Objective:To investigate survival and apoptotic responses of alveolar epithelial typeⅡcells(ATⅡ cell)under oxidative stress and to discuss the regulation mechanism mediated by c-jun NH2-terminal kinase(JNK).Methods:Primary rat alveolar epithelial typeⅡcells were attacked by Hydrogen peroxide(H2O2)and cells were pretreated with SP600125 in some groups.Cell viability,apoptotic rate and the expression of phosphorylated JNK(p-JNK)were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT)assay,flow cytometry and western blot analysis,respectively.Results:Compared with control group,decreased cell viability and increased apoptotic rate in ATⅡ cells occurred in time-dependent manner when treated with 500?mol/L H2O2 in different time.H2O2 induces phosphorylation of JNK.SP600125 enhanced cell viability and decreased apoptotic rate after H2O2-exposure.Conclusion:Apoptosis could be induced by H2O2 in ATⅡ cells in time-dependent manner.JNK signaling pathway may play a proapoptotic role in the regulation of apoptosis induced by H2O2.

Inhaled nitrous oxide (iNO) can alleviate pulmonary hypertension and enhance ventilation-perfusion matching to improve oxygenation in pediatric acute respiratory distress syndrome (PARDS).But duration of improvement was short.From the existing researches,iNO can't effectively improve outcome in PARDS.So iNO is not recommended for routine use in PARDS.However,iNO may be used in patients with documented pulmonary hypertension or severe right ventricular dysfunction.In addition,iNO can be a rescue intervention for severely PARDS to buy time and allow other therapies.

Methicillin-resistant Staphylococcus aureus (MRSA) infection can cause pneumonia,bacteremia,infective endocarditis and other diseases,seriously threat to the health of children.Pediatricians should discover the focus of infection.And the focus of infection should be removed or debrided in time.Vancomycin is an important drug for the treatment of MRSA infection,the use of Vancomycin need to ensure that the blood concentration is effective.Now,the advances in treatment of MRSA infection in children was mainly summarized.

Intracranial hypertension is one of the most common pediatric acute and severe diseases.Intracranial pressure(ICP) monitoring can dynamically evaluate the changes of the patients with brain injury,calculate the cerebral perfusion pressure,guide the clinical treatment.ICP monitoring can not reflect the cerebral microvascular dysfunction and cell dysfunction,so it is necessary to carry out multimodality monitoring based on ICP monitoring.The information integration of ICP monitoring and multimodality monitoring is helpful to further understand the pathophysiological mechanism of brain injury,and it is also helpful for individualized treatment of patients.

New guideline for the acute medical management of severe traumatic brain injury in infants,children,and adolescents was published in Pediatric Critical Care Medicine in 2012.This guideline made relevant recommendations and suggestions on intracranial pressure monitoring,threshold for treatment of intracranial hypertension,cerebral perfusion pressure thresholds,advanced neuromonitoring,neuroimaging and therapy for intracranial hypertension in pediatric patients with severe traumatic brain injury.This guideline was simply interpretated in order to improve the treatment of severe traumatic brain injury.

Objective To study the effects of dexamethasone(Dex) on expression of aquaporin-4(AQP4) in rabbit non-pigmented ciliary epithelium(NPCE).Methods To construct rabbit corticosteroid-induced glaucoma model and then compare the differences of AQP4 expression in NPCE with normal controls by immunohistochemistry and immunofluorescence methods,as well as Western blot method.Results The immunohistochemistry results indicated that the AQP4 expression in NPCE of DEX group(OD=0.119?0.072) was suppressed(0.242?0.056)(P

Objective: To investigate the application of regional citrate anticoagulation with calcium hemofiltration basic solution in continuous hemofiltration in children. Method: The clinical data of 18 patients with citrate anticoagulation in continuous hemofiltration in children, excluding the hepatic failure and septic shock cases, were analyzed retrospectively, from September 2015 to August 2016 in Intensive Care Unit of the Children′s Hospital of Chongqing Medical University.The commercial calcium hemofiltration basic solution was used as displacement liquid . The blood gas analysis, electrolyte, four coagulation tests during the treatment and the corresponding relations of quantity of blood flow(QB), quantity of citrate flow(QCi), quantity of sodium bicarbonate flow(QSB), quantity of calcium flow(QCa), quantity of filtered solution flow (Qf) were monitored. Meanwhile, the blood gas analysis, electrolyte, four coagulation tests, useful life of filter, bleeding and clotting events internal and external before, during and after the treatments were monitored, too. And the common complications of citrate anticoagulation, such as hypocalcaemia, metabolic alkalosis, citrate accumulation and hypernatremia were observed. Result: Continuous hemofiltration was applied in 18 patients for 734.5 hours, and the average useful life of filter was (25±11)h.There was no obvious clotting event. There were 168 groups of datum of the blood gas analysis, electrolyte, four coagulation tests during the treatment and the relationships of QB, QCi, QSB, QCa, Qf had been collected. The relationships of the initial parameter settings of QB, QCi, QSB, QCa and Qf were concluded as QCi=1.8×QB, QCa=0.12×QB, QSB=0.01×Qf . There were 150 times(89.3%)of extracorporeal ionized calcium(iCa_E²⁺) and 162 times(96.4%) of intracorporal ionized calcium(iCa_I²⁺) reached the anticoagulation target. Although all the comparisons of Na⁺ ((136.2±4.1)vs.(138.2±2.4)vs.(138.5±3.9)mmol/L), iCa²⁺ ((1.07±0.11)vs.(1.21±0.12)vs.(1.17±0.09)mmol/L), HCO₃^- ((22±4)vs.(28±5)vs. (26±4)mmol/L) among before, during and after treatment had significant difference(F=6.414, 18.950, 19.151; P=0.002, 0.000, 0.000). Each mean parameter was within the nearly normal range, except that the HCO₃^- increased slightly. High HCO₃^- was the most common complications, which happened 87 times (51.8%) during the treatment and 11 cases(37.9%) after the treatment. There was none with refractory hypocalcemia and total ionized calcium(TCa²⁺ )/iCa²⁺ above 2.5, which hints the accumulation of citrate. Conclusion The commercialized displacement liquid containing calcium can be used in RCA-CHF in children safely and simply.

Traumatic brain injury (TBI) is a common and critical illness in pediatrics,and it is also an important cause of death and disability in children. TBI may cause hyperglycemia,which may be related to stress,inflammation,pituitary function and iatrogenic factors. Hyperglycemia is closely related to the mortality and outcome of children with TBI. However strict glycemic control did not achieve good effects in patients with TBI.

Objective: To investigate the effect of fiberoptic bronchoscope-guided one-lung ventilation (OLV) on treatment of intractable atelectasis in children. Method: This retrospective cohort study was conducted in Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University from December 2014 to May 2017. Six patients with intractable atelectasis of left lung were included. Three cases were male and three female with the age from 1.5 to 11.0 years. The endotracheal tube was intubated to the left main bronchus for OLV by the guidance of fiberoptic bronchoscopy. The effect of treatment by monitoring the chest imaging after treatment was evaluated. Result: Six pediatric patients were successfully cured by OLV. The duration of OLV ranged from 1.5 to 30.0 hours, and the intervals of OLV were usually 3 to 5 days. Each patient received 6 to 20 OLV treatments. Chest images showed the left lung reexpanded obviously after OLV treatments. Five patients successfully weaned from invasive ventilation and were discharged. Another patient turned better, discharged from hospital with noninvasive ventilation and weaned from noninvasive ventilation one month later after discharge. During the procedure of OLV, the vital signs of all patients were stable and no complication occurred. Conclusion OLV with selective bronchial intubation guided by fiber bronchoscope is a safe and effective treatment for intractable atelectasis in children.

Objective: Based on the Chinese Medicine Heritage Auxiliary Platform (V2.5) software, to analyze the differences in prescriptions for the treatment of Alzheimer's disease and Vascular dementia in the literature of the past five years, and to find the rules of prescription. Methods: Screening CNKI, VIP, and Wan fang data for nearly 5 years to find the prescriptions for the treatment of Alzheimer's disease and Vascular dementia, and constructing a prescription database through the Chinese Medicine Heritage Auxiliary Platform (V2.5) software, and utilizing the Data mining algorithms such as association rules and entropy clustering of the software. Compare the frequency of medication, the drug.s natural, flavor and channel tropism, the common drug pairs, the potential drug pairs, and the differences in the new prescriptions used in the treatment of senile dementia and vascular dementia. Results: 13 of the top 20 high frequency herbs used in AD and VD are the same, the other is different. Its common pathogenesis reflect the interaction of deficiency, stasis and phlegm, while the difference shows that AD focuses on spleen and kidney deficiency, insufficiency of essence and blood, but VD focuses on the interaction of phlegm blood stasis and toxic turbidity obstruction in collaterals. They both use warm herbs in nature and flavor, but AD mainly use sweet and warm herbs, followed by calm and cold herbs, while VD mainly use bitter and warm herbs, followed by cold and calm herbs; The channel tropisms both are mainly liver channel, followed by heart channel, spleen channel and kidney channel. In addition, 16 potential medicine pairs, 7 new prescriptions, 26 new prescriptions and 13 new prescriptions were found. Conclusion:Prescriptions for AD and VD have similarities and differences, with emphasis on each other, suggesting that the former focuses on warming Yang and invigorating spleen, while the latter focuses on resolving phlegm and removing blood stasis, detoxifying and awakening the brain.