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The patients with trauma have a high mortality and disability rate, and the incidence of trauma is increasing year by year.Rapid and accurate diagnosis is the key to improve the prognosis of patients with trauma.The traditional diagnostic imaging techniques are X-ray and CT examination.Although X-ray examination can be completed at the bedside, its sensitivity is not high.The diagnostic sensitivity of CT examination is high, but it can not be completed by bedside.Moreover, the process of repeated transportation of patients will delay the best treatment time, even cause secondary injury.Bedside ultrasound has the advantages of fast, real-time, noninvasive and repeatable operation.With the continuous development of bedside ultrasound technology, it has been widely used in the diagnosis of trauma.This review summarized the clinical applications of bedside ultrasound in trauma patients.
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Pediatric acute lung injury(ALI)is a common disease in pediatric intensive care unit with a high fatality rate.Because the etiology of ALI is complex, the exact pathogenesis of ALI is not clear.At present, it is known that the important factors leading to the incidence of ALI in children are oxidative stress and dysregulation of inflammatory response.Progressive hypoxemia and respiratory distress are the main clinical manifestations of ALI.Respiratory support and drug control are the common treatment measures.In recent years, stem cell and molecular targeted therapy as new treatment pathways of ALI, have achieved certain achievements in the research, and are expected to become new treatment methods of ALI in chidren.
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Severe viral pneumonia in children has become an urgent public health problem in view of its high morbidity and mortality.Neutralizing antibodies, as passive immune agents, can be injected into the body so that the body can quickly obtain immunity against specific viruses and have the potential to prevent and treat severe viral pneumonia in children.This review analyzed the possible mechanisms by which neutralizing antibodies play roles in severe viral pneumonia in children, discussed the shortcomings of existing research and possible challenges, and attempted to point out the direction worthy of future research.
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Children′s unique physiological, developmental and psychological attributes make them one of the most vulnerable groups in large-scale flood disasters.Formulating a reasonable and feasible emergency preparedness plan for flood disasters can improve their ability to cope with flood disasters and optimize the outcomes of children suffering from flood disasters.The emergency preparedness plan for children′s flood disaster should cover the allocation and utilization of various resources during disasters, regional cooperative rescue and evacuation of children, ethical problems in treatment under special circumstances, psychological counseling of children, family members and medical personnel.Relevant staff of pediatric emergency rescue need to consider all aspects and make reasonable plans so that the rescue work of children affected by disasters can be carried out in an orderly manner.
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Thrombotic microangiopathy(TMA) is a group of clinical and pathological syndromes, characterized mainly by hemolytic anemia, thrombocytopenia, and multiple organ dysfunctions caused by a variety of factors.Classic types of TMA include hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura(TTP). HUS is a critically ill glomerular disease.Depending on the pathogenesis, HUS is currently divided into 2 categories, namely typical and atypical HUS.Atypical HUS is at a rapid onset and is a type of dangerous disease, which tends to recur easily, and has high mortality in its acute phase.TTP is a rare but fatal entity of TMA.The pathophysiology of the disease is based on a severe functional deficiency of a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13(ADAMTS-13), the specific von Willebrand factor(VWF)-cleavage protease.This deficiency may be either acquired or congenital.The activity of plasma ADAMTS-13<10%is the only definitive method for diagnosing TTP.This article reports the recent advances on the diagnosis and treatment of severe TMA in children.
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Vitamin D is a necessary fat-soluble vitamin in the body.It is found that not only does vitamin D deficiency associate with infant nutritional rickets, but it can also affect the functions of nervous, respiratory, immune, cardiovascular, endocrine, skin, kidney, and other function of systems.This paper made an overview of factors influencing infant vitamin D levels, including season of birth, sunshine time, eating habits, feeding patterns and prenatal vitamin D supplement dose.Among the above, as the vitamin D deficiency of infants and young children in plateau areas is quite special, thus it is emphasized in this review, in order for prevention and treatment of vitamin D deficiency.
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In recent years, domestic and foreign studies have found that vitamin D deficiency is widespread in adults and children.Neonates and pregnant women are at high risk of vitamin D deficiency.Vitamin D deficiency during pregnancy is associated with adverse pregnancy outcomes, such as premature birth, limited fetal growth and also has an adverse impact on the development of neonatal nervous system and respiratory disease susceptibility.This paper reviews the effects of vitamin D deficiency on neonates during pregnancy.
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Objective To investigate the effects of bone mesenchymal stem cells(BMSC) on the expression level of inflammatory factors IL-1beta and IL-10 from young rats with acute lung injury(ALI).Methods Seventy-two SPF male SD young rats were randomly divided into three groups:control group,disease model group(model group),disease model + BMSC(treatment group).Each group was then randomly divided into four subgroups according to the treatment phages.The juvenile rat ALI models were established.BMSC was injected into the treatment group,and DMEM was injected into the model and the control groups.Then,the pathological changes of lung tissues were observed.The W/D ratio,the neutrophil count and protein content in bronchoalveolar lavage fluid(BALF) were measured.The changes of IL-1beta and IL-10 contents were detected.Results Compared with the control group and the treatment group,the number of neutrophils,total protein content and W/D ratio of BALF lung tissue in the model group increased significantly in each period(P ＜ 0.05).The degree of lung injury in the treatment group was significantly weaker than that in the model group.The levels of IL-1beta and IL-10 in serum decreased in different treatment periods(48 hours vs 6 hours,P ＜0.05).In model group,IL-1beta was abundantly expressed in the cytoplasm and wall of alveolar epithelial cells,while in treatment group,the expression intensity of IL-1 beta protein was significantly decreased.The levels of IL-1 beta and IL-10 protein in lung tissues of model group were significantly higher than those of control group(P ＜0.05).Conclusion BMSC has an important effect on the expression of inflammatory factors IL-1beta and IL-10 in ALI young rates.BMSC can alleviate the inflammatory reaction of long injury and participate in the repair of lung iniury.
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Objective To investigate the status of clinical nutrition management in patients in PICU,and to provide data for promoting the improvement and development of clinical nutrition of pediatric critically ill patients.Methods A questionnaire survey was conducted on PICU specialists.The nutrition assessment,nutrition intervention and nutrition management of critically ill children in PICU were investigated.The results were summarized and analyzed.Results A total of 39 PICU specialists were involved in this survey.The nutritional assessment methods and guidelines in domestic PICU were not unified.Twenty-five respondents (64.1%) believed that both clinical performance and the scales as the basis can decide whether the patients should be fed or not;all respondents believed that nutritional assessment and intervention time need to be determined by the needs of the patients;23 respondents(58.9%) used weight only as their nutritional monitoring indicators.Twenty-eight respondents(71.8%) considered that gastric tube was the first choice way to feeding for the critically ill children;20 respondents(51.3%) believed that critically ill children should be fed within 24 hours.Twelve respondents (33.3%) believed that critically ill children should be fed between 24 to 48 hours.Thirty-three respondents(84.6%) advocated early enteral nutrition;36 respondents (92.3%) considered that the main reasons of fasting in critically ill children were vomiting or abdominal distension or gastrointestinal bleeding.Twenty-eight respondents(71.8%) believed that according to the results of gastrointestinal function evaluation,they made decisions whether the patient to fast or not.Twenty-three respondents(59.0%) considered that specialists in PICU were the decision maker of the clinical nutrition in critically ill children.Twenty-four (61.5%) of the respondents believed that we needed to establish our own routines in management of nutrition in PICU.Conclusion At present in China,a lot of achievements have been made in the nutritional assessment,monitoring,early enteral nutrition intervention and management in critically ill children,but it is not enough.We need to make more effort to enhance the critically nutrition level in PICU,and we have a lot of research to do about nutrition assessment and nutrition intervention mode.It is recommended to establish Chinese guidelines or consensus to enhance the level of nutritional treatment of critically ill children.
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Objective To explore the relationship between pathogen and disease characteristics of community-acquired bacterial bloodstream sepsis in PICU.Methods The clinical data of children diagnosed as sepsis admitted to the PICU of Shengjing Hospital of China Medical University between June 2011 and June 2016 were retrospectively analyzed.Medical records were screened to confirm the diagnosis of commu-nity-acquired bacteria bloodstream sepsis.Results One hundred and ninety-one children(108 males and 83 females) had confirmed community-acquired bacteria bloodstream sepsis with the following characteristics:167 patients(87.4%) with the age less than 36 months,50 patients(26.2%) with co-existing disease,40 pa-tients(20.9%) with shock,of which 33 patients had septic shock,and 41 patients(21.5%) died.Gram-posi-tive bacteria was the predominant pathogen(73.3%,140/191).Streptococcus pneumoniae was the primary pathogen(19.9%,38/140). Conclusion Community-acquired bacteria bloodstream sepsis in PICU most commonly affects children less than 36 months of age.Gram-positive bacteria are the predominant pathogenic bacteria,the most common pathogens are Streptococcus pneumoniae,Staphylococcus epidermidis,Staphylo-coccus aureus,Streptococcus pyogenes and Escherichia coli.The highest mortality rate in septic children is caused by Pseudomonas aeruginosa.Children with co-existing disease,sepsis complicated with shock and pa-tients requiring mechanical ventilation are risk factors for death.
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Objective To study the nutritional status and influencing factors of children aged 1-36 months in Naqu People′s Hospital of Tibet Autonomous Region of China,and to provide reference for further improvement of their physical quality and health level.Methods The infants and young children hospitalized from January 2015 to December 2016 were enrolled in the study.The basic information were collected,which included gender,age,weight,height,diseases,feeding patterns,adding supplementary time,etc.The Z-score of the indicators for the growth and development of children recommended by WHO were evaluated,and the children′s malnutrition status and its influencing factors were analyzed.Results A total of 1 371 infants were included in the study,which included 753 male infants and 618 females,with a ratio of 1.2 to 1.The rates of growth retardation,low weight and weight loss were 25.31%(347 cases),18.75%(257 cases) and 6.13%(84 cases),respectively.There was no significant difference in the incidence of growth retardation,low body weight and weight loss among infants and young children with different months of age (1 to 6 months,7 to 12 months,13 to 24 months,25 to 36 months).The feeding mode and the time of addition of the supplemen-tary food (tsamba paste) had a significant effect on the incidence of malnutrition in infants less than 6 months old.The incidence of malnutrition in infants with exclusive breastfeeding was lowest (28.88%,93/322).The earlier the tsamba paste was added,the higher the incidence of malnutrition.Conclusion The in-cidence of malnutrition in infants and young children in Naqu People′s Hospital is high.Correct feeding con-cept should be paid attention to.Early breastfeeding and adding supplementary food rationally for infants and young children are very important,which is beneficial to promote their nutritional status and improve the health.
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High volume hemofiltration(HVHF) is an important development in the field of blood purification,which has a significant effect on the stability of hemodynamics,clearance of inflammatory factors and metabolic toxins in the body. HVHF also has some drawbacks in the treatment. At present,HVHF has an increasingly wide application in pediatric critical diseases,such as systemic inflammatory response syndrome, sepsis or septic shock,multiple organ dysfunction syndrome,acute kidney injury,acute poisoning,etc. It has become an important treatment in pediatric emergency medicine.
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Objective To observe and discus the clinical features and outcome of aseptic encephali-tis in children. Methods One hundred and one cases treated in PICU of Shengjing Hospital of China Medi-cal University and diagnosed with aseptic encephalitis from December 2009 to December 2012 were enrolled. Results The clinical manifestations, signs, laboratory examinations and outcome were analyzed retrospec-tively. Among them, 54 cases were male,47 cases were female,12 cases aged from 1 month old to 6 months old,12 cases aged from 7 months old to 1 year old,36 cases aged from 2 years old to 3 years old,12 cases aged from 4 years old to 6 years old,19 cases aged from 7 years old to 14 years old. The fever was the most common clinical manifestation, a total of 92 cases ( 91. 1%) , followed by convulsions, a total of 79 cases (78. 2%),63 cases with meningeal irritation or pathological signs positive(62. 4%). The sensitivity of elec-troencephalography( EEG) was the highest for diagnosis of aseptic encephalitis,89 cases underwent EEG with abnormal rate of 84. 3%(75/101). Followed by head MRI scan,97 cases underwent head MRI scan with ab-normal rate of 55. 7%(54/101). All cases underwent cerebrospinal fluid examination,50 cases with white blood cells and(or) protein increased(49. 5%). The sensitivity of head CT scan was the lowest,the abnor-malities were found in 11 cases ( 17. 5%) among 63 cases underwent head CT scan. All cases were given comprehensive treatment of sedation, antifebrile, reducing intracranial pressure and nerve nutrational treat-ment. Seventy cases were cured,20 cases left neurological sequelae,7 cases gave up treatment,4 cases died. Conclusion The children aseptic encephalitis occurs in infants and young children,the incidence of male and female are equal. The clinical manifestations are diverse,the most common manifestations are fever and con-vulsion,EEG and MRI are with high sensitivity. Most patients have good outcome if received symptomatic treatment early. A few cases left neurological sequelae,such as consciousness and dyskinesia. Respiratory fail-ure,neurogenic shock,eventually death would occour if the brainstem was involved.
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Objective To reduce the incidence rate of sepsis caused by multidrug-resistant acinetobacter baumanni and provide the basis for clinical antibiotics use.Methods It is one retrospective case-controled study.Thirty-six patients with multidrug-resistant acinetobacter baumanni infection(case group) and 42 patients with non-multidrug-resistant acinetobacter baumanni infection(control group) admitted in PICU during 2009 to 2013 were enrolled in the study.Seven high risk factors including the irrational antibiotics use,the length of hospital stay,tracheal intubation,the length of mechanical ventilation,the basic diseases (hematologic malignancies,congenital heart disease,inherited metabolic diseases),use of central venous catheters and the length of using central venous catheters were analyzed.The drug sensitivity of multidrug resistant acinetobacter baumanni was detected.Results There were significantly differences in 7 high risk factors between case group and control group,including irrational antibiotics using (29 cases vs.18 cases),the length of hospital stay ＞7 d(35 cases vs.12 cases),tracheal intubation(22 cases vs.8 cases),mechanical ventilation ＞ 7 d (19 cases vs.2 cases),basic diseases (9 cases vs.3 cases),using of central venous catheters (18 cases vs.2 cases) and central venous catheters using ＞ 7 d(9 cases vs.1 cases) ;multidrug resistant acinetobacter baumanni had high resistance against penicillins,cephalosporins,aminoglycesides,quinolones,sulfonamides (94.87％,74.36％,76.92％,65.38％ and 56.41％),but had high sensitivity to carbapenems and tetracyclines (55.56％ and 77.78 ％).Sixteen cases infected with pandrug resistant acinetobacter baumanni infection (44.44％),4 cases infected with whole drugresistant acinetobacter baumanni (11.11％).Conclusion The irrational antibiotics use,the length of hospital stay,tracheal intubation,the length of mechanical ventilation,the basic diseases,central venous catheters and the length of using central venous catheters are the high risk factors of spesis caused by multidrug resistant acinetobacter baumanni; only carbapenems and tetracyclines can keep high sensitivity rate to multidrug resistant acinetobacter baumanni among clinical antibiotics.
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Klebsiella Pneumoniae is a opportunity infection and nosocomial infection bacteria in Enterobacteriaceae,which can lead to serious infection or death.Klebsiella Pneumoniae leads to increased infections proportion in recent years,which resisits to many common antibiotics.Clinical drug resistant strains include Carbapenem-resistant Klebsiella Pneumoniae,Multidrug-resistant Klebsiella Pneumoniae,Extensively drug resistant bacteria and Pandrug-resistant Klebsiella Pneumoniae.Researches beared out that the risk factors of acquiring nosocomial infection of Klebsiella Pneumoniae are state of an illness,time of hospitalization,mechanical ventilation,the kind and number of antibiotics.
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Objective To explore the change of serum procalcitonin (PCT)in infectious diseases and the relationship between PCT and the severity of illness in children.Methods This was a single-center prospective study of serum procalcitonin concentration in children with infectious diseases.Ninty-five children with infectious diseases (mycoplasma infection 30 cases,viral infection 30 cases,bacterial infection 35 cases),hospitalized in PICU of Shengjing Hospital from April 2011 to April 2013,were divided into three groups:non-serious group(64 cases),serious group(20 cases)and very serious group(11 cases)according to pediatric critical illness score(PCIS).Bacterial infectious patients were divided into two groups:gram positive bacterial group(20cases),gram negative bacterial group(15 cases).Twenty children of non-infectious diseases during the same period were selected as the control group.Serum PCT levels were detected by using VIDAS BRAHMS PCT detection system(rapid semi-quantitative PCT test).Laboratory detection was conducted in Department of Laboratory Medicine,Shengjing Hospital of China Medical University.Results The serum PCT levels of the control,the bacterial infection,virus infection,and mycoplasma infection group were (0.41 ± 0.34) μg/L,(2.56 ± 0.38)μg/L,(0.52 ±0.44) μg/L and(0.21 ±0.10) μg/L.The serun PCT levels higher than or equal to 0.5 μg/L were defirned as positive.There was significant difference in PCT positive rate between bacterial infection group and the control grouP(x2 =28.05,P ＜0.05).The serum PCT levels of children with infectious diseases were higher than those of non-infection group,mycoplasma infection group and virus infection group(P ＜ 0.05).Besides,the PCT value of gram negative bacillus infection group was also obvious higher than gram positive infection group.There was no significant difference among the non-infection group,mycoplasma infection group and virus infection group(P ＞ 0.05).There was significant negative correlation between the serum PCT concentration and the PCIS score in children with infectious diseases (r =-0.579 ～-0.793,P ＜ 0.05).The higher concentration of PCT in children with the infectious diseases indicated higher severity illness scores,more complications,and longer length of hospital stay.Conclusions PCT may provide an informative and sensitive molecular marker for pathogen identification (bacterial infection,pneumonia mycoplasma infection or viral infection).In the early diagnosis of infectious disease,PCT assay can help predict the severity of the disease.
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Antibiotics are commonly used in Pediatric Intensive Care Unit.Diarrhea is clearly one of the most common side effects encountered with antibiotic therapy.Most cases of antibiotic-associated diarrhea can be classified in two categories:cases in which Clostridium difficile is implicated and cases in which no putative agent or recognized pathophysiological mechanism is clearly established.In most cases of antibiotic-associated diarrhea in which Clostridium difficile is not detected,no etiologic agent is identified,and diarrhea is usually mild and self-resolving.As the cause of approximately 25％ of all cases of antibiotic-associated diarrhea,Clostridium difficile is responsible for almost all cases of pseudomembranous colitis and many instances of severe antibioticassociated diarrhea.For that reason,the term antibiotic-associated diarrhea is often considered synonymous with Clostridium difficile-associated diarrhea.Through a comprehensive review of current medical literature,this article provides an update on pathogenesis,diagnostics as well as therapeutic and prevention strategies,which may be helpful in clinical prctice.
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Objective To observe the clinical effect of plasma exchange(PE) combined with continuous veno-venous hemodialysis filtration(CVVHDF) in children with acute liver failure.Methods Thirty-nine cases with acute liver failure admitted to pediatric intensive care unit of Shengjing Hospital Affiliated to China Medical University from August 2008 to January 2014 were treated with PE combined with CVVHDF.CVVHDF was performed after PE immediately,each PE + CVVHDF lasted 24 ～ 72 hours.Prothrombin time,blood ammonia,alanine transaminase,aspartate transaminase,serum total bilirubin,conjugated bilirubin were detected before and after PE + CVVHDF treatment.Glasgow Coma Scale were assessed before and after PE +CVVHDF in the thirty-five cases with hepatic encephalopathy.Results After the treatment of PE + CVVHDF,20 children were clinical recover,7 died,12 abandoned the treatment and the results of follow-up were death.PE + CVVHDF was effective in the treatment by decreasing serum total bilirubin,conjugated bilirubin,alanine transaminase,aspartate transaminase [(128.8 ± 82.6) μmol/L vs (73.2 ± 92.4) μmol/L; (90.2 ±71.5) μmol/L vs (55.1 ± 42.6) μmol/L; (3 024.1 ± 2 457.0) U/L vs (1 256.8 ± 757.8) U/L; (3 420.6 ±2 216.3) U/L v s (579.4 ± 338.6) U/L] (P ＜ 0.05),increasing Glasgow Coma Scale (9.5 ± 3.1 vs 12.1 ±2.9) (P ＜0.01),shortening prothrombin time[(40.4 ± 23.0) s vs (22.8 ±9.4) s] (P ＜0.01),in association with the improvement of hemorrhage tendency.Conclusion PE + CVVHDF significantly improves clinical symptoms and biochemical abnormalities in children with acute liver failure.Security of PE + CVVHDF is good and with no obvious adverse reactions.
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Objective To explore the changes in expression levels of nuclear factor(NF)-κB,tumor necrosis factor(TNF)-e in the lungs of juvenile mice with acute lung injury(ALI) induced by lipopolysaccharide(LPS).And observe the repair of lung damage after intervening with exogenous mesenchymal stem cells(MSCs).Methods Thirty male juvenile C57 mice were randomly divided into the control group,the ALI group,and the ALI + MSCs group by the random number table method.Mice from each group were euthanized at 12 h and 48 h.The ALI model of juvenile mice was established by intraperitoneal injection of LPS 10 mg/kg.MSCs from mice bone marrow were isolated,cultured and amplified in vitro,and the MSCs (1 × 106/ml) 0.1 ml were given to mice via caudal vein.MSCs marker were identificated by flow cytometry.Pathomorphological changes of mice lung were observed under light microscope after Hematoxylin-Eosin staining.The protein expression changes of NF-κB,TNF-α were observed using immunohistochemistry.Resu]ts Compared with the control group,the protein expression levels of NF-κB,TNF-α were significantly higher at 12 h and 48 h in the lungs of the ALI group(P ＜ 0.05).While those in ALI + MSCs group were markedly lower at these time points than the ALI group [NF-κB:12 h:(0.181 ± 0.008) OD vs (0.203 ±0.008) OD,48 h:(0.197 ± 0.002) OD vs (0.210 ± 0.005) OD; TNF-α:12 h:(0.185 ± 0.004) OD vs (0.201 ± 0.011) OD,48 h:(0.185 ± 0.002) OD vs (0.215 ± 0.009) OD] (P ＜ 0.05).Histopathological evalution showed that typical pathological inflammation lesions in the lung were observed in ALI group,including alveolar congestion,hemorrhage,edema,infiltration of neutrophils in the airspace or vessel wall,thickness of the alveolar wall;pathological changes were relieved obviously in ALI + MSCs group.Conclusion The expression of NF-κB and TNF-α are increased in lung tissues in the juvenile mice model of ALI induced by LPS.MSCs can alleviate injury degree of ALI induced by LPS in mice,the mechanism of action may correlate with decreasing NF-κB and TNF-α content in lung tissue.
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Objective To investigate the clinical characteristics of invasive pneumococcal disease (IPD) and its drug resistance among children under the age of 5 years.Methods Clinical characteristics of 45 children of IPD admitted to the Shengjing Hospital of China Medical University from 2009 to 2010 and antimicrobial non-susceptibility results were analyzed retrospectively.Results Forty-five cases of IPD were confirmed by positive culture of sterile body site,most of which occurred between April and June.Most of the IPD children were below the age of 2 years,which accounted for 66.7％ (30/45).The disease spectrum included bacteremia in 32 cases (71.1％),encephalitis in 9 cases (20.0％),empyema in 23 cases (51.1％),necrotizing pneumonia in 10 cases (22.2％).Pneumococcal non-susceptibility to erythromycin were found to be 100％,to clindamycin were 95％,to tetracycline were 95.12 ％,to trimethoprim-sulfamethoxaole were 80.49％,to chloramphenicol were 18.18％,while pneumococcal resisitanse to rifampicin,quinolones and vancomycin were 0.Eight of eleven and 18/24 were found to be pneumoccal resistance to penicillin and cephalosporin respectively and their minimum inhibitory concentrations were high.Twenty five cases were cured (55.6％).Fifteen cases were improved (33.3％).Four cases died (8.9％).One cases was retreated.All cases of death were under the age of 2 years.Conclusion IPD is more common with a high mortality rate among those under the ages of 2 years.Poor outcome is associated with Streptococcus pneumoniae resistance to antibiotics.