Early weaning from mechanical ventilation in children will lead to an extubation failure,however,prolonging mechanical ventilation will increase the risk of ventilator associated complication and the economical burden of disease.Nowadays there is no unified and objective ventilator weaning indexes in pediatrics,so it is significant to searching for appropriate and feasible ventilator weaning indexes.This article detailed the current progress on the condition and predictors of ventilator weaning in children,and comparing the predictability and accuracy of ventilator weaning indexes in children,also looking forward to the possibility of higher accuracy or scheme in ventilator weaning that used for clinical purposes.

Objective Study on the best drug compatibility for the double-lumen endobronchial intubation anesthesia. Methods Eighty ASA Ⅰ - Ⅱ patients undergoing selective thoracis surgery requiring intubation with double-lumen tubes were randomly divided into A and B group, with 40 cases in each group.The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), were recorded before induction (T0) , after drug injection (T1), during intubation (T2), and at 1 min (T3), 3 min (T4)and 5 min (T5) after intubation. Results There was no significant difference in SBP, DBP and HR between the two groups at T0[(124. 9 ± 16. 0) mmHg vs (125.8 ±6. 4) mmHg, (73. 1 ±9. 9)mmHg vs (74. 3± 10. 4) mmHg, (81.8 ± 6. 6) times/min vs (82. 4 ± 8. 1) times/min] (P ＞ 0. 05). Compared with parameter at T0, SBP, DBP and HR, parameters in two groups in T1 were all significantly decreased after anesthesia [(94. 8 ± 10. 03) mmHg vs (96. 9 ± 10. 1) mmHg, (57. 3 ± 7. 66) mmHg vs (55.4 ± 7. 03) mmHg,(69. 6 ± 7. 43) times/min vs (66. 3 ± 7. 03) times/min] (P ＜ 0. 05). The cardiovascular parameters at T0,T2, T3, T4 were all comparable with those in group B [SBP: (130 ± 11.6) mmHg, (125.6 ± 10. 43) mmHg,(120. 1 ± 12. 3)mmHg,(116. 8± 11.4)mmHg;DBP:(75.6 ±9. 12)mmHg,(76. 2 ±9. 8)mmHg,(73. 1 ±9. 2) mmHg, (71.6 ± 8.46) mmHg; HR: (88 ± 9. 12) times/min, (82. 9 ± 7.5) times/min, (81.9 ± 8.2)times/min, (79. 9 ± 7. 8) times/min] (P ＞ 0. 05) , which were significantly higher than those in group A [SBP: (146. 3 ± 14. 2) mmHg, (141.2 ± 10. 63) mmHg, (137. 2 ± 13.23) mmHg, (122. 9 ± 11.6) mmHg;DBP: (94. 9 ± 10. 6) mmHg, (84 ± 9.63) mmHg, (79. 9 ± 9) mmHg, (75.8 ± 8. 3) mmHg; HR: (102 ±10. 63) times/min, (97.6 ± 9. 23) times/min, (87. 7 ± 8. 2) times/min, (82. 1 ± 7.32) times/min] (P ＜0. 05). The parameters at T2, T3, T4 in group A were obviously higher than those group B (P ＜ 0. 05).Conclusions Cardiovascular response with double-lumen endobronchial intubation by sufentanil-induced was stronger than fentaty, sufentanil had more stable hemodynamic parameters and it worth to be usd in clinic.

Objective To investigate the effect of defecation modes on constipation and anxiety in patients with acute intracerebral hemorrhage.Methods Sixty three conscious patients with acute hintracerebral hemorrhage were recruited in this study.Twenty five patients chose bedside closestool for defecation according their own intention and 38 chose in bed defecation.The incidence of constipation was documented and the severity of anxiety was evaluated with Zung self-rating anxiety scale (SAS) at day 7,14,21 and 28 after admission in two groups.Results Patients using bedside closestool for defecation had significantly lower rate of constipation between day 14-28 after admission (x2 =63.0,P ＜ 0.01) and lower SAS scores at day14,21 and 28 after admission (t =6.7,7.7 and 9.8,all P ＜0.01) than those with in bed defecation.Conclusions The bedside mode of defecation may improve constipation and anxiety in patients with acute intracerebral hemorrhage.

Objective To investigate the effect of nursing ward rounds with doctors on cognition disease of primary caretakers of asthmatic children . Methods According to the admission sequence, 82 asthmatic patients and their primary caretakers were set as the control group, 76 asthmatic patients and their primary caretakers were set as the observation group. The control group adopted the traditional method of separating ward rounds between doctors and nurses. The observation group used the method of nursing ward rounds with doctors. Then their differences were compared in terms of cognition of disease and medical compliance of these two groups′primary caretakers. Result The observation group was significantly better than the control group in terms of the cognition of disease and medical compliance (P<0.01). Conclusions The method of nursing ward rounds with doctors can improve the cognition of disease and medical compliance of the asthmatic patients′ primary caretakers. It can effectively monitor and manage the asthmatic patients and control the disease recurrence. As effective ward rounds, it is worth in clinical application.

Objective: To explore the working methods of clinical pharmacists for improving the rationality of drug use through participating in individualized treatment practice for the patients with tumor.Methods: Clinical pharmacists participated in the individualized treatment of the patients with tumor, found out adverse drug interactions, adjusted dosage for the renal insufficiency patients, treated infection or pain and corrected inappropriate drug combination, etc.Results: Clinical pharmacists provided integrated pharmaceutical care and offered medical advice in accordance with the individualized information of patients, which improved the treatment effect and avoided potential adverse drug reactions or adverse events.Conclusion: Clinical pharmacists provide pharmaceutical care and participate in the performance of individualized treatment for cancer patients, which can effectively improve the level of drug treatment.

Objective To explore the continuous care needs of stroke patients when discharge,and analyze the related influenced factors.Methods One hundred and twenty cases with first stroke attack were selected,and their continuous care needs were investigated by methods of filling in questionnaires when discharged.The National Institutes of Health Stroke Scale and Barthel Index were applied to assess the severity of acute stroke and their ability of daily life when cases were admitted and discharged,respectively.We investigated the continuous care needs of stroke patients,and analyzed the relationship of that with the severity of acute stroke and their ability of daily life.Results The top five continuous care needs were knowledge of stroke,safety administration,methods of rehabilitation,self control and monitoring blood pressure,and diet direction.Those ratios of needs ranged from 87.25%to 94.12%.The score of continuous care needs had a positive relationship with that of NIHSS(r=0.271,<0.05),and had a negative relationship with that of BI both at the time of discharge(r=-0.226,<0.05).Conclusion The various continuous care needs are very common in patients with first stroke attack for varied reasons.More serious the neurological dysfunction and lower ability of daily life,higher the level of needs for continuous care.

Objective　To observe the curative effect and sid e effect of the gastrokinetic agent mosapride citrate by RCT. Methods　 42 cases of functional dyspepsia (FD) were divided into two groups rando mly, the group of mosapride(21 cases):orally administrated mosapride, 5mg, t.i.d for 4 weeks, and the control (21 cases):orally administrated domperidone, 5mg, t.i.d for 4 weeks. Symptoms and side effects were recorded before and at d 14, d 28 after administration of the medicines according to GCP and double blind pri ciple. Gastric empting test was also carried out in randomly selected patients. Results　Mosapride and domperidone were significantly effective on alleviating symptoms of the patient with FD. In mosapride treated group the half emptying time was shortened and the 120 min remain rate was reduced. No sid e effect was found. Conclusion　These results suggest that mosa pride 5 mg t.i.d. is effective and safe on alleviating symptoms of patients with FD and improving the ga stric empting time.

Objective To measure hepatic blood flow of the normal liver and cirrhotic liver with hepatocellular carcinoma using multi-slice spiral CT(MSCT),and to evaluate the feasibility of the quantitative judgement of classification of liver cirrhosis with CT perfusion imaging.Methods CT dynamic perfusion imaging was performed in 53 subjects,including 32 patients of liver cirrhosis with hepatocellular carcinoma and 21 patients without liver disease(control subjects).The patients of liver cirrhosis with hepatocellular carcinoma were divided into three groups by CT morphologic classification :17 were classified as light liver cirrhosis group,8 as moderate group,7 as severe group.The parameters of CT perfusion included blood flow(BF),blood volume(BV),mean transit time(MTT),hepatic arterial fraction(HAF)and impulse residue function to(IRF To).The parameters were analyzed by the CT perfusion 3 software package(GE)with deconvolution method,and the correlation of the CT morphologic classification of liver cirrhosis with Child-Pugh functional classification was further evaluated.100 g-1,(17.81±6.59)ml/100 g,(9.52±3.08)s,0.20±0.08 and(4.38±2.35)s,respectively,while 0.27±0. 09 and (4. 14±2. 16)s, respectively. The mean BF, BV and HAF between normal livers and liver cirrhosis were statistically significant (P＜0. 05), and there were significant statistical differences in BF, BV and HAF among light, moderate and severe liver cirrhosis (P＜0. 05). The CT morphologic classification of liver cirrhosis was correlated positively with Child-Pugh classification (r=0. 935, P=0. 001 ). Conclusions Hepatic perfusion with MSCT can reflect the change of blood flow of cirrhotic liver, and MSCT perfusion can quantitatively evaluate the liver cirrhosis degree of patients with hepatocellular carcinoma.

Objective To assess the reflectance confocal microscopic features of childhood lichen planus (LP),and to evaluate the performance of reflectance confocal microscopy (RCM) in the diagnosis of childhood LP.Methods RCM was performed for imaging of lesions in 35 children with LP.Then,biopsies were carried out at the same sites followed by histopathological examination.A comparison was conducted between confocal microscopic and histopathological findings.All the 35 cases were diagnosed based on clinical manifestations and histopathological findings.Results RCM imaging of lesions in the 35 cases showed cellular edema forming lowly reflective areas in the epidermis,sharp transition between the granular and spinous layers,and infiltration of moderately reflective inflammatory cells,which corresponded to wedge-shaped thickening of the granular layer on pathological examination.The dermo-epidermal junction was unclear,and dermal papillary rings were obscure or absent with infiltration of inflammatory cells arranged in lamelliform structures around the dermo-epidermal junction,which corresponded to interface dermatitis on histopathological examination.A band-like infiltration of inflammatory cells,including big,highly reflective oval or stelliform pigmentophages and small,moderately reflective round lymphocytes,was observed in the dermis,and the thickness of infiltration was measurable.Dilated blood vessels were longitudinally distributed in the papillary dermis with perivascular infiltration of inflammatory cells and pigmentophages.RCM images were highly consistent with histopathological findings in these patients.Conclusion RCM,as a real-time non-invasive imaging technique,can serve as an auxiliary examination method for the diagnosis of childhood LP.

Objective To evaluate the immune response triggered by an in-house constructed hu-man metapneumovirus multi-epitope antigen ( MEA) in a mouse model .Methods Female SPF BALB/c mice at age 4-6 weeks were used in the study and divided into 7 groups.Mice in the five groups including MEA+oligodeoxynucleotides containing CpG motifs ( CpG ODN) intraperitoneal injection ( i.p.) treatment group, MEA+Alum i.p.treatment group, MEA+Alum+CpG ODN i.p.treatment group, MEA+CpG ODN intranasal (i.n.) treatment group and MEA+Alum+CpG ODN i.n.treatment group were immunized three times on days 0, 14 and 21, and those in the other experimental group were immunized intramuscularly with MEA+Quickantibody5W on days 0 and 21.A control group without treatment was set up accordingly .All mice were sacrificed two weeks after the last immunization .Antibodies including IgG , IgG1, IgG2a and IgA in serum samples were detected by ELISA .MTS assay was performed to analyze the proliferation of lympho-cytes.The cytotoxicity of cytotoxic T lymphocytes (CTL) was measured by LDH assay.Flow cytometry was used to detect T lymphocyte subsets .The cytokines secreted by T helper cells ( Th1 and Th2) were analyzed with Bio-Rad Liquid Chips.Results High titers of IgG, IgG1 and IgG2a antibodies were produced in MEA treated mice except for those in intranasal treatment groups .Serum samples from three groups including the MEA+Alum i.p., MEA+Alum+CpG ODN i.p.and MEA+Quickantibody5W i.m.treatment groups were positive for IgA antibody .The highest titer of IgA antibody was detected in mice from the MEA+Alum+CpG ODN i.p.treatment group, which was 2.15×103.Compared with the control group, significantly enhanced proliferation of lymphocytes was observed in the MEA+Alum i.p., MEA+Alum+CpG ODN i.p.and MEA+Quickantibody5W i.m.treatment groups (P<0.05).Enhanced cytotoxic activities of CTL were observed in mice with ip.and i.m.treatments as compared with those in control group (P<0.05).The levels of CD4+/CD8+T cells were slightly increased in mice from the MEA+CpG ODN i.p., MEA+Alum+CpG ODN i.p. and MEA+Quickantibody5W i.m.treatment groups as compared with those in control group (P<0.05).In-creased secretion of IL-2, IFN-γand Th2-type cytokines including IL-4, IL-5 and IL-10 were detected in mice from the MEA+CpG ODN i.p.treatment group.The MEA+Alum i.p.treated mice showed a slightly increased secretion of IFN-γand significantly increased secretions of IL-4, IL-5 and IL-10.Significantly in-creased secretions of IFN-γ, IL-4, IL-5 and IL-10 were detected in mice from the MEA+Alum+CpG ODN i.p.treatment group.Significantly increased secretions of IFN-γ, IL-5, IL-10 and granulocyte-macrophage colony-stimulating factor (GM-CSF) were detected in mice from the MEA+Quickantibody5W i.m.treatment group.Conclusion MEA together with different adjuvants could stimulate high titers of specific antibodies , increase the proliferation of lymphocytes and enhance the cytotoxic activities of CTL .CpG ODN could bal-ance the Th1/Th2-mediated immune responses , and the balance could be enhanced when using CpG ODN in combination with Alum .A similar effect could be achieved by using the commercial adjuvant Quickanti -body5w.This study has paved the way for further investigation on the development of hMPV epitope vaccines and diagnostic reagents for hMPV as well as the epidemiological study of hMPV .