Objective To study the distribution of rifampicin,isoniazid in tissues of patients with tuberculosis wrist for the sake of providing siven guide toward operation and postoperative chemotherapy.Methods 32 patients with tuberculosis wrist,according to radiographic data,were divided into Center group(group Ⅰ)and Borderline groups(group Ⅱ).All patients received chemotherapy regimen of 3SHR(T)Z/6HR(T).After treatment for4 weeks,the patients'specimen of serum,and tuberculosis tissues(group Ⅰ)including sclerotic bone wall,sub-normal bone and tuberculosis tissues(group Ⅱ)including dissolved bone wall,sub-normal bone were obtained during operation at 1,2 hours respectively after oral medication.Then pretreatment and mensuration using HPLC method were carried out after specimen's removal.Results Concentrations of isoniazid and rifapentine in(group Ⅰ)and(group Ⅱ)sub-normal bone and dissolved bone were abeve the minimal bactericidal concentration values.Concentration of 2 drugs in(group Ⅰ)sclerotic bone wall were much lower than that in sub-normal bone and dissolved bone wall.Conclusion The concentration of 2 drugs in patients sclerotic bone wall of wrist were too lower to eliminate the mycobacterium tuberculosis,while an effective concentration for anti-tuberculosis chemotherapy should be find in sub-normal bone and dissolved bone of wrist.Thus,the sclerotic bone of wrist plays an important role in obstructing the drags penetration into tuberculosis.

BACKGROUND: The neurons in the medial septum (MS), vertical and horizontal limbs of diagonal band of Broca (vDB and hDB) in the basal forebrain contain rich androgen receptors (ARs) and estrogen receptors (ERs) by which androgen and estrogen can act dramatically on the neurons in the basal forebrain, subsequently affecting learning and memory processes.OBJECTIVE: To qualitatively and quantitatively investigate the effects of androgen replacement therapy on the nitric oxide synthase (NOS)-positive and nestin-positive neurons in the MS, vDB and hDB of castrated adult male rats.DESIGN: A randomly controlled study on experimental animals.SETTING: Department of Anatomy and Brain Research Laboratory of Zhngshan Medical College of Sun Yat-sen University.MATERIALS: The experiment was performed at Department of Anatomy and Brain Research Laboratory of Zhongshan Medical College of Sun Yatsen University from June 2001 to June 2002. Totally twenty-eight adult male Sprague-Dawley rats were randomly divided into four groups with seven rats in each group: androgen replacement therapy for 4 weeks following 24 hours of castration (ART1), androgen replacement therapy for 2 weeks following 2 weeks of castration (ART2), vehicle replacement therapy for 4weeks following 24 hours of castration (VRT), sham-operated group (Sham).INTERVENTIONS: ① ART1 group: The castrated rats received subcutaneous injection of testosterone proprionate (25 mg/kg) dissolved in 100 μL of sterile sesame oil every other day from 10:30 am to 11:00 am for 14 times (4 weeks). ② ART2 group: The castrated rats received subcutaneous injection of testosterone proprionate with the same dosage and method as ART1 group for 7 times (2 weeks). ③ The rats in VRT group received subcutaneous injection of 100μL of sterile sesame oil for 14 times (4 weeks) by the same regime as described above. ④ Rats in Sham group only received sham-operated treatments, and testes were intact and lived for 4 weeks.MAIN OUTCOME MEASURES: Morphology and counts of NOS-positive and nestin-positive neurons were observed in the MS, vDB and hDB with immunohistochemical method at various time points.RESULTS: Data of totally 28 rats were involved in the final analyses. ①Morphological features of both NOS-positive and nestin-positive neurons in the MS, vDB and hDB were not significantly changed among four groups. ② The number of NOS-positive and nestin-positive neurons in the MS and vDB of VRT group were significantly higher than those of Sham group (P＜ 0.05 or 0.01), whereas the numbers of the NOS-positive and nestin-posi-tive neurons in the MS and vDB of ART1 and ART2 groups was significantly lower than those of VRT group (P ＜ 0.05 or 0.01), which nearly reached the levels of sham group (P ＞ 0.05).CONCLUSION: Androgen replacement therapy produces no significant effects on the morphological features of NOS-positive and nestin-positive neurons, but the therapy can selectively decrease the numbers of NOS-positive and nestin-positive neurons in different subregions of the basal forebrain, which may be closely related to androgen downregulation of expressions of NOS and nestin by ARs-mediated mechanisms, thereby producing complex effects on learning and memory processes.

Objective To investigate the effect of vasoactive intestinal peptide (VIP) and methylprednisolone (MP) on Toll-like receptor (TLR)2/4 mRNA expression in endotoxin (lipopolysaccharide,LPS) induced shock.Methods Ninety Sprague-Dawley rats were randomly divided into LPS group (n =20),LPS + VIP group (n =20),LPS + MP group (n =20),LPS + VIP + MP group (n =20) and control group (n =10).LPS group injected intravenously LPS (E Coli O55B5) 10 mg/kg.LPS + VIP group,LPS + MP group and LPS + VIP + MP group were injected intravenously VIP 5 nmol/kg,MP 3 mg/kg and VIP 5 nmoL/kg + MP 3 mg/kg after LPS 10 mg/kg injection.The control group injected normal saline intravenously instead of LPS.The rats were sacrificed at 6 h and 24 h after injection and the intestine samples were collected.Pathological changes of the intestine were observed by microscopy.RT-PCR was used to detect the intestinal TLR2 mRNA and TLR4 mRNA expressions.Results Intestinal mucosa showed edema or necrotic change with structure of the microvilli disappeared after LPS injection.The inestinal lesions in VIP,MP and VIP + MP groups were milder than LPS group.At 6 h after LPS injection,TLR2 mRNA and TLR4 mRNA expressions were significantly up-regulated in LPS group,LPS + VIP group,LPS + MP group and LPS + VIP + MP group (TLR2 mRNA:1.14 ±0.38,1.17 ±0.42,1.16 ±0.41,0.92 ± 0.29;TLR4 mRNA 1.21 ±0.18,1.04 ± 0.38,1.11 ± 0.34,1.01 ± 0.20) compared with the control group (0.32 ± 0.20,0.24 ± 0.17) (P ＜ 0.01).But there was no significant difference between LPS group,LPS + VIP group,LPS + MP group and LPS + VIP + MP group (P ＞ 0.05).At 24 h after LPS injection,TLR2 mRNA and TLR4 mRNA expressions in LPS + VIP group,LPS + MP group and LPS + VIP + MP group (TLR2 mRNA:0.63 ± 0.12,0.59 ± 0.13,0.52 ±0.19;TLR4 mRNA 0.67 ±0.09,0.64 ±0.09,0.51 ±0.13) were significantly lower than LPS group (1.04 ± 0.38,0.82 ±0.18) (P ＜0.01) (P ＜0.05).Conclusion VIP and/or MP can mitigate intestinal injury induced by LPS shock.The gastrointestinal protection of VIP and glucocorticoids were related to downregulation signaling TLR2 mRNA and TLR4 mRNA expression.But VIP/MP and VIP + MP have no significant effect on expression of intestinal TLR2/4 mRNA until 24 h after LPS shock.

Objective To investigate the effect of a single or combined transplantation of the neural stem cells(NSCs) modified with gene of NGF or GDNF on the cholinergic neurons of basal forebrain of AD model rat. Methods The NSCs modified with gene of NGF or GDNF were implanted in single or combined into the lateral cerebral ventricle of the rats after fibria\|fornix transection.The rats were killed three weeks after transplantation and the brain sections concluding basal forebrain were cut coronally on a freezing microtome and were processed by immunohistochemistry staining with antibodies against ChAT.The numbers of ChAT positive neurons of medial septum(MS) and vertical diagonal band(VDB) were analyzied statistically with one way of Student\|Newman Kaels. Results In MS,the percentages of ChAT positive neurons at the lesion side to the intact side in NGF group was 81% which was significantly higher than that in the lesion group(34%),NSC group(36%) and GDNF group(50%), P 0\^05). Conclusion\ The injury cholinergic neurons can be protected in different extent after a single or combined transplantation of the neural stem cells modified with gene of NGF or GDNF.Among these three groups,greater protection was found in NGF group and NGF+GDNF group,and lesser protection in GDNF group.\;[

Aim To investigate the effect of magnesi-um isoglycyrrhizinate (MgIG)on radiation -induced pulmonary fibrosis in mice and the mechanism.Meth-ods Fifty female C57BL/6 mice were randomly divid-ed into control group,irradiation (RT)group,MgIG group,RT +MgIG group and RT +dexamethasone (DXM)group,with 1 0 mice in each group.Except for control group and MgIG group,the remaining mice were given a single 1 5Gy 60 Co γray on whole lung. The mice in each group were administered 2 h before irradiation and each day after irradiation:MgIG group and RT +MgIG group were administered with MgIG (1 00 mg·kg -1 )by intraperitoneal injection;control group and RT group were administered with normal sa-line (20 mL·kg -1 )by intraperitoneal injection;RT+DXMgroup was administered with DXM(0.5 mg· kg -1 )by intraperitoneal injection.After 1 2 weeks,the mice were sacrificed and lung tissues were taken out. The degree of alveolitis and pulmonary fibrosis were observed by HE staining and Masson staining.The ex-pressions of type Ⅰ collagen,type Ⅲ collagen and TGF-β1 protein were detected by immunohistochem-isty.Results The alveolitis,pulmonary fibrosis and expressions of type Ⅰ collagen,type Ⅲ collagen, TGF-β1 ,p-Smad2,p-Smad3 increased significantly in RT group compared with control group (P <0.05 ), and were significantly lower in RT +MgIG group and RT +DXMgroup than those in RT group(P <0.05). Conclusion MgIG can improve radiation-induced pulmonary fibrosis in mouse lung tissue,and its mech-anism may be related to the influence of MgIG on TGF-βsignaling pathway.

Objective To evaluate the value of noninvasive monitoring of pulmonary arterial pressure in the children with severe pneumonia and respiratory failure.Methods A prospective study was adopted to investigate 69 patients who suffered from severe pneumonia and respiratory failure in Pediatric Intensive Care Unit in Shanghai Children's Hospital from June 2013 to December 2013 were involved in this study,except for heart disease.The pulmonary arterial pressure (PAP) and cardiac function were monitored by using bedside color doppler ultrasound cardiogram,such as PAP,cardiac index (CI),left ventricle ejection fraction(LEFT),and heart early diastolic filling velocity maximum/heart late diastolic filling velocity maximum (E/A ratio).They were divided into 2 groups according to PAP,one group as pulmonary arterial pressure normal group,the other group as pulmonary arterial hypertension(PAH) group,and the impact of the PAP on the prognosis and mechanical ventilation was assessed.Milrinone[0.5 μg/(kg · min)] were given the patients who were combined with pulmonary hypertension,and the PAP and cardiac function before using Milrinone and 24 h,48 h and 72 h after giving medicine was observed.Results Among 69 cases,40 cases were male and 29 cases were female,age ranging from 2 months to 12 years old,and the weight range was (14.3 ± 8.9) kg.The pediatric critical illness score(PICS) was 70.5 ± 9.6,and the pediatric risk of score m ortality Ⅲ was 13.5 ± 5.0.Among 69 cases,46 cases had pulmonary arterial hypertension,38 cases of them experienced mechanical ventilation,and 9 cases died.Among 23 cases who had no pulmonary arterial hypertension,only 8 cases experienced mechanical ventilation.There was a significant difference in the mechanical ventilation rate and mortality between two groups(x2 =15.78,P ＜0.0l ; x2 =5.18,P ＜ 0.05).The mechanical ventilation time was longer in pulmonary arterial hypertension group (t =3.89,P ＜0.01).PAP was (58.23 ±5.44) mmHg(1 mmHg =0.133 kPa),(49.10 ±4.69) mmHg,(42.53 ±4.54)mmHg and(35.63 ±4.78) mmHg respectively before and after using Milrinone 24 h,48 h and 72 h in 46 cases with pulmonary arterial hypertension,and the pressure decreased significantly after using medicine (F =67.11,P ＜ 0.01).There was no significant difference in CI,LVEF and E/A(all P ＞0.05).However,9 cases of them did not show any response to Milrinone,and in the end they couldn't live without mechanical ventilation,they died.Conclusions Noninvasive pulmonary arterial pressure monitoring could be beneficial in judging patient's condition and assessing prognosis of children with severe pneumonia and respiratory failure,and milrinone could decrease PAP.

Objective To explore the clinical features and diagnostic methods of tuberculosis infection in PICU,and improve the understanding of tuberculosis.Methods We analysed the clinical features and diagnostic methods of severe tubercle bacillus infectious diseases in PICU from Jan 2009 to Dec 2012.Severity of disease was graded by pediatric critical illness score.The diagnosis of the pulmonary tuberculosis was in accord with the diagnostic criteria of paediatric pulmonary tuberculosis established by Chinese Medical Association paediatrics branch.And the diagnosis of tuberculosis meningitis and tuberculosis peritonitis based on the clinical physical examination,laboratory examination and pathologic finding.Results Among 22 cases enrolled in this study,totally 16 cases were pulmonary tuberculosis,6 cases were extrapulmonary tuberculosis,and 3 cases were tuberculosis meningitis.The clinical feature of severe tuberculosis infection in PICU was accompanying with one or multiple organ dysfunction besides tuberculosis infection symptom,among them,respiratory dysfunction occurred in 16 cases,cardiovascular dysfunction was observed in 2 cases,and central nervous system dysfunction was found in 3 cases,even 1 patient experienced cardiovascular system dysfunction,respiratory disorder as well as gastrointestinal system dysfunction simultaneously.Sixteen cases of pulmonary tubercle bacillus infection manifested respiratory failure besides fever,cough,shortness of breath and tuberculosis toxicosis symptom,2 cases of them developed into acute respiratory distress syndrome,8 cases needed mechanical ventilation.Two cases of pericardial effusion presented cardiac tamponade.The level of adenosine deaminase elevated in 12 cases,and the positive result of enzyme-linked immunospot assay for tubercle bacillius was observed in 14 cases.Conclusion It is very important to be aware of that severe tubercle bacillus infection exist in critically ill patients admitted in PICU,measuring the level of adenosine deaminase and taking enzyme-linked immunospot assay for tubercle bacillius test are important accessory examination for tuberculosis diagnosis in children.

Objective To study the changes of P-selectin and E-selectin in pediatric patients with critical illness ,and analyze their relationship with the severity and prognosis of diseases.Methods Forprospective study,42 critically ill patients admitted in pediatric intensive care unit (PICU ) from September,2012 to March,2013 as critically ill group were enrolled,and blood specimens were collected with 24 hours after admission.Another 42 cases blood samples were collected from children's physical examination as control group.The severity of the critically ill patients were evaluated by Pediatric Critical illness Score (PICS)and Pediatric risk of score mortality (PRISM)-III.The levels of serum P-selectin and serum E-selectin were measured by double antibody sandwich enzyme-linked immunoassay (ABC-ELISA). Results P-selectin and E-selectin in control group children and critically ill patients group were (37.23 ± 8.99)ng/mL,(36.24 ±17.82)ng/mL,and (107.24 ±35.53)ng/mL,(114.93 ±40.17)ng/mL, respectively.There were statistical differences between two groups (P=0.000).The levels of P-selectin and E-selectin in acute phase were higher than that of levels in recovery phase in critically ill group (P =0.000).Negative correlation was observed between P-selectin concentration and the PCIS score (r =-0.673,P=0.000),as well as E-selectin (r=-0.548,P=0.000).P-selectin level and E-selectin level based upon PRISMⅢ≥10 group were significantly higher than they in PRISMⅢ <10 group (P=0.003,P=0.014).In critically ill children,the differences in P-selectin,E-selectin were significant higher in death patients (P=0.003;P =0.000).Compared with the non-sepsis illness group,the level of P-selectin and E-selectin in the severe sepsis patients were significantly higher (P =0.04,P =0.025 ). Conclusions The levels of P-selectin and E-selectin are closely related to the severity and prognosis in critically ill children.Measuring the level of P-selectin and E-selectin could be used as a judegment the severity and to understand pathological physiological process.

Objective To investigate the changes of epithelial neutrophil activating peptide-78 (ENA-78) in the serum of patients with critical illness,and to analyze the relationship between the severity and prognosis.Methods Prospective case-control study was performed,and 42 cases of critically ill patients admitted to Pediatric Intensive Care Unit,Children's Hospital Affiliated to Shanghai Jiaotong University from Sep.to Nov.2013 were selected as critically ill group,blood specimens were collected within 24 hours and 7 days after their admission.Another 42 cases of blood samples were collected during physical examinations in this hospital as control group.The severity of critically ill patients were graded by Pediatric Critical Illness Score (PICS) and Pediatric Risk of Score Mortality (PRISM) Ⅲ,and the serum ENA-78 was measured by double antibody sandwich enzyme-linked immunoassay.Results 1.The level of ENA-78 in the control group was (0.44 ± 0.28) ng/L; ENA-78 in acute phase and recovery phase of critically ill group were (2.85 ± 0.89)ng/L and (1.00 ± 0.64)ng/L,respectively,there were statistical differences between control group and critically ill group,acute phase group and recovery phase group (all P =0.000).2.The negative correlation was observed between ENA-78 concentration and PCIS score(r =-0.724,P =0.000).ENA-78 in PRISM Ⅲ ≥ 10 group was significantly higher than that in PRISM Ⅲ＜ 10 group(P =0.000).The ENA-78 between death group and the survival group was significantly different(P =0.000).3.ENA-78 in patients with severe infection was higher than that in the non-infectious cases(P =0.000).4.With the organ dysfunction expanded ENA-78 rose accordingly,and the difference was statistically significant (P =0.000).Conclusions The level of ENA-78 is different in critically ill patients in children.It can provide reference of assessing the severity of disease and predicting prognosis by determing the ENA-78 level.

Objective To study critical hemophagocytic syndrome (HPS) or macrophage activation syndrome (MAS) presented with multiple organ dysfunction syndrome (MODS) in pediatric intensive care unit (PICU),including clinical features and outcomes In order to explore the effect of bedside continuous hemodialysis/hemofiltration (CBP) as adjuvant treatment for severe HPS/MAS.Methods A total of 19 children with HPS/MAS were hospitalized met the diagnostic criteria for HPS from January,2009 to December,2012.Twelve cases were treated with CBP by continuous venin-venin hemodialysis/hemofiltration (CVVHDF) or high-volume hemofiltration (HVHF) following conventional anti-inflammatory therapy.The replacement liquid dose was 50-75 ml/ (kg · h).The organs function were evaluated and laboratory biomarkers including blood 、electrolytes,ferritin changes were measured before and after CBP treatment.Results Ninteen cases of HPS were acute onset and developed to MODS rapidiy after admission to PICU.The main clinical features were the irregular fever or high fever,hepatosplenomegaly and significant liver damage,nervous system dysfunction and disseminated intravascular coagulation (DIC).Eight cases were death and mortality rate was 42.1％,and all death occurred in those aged less than 3 years old.The mortality rate were 25％ (3/12) and 71.4％ (5/7) in CBP group and non-CBP group respectively.After CBP for 6-24 hours,the fever returned to normal range and blood electrolytes improved.The serum ferritin,serum alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) reduced significantly.Serum creatinine (sCr),blood urea nitrogen (BUN) level improved.Four cases with acute respiratory distress syndrome (ARDS) improved and the ventilator parameters were downregulated.Conclusions Our findings indicate that HPS/MAS complicated with MODS is life threatening with high mortality rate.CBP therapy can lower the fever within a short time,correct electrolyte imbalance,stable circulatory function,improve the lung,liver,and brain function.It is suggested that CBP may be the potential effective therapy in severe HPS/MAS with MODS in children.