Sepsis is a common desease with a high mortality in pediatric intensive care unit. The patho-genesis of sepsis remains unclear. Recent studies have found that extracellular histones play an important role in the incidence of sepsis. This review provides new ideas for the diagnosis and treatment of sepsis.

Adult ; Breast Neoplasms ; metabolism ; pathology ; secondary ; Carcinoid Tumor ; metabolism ; pathology ; surgery ; Carcinoma, Adenoid Cystic ; pathology ; Carcinoma, Lobular ; metabolism ; pathology ; secondary ; Cervical Intraepithelial Neoplasia ; metabolism ; pathology ; surgery ; Chromogranin A ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Hysterectomy ; Keratins ; metabolism ; Neoplasms, Multiple Primary ; metabolism ; pathology ; surgery ; Ovarian Neoplasms ; metabolism ; pathology ; Sex Cord-Gonadal Stromal Tumors ; metabolism ; pathology ; Synaptophysin ; metabolism ; Uterine Cervical Neoplasms ; metabolism ; pathology ; surgery

Objective To review multi-center experience on rescue use of extracorporeal membrane oxygenation(ECMO) in pediatric patients with acute fulminant myocarditis and to investigate its short-term outcome in China.Methods The survey was conducted in 28 tertiary hospitals in China mainland.All children<18 years who had been supported with non-open chest ECMO to rescue acute fulminant myocarditis in PICU were reviewed.Results Twenty-three of 63 patients with ECMO support were diagnosed acute fulminant myocarditis.Their mean age was(86.3±48.8)months,mean weight was(25.8±12.1)kg,and mean left ventricular ejection fraction was(39.5±15.6)%.Eighteen patients(78.3%) survived to discharge and 5 cases(21.7%) died.The average length of ECMO was(119.1±57.3)h,(110.6±42.7)h for survival,(150.0±93.8)h for nonsurvival.There was no statistically difference between survival and death in ECMO support time(P=0.41).The mean arterial pressure increased from(60.7±23.7)mmHg(1mmHg=0.113kPa) of the beginning to(72.1±9.8)mmHg at 24h after ECMO treatment,and increase of mean arterial pressure was higher in the survival compared with the nonsurvival(P=0.04).The mean serum lactate decreased from(6.8±5.1)mmol/L at ECMO initiation to(2.9±2.6)mmol/L at 24h after ECMO treatment,and decrease of serum lactate was higher in survival group compared to nonsurvival group(P<0.001).Twenty-one patients(91.3%) were decanulated from ECMO successfully.Three patients died within 30 days after ECMO support,and eighteen patients survived to hospital discharge.The overall survival rate was 78.3%.There were no significant difference between the death and the survival in ECMO support time(P=0.41) and medical cost(P=0.24).The most common complications during ECMO were bleeding and disfunction of oxygenator.Of the 18 survivors,15 were followed up,4 experienced obvious sequelae,and 2 had neurologic issues.Conclusion ECMO is an effective hemodynamic support treatment that confers better clinical outcome for pediatric patients with acute fulminant myocarditis.

Objective To evaluate the significance of high-frequency oscillatory ventilation(HFOV) used in acute hypoxic respiratory failure(AHRF) children,failing to conventional ventilation.Methods This was a retrospective study of AHRF children ventilated by HFOV from January 2011 to September,2013.All patients were initially treated by conventional mechanical ventilation (CMV),and changed to be treated by HFOV if the patient met to one of the following criteria after the CMV parameters of PIP ＞ 30 mmH2O(1cmH2O =0.098 kPa) or PEEP ＞ 10 cmH2O with FiO2 100％ ∶ (1) SpO2 ＜ 90％ or PaO2 ＜ 60 mmHg (1 mmHg =0.133 kPa) ; (2) severe respiratory acidosis (PaCO2 ＞ 80 mmHg) ; (3) serious air leakage (mediastinal emphysema or pneumothorax).The following parameters were recorded:patient's gender,age,living PICU time,CMV ventilation time,HFOV ventilation time.We reviewed ventilation parameter settings (MAP,△P,F,FiO2),oxygenation index(PaO2/FiO2,OI),arterial blood gas,heart rate,blood pressure at different time points including late CMV(H0),2 h after HFOV(H2),6 h after HFOV(H6),12 h after HFOV(H12),24 h after HFOV (H24) and 48 h after HFOV (H48),respectively.Various indexes at different time points were compared between survival group and death group,oncology group and no-oncology group.Results PaO2 at H2 compared with H0 had significant improvement[76.9(61.9 ～ 128.0) mmHg vs 50.1 (49.5 ～68.0) mmHg,P =0.006] . PaO2/FiO2 at H2,H48 had significant improvement compared with those at H0,H24 [94.9(66.8 ～ 138.9) mmHg vs 68.0(49.5 ～86.8) mmHg,P=0.039; 135.0(77.6～240.0) mmHg vs 90.7 (54.6 ～161.7) mmHg,P =0.023)].All children's systolic pressure,diastolic blood pressure,heart rate at various time points had no difference (P ＞0.05).Compared to death group(n =14),PaO2/FiO2,OI at H6,H12,H24,H48 in survival group (n =9) had significant improvement(P ＜ 0.05).Compared to oncology group (n =10),OI at H2,H6 in no-oncology group(n =10) had significant improvement [(19.2 (13.9 ～ 26.6) vs 33.8 (19.7 ～ 48.3),P =0.049 ; 16.0(8.4 ～27.1) vs 28.9(20.9 ～38.9),P =0.027)],and mean airway pressure between two groups at H2,H6,H12 had significant improvement(P ＜ 0.05).Mortality had no significant differcence between two groups (4/10 vs 10/13,P =0.086).Conelusion HFOV used in children with AHRF which had failed with CMV ventilation can improve the patient's PaO2 and OI.Heart rate and blood pressure are stable during HFOV treatment.Oncology group patients needed higher initial MAP to improve oxygenation than no-oncology group patients when changed to HFOV treatment,but the mortality showed no difference between two groups.

[Summary] The aim of this study was to examine the association between obstructive sleep apnea-hypopnea syndrome ( OSAHS ) and microalbuminuria in type 2 diabetes mellitus patients. We found that severe OSAHS significantly increases the risk of early renal damage in type 2 diabetes mellitus patients with HbA1C<7% ( lowest oxygen saturation:OR=2. 41, 95% CI 1. 19-8. 08; apnea hyponea index: OR=2. 91, 95% CI 1. 50-9. 11), suggesting that OSAHS may increase the risk for early renal damage in type 2 diabetes mellitus, especially in those with successful control of glucose.

Objective To investigate the predictive value of fluid overload for mortality in children with severe sepsis.Methods In this retrospective study,the children with severe sepsis who were admitted to the Pediatric Intensive Care Unit (PICU),Children's Hospital of Soochow University between January 2011 and March 2015.Fluid accumulation was calculated in the first 72 hours after admission.Pediatric index of mortality Ⅱ (PIM2) score was calculated during the first 1 hour after admission.Multivariate Logistic regression analysis assessed the relationship between fluid overload and mortality after adjustment for confounding factors.The predictive value of fluid overload for mortality was assessed by the receiver operating characteristic curve and au area under the receiver-operating-characteristic curve (AUC).Results Of the 199 children admitted,62 cases (31.2％) died during PICU stay.Among the children,133 cases (66.8％) had fluid overload of＜5％,55 cases (27.6％)had fluid overload of≥5％-10％,and 11 cases (5.6％) had fluid overload of≥ 10％.Multivariate regression analysis showed that a high fluid overload percent (OR =1.263,95 ％ CI:1.113-1.434,P ＜ 0.001),a high PIM2 score (OR =1.028,95 ％ CI:1.012-1.043,P ＜ 0.001) and multiple organ dysfunction syndrome(OR =4.160,95％ CI:1.728-10.012,P =0.001) were independent risk factors for mortality in children with severe sepsis.The fluid overload was significantly associated with mortality (OR =1.309,95％ CI:1.158-1.480,P ＜0.001),even after adjustment for age and illness severity assessed by PIM2 scores.Fluid overload achieved AUC of 0.741 (95％ CI:0.661-0.820,P ＜ 0.001) for predicting mortality in children with severe sepsis.Conclusion Fluid overload developed during the first 72 hours after admission is independently associated with and predictive of PICU mortality in children with severe sepsis.

Objective To analyze the resistance genes in a muhidrug resistant Klebsiella pneumoniae (MDRKP) strain.Methods A MDRKP strain was isolated from bronchoalveolar lavage fluid in Pediatric Intensive Care Unit of Children's Hospital Affiliated to Soochow University in February 2012.Acquired resistance genes to beta-lactams,aminoglycosides,quinolones,ompK35 and ompK36 gene for outer membrane porin protein,and carbapenems targeting PBP2 gene were analyzed by PCR and verified by DNA sequencing.Results Acquired resistance genes TEM-1,SHV-1 to beta-lactam antimicrobial agents and aac(6′)-I b to aminoglycoside antimicrobial agents were positive in the strain of MDRKP.While 16S rRNA methylase,ompK35 and ompK36 genes for outer membrane porin protein were negative.Compared with susceptible strains,there were 9 synonymous mutations in PBP2 gene sequence of this MDRKP strain,but the amino acid sequences were the same.No mutation in quinolone resistance determining region (QRDR) was observed.Conclusion The multidrug resistance of the isolated Klebsiella pneumoniae strain may be related to 2 kinds of beta-lactam acquired resistance genes,1 kind of aminoglycoside acquired resistance gene,ompK35 and ompK36 genes defects and synonymous mutation in PBP2 gene.

Objective To investigate the changes of thyroid hormone in peritoneal dialysis patients and analyse its impact factors, as well as the therapeutic effects of small dose of thyroxine.Methods 150 uremic patients in Hunan Provincial People’s Hospital from December 2013 to December 2014 were selected, 70 cases of uremia non-dialysis patients were divided into group A, while 80 uremia peritoneal dialysis for more than half a year were divided into group B.70 cases healthy examinees during the same period in our hospital were selected as control group ( group C ) . The total triiodothyronine (T3), total thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), hemoglobin (Hb), serum albumin (ALB), total cholesterol (TC), triglyceride (TG), serum creatinine (SCr), C reactive protein (CRP) and left ventricular ejection fraction ( LVEF) , subjective global assessment of nutritional act ( SGA) and other indicators were detected in three groups.Patients in group B were divided into two sub-groups according to thyroid hormone levels: B1 group had normal thyroid level while B2 abnormal.And the administration of small dose of thyroid hormone was given to patients in group B2, and the effect of the administration was evaluated by the above indexes.Results The FT3 in group A and B were significantly lower than that in group C (P<0.01).There were significant differences of levels of ALB, CRP, SGA between group B1 and group B2, and the FT3 level in group B was significant correlated with SGA, ALB, LVEF(r=0.815,P<0.001;r=0.780,P<0.001;r=0.953,P<0.001).After treated with small dose of thyroid hormone, FT3 and LVEF were improved while FT4, TSH, ALB, SGA, CRP were not improved in group B2.Conclusion The thyroid hormone level in patients with continuous ambulatory peritoneal dialysis decreases which is dominated with FT3.The decreased thyroid level is significantly correlated with nutrition ( ALB, SGA) and left ventricular function.The administration of small dose of thyroid hormone can improve the left ventricular systolic function.

Cancer, also known as malignant tumor, is the second largest disease after heart disease, which is characterized by genomic instability and mutagenicity. Ataxia telangiectasia and RAD3-related kinase (ATR) are members of phosphatidylinositol 3-kinase (PIKK) family, belonging to serine/threonine kinase, one of the key kinases in DNA damage response (DDR) and DNA repair pathway. This paper reviews the latest progress in the ATR inhibitor field including mechanism of action (MOA), therapeutic applications, and the combination therapy from the perspective of medicinal chemistry. It also discusses the possible challenges and future directions of developing ATR inhibitor antitumor drugs, which could provide the scientists in this field the convenience for access the information and application guidance for clinical studies.

Literatures on pain intervention with transcutaneous electrical acupoint stimulation (TEAS) were collected by searching the databases both in Chinese and English, and summarized to understand the research progress of TEAS effects on pain mediators in recent years. This will provide a more objective and scientific theoretical basis for clinical practice of TEAS to treat pain syndrome, thus promoting the clinical application of TEAS. Our literature analysis indicated that TEAS effectively regulated the release levels of various pain factors such as prostaglandin, 5-hydroxytryptamine, interleukins, substance P and tumor necrosis factor-α to achieve the analgesic effects by affecting the conduction pathways. TEAS is a safe, non-invasive and effective treatment for pain syndrome. However, further research is necessary due to the lack of rigor of the current clinical trial design.