Mechanical ventilation plays an important role in the treatment of preterm infants,especially respiratory problems.With improvement in both antenatal and neonatal care and therapeutic strategies,premature babies are surviving more than ever.However,the incidence of bronchpulmonary dysplasia remains high which affects the clihical outcomes of premature infants.Non-invasive respiratory support techniques have been used in attempts to decrease lung injury and the complications of preterm infants.This review will focus on various ventilation modalities for managing preterm infants with respiratory failure and lung protective ventilation strategies to minimize lung injury in preterm infants.

Objective To study the clinical value of fat-suppression(FS)sequence and dynamic contrast-enhanced MRI in judging the nature of breast neoplasm.Methods Sixty patients with breast neoplasm(including malignant lesions in 40 cases and benign lesions in 20 cases)proved by histopathology were reviewed.All patients were undergone FS sequence and 30 cases underwent dynamic contrast-enhanced MRI examinations,time-signal curves were acquired.Results 22 malignant lesions in 20 cases and 46 benign lesions in 40 cases were found by FS.Dynamic contrast-enhanced MRI showed 18 malignant and 20 benign lesions.The malignant lesions had visible contrast-enhancement of administration of Gd-DTPA.Type Ⅲ curve was showed in 16 lesions(malignant in 14 and benign in 2),type Ⅱ in 5(malignant in 3 and benign in 2)and type Ⅰ in 17(malignant in 1 and benign in 16).There was significant difference between benign and malignant tumors on the type of time-signal curve(P

With the continuous rise of the elderly population in China,the aging phenomenon is becoming more and more severe,and it has become a major problem for social development.As a result,the demand for aging services is growing rapidly,but the supply of aging service management professionals is lagging behind and the gap between the two is deepening.This paper aims to provide a valuable reference and inspiration for China's education reform and practice in this field through a thorough study and comparative analysis of the training models of aging service management programs in United States colleges.This paper synchronized and analyzed similarities and differences in the aging service management programs between China and the United States in training objectives,admission requirements,and graduation requirements.This paper also reported the successful experience and unique advantages of the United States in the training of aging service management professionals.Based on the in-depth analysis of the talent training model of the colleges that offer aging service management educational programs in the United States,the aim of the systematic reform and innovation is to provide a solid supply guarantee and intellectual support for the healthy and harmonious development of China's aging society.Meanwhile,it will also effectively promote the smooth implementation of the national aging development strategy.

Objective To investigate the clinical outcome and placental characteristics of spontaneous twin anemia-polycythemia sequence (sTAPS). Methods Twelve cases with sTAPS delivered in Peking University Third Hospital from May 2013 to August 2016. The data of ultrasound characteristics, gestational age at delivery, and 1 minute Apgar score were analyzed,retrospectively. Placental superficial vascular anastomoses, placental territory discordance and the ratio of umbilical cords insertion distance to the longest placental diameter were also analyzed. Results (1) Only 1 case of sTAPS was diagnosed prenatally, the others were diagnosed postnatally because the fetal middle cerebral artery(MCA) doppler was not measured regularly. Five cases were complicated with selective intrauterine growth restriction (sIUGR). The median gestational age at delivery was 32.8 weeks(31-37 weeks). The pregnancies were terminated because 3 cases were sIUGR typeⅠ, 1 case was sIUGR type Ⅱ, 1 case was sIUGR type Ⅲ, 2 cases were fetal distress, 2 cases were severe pre-eclampsia, 2 cases were premature rupture of membrane, 1 case was fetal hydrops with abnormal doppler waveforms of ductus venouses. (2) When 5 sIUGR cases were excluded, there was no difference between the twins in birth weight [1797 g(940-2620 g),1648 g(980-2500 g);P=0.688]. The hemoglobin (Hb) level in all donor was significantly lower than recipient(P=0.000)and the inter-twin Hb difference was 147.6 g/L (84.0-216.0 g/L). While the reticulocyte percentage in donor was significantly higher than recipient (P=0.013) and reticulocyte percentage ratio was 3.60 (1.04-7.50). Five donor newborns had neonatal asphyxia, including 1 severe asphyxia, while no asphyxia happened in the recipient twins. (3) Arterio-arterial (A-A) anastomoses, veno-venous (V-V) anastomoses, arterio-venous (A-V) anastomoses were found in 3, 1 and 11 placentas, respectively. The total number of anastomoses was 2 (1-5) and the total diameter was 1.1 mm (0.4-2.1 mm), including 0 (0-1) A-A anastomoses with 0.2 mm (0.0-0.9 mm) in diameter and 2 (0-5) A-V anastomoses with 0.7 mm (0.0-2.1 mm) in diameter. The placental territory discordance was 0.17 (0.02-0.40) and the ratio of umbilical cords insertion to the longest placental diameter was 0.82 (0.34-0.99). Conclusions The pathogenesis of sTAPS might result from slow and chronic blood transfusion from donor to recipient through a few minuscule vascular anastomoses in the placenta. In all monochorionic twins, especially sIUGR cases, MCA doppler should be monitored closely in the second and third trimester, in order to diagnose and manage sTAPS in time.

Objective To design a system for real-time monitoring patients Based on Zigbee.Methods A wireless monitoring system was developed,the hardware of which was based on micro-cpu of MCS08 and Zigbee chip MC13192.Results Through this wireless system,doctors and nurses could know the location and physical situation of patients in real time so that the patients who were critically ill could be treated in time and the work of doctors and nurses could be relieved.Conclusion The system for monitoring patients in hospital based on Zigbee meets the nosocomial condition and can raise curative efficiency.

Objective:To study the molecular composition of bismuth potassium citrate. Methods:The content of bismuth was de-termined using a volumetric method, the content of potassium was determined by atomic absorption spectrometry, and the content of cit-rate root was determined by ion chromatography. The structure was predicted using 1 HNMR and the crystal structure was studied using X-diffraction test and scanning electron microscopy. The changes in the percentage ratio of the three components were investigated by accelerated stability tests. Results:On the dried basis, the percentage of the three molecular components was bismuth of 35%-38%, potassium of 7%-11% and root citrate of 49%-52%. The NMR spectra and the data indicated that the product had three isomers with the molecular structure of bismuth∶potassium∶root citrate=2∶2∶2. The X-diffraction test and SEM showed that the three forms of amor-phous, monocrystalline and polycrystalline might exist. The percentage ratio of the three elements before and after the stability test was basically stable. Conclusion:Bismuth potassium citrate may have three crystal forms with the percentage of the three structure parts within a certain range, and the structure is relatively stable.

Objective To evaluate the efficacy of fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in treatment of twin-twin transfusion syndrome (TTTS) and to investigate the incidence of TTTS complicated with selective intrauterine growth restriction (sIUGR) for better understanding the effects of sIUGR as a complication of TTTS on pregnancy outcomes. Methods A retrospective study was performed on 116 gravidas who were diagnosed with TTTS of Quintero stage Ⅰ - Ⅳ in Peking University Third Hospital from September 2008 to September 2014. Among them, 44 cases received FLOC therapy. The incidences of sIUGR in each Quintero stage of TTTS were analyzed. Pregnancy outcomes of those 44 cases treated with FLOC were observed and the differences among four stage groups were analyzed. Chi-square or Fisher exact test was performed for statistical analysis. Results (1) The survival rates of both twins from stage Ⅰ to Ⅳ groups were 4/7, 10/14, 5/19 and 3/4, respectively, with statistically significant difference (χ2=7.840, P=0.038), but that in stage Ⅲ group was lower than in stage Ⅱ group without significant difference (P'=0.008). Differences in the total fetal survival rate among the four groups were statistically significant [8/14, 75% (21/28), 32% (12/38) and 6/8, χ2=14.016, P=0.002]. The total fetal survival rate in stage Ⅲ group was significantly lower than that in stageⅡ group (P'<0.008). In patients with stage Ⅲ TTTS, those complicated with sIUGR, after receiving FLOC therapy, showed a lower total fetal survival rate than those without sIUGR [21% (6/28) vs 6/10, P<0.05]. (2) Among the 116 TTTS patients, there were 63 cases (54%) with sIUGR complication. Patients with sIUGR complication in TTTS stages Ⅰ to Ⅳ groups accounted for 40% (14/35), 48% (11/23), 78% (28/36) and 46% (10/22), respectively, and the differences were significant (χ2=11.963,P=0.007). The incidence of sIUGR in stage Ⅲ group was greater than that in stage Ⅰ group (χ2=10.482, P'=0.002), and those in both stage Ⅲ and Ⅱ groups were higher than in stage Ⅰgroup without significant difference. Conclusions TTTS patients in stage Ⅲ have lower survival rate of both twins and total fetal survival rates after FLOC therapy, which may be related to a higher incidence of concurrent sIUGR.

Objective:To define doctors professional risk connotation , the scientific judgment doctors profes-sional risk fact , seek medical professional risk guard against and dissolve the long -term mechanism , maintaining safety and legitimate rights and interests of the doctor′s body and mind .Methods:Using doctor -patient relation-ship as the research background , adopts the questionnaire survey , through the survey data analysis of the correla-tion between the doctor-patient relationship and the doctor professional risk , on the basis of the young workers , for example , the empirical research doctors professional risk existing conditions and the reality .Results:The doctor-patient relationship nervous career anxiety and unease , doctor of job burnout and the harm done by the profession itself, complicated medical environment cannot effectively solve the doctor occupational safety crisis , institutional arrangements and the prevention and control mechanism is not reasonable career crisis .Conclusion:The govern-ment should strengthen the professional risk management system design and the prevention and control institutions and hospitals to strengthen the construction of professional risk management and prevention and control system , the doctor should promote occupational consciousness of risk prevention and control and doctor -patient communication ability, the society should strengthen professional risk management and the prevention and control of environmental regulation .

BACKGROUND: The therapeutic effects of acupuncture on weight loss have been verified. How does the central neural system act on weight loss with acupuncture?What relationships are there between the central regulation and peripheral action?OBJECTIVE: To study the effect of acupuncture on feeding center of hypothalamus in obese cases.DESIGN: Randomized and controlled study in which the experimental animals were taken as the subjects.SETTING: Clinical medical college of a university of traditional chinese medicine.MATERIALS: The experiment was performed in Key Laboratory of Acupuncture and Moxibustion in Nanjing University of Traditional Chinese Medicine from June 1998 to January 2000. Fifty SD male rats were employed and randomized into acupuncture group, obese group and normal group.METHODS: The experimental obese model was prepared by feeding SD rats with high-fat forage. Microelectrode record of nerve cell and cerebral stereotaxic technique were applied, by the treatment with acupuncture on experimental obese rats, the electric activity (Hz) of nerve cell was observed at unit time in hunger center of lateral hypothalamus area(LHA) and satiety center of ventral medium nucleus of hypothalamus(VMH).MAIN OUTCOME MEASURES: Mass changes at the same stage before and after acupuncture in rats of every group and discharge frequency in LHA and VMH in rats of every group.RESULTS: Acupuncture reduced remarkably the excitability in LHA, the values of which in acupuncture, obese and normal groups were(9.4 ± 3.7),(21.4 ± 6. 8), (9. 1 ± 5.2) Hz respectively( P < 0. 01 ); improved electric activity frequency in VMH, the values of which in 3 groups were (21.1 ± 4. 3), (5.0 ± 1.3), ( 14. 5 ± 2. 2)Hz, respectively( P < 0.01 ), inhibited excessive appetite of obese rats and reduced calorie intake so as to achieve weight loss.CONCLUSION: The regulation of acupuncture on central neural nuclei in obese animals is one of the important mechanisms on weight loss.

Objective To observe the clinical efficacy of warm needling plus Chinese medicinal fumigation in treating rheumatoid arthritis (RA) due to cold-dampness.Method Fifty-three patients with RA due to cold-dampness were randomized into a treatment group of 27 cases and a control group of 26 cases. The control group was intervened by conventional medication, while the treatment group was by warm needling plus Chinese medicinal fumigation in addition to the medication used in the control group. The Visual Analogue Scale (VAS), joint symptom parameters, Score of Quantified Syndrome of Traditional Chinese Medicine, Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were observed before and after treatment, and the effective rate was evaluated by using the criteria stipulated by the American College of Rheumatology (ACR20).Result The VAS scores, joint symptom parameters, scores of quantified syndrome of traditional Chinese medicine, and HAQ were significantly changed after treatment in both groups (P<0.05). After treatment, the VAS score, joint swelling score, painful joint count, morning stiff duration, Score of Quantified Syndrome of Traditional Chinese Medicine, and HAQ in the treatment group were significantly different from that in the control group (P<0.05). The ESR and CRP levels were markedly changed after treatment in both groups (P<0.05). After treatment, the ESR and CRP levels in the treatment group were significantly different from that in the control group (P<0.05). The total effective rate was 74.1% in the treatment group versus 57.7% in the control group, and the difference was statistically significant (P<0.05).Conclusion Warm needling plus Chinese medicinal fumigation is an effective method in treating RA due to cold-dampness.