Objective:To investigate the efficacy of sequential mechanical ventilation based on pulmonary infection control window in the treatment of severe pneumonia complicated by respiratory failure in children.Methods:A total of 300 children with pneumonia complicated with respiratory failure who received mechanical ventilation in Jiande Second People's Hospital from January 2016 to December 2017 were included in this study. They were assigned to receive either conventional continuous invasive mechanical ventilation (control group, n = 150) or invasive- noninvasive sequential mechanical ventilation based on pulmonary infection control window (observation group, n = 150) according to the order of admission. Invasive ventilation time, intensive care unit stay, expiratory time, inspiratory time and time to peak tidal expiratory flow, blood gas analysis indexes, incidence of ventilator-associated pneumonia, pulmonary hemorrhage and pneumothorax were compared between the two groups. Results:After treatment, PaO 2 value [(97.31 ± 6.39) mmHg vs. (86.24 ± 10.92) mmHg], PaO 2/FiO 2 [(280.78 ± 40.12) mmHg vs. (210.75 ± 40.11) mmHg], pH value [(7.44 ± 0.01) vs. (7.27 ± 0.04)], expiratory time [(1.18 ± 0.12) s vs. (0.89 ± 0.11) s], inspiratory time [(0.79 ± 0.09) s vs. (0.39 ± 0.09) s], time to peak tidal expiratory flow [(0.41 ± 0.02) s vs. (0.21 ± 0.03) s] and the rate of successful weaning (96.67% vs. 78.67%) in the observation were significantly higher than those in the control group ( t = 13.287, 130.381, 9.231, 6.353, 9.793, 10.131, χ2 = 22.475, all P < 0.001). After treatment, PaCO 2 value [(39.76 ± 5.49) mmHg vs. (46.72 ± 7.51) mmHg], invasive ventilation time [(8.11 ± 3.21) d vs. (17.24 ± 4.52) d], intensive care unit stay [(15.03 ± 2.94) d vs. (21.94 ± 4.29) d], the proportion of children having ventilator-associated pneumonia (1.33% vs. 6.67%), the proportion of children having pulmonary hemorrhage (0.00% vs. 2.67%) and the proportion of children having pneumothorax (2.67% vs. 8.00%) in the observation group were significantly higher than those in the control group ( t = 14.798, 10.136, 9.962, χ2 = 5.556, 4.054, 4.225, all P < 0.05). Conclusion:Sequential mechanical ventilation based on pulmonary infection control window for the treatment of severe pneumonia complicated by respiratory failure in children can achieve good curative effects through greatly improving blood gas index and is highly safe.

Objective To investigate the relationship between C-C chemokinereceptor type 2 (CCR2) and p38 mitogen-activated protein kinase (p38MAPK) signaling pathway in the dorsal root ganglion of rats and further clarify the mechanism of inflammatory pain.Methods Sevemy-two female Sprague-Dawley rats,weighing 150-180 g,aged 3-4 months,were randomly divided into 3 groups (n =24 each) using a random number table:control group (group C),inflammatory pain group (IP group) and CCR2 inhibitor RS102895 group (group RS).Inflammatory pain was induced by subcutaneous injection of Freund's adjuvant 100μl into the plantar surface of the right hindpaw.RS102895 20 mg/kg was injected subcutaneously once a day for 7 consecutive days in addition to Freund's adjuvant in group RS.Mechanical paw withdrawal threshold (MWT) was measured before injection and at 1,3,5 and 7 days after injection.At 3,5 and 7 days after injection,8 rats in each group were sacrificed and the dorsal root ganglions were removed for determination of the expression of CCR2 and phosphor-p38MAPK (p-p38MAPK) (by immuno-histochemical staining),and CCR2 and p38MAPK mRNA (using fluorescent quantitative PCR).Immuno-histochemical staining was scored.Results Compared with group C,MWT was significantly decreased after injection,the number of p-p38MAPK positive neurons and immuno-histochemical staining score were increased,and CCR2 and p38MAPK mRNA expression was up-regulated in IP and RS groups.Compared with group IP,MWT was significantly increased after injection,the number of p-p38MAPK positive neurons and immuno-histochemical staining score were decreased,and CCR2 and p3gMAPK mRNAexpression was down-regulated in RS group.Conclusion CCR2 in the dorsal root ganglion is involved in the development of inflammato pain possibility through activating p38MAPK signaling pathway in rats.

Objective To provide data evidence for early diagnosis of bone and joint damage derived from brucellosis by analyzing its clinical and imaging characteristics.Methods Patients with brucellosis accepted in Ji'nan Infectious Disease Hospital form December 2013 to December 2014 were selected.Patients with bone and joint damage confirmed through imaging were further studied,their epidemiological and clinical characters,CT and MRI characteristics,treatment and outcome were summarized.Results Total of 97.8％ (45/46) patients had a clear contact history,most of them worked in poultry farming,taking up to 67.4％ (31/46).July to October was its peak time for attacking,taking up to 58.7％ (27/46).The clinical manifestations of patients were joint pain,swelling and activities obstacles.In the CT images,there was obvious bony destruction,characterized by multiple round or large areas of low density insect damage sample spots.There was osteosclerotic bone lesions or osteophyte formatted in edge.The paravertebral soft tissue was swelling,and the vertebral body deformation was not obvious,and there was vertebra small joint damage occasionally.In the MRI images,there was vertebral ligaments damage,or soft tissue damage,or osteoproliferation at the edge of the vertebral bodies.There was abnormal signal T1W1 or T2W1 signal,and FS-T1W1 showed high signal,while FS-T2W1 showed slightly high signal.The diagnosis rate of CT,MRI and CT combined MRI for bone and joint damage derived from brucellosis was 76.1％ (35/46),84.8％ (39/46) and 91.3％ (42/46),respectively.The main therapeutic drugs were doxycycline and rifampicin,and the clinical effective rate was 91.3％ (42/46).Conclusion The epidemiological characters,CT and MRI characteristics of bone and joint damage derived from brucellosis have certain representativeness,and the comprehensive investigation is beneficial for clinical diagnosis.

Objective To investigate the clinical value of the probe melting curve analysis‐based PCR assay for the detection of three types of αT .Methods A total of 149 blood and prenatal archival DNA samples (6 of which were amniotic fluid samples)with three knownαT genes ,which included 63 carriers with Hb CS ,22 cases with Hb QS ,43 individuals with Hb WS and 1 double heter‐ozygote with Hb CS and Hb WS) as well as 20 samples with normalα‐globin gene sequence that had been confirmed by RBD com‐bined with DNA sequencing were selected to test the specificity of probe melting curve analysis by blind analysis .Results The probe melting curve analysis accurately detected 100 of the DNA samples previously characterized by S RBD combined with DNA sequencing .Conclusion Probe melting curve analysis‐based PCR assay for the detection ofαT is featured with rapidity and accuracy and can be applied to clinical and prenatal diagnosis .

Objective: To investigate the nutritional status and its influencing factors among primary and middle school students in Yunfu City, Guangdong Province, so as to provide the basis for improving nutrition and health strategies for students. Methods: Primary and middle school students from 26 schools in 5 counties (cities, districts) of Yunfu City were selected in 2022 through multi-stage stratified cluster random sampling method. Demographic information, dietary and exercise behaviors were collected using questionnaire surveys, and the prevalence of malnutrition were analyzed. Factors affecting malnutrition was evaluated using a multinomial logistic regression model. Results: A total of 7 213 students were surveyed, including 3 881 boys (53.81%) and 3 332 girls (46.19%), and had a median age of 13.50 (interquartile range, 4.00) years. There were 2 667 primary school students (36.97%), 2 662 middle school students (36.91%) and 1 884 high school students (26.12%). There were 1 938 students suffered from malnutrition, with a detection rate of 26.87%. The detection rates for undernutrition, overweight and obesity were 11.66%, 9.75% and 5.46%, respectively. Multinomial logistic regression analysis showed that gender (boy, OR=2.227, 95%CI: 1.905-2.603), studying phase (primary school, OR=1.528, 95%CI: 1.239-1.884), ≥60 min/d of moderate/high-intensity exercise (0-1 d/week, OR=1.422, 95%CI: 1.153-1.753; 2-4 d/week, OR=1.280, 95%CI: 1.047-1.564) and frequency of having physical education (1-2 classes/week, OR=1.732, 95%CI: 1.084-2.767; 3-4 classes/week, OR=1.662, 95%CI: 1.026-2.693) were the influencing factors for undernutrition; gender (boy, OR=1.956, 95%CI: 1.656-2.311), frequency of sugary beverage intake (0 time/d, OR=0.721, 95%CI: 0.528-0.984) and frequency of having physical education (0 class/week, OR=2.087, 95%CI: 1.151-3.784; 1-2 classes/week, OR=1.644, 95%CI: 1.044-2.590; 3-4 classes/week, OR=1.685, 95%CI: 1.051-2.703) were the influencing factors for overweight; gender (boy, OR=2.459, 95%CI: 1.964-3.078) was the influencing factor for obesity among students. Conclusions Undernutrition, overweight and obesity coexist in primary and middle school students in Yunfu City. Gender, school phase, frequency of sugary beverage intake and frequency of having physical education are associated with malnutrition among primary and middle school students.

Objective To investigate the clinical value of noninvasive monitoring technique in intracranial hemorrhage and secondary brain edema after operation for traumatic brain injury (TBI).Methods A retrospective case-series analysis was done on 196 TBI patients (128 males and 68 females,aged 18-60 years old,median age 36.5 years old) admitted from January 2014 to December 2015 and treated surgically with simultaneous implantation of intracranial pressure (ICP) probe.There were 89 patients with Glasgow coma score (GCS) 6-8 points and 107 with GCS 9-12 points.The values of ICP were recorded.The changes of cerebral electrical impedance (CEI) were monitored in all patients through the BORN-BE noninvasive monitor.Results The disturbance factor of the BORN-BE noninvasive monitor in brain edema in the cerebral stage exhibited a strongly positive correlation with ICP (R =0.954,R2 =0.910,P ＜ 0.05).All the rebleeding occurred within 24 hours after operation in the study.The disturbance factor showed a significant reduction in the bleeding side,which exhibited a strongly negative correlation with the volume of cerebral hemorrhage (R =-0.982,R2 =0.964,P ＜ 0.05).Conclusion After operation for TBI,the ICE changes from dynamic noninvasive monitor can reflect the severity of brain edema digitally,indicating that the postoperative rebleeding and its volume may play an important role in selection of optimal treatment.

Objective To evaluate laparoscopic local resection for the treatment of gastric tumors. Methods The clinical data of 78 patients who received laparoscopic local resection at the PLA General Hospital from February 2006 to January 2010 were retrospectively analyzed. According to the tumor site and free range, total laparoscopic gastrectomy was applied to 45 patients, laparoscopic local resection was applied to 22 patients, laparoscopic and endoscopic tumor resection was applied to 11 patients. The efficacies of the surgical approaches were investigated. Results Laparoscopic local resection was successfully performed on the 78 patients without conversion to open surgery. The mean operation time and operative blood loss were 75 minutes (range, 45-120 minutes) and 60 ml (range, 35-90 ml), respectively. The mean diameter of the tumor was (2.5±1.3)cm (range, 0.7-4.8 cm). No mortality or morbidity occurred postoperatively. The bowel function recovery time and the duration of hospital stay were 35 hours (range, 25-42 hours) and 7.5 days (range, 6-9 days), respectively. The results of postoperative pathological examination verified that 63 patients were with gastric stromal tumor, 11 patients were with benign gastric diseases, including 5 with gastric heterotopic pancreas, 2 with inflammatory pseudotumor, 2 with hyperplastic polyp, 1 with schwannomas and one with angioma. Four patients were with carcinoid, 3 carcinoids were located in mucous layer and 1 invaded into muscular layer. The median time of follow-up was 26 months, and no anastomotic stenosis or port-site metastasis was observed. Of the 63 patients with gastric stromal tumor, 2 were treated with imatinib mesylate, 1 had tumor recurrence and received reoperation. Conclusion Laparoscopic local resection is safe and feasible for the treatment of benign gastric neoplasms, stromal tumor and early gastric tumors.

Objective:To compare the survival and prognostic factors of intraoperative radiotherapy (IORT) and postoperative radiotherapy (PORT) in female patients, aged≥50 years, diagnosed with node-negative breast cancer (≤ 3 cm in size).Methods:Clinical data of eligible early breast cancer patients between 2010 and 2015 were obtained from the SEER database. Patients were divided into the IORT and PORT groups according to the radiotherapy record and propensity score matching (PSM) was subsequently conducted. Kaplan-Meier curve was used to evaluate the overall survival (OS) and breast cancer-specific survival (BCSS) between two groups and Cox proportional hazard regression analysis was used to explore the risk factors of clinical prognosis.Results:7 068 patients were included after PSM. The median follow-up time was 32.0 months. The 5-year OS rates in the IORT and PORT groups were 96.8% and 93.8%, respectively. Univariate Cox analysis showed that radiotherapy, age, histological grade, T stage, estrogen receptor (ER) status and progesterone receptor (PR) status were the independent risk factors for OS, and histological grade, T stage, ER status, PR status and chemotherapy were the independent risk factors for BCSS. Multivariate Cox regression analysis demonstrated that patients who received IORT had better OS than PORT counterparts ( P=0.020). Besides, patients aged≥60 years obtained worse OS than those aged<60 years ( P=0.003). Patients with T 2 stage or ER-negative tumors had worse OS than those with T 1 stage tumors ( P<0.001) or ER-positive tumors ( P=0.001). Patients with grade Ⅲ-Ⅳ tumors achieved worse BCSS ( P=0.004). Subgroup analysis showed that IORT yielded better OS for elderly patients (≥60 years), grade Ⅲ-Ⅳ tumors, infiltrating duct carcinoma, T 2 stage tumors, ER-positive tumors, PR-positive tumors and patients without chemotherapy. Conclusions:IORT may bring benefit for highly selected patients with low risk of recurrence, which is not inferior to PORT in terms of short-term survival. Prospective studies with longer follow-up time are needed to confirm the findings.

Purpose: Numerous barriers hinder individuals with mental illness from seeking medical assistance in rural regions, yet a comprehensive understanding of these challenges remains elusive. This metasynthesis aims to understand the barriers and facilitators in medical help-seeking among rural individuals with mental illness. Methods: We systematically searched seven databases [PubMed, CINAHL, Medline (OVID), PsycINFO (OVID), Cochrane, Embase, and ProQuest] in May 2023 and included the studies if they reported the barriers or/and facilitators to seek healthcare in rural patients with mental illness. We conducted hand search and citation search on Google Scholar for literature supplements. Thematic analysis was employed. Results: The study included 27 articles reporting on the barriers and facilitators to seeking medical help in this population from 2007 to 2023. We ultimately identified themes at three levels: navigating the terrain of vulnerability and empowerment (the individual with mental illness), navigating the terrain of external environment (the external environment) and connectivity within the healthcare ecosystem for mental health (the health service system). Conclusions We must design more effective strategies to improve mental healthcare access for rural patients, considering cultural nuances and health service utilization patterns. This requires a multi-level approach, tailored to the unique needs of diverse populations.

Objective To evaluate the effect of electroacupuncture (EA) preconditioning on the activity of dynamin-related protein 1 (Drp1) in brain tissues during cerebral ischemia-reperfusion (I/R) in rats.Methods A total of 126 pathogen-free healthy adult male Wistar rats,weighing 250-300 g,were divided into 3 groups (n =42 each) using a random number table:sham operation group (group S),group I/R and EA preconditioning group (group EA).In group S,the blood vessels were only separated but not occluded.In group I/R,a nylon thread with rounded tip was inserted into the left middle cerebral artery advanced cranially until resistance was met,and middle cerebral artery occlusion was maintained for 2 h followed by reperfusion.In group EA,Baihui acupoints were stimulated with an electric stimulator (2/ 15 Hz disperse-dense waves,intensity 1 mA) for 30 min,lasting for 5 consecutive days,and the model of focal cerebral I/R was established at 24 h after the last stimulation.At 6,24 and 48 h of reperfusion,the neurologic deficit was assessed and scored,the mitochondria in the cerebral cortex on the ischemic side were extracted,the expression of Drpl in mitochondria was detected using Western blot,the mitochondrial uhrastructure was examined with an electron microscope,and neuroapoptosis was measured using TUNEL.The apoptosis rate was calculated.Results Compared with group S,the neurological deficit score and apoptosis rate were significantly increased,and the expression of Drpl in mitochondria was up-regulated at each time point in I/R and EA groups (P＜0.05).Compared with group I/R,the neurological deficit score and apoptosis rate were significantly decreased,and the expression of Drpl in mitochondria was down-regulated at each time point in group EA (P＜0.05).Conclusion The mechanism by which EA preconditioning reduces cerebral I/R injury may be related to inhibiting the activity of Drpl and thus inhibiting the excessive fission of mitochondria in rats.