Child ; Consensus ; Disease Management ; Humans ; Pediatrics ; Shock, Septic ; therapy

There are much more multidrug-resistant organisms (MDRO) in the intensive care unit than ever.If the doctors could distinguish the colonization from infection of MDRO,they can make right decision on the rational clinical use of antibiotics to reduce resistant organisms and nosocomial infection.However,it's a confused problem for clinicians to distinguish between colonization and infection.Bacterial culture combined with clinical symptoms and signs maybe helpful,but it is limited.There should be more objective indicators.This article was aimed to state the definition and relationship between colonization and infection,and how to determine the colonization and infection of MDRO.

Nearly every patient admitted into PICU is administered sedation and analgesia therapy.The precise control of the depth of sedation and the intensity of pain are often not well managed.Inappropriate treatment will cause more adverse effects.Self-assessment is considered the gold standard in pain rating,other complementary methods being the behavioural measures and the biological measures,that reflect the body's answer to pain.There is a growing need for reliable and valid sedation and pain instruments that can easily be incorporated into daily care.There are many methods for assessing pain and sedation in critical children,but none is completely accepted as an objective measure or suitable for all ages of children.The clinicians should choose appropriate assessment tools and even combine different tools according to the environment,condition and the characteristics of patients.

Acute liver failure (ALF) is rare in children but carries high mortality.It can progress to multi-organ failure and death.The etiology,clinical manifestations,diagnosis and prognosis of pediatric acute liver failure (PALF) are different from that of adults,and vary with age.The classic adult symptoms are often absent in children and the clinical encephalopathy may not be present.Children correctly diagnosed with well-characterized causes of PALF may benefit from the early implementation of directed medical therapies.Early recognition,diagnosis,and identification of prognostic factors will help in optimizing treatment and selecting patients for liver transplantation or artificial support,and improved their survival chances.

Pediatric advanced life support (PALS) training program development has been more than 20 years.PALS program provides a systematic,organized approach for the evaluation and management of acutely ill or injured children.It plays an active role in guiding treatment of critically ill children.In this paper,we reviewed the PALS training purpose,importance and training content,and introduced the current situation and promotion of PALS training in China.

Objective To investigate ultrasound diagnosis different types of placenta previa (PP)during the late pregnancy and its relationship with the perinatal outcome.Methods The clinical data of 170 pregnant women with PP and 170 healthy pregnant women who underwent ultrasound were retrospectively analyzed.PP-related risk factors were analyzed,the perinatal outcome of different types of PP were compared.Results Among PP pregnant women,complete PP was in 82 cases,partial PP was in 36 cases,marginal PP was in 32 cases,low-lying placenta was in 20 cases.The rate of age ＞ 30 years old,parity,gravidity,the number of abortion and the number of cesarean section in PP pregnant women were significantly higher than those in healthy pregnant women [59.4％(101/170) vs.40.0％(68/170),(1.5 ± 0.6) times vs.(1.3 ± 0.4) times,(2.4 ± 0.5) times vs.(1.7 ± 0.1) times,(1.7 ± 0.1) times vs.(1.1 ± 0.3) times,(1.3 ±0.3) times vs.(1.0 ± 0.1) times,P ＜ 0.01].Parity,gravidity,the number of abortion,the number of cesarean section,age,and the incidence rate of cesarean section,postpartum hemorrhage,placental adherence,premature delivery,neonatal weight ＜ 2.5 kg,5 min Apgar score ＜ 7 scores in complete PP pregnant women were significantly higher than those in partial PP,marginal PP and low-lying placenta pregnant women (P＜0.01).Conclusions Ultrasound can dynamically observe the development process of the PP.There is a certain correlation with the severity of risk factors of PP,early intervention can improve the prognosis.

Objective To determine the value of EUS- guided fine needle aspiration biopsy (FNAB)for the diagnosis of submucosal lesions.MethodsWe found 28 patients with upper gastrointestinal tract solid submucosal lesions by endoseopies. EUS was performed to assess the lesions arised from the specific layer of the wall and the lymph node metastasis. After excluding extrinsic normal tissues compressing the gastrointestinaltract, EUS guided FNAB were carried out. Results Among these patients, two were extrinsic normal tissues compressing the gastrointestinal tract and all other 26 patients were examined by EUS guided FNAB. EUS- guided FNAB failed in only 3 patients. Among the other 23 patients, cytology demonstrated malignant tumors in 4 patients(lymphoma, n=2; leiomyosarcoma, n=2) and benign lesions in 19 patients(leiomyoma, n=1;lipoma, n=1 ). The results of EUS-guided FNAB were validated by surgery (n=20), endoscopic treatment (n=1) or clinical follow-up (n=7). Conclusion EUS guided FNAB is a safe and accurate method for di-agnosis of submucosal lesions.

Objective To assess the effect of scene simulation-based teaching on pediatric advanced life support(PALS)skills in medical students.Methods The students of two grades of Department of Pedi-atrics in Capital Medical University participated in the PALS training.All of them had the examination of the-ory and skills of critical illness management and cardiopulmonary resuscitation in children before and after the scene simulation-based teaching on PALS.The questionnaire was filled out and the data was analyzed after the training.Results Fifty-one students completed the training.The average score after the training was sig-nificantly higher than that before the training(86.51 ±7.16 vs.53.85 ±14.24,P ﹤0.05).After the training, the error rate of ECG recognition,etiological identification and treatment of the disease,and the dosage as well as usage of medicine was significantly decreased (64.7% vs.15.7%,71.0% vs.10.5%,73.2%vs.25.9%).All of the students could use the defibrillator correctly and the students'satisfaction rate was more than 94%.Conclusion Scene simulation-based teaching on PALS skills can improve the theory and skills of critical illness management and cardiopulmonary resuscitation of children in medical students.

Objective To determine the value of endoscopic ultrasonography (EUS)-guided fine needle aspiration biopsy (FNAB) for differential diagnosis of pancreatic lesions. Methods EUS was performed in 23 patients with pancreatic lesions detected by CT, MRI, or US to assess the shape, size, and position of the lesions and the status of lymph nodes metastasis. After excluding blood vessel between the lesions and the fine needle by EUS, EUS guided FNAB was carried out. Results All patients were performed EUS-guided FNAB and only 2 patients failed. Among the other 21 patients, cytology and pathology demonstrated tumors in 10 patients (pancreatic carcinoma, n=8; pancreatic cystadenoma, n=1; non functional neuroendocrine tumor, n=1). The results of EUS-guided FNAB were evaluated by surgery (n=16), or clinical follow-up (n=7). The sensitivity was 83%, and speciality was 100%, and no complication occurred. Conclusions EUS-guided FNAB is a safe and accurate method for differential diagnosis of pancreatic lesions.

Child ; Continuous Positive Airway Pressure ; Humans ; Pediatrics