Objective To evaluate the mode of referral by response time for inter-hospital transfer of critically ill pediatric patients,and subsequently some measures taken for minimizing the response time in referral process.Methods A total of 9231 patients (≤14 years) transferred from primary hospital were included in a cross-section study.Information about age,sex,referral radius,the seasonal variation for inter-hospital transport of critically ill pediatric patients,time of referral telephone call and response time were collected.All computations were performed using the Statistic Package for Social Sciences for Windows version 18.0.Differences between groups were assessed by x2 tests or Wilcoxon test or Kruskal-Wallis for categorical data.Results Among all critically ill pediatric patients for the inter-hospital transfer,male to female ratio was 2.24:1,and the majority of patients were neonates and infants.Median retrieval mobilization time was 30 min (interquartile range,20-50 min).This study has demonstrated that referral time,age categories,referral radius,different years and seasons were associated with response time.Conclusions With the improvement of technologies and management mechanism,the response time was apparently minimized since the beginning of interhospital transportation.But there is still plenty of room for shortening rsponse time compared with advanced Westem countries.

Objective To determine the fecal elastase-1 (FE-1) in critically ill children in order to investigate the relationships between FE-1 and trypsin,sepsis as well as the severity of the disease.Methods Totally 402 critically ill children admitted in pediatric intensive care unit (PICU) of Hunan Children' s Hospital from July 2013 to March 2014 were studied.The formed stool of patients was collected during the first 24 h after admission.Subjects were divided to 3 groups according to FE-1 concentration:＞ 200 μg/g for normal pancreatic exocrine function (group A,n =300),100-200 μg/g for mild to moderate exocrine pancreatic insufficiency (group B,n =52),＜ 100 μg/g for severe pancreatic exocrine insufficiency (group C,n =50).The analyses of the relationships between FE-1 and pancreatic enzymes,sepsis severity,shock,the number of organ dysfunction,PCIS (pediatric critically ill score),SOFA score,and APACHE Ⅱ score were carried out.Chi-squared test was used for data statistics.The median and four percentile interval were used for the measurement data of abnormal distribution or non-neat variance,the rank sum test of each two of multiple samples compared each other was used for non-parametric test,only when it was statistically significant,and the Spearman method of correlation analysis was used for correlation analysis.Results (1) There was significant difference in serum lipase between group A and group B (P ＜ 0.01).(2) There was statistical difference in FE-1 level between sepsis group and non-sepsis group (P ＜ 0.05).Children with sepsis were divided into three groups according to the severity of sepsis:mild sepsis group,severe sepsis group and septic shock group.There were significant difference in FE-1 level among different severities of sepsis groups and as well as non-sepsis group (P ＜ 0.01).(3) The proportions of FE-1 in septic children of A,B and C groups in comparison with those in non-septic children of three groups were 65.79％ vs.78.13％,15.79％ vs.11.80％,18.42％ vs.10.07％,respectively.The proportions of FE-1 in septic children of B and C groups escalated were higher than those in children without sepsis.(4) The general trend in FE-1 concentrations varied along with the severity of sepsis.There were no significant differences in FE-1 concentration between non-sepsis group and mild sepsis group,and between severe sepsis group and septic shock group,but other paired comparisons between the four groups had statistical significant (P ＜0.01).(5) Along with FE-1 level decreased,the number of organ dysfunction,SOFA score,APS score (This is a part of APACHE Ⅱ score and other part,CPS,is excluded) increased and PCIS score decreased (rs1 =-0.194,P =0.000; rs2 =-0.348,P =0.000; rs3 =-0.176,P =0.000; rs4 =0.185,P =0.000).Conclusions Pancreatic exocrine function damage is associated with sepsis,the pancreatic dysfunction in patients with mild sepsis may not be significant,but its incidence increases gradually with the development of sepsis or with the deterioration of the disease.

OBJECTIVE To study the possibility of applying Anerdian skin disinfectant for blood donor skin disinfection. METHODS Put Anerdian at 21℃,35℃ and 42℃ to exposure in air for 24h,48h and 72 h,detect the volatilization volume,effective iodine and appearance of disinfectant,and evaluate its effect on blood donor elbow by culture method. RESULTS At 21℃ exposure for 24 h the volatilization rate for Anerdian was 5%,effective iodine was 0.215%.At 35℃ and 42℃ exposure for 24 h its volatilization rate was more than 5%,and effective iodine was within the range of 0.18-0.22%.The average killing logarithm value of elbow skin natural bacteria in 30 donors was over 1. CONCLUSIONS Anerdian disinfectant is suitable for blood donor predonation skin treatment.

Objective To investigate the adrenal histopathology damage in critically ill non-survival children,and the incidence of adrenal damage,and to explore the risk factors for the adrenal hemorrhage and necrosis in critically ill children.Methods A total of 141 critically ill non-survival children was admitted in this study in Hunan Children's Hospital from January 1,2005 to December 30,2012.Clinical data in children were systematically collected,including age,sex,sodium,potassium,blood gas analysis,liver and kidney function,blood clotting function,etiology,treatment and pediatric clinical illness score (PCIS) or neonatal critical illness score (NCIS),and pathological data.All data were analyzed by SPSS 18.0.Results Logistic regression analysis showed the factors of adrenal hemorrhage and necrosis of critically ill non-survival children were sepsis,PCIS score ＜ 80 critically ill children are risk factors for adrenal hemorrhage necrosis (P ＜ 0.05),ORwas 3.659 (95％ CI:1.344-9.965),and 2.325 (95％ CI:1.028 -5.258).Intravenous corticosteroids were protective factors for critically ill non-survival children with adrenal hemorrhage necrosis (P ＜ 0.05),and ORwas 0.377 (95％ CI:0.163-0.875).Conclusions There were two significant risk factors of adrenal hemorrhage and necrosis:sepsis and critical illness score less than 80 points.Intravenous corticosteroid is a protective factor in critically ill children.

Objective To analyze the clinical features of critically ill children with abnormal pancreatic ultrasound findings in order to explore the related risk factors for offering evidence-based diagnosis of pancreatic damage secondary to critical illness.Methods A prospective study was performed in 531 critically ill children admitted to pediatric intensive care unit(PICU) of 17 children' hospitals from January 2012 to March 2014.All patients were divided into control group(513 cases) and abnormal group(18 cases) according to the pancreatic ultrasound findings.Comparison of clinical features and biochemical indicators were made between two groups.The related risk factors associated with abnormal pancreatic ultrasound findings were analyzed by using Logistic regression analysis.ROC curves were used to evaluate the role of amylase and lipase in the diagnose of abnormal pancreatic ultrasound findings.Results The incidence of abnormal pancreatic ultrasound findings in critically ill children was 3.39%, the average age of abnormal group was significantly older than that in control group (P<0.01).There were not statistically significant differences in gender and primary disease between two groups.The incidence of hypotension was 22.2% and the incidence of abdominal muscle tension was 16.7% in abnormal group,which were statistically higher than those in control group (P<0.05).The levels of calcium, albumin of abnormal group were significantly lower than those in control group (P<0.01), and levels of serum amylase, lipase, lactate dehydrogenase in abnormal group were significantly higher than those in control group (P<0.01).The risk factors associated with abnormal pancreatic ultrasound findings were age, blood pressure, calcium,amylase.Area under the ROC curve of abnormal pancreatic ultrasound findings determined by amylase and lipase were 0.803 and 0.745,respectively (P<0.05).The sensitivity was 0.667, specificity was 0.881 when the serum amylase was 101.5 U/L, the sensitivity was 0.722, specificity was 0.928 when the serum lipase was 96.9 U/L.Conclusions The incidence of abnormal pancreatic ultrasound findings was rather low in critically ill children.The risk factors associated with abnormal pancreatic ultrasound findings were hypotension, hypocalcemia, and hyperamylasemia.The elevated serum amylase and lipase might be the most likely factors associtaed with abnormal pancreatic ultrasound findings.

With the development of tertiary treatment system,the higher quality of inter-hospital transport is the most critical factor for the prognosis of the critically ill pediatric patients,especially for pediatric patients whose condition is deteriorating rapidly.Improving the quality,creating the guideline,and establishing the network platform of inter-hospital will provide complete guarantee for inter-hospital transport of critically ill pediatric patients.With the development of information technology,the purpose of this study was to analyze the function of the network platform of inter-hospital transport in Hunan Children′s Hospital.

Objective To evaluate the diagnostic value of sympathetic skin response(SSR)in patients with vestibular vertigo.Methods SSR tests were performed on 1 20 patients with acute vestibular system vertigo,including 70 cases of central vertigo and 50 eases of peripherM vertigo.60 healthy subjects were also examined to serve as controls.Results In those with central vertigo,the abnormality rate in the SSR results was 87.1%(61/70).SSR latency was longer and its amplitude wag lower than in those with peripheral vertigo and in the heMthy controls.In those with peripheral vertigo the abnormality rate was 18.0%(9/50),but the average latency and amplitude were not significantly different from those of the healthy controls.Conclusion Persons with acute central vestibular vertigo may have sympathetic nerve dysfunction.SSR test results can be used as an electrophysiological index to distinguish central from peripheral vestibular vertigo.

Objective To analyse the relationship between insulin resistance and the pancreatic beta cell dysfunction in critically ill children with hyperglycemia,to investigate the relationship between the pancreas injury and pancreatic beta cells dysfunction.Methods Seven hundred and thirty-six critically ill children admitted in PICU of Hunan Children's Hospital from Nov 2012 to Mar 2013 were reviewed and analyzed.According to the maximum intravenous blood glucose within 24 h after admission,they were divided into severely elevated group (blood glucose ≥11.1 mmol/L,n =67),slightly elevated group(blood glucose 6.1 ～ 11.1 mmol/L,n =361) and control group (blood glucose ≤ 6.1 mmo/L,n =308).Serum insulin,C peptide,serum amylase,lipase,urinary amylase,HOMA-β,HOMA-IR were compared among 3 groups.According to the severity of sepsis,they were divided into non-sepsis group (n =414),sepsis group (n =237),severe sepsis group (n =64),septic shock group (n =21).Blood glucose,serum insulin,C peptide,HOMA-βand HOMA-IR were compared among 4 groups.Results (l)The levels of insulin,C peptide,blood amylase,lipase and urine amylase were gradually increased with elevated blood sugar(rs =0.235,P ＜ 0.05;C =0.142,P ＜ 0.05 ; rs =0.142,P ＜ 0.05 ; rs =0.119,P ＜ 0.05 ; r.s =0.093,P ＜ 0.05).The differences among 3 groups were significant (P ＜ 0.05).The levels of serum amylase (IU/L) [102.81 (10.48-191.69)],lipase(U/L) [69.75(10.67-121.85)] were higher than upper limit of normal in severely elevated group.HOMA-β fell to 18.75％ in severely elevated group.The level of HOMA-β was decreased with the increase of blood sugar level (rs =-0.108,P ＜ 0.05).The level of HOMA-IR was increased with the elevated blood sugar level(rs =0.455,P ＜ 0.05).(2) The levels of blood glucose,insulin,C peptide and HOMA-β were significantly different among 4 groups of non-sepsis,sepsis,severe sepsis and septic shock group (P ＜ 0.05),HOMA-IR showed no significant difference among 4 groups (P ＞ 0.05).The levels of blood sugar increased to 9.21 (6.21-19.60) mmol/L,HOMA-β declined to 10.52％ in septic shock group,and blood glucose,insulin,C peptide,HOMA-β were significantly different compared with the other 3 groups (P ＜ 0.05).Conclusion Hyperglycemia is associated with insulin resistance and pancreatic β cells dysfunction in critically ill children,the cause of beta cell dysfunction is secondary to pancremic injury.Pancreatic beta cells dysfunction inducing hyperglycemia is more significant than insulin resistance in sepsis children.

Objective To evaluate the early diagnosis value of serum cystatin C in the pediatric intensive care unit (PICU) children with septic acute kidney injury.Methods A total of 196 children in PICU confirmed with sepsis in Hunan Province Children's Hospital was enrolled in this study.Patients were divided into acute kidney injury (AKI) and non-AKI group according to whether accompanied with acute kidney injury.The serum cystatin C and serum creatinine were collected in 2 h,48 h,and 96 h after admission,and the clinical data were collected.The serum Cys C was drawn in receiver operating characteristic (ROC) curve.The sensitivity and specificity of Cys C were evaluated in diagnosis of septic AKI.Results The incidence of septic AKI was 35.20％,higher Cys C levels were risk factors for the onset of AKI,and OR was 26.218 (95％ CI:6.235 ～ 110.232).In AKI group,the serum Cys C level in 2 hours after admission was (2.05 ± 0.90)mg/L,which was higher than 48 hours (1.72 ± 0.72)mg/L and 96 hours (1.62 ±0.95) mg/L(Z =2.169,P =0.030; Z =2.789,P =0.005).In the septic AKI group,cystatin C and creatinine were positive correlation (r =0.582,P =0.000).The area under the ROC curve at 2hours after admission for serum cystatin C in diagnosis of AKI was 0.831.A cutoff point of 1.325 mg/L for 2 hours after admission was identified for cystatin C in the diagnosis of septic AKI,with a sensitivity of 87.1％and specificity of 78.9％.Conclusions Higher level of Cys C was risk factor for the onset of AKI.Compare to creatinine,cystatin C was earlier increased in children with septic AKI and positively correlated with it.It might be a biomarker for early diagnosis of septic AKI in PICU critical ill children.

OBJECTIVE To observe the neurotoxicity of 1-bromopropane(BP) and investigate the protective effects of edaravone(Edv) against BP-induced deficits of spatial learning and memory ability in rats by its anti-inflammatory mechanism. METHODS Adult male Wistar rats were ig given BP 800 mg·kg-1 to develop the model, followed by Edv 1, 3 and 5 mg·kg-1 ip treatment respectively 4 h later for consecutive 12 d. From the 7th day (d 7), all rats were subjected to the five-day place navigation in Morris water maze (MWM) to measure the escape latency and the total swimming distance. On d 6 of MWM, spatial probe test was performed and the crossing times of rats were recorded to evaluate the spatial memory ability. At the end of the behavioral experiment, four rats in each group were randomly selected and the frozen section of the whole brain was sliced for thionin staining and immunohisto?chemistry. The other eight sacrifced rat brains from each group were harvested for the determination of the tumor necrosis factor-α (TNF-α) and nitric oxide (NO) by ELISA and nitrate reductase method, respectively. RESULTS The results of MWM test showed that compared with control rats the escape latencies of rats in BP group were increased by 60.8%, 81.9%,124.0% and 323.3%, respectively, during the d 2-d 5 of MWM, and the total swimming distance increased by 47.0%, 66.4%, 106.0% and 277.6%, respectirely. All the differences between BP group and control group were significant (P<0.05, P<0.01). In the spatial probe trial, the crossing times of rats in BP group were significantly decreased, compared with the control rats (P<0.01). Morphologically, thionin staining and immunohistochemistry revealed significant microglia activation and neuron loss in the rat forebrains, accompanied by a 147.6% and 18.7% increase in NO and TNF-α levels in rats treated with BP respectively compared with control values (P<0.05, P<0.01). After co-treatment at different dosages of Edv with BP, the escape latencies of rats in BP+Edv 5 mg·kg-1 group were decreased by 38.4%and 44.3%(P<0.01), and the total swimming distance decreased 34.5%and 43.3%(P<0.05, P<0.01), respectively, compared with the BP treated rats on the d 4 and d 5 of MWM test. The microglia activation and neuron damage in the brain of rats induced by BP treatment were significantly alleviated in BP+Edv groups. In addition, the contents of NO and TNF-α were decreased in BP+Edv 1, 3 and 5 mg · kg-1 groups, with a decrease of 53.8%, 55.4% and 59.8% in NO, and 12.2%, 15.8% and 22.2% in TNF-α(P<0.05, P<0.01), respectively. CONCLUSION Edv could effectively protect against central neurotoxicity induced by BP via anti-neuro?inflammation.