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 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 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: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 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.

Objective To investigate the inhibitory effect of silencing survivin gene with siRNA on the growth of gastric cancer cells and its mechanism,and provide evidence in treatment for gastric cancer.Methods DNA template coding survivinspecific siRNA was designed and synthesized.Two recombinant plasmids (pGCsilencerU6/GFP/survivin-siRNA-1 and-2) were constructed.The gastric carcinoma cel1 line SGC-7901 were divided into three groups: liposome-treated control group,empty plasmid-transfected control group and survivin-siRNA-1 transfected group.In order to observe the effect of survivin-siRNA,the expressions of survivin mRNA and protein were detected by RT-PCR and Western blotting,respectively.Methyl thiazolyl tetrazolium(MTT) assay was applied to determine the cell growth status.Apoptotic rates were evaluated by flow cytometry(FCM).Results The results of Western blotting and RT-PCR indicated that the inhibitory rates of protein and mRNA in pGCsilenerU6/GFP/survivin-siRNA-1 transfected group(78.25% and 88.75%) were higher than those in liposome-treated control group(5% and 2%) and empty plasmid-transfected control group(1% and 6%)(P

OBJECTIVE To study the interaction of anthracene quinone type anti-tumor antibiotics and DNA as well as the experiment method.METHODS Spectrophotometry was developed including absorption spectrum,fluorescence spectrum,electrochemical method and so on.RESULTS The union of inlay and insertion observed in ultraviolet and visible spectrophotometry usually caused hypochromic effect and red shift.Under the certain concentrations of bovin serum albumin(BSA),the endogene fluorescence intensity of BSA orderly reduced with the increase in concentration of doxorubicin(adriamycin) hydrochloride(?em 344 and the peak shape were invariable);?ex and ?em at the biggest wave length of doxorubicin were 478 and 596 nm.The fluorescence intensity was maximal of the excitation and emission spectrum when pH was 3.0.CONCLUSIONS The interaction of doxorubicin and DNA is the strongest according to the experiment and is the most widely used at present in clinics.

Objective To investigate the gene transduction efficiency of lentiviral vector in leukemia cells to provide key basis for leukemia gene therapy. Methods A third-generation self-inactivating(SIN) lentiviral vector system based on human immunodeficiency virus type 1(HIV-1) was used to improve transduction efficiency.The transduction efficiency of the HIV-1-based vector was compared directly with the moloney murine leukemia virus(MLV) SIN vector in human leukemia cell line K562.The expression of green fluorescent protein(GFP) in cells was observed by fluorescence microscopy and flow cytometry(FCM) to detect the percentage of gene trasduction cells.Results The GFP expression in K562 cells was observed qualitatively by fluorescence microscopy.At the same gene transduction conditions,the GFP marker gene expression intensity and GFP positive cells in leukemia cells transduced with HIV vectors were significantly higher than those transduced with MLV vectors.Initial transduction efficiencies were almost 100% for the HIV and less than 40% for the MLV vectors. The transduction efficiency had significant difference between HIV vector group and MLV group(P