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Extracorporeal membrane oxygenation(ECMO)is more and more widely used in children as a supporting technology for cardiopulmonary organ failure, but bleeding and thrombus are still the most common and serious complications during the use of ECMO.Heparin is the most commonly used anticoagulant in children with ECMO.Activated clotting time, activated partial thromboplastin time, and anti-Ⅹa activity are often monitored to guide the dosage of heparin.However, the optimal dosage of heparin and the appropriate monitoring method are still unclear.This study aimed to summarize the research progress of anticoagulation and monitoring methods in children′s ECMO.
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Objective To explore the clinical features and gene diagnosis of the distal renal tubular acidosis (dRTA). Methods The clinical data and gene detection results of one child with dRTA were retrospectively analyzed. The related literatures were reviewed. Results Four-month-old female was admitted with frequent vomiting and hearing impairment. The laboratory examination showed refractory hypokalemia and it was difficult to correct metabolic acidosis. Gene detection found a new mutation on ATP6V1B1 gene. The diagnosis of dRTA was confirmed. Conclusions dRTA is a rare disease, ATP6V1B1 gene is the causative gene of the dRTA with sensorineural deafness.
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Objective To explore the clinical features and gene mutation types of Cornelia de Lange syndrome (CdLS), an inherited metabolic disease. Methods The clinical data and gene detection results of one case of CdLS were retrospectively analyzed. Results Two-year-old male had special appearance, microcephaly, bushy eyebrows with both sides meeting in the midline, long curly eyelashes, low body mass, and motor and mental retardation. NIPBL gene detection found the variation of the nucleotide in c.7176T>A (nucleotide 7176 in coding region changed from T to A). Conclusions CdLS is a rare congenital inherited metabolic disease. The clinical manifestations were special appearance and signs. The c.7176T>A mutation in NIPBL gene has not been reported at home and abroad.
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Objectives To analyze the relationship between the different dosage of vancomycin and its blood concentration in children in pediatric intensive care unit (PICU), the relationship between different valley concentrations and therapeutic efficacy and the adverse reactions. Methods The clinical data of 72 children admitted to PICU and treated with vancomycin from January 2013 to June 2016 were retrospectively reviewed. The vancomycin doses in 58 cases was 40 mg/(kg·d) and were 60 mg/(kg·d) 14 patients. In the subjects treated at 40 mg/(kg·d), administration by q12h were in 19 cases, q8h in 22 cases and q6h in 17 cases. After vancomycin was administered at least 4 doses, blood samples were collected, and the valley concentration was determined within 30 min before administration of vancomycin and peak concentration was determined within 30-60 min after administration of vancomycin. The concentration of vancomycin in plasma was detected by high performance liquid chromatography (HPLC). Results When vancomycin was administrated at 40 mg/(kg·d), there were no difference in valley concentration and peak concentration among the three groups of q12h, q8h, and q6h (P>0.05). The effective rate was not different between valley concentration ≤5 μg/mL and >5 μg/mL of vancomycin (81.8% vs. 84.0%, P>0.05). Compared with vancomycin 40 mg/(kg·d) group (q8h), the valley concentration and peak concentration in 60 mg/(kg·d) group were significantly increased (P<0.05). Conclusion It was difficult to reach a valley concentration of 10 μg/mL by using conventional doses of vancomycin. Thus, in order to achieve effective concentration and reduce adverse reactions, the dosage of vancomycin can be increased, and the times of administration can also be increased.
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Objective To investigate the effect of acupuncture on gap junction protein Cx43 expression in the hippocampal region in ischemia/reperfusion rats.Methods Wistar rats were randomized into normal, model, non-point acupuncture and acupuncture groups. A rat model of focal cerebral ischemia/reperfusion was made by modified middle cerebral artery thread occlusion. The model, non-point acupuncture and acupuncture groups were separately divide into four subgroups: 30, 60, 180 and 360 min ischemia/reperfusion, 10 rats each. The middle and lateral lines of vertex were given electroacupuncture in the acupuncture group of rats. A subcostal fixed point 10 mm above the iliac crest on the affect side was selected as an acupuncture point in the non-point acupuncture group. The model group was not treated. Cx43 protein expression was determined by an immunohistochemical method.Results There was a statistically significant difference in the behavior disorder (Bederson’s) score between the acupuncture group and the non-point acupuncture or model group after different times of cerebral ischemia/ reperfusion (P<0.05). There was a statistically significant difference in hippocampal Cx43 content between model, acupuncture or non-point acupuncture group and the normal group and between the acupuncture group and the model or non-point acupuncture group after different times of cerebral ischemia/reperfusion (P<0.05).Conclusions Acupuncture can inhibit the overexpression of Cx43, intervene in cerebral ischemia-reperfusion injury and produce a neuroprotective effect in ischemic brain injury.