Surgical management of Dandy-Walker syndrome in infants and the literature review / 中国综合临床

Dandy-Walker syndrome is one of the posterior fossa malformations, which is easily confused with arachnoid cyst or cerebellar dysplasia in clinical practice, leading to misdiagnosis. Dandy-Walker syndrome is easy to be combined with hydrocephalus, resulting in increased intracranial pressure, increased head circumference, growth retardation, spastic hemiplegia and other manifestations, and can also be accompanied by other nervous system malformations. On February 27, 2021, a child with Dandy-Walker syndrome with growth retardation as the primary manifestation was admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine. After multiple surgical treatment, the child's hydrocephalus was significantly improved. Through the analysis of the clinical data of the child's operation and the treatment of complications, it is helpful to improve the clinicians' understanding of the surgical treatment of the disease.

Influence of augmented renal clearance on the clinical application and therapeutic effect of vancomycin in critical children / 中国小儿急救医学

Objective:To explore the effect of augmented renal clearance(ARC)on 24-hour area under the concentration-time curve to minimum inhibitory concentration ratio(AUC 24/MIC)of vancomycin and prognosis in critical children, thus to provide proposal for individual dosage regimen. Methods:Sixty-five critical children treated with vancomycin, who suffered from sepsis/septic shock, were brought into this retrospective cohort study.According to estimate glomerular filtration rate, these children were divided into ARC group ( n=27) and normal group ( n=38). The influencing factor of AUC 24/MIC of vancomycin and therapy prognosis for two groups were detected and analyzed. Results:There were no significant differences between two groups in basic setting (age, sex, weight), scores of pediatric sequential organ failure assessment and pediatric risk of mortality Ⅲ, infection markers (C-reactive protein and procalcitonin), glutamic-pyruvic transaminase, hypoproteinemia, usage of diuretic and vasoactive agent( P>0.05). The patients from ARC group showed lower levels than those from normal group in AUC 24/MIC of vancomycin[375.2(300.8, 489.4) vs. 443.6(412.3, 593.2), Z=2.263, P=0.024] and it′s target achievement ratio (TAR)(40.7% vs. 76.3%, χ2=8.440, P=0.005). When usage of diuretic and vasoactive agent, the AUC 24/MIC of ARC group was lower than that of normal group( P<0.05). But there was no significant difference between ARC group and normal group regarding hypoproteinemia( P>0.05). The days of body temperature steady at least 48 hours[7.0(5.5, 9.0)d vs. 6.0(5.0, 8.0)d], the length of hospital stay[39.0(21.0, 58.0)d vs. 20.5(16.0, 28.0)d], the length of PICU stay[14.0(9.0, 31.5)d vs. 10.0(5.0, 15.0)d] were longer than those in normal group( P<0.05). There were no significant differences between ARC group and normal group regarding days of ventilation and infectious markers decreased at least 50%, as well as 28-days mortality( P>0.05). The multivariable analysis showed that the presence of ARC, hypoproteinemia, use of diuretics and vasoactive agent were significantly associated with AUC 24/MIC of vancomycin( P<0.05). Conclusion:ARC may down regulate levels of AUC 24/MIC and TAR of vancomycin.During ARC period, the usage of diuretic and vasoactive agent could affect the AUC 24/MIC of vancomycin.Individual dosage regimen should be employed for critical children suffered with ARC.

Clinical significance and risk factors for different experimental diagnosis of trauma-induced coagulopathy / 中国小儿急救医学

Objective:To explore the clinical significance of thrombelastography (TEG) and conventional coagulation tests (CCTs) in the diagnosis of trauma-induced coagulopathy(TIC) and the risk factors for TIC.Methods:Traumatic patients hospitalized in PICU at Shengjing Hospital of China Medical University from December 1, 2017 to January 31, 2019 were divided into three groups according to injury severity score(ISS): non-severe group(≤16 points), severe group (17-25 points) and extremely severe group(>25 points). All patients received 2.5 mL of venous blood at admission/after 6 h, 12 h, 24 h, and 48 h injury to detect TEG and CCTs.The prevalence, time of onset, recovery time of coagulation function and risk factors for TIC were summarized.Results:A total of 64 cases were collected, including 18 non-critical cases, 28 critical cases and 18 extremely critical cases.TEG and CCTs were used to diagnose TIC in nine cases(14.1%)and four cases(6.3%), respectively.TIC could be diagnosed by TEG at 6 hours after trauma, and 12 hours for CCTs.TEG was used to diagnose four cases of hypercoagulability.Univariate analysis showed that female, blood transfusion, transfusion, shock, multiple organ dysfunction syndrome, mechanical ventilation, hypothermia, low age, low glasgow coma scale (GCS) and high ISS were all risk factors for TIC.Logistics regression analysis found that children with high-risk factors such as girl, hypothermia, shock and mechanical ventilation were 4.333, 17.889, 10.208, and 4.479 times more likely to develop TIC than those without high-risk factors.For every 1 score increase in the ISS score, the risk of TIC increased by 1.147.As the age increased by 1 year, GCS increased by 1 point, and the risk of TIC decreased by 0.765 and 0.817, respectively, which were protective factors for TIC.Conclusion:TEG and CCTs are consistent in the diagnosis of TIC, but TEG is more sensitive at an earlier stage and can detect hypercoagulability.Female, shock, hypothermia, low age, high ISS, and low GCS are risk factors for TIC.

Role of activin A and NGF in co-stimulating neurite outgrowth of dorsal root ganglia ofembryonic chicken / 中国免疫学杂志

Objective:To investigate the effect of activin A and nerve growth factor ( NGF) NGF on stimulating neurite outgrowth of dorsal root ganglia(DRG)of the embryonic chicken.Methods:In this study,we observed that activin A and NGF together induced neurite outgrowth of DRG and kept survival of DRG neurons by the primary cultured DRGs from embryonic day 8 ( E8 ) chicken.calcitonin gene-related peptide(CGRP)CGRP mRNA expressions were analyzed by RT-PCR.Results: The DRG treated with activin A +NGF had obvious neurite outgrowth ,compared with only NGF group on day 3,and the number of living DRG neurons also increased.Activin A +NGF up-regulated the mRNA expressions of CGRP in DRG.Conclusion:The Data demonstrated that activin A with NGF can synergistically stimulate DRG neurite outgrowth and maintain the DRG neurons survival , suggesting that it is more effective that NGF and activin A together treat the associated disease of nerve system.