Abstract： Objective　To analyze and summarize the early clinical characteristics of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children, and to explore its related risk factors. Methods　A retrospective analysis was conducted on the clinical data of 518 patients with Mycoplasma pneumoniae pneumonia (MPP) admitted to the Department of Critical Care Medicine of Wuhan Children's Hospital from January 2020 to December 2023. According to the severity of the disease and treatment outcomes, the patients were divided into the RMPP group (n=127) and the general group (n=391). The differences in clinical features and laboratory indexes between the two groups were compared, and the risk factors of RMPP were screened out by logistic regression analysis. Results　There were no significant differences in gender, weight, onset season, and personal or family allergy history between the two groups (P>0.05). When categorized by age, the incidence of RMPP in the infant group (<3 years old, 18.92%) was lower than that in the preschool group (3-6 years old, 47.88%) and school-age group (>6 years old, 33.20%) (P<0.05), with no significant difference between the preschool group and school-age group. The probability of high fever, duration of fever, and duration of macrolide medication use in the RMPP group were significantly higher than those in the general group (P<0.05). The incidences of shortness of breath, diarrhea, convulsions, and rash in the two groups of children were also significantly different (P<0.05). There was a significant difference in white blood cell count, C-reactive protein, procalcitonin, lactate, blood urea nitrogen, alanine transaminase, D-dimer, interleukin-6 in the RMPP group were higher than those in the general group, with statistical significance (P<0.001). Among the 308 children in the general group who completed Mycoplasma pneumoniae DNA testing, the positive rate of Mycoplasma pneumoniae resistance sites was 57.47% (177/308), which was significantly lower than that of the RMPP group (76.38%, 97/127) (P<0.001). The rate of bacterial and viral co-infection in the RMPP group (59.84%) was significantly higher than that in the general group (P<0.001). The number of cases of pulmonary consolidation, atelectasis, and pleural effusion in the RMPP group was significantly higher than those in the general group (P<0.001). Multivariate logistic regression analysis showed that the duration of fever, bacterial co-viral infection, and positive Mycoplasma pneumoniae resistance gene loci were independent risk factors for RMPP. Conclusions　RMPP is more common in children over 3 years old and tends to occur in autumn and winter, and its early clinical symptoms are not typical. Clinical doctors should be highly vigilant about the occurrence of RMPP in patients who have prolonged fever despite macrolide treatment, bacterial and viral co-infections, or develop extrapulmonary complications (diarrhea, convulsions, rash). It is recommended that Mycoplasma pneumoniae resistance gene loci testing be performed as soon as possible, which can help to identify RMPP in the early stage.

Objective:To compare the effect of misoprostol respectively with sublingual administration and rectal administration in the treatment of postpartum hemorrhage. Methods:Totally 72 pregnant women were randomly divided into two groups with 36 cases in each. The sublingual group was given misoprostol 600 μg under the tongue immediately after the front shoulder of baby was delivered, while the rectal group was given misoprostol 600μg into rectum deeply. The amount of blood loss in 2 hours and 24 hours after the de-livery and the adverse reactions were compared between the two groups. Results: The postpartum hemorrhageon in 2 hours and 24 hours of the sublingual group was significantly less than that of the rectal group, and the incidence of postpartum hemorrhage in the sub-lingual group was significantly lower than that of the rectal group, and the difference was statistically significant (P<0. 05). After the treatment, the incidence of adverse reactions between the two groups had no significant difference (P>0. 05). However, the incidence of shiver in the sublingual group was significantly higher than that in the rectal group, and the difference was statistically significant ( P<0. 05). Conclusion:The preventive effect of misoprostol with sublingual administration on postpartum hemorrhage after natural vagi-nal delivery is better than that with rectal administration, which is safe and convenient, and worthy of promoted application in clinics.

Objective To investigate the effects of ketamine on the effector functions (phagocytosis, respiratory burst and release of proteolytic enzymes) of lipopolysaccharide (LPS) stimulated human neutrophils in vitro. Methods Blood samples were collected from healthy volunteers. The study was divided into four groups: LPS group and three ketamine groups (K1, K2 and K3). The final concentration of ketamine in each group was 0, 3, 30 and 300 ?g/ml respectively. Phagocytosis was assessed in whole blood by NBT phagocytosis test (n=8) and respiratory burst by flow cytometry (with dihydrorhodamine 123 as fluorescent marker, n=5). The release of three proteolytic enzymes was measured with isolated polymorphonuclear neutrophils (PMNs) by turbidimetry (lysozyme) and chromatometry (elastase and ? glucurolidase) methods (n=9).Results Ketamine dose dependently inhibited phagocytosis, respiratory burst and proteolytic enzyme releasing of LPS stimulated human neutrophils in vitro. Higher concentrations of ketamine were required to suppress respiratory burst as compared with the concentrations needed to suppress phagocytosis and proteolytic enzyme releasing.Conclusions The inhibitory effects of ketamine on the effector functions of LPS stimulated human neutrophils may contribute to the attenuation of neutrophil mediated inflammatory injuries.

Objective To study the acute effects of PM2.5 on the heart rhythm of spontaneously hypertensive rats(SHR)and the mechanism.Methods Twenty-eight male spontaneously hypertensive rats(SHR)were randomly divided into four groups.PM2.5 was administered by intratracheal instillation at the doses of 0 mg/kg,7.5 mg/kg,15 mg/kg and 30 mg/kg respectively.ECGs were monitored at 30 min,1 h and 24 h later.Results The numbers of the rats with arrhythmia in all groups increased at 30 min after treatment.At 1 h after treatment,in control group the rats recovered,but in PM2.5 groups abnormal ECGs was still showed.However,ECGs of all groups became normal 24 h later.As shown by laser scanning confocal microscope(LSCM),the expression of Cx43 in the heart tissue of rats in 15 mg/kg and 30 mg/kg groups significantly decreased compared with the control group.There was no significant change in content of MDA and SOD in the heart tissue of PM2.5 treated rats.Conclusion PM2.5 exposure through inhalation may induce arrhythmia in SHR rats and the downregulated expression of Cx43 may play an important role in the pathogenesis.

Objective To evaluate safety and effect of percutaneous balloon mitral valvuloplasty(PBMV) for patients with rheumatic mitral stenosis and left atrial thrombi.Methods PBMV was performed in 27 patients with rheumatic mitral stenosis and left atrial thrombi. 19 cases of left atrial fresh thrombi revealed by transesophageal echocardiography (TEE) received warfarin orally for 3-6 months before PBMV. Results PBMV was successful in all cases of mitral stenosis and left atrial thrombi. Left atrial fresh thrombi was completely resolved in 9 cases and became smaller chronic organized thrombi in 10 cases after warfarin anticoagulation treatment among 19 cases of left atrial fresh thrombi revealed by TEE. In 5 cases of left atrial chronic organized thrombi shown only transthoracic echocardiography and without anticoagulation treatment, one case had cerebral embolism. No complication occurred in other cases.Conclusions The study showed that patients with rheumatic mitral stenosis and atrial fibrillation should have routine TEE. PBMV for rheumatic mitral stenosis with left atrial thrombi after anticoagulation treatment is safe and effective.

Objective To investigate the cell cycle of airway smooth muscle cells(ASMC) in asthmatic rats with airway remodeling and to explore a new method for the prevention and treatment of asthma.Methods The asthmatic rat models were established.The pathologic changes of inner airway wall and ASMC were determined by observing and analyzing the lung tissue sections stained with HE,and the cell cycle distribution of ASMC were analyzed by flow cytometry.Results The inner airway wall and smooth muscle layer were much thicker in rats of asthma group than those of control group(P

To improve the quality of practice teaching in medical imaging,we explored the teaching methods on the basis of quality-oriented education,combining the special nature of the medical imaging and the clinical medicine program.

Comparative imaging can be used to analyse and compare diseases in different respects,which can not only conduce to students’transversal contrast of knowledge they have learned, but also improve the teaching effect of medical imaging and the students’clinical skills,and at the same time,lay a solid foundation of the research for future.

To observe the effects of Guanxinkang (GXK) decoction, a compound traditional Chinese herbal medicine, on serum lipids and apolipoprotein A I (ApoA I), apolipoprotein B (ApoB), apolipoprotein E (ApoE), C-reactive protein (CRP), serum amyloid A protein (SAA) and fibrinogen (Fbg) concentrations of ApoE-knockout mice with atherosclerosis, and to explore the mechanism of GXK decoction in anti-atherosclerosis.

OBJECTIVE To investigate the resistance of clinical isolated strains to the commonly used antibacterials in our hospital 2007-2008.METHODS Clinical isolated strains and sensitivity of drugs were detected by ATB system.The result of drug sensitivity was judged by CLSI standard and analyzed with statistical software WHONET5.3.RESULTS Altogether 3150 strains bacteria were isolated,17.4% were Gram-positive strains and 82.6% were Gram-negative strains,and the top five isolates were Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii,and Staphylococcus aureus.The reasistance rate of Gram-positive strains to minocycline was 15.4%.Five VRE strains were isolated.Various Enterobacteriaceae bacteria were sensitive to imipenem meropenem,cefoperazone-sulbactam and piperacillin-tazobactam,and their rate was 86.5% to 97.7%.Some of Acinetobacter and Stenotrophomonas maltophilia were multidrug resistant.CONCLUSIONS It is serous that multidrug resistance of isolated strains of the patients exists in our hospital.