ObjectiveTo study the differences in expression profiles of peripheral blood specific serum micro RNA(miRNA) in the comparison between those before and after Baihu Renshen decoction combined with Fufang Xiebai capsules for treatment of patients with severe pneumonia.Methods 136 patients with severe pulmonary infection accompanied by heat-phlegmand sthenic-fu syndrome admitted in the Department of Respiratory Medicine of Kunshan First People's Hospital Affiliated to Jiangsu University from January 2012 to December 2013 were enrolled in the study. They were treated with basic treatment and Baihu Renshen decoction〔gypsum 30 g(broken, wrapped in cotton cloth, firstly put in water to be boiled), American ginseng 4 g, fritillaria 10 g, bupleurum chinense 10 g, skullcap 10 g, fried gardenia(pittosporm root) 10 g, forsythia 12 g, honeysuckle 10 g, spiderwort grass(dayflower) 15 g, prepared licorice root 4 g〕 combined with Fufang Xiebai capsules〔mainly composed of longstamen onion bulb(macrostem onion)12 g, melon wilt(fructus trichosanthis) 12 g, pinellia 10 g, coptis chinensis 3 g〕. The changes of serum miRNA expression profiles before and after treatment were analyzed by Solexa sequencing. The peripheral blood serum specific miRNAs were confirmed by real-time fluorescent quantitation-polymerase chain reaction(qRT-PCR). Before and after treatment, the receiver operating characteristic curve(ROC curve) of patients with severe pulmonary infection was drawn, and the ROC curve was used to analyze the sensitivity and specificity of serum miRNA to the efficacy of the combination therapy and evaluate its clinical value.Results Solexa sequencing suggested that 42 kinds of miRNA appear to have over 2-fold in difference in the comparison between profiles before and after Baihu Renshen decoction combined with Fufang Xiebai capsules treatment. Real-time qRT-PCR confirmed miR-146a, miR-125b and miR-155 expressions were significantly decreased over 10 fold, suggesting that they should be specific miRNAs. The area under the ROC curve(AUC) of miR-146a was 0.81,95% confidence interval(95%CI)=0.73 - 0.89,miR-125b AUC=0.77,95%CI=0.71 - 0.83 and miR-155 AUC=0.89, 95%CI=0.83 - 0.95. Then, through selected clinical truncated(cut off)value,the sensitivity and specificity of three kinds of serum miRNA were calculated: 63% and 87% of miR-146a, 53% and 73% of miR-125b and 56% and 83% of miR-155.ConclusionAddition of Baihu Renshen decoction combined with Fufang Xiebai capsules on the basic treatment can induce significant changes of peripheral blood serum miRNA expression profiles in patients with severe pneumonia, and miR-146a, miR-125b and miR-155 among miRNAs could be their specific changes.

Objective To study the effects of Baihu Rensen decoction combined with Fufang Xiebai capsules for treatment of patients with severe pneumonia accompanied by heat-phlegm and sthenic-fu syndrome.Methods A prospective study was conducted; 266 severe pneumonia cases with heat-phlegm and sthenic-fu syndrome admitted into the Department of Respiratory Diseases in Kunshan Hospital Affiliated to Jiangsu University from January 2012 to December 2013 were selected. The patients were randomly divided into a integrated traditional Chinese and western medicine group (136 cases) and a western medicine treatment group (130 cases). Both groups were given basic conventional western medicine according to the disease situation. The integrated traditional Chinese medicine (TCM) was additionally given Baihu Rensen decoction combined with 350 mg of Fufang Xiebai capsules, 3 times a day, 4 grain each time, 7 days constituting a course of treatment. The rate of body temperature descent, the degree of improvement in clinical TCM symptoms, peripheral white blood cell (WBC) count, neutrophil percentage and the situation of endogenous pyrogen production in the two groups were compared.Results After treatment, the body temperature, TCM symptom scores, WBC count and neutrophil percentage were lower than those before treatment, 3 days after treatment these data reached their valley values, and the decrease in level was more significant in the combination group [body temperature (℃): 36.5±0.0 vs. 37.0±0.0, TCM symptom scores: 1.7±0.2 vs. 6.1±0.7, WBC (×109/L): 7.1±0.3 vs. 8.3±0.5, neutrophil percentage: 0.64±0.02 vs. 0.76±0.23, allP < 0.05]. Interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), interferon (IFN-α, IFN-γ), and interleukin-6 (IL-6) level in western medicine (WM) group was respectively marked 1, the levels of IL-1β, TNF-α, IFN-α, IFN-γ, and IL-6 in combination group after treatment for 6 hours were significantly lower than those of WM group, and reached the valley at 12 hours (the relative expression value of each of the above indexes in combination group to each of those in WM group was 0.37, 0.16, 0.21, 0.27 and 0.15 respectively), and had a mild rebound at 24 hours.Conclusion By the addition of Baihu Rensen decoction combined with Fufang Xiebai capsules on conventional basic medicine for treatment of severe pneumonia patients with heat-phlegm and sthenic-fu syndrome, the therapeutic effect is much better.

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 report the results of neurocutaneous axial island flaps in the forearm in clinical application.Methods:12 patients with soft tissue defects around the elbow and the wrist were treated with proximally or distally based island flaps based on the lateral and medial forearm cutaneous nerves.The flaps measured 9cm?8cm to 4cm?3cm.Results:The flaps totally survived in 11 pa- tients,the other was patially survived.The color and texture of the flaps were good.Their appearance and function were satisfactory after 12～18 months follow—up.Conclusions:On the basis of the vascu- larization of the lateral and medial cutaneous nerves of the forearm,some reliable island flaps were raised successfully.These flaps are easy to dissection and have a large arc of rotaion.They were satisfac- tory in repairing the soft tissue defects around the elbow,the distalone of third of the forearm and the wrist.

OBJECTIVETo investigate the changes in serum amylase (AMY) and lipase (LPS) and their clinical significance in patients with acute paraquat poisoning (APP).

METHODSThe clinical data of 62 APP. patients who were admitted to Guangzhou 12th People's Hospital in 2014 were retrospectively analyzed. With clinical death being regarded as the end point of observation, the 62 patients were divided into survival group (n=32) and death group (n=30). The fasting venous blood of the patients on the 1st, 3rd, and 7th day after admission were collected, and the AMY and LPS levels were determined; the obtained data were compared between the two groups and analyzed statistically.

RESULTSThe AMY and LPS levels of the survival group on the 1st, 3rd, and 7th day after admission were significantly lower than those of the death group (P<0.05); the AMY and LPS levels of the death group on the 3rd day were significantly higher than those on the 1st day after admission (P<0.05); the survival group demonstrated no significant changes in AMY and LPS levels (P>0.05).

CONCLUSIONChanges in AMY and LPS levels in APP patients are reliable indicators for the determination of poisoning severity and prognosis.

Amylases ; blood ; Humans ; Lipase ; blood ; Paraquat ; poisoning ; Poisoning ; blood ; mortality ; Prognosis ; Retrospective Studies

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 analyze the clinical features and prognosis of hyperglycemia and the relationship between the blood glucose level and the severity of disease in critically ill children.Methods A total of 349 critically ill children admitted in Pediatric Intensive Care Unit (PICU) from November 2009 to April 2010 were restrospectively analyzed.According to the levels of venous blood glucose within 24 h after admission,they were divided into very high level group (blood glucose ≥11.1 mmol/L,n =67 ),slightly high level group (blood glucose 6.3-11.1 mmol/L,n =134) and normal level group (blood glucose ≤6.3mmol/L,n =148).Blood glucose levels were measured within 24 hours,3 days and 7 days after admission.Electrolytes,inflammatory markers,cardiac enzymes,liver and kidney function as well as other biomarkers related to the severity and the prognosis of the patients were recorded after admission.The categorical variables were analyzed with Chi -squared test,the continuous variables were analyzed with t-test,F-test,U-test andH-test,and the correlation analysis was calculated by using Pearson Coefficients. Results In the very high level group,slightly high level group and normal level group,the average blood glucose levels were 16.98 ±7.08 mmol/L,8.25 ± 1.40 mmol/L and 4.89 ± 0.98 mmol/L ( P ＜ 0.01 ),respectively;and the Pediatric Critical Ⅲ Scores at admission were 81.22 ± 8.25,86.71 ± 6.40 and 86.15 ± 6.99 ( P ＜0.01 ),respectively,and the incidences of sepsis or septic shock were 55.23％,30.59％ and 14.18％,respectively (P ＜0.01 ),and the incidences of MODS were 46.26％,22.39％ and 16.23％,respectively (P ＜0.01 ).The blood glucose levels of patients with one organ failure and two organ failure were 8.27 ± 3.75 mmol/L and 8.88 ± 5.42 mmol/L,respectively ( P ＜ 0.05 ).The blood glucose levels of patients with two organ failure and multiple organ failure were 8.88 ± 5.42 mmol/L and 13.09 ± 8.23 mmol/L,respectively (P＜0.01).The mortality rates of three groups were 47.76％,14.93％ and 10.13％ (P ＜0.01 ),and the blood glucose levels at admission in survival group and death group were 7.57 ±4.11 mmol/L and 12.46 ± 8.17 mmol/L ( P ＜ 0.01 ).Conclusions Patients with hyperglycemia are often found in the PICU.It not only partially reflects the severity of the disease,but also serves as an important indicator for the prognosis.The blood glucose level is positively correlated to the number of compromised organs and the severity of the disease.Dynamic monitoring of blood glucose may be essential for controlling the symptoms and prediction of prognosis.

Objective To study the value of Procalcitonin (PCT) in predicting the severity of the critically ill children by analyzing the clinical data of increased PCT level.Methods A total of 392 patients with increased PCT admitted to the PICU of Hunan Children's Hospital from August 2011 to April 2012 were enrolled.The data of clinical manifestations,medical condition,sputum culture,organ function and prognosis were summarized and analyzed statistically.The continuous variables were analyzed with t-test,the categorical variables were analyzed with Chi-squared test,and the correlation analysis was calculated using Pearson coefficients.Results Serum PCT had a positive correlation with inflammatory markers such as C-reactive protein (CRP),white blood cell (WBC) count and the percentage of neutrophils (NEU％) (P ＜ 0.01).PCT was significantly higher when sputum culture was positive (P ＜0.05) but there were no obvious changes in CRP,WBC and NEUT％ (P ＞ 0.05).Serum PCT increased obviously in the presence of organ dysfunction.The higher serum PCT,the more likely multiple organ failure would happen.The PCT level upon admission in death group (63 cases) was (62.43 ± 70.19) ng/ml,which was higher than that in survival group (P ＜ 0.01).Conclusions PCT level is helpful in assessment of severity and prognosis of bacterial infection in critically ill children,and can reflect the organ dysfunction objectively.It can improve the survival rate and the life quality in critically ill children.

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.

Objective To retrospectively analyze the therapeutic results of patients with initially di-agnosed metastatic nasopharyngeal carcinoma (NPC). Methods From January 1995 to December 1998, 46 NPC patients with distant metastases were treated in Fujian provincial cancer hospital. Among these pa-tients, 43 were single site metastasis and 3 were multiple sites metastases;The site of metastasis were 19 pa-tients in the liver, 11 in the bone, 7 in the lung, 1 in the brain, 6 in mediastinal nodes and 6 in axillary lymph nodes. All patients received standard radiotherapy to the primary site and cervical node region with a median dose of 72 Gy. Forty-one patients (89%) received 1-5 cycles chemotherapy (cisplatin and 5-flu-orouracil), and 23 (50%) received palliative irradiation to the metastatic site. Results The median surviv-al time was 20 months. The 1-, 2-, 3-year and 5-year overall survival rates were 66%, 47%, 30% and 19%, respectively. Irradiation to the metastatic sites and KPS were the significant prognostic factors. Pa-tients with palliative irradiation to the metastatic site had longer survival than those without (39 months vs. 13 months, X2=8.63, P=0.012). Patients with good performance status (KPS≥80) had better outcomes thanthose with poor performance status (26 months vs. 12 months, X2= 3.95, P=0.035) . Conclusions Active therapy may prolong the survival of patients with initially diagnosed metastatic NPC, especially for those who have good performance status. Under systematic chemotherapy, radiotherapy to the primary site and supportive care, the palliative irradiation to the metastatic site may also yield a good result.