Objective:To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods:The prospective multicenter study was conducted in Zhejiang, China from May 1 st, 2019 to January 31 st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results:A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P<0.01). Conclusion:In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

Cardiovascular diseases(CVDs)are a leading factor driving mortality worldwide.Iron,an essential trace mineral,is important in numerous biological processes,and its role in CVDs has raised broad discussion for decades.Iron-mediated cell death,namely ferroptosis,has attracted much attention due to its critical role in cardiomyocyte damage and CVDs.Furthermore,ferritinophagy is the upstream mechanism that induces ferroptosis,and is closely related to CVDs.This review aims to delineate the processes and mechanisms of ferroptosis and ferritinophagy,and the regulatory pathways and molecular targets involved in ferritinophagy,and to determine their roles in CVDs.Furthermore,we discuss the possibility of targeting ferritinophagy-induced ferroptosis modulators for treating CVDs.Collectively,this review offers some new insights into the pathology of CVDs and identifies possible therapeutic targets.

Objective:To explore the effects of small-group collaborative stratified teaching in critical care medicine training for professional postgraduate students.Methods:We randomly assigned 71 professional postgraduate students who entered the Intensive Care Unit of The Affiliated Hospital of Qingdao University for standardized training between June 2020 and November 2020 into experimental group and control group. An entrance examination was taken after one week of unified training. Then the experimental group adopted small-group collaborative stratified teaching, while the control group adopted traditional teaching for training. After two months of training, the Mini-Clinical Evaluation Exercise (Mini-CEX) assessment, post competency assessment, exit examination, and teaching satisfaction evaluation were conducted. SPSS 25.0 was used for the t test and chi-square test. Results:In the Mini-CEX assessment, the experimental group had significantly higher scores in history-taking skills [(7.42±0.60) vs. (7.00±0.55)], physical examination [(7.47±0.56) vs. (6.94±0.24)], communication skills [(7.56±0.50）vs.(7.24±0.49)], clinical dialectical thinking [(7.53±0.56) vs. (7.03±0.39)], clinical judgement [(7.50±0.51) vs.(6.90±0.42)], organization/efficiency [(7.58±0.50) vs. (7.15±0.44)], and overall clinical competence [(7.64±0.49) vs. (7.17±0.39); all P<0.05] than the control group. In the post competency assessment, the experimental group had significantly better performance in clinical basic competence [(89.15±9.12) vs. (86.24±10.23)], medical knowledge application [(48.37±5.87) vs. (46.98±3.68)], teamwork [(48.10±3.55) vs. (45.96±4.83)], information and management [(68.52±7.61) vs. (66.38±5.54)], and academic research [(22.18±0.95) vs. (20.87±1.22); all P<0.05] than the control group. The experimental group was also significantly superior to the control group in terms of the exit examination score and teaching satisfaction (both P<0.05). Conclusions:Small-group collaborative stratified teaching can improve the quality of critical care medicine training for professional postgraduate students, and strengthen their clinical comprehensive abilities and post competencies.

Objective:To look for the problems faced in the construction of the tele-critical care system, explore the framework of construction of the tele-critical care system, and verify the application effects of the established tele-critical care system.Methods:Through literature review and on-site investigation and demonstration, the causes affecting the construction of the tele-critical care system were explored. Through on-site investigation of the actual situation of the critical care department in relevant hospitals, arguing and choosing intended intensive care unit (ICU) and cooperative third-party communication and equipment companies, and through the Internet of Things and 5G communication technology, a tele-critical care system with the core hospital of the group as the center and the member institutes within the group as the nodes was built. Via the established tele-critical care system, activities such as tele-monitoring, visual remote ward rounds, remote consultation, remote teaching were carried out to verify the functions of the system.Results:The insufficient cognition of relevant personnel, tele-medicine practice certification requirements, information security issues and the barriers of equipment information integration were the main causes affecting the construction of tele-critical care system. There were five parts in the tele-critical care system architecture foundations, including bed unit equipment and audio and video information collection system, lossless and secure transmission of collected information, real-time display of information in the remote center, real-time staff interaction between the centre and the nodal hospitals, and information cloud storage. It has been verified that patients' diagnostic and treatment information can be transmitted safely, losslessly and in real-time by a special line through private 5G network. Through this system, real-time and stable upload of audio and video information of patients and application information of monitors, ventilators and infusion work stations can be achieved; combined with tele-conference connections to conduct two-way communication with local medical staff, real-time tele-monitoring, visual remote ward rounds, remote consultation, remote teaching and other functions can be achieved.Conclusion:The tele-critical care system we established is feasible to construct within the medical group and can safely and effectively realize the functions of real-time tele-monitoring, visual remote ward rounds, remote consultation, and remote teaching.

Objective:To summarize the establishment and management experience of extracorporeal membrane oxygenation (ECMO) rapid response team, and explore a more efficient rescue mode.Methods:From January 2015 to September 2020, 85 patients treated with ECMO in Affiliated Hospital of Qingdao University were selected as the research objects. Thirty-eight patients treated with conventional ECMO from January 2015 to December 2019 were selected as the control group, and 47 patients treated with ECMO rapid response team from January 2020 to September 2020 were selected as the experimental group. The differences in team preparation time, catheterization time, treatment success rate, incidence of complications and equipment failure frequency between the two groups were compared.Results:There were no significant differences in gender, age or disease types between the two groups. The team preparation time and catheterization time of the experimental group were significantly shorter than those of the control group [team preparation time (minutes): 31.79±6.10 vs. 67.16±30.49, catheterization time (minutes): 40.62±7.13 vs. 84.89±19.29], and the incidence of complications was significantly lower than that of the control group [4.3% (2/47) vs. 21.1% (8/38)], and the differences were statistically significant (all P < 0.05). Conclusion:ECMO rapid response team can shorten the rescue preparation time, reduce the occurrence of complications, improve the team treatment efficiency, and provide ideas for emergency and critical patients.

Moschus chrysogaster (sifanicus) viral hemorrhagic disease (McVHD) is an acute and highly lethal infectious disease caused by Moschus chrysogaster hemorrhagic disease virus (McHDV) whose genome sequence is highly homologous with rabbit hemorrhagic disease virus. To screen the protective antigen of McHDV and set the basis for study of McVHD vaccine, the antigen epitope of major structural protein VP60 of McHDV was analyzed, and the specific primers were designed to obtain three amplified DNA sequences encoding the main antigen epitope of VP60 from McHDV by using RT-PCR. Then the three DNA fragments were sequenced and cloned to prokaryotic expression vector with pET-28a(+) by using overlap extension PCR, and finally the prokaryotic expression plasmid pET-truncated-VP60 was constructed. Subsequently, the pET-truncated-VP60 was transformed into Escherichia coli BL21(DE3), and the recombinant proteins were expressed by IPTG induction. Finally, the expressed protein was purified and applied to immunize that without immunizing with RHD vaccine, then the antiserum titers were evaluated by the hemagglutination inhibition test, and the immune-protective efficacy of the recombinant proteins was observed and analyzed through animal challenge test. The results showed that the multi-epitope DNA fragments of VP60 of McHDV was successfully expressed in the form of inclusion bodies in E. coli, and the relative molecular weight of recombinant proteins is about 45 kDa. After immunized with the recombinant proteins, 100% of New Zealand white rabbits were resistant to attack of McHDV, which indicates efficient immune-protective efficacy of chosen epitope recombinant protein. The study laid a foundation for the development of the new subunit vaccines of McVHD.

Objective:To observe the impact of application of ward rounds checklist on the post competency of residents in the standardized residency training of critical care medicine.Methods:From April 2016 to January 2017, different batches of residents who were admitted to the Department of Critical Care Medicine for standardized residency training were randomized into the experimental group and the control group. Both groups were taught by experienced ICU senior attending physicians one-to-one. The control group routinely conducted rounds and handovers. The experimental group implemented a ward rounds checklist system during rounds and handovers. The training time for each group was 2 months. According to the characteristics of ICU combined with the requirements of post competency, a questionnaire was formulated. SPSS 17.0 was used for t test and chi-square test. Results:The resident physicians in the experimental group gave more satisfactory evaluations in terms of the actual patient care ability, medical knowledge mastery, clinical work under the system, learning and improvement from work, professional literacy, and communication skills to reflect the post competency, and had relatively higher degree of satisfaction with the teaching training, all with statistical significance ( P<0.05). Conclusion:It's helpful to improve the post competency and teaching satisfaction of ICU residents by implementing the ward rounds checklist system during the rotation of resident physicians in the standardized residency training of critical care medicine.

OBJECTIVETo explore the efficacy of video-assisted anal fistula treatment (VAAFT) in treatment of complex anal fistula.

METHODSClinical data of 87 patients with complex anal fistula undergoing operation at Department of General Surgery, the Second Affiliated Hospital of Suzhou University from September 2015 to December 2016 were collected to conduct a cohort study. The operative procedure depended on economic conditions and patient preference. Patients were divided into VAAFT group (42 cases) and traditional fistula resection plus seton (FRS) group (45 cases). The procedure of FRS was to completely remove the fistula along external wall, the inner opening and surrounding scar tissues, then, the inner opening was closed with absorbable suture. For deeper and more complex fistula, the above procedure should be combined with seton. Based on the concept of endoscopic minimally invasive surgery, VAAFT could deal with the fistula and inner opening under direct vision. The brief steps were as follows: insertion of the anal fistula scope through external opening into the fistula; continuous injection of glycine-mannitol solution to expand and clean the foul fistula; electrocoagulation of all lesions; clearance of burnt tissues from the lumen with endoscopic brush and forceps; injection of medical fibrin glue through the inner opening; closing the inner opening by suture. Intraoperative and postoperative indices were compared between two groups.

RESULTSVAAFT group included 33 males and 9 females with mean age of (37.4±13.5) years, mean BMI of (24.3±3.2) kg/m, and mean disease course of (4.8±3.9) months. Of 42 cases, 5 had preoperative diabetes mellitus, 31 were high fistula and 11 were low fistula. FRS group included 32 males and 13 females with mean age of (42.1±15.6) years, mean BMI of (24.8±3.7) kg/m, and mean disease course of (5.7±3.6) months. Of 45 cases, 4 had preoperative diabetes mellitus, 37 were high fistula and 8 were low fistula. There were no significant differences in baseline data between two groups(all P>0.05). Compared with FRS group, VAAFT group had significantly shorter operative time [(44.6±10.5) minutes vs. (57.4±12.3) minutes, t=5.203, P=0.000], lower incidence of postoperative bleeding (14.3% vs. 33.3%,χ²=4.304, P=0.038), less pain (Visual Analogue Scale,VAS) (2.9±1.8 vs. 7.3±1.2, t=13.500, P=0.000), faster pain relief [(1.0±0.8) days vs. (4.5±1.2) days, t=15.890, P=0.000] and shorter hospital stay [(4.1±3.5) days vs.(7.5±2.3) days, t=5.389, P=0.000]. However, there were no significant differences between two groups in urinary retention rate, first postoperative fecal time and postoperative infection rate(all P>0.05). All patients were followed up for more than 6 months, FRS group had significantly higher incidence of anal incontinence than VAAFT group (20.0% vs. 2.4%, Fisher P=0.015). However, no significant difference in recurrence rate was found between VAAFT and FRS group(7.1% vs. 15.6%, Fisher P=0.317).

CONCLUSIONSCompared to traditional FRS treatment, VAAFT possesses some advantages in less injury, less pain, faster recovery, and lower postoperative anal incontinence rate. Thus, VAAFT is a superior operative choice in treatment of patients with complex anal fistula.

Adult ; Cohort Studies ; Fecal Incontinence ; Female ; Humans ; Male ; Middle Aged ; Rectal Fistula ; surgery ; Treatment Outcome ; Video-Assisted Surgery ; Young Adult

ObjectiveTo explore clinical effect and safety ofShaoyao-Gancao decoction combined withSiwu decoction for the patients with diabetic peripheral neuropathy (DPN).MethodsA total of 76 patients with DPN in our hospital from 2013 July to October 2015 were divided into control group and observation group by the random number method, 38 patients in each group. The control group were treated with conventional treatment combined with oryzanol injection, and the observation group were treated with Shaoyao-Gancaodecoction combined withSiwu decoction on the basis of control group. Both groups were treated for one month. The level of FPG, 2 hPG, HbAlc, TC, TG, LDL-C and HDL-C was detected respectively before and after treatment. The whole blood viscosity and plasma viscosity was detected with LBY-N6A self-cleaning rotary viscosimeter. The red blood cells deposited and platelet aggregation rate were tested with Winchester points vascular method and turbidimetric method, respectively.The leg nerve and sural nerve of nerve conduction velocity (nerve conduction velocity, NCV) were determined with electromyography, at the same time the clinical curative effect was evaluted.ResultsTotal effect rate of observation group was 89.5% (34/38), which was significantly higher than the control group 71.1% (27/38), and the difference was statistically significant (χ2=4.070,P=0.044); After treatment, the levels of FPG (6.12 ± 0.38 mmol/Lvs.6.58 ± 0.52 mmol/L, t=4.403), 2 hPG (7.83 ± 0.82 mmol/Lvs. 8.41 ± 0.93 mmol/L,t=2.884), HbAlc (6.27 ± 0.52%vs. 6.82 ± 0.64%, t=4.112) in the observation group were lower than those in the control group (P<0.05). The levels of TC (4.73 ± 0.83 mmol/L vs. 5.11 ± 0.64 mmol/L,t=52.235), TG (1.83 ± 0.35 mmol/Lvs. 2.03 ± 0.41 mmol/L, t=2.287) and LDL-C (2.91 ± 0.54 mmol/Lvs. 3.25 ± 0.58 mmol/L,t=2.645) in the observation group were lower than those in the control group (P<0.05), and the HDL-C (1.47 ± 0.33 mmol/Lvs. 1.26 ± 0.31 mmol/L,t=-2.859) in the observation group was higher than than that in the control group(P<0.05). The level of whole blood specific viscosity (10.16 ± 2.12 mPa?svs. 11.33 ± 2.51 mPa?s,t=2.195), plasma viscosity (1.24 ± 0.25 mPa?svs. 1.62 ± 0.37 mPa?s,t=5.246), red blood cell volume (0.31 ± 0.16L/Lvs. 0.42 ± 0.08 L/L,t=3.791) and platelet aggregation rate (50.21% ± 8.03%vs. 54.16% ± 7.82%,t=2.172) in the observation group were significantly lower than those in control group (P<0.05). The tibial nerve velocity (45.22 ± 3.20 m/svs. 38.26 ± 5.19 m/s,t=-7.037) and the common nerve velocity (43.22 ± 6.34 m/svs. 36.23 ± 4.81,t=-5.415) in the observation group were as significantly higher than those in control group (P<0.05).ConclusionsThe Shaoyao-Gancaodecoction combined withSiwu decoction could improve the state of blood sugar, blood lipid and blood rheology of patients with DPN, and improve nerve transfer speed of leg nerve and sural nerve, the curative effect is better than conventional western medicine therapy alone.

Objective To investigate the basic perceptions, attitudes and needs towards delirium among ICU professionals in Shandong province, so that to help the ICU supervisors design target training for ICU professionals. Methods A survey was employed utilizing a self-designed questionnaire among 917 ICU professionals(doctors and nurses) from 62 hospitals in Shandong province. Results The score of ICU professionals′ basic perception and behavioral attitude concerning ICU delirium were (24.56 ± 6.36) and (19.00 ± 3.01) points respectively. The score had significant positive correlation and indicates statistic significance (r=0.53, P<0.01). Academic, work experience and title had influence on the score of basic perception (F=14.49, 26.25, 40.16, P<0.05), work experience, category of ICU, title and category of hospital were the effect on the score of behavior and attitude (F=11.87, 8.64, 6.55, P<0.05;t=4.81, P<0.05). The lower rate of correct responding to knowledge of ICU delirium were as follows:the correct rate of delirium in ICU of typing to 56.92%(522/917); the clinical manifestations of ICU delirium accuracy 65.32%(599/917); andrisk factors for delirium in ICU of the correct rate for 70.34%(645/917).ICU professionals acquire knowledge pertaining delirium mainly through lectures, conferences, knowledge brochure , exchange of experience. Conclusions The ICU professionals in Shandong province have less knowledge on ICU delirjum.ICU management should recognize the importance of ICU delirium to strengthen the training of relevant knowledge, enhance delirium management, ensure the patient's safety and improve the prognosis of patients.