The 2012 version of international guidelines for management of severe sepsis and septic shock got re-revised on the basis of the 2008 version.For pediatric severe sepsis,the 2012 version enforces initial resuscitation;develops detailed ant-infection measures;stresses isotonic crystalloid fluid resuscitation and the use of albumin,hetastarch is no longer recommended ;reduces the value of early use of dopamine,and clears the use of corticosteroids indications and the use of blood products;mechanical ventilation is recommended to use lung protective ventilation strategy; standardizes sedation and analgesia applications; clears the level of blood glucose control;others include blood purification,nutrition,stress ulcer prevention recommendations.

Objective To investigate the value of the interhospital transportation and the advantage of the cooperative network to the critically ill children.Methods The clinical data of 232 critically ill chil-dren transported from other hospitals in long distances to PICU of Fudan University Affiliated Children Hos-pital cooperated with Shanghai 120 interprovincial transport Department,between Oct 2010 and Oct 2013, were analyzed retrospectively.Results At otal of 232 critically ill childrne were transported from 31 hospi-tals of Eastern China region including five provinces and the city of Shanghai.Among thse e critically ill chil-dren 141 casse were male and 91 cases were femla e,with age from 29 days ot 13 years( median age was 12 months) and weight from 2.5 to 66 kg ( median weight was 10 kg ) .The average pediatric clinical illness score was 80.4 ±7.7,155 cases(66.8%) were single organ dysfunction,55 cases(23.7%) were multiple organs dysfunction,105 cases(45.3%) were mechanical ventilation required fort ransportait on.Referral radi-us was 50-1 000 km(median).Among these patients,87 cases(37.3%) weret ransported over 200 km radius and73 cases(36%) were transop rted 101-200 km,62 cases(26.7%) were transported 100 km or less.D ur-ing the transportation,0 case died,3 cases(1.3%) received cardiopulmonary resuscitation treatment,2 cases (0.9%) received electrical conversion treatment,2 cases(0.9%) were replaced endotracheal intuab tion,the success rate of transportation was 100%.The top 4 disae ses were respiratro y id seases(90 cases,38.8%), neural diseases(43 cases,18.5%) ,cardiovascular diseases(36 cases,15.5%) and acute pediatric trauma(28 cases,12.1%) .Al l 232 cir tically ill children were admitted to our PICU for further treatment through the Green Channel.In the end, 178 cases ( 76.7%) discharged, 24 cases ( 10.3%) gave up and 32 cases (13.8%) died.Among thse e 232 rc itically ill children,30 cases(12.9%) received special organ replacement treatment,4 casse ( 1.7%) of whom were treated with extracorporeal membrane oxyg enation, 26 cases (11.1%) received blood purification therapy.Conclusion Establishing the system of transportation between PICU of hospitals will be propitious to treat the critically ill children energetically and effectively.It is worth pro-moting to master the transportation indication of children with critical illness,which is safe and reliable.

Objective To study the expressions of Hepcidin,bone morphogenetic protein 6 (BMP6) and hemojuvelin (HJV) in gastric cancer,and to explore their relationships with clinical pathological characteristics.Methods Hepcidin,BMP6 and HJV were detected by immunohistochemistry in 62 cases of gastric cancer patients,and the relationships among them and clinical pathological features were analyzed.Results Compared with normal gastric mucosa tissues,Hepcidin was highly expressed in gastric cancer tissues (13.3％ vs.56.5％,x2 =8.99,P ＜ 0.01),while the differences of the expression of BMP6 and HJV in the two groups were not statistically significant (60.0％ vs.40.3 ％,x2 =1.89,P ＞ 0.05;93.3％ vs.83.9％,x2 =0.88,P ＞ 0.05).The expression of Hepcidin was related to T stage (x2 =6.98,P =0.02),but it was not related to age,sex,lymph node metastasis,distant metastasis and anemia.The expressions of BMP6 and HJV were not related to T stage,age,sex,lymph node metastasis,distant metastasis and anemia.Hepcidin was not related to the expressions of BMP6 and HJV (r=0.13,P＞0.05;r=0.15,P＞0.05).Conclusion Hepcidin is highly expressed in gastric cancer tissues,which is related to the T staging of gastric cancer,and can be used as an objective indicator of the biological behavior of gastric cancer.There were no differences in the expression of BMP6 and HJV between normal gastric mucosa and gastric cancer tissues.

Objective To study the expression and significance of Neogenin,Hepcidin and serum ferritin(SF)in patients with cancer-related anemia.Methods To test the serum levels of Neogenin,Hepcidin and SF in 107 cases,including 55 cases with cancer-related anemia and 52 cases of non-anemia with tumor by ABC-ELISA.Results ①The serum levels of Neogenin in patients with cancer-related anemia were 0.77 ± 0.45 ng/ml,which were lower than 0.98 ± 0.60 ng/ml in non-anemia group (t=2.003 8,P <0.05).The serum levels of Hepcidin in patients with cancer-related anemia were 6.03±4.25 μg/ml, which was higher than 4.51±2.23 μg/ml in non-anemia group (t=2.319 5,P <0.05).②There were no difference in pa-tients between anemia and non-anemia (t=1.898 0,P >0.05).③In patients with cancer,there were positive correlation be-tween Neogenin and Hb (r=0.212 4,t=2.226 4,P <0.05),there were negtive correlation between Hepcidin and Hb (r=-0.310 1,t=3.345 2,P <0.01),but there were no correlation between SF and Hb (P >0.05).④There were positive cor-relation between Hepsidin and SF (r=0.486 6,P <0.01).Conclusion There were lower expression of Neogenin,higher ex-pression of Hepcidin in patients with cancer-related anemia is a complex process.The abnormal expression of Neogenin and Hepcidin which were lead to the loss of use of iron are the key factors attribute to anemia in patients with cancer.

Objective:To construct an adenovirus-mediated anti-sense RNA targeting K-ras exon 1 of SW1990 cell line and observe its effect on ceil proliferation and apoptosis after transferred into SW1990 cell line.Methods:K-ras exon 1 cDNA was cloned into shuttle vector pShuttle-CMV and the resultant plasmid was confirmed by enzyme digestion and PCR.Clones with inverted insertion were selected and co-transferred into E.coli BJ5183 with an adenoviral backbone plasmid pAdEasy-1 to produce recombinant plasmid by homologous recombination.Recombinants were then selected and transfected into 293 cell line to produce recombinant adenovirus.Recombinant adenovirus production was confirmed by PCR analysis and was amplified and purified;the virus titer was determined.Ad-LacZ was used to infect SW1990 cells and the infection efficiency was observed by X-gal staining.SW1990 cells was infected with the recombinant adenovirus and their proliferation and apoptosis were determined by MTT and annexin V/PI FCM assay.Results:A 282 bp target gene fragment was acquired by PCR;the titer of recombinant adenovirus was 7.6?10~8 pfu/ml before purification by CsCl_2 gradient centrifugation and 5.0?10~(10)pfu/ml after CsCl_2 gradient centrifugation.When the recombinant adenovirus was at 100 MOI,the infection efficiency of SW1990 cells nearly reached 100%.The transfection of recombinant adenovirus significantly inhibited SW1990 cell proliferation(P

Objective To determine the epidemiology of death in PICU in the past ten years.Meth-ods Retrospective cohort study was conducted in the PICU of Childrne ′s Hosip tal of Fud an University from January2005 to December 2014.Resulst The overall mortality rate of PICU was 8.5%overa 10-year peri-od for m January 2005 toD ecember 2014.Compared wti h the period from 2005 to 2009,the mortalti y rate in PICU decreasedf rom 9.7%to 8.0%during ht e period of 2010 to 2014.A totalo f 736 patients died over a 10-year pre iod,including 329(44.7%) infants,191(26.0%) toddlers,118(16.0%) preschoolers,and 98 (13.3%) school-age and adolsec ence.From 2005 to 2009,there were 269 deaths,of which 65.4% were infants and toddlers.From 2010 to 2014,there were 467 deaths,of which 73.7% were infants and toddlers. Among the diseases causing death,the severe pneumonia was the most common disease(21.6%),followed by malignant tumors ( 16.3%) , sepsis ( 15.4%) , accidental injury ( 13.7%) , and severe encephla itis (8.0%).In different age groups,the distribution of the diseases causing death was different,such as infants mainly with sevre e pneum onia(34.3%),t oddlers mainly with accidental injury(16.8%),preschoolers main-ly with accidental injury and malignant tumors(23.7%),school-age and adolescence mainly with malignant tumor(28.6%).From 2005 to 2009,77.5%deaths were critically and very critically ill patients,and the sep sis was the most common cause of death ( 27.6%) especially in very critically ill patients.From 2010 to 2014,83.0%deaths were critically and very critically ill patients,and the accidental injury was the most com-mon cause of death( 23.2%) especially in very critically ill patients, followed by sepsis ( 17.9%).There were 345 deaths ( 46.9%) occurred within the first week of admission, mainly with accidental injury (20.9%).There we re 391 deaths(53.1%) with the PICU stay for 7 or more days,and severe pneumonia (24.3%) was the most common cause of death.Modes of death were categorized as failed cardiopulmonary resuscitation(54.6%) adn forgoing life-sustaining treatme nt(45.4 %).Conclu sion Compared with the pe-riod from 2005 to 2009,the mortality rate in PICU decreaseds gi nificantly during the periodo f 2010 to 2014. The younger the patine t,the higher the mortality rate.Most deaths were attributed to severe pneumonia,fol-lowed by malignant tumors and sepsis.The causes of death also had relations with severity of diseases and lne gth of PICU stay.Failed cardiopulmonary resuscitation and forgoing life-sustaining treatment were still the mostc ommon mode of deaths.

Objective To study the expression and clinical significance of Livin ( anti-apoptosis protein) and Smac (promoting apoptosis factor) in patients with the non-Hodgkin lymphoma (NHL).Methods The expression of Livin and Smac were detected by immunohistochemical staining(SP) assay in 31 patients with NHL, and the relationship between Livin/Smac and clinical staging, IPI and prognosis were analyzed. Results The patients with positive expression of Livin had B symptom, high risk IPI, late clinical staging (Ⅲ/Ⅳ stage) and short survival time, while the ones with positive expression of Smac had no B symptom, early clinical staging( Ⅰ /Ⅱ stage), low risk IPI and good prognosis. The expressions of both Livin and Smac were not related to gender and age. Expression of Livin was not correlated to that of Smac (r =0.003,P ＞0.05). Conclusion For patients with NHL, the expression of Livin protein was related to poor prognosis and adverse clinical features, whereas the expression of Smac protein was related to good prognosis and clinical feature.

Objective To explore the effects and mechanisms of anti-endothelial cell antibody (AECA )in the alveolar cell apoptosis of the emphysema rats induced by smoking,and to discuss the intervention effects of methylprednisolone.Methods 39 male Sprague-Dawley rats were randomly divided into normal control group,model group,and intervention group,with 13 rats in each group.Emphysema models were established in the latter two groups.After exposing to cigarette smoking for one month,methylprednisolone injected intraperitoneally in the intervention group(10 mg/kg,1 time/d),6d/week.On the 90th day,inferiora vena cave blood samples were collected and all rats were sacrificed.The levels of AECA were detected in bronchial alveolar lavage fluid (BALF )and serum,respectively.Pathological changes were observed in lung tissues stained by hematoxylin eosin, quantitative determination of lung average mean linear intercept(MLI)and mean alveolar number(MAN)were preformed. Results Compared with normal group and intervention group,the levels of AECA in BALF and serum,MLI in the model group were higher(P<0.05 ),but the levels of MAN was lower (P<0.05);There is a positive correlation between AECA in BALF and MLI of rats(r=0.821,P<0.05),a negative correlation between AECA in BALF and MAN(r=-0.894,P<0.05.Conclusions ACEA may enroll the pathogenesis of emphysema in rats induced by smoking and related with the severity.Methylprednisolone may inhibit the formation of emphysema by reducing the expression level of AECA in airway.

Objective To investigate the parental origin for a rare case of complete hydatidiform mole and coexisting fetus and to discuss its diagnosis and differential diagnosis.Methods Tissues from the fetus,mole and placenta were collected and pathology analysis and chromosome analysis were done.The DNA from the fetus,mole and parents' peripheral blood leukocytes was amplified with five short tandem repeat (STR) markers (D4S2460,D18S488,D21S2039,DXS1205 and DYS219) at the same time to confirm the parental source of the hydatidiform.Results (1) Casereport:A 27-year-old woman,gravida 1,para 0,was found high risk for neural tube defects at 20 weeks of gestation.At 24+5 weeks of gestation,ultrasound examination demonstrated a normal fetus,a normal placenta and a huge mass with a multicystic appearance attached to the placenta with an obvious demarcation.The fetus died at 26 weeks of gestation.Serum human chorionic gonadotropin-β(β -hCG) level decreased obviously during the first two weeks after artificial induction,but elevated at the third week,and β-hCG titers fell to normal after 2 courses of chemotherapy.Fetus autopsy showed no structure abnormality.Histopathologic examination of the hydatidiform showed swelling of chorionic villi with hyperplasia of the trophoblast and formation of central cisterns suggesting of a twin pregnancy consisting of a complete hydatidiform mole and coexisting fetus.(2) Genetic analysis:The karyotype analysis of the normal placental villi was 46,XY; the cell cultures of fetal cartilage tissue and hydatidiform were failed.STR analysis showed that the fetus was diploid from biparental source;the mole was androgenetic source.And the mole had locus both from Y and X chromosome of the father,so it was heterozygous.It was suggested that this case was derived from one single oocyte fertilized with three spermatozoas.Conclusions STR analysis could be used to confirm the diagnosis of complete hydatidiform mole and coexisting fetus and to find the pathogenetic rnechanism.

OBJECTIVETo study the effect of puerarin on angiotensin II type 1 receptor (AT1) and angiotensin-converting enzyme 2 (ACE2) in spontaneous hypertension rat (SHR).

METHODSSHRs, 12 weeks old, were randomly divided into four groups: the model control group (A), the Verapamil group (B), and the two puerarin groups (C and D) treated by low dose and high dose of puerarin respectively. After being treated for 3 weeks, total RNA from tissues of heart, aorta and kidney in rats were extracted and mRNA expression levels of AT1 and ACE2 were determined by RT-PCR.

RESULTSAs compared with Group A, the mRNA expressions of AT1 and ACE2 in heart tissue were lower in Group C, and those in kidney tissue were higher in Group D (all P < 0.05); ACE2 mRNA expression was higher in Group D than in Group C (P < 0.05); no significant differences of the two indexes in aorta were shown among various groups. Besides, mRNA expressions of AT1 and ACE2 in heart and kidney tissue were proved to be positively linearly correlated.

CONCLUSIONHigh dose puerarin could increase the mRNA expressions of AT1 and ACE2 in kidney, while low dose puerarin could decrease them in heart; there might be a feed back correlation between AT1 and ACE2.

Animals ; Disease Models, Animal ; Gene Expression ; drug effects ; Heart ; drug effects ; Humans ; Hypertension ; drug therapy ; genetics ; metabolism ; Isoflavones ; administration & dosage ; Kidney ; drug effects ; metabolism ; Male ; Myocardium ; metabolism ; Peptidyl-Dipeptidase A ; genetics ; metabolism ; RNA, Messenger ; genetics ; metabolism ; Random Allocation ; Rats ; Rats, Inbred Dahl ; Receptor, Angiotensin, Type 1 ; genetics ; metabolism