Polysaccharide hydrogel containing silver nanoparticle@catechol microspheres with photothermal, antibacterial and anti-inflammatory activities for infected-wounds repair.

Anti-infection hydrogels have recently aroused enormous attraction, particularly in the treatment of chronic wounds. Herein, silver nanoparticle@catechol formaldehyde resin microspheres (Ag@CFRs) were fabricated by one-step hydrothermal method and subsequently encapsulated in hydrogels which were developed by Schiff base reaction between aldehyde groups in oxidized hyaluronic acid and amino groups in carboxymethyl chitosan. The developed polysaccharide hydrogel exhibited microporous structure, high swelling capacity, favorable mechanical strength, enhanced tissue adhesion and photothermal activities. Additionally, the hydrogel not only ensured long-term and high-efficiency antibacterial performance (99.9 %) toward E. coli and S. aureus, but also realized superior cytocompatibility in vitro. Moreover, based on the triple antibacterial strategies endowed by chitosan, silver nanoparticles and the photothermal properties of catechol microspheres, the composite hydrogel exhibited excellent anti-infection function, significantly downregulated inflammatory factors (TNF-α and IL-1ß) and promoted in vivo infected-wound healing. These results demonstrated that the polysaccharide hydrogel containing Ag@CFRs has great potential for infected-wounds repair.

Quantifying multi-dimensional services of water ecosystems and breakpoint-based spatial radiation of typical regulating services considering the hierarchical clustering-based classification.

This study proposes a set of water ecosystem services (WES) research system, including classification, benefit quantification and spatial radiation effect, with the goal of promoting harmonious coexistence between humans and nature, as well as providing a theoretical foundation for optimizing water resources management. Hierarchical cluster analysis was applied to categorize WES taking in to account the four nature constraints of product nature, energy flow relationships, circularity, and human social utility. A multi-dimensional benefit quantification methodology system for WES was constructed by combining the emergy theory with multidisciplinary methods of ecology, economics, and sociology. Based on the theories of spatial autocorrelation and breaking point, we investigated the spatial radiation effects of typical services in the cyclic regulation category. The proposed methodology has been applied to Luoyang, China. The results show that the Resource Provisioning (RP) and Cultural Addition (CA) services change greatly over time, and drive the overall WES to increase and then decrease. The spatial and temporal distribution of water resources is uneven, with WES being slightly better in the southern region than the northern region. Additionally, spatial radiation effects of typical regulating services are most prominent in S County. This finding suggests the establishment of scientific and rational intra-basin or inter-basin water management systems to expand the beneficial impacts of water-rich areas on neighboring regions.

An intumescent flame-retardant system based on carboxymethyl cellulose for flexible polyurethane foams with outstanding flame retardancy, antibacterial properties, and mechanical properties.

A novel and eco-friendly intumescent flame-retardant system based on sodium carboxymethyl cellulose (CMC) was established for wide-used flexible polyurethane foams (FPUFs). FPUF-(APP6CMC1)GN1 with extremely uniform coatings extinguished and reached the UL-94 V-0 rating, and presented an improvement of thermal insulation properties. Moreover, there was a 58 % reduction in peak heat release rate for FPUF-(APP6CMC1)GN1 compared with that of FPUF, and the microstructure analysis of char residues indicated that a perfect intumescent char layer had formed on the surface of FPUFs. Especially, CMC and GN enhanced the compactness and stability of char layers. Therefore, little volatile production was generated under the protection of physical layers in the high temperature as evaluated during the thermal degradation processes. Meanwhile, the flame-retardant FPUFs remained the ideal mechanical properties and obtained excellent antibacterial properties, and the antibacterial rates of E.coli and S.aureus were 99.9 % (FPUF-(APP6CMC1)GN1). This work provides an eco-friendlier strategy for the design of multi-function FPUFs.

Flame-Retardant Cycloaliphatic Epoxy Systems with High Dielectric Performance for Electronic Packaging Materials.

Flame-retardant cycloaliphatic epoxy systems have long been studied; however, the research suffers from slow and unsatisfactory advances. In this work, we synthesized a kind of phosphorus-containing difunctional cycloaliphatic epoxide (called BCEP). Then, triglycidyl isocyanurate (TGIC) was mixed with BCEP to achieve epoxy systems that are rich in phosphorus and nitrogen elements, which were cured with 4-methylhexahydrobenzene anhydride (MeHHPA) to obtain a series of flame-retardant epoxy resins. Curing behaviors, flame retardancy, thermal behaviors, dielectric performance, and the chemical degradation behaviors of the cured epoxy system were investigated. BCEP-TGIC systems showed a high curing activity, and they can be efficiently cured, in which the incorporation of TGIC decreased the curing activity of the resin. As the ratio of BCEP and TGIC was 1:3, the cured resin (BCEP1-TGIC3) showed a relatively good flame retardancy with a limiting oxygen index value of 25.2%. In the cone calorimeter test, they presented a longer time to ignition and a lower heat release than the commercially available cycloaliphatic epoxy resins (ERL-4221). BCEP-TGIC systems presented good thermal stability, as the addition of TGIC delayed the thermal weight loss of the resin. BCEP1-TGIC3 had high dielectric performance and outperformed ERL-4221 over a frequency range of 1 HZ to 1 MHz. BCEP1-TGIC3 could achieve degradation under mild conditions in an alkali methanol/water solution. Benefiting from the advances, BCEP-TGIC systems have potential applications as electronic packaging materials in electrical and electronic fields.

Drought risk and water resources assessment in the Beijing-Tianjin-Hebei region, China.

Drought is a natural disaster that can influence all aspects of human life owing to its extensive and long-term implications. Global warming and rapid economic development have led to an increase in the drought risk. Meanwhile, rural communities are more drought-susceptible due to their greater closeness to nature and agriculture-based economies. Therefore, the scientific drought risk assessment and water resource utilization are of great significance. Drought risk refers to the potential losses from hazards imposed by drought events, which are a result of combined hazard, vulnerability, and exposure. This study focuses on drought risks in rural areas to provide references for risk assessment, disaster prevention, and water resource allocation. We chose the Beijing-Tianjin-Hebei region (where is water-scarce and suffers severe drought disasters) as the study area. We used the standardized precipitation evapotranspiration index (SPEI) to define the drought events and to extract the drought duration (D) and drought severity (S) according to the run theory. We also established three vulnerability curves based on the loss data, and assessed the risk of the primary industry, rural population, and cultivated areas, then superimposed it on the spatial distribution of water resources. The results indicated that Beijing has a high level of urbanization with a relatively low drought risk, and there are some high-risk areas in Tianjin and southeastern Hebei. Domestic water consumption is stable, and agricultural consumption has decreased. With the rapid increase in green areas in recent years, ecological water consumption has also increased. It has less water and a high-risk level of drought in southern areas. It is crucial to construct emergency water source projects for drought relief and make efficient use of limited water resources available.

Prediction of Spatiotemporal Changes in Sloping Cropland in the Middle Reaches of the Yangtze River Region under Different Scenarios.

With the rapid urban expansion and extensive occupation of cropland, sloping cropland has become an important cropland resource across China. How sloping cropland will change under different socioeconomic scenarios is poorly understood. Therefore, we modeled land-cover change using SSP-RCP multi-scenario simulations and analyzed the evolution and driving factors of sloping cropland change in the middle reaches of the Yangtze River Region (MRYRR). The results indicate the following: In the past twenty years, the cropland and sloping cropland areas in this region declined but the proportion of sloping cropland in total area has been increasing. The average slope of sloping cropland has increased from 7.95° to 8.28°. By 2035, the sloping cropland and total cropland areas will continue to decrease according to the current trend (SSP2-4.5). The average slope will increase maximally to 8.63° under the SSP4-3.4 scenario and minimally to 8.45° under the SSP4-6.0 scenario. Under SSP4-3.4, the extent of slope increase will exceed that in 2005-2010, when regional cropland slope showed the strongest increase in the past. Among 14 social, economic, and ecological factors, average annual precipitation and GDP contributed the most to the change in sloping cropland. This study provides support for decision-making in sustainable land resource allocation to balance urban expansion and cropland conservation.

MicroRNA-335-5p alleviates inflammatory response, airway fibrosis, and autophagy in childhood asthma through targeted regulation of autophagy related 5.

Childhood asthma is the most universal chronic disease, with significant cases reported. Despite the current progress in treatment, prognosis remains poor and the existing drugs cause serious side effects. This investigation explored the mechanisms and use of miR-335-5p on childhood asthma therapy. MiR-335-5p and ATG5 expression was analyzed in clinical plasma samples through RT-qPCR. Airway smooth muscle cells (ASMCs) were cultured, and transfected with miR-335-5p mimic, miR-335-5p inhibitor, and pcDNA3.1-ATG5, or co-transfected with miR-335-5p mimic + pcDNA3.1-ATG5. Asthma cell models were constructed through TGF-ß1, and animal models through ovalbumin (OVA). Monocyte-macrophage infiltration in bronchoalveolar lavage fluid (BALF) was determined by May-Grunwald-Giemsa staining, and collagen in lung tissue was assessed via Masson staining. Relationship between miR-335-5p and ATG5 was detected by dual-luciferase assay. Cell proliferation was detected by MTT assay. MiR-335-5p and ATG5 RNA expression was determined by RT-qPCR. Collagen I, collagen III, α-SMA, ATG5, LC3I/II, Beclin-1, and p62 protein expression levels in ASMCs were detected by western blot. MiR-335-5p expression was low, but ATG5 expression was high in childhood asthma. Versus OVA+ mimic NC group, the number of eosinophil and collagen in OVA+ miR-335-5p mimic group were reduced. In contrast to TGF-ß1 + mimic NC group, TGF-ß1 + miR-335-5p mimic group reduced inflammatory, airway fibrosis, and autophagy in ASMCs. ATG5 was miR-335-5p target. Overexpressing ATG5 significantly reversed the inhibitory effects of miR-335-5p on inflammatory response, fibrosis, and autophagy in ASMCs. Overall, the study concludes that MiR-335-5p alleviate inflammatory response, airway fibrosis, and autophagy in childhood asthma through targeted regulation of ATG5.

Unsupervised Hierarchical Clustering Identifies Immune Gene Subtypes in Gastric Cancer.

Objectives: The pathogenesis of heterogeneity in gastric cancer (GC) is not clear and presents as a significant obstacle in providing effective drug treatment. We aimed to identify subtypes of GC and explore the underlying pathogenesis. Methods: We collected two microarray datasets from GEO (GSE84433 and GSE84426), performed an unsupervised cluster analysis based on gene expression patterns, and identified related immune and stromal cells. Then, we explored the possible molecular mechanisms of each subtype by functional enrichment analysis and identified related hub genes. Results: First, we identified three clusters of GC by unsupervised hierarchical clustering, with average silhouette width of 0.96, and also identified their related representative genes and immune cells. We validated our findings using dataset GSE84426. Subtypes associated with the highest mortality (subtype 2 in the training group and subtype C in the validation group) showed high expression of SPARC, COL3A1, and CCN. Both subtypes also showed high infiltration of fibroblasts, endothelial cells, hematopoietic stem cells, and a high stromal score. Furthermore, subtypes with the best prognosis (subtype 3 in the training group and subtype A in the validation group) showed high expression of FGL2, DLGAP1-AS5, and so on. Both subtypes also showed high infiltration of CD4+ T cells, CD8+ T cells, NK cells, pDC, macrophages, and CD4+ T effector memory cells. Conclusion: We found that GC can be classified into three subtypes based on gene expression patterns and cell composition. Findings of this study help us better understand the tumor microenvironment and immune milieu associated with heterogeneity in GC and provide practical information to guide personalized treatment.

An overview of alginates as flame-retardant materials: Pyrolysis behaviors, flame retardancy, and applications.

Alginates, a kind of naturally occurring polysaccharides, have been exploited for functional materials owing to their versatility, sustainability, nontoxicity, and relatively low cost. Inherent flame retardancy is one of the most attractive features of alginates, as it enables the high-value-added utilization of alginates for eco-friendly flame-retardant materials. Now, the influence of metal ions on the flame retardancy and pyrolysis behaviors of alginates has been systematically studied; besides, the applications of alginates for flame-retardant materials have been greatly developed, such as for preparing flame-retardant fibers, fabrics, aerogel composites, and foams, as well as serving as a component or modifier of functional coatings, hybrids, and additives. This review will give an overview of the recent progress and the prospects of using alginates in flame-retardant fields, which can guide the design of bio-based flame retardants and benefit the further development of more diverse applications of alginates.

Fully bio-based coating from chitosan and phytate for fire-safety and antibacterial cotton fabrics.

In this study, a fully bio-based coating was constructed by layer-by-layer deposition of chitosan (CS) and ammonium phytate (AP), to obtain fire-safety and antibacterial cotton fabrics. With about 8% weight gains of CS/AP coatings, the treated cotton fabrics self-extinguished in the vertical burning test. The data obtained from cone calorimetry showed CS/AP/cotton had much lower smoke and heat production, which indicated the fire safety of the fabrics was significantly improved for the presence of CS/AP coatings. The flame-retardant mechanism of this system was finally proposed according to the analysis of gaseous products and char residues. What is more, CS/AP coatings had higher antibacterial activity in Gram-negative bacteria and did improve the tensile strength of cotton fabrics compared with AP coating. With its ease of operation and use of non-toxic chemicals, this fully bio-based coating can further offer a feasible flame-retardant and antibacterial solution of the inflammable natural fabrics.

Detection of epidermal growth factor receptor mutation in the peripheral blood of patients with esophageal carcinoma to guide epidermal growth factor receptor-tyrosine kinase inhibitor treatment.

OBJECTIVE: This study aimed to explore the epidermal growth factor receptor (EGFR) mutation in the peripheral blood of patients with esophageal carcinoma and analyze the relationship between EGFR-tyrosine kinase inhibitor (EGFR-TKI) therapeutic effect and EGFR mutation in peripheral blood. METHODS: A retrospective analysis was performed on 66 patients with esophageal carcinoma treated with EGFR-TKI (Gefitinib) from February 2014 to March 2017 in our hospital. Real-time polymerase chain reaction was applied to detect the mutation of the EGFR gene in peripheral blood specimens before patients were treated with EGFR-TKI. The relationship between EGFR mutation in the peripheral blood and clinical features of patients were analyzed. The correlation between EGFR mutation in peripheral blood and EGFR-TKI treatment response was also demonstrated. RESULTS: Among the 66 patients, 18 cases were determined as EGFR mutation in peripheral blood. The mutation rate was 27.3%. Among these patients, it observed 1 case of exon 18 2155G>A mutation, 3 cases of exon 19 2235-2249Del mutation, 5 cases of 2236-2250Del mutation, 1 case of 2254-2277Del mutation, 1 case of L747-A750Del mutation, 3 cases of exon 21 2576T>G mutation, 3 cases of 2497T>G mutation, and 1 case of 2504A>T mutation. EGFR mutation in the peripheral blood of patients with esophageal carcinoma was unrelated to the gender, age, and the location of the tumor (P < 0.05). By contrast, EGFR mutation was related to the pathological types of the patients (P < 0.05). The mutation rate of the EGFR of squamous cell carcinoma patients was significantly higher than that of adenocarcinoma patients (P < 0.05). Among EGFR wild-type patients, 8 cases were stable disease (SD), and 40 cases were progressive disease (PD), after EGFR-TIK treatment. No complete response (CR) and partial response (PR) patients were reported. The overall response rate (ORR) was 0.0%. Among the EGFR mutation group, 5 were SD cases, 5 were PD cases, and 8 were PR cases. No CR case was reported. The ORR was 44.4%. The ORR of the EGFR group was significantly higher than that of the wild-type group (P < 0.05). CONCLUSION: The detection of EGFR mutation in peripheral blood can be applied as an effective index for EGFR-TKI (Gefitinib) treatment in patients with esophageal carcinoma.

Comparison of clinical manifestations and antibiotic resistances among three genospecies of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex.

The Acinetobacter calcoaceticus-Acinetobacter baumannii (ACB) complex has emerged as a high priority among hospital-acquired pathogens in intensive care units (ICUs), posing a challenge to infection management practices. In this study, the clinical characteristics, antimicrobial susceptibility patterns, and patients outcome among genospecies were retrospectively compared. Samples were taken from the tracheal secretions of 143 patients in the ICU. Genospecies of the ACB complex were discriminated by analysis of the 16S-23S rRNA gene intergenic spacer (ITS) sequence. Univariate and multiple variable logistic regression analyses were performed to identify risk factors for infection and mortality. Three genospecies were isolated: A. baumannii (73, 51.0%), A. nosocomialis (29, 20.3%), and A. pittii (41, 28.7%). The results showed that the distribution of infection and colonization among the three genospecies were the same, while A. baumannii was more resistant to common antibiotics than A. nosocomialis and A. pittii. Advanced age, a long stay in the ICU, acute physiology and chronic health evaluation (APACHE) II score, the use of a mechanical ventilator, and previous antibiotic use were risk factors for patient infection. The APACHE II score was a risk factor for mortality in patients with ACB complex isolated from tracheal secretions. Poor outcome of patients with ACB complex isolated from tracheal secretion appears to be related to the APACHE II score rather than genospecies.

Epoxidized soybean oil cured with tannic acid for fully bio-based epoxy resin.

The construction of fully bio-based epoxy resins (EP) has been of particular interest in both academia and industrial circles for years; among these, epoxidized soybean oil (ESO) derived thermosets have received the most attention, but they usually exhibit poor performance due to their flexible fatty chains. Herein, tannic acid (TA), with its great degree of functionality and massive aromatic structures, was chosen as the multi-phenol curing agent for ESO to prepare fully bio-based EP thermosets with a high relaxation temperature and satisfactory mechanical properties. As a natural 2-substituted imidazole-containing substance, histidine (H) was used as the curing accelerator under moderate curing conditions (120-180 °C). This EP system showed high curing activity and a good curing degree while operating. The cured thermosets were found to be thermally stable (T 5% > 270 °C) and displayed a high relaxation temperature (77 °C) with a tensile strength of 23 MPa. Preliminary adhesion tests showed that the cured product exhibited a high lap-shear strength of about 19 MPa in adhesion failure mode. Taking these advantages into account, this kind of fully bio-based EP could introduce more chances for versatile applications, such as being used in structural materials and construction adhesives.

[Association between S100B gene polymorphisms and hand, foot and mouth disease caused by enterovirus 71 infection].

OBJECTIVE: To investigate the association between rs9722 polymorphisms in the S100B gene and hand, foot and mouth disease (HFMD) caused by enterovirus 71. METHODS: A total of 124 HFMD children with enterovirus 71 infection were enrolled as subjects, and 56 healthy children were enrolled as control group. The rs9722 polymorphisms in the S100B gene were detected for both groups, and the serum level of S100B protein was measured for 74 HFMD children. RESULTS: The rs9722 locus of the S100B gene had three genotypes, CC, CT, and TT, and the genotype frequencies were in accordance with Hardy-Weinberg equilibrium. Compared with the control group, the HFMD group had significant increases in the frequencies of TT genotype and T allele (P<0.01). Children with severe HFMD caused by enterovirus 71 infection had significantly higher frequencies of TT genotype and T allele than those with moderate or mild HFMD (P<0.05). Compared with the cured patients, the patients with poor prognosis had significant increases in the frequencies of TT genotype and T allele in the rs9722 locus of the S100B gene (P<0.05). Among the 74 children with HFMD, the children with TT genotype had the highest serum level of S100B protein, and those with CC genotype had the lowest level (P<0.01). CONCLUSIONS: T allele in the rs9722 locus of the S100B gene might be a risk factor for severe HFMD caused by enterovirus 71 infection.

A Digital Lock-In Amplifier for Use at Temperatures of up to 200 °C.

Weak voltage signals cannot be reliably measured using currently available logging tools when these tools are subject to high-temperature (up to 200 °C) environments for prolonged periods. In this paper, we present a digital lock-in amplifier (DLIA) capable of operating at temperatures of up to 200 °C. The DLIA contains a low-noise instrument amplifier and signal acquisition and the corresponding signal processing electronics. The high-temperature stability of the DLIA is achieved by designing system-in-package (SiP) and multi-chip module (MCM) components with low thermal resistances. An effective look-up-table (LUT) method was developed for the lock-in amplifier algorithm, to decrease the complexity of the calculations and generate less heat than the traditional way. The performance of the design was tested by determining the linearity, gain, Q value, and frequency characteristic of the DLIA between 25 and 200 °C. The maximal nonlinear error in the linearity of the DLIA working at 200 °C was about 1.736% when the equivalent input was a sine wave signal with an amplitude of between 94.8 and 1896.0 nV and a frequency of 800 kHz. The tests showed that the DLIA proposed could work effectively in high-temperature environments up to 200 °C.

An effective intervention to improve the cleanliness of medical lead clothes in an orthopedic specialized hospital.

Dirty medical lead clothes, contaminated with blood or other infected material, may carry ongoing bioburden, which increase the risk of hospital-acquired infection. In this study, we investigated medical lead clothes contamination levels and assessed the effectiveness of the intervention that was constructed to improve the cleanliness of lead clothes.

Analysis 320 coal mine accidents using structural equation modeling with unsafe conditions of the rules and regulations as exogenous variables.

Mining has been historically considered as a naturally high-risk industry worldwide. Deaths caused by coal mine accidents are more than the sum of all other accidents in China. Statistics of 320 coal mine accidents in Shandong province show that all accidents contain indicators of "unsafe conditions of the rules and regulations" with a frequency of 1590, accounting for 74.3% of the total frequency of 2140. "Unsafe behaviors of the operator" is another important contributory factor, which mainly includes "operator error" and "venturing into dangerous places." A systems analysis approach was applied by using structural equation modeling (SEM) to examine the interactions between the contributory factors of coal mine accidents. The analysis of results leads to three conclusions. (i) "Unsafe conditions of the rules and regulations," affect the "unsafe behaviors of the operator," "unsafe conditions of the equipment," and "unsafe conditions of the environment." (ii) The three influencing factors of coal mine accidents (with the frequency of effect relation in descending order) are "lack of safety education and training," "rules and regulations of safety production responsibility," and "rules and regulations of supervision and inspection." (iii) The three influenced factors (with the frequency in descending order) of coal mine accidents are "venturing into dangerous places," "poor workplace environment," and "operator error."

Gefitinib single drug in treatment of advanced esophageal cancer.

OBJECTIVE: The objective of this study is to evaluate the clinical efficacy and toxicity of gefitinib single drug in treatment of advanced esophageal cancer. MATERIALS AND METHODS: Forty-one case of advanced esophageal cancer were included from February 2012 to June 2016 in the Department of Oncology, Huaihe Hospital of Henan University. All of the included 41 cases were pathology or cytology confirmed of esophageal cancer with advanced stage with previously chemotherapy regimen of cisplatin or fluorouracil. The patients received gefitinib 250 mg/day orally until disease progression or development of unbearable drug-related toxicity. The objective response rate, overall survival, disease-free survival, and drug-related toxicity were recorded. RESULTS: All of the 41 cases had evaluable lesions with complete response rate of 0.0% (0/41), partial response rate of 4.9% (2/41), stable disease rate of 34.1% (14/41), and progression disease rate of 61.0% (25/41). The objective response rate and disease control rate were 4.9% (2/41) and 39.0% (25/41), respectively. At the follow-up, end-point of October 2016, we observed 33 death of the included 41 patients with median disease progression time of 2.2 months and median survival time of 6.1 months; most of the drug-related toxicity was Grade 1-3 nonhematological toxicity with the incidence of Grade 1-2 rash of 51.2% (21/41), Grade 3-4 rash of 17.1% (7/41), Grade 1-2 diarrhea of 26.8% (11/41), Grade 3-4 diarrhea of 7.3% (3/41), Grade 1-2 nausea and vomiting of 14.6% (6/41). CONCLUSION: Gefitinib can improve the survival rate and quality of life in patients with advanced stage esophageal cancer who failed for first-line chemotherapy.

[Clinical characteristics and prognostic factors of children with critical hand-foot-mouth disease treated with mechanical ventilation].

OBJECTIVE: To investigate the clinical characteristics of children with critical hand-foot-mouth disease (HFMD) who were treated with mechanical ventilation and to explore the risk factors for poor prognosis. METHODS: The clinical data of 63 children with critical HFMD who were admitted to the pediatric intensive care unit between April 2012 and September 2013 and needed mechanical ventilation were retrospectively analyzed. RESULTS: Among the 63 children, 43 were boys and 20 were girls, and their mean age was 25 ± 18 months, with 81% under 3 years old. The four death cases were all under three years old. Compared with the cured cases, the death cases had a significantly lower mean age (8 ± 3 months vs 25 ± 18 months; P<0.05). Poor peripheral circulation above the elbow or knee joint, pulmonary edema involving at least two thirds of the lung field, and pulmonary hemorrhage were all closely related to death (P<0.01). The death cases and cured cases had significantly different peripheral white blood cell counts, blood lactic acid, and blood glucose (24 ± 11× 109/L vs 12 ± 5×109/L; 6.6 ± 1.8 mmol/L vs 3.6 ± 1.7 mmol/L; 16.4 ± 2.5 mmol/L vs 10.0 ± 3.0 mmol/L). The cases with critical illness score <90 had a significantly higher death risk (P<0.01). CONCLUSIONS: Children with critical HFMD are mainly under 3 years old. The children face extremely high risk of death when they suffer from poor peripheral circulation above the elbow or knee joint, pulmonary edema involving at least two thirds of the lung field, and pulmonary hemorrhage. Significant increases in peripheral white blood cell counts, blood lactic acid, and blood glucose are risk factors for poor prognosis. Critical illness score is also related to poor prognosis.