Objective To explore the effect of protective ventilation strategies based on individualized positive end expiratory pressure(PEEP)regulated by driving pressure(Pd)in infants under OLV.Methods Sixty infants undergoing elective thoracoscopic surgery were randomly divided into the control group and driving pressure group,with 30 cases in each group.The two groups were compared in terms of MAP,HR,tidal volume(Vt),PEEP,Pd,airway peak pressure(Ppeak),and static lung compliance(Cs),and arterial blood gas during OLV before the artificial pneumothorax(T0),10 min(T1),30 min(T2),and 60 min(T3)after the artificial pneumothorax,and right at the end of the artificial pneumothorax(T4).Results There were no significant differences in MAP,HR,and Vt between the two groups at all the time points(P＞0.05).Both groups showed the increase in Pd and Ppeak and decresase in Cs at T1,T2,and T3(all P＜0.05).PaO2 and OI in both group were decreased and PaCO2 was increased at T2(all P＜0.05).Compared with the control group,the driving pressure group presented lower Pd and Ppeak,higher PEEP and Cs at T1,T2,and T3(P＜0.05),and higher PaO2 and OI(P＜0.05)and no significant differences in PaCO2 and FiO2 at T2(P＜0.05).The rate of rescue ventilation during OLV was lower in the driving pressure group(2 cases)than in the control group(9 cases)(6.9%versus 32.4%,P＜0.05).There was no significant difference in the inci-dence of postoperative complications between the two groups(P＜0.05).Conclusion The individualized positive end expiratory pressure(PEEP)regulated by Pd can optimize the PEEP settings upon infant individuals under OLV and improve the compliance and oxygenation of ventilated lung.

So far， there are still no specific treatment methods for severe hepatitis and liver failure， resulting in a mortality rate of over 70%， and they are the difficulties in the treatment of critical illness in China and globally. Liver transplantation is currently the most effective treatment method for end-stage liver disease， but only 1%‍ ‍—‍ ‍2% of patients can receive the opportunity for organ transplantation. The bioartificial liver support system utilizes external mechanical， physical， and biological devices to remove various harmful substances accumulated in the patient’s body， compensate for the metabolic functions of the liver， supplement necessary substances， improve internal environment， promote the recovery of liver function， help patients get through the critical period， and save time for liver transplantation， and therefore， it is considered one of the important methods for the treatment of end-stage liver disease. Since hepatocytes are the core element of bioartificial liver， this article summarizes the sources of liver seed cells， 3D culture methods， and corresponding bioreactor culture systems and hopes to gradually solve the core issue of large-scale in vitro preparation of hepatocytes to obtain hepatocytes with adequate quantity and quality， which urgently needs to be addressed in clinical application.

Objective:To investigate the lipidomics differences of CD4+T immune cells in diabetic kidney disease(DKD)mice,and screen out the differential metabolites with biological significance.Methods:CD4(L3T4)MicroBeads immunomagnetic beads were used to isolate CD4+T immune cells from spleen of BKS.Cg-Dock7m+/+Leprdb/J mice with spontaneous DKD;the purity of CD4+T cells were identified by flow cytometry.The non-targeted lipidomics of CD4+T cells were detected by LC-MS/MS,and the differ-ential metabolites were analyzed.Results:A total of 463 metabolites were detected by LC-MS.PCA and OPLS-DA analysis showed that the metabolic components were significantly separated;twenty-four differential metabolites were screened out.KEGG and enrich-ment analysis showed that the differential metabolites involved in the disorder of glycerol phospholipid metabolism.Conclusion:Phos-pholipid metabolism of CD4+T cells is closely related to the occurrence of DKD.Phospholipid metabolism targeting DKD CD4+T cells in DKD may be a new direction of DKD treatment.

The construction and operation of the hospital-wide radiation protection management information system is of great significance for improving the efficiency and quality of radiation protection management. A hospital has built a hospital-wide radiation protection management system, which consisted of four modules: radiation staff management module, protection items management module, site and equipment management module, and self-inspection module. The system adopted B/S mode, carried the lightweight J2EE framework-SpringBoot framework, and used mybatis, which was flexible and practical, as the persistence layer of the system, to store the data completely in the SQLServer database.Java language was used as the system development language, and the front and back-end separation architecture was used. Each of the four modules implemented the management responsibility departments and responsible personnel to carry out the all-round management of radiation protection, and realized the integrated, information-based and standardized management of radiation protection management in the hospital.

Objective:To evaluate the effects of intermittent change the angle of operating table on the skin in pressure areas of patients in prone position.Methods:A total of 150 hospitalized patients for elective surgical treatment in Yantai Yuhuangding Hospital from January 2019 to June 2019 were selected as subjects. The patients were divided into control group, 15° test group and 30° test group by random number table method, with 50 patients in each group. The control group received routine intraoperative pressure ulcer prevention measures, the 15° test group on the control group, the itinerant nurses adjusted the angle of the operating table according to the left 15°-supine-right 15° every half hour, and the 30° test group on the control group, the itinerant nurses adjusted the angle of the operating table according to the left 30°-supine-right 30° every half hour. The incidence of surgically related pressure ulcers and doctors' satisfaction with the surgical position of the three groups of patients were evaluated.Results:Pressure ulcers occurred in 8 patients of the control group, the incidence of pressure ulcers was 16%. Pressure ulcer occurred in 0 patient of the 15° test group, the incidence of pressure ulcers was 0. Pressure ulcers occurred in 2 cases in the 30° test group, the incidence of pressure ulcers was 4%. The difference was statistically significant ( χ2 value was 10.120, P<0.05). Further comparison showed that the incidence of pressure ulcers was statistically significant between the control group and the 15° test group ( P<0.016 7), while the incidence of pressure ulcers was not statistically significant between the control group and the 30° test group, between the 15° test group and the 30° test group ( P>0.016 7). The results of the postoperative doctors' satisfaction with the surgical body position were (27.880 ± 1.637), (27.520 ± 1.693), (26.920 ± 1.947) points in the control group, the 15° test group and the 30° test group, there was a statistically significant difference among the three groups ( F value was 3.779, P<0.05). Further comparison showed that there was no statistically significant difference in the score of surgical position satisfaction between the control group and the 15° test group, between the 15° test group and the 30° test group ( P>0.05). The satisfaction score of surgeons in the control group was higher than that in the 30° test group, and the difference was statistically significant( P<0.05). Conclusions:Intermittent adjustment of surgical position can reduce the incidence of pressure ulcers and improve the quality of nursing in the operating room without affecting the convenience of the surgeon. The optimal effect was achieved by adjusting the angle of the operating bed according to the left-leaning 15°-supine-right-leaning 15°at an interval of 30 minutes.

Objective:To explore the differences of static and dynamic spontaneous brain activity between male smoking addicts and healthy controls, and analyze the mechanism of smoking addiction.Methods:Based on static amplitude of low-frequency fluctuation (sALFF) and dynamic amplitude of low frequency fluctuation (dALFF), the differences of static and dynamic spontaneous brain activity were compared between male smoking addicts ( n=63) and healthy controls ( n=30) by independent sample t-test. Pearson correlation analysis was used to investigate the relationships between the altered dALFF values and score of Fagerstr?m test for nicotine dependence(FTND) and pack-years of smoking addicted males. Results:Compared with healthy controls, the values of sALFF in the left superior/middle/inferior orbitofrontal gyrus ( t=5.17, clusters≥108) were increased and the variation of dALFF in the right superior temporal/middle gyrus, left orbitofrontal region, left orbital superior/middle/inferior frontal gyrus, right orbitofrontal gyrus/middle/inferior frontal gyrus and right putamen ( t=4.90, 4.37, 4.91, 4.62, 4.59, clusters≥96) were also increased in the smoking addicted group. It was noteworthy that the dALFF values of the right superior temporal/middle gyrus( r=0.252, P=0.047), left orbital region superior frontal gyrus( r=0.281, P=0.026) and right putamen( r=0.313, P=0.012) were positively correlated with pack-years of male smoking addicts. Conclusion:Male smoking addicts may have abnormal static and dynamics spontaneous neural activity in prefrontal cortex (including orbital frontal lobe), putamen and superior temporal/middle gyrus, which are correlated with pack-years.

Objective:To construct an evaluation index system of first-aid ability of Operating Room nurses and to provide evidence for scientific evaluation of first-aid ability of Operating Room nurses and rationally setting up emergency nursing training programs in Operating Room.Methods:A research team was established in June 2019. Through literature review, a draft evaluation system of first-aid ability of Operating Room nurses was formed, and an consultation questionnaire was compiled. From July to September 2019, questionnaires were distributed by emails for expert letter consultation. Semi-structured interview, Delphi method and analytic hierarchy process were used to construct the evaluation index system of first-aid ability of Operating Room nurses and determine the weight of each index.Results:The positive coefficients of the 2 rounds of expert letter consultation were respectively 100.0% and 95.5%, the expert authority coefficients were respectively 0.94 and 0.92, and Kendall's coefficients of concordance were respectively 0.348 and 0.405. The final evaluation system for first-aid ability of Operating Room nurses included 5 first-level indexes and 23 second-level indexes.Conclusions:The evaluation system of first-aid ability of Operating Room nurses constructed in this study can comprehensively evaluate the first-aid ability of Operating Room nurses, which has a strong rigor and provides reference for scientifically setting up first-aid ability training courses and evaluation systems for operating room nurses.

OBJECTIVE: To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas. METHODS: A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, =33) and inverse ventilation group (group R, =33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T), OLV30 min (T), OLV60 min (T), and 15 min after recovery of TLV (T). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE). RESULTS: Sixty-three infants were finally included in this study. At T and T, Cdyn, PaO and OI in group R were significantly higher ( < 0.05) and Ppeak, PaCO and PA-aO were significantly lower than those in group N ( < 0.05). There was no significant difference in HR or MAP between the two groups at T and T ( > 0.05). The level of RAGE significantly increased after the surgery in both groups ( < 0.05), and was significantly lower in R group than in N group ( < 0.05). CONCLUSIONS In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.
Cystadenoma ; surgery ; Humans ; Infant ; Lung ; surgery ; One-Lung Ventilation ; Positive-Pressure Respiration ; Thoracoscopy ; Treatment Outcome

OBJECTIVE: To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas. METHODS: A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, =33) and inverse ventilation group (group R, =33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T), OLV30 min (T), OLV60 min (T), and 15 min after recovery of TLV (T). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE). RESULTS: Sixty-three infants were finally included in this study. At T and T, Cdyn, PaO and OI in group R were significantly higher ( < 0.05) and Ppeak, PaCO and PA-aO were significantly lower than those in group N ( < 0.05). There was no significant difference in HR or MAP between the two groups at T and T ( > 0.05). The level of RAGE significantly increased after the surgery in both groups ( < 0.05), and was significantly lower in R group than in N group ( < 0.05). CONCLUSIONS In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.
Cystadenoma ; therapy ; Humans ; Infant ; Lung ; One-Lung Ventilation ; Positive-Pressure Respiration ; Thoracoscopy

Objectives To investigate the efficacy and safety of quadruple regimen containing doxycy-cline,amoxicillin and clavulanate potassium in the treatment of Helicobacter pylori(Hp)after the failed initial eradication. Methods A total of 136 patients who had a failed course of initial eradication therapy were randomly divided into four groups. The 46 patients in group A were given rabeprazole,colloidal bismuth tartrate,doxycy-cline,amoxicillin and clavulanate potassium for 14 days). The 45 cases in group B were treated with rabeprazole, colloidal bismuth tartrate,doxycycline,amoxicillin and clavulanate potassium for 10 days. The 45 cases in control group received rabeprazole,colloidal bismuth tartrate,levofloxacin,amoxicillin for 14 days. After 4 weeks of treat-ment,the 13C-urea breath test was performed. The Hp eradication rates,adverse reactions,treatment compliance and cost-effectiveness ratio of the three groups were evaluated. Results A total of 130 patients completed the study. The intention to treat(ITT)and Per-protocol(PP)analyses revealed that the eradication rates of the three groups were 71.74% and 76.74%(group A),71.11% and 72.72%(group B),51.11% and 53.49%(control group),respectively. The ITT and PP of group were significantly higher than those of control group(P < 0.05). But there was no significant difference between group B and control group(P > 0.05). The rates of adverse reac-tions in each group were not statistically significant(P > 0.05),and the patient compliance of three groups was more than 80%. The cost and cost-effectiveness ratio showed that group B < control group < group A. Conclu-sions The quadruple therapy containing doxycycline,amoxicillin and clavulanate potassium as a rescue regimen given for 14 days is safe,effective and with high patient compliance,which is of high clinical significance.