Mechanicalventilation in newborns can be divided into invasive mechanical ventilation and non-invasive me-chanical ventilation. In order to reduce invasive ventilation-induced lung injury, more and more non-invasive ventilation patterns have been used clinically. Early application of nasal intermittent positive pressure ventilation (NIPPV) has become the main mode of non-invasive ventilation in many neonatal intensive care units (NICU). At the same time, the combination with selective pulmonary surfactant can reduce the incidence of chronic lung disease. This article reviews the use and prospect of non-invasive respiratory support modes which include continuous positive airway pressure (CPAP) and bi-level CPAP mode (BiPAP) such as SiPAP and NIPPV. Some modes which are in the research stage were also reviewed including synchronized nasal intermittent positive pressure ventilation, neurally adjusted ventilatory assist and non-invasive high-frequency oscillatory ventilation.

Objective To study the incidence of complications and the influence on early postnatal growth and development in very low birth weight infant(VLBWI) fed by breast milk.Methods From January 1, 2010 to December 31, 2013, 351 VLBWIs, who were appropriate for gestational age and hospitalized in Neonatal Intensive Care Unit of Tianjin Central Hospital of Obstetrics and Gynecology, were included in this study after exclusion of those with small for gestational age, large for gestational age, severe perinatal asphyxia at birth, withdrawing treatment or death, and mixed feeding infants.The group of formula-fed infants (FFI) were 168 VLBWI admitted between January 1, 2010 to December 31, 2011 and the group of breast milk-fed infants (BFI) were 183 VLBWI admitted between January 1, 2012 to December 31, 2013.For BFIs, we added human milk fortifier when oral intake reached 100 ml/kg.All subjects were followed up to 40 weeks of corrected gestational age.We compared the incidence of complications and infantile growth and development from birth to 30 days old between the two groups.Independent sample t-test and Chi-square test were applied for statistical analysis.Results The incidence of feeding intolerance in FFIs was higher than that of the BFIs [27.4％ (46/168) vs 15.3％ (28/183)], so was the incidence of necrotizing enterocolitis [14.9％ (25/168) vs 5.5％ (10/183)] (x2=7.683 and 8.651, both P ＜ 0.05).The incidence of nosocomial infection, retinopathy of prematurity and bronchopulmonary dysplasia in FFI and BFI were 34.5％ (58/168) vs 33.3％ (61/183), 15.5％ (26/168) vs 10.4％ (19/183), and 11.3％ (19/168) vs 9.3％ (17/183), but none of them showed significant difference between the two groups (x2=0.055, 2.033 and 0.388, all P ＞ 0.05).Significant difference was neither found in weight gain from birth to 30 days old [(304± 137) vs (308± 123) g], height growth [(2.6± 1.1) vs (2.7± 1.2) cm] and head circumference growth [(2.5± 1.0) vs (2.4±0.9) cm] between the FFIs and BFIs (t=0.106, 0.614 and 0.485, all P ＞ 0.05).Conclusion Breast feeding is beneficial to VLBWI in decreasing the incidence of feeding intolerance and necrotizing enterocolitis without adverse effect on their early postnatal growth and development.

Objective To understand the whole situation of neonatal resuscitation in high risk deliveries.Methods Totally,3 420 neonates born from high risk pregnant mothers in Tianjin Central Obstetrics and Gynecology Hospital from September 2013 to November 2014 were recruited and divided into four groups according the needs of resuscitation,including no resuscitation group (Group A),initial resuscitation group (Group B),initial resuscitation plus bag-and-mask or T-piece ventilation (positive pressure ventilation group,Group C),tracheal intubation and/or external chest compression and/or epinephrine administation (tracheal intubation group,Group D).Variance analysis,Chi-square test and Logistic regression analysis were applied to compare the differences of clinical conditions among these groups and to analyze risk factors of tracheal intubation requirement for extensive resuscitation.Results Among the 3 420 newborns,2 360(69.0％) were assigned to Group A,565 (16.5％) to Group B,408 (11.9％) to Group C and 87 (2.5％) to Group D.Statistical differences were shown in the gestational age [(35.5 ± 4.1),(33.0 ± 4.3) and (32.1 ± 4.8) weeks],birth weight [(2 593.8 ± 663.6),(2 063.3 ± 973.9) and (1 839.0 ± 977.9) g],and the incidence of multiple births [66(11.7％),65(15.9％) and 23(26.4％)],abruptio placentae [15(2.7％),35(8.6％) and 9(10.3％)],umbilical cord prolapse [0(0.0％),2(0.5％),and 10(11.5％)],abnormal fetal heart rate in labor [28(5.0％),45(11.0％) and 46(52.9％)],prolonged labor [36(6.4％),35(8.6％),and 20(23.0％)],meconium stained liquor [32(5.7％),0(0.0％),and 8(9.2％)],and congenital anomaly [8(1.4％),12(2.9％) and 7(8.0％)] among Group B,C and D (F or x2=233.188,105.050,14.535,19.934,91.434,149.366,26.525,28.602 and 13.765,all P ≤ 0.05).Multiple regression analysis revealed that gestational age ≤ 28 weeks (OR=1.290,95％ CI:1.167-1.425),abnormal fetal heart rate in labor (OR=1.350,95％CI:1.184-6.862) and meconium stained liquor (OR=1.397,95％CI:1.051-6.825) were independent risk factors for endotracheal intubation requirement (all P ≤ 0.05).Conclusions More newborns born from high risk mothers may need resuscitation,especially for those in small gestational age,with abnormal fetal heart rate during labor and meconium-stained liquor,thus close monitoring and management are necessary.

Objective:To understand the current situation of nurses′ implementation of oral care for elderly patients, so as to improve oral care practice standard and quality of oral care constantly.Methods:Using convenient sampling method, 190 nurses in the general ward of the General Hospital of Ningxia Medical University were selected as the research object from September to November 2020. The self-designed questionnaire was used to investigate and analyze the implementation of oral care among elderly patients.Results:A total of 190 questionnaires were collected in this survey, 84.74%(161/190) of the nurses reported that the hospital or department had oral care practice standard; The proportion of nurses who evaluated the oral status of elderly patients by the oral care assessment tool was 17.89%(34/190).Only 14.74%(28/190) and 16.84%(32/190) of the nurses could always set the expected rehabilitation goals and formulate the corresponding nursing plans for the oral problems of elderly patients, respectively. When the elderly patients had special oral problems, 26.32% (50/190) of the nurses would proactively communicate with doctors or search literature; the oral knowledge and oral hygiene habits of the elderly patients would be known to nurses accounting for 5.26% (10/190).Conclusions:Nurses′ cognition of oral care for elderly patients is at a low level on the structure, process and outcome.Relevant nursing managers still need to further improve the oral care operation norms and the training of nurses′ knowledge and skills, so as to continuously promote the oral health of elderly patients.

Objective:To evaluate the efficacy of radiofrequency thermocoagulation with CT-guided transforaminal puncture of intervertebral foramen through the superior margin of costotransverse joint for refractory post-herpetic neuralgia (PHN) in the upper thoracic segment.Methods:Thirty patients with PHN in the upper thoracic segment underwent radiofrequency thermocoagulation with CT-guided intervertebral foramen puncture. The visual analogue scale and self-rating depression scale were used to evaluate the degree of postoperative pain and mental state before and after treatment, and patients were followed by telephone or outpatient visit.Results:No infection occurred after radiofrequency thermocoagulation in all 31 PHN patients. After operation, all patients had hypoesthesia in skin of the original pain area, the pain was significantly relieved, and the mental state improved significantly. The VAS scores were 5.94±0.93, 2.74±0.69, 2.68±0.70 and 2.45±0.51 before and 3 hours, 1 week, 1 month after treatment( t=18.80, t=18.80, t=16.44, all P<0.01). The SDS scores were 58.6±12.2, 47.7±4.4, 48.1±4.8 before and 1 week, 1 month after treatment( t=6.75, t=5.86, all P<0.01). There were 13 patients with moderate or severe depression before treatment, while no patients with moderate or severe depression after treatment; only 5 patients had mild depression one month after surgery. There was no hypoxemia under nasal catheter during the operation. Intraoperative hypertension was found in 19 cases; after treatment with Urapidil (12.5 - 50.0 mg), the blood pressure was not higher by 20% of the basal blood pressure and<180/100 mmHg (1 mmHg=0.133 kPa). No pneumothorax, perioperative cardiovascular and cerebrovascular accidents occurred. Conclusion:Radiofrequency thermocoagulation with CT-guided intervertebral foramen puncture through the superior margin of costotransverse joint can effectively relieve refractory PHN of the upper thoracic segment with safety.

Objective:To explore the responsibilities of respiratory nurses in the management of chronic obstructive pulmonary disease (COPD) patient and the difficulties in disease management, so as to provide reference basis for formulating COPD management training strategies for respiratory nurses.Methods:Using phenomenological methodology, 14 nurses from the Department of Respiratory and Critical Care Medicine in the General Hospital of Ningxia Medical University and the First People′s Hospital of Yinchuan were interviewed in a personal semi-structured way from May to August 2021, and the data were sorted and analyzed according to Colaizzi 7-step analysis method.Results:Nurses′understanding of the responsibilities of COPD patient management could be summarized into five themes: dynamic monitoring and management of patients′ health, nursing decision-making of sudden changes in patients′ condition, implementation of patients′ out of hospital follow-up, promotion of improvement of patients′ self-management behavior, and cooperation among multidisciplinary team members. The difficult experience of nurses in the management of COPD patients abstracted five themes: lack of professional knowledge of COPD management, lack of clinical nursing decision-making authority, lack of human and financial support for follow-up, lack of communication skills with patients, and lack of multidisciplinary team formation in the hospital.Conclusions:Respiratory nurses have a clear understanding of the responsibilities of COPD patient management, but there are multiple difficulties in performing their responsibilities. We should pay attention to the responsibility positioning and difficulty support of nurses′ COPD management, and formulate targeted training strategies to promote the improvement of COPD nursing quality.

Objective To observe the clinical effect of CT-guided percutaneous puncture of stylomastoid foramen and radiofrequency ablation on primary hemifacial spasm. Methods Twenty-seven patients with primary hemifacial spasm, admitted to and accepted CT-guided percutaneous puncture of stylomastoid foramen and radiofrequency ablation in our hospital from August 2018 to May 2019, were chosen in our study. Clinical data and efficacy of the patients were retrospectively analyzed. Results All patients were punctured to the stylomastoid foramen precisely under the guidance of CT localization; 21 could detect facial muscle twitch with 0.1-0.5 mA current, and positive results were also found in 6 patients with 0.5 mA current after adjusting the position of the needle tip. After standard radio frequency ablation (mean 83.3 ℃ for 23.7 seconds), 26 patients had complete disappearance of facial spasm, but left grade II (n=18) or grade III (n=8) facial paralysis; one patient with disappearance of abnormal electromyographic response waveform as the end criterion only partially relieved, but no facial paralysis. No facial hematoma, intracranial hemorrhage, infection, or death occurred. Follow-up for 2-12 months showed no recurrence or aggravation of facial paralysis. Conclusion CT-guided percutaneous puncture of stylomastoid foramen by radio frequency ablation can effectively treat primary hemifacial spasm, but there will be mild facial paralysis.

【Objective】 To investigate the serum levels of homocysteine (HCY) and cystatin C (Cys-C) in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)associated renal injury, and to explore the diagnostic value of combined detection of HCY and Cys-C in ANCA-associated renal injury. 【Methods】 We selected 70 ANCA-positive patients with renal injury admitted to the Department of Nephrology in our hospital from January 2016 to January 2019. Another 48 patients with ANCA-positive but not complicated with renal injury were in simple ANCA positive group while 50 patients with physical examination who came to the hospital during the same period were in control group. Healthy patients served as the control group. By comparing the differences in the test results of different groups, the area under the curve (AUC) of each test index for ANCA-positive renal injury was determined, and the correlation and diagnostic value of combined detection of HCY and Cys-C for ANCA-related renal injury were calculated. 【Results】 The levels of HCY and Cys-C in the ANCA positive combined with renal injury group, the pure ANCA positive group, and the control group differed significantly (P<0.05). The positive rates of HCY and Cys-C in the two groups were significantly different (P<0.05). The sensitivity and specificity of HCY and Cys-C in combination for the diagnosis of ANCA-positive related renal injury were significantly higher than those of the above indicators alone (P<0.05). ROC curve results showed that HCY combined with Cys-C had a better diagnosis for patients with positive ANCA and associated renal injury and a higher correlation. 【Conclusion】 HCY combined with Cys-C is closely correlated to ANCA-related renal injury, and the combined detection has a positive effect on the diagnosis of patients with ANCA-positive related renal injury, and has guiding value for the treatment of patients.

Cancer cell membrane (CCM) derived nanotechnology functionalizes nanoparticles (NPs) to recognize homologous cells, exhibiting translational potential in accurate tumor therapy. However, these nanoplatforms are majorly generated from fixed cell lines and are typically evaluated in cell line-derived subcutaneous-xenografts (CDX), ignoring the tumor heterogeneity and differentiation from inter- and intra- individuals and microenvironments between heterotopic- and orthotopic-tumors, limiting the therapeutic efficiency of such nanoplatforms. Herein, various biomimetic nanoplatforms (CCM-modified gold@Carbon, i.e., Au@C-CCM) were fabricated by coating CCMs of head and neck squamous cell carcinoma (HNSCC) cell lines and patient-derived cells on the surface of Au@C NP. The generated Au@C-CCMs were evaluated on corresponding CDX, tongue orthotopic xenograft (TOX), immune-competent primary and distant tumor models, and patient-derived xenograft (PDX) models. The Au@C-CCM generates a photothermal conversion efficiency up to 44.2% for primary HNSCC therapy and induced immunotherapy to inhibit metastasis via photothermal therapy-induced immunogenic cell death. The homologous CCM endowed the nanoplatforms with optimal targeting properties for the highest therapeutic efficiency, far above those with mismatched CCMs, resulting in distinct tumor ablation and tumor growth inhibition in all four models. This work reinforces the feasibility of biomimetic NPs combining modular designed CMs and functional cores for customized treatment of HNSCC, can be further extended to other malignant tumors therapy.
Animals ; Humans ; Squamous Cell Carcinoma of Head and Neck/therapy* ; Heterografts ; Photothermal Therapy ; Biomimetics ; Disease Models, Animal ; Head and Neck Neoplasms/therapy* ; Cell Line, Tumor ; Tumor Microenvironment