Objective To understand the characteristics of pathogenic bacteria and drug resistance of ventilator-associated pneu-monia(VAP)in neonatal intensive care unit (NICU),and to explore the corresponding prevention and control measures,and to pro-vide the basis for the VAP antibiotic treatment.Methods A total of 80 children with respiratory failure and ventilator assisted breathing were selected from the NICU as objects in this study.The clinical data,pathogenic bacteria and drug resistance were ana-lyzed retrospectively.Results In 80 cases,the incidence of VAP was 43.75% (35/80),a total of 70 strains of pathogenic bacteria were isolated,gram negative bacilli accounted for the highest proportion,accounting for 81.43% (57/70).Pseudomonas aeruginosa, Klebsiella pneumoniae were the most common gram negative bacilli.Gram positive cocci accounted for 8.57% (13/70),which domi-nated by methicillin resistant Staphylococcus aureus,in addition to susceptible to vancomycin,but resistant to the other antibiotics. Conclusion Gram negative bacillus are the main bacteria in VAP cases,and which are multiple drug-resistant pathogens.

Objective To evaluate the diagnostic performance of Xpert MTB/RIF for the diagnosis of tuberculous meningitis (TBM).Methods This was a prospective, single center clinical trial.A total of 116 consecutive patients with suspected meningitis who were admitted to Xijing Hospital from October 2013 to June 2015 were recruited.Mycobacterium tuberculosis ( MTB) and rifampicin ( RIF) resistance mutations in 1 ml cerebrospinal fluid ( CSF) were detected with Xpert MTB/RIF and the remaining sample was tested by Ziehl-Neelsen staining , MGIT960 liquid culture and other laboratory tests .And the enrolled patients were grouped according to the 2010 South African expert consensus .The diagnostic performance of Xpert MTB/RIF was evaluated by comparing against clinical score >5 points and MGIT960 liquid culture as reference standards respectively .The comparison was performed using a χ2 test or Fisher′s exact test for categorical variables and a nonparametric rank sum test for continuous variables .Results Among the enrolled 116 subjects, 23 subjects were diagnosed as definite-TBM by MGIT960 liquid culture, 16 subjects were classified as probable TBM , 27 subjects were classified as possible TBM , and 50 subjects were classified as non-TBM.When clinical score >5 points was used as a reference standard , the sensitivity of Xpert MTB/RIF (39.4%) was comparable with that of MGIT960 liquid culture (34.8%) (χ2 =0.292, P=0.589), and significantly better than that of Ziehl-Neelsen staining (9.9%) (χ2 =16.500, 12.771, P<0.001). No significant differences were found among the specificities of Xpert MTB /RIF, MGIT960 liquid culture and Ziehl-Neelsen staining ( 98.0%, 100.0% vs 98.0%, χ2 =1.014, P=0.602 ) .When tested against MGIT960 liquid culture as a reference standard , the sensitivity of Xpert MTB/RIF was 91.3%. Conclusions Xpert MTB/RIF is a rapid and specific method to detect MTB and RIF resistance in CSF .It exhibits a good rule in value for the diagnosis of TBM and a comparable sensitivity with MGIT 960 liquid culture, thus it can be used as the initial method for the diagnosis of tuberculous meningitis .

Objective To analyze the changes of serum hypoxia-inducible factor-1α(HIF-1α),vas-cular endothelial growth factor ( VEGF) and endothelin-1 ( ET-1) levels in neonates with hypoxia-induced pulmonary hypertension(HPH),and to explore the roles of three factors in the pathogenesis of HPH in neo-nates. Methods A total of 50 neonates with HPH in the neonatal intensive care unit as HPH group and an-other 25 non-HPH hospitalized neonates with similar clinical data in the same period as control group were enrolled from January 2014 to December 2017. The levels of serum HIF-1α,VEGF and ET-1 were deter-mined by enzyme linked immunosorbent assay when neonates were diagnosed as HPH and their pulmonary artery systolic blood pressure(PASP) decreased to 35 mmHg below respectively. The changes of three factors levels were analyzed and compared with those of control group at the same time point. Results (1) The levels of serum HIF-1α,VEGF and ET-1 of HPH group were significantly higher than those of the control group (F value were 151. 97,43. 31,and 129. 56 respectively,all P<0. 01). Furthermore,the more serious the grade of HPH,the higher the levels of three factors. The differences were statistically significant (all P<0. 01). (2) After PASP of neonates in HPH group decreased to 35 mmHg or below,the levels of serum HIF-1α,VEGF and ET-1 also significantly decreased,and the differences were statistically significant ( all P <0. 01). However,there were no statistically significant differences compared with those of the control group for the levels of serum HIF-1α and VEGF(both P>0. 05) in addition to serum ET-1 levels (F＝14. 98,P<0. 05). Conclusion High levels of HIF-1α,VEGF and ET-1 caused by hypoxia may play an important role in neonatal HPH.

OBJECTIVE：To observe the ef fectiveness and safety of bosentan in the treatment of hypoxic pulmonary hypertension（HPH）in neonates. METHODS ：From Jan. 2014 to Mar. 2019，a total of 82 HPH neonates hospitalized in the department of neonatology of our hospital were selected as research subjects. According to whether or not receiving bosentan therapy，50 cases were included into bosentan group and 32 cases into non-bosentan group. Meanwhile ，another 25 non-HPH neonates with serum sample retention time and general information such as gestational age at birth and day age matching the HPH group were selected as the control group. All neonates with HPH were given continuous intravenous infusion of Dopamine hydrochloride injection 5 mg/（kg·min）until PASP was normal. On this basis, neonates in the bosentan group were additionally given Bosentan tablets 1 mg/kg（fed after dissolving with appropriate amount of water for injection ）for q 12 h，72 h. The relationship between serum ET- 1 levels of neonates with HPH and PASP was analyzed ，as well as PASP before and after treatment and therapeutic efficacy between bosentan and non-bosentan groups ，the changes of arterial blood gas indexes and ADR in 3 groups were compared. RESULTS ：Before treatment ，the serum ET- 1 levels of bosentan group was （164.3±115.3）pg/mL，which was significantly higher than （41.9±3.7）pg/mL of control group and positively correlated with PASP level （r＝0.864，P＜0.001）. Total response rate of bosentan group was 90.00％，which was significantly higher than 71.88％ of non-bosentan group （P＜0.05）. After 72 h of treatment ，PASP of 2 groups was decreased significantly ，compared with before treatment （P＜0.001），and the bosentan group was significantly lower than the non-bosentan group （P＜0.05）. The PaO 2，SaO2，PaCO2 and OI in 3 groups was significantly improved compared with that before treatment （P＜0.001），and the PaO 2，SaO2 and OI in the bosentan group was significantly higher than that in the non-bosentan group （P＜0.05）. During the treatment period of bosentan and within one week after drug withdrawal，there was no significant change in serum LDH ，AST，ALT and Scr levels in neonates. There was no statistically significant difference in the incidence of feeding intolerance ，anemia，reduced WBC and reduced PLT in 3 groups（P＞0.05）. CONCLUSIONS： Bosentan can improve the oxygenation status of neonates with HPH, reduce PA SP，and short-termmedication is safe. com