Objective To explore the clinical characteristic of lab results and prognosis of severe intestinal virus infection dis -ease and to provide the objective basis for early intervention .Methods All children who were admitted in pediatric intensive care unit ( PICU) by laboratory diagnosis as cases of severe intestinal virus infection disease in Hunan Children 's Hospital from January 6 to No-vember 25, 2010 were selected as cases of this study .Their medical records were collected .The data was analyzed by χ2 test, Fisher's exact test , and binary logistic regression .Results A percentage ( 33.1%) of patients had abnormal white blood cell ( WBC ) counts, and the difference rates of younger group (under 1 year old) and upper 5 years old group were higher than that in 1~5 years old group with statistically significance (χ2 =12.13, P <0.01).The difference rates of aspartate aminotransferase (AST) and cardiac troponin I(cTnT) were 23.8%and 31.5%, respectively.A percentage (52.9%) of patients had reduced CD4 lymphocytes.Abnor-mal WBC, C reactive protein (CRP), and prognosis have no significant difference ( P >0.05).There were statistically significant differences in procalcitonin (PCT), AST, cTnT anomalies and prognosis ( P <0.01 or P <0.05).Conclusions Abnormal PCT, AST and cTnT are associated with the prognosis of children with severe intestinal virus infection , while WBC and CRP are not .

Objective To analyze the clinical features of the hyperamylasemia in critically ill children and investigate the related risk factors in order to provide the basis for prevention and treatment. Methods A total of 1036 critically ill children admitted in pediatric intensive care unit (PICU)from April,2011 to Oct,2012 were studied.They were divided into the high amylase group (n=82)and the normal group (n=954).According to the outcomes,the high amylase group was divided into survival group (n=61 ) and death group (n =21 ).The related risk factors of the occurrence and outcome of hyperamylasemia were analyzed by univariate and multivariate Logistic regression.Results There were statistically significant differences in rates of coagulation disorders, convulsions, disturbance of consciousness,pediatric critical illness score (PCIS)≤80,multiple organ dysfunction (MODS)≥3, sepsis,shock,and lactic acid (LA),procalcitonin (PCT),blood glucose (BG)between the high amylase group and the normal group (P<0.05 ).The differences in the rates of coagulation disorders,convulsions, mechanical ventilation,PCIS≤80,MODS≥3,and LA,PCT,oxygenation index,albumin,C-peptide,BG were statistically significant between the survival group and the death group (P <0.05 ).Multivariate Logistic regression analysis showed that the risk factors of the hyperamylasemia's occurrence were LA,PCT, BG,PCIS<80,MODS>3.Adjusted ORs confidence intervals of them were 1.662 (1.236-2.234),1.042 (1.025-1.060),1.612 (1.411-1.843),3.219 (1.311-7.905),3.411 (1.370-8.494),respectively. The hyperamylasemia's prognostic risk factors were PCT,C-peptide,PCIS ≤80,MODS >3,shock. Adjusted ORs confidence intervals of them were 1.066(1.021-1.113),1.437(1.017 ~2.030),16.137 (1.876-138.836),10.437(1.528-71.925),20.928(1.938-226.009),respectively.Conclusions The severity of the disease,the levels of LA,PCT,BG in critically ill children were positively correlated to the occurrence of hyperamylasemia.The severity of the disease,the incidence of organ failures,the levels of PCT,C-peptide combined shock in children with hyperamylasemia were positively correlated to the prognosis of hyperamylasemia.

Objective To explore the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in assessing severity and predicting prognosis in children with severe hand-foot-mouth disease (HFMD).Methods A total of 119 eligible children with severe HFMD admitted in the pediatric intensive care unit were enrolled in this retrospective study from March 2012 to March 2014.According to NT-proBNP level,children were divided into ≤ 500 pg/mL group (n =70) and ＞ 500 pg/mL group (n =49) ; whereas according to severity,children were divided into severe-type (n =74) and critical-type (n =45) ; and based on 28 days outcome in children with critical-type HFMD,children were divided into fatal group (n =27) and survival group (n =18).The chi-square test,two-sample t test,rank sum test Pearson or Spearman' s correlation,area under the receiver operating characteristic curve (AUC) were used to analyze 119 children with severe hand-foot-mouth disease (HFMD).Results Within 24 hours after admission,NT-proBNP ＞ 500 pg / mL group had higher rates of fever,abnormal breathing,abnormal heart rate,abnormal systolic blood pressure,capillary refill time ＞ 2 seconds and higher levels of laboratory biomarkers than NT-proBNP ≤ 500 pg/mL group (P ＜ 0.05) ; and during hospitalization,the rates of pulmonary edema,pulmonary hemorrhage and death also higher than NT-proBNP ≤ 500 pg/mL group (P ＜ 0.05).NT-proBNP,BS,WBC were higher in critical-type group than severe-type group (P =0.00),while the PCIS (pediatric critical illness score) was lower in critical-type group (x2 =14.70,P =0.00).NTproBNP was higher in fatal group than that in survival group (t =-2.60,P =0.01),PCIS was lower in fatal group (Z=2.70,P=0.01); and there were no statistically significant differences in BS and WBC between fatal and survival groups (BS:t =-0.60,P=0.55; WBC:t =-0.72,P=0.48).NT-proBNP,BS and WBC were negatively correlated with PCIS (r values were-0.58,-0.46,-0.56,P values were 0.00).The AUCs of NT-proBNP,BS,WBC and PCIS to determine the severity of severe HFMD children were 0.94,0.80,0.74,and 0.97,respectively; and to predict 28 days survival in criticaltype HFMD were 0.73,0.56,0.53,and 0.73,respectively.Conclusions Higher level of NT-proBNP could prompt cardiopulmonary involvement.NT-proBNP could reflect the severity of illness and served as a sensitive marker in predicting 28-day survival,being better than BS and WBC.

Objective To investigate the serum procalcitonin (PCT) levels in sepsis caused by the bacteria,virus and mycoplasma and explore the role of PCT in etiology diagnosis of sepsis in children.Methods Three hundreds and thirty critically ill children with sepsis caused by bacteria,virus and mycoplasma admitted in PICU of Hunan Children' s Hospital from Feb 1,2011 to Sep 1,2012 were reviewed and analyzed.The PCT levels were measured at admission and day 3.The differences in accidence of sepsis caused by bacteria,viruses and mycoplasma according to different serum PCT levels were analyzed.The differences of PCT levels at admission and day 3 in sepsic children caused by bacteria,viruses and mycoplasma were analyzed.Results The level of serum PCT in sepsis caused by bacterial infection were distinctly increased,caused by virus and mycoplasma infections was not obvious but the increases of serum PCT [0.71 (8.14)ng/ml,0.15 (1.68) ng/ml,0.28 (1.89) ng/ml].According to various PCT levels(0.05 ～ ng/ml,0.5 ～ng/ml,2 ～ ng/ml,10 ～ 300 ng/ml),the differences of accidence of sepsis caused by bacteria,virus and mycoplasma were also statistically significant(x2 =84.50,P ＜ 0.01).The PCT level of septic children caused by bacterial infection in day 3 was significantly decreased compared with that at admission [0.32 (5.68) ng/ml vs 0.71 (8.14) ng/ml] (U =19.34,P ＜0.05).Conclusion PCT plays a certain role in etiology diagnosis of sepsis in children.The increased PCT levels which can be reduced by anti-inflammatory treatment indicate the likelihood of bacterial infection and sepsis.The increase of PCT induced by viral and mycoplasma infections is not obvious,but bacterial infection can not be completely ruled out.

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 investigate the prognostic value of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with sepsis.Methods A total of 162 patients was enrolled with consecutive pediatric intensive care unit (PICU) admissions during the study period of Jan 1st,2013 to June 30th,2013 at Hunan Children's Hospital.The 162 septic patients were divided into sepsis group and severe sepsis group,sepsis group and septic shock group,and survival group and death group.NT-proBNP was tested in the first and third day after 162 septic patients in hospital.Pediatric critical illness score (PCIS) score was assessed in all patients.NT-proBNP was compared between groups.The change of NT-proBNP was summarized between groups.The relationship between NT-proBNP and PCIS was analyzed.Results (1) The plasma NT-proBNP level of the first day after admission in the severe sepsis group and septic shock group was higher than sepsis group,the PCIS in the sepsis group was higher than severe sepsis group and septic shock group,with significant difference (P ＜ 0.05).(2) The plasma NT-proBNP level of the first day after admission in the death group was higher than the survival group,the PCIS in the death was lower than the survivor group,with significant difference (P ＜ 0.05).In the death group,the plasma NT-proBNP level of the third day after admission was higher than the NT-proBNP of the first day after admission (P =0.037) ; contrarily,the plasma NT-proBNP level of the third day after admission was lower than the NT-proBNP of the first day after admission in the survival group (P =0.023).Conclusions NT-proBNP could be used to assess the condition of septic patients,and dynamic test NT-proBNP can help to predict septic patient’s prognosis.

Objective To evaluate the early diagnosis value of serum cystatin C in the pediatric intensive care unit (PICU) children with septic acute kidney injury.Methods A total of 196 children in PICU confirmed with sepsis in Hunan Province Children's Hospital was enrolled in this study.Patients were divided into acute kidney injury (AKI) and non-AKI group according to whether accompanied with acute kidney injury.The serum cystatin C and serum creatinine were collected in 2 h,48 h,and 96 h after admission,and the clinical data were collected.The serum Cys C was drawn in receiver operating characteristic (ROC) curve.The sensitivity and specificity of Cys C were evaluated in diagnosis of septic AKI.Results The incidence of septic AKI was 35.20％,higher Cys C levels were risk factors for the onset of AKI,and OR was 26.218 (95％ CI:6.235 ～ 110.232).In AKI group,the serum Cys C level in 2 hours after admission was (2.05 ± 0.90)mg/L,which was higher than 48 hours (1.72 ± 0.72)mg/L and 96 hours (1.62 ±0.95) mg/L(Z =2.169,P =0.030; Z =2.789,P =0.005).In the septic AKI group,cystatin C and creatinine were positive correlation (r =0.582,P =0.000).The area under the ROC curve at 2hours after admission for serum cystatin C in diagnosis of AKI was 0.831.A cutoff point of 1.325 mg/L for 2 hours after admission was identified for cystatin C in the diagnosis of septic AKI,with a sensitivity of 87.1％and specificity of 78.9％.Conclusions Higher level of Cys C was risk factor for the onset of AKI.Compare to creatinine,cystatin C was earlier increased in children with septic AKI and positively correlated with it.It might be a biomarker for early diagnosis of septic AKI in PICU critical ill children.

Objective To evaluate the clinical value of N-terminal pro brain natriuretic peptide (NT-proBNP) in septic children with myocardial damage.Methods From Jan 1 to Jun 30,2013,162 children confirmed with sepsis in PICU of Hu'nan Children's Hospital were enrolled in the study.Patients were divided into myocardical injury and non-myocardical injury group according to whether accompanied with myocardial injury.NT-proBNP,lactate dehydrogenase,creatine kinase isoenzyme (CK-MB),troponin Ⅰ (cTnⅠ),myoglobin(MB) of patients were measured within 24 h after admission.The NT-proBNP level between two groups was compared.The correlations between NT-proBNP and cTnⅠ,CK-MB were studied respectively.Results The NT-proBNP level[M(Q)] in myocardial injury group[3 632 (668.5,15 453.5) pg/ml] was higher than that in non-myocardial injury group[349 (169,1 500) pg/ml],which was significantly different(Z =91.881,P =0.000).The levels of NT-proBNP,CK-MB,cTnⅠ,MB were abnormal distributions.There were positive correlations between logNT-proBNP and logCK-MB (r =0.367,P =0.000),logcTnⅠ(r =0.304,P =0.001) and logMB (r=0.302,P =0.000).NT-proBNP value of 1 163 ng/ml had a sensitivity of 76％ and a specificity of 74％ to diagnose myocardial injury.Conclusion NT-proBNP could help to diagnose sepsis with myocardial damage.

Objective To establish and maintain the life cycle of Clonorchis sinensis in laboratory.Methods Adult worms and eggs of Clonorchis sinensis were collected from naturally infected cats.Eggs were ingested by freshwater snails in aquarium.When the cercariae were released from infected snails, they invaded into freshwater fishes.From the 30th day on after the release of cercariae, the infection rate and metacercariae density in freshwater fishes were determined.Results After 95 days the infected snails began shedding cercariae in a temperature range of 24.3-37.2 ℃, and no cercariae were found under 20 ℃.The infection rate in the snails Parafossarulus striatulus and Alocinma longicornis was 12.5% and 18.0%, respectively.Metacercariae were found in fish at 30 days after cercariae infection, and matured metacercariae were detected in 45 days.The number of metacercariae per gram of fish meat in Pseudorasbora parva, Ctenopharyngodon idellus, Rhodeus sinensis, Hypophthalmichthys nobilis, Cirrhinus molitorella, Carassius auratus, Cyprinus carpio and Oreochromis niloticus was 1 792, 16, 8, 6, 5, 4, 4, and 2, respectively.Rats and cats were fed with metacercariae from fish to receive adult worms.Conclusion Life cycle of Clonorchis sinensis has been established and maintained in the laboratory.

Objective To investigate the role of Wnt/β-Catenin signaling pathway in the endotoxin induced acute lung injury (ALI) during the treatment by mesenchymal stem cells (MSCs).Methods Six SPF male SD rats were isolated and bone marrow mesenchymal stem cells were cultured.A total of 72 SPF male SD rats with 6-week-old were randomly (random number) divided into 4 groups:control group (n =18) in which phosphate buffered solution (PBS) used instead of lipopolysaccharide (LPS);LPS group (n =18) in which LPS used to induce acute lung injury;LPS + MSCs group (n =18) in which MSCs directly transplanted after injection of LPS;Control + MSCs group (n =18) in which MSCs transplanted after injection of PBS.And then 6 rats of each group were sacrificed at 6 h,24 h,and 48 h separately after injection of LPS.At 24 h after the modeling,lung tissue was taken and the levels of Wrnt signaling pathway components were detected by using immunohistochemistry and Western blot.In addition,quantitative realtime PCR was used to detect the expression of Wnt signaling pathway target genes.Results Compare with the PBS control group,significant decrease in lung dry-to-wet ratio and increase in arterial oxygen partial pressure (PaO2) were found in MSCS transplantation groups.According the immunohistological results,Wnt 5a was significantly increased in the LPS-induced ALI rats and decreased after MSCs transplantation.Moreover,decrease in levels of GSK-3β phosphorylation and β-catenin was found in the lung tissue after MSCs transplantation.In addition,the expressions of Wnt signaling target genes Vegf,Axin2 and Klf4 were decreased significantly after MSCs transplantation.Conclusions In the setting of ALI,the therapeutic effect of MSCs was exerted by decreasing the expressions of Wnt 5a,GSK-3β phosphorylation,β-catenin,and Wnt signaling target genes Vegf,Axin2 and Klf4.Wnt signaling implicated in the therapeutic effect of MSC in the setting of ALI.