Objective To investigate the clinical effect of three kinds of dose of pulmonary surfactant (PS) in neonatal respiratory distress syndrome (NRDS), and to determine the optimal dose. Methods One hundred and seventy-four cases of NRDS were divided into A group (59 cases), B group (57 cases) and C group (58 cases) according random digits table. Based on the conventional treatment, children in A group were given large dose of poractant alfa injection 250 mg/kg, children in B group were given 200 mg/kg, and children in C group were given 100 mg/kg. After treatment for 1, 6, 12 and 24 h, the arterial oxygen saturation (SaO2), inspired oxygen concentration (FiO2), arterial oxygen tension (PaO2), oxygenation index (OI), arterial/alveolar oxygen tension ratio (a/APO 2), ventilator using and oxygen using time and the incidence of complication were compared. Results After treatment for 12,and 24 h, the levels of SaO 2 in A group and B group were significantly higher than those in C group: 0.936 ± 0.018, 0.935 ±0.019 vs. 0.857 ±0.027;0.941 ±0.017, 0.946 ±0.015 vs. 0.847 ±0.053, and there were significant differences (P<0.01). After treatment for 12 and 24 h, the levels of SaO 2 in A group and B group had no significant differences ( P>0.05). After treatment for 1, 6, 12, and 24 h, the levels of FiO 2 and OI in A group and B group were significantly lower than those in C group, and the levels of PaO 2 and a/APO2 in A group and B group were significantly higher than those in C group. There were significant differences (P<0.01). The levels of FiO2, OI, PaO2 and a/APO2 in A group and B group had no significant differences ( P>0.05). The ventilator using time in A, B and C group were (108.6±23.5) , (119.6±32.8), (156.3±27.3) h, and there were significant differences (P<0.05 or<0.01). The oxygen using time in A and B group had no significant difference ( P>0.05). The oxygen using time in C group was significantly longer than that in A and B group: (186.5 ± 52.8) h vs. (148.7 ±24.4), (154.6±28.2), P<0.01. The incidence of complication in A and B group had no significant difference ( P>0.05).The incidence of complication in C group was significantly higher than that in A and B group:29.31%(17/58) vs. 13.56%(8/59), 12.28%(7/57), P<0.05. Conclusions Poractant alfa injection 200 mg/kg is optimal dosage for poractant alfa injection in the treatment of NRDS, and it can effectively improve oxygenation and ventilation function, reduce the incidence of complication, shorten the course of disease and improve the prognosis and increase the cure rate. Excessive dose is waste, and little dose can not get effective treatment.

Objective To study the death mode and mechanism of HeLa cancer cell induced by five strain bluetongue virus(BTV). Methods Transmission electron microscope(TEM) was introduced to study changes of ultrastructure. Growth and apoptosis of HeLa cell infected with bluetongue virus were detected with MTT assay and flow cytometry. DNA fragmentation and the activity of caspase-3, -8, -9 were determined by colorimetric assay. Results Many HeLa cells which infected with BTV were observed apoptosis and lyse, and in the plasma were found many viral inclubodies and subviral particles without outer layer proteins. BTV could inhibit HeLa cell proliferation moderately and different serotypes of virus had different effect. Various stages of apoptotic cells were found by flow cytometry and the percentage of apoptosis caused by five strain bluetongue virus were not the same. DNA-Ladder was typical. Caspase-3,-8 ,-9 activity were increased by varying degrees. Conclusion BTV could infect in HeLa cell efficiently and induce it to apoptosis in vitro, then different serotypes of virus have different effect.

Objective To investigate the survival rate in elderly patients with long-term catheters hemodialysis.Methods A total of 127 elderly patients receiving maintained hemodialysis were included in this study.Patients were divided into two groups according to catheter location:long term indwelling internal jugular vein catheter group and long term indwelling vena iliac external catheter group.The baseline anthropometric and laboratory parameters were measured.The catheter dysfunction and catheter related complications were observed.Results The incidence of catheter dysfunction was higher in iliac vein catheter group than in internal jugular vein catheter group (51.5 ％ vs.24.5％,x2 =8.459,P=0.015),and there were no significant differences in the catheter related infection rate and cardiovascular (CVD) event rate between the two groups.Kaplan-Meier survival curves showed that mean survival time was lower in vena iliac external catheter group than in internal jugular vein catheter group (1.9 years vs.2.5 years,x2 =10.847,P=0.001),and still was lower after controlling the catheter dysfunction and cardiovascular events (x2 =9.915,P=0.002;x2=4.368,P =0.037).Multivariate logistic regression analysis showed that levels of hemoglobin,creatinine,systolic blood pressure,parathormone and age were the independent risk factors for mortality in elderly patients with long term catheter hemodialysis.Conclusions There is a high incidence of CVD events in elderly patients with long-term catheter hemodialysis.The incidence of catheter dysfunction is higher and the survival rate is lower in elderly patients with long-term indwelling vena iliac external catheter hemodialysis.

ObjectiveTo evaluate the treatment efifcacy of the treatment promotion of standardized management for chil-dren with asthma.MethodsMedical records of 150 children with asthma were reviewed and divided into management group or control group according to whether standardized management was accepted. Comprehensive asthma education for asthma pa-tients and their parents including asthma associated basic knowledge education, health education as well as follow-ups at deifned intervals was conducted in 78 cases. In the meantime, standardized asthma therapies were performed. Control group involved 72 cases who did not receive asthma education managements and only accepted regular clinical therapies. After 1-year observational follow-up, , clinical efifcacy of children with asthma, changes of knowledge-attitude-practice of parents, and compliance of med-ication were compared between the two groups.ResultsAfter promotion of standardized managements treatment, asthma con-trol rates in the management group were signiifcantly higher than that of the control group(χ2=54.68,P<0.01); In addition, the rate of asthma attacks, emergency visits as well as hospitalizations were obviously reduced in the management group than control group (both withP<0.01). Knowledge associated with asthma, therapy and management executions as well as knowledge-atti-tude-practice of parents also demonstrated apparent elevations in the management group (P<0.01); At the same time, management group has illustrated superior medication compliance over the control group (χ2=66.27,P<0.01).ConclusionPromotion of standardized treatment management among children with asthma can help to achieve effective control by raising levels of knowl-edge-attitude-practice of the parents as well as the patient’s compliance to the treatment.

Objective To investigate the survival of older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis. Methods A total of 70 older patients with external iliac vein tunneled cuffed catheters on maintenace hemodialysis were included in this study, there were 94 patients with internal jugular vein tunneled cuffed catheters as control group. The baseline anthropometric and 1aboratory parameters were measured. The catheter dysfunction and catheter related complications were documented. Results There were lower survival rate and catheter survival in the external iliac vein group compared with internal jugular vein group(χ2=13.714, P<0.01; χ2=13.093, P<0.01). Compared with internal jugular vein group, there was lower rate of catheter infection in external iliac vein group(χ2=9.416, P<0.01); In addition, there were higher rate of cardiovascular disease(CVD) events and catheter dysfunction among patients in external iliac vein group (χ2=7.492, P<0.01; χ2=5.912, P<0.05). Furthermore, the incidence of catheter dysfunction and cardiovascular disease events were the independent risk factors of mortality for older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis by Cox regression model. Conclusions Patients with iliac vein tunneled cuffed catheters have a shorter survival time. Those with catheter dysfunction or cardiovascular disease events are in higher risk of mortality.

AIM: To investigate homeodomain-interacting protein kinase 2(HIPK2) gene expression level and its clinical significance in acute leukemia(AL) patients.METHODS: HIPK2 mRNA was determined by semi-quantitative reverse transcriptase polymerase chain reaction(semi-quantitive RT-PCR) in patients with acute leukemia and healthy donors.The relative transcription level was compared between the study group and the control group.RESULTS: ① The relative expression level of HIPK2 mRNA in AL patients was 0.364?0.286,significantly lower than that in control(1.160?0.272,P0.05).CONCLUSION: AL has significantly lower HIPK2 mRNA expression as compared to normal control,which may be associated with leukemogenesis and/or disease progression of AL.

Objective:To compare the severity of sepsis caused by severe acute pancreatitis (SAP) and community-acquired pneumonia (CAP), improve the understanding of sepsis caused by different types of inflammatory reaction, and provide basis for clinical evaluation of condition and prognosis.Methods:From November 2018 to October 2020, 42 patients with SAP (SAP induced sepsis group) and 68 patients with CAP (CAP induced sepsis group) were selected from Beijing Shunyi Hospital and Dongzhimen Hospital of Beijing University of Chinese medicine. All patients met the diagnostic criteria of sepsis-3 in 2016. The clinical data were analyzed retrospectively, and the indexes, Acute Physiology and Chronic Health Enquiry (APACHE Ⅱ) score and Sequential Organ Failure Assessment (SOFA) score at different time points between the two groups were compared. The correlation between APACHE Ⅱ score and SOFA score and other indicators was analyzed.Results:(1) The mortality rate of SAP induced sepsis group was significantly lower than that of CAP induced sepsis group (2.38% vs 41.18%, P<0.001). The APACHE Ⅱ score and SOFA score of SAP induced sepsis group on the 1st, 3rd and 7th day of hospitalization were significantly lower than those of CAP induced sepsis group at the same time point (APACHE Ⅱ: 10.55±1.16 vs 18.51±0.69, P<0.001, 8.78±0.79 vs 15.45±1.12, P<0.001, 7.77±0.77 vs 12.98±1.08, P<0.001; SOFA: 3.71±0.53 vs 5.57±0.37, P<0.001, 3.24±0.44 vs 5.21±0.52, P<0.001, 2.87±0.14 vs 5.19±0.55, P<0.001). (2) In SAP-induced sepsis group, APACHE Ⅱ score was correlated with lactic acid(Lac), platelet (PLT), PCO 2, creatinine (Cr), aspartate transaminase (AST) and SOFA score, while SOFA score was correlated with Lac, C-reactive protein (CRP), PLT, PO 2, PCO 2, Cr, AST, alanine aminotransferase (ALT) and APACHE Ⅱ score. In CAP-induced sepsis group, APACHE Ⅱ score was correlated with SOFA score. Conclusions:The combination of APACHE Ⅱ score, SOFA score and different clinical indexes has a good indication for judging the severity and prognosis of sepsis patients with different pathogenesis.

We report a case of suspected fetal congenital glaucoma detected by prenatal ultrasound. The mother had no history of cold, medication, or radiation exposure in the first trimester. Routine prenatal ultrasound at 23 +2 weeks of gestation found a 2.5 mm ventricular septum defect, and the sagittal and transverse diameters of the left and right eyeballs were all greater than the normal range of the same gestational weeks, which were noted at 18.57 mm and 17.26 mm, 18.21 mm and 17.22 mm, respectively. Dynamic observation revealed that the bilateral eyelids were unable to close with cornea being exposed to amniotic fluid. The pregnancy was terminated at 23 +6 weeks and a stillborn female weighing 650 g was delivered two days later. Congenital glaucoma was highly suspected by postnatal ophthalmic examination, accompanied by a deformity of the left thumb. No abnormality was detected on fetal chromosome karyotyping or whole-exon sequencing. When unilateral or bilateral megalophthalmos in the fetus is detected by prenatal ultrasound, congenital glaucoma should be considered.

Objective To understand patient pathway and clinical characteristics of chronic diseases in urban areas of Shanghai. Methods A total of 10 002 residents were enrolled and assigned to the chronic disease group (including hypertension, diabetes, coronary heart disease, myocardial infarction, and ischemic stroke) and the non-chronic disease group. Body mass index,fasting blood glucose, triglyceride,total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were tested.Difference of patient pathway and clinical characteristics of those chronic diseases was compared. Results Above chronic diseases were observed in 37.7% participants. About 2/3 diseases were confirmed and 80% patients were followed up in healthcare units not far away from home. Patients with coronary heart disease and myocardial infarction showed more outpatient visit to tertiary hospitals (P＜0. 05 ). However, patients with ischemic stroke had health check, rehabilitation and pharmacy done mainly in local healthcare centers (P＜0. 05 ). Diastolic blood pressure of patients visiting local doctors was significantly decreased (P＜0. 05). Conclusion Some differences in patient pathway were found in this study. Communication and cooperation between medical institutions should be intensified for effective chronic disease control.

Objective To assess the effectiveness of combining problem-based learning(PBL),team-based learning(TBL),and clinical pathway(CP)in standardized training of periodontology residents.Methods A total of 48 residents who were transferred to the Department of Periodontology at the Fourth Affiliated Hospital of Harbin Medical University from January to October 2023 were ran-domly assigned to either the traditional teaching group or the PBL,TBL,and CP combined teaching group,with 24 participants in each group.The traditional teaching group followed conventional teaching methods,while the PBL,TBL,and CP combined teaching group utilized a combination of these three methods.Prior to completing their rotation,both groups underwent professional assessments as well as surveys on satisfaction with standardized training and self-evaluation.Results The professional examination scores ofcombined teaching group were significantly higher than those of the traditional teaching method group(P＜0.05).Both groups expressed satisfac-tion with standardized training and demonstrated proficiency in diagnosing and treating periodontitis through instruction;no statistically significant difference was observed between them(P＞0.05).However,compared to the traditional teaching group,students in the PBL,TBL,and CP combined teaching group showed significant improvements in doctor-patient communication skills,active informa-tion retrieval abilities,learning interest levels,team discussions,and clinical logical thinking abilities(P＜0.05).Conclusion Im-plementing a combination of PBL,TBL,and CP during standardized training of periodontology residents can enhance students'profes-sional examination scores and self-evaluation results,which promotes educational reform development by providing an objective basis.