ObjectiveTo develop a full-process data platform of renal rehabilitation, diagnosis and quality control information. MethodsA hierarchical architectural design was proposed, adhering to clinical pathway models and standardized data protocols. The platform comprehensively covered assessment, intervention, follow-up and quality control for maintenance hemodialysis (MHD) patients. By integrating multidisciplinary resources and standardizing rehabilitation workflows, it delivered standardized and intelligent rehabilitation services. ResultsThe platform achieved standardized and intelligent management of rehabilitation services, effectively improved the physiological function, psychological state and quality of life convenience for MHD patients, while significantly reduced the economic and care burden on patients' families and society. ConclusionThe rehabilitation service model based on a full-process data platform may provide scientific and systematic support for MHD patients.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

Objective:To explore the effect and mechanism of USP7 on immune and inflammatory response of EV71 infection.Methods:THP-1 cells were induced to differentiate into t-Mφ cells by PMA,cells were treated by targeted USP7 inhibitor P22077,and divided into DMSO control group and P22077 experimental group,and infected with EV71.ELISA was used to detect supernatant concentration of IL-6,CCL3,TNF-α of cells separately.RT-qPCR was used to detect RNA expression of EV71-VP1,plaque test was used to detect virus titer in cell supernatant.Western blot was used to detect expressions and phosphorylation of molecules related to innate immune signaling pathway.Full-length plasmid Myc-USP7 and Flag-MDA5 were constructed and transfected into HEK293T cells,and Co-IP was used to detect external interaction between USP7 and MDA5 with Myc antibody and Flag antibody,respectively.Infected t-Mφ cells with EV71,and Co-IP detection of their interaction by USP7 and MDA5 antibodies,respectively.t-Mφ cells of DMSO control group and P22077 experimental group were infected with EV71,CHX test was used to detect expression of MDA5 and downstream related molecules.Transfected Flag-MDA5,Myc-USP7,HA-Ub or HA-K48 plasmids,Co-IP detection of ubiquitination and ubiquitination types of MDA5 regulated by USP7 with Flag antibody.Co-IP detection of MDA5 ubiquitination types regulated by USP7 in t-Mφ cells by using MDA5 antibodies.Results:After infected with EV71 and inhibited of USP7,mRNA and protein expres-sions of IL-6,CCL3 and TNF-α were decreased(P<0.05),while EV71 replication(P<0.05),and titer increased;expression of MDA5,and activation of p-IKKα/β,p-IκBα and p-p65 in innate immunity signal pathway decreased.Interaction between USP7 and MDA5 could inhibit MDA5 degradation by inhibiting K48 ubiquitination of MDA5.Conclusion:USP7 stabilizes MDA5 expression by inhibiting K48 ubiquitination of MDA5,thereby positively regulating EV71 infection immunity and inflammatory response.

Objective To analyze the efficacy and safety of different doses of esketamine for laparoscopic high hernia sac ligation in school-age children.Methods The school-age children who underwent laparoscopic high ligation of hernia sac were divided into small-dose group and conventional-dose group according to cohort method.The conventional-dose group was given intravenous 0.75 mg·kg-1 esketamine hydrochloride injection to prepare for induction;the small-dose group was given intravenous 0.50 mg·kg-esketamine hydrochloride injection to prepare for induction,and the two groups were given the same anesthesia induction,anesthesia maintenance and postoperative analgesia.The recovery time,laryngeal mask removal time,anesthesia recovery room residence time,children face,legs,activity,cry,consolability behavioral tool(FLACC)score of the children in the two groups were observed,the hemodynamic indexes were recorded at the time of entry(T1),before anesthesia induction(T2),immediately after laryngeal mask placement(T3),and the safety was evaluated.Results A total of 39 cases and 43 cases children were included in the conventional-dose group and the small-dose group,respectively.After treatment,the recovery time of conventional-dose group and small-dose group were(26.36±3.91)and(23.21±3.55)min;the time of removing laryngeal mask were(13.02±2.15)and(12.24±2.30)min;the retention time of postanesthesia care unit(PACU)were(37.23±5.64)and(32.11±5.36)min;the scores of FLACC were(2.08±0.45)and(2.16±0.51)points,respectively.At T1,T2 and T3,the heart rate(HR)of the conventional-dose group were(99.23±15.78),(102.19±17.20)and(118.30±14.96)beat·min-1;that of the small-dose group were(99.93±16.27),(103.28±16.75)and(120.19±15.39)beat·min-1,respectively.The mean arterial pressure(MAP)of the conventional-dose group were(84.56±7.22),(85.92±6.96)and(89.89±7.02)mmHg;that of the small-dose group were(84.88±6.87),(86.16±6.45)and(91.12±7.31)mmHg,respectively.There were statistically significant differences in the recovery time and PACU retention time between the small-dose group and the conventional-dose group(all P＜0.05).The adverse drug reactions in the two groups mainly included nausea and vomiting,increased secretions and transient hypertension.The incidence of total adverse drug reactions in the conventional-dose group and the small-dose group were 10.26％and 4.65％,respectively,with no statistical significance(P＞0.05).Conclusion Small-dose esketamine hydrochloride injection can effectively maintain hemodynamic stability in the preoperative intravenous administration of school-age children undergoing laparoscopic high ligation of hernia sac,and the effect of reducing postoperative pain and inhibiting agitation during the recovery period is comparable to that of conventional-dose,with good safety.

Informal caregivers play an important role in chronic disease management, and their level of caregiver activation directly affects the quality of care and health outcomes of patients with chronic diseases. This article summarizes the concept, assessment tools, current status, influencing factors, and interventions of caregiver activation among informal caregivers of patients with chronic diseases, aiming to provide a reference for research on caregiver activation.

Objective:To evaluate the efficacy and safety of spesolimab in the treatment of generalized pustular psoriasis (GPP) .Methods:Six patients with GPP were retrospectively collected from Nanjing Drum Tower Hospital from February 2024 to April 2024, including 2 males and 4 females, aged 16 - 50 years. Four patients had a history of plaque psoriasis. Before treatment, the GPP Area and Severity Index (GPPASI) scores of the patients ranged from 24.6 to 60.8 points, and their GPP Physician Global Assessment (GPPGA) scores ranged from 2 to 4 points. All the 6 patients were intravenously injected with a single dose of 900 mg of spesolimab. Their GPPASI and GPPGA scores were recorded at weeks 1, 4, and 12, and adverse reactions were monitored during the treatment and follow-up.Results:Twenty-four hours after treatment, pustules were markedly reduced in the 6 patients with GPP; at week 1, pustules completely subsided, but erythema persisted; at week 4, both GPPASI and GPPGA scores decreased to 0 points; at week 12, no recurrence was observed. The patients with comorbid hypertension (4 cases), diabetes (1 case), or kidney disease (2 cases) maintained stable pressure or blood glucose levels, or showed improved renal function during the treatment and follow-up. Two patients experienced a transient fever after the treatment with spesolimab, resolving spontaneously after 2 days; two other patients exhibited exacerbation of plaque psoriasis. During the 12-week follow-up, none of the 6 patients experienced serious adverse reactions such as infections.Conclusion:In this study, spesolimab demonstrated rapid-onset efficacy and favorable safety in the treatment of GPP; conventional-dose spesolimab seemed safe for GPP patients with kidney disease.

Objective:To investigate the effect of physical activity on mortality risk in patients with chronic obstructive pulmonary disease (COPD) in Sichuan Province.Methods:Based on baseline data from 2004 to 2008 from the China Kadoorie Biobank project site in Pengzhou City, Sichuan Province, a total of 8 501 COPD patients aged 30-79 years were enrolled and followed up for a long period to determine mortality outcomes. Quartiles were used to group physical activity levels. The Cox proportional hazards regression model was used to analyze the effect of physical activity level on mortality outcomes.Results:As of December 31, 2017, the cumulative follow-up of the participants totaled 85 600.58 person-years (mean follow-up duration: 10.07 years). During this period, a total of 2 000 deaths were recorded, yielding a cumulative mortality rate of 23.53%. Among these deaths, 665 were attributed to COPD, corresponding to a cumulative mortality rate of 7.82%; and 1 116 were attributed to cardiovascular and cerebrovascular disease (CVD), corresponding to a cumulative mortality rate of 13.13%. The Cox proportional hazards regression model analysis revealed that, after adjusting for confounding factors, total physical activity was associated with a reduced risk of mortality from COPD, CVD, and all causes in patients with COPD. Compared with the low-level group of total physical activity, the medium-high-level group had the lowest risk of COPD mortality, with an HR of 0.39 (95% CI: 0.30-0.49). The high-level group had the lowest risk of CVD death and all-cause death, with HRs of 0.46 (95% CI: 0.37-0.56) and 0.55 (95% CI: 0.48-0.64), respectively. The lowest risk of COPD death and CVD death was found in the medium-high level of work-based physical activity group, with HRs of 0.36 (95% CI: 0.28-0.46) and 0.43 (95% CI: 0.36-0.51), respectively; the risk of all-cause mortality was lowest in the medium-high and high-level groups, with HRs values of 0.53 (95% CI: 0.46-0.61) and 0.53 (95% CI: 0.45-0.61). The risk of COPD death was lowest in the high-level transportation physical activity group, with an HR of 0.66 (95% CI: 0.53-0.83), and the risk of CVD and all-cause death was lowest in the medium-high level group, with HRs of 0.63 (95% CI: 0.53-0.76) and 0.73 (95% CI: 0.64-0.84), respectively. The risk of COPD death and CVD death was the lowest in the high-level domestic physical activity group, with HRs of 0.66 (95% CI: 0.49-0.89) and 0.76 (95% CI: 0.61-0.95), respectively, and the risk of all-cause death was the lowest in the medium-high level group, with an HR of 0.82 (95% CI: 0.72-0.94). There is no statistical association between leisure physical activity and the risk of death from three types of diseases. Conclusions:Total physical activity, including work-based, transportation-based, and domestic physical activity, reduced the risk of COPD, CVD, and all-cause mortality in patients with COPD in Sichuan Province. The magnitude of mortality risk was influenced by the type and level of physical activity.

Objective:To explore the effect and mechanism of USP7 on immune and inflammatory response of EV71 infection.Methods:THP-1 cells were induced to differentiate into t-Mφ cells by PMA,cells were treated by targeted USP7 inhibitor P22077,and divided into DMSO control group and P22077 experimental group,and infected with EV71.ELISA was used to detect supernatant concentration of IL-6,CCL3,TNF-α of cells separately.RT-qPCR was used to detect RNA expression of EV71-VP1,plaque test was used to detect virus titer in cell supernatant.Western blot was used to detect expressions and phosphorylation of molecules related to innate immune signaling pathway.Full-length plasmid Myc-USP7 and Flag-MDA5 were constructed and transfected into HEK293T cells,and Co-IP was used to detect external interaction between USP7 and MDA5 with Myc antibody and Flag antibody,respectively.Infected t-Mφ cells with EV71,and Co-IP detection of their interaction by USP7 and MDA5 antibodies,respectively.t-Mφ cells of DMSO control group and P22077 experimental group were infected with EV71,CHX test was used to detect expression of MDA5 and downstream related molecules.Transfected Flag-MDA5,Myc-USP7,HA-Ub or HA-K48 plasmids,Co-IP detection of ubiquitination and ubiquitination types of MDA5 regulated by USP7 with Flag antibody.Co-IP detection of MDA5 ubiquitination types regulated by USP7 in t-Mφ cells by using MDA5 antibodies.Results:After infected with EV71 and inhibited of USP7,mRNA and protein expres-sions of IL-6,CCL3 and TNF-α were decreased(P<0.05),while EV71 replication(P<0.05),and titer increased;expression of MDA5,and activation of p-IKKα/β,p-IκBα and p-p65 in innate immunity signal pathway decreased.Interaction between USP7 and MDA5 could inhibit MDA5 degradation by inhibiting K48 ubiquitination of MDA5.Conclusion:USP7 stabilizes MDA5 expression by inhibiting K48 ubiquitination of MDA5,thereby positively regulating EV71 infection immunity and inflammatory response.

Objective:To investigates the efficacy and safety of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in treating older patients(≥60 years old)with hematologic malignancies.Methods:We conducted a retrospective study involving 67 patients aged 60 years and above, diagnosed with malignant hematological diseases, who received allo-HSCT at the Clinical Research Centrer for Haematologic Diseases of the First Affiliated Hospital of Soochow University between June 2015 and March 2023.We collected pre-transplant data, including the patients' age, gender, pre-transplantation disease risk stratification, disease status, and the haematopoietic cell transplantation comorbidity index(HCT-CI). We retrospectively analyzed clinical data regarding treatment-related toxicity, infections, acute and chronic graft-versus-host disease(a/cGVHD), as well as recurrent and non-recurrent deaths, to estimate the overall survival(OS)rate and event-free survival (EFS)rate.Results:Sixty-seven patients were included in the study, comprising 55 males(82.1%)and 12 females(17.9%), with a median age of 63(61, 65) years .The cohort consisted of 42 cases of acute myeloid leukaemia, 22 cases of myelodysplastic syndromes, and 3 cases of acute lymphoblastic leukaemia.The Kaplan-Meier analysis showed that the 1-year OS and EFS rates were 62.9% and 59.2%, respectively, while the 2-year OS and EFS rates were 55.3% and 51.8%, respectively.The cumulative incidence of 1-year non-relapse mortality and relapse was 25.4% and 21.2%, respectively.A total of 13 patients developed grade Ⅱ-Ⅳ aGVHD, with a 1-year cumulative incidence of 22.0%, and 7 patients developed cGVHD requiring treatment.When stratified by age group, the OS rate was higher in patients aged 60~64 years compared to those aged ≥65 years; however, this difference was not statistically significant(Log-rank χ2=0.99, P=0.317). In contrast, when stratified by disease load, the OS rate was significantly higher in the complete remission(CR)group than in the non-CR group, with a statistically significant difference(Log-rank χ2=15.04, P<0.001). When stratified by donor type, the OS rate was higher in the human leukocyte antigens (HLA) allogeneic group compared to the haploinsufficiency group; however, the difference was not statistically significant(Log-rank χ2=2.71, P=0.100). Twenty-seven patients died at an average of 125 days (range 3-1 054 days) after HSCT.The causes of death included leukemia recurrence in 9 cases (33.3%), infection in 8 cases (29.6%), GVHD in 5 cases (18.5%), poor implantation in 3 cases (11.1%), multi-organ failure in 1 case (3.7%), and cerebrovascular accident in 1 case (3.7%). The results of multifactorial analysis indicated that a pre-transplant tumor load greater than 5% was an independent risk factor for OS after transplantation ( HR=4.59, 95% CI: 2.01-10.42, P<0.001)as well as for disease recurrence ( OR=13.11, 95% CI: 1.96-87.87, P=0.008). Additionally, the occurrence of infection was identified as an independent risk factor for non-recurrent death after transplantation( OR=3.95, 95% CI: 1.13 to 13.71, P=0.031). Conclusions:For patients aged 60 years or older with hematologic malignancies, HSCT can serve as a viable treatment option, particularly for those with refractory recurrence and high cytogenetic risk, as it has the potential to significantly enhance prognosis and increase both EFS and OS rates.

Objective:To evaluate the efficacy and safety of spesolimab in the treatment of generalized pustular psoriasis (GPP) .Methods:Six patients with GPP were retrospectively collected from Nanjing Drum Tower Hospital from February 2024 to April 2024, including 2 males and 4 females, aged 16 - 50 years. Four patients had a history of plaque psoriasis. Before treatment, the GPP Area and Severity Index (GPPASI) scores of the patients ranged from 24.6 to 60.8 points, and their GPP Physician Global Assessment (GPPGA) scores ranged from 2 to 4 points. All the 6 patients were intravenously injected with a single dose of 900 mg of spesolimab. Their GPPASI and GPPGA scores were recorded at weeks 1, 4, and 12, and adverse reactions were monitored during the treatment and follow-up.Results:Twenty-four hours after treatment, pustules were markedly reduced in the 6 patients with GPP; at week 1, pustules completely subsided, but erythema persisted; at week 4, both GPPASI and GPPGA scores decreased to 0 points; at week 12, no recurrence was observed. The patients with comorbid hypertension (4 cases), diabetes (1 case), or kidney disease (2 cases) maintained stable pressure or blood glucose levels, or showed improved renal function during the treatment and follow-up. Two patients experienced a transient fever after the treatment with spesolimab, resolving spontaneously after 2 days; two other patients exhibited exacerbation of plaque psoriasis. During the 12-week follow-up, none of the 6 patients experienced serious adverse reactions such as infections.Conclusion:In this study, spesolimab demonstrated rapid-onset efficacy and favorable safety in the treatment of GPP; conventional-dose spesolimab seemed safe for GPP patients with kidney disease.