[Clinical characteristics of new-onset organ dysfunction in pediatric intensive care unit].

Objective: To investigate the incidence and clinical characteristics of new-onset organ dysfunction of patients in pediatric intensive care unit (PICU). Method: A retrospective observational study identified all patients admitted to the PICU of Shengjing Hospital Affiliated to China Medical University from January 2015 to January 2016. The functional status score (FSS) was evaluated at admission and hospital discharge respectively, and the difference defined as ΔFSS between the FSS at hospital discharge and the FSS at admission was calculated. According to the initial FSS, the patients were divided into normal group (6-7 scores), mildly abnormal group (8-9 scores), moderate abnormal group (10-15 scores), severe abnormal group (16-21 scores) and extreme severe abnormal group (22-30 scores). According to the primary disease, all cases were divided into cardiovascular disease group, urinary disease group, surgery group, digestive disease group, neurological disease group, respiratory disease group, hematological disease group, poisoning group and other group. According to the FSS domain, all cases were divided into mental status group, sensory group, communication group, motor group, feeding group, respiratory group. The incidence of new-onset organ dysfunction, the case fatality rate and the FSS of each group were calculated. Comparisons were performed using a chi-square test, t test and analysis of variance. Result: The study population included 928 patients (561(60.5%) male, mean age (31.1±1.3) months). The incidence of new-onset organ dysfunction was 8.8%(82/928) and the case fatality rate was 1.3%(12/928). The FSS at hospital discharge(scores), ΔFSS (scores) and the incidence of new-onset organ dysfunction were significantly less in patients in the normal group (6.38±0.17, -0.20±0.17 and 1.3%(3/229), respectively) compared to patients in the mildly abnormal group (7.09±0.27, -1.39±0.27 and 7.2%(12/170), respectively, t=2.36, 3.93, χ(2)=7.39, all P<0.05), patients in the moderately abnormal group (8.86±0.28, -2.76±0.28 and 10.6%(38/359), t=6.56, 6.91, χ(2)=17.14, all P<0.05), patients in the severely abnormal group(13.56±0.88, -4.39±0.88 and 24.6%(19/79), t=12.29, 7.13, χ(2)=42.43, all P<0.05) and patients in the extreme severely abnormal group(18.68±0.99, -6.59±0.91 and 10.9%(10/91), t=18.15, 10.10, χ(2)=13.27, all P<0.05). Significant difference was found regarding the incidence of new-onset organ dysfunction among patients in cardiovascular disease group (27.3%, 24/88), surgery group (9.2%, 6/65), digestive disease group (8.2%, 8/97), neurological disease group (7.7%, 23/299), respiratory disease group (6.9%, 17/248), hematological disease group (3.9%, 2/51) and toxic group (0, 0/61) (χ(2)=37.75, all P<0.05). There were significant differences among primary disease groups regarding the FSS at admission, the FSS at hospital discharge, ΔFSS, Δmental status FSS, Δsensory FSS, Δcommunication FSS, Δmotor FSS, Δfeeding FSS, and Δrespiratory FSS (F=13.56, 8.97, 10.84, 6.30, 7.37, 7.84, 7.47, 9.97, 10.50, all P<0.05). Conclusion: The incidence of new-onset organ dysfunction in PICU was high. The case fatality rate in patients with new-onset organ dysfunction was high. The functional status at hospital discharge was strongly associated with the functional status at admission. Patients in the cardiovascular disease group had the highest incidence of new-onset organ dysfunction and the most severe deterioration of functional status.More attention must be paid to motor function and respiratory function in cardiovascular disease, respiratory disease and hematological disease.

[Investigation on extracorporeal membrane oxygenation application in pediatric intensive care unit in China].

OBJECTIVE: To review the use of non-open chest extracorporeal membrane oxygenation (ECMO) in pediatric intensive care unit (PICU) in China. METHOD: The survey was conducted in 28 tertiary hospitals in China mainland from March to October 2015. All children <18 years of age have been supported with non-open chest ECMO in PICU were reviewed.Patient demographics, diagnosis, indication for ECMO, details of ECMO support, complications, and patient survival were analyzed. All the patients were divided according to age into pediatric patients (age>28 d) and neonatal patients (age 0-28 d). For non-normally distributed measurement data, two groups were compared using independent samples of the Mann Whitney U test and for categorical data constitute ratio were compared by χ(2) test or Fisher's exact test. RESULT: A total of 63 patients received non-open chest ECMO support during this study, including 51 pediatric patients and 12 neonates. For 51 pediatric patients, their mean age was 55.5 (15.0-117.0) months, and mean weight was 17.5 (10.0-32.9) kg. Cardiac failure was the primary indication in 28 patients, respiratory failure in 21 patients, and both cardiac and respiratory in 2 patients. Patients with cardiac disease had a lower mortality rate compared with cases with respiratory disease (21%(6/28) vs. 67% (14/21), χ(2)=9.145, P=0.002). The average length of ECMO run was 112.0 (74.5-175.2) h, and 96.7(76.2-139.5)h for cardiac patients, 149.0(78.9-241.0)h for patients with respiratory disease. There were no significant difference between patients with cardiac disease and patients with respiratory disease in ECMO support time (Z=1.476, P=0.140). Forty-two patients (82%) were decanulated from ECMO successfully, and thirty-one (61%) patients survived to hospital discharge. The most common complications during ECMO run were bleeding, hemolysis and disfunction of oxygenation. Of the 25 (49%) survivors whom we followed up, 8 (17%) experienced obvious sequelae, and 5 (10%) had neurologic problems. Of twelve neonates, their mean weight was(3.2±0.5)kg. The primary cause of ECMO was neonatal respiratory distress syndrome(7 cases). All of the neonatal patients were treated with veno-arterial (VA)-ECMO. The mean duration of ECMO support was 88.4 (45.50-110.25) h. Seven patients were decanulated from ECMO successfully, five survived to hospital discharge. CONCLUSION: ECMO support can significantly improve the prognosis of pediatric and neonatal patients with refractory respiratory and cardiac failure. More efforts are needed on patient selection, experienced team establishment and ECMO therapy technology improvement need further improvement in China in the future.

Construction of a Hep-2 cell line stably transfected with Livin shRNA.

OBJECTIVE: The aim of this study was to construct a eukaryotic expression plasmid with a short hairpin RNA (shRNA) targeting Livin in order to obtain a stably transfected Hep-2 cell line with a reduced expression of Livin. METHODS: The shRNA targeting Livin mRNA was designed, and a shRNA plasmid and a negative control plasmid were constructed. After amplification in E. coli, restriction endonuclease digestion and sequence confirmation, the plasmids were transfected into Hep-2 cells using Lipofectamine 2000. The stably transfected cell line was screened using G418, and inhibition of Livin mRNA and protein levels were detected using real-time PCR and western blotting, respectively. RESULTS: pGenesil-Livin-shRNA eukaryotic expression plasmid was successfully constructed and identified by sequencing. Green fluorescent protein (GFP) expression was observed in Hep-2 cells transfected with shRNA plasmids by fluorescence microscopy. The expression levels of Livin mRNA and protein decreased significantly in Hep-2 cells transfected with the shRNA recombinant plasmid. The mRNA level was reduced by 47.17 %, and the protein level was reduced by 34.25 %. CONCLUSION: The shRNA eukaryotic expression plasmid targeting Livin was successfully constructed, which could significantly inhibit the expression of Livin in laryngeal cancer Hep-2 cells. This provides a basis for future research on the function of Livin in Hep-2 cells, and gene therapy for laryngeal cancer.