Objective:To explore the detection of potentially pathogenic bacteria (PPB) in the nasopharynx of children with respiratory syncytial virus (RSV) bronchiolitis and the influence of PPB types on disease severity.Methods:In this retrospective cohort study, clinical data of patients hospitalized for RSV bronchiolitis at Department of Respiratory Medicine, Children′s Hospital of Soochow University between January 1, 2017 and December 31, 2019 were retrospectively analyzed.The virus, Mycoplasma pneumoniae and bacteria in nasopharyngeal secretion of children were detected.They were classified into <3 months group, 3-<6 months group, 6 months-<1 year group and 1-2 years group based on the age.In addition, they were further classified into RSV infection group, RSV+ G + group, RSV+ G - group and RSV+ G + + G - group based on detected PPB in the nasopharynx.Comparison of RSV + PPB frequency between groups was performed by Chi- squared test, clinical characteristics were compared by using Mann- Whitney U test. Results:A total of 280 patients with RSV bronchiolitis were included in the study, involving 113 cases (40.4%) with PPB in the nasopharynx.The most-common detection bacterium was Streptococcus pneumoniae.The detection rate of Streptococcus pneumoniae increased with age ( χ2=12.609, P=0.005), while that of Staphylococcus aureus decreased with age ( χ2=8.387, P=0.034). Compared with RSV group, patients in RSV+ G - group had a longer length of stay, higher rate of fever and shortness of breath, higher oxygen supplement and higher C-reactive protein (CRP) (all P<0.05). Compared with RSV group, patients in RSV+ G + group were older, and they had higher rate of fever, higher percentage of neutrophil, lower percentage of lymphocyte and higher CRP (all P<0.05). Conclusions:PPB in nasopharynx can be detected in about 40% of children hospitalized with RSV bronchiolitis, and nasopharynx complicated with PPB infection may affect the severity of RSV bronchiolitis.

过敏性疾病的患病率在全球范围内呈上升趋势,严重影响了特应性个体的健康和生活质量.越来越多的证据支持肠道微生态失衡与过敏性疾病的发生、发展和转归有关.益生菌可以通过纠正微生态失衡、维持黏膜屏障、调节免疫功能等机制在过敏性疾病防治方面发挥一定作用.文章对近年来益生菌在儿童食物过敏、特应性皮炎、哮喘和变应性鼻炎等方面的研究和应用现状进行梳理和分析,为临床医师提供参考.

Objective:To investigate the clinical characteristics of influenza A and influenza B pneumonia and the risk factors of severe influenza pneumonia in children.Methods:The epidemiology, clinical characteristics, laboratory tests and pathogens of co-infection in children with pneumonia caused by influenza A virus and influenza B virus, and the risk factors of severe influenza pneumonia were retrospectively analyzed.Results:(1) The cases of influenza A infection accounted for 65.1% and those with influenza B infection accounted for 32.9% among the 711 children with influenza pneumonia.The dominant strain was Influenza B Victoria virus in spring and summer, influenza A(H 3N 2) virus in autumn, and influenza A(H1N1) virus in winter.The dominant strain was influenza A virus at the age of < 1 year and ~3 years, influenza A virus and influenza B virus at the age of ~6 years, and influenza B virus at the age of ≥6 years.(2) The gastrointestinal symptoms were more common in children with influenza B pneumonia compared with those with influenza A pneumonia(53.4% vs 44.7%, χ2=4.728, P=0.030), but crackles and wheezing were more common in children with influenza A pneumonia compared with those with influenza B pneumonia(80.1% vs 70.5%, 36.9% vs 25.6%, χ2=8.945, 8.093, all P<0.05). (3) The percentage of decreased lymphocyte count in children with influenza B pneumonia was higher than those with influenza A pneumonia(5.6% vs 1.9%, χ2=6.633, P=0.010). (4) Mixed Mycoplasma Pneumoniae was more common in children with influenza B pneumonia compared with those with influenza A pneumonia(23.9% vs 10.8%, χ2=20.789, P<0.001), and mixed virus and bacteria were more common in children with influenza A pneumonia compared with those with influenza B pneumonia(15.8% vs 8.1%, 50.1% vs 41.9%, χ2=7.934, 4.221, all P<0.05). (5) Multivariate logistic regression analysis showed that age <2 years( OR=1.886, 95% CI 1.149~3.096, P=0.012), increased LDH( OR=1.736, 95% CI 1.080~2.790, P=0.023), the percentage of lymphocyte decreased( OR=2.762, 95% CI 1.669~4.571, P<0.001) and the percentage of CD3 + decreased ( OR=6.019, 95% CI 3.993~9.331, P<0.001)were risk factors for severe influenza pneumonia. Conclusion:Among hospitalized children with influenza pneumonia, there were some differences in the age of infection, clinical characteristics, laboratory tests and pathogens of co-infection between the cases caused by influenza B and influenza A, and clinicians should remain vigilant for the occurrence of severe influenza pneumonia.

Objective:To explore the clinical features and risk factors of systemic lupus erythematosus(SLE) concomitant with interstitial lung disease(ILD) in children.Methods:A retrospective analysis was performed.A total of 111 hospitalized children diagnosed with SLE in the Department of Rheumatology and Immunology, Children′s Hospital of Soochow University from February 2016 to November 2018 were selected as the research subjects and divided into the SLE-ILD group(18 cases) and the SLE-non-ILD group(93 cases)according to the lung high-resolution CT manifestations. T-test and Wilcoxon rank sum test were used to compare and analyze the general situation, clinical manifestations and laboratory results.Multivariate Logistic regression was used to analyze the risk factors of SLE-ILD. Results:The prevalence of SLE-ILD was 16.2%(18/111 cases). There were significant differences between the SLE-ILD group and the SLE-non-ILD group in the course of disease [14.00 (12.00-24.25) months vs.1.00(1.00-2.00) months], the incidence of serositis [55.6%(10/18 cases) vs.8.6%(8/93 cases)], post-activity shortness of breath [83.3%(15/18 cases) vs.25.8%(24/93 cases)], nervous system damage [27.8%(5/18 cases) vs.6.5%(6/93 cases)], cardiovascular system damage [38.9%(7/18 cases) vs.9.7%(9/93 cases)], the occu-rrence of increased erythrocyte sedimentation rate [66.7%(12/18 cases) vs.31.2%(29/93 cases)], the decreased C 3[88.9%(16/18 cases) vs.62.4%(58/93 cases)], positive anti neutrophil cytoplasmic antibody (ANCA) [88.9%(16/18 cases) vs.18.3%(17/93 cases)], positive anti-Sm antibody [61.1%(11/18 cases) vs.15.1%(14/93 cases)] and anti ribonucleoprotein antibody (anti RNP antibody)[66.7%(12/18 cases) vs.16.1%(15/93 cases)](all P<0.05). Logistic regression analysis demonstrated that serositis( OR=30.535, 95% CI: 2.167-430.336, P=0.011), shortness of breath after exercise( OR=55.115, 95% CI: 1.117-2 579.852, P=0.041), positive ANCA( OR=65.090, 95% CI: 4.488-944.071, P=0.002) and positive anti-RNP antibody( OR=10.007, 95% CI: 1.362-73.500, P=0.024) were risk factors for SLE-ILD. Conclusions:The longer the course of SLE, the higher the incidence of ILD; serositis, shortness of breath after exercise, positive ANCA and positive anti RNP antibody may be risk factors for SLE-ILD.

Objective:To investigate the detection, epidemiological and clinical characteristics of human rhinovirus(HRV) in hospitalized children with respiratory tract infections.Methods:The study population comprised of 10 514 children with respiratory tract infections admitted to Department of Respiration, the Children′s Hospital of Soochow University, between January 2013 and December 2019.The nasopharyngeal aspirates and medical history were obtained by qualified medical personnel.Reverse transcription-polymerase chain reaction method was used to test HRV.Results:The total positive rate of human rhinovirus was 14.2%(1 493/10 514), and there was no significant difference between male and female( χ2=2.006, P=0.157). The positive rates from 2013 to 2019 were 9.7%, 14.6%, 19.1%, 18.6%, 18.1%, 11.0%, 11.4% respectively, and there were significant differences among these groups( χ2=116.580, P<0.001). HRV distributed throughout the year with a peak in summer and autumn(June to November), followed by spring, and the lowest in winter.The detection rates of HRV infection rates were 14.2%, 15.5%, 13.5% and 9.8% in the age group of 28 d~6 months, ~2 years, ~7 years and>7 years respectively, and there were significant differences among these age groups( χ2=16.124, P<0.001). The detection rate of HRV in children under 2 years was higher( χ2=7.711, P=0.005). The clinical characteristics of HRV infection were fever, cough, wheezing and even dyspnea.Bronchopneumonia had the highest percentage(68.9%), followed by bronchitis(13.2%). Compared with non-coinfection group, patients with coinfection with other viruses were more prone to wheezing and pulmonary rales( χ2=9.483, 10.821, P=0.024, 0.013), and coinfection with mycoplasma was more likely to cause fever and lobar pneumonia( χ2=51.585、96.060, P all<0.001); 57.8% presented leukocytosis, while 15.6% showed a higher CRP(>15 mg/ml). The increase of CRP and leukocytosis were more obvious in children under 2 years of age( χ2=26.097, 55.973, P all<0.001). Conclusion:HRV was a major viral pathogen of RTIs in recent 7 years, distributing throughout the year with a peak in summer and autumn, mainly involving children under 2 years of age.The clinical features were diverse, and the clinical symptoms were severe in childhood coinfections with other pathogens.

目的:探讨百日咳综合征住院患儿的临床特点及影响住院危险因素，提高临床诊治水平。方法:回顾性分析2014年至2019年在苏州大学附属儿童医院呼吸科住院的489例百日咳综合征患儿的病史、症状、体征、实验室检查及病原学等资料，总结其临床特点及影响住院危险因素。结果:年龄<3个月占53.17%，3～6个月占24.13%，>6个月占22.70%。患儿均有痉挛样咳嗽，其他症状发生率依次为喘息32.11%、咳嗽后青紫7.16%、呼吸困难3.27%、咳嗽后吸气性回声2.04%。实验室检查中白细胞升高占75.05%，淋巴细胞比例升高占73.62%，CRP升高占13.29%，血小板计数升高占85.89%。病原学检测阳性率61.15%，病毒检出率为35.58%，细菌检出率为30.47%，肺炎支原体检出率为13.70%，单一病原排序前5位是鼻病毒(24.57%)、肺炎支原体(16.46%)、肺炎链球菌(10.57%)、呼吸道合胞病毒(8.85%)、流感嗜血杆菌(8.11%)；混合感染占17.79%，其中病毒混合细菌占62.07%，病毒混合肺炎支原体占19.54%，细菌混合肺炎支原体占13.79%，病毒、细菌及肺炎支原体混合占4.60%。季节以春、夏季最为多见，占73.00%，其次为秋季19.02%，冬季7.98%。住院≥14 d的患儿中重症肺炎、先天性气道发育畸形、先天性心脏病、胃扭转、喘息发生率均明显高于住院<14 d患儿，差异均有统计学意义( χ 2＝54.920、13.986、4.770、19.966、6.891， P均<0.05)。 结论:百日咳综合征多见于6个月以下患儿，以春夏季多见，痉挛样咳嗽是特征性临床表现，血常规提示以淋巴细胞为主的白细胞升高，感染病原依次是病毒、细菌和肺炎支原体，前3位病原体依次是鼻病毒、肺炎支原体和肺炎链球菌，年龄<1岁易发生混合感染。有喘息症状、病情重、有先天性气道发育异常、先天性心脏病、胃扭转是住院时间延长的危险因素。

Objective:To analyze the clinical characteristics of patients suffering from plastic bronchitis (PB) caused by Mycoplasma pneumoniae (MP) and explore its risk factors as well. Methods:A retrospective analysis on clinical and laboratory data of PB children caused by MP and treated in Department of Respiratory in Children′s Hospital of Soochow University from January 2011 to December 2017, compared with MP pneumonia(MPP) children without PB in the same period.Meanwhile, Logistic regression analysis was performed. Results:Among the 306 MPP children, there were 50 cases in the PB group and 256 cases in the non-PB group.Compared with children in the non-PB group, children in PB group were higher in terms of age [(82.74±35.17)months vs.(66.63±35.67) months], percentage of neutrophils (0.705 8±0.139 1 vs.0.605 7±0.162 6), C reactive protein(CRP) [17.4(10.21, 42.86) mg/L vs.11.43(4.55, 23.66) mg/L], D-dimer(DD) [1 071 (279.5, 2 386.5) μg/L vs.523 (233, 1 099.5) μg/L], lactate dehydrogenase(LDH) [491.1 (342.3, 607.4) U/L vs.394.9 (319.1, 512.8) U/L], erythrocyte sedimentation rate(ESR)[25.0 (17.0, 36.0) mm/1 h vs.15.5(9.0, 28.0) mm/1 h], aspartate aminotranferase(AST) [33.5(26.1, 49.3) U/L vs.29.2(24.0, 37.2) U/L], alanine aminotransferase (ALT) [19.1(11.45, 31.50) U/L vs.13.6 (10.3, 23.15) U/L], IgA [1.46(0.98, 2.12) mg/L vs.1.15 (0.64, 1.60) mg/L], CD3 -CD (16+56)+ (0.155 0±0.088 6 vs.0.120 2±0.071 5), allergy history [44.0%(22/50 cases) vs.25.8%(65/256 cases)], mixed infection [38.0% (19/50 cases) vs.24.6%(63/256 cases)], and microscopic mucosal erosion [10.0%(5/50 cases) vs.2.3%(6/256 cases)] (all P<0.05). Logistic regression analysis displayed that allergy history ( OR= 5.604, 95% CI: 1.937-16.216), age ( OR = 3.142, 95% CI: 1.425-6.929), percentage of neutrophils ( OR=2.387, 95% CI: 1.088-5.238), CRP ( OR=3.959, 95% CI: 1.072-14.662), and DD ( OR=7.824, 95% CI: 2.824-21.673) were independent risk factors for PB caused by MP infection (all P<0.05). The cut-off values of age, percentage of neutrophils, CRP, and DD were 64 months, 0.70, 35 mg/L, and 2 000 μg/L. Conclusions:Children with PB caused by MP often develop in older and allergic children who have stronger inflammatory reactions, immune disorders, and hyperfibrinolysis.

目的 分析坏死性肺炎儿童的临床特征、治疗及预后,提高对其认识和诊治水平.方法 回顾性分析2014年1月至2019年12月在苏州大学附属儿童医院诊断为坏死性肺炎患儿的病因、临床表现、实验室检查、影像学改变、并发症、治疗方法、随访情况.结果 80例儿童坏死性肺炎患儿,男39例,女41例,年龄为3.4(1.5,8.2)岁.所有患儿均有高热、咳嗽、咳痰,热峰为39.9(39.2,40.0)℃,热程为13.4(7.0,16.0)d,住院时间为20.0(16.0,29.8)d.外周血白细胞计数为18.3(13.0,22.6)×109/L,中性粒细胞比例为83.5 (75.7,89.5)％,C反应蛋白为105.0(41.8,183.3) mg/L,降钙素原为0.4(0.2,2.9) ng/L,血沉为21.0(10.3,47.8) mm/h,乳酸脱氢酶为525.4(365.3,792.0) U/L,纤维蛋白原为5.2(3.8,6.3) g/L,D-.二-聚体为2040.5(890.0,5351.3) μg/L.病原体检出率为71.3 ％(57/80),其中细菌为41.3％(33/80),肺炎支原体为28.8％(23/80),病毒为25.0％ (20/80),前5位的病原体依次为肺炎支原体占28.8％(23/80)、肺炎链球菌占27.5％(22/80)、金黄色葡萄球菌占11.3％ (9/80)、博卡病毒和鼻病毒各占7.5％(6/80)、腺病毒占6.3％(5/80).混合感染率为26.3％(21/80),以肺炎链球菌混合流感病毒常见.55例患儿出现肺部并发症,主要是胸腔积液、脓胸、支气管胸膜瘘、气胸,经抗生素、糖皮质激素、丙种球蛋白等药物治疗,支气管肺泡灌洗、胸腔闭式引流等对症支持治疗,临床症状缓解出院.62.5％(50/80)的患儿随访了3个月～1年,患儿均无明显呼吸道症状,复查胸部CT或胸片,10例有少许斑片影,2例遗留纤维条索影,3例遗留肺空腔病变,其余肺部病灶均消失.结论 儿童坏死性肺炎常见病原菌为肺炎支原体、肺炎链球菌、金黄色葡萄球菌,少数为博卡病毒、腺病毒、流感病毒,其病情重,常合并胸腔积液,经积极抗感染、抗炎及对症支持等治疗,预后良好,极少部分遗留肺结构的破坏.

目的 探讨苏州大学附属儿童医院呼吸道感染住院患儿流感监测情况.方法 分析2016年1月至2019年12月在苏州大学附属儿童医院呼吸科7322例因急性呼吸道感染(ARTI)住院患儿流感病毒感染资料.采用RT-PCR法进行流感病毒的检测,并进行A/H1N1及A/H3N2、B/Victoria及B/Yamagata的亚型鉴定.结果 (1)7322例住院患儿中,共检出流感病毒阳性742例(10.1％),2016-2019年各年分别为10.4％、8.6％、6.0％、15.2％.(2)流感病毒-A检出阳性率(6.7％)高于流感病毒-B(3.6％),以A/H1N1亚型最常见(45.0％),其他依次为B/Victoria(26.4％)、A/H3N2 (19.1％)、B/Yamagata(7.5％),有4例A/H1N1+B/Yamagata混合感染、10例A/-H3N2+ B/Victoria混合感染.(3)＞3～5岁组流感病毒阳性率最高(14.3％),其次是＞1～3岁组(12.0％),流感病毒-B发病年龄[38.0(13.0,56.0)个月]大于流感病毒-A[16.0(7.0,38.0)个月](Z=-6.456,P＜0.001).(4)以冬季阳性检出率最高,占流感总检出率的54.9％,其次是春季(36.0％),2017年12月至2018年2月有一流行高峰.(5)流感病毒易发生混合感染(64.4％),最常见的混合感染病原是流感嗜血杆菌(21.2％),其次是肺炎链球菌(17.5％)和肺炎支原体(15.0％).(6)95.8％的住院患儿流感合并肺炎,最主要的症状是发热(86.7％)、咳嗽(98.1％),其次是消化道症状(51.5％).结论 流感病毒是苏州大学附属儿童医院呼吸道感染住院患儿的重要病原,以A/H1N1亚型最常见,不同年份、季节、月份及年龄流行的流感病毒亚型存在一定差异.＞3～5岁年龄组最多,冬季发病率最高,以肺炎为主要疾病表现,主要临床表现是发热和咳嗽,流感病毒易发生混合感染,多数患者预后良好,均未发生死亡.

Objective:To investigate the clinical characteristics and risk factors of bronchiolitis obliterans (BO) after adenovirus pneumonia.Methods:Clinical data of 266 children with adenovirus pneumonia hospitalized in Children′s Hospital of Soochow University from January 2011 to December 2017 were retrospectively analyzed.Accor-ding to whether they developed BO, children with adenovirus pneumonia were divided into the BO group and the non-BO group.Clinical features of the BO group and the non-BO group were compared by t test, rank sum test or chi square test.Risk factors were analyzed by Logistic regression approach. Results:Among 266 children with adenovirus pneumonia included, 37 patients were developed into BO group, and their age was significantly younger than that of the non-BO group [12.0(8.0, 17.5) months vs.32.0(13.0, 48.0) months, P<0.001]. Compared with the non-BO group, there were more proportion of preterm infants[10.8%(4/37 cases) vs.3.1%(7/229 cases), P=0.028], more instances of comorbidities [21.6%(8/37 cases) vs.4.4%(10/229), P<0.001] and more children with allergic diseas[35.1%(13/37 cases) vs.20.1%(46/229 cases), P=0.041] in the BO group, and the difference was statistically significant.The duration of fever in the BO group was significantly longer than that of the non-BO group [10(4.0, 13.5) d vs.6(4.0, 9.0) d, P=0.011] children with symptoms of wheezing, shortness of breath, and hypoxemia in the BO group were significantly more than the non-BO group[81.1%(30/37 cases) vs.27.9%(64/229 cases), P<0.001; 64.9%(24/37 cases) vs.5.7%(13/229 cases), P<0.001; 59.5%(22/37 cases) vs.6.6%(15/229 cases), P<0.001]. The platelet count, IgG level, and CD3 -CD 19+ lymphocyte percentage were significantly higher in the BO group than the non-BO group [(364±104)×10 9/L vs.(297±105)×10 9/L, P=0.001; 6.74(4.92, 10.16) g/L vs.5.93(1.00, 8.04) g/L, P=0.016; (33.5±15.3)% vs.(26.1±10.2)%, P=0.008]. In contrast, the percentage of CD3 + CD4 + lymphocytes in the BO group was lower than the non-BO group[(29.1±8.0)% vs.(32.5±9.4)%, P=0.044], the difference was statistically significant.The BO group had a higher rate of mixed bacterial infection than the non-BO groups[37.8%(14/37 cases) vs.16.6%(38/229 cases), P=0.003]. An age<26 months, comorbidities, premature birth history, wheezing, shortness of breath, and hypoxemia were independent risk factors for BO after adenovirus pneumonia( OR=4.808, 30.667, 7.558, 3.909, 8.842, 8.607, all P<0.05). Conclusions:An age of less than 26 months, a history of premature delivery comorbidities, wheezing, shortness of breath and hypoxemia, are independent risk factors for BO after adenovirus pneumonia.Children with above manifestations should receive high resolution CT as soon as possible to determine whether it is BO.

目的 从儿童流感的临床指标中获得具有提示和区分作用的指标.方法 该研究共纳入2019年11月—2020年02月470例在苏州大学附属儿童医院进行流感治疗的患儿,通过比较甲流和乙流患儿的临床基本资料、血常规指标、血生化全套、心肌三项及C反应蛋白(CRP)等数据.结果 乙流组患儿的年龄显著大于甲流组患儿,差异有统计学意义(P<0.05);而在其他项目上两组患儿差异无统计学意义.两组患儿在白细胞计数(WBC)、中性粒细胞(NEU)计数、NEU百分比、淋巴细胞(LY)百分比、单核细胞(MO)百分比及血小板计数(PLT)等指标上差异有统计学意义(P<0.01).两组患儿生化全套指标、心肌三项及CRP指标比较差异无统计学意义.结论 血常规指标在甲流和乙流患儿中有显著差异,可以作为区分两类流感的指示性指标.

目的:探讨小儿呼吸内科临床带教中临床路径教学方法应用的效果.方法:小儿呼吸内科实习生72例,摸球法分为观察组和对照组各36例.观察组采取临床路径教学法,对照组采取常规教学法带教,比较两组理论知识、操作技能和综合能力成绩以及对带教的认可度.结果:观察组理论知识、操作技能、综合能力成绩分别为97.25±1.02分,96.75±1.56分和95.88±2.14分,高于对照组的90.16±1.27分,88.57±2.01分和87.69±4.62分,差异均有统计学意义(P<0.05);观察组实习生对带教认可度97.22％,高于对照组的77.78％,差异有统计学意义(P<0.05).结论:临床路径教学法用于小儿呼吸内科临床带教,可提升实习生考核成绩和对带教的认可度,值得临床推广.

综述阿奇霉素的作用机制、不良反应及预防门诊病人输注阿奇霉素所致胃肠道反应的方法,提示护理人员应寻求一种预防阿奇霉素所致胃肠道反应的更佳、更易被门诊病人接受的方法,以减轻病人痛苦,加速病人恢复.

[目的]探讨精细化管理在门诊输液室预约输液中的应用效果.[方法]选取2015年1月-2015年6月(精细化管理前)预约输液病人180例为对照组;选取2015年7月-2015年12月(精细化管理后)预约输液病人180例为观察组.对照组采用常规输液预约流程,观察组采用精细化管理,通过采用无线输液预约系统、弹性排班、流程优化、个人数字助理(PDA)扫描及专用储药柜等精细化管理措施为2 d以上的输液病人提供免费预约服务,比较两组预约病人满意度、输液等候时间及差错发生率.[结果]观察组预约输液病人满意度显著提高(P<0.05),等候时间显著缩短(P<0.05),护士差错发生率显著减少(P<0.05).[结论]对预约病人实施精细化管理,极大地优化了输液流程,降低了护理风险,提高了门诊护理服务质量.

Objective:To investigate the expression of inducible costimulatory ( ICOS) and inducible costimulatory ligand ( ICOSL) on peripheral blood mononuclear cells ( PBMCs ) and their clinical relationship with rheumatoid arthritis ( RA ) patients.Methods:Peripheral blood samples were collected from 85 RA patients and 50 HC in this study.Expression of ICOS and ICOSL on PBMC from the subjects were detected by flow cytometry and real-time polymerase chain reaction( RT-PCR).The alteration of ICOS and ICOSL were observed after hormone therapy in 15 patients with RA and the relationship between their expression level and patients′clinical manifestations were analysed.Results:The ICOS and ICOSL mRNA level of RA patients′PBMCs were significantly higher than that in HC.The expression level of ICOS on CD4+T cells was higher than than that in HC[(7.08±4.72)% vs (3.01+1.39)%,P<0.0001].The expression of ICOSL on monocytes[(5.77±3.45)%vs (3.64±1.43)%,P<0.05] and B cells [(5.78± 4.52)%vs (3.97±1.63)%,P<0.05] were significantly elevated in RA patients.In RA patients with active disease,however,ICOSL expression on monocytes and B cells were increased as compared with those in inactive RA patients [ ( 5.45 ±3.50 )% vs ( 4.04 ± 1.55)%,P=0.036],[(6.59 ±5.74)%vs (5.63±4.30)%,P=0.016].Furthermore,after receiving immunosuppressive therapy, the expressions of ICOS and ICOSL were notably reduced as compared with pre-therapy levels on PBMCs from patients [ ( 5.45 ±3.50)%vs (4.04±1.55)%,P=0.036],[(6.59 ±5.74)%vs (5.63±4.30)%,P=0.016].Conclusion:The high levels of ICOS and ICOSL expression were closely correlated with the degree of disease and therapeutic response,suggesting that ICOS/ICOSL pathway may play a critical role in pathogenesis of RA.

A network of approximately 35 volunteers from relevant departments and high-risk divisions was set up with the head nurse of the Orthopedics Department in charge. Trainings on the causes and mechanism of Deep Vein Thrombosis (DVT) as well as ways and strategies of intervention were held in a relaxing and pleasant atmosphere. Experts were asked to give lectures so that a lively culture of organizational learning was formed. Regular problem-oriented analyses of typical cases were conducted to share experience and prevent DVT at the very beginning. Regional radiation: The salon was open to colleagues in nursing from ifrst-class and second-class hospitals in the surrounding areas so that they could participate in the training, discussion and sharing sessions. In the meantime, the concept of "DVT prevention" was advocated in all levels of training programs to achieve regional radiation and wide coverage. The incidence of DVT decreased signiifcantly from the academic salon in our hospital. It's an effective model of organized nursing interventions will achieve the "glass ceiling effect" of "prevention ifrst".

This study is to explore the clinical significance of B7-H3 in rheumatoid arthritis(RA) patients by detecting the expression of soluble B7-H3(sB7-H3) and the gene isoforms in peripheral blood.The expression of sB7-H3 in the serum of RA patients and healthy controls(HC) was detected by ELISA and analyzed with relevant clinical data.At the same time peripheral blood mononuclear cells(PBMC) was isolated from RA and HC individuals and membranous B7-H3 in CD14+ monocytes was detected by flow cytometer.The mRNA expression of two isoforms of B7-H3 was detected by RT-PCR.The results show that the expression of sB7-H3 is significantly lower in RA patients than in HC individuals(t=7.767,P<0.0001).RA patients in acute episode had lower expression of sB7-H3 than patients in relief episode(t=2.874,P=0.0057) and the sB7-H3 expression negatively correlated to the counts of joints involved(r=-0.3969,P=0.0063).Both the expression of membranous B7-H3(mB7-H3) in CD14+cells and the mRNA expression of B7-H3 in PBMC were significantly higher in RA patients than in HC individuals.The main form of mRNA expressed was 4IgB7-H3.The soluble and membranous B7-H3 was expressed in the blood of RA and the molecule might take part in activating autoreactive T cells and thus promote the progress of the disease.

Objective To establish a nursing quality evaluation scale for the prevention of Ventilator-associated Pneumonia(VAP).Methods Based on the evidence-based practice guidelines for the prevention of VAP and literature review,the indicators of nursing quality evaluation were identified tentatively.Then Delphi method was used and 18 experts were investigated and consulted by two rounds.Results The index of experts activity was 94.44% and 100.00% in the first and second round of Delphi consultation,respectively.The experts' authority coefficient was 0.88.The scale comprised 25 indicators in 7 dimensions at last.Conclusion The reliability and authority of the scale are acceptable and it can be used to evaluate the nursing quality of preventing VAP.

Objective To test the reliability and validity of the Knowledge and Practice Questionnaire of Ventilator-associated Pneumonia (VAP) Prevention.Methods Questionnaire was established by literature review,expert consultation and group discussion.101 ICU nurses in a hospital of Jiangsu Province by convenience sampling method participated in the investigation.The reliability and validity was tested with Cronbach's α coefficient,factor analysis and content validity index.Results Factor analysis indicated a good construction validity of the questionnaire,high load value in 20 items and the general accordance with the questionnaire construction in 6 dimensions,eg.enteral nutrition care,hand washing,trachea cuff care,suctioning care,ventilator pipe care and oral care.The Cronbach's α coefficient in the 6 dimensions were 0.778,0.686,0.673,0.620,0.605 and 0.711,respectively.The total internal consistency reliability of the questionnaire was 0.864.Conclusion The questionnaire is reliable and valid for evaluating the knowledge and practice for preventing VAP in ICU nurses.

颅脑损伤昏迷患者不能正常进食,而机体又呈高代谢高分解状态.为了给患者提供必要的营养支持,临床中往往需要给患者插胃管进行鼻饲营养液.护士在执行鼻饲的过程中,任何细小的疏忽都可导致严重的后果,给患者及医院带来损失.我院神经外科2007年6月～2008年12月共收治脑损伤昏迷患者78例,均予鼻饲营养液,现将鼻饲营养液过程中的相关问题分析如下.