Objective To evaluate the application effect of positive end-expiratory pressure(PEEP)guided by driving pressure on intraoperative oxygenation and postoperative complications in patients undergoing orthotopic liver transplantation(OLT).Methods A total of 118 patients underwent OLT from January 2020 to September 2023,89 males and 29 females,aged 18-70 years,BMI＜28 kg/m2,ASA physical status Ⅲ or Ⅳ.Patients were divided into two groups using the random number table method:drive pressure group(group D)and PEEP group(group P),59 patients in each group.Volume controlled ventilation was used during general anesthesia in two groups,I:E 1:2,VT 6 ml/kg(ideal body weight),RR 10-15 beats/minute.In group D,the PEEP titration test was started after 5 minutes of mechanical ven-tilation,gradually increasing PEEP from 2 to 10 cmH2O,selecting the PEEP that produced the lowest driv-ing pressure,and maintaining this PEEP until the end of the surgery.In group P,the PEEP was maintained at 5 cmH2O during surgery.The amount of intraoperative out put and intake,and the use of vasoactive drugs were recorded.The HR,SBP,DBP,peak airway pressure(Ppeak),airway plateau pressure(Pplat),PEEP,and blood gas analysis results were recorded 5 minutes after intubation(T1),during the anhepatic phase(T2),during the neohepatic phase(T3),and at the end of the operation(T4),and driving pres-sure,dynamic pulmonary compliance(Cdyn),oxygenation index(OI),and dead space fraction(VD/VT)were calculated.The occurrence of postoperative pulmonary complications(PPCs)within 7 days after opera-tion was recorded.Results Compared with group P,the amount of crystalloid and the usage frequencies of norepinephrine,phenylephrine,and epinephrine in group D were significantly increased(P＜0.05).Com-pared with T2,HR was significantly decreased,SBP and DBP were significantly increased at T1,T3,and T4 in the two groups(P＜0.05).Compared with T1,Ppeak,Pplat,driving pressure,and OI were signifi-cantly increased at T2-T4,and Cdyn was significantly decreased at T3 and T4 in the two groups(P＜0.05).Compared with group P,the incidence of PPCs in group D was significantly decreased(P＜0.05).There were no significant differences in other indexes between the two groups.Conclusion The driving pressure guided PEEP ventilation improves intraoperative oxygenation and reduces the incidence of PPCs in patients undergoing OLT,but the use of intraoperative vasoactive drugs increases.

Background The safety of drinking water is closely related to people's health. In recent years, relevant studies have identified some health related problems with drinking water in Inner Mongolia Autonomous Region. The complex and diverse natural environment embraced by the vast jurisdiction of the region may lead to uneven drinking water quality across the region. Objective To evaluate eight chemicals including arsenic, cadmium, chromium (hexavalent), lead, mercury, fluoride, trichloromethane, and carbon tetrachloride in urban drinking water in Inner Mongolia Autonomous Region in 2021, and to provide reference for optimizing urban water supply system and ideas for further developing strategies to promote population health. Methods A total of 1228 monitoring sites were set up in urban areas of Inner Mongolia, and water samples were collected once in dry season (May) and once in wet season (August−September). Eight chemicals of interest in drinking water were detected according to the Standard examination methods for drinking water, and assessed for health risks using the health risk assessment model recommended by the United States Environmental Protection Agency (USEPA) and following the Technical guide for environmental health risk assessment of chemical exposure. Mann-Whitney U test was used to compare the concentrations of eight chemicals in urban drinking water by water seasons and water sample types. Results In 2021, a total of 2381 samples of urban drinking water were tested in the Inner Mongolia Autonomous Region, including 1195 samples in wet season and 1186 samples in dry season; 389 samples of finished water and 1992 samples of tap water. The positive rates of arsenic and fluoride were 26.25% and 96.77%, respectively. The positive rates of cadmium, chromium (hexavalent), lead, mercury, trichloromethane, and carbon tetrachloride were 6.22%, 16.63%, 6.09%, 16.67%, 18.98%, and 8.36%, respectively. The exceeding standard rate of fluoride was 4.87%. Trichloromethane and carbon tetrachloride were qualified in all samples. There were statistical differences in the concentrations of arsenic, cadmium, chromium (hexavalent), lead, and carbon tetrachloride in urban drinking water between water seasons (Z=−3.847, P<0.05; Z=2.464, P=0.014; Z=−3.129, P=0.002; Z=4.341, P<0.05; Z=4.342, P<0.05). Only fluoride concentration was found statistically different among different water sample types (Z=−2.287, P=0.022). The non-carcinogenic risks of ingestion and dermal exposure to each chemical in drinking water by water seasons and water sample types were all less than 1, but the P₉₅ total non-carcinogenic risks of oral exposure were greater than 1. The P₉₅ carcinogenic risks of oral exposure to some chemicals in drinking water by water seasons and water sample types were>10⁻⁴, which suggested carcinogenic risks, while the carcinogenic risks of dermal explore to chemicals were all less than 10⁻⁶. Conclusion In 2021, urban drinking water in Inner Mongolia Autonomous Region is generally safe, but arsenic, cadmium, chromium (hexavalent), lead, mercury, and fluoride still exceed the national limits, posing certain health risks.

The neural stimulator is a core component of animal robots. While the control effect of animal robots is influenced by various factors, the performance of the neural stimulator plays a decisive role in regulating animal robots. In order to optimize animal robots, embedded neural stimulators had been developed using flexible printed circuit board technology. This innovation not only enabled the stimulator to generate parameter-adjustable biphasic current pulses through control signals, but also optimized its carrying mode, material, and size, overcoming the disadvantages of traditional backpack or head-inserted stimulators, which have poor concealment and are prone to infection. Static, in vitro, and in vivo performance tests of the stimulator demonstrated that it not only had precise pulse waveform output capability, but also was lightweight and small in size. It had excellent in vivo performance in both laboratory and outdoor environments. Our study has high practical significance for the application of animal robots.
Animals ; Robotics

Abstract To describe the clinical features of myelin oligodendrocyte glycoprotein antibody-related diseases associated with seizures. MethodsPatients with positive blood or cerebrospinal fluid MOG antibody test who were admitted to the Fifth Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Zhengzhou University from April 2016 to April 2021 were retrospectively analyzed to understand the general data，clinical features，laboratory examination，imaging examination，EEG results，treatment and prognosis of patients with seizures in the course of the disease. ResultsFifteen patients（21.4%，15/70）with positive MOG antibody had seizures at the first onset，including 11 children and 4 adults，with an average onset age of 17.4 years（3-53 years）. The clinical manifestations were ADEM-like in 6 cases，unilateral cortical encephalitis in 5 cases，isolated seizures in 3 cases and anti-NMDAR encephalitis in 1 case. The types of epileptic seizures are generalized tonic-clonic seizures in 10 cases，focal motor seizures in 3 cases and status epilepticus in 2 cases. In addition to headache，fever and corresponding cortical related symptoms，it can also involve the brain stem，optic nerve and spinal cord. In the acute phase，EEG is often abnormal，and slow-wave changes appear in the cortex area corresponding to the involved side.Head MRI often shows cortical involvement，showing local cortical swelling，shallow sulcus，the high signal in FLAIR，and enhanced meningeal linear enhancement. Glucocorticoid or combined with human immunoglobulin is effective in the acute phase. After 2-31 months follow up，6 patients relapsed，5 patients were treated with immunosuppressant，and 10 patients were prolonged with antiepileptic drugs. ConclusionsSeizures is common in MOG antibody related diseases，mostly in the clinical phenotype of ADEM and unilateral cortical encephalitis. The most common seizure type is a generalized tonic-clonic seizure，and the cortex on the affected side of EEG shows slow wave changes. Head MRI usually involves cerebral cortex and subcortical white matter，and some patients with isolated epilepsy may have typical demyelinating changes afterwards. Immunotherapy is effective in the acute stage，and some patients need to be treated with immunosuppressants and extended antiepileptic drugs.

Objective:To explore the related factors influencing the length of hospital stay(LOS) of pregnant women with heart disease (PWHD) after cesarean section.Methods:A total of 306 patients with PWHD who underwent cesarean section from January 2012 to March 2019 were collected. Among them, 203 patients had not undergone heart surgery (uncorrected group) and 103 patients who had undergone heart surgery (corrected group) during the same period. Demographic, perioperative and postoperative data were recorded. Predictors associated with postoperative LOS were determined using univariate and multivariate linear regression analysis models.Results:(1) The median LOS after cesarean section in the uncorrected group was 6 days (5-8 days). The results of univariate linear regression analysis showed that 38 parameters had significant impact on LOS ( P<0.05). The results of multivariate linear regression analysis showed that 5 parameters were independent risk factors for prolonged LOS in the uncorrected group; among them, the median LOS in uncorrected group with hypertensive disorders of pregnancy was 3 days longer than that in patients with PWHD alone [7 days (5-8 days) vs 4 days (4-5 days), β=0.195, P=0.001]; the median LOS in uncorrected group with high serum creatinine was 3 days longer than normal patients [7 days (5-13 days) vs 4 days (4-5 days), β=0.145, P=0.015]; the LOS of patients who chose general anesthesia was 2 days longer than that of patients who chose spinal anesthesia [6 days (4-8 days) vs 4 days (4-5 days), β=0.154, P=0.007]; the LOS of patients with postoperative pulmonary infection was 4 days longer than that of patients without pulmonary infection [8 days (5-15 days) vs 4 days (4-5 days), β=0.269, P<0.01]; the LOS of patients who admitted to ICU after surgery was 2 days longer than that not admitted patients [6 days (5-8 days) vs 4 days (4-5 days), β=0.268, P<0.01]. (2) The median LOS after cesarean section in corrected group was 4 days (4-5 days). The results of univariate linear regression analysis showed that 8 parameters had significant impact on the LOS (all P<0.05). The results of multivariate linear regression analysis showed that 2 parameters, which were American Society of Anesthesiologists (ASA) grade ( β=0.198, P=0.028) and intraoperative blood loss ( β=0.285, P=0.003), were the independent risk factors for prolonged LOS in corrected group. Conclusion:Preoperative with hypertensive disorders of pregnancy, preoperative creatinine increase, intraoperative general anesthesia, postoperative pulmonary infection, and postoperative admission to ICU are independent predictors of prolonged LOS in uncorrected patients with PWHD; ASA classification and intraoperative bleeding are independent predictor of prolonged postoperative LOS in patients with corrected PWHD.

Objective:To evaluate the efficacy of continuous infusion of lidocaine via urinary catheter for postoperative analgesia in patients undergoing urological surgery.Methods:Forty male American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-75 yr, with body mass index of 18-25 kg/m 2, scheduled for elective percutaneous nephrolithotomy, were divided into 2 groups ( n=20 each) using a random number table method: continuous infusion of lidocaine through urinary catheter group (group L) and patient controlled intravenous analgesia (PCIA) group (group PCIA). All the patients underwent total intravenous anesthesia, and a matched type of sterile urethral irrigation catheter was inserted after the operation.In group L, 0.5% lidocaine was continuously infused at a rate of 5 ml/h via the urinary catheter, while the equal volume of 0.9% normal saline was continuously infused via the urinary catheter, and PCIA was connected in group PCIA.PCIA solution contained sufentanil 125 μg (diluted to 250 ml in normal saline), and the PCA pump was set up with a 5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 5 ml/h.When visual analogue score was>4, sufentanil 0.05 μg/kg was injected intravenously as rescue analgesic.The development and severity of catheter-related bladder discomfort (CRBD) were recorded immediately at the end of the operation (T 1), and at 6 h (T 2), 24 h (T 3) and 48 h (T 4) after the operation, respectively.Riker sedation-agitation scale (SAS) score was recorded at T 1, 2, and QoR-9 scale was recorded at T 3, 4.The concentrations of serum cortisol (Cor), norepinephrine (NE), epinephrine (E) and blood glucose (Glu) were measured by enzyme linked immunosorbent assay.First off-bed time, exhaust time, length of hospital stay after surgery, and the requirement for rescue analgesia and adverse reactions (nausea and vomiting, respiratory depression, hypotension, skin itching) within 48 h after the operation were recorded. Results:Compared with group PCIA, the incidence of CRBD and the severity were significantly decreased at T 1-4, SAS score was decreased at T 1, 2, QoR-9 score was increased at T 3, 4, Cor, NE, E and Glu concentrations were decreased at T 1-4, the incidence of postoperative rescue analgesia was decreased, first off-bed time, exhaust time and length of hospital stay after surgery was shortened, and the incidence of postoperative nausea and vomiting, respiratory depression, hypotension, skin itching was decreased in group L ( P<0.05). Conclusion:Continuous infusion of lidocaine through the urinary catheter can provide good postoperative analgesia, reduce postoperative stress response and adverse reactions, and facilitate early postoperative recovery in patients undergoing urological surgery.

Objective:To investigate the risk factors of fulminant myocarditis in children.Methods:The clinical data of 67 children with clinical diagnosis of viral myocarditis from January 2015 to December 2018 in our hospital were retrospectively analyzed.The children were divided into fulminant myocarditis group( n=13)and common myocarditis group( n=54). The clinical data of gender, age, history of pre-infection, clinical manifestations, laboratory tests, electrocardiogram, echocardiography, and imaging findings were compared between the two groups.The multiple Logistic regression analysis was used to identify the independent risk factors of fulminant myocarditis. Results:(1)Seven cases(53.8%)died in the fulminant myocarditis group, 4 cases(30.8%) of them died within 24 hours after admission, and all the children in the common myocarditis group improved and discharged.(2)The incidences of facial cyanosis, abdominal distension, convulsions, and chills were higher in the fulminant myocarditis group than those in the common myocarditis group( P<0.05). (3)The level of creatinekinase-MB, lactate dehydrogenase, α-hydroxybutyric dehydrogenase and aspartate transferase in the fulminant myocarditis group were higher than those in the common myocarditis group( P<0.05). (4)On electrocardiogram, QRS wave duration in the fulminant myocarditis group was longer than that in the common myocarditis group[118(82, 127)ms vs.62(62, 122)ms, P<0.05]. The incidences of ventricular tachycardia in the fulminant myocarditis group was higher than that in the common myocarditis group( P<0.05). (5)In the fulminant myocarditis group, the incidences of left ventricular ejection fraction(LVEF)decreased, the left ventricular short axis fraction shortening(LVFS), and the incidence of left ventricular enlargement were higher than those in the common myocarditis group[92.3%(12/13)vs.18.5%(10/54), 84.6%(11/13)vs.9.3%(5/54), 76.9%(10/13)vs.13.0%(7/54), P<0.05]. Chest X-ray examination of the fulminant myocarditis group showed that the incidences of heart shadow enlargement and pulmonary blood stasis were higher than those in the common myocarditis group( P<0.05). (6)Multiple Logistic regression analysis revealed that LVEF reduction( OR=19.015, 95% CI 1.456-248.348, P=0.025), LVFS reduction( OR=18.691, 95% CI 2.062-169.453, P=0.009)and prolonged QRS wave duration( OR=1.040, 95% CI 1.001-1.082, P=0.046) were independent risk factors for fulminant myocarditis. Conclusion:The early mortality of fulminant myocarditis is high in children, and the LVEF reduction, LVFS reduction and prolonged QRS wave duration are independent risk factors for fulminant myocarditis.

Objective To discuss thk curk kffkct and sidk kffkcts of donor anti-CD19 chimkric antigkn rkckp-tor T lemphocetks(CD19 CLA-T)for trkating rkcurrknt acutk B-ckll lkuckmia aftkr allogknkic hkmatopoiktic stkm-ckll transplantation(Lllo-HSCT),and to analezk thk influkncing factors for this thkrape. Methods Thk clinical data of 5 acutk B-ckll lkuckmia patiknts wkrk analezkd rktrospkctivkle who rklapskd aftkr Lllo-HSCT and rkckivkd donor CD19 CLA-T thkrape at Bkijing Childrkn＇s Hospital from Jule 2015 to Octobkr 2017. Diskask status bkfork infusion, conditioning rkgimkn,rkinfusion ckll dosk,and sidk-kffkct of CLA-T infusion,changks in thk rklatkd immunological indicators,and follow-up trkatmknt rksults wkrk invkstigatkd. ResuIts Onk patiknt had no kffkct,othkr patiknts got rk-mission or minimal rksidual diskask(MAD)nkgativk within 4 wkkcs aftkr CLA-T infusion,and thk middlk timk was 14 daes. Pkriphkral CLA-T pkac happknkd 2 wkkcs aftkr CLA-T infusion. Be thk last follow,2 patiknts dikd of lkuckmia, 3 patiknts wkrk alivk,and 1 cask of thkm livkd with tumor aftkr CD19 nkgativk rklapsk,othkrs livkd with diskask-frkk condition. Cetocink rklkask sendromk(CAS)was thk most common sidk kffkct,happkning in 1 to 2 wkkcs aftkr infusion, 1 patiknt had nkurologic toxicitiks,and 2 patiknts had suspicious graft -vkrsus -host diskask. ConcIusions Donor CD19 CLA-T thkrape has a good short-tkrm kffkct for rklapskd B -ckll lkuckmia patiknts aftkr Lllo -HSCT,but long-tkrm kffkct rkquirks furthkr obskrvation;CAS is thk most common sidk-kffkct. Off-targkt and ckll kxhaustion ark thk main rkasons for dkfkat.

Kartagener syndrome is a rare autosomal recessive disease with low incidence.Clinically,typical visceral inversion,bronchiectasis and sinusitis triad are typical.The pathogenesis of the disease is not clear.The principle of treatment is mainly symptomatic treatment,postponing the progress of bronchiectasis,Lack of fundamental treatment.The disease generally has a good prognosis.This article reviews recent advances in the diagnosis and treatment of Kartagener syndrome at home and abroad.

Objective To analyze the clinical characteristics,treatment and prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT)-associated thrombotic microangiopathy (TA-TMA) in children.Methods The clinical information,treatment and prognosis of 9 cases with TA-TMA hospitalized following alloHSCT from January 2008 to November 2017 in Hematology Oncology Center,Beijing Children's Hospital,Capital Medical University were retrospectively analyzed.Results Of all the 283 allo-HSCT recipients,9 patients (3.2％) were diagnosed as TA-TMA.Among them,there were 5 male and 4 female,with a median age of 94 months (39-129 months).The median time to of diagnosis was 63 days (6-342 days) after HSCT.Additionally,the median platelet counts,hemoglobin and lactate dehydrogenase(LDH) levels were 44 × 109/L [(7-75) × 109/L],76 g/L (40-105 g/L) and 594 U/L(445-1 386 U/L).Neurological symptoms were found in 5 of the patients,4 had kidney involvement,and 6 had gastrointestinal involvement.The major treatment of TA-TMA was plasma exchange,Rituximab and defibrotide instead of the use of calcineurin inhibitors.Finally,4 patients achieved response after treatment,5 children died of ineffective treatment.Conclusion TA-TMA is a fatal complication after allo-HSCT.It can lead to multiorgan and multi-systems dysfunction.If there are more than 2 systems involved in TA-TMA,it suggests poor prognosis.The combined therapy is better than monotherapy,and the selective individual treatment of TA-TMA is essential.