Analysis of blood carnitine profile and SLC22A5 gene variants in 17 neonates with Primary carnitine deficiency / 中华医学遗传学杂志

OBJECTIVE@#To analyze the blood free carnitine (C0) level and SLC22A5 gene variants in 17 neonates with Primary carnitine deficiency (PCD) and to determine its incidence in local area and explore the correlation between C0 level and genotype.@*METHODS@#148 043 newborns born in 9 counties (cities and districts) of Ningde city from September 2016 to June 2021 were selected as study subjects. Blood free carnitine and acyl carnitine of 148 043 neonates were analyzed. Variants of the SLC22A5 gene were screened in those with blood C0 < 10 µmol/L, or C0 between 10 ∼ 15 µmol/L. Correlation between the free carnitine level and genetic variants was analyzed.@*RESULTS@#In total 17 neonates were diagnosed with PCD, which yielded a prevalence of 1/8 707 in the region. Twelve variants of the SLC22A5 gene were identified, with the common ones including c.760C>T, c.1400C>G and c.51C>G. Compared with those carrying other variants of the gene, children carrying the c.760C>T variant had significantly lower C0 values (P < 0.01).@*CONCLUSION@#The prevalence of PCD is relatively high in Ningde area, and intervention measures should be taken to prevent and control the disease. The c. 760C>T variant is associated with lower level of C0, which can provide a clue for the diagnosis.

Application of ureteral access sheath in the operation of middle and lower ureteral calculi in patients with massive benign prostatic hyperplasia / 中华外科杂志

Objective: To examine the effectiveness and safety of application of the ureteral access sheath in the treatment of middle or lower ureteral calculi in patients with large-volume benign prostatic hyperplasia above grade Ⅲ, which is expected to avoid the simultaneous or staged treatment of benign prostatic hyperplasia via eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia. Methods: From April 2018 to December 2020, the clinical data of 27 patients with massive benign prostatic hyperplasia above grade Ⅲ and middle and lower ureteral calculi treated with indwelling ureteral access sheath plus ureteroscopy holmium laser lithotripsy at Department of Urology, Zhejiang Quhua Hospital were retrospectively analyzed and followed up. All the patients were male, aged (69.7±12.8) years (range: 55 to 87 years). Prostate volume measured by transrectal ultrasound was (94.8±16.2) cm3 (range: 85 to 186 cm3). The ureteral access sheath was indwelled in advance, and then the semirigid ureteroscopy was introduced through the working channel of the sheath. Holmium laser lithotripsy was performed, and intraoperative and postoperative complications were recorded. Urinary abdominal plain X-ray or CT urography were performed at 1-and 2-month postopaerative to evaluate the residual stones and clinical efficacy. Results: The ureteral access sheath was placed and holmium laser lithotripsy under a semirigid ureteroscopy was performed successfully in all the 27 patients. In 2 patients, a second session of auxiliary procedure was required due to the large load of preoperative stones and residual stones after surgery, among whom 1 patient received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy plus ureteroscopic lithotripsy. The stone free rate at 1-and 2-month postoperative were 92.6% (25/27) and 100% (27/27), respectively. There were no severe complications such as ureteral avulsion and perforation, perirenal hematoma, septic shock, severe hematuria, urinary retention, iatrogenic ureteral stricture occurred during and after the surgery. The ureteral calculus was wrapped by polyps heavily in 1 patient, he was diagnosed as ureteral stenosis 1 month postoperative, receiving laparoscopic resection of ureteral stricture plus anastomosis 3 months postoperative. Conclusions: In the operations of middle and lower ureteral calculi in patients with large-volume prostatic hyperplasia above grade Ⅲ, the ureteral access sheath can be placed first to effectively eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia, and then semirigid ureteroscopic lithotripsy can be safely performed. It could avoid the treatment of benign prostatic hyperplasia at the same time or by stages.

Patients with perihilar cholangiocarcinoma resection combined with portal vein resection and reconstruction / 中华肝胆外科杂志

Objective:To study the safety and efficacy of combining portal vein resection and reconstruction (PVR) with resection of perihilar cholangiocarcinoma (PHC).Methods:A total of 104 patients with PHC who underwent hepatectomies for either biliary resection alone or biliary resection combined with PVR from October 2006 to December 2019 at the Department of Hepatopancreatobiliary, Ningbo Medical Center of Lihuili Hospital entered into this study. There were 63 males and 41 females, with the age of (64.4±10.4) years. The control group consisted of 75 patients who underwent biliary resection alone, while the PVR group consisted 29 patients with biliary resection combined with PVR. The patient characteristics and the follow-up outcomes of the two groups were analyzed and compared. Survival analyses were performed using the Kaplan Meier method with the log-rank test.Results:Wedge resection of portal vein, side to side anastomosis in 2 cases, segmental resection and end to end anastomosis in 27 cases. The time taken for PVR and portal vein resection were (12.7±2.9)(range 8 to 18)min and (20.7±7.3)(range 8 to 38) mm, respectively. The estimated blood loss for the PVR group was significantly more than the control group [ M( Q1, Q3)] 800.0 (600.0, 1 500.0) ml vs. 600.0(500.0, 1 000.0) ml ( P<0.05). Based on postoperative pathological studies, the proportion of lymph node metastasis was significantly higher in the PVR group than the control group (58.6% vs. 32.0%, P<0.05). Clavien-Dindo grade Ⅲ and above complications were 30.7%(23/75) and 34.5%(10/29) in the control and PVR groups, respectively ( P>0.05). The re-operation and postoperative 90 days mortality rates were 9.3%(7/75) and 2.7%(2/75) in the control group, compared with 3.4%(1/29) and 0 in the PVR group, respectively (both P>0.05). The 1-, 3- and 5-year survival rates were 81.1%, 44.8% and 36.4% respectively for the control group and 78.1%, 35.9% and 31.4% for the PVR group (χ 2=0.33, P=0.570). Conclusion:When compared to biliary resection alone, biliary resection combined with PVR did not significantly increase postoperative complication and mortality rates, but with comparable long-term survival outcomes. Combined biliary resection with PVR was safe and improved the resection rate in selected patients with locally advanced PHC.

Analysis of clinical characteristics and prognostic factors of hemophagocytic lymphohistiocytosis in pediatric intensive care unit / 中华实用儿科临床杂志

Objective:To explore the clinical features and the mortality risk factors of hemophagocytic lymphohistiocytosis (HLH) in pediatric intensive care unit (PICU).Methods:Clinical data of 68 children diagnosed as HLH and treated in PICU, the Children′s Hospital, Zhejiang University School of Medicine between January 2014 and December 2020 were retrospectively analyzed.According to the lowest pediatric critical illness score (PCIS) within 24 h after admission to PICU, they were divided into non-critical group, critical group and extremely critical group.Moreover, they were further divided into survivors and non-survivors based on the prognosis.Clinical characteristics in each group were analyzed and compared. Logistic regression analysis was performed to obtain the estimates of odds ratio ( OR) and corresponding 95% confidence interval ( CI) of possible predictive factors for death. Results:The median age of recruited 68 children with HLH and treated in PICU was 26 months, involving 39 female and 29 male patients.The overall mortality rate was 45.59%(31/68 cases). Epstein-Barr virus (EBV) infection was the major cause of HLH.The mortality of non-critical group, critical group and extremely critical group were 21.05% (8/38 cases), 57.14% (8/14 cases) and 93.75% (15/16 cases), the difference was statistically significant ( P<0.05). The PCIS, the pediatric logistic organ dysfunction score 2 (PELOD-2), duration of fever, mechanical ventilation within 6 h, vasoactive use, gastrointestinal and pulmonary hemorrhage, disseminated intravascular coagulation (DIC), hepatobiliary dysfunction (HBD) and acute kidney injury (AKI), acidosis[pH and base excess (BE)], hemoglobin (Hb), prothrombin time (PT), and activated partial thromboplastin time (APTT), serum creatinine (Scr), interleukin-6 (IL-6) were significantly different between survivors and non-survivors (all P<0.05). The Logistic regression analysis showed that PCIS ( OR=0.800, 95% CI: 0.707-0.905, P<0.001), Hb ( OR=0.929, 95% CI: 0.871-0.991, P=0.027), APTT ( OR=0.954, 95% CI: 0.910-0.990, P=0.047), and AKI( OR=29.064, 95% CI: 3.072-274.957, P=0.003) were risk factors for the death of HLH. Conclusions:HLH has a very high mortality and requires critical care in PICU, low PCIS, anemia, prolonged APTT and AKI are independent risk factors for the death of HLH.

Predictive value of BAT score in the prognosis of patients with spontaneous intracerebral hemorrhage / 中华急诊医学杂志

Objective:To study the predictive value of BAT score for the prognosis of patients with spontaneous intracerebral hemorrhage (sICH).Methods:A retrospective analysis of 93 sICH patients in the Emergency Department of the Second Affiliated Hospital of Wannan Medical College from January 2018 to December 2020 was conducted, and the patients were classified into the good prognosis group ( n=34) and the poor prognosis group ( n=59) according to the Glasgow Outcome Score (GOS) 3 months after the discharge. Clinical data such as basic data of patients, admission vital signs, laboratory indicators, National Institute of Health stroke scale (NIHSS) score and BAT score and other clinical data of the two groups were compared. Multivariate logistic regression was used to analyze the risk factors affecting poor prognosis of sICH patients. The receiver operating characteristic (ROC) curve was drawn to analyze predictive value of BAT score for poor prognosis of sICH patients. Results:The admission systolic blood pressure, white blood cell count, hypertension complications, emergency BAT score and NIHSS score of patients in the poor prognosis group were significantly higher than those in the good prognosis group ( P<0.05). Multivariate logistic regression analysis indicated that the admission systolic blood pressure ( OR=1.024, 95% CI: 1.002~1.046, P=0.035) and emergency BAT score ( OR=2.640, 95% CI: 1.445-4.825, P=0.002) could accurately predict the poor prognosis of sICH patients. ROC curve analysis showed that the area under ROC curve (AUC) of BAT score was 0.792, the sensitivity was 79.3%, and the specificity was 76.5%. The AUC of systolic blood pressure for predicting poor prognosis of sICH patients was 0.701, and the sensitivity was 55.2%, and the specificity was 88.2%. The AUC of BAT score combined with systolic blood pressure for predicting poor prognosis of sICH patients was 0.835. Conclusions:BAT score and admission systolic blood pressure could more accurately predict poor prognosis of sICH patients. The combination of them had a higher efficacy in predicting poor prognosis of sICH patients after 3 months.

Study on the production efficiency of platelet components in 24 prefecture-level blood stations in China / 中国输血杂志

【Objective】 To learn the production efficient of platelet components among prefecture-level blood stations in China, to provide supporting data for those blood stations to optimize the production mode of platelet components and continuously improve production efficiency and supply capacity. 【Methods】 The data from 2017 to 2020 was obtained from 24 prefecture-level blood stations who were the members of the practice comparison network for blood institutes in China. The collection units of apheresis platelets, the number of dual-collections of apheresis platelets and plasma, the average apheresis units of one platelet apheresis procedure, the discarded rate of apheresis platelets, the amount of expired apheresis platelets and the amount of apheresis platelets issued were collected. For concentrated platelets, the prepared amount of platelet concentrates and the amount of expired platelet concentrates were collected; both the quantity of qualified and issued concentrated platelets were submitted for statistical analysis.The total output and efficiency of platelet components were calculated based on the collected data. 【Results】 The average annual growth rate of apheresis platelets collection in 24 prefecture-level blood stations was 12.23%, accounting for 99.80% of the total platelet output; the average collection unit of one platelets apheresis procedure was 1.75; from 2019 to 2020, only 5 blood stations performed dual-collection of platelet and plasma during one apheresis procedure; the discarded rate of apheresis platelets was 0.28%, of which 0.007% was due to expiration. A total of 1 621.2 therapeutic units of concentrated platelets were prepared, and 13.03% of them was discarded due to the expiration. The production efficiency of platelet components was 97.56%, of which the production efficiency of apheresis platelets was 97.61% and the production efficiency of concentrated platelets was 74.43%. 【Conclusion】 There are large regional differences in the supply capacity of platelet components in prefecture-level blood stations. Apheresis platelets are the main resource of platelet components product, and the collection capacity is increasing over the years with the characteristics of high production efficiency and low expiration scrapping rate. However, the preparation of concentrated platelets are still limited with relatively low production and high expiration discarded rate.

Comparison of the characteristics of NK cells after two different methods of expansion and observation of the clinical efficacy in patients who relapsed post allogeneic hematopoietic stem cell transplantation / 中华血液学杂志

Objective: To explore the differences in the biological effects of different expansion systems on natural killer (NK) cells, as well as the safety and preliminary clinical efficacy in the treatment of patients with recurrence after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Peripheral blood cells from healthy donors were stimulated with either CD3 combined with CD52 or K562 feeder cells loaded with IL-21/4-1BB to induce NK cell expansion. Changes in the NK cell phenotype, cytokine secretion, and cytotoxicity before and after expansion were detected. We also evaluated the safety and clinical efficacy of two different expansion strategies for patients received NK infusion. Results: Compared with the CD3/CD52 monoclonal antibody amplification system, the feeder cell expansion group had a higher purity of NK cells and higher expression ratios of NK cell surface activation receptors such as DNAM-1 and NKp30, while inhibitory receptor CTLA-4 expression was low and NKG2D/CD25/CD69/ Trail/PD-1/TIM-3/TIGIT had no statistically significant differences between the groups. Further functional results showed that the expression level of KI67 in NK cells after expansion in the two groups increased significantly, especially in the feeder cell expansion group. Simultaneously, the perforin and granzyme B levels of NK cells in the feeder cell expansion group were significantly higher than in the CD3/CD52 expansion group. A retrospective analysis of eight patients who received monoclonal antibody-expanded NK cell reinfusion and nine patients with trophoblast cell-expanded NK cell reinfusion was done. The disease characteristics of the two groups were comparable, NK cell reinfusion was safe, and there were no obvious adverse reactions. Clinical prognostic results showed that in the CD3/CD52 monoclonal antibody amplification group, the MRD conversion rate was 50% (2/4) , and the feeder cell expansion group was 50% (3/6) . After 5 years of follow-up from allo-HSCT, three patients in the monoclonal antibody expansion group had long-term survival without leukemia, and the remaining five patients had died; two patients died in the feeder cell expansion group, and the other six patients had long-term survival. Six cases had GVHD before NK cell reinfusion, and GVHD did not aggravate or even relieved after NK cell reinfusion. Conclusions: Preliminary results show that the biological characteristics of NK cells with diverse expansion strategies are significantly different, which may affect the clinical prognosis of patients with recurrence or persistent minimal residual disease after HSCT. The two groups of patients treated with NK cells from different expansion strategies had no obvious adverse reactions after NK cell infusion, but efficacy still needs to be further confirmed.

Safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with peritoneal metastasis / 中华胃肠外科杂志

Objective: To investigate the safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with different types of peritoneal metastasis. Methods: A prospective study "one arm exploratory clinical study of conversion therapy of apatinib with S-1 and oxaliplatin in the treatment of advanced gastric cancer" (clinical registration ChiCTR-ONC-17010430) from medical record database was retrospectively analyzed. Patients aged 18-70 years with gastric cancer peritoneal metastasis confirmed by histology and laparoscopic exploration, and had not receive radiotherapy, chemotherapy, targeted therapy or immunotherapy before were enrolled. Before operation, the patients received 6 cycles of S-1 (80-120 mg/d, d1-d14) and oxaliplatin (130 mg/m(2), d1), and 5 cycles of apatinib (500 mg/d, d1-d21) conversion regimen. Three weeks after chemotherapy, whether the operation was performed or not depending on re-evaluation and patient preference. The main outcome were adverse reactions, and the secondary outcome were objective remission rate (ORR), disease control rate (DCR), and overall survival (OS) rate. The follow-up period was up to May 2020. Results: A total of 27 patients with gastric cancer peritoneal metastasis were enrolled in this study. There were 13 males and 14 females, with a median age of 58 (30-68) years old. There were 9 cases of P1a, 5 cases of P1b, and 13 cases of P1c. There were 14 cases with 1-5 scores of PCI (peritoneal cancer index), and 13 cases with 6 scores or above. The incidence of adverse reactions was 100%. The most common adverse reactions were hematological events including leucopenia (70.4%, 19/27) and granulocytopenia (74.1%, 20/27). Non-hematological adverse events included fatigue (51.9%, 14/27) and oral mucositis (37.0%, 10/27). One patient was withdrawn due to grade 4 thrombocytopenia. Among 26 patients with feasible efficacy evaluation, 18 (69.2%) achieved partial remission, 3 (11.5%) achieved stable disease, and 5 (19.2%) disease progression. The objective remission rate was 69.2% (18/26) and the disease control rate was 80.8% (21/26). Fourteen patients underwent surgery, including 6 patients undergoing R0 resection with the R0 resection rate of 42.9% (6/14). The postoperative pathological response rate was 64.3% (9/14). The follow-up time was 12-40 months, and the follow-up rate was 100%. The 1-year OS rate was 65.2% and the survival time was (14.0±1.7) months. The 1-year OS rates of P1a/P1b group and P1c group were 81.8% and 42.0% respectively, whose difference was statistically significant (P=0.041). The 1-year OS rates of PCI 1-5 group and PCI ≥6 group were 67.3% and 38.5% respectively, whose difference was statistically significant (P=0.022). Conclusion: In the conversion treatment of gastric cancer peritoneal metastasis, the safety of apatinib combined with oxaliplatin and S-1 is acceptable, and this regimen shows a good short-term survival efficacy in patients with P1a/P1b and PCI of 1-5.

Application of Essential Anatomy software in the clinical practice teaching of spinal surgery / 中华医学教育探索杂志

In this paper, the current situation and existing problems of spinal surgery practice are analyzed and summarized. Combined with the review of the structure and function of spinal region, we have expounded the application and advantages of Essential Anatomy software in the clinical practice teaching of spinal surgery. This software has a friendly interface, simple operation, real content, intuitive and visual model, and it can provide videos and slice function, which makes the original complex and abstract spinal anatomy practice content become novel and vivid, and greatly deepens doctors' understanding of the structure, function, movement and the disease pathogenesis of spinal region. At the same time, it also greatly mobilizes the learning interest and initiative of the clinical practice doctors, and improves the effect of clinical practice.

Analysis of the effect of valproic acid with different loading doses in treatment of children with status epilepticus / 中国小儿急救医学

Objective:To explore the effect of valproic acid with different loading doses in treatment of children with status epilepticus.Methods:The data of children who were hospitalized in the intensive care unit of the Children′s Hospital Affiliated to Zhejiang University because of status epilepticus from January 1, 2013 to December 31, 2017 were collected.All the patients were divided into different groups according to loading dose of valproic acid.The effect were analyzed in different groups.Results:(1)There were 66 children with status epilepticus were admitted, including 35 males and 31 females.Among all children with status epilepticus, the etiology included epilepsy( n=36, 54.5%), intracranial infection( n=16, 24.2%), hypoxic asphyxia ( n=3, 4.5%), intracranial tumor( n=2, 3.0%), abnormal brain development( n=2, 3.0%), intracranial hemorrhage( n=2, 3.0%), and etiology was not clear( n=5, 7.6%). (2)All children with status epilepticus were divided into four groups according to different valproic acid loading dose(0 mg/kg, 10-15 mg/kg, 16-39 mg/kg, 40 mg/kg). There are no significant differences in gender and age among groups.There were no significant differences in duration of status epilepticus and epileptic treatment efficiency( P=0.402, 0.034). (3)All children were monitored for liver function after the treatment of sodium valproate, and no patient had been found increased alanine aminotransferase. Conclusion:There are no significant differences in the effect of different valproic acid loading doses in children with status epilepticus, and no adverse side effects are observed in children with status epilepticus who received a dose of 40 mg/kg.

Pediatric airway foreign body retrieval during the prevention and control of 2019 novel coronavirus / 中华急诊医学杂志

The prevention and control of 2019 novel coronavirus (2019-nCoV) is currently the primary task of all industries in China. The virus infection is mainly transmitted by respiratory droplets, airborne and close contact. Pediatric foreign body in the respiratory tract is a common otorhinolaryngology emergency, especially occurred in 1-3 years old children, and usually causes airway obstruction, suffocation and pneumonia, which may become an acute threat to life. The principle treatment in otorhinolaryngology emergency room is direct laryngoscope, bronchoscope and foreign body removal. Due to the close contact between the relevant medical staff and child during the operation, a large number of droplets and aerosols can be produced during the reactive cough of the child. Combined with the characteristics of the operation, this article intends to provide advices on diagnosis and treatment of airway foreign body removal for pediatric otorhinolaryngology colleagues during the prevention and control of 2019-nCoV. Adjustments could be made subsequently due to changes of the epidemic situation and the recognition of 2019-nCoV.

Analysis of the effect of valproic acid with different loading doses in treatment of children with status epilepticus / 中国小儿急救医学

Objective@#To explore the effect of valproic acid with different loading doses in treatment of children with status epilepticus.@*Methods@#The data of children who were hospitalized in the intensive care unit of the Children′s Hospital Affiliated to Zhejiang University because of status epilepticus from January 1, 2013 to December 31, 2017 were collected.All the patients were divided into different groups according to loading dose of valproic acid.The effect were analyzed in different groups.@*Results@#(1)There were 66 children with status epilepticus were admitted, including 35 males and 31 females.Among all children with status epilepticus, the etiology included epilepsy(n=36, 54.5%), intracranial infection(n=16, 24.2%), hypoxic asphyxia (n=3, 4.5%), intracranial tumor(n=2, 3.0%), abnormal brain development(n=2, 3.0%), intracranial hemorrhage(n=2, 3.0%), and etiology was not clear(n=5, 7.6%). (2)All children with status epilepticus were divided into four groups according to different valproic acid loading dose(0 mg/kg, 10-15 mg/kg, 16-39 mg/kg, 40 mg/kg). There are no significant differences in gender and age among groups.There were no significant differences in duration of status epilepticus and epileptic treatment efficiency(P=0.402, 0.034). (3)All children were monitored for liver function after the treatment of sodium valproate, and no patient had been found increased alanine aminotransferase.@*Conclusion@#There are no significant differences in the effect of different valproic acid loading doses in children with status epilepticus, and no adverse side effects are observed in children with status epilepticus who received a dose of 40 mg/kg.

Pediatric Airway Foreign Body Retrieval During the Prevention and Control of 2019 Novel Coronavirus / 中华急诊医学杂志

The prevention and control of 2019 novel coronavirus (2019-nCoV) is currently the primary task of all industries in China. People can be infected through respiratory droplets, airborne and close contact. Pediatric airway foreign body is a common otorhinolaryngology emergency, especially occurred in 1 to 3-year-old children. It usually causes complications like airway obstruction, suffocation and pneumonia, which may become an acute threat to life. The common practice in otorhinolaryngology emergency room is to perform direct laryngoscope, bronchoscope and foreign body removal. Medical staff need to be closely contacted with these children during surgical operation, who may produce massive droplets and aerosols during examination. With a combination of characteristics of surgical operation, this article intends to provide advices on diagnosis and treatment of airway foreign body removal for pediatric otorhinolaryngology colleagues during the prevention and control of 2019-nCoV. Adjustments could be made subsequently due to changes of the epidemic situation and the recognition of 2019-nCoV.

Trastuzumab-Induced Severe Thrombocytopenia:A Case Report and Literature Review / 中国医学科学杂志(英文版)

We present a 29-year-old woman with pT2N0M0 breast cancer, histological diagnosis of invasive ductal carcinoma, ER and PR low positive, and HER-2 (3+). The patient developed trastuzumab-induced thrombocytopenia in 6 hours after an intravenous infusion of trastuzumab at the second cycle of trastuzumab treatment with the symptom of abnormal uterine bleeding. Laboratory exam revealed a sharp drop of platelet count down to 3×10

Diagnosis and treatment recommendation for pediatric COVID-19 (the second edition) / 浙江大学学报·医学版

The coronavirus disease 2019 (COVID-19) has caused a global pandemic. All people including children are generally susceptible to COVID-19, but the condition is relatively mild for children. The diagnosis of COVID-19 is largely based on the epidemiological evidence and clinical manifestations, and confirmed by positive detection of virus nucleic acid in respiratory samples. The main symptoms of COVID-19 in children are fever and cough; the total number of white blood cell count is usually normal or decreased; the chest imaging is characterized by interstitial pneumonia, which is similar to other respiratory virus infections and infections. Early identification, early isolation, early diagnosis and early treatment are important for clinical management. The treatment of mild or moderate type of child COVID-19 is mainly symptomatic. For severe and critical ill cases, the oxygen therapy, antiviral drugs, antibacterial drugs, glucocorticoids, mechanical ventilation or even extracorporeal membrane oxygenation (ECMO) may be adopted, and the treatment plan should be adjusted timely through multi-disciplinary cooperation.

Influence of influenza A and B virus infections on human aortic smooth muscle cells and the expressions of cytokines / 医学研究生学报

Objective　Vascular smooth muscle cells are the main cells in atherosclerosis. Reports are rarely seen on influenza virus infection on human aortic smooth muscle cells (HASMC) and its influence on the expressions of the related cytokines. This study was to investigate the impact of influenza A virus (IAV) and influenza B virus (IBV) infection on HASMCs and the expressions of cytokines. Methods　HASMCs were stimulated with IAV or IBV or not stimulated with virus (the control). The nucleoprotein of the influenza virus in the cells was detected by immunofluorescence assay, the proliferation of the cells determined with CCK8, and the level of influenza virus RNA in the supernatant measured by qPCR. The collected supernatant was used to infect Madin-Darby canine kidney (MDCK) cells and detect the influenza virus nucleoprotein. The expressions of the cytokines of the influenza virus after 24 hours of infection were determined by qPCR.　Results　At 3 and 4 days after infected with influenza virus, the proliferation of the HASMCs was significantly inhibited in the IAV and IBV groups as compared with the control (P<0.05). The expression of virus RNA in the supernatant of the IBV group at 3 days was 5.75 times as high as that at 2 days (P<0.05), dropped at 4 days but still higher than that at 2 days (P<0.01). Compared with the normal culture medium, the medium with virus growth fluid significantly elevated the RNA level of IAV (0.842±0.148 vs 15.182±1.932, P< 0.01) and IBV (0.962±0.033 vs 4.029±0.681, P<0.01). After infection, the expression of MCP-1 was remarkably up-regulated in the IAV and IBV groups (4.364±0.193 and 3.348±0.507) in comparison with that in the control group (1.001±0.001) (P<0.05), and so were the expressions of IL-6 and TNF-α (P<0.05).　Conclusion　Both IAV and IBV can infect HASMCs and increase the expressions of the cytokines MCP-1, IL-6 , and TNF-α.

Observation of tigecycline treatment for children with severe infection / 中国实用儿科杂志

OBJECTIVE: To evaluate the efficacy and safety of tigecycline therapy in children with severe infection.METHODS: We conducted a restrospective chart review of 114 children with severe infection in a tertiary hospital from May 1,2012 to April 30,2017. Inclusion criteria: receiving tigecycline administration for at least 2 days(4 doses). Clinical data and laboratory results were recorded before and after the therapy. RESULTS: Totally 114 children were enrolled,including 47 patients diagnosed with Acinetobacter baumanmii infection,with 52 Acinetobacter baumanmii strains. The in-hospital mortality was 23.4%. Median duration of tigecycline treatment was 13 days(2.5-13.5 days). Median duration of antibiotics prior to tigecycline treatment was 9 days(2-27 days). The total clinical improvement rate was 47.3%,and the etiological eradication rate was 38.9%. After treatment 24 cases got clinically improved in 47 patients and 26 strains were eradicated. No serious adverse effect was reported. CONCLUSION: The efficacy and safety of tigecycline should not be overvalued. Additional data from randomized controlled trials are required to assess the administration of tigecycline.

Observation of tigecycline administration in gram-negative bacteria infected children with ventilator-associated pneumonia / 中国小儿急救医学

Objective To investigate the efficacy and safety of tigecycline therapy in children with ventilator-associated pneumonia infected by gram-negative bacteria. Methods We conducted a restrospective chart review of children with ventilator-associated pneumonia in a tertiary hospital from May 1,2012 to April 30,2017. Inclusion criteria:positive sputum culture result;receiving tigecycline administration of at least 2 days (4 doses). Clinical data and laboratory results were recorded before and after the therapy. Results Twenty-seven children were enrolled,with the in-hospital mortality of 37. 0％(10/27). Twenty-seven bacteri-a strains were recorded,all of which were gram-negative,with Acinetobacter baumanmii took up the most. Most bacteria were susceptible to tigecycline. Median duration of tigecycline was 10 days ( 3-27 days ) , 40. 7％ patients(11/27) got clinically improvement and 44. 4％(12/27) got pathogen eradication. Sulpera-zone was the most concomitantly used antibiotics. Totally 3 dosage models were observed and model 1(load-ing dose 2 mg/kg,maintain dose 1 mg/kg) and model 2 ( loading dose 1. 5 mg/kg,maintain dose 1 mg/kg) were the primary. Rate of clinical improvement and microbiology eradication in model 1 group was higher than other groups. No serious adverse effect was detected. Conclusion Tigecycline combined with other a-gents could be used as salvage therapy in gram-negative bacteria infected ventilator-associated pneumonia children and it is tolerated.

Fluid resuscitation in children with multiple trauma / 中国小儿急救医学

Hypovolemia is the most common cause of shock in children with multiple trauma. Early detection and treatment of hypovolemia is very important in the process of trauma resuscitation. Compensatory shock occurs when large amounts of blood are lost, and blood pressure is maintained by tachycardia and vas‐oconstriction. Hypobaric shock is characterized by hypotension and tachycardia. The fluid resuscitation of multiple traumas can be divided into two cases, when the bleeding is under control or not under control. In addition,massive transfusion is closely associated with multiple trauma.

Upregulation of miR-489-3p and miR-630 inhibits oxaliplatin uptake in renal cell carcinoma by targeting OCT2

Renal cell carcinoma (RCC) is one of the most common malignant tumors affecting the urogenital system, accounting for 90% of renal malignancies. Traditional chemotherapy options are often the front-line choice of regimen in the treatment of patients with RCC, but responses may be modest or limited due to resistance of the tumor to anticarcinogen. Downregulated expression of organic cation transporter OCT2 is a possible mechanism underlying oxaliplatin resistance in RCC treatment. In this study, we observed that miR-489-3p and miR-630 suppress OCT2 expression by directly binding to the OCT2 3'-UTR. Meanwhile, 786-O-OCT2-miRNAs stable expression cell models, we found that miRNAs could repress the classic substrate 1-methyl-4-phenylpyridinium (MPP), fluorogenic substrate ,-dimethyl-4-(2-pyridin-4-ylethenyl) aniline (ASP), and oxaliplatin uptake by OCT2 both and in xenografts. In 33 clinical samples, miR-489-3p and miR-630 were significantly upregulated in RCC, negatively correlating with the OCT2 expression level compared to that in adjacent normal tissues, using tissue microarray analysis and qPCR validation. The increased binding of c-Myc to the promoter of pri-miR-630, responsible for the upregulation of miR-630 in RCC, was further evidenced by chromatin immunoprecipitation and dual-luciferase reporter assay. Overall, this study indicated that miR-489-3p and miR-630 function as oncotherapy-obstructing microRNAs by directly targeting OCT2 in RCC.