BACKGROUND:Shape-memory polymer materials can be used as intrauterine device materials, which have certain shape changes under the influence of external temperature, and have good biodegradation, and are harmless to human body. OBJECTIVE:To prepare a poly(D,L-lactide)-based shape-memory intrauterine device and to analyze its application features. METHODS:Poly(D,L-lactide)-based shape-memory intrauterine device was prepared in this experiment. Sixty female New Zealand rabbits were randomly divided into two groups, with 30 rabbits in each group: experimental group were bilateraly implanted poly(D,L-lactide)-based shape-memory intrauterine device, and control group had no intrauterine device. Gross observation, blood test and histological examination were conducted at different time after implantation. RESULTS AND CONCLUSION:After 4 weeks of implantation, the intrauterine device was smooth and thickened and shortened compared with before implantation; after 6 weeks of implantation, the device became thinned and further shortened and even disappeared partialy. No significant difference was found in the leukocyte, erythrocyte, hemoglobin, platelet, creatinine and urea levels between the two groups at 6 weeks after implantation. In the experimental group, obvious edema and hyperemia in the tubal mucosa were visible at 4 weeks after implantation, and a very smal amount of infiltrated lymphocytes were present at 6 weeks after implantation, and edema and hyperemia were improved significantly. These findings indicate that after implantation, the poly(D,L-lactide)-based shape-memory intrauterine device can deform and degrade, and result in a certain pressure on the oviduct wal, but has no cel toxicity and possesses good application security.

Bronchiectasis is a kind of chronic lung disease which threatens the health of children in China.It can affect the lung function,life quality and development of the patients.There are varied causes of bronchiectasis,and some of the causes have the special intervention.So the etiology diagnosis of bronchiectasis is important.The aims of the treatment of bronchiectasis is removing the causes,releasing the symptoms,preventing the acute exacerbation,sustaining the lung function and life quality.It needs a long tern combine therapy.

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Objective To investigate the clinical application of radionuclide pulmonary V/Q scan in the diagnosis,evaluation of the severity and prognosis of pediatric patients with bronchiolitis obliterans (BO).Methods From February 2005 to April 2011,30 BO pediatric patients (18 males,12 females,age range:7 months-14 years) were prospectively recruited for radionuclide pulmonary V/Q scan.The relationship between the radionuclide pulmonary V/Q scan and clinical presentations was analyzed.Results Perfusion defects were seen in 25 cases (83.3％) and ventilation defects in 27 cases(90.0％).Among the 27patients with abnormal V/Q scan,matched abnormalities were seen in 13 cases (48.1％),mismatched in 1 case (3.7％) and reverse mismatched in 13 cases (48.1％).Of the 3 patients with mild disease,1 had normal V/Q scan while 2 showed V/Q defect in 1 segment.In the 10 patients with moderate disease,the mean number of segments having perfusion and ventilation defects was 3.7 and 5.6,respectively.In the 17 patients with severe disease,the mean number of segments having perfusion and ventilation defects was 6.0 and 8.2,respectively.During follow-up,all 8 patients with progressive disease presented with severe impairment of pulmonary perfusion and ventilation;while the 16 patients with improvement had mild impairment of pulmonary perfusion and ventilation or normal V/Q scan.Conclusion Radionuclide pulmonary V/Q scan is valuable for diagnosis,evaluation of the disease severity,and prognosis in pediatric patients with BO.

Objective To investigate whether low density lipoprotein receptor (LDLr) pathway involves in the progression of vascular calcification (VC) in hemodialysis patients under microinflammation.Methods Twenty-eight hemodialysis patients were divided into control and inflammation group according to plasma C-reactive protein level.Surgically removed tissues from radial artery of patients receiving arteriovenostomy were used in experiments.Foam cell formation and calcification deposition were observed by hematoxylin-eosin (HE) and alizarin red S staining respectively.VC-related protein expression,such as bone morphogenetic proteins-2 (BMP-2),collagen Ⅰ,alkaline phosphatase (ALP),and LDLr and its related nuclear factor of transcriptional regulation,such as sterol regulatory element binding protein-2 (SREBP-2) and SREBP cleavage-activating protein (SCAP),were detected by immunohistochemistry and immunofluorescence staining.Results HE and alizarin red S staining showed that there were parallel increased foam cell formation and calcium deposit in continuous cross-sections of radial arteries in inflammation group compared to control group,which were closely correlated with increased protein expressions of LDLr,SREBP-2,BMP-2,and collagen Ⅰ as shown by immunohistochemical and immunofluorescent staining.Confocal microscopy confirmed that inflammation enhanced the translocation of SCAP/SREBP-2 complex from endoplasmic reticulum to Golgi,thereby activating LDLr gene transcription.Inflammation increased protein expression of ALP and reduced protein expression of alpha-smooth muscle actin,contributing to the phenotype conversion of vascular smooth muscle cells in calcified vessels from the fibroblastic to the osteogenic,which were the main cell components in VC.Further analysis showed that the disruption of LDLr pathway induced by inflammation was positively correlated with the enhanced expression of BMP-2 and collagen Ⅰ (r=0.782,P＜0.01; r=0.644,P＜0.05).Conclusion Inflammation accelerates the progression of VC in hemodialysis patients through the disruption of LDLr feedback regulation.

Objective To investigate the effects of angiotensin Ⅱ (Ang Ⅱ) stimulating on cholesterol influx in human renal proximal tubular epithelial cells (HK-2) and the relation to low-density lipoprotein receptor (LDLr) pathway.Methods HK-2 cells were cultured and divided into the control group (incubated with serum-free medium) and Ang Ⅱ group (treated by 10-7 mol/L of Ang Ⅱ for 24 hours).The effects of Ang Ⅱ on lipid accumulation were examined by Oil red O staining and a quantitative assay of intracellular cholesterol.The expression of LDLr,sterol regulatory elementbinding protein (SREBP) cleavage activating protein (SCAP) and SREBP-2 mRNA and protein were examined by real-time PCR and Western blotting.The cotranslocation of SCAP-SREBP-2 from endoplasmic retieulum to Golgi in HK-2 cells was examined by immunofluorescent staining under confocal microscopy.Results Ang Ⅱ treatment increased intracellular lipid accumulation in HK-2 cells,which was associated with increased mRNA and protein expression of LDLr,SCAP,and SREBP-2 in HK-2 cells induced by Ang Ⅱ.Furthermore,results from confocal microscopy observation demonstrated that Ang Ⅱ increased the translocation of SCAP/SREBP-2 complex from endoplasmic reticulum to Golgi,thereby up-regulating LDLr gene transcription.Conclusion Ang Ⅱ disrupts LDLr feed-back regulation to increase cholesterol uptake and induce intracellular lipid accumulation.

Objective To explore the current status of healthcare-associated infection (HAI)and antimicrobial use in a children’s hospital.Methods Prevalence rates of HAI and antimicrobial use among hospitalized patients at 0∶00—24∶00 of May 1 ,2014 were investigated by combination of bedside visiting and medical record reviewing. Results A total of 1 027 patients were investigated,8 patients developed 10 times of infection,prevalence rate of HAI was 0.78%,prevalence case rate was 0.97%.HAI mainly occurred in patients in blood center (n =4),the main infection site was respiratory tract(upper respiratory tract,n=2;lower respiratory tract,n=2),antimicrobial usage rate was 62.12%.Antimicrobial usage rate,purpose of antimicrobial use,and combination use of antimicro-bial agents among different departments were all significantly different(all P <0.05).The departments with top 3 antimicrobial usage rates were neonatal center(89.69%),emergency center(76.00%),and comprehensive depart-ment(73.91 %);except department of ophthalmology-otorhinolaryngology-stomatology (preventive antimicrobial use accounted for 57.89%)and department of surgery(therapeutic antimicrobial use accounted for 26.32%),the other departments mainly used therapeutic antimicrobial agents;department of ophthalmology-otorhinolaryngology-stoma-tology,heart center,and neurological rehabilitation center mainly adopted single medication treatment (all >95%), two-drug combination rate in neonatal center accounted for 48.28%,three-drug combination rate in blood center ac-counted for 30.30%.Conclusion Routine surveillance on departments and sites of high HAI incidence should be in-tensified in children’s hospitals,training on knowledge of HAI among health care workers should be strengthened, and antimicrobial should be used rationally.

Objective To explore the clinical features of chronic granulomatous diseases and Mcleod syndrome caused by continuous X chromosome deletion. Methods The clinical data of two children diagnosed as chronic granulomatous disease and Mcleod syndrome by gene detection were retrospectively analyzed. Results Two males, 4 year 1 month and 1 year 9 month old, were both hospitalized due to persistent pulmonary infections. Both of them had a history of repeated severe infections and BCG vaccine associated lymphadenitis, and were diagnosed as X-linked chronic granulomatous disease for respiratory burst defects and deletion of all CYBB exons. Both of them had retarded motor development, and were diagnosed as DMD for detection of DMD gene exons and muscle speciifc promoter region and exon 1-2 deletion by MLPA. One case was found with obvious echinocytes, the other case showed whole exons deletion of XK gene. Both of them were diagnosed as Mcleod syndrome. Conclusion Continuous X chromosome deletion could lead to combination of Mcleod syndrome, DMD, and X-CGD, which may complicate the condition. Due to the lack of Kx antigen, repeated common blood transfusion can produce relative antibody, which lead to severe hemolytic crisis.

Objective To investigate the clinical features of invasive pneumococcal disease(IPD) in pediatric intensive care unit(PICU) and to analyze outcomes,so as to provide evidence for early and reasonable diagnosis and treatment as well as to improvement of prognosis.Methods A retrospective study was conducted at a research center for IPD in PICU in Beijing Children's Hospital from January 2013 to April 2016.Clinical data of children with IPD were collected and analyzed.All specimens were for bacteria culture,isolation,strain identification and drug sensitivity test.At the same time,the quellung test was used to identify serotypes of the streptococcus pneumoniae.Results A total of 30 children meeting inclusion criteria were included,19 male and 11 female.The median age was 1.5 years (range 3 months to 7.5 years).The Pediatric Critical Illness Scores (PCIS) were 72 (64,82) scores.There were 13 cases whose Glasgow Coma Scores (GCS) were below 15 scores.The 28-day mortality rate was 36.7％ (11/30 cases).Among death cases,there were 7 cases of purulent meningitis,3 cases of septicemia and 1 case of purulent pleurisy.The onset age,peripheral blood leucocytes count,PCIS and GCS of death group were significantly lower than those of survival group (all P ＜ 0.05).The mortality rate of children complicated with septic shock was significantly higher than that of children without septic shock [75.0％ (6/8 cases) vs 22.7 ％ (5/22 cases),P ＜ 0.05].The most common serotypes were 19F and 19A.The coverage rate of pneumococcal conjugate vaccine 13 was 96.7％.The percentage of penicillin nonsusceptible streptococcus pneumoniae was 73.3％,and the percentage of penicillin resistant streptococcus pneumoniae was 53.3％,and multi-drug resistant was 90％.Conclusions The mortality rate of IPD in PICU is high,and the main serotypes were 19F and 19A.Most patients of death group were less than 2 years old.Peripheral blood white blood cell count,PCIS and GCS were significantly reduced,and more complicated with septic shock.Vaccination of pneumococcal conjugate vaccine 13 for children less than 2 years old may reduce the incidence of IPD.

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