The etiology of acute pancreatitis in children is infection,drugs,trauma,or anatomic abnormalities.Acute pancreatitis is less frequent in children than in adults,but recent studies indicate that an increasing incidence in the pediatric population.Limited data of severe acute pancreatitis(SAP) remains.Abdominal pain and vomiting are important early symptoms.Also children may initially present with shock,followed by symptoms of multiple organ dysfunction.To date,there is no pediatric prognostic severity scoring system that is available to practice.The prognostic severity tool with 3 variables includes lipase,albumin,and WBC within 24 hours of admission may be applied to predict pediatric SAP.Continuous renal replacement therapy can effectively reduce systemic inflammatory response,improve the organ function and maintain the fluid balance,may be a new potential therapy in children with SAP.

Objective To evaluate the therapeutic effect of extra-fine choledochoscope in treating polypoid lesions of gallbladder by percutaneous trans-hepatic and trans-gallbladder puncture(PTGB). Methods Extra-fine choledochoscope(2. 7 mm diameter)was inserted into tract soon after it was made per-cutaneously trans-hepatic and dilated in one session,gallbladder polyps was removed with biopsy forceps or snare or basket,and PTCD drainage tube(10. 2 F diameter)was imbedded for external drainage until 10 days after. If the gallbladder puncture point fell on the bed and gallbladder polyps were not clearly visual-ized,or puncture points were on non-gallbladder bed of the body,drainage tube(10. 2 F diameter)was placed for external drainage. Results Forty-two patients were successfully punctured,and 40 patients were punctured accurately on the bed in,and the fresh endoscope tract of these patients was established in 45 mi-nutes on average. Of the 29 cases of simple bottom and body ventral polyps,complete clearance of gallbladder polyps was achieved in 27. Gallbladder polyps clearance rate was 93. 10%. Complications of minor hemobi-lia occurred in 9 cases,and infection of biliary tract occurred in 3 cases after operation. There was no recur-rence after a follow-up of 15 months on average. Conclusion Extra-fine choledochoscope by PTGB is a less invasive,more reliable and effective method to cure benign polypoid lesions of the gallbladder. The gallblad-der is preserved and for malignant polyps,it can help to achieve early diagnosis and provide reliable evidence for further treatment.

Objective To study the value of focused abdominal sonography for trauma (FAST) used by emergency doctor in emergency department. Method It's a prospective,double-blinded and controlled study from June 2008 to October 2009. A total of 97 casualties with severe multiple trauma, 72 male and 25 female aged from 14 to 88 years old with average age of (41 ± 16) ,admitted to emergency department were enrolled, and the bedside focused abdominal sonography for trauma was performed by emergency doctor. It was diagnosed as positive if free fluid was detected in abdomen or pericardium. The severe injury scores (ISS) were from 14 to 38 with average score of (23.2±9.3). The criteria of inclusion were age over 14 years old, injury happened within 12 hours and casualties admitted directly into emergency room. The criteria of exclusion were death of patients within 2 days without CT scanning of abdomen and exploration of abdomen with laporotomy, and operations directly determined by using FAST without conventinal sonographic examination. The FAST was compared with CT and conventional sonography judged by the findings observed during operation. Results The examination with FAST was completed in (3.18±0.79) min, whereas that with conventional sonography was (16.63t4.62) min(t = 28.61,P ＜0.001). The FAST was positive in 11 cases and negative in 86 cases, whereas the conventional sonography was positive in 13 cases and negative in 84 cases ( P = 0.5). There were 4 false negative findings in FAST resulting in 73% sensitivity, 100% specificity, 95.3% negative predictive value, 4.6% false negative rate, 100% positive predictive value, 0% false positive rate and 95.9% accuracy. Conclusions The emergency doctors are able to operate the FAST well for casualties with multiple trauma in emergency department after proper training.

Objective To study the changes of P-selectin and E-selectin in pediatric patients with critical illness ,and analyze their relationship with the severity and prognosis of diseases.Methods Forprospective study,42 critically ill patients admitted in pediatric intensive care unit (PICU ) from September,2012 to March,2013 as critically ill group were enrolled,and blood specimens were collected with 24 hours after admission.Another 42 cases blood samples were collected from children's physical examination as control group.The severity of the critically ill patients were evaluated by Pediatric Critical illness Score (PICS)and Pediatric risk of score mortality (PRISM)-III.The levels of serum P-selectin and serum E-selectin were measured by double antibody sandwich enzyme-linked immunoassay (ABC-ELISA). Results P-selectin and E-selectin in control group children and critically ill patients group were (37.23 ± 8.99)ng/mL,(36.24 ±17.82)ng/mL,and (107.24 ±35.53)ng/mL,(114.93 ±40.17)ng/mL, respectively.There were statistical differences between two groups (P=0.000).The levels of P-selectin and E-selectin in acute phase were higher than that of levels in recovery phase in critically ill group (P =0.000).Negative correlation was observed between P-selectin concentration and the PCIS score (r =-0.673,P=0.000),as well as E-selectin (r=-0.548,P=0.000).P-selectin level and E-selectin level based upon PRISMⅢ≥10 group were significantly higher than they in PRISMⅢ <10 group (P=0.003,P=0.014).In critically ill children,the differences in P-selectin,E-selectin were significant higher in death patients (P=0.003;P =0.000).Compared with the non-sepsis illness group,the level of P-selectin and E-selectin in the severe sepsis patients were significantly higher (P =0.04,P =0.025 ). Conclusions The levels of P-selectin and E-selectin are closely related to the severity and prognosis in critically ill children.Measuring the level of P-selectin and E-selectin could be used as a judegment the severity and to understand pathological physiological process.

Objective To approach the changes of serum insulin and peptide C and determine their relationship with inflammatory reaction in patients with severe multiple trauma. Methods The serum insulin, peptide C, tumor necrosis factor (TNF)-α, interleukin (IL)-10, C reactive protein (CRP) were detected in 30 patients with severe multiple trauma at days 1,3 and 7 after trauma to analyze the dynamic changes of serum insulin and peptide C and their correlations with Acute Physiology and Chronic Health Evaluation Ⅲ ( APACHE Ⅲ), cytokines and CRP. The changes of cytokines and CRP were also compared with those of serum insulin and peptide C in patients with different outcomes. The changes of serum insulin and peptide C of 35 healthy subjects were detected and used as control. Re-sults The serum insulin and peptide C levels of patients were higher than those in control group at each time point after trauma, with remarkably positive correlation with APACHE Ⅲ. Whether the serum glu-cose and age were controlled or not,serum insulin and peptide C were positively correlated with IL-10 at each time point and with TNF-α and CRP at days 3 and 7. The levels of serum insulin, peptide C and IL-10 were decreased with time in both groups with different outcomes. Meanwhile, the levels of TNF-α and CRP were decreased in the survival groups but increased in the death groups. The levels of above indices in death group were significantly higher than survival groups at the same time point. Conclusions The increasing of serum insulin and peptide C is correlated with inflammatory reaction after severe multiple trauma. The dynamic changes of both indices can either reflect injury severity or be used as an effective index in dynamically monitoring anti-inflammatory degree of the organism.

Objective To explore the application effect of quality control circle(QCC)in the construction of a new model for abdominal pain centers in county-level comprehensive hospitals.Methods A total of 160 patients with non-traumatic abdominal pain admitted to the department of emergency of Baiyin Central Hospital from June 2021 to October 2022 were selected as research objects.Divided by March 2022,from June 2021 to February 2022,and 80 patients with non-traumatic abdominal pain admitted to the department of emergency before the establishment of QCC management mode from June 2021 to February 2022 were given routine treatment and nursing care.After establishing the QCC theme,the targets were set according to the 10 steps of QCC activities,the circle members drew up the strategies and carried out the second development of the strategies one by one,evaluated the feasibility,economy,urgency and circle ability,formulated the treatment plan for the patients with abdominal pain,carried out the standardized treatment,selected the most suitable method to carry out and review,and finally evaluated the effect.The difference of tangible outcomes(the average response time for pre hospital emergency treatment,average response time for in-hospital emergency treatment,waiting time for abdominal special examination,consultation waiting time,emergency department retention time,and emergency surgery entry time,triage accuracy,incidence of adverse events)and non-tangible outcomes(problem-solving ability,personal qualities,sense of responsibility,communication and coordination ability,self-confidence,teamwork ability,enthusiasm,and mastery of QCC)between pre-and post-QCC patients were compared.Results ①Tangible results:after QCC,the average response time for pre hospital emergency treatment,average response time for in-hospital emergency treatment,waiting time for abdominal special examination,consultation waiting time,emergency department retention time,and emergency surgery entry time were significantly shortened compared to before QCC[pre hospital emergency response time(minutes):2.15±0.05 vs.4.25±0.25,average response time for in-hospital emergency treatment(minutes):58.32±10.25 vs.100.22±25.25,waiting time for abdominal special examination(minutes):29.78±6.44 vs.40.22±8.59,consultation waiting time(minutes):9.05±2.12 vs.13.15±3.12,emergency department retention time(minutes):58.60±9.25 vs.76.00±12.02,emergency surgery time(minutes):115.25±20.25 vs.153.22±25.32,all P<0.05],triage accuracy significantly improved compared to before QCC[98.75%(79/80)vs.87.50%(70/80),P<0.05],incidence of adverse events significantly decreased compared to before QCC[16.25%(13/80)vs.35.00%(28/80),P<0.05].Intangible achievements:after the implementation of QCC,circle members had significantly improved their problem-solving ability scores,personal qualities scores,sense of responsibility scores,communication and coordination ability scores,self-confidence scores,teamwork ability scores,enthusiasm scores,and mastery of QCC scores compared to before QCC(problem-solving ability scores:3.75±0.26 vs.2.89±0.19,personal qualities scores:3.76±0.24 vs.2.92±0.28,sense of responsibility scores:3.63±0.22 vs.3.20±0.33,communication and coordination ability scores:4.25±0.30 vs.3.20±0.33,self-confidence scores:3.52±0.30 vs.2.90±0.19,teamwork ability scores:3.63±0.29 vs.3.00±0.18,enthusiasm scores:3.63±0.27 vs.2.97±0.22,mastery of QCC scores:3.38±0.22 vs.2.91±0.27,all P<0.01),with significant intangible achievements.Conclusion Conducting QCC activities can improve the management level of abdominal pain patients and enhance the quality of medical care.

OBJECTIVETo evaluate efficacy of continuous blood purification (CBP) in childhood severe sepsis through the analysis of organ function, inflammatory mediators and prognosis.

METHODForty-seven children with severe sepsis aged 29 days -16 years who were treated in PICU of Shanghai and Zhejiang five hospitals during October 1, 2011 and September 30, 2012 were enrolled; 30 cases treated with CBP were recorded as logged group , 17 cases without CBP as unlogged group. Changes in the cardiovascular, respiratory function, renal function, inflammatory markers, PRISM score III, PCIS and survival were observed and compared between the two groups at baseline (d0), first days (d1), second days (d2), third days (d3), fifth days (d5).

RESULT(1) Cardiovascular function: In d3 and d5, heart rate (HR) and mean arterial pressure (MAP) were improved as compared to unlogged group (121, 119 vs. 138, 137; 71, 80 mmHg vs. 63, 62 mmHg, P < 0.05), with no statistical significance in arterial blood lactate concentration. (2) Oxygenation index (PaO₂/FiO₂) and arterial oxygen saturation (SaO₂) increased as compared to unlogged group, but did not reach statistical significance. (3) Blood urea nitrogen (BUN) and creatinine (Cr) were improved as compared with unlogged group from d1 (P < 0.05). (4) Inflammatory mediators did not show significant differences. (5) Twenty-eight days survival rate: logged group was 70.0%, unlogged group was 52.9%, but the difference was not statistically significant (P = 0.242).

CONCLUSIONCBP can improve circulatory function, oxygenation, and renal function in children with severe sepsis. No evidence was found that CBP could decrease the level of inflammatory mediators, improve critical score and 28 days survival rate.

Adolescent ; Blood Pressure ; Blood Urea Nitrogen ; Child ; Child, Preschool ; Creatinine ; blood ; Female ; Heart Rate ; Hemofiltration ; methods ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric ; Male ; Oxygen ; blood ; Oxygen Consumption ; Prognosis ; Prospective Studies ; Sepsis ; physiopathology ; therapy ; Survival Rate ; Treatment Outcome

Objective To develop a machine simultaneously integrating mechanized environmental cleaning and automatic mollusciciding and to evaluate its effectiveness of field application,so as to provide a novel Oncomelania hupensis snail control technique in the large?scale marshlands. Methods The machine simultaneously integrating mechanized environmental clean?ing and automatic mollusciciding,which was suitable for use in complex marshland areas,was developed according to the mech?anization and automation principles,and was used for O. hupensis snail control in the marshland. The effect of the machine on environmental cleaning and plough was evaluated,and the distribution of living snails was observed at various soil layers follow? ing plough. The snail control effects of plough alone and plough followed by mollusciciding were compared. Results The ma?chine could simultaneously complete the procedures of getting vegetation down and cut vegetation into pieces,plough and snail control by spraying niclosamide. After plough,the constituent ratios of living snails were 36.31% ,25.60% ,22.62% and 15.48% in the soil layers at depths of 0-5,6-10,11-15 cm and 16-20 cm respectively,and 61.91% living snails were found in the 0-10 cm soil layers. Seven and fifteen days after the experiment,the mortality rates of snails were 9.38% and 8.29% in the plough alone group,and 63.04% and 80.70% in the plough + mollusciciding group respectively(c27 d = 42.74,c215 d =155.56,both P values < 0.01). Thirty days after the experiment,the densities of snails were 3.02 snails/0.1 m2 and 0.53 snails/0.1 m2 in the soil surface of the plough alone group and the plough + mollusciciding group,which decreased by 64.92% and 93.60% ,respectively,and the decrease rate of snail density was approximately 30% higher in the plough + mollusciciding group than that in the plough alone group. Conclusions The machine simultaneously integrating mechanized environmental cleaning and automatic mollusciciding achieves the integration of mechanical environmental cleaning and automatic niclosamide spraying in the complex marshland areas,which provides a novel technique of field snail control in the large?scale setting in Chi?na.

Objective:To investigate pediatric sepsis-related mortality of pediatric intensive care unit(PICU) and family socioeconomic status in Yangtze River Delta.Methods:A prospective, multicenter observational study was conducted to collect sepsis cases from eight PICUs in Jiangsu, Zhejiang and Shanghai from August 2016 to July 2017.Sepsis cases were divided into normal sepsis group and severe sepsis group.The primary outcome was in-hospital death.Patient data were prospectively collected including age, gender, medical insurance status, long-term residence, source of admission, first-day pediatric sequential organ failure score(pSOFA) score, underlying diseases and socioeconomic characteristics including family education level, family annual economic income.Results:A total of 4, 983 patients admitted in PICUs, of which 651 patients were diagnosed sepsis on admission.The prevalence of sepsis was 13.1% (651/4 983), and overall mortality was 11.7% (76/651). The prevalence of severe sepsis was 28.3% (184/651), and the mortality was 20.1% (37/184). The overall median age was 0.9 years old.The infant group accounted for 50.8%, including 331 cases, followed by toddler group 19.8% (129 cases), preschool group 13.0% (86 cases), school group 11.8% (77 cases), and adolescent group 4.3% (28 cases). The median pSOFA score was 4.Logistic regression analysis showed that the OR value was 1.4(95% CI 1.3-1.5) of pSOFA score corresponding to the death of sepsis in hospital.There were 14.6% patients left hospital in medical insurance group, while 27.4% in non-medical insurance group, and there was significant difference between these two groups.The median of daily cost was 5, 446 RMB, among which the median of daily cost of sever sepsis was 6, 678 RMB.The median of total cost for sepsis was 36, 109 RMB, and that for severe sepsis was 41, 433 RMB. Conclusion:The sepsis-related mortality was high in PICU.The pSOFA score has a certain predictive value for the prognosis of sepsis.The burden of sepsis is still heavy.Compared with medical insurance families, non-medical insurance families have a higher proportion of choosing left hospital.

Objective:To understand the current situations and existing problems of pediatric emergency in Shanghai city and provide a basis for the construction and management of pediatric emergency.Methods:The questionnaire survey was used to investigate the current situations of pediatric emergency department in secondary and tertiary public hospitals in Shanghai city.Results:A total of 28 questionnaires were delivered, and 28 were responded.Six of the 28 hospitals had no administratively independent pediatric emergency or no separate pediatric emergency area.Of the 22 hospitals, each had an average of 9.7 professional emergency pediatricians, with the exception of one secondary hospital that lacked professional emergency pediatricians.Professional emergency pediatricians accounted for an average of 70.0% of all pediatricians.Of the 22 hospitals, 18(81.8%) were open 24 hours a day.Fourteen(63.6%) had independent triage.Eight children′s emergency rooms(36.4%) were shared with adults.Among the 22 hospitals, 20 hospitals filled in the annual total number of pediatric emergency visits, and the total number of pediatric emergency visits ranged from 2 791 to 467 428, with an average of 93 966.65.Conclusion:There are still some problems in the development of pediatric emergency department in secondary and tertiary public hospitals in Shanghai city, such as insufficient human resources, substandard personnel training, incomplete equipment and lack of critical first-aid techniques.Therefore, the construction and management of pediatric emergency department still need to be improved.