Objective To investigate the valuable echocardiographic parameters and to evaluate theright heart function of patients with pulmonary hypertension in ICU. Methods From March 2015 to February 2016,30 patients with pulmonary hypertension in the intensive care unit(ICU) of Dongzhimen hospital were enrolled in the experimental group,and another 33 patients without pulmonary hypertension in ICU were enrolled in the control group. All of the patients were given bedside echocardiography examination. Results Significant differences in the right atrial diameter and area ,the base diameter of the right ventricle ,the intermediate diameter portion ,the distal inner diameter of the proximal end of the right ventricular outflow tract ,the main pulmonary artery diameter ,the Tei index and the E/A were observed between the two groups. However ,no significant differences in the right ventricular free wall thickness,TAPSE,RVFAC,VREF and DT were foundbetween the two groups. Conclusion Tei index,the diameter of the right heart and the main pulmonary artery diameter are proposed to be the promising echocardiographic parameters to evaluate the right heart function of patients with pulmonary hypertension in ICU.

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.

Sepsis is a frequent condition with high mortality,and its early diagnosis in the pediatrics department is one of the keys to improve survival. C-reactive protein and procalcitonin have been used as bio-markers in the diagnosis of sepsis,but they have limited susceptibility and specificity,and can be elevated in non inflammatory condition. Presepsin is the free fragment of a glycoprotein expressed on monocytes/macro-phages. Preliminiary reports suggest that levels of presepsin are significantly higher in septic patients com-pared to healthy individuals, and presepsin is useful for evaluating the severity of sepsis.

OBJECTIVEThe mainstay of therapy in patients with septic shock is early and aggressive intravenous fluid resuscitation. However the type of intravenous fluid that would be ideal for managing septic shock has been intensely debated. In this study, the authors observed the effects of 3% hypertonic saline solution compared with normal saline solution as early fluid resuscitation in children with septic shock.

METHODIn this prospective study, 44 septic shock children seen in the intensive care unit (ICU) of the Children's Hospital Affiliated to Capital Institute of Pediatrics were enrolled from January 2012 to January 2014, of whom 33 were male and 11 were female. Patients were randomly divided into two groups: normal saline group (NS group, 24 patients) and 3% hypertonic saline group (HS group,20 patients). There were no significant differences between the 2 groups of patients in age, gender, pediatric critical illness score (PCIS), oxygenation index (OI = PaO2/FiO2), arterial lactate, initial hemodynamic parameters, serum sodium and treatment at time of admission. Patients in NS group received normal saline guided by standard therapy. Those in HS group received 6 ml/kg 3% hypertonic saline as a single bolus over 10 min to 15 min with a maximum of 2 boluses and other standard therapy. Heart rate (HR), mean arterial blood pressure (MAP), arterial lactate, oxygenation index, urine output, serum sodium, lactate clearance rate, PCIS, fluid infusion volume, vasoactive - inotropic score, mechanical ventilation time , as well as incidence of multiple organ dysfunction syndrome (MODS), and 28 days in - hospital mortality were recorded for all patients.

RESULT(1) HR, MAP in both groups were significantly higher after infusion than those on admission. There were no significant difference in HR and MAP at 1h, 3h, 6h and 24h after infusion between NS group and HS group. (2) OI in HS group was significantly higher than that on admission at 3 hours after infusion [(321. 8 ± 50. 7) vs. (296. 5 ± 58. 2) mmHg, t = -2. 50, P = 0. 018 ]), and it was significantly higher at 24 hours after infusion in NS group (325. 7 ± 62. 6) vs. (304. 2 ± 70. 4) mmHg, t = -2.60, P=0.016]. There were no significant differences in OI at 1h, 3h, 6h and 24h after infusion between NS group and HS group. (3) At 1 hour after infusion, serum sodium in HS group was significantly higherthan that in NS group [(138.3 ± 3.8)vs. (135.0 ± 3.5) mmol/L, t=8.77, P=0.005], and then no significant difference at 3h, 6h and 24h after infusion between two groups. (4) At 6 hours and 24 hours after treatment, fluid infusion volume in HS group was markedly less than that in NS group [6 h: (39. 2 13. 9) vs. (60. 8 ± 22. 4) ml/kg, t = 14. 21, P =0. 000; 24 h: (102. 9 ± 27. 7) vs. (130. 6 ± 33. 2 ) ml/kg, t= 8. 85, P = 0. 005]. Urine output had not significant different between the two groups. (5) There were no significant differences in 24h PCIS, 24h lactate clearance rate, vasoactive - inotropic score and mechanical ventilation time between the two groups. The incidence of MODS (80. 0% in HS group, 70. 0% in NS group) and mortality rate(5. 0% in HS group, 8. 3% in NS group) were similar in both groups.

CONCLUSIONThe 3% hypertonic saline was effective as resuscitation fluid in pediatric septic shock with respect to restoration of hemodynamic stability without obvious side effects. Hypertonic saline could more rapidly improve oxygenation and need less fluid infusion volume compared with normal saline.

Arterial Pressure ; Child ; Female ; Fluid Therapy ; Heart Rate ; Hemodynamics ; Humans ; Intensive Care Units ; Male ; Multiple Organ Failure ; Prospective Studies ; Resuscitation ; Saline Solution, Hypertonic ; therapeutic use ; Shock, Septic ; therapy ; Sodium Chloride ; therapeutic use

Objective To observe the formation of the biofilm in endotracheal tubes,the characteris-tics of etiology, drug resistance and relationship between the biofilm and ventilator-associated pneumonia ( VAP) . Methods A total of 60 cases of ventilated children patients whose mechanical ventilation time were≥48 h in the ICU from September 2010 to September 2012,according to the mechanical ventilation time,all cases were divided into 2 to 6 d group,7 to 14 d group and ≥15 d group. The incidence of VAP, biofilm structure under the electron microscope,etiology culture positive rate of the lower airway secretions and bio-film,etiological characteristics and drug resistance were prospectively studied. Results ( 1 ) A total of 19 cases occurred VAP in 60 cases of mechanical ventilation,the incidence of VAP was 31. 7%. (2) Observed by electron microscope,biofilm had formed in the endotracheal tube inner wall in early period of mechanical ventilation. With prolonged mechanical ventilation,biofilm structure had improved,as well as VAP incidence rate from 9. 1%(2 to 6 d group ) increased to 44. 4%(7 to 14 d group) and 88. 9%(≥15 d group). (3) A large number of pathogenic bacteria colonized in the biofilm. Gram-negative bacilli were dominate and drug resistance was high. (4) With prolonged mechanical ventilation,the cultured pathogens from the lower airway secretions and biofilm converged. Conclusion Biofilm could form in the endotracheal tube with mechanical ventilation patients,and is associated with the occurrence of VAP and refractory infections.

[ ABSTRACT ] AIM: To investigate the expression and clinical significance of bone morphogenetic protein 3 (BMP3) in hilar cholangiocarcinoma tissues.METHODS: Thirty cases of hilar cholangiocarcinoma specimens were col-lected.The expression of BMP3 at mRNA and protein levels in the tumor tissues and paracancerous tissues was detected by real-time PCR and Western blot.The hilar cholangiocarcinoma paraffin-embedded specimens (n=103) were collected. The protein expression of BMP3 was determined by immunohistochemical method, and the relationship of BMP3 protein ex-pression with clinical pathological characteristics was evaluated.RESULTS:In the 30 patients with hilar cholangiocarcino-ma, the expressions of BMP3 protein and mRNA in 22 cases of tumor tissues were significantly decreased compared with the adjacent normal tissues.The results of immunohistochemistry showed that 87 cases were negative and 16 cases were weakly positive in all 103 cases of hilar cholangiocarcinoma.The expression of BMP3 protein was associated with the tumor TNM staging, lymph node metastasis and tumor differentiation (P<0.05).CONCLUSION:BMP3 gene might be inhibited in human hilar cholangiocarcinoma.The down-regulation of BMP3 gene might be associated with the carcinogenesis and devel-opment of hilar cholangiocarcinoma.

Objective To deeply understand the risk factors of lymphedema for patients with breast cancer after surgery. Methods The phenomenological method was applied in this study. Semi-structured interview was used to collected data from 9 female breast cancer patients with lymphedema after surgery in our hospital from June to September 2016 for generic analysis. Results The risk factors of lymphedema could be categorized into four themes:(1)choice of treatment is the primary cause:axillary lymph node dissection; radiotherapy; chemotherapy; (2)not paying enough attention to lymphedema:lacking the knowledge of lymphedema; imbalance of physical activities for the affected limb; lacking awareness of exercise and protection of the affected limb. Conclusions Axillary lymph node dissection after radical surgery for patients with breast cancer is the primary cause of lymphedema, and paying not enough attention is an important factor, especially lacking the consciousness of prevention, so the nurses should emphasize education about prevention of lymphedema after surgery for patients, to improve the consciousness of them to reduce the occurrence of lymphedema and its influence on their quality of life.

To report the clinical course of 5 cases of pediatric plastic bronchitis and review the related literature.A total of 113 cases of pediatric plastic bronchitis occurring in China from 2000 to 2012 were retrieved through the databases of CNKI and Wanfang Med Online.Retrospective analyses were performed for the main symptoms,courses,etiologies,imaging findings,histopathological classifications,therapies and prognosis of 118 cases.Pediatric plastic bronchitis was one of critical diseases.Most of them had a rapid onset and a mortality rate.Bronchoscopy examination was essential for definite diagnosis and effective treatment.Airway management and chest physiotherapy were primary adjuvant tools.Early diagnosis and bronchoscopic treatment might result in improved prognosis.

Objective To investigate the risk factors of reoperation in patients with Crohn's disease recurrence.Methods The clinical data of 108 patients with Crohn's disease who were admitted to the Peking Union Medical College Hospital from March 2004 to September 2013 were retrospectively analyzed.Of the 108 patients,82 received single operation and 26 received reoperation.Twenty-five factors which might influence the reoperation were analyzed,which were gender,age,blood type,preoperative levels of white blood cells,neutrophils,lymphocytes hemoglobin,albumin,prealbumin,high sensitive-C reactive protein (hs-CRP),anti-saccharomyces cerevisiae antibody (ASCA),anti-neutrophil cytoplasmic antibody (ANCA),location and type of the lesions,extraintestinal manifestation,perianal lesions,history of smoking,appendectomy,course of the disease before the first operation,pre-operative administration of immunosuppressants,body mass index (BMI) before the first operation,onodera prognostic nutrition index (OPNI),enteral nutrition,emergent operation,complications after the first operation.The univariate analysis was done using the chi-square test or Fisher exact probability,and the multivariate analysis was done using the Logistic regression model.Results The results of univariate analysis showed that the level of preoperative prealbumin,hs-CRP,location and type of the lesion,the history of smoking,preoperative administration of immunosuppressants,enteral nutrition before the first operation were the risk factors of reoperation in patients with Crohn's disease (x2=5.928,4.805,7.491,12.363,5.229,9.026,16.506,P ＜ 0.05).The results of multivariate analysis showed that the lesion located at the ileocolon,administration of immunosuppressants prior to the first operation for 1 year and energy provided by enteral nutrition under 500 kcal/d before the first operation were the independent risk factors of reoperation (OR =1.908,3.535,5.489,95％ confidence interval:1.035-3.518,1.087-11.494,1.816-16.590,P＜0.05).Conclusions Patients with lesions located at the ileocolon,administration of immunosuppresants prior to the first operation for 1 year and energy provided by enteral nutrition under 500 kcal before the first operation have higher risk of Crohn's disease recurrence and reoperation.

Objective:To test the expression of Minichromosome maintenance complex component 7(MCM7) protein in hepato-cellular carcinoma(HCC) of different species including human, rat and tree shrew (tupaia) by cross-species oncogenomics approach, and to investigate the relationship between the expression of MCM7 and the development of hepatocellular carcinoma and its clinical significance. Methods:Western blot and Immunohistochemistry were applied to detect the expression levels of MCM7 protein in HCC tissues,corresponding HCC-adjacent liver tissues and normal liver tissues collected from different species including human, rat and tree shrew, respectively. The clinicopathologic factors were also analyzed with the results of Immunohistochemistry. Results:Western blot analysis showed that the expression of MCM7 protein in HCC tissues of human and rat were higher than that in corresponding HCC-ad-jacent liver tissues and normal liver tissues, respectively and significantly (P<0.05). However, the expression of MCM7 protein in HCC tissues of tree shrew were also higher than that in corresponding HCC-adjacent liver tissues and normal liver tissues, but no significant difference was found among three types of tissues (P>0.05).There was also no significant difference between HCC-adjacent liver tis-sues and normal liver tissues in three species (P>0.05). Immunohistochemical analysis showed that MCM7 protein was mainly ex-pressed in nucleus of HCC cells, and the positive rate of MCM7 protein in HCC tissues of human, rat and tree shrew were significantly higher than that in corresponding HCC-adjacent liver tissues and normal liver tissues, respectively (P<0.05). However, no significant difference was found between HCC-adjacent liver tissues and normal liver tissues (P>0.05). Moreover, the protein level of MCM7 was intimately related to patient's HCC stage, extrahepatic metastases and postoperative recurrence (P<0.05). Conclusion:MCM7 protein might play a pivotal role in hepatocarcinogenesis. In addition, it was probably related to patient's HCC stage, extrahepatic metastases and postoperative recurrence. It seems very likely that MCM7 may be applied as a new molecular target in HCC prevention and treat-ment.