristics, and to describe the molecular biological characteristics of invasive Staphylococcus aureus ( S. aureus) infected clinical isolates. Methods:The isolates of S. aureus caused by invasive infection were collected in Beijing Children's Hospital Affiliated to Capital Medical University from January 2016 to December 2019, and the clinical data of the corresponding children were collected retrospectively using electronic medical records. Multilocus sequence typing, spa typing and pvl gene were analyzed using the PCR. In addition, the minimum inhibitory concentrations (MIC) of antibiotics of all isolates were detected by the micro-broth dilution method, and the isolates were divided into the pvl+ and pvl- groups according to whether or not the S. aureus isolates carried pvl. The t test and the Mann-Whitney U test were used to compare the clinical symptoms between the pvl+ and pvl- groups. Chi-square test was used to compare the drug susceptibility between the two isolates. Results:A total of 127 cases of invasive S. aureus infection were collected during the study period. The white blood cell count, neutrophil count, and C-reaction protein level in the pvl+ group were significantly higher than those in the pvl- group ( P=0.001, P=0.001, P=0.005). The rate of pvl carrier was 44.9%. Among 57 pvl+ pathogenic strains, 64.9% (37/57) were MRSA. The multidrug resistance rate of pvl- isolates was higher than that of pvl+ isolates (70% vs. 49.12%, P=0.02). Conclusions:In invasive S. aureus infection, pvl+ strain is associated with elevated inflammatory markers in children. the positive rate of pvl is higher in clinical isolates, and the multidrug resistance rate of pvl- S. aureus is higher.

Objective:To develop an evidence-based nursing program for a patient with oral complications of dysphagia due to cerebral infarction.Methods:According to the principle of PICO, and the problem of patients' clinical manifestations, using the method of combining subject words and free words, the database of Uptodate, NICE, SIGN. RNAO, medical pulse guide network, BMJ, Cochranc library, PubMed, EMbase, CINAHL, China National Knowledge Infrastructure were searched and collected the clinical guidelines, systematic evaluation and randomized controlled trial of oral complications in patients with dysphagia of cerebral infarction.Results:Totally 1 clinical decision, 5 clinical guidelines, 4 expert consensus, 2 systematic evaluations, 1 Meta-analysis, 3 randomized controlled trial (RCT) were included. Based on the search results and the patient′s condition and wishes, nurses performed swallowing function tests every two days according to the Standard Swallowing function rating Scale (SSA), raised the head of the bed 40°~45° and holded it for 1 hour. Three times a day, the teeth were brushed with chlorhexidine oral care solution under negative pressure. Sputum scab was removed by mechanical scrubbing. The back of tongue was scrubbed by 6x tongue scraping technique every night. After the infection was controlled, the teeth were washed twice a day with 0.9% sodium chloride solution. Oral condition and swallowing function were evaluated daily. High flow humidification oxygen therapy and mask spray atomization inhalation were used. Swallowing training was performed on the third day after admission. Seven days after the evidence was applied to clinical practice, the oral mucosa was moist without peculiar smell and sputum scab, and the swallowing function was changed from grade IV to grade II.Conclusion:Nursing cerebral infarction patients with dysphagia, nurses should timely assess the patient's oral cavity and swallowing function, the application of chlorhexidine and 0.9% sodium chloride solution oral care solution mechanical scrubbing method and negative pressure washing brushing method can effectively remove sputum scab, use 6x tongue scraping technology to scrub the back of tongue, can reduce micro organisms, reduce halitosis; the application of nasal mask high flow humidification oxygen therapy and spray atomization inhalation humidification effect is obvious Therefore, early swallowing training can reduce the incidence of oral complications.