Objective:To apply broaden-and-build theory to the family nursing of children with asthma, and observe its effect on children's condition control, main caregivers' negative emotion and family function.Methods:This study is a historical control study. The control group included 148 groups of children's families who were treated in the Child Respiratory Department of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to June 2020, and the observation group included 122 groups of children's families who were hospitalized from January to July 2021. The control group implemented the routine in-hospital nursing and continuous nursing plan, while the observation group implemented the asthma family broaden-and-build nursing model. We observed the recurrence of the two groups of children six months after discharge, assessed the asthma control of the two groups using the Childhood Asthma Control Test, evaluated the depression, anxiety and stress of the main caregivers before and six months after discharge using the Depression Anxiety Stress Scale, and assessed the family function using the Family Assessment Device.Results:The number of recurrence and rehospitalization of children in the observation group was less than that in the control group, the duration of attack was shorter than that in the control group, and the score of Childhood Asthma Control Test was higher than that in the control group, with statistical differences ( P<0.05). Six months after discharge, the scores of anxiety, depression and stress of the main caregivers in the observation group were significantly lower than those in the control group, and the difference was statistical ( P<0.05). The score of family communication and emotional intervention in the observation group was lower than that in the control group before discharge, and the scores of children's families in the observation group in all dimensions of family function were lower than those in the control group six months after discharge, and the differences were statistically significant ( P<0.05) . Conclusions:Asthma family broaden-and-build nursing model can effectively control the condition of asthma in children, reduce the negative emotions of main caregivers, and improve their family functions.

Objective To analyze the application value of Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation sputum expulsion in children with severe pneumonia,and provide theoretical reference for the formulation of treatment plans for severe pneumonia.Methods From April 2022 to April 2023,120 children with severe pneumonia were selected from the Children's Respiratory Department of the Second Affiliated Hospital of Wenzhou Medical University.According to different treatment plans,the children were divided into traditional airway clearance group,Acapella positive expiratory pressure therapy group,high-frequency chest wall oscillation treatment group,and Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group,with 30 cases in each group.The duration of pneumonia symptom remission and hospitalization,as well as the difference of pulmonary function index and inflammatory factors before and after treatment were compared.Results Compared with traditional airway clearance group,Acapella positive expiratory pressure therapy group,high-frequency chest wall oscillation treatment group,the disappearance time of pulmonary rales,the recovery time of body temperature,the time of cough relief and the length of stay of children in the Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group were significantly shortened[the disappearance time of pulmonary rales(days):4.85±0.78 vs.8.47±2.36,5.22±2.12,5.38±1.56,the recovery time of body temperature(days):3.51±1.04 vs.7.84±2.34,4.45±1.92,4.76±1.59,the time of cough relief(days):7.45±2.15 vs.13.59±4.08,8.88±3.35,8.72±2.59,the length of stay(days):3.78±0.63 vs.8.29±2.07,5.02±1.44,4.96±1.25,all P<0.05].The disappearance time of pulmonary rales,the recovery time of body temperature,the time of cough relief,and the length of stay in Acapella positive expiratory pressure therapy group and high-frequency chest wall oscillation treatment group were shorter than those in traditional airway clearance group(all P<0.05).Forced expiratory volume in one second(FEV1),forced vital capacity(FVC)and FEV1/FVC after treatment were significantly higher than before treatment,and the inflammatory factors tumor necrosis fact-α(TNF-α),hypersensitive C-reactive protein(hs-CRP)and white blood cell count(WBC)were significantly lower than before treatment.After treatment,FEV1,FCV and FEV1/FVC in the Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group were significantly higher than those in the traditional airway clearance group,Acapella positive expiratory pressure therapy group and high-frequency chest wall oscillation treatment group[FEV1(L):3.65±1.33 vs.2.28±0.45,2.94±0.63,2.99±0.72,FVC(L):4.56±1.84 vs.2.94±0.83,3.46±1.28,3.65±1.34,FEV1/FVC:(72.36±8.84)％ vs.(59.84±4.05)％,(62.35±5.22)％,(64.59±5.58)％,all P<0.05].The pulmonary function indexes of children in Acapella positive expiratory pressure therapy group and high-frequency chest wall oscillation treatment group were higher than those in traditional airway clearance group(all P<0.05).After treatment,the levels of serum inflammatory factors in the Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group were significantly lower than those in the traditional airway clearance group,Acapella positive expiratory pressure therapy group,high-frequency chest wall oscillation treatment group[TNF-α(ng/L):14.62±4.55 vs.29.44±6.13,18.09±5.33,17.52±4.42,hs-CRP(mg/L):21.41±3.65 vs.48.67±8.39,40.24±6.42,37.24±5.12,WBC(×109/L):13.42±3.67 vs.19.29±6.45,15.43±5.34,14.22±4.14,all P<0.05],the serum inflammatory factor indexes of Acapella positive expiratory pressure therapy group,high-frequency chest wall oscillation treatment group were lower than those of traditional airway clearance group(all P<0.05).Conclusion Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation sputum expulsion is effective in the treatment of severe pneumonia in children,which can shorten the time of sputum improvement and hospital stay,reduce the level of inflammatory factors,improve the pulmonary function of the children,and promote the rehabilitation process of the children.

Objective: To introduce the application of free-style perforator flap based on aesthetic units to repair facial defect after tumor resection. Methods: By following the concept of free-style perforator flap and the principle of facial aesthetic unit, the design of a free-style perforator flap allowed over any nearby cutaneous vessel chosen purely on the characteristics of its Doppler signal. Conventional knowledge of anatomical landmarks and possible vascular variations were less relevant. A greater freedom in flap selection was gained to recover defect in different forms such as rotation flap, advanced flap and propeller flap, which were all based on free-style perforators. The flap size ranged from 1.5 cm×1.0 cm to 12.0 cm×6.0 cm with the perforator diameter of 0.3-3.0 mm in pedicle, and some of the pedicles are "perforator clusters" . Results: A total of 72 cases underwent surgery, and 68 cases survived completely with satisfactory appearance. 1 case healed two weeks later through dressing due to undesired healing, which result ed from high tension secondary postoperative blooding. 3 cases healed in a delay due to congestion and gained acupuncture treat. Conclusions The free-style perforator flap, which depended on Doppler-discerned perforator and facial aesthetic unit, represents safe, reliable and versatile for repairing facial defect after extended resection, and it not only offers a greater freedom in flap selection but also provides good aesthetic result.

Microphthalmia family of transcription factors (MiT/TFE) is very important for the regulation of cancer cell proliferation and energy metabolism.The MiT/TFE promotes the genesis and development of tumors by up-regulating the expression of lysosomal genes as well as acting on the oxidative metabolism and the oxidative stress response.MiT/TFE can also regulate lysosomal signaling including the mTORC1 and Wnt/3-catenin pathways.The relationship between MiT/TFE and folliculin (FLCN) is associated with the tumorigenesis.

Objective:To investigate the correlation of serum hs-CRP,D-dimmer and Lp-PLA2 with vulnerable plaque of coronary artery atherosclerosis in patients with coronary heart disease.Methods:Selected 106 cases of patients in our hospital from January 2014 to December 2015,all taken coronary angiography and intravascular ultrasound.Divided into three groups according to the results of the examination,the levels of serum hs-CRP,D-dimmer and Lp-PLA2 were examined and compared,and the correlation with fiber cap thickness,plaque eccentricity index,and vascular remodeling index were tested by Pearson correlation analysis.Results:Serum levels of hs-CRP,D-dimmer and Lp-PLA2 of vulnerable plaque group and stable plaque group were significantly higher than that of the control group (P＜0.05),and the serum levels of hs-CRP,D-dimmer and Lp-PLA2 of vulnerable plaque group were significantly higher than that of stable plaque group (P＜0.05);hs-CRP was negative correlated with the thickness of fibrous cap (r=-0.712,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.813,0.756;D-,P＜0.05),D-dimmer was negative correlated with the thickness of fibrous cap (r=-0.654,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.912,0.853,P＜0.05);Lp-PLA2 was negative correlated with the thickness of fibrous cap (r=-0.796,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.836,0.729,P＜0.05).Conclusion:Hs-CRP,D-dimmer and Lp-PLA2 have high correlation with vulnerable plaque in coronary artery disease,can be used as reference indexes for assessing the instability of coronary atherosclerotic plaque.

Objective To investigate the therapeutic effects of Saussurea involucrate injection in severe acute pancreatitis (SAP) in rats.Methods A total of 80 healthy Sprague-Dawley rats were divided into eight groups:SAP group (three hours、48 hours),Saussurea involucrate treated group (three hours、48 hours),ulinastatin control group (three hours、48 hours) and sham operation group (three hours、48 hours),10 rats in each group.After modeling,the rats of SAP group were regularly feeded and the rats of other three group were treated with Saussurea involucrate injection (1.04 mL/kg) intraperitoneal injection,ulinastatin 10 000 U/L tail vein injection,and saline femoral vein injection,respectively and injected every 12 hours.At three hours and 48 hours after treated,blood and pancreatic tissue samples were obtained.The mortality rate,serum amylase level and pathological changes of the pancreas of each group were observed.Serum tumor necrosis factor alpha (TNF-α),interleukin (IL)-6 and IL-10 levels were detected by enzyme linked immunosorbent assay (ELISA).The content of malondialdehyde (MDA) in pancreatic tissues was determined by chemical colorimetry.The level of TNF-α mRNA,IL 6 mRNA and IL-10 mRNA in pancreatic tissues were measured with reverse trascription-polymerase chain reaction (RT-PCR).The activity of nuclear factor kappa B p65 (NF-κB p65) in the pancreatic tissue was tested by immunohistochemistry.Single factor analysis of variance was used to compare multiple groups,and the least significant difference (LSD) method was used in the multiple comparisons between groups.Fisher's exact probability method was performed for rates comparison.Results At 48 hours,there was no statistically significant difference in mortality rate among Saussurea involucrate treated group,SAP group and ulinastatin groups (all P＞0.05).At 48 hours,the histopathology score (8.13 ± 0.64),levels of serum amylase ((2 597.0±214.0) U/L),TNF-α ((254.4±11.6) ng/L),IL-6 ((441.4±14.6) ng/L),levels of pancreatic tissues MDA ((311.0±10.6) mmol/L),TNF-α mRNA(2.04±0.08),IL-6 mRNA (1.77±0.04)and activity of NF-κB p65 ((25.90±2.90)％) of Saussurea involucrate treated group were all lower than those of SAP group (11.40±0.89,(4 780.0±101.0) U/L,(396.0±7.4) ng/L,(664.4± 7.6) ng/L,(418.0± 10.6) mmol/L,2.94±0.03,2.63±0.08 and (51.60±5.27) ％;however level of serum IL-10 ((133.5±6.9) ng/L vs (95.1±5.2) ng/L) and IL-10 mRNA of the pancreatic tissue (1.38±0.06 vs 0.85±0.03) significantly increased (F=253.07、441.63、489.40、2 465.00、196.65、477.89、562.79、131.70、560.18、570.04,all P＜0.01).There was no significant differences in all above parameters between Saussurea involucrate treated group and ulinastatin groups (7.56±0.88,(2 607.0±239.0) U/L,(252.2 ±9.2) ng/L,(443.4±9.6) ng/L,(308.4±9.2) mmol/L,2.10±0.12,1.74±0.04,(26.00±3.67)％,(134.5±7.8) ng/L and 1.42±0.06) at 48 hours (all P＞0.05).Conclusion Saussurea involucrate injection can eliminate oxygen free radicals and prevent to xidation,inhibit NF-κB activation,regulate synthesis and release of cytokines,and alleviate pancreatic injury in SAP rats,but it can not decrease mortality.