Adolescent ; Humans ; Lung ; diagnostic imaging ; pathology ; Lung Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Papilloma ; diagnostic imaging ; pathology ; surgery ; Pneumonectomy ; methods ; Tomography, X-Ray Computed

Objective To discuss the clinical feature of cholestasis preterm infants who have used parenteral nutrition early after birth,and analyze the relative factors and preventive meatures of parenteral nutrition associated cholestasis (PNAC).Methods We retrospectively analyzed the preterm infants who were born and hospitalized at Shengjing Hospital of China Medical University from January,2011 to April,2016.There were 89 cases in total that used at least 2 weeks of parenteral nutrition in the early stage after birth and were developed to cholestasis afterwards.We divided 89 cases into PNAC group and multifactor group:the former was corresponded to PNAC diagnosis standards,accounting for41 cases (46.07％);the latter with other etiology in addition to parenteral nutrition accounts for 48 cases.The clinical characteristics were studied and analyzed using case-control method.Results The sex ratio of premature cholestasis was 2.18:1,the mean gestational age was (31.05 ±2.15) weeks,the mean birth weight was (1360.55 ±421.14) g,and the mean using-time of parenteral nutrition was (26.22 ± 9.78) d.Futhermore,PNAC group was divided into hepatitis group and non-hepatitis group according to the alanine aminotransferase level,and they both had statistical significance in gestational age,starting time of parenteral nutrition,appearance time of jaundice,enteral feeding time,starting dose of amino acid,maximum dose of fat emulsion (P ＜ 0.05).We divided them into long-term group (≥20 d) and short-term group (＜ 20 d) according to the using time of parenteral nutrition.The level of alanine aminotransferase,glutamic oxalacetic transaminase,total bilirubin,direct bilirubin and bile acid of longterm group was higher than those of short-term group,but with P≥0.05.The multifactor group was mostly accompanied with multiple infections in the order of bacterial infection (75.0％),fungal infection (20.83％),cytomegalovirus infection (8.33％) and syphilis infection (2.08％),etc.The other complication's incidence rate of PNAC group and multifactor group had no statistical significance.In terms of prognosis,the liver function of two group improved remarkably than before,with PNAC group having more significance (P ＜0.05).Conclusion PNAC is the major factor of preterm cholestasis,and the degree of liver damage of PNAC preterm was related to starting time of parenteral nutrition,using time of parenteral nutrition,enteral feeding time,starting dose of amino acid and maximum dose of fat emulsion.The liver function of PNAC group is recovered obviously through regulatory treatment,and it possesses a better prognosis than multifactorgroup.

Immune thrombocytopenia (ITP) of childhood is the most common hemorrhagic disease which is characterized by isolated thrombocytopenia.Depending on individual patient characteristics,appropriate initial management for newly diagnosed ITP may be either watchful waiting or pharmacologic intervention.The main options for initial pharmacologic intervention include a single dose of intravenous immune globulin(IVIG) and/or a short course of glucocorticoids.For ITP children with severe or life-threatening bleeding,it is recommended that both platelet transfusions and the combination of pharmacotherapy.Approximately 20 percent of children who present with ITP will progress to chronic ITP(CITP).Children who develop CITP should have an additional evaluation to exclude other disorders.The pharmacologic options for CITP include Rituximab,and thrombopoietin (TPO)/TPO receptor agonist (Romiplostim or Eltrombopag).Combination therapy and novel immunological targeting drugs become more effective treatment options.Splenectomy is only suit for a small number of children with chronic refractory ITP patients who present significant and persistent hemorrhagic symptoms requiring repeated pharmacologic interventions.

OBJECTIVE To discuss effective methods of nosocomial infection management in disinfection supply division to control the nosocomial infection and improve quality of medical care.METHODS We established the overall arrangement of disinfection supply to strenthen the cleaning,packing and sterilization management for the recycled medical instruments,storage and distribution of the aseptic products,as well as the occupational exposure and protection among the staff in there,to establish the effective nosocomial infection management organization in whole hospital,particularly in disinfection supply division,to study technology of hospital infection,and to enhance the consciousness in control of nosocomial infection.RESULTS The medical safety was improved and nosocomial infection was controlled effectively.CONCLUSIONS The scientific management in disinfection supply division,is the main path way to control nosocomial infection.

Recently,the Society of Critical Care Medicine and the European Society of Intensive Care Medicine sponsored a 19-member Task Force to update the definitions of sepsis and septic shock at the forty-fifth Critical Care Medicine Annual Meeting in February 2016.Owing to an increased understanding of the harmful systemic response to infection,members of the multidisciplinary task force proposed that sepsis now be defined as life threatening organ dysfunction caused by a dysregulated host response to infection.To standardize the assessment of organ dysfunction,the Task Force members propose that provider use the sequential organ failure assessment(SOFA) score and quick SOFA (qSOFA).Although the systemic inflammatory response syndrome(SIRS) standard has high sensitivity and low specificity,the mortality of sepsis in the world has decreased significantly in the past 20 years.With the gradual realization of sepsis 3.0,will SIRS really be completely out of the stage of history? The SOFA and qSOFA criteria is not suitable for children.The author thinks that SIRS standard still has its practical application value.We need further studies on how to improve the sensitivity and specificity of sepsis diagnosis at the same.We should continue to validate sepsis 3.0.

Objective To evaluate the application value of the hematology analysis combined with genetic diagnosis in the prena-tal diagnosis of thalassemia.Methods 2 368 parturients were performed the prenatal diagnosis of thalassemia in the prenatal diag-nosis center of our hospital from July 2010 to April 2013,and those with positive hematological screening detection were performed the genetic diagnosis.Results The hematology analysis results showed 124 parturients of abnormal HbA2.The hematology analy-sis results in the abnormal parturients had the statistical difference compared with those in the rest healthy parturients (P <0.01). Among 124 pregnant women of hematological positive phenotype,there were 16 couples with the same genotype,in these 16 preg-nant women,15 cases were performed the prenatal diagnosis of thalassemia,there were 7 cases of αthalassemia gene,2 cases of βgenotype,6 cases of normal genotype,3 cases of severe fetal thalassemia,including 2 cases of α-thalassemia(genotype--SEA/--SEA ),1 case ofβ-thalassemia(genotype 41-42/IVS-Ⅱ-654).All pregnant women terminated pregnancy after informing the patients.Conclu-sion The hematology analysis combined with genetic diagnosis plays an important role in the construction of perfect thalassemia prenatal detection and diagnosis intervention mode,and is worthy of popularization and application.

Objective To investigate the application value of fluorescence in situ hybridization (FISH)in prenatal diagnosis and compared with karyotype analysis of cells from amniotic fluid.Methods A total of 183 high-risk pregnant women received for a FISH and karyotype analysis who taken prenatal disgnosis in Meizhou people′s hospital between April 2012 and November 2013. Results According to the test results of karyotype analysis.There were 9 cases of chromosomal abnormality in 183 pregnant women.Among 9 cases,3 cases were trisomy 21,3 cases were trisomy 18,2 cases were XO and one case of XXY.One case of tri-somy 18 was showed normal using the FISH.Other cases were consistent with karyotype analysis result.Conclusion FISH is a rapid,reliable and prompt prenatal diagnosis method,combined with karyotype analysis will maximize the detection efficacy in pre-natal diagnosis of chromosome abnormalities.

Henoch-Sch?nlein purpura ( HSP ) is the most common disease with small vasculitis as the main pathological changes in childhood. Gastrointestinal symptoms as the main clinical manifestations are called abdominal type allergic purpura,some children show abdominal symptoms before skin purpura,even without skin purpura during the whole course of disease,which usually leads to misdiagnose. This article summaries the clini-cal diagnosis and treatment progress of abdominal type allergic purpura.

Objective To analyse the differences between idiopathic and symptomatic childhood epilepsy with occipital patoxysms. Methods The medical records of 38 patients with interictal spikes and/or sharp waves over occipital areas,posterior temporal-parietal areas,or both were retrospectively analysed.Epidemiological data,ictal symptoms,electroencephalogram,neuroimaging studies,treatment response and prognosis were compared using chi-square test or Mann-Whitney U test. Results Four patients of idiopathic group had positive family history related to nervous system.Seizures were more frequent in symptomatic group than in idiopathic group.Both groups showed autonomic symptoms,while ictal vomiting and deviation of eyes were more common in the presence of Panayiotopoulos type.The prognosis of idiopathic group was much better than that of symptomatic group. Conclusion Panayiotopoulos syndrome is more common.Neurologic deficits and electroencephalographic characteristics are major factors to predict seizure remission in children with occipital lobe epilepsy.Idiopathic childhood epilepsy with occipital paroxysms may result in better prognosis.

Disrupted pancreatic ?-cell function and decreased ?-cell number are two of the main causes of type 2 diabetes mellitus.Recent studies have indicated that autophagy plays an important role in protecting pancreatic ?-cell and in maintaining the structure,number,and secretive function of pancreatic ?-cell.Although autophagy has been a focus of study in recent years,including areas such as tumor,neural diseases and aging,but its relationship with pancreatic ?-cell was not included.In this paper we review the concept of autophagy and its role in maintaining the normal function of pancreatic ?-cells.