OBJECTIVE To explore the effects of levosimendan on cardiac function， hemodynamics and prognosis of patients with septic shock complicated with myocardial depression， and evaluate the safety of levosimendan. METHODS Patients with septic shock complicated with myocardial depression who were admitted to the Department of Critical Care Medicine of Chongqing University Three Gorges Hospital from April 2021 to August 2023， underwent adequate fluid resuscitation， had a mean arterial pressure （MAP） ≥65 mmHg， and received pulse indicator continuous cardiac output （PiCCO） monitoring were enrolled. The patients were randomly divided into dobutamine group and levosimendan group according to a random number table， with 20 patients in each group. Both groups received intravenous infusion of Norepinephrine bitartrate injection at a dose of 0.1-2.0 μg/（kg·min）. On this basis， the dobutamine group additionally received intravenous infusion of Dobutamine hydrochloride injection at a dose of 5- 10 μg/（kg·min） for 3 to 7 days， while the levosimendan group additionally received intravenous infusion of Levosimendan injection at a dose of 0.1-0.2 μg/（kg·min） for 24 hours. Heart rate （HR） and hemodynamic parameters [systolic blood pressure， diastolic blood pressure， MAP， central venous pressure （CVP）]， PiCCO monitoring parameters [cardiac function index （CFI）， cardiac index （CI）， stroke volume index （SVI）， extravascular lung water index， global end-diastolic volume index， pulmonary vascular permeability index （PVPI）， global ejection fraction （GEF）， systemic vascular resistance index， left ventricular contractility index]， and prognosis indicators [death within 3 days after administration， mechanical ventilation time，intensive care unit （ICU） stay time， 28-day mortality rate] were compared between the two groups before treatment and at 24 and 72 hours after treatment. Adverse reactions were E-mail：recorded for both groups. RESULTS Compared with before treatment in the same group， CFI， CI and GEF at 24 hours after treatment， CI and GEF at 72 hours after treatment in the dobutamine group， as well as SVI at 24 hours after treatment and SVI and GEF at 72 hours after treatment in the levosimendan group were significantly increased； PVPI at 72 hours after treatment in the dobutamine group was significantly decreased （P＜0.05）. Compared with the dobutamine group during the same period， patients in the levosimendan group had significantly lower HR and significantly higher CVP at 24 hours after treatment （P＜0.05）. Within 3 days after administration， there were no deaths in either group； there were no statistically significant differences in mechanical ventilation time， ICU stay time， 28-day mortality rate， or the incidence of adverse reactions between the two groups （P＞0.05）. CONCLUSIONS For patients with septic shock complicated with myocardial depression who have undergone adequate fluid resuscitation and have a MAP of ≥65 mmHg， levosimendan is comparable to dobutamine in improving cardiac function and hemodynamic parameters， without affecting patients’ prognosis or increasing the risk of adverse reactions such as hypotension.

Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with knee osteoarthritis. The patellar component plays a crucial role in knee biomechanics and can influence postoperative outcomes. This study aimed to investigate the relationship between radiological indices of patellar height and patient outcomes following TKA. Methods: A retrospective analysis was conducted on patients who underwent TKA for osteoarthritis. Radiographic measurements of patellar height, including the Insall-Salvati (IS) ratio, modified Blackburne-Peel (mBP) ratio, Caton-Deschamps ratio, and plateaupatellar angle (PPA), were obtained. Clinical outcomes were assessed using the Knee Society Score (KSS) and the Forgotten Joint Score-12 (FJS-12). Patient satisfaction and postoperative complications were also evaluated. Statistical analyses, including correlation analysis and multiple regression models, were performed to determine the association between radiological indices and patient outcomes. Results: The study included 330 cases that met the inclusion criteria. The analysis revealed significant correlations between different radiological indices of patellar height and patient outcomes. Lower postoperative PPA was correlated with worse KSS and range of motion scores. A decreased mBP ratio was associated with poorer FJS-12 responses and higher risks of dissatisfaction and patellar clunk or crepitus. Increased IS ratio was linked to a lower likelihood of incidental giving way of the knee. Advanced age was associated with reduced dissatisfaction and incidental giving way probabilities. Conclusions The findings of this study demonstrate that radiological indices of patellar height can predict patient outcomes following TKA. Assessing patellar height using various radiographic measurements provides valuable information for surgical planning and prognostic evaluation. Understanding the impact of patellar height on clinical outcomes can aid in optimizing TKA procedures and improving patient satisfaction. These findings emphasize the importance of considering patellar height as a predictive factor in TKA and highlight its potential role in guiding postoperative management and rehabilitation strategies.

This article reported the comprehensive management of an extremely preterm infant with severe bronchopulmonary dysplasia. The patient born at 26 +6 gestational weeks was transferred to Children's Hospital of Fudan University due to invasive mechanical ventilation dependence at 61 d after birth and was diagnosed with severe bronchopulmonary dysplasia. A comprehensive treatment plan was adopted, including appropriate fluid restriction, improving nutrition, glucocorticoid administration, using antibiotics against Ureaplasma urealyticum infection to reduce pulmonary parenchymal lesions and alleviating pulmonary hypertension. The preterm infant was successfully extubated to non-invasive ventilation and subsequently weaned to a high-flow nasal cannula. Then, the patient was discharged at 372 d after birth (correct gestational age nine months and six days). At the 3-month follow-up after discharge, the patient remained on high-flow oxygen, but with lower flow and concentration of oxygen. Moreover, the growth, development and lung images were significantly improved. Follow-up to correct gestational age one year and 11 months, the child was not on oxygen any more, but on rehabilitation due to language and motor development retardation.

Common iliac artery ureteral fistula is a rare but potentially life-threatening disease which is difficult to diagnose clinically. This paper reports a case of common iliac artery ureteral fistula. The patient was admitted to our hospital due to ureterostomy bleeding for one day. He underwent radical cystectomy and bilateral ureterostomy for bladder cancer 4 years ago, and also underwent radiotherapy and bilateral ureteral stents indwelling after the operation. Angiography revealed a left common iliac artery pseudoaneurysm, and a left common iliac artery ureteral fistula was considered. The left common iliac artery stent-graft was implanted. The patient recovered well after the operation, and there was no obvious hematuria during follow-up period of 6 months.

OBJECTIVE：To improve the quality standard of Taraxaci Herba ，and to evaluate the quality of T. officinale from different origins. METHODS ：Based on the provisions of the 2020 edition of Chinese Pharmacopoeia （part Ⅰ）under the item “Taraxaci Herba ”，the method of content determination was added for the detection of water-soluble extracts （hot extraction method）and alcohol-soluble extracts （hot extraction method ），total flavonoids ，chlorogenic acid ，caffeic acid ，cichoric acid and isochlorogenic acid A. HPLC fingerprint was established by using 42 batches of T. officinale from 8 producing areas as object ，and principal component analysis was performed on the basis of above results. RESULTS ：The contents of alcohol-soluble extracts in 42 batches of T. officinale were 15.30％-30.40％，and those of water-soluble extracts were 27.59％-38.96％. The concentration of total flavonoids（UV spectrophotometry ），chlorogenic acid ，caffeic acid ，cichoric acid and isochlorogenic acid A （HPLC method ）were 0.016-0.096，0.003-0.196，0.004-0.117，0.025-1.578，0.002-0.152 mg/mL，respectively （all R2＞0.999）；RSDs of precision ， stability and repeatability tests were all lower than 2.00％（n＝6）；average sample recovery were 98.97％-103.53％，and RSDs were 1.19％-1.58％. The contents of total flavonoids ，chlorogenic acid ，caffeic acid ，cichoric acid and isochlorogenic acid A were 0.734％ -3.700％ ，0.004％ -0.123％ ，0.006％ - 0.087％ ，0.073％ -1.499％ ，0.005％ -0.109％ respectively in 42 batches of T. officinale. For 42 batches of T. officinale samples in HPLC fingerprint ，RSDs of the relative retention time of the common peak were 0-0.94％，and RSDs of the relative peak area were 0-125.57％. Among them ，the similarity of 39 batches of samples was all higher than 0.900. Results of principal component analysis showed that the quality of T. officinale from Shaanxi province was better，followed by medicinal materials from Hebei province. CONCLUSIONS ：Tentatively，the contents of alcohol-soluble extract，water-soluble extract ，total flavonoids ，chlorogenic acid ，caffeic acid ，cichoric acid and isochlorogenic acid A shall not be less than 17.0％，27.0％，1.383％，0.024％，0.021％，0.450％，0.021％ for Taraxaci Herba. In addition to the low content of caffeic acid in T. officinale from Shaanxi province ，the other indexes were better ；the content of caffeic acid in T. officinale from Hebei province was higher than that from Shaanxi province ，and other indicators were slightly lower than that from Shaanxi province. The quality of comprehensive evaluation of T. officinale from other origins was relatively poor ，and the quality of different batches of medicinal materials from the same origin was unstable.

Objective:To validate the feasibility of establishing a dosimetric model for insect species by investigating the ecological environment of an inland site in the northwestern China.Methods:For Damalacore, a simplified anatomical model based on anatomy and geometry and a model based on CT scan sequence image were established to produce a voxel model. In combination with the Monte Carlo particle transport process, the deposited energy of the radionuclides in the insect tissues/organs was obtained. The dose rate from 90Sr and 137Cs to Damalacore was calculated on the basis of empirical formula. Results:The dose rate from internal exposure to the simplified anatomical model was 8.58×10 -2for 90Sr and 4.25×10 -3μGy/h for 137Cs, whereas the dose rate from external exposure to the simplified anatomy model was 2.81×10 -2for 90Sr and 2.56×10 -1μGy/h for 137Cs, respectively. The internal exposure to the voxel model from 90Sr and 137Cs was 3.91×10 -2and 2.91×10 -3μGy/h, whereas the external exposure to the voxel model from 90Sr and 137Cs was 2.81×10 -2 and 2.56×10 -1μGy/h, respectively. The internal exposure from 90Sr and 137Cs to ERICA model was 1.46×10 -1 and 1.46×10 -2μGy/h, whereas the external exposure to the ERICA model from 90Sr and 137Cs was 5.79×10 -2 and 2.58×10 -1μGy/h, respectively. Conclusions:The calculated results based on the two models are similar to those based on ERICA model and therefore are proved reliable. With improved model accuracy, the calculated result are more close to the practical situation and feasible.

BACKGROUND: Particulate matter (PM) < 2.5 μm (PM METHODS: We obtained DNA methylation and exercise data of 496 participants (aged between 30 and 70 years) from the Taiwan Biobank (TWB) database. We also extracted PM RESULTS: DLEC1 methylation and PM CONCLUSIONS We found significant positive associations between PM
Adult ; Aged ; Air Pollutants/adverse effects* ; DNA Methylation/drug effects* ; Environmental Exposure/adverse effects* ; Exercise ; Female ; Humans ; Male ; Middle Aged ; Particulate Matter/adverse effects* ; Taiwan ; Tumor Suppressor Proteins/metabolism*

Objective:To analyze the risk factors of first endotracheal extubation failure and the related poor outcomes of extubation failure in intubated very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.Methods:The VLBW/ELBW infants intubated in the first 24 hours, and admitted from June 2016 to December 2017 in Neonatal Intensive Care Unit of the Children′s Hospital of Fudan University were recruited in the study, and they were divided into 2 groups of the extubation-failure group and the extubation-success group based on whether being reintubated in 72 hours after the extubation.The clinical data of all children were collected, and risk factors and the short-term outcomes were compared between the 2 groups.Results:One hundred and twenty-six VLBW/ELBW infants including 25 extubation-failure infants and 101 extubation-success infants were recruited, the extubation fai-lure rate was 19.8%.Extubation-failure infants had lower gestational age and lower birth weight compared with those of extubation-success group [gestational age: (27.9±2.1) weeks vs.(28.9±1.6)weeks; birth weight: 990(847-1 200) g vs.1 170(1 060-1 350) g], and the differences were statistically significant (all P<0.05). The multiple Logistic analysis demonstrated that lower gestational age was the independent risk factor of extubation failure( OR=0.92, 95% CI: 0.86-0.99, P<0.05). The outcome analysis showed that the combined outcomes of moderate-to-severe bronchopulmonary dysplasia(BPD) and death in the extubation-failure group were significantly higher than those in the extubation-success group ( OR=3.33, 95% CI: 1.28-8.63, P<0.05)after being adjusted by gestational age.The secondary outcomes of brain magnetic resonance imaging(MRI) abnormality rate in the extubation-failure group was significantly higher compared with the extubation-success group ( OR=3.93, 95% CI: 1.22-12.60, P<0.05), and the mechanical ventilation duration was significantly longer as well in the extubation-failure group compared with that in the extubation-success group[10.1 d (6.9 d, 20.9 d) vs.3.6 d(1.1 d, 8.6 d)], and the difference was statistically significant( P<0.05). The rest secondary outcomes were not significantly different between the 2 groups(all P>0.05). Conclusions:A high rate of extubation failure in VLBW/ELBW infants was a common issue, and the lower gestational age is the independent risk factor for extubation failure.Extubation failure potentially increases the risk of moderate-to-severe BPD or death in VLBW/ELBW infants.

Objective: To assess the performance of extracorporeal membrane oxygenation (ECMO) in the treatment of neonates with critical diseases. Methods: This study retrospectively analyzed the clinical data of nine critically ill neonates treated with ECMO because of cardiopulmonary failure due to respiratory disorders in Children's Hospital of Fudan University from August 2015 to April 2018. General information, diagnosis, indications and approaches of ECMO, clinical procedure of ECMO, laboratory results, weaning time, survival rate before discharge, length of stay, and mechanical and neurological complications were collected and described. Results: (1) There were six male and three female patients with an average gestational age and body weight of 39.6 weeks (35-41 weeks) and 3 600 g (2 580-4 650 g), respectively. Out of them, six cases survived after successfully weaning from ECMO. (2) Sepsis (two cases), meconium aspiration (two cases), pulmonary hypertension (three cases), diaphragmatic hernia (one case) and pulmonary dysplasia (one case) were diagnosed in the patients. All underwent veno-arterial (VA) ECMO using centrifugal pump. The median age to initiate ECMO was 40 h (23-100 h) after birth, and the median duration of ECMO support was 240 h (70-370 h). During the treatment with ECMO, cholestasis, intracranial hemorrhage and vocal cord paralysis occurred in three cases, and mechanical complications (mainly were bleeding, hemolysis, oxygenated membrane leakage and embolization) occurred in five cases. The mean length of hospital stay for the six survivors was 24 d (20-49 d), and two of them developed neurological complications mainly manifested as cerebral infarction. There were three died cases. One was a baby with diaphragmatic hernia who received hernia repair during ECMO after which celiac space syndrome and necrotizing enterocolitis were developed and his parents refused further treatment. In the second case, the parents gave up treatment when no improvement was achieved after two weeks of ECMO support. While the last case was complicated by severe cerebral hemorrhage during ECMO and died after receiving no further treatment. Conclusions ECMO is newly applied in the treatment of neonates in China and of great significance for critically ill neonates. However, much need to be learned about its utilization in this population considering the mortality and disability rate are still high.