The mi nimizign time on mechanical ventilait on is one of the great importna t issues in crit-ical ill patienst ,only limited guidance on weaing and extubation is available from the pediatric literature.T he clinical application ofni dicta ions for weaning are even less clear,and the protocol-based wae ningw ith sponta-neous breaht ing trail is a feasible way in pediatric intensive care unit.

OBJECTIVE:To cultivate qualified prescription-checking pharmacists and to ensure patients'rational drug use. METHODS:The status quo of prescription-checking pharmacists in China was analyzed and some concrete suggestions on how to cultivate qualified prescription-checking pharmacists were made.RESULTS:The phenomena of low educational level and low professional title,lack of professional knowledge and medical knowledge,lack of staff members were widespread in today's Chinese prescription-checking pharmacist professionals.CONCLUSION:The rational drug use can only be realized through being fully aware of the importance of prescription-checking pharmacists,enhancing whose admittance qualifications,working out professional standards for whom,clearly defining their responsibilities,strengthening their cultivation and increasing their numbers.

The incidence of severe viral pneumonia increased year on year,cardiac dysfunction is one of the commonest complications in severe pneumonia.But it is still controversial whether or not the severe pneumonia is associated with heart failure.This article focuses on the mechanisms and the treatment of severe pneumonia complicated with cardiac dysfunction.

Objective To explore the common complications and methods of treatment in the malignant obstruction of upper alimentary tract with stent insertion. Methods With interventional procedure under fluoroscopic guidance fourteen self expanding stents were implanted in twelve patients, including nine with strictures or obstructions of esophagus, three with obstructions of gastroduodenum. Of the fourteen, nine were coated stents and five were uncoated stents. Results All stents were implanted successfully, but complications after the procedure occurred sometimes. There complications included: 1. Food bolus obstructed in three patients. 2. Chest pain occurred in four patients. 3. Tumour overgrowth or hyperplasia of granulation tissue in three patients caused restenosis of gastrointestinal tract. 4. Stent replacement in three patients. 5. Hemorrhage occurred in two patients (over 300 ml) causing threat to life. Conclusions The implantation of self expanding stent is a simple and effective method offering good palliation for upper alimentary tract obstructions. The complications shoud be treated correctly.

Abstract: Although respiratory tract viral infections in children mainly cause respiratory diseases, severe respiratory viral infections are closely associated with infections, inflammation, or dysfunction of the nervous system. Common respiratory viruses such as human respiratory syncytial virus, influenza virus, coronaviruses, and human metapneumovirus can lead to severe neurological complications including encephalitis, acute disseminated encephalomyelitis, cerebellitis, Guillain-Barré syndrome, acute flaccid myelitis, and necrotizing encephalopathy, posing a threat to life. The outbreak of the SARS-CoV-2 epidemic has continuously increased the incidence and mortality of neurological complications in critically ill children. Therefore, this article will discuss the neuroinvasive mechanisms and neurological manifestations of respiratory viral infections in children, aiming to enhance early recognition of neurological complications related to respiratory viral infections in children by healthcare professionals and to minimize the harm of complications to children's health.

Through introducing the current situation of systemic pediatric emergency protocol,including five-level triage system,pediatric critical rescue protocol,pediatric trauma life support,emergency observation and guidelines for the pediatric intrahospital transport,we reviewed the issues of pediatric emergency to put forward recommendations.

Objective To compare the image guided effect between CT and Ultrasound for percutaneous catheter drainage and sclerotherapy in the treatment of hepatic cysts.Methods 26 patients with hepatic cysts underwent percutaneous catheter drainage and sclerotherapy by CT guided.87 cases underwent percutaneous catheter drainage and sclerotherapy by Ultrasound guided.Results 53 cysts underwent percutaneous puncture with 132 times by CT guided,and 5 cysts underwent sclerotherapy were failed(10.1％).231 cysts underwent percutaneous puncture with 267 times by Ultrasound guided,and 5 cysts underwent sclerotherapy were failed(2.1％).The failed rate of the two groups had statistifically significant difference(x2 =39.6875,P ＜ 0.05).Conclusion In the image guided technique for percutaneous catheter drainage and sclerotherapy in the treatment of hepatic cysts,Ultrasound had more advantages,high accuracy,real time visual,high success rate,less damage,economy and convenience than CT.

Objective To observe the effects of calcitriol on cellular proliferation and apoptosis,and on the expression of transforming growth factor-β1(TGF-β1)-induced α-SMA and extracellular matrix(ECM)synthesis in renal interstitial fibroblasts,so as to illustrate its potential roles and underlying mechanisms in preventing renal interstitial fibrosis. Methods In NRK-49F of cultured rats in vitro,cellular proliferation was detected by MTY.The cellular cycle and apoptosis were assessed by flow eytometry using annexin-V FITC/propidium iodide(PI).Real-time PCR was performed to detect the mRNA expression of α-SMA,CTGF and FN,and Western blot was performed to detect the protein expression of α-SMA and FN. Results Cellular proliferation was inhibited by calcitriol through G1-arrest (P＜0.05).But calcitriol had no effect on cell apoptosis(P＞0.05).Increased expression of α-SMA,CTGF and FN mRNA induced by TGF-β1were significantly suppressed by calcitriol as compared with TGF-β1 treated group (P＜0.05).However,there was no significant difference among the groups with various concentration of calcitrol (P＞0.05).The similar phenomenon of the level of α-SMA and FN protein expression was observed in all groups by Western blot. Conclusion Caleiniol inhibits cellular proliferation of renal interstitial fibroblast by G1-arrest,but has no effect on cell apoptosis,and can prevent renal interstitial fibrosis caused by TGF-β1.

Objective To explore the investigative studies of experimental value on the children suffered from a parotitis with pancreatitis.Methods 108 children patients were divided into 3 sub-groups:parotitis,parotitis with minigitis,parotitis with pancreatitis.45 cases were pantitis,24 were parotitis with pancreatitis and 39 were parotitis with minigititis.All the patients had serum amylase,serum lipase and abdominal B-ultrasound detected.All the results were statistically analyzed.Results The patients who had parotitis with pancreatitis were higher at abnonmal serum lipase and B-ultrasound(?~2=58.68,P

Objective To study the expression of transforming growth factor ?(TGF-?) and connective tissue growth factor(CTGF) in renal interslitium of patients with lupus nephritis(LN) and itssignificance. Methods Expression of TGF-?1, CTGF, CD3, CD68, proliferative nuclear cell antigen(PCNA) and ?-smooth muscle actin (?-SMA) in renal interstitium of LN patients were detected byimmunohistochemical staining. The degrees of staining in LN patients were compared to those in patients withminimal change disease (MCD) . Results Expression of TGF-?1 and CTGF in renal interstitium elevatedsignificantly in LN patients as compared to those in MCD patients. There was a positive correlation betweenthe expression of TGF-?1 and CTGF ( r = 0. 5316, P = 0. 023). The expression of ?-SMA and the numbersof CD3, CD68 and PCNA positive cells in renal intersitium were significantly increased in LN patients as compared with MCD cases. The expression of a-SMA in renal interstitium was correlated with the degree of renal interstitial lesions or fibrosis( r = 0. 436, P = 0.032) . Conclusion The increased expression ofTGF-?1 and CTGF in LN patients may be involved in the damage of renal interstitium and the infiltration ofinflammatory cells.