Caffeine has been applied in clinic more than 30years,nowadays,which is one of the safe and effective drugs for the treatment of neonatal disease.It has been proved that caffeine can significantly re-duce the major acute neonatal morbidities include apnea of prematurity,bronchopulmonary dysplasia,severe retinopathy,patent ductus arteriosus with surgical ligation.Moreover,recent research also shown that caffeine can improve babies neurological outcome and lung function.This review summarized the latest progression in the pharmacological characteristics,clinical applications and untoward effect of caffeine.

Objective To study the clinical efficacy of caffeine in premature infants receiving mechanical ventilation and related complications .Method From January 2014 to September 2016, preterm infants (28w≤GA<33w) treated with nasal continuous positive airway pressure (NCPAP) or conventional mechanical ventilation ( CMV ) in neonatal intensive care unit were studied .They were randomly assigned into the caffeine group and the control group .The caffeine group received caffeine when NCPAP ventilation was applied or adjusting to synchronized intermittent mandatory ventilation ( SIMV) mode.The control group was injected with 5%glucose without caffeine .The t test andχ2 test were used to analyze the clinical efficacy and related complications .Result A total of 96 patients receiving NCPAP ventilation were collected ( birth weight between 1300~2100 g), including 51 cases in caffeine group and 45 cases in the control group. 84 cases received CMV ventilation (birth weight between 1000~1499 g), with 43 cases in the caffeine group and 41 cases the control group.Among the NCPAP infants, the incidence of failure to withdraw ventilator (0% vs.13.3%) and the incidence of bronchopulmonary dysplasia (3.9% vs.17.8%) were lower in the caffeine group than the control group .The duration of assisted ventilation and hospital stay in the caffeine group were shorter than the control group [(6.2 ±3.1) d vs.(8.2 ±3.2) d, (16.3 ±8.7) d vs. (19.5 ±9.2) d], the differences were statistically significant (P<0.05).Among the CMV infants, the incidence of failure of A/C to SIMV mode transition and bronchopulmonary dysplasia were lower in the caffeine group than the control group and the duration of assisted ventilation and hospital stay were shorter . The differences were statistically significant ( P <0.05 ) . No differences were found in the related complications in each group ( P>0.05) . Conclusion Caffeine can help reduce the incidences of withdrawal failure, bronchopulmonary dysplasia , ventilation duration and hospital stay when using NCPAP and CMV ventilation.

Objective To study the effect of dopamine D1 receptor antagonist SCH23390 on the behavior of parkinsonian (PD) rats and on electrophysiological characteristics of the entopeduncular nucleus (EP).Methods Intracranial injection of 6-OHDA was conducted in 23 adult male Wistar rats to create PD animal models (experimental group) while the same amount of normal saline was injected in another 19 rats as a control group.(1) After intraperitoneal injection of SCH23390 at various concentrations of 0.010,0.015,0.020,0.025 and 0.030 mg/kg,the step frequency and the discontinuous moving frequency tests were carried out to determine the optimal concentration and time of intervention at 6 time points (10 main before,and 5～15,20～30,30～40,40～50 and 68～78 min after intervention) when all the rats were put on a treadmill at a speed of 8 r/min.(2) After recording electrodes were implanted into the EP in the rats,the signals of spikes in the EP in still and movement conditions were recorded simultaneously using the 16-Channel OmniPlex Neural Data Acquisition System.The spike signals collected were imported into Offiine Sorter to do cluster-sorting analysis and then into NeuroExplorer to analyze alterations in the firing pattern and firing rate of each type of neuron.(3) Frozen sections of the brain samples harvested by perfusion from the rats in the 2 groups were subjected to Nissl's staining and histological assay.Results (1) The behavioral tests showed that intraperitoneal injection of SCH23390 at 0.020 mg/kg at time points of 20～30 min and 30～40 min was optimal.The step frequency for the experimental group (24.47±1.35 step/min) was significantly decreased compared with that for the control group (30.77±2.06 step/min) (t=7.392,P=0.000).(2) After intervention by SCH23390,in movement and still conditions,the firing rate and variation coefficient of EP neurons were significantly higher in the experimental group than in the control group (P＜0.05).(3) The Nissl's staining showed a small number of lightly stained neurons were sparsely disposed in the injured cerebral substantia nigra and the histological assay found altogether 14 rats from which correct EP sites were collected.Conclusions This study demonstrated a negative regulating effect of dopamine D1 receptor antagonist SCH23390 on the behavior of PD rats,which may be exerted by changing the electrophysiological activity of EP.

Objective:To investigate the efficacy and adverse reactions of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) combined with chemotherapy in the treatment of superior mediastinal lymph node metastasis after esophageal cancer surgery.Methods:The clinical data of 72 patients with concurrent chemoradiotherapy for superior mediastinal lymph node metastasis after esophageal cancer surgery in Tai'an Cancer Prevention and Treatment Hospital from January 2019 to May 2021 were retrospectively analyzed, and they were divided into intensity-modulated radiotherapy (IMRT) group (36 cases) and SIB-IMRT group (36 cases) according to different radiotherapy methods. The short-term efficacy, long-term survival rate and adverse reactions of the two groups were compared.Results:The response rate in the IMRT group was 66.7% (24/36), the response rate in the SIB-IMRT group was 86.1% (31/36), and the difference between the two groups was statistically significant ( χ2 = 3.77, P = 0.047). The 1-, 2- and 3-year overall survival rates in the IMRT group were 75.0%, 44.4% and 27.8%, and the 1-, 2- and 3-year overall survival rates in the SIB-IMRT group were 83.3%, 52.8% and 33.3%; the difference in the overall survival between the two groups was not statistically significant ( χ2 = 0.70, P = 0.401). There were statistical differences in the incidence of leukopenia, radiation esophagitis and radiation pleural gastritis between the two groups (all P < 0.05). There were no statistical differences in the incidence of radiation pneumonia and gastrointestinal reactions between the two groups (both P > 0.05). Conclusions:SIB-IMRT combined with chemotherapy in patients with superior mediastinal lymph node metastasis after esophageal cancer surgery has good local control rate and mild adverse reactions.

Objective:To explore the application value of humidifying high-flow nasal cannula oxygen therapy (HHFNC) in children with pediatric intensive care unit (PICU) after weaning.Methods:From January 2018 to October 2021, 42 children with endotracheal intubation admitted to PICU of Tai′an city Central Hospital were prospectively selected and randomly divided into HHFNC group and nasal continuous positive airway pressure (NCPAP) group, with 21 patients in each group. The blood gas analysis [arterial partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide in artery (PaCO 2), PaO 2/oxygen concentration (FiO 2)], blood oxygen saturation (SaO 2), comfort, non-invasive ventilation time, and total hospital stay of the two groups of children 1 hour after using HHFNC and NCPAP were compared, and the rate of reintubation of trachea within 48 hours, gastroesophageal reflux, nasal injury, facial skin indentation, abdominal distension, and pulmonary air leakage were recorded. Results:There was no significant difference between the two groups in terms of blood gas analysis (PaO 2, PaCO 2, PaO 2/FiO 2), SaO 2, pulmonary air leakage, non-invasive ventilation time, hospital stay, and reintubation rate within 48 h after weaning (all P>0.05). Compared with NCPAP group, HHFNC group had higher comfort, lower incidence of facial skin indentation, gastroesophageal reflux, nasal injury and abdominal distension, and the difference was statistically significant (all P<0.05). Conclusions:HHFNC and NCPAP can both be used as the transitional respiratory support mode after weaning, and the clinical treatment effect are similar. The HHFNC group has higher comfort, which is more conducive to improving the tolerance of children, reducing adverse reactions, and has higher safety.