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 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 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 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 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 .

OBJECTIVE:To focus on the situation of clinical pharmacists particpating in the clinical drug treatment consulta-tion in China. METHODS:With the keywords of“clinical pharmacists”,“consultation”and others,retrieved from China Hospital Knowledge Database (CHKD),Wanfang Database and China BioMedical Literature Service System (SinoMed),the situation of clinical pharmacists particpating in the clinical drug treatment consultation in China was concluded and summarized. RESULTS:A total of 186 literatures were included,invloving 114 effective literatures. 2 606 cases were clinical pharmacists particpating in the clinical drug treatment consultation,2 257 cases were all or part of adoption of clinical pharmacists’suggestions,the execution lev-el of clinicians for clinical pharmacists’consultation suggestions reached 93.02%. After carrying out the clinical pharmacists’con-sultation suggestions,patients’condition improved or cured reached 2 290 cases,with the effective rate of 94.47%. CONCLU-SIONS:Clinical pharmacists participating in the clinical consultation has certain function,however,the working method and mode need to be further explored and standarized.

Objective To investigate the effect of radiotherapy combined with interventional therapy on the changes of vascular endothelial growth factor (VEGF) in patients with advanced cervical cancer.Methods 62 cases of cervical cancer collected in the first people’s hospital of jingzhou city during January 2009 to February 2014 were randomly divided into two groups.The patients in group A were treated with radiotherapy, and the patients in group B were treated with radiotherapy combined with interventional therapy.The level of vascular endothelial growth factor in two groups after treatment was measured by enzyme-linked immunoassay.Results The level of vascular endothelial growth factor of group A was ( 241.77 ±85.86 )μg/L, significantly higher than ( 124.66 ±65.86 )μg/L of group B.The level of vascular endothelial growth factor was related with cervical deterioration degree, tumor stage and lymph nodes metastasis (P<0.05),not with the patient’s age, and the size of the tumors.The level of vascular endothelial growth can reflect the clinical efficacy of patients after therapy (P<0.05).Conclusion Vascular endothelial growth factor level has a close relationship with the degree of deterioration of cervical cancer, tumor staging, lymph node metastasis and the curative effect after the interventional therapy.

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.

Background Constipation is a common complication after stroke, and the results investigated overseas showed the incidence was about 30% ～60%. The difference of results is so significant because the time investigated and the diagnosis criterion used are different. There are less relative report about risk factors of constipation and no report about the impact of constipation on pragnosis. The study is to investigate the incidence and risk factors of new-onset constipation after stroke in the patients with acute stroke and to evaluate the impact of new-onset constipation occurrence on the prognosis in the patients.Methods A prospective cohort study of new-onset constipation was performed to investigate 154 cases of acute stroke patients who were hospitalized from December 2003 to October 2004 in the department of neurology, the first Affiliated Hospital of Sun Yat-sen University. We recorded the demographics, medical history,stroke severity and medication used. National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI)and Modified Rankin Scale (MRS) were evaluated in the 1st week and 4th week after stroke to evaluate the neurological function and ability of an independent life. BI and MRS were recorded at the 12th week after stroke.Patients were then followed for the development of stroke, the event such as recurrence or death. Constipation was defined by Rome Ⅱ criteria.Results The incidence of new-onset constipation after stroke within 4 weeks was 55. 31%, and the highest risk was within seven days after onset of stroke. Cox regression showed that the incidence of constipation occurrence was strongly related to neurological functional status of patients in the 1st week assessed by BI and the transform of surrounding for defecation. In the 4th week and 12th week after stroke, the rates of poor prognosis in patients with constipation in middling state were both higher than patients without constipation, and the difference was statistically significant respectively(P ＜ 0. 01 ;P = 0. 012).Conclusions The new-onset constipation occurrence in acute stroke is very common and its main risk factor is functional status assessed by Barthel Index at the 1st week after onset and the transform of surrounding for defecation. The results indicate that the new-onset constipation occurrence after stroke has negative effects on the outcome of partial stroke patients.