The differential diagnosis of inguinal and scrotal emergencies in children is difficult and misdiagnosis might be associated with danger or even mortality.Early diagnosis and proper treatment are very important and explorational surgery should be carried out when diagnosis is in doubt.

Clinical risk index for babies( CRIB) is applied in low birth weight preterm neonates to assess the initial severity of illness,predict mortality risk rates,evaluate their own performance,and audit the performance between different medical institutions.CRIB plays an important role in the progressive develop-ment of neonatology.The scoring rules and advantagse of CRIB scorni g system were introud ced in this arti-cle.Teh scoring system is able to correctly predict mortaliyt probabilities and long-term neurodevelopmental outcomes for low birth weight preterm infants.

Objective To investigate the riskf actors associated with sepsis following surgery of con-genital heart disease in children, for early-recognizing and diagnosing, improving prognosis and decreasing mortality.Methods Retrospective study wa s employed,52 patients of sepsis and 104 patients of non-sepsis with similar age,sex,na d the same diseases were enrolled during Jan 2012 to Apr 2015 in cardiac intensive care unit.Variables such as age,sex,preoperative infection,delayed sternum closure,diaphragmatic paralysis, exploraot ry chest,cardiopulmonaryb ypass time, placed invasive catheter were included in the research fac-tors.The Logistic regression model was set up,OR and 95%CI were calculta ed.Results In sepsis group,the more shock and dysfunction organs,longre hospital stays,longer ICU stays and higher mortality were found compared to the non-sepsis group[25.32%vs.6.73%,3.5 ±1.1 vs.1.1 ±0.7,(35.1 ±11.2)d vs.(11.3 ±3.1)d,(21.3 ±7.1)d vs.(7.1 ±2.3)d,19.23%vs.4.81%,P<0.05].In the Logistic regres ion mod-e l,variables significantly associated with sepsisw ere preoperative infection,deal yed sternal closure,explorato-ry chest,and placed more invais ve duct,diahp ragmatic paralysis(P<0.05).OR value (95%CI) were 10.53 (1.73,64.2),26.66(2.69,263.83),19.47(1.87,203.02),4.99(1.36,18.31),8.32 (0.12,16.46 ), respectively.Conclusion Preoperative infection,delayed sternal closure,exploratory chest,placed more inva-sive duct,diaphragmatic paralysis are the risk factors of sepsis.Children with sepsis had poor clinical outcome compared to those without sepsis.

Objective The purpose of the study was to investigate the causes of hemoptysis and ex-plore the diagnostic procedures for hemoptysis in children. Methods The medical records of 42 children with hemoptysis admitted to the Respiratory Department of Hunan Children′s Hospital from June 2012 to June 2015 were collected by a retrospective study. The causes of hemoptysis were classified by pathogenesis,and the diagnosis of hemoptysis was evaluated in this study. The final diagnosis was divided into clear diagnosis and the cause was unknown. Results A total of 41(97. 6%) cases were diagnosed,1(2. 4%) case was not diagnosed. In 42 cases of hemoptysis,infection was the main cause of the disease,including 8(19. 0%) cases of pneumonia and 5(11. 9%) cases of bronchitis,and the following causes were bronchial artery fistula(10/42,23. 8%),idiopathic pulmonary hemosiderosis(8/42,19. 0%),bronchiectasis(5/42,11. 9%),pulmonary vascular malformation with pulmonary hypertension(3/42,7. 2%),pulmonary tuberculosis(2. 4%),bronchi-al foreign body(1/42,2. 4%) respectively. Thirteen cases of respiratory tract infection,and 5 cases of bron-chiectasis were diagnosed by chest CT,10 cases with pulmonary artery fistula were diagnosed by digital sub-traction angiography,8 cases of pulmonary hemosiderosis,1 case of pulmonary tuberculosis,and 1 case with bronchial foreign body were diagnosed by fiberoptic bronchoscopy. Three cases of pulmonary vascular malfor-mation and pulmonary hypertension were diagnosed by row helical CT angiography and cardiac color ultra-sound. Conclusion Hemoptysis in children is a heterogeneous group of respiratory disorders. Most causes could be identified by using the diagnostic procedures. Other factors, including medical history, CT, fiber bronchoscopy,multidetector CT angiography, cardiac color ultrasound and digital subtraction angiography, play important roles in the diagnosis of hemoptysis in children.

Septic cardiac dysfunction is very common in children with sever sepsis and septic shock, and the diagnosis mainly depends on echocardiography.In this article, we reviewed the diagnosis of septic cardiac dysfunction and its relation with prognosis.Meanwhile,we showed the hot spot and controversy on potential mechanisms of septic cardiomyopathy.

Continuous renal replacement therapy( CRRT) employs convection and adsorption to re-move pro-and anti-inflammatory mediators from plasma, helping to restore the immunologic homeostasis. CRRT also provide uninterrupted clearance of retained endogenous and exogenous toxins, along with acid-base,electrolyte,hemodynamics and volume homeostasis.CRRT may improve outcomes in critically ill pa-tients with sepsis-induced acute kidney injury,septic shock and multiple organ dysfunction syndrome.Region-al citrate anticoagulation, as compared to unfractionated heparin, report better filter survival times and less bleeding.Antibiotic dosing decisions should be individualized to take into account patient-related,CRRT-relat-ed,and drug-related factors.

Septic encephalopathy( SE) is defined as diffuse brain dysfunction that related to systemic inflammatory response and without clinical or laboratory evidence of central nervous system infection.SE is one of the most common complications of patients with severe sepsis.Its pathogenesis is very complex and is not yet clear.The clinical manifestations of SE varied and have no specificity, mainly for changes of con-sciousness and mental status.The performance of electroencephalography is more sensitive,and is associated with prognosis.Somatosensory evoked potentials could display the damage of cortical or subcortical path-ways.Brain MRI has a more accurate assessment of the nature and the extent of brain damage.SE is a diag-nosis of exclusion.Before the diagnosis of SE,we need to exclude other encephalitis and encephalopathy.The morbidity and mortality of SE are high.It requires close attention,early detection and timely treatment.

Objective To survye the relationshi p between blood pressure and body mass index ( BMI) ,waist-to-height ratio( WHtR) and body surface area( BSA) amogn 7 to 13 years old children in Jin-pan id strict,Haikou city.Methods A total of 1 018 school-age children aged from 7 to 13 years old were se-lected from two elementary schools in Jinpan distir ct,Haikou cti y.Blo odp ressure,height, weight and wa ist circumferencew ere measuredi n all children.BMI,WHtR,BSA were calculated and statistci al analyis s was performed by SPSS 22.0 software.Results The Pearson Correlation Coefficient of BMI and bloodp er ssure showed that BMI was posti vely correlatde with ob th systolic and id astoil c blood pressure(r=0.489,0.454, P<0.01,respective ly).The Pearos n Correlation Cofe ficient of WHtR and blood pressure showed that WHtR was positively correlated with both systolic and diastolic blood pressure(r=0.294,0.310,P<0.01,respec-tively) .The Pearson Correlation Coefficient of BSA and blood pressure showed that BSA was positively cor-related with both systolic and diastolic blood per ssure(r=0.603,0.520,P<0.01,respectively).The WHtR adn BSA of hypetr ension group were higher than those of the non-hypertension group( P<0.01) in both male and female children.Conclusion The blood pressure in 7 to 13 years old school-age children of Jinpan dis-trict,Haikou city is related to the BMI,WHtR and BSA respectively.

Objective To evaluate the efficacy and safety of bicyclol tablet on hepatic lesions caused by Epstein-Barr virus( EBV) infection in children.Methods A single-center controlled retrospective study was conducted in 121 children with hepatic lesions caused by EBV infection for evaluating safety,tolerability, and efficacy of treatment with bicyclol tablets or Glycyrrhizin capsules.Childer n in bicyclol group ( n=63 ) were treatedw ith bicyclol at blets and cotn rol group ( n =58 ) were treated with Glycyrrhizin capsules.The course of the treatment were both 8 weeeks for two groups.The level of the EBV load pretreatment and plas-ma aminotransferase,blood routine,urine routine pretreatment and 1 week,4 weeks and 8 weeks after treat-mentw ere analyzed er trospectively.Rse ults (1) The pal smaA LT level sigin ficantly decreased in theb icy-clol group compared with that in the contro l group(P<0.01), se pecai lly the levle after 8 weeks treatm ent. (2) Bicycol l was more effce tive in the bicyclol group than Glycyrrhizin capslu se in the control group( P<0.01).(3) Both grousp had no significantlya dvesr e events.Conclusion Bicyclol tablet can derc ease plas-ma aminotransferase level,espce ially ALT,inc hildren caused by EBV infection with better efficiency and safety.

Early goal-directed therapy ( EGDT ) emerged as a novel approach for reducing septic shock mortality and the EGDT protocol requires invasive patient monitoring to guide resuscitation with intra-venous fluids.EGDT was incorporated into guidelines published by the international Surviving Sepsis Cam-paign,but remains controversial.Recently,large randomized trials showed that EGDT did not significantly de-crease mortality in patients with septic shock compared with usual care.Fliud resuscitation and monitoring is the most important in septic shock.Therefore the EGDT is still valuable in present stage.Further,development practical methods for accurately assessing optimal fluid administration is needed.