Objective:To investigate the clinical efficacy of pentoxifylline sequential therapy combined with rasagiline and levodopa in the treatment of elderly patients with symptoms of Parkinson disease (PD), and the influence on hemorheology and serum Toll-like receptor 4 (TLR4) signaling pathway downstream related inflammatory factors.Methods:A prospective study method was used to select 90 elderly patients with PD with fluctuating symptoms who were admitted to the Eighth People′s Hospital of Hebei Province from June 2021 to October 2022 as research objects. The patients were divided into observation group and control group with 45 cases in each group according to random number table method. The observation group was treated with pentoxifylline sequential therapy combined with rasagiline and levodopa. The control group was treated with rasagiline combined with levodopa. The clinical efficacy of the two groups was compared. The unified Parkinson disease rating scale (UPDRS), Montreal cognitive assessment scale (MoCA), Berg balance scale (BBS) and 39-item Parkinson disease quality of life questionnaire (PDQ-39) were scored before and after treatment. Hemorheology indexes and serum levels of related inflammatory factors downstream of TLR4 signaling pathway, including whole blood high viscosity (HBV), whole blood low shear viscosity (LBV), plasma viscosity (PV), fibrinogen (FIB); TLR4, interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF) -α, were detected before and after treatment in both groups. The adverse reactions of the two groups were compared.Results:The total effective rate in observation group was significantly higher than that in control group: 93.33% (42/45) vs. 77.78% (35/45), and there was statistical difference ( P<0.05). After treatment, the UPDRS mental activity and emotional disorders, daily living ability, motor function, motor complications scores and PDQ-39 score of the two groups were significantly lower than before treatment, the MoCA and BBS scores were significantly higher than before treatment, and the improvement was more significant in the observation group, there were statistical differences ( P<0.05). After treatment, HBV, LBV, PV and FIB in the observation group were significantly decreased compared with those before treatment: (6.52 ± 0.92) mPa·s vs. (7.25 ± 1.24) mPa·s, (11.45 ± 1.24) mPa·s vs. (14.13 ± 1.64) mPa·s, (1.55 ± 0.17) mPa·s vs. (1.88 ± 0.22) mPa·s, (3.25 ± 0.47) g/L vs. (3.82 ± 0.52) g/L, and there were statistical differences ( P<0.05). There were no significant differences in hemorheology indexes of control group before and after treatment ( P>0.05). After treatment, serum levels of TLR4, IL-1β, IL-6 and TNF-α in both groups were significantly decreased compared with those before treatment, and the indexes in observation group were significantly lower than those in control group: (2.07 ± 0.18) ng/L vs. (2.58 ± 0.21) ng/L, (1.42 ± 0.17) ng/L vs. (2.28 ± 0.25) ng/L, (1.56 ± 0.22) ng/L vs. (2.42 ± 0.28) ng/L, (46.31 ± 3.17) ng/L vs. (54.34 ± 3.65) ng/L, and the differences were statistically significant ( P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05). Conclusions:Pentoxifylline sequential therapy combined with rasagiline and levodopa can effectively improve the hemorheology of elderly patients with PD accompanied by symptom fluctuations, reduce the levels of related inflammatory factors downstream of serum TLR4 signaling pathway, and improve clinical efficacy.

Objective To understand the proficiency level and sources of Traditional Chinese Medicine(TCM)health education among hemodialysis patients,in order to provide the basis for promoting the application of TCM nursing in hemodialysis patients.Methods Utilizing a convenience sampling approach,we conducted a survey from April to May 2023 involving hemodialysis patients from 7 tertiary TCM hospitals across Beijing,Hebei Province,Sichuan Province,and other regions.Custom-made questionnaires were utilized,gathering general information,respons-es conceming the level of mastery on TCM health education,and their primary sources of such knowledge.Results A total of 413 questionnaires were disseminated,and 392 proved valid,yielding a valid response rate of 94.92％.The score of patient's knowledge on TCM health education averaged(8.25±3.73),and an average score rate of 48.53％was obtained.In the patients undergoing hemodialysis,a relatively larger number of people possess knowl-edge of TCM health knowledge about relieving symptoms(50.8％～55.9％)and traditional Chinese daily life routines(56.4％～90.1％).However,fewer people are aware of how to use the five-tone therapy method for emotional inter-vention(40.8％)and principle of taking restorative Traditional Chinese Medicine(24.5％～36.7％),the dietary prin-ciples of"nurturing yang in spring and summer,and nurturing yin in autumn and winter"(14.3％),and theories of TCM kidney functions(9.9％).Approximately 23.0％of the patients sourced their TCM health education knowledge from new media platforms.Compared with new media method alone,patients who utilized only traditional education-al platforms(P=0.020),and those who combined both new media and traditional methods(P=0.018)demonstrated higher proficiency in TCM health education.Conclusion Hemodialysis caregivers are urged to develop a TCM health education framework that emphasizes emotional well-being and traditional wellness concepts,thereby fostering patient-centric TCM health ideologies.Hemodialysis education personnel are encouraged to leverage new media whilst ensuring education quality and effective outcomes.

Objective: To assess the effects of acute exposure to electronic cigarette ( e-cigarette ) on leukocyte and total protein levels in bronchoalveolar lavage fluid ( BALF ) and pulmonary surfactant protein expression in a mouse model, so as to provide insights into the elucidation of the mechanism underlying the damages to the respiratory system caused by e-cigarette. Methods: Twenty-one C57BL/6N female mice were randomly divided into the blank control group, the solvent control group and the nicotine group. Mice in the solvent control group and the nicotine group were exposed to the solvent aerosol or e-cigarette aerosol containing 25 mg/mL nicotine for 3 hours daily, while mice in the blank control group were bred in clean air. Following 3-day exposure, mouse BALF and lung specimens were collected. The cell morphology was observed using microscopy following Wright-Giemsa staining and the leukocyte count was estimated in BALF, while the total protein expression was quantified using bicinchoninic acid ( BCA ) assay. In addition, the mRNA expression of pulmonary surfactant protein genes was detected in mouse lung specimens using quantitative real-time PCR ( qPCR ) assay. Results: All mice in three groups grew well without obvious abnormality or death seen. Wright-Giemsa staining showed a higher number of mononuclear macrophages in mouse BALF in the nicotine group than in the blank control group and the solvent control group. The leukocyte counts were ( 2.00±0.77 )×107, ( 1.79±0.99 )×107 and ( 4.00±1.35 )×107 cells/L ( F=9.199, P=0.002 ), and the total protein levels were ( 0.16±0.03 ), ( 0.12±0.02 ) and ( 0.16±0.04 ) mg/mL in mouse BALF in the blank control group, solvent control group and nicotine group ( F=3.610, P=0.048 ), and the relative mRNA expression of pulmonary surfactant protein B (SP-B) and SP-D was 1.00±0.14, 0.82±0.12 and 0.74±0.07 ( F=5.491, P=0.028 ), and 1.00±0.06, 0.90±0.02 and 0.71±0.15 in mouse lung specimens, respectively ( F=10.460, P=0.005 ). The leukocyte count was significantly higher in the nicotine group than in the blank control group and solvent control group (P=0.007, 0.003), and the total protein content was higher in the nicotine group than in the solvent control group ( P=0.060 ), while the relative SP-B mRNA expression was lower in the nicotine group than in the blank control group ( P=0.025 ), and the relative SP-D mRNA expression was lower in the nicotine group than in the blank control group and solvent control group ( P=0.004, 0.041 ). Conclusion Acute exposure to e-cigarette results in elevated intrapulmonary inflammatory responses, pulmonary capillary barrier impairment and reduced pulmonary surfactant protein expression.

Objective To observe the effects of modified Liujunzi Decoction on improving isletβ-cell function of patients with the syndrome of spleen-deficiency and phlegm-stagnation of type2 diabetes mellitus.Methods Totally 72 patients were selected and divided into treatment group and control group randomly, with 36 cases in each group. Both groups were under diet adjustment and appropriate exercise and were given metformin hydrochloricle tablets, 0.5 g each time (1.0 g each time after 2 weeks), twice a day; acarbose, 50 mg each time, three times a day. The treatment group was given modified Liujunzi Decoction additionally, 200 mL each time, three times a day, orally. The course of treatment of the two groups was three months. Blood glucose, C peptide, INS, HbA1c, HOMA-IR, HOMA-β andΔI30/ΔG30 after 30 minutes of glucagon loading was recorded.Results Compared with before treatment, FBG, 30 min PBG, 2h PBG, HbA1c, FINS, fasting C-peptide, and HOMA-IR decreased in both groups, and the 30 min INS, 30 min C peptide, andΔI30/ΔG30 increased in the treatment group, with statistical significance (P<0.05). After treatment, there was statistical significance in FBG, 30 min PBG, 2 h PBG, HbA1c, fasting C-peptide, FINS, 30 min INS, 30 min C peptide, HOMA-IR, andΔI30/ΔG30 between the two groups (P<0.05).Conclusion Modified Liujunzi Decoction combined with Western medicine can better improve isletβ-cell function of patients with the syndrome of spleen-deficiency and phlegm-stagnation of type2 diabetes mellitus than Western medicine merely.

Objective: To investigate the incidence and pathogen distribution of ventilator-associated pneumonia (VAP) among preterm infants admitted to level Ⅲ neonatal intensive care units (NICU) in China. Method: A prospective study was conducted in 25 level Ⅲ NICU, enrolling all preterm infants <34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016. Chi-square test, t test and Mann-Whitney U test were used for statistical analysis. Result: A total of 7 918 patients were enrolled, within whom 4 623(58.4%) were males. The birth weight was (1 639±415) g and the gestational age was (31.4±2.0) weeks; 4 654(58.8%) infants required non-invasive mechanical ventilation and 2 154(27.2%) required intubation. Of all the mechanically ventilated patients, VAP occurred in 95 patients. The overall VAP rate was 7.0 episodes per 1 000 ventilator days, varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers. The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children′s hospitals and maternity-infant hospitals respectively, without significant differences (t=1.002, P=0.327). Gram-negative bacilli (76 strains, 91.6%) were the primary VAP microorganisms, mainly Acinetobacter baumannii (24 strains, 28.9%), Klebsiella pneumonia (23 strains, 27.7%), and Pseudomonas aeruginosa (10 strains, 12.0%). Conclusion The incidence of VAP in China is similar to that in developed counties, with substantial variability in different NICU settings. More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.

Objective To investigate the correlation analysis of amplitude-integrated electroencephalogram (aEEG) and magnetic resonance imaging (MRI) in infants with hypoxic-ischemic encephalopathy (HIE) to early evaluate the severity of HIE.Methods Ninety term infants with HIE were selected.They were detected by aEEG within 12 hours after birth,and accepted cranial MRI 3 to 7 days after birth.The infants were divided into 3 groups (aEEG normal,mild abnormality and severe abnormality) according to the result of aEEG.The Spearman correlation analysis was completed in infants with HIE between aEEG clinical grading and cranial MRI grading.Results In 90 infants with HIE,the clinical grading:mild HIE 44 cases (48.9％),midrange HiE 29 cases (32.2％) and severe HIE 17 cases (18.9％).Cranial MRI grading:mild 49 cases (54.4％),midrange 23 cases (25.6％) and severe 18 cases (20.0％).The result of aEEG:aEEG normal 43 cases (47.8％),aEEG mild abnormality 25 cases (27.8％) and aEEG sever abnormality 22 cases (24.4％).The result of correlation analysis showed that aEEG grading was positive correlation with the HIE clinical grading (r =0.970 7,P ＜ 0.01) and MRI grading (r=0.933 5,P ＜ 0.01).Conclusion The aEEG can early evaluate the severity of HIE.

Objective To investigate the early diagnostic and the prognostic value of amplitude integrated e-lectroencephalography(aEEG)in neonates with hypoxic - ischemic encephalopathy( HIE). Methods The medical data subjects were admitted to the Department of Neonatology,Children's Hospital of Hebei Province from January 2012 to December 2013. Ninety term infants with HIE were divided into 3 groups(mild,moderate and severe),and they were investigated respectively by aEEG monitoring within 12 hours after birth,and all of the infants accepted cranial magnetic resonance imaging(MRI)on 3 to 7 days after birth. The outcomes by MRI were divided into 3 groups(mildly abnor-mal,moderately abnormal and severely abnormal). The findings of aEEG monitoring were divided into 3 groups(nor-mal,mildly abnormal and severely abnormal),the correlation between the findings of aEEG and the severity of HIE was analyzed. The correlation between the results of aEEG and severity of MRI were analyzed. Behavior evaluation of infants with HIE were applied by Neonatal Behavioral Neurological Assessment(NBNA)score on 7 d,14 d,28 d after birth and prognostic evaluation of children with HIE was conducted based on Children's Development Center of China infants intelligence development test at 12 months of age. Results (1)Among 90 term infants with HIE,44 cases(48. 9% ) had mild HIE,29 cases(32. 2% )moderate and 17 cases(18. 9% )severe HIE;49 cases(54. 4% )had mildly ab-normal MRI,23 cases(25. 6% )moderately abnormal MRI and 18 cases(20. 0% )severely abnormal MRI;43 cases (47. 8% )had normal aEEG,25 cases(27. 8% )mildly abnormal and 22 cases(24. 4% )severely abnormal aEEG. (2)The findings of aEEG classification were correlated with the severity of HIE(r = 0. 970 7,P ﹤ 0. 001). The findings of aEEG classification were correlated with the severity of MRI(r = 0. 933 5,P ﹤ 0. 001).(3)NBNA score with severe-ly abnormal aEEG was obviously lower than that with the mildly abnormal aEEG. NBNA score on 7 d after birth:(14. 1 ± 4. 2)scores vs(32. 2 ± 2. 3)scores,on 14 d after birth:(17. 8 ± 5. 6)scores vs(33. 4 ± 2. 1)scores,on 28 d after birth:(18. 9 ± 8. 4)scores vs(34. 6 ± 2. 6)scores,and the difference was statistically significant(all P ﹤0. 05).(4)The infants with HIE were followed at 12 months of age. The development quotient mental development in-dex(MDI)and psychomotor development index(PDI)with severely abnormal aEEG were obviously lower than that with the mildly abnormal aEEG[MDI(65. 1 ± 4. 1)scores vs(89. 1 ± 6. 7)scores,PDI(67. 5 ± 10. 1)scores vs(90. 7 ± 8. 3)scores],the difference was statistically significant(all P ﹤ 0. 05). Conclusion It is indicated that aEEG can early evaluate the severity of HIE and help predict its neurological outcome.

Objective To analyze the changes of WBC classification,sugar and protein in cerebro-spinal fluid(CSF)and pathogenic bacteria of neonatal purulent meningitis.Methods Thirty-one neonates with bacterial meningitis in our department of neonatology from June 201 1 to June 2013 were enrolled,and the clinical features,pathogenic bacteria,laboratory examination of CSF were analyzed.Results Fever (90.3%),convulsions(67.7%)and changed consciousness(58.1 %)were common clinical symptoms.The incidences of other nervous system abnormal signs such as gastrointestinal dysfunction(25.8%),abnormal breathing(16.1 %),cervical resistance(16.1 %),bulging fontanel(9.7%)were lower.The Gram -negative bacteria was more than Gram -positive in both blood and CSF culture.The escherichia coli was the most common bacteria,with positive rate of 38.1 %(8 /21 )in blood culture and 55.5%(5 /9)in CSF culture.The germiculture positive rate in CSF was lower than in blood culture (29.0% vs.67.7%).Polymorphonuclear leukocyte(PMN)[(79.61 ±12.06)%]was the most predominant cell of the leukocyte classification in CSF within 1 week in all cases,PMN was still predominant in 1 to 2 weeks in 7 cases,while only 2 cases in 2 to 3 weeks still dominated by PMN,PMN was not the predominant cell 3 weeks later.Conclusion In the typi-cal neonatal purulent meningitis,PMN was the predominant cell in CSF within the first week,but the propor-tion of monocyte gradually increased and was dominant later.Escherichia coli was a common bacteria caused by this disease.

Objective To evaluate the clinical efficacy and safety of flexible fiberoptic bronchoscopy (FFB) and bronchoalveolar lavage (BAL) in treatment of neonatal atelectasis.Methods Eligible patients, who were diagnosed as neonatal pulmonary atelectasis and admitted consecutively to the neonatal intensive care unit of the Children's Hospital of Hebei Province from January 2013 to January 2015, were included in the study.They were randomly assigned to FFB group (n=30) and control group (n=28).Newborns in the FFB group received BAL under FFB, while those controls received tracheal irrigation after intubation.The duration of lung recruitment, oxygen exposure and antibiotic administration, hospital stay, culture results of respiratory secretions, prognosis and total expenses during hospitalization were compared between the two groups.Complications of FFB were also recorded.Chi-square test and t-test were performed for statistical analysis.Results (1) In the FFB group, atelectasis occurred in the upper fight lobe (n=26), upper lobes of both sides (n=1), lower right lobe (n=2) and lower left lobe (n=1), while in the control group, atelectasis occurred in the upper right lobe (n=26), lower left lobe (n=1) and middle right lobe (n=2) (x2=0.094, P ＞ 0.05).(2) The positive rate of bacteria culture results showed no difference between bronchoalveolar lavage fluid in FFB group and tracheal secretions in the controls [43％(13/30) vs 32％(9/28), x2=0.770, P ＞ 0.05].(3) The duration of lung recruitment, antibiotic administration and hospital stay of the FFB group were all shorter than those of the control group [(4.7±3.4) vs (7.4±6.6) d, (14.0±4.5) vs (20.3±10.9) d, (15.1±4.7) vs (21.8±12.3) d, t=-5.718, 8.604 and 7.733, all P ＜ 0.05].(4) Among babies in the FFB group, nine experienced fever and returned to normal after physical cooling;three showed more shadow in chest X-ray with aggravated dyspnea during a short period, and relieved 12 hours later;two had minimal hemorrhage from tracheal mucous membrane;one showed crying hoarse.Serious complications, such as pneumothorax, massive bleeding or cardiac arrest, did not occurred.No death or refuse of treatment was reported.Conclusion FFB and BAL is much more effective than tracheal irrigation after intubation in treatment of neonatal atelectasis without any severe complications.

Objective To compare the efficacy and safety of caffeine combined with humidified high-flow nasal cannula(HHHFNC) and nasal continuous positive airway pressure(nCPAP) on the treatment of apnea in very low birth weight (VLBW) preterm infants.Methods Totally 80 VLBW preterm infants with neonatal apnea,who were enrolled in the NICU of Hebei Province Children Hospital from September 2013 to March 2014,were randomly assigned to either HHHFNC group(39 cases) or nCPAP group(41 cases) according to respiratory support mode by random number table method,both groups were given caffeine.The incidence of severe apnea,incidence of reintubation,oxygen exposure time,duration of non-invasive ventilation time,feeding conditions and incidence of adverse events were compared.Results There were no significant differences in male/female ratio,gestational age,age at randomization and birth weight between the two groups(P ＞0.05).There were no significant differences in the incidence of severe apnea[15.4％ (6/39) vs 12.2 ％ (5/41)],incidence of reintubation [17.9 ％ (7/39) vs 19.5 ％ (8/41)],oxygen exposure time [(183.1 ± 31.2) h vs (175.9 ± 32.1) h],duration of non-invasive ventilation time [(163.3 ± 25.1) h v s (153.0 ± 26.2) h] between the two groups (P ＞ 0.05).The occurrence of abdominal distention [7.7 ％ (3/39) vs 24.4％ (10/41)],nasal trauma[2.6％ (1/39) vs 19.5 ％ (8/41)],head shaping [0.0％ (0/39)vs 29.3％ (12/41)] during treatment were lower in HHHFNC group than those of nCPAP group (P ＜ 0.05).Age began feeding was earlier in HHHFNC group than nCPAP group [(67.5 ± 19.1) h vs (96.3 ± 18.7) h,P ＜ 0.05],and day to full oral feeding was reduced in HHHFNC group than nCPAP group [(346.8±28.6) h vs (371.0 ±29.4),P ＜0.05].Conclusion HHHFNC combined with caffeine is effective on the treatment of apnea in VLBW preterm infants,and easier to make newborn tolerated.HHHFNC is an effective non-invasive respiratory support mode with few side effects.