Objective:To explore the application value of humidifying high-flow nasal cannula oxygen therapy (HHFNC) in children with pediatric intensive care unit (PICU) after weaning.Methods:From January 2018 to October 2021, 42 children with endotracheal intubation admitted to PICU of Tai′an city Central Hospital were prospectively selected and randomly divided into HHFNC group and nasal continuous positive airway pressure (NCPAP) group, with 21 patients in each group. The blood gas analysis [arterial partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide in artery (PaCO 2), PaO 2/oxygen concentration (FiO 2)], blood oxygen saturation (SaO 2), comfort, non-invasive ventilation time, and total hospital stay of the two groups of children 1 hour after using HHFNC and NCPAP were compared, and the rate of reintubation of trachea within 48 hours, gastroesophageal reflux, nasal injury, facial skin indentation, abdominal distension, and pulmonary air leakage were recorded. Results:There was no significant difference between the two groups in terms of blood gas analysis (PaO 2, PaCO 2, PaO 2/FiO 2), SaO 2, pulmonary air leakage, non-invasive ventilation time, hospital stay, and reintubation rate within 48 h after weaning (all P>0.05). Compared with NCPAP group, HHFNC group had higher comfort, lower incidence of facial skin indentation, gastroesophageal reflux, nasal injury and abdominal distension, and the difference was statistically significant (all P<0.05). Conclusions:HHFNC and NCPAP can both be used as the transitional respiratory support mode after weaning, and the clinical treatment effect are similar. The HHFNC group has higher comfort, which is more conducive to improving the tolerance of children, reducing adverse reactions, and has higher safety.

Objective: To analyze the epidemiological characteristics of acute paraquat(PQ)poisoning in children in southwest Shandong, and the risk factors for pulmonary interstitial fibrosis. Methods: This retrospective study was performed on the clinical data of children with acute PQ poisoning admitted from January 2013 to December 2017 in 12 hospitals in southwest Shandong.All participants were divided into pulmonary interstitial fibrosis group and no pulmonary interstitial fibrosis group on the basis of the chest CT 14 days after poisoning.The epidemiological characteristics and risk factors of pulmonary interstitial fibrosis were analyzed. Results: During the study period, a total of 307 children with acute PQ poisoning were admitted to 12 hospitals, of which 61 (19.87%) were suffering from acute PQ poisoning.Forty-nine cases with complete clinical data were analyzed, including 26 male and 23 female patients poisoned by oral.The age distribution ranged from 8 months to 14 years.Poisoning mainly occured from July to September of each year.The mortality of acute PQ poisoning was 8.2%(4/49), and the incidence of pulmonary interstitial fibrosis in survival patients was 44.4%(20/45). Statistical differences (P<0.05) were found between the pulmonary interstitial fibrosis and no pulmonary interstitial fibrosis, with regard to the times of blood purification, the time from poison exposure to blood purification, the application rate of glucocorticoids, the concentration of PQ in urine, the pediatric critical illness score, the time from poison exposure to gastric lavage, the white blood count at admission, serum creatinine, arterial blood lactate, PaO₂, PaCO₂, and PaO₂/FiO₂; however, there was no significant difference in the proportion of blood purification treatment, the mode of blood purification treatment, alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatine kinase and troponin.Stepwise logistic regression analysis showed that the time from exposure to poison to gastric lavage(OR=0.683, 95%CI 0.210-2.222)and to blood purification(OR=0.0133, 95%CI 0.004-0.042), the times of blood purification(OR=2.862, 95%CI 1.450-5.648), concentration of PQ in urine(OR=1.435, 95%CI 1.085-1.898), and the use of glucocorticoids(OR=0.190, 95%CI 0.048-0.757) were the risk factors for pulmonary interstitial fibrosis(P<0.05). Conclusion Early gastric lavage and blood purification, increasing the frequence of adminitrating purification appropriately, using low-dose glucocorticoids can reduce the incidence of pulmonary interstitial fibrosis of children with acute PQ poisoning.

Objective To explore the effectiveness of the new clinical teaching method based on problem leading-in and the reform of clinical talents training mode. Methods 180 clinical interns in de-partment of urology were selected as the subjects, which were randomly divided into experimental group and control group (90 clinical interns in each group). The clinical teaching effects of the two groups were compared by adopting the new clinical teaching methods and the traditional ones. Evaluation indexes con-sists of theoretical scores, operational skills and personal comprehensive quality scores. Results The results of the above three tests in the experimental group were all superior to those of the control group (P<0.05). The satisfaction of the experimental group in teaching method, teaching effect and teacher evaluation was obviously better than that in the control group (P<0.05). Conclusion The implementation of the new clinical teaching method based on problem leading-in is not only beneficial to improve the knowledge skills, com-prehensive quality and teaching satisfaction of clinical medical students, but also to the training of clinicians with high quality. The new clinical teaching method is of great significance for reforming the mode of clini-cal medical talents.

Objective To study the clinical efficacy of caffeine in premature infants receiving mechanical ventilation and related complications .Method From January 2014 to September 2016, preterm infants (28w≤GA<33w) treated with nasal continuous positive airway pressure (NCPAP) or conventional mechanical ventilation ( CMV ) in neonatal intensive care unit were studied .They were randomly assigned into the caffeine group and the control group .The caffeine group received caffeine when NCPAP ventilation was applied or adjusting to synchronized intermittent mandatory ventilation ( SIMV) mode.The control group was injected with 5%glucose without caffeine .The t test andχ2 test were used to analyze the clinical efficacy and related complications .Result A total of 96 patients receiving NCPAP ventilation were collected ( birth weight between 1300~2100 g), including 51 cases in caffeine group and 45 cases in the control group. 84 cases received CMV ventilation (birth weight between 1000~1499 g), with 43 cases in the caffeine group and 41 cases the control group.Among the NCPAP infants, the incidence of failure to withdraw ventilator (0% vs.13.3%) and the incidence of bronchopulmonary dysplasia (3.9% vs.17.8%) were lower in the caffeine group than the control group .The duration of assisted ventilation and hospital stay in the caffeine group were shorter than the control group [(6.2 ±3.1) d vs.(8.2 ±3.2) d, (16.3 ±8.7) d vs. (19.5 ±9.2) d], the differences were statistically significant (P<0.05).Among the CMV infants, the incidence of failure of A/C to SIMV mode transition and bronchopulmonary dysplasia were lower in the caffeine group than the control group and the duration of assisted ventilation and hospital stay were shorter . The differences were statistically significant ( P <0.05 ) . No differences were found in the related complications in each group ( P>0.05) . Conclusion Caffeine can help reduce the incidences of withdrawal failure, bronchopulmonary dysplasia , ventilation duration and hospital stay when using NCPAP and CMV ventilation.

Objective To explore the clinical value of multi-slice spiral CT (MSCT) and serum inflammatory markers in diagnosis of acute appendicitis.Methods A total of 78 patients with acute appendicitis who were admitted in our hospital from November 2015 to November 2016 were included in the study.Different CT grading,postoperative pathological types (simple appendicitis,purulent appendicitis,gangrenous appendicitis),WBC count of different pathogenic bacteria (E.coli,P.aeruginosa,and K.pneumoniae),NEUT％,and CRP level were detected.Results With the increasing of CT grading,WBC count,NEUT％,and CRP level were gradually elevated (P ＜ 0.05).WBC count,NEUT％,and CRP level in patients with simple appendicitis were significantly less than those with purulent appendicitis,and gangrenous appendicitis.And above indicators of patients with purulent appendicitis were significantly less than those with gangrenous appendicitis,and the pathological type showed a significant difference (P ＜ 0.05).The WBC count,NEUT％,and CRP level among patients with different pathogenic bacteria showed no significant difference (P ＞ 0.05).Conclusion Dynamic monitoring of WBC count,NEUT％,and CRP level and MSCT examination can contribute to more accurate diagnosis of acute appendicitis and the estimation of condition.

Objective To explore the clinical value of multi-slice spiral CT (MSCT) and serum inflammatory markers in diagnosis of acute appendicitis.Methods A total of 78 patients with acute appendicitis who were admitted in our hospital from November 2015 to November 2016 were included in the study.Different CT grading,postoperative pathological types (simple appendicitis,purulent appendicitis,gangrenous appendicitis),WBC count of different pathogenic bacteria (E.coli,P.aeruginosa,and K.pneumoniae),NEUT％,and CRP level were detected.Results With the increasing of CT grading,WBC count,NEUT％,and CRP level were gradually elevated (P ＜ 0.05).WBC count,NEUT％,and CRP level in patients with simple appendicitis were significantly less than those with purulent appendicitis,and gangrenous appendicitis.And above indicators of patients with purulent appendicitis were significantly less than those with gangrenous appendicitis,and the pathological type showed a significant difference (P ＜ 0.05).The WBC count,NEUT％,and CRP level among patients with different pathogenic bacteria showed no significant difference (P ＞ 0.05).Conclusion Dynamic monitoring of WBC count,NEUT％,and CRP level and MSCT examination can contribute to more accurate diagnosis of acute appendicitis and the estimation of condition.

Objective To evaluate the efficacy and safety of aripiprazole treatment for co-morbid attention defi?ciency hyperactivity disorder (ADHD) in children with Tourette syndrome (TS). Methods Forty four TS children with co-morbid ADHD were randomly divided into aripiprazole group and haloperidol group. The aripiprazole group and halo?peridol group received aripiprazole and haloperidol treatment for 12 weeks, respectively. Yale global tic severity scale (YGTSS) and Conners parent symptom questionnaire (PSQ) were used to assess the tic and ADHD symptoms before, 2, 4, 8 and 12 weeks after treatment. Side effects were recorded weekly. Results Repeated measure ANOVA indicated that the main effects of groups was not significant to the YGTSS scores (P>0.05), but significant to the PSQ scores (P<0.05). After 12-week treatment, the YGTSS scores between two groups were not significantly different (P>0.05). The PSQ scores of aripiprazole group were significantly lower than that of haloperidol group. The adverse reactions of aripiprazole group were milder compared with the haloperidol group (P<0.05). Conclusions The present study demonstrates that aripipra?zole has the same efficacy in the treatment of tics as haloperidol, improves co-morbid ADHD symptoms, and its adverse reactions are much less compared with haloperidol.

Objective To analyze the relationship between Tourette syndrome and mycoplasma pneumoniae.Methods Seventy Tourette syndrome children were selected as TS group, and seventy healthy children as control group, then throat swabs MP-DNA and plasma MP-IgM, MP-IgG were detected.TS group were divided into MP-DNA positive group (n =21) and MP-DNA negative group (n =21) according to result of throat swabs MP-DNA.TS group were given haloperidol orally, we noted down daily dose of haloperidol at weekend.On the basis of the haloperidol therapy, MP-DNA positive group were treated with azithromycin.Before and 1, 2, 4, 6, 8 weeks after treatnent, we assessed YGTSS of MP-DNA positive group and MP-DNA negative group.Results (1) MP-DNA positive rate of TS group and control group were 30％ and 0％ respectively, and the differences were significant (x2 =24.706, P =0.000);MP-IgM positive rate of TS group and control group were 27％ and 17％ respectively, and there was no significant difference between two groups (x2 =2.030, P =0.154);MP-IgG positive rate of TS group and control group were 80％ and 64％ respectively, and the differences were significant (x2 =4.301, P=0.038).(2) Before and after 1, 2 weeks of treatment, the score of YGTSS was 30.65 ±5.41, 12.14 ±5.93, 28.07 ±8.69, 29.63 ±2.99, 11.68 ±5.99, 25.80 ± 9.42 respectively in MP-DNA positive group and MP-DNA negative group, and there was no significant difference between two groups (P ＞ 0.05);After 4, 6 and 8 weeks of treatment, the score of YGTSS was 60.87 ±23.75, 71.93 ±13.08, 80.19±12.91, 46.94±18.76, 60.53 ±17.42, 71.08 ±14.22 respectively in MP-DNA positive group and MP-DNA negative group, and the differences were significant (P＜0.05);3.After 1, 2, 4 and 6 weeks of treatment, the daily dose of haloperidol was 0.43 ±0.12, 0.86±0.23, 1.71 ±0.46, 2.37 ±0.67, 0.44 ±0.11, 0.88 ±0.22, 1.76 ±0.44, 2.54 ±0.54 mg respectively in MP-DNA positive group and MP-DNA negative group, and there was no significant difference between two groups (P ＞ 0.05);After 8 weeks of treatment, the daily dose of haloperidol was 2.45 ± 0.75, 3.00±0.93mg, and the differences were significant (t=2.104, P=0.042).Conclusion Mycoplasma pneumoniae may play a role in the pathogenesis of Tourette syndrome, the pathogensis of Tourette syndrome been involed in immune reaction.

Background Diabetic cataract is one of the major ocular complications in diabetes mellitus,including cortical cataract,nuclear cataract,subcapsular cataract and mixed cataract,and different cataractogenesis may be associated with lens epithelial cells (LECs).Subcapsular cataract is one of diabetic cataracts.Studying the biological behavior of LECs in subcapsular cataract is crucial for prevention and treatment.Objective This study was to investigate the effects of Src-family tyrosine kinases (SFKs) on apoptosis and epithelial-mesenchymal transition (EMT) of human LECs cultured by high glucose.Methods Human LECs (HLE-B3) were cultured for 24 hours with DMEM containing 5.5 mmol/L glucose (normal control group),DMEM containing 35.5 mmol/L glucose (high glucose group) and DMEM containing 35.5 mmol/L glucose + 10 μmol/L PP1,a specific inhibitor of SFKs (PP1 group).In 3,6,12 and 24 hours after culture,the apoptosis of human LECs was detected by flow cytometry assay;morphological change of human LECs was observed under the inverted microscope,and the expressions of the markers of EMT,E-cadherin and a-smooth muscle actin (α-SMA),in the cells were detected by immnofluorescence staining.In addition,the alternations of p-Src418 (active c-Src),bcl-xl,survivin,caspase-3,E-cadherin and α-SMA proteins were assayed by Western blot analysis.Results An elevated expression level of p-Src418 was found in LECs in the high glucose group and peaked 6 hours after cultured.The expressions of p-Src418(grey levels) were 0.125 ±0.036 in the high glucose group,and which was significantly higher than 0.042±0.011 in the normal control group and 0.035 ± 0.018 in the PP1 group,respectively (both at P＜0.01).No remarkable differences were seen in the apoptotic rates between the high glucose group and normal control group in 6,12 and 24 hours after culture (all at P＞0.05).The apoptotic rates of human LECs were(6.433±2.084)％,(10.333±2.610)％ and (8.033±2.967)％ in the PP1 group,which were higher than (3.233 ± 1.320) ％,(3.533 ± 1.159) ％,(5.733 ±0.230) ％ in the high glucose group and (3.133±1.170)％,(2.833±0.751)％,(3.333±1.201)％ in the normal control group (all at P＜0.05),however,there were significant differences in the apoptosis between the high glucose group and the normal control group (all at P＞0.05).In 6 hours and 12 hours after cell culture,the expression levels of bcl-xl and survivin (grey values) in human LECs were significantly declined,but the expression of caspase-3 was increased in the PP1 group compared with the the high glucose group and the normal control group (all at P＜0.05).The LECs showed slender in shape 24 hours after culture in the high glucose group,but the cell shape was close to the normal in the PP1 group.Western blot and immunofluorescence assay revealed that the expression of E-cadherin in human LECs was significantly reduced and that of α-SMA was significantly increased 6 hours after culture in the high glucose group compared with the PP1 group and the normal control group (all at P＜0.05).Conclusions High glucose activates c-Src kinase of LECs in high glucose environment and therefore induces EMT and inhibits apoptosis.However,PP1 impedes the biological process of EMT and apoptosis of LECs to maintain the epithelial characteristics even under the stress of high glucose.

Objective To study the expression and signiifcance of phospholipid transfer protein (PLTP) and macrophage migration inhibitory factor (MIF) in mice with bronchopulmonary dysplasia (BPD). Methods Ninety-six 4-day-old mice were randomly divided into oxygen group and air group. Mice in oxygen group were exposed to a FiO2 of 65%, and mice in air group were exposed to air. On day 7, 14, 21 and 28, blood and lung tissue samples from 12 randomly selected mice in each group were obtained. The serum levels of MIF and PLTP were measured by ELISA assay. The morphological changes of lung tissue were ob-served with HE staining. Results The mice in oxygen group showed thickened lung parenchyma and obvious pulmonary ifbrosis. The radioactive alveolar count was signiifcantly lower in oxygen group than that in air group (P<0.01). PLTP level in air group was increased gradually from day 7 to day 21, and began to decrease on day 28. PLTP level in oxygen group was increased from day 7 to day 14, and decreased on day 21 and day 28. MIF level in air group did not change during the experiment. MIF level in oxygen group was signiifcantly increased from day 7 to day 21, and began to decrease on day 28. Conclusions MIF and PLTP may be good biomarkers for the diagnosis of BPD.