Objective:To evaluate the stability and bio-safety of warming moxibustion gel-unguentums( WMG) . Methods: With the commercially available package and at 40℃ ± 2℃, RH (75% ± 5%) for six months,the stability of WMG was inspected. Guinea pig skin sensitization test, rabbit skin irritation test and cell toxicity test were used to investigate the safety. Results:Compared to the results of 0 month, there was no difference in the sample character, containing paste percentage, adhesion, shape, weight difference and all theindices in TLC identification. Cell toxicity test showed that WMG had slight cytotoxicity. Guinea pig skin sensitization test and rabbit skin irritation test indicated that the grade of skin reaction was zero and the primary stimulus index of skin tissues was also zero. Conclusion:The quality of WMG is stable and the production preparation technology is feasible. Moreover, it is safe in transder-mal administration.

Objective To determine the vitamin D status in children with sepsis/severe sepsis in pediatric intensive care unit (PICU) in order to explor the association between vitamin D status and clinical outcomes,in turn to provide evidence for optimizing nutrition support.Methods It was a prospective,observational,multi-center study,carried out in patients with sepsis/severe sepsis from March 1,2013,to March 30,2014,in the PICUs of three tertiary-care children's hospitals.Total serum 25-hydroxy vitamin D [25 (OH) D] was measured by using an enzyme-linked immunosorbent assay at admission.The association of vitamin D status at admission with length of PICU length of stay,total hospital stay,in-hospital mortality,28-days mortality and costs were analyzed.Results A total of 194 patients includng 117 boys (60.3％)and 77 girls (39.7％) were enrolled.There were 96 patients with sepsis and 98 with severe sepsis.The mortality on discharge and 28 days were 6.7％ and 24.2％ respectively.The median vitamin D level was 9.79 ng/mL (5.32,18.46) at admission.Of them 77.8％ (151/194) had vitamin D deficiency and 50.5％ (98/194) had severe vitamin D deficiency.Patients with severe vitamin D deficiency,had higher mortality on discharge (P =0.011).Vitamin D status had no significant correlations with 28 days mortality,length of PICU stay,total hospital stay and costs.Conclusions More than three-quarters (77.8％) of children with sepsis/severe sepsis in PICUs had Vitamin D deficiency.Patients with severe vitamin D deficiency at admission had higher risk of mortality at discharge.

ObjectiveTo explore the clinical characteristics, diagnosis and treatment of neonatalCandida arthritis. Methods The clinical data from one case of neonatalCandida arthritis with swelling and pain in multiple joints as the ifrst symp-toms were reviewed.Results Boy born at 31 weeks' gestational age had the birth weight of 2100 g. The patients was admitted to neonatal intensive care unit after birth and treated with antibiotics for a long time due to infection. At 24 days after birth, blood culture showed the growth ofCandida albicans. At 29 days after birth, the bilateral knee joints showed swelling. TheCandida arthritis was diagnosed through X ray and joint-cavity lfuid culture. The patient was treated with Fluconazole for 13 weeks. When discharged, the joints swelling had been disappeared, while the muscle tension of the double upper limbs was signiifcantly weak. The shoulders had visible slight activities independently. The ifngers, wrists and elbows had less independent activities. The muscle tension of the double lower limbs was slight and the independent activity was more than upper limbs, but the extend was smaller than normal. The palmar grasp relfex was weak. The 30 months follow-up showed that each joint had even length, no abnormality and normal activities. The language and intelligence were normal.Conclusions NeonatalCandida arthritis is mostly combined with or secondary to systemic disseminated candidiasis, and the priority therapy is antifungal drugs. Surgical operation can be considered if necessary, which can improve the prognosis.

Objective To observe the clinical efficacy of acupoint application in canicular days plus TDP radiation in treating primary dysmenorrhea due to cold-dampness.Method Eighty-three patients were randomized into group A of 32 cases, group B of 20 cases, and group C of 31 cases. Group A was intervened by acupoint application plus TDP, group B was by acupoint application alone, while group C was by oral administration ofTong Jing Bao granules. The Visual Analogue Scale (VAS) scores of the three groups were observed before and after treatment, and the clinical efficacies were compared.Result The total effective rate was 93.1% in group A, versus 85.0% in group B and 77.4% in group C. The total effective rate of group A was significantly different from that of group B and group C (P<0.05). The total effective rate of group B was significantly different from that of group C (P<0.05). The VAS scores were changed significantly after treatment in the three groups (P<0.05). After treatment, the VAS scores of group A and B were both significantly different from that of group C (P<0.05).Conclusion Acupoint application plus TDP is an effective method in treating primary dysmenorrhea due to cold-dampness.

Objective To investigate the protective effect of isoflurane preconditioning on myocardium against isehemia-reperfusion(I/R)injury and the possible mechanism.Methods Fifty male SD rats weighing 250- 300 g were randomly divided into 5 groups(n=10 each):Ⅰ control group(C);Ⅱ I/R group and 3 isoflurane preconditioning groups with 0.5%(Ⅲ),or 1.0%(Ⅳ)or 2.0% isoflurane(Ⅴ).The animals were anesthetized with intraperitoneal pentobarbital 40 mg?kg~(-1).The hearts were immediately excised and placed in cold K-H solution.The aorta was canuulated and heart retrogradely perfused with K-H solution aerated with 95% O_2 and 5% CO_2 at 37℃ and 10 kPa in a langendorff apparatus.Left ventricular end-diastollc pressure(LVEDP)and left ventrieular systolic pressure(LVSP)were measured from a fluid-filled latex balloon in the left ventricle.The isolated hearts were made globally ischemic for 30 min followed by 60 rain reperfusion in group Ⅱ-Ⅴ.In the 3 isoflurane preconditioning groups the hearts were perfused with K-H solution saturated with 0.5% or 1.0% or 2.0% isoflurane for 15 rain followed by 15 rain washout before ischemia.The cardiac function variables including LVEDP,LVSP dp/dt_(min),dp/dt_(max) and HR were measured after epuilibrium(baseline values),immediately before ischemia,at the end of 30 min ischemia and 60 min reperfusion.The infarct size and cytochrome C level in cytoplasm and mitochondria of myocytes were measured.Results I/R significantly increased LVEDP and decreased LVSP,dp/dt_(min),dp/dt_(max) as compare with control group.Sevoflurane preconditioning significantly attenuated the depression of cardiac function caused by I/R.Only LVEDP was significantly higher during reperfusion period in the 3 sevoflurane preconditioning group than in the control group but there was no significant difference in LVSP,dp/ dt_(min),dp/dt_(max) between control group and the 3 preconditioning groups.The infarct size was significantly smaller in the 3 preconditioning groups than in I/R group.Cytochrome C level was significantly increased in cytoplasm but decreased in mitochondria in I/R group as compared with control group.Sevoflurane preconditioning significantly ameliorated the release of cytochrome C from mitochondria to cytoplasm in the 3 sevoflurane preconditioning group.Conclusion Isoflurane preconditioning can protect the heart against I/R injury by attenuation of the release of cytochrone C from mitochondria to cytoplasm.

Objective To study the differences of clinical manifestations,etiology and hospitalized outcomes of purulent meningitis in preterm and term infants.Method All preterm and term infants with purulent meningitis hospitalized in the Hospital from 2006 to 2015 were enrolled in this study.The data of neonate's condition,maternal condition,clinical manifestations,complications,etiology,treatment and outcomes of the preterm and term infants groups were compared.Result During the study period,44 preterm infants and 118 term infants were included.The time of onset for purulent meningitis of preterm infants group was statistically earlier than that of term infants group [11.2 (3.2,19.8) d vs.14.3 (5.6,23.9) d,P ＜ 0.05].The prognosis of preterm infants group was statistically worse than that of term infants group (P ＜ 0.05).Among them,the incidences of clinical manifestations in preterm infants group compared to term infants group were:fever (54.5％ vs.78.8％),seizure (11.4％ vs.26.3％),lethargy and poor response (59.1％ vs.38.1％),slow weight gain (9.1％ vs.0％),apnea (45.5％ vs.0.8％) and cyanosis (15.9％ vs.4.2％);all the differences between two groups were significant (P ＜ 0.05).The time of onset for purulent meningitis with complications was statistically earlier than those without complications [9.5 (4.1,20.5) d vs.13.8 (5.9,22.0) d,P＜0.05].The duration of treatment for purulent meningitis with complications was longer than that without complications [(42.2 ± 8.8) d vs.(28.7 ± 7.1) d,P ＜ 0.05],and the positive rate of pathogens was also statistically higher than those without complications (73.8％ vs.26.7％,P ＜0.05).Coagulase-negative staphylococcus was the main pathogen for both preterm and term infants group.Klebsiella pneumoniae was more common in preterm infants group than in term infants group (40.0％ vs.10.4％,P ＜0.05).Conclusion Preterm infants with purulent meningitis had early onset time,atypical clinical manifestations,and poor prognosis.The treatment course for purulent meningitis with complications is prolonged.The pathogens for neonatal purulent meningitis have already changed.The detection rate of conditional pathogens is increasing yearly,for which the clinicians should take note seriously.

BACKGROUND: Fish oil is one of mainly natural resources of n-3 fatty acids, which can inhibit cardiac allograft vasculopathy (CAV) and prolong the survival of cardiac allograft. But, the mechanism is unclear. Recent in vitro data suggested that n-3 fatty acids could inhibit the release of inflammatory transmitter by the activation of peroxisome proliferator-activated receptor-y (PPARy). OBJECTIVE: To test the hypothesis that n-3 fatty acids from fish oil ameliorates CAV development via activating PPARy. METHODS: A total of 6 Lewis rats and 18 Fisher344 rats were randomly selected as heart donors. An additional 24 Lewis rats were randomly and equally divided into 4 groups. In isograft group, heart transplantation was performed among Lewis rats, without any drug. In low-dose fish oil-treated group, F344→Lewis transplantation was performed. At 1 day following surgery, 0.03 mL/kg fish oil was treated by gavage for 8 weeks. In high-dose fish oil-treated group, F344→Lewis transplantation was conducted. At 1 day following surgery, 0.06 mL/kg fish oil was treated by gavage for 8 weeks. In control group, F344→Lawis transplantation was conducted. Cyclosporine A was administrated by gavage for 8 weeks. In the low-dose and high-dose fish oil-treated groups, cyclosporine A (1.5 mg/kg) was given daily by intramuscular injection for 2 weeks following surgery. CAV was evaluated by histological examination. Activity of nuclear factor (NF) k-B and PPARy was assessed in homogenate. Contents of monocyte chemoattractant protein-1 and interferon-inducible protein 10 were measured by enzyme-labeled immunosorbent assay (ELISA). Chemokine receptor CCR2 and CXCR3 expression was determined by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). RESULTS AND CONCLUSION: All 24 receptor Lewis rats were survived following surgery. The donor heart could regularly beat at 8 weeks following transplantation. Compared with the isograft group, severe CAV was detected in the control group al 8 weeks. Compared with the control group, CAV was significantly relieved, the activity of PPARy was significantly elevated, the activity of NF k-B was significantly decreased, levels of intragraft monocyte chemoattractant protein-1 and interferon-inducible protein-10 were significantly reduced in the low-dose and high-dose fish oil-treated groups (P < 0.001, P < 0.05), especially in the high-dose fish oil-treated group (P < 0.05). There was no significant difference in expression of chemokine receptors CXCR3 in the low-dose and high-dose fish oil-treated groups and control group. Our results demonstrated that n-3 fatty acids from fish oil can attenuate CAV development, possibly through activating PPARy and subsequently inhibiting the NF-kB activation, the chemokines secretion and its receptor expression in a dose-dependent fashion in rat models.

Objective To explore the clinical characteristics of tuberous sclerosis complex (TSC). Methods The clinical data of one child with TSC were collected. The clinical features and gene mutation were analyzed. Results A 36-day-old girl had abnormal nodules found by echocardiography, which was considered multiple cardiac rhabdomyomas. There were multiple hypomelanotic macules distributed over the skin surface of the trunk and legs. Cranial MRI showed cortical nodules, subependymal nodules and cerebral white matter radial migration line. A mutation in the TSC2 gene (c.4541-4544delCAAA) was found by second generation high-throughput sequencing technology and tuberous sclerosis complex was confirmed. Conclusion Gene detection is helpful in the early diagnosis of tuberous sclerosis complex.

Objective To explore the clinical outcomes of surgical treatment of brachial plexus cord terminal branch injuries combined with rupture of major upper limb vessels and discuss the optimal timing and surgical procedures.Methods From June,2007 to June,2012,there were 9 cases of the brachial plexus cord terminal branch injuries with concomitant major vessel injuries.Two cases had combined subclvian arterial injuries,1 had combined the first part of axillary arterial injuries,1 had the third part of axillary arterial injuries and 5 had brachial arterial injuries.Depending on the region,type and severity of the injuries,nerve and vascular reconstruction was done simultaneously in the acute phase of the injuries in 3 cases and in the subacute phase in another 2 cases.In 4 cases,the vessels were repaired acutely while nerve reconstruction was carried out in a second stage.Results Nine patients were followed-up from 50 to 78 months with an average of 61.8 months.There was no necrosis of the affected limbs.CTA showed that all the artificial blood vessels were patent after surgery.Nerve functions recovered to various extents.The muscle strength was recovered to grade 3 or better in 9 patients,except 3 cases in which the intrinsic muscles were control by ulnar nerve.(S) or better sensory recovery was seen in all repaired nerve area in 4 patients,and S3 or better sensory recovery was seen in part of the repaired nerve area in 5 patients.Conclusion The brachial plexus cord terminal branch injury is rare and complicated,which request a reasonable treatment program.Under the guideline of saving life first,primary and simultaneous reconstruction of both the nerves and vessels should be attempted by microsurgical treatment whenever possible for improving the success rate of surgery and a better functional recovery.

Objective To establish a model of multiple organ dysfunction syndrome in the elderly (MODSE) by intraperitoneal injection of different doses of zymosan, and to compare the multiple organ dysfunction syndrome (MODS) in adult and in the elderly rats. Methods Adult and senile rats, injected with different doses of zymosan intraperitoneally were examined for the changes in the function and morphology of the vital organs, including heart, liver, brain, lungs, and kidneys using blood gas and biochemistry analysis and histopathological examination methods. Results Compared with the normal controls of the adult and the elderly rats, the blood gas and blood biochemistry changed in different degrees in the different dosed zymosan groups. Pathological changes were also found in the vital organs including lungs, heart, liver, brain, kidneys, erc in the experimental groups. Under the same concentrations of zymosan, the reductions in respiratory, cardiac and renal functions in the senile groups were much more severe than those in the corresponding adult group. In the similar degree of model duplication, the senile rats had the tendency to die later than the adult rats. Conclusions Zymosan can be used in both elderly and adult rats to induce MODS model, and the best dosage for MODSE was 0.Sg/kg injected peritoneally. The model would hopefully be used in the study of mechanisms and the therapeutics on MODSE.