Objective To investigate the distribution and drug resistance of bacteria infection in children with pneumonia between pediatric intensive care ward and respiratory ward,in order to guide clinical treatment.Methods From 2010 January to 2014 January,two-hundred and sixty cases of pneumonia in hospitalized pediatric intensive care ward were included in the severe group,300 patients from respiratory ward into the common group,severe group were divided into the mechanical ventilation group (126 cases),non mechanical ventilation (134 cases),mechanical ventilation were divided into invasive ventilation group (94 cases),noninvasive ventilation group (32 cases).Conventional sputum specimens were detected,bacterial culture,identification and drug resistance of pathogenic bacteria ratio were done in each case,to compare the pathogenic bacteria and drug resistance rate of different groups.Results Both severe group and common group,gram negative bacteria were significantly higher than those of gram positive,But in the severe group,gram negative bacteria ratio was significantly higher than the common group (P ＜ 0.05),while the positive bacteria ratio was significantly lower than that of common group (P ＜ 0.05).Stenotrophomonas maltophilia,Acinetobacter and Pseudomonas aeruginosa ratio in severe group were significantly higher than that of common group (P ＜ 0.05),while the Haemophilus influenzae and Streptococcus pneumoniae in common group was significantly higher than the proportion of severe group (P ＜ 0.05).Stenotrophomonas maltophilia,Acinetobacter,Pseudomonas aeruginosa ratio in ventilation group was significantly higher than that of non ventilation group (P ＜ 0.05),and in the invasive ventilation group was significantly higher than the proportion of noninvasive ventilation group (P ＜ 0.05).Multi drug resistant bacteria detection rate in severe group was significantly higher than the common group (P ＜ 0.05).Conclusion Both pediatric intensive care ward and respiratory ward,bacterial lung infections are dominated by Gram negative bacteria,but bacteria spectrum and drug resistance have obvious difference,multi drug resistant bacteria detection rate in pediatric intensive care ward significantly higher than that of respiratory ward.Mechanical ventilation especially invasive mechanical ventilation may easily lead to drug-resistant strains.

Objective To explore the expression and significance of matrix metalloproteinases-9(MMP-9) and tissue inhibitors of matrix metalloproteinase-1(TIMP-1) in serum at acute phase of severe pneumonia in infants.Methods A total of 45 infants of pneumonia were selected and divided into 20 cases of severe pneumonia group and 25 cases of mild pneumonia group according to the severity of the disease,and all 45 infants were also divided into virus group of 24 cases and non-virus group of 21 cases on the basis of etiology.Additionally,20 cases of healthy children who accepted the physical examination at the same time were selected as the control group.Serum levels of MMP-9 and TIMP-1 were detected by using ELISA.Tidal breathing lung function was measured in all selected infants.Results Compared with the control group,the serum levels of MMP-9,TIMP-1 and MMP-9/TIMP-1 ratio of the infants with acute pneumonia were significantly higher,the severe pneumonia group were higher than the mild pneumonia group,and the virus group were higher than the non-virus group(P＜0.05).The ratio of the time to reach peak tidal expiratory flow to total expiratory time (TPTEF/TE) and the volume to reach peak tidal expiratory flow to total expiratory volume(VPTEF/VE) of pneumonia group in recovery period were significantly lower than those in the control group,severe pneumonia group were lower than those in the mild pneumonia group,and the virus group were lower than those in the non-virus group (all P＜0.05).There were no statistically significant about VT/kg among three groups.The serum MMP-9 levels and the MMP-9/TIMP-1 ratio were negatively correlated with TPTEF/TE and VPTEF/VE (r1=-0.459,-0.376; r2=-0.413,-0.327; all P＜0.05).Conclusion The serum levels of MMP-9 and the MMP-9/TIMP-1 ratio in the acute phase of infantile pneumonia are correlated with pneumonia severity and pulmonary function injury in recovery period,and the performance is particularly prominent in the viral pneumonia,and can be used as a prognosis monitoring indicator.

Objectives:To study the postoperative nutritional support in patients with pancreatic disease. Methods:Based on the kind of pancreatic disease,twenty two patients were randomly divided into PN+EN group and TPN group during 20 days after operation.Body weight,the restoring time of intestinal movement,the complications,the blood amylase,the serum glutamic pyruvic transaminase,the blood urea nitrogen,the blood sugar,the serum albumin(Alb),transferritin(TFN) and prealbumin(PAB) were compared on the first,fifth,tenth and twentieth day after operation. Results:Body weight of two groups reduced lightly.The blood amylase decreased remarkably.The functions of liver and kidney were recovered gradually.The blood sugar tended to restore normal.Alb,TFN,PAB of two groups increased remarkably( P

Objective To explore the association between polymorphisms in non-muscle myosin heavy chain 9 gene (MYH9) and hypertension susceptibility in chronic kidney disease (CKD)patients.Methods Five hundred and ninety-five persons,including 301 patients with CKD and 294 healthy controls,were enrolled in the study.Two single nucleotide polymorphisms (SNPs) (rs3752462,rs4821480) were genotyped by TaqMan assay or a restriction fragment length polymorphism assay for a further case-control study.The discrepancies of the patients'quantitive traits (including age,sex,systolic and diastolic blood pressure,frequency of different primary diseases and using different kinds of antihypertensive drugs) among different genotypes of the two MYH9 SNPs were analyzed.Meanwhile,the association between polymorphisms in MYH9 and hypertension susceptibility in CKD patients were analyzed in the rs3752462 site.Results The systolic blood pressure of CT genotype patients [(147.94± 27.40) mm Hg] was significantly higher than that of C C genotype patients [(136.43 ± 19.09)mm Hg] by single factor analysis of variance (P ＜ 0.05).The frequency of using all kinds of antihypertensive drugs for CC genotype patients (7.4％) was lower than that of TT (43.9％) and CT (48.7％) genotype patients (P ＜ 0.05).After correcting the age factor,the result of Logistic regression analysis showed that CC genotype was a protective factor of systolic blood pressure increasing.The probability of high blood pressure for CT genotype patients with CKD was 0.175 times than that of CC genotype (95％ CI 0.071,0.431).Conclusions The CKD patients who carry the rs3752462 site CC genotype of MYH9 gene are not prone to high blood pressure.Polymorphism of MYH9 gene rs3752462 site is associated with systolic blood pressure in CKD patients.It may indicate that allele C mutation for T can lead to the increase in systolic blood pressure.

AIM: To test the contents of tanshinone Ⅱ_A and salvianolic acid B in 56 batches of samples by HPLC,evaluate the current quality of Compound Danshen Tables. METHODS: HPLC,chromatographic conditions: The detection column was Agela-C_(18)(5 ?m,46 mm?250 mm) for tanshinone Ⅱ_A,mobile phase was methanol-water(73(∶)27),UV detection wavelength was set at 270 nm.The flow rate was 1 mL/min.The detection column of Agela-C_(18)(5 ?m,4.6 mm?250mm) was used for salvianolic acid with mobile phase of acetonitrile-methanol-formic acid-water(10(∶)30(∶)1(∶)59). UV wavelength was set at 286 nm.The flow rate was 1 mL/min.(RESULTS:) The most of samples conform to the requirement of Chinese Pharmacopoeia(2005),but the content of tanshinone Ⅱ_A was widely different and three batches of salvianolic acid B were lower than the requirement of Chinese Pharmacopoeia(2005). CONCLUSION: The quality of Compound Danshen Tables will be improved.

Objective To explore the clinical features of methylmalonic acidemia (MMA) in children admitted to the pediatric intensive care unit, to help improve our understanding of MMA. Methods The clinical data of 21 patients with MMA admitted to our PICU from December 2012 to August 2016 were analyzed. Diagnosis were confirmed by gas chromatography-mass spectrometry, GC/MS. Results twenty-four of 158 suspected cases were confirmed as having organic acidemia diseases including 21 cases of MMA, one case of propionic acidemia, one case of urea cycle disorders, and one case of glutaric acidemia. The main clinical manifestations were feeding difficulty, malnutrition (13 cases), developmental retardation (12 cases), lethargy (10 cases), tricuspid severe reflux and pulmonary hypertension (1 case), hydrocephaly (5 cases), muscular dystonia (three cases with hypertonia, and four with hypotonia), convulsion (7 cases), apnea, sobbing respiration (10 cases), chromatosis (6 cases), anemia (13 cases), edema (6 cases), thrombocytopenia (6 cases), hematuria and proteinuria (2 cases). Five cases gave up therapy before diagnosis was made. Sixteen cases received the treatment with Vitamin B12 and supplementation of L-carnitine. Seven cases gave up after treatment without effect or deterioration of condition. Eight cases were vitamin B12-responsive, and one case was vitamin B12-nonresponsive. The follow-up for a period ranging from three months to two years, among eight vitamin B12-responsive cases, 6 cases showed a favorable outcome with apparent improvement, one case had no symptom and one patient died from severe pneumonia. Vitamin B12-nonresponsive case was still alive. Conclusions The clinical manifestations of MMA are non-specific. Urine organic acid analysis is critical to early diagnosis of MMA in high-risk patients. Timely diagnosis and appropriate long-term treatment are essential to improve the prognosis of the disease.

Objective To investigate parenteral nutrition and enteral nutrition therapy for esophageal cancer patients nutritional status improvement.Methods Totally 63 patients with esophageal cancer were chosen,preoperative Nutritional Risk Screening 2002 (NRS2002) nutritional screening through joint after parenteral nutrition and enteral nutrition therapy.Patients with intestinal tolerability and complications after surgery on days 1 and 7 days nutrition indicators were observed,including total serum protein,albumin,prealbumin,hemoglobin,and lymphocyte count.Results Preoperative risk malnutrition occurred in 39 patients.Compared to patients on day 1 after the first 7 days,serum levels had no significant difference in total protein.Albumin,prealbumin,hemoglobin,and lymphocyte counts were significantly different statistical significance (P ＜ 0.05).Conclusions NRS2002 for nutritional screening patients at risk of malnutrition can be determined,and the combined parenteral and enteral nutrition therapies can improve nutritional status of patients with esophageal cancer.

Objective To investigate the role of S100B protein in the pathogenesis of patients with Japanese encephalitis (JE).Methods A total of 45 patients were enrolled in the Second Hospital of Hebei Medical University from August 2013 to October 2013,who were diagnosed as JE on the basis of clinical features and positive IgM antibodies against JE virus measured by enzyme-linked immunosorbent assay (ELISA) from the Center of Disease Control of Shijiazhuang.The JE patients were divided into initial phase group,acute phase group and convalescence group based on the course,mild JE group,moderate JE group and severe JE group based on the severity,MRI-no-lesion group and MRI lesions group based on the imaging findings of JE.Twelve cases with no evidence of infection in central nervous system in the meantime were chosen as control.The S100B protein was measured by ELISA.Results The content of S100B protein in cerebrospinal fluid was as follows:522.76 (393.35,620.37) pg/ml in mild JE group (acute phase group:609.77 (549.27,779.71) pg/ml,convalescence group:420.48 (344.36,453.19) pg/ml),792.09 (705.47,1 108.96) pg/ml in moderate JE group (acute phase group:770.19 (646.31,1 069.54) pg/ml,convalescence group:803.45 (602.90,1 396.84) pg/ml),and 1 021.94 (680.84,1 302.15) pg/ml in severe JE group (acute phase group:981.82 (680.84,1 826.28) pg/ml,convalescence group:989.00 (553.62,1 207.67) pg/ml).The S100B protein content was 561.52 (454.36,814.56) pg/ml,803.45 (602.90,1 104.01) pg/ml,762.22 (594.95,1 044.97) pg/ml,581.76 (442.51,1 069.10) pg/ml in MRI-no-lesion group,MRI lesions group,total acute phase group and total convalescence group,respectively.While in control group,the S100B protein content was 266.71 (205.72,390.05) pg/ml.The contents of S100B protein in moderate JE group,severe JE group,total acute phase group,total convalescence group,MRI-no-lesion group,MRI lesions group were higher than that in control group (H =4.864,5.497,5.075,3.918,2.971,4.981,P =0.000,0.000,0.000,0.000,0.009,0.000).The contents of S100B protein in mild JE group was lower than that in moderate JE group and severe JE group (H =-2.786,-3.514,P =0.032,0.003).Conclusions The level of S100B protein in cerebrospinal fluid is related with the severity,duration and imaging presentation of JE patients.The dynamic monitoring of S100B protein levels is of great significance for assessment of the patients' condition and curative effect.

ing microecological preparation,or continuously pumping EN fluid into the stomach or jejunum may reduce the incidence of diarrhea.

Objective To evaluate the effect of proper nutritional therapy guided by indirect caloimetry . Methods According to the digitaltable ,70 critically ill patients whose APACHE II >5 were randomly divided into oberserving ( nutritional therapy guided by indirect caloimetry ) and control groups ( nutritional therapy guided by harris-benedict formula),each group 35 cases.The results of nutrition support were analysed .Results TP,MAMC,ALB were higher than that before treatment in oberserving group (all P<0.05),the MAMC was also higher than that in control groups(P<0.05).There was no significant difference in Hb and TSF after treatment IN oberserving group (all P>0.05).Conclusion The nutritional therapy guided by indirect caloimetry by harris-benedict formula have the some nutritional effect in critically ill patients .