Objective To study the efficacy of Tripterygium wilfordii polyglycosides combined with doxycycline in the treatment of palmoplantar pustulosis.Methods From June 2014 to November 2017,144 patients with palmoplantar pustulosis treated in the Second People's Hospital of Changzhi were selected and divided into three groups according to different treatment methods,with 48 cases in each group.The doxycycline group was treated with doxycycline.The Tripterygium wilfordii polyglycosides group was treated with Tripterygium wilfordii polyglycosides.The combination group was treated with Tripterygium wilfordii polyglycosides combined with doxycycline.The symptom score decline index (SSRI),clinical effect and changes of T lymphocyte subsets in peripheral blood were compared among three groups.Results The SSRI improvement rates of pustule,erythema,scab and pruritus in the combination group were 95.83％ (46/48),93.75％ (45/48),97.92％ (47/48),97.92％ (47/48),respectively,which were higher than those in the doxycycline group [72.92％ (35/48),70.83％ (34/48),75.00％ (36/48),77.08％ (37/48)] and the Tripterygium wilfordii polyglycosides group [83.33 ％ (40/48),81.25 ％ (39/48),85.42％ (41/48),89.58 ％ (43/48)],the differences were statistically significant (x2 =9.417,8.542,10.568,6.306,all P ＜ 0.05).The total effective rate of the combination group was 95.83％ (46/48),which was higher than that of the doxycycline group [66.67 ％ (33/48)] and the Tripterygium wilfordii polyglycoside group [81.25 ％ (39/48)] (x2 =5.285,P ＜0.05;x2 =1.771,P =0.076).There were statistically significant differences in CD4+,CD4+,CD4+/CD4+ among the three groups (F =3.854,4.856,5.019,P =0.017,0.024,0.030).Conclusion Tripterygium wilfordii polyglycoside combined with doxycycline can improve the clinical symptoms and T lymphocyte immune function in patients with palmoplantar pustulosis.

Objective To observe the central retinal artery (CRA) hemodynamics of diabetic patients befroe and after treatment with fosinopril.Methods 19 cases (38 eyes) were treated with fosinopril,10 mg/d.Peak systolic velocity (Vs),mean velocity (Vm),endodiastole velocity (Vd),pulse index (PI) and resistance index (RI) of CRA were measured before and one month after treatment using color doppler flow imaging and compared with that of controls.Results Before treatment with fosinopril the CRA Vs,Vm and Vd of the patents were lower but PI and RI were higher than that of controls.After treatment the CRA Vs,Vm and Vd of the patients were increased but PI and RI were decreased (P

Objective To investigate the students' perception and effectiveness of the flipped class model in bilingual education in special population nutrition class.Method Two classes of Shanghai University of Traditional Chinese Medicine were exposed to either the flipped class model or the traditional class model.In the flipped class model,the students were provided a wealth of teaching resources such as short videos before class.In addition,a series of pedagogical approaches were used to develop the students' cognitive ability.The questionnaire survey and class quiz were employed to evaluate the students' perception and effectiveness of the flipped class model.Results The students in the experimental group have significant higher scores in professional vocabulary section [(23.10 ± 0.71) vs.(21.10 ± 0.67)],listening and speaking section [(21.20 ± 0.78) vs.(19.00 ± 0.74)],essay questions section [(37.80 ± 0.96) vs.(34.40 ± 1.15)],and total test scores [(82.20 ± 1.50) vs.(74.50 ± 1.52)] than did the students in the control group.In addition,the flipped class model ignites the students' learning interest,reduces the learning anxiety,and develops their learning autonomy.Conclusion The flipped class model is a highly effective means that promotes the student centered active learning.This study provides reference for implementation of the flipped class model in Chinese medical bilingual education.

Objective To research the diagnostic value of serum procalcitonin (PCT)for sepsis and bacterial infection in children,and evaluate the value of severity and prognosis evaluation by dynamic monitoring for PCT levels in children with sepsis.Methods Prospective study.From July 2011 to April 2012,297 children in PICU were divided into sepsis group(n =125)and non-sepsis group(n =172).The sepsis group were divided into severe sepsis group and non-severe sepsis group,at same time,to be divided into bacterial sepsis group and non-bacterial sepsis group.The concentrations of serum PCT,C-reactive protein (CRP),WBC,neutrophil ratio in different time periods were obtained;the pediatric critical illness scores were conducted and sepsis related organ failure assessment were evaluated,the condition of prognosis was observed.Results The level of PCT in sepsis group and non-sepsis group were (21.31 ± 18.27)ng/ml,(4.35 ± 2.63)ng/ml,respectively.PCT of sepsis group was higher than that of non-sepsis group (t =4.744,P ＜ 0.01).The area under ROC curve of PCT,CRP and WBC in sepsis group were 0.737 (95 ％ confidence interval:0.633 ～ 0.840),0.704 (95 ％ confidence interval:0.610 ～ 0.799),0.666 (95 ％ confidence interval:0.554 ～0.778),respectively.When the level of PCT was 10 ng/ml,the diagnosis of severe sepsis had critical value,with sensitivity 80.2％ and specificity 82.6％.We found that PCT rapidly increased at the early infection by dynamically observing PCT,CRP and WBC of sepsis group.Furthermore,when the infection was controlled after using the antibiotic for 5 days,PCT also quiekly came down.However,CRP,WBC remained high level after controlling the infection and they declined slower than PCT.The PCT level of the children in the dead group was significantly higher than that in the survival group.PCT showed negative correlation with pediatric critical illness score (r =-0.621,P ＜ 0.05),and positive correlation with sepsis related organ failure assessment(r =0.755,P ＜ 0.01).Conclusion PCT has important value for diagnosing severe sepsis and bacterial sepsis.Dynamic PCT monitoring is valuable in severity classification and prognosis assessment for critically ill children with sepsis,and provide guides for clinicians to adjust the antibiotic use in time.

Objective To investigate the clinical features,treatment,prognosis,and occurrence of neurogenic pulmonary edema(NPE) in children with severe hand-foot-mouth disease (HFMD) complicated with brain stem encephalitis and abnormal cranial magnetic resonance imaging (MRI).Methods 386 cases of severe HFMD were hospitalized in our Intensive Care Unit (ICU) from May to October 2010,of which 24 cases had abnormal cranial MRI.Their clinical symptoms,MRI features,treatment,and prognosis were analyzed.Results The clinical symptoms of severe HFMD with brainstem encephalitis included fever,startle,lethargy,vomiting,difficulty swallowing,drooling,and so on.The patients with abnormal cranial MRI were prone to have a neurogenic pulmonary edema (NPE) (5％ vs 6.5％,x2 =34.55,P ＜0.01).Conclusions The nervous system-affected parts of severe HFMD is the brain stem,thalamus,and spinal cord.Brain stem inflammation can be found early by the cranial MRI to be highly vigilant of NPE.During course of 1 ～ 5 day,special attention should be paid to the symptoms of the nervous system.The early detection,timely intervention,and prevention from NPE would result in the good prognosis.

ObjectiveTo explore the value of elevated amylase in assessment of severity of the disease and its inlfuencing factors in critically ill children.MethodThe clinical data from critically ill children hospitalized in pediatric intensive care unit were retrospectively analyzed from November 2009 to June 2014. According to levels of serum amylase, the critically ill children were divided into normal serum amylase group (≤103 IU/L) and elevated serum amylase group (>103 IU/L). The differences between two groups were compared.ResultsA total of 1920 critically ill children were enrolled, most of whom had primary respiratory and neurological diseases. Among them, 1470 children had normal serum amylase (76.6%) and 450 children had ele-vated serum amylase (23.4%). The elevated serum amylase group had signiifcantly higher rate of organs failure (≥4), lower rate of PCIS (<70), higher rate of invasive mechanical ventilation and mortality than those in normal serum amylase group (P<0.001). The correlation of serum amylase with lipase blood, urine amylase, blood urea nitrogen and creatinine were signiifcant (r=0.246 to 0.683,P<0.001). Blood amylase was positively correlated with shock index (r=0.111,P=0.002) and negatively correlated with respiratory failure index (r=0.133,P<0.001).ConclusionsSerum amylase could be used to assess the severity of disease. The elevated amylase was closely related to pancreatic exocrine function, renal function, ischemia, and hypoxia. The elevated serum amylase in critically ill children is a warning sign.

Objective To analyze the clinical features of the hyperamylasemia in critically ill children and investigate the related risk factors in order to provide the basis for prevention and treatment. Methods A total of 1036 critically ill children admitted in pediatric intensive care unit (PICU)from April,2011 to Oct,2012 were studied.They were divided into the high amylase group (n=82)and the normal group (n=954).According to the outcomes,the high amylase group was divided into survival group (n=61 ) and death group (n =21 ).The related risk factors of the occurrence and outcome of hyperamylasemia were analyzed by univariate and multivariate Logistic regression.Results There were statistically significant differences in rates of coagulation disorders, convulsions, disturbance of consciousness,pediatric critical illness score (PCIS)≤80,multiple organ dysfunction (MODS)≥3, sepsis,shock,and lactic acid (LA),procalcitonin (PCT),blood glucose (BG)between the high amylase group and the normal group (P<0.05 ).The differences in the rates of coagulation disorders,convulsions, mechanical ventilation,PCIS≤80,MODS≥3,and LA,PCT,oxygenation index,albumin,C-peptide,BG were statistically significant between the survival group and the death group (P <0.05 ).Multivariate Logistic regression analysis showed that the risk factors of the hyperamylasemia's occurrence were LA,PCT, BG,PCIS<80,MODS>3.Adjusted ORs confidence intervals of them were 1.662 (1.236-2.234),1.042 (1.025-1.060),1.612 (1.411-1.843),3.219 (1.311-7.905),3.411 (1.370-8.494),respectively. The hyperamylasemia's prognostic risk factors were PCT,C-peptide,PCIS ≤80,MODS >3,shock. Adjusted ORs confidence intervals of them were 1.066(1.021-1.113),1.437(1.017 ~2.030),16.137 (1.876-138.836),10.437(1.528-71.925),20.928(1.938-226.009),respectively.Conclusions The severity of the disease,the levels of LA,PCT,BG in critically ill children were positively correlated to the occurrence of hyperamylasemia.The severity of the disease,the incidence of organ failures,the levels of PCT,C-peptide combined shock in children with hyperamylasemia were positively correlated to the prognosis of hyperamylasemia.

Objective To determine the fecal elastase-1 (FE-1) in critically ill children in order to investigate the relationships between FE-1 and trypsin,sepsis as well as the severity of the disease.Methods Totally 402 critically ill children admitted in pediatric intensive care unit (PICU) of Hunan Children' s Hospital from July 2013 to March 2014 were studied.The formed stool of patients was collected during the first 24 h after admission.Subjects were divided to 3 groups according to FE-1 concentration:＞ 200 μg/g for normal pancreatic exocrine function (group A,n =300),100-200 μg/g for mild to moderate exocrine pancreatic insufficiency (group B,n =52),＜ 100 μg/g for severe pancreatic exocrine insufficiency (group C,n =50).The analyses of the relationships between FE-1 and pancreatic enzymes,sepsis severity,shock,the number of organ dysfunction,PCIS (pediatric critically ill score),SOFA score,and APACHE Ⅱ score were carried out.Chi-squared test was used for data statistics.The median and four percentile interval were used for the measurement data of abnormal distribution or non-neat variance,the rank sum test of each two of multiple samples compared each other was used for non-parametric test,only when it was statistically significant,and the Spearman method of correlation analysis was used for correlation analysis.Results (1) There was significant difference in serum lipase between group A and group B (P ＜ 0.01).(2) There was statistical difference in FE-1 level between sepsis group and non-sepsis group (P ＜ 0.05).Children with sepsis were divided into three groups according to the severity of sepsis:mild sepsis group,severe sepsis group and septic shock group.There were significant difference in FE-1 level among different severities of sepsis groups and as well as non-sepsis group (P ＜ 0.01).(3) The proportions of FE-1 in septic children of A,B and C groups in comparison with those in non-septic children of three groups were 65.79％ vs.78.13％,15.79％ vs.11.80％,18.42％ vs.10.07％,respectively.The proportions of FE-1 in septic children of B and C groups escalated were higher than those in children without sepsis.(4) The general trend in FE-1 concentrations varied along with the severity of sepsis.There were no significant differences in FE-1 concentration between non-sepsis group and mild sepsis group,and between severe sepsis group and septic shock group,but other paired comparisons between the four groups had statistical significant (P ＜0.01).(5) Along with FE-1 level decreased,the number of organ dysfunction,SOFA score,APS score (This is a part of APACHE Ⅱ score and other part,CPS,is excluded) increased and PCIS score decreased (rs1 =-0.194,P =0.000; rs2 =-0.348,P =0.000; rs3 =-0.176,P =0.000; rs4 =0.185,P =0.000).Conclusions Pancreatic exocrine function damage is associated with sepsis,the pancreatic dysfunction in patients with mild sepsis may not be significant,but its incidence increases gradually with the development of sepsis or with the deterioration of the disease.

Objective To evaluate the mode of referral by response time for inter-hospital transfer of critically ill pediatric patients,and subsequently some measures taken for minimizing the response time in referral process.Methods A total of 9231 patients (≤14 years) transferred from primary hospital were included in a cross-section study.Information about age,sex,referral radius,the seasonal variation for inter-hospital transport of critically ill pediatric patients,time of referral telephone call and response time were collected.All computations were performed using the Statistic Package for Social Sciences for Windows version 18.0.Differences between groups were assessed by x2 tests or Wilcoxon test or Kruskal-Wallis for categorical data.Results Among all critically ill pediatric patients for the inter-hospital transfer,male to female ratio was 2.24:1,and the majority of patients were neonates and infants.Median retrieval mobilization time was 30 min (interquartile range,20-50 min).This study has demonstrated that referral time,age categories,referral radius,different years and seasons were associated with response time.Conclusions With the improvement of technologies and management mechanism,the response time was apparently minimized since the beginning of interhospital transportation.But there is still plenty of room for shortening rsponse time compared with advanced Westem countries.

Objective To discuss the clinical value of procalcitonin (PCT) in guiding antibiotics use in children with severe diseases. Methods The clinical data of patients admitted to intensive care unit from January 2012 to July 2012 were retrospectively analyzed. The patients without antibiotics use before admission and with procalcitonin level less than 0.5 ng/ml on admission were selected. The body temperature, infection indicators and prognosis were compared between patients with and without antibiotics use during hospitalization. Results There was no difference in body temperature, PCT, C-reactive pro-tein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell count (WBC) on admission between patients with and without antibiotics use during hospitalization. The PCT level was increased signiifcantly (P<0.05) on the day of starting the an-tibiotics when compared with that on admission in 60 patients while there was no change in the levels of WBC and CRP. Com-pared with the day of starting the antibiotics, body temperature declined (P<0.05) and PCT level in 56 patients reexamined was decreased (P<0.05) at 3 days after antibiotics use. Two hundred and eleven patients (98.14%) had favorable prognosis. Conclu-sions Monitoring PCT can guiding the clinical use of antibiotics.