Objective To investigate the risk of respiratory failure (RF) in patients with severe pneumonia (SP), and to establish a prediction model to provide a reference for the development of individualized treatment plans for SP patients. Methods　A study was conducted on 313 patients with SP admitted to the Affiliate Huanghe Sanmenxia Hospital of Henan University of Science and Technology from January 2020 to January 2023. Patients were divided into a model group of 219 cases and a validation group of 94 cases in a 7∶3 ratio. Clinical factors, clinical scores, and laboratory indicators that may affect RF in patients with SP were collected. According to the presence or absence of RF, the model group patients were further divided into the RF group and the non-RF group. Clinical factors, clinical scores, and laboratory indicators were compared between the two groups. Potential influencing factors were screened using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate logistic regression to identify independent influencing factors of RF in SP patients. A column chart model was established using R language and validated. Results　Of 219 patients in the model group, 115 (52.51%) had RF. There were significant differences in age, smoking history, diabetes history, mechanical ventilation, hypoproteinemia, multidrug-resistant bacteria infection, acute physiology and chronic health score-Ⅱ (APACHE-Ⅱ), multiple organ dysfunction score (MODS), confusion urea respiratory rate blood pressure age-65 score (CURB-65), oxygenation index (OI), lactate (Lac), platelet (PLT), mean platelet volume (MPV), D-dimer (D-D), fibrinogen (Fib), and C-reactive protein (CRP) between the RF group and the non-RF group (P<0.05). The results of multivariate logistic regression analysis based on LASSO regression showed that hypoproteinemia, multidrug-resistant bacterial infection, APACHE-Ⅱ, Lac, PLT, MPV, and D-D were independent influencing factors for respiratory failure in SP patients. Receiver Operating Characteristic Curve (ROC) analysis results showed that the area under the curve (AUC) for predicting RF in SP patients was 0.874 (95%CI: 0.828-0.920) in the model group and 0.841 (95%CI: 0.788-0.894) in the validation group. Hosmer-Lemesho (H-L) goodness-of-fit test results showed that there was no statistically significant difference between the predicted and actual probabilities of RF in SP patients in the model group (χ2=2.432, P>0.05). The calibration curve results showed that the predicted curves of the model group and validation group were fitted with the standard curve. The results of the decision curves showed that when the probability threshold of concurrent RF in SP patients was 0.10 to 0.90, the net benefit to patients was greater than all patients with intervention or without intervention. Conclusions　RF in SP patients is mainly influenced by factors such as hypoproteinemia, multidrug-resistant bacterial infection, APACHE-Ⅱ, etc. The column chart model established in this study has high accuracy and discriminative ability for predicting RF in SP patients.

Objective:To evaluate the feasibility, safety and effectiveness of the active surveillance as an alternative to surgery in patients with low-risk papillary thyroid microcarcinoma(PTMC); And to explore potential surgical indicators based on characteristics of patients and medical environment.Methods:A prospective cohort study was conducted in patients with low risk PTMC and received active surveillance management( n=98). Patient adherence, non-progression surgery rates were described, cumulative incidence of tumor growth≥3 mm and tumor volume increase≥50% under ultrasonic monitoring, as well as tumor doubling rate(TDR) were evaluated. Results:A total of 98 patients were enrolled in this prospective cohort. The median age was 39(30, 45) years, and the median baseline diameter of the index tumors was 5.0(3.8, 6.8) mm, with 63.3% of tumors being≤5 mm. After a median 22(12, 44) months follow-up, tumor size growth≥3 mm and tumor volume increase≥50% occurred in 11(11.2%) and 50(51.0%) patients, and no new lymph node metastasis, distant metastasis, and death occurred. Five cases(5.1%) required delayed surgery, and other five non-progression patients opted in surgery based on their own preferences. One patient lost to follow-up. The median post-tumor progression TDRs was significantly lower than that of pre-tumor progression TDRs [size growth per year: -0.09(-0.12, 0.48) vs 0.91(0.86, 1.25), P=0.014, n=8; volume increase per year: 0.29(-0.14, 0.70) vs 1.04(0.66, 2.17), P<0.001, n=39]. After tumor size and volume progression, 62.5% and 43.6% of tumors were remained stable or shrank, respectively. Conclusions:Actived surveillance can be considered as one of the management strategies for low-risk PTMC. Given the differences in population and clinical characteristics, it should be taken in to consideration in developing active surveillance management, such as candidate criteria, follow-up strategies, and intervention indications.

Objective To evaluate the clinical value of ultrasound in evaluating the wrist nerve stem.Methods The examination of the high-resolution ultrasound about normal median nerve,ulnar nerve,radial nerve in the wrist on 100 normal volunteers,the courser,shape and sonographic appearance of the nerve stem were observed,and the vertical and horizontal diameter and the area of cross-section were measured.Results (1)Ultrasound clearly showed the nerve stem arranged and organization structures around it.(2) Ultrasound entirely measured the vertical and horizontal sections of normal median nerve,ulnar nerve,radial nerve in the wrist,besides it measured various diameters and the cross-section area.By comparing the vertical diameter of MN and RN between left hand and right hand of the same sexuality,the difference had no statistical significance (P＞0.05).By comparing the various diameters of UN between left hand and right hand of females,the difference had no statistical significance (P＞0.05) By comparing the vertical diameter between left hand and right hand of male,the difference had statistical significance (P＜0.05).To compare the vertical diameter of MN,RN and UN between male and females on the same side,the difference had statistical significance (P＜0.05).To compare the CSA of MN,RN and UN between left hand and right hand of the same sexiuality,the diffevence had no statistical significance (P＞0.05);By comparing the CSA of MN,RN and UN between male and females on the same side,the diffevence had statistical significance (P＜0.05).Median nerve cross-sectional area (CSA) and weight correlation was statistically significant (P ＜ 0.05) in a straight line,no statistically significant correlation was found between age and height (P＞ 0.05).(3) High resolution ultrasound clearly showed the neural surrounding adjacent to the organizational structure,and in line with gross anatomy section.Conclusion Ultraound has a clinical evalution value for examing the wrist nerve

ObjectiveTo investigate the prevalence,antibiotic characteristics as well as molecular background of community-associated methicillin-sensitive Staphylococcus aureus (CA-MRSA) from patients with skin and sofi tissue infections from 4 different hospitals in Beijing.MethodsFive hundred and one patients were enrolled from 4 hospitals prospectively.Patients with skin and soft tissue infections and no risk factors for healthcare-associated acquisition were included.Sample from the infection sites were collected for culture.Case report form was filled out for each patient.Antibiotic susceptibility test and molecular analysis was performed for each Staphylococcus aureus isolate.ResultsTotally 164 Staphylococcus aureus isolates were cultured from the patients with skin and soft tissue infections.Of them 5 isolates were CA-MRSA.These 5 CA-MRSA isolates harbored SCCmec Ⅰ, SCCmec Ⅲ, SCCmec Ⅳ,SCCmec Ⅴ and untypable,respectively.CA-MRSA was highly resistant to β-lactamase,levofloxacin,erythromycin and clindamycin,but susceptible to vancomycin,teicoplanin,linezolid,daptomycin,and trimethoprim/sulfamethoxazole.Prevalence of PVL in community-associated methicillin sensitive Staphylococcus aureus(CA-MSSA) and CA-MRSA were 41.9％ and 2/5.Other toxins expressed similarly between them.Combined with multilocus sequence typing (MLST) and spa typing,the major clones of CA-MSSA were ST398-t034,ST7-t796,ST398-t571,ST1t127,and ST188-t189,while in CA-MRSA were ST239-t037-SCCmec Ⅰ,ST239-t632-SCCmecⅢ,ST59-t437-SCCmecV,ST8-t008-SCCmecⅣ,and ST6-t701-NT.ConclusionsThe low prevalence of CA-MRSA in Beijing and complexity of the genetic background in CA-MRSA were observed.Clone spread is not found among CA-MRSAisolates.CA-MRSAexhibithigher resistancecomparedwithmethicillinsensitive Staphylococcus aureus (MSSA).Rational drug use scheme is called in the clinical practice to prevent development of high level resistance.