Antibiotics are commonly used in Pediatric Intensive Care Unit.Diarrhea is clearly one of the most common side effects encountered with antibiotic therapy.Most cases of antibiotic-associated diarrhea can be classified in two categories:cases in which Clostridium difficile is implicated and cases in which no putative agent or recognized pathophysiological mechanism is clearly established.In most cases of antibiotic-associated diarrhea in which Clostridium difficile is not detected,no etiologic agent is identified,and diarrhea is usually mild and self-resolving.As the cause of approximately 25％ of all cases of antibiotic-associated diarrhea,Clostridium difficile is responsible for almost all cases of pseudomembranous colitis and many instances of severe antibioticassociated diarrhea.For that reason,the term antibiotic-associated diarrhea is often considered synonymous with Clostridium difficile-associated diarrhea.Through a comprehensive review of current medical literature,this article provides an update on pathogenesis,diagnostics as well as therapeutic and prevention strategies,which may be helpful in clinical prctice.

Objective To observe the dynamic changes of renin-angiotensinsystem,collagen I(CoI) and intercellular adhesion molecule 1(ICAM-1) in hmg tissue of neonatal rats with lung fibrosis induced by hyperoxia.Methods One hundred and twenty term neonatal Wistar rats were randomly assigned into model group and air control group.The model group was continuously exposed to hyperoxia (FiO2=0.9)for 21 days,and the air control group was exposed to room air(FiO2=0.21).On the Ist,3rd,7th,14th and 21st day of exposure,the subjects were sacrificed.And then,the protein levels of CoI,ICAM-1 were measured by enzyme-linked immunosorbentassay and angiotensinII(AngII) by radio-immunity technique,the activity of angiotensin-convertion enzyme(ACE) were measured by biochemistry analysator,and the mRNA expression of ACE,AngII,CoI was measured by RT-polymerase chain reaction.The changes of lung histomorphology were observed.Results The ACE,AngII,CoI and ICAM-1 protein lev els of model group were (249.20±20.19)μg/g,(838.22±197.75)μg/g,(539.85±81.03) μg/g and (577.06±61.17)μg/g on the 14th day respectively and in.eased significantly as compared to the air control group (P＜0.05),and the ACE,AngII,CoI mRNA expression of modal group also increased signficantly on the 14th day (P＜0.05).The ACE,AngII,CoI and ICAM-1 protein levels of model group were(249.20±20.19)μg/g,(838.22±197.75)μ/g,(539.85±81.03)μg/g and (577.06±61.17)μg/g on the 21st day and increased to the peak respectively(P＜0.05),and the ACE,AngII and CoI mRNA expression had the same changes as well.The histopathological examination demonstrated different degrees of fibrosis in the model group.Conclusion The ACE,AngII,CoI and ICAM-1 protein levels and their mRNA expression were increased significantly on the 14th and 21st day in lung tissue of neonatal rats with lung fibrosis induced by hyperoxia.The renin-angiotensin system played a role in lung fibrosis induced by hyperoxia.

Klebsiella Pneumoniae is a opportunity infection and nosocomial infection bacteria in Enterobacteriaceae,which can lead to serious infection or death.Klebsiella Pneumoniae leads to increased infections proportion in recent years,which resisits to many common antibiotics.Clinical drug resistant strains include Carbapenem-resistant Klebsiella Pneumoniae,Multidrug-resistant Klebsiella Pneumoniae,Extensively drug resistant bacteria and Pandrug-resistant Klebsiella Pneumoniae.Researches beared out that the risk factors of acquiring nosocomial infection of Klebsiella Pneumoniae are state of an illness,time of hospitalization,mechanical ventilation,the kind and number of antibiotics.

Objective To observe and discus the clinical features and outcome of aseptic encephali-tis in children. Methods One hundred and one cases treated in PICU of Shengjing Hospital of China Medi-cal University and diagnosed with aseptic encephalitis from December 2009 to December 2012 were enrolled. Results The clinical manifestations, signs, laboratory examinations and outcome were analyzed retrospec-tively. Among them, 54 cases were male,47 cases were female,12 cases aged from 1 month old to 6 months old,12 cases aged from 7 months old to 1 year old,36 cases aged from 2 years old to 3 years old,12 cases aged from 4 years old to 6 years old,19 cases aged from 7 years old to 14 years old. The fever was the most common clinical manifestation, a total of 92 cases ( 91. 1%) , followed by convulsions, a total of 79 cases (78. 2%),63 cases with meningeal irritation or pathological signs positive(62. 4%). The sensitivity of elec-troencephalography( EEG) was the highest for diagnosis of aseptic encephalitis,89 cases underwent EEG with abnormal rate of 84. 3%(75/101). Followed by head MRI scan,97 cases underwent head MRI scan with ab-normal rate of 55. 7%(54/101). All cases underwent cerebrospinal fluid examination,50 cases with white blood cells and(or) protein increased(49. 5%). The sensitivity of head CT scan was the lowest,the abnor-malities were found in 11 cases ( 17. 5%) among 63 cases underwent head CT scan. All cases were given comprehensive treatment of sedation, antifebrile, reducing intracranial pressure and nerve nutrational treat-ment. Seventy cases were cured,20 cases left neurological sequelae,7 cases gave up treatment,4 cases died. Conclusion The children aseptic encephalitis occurs in infants and young children,the incidence of male and female are equal. The clinical manifestations are diverse,the most common manifestations are fever and con-vulsion,EEG and MRI are with high sensitivity. Most patients have good outcome if received symptomatic treatment early. A few cases left neurological sequelae,such as consciousness and dyskinesia. Respiratory fail-ure,neurogenic shock,eventually death would occour if the brainstem was involved.

Objective To observe the dynamic changes and the effects of Captopril on interstitial fibrosis in lung tissue of neonatal rats with lung fibrosis induced by hyperoxia. Methods Two hundred and forty neonatal Wistar rats were randomly assigned into model group, air control group, normal saline control and Captopril-trcated group (n=60 each).The air control group was exposed to room air (FiO2 = 0.21), and the rest three groups were continuously exposed to hyperoxia (FiO2 = 0.9) for 21 days. During the exposure, the Captopril-treated group received Captopril [ 30 mg/( kg·d) ] by intragastric administration, and the normal saline control group was administrated with normal saline instead, the model group did not receive any treatment. On the 1 st, 3 rd, 7 th, 14 th and 21 st day of exposure, the subjects were sacrificed. And then, the protein levels of collagen Ⅲ (Co-Ⅲ ) were measured by enzyme-linked immunosorbent assay and angiotensin Ⅱ(Ang Ⅱ )by radio-immunity technique, and the mRNA expression of Ang Ⅱ, Co- Ⅲ was measured by RT-polymerase chain reaction. The changes of lung histomorphology were observed. Results On the 14 th day, The Ang Ⅱ, Co- Ⅲ protein levels and their mRNA expression of modal group and normal saline control group increased significantly as compared to the air control group ( P < 0.05 ), except the Ang Ⅱ mRNA expression of normal saline control group. The Ang Ⅱ and Co-Ⅲ protein levels of model group was (838.22 ± 197.75 ) and ( 104.21 ± 43.37) ng/mg respectively, and normal saline control group was ( 759.97 ± 60.81 ) and ( 128.69 ± 54.74) ng/mg respectively on the 21 st day, their mRNA expression of two groups also increased to the peak on the 21 st day(P< 0.05).The AnglI and Co- Ⅲ protein levels of Captopril-treated group was (554.52 ± 59.32) and (39.90 ± 13.45) ng/mg on the 21 st day respectively, their mRNA expression was (1.50 ± 0.84 ) and (1.13 ± 0.55) respectively, and decreased significantly as compared to the model group and normal saline control group respectively (P<0.05), but increased significantly as campared to the air control group (P < 0.05). The histopathological examination demonstrated different degrees of alveolitis, broaden interstitium and reduced alveolar quantity in the model group and normal saline control group compared with air control group. The pathological changes were markedly alleviated in the Captopril-treated group. Conclusion Captopril may have protective effects on lung injury induced by hyperoxia.

Objective To explore the change of serum procalcitonin (PCT)in infectious diseases and the relationship between PCT and the severity of illness in children.Methods This was a single-center prospective study of serum procalcitonin concentration in children with infectious diseases.Ninty-five children with infectious diseases (mycoplasma infection 30 cases,viral infection 30 cases,bacterial infection 35 cases),hospitalized in PICU of Shengjing Hospital from April 2011 to April 2013,were divided into three groups:non-serious group(64 cases),serious group(20 cases)and very serious group(11 cases)according to pediatric critical illness score(PCIS).Bacterial infectious patients were divided into two groups:gram positive bacterial group(20cases),gram negative bacterial group(15 cases).Twenty children of non-infectious diseases during the same period were selected as the control group.Serum PCT levels were detected by using VIDAS BRAHMS PCT detection system(rapid semi-quantitative PCT test).Laboratory detection was conducted in Department of Laboratory Medicine,Shengjing Hospital of China Medical University.Results The serum PCT levels of the control,the bacterial infection,virus infection,and mycoplasma infection group were (0.41 ± 0.34) μg/L,(2.56 ± 0.38)μg/L,(0.52 ±0.44) μg/L and(0.21 ±0.10) μg/L.The serun PCT levels higher than or equal to 0.5 μg/L were defirned as positive.There was significant difference in PCT positive rate between bacterial infection group and the control grouP(x2 =28.05,P ＜0.05).The serum PCT levels of children with infectious diseases were higher than those of non-infection group,mycoplasma infection group and virus infection group(P ＜ 0.05).Besides,the PCT value of gram negative bacillus infection group was also obvious higher than gram positive infection group.There was no significant difference among the non-infection group,mycoplasma infection group and virus infection group(P ＞ 0.05).There was significant negative correlation between the serum PCT concentration and the PCIS score in children with infectious diseases (r =-0.579 ～-0.793,P ＜ 0.05).The higher concentration of PCT in children with the infectious diseases indicated higher severity illness scores,more complications,and longer length of hospital stay.Conclusions PCT may provide an informative and sensitive molecular marker for pathogen identification (bacterial infection,pneumonia mycoplasma infection or viral infection).In the early diagnosis of infectious disease,PCT assay can help predict the severity of the disease.

Children′s unique physiological, developmental and psychological attributes make them one of the most vulnerable groups in large-scale flood disasters.Formulating a reasonable and feasible emergency preparedness plan for flood disasters can improve their ability to cope with flood disasters and optimize the outcomes of children suffering from flood disasters.The emergency preparedness plan for children′s flood disaster should cover the allocation and utilization of various resources during disasters, regional cooperative rescue and evacuation of children, ethical problems in treatment under special circumstances, psychological counseling of children, family members and medical personnel.Relevant staff of pediatric emergency rescue need to consider all aspects and make reasonable plans so that the rescue work of children affected by disasters can be carried out in an orderly manner.

Objective To reduce the incidence rate of sepsis caused by multidrug-resistant acinetobacter baumanni and provide the basis for clinical antibiotics use.Methods It is one retrospective case-controled study.Thirty-six patients with multidrug-resistant acinetobacter baumanni infection(case group) and 42 patients with non-multidrug-resistant acinetobacter baumanni infection(control group) admitted in PICU during 2009 to 2013 were enrolled in the study.Seven high risk factors including the irrational antibiotics use,the length of hospital stay,tracheal intubation,the length of mechanical ventilation,the basic diseases (hematologic malignancies,congenital heart disease,inherited metabolic diseases),use of central venous catheters and the length of using central venous catheters were analyzed.The drug sensitivity of multidrug resistant acinetobacter baumanni was detected.Results There were significantly differences in 7 high risk factors between case group and control group,including irrational antibiotics using (29 cases vs.18 cases),the length of hospital stay ＞7 d(35 cases vs.12 cases),tracheal intubation(22 cases vs.8 cases),mechanical ventilation ＞ 7 d (19 cases vs.2 cases),basic diseases (9 cases vs.3 cases),using of central venous catheters (18 cases vs.2 cases) and central venous catheters using ＞ 7 d(9 cases vs.1 cases) ;multidrug resistant acinetobacter baumanni had high resistance against penicillins,cephalosporins,aminoglycesides,quinolones,sulfonamides (94.87％,74.36％,76.92％,65.38％ and 56.41％),but had high sensitivity to carbapenems and tetracyclines (55.56％ and 77.78 ％).Sixteen cases infected with pandrug resistant acinetobacter baumanni infection (44.44％),4 cases infected with whole drugresistant acinetobacter baumanni (11.11％).Conclusion The irrational antibiotics use,the length of hospital stay,tracheal intubation,the length of mechanical ventilation,the basic diseases,central venous catheters and the length of using central venous catheters are the high risk factors of spesis caused by multidrug resistant acinetobacter baumanni; only carbapenems and tetracyclines can keep high sensitivity rate to multidrug resistant acinetobacter baumanni among clinical antibiotics.

Objective To study the clinical application value of advanced breast cancer which resistence CAF regimen,treated with semimonthly regimen for paclitaxel combined with 5-fluorouracil/leucovorin 48-hour continuouse infusion.Methods 80 paients with CAF-regimen-resistant ABC were treated with paclitaxel combined with 5-fluorouracil/leucovorin continuouse infusion,paclitaxel 95mg/m2,d_1,LV 200mg,d_1,5-fluorouracil 3g/m2,continuouse infusion for 48 hours with infusion pump.every cycle lasted 2 weeks,at least 4 cycles.Results Of 80 patients,there were 9 complete and 26 partial responses,32 cases remained stable and 13 progressive.The overall response rate of 43.8%.The median time to progression was 8 months.The median survival time was 16.7 months,the patients with soft tissue,lung,pleura,bone,liver obtained response rat was 46.7%(21/45),38.5%(5/13),31.3%(5/16),40%(4/10),20%(2/10).Conclusions semimonthly regimen for paclitaxel combined with 5-fluorouracil/leucovorin 48-hour continuouse infusion is effective and acceptable toxicity,it could be considered as one of the standard chemotherapy for advanced breast cancer which resistence CAF regimen.

Objective To study changes of urinary protein in premature infants after asphyxia in order to explore influence of asphyxia on the renal function. Methods Microalbumin(mAlb),retinal-bindingprotein (RBP) ,N-acety-?-D-aminoglucosidase in urine and serum urea nitrogen(BUN),creatinine(Cr) were performed in 56 normal premature infants and 49 asphyxia ones with immunoturbidimetric method, ELISA method, rate method , enzymic method and picric acid method when they were 1,4,7 day age after born. Results (1)With ages increasing urinary mAlb took on decreasing trend in the same gestation age but there was no different while with the gestation age increasing in the same ages urinauy mAlb was decreased significantly (P