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Objective:To explore more clinical characteristics and outcomes of children with severe pneumonia induced by adenovirus type 7(Adv-7).Methods:Seventy children with severe pneumonia induced by Adv-7 admitted to the pediatric intensive care unit of Guangzhou Women and Children′s Medical Center from January 2016 to October 2019 were enrolled.The clinical features, treatments and outcomes of these children were recorded.Results:(1)There were 43 males(61.4%)and 27 females(38.6%). Thirty(42.9%)patients were 0-12 months old, 28(40.0%)patients were 13-36 months old, and 12(17.1%)patients were over 36 months old.(2)The average onset time of severe pneumonia induced by Adv-7 was(11.87±7.10)days before being admitted to PICU.The average sequential organ failure assessment score was 6.80±3.13.The average Murray lung injury score was 2.49±1.15.The average P/F value was(150.57±86.25)mmHg(1 mmHg=0.133 kPa). Sixty-four cases(91.4%)were involved in two or more area of lung on X-rays.All cases were diagnosed with sepsis.(3)Laboratory examination: white blood cell count was(7.6±5.5) ×10 9/L, platelet count was(238.8±164.2)×10 9/L, and C-reactive protein was(39.4±37.2)mg/L.(4)Treatments: intravenous gamma globulin was used in 65 cases(92.9%). Intravenous glucocorticoid was used in 45 cases(64.3%). Fiberoptic bronchoscopy was performed in 43 cases(61.4%). Blood purification treatment was performed in 21 cases(30%). Sixty-three patients(90.0%)were treated with non-invasive or invasive ventilator, high frequency ventilator-assisted ventilation was used in 20 cases(28.6%). Surfactant was used in six cases(8.6%). Extracorporeal membrane oxygenation was used in 19 cases(27.1%). (5)The average treatment time for ventilation was(13.10±11.58)days.The average time for temperature recover was(4.69±4.01)days in PICU.The average PICU stay time was(15.76±12.20)days.The average length of stay was(27.04±13.10)days.There were 16 patients died and the mortality was 22.9%. Conclusion:The children with severe pneumonia induced by Adv-7 were critical and had significant lung injuries.Suffering from active clinical treatment such as extracorporeal membrane oxygenation, some of these patients still had poor prognosis.
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Objective:To explore the clinical effect of high-titer plasma in the treatment of severe viral pneumonia in children.Methods:A total of 80 eligible children with severe viral pneumonia in intensive care unit of Guangzhou Women and Children Medical Center were enrolled in this retrospective study from January 2016 to June 2019, According to whether high-titer plasma was used or not, patients were divided into the high-titer plasma group (40 cases) and non-high-titer plasma group (40 cases). Chi-square test, Fisher's exact probability test and Mann-Whitney U test were used to compare the basic data, infection indicators, blood gas and ventilator parameters related indicators, treatment and prognosis of the two groups. Results:There were no significant differences in age, sex, admission weight, onset days and fever days between the high-titer plasma group and non-high- titer plasma group before entering the study (all P>0.05); There were no significant differences in the worst SOFA score, Murray lung injury score, chest X-ray involvement and sepsis within 3 days (all P>0.05). There were no significant differences in white blood cells, neutrophils and c-reactive protein between the two groups before and after entering the study (day 3 and 7) (all P> 0.05). There were no significant differences in arterial partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide (PaCO 2), lactic acid (Lac), mean airway pressure (MAP), oxygenation index (P/F) and oxygen index (OI) between the two groups before and after entering the study (day 1, 3 and 7) (all P>0.05). There were no significant differences in the use of immunoglobulin, hormone, fiberoptic bronchoscope, blood purification, high frequency ventilator, pulmonary surfactant and extracorporeal membrane between the two groups (all P>0.05). There were no statistical differences in the number of days using invasive ventilator, the number of days staying in PICU and the total length of hospital stay between the two groups (all P>0.05). There was shorter time of the body temperature decreased to normal time in the high-titer plasma group than in the non-high-titer plasma group ( Z=-2.10, P=0.04). The survival rate of the high-titer plasma group was higher than that of the non-high-titer plasma group (85% vs 65%, χ2=4.27, P=0.04). The average daily cost of the high-titer plasma group was less than that of the non-high-titer plasma group, 3 688.38 yuan (2 335.49, 5 741.51) yuan vs 3 979.24 yuan (2 670.68, 9 992.62) yuan, but the difference was not statistically significant (Z=-1.35, P=0.18). No serious adverse reactions were observed during the treatment with high-titer plasma. Conclusions:The treatment of severe viral pneumonia with high-titer plasma can shorten fever time and improve survival rate. High-titer plasma can be used as a safe and effective treatment for severe viral pneumonia.
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Objective@#To investigate the effects of astaxanthin on neuronal injury in hippocampus of rats after acute carbon monoxide poisoning(ACMP) and the relationship with NF-κB inflammatory signaling pathway.@*Methods@#Male SD rats screened by water maze were randomly divided into three group(n=50): control group (NC group), CO poisoning group (COP group), CO poisoning+ astaxanthin group (AST group) . ACMP rat model was established by static inhaled exposure method. Meanwhile, rats in AST group were further given astaxanthin twice a day by gavage.At 1 day, 7 days, 14 days, 21 days and 28 days after CO poisoning (10 rats in each group were selected), the learning and memory abilities were evaluated by Morris water maze test. The pathological changes of the neurons in hippocampal CA1 region were observed by hematoxylin-eosin(HE) staining.The expression and activation of NF-κB in hippocampus were detected by immunoblotting and immunofluorescence, and the expression of TNF-α and IL-6 protein in hippocampus were examined by ELISA.@*Results@#Morris water maze test showed that there were no significant difference in escape latency and crossing platform times between the three groups (P>0.05). Compared with NC group, the escape latency of COP group was prolonged at 14, 21 and 28 days after CO poisoning (t=-6.04, -6.28, -8.18, all P<0.05), and the number of crossing platform was decreased (t= 5.96, 7.85, 6.51, all P<0.05). Compared with the COP group, the escape latency of the rats in AST group at the 14, 21 and 28 days was shortened (t=4.74, 4.82, 5.98, all P<0.05), and the number of crossing platform was increased (t=-3.72, -4.45, -6.53, all P<0.05). Compared with NC group, the number of NF-κ B positive cells in CA1 area of hippocampus in COP group increased at every time point (t=-8.62, -18.00, -16.67, -11.15, -6.22, all P<0.05); the number of NF-κ B positive cells in CA1 area in AST group decreased at 7 d, 14 d, 21 d and 28 d after CO poisoning, the difference was statistically significant (t= 6.55, 6.96, 4.40, 4.17; all P<0.05). Western blot showed that the changes of NF-κB protein was similar to that of immunofluorescence. After 7 days of CO poisoning, the level of NF-κB protein in hippocampus of COP group was (1.44±0.08), it was higher than that of NC group (t=-20.07, P<0.05), while that of AST group was (0.68±0.10), it was lower than that of COP group (t=10.23, P<0.05). The results of Elisa showed that TNF-α and IL-6 in the hippocampus of COP group were higher than those of NC group at every time point(all P<0.05), while compared with COP group, TNF-α and IL-6 in AST group were lower (all P<0.05). After 7 days of CO poisoning, TNF -α in COP group ((39.04±5.29) pg/ml)was higher than that in NC group ((14.13±2.12) pg/ml) (t=-7.58, P<0.05); TNF -α in AST group ((25.77±3.31) pg/ml) was lower than that in COP group (t=3.69, P<0.05). After 7 days of CO poisoning, the level of IL-6 in COP group ((181.79±9.12) pg/ml)was higher than that in NC group ((73.12±11.04) pg/ml) (t=-8.24, P<0.05), and the level of IL-6 in AST group ((121.47±9.80) pg/ml) was lower than that in COP group (t=7.80, P<0.05).@*Conclusion@#The excessive inflammatory response which mediated by NF-κB signaling pathway is involved in ACMP-induced neuronal damage in hippocampus.Astaxanthin can down-regulate the expression of NF-κB inflammatory signaling pathway related proteins, and pave a way for the treatment of ACMP brain damage and cognitive dysfunction.
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Objective To investigate the role of nuclear transcription factor kappa B (NF-κB) -matrix metalloproteinase-9 (MMP-9) signaling pathway in delayed encephalopathy after acute carbon monoxide poisoning (DEACMP). Methods 150 male SD rats were randomly assigned to air control group (AC group) , CO poisoning group (CO group) , pyrrolidine thiocarbamate (PDTC) + CO poisoning group (PC group). DEACMP model was reconstructed by modified intraperitoneal injections. The 1, 3, 7, 14, and 21 d after intraperitoneal injection were observed here by different approaches. Morris water maze test was used to test the learning and memory ability of rats.HE staining was used to observe the morphology of hippocampal CA3 cells. Immunofluorescence and Western Blot methods were used to detect the expression of NF-κB and MMP-9. RT-PCR was used to measure the expression of MMP-9 mRN A. Transmission electron microscopy was used to observe the ultrastructure of synapses. Results After14 days, the average intubation period of CO group was longer than that of AC group (P < 0.05) , and that of PC group was shorter than that of CO group (P < 0.05). However, average intubation period of PC group was longer than that of AC group (P< 0.05). In CO group, the expression of NF-κB in hippocampus increased (day 1). At day 3, the expression of NF-κB rapidly increased. The expression of MMP-9 gene and protein increased in the first three days and then decreased thereafter. The expression of NF-κB and MMP-9 in PC group was lower than that in CO group (P < 0.05) , while it was higher than AC group (P < 0.05). The peak value of apoptosis in CO group was delayed to 7-14 d after exposure, the apoptotic cells in PC group decreased significantly, and it was obvious on the 14 th day.Electron microscopy showed that the damage of synapses ultrastructure in CO group was significantly heavier than that in PC group on the 14 th day. Conclusions NF-κB-MMP-9 signal pathway leads to DEACMP, and PDTC could alleviate the impairment of learning and memory ability in rats with acute CO poisoning.
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Objective To investigate the application value of contrast-enhanced ultrasound(CEUS) time-intensity curve in the radiofrequency ablation treatment of hepatocellular carcinoma.Methods Seventy-six patients with hepatocellular carcinoma (118 tumor lesions) conducted the ultrasound-guided radiofrequency ablation therapy.The acoustic quantitative analysis software was employed to dynamically analyze the residual ablation lesions,which were compared with the examination results of synchronous enhanced MRI,with the pathology as the gold standard,the benign and malignant tumor residual ablation lesions were performed the statistically comparative analysis.Results The accuracy of CEUS effect after liver radiofrequency ablation therapy was 82.2 ％,which of enhanced MRI was 83.9 ％;the difference between CEUS and enhanced MRI had no statistical significance(P＞ 0.05),their examination results had higher consistency;the benign residual ablation lesions after radiofrequency ablation had blood perfusion characteristics different from malignant residual lesions,the time-intensity curve showed that IMAX benign residual lesions were smaller than malignant residual lesions(P＜0.01).The benign residual lesions of RT and TTP were longer than the malignant residual lesions(P＜0.01);diagnosing benign and malignant had no statistical difference between CEUS and enhanced MRI (P＞0.05).Conclusion CEUS combined with the time-intensity curve can dynamically,intuitively and quantitatively reflect the blood perfusion differences among inactivated focus,benign and malignant residual lesions,and the surrounding liver parenchyma.
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Objective To investigate the application value of contrast-enhanced ultrasound(CEUS) time-intensity curve in the radiofrequency ablation treatment of hepatocellular carcinoma.Methods Seventy-six patients with hepatocellular carcinoma (118 tumor lesions) conducted the ultrasound-guided radiofrequency ablation therapy.The acoustic quantitative analysis software was employed to dynamically analyze the residual ablation lesions,which were compared with the examination results of synchronous enhanced MRI,with the pathology as the gold standard,the benign and malignant tumor residual ablation lesions were performed the statistically comparative analysis.Results The accuracy of CEUS effect after liver radiofrequency ablation therapy was 82.2 ％,which of enhanced MRI was 83.9 ％;the difference between CEUS and enhanced MRI had no statistical significance(P＞ 0.05),their examination results had higher consistency;the benign residual ablation lesions after radiofrequency ablation had blood perfusion characteristics different from malignant residual lesions,the time-intensity curve showed that IMAX benign residual lesions were smaller than malignant residual lesions(P＜0.01).The benign residual lesions of RT and TTP were longer than the malignant residual lesions(P＜0.01);diagnosing benign and malignant had no statistical difference between CEUS and enhanced MRI (P＞0.05).Conclusion CEUS combined with the time-intensity curve can dynamically,intuitively and quantitatively reflect the blood perfusion differences among inactivated focus,benign and malignant residual lesions,and the surrounding liver parenchyma.
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Objective To determine the levels of blood pancreatic stone protein/ regenerating protein(PSP/reg)and to explore the value of PSP/ reg in assessing severity and predicting prognosis of sepsis with or without panc-reatic damage. Methods In this prospective study,the clinical data and blood samples to measure PSP/ reg levels in 1,3 and 7 days after admission in the Pediatric Intensive Care Unit,Hunan Children's Hospital,from the children with sepsis from September 2013 to September 2014 were collected. According to levels of pancreatic trypsin(amylase or li-pase),the children were divided into normal group,mildly elevated group(1 - 3 times),and severely elevated group (more than 3 times);based on the condition of sepsis,the children were divided into sepsis group and severe sepsis group. Chi - square test,nonparametric rank sum test,Spearman correlation and area under the receiver operating cha-racteristic curve(AUC),Kaplan - Meier survival curves were used for statistical analysis. Results (1)A total of 226 children with sepsis were included in this study,among them pancreatic trypsin was normal in 159 cases(70. 4% ), pancreatic trypsin mildly elevated in 44 cases( 19. 4% ),and pancreatic trypsin severely elevated in 23 cases (10. 2% );125 cases(55. 3% )were sepsis,and 101 cases(44. 7% ,of which 29 cases were sepsis shock)were severe sepsis.(2)The correlation between PSP/ reg and serum amylase was maximum,while PSP/ reg had some correlation with serum lipase,but there was no correlation with C - peptide,insulin,glucose.(3)When pancreatic trypsin was normal or mildly elevated,severe sepsis group had higher levels of PSP/ reg than that of sepsis group(Z = - 7. 627,- 2. 965,P =0. 000,0. 003);while pancreatic trypsin was severe elevated,there was no significant difference in PSP/ reg levels be-tween sepsis group and severe sepsis group(Z = - 0. 134,P = 0. 894).(4)The AUC of PSP/ reg and procalcitonin to assess severity of sepsis were greater than 0. 7 in the children whose pancreatic trypsin was normal or mildly elevated, and there was no significant difference between them(P ﹥ 0. 05);while the AUC of C - reactive protein and WBC were less than 0. 7.(5)PSP/ reg levels gradually increased in non - survival children in 3 and 7 days,while survival children gradually declined. The AUC of PSP/ reg to predict prognosis was 0. 775,and 60 μg/ L was viewed as the critical point, sensitivity 89% ,specificity 67% . Children with PSP/ reg levels ≤60 μg/ L had higher rate of survival than children with ﹥ 60 μg/ L(χ2 = 36. 874,P = 0. 000). Conclusions PSP/ reg is closely associated with pancreatic exocrine func-tion,but PSP/ reg still can assess severity and predict prognosis in children with sepsis and pancreatic damage.
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Objective: To explore the approaches and ideas of clinical pharmacists participating in drug therapy of patients with brucellosis. Methods: Clinical pharmacists participated in the clinical consultation for one patient with brucellosis. Clinical pharmacists analyzed comprehensively by asking medical history, occupation and contact history in details, adjusting the treatment scheme and performing medical education etc. Results: The consultation comments and suggestions proposed by clinical pharmacists were recognized by clinics, which played an important role in assisting doctors in the rational drug use and significantly improved the medical treatment. Conclusion: Clinical pharmacists should participate in the individualized medication and help clinicians optimize drug therapy, which can improve the safety and efficacy of medication.
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Objective To compare the value of transvaginal ultrasound and MRI in diagnosis of the first-trimester cesarean scar pregnancy (CSP).Methods The transvaginal ultrasound and MRI data of 28 patients who were initially diagnosed as CSP were analyzed. Regarding the surgery and postoperative pathology as a gold standard,the differences between transvaginal ultrasound and MRI were compared in the sensitivity,specificity,diagnostic coincidence rate and the ability in showing the internal structure of gestational sac and its relationship with the surrounding tissue.Results 22 CSP patients were confirmed by surgical pathology in a total of 28 patients,while 20 CSP patients using transvaginal ultrasound and 1 9 using MRI were correctly diagnosed respectively,and the sensitivity,specificity and diagnostic coincidence rate were 90.9%,50.0%,82.1% vs 86.4%,83.3%,85.7%,respectively,exhibiting no statistical difference in the coincidence rates between two methods (χ2 =0.132,P=0.72 ).The pregnant bursa in 20 patients was found by pathology in 22 CSP patients,and 19 pregnant bursa with transvaginal ultrasound and 17 with MRI were confirmed respectively,exhibiting no statistical difference between two methods (χ2 =1.11,P =0.29).The yolk sac in 12 patients,embryos in 8,original heart tube in 5 and local scar pregnancy sac infiltration in 3 were found with transvaginal ultrasound,meanwhile those in 2,2,0 and 9 respectively were also found with MRI,exhibiting significant differences between the two methods (χ2 =13.8,P =0.000;χ2 =7.7,P =0.006;χ2 =7.2,P =0.007;χ2 =7.1,P=0.008).The pregnancy capsule hemorrhage in 7 patients and hemorrhage in uterine cavity in 9 were found with transvaginal ultrasound, meanwhile those in 14 and 1 5 were found with MRI,exhibiting significant differences (χ2 =6.6,P =0.01;χ2 =5.0,P =0.026). Conclusion The coincidence rate in diagnosis of CSP using transvaginal ultrasound or MRI is higher.Transvaginal ultrasound is superior to MRI in showing the yolk sac,embryos and original heart tube,while MRI is better than transvaginal ultrasound in showing the hemorrhage of uterine cavity or gestational sac and the relationship between pregnant bursa and the surrounding tissue.Combination of the two methods shows more value in early diagnosis of CSP.
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Objective To explore the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in assessing severity and predicting prognosis in children with severe hand-foot-mouth disease (HFMD).Methods A total of 119 eligible children with severe HFMD admitted in the pediatric intensive care unit were enrolled in this retrospective study from March 2012 to March 2014.According to NT-proBNP level,children were divided into ≤ 500 pg/mL group (n =70) and ＞ 500 pg/mL group (n =49) ; whereas according to severity,children were divided into severe-type (n =74) and critical-type (n =45) ; and based on 28 days outcome in children with critical-type HFMD,children were divided into fatal group (n =27) and survival group (n =18).The chi-square test,two-sample t test,rank sum test Pearson or Spearman' s correlation,area under the receiver operating characteristic curve (AUC) were used to analyze 119 children with severe hand-foot-mouth disease (HFMD).Results Within 24 hours after admission,NT-proBNP ＞ 500 pg / mL group had higher rates of fever,abnormal breathing,abnormal heart rate,abnormal systolic blood pressure,capillary refill time ＞ 2 seconds and higher levels of laboratory biomarkers than NT-proBNP ≤ 500 pg/mL group (P ＜ 0.05) ; and during hospitalization,the rates of pulmonary edema,pulmonary hemorrhage and death also higher than NT-proBNP ≤ 500 pg/mL group (P ＜ 0.05).NT-proBNP,BS,WBC were higher in critical-type group than severe-type group (P =0.00),while the PCIS (pediatric critical illness score) was lower in critical-type group (x2 =14.70,P =0.00).NTproBNP was higher in fatal group than that in survival group (t =-2.60,P =0.01),PCIS was lower in fatal group (Z=2.70,P=0.01); and there were no statistically significant differences in BS and WBC between fatal and survival groups (BS:t =-0.60,P=0.55; WBC:t =-0.72,P=0.48).NT-proBNP,BS and WBC were negatively correlated with PCIS (r values were-0.58,-0.46,-0.56,P values were 0.00).The AUCs of NT-proBNP,BS,WBC and PCIS to determine the severity of severe HFMD children were 0.94,0.80,0.74,and 0.97,respectively; and to predict 28 days survival in criticaltype HFMD were 0.73,0.56,0.53,and 0.73,respectively.Conclusions Higher level of NT-proBNP could prompt cardiopulmonary involvement.NT-proBNP could reflect the severity of illness and served as a sensitive marker in predicting 28-day survival,being better than BS and WBC.
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ObjectiveTo explore the value of elevated amylase in assessment of severity of the disease and its inlfuencing factors in critically ill children.MethodThe clinical data from critically ill children hospitalized in pediatric intensive care unit were retrospectively analyzed from November 2009 to June 2014. According to levels of serum amylase, the critically ill children were divided into normal serum amylase group (≤103 IU/L) and elevated serum amylase group (>103 IU/L). The differences between two groups were compared.ResultsA total of 1920 critically ill children were enrolled, most of whom had primary respiratory and neurological diseases. Among them, 1470 children had normal serum amylase (76.6%) and 450 children had ele-vated serum amylase (23.4%). The elevated serum amylase group had signiifcantly higher rate of organs failure (≥4), lower rate of PCIS (<70), higher rate of invasive mechanical ventilation and mortality than those in normal serum amylase group (P<0.001). The correlation of serum amylase with lipase blood, urine amylase, blood urea nitrogen and creatinine were signiifcant (r=0.246 to 0.683,P<0.001). Blood amylase was positively correlated with shock index (r=0.111,P=0.002) and negatively correlated with respiratory failure index (r=0.133,P<0.001).ConclusionsSerum amylase could be used to assess the severity of disease. The elevated amylase was closely related to pancreatic exocrine function, renal function, ischemia, and hypoxia. The elevated serum amylase in critically ill children is a warning sign.
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Pancreatic stone protein (PSP) is the product of exocrine pancreas mainly synthesized and secreted by the pancreas acinar cells, a small amount secreted by gastrointestinal cells. PSP is one of stress protein family members secreted in the pancreas. PSP increased in acute and chronic pancreatitis, diabetes, inlfammatory bowel disease and gastrointestinal tumors. In recent years, some studies showed that PSP has potential clinical value in pancreatic injury and sepsis. In this article, we reviewed the progress of pancreatic stone protein in pancreatic injury and sepsis.
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OBJECTIVE:To probe into the status quo of the drug resistance and the medication of pseudomonas aeruginosa so as to provide references for the clinic in the controlling of pseudomonas aeruginosa infection.METHODS:The susceptive rates of the susceptibility test performed on 148 pseudomonas areuginosa infection cases confirmed in 2004 in our hospital were collected statistically and a whole range tracking statistics were conducted on the use of antibacterials.RESULTS:Pseudomonas aeruginosa had a strong drug resistance,which had a different degree of drug resistance to all antibacterials;Antibiotics like piperacillin/tazobactam,ceftazidime and carbopenem took the lead in terms of their susceptive rates,which stood at 75.68%,73.65%and 70.27%,respectively;The cross resistances of the third generation cephalosporins and the compound agents of the third generation cephalosporins and their enzyme inhibitor were serious and which kept increasing rapidly;The adoption rates for the susceptive kinds were less than 50%before the susceptibility test.CONCLUSION:An effective way to control pseudomonas aeruginosa infection is to conduct strain culture and isolation and perform susceptibility test as early as possible.
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Objective To discuss the foreground of application of reverse engineering reconstruction of dental models and to establish the foundation of developing a system for complete denture CAD/CAM. Methods The models of an edentulous jaw were measured with reverse engineering, and the 3D models were reconstructed with a computer. Results 3D models of the edentulous jaw were achieved. The characteristics of these 3D images were clear and accurate. Conclusion CAD models are reconstructed with reverse engineering accurately and technical problems in 3D model of complete denture CAD/CAM are resolved.
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Objective:To compare color level among Vita,Shofu and Dentsply shade guide. Methods:Vita,Shofu and Dentsply shade guide were scanned into a computer and saved as BMP pictures. L *, a * and b * values of the color of the images were measured by Photoshop. Results:There was same trend of variation in color of the shade guides, but the maximum and minimum of L *, a * and b * in those shade guides were different. Conclusion: For matching color accurately, one shade guide can not be used to replace the other one in clinical application.