Objective:To observe the efficacy of external diaphragm pacing (EDP) combined with recombinant human growth hormone (rhGH) in the treatment of severe chronic obstructive pulmonary disease (CDOP).Methods:By the prospective study method, 80 patients with severe COPD were admitted to the Xianju People′s Hospital(Zhejiang Southeast Campus of Zhejiang Provincial People′s Hospital)/Xianju Hospital Affiliated to Hangzhou Medical College from April 2021 to April 2023 were divided into the combined group and the conventional group by the random number table method, with 40 cases in each group. All of them received anti-infection, nutritional support, and other conventional treatment. In addition, the combined group was given EDP+rhGH treatment, and they were intervened for 20 d. The diaphragm function, nutrition, pulmonary function, and serum levels of interleukin (IL-6), IL-23, type Ⅱ alveolar cell surface antigen (KL-6) changes before and after treatment and prognosis were compared between the two groups.Results:After treatment, the diaphragm function index diaphragm maximum expiratory pressure (MIP), diaphragm thickness (DTei), and diaphragm mobility (DE) in the combined group were higher than those in the conventional group: (45.36 ± 7.04) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (42.28 ± 6.43) cmH 2O, (0.32 ± 0.12) cm vs. (0.27 ± 0.06) cm, (3.40 ± 1.02) cm vs. (1.85 ± 0.64) cm, there were statistical differences ( P<0.05). After treatment, the nutritional status indexes of serum albumin (ALB), transferrin (Tf), and total protein (TP) in the combined group were higher than those in the conventional group: (34.62 ± 5.13) g/L vs. (31.75 ± 4.93) g/L, (2.21 ± 0.46) g/L vs. (2.00 ± 0.42) g/L, (63.80 ± 8.25) g/L vs. (60.24 ± 6.97) g/L, there were statistical differences ( P<0.05). After treatment, the percentage of forced expiratory volume in the first second (FEV 1) to the expected value (FEV 1%) and the ratio of FEV 1 to forced vital capacity (FEV 1/FVC) in the combined group were higher than those in the conventional group: (60.17 ± 6.30)% vs. (57.25 ± 6.24)%, (61.30 ± 7.04)% vs. (57.12 ± 7.25)%, there were statistical differences ( P<0.05). After treatment, the levels of IL-6, IL-23, and KL-6 in the combined group were lower than those in the conventional group: (23.13 ± 4.26) ng/L vs. (26.60 ± 4.75) ng/L, (20.84 ± 6.16) μg/L vs. (25.00 ± 5.89) μg/L, (375.10 ± 45.18) kU/L vs. (400.25 ± 46.27) kU/L, there were statistical differences ( P<0.05). The mechanical ventilation time and intensive care unit stay time in the combined group were shorter than those in the conventional group: (150.46 ± 10.24) h vs. (189.67 ± 15.43) h, (7.00 ± 2.03) d vs. (9.84 ± 2.72) d, there were statistical differences ( P<0.05). The rate of extubation within 1 week in the combined group was higher than that in the conventional group, and the 28-day mortality was lower than that in the conventional group: 90.00%(36/40) vs. 72.50%(29/40), 5.00%(2/40) vs. 22.50%(9/40), there were statistical differences ( χ2 = 4.02, 5.16, P<0.05). Conclusions:In the patients with severe COPD, EDP combined with rhGH can significantly improve the diaphragm function, nutritional status, and lung function, decrease serum IL-6, IL-23, and KL-6 levels, shorten the mechanical ventilation time, and reduce the 28-day mortality.

Objective:The study investigated the full-time Clinical Research Coordinators (CRCs) working in hospitals on their current working situation and explored affecting factors to provide suggestions for a professional and systemic clinical research workforce establishment in municipal medical institutions.Methods:A questionnaire survey was designed for CRCs in municipal hospitals in Shanghai, descriptive and one-way cross-tabulation analysis were conducted, using t-test for continuous numerical variables, rank-sum test for count variables and chi-square test for categorical variables.Results:Totaling 177 CRCs in 9 municipal hospitals in Shanghai answered the questionnaire. The average age of the respondents was 28.56±7.299 years old. Their professional background was mainly nursing and pharmacy (139/177, 87.53%), and bachelor degree (114/177, 64.41%). Averagely worked 2.50±1.632 years, the average number of research projects undertaken by CRC was 3.45±2.179, and the average number of cumulative projects involved was 8.72±9.341. The CRCs employed by hospitals mainly undertook Investigator-Initiated clinical Trial/Research projects (IITs) (26/36, 72.22%), while the CRCs employed by SMO companies mainly undertook Industry-Sponsored Clinical Trial (IST) projects (96/141, 68.09%). 85.88% (152/117) of CRCs held GCP certificates valid within three years, and the proportion of CRCs employed by hospitals held GCP certificates was lower than that of SMO companies ( P<0.05). Among the CRCs employed by hospitals, 23 (63.89%) said they had no position or were not clear about their position; The CRCs in SMO companies were mainly primary and intermediate (χ 2=84.119, P<0.05). The average number of research projects undertaken by CRC was 3.45±2.179, and the average number of cumulative projects involved was 8.72±9.341. Conclusions:With the development of clinical research, the full-time specialized CRCs in medical institutions mainly have 2 sources: from SMO/CRO companies or self-employment by medical institutions. In general, there are still problems in the CRC talent team as unclear entry standards, insufficient, lack career positioning planning, large mobility, imperfect training system, and imperfect promotion mechanism. It is suggested to unify occupational access standards and set specialty in colleges or universities. Strengthen post-service education and training system, establish multi-party collaborative training mechanism, standardize the assessment and evaluation, improve the job title promotion system, to promote the rapid development of CRC team.

Objective To explore the efficacy and safety of doxycycline in the treatment of Mycoplasmal pneumoniae pneumonia(MPP)in children under 8 years old.Methods A retrospective selection was made of 258 children with MPP under 8 years old who were admitted to Women and Children's Hospital of Ningbo University from July 2023 to June 2024 as the research subjects.The children were divided into the azithromycin group(n=156)and the doxycycline group(n=102)according to the different drugs used.The clinical indicators,inflammation-related indicators,liver function indicators before and after treatment and adverse reactions of two groups of children were compared.Results After treatment,the defervescence time,cough relief time,pneumonia image absorption time and hospital stay in doxycycline group were shorter than those in azithromycin group(P＜0.05),the number of patients who needed to use steroids and bronchoscope intervention,and the number of patients with total hospitalization costs more than 10 000 yuan were less than those in azithromycin group(P＜0.05).The C-reactive protein(CRP),D-dimer(DD),serum ferritin(SF)and lactate dehydrogenase(LDH)in both groups of children were significantly lower than those before treatment in this group(P＜0.05),and the reduction amplitzes of CRP,DD,SF and LDH in doxycycline group were significantly greater than those in azithromycin group(P＜0.05).There were no significant changes in alanine aminotransferase,aspartate aminotransferase and prealbumin between two groups of children before and after treatment(P＞0.05).The adverse reactions of two groups of children were mainly gastrointestinal reactions,and there was no statistically significant difference in the incidence rate(x2=0.254,P=0.204).Conclusion Doxycycline in treatment of MPP in children under 8 years old can effectively relieve clinical symptoms,reduce inflammatory responses,decrease hormone and bronchoscopy interventions,shorten hospital stays and reduce hospitalization costs,and has good safety.

Objective:To observe the efficacy of external diaphragm pacing (EDP) combined with recombinant human growth hormone (rhGH) in the treatment of severe chronic obstructive pulmonary disease (CDOP).Methods:By the prospective study method, 80 patients with severe COPD were admitted to the Xianju People′s Hospital(Zhejiang Southeast Campus of Zhejiang Provincial People′s Hospital)/Xianju Hospital Affiliated to Hangzhou Medical College from April 2021 to April 2023 were divided into the combined group and the conventional group by the random number table method, with 40 cases in each group. All of them received anti-infection, nutritional support, and other conventional treatment. In addition, the combined group was given EDP+rhGH treatment, and they were intervened for 20 d. The diaphragm function, nutrition, pulmonary function, and serum levels of interleukin (IL-6), IL-23, type Ⅱ alveolar cell surface antigen (KL-6) changes before and after treatment and prognosis were compared between the two groups.Results:After treatment, the diaphragm function index diaphragm maximum expiratory pressure (MIP), diaphragm thickness (DTei), and diaphragm mobility (DE) in the combined group were higher than those in the conventional group: (45.36 ± 7.04) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (42.28 ± 6.43) cmH 2O, (0.32 ± 0.12) cm vs. (0.27 ± 0.06) cm, (3.40 ± 1.02) cm vs. (1.85 ± 0.64) cm, there were statistical differences ( P<0.05). After treatment, the nutritional status indexes of serum albumin (ALB), transferrin (Tf), and total protein (TP) in the combined group were higher than those in the conventional group: (34.62 ± 5.13) g/L vs. (31.75 ± 4.93) g/L, (2.21 ± 0.46) g/L vs. (2.00 ± 0.42) g/L, (63.80 ± 8.25) g/L vs. (60.24 ± 6.97) g/L, there were statistical differences ( P<0.05). After treatment, the percentage of forced expiratory volume in the first second (FEV 1) to the expected value (FEV 1%) and the ratio of FEV 1 to forced vital capacity (FEV 1/FVC) in the combined group were higher than those in the conventional group: (60.17 ± 6.30)% vs. (57.25 ± 6.24)%, (61.30 ± 7.04)% vs. (57.12 ± 7.25)%, there were statistical differences ( P<0.05). After treatment, the levels of IL-6, IL-23, and KL-6 in the combined group were lower than those in the conventional group: (23.13 ± 4.26) ng/L vs. (26.60 ± 4.75) ng/L, (20.84 ± 6.16) μg/L vs. (25.00 ± 5.89) μg/L, (375.10 ± 45.18) kU/L vs. (400.25 ± 46.27) kU/L, there were statistical differences ( P<0.05). The mechanical ventilation time and intensive care unit stay time in the combined group were shorter than those in the conventional group: (150.46 ± 10.24) h vs. (189.67 ± 15.43) h, (7.00 ± 2.03) d vs. (9.84 ± 2.72) d, there were statistical differences ( P<0.05). The rate of extubation within 1 week in the combined group was higher than that in the conventional group, and the 28-day mortality was lower than that in the conventional group: 90.00%(36/40) vs. 72.50%(29/40), 5.00%(2/40) vs. 22.50%(9/40), there were statistical differences ( χ2 = 4.02, 5.16, P<0.05). Conclusions:In the patients with severe COPD, EDP combined with rhGH can significantly improve the diaphragm function, nutritional status, and lung function, decrease serum IL-6, IL-23, and KL-6 levels, shorten the mechanical ventilation time, and reduce the 28-day mortality.

Objective To explore the efficacy and safety of doxycycline in the treatment of Mycoplasmal pneumoniae pneumonia(MPP)in children under 8 years old.Methods A retrospective selection was made of 258 children with MPP under 8 years old who were admitted to Women and Children's Hospital of Ningbo University from July 2023 to June 2024 as the research subjects.The children were divided into the azithromycin group(n=156)and the doxycycline group(n=102)according to the different drugs used.The clinical indicators,inflammation-related indicators,liver function indicators before and after treatment and adverse reactions of two groups of children were compared.Results After treatment,the defervescence time,cough relief time,pneumonia image absorption time and hospital stay in doxycycline group were shorter than those in azithromycin group(P＜0.05),the number of patients who needed to use steroids and bronchoscope intervention,and the number of patients with total hospitalization costs more than 10 000 yuan were less than those in azithromycin group(P＜0.05).The C-reactive protein(CRP),D-dimer(DD),serum ferritin(SF)and lactate dehydrogenase(LDH)in both groups of children were significantly lower than those before treatment in this group(P＜0.05),and the reduction amplitzes of CRP,DD,SF and LDH in doxycycline group were significantly greater than those in azithromycin group(P＜0.05).There were no significant changes in alanine aminotransferase,aspartate aminotransferase and prealbumin between two groups of children before and after treatment(P＞0.05).The adverse reactions of two groups of children were mainly gastrointestinal reactions,and there was no statistically significant difference in the incidence rate(x2=0.254,P=0.204).Conclusion Doxycycline in treatment of MPP in children under 8 years old can effectively relieve clinical symptoms,reduce inflammatory responses,decrease hormone and bronchoscopy interventions,shorten hospital stays and reduce hospitalization costs,and has good safety.

Objective:The study investigated the full-time Clinical Research Coordinators (CRCs) working in hospitals on their current working situation and explored affecting factors to provide suggestions for a professional and systemic clinical research workforce establishment in municipal medical institutions.Methods:A questionnaire survey was designed for CRCs in municipal hospitals in Shanghai, descriptive and one-way cross-tabulation analysis were conducted, using t-test for continuous numerical variables, rank-sum test for count variables and chi-square test for categorical variables.Results:Totaling 177 CRCs in 9 municipal hospitals in Shanghai answered the questionnaire. The average age of the respondents was 28.56±7.299 years old. Their professional background was mainly nursing and pharmacy (139/177, 87.53%), and bachelor degree (114/177, 64.41%). Averagely worked 2.50±1.632 years, the average number of research projects undertaken by CRC was 3.45±2.179, and the average number of cumulative projects involved was 8.72±9.341. The CRCs employed by hospitals mainly undertook Investigator-Initiated clinical Trial/Research projects (IITs) (26/36, 72.22%), while the CRCs employed by SMO companies mainly undertook Industry-Sponsored Clinical Trial (IST) projects (96/141, 68.09%). 85.88% (152/117) of CRCs held GCP certificates valid within three years, and the proportion of CRCs employed by hospitals held GCP certificates was lower than that of SMO companies ( P<0.05). Among the CRCs employed by hospitals, 23 (63.89%) said they had no position or were not clear about their position; The CRCs in SMO companies were mainly primary and intermediate (χ 2=84.119, P<0.05). The average number of research projects undertaken by CRC was 3.45±2.179, and the average number of cumulative projects involved was 8.72±9.341. Conclusions:With the development of clinical research, the full-time specialized CRCs in medical institutions mainly have 2 sources: from SMO/CRO companies or self-employment by medical institutions. In general, there are still problems in the CRC talent team as unclear entry standards, insufficient, lack career positioning planning, large mobility, imperfect training system, and imperfect promotion mechanism. It is suggested to unify occupational access standards and set specialty in colleges or universities. Strengthen post-service education and training system, establish multi-party collaborative training mechanism, standardize the assessment and evaluation, improve the job title promotion system, to promote the rapid development of CRC team.

Objective:To analyze the clinical characteristics of eosinophilic lung diseases(ELD) in children to enhance pediatricians′ understanding of ELD.Methods:In this retrospective cross-sectional study, a total of 149 children with ELD were recruited from Beijing Children′s Hospital, Capital Medical University between April 1, 2007 and March 31, 2022.Chi-square test, Fisher′s exact test, Mann-Whitney U test and Kruskal-Wallis test were used to analyze data and conclude clinical characteristics.Spearman correlation was used to analyze the correlation between eosinophils in peripheral blood and bronchoalveolar lavage fluid.Chi-square test and Kappa consistency test were used to compare the differences and consistency in diagnostic results between bronchoalveolar lavage fluid or lung biopsy and eosinophil elevation with chest imaging abnormalities. Results:(1)The isolated lung involvement was mostly caused by allergic bronchopulmonary aspergillosis(9 patients), and other system involvement by idiopathic hypereosinophilic syndrome(89 patients).(2)The main respiratory manifestations included coughing(90 cases, 60.4%) and expectoration(41 cases, 27.5%), while 23.5%(35 cases) of patients had no respiratory symptoms; 50.3% had digestive system involvement, and 40.9% had skin involvement.These were the two most commonly affected organs.(3)Spearman correlation was performed between eosinophils in peripheral blood and bronchoalveolar lavage fluid( r=0.3, P<0.05).Chi-square test was performed to compare ELD diagnosed by bronchoalveolar lavage fluid or lung biopsy with peripheral blood eosinophilia accompanied by abnormal chest imaging( P<0.05).Kappa consistency test(Kappa<0.2) showed poor consistency between the two diagnostic methods. Conclusions:ELD are present in children, and multiple etiologies may be pathogenic.Among children with ELD, the isolated lung involvement is mainly caused by allergic bronchopulmonary aspergillosis.The digestive system and skin are the most commonly affected organs, except for lungs.The correlation between eosinophil levels in peripheral blood and bronchoalveolar lavage fluid is poor.

In recent years, with the rapid development of Chinese domestic surgical robot technology and the expansion of the application market, the "industry-university-research-medicine" collaborative innovation transformation mode has gradually developed and formed. Medical institutions play an important role in multi-party cooperation with enterprises, universities, and research institutes, as well as in product planning, technology research and development, achievement transformation, and personnel training. On the basis of reviewing the current situation of the development of the "industry-university-research-medicine" collaborative innovation transformation mode of domestic surgical robots, this study explores the multiple roles played by medical institutions in this mode and challenges, further putting forward corresponding recommendations.
Humans ; Robotics ; Universities ; Medicine ; Industry ; Technology

Objective:To compare the efficacy of combination therapy on cyclic vomiting syndrome(CVS)in children, and improve the efficacy of CVS treatment in the future.Methods:This study retrospectively analyzed patients′ medical records of CVS, which were admitted to Digestive Department of Beijing Children′s Hospital from 2012 to 2019.The treatment regimen was A(Cyproheptadine+ Doxepin+ Valproate), B(Propranolol+ Cyproheptadine), or C(Propranolol+ Amitriptyline). Meanwhile, the patients should take drugs more than three months.The clinical data of 42 cases were analyzed retrospectively, and the treatment effect after discharge was followed up by telephone until October, 2020.Results:Among the 42 cases, 17 were male and 25 were female, whose mean age of onset was (4.65±3.23) years, and the age of diagnosis was (6.79±3.58) years.The main accompanied symptoms were abdominal pain and upper gastrointestinal bleeding.Forty-two patients were moderate/severe CVS.The regimens A, B and C were observed in 7, 11, and 24 patients, respectively.The age at improvement was(8.17±4.12)years.The course of treatment was(1.37±0.96)years.The age at follow-up was(10.32±4.03)years.During the 1-year follow-up, 35 cases were effective, and the efficiency was 83.3%.Among them, 23 cases had no paroxysmal vomiting and 7 cases had no effect.There was no significant difference in therapy effects among group A, B and C. Between the effective group and non-effective group, there were statistical differences in the personal history of hiatus hernia( P=0.024), the weight at follow-up ( P=0.042), and the course of medication( P=0.020). Conclusion:The combination regimen has a higher effective rate in the treatment of CVS.There was no significant difference among the three regimens in the treatment of CVS.For children with refractory CVS, who can not be treated with combination therapy, individualized therapy should be further developed.

Objective:To evaluate the clinical efficacy and safety of Infliximab (IFX) in pediatric Crohn′s disease (CD).Methods:The efficacy of IFX therapy in 30 patients suffering from active CD who were not completely improved with traditional medicine and enteral nutrition or had intolerance to the medicine in Beijing Children′s Hospital Affiliated to Capital Medical University from December 2014 to December 2019 were retrospectively analyzed.Pediatric Crohn′s Disease Activity Index (PCDAI), blood biochemistry indices, mucosal healing, nutritional status, and adverse reactions were compared and evaluated.Results:Thirty active CD cases, with 18 males and 12 females, were enrolled, and the average age was (8.63±4.76) years old.Three cases who didn′t complete 3 times of IFX injection and 1 case who lost to be followed up were excluded.A total of 26 cases of CD in active period were enrolled in this study on efficacy.The clinical remission and response rate of 26 cases were 61.5% and 84.6%, respectively, at 14-week of IFX therapy.The clinical remission and response rate of 21 cases were 71.4% and 85.7%, respectively, at 30-week.The clinical remission and response rate of 15 cases were 86.7% and 93.3%, respectively, at 54-week.At week 14 th, PCDAI score [(9.56±8.05) scores vs.(29.02±10.86) scores] decreased compared with before treatment ( t=7.339, P<0.05). The levels of erythrocyte sedimentation rate [(15.54±10.26) mm/1 h vs.(33.77±21.30) mm/1 h] and C-reactive protein [(4.79±12.94 ) mg/L vs.(16.33±23.43) mg/L] were obviously decreased, and the hemoglobin [(126.27±16.51) g/L vs.(110.58±16.45) g/L], hematocrit [(37.03±3.95)% vs.(33.52±4.32)%], and albumin levels [(42.30±3.03) g/L vs.(37.13±5.68) g/L] were remarkably increased compared with those before treatment ( t=3.932, 1.993, -3.398, -3.060, -4.009, all P<0.05). Height for age Z score and body mass index Z score were increased after IFX treatment, without statistically significant differences (all P>0.05). Conclusions:IFX therapy had good clinical efficacy in controlling inflammatorys and inducing clinical remission in pediatric CD.