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.

Neonatal respiratory distress syndrome (RDS) is most common in premature infants,the smaller the gestational age,the higher the incidence.Continuous positive airway pressure (CPAP) started in the delivery room has been shown in multicentre randomized controlled trials to reduce the need for mechanical ventilation (MV) and surfactant.The European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants-2013 Update recommended that CPAP should be started from birth in all babies at risk of RDS and a starting pressure of at least 6 cmH2O(1 cmH2O =0.098 kPa)should be applied.CPAP with early rescue surfactant should be considered the optimal management for babies with RDS.Using CPAP immediately after birth with subsequent selective surfactant administration may be considered as an alternative to routine intubation with prophylactic or early surfactant administration in preterm infants.If endotracheal intubation is needed,early administration of surfactant is preferable.Nasal intermittent positive pressure ventilation may reduce the risk of extubation failure in babies failing on CPAP.Several strategies have been employed specifically to improve the success of noninvasive ventilation and shorten the duration of MV.Caffeine should be used to facilitate weaning from MV and to reduce bronchopulmonary dysplasia.A short tapering course of low-or very low-dose dexamethasone should be considered to facilitate extubation in babies who remain on MV after 1 ～ 2 weeks.Very early steroid treatment and treatment with high doses cannot be recommended.

ObjectiveTo study the effect of comprehensive rehabilitation therapy on activity of daily living(ADL) of old patients with stroke.Methods56 old patients with stroke were rehabilitated by the therapy of Bobath,Brunnstrom,Rood,PNF and psychotherapy for 3 months.The Modified Barthel Index (MBI) was applied to measure ADL before and after treatment.ResultsAfter treatment,the MBI of the patients was markedly higher than before(P<0.01),which was relative with the recovery of movement function and the psychology.ConclusionsThe rehabilitation therapy can improve ADL of old patients on stroke.

Objective To investigate the value of measurement of cardiac output in children by bio-reactance versus echocardiography.Methods Pediatric patients admitted in pediatric department of Peking University First Hospital from September to December 2012 who needed hemodynamic monitoring were enrolled prospectively.Cardiac index(CI)and stroke volume(SV)were measured by echocardiography and non-invasive cardiac output measurement(NICOM)and compared by Spearman correlation and Bland-Alt-man analysis.Results Thirty patients were included.The median age was 7.25 years.CI[M(P5 ,P95 )] measured by NICOM and echocardiography were correlated significantly[3.42(2.28,4.92)L /(min?m2 ) vs.3.51 (2.94,4.85 )L/(min?m2 ),R =0.385,P =0.035 ].Bland-Altman analysis revealed a bias of-0.22 L/(min?m2 )(P =0.051 ),limits of agreement of -1.40 to 0.95 L/(min?m2 ).SV[M(P5 ,P95 )] measured by NICOM and echocardiography were correlated more significantly [36.3 (12.6,87.8 )ml vs.39.4(14.7,86.9)ml,R =0.768,P ﹤0.001 ].Bland-Altman analysis revealed a bias of -3.1 ml(P =0.176),limits of agreement of -27.4 to 21.2 ml.Conclusion There is no significant difference between NICOM and echocardiography for the measurement of CI and SV in pediatric patients.Further validation studies need to be conducted before routine clinical use.

In this review, we have briefly described the concept, status quo and relevant variables of worldwide nurses′ professional identity. Moreover, there has been a detailed summary of promotion strategies on foreign nurses. The introduction mentioned above aims at exploring more effective and comprehensive promotion strategy, which might provide the theoretical basis for Chinese nursing identity studies.

ObjectiveTo recover the effect of rehabilitation therapy on the automatic nervous system(ANS)of patients with stroke. MethodsThe multiple index measurement was applied to measure ANS after stroke in 31 patients. The therapy of the Bobath,Brunnstrom and Rood were used as the basic methods for 3 months.ResultsThe balance index of the automatic nerve after treatment by the rehabilitation therapy was higher markedly than before(P<0.01).There is a correlativity with recovery of the movement function. Conclusions The rehabilitation can improve the function of automatic nerve.

Neurite outgrowth, a cell differentiation process involving membrane morphological changes, is critical for neuronal network and development. The membrane lipid, phosphatidylinositol (PI) 4,5-bisphosphate (PIP2), is a key regulator of many important cell surface events of membrane signaling, trafficking and dynamics. This lipid is produced mainly by the type I PI 4-phosphate 5-kinase (PIP5K) family members. In this study, we addressed whether PIP5Kalpha, an isoform of PIP5K, could have a role in neurite outgrowth induced by nerve growth factor (NGF). For this purpose, we knocked down PIP5Kalpha in PC12 rat pheochromocytoma cells by stable expression of PIP5Kalpha microRNA that significantly reduced PIP5Kalpha expression and PIP2 level. Interestingly, NGF-induced neurite outgrowth was more prominent in PIP5Kalpha-knockdown (KD) cells than in control cells. Conversely, add-back of PIP5Kalpha into PIP5Kalpha KD cells abrogated the effect of NGF on neurite outgrowth. NGF treatment activated PI 3-kinase (PI3K)/Akt pathway, which seemed to be associated with reactive oxygen species generation. Similar to the changes in neurite outgrowth, the PI3K/Akt activation by NGF was potentiated by PIP5Kalpha KD, but was attenuated by the reintroduction of PIP5Kalpha. Moreover, exogenously applied PIP2 to PIP5Kalpha KD cells also suppressed Akt activation by NGF. Together, our results suggest that PIP5Kalpha acts as a negative regulator of NGF-induced neurite outgrowth by inhibiting PI3K/Akt signaling pathway in PC12 cells.
Animals ; Enzyme Activation/drug effects ; Gene Knockdown Techniques ; Mice ; Nerve Growth Factor/*pharmacology ; Neurites/drug effects/*enzymology ; PC12 Cells ; Phosphatidylinositol 3-Kinases/metabolism ; Phosphatidylinositol 4,5-Diphosphate/metabolism ; Phosphorylation/drug effects ; Phosphotransferases (Alcohol Group Acceptor)/*metabolism ; Proto-Oncogene Proteins c-akt/metabolism ; Rats ; Reactive Oxygen Species/metabolism ; Signal Transduction/drug effects

Background and purpose: Thyroid carcinoma cells spread mainly through lymph node metastasis, and lymphangiogenesis plays an important role during the lymph node metastasis, but it is not very clear to understand the formation mechanism. This study was to investigate the correlative expressions of HPSE, VEGF-C, D2-40 and lymphangiogenesis in thyroid carcinoma. Methods: Immunohistochemistry SP method was used to detect the expressions of HPSE, VEGF-C and D2-40 in 77 patients with thyroid carcinoma including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC),medullary thyroid carcinoma (MTC), 32 of them with lymph node metastasis was enrolled into the study, D2-40 stained the lymphatic vessels, and lymphatic vessel density (LVD) was scanned under the light-microscope, and the correlation among the above indexes in different thyroid carcinoma types were analyzed respectively. Results: The expressions of HPSE, VEGF-C and D2-40 were observed to have a different degree in thyroid carcinoma, and the highest expression of the protein could be seen in the patients with papillary carcinoma (P<0.05),The expression ratios of HPSE,VEGF-C and D2-40 in different carcinoma types were 54.9%, 68.6%, 12.8±5.7 for PTC, 37.5%, 50%, 8.6±1.7 for FTC, 20% and 20%, 4.9±0.8 for MTC, respectively. There were significant different expressions of HPSE, VEGF-C and D2-40 between the patients with lymph node-positive group and node-negative group (P=0.014, P=0.048, respectively). In addition, the expressions of them were positively correlated (P<0.001, r=0.616). Conclusion: HPSE, VEGF-C and D2-40 have a close relationship with lymph node metastasis, HPSE and VEGF-C are related to the lymphangiogenesis.

Objective To study the clinical presentations,radiologic features,prognosis,and possible causes of liver injury associated umbilical venous catheter (UVC ).Methods We reviewed database of our NICU from December 2012 to November 2015 and identified preterm infants with liver injury while UVC in place.The gestational age,birth weight,gender,days of UVC in place prior to liver injury, the depth of UVC (cm),UVC tip position,ultrasound findings of liver injury,laboratory tests,treatment and outcomes were collected.Results During study period,322 infants received UVC insertion.Ten cases (3.1 %)of liver injury associated with UVC were diagnosed.Of the ten infants,nine were diagnosed as extravasation of fluid to liver parenchyma,and one was diagnosed as liver hematoma.The mean birth weight was (1184 ±207)g,mean gestational age was (28.5 ±1.7)weeks.The UVC tip was at thoracic (T) vertebrae T 9 to T 11 level,nine UVC tips were below the right diaphragm level.All UVCs were used for total parenteral nutrition before liver injury was diagnosed.Six infants had clinical manifestations,and four infants were free of clinical manifestations.The most prominent clinical signs were abdominal distension (n =5),weak bowel sounds (n =5)and hepatomegaly (n =4).One infant who was diagnosed with liver hematoma also had progressive hemoglobin decline (minimum 34 g/L)and shock.Abdominal ultrasound showed well-limited,irregular,hyperechoic rimmed lesions with heterogeneously hypoechoic centers or anechoic liquid dark space.Extravasation of fluid to liver parenchyma will restorate within one week after the UVC was remove.One baby who was diagnosed as liver hematoma passed away at 9 days of life.Liver ultrasound of eight returned to normal in 52 days to 3.5 months,and one had calcified lesions at 9 months of age.Conclusions Liver injury is an unusual complication of UVC insertion and usage.Proper positioning of the UVC tip may help to avoid this complication.Early recognition,prompt diagnosis with liver ultrasound examination and timely treatment can lead to better outcome in newborns with extravasation of fluid to liver parenchyma.