Objective:To analyze the influencing factors of hospitalization costs in patients with ischemic stroke,design a diagnosis related groups(DRG)subgrouping scheme,providing references for refined DRG subgrouping.Methods:Ischemic stroke patients discharged from a tertiary comprehensive hospital in Bengbu,Anhui Province from Jan 2021 to Dec 2023 were included.Through the rank-sum test and multiple linear regression analysis,the main factors influencing the hospitalization cost were analyzed.The E-CHAID algorithm was applied to construct a DRG subgrouping scheme,and the variance reduction and coefficient of variation were used to validate subgroup rationality.Results:The length of hospital stay,presence of surgical procedures,severity,and admission route were included in the decision tree model,generating 12 DRG subgroups.Both variance reduction and coefficient of variation confirmed high subgroup validity.Conclusion:The E-CHAID-based DRG subgrouping scheme for ischemic stroke inpatients is scientific and reasonable,supporting future adjustments in treatment-related grouping,hierarchical medical practices,and the fine hospital management.

Objective:To analyze the influencing factors of hospitalization costs in patients with ischemic stroke,design a diagnosis related groups(DRG)subgrouping scheme,providing references for refined DRG subgrouping.Methods:Ischemic stroke patients discharged from a tertiary comprehensive hospital in Bengbu,Anhui Province from Jan 2021 to Dec 2023 were included.Through the rank-sum test and multiple linear regression analysis,the main factors influencing the hospitalization cost were analyzed.The E-CHAID algorithm was applied to construct a DRG subgrouping scheme,and the variance reduction and coefficient of variation were used to validate subgroup rationality.Results:The length of hospital stay,presence of surgical procedures,severity,and admission route were included in the decision tree model,generating 12 DRG subgroups.Both variance reduction and coefficient of variation confirmed high subgroup validity.Conclusion:The E-CHAID-based DRG subgrouping scheme for ischemic stroke inpatients is scientific and reasonable,supporting future adjustments in treatment-related grouping,hierarchical medical practices,and the fine hospital management.

Objective:To understand the management of children with pediatric acute liver failure (PALF) in pediatric intensive care unit (PICU).Methods:A retrospective case-control study was conducted. A total of 101 children with PALF hospitalized in PICU of Beijing Children′s Hospital from July 2017 to October 2022 were included. Demographic, clinical management and prognosis data were collected. According to whether PALF was the main diagnosis, the patients were divided into primary diagnosis group and complication group. The primary diagnosis group was subdivided into effective group and ineffective group with routine treatment (except liver transplantation). The intergroup comparisons were performed using independent samples t-test, Mann-Whitney U test, χ2 test or Fisher exact test. Multivariate Logistic regression analysis was employed to identify risk factors associated with prognosis. Results:Among the 101 children with PALF, 58 were male and 43 were female, with an age of 30 (10, 103) months, 60 cases in primary diagnosis group and 41 cases in complication group. There were no significant differences in prothrombin time (PT) and international normalized ratio (INR) between the two groups (both P>0.05), while the total bilirubin, direct bilirubin and blood ammonia were all significantly higher in the primary diagnosis group (all P<0.05). Unoriginal liver failure (25 cases (42%)) and poisoning (13 cases (22%)) were the most common causes of PALF in the primary diagnosis group, while shock (17 cases, 43%) and hemophagocytic syndrome (14 cases (34%)) in the complication group. The mortality rate of the main diagnosis group was significantly lower than that of the complication group (25% (15/60) vs. 61% (25/41), χ2=13.18, P<0.001), as well as the incidence of combined organ function injury, while the amount of plasma used and the ratio of plasma exchange times to PICU hospitalization days were significantly higher (all P<0.05). In the primary diagnosis group, there were 32 cases (53%) in the effective group and 28 cases (47%) in the ineffective group. In the ineffective group, 15 cases (54%) died and 13 cases (46%) were transferred to another site for liver transplantation assessment. The hospitalization time of PICU in the effective group was significantly longer than that in the ineffective group, while the ratio of plasma exchange times to PICU hospitalization days, the average daily hours of continuous renal replacement therapy (CRRT), the rate of CRRT and the average daily plasma dosage in the effective group were all significantly lower than those in the ineffective group (all P<0.05). The worst PT, INR and blood ammonia, and the stage 4 hepatic encephalopathy morbidity and significant bleeding rate in the effective group were all significantly lower than those in the ineffective group (all P<0.05). Multivariate Logistic regression analysis showed that after adjusting for age, sex, total bilirubin, INR and blood ammonia, stage 4 hepatic encephalopathy was the independent risk factor for the failure of routine treatment of PALF ( OR=84.16,95% CI 4.04-1752.37, P=0.004). Conclusions:PT and INR could not specifically represent liver synthetic function in some PICU patients, so current PALF diagnostic criteria for PICU children has limitations. Complicated with stage 4 hepatic encephalopathy was an independent risk factor of the failure of conventional treatment in patients with PALF.

Objective:To understand the management of children with pediatric acute liver failure (PALF) in pediatric intensive care unit (PICU).Methods:A retrospective case-control study was conducted. A total of 101 children with PALF hospitalized in PICU of Beijing Children′s Hospital from July 2017 to October 2022 were included. Demographic, clinical management and prognosis data were collected. According to whether PALF was the main diagnosis, the patients were divided into primary diagnosis group and complication group. The primary diagnosis group was subdivided into effective group and ineffective group with routine treatment (except liver transplantation). The intergroup comparisons were performed using independent samples t-test, Mann-Whitney U test, χ2 test or Fisher exact test. Multivariate Logistic regression analysis was employed to identify risk factors associated with prognosis. Results:Among the 101 children with PALF, 58 were male and 43 were female, with an age of 30 (10, 103) months, 60 cases in primary diagnosis group and 41 cases in complication group. There were no significant differences in prothrombin time (PT) and international normalized ratio (INR) between the two groups (both P>0.05), while the total bilirubin, direct bilirubin and blood ammonia were all significantly higher in the primary diagnosis group (all P<0.05). Unoriginal liver failure (25 cases (42%)) and poisoning (13 cases (22%)) were the most common causes of PALF in the primary diagnosis group, while shock (17 cases, 43%) and hemophagocytic syndrome (14 cases (34%)) in the complication group. The mortality rate of the main diagnosis group was significantly lower than that of the complication group (25% (15/60) vs. 61% (25/41), χ2=13.18, P<0.001), as well as the incidence of combined organ function injury, while the amount of plasma used and the ratio of plasma exchange times to PICU hospitalization days were significantly higher (all P<0.05). In the primary diagnosis group, there were 32 cases (53%) in the effective group and 28 cases (47%) in the ineffective group. In the ineffective group, 15 cases (54%) died and 13 cases (46%) were transferred to another site for liver transplantation assessment. The hospitalization time of PICU in the effective group was significantly longer than that in the ineffective group, while the ratio of plasma exchange times to PICU hospitalization days, the average daily hours of continuous renal replacement therapy (CRRT), the rate of CRRT and the average daily plasma dosage in the effective group were all significantly lower than those in the ineffective group (all P<0.05). The worst PT, INR and blood ammonia, and the stage 4 hepatic encephalopathy morbidity and significant bleeding rate in the effective group were all significantly lower than those in the ineffective group (all P<0.05). Multivariate Logistic regression analysis showed that after adjusting for age, sex, total bilirubin, INR and blood ammonia, stage 4 hepatic encephalopathy was the independent risk factor for the failure of routine treatment of PALF ( OR=84.16,95% CI 4.04-1752.37, P=0.004). Conclusions:PT and INR could not specifically represent liver synthetic function in some PICU patients, so current PALF diagnostic criteria for PICU children has limitations. Complicated with stage 4 hepatic encephalopathy was an independent risk factor of the failure of conventional treatment in patients with PALF.

Objective:To observe any effect of endoscopic evaluation of swallowing (FEES) on the functional outcomes of post-stroke patients in the subacute phase.Methods:A retrospective case-control study was conducted of 52 patients who had received an FEES assessment (the FEES group) and 51 who had not (the control group). Both groups received swallowing rehabilitation and intake training based on the results of the FEES assessment and those of a modified volume-viscosity swallowing test. The primary outcome indicator was the incidence of pneumonia. Secondary outcome indicators were the rate of removal of the nasal feeding tube, the length of indwelling of the nasal feeding tube, functional oral intake assessment scale (FOIS) scores, eating technique at discharge, and the length of hospital stay.Results:Compared with the control group, the incidence of pneumonia in the FEES group was significantly lower (7.7% vs. 39.2%). The removal rate of the nasal feeding tube was significantly greater (75.0% vs. 41.0%). The FEES group showed a significant improvement in its average FOIS score. And the proportion of patients who could try partial oral eating or complete oral eating at discharge was significantly higher in the FEES group. Regression analysis indicated that the risk of pneumonia in the FEES group was positively related to the time from onset to the first FEES examination.Conclusion:Early FEES examination after a stroke could reduce the incidence of pneumonia, increase chances of removing the nasal feeding tube and improve the swallowing function and outcome of stroke survivors.

Objective To investigate the clinical and genetic features of congenital myasthenia syndrome with episodic apnea (CMS-EA) caused by gene mutation of choline acetyltransferase (CHAT)Methods The clinical data of 2 patients with congenital myasthenia syndrome were collected,and both were diagnosed from 2013 to 2015 in Beijing Children's Hospital,Capital Medical University.The clinical features and gene mutation characteristics were analyzed,and the patients were followed-up for therapeutic efficacy.Results The two patients (case 1 and case 2) had the onset soon after birth and at 3 months after birth respectively.The two patients were admitted to the PICU due to dyspnea,cyanotic episodes that required intubation.The patients had repeated apnea and became ventilator dependent.Case 1 died due to refusal of any treatment.Case 2 had a tracheotomy,and gradually weaned from ventilator after using pyridostigmine.The hospitalization of case 2 lasted 162 days.Case 2 was followed up to the age of 3 years and 4 months,and was extubated and was maintained on oral neostigmine but still had fluctuating ptosis and minor physical and mental retardation.Both cases were negative for anti-AChR,anti-acetylcholinesterase,anti-MuSK antibodies.Neostigmine test was negative in case 1 and suspiciously positive in case 2.Low-frequency repetitive nerve stimulation testing of case 2 was negative.Cranial MRI scans of both cases showed brain atrophy-like change.Genetic testing showed compound heterozygous deletions (exon 4,5,6) and pathogenic variant c.914T＞C (p.I305T) in CHAT in case 1,compound heterozygous variants c.1007T＞C (p.I336T) and c.64C＞T (p.Q22X) in CHAT in case 2.To our knowledge,compound heterozygous deletions (exon 4,5,6) and p.Q22X were novel,previously unreported variants.Conclusion CMS-EA usually presents at birth or in the neonatal period with hypotonia,ptosis,dysphagia due to severe bulbar weakness,and respiratory insufficiency with cyanosis and apnea.Early treatment with pyridostigmine is helpful to the improvement of clinical symptoms and prognosis.

Objective To analyze the interruptions of enteral nutrition (EN) and it's relationship to prognosis in children with sepsis in pediatric intensive care unit (PICU).Method Daily EN intake and reasons for EN interruptions were prospectively observed and recorded in children with sepsis who were admitted to our PICU from November 2012 to April 2013.Clinical prognosis was compared between children with and without EN interruptions by t,rank-sum and x2 tests.Result Totally 60 consecutive children were included,42 males,median age 9.67 (5.36,37.0) months;50 children suffered from EN interruptions,while 10 children did not.Median time to EN initiation was 2.59 (1.53,3.67) h;EN was interrupted in 83％ (50/60) of children,for a total of 108 times and 696 h,the most common reasons were fibrobronchoscopy and radiologic procedures,27 and 29 times respectively.Children spent 0.04 (0.02,0.08) of their total observation period without EN nutrition due to EN interruptions,and was not correlated with pediatric critically ill score (r =0.12,P =0.38).Children with EN interruptions suffered from longer PICU duration ((12 ± 7) vs.(7 ± 4) d,t =2.18,P =0.03),but there was no significant difference in the 28th hospital day's mortality between these two groups (6 cases vs.1 case,x2 =0.00,P =1.00).Conclusion EN is frequently interrupted due to procedures needed fasting,EN intolerance and other reasons in children with sepsis.EN interruptions may have something to do with prolonged PICU length of stay,but the relationship needs to be examined in future studies.

Multi-target drugs attract increasing attentions for the therapy of complicated neurodegenerative diseases. In this study, a computer-assisted strategy was applied to search for multi-target compounds by the pharmacophore matching. This strategy has been successfully used to design dual-target inhibitor models against both the acetylcholinesterase (AChE) and poly (ADP-ribose) polymerase-1 (PARP-1). Based on two pharmacophore models matching and physicochemical properties filtering, one hit was identified which could inhibit AChE with IC50 value of (0.337 +/- 0.052) micromol x L(-1) and PARP-1 by 24.6% at 1 micromol x L(-1).

Parthenogenetic embryonic stem (pES) cells isolated from parthenogenetic activation of oocytes and embryos, also called parthenogenetically induced pluripotent stem cells, exhibit pluripotency evidenced by both in vitro and in vivo differentiation potential. Differential proteomic analysis was performed using differential in-gel electrophoresis and isotope-coded affinity tag-based quantitative proteomics to investigate the molecular mechanisms underlying the developmental pluripotency of pES cells and to compare the protein expression of pES cells generated from either the in vivo-matured ovulated (IVO) oocytes or from the in vitro-matured (IVM) oocytes with that of fertilized embryonic stem (fES) cells derived from fertilized embryos. A total of 76 proteins were upregulated and 16 proteins were downregulated in the IVM pES cells, whereas 91 proteins were upregulated and 9 were downregulated in the IVO pES cells based on a minimal 1.5-fold change as the cutoff value. No distinct pathways were found in the differentially expressed proteins except for those involved in metabolism and physiological processes. Notably, no differences were found in the protein expression of imprinted genes between the pES and fES cells, suggesting that genomic imprinting can be corrected in the pES cells at least at the early passages. The germline competent IVM pES cells may be applicable for germ cell renewal in aging ovaries if oocytes are retrieved at a younger age.
Animals ; Cell Line ; Electrophoresis, Gel, Two-Dimensional ; Mice ; Parthenogenesis ; physiology ; Pluripotent Stem Cells ; metabolism ; Proteomics ; methods