Objective:To explore the clinical characteristics of children with septic shock and analyze the drug resistance of blood culture positive bacteria.Methods:The clinical data,positive blood culture strains and drug sensitivity results of 127 children with septic shock admitted to the Department of Intensive Care Medicine of Hunan Children's Hospital from September 2015 to August 2021 were retrospectively analyzed.Results:A total of 134 strains of bacteria or fungi were isolated from the blood culture samples of 127 children with septic shock,and gram-negative strains were the main ones,accounting for 67.16% (90/134).Haemophilus influenzae and Escherichia coli were the main gram-negative bacteria,accounting for 38.81% (52/134) and 20.15% (27/134)，respectively,while Streptococcus pneumoniae was the main gram-positive bacteria,accounting for 8.21% (11/134),and Candida albicans was the main fungus,accounting for 10.45% (14/134).The number of white blood cells,the levels of serum C-reactive protein,procalcitonin,venous blood sugar and arterial blood lactic acid in patients were all significantly higher than normal values,and the white blood cells count and neutrophil percentage in gram-positive bacterial infections were significantly higher than those with gram-negative bacterial infections and fungal infections( P<0.05).Procalcitonin increased most obviously when infected by gram-negative bacteria,and the difference was statistically significant ( P<0.05).Gram-positive strains were sensitive to vancomycin,teicoplanin,and linezolid,but only 50% of Streptococcus pneumoniae were sensitive to penicillin.Gram-negative strains had relatively high drug resistance,among which Klebsiella pneumoniae were only highly resistant to imipenem,cilastatin and levofloxacin,reaching 50%.Haemophilus influenzae was resistant to cephalosporins and β-amides enzyme antibiotic,and the drug sensitivity rate of lactamase antibiotics was high,with a resistance rate of 50% only to ampicillin,cefuroxime,amikacin,and compound sulfamethoxazole.There were not many fungal strains,and most antifungal drugs were effective against blood culture-positive fungi. Conclusion:The main pathogens of infection in children with septic shock are gram-negative bacteria,and have high resistance to general antibiotics.We should pay attention to their drug resistance when using antibiotics empirically.

Objective:To investigate the predictive value of sputum heparin binding protein(HBP) in sepsis related acute respiratory distress syndrome(ARDS).Methods:This study was a prospective case-control study.A total of 134 children with sepsis who were admitted in PICU at Hunan Children′s Hospital from January 2020 to November 2021 were included, including 63 children who had completed fiberoptic bronchoscopy.The 63 children were divided into sepsis without ARDS group, sepsis with mild ARDS group, and sepsis with moderate to severe ARDS group according to the presence and severity of ARDS.Sputum was collected and HBP was detected in all children with sepsis when they were admitted to the hospital.The alveolar lavage fluid within 72 hours of admission was reserved for HBP.The levels of interleukin (IL)-6 and tumor necrosis factor (TNF)- α were detected, and the blood biochemistry, pulmonary imaging, pediatric critical case score and other data within 72 hours were collected.Results:(1) Among 63 children with fiberoptic bronchoscopy, 29 were in sepsis without ARDS group, 18 were in the sepsis with mild ARDS group, and 16 were in the sepsis with moderate to severe ARDS group.There was no significant difference in the pediatric critical case score and the location of primary infection focus among the three groups at admission.The primary infection focus was respiratory system in 36 cases, whose sputum HBP level was (42.1±9.8) ng/mL, and 27 children with other systems infection, whose sputum HBP level was (37.8±10.8) ng/mL, there was no significant difference between two groups ( t=1.65, P=0.104). (2) There were significant differences in sputum HBP, alveolar lavage fluid HBP, IL-6 and TNF-α levels among sepsis with mild ARDS group, sepsis with moderate and severe ARDS group and sepsis without ARDS group ( P<0.05). The sputum HBP of 34 children with sepsis combined with ARDS was positively correlated with alveolar lavage fluid HBP, IL-6, TNF-α levels and lung injury score, and negatively correlated with SpO 2/FiO 2 ( P<0.05). (3)Among the 34 children with sepsis combined with ARDS, the sputum HBP concentration of children with invasive ventilation was significantly higher than that of children with non-invasive ventilation ( P<0.05). The sputum HBP concentration in children with three or more organ damage was significantly higher than that of children with two or less organ damage ( P<0.05). The sputum HBP concentration of dead children was higher than that of surviving children ( P<0.05). (4) The area under curve of sputum HBP for predicting ARDS was 0.772 (95% CI: 0.655~0.889). When the cut-off point value of sputum HBP was 27.9 mU/L, whose sensitivity and specificity were 70.6% and 79.3%, respectively.The area under curve of sputum HBP for predicting moderate and severe ARDS was 0.793 (95% CI: 0.661~0.926). When the cut-off point value of sputum HBP was 51.55 mU/L, whose sensitivity and specificity were 81.3% and 76.6%, respectively. Conclusion:Sputum HBP is elevated in children with sepsis and ARDS, which is related with the severity of the disease.Sputum HBP has a good predictive value for the diagnosis and severity of children with sepsis and ARDS, and can be used as a clinically effective and convenient evaluation index for children with sepsis related ARDS.

Objective:To investigate the clinical and radiological outcomes of ultrasound guided injection of platelet-rich plasma (PRP) in the treatment of intratendinous rotator cuff tear.Methods:A retrospective study was conducted to analyze the clinical data of 43 patients (46 shoulders) who had been treated for intratendinous partial-thickness rotator cuff tear by ultrasound guided injection of PRP consecutively from July 2021 to March 2022 at Department of Sports Medicine, Peking University Third Hospital. There were 23 males and 20 females, with an age of (47.8±13.5) years and a course of disease of 6 (4, 18) months, involving 22 left shoulders and 24 right shoulders. The visual analog scale (VAS) pain score, the University of California at Los Angeles (UCLA) rating scale, and the shoulder index of the American Shoulder and Elbow Surgeons (ASES) were determined before injection and at the last follow-up. The changes in tear size were also evaluated by magnetic resonance imaging (MRI) before PRP injection and 3 to 5 months after PRP injection.Results:The 43 patients were followed up for 15 (12, 17) months after treatment. Of this cohort, 7 shoulders (15.2%, 7/46) were recovered to complete normal and very satisfied with the injection effects while 19 shoulders(41.3%, 19/46) satisfied with the effects after injection, yielding an overall satisfaction rate of 56.5% (26/46). At the last follow-up, the VAS score [3.0 (2.0, 4.0) points], ASES score [80.0 (65.0, 88.8) points], and UCLA score [29.0 (20.0, 32.0) points] were significantly improved compared with those before injection [5.5 (4.0, 8.0) points, 55.0 (39.2, 65.0) points, and 16.0 (12.0, 20.3) points] ( P < 0.05). MRI evaluation showed the tear volume was significantly reduced after PRP injection [46.1 (20.9, 77.5) mm 3 before injection versus 28.2 (12.5, 63.6) mm 3 after injection] ( P<0.05), and a >50% tear volume diminution was observed in 13 shoulders (34.2%,13/38). There were no complications during or after injection. Conclusion:As the ultrasound guided injection of PRP into intratendinous lesions is effective and safe for patients with intratendinous partial-thickness rotator cuff tear, it can be an alternative treatment for the patients or professional athletes who are unwilling to undergo surgery.

Objective:To detect the abnormal changes of myocardial blood perfusion in patients with hypertrophic cardiomyopathy(HCM) by myocardial contrast echocardiography (MCE) combined with adenosine stress test.Methods:Fifteen adult patients with HCM who were treated in Fuwai Central China Cardiovascular Hospital from May 2021 to March 2022 were prospectively selected as the HCM group, and eighteen healthy volunteers matched by gender, age and body surface area during the same period were chosen as the control group. All subjects underwent routine echocardiography, rest and adenosine stress MCE. The MCE images were analyzed by QLab software to obtain the myocardial perfusion parameters: peak signal intensity (A value), rising slope of the curve (β value) and A×β value, and the differences of above parameters between the two groups were compared.According to whether the end-diastolic wall thickness ≥12 mm, the myocardial segments in the HCM group were divided into hypertrophic segments and non-hypertrophic segments. The differences in myocardial perfusion parameters were compared among control group segments, hypertrophic segments and non-hypertrophic segments of the HCM group. The correlations of stress myocardial blood flow with maximal left ventricular wall thickness (MLVWT), left ventricular mass index (LVMI) and left atrial volume index (LAVI) in the HCM group were analyzed.Results:Compared with the control group, the A value, β value and A×β value of whole myocardium, hypertrophic segments and non-hypertrophic segments in the HCM group were significantly decreased in the rest and adenosine stress state, and the differences were statistically significant (all P<0.05). In the stress state, the A value, β value and A×β value of the hypertrophic segments were significantly lower than those in the non-hypertrophic segments in the HCM group, and the detection rate of abnormal perfusion segments in the HCM group was significantly higher than that in the rest state(all P<0.05). Compared with the control group, the myocardial blood flow reserve of whole myocardium, hypertrophic segments and non-hypertrophic segments in the HCM group were significantly decreased, and the differences were statistically significant(all P<0.05). The stress myocardial blood flow in the HCM group was negatively correlated with MLVWT, LVMI and LAVI ( r=-0.815, -0.805, -0.742; all P<0.05). Conclusions:Myocardial blood perfusion abnormalities can occur in both hypertrophic and non-hypertrophic myocardial segments in patients with HCM, and adenosine stress MCE can significantly improve the sensitivity of detecting myocardial perfusion abnormalities. The stress myocardial blood flow in patients with HCM is negatively correlated with MLVWT, LVMI and LAVI.

Objective:To evaluate the right atrial volume and function abnormalities in patients with pulmonary hypertension (PH) by four-dimensional automatic quantitation technique, and to explore the application value of this technique in evaluating the risk stratification and World Health Organization functional class(WHO-FC) of PH patients.Methods:Eighty-four adult patients with PH diagnosed by right heart catheterization from April to October 2022 in Fuwai Central China Cardiovascular Hospital were consecutively enrolled as the PH group. All cases were divided into 3 groups according to the mean pulmonary arterial pressure (mPAP): mild PH group ( n=28), moderate PH group ( n=28), severe PH group ( n=28). Twenty-eight healthy volunteers matched by gender and age were included in the same period as the control group. The volume and strain parameters of the right atrium were obtained by analyzing the four-dimensional image of the right atrium using four-dimensional automatic quantitation technique, including right atrial minimum volume index (RAVImin), right atrial maximum volume index (RAVImax), right atrial presystolic volume index (RAVIpreA), right atrial ejection fraction (RAEF), right atrial passive ejection fraction (RAPEF), right atrial active ejection fraction, RAAEF, longitudinal strains of right atrial reserve, conduit and systolic period (RASr, RAScd, RASct), circumferential strains of right atrial reserve, conduit and systolic period (RASr-c, RAScd-c, RASct-c). The differences in right atrial parameters among four groups were compared.ROC curve was used to analyze the diagnostic efficiency of right atrial four-dimensional strain parameters for PH patients with WHO-FC≥Ⅲ. Pearson linear correlation analysis was used to investigate the relationships between RASr and right atrial area (RAA), NT-proBNP and tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure ratio (TAPSE/sPAP). Results:①Compared with the control group, RAEF, RAPEF, RASr, RAScd, RASr-c, RAScd-c were significantly decreased in mild, moderate and severe PH groups; while RAAEF, RASct, RASct-c were significantly increased in mild PH group and significantly decreased in moderate and severe PH groups, and the differences were statistically significant (all P<0.05). RAVImin, RAVImax, RAVIpreA gradually increased among the control, mild PH, moderate PH and severe PH groups, and the differences were statistically significant (all P<0.05). RAEF, RAPEF, RAAEF, RASr, RAScd, RASct, RASr-c, RAScd-c, RASct-c were decreased successively among mild, moderate and severe PH groups, and the differences were statistically significant (all P<0.05). ②ROC curve showed that RASr had the highest diagnostic efficiency in PH patients with WHO-FC ≥Ⅲ, and the cut-off value was 20.5% (AUC=0.914, P<0.001). ③Correlation analysis showed that RASr was correlated with RAA, NT-proBNP and TAPSE/sPAP ( r=-0.803, -0.621, 0.739; all P<0.001). Conclusions:The degree of right atrial function impairment increased in patients with mild, moderate and severe PH in turn. RASr is the best predictor of WHO-FC ≥Ⅲ in patients with pulmonary hypertension and is a potential parameter for risk stratification in patients with PH.

Abstract OBJECTIVE To analyze and summarize the research history, development status, trends and hotspots of Codonopsis Radix by bibliometrics. METHODS Search and screen the related literatures of Codonopsis Radix from the CNKI database and the Web of Science core collection database from Januar 1, 1992 to June 30, 2022. VOSviewer and CiteSpace softwares were used for visual analysis of the number of publications, authors, institutions, countries, funding funds, published journals, literature citation frequency, keywords, clustering and emergent word, and a visual graph was drew. RESULTS A total of 594 effective literature, 484 in Chinese and 110 in English were included. GAO Jianping and ZOU Yuanfeng were the scholars with the largest amount of Chinese and English literature. China was the country with the most published researches on Codonopsis Radix. The School of Pharmaceutical Science of Shanxi Medical University and the Chinese Academy of Sciences were the institutions with the largest number of Chinese and English literature publications respectively. The National Science Foundation of China was the largest fund to support the research of Codonopsis Radix. The journal that received the most Chinese and English literature were Journal of Chinese Medicinal Materials and International Journal of Biological Macromolecules respectively. The most frequently cited Chinese literature was a summary of the chemical constituents and pharmacological effects of Codonopsis Radix. The most frequently cited English literature was a study on the structure identification and pharmacological effects of Codonopsis Radix polysaccharides. The map of key words, clustering and emergent words in Chinese literature showed that the main research directions of Codonopsis Radix were compatibility formula, resource planting, pharmacological action and quality control. The map of key words, clustering and emergent words in English literature indicated that the study of Codonopsis Radix always focused on the material basis and mechanism of its active ingredients. CONCLUSION The annual publications on of Codonopsis Radix show an increasing trend, and the main research institutions are distributed in many universities and research institutes in China. Both Chinese and English literature have their own research directions, and the pharmacological effects of active ingredients are the common trend hotspots.

Objective? To expLore the effects of diaLectic nursing-oriented hybrid teaching modeL in pediatric nursing teaching in traditionaL Chinese medicine (TCM). Methods? TotaLLy 113 nursing students from 2 cLasses (midwifery) admitted in 2015 in the SchooL of Nursing, Nanjing University of Chinese Medicine were seLected by convenient sampLing. ALL the subjects were femaLe. The 2 cLasses were divided into the observation group (n=58) or the controL group (n=55) by coin tossing. Nursing students in the controL group received traditionaL teaching, whiLe nursing students in the observation group were taught with the diaLectic nursing-oriented hybrid teaching modeL. At the end of the course, the objective structured cLinicaL examination (OSCE) was used to evaLuate their diaLectic nursing abiLity; and the SeLf-Rating ScaLe of SeLf-Directed Learning (SRSSDL) was used to evaLuate their seLf-directed Learning abiLity. ResuLts? At the end of the course, the totaL score of diaLectic nursing and scores of various dimensions of the observation group were higher than those of the controL group (P＞ 0.05). The totaL score of seLf-directed Learning abiLity and scores of Learning awareness, Learning behavior, Learning strategy and interpersonaL skiLLs of the observation group were higher than those of the controL group (P＜0.05). ConcLusions? The hybrid teaching modeL in TCM pediatric nursing teaching in universities of Chinese medicine can enhance nursing students' diaLectic nursing abiLity, heLp to cuLtivate their seLf-directed Learning abiLity and achieve the best teaching resuLts.

Objective To probe into the gaps between the inpatient care needs at public tertiary hospitals and existing nursing services,for measures to improve the quality of nursing service.Methods The simple clinical score(SCS),Barthel index scale,patient care needs questionnaire,and actual service status questionnaire were used in a multi-centered stratified random sampling survey, covering the adult inpatient wards of 72 departments at six tertiary hospitals.The results were subject to a stratified analysis of patient care needs, and a comparative analysis between patient care needs and the actual status of the service.Results Statistically significant differences were found between the nursing needs of patients from among different departments,self-care abilities and those with different conditions(P<0.05); the patient care needs and actual service status in cleaning, eating, excretion, activities, health education, basic treatment and nursing of traditional Chinese medicine in terms of the differences were statistically significant (P<0.05); the comparative analysis found differences between patient care needs and actual service status.The top five patient care needs which were greater than the actual service status were namely temperature measuring,rehabilitation guidance,routine inspection,observation and psychological care.The top five areas with actual service status greater than patient care needs were namely turnover /back flapping, toilet assistance,temperature measuring,hands washing before and after meals,and herbal fumigation.The top five areas with minimal gap between needs and service were namely oral care, moxibustion, perineal care,assistance in using toilet in bed and manicure.Conclusions Departments, self-care abilities and conditions of patients vary with their needs of nursing.Based on the existing problems between patient care needs and the actual service status,nurses should increase their care in such soft indicators as rehabilitation guidance,routine inspection and disease observation, and fully meet the needs of patients.On the other hand,they are expected to enhance patients′health education and health literacy in such hard indicators as temperature measuring,turnover and back flapping.

Objective To construct a grading nursing care system at public hospitals based on the severity of illness and activities of daily living ( ADL). Methods Multi-center stratified random sampling was used to investigate the general adult patients hospitalized in 12 wards of six tertiary-level hospitals in the eastern, central and western parts of China from January to December of 2016. The Barthel index and simple clinical score ( SCS) were used to evaluate their ADL and severity of illness, while a customized direct nursing hour scale was applied to record the direct nursing time needed by patients in 24 hours. Nursing grades were defined according to different conditions and ADL and to the difference of patient needs of 24 h direct nursing hours. Results 7 200 patients were investigated in total, and 7 073 effective questionnaires were collected (98. 24% ). Seven new grades of nursing care were defined based on patients′ severity of illness, ADL and different 24 h direct nursing time. These grades match the existing four grading nursing care levels to become refined sub-levels. Conclusions Patients can be graded according to their conditions, ADL and the 24 h direct nursing time needed. Such a new method is more objective, specific and quantitative than before, conducive to upgrading fine management level of nursing.

Objective: To investigate the clinical effect and safety of rock salt aerosol therapy in the treatment of occupational allergic contact dermatitis. Methods: A total of 65 patients with acute exacerbation of occupational allergic contact dermatitis who were treated in the Outpatient Service and Inpatient Department of our hospital from March 2013 to December 2015 were enrolled and randomly divided into observation group and control group using a random number table. Both groups were givensymptomatic treatment including desensitization, and the patients in the observation group were given rock salt aerosol therapy for 2 courses in addition to the symptomatic treatment. The changes in symptoms, signs, blood eosinophil count, and IgE were observed. Results: There were significant changes in symptom score at the first and second courses of the treatment (P<0.05) , and there was an interaction between time of therapy and grouping (P<0.05) . There was no significant difference in symptom score before treatment between the two groups (P>0.05) , while there were differences at the first and second courses of the treatment (P<0.05) . After the second course of treatment, the observation group had a significantly higher overall response rate than the control group (P<0.05) ; both groups had significant reductions in blood eosinophil count and the observation group had a significantly greater reduction than the control group (P<0.05) . After two courses of treatment, both groups had significant increases in the number of patients with normal IgE (both P<0.05) , and after the second course of treatment, the observation group had a significantly higher number than the control group (P<0.05) . Both groups had mild adverse events, which did not affect the treatment. Conclusion In the treatment of occupational allergic contact dermatitis, rock salt aerosol therapy has a certain effect on the recovery of symptoms, signs, blood eosinophil count, and IgE.