1.Electroacupuncture Promotes Functional Recovery after Facial Nerve Injury in Rats by Regulating Autophagy via GDNF and PI3K/mTOR Signaling Pathway.
Jun-Peng YAO ; Xiu-Mei FENG ; Lu WANG ; Yan-Qiu LI ; Zi-Yue ZHU ; Xiang-Yun YAN ; Yu-Qing YANG ; Ying LI ; Wei ZHANG
Chinese journal of integrative medicine 2024;30(3):251-259
OBJECTIVE:
To explore the mechanism of electroacupuncture (EA) in promoting recovery of the facial function with the involvement of autophagy, glial cell line-derived neurotrophic factor (GDNF), and phosphatidylinositol-3-kinase (PI3K)/mammalian target of rapamycin (mTOR) signaling pathway.
METHODS:
Seventy-two male Sprague-Dawley rats were randomly allocated into the control, sham-operated, facial nerve injury (FNI), EA, EA+3-methyladenine (3-MA), and EA+GDNF antagonist groups using a random number table, with 12 rats in each group. An FNI rat model was established with facial nerve crushing method. EA intervention was conducted at Dicang (ST 4), Jiache (ST 6), Yifeng (SJ 17), and Hegu (LI 4) acupoints for 2 weeks. The Simone's 10-Point Scale was utilized to monitor the recovery of facial function. The histopathological evaluation of facial nerves was performed using hematoxylin-eosin (HE) staining. The levels of Beclin-1, light chain 3 (LC3), and P62 were detected by immunohistochemistry (IHC), immunofluorescence, and reverse transcription-polymerase chain reaction, respectively. Additionally, IHC was also used to detect the levels of GDNF, Rai, PI3K, and mTOR.
RESULTS:
The facial functional scores were significantly increased in the EA group than the FNI group (P<0.05 or P<0.01). HE staining showed nerve axons and myelin sheaths, which were destroyed immediately after the injury, were recovered with EA treatment. The expressions of Beclin-1 and LC3 were significantly elevated and the expression of P62 was markedly reduced in FNI rats (P<0.01); however, EA treatment reversed these abnormal changes (P<0.01). Meanwhile, EA stimulation significantly increased the levels of GDNF, Rai, PI3K, and mTOR (P<0.01). After exogenous administration with autophagy inhibitor 3-MA or GDNF antagonist, the repair effect of EA on facial function was attenuated (P<0.05 or P<0.01).
CONCLUSIONS
EA could promote the recovery of facial function and repair the facial nerve damages in a rat model of FNI. EA may exert this neuroreparative effect through mediating the release of GDNF, activating the PI3K/mTOR signaling pathway, and further regulating the autophagy of facial nerves.
Rats
;
Male
;
Animals
;
Rats, Sprague-Dawley
;
Electroacupuncture
;
Phosphatidylinositol 3-Kinase/metabolism*
;
Facial Nerve Injuries/therapy*
;
Phosphatidylinositol 3-Kinases/metabolism*
;
Beclin-1
;
Glial Cell Line-Derived Neurotrophic Factor
;
Signal Transduction
;
TOR Serine-Threonine Kinases/metabolism*
;
Autophagy
;
Mammals/metabolism*
2.Risk factors for bronchopulmonary dysplasia in twin preterm infants:a multicenter study
Yu-Wei FAN ; Yi-Jia ZHANG ; He-Mei WEN ; Hong YAN ; Wei SHEN ; Yue-Qin DING ; Yun-Feng LONG ; Zhi-Gang ZHANG ; Gui-Fang LI ; Hong JIANG ; Hong-Ping RAO ; Jian-Wu QIU ; Xian WEI ; Ya-Yu ZHANG ; Ji-Bin ZENG ; Chang-Liang ZHAO ; Wei-Peng XU ; Fan WANG ; Li YUAN ; Xiu-Fang YANG ; Wei LI ; Ni-Yang LIN ; Qian CHEN ; Chang-Shun XIA ; Xin-Qi ZHONG ; Qi-Liang CUI
Chinese Journal of Contemporary Pediatrics 2024;26(6):611-618
Objective To investigate the risk factors for bronchopulmonary dysplasia(BPD)in twin preterm infants with a gestational age of<34 weeks,and to provide a basis for early identification of BPD in twin preterm infants in clinical practice.Methods A retrospective analysis was performed for the twin preterm infants with a gestational age of<34 weeks who were admitted to 22 hospitals nationwide from January 2018 to December 2020.According to their conditions,they were divided into group A(both twins had BPD),group B(only one twin had BPD),and group C(neither twin had BPD).The risk factors for BPD in twin preterm infants were analyzed.Further analysis was conducted on group B to investigate the postnatal risk factors for BPD within twins.Results A total of 904 pairs of twins with a gestational age of<34 weeks were included in this study.The multivariate logistic regression analysis showed that compared with group C,birth weight discordance of>25%between the twins was an independent risk factor for BPD in one of the twins(OR=3.370,95%CI:1.500-7.568,P<0.05),and high gestational age at birth was a protective factor against BPD(P<0.05).The conditional logistic regression analysis of group B showed that small-for-gestational-age(SGA)birth was an independent risk factor for BPD in individual twins(OR=5.017,95%CI:1.040-24.190,P<0.05).Conclusions The development of BPD in twin preterm infants is associated with gestational age,birth weight discordance between the twins,and SGA birth.
3.Efficacy of bevacizumab combined with taxane drug in treating advanced human epidermal growth factor receptor-2 negative breast cancer
Yan ZHAO ; Yue ZHU ; Xiu WANG ; Jun LIU
Clinical Medicine of China 2024;40(4):291-297
Objective:To investigate the effect of bevacizumab combined with taxanes in the treatment of advanced human epidermal growth factor receptor-2 (HER-2) negative breast cancer.Method:A total of 61 patients with advanced HER-2 negative breast cancer admitted to SiChuan Mianyang 404 Hospital from January 2021 to June 2023 were selected as the research objects, giving one to paclitaxel (albumin combined type) treatment of 29 patients in control group, will be cut bead single combined therapy with paclitaxel (albumin combined type) of 32 patients into the observation group. The clinical efficacy (objective response rate (ORR) and disease control rate (DCR)), the levels of tumor markers (carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (carbohydrate)) before and after treatment were compared between the two groups CA125, carbohydrate antigen 153 (CA153), adverse reactions during treatment; Measurement data with normal distribution were represented as indicated, and comparison between groups was analyzed using the t test. Rate between group compared with chi-square test. The rank sum test was used to compare the constituent ratio of ordinal data between groups. Kaplan-Meier survival curve was used to analyze the prognosis of patients. Results After treatment, the ORR and DCR of the observation group were significantly higher than those of the control group (53.13%(17/32) vs 27.59 (8/29), 84.38% (27/32) vs 62.07% (18/29)), the differences were statistically significant ( χ2=4.10, 3.91, all P<0.05). After treatment, the serum CEA, CA125 and CA153 in the observation group were significantly lower than those in the control group (CEA: (15.76±1.89) ng/mL vs. (20.24±2.36) ng/mL, CA125: (25.78±3.44) kU/L vs (34.66±4.01) kU/L, CA125: (25.78±3.44) kU/L vs. (34.66±4.01) kU/L; CA153: (18.34±2.19) kU/L vs. (24.19±3.28) kU/L). The difference between the two groups was statistically significant ( t-values were 8.22, 9.31, and 8.26, all P<0.01). There was no significant difference in the incidence of adverse reactions between the two groups during treatment ( P>0.05). The median progression-free survival (PFS) of the observation group was significantly longer than that of the control group (8 months vs 5 months, χ2=7.14, P=0.008). Conclusions:Bevacizumab combined with taxanes in the treatment of patients with advanced HER-2 negative breast cancer has definite short-term efficacy, can inhibit the expression of tumor markers, prolong PFS, has good safety, and is worthy of clinical application.
4.JCAD deficiency attenuates activation of hepatic stellate cells and cholestatic fibrosis
Li XIE ; Hui CHEN ; Li ZHANG ; Yue MA ; Yuan ZHOU ; Yong-Yu YANG ; Chang LIU ; Yu-Li WANG ; Ya-Jun YAN ; Jia DING ; Xiao TENG ; Qiang YANG ; Xiu-Ping LIU ; Jian WU
Clinical and Molecular Hepatology 2024;30(2):206-224
Background/Aims:
Cholestatic liver diseases including primary biliary cholangitis (PBC) are associated with active hepatic fibrogenesis, which ultimately progresses to cirrhosis. Activated hepatic stellate cells (HSCs) are the main fibrogenic effectors in response to cholangiocyte damage. JCAD regulates cell proliferation and malignant transformation in nonalcoholic steatoheaptitis-associated hepatocellular carcinoma (NASH-HCC). However, its participation in cholestatic fibrosis has not been explored yet.
Methods:
Serial sections of liver tissue of PBC patients were stained with immunofluorescence. Hepatic fibrosis was induced by bile duct ligation (BDL) in wild-type (WT), global JCAD knockout mice (JCAD-KO) and HSC-specific JCAD knockout mice (HSC-JCAD-KO), and evaluated by histopathology and biochemical tests. In situ-activated HSCs isolated from BDL mice were used to determine effects of JCAD on HSC activation.
Results:
In consistence with staining of liver sections from PBC patients, immunofluorescent staining revealed that JCAD expression was identified in smooth muscle α-actin (α-SMA)-positive fibroblast-like cells and was significantly up-regulated in WT mice with BDL. JCAD deficiency remarkably ameliorated BDL-induced hepatic injury and fibrosis, as documented by liver hydroxyproline content, when compared to WT mice with BDL. Histopathologically, collagen deposition was dramatically reduced in both JCAD-KO and HSC-JCAD-KO mice compared to WT mice, as visualized by Trichrome staining and semi-quantitative scores. Moreover, JCAD deprivation significantly attenuated in situ HSC activation and reduced expression of fibrotic genes after BDL.
Conclusions
JCAD deficiency effectively suppressed hepatic fibrosis induced by BDL in mice, and the underlying mechanisms are largely through suppressed Hippo-YAP signaling activity in HSCs.
5.Content determination of ten flavonoids and alkaloids in Gleditsiae Sinensis Fructus, Gleditsiae Fructus Abnormalis, and Gleditsiae Spina.
Hu-Min XIE ; Yue-Guang MI ; Xiao-Yan XU ; Meng-Xiao SUN ; Er-Wei LIU ; Xiu-Mei GAO ; Xue LI ; Wen-Zhi YANG
China Journal of Chinese Materia Medica 2023;48(7):1899-1907
To study the quality control of three traditional Chinese medicines derived from Gleditsia sinensis [Gleditsiae Sinensis Fructus(GSF), Gleditsiae Fructus Abnormalis(GFA), and Gleditsiae Spina(GS)], this paper established a multiple reaction monitoring(MRM) approach based on ultra-high performance liquid chromatography-triple quadrupole-linear ion-trap mass spectrometry(UHPLC-Q-Trap-MS). Using an ACQUITY UPLC BEH C_(18) column(2.1 mm × 100 mm, 1.7 μm), gradient elution was performed at 40 ℃ with water containing 0.1% formic acid-acetonitrile as the mobile phase running at 0.3 mL·min~(-1), and the separation and content determination of ten chemical constituents(e.g., saikachinoside A, locustoside A, orientin, taxifolin, vitexin, isoquercitrin, luteolin, quercitrin, quercetin, and apigenin) in GSF, GFA, and GS were enabled within 31 min. The established method could quickly and efficiently determine the content of ten chemical constituents in GSF, GFA, and GS. All constituents showed good linearity(r>0.995), and the average recovery rate was 94.09%-110.9%. The results showed that, the content of two alkaloids in GSF(2.03-834.75 μg·g~(-1)) was higher than that in GFA(0.03-10.41 μg·g~(-1)) and GS(0.04-13.66 μg·g~(-1)), while the content of eight flavonoids in GS(0.54-2.38 mg·g~(-1)) was higher than that in GSF(0.08-0.29 mg·g~(-1)) and GFA(0.15-0.32 mg·g~(-1)). These results provide references for the quality control of G. sinensis-derived TCMs.
Flavonoids/analysis*
;
Alkaloids
;
Chromatography, High Pressure Liquid/methods*
;
Mass Spectrometry
;
Drugs, Chinese Herbal
6.DUS testing guidelines for new varieties of Chinese medicinal plants.
Cheng-Cai ZHANG ; Chao FANG ; Ming QIN ; Hong-Yang WANG ; Xiu-Zhi GUO ; Yue-Feng WANG ; Bin-Bin YAN ; Zi-Hua ZHANG ; Sheng WANG ; Lan-Ping GUO
China Journal of Chinese Materia Medica 2023;48(11):2896-2903
A rich diversity of wild medicinal plant resources is distributed in China, but the breeding of new plant varieties of Chinese medicinal plants started late and the breeding level is relatively weak. Chinese medicinal plant resources are the foundation for new varieties breeding, and the plant variety rights(PVP) are of great significance for the protection and development of germplasm resources. However, most Chinese medicinal plants do not have a distinctness, uniformity, and stability(DUS) testing guideline. The Ministry of Agriculture and Rural Affairs has put 191 plant species(genera) on protection lists, of which only 30 are medicinal species(genera). At the same time, only 29 of 293 species(genera) plants in the Protection List of New Plant Varieties of the People's Republic of China(Forest and Grass) belong to Chinese medicinal plants. The number of PVP applications and authorization of Chinese medicinal plants is rare, and the composition of variety is unreasonable. Up to now, 29 species(genera) of DUS test guidelines for Chinese medicinal plants have been developed. Some basic problems in the breeding of new varieties of Chinese medicinal plants have appeared, such as the small number of new varieties and insufficient utilization of Chinese medicinal plant resources. This paper reviewed the current situation of breeding of new varieties of Chinese medicinal plants and the research progress of DUS test guidelines in China and discussed the application of biotechnology in the field of Chinese medicinal plant breeding and the existing problems in DUS testing. This paper guides the further application of DUS to protect and utilize the germplasm resources of Chinese medicinal plants.
Agriculture
;
Biotechnology
;
Plant Breeding
;
Plants, Medicinal/genetics*
7.Shaofu Zhuyu Decoction attenuates fibrosis in endometriosis through regulating PTEN/Akt/mTOR signaling pathway.
Xiu-Jia JI ; Xiao-Hua ZHANG ; Can-Can HUANG ; Zuo-Liang ZHANG ; Hai-Yan MAO ; Bin YUE ; Bing-Yu LIU ; Quan-Sheng WU
China Journal of Chinese Materia Medica 2023;48(12):3207-3214
The present study aimed to investigate the protective role of Shaofu Zhuyu Decoction(SFZY) against endometriosis fibrosis in mice, and decipher the underlying mechanism through the phosphatase and tensin homolog deleted on chromosome ten(PTEN)/protein kinase B(Akt)/mammalian target of rapamycin(mTOR) pathway. Eighty-five BALB/c female mice were randomly assigned into a blank group, a model group, high-, medium, and low-dose SFZY(SFZY-H, SFZY-M, and SFZY-L, respectively) groups, and a gestrinone suspension(YT) group. The model of endometriosis was induced by intraperitoneal injection of uterine fragments. The mice in different groups were administrated with corresponding groups by gavage 14 days after modeling, and the blank group and model group with equal volume of distilled water by gavage. The treatment lasted for 14 days. The body weight, paw withdrawal latency caused by heat stimuli, and total weight of dissected ectopic focus were compared between different groups. The pathological changes of the ectopic tissue were observed via hematoxylin-eosin(HE) and Masson staining. Real-time PCR was employed to measure the mRNA levels of α-smooth muscle actin(α-SMA) and collagen type Ⅰ(collagen-Ⅰ) in the ectopic tissue. The protein levels of PTEN, Akt, mTOR, p-Akt, and p-mTOR in the ectopic tissue were determined by Western blot. Compared with the blank group, the modeling first decreased and then increased the body weight of mice, increased the total weight of ectopic focus, and shortened the paw withdrawal latency. Compared with the model group, SFZY and YT increased the body weight, prolonged the paw withdrawal latency, and decreased the weight of ectopic focus. Furthermore, the drug administration, especially SFZY-H and YT(P<0.01), recovered the pathological and reduced the area of collagen deposition. Compared with the blank group, the modeling up-regulated the mRNA levels of α-SMA and collagen-Ⅰ in the ectopic focus, and such up-regulation was attenuated after drug intervention, especially in the SFZY-H and YT groups(P<0.05,P<0.01). Compared with the blank group, the modeling down-regulated the protein level of PTEN and up-regulated the protein levels of Akt, mTOR, p-Akt, and p-mTOR(P<0.01, P<0.001). Drug administration, especially SFZY-H and YT, restored such changes(P<0.01). SFZY may significantly attenuate the focal fibrosis in the mouse model of endometriosis by regulating the PTEN/Akt/mTOR signaling pathway.
Female
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Animals
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Mice
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Humans
;
Proto-Oncogene Proteins c-akt/genetics*
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Choristoma
;
Endometriosis/genetics*
;
TOR Serine-Threonine Kinases/genetics*
;
RNA, Messenger
;
Signal Transduction
;
Body Weight
;
Mammals
;
PTEN Phosphohydrolase/genetics*
8.Clinical application of plasma exchange combined with continuous veno-venous hemofiltration dialysis in children with refractory Kawasaki disease shock syndrome.
Xia-Yan KANG ; Yuan-Hong YUAN ; Zhi-Yue XU ; Xin-Ping ZHANG ; Jiang-Hua FAN ; Hai-Yan LUO ; Xiu-Lan LU ; Zheng-Hui XIAO
Chinese Journal of Contemporary Pediatrics 2023;25(6):566-571
OBJECTIVES:
To study the role of plasma exchange combined with continuous blood purification in the treatment of refractory Kawasaki disease shock syndrome (KDSS).
METHODS:
A total of 35 children with KDSS who were hospitalized in the Department of Pediatric Intensive Care Unit, Hunan Children's Hospital, from January 2019 to August 2022 were included as subjects. According to whether plasma exchange combined with continuous veno-venous hemofiltration dialysis was performed, they were divided into a purification group with 12 patients and a conventional group with 23 patients. The two groups were compared in terms of clinical data, laboratory markers, and prognosis.
RESULTS:
Compared with the conventional group, the purification group had significantly shorter time to recovery from shock and length of hospital stay in the pediatric intensive care unit, as well as a significantly lower number of organs involved during the course of the disease (P<0.05). After treatment, the purification group had significant reductions in the levels of interleukin-6, tumor necrosis factor-α, heparin-binding protein, and brain natriuretic peptide (P<0.05), while the conventional group had significant increases in these indices after treatment (P<0.05). After treatment, the children in the purification group tended to have reductions in stroke volume variation, thoracic fluid content, and systemic vascular resistance and an increase in cardiac output over the time of treatment.
CONCLUSIONS
Plasma exchange combined with continuous veno-venous hemofiltration dialysis for the treatment of KDSS can alleviate inflammation, maintain fluid balance inside and outside blood vessels, and shorten the course of disease, the duration of shock and the length of hospital stay in the pediatric intensive care unit.
Humans
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Child
;
Plasma Exchange
;
Mucocutaneous Lymph Node Syndrome/therapy*
;
Continuous Renal Replacement Therapy
;
Renal Dialysis
;
Plasmapheresis
;
Shock
9.Protective effect of breviscapine against brain injury induced by intrauterine inflammation in preterm rats and its mechanism.
Si-Si WANG ; Shuang-Shuang XIE ; Yue-Xiu MENG ; Xiang-Yun ZHANG ; Yun-Chun LIU ; Ling-Ling WANG ; Yan-Fei WANG
Chinese Journal of Contemporary Pediatrics 2023;25(2):193-201
OBJECTIVES:
To study the protective effect of breviscapine against brain injury induced by intrauterine inflammation in preterm rats and its mechanism.
METHODS:
A preterm rat model of brain injury caused by intrauterine inflammation was prepared by intraperitoneal injections of lipopolysaccharide in pregnant rats. The pregnant rats and preterm rats were respectively randomly divided into 5 groups: control, model, low-dose breviscapine (45 mg/kg), high-dose breviscapine (90 mg/kg), and high-dose breviscapine (90 mg/kg)+ML385 [a nuclear factor erythroid 2-related factor 2 (Nrf2) inhibitor, 30 mg/kg] (n=10 each). The number and body weight of the live offspring rats were measured for each group. Hematoxylin-eosin staining was used to observe the pathological morphology of the uterus and placenta of pregnant rats and the pathological morphology of the brain tissue of offspring rats. Immunofluorescent staining was used to measure the co-expression of ionized calcium binding adaptor molecule-1 (IBA-1) and nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) in the cerebral cortex of offspring rats. ELISA was used to measure the levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-1β (IL-1β) in the brain tissue of offspring rats. Western blotting was used to measure the expression of Nrf2 pathway-related proteins in the brain tissue of offspring rats.
RESULTS:
Pathological injury was found in the uterus, and placenta tissue of the pregnant rats and the brain tissue of the offspring rats, and severe microglia pyroptosis occurred in the cerebral cortex of the offspring rats in the model group. Compared with the control group, the model group had significant reductions in the number and body weight of the live offspring rats and the protein expression levels of Nrf2 and heme oxygenase-1 (HO-1) in the brain tissue of the offspring rats (P<0.05), but significant increases in the relative fluorescence intensity of the co-expression of IBA-1 and NLRP3, the levels of the inflammatory factors IL-6, IL-8, and IL-1β, and the protein expression levels of NLRP3 and caspase-1 in the brain tissue of the offspring rats (P<0.05). Compared with the model group, the breviscapine administration groups showed alleviated pathological injury of the uterus and placenta tissue of the pregnant rats and the brain tissue of the offspring rats, significant increases in the number and body weight of the live offspring rats and the protein expression levels of Nrf2 and HO-1 in the brain tissue of the offspring rats (P<0.05), and significant reductions in the relative fluorescence intensity of the co-expression of IBA-1 and NLRP3, the levels of the inflammatory factors IL-6, IL-8, and IL-1β, and the protein expression levels of NLRP3 and caspase-1 in the brain tissue of the offspring rats (P<0.05). The high-dose breviscapine group had a significantly better effect than the low-dose breviscapine (P<0.05). ML385 significantly inhibited the intervention effect of high-dose breviscapine (P<0.05).
CONCLUSIONS
Breviscapine can inhibit inflammatory response in brain tissue of preterm rats caused by intrauterine inflammation by activating the Nrf2 pathway, and it can also inhibit microglial pyroptosis and alleviate brain injury.
Animals
;
Female
;
Pregnancy
;
Rats
;
Body Weight
;
Brain Injuries/prevention & control*
;
Caspase 1
;
Inflammation/drug therapy*
;
Interleukin-6
;
Interleukin-8
;
NF-E2-Related Factor 2
;
NLR Family, Pyrin Domain-Containing 3 Protein
;
Flavonoids/therapeutic use*
10.Application of transport ventilator in the inter-hospital transport of critically ill children.
Yuan-Hong YUAN ; Hui ZHANG ; Zheng-Hui XIAO ; Xiu-Lan LU ; Zhi-Yue XU ; Xin-Ping ZHANG ; Xia-Yan KANG ; Xiao-Ping ZHAO ; Li-Fen ZHU
Chinese Journal of Contemporary Pediatrics 2023;25(3):284-288
OBJECTIVES:
To study the application value of transport ventilator in the inter-hospital transport of critically ill children.
METHODS:
The critically ill children in Hunan Children's Hospital who were transported with or without a transport ventilator were included as the observation group (from January 2019 to January 2020; n=122) and the control group (from January 2018 to January 2019; n=120), respectively. The two groups were compared in terms of general data, the changes in heart rate, respiratory rate, and blood oxygen saturation during transport, the incidence rates of adverse events, and outcomes.
RESULTS:
There were no significant differences between the two groups in sex, age, oxygenation index, pediatric critical illness score, course of disease, primary disease, heart rate, respiratory rate, and transcutaneous oxygen saturation before transport (P>0.05). During transport, there were no significant differences between the two groups in the changes in heart rate, respiratory rate, and transcutaneous oxygen saturation (P>0.05). The incidence rates of tracheal catheter detachment, indwelling needle detachment, and sudden cardiac arrest in the observation group were lower than those in the control group during transport, but the difference was not statistically significant (P>0.05). Compared with the control group, the observation group had significantly shorter duration of mechanical ventilation and length of stay in the pediatric intensive care unit and significantly higher transport success rate and cure/improvement rate (P<0.05).
CONCLUSIONS
The application of transport ventilator in the inter-hospital transport can improve the success rate of inter-hospital transport and the prognosis in critically ill children, and therefore, it holds promise for clinical application in the inter-hospital transport of critically ill children.
Child
;
Humans
;
Critical Illness
;
Respiration, Artificial/adverse effects*
;
Intensive Care Units, Pediatric
;
Ventilators, Mechanical
;
Prognosis

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