It is still controversial whether or not the severe pneumonia is associated with heart failure in children.Currently,we pay more attention to the pathophysiological procedure of heart failure,such as pneumonia complicated with respiratory failure,shock and myocardial injury.Pay attention to the cardiopulmonary interaction mechanism and systemic inflammatory response.According to different pathophysiological mechanisms,guide the treatment by monitoring the hemodynamic status.

Adult ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Hygiene ; Male ; Middle Aged ; Occupational Health ; Young Adult

Objective:To analyze the value of Kang'ai injection on gastric cancer patients’ chemotherapy.Methods: Chosen gastric cancer patients with chemotherapy between December 2012 to December 2013 in our hospital as study subject, randomly divided into control group received conventional chemotherapy and observation groups received Kang'ai injection combine with chemotherapy, compared term effect after chemotherapy, immune function and quality of life scores.Results: 1)Observation group patients’ complete remission and partial remission after chemotherapy were significantly higher than control group patients(x2=2.471,x2=2.748;P<0.05); 2)Observation group patients’ IL-6, TNF-α, CD3+, CD4+ value was significantly higher than control group after receiving chemotherapy, CD8+ value was significantly lower than control group patients(t=2.627,t=2.462,t=2.748,t=2.846,t=2.735;P<0.05); 3)two groups of patients’ life quality scores before chemotherapy was no significant,after chemotherapy observation group patients’ life quality scores were significantly higher than control group patients(t=2.637,t=2.647,t=2.983;P<0.05).Conclusion: Kang'ai injection can significantly improve the effectiveness of chemotherapy in patients with gastric cancer,and optimize immune function, while improving the quality of life after chemotherapy.

[Summary]_ Severe hypertriglyceridemia is the third common cause of acute pancreatitis following after alcohol abuse and cholelithiasis. Moreover, it is also an important risk factor of cardiovascular events. However, the cases of severe hypertriglyceridemia caused by autoimmune disease were rare in clinical, which would bring the difficulty for diagnosis and treatment. A better understanding of the clinical characteristics, possible pathogenesis, and corresponding therapy of the disease would be helpful, which would reduce the risk of complications, and finally improve both the survival rate as well as quality of life of these patients.

Objective To investigate the clinical parameters,risk factors,treatment and clinical outcomes of pneumocystis pneumonia(PCP) in children without human immunodeficiency virus(HIV). Methods Retrospective a-nalysis was made for the clinical features,risk factors,treatment and prognoses of the non-HIV infected severe PCP pa-tients hospitalized at Pediatric Intensive Care Unit( PICU) of Children′s Hospital Affiliated to Capital Institute of Pedi-atrics. Results During April of 2010 to April of 2014,there were 10 cases of non-HIV infected severe PCP in PICU of Children′s Hospital Affiliated to Capital Institute of Pediatrics. All of the patients had predisposing diseases,in which 3 cases had connective tissue diseases,2 cases had acute leukemia,3 cases had severe pneumonia and 2 cases had con-genital immunodeficiency. The main clinical manifestations of those 10 patients were fever, cough, tachypnea and obvious dyspnea. All patients developed respiratory failure. The median value of Pediatric Critical Illness Score was 79. The median arterial oxygen pressure was 58 mmHg(1 mmHg=0. 133 kPa). The median oxygenation index was 103 mmHg. The median alveolo-arterial oxygen partial pressure difference was 43. 8 mmHg. The median CD4+T-lympho-cytes counts was 169 ×106/L. Eight patients on admission had mixed infection. Acute respiratory distress syndrome (ARDS) occurred in all of the patients,and 7 cases of them had multiple organ dysfunctions. All of the patients re-quired ventilation support. The median day for invasive mechanical ventilation days was 11 and the median day for non-invasive ventilation days was 6. The pneumothorax occurred in 5 patients. All patients received trimethoprim-Sulfame-thoxazole as initial therapy and Caspofungin treatment in combination in 7 cases of the patients. Six patients had nosoco-mial infection. The median time of PICU stay was 15. 5 days. Six patients survived and the mortality was 40%(4/10 cases) . Conclusions PCP is a kind of fatal diseases which occurred in patients with immunocompromised conditions and concurrent ARDS or multiple organ dysfunctions. Diagnostic suspicion and mechanical ventilation therapy with lung protective ventilation strategies may improve the clinical outcomes of non-HIV-infected PCP in children.

Objective To assess the value of two-dimensional speckle tracking echocardiography (2D-STE) of predicting the acute response to cardiac resynchronization therapy (CRT) in patients with congestive heart failure. Methods Twenty-four patients with congestive heart failure scheduled for CRT were included. 2D-STE was performed within 7 days of implantation with device ON and OFF. Left ventricular (LV) dyssynchrony was defined as an interval ≥130 ms for the absolute difference in time to peak radial strain for the anteroseptal wall versus the posterior wall (T_(AS-POST)) with 2D-STE. Acute hemodynamic response was measured as LVdp/dt, and percentage change in LVdp/dt was used to classify responders (Δdp/dt%＞25%) and nonresponders (Δdp/dt%≤25%). Results Fifteen patients (62.50%) were classified as acute responders. Compared with nonresponders, the responders demonstrated significant increase of LV ejection fraction and reduction of TAS-POST after CRT-ON. T_(AS-POST)was the only determinants of Δdp/dt%＞25%. T_(AS-POST)≥130 ms prognosticated acute response to CRT with sensitivity of 86.24% and specificity of 70.38%. Conclusion CRT can immediately increase the LV systolic function and synchrony. 2D-STE is highly predictive for acute response to CRT.

Objective To evaluate the left ventricular (LV) systolic dyssynchrony after the acute myocardial infarction (AMI) with two-dimensional speckle tracking echocardiography (STE). Methods STE were performed in 65 patients within 72 h of AMI and compared with 60 age- and sex-matched healthy volunteers. The peak longitudinal strain (LS_(peak)) was measured at LV myocardium. LV dyssynchrony was defined as an interval ≥130 ms for the absolute difference in time to peak radial strain for the anteroseptal wall versus the posterior wall (TAS-POST). Size of myocardial infarction (MIS)was confirmed by wall-motion score index (WMSI). Results The LS_(peak) and LV ejection fraction (LVEF) were lower, and WMSI and TAS-POST were larger in AMI patients compared with controls. Forty-two patients had developed LV dyssynchrony (64.62%), and there were strong correlation between LV dyssynchrony (TAS-POST) and LS_(peak), LVEF, and WMSI (MIS). MIS was the most independent predictor for systolic dyssynchrony. Conclusion AMI with normal QRS can induce LV dyssynchrony, which is mainly determined by MIS. STE is a reliable technique for accurate evaluation of LV synchrony.

Objective:To explore the clinicopathologic features and diagnostic criteria of hepatosplenic T-cell lymphoma (HSTCL). Methods: Three cases of HSTCL were seached for morphology, immunophenotypings, Epstein-Barr virus (EBV) in situ hybridization and T-cell receptor? (TCR?) gene rearrangement. Results: In the bone marrow, the infiltrative pattern of tumour cells was interstitial and sinusoidal infiltration in one case,while the other two cases showed diffuse infiltration. In the liver of one case and the spleen of another case, tumour cells respectively showed sinusoidal infiltration. The immunophenotyping: three cases showed strongly positive for CD3 and TIA-1, but negative for Granzyme B, CD56 and TCR?. EBV in situ hybridization was not detected in all the cases. TCR? monoclonal rearrangements were detected in two cases. Conclusion: HSTCL is a rare entity which is classified into peripheral T cell lymphomas. And it is regarded as a subset of unactived cytotoxic T-cell lymphomas. The negative results of EBV in situ hybridization and the presentation of TCR? gene monoclonal rearrangements may be helpful in diagnosis and differential diagnosis of HSTCL. These three cases showed similar characters to those of international cases reported.

Objective:To evaluate angioimmunoblastic T-cell lymphoma(AITL) completely, we gave in-depth investigation of histopathological features, specific immunochemical markers, antigen receptor gene rearrangements and in situ hybridization for Epstein-Barr virus (EBV). Methods: 15 cases of typical AITL displayed effacement of the normal lymph node architecture partially or completely, abundance of arborizing high endothelial vessels, infiltration of polymorphic cells and hyperplastic atypical T lymphocytes with or without clear cytoplasm. Clinical characteristics, histological manifestations, and immunohistochemical staining for CD3, CD20, CD4,CD21, CXCL13, CD10, and BCL6 were analyzed. Polymerase chain reaction for immunoglobulin heavy chain (IgH) and T cell receptor ? (TCR?) rearrangements and in situ hybridization for Epstein-Barr virus encoded RNA (EBER-1) were performed.Results: Histologically, we found eight cases with regressed lymphoid follicles, six with absence of follicles and one with hyperplastic follicles with interfollicular lesions. We also found eight cases displaying aggregation of clear cells, four infiltration of large lymphoid cells, five abundant epithelioid histiocytes. CD20 staining showed hyperplasia of large B cells in four cases. CD21 expression exihibited extrafollicular expansion of follicular dendritic cell meshworks in 11 cases (73.3%), partially with a tendency of perivascular distribution. Positive rate for CXCL13 and CD10 are 73.3% and 6.7% respectively. Monoclonal rearrangements of TCR? were detected in 6/15 (40%) of cases, IgH rearrangements in 7/15 (46.7%), of which five were monoclonal, while two oligoclonal. 8 out of 15 cases (53.3%) contained EBV-positive cells. Among the four cases with large B cell proliferation, three were EBV-positive. Conclusion: AITL display great complexity and diversity clinicopathologically. Only when we recognize such diversity, can we reasonably apply and properly evaluate immunochemical markers and molecular techniques, and thus give a correct diagnosis.

Rifabutin(RBT) is a rifamycin derivative,like rifampicin(RIF),registered for the prophylaxis and treatment of mycobacterium avium complex (MAC)in patients with AIDS by FDA in 1992.Subsequently,the drug was approved by many other countries.But now,it is used not only in the prophlaxis and treatment of mycobacterium avium complex but also in the treatment of pulmonary tuberculosis and Helicobacter pylori.For its high lipophilic characteristic and weak inducing properties compare to other rifamycin derivative,it can be applied in treatment with many diseases successfully,especially when combine with other antibiotics,and can solve the problem of traditional antibiotics resistance and increase the clinical safety of combined medical treatment.This paper just shows the progress of clinical pharmacological study and related aspects on rifabutin in order to instruct prescription.