Objective:To investigate the clinical manifestations, therapeutic strategies and prognostic outcomes in pediatric patients with severe Mycoplasma pneumoniae pneumonia (SMPP) complicated by cardiac thrombosis. Methods:This case series study retrospectively analyzed 15 pediatric patients with SMPP complicated by cardiac thrombosis. The patients was recruited from the Department of Pediatric Respiratory Medicine at Shandong Provincial Hospital Affiliated to Shandong First Medical University between July 2018 and January 2025. Comprehensive clinical data and follow-up information were collected.Results:Among the 15 children, 10 were male and 5 were female, and the age of onset was 8.0 (6.3, 10.0) years. All 15 children presented with fever and cough, while additional symptoms included dyspnea in 7 cases, chest pain in 6 cases, hemoptysis in 3 cases, and chest tightness in 1 case. The white blood cell count was 11.7 (9.5, 15.9)×10 9/L, C-reactive protein was 31.6 (17.5, 64.8) mg/L and lactate dehydrogenase was 548.2 (410.4, 768.3) U/L. A total of 14 children underwent testing for the Mycoplasma pneumoniae drug resistance genes 2063A>G and 2064A>G, of which 13 tested positive. The plasma D-dimer levels of 15 children were 8.77 (7.23, 12.50) mg/L, all of which were higher than normal. Among the 15 children, 5 had decreased activity of anticoagulant proteins (protein C, protein S, antithrombin Ⅲ), and 8 tested positive for antiphospholipid antibodies. Chest CT scans of all 15 children showed pulmonary consolidation and (or) atelectasis, with pleural effusion present in 12 cases. In the 15 children, thrombosis was detected at 14.0 (11.0, 18.0) days after the onset of illness. The locations of cardiac thrombosis included the right ventricle in 9 cases, the right atrium in 5 cases, and the left atrium in 1 case. Additionally, 10 cases had pulmonary vascular embolism, comprising 9 cases of pulmonary artery thrombosis and 1 case of pulmonary vein thrombosis. After anticoagulant treatment, cardiac thrombi disappeared in 10 children. Five children who did not show improvement with anticoagulation underwent surgical thrombectomy. In the follow-up of 15 children, lung imaging basically returned to normal, with no major hemorrhagic events or other adverse events. Conclusions:In children with Mycoplasma pneumoniae pneumonia, the presence of clinical symptoms such as shortness of breath, chest pain and hemoptysis, along with elevated plasma D-dimer levels, should raise suspicion for the possibility of cardiac thrombosis. SMPP complicated by cardiac thrombosis, prognosis is good following anticoagulation or surgical treatment.

Objective:To investigate the clinical manifestations, therapeutic strategies and prognostic outcomes in pediatric patients with severe Mycoplasma pneumoniae pneumonia (SMPP) complicated by cardiac thrombosis. Methods:This case series study retrospectively analyzed 15 pediatric patients with SMPP complicated by cardiac thrombosis. The patients was recruited from the Department of Pediatric Respiratory Medicine at Shandong Provincial Hospital Affiliated to Shandong First Medical University between July 2018 and January 2025. Comprehensive clinical data and follow-up information were collected.Results:Among the 15 children, 10 were male and 5 were female, and the age of onset was 8.0 (6.3, 10.0) years. All 15 children presented with fever and cough, while additional symptoms included dyspnea in 7 cases, chest pain in 6 cases, hemoptysis in 3 cases, and chest tightness in 1 case. The white blood cell count was 11.7 (9.5, 15.9)×10 9/L, C-reactive protein was 31.6 (17.5, 64.8) mg/L and lactate dehydrogenase was 548.2 (410.4, 768.3) U/L. A total of 14 children underwent testing for the Mycoplasma pneumoniae drug resistance genes 2063A>G and 2064A>G, of which 13 tested positive. The plasma D-dimer levels of 15 children were 8.77 (7.23, 12.50) mg/L, all of which were higher than normal. Among the 15 children, 5 had decreased activity of anticoagulant proteins (protein C, protein S, antithrombin Ⅲ), and 8 tested positive for antiphospholipid antibodies. Chest CT scans of all 15 children showed pulmonary consolidation and (or) atelectasis, with pleural effusion present in 12 cases. In the 15 children, thrombosis was detected at 14.0 (11.0, 18.0) days after the onset of illness. The locations of cardiac thrombosis included the right ventricle in 9 cases, the right atrium in 5 cases, and the left atrium in 1 case. Additionally, 10 cases had pulmonary vascular embolism, comprising 9 cases of pulmonary artery thrombosis and 1 case of pulmonary vein thrombosis. After anticoagulant treatment, cardiac thrombi disappeared in 10 children. Five children who did not show improvement with anticoagulation underwent surgical thrombectomy. In the follow-up of 15 children, lung imaging basically returned to normal, with no major hemorrhagic events or other adverse events. Conclusions:In children with Mycoplasma pneumoniae pneumonia, the presence of clinical symptoms such as shortness of breath, chest pain and hemoptysis, along with elevated plasma D-dimer levels, should raise suspicion for the possibility of cardiac thrombosis. SMPP complicated by cardiac thrombosis, prognosis is good following anticoagulation or surgical treatment.

In order to investigate the clinical manifestations and laboratory findings associated with brucellosis for the purpose of facilitating prompt clinical diagnosis and effective treatment, as well as to offer a laboratory reference for the prevention of brucellosis outbreaks. In this study, a retrospective cohort design was employed to gather epidemiological characteristics, clinical symptoms, and associated laboratory data from 391 patients diagnosed with bacterial culture-positive brucellosis at the People′s Hospital of Ningxia Hui Autonomous Region between 2019 and 2023. The patients were categorized into four age groups, with each group representing a 20 years age interval. Statistical analyses were conducted to examine the differences between these age groups using R version 4.3.2 and SPSS version 24.0 software. The results showed that among the 391 cases of brucellosis patients, fever (241 cases, 61.64%), lumbar and leg joint pain (225 cases, 57.54%), abnormal liver function (124 cases, 31.71%), spleen enlargement (78 cases, 19.95%), and cholecystitis (75 cases, 19.18%) were identified as the most prevalent clinical symptoms. Furthermore, the presence of clinical symptoms such as fever, lumbar and leg joint pain, abdominal pain and distension, headache, dizziness, rash, and complications including abnormal liver function, cholecystitis, spleen enlargement, exhibited statistical significance across four distinct age groups ( P<0.05). The initial presentation of acute fever and rash was more pronounced in the pediatric cohort. In contrast, the youth group exhibited a higher prevalence of acute fever, liver function abnormalities, dizziness, headache, and splenomegaly. Furthermore, the strong-age group and the older age group more frequently experienced lumbar and leg joint pain, and symptoms related to the liver, gallbladder, spleen, and digestive system. In terms of laboratory examination, the rates of decreased white blood cell count (WBC), red blood cell count (RBC) and platelet count (PLT) were 18.91% (73 cases), 28.94% (112 cases) and 22.34% (86 cases), respectively. C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total biluric acid (TBA), adenosine deaminase (ADA), alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), procalcitonin (PCT), and D-Dimer (D-Dimer). The proportion of patients with elevated quantitative test results was 88.56% (271 cases), 50.90% (197 cases), 52.20% (202 cases), 23.82% (91 cases), 75.72% (290 cases), 23.06% (89 cases), 40.89% (157 cases), 68.34% (218 cases) and 73.33% (209 cases), respectively. Among them, the quantitative detection results of CPR, ALP and D-Dimer had statistical significance among the 4 age groups ( χ2=16.366,28.089,7.880, P<0.05). Abnormally elevated laboratory parameters, including C-reactive protein (CRP), alkaline phosphatase (ALP), and D-dimer, were more pronounced in middle-aged and older cohorts, with a positive correlation to advancing age. Among the 391 brucella culture positive specimens, the top three departments with the highest number of isolations were infectious disease (52.4%, 204 cases), emergency (9.5%, 37 cases) and orthopedics (8.4%, 33 cases). In conclusion, the clinical manifestations of brucellosis are multifaceted and heterogeneous, frequently involving multiple organ systems, and the laboratory test results exhibit considerable variability. These findings indicate that clinicians should integrate clinical features of brucellosis with laboratory test results, considering the patient′s age group, to enhance diagnostic accuracy and triage efficiency in suspected cases. Improving relevant diagnostic examinations can thereby aid in the effective control and prevention of the disease.

In order to investigate the clinical manifestations and laboratory findings associated with brucellosis for the purpose of facilitating prompt clinical diagnosis and effective treatment, as well as to offer a laboratory reference for the prevention of brucellosis outbreaks. In this study, a retrospective cohort design was employed to gather epidemiological characteristics, clinical symptoms, and associated laboratory data from 391 patients diagnosed with bacterial culture-positive brucellosis at the People′s Hospital of Ningxia Hui Autonomous Region between 2019 and 2023. The patients were categorized into four age groups, with each group representing a 20 years age interval. Statistical analyses were conducted to examine the differences between these age groups using R version 4.3.2 and SPSS version 24.0 software. The results showed that among the 391 cases of brucellosis patients, fever (241 cases, 61.64%), lumbar and leg joint pain (225 cases, 57.54%), abnormal liver function (124 cases, 31.71%), spleen enlargement (78 cases, 19.95%), and cholecystitis (75 cases, 19.18%) were identified as the most prevalent clinical symptoms. Furthermore, the presence of clinical symptoms such as fever, lumbar and leg joint pain, abdominal pain and distension, headache, dizziness, rash, and complications including abnormal liver function, cholecystitis, spleen enlargement, exhibited statistical significance across four distinct age groups ( P<0.05). The initial presentation of acute fever and rash was more pronounced in the pediatric cohort. In contrast, the youth group exhibited a higher prevalence of acute fever, liver function abnormalities, dizziness, headache, and splenomegaly. Furthermore, the strong-age group and the older age group more frequently experienced lumbar and leg joint pain, and symptoms related to the liver, gallbladder, spleen, and digestive system. In terms of laboratory examination, the rates of decreased white blood cell count (WBC), red blood cell count (RBC) and platelet count (PLT) were 18.91% (73 cases), 28.94% (112 cases) and 22.34% (86 cases), respectively. C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total biluric acid (TBA), adenosine deaminase (ADA), alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), procalcitonin (PCT), and D-Dimer (D-Dimer). The proportion of patients with elevated quantitative test results was 88.56% (271 cases), 50.90% (197 cases), 52.20% (202 cases), 23.82% (91 cases), 75.72% (290 cases), 23.06% (89 cases), 40.89% (157 cases), 68.34% (218 cases) and 73.33% (209 cases), respectively. Among them, the quantitative detection results of CPR, ALP and D-Dimer had statistical significance among the 4 age groups ( χ2=16.366,28.089,7.880, P<0.05). Abnormally elevated laboratory parameters, including C-reactive protein (CRP), alkaline phosphatase (ALP), and D-dimer, were more pronounced in middle-aged and older cohorts, with a positive correlation to advancing age. Among the 391 brucella culture positive specimens, the top three departments with the highest number of isolations were infectious disease (52.4%, 204 cases), emergency (9.5%, 37 cases) and orthopedics (8.4%, 33 cases). In conclusion, the clinical manifestations of brucellosis are multifaceted and heterogeneous, frequently involving multiple organ systems, and the laboratory test results exhibit considerable variability. These findings indicate that clinicians should integrate clinical features of brucellosis with laboratory test results, considering the patient′s age group, to enhance diagnostic accuracy and triage efficiency in suspected cases. Improving relevant diagnostic examinations can thereby aid in the effective control and prevention of the disease.

【Objective】 To study the relationship between the plasma IgG, IgM, neutralizing antibody titer and sex, age, collection interval in convalescent patients with COVID-19, so as to guide the plasma collection of convalescent patients with COVID-19. 【Methods】 COVID-19 convalescent plasma was collected to determine the antibody titer, and the difference and correlation of data in each group were analyzed by SPSS statistical analysis software. 【Results】 The median titers (AU/mL)of IgG, IgM and neutralizing antibodies in males and females were 484.24 vs 516.04, 2.13 vs 1.73, and 1 124.74 vs 1 143.99, respectively, and there was no significant difference(P>0.05) . Age had weak positive correlation with IgG and neutralizing antibody, and the Spearman correlation coefficient was 0.188 (P<0.05). The median titers (AU/mL) of IgG, IgM and neutralizing antibody at first donation of 30 repeated donors were 522.3, 2.64 and 1 174.6, respectively, but at second donation were 332.08, 0.63 and 708.96, showing significant difference (P<0.05). 【Conclusion】 There was no significant difference in the plasma IgG, IgM and neutralizing antibody titers in convalescent COVID-19 patients of different ages and genders, and the titers met the requirements of clinical treatment guidelines. Although the plasma antibody level of repeated donors has decreased, it still has clinical value.

Objective:To investigate the clinical characteristics and etiology of pulmonary embolism in children, and to discuss the efficacy and safety of anticoagulation therapy.Methods:The data of 30 children with pulmonary embolism, who were treated with anticoagulation therapy in the Department of Pediatrics, Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2021, were analyzed retrospectively.The etiology, clinical characteristics, complications, outcomes and prognosis after anticoagulation treatment were analyzed.Results:There were 17 males and 13 females, with an average age of (8.95±2.58) years (age range: 4-13 years). The follow-up duration was 3-59 months.(1) The symptoms included cough in 30 cases (100.0%), fever in 29 cases (96.7%), shortness of breath in 27 cases (90.0%), chest pain in 15 cases (50.0%), hemoptysis in 9 cases (30.0%), bloody secretions under bronchoscopy but no hemoptysis in 4 cases (13.3%), and respiratory failure in 2 cases (6.7%). (2) The protopathy was Mycoplasma pneumoniae infection in 23 cases (76.7%), whose symptoms accorded with refractory Mycoplasma pneumoniae pneumonia.About 16 cases (53.3%) were positive for Mycoplasma pneumoniae drug resistance mutation 2063A>G or 2064A>G.Two cases (6.7%) had nephrotic syndrome.One case (3.3%) had purpura nephritis (nephrotic syndrome type). One case (3.3%) was lupus nephritis (nephrotic syndrome type). One case (3.3%) was hereditary protein S deficiency.One case (3.3%) had osteomyelitis and Staphylococcus aureus sepsis.One case (3.3%) had congenital heart disease.(3) Complications included limb thrombosis in 7 cases (23.3%), atrial thrombosis in 2 cases (6.7%), thoracic and abdominal deep venous thrombosis in 2 case (6.7%), cerebral infarction in 2 cases (6.7%), and splenic infarction in 1 case (3.3%). (4) Imaging examination showed that 30 children had lung consolidation/atelectasis (100.0%), and 24 cases had pleural effusion (80.0%). (5) Coagulation function examination suggested D-dimer increased to ≥ 5 mg/L in 21 cases (70.0%). (6) One case (3.3%) was given thrombolytic therapy with urokinase at the acute stage.Nine cases (30.0%) were treated with heparin/low molecular weight heparin.Twenty-one cases (70.0%) first received anticoagulation therapy with heparin/low molecular weight heparin and later took oral anticoagulant.Four cases (13.3%) were treated with Warfarin and 17 cases (56.7%) with Rivaroxaban.The anticoagulant treatment lasted 1-9 months.No recurrence of embolism or sequelae of chronic thromboembolic pulmonary hypertension was observed. Conclusions:Infection, especially Mycoplasma pneumoniae infection, is the main cause of pulmonary embolism in children.The symptoms of pulmonary embolism in children are atypical, so it is difficult to distinguish this disease from primary underlying diseases.Bronchoscopy can help find occult pulmonary hemorrhage.Unexplained shortness of breath in children of any age suggests the possibility of pulmonary embolism.Combination of clinical symptoms and necessary examination contribute to early diagnosis of pulmonary embolism.Then selection of appropriate anticoagulant drugs and timely anticoagulant therapy can improve the prognosis of children.

Objective To explore the effects of training system based on attitude-skill-knowledge (ASK) model in standardized training for new nurses.Methods From 2014 to 2015, we selected 130 new entry nurses in a standardized training base for nurses in Jingzhou as subjects. A total of 71 new entry nurses in 2014 were in the control group. A total of 59 new entry nurses in 2015 were in the observation group. Nurses of the control group were trained with the traditional training system. Nurses of the observation group were trained with the training system based on the ASK model. We compared the theoretical achievements, operational achievements and the clinical nursing ability of nurses in two groups after training.Results After training, the clinical nursing ability, theoretical achievements and operational achievements of nurses in the observation group were higher than those in the control group with significant differences (P<0.01).Conclusions The establishment of standardized training system based on the ASK model for new nurses improves the competency of new nurses and provides a reference for nurses standardized training.

Objective To compare predictive power for deep vein thrombosis among hip and knee joint replacement patients using Autar scale and Wells scale.Methods Convenience sampling method was used.Totally 331 patients from ten tertiary hospitals receiving hip and knee joint replacement were recruited.General information questionnaire,Autar scale and Wells scale were used to collect data.Telephone follow-up was performed at 2 weeks,1 month and 3 months after hospital discharge.The primary endpoint of follow-up was occurrence of DVT,and the secondary endpoint was no occurrence of DVT within 3 months after hospital discharge.Results The Cronbach's α coefficients of Autar scale ranged from 0.716 to 0.762 for scores 24h before operation,24h after operation and at the day of discharge,and those of Wells scale ranged from 0.580 to 0.603.The area under the ROC curve of Autar scale ranged from 0.726 to 0.798.The area under the ROC curve of Wells scale ranged from 0.568 to 0.628.Conclusion The predictive power of Autar scale was higher than that of Wells scale which enabled Autar scale to better predict deep vein thrombosis for patients receiving hip and knee joint replacement.

Objective To understand self-directed learning skills of nursing college students and its correlactive factors, so as to provide evidences for self-directed learning progress. Methods We conducted a survey of 316 full-time nursing students from Hubei College of Chinese Medicine by applying self-rating scale of self-directed learning (SRSSDL). Results The total score of self-directed learning skills was (210. 59 ± 22. 51). The dimension of interpersonal skills scored (45. 10 ± 5. 30), the dimension of learning strategies scored (42. 07 ± 3. 82), the dimension of learning evaluation scored (41. 70 ± 4. 08), the dimension of awareness scored (41. 57 ± 3. 91), the dimension of learning activities scored (38. 93 ± 3. 89). The scores of interpersonal skills and learning strategies were higher than that of learning evaluation and awareness. Learning activities scored the lowest. Conclusions Nursing college students had certain self-directed learning skills. According to correlactive factors of self-directed learning skills, and nursing educators can adopt relevant instructions and teaching strategies to promote their self-directed learning skills.

ObjectiveTo study the epidemiological characteristics of diabetes mellitus and awareness rate in Zhejiang adults.MethodA total of 17 437 adults from 15 counties were randomly selected with stratified multi-stage cluster sampling method from July to November,2010.Each participant was required to complete a set of standardized questionnaire,physical examination,and blood specimen collection.ResultsThe overall standardized rate of diabetes mellitus was 5.94％ ( crude prevalence 8.80％ ).It was increased by 96.67％ during past 8 years,as compared with the prevalence 3.02％ in 2002.The standardized rate of diabetes mellitus of the urban and rural area were 7.52％ and 5.19％ ( crude prevalence 11.33％ and 7.09％ ),respectively.The standardized rate of diabetes mellitus in the urban was higher than rural ( u =6.58,P＜0.05 ).The standardized rate of diabetes mellitus of the male and the female were 5.74％ and 6.15％ ( crude prevalence 8.36％ and 9.13％ ),respectively,without significant difference ( u =1.39,P＞0.05 ).The awareness rate of diabetes mellitus was 59.19％ ( 56.66％ in male and 61.23 ％ in female,x2 =3.26,P＞0.05 ).The awareness rate of the urban was higher than the rural (63.47％ vs 54.69％,x2=12.20,P＜0.01 ).ConclusionThe prevalence of diabetes mellitus showed a rapidly rising trend in Zhejiang province.The effective intervention should be taken at its early stage.