Relationship between serum thyroid hormone level and prognosis in critically ill children with euthyroid sick syndrome / 中国小儿急救医学

Objective:To investigate the association between serum thyroid level and prognosis of critically ill children with euthyroid sick syndrome(ESS).Methods:The clinical data and serum thyroid hormone levels of 176 children with ESS who were admitted to the Department of Pediatric Intensive Care Medicine at West China Second Hospital of Sichuan University from January 2015 to April 2021 were retrospectively collected.According to the prognosis, the children were divided into improved group and invalid group, as well as basic disease group and non basic disease group, and the differences of thyroid hormone between two groups were compared.The pediatric risk of mortality Ⅲ(PRISMⅢ) scores within 24 hours of admission were assessed, and the correlation between thyroid hormone level and PRISMⅢ score was analyzed.Results:Among 176 critically ill children with ESS, the most common diseases were sepsis(31.8%), severe pneumonia (23.8%) and heart failure(10.7%), respectively.The levels of free T3(FT3), T3, free T4(FT4) and T4 in invalid group were significantly lower than those in improved group ( P<0.05), but there was no statistical difference in thyroid-stimulating hormone(TSH) level between two groups( P>0.05). The levels of FT3, T3, FT4 and T4 were negatively correlated with PRISMⅢ score( r=-0.419, -0.459, -0.341, -0.383, respectively, P<0.05), and there was no correlation between TSH level and PRISMⅢ score ( P>0.05). The common underlying diseases of severe children with ESS were malnutrition(31/98), heart disease(30/98), hematologic neoplasms(15/98), and bronchopulmonary dysplasia(10/98). The median age of children in basic disease group was younger than that in non-basic disease group(0.7 years old vs. 2.0 years old, P<0.05); The proportion of children with underlying diseases in invalid group was 24.5%, which was significantly higher than that of children without underlying diseases (6.4%), and the difference was statistically significant ( P<0.05); There were no significant differences in the levels of FT3, T3, FT4, T4 and TSH between two groups ( P>0.05). Conclusion:In critically ill children, a variety of diseases can lead to ESS, and sepsis is the most common disease.Young children with underlying diseases should be more alert to ESS.The more severe the disease, the greater the decline of FT3, T3, FT4 and T4 levels.When low T3, T4 and TSH occur simultaneously, the prognosis of the children may be worse.Thyroid hormone level could be used as an indicator to evaluate the prognosis of critically ill children, which is needed further studies to explore.

Dose of intravenously infused cisatracurium for maintenance of deep neuromuscular blockade during thoracic surgery / 中华麻醉学杂志

Objective:To investigate the dose of intravenously infused cisatracurium for the maintenance of deep neuromuscular blockade during thoracic surgery.Methods:Patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, scheduled for elective thoracic surgery under general anesthesia, were studied.The patients were connected to a muscle relaxation monitor after entering the operating room.After the completion of muscle relaxant calibration and anesthesia induction, cisatracurium was intravenously infused at a constant rate to maintain deep neuromuscular blockade (post-tetanic count [PTC]≤5 ). The infusion rate was calculated by modified Dixon up-and-down method.The first patient received cisatracurium at 0.12 mg·kg -1·h -1.If the PTC was 0 or was maintained≤5 continuously, the infusion rate was decreased 0.01 mg·kg -1·h -1 in the next patient, until PTC was >5 during operation.The mean dose for the patient was used as initial dose.Then the infusion rate was increased/decreased by 0.005 mg·kg -1·h -1.The 95% effective dose of cisatracurium (ED 95) was the median of 6 thresholds. Results:A total of 22 cases completed the study.The ED 95 of continuous intravenous infusion of cisatracurium for the maintenance of deep neuromuscular blockade was 0.108 mg·kg -1·h -1(95% confidence interval 0.105-0.125 mg·kg -1·h -1). Conclusion:The dose of intravenous infusion of cisatracurium for the maintenance of deep neuromuscular blockade during thoracic surgery is 0.108 mg·kg -1·h -1.

The clinical features of children with Kawasaki disease in PICU / 中国小儿急救医学

Objective To summarize the clinical characteristics of children with Kawasaki disease (KD) in pediatric intensive care unit(PICU). Methods Medical record of children with KD at PICU were collected. At the same time,29 cases of KD in PICU were 1∶3 matched by age,gender and the time admitted in hospital with those admitted in general pediatric department(control group). Results PICU patients had longer length of hospital stay,longer fever duration compared with control group. In addition,patients in PICU had higher neutrophil percentage,C reaction protein,creatinine,urea nitrogen,N￣terminal natriuretic peptide and procalcitonin,but lower hemoglobin,blood platelet and albumin compared with the control group. What′s more,patients in PICU tended to find hemoglobin<100 g/L,platelet<150×109/L,albumin<30 g/L,abnor￣mal in urine routine and echocardiographic and more likely to have fever longer than 10 days when used intra￣venous immunoglobulin(IVIG) compared with control group. And PICU patients were more likely to require therapy with antibiotics,albumin,glucocorticoid and the second dose of IVIG. Some part of children in PICU group were treated with IVIG and glucocorticoid because of doubted severe infection before KD diagnosed,all patients in the control group used IVIG after the diagnosis. Conclusion Patients who admitted in PICU are severe and not typical in clinical manifestation. These patients are easily misdiagnosed as sepsis and more likely to be IVIG￣refractory and have coronary artery damage. We still worry that somebody might be misdi￣agnosed as sepsis,who are treated with IVIG and get better. Because they are not diagnosed as KD,these pa￣tient would not followe up like KD,but have potential risk of cardiovascular disease and need more alarming.

Progress of epidemiology and outcome for sepsis / 中华危重病急救医学

Sepsis is an uncontrolled host's response to infection and leads to life-threatening organ dysfunction. Traditional prognostic indicators for short-term mortality, such as intensive care unit (ICU) mortality, hospital mortality, cannot reveal the real and final outcome of sepsis patients. Sepsis patients remain high mortality even several years after hospital discharge, at the same time the quality of life, and the cognitive function were also damaged at varying degrees. Nowadays, studies about long-term quality of life for sepsis were still sparse and further study was still needed. This article aims to explore the epidemiology, short-term and long-term outcome so that it can provide some reference for assessment and intervention of long-term outcome of sepsis.

Diagnosis and treatment of sepsis associated encephalopathy / 中华实用儿科临床杂志

Sepsis associated encephalopathy (SAE) features are the diffuse cerebral dysfunction induced by the systemic response to the infection,without clinical or laboratory evidence of direct brain infection or other types of encephalopathy.The core feature of SAE is a diffuse disturbance in cerebral function free of any lateralizing signs.The primary clinical feature of SAE is a change in mental status,especially that of consciousness and cognition.The key prerequisite for the diagnosis of SAE is presence of extracranial infection.There is no precise criteria for the diagnosis of SAE or exclusion of it,and no well-established clinical or biological markers are available.But,neural electrophysiological examination,cranial imaging and biomarkers have been found with implications for the diagnosis of SAE.At present,treatment options for SAE are limited.Things of significant importance are early identification of change in mental status,searching for pathogens and lesions,as well as prompt anti-infectious treatment,maintaining hemodynamic stability and supporting therapy.

Risk factors for postoperative residual neuromuscular blockade in patients undergoing thoracic surgery / 中华麻醉学杂志

Objective To screen the risk factors for postoperative residual neuromuscular blockade (RNMB) in the patients undergoing thoracic surgery.Methods A total of 733 patients undergoing elective thoracic surgery with general anesthesia,without neuromuscular disease,skin temperature ≥32 ℃,were transferred to the postanesthesia care unit (PACU) after surgery and given synchronized intermittent mandatory ventilation.Neuromuscular blockade was monitored immediately after admission to the PACU,and the occurrence of postoperative RNMB was defined as a train of four (TOF) ratio ＜90％ at the time of extubation.The patients were divided into RNMB group and nonRNMB group according to whether or not postoperative RNMB occurred.Each parameter of baseline patient characteristics,complications,sites and methods of surgery,anesthesia time,requirement for muscle relaxants during surgery,TOF ratio on arrival to the PACU,requirement for muscle relaxant antagonists in the PACU,and extubation time were recorded.The risk factors of which P values were less than 0.05 would enter the multivariable logistic regression analysis to stratify the risk factors for postoperative RNMB.Results A total of 385 patients developed postoperative RNMB,and the incidence was 52.5％.The results of multivariate logistic regression analysis showed that complications such as diabetes,intraoperative application of two kinds of muscle relaxants,average intraoperative consumption of cisatracurium ≥ 0.14 mg · kg-1 · h-1,TOF ratio on arrival to the PACU ≤ 0.5,and extubation time ≤ 30 min were independent risk factors for postoperative RNMB (P＜0.05).Conclusion Complications such as diabetes,intraoperative application of two kinds of muscle relaxants,average intraoperative consumption of cisatracurium 0.14 mg · kg-1 · h-1,TOF ratio on arrival to the PACU ≤ 0.5,and extubation time ≤ 30 min are independent risk factors for postoperative RNMB in the patients undergoing thoracic surgery.

Clinical evidence for immunologic treatment in newborn infants with sepsis / 中华实用儿科临床杂志

Objective Neonatal sepsis (NS) is one of the main causes of neonatal death.Immune therapy is an important way in the comprehensive treatment of NS.This study investigated several databases in order to find the clinical evidence for the immunological treatment of neonatal sepsis (NS),and to explore its clinical application value.Methods Systematic reviews and randomized (or quasi-randomized) controlled trials (RCT) for immunological treatment of NS in newborn infants were searched from the databases of MEDLINE,EMBASE and Cochrane Library.The relevant literatures were statistically analyzed.Results Six systematic reviews (including 37 RCTs) were found to be involved in the therapy,and the drugs included intravenous immunoglobulin (containing high level of IgM),antistaphylococcal immunoglobulins,neutrophile granulocyte,granulocyte colony-stimulating factor,granulocyte-macrophage colony-stimulating factor,pentoxifylline and glutamine.Pentoxifylline could decrease the mortality (Z =2.71,P =0.006 8),shorten the hospitalization (Z =2.01,P =0.044),and reduce the incidence rate of necrotizing enterocolitis (NEC) (Z =1.67,P =0.095) of the NS infants.No therapeutic effect was found for other drugs in the treatment of NS.Conclusions Current clinical evidence for the immunological treatment of NS indicates that only Pentoxifylline could decrease the mortality,reduce the incidence rate of NEC and shorten the hospitalization of infants with NS.However,current evidence is only a small scale sampling and lacks multicenter studies.Researchers are encouraged to undertake large scale and well-designed multicenter trials to confirm the effectiveness of the immunological treatment of NS.

A case report of childhood Pseudomonas aeruginosa sepsis / 临床儿科杂志

Objective To summarize the clinical features of Pseudomonas aeruginosa sepsis in children. Methods We retrospectively review the clinical data of a baby boy with Pseudomonas aeruginosa sepsis and summarize its clinical character-istics. Results A ten-month male infants with onset symptom of fever, irritability, drowsiness, cough and sputum was diagnosed as Pseudomonas aeruginosa sepsis through blood and sputum culture. The baby recovered well after anti-infection treatment. Conclusions Timely and appropriate use of sensitive antibiotics can decrease severe complications and mortality rate of Pseu-domonas aeruginosa sepsis in children.

Expression and adjuvant effects of the fusion peptide TBP5 / 生物工程学报

Thymopentin (TP5) and bursopentin (BP5) are both immunopotentiators. To explore whether the TP5-BP5 fusion peptide (TBP5) has adjuvant activity or not, we cloned the TBP5 gene and confirmed that the TBP5 gene in a recombinant prokaryotic expression plasmid was successfully expressed in Escherichia coli BL21. TBP5 significantly promoted the proliferation of thymic and splenic lymphocytes of mice. The potential adjuvant activity of the TBP5 was examined in mice by coinjecting TBP5 and H9N2 avian influenza virus (AIV) inactivated vaccine. HI antibody titers, HA antibodies and cytokines levels (IL-4 and IFN-γ) were determined. We found that TBP5 markedly elevated serum HI titers and HA antibody levels, induced the secretion of both IL-4 and IFN-γ cytokines. Furthermore, virus challenge experiments confirmed that TBP5 contributed to inhibition replication of the virus [H9N2 AIV (A/chicken/Jiangsu/NJ07/05)] from mouse lungs. Altogether, these findings suggest that TBP5 may be an effective adjuvant for avian vaccine and that this study provides a reference for further research on new vaccine adjuvants.

Two-dimensional numerical analysis of impact response of the human tibia in Car-pedestrian accidents / 国际生物医学工程杂志

Objective The purpose of this paper was to use a new biphasic poroelastic tibia model to develop a two-dimensional numerical method for simulating impact responses of human tibia in car-pedestrian accidents. Methods The geometry of tibia model was reconstructed from CT scans of the left tibia of a living human volunteer. A poroelastic approach was utilized to establish the governing equations of the model and the finite element method was applied to solve these governing equations. Both cortical and cancellous components of tibia were represented using a poroelastic material model consisting of solid phase (matrix) and fluid phase (marrow). A lateral-medial impact direction was selected in the simulation analysis and the impact responses of the pedestrian tibia during 0-200 ms were analyzed. Results The bending deformation of the tibia predicted by the computer simulation was primarily concentrated on the impact zones. The displacement response of Node 107 in the impact zone indicated a peak displacement of -6 mm at around 75 ms, and the significant time delay between the impact force and the displacement response of the skeleton. The axial stress response at the center of element E77 in the impact zone indicated a peak stress of 140 MPa at around 30 ms,and the significant time delay was observed between the impact force and the axial stress response of the skeleton, too. Conclusion This research developed a two-dimensional numerical method for simulating impact responses of human tibia in car-pedestrian accidents. It was able to approximately simulate the bending deformation, lateral displacement response and axial stress response of pedestrian tibia in the impact zones,and the effects of the fluid phase on the solid phase. More in-depth investigation is helpful to further the biofidelity of tibia dynamics model.

Establishment and assessment of experimental periventricular leukomalacia models in newborn rats / 中国组织工程研究

BACKGROUND: The researches on the onset mechanism and intervention of periventricular leukomalacia (PVL) are affected due to few cases of generally-acknowledged animal model, so it is necessary to establish a reliable animal model for the study of PVL.0BJECTIVE: To establish PVL animal model of the 2-day-old SD rats.DESIGN: Randomized control animal trial.SETTING: Department of Pediatrics, West China Second University Hospital, Sichuan University.MATERIALS: A total of 36 2-day-old SD rats of cleaning grade and either gender, weighing 6-8 g, were provided by the West China Experimental Animal Center of Sichuan University; Mice anti-O4 was purchased by Chemicon Company,rabbit anti-glial fibrillary acidic protein (GFAP), rabbit anti-β-amyloid precursor protein (β-APP), rabbit anti-myeline basic protein (MBP), SABC immunohistochemical kit and DAB color reagent were all offered by Wuhan Boster Biological Technology Co., Ltd. Rabbit anti-mice IgG-FITC was obtained from Zhongshan Golden Bridge BioTechnology Co., Ltd.METHODS: The experiment was accomplished in the Laboratory of Women and Children, West China Second Hospital of Sichuan University between May and December in 2005. Totally 36 rats Were randomly divided into experimental PVL group and control group, 18 in each. The experimental PVL group was subjected to unilateral carotid ligation (UCL), and then they were put into a box filled with 6% oxygen and 94% nitrogen for 4 hours. Six rats were executed at ischemic 72hours, 14 days and 28 days respectively. Meanwhile sham surgeries were performed on the control group without ligation or exposure to hypoxia. And the time segment was identical with that of experimental group. ①Histopathological examination: Rat hearts were fixed by perfusion and stained with hematoxylin-eosin (HE). Light and electronic microscopy were used to observe the brain pathological and ultrastructure changes, ②Immunohistochemistry method was used to detect the distribution and expression of GFAP, β-APP, MBP and O4 in the white matter of both experimental and the control groups 72 hours post-operation. ③Neuroethology examination: Hanging test (rats were forced to hold the horizontal glass rod with forelegs, and the time of dropping was recorded in the distance of 45 cm.Scoring: 1 point: ＜ 10 s; 2 points: 10-30 s; 3 points: 30 s-2 minutes; 4 points: 2-5 minutes; 5 points: ＞ 5 minutes),inclined plane test (rats were laid on the inclined plate at the angle of 45° while rat heads turning upwards at the angle of more than 135°), open field test (square box without summit was divided into 9 equal grills at the bottom, rats were placed in the central grill to observe the activity within 30 seconds. Scoring: 1 point as rats entered the neighbor cage above half the body; 1 point as standing by hind limbs; total scores were the addition of the two), and cylinder test (rats were put in the cylinder of 20 cm×30 cm×5 cm to record the time of initial forepaw of each weight-bearing contact with the wall during a full rear, right (ipsilateral) or left (contralateral) percentage of total forepaw contacts at initiation was calculated.) were tested on the SD rats at 28 days post-operation. Then statistical management was conducted.MATN OUTCOME MEASURES: ①HE stain and electronic microscope were used to detect the histopathology changes after ischemia and hypoxia.②lmmunohistochemistry method was used to detect the expressions of GFAP, β-APP, MBP and O4 in the corresponding cell and tissue after ischemia and hypoxia. ③Neuroethology examination was used to evaluate the rats after ischemia and hypoxia by scores of each test.RESULTS: All 36 rats were involved in the result analysis. ①White matter damage was observed in the periventricular white matter in the PVL group by light and electronic microscopy at the early stage of post-operation; Ventricular dilatation and the loss of medullary sheath were detected in the white matter at the latter stage. ②The integrated optical density (IOD) of GFAP in PVL group was stronger than that of the control group (6 566.93±455.56, 1 069.32±791.71,P ＜ 0.05), and the mean diameter of GFAP-immunoreactive cells was increased in the brain tissue of PVL group compared with those of the control group [(11.69±0.97), (8.24±0.22), P ＜ 0.05]; β-APP immunohistochemistry demonstrated the IOD of PVL group was stronger than that of the control group [(59 304.07±6 864.03), (15 132.29±2 455.52),P＜ 0.05]; MBP IOD of the PVL group was decreased compared with the control group [(21 764.29±1 981.63), (69 174.72±3 199.90), P ＜ 0.05]; The density of O4-immunoreactive pyknotic cells was dramatically increased in the PVL group compared with the control group [(54.08±11.99), (1.25±0.51), P＜ 0.05].③In PVL group, the hanging time was shorter in the hanging test than that of the control group [(1.27±0.14), (4.24±0.59) minutes, P ＜ 0.05]; The turning-around time was longer in the inclined plane test than that of the control group [(7.17±2.32), (3.27±0.82) s, P ＜ 0.05]; The score in the open field test was decreased than that of the control group [(3.68±0.82), (12.67±1.00) s, P ＜ 0.05]; In the cylinder test the activity of the left limb was less than that of the right limb [(19.25±2.77), (64.55±0.36)%, P ＜ 0.05].CONCLUSION: PVL animal model can be successfully established by the method of UCL-hypoxia using the 2-day-old SD rat, and appears the obvious white atter damage, abnormal neurobehavior, reasonable pathological and behavior change.

Mechanical response numerical analysis of bone tissue based on liquid saturated biphasic porous medium model / 生物医学工程学杂志

A biphasic porous medium model based on the mixture theory in continuum mechanics frame was used to depict the distributions of osseous stress field, distortion field and pore pressure when the bone tissue was subject to various dynamic loads. In the model, the bone tissue was considered as a transversely isotropic, liquid saturated porous material. The coupling relationship among the distortion, fluid flow and the streaming potential is studied. The Galerkin weighted residual method was used to derive the finite element formulation for dynamic response and the streaming potential calculating formulation of bone tissue, the penalty finite element formulation was obtained via introducing the ratio term of pressure p and penalty parameter beta in the continuity equation and, in turn, eliminated the pressure term in governing equation sets. The computational results show that the viscoelastic behavior and the energy dissipation property in the bone tissue, especially in the cancellous bone, is caused to a great extent by the pore liquid flow and diffusion. Meanwhile, because of the existence of electrical double layer between the solid phase and liquid phase, when the liquid constituents in the pore diffuse, the streaming potential appears, and the growth and absorption of bone tissue is expedited.

SCANNING ELECTRON MICROSCOPY OF THE METACERCARIA OF PARAGONIMUS ILOKTSUENENS1S / 中国寄生虫学与寄生虫病杂志

The present report is concerned with the surface structure of the metacercaria of Pa-ragonimus iloktsuenensis as visualized with the scanning electron microscopy. The meta-cercariae were obtained from the liver of tne Sesarma dehaani collected in Yingkou county, Liaoning Province.The tegumental spines of the metacercaria are single-pointed and densely distributed over the entire body and are slightly different in size and shape in different parts of the body. On the forebody of the ventral surface, a vertical ridgeline can be seen in the middle of the spines.In addition to the short spines, there are two circles of non-ciliated papillae on both lips of the oral and the ventral suckers. Around the oral sucker, there are 12 papillae on the outer circle and 6 on the inner circle; around the ventral sucker, there are 6 papillae on both the outer and inner circles. No sensory papillae were found around the ventral sucker. On each side of the anterior part of the ventral side, 8 to 10 pairs of papillae are arranged in two rows.

THE RADIOPROTECTIVE EFFECT OF FLAVONOIDS FROM GINKGO BILOBA LEAVES / 营养学报

Objective: To study the radioprotective effect of flavonoids from Ginkgo biloba leaves(GBF). Methods: Three water extracts of GBF were prepared (low dosage 10 mg/100 ml, medium dosage 20 mg/100 ml and high dosage 100 mg/100 ml) and orally administered to mice . After 10 d, the mice were exposed to 8.5Gy -rays. After another 10 d of oral administration, the survival rates were recorded in 30 d. In another experiment, six groups of mice (three GBF groups, radiation control, normal control and cyclophosphamide group) were arranged. The first three groups were orally administered with low, medium and high dosage of GBF respectively for 11d; the other three groups with distilled water. Then the three GBF groups and radiation group were exposed to 1.0Gy -rays. Then they were orally administered again in the following 7d . Micronucleated polychromatic erythrocytes in bone-marrow and sperms (AFS) in mice were observed on the 21st day after termination of oral administration. Proliferation rates of lymphocyte (PRL) were determined in the three GBF groups and normal control. Results: Low, medium and high dosage of GBF increased the survival rates by 31.7%, 25.3% and 26.5% respectively(P

EFFECTS OF POLYSACCHARIDE FROM LYCIUM BARBARUM ON CELL APOPTOSIS AND bc1-2 GENE EXPRESSION IN IRRADIATED MICE / 营养学报

Objective:To study the effects of polysaccharide from Lycium barbarum (LBP) on cell apoptosis and bc1-2 gene expression in irradiated mice. Methods:Forty eight Kunming mice were divided into three groups (LBP group, radiation group and normal group). LBP chow was prepared through adding 0.8%LBP to normal chow and was supplied to LBP group. Normal chow was supplied to normal group and radiation group. LBP group and radiation group were exposed to whole-body 60Co ?-rays at the dose of 0.084 Gy/day for 6 w, five times a week and the total dose was 2.52Gy. Then the micronucleus frequency of polychromatic erythrocytes(MF),chromosome and sperm aberration frequency, caspase-3 mRNA expression, cell apoptosis and bcl-2 gene expression were detected. Results:LBP could significantly lower MF, chromosome and sperm aberration frequency, and cell apoptosis , and it could increase the proliferation activity of bone marrow cells and bc1-2 gene expression in irradiated mice and decrease caspase-3 mRNA expression.Conclusion:The radioprotective effect of LBP is related to regulation of cell apoptosis and bc1-2 gene expression.