Objective:To explore the influencing factors of multiple bronchoscopic lavage in children with lobar pneumonia and evaluate its predictive value.Methods:The clinical data of 184 children with lobar pneumonia who underwent bronchoscopic lavage in the Hubei Medical College Affiliated People′s Hospital from September 2018 to June 2022 were retrospectively analyzed. According to the number of lavage, they were divided into the single lavage group (108 cases) and the multiple (≥ 2 times) lavage group (76 cases). The two groups was matched in a 1∶1 ratio by using propensity score matching (PSM), and the influencing factors for multiple lavage after matching was analyzed by multivariate Logistic regression analysis. The predictive effect of risk factors on multiple lavage was analyzed by the receiver operating characteristic (ROC) curve.Results:After PSM matching, a total of 68 pairs of children were successfully matched. According to multivariate Logistic regression analysis, the duration of preoperative fever ≥7 d, pleural effusion, procalcitonin (PCT) ≥2.0 μg/L, white blood cell (WBC) ≥12.0 × 10 9/L, C-reactive protein (CRP) ≥10.0 mg/L, neutrophil ratio (N%) ≥70%, lactate dehydrogenase (LDH) ≥300 U/L, erythrocyte sedimentation rate (ESR) ≥35.0 mm/1 h, serum alanine aminotransferase (ALT)>40 U/L, serum albumin (ALB)<35 g/L and mucus thrombus were risk factors for multiple bronchoscopic lavage in children with lobar pneumonia ( OR = 3.031, 2.230, 2.125, 3.050, 2.735, 3.043, 3.025, 3.360, 2.962, 2.989, 3.108, P<0.05). According to ROC curve analysis, the sensitivity and specificity of the combination of 11 influencing factors in predicting multiple bronchoscopic lavage in children with lobar pneumonia were 72.10% and 63.20% respectively, and the area under the curve was 0.733. Conclusions:The duration of preoperative fever, pleural effusion, PCT, WBC, CRP, N%, LDH, ESR, ALT, ALB and mucus thrombus are all influencing factors for multiple bronchoscopic lavage in children with lobar pneumonia, and comprehensive evaluation of the above influencing factors has predictive effect on multiple bronchoscopic lavage in children.

Objective:To explore the effects of multidisciplinary continuous nursing based on the transtheoretical model (TTM) in patients after radiofrequency ablation for atrial fibrillation.Methods:Using a convenience sampling method, 280 patients who underwent radiofrequency ablation for atrial fibrillation at the China-Japan Union Hospital of Jilin University from January to December 2024 were enrolled. Patients treated from January to June 2024 were assigned to the control group ( n=140), and those treated from July to December 2024 were assigned to the intervention group ( n=140). The control group received routine continuous nursing, while the intervention group received multidisciplinary continuous nursing guided by the transtheoretical model. The 8-item Morisky Medication Adherence Scale (MMAS-8), Self-Rated Abilities for Health Practices Scale (SRAHP), Depression Anxiety and Stress Scale (DASS-21), and the Chinese Quality of Life Questionnaire for Cardiovascular Patients (CQQC) were used to evaluate the intervention effects. Results:A total of 135 patients in the control group and 137 patients in the intervention group completed the study. After the intervention, the MMAS-8, CQQC, and SRAHP scores of the intervention group were higher than those of the control group, with statistically significant differences ( P<0.05). The anxiety and stress subscale scores of the DASS-21 were lower in the intervention group compared with the control group, with statistically significant differences ( P<0.05) . Conclusions:Multidisciplinary continuous nursing based on the transtheoretical model can improve medication adherence, reduce negative psychological states, promote healthy behavior formation, and enhance the quality of life of patients after radiofrequency ablation for atrial fibrillation.

Objective To understand the awareness and willingness of primary medical staff in Songjiang District, Shanghai towards human papillomavirus (HPV) and its vaccines, and to provide references for improving the vaccination willingness of HPV vaccine and primary prevention of cervical cancer. Methods From July to August 2023, a questionnaire survey was conducted among the in-service medical staff in 17 community health service centers in Songjiang District, Shanghai, using the random sampling method. Descriptive analysis, χ² test and logistic regression were used for statistical analysis. Results A total of 951 valid questionnaires were collected during the survey. The awareness rate of HPV among medical staff was 92.74%, and the awareness rate of HPV vaccine was 93.38%. The maximum score for HPV knowledge was 6 points, with an average score of (3.99±1.34) points. The maximum score for HPV vaccine knowledge was 10 points, with an average score of (5.63±1.61) points. 881 (92.64%) medical staff were willing to receive or recommend HPV vaccination. Multivariate analysis showed that concerns about being infected with HPV (OR=2.648, 95% CI: 1.459-4.806), qualified score on HPV vaccine knowledge (OR=1.717, 95% CI: 1.012-2.912), high price burden of HPV vaccine (OR=0.343, 95% CI: 0.157-0.746), and concerns about side effects of vaccination (OR=0.443, 95% CI: 0.243-0.805) were the influencing factors for medical staff's willingness to vaccinate. Conclusion There is insufficient knowledge of HPV and its vaccines among primary medical personnel in Songjiang District, Shanghai. It is necessary to strengthen the continuing education of medical personnel through multiple channels, supplement the HPV-related knowledge system, and eliminate their concerns about vaccines.

Objective To investigate the changes in eosinophil counts and the activation of microglial cells in the brain tissues of mice at different stages of Angiostrongylus cantonensis infection, and to examine the role of microglia in regulating the progression of angiostrongyliasis and unravel the possible molecular mechanisms. Methods Fifty BALB/c mice were randomly divided into the control group and the 7-d, 14-d, 21-day and 25-d infection groups, of 10 mice in each group. All mice in infection groups were infected with 30 stage III A. cantonensis larvae by gavage, and animals in the control group was given an equal amount of physiological saline. Five mice were collected from each of infection groups on days 7, 14, 21 d and 25 d post-infection, and 5 mice were collected from the control group on the day of oral gavage. The general and focal functional impairment was scored using the Clark scoring method to assess the degree of mouse neurological impairment. Five mice from each of infection groups were sacrificed on days 7, 14, 21 d and 25 d post-infection, and 5 mice from the control group were sacrificed on the day of oral gavage. Mouse brain tissues were sampled, and the pathological changes of brain tissues were dynamically observed using hematoxylin and eosin (HE) staining. Immunofluorescence staining with eosinophilic cationic protein (ECP) and ionized calcium binding adaptor molecule 1 (Iba1) was used to assess the degree of eosinophil infiltration and the counts of microglial cells in mouse brain tissues in each group, and the morphological parameters of microglial cells (skeleton analysis and fractal analysis) were quantified by using Image J software to determine the morphological changes of microglial cells. In addition, the expression of M1 microglia markers Fcγ receptor III (Fcgr3), Fcγ receptor IIb (Fcgr2b) and CD86 antigen (Cd86), M2 microglia markers Arginase 1 (Arg1), macrophage mannose receptor C-type 1 (Mrc1), chitinase-like 3 (Chil3), and phagocytosis genes myeloid cell triggering receptor expressed on myeloid cells 2 (Trem2), CD68 antigen (Cd68), and apolipoprotein E (Apoe) was quantified using real-time quantitative reverse transcription PCR (RT-qPCR) assay in the mouse cerebral cortex of mice post-infection. Results A large number of A. cantonensis larvae were seen on the mouse meninges surface post-infection, and many neuronal nuclei were crumpled and deeply stained, with a large number of bleeding points in the meninges. The median Clark scores of mouse general functional impairment were 0 (interquartile range, 0), 0 (interquartile range, 0.5), 6 (interquartile range, 1.0), 14 (interquartile range, 8.5) points and 20 (interquartile range, 9.0) points in the control group and the 7-d, 14-d, 21-d and 25-d groups, respectively (H = 22.45, P < 0.01), and the median Clark scores of mouse focal functional impairment were 0 (interquartile range, 0), 2 (interquartile range, 2.5), 7 (interquartile range, 3.0), 18 (interquartile range, 5.0) points and 25 (interquartile range, 6.5) points in the control group and the 7-d, 14-d, 21-d and 25-d groups, respectively (H = 22.72, P < 0.01). The mean scores of mice general and focal functional impairment were all higher in the infection groups than in the control group (all P values < 0.05). Immunofluorescence staining showed a significant difference in the eosinophil counts in mouse brain tissues among the five groups (F = 40.05, P < 0.000 1), and the eosinophil counts were significantly higher in mouse brain tissues in the 14-d (3.08 ± 0.78) and 21-d infection groups (5.97 ± 1.37) than in the control group (1.00 ± 0.28) (both P values < 0.05). Semi-quantitative analysis of microglia immunofluorescence showed a significant difference in the counts of microglial cells among the five groups (F = 17.66, P < 0.000 1), and higher Iba1 levels were detected in mouse brain tissues in 14-d (5.75 ± 1.28), 21-d (6.23 ± 1.89) and 25-d infection groups (3.70 ± 1.30) than in the control group (1.00 ± 0.30) (all P values < 0.05). Skeleton and fractal analyses showed that the branch length [(162.04 ± 34.10) μm vs. (395.37 ± 64.11) μm; t = 5.566, P < 0.05] and fractal dimension of microglial cells (1.30 ± 0.01 vs. 1.41 ± 0.03; t = 5.266, P < 0.05) were reduced in mouse brain tissues in the 21-d infection group relative to the control group. In addition, there were significant differences among the 5 groups in terms of M1 and M2 microglia markers Fcgr3 (F = 48.34, P < 0.05), Fcgr2b (F = 55.46, P < 0.05), Cd86 (F = 24.44, P < 0.05), Arg1 (F = 31.18, P < 0.05), Mrc1 (F = 15.42, P < 0.05) and Chil3 (F = 24.41, P < 0.05), as well as phagocytosis markers Trem2 (F = 21.19, P < 0.05), Cd68 (F = 43.95, P < 0.05) and Apoe (F = 7.12, P < 0.05) in mice brain tissues. Conclusions A. cantonensis infections may induce severe pathological injuries in mouse brain tissues that are characterized by massive eosinophil infiltration and persistent activation of microglia cells, thereby resulting in progressive deterioration of neurological functions.

Height， as one of the crucial indicators for assessing children’s growth and development， has consistently been a global focus. With economic development and improvements in social living standards， the clinical management needs for children with short stature have been increasingly growing. While growth hormone brings hope to children with short stature， it also triggers ethical challenges such as medical standardization， expansion of indications， equitable accessibility， and informed consent. To avoid the ethical issues related to the use of pediatric growth hormone， multidimensional and comprehensive clinical management should be implemented for children with short stature， including strictly adhering to medical standards and ethical guidelines， enhancing public awareness， and promoting the standardized development of recombinant human growth hormone （rhGH） therapy and ethics.

Transient perivascular inflammation of the carotid artery(TIPIC)syndrome is a relatively rare disease,and ultrasound is the first screening method for initial diagnosis of the disease.Contrast-enhanced ultrasound(CEUS)has unique advantages in the follow-up of patients with TIPIC syndrome.This paper reports a patient with TIPIC syndrome who was treated with acute left neck pain.The inflammation was significantly re-lieved and subsided after treatment with non-steroidal anti-inflammatory drugs.The ultrasound changes of carotid artery lesions in this patient during follow-up were analyzed,and the application value of CEUS in the follow-up diagnosis of this disease was summarized,in the hope of providing clinical reference.

Objective:To explore and discuss the ethical issues and challenges arising from the rapid development of digital intelligence technology in medical research, and to propose strategies for addressing them.Methods:By reviewing the applications of big data, artificial intelligence, and other technologies in medical research, as well as the related ethical issues, discussions and analyses were conducted on aspects such as informed consent, privacy protection, data security, and algorithmic bias.Results:To address the numerous ethics issues and challenges in medical research in the digital intelligence era, researchers and institutions should actively respond with a stance of inclusivity and prudence.Conclusions:By improving the informed consent process, strengthening legal and policy frameworks, promoting interdisciplinary collaboration, and establishing risk assessment mechanisms, we can promote the continuous innovation and high-quality development of medical knowledge and practice.

Objective:To assess the effect of joint exposure to multiple air pollutants on sleep structure in patients with stable chronic obstructive pulmonary disease (COPD), identify key air pollutants, and analyze potential influencing factors.Methods:In this panel study, 92 stable COPD patients were recruited. From March 2021 to September 2023 in Beijing, all participants completed 254 nights of sleep monitoring. The total sleep duration, light sleep duration, deep sleep duration and rapid eye movement sleep duration and their respective proportions in total sleep duration were recorded. The exposure levels of fine particulate matter (PM 2.5), inhalable particulate matter (PM 10), nitrogen dioxide (NO 2), ozone (O 3), sulfur dioxide (SO 2), and carbon monoxide (CO) were estimated based on the infiltration factor method and time-activity logs of participants. To assess the lag effect of air pollutants, moving average concentrations of air pollutants from 0-1 day to 0-3 months were calculated. The linear mixed-effect model and Bayesian kernel machine regression (BKMR) model were used to assess the single and joint effects of air pollutants on sleep structure parameters in COPD patients, respectively. Results:All six types of air pollutants were associated with changes in sleep structure, manifesting as an increase in total sleep duration and light sleep proportion and a reduction in deep sleep proportion. The effects of O 3 were strongest at lag 0-6 days, while other air pollutants were at lag 0-3 months. Joint exposure to multiple air pollutants exerted significant joint effects on sleep structure, and NO 2 was identified as the dominant pollutant. NO 2 had a posterior inclusion probability (PIP) greater than 0.5 for light sleep proportion (PIP=0.691) and deep sleep proportion (PIP=0.957). With an interquartile range (IQR) increase of 8.6 μg/m 3 in NO 2 at lag 0-3 months, the light sleep proportion increased by 10.5% (95% CI: 2.2%-19.4%), and the deep sleep proportion decreased by 19.5% (95% CI:-30.6%- -6.8%). Conclusion:Joint exposure to air pollutants is associated with changes in sleep structure in stable COPD patients, and NO 2 may be a key pollutant.

Objective:To explore the effects of multidisciplinary continuous nursing based on the transtheoretical model (TTM) in patients after radiofrequency ablation for atrial fibrillation.Methods:Using a convenience sampling method, 280 patients who underwent radiofrequency ablation for atrial fibrillation at the China-Japan Union Hospital of Jilin University from January to December 2024 were enrolled. Patients treated from January to June 2024 were assigned to the control group ( n=140), and those treated from July to December 2024 were assigned to the intervention group ( n=140). The control group received routine continuous nursing, while the intervention group received multidisciplinary continuous nursing guided by the transtheoretical model. The 8-item Morisky Medication Adherence Scale (MMAS-8), Self-Rated Abilities for Health Practices Scale (SRAHP), Depression Anxiety and Stress Scale (DASS-21), and the Chinese Quality of Life Questionnaire for Cardiovascular Patients (CQQC) were used to evaluate the intervention effects. Results:A total of 135 patients in the control group and 137 patients in the intervention group completed the study. After the intervention, the MMAS-8, CQQC, and SRAHP scores of the intervention group were higher than those of the control group, with statistically significant differences ( P<0.05). The anxiety and stress subscale scores of the DASS-21 were lower in the intervention group compared with the control group, with statistically significant differences ( P<0.05) . Conclusions:Multidisciplinary continuous nursing based on the transtheoretical model can improve medication adherence, reduce negative psychological states, promote healthy behavior formation, and enhance the quality of life of patients after radiofrequency ablation for atrial fibrillation.