Objective To summarize the clinical characteristics of children with drug-induced hypersensitivity syndrome(DIHS)complicated with herpesvirus reactivation,and to promote the early and accurate identification,diagnosis,and treatment of DIHS in children.Methods The medication history,clinical manifestations,treatment,and prognosis of 12 children confirmed DIHS complicated with herpesvirus reactivation in Guangzhou Women and Children's Medical Center between January 2018 and March 2023 were retrospectively analyzed.The changes in hematological parameters,inflammatory indexes,and hepatic and renal function within 5 d before the eruption,5 d,and 6-10 d after eruption were compared.Results Of the 12 patients,the male-to-female ratio was 5∶1,with a median age of 27(interquartile range 20.50-34.75)months.Two or more antibiotics were used at least two to six weeks before onset,with a combination of 3 or more antibiotics in 7 children,and a combined or sequential application of 2 antibiotics in 5 children.The antibiotics included cephalosporins(n=12),semisynthetic penicillins(n=5),vancomycin(n=4)and azithromycins(n=7).All 12 patients presented fever,rashes,and multiple organ involvement.The rashes were red maculopapules in the early stage and then gradually developed into massive fusion exceeding 50%of the whole body.Among them,seven children were accompanied by facial edema,and two had purplish-red facial rashes.11 children suffered from exfoliative dermatitis in the later stage.12 children presented obviously enlarged lymph nodes.Liver involvement was the most common(100%,simple increase of transaminase in four children,cholestasis in six children,and hepatic failure in two children),and lung involvement was found in nine children.Laboratory examination showed no significant increase in leukocytes or eosinophils within 5 d before the eruption,but low levels of atypical lymphocytes.After the eruption,leukocytes,eosinophils,and atypical lymphocytes increased progressively.Inflammatory indexes of hypersensitive C-reactive protein(CRP),procalcitonin(PCT)increased dramatically before and after the eruption.All the children received intravenous immunoglobulin(IVIG)and methylprednisolone,two children were given antiviral therapy,and nine children were treated with multiple plasma exchanges.After treatment,nine children were cured,one developed immune reconstitution syndrome,and two died of hepatic failure.Conclusions Antibiotics are common allergenic drugs for DIHS in children.Its clinical manifestations include fever and rashes,accompanied by multiple organ involvement,such as the liver and lung.When leukocytes,eosinophils,and atypical lymphocytes are progressively elevated after the eruption,DIHS should be highly suspected,herpesvirus activation should be monitored,medication history should be traced,and early active immunotherapy and antiviral therapy should be conducted if necessary.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the correlation between subjective hearing impairment and cognitive function in the elderly in the community of Changzhou City.Methods:This study was a retrospective cohort study. A total of 1 132 elderly people recruited from 4 communities in Changzhou City from August to October in 2023 were selected as the research objects. The social demographic and cognitive function were collected, cognitive function was assessed using the mini-mental state examination (MMSE), while the connected test, replica cube, and clock draw in the Montreal cognitive assessment (MoCA) were selected to assess visuospatial and executive function. The subjects were divided into the no-hearing impairment group (726 subjects) and hearing impairment group (406 subjects) according to the self-reported hearing impairment of the elderly. The basic data of the two groups and the differences in different cognitive domains were analyzed, and the correlation between subjective hearing impairment and cognitive function of the elderly in the community was analyzed by univariate and multivariate logistic regression analysis.Results:The incidence of cognitive impairment in the hearing impairment group was significantly higher than that in the no-hearing impairment group (20.2% vs 6.6%), the scores of location orientation, memory, attention and calculation, recall, language ability, clock draw, and the total score of MMSE, visuospatial and executive function in the hearing impairment group were all significantly lower than those in the normal hearing group [(4.76±0.78) vs (4.91±0.45) points, (2.79±0.59) vs (2.90±0.36) points, 4 (3, 5) vs 5 (4, 5) points, 2 (1, 3) vs 2 (2, 3) points, 8 (7, 9) vs 9 (8, 9) points, 2 (2, 3) vs 3 (2, 3) points, 27 (24, 29) vs 27 (26, 29) points, 3 (2, 3) vs 3 (2, 4) points] (all P<0.05). There was a positive correlation between subjective hearing impairment and cognitive function impairment in community-dwelling elderly ( OR=3.544, 95% CI: 2.410-5.213) ( P<0.001). Conclusion:The incidence of cognitive impairment is higher in the community-dwelling elderly with subjective hearing impairment, and hearing impairment is a positive correlation factor of cognitive impairment.

Humans ; COVID-19 ; Consensus ; SARS-CoV-2 ; China

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective:To evaluate the application of SBAR mode handover card in transferring patients with mechanical ventilation for hyperbaric oxygen therapy.Methods:A total of 200 patients with mechanical ventilation, who were admitted to Zhejiang Mingzhou Rehabilitation Hospital and needed hyperbaric oxygen therapy from March 2019 to March 2020, were randomized into observation group and control group with 100 subjects in each group. When transferring the patients from ward to hyperbaric oxygen therapy center, the observation group used our self-designed SBAR mode handover card, while the control group used the conventional handover card. The incidence of nursing adverse events, some medical record missing during handover, nurses’ satisfaction rate on the transferring, and average transferring time were compared between the two groups.Results:There were 8 nursing adverse events and 2 cases of some medical record missing during handover in the observation group, which were less than the 21 events and the 11 cases in the control group. The nurses’ satisfaction rate was 96.0% in the observation group, which was significantly higher than that (83.0%) in the control group, with a statistically significance difference ( P<0.05). The average handover time of the observation group [(9.95±1.23) min] was shorter than that of the control group [(22.46±1.38) min], with a statistically significance difference ( P<0.05). Conclusion:SBAR mode handover card can standardize the handover of patients with mechanical ventilation for transferring to hyperbaric oxygen therapy, effectively reduce the occurrence of nursing adverse event and some medical record missing during handover, improve the handover efficiency, and the satisfaction rate of the nurses, so as to ensure the safety of transferring the patients in critical condition.

Objective:To evaluate the application of SBAR mode handover card in transferring patients with mechanical ventilation for hyperbaric oxygen therapy.Methods:A total of 200 patients with mechanical ventilation, who were admitted to Zhejiang Mingzhou Rehabilitation Hospital and needed hyperbaric oxygen therapy from March 2019 to March 2020, were randomized into observation group and control group with 100 subjects in each group. When transferring the patients from ward to hyperbaric oxygen therapy center, the observation group used our self-designed SBAR mode handover card, while the control group used the conventional handover card. The incidence of nursing adverse events, some medical record missing during handover, nurses’ satisfaction rate on the transferring, and average transferring time were compared between the two groups.Results:There were 8 nursing adverse events and 2 cases of some medical record missing during handover in the observation group, which were less than the 21 events and the 11 cases in the control group. The nurses’ satisfaction rate was 96.0% in the observation group, which was significantly higher than that (83.0%) in the control group, with a statistically significance difference ( P<0.05). The average handover time of the observation group [(9.95±1.23) min] was shorter than that of the control group [(22.46±1.38) min], with a statistically significance difference ( P<0.05). Conclusion:SBAR mode handover card can standardize the handover of patients with mechanical ventilation for transferring to hyperbaric oxygen therapy, effectively reduce the occurrence of nursing adverse event and some medical record missing during handover, improve the handover efficiency, and the satisfaction rate of the nurses, so as to ensure the safety of transferring the patients in critical condition.

Objective: To explore the association between plasma leptin (LEP) levels, soluble leptin receptor(SLR), free leptin index and breast cancer. Methods: 245 new female cases of primary breast cancer confirmed by histopathology examination were sequentially recruited into the study. A total of 245 age-matched healthy women were enrolled as controls during the same period. A standardized questionnaire was used to collect the demographic information of the subjects. Blood samples were collected and the levels of LEP and SLR in plasma were measured by enzyme linked immunosorbent assay. The differences of LEP, SLR and FLI expression between control and cases group, as well as different breast cancer subtypes and TNM stages were compared using t-test and ANOVA after stratification by menopause status. Multivariate logistic regression was used to explore the contributions of the three indexes to the risk of breast cancer. Results: Females in both cases and control group were (50.7 ± 9.4) years old. The level of SLR and FLI (P₅₀(P₂₅,P₇₅)) in premenopausal women were 18.4 (11.2, 28.7), 0.5 (0.4, 0.6) μg/L in case group and 27.7 (19.2, 43.4), 0.3 (0.3, 0.4) μg/L in control group (P<0.001). While the level of postmenopausal women in case group were 20.3 (12.8, 31.8), 0.5 (0.4, 0.6) μ g/L (P<0.001), and 30.1 (18.8, 40.5), 0.3 (0.3, 0.5) μg/L in control group (P<0.001), respectively. After adjustment for confounding factors and BMI, the relationship between FLI and breast cancer remained significant for both pre- and postmenopausal women while the association between SLR and breast cancer was significant only in premenopausal women. Compared with the lowest level of SLR, higer levels of SLR is associated with a reduced risk of breast cancer (premenopausal women, OR=0.10, 95% CI: 0.04-0.29, P_trend<0.001). Compared with the lowest level of FLI, FLI at higher levels is associated with an increased risk of breast cancer (premenopausal women, OR=7.14, 95% CI: 2.86-17.83, P_trend<0.001; postmenopausal women, OR=8.10, 95% CI: 2.85-22.98, P_trend<0.001). No significant association between LEP and breast cancer or association between the three indexes and breast cancer subtypes and TNM stages was found (P>0.05). Conclusion SLR may be a protective factor for breast cancer while FLI may increase the risk of breast cancer.

Objective: To compare different specimen types of lung adenocarcinoma in the detection of epidermal growth factor receptor (EGFR) gene and to correlate EGFR mutations with patient clinical features. Methods: One hundred lung adenocarcinoma cases were collected from June to December in 2015, at the First Affiliated Hospital of Xinjiang Medical University.Of the 100 lung adenocarcinoma samples, 43 were male and 57 were female. The age was from 40 to 88 years old, and the average age was 66 years. One hundred lung adenocarcinoma cases were divided equally into two groups. Mutation analysis of EGFR gene by real-time PCR was performed using biopsied tissue and paired blood samples in one group (n=50) and using pleural effusion and paired blood samples in the other group (n=50). Results: The mutation rate of EGFR gene in biopsy samples was 54% (27/50) , higher than that of blood samples (46%, 23/50), but without statistical differences (χ²=0.640, P=0.424). In contrast, mutation rate of EGFR gene in pleural effusion samples (42%, 21/50) was higher than that of blood samples (34%, 17/50), but without statistical differences(χ²=0.679, P=0.409). Two patients had EGFR mutation detected in paired blood samples but not in the corresponding biopsy samples, and four patients had EGFR mutation detected in pleural effusion samples but not in their paired blood samples. The mean progression-free survival of patients with detectable EGFR mutation were 9.5 months (tissue samples), 8.6 months (pleural effusion) and 8.5 months (blood). However, there was no statistical difference. Conclusions Blood samples may be used to assess EGFR mutations for patients with lung adenocarcinoma. However, further studies are needed to improve the sensitivity and accuracy in the detection of EGFR mutations using blood samples.

Objective: To investigate the point mutation of epidermal growth factor receptor (EGFR) gene and clinicopathologic characteristics in patients with non-small cell lung cancers(NSCLC)of Xinjiang region. Methods: Five-hundred and eighty-two cases of paraffin-embedded tissue in patients with NSCLC were collected between January 2013 and December 2015 in the First Affiliated Hospital of Xinjiang Medical University. The DNA was extracted from these tissues by Qiagen kit, to test thirty-two mutations in EGFR exons 18, 19, 20 and 21 using fluorescent quantitative qRT-PCR technology by TaqMan probe; the clinicopathologic features of patients were analyzed according to the mutation status of EGFR. Results: There were 173 cases with EGFR gene mutation in 582 cases of paraffin-embedded tissue in patients with NSCLC, and the mutation rate was 29.7%(173/582). There were statistical difference in female patients (50.5%, 98/194), no history of smoking(47.3%, 96/203), high differentiation(6/9), adenosquamous carcinoma(6/11), peripheral location (34.9%, 88/252), and surgical specimens(38.2%, 83/217), respectively (P<0.05). Multiple factors Logistic analysis showed that gender, degree of differentiation, and pathologic types had statistical differences to EGFR when α=0.05. There were no statistical differences between other variants. Conclusions There are higher rate EGFR gene mutation in women patients, non-smokers, and well-differentiated, adenocarcinoma. Gender, degree of differentiation and pathological patterns are independent influencing factors on EGFR mutation status.