Objective:To analyze the application of antitoxin therapy in severe infant botulism.Methods:A retrospective analysis was conducted on 14 cases of severe infant botulism treated at 3 pediatric medical centers from July 2020 to August 2024. This study investigated antitoxin dosage, treatment duration, discontinuation criteria and adverse reactions.Results:A total of 14 cases (12 males and 2 females) were included, with an age of 5.0 (3.8, 7.0) months. Botulinum toxin typing revealed 10 cases of Type B, 2 cases of Type A and 2 untyped cases. The interval from symptom onset to antitoxin administration was 9.0 (6.0, 11.5) d. The initial dosage of type A antitoxin was 12 500 (10 000, 22 500) U, while type B was 5 000 (5 000, 5 000) U. The dosage was tapered in some cases after symptom improvement, the duration of treatment was 16.5 (9.8, 25.3) d. In total, 11 infants discontinued medications after improvement in muscle strength, while 3 infants discontinued treatment after obtaining negative results from fecal mouse bioassays. Adverse events were reported in 2 cases, both of which resulted in rash, and 1 case was complicated with anaphylactic shock. All the patients survived upon discharge with a follow-up period of 11 d to 3 years and 8 months. Totally 12 infants had fully recovered, while 2 infants were still recovering after discharge.Conclusion:Antitoxin therapy is a feasible and safe approach which showed favorable prognosis in severe infant botulism.

Objective To explore the real experiences of nutrition impact symptoms in esophageal cancer patients during diagnosis and treatment,and to provide references for developing nutritional management strategies.Methods Using purposive sampling,15 esophageal cancer patients admitted to the thoracic surgery department of a tertiary grade A hospital in Guangzhou from October to December 2024 were selected for semi-structured interviews.Thematic analysis was used for data analysis.Results 4 themes and 12 sub-themes were identified:①Multiple symptom perceptions:esophageal obstruction-dysphagia,appetite-affecting symptoms,multiple symptom over-lap,and individual differences in symptom perception.② Insufficient symptom cognition:overestimation of symptom controllability and biased symptom attribution.③ Negative emotional reactions:anxiety and fear about eating,frustration with declining eating function,and helplessness and guilt about losing control over eating.④ Di-verse symptom coping strategies:avoidance coping,adaptive coping,and active nutritional management.Conclusion The nutrition impact symptom experiences of esophageal cancer patients are complex and diverse.Healthcare professionals should promptly identify and assess nutrition impact symptoms,provide nutrition health education,strengthen psychological guidance,and develop culturally distinctive individualized nutritional management strategies.

Objective To observe the effects of Bushen Antai Mixture on vascular recasting at the maternal-fetal interface in mice with recurrent spontaneous abortion(RSA)based on AMPK/ULK1/Beclin1 pathway.Methods CBA/J female mice and BALB/c male mice were caged at a ratio of 2:1 to establish normal pregnant mice(normal group),and CBA/J female mice and DBA/2 male mice were caged to establish RSA model.The RSA mice were randomly divided into model group,autophagy agonist group and TCM high-,medium-and low-dosage groups,with 10 mice in each group.From the first day of pregnancy,TCM high-,medium-and low-dosage groups were given Bushen Antai Mixture 35.1,11.7 and 3.9 g/kg by gavage respectively,and the normal group,model group and autophagy agonist group were given the same amount of normal saline by gavage for 15 days.The embryo development was observed and the embryo loss rate was calculated,the morphology of decidual tissue was observed by HE staining;the contents of vascular endothelial growth factor(VEGF)and vascular endothelial cadherin(VE-cadherin)in decidual tissue were detected by ELISA;the expressions of autophagy related proteins adenosine monophosphate-activated protein kinase(AMPK),UNC-51 like kinase 1(ULK1),Beclin1 and LC3B in decidual tissue were detected by Western blot.Results Compared with the normal group,the embryo loss rate of mice in the model group significant increased(P<0.01),the cells of the decidual tissue were disordered,the interstitium was edematous,the nuclei disappeared,there were a large number of inflammatory cells infiltration,the number of blood vessels was reduced,the contents of VEGF and VE-cadherin in decidual tissue significantly decreased(P<0.01),and the protein expressions of AMPK,ULK1,Beclin1,LC3BⅡ/LC3BⅠ significantly decreased(P<0.01).Compared with the model group,the embryo loss rate of mice in TCM high-,medium-and low-dosage groups and autophagy agonist group showed a significant downward trend(P<0.05),and the cells of decidual tissue were aligned,the interstitium edema was reduced,the nuclei of the cells increased,the inflammatory cells infiltration were reduced and the number of blood vessels increased,the contents of VEGF and VE-cadherin in decidual tissue significantly increased in TCM high-,medium-dosage groups and autophagy agonist group(P<0.05),and the protein expressions of AMPK,ULK1,Beclin1 and LC3BⅡ/LC3BⅠ significantly increased(P<0.01).Conclusion Bushen Antai Mixture may promote the recasting of blood vessels at the maternal-fetal interface by activating AMPK/ULK1/Beclin1 pathway,improve the pregnancy survival rate of RSA mice,and play a role in the treatment of RSA.

Severe pneumonia is one of the most common and critical respiratory diseases in clinical practice. It is characterized by rapid progression， difficult treatment， high mortality， and many complications， posing a significant threat to the life and health of patients. The pathogenesis of severe pneumonia is highly complex， and studies have shown that its occurrence and development are closely related to multiple signaling pathways. Currently， the treatment of severe pneumonia mainly focuses on anti-infection， mechanical ventilation， and glucocorticoids， but clinical outcomes are often not ideal. Therefore， finding safe and effective alternative therapies is particularly important. In recent years， with the deepening of research into traditional Chinese medicine （TCM）， it has gained widespread attention in the treatment of severe pneumonia. This paper reviewed the relationship between severe pneumonia and relevant signaling pathways in recent years and how TCM regulated these pathways in the treatment of severe pneumonia. It was found that TCM could regulate the Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor-κB （NF-κB）， Janus kinase （JAK）/signal transducer and activator of transcription （STAT）， phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR）， NOD-like receptor protein 3 （NLRP3）， and nuclear factor E₂-related factor 2 （Nrf2） signaling pathways， playing a role in reducing the inflammatory response， inhibiting cell apoptosis and pyroptosis， improving oxidative stress， and other effects in the treatment of severe pneumonia. Among these pathways， it was found that all of them regulated inflammation to treat severe pneumonia. Therefore， reducing inflammation is the core mechanism by which Chinese medicine treats severe pneumonia. This review provides direction for the clinical treatment of severe pneumonia and offers a scientific basis for the research and development of new drugs.

Objective To explore the real experiences of nutrition impact symptoms in esophageal cancer patients during diagnosis and treatment,and to provide references for developing nutritional management strategies.Methods Using purposive sampling,15 esophageal cancer patients admitted to the thoracic surgery department of a tertiary grade A hospital in Guangzhou from October to December 2024 were selected for semi-structured interviews.Thematic analysis was used for data analysis.Results 4 themes and 12 sub-themes were identified:①Multiple symptom perceptions:esophageal obstruction-dysphagia,appetite-affecting symptoms,multiple symptom over-lap,and individual differences in symptom perception.② Insufficient symptom cognition:overestimation of symptom controllability and biased symptom attribution.③ Negative emotional reactions:anxiety and fear about eating,frustration with declining eating function,and helplessness and guilt about losing control over eating.④ Di-verse symptom coping strategies:avoidance coping,adaptive coping,and active nutritional management.Conclusion The nutrition impact symptom experiences of esophageal cancer patients are complex and diverse.Healthcare professionals should promptly identify and assess nutrition impact symptoms,provide nutrition health education,strengthen psychological guidance,and develop culturally distinctive individualized nutritional management strategies.

Objective To observe the effects of Bushen Antai Mixture on vascular recasting at the maternal-fetal interface in mice with recurrent spontaneous abortion(RSA)based on AMPK/ULK1/Beclin1 pathway.Methods CBA/J female mice and BALB/c male mice were caged at a ratio of 2:1 to establish normal pregnant mice(normal group),and CBA/J female mice and DBA/2 male mice were caged to establish RSA model.The RSA mice were randomly divided into model group,autophagy agonist group and TCM high-,medium-and low-dosage groups,with 10 mice in each group.From the first day of pregnancy,TCM high-,medium-and low-dosage groups were given Bushen Antai Mixture 35.1,11.7 and 3.9 g/kg by gavage respectively,and the normal group,model group and autophagy agonist group were given the same amount of normal saline by gavage for 15 days.The embryo development was observed and the embryo loss rate was calculated,the morphology of decidual tissue was observed by HE staining;the contents of vascular endothelial growth factor(VEGF)and vascular endothelial cadherin(VE-cadherin)in decidual tissue were detected by ELISA;the expressions of autophagy related proteins adenosine monophosphate-activated protein kinase(AMPK),UNC-51 like kinase 1(ULK1),Beclin1 and LC3B in decidual tissue were detected by Western blot.Results Compared with the normal group,the embryo loss rate of mice in the model group significant increased(P<0.01),the cells of the decidual tissue were disordered,the interstitium was edematous,the nuclei disappeared,there were a large number of inflammatory cells infiltration,the number of blood vessels was reduced,the contents of VEGF and VE-cadherin in decidual tissue significantly decreased(P<0.01),and the protein expressions of AMPK,ULK1,Beclin1,LC3BⅡ/LC3BⅠ significantly decreased(P<0.01).Compared with the model group,the embryo loss rate of mice in TCM high-,medium-and low-dosage groups and autophagy agonist group showed a significant downward trend(P<0.05),and the cells of decidual tissue were aligned,the interstitium edema was reduced,the nuclei of the cells increased,the inflammatory cells infiltration were reduced and the number of blood vessels increased,the contents of VEGF and VE-cadherin in decidual tissue significantly increased in TCM high-,medium-dosage groups and autophagy agonist group(P<0.05),and the protein expressions of AMPK,ULK1,Beclin1 and LC3BⅡ/LC3BⅠ significantly increased(P<0.01).Conclusion Bushen Antai Mixture may promote the recasting of blood vessels at the maternal-fetal interface by activating AMPK/ULK1/Beclin1 pathway,improve the pregnancy survival rate of RSA mice,and play a role in the treatment of RSA.

Objective:To analyze the application of antitoxin therapy in severe infant botulism.Methods:A retrospective analysis was conducted on 14 cases of severe infant botulism treated at 3 pediatric medical centers from July 2020 to August 2024. This study investigated antitoxin dosage, treatment duration, discontinuation criteria and adverse reactions.Results:A total of 14 cases (12 males and 2 females) were included, with an age of 5.0 (3.8, 7.0) months. Botulinum toxin typing revealed 10 cases of Type B, 2 cases of Type A and 2 untyped cases. The interval from symptom onset to antitoxin administration was 9.0 (6.0, 11.5) d. The initial dosage of type A antitoxin was 12 500 (10 000, 22 500) U, while type B was 5 000 (5 000, 5 000) U. The dosage was tapered in some cases after symptom improvement, the duration of treatment was 16.5 (9.8, 25.3) d. In total, 11 infants discontinued medications after improvement in muscle strength, while 3 infants discontinued treatment after obtaining negative results from fecal mouse bioassays. Adverse events were reported in 2 cases, both of which resulted in rash, and 1 case was complicated with anaphylactic shock. All the patients survived upon discharge with a follow-up period of 11 d to 3 years and 8 months. Totally 12 infants had fully recovered, while 2 infants were still recovering after discharge.Conclusion:Antitoxin therapy is a feasible and safe approach which showed favorable prognosis in severe infant botulism.

Objective To identify and analyze the digital supervision issues of cross-province medical treatment in China,and propose countermeasures and suggestions.Methods Using literature research,expert interviews,and questionnaire surveys,from January 29,to February 132023,managers,staff from remote departments of medi-cal insurance bureau and scholar in the field of medical insurance in H province were selected.Principa l component analysis was used to extract questions,and based on the extraction results,a multiple logistic regression model to explore that have a significant impact on the digital supervision of cross-province direct settlement of medical treat-ment.Results The problems of digital supervision of direct settlement for medical treatment across provinces and re-gions in China can be divided into 7 categories,with a cumulative variance contribution rate of 63.17%.The connec-tion of digital regulatory systems,audit rules and early warning issues,as well as the lack of legal systems and defi-nitions have a significant impact on regulatory effectiveness(P＜0.05).Conclusion Incomplete construction of the digital supervision system between the place of insurance participation,and inadequate legal and institutional sateguards for the digital supervision of the direct settlement of cross-provincial cross-district medical consultations.Therefore,strengthening the basic construction of the digital supervision system for cross provincial and cross regional medical direct settlement,and improving the legal system for cross provincial and cross regional medical direct settle-ment digital supervision,have important guiding significance for the digital supervision of cross provincial and cross regional medical direct settlement in China.

Objective:To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes.Methods:The clinical data of children with septic shock in children′s PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results:A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs ( OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions:The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.

Objective:To investigate the clinical features, pathogen composition, and prognosis of septic shock in pediatric intensive care units (PICU) in China.Methods:A multicenter retrospective cohort study. A retrospective analysis was conducted on the clinical data of children with septic shock from 10 hospitals in China between January 2018 and December 2021. The clinical features, pathogen composition, and outcomes were collected. Patients were categorized into malignant tumor and non-malignant tumor groups, as well as survival and mortality groups. T test, Mann Whitney U test or Chi square test were used respectively for comparing clinical characteristics and prognosis between 2 groups. Multiple Logistic regression was used to identify risk factors for mortality. Results:A total of 1 247 children with septic shock were included, with 748 males (59.9%) and the age of 3.1 (0.9, 8.8) years. The in-patient mortality rate was 23.2% (289 cases). The overall pathogen positive rate was 68.2% (851 cases), with 1 229 pathogens identified. Bacterial accounted for 61.4% (754 strains) and virus for 24.8% (305 strains). Among all bacterium, Gram negative bacteria constituted 64.2% (484 strains), with Pseudomonas aeruginosa and Enterobacter being the most common; Gram positive bacteria comprised 35.8% (270 strains), primarily Streptococcus and Staphylococcus species. Influenza virus (86 strains (28.2%)), Epstein-Barr virus (53 strains (17.4%)), and respiratory syncytial virus (46 strains (17.1%)) were the top three viruses. Children with malignant tumors were older and had higher pediatric risk of mortality (PRISM) Ⅲ score, paediatric sequential organ failure assessment (pSOFA) score (7.9 (4.3, 11.8) vs. 2.3 (0.8, 7.5) years old, 22 (16, 26) vs. 16 (10, 24) points, 10 (5, 14) vs. 8 (4, 12) points, Z=11.32, 0.87, 4.00, all P<0.05), and higher pathogen positive rate, and in-hospital mortality (77.7% (240/309) vs. 65.1% (611/938), 29.7% (92/309) vs. 21.0% (197/938), χ2=16.84, 10.04, both P<0.05) compared to the non-tumor group. In the death group, the score of PRISM Ⅲ, pSOFA (16 (22, 29) vs. 14 (10, 20) points, 8 (12, 15) vs. 6 (3, 9) points, Z=4.92, 11.88, both P<0.05) were all higher, and presence of neoplastic disease, positive rate of pathogen and proportion of invasive mechanical ventilation in death group were also all higher than those in survival group (29.7% (87/289) vs. 23.2% (222/958), 77.8% (225/289) vs. 65.4% (626/958), 73.7% (213/289) vs. 50.6% (485/958), χ2=5.72, 16.03, 49.98, all P<0.05). Multiple Logistic regression showed that PRISM Ⅲ, pSOFA, and malignant tumor were the independent risk factors for mortality ( OR=1.04, 1.09, 0.67, 95% CI 1.01-1.05, 1.04-1.12, 0.47-0.94, all P<0.05). Conclusions:Bacterial infection are predominant in pediatric septic shock, but viral infection are also significant. Children with malignancies are more severe and resource consumptive. The overall mortality rate for pediatric septic shock remains high, and mortality are associated with malignant tumor, PRISM Ⅲ and pSOFA scores.