Objective To study the risk factors for failure of INSURE strategy in very and extremely low birth weight preterm (V/ELBW) infants.Method From January 2005 to December 2014,clinical data of 149 preterm infants (gestational age less than 32 weeks) admitted to neonatal department of Tongji Hospital who received intubation-surfactant-extubation (INSURE) strategy were collected.These infants were assigned into two groups:INSURE failure group and INSURE success group,according to whether a second dose of surfactant or mechanical ventilation was needed within 72 hours after first pulmonary surfactant treatment.The clinical characteristics and outcomes between the two groups were compared.Chi square and t tests were used to define the differences between groups.Logistic regression analysis was used to identify the independent risk factors for INSURE failure.Result Among the 1 149 patients,148 received INSURE treatment,and 113 cases (76.4％) were successfully treated with the INSURE strategy.The infants in the failure group were statistically lower in birth weight,gestation age,antenatal steroids utilization rate,PaO2 and PaO2/FiO2 than those in the success group,while the age of mother,male/female ratio and PaCO2 were higher in the failure group.Logistic regression analysis showed that male (OR =7.440,95％ CI 1.846 ～29.984),BW ＜ 1 000 g (OR =9.180,95％ CI 1.716 ～49.105),PaCO2 ＞48 mmHg (OR =5.996,95％ CI 2.088 ～ 17.213),PaO2/FiO2 ＜205 (OR =3.010,95％ CI 1.033 ～8.774) were independent risk factors for INSURE failure.Conclusion INSURE strategy failure was associated with gender,birth weight,gestation age,antenatal steroids utilization,PaO2,PaCO2 and PaO2/FiO2 of the first blood gas after birth.BW ＜ 1 000 g,PaCO2 ＞ 48 mmHg and PaO2/FiO2 ＜ 205 of the first blood gas after birth were independent risk factors for INSURE strategy failure.

Objective To investigate the association between pet ownership and lung function in children without asthma,and to provide scientific basis for the improvement of lung function in children. Methods Data was drawn from the cross-sectional study ,the clusters were randomly selected from 1 to 2 junior middle schools and primary schools in 24 administrative regions of seven cities in Liaoning Province. The ATS questionnaire survey was performed,and lung function including the forced expiratory volume in 1 second(FEV1),forced vital capacity (FVC),maximal mid-expiratory flow(MMEF)and peak expiratory flow(PEF)was measured by utilizing portable electronic spirometers. Results In this study ,about 6280 children without asthma aged 7 ~ 14 years were enrolled,49.47 % of the children was male. The average lung function of FVC,FEV1,PEF and MMEF was (2.63±0.75)L,(2.47 ± 0.70)L,(4.80 ± 1.42)L/s and(3.37±1.05)L/s,respectively. By adjusting confounding fac-tors,we found pet ownership in the first 2 years of life was significantly associated with the predicted lung function impairment of FVC<85%(aOR=1.30;95%CI:1.01~1.67);current pet ownership was significantly associated with the predicted lung function impairment of FVC < 85%(aOR = 1.32;95% CI:1.09 ~ 1.61),the predicted FEV1<85%(aOR=1.47;95%CI:1.19~1.83),the predicted PEF<75%(aOR=1.48;95%CI:1.16~1.88) and the predicted MMEF<75%(aOR=1.35;95%CI:1.09~1.66). The in utero exposure was not related to lung function impairment. Conclusion Pets ownership has damaging effects on lung function in children without asth-ma,and it reduces FVC,FEV1,PEF and MMEF in children.

Objective To explore the therapeutic effects of Ni-Ti memory alloy embracing fixator on the multiple fracture of ribs and flail chest. Method From January 2006 to December 2009, the effects of operation and long-term follow-up after internal fixation operation with memory alloy embracing fixator in patients with multiple fracture of ribs and flail chest were observed. Results The hospital stay of patients treated with memory alloy embracing fixator was 10.31 ± 3.14 days and pain was significantly reheved after treatment ( P= 0.02) .The rate of post-operative complications was 17.65% such as atelectasis, pulmonary infection, etc. There were fewer longterm complications and less influence to daily activity of life. Conclusions It is a advanced and practical method for patients with the multiple fracture of ribs by using Ni-Ti memory alloy embracing fixator with slighter trauma,simple, safe, reliable, good histocompatibility and fewer post-operative complications.

Objective To establish a 3D digitized visual model of the liver to provide anatomical structure for planning hepatic operations and creating accurate computer simulations of the liver.Methods Transverse sections of abdomen were chosen from the Chinese Visible Human dataset. The liver was reconstructed in three dimensions with surface rendering in combination with volume rendering reconstruction. Results Accurately segmented images of the main structures of liver were completed. The reconstructed structures could be displayed singly, in small groups or as a whole and could be continuously rotated in 3D space at different velocities. Conclusion The reconstructed liver is realistic and demonstrates the natural shape and exact position of hepatic structures. It provides an accurate model for the automated segmentation algorithmic study and a digitized anatomical model of the liver.

Objective To investigate the expressions of KLF2 mRNA and KLF4 mRNA in the acute lung injury (ALl) rats induced by lipopolysaccharide (LPS),and to analyze the correlation between KLF2,KLF4 and ALI.Methods A total of 100 SD rats were randomly divided into 2 groups:normal control group and LPS treated group,then the latter group was randomly further divided into 3 subgroups as per the serum and lung tissue samples taken separately at 2,4 and 24h after modeling.The ALI model was made by injecting 5mg/kg LPS into tail vein.The pathological changes of lung tissue were observed in each group,and the expressions of KLF2,KLF4 mRNA in serum and lung tissue were detected by RT-PCR.The data of laboratory findings were analyzed with SPSS 17.0 software for statistical analysis.Results The histopathological changes showed the most obvious damage of lung tissue occurred at 4 hours after modeling.The expressions of KLF2 mRNA and KLF4 mRNA in the lung tissue and serum of control group were significantly higher compared to LPS treated subgroups (P ＜0.01).The expression of KLF2 mRNA in LPS treated subgroup at 2 hours was lower than that in LPS subgroups at 4 hours and 24 hours (P ＜ 0.01),while the expression of KLF4 mRNA in LPS treated subgroup at 4 hours was lower than that in LPS treated subgroups at 2 hours and 24 hours (P ＜ 0.01).Conclusions The expression of KLF2 mRNA was occurred earlier than the pathological changes in acute lung injury,while the expression of KLF4 was emerged synchronously,and both KLF2 and KLF4 could be used as candidates of predictive and diagnostics molecular markers of ALI.

ObjectiveTo study the expression levels of YB-1 protein in hepatocellular carcinoma (HCC) tissues,tissues adjacent to tumour and normal liver tissues,and to explore the clinical significance.MethodsTo study the expression levels of YB-1 protein,immunochemistry was carried out on 58 HCC tissues and their corresponding adjacent tissues to tumour and on 20 normal liver tissues.The YB-1 protein with nuclear translocation was detected by Western blot in HCC tissues,tissues adjacent to tumour,normal liver tissues,HCC cell lines including QGY-7701 and SMMC-7721,and a normal hepatic cell line LO2.ResultsPositive signals of YB-1 protein were detected at a high level in HCC tissues (72.4％,42/58) when compared to tissues adjacent to tumour (41.4％,24/58) and to normal liver tissues (35 ％,7/20) (P＞0.05).The nuclear expression of YB-1 (31％,18/58) was significantly correlated with the pathologicalgrade,tumour size and portal venous invasion (P＜0.05).Using Western blot,the YB-1 protein with nuclear translocation was expressed at a higher level in HCC tissues (0.474±0.107) than in tissues adjacent to tumour and in normal liver tissues (P＜0.05).Similar results were obtained in HCC cell lines and the normal hepatic cell line (P＜0.05).ConclusionThe high expression of YB-1 in HCC and its nuclear translocation may be involved in human HCC progression.YB-1 may be a potential target for HCC treatment in the future.

Objective To build three-dimensional model of the pancreas and peripanercatic organs to provide morphological basis for imaging diagnosis and operation selection of pancreas diseases. Methods Serial cross-sectional images from the first Chinese visible human dataset were reviewed and the structures of pancreas and peripancreatic organs were reconstructed three-dimensionally by using 3D-Doctor software on PC. Results Three-dimensional structures of pancreas and peripancreatic organs were reconstructed successfully. All reconstructed structures could be displayed in multiple methods and color modes. Conclusions The internal and adjacent struc-tures of pancreas can be clearly shown on the reconstructed three-dimensional images. The visible model is a useful reference both for clinical diagnosis and surgical practice.

Objective To develop a hepatic surgical planning software for hepatic operation on deciding the rational operational scheme, simulating procedures before the operation to accomplish the precise operation and decrease the operative risk. Methods The software was used in clinical practice to analyze the surgical anatomy of human liver, calculate the liver volume and vascular territory, disclose the hepatic structures and simulate the operation before operation. Results The surgical planning software is very convenient in analyzing the surgical anatomy of human liver, calculating the liver volume or vascular territory and simulating the operation before operation. Conclusion The developed surgical planning software is very helpful in clearly disclosing hepatic structures, rationally deciding operation scheme and virtually simulating the operation.

Objective To evaluate the safety and efficacy of Zonisamide(ZNS) as adjunctive therapy in patients with refractory partial seizures receiving other antiepileptic drags (AEDs).Methods This was a randomized,double-blind,placebo-controlled study conducted at multi-centers.All 240 subjects were randomized to either the ZNS group or the placebo group in a 1:1 ratio.The double-blind treatment phase included a titration phase during which zonisamide dose inereased from 100 mg/day to 300 mg/day over 4 weeks and then a 12-week fixed-dose phase.The primary efficacy endpoint was,the median % reduction from baseline in all pattial seizure frequency(CPS+SPS+SGS)during the fixed-dose phase.The important secondaw endpoint wag the responder rate.Safety profiles and tolerance were also evaluated.Results The FAS analysis showed the median reduction from baseline in the ZNS group was greater than in the placebo group(48.4%vs 26.6%),the difference was significant for ZNS compared with placebo(F=4.904,P=0.028);The responder rates for all partial seizures(48.6%vs34.9%,X2=4.046,P=0.044)and for complex seizures(52.2% vs 33.3%,X2=5.607,P=0.018)were significantly higber in the ZNS group than in the placebo group in the FAS population.The overall adverse events(AEs)profile was comparable between the two groups.The most frequent AEs considered to be related to zonisamide by the investigator were headache,dizziness,somnolence,anorexia,nausea,etc.Conclusions ZNS is superior to placebo in reducing the frequency of partial seizures and well-tolerated.ZNS could be a choice of adjunctive therapy in patients with refractory partial seizures.

Objective To establish the three-dimensional model of pancreas and its surrounding structures.Methods The three-dimensional pancreas model was established and analyzed by using PC computer platform based on the data set from the first Chinese visible human female.Results The three-dimensional pancreas model,established successfully,could be rotated at any angles and could be sectioned at any orientation.The structures of each section could be displayed clearly.Conclusion Sectional anatomy at any orientation of the pancreas and its surrounding structures can be performed on our pancreas model,which has laid the foundation for virtual surgery of the pancreas.