Early weaning from mechanical ventilation in children will lead to an extubation failure,however,prolonging mechanical ventilation will increase the risk of ventilator associated complication and the economical burden of disease.Nowadays there is no unified and objective ventilator weaning indexes in pediatrics,so it is significant to searching for appropriate and feasible ventilator weaning indexes.This article detailed the current progress on the condition and predictors of ventilator weaning in children,and comparing the predictability and accuracy of ventilator weaning indexes in children,also looking forward to the possibility of higher accuracy or scheme in ventilator weaning that used for clinical purposes.

Objective Study on the best drug compatibility for the double-lumen endobronchial intubation anesthesia. Methods Eighty ASA Ⅰ - Ⅱ patients undergoing selective thoracis surgery requiring intubation with double-lumen tubes were randomly divided into A and B group, with 40 cases in each group.The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), were recorded before induction (T0) , after drug injection (T1), during intubation (T2), and at 1 min (T3), 3 min (T4)and 5 min (T5) after intubation. Results There was no significant difference in SBP, DBP and HR between the two groups at T0[(124. 9 ± 16. 0) mmHg vs (125.8 ±6. 4) mmHg, (73. 1 ±9. 9)mmHg vs (74. 3± 10. 4) mmHg, (81.8 ± 6. 6) times/min vs (82. 4 ± 8. 1) times/min] (P ＞ 0. 05). Compared with parameter at T0, SBP, DBP and HR, parameters in two groups in T1 were all significantly decreased after anesthesia [(94. 8 ± 10. 03) mmHg vs (96. 9 ± 10. 1) mmHg, (57. 3 ± 7. 66) mmHg vs (55.4 ± 7. 03) mmHg,(69. 6 ± 7. 43) times/min vs (66. 3 ± 7. 03) times/min] (P ＜ 0. 05). The cardiovascular parameters at T0,T2, T3, T4 were all comparable with those in group B [SBP: (130 ± 11.6) mmHg, (125.6 ± 10. 43) mmHg,(120. 1 ± 12. 3)mmHg,(116. 8± 11.4)mmHg;DBP:(75.6 ±9. 12)mmHg,(76. 2 ±9. 8)mmHg,(73. 1 ±9. 2) mmHg, (71.6 ± 8.46) mmHg; HR: (88 ± 9. 12) times/min, (82. 9 ± 7.5) times/min, (81.9 ± 8.2)times/min, (79. 9 ± 7. 8) times/min] (P ＞ 0. 05) , which were significantly higher than those in group A [SBP: (146. 3 ± 14. 2) mmHg, (141.2 ± 10. 63) mmHg, (137. 2 ± 13.23) mmHg, (122. 9 ± 11.6) mmHg;DBP: (94. 9 ± 10. 6) mmHg, (84 ± 9.63) mmHg, (79. 9 ± 9) mmHg, (75.8 ± 8. 3) mmHg; HR: (102 ±10. 63) times/min, (97.6 ± 9. 23) times/min, (87. 7 ± 8. 2) times/min, (82. 1 ± 7.32) times/min] (P ＜0. 05). The parameters at T2, T3, T4 in group A were obviously higher than those group B (P ＜ 0. 05).Conclusions Cardiovascular response with double-lumen endobronchial intubation by sufentanil-induced was stronger than fentaty, sufentanil had more stable hemodynamic parameters and it worth to be usd in clinic.

Objective To investigate the effect of defecation modes on constipation and anxiety in patients with acute intracerebral hemorrhage.Methods Sixty three conscious patients with acute hintracerebral hemorrhage were recruited in this study.Twenty five patients chose bedside closestool for defecation according their own intention and 38 chose in bed defecation.The incidence of constipation was documented and the severity of anxiety was evaluated with Zung self-rating anxiety scale (SAS) at day 7,14,21 and 28 after admission in two groups.Results Patients using bedside closestool for defecation had significantly lower rate of constipation between day 14-28 after admission (x2 =63.0,P ＜ 0.01) and lower SAS scores at day14,21 and 28 after admission (t =6.7,7.7 and 9.8,all P ＜0.01) than those with in bed defecation.Conclusions The bedside mode of defecation may improve constipation and anxiety in patients with acute intracerebral hemorrhage.

Objective To investigate the effect of nursing ward rounds with doctors on cognition disease of primary caretakers of asthmatic children . Methods According to the admission sequence, 82 asthmatic patients and their primary caretakers were set as the control group, 76 asthmatic patients and their primary caretakers were set as the observation group. The control group adopted the traditional method of separating ward rounds between doctors and nurses. The observation group used the method of nursing ward rounds with doctors. Then their differences were compared in terms of cognition of disease and medical compliance of these two groups′primary caretakers. Result The observation group was significantly better than the control group in terms of the cognition of disease and medical compliance (P<0.01). Conclusions The method of nursing ward rounds with doctors can improve the cognition of disease and medical compliance of the asthmatic patients′ primary caretakers. It can effectively monitor and manage the asthmatic patients and control the disease recurrence. As effective ward rounds, it is worth in clinical application.

Objective: To explore the working methods of clinical pharmacists for improving the rationality of drug use through participating in individualized treatment practice for the patients with tumor.Methods: Clinical pharmacists participated in the individualized treatment of the patients with tumor, found out adverse drug interactions, adjusted dosage for the renal insufficiency patients, treated infection or pain and corrected inappropriate drug combination, etc.Results: Clinical pharmacists provided integrated pharmaceutical care and offered medical advice in accordance with the individualized information of patients, which improved the treatment effect and avoided potential adverse drug reactions or adverse events.Conclusion: Clinical pharmacists provide pharmaceutical care and participate in the performance of individualized treatment for cancer patients, which can effectively improve the level of drug treatment.

Objective To measure hepatic blood flow of the normal liver and cirrhotic liver with hepatocellular carcinoma using multi-slice spiral CT(MSCT),and to evaluate the feasibility of the quantitative judgement of classification of liver cirrhosis with CT perfusion imaging.Methods CT dynamic perfusion imaging was performed in 53 subjects,including 32 patients of liver cirrhosis with hepatocellular carcinoma and 21 patients without liver disease(control subjects).The patients of liver cirrhosis with hepatocellular carcinoma were divided into three groups by CT morphologic classification :17 were classified as light liver cirrhosis group,8 as moderate group,7 as severe group.The parameters of CT perfusion included blood flow(BF),blood volume(BV),mean transit time(MTT),hepatic arterial fraction(HAF)and impulse residue function to(IRF To).The parameters were analyzed by the CT perfusion 3 software package(GE)with deconvolution method,and the correlation of the CT morphologic classification of liver cirrhosis with Child-Pugh functional classification was further evaluated.100 g-1,(17.81±6.59)ml/100 g,(9.52±3.08)s,0.20±0.08 and(4.38±2.35)s,respectively,while 0.27±0. 09 and (4. 14±2. 16)s, respectively. The mean BF, BV and HAF between normal livers and liver cirrhosis were statistically significant (P＜0. 05), and there were significant statistical differences in BF, BV and HAF among light, moderate and severe liver cirrhosis (P＜0. 05). The CT morphologic classification of liver cirrhosis was correlated positively with Child-Pugh classification (r=0. 935, P=0. 001 ). Conclusions Hepatic perfusion with MSCT can reflect the change of blood flow of cirrhotic liver, and MSCT perfusion can quantitatively evaluate the liver cirrhosis degree of patients with hepatocellular carcinoma.

Background Constipation is a common complication after stroke, and the results investigated overseas showed the incidence was about 30% ～60%. The difference of results is so significant because the time investigated and the diagnosis criterion used are different. There are less relative report about risk factors of constipation and no report about the impact of constipation on pragnosis. The study is to investigate the incidence and risk factors of new-onset constipation after stroke in the patients with acute stroke and to evaluate the impact of new-onset constipation occurrence on the prognosis in the patients.Methods A prospective cohort study of new-onset constipation was performed to investigate 154 cases of acute stroke patients who were hospitalized from December 2003 to October 2004 in the department of neurology, the first Affiliated Hospital of Sun Yat-sen University. We recorded the demographics, medical history,stroke severity and medication used. National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI)and Modified Rankin Scale (MRS) were evaluated in the 1st week and 4th week after stroke to evaluate the neurological function and ability of an independent life. BI and MRS were recorded at the 12th week after stroke.Patients were then followed for the development of stroke, the event such as recurrence or death. Constipation was defined by Rome Ⅱ criteria.Results The incidence of new-onset constipation after stroke within 4 weeks was 55. 31%, and the highest risk was within seven days after onset of stroke. Cox regression showed that the incidence of constipation occurrence was strongly related to neurological functional status of patients in the 1st week assessed by BI and the transform of surrounding for defecation. In the 4th week and 12th week after stroke, the rates of poor prognosis in patients with constipation in middling state were both higher than patients without constipation, and the difference was statistically significant respectively(P ＜ 0. 01 ;P = 0. 012).Conclusions The new-onset constipation occurrence in acute stroke is very common and its main risk factor is functional status assessed by Barthel Index at the 1st week after onset and the transform of surrounding for defecation. The results indicate that the new-onset constipation occurrence after stroke has negative effects on the outcome of partial stroke patients.

Objective　To observe the curative effect and sid e effect of the gastrokinetic agent mosapride citrate by RCT. Methods　 42 cases of functional dyspepsia (FD) were divided into two groups rando mly, the group of mosapride(21 cases):orally administrated mosapride, 5mg, t.i.d for 4 weeks, and the control (21 cases):orally administrated domperidone, 5mg, t.i.d for 4 weeks. Symptoms and side effects were recorded before and at d 14, d 28 after administration of the medicines according to GCP and double blind pri ciple. Gastric empting test was also carried out in randomly selected patients. Results　Mosapride and domperidone were significantly effective on alleviating symptoms of the patient with FD. In mosapride treated group the half emptying time was shortened and the 120 min remain rate was reduced. No sid e effect was found. Conclusion　These results suggest that mosa pride 5 mg t.i.d. is effective and safe on alleviating symptoms of patients with FD and improving the ga stric empting time.

Objective:To explore the clinical pharmaceutical care for cancer pain management. Methods: The intervention time of clinical pharmacists was determined. A comprehensive evaluation of cancer pain, physical function and life quality of patients was performed, the compliance of patients was scored, and individualized pharmaceutical service was carried out,consultation and sugges-tion on analgesics and adjuvant drugs were provided for doctors, and finally, the effect of pharmaceutical care was assessed. Results:Clinical pharmaceutical care could promote the rational drug use and improve the medical quality. Conclusion:Through the research of clinical pharmaceutical care for pain management,clinical pharmacists can play a practical and effective role in the pain treatment and management.

Objective To evaluate the immune response triggered by an in-house constructed hu-man metapneumovirus multi-epitope antigen ( MEA) in a mouse model .Methods Female SPF BALB/c mice at age 4-6 weeks were used in the study and divided into 7 groups.Mice in the five groups including MEA+oligodeoxynucleotides containing CpG motifs ( CpG ODN) intraperitoneal injection ( i.p.) treatment group, MEA+Alum i.p.treatment group, MEA+Alum+CpG ODN i.p.treatment group, MEA+CpG ODN intranasal (i.n.) treatment group and MEA+Alum+CpG ODN i.n.treatment group were immunized three times on days 0, 14 and 21, and those in the other experimental group were immunized intramuscularly with MEA+Quickantibody5W on days 0 and 21.A control group without treatment was set up accordingly .All mice were sacrificed two weeks after the last immunization .Antibodies including IgG , IgG1, IgG2a and IgA in serum samples were detected by ELISA .MTS assay was performed to analyze the proliferation of lympho-cytes.The cytotoxicity of cytotoxic T lymphocytes (CTL) was measured by LDH assay.Flow cytometry was used to detect T lymphocyte subsets .The cytokines secreted by T helper cells ( Th1 and Th2) were analyzed with Bio-Rad Liquid Chips.Results High titers of IgG, IgG1 and IgG2a antibodies were produced in MEA treated mice except for those in intranasal treatment groups .Serum samples from three groups including the MEA+Alum i.p., MEA+Alum+CpG ODN i.p.and MEA+Quickantibody5W i.m.treatment groups were positive for IgA antibody .The highest titer of IgA antibody was detected in mice from the MEA+Alum+CpG ODN i.p.treatment group, which was 2.15×103.Compared with the control group, significantly enhanced proliferation of lymphocytes was observed in the MEA+Alum i.p., MEA+Alum+CpG ODN i.p.and MEA+Quickantibody5W i.m.treatment groups (P<0.05).Enhanced cytotoxic activities of CTL were observed in mice with ip.and i.m.treatments as compared with those in control group (P<0.05).The levels of CD4+/CD8+T cells were slightly increased in mice from the MEA+CpG ODN i.p., MEA+Alum+CpG ODN i.p. and MEA+Quickantibody5W i.m.treatment groups as compared with those in control group (P<0.05).In-creased secretion of IL-2, IFN-γand Th2-type cytokines including IL-4, IL-5 and IL-10 were detected in mice from the MEA+CpG ODN i.p.treatment group.The MEA+Alum i.p.treated mice showed a slightly increased secretion of IFN-γand significantly increased secretions of IL-4, IL-5 and IL-10.Significantly in-creased secretions of IFN-γ, IL-4, IL-5 and IL-10 were detected in mice from the MEA+Alum+CpG ODN i.p.treatment group.Significantly increased secretions of IFN-γ, IL-5, IL-10 and granulocyte-macrophage colony-stimulating factor (GM-CSF) were detected in mice from the MEA+Quickantibody5W i.m.treatment group.Conclusion MEA together with different adjuvants could stimulate high titers of specific antibodies , increase the proliferation of lymphocytes and enhance the cytotoxic activities of CTL .CpG ODN could bal-ance the Th1/Th2-mediated immune responses , and the balance could be enhanced when using CpG ODN in combination with Alum .A similar effect could be achieved by using the commercial adjuvant Quickanti -body5w.This study has paved the way for further investigation on the development of hMPV epitope vaccines and diagnostic reagents for hMPV as well as the epidemiological study of hMPV .