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Objective:To study the predictive values of lung ultrasound (LUS) score and Downes score in selecting respiratory support strategies for newborns with dyspnea.Methods:From September 2021 to July 2022, newborns admitted to our hospital with dyspnea were selected and assigned into the non-invasive respiratory support (N) group, invasive respiratory support (I) group and control (C) group based on the respiratory support strategies on admission. LUS scores and Downes scores at 6, 24, and 48 h after birth were recorded. ROC curves were drawn to determine the predictive values of LUS and Downes scores for respiratory support strategies.Results:A total of 263 cases were enrolled, including 105 cases in N group, 56 cases in I group and 102 cases in C group. The differences of LUS and Downes scores between the three groups at the same timepoint were statistically significant with I group had the highest scores, N group second and C group lowest ( P<0.05). LUS and Downes scores within each group at different timepoints were significantly different ( P<0.05).In all three groups, LUS and Downes scores were decreased with longer duration of treatment. LUS score, Downes score and PaO 2/FiO 2 were positively correlated with each other ( P<0.05). The area under the curve (AUC) of LUS score and Downes score predicting non-invasive respiratory support within 6 h after birth were 0.900 (95% CI 0.861-0.940, P<0.05) and 0.889 (95% CI 0.847-0.931, P<0.05), respectively, with the same cutoff of 2.5. The AUC of the combination of LUS and Downes scores predicting non-invasive respiratory support was 0.944 (95% CI 0.915-0.973, P<0.05). The AUC of LUS score and Downes score predicting invasive respiratory support were 0.979 (95% CI 0.963-0.995, P<0.05) and 0.831 (95% CI 0.760-0.902, P<0.05), respectively, with the same cutoff of 5.5. The AUC of the combination of LUS and Downes scores predicting invasive respiratory support was 0.985 (95% CI 0.972-0.998, P<0.05). Conclusions:Both LUS score and Downes score have certain predictive values for respiratory support strategies in newborns with dyspnea.
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Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d<DOT≤15.0 d), Q 3 (15.0 d<DOT≤27.0 d) and Q 4 (DOT>27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%<breast milk intake ratio≤50%), medium-ratio breastfeeding group (50%<breast milk intake ratio≤75%) and high-ratio breastfeeding group (breast milk intake ratio>75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.
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Hand,foot and mouth disease (HFMD) is characterized by skin rashes in palms,feet and mouth ulcers and a few with complication even died.It occurs mainly children aged less than 5 years,especially in infants and young children aged 1-3 years.There are more than 20 kinds of enterovirus cause HFMD in children,and the main etiologic agents are human enterovirus 71 (EV71) and Coxsackievirus 16 (CA16).EV71 infection is more frequently associated with severe central-nervous-system complications in HFMD patients and thereby is a major cause of fatalities.Innate immunity plays an important role in anti-EV71 infection as the first immune barrier.And its main function is realized by natural immune cells,including monocytes/macrophages,dendritic cells,natural killing cells and invariant natural killer T cells and their secreted cytokines and chemokines.At present,more studies have shown that natural immune cells participate in the development of hand,foot and mouth disease caused by EV71.
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Objective To study the clinical effects of pulmonary recruitment maneuvers combined with pressure regulation volume control (PRVC) in the treatment of severe respiratory distress syndrome (RDS) in premature infants.Method From July 2015 to September 2016,preterm infants of grade Ⅲ-Ⅳ RDS who received PRVC treatment in neonatal department of Huai'an Maternal and Child Health Hospital were assigned into recruitment maneuver group and control group (without recruitment maneuver) using randon number table.The ventilator parameters were observed at 1,2,6,12,18 h and 24 h after ventilation.Recovery rate,duration of oxygen therapy and ventilation,duration of hospital stay,incidence of second dose of pulmonary surfactant and complications were compared between two groups.Result A total of 18 cases were included in recruitment maneuver group and 19 cases in control group.The recovery rate of recruitment maneuver group was higher than control group (16/18 vs.10/19).The duration of oxygen therapy [(6.6 ± 2.3) d vs.(11.8 ± 3.0) d],duration of ventilation [(4.1 ± 2.3) d vs.(6.4 ± 2.8) d],duration of hospital stay [(26.7 ± 7.0) d vs.(33.0 ± 8.4) d] in recruitment maneuver group were significantly shorter than control group (P ＜ 0.05).The proportion of bronchopulmonary dysplasia (1/18 vs.8/19),retinopathy of premature (1/18 vs.7/19),patent ductus arteriosus that require medication closure (1/18 vs.7/19)and incidence of second dose of pulmonary surfactant (2/18 vs.9/19) in recruitment maneuver group were significantly lower than control group (P ＜ 0.05).While the complication of air leak,necrotizing enteritis,Ⅲ-V grade intracranial hemorrhage showed no significant differences between the two groups (P ＞ 0.05).Conclusion Recruitment maneuvers combined with PRVC in treatment of severe RDS premature infants can improve recovery rate and oxygenation.It can also shorten the duration of oxygen therapy,ventilation and hospital stay.It can reduce the incidence of bronchopulmonary dysplasia and retinopathy of premature.It is worth spreading in clinical practice.reduce the incidence of bronchopuhmonary dysplasia and retinopathy.It is worthy of promotion.
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A total of 60 infants with severe persistent pulmonary hypertension (PPHN) at our NICU from January 2006 to December 2012 were divided into research group[(n =32,high-frequency oscillatory ventilation(HFOV) plus sildenafil)]and control group (n =28,HFOV only).Mean pulmonary arterial pulmonary arterial (MPAP),blood gas analysis,oxygenation index (OI),PO2 to fraction of inspired oxygen ratio (PO2/FiO2) before and after treatment were compared between two groups.After 3-day treatment,MPAP (mm Hg)(32 ±6) vs.(43 ±9)mm Hg,PCO2(mm Hg)(36 ±9) vs.(43 ±9),OI(56 ±22) vs.(85 ±21) in research group were significantly lower than those in control group(P ＜ 0.05) ; in comparison with control group,PO2(mm Hg) (89 ±15) vs.(72 ±22),PO2/FiO2(mm Hg) (223 ± 18) vs.(196 ±24) in research group were significantly higher(P ＜ 0.05).The time of ventilation use (d) (5.4 ± 1.3) vs.(6.3 ± 1.6) in research group was shorter than that of control group(P ＜0.05) while research group showed a higher clinical efficiency rate(％) (81.2 vs.50.0) (P ＜0.05).A combination of HFOV and sildenafil for severe PPHN can significantly reduce MPAP,shorten the duration of ventilation use and improve cure rate.
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Objective To analyze the curative effect of adult urethrocutaneous fistula after hypospadias repair with X-V dartos flap technique.Methods In the experimental group,the closed fistulas were wrapped with X-V dartos flap in the 22 cases of adult hypospedias fistulas from February 2007 to October 2010.In the control group,the routine fistulas repairs were preformed in the 35 cases of adult hypospadias fistulas from January 2000 to January 2007.The operative effects were compared between the two groups.Results All cases were followed up for 3-49(5.6±12.0)months,no fistula was found in the experimental group,while 7 fistulas(20.0%,7/35)were found in the control group.The fistulas rate had statistic difference between the two groupe(P<0.05).Conclusion The use of the X-V dartos flap technique can prevent adult urethroeutaneous fistula after failed hypospadias fistulas repair and raise the success rate.
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With the proposition of the cancer stem cell theory, researchers have separated and app-raised cancer stem cells from many malignant tumors such as leukemia, breast cancer, brain tumor, lung cancer, prostatic carcinoma and so on. Some scholars discovered that CD133+ may be a specific marker of the colon cancer,which led the fide of the colon cancer stem cell research. This paper presents the latest progress on colon cancer stern cell through its contribution on clinical drug-resistence, metastasis and application.
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Objective To summarize the management experience for difficult access during rigid transurethral ureteroscopy.Methods Rigid transurethral ureteroscopy was conducted in 640 patients with ureteral stones from January 1995 to November 2004.Difficult ureteroscope access was encountered in 72 patients and overcame by adjusting the pressure of hydraulic irrigation,changing the position of patient,dilating the ureter,or performing the percutaneous nephrostomy.Results Of the 72 patients with difficult retrograde access,successful ureteroscopy was achieved in 54 patients and conversions to open ureterolithotomy were required in 18 patients.Intraoperative complications included partial mucosal laceration in 10 patients and ureteral perforation in 6 patients.Follow-up examinations with intravenous pyelography for 13~36 months(mean,16 months) in 56 patients revealed patent ureter.Conclusions The key to successful retrograde access of rigid ureteroscope lies in the acquaintance with normal and pathologic anatomy and physiology of the ureter and urologist's operative skills and experience.