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At present, the routine specialized training for primary pediatricians (focusing on theoretical learning of public subjects) cannot meet the needs of primary pediatricians. In order to promote the development of children's medical care at the grassroots level and improve the quality, medical and clinical research abilities of regional pediatric medical personnel, the Children's Hospital of Chongqing Medical University has designed and built a "hierarchical training model for improving the professional ability of pediatricians" from the aspects of training objectives, training contents, training methods, construction and evaluation of training programs, and quality control. In addition, the 8-month "Pediatric Professional Basic Training" and the 9-month "Pediatric Professional Ability Improvement Training" were respectively carried out in Xianyang Children's Hospital. In the "Professional Basic Training", 88 trainees were comprehensively evaluated after training, 53 of whom were qualified or above. In the "Ability Improvement Training", 26 of the 29 students actually participated in the evaluation and reached the qualified level or above. Learners provided feedbacks that they have effectively improved their own knowledge structure, expanded their clinical diagnosis and treatment thinking and clinical research ideas, and provided some guidance for clinical work.
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Objective:To investigate the association of peripheral axial lengths and retinal curvatures with refractive status.Methods:A cross-sectional study was conducted out.Two hundred and eighty-seven eyes of 287 consecutive children aged 6-15 years old who recieved eye examinations at Beijing Tongren Hospital from July to October 2021 were enrolled, including 154 males and 133 females.Uncorrected and best corrected visual acuity were tested with a standard logarithmic visual acuity chart.Spherical equivalent (SE) was measured via an auto refractometer after cycloplegia with tropicamide.The hyperopic, emmetropic and myopic groups were defined with a SE >+ 0.5 D, SE >-0.5 D to ≤+ 0.5 D and SE≤-0.5 D, respectively.Central and 30° peripheral eye lengths (nasal, temporal, superior, inferior) were obtained using the Lenstar LS900.Retinal coordinates were derived from partial coherence interferometry modeling and converted to retinal curvatures.According to the median horizontal peripheral eye length differences (absolute difference between nasal and temporal), participants were assigned to H1 group (absolute difference <0.35 mm) or H2 group (absolute difference ≥0.35 mm). According to the median vertical peripheral eye length differences (absolute difference between superior and inferior), participants were assigned to V1 group (absolute difference <0.32 mm) or V2 group (absolute difference ≥0.32 mm). Four groups of V1H1, V1H2, V2H1 and V2H2 were constructed according to the grouping methods in both directions above.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2021-162). Written informed consent was obtained from guardians of each subject prior to any medical examination.Results:The central axial length was 23.53(22.93, 24.10)mm.Peripheral eye lengths of temporal, nasal, superior and inferior were 22.75(22.11, 23.22)mm, 22.99(22.32, 23.45)mm, 23.24(22.58, 23.75)mm and 23.12(22.52, 23.56)mm, respectively.Temporal eye length was shorter than nasal, showing a statistically significant difference ( Z=-3.58, P<0.01). Compared with H2 group, H1 group had shorter central, nasal, superior and inferior eye lengths, showing statistically significant differences (all at P<0.05). Compared with V2 group, V1 group had shorter central, nasal and superior eye lengths, showing statistically significant differences (all at P<0.05). SE of H1 group was + 0.06 (-1.06, + 0.75) D, which was significantly greater than -0.32 (-1.64, + 0.56) D of H2 group ( Z=-2.10, P=0.04). SE of V1 group was + 0.13 (-0.81, + 0.80) D, which was significantly greater than -0.56 (-1.83, + 0.48) D of H2 group ( Z=-3.39, P<0.01). The myopia ratio of V1 group was 33.5% (58/173), which was significantly lower than 50.5% (53/105) of V2 group ( χ2=7.83, P<0.01). There was a significant overall difference in SE among VIH1, V1H2, V2H1 and V2H2 groups ( H=24.79, P<0.01). SE was greater in V1H1 group than V1H2, V2H1 and V2H2 groups (all at P<0.01). There was a significant difference in both horizontal and vertical retinal curvatures among different refractive groups ( H=22.34, 19.30; both at P<0.01). The retical curvature in both directions of hyperopic and emmetropic groups were significantly larger than those of myopic group (both at P<0.01). Conclusions:Peripheral eye lengths are asymmetric in school-aged children.Higher asymmetry is associated with myopic shifts.Myopic children have a steeper retina than the hyperopic and emmetropic children.
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Objective:To analyze the feasibility of developing clinical pediatrics curriculum for pediatric students at the pre-clinical stage, and to provide a basis for the subsequent curriculum construction.Methods:A total of 90 pediatric medical students were enrolled, including pre-clinical group (G1, third semester of the second year, n=47) and the clinical clerkship group (G2, seventh semester of the fourth year, n=43). A questionnaire survey was conducted to compare the two groups from three aspects: clinical interest, learning methods and learning ability. And 24 and 20 students were randomly selected from the two groups to participate a clinical course respectively. Both of the formative evaluation and in-class test were carried out to compare the learning performance and learning effect between G1 and G2. SPSS 22.0 was used for data analysis. The counting data were described by case number and rate, and the frequency between groups was compared by chi-square test. When the chi-square test condition is not met, Fisher's exact test was performed. Normal distribution test was carried out for measurement data. Two independent sample t test was conducted for the comparison between groups of normal distribution data and Mann-Whitney U test for the comparison between groups of skewed distribution respectively. Results:There was no significant difference in clinical interest and pre-clinical interest between the two groups (Fisher's exact probability method, P=0.252, 1.000). There were partial differences in learning methods: G1 spent more time learning after class ( Z=-2.36, P=0.018), learned more in spare time ( Z=2.53, P=0.011), learned more on the homework ( P=0.020), and had a higher preview rate ( Z=-5.07, P < 0.001). There were also partial differences in learning ability: G2 had better literature retrieval ability ( χ2=10.57, P=0.001); G2 had higher scores on class and extended class performance ( t=-3.18, P=0.004; t=-10.14, P<0.001). In terms of learning effect, G2 scored higher scores on only one multiple choice question ( t=-2.46, P=0.022). Conclusion:The pediatrics students at the pre-clinical stage have certain interest and ability to receive clinical pediatrics courses. Sufficient pre-class preparation and appropriate curriculum design are helpful to the early cultivation of student's clinical thinking.
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Objective:To investigate the effects of different intensity of lighting on normal refractive development and form deprivation myopia (FDM) in guinea pigs.Methods:A total of 108 healthy 3-week-old guinea pigs were divided into normal refractive development guinea pigs ( n=54) and FDM guinea pigs ( n=54). FDM models were prepared in FDM animals by occlusion of the left eyes using an opaque mask, and the bilateral eyes were open in the normal refractive development guinea pigs.The guinea pigs were randomized to low (20 lx), normal(300 lx), and high intensity-lighting (5 000 lx) groups with a 12-hour light/12-hour dark cycle for 6 consecutive weeks under LED light.The ocular biometry was performed in a two-week interval.Axial length (AL) and dilated diopter were measured by A-scan ultrasonography and retinoscopy, respectively, and were compared after different lighting durations, and the change trends of them in normal refractive development and FDM guinea pigs were evaluated. Results:The AL values were not significantly different among low, normal and high intensity-lighting groups ( Fgroup=0.365, P=0.697), and the AL was gradually prolonged over the lighting duration ( Ftime=353.750, P<0.001). The diopters showed a statistically significant difference among different intensity-lighting groups ( Fgroup=3.576, P=0.034). The diopter in high intensity-lighting for 4 weeks was (+ 2.75±2.15) D, which was significantly higher than (0.41±3.07) D in the normal refrective development guinea pigs ( P<0.001). In the FDM guinea pigs, both AL and diopter were not significantly different among low, normal and high intensity-lighting groups ( Fgroup=0.105, P=0.900; Fgroup=0.973, P=0.387), and significant differences were seen in AL and diopter among three groups ( Ftime=408.302, 27.407; both at P<0.001). The diopter in FDM eyes of low intensity-lighting for 2 weeks was (+ 2.35±1.95) D, which was higher than (+ 1.90±0.97) D before lighting, with no statistically significant difference between them ( P>0.05). The AL was shortest and the AL change was smallest in normal refractive development guinea pigs of high intensity-lighting group.The diopter change in FDM guinea pigs of the low intensity-lighting group was significantly smaller than that in the normal intensity-lighting group ( P<0.001), with a transient hyperopia drift. Conclusions:The 5 000 lx lighting can slow down the development toward myopia in the normal refractive development eyes, and 20 lx lighting tends to delay the progression FDM eyes with a hyperopic shift after lighting for 2 weeks.
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Objective:To analyze the effect of SBAR (situation, background, assessment, and recommendation) sign-out template in the standardized residency training in a neonatal ward.Methods:Based on SBAR communication mode, we designed and optimized neonatal ward sign-out checklist, and a total of 67 residents were trained for 2 weeks from April 2019 to June 2019, with control group (before training) and observation group (after training). The assessment indicators of sign-out information included sign-out duration, the incidence of sign-out errors, quality assessment scores and shift satisfaction (including sign-out satisfaction and self-evaluation) as well as competencies. A total of 1 553 children's morning shift data were collected, and SPSS 22. 0 was used for t test and chi-square test. Results:In the control group, the sign-out duration was (23.4±4.7) min, the incidence of sign-out errors was (43.6±6.6)%, quality assessment scores were (6.3±0.7) points, the satisfaction degree was (76.5±4.6)%, and the self-evaluation scores were (5.2±2.1) points. While, in the observation group, the sign-out duration was (15.9±3.2) min, the incidence of sign-out errors was (21.1±2.3)%, quality assessment scores were (8.9±0.9) points, the satisfaction degree was (94.1±2.9)%, and the self-evaluation scores were (8.9±0.8) points, with statistically significant difference ( P<0.05). There were statistically significant differences between the two groups in clinical skills and medical service ability [(2.2±0.1) vs. (3.8±0.3)], interpersonal communication ability [(2.6±0.5) vs. (4.2±0.1) points], teamwork ability [(3.1±0.2) vs. (4.6±0.3)], information and management ability [(2.5±0.5) vs. (4.2±0.2)] ( P<0.05). Conclusion:The SBAR template can improve sign-out process and the clinical skills of standardized training residents.
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Objective To study the risk factors of severe complications possibly associated with exchange transfusion (ET) for patients with extreme hyperbilirubinemia.Method From May 2001 to May 2018,neonates with severe complications of ET were assigned into adverse event group.The propensity score principle was used to match adverse event group/the control group with the ratio of 1 ∶ 3.The neonates in the control group received ET without any severe complications.The demographic characteristics of patients,and other clinical data were reviewed.The Logistic regression analysis was used to determine the risk factors of severe complications of ET.Result Among the 1 535 neonates who received ET during the past 17 years,71 neonates (4.6％) were identified with severe adverse events,including apnea (30.6％),necrotizing enterocolitis (18.8％),heart failure (14.1％),respiratory failure (12.9％),and shock (8.2％).The Logistic regression analysis showed that acute bilirubin encephalopathy (ABE) score ≥ 3 (OR=6.383,95％CI 2.550～15.979),ETs ≥ 2 times (OR=11.825,95％CI 2.464～56.755),cardiac murmur ≥ grade Ⅲ (OR=20.417,95％CI 4.705～40.590),and dramatic blood pressure fluctuation during ET ≥ 30 mmHg (OR=13.612,95％CI 1.795～43.342) were risk factors of ET related severe complications (all P＜0.05).Conclusion The indications should be carefully assessed before ET.The patients with ABE score ≥ 3,ETs ≥ 2 times,cardiac murmur ≥ grade Ⅲ,or dramatic blood pressure fluctuation during ET ≥ 30 mmHg should be monitored carefully and ET should be stopped in time if necessary.
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Medical injection pump is a commonly used clinical equipment with high risk. Accurate detection of flow is an important aspect to ensure its reliable operation. In this paper, we carefully studied and analyzed the flow detection methods of three standards being used in medical injection pump detection in our country. The three standards were compared from the aspects of standard device, flow test point selection, length of test time and accuracy judgment. The advantages and disadvantages of these standards were analyzed and suggestions for improvement were put forward.
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Equipos y Suministros , Estándares de Referencia , Bombas de Infusión , Estándares de Referencia , Inyecciones , Personal Militar , Estándares de ReferenciaRESUMEN
Objective To explore the influence of the selecting questions from national question database on the Pediatrics theoretical examination of clinical undergraduates under the mode of teaching-examination separation. Methods to make an overall quantitative analysis of 304 test papers, selecting questions from national question database for the final pediatrics theoretical examination in the first term from 2017 to 2018, which was answered by two classes of clinical medicine students enrolled in 2014. Results From the distribution of these two classes' scores, it can seen that the frequency distribution on both sides of the average is relatively symmetrical and all of them presented normal distribution, but they are all below average and good grades are fewer. They account for 5.29% and 9.15% of the total number respectively in each class. The number of students who failed of the two classes accounts for 20.53% and 16.99% respectively. The difficulty coefficients of the total volume are respectively 0.67 and 0.69, whose overall difficulty is moderate. Moreover, the test reliability coefficients of two classes are 0.764 0 and 0.768 9 respectively. The discrimination of the total volume of these two classes are all 0.22. There are some errors for the examination papers including in multiple choice options, repetitive questions, too many ques-tions in circulatory system and questions above student current levels. Conclusion The result indicates that the testing questions show the difference of the students' ability and the reliability of the test through the overall quantitative analysis of the test. However, relatively low scores and a relatively large number of students failing the test indicate that students just stay in the old teaching and testing mode and they only master classroom knowledge. Therefore, they do not do self-learning well. Separation of teaching and testing could help to cultivate students' self-learning ability. At the same time, the quality of examination questions of the national question database and group questions should be constantly improved, which is the premise to ensure the objective reflection of students' learning ability.
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Objective To discuss the role of teachers in the integrated PBL teaching of pediatrics in the light of the investigation of students after PBL teaching.Method The multidisciplinary integrated PBL course established by the Department of Pediatrics of Chongqing Medical University has been implemented for more than two years in the teaching of the five year program in the Department of clinical medicine (pediatric direction).From September 28,2016 to October 25th,the researchers conducted a survey of 26 undergraduate students in the college who received PBL teaching at the professional probation stage.After the end of each PBL class,the teaching evaluation questionnaire recommended by Fudan University and Qian Ruizhe was distributed through the network teaching platform of Chongqing Medical University.The questionnaire was retrieved by students without a name,and the survey was carried out 3 times.The data of the questionnaire were summarized with Excel 2007.Result 77 questionnaires were issued and 77 were recovered,with a recovery rate of 100％.In the multidisciplinary integrated PBL class,94.8％-97.4％ students gave high score evaluation,and all the evaluation of teachers reached "excellent" level.In response to open-ended questions,students believed that teachers in teaching could inspire students to think positively,encourage students to express different views,create a mutually trusted environment for students,and cultivate students' interpersonal communication,communication and cooperation ability.Conclusion In pediatric multidisciplinary integrated PBL teaching,teachers should teach students correct learning methods,judge each student's knowledge and thinking level,and individualize teaching for each student's problems and characteristics.
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Objective To explore the application of clinical teaching unit (CTU) in the process of pediatric resident standardization training. Method From August 2015 to December 2015, trainers in the department of neonatology were randomly divided into the experimental group and the control group; two groups had the same basic training plan and the same training time. The experimental group needed to par-ticipate in CTU activities outside the rule training plan. Trainers of the experimental group were evaluated by the formative evaluation method, and the theoretical assessment and questionnaire survey were carried out at the end of training. SPSS 18.0 was used for t test. Results The ability of clinical thinking of the experimental group trainers in the practice of CTU was improved, and the scoring rate rose from 57.0％ to 85.7％; the test scores of experimental group had different increase, in which case analysis reflected the ability of clinical thinking was significantly higher than the control group (P<0.05). Conclusion CTU can improve the trainers' independent clinical thinking and other abilities, and gradually help them complete the transition from medical students to physicians.
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In France, home care is defined as an alternative to hospitalization.It aims at the patients who do not need full-time treatment in hospital, but who need the quality and technique of treatment which are same as hospital.It shortens the time of hospitalization, even sometimes to avoid hospitalization.This paper reviews home care and its application in neonatology in France, and discusses its application in China.
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Objective To investigate the effect of standardized usage of antibiotics and hand hygiene on carbapenem-re-sistant Enterobacteriaceae (CRE) infection in neonates. Methods According to the situation of standardized management of an-tibiotics in our hospital, the study period, from January 2011 to December 2013, was divided into pre-intervention, transition and post-intervention. Retrospective study was employed to analyze the antibiotics use density (AUD), the hand hygiene compliance rate among the medical staff, the positive rate of CRE and the nosocomial infection percentage of the neonatology department. Results From pre-intervention to post-intervention period, the AUD was decreased from 12.93 DDDs to 8.10 DDDs;hand hy-giene compliance rate of medical staff was increased from 53.49%to 83.33%;the detection rate of CRE was decreased from 3.71%to 2.27%. The differences were all signiifcant among different periods (P<0.01). The nosocomial infection percentage decreased from 0.22%to 0.17%and there was no signiifcant difference (P=0.441). Conclusions Standardized usage of antibiotics and hand hygiene can be served as economical yet effective approaches to controlling CRE infection in neonates.
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Nosocomial infection is a serious problem in the diagnosis, treatment and management of neonatal disease. Neonatal intensive care unit (NICU) is high risk place for nosocomial infections whose clinical features vary with age, nation and region. The improvemnts in hand hygiene measures and antibiotic stewardship and control of the risk are recommended to effectively prevent nosocomial infections in NICU and to improve the healthcare service in neonates.
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<p><b>OBJECTIVE</b>To investigate the role of nuclear factor-κB (NF-κB) activation in bilirubin-induced apoptosis of rat hippocampal neurons and the effect of TAT-NBD intervention on bilirubin neurotoxicity.</p><p><b>METHODS</b>Primary-cultured rat hippocampal neurons were treated with TAT-NBD in the initial 6 or 24 h or in the latter 6 h during a 24-h bilirubin exposure of the cells (early, continuous and late intervention groups, respectively). Immunocytochemistry was performed to detect NF-κB p65 protein expression, and the cell survival and apoptosis were assessed with a modified MTT assay, Annexin V-FITC/PI and TUNEL assay. IL-1β concentration in the supernatant was determined with ELISA.</p><p><b>RESULTS</b>Compared with the control cells, bilirubin-treated cells showed a significantly increased NF-κB p65 protein expression (P<0.01), which reached the peak level at 6 and 24 h (P<0.01). The cell survival rate in early TAT-NBD intervention group was (80.784∓9.767)%, significantly lower than that of the control group (P<0.01) but higher than that of bilirubin group (P<0.01); the apoptotic rate in early TAT-NBD intervention group was significantly higher than that of control group (P<0.01) but lower than that of bilirubin group (P<0.01). IL-1β concentration was significantly lower in early TAT-NBD intervention group (15.348∓0.812 pg/ml) than in bilirubin group (P<0.05). The continuous and late TAT-NBD intervention groups showed comparable cell survival rate, apoptotic rate and IL-1β concentration with bilirubin group (P>0.05).</p><p><b>CONCLUSION</b>NF-κB bidirectionally regulates bilirubin-induced apoptosis of rat hippocampal neurons. Selective inhibition of the early peak of NF-κB by TAT-NBD offers neuroprotective effect. TAT-NBD can be potentially used for prophylaxis of bilirubin-induced brain injury.</p>
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Animales , Femenino , Masculino , Ratas , Apoptosis , Bilirrubina , Toxicidad , Supervivencia Celular , Células Cultivadas , Hipocampo , Biología Celular , Interleucina-1beta , Metabolismo , Neuronas , Biología Celular , Metabolismo , Fármacos Neuroprotectores , Farmacología , Péptidos , Farmacología , Ratas Sprague-Dawley , Factor de Transcripción ReIA , MetabolismoRESUMEN
Paeoniflorin is one of the bioactive components of Paeonia lactiflora, a traditional Chinese herbal medicine. Some recent studies prove its distinguished neuroprotective effect. These neuroprotective mechanisms have become hot points and show closely correlated to activating adenosine A1 receptor, ameliorating the function of cholinergic nerve, regulating ion channel homeostasis, retarding oxidative stress and apoptosis of the neurocytes, promoting nerve growth, having an influence on astrocytes and being ableto penetrate though blood brain barrier. In this review, we present the neuroprotective mechanisms of paeoniflorin in the following eight aspects.
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Animales , Humanos , Apoptosis , Benzoatos , Farmacología , Hidrocarburos Aromáticos con Puentes , Farmacología , Medicamentos Herbarios Chinos , Farmacología , Glucósidos , Farmacología , Monoterpenos , Neuronas , Biología Celular , Metabolismo , Fármacos Neuroprotectores , Farmacología , Estrés Oxidativo , Paeonia , QuímicaRESUMEN
Objective To investigate the expressions of transforming growth factor-?1(TGF-?1)and ?-smooth muscle actin(?-SMA)in the lungs of mice with intra-amniotic endotoxin priming and exposed to 60% hyperoxia after born in order to elucidate the possible relationship with bronchopulmonary dysplasia(BPD).MethodsFifty C57 pregnant mice were divided into 2 groups:lipopolysaccharide(LPS,40 ?g/L)group and saline solution group,and then received an intra-amniotic injection of corresponding solution on E15.The neonatal mice of each group were randomized to be set in 60% oxygen exposure or in room air.So there were 4 subgroups,LPS+air,LPS+hyperoxia,saline+air and saline+hyperoxia groups.On days 1,3,7,10 and 14 after birth(8 rats each time point),the lung histological changes was assessed with hematoxylin and eosin(HE)staining for radial alveolar counting(RAC).The expressions of TGF-?1 and ?-SMA proteins were detected by immunohistochemical and immunofluorescence staining,and the expressions of TGF-?1 and ?-SMA mRNA by real-time polymerase chain reaction(RT-PCR).ResultsIn the LPS+hyperoxia group and saline+hyperoxia group,RAC began to decrease on day 3,and then further declined in a time-dependent manner.Compared with saline+hyperoxia group,LPS+hyperoxia group had significantly lower RAC(P
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Objective To evaluate the effect of the hyperbaric oxygenation therapy on the apoptosis of the hippocampal neuron and the impairment of cognitive function of the newborn rats suffering from bilirubin encephalopathy. Methods One hundred and forty-five five-day-old SD rats of both sex were randomly divided into 3 groups,control group,bilirubin encephalopathy group and hyperbaric oxygenation treated group. Bilirubin ( 10 mg/ml) was injected into the cerebellomedullary cistern to establish experiment model,and normal sodium was injected for control. The expression of cytochrome C and Caspase-3 in the hippocampus neurons were detected by immunohistochemistry and immunofluorescence,respectively,at the time of 6 h,1,3,5 d and 7 d after intra-cisternal injection. Neuronal apoptosis was checked by TUNEL method. The cognitive function was tested by Morris experiment. Results The expressions of the cytochrome C and Caspase-3 in hyperbaric oxygenation treated group were lower than those in bilirubin encephalopathy group,but higher than control group at abovementioned time points ( P
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Objective To observe the effect of inhaled nitric oxide(INO) on the nitric oxide synthase (NOS) in piglet suffered from severe meconium aspiration syndrome(MAS). Methods Severe MAS model of piglet was reproduced, the oxygenation effect and the activity of pulmonary NOS were measured, hybridization in situ of pulmonary slices was used to show the gene expression of inducible NOS(iNOS). Results INO therapy attenuated respiratory dysfunction in MAS, while discontinuation of INO induced “rebound pulmonary hypertension”. The activity of iNOS in MAS group is higher than that in control group (16.9?3.1) fmol/(mg Pro?min)vs (11.6?2.7) fmol/(mg Pro?min),( P