With the increasing incidence of chronic diseases,the research is conducted to actively explore out of hospital management models for chronic disease patients globally.Among them,virtual ward is a management model based on multidisciplinary team collaboration to provide professional medical and nursing services for unplanned hospitalization high-risk population.This model not only facilitates the transition of patients from inpatient settings to home environments,improving disease prognosis and reducing hospitalization risk,but also alleviates the bed burden on large hospitals.This article provides a review of the concept,development,construction of the operational system,and patient management processes of virtual wards,and offers insights and suggestions to provide references for the optimization and development of out of hospital management models for chronic disease patients in China.

With the increasing incidence of chronic diseases,the research is conducted to actively explore out of hospital management models for chronic disease patients globally.Among them,virtual ward is a management model based on multidisciplinary team collaboration to provide professional medical and nursing services for unplanned hospitalization high-risk population.This model not only facilitates the transition of patients from inpatient settings to home environments,improving disease prognosis and reducing hospitalization risk,but also alleviates the bed burden on large hospitals.This article provides a review of the concept,development,construction of the operational system,and patient management processes of virtual wards,and offers insights and suggestions to provide references for the optimization and development of out of hospital management models for chronic disease patients in China.

Objective·To explore the predictive value of diuretic renal scintigraphy parameters such as 20-minute residual rate(R20)for pyeloplasty in children with congenital unilateral ureteropelvic junction obstruction(UPJO).Methods·The clinical data and diuretic renal scintigraphy results of 110 children with congenital unilateral UPJO who were first treated at the Department of Nuclear Medicine,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from August 2018 to August 2023 were retrospectively analyzed.The imaging results and the progress of hydronephrosis were followed up after the first diuretic renal scintigraphy.According to the outcome event of pyeloplasty due to the progression of hydronephrosis,the children were divided into operation group and non-operation group.Age,gender,side of hydronephrosis,and baseline diuretic renal scintigraphy parameters including blood perfusion rate(BPR),differential renal function(DRF),time to peak(Tmax),time to half(T1/2)and R20 were compared between the two groups.Logistic regression was used to analyze the effect of various parameters on the progression of hydronephrosis.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of diuretic renal scintigraphy parameters for surgical intervention.Wilcoxon test was used to compare the examination parameters of two diuretic renal dynamic imaging.Results·During the follow-up,60 children underwent pyeloplasty after progression,and the other 50 children did not progress.The differences in DRF,Tmax,T1/2 and R20 between the two groups of children at baseline were statistically significant(all P<0.05).Univariate and multivariate Logistic regression analysis showed that only R20 was an independent predictor of pyeloplasty(OR=4.730,95%CI 1.009-1.178,P=0.030).R20 predicted pyeloplasty with a sensitivity of 88.3%,specificity of 56%,the area under the ROC curve of 0.758(95%CI 0.667-0.850,P=0.000),and the cut-off value of 90.08%.During the follow-up,38 children underwent the second diuretic renal scintigraphy,and the DRF was lower than before.The difference between the two DRFs was statistically significant(Z=-2.589,P=0.010),especially in children with R20≥90.08%(Z=-2.166,P=0.030).R20 in the non-operation group decreased significantly compared with the baseline(Z=-2.062,P=0.039).However,R20 in the operation group was higher than baseline,but the difference was not statistically significant(P>0.05).Conclusion·R20 plays an important role in the prediction of pyeloplasty in children with congenital unilateral UPJO.For children with R20≥90.08%,pyeloplasty should be performed as soon as possible to prevent further deterioration of renal function.

Since the National Health Commission launched the pilot work of " Internet+ nursing service" in 2019, medical institutions at all levels in China keep innovating their nursing service models to provide targeted high-quality care for discharged patients or special groups suffering from diseases and poor mobility. In April 2021, a tertiary hospital in Qingdao carried out the " Internet+ " whole course management practice with specialized nurses as the main service subjects, which center on discharged patients as the main service objects. By estabusing a management team and the construction of " Internet+ " information exchange platform, the hospital implemented the whole course of disease management process including patients′ pre-hospital management, in-hospital estimate, and post-hospital follow-up rehabilitation, to provide specialized nursing services such as PICC dressing change care, stoma care, and mother and infant care for patients at home. By February 2022, the " Internet+ " whole course management service had expanded to 50 kilometers away from hospital, with a total of 1 181 specialized nursing services. This management highlighted the characteristics of specialized nursing services in tertiary hospitals, accurately matched the needs of patients, reflected the concept of holistic care, and provided references for the rapid promotion of the development of " Internet+ nursing service" in China.

Objective:To investigate the resting energy expenditure of children with mechanical ventilation and analyze their association with anthropometric indicators (height, weight, and body mass index) and serum protein markers (pre-albumin, albumin, transferrin, and retinol).Methods:An observational study was held in Pediatric Intensive Care Unit(PICU) of Beijing Children′s Hospital, Capital Medical University, from August 2015 to April 2016.Critically ill children with mechanical ventilation were enrolled in this study.Inclusion criteria were as follows: (1)pediatric critical illness score<90 scores or meet the United States PICU admission criteria; (2)age>29 days, <18 years old; (3)mechanical ventilation>24 hours; (4) tidal volume >60 mL.Resting energy expenditure was determined by US Med Graphic Company CCM/D energy metabolism test system.German Famed Zywier intensive care bed with weight scale weighing, uniform measuring bed or meter measuring height, automatic biochemical analyzer and radioimmunoassay was adopted for the determination of albumin, pre-albumin, transferrin, retinol binding protein.SPSS 20.0 software was applied for carrying out Pearson line analysis correlation. Results:A total of 68 children were included in the study, including 36 males and 32 females, body weight (22.34±14.89) kg, height (122.23±14.89) cm, resting energy consumption (784.63±278.25) kcal(1 kcal=4.185 kJ), and resting energy consumption per kilogram of body weight (48.80±31.26) kcal.In anthropometric indicators, resting energy expenditure was significantly positively correlated with height, body weight ( r=0.764, 0.734, all P<0.05), a low positive correlation with body mass index( r=0.396, P<0.05). In serum proteomics, resting energy expenditure was negatively correlated with pre-albumin, transferrin ( r=-0.318, -0.282, all P<0.05), and a moderate negative correlation with retinol protein ( r=-0.505, P<0.05), while without correlation with albumin ( r=-0.075, P>0.05). Conclusions:The height, weight and serum proteomics of children with mechanical ventilation may affect resting energy expenditure.

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 evaluate the efficacy and safety of nasal continuous positive airway pressure(NCPAP) in the treatment of congenital airway stenosis with severe pneumonia.Methods:A single-center retrospective clinical study was used to select children with congenital airway stenosis and pneumonia who were admitted to PICU of Beijing Children′s Hospital of Capital Medical University during 5 years and treated with NCPAP within 48 hours after admission.The baseline data, clinical manifestations, vital signs, arterial blood gas, clinical outcomes, NCPAP use time and adverse reactions were collected.Results:A total of 64 children were included in this study, with 58 cases in the effective group and six cases in the ineffective group.The total effective rate of NCPAP was 90.6% (58/64) during 5 years.In the effective group, 63.8% patients were weaned in three to seven days, with an average weaning time of 6.09 days.In the effective group, the heart rate and PaCO 2 after NCPAP treatment were significantly lower than that before treatment, and pH and PaO 2 were significantly higher than that before treatment, and the difference was statistically significant (all P<0.05). A total of six patients in the ineffective group were finally changed to tracheal intubation and invasive ventilation.The survival rate of both groups was 100%.All cases had no adverse reactions or complications. Conclusion:NCPAP can effectively improve the oxygenation in children with congenital airway stenosis and severe pneumonia, with high efficiency and good safety.

Objective To evaluate the effectiveness of nutritional support in the treatment of primary chylous reflux obstacle caused by primary lymphatic dysplasia among infants and investigate the effects of the essential components of therapeutic formula milk in treating this disease.Methods Seven infants,who were diagnosed at Beijing Shijitan Hospital between 2012 and 2014 with primary chylous reflux obstacle and aged (8.9±4.6) months at the onset,were retrospectively analyzed to evaluate effectiveness of the nutrition support and prognosis of the disease.Results After personalized enteral nutrition support (using proteins,short peptides and medium-chain triglyceride) of (8.3±2.8) months,heights and weights of all the seven infants were kept between the 3rd and 97th percentile lines,and the growth curve showed onward and upward trend.Their plasma albumin levels reached (43.7±4.4) g/L.The infants defecated 1-2 times a day and the texture of feces was formed and soft with yellow color.Conclusion Clinical symptoms and physical signs of the seven infants were improved after nutrition support,which contributed to the recovery.

Objective: To analyze the resting energy expenditure and optimal energy supply in different age groups of critically ill children on mechanical ventilation in pediatric intensive care unit (PICU). Methods: Patients on mechanical ventilation hospitalized in PICU of Beijing Children's Hospital from March 2015 to March 2016 were enrolled prospectively. Resting energy expenditure of patients was calculated by US Med Graphic company critical care management (CCM) energy metabolism test system after mechanical ventilation. Patients were divided into three groups:<3 years, 3-10 years, and >10 years. The relationship between the measured and predictive resting energy expenditure was analyzed with correlation analysis; while the metabolism status and the optimal energy supply in different age groups were analyzed with chi square test and variance analysis. Results: A total of 102 patients were enrolled, the measured resting energy expenditure all correlated with predictive resting energy expenditure in different age groups (<3 years (r=0.3, P=0.0) ; 3~10 years (r=0.6, P=0.0) ;>10 years (r=0.5, P=0.0) ) . A total of 40 cases in < 3 years group, including: 14 cases of low metabolism (35%), 14 cases of normal metabolism (35%), and 12 cases of high metabolism (30%); 45 cases in 3-10 years group, including: 22 cases of low metabolism (49%), 19 cases of normal metabolism (42%), 4 cases of high metabolism (9%); 17 cases in>10 years group, including: 12 cases of low metabolism (71%), 4 cases of normal metabolism (23%), 1 case of high metabolism (6%). Metabolism status showed significant differences between different age groups (χ²=11.30, P<0.01, r=-0.01). Infants had higher metabolic status, which lessened with aging. The total average actual energy requirement was (210±84) kJ/ (kg⋅d) . There were significant differences in actual energy requirement between age groups (F=46.57, P<0.001), with (277±77) kJ/ (kg⋅d) in<3 years group, (184±53) kJ/ (kg⋅d) in 3-10 years group, and (120±30) kJ/ (kg⋅d) in>10 years group. Conclusion The resting energy metabolism of the critically ill children on mechanical ventilation is negatively related to the age. The actual energy requirement should be calculated according to different ages.

Objective To investigate changes in serum levels of antinuclear antibody(ANA), anti?double?stranded DNA(dsDNA)antibody and anti?extractable nuclear antigen(ENA)antibody before and after anti?tumor necrosis factor?α(TNF?α)therapy in psoriatic patients. Methods Clinical data obtained from 32 patients with psoriasis were analyzed retrospectively. Of the 32 patients, 13 received intravenous injection of 5 mg/Kg infliximab at week 0, 2, 6 for 3 sessions, then once every 8 weeks(infliximab group), while other 19 received subcutaneous injection of 25 mg etanercept twice every week(etanercept group). The treatments in the 2 groups both lasted more than 3 months. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody and changes of clinical symptoms were detected and observed respectively before each treatment in the infliximab group, as well as every 3- 6 months in the etanercept group. The 75%reduction in psoriasis area and severity index(PASI75)and disease activity score of 28 joints(DAS28) were used to evaluate clinical efficacy. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody were measured by indirect immunofluorescence(IIF)assay, Western blot analysis combined with enzyme?linked immunosorbent assay(ELISA), and Western blot analysis, respectively. Results After 3?month treatment, the 32 patients achieved clinical remission to different extents. Of 32 patients receiving anti?TNF?αtherapy, 7(21.9%)developed new autoantibodies. Concretely speaking, 4 patients in the infliximab group developed autoantibodies in 8.3 ± 5.1 months, including 3 cases positive for ANA and 3 for anti?ENA antibody. Three patients in the etanercept group developed autoantibodies in 9.0 ± 3.0 months, including 3 cases positive for ANA and 1 for anti?ENA antibody. Conclusion Partial patients with psoriasis may develop autoantibodies after anti?TNF?αtherapy.