Observation of tigecycline treatment for children with severe infection / 中国实用儿科杂志

OBJECTIVE: To evaluate the efficacy and safety of tigecycline therapy in children with severe infection.METHODS: We conducted a restrospective chart review of 114 children with severe infection in a tertiary hospital from May 1,2012 to April 30,2017. Inclusion criteria: receiving tigecycline administration for at least 2 days(4 doses). Clinical data and laboratory results were recorded before and after the therapy. RESULTS: Totally 114 children were enrolled,including 47 patients diagnosed with Acinetobacter baumanmii infection,with 52 Acinetobacter baumanmii strains. The in-hospital mortality was 23.4%. Median duration of tigecycline treatment was 13 days(2.5-13.5 days). Median duration of antibiotics prior to tigecycline treatment was 9 days(2-27 days). The total clinical improvement rate was 47.3%,and the etiological eradication rate was 38.9%. After treatment 24 cases got clinically improved in 47 patients and 26 strains were eradicated. No serious adverse effect was reported. CONCLUSION: The efficacy and safety of tigecycline should not be overvalued. Additional data from randomized controlled trials are required to assess the administration of tigecycline.

Emergency use of extracorporeal membrane oxygenation in pediatric critically ill patients / 中华儿科杂志

<p><b>OBJECTIVE</b>The history of clinical application of extracorporeal membrane oxygenation (ECMO) has been more than 30 years. But in China, there were only a few ECMO centers with limited successful cases reported by the end of twentieth century. The high morbidities and mortalities in current pediatric ECMO practice are noted in China. Therefore, it is necessary to review the experience on rescue use of ECMO in critically ill pediatric patients.</p><p><b>METHOD</b>A retrospective analysis was done for patients who had been receiving ECMO treatment to rescue refractory cardiorespiratory failure from different causes in a hospital between July 2007 and May 2011.</p><p><b>RESULT</b>A total of 12 patients were treated with ECMO; 7 of them were male and 5 female, they aged 6 days to 11 years, weighed 2.8 - 35 (17.21 ± 11.64) kg. The underlying causes of cardiorespiratory failure were as follows: two cases with acute respiratory distress syndrome (ARDS) leading to respiratory failure, 4 with failure of weaning from cardiopulmonary bypass, 3 with fulminant myocarditis, 1 with right ventricular cardiomyopathy leading to repeated cardiac arrest, 1 with preoperative severe hypoxemia, and 1 with anaphylactic shock complicated with massive pulmonary hemorrhage and severe hypoxemia. Of the 12 cases, 3 were established ECMO (E-CPR) while underwent chest compression cardiopulmonary resuscitation (CPR). The mean ECMO support time was 151.75 (15 - 572) h. Seven patients (58.33%) were weaned from ECMO, 6 patients (50.00%) were successfully discharged. Six cases had bleeding from sutures, 2 cases with severe bleeding underwent thoracotomy hemostasis, 2 presented with acute renal failure. Infection was documented in 3 cases, hyperbilirubinemia in 2 cases, lower limb ischemia in 1 case, hyperglycemia in 3 cases, disseminated intravascular coagulation in 1 case, membrane lung leakage in 2 cases, systemic hemolysis in 3 cases, oxygenator failure in 2 cases and oxygenator thrombosis in one case. During the follow-up between 6 months and 4.5 years, 5 patients survived with good quality of life, without any documented central nervous system disorders. One case survived with the right lower extremity disorder from ischemic damage. His motor function has been improved following orthopedic operation at one year after discharge.</p><p><b>CONCLUSION</b>ECMO is a justifiable alternative treatment for reversible severe cardiopulmonary failure in critically ill children.</p>

Application of flow cytometry to detect PP65 antigenemia for diagnosis and monitoring of human cytomegalovirus infection / 中华儿科杂志

<p><b>OBJECTIVES</b>To evaluate the clinical significance of flow cytometry (FCM) to detect the cytomegalovirus (CMV) PP65 antigen in patients with CMV infection.</p><p><b>METHODS</b>Samples from 35 patients without CMV infection were used as negative control. The definite diagnosis of CMV infection was based on the national criteria for CMV infection. All 136 patients with CMV infection were examined with the FCM to detect CMV PP65 antigen, real-time fluorescence quantitative-polymerase chain reaction assay (RFQ-PCR) to detect CMV-DNA and ELISA to measure the serum level of IgM antibody against CMV. The results of these 3 assays in 2 groups (isolated organ involvement and disseminated diseases) were compared and the significance of PP65 antigenemia was evaluated. A short-term follow-up was undertaken in 18 patients.</p><p><b>RESULTS</b>The percentages of PP65 positivity in blood mononuclear cells (MNC) and polymorphic nuclear leukocyte (PMNL) from 35 negative control patients were 0.21% +/- 0.09% with a range of 0 - 0.41% and 0.24% +/- 0.10% with a range of 0.12% - 0.48%, respectively, which were not significantly different (t = 0.425, P > 0.05). The 95(th) percentiles (P(95)) of PP65 in MNC and PMNL were 0.39% and 0.45%, respectively, so a cutoff value of >/= 0.50% was set. Of the 136 patients with CMV infection, 118 samples from 118 patients were positive for PP65 antigenemia with a positive rate of 86.8%, which was not statistically different from that (90.4%, chi(2) = 0.91, P > 0.05) of CMV-DNA detected by RFQ-PCR assay but it was significantly higher than that (45.6%, chi(2) = 51.50, P < 0.005) of the detection by IgM measurement. PP65 detection was correlated with urine CMV DNA amplification (chi(2) = 63.78, P < 0.01) while the different detection rates between the two assays were not statistically significant (chi(m)(2) = 1.78,P > 0.05). PP65 detection was not correlated with serum IgM measurement while the detection rates between the two were significantly different (chi(m)(2) = 52.92,P < 0.01). No significant difference was found between the detection rates of CMV infection in MNC (45/53, 84.9%) and PMNL (43/53, 81.1%) (chi(m)(2) = 0.25, P > 0.05). Higher PP65 antigenemia level was correlated with systemic CMV infection, while lower level of PP65 was either in the patients with isolated organ involvement by CMV (chi(2) = 38.51, P < 0.005) or less severe in patient's situation. PP65 antigenemia of CMV infection returned to lower level or negative in recovery stage and increased when condition of patients deteriorated.</p><p><b>CONCLUSIONS</b>PP65 antigenemia detection by FCM is effective in the diagnosis of the active CMV infection. Quantitative monitoring of PP65 antigenemia is useful in the evaluation of patients with CMV infection.</p>

Clinical observation on acupoint electro-superconducting therapy with Cinese herbal drugs contained pad in treating children asthma / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the mechanism of acupoint electro-superconducting therapy with Chinese herbal drugs contained pad in treating children asthma.</p><p><b>METHODS</b>Sixty asthma children in the mild to moderate stage of asthma attack were randomly divided into two groups, the treated group and the control group. Besides the basic treatment, acupoint electro-superconducting therapy with the pad containing Chinese herbal drugs was applied to the treated group, and to the control group the same therapy but with pad of placebo was applied, seven days as a course of treatment. The peak exhalation force (PEF) was measured daily, and the cytokines, interleukin-10 (IL-10) and interferon-gamma (IFN-gamma) were determined before and after treatment.</p><p><b>RESULTS</b>No significant difference was found in the ratio of patients' PEF to the normal predicted value between the two groups before treatment (P > 0.05). But on the fourth day of the treatment course, the increase of PEF in the treated group was more obvious than that in the control group (P < 0.05). The IL-10 levels of two groups were raised after ending the treatment course, but the increment in the treated group was more obvious (P < 0.01). However, the changes of IFN-gamma levels after treatment showed insignificant difference between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>Acupoint electro-superconducting therapy with Chinese herbal drugs contained pad is helpful to improve the pulmonary function of children with asthma, it could also increase the serum IL-10 level in attack stage of the asthma children.</p>

Blue light source in phototherapy / 浙江大学学报·医学版

OBJECTIVE: To explore the efficacy of blue light-emitting diodes(LEDs) as a novel light source for phototherapy. METHODS: Equimolar bilirubin standard albumin solutions were irradiated with two light sources; LEDs and single side conventional blue light( sCBL). Light intensity was measured with a light meter. The emission intensity of LEDs was the same as sCBL. To estimate the effects of the two light sources, the change in bilirubin isomer before and during phtotherapy was determined using high-performance liquid chromatography. RESULTS: The effects of different light sources on equimolar bilirubin standard albumin solutions, the lumirubin (LR) and 4Z, 15E-Bilirubin IX alpha(ZE) formation of LEDs was the same as sCBL(P>0.05). CONCLUSION: LEDs is equally effective as single sCBL for phototherapy in vitro.