Predictive value of four pediatric scores of critical illness and mortality on evaluating mortality risk in pediatric critical patients / 中华危重病急救医学

Objective To assess the performance of pediatric clinical illness score (PCIS), pediatric risk of mortality scoreⅢ(PRISMⅢ), pediatric logistic organ dysfunction score 2 (PELOD-2), and pediatric multiple organ dysfunction score (P-MODS) in predicting mortality in critically ill pediatric patients. Methods The data of critically ill pediatric patients admitted to Pediatric Intensive Care Unit (PICU) of First Affiliated Hospital of Sun Yat-Sen University from August 2012 to May 2017 were retrospectively analyzed. The gender, age, basic diseases, the length of PICU stay were collected. The children were divided into survival group and non-survival group according to the clinical outcome during hospitalization. The variables of PCIS, PRISMⅢ, PELOD-2, and P-MODS were collected and scored. Receiver operating characteristic (ROC) curve was plotted, the efficiency of PCIS, PRISMⅢ, PELOD-2, and P-MODS for predicting death were evaluated by the area under ROC curve (AUC). Hosmer-Lemeshow goodness of fit test was used to evaluate the fitting degree of each scoring system to predict the mortality and the actual mortality. Results Of 461 critically ill children, 35 children were excluded because of serious data loss, hospital stay not exceeding 24 hours, and death within 8 hours after admission. Finally, a total of 426 pediatric patients were enrolled in this study. 355 pediatric patients were survived, while 71 were not survived during hospitalization, with the mortality of 16.7%. There was no significant difference in gender, age, underlying diseases or length of PICU stay between the two groups. PCIS score in non-survival group was significantly lower than that of survival group [80 (76, 88) vs. 86 (80, 92)], and PRISMⅢ, PELOD-2 and P-MODS scores were significantly increased [PRISMⅢ: 16 (13, 22) vs. 12 (10, 15), PELOD-2: 6 (5, 9) vs. 4 (2, 5), P-MODS: 6 (4, 9) vs. 3 (2, 6), all P < 0.01]. ROC curve analysis showed that the AUCs of PCIS, PRISMⅢ, PELOD-2, and P-MODS for predicting death of critical ill children were 0.649, 0.731, 0.773, and 0.747, respectively. Hosmer-Lemeshow test showed that PCIS predicted the mortality and the actual mortality in the best fitting effect (χ2= 7.573, P = 0.476), followed by PELOD-2 and P-MODS (χ12 = 9.551, P1= 0.145; χ22 = 10.343, P2= 0.111), while PRISMⅢ had poor fitting effect (χ2= 43.549, P < 0.001). Conclusions PRISMⅢ, PELOD-2 and P-MODS can discriminate between survivors and moribund patients well, and assessing the condition of critically ill pediatric patients with relatively accuracy. PCIS was the best fitting effect in predicting mortality and actual mortality, followed by PELOD-2 and P-MODS, while PRISMⅢ had poor fitting effect.

Current situation, clinical characteristics and management of human swine influenza A H1N1) in children / 国际儿科学杂志

Human swine influenza A (H1N1) is a highly transmissible infectious disease, which has spreaded globally and represented a continuous pandemic threat. The novel virus has predominantly affected the children and young adults. Clinical manifestations generally appear mild, but there are still many patients with severe complications leading to hospitalization. According to the current reports, the mortality in the early stages of the pandemic appears no more than seasonal influenza A . Children (especially less than 5years) are considered to be at higher risk of infection and complications. Pediatric patients with a underlying significant chronic disease such as chronic respiratory disease,cardiovascular disease and immunodeficiency disease, are at a higher risk of death. The neuraminidase inhibitors Oseltamivir and Zanamivir are effective for prophylaxis and treatment. Effective vaccines are regarded to be crucial for the control of influenza pandemics. This review focuses on the epidemiological situation, clinical characteristics and management of human swine influenza A (H1N1), so as to provide practical advice for clinicians.

Effects of berberine on fibronectin and p38MAPK signal pathway in rat glomerular mesangial cells cultured under high glucose condition / 中国药理学通报

Aim To investigate the effects of berberine on extracellular matrix in rat glomerular mesangial cells cultured under high glucose and its possible mechanism.Methods Six groups were divided according to the different experimental conditions:① Normal glucose group (NG);② Mannitol group (Mannitol);③ High glucose group (HG);④ SB203580 treatment group (HG+SB203580);⑤ Berberine low dosagegroup (HG+BBR 30 ?mol?L-1);⑥ Berberine high dosage group (HG+BBR 90 ?mol?L-1). The phospho-p38MAPK,phospho-cAMP response element binding protein (CREB) and fibronectin were detected by Western blot analysis. Results Berberine obviously decreased protein expression of fibronectin compared with high glucose group. Phospho-p38MAPK and phospho-CREB level was significantly lowered compared with that of high glucose group. Conclusion Berberine can inhibit extracellular matrix accumulation including fibronectin via p38MAPK signal pathway in treatment of diabetic nephropathy.