Objective:To explore the prognosis and influencing factors of early-onset neonatal sepsis (EONS), and provide the guidance for early clinical prevention and treatment.Methods:The clinical data of 147 children with EONS in Shijiazhuang Maternal and Child Health Hospital from January 2019 to December 2023 were retrospectively analyzed. The baseline data and prognosis data (good prognosis and poor prognosis) were recorded. Multivariate Logistic regression analysis was used to analyze the risk factors of poor prognosis in children with EONS. R3.5.3 software package was used to build a nomogram model for predicting poor prognosis in children with EONS, and the rms package was used to calculate the consistency index ( C- index), and Bootstrap self-sampling was used for internal verification. Results:Among the 147 children with EONS, 41 children (27.89%) had poor prognosis, and 106 children (72.11%) had good prognosis. The incidence of thrombocytopenia, incidence of bacterial meningitis, procalcitonin and lactate in children with poor prognosis were significantly higher than those in children with good prognosis: 68.29% (28/41) vs. 17.92% (19/106), 43.9% (18/41) vs. 1.89% (2/106), (70.36 ± 13.45) ng/L vs. (42.76 ± 10.37) ng/L and (6.18 ± 2.05) mmol/L vs. (4.22 ± 1.05) mmol/L, and there were statistical differences ( P<0.01); there were no statistical difference in gender composition, gestational age, birth weight, 1 min Apgar score, delivery mode, white blood cell, C-reactive protein, creatinine and the incidences of placental abruption, amniotic fluid contamination, maternal infection, necrotizing enterocolitis between the two groups ( P>0.05). Multivariate Logistic analysis result showed that thrombocytopenia, bacterial meningitis, high procalcitonin and high lactate were the independent risk factors for poor prognosis in children with EONS ( OR = 9.595, 22.657, 1.213 and 2.614; 95% CI 1.094 to 20.055, 1.833 to 41.328, 0.745 to 0.937 and 0.990 to 1.209; P<0.05 or <0.01). A nomogram model was constructed to predict poor prognosis in children with EONS, using thrombocytopenia, bacterial meningitis, procalcitonin and lactate as predictive factors. The nomogram model predicted that the correction curve for poor prognosis in children with EONS tended towards the ideal curve ( C- index = 0.987, 95% CI 0.975 to 0.998). Conclusions:The children with EONS have a higher risk of adverse prognosis, which may be related to their comorbidities with thrombocytopenia, bacterial meningitis, high procalcitonin and high lactate at diagnosis. The nomogram model established based on the indexes has a good predictive effect on the disease prognosis.

Objective:To investigate the possible mechanism of Zaogong Erteng decoction (ZGETD) in the treatment of endometritis.Methods:Femal mice were injected 2.5 mg/mL lipopolysaccharide into uterine horn to induce endometritis model. After modelling, low-dose ZGETD, high-dose ZGETD or amoxicillin was given once a day for 7 d. The appearance of the uterus and pathological changes of uterine tissue were observed 7 d later, and the uterine index was calculated. The expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6 in mouse uterine tissue was detected by enzyme-linked immunosorbent assay. The activity of myeloperoxidase (MPO) in mouse uterine tissue was measured by redox reaction. The active ingredients of ZGETD and the target and signal pathway of treatment of endometritis were analyzed by network pharmacology. Western blotting and qRT-PCR were used to detect the expressions of Toll-like receptor 4 (TLR4), P65, p-P65, interferon regulatory factor 3 (IRF3) and p-IRF3 proteins and chemokines CXCL5 and CXCL8 in the mouse uterus, respectively. Terminal dUTP nick end labeling detected endometrial cell apoptosis and endometrial thickness was measured. After treatment, the female rats were mated with the male rats, and the mating rate, the pregnancy rate and the number of implantation sits in the injected uterine horn on day 8 of gestation were counted. Results:Both ZGETD and amoxicillin have atherapeutic effect on endometritis, but compared with low-dose ZGETD and amoxicillin, high-dose ZGETD can significantly alleviate the edema and congestion of uterine tissue and reduce the uterine index (all P=0.001). After treatment, the uterine cavity epithelium of mice was smooth and complete, the uterine gland structure was normal, and no bleeding area and inflammatory cell aggregation were observed. Compared with amoxicillin, high-dose ZGETD significantly decreased the expression of inflammatory factors (TNF-α, IL-1β and IL-6) and MPO activity (all P<0.001). The expression of chemokines ( CXCL5 and CXCL8) was significantly reduced (all P<0.05). The signaling pathways TLR4, nuclear factor kappa-B (NF-κB) and TNF related to the treatment of endometritis by ZGETD were screened by network pharmacology, and their action targets (TLR4, NF-κB and IRF3) were verified. Quercetin, fisetin and luteolin were found to be the most active ingredients acting on these targets. High-dose ZGETD significantly inhibited the activation of TLR4/NF-κB and TLR4/IRF3 pathways ( P<0.05), decreased endometrial cell apoptosis ( P<0.05), and increased endometrial thickness ( P<0.001), mating rate ( P<0.001), pregnancy rate ( P<0.001) and implantation site number of uterine horn on the injection side of LPS after treatment ( P=0.001). Conclusion:High-dose ZGETD has a significant therapeutic effect on endometritis, which may be closely related to the down-regulation of TLR4 signaling pathway.

Objective:To explore the influencing factors of brain injury in children with neonatal asphyxia after resuscitation.Methods:The clinical data of 180 children with neonatal asphyxia from January 2017 to January 2024 in Shijiazhuang Maternal and Child Health Hospital were retrospectively analyzed, and all children were received resuscitation treatment. The children were divided into modeling group (126 cases) and validation group (54 cases) in a 7∶3 ratio. Among the children in modeling group, 51 children combined brain injury (brain injury subgroup), and 75 children did not combine brain injury (non-brain injury subgroup). The general data were recorded, and the continuous variables were determined by the receiver operating characteristic (ROC) curve to determine the optimal cut-off value. Multivariate Logistic regression analysis was used to analyze the independent risk factors of brain injury in children with neonatal asphyxia after resuscitation. The R language software "rms" package was used to construct a nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation. The nomogram model was internally verified by the calibration curve, and the prediction efficiency of the nomogram model was evaluated by the decision curve and ROC curve.Results:There was no statistical difference in general data between modeling group and validation group ( P>0.05). The gestation age<37 weeks proportion, severe asphyxia proportion, Ⅱ to Ⅲ grade amniotic fluid contamination proportion, intrauterine distress proportion and blood lactate in brain injury subgroup were significantly higher than those in non-brain injury subgroup: 60.78% (31/51) vs. 38.67% (29/75), 37.25% (19/51) vs. 17.33% (13/75), 27.45% (14/51) vs. 10.67% (8/75), 47.06% (24/51) vs. 26.67% (20/75) and (2.64 ± 0.61) mmol/L vs. (2.21 ± 0.56) mmol/L, and there were statistical differences ( P<0.05 or <0.01); there were no statistical differences in gender composition, birth weight, maternal age, maternal history of adverse pregnancy and childbirth, mode of delivery, parity, abnormal amniotic fluid volume, abnormal fetal position, abnormal umbilical cord, abnormal placenta, systolic blood pressure, diastolic blood pressure, body temperature and blood glucose between the two groups ( P>0.05). ROC curve analysis result showed that the optimal cutoff value of blood lactate was 2.59 mmol/L. Multivariate Logistic regression analysis result showed that the young gestation age, severe asphyxia, Ⅱ to Ⅲ grade amniotic fluid contamination, intrauterine distress and high blood lactate were independent risk factors of brain injury in children with neonatal asphyxia after resuscitation ( OR = 2.854, 3.428, 3.405, 3.427 and 7.844; 95% CI 1.166 to 6.983, 1.263 to 9.305, 1.076 to 10.768, 1.358 to 8.645 and 3.080 to 19.978; P<0.05 or <0.01). The gestation age, degree of asphyxia, amniotic fluid contamination, intrauterine distress and blood lactate were used as predictors to construct a nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation. The calibration curve analysis result showed that the calibration curve of the nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation tended towards the ideal curve ( C- index = 0.824, 95% CI 0.745 to 0.903). The decision curve analysis result showed that, when the risk threshold was greater than 0.18, the clinical net benefits provided by the nomogram model were higher than those of a single independent risk factor, and it could provide significant additional clinical net benefits in predicting the high risk of brain injury in children with neonatal asphyxia after resuscitation. ROC curve of internal validation analysis result that the curve (AUC) of the nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation was 0.824 (95% CI 0.744 to 0.903). ROC curve of external validation result showed that the AUC of the nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation was 0.838 (95% CI 0.714 to 0.962). Conclusions:The gestation age, degree of asphyxia, amniotic fluid contamination, intrauterine distress and blood lactate are independent risk factors for brain injury in children with neonatal asphyxia after resuscitation. The nomogram model constructed based on these factors has a high clinical benefit in predicting brain injury in children with neonatal asphyxia after resuscitation.

Objective:To explore the influencing factors of brain injury in children with neonatal asphyxia after resuscitation.Methods:The clinical data of 180 children with neonatal asphyxia from January 2017 to January 2024 in Shijiazhuang Maternal and Child Health Hospital were retrospectively analyzed, and all children were received resuscitation treatment. The children were divided into modeling group (126 cases) and validation group (54 cases) in a 7∶3 ratio. Among the children in modeling group, 51 children combined brain injury (brain injury subgroup), and 75 children did not combine brain injury (non-brain injury subgroup). The general data were recorded, and the continuous variables were determined by the receiver operating characteristic (ROC) curve to determine the optimal cut-off value. Multivariate Logistic regression analysis was used to analyze the independent risk factors of brain injury in children with neonatal asphyxia after resuscitation. The R language software "rms" package was used to construct a nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation. The nomogram model was internally verified by the calibration curve, and the prediction efficiency of the nomogram model was evaluated by the decision curve and ROC curve.Results:There was no statistical difference in general data between modeling group and validation group ( P>0.05). The gestation age<37 weeks proportion, severe asphyxia proportion, Ⅱ to Ⅲ grade amniotic fluid contamination proportion, intrauterine distress proportion and blood lactate in brain injury subgroup were significantly higher than those in non-brain injury subgroup: 60.78% (31/51) vs. 38.67% (29/75), 37.25% (19/51) vs. 17.33% (13/75), 27.45% (14/51) vs. 10.67% (8/75), 47.06% (24/51) vs. 26.67% (20/75) and (2.64 ± 0.61) mmol/L vs. (2.21 ± 0.56) mmol/L, and there were statistical differences ( P<0.05 or <0.01); there were no statistical differences in gender composition, birth weight, maternal age, maternal history of adverse pregnancy and childbirth, mode of delivery, parity, abnormal amniotic fluid volume, abnormal fetal position, abnormal umbilical cord, abnormal placenta, systolic blood pressure, diastolic blood pressure, body temperature and blood glucose between the two groups ( P>0.05). ROC curve analysis result showed that the optimal cutoff value of blood lactate was 2.59 mmol/L. Multivariate Logistic regression analysis result showed that the young gestation age, severe asphyxia, Ⅱ to Ⅲ grade amniotic fluid contamination, intrauterine distress and high blood lactate were independent risk factors of brain injury in children with neonatal asphyxia after resuscitation ( OR = 2.854, 3.428, 3.405, 3.427 and 7.844; 95% CI 1.166 to 6.983, 1.263 to 9.305, 1.076 to 10.768, 1.358 to 8.645 and 3.080 to 19.978; P<0.05 or <0.01). The gestation age, degree of asphyxia, amniotic fluid contamination, intrauterine distress and blood lactate were used as predictors to construct a nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation. The calibration curve analysis result showed that the calibration curve of the nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation tended towards the ideal curve ( C- index = 0.824, 95% CI 0.745 to 0.903). The decision curve analysis result showed that, when the risk threshold was greater than 0.18, the clinical net benefits provided by the nomogram model were higher than those of a single independent risk factor, and it could provide significant additional clinical net benefits in predicting the high risk of brain injury in children with neonatal asphyxia after resuscitation. ROC curve of internal validation analysis result that the curve (AUC) of the nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation was 0.824 (95% CI 0.744 to 0.903). ROC curve of external validation result showed that the AUC of the nomogram model for predicting brain injury in children with neonatal asphyxia after resuscitation was 0.838 (95% CI 0.714 to 0.962). Conclusions:The gestation age, degree of asphyxia, amniotic fluid contamination, intrauterine distress and blood lactate are independent risk factors for brain injury in children with neonatal asphyxia after resuscitation. The nomogram model constructed based on these factors has a high clinical benefit in predicting brain injury in children with neonatal asphyxia after resuscitation.

Objective:To explore the prognosis and influencing factors of early-onset neonatal sepsis (EONS), and provide the guidance for early clinical prevention and treatment.Methods:The clinical data of 147 children with EONS in Shijiazhuang Maternal and Child Health Hospital from January 2019 to December 2023 were retrospectively analyzed. The baseline data and prognosis data (good prognosis and poor prognosis) were recorded. Multivariate Logistic regression analysis was used to analyze the risk factors of poor prognosis in children with EONS. R3.5.3 software package was used to build a nomogram model for predicting poor prognosis in children with EONS, and the rms package was used to calculate the consistency index ( C- index), and Bootstrap self-sampling was used for internal verification. Results:Among the 147 children with EONS, 41 children (27.89%) had poor prognosis, and 106 children (72.11%) had good prognosis. The incidence of thrombocytopenia, incidence of bacterial meningitis, procalcitonin and lactate in children with poor prognosis were significantly higher than those in children with good prognosis: 68.29% (28/41) vs. 17.92% (19/106), 43.9% (18/41) vs. 1.89% (2/106), (70.36 ± 13.45) ng/L vs. (42.76 ± 10.37) ng/L and (6.18 ± 2.05) mmol/L vs. (4.22 ± 1.05) mmol/L, and there were statistical differences ( P<0.01); there were no statistical difference in gender composition, gestational age, birth weight, 1 min Apgar score, delivery mode, white blood cell, C-reactive protein, creatinine and the incidences of placental abruption, amniotic fluid contamination, maternal infection, necrotizing enterocolitis between the two groups ( P>0.05). Multivariate Logistic analysis result showed that thrombocytopenia, bacterial meningitis, high procalcitonin and high lactate were the independent risk factors for poor prognosis in children with EONS ( OR = 9.595, 22.657, 1.213 and 2.614; 95% CI 1.094 to 20.055, 1.833 to 41.328, 0.745 to 0.937 and 0.990 to 1.209; P<0.05 or <0.01). A nomogram model was constructed to predict poor prognosis in children with EONS, using thrombocytopenia, bacterial meningitis, procalcitonin and lactate as predictive factors. The nomogram model predicted that the correction curve for poor prognosis in children with EONS tended towards the ideal curve ( C- index = 0.987, 95% CI 0.975 to 0.998). Conclusions:The children with EONS have a higher risk of adverse prognosis, which may be related to their comorbidities with thrombocytopenia, bacterial meningitis, high procalcitonin and high lactate at diagnosis. The nomogram model established based on the indexes has a good predictive effect on the disease prognosis.

Objective:To investigate the possible mechanism of Zaogong Erteng decoction (ZGETD) in the treatment of endometritis.Methods:Femal mice were injected 2.5 mg/mL lipopolysaccharide into uterine horn to induce endometritis model. After modelling, low-dose ZGETD, high-dose ZGETD or amoxicillin was given once a day for 7 d. The appearance of the uterus and pathological changes of uterine tissue were observed 7 d later, and the uterine index was calculated. The expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6 in mouse uterine tissue was detected by enzyme-linked immunosorbent assay. The activity of myeloperoxidase (MPO) in mouse uterine tissue was measured by redox reaction. The active ingredients of ZGETD and the target and signal pathway of treatment of endometritis were analyzed by network pharmacology. Western blotting and qRT-PCR were used to detect the expressions of Toll-like receptor 4 (TLR4), P65, p-P65, interferon regulatory factor 3 (IRF3) and p-IRF3 proteins and chemokines CXCL5 and CXCL8 in the mouse uterus, respectively. Terminal dUTP nick end labeling detected endometrial cell apoptosis and endometrial thickness was measured. After treatment, the female rats were mated with the male rats, and the mating rate, the pregnancy rate and the number of implantation sits in the injected uterine horn on day 8 of gestation were counted. Results:Both ZGETD and amoxicillin have atherapeutic effect on endometritis, but compared with low-dose ZGETD and amoxicillin, high-dose ZGETD can significantly alleviate the edema and congestion of uterine tissue and reduce the uterine index (all P=0.001). After treatment, the uterine cavity epithelium of mice was smooth and complete, the uterine gland structure was normal, and no bleeding area and inflammatory cell aggregation were observed. Compared with amoxicillin, high-dose ZGETD significantly decreased the expression of inflammatory factors (TNF-α, IL-1β and IL-6) and MPO activity (all P<0.001). The expression of chemokines ( CXCL5 and CXCL8) was significantly reduced (all P<0.05). The signaling pathways TLR4, nuclear factor kappa-B (NF-κB) and TNF related to the treatment of endometritis by ZGETD were screened by network pharmacology, and their action targets (TLR4, NF-κB and IRF3) were verified. Quercetin, fisetin and luteolin were found to be the most active ingredients acting on these targets. High-dose ZGETD significantly inhibited the activation of TLR4/NF-κB and TLR4/IRF3 pathways ( P<0.05), decreased endometrial cell apoptosis ( P<0.05), and increased endometrial thickness ( P<0.001), mating rate ( P<0.001), pregnancy rate ( P<0.001) and implantation site number of uterine horn on the injection side of LPS after treatment ( P=0.001). Conclusion:High-dose ZGETD has a significant therapeutic effect on endometritis, which may be closely related to the down-regulation of TLR4 signaling pathway.

BACKGROUND:Our previous studies found that adding barium sulfate could improve the mechanical and radiopaque properties of calcium phosphate cement.However,with the degradation of calcium phosphate,the remaining radiopaque agent is difficult to degrade,and the space-occupying and osteoclast effects at the implantation site affect the bone repair process.Therefore,it is necessary to develop a new biodegradable radiopaque material. OBJECTIVE:To discuss the radiopaque ability of bioactive degradable material strontium polyphosphate(SrPP)and its impact on the physicochemical properties and osteogenic effect of calcium phosphate cement. METHODS:(1)Calcium phosphate cement(CPC),starch modified calcium phosphate cement(CPS)and starch modified calcium phosphate cement(20%SrPP-CPN)containing SrPP(20%mass fraction of bone cement powder)were prepared respectively,and the physicochemical properties of the three groups of bone cements were characterized.(2)The three groups of bone cement extracts were co-cultured with rat bone marrow mesenchymal stem cells,respectively,to detect cell proliferation,energy metabolism,and osteogenic differentiation.(3)Bone defects with a diameter of 5 mm were made on each side of the top of the skull of 24 SD rats,and they were randomly divided into control group(without any intervention),CPC group,CPS group,and 20%SrPP-CPN group for intervention,with 6 rats in each group.Relevant tests were performed after 4 and 12 weeks of intervention. RESULTS AND CONCLUSION:(1)Compared with the other two groups of bone cement,20%SrPP-CPN had enhanced radiopaque ability,increased compressive strength and degradation rate,and prolonged curing time,and 20%SrPP-CPN could release Sr2+ stably during degradation.(2)CCK-8 assay showed that 20%SrPP-CPN did not affect the proliferation of bone marrow mesenchymal stem cells.Cell starvation test(serum-free culture)showed that 20%SrPP-CPN could promote the proliferation of bone marrow mesenchymal stem cells compared with the other two groups of bone cement.Compared with the other two groups of bone cements,20%SrPP-CPN increased adenosine triphosphate concentration in bone marrow mesenchymal stem cells.Alkaline phosphatase and alizarin red staining showed that 20%SrPP-CPN could promote osteogenic differentiation of bone marrow mesenchymal stem cells compared with the other two groups of bone cement.(3)In the rat skull defect experiment,Micro-CT scanning and histological observation(hematoxylin-eosin and Masson stainings)showed that bone cement in 20%SrPP-CPN group was significantly degraded compared with that in CPC and CPS groups,and a large number of new bone tissues were dispersed in degraded bone cement.Immunohistochemical staining showed that Runx2 protein expression was increased in 20%SrPP-CPN group compared with CPC group and CPS group(P＜0.01).(4)These results show that 20%SrPP-CPN has good radiopaque ability and osteogenic properties.

OBJECTIVE To enrich the polymethoxyflavonoid-rich fraction from Citri Reticulatae Pericarpium using D101 macro-porous resin,and further to analyse the chemical constituents using High-Performance Liquid Chromatography Quadrupole-Time-of-Flight Mass Spectrometry(HPLC-Q-TOF-MS).METHODS Citri Reticulatae Pericarpium extract was adsorbed on D101 macro-porous resin and then eluted with different concentrations of ethanol to enrich the polymethoxyflavonoid-rich fraction;the content of the major flavonoid components was determined by high-performance liquid chromatography(HPLC);and the components were further an-alysed by HPLC-Q-TOF-MS.RESULTS The established HPLC method for the simultaneous determination of seven flavonoids in Citri Reticulatae Pericarpium extract was accurate and reliable.The contents of compounds such as nobiletin and tangeritin were signifi-cantly increased in the polymethoxyflavonoid-rich fraction.Using high resolution mass spectrometry(HRMS),70 and 60 compounds were identified from the Citri Reticulatae Pericarpium extract and the polymethoxyflavonoid-rich fraction,respectively,with 53 polyme-thoxyflavonoids being detected in these two extracts.CONCLUSION The results of this study provide an experimental basis for fur-ther identification of the pharmacological substance basis of the polymethoxyflavonoids in Citri Reticulatae Pericarpium and the estab-lishment of quality control methods.

Although primary vesical calculi is an ancient disease, the mechanism of calculi formation remains unclear. In this study, we established a novel primary vesical calculi model with d,l-choline tartrate in mice. Compared with commonly used melamine and ethylene glycol models, our model was the only approach that induced vesical calculi without causing kidney injury. Previous studies suggest that proteins in the daily diet are the main contributors to the prevention of vesical calculi, yet the effect of fat is overlooked. To assay the relationship of dietary fat with the formation of primary vesical calculi, d,l-choline tartrate-treated mice were fed a high-fat, low-fat, or normal-fat diet. Genetic changes in the mouse bladder were detected with transcriptome analysis. A high-fat diet remarkably reduced the morbidity of primary vesical calculi. Higher fatty acid levels in serum and urine were observed in the high-fat diet group, and more intact epithelia in bladder were observed in the same group compared with the normal- and low-fat diet groups, suggesting the protective effect of fatty acids on bladder epithelia to maintain its normal histological structure. Transcriptome analysis revealed that the macrophage differentiation-related gene C-X-C motif chemokine ligand 14 (Cxcl14) was upregulated in the bladders of high-fat diet-fed mice compared with those of normal- or low-fat diet-fed mice, which was consistent with histological observations. The expression of CXCL14 significantly increased in the bladder in the high-fat diet group. CXCL14 enhanced the recruitment of macrophages to the crystal nucleus and induced the transformation of M2 macrophages, which led to phagocytosis of budding crystals and prevented accumulation of calculi. In human bladder epithelia (HCV-29) cells, high fatty acid supplementation significantly increased the expression of CXCL14. Dietary fat is essential for the maintenance of physiological functions of the bladder and for the prevention of primary vesical calculi, which provides new ideas for the reduction of morbidity of primary vesical calculi.

Objective:To compared the positive rate of anal swab nucleic acid test and clinical characteristics of critical and general coronavirus disease 2019 (COVID-19) patients.Methods:Clinical data of 18 patients with COVID-19 admitted to the First People's Hospital of Lianyungang City from February to March 2020 were retrospectively analyzed. The patients were divided into general group ( n = 11) and critical ill group ( n = 7) according to the severity of the disease. The differences of gender, age, epidemiological characteristics, fever duration after admission, underlaying disease, positive rate of anal swab nucleic acid test at admission and two times of negative pharyngeal swab test were compared between the two groups. Results:There were no significant differences in gender, age, fever duration after admission or underlaying disease between the two groups. The number of anorectal swab positive cases in critically ill group was significantly higher than that in general group (cases: 4 vs. 1, P = 0.047). After two negative pharyngeal swab nucleic acid test, the number of anal swab positive cases in critical illness group was still higher than that in general group (cases: 2 vs. 0), but the difference was not statistically significant ( P = 0.137). The number of non-local infection in critical ill group was significantly higher than that in general group (cases: 4 vs. 0, P = 0.047). All of the 4 non-local infected patients had a history of living in Wuhan. Conclusions:The patients with anorectal swab nucleic acid positive may have a more serious condition. It may be a risk to transfer ill patients out of the isolation ward by the criteria of only two times of negative pharyngeal swab nucleic acid test. Patients returning to our city after infection in Wuhan may be more serious.