Prognosis and rehabilitation of sepsis-associated encephalopathy / 中华实用儿科临床杂志

Sepsis-associated encephalopathy (SAE) is a serious complication of sepsis, which can greatly increase the mortality of patients with sepsis, and may result in prolonged cognitive dysfunction in SAE survivors.Therefore SAE has received more and more attention in the field of critical illness.However, there are few studies on the mechanism of poor prognosis and possible predictors of SAE, and no specific rehabilitation methods have been reported.In this article, progress in the research on the prognosis and rehabilitation of SAE is summarized, in order to provide a reference for the long-term prognosis and rehabilitation treatment of severe sepsis in children.

Application value of continuous blood purification in pediatric intensive care unit: analysis of 203 cases / 中华危重病急救医学

Objective To explore the clinical application value of the continuous blood purification (CBP) technology in pediatric intensive care unit (ICU). Methods A retrospective study was conducted. All CBP patients admitted to pediatric ICU of Children's Hospital of Nanjing Medical University from 2015 to 2017 were enrolled. The disease diagnosis, CBP treatment mode, catheter placement, anticoagulation way, treatment time and adverse reactions were summarized and analyzed. Results ① A total of 203 children were included, male accounted for 59.1%; age 37 days to 14 years old, with an average of (4.52±3.60) years old; weight 3.3-68.0 kg, with an average of (21.38±13.77) kg.② There were a total of 660 CBP treatments, with an average of 3.25 times per person. The main treatment modes of CBP were plasma exchange (PE, 38.64%), and followed by continuous veno-venous hemodiafiltration (CVVHDF, 38.64%), hemoperfusion (HP, 16.51%) and continuous veno-venous hemofiltration (CVVH, 6.21%).③ Central venous catheterization was mainly placed in the right internal jugular vein (90.64%), followed by the right femoral vein (5.42%) and the left femoral vein (3.94%).④ Heparin sodium was the main anticoagulant in pipeline filters (84.73%), followed by low molecular weight heparin calcium (11.33%), sodium citrate and non-anticoagulant (both 1.97%). Mixed anticoagulants were used 21 children. ⑤ Primary diseases included poisoning (26.11%), liver failure (25.62%), sepsis (12.32%), shock after cardiopulmonary resuscitation (11.82%), acute respiratory distress syndrome (ARDS, 8.37%), central nervous system diseases (5.41%) and metabolic diseases (4.93%). The lowest efficacy of CBP was metabolic diseases, with mortality rate of 60.00%; followed by ARDS, shock after cardiopulmonary resuscitation, sepsis and liver failure, with mortality was 58.82%, 41.67%, 36.00% and 32.69%, respectively. The length of hospitalization stay of children with central nervous system diseases was (30.89±15.13) days.⑥ Adverse events of CBP treatment included uncontrollable restlessness (2.88%), hypotension (1.82%), allergic rash (1.21%), catheterization and pipeline coagulation (1.21%), filter coagulation (1.06%), decreased heart rate and oxygen saturation (0.76%); CBP was stopped in 8 children due to cardiac arrest during the treatment. Conclusion At present, the application of CBP technology in pediatric ICU is universal, and it is an important way to rescue critical illness.

Advances in pathophysiology of fluid resuscitation of septic shock in children / 中华实用儿科临床杂志

Fluid resuscitation is one of the most important advances in the treatment of septic shock in recent 20 years. Although saving many children's lives,this technique has been challenged by some studies. This article re-viewed systematically hemodynamics characteristic,myocardial depression and capillary leak syndrome in septic shock in children.

A systematic review of intravenous immunoglobulin for critical hand-foot-mouth disease / 中华实用儿科临床杂志

Objective To evaluate the effectiveness of intravenous immunoglobulin (IVIG) in critical hand-foot-mouth disease (HFMD).Methods The data from PubMed, MEDLINE, EMBASE, EBSChost, Cochrane Library, Cochrane Central Register of Controlled Trials, Ovid, China Biology Medicine disc, Wanfang Data, China National Knowledge Infrastructure, Chinese Citation Database, and other references and grey literatures were retrieved, screening out all those related to clinical trials on treating critical HFMD by IVIG.Standard methods of the Cochrane Collaboration were employed to evaluate the methodological quality of the trials.Meta analysis was performed with Rev man 5.3 software.Results Eleven trials including 967 cases were investigated.The meta analysis showed that IVIG had significantly clinical efficacy (OR =6.84,95％ CI:3.74-12.52 ,P ＜ 0.05).IVIG could significantly decrease duration of fever (MD =-1.94,95％ CI:-3.07--0.81 ,P ＜0.05) ,hospitalization time (MD =-4.56,95％ CI:-8.95--0.17,P ＜0.05).There was no significant difference in duration of fever (MD =-0.28,95 ％ CI:-0.59-0.03, P ＞ 0.05), duration of herpes (MD =0.18,95％ CI:-0.22-0.59, P ＞ 0.05), hospitalization time (MD =-0.12,95％ CI:-0.47-0.23, P ＞ 0.05) when the dosage of injection was adjusted.Conclusions IVIG is recommended for treating critical HFMD because it is effective in decreasing the duration of fever and hospitalization.Well designed studies with more sample in multi-center are required in further study to explore the efficacy and safety of IVIG on critical HFMD.

Virus induced acute respiratory distress syndrome in children / 中国小儿急救医学

The acute respiratory distress syndrome (ARDS) can be induced by viral diseases.Among these viruses that can affect the lung and cause ARDS,pandemic viruses head the list,with influenza viruses H1N1,H5N1,coronavirus and measles.Apart from these pandemic viruses,respiratory viruses such as adenovirus are sometimes responsible for viral pneumonia and ARDS.Other than antiviral drug,management of ARDS due to these virusesdoes not differ from that for ARDS caused by other diseases,including lung protective ventilation strategy,prone position ventilation,conservative fluid therapy,analgesia and sedation,ECMO and management of air leak.

The relationship between mobile phone dependence and attachment, social support among adolescents / 中华行为医学与脑科学杂志

Objective To explore the relationships among mobile phone dependence and attachment,social support among adolescent students.Methods 900 students from two vocational colleges in Shandong province were recruited by stratified sampling.They were assessed with Experiences in Close Relationships Inventory (ECR) Chinese version,Social Support Rating Scale and Mobile Phone Addiction Tendency Questionnaire.Results There were no significant differences of adolescent students'mobile phone dependence on gender,child status,and native place.The score of middle vocational school students'mobile phone dependence (45.84 ± 12.64)was significantly higher than that of higher vocational college students (40.68 ± 9.72),and there was significant difference between them (P ＜ 0.01).Mobile dependence was significantly positively related with attachment anxiety (r =0.469,P ＜ 0.01),and was significantly negatively related with social support (r =0.149,P ＜ 0.01).Attachment anxiety and social support were the direct predictors of mobile phone dependence,and social support played the partial mediating role between attachment anxiety and mobile phone dependence.Conclusions Mobile phone dependence is a common phenomenon among adolescent students,and the middle vocational school students' mobile phone dependence is more serious than that of the higher vocational college students.There are close relationships between mobile phone and attachment,social support.Attachment anxiety is not only directly but also indirectly associated with mobile phone dependence by social support.

Adverse effects and management of fluid resuscitation / 中国小儿急救医学

Adverse effects and management of fluid resuscitation were reviewed in this article,which included pulmonary and peripheral edema,complication in nervous system ( cerebral edema,central pontine myelinalysis,and extrapontine myelinalysis),electrolyte disturbances and metabolic acidosis.

Establishing long-term surviving model of ventilator induced lung injury in piglets by large tidal volume ventilation / 中华急诊医学杂志

Objective To establish a long-term surviving model of ventilator induced lung injury ( VILI) in piglets with large tidal volume ventilation. Methods A total of 21 piglets were randomly( random number) divided into trial experiment group (group A,n =9), injury group ( group B,n =6) and control group ( group C, n = 6). Each piglet was intubated orotracheally and intravascular cannulae were inserted both into carotid artery and external jugular vein. The tidal volume in 60 - 80 ml/kg was given to rats of group A and 50 ml/kg to rats of group B, and free breath to rats of group C. Vital signs, pneumatic mechanics, blood-gas analysis and hemodynamics were monitored every hour ( group A and group B from just after the model established 0 h, group C from 0 ～6 h). The t test or ANOVA test was used for statistical analysis. Left lung tissue was sent to biopsy after experiment. Results About 6 hours after mechanical ventilation with large tidal volume, PaO2/FiO2 lower significantly both in A and B group in comparison with control group (P ＜0.05 ) and histological changes hit the ALl criteria. Piglets ventilated with 50 ml/kg of tidal volume could survive for long-term. Conclusions The model of VILI in piglets made with 50 ml/kg of tidal volume ventilation was established successfully and survived for long-term.

Clinical observation of naloxone treatment in drowing children / 中国小儿急救医学

Objective To investigate the clinical effects and mechanism of naloxone treatment in drowing children.Methods A total of 97 drowing children were divided into treatment group(n=45)and control group(n=52)depending on whether the naloxone was administrated.General treatment was adopted in two groups.Treatment group Was given naloxone.The clinical effects were observed and the levels of betaendorphin(β-EP)in blood plasma were measured with radioimmunoassay(RIA)before and after treatment respectively.Results The total effective rate of treatment group(93.3%,42/45)Was significantly higher than that of control group(76.9%,40/52)(P＜0.05).As compared with that of control group(65.0%,26/40),nervous system disability rate in treatment group(33.3%,14/42)decreased significantly(P＜0.01).Continuous days of poor blood circulation,abnormal respiratory rhythm,convulsion and coma in treatment group were significantly shorter than those of control group respectively(P＜0.01).The level of β-EP was significantly lower in treatment group than that of control group(t=17.1,P＜0.01).Conclusion Clinical use of naloxone in the drowing children has curative result by reducing the level of blood plasma β-EP.

Step sequential therapy in rescuing infantile postrenal acute renal renal failure induced by melamine / 中华急诊医学杂志

Objective To investigate clinical characteristics and emergency managements of postrenal acute renal failure(ARV)induced by melamine in infant.Method Fluid therapy for urine alkalization and hydration,cistoscope drainage and peritoneal dialysis step by step were exerted in those who had both a history of certain milk intake and ARF according to the definition of pediatric ARF which developed by Pediatric Nephrology Assembly of Chinese Pediatric Association in 1994.Results Thirty-four postrenal ARF cases with anuria due to melamine in Nanjing Children's Hospital of Nanjing Medical University were involved in the study.Seventy cases(50%)re-ceived fluid therapy only.Nine cases(26.5%)received fluid thempy and eistoscope drainagemand 4 cases (11.8%)received fluid therapy and cistoscope drainage and peritoneal dialysis.Four cases(11.8%)received ur-gent peritoneal dialysis due to severe hyperkalemia.All cases(100%)survived.The urine pH at the first day.the second day,and after the second day in those who just pass away urine were 6.1±1.0、6.5±0.7.5.3±0.4,respectively(F=4.563,P=0.026).Conclusions Fluid therapy for urine alkalization and hydration and stop sequential thempy are effective in infant with postrenal ARF induced by melamine.

Effect of L-dopa on plasma homocysteine in elderly patients with Parkinson's disease / 中华神经科杂志

Objective To explore the effect of L-dopa on plasma homocysteine and folic acid in patients with parkinsons' s disease(PD).Methods Twenty eight elderly PD patients and thirty normal subjects were enrolled in this group.The homocysteine,cobalamin and folate were examined in normal group and in PD group before treatment and after being treated with L-dopa for six moths respectively.Then the homocysteine,cobalamin and folate were compared between the two groups.Results The plasma homocysteine levels increased in PD patient group after being treated with L-dopa for six months(19.19? 8.01)?mol/L as compared with those of the PD group before treatment(12.50?3.78)?mol/L and those of control group(12.60?3.94)?mol/L(P