Objective To detect the incidence and monality of the pediatric sepsis/severe sepsis,and to investigate the risk factors for poor prognosis in these patients.Methods From Jan.1 to Dec.31,2008,all pediatric patients admitted to PICU in Beijing Children's Hospital were prospectively surveyed.Both Chinese pediatric critical care scoring system and American guidelines for PICU admission and discharge were applied for screening subjects.The diagnosis criteria of pediatric sepsis/severe sepsis were made according to the definition determined on the International Pediatric Sepsis Consensus Conference held in the United States in early 2002.The qualified subjects were surveyed by questionnaire until discharge.After three months,the subjects were followed up by telephone.Results In a total of 742 children were screened.545 cases were critically ill,143 cases (26.2%) developed sepsis,and 104 cases (19.1%) deteriorated into a state af severe sepsis.Hospital mortality of severe sepsis was 21.2%,and that of sepsis was 0.7%.At the end of three months after discharged from hospital,mortality of severe sepsis was 30.8%.and that of sepsis was 1.4%.Patients under 3-year-old accounted for 72.5%.Pneumonia was the most common primary disease.The respiratory dysfunctions in severe sepsis cases were most common organ dysfunction (73.1%) . In surviving patients with severe sepsis,the PICU stay was significantly longer than that in deceased patients,and the PICU costs and average per capita costs were higher than the critically ill patients.Muhiple stepwise logistic regression analysis showed that pediatric critical illness score (PCIS score),capillary refilling Lime,respiratory dysfunction and hypoalbuminemia were the risk factors for death.Conclusions Sepsis/severe sepsis are common in the PICU,which have high mortality,high hospital charges.Infants and young children were the most commonly affected.Pneumoma was the most common primary disease.PCIS score.capillary filling time,respiratory dysfunction and hypoalbuminemia were the risk factors for death.

Hyper glycemia and hypoglycemia are associated with poor outcome of critically ill patients.No consistent evidence shows that intensive insulin strategy improves health outcomes in hospitalized patients.Because of its potentially harmful and life-threatening consequences,hypoglycemia represents the main limit to the development of a tight blood glucose control strategy in critical illness.Hypoglycemia-related neurological signs may be masked.The occurrence of hypoglycemia in critical illness,especially severe hypoglycemia,is associated with a poor prognosis.So it is necessary to closely detect glycemic variability and control the blood glucose in proper level.

Although acute respiratory distress syndrome (ARDS) has been the focus of extensive basic science and clinical research over the past 40 years,its pathogenesis is not clear.The therapies for ARDS have been not consensus.In addition to the lung-protective ventilatory strategies,effective pharmacologic therapy for ARDS remains extremely limited and still continue to explore and study.This paper reviews the cunent pharmacotherapies to treat ARDS,including neuromuscular blockers,corticosteroids,neutrophil elastase inhibitor,antioxidants,granulocyte macrophage-colony stimulating factor,β2 adrenergic receptor agonists,pulmonary vasodilators.

Formation of communicative ability has internality and chronicity. Currently, eval-uation methods for medical students' communicative skills include examination, questionnaire, and comprehensive evaluation. Each has its own merits and drawbacks. As an alternative, this paper pro-posed to construct student archives for evaluation of communicative skills and opted for a comprehen-sive mode, based on students' self-assessment, guided by the teacher, and combined with patients' assessment.

Adolescent ; Asthma ; blood ; Bronchitis ; blood ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Uteroglobin ; blood

Objective To study the activation of macrophage and upregulation of CD40 in neutropenic and nonneutropenic lipopolysaccharide (LPS)-induced acute lung injury (ALI).Methods Forty mice were randomly divided into four groups (neutropenic septic group,neutropenic control group,non neutropenic septic group and normal control group).The pathologic changes of mice lungs were observed after hematoxylin and eosin staining.CD40 expression was determined by flow cytometry.Cytokine tumor necrosis factor-α levels from bronchoalveolar lavage fluid (BALF) and serum were measured by ELISA.Results The average weight and peripheral blood white cell counts were increased significantly in the neutropenic group as compared to the non neutropenic group before the rats were sacrificed [(181.13 ± 16.94) g vs (168.56 ±5.03) g,(9.54 ± 1.25) × 109/L vs (2.56 ± 1.12) × 109/L,P ＜0.05,respectively].The cell counts in BALF were higher in neutropenic septic and non neutropenic septic groups compared to the normal control group [(3.33 ±0.26) × 106/L,(3.23 ± 0.06) × 106/L,(1.68 ± 0.23) × 106/L,P ＜ 0.05].The concentration of tumor necrosis factor-α from serum were increased significantly in neutropenic septic and non neutropenic septic groups as compared to the normal control group [(2 337.08 ± 1 148.85) pg/ml,(2 274.01 ± 1 569.37) pg/ml,(96.20 ± 93.69) pg/ml,P ＜ 0.05].The CD40 molecular expressions were higher in neutropenic septic and non neutropenic septic groups compared to the normal control group [(42.06 ± 11.90) ％,(46.38 ±7.42) ％,(21.62 ± 4.86) ％,P ＜ 0.01].Conclusion Upregulation of CD40 molecule induces the inflammatory cytokines releasing,then leads to ALI.Therefore both the inflammatory cytokines and CD40 play vital role in the pathogenesis of ALI.

Agenesis of Corpus Callosum ; diagnostic imaging ; genetics ; pathology ; Brain ; diagnostic imaging ; pathology ; Chromosomes, Human, Pair 15 ; Humans ; Infant, Newborn ; Magnetic Resonance Angiography ; Male ; Radiography ; Translocation, Genetic ; genetics

Objective To understand the sleeping time and the prevalence of sleep disturbances in children aged 3-12 years in Wuxi city.Methods Two thousand and three hundred seventy six children aged 3-12 years were investigated with questionnaires from June to September 2003.Results The average sleep time of 1 day in each age group was 11.61,10.91,10.68,10.27,9.81, 9.67,9.61,9.57,9.60,9.61 hours, respectively. The total prevalence of sleep disturbance was 25.5%. Among them, the sleep snoring prevalence was 7.8%; choke/gargling was 0.63%;mouth breathing was 6.6%;sleep apnea was 0.34%;rubbing teeth was 7.7%;sleep talking was 4.2%;somnambulate was 0.63%;enuresis was 1.4%;limber spasm was 3.2%;sleep inquietude was 6.2%。Conclusion Prevalence of sleep disturbance in children age 3-12 years was high and sleep time was shorter in Wuxi than that in other cities.

Objective To explore the clinical significance of serum clara cell secretory protein(CC16),total immunoglobulin E(TIgE)and eosinophil cationic protein(ECP)in children with asthma.Methods Serum were collected from 59 cases during asthmatic acute attacks,29 asthmatic children who were in mild conditions,and 30 cases who were in moderate to severe conditions,and 30 healthy children.Serum CC16 concentration were measured by enzyme-linked immunosorbent assay(ELISA),TIgE and ECP concentration were measured by uniCAP100.Results The levels of CC16 in serum of asthmatic children during acute attacks were significantly lower than that in control group(t=2.93 Pa

Aorta, Thoracic ; abnormalities ; Humans ; Infant ; Magnetic Resonance Angiography ; Male ; Pulmonary Artery ; abnormalities ; Recurrence ; Respiratory Insufficiency ; etiology ; Respiratory Sounds ; etiology ; Subclavian Artery ; abnormalities ; Vascular Diseases ; complications ; congenital ; diagnosis ; pathology ; physiopathology