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 analyze the diagnosis and treatment of 1 case of primary bone marrow diffuse large B cell lymphoma (DLBCL),and to provide the reference for its dignosis and treatment. Methods:Combined the medical history and other auxiliary examination results, the possibility of diagnosis of primary bone marrow lymphoma (PBML)was suspected. Bone marrow biopsy and immunohistochemistry were carried out for diagnosis, and R-CHOP (rituximab, cyclophosphamide,doxorubicin,vincristine,and prednisolone) was selected as the chemotherapy scheme. Results:The diagnostic basis of the case was in accordance with the diagnostic standard of PBML.According to the results of immunohistochemical staining,it was classified as the DLBCL subtype. Then the patient received 6 cycles of R-CHOP immune chemotherapy. Complete remission of bone marrow cell morphology was gained after the first cycle of R-CHOP treatment,and the patient was treated for another five cycles and the complete remission was retained in 3 months of follow up after drug withdrawal. Conclusion:Bone marrow biospy and immunohistochemistry have the unique diagnostic values for primary bone marrow DLBCL,and the regimens containing rituximab may provide a ideal efficacy during short term observation.

Objective Evaluation the effect to improve the eight-year program medical students` comprehensive ability between standard of PBL mode and complex scenarios PBL mode.Methods To comparative improved teaching quality between complex scenarios PBL teaching mode and standard of the PBL teaching mode by final exam scores and DREEM scale.Results The complex scenarios PBL teaching mode improve the ability of problem solving score significantly higher than the standard scores of PBL teaching mode at the start of analyzing questions and help students to stimulate interest, increase self-confidence, (P<0.05).Comparative analysis shows the comprehensive thinking ability of medical students has improved significantly.ConclusionsComplex scenarios PBL teaching mode can improve the ability of handling the students` study enthusiasm, comprehensive ability and strain capacity more effectively than that of standard PBL teaching mode.The obvious effect is worth promoting.

Objective:To analyze the mutation of 5′ noncoding region of BCL 6 gene in extranodal diffuse large B cell lymphoma (DLBCL) and the relationship between mutation and clinical characteristics.Methods:Extract DNA from paraffin bedded extranodal DLBCL cases,then PCR and sequenced.Meanwhile retrospective analysis was done.Results:The mutation rate was 13 64%(6/44).The clinical characteristics,such as age、sex、B symptom、bulky tumor mass、stage、the level of LDH、BM involvement and CR,had no significant influence on BCL 6 mutation;the survive time of DLBCL with/without BCL 6 mutation had no obvious difference,but there was a tendency the survival time of mutated patients was longer than that of non mutated (the mean survival time was 74 and 65 02 months,respectively);mutation wasn't an independent prognostic factor.Conclusion:The mutation of 5′ noncoding region of BCL 6 gene maybe partly involves in the mechanism of extranodal DLBCL. [

BACKGROUND: The central position of dendritic cells (DCs) has aroused increasing attention due to strong antigen presentation capability in anti-tumor. However, how to obtain enough functional DCs and reports regarding immunomodulator with low toxicity are few. OBJECTIVE: To investigate the effect of mycobacterium phlei F.U.36 (Utilins) on the proliferation and maturity of DCs derived from human umbilical cord blood in vitro.METHODS: The mononuclear cells were isolated from human umbilical cord blood using Ficoll-Hypaque method and cultured with Utilins, cytokine (human recombinant granulocyte/macrophage colonystimulating factor + recombinant human tumor necrosisfactor-α + recombinant human interleukin-4), or combination cytokine + Utilins, respectively. In addition, cells cultured with RPMI-1640 served as controls. Morphological features and growth of DCs were observed by an inverted microscope. Thephenotype changes of DCs, such CD1a and HLA-DR, were detected by flow cytometry at 9 days after culture. Moreover, DCs were stained by Wright-Giemsa and observed under oil lens. RESULTS AND CONCLUSION: Typical DCs with high expressions of CD1a and HLA-DR were obviously detected in all experimental groups except the control group. The positive rates of CD1a and HLA-DR in the Utilins group were higher than those in the control group, but lower than the cytokine group (P < 0.05). The HLA-DR positive rate of the combination group was higher than that of the cytokine group (P < 0.05). The results revealed that, Utilins can not only promote the proliferation of DCs derived from human umbilical cord blood in vitro but also cooperate with cytokines to induce the maturity of DCs.

Objective To systcmatically rcvicw the effect of goal-directed fluid therapy (GDFT) on outcomes following abdominal surgery.Methods Pubmed,Embase,CINAHAL,Scopus and Cochrane Library were searched from 1980 to May 2016 to identify randomized controlled trials involving the effect of GDFT on outcomes following abdominal surgery in adults (aged＞ 18 yr).GDFT served as therapy group,and conventional fluid therapy served as control group.The major evaluation indexes included the postoperative mortality rate,incidence of postoperative complications and length of hospital stay.The secondary evaluation index was the recovery of postoperative gastrointestinal function.Meta-analysis was conducted using the RevMan 5.1 and Stata 12.0 softwares.Results Forty-five randomized controlled trials involving 6344 patients were included in our meta-analysis,and there were 3406 cases in therapy group and 2938 cases in control group.The results of mcta-analysis showed that compared with control group,the number of patients who developed postoperative complications was significantly decreased,the length of hospital stay was shortened,and the time to first flatus and time to first liquid diet were shortened in therapy group (P＜0.05).There was no significant difference in the mortality rate between the two groups (P＞0.05).Conclusion GDFT can promote outcones following abdominal surgery and exerts no effects on the survival rate in patients.

Objective:To explore the influence of different cell culture methods in the genome-wide DNA methylation status of breast cancer MDA-MB-231 cells,and to clarify the relationship between genome-wide DNA methylation status and cell growth environment and the role of genome-wide DNA methylation status in the occurrence and development of tumor.Methods:The MDA-MB-231 cells were cultured with 2D and 3D cell culture models and mouse orthotopic transplantation model (Ti model)and collected, then DNA was extracted by DNA extraction kit and the genome-wide DNA methylation status of MDA-MB-231 cells after cultured with three different culture methods was detected by DNA methylation chip,then the value of beta,DiffScore and Delta_Beta of the CpG loci of each gene were calculated by applying Genomestudio software, and the differential methylation genes were screened by Genomestudio software and GO and Pathway analysis of these genes were performed in DAVID on-line analysis tool.Results:All 480 genes of the MDA-MB-231 cells showed significant differences in the degree of methylation in 3D and 2D models (P<0.05);86 448 genes in 3D and Ti models (P<0.05);90 005 genes in Ti and 2D models (P<0.05).The differential methylation genes in 3D and 2D,3D and Ti,and Ti and 2D models were enriched on the multicellular organismal development term and cell differentiation term (P<0.05);also on MAPK signaling pathway,cell adhesion molecules (CAMs),and regulation of actin cytoskeleton (P<0.05). Conclusion:There are differences in genome-wide DNA methylation status of MDA-MB-231 cells cultured in 2D, 3D cell culture and Ti models.

Objective To investigate the effect of group psychological counseling and peer education on depressive and anxiety symptoms of pregnant females with selective multiple pregnancy reduction in second trimester. Methods Sixty-two pregnant females with selective multiple pregnancy reduction in second trimester were randomly divided into intervention group(n=30)and control group (n=32), two groups of pregnant women all received routine nursing. The pregnant women of intervention group received group psychological counseling and peer education for one month before multiple pregnancy reduction. Results Before the intervention, the anxiety levels of the two groups of pregnant women were not significantly different. After the intervention, the intervention group had less anxiety symptoms than before the intervention[ before(54.2 ± 3.2)points,after(43.4 ± 3.1)points,t=13.250,P=0.000].After the intervention, the intervention group had less anxiety symptoms than the control group[the intervention group(43.4±3.1)points, the control group(50.0±4.4)points,t=6.712,P=0.000].Before the intervention, the depression levels of the two groups of pregnant women were not significantly different. After the intervention, the depression levels of the control group was not significantly different than those before the intervention. After the intervention, there was significantly lower depression score of the intervention group than that of the control group(P < 0.05) [before(56.9 ± 3.5)points, after(45.3 ± 2.5)points, t=14.773,P=0.000].After the intervention, the intervention group had lower depression score than the control group[the intervention group (45.3 ± 2.5) points, the control group (54.6 ± 3.0) points, t=12.802,P=0.000]. Conclusions Group psychological counseling and peer education can effectively improve depressive and anxiety symptoms of pregnant females with selective multiple pregnancy reduction in second trimester.

Aim To investigate the effects of Astragalus Mongholicus Bunge Lectin (AMML) on tumor cells proliferation,cell cycle and apoptosis by using human leukemia cell line (K562 cells).Methods The antiproliferation effect of AMML on K562 cells was detected by the colorimetric MTT assay.The apoptosis induced by AMML on K562 cells was explored by means of cell morphological and flow cytometry.Results AMML showed strong inhibiton of the growth of K562 cells in a time-and concentration-dependence. After incubation of K562 cells with AMML at a concentration of 60 mg?L-1 for 72 h,the inhibition ratio was 89%.Morphological observation showed that AMML-treated K562 cells displayed outstanding apoptosis characteristics,such as nuclear fragmentation,chromatin condensation. AMML induced significant cell cycle arrest at S phase in K562 cells,and the apoptosis of K562 cells was confirmed by flow cytometry.Conclusion AMML can inhibit the growth of K562 cells through S arrest and induce the apoptosis of K562 cells. Thus,AMML may be valuable for the treatment of cancer.