BACKGROUND:Resistance exercise increases muscle mass and improves muscle strength,but there is a lack of conclusive evidence on its effects on body composition.Controversial results from randomized controlled trials and multiple Meta-analyses pose a problem for clinical decisions on exercise interventions. OBJECTIVE:Based on the methodological paradigm of umbrella review,to explore the efficacy and safety of resistance exercise in improving the body composition of overweight and obese people. METHODS:We searched PubMed,Cochrane Library,Web of Science,and CNKI for systematic reviews on the effect of resistance exercise in overweight and obese people published from database inception to August 31,2022.Chinese search terms included"anti-resistance,resistance,self-weight,Meta,Meta-analysis,body composition,body fat percentage,fat mass,lean body mass,body mass."English search terms included"resistance training,strength training,weight-lifting strengthening program,body composition,body fat distribution,Meta-analysis,data pooling,overviews,clinical trial,clinical trial overviews."PRISMA was used to evaluate the methodological quality of the included studies,and a GRADE evaluation system was used to grade the quality of evidence. RESULTS AND CONCLUSION:A total of 14 Meta-analyses were included,and GRADE evidence quality evaluation showed that 2 outcome indicators were intermediate,12 were low,and 14 were extremely low.Compared with the control group,23 of the 32 outcome measures showed significant improvement.The intervention effect of resistance exercise on body fat percentage has reached a consensus,but the intervention effects on lean body mass,body mass index and visceral fat still need further confirmation.Resistance exercise is an effective and safe method to improve the body composition of overweight and obese people.The overall quality of the research and the evidence quality of the outcome indicators included in the systematic evaluation are generally low.In the future,the initial state,exercise goal and willingness of the subjects should be fully combined on the basis of clarifying the sample characteristics and refining the scheme design.Through multiple,scientific and personalized exercise prescription designs of water,air and elastic resistance,the safety and compliance of resistance exercise can be improved,providing clear evidence-based support and decision-making basis for resistance exercise intervention.

OBJECTIVE:Masks are one of the most important defenses against the virus.However,the impact of wearing masks during daily activities or sports on respiratory and circulatory function remains controversial.A comprehensive quantitative evaluation of the effects of mask-wearing on human heart rate,oxygen saturation and end-expiratory carbon dioxide by Meta-analysis was conducted.The effects of wearing different types of masks at different exercise intensities and time of exercise on the human respiratory and circulatory system were explored. METHODS:By February 2023,with"mask,face mask,N95,training,sports,running,walking,cycling"as the Chinese search terms and"masks,respiratory protective devices,N95 respirators,surgical face masks,exercise,resistance training,explosive training,muscle exercises"as English search terms,the experimental studies addressing the influence of exercise with a mask on hemodynamic indexes were retrieved from CNKI,Web of Science,PubMed,Cochrane Library and WanFang databases.The outcome indicators included three continuous variables-exercise center rate,blood oxygen saturation and end-expiratory carbon dioxide.Stata16.0 software was used to analyze the outcome indicators of the included literature.The PEDro scale was used as a quality assessment tool,and the funnel plot was used to analyze the impact of publication bias. RESULTS:Totally 25 articles involving 857 healthy children and adults were included in this Meta-analysis.The overall methodological quality was high,with 22 studies scoring 6 points on the PEDro scale,2 studies scoring 7 points and 1 study scoring 8 points.The meta-analysis results showed that compared with the control group,exercise with masks had no significant effect on heart rate(SMD=0.02,95%CI:-0.11 to 0.15,P=0.81),but increased end-expiratory carbon dioxide(SMD=0.60,95%CI:0.37 to 0.83,P=0.00),decreased oxygen saturation(SMD=-0.28,95%CI:-0.47 to-0.09,P=0.03).Intensity and duration were the factors that affected the heterogeneity between studies.Wearing a mask during high-intensity exercise significantly increased heart rate(SMD=-0.20,95%CI:-0.36 to-0.04,P=0.02).The effect of high-intensity and short-time exercise on blood oxygen saturation was significantly higher than that of other exercises(SMD=-0.40,95%CI:-0.70 to-0.10;SMD=-0.25,95%CI:-0.45 to-0.04).For end-expiratory carbon dioxide,maintaining a certain intensity and increasing the exercise time or increasing the intensity further increased the index significantly,reaching a moderate effect size(SMD=0.61,95%CI:0.06 to 1.15;SMD=0.58,95%CI:0.04 to 1.13). CONCLUSION:Existing evidence suggests that exercise with masks may have the adverse effect of increasing end-expiratory carbon dioxide and decreasing blood oxygen saturation.The influence of different exercise test time and intensities on the three outcome indexes was different.Wearing a mask during high-intensity exercise can significantly increase heart rate and decrease blood oxygen saturation.Maintaining moderate intensity for a long period or further increasing the intensity of exercise will lead to increased end-expiratory carbon dioxide levels.

Objective:To understand the degree of professional autonomy of nurses in Pediatric Nursing Alliance and the status of pediatric nursing practice environment, which providing guidance for the development of a series of specialized training in the alliance.Methods:Stratified random sampling method was used to conduct a questionnaire survey on nursing staff of different professional levels in Pediatric Nursing Alliance, which through the questionnaire star by using the questionnaire general information and training demand questionnaire, nurses practice professional autonomy scale, pediatric nursing staff structural empowerment questionnaire and nursing practice influencing factors questionnaire through the questionnaire star.Results:The total score for professional autonomy of nurses in the pediatric alliance was 192.66±18.63, the structural empowerment ( OR=1.137, 95% CI=1.084-1.194), lack of caring team ( OR=2.763, 95% CI=1.443-5.292) and performance evaluation ( OR=0.498, 95% CI= 0.274-0.908), specialized education and professional experience ( OR=0.548, 95% CI= 0.334-0.871) were affecting the clinical nursing practice. Conclusion:The degree of professional autonomy of nurses in the Pediatric Nursing Alliance is in the middle and high level. Key factors affecting nursing practice including insufficient structural empowerment, lack of opportunities to continue learning, lack of nursing teams, lack of effectiveness evaluation and the lack of specialized education and work experience, which guiding the pediatric nursing alliance to continuously deepen the connotation of pediatric nursing professional and innovative team collaboration new model, utilize the advantages of resources to actively cultivate specialized nursing research personnel, carry out multi-disciplinary and cross-disciplinary cooperation, improve the nursing quality evaluation index system, so as to enhance the professional nursing service capacity and value.

Objective:To analyze the cystic fibrosis transmembrane conductance regulator (CFTR) gene variations and phenotypes in 7 Chinese children.Methods:In this retrospective study, the data of 7 children with CFTR gene variations admitted to Children′s Hospital of Chongqing Medical University from December 2013 to October 2020 were extracted. The general information, clinical manifestations, gene variations, diagnosis and treatment were summarized.Results:Among the 7 children, 2 were males and 5 were females, aged 5.2(0.5-11.3) years. Main clinical manifestations included malnutrition (5 cases), recurrent respiratory infection (4 cases), bronchiectasis (3 cases), steatorrhea (3 cases), vomiting in infancy (2 cases), liver cirrhosis (2 cases), meconium ileus (1 case), metabolic alkalosis and hypochloremia (1 case). A total of 15 variations were found by whole exon sequencing and Sanger sequencing, among which 3 were newly discovered, and 7 were missense mutations. Four children were diagnosed as CF, and the other 3 were diagnosed as CFTR related disease (CFTR-RD). Compared with CF patients, the pancreatic insufficiency and typical CF lung disease were relatively mild in CFTR-RD patients. After treatment, 6 children were clinically improved, while the rest one withdrew treatment due to critical pulmonary infection and disturbance of water-electrolyte metabolism.Conclusions:The loci and phenotypes of CFTR gene variants vary hugely and the pathogenicity of some variations are not clear. Whole exon sequencing can facilitate the identification of CF-and CFTR-RD-causing variaions. For the cases not compatible with CF, CFTR-RD should be considered and evaluated by timely gene detection, so as to carry out appropriate long term management.

With the development of pediatric bronchoscopy and the accumulation of clinical experience, its indications are expanding, and it plays an increasingly important role in pediatric respiratory diseases.In this paper, by introducing the new techniques applied in clinical practice in recent years, such as bronchoscopic balloon dilatation, bronchoscopic ablation, bronchoscopic stenting, transbronchial lung biopsy and transbronchial needle aspiration, the progress of new techniques of interventional therapy in pediatric respiratory is briefly introduced.

Objective: To develop and evaluate an automatic intensity-modulated radiation therapy (IMRT) program for cervical cancer based on a database of overlap volume histogram (OVH) and high-quality cervical IMRT plans for previously-treated patients. Methods: A database consisting of high-quality IMRT plans and OVHs from 200 cervical cancer patients was established. OVHs of another 26 cervical cancer patients were converted into gray level images to calculate the image similarity compared with those from the database. The planning optimization function of the patients from the database with the highest image similarity was selected and inherent Pinnacle³ scripts were utilized to automatically generate IMRT plan. Finally, the dosimetric parameters, plan quality and design time were statistically compared between the automatic and manual plans. Results: The target coverage, conformity index and homogeneity index did not significantly differ between two plans (all P>0.05). The V₄₀, V₄₅ and mean dose for the rectum in the automatic plans were significantly decreased by 6.1%, 1.3% and 50.7 cGy than those in the manual plans (all P<0.05). Compared with the manual plans, the mean dose for the intestine and femur in the automatic plans were significantly reduced by 31.7 cGy and 188.9 cGy (both P<0.05), whereas the mean dose for the ilium was slightly decreased by 92.3 cGy in the automatic plans (P>0.05). The plan design time was shortened by 71% in the automatic plans. Conclusions The automatic IMRT plans based on a database of OVH and high-quality IMRT plans can not only significantly shorten the plan design time, but also reduce the irradiated dose of normal tissues without compromising the target coverage and conformity index.

Objective: To investigate the risk factors for pneumonia in children with Epstein-Barr virus (EBV) infectious mononucleosis(IM). Methods: The clinical data of children with EBV-IM from March 2015 to February 2018 in Children′s Hospital of Chongqing Medical University were retrospectively analyzed.The patients were divided into a pneumonia group and a non-pneumonia group.The difference between 2 groups was analyzed, including gender, age, duration of fever, the maximum temperature in disease duration, the size of liver, the size of spleen, tonsillopharyngitis, cervical lymphadenopathy, edema of the eyelids, white blood cell (WBC), lymphocyte, atypical-lymphocytes, C-reactive protein (CRP), procalcitonin (PCT), alanine transaminase (ALT), glutamic oxalacetic transaminas (AST), lactic dehydrogenase (LDH), cytomegalovirus (CMV) antibody, the titer of mycoplasma (MP) antibody, EBV DNA, length of stay, and hospitalization expenses.The single factor analysis was performed to analyze the above data between 2 groups, and the data with statistical significance were analyzed by the multifactor Logistic regression.The recei-ver operator characteristic (ROC) curve was drawn to evaluate the predicting ability of the indicators for IM combined with pneumonia. Results: Among 923 cases, 133 cases(14.4%) EBV-IM patients were complicated with pneumonia.The findings of single factor analysis indicated that the risk factors were the duration of fever, the size of liver, the size of spleen, and the titer of MP antibody (all P<0.05). The multifactor Logistic regression showed that the duration of fever, the size of liver, the titer of MP antibody were the risk factors for EBV-IM children with pneumonia (P=0.013, 0.028, 0.014). The area under curve (AUC) of the duration of fever was 0.624, and the critical value was 7.5 d (P=0.000); the AUC of the size of liver was 0.590, and the critical value was 2.65 cm (P=0.003). Conclusions The incidence rate of EBV-IM children combined with pneumonia was high.With the presence of the titer of MP antibody ≥1∶160, the duration of fever≥7.5 days, and the size of liver>2.65 cm, it may be independent risk factors for pneumonia in IM children with EBV infection, which requires special attention clinically and earlier chest imageological examination are needed.

Objective To investigate the precision of full six-degree target shift corrections using the ArcCHECK system.Metbods Fourteen patients receiving intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) in Fujian Medical University Cancer Hospital from May to September,2015 were selected.The first treatment setup errors were obtained using cone-beam computed tomography.The setup errors were simulated in ArcCHECK,and the full six-degree target shift corrections was used to correct the errors.The plans without and with setup errors and the plan with corrected setup errors were taken.The paired t-test was used to compare dose to agreement (DTA) and Gamma passing rates between the plan without setup errors and the plan with setup errors and plan with corrected setup errors.Results The DTA and Gamma passing rates were (96.76± 1.57)％ and (98.35±0.92)％ for the plan without setup errors,(59± 21.42) ％ and (62.86± 21.63) ％ for the plan with setup errors,and (91.41± 4.82) ％ and (94.11±4.33)％ for the plan with corrected setup errors.There were significant differences between the plan without setup errors and the plan with setup errors and plan with corrected setup errors in DTA passing rate (t=6.64 and 5.13,both P＜0.05) and Gamma passing rate (t=6.15 and 4.19,both P＜0.05).Conclusions The full six-degree target shift corrections can be used in IMRT for NPC,with good results in correcting setup errors and improving the precision for IMRT dose distribution.

Objective To observe the effects of seawater immersion at different temperatures on survival time and mortality and physiological state of non-anesthetized rats.Methods Totally 100 SD male rats(The abdominal cavity was implanted with a temperature sensor in advance)were randomly divided into five groups which were immersed in 20 ℃,17 ℃,15 ℃,13 ℃ and 10 ℃ seawater,respectively.Each group contains 20 rats.The changes of respiration,heart rate and muscle fibrillation within 2 hours were observed and the survival time and mortality of each group were counted in 24 hours.The decrease trend of intraperitoneal temperature in rats was analyzed retrospectively within 2 hours.Results Soaking for 10 minutes,the respiratory and heart rate of each group were significantly increased,but there was no significant difference among groups(P>0.05).The respiratory and heart rate decreased rapidly between 10 and 40 minutes,and the decline was slower relatively between 40 and 80 minutes.Soaking for 80 minutes,the respiration rate of rats among groups had significant difference(P<0.05).Immersing for 100 minutes,the heart rates of rats in each group were significantly different(P<0.05).Soaking for 20 minutes,the muscle fibrillation of 15 ℃,13 ℃ and 10 ℃ group reached the peak,and there were significant differences among groups(P<0.05),then disappeared.However the rats in 20 ℃ and 17 ℃ group reached the peak at 30 minutes,but there was no significant difference between two groups(P>0.05),hereafter the muscle fibrillation was maintained at a certain level.The mean survival time of 20 ℃ group,17 ℃ group,15 ℃ group,13 ℃ group and 10 ℃ group in 24 hours were(23.6±1.23)hours,(15.0±4.16)hours,(7.7±3.21)hours,(2.4±0.91)hours and (1.1±0.39)hours,respectively,and the survival curve of each group was statistically significant(P<0.05).The intraperitoneal temperature of rats showed a decline in the cliff,the lower the water temperature,the faster the descending.Soaking for 40 minutes,the difference of intraperitoneal temperature of each group was statistically significant(P<0.05).Conclusion The effects of seawater immersion at different temperatures on the physiological state and survival time and mortality of rats are significantly different.With the decrease of water temperature,the physiological state changes more obviously,the survival time is shorter and the mortality rate is higher.

In recent years,with the continuous development of medical technology and progress,knowledge regaming respiratory disease become deepening,especially in lower respiratory tract infection bacterial resistance,application of macrocyclic ester antibiotics,severe and refractory mycoplasma pneumonia,refractory asthma,interstitial lung diseases,pediatric interventional bronchoscopy,and stem cell therapy which all have made great progress.In this review,the related hotspot,difficulty and research progress are summarized.