Objective:To provide clinical data for early identification and diagnosis of vascular embolism in children.Methods:We collected and analyzed the clinical data of children with vascular embolism diagnosed at the Children Medical Center of the First Affiliated Hospital of Hunan Normal University from January 2017 to January 2020.Results:A total of 29 children with vascular embolism were included.The male to female ratio was 2.2∶1(20/9); the age range was 1 month to 13 years, and the median age(IQR) was 16 (6-41)months.Among them, 22 cases were diagnosed with venous thrombosis, including 13 children with lower limb venous thrombosis(13/29, 44.8%), and six children with intracranial venous thrombosis(6/29, 20.7%). Arterial embolism was found in six cases, and left atrial appendage thrombosis was found in one case.Severe pneumonia was the most common primary disease(19/29, 65.5%), followed by cardiopulmonary resuscitation(3/29, 10.3%), and Kawasaki disease(3/29, 10.3%). Analysis on the risk factors of vascular embolization diseases, including catheter-related, long-term bed rest, elevated D-dimer, mechanical ventilation, and intravenous hormone administration, showed that 89.2%(25/29)had ≥3 risk factors at the same time, and 82.8%(24/29)had ≥5 risk factors at the same time.Conclusion:In children with vascular thrombotic diseases, deep venous thrombosis, especially lower extremity venous thrombosis, are common.The severe pneumonia is more common in primary disease.Children with multiple risk factors have a higher risk of developing vascular embolism.In clinic, coagulation function should be monitored and local symptoms should be observed for early identification.

Patients with severe trauma usually present with lethal triad of trauma,which is composed of hypothermia,acidosis and trauma induced coagulopathy,and is closely related to poor prognosis of patients with trauma. Great efforts should be still made to evaluate the pathophysiological changes of patients with severe trauma,upgrade clinicians′ understanding of lethal triad of trauma,early identification and interven-tion,implement effective management such as injury controlled resuscitation,and further improve the progno-sis of patients.

Severely ill children usually present unstable vital signs and function impairment of one or more organs or systems.They also have or potentially have life-threatening clinical features.It's necessary for pediatric intensive care doctors to carry out bedside examinations, diagnoses and timely treatment according to the continuously changing condition of the children.In order to meet the requirements on the rescue time for critically ill patients, the point-of-care testing inspection mode characterized by gathering materials on the spot, simple operation and instant result reporting becomes increasingly popular among medical staff.

Objective To investigate the viral prevalence of acute lower respiratory tract infection (ALRTI)in children. Methods Totally 1165 children with clinical diagnosis of ALRTI during the period from August 2007 to September 2008 were involved in our study. The nasopharyngeal aspirate specimen was collected from each patient. RT-PCRs were performed to detect common respiratory tract viruses including respiratory syncytial virus (RSV), rhinovirus (HRV), parainfluenza virus (PIV, type 1 -3 ), influzenza virus type A and B (IFA,IFB), and PCR was used to detect adenovirus (ADV). Results 783 patients were identified to have at least one kind of viral pathogens and the overall positive rate was 67.2%. The most common virus was RSV (27%), followed by HRV ( 17.4% ) and PIV3 ( 13. 9% ). The peak infection seasons were winter and autumn. The etiological spectrum of ALRTI varied in different age groups. Two or more viruses were identified in 284 out of 783 cases ( 36. 3% ). The mixed infection rate was high in infants under 1 year old (63.7%) while it decreased to 8. 5% in children older than 3 years of age. Conclusion RSV, HRV and PIV3 were the most predominant pathogens in children less than 1 year old. The peak infection seasons were winter and autumn. The infection rate and mixed infection rate in infants under 1 year old were highest. The most common style was RSV and HRV mixed infection.

Objective To investigate the detection results and epidemiological characteristics of hu﹣man adenovirus (HAdV) among children with community acquired pneumonia ( CAP) in Hunan province. Methods A descriptive retrospective survey was conducted to investigate the clinical epidemiological data of 33 056 children with CAP admitted to the Children′s Medical Center of Hunan People′s Hospital from May 1st,2014 to April 30th,2019. The seasonal distribution and demographic characteristics of HAdV infection were analyzed. Results (1) A total of 33 056 children with CAP were included in this study. A total of 3 770 children with HAdV positive were detected,with a total detection rate of 11. 40% (3 770/33 056). From May 2014 to April 2019,the detection rates of adenovirus in different years were 13. 76%,8. 57%, 7. 94%,9. 53%,12. 36% and 24. 75% respectively. Adenovirus detection rate reached its peak in 2019. (2) The detection rate of HAdV among male children were higher than that among female children (χ2 ＝ 6. 374, P＝0. 012). Among 3 770 children with HAdV infection,3 036 (80. 53%) were from 6 months to 5 years old. The detection rate of adenovirus were different in different age groups. The highest detection rate was 16. 65% in 3 to 5 years old group (χ2 ＝526. 494,P<0. 001). Among children with severe pneumonia,the detection rate of adenovirus was 18. 43% (415/2 252). The detection rate of adenovirus was the highest in the age group of 6 months to 1 years, and the difference was statistically significant ( χ2 ＝71. 485, P <0. 001). (3) The detection rate of adenovirus was the lowest in autumn,and the other three seasons were all high﹣incidence seasons (χ2 ＝ 268. 744,P<0. 001). (4) The hospitalization days of adenovirus pneumonia were longer than those of non﹣adenovirus pneumonia (Z＝ －10. 419,P<0. 001). Conclusion The preva﹣lence of HAdV infection is related to age,season and sex. The susceptibility of adenovirus varies with severity of pneumonia. We should be vigilant against the outbreak of adenovirus infection characterized by years.

Objective: To investigate the detection results and epidemiological characteristics of human adenovirus (HAdV) among children with community acquired pneumonia (CAP) in Hunan province. Methods: A descriptive retrospective survey was conducted to investigate the clinical epidemiological data of 33 056 children with CAP admitted to the Children′s Medical Center of Hunan People′s Hospital from May 1st, 2014 to April 30th, 2019.The seasonal distribution and demographic characteristics of HAdV infection were analyzed. Results: (1) A total of 33 056 children with CAP were included in this study.A total of 3 770 children with HAdV positive were detected, with a total detection rate of 11.40% (3 770/33 056). From May 2014 to April 2019, the detection rates of adenovirus in different years were 13.76%, 8.57%, 7.94%, 9.53%, 12.36% and 24.75% respectively.Adenovirus detection rate reached its peak in 2019.(2) The detection rate of HAdV among male children were higher than that among female children (χ²= 6.374, P=0.012). Among 3 770 children with HAdV infection, 3 036 (80.53%) were from 6 months to 5 years old.The detection rate of adenovirus were different in different age groups.The highest detection rate was 16.65% in 3 to 5 years old group (χ²=526.494, P<0.001). Among children with severe pneumonia, the detection rate of adenovirus was 18.43% (415/2 252). The detection rate of adenovirus was the highest in the age group of 6 months to 1 years, and the difference was statistically significant(χ²=71.485, P<0.001). (3) The detection rate of adenovirus was the lowest in autumn, and the other three seasons were all high- incidence seasons (χ²= 268.744, P<0.001). (4) The hospitalization days of adenovirus pneumonia were longer than those of non-adenovirus pneumonia (Z=-10.419, P<0.001). Conclusion The prevalence of HAdV infection is related to age, season and sex.The susceptibility of adenovirus varies with severity of pneumonia.We should be vigilant against the outbreak of adenovirus infection characterized by years.

Since heparin-binding protein was first isolated by Shafer in 1984, its bactericidal function and heparin-binding characteristics have aroused the interest of scholars around the world, especially after the recent discovery of the inflammatory chemotactic effect of heparin-binding protein.The use in different fields such as the predictive role of pre-infection is gradually accepted.This review summarized the application of heparin-binding proteins in children with severe infectious diseases.

Objective To analyze the clinical characteristics of fatal cases with confirmed severe ad﹣enovirus pneumonia in children in order to improve the diagnosis and treatment. Methods The fatal cases of severe adenovirus pneumonia admitted to Pediatric Intensive Care Unit of Hunan Provincial People′s Hospital from January 2019 to July 2019 were collected,whose clinical features,diagnosis,treatment,and the causes of death were analyzed retrospectively. Results A total of eight children were enrolled, and the age ranged from 3 months to 3 years old,and five cases were between 6 months to 2 years old. Three cases had underly﹣ing diseases. Adenovirus genotype identification was performed on six patients,and the results showed that all patients were infected with adenovirus type 7. All patients presented persistent high fever,with a peak temper﹣ature between 39. 8℃ to 41. 0℃,which persisted 10 to 37 days. Blood routine test before admission PICU showed that four cases had the decrease in white blood count and hemoglobin concentration,accompanied by﹣increased serum ferritin levels. Seven cases complicated with infection. Four cases had parainfluenza virus type 3 infection. Six cases had bacterial infection,and Gram﹣negative bacilli were predominant. One had fun﹣gal septicemia. Conventional mechanical ventilation were performed in all patients in this group. Four cases in this group died of severe acute respiratory distress syndrome. The other four cases died of disseminated intra﹣vascular coagulation associated with massive gastrointestinal bleeding, pulmonary hemorrhage, heart failure and septic shock combined with multiple organ failure. Conclusion Fatal adenoviruspneumonia mostly app﹣pears in children between 6 months to 2 years old or with underlying diseases. Adenovirus type 7 was the main serotype. The occurrence of reactive hemophagocytic phenomenon should be worsen progression of the disease. Co﹣infection may be an important cause of death.

Objective:To analyze the epidemiological characteristics of Mycoplasma pneumoniae ( Mp) infection in hospitalized children with community-acquired pneumonia in Hunan Province and to provide a theoretical basis for clinical diagnosis and treatment. Methods:The epidemiological characteristics of Mp infection in children hospitalized for community-acquired pneumonia in the Children′s Medical Center of the First Affiliated Hospital of Hunan Normal University (Hunan Provincial People′s Hospital) from January 1, 2013 to December 31, 2021 were retrospectively analyzed. Results:A total of 55 681 children with community-acquired pneumonia were enrolled during the study period, of whom 27.24% (15 170/55 681) were tested positive for Mp. The positive rate was lower in boys than in girls (23.39% vs 33.39%, χ 2=665.998, P<0.001). The positive rate of Mp infection increased with age with the highest rate in children who were 5-14 years old (67.92%) and the lowest in infants less than one year old (6.38%). The detection rates of Mp infection varied between years with the highest rate in 2019 (38.31%). The positive rates of Mp infection during the COVID-19 epidemic in 2020-2021 were similar to those in 2013-2018. Among the children hospitalized for community-acquired pneumonia, the detection rate of Mp was significantly higher in summer and autumn than in winter and spring (χ 2=648.753, P<0.001), with the highest detection rate reaching to 56.91% in the summer of 2019. In contrast, the detection rates of Mp in the spring and summer of 2020 were 15.60% and 17.44%, respectively, being the lowest detection rates ever for spring and summer, while the detection rates in the autumn and winter rebounded (31.22% and 28.48%). During the Mp epidemic in 2019, the age at onset, the proportion of severe pneumonia and the cost of treatment were higher as compared with those in other years. In 2020, the number of cases positive for Mp was the lowest on record, as was the proportion of severe pneumonia and admission rate to PICU ( P<0.001). Conclusions:In hospitalized children with community-acquired pneumonia, there were gender, age and season differences in Mp infection. In the summer of 2019, there was a Mp epidemic in Hunan Province, which increased the proportion of severe pneumonia and the cost of treatment. After the outbreak of COVID-19, the rate of Mp infection dropped significantly in the spring of in 2020 as well as in the summer, but rebounded in the autumn and winter. This might be due to the strict restrictive measures taken early during the COVID-19 pandemic that effectively controlled the spread of Mp.

Objective:To summarize the clinical features, diagnosis, treatment, and outcomes of necrotizing pneumonia(NP)in children, so as to improve the understanding of NP.Methods:Children with NP admitted to the Children′s Medical Center of Hunan Provincial People′s Hospital from December 2012 to June 2020 were selected and divided into respiratory support group(nine cases) and non-respiratory support group(27 cases) according to whether they received respiratory support; and they were also divided into pleural effusion group(28 cases) and non-pleural effusion group(eight cases) according to whether combined with pleural effusion.The clinical data of all children were collected, and the differences between different groups were compared.Results:There were thirty-six children with NP, included 14 boys and 22 girls, with a median age of 30(12, 49) months, and the disease duration was 34(25, 42)days.All children had cough, 34 cases had fever, and the fever peak was 39.5(39.1, 40.0) ℃.Laboratory tests(all peaks) showed that blood white blood cell count was 20.77(15.65, 28.35)×10 9/L, neutrophil count was 15.11(8.52, 20.65)×10 9/L, C-reactive protein(CRP) was 104.00(23.45, 146.50)mg/L, D-dimer was 5.12(1.88, 8.04)mg/L, and lactate dehydrogenase(LDH) was 347.95(284.68, 447.81)U/L.The detection rate of pathogens was 58.33%(21/36), and the most common was Staphylococcus aureus(28.57%, 6/21). Eight cases underwent surgical treatment, including five cases of thoracoscopic surgery and three cases of thoracotomy.All patients improved and were discharged from hospital.The differences in hospital stay, white blood cell count, CRP, procalcitonin and LDH levels between respiratory support group and non-respiratory support group were statistically significant, and the median age, white blood cell count, CRP, D-dimer and LDH between pleural effusion group and non-pleural effusion group were statistically significant(all P<0.05). Further multivariate Logistic regression analysis showed that LDH was a risk factor for NP children receiving respiratory support( P<0.05), the area under the ROC curve of LDH was 0.802, whose the cut-off value was 471.21 U/L.There were no statistically significant differences in the indexes between effusion group and non-pleural effusion group. Conclusion:Children with NP are prone to repeated high fever, high inflammatory markers, and a long course of disease.Staphylococcus aureus is the most common pathogen.Serum LDH≥471.21 U/L is an early independent predictor of respiratory support for NP.