OBJECTIVE To analyze the clinical characteristics and pathogens for mixed infections in children with pertussis,so as to references for clinical diagnosis and treatment.METHODS A retrospective analysis was conduc-ted on the clinical data of 350 children diagnosed with pertussis and hospitalized in Wuhan Children's Hospital from Jan.2022 to Dec.2023.The clinical characteristics,peak white blood cell count,peak lymphocyte ratio,high-sensitivity C-reactive protein or C-reactive protein,procalcitonin and complications were compared between different age groups,as well as between the single infection group and the mixed infection group.RESULTS Mixed infections were observed in 291 children(83.14％),predominantly viral(63.43％,222/350),with human rhinovirus/enterovirus being the most common(32.57％,114/350).For children aged＜6 months,6 months to＜1 year and 1 to＜3 years,the incidence of family contact history of cough,panting,hasty breathing,respira-tory failure,peak white blood cell count and peak lymphocyte ratio were all higher than those aged 3 to＜6 years and≥6years(all P＜0.05).The incidence of post-cough vomiting was higher in children aged 6 months to＜1 year and 1 to＜3 years compared to other age groups(P＜0.05).The length of hospital stay decreased with in-creasing age(P＜0.05).The proportions of children with paroxysmal spasmodic cough,post-cough cyanosis,post-cough flushing,coughing spells,inspiratory three concave sign,pneumonia and pulmonary phlegm rales all generally decreased with age(all P＜0.05).Nodding respiration was only observed in children aged＜1 year(P＜0.05).The incidence of fever,co-infection with bacteria and Mycoplasma pneumoniae infection was higher in children aged 6 months to＜1 year,1 to＜3 years,3 to＜6 years and ≥ 6 years compared to those aged＜6 months(all P＜0.05).The incidence of fever was higher in the mixed infection group than that in the single in-fection group(P＜0.05).Children in the single infection group had longer hospital stays,higher incidence of par-oxysmal spasmodic cough,nocturnal cough,post-cough flushing,coughing spells,pulmonary phlegm rales and higher peak lymphocyte ratio(all P＜0.05).The incidence of paroxysmal spasmodic cough was higher in the sin-gle infection group for children aged＜3 months(P＜0.05).CONCLUSIONS The younger children with pertussis have a higher proportion of family contact history of cough and are more prone to clinical manifestations such as paroxysmal spasmodic cough,post-cough vomiting,post-cough cyanosis,and pneumonia.They also have higher peak white blood cell counts,peak lymphocyte ratios and longer hospital stays.As children'age increased,the in-cidence of fever,bacterial,and mycoplasma infections also increased.The types of pathogens in mixed infections varies with patients' age and pertussis mixed infections may mask typical clinical symptoms.

OBJECTIVE To analyze the clinical characteristics and pathogens for mixed infections in children with pertussis,so as to references for clinical diagnosis and treatment.METHODS A retrospective analysis was conduc-ted on the clinical data of 350 children diagnosed with pertussis and hospitalized in Wuhan Children's Hospital from Jan.2022 to Dec.2023.The clinical characteristics,peak white blood cell count,peak lymphocyte ratio,high-sensitivity C-reactive protein or C-reactive protein,procalcitonin and complications were compared between different age groups,as well as between the single infection group and the mixed infection group.RESULTS Mixed infections were observed in 291 children(83.14％),predominantly viral(63.43％,222/350),with human rhinovirus/enterovirus being the most common(32.57％,114/350).For children aged＜6 months,6 months to＜1 year and 1 to＜3 years,the incidence of family contact history of cough,panting,hasty breathing,respira-tory failure,peak white blood cell count and peak lymphocyte ratio were all higher than those aged 3 to＜6 years and≥6years(all P＜0.05).The incidence of post-cough vomiting was higher in children aged 6 months to＜1 year and 1 to＜3 years compared to other age groups(P＜0.05).The length of hospital stay decreased with in-creasing age(P＜0.05).The proportions of children with paroxysmal spasmodic cough,post-cough cyanosis,post-cough flushing,coughing spells,inspiratory three concave sign,pneumonia and pulmonary phlegm rales all generally decreased with age(all P＜0.05).Nodding respiration was only observed in children aged＜1 year(P＜0.05).The incidence of fever,co-infection with bacteria and Mycoplasma pneumoniae infection was higher in children aged 6 months to＜1 year,1 to＜3 years,3 to＜6 years and ≥ 6 years compared to those aged＜6 months(all P＜0.05).The incidence of fever was higher in the mixed infection group than that in the single in-fection group(P＜0.05).Children in the single infection group had longer hospital stays,higher incidence of par-oxysmal spasmodic cough,nocturnal cough,post-cough flushing,coughing spells,pulmonary phlegm rales and higher peak lymphocyte ratio(all P＜0.05).The incidence of paroxysmal spasmodic cough was higher in the sin-gle infection group for children aged＜3 months(P＜0.05).CONCLUSIONS The younger children with pertussis have a higher proportion of family contact history of cough and are more prone to clinical manifestations such as paroxysmal spasmodic cough,post-cough vomiting,post-cough cyanosis,and pneumonia.They also have higher peak white blood cell counts,peak lymphocyte ratios and longer hospital stays.As children'age increased,the in-cidence of fever,bacterial,and mycoplasma infections also increased.The types of pathogens in mixed infections varies with patients' age and pertussis mixed infections may mask typical clinical symptoms.

OBJECTIVE: To develop a method for identifying high-risk patients among septic populations requiring mechanical ventilation, and to conduct phenotypic analysis based on this method. METHODS: Data from four sources were utilized: the Medical Information Mart for Intensive Care (MIMIC-IV 2.0, MIMIC-III 1.4), the Philips eICU-Collaborative Research Database 2.0 (eICU-CRD 2.0), and the Anhui Medical University Second Affiliated Hospital dataset. The adult patients in intensive care unit (ICU) who met Sepsis-3 and received invasive mechanical ventilation (IMV) on the first day of first admission were enrolled. The MIMIC-IV dataset with the highest data integrity was divided into a training set and a test set at a 6:1 ratio, while the remaining datasets were served as validation sets. The demographic information, comorbidities, laboratory indicators, commonly used ICU scores, and treatment measures of patients were extracted. Clinical data collected within first day of ICU admission were used to calculate the sequential organ failure assessment (SOFA) score. K-means clustering was applied to cluster SOFA score components, and the sum of squared errors (SSE) and Davies-Bouldin index (DBI) were used to determine the optimal number of disease subtypes. For clustering results, normalized methods were employed to compare baseline characteristics by visualization, and Kaplan-Meier curves were used to analyze clinical outcomes across phenotypes. RESULTS: This study enrolled patients from MIMIC-IV dataset (n = 11 166), MIMIC-III dataset (n = 4 821), eICU-CRD dataset (n = 6 624), and a local dataset (n = 110), with the four datasets showing similar median ages and male proportions exceeding 50%; using 85% of the MIMIC-IV dataset as the training set, 15% as the test set, and the rest dataset as the validation set. K-means clustering based on the six-item SOFA score was performed to determine the optimal number of clusters as 3, and patients were finally classified into three phenotypes. In the training set, compared with the patients with phenotype II and phenotype III, those with phenotype I had the more severe circulatory and respiratory dysfunction, a higher proportion of vasoactive drug usage, more obvious metabolic acidosis and hypoxia, and a higher incidence of congestive heart failure. The patients with phenotype II was dominated by respiratory dysfunction with higher visceral injury. The patients with phenotype III had relatively stable organ function. The above characteristics were consistent in both the test and validation sets. Analysis of infection-related indicators showed that the patients with phenotype I had the highest SOFA score within 7 days after ICU admission, initial decreases and later increases in platelet count (PLT), and higher counts of neutrophils, lymphocytes, and monocytes as compared with those with phenotype II and phenotype III, their blood cultures had a higher positivity rates for Gram-positive bacteria, Gram-negative bacteria and fungi as compared with those with phenotype II and phenotype III. The Kaplan-Meier curve indicated that in the training, test, and validation sets, the 28-day cumulative mortality of patients with phenotype I was significantly higher than that of patients with phenotypes II and phenotype III. CONCLUSIONS Three distinct phenotypes in septic patients receiving IMV based on unsupervised machine learning is derived, among which phenotype I, characterized by cardiorespiratory failure, can be used for the early identification of high-risk patients in this population. Moreover, this population is more prone to bloodstream infections, posing a high risk and having a poor prognosis.
Humans ; Machine Learning ; Sepsis/therapy* ; Respiration, Artificial ; Intensive Care Units ; Organ Dysfunction Scores ; Male ; Female ; Middle Aged ; Adult

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 analyze the current situation of the knowledge-attitude-practice among noise-exposed workers at an airport apron. Methods A total of 494 noise-exposed workers from an airport apron were selected as the study subjects using the judgmental sampling method. A self-designed "Occupational Protection Knowledge, Attitudes, and Practices Questionnaire" was used to assess the current situation of knowledge-attitude-practice on occupational protection. Results Regarding the awareness of noise hazards among the study subjects, the awareness rates of noise-induced impairment on digestive function and reproductive system were the lowest (44.9% and 37.7%, respectively). The awareness rate of noise-induced negative emotions increased with length of service (P<0.01). Regarding the occupational protection knowledge for noise, the awareness rate of occupational noise-induced deafness was “incurable” was the lowest (39.1%). The support rate for five kinds of occupational protection attitudes for noise was generally >85.0%, while only 58.3% of the study subjects consistently or frequently wearing earplugs during work. The most common source of noise hazard and protection knowledge was pre-employment training (76.9%), followed by occupational disease prevention and control campaigns (76.1%). Conclusion Noise-exposed workers in this airport apron have incomplete awareness of non-auditory system hazards caused by noise, and the awareness of knowledge of some occupational protection is relatively low. Although their attitudes toward occupational protection are positive, many workers still fail to consistently wear personal protective equipment at work.

Health economics evaluation serves as a pivotal tool for decision-makers to identify the most valuable health intervention program under the condition of resource constraints and optimize the resource allocation.In contrast to the health economics evaluation that was conducted abroad,domestic research remains in an explorato-ry phase.This paper undertakes a systematic review of the application progress and existing limitations of health e-conomic evaluation methodologies in the infection prevention and control(IPC)field,aiming to offer insights and references for the standardized and in-depth development of health economic evaluations in the field of infection control,foster the practice of such evaluations in domestic settings,and push forward the sustainable advancement of China's IPC initiatives.

Objective T o explore the correlation between adult chest CT quantitative parameters and traditional Chinese medicine(TCM)constitution classification in adult persons with different body mass index(BMI).Methods The basic information of 205 adult subjects in the hospital was collected,including gender,age,height,weight,BMI,etc.They were divided into the low body mass group(BMI＜18.5 kg/mi2),normal body mass group(BMI 18.5-＜24.0 kg/m2)and overweight/obese group(BMI≥24.0 kg/m2)according to BMI.All subjects underwent the TCM constitution classification.The distribution of TCM constitutions a-mong the three groups with different BMI was analyzed.The quantitative chest CT parameters were collected,including fat content,muscle content,area of the middle slice of the transverse section image,transverse diam-eter,anteroposterior diameter,scan length,etc.The differences were compared among different TCM constitu-tions,individual basic information and chest CT quantitative parameters.Results In the low BMI group,the Qi-stagnation constitution was the highest;in the BMI normal group,the gentler constitution was the highest,while in the overweight/obese group,the phlegm-damp constitution was the highest.The gender,age,height,weight and BMI had significant correlation with the TCM constitution(P＜0.05).The fat content,fat vol-ume,muscle volume,area of transverse section ROI(AROI),transverse diameter,anteroposterior diameter and scan length/transverse diameter had significant correlation with the TCM constitution(P＜0.05).The differ-ences in BMI and fat content had statistical difference among the phlegm-damp constitution,Qi-stagnation constitution and the other Chinese medicine constitutions(P＜0.01).The fat content,fat volume and muscle volume had significant correlation with BMI(P＜0.01).The muscle content had no significant correlation with BMI(P＞0.05).The muscle content,scan length and transverse diameter/anteroposterior diameter had no significant correlation with the TCM constitution(P＞0.05).Conclusion The distribution difference of TCM constitution in adult persons with different BMI has the statistical significance.The chest CT quantita-tive parameters are closely correlated with TCM constitution classification.

Psoriasis is an incurable chronic inflammatory disease that requires new interventions. Here, we found that fibroblasts exacerbate psoriasis progression by promoting macrophage recruitment via CCL2 secretion by single-cell multi-omics analysis. The natural small molecule celastrol was screened to interfere with the secretion of CCL2 by fibroblasts and improve the psoriasis-like symptoms in both murine and cynomolgus monkey models. Mechanistically, celastrol directly bound to the low-density lipoprotein receptor-related protein 1 (LRP1) β-chain and abolished its binding to the transcription factor c-Jun in the nucleus, which in turn inhibited CCL2 production by skin fibroblasts, blocked fibroblast-macrophage crosstalk, and ameliorated psoriasis progression. Notably, fibroblast-specific LRP1 knockout mice exhibited a significant reduction in psoriasis like inflammation. Taken together, from clinical samples and combined with various mouse models, we revealed the pathogenesis of psoriasis from the perspective of fibroblast-macrophage crosstalk, and provided a foundation for LRP1 as a novel potential target for psoriasis treatment.

Objective To assess the clinical utility of single-molecule real-time technology(SMRT)in identifying triplicated α-globin genes and compound variant alleles.Methods A total of 36 samples with tripli-cated α-globin genes were collected.Among them,28 samples were confirmed by PCR flow-through hybridiza-tion and 8 samples were confirmed by Next Generation Sequencing(NGS).These 36 samples included tripli-cated α-globin genes compound variants with cis or trans arrangements unknown,such as αααanti4 2 compoundαcsα(2 cases),αααanti4.2 compound-α3.7(10 cases),and HKαα/--SEA pending confirmation(2 cases),SMRT technology was employed to detect thalassemia gene variants.Additionally,a pedigree with the genotype ofαααanti4.2 compound-α3.7 variant was recruited,including the proband(Ⅱ-1),its father(Ⅰ-1),and mother(Ⅰ-2).PCR flow-through hybridization and SMRT were employed to detect thalassemia gene variants.Results SMRT detected 35 out of 36 samples with triplicated α-globin genes,and 1 sample with quadrupllcated α-globin genes(ααααanti4.2).Among the 2 αααanti4 2 compound αCSα variant samples,both αααanti42 and αCSα were arranged in trans,with a genotype of αααanti4.2/αCSα.Among the 10 αααanti4.2 compound-α3.7 variant samples,9 samples hadαααanti4.2 and-α3.7 in a cis arrangement,with a genotype of HKαα/αα,and 1 sample had αααannti4.2 and-α3.7 in a trans arrangement,with a genotype of αααanti4.2/-α3.7.Compared with PCR flow-through hybridization,SMRT detected one case of a large segment deletion in the β-globin gene and two unknown variants,which led to an increase in the positive detection rate of approximately 10.71％(3/28).The pedigree analysis showed that the proband(Ⅱ-1)inherited αααanti4.2 and-α3.7 variants from his mother(Ⅰ-2),with a genotype of HKαα/αα,con-sistent with the SMRT detection results.Conclusion SMRT can accurately detect triplicated or quadrupllcat-ed α-globin genes,and compound variant alleles.It offers high accuracy,enables one-step identification of cis or trans arrangements,and provides comprehensive coverage of thalassemia gene variations,demonstrating its significant clinical value.

Health economics evaluation serves as a pivotal tool for decision-makers to identify the most valuable health intervention program under the condition of resource constraints and optimize the resource allocation.In contrast to the health economics evaluation that was conducted abroad,domestic research remains in an explorato-ry phase.This paper undertakes a systematic review of the application progress and existing limitations of health e-conomic evaluation methodologies in the infection prevention and control(IPC)field,aiming to offer insights and references for the standardized and in-depth development of health economic evaluations in the field of infection control,foster the practice of such evaluations in domestic settings,and push forward the sustainable advancement of China's IPC initiatives.