Objective:To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China.Methods:This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis.Results:Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) ( Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS ( Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion:Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.

Regeneration of rotator cuff tendon-bone interface is crucial in rotator cuff repair. The tendon-bone interface consists of four continuous and gradual regions: the tendon region, the unmineralized fibrocartilage region, the mineralized fibrocartilage region, and the bone region. The development and regeneration of various regions in the tendon-bone interface is regulated by growth factors, inorganic ions, mechanical stimulation, and hypoxic environment. Inspired by factors affecting the development and regeneration of the tendon-bone interface, many researchers have designed gradient scaffold systems that promote regionalized regeneration of the tendon-bone interface. The gradient distribution of these scaffolds includes inorganic ion gradients and growth factor gradients. According to different gradients of the scaffold system, osteogenesis, chondrogenesis and tendon differentiation of cells at the tendon-bone interface are promoted, and the healing of the tendon-bone is synchronously completed to realize the repair and regeneration of the rotator cuff tendon-bone interface. Current studies indicated that gradient multiphase scaffolds had high academic research value and guided significance for future clinical applications in the reconstruction of the tendon-bone interface. In this paper, the factors affecting the development and regeneration of the tendon-bone interface are reviewed, and the effects of these factors on osteogenesis, chondrogenesis and tendon formation of various regions in promoting rotator cuff tendon-bone interface repair are summarized. The properties and effects of reported gradient multiphase scaffolds for rotator cuff injury are discussed, including gradient scaffolds containing inorganic ions and growth factors. Finally, the problems and future development opportunities of gradient multiphase support in rotator cuff repair are summarized.

【Objective】 To explore the intention of voluntary blood donation in students from a middle vocational school in Jinhua and its influencing factors. 【Methods】 A total of 400 students were enrolled from a middle vocational school in Jinhua by convenience sampling, and a self-designed questionnaire was issued to each student to investigate the cognition, intention and attitude of voluntary blood donation. The influencing factors of voluntary blood donation intention were analyzed by Logistic regression. 【Results】 A total of 394 valid questionnaires(98.50%) were collected. For 394 surveyed students, the average score of cognition of voluntary blood donation was (7.27±2.69) points, and the overall rate of intention to voluntary blood donation was 21.32%. Logistic regression analysis equation consisted of family support, better cognition, feeling happy about blood donation and worrying about blood donation, with risk ratios(OR) as 31.78, 188.69, 26.27 and 0.01, respectively(all P<0.05). 【Conclusion】 Students from a middle vocational school showed poor congnition and intention of voluntary blood donation.Family support for voluntary blood donation, better cognition of voluntary blood donation and happiness for blood donation were positive factors, and the fear of blood donation was a negative factor.It is necessary to strengthen the publicity of blood donation among students in middle vocational school to improve their congnition and intention to voluntary blood donation.

Objective:To analyze the correlation among social support, positive coping and job burnout among nurses in Department of Infectious Diseases.Methods:From March 2020 to June 2021, convenience sampling was used to select 110 nurses from Department of Infectious Diseases of 8 ClassⅢ hospitals in Hangzhou, Zhejiang Province as the research object. The General Information Questionnaire, Maslach Burnout Inventory, Social Support Rating Scale (SSRS) , and Simple Coping Style Questionnaire (SCSQ) were used to investigate the nurses. Pearson correlation analysis was used analyze the correlation among job burnout, social support and positive coping. A total of 110 questionnaires were distributed, and 102 effective questionnaires were recovered, with an effective recovery rate of 92.73%.Results:Among the 102 nurses in Department of Infectious Diseases, 17.65% (18/102) were in mild burnout, 57.84% (59/102) were in moderate burnout, and 20.59% (21/102) were in severe burnout. The SSRS total score and each dimension score of nurses in Department of Infectious Diseases were positively correlated with the positive coping subscale score of SCSQ ( P<0.05) , and negatively correlated with the emotional exhaustion subscale and depersonalization subscale score of the Maslach Burnout Inventory ( P<0.05) , but it was positively correlated with the personal achievement subscale score ( P<0.05) . Conclusions:The overall job burnout of nurses in Department of Infectious Diseases was moderate to severe level, and social support and positive coping were correlated with job burnout. Nursing managers should develop measures to reduce the job burnout of nurses in Department of Infectious Diseases.

Objective:To explore the influencing factors and related countermeasures of malnutrition in patients with chronic liver failure (CLF) .Methods:The convenient sampling method was used to select 80 CLF patients admitted to Hangzhou First People's Hospital from March 2019 to March 2021. The clinical data of CLF patients were collected and patients were divided into the malnutrition group (57 cases) and the non-malnutrition group (23 cases) according to the presence or absence of malnutrition. Logistic regression analysis was used to explore the influencing factors of malnutrition in CLF patients, and to propose corresponding nursing strategies.Results:The incidence of malnutrition in 80 CLF patients was 71.25%. Between malnutrition group and non-malnutritrion group, there were statistical differences in age, smoking, body mass index (BMI) , disease course, etiological composition, Child-Push classification, number of adverse events, triceps skin fold thickness (TSF) , arm muscle circumference (AMC) , gastrocnemius muscle circumference (GC) , prealbumin (PA) and albumin (ALB) ( P<0.05) . Multivariate Logistic regression analysis showed that age, smoking, etiology, Child-Push classification and number of adverse events were the influencing factors of malnutrition in CLF patients ( P<0.05) . Conclusions:There are many influencing factors of malnutrition in CLF patients, and medical staff should warn the relevant factors and give targeted predictive nursing interventions to reduce the risk of malnutrition in patients.

Objective:To observe any effect of function-oriented training on the balance of recovering stroke survivors and on their ability in the activities of daily living.Methods:Sixty stroke survivors in recovery were randomly divided into an observation group ( n=30) and a control group ( n=30). The control group received routine rehabilitation training, while the observation group underwent function-oriented training for 6 weeks. Before and after the intervention, both groups were evaluated using the Berg balance scale (BBS), the Fugl-Meyer lower extremity assessment (FMA-L), the timed up-and-go test (TUGT) and the modified Barthel index (MBI). Results:After the treatment, significant improvement was observed in all of the measurements in both groups. The improvements in the average BBS, FMA-L and MBI scores and in the TUGT times of the observation group were significantly better than those of the control group.Conclusion:Function-oriented training can improve the balance and the ability in the activities of daily living of stroke survivors more effectively than the routine therapy.

Objective:To investigate the clinical features and long-term prognosis of pediatric acute lymphoblastic leukemia (ALL) with renal involvement as the initial manifestation, thus enhancing the diagnostic and therapeutic efficacy.Methods:Twenty-four cases of pediatric ALL with renal involvement as the initial manifestation treated in the First Affiliated Hospital of Zhengzhou University from March 2013 to March 2019 were analyzed retrospectively, and their clinical characteristics were analyzed.According to renal imaging examination findings, they were divided into abnormal group and normal group.The differences in clinical features between the two groups were compared, and the cumulative survival rate was evaluated by Kaplan-Meier method.Results:Among 1 030 newly treated cases of pediatric ALL, 24 cases(2.33%) had renal involvement as the initial manifestation, involving 20 males and 4 females, with a male/female ratio of 5∶1 and the median age of 4.3 years (1.3-14.0 years). There were 16 cases of superficial lymph node enlargement and 21 cases of hepatosplenomegaly.Immature cells in peripheral blood were found in 15 cases.Nine cases were examined with abnormal renal imaging, involving 8 cases returned normal after chemotherapy, and 1 died of renal failure.At the end of follow-up on August 1, 2020, there were 9 cases of bone marrow relapse, 11 survival cases, 10 death cases and 3 cases of loss to follow-up.There were no significant differences in the sex, age, immunophenotype, organ infiltration and urinary protein between the two groups (all P>0.05). The proportion of high creatinine level and intramedullary recurrence rate in the abnormal group were significantly higher than those in the normal group [55.6%(5/9 cases) vs.0(0/15 cases), P=0.003; 66.7%(6/9 cases) vs.20.0%(3/15 cases), P=0.036]. The survival analysis indicated that the 3-year cumulative survival in the abnormal group was significantly lower than that of normal group (17.3% vs.72.7%, χ2=4.047, P< 0.05). Conclusions:For children with unexplained renal involvement as the initial manifestation, clinicians should consider the possibility of leukemic renal infiltration or nephrogenic lymphoma.Physical examinations of the liver, spleen and lymph nodes, morphological analysis of peripheral blood cells, bone marrow examination and renal biopsy are important to make a definite diagnosis in time.Children with imaging abnormalities caused by leukemic renal infiltration are more likely to relapse and have a lower survival rate, which may be a poor prognostic factor for ALL.

Objective:To observe the clinical effects of aspirin combined with low-molecular-weight heparin in the prevention of preeclampsia in patients with hypertension during pregnancy.Methods:From October 2017 to December 2018, 120 patients with hypertension during pregnancy who were treated in the Maternal and Child Health Hospital of Cixi were selected.The patients were divided into control group and observation group according to the wishes of pregnant women and informed consent, with 60 patients in each group.Control group received single oral aspirin 100 mg daily from 11-13 + 6 weeks of pregnancy to 36 weeks of pregnancy or 5-10 days before termination of pregnancy.The observation group received 3075 IU of low-molecular-weight heparin subcutaneous injections daily from 11-13 + 6 weeks of pregnancy for 2 weeks, and was orally given aspirin 100 mg daily for 36 weeks or until 5-10 days before termination of pregnancy.The incidence of preeclampoia, adverse pvegnany outcome and complication of the two groups were observed and compared. Results:The incidences of preeclampsia, preterm birth, cesarean section, fetal distress, placental abruption and neonatal asphyxia in the observation group were 15.00%, 20.00%, 36.67%, 11.67%, 6.67% and 1.67%, respectively, which were significantly lower than those in the control group (31.57%, 35.00%, 55.00%, 30.00%, 23.33% and 15.00%, χ 2=4.658, 4.104, 4.061, 6.113, 6.535, 6.981, all P<0.05). The gestational age at delivery[(37.88±3.72)weeks] and the weight of the newborn [(2.63±0.24)kg] in the observation group were significantly larger than those in the control group[(36.11±3.59)weeks, (2.13±0.20)kg]( t=2.652, 12.397, all P<0.05). The incidences of postpartum blood loss, thrombocytopenia, oligohydramnios and pleural and ascites in the observation group were 5.00%, 1.67%, 5.00% and 16.67%, respectively, which were significantly lower than those in the control group (25.00%, 16.67%, 23.33% and 15.00%, χ 2=9.411, 8.106, 8.292, 6.981, all P<0.05). Conclusion:Low-dose aspirin and low-molecular-weight heparin for patients with hypertension during pregnancy can reduce the incidence of preeclampsia and improve adverse pregnancy outcomes, which is worthy of promotion and application.

Objective: To evaluate effects of mobile health intervention on vegetables and fruits intakes, screen time, body mass index, BMI Z score and waist circumference in children and adolescents. Methods: The literature search was performed to find articles published up to December 2018 in the databases: PubMed, Embase, Cochrane Library, CNKI, Wanfang. The articles focusing on the keywords of "prevention" "children" "adolescents" "obesity" "weight loss" "m-Health" "mobile phone" "mobile application" "mobile techonology" "cell phone" "smartphone" "mobile apps" for the delivery of children and adolescents obesity interventions were included. Stata 13.0 software was used for Meta-analysis. Results: A total of 15 studies were included, and mobile health had an effect on the vegetables and fruits intakes and screen time for children and adolescents. Mobile health was more effective in the intervention participants compared to controls, the standardized mean difference (SMD) and 95%CI were 0.54 (95%CI=0.27-0.81) and -0.32(95%CI=-0.47--0.18),respectively. However, no statistical differences in the BMI, BMI Z score and waist circumference were found between intervention and control groups. Conclusion The effect of mobile health intervention on obesity in children and adolescents needs more long-term follow-up and larger sample size studies to clarify.

Objective:To investigate the risk factors of birth weight discordance in dichorionic diamniotic (DCDA) twins.Methods:This study retrospectively analyzed 1 757 cases of DCDA twin pregnancies from 11 Chinese hospitals from January 1, 2014, to December 31, 2017. Birth weight discordance was defined as ≥ 20% difference between the twins. All cases were divided into two groups: the concordant group ( n=1 520) and discordant group ( n=237). General information was compared and the high-risk factors of birth weight discordance were analyzed. Mann-Whitney U test, Chi-square test or Fisher's exact test, and logistic regression analysis were used as statistical methods. Results:Compared with the concordant group, the discordant group showed a higher incidence of hypertensive disorders of pregnancy [24.5% (58/237) vs 12.8% (194/1 520), χ2=22.882, P<0.05], fetal structural malformations [4.2% (10/237) vs 1.0% (15/1 520), χ2=15.160, P<0.05], fetal distress [6.3% (15/237) vs 1.4% (21/1 520), χ2=22.602, P<0.05], umbilical cord abnormalities [3.8% (9/237) vs 1.2% (18/1 520), χ2=7.607, P<0.05] and abnormal placental cord insertion [3.8% (9/237) vs 1.4% (21/1 520), χ2=34.904, P<0.05], but lower incidence of premature rupture of membranes [11.0% (26/237) vs 16.5% (250/1 520), χ2=4.645, P=0.034]. Logistic regression analysis showed that the independent risk factors of birth weight discordance in DCDA twins were hypertensive disorders of pregnancy ( OR=2.258, 95% CI: 1.620-3.184, P<0.001), fetal structural malformations ( OR=4.268, 95% CI: 1.892-9.631, P<0.001), umbilical cord abnormalities ( OR=2.889, 95% CI: 1.245-6.705, P=0.014) and abnormal placental cord insertion ( OR=2.318, 95% CI: 1.012-5.311, P=0.047). Conclusions:Hypertensive disorders of pregnancy, fetal structural malformations, umbilical cord abnormalities and abnormal placental cord insertion may be the risk factors of birth weight discordance in DCDA twins.