Objective:To analyze the risk factors associated with difficult weaning in mechanical ventilation for pediatric patients and investigate the predictive value of utilizing lung ultrasound assessment to optimize preparation for weaning and enhance success rates, thereby establishing a scientific foundation.Methods:A multi-center, prospective observational study, convenience sampling was utilized to select 97 pediatric patients who underwent endotracheal intubation at the Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine and Fujian Provincial Children's Hospital between September 2022 and May 2023. Lung ultrasound scores (LUS), Pediatric Critical Illness Score (PCIS), indicators related to respiratory oxygenation function and follow-up weaning outcomes were collected within 48-72 hours post-mechanical ventilation and prior to the first spontaneous breathing trial. The predictive efficacy of LUS in conjunction with risk factors associated with weaning difficulty on pediatric weaning outcomes was evaluated independently.Results:Among the 97 children studied, there were 57 boys and 40 girls, with ages ranging from 1 month to 14 years. By following up with weaning outcomes, the pediatric patients were divided into 55 cases of successful weaning group and 42 cases of difficult weaning group. During 48-72 hours of mechanical ventilation, LUS ( OR=2.05, 95% CI 1.43-2.94, P<0.05) and PCIS ( OR=0.68, 95% CI 0.50-0.92, P<0.05) were early risk factors for subsequent difficulties in weaning. And meantime, the combination of LUS(≥20 points) and PCIS(≤72 points) could effectively predict the risk of difficult weaning with a sensitivity of 61.90%, specificity of 96.36%, and an area under curve value of 0.84. Furthermore, before the first spontaneous breathing test, LUS ( OR=4.29, 95% CI 2.36-7.81, P<0.05) and rapid shallow breathing index (RSBI) ( OR=1.84, 95% CI 1.01-3.36, P<0.05) were identified as risk factors for pediatric difficult weaning, and their combination LUS (≥16 points) and RSBI (>6.4) could predict the risk of difficult weaning more accurately with a sensitivity of 76.19%, specificity of 90.91%, and an area under curve value of 0.92. Conclusions:The application of pediatric ICU specialist nurses, based on bedside LUS combined with PCIS and RSBI, can effectively assess and identify the risk of children with difficult weaning in the early stage, and identify the risk factors, providing a scientific basis for implementing individualized pulmonary rehabilitation nursing and helping children successfully weaning.

Objective:To explore the clinical effect of predictive airway nursing model in mechanically ventilated children after liver transplantation.Methods:Using a before-and-after comparison study, we selected 76 cases of mechanically ventilated children undergoing pediatric living donor liver transplantation in Pediatric Intensive Care Unit from January 2016 to December 2019 at Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine. The children were divided into the control group (35 cases) and the intervention group (41 cases) in chronological order. The control group implemented conventional airway nursing, and the intervention group conducted predictive airway nursing. The hospitalization days, mechanical ventilation time, ventilator-associated pneumonia (VAP) incidence, ventilator removal ending and other indicators were compared between the two groups.Results:There was no statistically significant difference in the total incidence of secondary infection between the intervention group and the control group ( P>0.05) . The time of mechanical ventilation were shorter than that in the control group, and the differences were statistically significant ( P<0.05) . The intervention group was better than the control group in successfully removing the ventilator, and the difference was statistically significant ( P<0.05) . Conclusions:The predictive airway nursing model can shorten the time of mechanied ventilation in children after liver transplantation and increase the success rate of removing the ventilator, it can be used for clinical reference.

Objective To investigate the effect of low dose ionizing radiation on blood pressure of radiation workers. Methods A total of 219 medical staff from a hospital in Wuhan were enrolled in the present study. Of them, 115 radiation workers were included in the low-dose ionizing radiation exposure group, the remaining 104 non-radiation workers were used as the control group. The blood pressure of the two groups was measured. The individual annual doses of the exposed group were collected. The independent sample t test was used to compare the blood pressure of the two groups. The linear regression model was used to analyze the relationship between the annual dose and blood pressure of the exposed group, and the logistic regression analysis method was used to analyze the relationship between hypertension and the annual dose of the exposed group. Results It was found that the mean blood pressure of the exposed group was significantly higher than that of the control group, and the difference was statistically significant (P<0.05). Linear regression analysis found that there was no significant correlation between the annual dose of the exposed group and blood pressure. Logistic regression analysis revealed that in the exposed group, women had a higher risk of hypertension than men, while the individual annual dose was not significantly associated with hypertension. Conclusion Women in radiation work were at higher risk than men, and low-dose ionizing radiation was not significantly associated with changes in blood pressure in radiation workers.

Objective To explore the effect of oral-muscle biofeedback system training on the rehabilitation of cognitive dysfunction in patients with obstructive sleep apnea (OSA) after ischemic stroke.Methods A total of 60 cases of poststroke OSA patients with cognitive dysfunction admitted to the rehabilitation center of deAn hospital in changzhou city from June 2017 to March 2018 were selected.On the basis of routine rehabilitation treatment,the control group was given positive pressure ventilation treatment,and the observation group was given oral muscle biofeedback system training.The changes of polysomnography (PSG) parameters,Montreal cognitive assessment (MoCA) score,serum matrix metalloproteinase-9 (MMP-9) and plasma homcysteinemia (Hcy) expression levels in the two groups before and after treatment were compared.Results Apnea hypopnea index and maximum apnea time of the two groups were significantly decreased after treatment compared with those before treatment,and the lowest SpO2 and average SpO2 were significantly higher than those before treatment(P＜0.05).After treatment,MoCA total score and the dimensions score of patients in the observation group were significantly higher than those in the control group at the same time (P＜0.05).After treatment,the levels of Hcy((12.38±4.54) μmol/L) and MMP-9((124.52± 12.94) μg/L) in the observation group were significantly lower than those in the control group at the same time(Hcy(17.52±6.27) μmol/L,MMP-9(268.25±20.5 7)μg/L),and the difference was statistically significant (Hcy:t=3.637,P＜0.05;MMP-9:t =32.395,P＜0.05).Conclusions Positive pressure ventilation and oral muscle biofeedback system training have the same effect on OSA after stroke,but oral muscle biofeedback system training can also effectively improve patients' cognitive function.

Objective To determine whether the cross-sectional area (CSA)of the calf measured with MRI could stage lower ex-tremity lymphedema (LEL)secondary to gynecological cancer treatments.Methods 148 patients were enrolled in this research.116 females with unilateral LEL and 32 without LEL after gynecological cancer treatments underwent calf MRI and water displacement. Total soft tissue CSA (T),muscle CSA (M)and subcutaneous tissue CSA (S)of affected calf,and difference of T (DT),M (DM) and S (DS)between calves were obtained on MRI at mid-calf level.Volume of affected calf and difference of volume (DV)between calves were obtained by water displacement.Statistical analysis was performed to determine feasibility of MRI measurements for ac-cessing LEL.Results There were close correlations between volume and T or S of affected calf,and between DV and DT or DS of calves.The correlations of stages of LEL with T and S of affected calf as well as DT and DS were stronger than the volume of affect-ed calf and DV (P< 0.01).Multivariate analysis showed more significant differences in T and S than in volume of affected calf,and in DS than in DV between LEL stages (P< 0.05).No difference was found in volume of affected calf and in DV between stage 0 andⅠ. For staging LEL,DS showed the most profound discrimination ability among all measurable parameters.Conclusion DS of calves could be the most reliable parameter recommended for staging and early diagnosis of LEL.

Objective To evaluate the MR lymphangiography (MRL)in diagnosis of limb lymphedema.Methods A total of 582 patients with lymphedemtous limbs were enrolled in the study,MRL was performed at 3.0T MR.The morphology and enhancement of the lymph nodes,the number of lymphatic vessels and the lymph flow were evaluated.Results No matter in primary or secondary lymphedema,there were patients showed only lymph nodes affected,or only lymph vessels affected,and some patients showed both affected.Lymphatic aplasia,hypoplasia or hyperplasia were showed in primary lymphedema.Obstruction lymphatic vessels,and lym-phangiectasia were showed in secondary lymphedema.The velocity of lymph flow was (1.0±0.62)cm/min in affected limb of pa-tients with primary lymphedema,which was significantly slower than that of affected limb of patients with secondary lymphedema (2.22±1.64)cm/min(P<0.01)in dynamic contrast-enhanced MRL.In both type of lymphedema,the contrast enhanced lymph nodes showed less nodes with delayed enhancement and lower signal intensity,compared to that of lymph nodes in the contralateral normal side.Conclusion Dynamic contrast-enhanced MRL is helpful for assessing the anatomical and functional status of lymphatic system in lymphedematous limb.This new imaging techniques provides a powerful tool for the diagnosis of lymphedema.

AIM To explore the effects of glycyrrhetinic acid on the gastric ulcer rats infected by Helicobacter pylori (Hp) and its action mechanism.METHODS Gastric ulcer rat models were induced by acetic acid stress and then followed by Hp infection.After treatment with low and high doses of glycyrrhetinic acid,the ulcer index,gastric acid and proteinase activities in gastric ulcer rats were analyzed.The effects of glycyrrhetinic acid on the expressions of BCL2 and Caspase-3,the GSK3β activity in gastric mucosa and gastric epithelial cells,and the cell apoptosis level were then detected.RESULTS Glycyrrhetinic acid reduced the ulcer index,gastric acid and proteinase activities in rats.Besides,the expression of BCL2 was significantly up-regulated by glycyrrhetinic acid in gastric mucosa and gastric epithelial cells,whereas the expression of Caspase-3,level of cell apoptosis,and GSK3β activity were significantly reduced.After the treatment with GSK3 β activator LY294002,the level of BCL2 was down-regulated,Caspase-3 expression was increased,and the level of cell apoptosis was enhanced.CONCLUSION Glycyrrhetinic acid promotes the healing of gastric ulcer infected by Hp via regulating GSK3β activity and inhibiting apoptosis of gastric epithelial cells.

Objective To explore the effects of early growth response gene-1 (Egr-1) on bone marrow mesenchymal stem cells (BMSC) proliferation and osteogenic differentiation,which is aimed at providing new molecular targets for the treatment of osteoporosis.Methods Bone marrow was collected from adult men and the BMSCs were cultured primarily and observed by microscope.Meanwhile,flow cytometry was used for BMSCs phenotypic identification;After transfection of pcDNA3.1/Egr-1 into BM SCs,the level of BMSCs proliferation was determined by MTT respectively on the 2 d,4 d and 6 d;On the 7 d after transfection,the ALP activity assay was used for testing the ALP activity in BMSCs.And then,alizarin red S-calcium kit was used for measuring the calcified knots respectively on the 7 d,14 d and 21 d;On the 21 d after transfection,real-time qPCR and Western blotting were used respectively for measuring the expression of mRNA and protein of Egr-1,Runx2 and NDRG1;Further,BMSCs were transfected with Egr-1 siRNA,and the content of calcium nodules,ALP activity,the expression of Egr-1,Runx2 and NDRG1 were detected as above methods.Results The cells cultured in vitro showed high level of CD90 and CD29 and very low level of CD34 and CD45,which is accorded with the characteristic of BMSCs.The pcDNA3.1/Egr-1 transfection for BMSCs had no effect on cells prolifera tion.However,the calcified knots,ALP activity and the expression of Egr 1,Runx2 and NDRG1 were increased after transfection of pcDNA3.1/Egr-1 for BMSCs.In addition,Egr-1 siRNA showed the opposite effect with pcDNA3.1/Egr-1 transfection for BMSCs.Conclusion Egr-1 induces osteogenic differentiation of BMSCs by promoting NDRG1 but has no effects on proliferation of BMSCs.

Objective:To research the application of flurbiprofen compound small dose fentanyl with self-control vein analgesia after laparoscopic cholecystectomy and the influence on blood coagulation function.Methods:102 cases with laparoscopic cholecystectomy who were treated in our hospital from November 2015 to November 2016 were selected and divided into the control group and the research group,with 51 cases in each group.The patients in the control group were treated with postoperative intravenous analgesia with low-dose fentanyl,while the patients in the research group were treated with postoperative intravenous analgesia with flurbiprofen ester compound low-dose fentanyl.Then the fibrinogen (Fg),activated partial prothrombin time (APTT),prothrombin time (PT),platelet count (PLT),substance P,5-hydrocarbon serotonin (5-HT),interleukin 6,8 (IL-6,IL-8) and complications between two groups were observed and compared.Results:Before treatment,there was no statistically significant difference about the Fg,APTT,PT,PLT,substance P,5-HT,IL-6 and IL-8 between two groups (P＞0.05);After treatment,the Fg,APTT,PT,PLT,substance P,5-HT,IL-6 and IL-8 increased in the two groups,while the research group was lower than that of the control group,and the differences were statistically significant (P＜0.05).The postoperative complication rate of research group was lower than that of the control group (P＜0.05).Conclusion:Flurbiprofen ester compound small dose fentanyl with self-control vein analgesia can relieve coagulation function,and inhibit the levels of inflammatory factors.

[ ABSTRACT] AIM:To investigate the effect of artemisinin on lipopolysaccharide ( LPS)-induced intestinal epi-thelial barrier damage in IEC-6 cells and its molecular mechanism.METHODS:Cultured IEC-6 cells were divided to 5 groups:control group, LPS (100 mg/L) group and LPS +Artemisinin (30, 50 and 100μmol/L) groups.The cytotoxici-ty was detected by MTT assay.The releases of TNF-α, IL-1βand IL-6 in the IEC-6 cells were measured by ELISA.The transepithelial electrical resistance ( TER) was detected by electrical resistance tester, and the horseradish peroxidase (HRP) flux permeability were analyzed by a microplate reader.The expression of tight junction proteins, ZO-1, claudin-1 and occludin, and the expression of TLR4/MyD88/NF-κB at mRNA and protein levels were determined by RT-qPCR and Western blot.RESULTS:Artemisinin alone (up to 100 μmol/L) or in combination with LPS (100 mg/L) was not toxic to IEC-6 cells.Compared with control group, the releases of TNF-α, IL-1βand IL-6 in the culture supernatant of IEC-6 cells significantly increased after treatment with LPS.The expression of TLR4/MyD88/NF-κB was activated by LPS.LPS down-regulated the protein expression of ZO-1, claudin-1 and occludin.However, artemisinin treatment decreased the re-leases of TNF-α, IL-1βand IL-6 in the culture supernatant of IEC-6 cells.The expression of TLR4/MyD88/NF-κB at mR-NA and protein levels was gradually reduced after treatment with artemisinin.In addition, artemisinin upregulated the pro-tein expression of ZO-1, claudin-1 and occludin significantly (P<0.01) in a dose-dependent manner.CONCLUSION:Artemisinin attenuates LPS-induced intestinal epithelial barrier damage by inhibiting TLR4/MyD88/NF-κB activation in the IEC-6 cells.