Lymphocyte subsets in children with hemophagocytic lymphohistiocytosis (HLH) and its clinical significance.

OBJECTIVE: To study the peripheral blood lymphocyte subsets in children with hemophagocytic lymphohistiocytosis (HLH) in acute period as well as remission period, and compare them with healthy children to investigate the significance of lymphocyte subsets in the diagnosis, treatment, and prognosis in children with HLH. PATIENTS AND METHODS: From January 2009 to March 2014, 30 HLH patients were enrolled in this study. Among them, 20 were placed in the remission group, while 10 cases were placed in the death group. 6 cases died within 8 weeks due to the illness, and 4 cases died within 9 to 34 weeks. 30 children who were confirmed healthy after physical check-ups in the same period were enrolled in the control group. Peripheral blood was collected from both groups and lymphocyte subsets were studied using flow cytometry. RESULTS: The ratios of CD3+ T and CD8+ T cells increased in the HLH remission group and the death group, while CD4+, CD4+/CD8+ and CD3-CD16+CD56+NK ratios decreased. Difference detected in the proportion of CD19+ B cells was not statistically significant. By comparing lymphocyte subsets in the HLH acute period and the remission period in HLH patients we discovered that the differences in CD3+, CD8+, CD4+ and CD4+/CD8+, CD19+ B cells ratios were not statistically significant (p > 0.05). CD3-CD16+CD56+NK cells ratios in the remission period increased significantly. CONCLUSIONS: The lymphocyte subsets in children with HLH underwent obvious changes and there was an imbalance in cellular immunity. We believe that dynamic detection of changes may help us to evaluate the prognosis and the effect of the treatment.

The application of critical pathway management to resident doctor's standardized training in pediatrics.

OBJECTIVE: To further guide the standardized training work of the resident doctor and apply critical pathway management to resident doctor's standardized training. MATERIALS AND METHODS: The traditional training contents were adjusted. The main research content of evaluating the results of standardized training was designed, and the research method was adopted by the standardized training of the resident doctor. RESULTS: The resident doctors of the group with the new teaching method demonstrated a high participation rate. Because of the constraint of the standardized training, trainers would pay more attention to their training. CONCLUSIONS: The clinical pathway polishes up the ability of resident doctors, further guiding the standardized training work of a resident doctor.

The pathogenic detection for 126 children with diarrhea and drug sensitivity tests.

OBJECTIVE: To investigate the cause of infective diarrhea in children, special distribution of the infection and the drug sensitivity. PATIENTS AND METHODS: We carried out pathogenic detection and drug sensitivity tests for one hundred and twenty-six children with diarrhea, including 67 children in infant group (0-<1 year) and 59 children in child group (1-5 years). RESULTS: Fat particles and starch particles were seen in most stool samples under microscope; 42 kinds of pathogenic bacteria were obtained from 126 stool samples, including 10 Diarrheagenic E. coli (8 Enteropathogenic E. coli and Enteroinvasive E. coli); there were found 53 positive samples in the detection of anti-rotavirus antibody in 126 stool samples; in the drug sensitivity tests for major pathogenic bacteria, Staphylococcus aureus, Shigella, Salmonella and Diarrheagenic E. coli were highly sensitive. CONCLUSIONS: The abuse of antimicrobial agents may result in intestinal disorders, leading to aggravation in diarrhea and antimicrobial agents based on drug sensitivity tests may be served as fundamental treatment of diarrhea for children.

Evaluation of the role of 8-iso-PGF levels at multiple sites during intracranial hemorrhage in pediatric patients.

OBJECTIVE: The present study was planned to explore the role of 8-isomeric-prostaglandinF2α (8-iso-PGF2α) levels at the multiple sites of cerebrospinal fluid in children with intracranial hemorrhage. PATIENTS AND METHODS: 90 children with intracranial hemorrhage were admitted to Surgery Intensive Care Unit (SICU) of our hospital from January to December 2013 and were selected as study subjects. They were divided into group A (n=30), group B (n=30) and group C (n=30). The group A was given conventional treatment, the group B was treated with minimally invasive puncture and the group C was treated with cerebrospinal fluid decompression. After 1 d, 2 d, 3 d, and 7 d of hospitalization, enzyme-linked immunosorbent assay (ELISA) was used to detect the 8-iso-PGF2α levels in peripheral blood of children in all groups. On the day of admission and 10 d after treatment, 3 groups of children were implemented with brain nuclear magnetic resonance spectroscopy for metabolite analyses. RESULTS: On the day of admission there were no significant differences in the 8-iso-PGF2α levels among group A, B and C. Further, after 1 d, 3 d, 7 d of hospital stay, the 8-iso-PGF2α levels in peripheral blood showed a gradual downward trend, and decline range of the group C was greater than that of group A and B (p < 0.05). After 10 days of treatment, there were significant differences in the bilateral temporal lobe and hippocampal NAA/Creatinine (Cr), Cho/Cr, mI/Cr and NAA/mI among group A, B, and C. The survival rate of group C was higher than that of group A and B (p < 0.05). On the other hand, the prevalence of sequelae was significantly lower than that of group A and B (p < 0.05). The amount of blood loss in children with intracranial hemorrhage was positively correlated with the levels of 8-iso-PGF2α in peripheral blood (r = 0.546, p < 0.05) as observed by Spearman correlation analysis. CONCLUSIONS: 8-iso-PGF2α plays an important role in the pathogenesis of intracranial hemorrhage, and could be utilized as a biomarker of oxidative stress in children with intracranial hemorrhage. Further, cerebrospinal fluid decompression is a better method of treatment for intracranial hemorrhage.

[Neonatal bowel perforation successfully treated by conservative treatment: report of two cases].

Neonatal bowel perforation is a potentially lethal disease whose etiology and pathophysiology remain unclear. An aggressive approach with surgical intervention has been favored by some authors; otherwise, a high mortality rate was reported. In recent time, peritoneal drainage under local anesthesia for critically-ill premature infants with complicating perforation of necrotizing enterocolitis has had good results. Two cases of such perforation are reported. Case 1, a full-term baby was delivered by spontaneous delivery. Bowel perforation was found on the second day after birth. Case 2, a 27-week gestational age, premature baby, was delivered by emergent Cesarean section because of maternal placenta previa with massive vaginal bleeding. Bowel perforation was found, after feeding, on the seventh day after birth. Both sets of parents refused any surgical procedure, but the infants survived under medically conservative treatment, and the use of peritoneal drainage. This technique may be considered for neonates with bowel perforation if a surgical procedure is unsuitable or unacceptable.

[Ossification of the posterior longitudinal ligament of the cervical vertebrae and myelopathy].

6 cases of OPLL of the cervical vertebrae (OPLL = Ossification of the Posterior Longitudinal Ligament), all diagnosed by CT or X-ray, are reported in this paper. With a review of relevant literature and clinical manifestations of the 6 patients, the incidence, clinical features, diagnosis, differential diagnosis of OPLL and the relationship between OPLL and myelopathy are discussed. It is pointed out that OPLL usually appears as a myelopathy.