Objective To explore the changes of renin-angiotensin-aldosterone system in pediatric severe sepsis treated with continuous blood purification(CBP).Methods Prospective study,35 cases of critically ill children diagnosed with severe sepsis and admitted to PICU of Shanghai Children's Hospital of Shanghai Jiaotong University from June 2012 to May 2014 served as reseach objective.Based on the monitoring of vital signs,including central venous pressure,arterial blood pressure,mean arterial pressure,patients were treated with conventional therapy,as antibiotics,fluid therapy,and CBP by mode of continuous veno-venous hemodiafiltration or high volume hemofiltration.Plasma levels of rennin activity,angiontensin Ⅱ and aldosterone were measured by radioimmunoassay before and 24 h after CBP.Twenty-five cases of blood samples taken from the children collected from health care for liver function examination were matched as control group.Results Plasmalevelsofrenninactivitywere(2.11 ±1.93) pg/(L·h),(1.27±1.56) μg/(L·h),(0.37 ± 0.22) μg/(L· h) before and 24 h after CBP and control group,respectively.The levels of angiontensin Ⅱ were (426.78 ±332.37) ng/L,(364.40 ± 325.51) ng/L,(41.70 ± 10.81) ng/L,respectively.And the levels of aldosterone were (255.12 ± 218.18) ng/L,(134.92 ± 104.13) ng/L,(106.88 ±43.18) ng/L,respectively.The plasma levels of rennin activity,angiontensin Ⅱ,and aldosterone were higher in sepsis cases than in control group,while decreased obviously after CBP treatment(P ＜0.01,P ＜0.05).Eleven cases died and mortality was 31.4％ (11/35).After 24 h of CBP,the mean arterial pressure improved in 26 cases with septic shock and dopamine dose reduced(P ＜ 0.01).Conclusion The reaction of renin-angiotensin-aldosterone system is increased significantly in pediatric severe sepsis.CBP can down-regulate the levels of rennin activity,angiotensin Ⅱand aldosterone,but not worsen the circulation function.

Objective To investigate the distribution characteristics and drug resistance of pathogens isolated from pregnant woman′s urine samples.Methods The urine samples of pregnant women who underwent prenatal examination were collected and cultured.VITEK2 automatic bacterial analyzer was used to identify the bacteria strains,and Escherichia coli ,Streptococcus agalac-tiae were tested for their drug susceptibility.Results The positive rates of urine culture were 4.4%和 3.8% respectively in 2011 and 2012.The top 5 most isolated strains were Escherichia coli ,S .agalactiae ,Enterococcus faecalis ,K .pneumoniae and Propeus vulgaris .In 2011 and 2012,the resistance rates of Escherichia coli to ampicillin and piperacillin was more than 50%,ESBLs-produ-cing rate in Escherichia coli had decreased in 2012 than 2011,the resistance rates of S.agalactiae to erythromycin and clindamycin were more than 30%.Conclusion Escherichia coli accounted for the largest proportion in the strains isolated from urine samples of pregnant women,The pathogen of urinary tract infection in pregnant women are still mainly Gram-negative bacteria(Escherichia co-li),the main pathogens common antibiotics are varying degrees of resistance,pathogens all display common drug resistance of var-ying degrees.

Sepsis is a life-threatening organ dysfunction caused by the disorder of the body's response to infection, and is one of the main causes of death in critically ill patients. Ferroptosis is a kind of iron dependent cell death, characterized by intracellular reactive oxygen species (ROS) accumulation. Sepsis can cause a substantial accumulation of ROS in cells. The transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) is a key regulator of antioxidant and plays a critical protective role in sepsis induced ferroptosis by regulating the expression of proteins related to the ferroptosis pathway. Current studies have found that activation of Nrf2 has a protective effect on ferroptosis induced by sepsis. In this paper, we summarized the regulation mechanism of Nrf2 in ferroptosis, in order to provide references for the treatment of sepsis.

Sepsis is the organ dysfunction caused by infection.It is one of the most common critical diseases in clinic.Its morbidity and mortality are increasing year by year，which has seriously threatened human health.Innate immunity is the first line of defense against pathogens.Nature killer（NK）cells are important cells involved in the regulation of innate immunity in sepsis，and can play an important role on the progression of sepsis by secreting cytokines，inducing apoptosis and mediating cytotoxic effects.It has been found that the changes of NK cells in the early stage of sepsis are related to the prognosis of the disease.Therefore，further study on the role of NK cells in sepsis can provide a new idea for the clinical diagnosis and treatment of sepsis，and contribute to the early identification of sepsis and the improvement of prognosis.This review summarized the role and changes of NK cell in sepsis.

OBJECTIVETo study the relative expression of the genes involved in artemisinin biosynthesis in different tissues including roots, stems, leaves and flowers of Artemisia annua, and establish the relationship between gene expression and artemisinin accumulation, eventually leading to discover the mainly effective genes involved in artemisinin biosynthesis.

METHODThe 7 functional genes involved in artemisinin biosynthesis were detected at the level of expression by using qRT-PCR, and simultaneously the content of artemisinin in the 4 investigated tissues was detected in parallel.

RESULTThe 3 genes including HMGR, DXR and FPS which were involved in the upstream pathway of artemisinin biosynthesis showed the highest expression levels in flowers, and the 4 functional genes including ADS, CYP71AV1, CPR and AAR which were involved in the artemisinin-specific biosynthetic pathway were found to be expressed in all the 4 detected tissues. The highest expression level of ADS was found in leaves, then followed by flowers, and the lowest expression level of ADS was found in roots and stems. CYP71AV1 had highest expression level in flowers and lowest in leaves. CPR showed highest expression level in flowers, and AAR had lower expression levels in the other 3 artemisinin-specific pathway genes in all the tissues. The highest content of artemisinin was found in leaves (0.343 mg x g(-1)), then followed by flowers (0.152 mg x g(-1)), roots (0.062 mg x g(-1)) and stems (0.060 mg x g(-1)).

CONCLUSIONIn the biosynthesis of artemisinin, the upstream genes including HMGR from the MVA pathway, DXR from the MEP pathway and the checkpoint gene FPS were much more active in flowers, and this suggested that flowers might be the tissues of artemisinin precursor biosynthesis, and further DXR contributed more to artemisinin biosynthesis. The positive correlation of ADS expression and artemisinin content in tissues demonstrated that ADS played a very important role in artemisinin biosynthesis, which was the ideal target for engineering the artemisinin biosynthetic pathway. In summary, the functional genes involved in artemisinin biosynthesis do not express at the same level but synergistically.

Artemisia annua ; chemistry ; genetics ; metabolism ; Artemisinins ; metabolism ; Plant Proteins ; genetics ; metabolism ; Polymerase Chain Reaction

Objective:To evaluate the effect of serum cytokines and immune typing on the severity and prognosis of children with sepsis.Methods:One hundred and sixty children with sepsis admitted to No.2 PICU from May 2018 to May 2019 at Hunan Children′s Hospital were enrolled.Vital signs, blood routine and blood biochemical indexes of the children were collected within 24 hours after admission.Serum cytokine concentrations of interleukin(IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor(TNF)-α, and interferon (IFN)-γ were tested at the same time.According to the worst condition during the first 24 h after admission, and the consensus diagnostic criteria of experts in the diagnosis and treatment of septic shock in children in 2015, the patients were divided into sepsis group(76 cases) and severe sepsis group(84 cases). According to the prognosis of 28 days, the patients were divided into survival group(134 cases)and death group(26 cases). The differences of cytokine concentration and the composition of immune state among groups were compared.Results:The levels of IL-2[2.40(2.40, 2.55)pg/mL vs. 2.40(2.40, 3.76)pg/mL], IL-6[60.54(23.22, 250.38)pg/mL vs. 21.47(8.83, 57.94)pg/mL], IL-10[50.85(21.74, 217.12)pg/mL vs. 14.99(9.23, 28.79)pg/mL] , TNF-α[2.75(2.40, 5.15)pg/mL vs. 2.40(2.40, 3.23)pg/mL] and IFN-γ[8.01(4.34, 37.28)pg/mL vs.2.62(2.62, 28.56)pg/mL] in the severe sepsis group were significantly higher than those in the sepsis group( P<0.05). The levels of IL-10[99.57(10.51, 646.96)pg/mL vs. 23.17(11.74, 57.30)pg/mL] and TNF-α[3.08(2.40, 5.13)pg/mL vs. 2.45(2.40, 3.80)pg/mL] in the death group were significantly higher than those in the survival group( P<0.05). The risk of death in children with mixed antagonistic response syndrome (MARS) was significantly higher than those without MARS( OR 3.75, 95% CI 1.302-10.804). Conclusion:The increased concentrations of IL-2, IL-6, IL-10, TNF-α, and IFN-γ are significantly correlated with the severity of sepsis in children.Increased IL-10 concentration and the occurrence of MARS are significantly correlated with poor prognosis.The occurrence of MARS in children with sepsis should be highly vigilant for the poor prognosis.

Objective:To analyze the epidemiological characteristics, clinical characteristics and blood purification effect of mushroom poisoning in children.Methods:A retrospective study was conducted on 51 children with acute mushroom poisoning admitted to Hunan Children′s Hospital from 2002 to 2020.The epidemiological and clinical characteristics were analyzed, and the prognosis of children with different incubation periods was analyzed and compared.Among them, 36 critically ill children were treated with blood purification.Results:The age distribution was 66(43, 115)months.Mushroom poisoning had obvious seasonal and spatial aggregation.The first symptom was mainly manifested by digestive tract, which was manifested as vomiting, abdominal pain and diarrhea, accounting for 94.1% patients(48/51). The gastrointestinal tract type accounted for 45.1%(23/51) of the clinical types and the multi-organ damage type accounted for 51.0% patients(26/51). The length of hospital stay was 6(3, 11)days.Among them, early onset accounted for 45.1% patients(23/51), late onset accounted for 54.9% patients(28/51). Early onset hospitalization was shorter, about 4(2, 7)days, and fewer organs 1(0, 3) were damaged.The length of hospital stay of late onset was 8(3, 12)days, and the number of damaged organs was 4(2, 4). There was a statistically significant difference( P<0.05). Late onset patients had more severe organ function damage, including liver function, coagulation function, renal function, myocardial enzyme, and there was no significant difference in the final outcome between two groups.In 36 children who were given blood purification treatment, alanine aminotransferase, aspartate aminotransferase, prothrombin time, international normalized ratio, blood urea nitrogen, and lactate dehydrogenase were significantly improved, with statistically significant differences( P<0.05). Conclusion:Mushroom poisoning has obvious seasonal and geographical distribution characteristics; the first manifestation is mainly gastrointestinal symptoms; the clinical types are more common in gastrointestinal and multiple organ damage types.Children with early onset have shorter hospital stays and fewer complications than later onset.Blood purification treatment can significantly improve liver function, kidney function and blood coagulation function in children with toadstool poisoning.

Objective:To discuss the role of continuous blood purification (CBP) therapy in children with severe adenovirus pneumonia.Methods:A total of 114 children with severe adenovirus pneumonia admitted to the Department of PICU at Children′s Hospital of Hunan Province from June 2018 to July 2019 were selected as the research objects.According to whether treated with CBP, they were divided into CBP group and control group.The following indicators during the process of treatment were compared between two groups, including respiratory mechanics indicators[respiratory index(PaO 2/FiO 2), dynamic lung compliance(Cdyn)]; hemodynamic indicators(heart rate and mean arterial pressure); changes in levels of inflammatory factors interleukin(IL)-6, IL-10, tumor necrosis factor(TNF)-α and the prognosis 28 days after admission. Results:The respiratory mechanics index, serum IL-6 and TNF-α levels of two groups after treatment were significantly lower than those before treatment, and the serum IL-10 level was significantly higher than that of this group before treatment.There were statistical differences in the CBP group before and after treatment, while there was no statistical difference in control group.In the CBP group, the serum IL-6 and TNF-α levels after treatment were significantly lower than those of the control group( P<0.05), and the serum IL-10 level was significantly higher than that of the control group( P<0.05). The 28-day mortality rate of patients in CBP group was 8.6%(3/35), which was significantly lower than 13.9%(11/79) of control group ( P<0.05). Conclusion:CBP could improve the main respiratory mechanical indexes of adenovirus pneumonia and decrease the level of inflammatory cytokines.

Objective:To observe the activation of cerebral regions during swallowing by magnetoencephalography (MEG), and discuss the temporal and spatial characteristics of neural circuit.Methods:Ten healthy subjects were selected, and the magnetic signals of their brains were recorded using 148 channel full head type MEG system in the magnetic shielding room.Data were analyzed using CURRY8 analysis software and the localization algorithm was based on minimum modulus low resolution electromagnetic imaging method (LORETA). Every 300 ms data were set as an independent analysis stage and made the highest position of the cerebral cortex F-distribution values (F-distributed) as the activation area.The activation areas were analyzed during swallowing through time and space location.Results:Paracentral lobule, anterior central gyrus, medulla oblata, posterior central gyrus, inferior frontal gyrus, parietal lobules, angular gyrus, corpus callosum, middle frontal gyrus, cingulate gyrus, orbital gyrus, thalamus, bottom of third ventricle, corona radiata, precuneus, frontal insula, cerebellopontine angle, superior frontal gyrus and basal ganglia area were activated during swallowing, in which the top eight brain regions were paracentral lobule, anterior central gyrus, corpus callosum, posterior central gyrus, superior parietal lobule, middle frontal gyrus, cingulate gyrus, and basal ganglia.When the 10 subjects performed the deglutition, MEG signals of 8 subjects were mainly activated by the left cerebral hemisphere at 0-300 ms, the bilateral cerebral hemisphere or intermediate region at 301-600 ms, and the right cerebral hemisphere at 601-900 ms.MEG signal of 1 subject was activated by the right cerebral hemisphere at 0-300 ms, and the left cerebral hemisphere at 301-600 ms and 601-900 ms.MEG signal of 1 subject was mainly activated by the right cerebral hemisphere at 0-300 ms and 601-900 ms, and in the intermediate region at 301-600 ms.Conclusion:During swallowing the MEG signals appeared left laterality in the early stage and right laterality in the later stage, and showed a close correlation with time.There may be a swallowing neural circuit composed by the central region, corpus callosum, superior parietal lobule, middle frontal gyrus, cingulate gyrus and basal ganglia, in which the central region is the core.

Objective:To investigate the changes of inflammatory factors, serum amylase and lipase and pancreatic damage at different time points after establishment of cecal ligation and perforation in a rat model of sepsis, which provides a stable and reliable animal model for the study of pancreatic injury following sepsis in children.Methods:Sixty male SD rats were randomly divided into 6 h group, 12 h group, 24 h group and 48 h group in control group, sham group and cecal ligation and puncture (CLP) group.Rat model of sepsis was established by cecal ligation and perforation in CLP group, the sham group was treated with sham operation, and rats in control group were not treated.The levels of interleukin (IL)-1β, IL-10, amylase and lipase in each group were detected, and pancreatic tissue was taken for HE staining.Results:In this model, the 48 h survival rate of rats in the CLP group was 70%.With the prolongation of postoperative time in the CLP group, pancreatic tissue congestion, cell edema, and inflammatory cell infiltration gradually worsened.The pathological changes of pancreatic tissue in the Sham group were mild.The expression levels of IL-1β in CLP group and sham group increased first and then decreased, and reached the peak at 12 h. The expression levels of IL-1β in CLP group were significantly higher than those in control group and sham group at all time points( P<0.05). The expression level of IL-10 showed a gradually increasing trend, reaching a peak at 48 h. The expression level of IL-10 in CLP group was significantly higher than that in control group and sham group at all time points( P<0.05), which in sham group was significantly higher than that in control group( P<0.05). Serum amylase and lipase in CLP group showed an upward and then downward trend, reaching the peak at 24 h. The serum amylase levels at 24 h and 48 h were significantly higher than those in control group and sham group( P<0.05). Serum amylase levels in sham group were significantly different from those in control group at 12 h, 24 h and 48 h( P<0.05). Serum lipase level at 12 h, 24 h and 48 h was significantly higher than that in control group and sham group( P<0.05). There was no significant difference in serum lipase between sham group and control group( P>0.05). Conclusion:After CLP modeling, IL-1β, IL-10 elevation and pancreatic pathological changes appeared at the early stage, and the pathological changes gradually increased with time.Significant differences in serum amylase and lipase began to appear at 24 h and 12 h respectively.