Critically ill children suffer from pain and anxiety additionally in the face of severe organ dysfunction and often require analgesia and sedation.Different medications and combinations of medications can be used to achieve the desired effect.It is also important to keep in mind the possible adverse reactions and side effects associated with each medication.The side effect of the medications often used in children and prevention and therapy of common complications associated with analgesia and sedation is reviewed.

Objective To investigate the risk factors of sepsis associated encephalopathy( SAE) in children.Methods We collected the clinical data of 152 cases of children with sepsis admitted in PICU of Shenzhen Children′s Hospital from June 2013 to April 2015.All 152 cases were divided into the SAE group (n=46) and non SAE group(n=106).Single factor analysis and multi-fatc or Logsi ticr egression analysis were used to study the risk fatc ors of the occurrence and mro tality of SAE in children.Re sults The inci-dence of SAE was 30.3%amongs epsis.The mortality rate of children with SAE was obviously higher than that of children without SAE(17.4%,8/46 vs.1.9%,2/106; χ2 =13.234,P<0.001).Lo gistic regression analysi showed that coagulation disorder,hepatic insfu ficiency and peid atir c cliin cal illness score≤80 were indpe endent risk factro s of SAE.C oagulationd isorder was independent riks facot rs of SAE death.Conclusion The incidence and mortality of SAE are high.Ch ildren with coa gulta ion dsi order,hepatic insufficiecn y and pediatric clinical illness score≤80 shouldb e observed lc osely.

Objective To investigate the applied value of adipose-derived stromal cells(ADSCs) transfected glial cell-derived neurotrophic factor(GDNF)by lentivirus in cerebral transplantation.Methods Primarily isolated and cultured, the rat ADSCs were transfected GDNF by high-titer lentivirus. Then, configuration of cells and expression of neuron-specific enolase (NSE) were observed. By stereotaxic frame, transfected ADSCs were intrastriatally transplanted.1month and 2month after transplantation, survival and migration of marked cells were detected. GDNF expression, verified by Western blot, was compared with control group.Results ADSCs, transfected by lentivirus, can differentiate into neuron-like cells and express NSE in cytolymph. 1 month after transplantation, the majority of cells survived in transplanting area. 2 month later, part of transplanted cells still survived and migrated far from the transplanting area. In addition, the level of GDNF protein in the brain tissue was significantly higher compared with control group (all P

Objective Appraising the clinical curative effect on the lower extremity serious deep venous thrombosis through thrombolytic arterial catheterization.Methods With Seldinger's technique, placing catheter into popliteal artery through the contralateral healthy side femaral artery and then dripping the thrombolitic agents into the thrombotic popliteal artery. Results The cure rate reached 87% in the treatment group and for the controll group was 30%,( P

Objective To investigate the value of the three-dimensional high-resolution magnetic resonance imaging curve planar reformation(CPR)combined with virtual endoscopy reconstruction in vascular compression of trigeminal neuralgia.Methods 65 pa-tients with trigeminal neuralgia performed three-dimensional MR doubly excited balanced steady-state free precession sequence (3D-FIESTA-C),and CPR combined with virtual endoscopy reconstruction was used to evaluate the relationship of neurovascular anato-my.And 60 cases with microvascular decompression (MVD)surgery were analyzed.Results 65 cases of 3D-FIESTA-C CPR com-bined with MRVE showed responsibility vascular with a positive rate of 92.3% (60/65).60 cases of all patients with the results of surgery showed responsibility blood vessels and oppression parts with 3D-FIESTA-C CPR combined with MRVE,and it was found that the findings of oppression had a good consistency with MVD with the diagnose accordance rate of 95% (57/60).Conclusion Three-dimensional high-resolution magnetic resonance imaging CPR combined with virtual endoscopy reconstruction can be a new method to clearly and accurately show the anatomical relationship between blood vessels and nerves,which helps to improve the posi-tive rate of detection and to give operative guidance.

Objective:To explore the feasibility of screening for major fetal heart disease by training sonographers in township or county level hospitals .Methods:Training of B ultrasound scan for congeni-tal heart defects was given to the sonographers from one county hospital , and thirteen township hospitals ( or the district hospitals ) , and training of fetal echocardiography was given to sonographers from four city/county hospitals.The trained sonographers who had passed the examinations and had obtained quali-fications after six months of independent practice began to screen fetal congenital heart defects .To evalu-ate the effectiveness , sensitivity and specificity of screening was calculated by using the diagnosis of ex-pert neonatal/fetal echocardiographers as the gold standard .Results: A total of 3 425 fetuses received one fetal B ultrasound screening , one fetal echocardiography and one neonatal echocardiography from April 1, 2004 to December 31, 2005.One hundred and sixty-five B ultrasound screening images (4.9%) from township hospitals and fifty-six fetal echocardiography images (1.7%) from county or city centers couldn ’ t be reviewed because of poor quality .The sensitivity of fetal B ultrasound screening in the township and county hospitals was 30%and 0, and the specificity 93.3%and 99.9%, respectively. Nine fetuses with a major congenital heart disease were eventually found by the trained sonographers , and two cases were misdiagnosed and two unnoticed .The total sensitivity and specificity of fetal echocardio-graphy were 81.8% and 99.9%, respectively.The sensitivity in the county and city hospitals was 66 .7% and 100%, respectively .The specificity in the county and city hospitals was 99 .9%and 100%, respectively .Conclusion: Under the current circumstances , township hospitals are unable to perform effective fetal cardiac screening .Screening on fetal congenital heart disease is suggested to be taken by trained sonographers in county and city level medical centers .

Objective: To investigate the mechanism of electroacupuncture (EA) for treating depression and to explore the role of brevican in the medial prefrontal cortex (mPFC) in modulating stress susceptibility and the antidepressant effects of EA in rats. Methods: Twenty-four Sprague–Dawley (SD) rats were equally divided into three groups: green fluorescent protein (GFP) + control, GFP + chronic unpredicted mild stress (CUMS), and short-hairpin RNA targeting on brevican (shBcan) + CUMS. Another 24 SD rats were equally divided into CUMS + GFP, CUMS + GFP + EA, and CUMS + shBcan + EA groups. Behavioral tests were conducted to assess depression-like behavior. Western blot analysis was used to evaluate the expression of brevican, aggrecan, GLuA1, and PSD95 in mPFC subregions. Results: Behavioral parameter evaluation show that rats in the shBcan + CUMS group exhibited a significantly reduced sucrose preference (P = .0002) and increased immobility time (P = .0011) compared to those in rats in the GFP + CUMS group. Western blotting showed that brevican expression was significantly downregulated in the PrL of the shBcan + CUMS group compared with that in the GFP + CUMS group (P = .0192). Furthermore, compared to the CUMS + GFP + EA group, the CUMS + shBcan + EA group exhibited a significantly decreased sucrose preference (P = .0334), increased immobility time (P = .0465), and increased latency to food (P = .0261). In the CUMS + shBcan + EA group, the EA-induced brevican and PSD95 overexpression was reversed, compared with that in the CUMS + GFP + EA group (P = .0454 and P = .0198, respectively). Conclusion EA exerts its antidepressant effects through the modulation of brevican expression in rats. Our findings highlight the important role for brevican in stress susceptibility, which could be a potential target for treating depression.

Objective　To study the relationship between bax gene expression and endometrial carcinoma. Methods　Bax mRNA expression was evaluated by RT-PCR in a series of 8 normal proliferative endometrium (NPE), 6 simple and complex hyperplasia (SCH), 6 atypical hyperplasia (AH) and 42 endometrial carcinoma (EC).Results　All of the 8 NPE showed moderate bax mRNA expression. In 1 of 6 SCH, 2 of 6 AH and 27 of the 42 EC (64.3%), there was overexpresion of bax mRNA. In endometrial carcinoma, with the progression of clinical stage, increase in histologic grade and in depth of invasion to muscle layer, and lymph node metastersis,the positive rate of bax overexpression was correspondingly increased.Conclusion　The results suggest that bax expression affects the balance between the endometrial cell proliferation and apoptosis. Bax might play an important role in carcinogenesis and tumor progression of endometrial carcinoma. As a high risk factor it can be used to evaluate the biological behavior of endometrial carcinoma.

Objective　To study the relationship between bax gene expression and endometrial carcinoma. Methods　Bax mRNA expression was evaluated by RT-PCR in a series of 8 normal proliferative endometrium (NPE), 6 simple and complex hyperplasia (SCH), 6 atypical hyperplasia (AH) and 42 endometrial carcinoma (EC).Results　All of the 8 NPE showed moderate bax mRNA expression. In 1 of 6 SCH, 2 of 6 AH and 27 of the 42 EC (64.3%), there was overexpresion of bax mRNA. In endometrial carcinoma, with the progression of clinical stage, increase in histologic grade and in depth of invasion to muscle layer, and lymph node metastersis,the positive rate of bax overexpression was correspondingly increased.Conclusion　The results suggest that bax expression affects the balance between the endometrial cell proliferation and apoptosis. Bax might play an important role in carcinogenesis and tumor progression of endometrial carcinoma. As a high risk factor it can be used to evaluate the biological behavior of endometrial carcinoma.

BACKGROUNDAltered immunoresponse is associated with tumorigenesis and cancer progression. This study assessed the levels of tumor-infiltrating CD3 + or CD8 + T lymphocytes and interleukin-2 (IL-2) protein in radically resected non-small cell lung cancer (NSCLC) tissues to predict overall survival (OS) of the patients.

METHODSParaffin-embedded tissue specimens from 129 NSCLC patients were retrospectively collected for immunostaining of CD8 + , CD3 + , and IL-2 expression. Clinicopathological and survival data were collected and analyzed using the Chi-squared test, Kaplan-Meier curves, and the log-rank test or the Cox regression model.

RESULTSThe data showed a significant inverse association between CD8 + T lymphocyte levels and IL-2 expression (r = -0.927; P = 0.000) and between the levels of CD8 + and CD3 + T lymphocytes (r = -0.722; P = 0.000), but a positive association between CD3 + T lymphocyte levels and IL-2 expression (r = 0.781; P = 0.000) in NSCLC tissues. Furthermore, the levels of CD3 + and CD8 + T lymphocytes and IL-2 expression were associated with tumor stage (P = 0.023, 0.006, and 0.031, respectively) and the level of CD8 + T lymphocytes was associated with the patient gender (P = 0.024). In addition, the levels of CD8 + T lymphocytes were associated with an unfavorable 5-year OS, whereas patients with high levels of CD3 + T lymphocytes in tumor lesions and IL-2-expressing tumors had significantly better 5-year OS rates than patients with low levels.

CONCLUSIONSThe levels of CD8 + T cells in tumor lesions and IL-2 expression were both independent predictors of OS for these NSCLC patients. Thus, the detection of tumor-infiltrating CD3 + or CD8 + T lymphocytes and IL-2 expression could be useful to predict the prognosis of radically resected NSCLC patients.

CD3 Complex ; metabolism ; CD8-Positive T-Lymphocytes ; metabolism ; Female ; Humans ; Immunohistochemistry ; Interleukin-2 ; metabolism ; Lung Neoplasms ; immunology ; metabolism ; Lymphocytes, Tumor-Infiltrating ; metabolism ; Male ; Prognosis