Based on clinical features of refractory diseases and clinical practice experience for many years,the author expounded the therapeutic strategies from establishing individualized system of differentiation treatment,treatment strategies of refractory diseases,and the key for medication,and emphasized individual concerned therapy,separating primary and secondary treatment and grasping the physiological state to treat pathological changes.Thus complicated and changeable diseases can be treated clinically.

Anti-Bacterial Agents ; therapeutic use ; Emergencies ; Enterocolitis, Necrotizing ; diagnosis ; epidemiology ; etiology ; prevention & control ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; epidemiology ; etiology ; prevention & control ; Infant, Very Low Birth Weight ; Infection Control ; Intensive Care Units, Neonatal ; Premature Birth ; prevention & control ; Risk Factors

Brain Injuries ; surgery ; Female ; Humans ; Hypoxia-Ischemia, Brain ; surgery ; Infant, Newborn ; Male ; Neural Stem Cells ; cytology ; transplantation

Microorganisms can affect the development of body immune system.Intestinal flora regulate immune function by promoting the intestinal immune system development,inducing T cell differentiation to avoid or reduce the incidence of immune-related diseases.Allergic diseases are related with the body's immune system hypoplasia and imperfect immune regulation mechanism.The immune system can be affected by intestinal flora,and the distribution of flora in the body between children with allergies and healthy children are significantly different,indicating that the occurrence of allergic diseases are associated with intestinal microflora.Studies have reported probiotic are helpful to the prevention and treatment of allergic disease,providing a new way for the prevention and treatment of allergic diseases.

Anemia of prematurity is very common in preterm infant.Phlebotomy losses and inadequate production of erythropoietin are the main reasons.Treatment of anemia of prematurity includes delayed umbilical cord clamping at delivery,decreasing phlebotomy losses,use of red cell growth factors such as erythropoietin properly,red blood cell transfusions,which are based on indications and guidelines.In this article we review recent studies in preventing and treating anemia in preterm infants.

Patent ductus arteriosus (PDA)is a common disease among premature neonates and the management of which has always been a challenge to the neonatologists. Early treatment has been advocated as the first-line approach, and drug induced closure is yet the most effective, inexpensive, and convenient method. During the last two decades,indomethacin was often given as conservative treatment, and its closure rate in PDA was approximately 46% ～ 89%. However,indomethacin may increase the number of undesirable or harmful effects including renal damage, intraventricular hemorrhage, necrotizing enterocolitis, and enterobrosis,etc. Recently,ibuprofen is rapidly emerging as a new promising drug for treatment of PDA in preterm infants with closure rate of 73.0% ～95.5%. It is used as standard therapy to close PDA,and it has less influence on the hemodynamics of kidneys, brain and gastrointestinal tract. The surgery is needed in patients with drug treatment failure and cardio-pulmonary function damage.

Objective To evaluate the effect of chronic alcohol intake on the sedative potency of propofol through investigating the effect of chronic alcohol intake on the half-effective target effect-site concentration ( EC50 )of propofol required for loss of consciousness in patients. Methods Fifty male ASA Ⅰ or Ⅱ patients, aged 25-60 yr, weighing 50-80 kg, scheduled for elective surgery, were divided into 2 groups according to the history of chronic alcoholic intake ( n = 25 each): control group (alcoholic intake per day ＜ 25 g) and chronic alcoholic group (alcoholic intake per day＞45 g, lasting for 2 yr or more). The EC50 and 95% confidence interval (CI)were determined by up-and-down sequential method. The initial target effect-site concentration was 2 μg/nl in chronic alcoholic group and 1.5μg/ml in control group, and the ratio between the two successive concentrations was 1.05. Loss of consciousness was defined as loss of response to verbal command and eyelash stimulation. Results The EC50 of propofol that produced loss of consciousness was 3.92 (95 % CI 3.56-4.63 ) μg/ml in chronic alcoholic group and 2.73 (95%CI 2.26-3.31)μg/ml in control group. The EC50 of propofol was significantly higher in chronic alcoholic group than in control group ( P ＜ 0.05). Conclusion Chronic alcohol intake can increase the EC50 of propofol required to induce loss of consciousness and reduce sedative potency in patients.

Based on multiple painless needle insertion skills in clinic combined with own experience, the authors propose the opinion that different painless needle insertion methods need to be used according to the positions where acupoints are. The appropriate needle insertion mean must be selected in accord with the anatomical characteristic of acupoint position, namely, tapping insertion is applied in scalp part, skin-pinching up needle insertion is used in forehead and superficial nerve trunk, fingernail-pressure needle insertion in ocular region and positions where large blood vessels distribute, flying acupuncture insertion in face and finger tip, vibrating needle in occipitonuchal region, quivering insertion in abdomen, quick pricking by single hand in the four limbs and back, and chop acupuncture in palm and pelma. The insertion methods are systematically discussed in terms of preparation, acupoint position, manipulation and attention, etc, so that to provide the reference for painless needle insertion.
Acupuncture Points ; Acupuncture Therapy ; instrumentation ; methods ; Humans ; Meridians ; Needles

Objective To investigate the association between thyroid autoimmunity (TAI) and miscarriage.Methods A systematic review of both case-control and cohort studies on the association between TAI and miscarriage published before March 2009 was performed.All the literatures were abstracted based on the defined selection criteria by two independent investigators.Publication bias was tested by funnel plot.The odd ratios of case-control studies and relative risks of cohort studies were pooled respectively,depending on the result of heterogeneity test among the individual studies.The software Review Manager (version 4.3.1) was used for meta analysis.Results Electronic search yielded 23 articles,4 of which were reviews and were excluded.The remaining 19 clinical studies met the selection criteria,of which 7 were case-control studies and 12 cohort studies.A clear association between the presence of thyroid autoantibodies (TA) and miscarriage was found with a pooled odds ratio of 2.72 (95% CI 1.27-5.80,P = 0.01) in 7 case-control studies,and a pooled relative risk of 2.41 (95% CI 1.96-2.96,P＜0.01) in 12 cohort studies.Women with TA were found to have slightly older age (age difference,1.29 years,95% CI 0.43-2.16,P = 0.003) and raised TSH levels (TSH difference,0.61 mIU/L,95% CI 0.51-0.71,P＜0.01) compared with those without TA.Conclusion TAI is significantly associated with miscarriage,which can be interpreted as the direct involvement of TA.Alternatively,the association can be partially explained by the slightly older age in women with TA compared with those without.A third possibility is mild thyroid failure,as TSH levels in TA-positive but euthyroid women are higher than in TA-negative women.

Objective To study the effects of prolonged oxygen exposure at different concentrations on expressions of vascular endothelial growth factor (VEGF) and its receptors (VEGF receptor-1 ,VEGFR1 and VEGF receptor-2, VEGFR2)mRNA in lungs of neonatal rat. Methods Thirty-two SD rat pups were randomly divided into control and experimental group. Rats in the experimental group were further divided into three subgroups: 30% O2, 50% O2 and 75% O2 group. Each group had 8 rats. The rats were ,sacrificed at postnatal day 21 and their right lower lobes were collected. Expressions of VEGF, VEGFR1 and VEGFR2 mRNA were detected by RT-PCR. Results There was no effect on VEGF, VEGFR1 or VEGFR2 mRNA expression in 30% O2 group. The expressions of VEGF mRNA in the 75% O2 group was 0. 48 times of the control (P<0. 05). The expressions of VEGFR1 mRNA(P<0.01) and VEGFR2 mRNA (P<0.01) in 50% O2 and 75% O2 group were lower than those of control. Condusions Prolonged exposure to moderate or high oxygen concentration may reduce the expression of VEGF and its receptors' mRNA in the lung tissues of neonatal rats.