ABSTRACT
Objective:To study the clinical features of children with pertussis and the risk factors of severe pertussis.Methods:A retrospective analysis was performed based on clinical data and laboratory examination results of hospitalized children with pertussis who admitted to the intensive care unit, respiratory department, and emergency general department at Hunan Children′s Hospital from January 2019 to March 2020.According to the age, the patients were divided into age ≤3 months group( n=58)and age >3 months group( n=64). According to sputum culture, 63 cases were divided into negative sputum culture group and 59 cases were positive sputum culture group.The patients were also divided into vaccinated group( n=19)and unvaccinated group( n=103). Severe disease was seen in 28 cases, and the other 94 cases had the modest disease.The clinical characteristics between two groups were compared, and the risk factors of severe pertussis pneumonia were analyzed. Results:The hospitalization days in age ≤3 months group was higher than that in age >3 months group.It was also found that shortness of breath, apnea, cyanosis after coughing, heart rate decline were more common in age ≤3 months group than those in age >3 months group( P<0.05). The incidences of respiratory failure and heart failure in positive sputum culture group were higher than those in negative sputum culture group.Clinical characteristics such as hospitalization days, hospitalization expenses, peak white blood cell count, peak lymphocyte count, and incidence of bacterial infection were higher in severe pertussis group than those in non-severe pertussis group( P<0.05). Four patients were treated with exchange blood transfusion, and one patient died.Logistic regression analysis revealed that fever, wheezing, cyanosis after coughing and white blood cell count>20×10 9/L were risk factors for severe pertussis.White blood cell count of 20×10 9/L and lymphocyte count of 14×10 9/L had the highest sensitivity and specificity in predicting severe pertussis(0.71, 0.78; 0.54, 0.79). Conclusion:The younger the children are, the more likely they have shortness of breath, apnea, cyanosis, heart rate falls, and the longer the hospital stay.Bacterial infection will aggravate pertussis.Patients with fever, wheezing, cyanosis after coughing, and white blood cell count>20×10 9/L are more likely to develop severe pertussis.The white blood cell count >20×10 9/L and the lymphocyte count >14×10 9/L are associated with severe pertussis.
ABSTRACT
Objective To compare the clinical efficacy of different blood purification methods in children with acute liver failure,and to explore the clinical application mode,time and prognosis of blood pur-ification in children with acute liver failure. Methods The clinical data of 85 children with acute liver failure admitted to PICU of Hunan Children′s Hospital from January 2010 to October 2016 were retrospectively ana-lyzed. Sixteen patients were treated with general integrated medical treatment(conservative group). Twenty-seven patients were treated with continuous venovenous hemodiafiltration ( CVVHDF) model non-biological artificial liver on the basis of general integrated medical treatment(CBP group). Sixteen cases were treated with plasma exchange ( PE group). Twenty-six cases were treated with plasma exchange combined with CVVHDF mode (combination group). The main biochemical indexes,coagulation function,model for end-stage liver disease(MELD) score and delta MELD before and after treatment among groups were compared. Results Compared with those before treatment,the improvement of liver function and prognosis in the con- servative was not significant after treatment. There were significant differences in the improvement of liver function and prognosis among the other three groups treated with non-biological artificial liver. Comparing the biochemical indexes and prognosis of three groups of children treated with different modes of non-biological artificial liver,there was no significant difference in the total effective rate between PE group and CBP group [56. 3% (9/16) vs 55. 6% (15/27),P>0. 05]. The total effective rate of combined group[84. 6% (22/26)] was significantly higher than those of PE group and CBP group. There was no significant difference in the improvement of liver function between PE group and CBP group (all P>0. 05),but the indexes of liver function in combined group were significantly lower than those in PE group and CBP group ( P<0. 05). It significantly increased prothrombin activity,albumin and alpha-fetoprotein levels(all P<0. 05). At the same time,procalcitonin, sequential organ failure assessment scores, pediatric end-stage liver disease scores and MELD scores in the death group were significantly higher than those in the survival group,and there were significant differences between the two groups. However,the effect of non-biological artificial liver was not good in the subgroups of MELD<25 and MELD>40. Conclusion PE and CBP have a good effect on chil-dren with acute liver failure,and if combined with the two methods can improve the therapeutic effect. At the same time,MELD score should be monitored in children with acute liver failure,and non-biological artificial liver therapy should not be recommended for children with MELD<25 and MELD>40.
ABSTRACT
Objective To explore the application value of the FilmArray detection system in the diagnosis and treatment of severe pneumonia in children,and to understand the pathogenic characteristics of severe pneumonia in children.Methods A tolal of 158 nasopharyngeal swab specimens were collected from children with severe pneumonia in Hunan Children's Hospital from May 2017 to March 2018.FilmArray were used to detect respiratory pathogen.Blood routine,C-reactive protein (CRP),procalcitonin (PCT) and seven kinds of respiratory virus antigen were also performed on all the samples.The pathogenic characteristics of 158 cases of severe pneumonia were analyzed,and the positive rate of seven kinds of respiratory virus antigen test method and FilmArray were statistically analyzed.Results Among 158 patients with severe pneumonia,114(72.15％) were positive and 91 (57.59％) single pathogen infection were detected by FilmArray,with the highest detection rate of rhinoviruses/enteroviruses (16.46％).23(14.56％) mixed infection were detected by FilmArray,respiratory syncytial virus combined with adenovirus infection had the highest positive rate (2.53％).The detection of respiratory pathogens in different age groups was analyzed.The highest positivity rates of children aged ＜ 1 years were human rhinovirus/enterovirus and respiratory syncytial virus (25％),＞ 1-3 years was human rhinovirus/enterovirus (25％),3-5 years were influenza virus A and adenovirus (27.27％),＞ 5 years was human rhinovirus/enterovirus (26.08％).Among 158 patients,53(33.54％) had bacterial infection,and the most common bacterial infection was Streptococcus pneumoniae (7.59％).In seven respiratory virus antigen test negetive children,PCT in Film Array negative group was higher than that in Film Array positive group (P =0.03).The positive rate of FilmArray was higher than that of the seven respiratory virus antigen test method (72.15％ vs 19.62％,P ＜0.01).The level of white blood cell and cough days in pertussis group were higher than that in non-pertussis group,which was significantly different (P ＜ 0.01).The PCT level in non-pertussis group was higher than that in pertussis group,with significant difference (P ＜ 0.01).Conclusions FilmArray detection can detect 20 kinds of respiratory tract pathogens rapidly and accurately.The positive rate of detection is high,and the diagnosis rate of virus is improved.The combination of infection indicators and sputum culture results by clinicians can better guide the clinical diagnosis and treatment.
ABSTRACT
OBJECTIVE@#To study the effect of different energy feeding patterns on the nutritional status, clinical course, and outcome of children with congenital heart disease (CHD) and severe pneumonia.@*METHODS@#A total of 43 malnourished infants, aged 0.05). At discharge and 1 and 3 months after surgery, the control group had significantly higher degree of malnutrition and level of nutritional risk than the observation group (P<0.05). The analysis of variance with repeated measures showed significant differences in body weight, upper arm circumference, weight-for-age Z-score, height-for-age Z-score, weight-for-height Z-score, and albumin level at different time points and between different groups, and there was an interaction between group factors and time factors (P<0.05). Compared with the control group, the observation group had a significantly lower average daily intake of fluid, a significantly higher average daily intake of energy, and a significantly lower incidence rate of insufficient feeding during hospitalization (P<0.05). Compared with the control group, the observation group had significantly shorter length of hospital stay, duration of mechanical ventilation, and duration of postoperative pyrexia, as well as significantly lower hospital costs (P<0.05). No significant adverse reactions were observed in either group.@*CONCLUSIONS@#An appropriate increase in postoperative energy supply for children with CHD can improve the status of malnutrition and clinical outcome.
Subject(s)
Humans , Infant , Energy Intake , Heart Septal Defects, Ventricular , Therapeutics , Nutritional Status , Pneumonia , TherapeuticsABSTRACT
Objective To study the clinical data of patients treated with nasal continuous positive airway pressure (NCPAP) in PICU,and to explore the application time and range of NCPAP in critically ill children. Methods A prospective study was conducted to collect clinical data of 192 severe patients admitted to PICU from January 2016 to June 2017 who had shortness of breath after giving oxygen through nasal cath-eter for 1 hour and then switched to NCPAP. According to using NCPAP oxygen partial pressure,children were divided into three groups:group A[ shortness of breath ( PaO2≥70 mmHg,1 mmHg＝0. 133 kPa) ], group B[shortness of breath combined,reduced oxygen partial pressure(50mmHg<PaO2<70 mmHg)],and group C[shortness of breath combined respiratory failure(PaO2≤50 mmHg)]. The indicators of three groups of children at different time points of NCPAP were compared. Results Among 192 children,161 (83. 85%) had respiratory diseases,14 (7. 29%) had severe hand-foot-mouth disease,10 (5. 21%) had severe sepsis, and 7 (3. 65%) had other multiple organ disorders. PaO2/FiO2gradually increased after using NCPAP for 1 hour and 4 hours,and the improvement of oxygenation in group A was most obvious,there was significant difference among the three groups (P<0. 05). There were significant differences in heart rate,shortness of breath after using NCPAP for 1 hour and 4 hours among the three groups (P<0. 05). There were 2 cases of ventilation failure in group A (failure rate 3. 57%),9 cases (11. 11%) of ventilation failure in group C,30 cases (54. 55%) of ventilation failure in group C,and there was significant difference in the failure rate of noninvasive ventilation among the three groups (χ2＝51. 684,P<0. 001). There were significant differences in the discharge rate among the three groups (P<0. 05). Conclusion NCPAP has obvious effect on the critical-ly ill children with conventional oxygen remaining respiratory abnormalities;Children with respiratory failure under nasal catheter are prone to suffer from the failure of noninvasive assisted ventilation when using NCPAP assisted ventilation,closely monitor of the disease condition is needed.
ABSTRACT
Objective To investigate the clinical efficacy and safety of continuous blood purification (CBP) in the treatment of severe sepsis in infants. Methods A retrospective analysis of 40 infants with severe sepsis treated with CBP was performed at PICU of Hunan Children's Hospital from January 2014 to July 2017,and 50 infants with severe sepsis who were not treated with CBP at the same period were enrolled as control group. The indicators included blood gas analysis,lactic acid (Lac),blood glucose,electrolytes, blood routine,C-reaction protein ( CRP) and procalcitonin ( PCT),alanine aminotransferase ( ALT) and aspartate aminotransferase (AST),total bilirubin(TB),urea nitrogen (BUN),serum creatinine (Scr) and creatine kinase isoenzyme MB (CK-MB),pediatric critical illness score (PCIS). Results (1) After 3 days of treatment,the recovery of body temperature,heart rate,respiratory rate and blood pressure in CBP group were better than those in the control group,and the differences between two groups were statistically signifi-cant(P < 0. 05). (2) After treatment,the levels of base excess(BE),Lac,white blood cell (WBC),PCT, CRP,ALT,AST,TB and BUN of CBP group recovered better than those of the control group,the differences were statistically significant (P < 0. 05). (3) The ΔPCIS (D3-D1) of CBP group was higher than that of the control group,and the difference between two groups was statistically significant (P < 0. 05). (4) The fatali-ty rate of CBP group was lower than that of the control group,and there was no significant difference between two groups (P > 0. 05). (5) Two cases of thrombocytopenia,2 cases of femoral vein thrombosis,2 cases of hypovolemic shock,and 1 case of blood coagulation in filter happened in CBP gruop,all cases had no punc-ture site infection. Conclusion CBP can improve the vital signs,internal environment,inflammatory reaction and organ function of infants with severe sepsis,and the effect is better than that of traditional methods. The complications of CBP in infants with severe sepsis are relatively large,so we should strictly master the indica-tions of CBP in the treatment of severe sepsis in children.
ABSTRACT
Objective To evaluate the efficacy and safety of nasal continuous positive airway pres-sure (NCPAP) in treatment of severe pneumonia in children. Methods A series of 150 children with severe pneumonia were prospectively included from January 2016 to June 2017. The 150 children all still had short-ness of breath after 1 hours of nasal oxygen delivery,and then switched to NCPAP. We collected related clini-cal parameters (the basic vital signs,blood gas analysis index,shortness of breath,wheezing,groaning,nasal incitement,three depressions sign and NCPAP parameters) at three time points,including 0 h,1 h,4 h after using NCPAP. We compared the clinical parameters among the three time points before and after NCPAP with the purpose to assess the efficacy and safety of NCPAP. Results The proportion of shortness of breath (χ2=272. 218,P=0. 01),fast heart rate(χ2=31. 625,P=0. 01),wheezing(χ2=7. 624,P=0. 02),moaning (χ2=7. 203,P=0. 025),nasal flaring(χ2=74. 032,P＜0. 01),three depressions sign(χ2=117. 030,P＜0. 01) gradually decreased with statistically different among 0 h,1 h and 4 h after using NCPAP. PaO2/FiO2 (F=7. 32,P＜0. 01) gradually increased with statistically different among 0 h,1 h and 4 h after using NCPAP. Twenty-seven patients required intubations. PaO2and PaO2/FiO2in patiens received intubations were lower than those in patients only received NCPAP before treatment. Conclusion NCPAP is an effective and safe way for severe pneumonia children who remained abnormal breathing after conventional oxygen inhalation.
ABSTRACT
Objective To investigate the clinical features,treatment,prognosis,and occurrence of neurogenic pulmonary edema(NPE) in children with severe hand-foot-mouth disease (HFMD) complicated with brain stem encephalitis and abnormal cranial magnetic resonance imaging (MRI).Methods 386 cases of severe HFMD were hospitalized in our Intensive Care Unit (ICU) from May to October 2010,of which 24 cases had abnormal cranial MRI.Their clinical symptoms,MRI features,treatment,and prognosis were analyzed.Results The clinical symptoms of severe HFMD with brainstem encephalitis included fever,startle,lethargy,vomiting,difficulty swallowing,drooling,and so on.The patients with abnormal cranial MRI were prone to have a neurogenic pulmonary edema (NPE) (5％ vs 6.5％,x2 =34.55,P ＜0.01).Conclusions The nervous system-affected parts of severe HFMD is the brain stem,thalamus,and spinal cord.Brain stem inflammation can be found early by the cranial MRI to be highly vigilant of NPE.During course of 1 ～ 5 day,special attention should be paid to the symptoms of the nervous system.The early detection,timely intervention,and prevention from NPE would result in the good prognosis.
ABSTRACT
<p><b>OBJECTIVE</b>To study retrospectively the efficacy and complications of combined pedicle subtraction osteotomy (PSO) and polysegmental closing wedge osteotomy for correction of the severe rigid thoracolumbar kyphotic deformity in ankylosing spondylitis (AS).</p><p><b>METHODS</b>A total of 8 consecutive male patients with AS and severe thoracolumbar kyphotic deformity (mean age 32 years, range 28 - 46) were involved in this study from August 2004 to June 2007. The average preoperative Cobb angle of thoracic spine (T(1)-T(12)) was 96 degrees (range, 80 degrees - 112 degrees ), the mean preoperative angle of lumbar lordosis (L(1)-S(1)) was 10 degrees (5 degrees - 15 degrees ). The mean chin-brow angle was 47 degrees (range, 40 degrees - 58 degrees ). The average gaze angle was 43 degrees (range, 32 degrees - 50 degrees ). After preoperative assessment, single-level PSO was performed in L(3) vertebrae and two-level polysegmental closing wedge osteotomy was performed in thoracolumbar vertebrae (T(12)-L(1), L(1-2)). Radiographic and clinical results and complications were assessed.</p><p><b>RESULTS</b>The surgical time was (298.1 +/- 20.7) minutes and blood loss during the procedure was (1588.8 +/- 171.6) ml. The follow-up period was (11.5 +/- 7.7) months. The postoperative angle and the amount of correction of the thoracic and lumbar spine were 76.1 degrees +/- 9.6 degrees , 20.3 degrees +/- 1.1 degrees and 48.4 degrees +/- 4.7 degrees , 38.4 degrees +/- 4.7 degrees respectively. The postoperative chin-brow and gaze angle was 16.5 degrees +/- 4.6 degrees and 73.0 degrees +/- 5.2 degrees , respectively. The amount of correction for sagittal balance was (12.3 +/- 1.6) cm. No nerve, vascular injury, stress fracture and coronal decompensation occurred in the patients.</p><p><b>CONCLUSIONS</b>Combined PSO and polysegmental closing wedge osteotomy by posterior approach only is safe and effective for correction of the severe rigid thoracolumbar kyphotic deformity in AS. The visual field is significantly improved after surgery.</p>
Subject(s)
Adult , Humans , Male , Middle Aged , Follow-Up Studies , Kyphosis , General Surgery , Osteotomy , Methods , Retrospective Studies , Spondylitis, Ankylosing , Treatment OutcomeABSTRACT
In order to investigate the expression of recombinant TPO gene in COS-7 cells and in vivo of the mouse model, eukaryotic expressing plasmid pcd2/TPO with human TPO cDNA was constructed with DNA recombinant techniques. The plasmid pcd2/TPO was transiently transfected into the COS-7 cells by means of lipofection, the naked pcd2/TPO plasmid was injected into the skeletal muscle of mice with electric pulses. RT-PCR and ELISA methods were used to detect the TPO expression of the transfected COS-7 cells, both showed high level expression. The MTT test showed the expressed TPO had proliferative activity to TPO-dependent cell line. High efficiency of gene transfer in transgenic mice was also observed by RT-PCR and immunohistochemical methods. The serum TPO level [(1 185 +/- 264) ng/L] in transgenic mice was quite different compared with the normal mice [(250 +/- 76) ng/L]. All these results provided solid foundations for the research of TPO gene therapy in the future.