Objective To investigate the distribution and drug resistance of bacteria infection in children with pneumonia between pediatric intensive care ward and respiratory ward,in order to guide clinical treatment.Methods From 2010 January to 2014 January,two-hundred and sixty cases of pneumonia in hospitalized pediatric intensive care ward were included in the severe group,300 patients from respiratory ward into the common group,severe group were divided into the mechanical ventilation group (126 cases),non mechanical ventilation (134 cases),mechanical ventilation were divided into invasive ventilation group (94 cases),noninvasive ventilation group (32 cases).Conventional sputum specimens were detected,bacterial culture,identification and drug resistance of pathogenic bacteria ratio were done in each case,to compare the pathogenic bacteria and drug resistance rate of different groups.Results Both severe group and common group,gram negative bacteria were significantly higher than those of gram positive,But in the severe group,gram negative bacteria ratio was significantly higher than the common group (P ＜ 0.05),while the positive bacteria ratio was significantly lower than that of common group (P ＜ 0.05).Stenotrophomonas maltophilia,Acinetobacter and Pseudomonas aeruginosa ratio in severe group were significantly higher than that of common group (P ＜ 0.05),while the Haemophilus influenzae and Streptococcus pneumoniae in common group was significantly higher than the proportion of severe group (P ＜ 0.05).Stenotrophomonas maltophilia,Acinetobacter,Pseudomonas aeruginosa ratio in ventilation group was significantly higher than that of non ventilation group (P ＜ 0.05),and in the invasive ventilation group was significantly higher than the proportion of noninvasive ventilation group (P ＜ 0.05).Multi drug resistant bacteria detection rate in severe group was significantly higher than the common group (P ＜ 0.05).Conclusion Both pediatric intensive care ward and respiratory ward,bacterial lung infections are dominated by Gram negative bacteria,but bacteria spectrum and drug resistance have obvious difference,multi drug resistant bacteria detection rate in pediatric intensive care ward significantly higher than that of respiratory ward.Mechanical ventilation especially invasive mechanical ventilation may easily lead to drug-resistant strains.

Objective To explore the expression and significance of matrix metalloproteinases-9(MMP-9) and tissue inhibitors of matrix metalloproteinase-1(TIMP-1) in serum at acute phase of severe pneumonia in infants.Methods A total of 45 infants of pneumonia were selected and divided into 20 cases of severe pneumonia group and 25 cases of mild pneumonia group according to the severity of the disease,and all 45 infants were also divided into virus group of 24 cases and non-virus group of 21 cases on the basis of etiology.Additionally,20 cases of healthy children who accepted the physical examination at the same time were selected as the control group.Serum levels of MMP-9 and TIMP-1 were detected by using ELISA.Tidal breathing lung function was measured in all selected infants.Results Compared with the control group,the serum levels of MMP-9,TIMP-1 and MMP-9/TIMP-1 ratio of the infants with acute pneumonia were significantly higher,the severe pneumonia group were higher than the mild pneumonia group,and the virus group were higher than the non-virus group(P＜0.05).The ratio of the time to reach peak tidal expiratory flow to total expiratory time (TPTEF/TE) and the volume to reach peak tidal expiratory flow to total expiratory volume(VPTEF/VE) of pneumonia group in recovery period were significantly lower than those in the control group,severe pneumonia group were lower than those in the mild pneumonia group,and the virus group were lower than those in the non-virus group (all P＜0.05).There were no statistically significant about VT/kg among three groups.The serum MMP-9 levels and the MMP-9/TIMP-1 ratio were negatively correlated with TPTEF/TE and VPTEF/VE (r1=-0.459,-0.376; r2=-0.413,-0.327; all P＜0.05).Conclusion The serum levels of MMP-9 and the MMP-9/TIMP-1 ratio in the acute phase of infantile pneumonia are correlated with pneumonia severity and pulmonary function injury in recovery period,and the performance is particularly prominent in the viral pneumonia,and can be used as a prognosis monitoring indicator.

Objective To explore the clinical features of methylmalonic acidemia (MMA) in children admitted to the pediatric intensive care unit, to help improve our understanding of MMA. Methods The clinical data of 21 patients with MMA admitted to our PICU from December 2012 to August 2016 were analyzed. Diagnosis were confirmed by gas chromatography-mass spectrometry, GC/MS. Results twenty-four of 158 suspected cases were confirmed as having organic acidemia diseases including 21 cases of MMA, one case of propionic acidemia, one case of urea cycle disorders, and one case of glutaric acidemia. The main clinical manifestations were feeding difficulty, malnutrition (13 cases), developmental retardation (12 cases), lethargy (10 cases), tricuspid severe reflux and pulmonary hypertension (1 case), hydrocephaly (5 cases), muscular dystonia (three cases with hypertonia, and four with hypotonia), convulsion (7 cases), apnea, sobbing respiration (10 cases), chromatosis (6 cases), anemia (13 cases), edema (6 cases), thrombocytopenia (6 cases), hematuria and proteinuria (2 cases). Five cases gave up therapy before diagnosis was made. Sixteen cases received the treatment with Vitamin B12 and supplementation of L-carnitine. Seven cases gave up after treatment without effect or deterioration of condition. Eight cases were vitamin B12-responsive, and one case was vitamin B12-nonresponsive. The follow-up for a period ranging from three months to two years, among eight vitamin B12-responsive cases, 6 cases showed a favorable outcome with apparent improvement, one case had no symptom and one patient died from severe pneumonia. Vitamin B12-nonresponsive case was still alive. Conclusions The clinical manifestations of MMA are non-specific. Urine organic acid analysis is critical to early diagnosis of MMA in high-risk patients. Timely diagnosis and appropriate long-term treatment are essential to improve the prognosis of the disease.

Acute Disease ; Adult ; Emergency Nursing ; Emergency Treatment ; Humans ; Male ; Middle Aged ; Phosgene ; analogs & derivatives ; poisoning

Background Fibrin glue has been utilized to adhere the graft during the pterygium excision with conjunctival autografts.Several relevant clinical randomized controlled trial(RCT) and retrospective studies have been published abroad,but the samples for its effectiveness and safety issue of fibrin glue and suture are still underinvestigation.Objective Current study was to quantificationally assess the efficacy and safety of fibrin glue versus sutures in the application of pterygium excision with conjunctival autografts.Methods Based on established search strategy,a computerized literature search was conducted to identify all citations concerning the RCT for effectiveness and safety evaluation of fibrin glue and suture for the graft fixation during the pterygium excision with conjunctival autografts from MEDLINE ( from 2000 to October,2010 ),EMbase ( from 2000 to October,2010 ),Cochrane Central Register of Controlled Trials ( Issue 4,2010 ),CBMdisc ( 2000 to October 2010 ),CNKI ( 2000 to October 2010 ),and the relevant conference proceedings and references searched by hand was performed as supplement.The included literature was scored with Jadad table.The Cochrane Collaboration' s RevMan 5.0 software was used for the test of heterogeneity or test for overall effect.The effective indexes,such as operative duration,recurrence rate and complication,were evaluated by Meta analysis.Results Six RCTs involving 401 eyes of 377 participants were identified.These literatures were published with English in 2004-2010 from China,New Zealand,Sweden,Israel,Turkey and Malasia and the Jadad scores were 4-5.The quantitatively analysis revealed that fibrin glue appeared to short the operative time compared with suturing method (MD =14.23 ;95％ CI:- 16.18- 12.29;P=0.00) and drop the rate of recurrence ( RR =0.49,95％ CI:0.26 -0.95 ; P =0.03 ).No significant differences were found in the rate of postoperative graft dehiscence or absence (RR =3.41,95 ％ CI:0.85-13.68;P =0.08 ).Conclusions Fibrin glue shows the good effectiveness and easy application during the pterygium excision with conjunctival autografts.Long-term follow-up of multi-central RCTs with a larger number of cases are still needed to support this conclusion.

Objective To evaluate the performance of trilobed flaps for reconstruction of nasal tip defects. Methods Totally, 23 patients with nasal tip defects after tumor resection were enrolled into this study. Skin defects varied from 1.5 cm × 1.5 cm to 2.5 cm × 2.5 cm in size. According to the location and size of skin defects, trilobed flaps were designed, and the angle between two lobes ranged from 45° to 50°. The size of the first lobe was approximately equal to that of the skin defect, while the size of the second and third lobes decreased successively. During flap design, the integrity of nasal subunits was sufficiently considered, and the incision lines were placed along the boundary lines of the nasal subunit as far as possible, so as to conceal the incision scar with natural skin folds. Results After the operation, skin flaps survived with primary healing of incisions in all the patients. After 6 - 24 months of follow up, the color, texture and thickness of flaps were similar to those of their surrounding skin, and incision scars were inconspicuous. No malformation occurred in the nasal ala, nostril, nasal columella or surrounding organs, and satisfactory nasal appearance and function were achieved. Conclusion Trilobed flaps can be used to effectively repair relatively large skin defects of the nasal tip with satisfactory nasal appearance and function.

Objective To research the molecular biology characteristics and transient expression in BHK-21 cells of E geue segment from Japanese encephalitis virus(JEV) and construct an eukaryotic expression vector pEGFP-C1-JEV.Methods E gene segment of JEV was amplified by RT-PCR,construct the recombinant vector pEGFP-C1-JEV,which could express EGFP label proteins.Transfect pEGFP-C1-JEV vector into BHK-21 via LipofectAMINETM 2000,to observe expressing of EGFP label protein and transcription of aim gene,and to check up localization and antigenicity of expressed E protein by Immunohistochemistry and Western blot.Results It showed that the recombinant plasmid pEGFP-C1-JEV was successfully constructed and transfected to BHK-21 cells,the normal expression of green fluorescent protein expression rate was higher.RT-PCR showed that gene transcription in BHK-21 and normal expression,expression protein was mainly distributed in the cytoplasm of BHK-21 cells and the envelope in,and can with guinea pig anti-JEV antibody binding.Conclusion pEGFP-C1-JEV vector in BHK-21 cells was normal expression and there were no effect on cell growth and morphology.Meanwhile,on eukaryotic antigens was good antigenicity.This research as a base foundation for E protein gene of JEV eukaryotic expression and function in vitro and applied research.

Objective To investigate the infection characteristics and drug resistance of methicillin resistant Staphylococcus aureus after liver transplantation.Methods Retrospectively analyzed the clinical data of 170 patients who underwent liver transplantation in Beijing Chaoyang Hospital,Capital Medical University between January 2011 and April 2016.The incidence,pathogenic characteristics,distribution and drug resistance of methicillin resistant Staphylococcus aureus were analyzed.Results In this research,the methicillin resistant Staphylococcus aureus infection occurred in 23 cases after liver transplantation,and the incidence rate was 13.53％ (23/170).There were 27 strains of pathogens had been isolated,and 74.07％ (20/27) of pathogens were isolated from peritoneal drainage fluid.The most common methicillin resistant Staphylococcus aureus were Staphylococcus haemolyticus,Staphylococcus epidermidis and Staphylococcus hominis,accounting for 29.63％ (8/27),22.22％ (6/27) and 14.81％ (4/27).Drug sensitivity results indicated that the methicillin resistant Staphylococcus aureus were completely resistant to Penicillin,Oxacillin and Methicillin antibiotics.And the pathogens were extensively drug-resistant to Ciprofloxacin,Levofloxacin and Moxifloxacin,the resistance rates were 63％ (15/24),63％ (15/24) and 58％ (14/24).But the pathogens were sensitive to Teicoplanin,Vancomycin and Linezolid,and there have not been detected drug-resistant bacteria.Conclusions The infection of methicillin resistant Staphylococcus aureus is one of the most common pathogens after liver transplantation.Routine prophylactic antibiotics are not useful for the treatment,however,Teicoplanin,Vancomycin and Linezolid can be used as the first choice of treatment.

AIM: To observe the efficacy of surgical excision combined with autologous limbus conjunctival flap transplantation in the treatment of pterygium accompanied with conjunctival cyst.METHODS: Totally 126 patients 188 eyes with pterygium were hospitalized in Department of Ophthalmology of Tongji Hospital of Huazhong University of Science and Technology during August 2013 and August 2015.The patients were divided into two groups: observation group (11 eyes of 11 patients) with pterygium accompanied with conjunctival cyst and control group (177 eyes of 115 patients) with primary pterygium.All patients underwent slit lamp microscope examination, anterior segment photography, and anterior segment optical coherence tomography(OCT).The size of pterygium was calculated by multiplying neck width and length of the covered corneal.All patients underwent excision combined with autologous conjunctival flap transplantation, and the resections were performed pathological section with hematoxylin and eosin staining.All patients were followed up postoperatively for 4-28mo.RESULTS: All cases in the observation group were confirmed by postoperative pathological examination.All cyst walls were complete, and containing single layer of epithelial cells.The mean size of pterygium of the observation group was 6.9±1.7mm2, and 6.3±1.8mm2 for the control group.There was no significant difference between the two groups (P>0.05).The mean postoperative healing time of observation group was 2.1±0.9d, and 1.9±0.8d for the control group.There was no significant difference between the two groups (P>0.05).Recurrence was seen in two eyes within the follow-up period in the control group, and no recurrence in the observation group.CONCLUSION: Surgical excision combined with autologous limbus conjunctival flap transplantation is a safe and effective treatment for pterygium accompanied with conjunctival cyst.

OBJECTIVETo investigate the methylation status of zonula occludens-1 (ZO-1) gene promoter and its clinical significance in children with stage IV non-Hodgkin lymphoma (NHL) and to provide a basis for further etiological study and early diagnosis of this disease.

METHODSFifty-five children with a confirmed diagnosis of stage IV NHL (40 cases of T-NHL and 15 cases of B-NHL) were selected as the case group, and 20 children with diseases other than hematologic malignancies were selected as the control group. Bone marrow samples were collected from these subjects. Methylation-specific PCR (MS-PCR) was applied to evaluate the methylation status of ZO-1 gene promoter, and the integrated optical density (IOD) was determined. RT-PCR was used to measure the mRNA expression of ZO-1.

RESULTSMS-PCR showed that the methylated bands of ZO-1 gene promoter were found in 39 (70.9%) of 55 patients in the case group before treatment, while no ZO-1 gene promoter methylation was detected in the control group. With close tracking of 47 cases in the study group, consisting of 32 cases of T-NHL and 15 cases of B-NHL, the rates of ZO-1 gene promoter methylation prior to treatment were 72% and 67%, respectively, (P>0.572). The cases of T-NHL and B-NHL showed no significant changes in methylation rate in the early and middle phases of chemotherapy (P>0.05), but they showed significant changes in methylation rate in the late phase of chemotherapy (P<0.05). RT-PCR showed that the NHL cases carrying methylated ZO-1 gene had no mRNA expression of ZO-1, while all children in the control group had mRNA expression of ZO-1. There was no linear relationship between the total number of peripheral blood leukocytes and ZO-1 gene IOD (r=0.093, P=0.575); a positive correlation was found between the number of malignant cells in bone marrow and ZO-1 gene IOD (r=0.669, P<0.001).

CONCLUSIONSZO-1 gene shows a hypermethylation status in children with NHL, and the methylation level is positively correlated with the number of malignant cells in bone marrow. ZO-1 may be used as a novel molecular marker in early diagnosis, outcome assessment, prognostic evaluation, and detection of minimal residual disease.

Adolescent ; Child ; Child, Preschool ; DNA Methylation ; Female ; Humans ; Infant ; Lymphoma, Non-Hodgkin ; genetics ; Male ; Promoter Regions, Genetic ; Zonula Occludens-1 Protein ; genetics