Point-of-care pulmonary ultrasound is a widely used tool for rapid diagnosis and monitoring treatment in emergency departments and intensive care units.Pulmonary ultrasound has high sensitivity,specificity and diagnostic accuracy in identification of pneumonia,pneumothorax,pulmonary-embolism,pleural effusion,alveolar interstitial syndrome,etc.Besides,it can assess the lung aeration from interstitial syndrome to lung consolidation.Additionally,it provides real-time information of treatment response.Lung ulrasound applications in pulmonary disease were reviewed in this article.

In the present study, the expression, purification, toxicity detection and the adjuvant effect of the heat-labile enterotoxin in non-toxic mutant mLT63 of Escherichia coli were investigated, in which the inductive expression was performed under optimal condition for inductive expression and the toxicity of the products obtained from inductive expression were tested for toxicity after being purified and concentrated with affinity chromatography. BALB/c mice were immunized orally with the mutant mLT63 associated with Helicobacter pylori (Hp) subunit vaccine UreB, Omp11. After immunization, the specific antibody levels in serum, extract from gastric tissues and fecal extract were determind by means of ELISA assay and the results were subjected to statistical analysis. It was demonstrated that the mutant mLT63 of heat-labile entrotoxin of E.coli constructed in our laboratory devoided of any toxic effect as revealed by the rabbit ileal loop assay, but its adjuvant effect could be demonstrated in the associated immunization of mice with Hp subunit vaccine UreB and Omp11.

Objective To develop a portable medical drop speed monitoring equipment which can conveniently control the drop speed in infusion.Methods Taking the monolithic integrated circuit of 89C51 as a core,such units were designed as the master control unit,keyboard input system,drop speed detection,drop speed control,digital display,acousto-optics alarm circuit and electromotor drive.All circuit module units were connected in monolithic integrated circuit.The gathering data were transferred to monolithic integrated circuit in the form of electrical signals.After the operation,analysis and processing,monolithic integrated circuit transferred the data to demonstration module,electrical machinery and acousto-optics alarm circuit through the outlet.Results Automatically controlling the drop speed according to the difference of drop speed,this equipment can reach the required drop speed in 5~10s and maintain this speed with an error of 12 drops per minutes.Conclusion Portable medical drop speed monitoring equipment achieves the goal of the task and meets the clinical requirement.This equipment is worthy of popularizing.

Objective:To evaluate the value of lung ultrasonography score (LUS) on assessing extravascular lung water (EVLW) and prognosis in patients with acute respiratory distress syndrome (ARDS).Methods:The clinical data of 46 patients meeting ARDS Berlin definition admitted to intensive care unit (ICU) of Ningbo Yinzhou People's Hospital from July 2016 to December 2019 were retrospectively collected. The general data, vital signs, blood lactic acid (Lac), oxygenation index (OI), LUS, extravascular lung water index (EVLWI), sequential organ failure assessment (SOFA) score, clinical pulmonary infection score (CPIS) and the length of ICU stay were collected. According to the prognosis of patients during ICU treatment, the patients were divided into survival group and non-survival group, and the clinical characteristics between the two groups were compared. The correlation between LUS and OI, EVLWI, SOFA, and CPIS were analyzed by Pearson correlation analysis. Receiver operator characteristic (ROC) curve was plotted to determine the prognostic value of LUS for ARDS patients during ICU treatment.Results:Forty-six patients were enrolled in the analysis, of whom 32 patients survived (69.6%), and 14 patients died (30.4%) during ICU treatment. There was no significant difference in gender, age, left ventricular ejection fraction (LVEF) or heart rate (HR) between the two groups. Compared with the survival group, the mean arterial pressure (MAP) and OI in the non-survival group were significantly lowered [MAP (mmHg, 1 mmHg = 0.133 kPa): 57.48±33.34 vs. 85.45±19.56, OI (mmHg): 74.50±18.40 vs. 233.06±28.28, both P < 0.05], while Lac, LUS, EVLWI, SOFA and CPIS were significantly increased [Lac (mmol/L): 6.78±2.56 vs. 2.21±1.42, LUS score: 23.57±2.03 vs. 15.58±2.24, EVLWI (mL/kg): 22.93±2.56 vs. 12.96±2.18, SOFA score: 20.21±3.35 vs. 12.43±2.97, CPIS score: 8.07±1.38 vs. 4.59±1.04, all P < 0.01], and the length of ICU stay was significantly shortened (days: 9.33±3.28 vs. 16.89±4.12, P < 0.05]. Pearson correlation analysis showed that a significant negative linear correlation was found between LUS and OI ( r = -0.823, P < 0.01), and positive linear correlations were found between LUS and EVLWI, SOFA, CPIS ( r values were 0.745, 0.614, 0.757, respectively, all P < 0.01). ROC curve analysis showed that both LUS and EVLWI could predict the prognosis of ARDS patients during ICU treatment, and the areas under ROC curve (AUC) of LUS and EVLWI were 0.936 and 0.991, respectively. When the cut-off of LUS score was 20.5, the sensitivity and specificity were 85.7% and 81.2% respectively. Conclusions:LUS score has a good correlation with EVLWI monitored by pulse index continuous cardiac output (PiCCO), which can reflect lung water content. LUS score can be used as an early prognostic indicator for ARDS patients.

Objective:To evaluate the value of lung ultrasound (LUS) in the early assessment of patients with acute respiratory distress syndrome (ARDS).Methods:A prospective double-blind cohort study was conducted. Patients with ARDS conformed to the Berlin diagnosis criteria admitted to the Intensive Care Unit (ICU) of Ningbo Yinzhou People’s Hospital from July 2016 to January 2020. According to the oxygenation index (OI), the patients were divided into the mild to moderate group (100 mmHg

Objective:To investigate the clinical predictive value of combined diaphragmatic and pulmonary ultrasound in acute respiratory failure patients with mechanical ventilation (MV).Methods:From January 2020 to August 2022, patients with acute respiratory failure admitted to People's Hospital Affiliated to Ningbo University who underwent invasive MV and weaning were enrolled. After meeting the weaning standards, spontaneous breathing test (SBT) was performed using T-tube. Right diaphragm excursion (DE), diaphragm thickness and lung ultrasound score (LUS) were collected by bedside ultrasound at 30 minutes of SBT, and rapid shallow respiratory index (RSBI), diaphragmatic-shallow respiratory index (D-RSBI) and diaphragmatic thickening rate (DTF) were calculated. According to the weaning outcome, the patients were divided into successful weaning group and failed weaning group. The clinical data of all patients were collected, and the ultrasound parameters and clinical indicators were compared between the two groups. Receiver operator characteristic curve (ROC curve) was used to evaluate the predictive value of D-RSBI, RSBI, DE combined with LUS score and DTF combined with LUS score for weaning failure patients.Results:A total of 77 patients were enrolled, including 54 cases in the successful weaning group and 23 cases in the failed weaning group. The right DE and DTF of patients in successful weaning group were significantly higher than those in failed weaning group [right DE (cm): 1.28±0.39 vs. 0.88±0.41, DTF: (32.64±18.27)% vs. (26.43±15.23)%, both P < 0.05], LUS score, RSBI and D-RSBI were significantly lower than those in failed weaning group [LUS score: 11.45±2.67 vs. 18.33±3.62, RSBI (times·min -1·L -1): 72.21±19.67 vs. 107.35±21.32, D-RSBI (times·min -1·mm -1): 0.97±0.19 vs. 1.78±0.59, all P < 0.05]. ROC curve analysis showed that when the cut-off value of D-RSBI and RSBI was 1.41 times·min -1·mm -1 and 56.46 times·min -1·L -1, the area under the ROC curve (AUC) for predicting weaning failure was 0.972 and 0.988; and the sensitivity was 95.7% and 87.0%, respectively; the specificity was 81.0% and 100.0%, respectively. The AUC of right DE combined with LUS score and DTF combined with LUS score in predicting weaning failure were 0.974 and 0.985, respectively, with a sensitivity of 91.3% and a specificity of 98.1%. Conclusions:Combined assessment of diaphragmatic and pulmonary ultrasound is a good parameter to effectively predict weaning failure in MV patients, which has high application value in guiding weaning in MV patients, and is worthy of clinical application.

Objective:To explore the application value of ultrasound diaphragmatic function assessment in weaning from invasive mechanical ventilation in patients with respiratory failure.Method:Fifty-three patients with acute respiratory failure who underwent mechanical ventilation and weaning in People’s Hospital Affiliated to Ningbo University from January 2020 to February 2022 were selected for research. After weaning conditions, T-tube was used for spontaneous breathing test (SBT). At SBT-30 min, beside ultrasound was used to collect the right diaphragm movement (DE) and diaphragm thickness, and the shallow rapid breathing index (RSBI), diaphragm shallow rapid breathing index (D-RSBI) and diaphragm thickness change rate (DTF) were calculated. According to the outcome of weaning, the patients were divided into the successfully weaned group and unsuccessfully weaned group. All patients’ clinical data were collected, and the relationship between ultrasound parameters and clinical indexes was compared between the two groups The efficiency of each index for predicting the success rate of weaning was analyzed with the receiver operating characteristic (ROC) curve.Results:Fifty-three patients were enrolled in this study, including 36 patients in the successfully weaned group and 17 patients in the unsuccessfully weaned group. DE and DTF in the successfully weaned group were higher than those in the unsuccessfully weaned group (all P<0.05), RSBI and D-RSBI in the successfully weaned group were significantly lower than those in the unsuccessfully weaned group (all P<0.05). ROC curve analysis showed that when the cut-off value of DE, DTF, RSBI and D-RSBI were >1.21 cm, >27.5%, <48.68 times/(min·L) and <1.31 times/(min·mm), the sensitivity of predicting the success of weaning was 69.0%, 97.2%, 83.0% and 83.0% respectively, and the specificity was 59.0%, 47.1%, 94.1% and 94.3%, respectively. Conclusions:The evaluation of ultrasound diaphragmatic function can effectively guide the clinical mechanical ventilation patients to withdraw the machine, and improve the accuracy of predicting the success rate of weaning. Therefore, t ultrasound diaphragmatic function assessment has a high application value in guiding the mechanical evacuation of patients with mechanical ventilation, and can be widely applied in clinical practice.

Monkeypox is a zoonotic disease.Previous studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians′ understanding of monkeypox and achieve early detection, early diagnosis, early treatment and early disposal, the committee composed of more than 40 experts in the related fields of infectious diseases, pediatrics, infection control and public health formulate this expert consensus, on the basis of the latest clinical management and infection prevention and control for monkeypox released by the World Health Organization (WHO), the guidelines for diagnosis and treatment of monkeypox (version 2022) issued by National Health Commission of the People′s Republic of China and other relevant documents.During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis and differential diagnosis, treatment, discharge criteria, prevention, case management process and key points of prevention and control about monkeypox.