Objective:To investigate the effect of biological maternal sounds on blood gas analysis index, mechanical ventilation time, oxygen therapy time and hospital stay in mechanically ventilated children with severe pneumonia.Methods:This study was a randomized controlled trial. From June 2020 to November 2020, 128 mechanically ventilated children with severe pneumonia in Hunan Children′s Hospital were selected by convenient sampling method and divided into four groups with 32 cases in each group by random number table method. Group A was given routine nursing care, group B was given mother sounds, group C was given mother cardiotone, group D was given biological maternal sounds. Data of blood gas analysis index, mechanical ventilation duration, oxygen therapy duration, hospital stays were collected for comparative analysis.Results:Finally, group A, B, C, and D included 28, 30, 28 and 28 cases, respectively. There was no statistically significant difference in PaO 2 among the four groups on the 1st to 2nd day after intervention ( P>0.05), but PaO 2 on the 3rd to 7th day after intervention were (75.57 ± 12.88), (77.71 ± 15.81), (78.21 ± 14.51), (78.64 ± 17.71), (79.04 ± 11.57) mmHg (1 mmHg=0.133 kPa), (81.71 ± 17.89), (82.93 ± 18.36), (82.68 ± 15.47), (83.25 ± 14.24), (83.77 ± 13.90) mmHg, (80.89 ± 18.78) (82.11 ± 13.34), (82.96 ± 14.20), (83.43 ± 14.37), (83.68 ± 12.64) mmHg, (84.54 ± 18.77), (86.29 ± 10.94), (86.96 ± 10.53), (87.46 ± 12.64), (89.08 ± 12.21) mmHg, with statistically significant differences ( F values were 41.17 - 332.68, all P<0.01). Further pairwise comparison revealed that PaO 2 in group B and group C were higher than those in group A on the 3rd to 7th day after intervention, while those in group D were higher on the 3rd to 7th day after intervention than those in group A, B, and C, with statistically significant differences( t values were 3.35- 4.75, all P<0.01). There was no statistically significant difference in PaCO 2 among the four groups on the 1st to 4th day after intervention ( P>0.05), but PaCO 2 on the 5th to 7th day after intervention was (47.31 ± 2.89), (46.18 ± 2.06), (41.94 ± 2.09) mmHg, (44.73 ± 1.76), (41.38 ± 1.30), (38.33 ± 1.16) mmHg, (44.81 ± 1.24), (41.23 ± 1.89), (38.73 ± 2.55) mmHg, (40.83 ± 1.78), (37.87 ± 1.43), (34.78 ± 2.05) mmHg, with statistically significant differences ( F=29.48, 36.12, 34.52, all P<0.05). Further pairwise comparison revealed that PaCO 2 in group B and group C were lower than those in group A on the 5th to 7th day after intervention, while PaCO 2 in group D were lower than those in groups A, B, and C, with statistically significant differences ( t values were 3.37-4.85, all P<0.01). During the analysis of PaO 2 and PaCO 2 in the four groups at different time points, the interaction effects were not statistically significant ( P>0.05). There was no significant difference in invasive mechanical ventilation duration, non-invasive mechanical ventilation duration and hospital stay among the four groups after intervention ( P>0.05). The oxygen therapy time of the four groups were (8.61 ± 6.40), (6.17 ± 4.80), (6.23 ± 2.75), and (3.75 ± 2.10) days, with statistically significant differences ( F=17.27, P<0.01). Further pairwise comparison revealed that the oxygen therapy time in group B and group C was shorter than that in group A, while group D was significantly shorter than that in groups A, B, and C, with statistically significant differences ( t values were 4.02-4.74, all P<0.01). Conclusions:Biological maternal sounds is superior to maternal sound and mother cardiotone in improve the blood gas analysis index, shorten the oxygen treatment time, which is worthy of clinical promotion in neonatal unaccompanied ward.

Objective:To deeply understand the real emotional experience and needs of the parents of dying newborns, so as to provide a reference for future neonatal palliative care.Methods:From February to October 2021, purposeful sampling was used to select 15 parents of dying newborns in the Department of Neonatology of Hunan Children's Hospital as the research object. A qualitative research design was conducted, and the semi-structured interview method was used to conduct in-depth interviews with the research subjects, and NVivo 10.0 software was used for data analysis.Results:A total of 3 themes were extracted, namely, the ambivalence when giving up treatment, negative life effects after giving up, needs and expectations.Conclusions:Parents of dying newborns generally have ambivalence when they give up treatment. After giving up, they will show emotions such as sadness and helplessness, self-blame and regret, and depression. Understanding the real emotions and inner needs of the parents of dying newborns helps medical and nursing staff to pay attention to parents' negative psychology and understand their needs, and provide parents with targeted psychological support and other care, so as to help the parents of dying newborns and their families through a special period.

Objective:To explore the association between genetic polymorphism of APP gene and bipolar disorder(BD) in children and adolescents for seeking suitable single nucleotide loci(SNP), and provide reference for early diagnosis and intervention of children and adolescent BD.Methods:The genomic DNA of peripheral blood was extracted from 178 BD cases(case group) and 178 normal controls(control group) of Han children and adolescents.Four SNP loci of APP gene were selected and were analyzed by LDR-PCR SNP genotyping.Genotypes and allele differences were compared between the cases and control group by SPSS22.0 software.The software SHEsis was also used to make linkage disequilibrium and haplotype analysis.Results:The genotype frequency and allele frequency of the 4 SNP loci of APP gene were statistically significant different between the case group and the control group ( P<0.05). The association of s2040273, rs466433, rs463946, rs364048 with BD in the APP gene was statistically significant( P<0.05). The construction of 4 SNP haplotypes indicated that AACT, AGGC, and GACT accounted for more than 80% of the total.The percentage of haplotype AGGC in the case group(11.9%)was significantly higher than that in the control group(4.7%)( P<0.05), and the odds ratio of AGGC haploid was 2.727. Conclusion:Four SNP loci s2040273, rs466433, rs463946, rs364048 in the APP gene and haplotype AGGC are associated with BD in Han children and adolescents.These results confirmed that the APP gene is one of BD susceptible gene.

Objective To explore the influence of vagus nerve stimulation (VNS) on inflammatory factors in serum and nucleus of the solitary tract,and hippocampal apoptosis in rats with depression induced by chronic unpredictable stress ( CUS). Methods Totally 32 male Sprague Dawley ( SD) rats aged 8-9 weeks were selected. Eight rats were chosen as control group,and the other 24 rats were treated as the de-pression model with CUS. The rats were randomly divided into CUS,fluoxetine and VNS group,with 8 rats in each group after successful modeling. The control group and CUS group were induced by normal saline. Flu-oxetine group and VNS group were implanted with VNS stimulation electrode. The VNS stimulation lasted for 28 d. On the time points of before experiment,after modeling and after treatment,the sucrose consumption test and open-field test (OFT) were performed to observe the behavioral changes of rats. Elisa was used to detect the levels of TNF-α,IL-6 and IL-1β in serum and nucleus of the solitary tract. Cell apoptosis was ob-served with TUNEL staining in hippocampal CA1 region. Results ( 1) Sucrose consumption experiment and OFT showed that,compared with the CUS group,the consumption of sucrose,percentage of sucrose con-sumption,scores of vertical and horizontal movement increased significantly in the VNS group ( consumption of sucrose: (11. 78±2. 67) ml,(8. 06±2. 85) ml; percentage of sucrose consumption: (72. 31±9. 98)%, (63. 67±8. 95)%; score of vertical movement: (16. 61±3. 98),(10. 31±3. 86); score of horizontal move-ment: (44. 25±9. 59),(36. 21±7. 21)) (t=4. 87,7. 98,5. 87,9. 12,all P<0. 05). There was no signifi-cant difference between VNS and fluoxetine groups (consumption of sucrose: (11. 32±2. 66) ml; percentage of sucrose consumption: (71. 31±9. 03)%; score of vertical movement: (15. 63±4. 11); score of horizontal movement: (45. 61±8. 54)) (t=-0. 32,-1. 83,0. 98,-1. 13,all P>0. 05). (2) Compared with the CUS group,levels of TNF-α,IL-6 and IL-1β in serum decreased in the VNS group ( serum TNF-α: ( 46. 72 ± 11. 63) pg/ml,(125. 47±15. 18) pg/ml; serum IL-6: (243. 65±38. 90) pg/ml,(441. 39±83. 31) pg/ml;serum IL-1β: (209. 31±32. 45) pg/ml,(339. 21±76. 37) pg/ml) (t=-70. 38,-196. 25,-131. 13,all P<0. 05). The results in the VNS group were lower than those in the fluoxetine group (serum TNF-α: (58. 76 ±12. 64) pg/ml; serum IL-6: (308. 83± 64. 31) pg /ml,serum IL-1β: ( 249. 18 ± 43. 6) pg/ml) ( t=-15. 38,-64. 25,-18. 83,both P<0. 05). The levels of TNF-α,IL-6 and IL-1β in nucleus of the solitary tract in the VNS group were lower than those in the CUS ( TNF-α: (53. 52± 12. 31) pg/ml,(135. 51± 20. 64)pg/ml; IL-6: (265. 31±45. 63) pg/ml,(465. 32±60. 21) pg/ml; IL-1β: (212. 66±43. 32)pg/ml, (365. 96±76. 32) pg/ml) (t=-79. 38,-189. 13,-127. 50,all P<0. 05) and fluoxetine groups (TNF-α:(63. 42±10. 64) pg/ml; IL-6: (315. 62±53. 21) pg/ml; IL-1β: (278. 32±65. 38) pg/ml ) (t=-10. 25,-39. 00,-83. 00,all P<0. 05). (3) The apoptotic rate of hippocampal CA1 region in VNS group ((21. 41± 5. 86)%) was lower than that in the CUS group ((32. 78±8. 32)%) (t=-10. 75,P<0. 05); and there was no difference between VNS group and fluoxetine group ((22. 54±6. 31)%) (t=-1. 75,P>0. 05). Conclu-sion VNS can improve the depression behavior in rats with depression induced by CUS and the mechanism maybe related to inhibiting the expression of TNF-α,IL-6 and IL-1β in serum and nucleus of the solitary tract and cell apoptosis in hippocampal CA1 region.

Objective:To explore the effects of norepinephrine combined with dobutamine on the hemodynamics,blood lactic acid,creatinine clearance rate (CCr),fractional excretion ofH2O (FEH2O) and fractional excretion of sodium (FENa) of patients with septic shock.Methods:120 cases of patients with septic shock from January 2016 to December 2016 were selected as the research objectives and randomly divided into two groups with 60 cases in each group.Dobutamine was given to both groups,then norepinephrine was additionally given to the observation group,dopamine was additionally given to the control group.The clinical effect,changes of hemodynamics,blood lactic acid,CCr,FEH2O and FENa levels before and after treatment were compared between two groups.Results:The blood lactic acid and FENa levels of both groups were gradually decreased at 6,12,24 and 48 hours after treatment and were significantly lower than those before treatment;the CCr and FEH2O levels were gradually increased and significantly higher than those before treatment (P＜0.01).The blood lactic acid and FENa levels were gradually decreased at 6,12,24 and 48 hours after treatment and were significantly lower than those of the control group at same time (P＜0.01),the FEH2O level was significantly higher than that of the control group at the same time (P＜0.01).The MAP,SVRI of both groups at 6,12,24 and 48 hours after treatment were significantly higher than those before treatment,but the CI at 24,48 hours after treatment were significantly higher than those before treatment (P＜0.01),the MAP of observation group at 6,12,24 and 48 hours after treatment were significantly lower than those before treatment (P＜0.01),the MAP at 6,12 hours after treatment were significantly higher than those before treatment (P＜0.01),the HR of observation group at 6,12,24 and 48 hours after treatment were significantly lower than those of the control group,but SVRI was significantly higher than those of the control group (P＜0.01).The mortality of observation group was 18.33％ at 28th days after treatment,which was 35.00％ in the control group and significantly higher than that of the observation group (P＜0.05).Conclusion:Norepinephrine combined with dobutamine could improve the hemodynamics,reduce the blood lactate level,improve the renal perfusion and prognosis of patients with septic shock.

Objective To study the expression of plasma oxidized low-density lipoprotein (oxLDL) in children with acute phase Kawasaki disease (KD), and investigate its value for early prediction of coronary artery lesions in KD. Methods Totally 80 children with KD were collected. Children were divided into four groups by the results of echocardiogram of coronary artery in different periods: CAL1 group (children with coronary artery lesions (CAL+) both in acute and sub-acute phase, 8 cases), CAL2 group (children with CAL+in acute phase but recovery normal (CAL-) in sub-acute phase, 10 cases), NCAL1 group (children with CAL-in acute phase but occur CAL+ in sub-acute phase, 10 cases) and NCAL2 group (children with CAL- both in acute and sub-acute phase, 52 cases). The serum samples (before the use of intravenous immunoglobulin) were collected in acute phase. Twenty healthy controls and twenty fever controls were enrolled into the study, and their serum samples were collected. OxLDL was measured by enzyme linked immunosorbent assay (ELISA). They were compared using ANOVA, pairwise comparison LSD-t test. And ROC curve analysis was used to determine the threshold. Results Compared with the control groups,plasma oxLDL levels were higher in children with KD, both CA+and CAL-[(15.0±3.3) mU/L, (12.3±3.5) mU/L vs (9.2±2.2) mU/L, (8.0±2.3) mU/L, F=20.435, P<0.05]. Plasma oxLDL levels were increased more significantly in children with CAL+ than children with CAL- in KD [(15.0 ±3.3) mU/L vs (12.3 ±3.5) mU/L, t=2.28, P=0.002]. There was significant difference in the concentration of oxLDL between the groups of Kawasaki disease (F=5.068, P=0.003). Plasma oxLDL levels were significantly higher in the NCAL1 group than those in the NCAL2 group [(14.5 ±3.8) mU/L vs (11.9±3.3) mU/L, t=2.29, P=0.02], but there were no statistically significant difference between the NCAL1 group and CAL1 or CAL2 group [(14.5±3.8) mU/L vs (15.9±3.9) mU/L, (14.5±3.8) mU/L vs (14.2±2.7) mU/L, t=0.73, 0.20;P=0.41, 0.84]. ROCs analysis indicated that oxLDL≥13.83 mU/L, could be the threshold for the prediction of coronary artery lesions with the sensitivity of 0.607 and a specificity of 0.75. Conclusion OxLDL plays an important role in coronary artery lesions in KD. The coronary endothelial dysfunction is earlier than coronary dilatation, and oxLDL is expected to become a reliable early predictor of coronary artery lesions in KD.

AIM: To investigate the effects of astragalus injection combined with puerarin injection on endo-plasmic reticulum stress through PERK pathway in diabetic nephropathy mice .METHODS: Male KKAy mice were ran-domly divided into model group ( injected with normal saline ) and treatment group ( injected with astragalus and puerarin ) . The male C57BL/6J mice served as normal group .The mice were sacrificed 4 weeks after treatments for observing morpho-logical changes under electron microscope .The renal tissues were collected to determine the expression of protein kinase R-like endoplasmic reticulum kinase ( PERK ) , eukaryotic initiation factor 2α( eIF2α) and glucose-regulated protein 78 (GRP78) at mRNA and protein levels by real-time PCR and Western blot.RESULTS: Under electron microscope, the renal tubular epithelial cells in model group and treatment group showed the swelling of the nucleus , endoplasmic reticulum and mitochondria .The results of real-time PCR and Western blot showed that the expression of PERK , eIF2αand GRP78 at mRNA and protein levels in model group was higher than that in normal group (P<0.05), while that in treatment group was lower than that in model group .CONCLUSION: Astragalus injection combined with puerarin injection reduces the mRNA and protein expression of PERK , eIF2αand GRP78, thus inhibiting the endoplasmic reticulum stress in type 2 dia-betic mice to protect the kidney function .

Objective To analysis the clinical outcome at discharge and its risk factors of extremely preterm infants.Method To retrospectively analysis the clinical outcome at discharge and it's risk factors of extremely preterm infants (less than 28 weeks gestation) admitted from September 2008 to August 2014 in our Hospital.Result A total of 179 cases were enrolled.Survival rate was 59.2％ (106/179).Unfavorable outcome rate was 74.3％ (133/179),among them 73 cases died.The top five causes of death were severe bronchopulmonary dysplasia (BPD) (28 cases),Ⅲ ～ Ⅳ o intraventricular hemorrhage (IVH) (19 cases),sepsis (16 cases) and necrotizing enterocolitis (NEC) (6 cases).Among the 60 survivals with unfavorable outcomes,35 cases had either severe neurologic or ophthalmological sequela,and 25 cases had severe pulmonary sequela.Univariate analysis showed that,comparing with improved group,unfavorable outcome group had higher rates of not receiving prenatal steroids,placental abruption,male,small for gestation age,resuscitation with chest compression,admission age older than 72 hour,severe respiratory distress syndrome (RDS),without pulmonary surfactant (PS) usage,mechanical ventilation beyond 2 weeks and sepsis (P ＜ 0.05).Logistic regression analysis showed that those without prenatal steroids (OR =9.402,P =0.002),small for gestational age (OR =8.271,P =0.018),resuscitation with chest compression (OR =6.325,P =0.023),admission age older than 72 hour (OR =4.174,P =0.028) were independent risk factors for unfavorable outcome of extremely premature at discharge.Conclusion Extremely preterm infants have a higher rate of unfavorable outcome at discharge.Avoid small for gestational age,transfer properly and in time both in utero and after birth,and conduct prenatal steroids could improve their clinical outcome at discharge.

ObjectiveTo study the neuron protection mechanism of Uncariae Ramulus Cum Uncis extract for the MPTP-induced PD mice.MethodsC57BL/6 mice were randomly divided into control group, model group, Uncariae Ramulus Cum Uncis extract group and madopar group, and injected with MPTP in abdominal cavity. Behavior test was used to detect grabbing capacity and body movement coordination capacity: three biochemical indexes (SOD, MDA, GSH-Px) were detected by biochemical process and the activity of two immune enzyme-linked indexes (IL-1β, IL-6) were detected by enzymelinked immunosorbent assay.ResultsCompared with the control group, the autonomic activity numbers of mice increased and climbing pole time decreased in the model group (P<0.05), enzymatic activity of SOD and GSH-Px decreased significantly and the contents of MDA, IL-1β and IL-6 increased obviously (P<0.01). Compared with model group, the autonomic activity numbers of mice increased and climbing pole time decreased in the Uncariae Ramulus Cum Uncis extract group and madopar group (P<0.05). Enzymatic activity of SOD and GSH-Px increased and the contents of MDA and IL-1β and IL-6 decreased (P<0.05,P<0.01).ConclusionUncariae Ramulus Cum Uncis extract can reduce neuronic apoptosis PD mice, whose therapeutic action may be realized through eliminating oxygen free radicals, improving oxidation resistance and reducing inflammatory reactions.

Objective To optimize the prescription ofBaichanting Tablets by the central composite design-response surface methodology.Methods The doses of MCC, cCMC-Na, SiO2, and magnesium stearate were set as investigation factors; disintegration time and moisture rate were set as indexes. Linear equation quadratic polynomial described mathematic relationship of disintegration time and moisture rate with other four influence factors. Response surface was described according to the optimal mathematic models; the optimal prescription was chosen; predictive analysis was conducted.ResultsThe relationship of disintegration time and moisture rate with other four influence factors could not be described by linear equation. When quadratic polynomial matching was used, correlation coefficients were 0.837 9 and 0.923 1, with relatively high reliability. Optimal prescription contained 30.6%MCC, 10%cCMC-Na, 0.30%SiO2, and 0.10% magnesium stearate. The theoretical value and predicted value deviations of the disintegration time limit and moisture absorption rate were within 5%.Conclusion The predictability of the established model is good. Application of central composite design-response surface methodology can precisely optimize the prescription ofBaichanting Tablets.