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Objective:To evaluate the clinical significance of commonly used clinical inflammatory indicators in children with infectious diseases.Methods:A total of 354 children diagnosed with infectious diseases in our hospital from December 2018 to October 2020 were selected and divided into viral infection group(83 cases), sepsis group (65 cases), atypical pathogen infection group(23 cases), fungal infection group (11 cases), and bacterial infection group(172 cases). The data of serum amyloid A(SAA), procalcitonin(PCT), C-reactive protein(CRP), SAA/CRP, and interleukin (IL) in each group were collected.The fever peak, duration of fever, and fever subsidence time after admission were recorded.The receiver operating characteristic (ROC) curve was plotted, and the area under the curve(AUC), cut-off value, sensitivity and specificity were recorded.The correlation between fever and inflammatory indicators was analyzed.Results:The duration of fever in the atypical pathogen infection group was significantly higher than that in the other groups.Compared with the sepsis group, the differences regarding the levels of SAA, CRP, PCT, and IL-6 were statistically significant compared with those in the bacterial infection group, the atypical pathogen infection group, and the viral infection group (all P<0.05). SAA/CRP was the highest in the viral infection group, and its mean value was nearly twice compared with that in the sepsis group ( P<0.05). IL-10 was significantly different between bacterial infection group and viral infection group( P<0.05). Compared with the fungal infection group, the difference of interferon-γ was statistically significant compared with that in the bacterial infection group, viral infection group and sepsis group (all P<0.05). The ROC curves suggested that the AUC of SAA/CRP and IL-10 was the largest and the same in the viral infection group.The AUC of PCT in the sepsis group was the largest of 0.877, and the specificity was the highest at 91.7% when the PCT was 1.055 ng/mL.Correlation analysis found that SAA and CRP detected for the first time at admission were positively correlated with the time to heat remission. Conclusion:SAA/CRP has significant significance in differentiating sepsis and virus infection, and significantly increased PCT is an important sign of sepsis.
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Objective:To analyze the clinical characteristics and risk factors for mortality of severe pneumocystis carinii pneumonia(PCP)in pediatric liver transplant(LT)recipients.Methods:The data of severe PCP in LT recipients diagnosed at Shanghai Children′s Medical Center from November 2019 to February 2021 were collected.The clinical characteristics and risk factors for 28-day mortality were analyzed.Results:Fifteen patients were enrolled in the study.Thirteen cases survived and 2 cases were non-survived.There was no routine anti-pneumocystis prophylaxis after LT.The median age of onset of PCP was 12(7, 26)months.The median time after LT was 3.00(0.33, 4.00)months.The onset clustered in November-December and June-August.All patients were mechanically ventilated, and some patients were given prone ventilation(11 cases), neuromuscular blocking agents(13 cases)and high concentration oxygen(more than 60%, nine cases). Fourteen cases were complicated with other infections.Two cases were complicated with pneumothorax and subcutaneous/mediastinal emphysema.There were 2 cases with septic shock-like manifestation, 1 case of right heart insufficiency, 1 case of right heart failure(death), and 1 case of multiple organ failure(death). Compared with the survived group, the non-survived group had higher pediatric risk of mortality Ⅲ score[3.5(0.0, 6.0)vs.8.5(5.0, 12.0), Z=1.993, P=0.046] and lactate dehydrogenase level[1 731.5(1 012.0, 3 270.0)U/L vs.4 387.5(3 606.0, 5 169.0)U/L, Z=2.148, P=0.032]. Conclusion:PCP in pediatric LT is critical and complicated.Pediatric risk of mortality Ⅲ scores and lactate dehydrogenase increase in 28-day hospitalized deaths.
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Objective:To analyze the clinical characteristics and risk factors for mortality of severe pneumocystis carinii pneumonia(PCP)in pediatric liver transplant(LT)recipients.Methods:The data of severe PCP in LT recipients diagnosed at Shanghai Children′s Medical Center from November 2019 to February 2021 were collected.The clinical characteristics and risk factors for 28-day mortality were analyzed.Results:Fifteen patients were enrolled in the study.Thirteen cases survived and 2 cases were non-survived.There was no routine anti-pneumocystis prophylaxis after LT.The median age of onset of PCP was 12(7, 26)months.The median time after LT was 3.00(0.33, 4.00)months.The onset clustered in November-December and June-August.All patients were mechanically ventilated, and some patients were given prone ventilation(11 cases), neuromuscular blocking agents(13 cases)and high concentration oxygen(more than 60%, nine cases). Fourteen cases were complicated with other infections.Two cases were complicated with pneumothorax and subcutaneous/mediastinal emphysema.There were 2 cases with septic shock-like manifestation, 1 case of right heart insufficiency, 1 case of right heart failure(death), and 1 case of multiple organ failure(death). Compared with the survived group, the non-survived group had higher pediatric risk of mortality Ⅲ score[3.5(0.0, 6.0)vs.8.5(5.0, 12.0), Z=1.993, P=0.046] and lactate dehydrogenase level[1 731.5(1 012.0, 3 270.0)U/L vs.4 387.5(3 606.0, 5 169.0)U/L, Z=2.148, P=0.032]. Conclusion:PCP in pediatric LT is critical and complicated.Pediatric risk of mortality Ⅲ scores and lactate dehydrogenase increase in 28-day hospitalized deaths.
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Objective:To investigate the clinical characteristics, treatment process and prognosis of children with severe side effects after chimeric antigen receptor T cell immunotherapy(CAR-T), so as to provide evidence for timely intervention after CAR-T treatment.Methods:From June 1, 2015 to May 31, 2020, children with cytokine release syndrome(CRS)or immune cell related neurotoxicity syndrome(ICANS)who were treated with CAR-T therapy in our hospital and revealed severe effects transferred to PICU were included in the study, and their clinical course and multiple laboratory examination data were systematically analyzed.Results:Seventeen children showed CRS reaction and entered PICU after CAR-T therapy.The most common clinical symptoms were respiratory distress(13 cases) and circulatory disorder(10 cases), of which 7 cases were complicated with severe ICANS.Serum interferon -γ(IFN-γ)and interleukin-6(IL-6)levels significantly increased after CAR-T cell infusion, reaching the peak at (5.1±1.6)days.The serum levels of IFN-γ and IL-6 in children with severe CRS were significantly higher than those in children with mild CRS(all P<0.05). The level of serum IL-6 in children with high tumor load was significantly higher than that in children with low tumor load( P<0.05). The mortality rate of children with elevated level of serum TNF-α was higher(5/5 vs.3/11, P<0.05). Children with severe CRS were more likely to develop grade 4 ICANS(4/4 vs.0/3, P<0.05). The mortality rate of children with oxygenation index(P/F value)<200 mmHg(1 mmHg=0.133 kPa) was higher(5/5 vs.2/12, P<0.05). The vasoactive inotropic score[ M( Min, Max)] in the death group was significantly higher than that in survival group[29.5(14.0, 50.0) vs.1.5(0, 25.0), Z=8.000, P=0.027]. Conclusion:Serum IL-6 and IFN-γ are crucial causes of CRS.High tumor load is one of the factors causing high level of serum inflammatory factors.Respiration and circulation systems are the most frequently involved systems.Therefore, the evaluation indexes of these two systems can help us judge the prognosis of children.
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Objective:To explore the changes in the proportion and number of T cell subsets in different immune organs during sepsis.Methods:Eight-week-old female C57BL/6 mice were randomly divided into sepsis group and sham group.The experimental sepsis model was constructed through cecal ligation and puncture, and the sham group just underwent sham operation.Then we detected the changes in the total number of lymphocytes and in the ratio and absolute number of CD4 + T cells, CD8 + T cells, CD4 + CD25 high Foxp3 + regulatory T cells(Treg) and CD4 + CD25 low Foxp3 - effector T cells(Teff) in the mouse spleen, axillary and inguinal lymph nodes and bone marrow by cell counting and flow cytometry 24 h and 16 d after modeling. Results:In the spleens of septic mice, the ratio and absolute numbers of CD4 + T cells and Teff, as well as the absolute number of CD8 + T cells were significantly reduced 24 h and 16 d after modeling.There was no significant change in the number of Treg 24 h after modeling, but a significant increase occurred 16 d after modeling.During sepsis, the changes of CD4 + T cells, CD8 + T cells and Teff in mouse lymph nodes were basically the same as those in the spleen; but the changes in Treg were different, with no significant change in the early stage and a significant decrease in the late stage.In addition, the absolute numbers of CD4 + T cells, CD8 + T cells, and Teff in the bone marrow did not change significantly in the 24 h model, but decreased significantly in the 16 d model.The proportion and absolute number of Treg during sepsis were significantly reduced. Conclusion:During different periods of sepsis, there is a large consumption of lymphocytes in the spleen, lymph nodes and bone marrow.In most cases, the trend of Treg changes is inconsistent or even opposite to that of other T cell subsets.There are differences in the changes of T cells among major immune organs, suggesting that the responses of different immune organs to sepsis are heterogeneous.
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Due to incomplete function of gastrointestinal barrier, children are more likely to develop gastrointestinal dysfunction.The clinical application of related biomarkers helps early diagnosis and treatment of gastrointestinal dysfunction in children.By sorting out the studies in recent years, we explored the relationship between inflammatory indicators, intestinal epithelial barrier damage biomarkers, immunological biomarkers, gut microbiome and gastrointestinal dysfunction, and summarized the main problems and solutions faced in the research, which may help the screening, identification and clinical application of relevant biomarkers in subsequent research.
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Objective:To clarify the changes in the bone marrow vascular system in the early stage of sepsis in animal model.Methods:A sepsis mouse model was established by cecal ligation and puncture (CLP), and HE staining, immunofluorescence staining, flow cytometry and real-time quantitative PCR were used to comprehensively analyze the varieties of bone marrow vascular system in structure, the relative proportion of vascular endothelial cells and the expressions of damage-related genes at mRNA level.Results:A series of adaptive changes occurred in the bone marrow vascular system in the early stage of sepsis.Histological analysis showed that the bone marrow vascular structure was significantly remodeled.The average density of bone marrow sinusoids in the CLP group was (410.43±72.63)counts/mm 2, which was significantly higher than that in the sham group[(294.43±68.94)counts /mm 2, P<0.01]. The area of luminal pixels accounted for (43.46±3.21)%, which was significantly higher than that in the sham group[(30.28±4.44)%, P<0.001]. The exudation amount of evans blue in the bone marrow tissue of the CLP group was (0.42±0.12)ng/mg tissue, which was significantly higher than that in the sham group[(0.24±0.09)ng/mg tissue, P<0.05], suggesting increased vascular permeability.The results of flow cytometry analysis showed that the EC in bone marrow of the CLP group mice was in a proliferative state, with the proportion of Ki67 + endothelial cell increasing[(1.91±0.65)% vs.(5.06±1.10)%, P<0.01]. The mRNA levels of some genes related to the activation of vascular endothelial cells were up-regulated. Conclusion:Sepsis changes the structure and function of the bone marrow vascular system, and has a significant impact on the bone marrow microenvironment.
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Objective:To investigate the effect of plasma exchange (PE) and continuous blood purification(CRRT) on children with bee sting poisoning and multiple organ dysfunction syndrome (MODS).Methods:From January 2016 to September 2019, 37 children aged 9 months to 11 years with bee sting and MODS were treated with dexamethasone 0.5 mg/kg or methylprednisolone 3 mg-5 mg/kg anti allergic and anti-inflammatory and organ support. Among them, 26 cases were treated with plasma exchange and continuous blood purification (treatment group), and the rest 11 cases were only given conventional treatment, but did not receive blood purification treatment (control group).The critical illness score, liver and kidney functions, myolysis, pulmonary hemorrhage/pulmonary edema, coagulation disorders, shock, hemolysis, gastrointestinal failure and other organ damage, ICU stay time, mechanical ventilation time, organ dysfunction recovery time and clinical outcomes were retrospectively analyzed. In the treatment group, 18 cases started blood purification before 12 h after MODS (early treatment group) and 8 cases started blood purification after 12 h (delayed treatment group).Results:There was no significant difference in age, sex, child critical illness score, onset time and organ function damage between the treatment and control groups ( P>0.05). The cure rate of the treatment group was higher than that of the control group [(25/26 (96.15%) vs 8/11 (72.73%), P=0.036]. There was no significant difference in ICU stay between the control group and the treatment group [(10.03±7.74) d vs (12.01±6.95) d, P>0.05]. Among the 25 survivors in the treatment group, one patient had mild renal function damage and one patient had multiple necrosis of skin, subcutaneous and muscle tissue. Compared with 4 of the 8 survivors in the control group, the residual organ function damage in the treatment group was significantly less than that in the control group [(2/25 (8.00%) vs 4/8 (50.00%), P=0.031)].The recovery of liver function, renal function, myolysis and hemolysis in the treatment group was faster than those in the control group (all P < 0.05). The initiation of blood purification within 12 h after the occurrence of MODS required fewer times of plasma exchange and shorter CRRT time, ICU stay and ventilator time (all P < 0.05). Conclusions:In children with bee sting combined with MODS, plasma exchange and continuous blood purification can achieve better therapeutic effect and better clinical outcome.
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Sepsis is a common critical illness in clinic and a worldwide serious public health issue.Regulatory T cell(Treg) is a type of negative immune-regulatory cell that can affect the organism immune status through various pathways to inhibit inflammation.Mastering the research progress in related fields of Treg is of great significance for further understanding the pathogenesis of sepsis and exploring new diagnostic and therapeutic methods for sepsis.This review provided the recent research progress of Treg cells in sepsis.
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Objective:To investigate the clinical significance of inflammatory factors in bacterial infection children with glucose-6-phosphate dehydrogenase (G6PD) deficiency in PICU.Methods:A prospective cohort study was carried out from June 2014 to December 2017. 77 bacterial infection children with pediatric critical illness score less than 80 who were admitted to the PICU, were recruit in the study.The patient diagnosed as other basic diseases,with history of high-dose glucocorticoid use, discharged or died within 24 hours were excluded.The recruited patients were divided into G6PD deficiency group (observation group with 36 cases) and non-G6PD deficiency group (control group with 41 cases) according to the presence or absence of G6PD deficiency.Blood samples were taken at admission, 12 hand 24 h after hospitalization to detect the concentrations of tumor necrosis factor (TNF-α), interleukin 6 (IL-6), interleukin 10 (IL-10) andC-reactive protein (CRP). T test, χ2 test and Fisher exact test were used to analyze the changes of the above inflammatory factors, complications, prognosis, PICU stay time and hospitalization costs. Results:The levels of inflammatory factors in the observation group were significantly higher than those in the control group at admission, 12 and 24 hours after hospitalization, the differences were statistically significant (all P< 0.05). There was no statistically significant difference in thechangerate of inflammatory factors between the two groups during treatment; The PICU stay time of observation group was longer [(7.98 ± 6.55) vs (5.01 ± 6.21)] and the hospitalization cost (yuan) was higher [(36 634.09 ± 11 876.67) vs (31 571.42 ± 10 245.80)], P<0.05; Compared to the control group, the incidence ofsevere sepsis, septic shock, MODS increased significantly, and the curative rate decreasedsignificantly in observation group( P<0.05). Conclusions:G6PD-deficient children with bacterial infections had serious inflammatory reactions with poor prognosis and higher hospitalization costs and were susceptible to the occurrence of severe sepsis, septic shock and MODS.
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Objective@#To investigate the safety, feasibility and operation key points of whole lung lavage in infants with pulmonary alveolar proteinosis.@*Methods@#The clinical manifestations, genetic screening, therapeutic interventions and outcome of an infant with pulmonary alveolar proteinosis complicated with respiratory failure who received whole lung lavage in November 2018 in Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine were reported. Websites including PubMed, Springer Link, China National Knowledge Infrastructure (CNKI), Weipu Database, and Wanfang Database were searched using the key words of "whole lung lavage" "pediatric" and "pulmonary alveolar proteinosis" for articles published from their establishments to April 2019. Relevant literature was reviewed.@*Results@#A 3-month-old boy had experienced cough, shortness of breath and cyanosis for 1 week prior to admission to pediatric intensive care unit. Physical examination showed hepatosplenomegaly. Complete blood cell count showed mild anemia (hemoglobin 96 g/L) and normal white blood cells. The patient had normal C-reactive protein and normal blood platelet. Biochemical panel showed hypoalbuminemia (31 g/L), mildly elevated glutamic oxaloacetic transaminase (115 U/L) and blood ammonia (165 μmol/L), extremely elevated lactate dehydrogenase (>6 600 U/L) and hyperferritinemia (>4 500 μg/L). Chest computed tomography (CT) revealed decreased transmittance of both lungs, patchy high density shadow and ground glass opacity. Genetic testing revealed a mutation of c.625+1G>A in SLC7A7. Schiff reaction (PAS staining) in bronchoalveolar lavage fluid was positive. The patient was diagnosed with severe pneumonia, respiratory failure, lysinuria urinary protein intolerance, and pulmonary alveolar proteinosis. The patient received sequential unilateral whole lung lavage in 2 days and was successfully weaned from ventilator. He was discharged home breathing room air. Eleven articles (11 in English and non in Chinese) were reviewed. Twenty-one patients were included. After whole lung lavage, 76% (16/21) of the patients had improvement in respiratory function.@*Conclusions@#Whole lung lavage can effectively improve respiratory failure caused by pulmonary alveolar proteinosis in infant patients. The procedure is feasible and safe.
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Sepsis is a common clinical critical illness and causing serious public health problem worldwide. Lipopolysaccharide(LPS) release from the cytoderm of Gram-negative bacteria and is a pivotal initiating factor in the development of sepsis,which can induce pathological processes such as inflammation, coagulopathy and immunosuppression. Therefore,the research progress in LPS-related region is of great sig-nificance for understanding the pathogenesis of sepsis and developing new diagnostic and therapeutic methods for sepsis. This review summarized the related research progress of LPS and sepsis based on the recent litera-tures.
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Objective To explore the characteristics and value for predicting prognosis of cytokines in septic children with or without neutropenia.Methods Totally 138 septic children were divided into the neutropenia and non-neutropenia groups according to absolute neutropenic count.Septic children were divided into the shock and non-shock groups according to circulation function and organ perfusion.The levels of C-reactive protein,procalcitonin,cytokines,PRISM-Ⅲ and clinical outcomes were analyzed between the relative groups.Results (1) Totally 138 septic children were recruited,64 with neutropenia and 74 without neutropenia.The level of PRISM-Ⅲ of the neutropenia group was significantly higher than that of the non-neutropenia group (P=0.048).Mortality showed no significant difference between the two groups,but hospital stay in the neutropenia group was longer than that in the non-neutropenia group.The levels of C-reactive protein,IL-6,and IL-10 ihe neutropenia group were significantly higher than those of the non-neutropenia group (P=0.001;P=0.001;P=0.032).The level of TNF-α in the neutropenia group was significantly lower than that of the non-neutropenia group (P=0.032).(2)Among the 64 septic children with neutropenia,23 were combined with shock.The PRISM-Ⅲ level of the shock group was significantly higher than that of the non-shock group (P=0.001).The mortality of the shock group (43.5％,10/23) was significantly higher than the non-shock group (2.4％,1/41) (P=0.001).C-reactive protein,procalcitonin,IL-6,IL-10 and TNF-α in the shock group elevated obviously than those in the non-shock group (P=0.001;P=0.001;P=0.001;P=0.005;P=0.019).The area under receiver operating characteristic curve was 0.8 for IL-6 (cut-offvalue 315.38 pg/mL),0.8 for IL-10 (cutoff value 45.18 pg/mL),and 0.85 for TNF-α (cut-off value 1.95 pg/mL).(3) Among the 74 septic children without neutropenia,19 were combined with shock The PRISM-Ⅲ level of the shock group was significantly higher than that of the non-shock group (P=0.022).There was no significant difference of mortality between the two groups (P=0.3).IL-10 level in the shock group elevated obviously than that in the non-shock group (P=0.015).(4) Among the 42 children with sepsis shock,23 were combined with neutropenia.The PRISM-Ⅲ level of the neutropenia group was significantly higher than that of the non-neutropenia group (P=0.005).There was no significant difference of mortality between the two groups (P=0.29).The levels of C-reactive protein,procalcitonin,IL-6 and IL-10 in the neutropenia group were significantly higher than those in the non-neutropenia group (P=0.001;P=0.001;P=0.001;P=0.035).There was no difference of TNF-α level between the two groups.(5) Among the 96 children without sepsis shock,41 were combined with neutropenia.No difference of PRISM-Ⅲ level was observed between the neutropenia and nonneutropenia groups.The mortality of the neutropenia group was significantly lower than that in the non-neutropenia group (2.4％ vs 20％,P=0.02).The levels of C-reactive protein and IL-6 in the neutropenia group were significantly higher than those in the non-neutropenia group (P=0.005;P=0.033).The TNF-α level was significantly lower than that in the non-neutropenia group (P=0.007).Conclusions Compared to children without neutropenia,septic children combined with neutropenia have longer hospital stay,and septic shock children combined with neutropenia have higher mortality,and levels of IL-6,IL-10 and TNF-α were also significantly increased.The levels of IL-6,IL-10 and TNF-α can help to predict prognosis of children with sepsis.
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Sepsis is a common critical disease, the morbidity of sepsis increases in recent years. Interleukin( IL)-6 plays an important role in the progress of sepsis. It can induce inflammation and cause coagulation. Therefore,it is particularly important to study the relationship between sepsis and IL-6. In order to provide more direction and ideas for septic treatment,this paper summarized the related research progress of IL-6 and sepsis based on the recent literature.
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Objective To explore the expression and clinical value of long non-coding RNA ( lncRNA) in sepsis children. Methods The peripheral blood samples were analyzed from 15 sepsis children ( sepsis group) ,7 septic shock children( septic shock group) and 21 healthy children( healthy control group) . The real time-polymerase chain reaction was used to explore the expression of 9 kinds of lncRNA (AK092960,LOC100192426,VHDJH,AC006230. 3,AC019097. 7,RP4-652L8. 2,RP11-108A15. 2,NKILA and AK023660) which are closely related to the nuclear factor-κB pathway of the sepsis. And further analysis of lncRNA expression between sepsis,septic shock and health children were carried out. The specificity and sensitivity of the lncRNAs compared with C-reactive protein, procalcitonin and WBC for identification of patients with sepsis or septic shock were also evaluated. Results The expression of VHDJH,AC019097. 7, RP4-652L8. 2,RP11-108A15. 2, NKILA and AK02366 in the sepsis group were significantly higher than those in the healthy control group(P < 0.01). Among them,the expression of VHDJH,AC019097.7, RP4-652L8. 2,NKILA and AK023660 in the septic shock group were higher than those in the sepsis group (P<0. 01). Although the specificity and sensitivity of VHDJH, AC019097. 7, RP4-652L8. 2, NKILA and AK023660 were higher than C-reactive protein,procalcitonin and WBC for sepsis and septic shock,respectively, there was no significant difference statistically(P >0.05). Conclusion VHDJH,AC019097.7,RP4-652L8.2, RP11-108A15. 2,NKILA and AK023660 could be the potential diagnostic biomarkers of sepsis and might reflect its severity.
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From 1903,when Ophüls elaborated infectious pulmonary edema pathologically for the first time,till to 2015,"Pediatric acute respiratory distress syndrome:Consensus Recommendations From the Pediatric Acute Lung Injury Consensus Conference"was defined by Pediatric Acute Lung Injury Consensus Conference(PALICC),the development of infectious pulmonary edema experienced more than 110 years.In order to improve the re-recognition of infectious pulmonary edema,infectious acute respiratory distress syn-drome was expounded on the infectious pathogeny,infection sites,risk factors,diagnosis and treatment in this review.
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Objective To study the clinical significance of thromboelastography (TEG) for determining the presence of coagulation disorders in septic children.Methods A total of 100 patients suffering from sepsis or severe sepsis in pediatric intensive care unit (PICU) of Shanghai Children's Medical Center from February 2014 to January 2015 were recruited.TEG tests and conventional coagulation laboratory tests (CCTs) including platelet count,fibrinogen,prothrombin time (PT),activated partial thromboplastin time,D-dimers,and international normalized ratio (INR) were carried out in all patients at the primary diagnosis of sepsis.Another 25 healthy children taking physical examination were enrolled as control group.Rank Sum Test was used to detect the differences in coagulation markers and TEG between the groups and there was statistical significance when P ＜ 0.05.Receiver operating characteristic (ROC) curves were used to evaluate the roles of TEG and CCTs tests in this study.Results Of them,there were 56 patients with sepsis and 44 with severe sepsis.The male to female ratio was 63∶ 37,the median age was 11.5 (3.3-48) months,and 71％ patients suffered from underlying disease.According to TEG,72 patients had coagulation disorders,including 28 with hypercoagulation and 44 with hypocoagulation.CCTs tests showed 50 patients had coagulation disorders,including 29 with non-overt DIC and 21 with overt DIC.The rate of hypercoagulability was significantly higher in non-DIC group than in non-overt DIC group (46％vs.17.2％,P =0.016).The rate of hypocoagulability was significantly higher in overt DIC group than in non-overt DIC group (100％ vs.44.8％,P ＜ 0.01).Patients with hypercoagulation disorders had significantly shorter R (coagulation reaction time) and K (coagulation formation time) and greater α (angle α),MA (maximal amplitude) and CI (comprehensive coagulation index) compared with control group (P ＜ 0.01).According to CCTs results,patients with hypercoagulation had significantly prolonged PT compared with control group (P =0.002).Compared with sepsis group,severe sepsis group had significantly prolonged R and K and lower α,MA and CI (P ＜ 0.01).ROC analysis demonstrated that area under the curve (AUC) of TEG and CCTs variables for diagnosis of severe sepsis were significantly greater than 0.5.Both variables of α (P =0.000 2) and K (P =0.004 1) had significantly greater AUCs compared with Fib.Conclusions There were 72％ septic patients with coagulation disorders.The hypercoagulability occurred earlier in patients with sepsis and the hypocoagulability occurred later in patients with severe sepsis.The TEG may provide important information for clinicians to deal with coagulation disorders in septic children.
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Objective To characterize composition and antibiotic resistance of the pathogens isolated from patients' deep sputum with ventilator-associated pneumonia(VAP) in PICU of our hospital,and give support to the administration of antibiotics early and reasonably in clinic.Methods The study was conducted during the period of January 2009 to December 2013 at PICU of the Children's Hospital of Zhejiang University School of Medicine.One hundred and twenty-one cases of children who conformed to the diagnostic criteria of VAP after treated with ventilator were the object,the endotracheal aspirates were collected and transported to microbiology laboratory within 15 minutes.The pathogens were routinely analyzed and identified with WITEK60 and used Kirby-Bauer method for drug sensitive test,and identified with the special drug-resistant bacteria.Results Among 121 VAP diagnosed patients,127 pathogenic strains isolated from sputum specimen.Gram negative,Gram positive bacteria and fungi accounted for 64.57％ (82/127),29.92％ (38/127)and 5.51％ (7/127) respectively.Acinetobacter baumannii (25.61％,21/127),Escherichia coli (20.27％,17/127),Stenotrophomonas maltophilia (20.27 ％,17/127),Klebsiella pneumoniae (16.22％,12/127) and Pseudomonas aeruginosa (9.46％,11/127) were frequently identified isolates among Gram negative bacteria.The resistant rate of Gram negative bacteria in β lactam antibiotics was 77.62％.Ten strains of Staphylococcus epidermis and 6 strains of Staphylococcus aureus were identified isolates among Gram positive bacteria.Except the sensitive to vancomycin and linezolid,Gram positive bacteria were resistance to cephalosporin and aminoglycosides.All fungi were sensitive to the anti-microbial agents.Conclusion The Gram negative bacteria were more prevalent than Gram positive bacteria and fungi in VAP and show high drug resistance.It is pivotal to administer anti-microbial agents early and reasonably for VAP children.To emphasize surveillance to the antibiotic resistance and grasp the characteristics of the drug resistance are much important to VAP therapy.
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Severe sepsis and septic shock is a clinical syndrome with sequential organ dysfunction or tissue hypoperfusion induce by sepsis.Although early,adequately and rapidly initial resuscitation plays pivotal role in the management,but infusion of albumin,plasma,red blood cell,platelet,gamma globulin and other blood products and the immunological support with ulinastatin combined with thymosin,blood purification and anti CD14 monoclonal antibody therapy also play an important role.
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Objective To observe the curative effect of pulmicort aerosol combined with terbutaline aerosol in the treatment of infants with mycoplasma pneumonia (MP).Methods 240 children with MP were selected and according to the different treatment method,they were divided into the observation group and control group.120 cases in the observation group were treated with pulmicort combined with terbutaline inhalation therapy.120 cases in the control group received budesonide inhalation therapy.Immunological parameters of IgG,IgE and TNF-α level,the main clinical symptoms and clinical efficacy were compared between the two groups.Results Compared with before treatment,IgG significantly increased,IgE and TNF-α level significantly decreased after treatment in the two groups,the differences were statistically significant (t =19.965,10.780,3.468,6.002,5.440,4.885,all P ＜ 0.05).And those in the observation group were better than the control group (t =13.920,4.523,2.729,all P ＜ 0.05).The remis sion time of clinical symptoms such as body temperature,wheezing,cyanosis,cough and pulmonary rales in the observation group were significantly shorter than those of the control group (t =2.991,6.034,4.623,8.562,7.113,all P ＜ 0.05).The obvious effective rate of the observation group was 93.3％,which was higher than 79.2％ of the control group (x2 =8.140,P ＜ 0.05).There were no significant adverse reactions in two groups.Conclusion Budesonide combined with terbutaline atomization inhalation in the treatment of infants with mycoplasma pneumonia has short remission time of clinical symptoms,good efficacy and less adverse reactions,it is worthy of promotion.