Patients with inborn errors of metabolism and metabolic crisis sometimes are admitted in PICU.The symptoms include severe acidosis,hyperammonemia,cerebral edema,coma,lethargy,convulsion,vomit,muscles weakness,jaundice,respiratory disorders and so on.We should improve the understanding of inherited metabolism diseases.This paper reviewed the manifestation,diagnosis,management and therapeutic approach of inborn errors of metabolism,especially mentioned the importance of purification in treatment of metabolic crisis.

In this article we discussed the pathogenesis,pathology and clinical feature of nervous system damage,and treatment of severe EV71 infection. The neurological symptoms are associated with the direct damage of EV71 to the target neurons. We also discussed the treatment and method to avoid and reduce the severity of neurological sequelae for children with severe EV71 infection.

Objective: To study protective effect of taurine on gut barrier after hemorrhagic shock-reperfusion. Method: Twenty-four white rabbits were divided randomly into 3 groups: taurine group (A),shock group (B), control group (C). Result: Malondialdehyde and Ca~(2+) contents of intestinal mucosa remained unchanged in group A, but increased significantly in group B, Incidence of bacterial translocation in B group was markedly higher than that in C group at 30 min following reperfusion. Under light and electronic microscope,in comparsion with A and C groups,intestinl mucosa damage in B group became more severe. Conclusion: Taurine can protect gut barrier from intestinal ischemia reperfusion injury induced by hemorrhagic shock through reducing oxide free radical and preventing calcium overload.

Against the deficiencies of the current preventive medicine education curriculum,training programs and curriculum were reformed according to the training objectives of the modem preventive medicine, while new ideas of preventive medical personnel training were explored in order to cultivate practical professionals with a certain ability to innovate and to adapt the development of modern public health and preventive medicine preferably.

Background The incidence and progression of glaucomatous optic neuropathy is related to a disturbance of the retrobulbar hemodynamics.Compound anisodine is clinically applied for the treatment of ischemic ocular diseases.Objective To evaluate the effects of compound anisodine injection on the ocular blood flow of glaucoma patients.Methods Twenty-one patients with primary glaucoma were divided into the treatment group and the control group.The eyes of each patient in the treatment group were selected further into the treatment eye group (11 eyes with greater mean deviation [MD]) or the opposite eye group(11 eyes with lesser MD).One of the eyes of each patient in the control group with MD value were selected as control eyes (10 eyes).The treatment eye group received compound anisodine on the para-superficial temporal artery via subcutaneous injection once a day for 2 treatment periods (each period equals 14 days,with 7 days intermittent between periods,totally 35 days) in addition to routine treatment.The retrobulbar blood flow,optic disc data,refraction error,visual field and intraocular pressure were measured in 3 time points:Before treatment period (baseline test),one day after treatment period (the 1st postreatment test) and 35 days after treatment period (the 2nd posttreatment test).Results Compared with the control group,the peak systolic velocity (PSV) and end diastolic velocity (EDV) of short posterior ciliary artery (SPCA) of the treatment eye group were relatively increased significantly in the 1st posttreatment test (P =0.017,0.028),the PSV of SPCA of the opposite eye group was relatively increased significantly in the 1 st posttreatment test (P =0.049),the EDV of central retinal artery (CRA) of the opposite eye group was relatively increased significantly in the 2nd posttreatment test (P =0.035).In contrast to the treatment eye group,the inferior quadrant RNFL thickness of the optic disc decreased significantly in the 2nd posttreatment test in the control group (P =0.009),the 6 o'clock RNFL thicknesses of the optic disc decreased significantly in the 1 st posttreatment test in the control group (P =0.014),and the 6 o'clock and 7 o'clock RNFL thicknesses of the optic disc decreased significantly in the 2nd posttreatment test in the control group (P =0.029,0.011).Conclusions The application of compound anisodine for the treatment of primary glaucoma relatively increases the PSV and EDV of SPCA.

Objective To investigate the prevalence of nosocomial infections in Tianjin Children's Hospital and to provide database for monitoring and control of nosocomial infection.Methods The medical records of 6101 children admitted in the first half of 2005 and the laboratory results of isolated bacteria from clinical samples in 2005 were retrospectively investigated.Results The total nosocomial infection rate was 3.47%(212/6101),in which the surgical nosocomial infection rate was 2.66%(32/1204)and 2.95%(180/6101)infections were caused by non-surgical incisions.Respiratory tract was the most frequent infection site(119/212,56.1%).Several opportunistic pathogens were responsible for the major nosocomial infections,they were Escherichia coli,Coagulase negative staphylococcus,Enterococcus,Klebsiella pneumonia,Staphylococcus aureus and Pseudolnonas aeruginosa.Conclusion The pathogenic isolates for the infections show high resistance to most antibiotics.Monitor and control of the incidence of nosocomial infections and resistance to antibiotics should be enforced.

Objective To investigate prevalence and epidemiologic features of Saffold virus (SAFV) in hospitalized children with acute respiratory infection or digestive tract infection Tianjin area. Methods Nasopharyngeal aspirates from children with acute respiratory infection and fecal samples from children with digestive tract infection in Tianjin Children ’s Hospital were collected from January 2013 to December 2013. Viral nucleic acid was extracted, and SAFV infection was determined by using real-time quantitative PCR. Positive PCR products were sequenced. The sequencing results were aligned with known gene sequences of SAFV sequences in GenBank. The positive viral infection rate of nasopharyngeal aspirates and fecal samples, viral positive constituent ratio and positive detection rate in different age groups, seasonal distribution of SAFV infection were calculated. Other common respiratory tract or digestive tract viruses were also detected. Results Fourty-three (11.9%) nasopharyngeal aspirates from children with acute respiratory infection tested positive for SAFV. There was no significant difference between male and female infected children (aged between 6 d and 12 years old). The 79%(34/43) of the patients with SAFV infection aged under 1 year old. The infection most occurred in summer and winter. The 63 (16.4%) fecal samples from children with digestive tract infection tested positive for SAFV. There was significant difference between male and female infected children (aged between 5 h and 11 years old). SAFV infection was found to be year round. There was no significant difference in different age groups of nasopharyngeal aspirates and fecal samples. The mixed infection rate with SAFV and other respiratory tract or digestive tract viruses were 7.0%(3/43)and 12.7%(8/63), respectively. Conclusion Infection of SAFV had occurred in children with acute respiratory infection or digestive tract infection in Tianjin. SAFV has high detection rate in these children and is more common in children
aged under 1 year old. The data suggest that some of acute respiratory infection or digestive tract infections in pediatric patients are related to SAFV. The Clinical doctors should pay attention to them .

Objective To investigate the curative effect of sodium nitroprusside in the treatment of EV71-related pneumoedema/pneumorrhagia and hypotension in this study. Methods This was a retrospective study of a total 10 children with EV71-related pneumoedema/pneumorrhagia treated with sodium nitroprusside using case-control methods. The clinical manifestations and outcomes of the 10 children (present cohort) were compared with those of 8 children (past cohort) who had EV71-related pneumoedema/pneumorrhagia without sodium nitroprusside. Results Among these 10 patients,all were at the appearance of pneumoedema/pneumorrhagia, cardiac arrhythmia and hypotension. Two patients showed severe cardiac arrhythmia, two patients showed cardiac arrest for many times. All 10 patients were treated with mechanical ventilation and other conventional treatments. At the first time of the manifest of hypotension,sodium nitroprusside were put into practice in all 10 patients. Ten patients were treated with intravenously sodium nitroprusside in the stage of hypotension by maxi30 min ～ 1 h,the patients showed an improvement in vultus,pulse and peripheral circulation and decrease of heart rate and elevation of blood pressure after 30 min ～2 h,but at least 2～6 h later,the blood pressure tended to stabilize at normal standard. Conclusion Hypotension is the intensive stage in EV71-related hand,foot and mouth disease ,and the shock syndrome caused by acute left ventricular disorder is related to sympathetic nerve activity. Sodium nitroprusside can effectively reduce the cardiac afterload,and correct shock and improve the prognosis.

Objective To explore the changes of neutrophil elastase (NE) and surfactant protein A (SP-A) in acute lung injury(ALI) rats,and the effect of antioxidant. Methods Sixty healthy mature Wister rats were divided into 2 groups, the control group and treatment group. The rats in two groups all received peritoneal injection of E. coli to establish the ALI animal model. 30 minutes after injection of E. coli,the rats in treatment group were injected reduced glutathione from vena caudalis. The levels of NE in blood and expressions of SP-A in lung tissue were detected at 3,6 and 12 hours after injection of E. coli. Results ALI symptom appeared 3 hours after injection of E. coli in the control group, obvious after 6 hours, the rats vomi-ted pink secretion after 12 hours. Lung edema and bleeding were found by pathologic examination. No obvious symptom was found in treatment group after 3 hours, slight tachypnea after 6 hours, slight edema in pulmonary tissue after 12 hours. After administration of reduced glutathione,levels of NE at 3,6 and 12 hours in the treatment group were lower than those in the control group,and indicated statistical significance in 6 and 12 hours(P <0. 05) ;Levels of SP-A in 3,6 and 12 hours in the treatment group were higher than those in the control group, and indicated statistical significance in 3,6 and 12 hours (P < 0. 05). Conclusion Dysfunction of pulmonary surfactant is secondary in ALI, degradation of SP-A is the one of reasons, the application of reduced glutathione as antioxidant, could effectively suppress NE to decompose basosexine elastin of cells and destroy surface active protein, has protective effect on ALI.

AIM:To investigate whether the opening of ATP-sensitive K+(KATP) channels protects H9c2 car-diac cells against high glucose ( HG)-induced injury and inflammation by inhibiting the Toll-like receptor 4 ( TLR4 )/nu-clear factor-κB ( NF-κB) pathway.METHODS:The protein levels of TLR4 and NF-κB p65 were determined by Western blot.The levels of interleukin-1β(IL-1β) and tumor necrosis factor-α(TNF-α) were detected by ELISA.The cell viabil-ity was measured by CCK-8 assay.Mitochondrial membrane potential (MMP) was examined by rhodamine 123 (Rh 123) staining followed by photofluorography.The intracellular levels of reactive oxygen species ( ROS) were detected by 2′, 7′-
dichlorfluorescein-diacetate (DCFH-DA) staining followed by photofluorography.The number of apoptotic cells was ob-served by Hoechst 33258 nuclear staining followed by photofluorography.RESULTS: After the H9c2 cardiac cells were treated with HG (35 mmol/L glucose) for 24 h, the protein levels of TLR4 and phosphorylated NF-κB p65 ( p-NF-κB p65) were significantly increased.Pretreatment of the cells with 100 μmol/L diazoxide ( DZ, a KATP channel opener) for 30 min before exposure to HG considerably blocked the up-regulation of the TLR4 and p-NF-κB protein levels induced by HG.Moreover, co-treatment of the cells with 30 μmol/L TAK-242 (an inhibitor of TLR4) obviously inhibited the HG-in-duced up-regulation of the p-NF-κB p65 protein level.On the other hand, pretreatment of the cells with 100 μmol/L DZ had a clear myocardial protection effect, which attenuated the HG-induced cytotoxicity, inflammatory response, mitochon-drial damage, oxidative stress and apoptosis, evidenced by an increase in the cell viability, and decreases in the levels of IL-1βand TNF-α, MMP loss, ROS generation and the number of apoptotic cells.Similarly, co-treatment of H9c2 cardiac cells with 30μmol/L TAK-242 or 100μmol/L PDTC ( an inhibitor of NF-κB) and HG for 24 h also obviously reduced the above injuries and inflammation induced by HG.CONCLUSION: The opening of KATP channels protects H9c2 cardiac cells against HG-induced injury and inflammation by inhibiting the TLR4/NF-κB pathway.