Objective:To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods:The prospective multicenter study was conducted in Zhejiang, China from May 1 st, 2019 to January 31 st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results:A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P<0.01). Conclusion:In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

Objective To analyze the clinical efficacy of acupuncture combined with rehabilitation training in the treatment of post-stroke hemiplegia.Methods A retrospective study was conducted to select 121 cases of post-stroke hemiplegia patients who attended Haikou People's Hospital,Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from January 2021 to January 2023,and were divided into the control group and the acupuncture group according to whether acupuncture treatment was performed or not;59 cases in the control group were given conventional rehabilitation training methods of treatment,and 62 cases in the acupuncture group were added with acupuncture treatment on the basis of the conventional rehabilitation treatment.The course of treatment was 1 month.The changes in the traditional Chinese medicine(TCM)syndrome scores of the patients in the two groups were observed before and after treatment,as well as the cerebrovascular resistance values,including carotid artery mean blood flow(Qmean),mean velocity(Vmean),cerebrovascular bed characteristic impedance(Zc),and peripheral vascular resistance(R),and the changes in the Stroke Impact Scale(SIS),China Stroke Scale(CSS),and Fugl-Meyer Assessment(FMA)in the patients in the two groups were observed before and after treatment,and the clinical efficacy of the two groups was evaluated.Results(1)The total effective rate was 93.55%(58/62)in the acupuncture group and 79.66%(47/59)in the control group.The efficacy of the acupuncture group was superior to that of the control group,and the difference was statistically significant(P＜0.05).(2)After treatment,all TCM syndrome scores and total scores of patients in the two groups were significantly improved(P＜0.05),and the acupuncture group was significantly superior to the control group in improving TCM syndrome scores,with statistically significant differences(P＜0.05).(3)After treatment,the cerebral circulatory kinetic parameters of the patients in the two groups were significantly improved(P＜0.05),and the acupuncture group was significantly superior to the control group in improving the cerebral circulatory kinetic parameters,with a statistically significant difference(P＜0.05).(4)After treatment,the SIS,CSS,and FMA scores of patients in the two groups were significantly improved(P＜0.05),and the acupuncture group was significantly superior to the control group in improving the SIS,CSS,and FMA scores,and the differences were all statistically significant(P＜0.05).Conclusion The efficacy of acupuncture in the treatment of post-stroke hemiplegia is remarkable,and its efficacy is better than that of simple conventional rehabilitation training.

Objective To evaluate the characteristics of different antigen-specific T cell immune responses to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)after inoculation with 2 doses of SARS-CoV-2 inactivated vaccine for 12 months.Methods Fifteen healthy adults were enrolled in this study and blood samples collected at 12 months after receiving two doses of SARS-CoV-2 inactivated vaccine.The level and phenotypic characteristics of SARS-CoV-2 antigen-specific T lymphocytes were detected by activation-induced markers(AIM)based on polychromatic flow cytometry.Results After 12 months of inoculation with 2 doses of SARS-CoV-2 inactivated vaccine,more than 90%of adults had detectable Spike and Non-spike antigen-specific CD4+ T cells immune responses(Spike:14/15,P=0.0001;Non-spike:15/15,P<0.0001).80%of adults had detectable Spike and Non-spike antigen-specific CD8+ T cells immune responses(Spike:12/15,P=0.0463;Non-spike:12/15,P=0.0806).Antigen-specific CD4+ T cells induced by SARS-CoV-2 inactivated vaccination after 12 months were composed of predominantly central memory(CM)and effector memory 1(EM1)cells.On the other hand,in terms of helper subsets,antigen-specific CD4+ T cells mainly showed T helper 1/17(Th1/17)and T helper 2(Th2)phenotypes.Conclusions SARS-CoV-2 inactivated vaccination generates durable and extensive antigen-specific CD4+ T cell memory responses,which may be the key factor for the low proportion of severe coronavirus disease 2019(COVID-19)infection in China.

BACKGROUND:How to provide sufficient skin resources for scar plastic surgery and repair of extensive deep burn patients while avoiding the re-proliferation of scar tissue in the surgical area has always been an important topic in burn and wound repair research. OBJECTIVE:To observe the clinical application effects of artificial dermis combined with autologous scar epidermis in the repair of scar after extensive burns. METHODS:Retrospective analysis was performed on 73 patients with scar hyperplasia and contracture deformity after extensive burns in Bengbu Third People's Hospital Affiliated to Bengbu Medical College from January 2021 to January 2023.The patients were divided into three groups according to the treatment method:Group A(n=21,artificial dermis combined with autologous scar epidermis transplantation was used for treatment),group B(n=27,scar epidermis was transplanted after scar release in the functional site),and group C(n=25,functional site scar release after transplantation of thick skin treatment).Skin survival and infection at the receiving site,wound healing time at the receiving site and the donor site were recorded in the three groups.The scar status and functional recovery of the recipient area and donor area were evaluated by the Vancouver Scar Scale and activities of daily living. RESULTS AND CONCLUSION:(1)The skin infection rate was lower in group B than that in groups A and C(P<0.05).The survival grade was higher in group B than that in groups A and C(P<0.05).(2)The wound healing time at the receiving site was longer in group A than that in groups B and C(P<0.05).The wound healing time at the receiving site was longer in group C than that in group B(P<0.05).The wound healing time at the donor site was longer in group C than that in groups A and B(P<0.05).(3)Vancouver Scar Scale score was higher in group B than that in groups A and C at 12 months postoperatively(P<0.05).Vancouver Scar Scale score was higher in group C than that in groups A and B at 6 and 12 months postoperatively(P<0.05).The excellent grade of activities of daily living in groups A and C was significantly higher than that of group B at 12 months postoperatively(P<0.05).(4)The results showed that the application of artificial dermis combined with autologous scar epidermis composite transplantation in the treatment of scar contracture after extensive burn could not only achieve the same effect as that of intermediate-thickness skin,but also avoid postoperative scar re-hyperplasia at the donor site and shorten the time of complete wound healing at the donor site.Compared with scar epidermal transplantation,this treatment has obvious advantages.

Objective:This study aimed at investigating the efficacy and safety of eltrombopag in the treatment of adult primary immune thrombocytopenia (ITP) and evaluated the factors influencing its efficacy and side effects.Methods:A total of 198 patients with adult ITP who were admitted to Tianjin Medical University General Hospital between January 2018 and March 2022 were retrospectively analyzed. The efficacy of each starting dose of eltrombopag was evaluated, and adverse events were analyzed. The factors influencing efficacy were investigated, including sex, age, adult ITP type, platelet antibodies, and combined drug treatments.Results:Of the 198 patients, 70 males and 128 females with a median age of 45 years (18-88 years) were included; 130 (65.7%) had newly diagnosed adult ITP, 25 (12.6%) had persistent adult ITP, and 43 (21.7%) had chronic adult ITP. The bleeding event scores at baseline were assessed; 84.3% had scores of<4 and 15.7% had scores of ≥4. The eltrombopag response rate (initial response) at 6 weeks was 78.8% (complete response [CR]: 49.0%; CR1: 14.6%; CR2: 15.2%). The median response time to eltrombopag was 7 (7, 14) days. The initial response rates to 25, 50, and 75 mg eltrombopag were 74.1%, 85.9%, and 60.0%, respectively ( P=0.031). The initial response rate to the 50 mg dose was significantly higher than that of the 25-mg and 75-mg doses. Two patients received 100 mg as the starting dose, and their initial response was 0. Regarding dose adjustment, 70.7% of the patients remained on the starting dose, 8.6% underwent dose adjustment to 50 mg, and 6.1% underwent dose adjustment to 75 mg. Another two patients underwent dose adjustment to 100 mg. After dose adjustment, the persistent response rates were 83.6%, 85.3%, and 85.7% for the 25-, 50-, and 75-mg doses, respectively, with no significant difference. After dose adjustment, the sustained efficacy rate for the 100-mg dose (4 patients) was 100.0%. After 6 weeks of treatment with eltrombopag, the overall bleeding score of patients with ITP decreased. The number of patients with a score of ≥4 decreased to 0, the number of patients with a score of<4 decreased, and there was no significant change in the number of patients with a score of 1-2. The most common adverse event associated with eltrombopag was impaired liver function (7.7%). No thrombosis events or other adverse events were observed. ITP type and number of megakaryocytes significantly affected the initial response to eltrombopag. The initial response rates to eltrombopag for newly diagnosed adult ITP, persistent adult ITP, and chronic adult ITP were 85.3%, 56.0%, and 76.2%, respectively ( P=0.003). For megakaryocytes, the initial response rates were 61.8%, 87.1%, and 84.3% ( P=0.009) for the decreased, normal, and increased megakaryocyte groups, respectively. Conclusion:Eltrombopag, as a second-line or higher treatment for adult ITP, has a rapid onset of action and good safety. The initial response rate is significantly higher with a dose of 50 mg than with a dose of 25 mg. Patients with newly diagnosed ITP and those with normal or increased megakaryocyte numbers have a higher initial response rate to eltrombopag.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective: This study’s objective is to assess the efficacy and safety of Pulsed Magnetic Therapy System (PMTS) in improving insomnia disorder. Methods: Participants with insomnia disorder were randomly assigned to receive either PMTS or sham treatment for four weeks (n= 153; PMTS: 76, sham: 77). Primary outcomes are the Insomnia Severity Index (ISI) scores at week 0 (baseline), 1, 2, 3, 4 (treatment), and 5 (follow-up). Secondary outcomes are the Pittsburgh Sleep Quality Index at baseline and week 4, and weekly sleep diary-derived values for sleep latency, sleep efficiency, real sleep time, waking after sleep onset, and sleep duration. Results: The ISI scores of the PMTS group and the sham group were 7.13±0.50, 11.07±0.51 at week 4, respectively. There was a significant group×time interaction for ISI (F3.214, 485.271=24.25, p<0.001, ηp 2=0.138). Only the PMTS group experienced continuous improvement throughout the study; in contrast, the sham group only experienced a modest improvement after the first week of therapy. At the end of the treatment and one week after it, the response of the PMTS group were 69.7% (95% confidence interval [CI]: 58.6%–79.0%), 75.0% (95% CI: 64.1%–83.4%), respectively, which were higher than the response of the sham group (p<0.001). For each of the secondary outcomes, similar group×time interactions were discovered. The effects of the treatment persisted for at least a week. Conclusion PMTS is safe and effective in improving insomnia disorders.

As a diagnostic method to guide the treatment of sinew/fascia diseases, jingjin (muscle regions of meridians) differentiation is an important component of syndrome differentiation system of acupuncture and moxibustion. In clinical practice, because of the limitations of the ideological guidance of the holistic view, the systemic and dialectical thinking and the syndrome element collection, the system of diagnosis and treatment of sinew/fascia diseases is not comprehensive. Through combing the origin of the holistic view of jingjin, the paper expounds the differentiation framework of sinew/fascia diseases from 4 aspects of differentiation, i.e. the location of disease, etiology, nature of disease and condition of disease. It suggests to construct jingjin differentiation system by taking the holistic ideas as the core, the syndrome element research as the common method and the evidence-based medicine as the theoretical basis so that the thinking of syndrome differentiation and the diagnostic approaches based on jingjin theory can be enriched.
Humans ; Acupuncture Therapy ; Evidence-Based Medicine ; Language ; Meridians ; Moxibustion ; Syndrome

The article analyzes chief physician SUN Wuquan's empirical characteristics in treating neck-type cervical spondylosis:disease differentiation combined with pattern differentiation,emphasizing the assessment of tendons and bones,with DING's Tuina(Chinese therapeutic massage)manipulations and static Gongfa(Qigong exercise)as the predominant treatment,inherits the academic features of DING's Tuina school,"paying equal attention to tendons and bones,putting function first";thus provides a reference for treating neck-type cervical spondylosis with Tuina therapy.

Objective: To obtain the diversity and abundance of fast-growing bacteria in the surface water of the northeast coast of Hainan Island in China, different cultivation methods were employed. This study also aims to provide a reference for isolating bacterial samples from seawater sources and preventing marine-derived pathogens. Methods: Based on the principles of taxonomic design, surface seawater samples were collected from six locations along the northeast coast of Hainan Island in China in March, June, October, and December 2021. Then, bacterial enrichment was performed based on traditional cultivation methods for Salmonella, Vibrio, Burkholderia pseudomallei, Actinomycetes, and general marine bacteria. After that, bacterial species identification was conducted by 16S rDNA amplicon sequencing and metagenomic sequencing. Results: A total of 1 151 fast-growing cultivable bacteria belonging to 66 genera and 213 species were identified using five different culture protocols. In different cultivation protocols, Bacillus and Klebsiella demonstrated extensive discriminatory advantages and ranked among the top genera in terms of abundance. Protocol 1 had Escherichia, Klebsiella, and Citrobacter as dominant genera. Pathogenic bacteria detected by protocol 1 included Klebsiella pneumoniae and Escherichia coli, with 37 and 29 strains respectively, while Salmonella enterica was uniquely detected with seven isolates. Proteus, Enterococcus, and Providencia were the dominant genera in protocol 2, and Proteus mirabilis was the most abundant pathogenic bacteria detected with 66 isolates. Vibrio cholerae was uniquely detected with six isolates at a higher abundance. Klebsiella, Escherichia, and Acinetobacter were the dominant genera in protocol 3, and Klebsiella pneumoniae was the most abundant pathogenic bacteria detected with 53 isolates, while Acinetobacter nosocomialis was uniquely detected with seven isolates. Vibrio and Pseudoalteromonas were the dominant genera in protocol 4, and they showed advantages in isolating and cultivating Marine-derived Vibrio. Exiguobacterium, Staphylococcus, and Bacillus were the dominant genera in protocol 5. Bacillus cereus and Lactococcus lactis were the most abundant pathogenic bacteria detected with 20 and 15 isolates, respectively, while Lactococcus lactis was uniquely detected at higher abundance. Metagenomic sequencing showed that Klebsiella pneumoniae was significantly dominant with a gene abundance of 51.11%, followed by Alcanivorax sp. at 12.57%. Conclusion: The surface water of the northeast coast of Hainan Island in China exhibits a rich diversity of bacteria, with Klebsiella pneumoniae being highly abundant in the studied area. Different cultivation methods demonstrate distinct selective advantages in culturing bacterial genera and pathogens. Therefore, it is necessary to optimize cultivation conditions for specific marine bacteria.
Humans ; Water ; Bacteria/genetics* ; Seawater/microbiology* ; Escherichia coli ; Enterococcus ; Klebsiella pneumoniae ; China