Objective To explore the applicative effect of the clinical cluster management during perioperative period on esophageal cancer in elderly patients aged 75 years and over.Methods A total of 36 cases with esophageal cancer aged 75 years and over admitted into Thoracic Surgery Department in our hospital from January 2010 to February 2015 were divided into experimental and control group.Patients in experimental group received clinical cluster management including preoperative therapy for improvement of heart and lung function, selective protection during operation, strengthening support after operation and early nasal tube nutrition.Patients in control group received routine treatment for esophageal carcinoma during perioperative period.The postoperative complications, intensive care unit (ICU) stay, the incidence of anastomotic leakage,postoperative feeding time, postoperative hospitalization time and other indicators were observed.Results Among 20 patients in the experimental group, postoperative cardiopulmonary complications were found in 6 cases, postoperative cardiovascular complications in 3 cases and anastomotic leakage in 2 cases.Among 16 patients in the control group, postoperative cardiopulmonary complications were found in 12 cases, postoperative cardiovascular complications in 10 cases and anastomotic leakage in 5 cases.The incidences of postoperative cardiopulmonary and cardiovascular complications were lower in experimental group than in control group (x2 =7.200 and 8.693, P =0.007 and 0.003).The incidence of anastomotic leakage showed no significant difference between the two groups (x2 =2.562,P=0.109).The mean duration of ICU stay and postoperative hospitalization time were shorter in experimental group than in control group[(5.6±2.7) d vs.(9.8±4.9) d, (15.4±4.5) d vs.(20.6±5.5) d, t=3.208 and 3.125, P=0.003 and 0.004].There was no significant difference in postoperative feeding time between the two groups [(8.4±1.5)d vs.(9.1±1.1)d, t=1.569, P=0.126].Conclusions A tightly clustered clinical managements during perioperative period can minimize the incidences of postoperative complications and mortality rate in elderly patients with esophageal carcinoma.

Objective To investigate the literature research focus of Chinese Pediatric Emergency Medicine.Methods The papers published in Chinese Pediatric Emergency Medicine from 2006 to 2011 and indexed by wanfang database served as the basic data sources.Four thousands and fifty-four keywords were collected from 1194 literature.Keyword frequency statistics and the co-occurrence analysis were made by using bibliographic item co-occurrence matrix builder,and cluster analysis was made using SPSS 11.5 software.Results Newborns,premature,hand,foot and mouth disease,mechanical ventilation,sepsis,congenital heart disease was the top 10 high-frequency keywords.Cluster analysis diagram showed the research focus from articles published in Chinese Pediatric Emergency Medicine for the past six years,which included:(1) hand,foot and mouth disease; (2) prognostic factors for septic shock; (3) acute lung injury and acute respiratory distress syndrome; (4) neonatal asphyxia induced hypoxic-ischemic encephalopathy; (5) the disease of premature infants ; (6) the treatment of congenital heart disease complicated with severe pneumonia and heart failure; (7) the pathogens and drug resistance analysis of pediatric intensive care unit-acquired infection; (8) sepsis.Conclusion The main study law and direction of Chinese Pediatric Emergency Medicine in the past six years are proved by keyword co-words cluster analysis.

Objective To analyze the effect of GC-rich DNA fragments on the level of transgenic expression in Chinese hamster ovary (CHO) celts and its position effect.Methods The synthetic DNA fragment with GC-rich was cloned into the 5'or 3'or both 5'and 3'ends of expression cassette of expression vector.Three new expression vectors (pIRES-G1,pIRES-G2 and pIRES-G3) which was inserted with the GC-rich DNA fragments in different position were transfected CHO ceils,respectively,and then was observed under fluorescence microscope;the control vector was pIRES-EGFP.Stable transfected cell lines were screened under G418,and enhanced green fluorescent protein(EGFP) expression was analyzed by flow cytometry and the transgenic copy number was detected by quantitative real-time quantitative polymerase chain reaction (qRT-PCR).Results Three expression vectors with a GC-rich DNA fragments in different position were constructed successfully.The insertion of GC-rich DNA fragments at 3'end and both 5',3'ends of the box of expression vector could obviously improve the expression level of vector in CHO cells;and the expression level of the stably transfected CHO cells increased 1.39 fold and 1.32 fold compared to the control vector,respectively;the transgene copy number increased 1.32 fold and 1.24 fold compared with the control vector.While the insertion of GC-rich DNA fragments at 5'end of expression cassette had no obvious effect on the level of gene expression.Conclusion The role of DNA fragment with GC-rich in improving the transgenic expression of CHO cells is related to its position in the vector.The insertion of GC-rich DNA fragments at 3'end and both 5',3'ends of the box of expression vector can improve transgenic expression.

Objective To analyze the clinical characteristics of narcolepsy in children with obesity,and to e-valuate the impact of obesity on narcoleptic children clinically. Methods Forty cases first diagnosed as narcolepsy were recruited in the study who to see doctors at the Department of Neurology,Children's Hospital of Capital Institute of Pediatrics,from July 2012 to January 2015. According to diagnostic criteria for obesity by the body mass index(BMI) growth curve for the Chinese children and adolescents,they were divided into the obese group and the nonobese group. The general clinical data of 2 groups were analyzed,and the related metabolic indexes and the whole night polysomnog-raphy(PSG)of 2 groups were studied. Results In this group,male versus female 3: 1,obesity was found in 21 cases (52. 5% )and nonobesity was found in 19 cases(47. 5% )from the samples. The mean BMI of all patients was (21. 55 ± 3. 11)kg/ m2 . The average BMI of the obese group was(23. 09 ± 2. 46)kg/ m2 ,and BMI of the non - obese group was(19. 85 ± 2. 89)kg/ m2 . Obese children were younger at the onset of disease and by the time of diagnosis age [(7. 94 ± 2. 22)years old,(8. 76 ± 2. 36)years old]than nonobese children[(10. 75 ± 3. 10)years old,(12. 51 ± 2. 88)years old]. The fasting blood glucose and blood lipid in all patients were normal,and there was no significant difference between 2 groups. The total sleep time,sleep efficiency and the ratio of rapid eye movement(REM)phase of the obese group[(397. 45 ± 53. 76)min,(68. 70 ± 8. 90)% ,(18. 37 ± 4. 39)% ]were significantly lower than those of the non - obese group[(449. 95 ± 86. 49)min,(76. 58 ± 13. 60)% ,(22. 19 ± 6. 34)% ]. According to the sleep structure,the percentage of stageⅠnon rapid eye movement(NREM)sleep in the obese group[(20. 90 ± 6. 38)% ] was more than that in non - obese group[(16. 26 ± 4. 22)% ]. There was no difference between the percentage of stageⅡNREM sleep in the obese group[(42. 59 ± 5. 52)% ]and the non - obese group[(38. 54 ± 8. 74)% ]. Stage Ⅲ + Ⅳ(slow wave sleep)NREM sleep ratio in the obese group[(18. 14 ± 6. 97)% ]was significantly lower than that in the non - obese group[(22. 60 ± 5. 69)% ]. Conclusions Obesity is one of the most common comorbids in narcolepsy, which affects more than 50% of narcoleptic children,mostly younger at disease onset. The narcolepsy children with obe-sity has total sleep time decreased,sleep efficiency reduced and sleep structure disorder is more obvious. To improve the realization of obesity in narcolepsy children and early treatment is the key to the success of the therapy.

Objective To establish a detection method of Salmonella in laboratory animals based on a high-throughput sequencing technology, and to apply it in detection of Salmonella in laboratory animals.Methods DNA samples were extracted from mouse feces.Universal primers for 16S rDNA, 23S rDNA, 16S-23S rDNA, 23S-5S rDNA region, gyrB preferred area were designed, respectively.Each primer was tested and analyzed to determine the best amplification conditions and build a database.Forty-two samples of Salmonella were assayed by Illumina high-throughput sequencing technology and evaluated the specificity and stability of this method.Results The species preferred region of Salmonella was gyrB gene region.The primers for gyrB gene were FP5 ’-AACCACCGCAATCAGACCTT3‘ and FP5 ’-AGCCACGAAACCTTCACYA-3’.The primers were optimized and determined, through a high-throughput sequencing, and the sequence analysis detected very small amount of Salmonella in the 42 samples, indicating that this detection method is stable, highly sensitive, and the limit of detection reached to 0-102 CFU.Conclusions We have established a complete detection system for detection of Salmonella in laboratory animals based on a high-throughput sequencing technology, This system can detect trace amounts of Salmonella in laboratory animals, and this detection method is stable and highly sensitive, which can be also used in detection of other kinds of pathogenic microorganism in laboratory animals.

[Objective] To study the effects of Buyang Huanwu Decoction and Radix Astragali on astrocytes in gerbils with cerebral ischemia and reperfusion injury. [Methods] Gerbils model of cerebral ischemia was set up by occlusion of bilateral common carotid arteries. The dynamic expression of glial fibrillary acidic protein (GFAP) were determined by immunohistochemical method in reperfusion for 24 and 48 hours after 15 minutes of cerebral ischemia. [Results] Positive expression of GFAP reached a peak in reperfusion for 24 hours and was decreased by Buyang Huanwu Decoction and Radix Astragali. Positive GFAP expression was attenuated in reperfusion for 48 hours and enhanced by Buyang Huanwu Decoction and Radix Astragali increased the expression. [ Conclusion ] The regulatory effect of Buyang Huanwu Decoction and Radix Astragali on astrocytes may be one of its mechanisms in repairing nervous function after cerebral ischemia.

Objective:To investigate the effects and mechanism of β-carotene on inflammatory factors (IL-1 β,IL-6,TNF-α) in LPS-induced RAW264.7 cells.Methods:Firstly,RAW264.7 cells of being induced by 4 (5 μg/ml)for 24 h were treated with different concentration of β-carotene (20,40,80,160 pmol/L)for 3 h.The cells viability was measured by MTIT,the mRNA relative expression of IL-1 β,IL-6,TNF-cα was detected by fluorescence quantitative PCR,the secretion capacity of IL-1 β,IL-6,TNF-α was detected by ELISA and the protein relative expression of NF-κB p65 protein was measured by Western blot.Secondly,RAW264.7 cells were induced by LPS(5 μg/ml) and different concentration of PDTC(1,5,10 μg/ml)for 24 h,NF-κB p65 protein was measured by Western blot and inflammatory factors were detected by fluorescence quantitative PCR and ELISA.Finally,compared the changes in the relative expression of inflammatory factors and NF-κB p65 protein between LPS+PDTC group and LPS+PDTC + β-carotene group.Results:Compared with the LPS-induced group,β-carotene could increase the cell viability of LPS-induced RAW264.7 cells and inhibied the relative expression of inflammatory factors and NF-κB p65 protein.Inhibited the relative expression of NF-κB p65 protein could reduce the relative expression of inflammatory factors.Compared with the LPS+PDTC group,LPS +PDTC + β-carotene group could inhibit the relative expression of inflammatory factors significantly (P＜0.05).But,there was little difference about the relative expression of NF-κB p65 protein between this two groups.Conclusion:β-carotene inhibits the relative expression of inflammatory factors(IL-1 β,IL-6,TNF-α) in LPS-induced RAW264.7 cells through inhibition of NF-κB p65 protein in NF-κB pathway,this pathway isn't unique.

Objective To explore the factors influencing serum trough concentration of vancomycin in pediatric patients with severe gram-positive cocci pneumonia. Methods The general information, the biochemical test results, and plasma concentration of vancomycin were collected from 93 pediatric patients with severe gram-positive cocci pneumonia. The relative factors influencing trough concentration of vancomycin were analyzed retrospectively. Results With the dosage of 40-60 mg/(kg·d), serum trough concentration of vancomycin were between 10-20 mg/L in 26 patients, <10 mg/L in 54 cases, ≥20 mg/L in 13 cases. The ALT, AST, GFR, and γ-GT were significantly different among three groups (P<0.05); the 10-20 mg/L group had the highest levels of AST and γ-GT, the ≥20 mg/L group had the highest level of ALT and the lowest level of GFR. Multiple linear regression analysis showed that GFR was negatively linearly correlated with the serum trough concentration of vancomycin (R2=0.039, P<0.05). The median serum trough concentration of vancomycin in pediatric patients with GFR≥90, 60–90, 30–60 mL/(min·1.73m2) were 8.66, 18.21, 8.45 mg/L respectively, and the difference is statistically significant (P<0.05). Conclusions The serum trough concentration of vancomycin is negatively linearly correlated with GFR in pediatric patients with severe gram-positive cocci pneumonia. The patients with impaired renal function are easier to reach the target serum trough concentration of vancomycin. Clinical use of vancomycin should follow the low doses in the range the guideline recommended, and the serum trough concentration should be closely monitored.

Objective To analyze the clinical feature and common etiology of diffuse alveolar hemorrhage (DAH) in children. Methods Clinical data from 138 children with initially diagnosed DAH were retrospectively analyzed. The etiology, diagnosis, treatment, and prognosis had been summarized. Results Among 138 children, 76 were male and 62 were female. The clinical features are pallor ( 130 cases, 94 . 2%), cough ( 86 cases, 62 . 3%), fever ( 74 cases, 53 . 6%), anhelation ( 67 cases, 48 . 6%), hemoptysis ( 59 cases, 42 . 8%) and dyspnea ( 43 cases, 31 . 2%). Chest imaging changes were mainly patch shadow and ground glass shadow. Moreover, the detection rate of hemosiderin cells in sputum, gastric juice and bronchoalveolar lavage lfuid was 90 . 8%( 79/87 ). The common underlying diseases that caused DAH were idiopathic pulmonary hemosiderosis ( 65 cases), hematological system disease ( 22 cases), vascular inlfammatory diseases ( 15 cases), infectious diseases ( 14 cases) and cardiovascular disease ( 5 cases). The mortality rate in acute phase of DHA was 23 . 2%( 32/138 ). Conclusions DHA is a life-threatening clinical emergency disease, its cause was complex and diverse, and the acute mortality rate is high. Glucocorticoid is the ifrst choice of treatment for majority of patients.

Objective To investigate the possible risk factors for prognosis of diffuse alveolar hemorrhage (DAH) in children and to improve the recognition of the disease.Methods The study included 62 DAH pediatric patients hospitalized from January, 2006 to January, 2016. Clinical data were retrospectively analyzed. According to the basic diseases, children were divided into immune associated DAH and non-immune associated DAH to explore the effect of early glucocorticoid treatment on the two groups of DAH. Based on the prognosis, the patients were divided into the death group and the survival group to analyze its related risk factors.Results Of the 62 patients, 20 were of immune associated DAH, 42 of non-immune associated DAH. There was no signiflcant difference of early treatment with glucocorticoid between the two groups (P>0.05). In our cohort, 30 patients died, the total mortality was 48.4% (30/62). Pediatric critical illness score may be the independent risk factor for DAH mortality.Conclusions DAH is an acute, life-threatening event, the lower the pediatric critical illness score, the higher risk of death.