Severe pneumonia is one of the most common and critical respiratory diseases in clinical practice. It is characterized by rapid progression， difficult treatment， high mortality， and many complications， posing a significant threat to the life and health of patients. The pathogenesis of severe pneumonia is highly complex， and studies have shown that its occurrence and development are closely related to multiple signaling pathways. Currently， the treatment of severe pneumonia mainly focuses on anti-infection， mechanical ventilation， and glucocorticoids， but clinical outcomes are often not ideal. Therefore， finding safe and effective alternative therapies is particularly important. In recent years， with the deepening of research into traditional Chinese medicine （TCM）， it has gained widespread attention in the treatment of severe pneumonia. This paper reviewed the relationship between severe pneumonia and relevant signaling pathways in recent years and how TCM regulated these pathways in the treatment of severe pneumonia. It was found that TCM could regulate the Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor-κB （NF-κB）， Janus kinase （JAK）/signal transducer and activator of transcription （STAT）， phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR）， NOD-like receptor protein 3 （NLRP3）， and nuclear factor E₂-related factor 2 （Nrf2） signaling pathways， playing a role in reducing the inflammatory response， inhibiting cell apoptosis and pyroptosis， improving oxidative stress， and other effects in the treatment of severe pneumonia. Among these pathways， it was found that all of them regulated inflammation to treat severe pneumonia. Therefore， reducing inflammation is the core mechanism by which Chinese medicine treats severe pneumonia. This review provides direction for the clinical treatment of severe pneumonia and offers a scientific basis for the research and development of new drugs.

Objective To identify and analyze the digital supervision issues of cross-province medical treatment in China,and propose countermeasures and suggestions.Methods Using literature research,expert interviews,and questionnaire surveys,from January 29,to February 132023,managers,staff from remote departments of medi-cal insurance bureau and scholar in the field of medical insurance in H province were selected.Principa l component analysis was used to extract questions,and based on the extraction results,a multiple logistic regression model to explore that have a significant impact on the digital supervision of cross-province direct settlement of medical treat-ment.Results The problems of digital supervision of direct settlement for medical treatment across provinces and re-gions in China can be divided into 7 categories,with a cumulative variance contribution rate of 63.17%.The connec-tion of digital regulatory systems,audit rules and early warning issues,as well as the lack of legal systems and defi-nitions have a significant impact on regulatory effectiveness(P＜0.05).Conclusion Incomplete construction of the digital supervision system between the place of insurance participation,and inadequate legal and institutional sateguards for the digital supervision of the direct settlement of cross-provincial cross-district medical consultations.Therefore,strengthening the basic construction of the digital supervision system for cross provincial and cross regional medical direct settlement,and improving the legal system for cross provincial and cross regional medical direct settle-ment digital supervision,have important guiding significance for the digital supervision of cross provincial and cross regional medical direct settlement in China.

Objective:To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes.Methods:The clinical data of children with septic shock in children′s PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results:A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs ( OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions:The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.

Objective:To investigate the clinical features, pathogen composition, and prognosis of septic shock in pediatric intensive care units (PICU) in China.Methods:A multicenter retrospective cohort study. A retrospective analysis was conducted on the clinical data of children with septic shock from 10 hospitals in China between January 2018 and December 2021. The clinical features, pathogen composition, and outcomes were collected. Patients were categorized into malignant tumor and non-malignant tumor groups, as well as survival and mortality groups. T test, Mann Whitney U test or Chi square test were used respectively for comparing clinical characteristics and prognosis between 2 groups. Multiple Logistic regression was used to identify risk factors for mortality. Results:A total of 1 247 children with septic shock were included, with 748 males (59.9%) and the age of 3.1 (0.9, 8.8) years. The in-patient mortality rate was 23.2% (289 cases). The overall pathogen positive rate was 68.2% (851 cases), with 1 229 pathogens identified. Bacterial accounted for 61.4% (754 strains) and virus for 24.8% (305 strains). Among all bacterium, Gram negative bacteria constituted 64.2% (484 strains), with Pseudomonas aeruginosa and Enterobacter being the most common; Gram positive bacteria comprised 35.8% (270 strains), primarily Streptococcus and Staphylococcus species. Influenza virus (86 strains (28.2%)), Epstein-Barr virus (53 strains (17.4%)), and respiratory syncytial virus (46 strains (17.1%)) were the top three viruses. Children with malignant tumors were older and had higher pediatric risk of mortality (PRISM) Ⅲ score, paediatric sequential organ failure assessment (pSOFA) score (7.9 (4.3, 11.8) vs. 2.3 (0.8, 7.5) years old, 22 (16, 26) vs. 16 (10, 24) points, 10 (5, 14) vs. 8 (4, 12) points, Z=11.32, 0.87, 4.00, all P<0.05), and higher pathogen positive rate, and in-hospital mortality (77.7% (240/309) vs. 65.1% (611/938), 29.7% (92/309) vs. 21.0% (197/938), χ2=16.84, 10.04, both P<0.05) compared to the non-tumor group. In the death group, the score of PRISM Ⅲ, pSOFA (16 (22, 29) vs. 14 (10, 20) points, 8 (12, 15) vs. 6 (3, 9) points, Z=4.92, 11.88, both P<0.05) were all higher, and presence of neoplastic disease, positive rate of pathogen and proportion of invasive mechanical ventilation in death group were also all higher than those in survival group (29.7% (87/289) vs. 23.2% (222/958), 77.8% (225/289) vs. 65.4% (626/958), 73.7% (213/289) vs. 50.6% (485/958), χ2=5.72, 16.03, 49.98, all P<0.05). Multiple Logistic regression showed that PRISM Ⅲ, pSOFA, and malignant tumor were the independent risk factors for mortality ( OR=1.04, 1.09, 0.67, 95% CI 1.01-1.05, 1.04-1.12, 0.47-0.94, all P<0.05). Conclusions:Bacterial infection are predominant in pediatric septic shock, but viral infection are also significant. Children with malignancies are more severe and resource consumptive. The overall mortality rate for pediatric septic shock remains high, and mortality are associated with malignant tumor, PRISM Ⅲ and pSOFA scores.

Purpose To explore the application value of clinical-ultrasound parameter model in secondary hyperparathyroidism(SHPT).Materials and Methods A total of 86 patients(134 lesions)with renal insufficiency who underwent maintenance hemodialysis in the First Affiliated Hospital of Shihezi University from October 2020 to August 2022 were included and divided into group 1 according to the level of parathyroid hormone(iPTH)(iPTH＜300 pg/ml),group 2(iPTH 300-800 pg/ml)and group 3(iPTH≥800 pg/ml),all patients underwent gray-scale parathyroid ultrasound and acoustic palpation tissue quantitative imaging examinations.The characteristics of glandular gray-scale ultrasound and virtual touch tissue imaging quantification parameters between different groups,combined with relevant clinical indicators,established a clinical-ultrasound parameter model,used multiple linear regression to analyze the correlation between the model and iPTH,explored the independent risk factors of iPTH,and evaluated this model to evaluate SHPT the value of.Results There were significant differences in dialysis age,phosphorus,alkaline phosphatase,serum creatinine,corrected calcium and phosphorus product,lesion size,number,echo,shear wave velocity(SWV)max,SWVcen,and SWVmean among the three groups(F/x2/H=6.396-53.524,all P＜0.05).Dialysis age,phosphorus,alkaline phosphatase,and SWVratio were independent influencing factors of iPTH level(β=0.514,0.422,0.226,-0.368,all P＜0.005).The area under the curve,sensitivity,specificity and accuracy of the model for diagnosing SHPT and predicting surgical treatment with iPTH levels of 300 pg/ml and 800 pg/ml were 0.967,95.00％,100.00％,97.73％and 0.824,77.42％,71.43％and 90.00％,respectively.Conclusion Dialysis age,phosphorus,alkaline phosphatase and SWVratio are independent influencing factors of iPTH level,and the clinical-ultrasound parameter model is of great value in accurately assessing the severity of SHPT.

Ferroptosis is a novel iron-dependent mode of programmed cell death characterized by iron deposition and accumulation of lipid peroxidation. More and more studies have found that ferroptosis is closely related to the pathogenesis of type 2 diabetes mellitus （T2DM）. The yin-fire theory is an important part of LI Gao's spleen-stomach theory， and it is believed that qi-fire imblance and yin-fire internal generation is the main pathogenesis of T2DM. Abnormal iron metabolism may be an important prerequisite for T2DM yin-fire internal generation， while oxidative stress is the specific manifestation of T2DM qi-fire imbalance. Reactive oxygen species （ROS） is the end product of qi-fire imbalance， and lipid peroxide is the pathological products of T2DM yin-fire internal generation. This study intends to explore the pathological mechanism of qi-fire imbalance and yin-fire internal generation from the perspectives of iron metabolism， oxidative stress and lipid peroxidation， enriching the modern connotation of yin-fire theory， and benefiting traditional Chinese medicine to target against ferroptosis， and prevent and treat T2DM precisely.

Objective:To investigate the relationship among mobile phone dependence, sleep quality and creativity in college students and the role of sleep quality in mediating the relationship between mobile phone dependence and creativity.Methods:A simple random sampling method was used to select 2 976 undergraduate students from four universities in Heilongjiang province.The mobile phone dependence index scale, the self-rating sleep status scale and the Williams creativity tendency measure were used to assess all college students.The descriptive statistical analysis and Pearson correlation analysis in SPSS 26.0 statistical software, and the PROCESS 2.16.3 macro program was used to test the mediating effect of sleep quality.Results:(1)The total scores of creativity was (107.52±11.25), mobile phone dependence was (43.17±13.23) and sleep quality was (21.08±6.15) in college students.(2)Mobile phone dependence was significantly positively correlated with sleep quality( r=0.412, P<0.01) and negatively correlated with creativity ( r=-0.293, P<0.01). Sleep quality was significantly negatively related with creativity ( r=-0.294, P<0.01). (3)Sleep quality partly mediated the relationship between mobile phone dependence and creativity, the direct effect (effect value=-0.216) and mediating effect (effect value=-0.062) accounted for 77.7% and 22.3% of the total effect (effect value=-0.278), respectively. Conclusion:Sleep quality plays a partly mediating role in the relationship between mobile phone dependence and college students' creativity. Mobile phone dependence can not only directly predict college students' creativity, but also indirectly predict college students' creativity through sleep quality.

The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.

Objective To determine the anatomic distribution of metastatic inguinal nodes in gynecological malignancies,and to explore the delineation of clinical target volume(CTV). Methods A retrospective study was performed among 34 patients with gynecological malignancies and inguinal lymph node metastases. According to the anatomic distribution of metastatic inguinal nodes, CTV covering more than 95% of inguinal lymph nodes and the relationship of inguinal nodes with the femoral vein, greater saphenous vein and its branches, superficial fascia, and deep fascia were analyzed using vascular enhancement images obtained by computed tomography and magnetic resonance imaging as well as 3D reconstruction using the Eclipse Planning System. Results The 34 patients had a total of 145 positive inguinal nodes. In the 131 superficial nodes below the inguinal ligament, 129 were located between the superficial fascia and the deep fascia;the upper group of superficial nodes,containing 25 nodes,was located at 1 cm above the public symphysis and along superficial iliac circumflex vein;the middle group,containing 85 superficial nodes and 11 patients with single superficial node metastasis,was located at the same level of the public symphysis and close to the junction of the saphenous vein and the femoral vein;the lower group, containing 21 superficial nodes,was beneath the public symphysis and along the greater saphenous vein and medial and lateral superficial femoral veins.The 14 deep nodes were located on the medial side of the femoral vein. There were no positive nodes on the posterolateral side of the link between the posterolateral edge of the femoral vein and medial edge of the sartorius muscle. The upper edge of CTV kept 142 lymph nodes beneath the upper edge of the superior pubis ramus and left 3 lymph nodes up to the upper edge of the femoral head. The lower edge of CTV kept 143 lymph nodes above the lower edge of the lesser trochanter and left 2 lymph nodes at 2 cm beneath the lower edge of the lesser trochanter. Conclusions For CTV covering 98% of positive inguinal nodes, the anterior edge is the superficial fascia;the medial edge is composed by the inguinal ligament and the border of medial muscle to the femoral vessels;the posterolateral edge is the link between the posterolateral edge of the femoral vein and the medial edge of the sartorius muscle;the upper edge is the upper border of the femoral head;the lower edge is the lower border of the lesser trochanter.

Objective To explore the effect of quality control circle ( QCC) activities on increasing early neonatal contact rate of mother and early breast sucking rate .Methods Set up a QCC,then follow the steps of QCC with professional tools to solve existing problems in early skin-to-skin contact for mothers and their healthy newborn infants and early breast sucking .Rate was compared before and after the improvements .Results The early neonatal contact rate of mother and early breast sucking rate increased from 80.94% to 93.57%,and the difference was significant (χ2 =35.07,P<0.001).Conclusions The application of the quality improvement tool of QCC could improve the early skin-to-skin contact for mothers and their healthy newborn infants and early breast sucking , and helps the mother to breastfeed successfully .