Severe sepsis and septic shock is a clinical syndrome with sequential organ dysfunction or tissue hypoperfusion induce by sepsis.Although early,adequately and rapidly initial resuscitation plays pivotal role in the management,but infusion of albumin,plasma,red blood cell,platelet,gamma globulin and other blood products and the immunological support with ulinastatin combined with thymosin,blood purification and anti CD14 monoclonal antibody therapy also play an important role.

Objective To observe the curative effect of pulmicort aerosol combined with terbutaline aerosol in the treatment of infants with mycoplasma pneumonia (MP).Methods 240 children with MP were selected and according to the different treatment method,they were divided into the observation group and control group.120 cases in the observation group were treated with pulmicort combined with terbutaline inhalation therapy.120 cases in the control group received budesonide inhalation therapy.Immunological parameters of IgG,IgE and TNF-α level,the main clinical symptoms and clinical efficacy were compared between the two groups.Results Compared with before treatment,IgG significantly increased,IgE and TNF-α level significantly decreased after treatment in the two groups,the differences were statistically significant (t =19.965,10.780,3.468,6.002,5.440,4.885,all P ＜ 0.05).And those in the observation group were better than the control group (t =13.920,4.523,2.729,all P ＜ 0.05).The remis sion time of clinical symptoms such as body temperature,wheezing,cyanosis,cough and pulmonary rales in the observation group were significantly shorter than those of the control group (t =2.991,6.034,4.623,8.562,7.113,all P ＜ 0.05).The obvious effective rate of the observation group was 93.3％,which was higher than 79.2％ of the control group (x2 =8.140,P ＜ 0.05).There were no significant adverse reactions in two groups.Conclusion Budesonide combined with terbutaline atomization inhalation in the treatment of infants with mycoplasma pneumonia has short remission time of clinical symptoms,good efficacy and less adverse reactions,it is worthy of promotion.

Objective Our retrospective study is aimed to compare the effect and the adverse reaction of TNP(paclitaxel liposome +nedaplatin +tegafur)and PF(fluorouracil +cisplatin)in the treatment of head and neck squamous cell carcinoma(SCCHN).Methods Clinical data of patients with SCCHN received treatment at our hospital from 2009 to 2014 was retrospectively analyzed .Patients were divided into PF group and TNP group according to the treatment prescription .The general data,clinical features,treatment and the adverse reactions of the two groups were compared .Results A total of 54 patients was retrospective analyzed ,including 27 patients in TNP group and 27 in PF group.There was no significant differences in clinical data between the two groups .There was no significant differences in the location of the tumor ,clinical stage and differentiation degree between the two groups.The curative effect of TNP group was significantly ameliorated than the PF group .The incidence of gastro-intestinal reaction in TNP group was obviously lower than in PF group .There was no significant differences in the other adverse reactions .Conclusion In the treatment of SCCHN , TNP regimen is more effective than PF regi-men,and the incidence of gastrointestinal adverse reaction during the treatment is lower .

Objective To characterize composition and antibiotic resistance of the pathogens isolated from patients' deep sputum with ventilator-associated pneumonia(VAP) in PICU of our hospital,and give support to the administration of antibiotics early and reasonably in clinic.Methods The study was conducted during the period of January 2009 to December 2013 at PICU of the Children's Hospital of Zhejiang University School of Medicine.One hundred and twenty-one cases of children who conformed to the diagnostic criteria of VAP after treated with ventilator were the object,the endotracheal aspirates were collected and transported to microbiology laboratory within 15 minutes.The pathogens were routinely analyzed and identified with WITEK60 and used Kirby-Bauer method for drug sensitive test,and identified with the special drug-resistant bacteria.Results Among 121 VAP diagnosed patients,127 pathogenic strains isolated from sputum specimen.Gram negative,Gram positive bacteria and fungi accounted for 64.57％ (82/127),29.92％ (38/127)and 5.51％ (7/127) respectively.Acinetobacter baumannii (25.61％,21/127),Escherichia coli (20.27％,17/127),Stenotrophomonas maltophilia (20.27 ％,17/127),Klebsiella pneumoniae (16.22％,12/127) and Pseudomonas aeruginosa (9.46％,11/127) were frequently identified isolates among Gram negative bacteria.The resistant rate of Gram negative bacteria in β lactam antibiotics was 77.62％.Ten strains of Staphylococcus epidermis and 6 strains of Staphylococcus aureus were identified isolates among Gram positive bacteria.Except the sensitive to vancomycin and linezolid,Gram positive bacteria were resistance to cephalosporin and aminoglycosides.All fungi were sensitive to the anti-microbial agents.Conclusion The Gram negative bacteria were more prevalent than Gram positive bacteria and fungi in VAP and show high drug resistance.It is pivotal to administer anti-microbial agents early and reasonably for VAP children.To emphasize surveillance to the antibiotic resistance and grasp the characteristics of the drug resistance are much important to VAP therapy.

Objective:To clarify the changes in the bone marrow vascular system in the early stage of sepsis in animal model.Methods:A sepsis mouse model was established by cecal ligation and puncture (CLP), and HE staining, immunofluorescence staining, flow cytometry and real-time quantitative PCR were used to comprehensively analyze the varieties of bone marrow vascular system in structure, the relative proportion of vascular endothelial cells and the expressions of damage-related genes at mRNA level.Results:A series of adaptive changes occurred in the bone marrow vascular system in the early stage of sepsis.Histological analysis showed that the bone marrow vascular structure was significantly remodeled.The average density of bone marrow sinusoids in the CLP group was (410.43±72.63)counts/mm 2, which was significantly higher than that in the sham group[(294.43±68.94)counts /mm 2, P<0.01]. The area of luminal pixels accounted for (43.46±3.21)%, which was significantly higher than that in the sham group[(30.28±4.44)%, P<0.001]. The exudation amount of evans blue in the bone marrow tissue of the CLP group was (0.42±0.12)ng/mg tissue, which was significantly higher than that in the sham group[(0.24±0.09)ng/mg tissue, P<0.05], suggesting increased vascular permeability.The results of flow cytometry analysis showed that the EC in bone marrow of the CLP group mice was in a proliferative state, with the proportion of Ki67 + endothelial cell increasing[(1.91±0.65)% vs.(5.06±1.10)%, P<0.01]. The mRNA levels of some genes related to the activation of vascular endothelial cells were up-regulated. Conclusion:Sepsis changes the structure and function of the bone marrow vascular system, and has a significant impact on the bone marrow microenvironment.

Objective To study on bioactive chemical compounds against ultraviolet irradiation in antarctic ice microalgae.Methods Four kinds of Antarctic ice microalgae were cultured under the conditions of low temperature,illumination,UV-A and UV-B irradiation.The chemical compounds were extracted by methanol and analyzed by spectrophotometer and HPLC/MS.The molecular structures were elucidated according to these data.The chemical compounds were irradated by sunshine to observe the speed of degradation and to estimate the bioactivity.Results There were five active compounds in Chlorophyceae L-4 and 7 active compounds in Diatom HF-9,in which 6 compounds belong to MAAs(mycosporine-like amino acids) and were of more bioactivity against ultraviolet irradiation.Conclusion MAAs from of Antarctic ice microalgae play an important role in resisting ultraviolet irradiation.

Objective:To evaluate the clinical significance of commonly used clinical inflammatory indicators in children with infectious diseases.Methods:A total of 354 children diagnosed with infectious diseases in our hospital from December 2018 to October 2020 were selected and divided into viral infection group(83 cases), sepsis group (65 cases), atypical pathogen infection group(23 cases), fungal infection group (11 cases), and bacterial infection group(172 cases). The data of serum amyloid A(SAA), procalcitonin(PCT), C-reactive protein(CRP), SAA/CRP, and interleukin (IL) in each group were collected.The fever peak, duration of fever, and fever subsidence time after admission were recorded.The receiver operating characteristic (ROC) curve was plotted, and the area under the curve(AUC), cut-off value, sensitivity and specificity were recorded.The correlation between fever and inflammatory indicators was analyzed.Results:The duration of fever in the atypical pathogen infection group was significantly higher than that in the other groups.Compared with the sepsis group, the differences regarding the levels of SAA, CRP, PCT, and IL-6 were statistically significant compared with those in the bacterial infection group, the atypical pathogen infection group, and the viral infection group (all P<0.05). SAA/CRP was the highest in the viral infection group, and its mean value was nearly twice compared with that in the sepsis group ( P<0.05). IL-10 was significantly different between bacterial infection group and viral infection group( P<0.05). Compared with the fungal infection group, the difference of interferon-γ was statistically significant compared with that in the bacterial infection group, viral infection group and sepsis group (all P<0.05). The ROC curves suggested that the AUC of SAA/CRP and IL-10 was the largest and the same in the viral infection group.The AUC of PCT in the sepsis group was the largest of 0.877, and the specificity was the highest at 91.7% when the PCT was 1.055 ng/mL.Correlation analysis found that SAA and CRP detected for the first time at admission were positively correlated with the time to heat remission. Conclusion:SAA/CRP has significant significance in differentiating sepsis and virus infection, and significantly increased PCT is an important sign of sepsis.

BACKGROUNDSteady-state bone marrow (SS-BM) and granulocyte colony-stimulating growth factor-primed BM/peripheral blood stem-cell (G-BM/G-PBSC) are the main stem-cell sources used in allogeneic hematopoietic stem-cell transplantation. Here, we evaluated the treatment effects of SS-BM and G-BM/G-PBSC in human leucocyte antigen (HLA)-identical sibling transplantation.

METHODSA total of 226 patients (acute myelogenous leukemia-complete remission 1, chronic myelogenous leukemia-chronic phase 1) received SS-BM, G-BM, or G-PBSC from an HLA-identical sibling. Clinical outcomes (graft-versus-host disease [GVHD], overall survival, transplant-related mortality [TRM], and leukemia-free survival [LFS]) were analyzed.

RESULTSWhen compared to SS-BM, G-BM gave faster recovery time to neutrophil or platelet (P < 0.05). Incidence of grade III-IV acute GVHD and extensive chronic GVHD (cGVHD) was lower than seen with SS-BM (P < 0.05) and similar to G-PBSC. Although the incidence of cGVHD in the G-BM group was similar to SS-BM, both were lower than G-PBSC (P < 0.05). G-BM and G-PBSC exhibited similar survival, LFS, and TRM, but were significantly different from SS-BM (P < 0.05). There were no significant differences in leukemia relapse rates among the groups (P > 0.05).

CONCLUSIONSG-CSF-primed bone marrow shared the advantages of G-PBSC and SS-BM. We conclude that G-BM is an excellent stem-cell source that may be preferable to G-PBSC or SS-BM in patients receiving HLA-identical sibling hematopoietic stem-cell transplantation.

Adolescent ; Adult ; Aged ; Bone Marrow ; drug effects ; Bone Marrow Transplantation ; methods ; Child ; Female ; Granulocyte Colony-Stimulating Factor ; pharmacology ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; therapy ; Leukemia, Myeloid, Acute ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Stem Cells ; cytology ; Young Adult

Objective:To investigate the effect of plasma exchange (PE) and continuous blood purification(CRRT) on children with bee sting poisoning and multiple organ dysfunction syndrome (MODS).Methods:From January 2016 to September 2019, 37 children aged 9 months to 11 years with bee sting and MODS were treated with dexamethasone 0.5 mg/kg or methylprednisolone 3 mg-5 mg/kg anti allergic and anti-inflammatory and organ support. Among them, 26 cases were treated with plasma exchange and continuous blood purification (treatment group), and the rest 11 cases were only given conventional treatment, but did not receive blood purification treatment (control group).The critical illness score, liver and kidney functions, myolysis, pulmonary hemorrhage/pulmonary edema, coagulation disorders, shock, hemolysis, gastrointestinal failure and other organ damage, ICU stay time, mechanical ventilation time, organ dysfunction recovery time and clinical outcomes were retrospectively analyzed. In the treatment group, 18 cases started blood purification before 12 h after MODS (early treatment group) and 8 cases started blood purification after 12 h (delayed treatment group).Results:There was no significant difference in age, sex, child critical illness score, onset time and organ function damage between the treatment and control groups ( P>0.05). The cure rate of the treatment group was higher than that of the control group [(25/26 (96.15%) vs 8/11 (72.73%), P=0.036]. There was no significant difference in ICU stay between the control group and the treatment group [(10.03±7.74) d vs (12.01±6.95) d, P>0.05]. Among the 25 survivors in the treatment group, one patient had mild renal function damage and one patient had multiple necrosis of skin, subcutaneous and muscle tissue. Compared with 4 of the 8 survivors in the control group, the residual organ function damage in the treatment group was significantly less than that in the control group [(2/25 (8.00%) vs 4/8 (50.00%), P=0.031)].The recovery of liver function, renal function, myolysis and hemolysis in the treatment group was faster than those in the control group (all P < 0.05). The initiation of blood purification within 12 h after the occurrence of MODS required fewer times of plasma exchange and shorter CRRT time, ICU stay and ventilator time (all P < 0.05). Conclusions:In children with bee sting combined with MODS, plasma exchange and continuous blood purification can achieve better therapeutic effect and better clinical outcome.

From 1903,when Ophüls elaborated infectious pulmonary edema pathologically for the first time,till to 2015,"Pediatric acute respiratory distress syndrome:Consensus Recommendations From the Pediatric Acute Lung Injury Consensus Conference"was defined by Pediatric Acute Lung Injury Consensus Conference(PALICC),the development of infectious pulmonary edema experienced more than 110 years.In order to improve the re-recognition of infectious pulmonary edema,infectious acute respiratory distress syn-drome was expounded on the infectious pathogeny,infection sites,risk factors,diagnosis and treatment in this review.