Objective

To explore the risk factors for invasive syndrome in patients with Klebsiella pneumoniae liver abscess by analyzing the clinical characteristics of these patients.

Methods

A retrospective collection of data from 161 patients diagnosed with Klebsiella pneumoniae liver abscess at the First Affiliated Hospital of Nanjing Medical University between January 2017 and September 2023 was conducted. The 161 patients were divided into an invasive group of 64 cases （39.8%） and a non-invasive group of 97 cases （60.2%） based on whether invasive syndrome occurred during hospitalization. Basic data，initial symptoms， vital signs， laboratory examination results， and imaging manifestations were compared between the two groups. Univariate analysis and multivariate logistic regression analysis were used to assess the correlation of various indicators with the occurrence of invasive syndrome.

Results

The prevalence of diabetes in the invasive group was higher than that in the non-invasive group （P＜0.05）； The heart rate of patients in the invasive group was higher than that in the non - invasive group （P＜0.05）； Imaging manifestations showed that the maximum diameter of intra-hepatic abscesses in the invasive group was lower than that in the non-invasive group， while the probability of multiple intra -hepatic abscesses was higher in the invasive group than in the non-invasive group （P＜0.05）； There was no significant difference in the laboratory test indicators between the invasive group and the non-invasive group（P＞0.05）；Logistic regression analysis showed that independent risk factors included a history of diabetes， a higher heart rate， and a smaller maximum diameter of intra-hepatic abscesses （P＜0.05）.

Conclusion

Independent risk factors for invasive syndrome in patients with Klebsiella pneumoniae liver abscess include a history of diabetes， a higher heart rate， and a smaller maximum diameter of intra-hepatic abscesses. Clinically， it is necessary to strengthen the monitoring and early intervention for these high-risk patients to reduce the harm of invasive syndrome.

Objective

To study the characteristics of periostin， tenascin-C （TNC）， and soluble human matrix metalloproteinase-2 （sST2） levels in asthmatic children infected with Mycoplasma pneumoniae and their impact on acute asthma exacerbations.

Methods

A total of 187 asthmatic children with mycoplasma pneumoniae infection who were hospitalized and treated in our hospital from May 2020 to October 2022 were selected， including 104 males and 83 females， with ages ranging from 10 to 14 years and a mean age of（12.07±1.25） years. The children were categorized into two groups： a remission group （n=134） and an acute exacerbation group （n=53）， based on the presence of acute asthma exacerbation. A comparison was made between the two groups in terms of general clinical characteristics， as well as serum levels of periostin， TNC，and sST2. Univariate and multivariate logistic regression analyses were conducted to ascertain whether serum periostin， TNC， and sST2 levels could independently predict the risk of acute exacerbations in children with asthma infected by Mycoplasma pneumoniae. Through the use of receiver operating characteristic （ROC）curves， cutoff values for serum periostin， TNC， and sST2 were identified. Based on the results of multivariate logistic regression analysis， a risk prediction nomogram model incorporating serum periostin， TNC， and sST2 was constructed. The model degree of fitting was evaluated using Hosmer-Lemeshow test and calibration curves， the predictive performance was assessed through ROC curve analysis， and the clinical application value was evaluated using decision curve analysis （DCA）.

Results

Compared to the remission group， the acute exacerbation group had a lower proportion of regular use of inhaled corticosteroids （ICS）， a lower forced expiratory volume in one second/forced vital capacity ratio （FEV1/FVC），and forced expiratory volume in 1 second as a percentage of predicted value （FEV₁/pred）， and higher levels of serum periostin， TNC， and sST2（P＜0.05）. ROC analysis indicated that the AUC values for serum periostin， TNC， and sST2 in predicting acute exacerbations in children with asthma infected by Mycoplasma pneumoniae were 0.673， 0.737， and 0.720， respectively. Multivariate logistic regression analysis indicated that high periostin ［OR （95%CI）=1.031 （1.014～1.049）］， high TNC ［OR （95%CI）=1.099 （1.055～1.144）］， and high sST2 ［OR （95%CI）=1.171（1.080～1.271）］ were all independent risk factors for acute exacerbations in children with asthma infected by Mycoplasma pneumoniae （P＜0.05）. The nomogram model constructed based on the aforementioned three indicators demonstrated favorable degree of fitting （Hosmer-Lemeshow test： χ²=7.356， df=8， P=0.499）. ROC analysis revealed that the AUC value of this nomogram model for predicting acute exacerbations in pediatric patients was 0.838 （95% CI： 0.779～0.898， P＜0.001）. DCA analysis indicated that this nomogram prediction model exhibited satisfactory clinical net benefit across a threshold probability range of 0～0.95.

Conclusion

The levels of serum periostin， TNC， and sST2 in children with asthma complicated by Mycoplasma pneumoniae infection are strongly correlated with the likelihood of experiencing acute asthma exacerbations.Utilizing a model that incorporates these serum biomarkers can greatly assist healthcare providers in assessing the risk of acute asthma exacerbations in this specific group of children， thereby demonstrating significant clinical utility.

Objective

To explore the roles and immune regulatory mechanisms of key genes in mitophagy and ferroptosis in sepsis-induced acute respiratory distress syndrome （ARDS） using an integrative analysis of machine learning and transcriptomics.

Methods

The DEGs from the GSE32707 dataset in the GEO database were obtained and the differential genes screened. The core genes were identified and validated by secondary screening of DEGs with LASSO regression and the SVM-RFE algorithm， and their diagnostic performance with ROC curves was evaluated. DEGs-related biological pathways and immune cell interactions were investigated via GSEA and immune infiltration analysis. The hub genes by intersecting mitophagy-related genes， ferroptosis markers， and core DEGs were determined. A multi-dimensional regulatory network was established by predicting miRNA targets （using miRWalk， etc.） and ubiquitination interactions （using UbiBrowser）， and then potential regulatory mechanisms of hub genes were explored.

Results

Initially， 576 DEGs were screened. Then， 12 core genes were identified via machine learning algorithms. GSEA and immune infiltration analysis showed these core genes were significantly enriched in immune-related pathways. By integrating mitophagy and ferroptosis-related genes with core DEGs， FTH1 was identified as a hub gene， whose expression positively correlated with neutrophil levels and CCR. Mechanistic exploration suggested FTH1 expression might be regulated by miR-224-5p and interact with the E3 ubiquitin ligase SMURF1， implying its potential involvement in disease progression via ubiquitination modification.

Conclusion

This study， combining machine learning and multi-omics integration， first identifies FTH1 as a key regulator of mitophagy and ferroptosis in sepsis-related ARDS. It reveals a regulatory network where FTH1 might be targeted by miR-224-5p and interact with SMURF1， offering new directions and a theoretical basis for developing early immunointervention targets for this disease.

Objective

To explore the clinical practice value of intelligent transformation of trauma care.

Methods

A total of 79 trauma patients rescued from our trauma center from January to June 2023 were selected as the control group， and 77 cases of trauma patients rescued from July to December of the same year were selected as the experimental group. The control group used the original trauma intelligent nursing system to carry out integrated trauma rescue combining rapid response and long-term management，while the experimental group improved the technical scheme of the trauma nursing system， and carried out intelligent transformation of trauma nursing through hardware configuration expansion and software function expansion. The rate of timely management of injury treatment， the success rate of treatment， the incidence of anxiety and depression symptoms， and the self-burden of patients were compared between the two groups.

Results

The experimental group was higher than the control group in reaching the standard of time management and the success rate of treatment. The incidence of anxiety and depression symptoms and selfburden of patients were decreased， and the difference was statistically significant （P＜0.05）.

Conclusion

The use of advanced information technology to explore the driving force of medical nursing data can promote the construction of a complete trauma treatment chain and improve the efficiency and effect of trauma care.

口服毒物中毒后早期的胃肠道毒物清除非常重要。胃肠道毒物清除的方法包括洗胃、全胃肠洗消、全胃肠盥洗、导泻、催吐等。对于洗胃，国内和国外有着截然不同的观点，关于引起中毒的毒物谱，国内和欧美地区有着明显的不同，国内引起致死性中毒的毒物比如百草枯、敌草快、剧毒有机磷农药在欧美国家是禁止使用的，欧美国家中毒性疾病以药物中毒多见。国内专家推荐洗胃，欧美专家不推荐洗胃。关于早期胃肠道毒物清除，目前山东大学齐鲁医院中毒与职业病科主要采用洗胃联合全胃肠洗消的方法。早期胃肠道毒物清除有四个重要的作用，即毒物清除、阻断毒物的肠肝循环、保护胃肠道和防治脓毒症的作用。特殊情况下胃肠道毒物清除要综合各种影响因素。对于胃肠道毒物清除所引起的并发症要及时规范处理。

Objective

To analyze the impact of feedforward control combined with body temperature management on the rescue quality and prognosis of patients with traumatic hemorrhagic shock in the emergency department.

Methods

A total of 80 patients with traumatic hemorrhagic shock admitted to the emergency department of Zhujiang Hospital， Southern Medical University from October 2023 to October 2024 were studied， including 46 males and 34 females， aged 18 to 78 years， with an average age of （48.12±2.63） years. From October 2023 to April 2024， 40 patients were in the control group （without feedforward control combined with temperature management）， and from May 2024 to October 2024， 40 patients were in the experimental group （with feedforward control combined with temperature management）. The changes in body temperature， rescue quality， and prognosis of the two groups were observed.

Results

There was no significant difference in pre-hospital body temperature between the two groups （P＞0.05）. At admission and 1 hour after admission， the body temperature of the experimental group was higher than that of the control group.The effective rewarming rate of the experimental group was 95.00%，which was higher than 80.00%of the control group （P＜0.05）. The rescue time of the experimental group was shorter， and the rescue success rate was 92.50%， which was higher than 75.00% of the control group （P＜0.05）. The complication rate of the experimental group was 10.00%， which was lower than 32.50% of the control group （P＜0.05）.

Conclusion

In patients with traumatic hemorrhagic shock in the emergency department， feedforward control combined with temperature management can effectively increase body temperature， improve rescue efficiency and success rate，and reduce the risk of complications，thereby helping to improve prognosis.

Objective

To investigate the current status of pre-hospital emergency knowledge，attitudes， beliefs and practices （KABP） among non-medical college students， providing a basis and direction for the development of campus emergency training programs.

Methods

A random sample of non-medical college students from four institutions in Kunshan was surveyed using a self-designed questionnaire.Group t-tests and mean analysis were employed to examine the influence of factors such as gender， education level，health status， and previous training experience on KABP.Interviews with campus administrators were conducted to gather information about campus emergency first-aid training and to identify influencing factors， with feasible recommendations for improvement.

Results

A total of 9，311 participants completed the survey， with females comprising 38.90%， a lower proportion than males.Among respondents， 30.20%had prior first-aid training experience， while 69.80% had no such experience.Of those with training， 21.34%had received it within the last three months， 2.90% within the last six months， and 5.96% within the last year.Regarding willingness to participate in future training， 67.73% expressed interest， while 33.27% were unwilling.The average scores for first-aid knowledge， attitudes， and behaviors were 14.60， 43.92， and 25.90，respectively.Of the 30 items analyzed， 23 were found to have significant correlations with prior training，while 7 were not.Multivariate logistic regression analysis revealed that gender， health status， education level，household registration， and prior training experience had statistically significant effects on first - aid knowledge， attitudes， and behaviors （P＜0.05）.

Conclusion

First-aid training among college students in Kunshan is inadequate， which is linked to a general lack of awareness regarding campus health emergency management.Overcoming the limitations of time， resources， and interaction space for students are crucial.Training programs should focus on life-saving knowledge and skills， prioritizing the assessment， recognition，and provision of first-aid for rare， critical， and specialized emergencies.These programs should aim to equip students with practical， success-promoting experiences.Non-medical college students possess strong first-aid knowledge and display positive attitudes and behaviors toward first-aid.They can be cultivated as key participants in both campus and societal emergency first-aid efforts， representing a valuable high-quality population for the effective implementation and transfer of first-aid training outcomes into real-world applications.

Objective

To analyze the related factors of the pause duration caused by the manualmechanical conversion of cardiopulmonary resuscitation （CPR） in out-of-hospital cardiac arrest （OHCA）patients.

Methods

A retrospective cohort study was conducted to analyze the OHCA patients treated by the direct-affiliated emergency stations of Yixing Emergency Medical Center from June 2023 to January 2024， all of whom received mechanical chest compression outside the hospital. A total of 160 OHCA patients were enrolled， including 120 males （75.0%） and 40 females （25.0%）， aged 34 to 89 years， with an average age of （62.75±15.48） years. Basic patient information， rescue data， and data related to the pause duration caused by the conversion to mechanical compression were collected.

Results

The patient's weight （r=0.238， P=0.002）， body mass index （r=0.238， P=0.002）， and the duration of mechanical compression initiation（r=0.912， P＜0.001） were positively linearly correlated with the pause duration. Multiple linear regression analysis revealed that the patient's height （P=0.01）， body mass index （BMI） （P=0.046）， and the duration of mechanical compression initiation （P＜0.001） were independent risk factors for the pause duration.

Conclusion

The patient's height， BMI， and the duration of mechanical compression initiation are correlated with the duration of chest compression interruption.

Objective

To observe the impact of cardiopulmonary ultrasound - guided fluid resuscitation and goal-directed therapy on the prognosis of patients with septic shock.

Methods

A total of 96 patients diagnosed with septic shock hospitalized in Affiliated Hospital of Zunyi Medical University from March 2023 to December 2024 were selected and randomly divided into cardiopulmonary ultrasoundguided fluid therapy group （ultrasound group） and goal-directed therapy group （GDT group） according to random number table， with 48 patients in each group. Among them， there were 59 males and 37 females and the age ranged from 21 to 80 years， with a median age of 56.5 （44.0， 68.0） years. The baseline data of patients at admission were collected. The patients in the ultrasound group underwent critical care ultrasound examination， including cardiac systolic and diastolic function， inferior vena cava diameter and dilatation index， and lung condition at the time of admission （0 h）， 24 h， 48 h and 72 h after treatment，respectively， to guide fluid therapy. GDT group guided fluid management according to central venous pressure （CVP）， mean arterial pressure （MAP）， central venous oxygen saturation （ScvO₂）， urine volume and lactic acid （Lac）. Clinical data， fluid volume， NT-proBNP changes of the two groups were compared and prognostic indicators were observed， including 24-hour resuscitation targeting rate， lactate clearance rate（24 h，48 h，72 h），mechanical ventilation time，length of intensive care unit（ICU）and hospital stay，mortality within ICU and 28 days.

Results

With the prolongation of treatment， the heart rate and NT-proBNP of the two groups gradually decreased， and the MAP gradually increased （P＜0.05）. Compared with the GDT group，the fluid resuscitation guided by the cardiopulmonary ultrasound could increase the 24 h resuscitation targeting rate，increase lactate clearance rate at 24 h，48 h and 72 h，reduce the volume of fluid resuscitation at 24 hours and 48 hours， increase output， fluid balance and urine volume of 48h and 72 h， and accelerate the decline of NT-proBNP. There were no statistically significant differences in the time of mechanical ventilation， length of stay in ICU and hospital， mortality in ICU and 28 days between GDT group and ultrasound group （P＞0.05）.

Conclusion

Cardiopulmonary ultrasound can be used to guide the fluid treatment of patients with septic shock， improve the 24-hour resuscitation targeting rate and lactate clearance rate， reduce the infusion volume during resuscitation， significantly reduce NT-proBNP and therefore alleviate myocardial injury.

Objective

To observe the effect of different doses of dexmedetomidine nasal drops in the elderly percutaneous vertebroplasty （PVP）.

Methods

A total of 100 elderly patients who underwent elective Percutaneous Vertebroplasty （PVP） at the Traditional Chinese Medicine Hospital of Pi District，Chengdu City from June to December 2023， including 38 males and 62 females. Their ages ranged from 60 to 79 years old， with an average age of （69.08±4.86） years. Patients were divided into 4 groups（n=25） by random number table method： dexmedetomidine 0.8 μg/kg group （D1 group）， 1.0 μg/kg group （D2 group）， 1.2 μg/kg group （D3 group） and normal saline control group （N group）. Ramsay calm score， visual analog scale （VAS）， mean arterial pressure （MAP）， heart rate （HR） and pulse oxygen saturation （SpO₂） were compared immediately after entering the operating room （T1）， 30 min after nasal drops （T2）， immediately after cannula reached vertebra （T3）， bone cement injection （T4）， and 5 min after resuming position （T5）between the groups. Intraoperative adverse reactions were recorded.

Results

The sedation score at each time point of D3 group after nasal drip was higher than that of other groups （P＜0.05）.At T3 and T4，the pain score of D3 group was lower than that of other groups （P＜0.05）. There was no significant difference in MAP and HR of D3 group at T3 and T4 compared with T2 （P＞0.05）.Postoperative blood glucose in all groups was higher than that before surgery （P＜0.05）， and the increase of blood glucose in D3 group was lower than that in other groups （P＜0.05）. The amount of lidocaine and operation time in D3 group were lower than those in other groups （P＜0.05）， and the satisfaction score in D3 group was higher than that in other groups （P＜0.05）.The incidence of agitation and intraoperative hypertension in group N was higher than that in other groups（P＜0.05）.However，there was no statistical difference in the occurrence of adverse reactions among all groups（P＞0.05）.

Conclusion

For elderly patients undergoing PVP treatment， 1.2 μg/kg of dexmedetomidine can be effectively sedated and analgesic before operation，and patients are safer，more comfortable and satisfied.

急、慢性创面是急诊科常见、多发病。慢性创面（压力性损伤、糖尿病足等）具有发病率高、致残率高、治疗周期长、费用高、合并多个基础疾病且涉及多个专科等特点，病源很广、市场需求巨大。国家卫生健康委员会文件提到“加强创面修复相关临床科室（内分泌、普外、骨科、烧伤科等）的能力建设”，但漏了关键的急诊科。我们认为急诊科是治疗慢性创面最佳科室之一，理由：急诊科具有扎实理论、技能基础，具备清创手术场所以及急诊病房，糖尿病足亦需急诊血运重建，慢创需要急治。急诊科应重视急诊创面中心建设，运作模式为以患者为中心的多学科诊疗模式（MDT）模式；在强化压力性损伤和糖尿病足防治理念同时，应加强负压封闭引流术（VSD）和整形美容缝合技能培训，还应注重犬伤和破伤风规范防治，医、教、研全面发展。

Objective

To observe the effect of quality control circle and interactive health education in children with severe bronchial asthma.

Methods

A total of 152 children with severe bronchial asthma admitted to the Third Affiliated Hospital of Nanjing Medical University from January 2022 to May 2024 were selected as the research subjects； there were 82 males and 70 females， aged 5～11 years， with mean （8.10±2.00） years.They were divided into control group （routine care， n=76） and observation group （interactive health education， n=76）.FeNO， pulmonary function （FVC， FEV1， PEF）， psychological state （HAMD，HAMA）， caring ability （MCEM）， and disease control effect （C-ACT） were compared.

Results

The level of FeNO in two groups at 1 month and 3 months was lower than that before intervention （P＜0.05）.The FeNO levels of the children in the observation group were lower than those in the control group after 1 month and 3 months of intervention （P＜0.05）.After intervention， the scores of FVC， FEV1， PEF and parents' MCEM scores were higher than those before intervention （P＜0.05）.After intervention， FVC， FEV1， PEF and parents'MCEM scores of the observation group were higher than those of the control group （P＜0.05）.HAMD and HAMA scores after intervention were lower than those before intervention （P＜0.05）.After intervention，HAMD and HAMA scores in the observation group were lower than those in the control group （P＜0.05）.After intervention， the C-ACT score of the observation group was higher than that of the control group （P＜0.05）.

Conclusions

The corresponding application of quality control circle and interactive health education in children with severe bronchial asthma can improve the lung function of children， reduce the level of FeNO，improve the psychological state of children and the ability of parents to take care of children， and thus increase the control effect of severe bronchial asthma.