Objective To explore the treatment effect and prognosis of BiPAP non-invasive ventilator of sequential mechanical ventilation for the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary encephalopathy,and to provide the basis for clinical therapy.Methods According to the digital table,62 AECOPD patients with pulmonary encephalopathy were selected and randomly divided into the two groups.And 30 cases in the control group received routine treatment,and 32 cases in the observation group received BiPAP non-invasive ventilator sequential ventilation.The partial pressure of oxygen (PaO2),partial pressure of carbon dioxide (PaCO2) and oxygen saturation (SaO2) before and after treatment,the changes of heart rate,respiratory rate and average arterial pressure of the two groups and the improvement time were observed.Results PaO2 and SaO2 of the two groups after treatment were higher than those before treatment (t =12.30,10.37,11.42,13.71,all P ＜0.05).PaO2 and SaO2 of the observation group after treatment were (77.14 ±4.16)mmHg and (90.37 ± 2.04) ％,which were higher than the control group after the treatment (72.96 ± 3.22) mmHg and (85.80 ± 1.96) ％(t =6.58,7.14,all P ＜ 0.05).PaCO2 of the two groups after treatment was lower than that before treatment (t =9.25,10.22,all P ＜ 0.05).PaCO2 of the observation group after treatment was (50.12 ± 2.86) mmHg,which was lower than that before treatment (54.27 ± 3.01) mmHg (t =6.29,P ＜ 0.05).The heart rate,respiratory rate and mean arterial pressure of the control group and the observation group after treatment were lower than before treatment (t =10.11,9.43,8.66,11.28,8.56,9.15,all P ＜0.05).The heart rate,respiratory rate and mean arterial pressure of the observation group after treatment were (76.52 ± 4.35) times/min,(20.35 ± 1.08) times/min and (83.26 ±3.07)mmHg,which were lower than those of the control group after treatment (t =6.44,5.82,6.70,all P ＜ 0.05).The blood gas improvement time,ventilation time and hospitalization time of the observation group were (4.06 ±1.17)d,(4.53 ±0.90) d and (16.18 ±2.20) d,which were lower than the control group (t =6.13,7.05,5.97,all P ＜ 0.05).Conclusion The BiPAP non-invasive ventilator sequential ventilation for the treatment of AECOPD with pulmonary encephalopathy has good treatment effect,which can improve the difficult ventilation of patients,avoid hypoxia and CO2 retention,shorten treatment time.

Objective To explore the effect and safety of mycophenolate mofetil (MMF) and glucocorticoid on Henoch-Schonlein purpura nephritis in children and compared with cyclophosphamide (CTX).Methods The data of 48 patients diagnosed as Henoch-Schonlein purpura by renal biopsy were retrospectively analyzed.Median follow-up time was 22(7,48) months.The subjects were divided into 2 groups.34 cases were in the MMF group:MMF (15-20 mg · kg-1 · d-1 or 800-1200 mg/m2)+prednisone,and 14 cases in the CTX group:CTX (8-12 mg · kg-1 · d-1) + prednisone.Clinical and laboratory data were collected at baseline and 1,3,6 months after treatment.During follow-up,cumulative retreatment rate and adverse reactions after treatment were recorded.Results In two groups after treatment for 1,3,6 months,24 hours urinary protein quantitative was significantly lower than the baseline value,serum albumin (sAlb) was significantly higher than the baseline value,and serum creatinine (Scr) indicated no statistically significant difference during the follow-up period.After the treatment of 1 month,the efficient rate of MMF group was higher than the CTX group (MMF 73.5 ％ vs 42.9％,P=0.046),the effective treatment of 3,6 months at the end of the follow-up,no statistically significant difference were observed in the accumulative remission rate.The total rate of retreatment was 10.4％ (5/48),where MMF group was lower that of the than CTX group (3.0％ vs 28.6％,P＜0.001).The retreatment often occurred after discontinuation of prednisone and CTX,MMF reduction process.Eleven children received IMPDH2 gene polymorphisms test in MMF group,9 AA children had shorter time for drugs to be effective than that of the AG and GG children.The incidence of adverse reactions of MMF group was obviously lower than CTX group at the end of the follow-up (8.8％ vs 35.7％,P=0.025),where two groups developed fungal infection.Conclusions The short-term effect of both groups are the same,but the recurrent rate and incidence of adverse reactions of MMF group are lower than those of the CTX group.The preliminary study shows that IMPDH2 gene polymorphisms is associated with MMF curative effect and adverse reactions.

Objective·To evaluate the changes in cognitive function in overweight and obese adolescents,and explore the association between cognitive function and fibroblast growth factor 21(FGF21).Methods·A total of 175 adolescents from a senior high school in Shanghai were divided into normal weight group(n=50),overweight group(n=50)and obese group(n=75)based on their body mass index(BMI).General information,anthropometric data and laboratory testing indicators of the adolescents were collected and compared.The cognitive function of the three groups of adolescents was assessed by using the accuracy(ACC)and reaction time of Flanker task and n-back task.Enzyme-linked immunosorbent assay(ELISA)was used to detect the serum FGF21 level of the three groups of adolescents.Partial correlation analysis and multiple linear regression model were used to evaluate the correlation between cognitive task performance and anthropometric data and laboratory testing indicators.Results·Compared with the normal weight group,systolic blood pressure,diastolic blood pressure,and the levels of fasting plasma glucose,glycosylated hemoglobin and triacylglycerol in the obese group were higher(all P<0.05).Under congruent or incongruent stimulus conditions in the Flanker task,there was no significant difference in ACC between any two groups;compared with the normal weight and overweight groups,the reaction time of the adolescents in the obese group was prolonged(all P<0.05).In the n-back task,there were no significant differences in ACC between any two groups,while the obese group had longer reaction time in the 1-back and 2-back tasks compared to the normal weight and overweight groups(all P<0.05).Compared with the normal weight group,serum FGF21 levels of the adolescents in the obese group were higher(P=0.000).Partial correlation analysis showed that the reaction time of the adolescents in Flanker and n-back tasks was correlated with their BMI,body fat mass,waist circumference,waist-to-hip ratio and FGF21 level(all P<0.05).Multiple linear regression analysis further confirmed that BMI was associated with prolonged reaction time in cognitive-related behavioral tasks in the adolescents(all P<0.05),and FGF21 level was associated with ACC in the 2-back task(P=0.000)and reaction time in the incongruent stimulus condition(P=0.048).Conclusion·Overweight and obese adolescents have cognitive impairments,and BMI and serum FGF21 levels are associated with changes in their cognitive function.