Sepsis is the most common cause of death in infants and children in the world.Common infection sites leading to sepsis include respiratory tract,bloodstream,urinary tract,alimentary tract,central nervous system,and endocardia.Infection site is hypothesized to have the significant susceptibility.There is little epidemiological or national research data on the site of sepsis in China.In this article,we discussed the susceptibility of infection site in sepsis by literature review.Identifying infection site early would help guide clinical decision making in diagnosis, treatment and prognosis.

Objective To investigate the effect of continuous renal replacement therapy ( CRRT) on the reg-ulation of Treg/Th17 in patients with severe sepsis,and related inflammatory factors IL-6,IL-17,IL-10,and TNF-α.Methods 60 patients with severe sepsis were randomly divided into two groups,30 cases in each group.The control group received conventional treatment,and the observation group was treated with CRRT on the basis of the control group.Flow cytometry was used to detect the levels of Tregs and Th17 cells,and IL-6,IL-10,IL-17 and TNF-αwere detected by ELISA method.At the same time,the APACHEII score,ICU length of hospital stay were observed and recorded.Results After treatment,APACHE Ⅱscore,ICU length of hospital of the observation group were lower than the control group,there were statistically significant differences(t=4.258,t=4.518,all P<0.05). The expression levels of Th17,Treg and Tregs/Th17 in the observation group were significantly lower than the control group,the differences were statistically significant (t=5.872,4.267,4.285,all P<0.05).The expression levels of IL-6,IL-17,TNF-αin the observation group decreased more significantly than the control group,the differences were statistically significant (t=5.829,5.257,5.983,all P<0.05).But the expression level of IL-10 in the two groups had no obvious change[(35.26 ±18.63) pg/mL vs (35.52 ±20.09) pg/mL,t=2.164,P>0.05].Conclusion CRRT can not only remove the inflammatory mediators of abnormal expression,improve the function of T cells,but also can maintain the balance between Th17 and Treg,improve the immune disorders,and improve the prognosis of sepsis.

Objective To evaluate the feasibility of optimized scan protocol in whole-brain perfusion imaging with 320-MDCT scanner.Methods Twenty healthy volunteers were randomly divided into control group (13 patients) and test group (7 patients).The standard perfusion scan protocol (collecting 19 volumes)was applied in control group.The optimized perfusion CT scan protocol(collecting ll volumes)formulated by reducing scanning phases reasonably and changing the collection intervals was applied in test group.The regions of interest(ROI) with area of(20 ± 2)mm2 were located in the bilateral frontal white matter,parietal white matter,centrum semiovate,basal ganglia,occipital lobe and cerebellum.Bilateral perfusion values from ROI were measured,including cerebral blood volume(CBV),mean transit time (TTP),cerebral blood flow (CBF),mean transit time (MTT) and delay time (DT).Results Dose length product (DLP)and effective dose (ED)in optimized protocol were decreased 42.02％ as compared to control group.Every relative perfusion value of both sides from both groups were not statistically significant (P ＞ 0.05).Every relative perfusion parameters from individual territory in both groups showed no significant differences (P ＞ 0.05).Conclusions Using the optimized scan protocol,we could obtain the same whole-brain perfusion values could be obtained with the default standard protocol and less radiation dose.

BACKGROUND:There are many methods that can repair Pilon fracture, but the effects are not ideal. With the development of science and technology, fundamental change of fracture fixation principle and innovation of technology and idea has brought new opportunities for Pilon fracture repair. Biological immobilization technology can further reduce the further damage to blood supply of bone outer membrane on the fracture end, do not disturb biomechanical environment of fracture healing, and is the new trend of present research and development. OBJECTIVE:To investigate the effect of locking compression plate fixation for repair of Pilon fracture using biological fixation technique. METHODS:Clinical data of 76 patients with Pilon fracture treated using locking compression plate fixation in the Nanhai District Economic Development Zone Guanyao Branch of the People’s Hospital from June 2008 to December 2013 were retrospectively analyzed. There were 49 males and 27 females, at the age of 39.5 years on average (range from 19 to 60 years). According to Ruedi-Algower classification, there were 54 cases of type II and 22 cases of type III. In accordance with biological fixation technique, locking compression plate fixation was applied to treat Pilon fracture. Folowing treatment, they were regularly folowed up. Reduction quality was assessed by Burwel-Charnley radiological criteria. X-ray films were reviewed to observe fracture healing. During final folow-up, ankle function was evaluated according to Baird-Jackson score. RESULTS AND CONCLUSION:A total of 76 patients were folowed up for 6 to 24 months. Reduction quality assessed by Burwel-Charnley radiological criteria was as folows: anatomic reduction of 68 cases, reduction of 8 cases, 71 cases of one-stage wound healing, and 5 cases of wound healing after dressing change, with the rate of one-stage healing of 93%. Fractures of al patients were healed. The healing time was 4 to 8.5 months, averagely 6.25 months. During final folow-up, ankle function assessed by Baird-Jackson score was as folows: there were 69 excelent cases, 5 good cases and 2 average cases. These results indicate that locking compression plate fixation for Pilon fracture obtained good stability, could effectively avoid the damage of fracture end blood supply, shorten the healing time; it was simple to operate, had smal injury to soft tissue, and was an effective fixation method to repair Pilon fracture.

Objective To explore the viral etiology spectrum of different age and different seasons for neo-natal pneumonia.Methods Medical records of 1 073 cases of neonatal pneumonia in our hospital were retrospectively analyzed,line direct immunofluorescence assay were used to detect nasopharyngeal secretions of newborns,the test results were statistically analyzed.Results In 1 073 cases with neonatal pneumonia,406 cases were detected positive with virus infected,the positive rate was 37.8%,7 cases were mix infected.334 cases were infected by respiratory syncytial virus(RSV),which had the highest detection rate,accounting for 82.3%;RSV infection rate in 1 -6 month baby was 36.4%,which was higher than the >6 -12 month -old baby with RSV infection rate 26.5%,the difference was statistically significant(χ2 =12.25,P <0.05);RSV infection rate in winter and spring group was 39.7%,which was significantly higher than that in autumn and winter group(13.6%);PIV3 infection rate in winter and spring group was 1.8%,significantly lower than that in autumn and summer group(9.1%),the difference was statistically signifi-cant(χ2 =31.27,P <0.05 ).Conclusion RSV is the most common viral in neonatal pneumonia,more attention should be payed to RSV infection control in small babies and at winter and spring,pay attention to PIV3 infection at autumn and summer.

Objective To evaluate the reliability of CT perfusion parameter values of the normal hepatic segments and neoplasms, obtained with deconvolution (DC) and maximum slope (MS) algorithms. Methods Perfusion parameter values of 111 ROIs in 62 normal hepatic segments and 49 neoplasms derived from 62 CT perfusion studies performed with 320 multi-slice CT, were retrospectively analyzed by two experienced radiologists. BF,BV and PI according to DC and MS algorithms were compared with t paired test, Pearson correlation and Bland-Altman agreement analysis. Interobserver agreement for all perfusion parameters was calculated using intraclass correlation coefficients (ICC). Results Interobserver agreement measured with ICC was very good for all perfusion parameters (≥0.95). BFdc and BVdc exceeded the BFms and BVms in normal hepatic segments and neoplasms (P<0.05); PIdc significantly exceeded the PIms in normal hepatic segments(P<0.05) ,while no difference were found in hepatic neoplasms(P>0.05). Both pairs of perfusion measurements significantly correlated with each other(r>0.9, P<0.01),but the agreement of BF, BV and PI according to DC and MS algorithms was not good. Conclusions CT perfusion values such as BF,BV and PI obtained by DC and MS algorithms correlated significantly with each other, but with poor agreement.

Objective To investigate the expression profile of human genes in response to acute sodium arsenite treatment by cDNA microarray. Methods The RNA was purified from the L-02 cells without and with arsenite sodium induction for 2 hours, 15 hours and 24 hours, respectively. Results The hybridization patterns were different between every interval of arsenite induction. Expression of hCYR61 increased after 2 hours' induction, but decreased after 15 hours and 24 hours. Expression of metallothionein Ⅳ and Ⅲ elevated at the whole induction phase. HSP86 was up-regulated after 15 hours and 24 hours' induction, but it did not alter at two hours' induction. Conclusion When exposed to arsenite, the cells are under a meet-an-emergency situation to synthesize the most necessary protein and inhibit synthesis of unessential proteins.

OBJECTIVETo evaluate efficacy of continuous blood purification (CBP) in childhood severe sepsis through the analysis of organ function, inflammatory mediators and prognosis.

METHODForty-seven children with severe sepsis aged 29 days -16 years who were treated in PICU of Shanghai and Zhejiang five hospitals during October 1, 2011 and September 30, 2012 were enrolled; 30 cases treated with CBP were recorded as logged group , 17 cases without CBP as unlogged group. Changes in the cardiovascular, respiratory function, renal function, inflammatory markers, PRISM score III, PCIS and survival were observed and compared between the two groups at baseline (d0), first days (d1), second days (d2), third days (d3), fifth days (d5).

RESULT(1) Cardiovascular function: In d3 and d5, heart rate (HR) and mean arterial pressure (MAP) were improved as compared to unlogged group (121, 119 vs. 138, 137; 71, 80 mmHg vs. 63, 62 mmHg, P < 0.05), with no statistical significance in arterial blood lactate concentration. (2) Oxygenation index (PaO₂/FiO₂) and arterial oxygen saturation (SaO₂) increased as compared to unlogged group, but did not reach statistical significance. (3) Blood urea nitrogen (BUN) and creatinine (Cr) were improved as compared with unlogged group from d1 (P < 0.05). (4) Inflammatory mediators did not show significant differences. (5) Twenty-eight days survival rate: logged group was 70.0%, unlogged group was 52.9%, but the difference was not statistically significant (P = 0.242).

CONCLUSIONCBP can improve circulatory function, oxygenation, and renal function in children with severe sepsis. No evidence was found that CBP could decrease the level of inflammatory mediators, improve critical score and 28 days survival rate.

Adolescent ; Blood Pressure ; Blood Urea Nitrogen ; Child ; Child, Preschool ; Creatinine ; blood ; Female ; Heart Rate ; Hemofiltration ; methods ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric ; Male ; Oxygen ; blood ; Oxygen Consumption ; Prognosis ; Prospective Studies ; Sepsis ; physiopathology ; therapy ; Survival Rate ; Treatment Outcome

Objective To investigate the serum high mobility group box-1 protein level of children's patients with a-cute traumatic brain injury and it's expression changes and clinical significance. Methods A total of 87 children's patients with acute traumatic brain injury were randomly divided into three groups: severe group (≤8 scores), moderate group(9 to 12 scores) and minor group(13 to 15 scores) according to the patients' Glasgow Coma Scale on admission. Their venous blood were drawn at 3 h, 6 h, 12 h, 24 h, 48 h after injury and the serum HMGB1 were determined by en zyme linked immunosorbent assay(ELISA). The serum HMGB1 concentration were compared between different groups, survivors and non-survivors in 28 days, patients who developed acute lung injury(ALI) or sepsis and who did not deve-lope ALI or sepsis in severe injury group. Results Compared with the minor and moderate group, the serum HMGB1 level in severe group were significantly elevated at each time points(P<0.01). At 6 h, 12 h, 24 h, 48 h time points, the serum HMGB1 level in the moderate group increased significantly compared with the minor group (P<0.01). The serum HMGB1 levels at 24 h after injury were higher in non-survivors compared with survivors (P<0.01). The serum HMGB1 levels in those patients who developed acute lung injury (ALI) or sepsis were higher than who did not develope ALI or sepsis (P<0.01). Conclusion The serum HMGB1 concentration is increased early and may be a ‘alarm signal'prog-nosticating prognosis and complication after acute traumatic brain injury in children.

Objective? To explore the current perceived vulnerability and parenting stress (PS) in mothers of children with congenital heart disease (CHD) and to analyze the correlation between the two. Methods? The mothers of 176 children with congenital heart disease admitted in the 2nd Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from September 2017 to September 2018 were selected using convenient sampling and investigated with the General Information Questionnaire, Child Vulnerability Scale (CVS) and Parenting Stress Index-Short Form (PSI-SF). Results? Totally 176 questionnaires were distributed and collected, including 168 valid questionnaires, accounting for a recovery rate of 95.45%. The CVS score of the mothers of CHD children averaged (8.77±3.59); their PSI-SF scores saveraged (100.74±10.55); there was statistically significant difference in PSI-SF scores between mothers with different educational background and single child or not (P＜0.05); the total CVS score was positively correlated with the total PSI-SF score and the scores of its various dimensions (r=0.262-0.569); multivariate stepwise regression analysis showed that mothers with different educational background, single child,and the total score of CVS were factors of parenting stress, except the effect of general information, the total score of CVS can explain 17% of the total variation. Conclusions? The perceived vulnerability and PS of the mothers of CHD children stand at high levels. Their perceived vulnerability is positively correlated with their PS. Medical and nursing workers may improve their PS by reducing their perceived vulnerability, thus providing better family care for CHD children.