Objective To investigate the influencing factors of antibiotic-associated diarrhea(AAD)following congenital heart disease(CHD)surgery in pediatric patients,develop a nomogram-based predictive model,and validate its efficacy.Methods A retrospective analysis was conducted on the clinical data of pediatric patients who underwent CHD surgery in the Pediatric Intensive Care Unit(PICU)of a tertiary hospital in Guang-dong Province from July 2022 to July 2024.Patients were categorized into an AAD group and a non-AAD group.Univariate and multivariate logistic regression analyses were performed to identify risk factors for AAD occurrence following CHD surgery.A risk prediction model was developed,and a nomogram was constructed.The predictive performance of the model was evaluated using the Receiver Operating Characteristic(ROC)curve to calculate the area under the curve(AUC),the Hosmer-Lemeshow goodness-of-fit test,calibration curves,and clinical decision curve analysis.External validation of the model was conducted using data from patients in the Surgical Intensive Care Unit(SICU).Results The incidence of AAD following CHD surgery was 48.52%(229 out of 472 cases).Risk factors for AAD included the combined use of antibiotics,mechanical ventilation,elevated C-reactive protein levels,prolonged surgical duration,and extended antibiotic usage time(all with OR>1,P<0.05).Conversely,probiotic administration was identified as a protective factor(OR<1,P<0.05).The predictive model demon-strated excellent discrimination,as evidenced by the ROC curve areas:0.922(95%CI:0.894～0.951)in the modeling group,0.886(95%CI:0.838～0.915)in the internal validation group,and 0.862(95%CI:0.784～0.941)in the external validation group.Additionally,the model exhibited satisfactory calibration,as indicated by the Hosmer-Lemeshow test results:χ2=7.96,P=0.538 in the modeling group;χ2=4.24,P=0.895 in the inter-nal validation group;and χ2=9.923,P=0.270 in the external validation group.Furthermore,the model provided significant clinical utility.Conclusions Combined antibiotic use,duration of antibiotic therapy,mechanical ventilation,surgical duration,C-reactive protein(CRP)levels,and probiotic administration are key factors influ-encing the occurrence of AAD.The risk prediction model developed based on these variables demonstrates robust predictive performance and can serve as a valuable reference for the development and implementation of preventive and therapeutic strategies in clinical practice.

Objective To investigate the effects and mechanism of Dahuang Lingxian Prescription on bile duct reaction of cholestatic liver fibrosis rats caused by bile duct ligation.Methods A total of 40 SD rats were randomly divided into blank group,model group,ursodeoxycholic acid group and Dahuang Lingxian Prescription group,with 10 rats in each group.Except for the blank group,the remaining groups of rats underwent bile duct ligation surgery to establish a cholestatic liver fibrosis model.After surgery,the ursodeoxycholic acid group was given ursodeoxycholic acid solution by gavage,Dahuang Lingxian Prescription group was given Dahuang Lingxian Prescription solution by gavage,and the blank group and model group were given equal volume of normal saline by gavage,once a day for 3 consecutive weeks.The activities of serum AST,ALT,ALP,GGT and the contents of TBIL,TBA were tetected,the morphology of liver tissue was observed by HE staining,and the liver fibrosis was observed by Masson staining,immunohistochromic staining and Western blot were used to detect the expressions of CK19,CK7,EpCAM and SOX9 proteins.Results Compared with the blank group,the liver surface of the model group rats was rough,with a harder texture and obvious graininess,HE staining showed damage to the liver lobule structure,forming pseudo lobules,a large number of bile duct hyperplasia and inflammatory cell infiltration,and a significant increase in collagen fiber deposition(P<0.01);the activities of serum AST,ALT,ALP,GGT,as well as the contents of TBIL and TBA significantly increased(P<0.01);the positive expressions of CK19,CK7 and EpCAM in liver tissue significantly increased(P<0.01),and the protein expressions of CK19,CK7,EpCAM and SOX9 significantly increased(P<0.01).Compared with the model group,the appearance and texture of the liver of the rats in the ursodeoxycholic acid group and Dahuang Lingxian Prescription group were relatively softer,the lobular structure was less damaged,the inflammatory cells infiltration was less,the collagen fiber deposition was significantly reduced(P<0.01),the activities of serum AST,ALT,ALP,GGT,and the contents of TBIL and TBA were significantly decreased(P<0.01);the expressions of TBA and TBIL were significantly decreased(P<0.01),the positive expressions of CK19,CK7 and EpCAM significantly decreased(P<0.01),and the protein expression of CK19,CK7,EpCAM and SOX9 significantly decreased(P<0.01).Conclusion Dahuang Lingxian Prescription can inhibit the bile duct reaction associated with liver progenitor cells,decrease the expression of CK19,CK7,EpCAM and SOX9,and thus improve the cholestatic liver fibrosis of rats induced by bile duct ligation.

Objective To explore the effect of the blood flow restriction(BFR)at 40%arterial oc-clusive pressure(AOP)on ergometer cycling maximal lactate steady state(MLSS).Methods A total of 11 male college students majoring in sports science(age 23±2 yrs,height 176±5 cm,weight 74.6±5.5 kg,body fat 14.5%±4.7%)were selected.The test in this study was divided into 4 parts:① an incremental ramp test to determine the maximal aerobic power(Pmax);② the MLSS test to determine the blood lactate concentration of MLSS(MLSSc),the work load of MLSS(MLSSw),and the percentage of MLSSw relative to Pmax(%MLSSw);③ the 30 min constant load BFR test(MLSS-BFR)of MLSSw based on the test ② to determine the heart rate,blood lactate and subjec-tive fatigue of MLSSw at the BFR;④ MLSS test at BFR(BFR-MLSS)to determine MLSSc and MLSSw.The BFR was performed using an adjustable pressure compression cuff applied externally to the nearest point to the thigh,at a pressure of 40%AOP.Heart rate was monitored throughout the test.When measuring the constant load in test ②③④,restrictive pressure was released for 30 s ev-ery 5 min.During the release,a blood sample was collected from the earlobe for analysis of blood lac-tate.After the constant load test,the perceived exertion was collected immediately.Results MLSSw(152.5±28.8 vs 161.3±28.1 W,P<0.05,ES=0.84)and%MLSSw(53.4%±5.7%vs 56.7%±5.5%,P<0.05,ES=0.82)of BFR-MLSS test were significantly lower than those of MLSS test.However,no significant differences were found between the BFR-MLSS and MLSS test in MLSSc(5.61±1.18 vs 5.61±0.81 mmol/L,P>0.05,ES=0.01),heart rate(152.6±14.8 vs 150.7±10.7 bpm,P>0.05,ES=0.17)and RPE(14.8±3.3 vs 14.9±2.9,P>0.05,ES=0.06).Conclusion BFR exercise achieves MLSS at a lower external load(power output),and does not reduce the internal load of MLSS.Moreover,BFR increases the internal load for the same external load,but the division of the internal load interval seems to be the same during exercise with or without BFR.

Objective To investigate the effects and mechanism of Dahuang Lingxian Prescription on bile duct reaction of cholestatic liver fibrosis rats caused by bile duct ligation.Methods A total of 40 SD rats were randomly divided into blank group,model group,ursodeoxycholic acid group and Dahuang Lingxian Prescription group,with 10 rats in each group.Except for the blank group,the remaining groups of rats underwent bile duct ligation surgery to establish a cholestatic liver fibrosis model.After surgery,the ursodeoxycholic acid group was given ursodeoxycholic acid solution by gavage,Dahuang Lingxian Prescription group was given Dahuang Lingxian Prescription solution by gavage,and the blank group and model group were given equal volume of normal saline by gavage,once a day for 3 consecutive weeks.The activities of serum AST,ALT,ALP,GGT and the contents of TBIL,TBA were tetected,the morphology of liver tissue was observed by HE staining,and the liver fibrosis was observed by Masson staining,immunohistochromic staining and Western blot were used to detect the expressions of CK19,CK7,EpCAM and SOX9 proteins.Results Compared with the blank group,the liver surface of the model group rats was rough,with a harder texture and obvious graininess,HE staining showed damage to the liver lobule structure,forming pseudo lobules,a large number of bile duct hyperplasia and inflammatory cell infiltration,and a significant increase in collagen fiber deposition(P<0.01);the activities of serum AST,ALT,ALP,GGT,as well as the contents of TBIL and TBA significantly increased(P<0.01);the positive expressions of CK19,CK7 and EpCAM in liver tissue significantly increased(P<0.01),and the protein expressions of CK19,CK7,EpCAM and SOX9 significantly increased(P<0.01).Compared with the model group,the appearance and texture of the liver of the rats in the ursodeoxycholic acid group and Dahuang Lingxian Prescription group were relatively softer,the lobular structure was less damaged,the inflammatory cells infiltration was less,the collagen fiber deposition was significantly reduced(P<0.01),the activities of serum AST,ALT,ALP,GGT,and the contents of TBIL and TBA were significantly decreased(P<0.01);the expressions of TBA and TBIL were significantly decreased(P<0.01),the positive expressions of CK19,CK7 and EpCAM significantly decreased(P<0.01),and the protein expression of CK19,CK7,EpCAM and SOX9 significantly decreased(P<0.01).Conclusion Dahuang Lingxian Prescription can inhibit the bile duct reaction associated with liver progenitor cells,decrease the expression of CK19,CK7,EpCAM and SOX9,and thus improve the cholestatic liver fibrosis of rats induced by bile duct ligation.

Objective To investigate the influencing factors of antibiotic-associated diarrhea(AAD)following congenital heart disease(CHD)surgery in pediatric patients,develop a nomogram-based predictive model,and validate its efficacy.Methods A retrospective analysis was conducted on the clinical data of pediatric patients who underwent CHD surgery in the Pediatric Intensive Care Unit(PICU)of a tertiary hospital in Guang-dong Province from July 2022 to July 2024.Patients were categorized into an AAD group and a non-AAD group.Univariate and multivariate logistic regression analyses were performed to identify risk factors for AAD occurrence following CHD surgery.A risk prediction model was developed,and a nomogram was constructed.The predictive performance of the model was evaluated using the Receiver Operating Characteristic(ROC)curve to calculate the area under the curve(AUC),the Hosmer-Lemeshow goodness-of-fit test,calibration curves,and clinical decision curve analysis.External validation of the model was conducted using data from patients in the Surgical Intensive Care Unit(SICU).Results The incidence of AAD following CHD surgery was 48.52%(229 out of 472 cases).Risk factors for AAD included the combined use of antibiotics,mechanical ventilation,elevated C-reactive protein levels,prolonged surgical duration,and extended antibiotic usage time(all with OR>1,P<0.05).Conversely,probiotic administration was identified as a protective factor(OR<1,P<0.05).The predictive model demon-strated excellent discrimination,as evidenced by the ROC curve areas:0.922(95%CI:0.894～0.951)in the modeling group,0.886(95%CI:0.838～0.915)in the internal validation group,and 0.862(95%CI:0.784～0.941)in the external validation group.Additionally,the model exhibited satisfactory calibration,as indicated by the Hosmer-Lemeshow test results:χ2=7.96,P=0.538 in the modeling group;χ2=4.24,P=0.895 in the inter-nal validation group;and χ2=9.923,P=0.270 in the external validation group.Furthermore,the model provided significant clinical utility.Conclusions Combined antibiotic use,duration of antibiotic therapy,mechanical ventilation,surgical duration,C-reactive protein(CRP)levels,and probiotic administration are key factors influ-encing the occurrence of AAD.The risk prediction model developed based on these variables demonstrates robust predictive performance and can serve as a valuable reference for the development and implementation of preventive and therapeutic strategies in clinical practice.

Objective To explore the effect of the blood flow restriction(BFR)at 40%arterial oc-clusive pressure(AOP)on ergometer cycling maximal lactate steady state(MLSS).Methods A total of 11 male college students majoring in sports science(age 23±2 yrs,height 176±5 cm,weight 74.6±5.5 kg,body fat 14.5%±4.7%)were selected.The test in this study was divided into 4 parts:① an incremental ramp test to determine the maximal aerobic power(Pmax);② the MLSS test to determine the blood lactate concentration of MLSS(MLSSc),the work load of MLSS(MLSSw),and the percentage of MLSSw relative to Pmax(%MLSSw);③ the 30 min constant load BFR test(MLSS-BFR)of MLSSw based on the test ② to determine the heart rate,blood lactate and subjec-tive fatigue of MLSSw at the BFR;④ MLSS test at BFR(BFR-MLSS)to determine MLSSc and MLSSw.The BFR was performed using an adjustable pressure compression cuff applied externally to the nearest point to the thigh,at a pressure of 40%AOP.Heart rate was monitored throughout the test.When measuring the constant load in test ②③④,restrictive pressure was released for 30 s ev-ery 5 min.During the release,a blood sample was collected from the earlobe for analysis of blood lac-tate.After the constant load test,the perceived exertion was collected immediately.Results MLSSw(152.5±28.8 vs 161.3±28.1 W,P<0.05,ES=0.84)and%MLSSw(53.4%±5.7%vs 56.7%±5.5%,P<0.05,ES=0.82)of BFR-MLSS test were significantly lower than those of MLSS test.However,no significant differences were found between the BFR-MLSS and MLSS test in MLSSc(5.61±1.18 vs 5.61±0.81 mmol/L,P>0.05,ES=0.01),heart rate(152.6±14.8 vs 150.7±10.7 bpm,P>0.05,ES=0.17)and RPE(14.8±3.3 vs 14.9±2.9,P>0.05,ES=0.06).Conclusion BFR exercise achieves MLSS at a lower external load(power output),and does not reduce the internal load of MLSS.Moreover,BFR increases the internal load for the same external load,but the division of the internal load interval seems to be the same during exercise with or without BFR.

Social behaviors are fundamental and intricate functions in both humans and animals, governed by the interplay of social cognition and emotions. A noteworthy feature of several neuropsychiatric disorders, including autism spectrum disorder (ASD) and schizophrenia (SCZ), is a pronounced deficit in social functioning. Despite a burgeoning body of research on social behaviors, the precise neural circuit mechanisms underpinning these phenomena remain to be elucidated. In this paper, we review the pivotal role of the prefrontal cortex (PFC) in modulating social behaviors, as well as its functional alteration in social disorders in ASD or SCZ. We posit that PFC dysfunction may represent a critical hub in the pathogenesis of psychiatric disorders characterized by shared social deficits. Furthermore, we delve into the intricate connectivity of the medial PFC (mPFC) with other cortical areas and subcortical brain regions in rodents, which exerts a profound influence on social behaviors. Notably, a substantial body of evidence underscores the role of N-methyl-D-aspartate receptors (NMDARs) and the proper functioning of parvalbumin-positive interneurons within the mPFC for social regulation. Our overarching goal is to furnish a comprehensive understanding of these intricate circuits and thereby contribute to the enhancement of both research endeavors and clinical practices concerning social behavior deficits.
Prefrontal Cortex/physiopathology* ; Humans ; Social Behavior ; Animals ; Autism Spectrum Disorder/physiopathology* ; Schizophrenia/physiopathology* ; Receptors, N-Methyl-D-Aspartate/physiology* ; Interneurons/physiology*

Administrative multi-disciplinary team (MDT) is an efficient management approach that involves multiple administrative departments working together to solve cross functional systemic problems. Grid management improves management efficiency by constructing a three-level management network, efficiently transmitting information and coordinating resources. Starting from 2021, Children′s Hospital, Zhejiang University School of Medicine has adopted a combination of administrative MDT and grid management, with the average length of stay as the starting point to carry out medical efficiency management. Through the three stages of pre-, during-, and post-treatment, the hospital has reconstructed processes from technological innovation, information construction, team collaboration, and other aspects to shorten ineffective length of stay. After 3 years of practice, the average length of stay has been reduced from 6.41 d to 5.54 d, achieving an improvement in service efficiency while ensuring medical quality and safety.

To create flexible and high-quality pediatric continuing education opportunities, the Children's Hospital of Zhejiang University School of Medicine has developed an online teaching system based on the medical consortium information system, mobile application, and website, which includes "5G+" digital classroom for case teaching, hierarchical diagnosis and treatment tracking, mobile courses, and live interactive lectures about difficult medical cases as support extensions of offline training. From 2020 to 2023, over 9 000 people participated in online activities. The results of questionnaire survey, theoretical examination, and semi-structured interview showed that the members of the medical consortium were satisfied with the training content and effect of the online medical continuing education model; medical personnel's theoretical levels were improved after training; the interviewees believed that online training was flexible and convenient with regard to time, location, and space, with positive impact for improving clinical ability and personal development. However, the online form cannot yet replace the traditional refresher training completely. In the future, we will establish a unified evaluation and assessment mechanism, form a standardized management system, and introduce advanced technologies, so as to encourage enthusiastic and effective participation, and promote the rational and efficient use of medical education resources.