ObjectiveTo study the differences in expression profiles of peripheral blood specific serum micro RNA(miRNA) in the comparison between those before and after Baihu Renshen decoction combined with Fufang Xiebai capsules for treatment of patients with severe pneumonia.Methods 136 patients with severe pulmonary infection accompanied by heat-phlegmand sthenic-fu syndrome admitted in the Department of Respiratory Medicine of Kunshan First People's Hospital Affiliated to Jiangsu University from January 2012 to December 2013 were enrolled in the study. They were treated with basic treatment and Baihu Renshen decoction〔gypsum 30 g(broken, wrapped in cotton cloth, firstly put in water to be boiled), American ginseng 4 g, fritillaria 10 g, bupleurum chinense 10 g, skullcap 10 g, fried gardenia(pittosporm root) 10 g, forsythia 12 g, honeysuckle 10 g, spiderwort grass(dayflower) 15 g, prepared licorice root 4 g〕 combined with Fufang Xiebai capsules〔mainly composed of longstamen onion bulb(macrostem onion)12 g, melon wilt(fructus trichosanthis) 12 g, pinellia 10 g, coptis chinensis 3 g〕. The changes of serum miRNA expression profiles before and after treatment were analyzed by Solexa sequencing. The peripheral blood serum specific miRNAs were confirmed by real-time fluorescent quantitation-polymerase chain reaction(qRT-PCR). Before and after treatment, the receiver operating characteristic curve(ROC curve) of patients with severe pulmonary infection was drawn, and the ROC curve was used to analyze the sensitivity and specificity of serum miRNA to the efficacy of the combination therapy and evaluate its clinical value.Results Solexa sequencing suggested that 42 kinds of miRNA appear to have over 2-fold in difference in the comparison between profiles before and after Baihu Renshen decoction combined with Fufang Xiebai capsules treatment. Real-time qRT-PCR confirmed miR-146a, miR-125b and miR-155 expressions were significantly decreased over 10 fold, suggesting that they should be specific miRNAs. The area under the ROC curve(AUC) of miR-146a was 0.81,95% confidence interval(95%CI)=0.73 - 0.89,miR-125b AUC=0.77,95%CI=0.71 - 0.83 and miR-155 AUC=0.89, 95%CI=0.83 - 0.95. Then, through selected clinical truncated(cut off)value,the sensitivity and specificity of three kinds of serum miRNA were calculated: 63% and 87% of miR-146a, 53% and 73% of miR-125b and 56% and 83% of miR-155.ConclusionAddition of Baihu Renshen decoction combined with Fufang Xiebai capsules on the basic treatment can induce significant changes of peripheral blood serum miRNA expression profiles in patients with severe pneumonia, and miR-146a, miR-125b and miR-155 among miRNAs could be their specific changes.

Objective To study the effects of Baihu Rensen decoction combined with Fufang Xiebai capsules for treatment of patients with severe pneumonia accompanied by heat-phlegm and sthenic-fu syndrome.Methods A prospective study was conducted; 266 severe pneumonia cases with heat-phlegm and sthenic-fu syndrome admitted into the Department of Respiratory Diseases in Kunshan Hospital Affiliated to Jiangsu University from January 2012 to December 2013 were selected. The patients were randomly divided into a integrated traditional Chinese and western medicine group (136 cases) and a western medicine treatment group (130 cases). Both groups were given basic conventional western medicine according to the disease situation. The integrated traditional Chinese medicine (TCM) was additionally given Baihu Rensen decoction combined with 350 mg of Fufang Xiebai capsules, 3 times a day, 4 grain each time, 7 days constituting a course of treatment. The rate of body temperature descent, the degree of improvement in clinical TCM symptoms, peripheral white blood cell (WBC) count, neutrophil percentage and the situation of endogenous pyrogen production in the two groups were compared.Results After treatment, the body temperature, TCM symptom scores, WBC count and neutrophil percentage were lower than those before treatment, 3 days after treatment these data reached their valley values, and the decrease in level was more significant in the combination group [body temperature (℃): 36.5±0.0 vs. 37.0±0.0, TCM symptom scores: 1.7±0.2 vs. 6.1±0.7, WBC (×109/L): 7.1±0.3 vs. 8.3±0.5, neutrophil percentage: 0.64±0.02 vs. 0.76±0.23, allP < 0.05]. Interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), interferon (IFN-α, IFN-γ), and interleukin-6 (IL-6) level in western medicine (WM) group was respectively marked 1, the levels of IL-1β, TNF-α, IFN-α, IFN-γ, and IL-6 in combination group after treatment for 6 hours were significantly lower than those of WM group, and reached the valley at 12 hours (the relative expression value of each of the above indexes in combination group to each of those in WM group was 0.37, 0.16, 0.21, 0.27 and 0.15 respectively), and had a mild rebound at 24 hours.Conclusion By the addition of Baihu Rensen decoction combined with Fufang Xiebai capsules on conventional basic medicine for treatment of severe pneumonia patients with heat-phlegm and sthenic-fu syndrome, the therapeutic effect is much better.

Objective To research the diagnostic value of serum procalcitonin (PCT)for sepsis and bacterial infection in children,and evaluate the value of severity and prognosis evaluation by dynamic monitoring for PCT levels in children with sepsis.Methods Prospective study.From July 2011 to April 2012,297 children in PICU were divided into sepsis group(n =125)and non-sepsis group(n =172).The sepsis group were divided into severe sepsis group and non-severe sepsis group,at same time,to be divided into bacterial sepsis group and non-bacterial sepsis group.The concentrations of serum PCT,C-reactive protein (CRP),WBC,neutrophil ratio in different time periods were obtained;the pediatric critical illness scores were conducted and sepsis related organ failure assessment were evaluated,the condition of prognosis was observed.Results The level of PCT in sepsis group and non-sepsis group were (21.31 ± 18.27)ng/ml,(4.35 ± 2.63)ng/ml,respectively.PCT of sepsis group was higher than that of non-sepsis group (t =4.744,P ＜ 0.01).The area under ROC curve of PCT,CRP and WBC in sepsis group were 0.737 (95 ％ confidence interval:0.633 ～ 0.840),0.704 (95 ％ confidence interval:0.610 ～ 0.799),0.666 (95 ％ confidence interval:0.554 ～0.778),respectively.When the level of PCT was 10 ng/ml,the diagnosis of severe sepsis had critical value,with sensitivity 80.2％ and specificity 82.6％.We found that PCT rapidly increased at the early infection by dynamically observing PCT,CRP and WBC of sepsis group.Furthermore,when the infection was controlled after using the antibiotic for 5 days,PCT also quiekly came down.However,CRP,WBC remained high level after controlling the infection and they declined slower than PCT.The PCT level of the children in the dead group was significantly higher than that in the survival group.PCT showed negative correlation with pediatric critical illness score (r =-0.621,P ＜ 0.05),and positive correlation with sepsis related organ failure assessment(r =0.755,P ＜ 0.01).Conclusion PCT has important value for diagnosing severe sepsis and bacterial sepsis.Dynamic PCT monitoring is valuable in severity classification and prognosis assessment for critically ill children with sepsis,and provide guides for clinicians to adjust the antibiotic use in time.

Objective:To report the results of neurocutaneous axial island flaps in the forearm in clinical application.Methods:12 patients with soft tissue defects around the elbow and the wrist were treated with proximally or distally based island flaps based on the lateral and medial forearm cutaneous nerves.The flaps measured 9cm?8cm to 4cm?3cm.Results:The flaps totally survived in 11 pa- tients,the other was patially survived.The color and texture of the flaps were good.Their appearance and function were satisfactory after 12～18 months follow—up.Conclusions:On the basis of the vascu- larization of the lateral and medial cutaneous nerves of the forearm,some reliable island flaps were raised successfully.These flaps are easy to dissection and have a large arc of rotaion.They were satisfac- tory in repairing the soft tissue defects around the elbow,the distalone of third of the forearm and the wrist.

OBJECTIVETo investigate the changes in serum amylase (AMY) and lipase (LPS) and their clinical significance in patients with acute paraquat poisoning (APP).

METHODSThe clinical data of 62 APP. patients who were admitted to Guangzhou 12th People's Hospital in 2014 were retrospectively analyzed. With clinical death being regarded as the end point of observation, the 62 patients were divided into survival group (n=32) and death group (n=30). The fasting venous blood of the patients on the 1st, 3rd, and 7th day after admission were collected, and the AMY and LPS levels were determined; the obtained data were compared between the two groups and analyzed statistically.

RESULTSThe AMY and LPS levels of the survival group on the 1st, 3rd, and 7th day after admission were significantly lower than those of the death group (P<0.05); the AMY and LPS levels of the death group on the 3rd day were significantly higher than those on the 1st day after admission (P<0.05); the survival group demonstrated no significant changes in AMY and LPS levels (P>0.05).

CONCLUSIONChanges in AMY and LPS levels in APP patients are reliable indicators for the determination of poisoning severity and prognosis.

Amylases ; blood ; Humans ; Lipase ; blood ; Paraquat ; poisoning ; Poisoning ; blood ; mortality ; Prognosis ; Retrospective Studies

Objective To determine the fecal elastase-1 (FE-1) in critically ill children in order to investigate the relationships between FE-1 and trypsin,sepsis as well as the severity of the disease.Methods Totally 402 critically ill children admitted in pediatric intensive care unit (PICU) of Hunan Children' s Hospital from July 2013 to March 2014 were studied.The formed stool of patients was collected during the first 24 h after admission.Subjects were divided to 3 groups according to FE-1 concentration:＞ 200 μg/g for normal pancreatic exocrine function (group A,n =300),100-200 μg/g for mild to moderate exocrine pancreatic insufficiency (group B,n =52),＜ 100 μg/g for severe pancreatic exocrine insufficiency (group C,n =50).The analyses of the relationships between FE-1 and pancreatic enzymes,sepsis severity,shock,the number of organ dysfunction,PCIS (pediatric critically ill score),SOFA score,and APACHE Ⅱ score were carried out.Chi-squared test was used for data statistics.The median and four percentile interval were used for the measurement data of abnormal distribution or non-neat variance,the rank sum test of each two of multiple samples compared each other was used for non-parametric test,only when it was statistically significant,and the Spearman method of correlation analysis was used for correlation analysis.Results (1) There was significant difference in serum lipase between group A and group B (P ＜ 0.01).(2) There was statistical difference in FE-1 level between sepsis group and non-sepsis group (P ＜ 0.05).Children with sepsis were divided into three groups according to the severity of sepsis:mild sepsis group,severe sepsis group and septic shock group.There were significant difference in FE-1 level among different severities of sepsis groups and as well as non-sepsis group (P ＜ 0.01).(3) The proportions of FE-1 in septic children of A,B and C groups in comparison with those in non-septic children of three groups were 65.79％ vs.78.13％,15.79％ vs.11.80％,18.42％ vs.10.07％,respectively.The proportions of FE-1 in septic children of B and C groups escalated were higher than those in children without sepsis.(4) The general trend in FE-1 concentrations varied along with the severity of sepsis.There were no significant differences in FE-1 concentration between non-sepsis group and mild sepsis group,and between severe sepsis group and septic shock group,but other paired comparisons between the four groups had statistical significant (P ＜0.01).(5) Along with FE-1 level decreased,the number of organ dysfunction,SOFA score,APS score (This is a part of APACHE Ⅱ score and other part,CPS,is excluded) increased and PCIS score decreased (rs1 =-0.194,P =0.000; rs2 =-0.348,P =0.000; rs3 =-0.176,P =0.000; rs4 =0.185,P =0.000).Conclusions Pancreatic exocrine function damage is associated with sepsis,the pancreatic dysfunction in patients with mild sepsis may not be significant,but its incidence increases gradually with the development of sepsis or with the deterioration of the disease.

ObjectiveTo explore the value of elevated amylase in assessment of severity of the disease and its inlfuencing factors in critically ill children.MethodThe clinical data from critically ill children hospitalized in pediatric intensive care unit were retrospectively analyzed from November 2009 to June 2014. According to levels of serum amylase, the critically ill children were divided into normal serum amylase group (≤103 IU/L) and elevated serum amylase group (>103 IU/L). The differences between two groups were compared.ResultsA total of 1920 critically ill children were enrolled, most of whom had primary respiratory and neurological diseases. Among them, 1470 children had normal serum amylase (76.6%) and 450 children had ele-vated serum amylase (23.4%). The elevated serum amylase group had signiifcantly higher rate of organs failure (≥4), lower rate of PCIS (<70), higher rate of invasive mechanical ventilation and mortality than those in normal serum amylase group (P<0.001). The correlation of serum amylase with lipase blood, urine amylase, blood urea nitrogen and creatinine were signiifcant (r=0.246 to 0.683,P<0.001). Blood amylase was positively correlated with shock index (r=0.111,P=0.002) and negatively correlated with respiratory failure index (r=0.133,P<0.001).ConclusionsSerum amylase could be used to assess the severity of disease. The elevated amylase was closely related to pancreatic exocrine function, renal function, ischemia, and hypoxia. The elevated serum amylase in critically ill children is a warning sign.

Objective To evaluate the mode of referral by response time for inter-hospital transfer of critically ill pediatric patients,and subsequently some measures taken for minimizing the response time in referral process.Methods A total of 9231 patients (≤14 years) transferred from primary hospital were included in a cross-section study.Information about age,sex,referral radius,the seasonal variation for inter-hospital transport of critically ill pediatric patients,time of referral telephone call and response time were collected.All computations were performed using the Statistic Package for Social Sciences for Windows version 18.0.Differences between groups were assessed by x2 tests or Wilcoxon test or Kruskal-Wallis for categorical data.Results Among all critically ill pediatric patients for the inter-hospital transfer,male to female ratio was 2.24:1,and the majority of patients were neonates and infants.Median retrieval mobilization time was 30 min (interquartile range,20-50 min).This study has demonstrated that referral time,age categories,referral radius,different years and seasons were associated with response time.Conclusions With the improvement of technologies and management mechanism,the response time was apparently minimized since the beginning of interhospital transportation.But there is still plenty of room for shortening rsponse time compared with advanced Westem countries.

Objective To study the value of Procalcitonin (PCT) in predicting the severity of the critically ill children by analyzing the clinical data of increased PCT level.Methods A total of 392 patients with increased PCT admitted to the PICU of Hunan Children's Hospital from August 2011 to April 2012 were enrolled.The data of clinical manifestations,medical condition,sputum culture,organ function and prognosis were summarized and analyzed statistically.The continuous variables were analyzed with t-test,the categorical variables were analyzed with Chi-squared test,and the correlation analysis was calculated using Pearson coefficients.Results Serum PCT had a positive correlation with inflammatory markers such as C-reactive protein (CRP),white blood cell (WBC) count and the percentage of neutrophils (NEU％) (P ＜ 0.01).PCT was significantly higher when sputum culture was positive (P ＜0.05) but there were no obvious changes in CRP,WBC and NEUT％ (P ＞ 0.05).Serum PCT increased obviously in the presence of organ dysfunction.The higher serum PCT,the more likely multiple organ failure would happen.The PCT level upon admission in death group (63 cases) was (62.43 ± 70.19) ng/ml,which was higher than that in survival group (P ＜ 0.01).Conclusions PCT level is helpful in assessment of severity and prognosis of bacterial infection in critically ill children,and can reflect the organ dysfunction objectively.It can improve the survival rate and the life quality in critically ill children.

Objective To evaluate the clinical effect of the reversed saphenous fasciocutaneous island flap combined with the VSD therapy in plate exposure of the distal tibia.Methods From January 2008 to July 2010,seven patients with hardware exposure following internal fixation of the distal tibia fracture were treated by VSD therapy and reversed saphenous fasciocutaneous island flap reconstruction.The VSD therapy was performed from 7 to 26 days after hardware exposure,and the flap transfer was performed 7 to 14 days after the VSD therapy.The size of the soft-tissue defect ranged from 4 cm × 2 cm to 13 cm × 4 cm.The mean follow-up was 10.6 months after the fracture (range,8-14 months).Results The average times of the VSD therapy was 1.3.After VSD was removed,the exposed hardware was covered by healthy granulation tissue in all cases.All flaps were successfully transplanted,and the size of flap ranged from 6 cm × 3 cm to 15 cm × 6 cm.Six of 7 flaps survived completely without further procedures.The necrosis of the distal margin of the flap occurred in 1 patient.A solid bony union was confirmed by the X-ray in all patients after 4-6 months postoperatively.No skin defects or fistulae were observed.Conclusion The combination of the reversed saphenous fasciocutaneous island flap and VSD therapy could save the exposed hardware and cover the soft tissue defects in the distal tibia.