Acute liver failure is a pediatric clinical critical disease with complex etiology,rapid progress and medical treatment,contributing to a high fatality rate. Artificial liver support system can remove a variety of toxic substances through mechanical,physicochemical or biological device to replace part of liver function like metabolism,detoxification,or synthesis temporarily to win precious time for liver cell regeneration and further clinical therapy,which has become an important treatment of acute liver failure at present. Considered the limita-tions of different blood purification mode,combined mode of blood purification is mostly applied in clinical ther-apy. This article aims to review the effect of plasma exchange combined with continuous veno-venous hemodial-ysis/filtration for the treatment of children with acute liver failure.

Objective To study the changes of serum procaleitonin(PCT) in the children with acute liver failure,and to investigate the relationship between PCT and severity and prognosis of acute liver failure.Methods A retrospective analysis of 24 children with acute liver failure admitted in Shengjing Hospital Affiliated to China Medical University from October 2010 to November 2013 was performed.The changes of serum PCT,blood routine,C-reactive protein,blood culture,virus,Mycoplasma pneumoniae antibody,blood ammonia,serum alaninetransaminase,serum glutamic oxaloacetic transaminase,international normalized ratio and prothrombin time level were observed.Results The serum PCT of children with acute liver failure originally increased at different degree.The serum PCT of 21 cases was more than 0.5 μg/L.The dynamic monitoring results of serum PCT in 6 cases on day 1,day 3,and day 8 were (12.55 ± 13.65) μg/L,(5.62 ±8.12) μg/L,(0.15 ± 0.26)μg/L,respectively,which showed decrease tendency.In 24 children with acute liver failure,serum PCT,international normalized ratio,blood ammonia of survival cases were significantly decreased compared with death cases[(28.37 ±60.22) μg/L vs(12.24 ± 14.76) μg/L;4.28 ± 2.50 vs 3.16 ±1.41 ; (213.30 ± 185.87) μmol/L vs (128.89 ± 102.17) μmol/L] (P ＜ 0.05).Conclusion Acute liver failure could increase the levels of serum PCT.Serum PCT may be an effective index to evaluate liver function,curative effect and prognosis of patients with acute liver failure.

Objective To analyze the clinical characteristics and risk factors of prognosis in children with brain trauma.Methods We retrospectively analyzed the clinical data of 125 cases diagnosed as brain trauma in PICU of Shengjing Hospital affiliated to China Medical University from January 2009 to December 2014.The risk factors influencing prognosis were analyzed by using single factor analysis and multiple factors Logistic regression methods.The risk factors included Glasgow coma score (GCS) on admission,blood glucose,lactic acid,prothrombin time,international normalized ratio (INR),serum sodium,serum potassiumin,pulse within 24 hours after admission,gender,age,time for therapy,shock,respiratory failure,cerebral hermia and surgery.Results Eighty-four cases survived and 41 cases died.The fatality rate was 32.8％.T test and chi-square test of risk factors showed that GCS score,blood glucose,blood lactic acid,INR,respiratory failure,shock had a significant influence on the prognosis of brain trauma in children (P ＜ 0.05).Multviariable Logistic regression analysis showed that GCS score,blood glucose,blood lactic acid,respiratory failure were independent risk factors affecting the prognosis of brain trauma (OR =7.434,0.473,0.615,0.000,P ＜ 0.05).Conclusion Pediatric brain trauma has a rapid progress and poor prognosis with high mortality and disability rate.GCS score,blood sugar,blood lactic acid,respiratory failure are independent risk factors for prognosis of brain trauma in children.

BACKGROUND:There are many researches on the finite element analysis of total hip arthroplasty, but the biomechanical distribution after hip surface replacement is little reported.OBJECTIVE: To analyze the biomechanical characteristics after hip surface replacement based on three- dimensional finite element analysis.METHODS: The three-dimensional finite element model after metal-to-metal hip surface replacement was established.The load of 350 N paralleling to the gravity line was loaded on the acetabulum. The stress distribution of the prosthesis and femur and the stress of the different regions of the femoral head were observed.RESULTS AND CONCLUSION: (1) The stress value of the acetabular cup was significantly higher than that of the acetabular body ((0.63± 0.34) vs. (1.89±0.67) MPa, P < 0.05). (2) The stress was concentrated on the femoral neck. The femoral head and femoral neck junction appeared with stress occlusion. The stress around the femoral prosthesis stem was (158.24±28.79) MPa, and the stress value of the femoral prosthesis stem was (186.46±22.37) MPa, showing no significant difference (P > 0.05). (3) The stress value showed significant difference among femoral head regions (P <0.05), and the stress of the regions 6 and 8 was significantly higher than that of the other regions (P < 0.05). (4) These results show that after metal-to-metal hip surface replacement, femoral neck stress is concentrated, the stress of the femoral prosthesis is occluded, and the stress at the medial femoral neck as well as the junction of femoral neck prosthesis and bone is larger.

Objective To study the feasibility of microsurgical technique to denervate sympathetic of femoral artery in rabbit, providing a reliable animal experimental model for further study of the mechanism of neuralization in bone tissue engineering.Methods From July, 2014 to July, 2015, 21 New Zealand white rabbits were divided into 4 groups randomly: the control group (n =3), the 4 weeks group (n =6), the 8 weeks group (n =6) and the 12 weeks group (n =6).Bilateral femoral arteries of the 21 rabbits were exposed.Adventitia of femoral arteries in 3 test groups were removed for about 2cm by microsurgical technique, whereas adventitia of the control group remained intact without any treatment.The arteries samples were collected at 4 weeks, 8 weeks and 12 weeks after treatment.The structure of vascular were indicated by hematoxylin-eosin (HE) staining, and the distribution and volume of the sympathetic fibers were evidenced by glyoxylic acid staining and the expression of tyrosine hydroxylase (TH), the marked protein of sympathetic.Results The adventitia of 3 test groups were invisible or lost most of it while the control group remained intact shown by HE staining.For glyoxylic acid staining, the fluorescence intensity value of the control group, 4 weeks group, 8 weeks and 12 weeks were 0.08124 ± 0.00260, 0.02920 ± 0.00206, 0.02661 ± 0.00233, 0.03094 ± 0.00211, respectively (n =6).The distribution and fluorescence intensity of sympathetic nerve were both significantly reduced in test groups compared to the control group (P ＜ 0.05).And there was no statistical difference among the 3 test groups (P ＞ 0.05).Semi-quantitative analysis of the expression of TH was 0.8626 ± 0.03519, 0.3631 ± 0.03019, 0.3964 ± 0.02239, 0.3487 ± 0.02356 respectively, which showed the same tendency as glyoxylic acid staining test.Conclusion Microsurgical technique is promising as an ideal method for the local denervation of sympathetic nerve from artery system as it can significantly reduce sympathetic fibers on adventitia without regeneration during the experimental period.

Adolescent ; Adult ; Drug Industry ; Hematologic Tests ; Humans ; Middle Aged ; Occupational Exposure ; Platinum Compounds ; blood ; Workplace ; Young Adult

Excess energy has become a main reason for increasingly serious human health hazards. Excess energy, mainly ectopically deposits in the liver, pancreas and other organs in the form of triglycerides, and produces chronic oxidative, nitrosative stress (ONS) , and fat toxicity, resulting in insulin resistance and impaired insulin secretion, and further impaired glucose regulation (Pidan). By combining Chinese medical pathogeneses and symptoms analyses, authors found this process has features of Gan disease transferring to Pi. Based on a number of related guidelines and clinical practice, we demonstrated treating sputum and stasis by the same method was one treatment method for intervening liver disease transferring to spleen in metabolic diseases. This idea helps to organic integrating prevention and treatment of major metabolic diseases including non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus, which can improve clinical effectiveness and efficiency of Chinese medicine.
Diabetes Mellitus, Type 2 ; therapy ; Early Intervention (Education) ; Humans ; Insulin ; Insulin Resistance ; Metabolic Diseases ; Non-alcoholic Fatty Liver Disease ; Risk Factors ; Triglycerides

Objective To explore the expression of nemo-like kinase (NLK) in primary hepatic carcino-ma (HCC) and its clinicopathological significance. Methods The expression of NLK was detected in 136 HCC samples by Immunohistochemistry. Results NLK expression was significantly up-regulated in HCC specimens compared to corresponding normal liver tissues. High expression of NLK was significantly associated with Ed-mondson-steiner grade, tumor size and number of tumor nodules (all P < 0.05). There was positive correlation between NLK and proliferation marker Ki-67 (P < 0.01). Kaplan-Meier analysis showed the high expression NLK group was significantly associated with poor overall survival and disease-free survival (all P < 0.001). Univariate analysis showed that the high expression NLK was associated with poor prognosis (P < 0.001). Multivariable Cox regression analysis suggested that the expressions of NLK and Ki-67 , Edmondson-steiner grade , metastasis , tu-mor size and number of tumor nodules were independent prognostic indicators for HCC. Conclusions NLK was markedly upregulated in HCC specimens, and it might be an independent prognostic marker for HCC. NLK might play an important role in tumorigenesis, progression and prognosis of HCC.

Objective To study the impact of the off-pump coronary artery bypass compared to the on-pump coronary artery bypass technique on the rate of acute kidney injury.Methods A retrospective analysis of 824 patients accepted coronary artery bypass surgery in FuWai Hospital Surgical ICU from March 2011 to January 2013.Patients were divided into two groups according to the surgical approach,597 patients in on-pump group and 227 patients in off-pump group.Then compared the difference of acute kidney injury incidence in the two groups.Results 92 patients in the on-pump group occurred AKI,the incidence of AKI was 15.4％.32 patients in the off-pump group occurred AKI,the incidence of AKI was 14.1％.Two groups of patients had no statistical difference in the incidence of AKI,x2 =0.222,P =0.638.Based on the preoperative baseline creatinine clearance levels.We defined normal creatinine clearance (SCR ≥ 60 ml/min),mild renal insufficiency (45 ml/min ＜ SCR ＜60 ml/min),moderate renal dysfunction group(31 ml/min ＜ SCR ＜45 ml/min).Decline with the preoperative creatinine clearance rate,the AKI incidence was elevated significantly,P ＜0.05.Patients with moderate renal insufficiency,offpump patients had lower incidence of AKI than those in on-pump group,P ＜ 0.05.The incidence of renal replacement in the two group patients had no statistical differences.Conclusion The incidence of AKI after coronary artery bypass surgery had no statistical differences with or without pump.In the patients with preoperative moderate renal insufficiency,off-pump can reduce the incidence of AKI,but could not change the kidney the incidence of renal replacement treatment.

Objective To investigate the diagnostic value of plasma B-type natriuretic peptide(BNP) in left to right shunt congenital heart disease accompanied by heart failure in PICU.Methods We retrospectively reviewed the clinical data of 52 cases diagnosed left to right shunt congenital heart disease in the PICU of Shengjing Hospital of China Medical University from January 2012 to June 2014.The cases were divided into negative control group(n=18) and heart failure group(n=34) according to the criteria for the diagnosis of pediatric heart failure.We respectively compared plasma BNP,size of heart defects,left ventricular end-diastolic volume index(LVEDVI),ratio of left ventricular early diastolic filling blood flow velocity and left ventricular late diastolic filling blood flow velocity(E/A),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure(PASP),and cardiothoracic ratio between the two groups.We analyzed the correlation between plasma BNP and the size of heart defects,LVEDVI,E/A,cardiothoracic ratio,LVEF,PASP.The receiver operating characteristic curve was used to determine the optimal cut-off value of plasma BNP to diagnose heart failure.Results Plasma BNP were 87.7(22.7,165.7)pg/ml in negative control group and 716.5(326.8,1813.0)pg/ml in heart failure group.The plasma BNP level of heart failure group was significantly higher than that of negative control group(Z=5.3,P<0.01).Size of heart defects were 5.0(3.0,6.8) mm in negative control group and 7.4(5.5,9.0)mm in heart failure group.Size of heart defects of heart failure group was significantly higher than that of negative control group(Z=3.5,P<0.01).LVEDVI were (44.6±18.3)ml/m3 in negative control group and (70.8±38.4)ml/m3 in heart failure group.LVEDVI of heart failure group was significantly higher than that of negative control group(t=2.7,P=0.01).E/A were 1.3±0.3 in negative control group and 1.1±0.3 in heart failure group.E/A of negative control group was significantly higher than that of heart failure group(t=2.2,P=0.04).Plasma BNP had a positive relation with cardiothoracic ratio(r=0.49,P=0.01) and a negative correlation with E/A(r=-0.28,P=0.04).The optimal cut-off value of plasma BNP was 181.8 pg/ml.The sensitivity of diagnosis of heart failure was 94% and the specificity was 88%.The area under the receiver operating characteristic curve was 0.951.Conclusion Plasma BNP may comprise a sensitive marker for heart failure of left to right shunt congenital heart disease.It is recommended that 181.8 pg/ml is the optimal cut-off value to diagnose heart failure of left to right shunt congenital heart disease.