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.

Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.

Objective:To systematically evaluate the efficacy and safety of iGlarLixi in the treatment of type 2 diabetes, providing evidence-based support for rational clinical medication.Methods:A systematic review was conducted by retrieving articles from PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI, Wanfang, and VIP databases to collect randomized controlled trials comparing the efficacy and safety of iGlarLixi(intervention group) with placebo or other anti-hyperglycemic drugs(control group) in the treatment of type 2 diabetes. The search was conducted from the inception of the databases up to August 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in the included studies. Meta-analysis was performed using RevMan 5.4 software. Results:A total of 11 studies with 6 392 patients were included in the meta-analysis. The results of the meta-analysis showed that in terms of efficacy, compared to insulin and GLP-1RAs, iGlarLixi demonstrated better reduction in patients′ HbA 1C levels(Insulin group WMD=-0.40, 95% CI -0.54--0.27, P<0.001; GLP-1RAs group WMD=-0.86, 95% CI -1.05--0.68, P<0.001), increased HbA 1C target rate(Insulin group OR=2.83, 95% CI 2.00-3.99, P<0.001; GLP-1RAs group OR=6.45, 95% CI 4.81-8.64, P<0.001), increased HbA 1C control rate without weight gain(Insulin group OR=3.00, 95% CI 2.43-3.71, P<0.001; GLP-1RAs group OR=2.67, 95% CI 1.76-4.06, P<0.001). Furthermore, iGlarLixi showed an advantage in weight reduction compared to the insulin group and demonstrated superior reduction in fasting plasma glucose compared to the GLP-1RAs group. In terms of safety, the incidence of hypoglycemic events in the iGlarLixi group was similar to that in the insulin group, but the incidence of gastrointestinal adverse events was higher than that in the insulin group. There was no difference in the incidence of gastrointestinal adverse events compared with GLP-1RAs, but the incidence of hypoglycemic events was higher in the iGlarLixi group. The incidence of serious adverse events was similar to that in the insulin and GLP-1RAs groups(Insulin group OR=0.94, 95% CI 0.71-1.23, P=0.640; GLP-1RAs group OR=0.97, 95% CI 0.61-1.52, P=0.880). Conclusion:iGlarLixi is superior to insulin but inferior to GLP-1RAs in reducing body weight, and the overall incidence of adverse events is not significantly different from that of insulin and GLP-1RAs, indicating that iGlarLixi is well tolerated and safe, and has a good clinical application prospect.

The standardized training of specialist doctors is an important part of medical education after graduation and it is the only way to train clinicians to diagnose and treat the specialist diseases independently by using a standardized and high-quality way. The prevalence of periodontal disease and the proportion of patienets with severe and advanced periodontitis in our country are high and the diagnosis and treatment process for the periodontal disease are complicated. There is an urgent need to expand the team of periodontal specialists capable of the specialized treatment. The training of periodontal specialists in our country has just started. The present article summarizes the exploration and practice of periodontal specialist training in Peking University School and Hospital of Stomatology in the past five years, including the establishment of training bases, formulation of clear training goals, strict implementation of training rules, strengthening of process quality control to ensure the trainees could reach the expected standard of periodontal specialist after training. Through the summary of the previous stage practice, the authors hope to explore and establish a periodontal specialist training system in line with our country′s national conditions and further to promote and accelerate the pace of nationwide periodontal specialist training system.

Objective:To investigate the clinical manifestation, genetic characteristics, treatment and prognosis of Crouzon-like syndrome.Methods:Clinical data of one case of Crouzon-like syndrome diagnosed in Children′s Hospital Affiliated to Zhengzhou University in May 2019 were collected, including clinical test, treatment plan, follow-up outcomes. The clinical characteristics and the mutation characteristics of IL11RA-related Crouzon-like syndrome were analyzed combined with the literature.Results:The male proband, five years and four months old, was admitted with the main clinical manifestations including headache, vomiting, exophthalmos, ocular hypertelorism, nasal root flat and scaphocephaly. CT showed that the cerebellar tonsil moved down slightly, the occipital magnum was full, the bilateral cranial plates were locally thinner, the bilateral cranial diameters were increased, and the cranial seams were closed. Magnetic resonance imaging showed ChiariⅠmalformation. The mutation c.40_63del and splice site mutation c.811-2A>G of the patient′s IL11RA gene were screened by whole exome sequencing. Sanger sequencing showed that the mutations are compound heterozygous and both are first reported. The mutation c.811-2A>G was derived from the patient′s mother, and the other one is de novo.Conclusions:The main clinical manifestations of Crouzon-like syndrome are craniosynostosis and midface hypoplasia and ocular deformity. The study identified two novel mutations in the Crouzon-like syndrome related IL11RA gene. Genetic sequencing is helpful for accurate diagnosis and timely surgical treatment.

Objective: To construct and identify a mouse model with conditional knockout (cKO) of p75 neurotrophin receptor (p75NTR-cKO) gene in epidermis cells by Cre-loxP system. Methods: Five p75NTR^flox/flox transgenic C57BL/6J mice (aged 6-8 weeks, male and female unlimited, the age and sex of mice used for reproduction were the same below) and five keratin 14 promotor-driven (KRT14-) Cre^{+ /-} transgenic C57BL/6J mice were bred and hybridized via Cre-loxP system. Five p75NTR^flox/+ ·KRT14-Cre^{+ /-} mice selected from the first generation of mice were mated with five p75NTR^flox/flox mice to obtain the second generation hybrids. After the second generation mice were born 20-25 days, the parts of the mice tail were cut off to identify the genotype by polymerase chain reaction method. Four p75NTR gene complete cKO mice (6 weeks old) and 4 wild-type mice (6 weeks old) were selected and sacrificed respectively. The abdominal skin tissue and brain tissue were excised to observe the expression of p75NTR in the two tissue of two types of mice by immunohistochemical staining. The abdominal skin tissue of two types of mice was obtained to observe the histomorphological changes by hematoxylin and eosin staining. Results: (1) Twenty second generation mice were bred. The genotype of 4 mice was p75NTR^flox/flox·KRT14-Cre^{+ /-}(p75NTR^-/-), i. e. p75NTR gene complete cKO mice; the genotype of 5 mice was p75NTR^flox/+ ·KRT14-Cre^{+ /-}, i. e. p75NTR gene partial cKO mice; the genotype of 5 mice was p75NTR^flox/flox·KRT14-Cre^-/-, and that of 6 mice was p75NTR^flox/+ ·KRT14-Cre^-/-, all of which were wild-type mice. (2) The expression of p75NTR was negative in skin epidermis tissue of p75NTR gene complete cKO mice, while numerous p75NTR positive expression was observed in skin epidermis tissue of wild-type mice. Abundant p75NTR positive expression was observed in brain tissue of both wild-type mice and p75NTR gene complete cKO mice. (3) There was no abnormal growth of skin epidermis tissue in both wild-type mice and p75NTR gene complete cKO mice, with intact hair follicle structure. Conclusions Applying Cre-loxP system can successfully construct a p75NTR-cKO mice model in epidermis cells without obvious changes in skin histomorphology.

Objective: To explore the effect of ambient fine particulate matters (PM_2.5) exposure on nasal oxidative stress level in patients with allergic rhinitis (AR). Methods: A panel of sixty AR patients was recruited as subjects. Four repeated measurements were carried out from June 2017 to January 2018. Nasal irrigation solution was collected and examined for malondialdehyde (MDA) and superoxide dismutase (SOD). Monitoring data of atmospheric pollutants and meteorological factors during measurement periods were also collected. Time activity pattern combined with micro-environment monitoring method was used to evaluate PM_2.5 exposure. Mixed effect model was applied to analyze the relationship between PM_2.5 exposure concentration and oxidative stress level. Results: 49 subjects accomplished the four repeated measurements, and the mean±SD of their age was (36.7±8.4) years old. The median of MDA and SOD in four measurement periods was 3.70, 3.70, 5.58, 6.24 nmol/ml, and 105.50, 102.50, 95.00, 96.50 U/ml. The concentration of PM_2.5 exposure in four measurement periods was (40.0±2.7), (41.5±2.5), (52.3±5.9) and (74.7±4.9) μg/m³, respectively. Results of single pollutant mixed effect model analysis showed that 0-, 1-, 2-, 3-day lag concentrations of PM_2.5 was significantly positively associated with MDA, about β (95%CI) estimated as 0.24 (0.17, 0.30), 0.34 (0.27, 0.41), 0.32 (0.20, 0.44) and 0.33 (0.23, 0.43), respectively. 0-, 1-, 2-day concentrations of PM_2.5 was significantly negatively associated with SOD, about β (95%CI) estimated as -0.99 (-1.66, -0.31), -1.35 (-2.08, -0.62) and -0.94 (-1.80, -0.07), respectively. Multivariate analysis found that lag 1-day concentration of PM_2.5 was still significantly associated with MDA and SOD after controlling for temperature, age and other influencing factors. For a 10 μg/m³ increase of PM_2.5 concentration, MDA increased 0.26 (95%CI: 0.18, 0.33) nmol/ml, and SOD decreased 0.87 (95%CI: 0.21, 1.53) U/ml. Conclusion Our results suggested that PM_2.5 exposure can aggravate the nasal oxidative stress response of AR patients.

Objective: To explore the training pattern of periodontal probing practice so as to improve the accuracy of probing depth measurements of undergraduate students. Methods: Sixty-two undergraduate dental students in their pre-clinical training course were divided into two groups (31 students in each group): the reform group and the control group. The students in reform group learned and practiced periodontal probing by using transparent gingiva models for 30 minutes, and using conventional periodontal probing models for further 90 minutes in two sessions. The total practicing time was 2 hours. The students in control group learned and practiced periodontal probing using conventional periodontal probing models only for 1 hour of practicing time. After the training, new conventional periodontal probing models were used to evaluate the accuracy of probing depth measurements of the students in the two groups. The probing depths of Ramfjord index teeth were recorded by the students and were compared with the results of an experienced teacher's measurements. Results: The percentage of absolutely consistent sites in the reform group (63.4% [708/1 116]) was significantly higher than that of the control group (60.0% [670/1 116]) (P=0.012). In both reform group and control group, the percentages of absolutely consistent sites of the incisors (reform group: 69.1% [257/372], control group: 65.9% [245/372]) were significantly higher than those of the molars (reform group 58.9% [219/372], control group 54.3% [202/372])(P< 0.01), meanwhile, the percentages of absolutely consistent sites of the buccal-lingual sites (reform group: 88.7% [330/372], control group: 80.4% [299/372]) were significantly higher than those of the interproximal sites (reform group: 50.8% [378/744], control group: 49.9% [371/744])(P<0.01). Conclusions The comprehensive reform of periodontal probing training could improve the accuracy of probing depth measurement of the undergraduate students. During the pre-clinical practice, probing training in the molar areas and the interproximal sites should be reinforced.

Objective: To investigate the application of high-frequency ultrasound in dermabrasion of patients with deep partial-thickness burns. Methods: Twenty-six patients with deep partial-thickness burns conforming to the study criteria were hospitalized in our unit from March 2015 to March 2016. Patients were all performed with dermabrasion. The structure of skin tissue and blood flow signals of uninjured side and wounds before dermabrasion, and those of wounds immediately post dermabrasion and on post dermabrasion day (PDD) 1, 3, 5, 7, 10, 14, and 21 were detected with high-frequency ultrasound, and the percentage of blood flow signals was calculated. According to the results of comparison between percentage of blood flow signals of wounds and that of normal skin before dermabrasion, patients were divided into no significant decrease group (NSD, n=19) and significant decrease group (SD, n=7). Wound healing time of patients in two groups was recorded. Data were processed with analysis of variance of repeated measurement, LSD test, t test and Chi-square test. The correlation between the percentage of blood flow signals of wounds before dermabrasion and wound healing time of 26 patients were analyzed by Spearman correlation analysis. Results: (1) Epidermis of normal skin of patients in two groups before dermabrasion showed continuous smooth linear hyperecho, which was stronger than that of dermis, and boundary of dermis and subcutaneous tissue showed stronger discontinuous linear echo than that of dermis, which gradually transited to subcutaneous tissue. In group NSD, epidermis of wound of patients before dermabrasion showed intermittent rough linear echo, which was weaker than that of normal skin epidermis, and there was no obvious abnormity of boundary between dermis and subcutaneous tissue. Immediately post dermabrasion and on PDD 1, no linear hyperecho of epidermis was observed, showing complete attrition of epidermis, and the echo of dermis and subcutaneous tissue had no obvious change as compared with that before dermabrasion, with flat surface of dermis and partly abraded superficial-dermis but relatively well preserved dermal tissue in whole. The epidermis showed discontinuous linear hyperecho, and epidermis was discontinuously regenerated on PDD 3 and 5. Partial continuous linear hyperecho was detected in the epidermis, showing partial continuous regeneration of epidermis on PDD 7 and 10. The regenerated epidermis was thicker than normal skin epidermis and showed rough linear hyperecho with non-uniform thickness on PDD 14. The regenerated epidermis was thicker than normal skin epidermis and showed rather smooth linear hyperecho with uniform thickness on PDD 21. In group SD, the structure of epidermis and dermis of wound of patients before dermabrasion, immediately post dermabrasion, and on PDD 1 was similar to that in group NSD, but the echo of boundary of dermis and subcutaneous tissue was weakened in different degrees. There was no linear hyperecho of epidermis, showing no epidermis was regenerated on PDD 3 and 5. Intermittent regeneration of epidermis appeared on PDD 7 and 10 with intermittent linear hyperecho. Partial continuous linear hyperecho was detected in the epidermis, showing partial continuous regeneration of epidermis on PDD 14 and 21. (2) The percentages of blood flow signals of wounds of patients in group NSD before dermabrasion, immediately post dermabrasion, and on PDD 1 were (3.1±1.3)%, (6.5±2.0)%, and (5.3±1.9)% respectively, higher than those in group SD [(0.9±1.1)%, (3.5±1.3)%, and (3.6±0.9)% respectively, P<0.05 or P<0.01]. The percentages of blood flow signals of wounds of patients in two groups were similar at the other time points (with P values above 0.05). Compared with the percentage of normal skin in the same group [(3.2±0.7)%], the percentages of blood flow signals of wounds of patients in group NSD were significantly increased immediately post dermabrasion and on PDD 1 (with P values below 0.01) but had no significant change at the other time points (with P values above 0.05). The percentage of blood flow signals of wounds of patients before dermabrasion in group SD was significantly lower than that of normal skin in the same group [(2.8±0.6)%, P<0.01]. The percentage of blood flow signals of wounds of patients in group SD was close to that of normal skin in the same group at each time point post dermabrasion (with P values above 0.05). (3) The wound healing time of patients in group NSD was (16.2±2.5) d, lower than that in group SD [(30.9±2.9) d, t=12.67, P<0.01]. There was obvious negative correlation between the percentage of blood flow signals of wounds before dermabrasion and wound healing time of 26 patients (r=-0.77, P<0.01). Conclusions High-frequency ultrasound is a good way to observe the imaging features of wounds in patients with deep partial-thickness burns before and after dermabrasion, and it can provide objective imaging evidence for the performance of dermabrasion in patients with deep partial-thickness burns.