Inhaled nitrous oxide (iNO) can alleviate pulmonary hypertension and enhance ventilation-perfusion matching to improve oxygenation in pediatric acute respiratory distress syndrome (PARDS).But duration of improvement was short.From the existing researches,iNO can't effectively improve outcome in PARDS.So iNO is not recommended for routine use in PARDS.However,iNO may be used in patients with documented pulmonary hypertension or severe right ventricular dysfunction.In addition,iNO can be a rescue intervention for severely PARDS to buy time and allow other therapies.

Methicillin-resistant Staphylococcus aureus (MRSA) infection can cause pneumonia,bacteremia,infective endocarditis and other diseases,seriously threat to the health of children.Pediatricians should discover the focus of infection.And the focus of infection should be removed or debrided in time.Vancomycin is an important drug for the treatment of MRSA infection,the use of Vancomycin need to ensure that the blood concentration is effective.Now,the advances in treatment of MRSA infection in children was mainly summarized.

OBJECTIVE:To put forward the developing direction of drug managing enterprises in order to provide the reference for the governmental polices.METHODS:A field investigation was carried out in Shannxi province to analyze the problems existing in the drug managing enterprises after GSP authentication.RESULTS&CONCLUSION:Multielement,linkage,large scale,standardization,consideration,and information all constitute important factors in the development of drug managing enterprises.

Objective:To study the characteristics,related factors and precautionary measures of ceftriaxone-induced anaphylactic shock,and provide reference for clinical safe medication.Method:The literature between January, 1994 and December,2007 was collected from Chinese Journal Full-text Database,Chinese Science and Technology Journal Full-text Database,and Wanfang Medicine Data China info,70 cases with ceftriaxone-induced anaphylactic shock were reviewed and analyzed.Result:Of the 70 cases,43(61.4%) were male,and 27(38.6%) were female.64(91.4%) received intravenous fusion or intravenous injection and 6(8.6%),intramuscular or prostate capsule injection.Most of the anaphylactic shock cases occurred within 20 minutes(71.2%) after administration.61 cases recovered(87.1%) and 8 cases died(11.4%) and 1 cases became vegetable(1.5%) after treatment.Conclusion:The ceftriaxone-induced anaphylactic shock is rapid so as to be timely rescued.Patients should be asked about their case history and medication history in detail before treatment in order to reduce occurrences of shock.

New guideline for the acute medical management of severe traumatic brain injury in infants,children,and adolescents was published in Pediatric Critical Care Medicine in 2012.This guideline made relevant recommendations and suggestions on intracranial pressure monitoring,threshold for treatment of intracranial hypertension,cerebral perfusion pressure thresholds,advanced neuromonitoring,neuroimaging and therapy for intracranial hypertension in pediatric patients with severe traumatic brain injury.This guideline was simply interpretated in order to improve the treatment of severe traumatic brain injury.

Intracranial hypertension is one of the most common pediatric acute and severe diseases.Intracranial pressure(ICP) monitoring can dynamically evaluate the changes of the patients with brain injury,calculate the cerebral perfusion pressure,guide the clinical treatment.ICP monitoring can not reflect the cerebral microvascular dysfunction and cell dysfunction,so it is necessary to carry out multimodality monitoring based on ICP monitoring.The information integration of ICP monitoring and multimodality monitoring is helpful to further understand the pathophysiological mechanism of brain injury,and it is also helpful for individualized treatment of patients.

Objective To investigate the clinical effects of surgical small incision treatment of patent ductus arteriosus (PDA) in premature infants with titanium clip.Methods One hundred children received and cured by our hospital from January 2010 to January 2013 were divided into two groups.Group A:body weight ＞ 1.5 kg of patent ductus arteriosus (PDA),71 cases of premature children; group B:body weight ＜ 1.5 kg of low body weight preterm the children PDA,29 cases.The operations were performed in the newborn intensive care unit (NICU).The patient was placed in a lateral position with the left arm abduction under general anesthesia.A 1.5-2.5 cm long posterolateral mini-thoracotomy was made and the pleural cavity was entered via the 2-3rd intercostal space.The PDA was closed with two titanium clips.Results Ninety-nine cases were cured,1 died.2 residual shunt postoperatively.One patient on postoperative 5 day was found wound infected,wound healing after the use of antibiotics by intravenous.There was no significant difference in incidence of postoperative complications and mortality rate between group A and group B (P ＞ 0.05).Majority of children successfully weaned from the ventilator due to the rapid improvement of hemodynamics and lung conditions.In group B,mechanical ventilation time (12.6 ± 7.5) d and postoperative hospital stay (21.0 ± 15.4) d was significantly longer than group A ((9.6 ± 4.2) d and (12.0 ± 10.8) d),the difference between the two groups was significant (t =7.35,9.12,P ＜ 0.05).Conclusion (1) It is a viable treatment that bedside minimally invasive titanium clip closed ductus arteriosus in preterm children PDA.(2) As the treatment of low body weight premature children is poor,the tolerance of the surgical trauma of the surgery as a minimally invasive,simple method is particularly suitable for low body weight premature children PDA.

BACKGROUND: Some studies have shown that bone marrow mesenchymal stem cells and al ograft bone have a certain role for repairing bone defects, but the effectiveness on cancel ous bone defects is seldom reported so far. OBJECTIVE: To observe the effectiveness of bone marrow mesenchymal stem cells combined with al ogeneic bone on cancel ous bone defects. METHODS: The models of cancel ous bone defects (0.6 cm×1.2 cm) were made artificial y in both condylus lateralis femoris of New Zealand white rabbits: one side served as model group implanted with combination of bone marrow mesenchymal stem cells and al ogeneic bone, and the other side was considered as control group implanted with al ogeneic bone. RESULTS AND CONCLUSION: The model group was better than the control group in new bone growth and defect repair at 4, 8, 12 weeks after implantation, which was confirmed by general observation, X-ray examination and hematoxylin-eosin staining. There was a large amount of trabecular bone formation and mature lamel ar bone tissue in bone defects of model group by histological observation at 12 weeks after implantation, and bone defects of the model group were repaired basical y; while there were only abundant woven bones in the control group, and bone defects in the control group were not repaired effectively. Scores on Lane-Sandhu’s X-ray combined with histological observation were higher in the model group than the control group (P < 0.05). Biomechanical test showed that the maximum pressure load of the femoral condyle and load/strain ratio in the model group were significantly higher than those in the control group at 12 weeks after implantation (P < 0.05),while the maximum strain and displacement of the model group was lower than that of the control group (P < 0.05). These findings suggest that the combination of bone marrow mesenchymal stem cells and al ogeneic bone is superior to simple al ogeneic bone implantation in the repair of cancel ous bone defects of the femoral condyle.

Objective To sum the clinical experiences of the treatment in congenital heart disease single ventricle with extracardiac conduit (EC) fenestration.Methods Ninety-five patients diagnosed with univentricular heart disease underwent EC using Gore-Tax conduits at the Department of Children's Heart Center,Justus-Liebig-University Giessen Germany from June 1996 to July 2010.According to EC with or without fenestration,the patients were divided into two groups.Seventy-one routine fenestration of the extracardiac conduit (the fenestration group),58 patients (58/71) of children with high-risk preoperative intraoperative fenestration,13 cases (13/71) were due to low cardiac Rankinginterventional fenestration; extracardiac conduit fenestration (non-windowed group) did not undergo surgery in 24 patients (24/95).Results The fenestration had no death; Three died in non-windowed group.Postoperative effusions and postoperative mean pulmonary artery pressure in group without fenestration ((14.2 ± 2.3) d and (15.1 ± 3.4) mm Hg respectively) were significantly higher than group with fenestration ((10 ± 3.2) d and (13.2 ± 2.8) mm Hg respectively).It had significant differences(P =0.016).In the group with fenestration and without fenestration,postoperative oxygen saturation((90.3 ±4.0)％,(91.7 ±5.2)％),postoperative thrombosis (11.3％ (8/71),12.5％ (3/24)),and postoperative neurological problems (18.3％ (13/71),20.8％ (5/24)) did not differ between cohorts.Conclusion It is effective and safe to treat congenital heart disease single ventricle with EC.EC with fenestration can improve acute postoperative mortality by rising cardiac output,thereby can reduce early postoperative mortality.

OBJECTIVE:To study the status quo of the drug handling enterprises that passed GSP authentication.METHODS:Targeted at part of GSP authentication-passed drug handling enterprises in Shanxi province,research methods like interview,direct observation,questionnaires etc.were adopted in the study.RESULTS&CONCLUSION:Some items in the current GSP need to be further specified and quantified.The GSP authentication should be conducted in strata.Drugs handling enterprises should emphasis the training of staffs to improve their comprehensive qualities,utilize and improve hard-ware facilities to improve business running conditions and warehouse conditions,strengthen the checking system through the evolvement of quality management rules and post responsibility regulations and to strengthen drug handling enterprises’man-agement on drug sources.