Humans ; Irritable Bowel Syndrome ; physiopathology ; Sensation ; Serotonin ; physiology ; Signal Transduction ; Viscera ; physiology

Acute kidney injury in children is frequently a component of the multiple organ dysfunction syndrome. It often occurs within the severe catabolic phase determined by critical illness and is intensified by metabolic derangements. Nutritional support is critical for these children to improve outcomes. Meeting the special nutritional needs of these critical children with acute kidney injury often requires nutritional supplemen-tation by either the enteral or the parenteral route. The nutritional requirements of these children should be frequently reassessed for individualized nutritional support and carefully integration with renal replacement therapy.

The injury of the intestinal mucosal barrier is a common pathophysiological process in critically ill children,which can cause translocation of bacteria and endotoxin,enterogenic infection,even multiple organ failure.Early diagnosis of intestinal mucosal barrier damage,positive correction of intestinal dysfunction and appropriate nutritional support can improve the curative effect and prognosis.The concept,diagnosis and nutritional support progress of intestinal barrier dysfunction in critically ill children were reviewed in the paper.

Objective To investigate the alterations of outer membrane permeation of multiple-antibiotic-resistant Proteus mirabilis.Methods Laboratory-derived cefotaxime-resistant mutants were induced by serial passages of clinical isolated susceptible Proteus mirabilis on cefotaxime-containing agar.Thereafter,the outer membrane proteins(OMP)of the parental strains and mutants were analyzed by sodium dodeeyl sulfate-polyacrylamide gradient gel electrophresis(SDS-PAGE)and the uptake of ciprofloxacin (CPLX)was determined with high pressure liquid chromatography(HPLC).Lastly,morphological analysis was performed by scanning and transmission electron microscopy.Results Compared with the parental strains.the mutants wete resistant to quinolones,cephalosporins and penicillins;the content of OMP with relative molecular weight 40 000 was reduced and that of 37 000 0MP was increased.The uptake of CPLX was reduced and the ratios of peak concentration were decreased to 1:1.74,1:1.53 compared with that of suseeptible strains.CPLX concentration absorbed was lower than the break point 1 mg/L of resistance and the difference of CPLX intracellular concentration between resistant and susceptible strains was less than 2 times.which resulted in much more increase of minimum inhibitory concentrations(MICs).Meanwhile,it was observed under electronic microscopy that resistant strains lost the rodlike shape and had more distinctive membrane fold,wider periplasmic space and les8 nucleiods.Conclusion The multiple-antibiotic-resistant Proteus mirabilis shows decrease of drug uptake and changes of ultrastructure,which may be related to alterations of outer membrane permeation.

Acute respiratory distress syndrome(ARDS) is a lung inflammation caused by variety of promoting inflammation factors induced by many causes.High permeability pulmonary edema is the basic pathophysiology characteristics of ARDS.Reasonable fluid management of ARDS helps to improve the pulmonary edema and reduce the mortality.Timely and effective nutrition therapy is one of the most important interventions.Nutrition support goals of ARDS patients have already been changed from purely providing the energy and substrate of the cells' and body's metabolism to regulating metabolism disorders,regulating immune,and acting as a disease treatment drug for the target.In the treatment of patients with ARDS,how to develop the nutrition strategies which can not only satisfy patients' nutrition requirements,and at the same time,but also restrain inflammatory reaction,improve the oxygenation of ARDS patients even reduces mortality is worth concerned.

The adenovirus pneumonia is one of the severe pneumonia in infants and young children.Adenovirus serotype 3 and 7 can cause severe clinical presentation,a wide range of clinical syndrome,difficult treatment,high mortality and serious pulmonary sequelae.The epidemiology,pathogenesis,clinical manifestation,treatment and prognosis of severe adenovirus pneumonia in children are reviewed in the paper.

Objective To observe the autofluorescence (AF) manifestation in related lesions of periphery retinopathy. Methods Sixty eyes of 42 patients with periphery retinopathy underwent the examination of Optomap fundus photograph (200°) and fundus fluorescein angiography (FFA). The HRA Ⅱ melanin-related near-infrared fundus autofluorescence (NIA, excitation 795 nm) and lipofuscin-related fundus autofluorescence (FAF, excitation 488 nm) were measured for all the patients. The AF was recorded with nine images per second, and then a final AF image with 55° view and 822 × 768 pixel was generated by the HRA. AF images can be valuable or valueless if there was or was not visible blood vessels and related retinal tissues on the image. AF from lesion regions can be normal or abnormal fluorescence comparing to the normal vascular and retinal tissue AF. The abnormal fluorescence was divided into no AF, weak AF and strong AF relative to the background grayscale. The grading consistency of abnormal fluorescence based on FAF and NIA examination was comparatively analyzed. Results Valuable AF images were captured in 53/60 eyes (88. 33%)and valueless AF images were captured in 7/60 eyes (11.67%). Among 53 eyes with valuable AF image, NIA showed normal fluorescence in 28 eyes (52. 83%), abnormal fluorescence with sheet-like, dot-shaped or stripped in 25 eyes (47.17%); FAF showed normal fluorescence in two eyes (3.77 % ), abnormal fluorescence with sheet-like, scattered along vessels or pigments in 51 eyes (96.23 % ).Twenty-five eyes with abnormal fluorescence were observed both in two examinations, including same grades in 18 eye (72.00%) and different grades in seven eyes (28.00%). Conclusion The AF manifestation with different levels exists in related lesions of periphery retinopathy.

Objective To evaluate the predisposing factors and clinical features of rhabdomyolysis (RM) in children and to investigate the differences in therapeutic effect between blood purification treatment and conventional hydration alkalization treatment.Methods This retrospective analysis included clinical feature,predisposing factors,laboratory examination and complications of 29 RM cases from February 2010 to October 2012 in pediatric intensive care unit of Beijing Children's Hospital.We also compared the differences in therapeutic effects between blood purification treatment and conventional hydration alkalization treatment.Results The clinical features of RM in children was not typical.Infectious diseases were the most common cause of RM in children (55.2％,16/29),followed with congenital and inherited metabolic diseases (17.2％,5/29),drug induced diseases (3 cases),poisoning,diabetic ketoacidosis,electrical injury,strenuous exercise and unknown cause (1 case respectively).Among the laboratory tests,blood creatine kinase (CK)was significantly increased,accompanied by electrolyte imbalances including hypocalcemia,hypokalemia,hypophosphatemia.Sixteen cases (55.2％,16/29) had acute kidney injury (AKI).AKI group had significantly higher CK values than those without AKI (13 cases) [(54 106 ±57 542) IU/L vs (16 507 ± 13 284) IU/L,P =0.002].Blood purification enhanced the CK clearance.As compared with hydration alkalization group(11 cases),blood purification group(6 cases) showed a shorter time duration for a 50％ reduction in creatinine clearance [2.0 (1.5 ～ 2.5) d vs 3.5 (2.0 ～ 5.0) d,P =0.015].Blood purification group also had a shorter time duration for CK lowering below 2000 IU/L,but the difference was not statistically significant [4.0 (3.5 ～9.0) d vs 8.0(6.0 ～ 12.0) d,P =0.062].Conclusion Infectious diseases are the most common cause for RM in children;AKI and electrolyte imbalance are common complications;blood purification therapy makes CK drop faster than hydration alkalization treatment.

?Retinal ischemia - reperfusion injury ( RlRl ) is a common clinical disease, and the producing mechanism is still in research. Experimental and clinical research in recent years have showed that the mechanism of RlRl and oxygen free radicals, gene regulation, calcium overload, inflammatory cytokines and other factors are closely related. ln this article, we summarized the current situation that the scholars at home and abroad study traditional Chinese medicine extract of prevention and treatment of RlRl.

Objective To investigate the mechanism of high-glucose-induced injury to human peritoneal mesothelial cells(HPMC). Methods (1)The cultured HPMCs were exposed to culture medium containing different concentrations of glucose(1. 5% , 2. 5% , 4. 25% )for 48 hours and 4. 25% mannitol and normal culture medium were as control. Then apoptosis was observed by flow cytometry and caspase-3 activity was measured by ApoAlert?CPP33/Caspase-3 Assay kits. (2) The cultured HPMCs were exposed to 4.25% glucose culture medium containing different concentrations of caspases inhibitor, Z-VAD. fmk (25, 50, 100 ?mol/L) for 48 hours and 4. 25% glucose culture medium containing DMSO was as control. Then apoptosis was observed by flow cytometry and caspase-3 activity was measured by ApoAlert?CPP33/ Caspase-3 Assay kits as well. Results (1) Glucose increased caspase-3 activity in a concentration-dependent manner. Compared to control, caspase-3 activity was significantly higher in 4. 25% glucose group and 2. 5% glucose group, but not significantly different in 1. 5% glucose group and 4. 25% mannitol group. (2) Apoptotic rate of HPMC was significantly lower in Z-VAD. fmk group than that in control. Z-VAD. fmk decreased the number of apoptotic cells in a concentration-dependent manner. Also, caspase-3 activity of HPMC was significantly lower in Z-VAD. fmk group than that in control. Conclutions (1) High-glucose can induce apoptosis and caspase-3 activation of HPMC in a dose-dependent manner. (2) Z-VAD. fmk inhibits high glucose-induced apoptosis of HPMC in a dose-dependent manner. (3)High glucose induces apoptosis of human peritoneal mesothelial cells by caspase-3 activation.