Objective To investigate the effects of prone positioning on oxygenation and lung mechanics in neonates with mechanical ventilation.Methods Twenty cases of neonates,selected from Shanghai Children′s Hospital(from May 2008 to Feb 2009),were randomized to supine-prone position group (n=10) and prone-supine position group (n=10) using a crossover design.During 6h,these neonates were placed in the supine position for 3h then in the prone position for 3h or in reversed order.The ventilator parameters,results of arterial blood gas and the lung mechanics were recorded.Results Without obvious changes of ventilator parameters,PaO2 improved significantly when the incubated neonates were placed in the prone position for 3h compared to supine [(74.50±15.37)mm Hg vs (67.60±13.66)mm Hg,1mm Hg=0.133kPa,P<0.05).Similarly,oxygenation index of prone positioning for 3h was (201.86±55.96)mm Hg,which was higher than that of (184.38±63.58)mm Hg,the value of supine positioning for 3 h.There were significant differences (P<0.05).Our results showed that 60% (12/20) of the neonates responded to prone positioning,with oxysenation index increasing as much as 17mm Hg on average.Improvement in minute volume,tidal volume and dynamic compliance of the lung were achieved after prone positioning for 3h (P=0.011,0.020,0.045).The airway resistance did not decrease significantly (P=0.422),but the average decreased in the prone position.Conclusion Oxygenation and the lung mechanics are improved significantly in the neonates with prone position compared with supine position.

The triggering receptor expressed on myeloid cells (TREM) -1 is a recently identified molecule involved in the inflammatory response.It belongs to the immunoglobulin superfamily,it was reported that it has relation with inflammatory response mediated by several microbial components,besides its soluble form was observed and identified at significant levels in bacterial infection of neonate.So it may become a valuable diagnostic marker of serious bacterial infection in neonate.

In this study nine cases of thallium poisoning in a series of homicidal poisoning were analyzed in order to provide more information concerning thallium poisoning. It was found that the most common clinical feature of thallium poisoning was peripheral neuropathy and paraesthesia was more common than amyasthenia. Understanding of these clinical characteristics of thallium poisoning was helpful to early identification and differential diagnosis. Since the early administration of Prussian Blue, as a specific antidote for thallium poisoning, can substantially improve the prognosis, it is of great importance to establish a correct and early diagnosis.

Objective To evaluate and compare the value of interleukin(IL)-6,IL-8,tumor necrosis factor(TNF)-α,and soluble form of triggering receptor expressed on myeloid cells (sTREM)-1 in neonatal infection and detect the relationship between them.Methods Eighty-five full-term newborns who were admitted to the neonatal ward of Shanghai Children's Hospital of Shanghai Jiaotong University were enrolled,according to the locations and severity of infection,the patients were divided into three groups:systemic infection group (n =27),local infection group(n =28),and non-infection group (n =30).The level of plasma sTREM-1 was measured by enzyme-linked immunosorbent assay,and the levels of IL-6,IL-8 and TNF-α were measured using cytometric bead array.Results (1) The levels of sTREM-1,IL-6,IL-8 and TNF-α were significantly higher in infants with systemic infection group than local infection group and non-infection group(P ＜0.05).(2) There were 17 survivors and 10 deaths in systemic infection group,and the level of sTREM-1 in the non-survivor [(121.64 ±49.31) pg/ml] was higher than the survivor[(73.13 ± 34.92) pg/ml,P =0.006].But the levels of IL-6,IL-8 and TNF-α were not statistically significant in the survivor and the death (P ＞ 0.05).(3) Based on the receiver operating characteristic analysis,cutoff values were identified for each variable that maximized both the sensitivity and specificity.These markers were considered positive if sTREM-1 ≥43.75 pg/ml,IL-6 ≥ 89.80 pg/ml,IL-8 ≥569.55 pg/ml and TNF-α ≥ 24.80 pg/ml.Among these indexes,the sensitivities were 85.5％,89.1％,70.1％ and 69.5％ respectively; the specificity were 80.0％,100％,100％ and 93.3％ respectively.Compared the area under curve(AUC) of them,IL-6(AUC =0.981)＞ sTREM-1 (AUC =0.868) ＞ TNF-α (AUC =0.864) ＞ IL-8 (AUC =0.852).sTREM-1 was correlated with IL-6,IL-8 and TNF-α(Spearman coefficient of rank r =0.532,P ＜0.01 ;r =0.420,P ＜0.01 ;r =0.531,P ＜0.01).Conclusion (1) The levels of plasma sTREM-1,IL-6,IL-8 and TNF-α were higher in neonatal infections;(2) sTREM-1 was associated with prognosis; (3) sTREM-1 was correlated with IL-6,IL-8 and TNF-α.

Objective To observe the changes of serum soluble form of triggering receptors expressed on myeloid cell-1 (sTREM-1) level in full-term newborns with infection and to investigate the relationship between serum sTREM-1 and neonatal bacterial infection.Methods Eighty-five full-term newborns admitted to the neonatal ward of Shanghai Children s Hospital of Shanghai Jiaotong University were selected into this study.According to the locations and severity of infection,patients were divided into 3 groups: severe infection group (n = 27),mild infection group (n = 28),non-infection group (n = 30).The samples of infection groups were collected before using antibiotics and within 48 h after infection symptom occurred; others were collected during hospitalization.For the neonates with organ dysfunction in the severe infection group,samples were also collected at the third and seventh day of infection.Serum sTREM-1 was measured by enzyme-linked immunosorbent assay.Analysis of variance was used to compare the difference between groups.Receiver operating characteristic (ROC) curve was used to calculate the sensitivity,specificity,positive and negative predictive value and Youden index.Results (1) Serum sTREM-1 level of severe infection group[(91.2±47.3) pg/ml] was significantly higher than that of mild infection group[(68.8 + 30.4) pg/ml] and non-infection group[(35.5±17.6) pg/ml],respectively (P＜0.05).(2) Serum sTREM-1 level of the survival newborns (n= 17) in the severe infection group was lower than that of dead ones[(73.1±34.9) pg/ml vs (121.6±49.3) pg/ml,t= - 2.995,P = 0.006].(3) For the survival patients,the serum sTREM-1 level decreased in the first week of infection,while that of dead patients increased,the cut-off value was 100.6 pg/ml.(4) Based on the ROC analysis,43.8 pg/ml was selected as the the cut-off value,area under the curve was 0.868,and sensitivity was 85.5%,specificity 80.0%,positive predictive value 0.887,negative predictive value 0.750,Youden index 0.655.Conclusions Serum sTREM-1 level increases in neonatal infection.The change of serum sTREM-1 level in patients with severe infection is correlated to the prognosis.

ObjectiveTo explore the application of new tec hn iques: pulmonary surfactant(PS), nasal continuous positive airway pressure (NCPA P) and the neonatal transportation on the morbidity and mortality of ventilated very low birth weight infant (VLBWI).MethodsSeventy three VL BWI ventilated because of respiratory failure ,recurrent apnea and cardiopulmo nary resuscitation were enrolled in this study. They were divided into two group s according to the use of new techniques, before and after. There were 32 cases during 1995～1998 in group A and 41cases during1999～2002 in group B. In group B, PS was used in 10 cases (24%); NCPAP in 12 cases (29%) after extubation, and transportation in 11 cases (27%).ResultsThe survival rate in group B were significantly improved (71% vs 39%, P

Objective To study the expression of high mobility group box 1 (HMGB1),matrix metalloproteinase-9(MMP-9) and vascular endothelial growth factor-C (VEGF-C)gene in papillary thyroid carcinoma (PTC) and their significance.Methods Expression of HMGB1,MMP-9,VEGF-C proteins and HMGB1 mRNA was detected by technology of immunohistochemistry(SP) and in situ hybridization in 58 cases of PTC tissues,20 cases of thyroid adenoma tissues,25 cases of nodular goiter tissues and 10 cases of normal thyroid tissues.Results Expression of HMGB1,MMP-9,VEGF-C proteins and HMGB1 mRNA in PTC tissues was much higher than that in the 3 non-cancerous tissues (P ＜ 0.05).The positive expression rate of HMGB1,MMP-9 proteins and HMGB1 mRNA was closely associated with the thyroid carcinoma size and lymph node metastasis (P ＜0.05).There was also closely association between the positive expression rate of VEGF-C protein and lymph node metastasis(P ＜ 0.05).The positive expression rate of HMGB1,MMP-9,VEGF-C proteins and HMGB1 mRNA had no association with patients' sex or age(P ＞ 0.05).The expression of HMGB1,MMP-9 and VEGF-C proteins had positive correlation with each other(P ＜ 0.05).The expression of HMGB1 protein and HMGB1 mRNA was also positively correlated with each other(P ＜0.05).Conclusion Expression of HMGB1,MMP-9,VEGFC proteins and HMGB1 mRNA in PTC is correlated with the progress,invasion,metastasis of PTC,by detecting them may help to predict the clinical progress and prognosis.

Objective To investigate the expression of Toll like receptor 2 (TLR2) mRNA and TLR4 mRNA in renal tissues of rats with endotoxin-induced shock, and explore the possible effects and mechanism of vasoactive intestinal peptide (VIP) and methylprednisolone ( MP) on renal injury. Methods Endotoxin (E coli O55: B5 LPS, 10 mg/kg) was injected intravenously to the rats to establish the endotoxin-induced shock models ( LPS group, n = 16). The rats in LPS + VIP group (n = 16) was injected with VIP (5 nmol/kg) after model establishment, and those in LPS + VIP + MP group (n = 16) was injected with VIP (5 nmol/kg) and MP (3 mg/kg) after model establishment. Besides, normal saline control group (control group) was established( n = 8). Electron microscope was used to observe the histopathological changes in renal tissues 6 h and 24 h after model establishment, and RT-PCR was performed to evaluate the expression of TLR2 mRNA and TLR4 mRNA in renal tissues. Results Six h after model establishment, glomerular endothelial cell swelling and vacuolar degeneration of mitochondria were observed in LPS group under electronic microscope. Twenty-four h after model establishment, mitochondrial swelling, vacuolar degeneration and slight nucleus pyknosis of renal tubular cells were observed in LPS group. The renal pathological changes in LPS + VIP group and LPS + VIP + MP group were much less severe than those in LPS group at the same time. The expression of TLR2 mRNA and TLR4 mRNA in LPS, LPS + VIP and LPS + VIP + MP groups was significantly higher than that in control group 6 h after LPS injection (P <0.01), while the expression of TLR2 mRNA and TLR4 mRNA in LPS group was higher than that in the other groups 24 h after LPS injection (P < 0.01) . Conclusion The expression of TLR2 mRNA and TLR4 mRNA in renal tissues of rats with endotoxin-induced shock is markedly up-regulated. VIP and MP can obviously alleviate renal pathological changes, and the mechanism may contribute to impacting on the expression of TLR2 mRNA and TLR4 mRNA.

ObjectiveTo investigate the cause,diagnosis and treatment measures of neonatal pneumothorax.MethodsThe clinical data of 98 cases with neonatal pneumothorax in our hospital from Mar 2005 to Mar 2010 were reviewed retrospectively.ResultsThere were 27 premature neonates and 71 full-term neonates in the 98 cases.Ten cases were spontaneous pneumothorax and 88 cases were non spontaneous pneumothorax.After the treatnent of primary disease,pleural aspiration,chest drainage and mechanical ventilation,88 cases were cured,8 cases were improved and 2 cases died.ConclusionNeonatal pneumothorax is related with cesarean section,improper use of endotracheal intubation,meconium aspiration,premature hyaline membrane disease using pulmonary surfactant and ventilator therapy.Most pneumothorax is due to lung disease.The prevention of preterm birth and asphyxia can reduce the incidence of neonatal pneumothorax.

Practice base of professional moral education of university is the important constituent of practice base of moral education of university. Practice base of professional moral education of university is a training place of undergraduate professional ideal、professional concept、professional attitude、professional discipline、professional style、professional value which be built by the nation、all levels of local government or university according as the moral education goal of university and the undergraduate body and mind law of development, specially the law of moral forms. The construction of practice base of professional moral education of university is a important action to enhance the actual effect of the professional moral education for medico. The construction of practice base of professional moral education of university ought to follow the policy of"being educated、enhancing ability、contributing" and the principle of "benefiting each other、adjust measures to local conditions and economy、understanding each other and integrating through free will". Finally the article discuss the pattern of the construction of practice base of professional moral education of university for medico and put forward three kind of patterns of the construction of practice base of professional moral education of universityaccording to the actual fact of the college.