Objective To investigate the effects of airway pressure release ventilation (APRV) in children with severe pneumonia-related acute respiratory distress syndrome(ARDS).Methods Ten children suffering severe pneumonia-related ARDS with APRV were included in Pediatric Intensive Care Unit, Beijing Children's Hospital,Capital Medical University from March 2011 to October 2014.Ventilation variables, changes of airway pressure and Ramsay scores were collected and compared with that in conventional ventilation (CV).Clinical variables were measured at CV before APRV and at 1,4,12,24 hours after transition to APRV.Results High airway pressure(Phigh) at each time point during APRV was significantly lower than peak airway pressure (Ppeak) or plateau airway pressure (Pplat) in CV[(26.00 ±2.94) cmH2O(1 cmH2O =0.098 kPa) ,(24.40 ±3.34) cmH2O,(23.30 ±3.46) cmH2O,(23.00 ± 3.80) cmH2O vs (31.80 ± 5.59) cmH2O, P ＜ 0.01].Mean airway pressure (Pmean) at each time point during APRV was significantly higher than that in CV [(23.00 ± 2.86) cmH2 O, (21.69 ± 3.12) cmH2 O, (20.89 ± 3.31) cmH2 O, (20.46 ± 3.48) cmH2 O vs (17.50 ± 2.37) cmH2 O, P ＜ 0.05].Fraction of inspired oxygen (FiO2) were significantly decreased at 4, 12 and 24 hours after APRV than that in CV [(73.00 ± 22.39) ％, (63.50 ± 20.16) ％, (63.00 ± 21.11) ％ vs (88.00 ± 15.49) ％, P ＜ 0.05].Ramsay scores were significantly decreased at each time point during after APRV than that in CV [(3.90 ± 0.74) scores, (2.90 ± 0.88) scores, (3.00 ± 1.15) scores,(3.50 ± 0.71) scores vs (4.60 ± 0.52) scores, P ＜ 0.05].Conclusions Compared with CV, APRV had a lower Phigh and FiO2 ,a higher Pmean and more shallow sedation.APRV may be an effective ventilation mode in children's severe pneumonia-related ARDS.

Objective To study the clinical features of invasive pneumococcus disease (IPD) with resistance to antimicrobial agents in children,and to improve the diagnosis and treatment of this disease.Methods The clinical data from 21 IPD patients younger than 13 years old were collected from January 2008 through December 2010 in Pediatric Intensive Care Unit in Beijing Children's Hospital for retrospective analysis. Specimens of blood,pleural effusion,cerebrospinal fluid and soft tissue aspirated were collected from these children,and 23 strains of streptococcus pneumonia (SP) were cultured,isolated and confirmed,and the antibiotics susceptibility to penicillin and other antibiotics of these strains were assayed.Results Among the 21 IPD children,the ratio of male to female was 0.9∶1,and the age was 5 months to 13 years,with 61.9％ of them under 2 years.Of them,12 patients (57.1％ ) had purulent pleurisy,and 1 (4.8％ )patient had an underlying disease diagnosed to be X - linked agammaglobulinemia (XLA).There was no seasonal difference in the occurrence rate of this disease. Eight (38.1％) patients were cured,11(52.4％ ) were improved,while 2 (9.5％ ) patients not improved without death.There was no statistically significant difference in the annual detection rate of invasive SP (x2 =3.711,P =0.156).The incidences of penicillin-intermediate susceptibility SP (PISP) and penicillin-resistant SP (PRSP) were 47.8％ and 26.1％ respectively.The rate of resistance to multiple antibiotics was 91.3％.Conclusions Children aged less than 5 years,especially younger than 2 years,are prone to IPD,and purulent pleurisy and septicemia are often seen in this disease. Some patients had the underlying diseases.The complications included hemophagocytic syndrome,acute respiratory distress syndrome,septic shock,bronchial pleural fistula and so on.The multidrug resistance rate was 91.3％.It is important to put great emphasis on the monitoring antibiotics resistance to invasive pneumococcal disease.

Objective To discuss the surgical treatment for huge hepatoblastoma in children,and the technique of hepatectomy without blockade of the blood supply to the remained liver lobes.Methods We reviewed 12 cases of huge hepatoblastorna who had been operated from July 2001 to January 2009 in our hospital.The mean age of the children was 3.2 years(range,11 months to 12 years).The diameter of the tumor was from 10 to 23 cm.3～7 cycles of chemotherapy was routinely administrated before operation.When the tumor reduced to a certain size that radical resection could be performed safely,regular hepatectomy was conducted.Hepatoblastoma resection without blocking the blood supply to the remained liver lobes was performed in every patient.Results The operations were successfully accomplished in all the 12 children.5 cases received right trihepatectomy (segment Ⅳ,Ⅴ～Ⅷ),4 cases received right hemihepatectomy(segment Ⅴ～Ⅷ),and the other 3 cases received Ⅳ,Ⅶ,Ⅷ segmentectomy,right Ⅴ,Ⅵ segmentectomy,and left hemihepatectomy respectively.The intraoperative hemodynamic parameters were stable,and there was no perioperative mortality.Postoperative chemotherapy wag routinely administrated.The follow-up period varied from 2 to 92 months.11 children survived and were disease free,among those 6 children have survived for more than 5 years.One child had brain and lung metastasis 5 months post operation,and died 7 months post operation. Conclusion Preoperative chemotherapy administrated to children with huge hepatoblastoma can reduce the tumor size and render tumor reseetable.Hepatoblastoma resection without blocking the blood supply to the remained liver lobes is a safe and feasible surgical technique.

Objective To explore the clinical features of sentinel polyps (rectal polyps with proximal colon carcinoma) and its correlation with proximal colon carcinoma.Methods From January 2003 to December 2013,the clinical features of 963 hospitalized patients with rectal polyps were retrospectively analyzed.According to whether the patient with colon carcinoma,the clinical data of rectal polyps patients were divided into pure polyps group (n=855) and sentinel polyps group (n 108).The characteristics under endoscopy,clinical pathological features,treatment and prognosis of the two groups were observed.Chi square test was performed for differences comparison between groups.Results The length of stay in hospital of 963 patients was from four to 33 days,the average age was (49.7 ± 9.4) years,and the majority of the patients were male (n=610,63.3％).A total of 785 patients (81.5％) had non-specific abdominal symptoms,such as frequency or habit change of defecation,hematochezia,abdominal pain,abdominal distension.The relatives within three generation of 78 patients (8.1 ％) were diagnosed with tumor and some relatives of the patients diagnosed with familial adenomatous polyposis (2.2％,21/963).The positive rate of tumor marker of sentinel polyps group was higher (69.4％,75/ 108) than that of pure polyps group (6.8％,58/855; x2 =316.285,P＜0.01).The proximal colon carcinoma of patients with sentinel polyps appeared as neoplasma with circumferential growth,there was no specific appearance between distal rectal polyps and proximal colon carcinoma.When compared with pure polyps group,most polyps of sentinel polyps group were in maximum diameter over 1 cm (61.1％ (66/108) vs 46.9％ (401/855)),multi polyps (n＞5,38.9％ (42/108) vs 11.8％ (101/855)) and adenomatous polyp (83.3％ (90/108) vs 35.6％(304/855),x2=7.752,55.595 and 90.544,all P＜ 0.01).Majority of the proximal colon carcinoma with rectal polyps was papillary adenocarcinoma and tubular adenocarcinoma which was account for 75.9％ (82/108).Some were mucinous carcinoma and signet ring cell carcinoma.Most of the proximal colon carcinoma with rectal polys did not penetrate the serosa layer (Duk A-+Duk B,59.3％,64/108) and with little distant metastasis (Duke D,17.6％,19/ 108).Ninty-five point six percent (817/855) of patients with pure polyps underwent endoscopic treatment and all of them were cured and discharged.Forty-one point seven percent (45/108) of patients of sentinel polyps group accepted the radical operation and 19.4％ (21/108) received endoscopic submucosal dissection.Conclusions If multiple,maximum diameter over 1 cm and adenomatous rectal polyps were detected under colon endoscope,the possibility of carcinogenesis of the polyps or the proximal colon should be awared.If the endoscope is difficult to go further or the patient can not tolerate the whole colon examination,the patient should be followed up in short-term and complete the whole colon examination.

BACKGROUND:Intraocular refractive operation with phakic intraocular lens implantation has been used in highly refractive errors patients with over-high diopter and thinner corneal thickness, which has the advantages of reversibility and retain the eye's accommodation. OBJECTIVE:To evaluate the safety and stability of posterior chamber phakic intraocular lens implantation in comparison with Lasik correction for high myopia. METHODS:Total y 126 col ege students with high myopia, 63 males and 63 females, aged (21.87±1.18) years, were randomly divided into test and control groups. In the test group, col ege students received posterior chamber phakic intraocular lens implantation, while those in the control group were subject to Lasik correction. During 1-year fol ow-up, naked vision, corrected visual acuity, contrast sensitivity, and postoperative untoward reaction were observed, and the effectiveness and safety indexes were calculated in the two groups. RESULTS AND CONCLUSION:The effectiveness and safety indexes in the test group were both superior to those in the control group (P<0.05). After 1 year of fol ow-up, the contrast sensitivity light and dark environment in the test group was significantly improved, which was also higher than that in the control group. Decreased night vision and glare was found in five cases of the control group and one case of the test group. These findings indicate that posterior chamber phakic intraocular lens implantation is safe and effective that can improve the visual quality in clinic.

Objective To study the effects of salt sensitivity on evolution of blood pressure and develope- ment to hypertension from adolescents to youth.Methods A baseline survey was carried out in 4623 adolescents aged 6-15 years old in Hanzhong rural area in 1987,310 of them were recruited for determination of salt sensitiv- ity using the tests of oral saline load and furosemide sodium-volume depletion.Salt sensitivity (SS) were diag- nosed in 101 while 209 subjects as no-sah sensitivity (NSS).This cohort of adolescents were followed up for av- erage 18 years.Results The response rate for this cohort of adolescents was 71.9%.At the end of follow up period,BP in subjects with baseline SS was higher in youth than that in NSS (SBP:122.9?13.1 vs 117.3?12.4, P

OBJECTIVETo explore the effectiveness of absorbable hemostatic fluid gelatin in preventing postoperative cerebrospinal fluid leakage.

METHODSThe clinical data of 17 patients with dura mater tear were retrospectively analyzed from March to September in 2003. There were 16 males and 1 female, aged from 16 to 67 years old with an average of (39.6 ± 15.4) years. The injury site was at cervical vertebrae in 1 case, thoracic vertebrae in 9 cases, thoracolumbar junction in 4 cases, lumbar vertebrae in 3 cases. There were burst fracture in 4 cases and fracture-dislocation in 13 cases. According to ASIA grade, 12 cases were grade A, 2 cases were grade B, 2 cases were grade D, 1 case were grade E. Two cases caused by traffic accident, 10 by high falling, 4 by heavy parts crash, 1 by stairs fell during the earthquake. Absorbable hemostatic fluid gelatins were used to plug the dura mater tear,in order to prevent postoperative cerebrospinal fluid leakage. Postoperative drainage were recorded every day.

RESULTSOf 17 patients, 15 cases did not develop with cerebrospinal fluid leakage. Two cases develop with cerebrospinal fluid leakage after operation and their drainage were removed at 6 to 7 days after operation. In all cases, no complications related with cerebrospinal fluid leakage occurred, such as headache, dizzy, fever,neck resistance, rash, incision disunion, incision infection, hematoma, neurologic symptoms aggravation. No abnormal phenomena was found on incision surrounding at follow-up of 9 months.

CONCLUSIONUsing absorbable hemostatic fluid gelatin to plug the dura mater tear during operation is an effective method in preventing postoperative cerebrospinal fluid leakage.

Adolescent ; Adult ; Aged ; Cerebrospinal Fluid Leak ; prevention & control ; Female ; Gelatin ; administration & dosage ; Hemostatics ; administration & dosage ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control

OBJECTIVETo establish the method for isolation, culture, and differentiation induction of nestin-positive cells in fetal rat hepatic cells.

METHODSHepatic cells were obtained from fetal rats by means of mechanical separation and hanging-drop culture, and after two days of primary culture, the medium was changed for further cell culture in the presence of 20% fetal bovine serum (containing glucose 25 ml/L, mycillin 100 U/ml, pH 7.6), 10 mmol/L nicotinamide, 1 mg/L insulin, affix N2, basic fibroblast growth factor, stem cell factor, epidermal growth factor and leukemia inhibitory factor.

RESULT AND CONCLUSIONNestin-positive cells were obtained from fetal rat liver, which can differentiate into islet beta cells after culture and expansion in vitro.

Animals ; Cell Differentiation ; drug effects ; physiology ; Cell Separation ; methods ; Cell Transdifferentiation ; drug effects ; physiology ; Cells, Cultured ; Epidermal Growth Factor ; pharmacology ; Female ; Fetus ; Fibroblast Growth Factor 2 ; pharmacology ; Hepatocytes ; cytology ; metabolism ; Insulin ; pharmacology ; Intermediate Filament Proteins ; biosynthesis ; Islets of Langerhans ; cytology ; drug effects ; Leukemia Inhibitory Factor ; pharmacology ; Liver ; Male ; Nerve Tissue Proteins ; biosynthesis ; Nestin ; Rats ; Rats, Wistar ; Stem Cell Factor ; pharmacology

OBJECTIVE To investigate the distribution and drug resistance status to pathogens from urinary tract and offer scientific evidence for reasonable usage of antibiotics.METHODS Totally 389 isolates derived from infected urinary tract in mountain area of western Hubei Province from 2002 to 2005 were identified and antibiotic susceptibility test was performed.RESULTS Escherichia coli accounted for 66.1% ranking the first.The isolates were all susceptible to imipenem and vancomycin.The ratio of ESBLs in E.coli and Klebsiella pneumoniae was 23.7% and 25.9%,respectively.CONCLUSIONS The drug resistance rate in isolates derived from infected urinary tract of patients in mountain area was lower than in plain region of Hubei Province.