Sepsis is systemic inflammatory response syndrome associated with infection.Early recognition of severe sepsis or septic shock,early hemodynamic resuscitation and the immediate initiation of effective intravenous anti-infective therapy are the cornerstones in the management of patients with sepsis.The infectious microorganisms associated with sepsis in pediatric patients vary with the patient's age and immune status.Initial empirical antimicrobial therapy should include one or more drugs that have activity against all likely pathogens and that penetrate in adequate concentrations into the presumed source of sepsis.Empirically therapy should be de-escalated to the most appropriate single therapy as soon as the susceptibility agent is known.

Neonatal respiratory distress syndrome (RDS) is most common in premature infants,the smaller the gestational age,the higher the incidence.Continuous positive airway pressure (CPAP) started in the delivery room has been shown in multicentre randomized controlled trials to reduce the need for mechanical ventilation (MV) and surfactant.The European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants-2013 Update recommended that CPAP should be started from birth in all babies at risk of RDS and a starting pressure of at least 6 cmH2O(1 cmH2O =0.098 kPa)should be applied.CPAP with early rescue surfactant should be considered the optimal management for babies with RDS.Using CPAP immediately after birth with subsequent selective surfactant administration may be considered as an alternative to routine intubation with prophylactic or early surfactant administration in preterm infants.If endotracheal intubation is needed,early administration of surfactant is preferable.Nasal intermittent positive pressure ventilation may reduce the risk of extubation failure in babies failing on CPAP.Several strategies have been employed specifically to improve the success of noninvasive ventilation and shorten the duration of MV.Caffeine should be used to facilitate weaning from MV and to reduce bronchopulmonary dysplasia.A short tapering course of low-or very low-dose dexamethasone should be considered to facilitate extubation in babies who remain on MV after 1 ～ 2 weeks.Very early steroid treatment and treatment with high doses cannot be recommended.

OBJECTIVE: To detect the expressions of p-Stat3 and c-myc in human laryngeal squamous cell carcinoma (LSCC) tissue and Hep2 cell line, and to find the relationship between them. METHOD: Immunohistochemistry was used to detect the expressions of p-Stat3 and c-myc in 60 cases of LSCC and 30 cases of vocal cord polyp tissue. The protein levels of p-Stat3 and c-myc in Hep2 cell line was determined by immunocytochemistry. Western blotting was used to determine the protein levels of p-Stat3 and c-myc in Hep2 after treating with different concentrations of Stattic. RESULT: The positive rates of p-Stat3 and c-myc were 65% and 70% in the LSCC tissue, compared with that in the vocal cord polyp tissue, with significant difference (P < 0.05). The expression of p-Stat3 in LSCC tissue was associated with that of c-myc (r = 0.273, P < 0.05). The protein levels of p-Stat3 and c-myc were detected in the Hep2 cell line. Stattic inhibited Stat3 phosphorylation and c-myc in the Hep2 cell line in a concentration-dependent manner. CONCLUSION p-Stat and c-myc were up regulated in the tissue of laryngeal squamous cell carcinoma and the Hep2 cell line. Stattic inhibits the constitutively active p-Stat3 signaling pathway, and downregulats the expression of c-myc. The strong constitutive p-Stat3 signaling pathway in LSCC makes p-Stat3 a target for the development of novel therapeutic strategies.
Carcinoma, Squamous Cell ; metabolism ; pathology ; Cell Line, Tumor ; Head and Neck Neoplasms ; metabolism ; pathology ; Humans ; Immunohistochemistry ; Laryngeal Neoplasms ; metabolism ; pathology ; Phosphorylation ; Proto-Oncogene Proteins c-myc ; metabolism ; STAT3 Transcription Factor ; metabolism ; Signal Transduction ; Squamous Cell Carcinoma of Head and Neck

Objective To evaluate the validity of Community Extremity Disability Assessment Schedule (CEDA) in community rehabilitation. Methods 313 patients with hemiplegia after stroke were divided into rehabilitation group and control group. The rehabilitation group received community-based rehabilitation (CBR) for 3 months, and was assessed with Community Extremity Disability Assessment Schedule before and 1 month, 2 months and 3 months after rehabilitation respectively. And it was compared with Fugl-Meyer Assessment (FMA). The control group received the same evaluation only. Results The scores of CEDA and FMA improved more in the rehabilitation group than in the control group 2 months after rehabilitation (P<0.01). The score of CEDA positively correlated with the FMA (r=0.643, P<0.01). Conclusion CEDA can be used to evaluate the efficacy of community rehabilitation.

Objective To investigate the value of measurement of cardiac output in children by bio-reactance versus echocardiography.Methods Pediatric patients admitted in pediatric department of Peking University First Hospital from September to December 2012 who needed hemodynamic monitoring were enrolled prospectively.Cardiac index(CI)and stroke volume(SV)were measured by echocardiography and non-invasive cardiac output measurement(NICOM)and compared by Spearman correlation and Bland-Alt-man analysis.Results Thirty patients were included.The median age was 7.25 years.CI[M(P5 ,P95 )] measured by NICOM and echocardiography were correlated significantly[3.42(2.28,4.92)L /(min?m2 ) vs.3.51 (2.94,4.85 )L/(min?m2 ),R =0.385,P =0.035 ].Bland-Altman analysis revealed a bias of-0.22 L/(min?m2 )(P =0.051 ),limits of agreement of -1.40 to 0.95 L/(min?m2 ).SV[M(P5 ,P95 )] measured by NICOM and echocardiography were correlated more significantly [36.3 (12.6,87.8 )ml vs.39.4(14.7,86.9)ml,R =0.768,P ﹤0.001 ].Bland-Altman analysis revealed a bias of -3.1 ml(P =0.176),limits of agreement of -27.4 to 21.2 ml.Conclusion There is no significant difference between NICOM and echocardiography for the measurement of CI and SV in pediatric patients.Further validation studies need to be conducted before routine clinical use.

Objective: To evaluate the effects of functional appliance and multi-bracket appliance on Angle Class II malocclusions coupled with vertical and transversal problems. Methods:Headgear-activator, Herbst appliance and multi-bracket appliance were used to treat 20 patients with Class II malocclusions coupled with vertical and transversal problems aged from 10 to 15 years. The lateral cephalograms were measured with Winceph 8. 0 software and statistical analysis was carried by SPSS 13. 0 software. Results:The sagi-tal, vertical, transversal problems had mainly been resolved at the end of functional appliance treatment. The SNB were increased( P<0. 05), ANB were decreased(P<0. 05), upper posterior teeth were intruded and distally moved(P<0. 05), lower posterior teeth were extruded and mesialy moved(P<0. 05). After multi-bracket appliance treatment, the anterior teeth achieved normal overbite and over-jet. The molar relationship changed from class II to class I. Mandibular plane angle was not clockwise rotated(P>0. 05). The upper and lower dentition were harmony in sagital, vertical and transversal. Conclusion: Functional appliance combined with multi-bracket appliance can be used effectively and conveniently for the treatment of Class II malocclusions coupled with vertical and transversal prob-lems.

OBJECTIVETo evaluate preliminarily the efficacy on functional constipation treated with electroacupuncture of different acupoint prescriptions.

METHODSOne hundred and four patients were randomized into a front-mu and back-shu points group (19 cases), a he-sea points group (34 cases), a he-sea, front-mu and back-shu points group (26 cases) and a western medication control group (25 cases). In the front-mu and back-shu points group, electroacupuncture was applied at bilateral Tianshu (ST 25) and Dachangshu (BL 25). In the he-sea points group, electroacupuncture was applied at bilateral Quchi (LI 11) and Shangjuxu (ST 37). In the he-sea, front-mu and back-shu points group, electroacupuncture was applied at unilateral Tianshu (ST 25), Dachangshu (BL 25), Quchi (LI 11) and Shangjuxu (ST 37). In the three groups above, the treatment was given 5 times a week in the first two weeks and 3 times a week in the next two weeks. In the western medication control group, mosapride citrate tablets were prescribed for oral administration, 1 table (5 mg) each time, 3 times a day, continuously for 4 weeks. The period of research was 9 weeks, including 1 week for baseline evaluation, 4 weeks for treatment and 4 weeks for follow-up. The weekly defecation frequency was taken as primary index, while the defecation difficulty and life quality score were taken as the secondary indices for the efficacy evaluation after treatment and in follow-up.

RESULTSAccording to the intention-to-treat (ITT) analytic principle, 104 cases were all enrolled in the final analysis. (1) After treatment, the weekly frequency of defecation was all increased significantly in the four groups (P < 0.05, P < 0.01). The efficacy of the three electroacupuncture groups was similar to that of western medication control group (P > 0.05). In follow-up, the increasing effect on the weekly frequency of defecation was maintained in the he-sea points group (P < 0.01), superior to the front-mu and back-shu points group and the western medication control group (P < 0.05, P < 0.01); the weekly frequency of defecation was not improved in the rest three groups (P > 0.05). (2) After treatment, defecation difficulty was relieved in the he-sea points group, the he-sea, front-mu and back-shu points group and the western medication control group (P < 0.05, P < 0.01). In follow-up, the improvements were still significant in the he-sea points group and the he-sea, front-mu and back-shu points group (both P < 0.01). (3) After treatment, the life quality score was significantly improved in the patients of the he-sea points group (P < 0.05). The difference was not significant in the rest three groups as compared with that before treatment (all P > 0.05).

CONCLUSIONThe weekly frequency of defecation is increased effectively after treatment in the three electroacupuncture groups and the efficacy is similar to mosapride citrate tablets. The bilateral Quchi (LI 11) and Shangjuxu (ST 37) in he-sea acupoints increase significantly the weekly frequency of defecation, relieve defecation difficulty and improve life quality. Acupuncture efficacy is sustained for 4 weeks. This acupoints prescription is the best in the treatment of functional constipation.

Acupuncture Points ; Adult ; Aged ; Constipation ; physiopathology ; therapy ; Defecation ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Objective To study the clinical presentations,radiologic features,prognosis,and possible causes of liver injury associated umbilical venous catheter (UVC ).Methods We reviewed database of our NICU from December 2012 to November 2015 and identified preterm infants with liver injury while UVC in place.The gestational age,birth weight,gender,days of UVC in place prior to liver injury, the depth of UVC (cm),UVC tip position,ultrasound findings of liver injury,laboratory tests,treatment and outcomes were collected.Results During study period,322 infants received UVC insertion.Ten cases (3.1 %)of liver injury associated with UVC were diagnosed.Of the ten infants,nine were diagnosed as extravasation of fluid to liver parenchyma,and one was diagnosed as liver hematoma.The mean birth weight was (1184 ±207)g,mean gestational age was (28.5 ±1.7)weeks.The UVC tip was at thoracic (T) vertebrae T 9 to T 11 level,nine UVC tips were below the right diaphragm level.All UVCs were used for total parenteral nutrition before liver injury was diagnosed.Six infants had clinical manifestations,and four infants were free of clinical manifestations.The most prominent clinical signs were abdominal distension (n =5),weak bowel sounds (n =5)and hepatomegaly (n =4).One infant who was diagnosed with liver hematoma also had progressive hemoglobin decline (minimum 34 g/L)and shock.Abdominal ultrasound showed well-limited,irregular,hyperechoic rimmed lesions with heterogeneously hypoechoic centers or anechoic liquid dark space.Extravasation of fluid to liver parenchyma will restorate within one week after the UVC was remove.One baby who was diagnosed as liver hematoma passed away at 9 days of life.Liver ultrasound of eight returned to normal in 52 days to 3.5 months,and one had calcified lesions at 9 months of age.Conclusions Liver injury is an unusual complication of UVC insertion and usage.Proper positioning of the UVC tip may help to avoid this complication.Early recognition,prompt diagnosis with liver ultrasound examination and timely treatment can lead to better outcome in newborns with extravasation of fluid to liver parenchyma.

The pathophysiology of neonatal necrotizing enterocolitis (NEC) is not clear, but is considered to be multifactorial.Immaturity of the gut, hypoxia-ischemia, formula feeding and microbial dysbiosis play roles in inducing intestinal inflammatory response.This review discussed the development process of infant gut microbiota, the factors affecting neonatal intestinal colonization, the roles of gut microbiome in the pathogenesis of NEC, and the manifestations of early microecology disorder in NEC.In addition, studies on the use of probiotics to prevent NEC and the risks of using probiotics in preterm infants were also summarized.

ObjectiveTo explore the effectiveness and practicability of training technique in hemiplegia.Methods313 stroke patients with hemiplegia were divided randomly into the control group and training group, and treated with integrative training technique for hemiplegia impairment during 3 months. Locomotor recovery and the performance of activities of daily living (ADL) of patients in two groups were assessed before and after one, two and three months training respectively, using Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM) and the scale of impairment in community rehabilitation.ResultsAfter treatment, FMA, FIM and the scale of impairment in community rehabilitation of the patients in the training group improved significantly ( P<0.001), the effectiveness was better than that of the control group ( P<0.05～0.001).The scales of FMA and FIM were proportional to the scale of impairment in community rehabilitation.ConclusionThe training technique for hemiplegia has ideal rehabilitation effectiveness.