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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 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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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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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.