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 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 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 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 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.

BACKGROUND:Human umbilical cord mesenchymal stem cells (hUC-MSCs) may be mutated duringin vitro culture based on the spontaneous malignant transformation of adult stem cells and tumor stem cell theory, and there may be a risk of tumorigenesis after in vivo transplantation. Therefore, to establish and perfect the in vitro safety testing procedures will actively promote the clinical application of stem cells. OBJECTIVE:To investigate the tumorigenic mechanism of hUC-MSCs and the expression level of DNA methyltransferase (DNMTs) in hUC-MSCs. METHODS:Primary hUC-MSCs were isolated and expanded by tissue adherent culture. 3-Methycholanthrene was used to cause the malignant transformation in hUC-MSCs (experimental group), followed by morphological observation and tumorigenesis experiment in nude mice. Then, the tumor tissues were obtained and identified by pathological examination and primary cell culture, and the levels of DNMTs mRNA in hUC-MSCs treated with 3-methycholanthrene and dimethyl sulfoxide (control group) were detected by real-time RT-PCR and compared. RESULTS AND CONCLUSION:hUC-MSCs treated with 3-methycholanthrene led to malignant transformation, which showed malignant growth and non-integer ploidy changes in the cell nuclei, and formed a malignant tumor in immune-deficient mice after injection. Compared with the control group, the cells in the experimental group showed higher expression of DNMTs mRNA as detected by real-time RT-PCR. To conclude, hUC-MSCs can trigger malignant transformation in the morphology and the epigenetics under certain conditions. DNMTs can be a candidate for prevention against malignant transformation of transplanted stem cells.

Objective To analyze the clinical value of continuous veno-venous hemofiltration (CVVH) treatment in children with severe hand-foot-and-mouth disease(HFMD) complicated with cardiopulmonary failure,via the prognostic comparison of the general comprehensive treatment and CVVH add-on treatment.Methods Fifty-one cases of severe HFMD with cardiopulmonary failure were divided into a CVVH group (n =19) and a control group(n =32) based on whether CVVH add-on or not.Their physiological and biochemical indicators were recorded and pediatric critical illness score (PCIS) and pediatric risk of mortality score (PRISM Ⅲ) were calculated within 24 hours,when they were diagnosed with neurogenic pulmonary edema (NPE)/pulmonary hemorrhage.Both groups were treated with endotracheal intubation,mechanical ventilation with high PEEP,corticosteroids,ulinastatin,actively lowering the intracranial pressure,fluid resuscitation,milrinone,dopamine and other vasoactive drugs,high-dose intravenous gamma globulin,the CVVH group were added with CVVH treatment(duration ＞ 12 h).Prognosis difference of CVVH add-on treatment after diagnosed with NPE/pulmonary hemorrhage by tracking indicators of the third day.Survival analysis between two groups were compared by 3-day survival rates,7-day survival rates,28-day survival rates and the finally survival rates.Results (1) The overall conditions of two groups were comparable when diagnosed with NPE/pulmonary hemorrhage.PCIS,PRISM Ⅲ,WBC counting,lactic acid,micro-blood sugar,myocardial enzymes and liver enzymes showed no significant difference between two groups.Three days after treatment,WBC and lactic acid decreased,but there was no significant difference (P ＞ 0.05),the remaining indicators had significantly improved in the CVVH group than those in the control group (P ＜ 0.05).(2) The 3-day survival rate,7-day survival rate,28-day survival rate and the finally survival rates in control group and CVVH group were 40.63 ％ vs.84.21％,37.50％ vs.73.68％,25.00％ vs.63.16％,18.75％vs.52.63％,the survival rate in CVVH group were significantly higher(P ＜0.05).(3)The survival curve indicated that the survival time of CVVH group was significantly longer than that of the control group,the median survival time were 17 d and 2 d,respectively,and the difference was statistically significant (P ＜ 0.05).(4)In the CVVH group,15 cases received CVVH after diagnosed with NPE/pulmonary hemorrhage within 12 hours,of which 10 cases(66.67％) ultimately survived,while the other 4 cases received CVVH after 12 h were all end to death,the difference was statistically significant(P ＜ 0.05).Further analysis of the impact of the timing of blood purification on the prognosis of children showed that the mortality rates of children received CVVH within 6 hours,6 to 12 hours,after 12 hours of diagnosis of NPE/pulmonary hemorrhage,were 2/8,3/7,4/4,respectively.Conclusion Continuous hemofiltration can significantly improve the prognosis of children with severe HFMD,and may be preferable to perform in early stage.

Objective To study the exocrine pancreatic function in critically ill children with septic shock,sepsis and hyperlactacidemia.Methods A total of 64 critical pediatric patients were admitted from Jan 2009 to Oct 2012,and clinical and laboratory findings including pancreatic function,and histopathological features and score after autopsy were reviewed.Results (1) Compared with non-septic shock children,the pancreatic pathology score and serum lipase in septic shock group were significantly higher and serum calcium was significantly reduced (P ＜0.05) ; (2) The pancreatic histopathology score was significantly increased in patients with elevated plasma lactate ≥2 times (P ＜0.05),but there were no significant differences in serum calcium and blood amylase and lipase between patients with elevated plasma lactate level and patients with normal plasma lactate level; (3) The concentrations of serum amylase,lipase and urinary amylase were significantly increased in patients with pancreatic histopathology score ＞4 points compared with score ≤4 points patients,but there were no significant differences in above three biomarkers between patients with score ≤3 points and patients with score ＞3 points.Conclusions The pancreas is vulnerable to damage easily occurred in septic shock children especially complicated with hyperlactacidemia.The pancreatic histopathology score ＞ 4 points can be as a sensitive and reliable indicator of pancreas damage.