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 investigate the adrenal histopathology damage in critically ill non-survival children,and the incidence of adrenal damage,and to explore the risk factors for the adrenal hemorrhage and necrosis in critically ill children.Methods A total of 141 critically ill non-survival children was admitted in this study in Hunan Children's Hospital from January 1,2005 to December 30,2012.Clinical data in children were systematically collected,including age,sex,sodium,potassium,blood gas analysis,liver and kidney function,blood clotting function,etiology,treatment and pediatric clinical illness score (PCIS) or neonatal critical illness score (NCIS),and pathological data.All data were analyzed by SPSS 18.0.Results Logistic regression analysis showed the factors of adrenal hemorrhage and necrosis of critically ill non-survival children were sepsis,PCIS score ＜ 80 critically ill children are risk factors for adrenal hemorrhage necrosis (P ＜ 0.05),ORwas 3.659 (95％ CI:1.344-9.965),and 2.325 (95％ CI:1.028 -5.258).Intravenous corticosteroids were protective factors for critically ill non-survival children with adrenal hemorrhage necrosis (P ＜ 0.05),and ORwas 0.377 (95％ CI:0.163-0.875).Conclusions There were two significant risk factors of adrenal hemorrhage and necrosis:sepsis and critical illness score less than 80 points.Intravenous corticosteroid is a protective factor 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.

Objective To investigate the clinical features,treatment,prognosis,and occurrence of neurogenic pulmonary edema(NPE) in children with severe hand-foot-mouth disease (HFMD) complicated with brain stem encephalitis and abnormal cranial magnetic resonance imaging (MRI).Methods 386 cases of severe HFMD were hospitalized in our Intensive Care Unit (ICU) from May to October 2010,of which 24 cases had abnormal cranial MRI.Their clinical symptoms,MRI features,treatment,and prognosis were analyzed.Results The clinical symptoms of severe HFMD with brainstem encephalitis included fever,startle,lethargy,vomiting,difficulty swallowing,drooling,and so on.The patients with abnormal cranial MRI were prone to have a neurogenic pulmonary edema (NPE) (5％ vs 6.5％,x2 =34.55,P ＜0.01).Conclusions The nervous system-affected parts of severe HFMD is the brain stem,thalamus,and spinal cord.Brain stem inflammation can be found early by the cranial MRI to be highly vigilant of NPE.During course of 1 ～ 5 day,special attention should be paid to the symptoms of the nervous system.The early detection,timely intervention,and prevention from NPE would result in the good prognosis.

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 determine the vitamin D status in children with sepsis/severe sepsis in pediatric intensive care unit (PICU) in order to explor the association between vitamin D status and clinical outcomes,in turn to provide evidence for optimizing nutrition support.Methods It was a prospective,observational,multi-center study,carried out in patients with sepsis/severe sepsis from March 1,2013,to March 30,2014,in the PICUs of three tertiary-care children's hospitals.Total serum 25-hydroxy vitamin D [25 (OH) D] was measured by using an enzyme-linked immunosorbent assay at admission.The association of vitamin D status at admission with length of PICU length of stay,total hospital stay,in-hospital mortality,28-days mortality and costs were analyzed.Results A total of 194 patients includng 117 boys (60.3％)and 77 girls (39.7％) were enrolled.There were 96 patients with sepsis and 98 with severe sepsis.The mortality on discharge and 28 days were 6.7％ and 24.2％ respectively.The median vitamin D level was 9.79 ng/mL (5.32,18.46) at admission.Of them 77.8％ (151/194) had vitamin D deficiency and 50.5％ (98/194) had severe vitamin D deficiency.Patients with severe vitamin D deficiency,had higher mortality on discharge (P =0.011).Vitamin D status had no significant correlations with 28 days mortality,length of PICU stay,total hospital stay and costs.Conclusions More than three-quarters (77.8％) of children with sepsis/severe sepsis in PICUs had Vitamin D deficiency.Patients with severe vitamin D deficiency at admission had higher risk of mortality at discharge.