OBJECTIVE To investigate the clinical characteristics of the acute appendicitis children with Streptococ-cus milleri group(SMG)infection and explore the association between SMG infection and severity of acute appen-dicitis.METHODS A retrospective study was conducted for the children with acute appendicitis who were trea-ted in Wuhan Children's Hospital from Jan.2021 to Dec.2023.The distribution of pathogens isolated from the children with acute appendicitis was analyzed.The children with acute appendicitis were divided into the SMG group(with Streptococcus constellatus/Streptococcus anginosus tested positive)and the non-SMG group according to the test result of SMG in abdominal pus specimens.The clinical characteristics and the results of preoperative laboratory tests were observed and compared between the two groups of children.RESULTS A total of 464 children with acute appendicitis were included in the study,715 strains of pathogens were isolated from the submitted pus specimens.Among the isolated gram-positive bacteria,S.constellatus and S.anginosus were dominant,account-ing for 12.31％and 9.37％,respectively.The analysis of drug resistance showed that the drug resistance rates of the S.constellatus and S.anginosus strains to clindamycin and erythromycin were greater than 40％.As com-pared with the non-SMG group,the length of hospital stay was longer in the SMG group[(10.34±3.93)days],the highest body temperature was higher[(37.78±1.24)℃];the percentage of the children with the use of anti-biotics more than 7 days was 87.10％in the SMG group,the appendiceal perforation rate was 75.48％,the inci-dence rate of diffuse peritonitis was 36.77％,remarkably higher than those of the non-SMG group(allP＜0.05).The total white blood cells was[15.10(11.01,19.13)× 109/L]in the SMG group,with the C-reactive pro-tein(CRP)[76.30(29.23,127.75)mg/L],the fibrinogen[5.01(3.82,6.38)g/L],the serum sodion level[135.35(132.48,137.63)mmol/L];there were significant differences in the above indexes between the SMG group and the non-SMG group(P＜0.05).CONCLUSION The SMG infection is closely associated with the severi-ty of acute appendicitis in the children,and the children are usually complicated with the rise of fibrinogen and CRP and tended to have hyponatremia.

BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

OBJECTIVE To investigate the clinical characteristics of the acute appendicitis children with Streptococ-cus milleri group(SMG)infection and explore the association between SMG infection and severity of acute appen-dicitis.METHODS A retrospective study was conducted for the children with acute appendicitis who were trea-ted in Wuhan Children's Hospital from Jan.2021 to Dec.2023.The distribution of pathogens isolated from the children with acute appendicitis was analyzed.The children with acute appendicitis were divided into the SMG group(with Streptococcus constellatus/Streptococcus anginosus tested positive)and the non-SMG group according to the test result of SMG in abdominal pus specimens.The clinical characteristics and the results of preoperative laboratory tests were observed and compared between the two groups of children.RESULTS A total of 464 children with acute appendicitis were included in the study,715 strains of pathogens were isolated from the submitted pus specimens.Among the isolated gram-positive bacteria,S.constellatus and S.anginosus were dominant,account-ing for 12.31％and 9.37％,respectively.The analysis of drug resistance showed that the drug resistance rates of the S.constellatus and S.anginosus strains to clindamycin and erythromycin were greater than 40％.As com-pared with the non-SMG group,the length of hospital stay was longer in the SMG group[(10.34±3.93)days],the highest body temperature was higher[(37.78±1.24)℃];the percentage of the children with the use of anti-biotics more than 7 days was 87.10％in the SMG group,the appendiceal perforation rate was 75.48％,the inci-dence rate of diffuse peritonitis was 36.77％,remarkably higher than those of the non-SMG group(allP＜0.05).The total white blood cells was[15.10(11.01,19.13)× 109/L]in the SMG group,with the C-reactive pro-tein(CRP)[76.30(29.23,127.75)mg/L],the fibrinogen[5.01(3.82,6.38)g/L],the serum sodion level[135.35(132.48,137.63)mmol/L];there were significant differences in the above indexes between the SMG group and the non-SMG group(P＜0.05).CONCLUSION The SMG infection is closely associated with the severi-ty of acute appendicitis in the children,and the children are usually complicated with the rise of fibrinogen and CRP and tended to have hyponatremia.

Background::A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator (rhTNK-tPA) has previously shown its preliminary efficacy in ST elevation myocardial infarction (STEMI) patients. This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase (rt-PA) in Chinese patients with STEMI.Methods::In this multicenter, randomized, open-label, non-inferiority trial, patients with acute STEMI were randomly assigned (1:1) to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min. The primary endpoint was recanalization defined by thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3. The secondary endpoint was clinically justified recanalization. Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events (MACCEs) and safety endpoints.Results::From July 2016 to September 2019, 767 eligible patients were randomly assigned to receive rhTNK-tPA ( n = 384) or rt-PA ( n = 383). Among them, 369 patients had coronary angiography data on TIMI flow, and 711 patients had data on clinically justified recanalization. Both used a –15% difference as the non-inferiority efficacy margin. In comparison to rt-PA, both the proportion of patients with TIMI grade 2 or 3 flow (78.3% [148/189] vs. 81.7% [147/180]; differences: –3.4%; 95% confidence interval [CI]: –11.5%, 4.8%) and clinically justified recanalization (85.4% [305/357] vs. 85.9% [304/354]; difference: –0.5%; 95% CI: –5.6%, 4.7%) in the rhTNK-tPA group were non-inferior. The occurrence of 30-day MACCEs (10.2% [39/384] vs. 11.0% [42/383]; hazard ratio: 0.96; 95% CI: 0.61, 1.50) did not differ significantly between groups. No safety outcomes significantly differed between groups. Conclusion::rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery, a validated surrogate of clinical outcomes, among Chinese patients with acute STEMI.Trial registration::www.ClinicalTrials.gov (No. NCT02835534).

Objective To develop a group psychological training program to cultivate a sense of meaning in life for retired soldiers during the transitional period,and to explore the efficacy of the training.Methods A psychological training program for retired soldiers during the transitional period was developed based on Delphi method.A total of 64 retired soldiers who participated in a retirement training in transitional period were subjected through cluster sampling in a certain city in Shandong province and assigned into a training group(n=31)and a control group(n=33).The training group attended group psychological training based on the developed training program(twice a week,1.5～2 h each time,for 4 weeks),and the control group received routine adaptive training for retirement.Purpose in Life(PIL)Test,Chinese Perceived Stress Scale(CPSS)and Social Adaptability Scale(SAS)were used to survey the participants before(T1),and at the end of(T2)and 1 month after the training(T3).Results ① The results of 2 rounds of expert consultation showed that the coefficient of authority(Cr)was 0.89,and the Kendall's coefficient(ω)of the 2 rounds was 0.134 and 0.204,respectively(P＜0.001),with a coefficient of variation ranging from 0.05 to 0.14.The prepared group psychological training program consisted of 3 first-level indexes,6 second-level indexes,and 24 third-level indexes.② The results of the interaction between group and time after training showed that the training group had significantly higher total score and score of each dimension in sense of meaning in life,and increased total score of social adaptability,but lower total score of perceived stress when compared with the control group(all P＜0.001).③ The results of group main effect after training indicated that obviously higher total score and score of each dimension in sense of meaning in life(P＜0.01),elevated total score of social adaptability(P＜0.01),and reduced total score of perceived stress(P＜0.001)were observed in the training group than the control group.④ The results of the post-training time main effect revealed that the training group had notably higher total score and score of each dimension in sense of meaning in life(P＜0.05),increased total score of social adaptability(P＜0.001),and decreased total score of perceived stress(P＜0.001)when compared with the control group.Conclusion Our developed group psychological training can significantly improve the sense of meaning in life,reduce perceived stress and improve their social adaptation ability for retired soldiers during the transitional period.

OBJECTIVE To study the anti-inflammatory immune response effects of lactoferrin in the treatment of periodontitis and its mechanism. METHODS One hundred SD rats were randomly divided into blank control group, model group, lactoferrin administration group low, medium, high dose group(1, 2, 3 g·kg-1), metronidazole positive control group (0.02 g·kg-1), PDTC group(200 mg·kg-1), lactoferrin+PDTC group(2 g·kg-1, 200 mg·kg-1), MCC950 group(1 mg·kg-1) and lactoferrin+MCC950 group(2 g·kg-1, 1 mg·kg-1), 10 rats in each group. Silk thread ligation combined with 10% sucrose drinking water was used to establish the model, and then the drug was administered orally once a day. The blank control group and the model group were administered orally with 0.9% NaCl. The rats in each group were sacrificed after one month of continuous administration. The contents of IL-1b, IL-8 and IL-10 were detected by ELISA kit, and the expressions of TLR2-NF-κB pathway and NLRP3 inflammasome related proteins were detected by Western blotting. HE staining was used to observe the pathological changes of the periodontal tissues of the rats in each group. RESULTS Compared with the model group, the symptoms of periodontitis in each dose group of lactoferrin were significantly improved. HE staining showed that the infiltration of inflammatory cells was reduced, and the proliferation of fibroblasts was active. The protein expressions of TLR2, NF-κB, NLRP3, Caspase-1 p20 and GSDMD-N decreased, the content of pro-inflammatory factor IL-8 and IL-1b decreased, and the content of anti-inflammatory factor IL-10 increased. CONCLUSION Lactoferrin may play a role in the regulation of inflammatory immune response in the treatment of periodontitis by down-regulating the protein expression of TLR2-NF-κB-NLRP3 pathway, reducing the initiation of inflammatory response and the release of inflammatory factors, so as to achieve the purpose of anti-inflammatory.

Objective:This study aims to investigate the prevalence of internet addiction, morningness-eveningness preference of sleep-wake chronotype, and sleep quality and the correlates of internet addition among first-year undergraduate students.Methods:The newly admitted undergraduates ( n=9 157) of a comprehensive university in 2019 were invited to participate in an online survey from September 2019 to December 2019. The Young′s 20-item Internet Addiction Test, the Pittsburgh sleep quality index, and the Morningness-Eveningness Questionnaire (MEQ) were used to measure internet addiction, sleep quality, and the types of morningness-eveningness preference respectively. Logistic regression analysis was used to analyze factors independently related to internet addiction with demographic variables (i.e., gender and age), sleep problems, and morningness-eveningness preference adjusted. Results:A total of 7 457 (81.4%) newly admitted undergraduates completed the questionnaires. The prevalence of internet addiction in the total sample was 8.86% (661/7 457), while the corresponding figures were 10.04% (348/3 466) in female students and 7.84% (313/3 991) in male students. The prevalence of sleep problems was 11.73% (875/7 457). For chronotype, the prevalence of evening type, intermediate type, and morning type was 54.73% (4 081/7 457), 43.02% (3 208/7 457) and 2.25% (168/7 457) respectively. After adjusting the interaction of related factors in the logistic regression analysis, being female ( OR=1.26), having sleep quality ( OR=4.12), and having sleep-wake chronotype of intermediate type ( OR=0.37) and morning type ( OR=0.24) were independently associated with internet addiction. Conclusions:Female students had higher prevalence of internet addiction than male students. Majority of students had a chronotype of intermediate or evening type. The sleep-wake chronotype was independently associated with internet addiction after controlling sleep quality, which indicated that sleep biological rhythm may be involved in the mechanism of the occurrence of internet addiction.

Objective:This study aims to investigate the prevalence of internet addiction, morningness-eveningness preference of sleep-wake chronotype, and sleep quality and the correlates of internet addition among first-year undergraduate students.Methods:The newly admitted undergraduates ( n=9 157) of a comprehensive university in 2019 were invited to participate in an online survey from September 2019 to December 2019. The Young′s 20-item Internet Addiction Test, the Pittsburgh sleep quality index, and the Morningness-Eveningness Questionnaire (MEQ) were used to measure internet addiction, sleep quality, and the types of morningness-eveningness preference respectively. Logistic regression analysis was used to analyze factors independently related to internet addiction with demographic variables (i.e., gender and age), sleep problems, and morningness-eveningness preference adjusted. Results:A total of 7 457 (81.4%) newly admitted undergraduates completed the questionnaires. The prevalence of internet addiction in the total sample was 8.86% (661/7 457), while the corresponding figures were 10.04% (348/3 466) in female students and 7.84% (313/3 991) in male students. The prevalence of sleep problems was 11.73% (875/7 457). For chronotype, the prevalence of evening type, intermediate type, and morning type was 54.73% (4 081/7 457), 43.02% (3 208/7 457) and 2.25% (168/7 457) respectively. After adjusting the interaction of related factors in the logistic regression analysis, being female ( OR=1.26), having sleep quality ( OR=4.12), and having sleep-wake chronotype of intermediate type ( OR=0.37) and morning type ( OR=0.24) were independently associated with internet addiction. Conclusions:Female students had higher prevalence of internet addiction than male students. Majority of students had a chronotype of intermediate or evening type. The sleep-wake chronotype was independently associated with internet addiction after controlling sleep quality, which indicated that sleep biological rhythm may be involved in the mechanism of the occurrence of internet addiction.

Objective: To understand the confidence-related factors of refusing unprotected sex behavior among college students in Zhejiang province. Methods: Stratified cluster random sampling method was conducted among college students from 13 colleges and universities in Zhejiang province, from October to November, 2018. A total of 3 718 students who self-reported "ever having had sexual contacts" were enrolled. Chi-square test was used to compare the confidence of rejecting unprotected sex under different demographic characteristics, sexual attitude/behaviors and different intervention approaches. Multivariate logistic regression model was used to analyze the related factors. Results: A total of 3 718 college students were involved in this study with average age as (20.17±1.38) years old and 70.5% (2 620/3 718) were male. The proportions of having confidence to refuse unprotected sex behavior were 74.9% (1 963/2 620) of male and 77.9% (896/1 098) of female students, respectively. According to the results from multivariate logistic regression analysis, factors that related to the confidence of refusing unprotected sex behavior in male students would include, did not accept casual sex behavior (compared with accepted students, OR=2.247, 95%CI: 1.828-2.762), did not accept homosexual behavior (compared with accepted students, OR=1.810, 95%CI: 1.302- 2.516), having casual sex behavior in the past one year (compared with having no sex behavior, OR=1.345, 95%CI: 1.051-1.721), aware of the availability of HIV self-test reagents service in college (compared with did not knew, OR=1.381, 95%CI: 1.011-1.887), having taken the HIV infection risk self-assessment in college (compared with did not take, OR=1.707, 95%CI: 1.374-2.121). In female students, the factors would include: being urban resident (compared with rural residence, OR=1.816, 95%CI: 1.225-2.693), 21 years old or above (compared with 20 years old or below, OR=1.469, 95%CI: 1.075-2.007), having taken the HIV infection risk self-assessment in college (compared with did not take, OR=1.597, 95%CI: 1.093-2.333), etc. Conclusions Both male and female college students had higher confidence in refusing unprotected sex behavior. For male students, refusing casual or homosexual contacts, having casual sex in the recent year, knowing HIV self-test reagents service and having had HIV-related risk self-assessment in college as related factors. However, for female students; city residence, 21 years old and above, and having a HIV infection risk self- assessment in college appeared as related factors. Sexual health education should be strengthened to reduce unprotective sex behavior and to promote HIV infection risk self-assessment among the college students.

Objective To observe the application of multiple fluorescent PCR (Polymerase Chain Reaction) in the diagnosis and clinical detection of bloodstream infection. Methods 256 blood cultures were collected by the Laboratory Department of Yinzhou People′s Hospital from January 2018 to May 2018, and were detected by multiplex fluorescent PCR. The results of the PCR were compared with the traditional blood culture bacteria identification instrument (traditional blood culture method). The number of positive and negative samples and the number of corresponding samples of the two methods were counted. Then, they analyzed the specificity and sensitivity of multiplex fluorescence PCR in the diagnosis of bloodstream flow infections. Results A total of 18 pathogenic microbes are detected through blood culture and PCR. Multiple fluorescent PCR detects 142 positive samples and 114 negative samples. Among them, 132 samples also show positive through blood culture, and 111 samples show negative. The consistency rate between multiple PCR and traditional blood cultures is 91.8％ (235/256). The negative prediction rate of PCR is 97.4％ (111/114), sensitivity rate 97.8％ (132/135), specificity rate 91.7％ (111/121). 10 samples show positive through multiple fluorescence PCR but negative for blood culture, 3 samples show positive through blood culture but negative for PCR. Besides, there are 3 types of pathogens that exceed the detection range of PCR. Conclusions Multiplex PCR method can detect 17 pathogens in blood culture specimens of patients, which can not only optimize the traditional blood culture process, but also greatly shorten the reporting time and improve the detection rate of blood culture methods. Especially for patients treated with antibiotics, it can reduce missed detection and improve the diagnostic rate of bloodstream infections.