Invasive fungal infection(IFI) is becoming increasingly important issue in pediatrics and pediatric intensive care unit. IFI often occurs in newborns and children with immune dysfunction. Candida and Aspergillus spp. are the most commonly isolated organisms. Early diagnosis can improve the prognosis of IFI. The 1,3-β-D-glucan(G)test,galatomannan antigen(GM)test and PCR test can aid earlier dignosis for IFI in high-risk children.

CD163 is one of transmembrane glycoproteins expressed only in activated monocyte-macrophage cell membrane, which acts as a marker of activated macrophages. In sepsis, CD163 activates the intracellular signal transduction pathways in macrophages,regulates TNF-α, IL-10 and IL-6 expression, have antiinflammatory and antioxidant effects in the inflammatory process. Soluble CD163 (sCD163) is a soluble form of CD163 ,which could play anti-inflammatory and immunoregulatory effects by inhibiting T cells proliferation and activation. Serum concentration of sCD163 may be highly increased when severe infection. Detection of serum sCD163 is helpful to diagnose sepsis,and to evaluate the prognosis of severe infection and sepsis.

Pediatric acute liver failure has a high mortality.Liver transplantation is the only definite treatment.Extracorporeal liver support can be employed as a strategy for bridging to transplantation or recovery.There are three types of device for temporary support:biological,non-biological (also called artificial) and bio-artificial (hybrid techniques).Early non-biological device including hemodialysis,hemoperfusion/plasma perfusion and plasmapheresis have improved biochemical efficacy,but there are little data for clinical end points.Continuous blood purification and the combination of various non-biological methods such as the molecular adsorbent recirculatory system and Prometheus(R) are new extracorporeal blood purification therapy.The results of many experimental and clinical trials have improved the efficacy of the above mentioned methods.

Continuous renal replacement therapy( CRRT) employs convection and adsorption to re-move pro-and anti-inflammatory mediators from plasma, helping to restore the immunologic homeostasis. CRRT also provide uninterrupted clearance of retained endogenous and exogenous toxins, along with acid-base,electrolyte,hemodynamics and volume homeostasis.CRRT may improve outcomes in critically ill pa-tients with sepsis-induced acute kidney injury,septic shock and multiple organ dysfunction syndrome.Region-al citrate anticoagulation, as compared to unfractionated heparin, report better filter survival times and less bleeding.Antibiotic dosing decisions should be individualized to take into account patient-related,CRRT-relat-ed,and drug-related factors.

Orthodox Manual of External Diseases is a book giving an exhaustive description on various kinds of external and surgical disease,written by CHEN Shi-gong(1617),the author pay more attention to concept of wholism and syndrome differentiation.He provided the original view on the treatment of disease that combine internal with external therapy,needle with herbs.① All the external symptoms originates from internal causes and all diseases arisen from pathogenetic fire.Carbuncle definitely caused by visceral disorders,addiction to greasy diet,overstrain and exhaustion of sexual activities.② Based on occurrence and development of surgical disease,currency of ebb and flow between pathogenic factors and health qi,he provided three therapeutic methods for surgical disease including resolving,expelling from within,and reinforcing.③ He created and improved some surgical operation and provide the new therapeutic way that expelling the pathogenic factor by opening and drainage.④ He also believed that invigorating and regulating spleen and stomach,harmonizing qi and blood should be put in the first place when treating disease.

Paediatric fulminant myocarditis presentation occurs acute onset,rapid progress,often with serious arrhythmia,cardic shock or heart failure,which lead to death during the acute phase.Symptoms with shortness of breath,cyanosis,vomiting,abdominal pain were commonly observed,and may be easy to delay the diagnosis.Early recognition and appropriate treatment can reduce mortality of fulminant myocarditis in children.This paper also summarized the hemodynamic monitoring,extracorporeal membrane oxygenation,and circulatory support by temporary ventricular assist devices application in fulminant myocarditis.

Biomarkers are objective tools with an important role for diagnosis in patients with acute myocarditis.Traditional biomarkers,such as aspartate aminotransferase,creatine kinase and myoglobin seem to have low sensitivity.Creatine kinase-MB′s major limitation is short in half-life,which makes monitoring more difficult.To date,cardiac troponins are closest to optimal biomarker with high sensitivity and specificity in the early diagnosis of acute myocarditis.Novel biomarkers,including stromal cell-derived factor 1 ,heart-type fatty acid binding protein and MicroRNA have the potential to be valuable biomarkers for early diagno-sis.Combining biomarkers and clinical features have appeared to improve diagnostic accuracy than either one alone.

Lactate acid is an attractive biomarker reflecting microcirculatory dysfunction and tissue hypoxia.Surviving Sepsis Campaign in 2012 recommend lactate acid as one of the practical biomarkers representingtissue hypoxiato guide management of patients of septic shock.The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) in 2016 updated septic shock clinical criteria as a vasopressor requirement to maintain a mean arterial pressure of 65mmHg(1mmHg=0.133kPa) or greater and serum lactate acid level greater than 2mmol/L(>18mg/dl) in the absence of hypovolemia.Lactate acid ≥4mmol/L is often associated with poor clinical outcomes in septic shock patients.Lactate-guided therapy is becoming increasingly important in guiding the resuscitation and the use of vasoactive agents of septic shock.Lactate clearance and early lactate area are valuable indicators to predict the prognosis in patients with septic shock.

Acute Lung Injury ; therapy ; Humans ; Respiratory Distress Syndrome, Adult ; therapy

Platelet-derived growth factor (PDGF), a potent chemotactic and mitogenic factor, is involved in the regulation of hematopoiesis and platelet production. Our studies demonstrate the presence of functional PDGF receptors (PDGFR) on human megakaryocytes/platelets and CD34(+) cells, and their ability to mediate a mitogenic response. PDGF promotes the ex vivo expansion of human hematopoietic stem (CD34(+)) and progenitor (CD41(+)) cells. More significantly, PDGF enhances the engraftment of human CD45(+) cells and their myeloid subsets (CD33(+), CD14(+) cells) in NOD/SCID mice. PDGF also stimulates in vitro megakaryocytopoiesis via PDGFR and/or the indirect effect on bone marrow microenvironment to produce TPO and other cytokines. It also shows a direct stimulatory effect of PDGF on c-Fos, GATA-1 and NF-E2 expressions in megakaryocytes. We speculate that these transcription factors may be involved in the signal transduction of PDGF on the regulation of megakaryocytopoiesis. PDGF also enhances platelet recovery in mouse model with radiation-induced thrombocytopenia. This radioprotective effect is likely to be mediated via PDGFR with subsequent activation of the PI3K/Akt pathway. It provides a possible explanation that blockage of PDGFR may reduce thrombopoiesis and play a role in imatinib mesylate-induced thrombocytopenia.
Animals ; Hematopoietic Stem Cells ; cytology ; Humans ; Megakaryocytes ; cytology ; Mice ; Platelet-Derived Growth Factor ; metabolism ; Receptors, Platelet-Derived Growth Factor ; metabolism ; Thrombopoiesis