Current situation of medical humanistic quality cultivation throughout the whole-process education of medical students under the background of "New Era" / 中华医学教育探索杂志

Objective:Under the background of "new medical science", to construct a whole-process education path with "education as the driving force - moral cultivation as the core", and to provide a decision-making basis for the reform, innovation, and development of humanistic quality education in medical colleges.Methods:Five-year clinical medical students (freshman to fifth graders) from Qiqihar Medical University were selected as the research objects. The evaluation model and questionnaire of humanistic quality of clinical medical students were constructed by literature analysis. The Questionnaire Star platform was used to investigate and collect data by random sampling of clinical medical undergraduates, and the data results were analyzed by SPSS 26.0 to explore the path of building the whole-process education.Results:The empirical research on the cultivation of humanistic quality of medical students showed that the average humanistic attitude score of medical students was (3.47±0.75) points. From the perspective of gender, the scores of humanistic cognition, attitude, and behavior of male students were 2.81, 3.68, and 3.22 points, respectively, which were all significantly higher than those of female students (2.52, 3.22, and 2.95 points, respectively) ( P<0.05). The data from freshmen to the fifth graders showed that humanistic cognition, attitude, and behavior scores all presented an increasing trend with the grade. Using the "Knowledge, Attitude/Belief, Practice" model, it was found that the cognitive rate of humanistic quality of medical students was relatively ideal, and the awareness rate of medical students in different grades was different. The cross analysis showed that the effect of ideological morality and political literacy education on medical students in medical colleges had a significant cross-relationship with multiple choice questions. Conclusion:The humanistic quality of clinical medical students needs to be improved, and the cultivation of medical humanistic quality should run through the whole process from the first year to the fifth year, so as to improve the comprehensive training of professional ability and promote the all-round development of medical students.

Practice research on improving the capability of service-based education in basic teaching organizations in colleges and universities from the perspectives of four characteristics and four abilities / 中华医学教育探索杂志

Objective:To implement the teaching activities for cultivating the four characteristics (innovation, development, integration, and ecology) and the four abilities (political ability, learning ability, cross-border ability, and driving force), and to provide a reference for improving the capability of service-based education in basic teaching organizations.Methods:The basic teaching organization in School of Basic Medical Sciences, Qiqihar Medical University, was selected for research, and the action research method and the focus group interview method were used to carry out characteristic teaching activities around the cultivation of the four characteristics and the four abilities. After the implementation of these activities, Sojump, a questionnaire platform, was used to conduct a survey among full-time and part-time teachers and teaching administrators, and the effect of each activity on the cultivation of the four characteristics and the four abilities was analyzed. The strategies to enhance abilities were improved based on the results of the above analyses. SPSS 25.0 software was used for data processing, and categorical data were expressed as frequency and percentage.Results:The data analysis showed that through cultivation of the four characteristics and the four abilities, each designed activity had a remarkable effect on improving the capability of service-based education in the basic teaching organization, with a mean value of 80.77%(63/78)- 91.03%(71/78), and only the activities centered on "integration" had a relatively low value of "obvious effect", which accounted for 64.10%(50/78).Conclusion:Under the guidance of the new concept of "New Medicine" and with the opportunity of capacity building, a series of teaching activities focusing on the four characteristics and the four abilities can effectively improve the capability of service-based education in basic teaching organizations in colleges and universities through targeted ability training.

Comparison of clinical characteristics and outcomes of infants with moderate and severe acute respiratory distress syndrome diagnosed according to baseline oxygenation index / 中国小儿急救医学

Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.

An email-based survey of treatment strategies in children with septic shock in China / 中国小儿急救医学

Objective:To describe the treatment strategies in children with septic shock in China.Methods:A questionnaire was prepared and 368 pediatric intensivists from the Pediatric Critical Care Physician Branch of Chinese Medical Doctor Association were surveyed about the treatment of pediatric septic shock from April to June 2017.Results:Surveys were received from 87.2%(68/78) institutions and 368 questionnaires (response-rate 45.1%) were included.59.2% and 77.7% of the respondents chose debridement surgery and fluid drainage as source control intervention.Antibiotics were used within 1 hour of shock in 90.8% of respondents.98.4% of respondents chose normal saline, 72.3% of respondents chosen albumin, and 53.8% of respondents chosen plasma for fluid resuscitation.When no venous access was available during shock resuscitation, 57.1% of respondents preferred intraosseous access.79.3% and 83.2% of the respondents used the adjuvant therapy such as glucocorticoids and intravenous immunoglobulin.96.7%, 85.3% and 22.0% of respondents were likely to provide oxygen and mechanical ventilation, continuous renal replacement, and extracorporeal membrane oxygenation as organ support, respectively.Additionally, 322 (88.7%), 188 (51.1%), and 85 (23.1%) respondents chose the "best advice" options to simulated clinical cases of fluid resuscitation, inotropic agents, and vasoactive agents, respectively.In the simulated cases of vasoactive drugs and inotropic drugs, 69.3% and 24.2% of the respondents chose fluid resuscitation strategy, respectively.In cases of fluid resuscitation, 49.7% (183/368) of respondents reported performing fluid responsiveness and volume status assessment, and instruments used in the assessment included bedside echocardiography[39.4% (145/368)], bioreactance[10.3% (38/368)], transpulmonary thermodilution devices[6.3% (23/368)]. Pediatricians who received advanced life support courses for children ( P=0.006) and intensive care specialist training center training ( P=0.002) were more likely to choose the " best recommendation" option than those who did not attend the training. Conclusion:The current status of pediatric septic shock treatment strategies in China are active source control intervention, antibiotic use and organs support, and increased awareness of non-invasive hemodynamic monitoring.However, there may be excessive fluid infusion and inappropriate use of plasma, glucocorticoids and intravenous immunoglobulin.Different training and continuing education may improve rational treatment strategies.

High frequency oscillatory ventilation for acute respiratory distress syndrome / 中国小儿急救医学

High frequency oscillatory ventilation(HFOV) in the treatment of acute respiratory distress syndrome(ARDS), there are significant differences in clinical research status and evidence level among different participants.HFOV for adult ARDS: current clinical evidence suggests that HFOV is not recommended for routine mechanical ventilation in adults with ARDS.HFOV for pediatric ARDS: there is no sufficient evidence to show that HFOV is superior to conventional mechanical ventilation.Nor does it prove that HFOV is harmful.The current recommendation is: HFOV could be considered as an alternative ventilatory mode in patients with moderate-to-severe pediatric ARDS, whom with conventional mechanical ventilation plateau airway pressures exceed 28 cmH 2O(1 cmH 2O=0.098 kPa) in the absence of clinical evidence of reduced chest wall compliance.HFOV for neonatal ARDS: the existing research evidence shows that HFOV can moderately reduce the incidence of chronic lung disease in the premature infants with neonatal ARDS.It has certain advantages in improving oxygenation and alleviating ventilator induced lung injury in acute phase.It also has certain advantages for improving pulmonary function and neurodevelopmental in the long term.

Application of neurally adjusted ventilatory assist in the weaning from prolonged mechanical ventilation in pediatrics / 中华实用儿科临床杂志

Objective:To investigate the clinical effect of neurally adjusted ventilatory assist (NAVA)on weaning from prolonged mechanical ventilation (PMV) in pediatrics and its influence on related parameters of respiratory mechanics.Methods:A retrospective analysis was conducted on 12 children in the pediatric intensive care unit (PICU) of Children′s Hospital, Capital Institute of Pediatrics from July 2014 to July 2020.All the cases adopted NAVA for weaning from PMV, and the type of NAVA included invasive NAVA and non-invasive neurally adjusted ventilatory assist with NAVA.The main diagnosis, etiology, oxygenation index (OI), pediatric critical illness score (PCIS), treatment of mechanical ventilation(MV), respiratory mechanics indexes, length of stay in PICU and prognosis were recorded.Besides, the complications that happened after transition to NAVA were evaluated.The rank sum test was used for comparison of respiratory mechanics indexes and blood gas values before and after NAVA ventilation. Results:Among the 12 children, 11 cases had basic diseases.There were 8 premature infants complicated with chronic lung diseases.Two cases had Wilson-Mikity syndrome.One case had congenital omphalocele, 1 case had Prader-Willi syndrome (PWS), 1 case had spinal muscular atrophy (SMA). The main diagnosis of 8 children was acute respiratory distress syndrome (ARDS). The median duration of MV and PICU stay was 32.0 (25.0, 39.0) days and 39.5(29.5, 48.5) days.The median duration of invasive NAVA and non-invasive-NAVA was 5.5 (3.8, 6.3) days and 7.0(5.0, 9.5) days.All cases were successfully weaned from MV(100%), and the survival-to-discharge rate was 100%.There were no complications related to NAVA.After ventilation for 6 hours, no significant difference was observed in respiratory mechanical parameters between synchronized intermittent mandatory ventilation (SIMV) and NAVA (all P>0.05). However, compared with SIMV, NAVA significantly decreased the arterial partial pressure of carbon dioxide[43.50 (41.75, 46.00) mmHg vs.48.50 (45.25, 56.00) mmHg, 1 mmHg=0.133 kPa] ( Z=-2.253, P=0.024), increased the arterial partial pressure of oxygen[68.00 (65.00, 72.25) mmHg vs.62.00 (59.00, 64.75) mmHg] ( Z=-2.733, P=0.006), and reduced the value of OI[3.70 (3.38, 5.60) vs.5.90 (4.58, 7.08)]( Z=-2.272, P=0.023). Conclusions:NAVA is a safe and effective approach to weaning from PMV in children.Compared to SIMV, NAVA can greatly improve ventilation and oxygenation.NAVA is strongly recommended to PMV infants with chronic lung diseases who have failed to wean from ventilation.

High frequency oscillatory ventilation and conventional mechanical ventilation in the treatment of infants with severe respiratory syncytial virus pneumonia: a randomized controlled trial / 中华危重病急救医学

Objective:To compare the clinical efficacy of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) in the treatment of infants with severe respiratory syncytial virus (RSV) pneumonia.Methods:A prospective randomized controlled trial was conducted. The infants with severe RSV pneumonia who received invasive mechanical ventilation admitted to intensive care unit (ICU) of Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2018 to December 2019 were enrolled. According to the order of admission, each infant was assigned to HFOV group or CMV group by random number table. The basic data, pediatric critical score, blood gas analysis, ventilator parameters, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO 2)/arterial partial pressure of oxygen (PaO 2)×100], duration of mechanical ventilation, length of ICU stay, complications, prognosis, use of muscle relaxants and vasoactive drugs and other clinical indicators of the two groups were recorded. Results:A total of 28 infants were enrolled in the analysis, including 15 infants receiving CMV and 13 infants receiving HFOV. There were no significant differences in age, body weight, pediatric critical score and OI before enrollment, type Ⅱ respiratory failure, multiple organ dysfunction, basic diseases and laboratory examination indexes before enrollment between the two groups. Six hours after enrollment, compared with CMV group, heart rate (HR), respiratory rate (RR), case of transcutaneous oxygen saturation (SpO 2) decrease, case of HR decrease, case of cardiopulmonary resuscitation (CPR) and OI in HFOV group were significantly decreased [HR (bpm): 130 (125, 138) vs. 144 (140, 160), RR (times/min): 35 (34, 38) vs. 40 (35, 45), SpO 2 decrease (case: 1 vs. 10), HR decrease (case: 0 vs. 6), CPR (case: 0 vs. 4), OI: 6.5 (4.4, 8.9) vs. 9.3 (8.0, 12.8)], while case of use of muscle relaxants (case: 3 vs. 0) and volume of 7-day positive fluid balance [mL/kg: 167.1 (113.8, 212.6) vs. 90.8 (57.8, 112.7)] were significantly higher, the differences were statistically significant (all P < 0.05). There was no use of blood purification treatment, no severe complications such as pneumothorax and intracranial hemorrhage, and no death within 28 days in the two groups. Conclusion:Compared with CMV, HFOV in the treatment of infants with severe RSV pneumonia can improve the oxygenation level and clinical physiological indexes earlier, reduce the incidence of adverse events such as HR, SpO 2 decrease and CPR, increase the use of muscle relaxants and the positive fluid balance, and do not increase the incidence of severe complications such as pneumothorax and intracranial hemorrhage, so its clinical application is safe.

Point-of-care testing and its development trend / 中国小儿急救医学

Point-of-care testing(POCT) has developed rapidly in recent years and is widely used in families, communities, hospitals and all kinds of rescue sites.It plays an important role in the fields of infection, tumor, metabolic diseases, acute and severe diseases and so on.It has technical advantages in disease epidemiological investigation, disease diagnosis, condition and curative effect evaluation.With fast, portable, easy to operate characteristics, the future development potential of POCT is huge.

Analysis of factors related to breastfeeding of premature infants discharged from neonatal intensive care unit / 中国实用护理杂志

Objective:To retrospectively analyze the influencing factors during the hospitalization of premature infants in the neonatal intensive careunit (NICU) based on the breast-feeding choices of the primary family caregivers of premature infants discharged from NICU.Methods:According to the breast-feeding status of 342 premature infants discharged from the NICU from The First hospital of Jilin University from June 1st, 2019 to December 31th, 2019, a self-designed data collection form for premature infants was used to investigate them, and the influencing factors of NICU hospitalization on breast-feeding selection were retrospectively analyzed.Results:The factors influencing breastfeeding included gestational age ( tvalue was-2.177, P=0.029), birth weight ( tvalue was-2.036, P=0.043), feeding mode during hospital stay ( χ2value was 6.582, P=0.010), length of hospital stay ( Zvalue was-2.205, P=0.027), maternal age ( Zvalue was-2.975, P=0.003), maternal education level ( χ2value was 8.350, P=0.04) and twin pregnancy ( χ2value was 7.367, P=0.007). The results of multivariate Logistic regression analysis showed that breast-feeding during hospitalization ( P=0.003) and older age of the mother ( P<0.001) were favorable factors to promote breast-feeding. Twin pregnancy ( P=0.006), low maternal education ( P=0.001) and gestational age ( P=0.006) were the risk factors that were not conducive to the implementation of breastfeeding. Conclusion:During the hospital period, the implementation of breastfeeding and the old age of the mother are conducive to the choice of breastfeeding after discharge, while twin pregnancy, low education of the mother and premature infants of large gestational age are not conducive to the implementation of breastfeeding.

Progress in the diagnosis and treatment of spinal cord injury without radiologic abnormality in children / 中国小儿急救医学

Spinal cord injury without radiologic abnormality (SCIWORA) is more common in children than adults.The reason is that the spinal cord is much more compliant than the spinal cord in children.Under trauma, the elastic changes of accommodating spine exceed the elastic limit of spinal cord, which is manifested as a stretch injury of spinal cord and its secondary pathological changes.The range of symptoms is wide and the clinical manifestations are complex and diverse.MRI is the key to diagnosing suspected cases.The treatment plan is related to the severity and characteristics of spinal cord injury.The acute phase of complete spinal cord injury requires necessary respiratory, circulatory, nutritional assessment and supportive treatment.High-dose corticosteroid therapy is not currently recommended.

Serum Presepsin in the diagnosis and assessment of sepsis in children / 中国小儿急救医学

Objective:To investigate clinical significance of Presepsin(soluble CD14 subtype) in the diagnosis and condition assessment of sepsis in children compared with traditional biomarkers.Methods:For the prospective study, 102 children with sepsis admitted to the PICU of the Children′s Hospital of the Capital Institute of Pediatrics from January 2017 to December 2018 were selected, including 57 cases in the sepsis group, 45 cases in the severe sepsis/septic shock group and 25 cases in the non-infectious systemic inflammatory response syndrome(SIRS group), and 35 children with healthy physical examination during the same period as the control group.The sepsis group was further divided into the survival group( n=86)and the death group( n=16)based on the 28-day mortality.The data collected included serum Presepsin, procalcitonin(PCT), C-reaction protein(CRP) and interleukin(IL)-6 levels on days 1, 3 and 7 of admission, and compared with paediatric critical case scores. Results:(1)The levels of serum Presepsin [12.43(7.21, 15.07) ng/mL], PCT [23.00(5.70, 87.00) ng/mL], CRP [160.0(105.5, 200.0) mg/L], IL-6 [1 000.0(125.0, 1, 000.0) pg/mL] were significantly higher than those in the sepsis, SIRS and control groups( P<0.001). (2) The area under the ROC curve(AUC) values for Presepsin, PCT, and IL-6 subjects on day 1 of admission were 0.856, 0.812, and 0.516, respectively.The sensitivity of Presepsin at a cut-off value of 4.40 ng/mL for the diagnosis of sepsis was 81.1% and the specificity was 72.3%, which would significantly higher diagnostic efficacy of the combination of Presepsin, PCT and IL-6.(3) There was a significant difference between the survival and death groups in Presepsin( P<0.001), and Presepsin was significantly higher in the death group on days 3 and 7 than those in the survival group(both P<0.001); IL-6 was significantly higher in the death group on day 3 than that in the survival group( P=0.04); the differences in PCT and CRP between the death and survival groups at all time points were not statistically significant(both P>0.05 ). (4) The AUCs of inflammatory factors on days 1, 3 and 7 to predict sepsis outcome were 0.597, 0.656 and 0.951 for Presepsin, 0.576, 0.613 and 0.655 for PCT and 0.726, 0.786 and 0.664 for IL-6, respectively.The diagnostic values of Presepsin on day 7 and IL-6 on days 1 and 3 were higher.The combination of Presepsin, PCT and IL-6 significantly improved the prognostic judgment of sepsis.(5) The difference between sepsis-related acute kidney injury(AKI) and non-AKI was not statistically significant when comparing Presepsin on day 1 and 3(all P>0.05). Presepsin levels on day 7 were significantly higher in children with sepsis-associated AKI than in those without AKI( P<0.001). Conclusion:Presepsin is a good biomarker for sepsis diagnosis in children, which is equivalent to PCT in the diagnosis of sepsis, superior to IL-6 and superior to PCT in the prognosis evaluation.Combined testing of Presepsin, PCT and IL-6 may improve the diagnosis of sepsis and the assessment of the condition in children.

Identifying bacterial and viral infections / 中国小儿急救医学

Early accurate identification of bacterial and viral infections in acute infections has been a clinical challenge.With the rapid development and progress of various clinical tests and detection technologies, more and more indicators of etiology, human genetics and molecular biology are used to identify bacterial and viral infections.In the future, more test indicators will be adopted point-of-care testing method to facilitate clinical application.There will be a more accurate and abundant biomedical information platform and a more efficient hospital information system for comprehensive analysis of multiple indicators to provide more accurate pathogen diagnosis and contribute to the best clinical practice.

Severe adenovirus infection damage to the blood system / 中国小儿急救医学

Severe adenovirus pneumonia and disseminated adenovirus infection can cause damage to the blood system.Those damages included coagulopathy, hemolytic phagocytosis, acquired hemophagocytic lymphohistiocytosis, leukocyte abnormalities.All of the above injuries are related to the uncontrolled immune inflammatory response to adenovirus infection.Direct injury caused by adenovirus infection and immune inflammation are the main injury mechanisms.

Severe adenovirus infection damage to the blood system / 中国小儿急救医学

Severe adenovirus pneumonia and disseminated adenovirus infection can cause damage to the blood system. Those damages included coagulopathy,hemolytic phagocytosis,acquired hemophagocytic lymphohistiocytosis,leukocyte abnormalities. All of the above injuries are related to the uncontrolled immune inflammatory response to adenovirus infection. Direct injury caused by adenovirus infection and immune in﹣flammation are the main injury mechanisms.

Survey on the prevalence of continuous blood purification in Chinese pediatric critical care / 中华儿科杂志

Objective@#To investigate the current application status of continuous blood purification (CBP) technology and equipment in pediatric intensive care unit (PICU) in China.@*Methods@#A cross-sectional survey was conducted to understand the current popularization of CBP technology and equipment, the management of CBP equipment and consumables, and the application of CBP in different diseases. A questionnaire named Application Status of Continuous Blood Purification Technology was applied. Children's hospitals and polyclinic hospitals with the pediatric qualification (pediatric emergency or critical care unit members of Chinese Medical Association and Chinese Medical Doctor Association) were selected.@*Results@#From December 2016 to February 2017, 53 hospitals completed the questionnaire, including 7 in northeast, 6 in north China, 16 in east China, 9 in south China, 5 in central China, 4 in the northwest, and 6 in the southwest region. Continuous renal replacement therapy (CRRT), the most widely used technology, was carried out in 51 hospitals. Other technologies were peritoneal dialysis (IPD) (n=37), artificial liver support (ALSS) (n=26) and blood adsorption (PA) (n=13). There were 107 CBP machines in the 51 hospitals used CBP technology, with an average of 2.10/hospital. In 36 hospitals CBP machines were managed independently by PICU (70%). Hospitals made their own displacement liquid (n=40, 78%), or purchased displacement liquid (n=11, 22%). Hospitals prepared dialysate on their own (n=38, 75%), or purchased dialysate (n=13 hospitals, 25%). In 46 (90%) hospitals, hemodialysis catheter was placed independently by PICU doctors. The routine operation and maintenance of CBP were mainly completed by the PICU nurses in 36 hospitals (71%). There were 39 hospitals (76%) where professional nurses manage and maintain CBP. Puncture sites were femoral vein (n=26, 51%), internal jugular vein (n=21, 41%) and venae subclavia (n=4, 8%). Forty-two hospitals (82%) selected B-mode ultrasound positioning and guidance when performing internal jugular vein puncture. A total of 40 (78%) hospitals have developed post dilution and combined dilution techniques during the implementation of CBP. The most common indications of CBP technology were different in different regions. They were sepsis in northeast (24.0%, 243/1 011) and east China region (32.0%, 982/3 069), multiple organ dysfunction syndrome in south China (29.2%, 444/1 520), north China (15.8%, 126/796), and southwest region (30.1%, 460/1 526), drug poisoning in central China region (21.6%, 325/1 506), and renal failure in northwest region (53.0%, 44/83).@*Conclusions@#CBP technology is widely used in the field of pediatric severe diseases in China. The eastern regions possess more CBP equipment than the western regions. CBP is widely used in the treatment of sepsis.

Advances in the application of intraaortic balloon pumping in children / 中国小儿急救医学

Intraaortic balloon pump (IABP) is one of the short-term circulatory mechanical support technique. This technique can increase the blood flow of the coronary arteries to improve the blood and oxy-gen supply to myocardium,reduce the cardiac afterload,increase cardiac output. This technique was first used on adult in 1967 and till 1980 doctor Pollock used it on children successfully. After that there were several reports of pediatric patients using IABP,most of them are patients with congenital heart disease who had low cardiac output syndrome postoperatively,others were cardiomyopathy,myocarditis and children waiting for a heart transplant, total survival rate was 25%-100%. For children who can′t wean from cardiopulmonary bypass,bridge to the use of ventricular assist or extracorporeal membrane oxygenation and heart transplant, left ventricle failure leads to low cardiac output,IABP can be used to improve cardiac output and reduce mor-tality. However,with maturing of extracorporeal membrane oxygenation and ventricular assist device,whether IABP is the best choice for early cardiac assistance needs to be further studied.

Cardiac functional medication support / 中国小儿急救医学

Heart failure is a complex syndrome with heterogeneous etiology,some unclear mecha-nism and poor prognosis. Medication therapy is the first and most commonly used method. Although the understanding of the pathophysiological mechanism of heart failure is deepening continually and new thera-peutic medications are also being used in clinical practice. However,there are still many pathogenesis and clinical mechanism unclear and there is a lack of effective therapeutic medications. The study of heart failure in children and clinical drug therapy is far worse than that of adults. There are well-established guidelines for the management of heart failure in the adult population,but an equivalent consensus in children is lacking. High quality clinical research is needed for improving drug treatment regimens in children.

Adverse reactions of catecholamines in shock treatment / 中国小儿急救医学

Catecholamines is an important part of the treatment of shock.Its best goal is not only to maintain the patient′s blood pressure,but also to increase the effective perfusion of tissues and organs, improve microcirculation and prevent multiple organ dysfunction. But in the current clinical practice, catecholamines are often"double-edged sword". Therefore,focusing on the benefits of each catecholamine while taking into account the adverse reactions of the drug may be the key to finding the best solution.

Risk and prevention of off-label drug uses / 中国小儿急救医学

Pediatric off-label drug use is common especially at critical care and emergency field. Off-label drug use has its rationality and necessity. However, its risks must be taken seriously and actively prevented. We should concern the risks of off-label prescriptions and prevent them in advance. Standardizing the implementation plan and procedures of clinical off-label drug use from national regulations to medical institutions could make benefits for both patients and physicians. It will improve medication safety eventually.

Clinical analysis of human bocavirus infection in children with severe lower respiratory tract infection / 中华实用儿科临床杂志

Objective To explore the clinical characteristics of human bocavirus (HBoV) infection in the children with severe lower respiratory tract infection.Methods The clinical data of the hospitalized children with sputum HBoV-positive were analyzed retrospectively,who were hospitalized at the Pediatric Intensive Care Unit of Children's Hospital Affiliated to Capital Institute of Pediatrics from September 1,2016 to March 31,2017.Results A total of 17 children were included in the study.The ratio of male to female was 15 ∶ 2.The diagnostic age ranged from 4 months to 4 years and 10 months old.82.4％ (14/17 cases) of the patients were infants less than 2 years old.Autumn and winter were high-occurrence seasons.Pediatric Critical Illness Scores(PCIS) were 68-88 scores(median 82 scores).PCIS was less than 70 scores in 1 case,and between 70 scores and 80 scores in 7 cases,and more than 80 scores in 9 cases.The main clinical manifestations were respiratory system involvement,including dyspnea in 17 cases (100％),fever in 14 cases (82.4％),cough in 16 cases (94.1％),wheezing in 13 cases (76.5％),and moist rales in 13 cases (76.5％).The main abnormal chest radiological findings showed patchy shadows in 7 cases (41.2％) and consolidation in 6 cases (35.3％).The oxygenation index was 73.9-296.0 mmHg(1 mmHg =0.133 kPa),and median was 176 mmHg.The oxygenation index was between 100-200 mmHg in 7 cases(41.2％),and less than 100 mmHg in 2 cases(11.7％).Type Ⅰ respiratory failure occurred in 11 cases (64.7％),while type Ⅱ respiratory failure occurred in 6 cases (35.3 ％).All of the patients need respiratory support with mechanical ventilation.Among them,6 patients (35.3％) were treated by non-invasive ventilation and their ventilation time were 25-128 h(median 65 h),while 11 patients (64.7％) were treated by invasive ventilation and their ventilation time was 42-178 h(median 70 h).Other organ or system dysfunction is mild.The length of hospital stay ranged from 3 days to 13 days.The cure rate was 100％.Conclusions HBoV infection in the children with severe lower respiratory tract infection is common in infants under 2 years old,with acute onset and rapid recovery.The obvious clinical symptoms are fever,cough,wheezing and dyspnea.Although respiratory failure is common,other organ or system dysfunction is mild,which may bring about a good prognosis.