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Objective:To evaluate the feasibility of using bedside ultrasound and serum biomarkers for the prediction of sepsis-induced myocardial dysfunction(SIMD)and mortality in septic shock patients.Methods:The patients diagnosed as septic shock were enrolled in the study from January 2019 to July 2021 in PICU at Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine.Bedside ultrasound results were recorded at day 1, 2, 3, 7 and 10.Blood samples were collected at the same time, markers of myocardial injury were detected, and prognosis was recorded at 28 days.According to the left ventricular ejection fraction (LVEF), children with septic shock were divided into SIMD group and non-SIMD group.Those with LVEF <50% or decreased by ≥10% from baseline level were defined as SIMD.Differences in cardiac ultrasound parameters and biomarkers between two groups were compared.Logistic regression analysis was performed to determine the independent risk factors for SIMD and the independent risk factors for death at 28 days after septic shock.The area under the receiver operating characteristic curve (AUC) was used to evaluate the efficacy of different indicators in predicting SIMD and the death outcome of children with septic shock on 28 days.Results:A total of 57 children were enrolled, including 28 cases in SIMD group and 29 cases in non-SIMD group.Univariate analysis showed that there were statistically significant differences in pediatric critical illness score, N-terminal B-type natriuretic peptide(NT-proBNP), LVEF and left ventricular short axis shortening rate between two groups ( P<0.05). Logistic analysis demonstrated that LVEF( OR=0.890, 95% CI 0.818-0.969, P=0.007)and NT-proBNP ( OR=1.000, 95% CI 1.000-1.000, P=0.015)could independently predict SIMD.There were 42 cases in survival group and 15 in non-survival group according to the prognosis on 28 days.Univariate analysis showed that there were significant differences in pediatric risk mortality score Ⅲ, pediatric sequential organ failure assessment, cardiac troponin I, and mitral annular plane systolic excursion(MAPSE)( P<0.05). Logistic analysis showed that only MAPSE independently predicted mortality( OR=85.670, 95% CI 1.685-4 356.736, P=0.026). Compared with MAPSE(AUC=0.727), MAPSE combined with pediatric risk mortality score Ⅲ, pediatric sequential organ failure assessment, cardiac troponin I(AUC=0.926) could be better to predict the 28 days prognosis of patients with septic shock on 28 days. Conclusion:NT-proBNP increases significantly in the early stage of SIMD.MAPSE shows no difference between SIMD and non-SIMD patients.MAPSE is correlated with the prognosis of patient with septic shock.
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The clinical data of 2 children with early graft liver dysfunction (EAD) admitted to the Pediatric Intensive Care Unit, Shanghai Children′s Medical Center, Shanghai Jiaotong University School of Medicine were retrospectively analyzed to discussed the therapeutic significance of non-biological artificial liver technology, such as intermittent plasma exchange (PE) combined with continuous veno-venous hemodiafiltration (CVVHDF) in children with EAD.Case 1 was suffering from biliary atresia, and case 2 was suffering from Niemann-Pick disease.Graft liver dysfunction and multiple organ dysfunction occurred in 2 children after liver transplantation.PE and CVVHDF were initiated early in the first two days after liver transplantation.After one-week therapy with intermittent PE plus CVVHDF, acute multiple organ dysfunction were reversed with liver function remarkably improved in the 2 cases.Therefore non-biological artificial liver technique can be tried after liver transplantation in children.This technique contributes to the recovery of liver function and can improve the secondary multi-organ insufficiency.
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There is a wide variety of diseases resulting in pediatric right heart failure because of children′s special disease spectrum,the main mechanisms include pressure or volume overload,myocardial lesions and arrhythmia,etc.On the basis of adult studies,tailored treatment should be considered in pediatric patients.
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Fulminant myocarditis is one of the most common diseases causing sudden cardiac death in pediatrics and young adults.The pathophysiology of fulminant myocarditis involves both direct myocyte dysfunction and immune-mediated tissue injury,which result in severe damage in cardiac structure and func-tion.It always rapidly developed into cardiogenic shock in several hours.Despite the high mortality rate,if pa-tient response well to a series of progressive treatment,most of them would get complete resolution.Better understanding of the hemodynamic changes of fulminant myocarditis is the key point of rapid diagnosis and proper interventional treatment.In this article we made a summary introduction of those hemodynamic chan-ges in fulminant myocarditis.
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Objective To evaluate the value of integrated use of bedside lung ultrasound and echo-cardiography in PICU.Methods Two cases with respiratory failure and shock were monitored using inte-grated bedside lung ultrasound and echocardiography.Breathing and circulation support solutions were adopt-ed according to Bedside Lung Ultrasound in Emergency(BLUE)and Fluid Administration Limited by Lung Sonography(FALLS).Results Case 1 with acute lymphoblastic leukemia complicated with severe phneu-monia was measured as “B-profile”throughout both lung fields which interpreted as pulmonary edema ac-cording to the BLUE protocol.He was diagnosed as acute respiratory distress syndrome later and supported by non-invasive ventilation according to the lung ultrasonography.After 4 days,the numbers of B line were sig-nificantly reduced with PaO2/FiO2 >300 mmHg(1 mmHg=0.133 kPa)and the improvement in chest X ra-diography was found,ventilation was weaned accordingly.Case 2 was diagnosed as septic shock and acute re-spiratory distress syndrome with volume resuscitation and mechanical ventilation.According to FALLS proto-col,we ruled out obstructive and cardiogenic shock,and assessed the variation in inferior vena cava diameter and aortic systolic velocity-time integral as a guide to fluid therapy.At the 8th hour in PICU,case 2 recovered from shock.Conclusion Integrated use of bedside lung ultrasound and echocardiography is clinically signifi-cant for the rescue of critically ill patient with respiratory failure and shock.
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Fluid resuscitation is the primary step in the management of acute circulation failure,aims to make a significant increase in cardiac output,and then providing adequate blood perfusion for peripheral tissues.According to Frank-Starling curve,the positive outcome only occurs in patients within a certain range of cardiac function,while in other conditions fluid overload would immediately increase the mortality. Distinguish-ing volume responders form non-responders effectively is still a serious problem common to adult and pediatric physicians at intensive care unit.Volume responsiveness assessment using transthoracic echocar-diography has become a research hotspot during the past few years,this review aims to make a summary of those findings as well as the present situation in pediatric field.
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Recently,echocardiography,such as pulsed wave doppler imaging,tissue doppler imaging,strain and strain rate imaging,speckle tracking imaging as well as velocity vector imaging are being more and more widely used in whole and segmental cardiac functional assessment of congenital heart disease( CHD).With its own technical characteristics,each of them shows advantages and weaknesses in different type of CHD.This paper aims to make a brief review of the latest clinical achievements in those techniques.It will be helpful to reasonable selection or application of these techniques,and more importantly,to better guidance for clinical medication,establishment of surgical outline and assessment of cardiac functional outcomes.
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An S-naproxen（S-NAP）molecularly imprinted monolithic stationary phase（MIMSP）with specific recognition for S-NAP and naproxen（NAP）was prepared by in situ technique,utilizing 4-vinylpridine（4-VP）as a function monomer,ethylene glycol dimethacrylate（EDMA）as a cross-linking agent,and low-polar solvents（toluene and dodecanol）as porogenic solvents.The selectivity of the polymers for S-NAP and NAP was evaluated by high performance liquid chromatography（HPLC）.The binding characteristics were tested by Scatchard analysis.Racemic NAP could be specifically separated to some extent.At the same time,NAP could be separated from ibuprofen under optimized conditions.Scatchard analysis showed that two classes of binding sites existed in the S-NAP-imprinted polymers,with their dissociation constants estimated to be 1.045 and 5.496 μM,respectively.The results demonstrate that S-NAP and NAP can be recognized specifically on the obtained MIMSP.
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An S-naproxen (S-NAP) molecularly imprinted monolithic stationary phase (MIMSP) with specific recognition for S-NAP and naproxen (NAP) was prepared by in situ technique,utilizing 4-vinylpridine (4-VP) as a function monomer,ethylene glycol dimethacrylate (EDMA) as a cross-linking agent,and low-polar solvents (toluene and dodecanol) as porogenic solvents.The selectivity of the polymers for S-NAP and NAP was evaluated by high performance liquid chromatography (HPLC).The binding characteristics were tested by Scatchard analysis.Racemic NAP could be specifically separated to some extent.At the same time,NAP could be separated from ibuprofen under optimized conditions.Scatchard analysis showed that two classes of binding sites existed in the S-NAP-imprinted polymers,with their dissociation constants estimated to be 1.045 and 5.496 μM,respectively.The results demonstrate that S-NAP and NAP can be recognized specifically on the obtained MIMSP.
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Objective To establish a rapid, accurate and sensitive chemiluminescence method for determining sulfydryl-containing drugs. Methods In sulfuric acid solution, glyoxal could be oxidized by potassium permanganate, and weak chemiluminescence could be observed. Chemiluminescence signal could be enhanced in the presence of sulfydryl-containing drugs. Thus, on this basis we established a new method of determining the concentration of sulfydryl-containing drugs with flow injection chemiluminescence analysis. Results Under the optimized conditions, the linear range of methimazole, captopril and acetylcysteine was 1.0×10~(-8)- 5.0×10~(-6), 7.0×10~(-8)-1.0×10~(-6) and 3.0×10~(-8)-1.0×10~(-6)g/mL, respectively. The limit of detection of methimazole, captopril and acetylcysteine was 1.0, 3.9 and 3.7ng/mL, respectively. Conclusion The method was successfully applied to determine the three drugs that contain sulfydryl. Compared with the results of pharmacopeia methods, the results we obtained were satisfactory.