Fifty-six patients with swallowing dysfunction after cerebral apoplexy were treated by acupuncture and swallowing function training. The curative effect is satisfactory and the total effective rate was 96.4%.

Objective To investigate the changes of follicular regulatory T cells ( Tfr cells) and follicular T helper cells ( Tfh cells) in peripheral blood of children with myasthenia gravis ( MG) . Methods We recruited 28 MG patients and 20 healthy subjects in this study. The percentages of Tfh and Tfr cells in peripheral blood samples were measured by flow cytometry. Real-time PCR was performed to detect the ex-pression of transcription factors and regulatory factors of Bcl-6, c-MAF, Blimp-1 and PD-1 at mRNA level. ELISA was used to detect the levels of IL-2, IL-6, IL-10 and IL-21 in plasma samples and the titers of Ach-Rab and PsMab. Results Compared with the healthy subjects, the MG patients showed higher percentages of Tfh cells and lower percentages of Tfr cells before receiving treatment. The expression of Bcl-6 and c-MAF on CD4+T lymphocytes cells at transcriptional level were significantly enhanced, while the expression of Blimp-1 on CD4+T cells and the expression of PD-1 on Treg cells at transcriptional level were inhibited in the MG patients in comparison with those in healthy subjects. Moreover, decreased levels of IL-2 and increased levels of IL-21 were found in plasma samples collected from the MG patients. Conclusion The decreased percentages of Tfr cells and increased percentages of Tfh cells in patients with MG resulted in abnormal ratios of Tfr/Tfh cells, which might be involved in the immunological pathogenesis of MG. Several changes in the patients with MG might be responsible for the imbalanced ratio of Tfr/Tfh cells, which included changes of IL-2 and IL-21 in microenvironment, enhanced expression of Bcl-6 and c-MAF at mRNA level and inhibited expression of Blimp-1 at mRNA level on CD4+T cells as well as over-expression of PD-1 at mRNA level on Treg cells.

Objective To investigate the influence of IVIG on immunologic function and cytokines levels in children with EV71 infection associated high-risk pulmonary hemorrhage. Methods According to the inclu-sion criteria , 64 children were enrolled and randomly divided into two groups: 39 cases in the IVIG treatment group and 25 cases in the general treatment group. The alternations of blood and immune cytokine markers before and after treatment were detected in the patients. Results (1) Before treatment, the peripheral blood T cells, TH and B cells in the IVIG group were higher than those in the general group , but the peripheral blood IgA was lower than that in the general group(P < 0.05); (2) In the IVIG group, the NK cells and IgG increased and T cells, TH cell and B cells significantly decreased after receiving IVIG therapy (P < 0.05); (3)No significant difference was observed in the levels of IL-6 and IL-10 in the two treatment groups before treatment. However , after IVIG treatment, IL-6 and IFN-γ levels reduced, IL-10 level increased (P < 0.05). After the general treat-ment, no significant difference was found in levels of IL-6,IL-10 and IFN-γ in peripheral blood (P > 0.05). Conclusion Disorders of cellular immunity and humoral immunity appeared in children with EV71 infection-re-lated high-risk pulmonary hemorrhage. It has clinical value to use IVIG timely to regulate the immune disorder.

Abstract: Objective　To compare and analyze the clinical characteristics, diagnosis, and treatment of different subtypes of severe influenza in neonates to provide a reference for the diagnosis and treatment of neonatal severe influenza. Methods A cohort of 40 neonates with severe influenza who were hospitalized in the neonatology ward of Children's Hospital Affiliated to Zhengzhou University between January 2019 to December 2023 were selected and divided into two groups based on the virus subtype: influenza A (n=23) and influenza B (n=17). A retrospective analysis was conducted to compare general information, clinical manifestations, auxiliary examinations, complications, and treatment outcomes of neonates with severe influenza A and B infection. Results The number of days of hospitalization was longer in cases of influenza A than that of influenza B. The proportion of neonates with severe influenza A who exhibited fever was higher than that for influenza B, and a higher percentage of those with fever had peak temperatures ranging from 38.1 ℃ to 39 ℃. Gastrointestinal symptoms, including vomiting and diarrhea leading to dehydration, were more evident in severe influenza B cases. The proportion of influenza A cases with abnormal creatine kinase-MB isoenzyme levels (>25 U/L) was higher than that of influenza B, and the differences were statistically significant (P<0.05). There were no significant differences between the two types of influenza in other clinical manifestations, the incidence of pneumonia/respiratory failure complications, peripheral blood leukocyte count and classifications, the proportion of abnormal aspartate aminotransferase (AST) (>40 U/L), alanine aminotransferase (ALT) (>40 U/L), and creatine kinase (CK) (>200 U/L), and lactate dehydrogenase (LDH) values (all P>0.05). In terms of treatment, neonates treated with Oseltamivir within 48 hours of onset mainly suffered from influenza A. Among those treated with Oseltamivir, the proportion of influenza A cases whose body temperature returned to normal within 24 hours was relatively higher, whereas, for those whose temperature returned to normal within 24-72 hours, the proportion was relatively higher in influenza B cases. These differences were statistically significant (all P<0.05). Conclusions Severe neonatal influenza usually occurs in winter and spring. After severe infection, fever is more obvious in neonates with influenza A, which is more likely to cause myocardial cell damage. Neonates with influenza A can be treated with Oseltamivir earlier and return to normal body temperature faster than those with influenza B after Oseltamivir treatment. Gastrointestinal symptoms are more common in neonates with severe influenza B.

Objective To investigate the expression of SP 100 protein in ATRA-treated NB4 cells and its effect on pro-liferation in NB4 cells.Methods Q-PCR was employed to measure the expression of SP 100 mRNA;Western blot was used to detect the expression of SP 100 protein; Immunofluorescence was adopted to determine the location of SP100;Cell viability was analyzed by CCK 8;Flow cytometry was used for cell cycle analysis .Results ATRA may induce the expression of mRNA and protein of SP 100.ATRA changes the location of SP100 from a micro-punctate pattern into a punctate nuclear pattern in NB 4 cells.SP100-shRNA promotes the proliferation of NB 4 cells and in-creased the cells in G2/M phase.Conclusions The expression of SP100 was significantly increased in ATRA-treated NB4 cells, and SP100 may be involved in the regulation of proliferation activity of NB 4 cells.

Objective To explore the relationship between organizational innovation atmosphere and nurses′job satisfaction in China. Methods 300 nurses were sampled during January-February 2018 using convenience sampling method, for a questionnaire survey with the general information questionnaire, nurse organizational innovation atmosphere scale and Minnesota satisfaction scale. Results 282 valid questionnaires were recovered out of 300 questionnaires issued, accounting for 94% of valid recovery rate. The score of organizational innovation atmosphere was 81.35 ± 14.51, and that of job satisfaction was 69.85 ± 14.91, proving a correlation between organizational innovation atmosphere and job satisfaction (P<0.01). A hierarchical regression analysis showed that, with demographic data under control, the regression model can explain 52% of the variance in nurses′ job satisfaction.Conclusions Organizational innovation atmosphere and nurses′ job satisfaction of the hospital are both at a higher level. Good organizational innovation atmosphere contributes to higher job satisfaction of nurses.

Objective To observe the clinical effects of L-carnitine in myocardial enzyme abnormality caused by enterovirus in children with hand foot and mouth disease (HFMD). Methods 660 HFMD children patients with myocardial enzyme abnormality from May 2013 to June 2016 were enrolled and randomly divided into three groups. Group A(n=220)was treated with 1′6-FDP,group B with L-carnitine and group C with L-carnitine combined with 1′6-FDP. All groups were given routine anti-virus and symptomatic treatment. The clinical efficacy was compared across the three groups in terms of myocardial enzyme spectrum,heart rate,ECG,severe conver-sion rate before and after treatment. Results (1)Before treatment,there was no significant difference between the three groups in gender,age,course of disease,heart rate,myocardial enzyme spectrum and other indicators. (2)After treatment,the cure rate of HFMD in group B and group C were significantly higher than that in group A (both P<0.05);the rate of severe cases and the ECG normal rate in group B and group C were significantly lower than those in group A(both P<0.05),the time for heart rate resuming to normal in group B and in group C was all significantly shorter than that in group A(both P<0.05). There were no significant differences between group B and group C in clinical cure rate,severe conversion rate,recovery rate of ECG and heart rate recovery(all P>0.05).(3)In comparison with group A,after treatment,the levels of myocardial enzyme in group A and group B were decreased significantly(P < 0.05)and the recovery rates of myocardial enzyme in group A and the group B were significantly higher (P < 0.05),but no significant difference were observed between group A and group B (P>0.05). Conclusions For HFMD children with myocardial enzyme abnormality caused by enterovirus ,L-car-nitine together with myocardial nutritional therapy can significantly improve the myocardial enzyme indexes and electrocardiogram abnormality. It reduces the rate of severe cases and improve the prognosis.

Objective To evaluate the effect of using"metronome"to guide chest compression in the new nurse training of cardiopulmonary resuscitation(CPR). Methods From 2015 to 2016,385 new nurses were enrolled and randomly by random number table divided into four groups based on Solomon four-group design:control group 1(96 nurses),sudy group 1(89 nurses),control group 2(104 nurses) and study group 2(96 nurses),Control group 1 and control group 2 accepted normal training plus "chest compressions operation formula" training,study group 1 and study group 2 got "metronome" guiding based on the frequency training.Control group 1 and study group 1 took a baseline test before the training started,while control group 2 and study group 2 didn't.Four groups took part in an operational test after the seven days of training. Results There was no statistical difference between the baseline test scores of control group 1 and study group 1(P>0.05).After the training,the score of study group 1 was 93.4±3.5, which was significantly higher than 91.6 ± 4.7 of control group 1(t=-2.870, P<0.01).Through covariance analysis,after removing the impact of the baseline test score,the score of study group was statistically significant higher than that of control group 1 (F=7.33, P=0.007).Furthermore,there was no statistically significant interaction between the baseline test score and training method (P>0.05).Meanwhile,after training,study group 2 scores was 93.5±3.5,which was statistically higher than 92.1±4.0 of control group 2(t=2.670,P=0.008).Control group 1 were combined with control 2 to form control group,as well as study group 1 with study group 2 to form study group.A comparison between these two new groups indicates that the new study group surpasses the new control group with lower error frequencies in the position,depth and frequency of external cardiac compression (t=4.701 8, 12.488 9, 11.993 9, P<0.05).In addition,the study group also showed a better performance, when taking into consideration of the region and skills of compression and the observation of complexion,while there was no statistical difference between the error frequencies in these three aspects of these two new groups(P>0.05). Conclusions In the CPR training of new nurses,using a 100 times/min"metronome"can help new nurses grasp the accurate compression rates and depth, improve the overall quality of this procedure,making it a simple and effective training method,which is worthy of popularization.

Objective: To explore the application value of endoscope in probing the chronic wound with sinus tract in clinic. Methods: Twenty-eight chronic wounds with sinus tracts from 27 patients conforming to the inclusion criteria admitted to Outpatient Department of Wound Healing Center of Ruijin Hospital from December 2017 to March 2018 were investigated in a prospective and self-controlled trial. After being cleaned, the diameter of the opening of sinus tract was measured with a rule. A probe was used to measure the depth of a sinus tract according to the touch from the probe extremity in operation, and to measure the depth of a sinus tract that could be observed with naked eyes with the help of a pair of hemostatic forceps. Five minutes later, a probe was inserted deeply into the sinus tract to measure the depth under the endoscopic view combined with touch from the probe extremity in operation. Afterwards, the sinus tract was observed with endoscope, and the depth of the tract which could be observed under the endoscopic view was measured using a probe inserted deeply into the sinus tract. After completion of the above exploration, the sinus tract was infused with contrast agent Omnipaque 350 and scanned by computed tomography (CT) later to obtain its depth. The following indicators were calculated: the ratio of the depth of the sinus tract measured by CT to the diameter of the opening of the sinus tract (hereinafter referred to as the depth/diameter ratio of the sinus tract), the deviation rate comparing the depth of the sinus tract measured by conventional method (measured by probe only) and by endoscope (measured by probe under the endoscope view) with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the measured depth of the sinus tract), the deviation rate comparing the depth of the sinus tract that could be observed measured by conventional method and by endoscope with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the depth of the sinus tract that could be observed). Data were processed with paired t test. Pearson correlation analysis was applied to analyze the correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope. Results: The depth/diameter ratio of the sinus tract of this group of wounds was 1-32 (8±7). The deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method were (19±14)% and (79±18)%, respectively, both obviously larger than (9±9)% and (25±25)% by endoscope (t=3.837, 13.626, P<0.01). Positive correlation existed between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by conventional method, and between the depth/diameter ratio of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope (r=0.514, 0.585, 0.651, P<0.01). However, there was no obvious correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by endoscope (r=0.113, P>0.05). Conclusions Compared with the conventional method, application of endoscope is able to get more accurate data of chronic wounds with sinus tracts and observe the wounds with wider range.

Objective: To observe the neuro-protective effect of Levocarnitine on severe hand, foot and mouth disease (HFMD) after enterovirus 71(EV71) infection, to preliminarily explore the possible mechanism preliminarily. Methods: One hundred and thirty-two children with EV71 infection and HFMD combined with serum S100 protein and neuronspecific enolase (NSE) abnormalities who were admitted to Children′s Hospital Affiliated to Zhengzhou University from March 2015 to July 2016 were enrolled in the study.They were divided into the routine group and the Levocarnitine group by the random number grouping method.The routine group (66 cases, including 32 males and 34 females, median age of 2 years and 3 months) was given symptomatic treatment such as antiviral therapy while the Levo-carnitine group (66 cases, including 36 males and 30 females, median age of 2 years and 5 months) was treated with Levocarnitine for neuroprotection on the basis of routine group.Forty healthy children (23 males and 17 females, median age of 2 years and 6 months) who were examined at the Children′s Hospital Affiliated to Zhengzhou University during the same period were selected as the healthy control group.The levels of S100, NSE, soluble apoptosis-related factors (sFas), soluble apoptosis-related factor ligands (sFasL), malondialdehyde (MDA), superoxide dismutase (SOD) in serum were compared between the healthy control group and children with HFMD.The levels of above-mentioned indexes in cerebrospinal fluid and serum, efficacy-related indicators such as duration of fever, white blood cell count on the 3^rd day of treatment, time to remission of nervous system symptoms, time of disease progression and critical conversion rate were compared between 2 groups of children with HFMD.The correlation between sFas, sFasL, MDA, SOD and S100, NSE was performed Results: (1) The levels of S100 [(0.38±0.16) μg/L vs. (0.06±0.23) μg/L], NSE [(43.70±8.80) μg/L vs. 10.10±3.60) μg/L], sFas [(6.61±1.86) μg/L vs. (3.88±1.22) μg/L], sFasL[(101.40±20.7) μg/L vs. (54.4±13.3) μg/L] and MDA[(11.98±2.54) nmol/L vs. (4.08±1.45) nmol/L] in serum of HFMD group were significantly higher than those of the healthy control group (t=-12.245, -22.895, -8.273, -12.803, -17.960, all P<0.05), while the SOD level [(57.10±10.40) kU/L vs. (70.3±14.4) kU/L] was significantly lower (t=5.457, P<0.05). (2) With the extension of treatment time for HFMD children in the two groups, S100 and NSE in cerebrospinal fluid, S100, NSE, sFas, sFasL and MDA in serum decreased, while SOD level increased.On the 3^rd and 7^th day after treatment, S100 (t₃=3.491, t₇=14.434), NSE (t₃=2.920, t₇=23.490) in cerebrospinal fluid, S100 (t₃=5.277, t₇=3.614), NSE (t₃=4.652, t₇=10.525), sFas (t₃=6.399, t₇=7.514), sFasL (t₃=11.155, t₇=8.804) and MDA (t₃=6.348, t₇=7.499) in serum of Levocarnitine group were significantly lower than those of routine group (all P<0.05), while SOD (t₃=3.162, t₇=-3.529) was significantly higher than that of routine group (P<0.05). (3) The relief time of neurological symptom in levocarnitine group was significantly shorter than that in the routine group [(1.23±0.65) d vs. (1.84±0.47) d], and WBC on the 3^rd day after treatment [(9.14±2.93)×10⁹/L vs. (7.12±2.58)×10⁹/L] and the progression time of the disease [(29.74±7.85) h vs. (17.36±8.73) h] were significantly better than the those in the routine group (t=-6.178, 4.204, 8.567, all P<0.05). The critical conversion rates of Levocarnitine group and the routine group were 7.58% and 18.18%, respectively, and the difference in critical conversion rate was not statistically significant (χ²=2.316, P>0.05). (4)There was a positive correlation between S100 and sFas, sFasL, MDA in children with HFMD (r=0.373, 0.735, 0.334, P<0.05). NSE was positively correlated with sFas and sFasL (r=0.479, 0.601, all P<0.05), while SOD and S100 were negatively correlated with NSE (r=-0.425, -0.460, all P<0.05). Conclusions Levocarnitine has good curative effect on severe HFMD in children infected by enterovirus EV71, which can effectively protect the cranial nerves.The mechanism may be related to scavenging oxygen free radicals and blocking nerve cell apoptosis.