Expression of Serum HMGB1 and CD14 mononuclear Toll-like Receptors in Children with Hemophagocytic Syndrome and Their Effect on Prognosis / 中国实验血液学杂志

OBJECTIVE@#To detect the expression of serum HMGB1 and CD14 monocyte Toll-like receptors in children with hemophagocytic syndrome (HPS), and to analyze its effect on the prognosis of children.@*METHODS@#Eight-three children with HPS admitted in Department of pediatrics of Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were selected and enrolled in HPS group, at the same time 50 healthy children with same age were selected and enrolled in control group. The peripheral blood of children in 2 groups was collected. The flow cytometry was used to detect the expression of Toll-like receptors (TLR2, TLR4 and TLR6) in peripheral blood CD14 monocytes, the ELISA was used to detect the expression of HMGB1 in serum of peripheral blood. The relationship of TLR2, TLR4, TLR6 and HMGB1 expression with the clinical parameters, short-term therapentic efficacy and prognosis was analyzed, the relation of TLR2, TLR4 and TLR6 expression with HMGB1 also was analyzed.@*RESULTS@#The expression of TLR2, TLR4 and TLR6 on surface of CD14 monocytes and fluorescence intensity in HPS group were significantly higher than those in control group (P＜0.05). The serum HMGB1 level in HPS group was significantly higher than that in control group (P＜0.05). The expression levels of TLR2, TLR4, TLR6 and HMGB1 in HPS children who were in acute phase or had decrease of albumin or hemoglobin levels, thrombocytopenia, neutrophil absolute value to low and increase of triglycerides level, in HPS group all significantly increased, the difference in children with different sex and age was no statistically significant (P＞0.05). After treatment, the expressions of TLR2, TLR4, TLR6 and HMGB in CR and NAD groups was significantly lower than that before treatment (P＜0.05), while the expressions levels of TLR2, TLR4, TLR6 and HMGB in AD and RD groups were no statistically significant different from those before treatment (P＜0.05); the expressions levels of TLR2, TLR4, TLR6 and HMGB in dealth group all were higher than those in survival group (P＜0.05). The serum HMGB1 levels in HPS children positively correlated with expression of TLR2, TLR4 and TLR6 on CD14 monocytes (P＜ 0.05).@*CONCLUSION@#The expression rate and level of TLR2, TLR4 and TLR6 on CD14 monocytes in HPS children are significantly higher than those in healthy children.The expression levels of TLR2, TLR4, and TLR6 positively correlate with serum HMGB1 content, which provides reference for the diagnosis and prognosis of children with HPS.

Efficacy of analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety of different analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit (PICU).</p><p><b>METHODS</b>Eighty children with mechanical ventilation in the PICU who needed analgesic and sedative treatments were equally and randomly divided into midazolam group and remifentanil+midazolam group. The sedative and analgesic effects were assessed using the Ramsay Scale and the Face, Legs, Activity, Cry and Consolability (FLACC) Scale. The following indices were recorded for the two groups: vital signs, ventilator parameters, organ function, total doses of remifentanil and midazolam, duration of mechanical ventilation, length of PICU stay, PICU cost, and incidence of adverse events.</p><p><b>RESULTS</b>Satisfactory sedation was achieved in the two groups, but the remifentanil+midazolam group had a significantly shorter time to analgesia and sedation than the midazolam group. The remifentanil+midazolam group had a significantly higher percentage of patients with grade 3-4 on the Ramsay Scale and a significantly lower dose of midazolam than the midazolam group (P<0.05). Both groups showed decreases in heart rate (HR), mean arterial pressure (MAP), and spontaneous breathing frequency (RRs) after treatment. However, the remifentanil+midazolam group had significantly greater decreases in HR at 3-24 hours after treatment and MAP and RRs at 3-12 hours after treatment than the midazolam group (P<0.05). Compared with the midazolam group, the remifentanil+midazolam group had significantly higher ventilator tidal volume and transcutaneous oxygen saturation at 6 and 12 hours after treatment and significantly lower end-tidal carbon dioxide partial pressure at 6 and 12 hours after treatment (P<0.05). The remifentanil+midazolam group had significantly shorter time to awake, extubation time, duration of mechanical ventilation, and length of PICU stay than the midazolam group (P<0.05). There were no significant differences in PICU cost, incidence of adverse events, and hepatic and renal functions before and after treatment between the two groups (P>0.05). Both groups showed a significant decrease in fasting blood glucose level after treatment (P<0.05).</p><p><b>CONCLUSIONS</b>For children with mechanical ventilation in the PICU, remifentanil+midazolam treatment can rapidly achieve analgesia and sedation, improve the effect of mechanical ventilation, and reduce the dose of sedative compared with midazolam alone, and is well tolerated.</p>

Clinical value of serum procalcitonin in evaluating severity of infant muggy syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the correlation between serum procalcitonin (PCT) level and severity of infant muggy syndrome (IMS) and the predictive value of PCT in the development of multiple organ dysfunction syndrome (MODS) in children with IMS.</p><p><b>METHODS</b>Fifty children with IMS were classified into two groups according to the presence of MODS: MODS (n=29) and non-MODS (n=21). According to a 30-day follow-up result, they were classified into survival (n=36) and deceased groups (n=14). Vital signs, routine biological measurements (arterial blood gas, blood routine, CRP, liver and kidney functions, myocardial enzyme and so on) and the disease severity evaluated by the Pediatric Critical Illness Score (PCIS) within 24 hours of admission were recorded. Serum levels were measured using the semi-quantitative PCT-Q test within 24 hours of admission.</p><p><b>RESULTS</b>Forty-seven children (94%) had elevated serum PCT levels (≥ 0.5 ng/mL) at admission. There were lower PCIS scores, higher rates of MODS and higher levels of serum PCT in deceased patients than survivors (P<0.05). There was a significant negative correlation between serum PCT levels and PCIS scores (r=-0.84, P<0.05). Serum PCT levels in the MODS group were significantly higher than in the non-MODS group (P<0.01). Receiver operating characteristic curve showed that, if the cut-off point of serum PCT level was 10.6 ng/mL, the sensitivity and specificity of PCT were 79.3% and 90.5% respectively, in predicting MODS, with the area under the curve of 0.924 ( P<0.01).</p><p><b>CONCLUSIONS</b>Serum PCT level at admission is correlated with the severity of IMS and it may be an early predictive marker of MODS.</p>

Effect of hyperoxia on p53 and PCNA expression in fetal rat lung fibroblasts / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of hyperoxia exposure on the expression of p53 and proliferating cell nuclear antigen (PCNA) in fetal rat lung fibroblasts (LFs).</p><p><b>METHODS</b>Primary rat embryonic LFs were cultured in vitro. LFs grew to subconfluence and then were randomly divided into air and hyperoxia exposure (95% O₂, 5% CO₂) groups. After LFs were cultured for 12 and 24 hours, the proliferation was analyzed by MTT. p53 mRNA level was detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR). p53 and PCNA protein levels were determined by Western blot.</p><p><b>RESULTS</b>After 12 and 24 hours of culture the growth inhibition rate of LFs was 8% and 23% respectively in the hyperoxia exposure group. p53 mRNA and protein levels increased significantly (P<0.01) in the hyperoxia exposure group after 12 and 24 hours of culture compared with the air exposure group. Hyperoxia exposure decreased PCNA expression after 24 hours of culture (P<0.01).</p><p><b>CONCLUSIONS</b>Hyperoxia exposure increases p53 level and decreases PCNA expression, resulting in inhibitions of LFs proliferation and DNA repair.</p>

Invasive fungal infections in the pediatric intensive care unit: a clinical analysis of 38 cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features of invasive fungal infections (IFI) in the pediatric intensive care unit (PICU) and, to provide a basis for the effective prevention and treatment of IFI.</p><p><b>METHODS</b>Retrospective analysis was performed on the clinical features and treatment outcomes of 38 children with IFI who were admitted to the PICU of Wuhan Children's Hospital between January 2009 and August 2012.</p><p><b>RESULTS</b>Pulmonary fungal infection (89%) was the most common among the 38 cases. Before diagnosis of IFI, all patients had severe underlying diseases and received several broad-spectrum antibiotics, including carbapenems, which were used in 95% of cases; 47% of all cases had been treated with corticosteroids systemically; all patients had received invasive operations, and 47% of them had undergone endotracheal intubation and mechanical ventilation. None of these cases had either typical clinical symptoms and signs or specific imaging findings. Fifty-six strains of fungi were isolated, with Candida albicans (41%), Aspergilli (25%), and Mucor (20%) being the most common ones. All patients received timely antifungal therapies, 15 cases were cured and 16 cases showed improvements, with a response rate of 82%, and the rate of adverse events was 16%.</p><p><b>CONCLUSIONS</b>In the PICU, the respiratory tract is the most common site of IFI infection, and Candida albicans is the leading pathogen. Severe underlying diseases, use of broad-spectrum antibiotics and corticosteroids, and invasive operations are the main risk factors for IFI in the PICU. Early diagnosis and timely treatment with high-performance antifungal drugs can improve the prognosis in children with IFI.</p>

Risk factors and antibiotic resistance of pneumonia caused by multidrug resistantAcinetobacter baumannii in pediatric intensive care unit / 世界急诊医学杂志（英文）

@#BACKGROUND: With beta-lactam drugs and immunosuppressants widely used, the infection caused byAcinetobacter baumannii (Ab) has become more and more serious with multidrug resistant Acinetobacter baumannii (MDRAb) emerging and worsening rapidly. Compared with other patients, the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit (PICU) because of immune deficiency, severe basic diseases, prolonged hospitalization and invasive operations. Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children. METHODS: A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb (NMDRAb) pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children's Hospital. Clinical data were analyzed with univariate and multivariate Logistic regression. RESULTS: In 176 clinical strains ofAcinetobacter baumannii isolated, there were 128 strains of MDRAb, accounting for 72.73％. Drug susceptibility tests showed that the resistance rates of β-lactam antibiotics were more than 70％ except for cefoperazone sulbactam. The rates to carbapenems were higher than 90％. They were significantly higher than those of NMDRAb. Amikacin, levofloxacin, ciprofloxacin and minocycline had the lowest drug-resistance rates (<20％). Multivariate Logistic regression revealed that ICU stay, the time of mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia. CONCLUSIONS: MDRAb is an important opportunistic pathogen to pneumonia in PICU, and its drug-resistance is severe. It increases significantly the mortality of patients. It is important to take the effective prevention measures for controlling it.

Effects of mitomycin C on membrane permeability and ultrastructure changes in human pterygium fibroblasts / 中华实验眼科杂志

Background Mitomycin C (MMC) has an inhibitory effect on the growth and proliferation of human pterygium fibroblasts,however,there is little literature about its influence on plasma membrane. Objective This study was to investigate the influence of MMC on the physical and chemical features and ultrastructures of plasma membrane. Methods Human pterygium tissues were obtained during the surgery.Human pterygium fibroblasts were primarily cultured and passaged using explant cultured method and identified by Vimentin staining.The third generation of cells were incubated to 96 well plate at a density of 5 × 103 cells/well,and 0,50,100,200,300 and 400 mg/L MMC was added in the culture well respectively to act for 12 hours.Cell viability was assayed using cell counting kit-8 ( CCK-8 ),and cellular apoptosis was detected using annexin V-FICT/PI.The changes of cell membrane structure were examined under an atomic force microscope.Malondialdehyde( MDA ) content in cell supernatant and level of lactate dehydrogenase ( LDH ) in extracellular fluid were detected to assess the lipid peroxidation level and permeability of cell membrane.Intracellular Ca2+ changes and membrane surface topography were assessed by Fluo-3/AM mark and flow cytometry( FCM ).This study was approved by Ethic Commission of Affiliated First Hospital of Jinan University.Informed consent was obtained from each patient. Results A lot of cells grew with the shape of spindle 1-2 weeks after culture.Positive response was seen in cultured cells for Vimentin.Growth and proliferation of the cells reduced 12 hours after action of MMC with the increase of MMC concentrations.The apoptosis rate of human pterygium fibroblasts was 4.2％,4.2％,5.4％,19.3％ and 25.8％ in 0,50,100,200 and 300 mg/L MMC groups respectively.Different degrees of abnormalities of cells membrane were found in various concentrations of MMC groups.The elevated contents of LDH and MDA in extracellular fluid were detected in various concentrations of MMC groups compared with the control group,and the LDH and MDA levels were gradually ascended as the increase of MMC concentrations,with a significant difference between any two groups(P＜0.05).The disturbance of intracellular Ca2+ homeostasis was also been seen after MMC acted. Conclusions MMC leads to the changes of physical and chemical features in human pterygium fibroblasts at a dose-dependent manner.Cell membrane may be the acting target of MMC.

Distribution and antibiotic resistance of pathogens isolated from ventilator-associated pneumonia patients in pediatric intensive care unit / 世界急诊医学杂志（英文）

@#BACKGROUND: With mechanical ventilation widely used in intensive care unit, the ventilator associated pneumonia (VAP) has become a common and serious complication in critically ill patients. Compared with adults, the incidence of VAP and the mortality are higher in children in pediatric intensive care unit (PICU) because of immune deficiency, severe basic diseases, and increased use of artificial airway or mechanical ventilation. Hence it is of significance to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence and mortality of VAP in children. METHODS: From January 2008 to June 2010, 2758 children were treated in PICU of Wuhan Children's Hospital. Among them, 171 received mechanical ventilation over 48 hours in PICU, and 46 developed VAP. The distribution and drug-resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed. RESULTS: A total of 119 pathogenic microbial strains were isolated. Gram-negative bacilli (G-) were the most (65.55％), followed by fungi (21.01％) and gram-positive cocci (G+, 13.45％). Among them, the most common pathogens were Acinetobacter baummannii, Escherichia coli, Klebsiella pneumoniae, candida albicans and coagulase-negative staphylococci. Antibiotic susceptibility tests indicated that the multiple drug-resistances of G- and G+ to antibiotics were serious. Most of G- was sensitive to ciprofloxacin, amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. The susceptibility of G+ to vancomycin, teicoplanin and linezolid were 100％. Fungi were almost sensitive to all the antifungal agents. The primary pathogens of VAP were G-, and their multiple drug-resistances were serious. CONCLUSION: In clinical practice we should choose the most sensitive drug for VAP according to pathogenic test.

Protective Effect of Hyperoxia Liquid on Multiple Organ Damage during Ischemic Reperfusion Injury in Infants with Muggy Syndrome / 实用儿科临床杂志

0.05).But after the treatment,there were significant increases in pa(O2),SaO2 and PCIS(Pa0.05).Conclusions Early application of hyperoxia liquid could decrease multiple organ anoxia and the damage of lipid peroxidation.It has obviously protective effects on multiple organ damage during ischemic reperfusion in infants with muggy syndrome.

Clinical Analysis of Pulmonary Fungal Infection in 40 Children in Intensive Care Unit / 实用儿科临床杂志

Objective To investigate the risk factors of pulmonary fungal infection in intensive care unit(ICU),and discuss the strategy of prevention and treatment.Methods Forty children with pulmonary fungal infection in ICU of Wuhan Children's Hospital from Jan.2003 to Jan.2007 were analyzed retrospectively,including primarily diseases,application of antibiotics,adrenal cortical hormone and virulence operation,therapy and turnover.Results All children were accepted the therapies of broad spectrum antibiotics and glucocorticoids for long time before definite diagnosis of pulmonary fungal infection.Seventy-five percent children were received invasive operations or therapies.Their average time of stayed in hospital was 37.8 d.The clinical symptoms and imaging examinations were untypical.Blastomyces albicans was the main pathogen.After the antifungal agents and supportive treatment used in time,35 cases(87.5%) were cured and 5 cases(12.5%) died.Conclusions The major risk factors of children pulmonary fungal infection are long-time use of broad spectrum antibiotics and glucocorticoids.The pulmonary fungal infection can decrease by rational use of broad spectrum antibiotics and glucocorticoids,decreasing the unnecessary invasive operations,strengthening the supportive therapies of micro-ecosystem,and applying the antifungal agents in time.

Significance of Endothelin-1 and Interleukin - 8 Levels in Tracheal Aspirates of Children with Acute Respiratory Distress Syndrome / 实用儿科临床杂志

Objective To investigate the role of endothelin - 1( ET-1) and interleukin-8( IL-8) in tracheal aspirates (TA) in children with acute respiratory distress syndrome(ARDS). Methods The levels of ET- 1 and IL - 8 in TA of 13 patients with ARDS and 11 controls were assayed by enzyme - linked immunosorbent assay. Lung injury score was applied to all patients. Results The levels of ET-1 and 1L-8 in TA were significantly higher in ARDS than those in controls (P