Child ; Humans ; Practice Guidelines as Topic ; Sepsis ; therapy ; Shock, Septic ; therapy

Objective To investigate the influences of mutation at precore and basic core promoter(BCP) region in hepatitis B virus(HBV) on the immune response of specific cytotoxic T lymphocytes(CTL) in patients with chronic hepatitis B(CHB).Methods The number of specific CTL in peripheral blood mononuclear(PBMC) of CHB patients were tested by cytokine flow cytome- try(CFC) and HBV core18-27 peptide.HBV precore and BCP fragments were directly sequenced. Results Twenty-one(38.9%) samples were HBV precore G1896A mutation.Twenty-six(48.1%) samples were BCP region 1762/1764 combined mutation.Thirteen(24.1%) stains were three sites mutated simultaneously.Stimulated with HBV core 18-27 in vitro,the specific CTL level was signifi- cantly higher in the patients with G1896A mutation and BCP region mutation [(0.41?0.09)%, (0.36?0.08)%,(0.48?0.08)%,respectively]than those without mutation[(0.11?0.06)%, P

OBJECTIVESepsis, severe sepsis, and septic shock are frequently encountered and highly lethal conditions among children treated in ICU; however, no many reports on research on serum albumin levels of children under these conditions are available in literature and little is known about the relationship between serum albumin level and prognosis. In this prospective study, the author observed the levels of serum albumin of children with sepsis/severe sepsis/septic shock, and explored the relationship between serum albumin level and severity of illness or prognosis.

METHODFor sepsis/severe sepsis/septic shock patients admitted to the pediatric intensive care unit (PICU) during the year 2008, serum albumin concentration in peripheral blood was examined within 24 h after admission. According to the diagnostic criteria, hypoalbuminemia was defined as serum albumin level of < 35 g/L.

RESULTA total of 247 cases of sepsis/severe sepsis/septic shock children were enrolled. In the order of sepsis/severe sepsis/septic shock group, there were 143, 65 and 39 cases. Overall rate of hypoalbuminemia was 72.9% (180/247). The rate of hypoalbuminemia in children with sepsis, severe sepsis or septic shock was 59.4% (85/143), 86.2% (56/65) and 100% (39/39), respectively. The mortality of hypoalbuminemic patients in sepsis, severe sepsis and septic shock group showed significant difference (P < 0.001). The rates of hypoalbuminemia of the survived cases (69.5%) was significantly lower than that of the non-survived cases (94.1%). Pediatrics critical illness score (PCIS) and serum albumin concentration was positively correlated (P < 0.001), and the mortality was negatively correlated with serum albumin concentration (P < 0.05).

CONCLUSIONHypoalbuminemia is common among children with sepsis/severe sepsis/septic shock and serum albumin level is closely related to prognosis. Serum albumin level monitoring on the basis of PCIS scoring has important clinical prognostic significance in evaluating the prognosis of severe sepsis/septic shock patients.

Adolescent ; Child ; Child, Preschool ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric ; Prognosis ; Prospective Studies ; Sepsis ; blood ; diagnosis ; Serum Albumin ; metabolism ; Shock, Septic ; blood ; diagnosis

Objective To evaluate the role of early cleavage embryo in combination with embryo growth rate and morphology scoring in embryo selection in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Methods Six hundred and ten IVF/ICSI cycles were randomly assigned to group A(269 cycles) and group B(341 cycles). In group A, transferred embryos were chosen according to embryo growth rate and morphology scoring by 72 h(D3) after fertilization, while early cleavage embryo was added to the selecting system in group B. The pregnancy rate and implantation rate were compared between two groups, and the clinic outcomes were compared between transfers with early cleavage embryos and without early cleavage embryos in group B. Results The pregnancy rate and implantation rate in group B were significantly higher than those in group A (P < 0.05). Transfers with early cleavage embryos also achieved much higher pregnancy rate and implantation rate in group B (P < 0.01). Conclusion Compared with embryo growth rate and morphology scoring, early cleavage embryo in combination with embryo growth rate and morphology scoring can improve the clinical outcomes in IVF/ICSI cycles.

Objective To evaluate the clinical outcome and relative factors of intervention treatment for atherosclerotic renal artery stenosis in elderly patients.Methods The clinical data of 79 patients diagnosed as atherosclerotic renal artery stenosis by angiography and treated by revascularization were analyzed.Results There were 55(69.6%)successes and 24(30.4%)failures in decreasing blood pressure and 28(35.4%)successes and 51(64.6%)failures in improving renal function after intervention treatment.Predictors of favorable outcome of intervention treatment in decreasing blood pressure were related to lower urine protein,higher glomerular filtration rate,higher systolic and diastolic blood pressure before treatment,lower resistance index(RI)of renal artery,and no complication of cerebral vascular diseases.Predictors of favorable outcome of intervention treatment in improving renal function were related with percentage of angiographic stenosis,category of antihypertension and lower urine protein.The logistic regression analysis showed that the percentage of angiographic stenosis was the most important predictor of intervention treatment for blood pressure control,age and level of serum creatinine before intervention treatment were the most important predictors of intervention treatment for improving renal faction.Conclusion Percentage of stenosis(≥85%),age(133 ?mol/L)can be used as the predictors of therapeutic success for renovascular stenosis in older patients.

Objective Blood pressure variability (BPV) is an independent risk factor for the death of patients with maintenance hemodialysis (MHD).There is no study on the influencing factors of BPV at home in HD patients in China.The article aimed to investigate MHD patients'BPV at home and related influencing factors in order to provide theoretical basis for reducing home BPV (HBPV) clinically. Methods We chose 103 patients who were treated with MHD in the Renal Medicine Room of Nephrology Department in three upper first -class hospitals including Jiangsu Provincial People 's Hospital, the First Affiliated Hospital of Suzhou University and the Affiliated Hospi -tal of Jiangsu University from March 2017 to October 2017.We col-lected their 7 days'blood pressure monitoring at home and blood pressure before dialysis, average value and standard deviation in sys -tolic blood pressure monitoring at home, and took the coefficient of variation of systolic blood pressure as the expression of HBPV .The patients were divided into high BPV group (BPV≥5.8％) and low BPV group (BPV<5.8％) according to the average BPV.At the same time, we recorded indexes such as sex , age, dialysis age, primary disease, BMI, inter-dialytic weight gain (IDWG), left ven-tricular mass index(LVMI) and analyzed relative influencing factors by multiple linear regression . Results The age, IDWG and LV-MI were positive independent influencing factors of HBPV (R 2 =0.467,F=10.945,P<0.001).According to standardized regression co-efficient, the contribution of each variable to HBPV was as follows : PIBWG >Age>LVMI. Conclusion In clinical nursing, we should actively control the IDWG of patients , encourage patients to monitor their blood pressure at home , and increase their awareness of the importance of home BPV.Meanwhile, HBPV is an important index for predicting left ventricular hypertrophy and can be used as an objective tool to improve patients 'self-management ability.

Objective To investigate the status of hypnotic agents administation in hospitalized elderly patients, and the relativity between incidents and the hypnotics consuming, in order to reduce the side effects of hypnotics in the clinics. Methods Investigated the outflow status of hypnotics in the clinical pharmacy, and status of the category, volume , consuming time of the old patients, and whether or not they received evaluation of sleeping quality before they taking the hypnotics was also investigated, and the factors affect the result of hypnotics and its negative consequences were educated. Results The mainly used of hypnotics in clinics was benzodiazepines, with various category and quantity, depending on different disease the individuals suffering from. There still existed hidden danger of consuming hypnotics, such as many patients hadn' t not received sleeping quality evaluation before taking them. There were also some factors affected the quality of patients sleep after taking medicines. Conclusions The health education of doctors, nurses and patients should be strengthened. It' s also recommended that early non-medicine intervention and reduction of the circumstance affecting factors would be benefit for the less use of hypnotics therefore reduce its side effects. The evaluation of sleep quality is also essential in the instruction of hypnotics using in clinics.

OBJECTIVETo detect the influence of mannitol on cerebral blood flow of post-resuscitation children by transcranial Doppler (TCD).

METHODSThe blood flow changes of left side middle cerebral artery (MCA) and extracranial internal carotid artery (EICA) were monitored by TCD in 21 post-resuscitation children. TCD waveforms, peak velocity (Vp), diastolic velocity (Vd), mean velocity (Vm) and pulsitility index (PI) of MCA and EICA were monitored daily and 30 minutes before and after the first dose of mannitol. Glasgow scores were estimated in the meantime. The patients were divided into 2 groups according to the patterns of diastolic flow. Patients in group I showed no diastolic flow or retrograde diastolic flow (n = 9), and patients in group II had positive diastolic flow (n = 12).

RESULTSVp, Vd, Vm, PI of MCA and EICA in group I patients had no significant change after the administration of mannitol and the Glasgow scores were much lower than that of group II patients (P < 0.05). TCD waveforms showed no improvement in group I patients and their outcomes were poor. Vd, Vm and Vp of MCA and Vd of EICA in group II patients increased, PI of MCA decreased (P < 0.05), while Vp, Vm, PI of EICA had no significant change. TCD waveforms recovered within one week. All the patients in this group survived.

CONCLUSIONSThe results suggested that mannitol could improve cerebral perfusion in patients with mild brain damage. These patients usually had increased diastolic blood flow in the early stage. Lack of or retrograde diastolic flow of TCD waveforms might be associated with severe brain damage with poor outcome. Mannitol had no effect on improving cerebral blood flow in these patients.

Adolescent ; Blood Flow Velocity ; Cardiopulmonary Resuscitation ; Cerebrovascular Circulation ; drug effects ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Mannitol ; pharmacology ; Middle Cerebral Artery ; physiopathology ; Ultrasonography, Doppler, Transcranial ; methods

A sensitive high performance liquid chromatography-electrospray ionization-mass spectrometry (HPLC-ESI-MS) method was established for the determination of eplerenone (EP) in human plasma. The plasma samples of EP were extracted with ethyl acetate and separated by HPLC on a reversed phase C18 column with a mobile phase of 10 mmol x L(-1) ammonium acetate water solution-methanol (30 : 70, v/v). EP was determined with electrospray ionization-mass spectrometry (ESI-MS) in the selected ion monitoring (SIM) mode. The calibration curves were linear over the range of 2-4 000 ng x mL(-1) for EP. The lower limit of quantification was 2 ng x mL(-1). The method has been successfully applied in the pharmacokinetic study of the EP tablets. The main pharmacokinetic parameters of EP after oral administration of 25 mg, 50 mg, 100 mg were as follows, t1/2: (4.9 +/- 2.1), (4.7 +/- 1.5), (5.9 +/- 1.2) h; AUC(0-infinity): (4 402 +/- 1 735), (8 150 +/- 2 509), (13 783 +/- 4 102) microg x h x L(-1); and MRT: (6.2 +/- 2.1), (6.6 +/- 1.3), and (7.2 +/- 1.6) h. Parameters of EP after oral administration of multiple doses of 50 mg were as follows, t1/2: (6.1 +/- 1.7) h; AUC(ss): (10 071 +/- 4220) microg x h x L(-1); MRT: (8.1 +/- 2.3) h; and DF: (3.2 +/- 1.0).
Chromatography, High Pressure Liquid ; methods ; Humans ; Spectrometry, Mass, Electrospray Ionization ; methods ; Spironolactone ; analogs & derivatives ; blood ; pharmacokinetics

OBJECTIVETo evaluate whether or not intracytoplasmic sperm injection (ICSI) can improve previous fertilization limitation on conventional in vitro fertilization (IVF).

METHODSOne hundred and thirty-six completed cycles in 113 patients with ICSI treatment were grouped. Group 1 was 106 cycles perform ICSI because of male factor, and group 2 was other 30 cycles with the history of fertilization failure and fertilization rate < 20% on conventional IVF, also assembling the cycles in group 2 according to the fertilization rate.

RESULTSThere was no significant difference between two groups in the rates of normal fertilization(70.49% vs 72.02%), good quality embryos (38.28% vs 38.81%), and clinical pregnancy (40.57% vs 40.00%) (P > 0.05). The fertilization rate of a majority of cycles (70.00%, 21/30) in group 2 was higher than 50%, and the mean of fertilization rates was 79.79%.

CONCLUSIONICSI can improve the fertilization limitation following IVF during previous cycles, and the fertilization rates was similar to those treated ICSI because of male factor.

Female ; Fertilization ; Fertilization in Vitro ; Humans ; Male ; Oocytes ; Pregnancy ; Pregnancy Rate ; Sperm Injections, Intracytoplasmic