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Objective:To analyze and discuss the application value and teaching effect of simulate patients (SP)-assisted problem-based learning (PBL) combined with team-based learning (TBL) mode in pediatric first aid teaching, in order to provide a new reference for the reform of standardized residency training and teaching mode of pediatrics in the new era in China.Methods:A total of 103 residents who participated in the standardized training in the Department of Pediatrics of Hunan Children's Hospital from January 2018 to December 2020 were selected as the research objects, and they were divided into the control group (50 cases) and the experimental group (53 cases). The control group adopted the previous teaching mode of residents, while the experimental group adopted the SP-assisted PBL combined with TBL mode. In this study, SPSS 22.0 software was used for t test and chi-square test. Results:The examination scores of the experimental group in the theoretical knowledge of pediatric first aid, clinical thinking and skills, and application of pediatric first aid skills were higher than those in the control group [(86.98±3.42), (85.69±5.13), (89.62±4.75)] vs. [(77.23±4.16), (81.16±3.96), (76.54±5.78)], with statistically significant differences between the two groups ( P<0.05). The questionnaire survey showed that the clinical thinking and pediatric emergency skills, doctor-patient communication ability, teamwork ability and other aspects of the experimental group were significantly better than those of the control group ( P<0.05). Conclusion:The SP-assisted PBL combined with TBL mode can produce positive effects in the standardized residency training of pediatrics, which will help residents better master pediatric first aid skills, improve their clinical comprehensive capabilities, and be more conducive to improving the quality of pediatric residency training, which is worth promoting in the new era.
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Objective:To investigate the etiology, prognosis and clinical characteristics of abnormal serum amylase and lipase in children.Methods:This study was a retrospective study.A total of 7 813 children older than 28 days who had their serum amylase and lipase detected in Hunan Children′s Hospital from August 2017 to August 2020 were included as the study subjects.Children with acute and chronic pancreatitis were excluded.The age, gender, impatient department, imaging exams, discharge outcomes, main diagnosis, diagnostic ICD10 code, and the highest values of serum amylase and lipase during hospitalization were collected through the medical record system.According to the levels of serum amylase and lipase, the children were divided into 3 groups.Patients in group A had normal serum amylase and serum lipase levels.The serum amylase or lipase levels of patients in group B was 1 to 3 times higher than that of group A. The serum amylase or lipase levels in group C was 3 times higher than that of group A. Group B and group C had abnormal pancreatic enzyme levels.According to the prognosis, patients were divided into the survival group and the death group.The relationship of the occurrence of abnormal serum amylase and lipase levels with the age, sex, disease type and prognosis of children was analyzed.Results:The ratio of abnormal trypsin in male and female was 11.5% and 12.9%, respectively.The number of children with abnormal pancreatic enzyme levels in the 28 day -1 year old group, >1-3 years old group, >3-6 years old group, >6 -12 years old group and > 12 year old group were 37 cases (4.6%), 185 cases (15.4%), 199 cases (10.5%), 431 cases (13.9%), and 94 cases (11.7%), respectively.The mortality rate was 1.6% (112/6 867 cases) in group A, 5.2% (32/617 cases) in group B, and 7.6% (25/329 cases) in group C. The mortality risk of group B and C was both higher than that of group A. Compared with group A, the OR (95% CI) of group B and group C was 3.30 (2.21-4.93) and 4.96 (3.17-7.77), respectively.In group C, the top five diseases were parotitis (26.4%), cholangiectasis (11.6%), choledochal cysts (8.5%), gastroenteritis (4.5%) and sepsis (3.3%). Conclusions:Pancreatic enzyme abnormalities in children are associated with adverse prognosis.Pancreatic enzyme abnormalities are more prone to occur in children aged >1-3 with mumps, digestive diseases and congenital digestive system structural deformities.In addition, children with sepsis are also easy to present pancreatic enzyme abnormalities.Clinical attention should be paid to the possibility of secondary pancreatic damage in children with sepsis.
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Surgery is the mainstay of treatment for early lung cancers, but there is still a risk of recurrence and metastasis after surgery. With the advancement of molecular biology and detection methods, detecting the level of postoperative peripheral blood minimal residual disease (MRD) in patients can dynamically monitor recurrence and determine prognosis. Due to the wide variety of MRD detection methods, uneven detection power, lack of uniform standards and prospective study validation, clinical application is still controversial. The further development of MRD detection for early stage cell lung cancer still needs technical progress, standardized detection criteria and credible clinical data.
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Objective:To investigate the effect of radioactive 125I seed on angiogenesis of subcutaneously transplanted hepatocellular carcinoma in nude mice and underlying mechanism. Methods:The subcutaneous transplanted tumor model of human hepatocellular carcinoma Huh7 cells was established in nude mice. Twelve nude mice were randomly divided into observation group and control group with 6 mice in each group. The 125I seed with activity of 2.96×10 7Bq was implanted into the transplanted tumor of observation group and another with 0 Bq as control group, respectively. The volume of the transplanted tumor was measured every 4 d and the growth curve of the tumor was recorded. The microvessel density (MVD) of the transplanted tumor was evaluated by immunohistochemical detection of CD31. VEGF-A and HIF-1α protein and mRNA were detected by immunohistochemistry and RT-PCR, respectively. Results:The growth rate of tumor in the observation group was slower than that in the control group, and the difference of tumor volume between two groups at 12 d after 125I seed implantation was significantly different( t=3.167, P<0.05). At 28 d after transplantation, the tumor volumes of control and observation group approached to (963.61 ± 89.56) mm 3and (602.10±75.98) mm 3, respectively. The MVD of the observation group was significantly lower than that of the control group ( t=6.361, P<0.05). The relative expression of VEGF-A and HIF-1α mRNA in the observation group was significantly lower than that in the control group ( t=10.480, 6.414, P<0.05). Protein expression levels of VEGF-A and HIF-1α in the observation group were lower than those in the control group ( t=10.890, 12.250, P<0.05). Conclusions:Radioactive 125I seed can inhibit the growth of HCC xenografts by reducing tumor microvessels, which may be related to the decrease of VEGF-A and HIF-1α expression.
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Objective:To explore the feasibility and prognosis of prenatal ultrasonic diagnosis of fetal isolated vascular ring at 11-13 + 6 weeks. Methods:A total of 36 996 fetuses were selected to compare the results of ultrasound screening at 11-13 + 6 weeks and 20-24 weeks of pregnancy in Guangxi Maternity & Child Healthcare Hospital from January 2016 to January 2020, the reasons for missed diagnosis and misdiagnosis of fetal isolated vascular ring by ultrasonography in the first trimester were summarized. Results:Thirty-five cases were diagnosed as isolated vascular ring in the first trimester, including 19 cases right aortic arch combined with aberrant left subclavian artery with "U-shaped" vascular ring, 7 cases double aortic arch with "O-shaped" vascular ring, and 9 cases aberrant right subclavian artery with "C-shaped" vascular ring. While 155 cases were diagnosed as isolated vascular ring at 20-24 weeks of pregnancy, consisting of 18 cases of combined with aberrant left subclavian artery, 9 cases of double aortic arch, 126 cases of aberrant right subclavian artery and 2 cases of pulmonary artery sling, the diagnosis coincidence rates were 94.74%, 77.78%, 7.14%, 0(Kappa value were 0.97, 0.88, 0.13, 0). For the diagnosis of right aortic arch combined with aberrant left subclavian artery, double aortic arch and aberrant right subclavian artery in the first trimester, the specificities were 99.99%, 100%, 100%, the sensitivities were 100%, 77.78%, 7.14%, the false-positive rates were 0.01%, 0, 0, the false-negative rates were 0, 22.22%, 92.86%, and the Youden′s indices were 0.99, 0.78, 0.07.Conclusions:Right aortic arch combined with aberrant left subclavian artery and double aortic arch have high coincidence rate by ultrasonography in the first trimester, while the diagnostic coincidence rate of isolated aberrant right subclavian artery was low. Ultrasound screening for isolated vascular ring in the first trimester still needs ultrasound examination in the second trimester to exclude the minor cardiac malformations that are difficult to diagnose in the first trimester.
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Objective:To assess the value of ultrasonography in the diagnosis of fetal isomerism syndrome in the first trimester.Methods:Sonographic features of 15 fetuses with isomerism syndrome diagnosed in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2015 to March 2020 were reviewed. Ultrasonic characteristics in the first trimester were analyzed, and the ultrasonic characteristics of early mid-trimester and pathological anatomical results were combined for comparison.Results:There were 6 cases of left isomerism syndrome (LIS) and 9 cases of right isomerism syndrome (RIS) in the 15 fetues.Increased nuchal translucency(NT) (≥3.0 mm, 6 cases), reversed A wave in ductus venosus (10 cases), and atrio-ventricular valve regurgitation (14 cases) were found during the first trimester. There were 14 cases with abnormal visceral laterality. Of the 15 fetues, 14 cases with cardiac malformations, including 6 cases of functional single ventricle, 8 cases of complete atrioventricular septal defect (CAVSD), and 12 cases with great artery abnormalities. All of the 6 LIS cases had bradycardia, 3 cases had interruption of inferior vena cava (IVC). Six cases of RIS had juxtaposition of descending aorta and IVC, and 1 case of RIS had total anomalous pulmonary vein drainage. The major structural malformations were consistent with the early mid-trimester ultrasound examination or autopsy. Karyotype and chromosomal microarray were available in 12 cases and all were normal.Conclusions:Isomerism syndrome has high positive rate of fetal aneuploidies ultrasonographic marker, especially with the atrio-ventricular valve regurgitation, but the risk of chromosome abnormality is low. Ultrasound screening for fetal cardiac structural abnormalities is beneficial to the early diagnosis of isomerism syndrom in the first trimester.
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Objective:To observe the therapeutic effect of echinacoside (ECH) on liver injury and glucose metabolism disorder in sepsis rats induced by cecal ligation and puncture (CLP), and to explore its possible mechanism.Methods:Forty eight male Sprague Dawley (SD) rats were randomly divided into four groups: sham group (sham), model group (CLP), treatment group (CLP+ ECH) and inhibitor group (CLP+ ECH+ EX527). The sham group only received laparotomy, and the model group underwent CLP. The treatment group was intragastric administration of echinacea (30 mg/kg) every day after CLP modeling. The inhibitor group was injected with silence information regulator 1 (SIRT1) inhibitor EX527 (5 mg/kg) one hour before CLP, and then treated the same as the treatment group. Fasting blood glucose, insulin and serum biochemical indexes were detected in virous groups. The serum levels of interleukin (IL)-1 β, IL-6 and tumor necrosis factor-α(TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA). 2′, 7′- dichlorofluorescein diacetate (DCFH-DA) staining was used to observe the production of reactive oxygen species (ROS) in liver tissue of rats in each group; hematoxylin-eosin (HE) staining was used to observe the pathological changes of liver tissue in each group; The expressions of SIRT1, glucose-6-phosphatase (G6Pase), phosphoenolpyruvate carboxykinase (PEPCK), phosphorylated signal transducers and activators of transcription 3 (p-STAT3) and phosphorylated protein ki-nase B(p-AKT) were detected by Western blot.Results:Compared with sham group, the levels of serum glucose, serum insulin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), ROS, IL-1β, IL-6 and TNF-α in model group increased, while the liver glycogen and survival rate decreased (all P<0.05). After echinacoside treatment, the serum glucose, serum insulin, ALT, AST, ROS , IL-1β, IL-6 and TNF-α levels decreased, and the liver glycogen and survival rate increased (all P<0.05); After SIRT1 inhibitor intervention, the levels of serum insulin, ALT, AST, IL-6 and ROS in the inhibitor group increased ( P<0.05). HE staining showed that there were infiltration and necrosis of inflammatory cells in the liver tissue of model group, and echinacoside could significantly reduce the focal and massive necrosis; Western blot showed that compared with the sham group, the expression levels of SIRT1, p-STAT3 and p-AKT protein in the model group decreased, while the expression levels of G6Pase and PEPCK protein increased ( P<0.05); After echinacoside treatment, the expression levels of SIRT1, p-STAT3 and p-AKT increased, while the expression levels of G6Pase and PEPCK decreased ( P<0.05). After SIRT1 inhibitor intervention, the expression of SIRT1, p-STAT3 and p-AKT protein decreased, and the expression of G6Pase and PEPCK protein increased in the inhibitor group ( P<0.05). Conclusions:Echinacoside is a potential therapeutic agent for sepsis associated liver injury and glucose metabolism disorders, which may play a role by targeting SIRT1 to activate STAT3 and AKT in the liver.
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Objective:To investigate whether miRNA-296-5p can inhibit enterovirus 71 (EV71) virus replication in neural cells SK-N-SH by targeting the phosphatase and tensin homology deleted on chromosome 10 (PTEN)/phosphatidylinositol 3-kinase (PI3K)/serine/threonine kinases (AKT) signaling pathway.Methods:Serum samples were collected from patients with EV71 virus-infected hand-foot-mouth disease and normal physical examination, and the expressions of serum inflammatory factors procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) , interleukin-6 (IL-6), IL-1β, and IL-13 were detected by enzymelinked immunosorbent assay (ELISA). Human neuroblastoma SK-N-SH cells infected by EV71 virus in logarithmic growth phase were set up as control group, miRNA-296-5p mimic group and miRNA-296-5p inhibitor group. The transfection was carried out according to the Lipofectamine 2000tm cell transfection reagent. The expression of EV71-VP1 gene mRNA and protein and PTEN/PI3K/Akt signal pathway related molecules in three groups of cells was observed by real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) and Western blot.Results:ELISA test results showed that the levels of serum inflammatory factors PCT, CRP, TNF-α, IL-1β, IL-6 and IL-13 in patients with EV71 virus-infected hand, foot and mouth disease were significantly higher than those in normal physical examination ( P<0.05). The results of qRT-PCR and Western blot showed that the mRNA and protein levels of mirna-296-5p and PTEN in SK-N-SH were significantly decreased after EV71 virus infection, while the mRNA and protein levels of EV71-VP1 and molecules related to PI3K/AKT signaling pathway were significantly increased ( P<0.05). The expression of PTEN was significantly increased in the miRNA-296-5p mimic group, and the expression of EV71-VP1 and the activation of the PI3K/AKT signaling pathway were inhibited, while the effect was reversed in the miRNA-296-5p inhibitor group ( P<0.05). Conclusions:MiRNA-296-5p inhibits the replication of EV71 virus in neural cells SK-N-SH by targeting the PTEN/PI3K/AKT signaling pathway, while reducing the cellular inflammatory response, targeting miRNA-296-5p and downstream PTEN/PI3K/AKT The signal pathway is expected to provide therapeutic targets and theoretical basis for the treatment of hand-foot-mouth disease caused by clinical EV71 virus.
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Objective@#To analyze the clinical features of acute liver failure in critically ill children, to investigate the risk factors affecting the prognosis of acute liver failure in critically ill children, and to provide evidence for clinical diagnosis and prognosis.@*Methods@#The data of 85 children with acute liver failure who conformed to the diagnostic criteria from January 2011 to January 2017 at Hunan Children′s Hospital were analyzed.According to the prognosis of children with acute liver failure, all children were divided into the survival group (49 cases) and the death group (36 cases). Univariate and multivariate Logistic regression methods were used to analyze the risk factors affecting the prognosis of children with acute liver failure.@*Results@#There were statistically significant differences of enzyme bile isolation[26.5% (13/49 cases) vs.55.6%(20/36 cases), χ2=7.361, P=0.007], hepatic encephalopathy [16.3%(8/49 cases) vs.38.9%(14/36 cases), χ2=5.507, P=0.019], total bilirubin [72.30(3.93-428.80) μmol/L vs.153.08(3.23-776.26) μmol/L, U=-2.283, P=0.027], albumin [35.02(22.89-45.30) g/L vs.28.90(18.30-40.26) g/L, U=4.640, P=0.000], alanine aminotransferase [1 626.10(23.01-9 518.41) U/L vs.533.08(7.02-5 163.83) U/L, U=2.992, P=0.004], aspartate aminotransferase [1 611.20(34.51-15 850.02) U/L vs.715.54(60.06-10 280.42) U/L, U=2.312, P=0.023], blood ammonia [71.02(16.04-148.56) μmol/L vs.81.02(33.04-274.02) μmol/L, U=-2.057, P=0.046], prothrombin time [23.10(13.61-81.23) s vs.33.91(12.62-84.57) s, U=-2.364, P=0.022], activated partial prothrombin time [52.91(4.02-181.02) s vs.67.35(31.20-180.02) s, U=-2.226, P=0.029], and end-stage liver disease model score [13.00(-9.00-52.00) score vs.27.50(-9.00-88.00) score, U=-3.082, P=0.003] in the children with acute liver failure between the survival group and the death group.Multivariate Logistic regression analysis showed that total bilirubin (OR=0.236, 95%CI: 0.059-0.946, P=0.041), albumin(OR=0.854, 95%CI: 0.746-0.976, P=0.019), enzyme bile separation (OR=1.063, 95%CI: 1.031-1.119, P=0.005) and hepatic encephalopathy (OR=1.439, 95%CI: 1.021-2.043, P=0.017) were risk factors for the prognosis of children with acute liver failure.@*Conclusions@#The level of the total bilirubin and the ratio of enzyme bile isolation and hepatic encephalopathy are positively correlated but the level of albumin is negatively correlated with the prognosis of critically ill children with acute liver failure.
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Objective: To investigate the application of single-molecule PCR (SM-PCR) in the detection of plasma ctDNA for the treat-ment of patients with advanced lung adenocarcinoma. Methods: In total, 30 patients diagnosed with advanced lung adenocarcinoma were enrolled between June 2017 and May 2018. ctDNA fragments of the target genes (EGFR, KRAS, BRAF, ALK, HER2, and TP53) from the blood samples were enriched by SM-PCR, and DNA libraries were prepared. Finally, a high-throughput sequencing was performed. The EGFR detection of tumor tissue samples was performed using real-time fluorescence PCR based on the amplification refractory mutation system (ARMS) and consistency in the results of EGFR mutation detection in the plasma and tissue was compared. Results:The results of both the methods were consistent (Kappa=0.867, P<0.001). The McNemar's test also indicated that the results are not statistically different (P=0.500). Conclusions: SM-PCR can be used for the detection of plasma EGFR mutations. The target detection sites are more comprehensive and multiple mutations can be detected at the same time. Results of the analysis are more precise and can be absolutely quantified.
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Objective To investigate the safety and efficacy of enteral nutrition in critically ill children with hyperpancreorrhea including hyperamylasemia and hyperlipasemia in order to provide the rationale of nutritional support for such critically ill children. Methods A total of 90 critically ill children with hyperpancreorrhea admitted in pediatric intensive care unit were enrolled for prospective study in a period from January 2014 to December 2015. The patients were randomly(random number) divided into fasting group (n=30), and in those with fasting time exceeded three days, intravenous nutrition was given; ordinary milk group (n=30) and special milk group (n=30) and in this group, those with age<1 year were given AiErShu, while those with age >1 year were given small hundred peptides in addition to the basis of routine treatment. Clinical data and biochemical findings in different groups were analyzed by X2test, t test, F test or non-parametric test to evaluate the safety and efficacy of enteral nutrition in critically ill children with hyperpancreorrhea. Results (1) There were statistically significant differences in rates of nutrition support-related symptoms such as diarrhea, electrolyte imbalance, blood glucose disorder among groups (χ2=6.975,6.074,6.300,P=0.031,0.048,0.043). (2) There were statistically significant difference in rates of serum amylase or lipase levels more than upper limit on the third day among different groups (χ2=7.081, P=0.029). There was no statistically significant difference in rates of fecal elastase-1<200 μg/g 24 hours after admission, on the 3rd day and on the 7th day among different groups (P＞0.05). There was statistically significant difference in procalcitonin on the 7th day among different groups (H=6.251,P=0.044). There was statistically significant difference in oxygenation index on the 3rd day among different groups (F=3.119, P=0.049). There was statistically significant difference in lactate on the 7th day among different groups (F=6.449,P=0.040). There was statistically significant differences in albumin on the 3rd day and on the 7th among different groups (F=5.451,P=0.006; H=24.861,P＜0.01). (3) There were statistically significant differences in PICU stay and hospital stay among different groups (F=3.222,3.891,P=0.045 ; 0.024). There was statistically significant difference in survival rate among different groups (χ2=6.240, P=0.044).Conclusions Early and right enteral nutrition was safe and effective for critically ill children with hyperpancreorrhea, and the special milk powder such asr AiReShu and small hundred peptides suitable for children with hyperpancreorrhea could effectively support nutrition for critically ill children with hyperpancreorrhea,improve the status of illness, promote disease recovery, shorten hospital stay and improve the prognosis.
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Objective To investigate the clinical significance the clinical significance of the changes of ser-um tumor necrosis factor-α(TNF-α),nitric oxide(NO),interleukin-1β(IL-1β),and interleukin-6(IL-6)in pa-tients with colorectal cancer during perioperative period.Methods A total of 73 patients with colorectal cancer who underwent radical surgery in our hospital during December 2014 to December 2016 were selected as the observation group.At the same time,42 cases of healthy persons in our hospital from December 2014 to De-cember 2016 were selected as control group.The 5 mL of peripheral venous blood was collected 2 days after admission and 3 days after admission,and serum was separated.The levels of TNF-,IL-1 and IL-6 were meas-ured by enzyme-linked immunosorbent assay(ELISA).The level of NO was measured by nitric acid reduction method(mL).Results The serum levels of TNF-α,IL-1β,IL-6 content in the observation group were higher than those in the control group,and the content of NO was lower than that of control group,and the difference was statistically significant(P<0.05);there were no significant differences between the serum TNF-α,NO, IL-1β,IL-6 levels of colon and rectal cancer patients(P>0.05);TNF-α,IL-1β,IL-6 levels of patients at I and II phase were lower than those of patients at III and IV phase,while the content of NO was higher than that of patients at III and IV phase,and the difference was statistically significant(P<0.05);serum TNF-α,IL-1β, IL-6 levels after the operation were lower than those before operation,and the content of NO was higher than that before operation,and the difference was statistically significant(P<0.05).Conclusion The levels of ser-um TNF-a,IL-1 beta and IL-6 in the patients with colorectal cancer were increased with the severity of the disease,w hile the NO decreased with the severity of the disease.
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Objective To investigate the status quo of the cerebral injury in patients with acute stress disorder (ASD) and the impact of family function,mental toughness,and the characteristics of brain lesions on it.Methods A total of 349 patients were enrolled from North China University of Science and Technology affiliated hospital neurology department and neurosurgery department from May 2016 to November 2016 and they were tested with Stanford Acute Stress Reaction Questionnaire (SASRQ),the family function assessment scale (APGAR),Chinese version of mental toughness scale (CD-RISC).Results 349 cases of patients with SASRQ score (57.21±44.97),8 to 39 160 people (45.8％),40 to 56 85 people (24.4％),57 to 150 104 people (29.8％).The results showed that whether the hemiplegia (β=-0.030),family function (β=-0.032),mental toughness (β=0.886),disturbing degree (β=0.052),bad days (β=0.060)were picked in the regression equation (P＜0.05).Conclusion There were obvious acute stress symptoms in patients with brain injury.The individuals who have family dysfunction,the worse the psychological resilience and the higher the disturbance degree of the patients with hemiplegia,may be likely to get acute stress disorder.
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Objective To analyze the clinical features of critically ill children with abnormal pancreatic ultrasound findings in order to explore the related risk factors for offering evidence-based diagnosis of pancreatic damage secondary to critical illness.Methods A prospective study was performed in 531 critically ill children admitted to pediatric intensive care unit(PICU) of 17 children' hospitals from January 2012 to March 2014.All patients were divided into control group(513 cases) and abnormal group(18 cases) according to the pancreatic ultrasound findings.Comparison of clinical features and biochemical indicators were made between two groups.The related risk factors associated with abnormal pancreatic ultrasound findings were analyzed by using Logistic regression analysis.ROC curves were used to evaluate the role of amylase and lipase in the diagnose of abnormal pancreatic ultrasound findings.Results The incidence of abnormal pancreatic ultrasound findings in critically ill children was 3.39%, the average age of abnormal group was significantly older than that in control group (P<0.01).There were not statistically significant differences in gender and primary disease between two groups.The incidence of hypotension was 22.2% and the incidence of abdominal muscle tension was 16.7% in abnormal group,which were statistically higher than those in control group (P<0.05).The levels of calcium, albumin of abnormal group were significantly lower than those in control group (P<0.01), and levels of serum amylase, lipase, lactate dehydrogenase in abnormal group were significantly higher than those in control group (P<0.01).The risk factors associated with abnormal pancreatic ultrasound findings were age, blood pressure, calcium,amylase.Area under the ROC curve of abnormal pancreatic ultrasound findings determined by amylase and lipase were 0.803 and 0.745,respectively (P<0.05).The sensitivity was 0.667, specificity was 0.881 when the serum amylase was 101.5 U/L, the sensitivity was 0.722, specificity was 0.928 when the serum lipase was 96.9 U/L.Conclusions The incidence of abnormal pancreatic ultrasound findings was rather low in critically ill children.The risk factors associated with abnormal pancreatic ultrasound findings were hypotension, hypocalcemia, and hyperamylasemia.The elevated serum amylase and lipase might be the most likely factors associtaed with abnormal pancreatic ultrasound findings.
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Objective: To optimize the extraction process of Yunpitongbian decoction.Methods: With the extraction yield and the contents of hesperidin and atractylenolide Ⅲ as the comprehensive evaluation indices, and based on the results of single factor tests, Box-Behnken response surface methodology was used to optimize the extraction process with the extraction duration, extraction times and liquid-solid ratio as the independent variables.Results: The optimum processing conditions were as follows: extracted three times with 15-fold amount of solvent and extraction time of 66 min.The measured value of comprehensive score was 1.198 40, which was close to the predicted value of 1.204 78.Conclusion: The optimized extraction process of Yunpitongbian decoction is simple and feasible with good predictability.
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ObjectiveTo observe the effects of ultrafiltration extract from Angelica Sinensis Radix and Hedysari Radix on PC12 cell apoptosis induced by H2O2; To discuss its mechanism of action.Methods H2O2 was used in the incubation of PC12 cells to establish the oxidative damage nerve cell apoptosis model. The experiment was divided into normal control group, model group, and three different dosages (0.375, 0.75, 1.5 g/L) of ultra-filtration extracted from Angelica Sinensis Radix and Hedysari Radix after modeling for interference. Rate of cell apoptosis was detected by flow cytometry; mitochondrial membrane potential was measured by laser scanning confocal microscopy; the protein expressions of cleaved Caspase-3, Bax and Bcl-2 were detected by Western blot.Results Compared with the model group, rates of cell apoptosis in the different dosage groups decreased significantly; membrane potential of mitochondria increased; the protein expressions of cleaved Caspase-3 and Bax decreased; the expression of Bcl-2 increased; the ratio of Bcl-2 and Bax increased (P<0.05).Conclusion The ultra-filtration extracted from Angelica Sinensis Radix and Hedysari Radix can inhibit PC12 cell apoptosis induced by H2O2.
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BACKGROUND:In the treatment of primary knee osteoarthritis, total knee arthroplasty is a common treatment, but there are some shortcomings in the traditional operation, which maylead to early failure of the prosthesis. OBJECTIVE:To explore the difference of computer-assisted total knee arthroplasty by vastus medialis approach from the traditional total knee arthroplasty. METHODS:A total of 79 patients with primary knee osteoarthritis were randomly divided into control group (41 cases) and observation group (38 cases), which underwent conventional total knee arthroplasty and computer-assisted total knee arthroplasty by vastus medialis approach. Surgical incision, operation time, total blood loss and drainage volume were recorded and compared in both groups. In 12 months of folow-up, Hospital for Special Surgery knee score was evaluated, and the complications were recorded and compared between the two groups. RESULTS AND CONCLUSION:(1) Operative incision was significantly less in the observation group than in the control group. Operation time was significantly shorter in the observation group than in the control group. Total blood loss and drainage volume were significantly lessin the observation group than in the control group (alP< 0.05). (2) Patients in both groups were folowed up for 12 months. Index score and total score of knee function were significantly higher in the observation group than in the control group (al P< 0.05). (3) No adverse events such as infection, prosthesis loosening or fracture appeared in the observation group. In the control group, four cases affected prosthesis loosening. One case suffered from wound infection. Above events were improved obviously after active treatment. No serious complications occurred. The incidence of complications was significantly lower in the observation group than in the control group (P< 0.05). (4) The results show that, compared with the traditional operation, the choice of the femoral medial approach and the use of computer aided design technology can simulate the knee replacement process, set the cutting position, improve the accuracy and success rate of surgery, have less trauma, and effectively improve knee function, and reduce the incidence of postoperative complications.
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ObjectiveTo explore the value of elevated amylase in assessment of severity of the disease and its inlfuencing factors in critically ill children.MethodThe clinical data from critically ill children hospitalized in pediatric intensive care unit were retrospectively analyzed from November 2009 to June 2014. According to levels of serum amylase, the critically ill children were divided into normal serum amylase group (≤103 IU/L) and elevated serum amylase group (>103 IU/L). The differences between two groups were compared.ResultsA total of 1920 critically ill children were enrolled, most of whom had primary respiratory and neurological diseases. Among them, 1470 children had normal serum amylase (76.6%) and 450 children had ele-vated serum amylase (23.4%). The elevated serum amylase group had signiifcantly higher rate of organs failure (≥4), lower rate of PCIS (<70), higher rate of invasive mechanical ventilation and mortality than those in normal serum amylase group (P<0.001). The correlation of serum amylase with lipase blood, urine amylase, blood urea nitrogen and creatinine were signiifcant (r=0.246 to 0.683,P<0.001). Blood amylase was positively correlated with shock index (r=0.111,P=0.002) and negatively correlated with respiratory failure index (r=0.133,P<0.001).ConclusionsSerum amylase could be used to assess the severity of disease. The elevated amylase was closely related to pancreatic exocrine function, renal function, ischemia, and hypoxia. The elevated serum amylase in critically ill children is a warning sign.
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<p><b>OBJECTIVE</b>To assess the performance of pediatric risk of mortality (PRISM), pediatric index of mortality 2 (PIM2) in predicting mortality in critically ill pediatric patients via a prospective study.</p><p><b>METHOD</b>The outcome and the variables required to calculate PRISM and PIM2 were collected. The efficiency of PRISM and PIM2 in differentiation between death and survival by calculating the area under the receiver operating characteristic curve (ROC). Calibration across deciles of risk was evaluated using the Hosmer-Lemeshow goodness-of-fit χ(2) test.</p><p><b>RESULT</b>A total of 412 critically ill pediatric patients transferred to Hunan Children's Hospital during August 1, 2012 and May 31, 2013 were enrolled in the study, and more than two-thirds of the children were suffering from respiratory and miscellaneous diseases; 45 (10.9%) inter-hospital transport of critically ill pediatric patients died at the time of hospitalization. The expected number of deaths were 45.01 by PRISM, and the expected number of deaths were 44.99 by PIM2. The expected mortality rate was 10.9% for PRISM or PIM2. The standardized mortality rate was 1.000 (0.710-1.290) for PRISM and 1.000 (0.710-1.290) for PIM2. The Hosmer-Lemeshow test gave a chi-square of 8.75 (P=0.364) for PRISM and 22.75 (P<0.05) for PIM2, PRISM had better fitting with the actual mortality than PIM2. The area under the receiver-operating characteristics (ROC) curve (95% confidence intervals, CI) were 0.829 (0.768-0.890) for PRISM and 0.758 (0.667-0.849) for PIM2.</p><p><b>CONCLUSION</b>Although the PIM2 test is less well calibrated overall, both PRISM and PIM2 can offer a good capacity for discriminating between survivors and moribund patients. The good performance of PRISM and PIM2 are demonstrated in predicting mortality probability in critically ill pediatric patients.</p>
ABSTRACT
Objective To analyse the relationship between insulin resistance and the pancreatic beta cell dysfunction in critically ill children with hyperglycemia,to investigate the relationship between the pancreas injury and pancreatic beta cells dysfunction.Methods Seven hundred and thirty-six critically ill children admitted in PICU of Hunan Children's Hospital from Nov 2012 to Mar 2013 were reviewed and analyzed.According to the maximum intravenous blood glucose within 24 h after admission,they were divided into severely elevated group (blood glucose ≥11.1 mmol/L,n =67),slightly elevated group(blood glucose 6.1 ～ 11.1 mmol/L,n =361) and control group (blood glucose ≤ 6.1 mmo/L,n =308).Serum insulin,C peptide,serum amylase,lipase,urinary amylase,HOMA-β,HOMA-IR were compared among 3 groups.According to the severity of sepsis,they were divided into non-sepsis group (n =414),sepsis group (n =237),severe sepsis group (n =64),septic shock group (n =21).Blood glucose,serum insulin,C peptide,HOMA-βand HOMA-IR were compared among 4 groups.Results (l)The levels of insulin,C peptide,blood amylase,lipase and urine amylase were gradually increased with elevated blood sugar(rs =0.235,P ＜ 0.05;C =0.142,P ＜ 0.05 ; rs =0.142,P ＜ 0.05 ; rs =0.119,P ＜ 0.05 ; r.s =0.093,P ＜ 0.05).The differences among 3 groups were significant (P ＜ 0.05).The levels of serum amylase (IU/L) [102.81 (10.48-191.69)],lipase(U/L) [69.75(10.67-121.85)] were higher than upper limit of normal in severely elevated group.HOMA-β fell to 18.75％ in severely elevated group.The level of HOMA-β was decreased with the increase of blood sugar level (rs =-0.108,P ＜ 0.05).The level of HOMA-IR was increased with the elevated blood sugar level(rs =0.455,P ＜ 0.05).(2) The levels of blood glucose,insulin,C peptide and HOMA-β were significantly different among 4 groups of non-sepsis,sepsis,severe sepsis and septic shock group (P ＜ 0.05),HOMA-IR showed no significant difference among 4 groups (P ＞ 0.05).The levels of blood sugar increased to 9.21 (6.21-19.60) mmol/L,HOMA-β declined to 10.52％ in septic shock group,and blood glucose,insulin,C peptide,HOMA-β were significantly different compared with the other 3 groups (P ＜ 0.05).Conclusion Hyperglycemia is associated with insulin resistance and pancreatic β cells dysfunction in critically ill children,the cause of beta cell dysfunction is secondary to pancremic injury.Pancreatic beta cells dysfunction inducing hyperglycemia is more significant than insulin resistance in sepsis children.