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Objective: To summarize the pathogenic characteristics of bloodstream infection (BSI)-induced severe sepsis and analyze the influence factors in pediatric intensive care unit (PICU). Methods: Pediatric patients who were diagnosed with severe sepsis caused by BSI in the PICU of Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to December 2021 were retrospectively selected and divided into survival group and death group according to their discharge outcomes. Clinical characteristics, laboratory parameters, pathogenic characteristics and drug resistance of the patients were collected. The characteristics of pathogens, clinical and laboratory indicators were summarized, and the influencing factors of death in children with severe sepsis caused by BSI were analyzed based on binary multivariate logistic regression. Results: A total of 132 patients, aged [ M ( Q 1 , Q 3 )] 36 (10, 119) months, with BSI-induced severe sepsis were enrolled in this study, including 81 males and 51 females. There were 38 cases aged 36 (15, 120) months in the death group, including 23 males and 15 females. There were 94 cases, aged 36 (8, 108) months, in the survival group, including 58 males and 36 females. A total of 132 strains of pathogens were isolated, including 87 strains (65.9%) of Gram-negative bacteria. The top 5 pathogens were Klebsiella pneumoniae (24 cases, 18.2%), Escherichia coli (17 cases, 12.9%), Acinetobacter baumannii (13 cases, 9.8%), Pseudomonas aeruginosa (10 cases, 7.6%) and Staphylococcus aureus (10 cases, 7.6%). The proportion of multi-drug resistant bacteria in hospital-acquired BSI was higher than that in community-acquired BSI [52.9% (36/68) vs 15.6% (10/64), P =0.001]. The proportions of community-acquired infection were 58.5% (55/94) and 23.7% (9/38) in the survival and death groups, respectively, the difference was statistically significant ( P <0.001). The proportion of central venous catheter insertion before bloodstream infection in the death group was higher than that in the survival group [63.2% (24/38) vs 42.6% (40/94), P =0.034]. According to the binary multivariate logistic regression analysis, hospital-acquired infection ( OR =4.80, 95% CI : 1.825-12.621, P =0.001), absolute neutrophil count (ANC) ( OR =0.93, 95% CI : 0.863-0.993, P =0.030) and decreased albumin ( OR =0.89, 95% CI : 0.817-0.977, P =0.014) were risk factors for death. Conclusions: The common pathogen of BSI-induced severe sepsis in PICU is Gram-negative bacteria. The proportion of multi-drug resistant organisms of BSI obtained in hospitals is high. Children with severe sepsis due to BSI with nosocomial acquired infection, ANC and decreased albumin have a high risk of death.

Objective: To analyze the cardiac magnetic resonance (CMR) imaging feature of clinically diagnosed myocarditis patients with negative endocardial biopsy (EMB) results, and to further demonstrate the diagnostic value of CMR in these patients. Methods: This was a retrospective case series study. Fourteen patients, who were clinically diagnosed as myocarditis according to 2013 European Society of Cardiology (ESC) clinical diagnostic criteria for myocarditis, but with negative EMB results, were enrolled. All patients underwent CMR examinations. The morphological, functional and histological changes of the heart were assessed based on black blood sequence, cine sequence, T2W-STIR sequence and contrast agent late gadolinium enhancement,(LGE). Results: There were 10 males and 4 females in this cohort, the age was (25.6±13.2) years. The interval between symptom onset and CMR was 21 (13, 60) days, and the interval between symptom onset and EMB was 19 (9, 40) days. There were 13 patients with abnormal CMR results including myocardial oedema, fibrosis, decreased ejection fraction, pericardial effusion or increased cardiac chamber dimension. Nine out of 14 patients had CMR morphological and/or functional abnormalities, including 1 case of left atrium enlargement, 1 case of left ventricle enlargement, 3 cases of right ventricle enlargement, 4 cases of increased left ventricular end diastolic volume index. Left ventricular ejection fraction was<50% in three cases, right ventricular ejection fraction was<40% in 5 cases, and pericardial effusion depth>3 mm was detected in 3 cases. Of the 14 patients, 11 had histological changes, of which 6 had T2 ratio≥2. Among the 10 patients (10/14) with positive LGE, the most common patterns were subepicardial LGE of the lateral wall and/or midwall LGE of the septum ( n =9); 2 cases showed extensively subendocardial LGE of the left ventricular wall. No LGE involved in the right ventricular wall in the whole cohort. Conclusion: CMR plays a complementary role in the diagnosis of myocarditis in clinically diagnosed myocarditis patients with negative EMB findings.

Objective: To observe the clinical features and effects of extracorporeal membrane oxygenation (ECMO) in critically ill children with acute fulminant myocarditis (AFM). Methods: A retrospective analysis was performed in pediatric patients with AFM requiring ECMO, from December 2015 to December 2018, who were admitted to the Pediatric Intensive Care Unit (PICU) in Shanghai Children's Hospital. According to whether patient was alive at least 48 hours after weaning, the children were divided into successful weaning group (9 cases) and unsucessful weaning group (3 cases). The factors related to successful ECMO weaning were explored. The changes of clinical and biochemical parameters before and after ECMO treatment in successful weaning group were analyzed. Continuous variables were presented as median (inter quartile range) for abnormal distribution data, and Mann-Whitney U test was used to compare the data. Results: A total of 12 pediatric patients including 4 males and 8 females were enrolled in this study. The median body weight was 20 (17, 36) kg, and the median age was 66 (48, 103) months. Nine cases were successfully weaned from ECMO, and 8 cases survived to discharge, and 4 cases died in the hospital. The median interval between symptoms onset and ECMO establishment was 3.0 (2.2, 4.0) days, the median duration of ECMO support was 120 (68, 152) hours. In the unsuccessful weaning group, patients displayed higher levels of initiallactic acid (LA), higher vasoactive-inotropic score (VIS), and longer QRS duration before ECMO establishment when compared with those in the successful weaning group (all P< 0.05). After ECMO establishment, mean arterial pressure (MAP), systemic central venous oxygen saturation, LA, myocardial injury markers and left ventricular ejection fraction were all significantly improved in the successful weaning group (all P< 0.05). Conclusion: In pediatric AFM patients, serum LA level, VIS and QRS duration before ECMO establishment are associated with successful ECMO weaning.

This paper describes the development of Department of Burns of the 159th Hospital of PLA in the past 60 years and shows their spirit of hard working and achievements of several generations.

Objective: To investigate the cumulative effect of family history of cardiovascular disease(CVD)and overweight on ischemic stroke events in the Mongolian population. Methods: Study participants were recruited from 32 villages from May 2002 to August 2012 in Kezuohou Banner(county)and Naiman Banner in Inner Mongolia, China. Among 3 457 Mongolian people aged ≥20 years old living in these villages, 2 589 were selected to participate in this study. None of the participants had chronic kidney disease, malignant tumor, thyroid disease or adrenalopathy, or acute infectious disease. The 2 589 participants were followed for a mean of 9.2 years. Six participants were lost to follow up, resulting in a follow-up rate of 99.8%. Information collected included demographic characteristics, lifestyle risk factors, alcohol consumption, cigarette smoking, history of disease, family history of CVD, and physical examination. Ischemic stroke incidence information was collected during follow-up. All participants were categorized into four subgroups according to family history of CVD and overweight status. Cox proportional hazards models were used to estimate the hazard ratios( HR )and 95% CI of ischemic stroke events among subgroups, compared with the subgroup with no family history of CVD and body mass index(BMI)<24 kg/m 2 (the reference group). Results: Among 2 589 participants, 76 ischemic stroke events occurred after follow-up, and 8 were excluded because of lack of key data. Finally, 2 581 participants were included in the analysis, and the incidence density was 323/100 000 person-years. The cumulative incidence rates of ischemic stroke were 2.48%, 1.86%, 6.67% and 9.00% in the no family history of CVD and BMI <24 kg/m 2 , no family history of CVD and BMI ≥24 kg/m 2 , family history of CVD and BMI <24 kg/m 2 and family history of CVD and BMI ≥ 24 kg/m 2 subgroups, respectively. Using the Cox proportional hazards model, after further adjustment for age, gender, smoking, drinking, FPG, hypertension, total cholesterol, triglycerides, and heart rate, the risk of ischemic stroke in the subgroup with a family history of CVD and BMI ≥24 kg/m 2 was higher than the reference group( HR : 2.61, 95% CI : 1.16-5.87). However, the risk of ischemic stroke in other two groups was not statistically significant compared with the reference group. The HR (95% CI )values in the no family history of CVD and BMI ≥24 kg/m 2 and family history of CVD and BMI <24 kg/m 2 subgroups were 1.18(0.5- 2.39)and 1.27(0.67- 2.42), respectively. Conclusion: In the Mongolian population, a family history of CVD and coexistent overweight may increase the risk of ischemic stroke events, suggesting that in people with family history of cardiovascular disease, weight control is conducive to the prevention of ischemic stroke.

Objective: To explore the influence of exogenous putrescine and cadaverine on pro-inflammatory factors in the peripheral blood of rabbits., Methods: Forty ordinary adult New Zealand rabbits were divided into saline, necrotic tissue homogenate (NTH), putrescine, and cadaverine groups according to the random number table, with 10 rabbits in each group. Saline, NTH, 10 g/L putrescine, and 10 g/L cadaverine were respectively peritoneally injected into rabbits of corresponding group in the amount of 1 mL/kg. The blood sample in the volume of 2 mL was collected from the central artery of rabbit ears before injection and at 2, 6, 12, 24, 30, 36, 48, 60 hours post injection (PIH). Contents of TNF-α, IL-1, and IL-6 in the serum were determined with enzyme-linked immunosorbent assay. Data were processed with repeated measurement data analysis of variance and Spearman correlation analysis, and cubic model curve was applied in curve fitting for the contents of inflammatory factors., Results: (1) The serum contents of TNF-α, IL-1, and IL-6 were increased in NTH, putrescine, and cadaverine groups in different degrees at most post injection time points. There was no significant change in the concentrations of the three pro-inflammatory factors in saline group, and they were significantly lower than those of the other three groups at most post injection time points (with F values from 3.49 to 13.58, P values all below 0.05). The serum contents of TNF-α, IL-1, and IL-6 in putrescine group began to increase at PIH 2, 6, and 6, which was similar to the trend of NTH group, but the changes were delayed compared with those of cadaverine group(all at PIH 2). The peak values of TNF-α, IL-1, and IL-6 in putrescine group were respectively (339 ± 36), (518 ± 44), and (265.9 ± 33.5) pg/mL, which were significantly lower than those of cadaverine group [ (476 ± 86), (539 ± 22), and (309.4 ± 27.1) pg/mL], with F values respectively 5.11, 1.90, and 5.56, P values all below 0.05. (2) The period of time in which contents of TNF-α, IL-1, and IL-6 began to increase (PIH 3-4) and the peaking time of the three pro-inflammatory cytokines (PIH 18-30) in putrescine group appeared later than those of cadaverine group (PIH 2 and 12-30). The duration of peaking time of the three pro-inflammatory cytokines in putrescine group was shorter than that of cadaverine group (PIH 18-30 vs. PIH 12-30). The increasing period and the duration of peaking time of TNF-α, IL-1, and IL-6 in putrescine group were close to those of NTH group (PIH 3-5 and 18-30). The correlation coefficient test analysis showed that the trends of changes in contents of three pro-inflammatory cytokines in putrescine group were significantly correlated with those of NTH group (r(TNF-α) = 0.933, P < 0.01; r(IL-1) = 0.967, P < 0.01; r(IL-6) = 0.950, P < 0.01). The obvious correlation between cadaverine group and NTH group was only found in the contents of IL-1 and IL-6 (r(IL-1) = 0.913, P < 0.01; r(IL-6) = 0.883, P < 0.05)., Conclusions: Both exogenous putrescine and cadaverine can cause inflammatory reaction in rabbits. The trend of the inflammatory reaction induced by putrescine was similar with that by NTH, suggesting that putrescine may play a leading role in the inflammatory reaction induced by necrotic tissue decomposition.

Objective: To explore the surgical managements of open wounds from 5·12 Wenchuan Earthquake., Methods: In this report, fifty one patients with open wounds were treated after transported into West China Hospital from May 12 to 26 in 2008 after 5·12 Wenchuan Earthquake. Among 51 cases, open wounds were due to open fractures (n = 8), fasciotomy (n = 6), exposed bone (n = 8) and defects of skin and soft tissue (n = 29). All cases had wound infections. Sixty operations were performed, including muscle and myocutaneous flap (n = 4), skin grafting (n = 30), NPWT (negative pressure wound therapy) (n = 2) and debridement (n = 24)., Results: Four cases of muscle and myocutaneous flaps survived with an excellent blood circulation. And 30 cases of skin grafting had a survival rate of over 90%, 2 cases of NPWT and 24 cases of debridement required further treatment., Conclusion: With adequate surgical managements, open wound healing from an earthquake may be accelerated and the functions maximally preserved.

Negative-pressure wound therapy (NPWT) has been used to help wound healing since early 1970s, and it has been used increasingly for treating a wide variety of wounds since the early 1990s and started to popularize in China near the mid 1990s. This technique is different from conventional dressing change, as it controls local humidity, alleviates edema, and improves local circulation all by negative pressure. The method generally involves the application of a dressing on the wound surface, connecting the dressing to a vacuum pump through a tube, and then sealing the wound with adhesive films. Most of the clinicians in China believe that NPWT is helpful in accelerating wound healing, though as yet there is no strong evidence to support it. Therefore, it is necessary to conduct more research to further clarify the mechanism and therapeutic effect of NPWT.

Objective: To investigate the molecular mechanism of osteoarthritis (OA) through the differential expressed proteins of advanced osteoarthritic chondrocytes., Methods: Normal articular cartilage (NAC, n = 22) were obtained from knee cartilage of donors without knee diseases and osteoarthritic cartilage (OAC, n = 17) from OA patients undergoing knee arthroplasty. Total protein was extracted from chondrocytes and loaded directly for two-dimensional gel electrophoresis (2-DE). Gel images were analyzed with the software Imagemaster 2-D platinum3.0 to screen the differential expression protein spots. Target spots were excised and digested and the resulting peptides submitted for mass spectrometry analysis. Identities of differential expressed proteins were recognized through matching the peptide mass finger printing of each spot with NCBI protein database by MASCOT., Results: About 1000 protein spots were presented in the 2-DE gels for each group. Thirty-five NAC spots and 31 OAC spots were confirmed to be differential expression protein spots. Among these spots, 19 proteins were identified by MASCOT, including type VI collagen, enzymes involved in collagen synthesis, shock related proteins and some novel proteins with unknown functions., Conclusion: The differential expressed proteins isolated and identified by the present study provide valuable information on various aspects of OA pathology. It may help us to gain new insights into the molecular mechanism of OA.

Objective: To observe the association between the number of peripheral blood stem cells (PBSC) and cardiac function index (NYHA grade, left ventricular ejection fraction, LVEF, N-terminal-proB-type Natriuretic Peptide, NT-pro BNP) in patients with ischemic heart failure (IHF)., Methods: A total of 199 patients hospitalized in our department between August 2007 and April 2008 due to IHF were included in this study. NYHA grade, LVEF (measured by echocardiography), plasma NT-proBNP and number of PBSC were analyzed., Results: PBSC number was significantly decreased in proportion with increasing NYHA grade and PBSC number was significantly lower in patients with NYHA IV than that with class II and III (all P<0.01). LVEF was positively correlated with PBSC number (r = 0.35, P = 0.001), NT-proBNP was negatively correlated with PBSC number (r = - 0.39, P = 0.009). Multiple regression analysis showed that LVEF and NT-proBNP were major determinants of PBSC (Beta = 0.14, - 0.25, 95% CI = -0.01 - 0.02, -0.18 - -0.04, P<0.05, P<0.01)., Conclusion: PBSC number was significantly correlated to cardiac function in IHF patients.

The article reviewed the history and the main experiences of rescue of mass burn casualties and their treatment during the past fifty years in China. Some issues including medical support for mass burn casually and treatment regime in future, such as the prevention of burn calamities, further elevation of the cure rate and lowering in the rate of disability, further development in network of burn care and preliminary scheme of rescue of mass burn casualties and their treatment, accelerating the development and study on the substitutes of allo-skin graft were discussed.

Objective: To investigate the correlation between the number and activity of circulating endothelial progenitor cells (EPCs), insulin resistance and severity of coronary lesions in patients with coronary artery disease (CAD)., Methods: Patients with coronary angiography evidenced CAD were divided in insulin resistance group (IR, n = 25) and insulin sensitive group (IS, n = 44) according to insulin level, 25 health volunteers served as control. Circulating EPCs were marked as KDR/CD133+ cells via fluorescence-activated cell sorter analysis. EPCs were also isolated from peripheral blood and cultured in vitro for 7 days, identified by DiI-acLDL uptake and lectin staining methods. EPCs migration activities were determined by modified Boyden chamber assay, EPCs proliferation activities were determined by MTT assay., Result: Circulating EPCs number was significantly lower in IR group compared with IS group [(0.34 +/- 0.08) per thousand vs. (0.47 +/- 0.09) per thousand, P < 0.01] and control group (P < 0.05). Both insulin resistance index (r = -0.291, P = 0.01)and Gensini score (r = -0.3984, P = 0.006)were negatively correlated with number of circulating EPCs. Proliferation and migration capacities of EPCs were also significantly lower in IR group compared to those in IS group (all P < 0.05) and control group (all P < 0.05)., Conclusions: Insulin resistance/hyperinsulinemia could aggravate severity of coronary artery lesions via reducing the number and activities of circulating EPCs in patients with CAD.

Objective: To explore the feasibility of transplanting the skin from chimeric rats to rabbits., Methods: Chimeric rats were produced by transplanting the haematopoietic stem cells (HSCs) from rabbit marrows into fetal rats in uterus and followed by injecting the HSCs into the livers of the rats at newborn stage. After six weeks, the skin from chimeric rats was transplanted to the rabbits. In group A, the skin grafts from chimeric rat donors were transplanted to the HSCs donating rabbits, with the skin from non-chimeric rat to normal rabbits were used as control. In group B, the skin grafts from chimeric and non-chimeric rats were transplanted to the HSCs donating rabbits at the same time. Gross observation and the surviving time of heterogenic-skin graft were observed. The wound healing time was also recorded., Results: In group A, the surviving time and the wound healing time of non-chimeric grafts were (9.3 +/- 1.8) days and (20.9 +/- 2.1) days, respectively, while those in chimeric grafts were (15.1 +/- 2.6) and (18.5 +/-1.3) days, respectively. In group B, the surviving time and the wound healing time of non-chimeric grafts were similar to those of group A. Compared with those in non-chimeric grafts, the surviving time of chimeric grafts in both groups were prolonged (P < 0.01), and the wound healing time shortened (P < 0.05 or 0.01). Most of the wounds healed quickly after rejection of chimeric grafts, while the wounds with non-chimeric grafts were re-opened with exudation and some necrotic tissue., Conclusion: Immunologic tolerance for skin graft can be induced by the skin from chimeric donors, which can prolong the surviving time of skin grafts and shorten the wound healing time.

Objective: To investigate the effect of sirolimus on differentiation, proliferation, adhesion and migration of endothelial progenitor cells (EPC) in vitro., Methods: (1) Mononuclear cells (MNC) were isolated from rat bone marrow by Ficoll density gradient centrifugation and cultured on fibronectin-coated culture dishes with or without sirolimus (0.01 - 100 ng/ml) for 12 days. (2) After 8 days cultured, attached cells were treated with sirolimus (0.1 - 200 ng/ml) or vehicle for various time points (12 h, 24 h, 48 h and 96 h). EPC were identified as adherent cells double positive stained for FITC-UEA-I and DiI-acLDL under laser confocal immunofluence microscope. EPC proliferation, migration were assayed with MTT assay and modified Boyden chamber assay respectively., Results: EPC number differentiated from MNC at 12 days was significantly lower in sirolimus treated cells in a dose-dependent manner than that of vehicle-treated cells. Sirolimus also significantly inhibited the proliferative, migratory and adhesive capacity of EPC in a time and dose dependent manner., Conclusion: Present results suggested that sirolimus could inhibit EPC differentiation from MNC and reduce the proliferation, migration and adhesion capacities of EPC.

Objective: To investigate the effect of COX1 and COX2 on angiogenesis and endothelial progenitor cell mobilization in rats with experimental myocardial infarction (MI)., Methods: The rats were randomly divided into 3 groups: MI group, MI plus rofecoxib group and MI plus valeryl salicylate group. At the 7th day after operation, circulating EPCs, plasma VEGF and HIF-1alpha mRNA of ischemic myocardium were measured. At the 28th day post operation, capillary densities were also measured in ischemic myocardium., Result: Compared with the MI group and the MI plus valeryl salicylate group, circulating EPCs, plasma VEGF, HIF-1alpha mRNA and capillary densities of ischemic myocardium were all decreased in MI plus rofecoxib group., Conclusion: The present study revealed that COX2 play an important role with angiogenesis and endothelial progenitor cell mobilization in rat with experimental MI by modulating expression of VEGF and HIF-1alpha.

Objective: To investigate the influence of intravenous infusion of 50 g/L fructose on post-operative blood glucose level in burn patients, and to evaluate its therapeutic value and safety., Methods: A prospective, randomized, double blinded clinical trial was conducted. Forty-one burn patients with burn area ranging between 10% -30% of total body surface (TBSA) and third degree burns ranging between 1% -10% TBSA were enrolled in the study and randomized into experiment group (E, n = 21, with intravenous infusion of 500 ml of 50 g/L fructose daily for 3 days after escharectomy) and control group ( C, n = 20, with intravenous infusion of glucose 1 day after escharectomy for 3 days). Intravenous infusion of other carbohydrate liquids or oral intake of sugar was withhold within 4 hours of fructose or glucose infusion. Physical signs and side effects were observed during the administration. The plasma glucose contents before operation and on 1, 2 and 3 post-operation day( POD) were measured. The serum content of lactic acid, uric acid, hepatic and renal function were determined before operation and on 4 POD., Results: Physical signs before and after drug administration, and plasma glucose content before operation, as well as before and after fructose administration in 3 POD exhibited no obvious difference between the two groups ( P > 0. 05 ). The plasma glucose content was increased 3 days after operation in the control group, and it reached the peak on 3 POD [ (8. 4+/-3. 5) mmol/L] , which was markedly higher than that before glucose administration [ (6. 4+/-2.4) mmol/L, P <0. 01) ]. The plasma contents of lactic acid and uric acid showed no obvious difference ( P >0.05) between the two groups, and also no difference before and after operation ( P > 0. 05). No changes were observed in hepatic and renal functions., Conclusion: Intravenous infusion of 50 g/L D-fructose is safe because it exerts little influence on blood glucose level.