Changes of nicotinic acetylcholine receptor α7 expression in CD4 + CD25+ T lymphocytes of children with sepsis / 中华实用儿科临床杂志

Objective To study the expression of nicotinic acetylcholine receptor α7 in CD4 + CD25 + T lymphocytes of peripheral blood in children with sepsis,and to analyze the role of α7nAChR in the development of sepsis.Methods Forty-nine hospitalized patients with sepsis from Nov.2011 to Dec.2012 in PICU of Nanjing Children's Hospital Affiliated to Nanjing Medical University were enrolled,and they were divided into the survival group (n =33)and the dead group (n =16) in accordance with the outcome.At the same time,the total of 40 cases including the children receiving inguinal hernia repair and the children receiving health examination were enrolled as control group.Peripheral venous blood was collected to detect the expression of CD4 +/CD25 +/α7nAChR by indirect flow cytometry.Simultaneously,the CD3 +,CD4 +,CD8 +,CD4 +/CD8 + ratio were detected,and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores were calculated.Results The expressions of CD4 +/CD25 +/α7nAChR in sepsis group were much lower than those in the control group [(25.8 ± 3.1) ％ vs (34.9 ± 2.9) ％,P ＜ 0.05] ; and the expression of CD4 + CD25 +/α7nAChR in the dead group was also significantly lower than that in the survival group [(22.4 ± 2.5) ％ vs (28.1 ± 2.9) ％,P ＜ 0.05].The expressions of α7nAChR on CD4 +/CD25 + T lymphocytes of peripheral blood in children with sepsis was negatively correlated with the APACHE Ⅱ score (r =-0.512,P ＜ 0.05).The CD3 +,CD4 +,CD4 +/CD8 + ratios in the dead group were significantly lower than those in the control group (all P ＜ 0.05) ; in the survival group and the control group,the values of CD3 +,CD4 +,CD8 + were not significantly different,while the ratios of CD4 +/CD8 + between these 2 groups had a significant difference(P ＜ 0.05).Conclusions The expressions of α7nAChR on the CD4 + CD25 +T lymphocytes in the children with sepsis were reduced,and the expressions were lower,the outcome were worse;the children with sepsis have cell immune dysfunction.

Progress in pediatric analgesia-sedation / 中华实用儿科临床杂志

Because of the increasing indications for neuroradiologic imaging,improvement in diagnostic and interventional procedures,sedation and analgesia are more and more used in various areas of the pediatrics recently.Followed by adverse reactions,it is also showed a high incidence of difficult predictability and variabihty trends.This article discusses the development,management and monitoring of analgesia-sedation in pediatrics,as well as commonly used drugs.Some informations and guidances of the analgesic-sedation for pediatric physician are provided.

Etiology of hand-foot-and-mouth disease seen in Nanjing in 2010 and molecular characteristics analysis of EV71 / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the etiological agent of hand-foot-and-mouth disease (HFMD), and to genetically characterize enterovirus 71 (EV71) isolated from clinical specimens of HFMD patients in Nanjing in 2010.</p><p><b>METHOD</b>Throat swab specimens were collected from 248 inpatients with HFMD in Nanjing Children's Hospital and then viral isolation was performed. Real-time PCR was used for detection of EV71, coxsackievirus A16 (Cox A16) and other enteroviruses from the positive isolates. Twenty EV71 strains from different clinical types of cases were selected for entire VP1 coding gene amplification and sequencing, finally a phylogenetic tree was constructed among the 20 EV71 strains and EV71 representative strains of known genotypes and subgenotypes.</p><p><b>RESULT</b>From the 248 throat swabs specimens, 110 EV71 strains, 28 Cox A16 strains, and 8 other enterovirus strains were isolated and the positive rate was 44.35%, 11.29%, 3.23%, respectively. Then nucleotide sequencing was performed on the 20 EV71 strains. There was little difference in the nucleotide and the amino acid sequences among the 20 EV71 strains, the homology was 95.51%-100% and 98.32%-100%, respectively. The phylogenetic tree showed that all the 20 EV71 strains belonged to C4 subgenotype.</p><p><b>CONCLUSION</b>EV71 was the main pathogen of HFMD in Nanjing in 2010 and all the analyzed isolates belonged to C4 serotype. No significant difference was found in sequence of VP1 region of EV71 isolated from different clinical types of cases.</p>

Mortality and morbidity of acute hypoxemic respiratory failure and acute respiratory distress syndrome in infants and young children / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute hypoxemic respiratory failure (AHRF) often develops acute respiratory distress syndrome (ARDS), and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively. This study aimed at prospectively investigating incidence, causes, mortality and its risk factors, and any relationship to initial tidal volume (V(T)) levels of mechanical ventilation, in children £5 years of age with AHRF and ARDS.</p><p><b>METHODS</b>In 12 consecutive months in 23 pediatric intensive care units (PICU), AHRF and ARDS were identified in those requiring > 12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge. ARDS was diagnosed according to the American-European Consensus definitions. The mortality and ventilation free days (VFD) were measured as the primary outcome, and major complications, initial disease severity, and burden were measured as the secondary outcome.</p><p><b>RESULTS</b>In 13 491 PICU admissions, there were 439 AHRF, of which 345 (78.6%) developed ARDS, resulting in incidences of 3.3% and 2.6%, and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia (62.9%) and sepsis (33.7%) as major underlying diseases respectively. No association was found in V(T) levels during the first 7 days with mortality, nor for V(T) at levels < 6, 6 - 8, 8 - 10, and > 10 ml/kg in the first 3 days with mortality or length of VFD. By binary Logistic regression analyses, higher pediatric risk of mortality score III, higher initial oxygenation index, and age < 1 year were associated with higher mortality or shorter VFD in AHRF.</p><p><b>CONCLUSIONS</b>The incidence and mortalities of AHRF and ARDS in children £5 years were similar to or lower than the previously reported rates (in age up to 15 years), associated with initial disease severity and other confounders, but causal relationship for the initial V(T) levels as the independent factor to the major outcome was not found.</p>

Pyogenic liver abscess caused by Klebsiella pneumoniae: analysis of the clinical characteristics and outcomes of 84 patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The increased incidence of pyogenic liver abscess caused by Klebsiella pneumoniae (K.pneumoniae) was reported in the recent literature. This study was conducted retrospectively to investigate the clinical characteristics and outcomes of these patients.</p><p><b>METHODS</b>Microbiological and medical databases of a medical center were searched from January 2000 to June 2003. Eighty-four patients with liver abscess caused by K.pneumoniae were analyzed.</p><p><b>RESULTS</b>In the 84 patients, 52 men and 32 women aged (58.2 +/- 13.3) years on average, 64.4% had concomitant diabetes mellitus and 23.8% had biliary disease. The most common clinical symptoms were fever (98.8%), chills (69.0%) and abdominal pain (58.3%). 85.7% of the 84 patients received catheter drainage for the abscess. The length of hospital stay was (17.4 +/- 8.7) days. The mortality rate was 7.1%. Older age and presence of biliary disease were associated with mortality.</p><p><b>CONCLUSIONS</b>The low mortality of our patients was probably related to the high proportion of patients who received catheter drainage. Older age and presence of biliary disease were associated with the mortality.</p>

Supplementation of milk formula with galacto-oligosaccharides improves intestinal micro-flora and fermentation in term infants / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Oligosaccharides in human milk may protect infants by improving the intestinal micro-flora and fermentation. This study was to investigate effects of infant formula milk consisting of galacto-oligosaccharide (GOS) on intestinal microbial populations and the fermentation characteristics in term infants in comparison with that of human milk.</p><p><b>METHODS</b>The test formula (Frisolac H, Friesland, Netherland) was supplemented with GOS at a concentration of 0.24 g/dl. Human milk and another formula without oligosaccharides (Frisolac H, Friesland, Netherland) were used as positive and negative control respectively. Growth, stool characteristics, and side effects of the recruited infants were recorded after 3 and 6 months' follow-up, and the fecal species were collected for the analysis of intestinal micro-flora, short chain fatty acid (SCFA) and pH.</p><p><b>RESULTS</b>At the end of 3- and 6-month feeding period, intestinal Bifidobacteria and Lactobacilli were significantly increased in infants fed with GOS supplemented formula and human milk when compared with infants fed with negative control formula; however, there was no statistically significant difference between GOS supplemented formula and human milk groups. Stool characteristics were influenced by the supplement and main fecal SCFA (acetic), and stool frequency were significantly increased in infants fed with GOS supplemented formula and human milk, while the fecal pH was significantly decreased as compared with that of negative control (P < 0.05). Supplementation had no influence on incidence of side effects (including crying, regurgitation and vomiting).</p><p><b>CONCLUSIONS</b>Supplementing infant formula with GOS at a concentration of 0.24 g/dl stimulates the growth of Bifidobacteria and Lactobacilli in the intestine and stool characteristics are similar to in term infants fed with human milk.</p>