Objective To explore the changes and clinical value of serum insulin like growth factor-1 (IGF-1) and adiponectin in newborns with hypoxic ischemic encephalopathy (HIE). Methods Fifty-two HIE newborns were recruited in this study, including 15 severe, 20 moderate and 17 mild HIE newborns. Twenty healthy newborns were selected as controls. Serum levels of IGF-1 and adiponectin were detected 3-to-5 days (acute period) and 10-to-14 days (recovery period) after birth. Results Serum levels of IGF-1 and adiponectin in the acute period differed signiifcantly among groups of different severity (P<0.05). Serum levels of IGF-1 and adiponectin were decreased with the increase of HIE severity. The level of adiponectin in moderate and severe HIE was lower than that in mild HIE (P<0.05). In recovery period, the level of IGF-1 in severe HIE was lower than that in control (P<0.05). Serum levels of IGF-1 and adiponectin in the acute period was positivity correlated with those in umbilical cord blood of HIE newborns (r=0.531, r=0.611, P<0.01). Conclusions Decreased levels of IGF-l and adiponectin in HIE newborns are correlated with the pathological process of HIE, and can be regarded as indices for severity of HIE. IGF-l and adiponectin is of signiifcance in the clinical diagnosis and prognosis of HIE.

BACKGROUND:microRNA-17 is confirmed to play an important role in the development of pulmonary hypertension. Some research has shown that hypoxia-induced proliferation in human pulmonary artery smooth muscle celldepends on the induction of arginase II. There is no report about whether there is some interaction between microRNA-17 and arginase II in human pulmonary artery smooth muscle cells.
OBJECTIVE:To investigate the possible interactions between microRNA-17 and arginase II in hypoxic human pulmonary artery smooth muscle cells.
METHODS:Passage 4 human pulmonary artery smooth muscle cells were cultured in 21%O 2 and 5%CO 2 (normoxia) or 1%O 2 and 5%CO 2 (hypoxia), and then transfected with mimic or inhibitor of microRNA-17 or arginase II-smal interfering RNA. RNA, microRNA and protein were isolated separately. Expression of microRNA-17 and arginase II was detected with real-time quantitative PCR and western blot assay. RESULTS AND CONCLUSION:The level of microRNA-17 was significantly increased in cultured human pulmonary artery smooth muscle cells exposed to 1%O 2 hypoxia, as was arginase II mRNA and protein expression. Furthermore, inhibition of microRNA-17 expression decreased the mRNA and protein levels of arginase II in the human pulmonary artery smooth muscle cells under hypoxia. Conversely, over-expression of microRNA-17 increased the mRNA and protein levels of arginase II in the human pulmonary artery smooth muscle cells under normoxia and hypoxia. Knockdown of arginase II by siRNA abolished the hypoxia-induced up-regulation of microRNA-17 expression. These findings indicate that arginase II is a target gene of microRNA-17 and can regulate the expression of microRNA-17 in human pulmonary artery smooth muscle cells.

Objective To observe the complications in children after percutaneeus closure of atrial septal defect (ASD). Methods 192 children,who successfully received percutaneous closure of ASD in our hospital were enrolled in this study. Diameter of ASD was 8.0 ～ 33.0( 16.7± 8.0) mm, the diameter of occluder was 8.0 ～ 38.0 ( 18.9 ± 8.2) mm. The follow-up term ranges from 1 month to 4 years, with a mean of 19.0 ± 4.5 months. Standard 12-lead electrocardiography (ECG) and transthoracic echocardiography (TIE) were performed before closure, 24 including: minimal-moderate residual shunt in 3 patients ( 1.6% ), atrial-ventricle block (AVB) in 1 ( 0.5 % ), sinus There were 184 cases of single-hole ASD, with complication rate of 2.7% (5/184) , including the complication rate in diameter of siagle-hole ASD less than 10mm was 0% , that in ASD between 10 mm and 20 mm was 1.7% (2/119) ,that in ASD more than 20 mm was 5.0% (3/60) ,while there were 8 cases of two- and multi-hole ASD, clusion, including 3 cases of minimal-moderate residual shunt, 1 case of atrial-ventricle block, 1 case of sinus brady-cardia, and 1 case of device-micro-malplesition. 2 days to 2 weeks after procedure, 1 case developed pelade ( 1/192 ). completely recovered (57. 1% ), including 1 case of residul shunt, 1 case of atrial-ventricle block, sinus bradycardia and 1 case of pelade. 2 cases of minimal residual and 1 case of device-micro-malposition were not recov-ered. Conclusions Transeatheter closure of ASD is safe and effective with few complications, most of which disapp-eare completely during follow up term. Long-term follow-up is needed to evaluate the progress of some rare complica-tions.

Convulsion is one of the most common pediatric emergencies.It can be caused by many factors,and the most common one is febrile convulsion.A severe or prolonged seizure can cause neurological damage,so it is necessary for timely and standardized treatment.The first step in emergency treatment is to keep the airway unobstructed,and control convulsion as soon as possible.The second step is to look for the cause of the disease,and to follow up the drug treatment for the cause of the disease.Children should be admitted to hospital for further diagnosis and treatment when necessary.

Objective:To investigate the epidemiological characteristics, treatment and prognosis of pediatric severe sepsis in PICU in Shandong Province from 2018 to 2021, in order to provide a scientific basis for the prevention and treatment of severe sepsis in children.Methods:A multicenter retrospective observational study was conducted at PICUs from 19 hospitals in Shandong Province.Patients aged>28 days and ≤18 years, diagnosed with severe sepsis or septic shock who admitted to these PICUs during January 1, 2018 and December 31, 2021 were enrolled.Results:(1)From 2018 to 2021, the total number of hospitalized children and the number of children with severe sepsis admitted to the PICU showed an overall downward trend, with the most significant decrease in 2020.(2)During the study period, among the hospitalized children in PICU, the prevalence rate of children with severe sepsis fluctuated from 1.95% to 2.37%, and the median age fluctuated from 1.29 to 2.00 years old, more males than females.(3)Median pediatric sequential organ failure assessment score fluctuated between 5 and 6 at 24 hours after admission.(4)The most common primary infection site was the respiratory system, followed by the digestive system.(5)Since 2020, the propotion of children receiving fluid resuscitation, blood purification, mechanical ventilation, and glucocorticoid therapy has decreased significantly.(6)The median length of PICU stay was 9.22 to 11.51 days.(7)The median PICU costs decreased significantly from 41 075 yuan in 2018 to 30 972 yuan in 2021.(8)In-hospital mortality showed an overall decreased trend, reaching a maximum of 17.61% in 2019 and a minimum of 12.77% in 2020.Conclusion:From 2018 to 2021, there was no significant change in the incidence of pediatric severe sepsis in PICUs in Shandong province while the overall in-hospital mortality rate and the PICU costs showed a reduced trend.

Sepsis, a systemic inflammatory response syndrome caused by infection, is a common cause of death in ICU patients.Current studies suggest that patients with sepsis have stress-induced hyperglycemia, of which insulin resistance is a direct cause.During sepsis, many factors such as increased hormone release, excessive release of inflammatory mediators and lipogenic factors, oxidative stress, and endoplasmic reticulum stress, lead to the development of insulin resistance by hindering insulin signaling and reducing insulin sensitivity.This article elaborated the mechanism of insulin resistance in sepsis from the above aspects.

As one of the important causes of death in critically ill patients，septic shock has always been the focus of research in the field of critical care medicine.Correct and rational use of vasoactive drug is an important treatment for septic shock.The hemodynamic changes of septic shock in children and adults are different，which lead to the different use of vasoactive drugs.This review summarized the similarities and differences of the application of vasoactive drugs between children and adults with septic shock，thus could provide a reference for clinical practice.

Fluid overload is frequently found in critically ill patients with pediatric heart failure.Volume management is one of the important therapeutic measures for pediatric patients with heart failure, the aim of which is to achieve the best individual volume homeostasis.Assessment of volume status is the premise and foundation of volume management.The comprehensive evaluation and effective management of volume status leave clinical doctors a great challenge.In order to provide guidance and evidence for clinicians, this review elucidated the methods for assessment and management of volume status for pediatric patients with heart failure.

Hyperglycemia, hypoglycemia, and even glucose metabolism crisis and cerebral edema are common complications in critically ill children with glucose metabolism disorders.In clinical practice, blood glucose monitoring should be strengthened.When glucose is abnormal, it should be treated in time to control it within the normal range and reduce complications.This review elucidated and discussed the diagnosis of hyperglycemia and hypoglycemia, blood glucose monitoring, glycemic target and treatment scheme for abnormal glucose metabolism in critically ill children to provide suggestions for blood glucose management in pediatric intensive care unit.

Clq/tumor necrosis factor related proteins(CTRPs)are a newly discovered superfamily of proteins with wide tissue distribution and diverse biological functions, which are involved in the regulation of glucose and lipid metabolism, vascular endothelial cell function and inflammatory response.There are few studies on the relationship between CTRP family and sepsis, and a few studies have shown that some CTRP family members are involved in the occurrence and development of sepsis.This review introduced the role of CTRP family in sepsis and related mechanism.