Objective:To investigate the effects of probiotics on the stabilization of blood glucose and its mechanism in children with severe infectious pneumonia.Methods:Eighty children with severe infectious pneumonia admitted to PICU were enrolled in the clinical trial prospectively.They were divided into two groups by random.Forty patients given probiotics were regarded as treatment group,the others not given probiotics were considered to be controlled group,in addition to the regular therapy.Blood glucose,plasma H2 S,D-lactate and acetic acid,propionic acid and butyric acid concentrations in stools were measured respectively at the beginning of the treatment and on day 8 after the treatment.At the same time the changes of blood glucose,fluctuation of them and prognosis were examined.Results:There was no significance in all the parameters of the two groups at the beginning of the treatment (P ＞ 0.05).The levels of plasma H2S and acetic acid,butyric acid in the stools of the probiotics group was (24.6 ± 7.4) μmol/L,(32.8 ± 8.6) μmol/g,(15.2 ± 5.2) μmoL/g on the day 8 respectively;but the concentration of these parameters in the control group was (20.9 ± 7.4) μ mol/L,(28.6 ± 7.9) μmol/g,(12.9 ± 5.0) μmoL/g.Meanwhile the level of D-lactate in patients given probiotics (1.25 ± 0.39) μg/ ml was significantly lower than that the control group (1.45 ± 0.4) μg/ml.The blood glucose (6.1 ± 2.7) mmol/L was lower than than in the other group (7.4 ± 2.7) mmol/L on day 8.And a higher recov ery rate was found in probiotic group.Furthermore,blood glucose and H2S,acetic acid levels expressed negative correlation at 8 day;but positive correlations were found between blood glucose and D-lactate (P ＜ 0.05).Conclusion:Application of probiotics to children with severe infectious pneumonia can moderate the structure of enterobacteria,reinforce the intestinal barrier and elevate the levels of plasma H2S and had positive effects on the stabilization of blood glucose and prognosis.

Objective To explore the effects of early active mobilization on hand function after zone 5 flexor tendon and ulnar nerve repair.Methods Fifty-five patients who had received primary repair in zone 5 of a flexor tendon and the ulnar nerve were randomly divided into an observation group (26 cases, 88 digits) and a control group (27 cases, 91 digits).Both groups were given routine treatment after the operation, and started to do active and passive exercise 4 weeks later.The observation group was additionally forced to do active range of motion exercise training starting 8 days after the operation.Twelve weeks after the operation, the hand function of both groups was assessed using the total active motion (TAM) scoring system of the American Society for Surgery of the Hand, peripheral nerve function evaluation and the disabilities of arm-shoulder-hand (DASH) scale.Results At the end of the treatment, the average TAM score of the observation group was significantly better than that of the control group.The average active movement range of the wrist in palm flexion, dorsal extension, ulnar deviation and in radial deviation were all significantly better than in the control group.Grip strength, overall hand function and DASH score were also significantly better on average.Conclusion Early active mobilization following flexor tendon and ulnar nerve repair can effectively promote the recovery of hand function.

Objective:To evaluate the relationship of vitamin D deficiency(VDD) between sepsis and septic shock among critical ill children, and investigate the influence of VDD on etiology and prognosis of sepsis.Methods:The observational cohort studies, involving vitamin D and critically ill children, were searched in Medline, Web of Science, EBSCO host and China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform.The quality assessment was conducted on the basis of the Newcastle-Ottawa Quality Assessment Scale.Consistent definitions of sepsis and septic shock were applied and standardized data were obtained following the study design.We retrieved the clinical outcomes related to septic shock and serum 25-hydroxyvitamin D 3concentrations and made a meta-analysis for the relation between VDD and clinical outcomes at two cut-offs. Results:In the analysis of collected data including severe VDD as a risk factor for incidence of sepsis and septic shock, the pooled RRwas 1.71(95% CI1.11 to 2.63, P=0.01) and 2.05(95% CI1.35 to 3.10, P<0.001) respectively, which were all higher compared with VDD.And severe VDD was also associated with cv-SOFA score( RR0.68, 95% CI0.45 to 0.91, P<0.001). However, no significant differences in mortality or the duration of vasopressor was found at severe VDD or VDD cut-off levels among septic shock patients. Conclusion:Among pediatric critical illness, severe VDD is more likely related to the incidence for sepsis and septic shock compared with VDD.And comorbidity with severe VDD could increase the cv-SOFA score of septic children.

69 crabs were collected from Daxing, Gekui and Niukong townships of Lvchun county, Yunnan Province in 2006 and excysted metacercariae were only obtained from crabs of Niukong. The infection rate was 27.6% (8/29) with an average metacercaria number of 2.25 each crab. No encysted metacercariae were found. The excysted metacercariae were morphologically identified as Paragonimus proliferus.

Objective To investigate the regulatory effects of probiotics on ghrelin and their pro-tective effects on pulmonary function of children during acute lung injury.Methods Fifty children with acute lung injury were recruited form Henan Provincial People′s Hospital during 2010 to 2013 and randomly divided into two groups.In addition to regular therapy, those who received probiotics treatment were set up as the probiotics treatment group and the others were considered as the control group.Levels of ghrelin, sur-factant protein A( SP-A) , TNF-αand IL-6 in serum samples were measured before and 10 days after the cor-responding treatments.Each patient was analyzed by pulmonary function test and echocardiography.The vol-ume to peak expiratory flow ( VPEF) , ratio of time to reach peak tidal expiratory flow to total expiratory time ( TPTEF/TE) , mean arterial pressure ( MAP) and pulmonary artery pressure ( PAP) were recorded for sta-tistical analysis.Results The levels of SP-A, TNF-αand IL-6 in serum samples from the probiotics treat-ment group were decreased on day 10 as compared with those of the control group [(195.9±54.3) ng/ml vs (245.5±56.4) ng/ml, (382.0±56.4) pg/ml vs (440.7±46.8) pg/ml, (221.5±62.6) pg/ml vs (303.5 ±83.9) pg/ml;P<0.05] .Children from the probiotics treatment group showed higher values of VPEF and TPTEF/TE on day 10 as compared with those without probiotics treatment [(25.3±4.5) ml vs (23.8±4.6) ml, (29.5±4.3) %vs (26.8±4.7) %;P<0.05].Treatment of children with probiotics increased MAP and decreased PAP [(74.5±6.7) mmHg vs (71.9±6.9) mmHg, (25.5±6.4) mmHg vs (29.1±6.2) mmHg] .The levels of ghrelin in patients received probiotics treatment were higher than those of children without probiotics treatment [(329.3 ±49.6) pg/ml vs (296.6 ±48.5) pg/ml].The levels of ghrelin showed negative correlations with the levels of SP-A, TNF-α, IL-6 and PAP on day 10, but positive correla-tions with TPTEF/TE and MAP (P<0.05).Conclusion Use of probiotics to children with acute lung inju-ry could regulate the level of ghrelin, alleviate the inflammation of lungs and improve the recovery of lung function and circulation.Therefore, probiotics treatment had positive effects on the protection of pulmonary function.

OBJECTIVE: To study the clinicopathological characteristics, diagnosis and differential diagnosis of hypopharyngeal carcinosarcoma. METHOD: Clinical data of one case with hypopharyngeal carcinosarcoma proved by pathology were analyzed retrospectively. The related literatures were reviewed. RESULT: The masses were surgically removed,and the postoperative diagnosis was confirmed to be carcinosarcoma by histopathological examination. After radiotherapy and chemotherapy, the patient recovered well postoperatively without recurrence during 18-month follow-up. CONCLUSION Carcinosarcoma of the hypopharynx is an extremely rare malignant tumor with distinctive histological, clinical and immunohistochemical features. The final diagnosis depends on histopathology. This tumor should be differentiated from other tumors such as sarcomatoid carcinoma and the reaction of radiotherapy of carcinoma. Surgery is the proper treatment strategy for carcinosarcoma of the hypopharynx. The patients with locally advanced, postoperative residual tumor or tumor without clear safe surgical margin should undergo radiotherapy, and the postoperative follow up should be in time.
Carcinoma, Squamous Cell ; diagnosis ; pathology ; Carcinosarcoma ; diagnosis ; pathology ; Humans ; Hypopharyngeal Neoplasms ; diagnosis ; pathology ; Hypopharynx ; pathology ; Male ; Middle Aged ; Rhabdomyosarcoma ; diagnosis ; pathology

To observe whether PCSK9 inhibitor combined with statin therapy can bring additional benefits on near-term clinical prognosis in patients with acute cerebral infarction，in order to provide clinical data on the effects of PCSK9 inhibitors in the early treatment of patients with cerebral infarction. Methods124 patients with acute cerebral infarction admitted to the neurology ward of our hospital from December 2020 to July 2021 were included as study subjects. A 90-day clinical follow-up was used to compare the differences in hematological indices，clinical neurological function scores，documentation of recurrent cerebral infarction and other thrombotic events during the follow-up period and differenses in the time to recurrence between the PCSK9 inhibitor combined with statin treatment and standard statin treatment groups. ResultsThe levels of hs-CRP，IL-6，Lp-PLA2，HCY，TC and LDL-C，NIHSS score and mRS score in the PCSK9 inhibitor combined with statin treatment group and the standard statin treatment group were all decreased before and after treatment（P<0.05），and there was a statistically significant difference in the combined treatment group（P<0.05），and lowered TG（P<0.05），while the level of HDL-C was improved（P<0.05）. There was no statistical significance in fasting plasma glucose of both groups before and after treatment（P>0.05）. Compared with the combined treatment group，the recurrence rate of cerebral infarction in the standard treatment group was obviously high（χ2=7.694，P=0.006），while the time to cerebral infarction recurrence was significantly longer in the combined treatment group（P<0.05）. ConclusionPCSK9 inhibitors can effectively reduce peripheral inflammatory response，promote neurological function recovery，significantly reduce stroke recurrence rate，and significantly prolong the recurrence time.

Objective To evaluate the efficacy of one stage anterior debridement combined with posterior pedicle screw fixation in the treatment of cervical intervertebral space infection.Methods From June 2010 to June 2016,28 cases were fixed by anterior debridement combined with the posterior vertebral pedicle screws for the cervical intervertebral space infection,19 males and 9 females.The average age was 45-74 years (58±14.5 years old).21 cases (75％) were spontaneous infection,of which 6 cases were diabetes mellitus,15 cases were over 60 years old.The remaining 7 cases (25％) were intervertebral space infection after radiofrequency ablation of the cervical spine.All patients were excluded from tuberculosis and Brucella infection.All patients underwent hematological examination,with emphasis on WBC,ESP and CRP.All patients received JOA score before operation,applied antibiotic according to blood culture and drug sensitive test.All patients underwent one stage anterior debridement combined with posterior pedicle screw fixation,and the operative time and bleeding volume were recorded.After the operation,intravenous antibiotic therapy was continued,and the application of antibiotics was guided according to the results of ESP and CRP,and the time for the application of antibiotics was recorded.Follow up was performed at 3 months,6 months and 1 years after operation respectively.The JOA score and postoperative cervical lordosis Cobb angle were recorded.Results All operations were successfully completed in this group.The operation time was 130-225 min,with an average of 145.5±12.7 min.The intraoperative blood loss was 40-100 ml,with an average of 67±35.2 ml.The incision was healed in one stage.The time of application of antibiotics in 28 patients was 21-87 days,with an average of 30.8±8.7 days.The longest application time of antibiotics was 87 days,and no relapse was found during follow-up.The postoperative JOA score increased from 11.3± 1.2 to three months 14.9 ± 1.96 postoperatively and 6 months 15.1 ± 1.55 and 1 years 16.5±0.48 after operation.The JOA score was significantly higher than that before operation.No significant loss and change of the Cobb angle in the cervical spine surgery were found.All cases had good bone graft fusion at 1 years.Conclusion One stage anterior debridement combined with posterior pedicle screw fixation is a safe and effective method for the treatment of cervical vertebra instability and nerve function injury caused by cervical intervertebral space infection.It provides a new way for the treatment of cervical intervertebral space infection.

Objective:To evaluate the effect and safety of adjustable closed loop(ACL) in the treatment of short bowel syndrome (SBS).Methods:From January 2017 to December 2017, the clinical data of 2 cases with ostomy in continuity after surgery in Children's Hospital Affiliated to Xi'an Jiaotong University were analyzed.The age was 1 and 3 months, both were females, and preservation of intestinal tube length were 65 cm and 60 cm respectively.They were all diagnosed SBS with a lot of stool like water.Self-made ACL was installed to maintain SBS.The blood circulation of stoma, weight, BMI, defecating, abdomen, nutrition status changes, nursing convenience, intestinal infection susceptibility were observed.Results:There was no necrosis in stoma, and the overall condition was improved, and no significant increase in abdominal distension.ACL used in babies with ostomy in continuity could improve the anus stool, weight, nursing convenience.Conclusion:ACL installed in baby with SBS could contribute to intestinal management, and is easy to install.