Objective To summarize the clinical features and biological markers of critically ill children with pancreatic necrosis. Methods The clinical data of 5 ill children whose autopsy confirmed pancreatic necrosis in our hospital from 2003 to 2009 were collected and the pathological results were analyzed.Results Five cases appeared as acute onset and fever. Clinical manifestation of 2 cases included abdominal pain and 2 cases represented abdominal bulging,lots of flatulence and gastrointestinal bleeding. Four cases represented abnormal liver function and significant decrease of albumin,3 cases with increase of C-reactive protein. No case showed abnormal pancreas acoustic image of abdominal B-ultrasonography. Autopsy confirmed that 5 cases represented varying degrees necrosis of the pancreas, which complicated with the damage of adrenal gland,liver,lung,heart, spleen, kidney,intestine, thymus, mediastinal and mesenteric lymphnodes. All died in 36 hours after the children'conditions were changed. Two cases died of acute hemorrhagic necrosis of the pancreas,3 cases died of multiple organ failure based on pancreatic necrosis. Conclusion Pancreatic necrosis in critically ill children presents acute onset and short course,is prone to result in multiple organ damage or failure.

Objective To investigate the adrenal histopathology damage in critically ill non-survival children,and the incidence of adrenal damage,and to explore the risk factors for the adrenal hemorrhage and necrosis in critically ill children.Methods A total of 141 critically ill non-survival children was admitted in this study in Hunan Children's Hospital from January 1,2005 to December 30,2012.Clinical data in children were systematically collected,including age,sex,sodium,potassium,blood gas analysis,liver and kidney function,blood clotting function,etiology,treatment and pediatric clinical illness score (PCIS) or neonatal critical illness score (NCIS),and pathological data.All data were analyzed by SPSS 18.0.Results Logistic regression analysis showed the factors of adrenal hemorrhage and necrosis of critically ill non-survival children were sepsis,PCIS score ＜ 80 critically ill children are risk factors for adrenal hemorrhage necrosis (P ＜ 0.05),ORwas 3.659 (95％ CI:1.344-9.965),and 2.325 (95％ CI:1.028 -5.258).Intravenous corticosteroids were protective factors for critically ill non-survival children with adrenal hemorrhage necrosis (P ＜ 0.05),and ORwas 0.377 (95％ CI:0.163-0.875).Conclusions There were two significant risk factors of adrenal hemorrhage and necrosis:sepsis and critical illness score less than 80 points.Intravenous corticosteroid is a protective factor in critically ill children.

Objective To investigate the selection of flaps for the reconstruction of facial skin defects.Methods A total of 40 patients with facial skin defects were treated from February 2011 to February 2015 in our hospital,and they were given different surgery methods ac-cording to the different facial skin defect sizes.Minor defects were primarily treated by direct suturing;medium-sized defects were treated by local skin flap transposition or island skin flap;and larger defects were treated by expanded skin flap.Results All patients were followed up for 1 to 2 years.All the flaps survived with good color and texture match.All the scars healed well which were almost invisible.There was no obvious deformity in the donor and recipient sites.In addition,there was no lesion recurred.Conclusion Select suitable flaps for the recon-struction of facial skin defects according to the face defect area could get reliable blood supply of the flap,inapparent incision scar and a high level of satisfaction.

Objective To evaluate extended vs standard left lateral lobectomy for left lateral lobe hepatolithiasis.Methods A retrospective study was conducted on the clinical data of 110 patients who underwent hepatectomy for hepatolithiasis limited to left lateral lobe of the liver.Results 42 patients received left lateral lobectomy, 68 patients did left hemihepatectomy.There were no marked difference between the two groups in the operation time, introperation or postoperation blood loss, bile leak and bleeding on the hepatic cut surface, liver function and the postoperative hospital stay.The incidence of residual and recurrent stones was 14.3％ and 11.9％ in left lateral lobectimy group and 0％, 0％ in left hemihepatectomy group.Conclusion Left hemihepatectomy for left lateral lobe hepatolithiasis is a safe and effective procedure.

BACKGROUND:Whether plumbum(Pb) exposure induced learning and memory disorder in animals is correlated with the changes of the activity of protein kinase C(PKC) in the brain tissue? OBJECTIVE:To investigate the alterative rules of PKC activity in the brain tissue of rat in development stage under chronic exposure of Pb and its effects on the memory development of the mice. DESIGN:A randomized controlled study employing experimental animals as subjects. SETTING: Cellbiology Key Laboratory of the Ministry of Health,China Medical University. MATERIALS:The study was conducted in the Laboratory of Biochemistry and Molecular Biology of China Medical University. Totally 72,5- 6 weeks old Kunming mice were selected. METHODS:Lead acetate of different concentration was used to feed female mice after copulation.Fetal mice contacted Pb through breast feeding and drinking water.Fetal mice were executed separately on 1st day(P1),8th day(P8),15th day(P15),22nd day(P22), and 30th day(P30) after birth for brain tissue harvesting.PCK activity in the brain tissue of the mice exposed to Pb was detected in vitro by[γ 32P] ATP.Budding mice were exposed to lead acetate of different concentration for the observation of the effects of Pb in difference concentration on the memory of the mice through memory behavioral training and test by passive avoidance response experiments. RESULTS:PKC activity detection indicated that PKC activity in brain of Pb exposed budding mice during initial growth stage was higher than normal,while it was lower than normal during advanced stage of growth.High concentration Pb had relative stronger inhibition on PKC activity.Memory behavioral training indicated that low concentration Pb would induce elevation of memory curve in the initial stage of the development in mice but reduction of memory curve in middle and long term.The increase of Pb concentration would reduce memory curve. CONCLUSION:Pb has inhibitive effects on the development of PKC activity in brain tissue of mice:the higher the Pb concentration is, the more significant the inhibition is.Low concentration Pb seems to have stimulatory effects on memory in short period while long term exposure to Pb would induce memory inhibition.The inhibitive effect of high concentration Pb is more significant.Pb has certain correlation with PKC activity in brain tissues of budding mice and memory function.

Objective To study the exocrine pancreatic function in critically ill children with septic shock,sepsis and hyperlactacidemia.Methods A total of 64 critical pediatric patients were admitted from Jan 2009 to Oct 2012,and clinical and laboratory findings including pancreatic function,and histopathological features and score after autopsy were reviewed.Results (1) Compared with non-septic shock children,the pancreatic pathology score and serum lipase in septic shock group were significantly higher and serum calcium was significantly reduced (P ＜0.05) ; (2) The pancreatic histopathology score was significantly increased in patients with elevated plasma lactate ≥2 times (P ＜0.05),but there were no significant differences in serum calcium and blood amylase and lipase between patients with elevated plasma lactate level and patients with normal plasma lactate level; (3) The concentrations of serum amylase,lipase and urinary amylase were significantly increased in patients with pancreatic histopathology score ＞4 points compared with score ≤4 points patients,but there were no significant differences in above three biomarkers between patients with score ≤3 points and patients with score ＞3 points.Conclusions The pancreas is vulnerable to damage easily occurred in septic shock children especially complicated with hyperlactacidemia.The pancreatic histopathology score ＞ 4 points can be as a sensitive and reliable indicator of pancreas damage.

The aging process of human colonic epithelium involves a slow decline in physiological vigor and an increasing susceptibility to age-related diseases, especially, colon cancer, but the molecular mechanisms of the aging and susceptibility of aged colonic epithelium to carcinogenesis is still unclear. Identification of aging related proteins in colonic epithelium will help to reveal the molecular mechanisms of colonic epithelial aging and age-related colonic diseases. Therefore, the total proteins of human normal colonic epithelial tissues from 10 young and 10 old men were separated by two-dimensional gel electrophoresis(2-DE), respectively. PDQuest software was applied to analyze 2-DE images, the differentially expressed protein spots of colonic epithelium between young and old groups were identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF-MS), and the expression levels of partial identified proteins were determined by real-time quantitative PCR and immunohistochemistry. Well-resolved, reproducible 2-DE maps of human colonic epithelial tissues from young and old men were established, 17 aging related proteins were identified by MALDI-TOF-MS, and the differential expression levels of partial identified proteins were confirmed by real-time quantitative PCR and immunohistochemistry. The results indicate that injury of mitochondrial function and decline of antioxidant capability are important reasons for the aging of human colonic epithelium, and four differential proteins (guanine nucleotide-binding protein beta subunit-like protein, stress-70 protein, 40 S ribosomal protein SA and chloride intracellular channel protein1) may be involved in susceptibility of aged colonic epithelium to carcinogenesis.

OBJECTIVETo study the reversal effect of nomegestrol acetate (NOM) on mutidrug resistance (MDR) in MCF7/ADR and its mechanism.

METHODSUsing tetrazolium dye assay, effects of various concentrations of NOM on sensitivity to ADR in MCF7/ADR was studied. Expression of MDR related genes MDR1, glutathoine S-transferase Pi (GSTpi), Topoisomerase II alpha (Topo II alpha) and MDR related protein (MRP) were assayed by reverse transcription-polymerase chain reaction (RT-PCR) and immunocytochemistry assay. Using flow cytometry (FCM), intracellular ADR concentration effects on cell cycle were observed.

RESULTSNOM significantly reversed MDR in MCF7/ADR. After NOM 20, 10 and 5 micromol/L treatment, the chemosensitivity to ADR increased to 21, 12 and 8 times. The reversal activity of NOM was stronger than that of the precursor compound megestrol acetate, and was comparable to that of verapamail. After treatment with NOM 5 micromol/L both MDR1 and GSTpi mRNA genes expression began to decline on D2 (P < 0.05, & P < 0.01) and reached the lowest level on D3 (both P < 0.01), but the expression levels began to rise on D6 again (both P < 0.05). The expression of MRP and Topo II alpha gave no significant change. Changes of P-gp and GSTpi protein expressions were similar to those of their mRNA expressions, showing early decline and late rise. Two hours after NOM 20, 10, and 5 micromol/L treatment, intracellular ADR concentration increased 2.7, 2.3 and 1.5 times, respectively. FCM data showed that after forty-eight hours, combined administration of NOM (20 micromol/L) and ADR (from low concentration to high concentration), MCF7/ADR cells showed gradual arrest in the G(2)M phase with the increase of ADR dose.

CONCLUSIONNOM has strong reversal effects on MDR in MCF7/ADR. The reversal takes place via different routes, i.e. down regulating mRNA and protein expression levels of MDR1 and GSTpi, increasing intracellular drug concentration, and enhancing the arrest of ADR in cells at G(2)M phase.

ATP-Binding Cassette, Sub-Family B, Member 1 ; genetics ; metabolism ; Antigens, Neoplasm ; Breast Neoplasms ; genetics ; pathology ; Cell Survival ; drug effects ; DNA Topoisomerases, Type II ; genetics ; metabolism ; DNA-Binding Proteins ; Drug Resistance, Neoplasm ; genetics ; Gene Expression Regulation, Neoplastic ; drug effects ; Glutathione S-Transferase pi ; Glutathione Transferase ; genetics ; metabolism ; Humans ; Immunohistochemistry ; Inhibitory Concentration 50 ; Isoenzymes ; genetics ; metabolism ; Megestrol ; Multidrug Resistance-Associated Proteins ; genetics ; metabolism ; Norpregnadienes ; pharmacology ; Progesterone Congeners ; pharmacology ; RNA, Messenger ; drug effects ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Tumor Cells, Cultured ; Verapamil ; pharmacology

Objective To study the value of whole tumors T2WI gray histogram analysis for differential diagnosis of three commonly presented pediatric posterior fossa tumors. Methods A retrospective analysis was conducted to compare brain MRI examination and pathology diagnosis of 133 cases of posterior fossa tumors in pediatric patients in our hospital.Among them, there were 49 cases of ependymoma(there were 25 males and 24 females), 36 cases of astrocytoma(WHO grade Ⅰ)(there were 19 males and 17 females), 48 cases of medulloblastoma(there were 36 males and 12 females),aged 1 to 14 years old, with an average (7±2) years old. Respectively draw the region of interest (ROI) in the T2 MR transaxial images of three groups on each layer of tumor level by using Mazda software and analyze the whole tumors gray histogram, including mean,variance, kurtosis,skewness, perc.01%,perc.10%,perc.50%,perc.90% and perc.99%.The histogram parameters of the three groups were not normally distributed. The Kruskal-Wallis test was used to compare the three groups. Bonferroni test was used to compare the two groups to find out statistical significance of each parameter. Results Through histogram analysis of 9 parameters, these 9 parameters were statistically significant (all P <0.05),including mean,variance,kurtosis,skewness, perc.01%,perc.10%,perc.50%,perc.90% and perc.99%. The sensitivity of skewness to differentiate ependymoma and the astrocytoma was 69.4％, the specificity was 77.8％, the area under the curve was 0.744, and the best cut-off value was-0.08. The sensitivity of kurtosis to differentiate astrocytoma and the medulloblastoma was 95.8％, the specificity was 97.2％ and the area under the curve was 0.972, the cut-off was 1.68. The sensitivity of kurtosis to differentiate ependymoma and the medulloblastoma was 91.7％, the specificity was 89.8％and the area under the curve was 0.932,the cut-off was 1.90.They had a high identification efficiency. Conclusions The T2WI gray histogram analysis based whole tumors is helpful for the dignosis of three types of pediatric posterior fossa tumors. Skewness has a high diagnostic efficiency to differentiate ependymoma and the astrocytoma. Kurtosis has a high diagnostic efficiency to differentiate ependymoma and the medulloblastoma. Kurtosis has a high diagnostic efficiency to differentiate ependymoma and medulloblastoma.

Objective To explore the MRI features of cavernous hemangioma in the thoracic spinal epidural space,to improve the recognition of the disease.Methods The clinical,pathological and MRI data of 7 cases with cavernous hemangioma in the thoracic spinal epidural space confirmed by surgery and pathology were analyzed retrospectively.Results 7 cases of cavernous hemangioma in the thoracic spinal epidural space were included in our study,all cases underwent MRI contrast enhancement examination and 6 of them underwent conventional MRI examination.On T1WI,4 cases showed hypointensity,2 cases showed slightly hypointensity and 1 case showed mixed slightly hypointensity.On T2WI,5 cases showed slightly hyperintensity,1 case showed slightly hypointensity. On fat suppression sequence,5 cases showed hyperintensity,1 case showed heterogeneous hyperintensity.On diffusion-weighted imaging (DWI),7 cases showed obviously hyperintensity.On contrast-enhanced images,the lesions enhanced homogeneously in 5,enhanced heterogeneously in 2.Conclusion MRI can display the location,appearance and enhancement pattern of thoracic spinal epidural cavernous hemangioma distinctly,while definite diagnosis of which still depends on pathology.