Objective:To analyze the epidemiological characteristics of respiratory syncytial virus (RSV) among children in Hebei from 2019 to 2023.Methods:A total of 46 576 lower respiratory tract specimens were collected from hospitalized children in the Children′s Hospital of Hebei Province from 2019 to 2023. Multiple RT-PCR and capillary electrophoresis were used to detect 13 common respiratory pathogens in the specimens, and the results were statistically analyzed.Results:The overall positive rate of RSV was 18.76%(8 739/46 576). The overall positive rates of RSV in male and female children were 18.84%(5 174/27 462) and 18.65%(3 565/19 114), respectively, showing no statistically significant difference between genders (χ 2=0.916, P=0.339). A linear relationship was found between the positive rate of RSV and age ( P<0.01). There was a significant difference in the positive rates of RSV in different years (χ 2=723.71, P<0.01). The positive rate of RSV peaked in the period from December to February from 2019 to 2021. In 2019 and 2020, the positive rates of RSV were very low from May to October, while the positive rate of RSV was above 10% throughout the whole year of 2021 and small off-season epidemics occurred in May and August. The positive rate of RSV was low in 2022, and no significant seasonal change was observed. The rate of RSV infections peaked from April to June in 2023. There were significant differences in the rates of RSV infections before, during and after the COVID-19 epidemic in each age group ( P<0.01). The rate of mixed infections was 29.20%(2 522/8 739), and the most common other respiratory pathogen was human rhinovirus (52.29%, 1 342/2 552 ). Conclusions:RSV is a common pathogen causing respiratory tract infections in children in Hebei, especially in children under 3 years old. After the COVID-19 epidemic, there are off-season RSV epidemics. Given the variations in the epidemiological features of RSV, it is necessary to carry out continuous monitoring of RSV to provide scientific data for the prevention and control of related diseases.

Objective:To develop a limb function exercise program for patients on extracorporeal membrane oxygenation (ECMO) and provide theoretical guidance for clinical nursing staff.Methods:A research team was formed to systematically review domestic and international literature on functional exercise for ECMO patients, extracting relevant evidence to form the initial version of the limb function exercise program. From June to July 2023, the Delphi method was used to conduct two rounds of expert consultations with 18 experts from three provinces and municipalities directly under the central government, including Shanghai, Jiangsu, and Shanxi. Based on the experts' feedback, the program items were revised to form the final version of the exercise program.Results:In the first round, 18 experts were consulted, with a valid response rate of 94.44% (17/18); in the second round, 17 experts participated, with a 100.00% (17/17) response rate. The expert authority coefficient was 0.859 in both rounds. The coefficient of variation for each level of indicator in the second round ranged from 0 to 0.160, and Kendall's coefficient of concordance was 0.092 to 0.130 ( P<0.01). The final ECMO patient limb function exercise program consisted of four primary indicators (preparation, assessment, exercise methods, and safety monitoring), 13 secondary indicators, and 44 tertiary indicators. Conclusions:The ECMO patient limb function exercise program developed in this study is scientifically sound and reliable, offering a reference and guidance for the implementation of limb function exercises for ECMO patients.

The interventional therapy of vascular stent implantation is a popular treatment method for cardiovascular stenosis and blockage. However, traditional stent manufacturing methods such as laser cutting are complex and cannot easily manufacture complex structures such as bifurcated stents, while three-dimensional (3D) printing technology provides a new method for manufacturing stents with complex structure and personalized designs. In this paper, a cardiovascular stent was designed, and printed using selective laser melting technology and 316L stainless steel powder of 0-10 µm size. Electrolytic polishing was performed to improve the surface quality of the printed vascular stent, and the expansion behavior of the polished stent was assessed by balloon inflation. The results showed that the newly designed cardiovascular stent could be manufactured by 3D printing technology. Electrolytic polishing removed the attached powder and reduced the surface roughness Ra from 1.36 µm to 0.82 µm. The axial shortening rate of the polished bracket was 4.23% when the outside diameter was expanded from 2.42 mm to 3.63 mm under the pressure of the balloon, and the radial rebound rate was 2.48% after unloading. The radial force of polished stent was 8.32 N. The 3D printed vascular stent can remove the surface powder through electrolytic polishing to improve the surface quality, and show good dilatation performance and radial support performance, which provides a reference for the practical application of 3D printed vascular stent.
Humans ; Stainless Steel ; Powders ; Cardiovascular System ; Constriction, Pathologic

Objective To investigate the clinical correlations between mechanical power (MP) and lung ultrasound score (LUS), and analyze their evaluation value of prognosis in patients with acute respiratory distress syndrome (ARDS). Methods Patients with moderate to severe ARDS, who underwent invasive mechanical ventilation admitted to intensive care unit (ICU) of the Lianyungang Affiliated Hospital of Xuzhou Medical University from January 2017 to March 2019 were enrolled. The MP and LUS were recorded 0, 24, 48 and 72 hours after ICU admission. The patients were divided into death group and survival group according to the 28-day prognosis. The trends of MP and LUS in the two groups and their differences between groups were analyzed. Then the MP and LUS were analyzed by bivariate correlation analysis, and their correlations with acute physiology and chronic health evaluationⅡ (APACHEⅡ), sequential organ failure assessment (SOFA), oxygenation index (PaO2/FiO2), and blood lactate (Lac) were also analyzed. The predictive value of MP and LUS 0 hour and 72 hours in ICU for 28-day mortality in patients with moderate to severe ARDS was analyzed by receiver operating characteristic (ROC) curve. Results At the end, 83 patients were enrolled, with 32 died and 51 survived in 28-day. The Lac level, APACHEⅡ and SOFA in the death group were significantly higher than those in the survival group, while PaO2/FiO2 was significantly lower than the survival group, and the other baseline indicators were not statistically significant between the two groups. As the treatment time increased, the MP and LUS of the survival group showed a significant decrease trend, while the death group showed a significant upward trend. The MP and LUS of the death group 0, 24, 48, 72 hours after ICU admission were significantly higher than those of the survival group [MP (J/min): 20.97±3.34 vs. 17.20±4.71, 21.56±3.48 vs. 16.87±3.85, 22.72±2.97 vs. 16.13±3.52, 25.81±3.46 vs. 15.24±3.78; LUS: 19.17±3.31 vs. 16.27±4.28, 20.28±3.65 vs. 15.27±3.23, 21.53±4.32 vs. 13.63±3.71, 23.94±3.82 vs. 12.53±2.94, all P < 0.05]. There was a significant positive correlation between MP and LUS 0, 24, 48, 72 hours after ICU admission (r value was 0.547, 0.577, 0.754, and 0.783, respectively, all P < 0.01). The MP and LUS at 0 hour of ICU admission were significantly positively correlated with SOFA and PaO2/FiO2 (r value was 0.421, 0.450, and 0.409, 0.536, respectively, all P < 0.01), but no correlation with Lac and APACHEⅡ was found. The ROC curve analysis showed that the MP and LUS at 0 hour and 72 hours had predictive value for the 28-day mortality [the area under the ROC curve (AUC) of MP was 0.836, 0.867; and the AUC of LUS was 0.820, 0.891, all P < 0.01]. Conclusions There was a significant correlation between MP and LUS in patients with moderate to severe ARDS. The MP and LUS could be used early to evaluate the 28-day prognosis of patients with moderate to severe ARDS.

Objective: To systematic review the effect of preoxygenation (PreOx) and apnoeic oxygenation (ApOx) during intubation in the critically ill patients by network Meta-analysis. Methods: The PubMed, Embase, the Cochrane Library, CNKI and Wanfang Data were searched by computer to collect randomized controlled trials (RCT) of PreOx and ApOx techniques in the intensive care unit (ICU) from inception to January 30th, 2019. PreOx techniques (p) included nasal cannula (NC), high flow nasal cannula (HFNC), bag valve mask (BVM), bi-level positive airway pressure (BiPAP), non-rebreather mask (NRM) and non-invasive ventilation (NIV), etc.; ApOx technique (a) referred to HFNC. Experimental group strategy was PreOx combined with ApOx, and control group strategy was PreOx alone. The outcomes were as follows: the lowest value of pulse oximetry (SpO₂) during the intubation procedure, the incidence of severe desaturations (SpO₂ < 0.80), and severe intubation-related complications [including SpO₂ < 0.80, systolic blood pressure < 80 mmHg (1 mmHg = 0.133 kPa), vasopressor 30% dose increment, cardiac arrest and death]. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistic analysis was performed by RevMan 5.3 software, Stata 15.1 software and WinBUGS 1.4.3 software. Results: A total of 7 RCTs involving 796 patients were included. Meta-analysis showed that, compared with the control group, the lowest SpO₂ in the experimental group was significantly increased [mean difference (MD) = 1.42, 95% confidence interval (95%CI) was 0.60 to 2.25, P = 0.000 7], the incidence of severe complications was significantly decreased [odds ratio (OR) = 0.54, 95%CI was 0.32 to 0.92, P = 0.02], but the incidence of SpO₂ < 0.80 did not improve significantly (OR = 0.65, 95%CI was 0.40 to 1.05, P = 0.08). The network Meta-analysis showed that, compared with non-pressure mask (NPM)p, (HFNC+NIV)p+HFNCa (OR = 51.20, 95%CI was 2.06 to 3 518.68) and NIVp (OR = 5.80, 95%CI was 1.25 to 34.70) had a significant reduction in the incidence of SpO₂ < 0.80 (both P < 0.05). There were no significant differences in the incidence of severe complications during intubation among (HFNC+NIV)p+HFNCa, HFNCp+HFNCa, NIVp and NPMp. The occurrence rate of SpO₂ < 0.80 and severe complications using different oxygenation techniques decreased sequentially in NPMp, HFNCp+HFNCa, NIVp and (HFNC+NIV)p+HFNCa. Conclusion (HFNC+NIV)p+HFNCa should be of a priority choice for critically ill patients during intubation.

Objective: To investigate the value of mechanical power (MP) to predict the potential of the lung recruitment maneuver and assess prognoses in patients with acute respiratory distress syndrome (ARDS). Methods: Patients with moderate-to-severe ARDS who required mechanical ventilation therapy longer than 24 hours were randomly selected April 2017 to April 2019. The lung recruitment maneuver (RM) protocol was performed according to the patient's condition, their MP, lung ultrasound score (LUS), oxygenation index (P/F), and dead volume ratio (Vd/Vt), which were monitored before the RM and one hour after the RM. The patients were divided into the lung recruitment maneuver potential positive group (RMP-P group) and lung recruitment maneuver potential negative group (RMP-N group) according to whether the variation in the patient's RM aeration score (ΔLUS) was≥5. Differences in MP between the two groups were compared and correlations between MP variation (ΔMP), aeration score variation (ΔLUS), oxygenation index variation (ΔP/F), and dead volume ratio variation (ΔVd/Vt) were analyzed. The receiver operating characteristic curve (ROC) was used to calculate the predictive value of MP for the potential of RM and the prognosis (28-day mortality) of patients with moderate or severe ARDS. Results: Eighty-three patients were enrolled in the study, 45 in the RMP-P group and 38 in the RMP-N group. There was no statistical difference in the baseline levels between the two groups (P>0.05). After RM treatment, MP, LUS scores, and Vd/Vt for each patient in the two groups decreased significantly compared to the pre-RM values, whereas, the P/F increased significantly (P<0.05). The MP, LUS scores, and Vd/Vt in the RMP-P group were significantly lower than those in the RMP-N group (P<0.05), whereas there was no difference in the P/F between the two groups after RM treatment (P>0.05). The ΔMP, ΔLUS, and ΔVd/Vt in the RMP-P group were significantly higher than those in the RMP-N group (P<0.05). There was no difference in the ΔP/F between the two groups (P>0.05). There was a significant positive correlation between ΔMP and ΔLUS and ΔVd/Vt in all patients (r=0.4746, 0.3995, P<0.01) and no significant correlation withΔP/F (r=0.0314, P>0.05). The area under the ROC curves of ΔMP for predicting the potential of RM was 0.856, with a sensitivity of 91.1% and a specificity of 63.2%. The AUC of the 28-day survival status was 0.788, with a sensitivity of 84.3% and a specificity of 62.5% (P<0.05). Conclusions Mechanical power monitoring before and after RM can be used to predict the potential of the lung recruitment maneuver and assess the prognosis in patients with moderate-to-severe ARDS.

PURPOSE: Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone administered every 3 weeks (R-CHOP-21) is the standard care for diffuse large B-cell lymphoma (DLBCL). It is unknown whether the dose-dense R-CHOP (R-CHOP-14) could improve the outcome of the disease in Asian population. MATERIALS AND METHODS: Newly diagnosed DLBCL patients were centrally, randomly assigned (1:1) to receive R-CHOP-14 or R-CHOP-21. R-CHOP-14 was administered every 2 weeks, and R-CHOP-21 was administered every 3 weeks. Primary end point was disease-free survival (DFS). Secondary end points included overall survival (OS), progression-free survival (PFS), response rate and toxicities. RESULTS: Seven hundred and two patients were randomly assigned to receive R-CHOP-14 (n=349) or R-CHOP-21 (n=353). With a median follow-up of 45.6 months, the two groups did not differ significantly in 3-year DFS (79.6% for R-CHOP-14 vs. 83.2% for R-CHOP-21, p=0.311), 3-year OS (77.5% for R-CHOP-14 vs. 77.6% for R-CHOP-21, p=0.903), or 3-year PFS (63.2% for R-CHOP-14 vs. 66.1% for R-CHOP-21, p=0.447). Patients with an International Prognostic Index (IPI) score ≥ 2 had a poorer prognosis compared to those with an IPI score < 2. Grade 3/4 hematologic and non-hematologic toxicities were manageable and similar between R-CHOP-14 and R-CHOP-21. CONCLUSION: R-CHOP-14 did not improve the outcome of DLBCL compared to R-CHOP-21 in Asian population. With manageable and similar toxicities, both of the two regimens were suitable for Asian DLBCL patients. For high-risk patients with IPI ≥ 2, new combination regimens based on R-CHOP deserve further investigation to improve efficacy.
Asian Continental Ancestry Group ; B-Lymphocytes ; Cyclophosphamide ; Disease-Free Survival ; Doxorubicin ; Follow-Up Studies ; Humans ; Lymphoma, B-Cell ; Prednisone ; Prognosis ; Rituximab ; Vincristine

OBJECTIVE: To systematic review the effect of preoxygenation (PreOx) and apnoeic oxygenation (ApOx) during intubation in the critically ill patients by network Meta-analysis. METHODS: The PubMed, Embase, the Cochrane Library, CNKI and Wanfang Data were searched by computer to collect randomized controlled trials (RCT) of PreOx and ApOx techniques in the intensive care unit (ICU) from inception to January 30th, 2019. PreOx techniques (p) included nasal cannula (NC), high flow nasal cannula (HFNC), bag valve mask (BVM), bi-level positive airway pressure (BiPAP), non-rebreather mask (NRM) and non-invasive ventilation (NIV), etc.; ApOx technique (a) referred to HFNC. Experimental group strategy was PreOx combined with ApOx, and control group strategy was PreOx alone. The outcomes were as follows: the lowest value of pulse oximetry (SpO₂) during the intubation procedure, the incidence of severe desaturations (SpO₂< 0.80), and severe intubation-related complications [including SpO₂< 0.80, systolic blood pressure < 80 mmHg (1 mmHg = 0.133 kPa), vasopressor 30% dose increment, cardiac arrest and death]. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistic analysis was performed by RevMan 5.3 software, Stata 15.1 software and WinBUGS 1.4.3 software. RESULTS: A total of 7 RCTs involving 796 patients were included. Meta-analysis showed that, compared with the control group, the lowest SpO₂ in the experimental group was significantly increased [mean difference (MD) = 1.42, 95% confidence interval (95%CI) was 0.60 to 2.25, P = 0.000 7], the incidence of severe complications was significantly decreased [odds ratio (OR) = 0.54, 95%CI was 0.32 to 0.92, P = 0.02], but the incidence of SpO₂ < 0.80 did not improve significantly (OR = 0.65, 95%CI was 0.40 to 1.05, P = 0.08). The network Meta-analysis showed that, compared with non-pressure mask (NPM)p, (HFNC+NIV)p+HFNCa (OR = 51.20, 95%CI was 2.06 to 3 518.68) and NIVp (OR = 5.80, 95%CI was 1.25 to 34.70) had a significant reduction in the incidence of SpO₂ < 0.80 (both P < 0.05). There were no significant differences in the incidence of severe complications during intubation among (HFNC+NIV)p+HFNCa, HFNCp+HFNCa, NIVp and NPMp. The occurrence rate of SpO₂ < 0.80 and severe complications using different oxygenation techniques decreased sequentially in NPMp, HFNCp+HFNCa, NIVp and (HFNC+NIV)p+HFNCa. CONCLUSIONS (HFNC+NIV)p+HFNCa should be of a priority choice for critically ill patients during intubation.
Critical Illness ; Humans ; Intubation, Intratracheal ; Network Meta-Analysis ; Noninvasive Ventilation ; Oxygen Inhalation Therapy ; Respiratory Insufficiency

Objective To investigate the correlation between blood flow velocity and respiratory variability in different parts of left heart of patients with sepsis via measuring the flow velocity of the E-wave of mitral valve (MV), peak flow velocity of left ventricular outflow tract (LVOT), and respiratory variability (ΔVpeak) by ultrasonography. Methods Totally 81 patients with sepsis hospitalized in ICU were chosen consecutively from March 2017 to October 2017. Each patient's flow velocity of the E-wave of mitral valve and peak flow velocity of LVOT was inspected, by apical four-chamber view and apical five-chamber view respectively, to calculate the respiratory variability. Results (1) Of the 81 patients with sepsis, 33 patients (40.7％) had complete control of mechanical ventilation (no spontaneous breathing trigger), and 48 patients (59.3％) had spontaneous breathing and incomplete control of mechanical ventilation (partial spontaneous breathing trigger). (2) There was no significant difference in the mean values of flow velocity of the E-wave of mitral valve and peak flow velocity of LVOT in patients with sepsis. Whereas the flow velocity of the E-wave of mitral valve (0.15±0.05) was greater than the peak flow velocity of LVOT (0.12±0.04) with statistical significance (P<0.01). In sepsis patients with complete control of mechanical ventilation (no spontaneous breathing trigger), respiratory variability in the flow velocity of the E-wave of mitral valve (0.17±0.06) was significantly greater than the peak flow velocity of LVOT (0.11±0.03), P<0.01, whereas in sepsis patients with incomplete control of mechanical ventila tion (partial spontaneous breathing trigger), there was no statistically significant difference between the respiratory variability in flow velocity of the E-wave of mitral valve (0.14±0.04) and in the peak flow velocity of LVOT (0.13±0.03), P=0.102. (3) The respiratory variability in flow velocity of the E-wave of mitral valve was correlated with the peak flow velocity of LVOT (r=0.670, P<0.01). The flow velocity of the E-wave of mitral valve was all correlated with the peak flow velocity of LVOT in both sepsis patients with complete control of mechanical ventilation (no spontaneous breathing trigger) (r=0.894, P<0.01), and sepsis patients with incomplete control of mechanical ventilation (partial spontaneous breathing trigger) (r=0.774, P<0.01), respectively. Conclusions The respiratory variability in flow velocity of the E-wave of mitral valve was correlated with that in the peak flow velocity of LVOT, which may provide a new indicator in evaluating the fluid responsiveness of patients with sepsis.

Objective To explore whether the norepinephrine transporter(NET) gene T-182C and G1287A polymorphisms are involved in the etiology of schizophrenics among the Chinese Han population.Methods 249 schizophrenics(case group) and 309 healthy physical examiners(control group) of the Chinese Han population were collected.Ligase detection reaction was used to detect the genotype distributions and allele frequencies of NET rs2242446 and rs5569 polymorphisms in the two groups.The genotype distributions and allele frequencies of these two single nucleotide polymorphisms (SNPs) were also compared in the case and control groups.Results In the case group,the TF genotype of the NET gene loci rs2242446 was the most,48.6％,and the CC genotype of which was the least,8.4％.In the control group,the CT genotype was the most,47.9％,and the C C genotype was the least,11.3％,the minimum allele frequency was 29.9％.In the case group,the GG genotype of the NET gene loci rs5569 was the most,46.2％,and the CC genotype was the least,9.6％.In the control group,GG genotype was the most,51.5％,and the AA genotype was the least,10.3％,and the minimum allele frequency was 29.4％.No significant differences in the genotype and allele distribution of NET rs2242446 and rs5569 were found in Chinese-Han patients with schizophrenia and control participants (all P＞ 0.05).In gender-specific analyses,similarly,no significant differences were found for rs2242446 and rs5569 genotype and allele distributions in either the male or the female case-control comparisons (all P＞ 0.05).Conclusion The NET rs2242446 and rs5569 polymorphisms are not associated with schizophrenia in Chinese Han population.