Department ofPediatrics,the Maternal and Child Health Hospital ofHuzhou,Huzhou,Zhejiang 313000,China(Shen ZZ)Objective To observe the effect of phentolamine in the treatment of severe hand foot and mouth disease with acute pulmonary edema.Methods 90 children with severe hand foot and mouth disease and acute pul-monary edema from January 2014 to December 2015 in our hospital were selected as the research subjects.All the children were randomly divided into 45 case of the observation group and 45 case of the control group.They were given conventional drug therapy and positive pressure ventilation,the control group was given milrinone,5μg/kg,the obser-vation group was given phentolamine,5μg/kg.The myocardial enzymes and cardiac troponin were detected before intervention and after 72h intervention,the blood gases index and ventilator parameter were analyzed,and the time of ventilator support and hospital stay were compared.Results (1)The CK -MB,CK,troponin of the observation group and the control group after treatment were (17.52 ±1.33)U /L and (28.23 ±3.89)U /L,(120.42 ±6.21)U /L and (150.86 ±8.67)U /L,(0.46 ±0.07)μg/L and (0.96 ±0.06)μg/L,which were significantly higher than before treatment (t =5.024 and 8.455,9.353 and 14.757,6.356 and 9.505,all P <0.01),but the CK -MB,CK,troponin of the observation group after treatment were significantly lower than the control group (t =5.601,7.426,5.829,all P <0.01 ).(2)The PaO2 and PaCO2 of the intervention group and the control group after 72h intervention were (80.24 ±14.35)mmHg and (62.30 ±5.68)mmHg,(39.38 ±6.08)mmHg and (46.10 ±3.42)mmHg respectively, which were significantly improved than before treatment,the differences were statistically significant (t =11.352 and 7.204,7.827 and 5.287,all P <0.01),there were statistically significant differences between the two groups after the intervention (t =7.426,5.829,all P <0.01).The FiO2 ,PIP,PEEP of the two groups after treatment were significantly lower than before treatment,the differences were statistically significant (t =8.446 and 6.905,9.705 and 7.832, 8.605 and 6.889,all P <0.01),there were statistically significant differences between the two groups after the inter-vention (t =3.461,5.165,4.532,P <0.05 or P <0.01).(3)The time of mechanical ventilation and hospitalization in the observation group and the control group were (3.42 ±1.61)d and (5.06 ±2.15)d,(15.40 ±3.62)d and (18.62 ±3.81)d,the differences were statistically significant(t =3.513,3.734,all P <0.05).Conclusion Phent-olamine has better effect than milrinone in the treatment of severe hand foot and mouth disease with acute pulmonary edema,it can control the disease progression and improve clinical outcomes and has better clinical value.

Objective To explore learning burnout psychology and professional identity of nursing students studying at the traditional Chinese medicine college.Methods 200 students were surveyed by learning burnout and professional commitment scale.Results Learning burnout level of nursing students was higher,depression scores were the highest in four dimensions.Professional commitment kept within medium level.The professional identity was low.The inheritance commitment score was the lowest in each dimension analysis.Conclusions Schools and teachers should take corresponding measures to improve professional commitment level,so as to reduce learning burnout level and ensure long-term stable development of nursing profession.

Background Interleukin-6 (IL-6) is a pleiotropic cytokine involving in inflammation and wound healing.Previous report found that IL-6 increases phosphorylated STAT3 (p-STAT3) level and promotes corneal epithelial wound healing by stimulating migration.However,the essential role of IL-6 in corneal epithelial wound healing and the expression changes in diabetic mellitus remains unknown.Objective This study was to explore the roles of IL-6 in corneal epithelial proliferation and wound healing in both normal and diabetic mice.Methods Fifty-two normal C57BL/6 mice were randomized into normal control group (32 mice) and diabetic group (20 mice).Type 1 diabetic mellitus was induced by intraperitoneal injections of 50 mg/kg streptozotocin once per day for consecutive 5 days in the mice of the diabetic group.Whole corneal epithelium was scraped in all mice,and the corneal epithelial defect area was examined by fluorescein staining in 24,48 and 72 hours after corneal epithelium removal.Recombinant mouse IL-6 or anti-IL-6 blocking antibody of 5 μl were subconjunctivally injected according to the grouping and contrasted with PBS injection group or isotype control antibody group,respectively.TKE2 cells,a mouse corneal epithelial stem/progenitor cell line,were trypsinized and incubated in the KSFM with different concentrations of IL-6 or without IL-6,and colony formation efficency (CFE) was examined by crystal violet staining.The expressions of △NP63 and Ki67,specific makers of stem cells,were detected by immunofluorescine technology.The expressions of △NP63,Ki67 and p-STAT3 proteins were assayed in the cells by Western blot,respectively.The expression of IL-6 mRNA and protein in the regenerated corneal epithelium was detected by real time quantitative PCR and ELISA.The use and care of the mice complied with the Statement of Association for Research in Vision and Ophthalmology.Results The percentage of residual corneal epithelium defect area with initial detect area was gradually shrinked over time after PBS and IL-6 injection in both normal control mice and diabetic mice,and the percentage of residual corneal epithelium defect area was significantly reduced in the IL-6 injected group compared with the PBS injected group (normal control group:Fgroup =19.982,P ＜ 0.01;Ftime =589.350,P ＜ 0.01;Diabetic group:Fgroup =25.411,P＜0.01;Ftime =334.807,P＜0.01).The CFE was (13.23± 1.12)％,(15.87± 1.30)％,(21.69±1.62)％,(25.33±1.28)％ and (18.67±1.54)％ in the blank control group and 10,20,50,100 ng/ml IL-6-treated groups,respectively,showing a gradual increase of CFE dependent upon IL-6 concetrations (F =35.547,P＜0.01).The expressions of △NP63,Ki67,p-STAT3 proteins in the cells were gradually increased over time after 50 ng/ml IL-6 treated for 5,10,15,30 and 60 minutes,and the relative expression level of the cytokines was significnatly higher in the IL-6 cultured groups than that without IL-6 culture group (all at P＜0.05).The relative expression of IL-6 mRNA in the regenerated corneal epithelilum was 0.45±0.21 and 1.00±0.16 in the diabetic group and normal control group,respectively,and compared with the normal control group,the expression of IL-6 mRNA reduced by 56％ (t=3.42,P=0.03).The content of IL-6 protein in regenerated corneal epithelium of the diabetic group was (257±12) ng/μl,which was significantly lower than (323 ± 17) ng/μl of the normal control group (t =5.60,P＜0.01).Conclusions IL-6 promotes the proliferation and regeneration of corneal limbal stem cells to repair defected corneal epithelium by activating STAT3 signaling pathway in both normal and diabetic mice,while the blocking of endogenous IL-6 impairs the corneal epithelial cell activation and wound healing.

Objective To study miRNA expression differences in ovalbumin(OVA)- induced murine asthma models of mice and mast cells stimulated by inflammatory cytokines stimulation,and to better understand asthma deve-lopment so as to provide potential target for its prevention and treatment. Methods OVA - induced murine asthma models were validated by detecting cells in bronchoalveolar lavage fluid(BALF)and histopathology. And miRNA ex-pression differences in the lung tissues between the model group and the normal control group were detected by real -time polymerose chain reaction PCR . After tumor necrosis factor - α(TNF - α),interleukin 12(IL - 12)stimulation, miRNA expression differences in murine mast cells P815 were detected. Results The number of total cells and eosino-phil cells both increased in BALF of the model group[(12. 8 ± 2. 2)x 107 / L vs(5. 6 ± 2. 5)x 107 / L,t = 4. 760,P ﹤0. 05;(6. 6 ± 1. 9)x 107 / L vs(0. 8 ± 0. 8)x 107 / L,t = 8. 068,P ﹤ 0. 05]. In addition,histopathology showed more inflammatory cell infiltration in the model group than that in the normal control group,indicating that the models were validated. The expression of miRNA - 155 was up - regulated approximately 5. 0 - fold in the lung tissues of the model group(P ﹤ 0. 05),while miRNA - 192 showed no differences compared with the controls. After TNF - α and IL - 12 stimulated P815 mast cells,miRNA - 192 expressions in P815 were expression in P815 was up - regulated approximate-ly 1. 9 - fold and 1. 7 - fold after TNF - α and IL - 12 stimulation,respectively(P ﹤ 0. 05). Conclusions It is conclu-ded that miRNAs are differentially expressed in the presence of OVA - induced murint asthma models and mast cells stimulated by inflammatory cytokines. These differentially expressed miRNAs may regulate the function of mast cells and involved in the pathogenesis of asthma.

Objective To investigate the efficacy of standardized protocol,including prenatal diagnosis,perinatal management and treatment,on babies with meconium peritonitis.Methods A standardized protocol with prenatal diagnosis,perinatal management,treatment and follow-up on congenital anomaly was founded by Capital Institute of Pediatrics and several other obstetric hospitals.Thirty neonates diagnosed as meconium peritonitis prenatally from March 15,2006 to August 27,2012 were intervened according to this protoccl.The data of diagnosis,treatment after birth and prognosis were analyzed.Results (1) Prenatal diagnosis:Abnormal meconium peritonitis relative signs were found by ultrasound in all of these 30 cases.Among them,23 cases presented with intestine dilation,15 with polyhydromnios,nine with ascites,four with abdominal cystic mass and four calcification.(2)Diagnosis after birth (n=27):The most common imaging findings in abdominal X-ray were distention (27 cases),dilated intestine with air-fluid levels (22 cases) and calcification (11 cases).The most common imaging findings in ultrasound were obvious intestinal dilation (19 cases),cystic mass (7 cases) and calcification (7 cases).(3) Operation:Except for three cases without symptoms,the other 27 infants received operation at averagely 42 hours after birth (12 h-5 d).Besides the basic treatment as removal of the fuci and dissection of adhesion,peritoneal drainage was performed in one infant,two-stoma enterostomy in seven infants,inverted T-shape enterostomy in eight infants and primary intestinal anastomosis in 11 infants.Among these 27 cases,24 cases were cured,2 cases refused following treatment after surgery and one case was lost to follow up.Conclusions Standardized protocol with prenatal diagnosis,perinatal management and earlier intervention might improve the prognosis of meconium peritonitis.

Objective To investigate the prenatal diagnosis, perinatal management and standardized treatment protocol for neonates with duodenal obstruction. Methods A network in prenatal diagnosis, perinatal management and monitoring of congenital malformation was founded between Beijing Obstetrics and Gynecology Hospital and the Capital Institute of Pediatrics. Forty-four fetuses were prenatally diagnosed as duodenal obstructions by this network from July,2001 to September, 2010. The data of prenatal diagnosis, treatment after birth and prognosis were analyzed. Results Among 44 patients diagnosed as fetal duodenal obstruction by prenatal ultrasonography, three cases underwent induced abortion, three were in pregnancy, 14 were lost during follow-up and 24 were confirmed by surgical treatments after birth. Within 24 neonates underwent surgery, 21 showed double-bubble sign and 20 combined with polyhydroamnios in prenatal ultrasonography. Twenty-four neonates underwent upright abdominal plain film examination,22 showed double-bubble sign, 1 showed single-bubble sign and 1 showed triple-bubble sign,respectively. Nineteen neonates underwent upper gastroenterography which showed distention of stomach and duodenum, increased stomach peristalsis and an obstacle of duodenum emptying. Within 23 neonates underwent ultrasonographic studies, 10 showed distention and increased peristalsis of duodenum. Following surgical procedures were performed: diamond shape anastomosis was completed in 19 cases with annular pancreas; duodenal vertical resection, across suture and excision of the membrane was done in four cases with duodenum membranate stenosis; end-to-back anastomosis was taken in one case with duodenal separate atresia; Ladd's procedure was applied in 11 cases associated with malrotation. All patients were cured. Conclusions Standardized perinatal management and earlier intervention should be offered to newborns with duodenal obstruction to achieve better effects.

Objective: To observe hypoglycemic effects of Yunu Decoction, Zuogui Pill and Shenqi Pill, three compound traditional Chinese herbal medicines, in treatment of diabetes mellitus induced by alloxan in rats, and to compare the therapeutic effects among the three recipes for nourishing yin, clearing away heat, and nourishing yin and warming yang. Methods: Diabetes mellitus was induced in rats with alloxan at a dose of 60 mg/kg via tail vain injection. The diabetic rats were randomly divided into four groups: alloxan model group, Yunu Decoction-treated group, Zuogui Pill-treated group and Shenqi Pill-treated group. Rats in the three recipe groups were administered intragastrically with water extraction of Yunu Decoction, Zuogui Pill, and Shenqi Pill accordingly for 10 days. Then the level of blood glucose was measured by glucose oxidase method and the glucose tolerance was determined. Results: Compared with the normal rats, blood glucose level in the alloxan model group was obviously increased (P<0.05). Glucose levels in the three recipe groups were obviously decreased as compared with the alloxan model group (P<0.05), and glucose level in the Yunu Decoction-treated group after treatment was significant lower than before treatment (P<0.05). The glucose tolerance test indicated that rats in the alloxan model and three recipe groups revealed impaired glucose tolerance as compared with the normal rats, and there were no significant differences between the alloxan model group and the three recipe groups. Conclusion: Yunu Decoction, Zuogui Pill and Shenqi Pill can effectively decrease the glucose level of the rats with diabetes mellitus induced by alloxan, and Yunu Decoction showed the best therapeutic effects. The glucose tolerance test shows that the three recipes cannot correct the abnormal metabolism of glucose.

OBJECTIVEImprove the electronic application appointment and scheduling methods in hospital to optimize patients appointment and improve utilization of hospital inspection equipment.

METHODAnalyze the workflow of existing electronic application and put forward the improvement scheme.

RESULTDeveloped a set of efficient appointment scheduling system, thus optimize the workflow of hospital exam.

CONCLUSIONThis system not only optimizes the patient's examination time, but also improves the utilization of hospital inspection equipment.

Objective To evaluate the efficacy of a two-step infusion therapy with meropenem against noso-comial multi-drug resistant Pseudomonas aeruginosa infections in elderly patients with chronic obstructive pulmonary disease.Methods 112 elderly patients with nosocomial multi-drug resistant Pseudomonas aeruginosa infections and chronic obstructive pulmonary disease were randomized into two groups:two-step infusion therapy group ( rapid first-step infusion in 30 minutes and slow second-step infusion in 2.5 hours) and traditional 30 minutes infusion therapy group.The antibiotic clinical efficacy and bacteriological efficacy were observed between two groups .Results The clinical efficacy of observation group and control group were 82.2%(46/56) vs 57.1%(32/56).The difference was statistically significant(χ2 =10.185,P<0.05);The bacteriological efficacy of observation group and control group were 75.0%(42/56) vs 46.4%(26/56),The difference was statistically significant (χ2 =10.265,P<0.05). Conclusion The clinical efficacy and bacteriological efficacy of two-step infusion therapy with meropenem against nosocomial multi-drug resistant Pseudomonas aeruginosa infections in elderly patients with chronic obstructive pulmo -nary disease were superior to the traditional therapy .

Objective:Based on the occupational cohort of Beijing Medical Examination Center, to explored the relevant factors of nonalcoholic fatty liver disease (NAFLD), and to provide scientific basis for screening and early diagnosis of NAFLD in high-risk population.Methods:Based on the cohort of occupational population who underwent physical examination in Beijing physical examination center from January to December 2009, the physical examination indexes were collected, and a retrospective survival cohort with a follow-up period of 3 years was established.According to the idea of nested case-control study, each case was randomly matched with the same gender, age and physical examination time in the same month by using the method of random sampling without putting back.Conditional logistic regression model was established by using the matched data.The diagnostic value of related indicators for NAFLD was analyzed by receiver operating characteristic curve (ROC).Results:A total of 1 194 subjects were included, including 684 males (57.3%, 684/1 194) and 510 females (42.7%, 510/1 194). The age was (50.8±11.6) years.The age ranged from 24.0 to 88.0 years.There were 597 patients with NAFLD, including 342 males and 255 females.Logistic regression analysis showed that body mass index, high density lipoprotein cholesterol, hemoglobin, platelet count, uric acid and urea nitrogen were statistically significant in male model (all P<0.05). Body mass index( OR=1.242, 95% CI 1.143-1.349, P<0.001), hemoglobin( OR=1.034, 95% CI 1.015-1.053, P<0.001), platelet( OR=1.005, 95% CI 1.002-1.009, P=0.005), uric acid( OR=1.004, 95% CI 1.001-1.006, P=0.004), high density lipoprotein cholesterol( OR=0.377, 95% CI 0.184-0.775, P=0.008) and urea nitrogen( OR=0.807, 95% CI 0.693-0.938, P=0.005) were protective factors for NAFLD in male patients..Body mass index( OR=1.552, 95% CI 1.366-1.762, P<0.001), triglyceride ( OR=2.606, 95% CI 1.616-4.204, P<0.001), blood glucose( OR=2.199, 95% CI 1.332-3.631, P=0.002), uric acid( OR=1.005, 95% CI 1.001-1.010, P=0.024) in female model were statistically significant ( P<0.05), and were risk factors for NAFLD in female patients. Conclusion:The incidence rate of NAFLD was different among different gender and age, body mass index, high density lipoprotein cholesterol, hemoglobin, platelet count, uric acid, urea nitrogen, triglyceride and blood glucose were closely related to the incidence of NAFLD.