Objective To explore the clinical efficacy,adverse reactions and serum levels of IL -10 and TNF-αin children with peptic ulcer undergoing sequential therapy.Methods 68 children with peptic ulcer were selected and randomly divided into two groups,34 cases in each group.The control group received quadruple therapy, namely omeprazole,amoxicillin,clarithromycin and bismuch treatment for seven days.The treatment group underwent sequential therapy:the first 5 d of oral omeprazole,amoxicillin treatment,and the next 5 d omeprazole,amoxicillin and inidazole treatment.The clinical efficacy,adverse reactions,IL-10 and TNF-αlevels of the two groups were com-pared.Results The total effective rates after treatment of the control group and treatment group were 88.24% and 91.18% respectively,there was no statistically significant difference between the two groups(χ2 =1.21,P>0.05). After treatment,the levels of IL-10 and TNF-αin the control group were (24.93 ±6.29)pg/mL and (37.93 ± 8.28)pg/mL,which were significantly decreased (t=5.52,P<0.05,t=8.51,P<0.01).And the levels of IL-10 and TNF-αin the treatment group were (21.36 ±6.31)pg/mL and (29.67 ±6.38)pg/mL,which were significantly decreased(t=11.15,12.29,all P<0.01).The levels of IL-10 and TNF -αof the treatment group were much significant than those of the control group after the sequential therapy (t=3.32,P<0.05,t=8.71,P<0.01). Conclusion Sequential therapy for the treatment of children with peptic ulcer has better effect than the quadruple therapy,and can reduce serum IL-10 and TNF-αlevels,it is worthy of promoting.

Objective To investigate the change of blood lactate level in children with severe sepsis,and its relationship with clinical prognosis.Methods 90 children with severe sepsis who treated in our hospital from February 201 3 to May 201 4 were selected as the study subjects.According to the prognosis of children,they were divided into survival group and death group,45 cases in each group.The blood lactate levels at different time points, blood lactate clearance rates between the two groups at different time points as well as fibrin,oxygenation index and D -dimer levels were compared after admission.Results After treatment,the fibrin,oxygenation index and D -dimer levels in the two groups were improved.The fibrin and D -dimer levels in the survival group[(2.71 ±0.31 )ng/mL, (0.89 ±0.1 0)mg/L)]were lower than those in the death group[(2.89 ±0.21 )ng/mL,(1 .26 ±0.1 8)mg/L)],the differences were significant(t =3.224,P =0.001 ;t =1 2.053,P =0.000).The oxygenation index of the survival group[(1 96.23 ±1 4.69)mmHg)]was higher than that of the death group [(1 80.23 ±21 .03 )mmHg)],the difference was significant(t =4.1 84,P =0.000).The EGOT compliance rate,APACHE Ⅱscore and MODS incidence rate of survival group were significantly lower than those of the death group,the differences were significant(t =7.200,P =0.007;t =9.1 49,P =0.000;t =29.298,P =0.000).The blood lactate levels at each time points in the survival group were significantly lower than the death group,the differences were statistically significant(t =50.543, P =0.000;t =33.932,P =0.000;t =1 7.91 5,P =0.000;t =28.703,P =0.000).The 6 h,24 h blood lactate clearance rates≥1 0% of the survival group (73.33%,80.00%)were significantly higher than those of the death group(37.78%,44.44%),the differences were significant(χ2 =1 1 .520,P =0.000;χ2 =1 2.1 00,P =0.000). Conclusion Lactate level in children with sepsis is an important indicator of prognosis in children with severe sepsis,with guidance for the treatment of children with sepsis.

Objective To analyze the therapeutic effect of qiweiqingyan aerosol combined with ribavirin in the treatment of herpetic angina of children hand-foot-mouth disease,and to compare the clinical effects with sim-ple use of ribavirin.Methods 160 children with hand foot and mouth disease were divided into two groups by random number table.They were the observation group (80 cases)and control group (80 cases),respectively.Two groups were both given ribavirin aerosol in the treatment,the observation group were added with qiweiqingyan aerosol agent to carry out treatment,then the clinical curative effects of the observation group and control group were copared.Results In the observation group,the total effective rate was 96.25%,and the total effective rate of the control group was 85.00%,the difference between the two groups had statistical significance (χ2 =5.959,P<0.05).Marked effective rate of the observation group was 86.25%.In the control group,the significant efficiency was 37.50%.The difference between the two groups had statistical significance (χ2 =40.300,P<0.05 ).Defervescence time and bleb disappear time were shorter in the observation group compared to the control group,the difference between the two groups was statistically significant (t=47.880,8.063,5.100,all P<0.05).The adverse reactions in the observation group were significantly lower than those in the control group (χ2 =9.608,P<0.05 ),after statistical analysis.Conclusion Using qiweiqingyan aerosol combined with ribavirin in the treatment of children hand foot and mouth herpangina,can significantly shorten the time of treatment,reduce adverse reactions and improve the cure rate.

Objecfive To investigate the role of serum Insulin-like growth factor(IGF)-1,insulinlike growth factor-binding potein(IGFBP)-3 in children with Henoch-Schonlein purpura(HSP).Methods The serum concentration of IGF-1,1GFBP-3 was measured by enzyme-linked immunosorbent assay(ELISA)method in 45 acute SHP patients,40 recoverv patients and 30 healthy controls.Results The serum levels of IGF-1 [(452±183)μg/L],IGFBP-3 [(13 897±3124)μg/L] and C-reactive protein(CRP)[(20±8)mg/L]in acute phase were significantly higher than those in healthy controls(P<0.0 1)and higher than those during recovery period.The serum level of IGF-1,IGFBP-3 for the HSP patients dropped back slowly and their levels during recovery period were the same as those in healthy controls(P>0.05).The serum levels of IGF-1[(621±253)μg/L] and IGFBP-3[(18 763±3173)μg/L] were higher in the renal damage group than in the non-renal damage group(P<0.01).and the same in patients with gastrointestinal symptoms group as in patients without gastrointestinal symptoms group(P>0.05).whereas the serum level of CRP was not significantly different(P>0.05).The serum levels of IGF-1,IGFBP-3 showed positive correlation with the level of CRP(r=0.624,0.672,P<0.01).Conclusion The IGF-1 and IGFBP-3 may play an important role in the pathological mechanism of HSP.The level of IGF-1 may be used as an indicator for HSP disease activity and progression.IGF-1 mav have a close relation with the damageof renaJ system in HSP.

Objective:To analyze and compare VP1 and VP4 genetic characteristics of human enterovirus 71(EV71) isolated from children with severe and mild hand-foot and mouth disease(HFMD).Methods:EV71 strains isolated from severe HFMD patients (6 cases) and mild HFMD patients (6 cases) in Taizhou district, Zhejiang province were included during 2016.Total virus RNA was extracted by Viral RNA Mini Extraction Kit, and reverse transcription polymerase chain reaction(RT-PCR) was used to amplify the sequence of the VP1 and VP4 genes of EV71.And then the sequencing results were compared with those of A, B, C genotype reference EV71 strains from GenBank by nucleotide alignment and amino acid alignment analysis.Results:There were no statistically significant differences in sex and age between the two groups(χ 2=14.51, t=2.82, all P<0.05). The homogeneity between EV71 strains from severe patients and mild patients was 95.8%~99.6% and 99.1%~100.0% for VP1 nucleotide sequences and amino acid sequences, respectively, while 95.0%~99.9% and 99.0%~100.0% for VP4 nucleotide sequences and amino acid sequences, respectively.The twelve EV71 strains isolated from HFMD patients in Taizhou shared the highest identity with EV71-genotype C, especially genotype C4a.In addition, compared with the mild patients, three respective strains from severe HFMD patients showed mutations at the residue 170 in the VP1 protein(V→L), residue 293 in the VP1 protein(A→S) and residue 7 in the VP4 protein(T→A). Conclusion:All EV71 strains isolated from severe and mild HFMD patients in Taizhou district share high homology of nucleotide and amino sequence, and all of them belong to subgenogroup C4a.The mutations in the VP1 and VP4 of EV71 might be related to HFMD disease severity.

Objective:To discuss the clinical curative effect of the minimally invasive percutaneous suture technique of eight times for repairing closed injury extensor tendon zone I of finger.Methods:From February 2017 to January 2020, 12 patients (male 8, female 4) with mallet finger deformity were retrospectively studied, with an average age of 35 years (range, 18-50 years). And all the affected fingers were acute closed rupture of extensor tendon in zone I of single finger, 5 cases of the left finger and 7 cases of the right finger. There were 1 case of the thumb finger, 2 cases of the index finger, 3 cases of the middle finger, 4 cases of the ring finger and 2 cases of the little finger. 12 patients with fresh sputum mallet fingers were with 3-0 thread monofilament suture on extensor tendon zone I of finger in the minimally invasive percutaneous suture technique of eight times, and the distal end of the tendon was fixed to the base of the distal phalanx through the bone hole. Removal of the Kirschner wire 6-8 weeks, the brace was used to fix the affected finger in the dorsal extension. The flexion and extension of the affected finger was gradually strengthened. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up. The active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured, and the total action movement (TAM) of the finger were recorded. Finger function was evaluated according to TAM of the American Association of Hand Surgeons.Results:All operations were successfully completed, the operation time of the patients ranged from 18 to 25 min, with an average of 20.1±0.2 min. There was only a small amount of bleeding in the surgery. All 12 cases were followed up and the follow-up periods ranged from 6 to 14 months, with an average of 10.2±1.1 months. Mallet finger deformities were all corrected postoperatively; there were no knot exposure, skin necrosis and other complications. According to the Crawford standard, 9 cases were excellent, 2 cases were good, and 1 case was fair. The excellent and good rate was 91.7% (11/12). The mean active flexion of distal interphalangeal joints on the wounded finger and healthy finger were 82.11°±2.02° and 84.09°±2.01°, the mean active extension of distal interphalangeal joints on the wounded finger and healthy finger were -2.04°±3.01° and 0.02°±1.02°, there were significant differences between them ( t=2.447, 3.246; P=0.019, 0.004). The degrees of active joint activity of wounded finger were: 91.02°±4.01° of the metacar-pophalangeal joint, 94.04°±2.11° of the proximal interphalangeal joint, 83.01°±2.02° of the distal interphalangeal joint, and 265.05°±13.04° of total active activity; the degrees of active joint activity of healthy finger were: 93.01°±3.21° of the metacar-pophalangeal joint, 94.03°±3.07° of the proximal interphalangeal joint, 85.02°±2.01° of the distal interphalangeal joint, and 269.02°±12.10° of total active activity. The TAMs of the healthy side were 269.02°±12.10°, and the TAMs of the affected side were 265.05°±13.04°, there was no significant difference between them ( P>0.05). According to TAM system assessment criteria: excellent in 9 patients, good in 3 patients, and the excellent and good rate was 100% (12/12). Conclusion:The minimally invasive percutaneous suture technique of eight times can well repair closed injury extensor tendon zone I of finger, can have satisfactory treatment outcome in mallet finger with a simple procedure and good outcome. It is a simple, safe, effective method with minimal invasion.

BACKGROUND: Postoperative cholangitis is a common but severe complication after Kasai portoenterostomy for biliary atresia (BA). This study aimed to identify its prognostic factors. METHODS: Two sets of liver paraffin-embedded tissue samples were collected from BA patients who received Kasai portoenterostomy (n = 25 and n = 31, respectively). Patients were divided into non-cholangitis and cholangitis groups. The infiltration of CD4+, CD8+, CD45RO+, CD68+ cells and expression of Beclin1 were quantitatively evaluated in immunohistochemical analysis. RESULTS: Cholangitis group had a significantly lower CD8+ T cell infiltration but a higher CD45RO+ cell infiltration, and a lower Beclin1 level than non-cholangitis group (all P < 0.01). Multivariate logistic regression analysis indicated that infiltration of CD8+ cells (odds ratio [OR], 0.112; 95% confidence interval [CI], 0.022–0.577) and CD45RO+ cells (OR, 3.88; 95% CI, 1.37–11.03), and Beclin1 level (OR, 0.088; 95% CI, 0.018–0.452) were independent influence factors for early postoperative cholangitis. Receiver operating characteristic (ROC) analysis showed that area under ROC curve (AUROC) values for CD8+ cells, CD45RO+ cells and Beclin1 were 0.857, 0.738 and 0.900, respectively. CONCLUSION: Our findings demonstrated the CD8+ cells, CD45RO+ cells and Beclin1 level possessed the prognostic value for early postoperative cholangitis following Kasai operation, which may be helpful to develop new prevention and treatment strategies for postoperative cholangitis.
Biliary Atresia* ; Cholangitis* ; Humans ; Liver ; Logistic Models ; ROC Curve ; T-Lymphocytes*