Objective:To compare the clinical efficacy of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) in the treatment of infants with severe respiratory syncytial virus (RSV) pneumonia.Methods:A prospective randomized controlled trial was conducted. The infants with severe RSV pneumonia who received invasive mechanical ventilation admitted to intensive care unit (ICU) of Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2018 to December 2019 were enrolled. According to the order of admission, each infant was assigned to HFOV group or CMV group by random number table. The basic data, pediatric critical score, blood gas analysis, ventilator parameters, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO 2)/arterial partial pressure of oxygen (PaO 2)×100], duration of mechanical ventilation, length of ICU stay, complications, prognosis, use of muscle relaxants and vasoactive drugs and other clinical indicators of the two groups were recorded. Results:A total of 28 infants were enrolled in the analysis, including 15 infants receiving CMV and 13 infants receiving HFOV. There were no significant differences in age, body weight, pediatric critical score and OI before enrollment, type Ⅱ respiratory failure, multiple organ dysfunction, basic diseases and laboratory examination indexes before enrollment between the two groups. Six hours after enrollment, compared with CMV group, heart rate (HR), respiratory rate (RR), case of transcutaneous oxygen saturation (SpO 2) decrease, case of HR decrease, case of cardiopulmonary resuscitation (CPR) and OI in HFOV group were significantly decreased [HR (bpm): 130 (125, 138) vs. 144 (140, 160), RR (times/min): 35 (34, 38) vs. 40 (35, 45), SpO 2 decrease (case: 1 vs. 10), HR decrease (case: 0 vs. 6), CPR (case: 0 vs. 4), OI: 6.5 (4.4, 8.9) vs. 9.3 (8.0, 12.8)], while case of use of muscle relaxants (case: 3 vs. 0) and volume of 7-day positive fluid balance [mL/kg: 167.1 (113.8, 212.6) vs. 90.8 (57.8, 112.7)] were significantly higher, the differences were statistically significant (all P < 0.05). There was no use of blood purification treatment, no severe complications such as pneumothorax and intracranial hemorrhage, and no death within 28 days in the two groups. Conclusion:Compared with CMV, HFOV in the treatment of infants with severe RSV pneumonia can improve the oxygenation level and clinical physiological indexes earlier, reduce the incidence of adverse events such as HR, SpO 2 decrease and CPR, increase the use of muscle relaxants and the positive fluid balance, and do not increase the incidence of severe complications such as pneumothorax and intracranial hemorrhage, so its clinical application is safe.

ObjectiveTo analyse the clinical characteristics of pancreatic intraductal papillary mucinous neoplasm (IPMN) which coexists with extrapancreatic malignancy (EPM),with an aim to provide strategies for clinical diagnosis and treatment.MethodsThe PubMed was used to search for the pancreatic IPMN related articles with positive pathologic results.A pooled analysis was then performed.The ratio ofpancreatic IPMNs coexisting with EPMs and the locations (or the type) of EPMs were analyzed.ResultsAfter a strict process of screening,18 articles met the pre-determined standardsand were accepted.Of the 1327 patients,363 had coexisting EPMs (27.35％).There were 392 EPMs in these 363 patients.The EPMs occurred in almost all the systems of the body,especially in the digestive tract and its related organs,which accounted for 63.06％ of the EPMs. Conclusions There is a tendency for patients with pancreatic IPMN to have coexisting EPM. More than half of these EPMs are malignant tumors in the digestive system. When pancreatic IPMN is diagnosed,the clinician should be aware of the possible coexistence of an EPM and should look for the possibility of a new EPM developing in a patient after treatment of pancreatic IPMN.

Objective To evaluate the clinical value of noninvasive positive-pressure ventilation (NPPV) treatment in acute respiratory distress syndrome caused by acute pancreatitis. Methods A retrospective study of 27 cases, with acute respiratory distress syndrome (ARDS) caused by acute paucreatitis,who were admitted to our department from Jan 2007 to May 2010 and treated with NPPV, was performed. The changes of heart rate, respiratory rate, PaO2, oxygenation index (OI) and PaCO2 before and after treatment were compared. Results The heart rate, respiratory rate of 25(92.6％ ) patients decreased from (118.4 ±13.4)/min, (32.1 ± 1.7)/min to ( 81.9 + 8.5 )/min, ( 19.9 ± 2.1 )/min; PaO2, OI and PaCO2 increased from (74.1 ±5.0)mmHg, (148.2 +10.0)mmHg, (28.7 ±1.6)mmHg to (110.4 ±20.8)mmHg, (204.5±71.1)mmHg, (38.4 +3.6)mmHg 48 h after NPPV, respectively, and they recovered and were transited to oxygen supply by Venturi mask. 2 (7.4％) patients deteriorated and were transited to invasive positive-pressure ventilation support. Conclusions NPPV could effectively improve oxygenation of patients with ARDS caused by acute pancreatitis. The procedure of NPPV is relatively easy to use and to learn with few complications, and worth of clinical application.

Objective To investigate the effect of sevoflurane postconditioning on the activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase during myocardial ischemia-reperfusion (I/R) in rats and the possible mechanism. Methods Forty-five healthy male Wistar rats weighing 250-280 g were randomly divided into 3 groups ( n = 15 each): sham operation group (group S), I/R group and sevoflurane postconditioning group (group Spo). Myocardial I/R was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 120 min of reperfusion. In group S the anterior descending branch was only exposed but not ligated. Group Spo received 5 min inhlation of 2.5% sevoflurane 1 min before reperfusion. The myocardial tissues were taken at 2 h of reperfusion for determination of infarct size and activities of Na+ -K+ -ATPase and Ca2 * -Mg2 * -ATPase. Results The infarct size was significantly larger and the activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase were signifi cantly lower in group I/R than in group S ( P ＜ 0.05). The infarct size was significantly smaller and the activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase were significantly higher in group Spo than in group I/R (P ＜ 0.05 ). Conclusion Sevoflurane postconditioning can reduce myocardial I/R injury through increasing the activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase.

Objective To observe the improvement effects of Qingshen Granule on the life quality of chronic kidney disease (CKD) patients with damp-heat syndrome. Methods The CKD patients with damp-heat syndrome were randomly divided into experimental group and control group. The control group was treated with Western medicine, and the treatment group was treated with Qingshen Granules additionally for 12 weeks. SCr and eGFR were observed before and after treatment, and the life quality was investigated by KDQOL-SFTM1.3. Results Actually 156 cases were completed, including 77 cases in the treatment group and 79 cases in the control group. The total rate of curative effect was 81.82% (63/77) in teatment group, and (63.29%, 50/79) in control group, with significent difference (P<0.05). Multivariate linear regression analysis indicated that gender, education level, TCM syndrome score, CKD stage, eGFR and Hb level could affect the life quality. The scores of KDQOL-SFTM and its containing the MOS item short from health survey (SF-36) and kidney disease targeted areas (KDTA) were significantly improved after treatment in experimental group (P<0.05), while the scores in control group were with no significant improvement. The improving effects of PCS, and SPL, SLEEP, PS in KDTA in treatment group were significantly superior to those in control group (P<0.05). The scores of life quality in effective and stable cases increased significantly after treatment compared with before treatment (P<0.05). Conclusion Qingshen Granules can effectively improve the life quality of CKD patients with damp-heat syndrome, and the effect is not dependent on the improvement of laboratory indexes (renal function).

Objective To observe the effect of traditional Chinese medicine (TCM) Qingshen granule on signal transduction pathway of fokal adhesion kinase-rat sarcoma-mitogen activated protein kinase (FAK-Ras-MAPK) in renal tissue of rats with renal interstitial fibrosis (RIF). Methods Forty Spargue-Dawley (SD) rats were randomly divided into normal control, model, Bailing capsule and Qingshen granule groups (each, n = 10). The rat model with RIF was reproduced by unilateral ureteral obstruction (UUO) or ligation method. The rats in Bailing capsule group were treated with Bailing capsule dissolved in 4 mL warm water, and the dosage was 0.3 g·kg-1·d-1 for intragastric administration;the rats in Qingshen granule group were treated with Qingshen granule dissolved in 4 mL warm water, its dosage was 6 g·kg-1·d-1 for intragastric administration, and equal volume of normal saline was given to normal control group and model group by gavage. After treatment for 8 weeks, the levels of blood urea nitrogen (BUN), serum creatinine (SCr), fibronectin (FN),α-smooth muscle actin (α-SMA) were determined in each groups. The renal tissue expression levels of FAK, Ras, p38MAPK, FN, α-SMA were determined in various groups by immunohistochemistry staining method. Results Compared with the normal control group, the levels of serum BUN, SCr, FN and α-SMA were significantly increased in the model group. There were no significant differences in the levels of serum BUN and SCr before administration of drugs between Bailing capsule group and Qingshen granule group (both P>0.05). The levels of BUN, SCr, FN, andα-SMA were all significantly lowered in the two treatment groups than those of the model group after administration, the descent in Qingshen granule group being more marked [BUN (mmol/L):13.18±4.91 vs. 18.56±5.59, SCr (μmol/L): 104.80±12.04 vs. 119.02±12.47, FN (mg/L): 29.72±16.75 vs. 46.38±8.63, α-SMA (kU/L):5.49±2.68 vs. 7.13±2.37, all P < 0.05]. The immunohistochemistry staining showed: the kidney tissue expression levels of FAK, Ras, p38MAPK, FN, and α-SMA in the model group were significantly higher than those of normal control group, above indexes were all significantly lower in Bailing capsule group and Qingshen granule group than those of the model group, and the descent in Qingshen granule group was more obvious (FAK: 3.00±1.41 vs. 5.28±2.21, FN: 4.25±1.04 vs. 6.29±2.06, α-SMA: 3.25±1.28 vs. 4.86±1.57, p38MAPK: 2.50±1.31 vs. 4.71±2.50, Ras:3.50±1.41 vs. 4.29±1.38, all P<0.05). Conclusion Qingshen granule can reduce serum BUN and SCr levels in rats with RIF, and inhibit the activation of FAK-Ras-MAPK signal transduction pathway in the kidney, thereby it may reduce the generation of FN andα-SMA and play a role of anti-RIF.

Althoughtheevidenceoftheevidence-basedmedicinehasshowedthatrecombinant tissue-type plasminogen activator can effectively open the occluded vessels, because of its short therapeutic time w indow and the risk of bleeding, the thrombolytic rate is general y low er currently. Clinical studies have show ed that telestroke can effectively shorten the treatment time of the patients, increase the thrombolytic rate, reduce the risk of bleeding, and improve the outcomes of patients. Although the application of telestroke is restricted in many w ays, such as technology, policy, and funding, w ith the grow ing maturity of the related technologies, telestroke w il play an increasingly important role in the treatment of stroke.

Objective To report 11 cases with the tissue defects of their upper or lower limbs repaired with the anastomsed medial sural artery perforator flaps.Methods The free medial sural artery perforator flaps,with length of 8 cm to 15 cm and width of 6 cm to 14 cm were used for tissue defect reconstruction of the distal upper or lower limbs in 11 cases,including 6 females and 5 males.The flap was harvested from the ho- mo-lateral calf,confined between the posterior-medial edge of the tibia and the middle line of the calf and a- bove the distal half part of the medial sural muscle,with a same axis of this muscle.Results Ten cases survived very well,which was relatively thin,and the donor site can be acceptable.One case resulted in a complete flap necrotized and covered with a split skin graft.No obvious motor function defect was observed of the donor leg.Conclusion The anastomsed medial sural artery perforator flap is alternative donor flap for the upper or lower limb tissue defect repair,especially for the defect in the hand or foot.

Objective:To investigate the influence of sCD80-Linker-sCD40L fusion protein on the unspecific anti- tumor immunity in vitro.Methods:Ovarian cancer SKOV3 cells were separately transfected with recombinant adenoviral vectors containing sCD80-Linker-sCD40L fusion gene,sCD80 gene,sCD40L gene or with control adenovirus.The expres- sion of the sCD80-Linker-sCD40L fusion protein,sCD80 protein and sCD40L protein in the supernatants of SKOV3 cells was determined by ELISA.Dendritic cells(DCs)were cultured with peripheral blood mononuclear cells from a patient with ovarian carcinoma.DCs and autologous T cells were co-cuhured and were exposed to different supernatants for 48 h. The allostimulatory effects of DCs on T cells were determined by mixed lymphocyte reaction(MLR).The unspecific kill- ing activities of induced T cells against SKOV3/K562 cells were measured by LDH-releasing assay.Results:ELISA assay showed that levels of the sCD80-Linker-sCD40L fusion protein,sCD80 protein and sCD40L protein in the supernatants of transfeced SKOV3 cells were 2.791 ng/ml,1.956 ng/ml and 1.407 ng/ml,respectively.The fusion protein-exposed DCs ([0.382?0.053]vs[0.167?0.028],P

Objective To study the clinical characteristics which are related to malignancy in pancreatic intraductal papillary mucinous neoplasm (IPMN) with an aim to provide evidence for clinical practice.Methods Using PubMed,all pancreatic IPMN related articles with positive pathologic results before July 30th,2011 were studied.A pooled analysis was carried out on the morphological features of the disease.The analysis included gender,diameter of main pancreatic duct,diameter of cystic lesion,mural nodules and histological types (benign/malignant) of the neoplasm.Results 98 articles (including 1902 cases) were collected and analyzed.1025 cases were benign (53.89％) and 877 cases (46.11 ％) were malignant.Morphologically,there were a correlation between main pancreatic duct dilatation (≥5 mm),cystic lesion of large size (≥30 mm),presence of mural nodules and malignancy.The OR (95％ CI) were 5.591 (3.657-8.548),3.633 (2.626-5.027) and 4.983 (3.872-6.412) respectively.Conclusions A main pancreatic duct dilatation (≥5 mm),cystic lesions of large size (≥30 mm) and presence of mural nodules prompt the tumor to be malignant.In clinical work,the management of pancreatic IPMN should be made prudently based on comprehensive analysis of clinical features and the patient's status and intent.