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Objective:To discuss the feasibility of offering specialized courses of critical care medicine in undergraduate clinical medicine education, so as to alleviate the shortage of critical care medicine staffs and lay a foundation for improving the success rate for the treatment of critical cases.Methods:The undergraduates majoring in clinical medicine from 2008 to 2011 in Guizhou Medical University (the former Guiyang Medical College) were enrolled. After they had been enrolled in the undergraduate education for 3 years and were ready for Grade four, which meant basic medicine teaching had been completed and clinical medicine teaching was about to start, they were introduced and preached to each discipline, including critical care medicine. The undergraduates were free to choose professional direction of clinical training in Grade four. Students majoring in clinical medicine from 2012 to 2014 were free to choose their major direction when they entered the school.Results:From September 2011 to July 2019, the university had cultivated 246 undergraduates majoring in clinical critical care medicine from 2008 to 2014, and the critical care medicine professional team of affiliated hospital had undertaken 540 teaching hours. By July 2019, all students had graduated on time, with an employment rate of 100%. Forty students took postgraduate programs in our school and other schools, accounting for 16.3%.Conclusions:Professional education of critical care medicine in the undergraduate course of clinical medicine can mobilize students' interest in learning and subjective initiative, which is conducive to career selection. During the clinical training, the students can identify and timely cure critical care cases in the early stage, and partly alleviate the current shortage of critical care medical staffs.
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Objective:To know the critical care resources of the different class-hospitals in Guizhou Province, China, and to provide the direction and evidence for quality improvement and discipline construction of critical care medicine in Guizhou Province.Methods:The resource status of the departments of intensive care unit (ICU) in Guizhou Province was obtained through form filling and/or field investigation. The forms were filled and submitted from May 2017 to February 2018, and the field investigation (some of the hospitals) was carried out in March 2018. The data of hospitals in Guizhou Province in 2018, was obtained from the official website of Health Committee of Guizhou Province, which was released online on November 28th, 2019. The obtained data were summarized and analyzed according to different aspects such asthe status of ICU construction, main equipment configuration and technology implementation.Results:There were 39 third-class hospitals and 77 second-class hospitals included in this study, which accounted for 76.5% (39/51) of third-class public hospitals and 50.0% (77/154) of second-class public hospitals respectively. Among them, there were 86.8% (33/38) of third-class general hospitals and 50.4% (69/137) of second-class general hospitals respectively. In terms of ICU construction, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were established earlier [years: 2011 (2008, 2012) vs. 2013 (2011, 2015), P < 0.01], had more ICU beds, doctors and nurses [15 (11, 20) vs. 8 (6, 10), 9 (8, 11) vs. 6 (5, 7), 25 (20, 41) vs. 15 (12, 19), respectively, all P < 0.01]. However, there were no significant differences regarding the doctor-bed ratio and the nurse-bed ratio in ICUs between second-class hospitals and third-class hospitals. In terms of main equipment configuration, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals had more ventilators, higher ratio of ventilators to beds, more infusion pumps, higher ratio of infusion pumps to beds, more monitor, gastrointestinal nutrition pumps and single rooms, and higher proportion of ICUs equipped with negative pressure rooms [ventilators: 14 (10, 18) vs. 6 (4, 8), ratio of ventilators to beds: 1.0 (0.7, 1.1) vs. 0.8 (0.6, 1.0), infusion pumps: 10 (6, 20) vs. 5 (3, 8), ratio of infusion pumps to beds: 0.8 (0.0, 1.0) vs. 0.0 (0.0, 0.4), monitor: 18 (13, 24) vs. 9 (6, 12), gastrointestinal nutrition pumps: 2 (1, 5) vs. 1 (0, 3), single rooms: 2 (1, 3) vs. 1 (0, 3), proportion of ICUs equipped with negative pressure rooms: 53.8% (21/39) vs. 31.5% (23/73), respectively, all P < 0.05]. Furthermore, there were higher proportions of ICUs equipped with portable ventilator, pulse indicator continuous cardiac output monitoring (PiCCO), intra-aortic balloon pump (IABP), extra-corporeal membrane oxygenation (ECMO), B ultrasound machine, bronchoscope, pressure of end-tidal carbondioxide (P ETCO 2) monitoring, bispectral index (BIS) monitoring, bedside gastroscopy, the apparatus used for the prevention of deep vein thrombosis of lower extremity in third-class hospitals than in second-class hospitals [portable ventilator: 86.7% (26/30) vs. 59.6% (28/47), 43.3% (13/30) vs. 1.5% (1/66), 14.3% (4/28) vs. 0% (0/65), 10.7% (3/28) vs. 0% (0/65), 62.5% (20/32) vs. 37.3% (25/67), 97.1% (33/34) vs. 63.6% (42/66), 60.6% (20/33) vs. 28.4% (19/67), 17.2% (5/29) vs. 0% (0/65), 27.6% (8/29) vs. 1.5% (1/65), 77.4% (24/31) vs. 52.3% (34/65), respectively, all P < 0.05]. In terms of skills development, there were more ICUs carried out intracranial pressure monitoring, abdominal pressure monitoring, ultrasound diagnosis, bronchoscope examination and treatment and blood purification in third-class hospitals than in second-class hospitals [31.6% (12/38) vs. 14.7% (11/75), 75.7% (28/37) vs. 38.6% (27/70), 61.5% (24/39) vs. 24.3% (18/74), 89.7% (35/39) vs. 45.9% (34/74), 92.3% (36/39) vs. 48.6% (36/74), respectively, all P < 0.05]. Conclusions:The data were mainly derived from public general hospitals in Guizhou Province. Compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were founded earlier and larger, had better hardware configuration and could carry out more skills. However, the human resource situations were similar between second-class hospitals and third-class hospitals. Both second-class hospitals and third-class hospitals have a need to improve the allocation of manpower and equipment and expand various skills in ICUs, while it is more urgent for second-class hospitals.
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Objective To evaluate the clinical application of implantation of totally implantable venous access port (TIVAP) via the internal jugular vein (IJV) guided by ultrasonography in infants.Methods The clinical data of 446 sick infants,who received TIVAP at the Affiliated Shanghai Children's Medical Center,School of Medicine,Shanghai Jiaotong University,China (single center) during the period from January 2009 to July 2016,were retrospectively analyzed.The time spent on surgery,the success rate of first puncturing of IJV and the incidence of puncture-related complications were recorded,and the results were compared between traditional IJV blind puncture group and ultrasound-guided IJV puncture group.Results Of the 446 sick infants,traditional IJV blind puncture was employed in 265 and ultrasound-guided IJV puncture was adopted in 181.In traditional IJV blind puncture group,the mean time spent on surgery was 7.6 min,the success rate of first puncturing of IJV was 75.85％ (201/265),and the incidence of puncturerelated complications was 5.66％ (15/265).In ultrasound-guided IJV puncture group,the mean time spent on surgery was 4.2 min,the success rate of first puncturing of IJV was 97.24％(176/181),and the incidence of puncture-related complications was 1.70％ (3/181).Conclusion For the performance of TIVAP implantation in sick infants,the use of ultrasound-guided IJV puncture technique can shorten the operation time,improve the success rate of first puncturing,and reduce the incidence of puncture-related complications.Therefore,ultrasound-guided IJV puncture is a safe,effective,simple and feasible technique.This technique is worthy of clinical promotion.
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Objective To investigate the clinical value of single-incision laparoscopic inguinal high ligation in children with recurrent inguinal hernia . Methods Clinical data of 30 pediatric recurrent inguinal hernia cases treated with single-incision laparoscopy in our hospital between January 2011 and February 2016 were analyzed retrospectively .The patients were aged 1-11 years old (mean, 6.1 ±3.3 years old).For indirect inguinal hernia, a non-absorbable suture was placed around the extra-peritoneal space of the inguinal inner ring by means of a needle with a thread hole and a hooked needle under laparoscope , and the hernial sac was highly ligated by knotting the purse string suture .If a direct inguinal hernia was identified , a similar method was used to ligate the hernial sac , and the umbilical artery fold was sutured to the Hesselbach ' s triangle in order to enhance the weak tissue . Results After surgeries, we found 28 cases were recurrent indirect inguinal hernia (4 cases with contralateral concealed hernia ), and the other 2 cases were direct inguinal hernia .The operation time ranged from 12 to 45 min (mean, 21.4 ±8.2 min).All th cases recovered with inconspicuous scars , and no recurrence or complications were found during a follow-up for 2-53 months ( mean, 23.9 ±12.5 months). Conclusions Single-incision laparoscopic inguinal high ligation is a safe and effective procedure for children with recurrent inguinal hernia .This procedure does not cause obvious scars for patients , and can diagnose and treat the occult hernia and direct hernia at the same time .
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Objective To discuss the blood substitutes during the perioperative period for hemophilic children with surgical disease as well as the coping strategies to its postoperative complications.Methods A retrospective study between 2003 and 2013 from one our centre identified a total of 41 perations performed in haemophiliac patients.33 patients were diagnosed with haemophilia A,among whom 10 were severe cases,13 moderate cases and 8 mild cases.8 patients were diagnosed with haemophilia B,among whom 2 were severe cases and 6 were mild cases.Different kinds of operation were required for each case.Results According to the monitoring of the coagulation tests PT and APTT before and after the operation respectively,after the use of the blood substitutes such as FV Ⅲ,PPSB and fresh frozen plasma,38 patients underwent surgical treatment successfully and had full recovery without any surgical complications,1 patient was dead,1 suffered intraperitoneal hemorrhage and 1 had delayed wound healing.Conclusion Full preparation and thorough plan before the operations,combined with appropriate blood substitutes can effectively reduce postoperative bleeding for hemophilic children.
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<p><b>OBJECTIVE</b>To summarize the clinical characteristics, early diagnosis, comprehensive treatment and prognosis of 6 cases of children with post-transplantation lymphoproliferative disorder (PTLD) after liver transplantation.</p><p><b>METHOD</b>Data of 6 cases with PTLD seen between January 2011 and December 2013 were retrospectively analyzed. The anti-rejection drug dose adjustments, the effect of rituximab, antiviral therapy and comprehensive treatment program after surgery were explored.</p><p><b>RESULT</b>(1) The diagnosis of PTLD was confirmed by histologic findings. Six cases of PTLD including 3 males and 3 females were diagnosed as congenital biliary atresia and underwent split liver transplantation. The occurrence rate of PTLD was 2.9%. (2) The median time to the development of PTLD was less than 6 months. The initial symptom of PTLD in all patients was fever and clinical manifestations of PTLD were non-specific, depending on the involving organs. Five cases of PTLD developed gastrointestinal symptoms, including diarrhea, abdominal pain, and abdominal distension. One case developed respiratory symptoms, including cough and tachypnea. Three cases had lymph node involvement. In 2 cases pathophysiology involved polymorphic lymphocyte proliferation and in 4 cases B lymphocyte proliferation. (3) Two cases died, in whom EBV DNA was not detected and were diagnosed as PTLD by surgical pathology before death. Four survived cases had high EBV-DNA load and then were diagnosed as PTLD by biopsy pathology. (4) Of the 6 cases of PTLD, 2 cases died and 4 cases survived. The overall mortality was 33%. The dead cases were only treated with laparotomy because of intestinal obstruction or perforation and the survived cases were treated with tacrolimus at reduced doses or discontinuation and rituximab. In 2 cases antiviral therapy (acyclovir) was continued, including 1 cases of intestinal obstruction treated with surgical repair. All the survived patients were followed up for 4 months to 1 year and no evidence has been found.</p><p><b>CONCLUSION</b>EBV infection is the high risk factor for PTLD after liver transplantation. Close clinical surveillance of EBV DNA for pediatric liver transplantation was important for the early diagnosis of PTLD. Reducing doses of immunosuppressive agents and rituximab is the initial therapy for PTLD. A reduction in the dose of tacrolimus is suggested. Operation therapy can also play a role in the management of local complications.</p>
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Female , Humans , Infant , Male , Antiviral Agents , Biliary Atresia , Therapeutics , DNA, Viral , Drug Therapy, Combination , Early Diagnosis , Epstein-Barr Virus Infections , Diagnosis , Therapeutics , Immunosuppressive Agents , Liver Transplantation , Lymphoproliferative Disorders , Diagnosis , Mortality , Therapeutics , Pediatrics , Postoperative Complications , Retrospective Studies , Survival Rate , TacrolimusABSTRACT
In order to improve the accuracy for quantitating the bovine foamy virus(BFV)in vitro,we developed a baby hamster kidney cell(BHK)-21-derived indicator cell line containing a plasmid that encodes the firefly luciferase driven by the BFV long terminal repeat promoter(LTR,from -7 to 1012). The BFV titer could be determined by detecting the luciferase expression since the viral trans-activator BTas protein activates the promoter activity of the LTR. One clone,designated BFVL,was selected from ten neomycin-resistant clones.BFVL showed a specific and inducible dose-and time-dependent luciferase activity in response to BFV infection.Although the changes in luciferase activity of BFVL peaked at 84 h post infection,it was possible to differentiate infected and uninfected cells at 48 h post infection. A linear relationship was established between the multiplicity of infection(MOI)of BFV and the activated ratio of luciferase expression in BFVL. Moreover,the sensitivity of the BFVL-based assay for detecting infectious BFV was 10,000 times higher than the conventional CPE-based assay at 48 h post infection. These findings suggest that the BFVL-based assay is rapid,easy,sensitive,quantitative and specific for detection of BFV infection.
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Objective To evaluate the effect of spleno-left adrenal vein shunt for the treatment of portal hypertensive upper GI bleeding caused by portal vein cavernous transformation in children.Methods Spleno-left adrenal vein shunt was performed in 8 children with portal hypertension due to cavernous transformation.The clinical data was reviewed.Results Portal vein pressure decreased significantly from (30±11)mm Hg to(22±7) mm Hg after shunt.There was no mortality perioperatively and during the follow-up.There were no recurrent hemorrhage nor hepatic encephalopathy occurring in the follow-up and all the children have normal intelligence and normal liver function though blood ammonia level increased significantly from(18±7)μmol/L to (60±17)μmol/L in 4 cases.In 7 cases in which preoperative whole blood cell count significantly decreased,the postoperative WBC,RBC,Hb and PLT was (7.64 ±4.46)×10~9/L,(4.54±0.97)×10~(12)/L,(133±5) g/L and (355.40±107.36)×10~9/L respectively (all P ＜0.05).In one case suffering from preoperative low PLT count the postop PLT reached 333×10~9/L,which was significantly higher than that preoperatively.Esophageal varices ameliorated in 6 cases.No stenosis of anastomotic stoma and thrombosis developed.Conclusion Spleno-left adrenal vein shunt is an effective procedure to treat portal vein cavernous transformation induced portal hypertension in children.
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Besides its function as a pathogenicity determinant, the Tombusvirus P19 also serves as a suppressor of RNA interference (RNAi) by sequestering intracellular small RNAs such as the small interfering RNAs (siRNAs) and microRNAs (miRNAs). However, the effect of P19 on mammalian cells has not been evaluated before. A human embryonic kidney 293 cell line that stably expressed p19 (HEK293-p19) was generated. Flow cytometric analysis revealed that over-expression of P19 caused a significant accumulation of G2/M phase cells. Cell proliferation assays demonstrated a reduced DNA replication and cell growth in HEK293-p19 cells. Moreover, p19 altered the expression profiles of a number of cell cycle regulators in HEK293 cells, such as upregulafion of cyclin A1, CDK2, CDK4, CDK6, p18, cyclin D2, p19INK4d and E2F1, and downregulation of p15, cyclin A2, cyclin B1 and cyclin E1. Thus, the data strongly indicate that p19 might influence multiple G2/M regulators to cause G2/M arrest.
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Objective To develop prototype foamy virus (PFV) detection method by loop-mediated isothermal amplification. Methods Three pairs of primers targeting core region of PFV integrase were designed in this study and Bst DNA polymerase was used to amplify target sequence at 63℃. The system was established with all the conditions optimized. Results The method was established with the plasmid containing target sequence as the template. This method could specifically detect PFV infectious clone, no crossreaction was observed with human immunodeficieney virus infectious clone, bovine immunodefieiency virus infectious clone and bovine foamy virus infectious clone as templates. The detection capability of this system was 50 copy, one order more sensitive than PCR. The amplification could be finished in 15 min and human genomic DNA did not adversely affect the amplification efficiency. Conclusion The PFV detection method by loop-mediated isothermal amplification was established and it had potential usefulness in PFV detection.
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The Borf1 protein is encoded by an immediate-early gene of the bovine foamy virus (BFV) and plays a key role in the viral life cycle. Borf1 is a DNA binding protein which can transactivate both the long terminal repeat (LTR) and the internal promoter (IP) of BFV by specifically binding to the transactivation responsive element (TRE). To analyze the subcellular localization of Borf1 during the BFV life cycle, this gene was cloned into a prokaryotic expression vector and expressed in a soluble form. After the purification and immunization, we raised the mouse anti-Borf1 serum with a high titer based on ELISA results. Western blot analysis showed that the antiserum could specifically recognize the Borf1 protein that was expressed in 293T cells. With this specific serum, we revealed the nuclear and cytoplasmic localization of Borf1 in HeLa cells that was transfected with Borf1. Moreover, the immuno-fluorescence assay also showed that the localization of Borf1 during the infection and transfection of BFV was identical.
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Objective To compare the infectivity between laboratory adapted human inununodefi- ciency virus(HIV-1) and primary HIV-1 isolates for different mucosal epithelial cell lines. Methods Mu-cosal epithelial cells Caco-2, T-84, HeLa and lymphocyte MT-4 were infected with laboratory adapted HIV-1 SF33 and 2 primary HIV-1 isolates (02010561, 02010141). Culture supernatant and cells were collected respectively on 3-4 days interval after virus inoculation. The former was tested for HIV-1 antigen P24 level and viral load, and the latter was tested for total viral DNA and integrated viral DNA. Results All 3 virus strains could infect MT-4 cells and integrate into their genome. Only HIV-1 SF33 could infect Caco-2 cells but could not integrate into their genomic DNA. Both HIV-1 SF33 and 02010561 infected HeLa cells but only integration of HIV-1 SF33 was detected. All the 3 HIV-1 strains infected T-84 cells but only the integra-tion of HIV-1 SF33 and 02010141 was observed. Conclusion Although laboratory adapted and primary HIV-1 strains are able to infect human mucosal epithelial cell lines, transient or productive infection estab-lished in different mucosal epithelial cells is dependent on the character of cells and virus strains.
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Objective To investigate the feasibility of laparoscopy assisted Meckel’s diverticulum resection in children. Methods Meckel’s diverticulum resection was performed under laparoscope in 12 children from October 2000 to April 2002.Two 3 mm incisions were made on the McBurney point and the midpoint between the umbilicus and the pubis,respectively.Three 3 mm trocar were introduced.When the diverticulum was found,the incision was prolonged to 2 cm long along the inferior border of the umbilicus.The lesion was removed externally and the intestine was anastomosed. Results All operations were completed smoothly under laparoscope. The intraoperative blood loss was 2～3 ml and the operation time was 1 2～2 5 h.The diverticulum was 1 cm?2 cm～3 cm?4 cm in size.The patients were dismissed 5～7 days after surgery,without obvious scar formation. Conclusions Laparoscopic Meckel’s diverticulum resection is feasible, with the advantages of the minimal invasion, rapid recovery and unobvious scars.
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Objective To investigate the value of ultrasound examination in the diagnosis of acute appendicitis. Methods Emergency abdominal ultrasound examination was performed on 152 children who had clinically suspected acute appendicitis. Results Sixty-three children were diagnosed as acute appendicitis by ultrasound . Among them, fifty-nine children had emergency appendectomy; the other 4 had delayed appendectomy six months after conservative therapy for appendiceal mass. All of the diagnoses were confirmed to be correct by pathologis examination . Among the other 89 children, the diagnosis was luteinic rupture in 4, choledochal cyst in 2, omental cyst in 1, hydronephrosis in 1, and nephrolithiasis in 1. Eighty of them were diagnosed as mesenteric lymphadenitis and treated conservatively. Seventy-six of these eighty children recovered , and appendectomy was performed on four patients. In two of them the diagnosis was suppurative appendicitis, and in two, the diagnosis was simple appendicitis. Conclusions Combined with consideration of the symptoms and signs, ultrasound is valuable in the diagnosis of appendicitis.