Objective:To investigate the efficacy and safety evaluation of omalizumab in patients with chronic urticaria who are not well treated with antihistamine and have a history of anaphylactic shock.Methods:A retrospective observational real-world study was conducted in which patients with chronic urticaria who were admitted to Peking University First Hospital from November 2018 to January 2024 who were poorly treated with antihistamine drugs and had a history of anaphylactic shock were selected as the study subjects, and 300 mg of omalizumab was injected subcutaneously every 4 weeks, and the occurrence of UCT (urticaria control test), the number of occurrences of anaphylactic shock and other adverse events were recorded during the treatment.Results:Among the 11 patients who started omalizumab treatment for 3 months, 10 patients had complete control of chronic urticaria (UCT=16), 1 patient was partially controlled (UCT=15), and 9 patients did not have anaphylactic shock during follow-up (10 cases after 12 months of follow-up and 1 case after 2 months of follow-up). Two patients developed anaphylactic shock after omalizumab injection. In this study, during the follow-up period (2-38 months), 11 patients were well tolerated with omalizumab, of which 4 continued to use omalizumab for urticaria, 6 stopped using omalizumab due to good urticaria control and no recurrence of anaphylactic shock, and 1 was lost to follow-up.Conclusion:Omalizumab may have good efficacy and safety in patients with chronic urticaria who are poorly treated with antihistamines and have a history of anaphylactic shock, and may have a potential role in preventing anaphylactic shock.

Objective:To investigate the pathogenesis and clinical manifestations of anaphylactic shock and to evaluate the effectiveness of existing treatments, so as to improve the understanding of anaphylactic shock and to properly manage patients with anaphylactic shock.Methods:A retrospective observational study was conducted to select 63 patients with anaphylactic shock who were diagnosed and treated in Peking University First Hospital from July 2017 to June 2023 as the study objects, and the clinical data including basic information, present medical history, vital signs, past medical history, emergency treatment measures and prognosis were collected, and the causes, clinical manifestations and emergency treatment measures of anaphylactic shock were descriptively analyzed.Results:The causes of anaphylactic shock in 63 subjects could be divided into drug allergy (50.79%), food allergy (15.87%), blood product allergy (11.11%), others (3.17%), radiotherapy (1.59%), strenuous exercise (1.59%), hemodialysis (1.59%), and the triggers in 9 cases (14.29%) were unclear. The clinical manifestations can be abnormalities of the skin, respiratory system, cardiovascular system, gastrointestinal system and urinary system, among which the most common skin manifestations are wheal rash, itching, redness and swelling (79.37%), the most common manifestation of the respiratory system is dyspnea (30.16%), and the highest proportion of cardiovascular manifestations is blood pressure lower than 90 mmHg or baseline blood pressure drop of 30 mmHg (100.00%). The most commonly used therapeutic drugs were epinephrine (49.2%), glucocorticoids (69.8%), antihistamines (52.4%), vasopressors (12.7%), and others.Conclusion:The causes of anaphylactic shock are different, and the clinical manifestations are complex and diverse, and the condition can be severe and life-threatening. Clinically, attention should be paid to the early and accurate identification of high-risk patients, the prevention of anaphylactic shock, and the timely taking of corresponding measures to protect the life safety of patients once anaphylactic shock occurs. Early diagnosis and prompt treatment are key to managing anaphylactic shock.

Objective:To investigate the efficacy and safety evaluation of omalizumab in patients with chronic urticaria who are not well treated with antihistamine and have a history of anaphylactic shock.Methods:A retrospective observational real-world study was conducted in which patients with chronic urticaria who were admitted to Peking University First Hospital from November 2018 to January 2024 who were poorly treated with antihistamine drugs and had a history of anaphylactic shock were selected as the study subjects, and 300 mg of omalizumab was injected subcutaneously every 4 weeks, and the occurrence of UCT (urticaria control test), the number of occurrences of anaphylactic shock and other adverse events were recorded during the treatment.Results:Among the 11 patients who started omalizumab treatment for 3 months, 10 patients had complete control of chronic urticaria (UCT=16), 1 patient was partially controlled (UCT=15), and 9 patients did not have anaphylactic shock during follow-up (10 cases after 12 months of follow-up and 1 case after 2 months of follow-up). Two patients developed anaphylactic shock after omalizumab injection. In this study, during the follow-up period (2-38 months), 11 patients were well tolerated with omalizumab, of which 4 continued to use omalizumab for urticaria, 6 stopped using omalizumab due to good urticaria control and no recurrence of anaphylactic shock, and 1 was lost to follow-up.Conclusion:Omalizumab may have good efficacy and safety in patients with chronic urticaria who are poorly treated with antihistamines and have a history of anaphylactic shock, and may have a potential role in preventing anaphylactic shock.

Objective:To investigate the pathogenesis and clinical manifestations of anaphylactic shock and to evaluate the effectiveness of existing treatments, so as to improve the understanding of anaphylactic shock and to properly manage patients with anaphylactic shock.Methods:A retrospective observational study was conducted to select 63 patients with anaphylactic shock who were diagnosed and treated in Peking University First Hospital from July 2017 to June 2023 as the study objects, and the clinical data including basic information, present medical history, vital signs, past medical history, emergency treatment measures and prognosis were collected, and the causes, clinical manifestations and emergency treatment measures of anaphylactic shock were descriptively analyzed.Results:The causes of anaphylactic shock in 63 subjects could be divided into drug allergy (50.79%), food allergy (15.87%), blood product allergy (11.11%), others (3.17%), radiotherapy (1.59%), strenuous exercise (1.59%), hemodialysis (1.59%), and the triggers in 9 cases (14.29%) were unclear. The clinical manifestations can be abnormalities of the skin, respiratory system, cardiovascular system, gastrointestinal system and urinary system, among which the most common skin manifestations are wheal rash, itching, redness and swelling (79.37%), the most common manifestation of the respiratory system is dyspnea (30.16%), and the highest proportion of cardiovascular manifestations is blood pressure lower than 90 mmHg or baseline blood pressure drop of 30 mmHg (100.00%). The most commonly used therapeutic drugs were epinephrine (49.2%), glucocorticoids (69.8%), antihistamines (52.4%), vasopressors (12.7%), and others.Conclusion:The causes of anaphylactic shock are different, and the clinical manifestations are complex and diverse, and the condition can be severe and life-threatening. Clinically, attention should be paid to the early and accurate identification of high-risk patients, the prevention of anaphylactic shock, and the timely taking of corresponding measures to protect the life safety of patients once anaphylactic shock occurs. Early diagnosis and prompt treatment are key to managing anaphylactic shock.

Objective To observe the value of spectral CT multi-parameter imaging for preoperative predicting lymph node metastasis(LNM)of gastric cancer.Methods Totally 136 patients with gastric adenocarcinoma were retrospectively enrolled.The patients were further divided into LNM group(n=74)and non-LNM group(n=62)according to postoperative pathological findings of lymph nodes status.Clinical data,conventional CT findings and spectral CT parameters were compared between groups.Factors being significant different between groups were included in multivariate logistic regression analysis to screen independent predictors of gastric cancer LNM.Clinical+conventional CT model(model 1),spectrum CT model(model 2)and combined model(model 3)were constructed based on the above independent predictors,respectively.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for preoperative predicting LNM of gastric cancer.Results CT-N stage,CT-T stage,70,100 and 140 keV CT valuestumor at arterial phase(AP),arterial enhancement fraction(AEF)and normalized iodine concentration at venous phase(NICVP)were all independent predictors of gastric cancer LNM(all P＜0.05).AUC of model 3 was 0.846,higher than that of model 1 and model 2(AUC=0.767,0.774,Z=-0.368,-2.373,both P＜0.05)for preoperative predicting LNM of gastric cancer,while the latter two were not significantly different(Z=-0.152,P=0.879).Conclusion Spectral CT multi-parameter imaging could effectively predict LNM of gastric cancer preoperatively.

Objective To observe the value of spectral CT parameters for evaluating T staging of advanced gastric cancer(AGC).Methods Totally 155 AGC patients were collected and divided into T2 stage(n=40)and T3/4a stage(n=115)according to postoperative pathology.CT values,water concentration(WC)and iodine concentration(IC)of AGC lesions on 40-140 keV arteriovenous phase single energy level images were measured,and the standardized IC(nIC)and spectral curve slopes k1 and k2 were calculated.Clinical variables and spectral quantitative parameters were compared between groups,and receiver operating characteristic curve was plotted,the area under the curve(AUC)was calculated to evaluate the value of each parameter and model for identifying T2 and T3/4a stage AGC.Results Tumor thickness,proportion of low differentiation degree,CT100kev,CT140kev,and WC values in T3/4a group were all significantly higher than those in T2 group(all P＜0.05).CT140keV of AGC lesions on venous phase images presented the highest discrimination efficacy among single parameters,with AUC of 0.782.AUC of clinical-arterial phase-venous phase model was 0.848,higher than that of clinical model and arterial phase model alone(both P＜0.05)but not significantly different compared with AUC of venous phase model(P＞0.05).Conclusion Spectral CT quantitative parameters,especially venous phase parameters could be used to effectively identify T stage of AGC.Multi-parameter combined models had higher diagnostic value.

Objective:To construct a hierarchical management model of performance objectives,and to explore its application value in the management of medical equipment procurement process.Methods:The procurement performance evaluation indicators were screened from the medical equipment procurement declaration level,process level,use level and disposal level,and the comprehensive evaluation model was developed by entropy weight method and data envelopment analysis(DEA)method to form the process management plan at the level of personnel,system,data and equipment.A total of 717 sets of medical equipment purchased by Beijing Youan Hospital from 2019 to 2022 were selected,and the conventional management mode(348 units)and hierarchical management mode(369 units)were used for management according to different performance objectives evaluation methods.The performance objectives achievement,the quality of procurement process management and the satisfaction of clinical allocation management of medical equipment procurement under different management modes were compared.Results:The 369 units of equipment under the hierarchical management model included operating room equipment,laboratory equipment,inpatient treatment equipment,disinfection supply equipment and other medical equipment,and the performance objectives achievement of the procurement were(96.10±3.46)%,(96.76±2.65)%,(95.59±2.52)%,(96.06±2.34)%and(96.88±1.75)%,respectively,which were higher than those of the management model,the difference was statistically significant(t=2.663,2.801,2.858,4.111,3.548,P＜0.05)The effective ratio of DEA in the comprehensive evaluation of the medical equipment procurement declaration level,process level,use level and disposal level under the hierarchical management model were 96.7%,98.6%,94.6%and 99.7%,respectively,which were higher than those of the conventional management model,the difference was statistically significant(x2=10.983,9.327,7.270,12.309,P＜0.05).The satisfaction of clinical departments with the procurement and use of medical equipment under the hierarchical management model were(95.82±2.83)%and(97.25±1.96)%,respectively,which were higher than those of the conventional management model,the difference was statistically significant(t=5.575,5.248,P＜0.05).Conclusion:The hierarchical management model can effectively implement the performance objectives of medical equipment procurement,improve the management quality of medical equipment procurement process,improve satisfaction of clinical departments and management personnel after procurement,and ensure the quality of equipment operation.

Objective:To investigate the effect of exercise rehabilitation combined with psychotherapy and exercise rehabilitationn alone in elderly patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods:A total of 150 elderly patients(≥65 years)admitted to our hospital with CHD after primary PCI were enrolled and randomly divided into the group A(conventional drug therapy), group B(conventional drug therapy+ exercise rehabilitation)and group C(conventional drug therapy + exercise rehabilitation+ psychotherapy), with 50 patients in each group.Patients in groups B and C were intervened at two weeks after PCI, once a week for 12 weeks.Changes of Hamilton anxiety scale(HAMD)scores, Hamilton depression scale(HAMA)score, 6 min walking test, left ventricular ejection fraction(LVEF)and metabolic equivalents(METs)were compared among the three groups.Results:Before treatment, the METs were significantly lower in the group B(3.58±0.14)compared with the groups A(3.69±0.18)and C(3.68±0.15), and were similar between groups A and C. After 12 weeks of treatment, compared with the indicators before treatment, the HAMA scores were similar in the group A(12.98±2.51 vs. 12.16±2.91, P>0.05), and were significantly decreased in groups B(12.90±2.12 vs.8.06±2.11, P<0.05)and C(13.03±2.52 vs.6.96±2.13, P<0.05); HAMD scores were all markedly decreased in all three groups(group A: 22.38±2.52 vs.20.87±2.12; group B: 22.58±2.57 vs.17.25±2.32; group C: 22.23±2.35 vs.13.39±2.25), and were decreased most in the group B, followed by groups A and B( P<0.05). Furthermore, the LVEF group A: (49.08±1.59)% vs.(52.15±1.91)%; group B: (48.99±2.11)% vs.(57.56±2.13)%; group C: (49.04±2.02)% vs.(59.92±1.93)%, 6 min walking distance test(m)(group A: 360.78±12.50 vs.370.16±12.41; group B: 359.21±10.54 vs.394.19±15.56; group C: 363.12±15.28 vs.413.29±18.15)and METs(group A: 3.69±0.18 vs.3.91±0.21; group B: 3.58±0.14 vs.4.89±0.09; group C: 3.68±0.15 vs.5.77±0.13)were significantly improved in all groups after the treatment.Among them, group C was improved most, followed by groups B and A(all P<0.05). Conclusions:Exercise rehabilitation combined with psychotherapy is of great significance to improve the physical condition of elderly patients with CHD after PCI, and it is better than the routine exercise rehabilitation alone.

Objective: To investigate the genetic characteristics of human norovirus (NoV) among infants under 5 years of age with diarrhea in Chaoyang District, Beijing from 2011 to 2017. Methods: NoV-positive stool samples were collected from 2011 to 2017 in this region. The partial RdRp and VP1 genes were amplified and sequenced. Multi-sequence alignment was performed and phylogenetic tree was constructed using Mega software. Results: A total of 151 samples were sequenced and analyzed. The ratio of male and female was 2.28∶1 with mean age of 1.72 years. Fourteen NoV subtypes were detected, including GII.Pe/GII.4 (47.68%), GII.P12/GII.3 (20.53%), GII.P4/GII.4 (17.22%), GII.P16/GII.2 (3.31%), GII.P12/GII.12 (1.99%), GII.P17/GII.17 (1.99%), GII.P16/GII.13 (1.32%), GII.P7/GII.7 (1.32%), GII.P7/GII.6 (1.32%), GII.P2/GII.2 (0.66%), GII.P21/GII.21 (0.66%), GII.Pg/GII.12 (0.66%), GI.Pa/GI.3 (0.66%) and GI.P6/GI.6 (0.66%). Conclusions NoV genetic diversity was found among infants under 5 with diarrhea in Chaoyang district, Beijing. The subtypes from surveillance and those from epidemics occurred in chronological order. The surveillance should be strengthened for early detection of new subtype for monitoring the epidemic and vaccine design.

Objective: To investigate the genetic characteristics of human adenovirus (AdV) among infants with diarrhea in Chaoyang district, Beijing from 2011 to 2017. Methods: Adenovirus positive stool samples were collected from 2011 to 2017 in Chaoyang District of Beijing. The hexon region genes of human adenovirus were sequenced. Multi-sequence alignments were performed and phylogenetic tree was constructed by Mega software. Results: A total of 64 samples were sequenced and analyzed. The ratio of male to female was 11∶5. The mean age was 1.56 years. Among them, AdV41 accounted for 70.31%, followed by AdV31 (26.25%), AdV40 (4.69%), AdV1 (3.13%), AdV5 (3.13%), AdV6 (3.13%), AdV7 (3.13%), AdV2 (1.56%), AdV3 (1.56%), AdV4 (1.56%) and AdV61 (1.56%). Conclusions Human adenovirus may play an important role in viral diarrhea in Chaoyang district from 2011 to 2017. The current adenovirus epidemic is complex and AdV41 was the dominant strain in this region.