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 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

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.

A simple,fast and highly sensitive fluorescence analysis method for detection of mercury ion was developed based on N-methyl-mesoporphyrin IX (NMM)/G-quadruplex DNA system and specific T-Hg-T mismatches.In this strategy,a large number of thymine was introduced into guanine-rich oigonucleotides which could form G-quadruplex.In the presence of Hg2+,guanine-rich oigonucleotides and complementary strand could form double-stranded DNA molecule by specific T-Hg-T mismatch pair,leading to destruction of G-quadruplex DNA structure.In the absence of Hg2+,guanine-rich oigonucleotides spontaneously formed G-quadruplex DNA structure that could bound NMM to generate intense fluorescence.Based on the above facts,a sensitive fluorescence biosensor for determination of Hg2+ was fabricated.And the optimal conditions for Hg2+ determination were as follows:buffer solution pH of 6.7,20 mmol/L KCl and 2.5 μmol/L NMM in buffer and incubation for 2 h.Under the optimal conditions,the fluorescence intensity signal change (F0-F) and the Hg2+ concentration exhibited a linear correlation within 50 nmol/L to 1000 nmol/L range with a low detection limit of 22.8 nmol/L (3σ).The biosensor exhibited good selectivity toward common metal ions.The developed method was successfully employed to detect Hg2+ in tap water with recovery of 106.1％-107.8％.

Objective To evaluate the relationship between lactate,lactate clearance rate and prognosis of children with septic shock.Methods A total of 42 children with septic shock admitted in the PICU from Oct 2009 to Jun 2011 were enrolled in the study.All the children were given goal-directed therapy early according to the treatment routine of septic shock.The blood lactate levels before resuscitation and at 1h,2h,6 h after resuscitation were detected,the lactate clearance rates at 1 h,2 h,6 h after resuscitation were calculated.All the patients were divided into the survival group ( n =20 ) and the non-survival group ( n =22 ) by prognosis.The relationship between the early lactate level,lactate clearance rate and prognosis of the children with septic shock was evaluated.Results ( 1 ) The lactate levels before resuscitation and at 1 h,2 h,6 h after resuscitation in the survival group were significantly lower than those in the non-survival group [ (3.92 ± 2.58) mmol/L vs (6.91 ± 4.16) mmol/L,( 2.79 ± 1.89 ) mmol/L vs ( 7.93 ± 4.39 ) mmol/L,( 2.20 ±1.83) mmol/L vs (9.20 ±4.97) mmol/L,( 1.32 ±0.51 ) mmol/L vs (9.94 ±5.02) mmol/L,P ＜0.05].(2) The lactate clearance rates at 1 h,2 h,6 h after resuscitation in the survival group were significantly higher than those in the non-survival group [ (26.31 ± 20.82) ％ vs ( - 24.28 ± 53.39 ) ％,(43.46 ± 17.85 ) ％ vs (-34.31±58.98)％,(61.04±16.71)％ vs ( -45.33 ±83.51)％,P＜0.05].(3) The area under curve of the lactate and the lactate clearance rate at 6 h after resuscitation were 99.4％ and 96.7％ according to the receiver operating characteristic curve.The children had high mortality if the lactate value ＞ 2.20 mmol/L and lactate clearance rate ＜ 18.65％ at 6 h after resuscitation.Conclusion It is important to dynamicly monitor the lactate of the children with septic shock,the lactate and the lactate clearance rate at 6 h after resuscitation can be used to evaluate the prognosis.

Objective To investigate the clinical characteristics of invasive pneumococcal disease (IPD) and its drug resistance among children under the age of 5 years.Methods Clinical characteristics of 45 children of IPD admitted to the Shengjing Hospital of China Medical University from 2009 to 2010 and antimicrobial non-susceptibility results were analyzed retrospectively.Results Forty-five cases of IPD were confirmed by positive culture of sterile body site,most of which occurred between April and June.Most of the IPD children were below the age of 2 years,which accounted for 66.7％ (30/45).The disease spectrum included bacteremia in 32 cases (71.1％),encephalitis in 9 cases (20.0％),empyema in 23 cases (51.1％),necrotizing pneumonia in 10 cases (22.2％).Pneumococcal non-susceptibility to erythromycin were found to be 100％,to clindamycin were 95％,to tetracycline were 95.12 ％,to trimethoprim-sulfamethoxaole were 80.49％,to chloramphenicol were 18.18％,while pneumococcal resisitanse to rifampicin,quinolones and vancomycin were 0.Eight of eleven and 18/24 were found to be pneumoccal resistance to penicillin and cephalosporin respectively and their minimum inhibitory concentrations were high.Twenty five cases were cured (55.6％).Fifteen cases were improved (33.3％).Four cases died (8.9％).One cases was retreated.All cases of death were under the age of 2 years.Conclusion IPD is more common with a high mortality rate among those under the ages of 2 years.Poor outcome is associated with Streptococcus pneumoniae resistance to antibiotics.

Objective To observe the clinical effect of plasma exchange(PE) combined with continuous veno-venous hemodialysis filtration(CVVHDF) in children with acute liver failure.Methods Thirty-nine cases with acute liver failure admitted to pediatric intensive care unit of Shengjing Hospital Affiliated to China Medical University from August 2008 to January 2014 were treated with PE combined with CVVHDF.CVVHDF was performed after PE immediately,each PE + CVVHDF lasted 24 ～ 72 hours.Prothrombin time,blood ammonia,alanine transaminase,aspartate transaminase,serum total bilirubin,conjugated bilirubin were detected before and after PE + CVVHDF treatment.Glasgow Coma Scale were assessed before and after PE +CVVHDF in the thirty-five cases with hepatic encephalopathy.Results After the treatment of PE + CVVHDF,20 children were clinical recover,7 died,12 abandoned the treatment and the results of follow-up were death.PE + CVVHDF was effective in the treatment by decreasing serum total bilirubin,conjugated bilirubin,alanine transaminase,aspartate transaminase [(128.8 ± 82.6) μmol/L vs (73.2 ± 92.4) μmol/L; (90.2 ±71.5) μmol/L vs (55.1 ± 42.6) μmol/L; (3 024.1 ± 2 457.0) U/L vs (1 256.8 ± 757.8) U/L; (3 420.6 ±2 216.3) U/L v s (579.4 ± 338.6) U/L] (P ＜ 0.05),increasing Glasgow Coma Scale (9.5 ± 3.1 vs 12.1 ±2.9) (P ＜0.01),shortening prothrombin time[(40.4 ± 23.0) s vs (22.8 ±9.4) s] (P ＜0.01),in association with the improvement of hemorrhage tendency.Conclusion PE + CVVHDF significantly improves clinical symptoms and biochemical abnormalities in children with acute liver failure.Security of PE + CVVHDF is good and with no obvious adverse reactions.

Objective To investigate the status of clinical nutrition management in patients in PICU,and to provide data for promoting the improvement and development of clinical nutrition of pediatric critically ill patients.Methods A questionnaire survey was conducted on PICU specialists.The nutrition assessment,nutrition intervention and nutrition management of critically ill children in PICU were investigated.The results were summarized and analyzed.Results A total of 39 PICU specialists were involved in this survey.The nutritional assessment methods and guidelines in domestic PICU were not unified.Twenty-five respondents (64.1%) believed that both clinical performance and the scales as the basis can decide whether the patients should be fed or not;all respondents believed that nutritional assessment and intervention time need to be determined by the needs of the patients;23 respondents(58.9%) used weight only as their nutritional monitoring indicators.Twenty-eight respondents(71.8%) considered that gastric tube was the first choice way to feeding for the critically ill children;20 respondents(51.3%) believed that critically ill children should be fed within 24 hours.Twelve respondents (33.3%) believed that critically ill children should be fed between 24 to 48 hours.Thirty-three respondents(84.6%) advocated early enteral nutrition;36 respondents (92.3%) considered that the main reasons of fasting in critically ill children were vomiting or abdominal distension or gastrointestinal bleeding.Twenty-eight respondents(71.8%) believed that according to the results of gastrointestinal function evaluation,they made decisions whether the patient to fast or not.Twenty-three respondents(59.0%) considered that specialists in PICU were the decision maker of the clinical nutrition in critically ill children.Twenty-four (61.5%) of the respondents believed that we needed to establish our own routines in management of nutrition in PICU.Conclusion At present in China,a lot of achievements have been made in the nutritional assessment,monitoring,early enteral nutrition intervention and management in critically ill children,but it is not enough.We need to make more effort to enhance the critically nutrition level in PICU,and we have a lot of research to do about nutrition assessment and nutrition intervention mode.It is recommended to establish Chinese guidelines or consensus to enhance the level of nutritional treatment of critically ill children.

Vitamin D is a necessary fat-soluble vitamin in the body.It is found that not only does vitamin D deficiency associate with infant nutritional rickets, but it can also affect the functions of nervous, respiratory, immune, cardiovascular, endocrine, skin, kidney, and other function of systems.This paper made an overview of factors influencing infant vitamin D levels, including season of birth, sunshine time, eating habits, feeding patterns and prenatal vitamin D supplement dose.Among the above, as the vitamin D deficiency of infants and young children in plateau areas is quite special, thus it is emphasized in this review, in order for prevention and treatment of vitamin D deficiency.

Objective To investigate the therapeutic effect and safety of microneurosurgery associated with Gamma Knife radiosurgery on the large meningiomas in sellar region, and to clarify its clinical curative effect. Methods The clinical data of 34 patients with large meningiomas in sellar region underwent microsurgery were retrospectively analyzed.All of them underwent microsurgery,and then treated with Gamma Knife radiosurgery in one month after operation if there were residual tumors.The tumor removal of situation,complication,rate of symptom remission,and recurrence rate were analyzed.Results Among the 34 patients,total resection (7 cases of Simpson grade Ⅰ and 12 cases of Simpson grade Ⅱ)was achieved in 19 cases (55.9%),subtotal resection (Simpson grade Ⅲ )in 14 cases (41.2%), and partial resection (Simpson grade Ⅳ )was achieved in 1 case (2.9%).The major complications were cranial nerve injuries (such as oculomotor nerve, trochlear nerve and abducens nerve,n=6),the contralateral limb paresis (n = 2),postoperative bleeding (n = 1),CSF leak with infection (n=3),and secondary epilepsy (n = 3 ); no death occurred postoperatively. All these patients were followed up for about 3 to 48 months.Postoperative headache disappeared in 24 cases (80%),and 6 cases were alleviated (20%);postoperative vision improved in 12 cases (80%),remained unchanged in 2 cases (13.3%)and deteriorated in 1 case (6.7%); postoperative olfactory function improved in 5 cases (62.5%) and 3 cases unchanged (37.5%); 5 cases recoverd from the ocular motility disorder (71.4%), and 2 cases unchanged (28.6%);7 cases recoverd from thehemiplegia (100%).One of the total resection cases (5.2%)and two of the non-total resection (13.3%)suffered from tumor recurrence.All of the non-total resection cases were treated with Gamma Knife radiosurgery.Conclusion The clinical effect of microneurosurgery associated with Gamma Knife radiosurgery in treatment of large meningiomas in sellar region is satisfactory.