Objective To explore the clinical value of IgE and IL-5 in diagnosis of mycoplasma pneumoniae children with bronchial asthma.Methods 40 mycoplasma pneumoniae infection children complicated with bronchial asthma were chosen as the observation group,the other 40 mycoplasma pneumoniae infection children without bronchial asthma were selected as the control group.All children were admitted to hospital,the next morning fasting blood was obtained to detect IgE and IL-5 levels.Results The serum total IgE level of observation group was (335.74 ±38.84) IU/ml,the level of IL-5 was (311.86 ± 35.28) ng/L,which were significantly higher than control group (P ＜0.05).Binary Logistic regression analysis showed that,serum IgE level and IL-5 level had statistically significant difference (P ＜ 0.05).Conclusion Mycoplasma pneumoniae infection in children with bronchial asthma,the IgE and IL-5 levels increased more obviously,and the levels of serum IgE and IL-5 were important risk factors of onset of children with Mycoplasma pneumoniae infection combined bronchial asthma.

Objective To investigate the application effect of montelukast in children with mild asthma.Methods 120 patients with mild asthma were randomly divided into the treatment group and the control group,the control group was given conventional therapy,the treatment group was treated with montelukast on the basis of the control group.Two groups were treated for 4 weeks as a course.Results The total effective rate of treatment group was 91.7％,which was significantly higher than 73.3％ in the control group (x2 =3.89,P ＜0.05).The daytime and nighttime asthma score in the treatment group were (0.13 ± 0.05)points,(0.12 ± 0.04)points,which were significantly lower than (1.13 ± 0.21) points,(0.43 ± 0.23) points in the control group.The symptom-free days was (17.43 ± 2.87) d,which was significantly longer than (9.34 ± 1.57) d in the control group(t =2.32,1.97,5.75,all P ＜ 0.05).IL-6,TNF-α,IgE in the treatment group after the treatment were (140.5 ± 6.4) ng/L,(40.1 ± 4.9) IU/ml,(105.6 ± 8.8) IU/ml,which were significantly lower than (189.3 ± 9.7) ng/L,(78.6 ± 7.5) 1U/ml,(155.4 ±10.5) IU/ml in the control group (t =11.97,8.75,13.56,all P ＜ 0.05).The incidence rate of adverse reaction in the treatment group was 13.3％ and 10％ in the control group,there was no significant ditterence(x2 =1.32,P ＞0.05).Conclusion Montelukast can significantly improve the inflammatory state in children with mild asthma,relieve clinical symptoms,improve the therapeutic effect,and has less adverse reactions.

Objective To analyze the clinicopathological characteristics,diagnosis,treatment outcomes and prognosis of patients with pancreatic neuroendocrine tumors (PanNETs).Methods The clinicopathological characteristcs and prognostic factors of 88 patients who were diagnosed with pancreatic neuroendocrine tumors by postoperative pathology were analyzed retrospectively.The data included age,sex,symptoms,tumor size,pathological grades,TNM staging,treatment and follow up.Results There were 28 males and 60 females.The ratio of male to female was 1 ∶ 2.1,with a mean age of 42 (range 8～75) years.Of the 88 PanNETs,74(84.1％) were nonfunctional tumors.Using the WHO 2000 pathological classification system,there were 35 well differentiated endocrine tumors (WDET),29 well differentiated endocrine carcinomas (WDEC),and 24 poorly differentiated endocrine carcinomas (PDEC).Using the 7th AJCC TNM staging system,23(26.1％),46(52.3％),13(14.8％) and 6 patients (6.8％) were diagnosed to have stage Ⅰ,Ⅱ,Ⅲ and Ⅳ,respectively.The overall 5-year survival rate was 72.0 ％.Univariable analysis revealed tumor size,histopathological grades,TNM staging and radical surgery were associated with prognosis.Multivariate analysis showed histopathological grades,TNM staging and radical surgery were independent risk factors of survival.Conclusions PanNETs are rare pancreatic neoplasms with high heterogeneity and low malignant potential.PanNETs have various clinical manifestations and the preoperative misdiagnosis rate is high.A definitive diagnosis depends on pathological examination.The new TNM and pathological classification systems have good predictive abilities on survival.The majority of patients who received radical surgery or surgical comprehensive therapy have good prognosis.

Objective To investigate the diagnosis and treatment of autoimmune pancreatitis (AIP).Methods The clinical data of 25 patients with AIP who were admitted to the Cancer Hospital of Tianjin Medical University between January 2009 and December 2013 were retrospectively analyzed.Patients received the test of serum γ-globulin and IgG4 and abdominal imaging examination.The revised HISORt or results of postoperative pathological examination were performed as diagnostic criteria.Patients who were unable to tolerate surgery were treated by oral prednisone.The focal masses were apparent in the pancreas by imaging examination,which cannot exclude the possibility of malignancy because of ambiguous pathologic characters of masses.Patients who received ineffective hormonal therapy and were able to tolerate surgery underwent surgery.All the patients were followed up by outpatient examination and telephone interview up to December 2014.Results Primary symptoms:jaundice was detected in 16 patients,obvious weight loss (weight loss ＞ 10％ standard body mass) in 4 patients,chronic diarrhea (duration of diarrhea ＞ 2 months or 2 weeks ＜ duration of intermittent diarrhea ＜ 4 weeks) in 3 patients and abdominal pain in 2 patients.Abnormal level of serum γ-globulin and increasing level of IgG4 were detected in 13 and 1 pateints.The results of imaging examinations showed that pancreatic masses,stenosis of bile duct and extrapancreactic organ involvement were detected in 19,6 and 11 patients.Of 25 patients with AIP,10 underwent conservative treatment without adverse reaction and 15 underwent surgical treatment,including 13 of 15 patients undergoing pancreaticoduodenectomy and 2 of 15 patients undergoing resection of the body and tail of the pancreas + splenectomy.The operation time,volume of intraoperative blood loss and postoperative recovery time of gastrointestinal function in 15 patients undergoing surgery were (271 ±59) minutes,(268 ± 109) mL and (3.8 ± 1.2)days.After operation,2 patients were complicated with abdominal infection and had remission of symptoms by symptomatic treatment,including 1 with pancreatic fistula and 1 with delayed gastric emptying.The duration of hospital stay of 15 patients undergoing surgery was (11.5 ± 2.9)days.The results of postoperative pathological examination showed that there were central acinar atrophy,extensive fibrosis,lymphoplasmacytic cell infiltration,nerve tissue surrounded by the plasma cell lymphoma and obstructive phlebitis.The absolute value of positive cells of IgG4 was more than 50 high power field and number of positive cells of IgG4 was more than positive cells of 40％ IgG.Twenty-five patients were followed up for a median time of 27 months (range,6-47months).Nineteen patients had remission of symptoms at month 6 after treatment with normal level of serum γ-globulin and IgG4 and without recurrence of pancreatic masses,including 7 receiving conservative treatment and 12 receiving surgical treatment.Conclusions The clinical signs of AIP are jaundice,abnormal serum γglobulin and pancreatic masses which are found by imaging examination.Surgery is safe and effective for the treatment of AIP,while surgical indications should be strictly followed because of the surgical trauma.

Objective:To summarize the surgical treatment experience of thoracic solitary fibrous tumors(SFTs),especially some spe-cial SFTs.Methods:Patients with SFTs in our department between January 2009 and May 2017 were recruited in this study and the clinical characteristics were summarized.Results:Twenty-one patients(11 men and 10 women)with an average age of 48.3 years were included.Tumor sizes ranged from 3 to 30 cm and 13 patients(61.9%)harbored pleural tumors,while 8 patients harbored tu-mors from other special thoracic sites (including 1 case of trachea SFT and 1 case of pulmonary SFT). Surgical treatment was per-formed in 19 patients,17 of whom underwent complete tumor resection and two patients underwent palliative resection.One patient did not undergo surgery and was lost to follow-up,and another patient who did not undergo surgery died because of a heart attack af-ter discharge.The 19 patients who underwent surgery were followed up for 1-96 months,3 patients of whom underwent reoperation for tumor recurrence at 12,26,and 72 months after surgery,respectively,while the remaining patients had no recurrence.Seven pa-tients(33.3%)were confirmed with malignancy after operation or biopsy.Conclusions:Thoracic SFTs are mainly from the pleura and the surgical results are favorable.Resection after recurrence can achieve favorable results.

Objective:To understand the function of diaphragm and analyze the clinical factors affecting the function of diaphragm by measuring twitch tracheal pressure (TwPtr) in patients with mechanical ventilation and in the weaning phase.Methods:Patients with more than 48 hours of invasive mechanical ventilation admitted to the department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2015 to March 2017 were enrolled. After the patient entered the weaning stage, TwPtr of patients was monitored by two-way non repetitive automatic respiratory trigger device, the effects of duration of mechanical ventilation, severe pulmonary infection, sedative application and chronic obstructive pulmonary disease (COPD) on weaning were analyzed.Results:A total of 62 patients were included, of which 45 were male and 17 were female. The average age was (66.8±11.7) years old. Twenty-three cases had severe pneumonia. The absolute value of TwPtr in severe pneumonia group was lower than that in non-severe pneumonia group [cmH 2O (1 cmH 2O = 0.098 kPa): 10.40±5.81 vs. 14.35±5.22, P = 0.021]. However, there was no significant difference in the duration of mechanical ventilation between the severe pneumonia group and non-severe pneumonia group [days: 26 (17, 43) vs. 15 (11, 36), P = 0.091]. In 62 patients with mechanical ventilation, there was a negative correlation between TwPtr and duration of mechanical ventilation ( r = 0.414, P = 0.002), there was also a negative correlation between the duration of mechanical ventilation and TwPtr after the assessment of diaphragm function ( r = 0.277, P = 0.039). There was a linear relationship between TwPtr and sedatives ( r = 0.220, P = 0.040), but there was no correlation between TwPtr and COPD ( r = -0.178, P = 0.166). Conclusions:For patients in the weaning stage of mechanical ventilation, severe pulmonary infection is one of the factors that affect the diaphragm dysfunction. There is a certain correlation between the diaphragm dysfunction and the use of sedatives.

Objective:To compare the difference of low-level assisted ventilation and T-piece method on respiratory mechanics of patients with invasive mechanical ventilation during spontaneous breathing trial (SBT) within 3 days before extubation.Methods:A retrospective observational study was conducted. Twenty-five patients with difficulty in weaning or delayed weaning from invasive mechanical ventilation who were admitted to department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2018 to June 2020, and were in stable condition and entered the weaning stage after more than 72 hours of invasive mechanical ventilation were studied. A total of 119 cases of respiratory mechanical indexes were collected, which were divided into the low-level assisted ventilation group and the T-piece group according to the ventilator method and parameters used during the data collection. The different ventilation modes related respiratory mechanics indexes such as the esophageal pressure (Pes), the gastric pressure (Pga), the transdiaphragmatic pressure (Pdi), the maximum Pdi (Pdimax), Pdi/Pdimax ratio, the esophageal pressure-time product (PTPes), the gastric pressure-time product (PTPga), the transdiaphragmatic pressure-time product (PTPdi), the diaphragmatic electromyography (EMGdi), the maximum diaphragmatic electromyography (EMGdimax), PTPdi/PTPes ratio, Pes/Pdi ratio, the inspiratory time (Ti), the expiratory time (Te) and the total time respiratory cycle (Ttot) at the end of monitoring were recorded and compared between the two groups.Results:Compared with the T-piece group, Pes, PTPes, PTPdi/PTPes ratio, Pes/Pdi ratio and Te were higher in low-level assisted ventilation group [Pes (cmH 2O, 1 cmH 2O = 0.098 kPa): 2.84 (-1.80, 5.83) vs. -0.94 (-8.50, 2.06), PTPes (cmH 2O·s·min -1): 1.87 (-2.50, 5.93) vs. -0.95 (-9.71, 2.56), PTPdi/PTPes ratio: 0.07 (-1.74, 1.65) vs. -1.82 (-4.15, -1.25), Pes/Pdi ratio: 0.17 (-0.43, 0.64) vs. -0.47 (-0.65, -0.11), Te (s): 1.65 (1.36, 2.18) vs. 1.33 (1.05, 1.75), all P < 0.05], there were no significant differences in Pga, Pdi, Pdimax, Pdi/Pdimax ratio, PTPga, PTPdi, EMGdi, EMGdimax, Ti and Ttot between the T-piece group and the low-level assisted pressure ventilation group [Pga (cmH 2O): 6.96 (3.54,7.60) vs. 7.74 (4.37, 11.30), Pdi (cmH 2O): 9.24 (4.58, 17.31) vs. 6.18 (2.98, 11.96), Pdimax (cmH 2O): 47.20 (20.60, 52.30) vs. 29.95 (21.50, 47.20), Pdi/Pdimax ratio: 0.25 (0.01, 0.34) vs. 0.25 (0.12, 0.41), PTPga (cmH 2O·s·min -1): 7.20 (2.54, 9.97) vs. 7.97 (5.74, 13.07), PTPdi (cmH 2O·s·min -1): 12.15 (2.95, 19.86) vs. 6.87 (2.50, 12.63), EMGdi (μV): 0.05 (0.03, 0.07) vs. 0.04 (0.02, 0.06), EMGdimax (μV): 0.07 (0.05, 0.09) vs. 0.07 (0.04, 0.09), Ti (s): 1.20 (0.95, 1.33) vs. 1.07 (0.95, 1.33), Ttot (s): 2.59 (2.22, 3.09) vs. 2.77 (2.35, 3.24), all P > 0.05]. Conclusions:When mechanically ventilated patients undergo SBT, the use of T-piece method increases the work of breathing compared with low-level assisted ventilation method. Therefore, long-term use of T-piece should be avoided during SBT.