基于多平台混合教学模式在通风空调工程课程中的应用探讨

为提升通风空调工程课程教学效果,探讨了一种混合教学模式在通风空调工程课程中的应用。该模式融合翻转课堂与多平台构成。开展翻转课堂教学、建立基于互联网的“小范围”知识获取平台,以及研究生与本科生互动平台,三者融合以提升学生课程参与度,提高课程知识转化率,增强本科学生与土木水利专业学位硕士互动,完善课程教育体系。最终达到学生在通风空调工程领域的专业素养和实际应用能力逐步提高的目的,为通风空调工程课程的教学改革提供有效的经验。

Severe pediatric COVID‑19:a review from the clinical and immunopathophysiological perspectives

Background Coronavirus disease 2019(COVID-19)tends to have mild presentations in children.However,severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times,meriting further attention from clinicians.Meanwhile,the intricate interactions between the pathogen virulence factors and host defense mechanisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood.Data sources A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed,Embase,and Wanfang databases.Searched keywords included“COVID-19 in children”,“severe pediatric COVID-19”,and“critical illness in children with COVID-19”.Results Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated status.Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations,while various forms of cardiovascular and neurological involvement may also be seen.Multiple immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways,whose dysregulation in severe and critical diseases translates into adverse clinical manifestations.Multisystem inflammatory syndrome in children(MIS-C),a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure,denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity.Despite the considerable dissimilarities between the pediatric and adult immune systems,clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines.Conclusions Severe pediatric COVID-19 can affect multiple organ systems.The dysregulated immune pathways in severe COVID-19 shape the disease course,epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults.Consequently,further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.

夏季奶牛场生物气溶胶分布规律与环境影响因子研究

为探究典型季节下的奶牛场生物气溶胶的分布规律和多元环境因子对其影响程度,对天津市某规模化奶牛场生物气溶胶、环境参数进行连续采集,分析了夏季奶牛场生物气溶胶浓度和载体粒径的时空分布规律,同时筛选出对其浓度具有重要影响的环境因子。结果表明,在空间分布上,牛场近地面1 m高度处的生物气溶胶浓度显著高于近地面4 m高度处浓度(P<0.01)。在粒径分布上,各采样点的分布规律无显著差异(P>0.05),不同粒径粒子所占比例接近且存在粒径越小所占比例越小的趋势,粒径大于2.1μm的粒子约占总数的80%。运用随机森林模型得到了10个影响因子对生物气溶胶浓度的影响程度,其中风向(WD)、温度(T)、紫外辐射强度(UV)、悬浮颗粒物浓度(PM100)等对浓度影响较大。为进一步探究影响因子之间的关系,通过层聚类的方法分析各影响因素之间的共线性关系,发现PM10、PM1与PM2.5之间以及UV与GHI之间具有强共线性关系,可以去除强共线性影响因子,保留组内一种环境因子为代表,以节约采集成本。本研究可为国内牛场空气环境污染排放测定提供参考。

Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus

Since December 2019,an epidemic caused by novel coronavirus (2019-nCoV) infection has occurred unexpectedly in China.As of 8 pm,31 January 2020,more than 20 pediatric cases have been reported in China.Of these cases,ten patients were identified in Zhejiang Province,with an age of onset ranging from 112 days to 17 years.Following the latest National recommendations for diagnosis and treatment of pneumonia caused by 2019-nCo V (the 4th edition) and current status of clinical practice in Zhejiang Province,recommendations for the diagnosis and treatment of respiratory infection caused by 2019-nCoV for children were drafted by the National Clinical Research Center for Child Health,the National Children's Regional Medical Center,Children's Hospital,Zhejiang University School of Medicine to further standardize the protocol for diagnosis and treatment of respiratory infection in children caused by 2019-nCoV.

Clinical application of extracorporeal membrane oxygenation in children with refractory cardiopulmonary failure

Background:This study aimed to discribe the experience in supporting children with refractory cardiopulmonary failure with extracorporeal membrane oxygenation(ECMO).Methods:We retrospectively reviewed 12 children with refractory cardiopulmonary failure supported with ECMO from February 2009 to August 2015 in the Pediatric Intensive Care Unit(PICU),Children's Hospital,Zhejiang University School of Medicine.Results:Seven of the 12 patients were weaned successfully from ECMO and dischaged from the hospital,with a survival rate of 58.3%(7/12).Among them,fi ve patients had acute fulminant myocarditis(AFM).Complications during ECMO included hemorrhage,hemolysis,thrombosis,acute kidney injury,and secondary hematogenous infection.During 1-24 month follow-up,the seven surviving patients recovered with normal cardiopulmonary function.Conclusion:ECMO is useful for supporting children with refractory cardiopulmonary failure,especially for treatment of AFM.

Reconstruction of a new pulmonary artery in arterial switch operation

Background:This study was undertaken to evaluate the new method for the reconstruction of the pulmonary artery in arterial switch operation(ASO).Methods:A total of 108 consecutive infants with congenital heart disease were treated with ASO in our department between January 2004 and June 2012.The new pulmonary arterial root was reconstructed with a fresh autologuos pericardium which was clipped pants­like with continuous mattress suture of 6-0 Prolene thread.Patients were reexamined consecutively at 3 and 6 months and 1,2 and 6 years after discharge.The pulmonary arterial blood velocity was measured by continuous Doppler during systole.The pulmonary flow of healthy children of same age was also measured in the control group.Simplified Bernoulli formula was used to calculate the pressure gradient via the pulmonary artery for determining whether there was pulmonary stenosis.Results:In this series,96 infants survived after the surgery and 88 were followed up with a mean peirod of(22±4)months.No pulmonary stenosis was detected with the simplified Bernoulli formula.Conclusion:No pulmonary stenosis was detected with the simplified Bernoulli formula.

Perioperative extracorporeal membrane oxygenation in pediatric congenital heart disease:Chinese expert consensus

Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.

Management of persistent pulmonary hypertension in newborns with ECMO support: a single center's experience

Background To summarize the experience of management of persistent pulmonary hypertension of the newborn (PPHN) with extracorporeal membrane oxygenation (ECMO) support.Methods We presented three neonates with PPHN supported by ECMO in our center.Medical records and patient management notes were retrospectively reviewed.Results For two neonates with congenital diaphragmatic hernia (CDH),diaphragm repair surgery was done under ECMO support.One patient was weaned from ECMO after 73 hours,and recovered well at the last follow-up after 1 year.The other patient was weaned from ECMO after 167 hours,and he died from septic shock 21 days after decannulation.For the neonate with idiopathic PPHN,ECMO was withdrawn successfully.Conclusions ECMO is an effective rescue means for refractory PPHN.Appropriate intervention timing,accurate coagulation,and volume management are important.

Prognostic factors in children with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation

Background Pediatric acute fulminant myocarditis(AFM)is a very dangerous disease that may lead to acute heart failure or even sudden death.Previous reports have identified some prognostic factors in adult AFM;however,there is no such research on children with AFM on venoarterial extracorporeal membrane oxygenation(VA-ECMO).This study aimed to find relevant prognostic factors for predicting adverse clinical outcomes.Methods A retrospective analysis was performed in an affiliated university children’s hospital with consecutive patients receiving VA-ECMO for AFM from July 2010 to November 2020.These children were classified into a survivor group(n=33)and a non-survivor group(n=8).Patient demographics,clinical events,laboratory findings,and electrocardiographic and echocardiographic parameters were analyzed.Results Peak serum creatinine(SCr)and peak creatine kinase isoenzyme MB during ECMO had joint predictive value for in-hospital mortality(p=0.011,AUC=0.962).Based on multivariable logistic regression analysis,peak SCr level during ECMO support was an independent predictor of in-hospital mortality(OR=1.035,95%CI 1.006 to 1.064,p=0.017,AUC=0.936,with optimal cut-off value of 78μmol/L).Conclusion Tissue hypoperfusion and consequent end-organ damage ultimately hampered the outcomes.The need for left atrial decompression indicated a sicker patient on ECMO and introduced additional risk for complications.Earlier and more cautious deployment would likely be associated with decreased risk of complications and mortality.

Surgical minimal invasive left atrial decompression during venoarterial extracorporeal membrane oxygenation for pediatric acute fulminant myocarditis

Venoarterial extracorporeal membrane oxygenation(VA ECMO)has been considered as the first-line treatment for acute fulminant myocarditis(AFM)when traditional treatment is ineffective.Peripheral vascular VA ECMO can partially reduce right ventricular preload,but it can increase left ventricular(LV)after-load.1 The increased afterload may cause difficulty in LV blood ejection in patients with severely impaired LV function.

Lessons learned from ECMO support in pediatric patients with D-transposition of the great arteries:preoperative,intraoperative and postoperative

Background Extracorporeal membrane oxygenation(ECMO)support on D-transposition of the great arteries(D-TGA)carries formidable challenges.Methods A retrospective study was performed on pediatric patients with D-TGA supported by ECMO from July 2007 to December 2019.This study summarized the clinical experience of ECMO support in pediatric patients with D-TGA preoperative,intraoperative,and postoperative.Results Overall,16 children with D-TGA received ECMO support during this period.Two(2 of 16)were supported before cardiac surgery,3(3 of 16)were supported postoperatively in the intensive care unit,and 11(11 of 16)failed to wean off cardiopulmonary bypass.Two cases of preoperative ECMO support for patients with D-TGA with an intact ventricular septum and restrictive atrial septum due to severe hypoxemia died.In this study,D-TGA with coronary artery malformation and other complicated deformities died(8 of 14),whereas uncomplicated D-TGA without coronary artery malformation all survived(6 of 14).The wean-off rate of ECMO patients supported in D-TGA was 62.5%(10 of 16),while the 30-day survival rate was 44%(7 of 16).Conclusion Although a promising ECMO weaning rate was obtained,30-day survival of this population was frustrating,mainly attributed to the original anatomy of coronary arteries and the concomitant deformities.