Objective To analyze the expression and detection significance of community acquired respiratory distress syndrome(CARDS)toxin in bronchoalveolar lavage fluid(BALF)in children with severe Mycoplasma pneumoniae pneumonia(SMPP).Methods The BALF samples of children diagnosed with Mycoplasma pneumoniae pneumonia(MPP)were collected from the Department of Pulmonology,Children's Hospital Affiliated to Capital Institute of Pediatrics from August 2021 to April 2022,the relative expression of CARDS toxins was determined by quantitative realtime polymerase chain reaction(qPCR).The patients were divided into SMPP group and non-SMPP group(control group).The relative expression of CARDS toxin and other clinical indicators were compared between the two groups.The risk factors of SMPP were analyzed.The predictive value of the indicators was analyzed using receiver operating characteristic(ROC)curves.Results ①The relative expression level of CARDS toxin(Z=-6.151),D-dimer(Z=-5.102)and lactate dehydrogenase(LDH)(Z=-6.337)in SMPP group were significantly higher than those in control group(P<0.001).The white blood cell(Z=-2.155),neutrophil ratio(t=2.988)and C-reactive protein(CRP)(Z=-3.360)were higher than those in control group(P<0.05).②The relative expression of CARDS toxin was positively correlated with serum LDH(r=0.258,P<0.05).③Binary Logistic regression analysis showed that fever time(OR=1.271,95% CI:1.079-1.497),LDH(OR=1.011,95% CI:1.005-1.017)and CARDS toxin(OR=6.210,95% CI:2.646-14.577)were risk factors for SMPP.Conclusion CARDS toxin was closely related to MPP disease,and was significantly increased in SMPP group.CARDS toxin was one of the independent risk factors for SMPP and positively correlated with serum LDH level.It can be used as a good indicator to evaluate the condition,combined with fever time and LDH has clinical significance.

Objective To analyze the expression and detection significance of community acquired respiratory distress syndrome(CARDS)toxin in bronchoalveolar lavage fluid(BALF)in children with severe Mycoplasma pneumoniae pneumonia(SMPP).Methods The BALF samples of children diagnosed with Mycoplasma pneumoniae pneumonia(MPP)were collected from the Department of Pulmonology,Children's Hospital Affiliated to Capital Institute of Pediatrics from August 2021 to April 2022,the relative expression of CARDS toxins was determined by quantitative realtime polymerase chain reaction(qPCR).The patients were divided into SMPP group and non-SMPP group(control group).The relative expression of CARDS toxin and other clinical indicators were compared between the two groups.The risk factors of SMPP were analyzed.The predictive value of the indicators was analyzed using receiver operating characteristic(ROC)curves.Results ①The relative expression level of CARDS toxin(Z=-6.151),D-dimer(Z=-5.102)and lactate dehydrogenase(LDH)(Z=-6.337)in SMPP group were significantly higher than those in control group(P<0.001).The white blood cell(Z=-2.155),neutrophil ratio(t=2.988)and C-reactive protein(CRP)(Z=-3.360)were higher than those in control group(P<0.05).②The relative expression of CARDS toxin was positively correlated with serum LDH(r=0.258,P<0.05).③Binary Logistic regression analysis showed that fever time(OR=1.271,95% CI:1.079-1.497),LDH(OR=1.011,95% CI:1.005-1.017)and CARDS toxin(OR=6.210,95% CI:2.646-14.577)were risk factors for SMPP.Conclusion CARDS toxin was closely related to MPP disease,and was significantly increased in SMPP group.CARDS toxin was one of the independent risk factors for SMPP and positively correlated with serum LDH level.It can be used as a good indicator to evaluate the condition,combined with fever time and LDH has clinical significance.

Objective:To investigate the value of community acquired respiratory distress syndrome (CARDS) toxin combined with IFN-γ in the early prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods:A total of 100 children diagnosed with Mycoplasma pneumoniae pneumonia (MPP) were selected as the study objects. Among them, 36 cases were diagnosed with RMPP and 64 cases without RMPP were set as control group. The general data, clinical symptoms, signs, laboratory tests and internal and external pulmonary complications were compared between the two groups. The independent risk factors for RMPP was analyzed by Binary Logistic regression, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of the indicators. Results:The fever time and hospital stay in RMPP group were significantly longer than those in control group, the relative expression of CARDS toxin, neutrophil ratio, C-reactive protein, D-dimer, lactate dehydrogenase, IL-6 and IFN-γ levels in RMPP group were higher than those in control group, and the differences were statistically significant. Binary Logistic regression analysis showed that long fever duration, increased expression of IFN-γ and CARDS toxin and extrapulmonary complications were independent risk factors for RMPP. ROC curves were drawn for the three continuous variables of fever time, IFN-γ, and relative expression of CARDS toxin, the sensitivity and specificity of the combined prediction of the three indexes were 86.1% and 73.4%, respectively.Conclusions:CARDS toxin is closely related to MPP. Fever duration, IFN-γ, relative expression of CARDS toxin and extrapulmonary complications are independent risk factors for RMPP. Especially when the fever time is more than 10.5 d, IFN-γ is more than 31.79 pg/ml, and the relative expression of CARDS toxin is more than 1.18, the possibility of RMPP should be noted.

Objective:To investigate the value of community acquired respiratory distress syndrome (CARDS) toxin combined with IFN-γ in the early prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods:A total of 100 children diagnosed with Mycoplasma pneumoniae pneumonia (MPP) were selected as the study objects. Among them, 36 cases were diagnosed with RMPP and 64 cases without RMPP were set as control group. The general data, clinical symptoms, signs, laboratory tests and internal and external pulmonary complications were compared between the two groups. The independent risk factors for RMPP was analyzed by Binary Logistic regression, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of the indicators. Results:The fever time and hospital stay in RMPP group were significantly longer than those in control group, the relative expression of CARDS toxin, neutrophil ratio, C-reactive protein, D-dimer, lactate dehydrogenase, IL-6 and IFN-γ levels in RMPP group were higher than those in control group, and the differences were statistically significant. Binary Logistic regression analysis showed that long fever duration, increased expression of IFN-γ and CARDS toxin and extrapulmonary complications were independent risk factors for RMPP. ROC curves were drawn for the three continuous variables of fever time, IFN-γ, and relative expression of CARDS toxin, the sensitivity and specificity of the combined prediction of the three indexes were 86.1% and 73.4%, respectively.Conclusions:CARDS toxin is closely related to MPP. Fever duration, IFN-γ, relative expression of CARDS toxin and extrapulmonary complications are independent risk factors for RMPP. Especially when the fever time is more than 10.5 d, IFN-γ is more than 31.79 pg/ml, and the relative expression of CARDS toxin is more than 1.18, the possibility of RMPP should be noted.

Objective:To investigate the effects of high-energy shock and vibration on cortex injury and peripheral blood immune cells in goats.Methods:Seventeen Boer goats without gender preference were selected. By using random number tables, the goats were divided into normal control group ( n=5) and shock and vibration injury group ( n=12). The goats in the normal control group were anatomized routinely and their brain was collected after being sacrificed without any other treatment. The goats in the high-energy shock and vibration model group were placed on a loading table (part of the BY10-100 instant shock and vibration simulation platform) in a restrained state, and made into a high-energy shock and vibration injury model induced by a vertical impact waveform generator. The intravenous blood samples were taken from the goats in the shock and vibration injury group before and at 0, 3, 6 and 24 hours after injury.Then, the goats were sacrificed and the following procedures were the same as the normal control group. At 24 hours after injury, the brain injury and the histopathological changes of the cerebral cortex in the normal control group and shock and vibration injury group were observed by gross pathological and anatomical examination and HE staining. The mRNA expression of zonula occludens 1 (ZO-1), tight junction protein 5 (Claudin-5), glial fibrillary acidic protein (GFAP), ionized calcium binding adaptor molecule 1 (IBA-1), interleukin (IL)-1β, IL-6 and cluster of differentiation antigen 177 (CD177) of the cerebral cortex in the normal control group and shock and vibration injury group were measured through fluorogenic quantitative polymerase chain reaction. The expression of ZO-1 and Claudin-5 proteins of the cerebral cortex in the normal control group and shock and vibration injury group were detected by Western blotting. Hematology analyzer and coagulation analyzer were used to detect white blood cell count, neutrocyte, lymphocyte, monocyte, prothrombin time 1 (PT-1), prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin activity (PTA) and fibrinogen (FIB) levels in goats of the shock and vibration injury group before and at 0, 3, 6 and 24 hours after injury, respectively. Results:At 24 hours after injury, no visible contusion or necrosis was found in goat brain tissue in the shock and vibration injury group; the cerebral micro-vessels presented with a local dilation, hyperemia, edema, aggregation of inflammatory cells, disruption of vessel walls and leakage of red blood cells. These changes were not observed in the normal control group. In the shock and vibration injury group, ZO-1 and Claudin-5 mRNA expressions in the cerebral cortex were 0.25±0.10 and 0.09(0.04, 0.44) respectively, which were significantly lower than those of the normal control group [1.00±0.15 and 0.99(0.80, 1.20)]; GFAP, IBA-1, IL-1β, IL-6 and CD177 mRNA expression levels were 4.40(3.88, 6.75), 2.60±1.07, 3.04±0.51, 2.71±0.45 and 2.93±0.62 respectively, which were significantly higher than those of the normal control group [1.00(0.78, 1.22), 1.00±0.37, 1.00±0.27, 1.00±0.57 and 1.00±0.35]; ZO-1 and Claudin-5 protein expression levels were 0.41±0.06 and 0.42±0.11 respectively, which were significantly lower than those of the normal control group (1.08±0.12 and 0.91±0.23) (all P<0.01). In the shock and vibration injury group, the levels of white blood count, neutrocyte, and lymphocyte in peripheral blood were (13.7±3.3)×10 9/L, (35.3±14.8)% and (57.2±15.1)% respectively before injury, (19.4±3.1)×10 9/L, (60.5±12.5)% and (33.6±14.2)% respectively at 3 hours after injury, and (20.6±3.6)×10 9/L, (63.6±13.0)% and (30.9±15.0)% respectively at 6 hours after injury. By contrast, the levels of white blood count and neutrocyte were significantly increased but the level of lymphocyte was significantly decreased at 3 and 6 hours after injury ( P<0.05 or 0.01); the levels of the above indicators showed no significant changes at 0 and 24 hours after injury (all P>0.05); the level of monocyte did not change significantly at all time points before and after injury (all P>0.05). The levels of PT-1, PT-INR, APTT, TT, PTA and FIB in the shock and vibration injury group did not change significantly at each time point before and after injury (all P>0.05). Conclusion:Cerebral cortex microvascular injury and disruption of blood-brain barrier can be initiated in the early stage of high-energy shock and vibration injury in goats, accompanied by the presence of central and peripheral inflammatory response.

The objectives of the paper is to more accurate understand the use demands of wise classrooms for medical students, and provide scientific basis for wise classroom managers when formulating wise classroom environment optimization strategies. In the paper, the questionnaire survey method was used to investigate 23 indicators in 4 dimensions of hardware facilities, information technology, teaching methods and medical wise classroom features. And the data of 1 074 questionnaires were analyzed using KANO model analysis technology and satisfaction importance quadrant chart. Among the 23 demand indicators, there are 6 required attributes, 7 expected attributes, 9 charm attributes and 1 non-differential attribute. According to the theoretical importance ranking of the KANO model, wise classroom managers should first improve the quality of indicators related to necessary attributes, give priority to the quality of indicators related to expected attributes, and finally meet the requirements of indicators related to charm attributes. Relevant policies and construction suggestions for smart classrooms are put forward from the three levels of school top-level design, teachers and managers in the paper.

This study summarizes related studies on readiness for online teaching in China and globally and constructs an online teaching readiness scale for higher education teachers with reference to related studies on online teaching competency, blended teaching readiness, and influencing factors for online teaching. This scale includes five dimensions, i.e., belief, teaching readiness, technical readiness, online communication readiness, and institutional support. A questionnaire survey and statistical analyses were performed to investigate the rationality of the scale, and then the scale was modified. The results show that the indicators of the scale have a good degree of fitting, and this study provides a necessary standard for examining the online teaching readiness of higher education teachers and new ideas for online teaching in colleges and universities.

There are many difficulties in digital medical teaching, including new course content, multiple key and difficult points, wide knowledge coverage, large knowledge structure span, high requirements for teachers, and few shared resources for online teaching during the epidemic. This research aims to give full play to the advantages of our team in the field of digital medicine, and promote the construction of network resources of this course and its extensive development in more universities through the exploratory and research on the course construction and teaching mode of the Digital Medicine MOOC (massive open online course). The questionnaire study found that the satisfaction score of the average satisfaction score of MOOC teaching in terms of students' pre-class preview, quick grasp of knowledge points in class and after-class review reached more than 90 points, and the score of improving students' learning initiative was (88.10±10.87) points. It can be seen that the use of MOOC teaching mode can significantly help students to preview before class, master knowledge points in class and review after class, and improve students' initiative in learning. The research suggests that the production of Digital Medicine MOOC should keep the consistency and individuality of all knowledge points under the framework of digital medical knowledge; teachers should focus on the explanation of basic knowledge points and deepen in further step integrated with frontiers of this field; it’s suggested to make a separate MOOC on frontier knowledge and application explanation, so as to cope with the outdated courseware content caused by the development and update of this subject.

Objective To explore the clinical features of children infected with macrolide-resistant (MR) Mycoplasma pneumonia(MP) isolates and genetic typing of all isolates.Methods Polymerase chain reaction(PCR) of MP positive in 96 nasopharyngeal or bronchoalveolar lavage fluid (BALF) samples were collected from patients diagnosed as MP pneumonia in the Affiliated Children's Hospital of the Capital Institute of Pediatrics from January 2013 to October 2015.Fifty-five cases were male,41 cases were female;19 cases (19.8％) were 1 to 3 years old,18 cases (18.7％) were more than 3 to 5 years old,59 cases(61.5％) were more than 5 to 13 years and 2 months old.These samples were tested for MR associated mutations in the 23S rRNA of MP,and were divided into the MR group and the macrolide-sensitive (MS) group.Furthermore,the genotype of all the isolates were performed by conducting P1-restriction fragment length polymorphism(P1-RFLP) analysis and multiple-locus variable-number tandem-repeat analysis (MLVA) method.The clinical characteristics including the age,gender,hospitalization duration,symptoms,signs,fever duration,fever duration after macrolide therapy,white blood cell count,C-reactive protein (CRP),chest X-ray and/or chest computed tomography,which were compared between different groups.SPSS 11.5 software was used to analyze the statistical data.Statistical significance was determined at the 0.05 level of a two-tailed test.Results MR mutations were identified in the 23S rRNA gene in 81 specimens (84％),and the 96 specimens were divided into MR group(81 cases) and MS group (15 cases).There were statistical differences in fever duration,hospitalization duration,the incidence of complications and CRP level between the MR group and MS group (t =2.061,Z =-3.368,x2 =5.856,Z =-2.165,all P ＜ 0.05).There were no statistical differences in age,white blood cell count,consolidation percentage on chest radiography and fever duration after macrolide therapy(all P ＞ 0.05).All the 96 isolates were performed by adopting P1-RFLP typing,but 5 isolates were not typed successfully,while 81 cases (89.0％) isolates were typed as P1-Ⅰ and 10 isolates(11％) were typed as P1-Ⅱ c.The hospitalization duration and the fever duration after macrolide therapy in the P1-Ⅰ were longer than the P1-Ⅱ c group,and the difference was statistically significant (Z =-2.197,2.237,all P ＜ 0.05).There were no statistical differences in age,fever duration,white blood cell count,CRP level,consolidation percentage on chest radiography and the incidence of complications (all P ＞ 0.05).Seventy-three cases (90％) of P1-Ⅰ group were MR isolates,8 cases (10％) were MS isolates;3 cases (30％) of the P1-]Ⅱ c group were MR isolates,7 cases (70％) were MS isolates.The MR isolates in P1-Ⅰ group were much more than P1-Ⅱ c group.There was obvious statistical difference in the proportion of MR isolates between 2 groups (x2 =19.209,P ＜ 0.01).All the 96 isolates were performed by modified MLVA typing,82 cases(85.5％) were typed as M4-5-7-2,11 cases(11.5％) were typed as M3-5-6-2,1 case (1.0％) was typed as M4-5-5-2,and 2 cases (2.0％) were typed as M4-5-6-2.Because there were less cases of the M4-5-5-2 and M4-5-6-2 type,only the clinical data of M4-5-7-2 and M3-5-6-2 group were compared.The hospitalization duration and the fever duration after macrolide therapy in the M4-5-7-2 group were longer than the M3-5-6-2 group,and the difference was statistically significant(Z =-2.406,-4.472,all P ＜ 0.05).There were no statistical differences in age,fever duration,white blood cell count,CRP level,consolidation percentage on chest radiography and the incidence of complications(all P ＞ 0.05).Seventy-four cases (90％) of the M4-5-7-2 group were MR isolates,8 cases (10％) were MS isolates;4 cases (36％) of the M3-5-6-2 group were MR isolates,7 cases (64％) were MS isolates.The MR isolates in M4-5-7-2 group were much more than M3-5-6-2 group.There was obviously statistical difference in the proportion of MR isolates between 2 groups (x2 =17.022,P ＜ 0.01).Conclusions In the MR group,the children had longer fever duration and hospitalization duration,higher incidence of complications and higher CRP level than those in the MS group.The MR rates of MP in China was high.P1-Ⅰ and M4-5-7-2 are the predominate genotypes.There may be a correlation between genotype and MR.

BACKGROUNDMycoplasma pneumonia (M. pneumoniae) is one of the key pathogens of community-acquired pneumonia. A global pandemic of M. pneumoniae has occurred since 2010. The aim of this study was to survey the prevalence of M. pneumoniae in children in Beijing from 2007-2012.

METHODSA total of 3 073 clinical specimens were obtained from pediatric patients with respiratory tract infections from January 2007 to December 2012, and examined by nested polymerase chain reaction. PCR products were visualized by 2% agarose gel electrophoresis, positive products sequenced, and compared with reference sequences in GenBank. Macrolide resistance-associated mutations were also detected for some positive samples.

RESULTSOf the 3 073 specimens, 588 (19.13%) were positive for M. pneumoniae, 12.4% of which were accompanied by viral infections. Positive rates for M. pneumoniae were highest in 2007 and 2012, showing a significant difference when compared with other years. Infections tended to occur in autumn and winter and positive rates were significantly higher for children aged 3-16. The rate of macrolide resistance-associated mutations was 90.7%, and the predominant mutation was an A→G transition (89.92%) at position 2063 in domain V of the 23S rRNA gene.

CONCLUSIONSM. pneumoniae outbreaks occurred in 2007 and 2012 in pediatric patients in Beijing, which is consistent with the global prevalence of M. pneumoniae. M. pneumoniae can cause multi-system infections in children, and may be accompanied with viral infections. We determined that school-age children are more susceptible to this disease, particularly in autumn and winter. Gene mutations associated with macrolide resistance were very common in M. pneumoniae-positive specimens during this period in Beijing.

Adolescent ; Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Female ; Humans ; Macrolides ; therapeutic use ; Male ; Mycoplasma pneumoniae ; pathogenicity ; Pneumonia, Mycoplasma ; drug therapy ; epidemiology ; Prevalence