Objective To investigate the decoction use compliance of the children with the pediatric community acquired pneumonia(CAP) by providing the pharmaceutical care from the clinical pharmacist.Methods 252 patients with CAP were divided into the observation group and control group.The patients of the observation group were provided with pharmaceutical care,including drug use education,drug use guiding,etc,while the patients in the control group were not given any pharmaceutical care from the clinical pharmacist.Results The rate decoction use compliance in the observation group was 78.1％,which was 39.1％ in the control group,the difference between the two groups was significant (x2 =12.56,P ＜ 0.05).Conclusion Pharmaceutical care can improve the rate decoction use compliance decrease the drug waste.

With the development of phamacogenomic and molecular biology, it has been revealed that the curative effect of non-small-cell lung cancer (NSCLC) is closely related to tumor molecular markers. Predictive biomarkers in NSCLC patients, including ERCC1, BRCA1, hMLH1, hMSH2, RRM1, β-tubulin, TS,EGFR and K-ras, can predict individual patient's response to chemotherapy or targeted therapy, making individualized therapy be possible.

Objective To evaluate the curative effect and toxicities of platinum-based double regimens for patients aged ≥ 65 with advanced non-small-cell lung cancer (NSCLC) and identify the prognosis factors. Methods 70 patients aged ≥65 with staged ⅢA-Ⅳ NSCLC, who received platinum-based double regimens as first line treatment, were emrolled.Response rates and toxicities were evaluated.Progression free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression analysis was used to identify the potential prognosis factors.Results The median chemotherapy cycles was 3.The overall response rate was 41.5 % (22/53), and there was no difference between patients aged ＜70 and ≥70 (χ2 =1.945, P =0.378).The median PFS and OS were 6.0 months and 12.5 months.The chemotherapyrelated hematologic toxicities were common.Multivariate analysis revealed that performance status, numbers of metastasis, chemotherapy cycles were significant independent predictive factors for OS. Conclusion In elderly advanced NSCLC, platinum-based doublets show inspiring efficacy, but with more adverse events, and could not be all well tolerated. It should be personalized. Patients with poor performance status and multiple organs metastasis are hard to benefit from combined chemotherapy.Three to six cycles of chemotherapy is the optimal duration for patients who could be well tolerated.

24.34, the sensitivity and specificity were 95.0% and 75.8%, respectively. Conclusion: The autofluorescence spectrum of dilute gastric juice may become an effective means in the diagnosis and screening of gastric carcinoma.

Objective:To investigate the therapeutic efficacy and potential mechanisms of integrin α vβ 3-targeted radionuclide therapy (TRT) in combination with anti-programmed cell death protein ligand 1 (PD-L1) immunotherapy. Methods:Integrin α vβ 3-targeted molecule Arg-Gly-Asp (RGD) was conjugated with Evans blue (EB) and then labeled with 177Lu to obtain 177Lu-EB-RGD. The radioactivity and radiochemical purity were determined. MicroSPECT imaging, biodistribution, and in vivo therapeutic efficacy were subsequently performed in MC38 murine colon cancer models. Volume of tumor and body mass of mice were observed to assess the therapeutic efficacy and safety ( n=9 in each group). Flow cytometry was used to evaluate therapy response of saline-treated (control, group A), 18.5 MBq 177Lu-EB-RGD-treated (group B), 10 mg/kg PD-L1 antibody-treated (group C), TRT combined with immunotherapy-treated (group D, 18.5 MBq 177Lu-EB-RGD and 10 mg/kg PD-L1 antibody) mice and alterations in tumor microenvironment (PD-L1 + immune cells, CD8 + T cells and regulatory T cells). Independent-sample t test and repeated measures analysis of variance were used for data analysis. Results:The radioactivity of 177Lu-EB-RGD was (55.85±14.00) GBq/μmol. SPECT imaging clearly visualized the MC38 tumors in mice models with high uptake and long retention time, the tumor/muscle ratio reached 14.87±0.88 at 24 h postinjection, while less uptake and retention in normal tissues. Tumor uptake of 177Lu-EB-RGD was significantly higher than that of 177Lu-RGD 4 h post-injection ((12.00±1.60) vs (3.69±0.37) %ID/g; t=8.63, P<0.01). The efficacy results between each treatment group was significantly different ( F=7.32, P=0.03) at day 6 post-treatment. The combination therapy showed the most outstanding anti-tumor efficacy with 7/9 mice showed complete response. Flow cytometry results showed that TRT up-regulated the PD-L1 expression significantly, namely, PD-L1 + immune cells in group B and group A were significantly different (CD45 + /PD-L1: 2.34% vs 0.95%, CD11b + /PD-L1: 2.41% vs 0.66%; t values: 11.17 and 8.70, both P<0.01); immunotherapy and combination therapy dramatically stimulated the infiltration of CD8 + T cells (2.07% vs 0.26%, 2.71% vs 0.26%; t values: 4.10 and 6.03, both P<0.05). Conclusion:TRT in combination with immunotherapy synergistically enhance anti-tumor efficacy, which is expected to play a role in the treatment of patients with advanced tumor where TRT can be applied.

Objective To summarize the experience of cannulation for extracorporeal membrane oxygenation (ECMO) in infants less than 5 kg. Methods Eleven infants with ECMO support who weighed less than 5 kg were admitted to critical care medicine of Guangzhou Women and Children's Medical Center from June 2016 to June 2018 were enrolled. Retrospective analysis of support type, configuration, site of cannula and complication of ECMO was performed. Results The 11 infants consisted of 9 males and 2 females. The weight on ECMO of 1.96-4.60 kg, with an average of (3.14±0.65) kg; age 0.1-30.0 days, with a median of 5.6 (1.5, 8.3) days. Four cases were given ECMO because of congenital diaphragmatic hernia with severe pulmonary hypertension and other 7 cases were cannulated due to complication of congenital cardiac surgery. All infants were received veno-arterial (V-A) ECMO. In 4 cases, the cannulas were placed in the right internal jugular vein for drainage (8-10 French catheter with 6.0-7.5 cm depth) and the right carotid artery for infusion (6-8 French catheter with 2.5-3.5 cm depth); the average time of cannulation in right carotid and jugular vessels was (73±20) minutes (range 55-100 minutes). In other 7 cases, the cannulas were inserted into the right atrium (12-14 French catheter with 2.8-3.0 cm depth) for draining blood and returning it to the ascending aorta (6-8 French catheter with 1.0-2.0 cm depth); the average time of cannulation in central vessels was (64±31) minutes (range 35-110 minutes) with exclusion of 2 cases intraoperative cannulation. There were three infants with complications. One episode was shown in vascular rupture, one in catheter site hemorrhage and one in cannula malposition with later repositioning. There was no case of insertion site infection, cannula-related bloodstream infection and accident detached cannula. Conclusion Cannulation for ECMO can be performed in infants less than 5 kg with a high rate of success and a low rate of complication owing to appropriate catheter and skillful cannulation.

Objective:To study the incidences of postoperative complications and nutritional status following different timings of stoma reversal in necrotizing enterocolitis (NEC).Method:From January 2017 to December 2019, NEC patients receiving enterostomy surgery and later stoma reversal in our hospital were retrospectively analyzed. They were assigned into three groups according to the timing of stoma reversal: early group (reversal within 8 weeks of stoma formation), middle group (reversal at 8~12 weeks from stoma formation) and late group (reversal after 12 weeks from stoma formation). Weight-for-age-Z-score (WAZ) was used to evaluate nutritional status.Result:A total of 56 infants were enrolled, including 6 cases in the early group, 11 cases in the middle group, and 39 cases in the late group. The gestational age and birth weight were (33.4±3.4) weeks and (1 894±640) g, respectively. The median age of stoma formation and the interval between stoma formation and reversal were 16.5 (8.0, 28.2) days and 94.0 (76.5, 126.5) days. No significant differences existed on gestational age, birth weight, age of stoma formation and complications of stoma reversal among the three groups ( P>0.05). The incidence of growth retardation (WAZ<-2) was 14.3% at stoma formation, and significantly increased to 62.5% at stoma reversal ( P<0.05). The WAZ at stoma reversal in early, middle and late groups were (-3.2±1.9), (-3.0±1.6) and (-2.3±1.5), without significant differences( P>0.05). The WAZ gradually increased to (-0.7±1.2), (-0.1±2.0) and (-0.1±0.8) at 42~48 weeks after reversal, respectively. Conclusion:The timing of stoma reversal may not influence the complications of reversal. Growth retardation are common in NEC infants with stoma formation and stoma reversal may improve the nutritional status of the infants. Early reversal of stoma is suggested to improve the nutritional status of patients with poor weight gain after stoma formation.

Objective: To compare the difference in imaging and clinical effects between gap balance technique and measured resection technique in total knee arthroplasty (TKA). Methods: We recruited 300 patients undertaking TKA from July 2014 to July 2016. TKA were performed by using gap balance technique or measured resection technique randomly. The intraoperative rotation of femoral prosthesis, changes of joint line, osteotomy volume, preoperative and postoperative KSS score, WOMAC score, VAS and ROM were compared between the two groups. Results: A total of 292 patients were included in the present study, and 248 patients were successfully followed up for 2 years. The operation duration of the gap balance group was 65.9±14.1 min, which was significantly less than that of the measured osteotomy group 70.5±16.5 min (t=2.36, P=0.02). The rotation angle α of the femoral prosthesis measured on CT scan postoperative in gap balance group was 0.67°±1.71°, which was significantly smaller than that of the measured resection technique group 1.25°±2.53° (t=2.12, P=0.03). The external rotation angle β between the osteotomy plate and femoral posterior condyle line in the gap balance group was 1.25°±1.26°, which was significantly greater than that of the measured resection technique 0.28°±0.19° (t=6.57, P<0.01). The bone cut volume of femoral medial posterior condyle in gap balance group 9.85±1.37 mm showed a statistically difference (t=2.02, P=0.04) compared with that of the measured osteotomy group 9.52±1.19 mm. The KSS score was 83.8±10.2 in the gap balance group after 1 month. It was superior to the measured resection technique group of 80.5±9.4 with statistical significance (t=2.65, P=0.01). The knee ROM was 101.7°±12.7° in the gap balance group at 1 month after surgery, which was better than that in the measured resection technique group 98.2°±11.8° (t=2.25, P=0.03). Conclusion The axis of the femoral prosthesis was more consistent with STEA in the gap balance group of TKA. The gap balance group had better ROM and KSS functional scores at the first month after surgery. However, there was no statistical difference in knee function at the 2-year follow-up between the two groups.

This article reported a case of neonatal CHARGE syndrome complicated by congenital esophageal atresia. A prenatal ultrasound examination at 30 weeks of gestation revealed polyhydramnios and a small magenblase of the fetus, then fetal MRI suggested congenital esophageal atresia. The infant was born with severe asphyxia at 37 +5 gestational weeks by cesarean section due to placental abruption with a birth weight of 2 310 g. Gastric tube could not be placed after resuscitation. Congenital esophageal atresia complicated by tracheoesophageal fistula was diagnosed by esophageal imaging. Bilateral choanal atresia was detected by electronic nasopharyngoscopy and MRI. Moreover, skull defect, suspected meningocele were also observed. CHARGE syndrome was confirmed by whole exome sequencing, revealing a frameshift deletion of c.2155delA (p.Thr719GlnfsTer9) in the CHD7 gene. The infant died after withdrawing treatment.

Objective To summarize the experience of perioperative management for repair of congenital diaphragmatic hernia (CDH) supported by extracorporeal membrane oxygenation (ECMO). Method Retrospective review was conducted for the clinical data of CDH patients who received surgical repair on ECMO from December 2016 to June 2018 in Guangzhou Women and Children's Medical Center. Result Four fetus with prenatal diagnosis of left-side CDH were transferred to our Center and received standardized perinatal management. Moderate-severe pulmonary hypoplasia was recognized after evaluation by fetal imaging. Four cases were initiated with veno-arterial ECMO at 3, 35, 41, 11 h of life, respectively. Repair of the diaphragmatic defect was performed within two weeks after cannulation of ECMO. Furthermore, activated clotting time goals were adjusted to 180～220 s, activated partial thromboplastin time were stabilized between 50～80 s, platelets count were maintained>100×109/L and hematocrit was kept>30％before the surgery. The surgeries of four patients were completed on the 0.9th, 0.5th, 3.6th, 5.1th day of life on ECMO, respectively. The defect was repaired by parachute patch. The operative time was 85～210 min. According to CDH Staging System defect size (A to D), there were two with defects at grade C and other two at grade D. Postoperative total volume of drainage was 215～1301 ml and ECMO duration was 3.0～39.3 d. Three of them survived during neonatal period, while one died. Conclusion Repair of CDH on ECMO is feasible and help to improve neonatal survival, especially for those with moderate-severe pulmonary hypoplasia.