Continuous blood purification is continuous, slow removal of water and solute molecules in the blood.So,it is a treatnent modality of organ supports.With the development of blood purification in children,application of continuous blood purification in children is beyond the field of renal replacement therapy.Treatment indications include systemic inflammatory response syndrome,sepsis,multiple organ dysfunction syndrome,acute respiratory distress syndrome,bums,etc.Continuous blood purification has become the most important treatment in pediatric intensive care unit.Because of the children's physiological features,blood purification equipment and the disease spectrum, continuous blood purification requires higher technology and presents more difficultits.

Objective To explore the effect of evidence-based care on the constipation of psychiatric patients.Methods The constipations in 328 psychiatric patients admitted to our department were intervened with evidence-based nursing.Frequency for defecation,incidence of difficult defecation and incidence of dry stool before intervention were compared to those two weeks after intervention.Result Two weeks after intervention,the defecation frequency,incidence of difficult defecation and incidence of dry stool were all significantly lower than those before the intervention(P<0.001).Conclusions The evidence-based nursing used in care to psychiatric patients with constipation can reduce the incidence of constipation,and relieve their physiological and psychological pains.

Activated protein kinase ( AMPK) , an important energy receptor , plays a very important role in regulating organ-ism and the energy metabolism of the cell .AMPK has complex relationship with survival of different types of breast cancer cells .Ac-cording to different conditions , AMPK may exist both anti or promoting effect on tumor .In this review , we summarize the relationship between AMPK and breast cancer related signal pathways , AMP and breast cancer endocrine therapy , breast cancer chemotherapy , ra-diotherapy for breast cancer , treatment of triple negative breast cancer and multi drug resistance of the relationship , we also expound some drugs related to AMPK and used in clinical setting .

Sepsis associated encephalopathy (SAE)is the most common form of encephalopathy in the pediatric intensive care units and might appear before other systemic features of sepsis.The pathogenesis of SAE is complex and not clear.SAE causes increased morbidity and mortality but has limited therapeutic options.SAE has become a hot issue in critical care medicine.

Objective To evaluate the feasibility of suprasternal mini-thyroidectomy.Methods A total of 15 patients with nodular goiter underwent suprasternal mini-thyroidectomy(2.5-3.5 cm in incision at length) with ultrasonic scalpel.Results All operations including unilateral partial thyroidectomy(n=4),unilateral subtotal thyroidectomy(n=2) and bilateral subtotal thyroidectomy(n=9)were completed successfully.The mean operation time was 46 minutes(range,30-65 minutes).The intraoperative blood loss was less than 10 ml,except 25 ml in one patient.No complications occurred except superficial Ⅱ degree skin burn in 2 patients.The mean postoperative hospital stay was 1.8 days(range,1-3 days).All the patients were followed up for 8-10 months and no recurrence was found.Conclusions Suprasternal mini-thyroidectomy is feasible and safe with certain cosmetic effects.

Multiple organ dysfunction syndrome(MODS),a hot topic worldwide,has made rapid progress with nigh mortality.MODS in pediatrics versus MODS in adults are similar but different.Due to special age-related physiological characteristics.It is difficult to carry out randomized controlled clinical study compared with adults.Diagnosis and treatment of pediatric MODS can only be obtained with reference to adult MODS.This study reviews on the epidemiology,clinical scoring system,pathogenesis,clinical features and treatment of MODS in pediatrics.

Objective To explore the distribution of pathogens, bacterial drug resistance, clinical features and prognosis of bacterial meningitis (BM) in children.MethodsThe clinical data of children diagnosed with BM during January 2011 to July 2015 were retrospectively analyzed. Children were divided into good outcome group and poor outcome group by the outcome at discharge. The distribution of pathogens, bacterial drug resistance, clinical features, and prognosis were analyzed among different groups.ResultsThere were included 95 children diagnosed with BM,. among whom 69 (72.6%) children had Gram-positive bacterial infections with predominantStreptococcus pneumonia (43 cases, 45.3%) and 26 (27.4%) children had Gram-negative bacterial infections with predominantEscherichia coli (13 cases, 13.7%). More than 50%Streptococcus pneumonia andEscherichia coli were resisted to penicillin. The neurological complications in children with BM included subdural effusions, hydrocephalus, cerebral parenchyma injury, and hearing and visual impairment, et.al. Multivariate logistic regression analysis showed that consciousness, coma, and low level of glucose in cerebrospinal lfuid were the independent risk factors for adverse outcome at discharge.ConclusionStreptococcus pneumonia andEscherichia coli were the predominant pathogens in children with BM with high resistance rate to penicillin. BM children may have varying degrees of neurological sequelae. The unconsciousness and low level of glucose in cerebrospinal lfuid were associated with unfavorable outcomes at discharge.

Objective To study the reasonable doses, efficacy and safety of regional citrate anticoagulation (RCA) for continuous veno-venous hemofiltration(CVVH) in children. Methods There were 66 patients hospi-ta-lized in Pediatric Intensive Care Unit of Zhujiang Hospital,Southern Medical University treated with RCA-CVVH that were recruited in the study from October 2012 to July 2014. The patients were divided into 4 groups according to their weight:≤10 kg( group Ⅰ) ,20 kg≥weight>10 kg( group Ⅱ) ,30 kg≥weight>20 kg( group Ⅲ) ,>30 kg( groupⅣ),and each group randomly received 2 different doses of anticoagulant acid citrate dextrose formula A(ACD-A):ACD-A(mL/h)=0. 75×blood flow rate(BFR)(mL/min)(A dose) and ACD-A=1. 5×BFR(B dose). Data of hemo-filter duration, activated partial thromboplastin time( APTT) ( systemic and circuit) , ionized calcium( Ca2+) ( systemic and circuit), blood urea nitrogen(BUN), serum creatinine(Cr), alanine aminotransferase(ALT), aspartate amin-otransferase(AST), blood pH, sodium ion(Na+), bicarbonate ion(HCO3-) were collected and analyzed. Results There was no significant difference in BUN,Cr,ALT,AST and APTT of 2 different doses of ACD-A among the groups (all P>0.05);pH of B dose of ACD-A in group Ⅰwas significantly higher than that in A dose(F=7.384,P=0. 015);pH of B dose of ACD-A in groupⅡwas significantly higher than that in A dose(F=4. 492,P=0. 046),HCO3-of B dose of ACD-A in groupⅠwas significantly higher than that in A dose(F=7. 735,P=0. 013);HCO3-of B dose of ACD-A in groupⅡwas significantly higher than that in A dose(F=4. 644,P=0. 042);hemofilter duration of B dose of ACD-A in group Ⅲ was significantly higher than that in A dose(t=-3. 147,P=0. 016);hemofilter duration of B dose of ACD-A in groupⅣwas significantly higher than that in A dose(t=-6. 342,P=0. 000). Conclusions RCA-CVVH is effective and safe for critical children,and different doses of ACD-A for children with different weight can re-duce metabolic alkalosis and enhance regional anticoagulation.

Objective To explore the sleep quality and its influencing factors among the patients with schizophrenia of Hui and Han populations in the rural areas in Ningxia Hui Autonomous Region.MethodsTotally 296 patients with schizophrenia of Hui and Han populations in the rural areas were selected from 2 counties of Wuzhong and Zhongwei in Ningxia Hui Autonomous Region by using cluster random sampling method.Self-made general information questionnaire was used to collect the demographic and clinical characteristics of the patients with schizophrenia.The Pittsburgh Sleep Quality Index(PSQI) was used to evaluate the sleep quality.Brief Psychiatric Rating Scale(BPRS),Hamilton Depression Scale(HAMD) and Hamilton Anxiety Scale(HAMA) were used to measure the psychotic symptoms,depressive symptoms and anxiety symptoms,respectively.ResultsIn the rural areas,the incidence of sleep disorder in the patients with schizophrenia of Hui and Han populations was 84.5%.The influencing factors of sleep disorder in the patients with schizophrenia in the rural areas were age(B=0.055,P=0.012,OR=1.057,95%CI:1.012-1.103),nationality(B=2.250,P<0.01,OR=9.485,95%CI:2.701-33.319),marital status(B=-1.506,P=0.003,OR=0.222,95%CI:0.081-0.605),course of disease(B=-0.003,P=0.089,OR=0.997,95%CI:0.993-1.001),the total score of HAMD(B=0.079,P=0.007,OR=1.083,95%CI:1.021-1.148)and the total score of HAMA(B=0.060,P=0.036,OR=1.061,95%CI:1.004-1.122).ConclusionSleep disorders are common and associated with multiple factors in patients with schizophrenia of Hui and Han populations in Ningxia rural area.In clinical practice,more attention should be paid to the identification and intervention of sleep disorders,so as to improve the sleep quality for the patients with schizophrenia.

OBJECTIVE To investigate the distribution and the resistance of pathogens from the children with VAP in PICU,and to analyze the reasons of antibiotics resistance of the pathogens.METHODS The sputum obtained from the children with final diagnosis of VAP in PICU was cultured and identified from Jan 2005 to Dec 2006.The resistance of the bacteria identified to antibiotics used frequently was determined by Kirby-Bauer method.RESULTS A total of 187 strains were isolated from sputum specimens,of which Gram-negative bacilli and Gram-positive cocci accounted for 76.5% and 23.5%,respectively.Acinetobacter baumannii(17.7%),Escherichia coli(16.0%),Pseudomonas aeruginosa(15.0%) and Klebsiella pneumoniae(13.9%) were the most frequently isolates of Gram-negative bacilli.Their resistant rates to ?-lactam antibiotics were high,especially the ESBLs-producing strains in E.coli and K.pneumoniae.The Staphylococcus epidermidis(5.9%),Staphylococcus aureus(4.8%) and Enterococcus faecalis(4.3%) were the most common strains of Gram-positive cocci.No vancomycin-resistanct strains were found,but resistance rates to ?-lactam antibiotics and other antibiotics were high in S.epidermidis and S.aureus.CONCLUSIONS The main strains cultured from the sputum specimens of children with VAP in PICU are Gram-negative bacilli with high resistance rates to antibiotics,especially the ESBLs producing bacilli to ?-lactam antibiotics.Staphylococcus are the main Gram-positive cocci.