Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To summarize the clinical characteristics of invasive Group A Streptococcus (GAS) infection in children and to provide reference for its clinical treatment and diagnosis. Methods:The medical records of inpatients whose sterile body fluids tested positive for GAS in Beijing Children′s Hospital from February 2013 to June 2024 were reviewed in this case series study.The clinical information of the patients was collected and summarized as a case report.Non-normally distributed measurement data were represented by the median ( M), and count data were represented by cases (%). Results:There were 42 cases of invasive GAS infection, with a median age of 6 years and 3 months (range: 14 days to 13 years and 7 months).Twenty-seven patients (64.3%) developed this disease in winter.In terms of susceptibility factors, there were 4 cases of trauma, 2 cases of influenza A, 1 case of neuroblastoma chemotherapy myelosuppression, 1 case of acute lymphoblastic leukemia chemotherapy myelosuppression, 1 case of varicella, and 1 case of scald among these 42 patients, there are no other obvious susceptibility factors.The types of specimens in which GAS was detected included 23 blood specimens, 9 pleural effusions, 9 sterile-site pus specimens, and 5 cerebrospinal fluids.GAS was detected in 4 children from two types of specimens simultaneously.The methods for detecting GAS included bacterial culture in 35 cases and next-generation sequencing in 9 cases.Two children tested positive for GAS by both methods.According to clinical diagnoses, there were 17 cases of pneumonia, 13 cases of streptococcus toxic shock syndrome, 10 cases of purulent meningitis, 6 cases of purulent osteomyelitis, 6 cases of purulent arthritis, 5 cases of cellulitis, 3 cases of necrotizing fasciitis, 2 cases of infectious myositis, and 2 cases of cervical abscess.Two or more clinical manifestations were detected in 26 patients.Drug sensitivity reports were available for 26 cases.All strains were sensitive to Penicillin, Vancomycin, Linezolid, Ceftriaxone and Cefepime.All except 2 were resistant to Clindamycin, and all were resistant to Erythromycin.All 42 cases were treated with intravenous antibiotics, and 21 of them also received human immunoglobulin.Three of the patients died and 39 were discharged from hospital. Conclusions:Pediatric invasive GAS infection occurs mainly in winter and manifests as pneumonia, purulent meningitis, purulent osteomyelitis, and purulent arthritis.The strains are sensitive to β-lactam antibiotics, Vancomycin and Linezolid, and most are resistant to Clindamycin and Erythromycin.

Objective:To summarize the clinical characteristics of invasive Group A Streptococcus (GAS) infection in children and to provide reference for its clinical treatment and diagnosis. Methods:The medical records of inpatients whose sterile body fluids tested positive for GAS in Beijing Children′s Hospital from February 2013 to June 2024 were reviewed in this case series study.The clinical information of the patients was collected and summarized as a case report.Non-normally distributed measurement data were represented by the median ( M), and count data were represented by cases (%). Results:There were 42 cases of invasive GAS infection, with a median age of 6 years and 3 months (range: 14 days to 13 years and 7 months).Twenty-seven patients (64.3%) developed this disease in winter.In terms of susceptibility factors, there were 4 cases of trauma, 2 cases of influenza A, 1 case of neuroblastoma chemotherapy myelosuppression, 1 case of acute lymphoblastic leukemia chemotherapy myelosuppression, 1 case of varicella, and 1 case of scald among these 42 patients, there are no other obvious susceptibility factors.The types of specimens in which GAS was detected included 23 blood specimens, 9 pleural effusions, 9 sterile-site pus specimens, and 5 cerebrospinal fluids.GAS was detected in 4 children from two types of specimens simultaneously.The methods for detecting GAS included bacterial culture in 35 cases and next-generation sequencing in 9 cases.Two children tested positive for GAS by both methods.According to clinical diagnoses, there were 17 cases of pneumonia, 13 cases of streptococcus toxic shock syndrome, 10 cases of purulent meningitis, 6 cases of purulent osteomyelitis, 6 cases of purulent arthritis, 5 cases of cellulitis, 3 cases of necrotizing fasciitis, 2 cases of infectious myositis, and 2 cases of cervical abscess.Two or more clinical manifestations were detected in 26 patients.Drug sensitivity reports were available for 26 cases.All strains were sensitive to Penicillin, Vancomycin, Linezolid, Ceftriaxone and Cefepime.All except 2 were resistant to Clindamycin, and all were resistant to Erythromycin.All 42 cases were treated with intravenous antibiotics, and 21 of them also received human immunoglobulin.Three of the patients died and 39 were discharged from hospital. Conclusions:Pediatric invasive GAS infection occurs mainly in winter and manifests as pneumonia, purulent meningitis, purulent osteomyelitis, and purulent arthritis.The strains are sensitive to β-lactam antibiotics, Vancomycin and Linezolid, and most are resistant to Clindamycin and Erythromycin.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To visualize and analyze the literature related to nurses′ psychological contract at home and abroad by CiteSpace software, discuss the development trend, and to provide reference for subsequent research.Methods:Literature related to nurses′ psychological contract collected by China National Knowledge Infrastructure and Web of Science from the establishment of the database to August 31, 2023 were retrieved. CiteSpace software was used to visually process the authors, institutions, keywords, publication trends and other types of nodes. Combined with the visualization map, the research status and hot trends of nurses′ psychological contract were analyzed.Results:A total of 175 articles in English and 126 articles in Chinese were included. The annual publication volume showed a zigzag upward trend. Chen Furong′s team published the most Chinese literature, while Rodwell J′s team published the most English literature. Shanxi Medical University and Monash University were the research institutions with the largest number of publications in Chinese and English respectively. Domestic research hotspots mainly focused on 5 directions: the status quo investigation, influence factors, intervention strategies, the impact on performance behavior, the content and structure of nurses′ psychological contract. Foreign research hotspots mainly focused on 3 directions: the influence factors, intervention strategies and the impact on performance behavior.Conclusions:The overall number of papers published in the field of nurses′psychological contract research at home and abroad is small, and the depth and breadth of the research are far from enough. The cooperation between authors and institutions should be strengthened, the research direction should be more diversified, and the mediation effect analysis and influence mechanism research of psychological contract should be paid attention to, so as to construct a multipath nurses′psychological contract system complied with national condition.

Objective:To investigate the method and effect of correcting upper eyelid depression with released orbital diaphragmatic fat.Methods:From January 2017 to June 2020, there were 26 female patients with upper eyelid depression in this department of Hebei Chengde Stomatological Hospital. The patients aged 22-54 years, with average 43 years. An external mass orbital diaphragm fat release reverse folding repositioning with fat placement in the upper lid depression was performed in 26 patients. An incision about 4 mm long was made in the middle and lateral of the orbital diaphragm to ensure the integrity of the orbital diaphragm as far as possible. The photos of beauty seekers before and 6 months after operation were compared to observe the correction effect of upper eyelid depression and the shape of upper eyelid.Results:All 26 patients had one-stage healing of the surgical incision without infection, with inconspicuous incisional scarring. At 6 months postoperatively, 18 patients had satisfactory results; 1 patient had improved results due to insufficient fat; and 1 patient had poor results due to too little fat and poor filler placement, which was later improved by autologous fat grafting.Conclusions:External mass orbital fat release reverse folding repositioning for correction of upper eyelid depressions is a surgical procedure with obvious results, little trauma, and following the principle of anatomical recovery, which is worthy of clinical application.

Objective:To translate the Perioperative Comfort Scale (PCS) into Chinese, and test its reliability and validity.Methods:After translation, expert correction, cultural adjustment, and pre-investigation, the items for the simplified Chinese version of PCS were determined. From October to December 2020, convenience sampling was used to select 225 surgical patients from the First Affiliated Hospital of University of Science and Technology of China as the research object. The patients were investigated with the General Information Questionnaire and the Chinese version of PCS. Exploratory factor analysis was used to evaluate the construct validity of the Chinese version of PCS, and Cronbach's α coefficient was used to evaluate the reliability of the scale. Spearman correlation analysis method was used to analyze the correlation between each dimension and the relationship between each dimension and the total scale. A total of 225 questionnaires were distributed, 218 valid questionnaires were recovered, and the valid recovery rate was 96.9%.Results:The Chinese version of PCS extracted 4 factors by factor analysis, with a total of 18 items, and the cumulative total variance explanation rate was 61.511%. The content validity index of each item of the scale was 0.95, and the content validity index of item level was from 0.800 to 1.000. The overall Cronbach's α coefficient of the scale was 0.844, and the test-retest reliability of the scale was 0.749. Item analysis showed that the Spearman correlation coefficient of each item and the total scale score was>0.3 except for the sixteenth item whose correlation coefficient was 0.277.Conclusions:The Chinese version of the PCS has good reliability and validity, and can be used to evaluate the intraoperative comfort of patients without general anesthesia during the perioperative period.

Objective:To explore the application method and effect of online teaching of pediatrics in undergraduate clinical medicine.Methods:From March to August, 2020, two classes of pediatrics were selected as research objects: 67 students from Batch 2016 "5+3" clinical medicine class were taught by providing recorded teaching resources and online communication and answering questions (hereinafter referred to as "recorded courses"); 39 students from Batch 2015 "5+3" clinical medicine class were taught by live courses and online communication and answering questions (hereinafter referred to as "live courses"). Through the questionnaire survey on the two groups of students, the effect of the two online teaching methods were compared and the medical students' views and suggestions on them were collected. SPSS 26.0 was used for statistical analysis.Results:Most of the students in the two groups (98.1%) agreed with the effect of the online teaching of pediatrics and thought it could meet their learning needs. There was no significant difference in the online teaching effect between recorded courses group and live courses group ( P > 0.05). However, they had a poor recognition with the implementation of complete online teaching in the future, while they preferred the combination of online teaching with practical exercises in offline hospitals. Conclusion:Online teaching of pediatrics has been recognized by medical students. The two online teaching methods have their own advantages: recorded courses are more planned and the content is more rigorous; live courses are more interactive and flexible. However, considering that medicine is a highly practical subject, it still needs to be supplemented by offline practice while giving full play to the advantages of online teaching.

Objective To analyze the clinical characteristics of community-acquired influenza virus pneumonia in hospitalized children and improve the clinicians' understanding level of this disease.Methods Data of 70 cases with community-acquired influenza virus pneumonia admitted to the Respiratory Department and Infectious Disease,Beijing Children's Hospital,Capital Medical University,from November 2009 to April 2018 were collected and the clinical characteristics were analyzed.Results Of the 70 cases,61 cases(89.7％) were discharged after improvement.The median age was 3.5 years old,and 50 cases(71.4％) were 0 to 5 years old.There were 29 cases with severe influenza pneumonia,41 cases with mild influenza pneumonia,3 cases died,and 19 cases (27.1％) had underlying diseases.Sixty-four cases (91.4％) were hospitalized in winter and spring.The first symptoms were mainly fever in 64 cases (91.4％) and cough in 65 cases (92.9％),and temperatures were mostly from 39.1 ℃ to 41.0 ℃.Lung auscultation was dominated by moist rales (30 cases,58.8％) and wheezing (8 cases,15.7％).There were many complications of influenza virus pneumonia,including 19 cases with myocardial injury,11 cases with liver function injury,4 cases with toxic encephalopathy,3 cases with electrolyte disturbance,2 cases with multiple organ failure,2 cases with hemophagocytic syndrome,and 1 case with septic shock.Chest radiographic results reveal bilateral inflammation in 40 children (57.1％),prodominatly in lower lobe lesions (39 cases).The common changes were patchy shadow,interstitial parenchymal lesion,ground glass shadow,and pleural effusion.Forty-seven children (67.1％) were infected by influenza A,and 23 children(32.9％) were co-infected.The percentage of severe cases with underlying diseases (68.4％) was significantly higher than that in children without chronic diseases (31.4％),the difference was statistically significant (x2 =7.830,P =0.005).The increase rate of C reaction protein (CRP) in severe cases (54.3％) was significantly higher than that in mild cases (28.6％),the difference was statistically significant (x2 =4.769,P =0.029).Conclusions Community-acquired influenza virus pneumonia in children mainly occurs in winter and spring.It is more common seen in children under 5 years of age.The main clinical manifestations of community-acquired influenza virus pneumonia are high fever and cough,extrapulmonary complications are more common.Most children have moist rales and showed bilateral inflammation and lower lobe lesions in chest radiography.Children with underlying diseases are more likely to develop severe influenza virus pneumonia.Elevated CRP is associated with severe influenza virus pneumonia.Most patients have a good prognosis,but there are still cases of death.

Objective To describe the etiology,clinical characteristics and prognosis in children With intracra﹣nial hemorrhage Who Were admitted to pediatric intensive care unit(PICU)and to analyze factors associated With poor prognosis,in order to provide evidence for prevention and early prognosis evaluation. Methods This Was a prospective, single－center study including the children With intracranial hemorrhage Who Were admitted to PICU of Beijing Chil﹣dren＇s Hospital from October 1,2014 to January 31,2017. Children＇s basic information and survival on the 28th day after hospital discharge Were collected. Prognosis Was evaluated by means of pediatric cerebral performance category score(PCPC)or pediatric overall performance category score( POPC). The related factors With poor prognosis Were analyzed. Results Ninety－five children(58 boys and 37 girls)Were included;mortality at hospital and on the 28th day after discharge Were 7. 4% and 22. 1%,respectively. Trauma(68. 4%)Was the most common cause for intracranial hemorrhage(ICH). The most common cause of spontaneous intracranial hemorrhage in infants Was vitamin K deficiency (4／16 cases,0. 25),but hematological diseases in school－aged children(7／11 cases,63. 6%). Univariate analysis shoWed intraparenchymal,intraventricular,extradural hemorrhage. Multiple sites hemorrhage,trauma,hematological sys﹣tem diseases,surgery,and loW GlasgoW coma scale(GCS)at PICU discharge Were associated With poor prognosis(χ2 ﹦9. 653,10. 658,7. 237,5. 657,10. 966,4. 471,7. 429,31. 308,all P﹤0. 05). Multivariate analysis shoWed that intra﹣ventricular hemorrhage and loW GCS at PICU discharge Were independent risk factors for poor prognosis( all P ﹤0. 001). ICH caused by trauma had a relatively better prognosis( P﹦0. 015). Conclusions The majority of patients With ICH admitted to PICU are infants. The most common cause is trauma. The most common cause of spontaneous ICH in infants is vitamin K deficiency,but hematological diseases in school－aged children. ICH and loW GCS at PICU dis﹣charge are independent risk factors for poor prognosis. ICH caused by trauma has a relatively better prognosis. Reducing accidental injury is the key to prevent ICH in children.