Objective To investigate the risk factors of feeding intolerance in preterm infants and provide reference for the prevention and intervention.Methods Two hundred and Seventy preterm infants were included in the study.The clinical data were collected to analyze the risk factors.Results There were 108 cases showed feeding intolerance.Gestational age,weight,1 minute Apgar,fetal distress,application of aminophylline,stomach bleeding,application of ventilator,prenatal use of GCs,abnormal placenta,perinatal infection were related factors of feeding intolerance in preterm infants.Multivariate Logistic regression analysis showed that application of aminophylline,stomach bleeding,application of ventilator were the independent risk factors of premature infants with feeding intolerance,gestational age was protective factors of feeding intolerance.Conclusion Premature infants with feeding intolerance caused by a variety of factors,and the reasonable measures of prevention and intervention were needed.

Objective To summarize the risk factors of head up tilt test (HUTT) in children with vasovagal syncope,and provide theoretical reference for the diagnosis of vasovagal syncope.Methods The total of 340 children with headache and syncope were included in the study,all the cases received HUTT,including basic tilt table test and sublingual nitroglycerin test.And they were divided into HUTT positive group and HUTT negative group according to the results.The clinical information of two groups was analyzed by multivariate Logistic regression to summarize risk factors.Results The frequency of syncope in HUTT positive group was 2.3 ± 1.1,significantly higher than that in HUTT negative group (0.7 ±0.2),chest tightness and blurred vision ratios were significandy higher than those in HUTT negative group (84/186,48/186 vs.34/154,23/154).Single factor analysis showed,older than 12 years old,female,blurred vision,with history and genetic history of syncope,numerous of syncope,chest tightness,fatigue were related factors as positive results for HUTT.Multivariate Logistic regression analysis showed,older than 12 years old,female,with history and genetic history of syncope were independent risk factors of positive HUTF.β was 0.744,1.126,1.312,0.514 respectively,95％ CI was 1.132-5.968,1.985-5.040,1.366-9.677,1.683-6.532 respectively.Conclusion Age,gender,family history,history of syncope have important significance to predict HUTT results.

Objective To develop a high stability and wide coverage network with power cat technology to promote hospital informatization.Methods The common network layout methods were compared,and the advantages of power cat technology were introduced when used for network layout.A series or parallel connection method was used to lay the power cat in the existing power line,and to achieve the full coverage of the hospital network.Results Power cat technology gained advantages in high efficiency,low cost and high stability when used for network layout.Conclusion A stable,economic and convenient network is constructed in the hospital with power cat technology.

Objective To retrospectively analyze the MRI findings of epithelioid angiomyolipoma (EAML) of the liver.Methods The MR findings in a series of 8 patients with pathologically proven liver EAML were retrospectively analyzed. Distribution of lesions, signal intensity characteristics, tumor vascularity,feeding arteries and draining veins, fat, hemorrhage, cystic necrosis and pseudocapsule formation were evaluated and correlated with pathology.Results A single lesion was found in each of the 8 patients.All eight lesions showed long T1,long T2 inhomogeneous signal,and high DWI signal. There was only 1 lesion presented with fat,3 lesions presented with hemorrhage. On the dynamic contrastenhanced MRI scan,all 8 lesions manifested as hypervascular with tortuous vasculature in 7 patients.Dilated feeding arteries and draining veins were seen in 5 patients. Conclusion Liver EAML has unique MR imaging features,exhibiting hyperwascular lesions with dialated,tortuous feeding arteries,and draining veins on DCE MRI,which could be helpful in the differential diagnosis of liver EAML.

Objective To investigate the effects of bevacizunab on the antioxidative function of human retinal pigment epithelium (RPE),in order to explore the possible mechanism of macular atrophy induced by the application of anti-vascular epithelial growth factor (VEGF) agents in age-related macular degeneration.Methods Human RPE cells were incubated in DMEM/F12 medium containing 0.25 g · L-1 bevacizumab and divided into 5 groups according to incubation period:0 hour(control),12 hours,24 hours,48 hours and 72 hours,and then the oxidative stress was induced by adding H2O2.Cell viability was measured by the CCK8 assay.MitoSox Red was used to determine mitochondrial reactive oxygen species (mtROS) production.Mitochondrial membrane potential was measured using the JC-1 assay.The expression levels of NOX4 and HO-1 were detected by RT-PCR and Western blot,respectively.Results CCK8 assay determination showed that the above treatment had no significant effect on cell viability,the cell viability of 0 hours,12 hours,24 hours,48 hours and 72 hours were (100.2 ±3.3)％,(99.2 ±2.7)％,(102.5 ±6.4)％,(103.9 ±3.7)％,(103.6 ±3.3)％,the difference was not statistically significant (P ＞ 0.05).Compared with the control group,the levels of mtROS increased at 12 hours,24 hours,48 hours and 72 hours,the difference was statistically significant (P ＜ 0.05).Mitochondrial membrane potential at 12 hours,24 hours,48 hours,72 hours were lower than the control group,the difference was significant,48 hours reached the lowest,72 hours significantly increased,but still lower than the control group.RT-PCR and western blot results demonstrated that the expression of NOX4 mRNA and protein increased at 12 hours,24 hours,48 hours and 72 hours,and reached the highest at 24 hours,then decreased significantly,but still higher than the control group,the difference was statistically significant (P ＜0.01).Compared with the control group,the expression of HO-1 mRNA decreased at 24 hours,48 hours and 72 hours,while the expression of HO-1 protein decreased at 48 hours and 72 hours,the difference was statistically significant (P ＜ 0.05).Conclusion The clinical concentration of bevacizumab can reduce the anti-oxidative function of RPE cells,which may be one of the causes of progressive macular atrophy after long-term anti-VEGF therapy.

OBJECTIVE To strengthen the management for visitors in the newborn nursery,in order to reduce the newborn hospital infection rate and enhance the hospital infection management quality in the newborn nursery.METHODS Taken the air and the object surface sampling in the newborn nursery,and the sampling derived from the hands of staff and visitors to undertake the contrast examination.RESULTS Before and after visits,the air pollution rate was over norm by increase of 58.3%,and after disinfection it declined 75.0%,after visiting,the object surface contamination rate was over norm by 56.3%,after disinfection it fell by 77.1%.Before washing-hands,the bacterial contamination rate of visitors and staff was over norm by respectively 100.0% and 68.3%,after washing,the passing rate of visitors was 92.0%,and no medical staff were over norm.CONCLUSIONS To adopt the effective management for visitors in the newborn nursery is very important to reduce the hospital infection rate in newborn nursery.

Objective Stanford type A acute aortic dissection is a life-threatening medical condition with high rates of morbidity and mortality that requires surgical repair, on an emergency basis. The extent of aortic arch repair that should be carried out during emergency surgery of this type is controversial. This study was conducted to report clinical experience on aortic arch repair and determine surgical indication, optimal operative procedures and strategy for Stanford type A acute aortic dissection. Methods 210 consecutive patients with acute Stanford A aortic dissection who underwent aortic arch replacement combined with implantation of stented elephant trunk into the descending aorta between August 2005 and August 2010. Surgical procedures included hemi-aortic arch replacement in 92 patients, subtotal aortic arch replacement in 50 patients and total aortic arch replacement in 68 patients. All operations were performed with the aid of deep hypothermic circulatory arrest and selective antegrade cerebral perfusion (SACP). Enhanced computed tomography scanning was performed to evaluate the postoperative outcomes, particularly the fate of the false lumen remaining in the descending thoracic aorta by aortic arch replacement combined with implantation of stented elephant trunk during follow up. Results Average cardiopulmonary bypass time was (146 ±52) min. The average cross clamp time was(93 ±25)min and average selective cerebral perfusion and circulatory arrest time was(35 ±14)min. The overall in-hospital mortality was 4. 8% (10/210) and morbidity was 8. 6% ( 18/210). Postoperative complications included acute renal failure, stroke, mediastinitis and respiratory insufficiency. During the follow-up period [mean (27 ± 18) months, ranged 2 to 60 months], 1 patient underwent reoperation due to the descending thoracic and abdominal aortic aneurysm. There was no late death. Follow-up enhanced CT scanning showed about 74% false lumens obliterated at the level of the distal border of the stent graft post operation. Conclusion Open aortic arch replacement is an effective approach and provides acceptable outcomes for type A acute aortic dissection. Optimal treatment strategy is the key factor to success in emergency surgical intervention.

Objective To characterize pancreatic perfusion in swines with experimental chronic pancreatitis(CP)by dynamic contrast-enhanced MRI and to correlate it with the severity of CP.Methods Twenty-two swines were randomly selected and made CP by ligation of main pancreatic duct.Six healthy swines served as control.MR perfusion study with dynamic contrast-enhanced MRl was carried out on the swines under anesthesia.The animals were euthanized after MR perfusion exam.The swines were divided into 4 groups according to the histological results of pancreas:normal group,group of CP of grade 1,group of CP of grade 2,and group of CP of grade 3.The maximum perfusion slope rate,the time-to-peak value and the maximum enhancement rate was compared between the groups using variance analysis,and the relationship between each perfusion parameters and severity of CP was made by correlative analysis.Results Twenty-one swines underwent MR perfusion study,including 7 swines in normal group,7 in group of grade 1 CP,3 in group of grade 2 CP,and 4 in group of grade 3 CP.On signal intensity time curve(SI-T)derived from MR perfusion weighted imaging,the m~imum slope rate was(10.88±1.20)%,(10.59±1.02)%,(6.67±1.31)%,and(5.48±1.97)%for normal swines,swines with grade 1 CP,swines with grade 2 CP and swines with grade 3 CP,respectively(F=20.51,P＜0.05).The time-to-peak value was(13.82±3.09)s,(12.31±5.52)s,(20.55±3.79)s and(37.26±14.56)s respectively(F=10.68,P＜0.05).The maximal signal enhancement rate was(62.95±20.20)%,(60.44±20.00)%,(46.33±22.70)%,and(67.65±32.66)%,respectively(F=0.53,P＞0.05).The highest slope value(r=-0.72,P＜0.05)and the time-to-peak(r=0.54,P＜0.05)of the SI-T curve were correlated to the severity of CP,respectively.However there was no linear correlation between the maximal signal enhancement rate and the severity of CP.Conclusion MR perfasion weighted imaging has a potential to diagnose and to grade experimental chronic pancreatitis.

Objective:To understand the status of sedation and analgesia treatment and management in pediatric intensive care unit(PICU) in Shandong Province, and to provide the basis for the improvement of sedation and analgesia treatment plan.Methods:This study was a multi-center retrospective study.The PICUs of 6 tertiary hospitals in Shandong Province participated in this study.The data of 1 340 children admitted to these 6 PICUs from January 2016 to December 2018 were collected.The age, gender, the pediatric risk of mortality score Ⅲ at 24 hours after admission, whether they received mechanical ventilation, whether they received sedation and(or) analgesia, whether they were monitored sedation and(or) analgesia, and in-hospital mortality were analyzed.The children were divided into the simple sedation group( n=798), the sedation + analgesia group( n=120) and the non-sedation analgesia group( n=422) according to whether they received sedation and(or) analgesia.The diseases, proportion of mechanical ventilation, incidence of hypotension, average length of stay in PICU and in-hospital mortality were compared among the three groups. Results:The median age of the 1 340 children was (13.3±6.4) months, including 786 males(58.7%). Sedation therapy had been carried out in 6 PICUs, of which 5 PICUs had routine sedation assessment; 4 PICUs had carried out analgesic therapy, of which only 2 had routine pain assessment.A total of 918 children(68.5%)received sedation and(or) analgesia, midazolam was the most commonly used sedative drug, followed by dexmedetomidine, and 526 children(57.3%)were monitored for sedation assessment, the most commonly used assessment method was the Richmond agitation sedation score.One hundred and twenty(9.0%)cases received sedation combined with analgesia, fentanyl was the most commonly used analgesic, and 38 children(31.7%) underwent routine pain assessment.There was no significant difference in age and sex among the three groups.The proportion of surgical diseases and patients received mechanical ventilation(100.0%, 120/120) were the highest in the sedation + analgesia group.The proportion of mechanically ventilated patients was the lowest in the non-sedation analgesia group(11.4%, 48/422). The mean duration of mechanical ventilation in the sedation + analgesia group was slightly shorter than that in the simple sedation group( P>0.05). The incidence of hypotension was highest in the sedation + analgesia group, and lowest in the non-sedation analgesia group[21.7%(26/120) vs.2.1%(9/422), P<0.01]. There was no significant difference in in-hospital mortality and mean PICU stay among three groups. Conclusion:Benzodiazepines are still the main sedative drugs used in PICUs in Shandong Province.In recent years, the usage of dexmedetomidine has gradually increased, but the proportion of analgesic use is very low.At present, analgesic and sedative therapy is mainly used for children after surgery and receiving mechanical ventilation.Although analgesic and sedative therapy does not increase the in-hospital mortality and average length of stay in PICU, it increases the incidence of hypotension.The sedative and analgesic treatment and assessment in the PICU of Shandong Province are still not standardized, mainly reflected in infrequently analgesic treatment and the assessment of sedation and pain, which need to be further improved.

Objective To investigate the relationship between the oxidized low-density lipoprotein(ox-LDL) in the blood from the coronary sinus and impaired endothelium-dependent vasodilation in patients with coronary artery disease(CHD).Methods Four groups of patients were subjected,including acute myocardial infarction group(AMI,n=22),unstable angina group(UA,n=29),and stable angina group(SA, n=25) and control group(n=20) who was first suspected as CHD and then verified with normal coronary angiograms.Blood form the coronary sinus was collected through cardiac cathetering and the ox-LDL level was measured by Sandwich ELISA method.Brachial arterial hyperemia-induced flow mediated dilation(FMD) and sublingual nitroglycerin(NTG) mediated vasodilation were measured by high resolution ultrasound.Results The blood level of ox-LDL in patients with CHD was markedly higher than those in control group(P