Objective:To explore the feasibility and safety of long-term home mechanical ventilation(HMV) in children with chronic respiratory failure.Methods:Clinical data of 11 children with chronic respiratory failure, who underwent HMV with the care of the First Affiliated Hospital of Xiamen University from January 2013 to December 2019, were retrospectively reviewed. The clinical manifestation, growth and development, quality of life, adverse events and prognosis of HMV children were analyzed.Results:There were 8 boys and 3 girls with the onset age of 26 days to 13 years old; and the age at starting HMV was 3 months to 13 years old. Eight children were diagnosed as neuromuscular diseases, and 3 children were diagnosed as respiratory diseases. The duration of institutional mechanical ventilation was 2 weeks to 8 months. Six patients underwent invasive HMV via a tracheostomy, and 5 received non-invasive ventilation via nasal and face masks. Bi-level positive airway pressure ventilation mode was applied in all the patients. The duration of HMV was 3 months to 27 months. During follow-up, no HMV related adverse events were observed. Both the quality of life and nutritional status were improved in all cases. One patient lost follow-up 9 months later and 1 patient died of severe adenovirus pneumonia during hospitalization for examination, the remaining 9 cases survived. Liberation from HMV was obtained in 4 patients. The frequency of readmission was 1 to 2 times.Conclusion:It is suggested that long-term HMV is safe and feasible for children with chronic respiratory failure.

Enteritis ; diagnosis ; Eosinophilia ; diagnosis ; Gastritis ; diagnosis ; Humans ; Pancreatitis ; diagnosis

Objective To explore the clinical-pathological characteristics, treatment and prognosis of eosinophilic gastro-enteritis in children. Methods The data of clinical manifestation, laboratory examination, endoscopy, biopsy, management and prognosis from 2 pediatric patients with eosinophilic gastroenteritis were retrospectively analyzed. Related articles were reviewed. Results The age of two patients was 13 and 14 years old. Case 1 was male and had an onset with acute pancreatitis. Case 2 was female with a history of food allergy and had an onset with unexplained ascites. Both patients presented with signiifcantly increased peripheral eosinophil count (45.9%-64.8%) and serum IgE (246-393 IU/ml). Bone marrow cytology showed increased proportion of eosinophils in both patients. Gastroscopy was performed in case 1 while gastroscopy and colonoscopy endoscopy were performed in Case 2 and the results indicated eosinophilic inifltration in duodenum. Duodenal mucosa biopsy showed eosinophilic inifltration in case 1 while gastrointestinal pathology biopsy showed multiple mucosal eosinophil inifltration in case 2. After the therapy of food avoidance, steroid and anti-allergic drugs, both patients had complete remission 1 week later. Meanwhile the peripheral eosinophil count was decreased to normal. Case 1 was followed up for 24 months, and case 2 was followed up for 2 months. Both patients showed no evidence of relapse. Conclusions The clinical manifestation and endoscopic examination of eosinophilic gastroenteritis in children are protean and lack of speciifcity. Unexplained gastrointestinal symptoms accompanied with eosinophilia may suggest the possibility of eosinophilic gastroenteritis. Eosinophilic inifltration in ascites and gastrointestinal mucosa strongly indicate the di-agnosis of eosinophilic gastroenteritis. After exclusion of other possible diseases, the deifnite diagnosis can be made.

Objective To discuss the application form, method and effect of blending learning based on MOOC in Obstetrics and Gynecology Nursing Course, so as to improve learning quality and com-prehensive qualities of students. Methods Randomly selected a nursing undergraduate class as experi-mental group (n=190) and another as control group (n=189);blending learning and traditional teaching model were adopted, respectively. T test and chi-square test were used to compare scores of final exam in two groups, and Rating Scale of Self-directed Learning Competence for Nurses and Scale of Clinical Commu-nication Competence for Nursing Students were used to evaluate two groups before and after the course. Results The average score (76.30±7.08) and excellent rate (35.79％) in the experimental group were higher than those in the control group of (74.78 ±7.18) and 25.93％, with significance differences (P<0.05);Surveys showed that after the course, the autonomous learning ability and the clinical communication ability of students in the experimental group were better than before, and were better than those in the control group. Conclusion Blending learning can be applied to Obstetrics and Gynecology Nursing Course, which can effectively improve learning quality and enhance students' ability of independent study and clinical com-munication, with satisfactory teaching effects to both teachers and students.

Objective To establish a mice model of diffuse large B-cell lymphoma (DLBCL) that was treated with adoptive immunity of Th17 cells cultured in vitro,and to analyze the relationship between IL-17 and MHC Ⅱ expression and their relation with tumor growth.Methods The CD4+CD62L+ T cells purified by MACS were stimulated under cytokine conditions including anti-CD3,anti-CD28,TGF-β and IL-6 in vitro,and SUDHL-4 cells were cultured and inoculated the SCID mice to establish DLBCL mice models.The mice were divided into Th17 cells immunity group (30 mice) and control group (20 mice).Th17 cells were injected to mice to get the adoptive immunity in immunity group,and 0.9 ％ NaCl in control group.The half mice were terminated at median disease onset time and median survival time,respectively.ELISA was used to detect IL-17 expression,and immunohistochemistry was applied to detect MHC Ⅱ expression in the tumor tissues.Results The median disease onset time of DLBCL mice model was 8 d,and median survival time was 28 d.The IL-17 and MHC Ⅱ expression levels in Th17 cells immunity group [(11.93±0.56) pg/ml,(69.13t0.36) ％] were higher than those in control group [(9.82±0.26) pg/ml,(42.59±0.12) ％] (both P＜ 0.000 1).Along with the progress of DLBCL,IL-17 and MHC Ⅱ expression levels were decreased [(9.53±0.18) pg/ml,(54.63±0.45) ％,both P ＜ 0.000 1].There was a significantly positive correlation between IL-17 and MHC Ⅱ (r=0.89,P=0.000).Conclusions The expression level of MHC Ⅱ can be used as a factor to judge the disease situation of DLBCL,and combination detection of the expression of both IL-17 and MHC Ⅱ will provide more reference values for judgment of the disease situation and the progress of DLBCL.

The early recognization and intervention of patients at risk of clinical deterioration plays an extreme-ly important role in improving the prognosis and decreasing mortality of those patients. Pediatric early warning score (PEWS)is a simple pediatric scoring system consisting of some physiological indicators.It can be used to dynamically evaluate the severity of illness either in pediatric emergency department or in inpatient wards and also to guide correspon-ding interventions.PEWS is easy to operate,time saving and also showed a good repeatability during clinical implemen-tion.So far,numerous clinical studies have demonstrated that PEWS shows high sensibility and specificity in early identifi-cation of clinical deterioration and is worthy of further clinical application.However,there is still no consensus about its cut-off score,which needs further substantial clinical research to verify.

Objective: To assess the effectiveness in optimizing resources and shortening critical children′s waiting time in pediatric emergency department (PED) with five-level pediatric emergency triage system (PETS). Methods: This retrospective study was conducted in the First Affiliated Hospital of Xiamen University after PETS was applied. The data of patients who visited the pediatric emergency department from January 2015 to December 2017 were collected and analyzed, including age, sex, diseases, visiting time, triage rate and destination. Results: A total of 375 985 patients were included, among whom males were 225 308 (59.9%) and females were 150 677 (40.1%), all younger than 14 years of age. The number of critical cases (level Ⅰ, level Ⅱ and level Ⅲ) was increased from 4 719 (3.7%) in 2015, 12 209 (10.2%) in 2016 to 16 188 (12.7%) in 2017. The number of non-critical patients (level Ⅴ) decreased year by year, as from 98 213 (76.8%) in 2015 to 75 210 (62.6%) in 2016 and 78 857 (61.7%) in 2017. The patients who classified as level Ⅰ or levelⅡaccording to the PETS were seen immediately by physician (n=1855, 0.5%). Overall, 119 738 patients (98.3%) who were classified as level Ⅲ or level Ⅳ could be seen by physician in a timely manner according to triage guidelines, while 2 112 patients (1.7%) could not. The mean waiting time was 9.09 min in level Ⅲ, 17.7 min in level Ⅳ, and 55.76 min in level Ⅴ patients, respectively. The critical cases admitted to the intensive care units were 175 (36.2%) in 2015, 350 (62.8%) in 2016 and 374 (66.2%) in 2017. The etiologies were respiratory diseases (73.3%), gastrointestinal diseases (15.8%) and infectious diseases (3.1%). Conclusion The application of PETS could optimize emergency resources and shorten the waiting time of critically ill children.

Objective:To explore the application of mixed teaching mode based on small private online course (SPOC) and interactive tool in course of obstetric and gynecological nursing bilingual education.Methods:Nursing undergraduates from Batch 2018 of Chongqing Medical University were recruited in the study, with 336 students in the intervention group and 332 students in the control group. Mixed teaching method based on the SPOC and interactive tool was used for teaching in the intervention group, and traditional teaching methods were used in the control group. At the end of the course, formative evaluation indicators, such as students' academic performance, online study and students' classroom performance were compared between the two groups. SPSS 26.0 was used to perform t test and chi-square test of the data. Results:The final scores of the intervention group were (67.84±8.65) points, compared with the control group [(66.50±7.29) points]; the bilingual section scores of the intervention group were (5.32±1.90) points, compared with the control group [(4.95±1.92) points], with statistically significant differences between the two groups ( P<0.05). The online study and students' classroom performances of the intervention group were better than those of the control group ( P<0.05). Most students of the intervention group believed the mixed teaching method based on the SPOC and interactive tool could develop the ability of autonomous learning, improve the professional achievement and enhance the level of English. Conclusion:The mixed teaching method based on the SPOC and interactive tool can develop the students' ability of autonomous learning and enhance the teaching effect.

Objective: To investigate potential biomarkers for different types of hand, foot and mouth disease(HFMD). Methods: Nuclear magnetic resonance(NMR)-based metabolomics methods were used to analyze the metabolic differences in serum of HFMD and healthy controls.Partial least squares discriminant analysis(PLS-DA)and orthogonal partial least square discriminant analysis(OPLS-DA)were used for analysis of metabolite profiles.Differential statistical analysis was performed by t tests using GraphPad Prism 5 software. Results: The levels of lipid, leucine, valine, β-hydroxybutyric acid, acetone, glucose, glycoprotein, glycerol, glycine, choline, trimethylamine oxide and lactate in HFMD increased significantly compared with healthy controls, whereas the levels of acetic acid and creatine decreased significantly.Additionally, the level of acetone further increased in the severe type of HFMD compared with the mild type, whereas the levels of lipid and trimethylamine oxide decreased. Conclusion These statistically significant differences are involved in lipid metabolism, glucose metabolism and protein metabolism in different types of HFMD.Lipid, acetone and trimethylamine oxide can be used as potential biomarkers of HFMD.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.