Objective To investigate the effects of positive end-expiratory pressure (PEEP) after recruitment maneuvers (RM) on respiratory mechanics and gas exchange during laparoscopy in obese patients.Methods Sixty-three ASA physical status Ⅱ or Ⅲ patients,aged 42-64 yr,with body mass index 30-40kg/m2,were randomly allocated into 3 groups (n=21 each):PEEP0 group,PEEP5 group and PEEP10 group.PEEP was not given after RM in PEEP0 group.In PEEP5 and PEEP10 groups,a recruiting maneuver was followed by PEEP 5 and 10 cm H2 O,respectively,until the end of pneumoperitoneum.The intraabdominal pressure was set at 12mmHg in the three groups.Parameters of respiratory mechanics including peak airway pressure (Ppeak),airway plateau pressure (Peat),chest wall plateau pressure (PplatCW),airway resistance (Raw),elastance of respiratory system (ERS),elastanc of chest wall (ECW) and elastance of lung (EL) and parameters of gas exchange including oxygenation index (PaO2/FiO2),arterial to end-tidal difference in carbon dioxide (Da-ETCO2),alveolar-arterial oxygen tension difference (DA-aO2),and dead space/tidal volume ratio (VD/VT) were measured before pneumoperitoneum (T0),at 20 min of pneumoperitoneum (T1),at 10 min after the end of recruitment (T2),and at the end of pneumoperitoneum (T3).Results Da-ETCO2,ERS and Raw were decreased at T2,ECW and EL were decreased at T3 in PEEP5 group,and Da-ETCO2,VD/VT,DA-aO2,Pplatcw Raw and EL were decreased at T2.3,and PaO2/FiO2 was increased at T2,ECW was decreased at T3 in group PEEP10 as compared with that in group PEEP0 (P ＜ 0.05).Da-ETCO2 and VD/VT were decreased and PaO2/FiO2 was increased at T2,3,Raw was increased and EL was decreased at T2 in group PEEP10 as compared with that in group PEEP5 (P ＜ 0.01).Conclusion PEEP after RM can improve respiratory mechanics and gas exchange during laparoscopy in obese patients and PEEP maintained at 10 cm H2O after RM provides better efficacy than PEEP at 5 cm H2 O.

Objective To study the serum levels of brain natriuretic peptide (BNP) and the correlation with the heart function in children with Kawasaki disease(KD), and to explore its clinical value for diagnosis of KD. Method A total of 43 children aged from 5 months to 8 years with mean age of (2.3 + 0.6) years with KD admitted from February 2007 to April 2009 were enrolled into this study as KD group, and patients with myocarditis, myocardiopathy, congenital heart disease and other primary heart disease were ruled out. Another 30 healthy children were taken as control health group. There were no significant differences in age and gender between two groups (P >0.05) .The serum levels of BNP were measured both in acute and recovery stages of KD by using ELISA. The serum levels of BNP in healthy children were measured randomly once. The left ventricular ejection fraction (LVEF), left ventricular shorten fraction ( LVSF), cardiac index (CI) and left ventricular inflow velocity through the mitral annulus (including E-velocity and A-velocity) were measured by using two-dimensional echocardiography in acute and recovery stages of KD. Data were analyzed with t -test and the linear regression analysis test. Results The serum level of BNP in acute stage was (517.26 + 213.40) ng/mL and was significantly higher than that in recovery stage (91.56 + 47.97) ng/mL, and higher than that in control group (91.56 + 47.97) ng/mL (P < 0.01). The levels of LVEF, LVSF and CI in the acute stage were significantly lower than those in the recoverystage ( P < 0.0%), but there was no significant difference in E/A between acute stage and recovery stage (P > 0.05). The BNP level had negative correlation with the levels of LVEF, LVSF and CI(r = -0.63, -0.52, and - 0.53, respectively, P < 0.05), but had no significant correlation with E/A (r = - 0.18, P > 0.05). Conclusions The serum levels of BNP increase significantly in the KD patients, and have negative correlation with the levels of LVEF, LVSF and CI. The detection of serum levels of BNP has an important significance for diagnosis of KD.

Objective To study the adenovirus infection and popular features in hospitalized respira-tory infection children of Qingdao area. Methods A total of 6 820 cases of respiratory infection from March 2011 to February 2014 in our hospital were enrolled,the average age was 5 years and 2 months old. Their ve-nous serums were collected on the first day of hospitalization,adenovirus IgM was monitored by indirect im-munofluorescence application. The adenovirus-positive rates of cases between different age groups, seasons and diseases were observed. Results Adenovirus were positive in 1 043 children,the rate was 15. 29%. The positive rate of young children group(1-3 years old) was 16. 92%,which was highest,there was statistic difference between young children group and other age groups(χ2 =12. 50,P<0. 05). Adenovirus infection rates were upward in recent years,the infection rates of winter and spring were higher than those of summer and fall,and there were significant differences between them(χ2 =28. 89,P <0. 05). The positive rate of AdV-IgM in children with severe respiratory tract infection was higher[19. 90%(877/4 408)]than that of the children with mild infection[12. 27%(296/2 412)](χ2 =64. 25,P<0. 05). Conclusion In recent years, adenovirus infection rate in Qingdao hospitalized respiratory infection children was rising,the infection rates in winter and spring were high,young children were the most vulnerable populations. The positive rate of ade-novirus infection in children with severe respiratory tract infection is higher than that of the children with mild respiratory tract infection.

Objective To establish a less-damage method for tracheal intubation so as to improve the quality of post-cardiac arrest syndrome.Methods Thirty rabbits wvere divided into 3 groups of 10 rabbits each according to the random number table:group A receiving direct endotracheal intubation after anesthesia,Group B separation of cervical tissue and retrograde tracheal intubation after anesthesia and Group C percutaneous retrograde tracheal intubation after anesthesia.After the intravenous injection of forskolin,cardiac arrest was induced by endotracheal tube clamping.After 5 minutes of untreated arrest,conventional cardiopulmonary resuscitation was initiated.Changes in arterial pressure,occurrence of post-resuscition syndrome and survival time were examined in all groups.Results Groups A,B and C showed 40％,60％ and 80％ success rate in cardiopulmonary resuscitation (P ＜ 0.01) and animal survival time of 23.4 hours (11.6-35.8 hours),62.7 hours (29.4-88.6 hours) and 79.5 hours (40.9-118.2 hours) (P ＜ 0.01).Conclusions Percutaneous retrograde tracheal intubation is suitable to increase cardiopulmonary resuscitation rate and survival rate in rabbits with post-cardiac arrest.The model has good stability and repeatability and can be used for study of post-cardiac arrest syndrome.

Objective:To summarize the characteristics of chest CT imaging and prognosis of children with necrotizing pneumonia (NP) after flexible bronchoscopy, in order to improve the clinician′s diagnosis and treatment of this disease.Methods:The clinical information, imaging features of the sixty-six patients suffering from NP, who were diagnosed and treated in Qingdao Women and Children′s Hospital from September 2015 to April 2019, were retrospectively analyzed. Fourty-six cases who were treated with flexible bronchoscopy alveolar lavage(treatment group) were comparative analyzed with the left 20 cases who were not treated with flexible bronchoscopy alveolar lavage(control group).Results:In treatment group, all patients appered lung consolidation at early stages, and multiple balloon chambers emerged in consolidation shadows in late period. There was no statistic difference in basic information, clinical manifestations, laboratory examinations and etiology between the control group and treatment group( P>0.05). The treatment group had a lower incidence of pulmonary complications and a higher lung shadow full absorption rate, which showed the statistical difference( P<0.05). Conclusion:The flexible bronchoscopy alveolar lavage plays an important role in the process of treating the children with NP, and chest CT provides reliable imaging evidence in the early diagnosis and prognosis of the NP children.

Objective To study the pulmonary artery shrink pressure(PASP) and pulmonary function in children with asthmatic diseases,and screen pulmonary arterial hypertension (PAH).To probe the correlation between PASP and pulmonary function.Methods Ninety children with asthmatic diseases from November 2014 to April 2015 at the Department of Respiratory,Women and Children's Hospital of Qingdao City were chosed as asthmatic group,and 90healthy children in the same period were selected as healthy control group.PASP and pulmonary function were detected by Doppler ultrasound and tidal flow-volume loop respectively within 24 hours of admission,the respite degrees were assessed by clinical and tidal flow-volume loop.SPSS 13.0 statistical software was used for statistical analysis.Results PASP of the asthmatic group and the healthy control group was (3.24 ±0.66) kPa and (3.15 ±0.49) kPa,and the difference was statistically significant (F =7.50,P ＜ 0.05).There were 10 cases of PAH in the asthmatic group,which had statistically difference with the healthy control group (x2 =10.59,P ＜ 0.05).The tidal volume per kilogram,the ratio of time to peak tidal expiratory flow to total expiratory time,the ratio of volume to peak expiratory flow to total expiratory volume of the asthmatic group were (6.62 ± 1.63) mL/kg,(26.76 ± 6.48) ％ and (26.66 ± 6.54) ％,and these three indicators of the healthy control group were (8.38 ± 0.80) mL/kg,(34.35 ± 2.84) ％ and (34.23 ±3.02) ％,but that of the former group were less than that of the lower respectively (F =86.28,138.08,113.27,all P ＜0.05).PASP had negative correlation with the ratio of time to peak tidal expiratory fow to total expiratory time in the asthmatic group (r =-9.45,P ＜ 0.05).PASP was increased with the aggravation of respite,and it had statistical difference between the mild or moderate asthmatic group [(3.43 ± 0.50) kPa,(3.66 ± 0.59) kPa] and the severe group [(4.20 ± 0.75) kPa] (x2 =24.81,12.55,all P ＜ 0.05),and the cases of PAH had significant differences among these 3 groups (0,2,8 cases in mild,mode rate and severe group,respectively) (x2 =54.92,P ＜ 0.05).Conclusions For children with more severe airway obstruction and wheezing,the risk of PASP and PAH will be higher.It is helpful to reduce right ventricular function damage for children with asthmatic diseases by measuring PASP and screening PAH in the early stage according to the clinical condition and lung function.

Objective: To establish a mouse model of osteoarthritis (OA) and study the bone microarchitecture and bone metabolism of tibial subchondral bone in early stage of OA. Methods: The mouse model of post-traumatic osteoarthritis (PTOA) with anterior cruciate ligament (ACLT) was established by using c57 mice. The Sham operation group served as the control group. All mice were fed with conventional diet. All mice were sacrificed after 4 weeks. The degeneration of knee joint was observed by HE staining and Safranin O-Fast Green staining. The number of osteoclasts was counted by TRAP staining. Micro CT was used to analyze the quantitative parameters of the microstructure of tibia subchondral bone in mice. Serum levels of bone resorption biomarker CTX I and cartilage degeneration marker CTX II were determined. Results: After ACLT 4 weeks, the average score of OARSI in ACLT group was 3.2, which was higher than that in Sham group, and the joint degeneration occurred in mice, presenting the pathological characteristics of early OA. Compared with the sham operation phase, the total subchondral bone volume (TV) of ACLT group was 4.72 mm³, increased by 13.6%; the bone trabecular resolution (Tb.Sp) was 0.130 and 0.154 mm, respectively, and the ACLT group also increased by 18.8%; the bone volume/tissue volume (BV/TV) was 0.470 and 0.294, respectively, and the ACLT group decreased by 48.9%; the bone trabecular thickness (Tb.Th) was 0.162 and 0.083 mm groups, ACLT decreased by 37.5%. Trap staining showed that the number of osteoclasts per unit volume in ACLT group was 72, which was significantly higher than that in sham operation group. The CTX I of mice in the sham operated ACLT group and sham operated group were 20.9 ng/ml and 18.29 ng/ml, with an increase of 48.9% in the ACLT group; the CTX II of mice in the ACLT group and sham operated group were 35.5 ng/ml and 28.6 ng/ml, with an increase of 24.1% in the ACLT group. Conclusion ACLT Mouse model can successfully construct early OA, which confirms the early loss of osteochondral bone and the pathological changes of osteoclast activation in OA, and provides a new specific target for the treatment of OA.

OBJECTIVE：To optim ize the water extraction-ethanol precipitation technology of polysaccharide from Litchi chinensis seed，and to evaluate its hypoglycemic activity in vitro . METHODS ：The content of polysaccharides was determined by phenol-sulfuric acid colorimetry ，and the extraction rate of polysaccharides was calculated. Single factor test and response surface methodology were used to optimize the water extraction technology with the ratio of material to liquid ，extraction times and extraction time as factors ，and the extraction rate of polysaccharide as index. Single factor test was used to screen the concentration volume fraction of water extract and ethanol precipitation Using acarbose as contro l，4-nitrophenol-α-D-glucopyranoside method was used to investigate in vitro inhibitory activity of polysaccharide from L. chinensis seed to α-glucosidase. RESULTS ：The optimal technology was the ratio of material to liquid 1∶19 （g/mL），decocting for 3 times，1 h for each time ，concentrating the water extract to 40％ of original volume ，and adding ethanol to 80％ volume fraction. After deproteinization by Sevage method ，the crude polysaccharide of L. chinensis seed was obtained. The results of 3 times of validation tests showed that ，extraction rates of polysaccharide were 7.61％，7.89％，7.99％，average extraction rate was 7.83％（RSD＝2.52％，n＝3）. The contents of polysaccharide were 55.57％，55.83％ and 56.66％，average content was 56.02％（RSD＝1.81％，n＝3）. The inhibitory activity of the polysaccharide from L. chinensis seed to α-glucosidase were increased as concentration ；its IC 50 was 0.056 mg/mL，which was lower than positive control acarbose （0.196 mg/mL）. CONCLUSIONS：The optimal water extraction-ethanol precipitation technology of polysaccharide from L. chinensis seed is stable and feasible. The polysaccharide from L. chinensis seed show significant in vitro inhibitory effect on α-glucosidase，which is better than that of acarbose.

Objective: To assess the effects of different nutritional support methods on postoperative recovery in patients with gastric cancer. Methods: 98 patients who received radical gastrectomy were divided into three groups: parenteral nutrition group (PN group) (n=36), early enteral nutrition group (EEN group) (n=33) and early oral feeding group (EON group) (n=29). Tolerance of enteral nutrition, postoperative recovery and economic indicators were compared. Results: The number of laparoscopic-assisted surgeries was 18, 17 and 25 in PN group, EEN group and EON group, respectively. There was no significant difference in sex, age and body mass index(BMI) among the three groups. Gastrointestinal function recovered slowly in 3 cases, including 2 cases in EEN group and 1 case in EON group. 1 case in EON group had abdominal hemorrhage. Median postoperative hospital stay in PN, EEN and EON group was 11.0, 11.0 and 8.0 days respectively, and significant reduction can be found in EON group(P<0.001). The complication rates were 30.5% (11 cases), 12.1% (4 cases), and 13.8% (4 cases), respectively, with no statistically significant difference(P=0.102). The median nutritional support costs for PN group, EEN group, and EON group were 4 543.3, 974.2, and 265.0 yuan, respectively. The median albumin consumption was 90.0, 40.0, and 0 g, respectively. The EON groups were significantly lower (P<0.001). The results of the laparoscopic assisted subgroup and the ones of whole group were consistent. Conclusion Compared with parenteral nutrition and early enteral nutrition, early oral feeding can reduce the amount of albumin consumption, decrease the cost of nutrition support and shorten the average hospital stay after surgey without increasing the incidence of complications.