Objective:To investigate the feasibility and clinical effects of ultra early enteral nutrition (≤24 h) in critically ill children supported by extracorporeal membrane oxygenation (ECMO).Methods:A retrospective cohort study was conducted. Clinical data of 43 critically ill children who received ECMO support in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital from January 2016 to December 2023 were collected, including general information, nutritional support modalities, and enteral nutrition tolerance. Based on the timing of enteral nutrition initiation, patients were divided into the within 24 h enteral nutrition group and the after 24 h enteral nutrition group. Nutritive indicators, nutritional intake, duration of ECMO support, duration of mechanical ventilation duration, and mortality rates were compared between the 2 groups using the two independent sample t test, Mann-Whitney U test, χ2 test and Fisher′s exact test. Results:Among the 43 children, 25 were male and 18 were female, with an age of 47 (18, 97) months. There were no statistically significant differences between the within 24 h enteral nutrition group (21 cases) and the after 24 h enteral nutrition group (22 cases) in terms of age, body mass index Z score, total protein, albumin, hemoglobin levels before ECMO support, duration of ECMO support, duration of mechanical ventilation, length of PICU stay, number of enteral nutrition intolerance events, number of enteral nutrition interruption, or mortality rate (all P>0.05). The protein intake adequacy rate during ECMO support was higher in the within 24 h enteral nutrition group than in the after 24 h enteral nutrition group (0 (0, 21%) vs. 0 (0, 0), U=175.00, P<0.05). Conclusions:Ultra early enteral nutrition is safe for children supported by ECMO. Initiating enteral nutrition within 24 h can increase the proportion of days with adequate protein intake in ECMO children without increasing the occurance of enteral nutrition intolerance or interruptions.

Objective To observe the value of AcoStream thrombus aspiration catheter for treating intermediate-high risk acute pulmonary embolism(APE).Methods Twenty-six patients with intermediate-high risk APE who underwent treatment with AcoStream thrombus aspiration catheter were retrospectively collected.The immediate technical success rate,procedure success rate and thrombus clearance rate of target vessels were recorded,as well as clinical success rate and complications in perioperative period and the recurrence of pulmonary embolism(PE)during follow-up.Results Among 26 patients with intermediate-high risk APE,the immediate technical success rate was 100%(26/26),the procedure success rate was 92.31%(24/26),and the immediate thrombus clearance rate of target vessels was 63.37%as median,including 16 cases(16/26,61.54%)achieved thrombus clearance rate grade Ⅱ or above.The perioperative period clinical success rate of treating intermediate-high risk APE was 96.15%(25/26).Two patients experienced transient arrhythmia and other 2 patients experienced worsening transient chest tightness during the procedure,and 1 case developed hematoma at the puncture site after treatment.During follow-up,no recurrence of symptomatic PE was observed.Conclusion AcoStream thrombus aspiration catheter was safe and effective for treating intermediate-high risk APE,worthy clinical promotion and application.

Objective To observe the value of AcoStream thrombus aspiration catheter for treating intermediate-high risk acute pulmonary embolism(APE).Methods Twenty-six patients with intermediate-high risk APE who underwent treatment with AcoStream thrombus aspiration catheter were retrospectively collected.The immediate technical success rate,procedure success rate and thrombus clearance rate of target vessels were recorded,as well as clinical success rate and complications in perioperative period and the recurrence of pulmonary embolism(PE)during follow-up.Results Among 26 patients with intermediate-high risk APE,the immediate technical success rate was 100%(26/26),the procedure success rate was 92.31%(24/26),and the immediate thrombus clearance rate of target vessels was 63.37%as median,including 16 cases(16/26,61.54%)achieved thrombus clearance rate grade Ⅱ or above.The perioperative period clinical success rate of treating intermediate-high risk APE was 96.15%(25/26).Two patients experienced transient arrhythmia and other 2 patients experienced worsening transient chest tightness during the procedure,and 1 case developed hematoma at the puncture site after treatment.During follow-up,no recurrence of symptomatic PE was observed.Conclusion AcoStream thrombus aspiration catheter was safe and effective for treating intermediate-high risk APE,worthy clinical promotion and application.

Objective:To investigate the feasibility and clinical effects of ultra early enteral nutrition (≤24 h) in critically ill children supported by extracorporeal membrane oxygenation (ECMO).Methods:A retrospective cohort study was conducted. Clinical data of 43 critically ill children who received ECMO support in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital from January 2016 to December 2023 were collected, including general information, nutritional support modalities, and enteral nutrition tolerance. Based on the timing of enteral nutrition initiation, patients were divided into the within 24 h enteral nutrition group and the after 24 h enteral nutrition group. Nutritive indicators, nutritional intake, duration of ECMO support, duration of mechanical ventilation duration, and mortality rates were compared between the 2 groups using the two independent sample t test, Mann-Whitney U test, χ2 test and Fisher′s exact test. Results:Among the 43 children, 25 were male and 18 were female, with an age of 47 (18, 97) months. There were no statistically significant differences between the within 24 h enteral nutrition group (21 cases) and the after 24 h enteral nutrition group (22 cases) in terms of age, body mass index Z score, total protein, albumin, hemoglobin levels before ECMO support, duration of ECMO support, duration of mechanical ventilation, length of PICU stay, number of enteral nutrition intolerance events, number of enteral nutrition interruption, or mortality rate (all P>0.05). The protein intake adequacy rate during ECMO support was higher in the within 24 h enteral nutrition group than in the after 24 h enteral nutrition group (0 (0, 21%) vs. 0 (0, 0), U=175.00, P<0.05). Conclusions:Ultra early enteral nutrition is safe for children supported by ECMO. Initiating enteral nutrition within 24 h can increase the proportion of days with adequate protein intake in ECMO children without increasing the occurance of enteral nutrition intolerance or interruptions.

Sugar-sugar glycosyltransferases play important roles in constructing complex and bioactive saponins. Here, we characterized a series of UDP-glycosyltransferases responsible for biosynthesizing the branched sugar chain of bioactive steroidal saponins from a widely known medicinal plant Paris polyphylla var. yunnanensis. Among them, a 2'-O-rhamnosyltransferase and three 6'-O-glucosyltrasferases catalyzed a cascade of glycosylation to produce steroidal diglycosides and triglycosides, respectively. These UDP-glycosyltransferases showed astonishing substrate promiscuity, resulting in the generation of a panel of 24 terpenoid glycosides including 15 previously undescribed compounds. A mutant library containing 44 variants was constructed based on the identification of critical residues by molecular docking simulations and protein model alignments, and a mutant UGT91AH1^Y187A with increased catalytic efficiency was obtained. The steroidal saponins exhibited remarkable antifungal activity against four widespread strains of human pathogenic fungi attributed to ergosterol-dependent damage of fungal cell membranes, and 2'-O-rhamnosylation appeared to correlate with strong antifungal effects. The findings elucidated the biosynthetic machinery for their production of steroidal saponins and revealed their potential as new antifungal agents.

Objective:To construct the delirium prevention nursing program in ICU children and explore its clinical effect.Methods:The literature analysis and expert meeting method were used to construct the delirium prevention nursing program in ICU children. Using the convenient sampling method, a total of 315 ICU children who were admitted to Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from February to July 2020 were selected as the control group and 309 ICU children admitted from August 2020 to January 2021 were selected as the experimental group. The control group adopted routine nursing, while the experimental group adopted delirium prevention nursing program in ICU children on the basis of routine nursing. The differences in the incidence of delirium, mechanical ventilation time, ICU stay and ICU costs were compared between the two groups.Results:After the intervention, the incidence of delirium in the experimental group was 15.9% (49/309) and the ICU stay was 4.0 (2.5, 7.0) days, which were lower than 29.2% (92/315) and 5.0 (3.0, 10.0) d in the control group, and the differences were statistically significant (χ 2=15.892, Z=-2.341; P<0.05) . Conclusions:The establishment and application of delirium prevention nursing program for ICU children can effectively reduce the incidence of delirium in ICU children and length of stay in ICU.

With the development of biomimetic technology, more and more in vitro models are used to simulate human physiological and pathological processes.These in vitro models can solve some scientific problems, such as studying drug effects in real-timely and visually.As an in vitro model, organ-on-a-chip provides novel means and methods for basic and applied science.The vascularized organ-on-a-chip, as a special kind of organ-on-a-chip, can better simulate the structure and function of human blood vessels.In this review, we summarized the structure and function of different vascularized organ-on-a-chip, analyzed the application of vascularized organ-on-a-chip in simulating physiological and pathological processes, and discussed the advantages and problems to be solved of vascularized organ-on-a-chip as a new in vitro model.Finally, the application of vascularized organ-on-a-chip is proposed.

Objective To develop a measuring tool for the elderly care service needs in the community.Methods Based on the literature search and Delphi expert consultation,a measuring tool for elderly care service needs was developed.The reliability (internal consistency coefficient) and validity (surface validity,content validity,criterion-related validity) of the developed measurement tool were evaluated with on-site expert consultation and the cross-sectional survey.Results A 11-dimension measurement tool was developed,which covered physical health,mental health and desires for old-age support assessment.The reliability evaluation showed that there was significant correlation (P＜0.05) among the measurement dimensions of the physical health and the mental health of the elderly in community.The validity evaluation showed that the measurement methods for the measurement dimensions of the elderly care needs,including the evaluation items,evaluation methods,and rating methods,all got below 2 scores in applicability assessment,and the measurement methods of the self-care ability,vision,the self-willingness/information expression of the elderly,the ability of the elderly to understand the willingness/information expressed by others,and the ability to provide family care were all supported by more than 50％ experts,which indicated that the surface validity and content validity were good.There was a significant positive correlation between the living places of the elderly and the needsof elderly care services (r=0.214,P＜0.01),and there were significant correlations between all measurement dimensions with the living place except anxiety (P＜0.05),which indicated that the measurement tool had an acceptable criterion-related validity.The consistency of self-supporting willingness,the family willingness to care for the elderly with the current old-age care place were relatively poor (Kappa=0.063,P=0.007;Kappa=0.051,P=0.006).Conclusion The overall performance of the measurement tool for the elderly care service needs developed in this study is acceptable.It has been approved by both the elderly care service suppliers and the elderly care service needs evaluators.It also shows some internal consistency in measurement results of the demanders,and is consistent with the actual living place.

Objective To survey on the elderly care needs in the community of Shanghai.Methods From February 2017 to May 2017,a survey on the elderly care needs was conducted using stratified sampling method among 4 312 residents aged ≥60 years in Malu township of Shanghai Jiading District.The survey involved physical health status (illness,self-care ability,vision,risk of falls),mental health status (expression ability in feelings of self-will/information,comprehension in others' willingness/information,depression,anxiety),social health status(family care ability),and willingness for elderly care method (self-desires for old-age support,family-desires for old-age support).The survey was implemented by family doctors.Results The total demand for elderly care services for the elderly in Malu Township was skewed,with a median score of 9.9 points (5.7,15.1).In terms of physical health status,72.7％(3 135) of the elderly suffered from one or more diseases,90.8％(3 915) of the elderly had good self-care ability,83.5％ (3 600) of the elderly had good eyesight,and 98.5％(4 247) of the elderly had only mild risk of falling;in terms of mental health status,81.8％(3 527) of the elderly had normal expression ability of self-willingness/information,and 98.3％(4 239) of the elderly had normal understanding ability of wishes/information expressed by others,87.5％(3 773) of elderly people did not have depression,97.0％(4 183) of the elderly had no anxiety;in terms of social health,58.7％(2 531) of elderly people had normal family care ability;58.7％(2 531) of elderly people were willing to get home-based care,and 53.0％(2 285) of their families also hoped that the elderly could get home-based care.Conclusion The needs of elderly care services is at a lower level among old-aged residents in Malu township,however,there is a relatively low social health status.This study provides an objective quantitative basis for the targeted development of medical care and support services for the elderlv in the communitv in the future.

Objective To develop and allocate regional elderly care resources based on local service needs.Methods From February 2016 to May 2016,a face-to-face questionnaire survey was conducted to measure the elderly care service needs among residents over 60 years of age in Malu Township of Shanghai Jiading District.A telephone survey on the old-age care resources in Malu Township was carried out in November 2016.The demarcation of the aged care service needs was considered according to the resource classification from supplier side and the needs scores from the demander side.Kappa consistency test was used to compare the current care setting and the care setting matched to the real needs on the basis of the demarcation criteria.Results The results of the demarcation showed that 8 old-aged with score ≥ 44.5 in the survey (0.2％) should have the skilled nursing facility-based care;218 with the score of 24.1 to 44.4 (5.1％) should have the welfare institution-based care;60 with score of 23.2 to 24.0 (1.4％) should have elderly home-based care;72 with scores of 22.1 to 23.1 (1.7％) should have the community-based care;3 954 with score ≤ 22.0 (91.6％) should have home-based care.The consistency between the status of current care setting and the care setting matched to the real needs based on the demarcation criteria was poor (Kappa=0.092,P＜0.01).Conclusions This study sets a grading criterion for the service objects of the various aged care services in Malu Township,and provides a basis for the orderly,rational and fair distribution of the regional old-age care service resources.However,the current resource allocation in the region is not accurately matched to the real needs,the problem should be solved with the application of the demarcation criterion.