Objective To analyze the clinical features of the hyperamylasemia in critically ill children and investigate the related risk factors in order to provide the basis for prevention and treatment. Methods A total of 1036 critically ill children admitted in pediatric intensive care unit (PICU)from April,2011 to Oct,2012 were studied.They were divided into the high amylase group (n=82)and the normal group (n=954).According to the outcomes,the high amylase group was divided into survival group (n=61 ) and death group (n =21 ).The related risk factors of the occurrence and outcome of hyperamylasemia were analyzed by univariate and multivariate Logistic regression.Results There were statistically significant differences in rates of coagulation disorders, convulsions, disturbance of consciousness,pediatric critical illness score (PCIS)≤80,multiple organ dysfunction (MODS)≥3, sepsis,shock,and lactic acid (LA),procalcitonin (PCT),blood glucose (BG)between the high amylase group and the normal group (P<0.05 ).The differences in the rates of coagulation disorders,convulsions, mechanical ventilation,PCIS≤80,MODS≥3,and LA,PCT,oxygenation index,albumin,C-peptide,BG were statistically significant between the survival group and the death group (P <0.05 ).Multivariate Logistic regression analysis showed that the risk factors of the hyperamylasemia's occurrence were LA,PCT, BG,PCIS<80,MODS>3.Adjusted ORs confidence intervals of them were 1.662 (1.236-2.234),1.042 (1.025-1.060),1.612 (1.411-1.843),3.219 (1.311-7.905),3.411 (1.370-8.494),respectively. The hyperamylasemia's prognostic risk factors were PCT,C-peptide,PCIS ≤80,MODS >3,shock. Adjusted ORs confidence intervals of them were 1.066(1.021-1.113),1.437(1.017 ~2.030),16.137 (1.876-138.836),10.437(1.528-71.925),20.928(1.938-226.009),respectively.Conclusions The severity of the disease,the levels of LA,PCT,BG in critically ill children were positively correlated to the occurrence of hyperamylasemia.The severity of the disease,the incidence of organ failures,the levels of PCT,C-peptide combined shock in children with hyperamylasemia were positively correlated to the prognosis of hyperamylasemia.

Objective To analyze the clinical features of critically ill children with abnormal pancreatic ultrasound findings in order to explore the related risk factors for offering evidence-based diagnosis of pancreatic damage secondary to critical illness.Methods A prospective study was performed in 531 critically ill children admitted to pediatric intensive care unit(PICU) of 17 children' hospitals from January 2012 to March 2014.All patients were divided into control group(513 cases) and abnormal group(18 cases) according to the pancreatic ultrasound findings.Comparison of clinical features and biochemical indicators were made between two groups.The related risk factors associated with abnormal pancreatic ultrasound findings were analyzed by using Logistic regression analysis.ROC curves were used to evaluate the role of amylase and lipase in the diagnose of abnormal pancreatic ultrasound findings.Results The incidence of abnormal pancreatic ultrasound findings in critically ill children was 3.39%, the average age of abnormal group was significantly older than that in control group (P<0.01).There were not statistically significant differences in gender and primary disease between two groups.The incidence of hypotension was 22.2% and the incidence of abdominal muscle tension was 16.7% in abnormal group,which were statistically higher than those in control group (P<0.05).The levels of calcium, albumin of abnormal group were significantly lower than those in control group (P<0.01), and levels of serum amylase, lipase, lactate dehydrogenase in abnormal group were significantly higher than those in control group (P<0.01).The risk factors associated with abnormal pancreatic ultrasound findings were age, blood pressure, calcium,amylase.Area under the ROC curve of abnormal pancreatic ultrasound findings determined by amylase and lipase were 0.803 and 0.745,respectively (P<0.05).The sensitivity was 0.667, specificity was 0.881 when the serum amylase was 101.5 U/L, the sensitivity was 0.722, specificity was 0.928 when the serum lipase was 96.9 U/L.Conclusions The incidence of abnormal pancreatic ultrasound findings was rather low in critically ill children.The risk factors associated with abnormal pancreatic ultrasound findings were hypotension, hypocalcemia, and hyperamylasemia.The elevated serum amylase and lipase might be the most likely factors associtaed with abnormal pancreatic ultrasound findings.

ObjectiveTo investigate the efficiency of autologous transplantation of peripheral blood stem cells for treatment of patients with diabetic lower limb ischemia.MethodsEighteen patients of type 2 diabetes with diabetic lower limb ischemia (30 legs) were treated by autologous transplantation of peripheral blood stem cells.ResultsThe limb pain, cool feeling and numbness feeling improved significantly after PBSC transplantation,the improvement rate were 96.7％, 100.0％ and 95.8％ respectively.Intermittent claudication was also relieved significantly, total remission rate was 76.9％.The ABI and TcPO2 of patients increased significantly at 3 months after transplantation.After the transplantation ABI raised from 0.60 ± 0.11 to 0.71 ±0.12(t =-6.882, P ＜ 0.01) .93.3％ of patients' TcPO2 raised in different degrees.The foot infections were well controlled.Ulcer or toes gangrene got better or healed.No obvious complications or adverse reaction were observed after the transplantation.ConclusionAutologous transplantation of peripheral blood stem cells shows to be a simple, safe and effective method in treating patients with diabetic lower limb ischemia.

BACKGROUND: Changes in extracellular of chondrocyte can reflect influence of external force on temporomandibular joint and adaptability of body to external force. OBJECTIVE: To study the effect of cyclic tensile stress on main extracellular matrix of condylar chondrocyte.METHODS: The cyclic tensile stress was exposed to the third passage condylar chondrocyte for 0, 1, 6, 12 and 24 hours, respectively, using a Flexcell Strain Unit-5000T system (10% surface elongation, 6 cycles/min). After mechanical loading, total RNA was extracted from the cells harvested from Six-well BioFlex flexible cell Petri Dish, reverse transcribed, and reverse trabscription-PCR was performed to quantify mRNA levels for type Ⅱ collagen and aggrecan.RESULTS AND CONCLUSION: Compared with the control group (0 hour group), both type Ⅱ collagen and aggrecan mRNA expression was significantly increased after loading for 6 hours (P < 0.05), but began to decrease since 12 hours, and significantly decreased at 24 hours (P < 0.05). Results showed that cyclical tensile stress stimuli can affect the synthesis of main extracellular matrix of condylar cartilage, i.e. the synthesis was gradually enhanced with prolonged stimulation duration, but significantly inhibited in response to further stress stimuli.

OBJECTIVE: To investigate the self-management behaviors of patients with type 2 diabetes mellitus (DM) in a community and to explore the relationship between self-management behaviors and the glycemic control. METHODS: A total of 211 type 2 DM patients in a community were selected by stratified random sampling. Patients were grouped according to the scores of self-management behaviors. The fasting plasma glucose (FPG), 2 h postprandial plasma glucose (2hPG) and glycated hemoglobin (HbA1C) level were tested. The differences between groups and relationship between self-management behaviors and glycemic control were analyzed. RESULTS: Self-management behaviors of most patients were not effective, and 2hPG and HbA1C were affected by different levels of the self-management behaviors (P<0.05). The self-management behaviors were negatively related to FPG (r=-0.277, P=0.015), 2hPG (r=-0.453, P=0.001), and HbA1C (r=-0.435, P=0.001). Glycemic control of the patients whose course of disease was over 5 years was significantly different due to different self-management behaviors. FPG level of the patients was positively related to alimentary control. The 2hPG level of the patients was positively related to alimentary control, medication persistence, and blood glucose self-monitoring. The HbA1C level of the patients was positively related to alimentary control and medication persistence. The times the patients received DM education, the way to use insulin, and the disease course of the patients were important factors to affect self-management behaviors of type 2 DM in the community. CONCLUSION Self-management behaviors of type 2 DM patients in the community are not effective. Satisfactory self-management behaviors, specially the control of 2hPG and HbA1C are beneficial to glycemic control. We can improve the self-management behaviors in type 2 DM patients by paying attention to the disease course, the treatment method, and the contents and effect of DM education.
Adult ; Aged ; Aged, 80 and over ; Attitude to Health ; Blood Glucose ; metabolism ; Blood Glucose Self-Monitoring ; statistics & numerical data ; China ; Community Networks ; Diabetes Mellitus, Type 2 ; blood ; psychology ; therapy ; Diet, Diabetic ; methods ; psychology ; Female ; Glycated Hemoglobin A ; analysis ; Humans ; Male ; Middle Aged ; Patient Education as Topic ; Self Care ; methods ; psychology ; Surveys and Questionnaires ; Young Adult

Objective To analyse the relationship between insulin resistance and the pancreatic beta cell dysfunction in critically ill children with hyperglycemia,to investigate the relationship between the pancreas injury and pancreatic beta cells dysfunction.Methods Seven hundred and thirty-six critically ill children admitted in PICU of Hunan Children's Hospital from Nov 2012 to Mar 2013 were reviewed and analyzed.According to the maximum intravenous blood glucose within 24 h after admission,they were divided into severely elevated group (blood glucose ≥11.1 mmol/L,n =67),slightly elevated group(blood glucose 6.1 ～ 11.1 mmol/L,n =361) and control group (blood glucose ≤ 6.1 mmo/L,n =308).Serum insulin,C peptide,serum amylase,lipase,urinary amylase,HOMA-β,HOMA-IR were compared among 3 groups.According to the severity of sepsis,they were divided into non-sepsis group (n =414),sepsis group (n =237),severe sepsis group (n =64),septic shock group (n =21).Blood glucose,serum insulin,C peptide,HOMA-βand HOMA-IR were compared among 4 groups.Results (l)The levels of insulin,C peptide,blood amylase,lipase and urine amylase were gradually increased with elevated blood sugar(rs =0.235,P ＜ 0.05;C =0.142,P ＜ 0.05 ; rs =0.142,P ＜ 0.05 ; rs =0.119,P ＜ 0.05 ; r.s =0.093,P ＜ 0.05).The differences among 3 groups were significant (P ＜ 0.05).The levels of serum amylase (IU/L) [102.81 (10.48-191.69)],lipase(U/L) [69.75(10.67-121.85)] were higher than upper limit of normal in severely elevated group.HOMA-β fell to 18.75％ in severely elevated group.The level of HOMA-β was decreased with the increase of blood sugar level (rs =-0.108,P ＜ 0.05).The level of HOMA-IR was increased with the elevated blood sugar level(rs =0.455,P ＜ 0.05).(2) The levels of blood glucose,insulin,C peptide and HOMA-β were significantly different among 4 groups of non-sepsis,sepsis,severe sepsis and septic shock group (P ＜ 0.05),HOMA-IR showed no significant difference among 4 groups (P ＞ 0.05).The levels of blood sugar increased to 9.21 (6.21-19.60) mmol/L,HOMA-β declined to 10.52％ in septic shock group,and blood glucose,insulin,C peptide,HOMA-β were significantly different compared with the other 3 groups (P ＜ 0.05).Conclusion Hyperglycemia is associated with insulin resistance and pancreatic β cells dysfunction in critically ill children,the cause of beta cell dysfunction is secondary to pancremic injury.Pancreatic beta cells dysfunction inducing hyperglycemia is more significant than insulin resistance in sepsis children.

Aim To investigate the molecular mecha-nism of Gab2 in the invasion and metastasis of breast cancer and provide a theoretical basis for clinical pre-vention of breast cancer invasion and metastasis. Methods The Gab2 , MMP-2 and MMP-9 expressions in 80 cases of breast cancer were detected by immuno-histochemistry . Western blot was used to detect the ex-pression of Gab2 protein in MDA-MB-231 cells and MCF-7 cells. The siRNA plasmid was used to transfect MDA-MB-231 cells. Western blot was used to detect the proteins expression of Gab2 , MMP-2 and MMP-9 . Transwell in vitro experiment was used to detect the in-vasion ability of each group transfected MDA-MB-231 cells, Western blot was used to analyze phosphorylation of Akt and ARK5 induced by epithelial growth factor ( EGF ) in transfected cells ( SiGab2/MDA-MB-231 and Scr/MDA-MB-231 ) . Results The expression of Gab2 protein in invasive ductal carcinoma was signifi-cantly higher than in normal breast tissue ( P<0. 01 ) . The expression of Gab2 was dramatically correlated with lymph node metastasis, ER expression, tumor his-tological grade, MMP-2 and MMP-9 (P<0. 05). The expression of Gab2 protein in MDA-MB-231 cells was higher than in MCF-7 cells. The expression of Gab2, MMP-2 and MMP-9 decreased in SiGab2/MDA-MB-231 cells and the invasion ability of SiGab2/MDA-MB-231 cells was significantly decreased ( P<0. 05 ) , and after 5 minutes’ stimulating by EGF, the phosphoryla-tion of Akt and ARK5 was significantly reduced. Con-clusion Gab2 can promote the invasion and metasta-sis of breast cancer by effecting the expression of MMP-2 and MMP-9 through PI3 K/ Akt /ARK5 signal path-way.

Objective To make students at different levels not only learn theoretical knowledge of acupuncture-moxibustion manipulation skills but also achieve full operating training, strengthen the combination of theory and practice and improve the teaching quality of clinical disciplines by applyingmultimedia-subject participationteaching method to acupuncture-moxibustion manipulation techniques in the experimental teaching of acupuncture and moxibustion. Method The students were randomized, according to grade, into experiment (n=114) and control (n=115) groups. The teaching content was the same in the two groups. The experiment group received multimedia-subject participationteaching method. After the multimedia teaching, the students did an independent demonstration and made a self-evaluation, the teachers made a comment and the students did independent practice again in groups. The control group received conventional theory teaching and did practice under demonstration in the experimental lesson. The examination and questionnaire were used as assessment indicators to evaluate the effect ofmultimedia-subject participationteaching method applied to acupuncture-moxibustion technique teaching. Result Statistical analysis was made using the SPSS11.5 statistical software package. The independent samples t-test is used for a between-groups comparison. The statistical result showed that satisfaction was 100%in the experiment group and 75.7%in the control group;there was a statistically significant difference between the two groups (P<0.05). Conclusion Multimedia-subject participationteaching method is an innovation in acupuncture-moxibustion technique teaching and helps the students to better master acupuncture-moxibustion manipulation skills. Mastery of theoretical knowledge before real practice is the key to proficient manipulation. The combination of the two in classroom teaching yields twice the result with half the effort. Carrying out multimedia-subject participation teaching method will help to further deepen the teaching reform and to improve the level and quality of“Acupuncture and Moxibustion”teaching.

Objective To observe the effect of the nutrition management according to the JCI(Joint Commission on Accreditation of Healthcare Organizations)management standard for critically ill pediatric patients with mechanical ventilation.Methods A total of 330 cases with mechanical ventilation were en-rolled in the control group from Hunan Province Children's Hospital PICU between Jan.2012 and Dec.2012, and these pediatric patients were managed with the conventional nutrient management.A total of 359 pediatric patients with mechanical ventilation were admitted to the experimental group from Jan.2013 to Dec.2013 and these patients were managed with nutrient management based on JCI standards.The length of mechanical venti-lation,stay in ICU,stay in hospital were compared between two groups,and the incidence of ventilator-associ-ated pneumonia,abandonment rate and mortality were also compared between experimental group and control group.Results The length of mechanical ventilation in control group[(8.39 ±1.34)days]was longer than that of experimental group[(5.69 ±1.12)days].The length of stay in PICU for control group[(12.32 ± 1.37)days]was more than that in experimental group[(9.42 ±1.53)days].The length of stay in hospital for control group [(15.37 ±2.16 )days]was higher than that of experimental group [(12.63 ±2.29 ) days].The incidence of ventilator-associated pneumonia(9.7%)in control group was higher than that of ex-perimental group,and the giving up or mortality rate in control group(8.48%)was higher than that of exper-imental group(4.35%).And there were significant differences by statistical analysis(P ﹤0.01 ,respective-ly).Conclusion According to the nutritional management in JCI standard,the length of mechanical ventila-tion,stay in PICU and stay in hospital time,the incidence of ventilator-associated pneumonia,and the aban-doned or mortality rate were reduced for critically ill pediatric patients with mechanical ventilation.

Objective: This study was to investigate the necessity of wearing a cervical collar after single-segment anterior cervical discectomy and decompression. Methods: The experimental methods were used to group the two wards in the same department. There were 54 patients in the experimental group and 48 patients in the control group. The patients in the experimental group did not wear the cervical collar during the postoperative outpatient activities and after discharge. The control group patients wore the cervical collar within 3 months after walking and after discharge. The cervical dysfunction index of the two groups before surgery and 3 months after surgery was compared between the two groups; also vertebral fusion at 6 months postoperatively; and SF-36 (Quality of Life Assessment Scale) scores before surgery and 3 months after surgery. Results: The NDI of the experimental group was significantly lower than that of the preoperative NDI (20.62%±1.94% vs 26.06%±2.17%) (t=18.32, P<0.01). The NDI of the control group was 3 months after operation compared with the preoperative NDI (21.30±%1.87% vs26.26%±2.74%) also had a significant decrease (t=16.67, P<0.01). The NDI of the experimental group was significantly lower than that of the preoperative NDI (14.97%±1.85%vs26.06%±2.17%) (t=31.93, P<0.01), the NDI of the control group was significantly lower than that of the preoperative NDI (15.98%±1.49% vs26.26%±2.74%) at 6 months after operation (t=24.45, P<0.01). The difference was statistically significant. The SF-36 score in the last 3 months was higher than that in the control group (53.37±9.23 vs 45.77±8.07), and the difference was statistically significant (t=4.40, P<0.01). Conclusions Compared with the external fixation without neck and neck, the treatment of cervical external fixation does not affect the postoperative treatment effect, and can improve the quality of life of patients.