Objective To investigate the efficacy of volume target pressure control(VTPC)and synchronized intermittent mandatory ventilation(SIMV)in treating severe neonatal respiratory distress syndrome(NRDS). Methods Fifty - six admitted cases with severe NRDS hospitalized in Jiangmen Central Hospital from October 2012 to March 2015 were randomly divided into 2 groups:28 cases in VTPC group were treated by VTPC and SIMV,and 28 cases in pressure control ventilation(PCV)group were treated by PCV and SIMV. There was no significant difference between 2 groups in terms of gender,gestational age,and birth weight(all P ﹥ 0. 05). Artery blood gas analysis was performed at 6 hours,12 hours,24 hours,and 48 hours respectively after ventilation. The following parameters were observed:the time of invasive mechanical ventilation,duration of oxygen therapy,mortality and the incidence rates of hypocapnia,pneumo-thorax,ventilator associated pneumonia( VAP),grade Ⅲ - Ⅳ periventricular intraventricular hemorrhage( PVH -IVH),periventricular leukomalacia(PVL)and bronchopulmonary dysplasia(BPD). Results No case in 2 groups withdrew from the test. There was no significant difference between 2 groups in terms of the first treatment time and total doses of poractant alfa injection(all P ﹥ 0. 05). The time of invasive mechanical ventilation in VTPC group[(71. 75 ± 9. 82)h]was shorter than that in PVC group[(97. 89 ± 16. 88)h](t = 7. 083,P = 0. 000). Hypocapnia incidence of four blood gas analysis in VTPC group[(19. 64 ± 14. 20)% ]was lower than that in PCV group[(47. 32 ± 18. 43)% ] (t = 6. 294,P = 0. 000). Incidence rates of VAP and PVL in VTPC group were lower than those in PCV group(χ2 =5. 197,P = 0. 023;χ2 = 4. 766,P = 0. 029). However,duration of oxygen therapy,mortality and the incidence rates of pneumothorax,Ⅲ - Ⅳ PVH - IVH and BPD were not significantly different between 2 groups( all P ﹥ 0. 05). Conclusion VTPC + SIMV has a better efficacy than PCV + SIMV in the treatment of NRDS.

Objective To study the impact of severe idiopathic pulmonary arterial hypertension (IPAH) on pregnancy outcome and to investigate the effect of multidisciplinary approach during pregnancy on the pregnancy outcome in pregnant woman with severe IPAH.Methods Between March 2007 and November 2013,10 pregnant women with severe IPAH undergoing treatment in Beijing Anzhen Hospital were studied retrospectively.Hemodynamic measurements,medical therapy,manner of delivery,anesthetic administration,multidisciplinary management and outcomes were assessed.Results All 10 cases were first diagnosed at the mean of (24 ± 3) weeks during the pregnancy.The systolic pulmonary artery pressure (sPAP) estimated by transthoracic echocardiography was (95.6 ± 1.3) mmHg (1 mmHg =0.133 kPa).Seven cases of class Ⅲ and 3 cases of class Ⅳ were recorded by World Health Organization functional class.One patient underwent pregnancy termination at gestational age of 21 weeks with no maternal death or complications,nine patients continued pregnancy and all the patients underwent cesarean section.The mean pregnancy length was (31 ± 5) weeks.Nine had cesarean deliveries during continuous epidural anesthesia,and one during general anesthesia.There were three maternal deaths in hospital (5,2,3 days postpartum),and seven patients were alive,and the average hospitalization days was (8 ± 4) days.One fetus lost with cesarean section.Two were term delivery,and seven cases were premature delivery.The average weight is (1 948 ± 731) g and nine were alive and no malformation.Conclusions Because of maternal mortality in patients with severe IPAH remains prohibitively high,patients should continue to be counseled to avoid pregnancy.Women with severe IPAH who become pregnancy should be followed by multidisciplinary approach,and cesarean deliveries during continuous epidural anesthesia are a relatively safe way for pregnancy termination in patients with severe IPAH.

Objective To explore the preventive effect of Fluconazole on invasive fungous infections in premature infants.Methods Two hundred and thirty-four cases of preterm infants hospitalized in Jiangmen Central Hospital from Feb.2008 to Oct.2013 were analyzed by retrospective study.The subjects were divided into 3 groups based on whether Fluconazole was used and it was used orally or intravenously for the prevention of invasive fungous infections in premature infants.The Fluconazole prophylaxis was not given to group A,whereas oral Fluconazole prophylaxis [6 mg/(kg · times),every other day] and intravenous Fluconazole prophylaxis [3 mg/ (kg · times),once every 3 days] were applied in group B and group C.The incidence of invasive fungous infections and the clinical effects of Fluconazole on the 3 groups were evaluated and compared.Results The number of cases analyzed in the study were 53,115 and 66 cases in group A,group B and group C,respectively.There were no significant differences between the 3 groups in terms of gender,gestational age,birth weights,length of hospitalization,intravenous nutrition,and number of peripherally inserted central catheter,antibiotics and invasive mechanical ventilation use days (all P ＞ 0.05).The incidences of invasive fungal infections were 11.32％ (6/53 cases),6.96％ (8/115 cases) and 0 in group A,group B and group C,respectively.The prophylaxis effects between the 3 groups were significantly different (x2 =7.078,P =0.029).Group A and group B were not significantly different (x2 =0.905,P =0.342),but group C was better than group A and group B,and the differences were significant (P =0.007,0.028).Conclusions Prevention of invasive fungous infections by intravenous Fluconazole has good curative effects,and which can be used as the first choice.

OBJECTIVETo describe the epidemiological characteristics of nonfatal child pedestrian injuries and provide information to help understand an important public-health problem.

METHODSThis was a school-based, cross-sectional questionnaire survey. The sample (42 750 children) was obtained from two urban cities of Guangdong Province, China, using multi-stage randomized sampling. Information was collected by the respondents self-reporting in the classroom.

RESULTSThe incidence rate of nonfatal child pedestrian injuries in the cities was 2.0%. Boys had a higher incidence rate (2.6%) than girls (1.4%). Compared to other children, those aged 10 years are at the highest risk. The primary places of occurrence were sidewalks, residential roads, and crosswalks. High-risk behavior of the children immediately prior to injury included mid-block crossings, playing on roads, and crossing on red lights. The major vehicles that caused pedestrian injuries were bicycles, car or vans, and motorcycles. Bruises, fractures, and injuries to the internal organs were the top three types of injuries. Almost 40% of victims were hospitalized, and nearly 30% of the victims suffered long-term disabilities.

CONCLUSIONThis study shows that nonfatal child pedestrian injuries are a very serious public-health problem in the urban cities of Guangdong. Based on the epidemiological characteristics, prevention strategies and further research should be carried out to reduce the occurrence of injuries.

Accident Prevention ; methods ; Accidents, Traffic ; prevention & control ; statistics & numerical data ; Animals ; Child ; China ; epidemiology ; Cross-Sectional Studies ; Data Collection ; Female ; Humans ; Incidence ; Male ; Motor Vehicles ; Surveys and Questionnaires ; Urban Population ; statistics & numerical data ; Wounds and Injuries ; epidemiology

Objective To analyze the age difference of gram negative isolates(GNB)from blood culture and antibiotic resistance profile between children and adults. Methods Age difference of pathogen distribution of GNB isolated from blood culture during 2015-2017 were retrospectively analyzed. WHONET 5.6 and Graphpad Prism 6 were used to perform Chi-square test on the pathogen proportion and antibiotic resistance rate. Results A total of 20 145 bacterial strains were isolated in Chongqing from 2015 to 2017. The top three strains of GNB were E. coli(56.7％, 6 688/11 799), K. pneumoniae(19.6％, 2 308/11 799), and P. aeruginosa(4.4％, 522/11 799). The resistant rate of E. coli to carbapenems was less than 1％. The resistant rate of K. pneumoniae to carbapenems was about 5％, while the resistant rate of S. marcescens was approximately 9％, similar to E. cloacae. The overall resistance rates of E. coli from adult patients to most antiobiotic agents were significantly higher than those of children, but the overall resistance rate of K. pneumoniae from children was higher than those of adults. The drug resistance rate of A. baumannii was higher than P. aeruginosa. A. baumannii isolates from adult patients were highly resistant to all drugs tested and more resistant than those from pediatric patients. Conclusions Majority of GNB strains isolated from blood culture were E. coli and K. pneumoniae, for which carbapenems are still active. More attention should be paid to carbapenem-resistant K. pneumoniae from children and A. baumannii from adults. National surveillance of nosocomial bloodstream infection should be highly evaluated.