Fiber bronchoscopy has been used in pediatric for decades,and has became the important diagnostic tools in pediatric respiratory diseases.with the improvement of fiber bronchoscope equipment and the advancement of operation technology,fiber bronchoscope has been expanded unceasingly in pediatric, especially in the critically ill children.As a common critical disease in pediatric,severe pneumonia is urgent, serious and high rate of mortality.As the effect of conventional antibiotic treatment is not ideal in current, while fiber bronchoscopy with the dual function of examination and treatment makes it use more and more widely in children with severe pneumonia.Fiber bronchoscopy can improve the effect of treatment in children with severe pneumonia,short the course of the disease,improve the prognosis of children,reduce the rate of mortality.

Objective To explore the potential risk of category Ⅱ fetal heart rate(FHR) tracing according to the latest electron-ic fetal monitoring tracings .Methods The prenatal fetal heart rate tracings in 400 parturients with hospitalized delivery in this hos-pital from November 2011 to October 2012 were classified by category .Among them ,the pregnancy outcomes were compared be-tween the category Ⅰ FHR tracings(control group) and category Ⅱ FHR tracings(observation group) .Results The case number of meconium-staining amniotic fluid ,cesarean rate ,hypamniony and umbilical cord abnormality was significantly higher than that of the control group with statistical difference between the two groups (P<0 .05);the case number of neonatal asphyxia ,aging of pla-centa and neonatal death had no statistical difference between the two groups (P>0 .05);among the groups with various fetal heart monitoring abnormalities ,the rate of meconium-staining amniotic fluid in the decreased variation group was significantly higher than that in the fetal tachycardia group ,the difference showing statistical significance (P<0 .05);the rate of meconium-staining amniotic fluid in the fetal tachycardia group was significantly higher than that in the prolonged acceleration and ineffective acceleration group with statistical difference (P< 0 .05);the pregnant outcomes had no statistical differences among the other groups .Conclusion Compared with the category Ⅰ FHR tracings ,the category Ⅱ FHR tracings indicate a potential risk to the fetus ,which need to strengthen the prenatal and intrapartum fetal monitoring .

In the course of patient care, it may occur that doctors and patients have unbalanced grasp of medical information, which directly affects the building of doctor-patient trust and patients'evaluation of medical effects. Instrumental methods for building and enhancing doctor-patient trust include mainly the use of relative networks or the presentation of favors while affective methods chiefly include mutual respect and the promotion of friendly relations via communication. The rebuilding of doctor-patient relationship of trust, however, can be approached from the following seven perspectives: ①establishing and perfecting the system of rendering information accessible to the public; ②raising the managers'awareness of trust; ③building an atmosphere of trust acceptable to the entire staff members; ④accepting the restraint of standards and morality; ⑤rendering information accessible to the public in a realistic way; ⑥taking the initiative in clearing up doubts and performing the obligation of notification; and ⑦perfecting the mechanisms of supervision and reward.

Objective To investigate the changes of cardiac aldosterone and mineralocorticoid receptor (MR) in Sprague-dawley (SD) rats with chronic heart failure (CHF) induced by isoproterenol (ISO). Methods The SD rats were randomly divided into CHF group (n=9) and normal control(NC) group (n=10). The experimental CHF group was induced by subcutaneous injection of ISO, and the NC group received same dose injection of sodium chloride. The heart function was evaluated with both echocardiography and hemodynamics. The contents of aldosterone in both plasma and heart were assessed by radioimmunoassay. The expression of MR was measured by Western blot and immunohistochemistry staining. Results Compared with NC group, the heart function was decreased in CHF group, the left ventricular ejection fraction was (38.8%±4.0%) in CHF and(79. 4%±4.6%), in NC group. The maximal rate of increase of ventricular pressure (+dp/dtmax) was (7164.4±502.6) mm Hg(1 mm Hg=0.133 kPa)/s in CHF and (10199.5±462.9) mm Hg/s in NC group (both P＜0. 01 ). The contents of aldosterone both in plasma and heart were higher in CHF group than in NC group [(0.63±0.06)μg/L vs. (0.3±0.07) μg/L, (0.41±0.05) μg/kgvs. (0.08±0.01)μg/kg, both P＜0. 01]. The MR expression was increased in CHF group versus in NC group (P＜0.01). Conclusions The heart function is decreased in rats with CHF induced by ISO, which is similar to dilated cardiomyopathy. The higher levels of aldosterone both in circulation and in heart as and well as MR expression upregulation in heart may play important roles in the pathogenesis of CHF induced by ISO.

Background: Chronic obstructive pulmonary disease (COPD) is an important clinical disease, and its global prevalence and mortality rates are high. It is meaningful to investigate the efficacy of integrative respiratory rehabilitation training in quality of life and respiratory physiology of COPD patients in stable phase. Objective: To observe the efficacy of integrative respiratory rehabilitation training in exercise ability and quality of life of COPD patients in stable phase. Design, setting, participants and interventions: Eighty outpatients and inpatients with COPD from Department of Respiratory Medicine, Taihe Hospital, Yunyang Medical College were randomly divided into 4 groups, with 20 patients in each group. The patients in group A only received drug therapy, the patients in group B received traditional qigong training, the patients in group C received modern rehabilitation training, and the patients in group D received integrative respiratory rehabilitation training. Main outcome measures: Chronic respiratory questionnaire (CRQ), 6-minute walking distance and Borg score in each group were examined before and after one-, three-, and six-month and one-year treatment. Results: The 6-minute walking distance, Borg score and CRQ score in group A had no significant changes after treatment (P>0.05). After one-month treatment, there were no significant differences in 6-minute walking distance and Borg score in groups B, C and D as compared with those before treatment (P<0.05). After three-month treatment, 6-minute walking distance and Borg score were improved in groups B, C and D (P<0.05). After six-month and one-year treatment, 6-minute walking distance, Borg score and CRQ score in groups B, C and D were improved as compared with those before treatment (P<0.05), and there were significant differences between group D and any of groups A, B and C (P<0.05). Conclusion: Modern rehabilitation training, traditional qigong training and integrative respiratory rehabilitation training programs all can improve the quality of life and exercise ability of COPD patients, and integrative respiratory rehabilitation training program is better than modern rehabilitation training and traditional qigong training programs. The efficacy of respiratory rehabilitation training is time-dependent, and need long-time adherence to the therapy.

Objective:To study the short-term effects,toxic side effects and immune function of Aidi injection adjuvant GP methods chemotherapy for advanced non-small cell lung cancer(NSCLC).Methods:130 patients with advanced NSCLC were divided into study group and the control group according to treatment methods.The study group were given Aidi injection +GP,and the control group only treated with GP.The short-term effects,toxic side effects gradeⅢ-Ⅳand immune function changes were compared between the two groups.Results:The overall response rate was 40.28%in study group,higher than 37.93% in control group(P>0.05).The two groups showed differences in the rates of leucocyte decrease,gastrointestinal reaction and platelets decrease(P<0.05).The levels of CD4,CD8 and CD4/CD8 didn′t changed obviously in study group(P>0.05),while in the control group the levels of CD4,CD8 and CD4/CD8 changed more significantly than before(P<0.05).The two groups also produced differences in CD4,CD8 and CD4/CD8 after treatment( P<0.05 ) .Conclusion: The short-term effects of Aidi injection adjuvant GP chemotherapy regimen for advanced NSCLC is similar to only GP chemotherapy,but it can obviously reduce the incidence of toxic side effects and prevent the immune func-tion.

Objective To discuss the signiifcance of serum albumin level in assessing severity, progress and prognosis of sepsis in children. Methods The clinical data of 212 patients diagnosed with sepsis admitted to PICU from February 2010 to July 2010 were retrospectively analyzed, and 52 patients had severe sepsis and 31 patients had septic shock. Meanwhile, 110 non-sepsis patients were selected as controls. The relationships of hypoalbuminemia with pediatric critical illness score (PCIS), pediatric risk of mortality III (PRISM III) and prognosis were evaluated, and the change of albumin level in patients with dif-ferent severity of sepsis was observed. Relative factors analysis of albumin level ≤25 g/L was performed. Results As the serum albumin level was decreased, the PCIS was signiifcantly decreased while the PRISM III was increased (P<0.01). The se-rum albumin level was signiifcantly different among children with septic shock, severe sepsis and sepsis and controls (F=13.938, P=0.000). The results of relative factors analysis showed that sepsis children with an albumin level≤25 g/L had more organ failures, higher mortality, longer hospital and PICU stay and more likelihood for ventilator support (P<0.01). Lower albumin levels were accompanied with lower rates of recovery and improvement but higher mortality (rs=-0.161, P=0.000). Conclusions Hypoalbuminemia can be used as indirect indicator for severity of infection. The albumin level≤25 g/L indicated the severity of illness and prognosis in children with sepsis.

Objective To investigate the efficacy of ablative fractionated erbium: yttrium aluminum garnet (Er: YAG) laser in facial acne scars and enlarged pores. Methods Forty-one patients with mild to moderate pitted acne scars and 23 patients with enlarged pores were treated with 81 (9 × 9) bits of facula for 3 to 5 sessions at an interval of 1 month. For acne scars, the pulse duration was medium to long, energy at 800 to 1200 mJ, and number of stacking passes 4 to 8; for enlarged pores, the pulse duration was medium, energy at 800 to 1000 mJ and number of stacking passes 2 to 4. The clinical improvement was evaluated by 2 blinded dermatologists. Meanwhile, the satisfaction rate was self-assessed by patients. Three-dimensional (3D) micro-topography imaging system was used to evaluate the improvement in surface roughness. Results The efficacy reached 82.93% and 86.96% for ache scars and enlarged pores, respectively. The satisfaction rate was 88.80% and 91.30% in patients with ache scars and those with enlarged pores, respectively. After treatment, the Ra and Rz values, as the indicators of roughness, decreased by 18.74% and 21.01%, individually (P < 0.001) in 11 patients including 6 with acne scars and 5 with enlarged pores. Conclusion Ablative fractionated Er:YAG laser can efficiently resurface pitted ache scars and shrink enlarged pores.

Objective To investigate the antibiotic resistance and the phenotype and genotype of metallo-β-lactamase in clinical isolates Chryseobacterium spp.Methods The MIC of 18 antibiotics in 50 Chryseobacterium spp.isolates was detected by agar dilution method.Phenotype of metallo-β-laetamase was detected by three-disc synergy test and modified three dimension test.Polymerase chain reaction(PCR)detection for metallo-β-lactamase gene was conducted for all isolates,and then the DNA sequence analysis was conducted for the PCR products which are positive for metallo-β-lactamase and identify genotype.conjugation experiment was used to study the transmission of metallo-β-lactamase encoding gene.pIs of β-lactamase was measured by isoelectric focusing assay. Results The antibiotic resistance of 50 clinical isolates of Chryseobacterium spp.against imipenem,Meropenem was 82.0%and 82.0%respectively.However,these isolated had high resistance to gatifloxacin.levofloxacin and rifampin compared with other antibiotics.Phenotype detection showed 33 isolated produced metallo-β-lactamase using three-disc synergy test and modified three dimension test,and the incidence of producing metallo-β-lactamase was 66.0%.Twenty isolateds producing Chryseobacterium indologenes were detected to have metallo-β-laetamase genotype by PCR amplification,among them 9 isolates containing blaIND-1 genotype and 10 isolateds containing blaIND-2 genotype.Strain CI-25 was identified to represent blaIND-LIKE genotype.Fourteen Chryseobacterium meningosepticum were detected to have metallo-β-lactamase genotype by PCR amplification,including 15 blaB and 2 blaGOB. The number of strain producing blaB1,blaB2,blaB3 and blaB11 in Chryseobacterium meningosepticum was 2,5,4 and 4,respectively. Conjugation experiments showed that metallo-β-lactamase encoding gene cannot be transfered. The extracted plasmid of 4 strains did not harbor metallo-β-lactamase gene.Strain C-5 was proved to have blaIND-1 gene,but its phenotype and IEF of metallo-β-lactamase was negative.Conclusions Chryseobacterium spp.had high frequency of multidrug resistance and high incidence for producing metallo-β-lactamase,and thus it was difficult to be treated.The gene of metallo-β-lactamase located on chromosome of Chryseobacterium spp.and cannot be transfered.There was negative or low lever of expression of blaIND-1.

Objective To id scuss the role and safety of fiberoptic bronchoscopy for diagnosing and treating respiratory dsi ease in PICU.Methods A total of 95 eil gible children with respri atory diseases admi-tted ni PICU of Hu′nan Prvo inec Children′s Hospital were enroll ed in this retrospectvi e study from January 2013t o December 2013, and the efficacy and complications of fiberoptic bronchoscopy were assessed.Results A total of 95 children underwented bronchoscopy 112 timest, he most common of microscopic examination resutl s was tracheal bronchitis ( 62.1%) , followed by congenital airway abnormality ( 21.1%); 58 times (56.9%) showed becteria positive in 102 times lavage and sputum culture results, including 16 times (27.6%) of Klebsiella pneumoniae bacteria,12 times(20.7%) of Acinetobacter baumannii.After under-wenting bronchoscopy and lavage wash,blood gas analysis of pH value,PaO2 ,PaCO2 ,SaO2 had significant improvement than before( P<0.05 ) , respiratory rate had improved than before ( P<0.05 ) , little effect in heart rate(P>0.05).The inrt aopear tive and postoperative transient comlp ications were obserev d in 38 times (33.9%).Conclusion The appil cation of fiberoptic bronchoscopy for diagnosing and ter ating disease in PICU has a cetr ia n value, its vo erall safety is reliable.