OBJECTIVE:Coronary artery lesions (CALs) are a major complication of Kawasaki disease (KD); however, data on CAL incidence and risk factors in recurrent KD are limited. METHODS:Ninety-seven children with recurrent KD were retrospectively enrolled from 2013 to 2022, and CAL incidence was tracked during admission, discharge, and during follow-up. RESULTS:Initially, 27.8% had CAL at admission and discharge, declining to 7.2% at 12 months post-discharge. Most patients (66 of 97, 68.0%) did not exhibit CAL at any of the time points, 7 cases presented CAL at all time points, indicating a persistent CAL. The remaining 20 cases presented CAL at admission but recovered at discharge or during follow-up. Notably, transient CALs had presented at discharge, or during the follow-up, but finally resolved at 12 months after discharge. Notably, prior IVIG resistance and increased prothrombin time seemed associated with CAL in recurrent KD, suggesting they could help identify patients needing close monitoring. CONCLUSION:The study highlights decreasing CAL incidence over time in recurrent KD but with diverse patterns, emphasizing the importance of monitoring and further investigations to confirm these findings.

Oral microecological imbalance is closely linked to oral mucosal inflammation and is implicated in the development of both local and systemic diseases, including those caused by viral infections. This review examines the critical role of the interleukin (IL)-17/helper T cell 17 (Th17) axis in regulating immune responses within the oral mucosa, focusing on both its protective and pathogenic roles during inflammation. We specifically highlight how the IL-17/Th17 pathway contributes to dysregulated inflammation in the context of respiratory viral infections. Furthermore, this review explores the potential interactions between respiratory viruses and the oral microbiota, emphasizing how alterations in the oral microbiome and increased production of proinflammatory factors may serve as early, non-invasive biomarkers for predicting the severity of respiratory viral infections. These findings provide insights into novel diagnostic approaches and therapeutic strategies aimed at mitigating respiratory disease severity through monitoring and modulating the oral microbiome.

报告1例子宫两处动静脉瘘合并胚物残留的病例.该患者因稽留流产刮宫术后,阴道淋漓出血伴阵发性大量出血收入院.入院后行子宫动脉栓塞术,明确诊断子宫动静脉瘘.第2天行宫腹腔镜联合手术,宫腔镜检查发现宫腔内残留胚物样组织,腹腔镜检查发现右侧宫角和左侧宫底近左侧宫角处紫蓝色病灶,表面被覆畸形血管,切除右侧宫角及左侧宫底病灶过程中,可见肌层间管状扩张血管.子宫动静脉瘘可出现阵发性大出血,当其合并胚物残留时,出血风险更高,临床需提高对子宫动静脉瘘合并胚物残留的认识.超声作为首选影像学检查,子宫动脉收缩期峰值血流速度(peak systolic velocity,PSV)大于60～70 cm/s时,需即刻干预.数字减影血管造影(digital subtraction angiography,DSA)是诊断子宫动静脉瘘的金标准,可同时行子宫动脉栓塞术减少出血.术中应仔细探查肌壁间病灶,谨防肌壁间多处动静脉瘘形成,造成漏诊.如子宫动静脉瘘合并胚物残留,宫腹腔镜联合手术可能是推荐治疗方式.

Introduction The rapid rise of azole resistance in Candida tropicalis causing invasive infections has become a public health concern; however, the prevalence of resistant isolates in urine samples was not well studied, because the clinical significance of candiduria was not unambiguous due to possible host colonization. Methods We performed a 12-year laboratory-based surveillance study of C. tropicalis causing either invasive infection or candiduria and studied their susceptibility profiles to common antifungal drugs. The complete coding domain sequence of the ERG11 gene was amplified in all fluconazole resistant isolates, and aligned with the wild-type sequence to detect nucleotide mutations. Results A total of 519 unique C. tropicalis strains isolates, 69.9% of which were isolated from urine samples and remaining 30.1% were invasive strains. Overall, 16.5% isolates were confirmed to be resistant to fluconazole, of which 91.9% were cross-resistant voriconazole. Of note, at the beginning of surveillance (2010–2011), the fluconazole resistance rates were low in both candiduria and invasive groups (6.8% and 5.9%, respectively). However, the resistant rate in the candiduria group significantly increased to 29.5% since 2012–2013 ( p = 0.001) and stayed high since then, whilst the resistance rate in the invasive group only showed a gradually increasing trends till 2021 ( p > 0.05). Sequence analysis of ERG11 from fluconazole-resistant strains revealed the prevalence of A395T/W mutations were relatively low (16.7%) in the beginning but reached 87.5–100% after 2014. Moreover, the A395W heterozygous mutation isolates became predominant (>60% of resistant strains) after 2016, and indeed isolates carrying corresponding amino acid substitution (Y132F) was highly resistant to fluconazole with MIC 50 exceeded 256 μg/ml. Conclusion Our study revealed high azole resistant rate in candiduria with its increasing trends observed much earlier than stains causing invasive infections. Given antimicrobial resistance as a critical “One Health” issue, the emergence of antifungal resistance in Candida species that are common commensal colonizers in the human body should be concerned.

Purpose To explore the risk factors and develop predictive models for intravenous immunoglobulin (IVIG) resistance in children with recurrent Kawasaki disease (KD). Patients and Methods Patients with recurrent KD were retrospectively reviewed. Clinical and laboratory data at recurrence were collected and compared between patients with and without IVIG resistance. The patients were randomly divided into training and validation cohorts for model development and validation. All variables were subjected to standard Lasso and its variant group Lasso analyses, respectively, to construct predictive models. Model performance was evaluated by receiver operating characteristics (ROC) curves, calibration curves, and Hosmer-Lemeshow tests. Results A total of 90 children with recurrent KD were included. A total of 16 cases were IVIG resistant. The patients with IVIG resistance had higher age and IVIG resistance probability at the first episode, increased CRP levels, neutrophil count, neutrophil percentage, direct bilirubin level, prothrombin time, and international normalized ratio, and decreased lymphocyte count, lymphocyte percentage, and serum sodium levels. Five variables including age and IVIG resistance at the first episode, lymphocytes count, serum sodium levels, and CRP levels were finally selected by standard Lasso (lLasso model) and four variables including age and IVIG resistance at the first episode, neutrophil percentage, and CRP levels were selected by group Lasso (gLasso). ROC curves suggested lLasso and gLasso models had similar excellent discrimination in both the training cohort (0.895 vs 0.906) and the validation cohort (0.855 vs 0.909). Hosmer-Lemeshow tests suggested the two models exerted a good calibration. Two nomograms were also constructed to facilitate the potential application of the two models. Conclusion Age and IVIG resistance at the first episode and some laboratory variables may be risk factors for IVIG resistance in recurrent KD. Two predictive models for IVIG resistance with excellent performance were established in recurrent KD. External validation should be performed before clinical use.

目的:调查青年护士健康信念的现状,并分析其影响因素.方法:采用便利抽样法,于2020年10月—11月抽取北京市某三级甲等医院的557名护士作为研究对象,采用一般资料调查表、中国成年人多维度健康信念量表、Wallston健康价值量表、组织支持感量表进行横断面调查,采用多元线性回归分析确定影响青年护士健康信念的因素.结果:青年护士的健康信念评分为(117.87±17.02)分;护士职称、是否愿意成为健康榜样、组织支持是影响青年护士健康信念的重要因素,共解释健康信念总变异度的26.7％.结论:青年护士健康信念水平处于中等偏高水平,护理管理者应积极调动护士的内在驱动力,提升其自主成为健康榜样的意愿,同时给予充足的组织支持,提高其健康信念水平,进而更好地发挥其健康促进作用.

Background Spontaneous coronary artery dissection (SCAD) is now recognized as an important cause of acute coronary syndrome (ACS), which is thought to be more prevalent in women. However, the male patients, on the other hand, cannot be easily ignored. Case presentation A 26-year-old male suffered from SCAD that occurred in the left main coronary artery (LMCA) and a secondary acute myocardial infraction (AMI). Coronary CT angiography and coronary angiography (CAG) revealed aneurysms in the LMCA and right coronary artery (RCA), as well as a total occlusion in the proximal branch of the left anterior descending artery (LAD). Along with drug therapy, coronary artery bypass graft (CABG) surgery was recommended, and the patient has been symptom-free for one year. Conclusion We report a case of spontaneous left main coronary artery dissection that occurred in a young male. The necessity of identifying typical imaging features and following up patients with SCAD for life to reduce the risk of fatal cardiac complications cannot be overstated.

This article analyzes the overview of ward classification management, and its research status, impact on nursing management, the existing problems and related solutions. The goal of this article is to provide a sound scientific basis for nursing management in the future, and lay the foundation for the hospital to implement post classification management, optimize the allocation of human resources, establish performance appraisal mechanism and improve the quality of nursing.

目的 初步评价结核分枝杆菌(Mycobacterium tuberculosis,MTB)临床耐药分离株和实验室诱导耐药株的毒力变化表征.方法 选取MTB标准株H37Rv和减毒株H37Ra各1株、4株临床耐药分离株(15833、16030、17080和30744,各1株)和8株实验室诱导耐药株[分别为单耐Pretomanid(PA-824)菌株(P1)、单耐利奈唑胺(Lzd)菌株(L1)、单耐PBTZ-169菌株(169-1、169-2、169-3,各1株),以及同时耐PA-824和Lzd的LPDR菌株(PL1、PL2、PL3,各1株)].测定临床耐药分离株对一、二线抗结核药物和实验室诱导耐药株对Lzd、PA-824、PBTZ-169的最低抑菌浓度(minimum inhibitory concentration,MIC)值.绘制各研究菌株的体外生长曲线及测量感染巨噬细胞2 d后的胞内菌落形成单位(colony forming units,CFU),并测定感染2 d后巨噬细胞释放乳酸脱氢酶(lactate dehydrogenase,LDH)的含量.动物实验选取BALB/c小鼠168只,6～7周龄,体质量16～18 g/只,分为14组,每组12只.将各耐药菌株以尾静脉注射的方式感染BALB/c小鼠,记录小鼠半数生存期,进行生存分析.结果 体外实验表明,MTB临床耐药分离株30744生长曲线相比于其他耐药株的生长平台期提前,菌株体外适应性较低,其余各耐药菌株生长曲线趋势基本一致.临床耐药分离株(15833、16030、30744、17080)和对Lzd和PA-824同时耐药的实验室诱导耐药株(PL1、PL2、PL3)感染巨噬细胞2 d后的胞内CFU计数[分别为(5.180±0.074)、(5.571±0.029)、(5.550±0.073)、(5.446±0.099)、(5.763±0.197)、(5.907±0.053)、(5.661±0.083)log10 CFU/ml]明显低于标准株 H37Rv[(6.207±0.028)log10 CFU/ml],差异均有统计学意义(t=17.932、12.758、12.034、10.241、4.796、7.042、9.113,P 值均＜0.05).另外,菌株 15833、16030、30744、1708、P1、L1、PL1、PL2、PL3、169-1、169-2、169-3感染巨噬细胞2 d后LDH释放量的吸光度A490值比值(分别为0.252±0.039、0.412±0.078、0.247±0.022、0.358±0.054、0.329±0.015、0.483±0.017、0.328±0.046、0.455±0.075、0.283±0.041、0.258±0.044、0.374±0.080、0.311±0.097)均明显低于标准株 H37Rv(0.958±0.025),差异均有统计学意义(t=27.269、16.788、38.244、24.238、44.005、32.698、27.713、15.171、31.798、31.472、16.515、15.570,P 值均＜0.01).体内毒力实验显示:(1)所有菌株感染小鼠后,半数生存期(≥15d)均明显长于H37Rv标准株(12d).(2)小鼠生存曲线显示:准广泛耐药菌株感染小鼠的存活时间长于耐多药菌株,即30744＞17080＞16030＞15833;双重耐药菌株LPDR组小鼠存活时间＞PBTZ-169耐药菌株组=单耐Lzd组＞单耐PA-824耐药菌株组.结论 MTB耐药株的毒力均较野生型标准株下降,毒力的大小与该菌株耐药的数量可能呈负相关.

目的 探索护士知觉压力水平对其健康行为能力的影响.方法 于2020年10-11月选取北京市某三级甲等医院的784名护士为研究对象,采用一般资料调查表、知觉压力量表和健康行为能力自评量表进行调查.结果 护士知觉压力评分为25.02±6.23,处于健康危险性压力状态的护士为519名(占66.2％),健康行为能力评分为81.53±20.61.护士知觉压力与健康行为能力呈负相关(r=-0.399,P＜0.01).多元线性分层回归显示,护士知觉压力水平是其健康行为能力的影响因素,紧张感及失控感两个维度均会影响护士的健康行为能力(均P＜0.01).结论 护士感知到的知觉压力水平越高其健康行为能力越差,护理管理者应通过多种策略给予护士心理社会支持,改善其压力水平,从而提升其健康行为能力,实现身心健康.

细菌性阴道病(bacterial vaginosis,BV)是阴道内厌氧菌混合感染,由正常菌群失调引起,是育龄期女性最常见的下生殖道感染性疾病[1-2]. 现如今阴道微生态的诊断评价体系已相对完善,国内外均有针对BV诊治的相关指南以指导临床治疗,但是对于特殊状态下BV的处理,如无症状性BV及复发性BV,临床实际工作中经常出现,但目前尚无统一定论,给诊断与治疗带来了一定难度,也是目前需要关注的问题.

目的了解护理专科门诊护士职业认同感现状,为优化护理专科门诊管理提供参考.方法采用整群抽样法,对北京市22所市属医院521名护理专科门诊护士进行职业认同感调查.结果护理专科门诊护士职业认同感得分(117.84±20.73)分;不同学历、职称、出诊方式及护理专科门诊类别护士的职业认同感得分差异有统计学意义(P<0.05,P<0.01).结论护理专科门诊护士的职业认同感处于中等水平,应优化专科护士的使用,提升其职业认同感.

目的 探讨信息化抢单模式在手术患者交接环节中的应用效果.方法 在医院信息系统基础上开发并使用手术患者身份识别信息及转运抢单系统,应用于手术患者交接转运环节,通过信息化抢单模式进行患者术前的转运工作,扫描手术患者信息条码通知单及患者腕带上的二维码实现手术患者转运交接及患者入手术室核对,病区与手术室护士通过信息系统共享手术患者的相关信息完成身份识别.将使用信息化抢单模式系统前(201 7年7月1日-2018年6月30日)的择期手术作为对照组,使用信息化抢单模式系统后(2018年7月1日-2019年6月30日)的择期手术作为观察组;比较使用信息化抢单模式系统前后的交接失误率及使用者满意度.结果 信息化抢单模式系统在临床应用以来降低了手术患者身份错误的发生,失误率由0.23％降低到0.03％(x2=21.018,P＜0.01).并且提高了信息化转运使用者的便捷度,术间护士的满意度由33％提升到71.6％(x2 =28.953,P＜0.01),运送人员满意率由15.4％提升到84.6％(x2=15.231,P＜0.01).结论 信息系统应用于手术患者交接,保证手术患者身份识别的准确性及交接安全,值得推广.

目的 探讨护士心理韧性与职业发展之间的关系,为促进护士的职业发展提供参考依据.方法 2019年11月—12月,采用方便抽样法选取全国71 477名护士作为调查对象,采用心理韧性量表、职业发展问卷进行数据收集,并进行职业发展现状、心理韧性现状的相关性分析.结果 共回收有效问卷70 932份,有效回收率为99.24％.调查对象心理韧性总分为(90.49±15.71)分,职业发展总分为(123.42±19.57)分,心理韧性与职业发展呈正相关(r=0.618,P＜0.001).多元分层回归分析结果显示,心理韧性进入了护士职业发展影响因素模型(F=4 474.791,P＜0.001),可独立解释护士职业发展37.3％的变异.结论 护士心理韧性水平越高,护士职业发展水平越好,护理管理者应高度关注护士的心理韧性水平,并以科学的方法提高护士的心理韧性水平,促进护士的职业发展.

Background Patients with pelvic inflammatory disease (PID) are at an increased risk of ectopic pregnancy, infertility, and varying degrees of chronic pelvic pain. The aims of this study were to establish a rat model of PID and characterize its progression in order to assist in the study of pathophysiological mechanisms and to provide animal model for future studies of PID treatments. Methods Fifty Sprague-Dawley rats (female, 6-weeks-old) were divided into a model group (n=28) and a control group (n=22). The rat endometrium was mechanically injured by a needle which moved back and forth 3 times on the endometrial tissue, and a mixed bacterial solution (6×108 CFU) of equal concentrations of Escherichia coli and Staphylococcus aureus was injected into both horns of the rat uterus. Physiological characteristics including weight, temperature, blood, and inflammatory factors were compared, and immunohistochemistry and transmission electron microscopy were used to evaluate the progress and sequela of PID. Results The model rats experienced acute PID in the first 14 days and exhibited higher body temperatures and decreased body weight. Infection-related factors in the blood were also significantly changed compared with the normal group, with obviously increased serum levels of C-reactive protein (CRP), interferon gamma (IFN-γ), and interleukin-4 (IL-4). Congestion and edema were observed in the uteri of the model rats, followed by infiltration of numerous inflammatory cells and ultrastructural morphology changes. Histological examination of the uterus showed that adhesion initially appeared at approximately 21 days. In addition to the increased collagen fibers biomass, the expression of transforming growth factor-beta 1 (TGF-β1) was elevated, which might have contributed to pelvic tissue adhesion formation in the PID sequela. Conclusions This study clearly described the characteristics and progression of PID in a rat model. The detailed evidence increased our understanding of the pathogenesis and progression of PID and may be useful for future studies of PID treatments.

目的:对护士给药、药物过敏试验、输血、标本采集送检、观察监测等代表核心护理工作的质量内容进行周期性客观测量与持续改进,寻找改善结果的规律.方法:对2015年至2018年间护士执行医嘱过程在临床信息系统留痕后提取到的201254条对应数据进行研究,以准确性、及时性、有效性指标,分类测量护理质量,3个月为一个质量周期,首个周期的质量为基线值,之后各周期质量与之比较,同时与前一周期质量比较.结果:与基线质量比较,一般第一次存在统计学差异(P<0.05)最迟出现在第二个质量周期,此后凡优于第一次与基线质量比较具有统计学差异的指标的质量,较基线质量均具有统计学意义,无时间局限;与前一周期质量比较,存在统计学差异(P<0.05)出现的质量周期与维持时间不等.结论:大数据的非现场质量测量实现了客观、公平、实时的质量测量,形成精准质量控制,揭示了一定条件下质量改进变化轨迹与规律.

目的 探索CYP2C19失功能等位基因与急性冠状动脉综合征经皮冠状动脉介入(PCI)术后应用氯吡格雷抗血小板治疗患者主要不良心脑血管事件和出血风险的相关性.方法 研究设计为回顾性队列研究.筛选并纳入2015年7月至2016年3月于首都医科大学附属北京安贞医院诊断为急性冠状动脉综合征并且成功接受PCI术的患者826例,根据患者是否携带失功能等位基因CYP2C19*2、*3分为携带失功能等位基因组和未携带失功能等位基因组,收集患者出院1年后的随访数据,对主要不良心脑血管事件及出血事件的发生进行评估.结果 826例患者中478例纳入携带失功能等位基因组,348例纳入未携带失功能等位基因组.Cox多元回归模型分析结果提示,与未携带失功能等位基因组相比,携带失功能等位基因组的主要不良心脑血管事件发生风险升高270％(风险比=3.702,95％置信区间:1.076 ～12.735,P=0.038).在出血风险方面,携带失功能等位基因仅能降低小出血发生风险(风险比=0.655,95％置信区间:0.435 ～0.986,P=0.043),对于大出血则无影响(风险比=1.032,95％置信区间:0.228～4.664,P=0.967).结论 携带CYP2C19失功能等位基因的急性冠状动脉综合征患者PCI术后使用氯吡格雷抗血小板治疗具有更高的主要不良心脑血管事件的发生风险和更低的小出血风险.

目的 调查行外科大手术治疗的老年患者术后低蛋白血症的发生现状,分析其影响因素,为临床实践提供一定的参考和依据.方法 采用前瞻性队列研究,收集2016年10月—2018年10月在北京市某三级甲等医院行外科大手术治疗的老年患者术前、术中资料,了解术后低蛋白血症的发生现状,采用二分类Logistic回归分析其影响因素.结果 外科大手术老年患者术后低蛋白血症的发生率为15.2％(55/363),二分类Logistic回归分析结果显示,衰弱状态(OR=6.831,95％CI=3.187～14.639)、美国麻醉医师协会分级(OR=5.414,95％CI=2.070～14.162)及手术时间(OR=1.726,95％CI=1.401～2.126)是术后低蛋白血症发生的危险因素,术前白蛋白(OR=0.457,95％CI=0.215～0.971)是术后低蛋白血症发生的保护因素.结论 在临床实践中医护人员应注重对老年人术前衰弱及营养状况的关注,通过全面老年综合评估筛查术后低蛋白血症发生的高危人群,及时开展相适应的干预措施,将干预时间窗提前以提升老年人手术抗应激能力,改善患者预后.

BACKGROUND:Kawasaki disease (KD) is a type of pediatric vasculitis. Ten to twenty percent of children with KD do not respond to initial intravenous immunoglobulin (IVIG) treatment which called refractory Kawasaki disease. If untreated, approximately 15-25% of KD patients have complications. Therefore, it is important to predict whether KD is resistant to IVIG at an early stage. The aim of this study was to determine whether cytokines are predictors of refractory KD in children. METHODS:We retrospectively reviewed the medical records of 265 children diagnosed with KD who received IVIG within 10 days of fever onset at Beijing Children's Hospital. Refractory Kawasaki disease was defined as persistent or recrudescent fever beyond 36 h after IVIG. Before IVIG and 3 days after temperature normalization following IVIG treatment, the concentrations of cytokines in the serum including interferon gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), interleukin-6 (IL-6), interleukin-4 (IL-4), interleukin-2 (IL-2) and other conventional inflammatory mediators including white blood cells counts (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and albumin were detected. The patients were divided into 2 groups: IVIG-sensitive group and refractory group. RESULTS:Of the 265 patients, 47 (17.7%) were refractory. After treatment with IVIG, the serum levels of IFN-γ, TNF-α, IL-10 and IL-6 in both groups were significantly lower than those before treatment (P < 0.05). Before treatment, the serum levels of IFN-γ, TNF-α, IL-10 and IL-6 in refractory group were significantly higher than those in IVIG-sensitive group (P < 0.05). There were no significant differences in IL-4 or IL-2 levels between the 2 groups. The results of logistic regression analysis showed that IFN-γ, IL-6, fever duration and serum albumin were independent risk factors for refractory KD. The area under the receiver operating characteristic curve (ROC curve) for IFN-γ was 0.781, and the cut-off value for refractory was 7.37 pg/ml, while the area under the ROC curve for IL-6 was 0.837, and the cut-off value for refractory was 70.13 pg/ml. CONCLUSIONS:IFN-γ and IL-6 were independent risk factors for refractory Kawasaki disease in children. KD patients with serum levels of IFN-γ above 7.37 pg/ml and IL-6 above 70.13 pg/ml before treatment were prone to refractory.