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.

Objective To investigate the effect and its mechanism of ziyuglycoside Ⅱ on proliferation, migration, invasion and apoptosis of colon cancer cells HT-29. Methods The effect of ziyuglycoside Ⅱ on cell proliferation of colon cancer cells HT-29 was determined by CCK-8 method; the effect of ziyuglycoside Ⅱ on cell migrative capacity of colon cancer cells HT-29 was determined by scratch assay; the effect of ziyuglycoside Ⅱ on cell invasive capacity of colon cancer cells HT-29 was determined by transwell assay; the effects of ziyuglycoside Ⅱ on cell apoptosis of colon cancer cells HT-29 was determined by flow cytometry; the effects of ziyuglycoside Ⅱ on mRNA and protein expression of protein kinase B (AKT)/phosphatidylinositol-3-kinase (PI3K) signal pathway were determined by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) and western-blot, respectively. Results Ziyuglycoside Ⅱ (0, 1, 5, 10, 20, 40, 60 and 80 μmol/mL) inhibited proliferation of colon cancer cells HT-29 in a dose-dependent manner. Ziyuglycoside Ⅱ (5, 10 and 20 μmol/mL) inhibited migration of colon cancer cells HT-29 in a dose-dependent manner. Ziyuglycoside Ⅱ (5, 10 and 20 μmol/mL) inhibited invasion of colon cancer cells HT-29 in a dose-dependent manner. Ziyuglycoside Ⅱ (5, 10 and 20 μmol/mL) promoted apoptosis of colon cancer cells HT-29 in a dose-dependent manner. Ziyuglycoside Ⅱ (5, 10 and 20 μmol/mL) increased mRNA expression of AKT and PI3K, decreased mRNA expression of Caspase-3 and Caspase-9. Ziyuglycoside Ⅱ (5, 10 and 20 μmol/mL) increased protein expression of phosphorylated protein kinase B(p-AKT) and phosphorylphosphatidylinositol-3-kinase (p-PI3K), increased the expression of Cleaved-Caspase-3 and Cleaved-Caspase-9 protein. Conclusion Ziyuglycoside Ⅱ can inhibit proliferation, migration and invasion of colon cancer cells HT-29, and promote the apoptosis of colon cancer cells HT-29. Its mechanism may be related to regulating the signal pathway of AKT/PI3K via promoting phosphorylation of AKT and PI3K protein, activation of Caspase-3 and Caspase-9 protein.

Objective:To investigate the etiology, prognosis and clinical characteristics of abnormal serum amylase and lipase in children.Methods:This study was a retrospective study.A total of 7 813 children older than 28 days who had their serum amylase and lipase detected in Hunan Children′s Hospital from August 2017 to August 2020 were included as the study subjects.Children with acute and chronic pancreatitis were excluded.The age, gender, impatient department, imaging exams, discharge outcomes, main diagnosis, diagnostic ICD10 code, and the highest values of serum amylase and lipase during hospitalization were collected through the medical record system.According to the levels of serum amylase and lipase, the children were divided into 3 groups.Patients in group A had normal serum amylase and serum lipase levels.The serum amylase or lipase levels of patients in group B was 1 to 3 times higher than that of group A. The serum amylase or lipase levels in group C was 3 times higher than that of group A. Group B and group C had abnormal pancreatic enzyme levels.According to the prognosis, patients were divided into the survival group and the death group.The relationship of the occurrence of abnormal serum amylase and lipase levels with the age, sex, disease type and prognosis of children was analyzed.Results:The ratio of abnormal trypsin in male and female was 11.5% and 12.9%, respectively.The number of children with abnormal pancreatic enzyme levels in the 28 day -1 year old group, >1-3 years old group, >3-6 years old group, >6 -12 years old group and > 12 year old group were 37 cases (4.6%), 185 cases (15.4%), 199 cases (10.5%), 431 cases (13.9%), and 94 cases (11.7%), respectively.The mortality rate was 1.6% (112/6 867 cases) in group A, 5.2% (32/617 cases) in group B, and 7.6% (25/329 cases) in group C. The mortality risk of group B and C was both higher than that of group A. Compared with group A, the OR (95% CI) of group B and group C was 3.30 (2.21-4.93) and 4.96 (3.17-7.77), respectively.In group C, the top five diseases were parotitis (26.4%), cholangiectasis (11.6%), choledochal cysts (8.5%), gastroenteritis (4.5%) and sepsis (3.3%). Conclusions:Pancreatic enzyme abnormalities in children are associated with adverse prognosis.Pancreatic enzyme abnormalities are more prone to occur in children aged >1-3 with mumps, digestive diseases and congenital digestive system structural deformities.In addition, children with sepsis are also easy to present pancreatic enzyme abnormalities.Clinical attention should be paid to the possibility of secondary pancreatic damage in children with sepsis.

The postoperative pathological staging system (pTNM) has become an important reference for the selection of various tumor treatment strategies and prognosis evaluation at a global scale, and is a powerful predictor of the prognosis of a variety of solid tumors, but the prognosis is still different in patients with the same pTNM staging. In recent years, studies have confirmed that the negative lymph nodes count (NLNC) is related to the prognosis of a variety of solid tumors. Higher NLNC can improve the prognosis of cancer patients, and NLNC can reduce staging migration, which is expected to be a supplement to the pTNM staging system. This article reviews the value of NLNC in the prognosis of solid tumors.

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.

Chronic disease management is a challenging issue in China. To address the needs of talents and mature innovation ecosystem related to chronic disease management, The First Affiliated Hospital of Sun Yat-sen University(FAH-SYSU) actively responds to the national strategy to promote the high-quality development of the hospital through strengthening strategic planning, top-level design, and systematic consideration. Precise management of chronic diseases was taken as key measure for the construction of a national medical center. With continuous exploration in establishing talent pool, innovation center and application platform, and chronic disease management system that focuses on core elements of talent and innovation, the FAH-SYSU Model for the precise management of chronic diseases has been initially formed.

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 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.

Objective:To summary the mixed infection as well as clinical characteristics and analyze the risk factors for mixed infection of severe adenovirus pneumonia(SAP) in children.Methods:The clinical data of 114 children with SAP were retrospectively analyzed.Multivariate Logistic regression analysis was performed to assess the risk factors for mixed infection.Results:The incidence age was from 6 months to 2 years(62.5%). High fever(94.7%), cough(98.2%), dyspnea(86.8%) and lethargy(95.6%) were the main symptoms.Laboratory examination showed that children with SAP were prone to increased white blood cell count, C-reactive protein, procalcitonin, aspartate aminotransferase, alanine aminotransferase and CK-MB, as well as decreased proportion of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + and NK cells.The main complications intrapulmonary organ were respiratory failure(80.7%). The main complications extrapulmonary organ were circulatory complications (55.3%). SAP was easily combined with other pathogenic infections.Streptococcus pneumoniae(22.9%)was the most common bacterial pathogen.Respiratory syncytial virus(10.0%)were the most common virus, in addition, mycoplasma pneumoniae(17.1%) was also common.Multivariable Logistic regression analysis showed that the decreasing ratio of CD4 + /CD8 + and NK cells, congenital heart disease and congenital airway dysplasia were the independent risk factors for mixed infection of SAP in children( P<0.05). Conclusion:The SAP patients could easily suffer from mixed infection and high fatality rate.Immune dysregulation is the important risk factors for mixed infection of SAP in children.So immunoregulatory treatment is very important.

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.