Objective To discuss the radiological characteristics and improve the diagnostic ability of SARS in children. Methods The clinical data and X-ray findings of 35 SARS cases who hospitalized during Jan, 2003～Apr, 2003 were retrospectively analyzed. Results Chest X-ray features were as follows: massive consolidation (27 cases, 77.1%), pulmonary interstitial infiltration (6 cases, 17.1%), and mixed pattern (2 cases, 5.7%). There were two patients with emphysema, but no patient with lung abscess or pleural lesion. The radiological dynamic changes showed that the lesions of lung appeared early, the severest period was between the fifth day and the seventh day, the X-ray findings were not consistent with physical sign, and the absorption of lesion was slower than the clinical process. Conclusion There are some certain radiographic characteristic in children with SARS. A correct diagnosis can be made by closely combining the X-ray findings with clinical and laboratory results.

Objective To collect the information about types and clinically-used materials for the dentures, and evaluate the current conditions and characteristics of prosthodontic treatment in Shanghai. Methods Three municipal public hospitals and two private commercial dental labs in Shanghai were served as sample units. The application information on fixed partial dentures, removable partial dentures and complete dentures from January 2005 to December 2007 was collected. The number of dentures in each sample unit, the total proportion of each type of dentures, and the proportion of each type of dentures in public hospitals or private labs were retrospectively analysed. Results From 2005 to 2007, the number of dentures increased by approximately 20% annually. The number of dentures made in private labs increased by 43.58% in 2005 to 2006 and 23.23% in 2006 to 2007.As to the types of dentures, fixed partial dentures constituted the largest proportion (74.49%-76.19% for public hospitals and more than 80% for private labs), while complete dentures accounted for the smallest proportion (5.07% to6.24% for public hospitals and 1.02% to 1.38% for private labs) . Conclusion With an ever-growing awareness of oral health, prosthodontics has been developing rapidly in Shanghai. The rapid increase trend of private dental clinics is noticeable. Fixed partial dentures constitute the largest proportion, while the proportion of complete denture gradually decreases year by year.

Objective To develop a set of indicators for measuring the performance of China's Healthcare Improvement Initiative.Methods Such methods as literature review,expert consultation and onsite preliminary experiment were used,to study and demonstrate the indicators,the evaluation framework,the weight,evaluation indicators,and evaluation standards.Results The final evaluation indicators for medical institutions included nine class-1 indicators,29 class-2 indicators,and 56 class-3 indicators;those for healthcare administrations included six class-1 indicators,nine class-2 indicators,and 13 class-3 indicators.Conclusions The system takes into full account the special nature of healthcare,and mission of the Initiative,as the well as the quality,safety,efficiency and equity of healthcare,to make the system scientific and operational.

Objective To investigate the efficacy of heated humidified high-flow nasal cannula (HHHFNC) as the primary means of respiratory support for preterm infants with mild or moderate respiratory distress syndrome (RDS).Methods Randomized controlled trials (RCTs) about HHHFNC and/or nasal continuous positive airway pressure (nCPAP) in preterm infants with RDS were searched in PubMed,EMBASE,Cochrane library,Chinese Journal Full-text Database (CJFD),Wanfang Data base,VIP Database and China Biology Medicine disc (CBM).Meta-analysis was conducted with Review Manager 5.2 software to compare HHHFNC and CPAP groups in the outcomes ofpreterm infants with RDS,which included initial support failure,nasal trauma,pre-discharge mortality and incidences of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) before discharge.Results Eight randomized trials,including 1 400 preterm infants with RDS were included.Results of the meta-analysis demonstrated that no significant difference in the percentage of initial support failure was observed between the two groups (RR=1.22,95％CI:0.94-1.59,P=0.13),and HHHFNC was associated with decreased risk for nasal trauma (RR=0.35,95％CI:0.24-0.52,P＜0.001).There was no significant difference in the incidence of death,BPD,PDA or gas leaking before discharge between the two groups.Conclusions HHHFNC is an efficient respiratory support for preterm infants (gestational age over 28 weeks) with mild or moderate RDS.

Objective:To construct an evaluation indicator system for the health management effects in high-risk stroke population.Methods:From March to May 2020, based on health ecology theory, social cognitive theory and knowledge, attitude/belief, practice theory, the first draft of the evaluation index system for health management effects of high-risk stroke groups was drawn up by literature review and group discussion. Through two rounds of Delphi expert consultation, the evaluation index system of health management effects of high-risk stroke groups was established, and the weight of each index was determined by analytic hierarchy process (AHP). A total of 22 experts were invited to participate in expert consultation. Twenty-two questionnaires were sent out in the first round, and 20 questionnaires were recovered, of which 20 were valid (90.9%). In the second round of correspondence, 20 questionnaires were sent out and 19 questionnaires were recovered, of which 19 were valid (95.0%).Results:The authority coefficients of the two rounds of expert consultation (Cr) was 0.933 and 0.937, respectively. The Kendall coordination coefficients W of importance in the second round was significantly higher than that in the first round (0.299 vs 0.172) ( P<0.001). The mean of importance score (Mj) of each index was 4.10-5.00, coefficient of variation (CV) was 0-0.235, and full mark ratio (Kj) was 0.26-1.00. Finally, an evaluation index system of the health management effects for high-risk stroke population was constructed, which included 3 first-level indicators (individual characteristics, behavior style, environmental support), 12 second-level indicators and 58 third-level indicators. Conclusions:The evaluation index system of the health management effects for high-risk stroke population is established in this study, which provides scientific quantitative indicators and evaluation tools. The enthusiasm, authority and coordination of consultation experts are strong, which indicates that the indicator system is feasible.

Objective:To prepare a phase-change lipid nanoparticle modified by tumor homing membrane-penetrating peptide (tLyP-1) and carrying paclitaxel (PTX) engineered by metal polyphenol network (TA-Fe 3+ ), and evaluate the therapeutic effects of tumor targeting, ultrasound/photoacoustic imaging and photothermal combined chemotherapy in vitro. Methods:Phase-change lipid nanoparticles (t-P@TFP) with TA-Fe 3+ engineered PTX mediated by tLyP-1 were prepared by solvent replacement method, thin film hydration method and double emulsification method. Its detection and characterization, in vitro targeting ability, photothermal conversion ability, in vitro photoacoustic and ultrasonic imaging ability, CCK-8 method, cell live and death double staining method and flow cytometry method were used to detect the safety of nanoparticles and the killing effects of different nanoparticles on 4T1 cells. Results:t-P@TFP nanoparticles were successfully prepared. Transmission electron microscopy showed that the nanoparticles were spherical with uniform shape and size, with a particle size of (209.8±1.56)nm and a potential of (-25.9±1.36)mV. Laser confocal scanning microscopy showed that t-P@TFP nanoparticles could gather around 4T1 cells in a targeted manner. It had an efficient photothermal conversion effect, and nanoparticles could quickly become microbubbles after being irradiated by near-infrared laser, which enhanced the in vitro ultrasonic imaging effect; The photoacoustic signal of nanoparticles increased with the increase of concentration. CCK-8 method, double staining of living and dead cells and flow cytometry showed that t-P@TFP combined photothermal chemotherapy had the best anti-tumor effect. Conclusions:t-P@TFP nanoparticles are successfully prepared. The nanoparticles have good targeting ability for photoacoustic and ultrasonic imaging and have good photothermal effect, killing breast cancer cells, which is expected to realize the integration of diagnosis and treatment.

OBJECTIVETo study the effects of high frequency oscillatory ventilation (HFOV) with different position on oxygenation and hemodynamics of dogs with severe smoke inhalation injury.

METHODSAfter being treated with conventional mechanical ventilation, 12 dogs were inflicted with severe smoke inhalation injury and treated by HFOV for 30 min. They were divided into HFOV+prone positioning (PP) group and HFOV+supine positioning (SP) group according to the random number table, with 6 dogs in each group. They received HFOV with corresponding position for 8 hours respectively.

RESULTSof blood gas analysis (pH, PaO₂ and PaCO₂ levels), oxygen index (OI) and hemodynamic parameters [heart rate, mean arterial pressure (MAP), and cardiac output (CO)] were recorded or calculated before injury, immediately after injury, and at post ventilation hour (PVH) 2, 4, 6, 8. Data were processed with analysis of variance of repeated measurement, and LSD- t test.

RESULTS(1) At PVH 8, pH value of dogs in group HFOV+PP was significantly higher than that in group HFOV+SP (t = 3.0571, P < 0.05). Compared with those observed immediately after injury, except for group HFOV+SP at PVH 2 and 4 (with t values respectively 2.066 5 and 1.440 7, P values all above 0.05), the pH values in both groups at other treatment time points were decreased (with t values from 2.449 5 to 3.985 3, P < 0.05 or P < 0.01). At PVH 2, 4, 8, the PaO₂ levels in group HFOV+PP [(131 ± 26), (150 ± 40), (112 ± 30) mmHg, 1 mmHg = 0.133 kPa] were higher than those in group HFOV+SP [(81 ± 15), (96 ± 5), (83 ± 6) mmHg, with t values from 2.366 4 to 4.083 5, P < 0.05 or P < 0.01]. The PaO₂ levels in both groups from PVH 2 to PVH 8 were increased, compared with those observed immediately after injury [(55 ± 15) mmHg in group HFOV+SP and (48 ± 11) mmHg in group HFOV+PP, with t values from 2.473 6 to 7.2310, P < 0.05 or P < 0.01]. No statistically significant differences were observed in PaCO₂ level at each time point between two groups (with t values from 0.661 0 to 2.141 9, P values all above 0.05). No statistically significant differences were observed in PaCO₂ levels from PVH 2 to PVH 8 compared with those observed immediately after injury in both groups (with t values from 0.126 2 to 1.768 3, P values all above 0.05). (2) The OI values in group HFOV+SP were significantly higher than those in group HFOV+PP from PVH 2 to PVH 8 (with t values from 3.091 9 to 3.791 6, P < 0.05 or P < 0.01). The OI values in both groups from PVH 2 to PVH 8 were significantly decreased, compared with those observed immediately after injury (with t values from 2.702 0 to 5.969 3, P < 0.05 or P < 0.01). (3) At PVH 6 and PVH 8, heart rate in group HFOV+PP was significantly higher than that in group HFOV+SP (with t values respectively 4.255 9 and 4.765 9, P values both below 0.01). Compared with that observed immediately after injury, heart rate in group HFOV+PP was significantly decreased (with t values from 3.006 2 to 5.135 5, P < 0.05 or P < 0.01) except for PVH 2 (t = 1.938 2, P > 0.05). However, there was no statistical significant difference at each treatment time point in group HFOV+PP (with t values from 0.786 5 to 1.525 8, P values all above 0.05). There was no statistically significant difference in MAP between two groups at each time point (with t values from 0.045 8 to 1.783 4, P values all above 0.05). Compared with that observed immediately after injury, MAP in group HFOV+SP was significantly decreased at PVH 8 (t = 2.368 3, P < 0.05); MAP in group HFOV+PP was significantly decreased at PVH 2 (t = 3.580 1, P < 0.01). At PVH 2 and 4, the CO values in group HFOV+SP were significantly higher than those in group HFOV+PP (with t values respectively 2.310 3 and 4.526 5, P values both below 0.01). Except for group HFOV+SP at PVH 2 (t = 1.294 1, P > 0.05), CO values at other treatment time points in both groups were significantly lower than that observed immediately after injury (with t values from 2.247 0 to 4.067 8, P < 0.05 or P < 0.01).

CONCLUSIONSHFOV+ PP can improve oxygenation with no obvious CO₂ retention or adverse effect on hemodynamic parameters of dogs with severe smoke inhalation injury. Therefore, it is recommended for clinical application.

Animals ; Carbon Dioxide ; blood ; Disease Models, Animal ; Dogs ; Hemodynamics ; High-Frequency Ventilation ; Male ; Oxygen ; blood ; Prone Position ; Smoke Inhalation Injury ; physiopathology ; therapy ; Supine Position

Humans ; Severe Acute Respiratory Syndrome ; diagnosis ; therapy

Objective: To carry out the 4^th round of third-party evaluation on the implementation and effect of the 1^st year of the 2^nd Phase National Healthcare Improvement Initiative(abbreviated as Initiative)since 2015. Methods: The 4^th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations. Results: The 4^th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces(autonomous regions, municipalities directly under the Central Government)and Xinjiang Production and Construction Corps.Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1%, 96.7%for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved. Conclusions The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction.