Septic shock is the most common complication in severe septic patients.These patients clinically present shock manifestations due to capillary leak,extravasation in the third space,the anomaly distribution of blood volume,and decreased effective circulating volume,secondary to the severe inflammatory reaction.Early reasonable fluid resuscitation is one of the main therapy to deduce the mortality of septic shock.The time point of fluid resuscitation,volume control,and therapeutic evaluation play important role in the treatment of septic shock.

with the development of emergency medicine with respiratory failure in children,imaging has played an important role in critical care of children.Critically ill patients often require ventilator,which need to use imaging methods to monitor the trerapeutic effects and adverse reactions.By imaging tests.it can be helpful in understanding the nature of lung diseases,verifying intubation's location,monitoring ventilatory complications,assessing the comprehensive effect of ventilator,and facilitating ventilator parameter adjustment and mode selection.

Respiratory tract infection is a commo n disease in hc ildren.The pathoeg ns of respiratory trract infection are very complex, includingvi ruses, bactre ia, mycoplasma pneumoniae, and fugn al, etc.The research of respiratro y pathogens is imp ortant for clinical diagnosis na d treatmento f respiratory tract infec-tions in children.In this article,we make a brife introduction to the ca qiu sition and interpretation of respirato-ry pathogens in cih ldren.

Acute respiratory distress syndrome(ARDS) is a common critical disease in pediatric patients,and mechanical ventilation is one of the most important methods for respiratory support.High frequency oscillation ventilation,which has these characteristics of low tidal volume,low airway pressure,and low alveolar injury,is a safe and effective treatment of ARDS.This article will elaborate about current status and recognition of high frequency ventilation in ARDS.

Tracheal gas insufflation is a non conventional respiratory support technology. It might avoid severe CO2 retention in lung protective ventilation strategy, reduce ventilator-associated lung injury, which was recommented recently. In this article,we made a brief introduction of the principle,classification and clinical applications of tracheal gas insufflation technique.

Objective To observe the possible effect of inactivated schistosome ova on the expression of intestinal epithelial tight junctions ZO-1 and Occludin gene in mouse colitis induced by tinitrobenzene sulfonic acid (TNBS) and its mechanism. Methods Fifty mice were divided into control group (group A, n= 10),TNBS plus normal saline(NS) group(group B, n= 20) and TNBS plus inactivated schistosome ova group(group C, n= 20). Group C was exposed to 10 000 freeze-killed schistosome ova by intraperitoneal injection at day 14 and day 3 before colitis induction. Meanwhile,group B was exposed to 1 ml NS by intraperitoneal injection. The mice in group B and C were challenged with 3 mg TNBS to induce colitis. All mice were killed 7-day after colitis induction and assessed with following variables including mortality, pathological change with HE staining of colon.The transcription levels of ZO-1 and Oceludin in colon tissues were examined using Real-time PCR.The expression and distribution of ZO-1 and Occludin proteins were detected by Western blotting and immunohistochemistry. ResultsIn comparison with group B inactivated schistosome ova most effectively reduced the mortality (30% vs 15 %) and histopathologic severity of TNBS-induced colitis (4.21±0.40 vs 1.74±0.10). The transcription levels of ZO-1 and Occludin in group B were decreased compared with those in group A and group C (P<0.01). When compared with group B,group C showed a significant elevation of the alteration of ZO-1, Occludin proteins expression and localization. Conclusion The results clearly show that schistosome ova treatment reduced the severity of experimental colitis through the regulation of tight junction proteins.

Objective To investigate the effect of Schistosoma japonicum ova on the expression of intestinal NOD2/CARD15 in the mice induced by 2,4,6-trinitrobenzesulfonic acid (TNBS). Methods Mice (n=50) in the experiment were randomly allocated into 3 groups: control group (n=10), TNBS+saline (n=20) and TNBS+Schistosoma japonicum ova (n=20). TNBS enema (100 mg/kg) was applied to the two TNBS groups in order to establish a colonitis model. Schistosoma japonicum ova was administered i.p. on the 14~(th) and 3~(rd) day before the instillation of haptenating agent. All mice were killed on the 7~(th) day after colitis induction. The transcription level of NOD2 in colon tissues was measured by Real time PCR, and the expression of NOD2 protein was measured by Western blot. Results The transcription and protein levels of NOD2 in TNBS-induced mice increased statistically compared with those of the normal group (P<0.05). Compared with the TNBS-induced mice, Schistosoma japonicum ova-treated ones exhibited a statistical reduction of gene and protein expression (P<0.05). Conclusions TNBS-treated mice exhibited a statistical increased expression of NOD2/CARD15, Schistosoma japonicum ova treatment reduced the severity of experimental colitis through down-regulating NOD2/CARD15.

Acute kidney injury(AKI) is a clinical syndrome characterized as acute renal dysfunction with difficult treatment and high mortality,and is one of the most common complications in critically ill patients.Till now,the blood creatinine and urine volume were widely used to diagnose AKI in clinic,but both of them could not represent the change of renal function timely and accurately.Some new biomarkers provide new probable criteria for early diagnosis and treatment of AKI.In this paper,we make a review on new biological markers focused on AKI research at present.

The mechanism of sepsis is complicated,currently the treatment of severe sepsis is still a challenge.When infected,the body would release cytokines and inflammatory mediators,resulting in out of control of inflammatory reaction and disorder of immune system.Furthermore,sepsis and severe sepsis will be developed.The technique of continuous blood purification (CBP)can powerfully clear solute as water,metabolic wastes,toxic substances,cytokines and inflammatory mediators.Now this technique is not only applied in renal disorders,but also widely used in rescue treatment for critically ill patients.Recently,the guide of sepsis recommended CBP as a method of treating severe sepsis.With CBP application in the early stage of children severe sepsis,it can improve function of heart and lung function,renal function,immune function,coagulation function,and etc.CBP is becoming more and more important in the treatment of children severe sepsis.There are some remaining problem to be resolved,and the individaulized treatment for children sepsis is the focus in the future study.

Severe sepsis and septic shock is a clinical syndrome with sequential organ dysfunction or tissue hypoperfusion induce by sepsis.Although early,adequately and rapidly initial resuscitation plays pivotal role in the management,but infusion of albumin,plasma,red blood cell,platelet,gamma globulin and other blood products and the immunological support with ulinastatin combined with thymosin,blood purification and anti CD14 monoclonal antibody therapy also play an important role.