Hemophagocytic lymphohistiocytosis(HLH)is a disease caused by various pathogenic factors and characterised by activated lymphoid cells and tissue cells,which release massive cytokines and results in hypercytoki-nemia and severe functional distraction of visceral organs.The disease is classified to primary/inherited HPS and sec-ondary/reactive HPS.The hypercytokinemia play a key role in the process of disease development.In this article,the hypercytokinemia in the pathogenesis of children HLH was reviewed.

Objective:To investigate the clinical features and prognostic factors in children with sepsis complicated with myocardial injury.Methods:The clinical data of children with sepsis complicated with myocardial injury from January 2017 to January 2019 in Department of Intensive Care Unit, Children′s Hospital of Kunming City, were retrospectively analyzed. The pediatric critical illness score (PCIS) at admission, gender, age, infection site, clinical outcome, mechanical ventilation and blood purification were recorded. The etiological results, creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), myoglobin, hypersensitive cardiac troponin T (hs-cTnT), procalcitonin (PCT), lactate, left ventricular ejection fraction (LVEF), cardiac output, left ventricular truncation rate (LVFS) were recorded. According to the clinical results, the children were divided into improvement group and deterioration group, and the clinical data of each group were compared. The receiver operating characteristic (ROC) curve and multivariate Logistic regression were used to screen the relevant clinical indicators that could predict the prognosis of children.Results:A total of 138 children with sepsis complicated with myocardial injury were enrolled. Thirty cases died in 28 d, and the mortality of 28 d was 21.7%. The respiratory tract was the main infection site, and the main pathogens were gram-negative bacteria and virus. The 35.4% (28/79) of children were complicated with multiple infections. There were 102 cases in improvement group; and there were 36 cases in deterioration group, among whom 5 cases died in hospital and 31 cases was discharged without treatment. The proportion of the girls in deterioration group was significantly higher than that in improvement group: 63.9% (23/36) vs. 34.3% (35/102), and there was statistical difference ( P<0.01); there were no statistical differences in age, infection site, mechanical ventilation, blood purification and PCIS between 2 groups ( P>0.05). The hs-cTnT and lactate in deterioration group were significantly higher than those in improvement group: (1.87 ± 0.67) ng/L vs. (1.62 ± 0.51) ng/L and (0.46 ± 0.31) ng/L vs. (0.34 ± 0.27) ng/L, and there were statistical differences ( P<0.05); there were no statistical differences in CK, CK-MB, myoglobin, PCT, LVEF, cardiac output and LVFS between 2 groups ( P>0.05). ROC curve analysis result showed that the hs-cTnT and lactate were risk factors for predicting clinical prognosis in children with sepsis complicated with myocardial injury, the area under the curve were 0.623 and 0.613, the optimal value were 159.59 and 2.65 ng/L, with a sensitivity of 36.1% and 55.6%, and a specificity of 98.2% and 70.6%. Multivariate Logistic regression analysis result showed that the hs-cTnT and gender were independent risk factors for prognosis ( OR = 2.237 and 0.286, 95% CI 1.093 to 4.578 and 0.127 to 0.644, P = 0.028 and 0.003). Conclusions:The 28 d mortality in children with sepsis complicated with myocardial injury is higher, and the respiratory tract is the most common infection site. The increased hs-cTnT and lactate levels indicate that the prognosis is poor in children with sepsis complicated with myocardial injury. The hs-cTnT and and gender are independent risk factors of prognosis.

Objective:To investigate the influence of hemoglobin glycation index (HGI) on the risk of incident chronic kidney disease (CDK) among nondiabetic patients.Methods:Prospective cohort study. At baseline, a total of 7 407 nondiabetic patients without a history of CKD from Pingguoyuan Community of the Shijingshan District in Beijing were included from December 2011 to August 2012, who were then divided into three groups according to the tertiles of their baseline HGI levels. The CKD incidence rate was compared among the different HGI groups at last follow-up. Cox multivariable regression was applied to evaluate whether HGI measures predicted CKD risk. Test for trend across tertiles were examined using ordinal values in separate models.Results:The mean age of the subjects was (56.4±7.5) years, and 4 933 (66.6%) were female. At mean follow-up of 3.23 years, 107 (1.4%) individuals developed CKD. The incidence of CKD was gradually increasing from the low to high HGI groups [1.1% (28/2 473) vs. 1.2% (31/2 564) vs. 2.0% (48/2 370), P=0.016]. In the multivariate Cox regression analysis, after adjustment for potential confounders, the high HGI group had a 68.5% increased risk of CKD compared with the low HGI group ( HR=1.685, 95% CI 1.023 to 2.774). CKD risk increased with increasing HGI tertiles ( P for trend=0.028). Conclusion:High HGI is associated with an increased risk for CKD in the nondiabetic population, indicating that HGI may help identify individuals at high risk for CKD.

Objective To investigate the distribution characteristics and changing tendency of urinary tract stones.Methods From January 2011 to May 2017,clinical data of 15 269 patients treated in our center was retrospectively reviewed.The stone components were detected by the automatic stone infrared spectroscopy system and the predominant components were recorded.There were 9 019 male patients and 6 250 female patients.The patients were divided into four groups according to their age,including group A ≤ 18 years;group B 19-40 years;group C 41-60 years;and group D ＞ 60 years.Compared the distribution characteristics of urinary tract stones of patient in different groups of sex,age and calendar year.Results Calcium oxalate stones were more prevalent in males than females [6 221 (69.0％)vs.3 582 (57.3％),P ＜ 0.001],but calcium phosphate stones [210 (3.4％) vs.210 (2.3％)],magnesium ammonium phosphate stones [230(3.7％) vs.165 (1.8％)] and carbonate apatite stones [1 328 (21.3％) vs.1 030 (11.4％)] were more common in females than males (P ＜ 0.001,respectively).The proportion of uric acid stones in group D [679(20.7％)] was higher than that in group A [23(9.1％)],group B[260(7.9％)],group C [1 163 (13.8％)] (P ＜0.001,respectively).The peak of carbonate apatite stones was showed in group B [652(19.7％)] (P＜0.001,respectively).Ammonium urate stones [9(3.5％)] and cystine stones [36 (14.2％)] were more frequent in group A(P ＜0.001,respectively).In adults,the percentage of uric acid stones increased with age,such as group B [260(7.9％)],group C [1 163(13.8％)],group D [679 (20.7％)].And the carbonated apatite stones decreased with age,such as group B [652 (19.7％)],group C [1 270(15.1％)],group D [416(12.7％)] (P ＜0.001,respectively).Further analysis showed the proportion of calc ium oxalate (OR =0.944,95 ％ CI 0.927-0.962,P ＜ 0.001),ammonium urate stones (OR =0.854,95％ CI 0.742-0.982,P =0.027) decreased,while calcium phosphate (OR =1.192,95％ CI 1.127-1.261,P ＜0.001),uric acid (OR =1.042,95％ CI 1.015-1.069,P =0.002) and ammonium magnesium phosphate (OR =1.078,95％ CI 1.019-1.141,P =0.009) stones increased with time.Conclusions The distribution of stones was different in genders and age.Calcium oxalate stones were more common in male patients,while ammonium magnesium phosphate and carbonate apatite stones were more common in female patients.Uric acid stones were more frequent in patients older than 60,while carbonate apatite were more frequent in the 19-40 age group.The proportion of calcium oxalate and ammonium urate stones showed a downward trend,whereas calcium phosphate,uric acid and magnesium ammonium phosphate stones increased with time.

Arsenic trioxide (ATO) has been identified as an effective treatment for acute promyelocytic leukemia (APL) but is much less effective against solid tumors such as hepatocellular carcinoma (HCC). In the search for ways to enhance its therapeutic efficacy against solid tumors, we have examined its use in combination with a novel derivative of β-elemene, N-(β-elemene-13-yl)tryptophan methyl ester (ETME). Here we report the effects of the combination on cell viability, apoptosis, the cell cycle and mitochondria membrane potential (MMP) in HCC SMMC-7721 cells. We found that the two compounds acted synergistically to enhance antiproliferative activity and apoptosis. The combination also decreased the MMP, down-regulated Bcl-2 and pro-proteins of the caspase family, and up-regulated Bax and BID, all of which were reversed by the p53 inhibitor, pifithrin-α. In addition, the combination induced cell cycle arrest at the G2/M phase and reduced tumor volume and weight in an xenograft model of nude mice. Overall, the results suggest that ETME in combination with ATO may be useful in the treatment of HCC patients particularly those unresponsive to ATO alone.

【Objective】 To investigate the causes of abnormal decrease in maximum amplitude(MA) of thromboelastography(TEG) and its effect on prognosis by monitoring the changes of coagulation-related indexes in emergency trauma patients. 【Methods】 A total of 319 cases of trauma patients admitted to our hospital from September 2020 to September 2023 were retrospectively analyzed, and the coagulation-related indexes of 0 h and 24 h after admission were observed. According to the MA results, they were divided into normal MA group(>50 mm) and reduced MA group(≤50 mm) to compare the hemoglobin(Hb), platelets count(Plt), activated partial thromboplastin time(APTT), prothrombin time(PT), fibrinogen(Fib), thrombin time(TT), D-dimer(D-D), coagulation reaction time(R), clot formation kinetics(Angle), 30 min clot dissolution rate(Ly30), MA, thrombine-antithrombin complex(TAT) and plasminase-α2 plasminase inhibitor complex(PIC). The correlation between MA and fibrinolysis indexes in 319 trauma patients was analyzed. According to whether tranexamic acid(TXA) was used, the reduced MA group was divided into a TXA group and a non-drug group. The differences in the change of the above coagulation-related indexes, mortality rate and changes in blood product dosage were compared between the two groups. 【Results】 Compared with the normal MA group, Hb, Plt, Fib, diastolic blood pressure and GCS scores decreased, while heart rate, ISS score and mortality increased significantly in the reduced MA group(P<0.05). The R, PT and TT were prolonged significantly(P<0.05), and PIC and D-D increased significantly(P<0.05) in the reduced MA group. Correlation analysis found that MA had no correlation with Ly30, TAT and APTT, but was correlated with Angle(r=0.803), Plt(r=0.544), Fib(r=0.581), PIC(r=-0.443) and D-D(r=-0.343). Compared with the non-drug group, the change of Angle, MA and FIB in the TXA group increased significantly(P<0.05), while the change of PIC decreased(P<0.05). Cryoprecipitate and platelet transfusion in the TXA group reduced significantly(P<0.05), and red blood cell transfusion had a decreasing trend, but the difference was not significant(P>0.05). The mortality rate in the TXA group was reduced significantly(P<0.05). 【Conclusion】 Hyperfibrinolysis may be an important factor in the abnormal decrease of MA in emergency trauma patients. Treatment with TXA can improve its effect on MA, and reduce the transfusion of blood products and the patient mortality.