For the children,viral encephalitis is a common infectious disease of central nervous system,which is characterized by high incidences,unfavourable prognosis and high mortality rate.The Japanese encephalitis virus,herpes simplex virus,enteroviruses,EB virus,cytomegalovirus are the common pathogens.There are some emerging virus also cause encephalitis,such as west nile virus,borna disease virus,banna virus,nipah virus and so on.It is of significance for the doctors and scientific research personnels to study the pathogens of viral encephalitis.

Objective To investigate the mechanism of apoptosis induced by endoplasmic reticulum stress during sepsis.Methods Septic model of H9C2 cells was established by lipopolysaccharide (LPS).CHOP mRNA,mitochondrial membrane potential (MMP) and apoptosis were assessed by real-time PCR,flow cytometry respectively at LPS administration 24 h with or without salubrinal (inhibitor of endoplasmic reticulum stress).Results The expression of CHOP mRNA and apoptosis were upregulated,but MMP was decreased after LPS exposure 24 h compared with control group[2.40 ±0.30 vs 1.00 ±0,(16.58 ±2.71) ％ vs (3.85 ± 1.07) ％,1.07 ± 0.33 vs 2.62 ± 0.51,P ＜ 0.05).Compared with LPS group,salburinal pretreatment decreased LPS-induced upregulation of CHOP mRNA (1.60 ± 0.23 vs 2.40 ± 0.30,P ＜ 0.05),meanwhile,salburianl alleviated MMP(1.85 ± 0.31 vs 1.07 ± 0.33,P ＜ 0.05) and LPS-induced apoptosis [(6.05 ± 1.48) ％ vs (16.58 ± 2.71) ％,P ＜ 0.05].Conclusion Salubrinal plays a cytoprotective role against apoptosis induced by LPS through inhibition of CHOP mRNA,which leads to mitochondrial impairment.Endoplasmic reticulum stress may induce apoptosis via mitochondrial pathway in the septic model of H9C2 cardiomyocytes.

Objective To silence the expression of tissue factor(TF) gene of human umbilical vein endothelial cell(HUVECs) of the newborns with placental abruption(PA) and normal newborns.Methods There were two groups in the experiment,normal group and PA group.Three different treatments were established in each group:(1) the blank; (2) the false-intervention ; (3) the TF gene silencing.There were three samples in each treatments.After these treatments,the changes of mRNA expression of the HUVECs were observed before and aftcr thc gene silencing and the changes of the immunofluorescence of the TF protein level.Results After amplificated,plasmid DNA were sequenced to show that the pENTRTM/U6-TF-shRNA was the positive clone.After the transfected,the levels of the mRNA of TF decreased from 0.657 ± 0.097 to 0.220 ± 0.030 and 1.323 ± 0.323 to 0.207 ± 0.150 in the normal and PA group respectively.Compared with the normal group,there were significant differences for the levels of TF mRNA in PA group with the blank,(1.323 ± 0.323 vs 0.657 ± 0.097,P =0.023) and the same result for the second management (1.057 ±0.178 vs 0.540 ± 0.079,P =0.01).But there was no significant difference between the normal and PA group after RNA interference gene silencing (0.220 ± 0.030 vs 0.207 ± 0.150,P ＞ 0.05).Meanwhile,there were significant differences among the three managements in the themselves groups of normal and pathological ones(F =19.30,P =0.002 ;F =27.66,P =0.001).Conclusion The vectors are transfected into HUVECs and play the biological function.And they silence the expression of TF mRNA.PENTRTM/U6-TF-shRNA could inhibit the expression of TF mRNA of HUVECs in the PA newborn.

Sepsis is systemic inflammatory response syndrome associated with infection.Early recognition of severe sepsis or septic shock,early hemodynamic resuscitation and the immediate initiation of effective intravenous anti-infective therapy are the cornerstones in the management of patients with sepsis.The infectious microorganisms associated with sepsis in pediatric patients vary with the patient's age and immune status.Initial empirical antimicrobial therapy should include one or more drugs that have activity against all likely pathogens and that penetrate in adequate concentrations into the presumed source of sepsis.Empirically therapy should be de-escalated to the most appropriate single therapy as soon as the susceptibility agent is known.

Objective To investigate the effect of hyperoxia on the expression and transport function of epithelial sodium channel (ENaC) in neonatal rat alveolar epithelial type Ⅱ(AT Ⅱ) cells.Methods AT Ⅱ cells were isolated from neonatal rats,and primarily cultured under hyperoxic or normoxic conditions.Western blot was applied to examine the ENaC expression,and the amiloride-sensitive Na + currents were recorded using the whole-cell patch clamp technique.Results Hyperoxia upregulate the expression of β-ENaC and γ-ENaC subunits in the neonatal rat ATⅡ cells(β-ENaC:1 d:0.43 ±0.06 vs0.32 ±0.04,P =0.047;2 d:0.73±0.06 vs 0.50±0.08,P =0.019;3 d:0.72 ±0.08 vs 0.52 ±0.06,P =0.027;γ-ENaC:1 d:0.64±0.05 vs0.53 ±0.05,P =0.044;2 d:0.76 ±0.03 vs 0.52 ±0.04,P =0.001 ;3 d:0.77 ±0.06 vs 0.61 ±0.05,P =0.025).In addition,the amiloride-sensitive Na+ currents in hyperoxia-exposed AT Ⅱ cells were also increased (1d:13.71 ±2.77 vs8.92±1.38,P＜0.001;2d:29.12±11.03 vs 10.41 ±1.80,P＜0.001),which was consistent with the upregulated expression of β-ENaC and γ-ENaC.However,the expression of α-ENaC was inhibited by hyperoxia to some extent (1 d:0.31 ± 0.05 vs 0.46 ± 0.05,P =0.025 ; 2 d:0.30 ±0.01 vs0.38±0.02,P=0.002;3d:0.37±0.06 vs 0.37 ± 0.08,P =0.983).Conclusion Hyperoxia enhanced the transport function of ENaC in neonatal rat AT Ⅱ cells.Dysfunctional transport of Na + may not be a key factor involving in pulmonary edema at the early stage of bronchopulmonary dysplasia.

Objective To summarize the management of cardiopulmonary bypass(CPB) for infants below 10 kilograms with congenital heart diseases.Methods From Jan 2010 to Apr 2011,the clinical datas of 122 infants aged from 1.5 months to 2 years with body weight 3 to 10 kilograms,who underwent open heart surgery under mild or moderate hypothermia CPB were retrospectively analyzed.Results Among all the 122 infants,CPB time was 13 ～ 118 min [(62.69 ± 21.48) min],aortic cross-clamp time was 0 to 86 min [(35.47 ± 19.51) min].All patients were spontaneous resuscitation and successfully weared from the machine,no severe complications associated with CPB occurred,3 infants died (2.46％,3/122) after operation.Conclusion Using membrane oxygenator,circuit tubing and artery filter with less priming,and highflow perfusion during CPB,maintaining hemodynamics stable,holding reasonable hematocrit and colloid osmotic pressure,good myocardial protection and ultrafiltration are the significant elements of the management of CPB in infants with weight less than 10 kilograms.

Objective To analyze the risk factors for perioperative mortality in children after total correction of tetralogy of Fallot (TOF),in order to provide better operation and decrease the mortality rate.Methods We enrolled 191 TOF patients including 142 males and 49 females at Chengdu Cardiovascular Hospital between Jan 2003 and Dec 2010.The age ranged from 4 months to 12 years.Preoperative,perioperative and postoperative clinical data of all patients were corrected and the risk factors for mortality after total correction of TOF were analyzed.Results Among all the 191 cases,6 cases death (3.14％) occurred in early postoperative,the main causes of death were postoperative infection with multiple organ failure (3 cases),low cardiac output syndrome (2 cases),cerebral complications (1 cases).Among them,2 children (6.67％,2/30) died in age≤6 months,1 child (1.41％,1/71)died in age ranged from 6 months to 3 years,3 children (3.33％,3/90) died in age ranged from 3 years to 12 years.The results of logistic regression and model selection indicated that age ≤ 6 months (OR =4.606,95 ％ CI 1.811 ～ 11.719,P ＜ 0.05),percutaneous oxygen saturation ＜ 70％ before operation (OR =0.982,95％ CI 0.501 ～ 1.932,P ＜ 0.01),Nakata index ＜140 mm2/m2(OR =16.960,95％ CI 1.414 ～ 150.390,P ＜ 0.01),cardiopulmonary bypass time ＞ 150 min (OR =4.398,95 ％ CI 2.091 ～ 9.216,P ＜ 0.01) and multiple organ failure (OR =4.872,95 ％ CI 2.583 ～9.192,P ＜0.05)were risk factors for early postoperative death after total correction of TOF.Conclusion Postoperative mortality in children after total correction of TOF can be predicted by risk factors of age,percutaneous oxygen saturation,Nakata index,cardiopulmonary bypass time,and multiple organ failure.

Objective To explore perinatal risk factors associated with the neurobehavioral development of small for gestational age (SGA) full-term neonates.Methods This prospective cross-sectional study included 111 full-term newborn infants from Apr 2008 to Apr 2010 born in Yan-tai Yuhuangding Hospital.Detailed clinical data in perinatal period of all subjects were recorded.Infants aged 3 ～ 7 days were assessed with neonatal behavioral neurological assessment (NBNA) for neurobehavioral development.Logistic regression analysis was used to explore risk factors associated with the score of NBNA.Results Significant differences (P ＜ 0.05) were found between full-term SGA (10.72 ± 1.41,7.13 ± 0.96,7.32 ± 0.74,37.16 ±1.32) and normal neonates (11.27 ± 1.04,7.89 ± 0.72,7.62 ± 0.64,39.12 ± 0.76) in terms of capacity,active and passive muscle tension and NBNA score.Full-term SGA neonates had lower score than control.Univariate logistic regression showed that delivery,placenta abnormalities,umbilical cord abnormalities,infection in perinatal period,gestational hypertension,twin pregnancy,hyperbilirubinemia affected neurobehavioral development of full-term SGA infants.Multivariate logistic regression showed that mothers' infection in perinatal period (OR =2.175,95 ％ CI 1.981 ～ 2.408,P ＜ 0.05),twin pregnancy (OR =1.936,95％ CI 1.517 ～2.368,P ＜ 0.05) and hyperbilirubinemia (OR =1.518,95％ CI 1.072-2.149,P ＜ 0.05) were risk factors for neurobehavioral delay of full-term SGA infants.Conclusion Full-term SGA neonates showed poorer quality in neurobehavior.Risk factors associated with neurobehavior of full-term SGA infants included mothers' infection in perinatal period,twin pregnancy and hyperbilirubinemia.

Objective To observe the efficacy and safety of different initial doses of nebulized budesonide inhalation (BI) in infants and young children with moderate to severe asthma exacerbations.Methods A multi-center,parallel controlled clinical trial was performed during Sep 2008 to Apr 2010 in three hospitals,which were Department of Pediatrics,Shanghai Jiaotong University Affiliated Shanghai First People's Hospital,Department of Pediatrics,Shanghai Jiaotong University School of Medicine Affiliated Xinhua Hospital,and Department of Respiratory,Fudan University Affiliated Children's Hospital.One hundred and fifty children aged 6 to 36 month with moderate to severe asthma exacerbations were randomly divided into two groups.The high-starting-dose group was treated with a dose of 1 mg nebulized BI every 8 h for 2 days,while the conventional-starting-dose group was treated with a dose of 0.5 mg cvcry 8 h for 4 days.The terbutaline sulfate aerosol liquid was administered with a dose of 2.5 mg each time as needed.The primary outcome measures were severity scores,which were assessed at admission (0 h),and 8 h,16 h,24 h,48 h,72 h after treatment separately.The secondary outcome measures included the use of β2 receptor agonist,the systemic use of corticosteroids,average length of hospital stay and total cost.The data was analyzed with SPSS 13.0.Results (1) The clinical severity scores were significantly decreased at all time points after treatment in both groups (P ＜ 0.05).Compared with conventional starting-dose of BI,high starting-dose of 3.25 ± 1.82,P ＜ 0.01).(2) The terbutaline doses and the systemic corticosteroids do-ses were significantly reduced in high-starting-dose group compared with conventional-starting-dose group [(16.27 ± 12.99) mg vs (22.90 ± 18.27) mg,P ＜ 0.05 ; (4.54 ± 18.18) mg vs (11.16 ± 21.34) mg,P ＜ 0.05).The average length of hospital stay and the total cost of the two groups showed no significant differences (P ＞ 0.05).(3) There were no side effects associated with BI.Conclusion Compared with conventional treatment,high-starting-dose of BI can control symptoms fast and reduce the use of systemic corticosteroid without any side effects.BI improved symptoms more quickly at 8 h (2.87 ± 1.60 vs 4.48 ± 2.24,P ＜ 0.01) and 16 h (2.48 ± 1.56 vs

Objective To assess the efficacy and safety of two different protocols of ketogenic diet (KD)-eating on demand or eating at regular intervals for refractory epilepsy in children.Methods Sixty children with refractory epilepsy were randomly divided into eating on demand group (n =30) and eating at regular intervals group (n =30) by random number table method.After taking the whole amount of KD,the capillary blood ketone and glucose level and urine ketone were monitored every 6 hours in 72 continuous hours.Seizure frequency and onset time were recorded.Antiepileptic efficacy and diet tolerability of the two groups were evaluated on 4 weeks,12 weeks,24 weeks and 48 weeks after initiating the diet.Adverse effects were monitored.Results After treatment of 4 weeks,the complete seizure remission rates of eating on demand group and eating at regular intervals group were 33.3％ (10/30) and 30.0％ (9/30) respectively,which suggested a comparable efficacy for two groups (P ＞ 0.05).The day when KD started to work was averaged (6.18 ± 2.42) d and (8.63 ± 2.63) d respectively.The group of eating on demand showed a faster onset of action (P ＜0.05).After treatment of 12 weeks,24 weeks and 48 weeks,complete seizure remission rates of eating on demand group were 30.0％ (9/30),34.8％ (8/23) and 36.8％ (7/19) respectively;the eating at regular intervals group were 33.3％ (10/30),30.4％ (7/23) and 44.4％ (8/18) respectively.The two groups had no significant difference (P ＞ 0.05).One year later,the treatment retention rates of the two groups were 63.3 ％ (19/30) and 60.0％ (18/30) respectively.There was no significant difference (P ＞ 0.05).The adverse effects mainly including transient gastrointestinal symptoms and metabolic disturbances were mostly tolerable and curable.Conclusion The two different protocols of KD-eating on demand and eating at regular intervals are both effective and well-tolerated for refractory epilepsy in children.While protocol of eating on demand is more easier to achieve ketotic state and the effect is more quickly,so it can be more easily received by children.Therefore in clinical practice,we can choose flexible eating time according to children's eating habits,which can improve the therapeutic compliance.