Objective To investigate the validity and clinical value of application of nasal continuous positive airway pressure (NCPAP) in neonatal respiratory distress syndrome (NRDS) after weaning from mechanical ventilation.Methods The 92 infants with NRDS received mechanical ventilation were randomly divided into the group of NCPAP (46 cases) and the group of oxygen via head box (46 cases) by systematic sampling method.The successful rate of weaning from mechanical ventilation,and incidence of complications such as apnea,broncho-pulmonary dysplasia,ventilator-associated pneumonia,intraventricular hemorrhage,periventricular leukomalacia,retinopathy of premature infant were compared between the 2 groups.Results The group of NCPAP,41 cases were successful of weaning from mechanical ventilation,the successful rate was 89.13％ (41/46).The group of oxygen via head box,33 cases were successful of weaning from mechanical ventilation,the successful rate was 71.74％(33/46).There was statistical difference between the 2 groups (P ＜0.05).The incidences of apnea and broncho-pulmonary dysplasia in the group of NCPAP were significantly lower than those in the group of oxygen via head box [15.22％ (7/46) vs.36.96％ (17/46),6.52％ (3/46) vs.21.74％ (10/46)],there were statistical differences between the 2 groups (P ＜ 0.05).There were no statistical differences in the incidences of ventilator-associated pneumonia,intraventricular hemorrhage,periventricular leukomalacia,retinopathy of premature infants between the 2 groups (P ＞ 0.05).Conclusion NCPAP is more effective than directly removing respirator in the infants with NRDS weaning from mechanical ventilation,it deserves further study and application in clinical practice.

Doctor-patient trust is the core and foundation of harmonious doctor-patient relationship, because our country is at the stage of social transformation and deepening medical reform, various problems make the doctor-patient relationship unoptimistic, and there appeared crisis of confidence between doctors and patients. This arti-cle analyzes the current situation of doctor -patient trust in our country, based on the clarification of doctor -patient trust. It also comb the researches focused on doctor-patient trust evaluation on the basis of domestic and foreign literature. It is expected to provide a reference to the future evaluation of doctor-patient trust, to improve the level of trust between doctors and patients, and to build a harmonious doctor-patient relationship.

Objective To explore the changes and their correlation of event-related potential(ERP)and the plasma levels of monoamine neurotransmitter in the patients with epilepsy.Methods ERP and the plasma levels of noradrenalin(NE),dopamine(DA) and 5-hydroxytryptamine(5-HT) were tested in 50 patients with epilepsy,and the results were compared with the normal controls.Results The latency of N2,P3 of ERP and the amplitude of P3 in the epilepsy group were significant longer and lower than those in the normal control group(all P

The incidence of acute kidney injury(AKI) in neonate is not low,it occurs in many cases such as ischemic-hypoxic injury,infection,administration of nephrotoxicity drugs and urinary tract obstruction,of which perinatal asphyxia ranked first in China.Due to the severe food security crisis,the occurrence of urinary tract obstruction is rising in recent years.The child health care should pay attention to prevent and screen this kind of disease for the high risk group.The diagnosis of AKI is difficult for newborn because serum creatinine and urine are hard to make a definite boundary.So study of early markers of AKI seems to be of great importance,of which neutrophil gelatinase associated lipocalin and cystatin C are research focuses,treatments should aim at solving primary disease such as ischemic,and so on.Renal replacement therapy is recommended when it comes to severe cases,but mortality still remains high,corresponding to severe primary disease and complications.

Objective To explore the impacts of magnetic fields of different intensities on the superoxide dismutase (SOD) activity and malondialdchvde (MDA) levels in rat pancreatic islet cells under normal and hypoxic conditions.Methods Rat pancreatic islet cells were culured,and after 3 days were subjected to a magnetic field of either 44.8 mT,90.6 mT or 182.1 mT under either normal or hypoxic conditions.Control cells received no magnetic field exposure,SOD activity and MDA level were measured after 72 hr.Results The cultured cells grew linearly with optical density (OD) of 0.067 ± 0.021 after 2 days and 0.449 ± 0.113 afier 5 days.SOD activity was significantly lower in the three magnetic field intervention groups than in the control group.Under hypoxic culture conditions,in all the magnetic field intervention groups SOD activity increased at first and then deereased.Under normal culture conditions,MDA content was significantly higher in the 182.1 mT group than in the control group.In the other two groups it was significantly lower.Conclusion Magnetic field exposure can cause oxidative damage to pancreatic islet cells,at least rat cells in culture.Under hypoxic culture conditions a magnetic field can inhibit such damage.

Objective To retrospectively explore the incidence and causes of apnea after operation for retinopathy of prematurity(ROP). Methods The clinical data of 17 premature infants with operation for ROP(ROP group)and the other 23 premature infants without ROP(control group)were collected.The occurrence of apnea(time of onset and remission and original diseases) was recorded after operation in ROP group and at adjusted 37 weeks of gestational age in control group.Follow-up was conducted for 4 weeks,and the prevalences of apnea were compared between these two groups.Results There was significant difference in prevalenees of apnea between ROP group and control group ( 52.9%vs 21.7%,P<0.05).In ROP group,time of occurrence of apnea was (38±40)h after operation,and time of remission was (126±145)h after onset.Among the infants with apnea,there were 3 cases of pneumonia(33.3%),1 case of hypoglycemia(11.1%)and 5 cases with unexplained causes(55.5%). Conclusion Infants after operation for ROP are more prone to apnea,and pediatricians and ophthalmologists are required to collaborate in the perioperative care.

Aim To study the influence of Sodium fer-ulate ( SF) on bone metabolism in glucocorticoid–in-duced osteoporosis rats. Methods Thirty cases of fe-male Wistar Rats(3-month-old) were divided into con-trol group, model group and SF group ( low-dose group, middle-dose group, high-dose group ) by ran-domized block design. Double fluorochrome labeling with calcein was performed before necropsy. The left tibia was taken for bone histomorphometry. Results In static parameters, the proximal tibia cancellous bone trabecular thickness, trabecular quantity and area ratio were significantly reduced in model group compared with control group;while compared with model group, those were increased in middle and high-dose SF group. Trabecular separation degree was increased in model group compared with control group, while it was decreased in middle and high-dose SF group compared with model group. In dynamic parameters, the calcula-tion parameters of cancellous bone mark perimeter rate and the bone formation rate were increased in model group compared with control group, in middle and high-dose SF group the bone formation rate was in-creased compared with model group. In bone cells, os-teoclast number per mm, osteoblast number per mm, percent osteoblast surface perimeter and percent osteo-clast surface perimeter were increased in model group compared with control group. In growth-plate, the thickness of growth-plate was increased in model group compared with control group. In bone cells and growth-plate there was no statistical significance between treat-ment group and model group. Conclusion This study demonstrates that SF can increase bone mass and im-prove bone structure,which may be related to the im-provement of bone formation. SF is effective for GIOP in rats.

Objective To compare the effectiveness and safety of ultramini percutaneous nephrolithotomy (UMP) and retrograde intrarenal surgery (RIRS) in treatment of moderate-sized (about 1-2 cm) renal lower caliceal calculi.Methods From March 2015 to December 2016,patients in our hospital scheduled for surgery due to renal lower caliceal calculi with the greatest diameter of 10-22 mm were prospectively analyzed.Patients were randomized into two groups according to the random number table.Group UMP's operational channel was only F14 and the nephroscope's diameter was 1 mm.200 μm holmium laser lithotripsy was used to break the stones which was rushed out by eddy cuurent.In Group RIRS,all patients needed placing a F6 double J stent preoperatively for two weeks.A flexible ureteroscope sheath required imbedding intraoperatively.The stones were smashed by 200 μm holmium laser lithotripsy through the WOLF flexible ureteroscope.The intraoperative and postoperative datas including stone-free status and the complications were compared.Results 100 patients were enrolled in the study 50 patients in Group UMP,28 were male and 22 were female,mean age was 43.4 ± 7.9 years old.Mean stone size was 14.5 ±3.0 mm(range 10-22 mm).Among them,18 cases were complicated with mild and moderate hydronephrosis.The other 50 cases were allocated to Group RIRS,including 31 males and 19 females.Their mean age was 44.5 ± 8.3 years old and mean stone size was 13.7 ± 3.1 mm (range 10-21 mm).Among them,16 cases were complicated with mild and moderate hydronephrosis.No statistically significant difference were seen between the two groups (P ＞ 0.05).After three months' follow-up,one-time stone free rate(SFR) of UMP group was 94.0％ (47/50),which was significantly more superior than the 72.0％ (36/50) of the RIRS group(P ＜ 0.05).The intraoperative decrease in hemoglobin were (7.8 ± 3.3) g/L vs.(3.1 ± 3.4) g/L,and operating time(26.5 ± 6.1) min vs.(43.3 ± 6.3) min.Significant differences were also seen between the two groups(P ＜0.05).There was more blood loss and less operating time in the group of UMP.The hospital stay,delayed hemorrhage and postoperative fever between the UMP and RIRS groups were (4.3±1.3)d vs.(3.24 ± 1.21)d,8.0％ (4/50)vs.0(0/50),16.0％ (8/50)vs.12.0％ (6/50) respectively.No significant differences were seen (P ＞ 0.05).Conclusions Both UMP and RIRS procedures are effective and safe in the treatment of moderate-sized renal lower caliceal calculi.Compared with RIRS,UMP may be more effective and has less operating time,however wtih more intraoperative blood loss.

Objective To summarize the clinical manifestations,diagnosis and treatment of perinatal tuberculosis.Methods We retrospectively analyzed the clinical data of six infants with perinatal tuberculosis treated in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2000 to December 2016.Results (1) The six patients were at the age of 27 to 60 days at the onset,while the mean ages of full-term and preterm infants were (31 ± 4) and (55± 6) days,respectively.Three mothers were diagnosed with active tuberculosis (two of which were diagnosed after parturition).(2) Three infants were admitted to the hospital with fever including two having respiratory diseases,one with external auditory canal secretions and deviated mouth,and two with secretions in the external auditory canal and masses in the head and neck.One was diagnosed as hepatosplenic tuberculosis,three as miliary tuberculosis (one was complicated by tuberculous meningitis and one with tuberculous meningitis and cervical lymph node tuberculosis),one with left cervical and temporal tuberculosis,and one with miliary tuberculosis complicated with left temporal,external auditory canal and cervical lymph node tuberculosis.(3) Two cases were positive for purified protein derivative skin test and two were positive for tuberculosis infection T cell spot test.Five cases were negative in anti-tuberculosis antibody test.Typical miliary shadows in the lungs of three infants were shown on chest X-ray.Two cases received auriculotemporal CT/MRI,indicating space-occupying lesions and destruction in the middle ear and mastoid process.Cranial MRI findings indicated one case had tuberculous meningitis.Diagnosis of three cases were confirmed by biopsy or after operation.(4) All six patients survived.Four cases recovered after combined treatment of isoniazid,rifampicin and pyrazinamide and two were transferred to a specialized hospital for further treatment.(5) All six patients were fully recovered in follow-ups at 2-3 years after discharge with normal development comparing with healthy children of the same age.Conclusions Perinatal tuberculosis,with nonspecific clinical manifestations,has a low incidence of infection but a high mortality rate.Suspected cases require full consideration including clinical symptoms,dynamic observation of laboratory findings and imaging features,and pathological examination when necessary.Maternal history of tuberculosis should be consulted and timely treatment is mandatory to improve the outcomes.

Objective:To resolve the issue of poor automatic segmentation of the bowel in women with pelvic tumors, a Dense V-Network model was established, trained and evaluated to accurately and automatically delineate the bowel of female patients with pelvic tumors.Methods:Dense Net and V-Net network models were combined to develop a Dense V-Network algorithm for automatic segmentation of 3D CT images. CT data were collected from 160 patients with cervical cancer, 130 of which were randomly selected as the training set to adjust the model parameters, and the remaining 30 were used as test set to evaluate the effect of automatic segmentation.Results:Eight parameters including Dice similarity coefficient (DSC) were utilized to quantitatively evaluate the segmentation effect. The DSC value, JD, ΔV, SI, IncI, HD (cm), MDA (mm), and DC (mm) of the small intestine were 0.86±0.03, 0.25±0.04, 0.10±0.07, 0.88±0.05, 0.85±0.05, 2.98±0.61, 2.40±0.45 and 4.13±1.74, which were better than those of any other single algorithm.Conclusion:Dense V-Network algorithm proposed in this paper can deliver accurate segmentation of the bowel organs. It can be applied in clinical practice after slight revision by physicians.