The development process of non-invasive ventilation (NIV) has been nearly a century, reflecting the history of modern medical development. At present, NIV is widely used in pediatrics,and which is an important component of respiratory support therapy, as well as an important method for treating acute respiratory failure in children. However, non-invasive ventilation, due to its own characteristics, has limitations and contraindications, and cannot replace invasive mechanical ventilation. Before using NIV, it is necessary to carefully evaluate the patient's condition. NIV may fail in the treatment of pediatric patients with acute respiratory distress syndrome, immune dysfunction and post-extubation with acute respiratory failure, leading to poor prognosis. When the efficacy of NIV is poor and the condition worsens, prompt tracheal intubation and invasive mechanical ventilation treatment should be performed. Medical personnel should strengthen their training on the use of NIV.Teams with experienced members and refined management are important guarantees for the safe and effective use of NIV.

Prone position ventilation(PPV) is an effective treatment for moderate to severe pediatric acute respiratory distress syndrome(PARDS) and should be used in the early stage. PPV can improve oxygenation and reduce mortality.However, at present, the rate of application of PPV in moderate to severe PARDS is still low, which may be related to the insufficient understanding of its therapeutic effect and the lack of trained and skilled staff.Prone operation requires the coordinated efforts of doctors and nurses.Three to five medical personnel are required to participate in this routine operation, and the endotracheal tube and various invasive tubes must be carefully fixed.The safety of children during the prone operation should be guaranteed, and the extubation, migration or kinking of invasive pipelines must be avoided.Children receiving extracorporeal membrane oxygenation can be ventilated in prone position, but additional operators are required during prone operation.Medical staff should receive training related to the prone operation, master the contraindications of PPV, and avoid related complications.After the outbreak of COVID-19, the application of PPV has gradually increased.The key research progress of PPV in acute respiratory distress syndrome mostly comes from the adult field.More clinical studies should be carried out on the use of PPV in pediatrics in the future, so as to better treat PARDS.

Objective:To investigate the efficacy and safety of hydromorphone for postoperative analgesia in children with congenital heart disease, and provide a suitable reference dose for postoperative analgesia in children.Methods:Using a prospective study, 157 patients with congenital heart disease(ASA Ⅱ- Ⅳ) admitted to pediatric intensive care unit at Children′s Hospital of Chongqing Medical University from November 2019 to November 2021 were randomly divided into five groups.Low-dose hydromorphone group (H1 group, 30 cases): hydromorphone dose ≥2 and <3 μg/(kg·h), hydromorphone medium-dose group (H2 group, 30 cases): hydromorphone dose ≥3 and <4 μg/(kg·h), high-dose hydromorphone group (H3 group, 31 cases): hydromorphone dose ≥4 and ≤5 μg/(kg·h), sufentanil group (S group, 36 cases): the dose of sufentanil was 0.08 μg/(kg·h), morphine group (M group, 30 cases): the dose of morphine was 20 μg/(kg·h). The five groups of children received midazolam 2 μg/(kg·min) intravenously at the same time as sedative therapy.Pain score and sedation score were scored at 1 h, 4 h, 8 h, 12 h, and 24 h after operation.Heart rate, mean arterial pressure, blood glucose, lactate, and serum cortisol levels were also monitored and detected, and the occurrence of adverse reactions, the number of cases requiring additional analgesic and sedative drugs, as well as the duration of mechanical ventilation were compared.Results:(1) There were no significant differences regarding the age, body weight, cardiopulmonary bypass time, pediatric critical illness score and ASA score among five groups (all P>0.05). (2) There was no significant difference in the levels of respiration, heart rate, blood sugar, lactate and serum cortisol among five groups after operation.There was no significant difference in preoperative mean arterial pressure among the groups, but there was significant difference in the postoperative mean arterial pressure among the groups at 4 h and 8 h( P<0.05). (3) The analgesic satisfaction of H1 group, H2 group and H3 group at 1 h, 4 h, 12 h and 24 h after operation was significantly higher than that in M group ( P<0.05). There was no significant difference in analgesic satisfaction among H1 group, H2 group and H3 group at each time point.(4) The sedation satisfaction of H1 group, H2 group and H3 group at 4 h and 24 h after operation was significantly higher than that in M group ( P<0.05). There was no significant difference in sedation satisfaction among H1 group, H2 group and H3 group at each time point.(5) There was no significant difference in postoperative analgesia satisfaction and sedation satisfaction between H1 group, H2 group, H3 group and S group.(6) Children in H1 group[1(0, 2)], H2 group[1(0, 2)], H3 group[1(0, 2)] had fewer additional doses within 24 hours than that in M group[2(2, 3)]( P<0.05), and fewer children in H1 group, H2 group and H3 group had been given analgesic sedatives than that in M group ( P<0.05); The extubation time was shortest in H2 group and S group[H2 group(88.3±2.9) h, S group(85.9±3.0) h]. (7) There were no adverse reactions in H1 group, H2 group, H3 group and S group, and there were two cases of apnea in M group. Conclusion:The analgesic effect of hydromorphone in children with congenital heart disease after surgery is better than that of morphine, and the effect of hydromorphone is comparable to that of sufentanil.Hydromorphone 3-4 μg/(kg·h)+ midazolam 2 μg/(kg·min) can achieve satisfactory analgesic and sedative effects in children after congenital heart surgery, with few adverse reactions, safe and reliable, which is an excellent choice for postoperative analgesia and sedation in children.

Objective: To explore the clinical features and risk factors of hepatic injury due to immune checkpoint inhibitors (CPI) therapy in malignant tumor. Methods: Data of 112 patients (64 men and 48 women) who received CPI between January 2016 and March 2019 in Chinese Academy of Medical Sciences and Peking Union Medical College Shenzhen Hospital, and Huazhong University of Science and Techology Union Shenzhen Hospital were retrospectively collected. The median age of these patients was 60 years. Results: Hepatic adverse events were observed in 30 patients out of 112 patients (26.8%). Among them, the incidence of grade 3-5 hepatic adverse events were 7.14% (8/112). The median time of hepatic adverse event occurrence was 3 weeks (2-30) after undergoing therapy. The results of univariate and multivariate analyses showed that liver cancer was attributed to the CPI induced hepatitis (P<0.05). Patients with severe hepatic injury got almost complete resolution after receiving methlprednisolone for 4 to 6 weeks. Conclusion Live cancer is the risk factor of CPI-related hepatic adverse events.

Objective:To explore the reference ranges and influential factors of disturbance coefficient (DC) in children without craniocerebral injury at different ages.Methods:Two hundred children without craniocerebral injury admitted to the Department of Orthopaedics in Children′s Hospital of Chongqing Medical University from May 2018 to October 2019 were enrolled in this prospective study. The children were divided into four groups according to age, 0-1 year, >1-3 years, >3-5 years and >5-16 years, each of which included 50 children. Each child had DC measured twice with the non-invasive dynamic cerebral edema monitor, and the average value was used as the terminal DC value. Each measurement lasted 15 minutes, 12 hours apart. The difference of DC values among the four groups and between different genders were compared with ANOVA test and nonparametric test. And the Loess local weighted nonparametric regression analysis was used to explore the change of DC according to the increase of age, weight and head circumference (HC).Results:The reference values of DC for children of 0-1 year,>1-3 years, >3-5 years, and >5-16 years were 60±14, 92±18, 112±18, 135±18, respectively ( F=175.690, P<0.01). There was no statistical significance in DC between male and female children either in the whole or in each separate age group (103 (81, 125) vs. 102 (68, 123) , Z=-0.739, P=0.460; 59 (52, 68) vs. 57 (53, 65) , Z=-0.243, P=0.808; 88 (81, 105) vs. 95 (70, 105) , Z=-0.776, P=0.437; 117 (99, 120) vs. 113 (101, 123) , Z=-0.170, P=0.865; 137 (123, 143) vs. 142 (123, 160) , Z=-1.279, P=0.201). When the child′s age was younger than 5 years, weight was less than 18 kg or HC was less than 51 cm, the DC increased significantly with the increase of age, weight or HC. However, when the age, weight and HC were over the above values, the DC did not show obvious increase, but approaching to stable values of 135, 130, and 130, respectively. Conclusions:For children without craniocerebral injury, the reference values of DC are obviously different at different ages. DC is positively related to age, weight and HC, but not related to gender.

Traumatic brain injury (TBI) is a common and critical illness in pediatrics,and it is also an important cause of death and disability in children. TBI may cause hyperglycemia,which may be related to stress,inflammation,pituitary function and iatrogenic factors. Hyperglycemia is closely related to the mortality and outcome of children with TBI. However strict glycemic control did not achieve good effects in patients with TBI.

In addition to pneumonia,Mycoplasma pneumoniae (MP)infection can also cause Stevens-John-son syndrome,hemophagocytic lymphohistiocytosis,hepatitis,nervous system disease,and other serious diseases,which seriously threat to the health of children. The pathogenesis of multisystematic damage caused by MP infection is not fully understood,but it may be related to the abnormality of immune reaction after MP infection. Pediatricians should be fa-miliar with clinical manifestation of MP infection,as far as possible to the early diagnosis and treatment to improve the prognosis. This article mainly introduces the multiple system damage caused by MP infection in children.

Objective: Based on the Chinese Medicine Heritage Auxiliary Platform (V2.5) software, to analyze the differences in prescriptions for the treatment of Alzheimer's disease and Vascular dementia in the literature of the past five years, and to find the rules of prescription. Methods: Screening CNKI, VIP, and Wan fang data for nearly 5 years to find the prescriptions for the treatment of Alzheimer's disease and Vascular dementia, and constructing a prescription database through the Chinese Medicine Heritage Auxiliary Platform (V2.5) software, and utilizing the Data mining algorithms such as association rules and entropy clustering of the software. Compare the frequency of medication, the drug.s natural, flavor and channel tropism, the common drug pairs, the potential drug pairs, and the differences in the new prescriptions used in the treatment of senile dementia and vascular dementia. Results: 13 of the top 20 high frequency herbs used in AD and VD are the same, the other is different. Its common pathogenesis reflect the interaction of deficiency, stasis and phlegm, while the difference shows that AD focuses on spleen and kidney deficiency, insufficiency of essence and blood, but VD focuses on the interaction of phlegm blood stasis and toxic turbidity obstruction in collaterals. They both use warm herbs in nature and flavor, but AD mainly use sweet and warm herbs, followed by calm and cold herbs, while VD mainly use bitter and warm herbs, followed by cold and calm herbs; The channel tropisms both are mainly liver channel, followed by heart channel, spleen channel and kidney channel. In addition, 16 potential medicine pairs, 7 new prescriptions, 26 new prescriptions and 13 new prescriptions were found. Conclusion:Prescriptions for AD and VD have similarities and differences, with emphasis on each other, suggesting that the former focuses on warming Yang and invigorating spleen, while the latter focuses on resolving phlegm and removing blood stasis, detoxifying and awakening the brain.

Objective: To investigate the effects of compatibility of Radix Ginseng and Radix Scutellariae (CRH) on learning and memory ability in multi-infarct dementia (MID) model rats and to explore the mechanism from the perspective of brain energy. Methods: We established MID rat model by thrombus injection, and learning and memory ability of MID rats was evaluated by Morris water maze; HE staining was used to observe the pathological changes in hippocampal CA1 region of rats; the contents of ATP, ADP and AMP in brain tissues were determined by highperformance liquid chromatography; flow cytometry was used to detect the changes of mitochondrial swelling and mitochondrial membrane potential in hippocampus of rats. Results: Compared with the rats in model group, the escape latency was significantly shortened in both high and low dose groups (P ＜ 0.05) . The times of crossing the platform were increased in both high and low dose groups (P ＜ 0.05) . The disorder of cell arrangement and loss of number of cell layers were significantly improved in high and low dose groups (P ＜ 0.05) . The degree of mitochondria swelling was significantly reduced in low dose group (P ＜ 0.05) . The decreasing trend of mitochondrial membrane potential was improved (P ＜0.05), and the energy charge of brain tissue was increased in high dose group rats (P ＜ 0.05) . Conclusion: CRH improved the cognitive decline and increased the concentration of energy charge in MID rats which was in relation to protect mitochondrial damage and improve brain energy, and further protect neurons.

Objective: To investigate the effects of Kaixin Powder on learning and memory, ATP/AMP ratio, GABA andiNOS levels in rats with multiple infarct dementia. Methods: The rat model of multi-infarct dementia was established bymicro-thromboembolism. Morris water maze and opening experiment were used to evaluate learning and memoryfunction. The pathological changes of hippocampal CA1 area were evaluated by HE staining. The contents of ATP andAMP in brain tissue were determined by HPLC. The content of γ-aminobutyric acid and iNOS in peripheral blood weredetected by ELISA kit. Results: Compared with the rats of model group, rats of Kaixin Powder group can significantlyshorten the escape latency, increase the number of crossing platforms, Results: Compared with the model group, increasethe standing times in the opening experiment, prolong the exercise time, shorten the resting time, improve the nerve celldamage in the hippocampal CA1 area, and significantly increase the ratio of ATP/AMP of brain tissue, decreased brainGABA content and serum iNOS content (P ＜ 0.05) . Conclusion: Kaixin Powder has the effect of improving learning andmemory function and abnormal motor behavior in rats with multiple infarct dementia. The mechanism is related toreducing GABA and i NOS content in brain tissue, increasing ATP/AMP ratio in brain tissue and improving energysupply in brain tissue.