Childhood pneumonia,especially severe pneumonia is the leading cause of death in children under 5 years old,so,early diagnosis and reasonable management are particularly important for reducing mortality of children with severe pneumonia.At present,the diagnostic criteria of severe pneumonia in children is not unified,resulting in the lack of comparability in clinical research of different hospital.The policy guidance of clinical research is weak in Chinese future development of appropriate countermeasures.This paper mainly introduces the diagnosis criteria of severe pneumonia from China,World Health Organization,British and American in children,illustrates their advantages and disadvantages,and to provide a reference for pediatricians in using different diagnostic criteria.

Sepsis caused by infection is one of the most common diseases in ICU.In 1991,the concept of sepsis was first put forward for the purpose of unifying cognition,early diagnosis and treatment,and reducing the fatality rate of severe infection.Over the past 20 years,with the development of the septic pathophysiology,its definition and clinical criteria have been constantly updated and improved.In 2016,a task force convened by European Society of Intensive Care Medicine and the Society of Critical Care Medicine revised the definition and clinical criteria of sepsis,namely,Sepsis-3.It mainly emphasizes infection leading to homeostasis disequilibrium,and organ dysfunction with potentially fatal risk.The definition is updated each time;many new theories or ideas are incorporated,and are also some controversies.This review focused on the definition and clinical criteria of sepsis,and the controversies of Sepsis-3.

Objective To evaluate the effect of reminiscence therapy on quality of life and happiness degree of spouses of patients with Parkinson′s disease. Methods A total of 60 spouses of patients with Parkinson′s disease were divided into experimental group and control group according to the hospital number with 30 cases each. Both groups received routine health education. In addition, reminiscence therapy was implemented in experimental group for 8 weeks. The spouses were investigated with The World Health Organization Quality Of Life- BREF (WHOQOL- BREF) and Memorial University of Newfoundland Scale of Happiness (MUNSH) before and after intervention. Results Before intervention, the scores of WHOQOL-BREF was (59.47±13.52) points in control group and (59.42±13.45) points in experimental group,and there was no significant difference(t=1.00, P > 0.05). After intervention, the scores of WHOQOL- BREF was (60.12±13.48) points in control group and (72.65±11.32) points in experimental group,and there was significant difference (t=3.45, P < 0.05). Before intervention, the scores of MUNSH was (22.52±6.34) points in control group and (22.34±6.12) points in experimental group,and there was no significant difference(t=0.39, P > 0.05). After intervention, the scores of MUNSH was (22.75±6.24) points in control group and (34.56±5.78) points in experimental group,and there was significant difference(t=13.65, P < 0.01). Conclusions Reminiscence therapy could effectively improve the quality of life and happiness degree of spouses of patients with Parkinson′s disease.

ObjectiveTo discuss the clinical diagnosis, treatment and genetic diagnosis of congenital chloride diarrhea (CCD), a rare autosomal recessive disease.Methods One month old boy with persistent diarrhea, hypochloremia, hyponatremia, hypokalemia and metabolic alkalosis, his stool electrolyte testing, clinical treatment and follow-up, as well as his and his parents’ SLC26A3 gene mutation analysis were retrospectively analyzed.Results The fecal electrolyte testing showed that the levels of Cl- and K+ were increased and the level of Cl- was much higher than the sum of Na+ and K+. After replacement therapy with NaCl and KCl, the blood electrolyte recovered to normal. Follow-up 4 years, the boy had a normal growth and development. Mutation analysis onSLC26A3 gene showed there was a homozygous mutation of 239G>A and both his father and mother carried the same heterozygous mutation. This mutation was ifrst discovered in China.Conclusions The sequencing analysis ofSLC26A3 mutation may help to diagnosis CCD.

Objective To research the clinical curative effect of pegylated interferon α-2a (Peg-IFNα-2a) combined with ribavirin in treating chronic hepatitis C with positive autoantibodies.Methods The autoantibodies were screened in 93 cases of chronic hepatitis C patients and then the patients were divided into positive group and negative group.Both of the two groups were given therapy with Peg-IFN α-2a combined with ribavirin.The capacity of hepatitis C virus (HCV) RNA,virological response rate,and blood concentration of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were quantified before and in the process of treatment.Results Twenty-eight patients had autoantibodies,with 17 patients of antimitochondrial antibody,8 patients of anti smooth muscle antibody and 3 patients of anti-liver-kidney microsomal antibody-1.The quantity of HCV RNA and the virological response rate had no significant difference before and after treatment (P ＞ 0.05).The concentration of ALT and AST in positive group were higher than those in negative group before and in the process of treatment,while there were obvious differences only after 36 weeks of treatment (P ＜ 0.05).Conclusion Peg-IFN α-2a combined with ribavirin is effective for chronic hepatitis C for all the patients,but liver function of autoantibody negative patients have a better recovery.

Objective To observe the changes and significance of the activity of nuclear factor kappa B(NF-?B)in peripheral blood mononuclear cell(PBMC)of the critical patients with hyperglycemia,who were treated by intensive insulin therapy.Methods One hundred and twelve critical patients with hyperglycemia were randomly assigned to receive intensive insulin therapy(maintenance of blood glucose at a level between 4.4~6.1mmol/L,57 patients)or to receive conventional treatment(maintenance of blood glucose at a level between 8.0~11.1mmol/L,55 patients).2ml venous blood was collected to extract nucleoprotein in PBMC,and the NF-?B activity of PBMC was detected by electrophoretic mobility shift assay(EMSA)on 24h,4d and 10d.NF-?B oligonucleotide probe was labeled by digoxin.The Gel-Imaging system(UVP company)was used to record optical density values(OD)which represented the NF-?B activity.Results NF-?B activities in PBMC of the patients who received intensive insulin therapy(44.69?10.46,34.47?14.32 and 25.95?11.50 at the 24th hour,4th day and 10th day,respectively)were significantly lower than that of the patients who received conventional treatment(50.37?11.54,43.76?10.27 and 35.87?9.97 at 24th hour,4th day and 10th day,respectively,P

Objective To investigate the effect of Dexamethasone on microtubule - associated protein 1 light chain 3(LC3)expression of cells and neurons in cerebral cortex of juvenile Wistar rats with sepsis. Methods Models of juvenile Wistar rats with sepsis were established through cecal ligation and puncture(CLP). Totally 60 cases of 30 -day - old juvenile male Wistar rats were randomly divided into sham - operation group(10 cases),non - treated group (25 cases)and Dexamethasone group(25 cases). Twelve hours after CLP,rats in Dexamethasone group were injected with Dexamethasone(1 mg / kg)via tail vein every other day,with a total of 3 times. The same dose of saline was used in the non - treated group. All rats were killed at the age of 40 days. Expressions of LC3 and neuronal nuclei(NeuN)of cells in cerebral cortex of rats were detected by using immunofluorescence assay,and the number of positive cells was calculated by using image analysis system software. Expressions of LC3 - Ⅰ and LC3 - Ⅱ protein were measured by a-dopting Western blot. Results Three hours after CLP,rats appeared to be curled up and showed piloerection and shi-vering and the neurobehavioral score in non - treated group was significantly lower than that in sham - operation group (t = 9. 895,P = 0. 000). Twelve of 25 rats in Dexamethasone group died in 10 days after CLP(48% ),while 8 of 25 rats in non - treated group died(32% ),and the difference was not statistically significant between the 2 groups(χ2 =1. 333,P = 0. 248). The immunofluorescence staining and image analysis showed the percentage of LC3 positive cells in non - treated group was significantly increased(0. 606 7 ± 0. 030 1 vs 0. 353 3 ± 0. 025 8,t = 15. 644,P = 0. 000;0. 606 7 ± 0. 030 1 vs 0. 270 3 ± 0. 019 4,t = 22. 450,P = 0. 000). In non - treated group,the LC3 expression of cells in the cerebral cortex of rats was up - regulated,and the LC3 - Ⅱ/ LC3 - Ⅰ ratio was significantly higher than that in sham operation group and Dexamethasone group(0. 413 3 ± 0. 022 5 vs 0. 205 0 ± 0. 015 2,t = 18. 802,P = 0. 000;0. 413 3 ± 0. 022 5 vs 0. 185 0 ± 0. 023 5,t = 17. 206,P = 0. 000). The LC3 positive neurons in the cerebral cortex of rats were less in sham operation group and Dexamethasone group. The LC3 positive neurons were more in non - treated group than that in sham operation group and Dexamethasone group(0. 580 0 ± 0. 020 0 vs 0. 298 3 ± 0. 014 7,t =27. 783;P = 0. 000;0. 580 0 ± 0. 020 0 vs 0. 261 7 ± 0. 017 2,t = 28. 614;P = 0. 000). Conclusions The LC3 expres-sion of cells in the cerebral cortex of juvenile Wistar rats with sepsis was up - regulated,LC3 - Ⅱ/ LC3 - Ⅰ ratio in-creased,and the number of LC3 positive neurons also increased,while Dexamethasone could have inhibitory effect on them.

ObjectiveTo research the endothelial dysfunction and early changes in arterial elasticity in patients with hyperlipidemia and effects of atorvastatin on these changes.Methods40 patients with hyperlipidemia but without any treatment in our hospital were selected as a study group,and 30 healthy people were selected as control group.Use the Flow mediated dilation,FMD detection which bases on the echo-trackingtechnology,eTRACYING to evaluate the right brachial atherosclerosis parameters and vascular diastolic parameters,including the pressure strain elastic modulus(Ep) ;stiffness index (β) ;compliance (AC) ;FMDs and FMDd.The study group take atorvastatin 20mg per day,then retested above parameters and TC,LDL-C after 12 weeks and analyzed all parameters.ResultsThe values of β and Ep in study group are significantly higher than the control group (all P ＜ 0.001 ),but AC;FMDs and FMDd are significantly lower than the control group( all P ＜ 0.001 ).The results of the study group after the treatment of atorvastatin are as follwing:TC,LDL-C,β and Ep are lower than before,AC,FMDs and FMDd are higher than before;and the differences are of significance in statistics ( all P ＜ 0.001 ).ConclusionHyperlipidemic patients had shown the vascular endothelial injury and vascular early hardening before the abnormal changes in intimal,but the atorvastatin intervention could reverse these changes.

Objective To study the expression of nuclear factor-?Bp65 (NF-?Bp65) in gastric carcinoma and its relationship with vascular endothelial growth factor (VEGF). Methods The expression of NF-?Bp65 and VEGF in 56 gastric carcinomas was detected with immunohistochemistry and compared with benign tissues. Results The positive rates of NF-?Bp65 and VEGF in 56 gastric carcinomas were 62.5% and 76.8% respectively,and which were higher than those of gastric mucosal atypical hyperplasia (33.3% and 44.4%) and the normal gastric mucosa(0 and 8.3%) (P0.05). There was positive correlation between NF-?Bp65 and VEGF expression (r=0.36,P

Objective Neonatal sepsis (NS) is one of the main causes of neonatal death.Immune therapy is an important way in the comprehensive treatment of NS.This study investigated several databases in order to find the clinical evidence for the immunological treatment of neonatal sepsis (NS),and to explore its clinical application value.Methods Systematic reviews and randomized (or quasi-randomized) controlled trials (RCT) for immunological treatment of NS in newborn infants were searched from the databases of MEDLINE,EMBASE and Cochrane Library.The relevant literatures were statistically analyzed.Results Six systematic reviews (including 37 RCTs) were found to be involved in the therapy,and the drugs included intravenous immunoglobulin (containing high level of IgM),antistaphylococcal immunoglobulins,neutrophile granulocyte,granulocyte colony-stimulating factor,granulocyte-macrophage colony-stimulating factor,pentoxifylline and glutamine.Pentoxifylline could decrease the mortality (Z =2.71,P =0.006 8),shorten the hospitalization (Z =2.01,P =0.044),and reduce the incidence rate of necrotizing enterocolitis (NEC) (Z =1.67,P =0.095) of the NS infants.No therapeutic effect was found for other drugs in the treatment of NS.Conclusions Current clinical evidence for the immunological treatment of NS indicates that only Pentoxifylline could decrease the mortality,reduce the incidence rate of NEC and shorten the hospitalization of infants with NS.However,current evidence is only a small scale sampling and lacks multicenter studies.Researchers are encouraged to undertake large scale and well-designed multicenter trials to confirm the effectiveness of the immunological treatment of NS.