Early recognition and treatment of pediatric septic shock is key strategy to improve prognosis and reduce the mortality,yet controversy still surrounds the current fluid therapy approach.Recently,the results of the Fluid Expansion as Supportive Therapy (FEAST) trial in African children with severe febrile and hypoperfusion illnesses challenge many established principles about pediatric fluid resuscitation,and lead to intense discussion.This review is to describe the current fluid supportive therapy and possible potential mechanisms of increased death associated with bolus resuscitation.

Objective To explore the changes and clinical significance of iron metabolism indexes such as serum ferritin (sFn),serum transferritin (sTf),serum transferritin receptor (sTfR) in patients with hematologic malignant disease before and after treatment.Methods Fifty-nine patients with hematologic malignant disease were enrolled.We measured the blood routine,bone marrow routine and iron bound of bone marrow cells and sFn、sTf、sTfR before and after treatment.The control group was 43 healthy Volunteers.Result Before treatment the level of patients sFn increased obviously,which was higher than that of control significantly (P ＜ 0.05).After chemotherapy,the level of sFn in remission group decreased obviously,which was still higher than that of normal control.sFn expression in non-remission group was not different from that before therapy or normal control (P ＞ 0.05).The level of sTf was lower than that of control significantly pretreatment and aftertreatment (P ＜ 0.05).While there was no different between remission group and nonremission group after chemotherapy (P ＞ 0.05).The level of sTfR in non-remission group after chemotherapy was higher than that of control.Correlation analysis showed that there was positive correlation between the serum level of sFn and the original and naive bone marrow cells (r =0.347).And there was negative correlation between sFn and hemoglobin (r =-0.207).But there was no significant correlation between sFn and bone marrow iron.Conclusions It is possible to predict treatment response and prognosis in hematologic malignant disease by the decrease of sFn after chemotherapy.But sTf and sTfR are not good indexes to predict treatment response in a short time.Prevalence of anemia among patients with tumor was not only because of iron deficiency.So iron supplementation should be cautious.

Objective To explore the feasibility of clinical applications of the transvaginal cavity mirrors operation on treating ectopic intra-uterine device (IUD) in uterus.Methods The clinical information was collected about 2 patients who suffered from ectopic IUD in pelvic and underwent transvaginal laparoscopic surgery.Results Ectopic devices were taken out by transvaginal laparoscopy operation in all two cases.The operation time was short and quick recovery was quickly.Conclusion Transvaginal laparoscopy operation was proved as a minimally invasive method for ectopic IUD in uterus.

The essential purpose of medical education is to cultivate qualified medical talents for health career.In the course of medical edUCation reform.it is the most important task to focus on the specjalties of mealical education,to follow the rules from medical education,to make jnnovations on the basis of practical conditions and to develop medical edUCation by means of innovation.

With the gradual transformation of the American medical model from biomedical medel to bio-psycho-social model,the advancement both in the medical security and service system,preventire medicine as well as the protection of environment have been emphasized,while the revolution of the medical education has been carried out according to the divemified requirements of the bio-psyeho-social model,and the focus of health care has been moved forward.

Objective To investigate and compare the impacts of health education and psychological intervention on the clinical effects of patients with hypertension. Methods 102 hypertension cases were collected and were randomly divided into three groups, health education group (36 cases), psychological intervention group (30 cases) and comparison group (36 cases). Compliance with prescription,anxiety level and blood pressure were observed both before and after the health education and psychological intervention. Result After health education,compliance with prescription in health education group was significantly improved ( P ＜ 0. 01 ), and blood pressure control of health education group was more preferable than the comparison group ( P ＜ 0. 01 ). After psychological intervention,anxiety level in psychological intervention group was significantly decreased ( P ＜ 0. 05 ), and blood pressures control of psychological intervention group was more preferable than the comparison group ( P ＜ 0. 01 ). Blood pressures had no statistical significance between health education group and psychological intervention group. Conclurion Health education could improve compliance with prescription, and paychological intervention could improve patients' mentl health, and both of them were conducive to the control of blood pressure of patients.

The effect of inducers on leukemia cell line K562 was studied in liquid culture system in vitro. Our experimental results showed that hemin induced cells only to produce hemoglobin without suppressing the growth of cells; Butyric sodium inhibited only the growth of cells without induction of hemoglobin; Cytosine arabinoside and harring-tonine could induce the hemoglobin of cells in their toxicant quantification.The results suggest that hemin and butyric sodium may have not be a therapeutic effect on leukemia patient; The effect of induced differentiation and cell toxicity of cytosine arabin- oside and harringtonine may be closely interconnected. Clinically, there is still the possibility of cell toxicity in treatment of leukemia patients with small dosage of those drugs, and the effect of those drugs may be the combination of cell toxicity, induced differentiation and cell sensitivity.

Objective:To study the relationship between idiopathic thrombocytopenic purpura (ITP) and various virus infections in children.Methods:The human parvovirusB 19(HPV-B 19),Epstein-Barr virus(EBV),Cytomegalovirus and Coxsackie virus (CBV 1-6) were detected using ELISA test in 102 patients with ITP.Results:The HPVB-19 IgM was positive in 41 patients(40.12%).CBV1-6 IgM was positive in 28 patients(27.45%).The CMV IgM was positive in 17 patients(16.66%).The EBV IgM was positive in 7 patients(6.86% ).The total rate of these four viruses was 50.98% of the patients with ITP observed in this study.Except EBV,the virus infections positive rate in this study were significantly higher than that of control group.( P

Objective To investigate the levels and clinical significance of serum adiponectin(ADPN),high sensitive C-reactive protein(hs-CRP)and cystatin C(CysC)in type 2 diabetic nephropathy.Methods 75 outpatients and the inpatients with type 2 dia-betes mellitus(T2DM)in our hospital from February 2013 to May 2013 were selected and divided into three groups according to the urinary albumin excretion rate (UAER),normal-albuminuria group(UAER<30 mg/d,30 cases),micro-albuminuria group (UAER 30-300 mg/d,22 cases)and macro-albuminuria(UAER>300 mg/d,23 cases).30 subjects of healthy physical examination were selected as the control group.Urine microalbumin was measured by the immune turbidimetric method,UAER was calculated ac-cording to the 24 h urine volume,CysC and hs-CRP were measured by the immune turbidimetric method,and ADPN was measured by the enzyme linked immunosorbent assay(ELISA).The ADPN,hs-CRP and CysC levels were compared among groups.Results The ADPN level in 3 type 2 diabetic nephropathy groups was lower than that in the control group,the difference was statistically significant (P <0.05 ).With increase of UAER,serum ADPN,hs-CRP and CysC levels in 3 type 2 diabetic nephropathy groups were increased,the difference among the groups was statistically significant (P <0.05 ).The levels of serum ADPN,hs-CRP and CysC in type 2 diabetic nephropathy were positively correlated with UAER(r=0.715 6,0.476 3,0.741 3,P <0.05).Conclusion The combined detection of serum ADPN,hs-CRP and CysC has important reference value for the diagnosis and disease course of early renal damage in T2DM.

Objective To investigate the prevalence of glucose‐6‐phosphate dehydrogenase (G6PD) deficiency and distribu‐tion of mutations in G6PD gene in Guiyang region .Methods A total of 515 DNA samples taken from newborn umbilical cord blood were collected ,15 mutations and one single nucleotide polymorphism in G6PD gene were detected by using of the Sequenom Mas‐sArray MALDI‐TOF‐MS system .Results Among the 515 samples ,10 were determined to have one of the G6PD gene mutations with a detection rate of 1 .94% ,5 mutation types were detected as follow :1388G>A accounted for 40 .0% (4/10 cases) ,1024C> T and 519C> T accounted for 20 .0% (2/10 cases) respectively ,1376G> T and 95A>G accounted for 10 .0% (1/10 cases) respec‐tively .The single nucleotide polymorphism allele frequency of 1311C>T was 12 .79% .Conclusion Guiyang is a region with higher prevalence of G6PD deficiency ,1388 G>A is the most common mutation of G6PD gene in this region .