Objective:To investigate the efficacy and safety of tocilizumab in the treatment of critically ill children with acute necrotizing encephalopathy (ANE).Methods:It is a retrospective cohort study. The children with ANE admitted to the pediatric intensive care unit of 4 Chinese tertiary hospitals from December 2022 to November 2023 were divided into conventional treatment group and tocilizumab group, and the comparison between groups was performed by using Mann ‐ Whitney U test or Chi-square test. Results:Among 21 cases of severe ANE, there were 11 males with the onset age of 65 (27, 113) months. The duration from onset to PICU admission was 2 (1, 2) days. There were 13 cases of ultra-high fever (greater than 40 ℃), including 18 cases of convulsions, and 19 cases with a GCS score of less than 8 points. The causative agent was novel coronavirus Omicron in 7 cases and influenza A in 14 cases. All cases had central respiratory failure requiring mechanical ventilation. Of the 21 cases, 18 were shock, 15 were coagulopathy, 10 were kidney injury and 13 were liver dysfunction. Of these hospitalized patients, 8 children with ANE were treated with tocilizumab. Eight cases received continuous blood purification (CBP) treatment, 5 of them were combined with plasmapheresis. Serum cytokine levels were elevated in 21 children with ANE, including (interleukin, IL)-6 and IL-8 (61 (22, 1 513) and 68 (5, 296) ng/L). There were 14 cases (67%) deaths, including 11 cases in the conventional treatment group and 3 cases in the tocilizumab group. There was no significant difference in the mortality rate between the two groups ( P=0.056). Tocilizumab-related rash or other adverse events were not observed. Conclusions:The motality of critically ill ANE patients was high. The combination of Tocilizumab with conventional treatment did not reduce the motality of severe ANE patients, and no adverse reactions of tocilizumab were observed.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

BACKGROUND: The therapeutic potential of exosomes from human umbilical cord mesenchymal stem cells (HUMSCsExo) for delivering specific circular RNAs (circRNAs) in treating premature ovarian failure (POF) is not well understood.This study aimed to explore the efficacy of HUMSCs-Exo in delivering hsa_circ_0002021 for POF treatment, focusing on its effects on granulosa cell (GC) senescence and ovarian function. METHODS: Bioinformatic analysis was conducted on circRNA profiles using the GSE97193 dataset from GEO, targeting granulosa cells from varied age groups. To simulate granulosa cell senescence, KGN cells were treated with cyclophosphamide (CTX). HUMSCs were transfected with pcDNA 3.1 vectors to overexpress hsa_circ_0002021, and the HUMSCsExo secreted were isolated. These exosomes were characterized by transmission electron microscopy (TEM) and Western blotting to confirm exosomal markers CD9 and CD63. Co-culture of these exosomes with CTX-treated KGN cells was performed to assess b-galactosidase activity, oxidative stress markers, ROS levels, and apoptosis via flow cytometry.Interaction between hsa_circ_0002021, microRNA-125a-5p (miR-125a-5p), and cyclin-dependent kinase 6 (CDK6) was investigated using dual-luciferase assays and RNA immunoprecipitation (RIP). A POF mouse model was induced with CTX, treated with HUMSCs-Exo, and analyzed histologically and via immunofluorescence staining. Gene expression was quantified using RT-qPCR and Western blot. RESULTS: hsa_circ_0002021 was under expressed in both in vivo and in vitro POF models and was effectively delivered by HUMSCs-Exo to KGN cells, showing a capability to reduce GC senescence. Overexpression of hsa_circ_0002021 in HUMSCs-Exo significantly enhanced these anti-senescence effects. This circRNA acts as a competitive adsorbent of miR-125a-5p, regulating CDK6 expression, which is crucial in modulating cell cycle and apoptosis. Enhanced expression of hsa_circ_0002021 in HUMSCs-Exo ameliorated GC senescence in vitro and improved ovarian function in POF models by modulating oxidative stress and cellular senescence markers. CONCLUSION This study confirms that hsa_circ_0002021, when delivered through HUMSCs-Exo, can significantly mitigate GC senescence and restore ovarian function in POF models. These findings provide new insights into the molecular mechanisms of POF and highlight the therapeutic potential of circRNA-enriched exosomes in treating ovarian aging and dysfunction.

Objective:To investigate the clinical epidemiological data of children with prolonged mechanical ventilation (PMV) in pediatric intensive care unit(PICU), and analyze the primary disease of children with PMV as well as the disease characteristics and prognosis of children with PMV under different kinds of primary disease.Methods:The clinical data of hospitalized children with PMV in PICU at Children′s Hospital of Fudan University from January 2019 to December 2020 were retrospectively collected.Results:A total of 46 children with PMV were collected.There were 18 males (39.1%) and 28 females (60.9%). The median age was 37 (8, 86) months and the median body weight was 15 (7, 20) kg.The average pediatric critical illness score at admission was 84.2±7.7, PaO 2/FiO 2 was (245.5±99.8)mmHg.The primary diseases leading to PMV were as follows: there were 14 cases of severe pneumonia, eight cases of severe encephalitis, five cases of bronchopulmonary dysplasia, three cases of upper airway obstruction/craniofacial deformity, three cases of myasthenia, three cases of brain stem tumor, three cases of mitochondrial encephalomyopathy, two cases of spinal muscular atrophy, two cases of Prader-Willi syndrome, one case of dermatomyositis, one case of severe brain injury, and one case of central hypoventilation.The causes of unable to withdraw ventilator were respiratory dysfunction in 24 cases, brain dysfunction in 16 cases, and diaphragm dysfunction in six cases.Compared with neuromuscular diseases, children with PMV caused by respiratory diseases had lower month age, higher preterm birth rate, lower PaO 2/FiO 2 ratio, higher parameters for ventilator treatment, and the differences were statistically significant ( P<0.05). Children with PMV caused by neuromuscular diseases had lower Glasgow coma score and higher coma rate, and the differences were statistically significant ( P<0.05). A total of nine (19.6%) cases underwent tracheotomy.A total of 23 (50.0%) cases were successfully extubated from ventilator, six (13.0%) cases were dependent on invasive ventilator, and six (13.0%) cases were breathing with tracheotomy tube.The median mechanical ventilation time was 33 (28, 40) days, the median PICU hospital stay was 42 (34, 56) days, and the median hospital stay was 51 (41, 65) days.A total of 27 (58.7%) cases were improved and discharged, four (8.7%) cases were transferred to rehabilitation hospital, four (8.7%) cases were transferred to local hospital, and 11 (23.9%) cases died in hospital or at home after giving up. Conclusion:The main causes of PMV in PICU children are respiratory dysfunction, brain dysfunction and diaphragm dysfunction.50.0% of the children with PMV could be discharged from the ventilator, and 23.9% died or died after giving up.

The fixed number package management of medical consumables is an important content of SPD management mode. In the process of medical low-value consumables management, hospitals are generally faced with the problems of frequent access and low matching between push quantity and actual use quantity, resulting in complicated access operations of medical staff, shortage or hoarding of consumables and so on. In order to reduce the times of taking and using consumables and improve the comfort of medical staff, the authors dynamically adjusted the content and push quantity of fixed number packages according to the historical use data. The results showed that the adjusted fixed number setting could significantly reduce the average daily access times of medical staff, and reduce the probability of out of stock and hoarding.

【Objective】 To explore the factors affecting the off-site vasovagal reactions in whole blood donors, aimed at providing references for formulating interventions. 【Methods】 The off-site vasovagal reactions in whole blood donors in 2019 was investigated in terms of gender, age, frequency of blood donation, weight and season were classified and analyzed. 【Results】 Among the 42 874 donors who donated 400 mL of whole blood, 67 had non-severe off-site vasovagal reaction, accounting for 0.16%, and none developed severe reaction. Single-factor and multi-factor correlation analysis showed that the age (18~25 years old) and weight (< 55 Kg) were the main influencing factors of off-site vasovagal reaction, while gender, blood donation frequency and season showed no statistical significance. 【Conclusion】 We should pay close attention to the factors predicting the off-site vasovagal reaction and formulate corresponding interventions to reduce the reaction rates, so as to improve the quality of blood donation service, and ensure the safety of blood donors.

Changes in the intrinsic characteristics of brain neural activities can reflect the normality of brain functions. Therefore, reliable and effective signal feature analysis methods play an important role in brain dysfunction and relative diseases early stage diagnosis. Recently, studies have shown that neural signals have nonlinear and multi-scale characteristics. Based on this, researchers have developed the multi-scale entropy (MSE) algorithm, which is considered more effective when analyzing multi-scale nonlinear signals, and is generally used in neuroinformatics. The principles and characteristics of MSE and several improved algorithms base on disadvantages of MSE were introduced in the article. Then, the applications of the MSE algorithm in disease diagnosis, brain function analysis and brain-computer interface were introduced. Finally, the challenges of these algorithms in neural signal analysis will face to and the possible further investigation interests were discussed.

Objective: To understand the status and related factors of quality of life (QOL) among children aged 4-5 years old in rural areas of Anhui Province, and to provide a reference for improving the quality of life among children in rural areas. Methods: A total of 4 457 preschool children aged 4-5 years old were selected from rural areas in five counties of Anhui Province by cluster sampling method. Parents of children were surveyed using the Pediatric Quality of Life Inventory Measurement Models 4.0. Results: The total QOL score of children aged 4-5 years old in rural areas of Anhui Province was (79.44±12.51). The scores of emotional function, school performance and psychosocial summary were higher in left-behind children than that in non-left-behind children(t=2.99, 3.51, 3.22, P<0.05). Multivariate Logistic regression analysis showed that the older children (OR=0.82, 95%CI=0.71-0.95) and the bigger size of households (OR=0.85, 95%CI=0.73-0.98) were positively associated with quality of life of children, while the higher father’s educational level(OR=1.40, 95%CI=1.21-1.62), the lower father’s income, mothers doing housework or unemployment and children suffering from illness in the past two weeks (OR=1.76, 95%CI=1.50-2.06) were negatively associated with quality of life of children(P<0.05). Conclusion The quality of life of children aged 4-5 year old in rural areas of Anhui Province is relatively low. The children’s age, the father’s education level, the father’s annual income, the mother’s occupation, the size of households, and children suffering from illness in the past two weeks were the related factors that affectchildren’s quality of life.

Objective To establish the continuing nursing model for ventilator-dependent children in China and explore its feasibility.Methods Ventilator-dependent children in our hospital from October 2015 to February 2017 were recruited.Self-designed home ventilation follow-up card and long-term ventilator-dependent children outpatient follow-up card were used to collect information.We established files for patients trained and evaluated caregivers conducted discharge assessment for patients and family status performed follow-up and management.Results Totally 30 cases of parents and caregivers received home care training and passed the examination 15 cases of ventilator-dependent children returned home with home ventilator and 12 received follow-up.The total readmission rate was 58.3％;among them the readmission rate in one month was 33.3％.One case died due to deteriorated primary disease and 11 cases used home mechanical ventilation successfully during follow-up.The length of home mechanical ventilation varied from 5 months to 2 years.Conclusion The continuing nursing model for ventilator-dependent children is feasible.

Fifteen patients with sinus-type pressure ulcer in ischial tuberosity were admitted to our unit from April 2013 to April 2017, including 12 patients of unilateral pressure ulcer and 3 patients of bilateral pressure ulcer. The wounds were with infection of different degrees. The outer wound area of pressure ulcer before debridement ranged from 1.5 cm×1.0 cm to 6.0 cm×5.0 cm. Fifteen patients with 15 pressure ulcers were treated with vacuum sealing drainage for 3 to 13 days after debridement and sinus wall resection. Unilateral pressure ulcer was repaired with posterior femoral bilobed flap. One side of bilateral pressure ulcer was repaired with posterior femoral bilobed flap, and the other side was repaired with gluteus maximus muscle flap combined with local flap. The size of flaps ranged from 11.0 cm×7.5 cm to 15.0 cm×10.0 cm. Epidermis of the distal part and edge of the main flap was removed to make complex dermal tissue flap to fill the deep cavity. The other part of the main flap was applied to cover wound, and another flap of the bilobed flap was applied to cover the donor site where main flap was resected. The donor sites were sutured directly. The posterior femoral bilobed flaps in 15 patients survived after operation. Pressure ulcers of 12 patients were healed well. Incision of 2 patients ruptured and healed 15 days after second sewing. One pressure ulcer with infection under the flap healed on 16 days post second completely debridement. During follow-up of 3 to 18 months, flaps were with soft texture, good appearance, and no recurrence.