The discussion on the connotation of children’s subjectivity is not only a response to the lack of children’s subjectivity at the current stage of health management, but also a reference for children’s medical science popularization. Based on the perspective of social critical theory, this study used empirical research methods to review the "Dream Medical College" project of Children’s Hospital of Fudan University. The current situation and influencing factors of health management experience of 1 520 children participating in the "Dream Medical College" project were analyzed. The study showed that 96.35% of 1 316 subjects had diagnosis and treatment experience in specialized hospitals, and the overall negative emotional performance was at a low level (0~12 points). There was significant correlation between diagnosis and treatment, invasive experience and children’s emotional performance (P<0.05). The study revealed that the diagnosis and treatment field is the main practice place of children’s health management, while the subjective of children with different diagnosis and experience perform significantly different. Children over 4 years old have better language anxiety than physical anxiety when receiving diagnosis and treatment. Although medical science popularization is an important practical form of children’s health management, it lacks the science popularization content of invasive diagnosis and treatment and emotional management, and creative popular science form is more suitable for children with long-term and frequent diagnosis and treatment experience.

This article presents a case of acute ST-segment elevation myocardial infarction (STEMI) in a pregnant woman caused by coronary artery dissection. The 41-year-old patient had undergone cardiac valve surgery at the age of 1 and had no risk factors such as hypertension, diabetes, smoking, alcohol use, or a family history of coronary artery disease. At 31 +1 weeks of gestation, she experienced sudden chest pain for 4 hours and was emergently referred to Peking University First Hospital on June 1, 2021. Electrocardiogram revealed ST-segment elevation in leads I, aVL, and V 2 to V 6. Biochemical assays showed elevated levels of high-sensitivity cardiac troponin I and creatine kinase-MB. Echocardiography indicated segmental ventricular wall motion abnormalities (apical) and reduced left ventricular function, confirming the diagnosis of acute anterior wall STEMI. The patient promptly underwent emergency coronary angiography and percutaneous coronary intervention and confirmed coronary artery dissection. Postoperative care included antiplatelet, anticoagulation, and supportive treatment. At 34 +3 weeks of gestation, with the condition of acute anterior wall STEMI being relatively stable, a cesarean section was successfully performed. Regular cardiology follow-ups were scheduled postpartum, and cardiac function was normal in two years after discharge.

Objective:To systematically evaluate the efficacy and safety of photodynamic therapy (PDT) in the treatment of port-wine stains (PWS).Methods:PubMed, Cochrane Library, CNKI, Wanfang database were electronically searched to collect randomized controlled trials (RCTs) of PDT for PWS and data was analyzed using RevMan 5.4 provided by Cochrane Collaboration from March 2022 to March 2023 in the Department of Dermatology, Affiliated Hospital of Jiangsu University.Results:A total of 9 studies involving 1 190 patients were included. Two studies compared PDT with placebo, the total efficiency rate of PDT was increased ( OR=24.81, 95% CI: 14.68-41.93, P<0.01). Four studies compared PDT with laser [pulsed dye laser (PDL), CO 2 laser] and showed that PDT had a higher therapeutic efficiency ( OR=3.43, 95% CI: 1.79-6.58, P<0.01). The efficiency rate of PDT was lower than PDT + PDL in two studies ( OR=0.19, 95% CI: 0.08-0.45, P<0.01). The treatment reaction of PDT group was higher than that of placebo group, especially pain, burning, pruritus, swelling and scab ( OR=49.99, 95% CI: 23.95-104.35, P<0.01; OR=5.22, 95% CI: 3.40-8.02, P<0.01; OR=8.68, 95% CI : 4.75-15.87, P<0.01; OR=62.04, 95% CI: 23.92-160.9, P<0.01; OR=203.14, 95% CI: 28.91-1427.34, P<0.01), the incidence of blister was not higher than that of placebo group ( OR=2.62, 95% CI: 0.88-7.85, P=0.08). Compared with placebo, long-term adverse reactions were increased, especially hyperpigmentation ( OR=65.62, 95% CI: 4.06-1061.30, P<0.01). Both PDT and PDL showed treatment response, but the most common long-term adverse reaction hyperpigmentation did not increase ( OR=1.04, 95% CI: 0.59-1.82, P=0.89). There was no significant difference in the incidence of long-term adverse reaction hyperpigmentation between PDT and PDT+ PDL groups ( OR=1.69, 95% CI: 0.40-7.23, P=0.48). Conclusions:PDT is effective in the treatment of PWS, and has a better effect than the current treatment. Although the treatment reaction is higher, the most common long-term adverse reaction hyperpigmentation does not increase, and PDT combined with PDL is a new direction to improve the efficiency rate.

Purpose: Radiation-induced dermatitis (RD) is a common side-effect of therapeutic ionizing radiation that can severely affect patient quality of life. This study aimed to develop a risk prediction model for the occurrence of RD in patients with cervical carcinoma undergoing chemoradiotherapy using electronic medical records (EMRs). Methods: Using EMRs, the clinical data of patients who underwent simultaneous radiotherapy and chemotherapy at a tertiary cancer hospital between 2017 and 2022 were retrospectively collected, and the patients were divided into two groups: a training group and a validation group. A predictive model was constructed to predict the development of RD in patients who underwent concurrent radiotherapy and chemotherapy for cervical cancer. Finally, the model's efficacy was validated using a receiver operating characteristic curve. Results: The incidence of radiation dermatitis was 89.5% (560/626) in the entire cohort, 88.6% (388/438) in the training group, and 91.5% (172/188) in the experimental group. The nomogram was established based on the following factors: age, the days between the beginning and conclusion of radiotherapy, the serum albumin after chemoradiotherapy, the use of single or multiple drugs for concurrent chemotherapy, and the total dose of afterloading radiotherapy. Internal and external verification indicated that the model had good discriminatory ability. Overall, the model achieved an area under the receiver operating characteristic curve of .66. Conclusions The risk of RD in patients with cervical carcinoma undergoing chemoradiotherapy is high. A risk prediction model can be developed for RD in cervical carcinoma patients undergoing chemoradiotherapy, based on over 5 years of EMR data from a tertiary cancer hospital.

Objective:To investigate the therapeutic effects of photodynamic therapy (PDT) on a rat model of ulcerative colitis (UC) induced by Escherichia coli. Methods:Each rat was administered 1 ml of 1×10 9 enteric invasive E. coli to establish an UC model. Thirty-six Sprague Dawley rats were randomly divided into control, model, low-dose LD 4-PDT, medium-dose LD 4-PDT, high-dose LD 4-PDT (60, 120, 240 μg/kg), and levofloxacin (LEV) (100 mg/kg) groups, with six rats in each group. The UC model was established in all groups except the control group, which received 0.9% sodium chloride injection once. The first day of E. coli administration was recorded as day 0, and treatment was initiated on day 7 with LD 4 enema, levofloxacin gavage, and alternating enema/gavage for a total of four times. After a 30-minute exposure to each dose, the colon was irradiated using a 650 nm laser PDT system with an energy density of 25 J/cm 2, while the LEV group was not irradiated. The levels of body mass, colon length, intestinal pathological tissue, inflammatory factors interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), oxidative stress factors myeloperoxidase (MPO), glutathione (GSH), and superoxide dismutase (SOD) were compared among all groups. Results:The body mass and colon length of the model group were lower than those of the control group. The body mass and colon length of the low, medium, and high -dose LD 4-PDT groups and LEV group were higher than those of the model group. Compared to the control group, the model group exhibited more epithelial cell loss, multiple ulcers, infiltration of inflammatory cells into the mucosa and submucosa, and decreased goblet cells. In contrast, the surface mucosa of colon tissue recovered, goblet cells increased, and ulcer healing was good in the low, medium, and high-dose LD 4-PDT groups and LEV group compared to the model group. Compared to the control group, the levels of TNF-α, IL-6, and MPO inflammatory factors were significantly increased in the model group ( all P < 0.001). Compared to the model group, the levels of TNF-α, IL-6, and MPO inflammatory factors in colon tissue from the low, medium, and high -dose LD 4-PDT groups and LEV group were significantly decreased ( P < 0.05, P < 0.001). Compared to the control group, MDA levels were increased, while GSH and SOD levels were decreased in the model group. In contrast, MDA levels in the low, medium, and high-dose LD 4-PDT groups were decreased ( P < 0.05, P < 0.001), while GSH and SOD levels were increased compared to the model group. Conclusions:Low-dose LD 4-PDT promotes the healing of colon mucosa, alleviates inflammation, regulates oxidative stress, and improves symptoms of UC.

Objective: To evaluate the effect of parametrial status on FIGO stage IIIC1 cervical cancer. Methods: A retrospective study was conducted from June 1, 2009, to December 31, 2018.Patients with stage IIIC1 cervical cancer were included and stratified into two groups based on the status of parametrial involvement. Patients with IIIA or IIIB were selected as control. The primary outcomes are overall survival (OS) and progression-free survival (PFS). Results: Of 586 patients included, 377 patients were stage IIIC1 (group A) and 209 patients were stage IIIA/IIIB (group B). Compared control, stage IIIC1 was not associated with worse 5-year OS or PFS. Of the stage IIIC1 patients, 58.1% without parametrial involvement (group A1) and 41.9% with parametrial involvement (group A2). Patients of group A1 showed a better prognosis than group A2 both in 5-year rates of OS (79.09% vs. 59.43%, p<0.001) and PFS (73.27% vs. 56.95%, p=0.0002). However, patients of group A1 showed a better prognosis than group B both in OS and PFS. Also, patients of group A2 showed a comparable prognosis to group B both in OS and PFS. Conclusion Reclassification of stage IIIC1 cervical cancer without parametrial into a new stage is more appropriate and improves discriminatory ability.

Flagella are the main motility structure of Clostridioides difficile that affects the adhesion, colonization, and virulence of C. difficile in the human gastrointestinal tract. The FliL protein is a single transmembrane protein bound to the flagellar matrix. This study aimed to investigate the effect of the FliL encoding gene flagellar basal body-associated FliL family protein (fliL) on the phenotype of C. difficile. The fliL gene deletion mutant (ΔfliL) and its corresponding complementary strains (: : fliL) were constructed using allele-coupled exchange (ACE) and the standard molecular clone method. The differences in physiological properties such as growth profile, antibiotic sensitivity, pH resistance, motility, and spore production ability between the mutant and wild-type strains (CD630) were investigated. The ΔfliL mutant and the : : fliL complementary strain were successfully constructed. After comparing the phenotypes of strains CD630, ΔfliL, and : : fliL, the results showed that the growth rate and maximum biomass of ΔfliL mutant decreased than that of CD630. The ΔfliL mutant showed increased sensitivity to amoxicillin, ampicillin, and norfloxacin. Its sensitivity to kanamycin and tetracycline antibiotics decreased, and the antibiotic sensitivity partially returned to the level of CD630 strain in the : : fliL strain. Moreover, the motility was significantly reduced in the ΔfliL mutant. Interestingly, the motility of the : : fliL strain significantly increased even when compared to that of the CD630 strain. Furthermore, the pH tolerance of the ΔfliL mutant significantly increased or decreased at pH 5 or 9, respectively. Finally, the sporulation ability of ΔfliL mutant reduced considerably compared to the CD630 strain and recovered in the : : fliL strain. We conclude that the deletion of the fliL gene significantly reduced the swimming motility of C. difficile, suggesting that the fliL gene is essential for the motility of C. difficile. The fliL gene deletion significantly reduced spore production, cell growth rate, tolerance to different antibiotics, acidity, and alkalinity environments of C. difficile. These physiological characteristics are closely related to the survival advantage in the host intestine, which is correlated with its pathogenicity. Thus, we suggested that the function of the fliL gene is closely related to its motility, colonization, environmental tolerance, and spore production ability, which consequently affects the pathogenicity of C. difficile.
Humans ; Clostridioides/metabolism* ; Clostridioides difficile/metabolism* ; Bacterial Proteins/metabolism* ; Virulence ; Anti-Bacterial Agents/metabolism*

The discussion on the connotation of children’s subjectivity is not only a response to the lack of children’s subjectivity at the current stage of health management, but also a reference for children’s medical science popularization. Based on the perspective of social critical theory, this study used empirical research methods to review the "Dream Medical College" project of Children’s Hospital of Fudan University. The current situation and influencing factors of health management experience of 1 520 children participating in the "Dream Medical College" project were analyzed. The study showed that 96.35% of 1 316 subjects had diagnosis and treatment experience in specialized hospitals, and the overall negative emotional performance was at a low level (0~12 points). There was significant correlation between diagnosis and treatment, invasive experience and children’s emotional performance (P<0.05). The study revealed that the diagnosis and treatment field is the main practice place of children’s health management, while the subjective of children with different diagnosis and experience perform significantly different. Children over 4 years old have better language anxiety than physical anxiety when receiving diagnosis and treatment. Although medical science popularization is an important practical form of children’s health management, it lacks the science popularization content of invasive diagnosis and treatment and emotional management, and creative popular science form is more suitable for children with long-term and frequent diagnosis and treatment experience.

To construct TeI3c/4c-based and temperature-inducible gene inactivation system (Thermotargetron) and to apply it to gene inactivation of mesophilic bacteria. The subunit of flagellum (fliC) and C4 dicarboxylate orotate:H⁺ symporter (dctA) genes were chosen as targets in the genome of Escherichia coli HMS174 (DE3) strain. According to recognition roles of TeI3c/4c intron, the fliC489a, fliC828s, fliC1038s and dctA2a sites were chosen as target sites. Gene-targeting plasmids were constructed based on pHK-TT1A by using overlap PCR method and transformed into HMS174 cells. An aliquot mid-log phase cultures of the transformants were shocked at 48 °C and plated on LB plate (containing chloramphenicol). Afterwards, gene mutants were screened by using colony PCR and DNA sequencing. After the mutants were obtained, the phenotypes of ΔfliC and ΔdctA gene mutants were characterized by using agar puncture and carbon metabolism experiments. Colony PCR and sequencing results show that TeI3c/4c intron was inserted in the designed sites of fliC and dctA genes. The gene-targeting efficiency of Thermotargetron system was 100%. Phenotype verification experiments of the mutants demonstrated that the cell motility of all ΔfliC mutants was damaged and the malate assimilation ability of ΔdctA mutant was deprived comparing to wild-type HMS174 strain. In our study, a temperature-inducible and high-efficiency gene inactivation system was established for mesophilic bacteria. This system could achieve high efficiency and precise gene inactivation by modulation of the incubation duration of the transformants at 48 °C.

Objective:To explore the effect of small dose of low molecular weight heparin on the prognosis of elderly patients with severe pneumonia using systematic evaluation method.Methods:Databases including Wanfang data, VIP, CNKI, SinoMed, PubMed, Embase and Cochrane Library were searched for randomized controlled trial (RCT) studies about the comparison of conventional therapy and low molecular weight heparin on prognosis of elderly patients with severe pneumonia from the time of database establishment to August 2019. The patients in conventional treatment group were treated by improving ventilation, anti-infection, eliminating phlegm, relieving asthma and maintaining homeostasis while those in low molecular weight heparin group were subcutaneously injected with low molecular weight heparin of 4 000 U, once a day for 7 days. The patients' main outcomes included the oxygenation index (PaO 2/FiO 2) after 7 days of treatment, duration of mechanical ventilation, mortality in hospital, and secondary outcomes included acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and coagulation function after 7 days of treatment, the length of intensive care unit (ICU) stay, and incidence of bleeding. Data extraction and quality evaluation were conducted. The Meta-analysis of included studies that met the quality standards was performed using RevMan 5.3 software. Funnel diagram analysis was used to analyze the parameters with no less than 10 studies enrolled. Results:A total of 14 RCT studies were enrolled involving 1 173 elderly patients with severe pneumonia, among whom 590 received low molecular weight heparin while the other 583 received conventional therapy. All the included studies were well designed and of high quality. The results of Meta-analysis showed that compared with conventional therapy, small dose of low molecular weight heparin significantly elevated PaO 2/FiO 2 after 7 days of treatment [mean difference ( MD) = 19.25, 95% confidence interval (95% CI) was 16.88 to 21.61, P < 0.000 01], shortened the duration of mechanical ventilation ( MD = -48.88, 95% CI was -67.42 to -30.33, P < 0.000 01), and decreased mortality in hospital [odds ratio ( OR) = 0.40, 95% CI was 0.22 to 0.73, P = 0.003] and APACHEⅡ score after 7 days of treatment ( MD = -3.38, 95% CI was -3.94 to -2.83, P < 0.000 01), and shortened the length of ICU stay ( MD = -4.51, 95% CI was -5.75 to -3.27, P < 0.000 01). There was no significant difference in the changes of coagulation parameters after 7 days of treatment or the incidence of bleeding between low molecular weight heparin group and conventional therapy group [7-day thrombin time (TT): MD = 0.57, 95% CI was -0.15 to 1.28, P = 0.12; 7-day prothrombin time (PT): MD = 0.32, 95% CI was -0.35 to 0.98, P = 0.35; 7-day fibrinogen (FIB): MD = -0.17, 95% CI was -0.45 to 0.10, P = 0.22; incidence of bleeding: OR = 0.86, 95% CI was 0.36 to 2.07, P = 0.74]. The funnel diagram showed that there was publication bias of included 10 studies about APACHEⅡ score after 7 days of treatment. Conclusion:Small dose of low molecular weight heparin can improve the prognosis of elderly patients with severe pneumonia and it has no obvious side-effect on coagulation function.