Objective Some children with congenital heart defect would get serious acute respiratory distress syndrome in ICU postoperatively,which is a tough problem.We summarized the clinical effects of synchronized intermittent mandatory ventilation (SIMV)with expiratory high frequency ventilation (HFV) for these patients in our center.Methods A total of 13 pediatric patients,with(8.15 ±4.34)months old and (8.23 ±4.01 )kg weight,used SIMV with expiratory HFV from Jan 2012 to Aug 2013.Keeping the original SIMV conditions unchanged,the expiratory oscillation amplitude were 25 to 35 Ann(A)and the oscillation frequency of 7 to 9 hertz(Hz).All patients were divided into two groups to oxygenation index(OI)30 min before HFV,high OI group(OI≤20,n ﹦5)and low OI group(OI 〈20,n ﹦8).OI ﹦MAP ×FiO2 /PaO2 .The values of OI,PaO2 /FiO2 and PaCO2 of two groups were monitored before and at 2,6,24,48 h after HFV re-spectively.Results The values of OI of all 13 patients were 19.31 ±4.42 before HFV,and then decreased to 18.77 ±5.18,16.00 ±5.22,14.77 ±6.56,and 13.92 ±6.53 respectively at 2,6,24 and 48 hours later (P 〈0.01 ).But there was no significant difference of OI in high OI group in different time points.The val-ues of PaCO2 of all 13 patients were(43.46 ±5.67)mmHg(1 mmHg ﹦0.133 kPa)before HFV,and de-creased to(38.31 ±4.21)mmHg,(37.61 ±3.36)mmHg,(34.77 ±3.81 )mmHg,and(35.92 ±2.39)mmHg respectively at 2,6,24,and 48 hours after HFV(P 〈0.01 ).Three dead patients were all in high OI group. Conclusion The mortality rate of serious acute respiratory distress syndrome with congenital heart diseases postoperatively is high.SIMV with expiratory HFV can improve oxygenation and reduce carbon dioxide,and the effect is better when OI 〈20.

Objective To investigate the correlation between the features of multimodal magnetic resonance imaging (MRI) and the expression of human epidermal growth factor receptor-2 (HER-2) in ductal carcinoma in situ (DCIS). Methods A total of 53 patients with DCIS confirmed by surgery and pathology in Dezhou Second People’s Hospital from September 2018 to June 2021 were analyzed retrospectively. The patients were divided into HER-2 positive group (29 cases) and HER-2 negative group (24 cases). MRI features were compared between the two groups. Results There were significant differences in the internal enhancement characteristics, microvascular sign, and time-intensity curve type between the two groups (P < 0.05). There were no significant differences in lesion morphology, non-mass-like enhancement pattern, and apparent diffusion coefficient value (P > 0.05). The HER-2 positive group showed clumped enhancement (65.5%), type Ⅱ (48.1%) andtype Ⅲ (29.6%) time-intensity curves, and microvascular sign (89.7%). The HER-2 negative group showed clusteredring enhancement (50.0%), type Ⅱ (45.8%) and type I (54.2%) time-intensity curves, and microvascular sign (54.2%). A combination of clumped enhancement, microvascular sign, and type Ⅲ time-intensity curve showed 100% specificity and 100% positive predictive value for the diagnosis of HER-2 positive DCIS. Conclusion Clumped enhancement, microvascular sign, and type Ⅱ or Ⅲ time-intensity curve on MRI can largely reflect the expression of HER-2 in DCIS. The three can be used in combination to improve the diagnostic efficiency of HER-2 positive DCIS.

Objective To explore the value of ¹⁸F-FDG PET/CT in the diagnosis of cholangiocarcinoma. Methods Data were collected from 44 patients with cholangiocarcinoma who underwent PET/CT in Affiliated Cancer Hospital of Shandong First Medical University from September 2017 to October 2020. All patients underwent upper abdominal CT and MRI and whole-body PET/CT. The diagnostic value of three examinations was compared for primary lesions, recurrent lesions, and regional lymph node metastasis of cholangiocarcinoma. Results There were no significant differences in the diagnostic sensitivity of CT, MRI, and PET/CT in the primary lesions and regional lymph node metastasis of cholangiocarcinoma (P > 0.05). There were significant differences in the diagnostic sensitivity of the three examinations for recurrent cholangiocarcinoma lesions (P < 0.05). Conclusion PET/CT has high diagnostic value for recurrent lesions of cholangiocarcinoma, but the three examinations showed no significant differences in the diagnostic sensitivity for primary lesions and regional lymph node metastasis.