Objective:To explore the influencing factors of early postoperative complications after radical resection of congenital choledochal cyst (CCC) in a single center and provide some clinical basis and guidance for reducing postoperative complications.Methods:Case control study.Clinical data of 124 children (29 boys and 95 girls) with CCC diagnosed and radically treated at the Affiliated Hospital of Zunyi Medical University from September 2010 to October 2019 were analyzed.According to postoperative complications (bile leakage, gastrointestinal anastomotic fistula, bleeding, incision dehiscence, cholangitis, abdominal infection, pancreatitis, and lymphatic fistula), these children were divided into the complication group (group A) and non-complication group (group B). Age, laboratory indicators[preoperative white blood cell (WBC) count, hemoglobin, glutamic pyruvic transaminase, prealbumin, and postoperative albumin], and clinical factors, such as operation method, operation time, intraoperative blood loss, cyst type, cyst diameter, hepatic duct diameter, abdominal operation history, biliary sludge and calculus, hepatic duct anatomic variation, and pancreaticobiliary maljunction were statistically analyzed between the two groups.The t-test was performed for normal distribution of the measurement data, and the non-parametric rank sum test for non-normal distribution.Multivariate analysis was made using Logistic regression. Results:Among the 124 children, 25(20.16%) had complications, and 99(79.84%) had no complications.Bile leakage occurred in 14 children (11.29%), of whom 7 received operation again and 7 received conservative treatment.Gastrointestinal anastomotic fistula occurred in 2 children (1.61%), of whom 1 was re-operated and 1 was cured conservatively.One child (0.81%) was complicated with bleeding and cured by re-operation.Two children (1.61%) were complicated with incision dehiscence, of whom 1 was cured by re-operation and 1 was cured by conservative treatment.Cholangitis in 2 children (1.61%), abdominal infection in 2 children (1.61%), pancreatitis in 1 child (0.81%), and lymphatic fistula in 1 child (0.81%) were all conservatively cured.No significant difference was found in non-normal distribution indicators-age and WBC count-between the two groups (all P>0.05). Blood loss volume and cyst diameter were significantly different between the two groups (all P<0.05). Postoperative albumin[(27.84±4.62) g/L vs.(32.45±3.72) g/L] meeting the normal distribution showed a statistically significant difference between the two groups ( t=5.254, P<0.05). Logistic multivariate regression analysis suggested that preoperative anemia ( OR=7.922, 95% CI: 1.468-42.757) and biliary sludge and calculus ( OR=1.295, 95% CI: 1.075-4.359) were independent risk factors for postoperative complications; postoperative albumin ( OR=0.055, 95% CI: 0.012-0.244) was a protective factor for postoperative complications, and the differences were statistically significant (all P<0.05). Conclusions:The larger the cyst diameter, the more the intraoperative bleeding, and the higher the risk of operation.Treating anemia before operation, clearing sludge in the hepatic duct during operation, reducing bleeding, and strengthening the monitoring of albumin and hemoglobin during the perioperative period can prevent and reduce early complications after radical resection of CCC in children.

Objective:To construct and validate a nomogram for prediction of in-hospital postoperative heart failure(PHF)in elderly patients with hip fracture.Methods:This was a retrospective cohort study.The patients aged ≥65 years undergoing hip fracture surgery in Peking University Third Hospital from July 2015 to December 2023 were enrolled.The patients admitted from July 2015 to December 2021 were divided into a development cohort,and the others admitted from January 2022 to December 2023 in to a validation cohort.The patients'clinical data were collected from the electronic medical record sys-tem.Univariate and multivariate Logistic regression were employed to screen the predictors for PHF in the patients.The R software was used to construct a nomogram.Internal and external validation were per-formed by the Bootstrap method.The discriminatory ability of the model was determined by the area un-der the receiver operating characteristic curve(AUC).The calibration was evaluated by the calibration plot and Hosmer-Lemeshow goodness-of-fit test.Decision curve analysis(DCA)was performed to assess the clinical utility.Results:In the study,944 patients were eventually enrolled in the development co-hort,and 469 were in the validation cohort.A total of 54(5.7％)patients developed PHF in the deve-lopment cohort,and 18(3.8％)patients had PHF in the validation cohort.Compared with those from non-PHF group,the patients from PHF group were older,had higher prevalence of heart disease,hyper-tension and pulmonary disease,had poorer American Society of Anesthesiologists(ASA)classification(Ⅲ-Ⅳ),presented with lower preoperative hemoglobin level,lower left ventricular ejection fraction,higher preoperative serum creatinine,received hip arthroplasty and general anesthesia more frequently.Multivariate Logistic regression analysis showed that age(OR=1.071,95％CI:1.019-1.127,P=0.008),history of heart disease(OR=5.360,95％CI:2.808-10.234,P＜0.001),preoperative he-moglobin level(OR=0.979,95％CI:0.960-0.999,P=0.041),preoperative serum creatinine(OR=1.007,95％CI:1.001-1.013,P=0.015),hip arthroplasty(OR=2.513,95％CI:1.259-5.019,P=0.009),and general anesthesia(OR=2.024,95％CI:1.053-3.890,P=0.034)were the independent predictors for PHF in elderly patients with hip fracture.Four preoperative predictors were incorporated to construct a preoperative nomogram for PHF in the patients.The AUC values of the nomo-gram in internal and external validation were 0.818(95％CI:0.768-0.868)and 0.873(95％CI:0.805-0.929),indicating its good accuracy.The calibration plots and Hosmer-Lemeshow goodness-of-fit test(internal validation:x2=9.958,P=0.354;external validation:x2=5.477,P=0.791)showed its satisfactory calibration.Clinical usefulness of the nomogram was confirmed by decision curve analysis.Conclusion:An easy-to-use nomogram for prediction of in-hospital PHF in elderly patients with hip fracture is well developed.This preoperative risk assessment tool can effectively identify patients at high risk of PHF and may be useful for perioperative management optimization.

Objective To identify the pathogenic bacteria such as Staphylococcus aureus and Enterococcus faecalis in bloodstream infec-tions with high confidence based on three deep learning models such as GoogleNet,ResNet101,and Vgg19,compare the performance and classification ability of these models,and explore the feasibility of applying the deep learning models for the rapid identification of pathogenic bacteria in bloodstream infections.Methods The preprocessed Gram-stained bacterial images,including 1 682 images for Staphylococcus aureus and 1 723 for Enterococcus faecalis,and 688 blank control microscopic images were input into three models for training and validation,respectively.Among them,1 344 images for Staphylococcus aureus,1 376 for Enterococcus faecalis,and 544 blank control images were used for training,and the remaining images were used for validation.The model with the best performance was identified according to the classification parameters between the models.Results The ResNet101 model had the lowest cross-en-tropy loss value(0.008 710 3),the largest Epoch value(93),and the highest accuracy rate(99％)for identifying the three types of validation set images.The cross-entropy loss value,Epoch value,and accuracy rate of the GoogleNet model were 0.063 89,86 and 98.6％,respectively,for identifying the three types of validation set images.Those of the Vgg19 model were 0.035 682,86 and 97.7％,respectively.Conclusion The ResNet101 model has the best performance in the classification of three kinds of images.The deep learning model may accurately,reliably and rapidly identify the Gram-stained images of pathogenic bacteria such as Staphylococcus aureus and Enterococcus faecalis in bloodstream infections.

Chronic hepatitis B virus (HBV) infection will greatly contribute to raising the occurrence probability of cirrhosis and hepatocellular carcinoma in patients. Although existing antiviral treatment regimens have a certain effect on delaying disease progression and improving prognosis, it is still not effective in attaining functional cures. Hepatitis B virus DNA integration may be one of the reasons for this phenomenon. Therefore, this paper reviews the possible mechanisms of HBV DNA integration in maintaining chronic inflammation of the liver, evading existing antiviral treatment methods, and inducing hepatocellular carcinoma so as to further deepen the understanding of the role of HBV DNA integration in the occurrence and development of chronic hepatitis B, providing ideas and references for formulating better treatment strategies.

Objective To investigate the pharmacological effects of"Yajieshaba"on mice with alcohol-induced liver injury and to investigate the mechanism of the impact of"Yajieshaba"on the regulation of intestinal flora by 16S rDNA technology.Methods Healthy male KM mice were randomly divided into control,model,"Yajieshaba"low,medium,and high dose(0.39,1.17 and 3.51 g·kg-1)groups and Bifendatatum(2.93 mg·kg-1)groups,with eight mice in each group.After one week of pre-administration of"Yajieshaba",a mouse model of acute alcoholic liver injury was established by a single instillation of 56%alcohol,and the levels of AST and ALT in the serum of mice were measured,and the morphological changes of liver histology were observed by HE staining;secondly,faecal DNA was extracted from each group under aseptic operation,and 16S rDNA sequencing and differential analysis by alpha diversity and species composition at the phylum and genus levels were performed.Results The results showed that the biochemical indexes of liver function(ALT and AST)were significantly improved by"Yajieshaba",and the degree of liver damage was significantly reduced by HE staining.At the phylum level,it significantly decreased the abundance of Aspergillus and increased the quantity of Bacteroides;at the genus level,it significantly up-regulated the plenty of Bacteroides and Prevotella and downregulated a lot of Prevotella and Helicobacter.At the genus level,"Yajieshaba"significantly up-regulated the abundance of Bacillus spp.and Prevotella spp.and down-regulated the abundance of Prevotella spp.and Helicobacter spp.Conclusion"Yajieshaba"may play an anti-acute alcoholic liver injury effect by regulating the intestinal flora and metabolites.

Objective:To explore the incidence and influencing factors of wheezing among children and adolescents aged 3-18 years in 11 cities in China from 2022 to 2023.Methods:From October 2022 to August 2023, 11 cities including Xishuangbanna in Yunnan Province, Suqian in Jiangsu Province, Chifeng and Hohhot in Inner Mongolia, Tangshan in Hebei Province, Changzhi in Shanxi Province, Yinchuan in Ningxia Province, Lanzhou and Dingxi in Gansu Province, Linyi in Shandong Province, and Tonghua in Jilin Province were selected as research sites to recruit kindergarten children and primary and secondary school adolescents in local urban areas. A total of 21 959 children and adolescents were included in this study. Demographic information, wheezing data (whether wheezing has occurred in the past and whether wheezing attacks have occurred in the past one year), personal history, family history and other information were collected through questionnaires. The multivariate logistic regression model was used to analyze the influencing factors of wheezing attacks in the past one year.Results:The mean age of 21 959 children and adolescents was (12.09±3.65) years old, and 52.3% (11 480) were boys. The incidence of wheezing history was 3.7% (816 cases), and the incidence of wheezing attacks in the past year was 2.5% (556 cases). The multivariate logistic regression model analysis results showed that compared with older age, girls, full-term natural delivery, no allergic rhinitis, no family history of allergic diseases, no passive smoking, partial diet, natural conception and childbirth, the children aged 3-18 years with young age, male, partial diet, passive smoking, family history of allergic diseases, allergic rhinitis, cesarean section, premature birth, and assisted reproduction had a higher risk of wheezing [ OR (95% CI): 0.86(0.84-0.88), 1.27(1.07-1.51), 2.31(1.95-2.75), 2.09(1.76-2.47), 3.5(2.80-4.37), 4.05(3.39-4.83), 1.20(1.02-1.43), 2.26(1.66-3.09), and 1.67(1.01-2.78)]. Conclusion:From 2022 to 2023, the incidence of wheezing among children aged 3-18 years in China is not significantly higher than before, and childhood wheezing may be related to factors such as children′s age, gender, dietary habits, family and personal history of allergic diseases, passive smoking, and perinatal period.

Objective:To explore the incidence and influencing factors of wheezing among children and adolescents aged 3-18 years in 11 cities in China from 2022 to 2023.Methods:From October 2022 to August 2023, 11 cities including Xishuangbanna in Yunnan Province, Suqian in Jiangsu Province, Chifeng and Hohhot in Inner Mongolia, Tangshan in Hebei Province, Changzhi in Shanxi Province, Yinchuan in Ningxia Province, Lanzhou and Dingxi in Gansu Province, Linyi in Shandong Province, and Tonghua in Jilin Province were selected as research sites to recruit kindergarten children and primary and secondary school adolescents in local urban areas. A total of 21 959 children and adolescents were included in this study. Demographic information, wheezing data (whether wheezing has occurred in the past and whether wheezing attacks have occurred in the past one year), personal history, family history and other information were collected through questionnaires. The multivariate logistic regression model was used to analyze the influencing factors of wheezing attacks in the past one year.Results:The mean age of 21 959 children and adolescents was (12.09±3.65) years old, and 52.3% (11 480) were boys. The incidence of wheezing history was 3.7% (816 cases), and the incidence of wheezing attacks in the past year was 2.5% (556 cases). The multivariate logistic regression model analysis results showed that compared with older age, girls, full-term natural delivery, no allergic rhinitis, no family history of allergic diseases, no passive smoking, partial diet, natural conception and childbirth, the children aged 3-18 years with young age, male, partial diet, passive smoking, family history of allergic diseases, allergic rhinitis, cesarean section, premature birth, and assisted reproduction had a higher risk of wheezing [ OR (95% CI): 0.86(0.84-0.88), 1.27(1.07-1.51), 2.31(1.95-2.75), 2.09(1.76-2.47), 3.5(2.80-4.37), 4.05(3.39-4.83), 1.20(1.02-1.43), 2.26(1.66-3.09), and 1.67(1.01-2.78)]. Conclusion:From 2022 to 2023, the incidence of wheezing among children aged 3-18 years in China is not significantly higher than before, and childhood wheezing may be related to factors such as children′s age, gender, dietary habits, family and personal history of allergic diseases, passive smoking, and perinatal period.

Objective:To develop the Self-management Behavior Questionnaire for Middle-aged and Young Patients with Myocardial Infarction and test its reliability and validity.Methods:Using social cognitive theory, self-efficacy theory, and self-management theory as theoretical frameworks, a preliminary questionnaire was formed through literature review, semi-structured interviews, and Delphi expert consultation. Convenience sampling was used to select middle-aged and young patients with myocardial infarction from the First Affiliated Hospital of Henan University of Chinese Medicine, Henan Provincial Chest Hospital, and the Second Affiliated Hospital of Zhengzhou University from June to July 2022 for investigation, and item analysis and exploratory factor analysis of the questionnaire were conducted. From August to November 2022, middle-aged and young patients with myocardial infarction from the Heart Center of the First Affiliated Hospital of Henan University of Chinese Medicine were selected for investigation, and confirmatory factor analysis and reliability testing of the questionnaire were conducted.Results:A total of 300 and 480 questionnaires were distributed, respectively, and 280 and 468 valid questionnaires were collected, with effective response rates of 93.33% (280/300) and 97.50% (468/480), respectively. The Self-management Behavior Questionnaire for Middle-aged and Young Patients with Myocardial Infarction included 31 items. The total Cronbach 's α coefficient of the questionnaire was 0.918, the half reliability coefficient was 0.853, and the retest reliability coefficient was 0.975. The content validity index of the questionnaire level was 0.965, and the content validity index of the item level was 0.830 to 1.000. Exploratory factor analysis extracted 6 common factors with a cumulative variance contribution rate of 69.795%. Confirmatory factor analysis showed that the model fitted well and the questionnaire factor structure was stable. Conclusions:The Self-management Behavior Questionnaire for Middle-aged and Young Patients with Myocardial Infarction developed in this study has good reliability and validity, which can provide references for medical and nursing staff to evaluate the self-management behavior of middle-aged and young patients with myocardial infarction.

Objective:To evaluate the safety and efficacy of enhanced recovery after surgery(ERAS) in the perioperative period of congenital choledochal cysts in children.Methods:This is a multicenter prospective randomized controlled study. The clinical data of 273 pediatric congenital choledochal cysts(CCC) patients who underwent surgery at 14 medical centers with complete follow-up data were collected through the medical data analysis platform. Among them, 123 cases in ERAS group were managed perioperatively in strict accordance with ERAS mode, and 150 cases in conventional group were managed according to traditional mode. The length of hospital stay,time to first farting, time to complete feeding, the incidence of complications, cost and readmission rate within 30 days,stress indexes and liver function were compared between the two groups.Results:Compared with the conventional group, median time to start farting (2.0 d vs. 3.0 d, P<0.001), median time to complete feeding (5.0 d vs. 7.0 d, P<0.001), median postoperative hospitalization time (6.0 d vs. 9.0 d, P<0.001),the median total length of stay(13.0 d vs. 15.0 d, P<0.001) were shorter,the median hospitalization cost (37,000 yuan vs.43,000 yuan P<0.001) was lower, and stress indexes recovered quickly. The incidence of postoperative hospital stay and readimission rate within 30 d were not statistically different between the two groups. Conclusion:It is safe and feasible to implement ERAS for children with CCC in the perioperative period, which can reduce stress response, speed up recovery,and save medical costs.

Ras-related C3 botulinum toxin substrate 1 (Rac1) is a member of the small Rho guanosine triphosphatase (GTPase) family, having GTPase activity and serving as a " molecular switch" in a variety of cell signal transduction processes.It is involved in cell migration, adhesion, proliferation and apoptosis.Rac1 can affect the migration of neural crest cells through regulating the actin polymerization of neural crest cells and the formation of membrane protrusions, possibly leading to disorders related to abnormal neural crest migration, such as congenital megacolon and cardiac outflow tract defects.In this article, the main biological functions of Rac1 and its role in the mechanism of ente-ric neural crest cell development were described.