Objectives To analysis the main characteristics and changes of the internal death in pediatric intensive care unit (PICU) in the past five years. Methods The clinical data of 330 death cases in PICU internal medicine were retrospectively analyzed from January 2008 to December 2012. Results The mortality rate in PICU dropped from 5.85%to 3.96% from 2008 to 2012. Among 330 death cases, 136 cases (41.2%) were infants, 73 cases (22.1%) were toddlers, 51 cases (15.45%) were preschoolers, and 70 cases (21.21%) were school-age and adolescence. In different years, the differences of distribution of death in different age groups were statistical significance (χ2=6.90, P=0.009). In all years, the infant had the highest death rate. As the time progresses, the death rate of the infant and young children decreases, while the death rate of the school-age and adolescence increases. Among the diseases caused death, the cardiovascular disease was the most common disease (33.94%), followed by hematologic malignancy (31.52%). The difference of distribution of the diseases caused death in different age group was statistically significant (P<0.01). The cardiovascular disease was main cause of death in infant, and the hematologic malignancy was the main cause of death in other three age groups. Within 24 h admission, the pediatric critical illness score (PCIS) had been assessed, 67.49% was critical and 15.48%was extremely critical. The hospitalization time was negatively correlated with PCIS (r=-0.313, P<0.001). Conclusions In the past five years, the mortality in PICU declined year by year. Cardiovascular disease in infancy and hematologic malignancy in non infancy are the leading cause of death in children. Admission in critical or extremely critical condition is the reason of early death in hospital.

Objective To evaluate the significance of high-frequency oscillatory ventilation(HFOV) used in acute hypoxic respiratory failure(AHRF) children,failing to conventional ventilation.Methods This was a retrospective study of AHRF children ventilated by HFOV from January 2011 to September,2013.All patients were initially treated by conventional mechanical ventilation (CMV),and changed to be treated by HFOV if the patient met to one of the following criteria after the CMV parameters of PIP ＞ 30 mmH2O(1cmH2O =0.098 kPa) or PEEP ＞ 10 cmH2O with FiO2 100％ ∶ (1) SpO2 ＜ 90％ or PaO2 ＜ 60 mmHg (1 mmHg =0.133 kPa) ; (2) severe respiratory acidosis (PaCO2 ＞ 80 mmHg) ; (3) serious air leakage (mediastinal emphysema or pneumothorax).The following parameters were recorded:patient's gender,age,living PICU time,CMV ventilation time,HFOV ventilation time.We reviewed ventilation parameter settings (MAP,△P,F,FiO2),oxygenation index(PaO2/FiO2,OI),arterial blood gas,heart rate,blood pressure at different time points including late CMV(H0),2 h after HFOV(H2),6 h after HFOV(H6),12 h after HFOV(H12),24 h after HFOV (H24) and 48 h after HFOV (H48),respectively.Various indexes at different time points were compared between survival group and death group,oncology group and no-oncology group.Results PaO2 at H2 compared with H0 had significant improvement[76.9(61.9 ～ 128.0) mmHg vs 50.1 (49.5 ～68.0) mmHg,P =0.006] . PaO2/FiO2 at H2,H48 had significant improvement compared with those at H0,H24 [94.9(66.8 ～ 138.9) mmHg vs 68.0(49.5 ～86.8) mmHg,P=0.039; 135.0(77.6～240.0) mmHg vs 90.7 (54.6 ～161.7) mmHg,P =0.023)].All children's systolic pressure,diastolic blood pressure,heart rate at various time points had no difference (P ＞0.05).Compared to death group(n =14),PaO2/FiO2,OI at H6,H12,H24,H48 in survival group (n =9) had significant improvement(P ＜ 0.05).Compared to oncology group (n =10),OI at H2,H6 in no-oncology group(n =10) had significant improvement [(19.2 (13.9 ～ 26.6) vs 33.8 (19.7 ～ 48.3),P =0.049 ; 16.0(8.4 ～27.1) vs 28.9(20.9 ～38.9),P =0.027)],and mean airway pressure between two groups at H2,H6,H12 had significant improvement(P ＜ 0.05).Mortality had no significant differcence between two groups (4/10 vs 10/13,P =0.086).Conelusion HFOV used in children with AHRF which had failed with CMV ventilation can improve the patient's PaO2 and OI.Heart rate and blood pressure are stable during HFOV treatment.Oncology group patients needed higher initial MAP to improve oxygenation than no-oncology group patients when changed to HFOV treatment,but the mortality showed no difference between two groups.

Objective To study the expression and the mechanism of miR-155in the villi of patients with unexplained recurrent spontaneous abortion (URSA).Methods The expression of miR-155 in the villi of 36 cases with URSA (URSA group) and 25 women with normal early pregnancy (control group) were detected by stem-loop real-time reverse transcription (RT) qPCR.Expression of hypoxia inducible factor-1 (HIF-1α),vascular endothelial cell growth factor(VEGF) and micro lymphatic vessel density (MVD) in the villi of were measured by immnohistochemical staining among two groups.Results (1) miR-155 expression:the mean miR-155 expression were 1.456 (0.489,2.459) in URSA group and 2.833 (1.740,3.794) in control group,which reached statistical difference (P ＜0.05).The mean expression of miR-155 of 1.683 (0.902,2.459) in URSA group with abortion times (≤ 3) was significantly higher than 1.229 (0.489,1.719) in URSA group with more than 4 times abortion (P ＜ 0.05).(2) Indexes:the expression of HIF-1α,VEGF and MVD value were 121 ± 12,134 ± 12,36 ± 6 in URSA group and 99 ± 10,109 ± 10,28 ±4 in control group,which reached statistical difference(P ＜ 0.01).The expression of HIF-1α,VEGF and MVD value of 119 ± 12,134 ± 12,35 ± 5 in URSA group with less than 3 times abortion was significantly lower than 128 ± 12,138 ± 12,43 ± 6 in URSA group with more than 4 times abortion (P ＜ 0.01).Conclusions The expression of miR-155 and HIF-1α is topically stimulated by oxygen signal.HIF-1α adjusts the transcription and translation of VEGF,which together involved in placental trophoblast invasion and placental angiogenesis.The low expression of miR-155 could interfere with expression of HIF-1α and VEGF,which might be involved in villous vascular dysplasia in URSA.

Objective To investigate the levels of Th1 and Th2 cell in the peripheral and the cytokines (IFN-γ,TNF-α,IL-12,IL-10,IL-4) in the culture medium at different time in the porcine model with multiple organ dysfunction syndrome(MODS) after continuous blood purification(CBP). Methods Twenty-four young porcines were given intravenous infusion of endotoxin to induce MODS, then were randomly divided into 2 groups:CBP group(n = 12) and MODS group without CBP(n = 12). Continuous venovenous hemodiafiltration (CVVHDF) was the main mode for CBP. At baseline, onset of MODS, and 2 h,4 h,6 h after treatment of CVVHDF,we picked the blood respectively to separate the T helper cell using the beads,detected the Th1 and Th2 cell by FACS and detected the cytokines (IFN-γ,TNF-α,IL-12,IL-10,IL-4) in the culture medium by ELISA. Results The MODS group showed a obvious rise in TNF-α,the drop tendency in IL-12,IFN-γ,IL-10,Th1/Th2 ratio, and no significant change in IL-4. After the treatment, the CBP group showed the drop in TNF-α and IL-4;and increase in IL-12,IFN-γ,IL-10 and Th1/Th2 ratio. Conclusion CBP helps to dear immune function,and restore the balance of Th1/Th2 in porcine MODS model.

Objective To explore the safety and therapeutic efficiency of continuous renal replacement therapy(CRRT) without anticoagulation for critically ill children with high risk of bleeding.Methods We retrospectively analyzed 51 patients undergoing bedside CRRT in the PICU of our hospital from December 2007 to July 2015.Patients were divided into two groups induding CRRT with anticoagulation(n=33) or without anticoagulation (n=18).The therapeutic efficiency and complications were compared between two grous.Results Totally 168 CRRT circuits were performed in these 51 patients including 62 (36.9％)circuits without anticoagulation in 18 patients with high risk of bleeding and 106(63.1％) with anticoagulation by heparin.The circuits life of CRRT without anticoagulation was (12.31±6.64) h,which was shorter than that of CRRT with anticoagulation [(17.43±9.97)h] (P＜0.001).The levels of blood creatinine,blood urea nitrogen,C-reactive protein,and lactate significantly improved after both therapies (P＜0.05).PT and APTT did not change in CRRT without anticoagulation for hemorrhagic complications(P＞0.05).APTT[(52.36±5.00)s vs.(76.48±9.02)s,P=0.013] and PLT[(127.3±20.85)×109/L vs.(95.52±15.46)×109/L,P=0.041]were significantly longer in CRRT with anticoagulation by heparin compared with those before treatment.Conclusion CRRT without anticoagulation reduces bleeding risks and achieves an acceptable circuit life.The strategy can be applied as an alternative to critically ill children at high risks of bleeding who need continuous blood purification.

Objective To evaluate the value of integrated use of bedside lung ultrasound and echo-cardiography in PICU.Methods Two cases with respiratory failure and shock were monitored using inte-grated bedside lung ultrasound and echocardiography.Breathing and circulation support solutions were adopt-ed according to Bedside Lung Ultrasound in Emergency(BLUE)and Fluid Administration Limited by Lung Sonography(FALLS).Results Case 1 with acute lymphoblastic leukemia complicated with severe phneu-monia was measured as “B-profile”throughout both lung fields which interpreted as pulmonary edema ac-cording to the BLUE protocol.He was diagnosed as acute respiratory distress syndrome later and supported by non-invasive ventilation according to the lung ultrasonography.After 4 days,the numbers of B line were sig-nificantly reduced with PaO2/FiO2 >300 mmHg(1 mmHg=0.133 kPa)and the improvement in chest X ra-diography was found,ventilation was weaned accordingly.Case 2 was diagnosed as septic shock and acute re-spiratory distress syndrome with volume resuscitation and mechanical ventilation.According to FALLS proto-col,we ruled out obstructive and cardiogenic shock,and assessed the variation in inferior vena cava diameter and aortic systolic velocity-time integral as a guide to fluid therapy.At the 8th hour in PICU,case 2 recovered from shock.Conclusion Integrated use of bedside lung ultrasound and echocardiography is clinically signifi-cant for the rescue of critically ill patient with respiratory failure and shock.

Objective To determine the changes of the host's inflammatory response throughout the course of sepsis secondary to pneumonia by evaluating the serum levels of interleukin (IL)-6 and IL-10.Methods Sixty-two patients who were diagnosed with pneumonia and hospitalized in PICU from Sep 2008 to Mar 2009 were enrolled in this study.They were divided into 3 groups:pneumonia group (n =31 ),sepsis group (n =20) and severe sepsis group (n =11 ).The serum levels of IL-6 and Il-10 were measured by enzyme-linked immunosorbent assay at the day 1 and day 4 after admitted to PICU.Results The pediatric risk of score mortality Ⅲ scores and fatality rate were significantly higher in severe sepsis group compared to the other two groups (P ＜ 0.05).The levels of IL-6 were (55.68 ± 61.41 ) pg/ml,(57.46 ± 96.56) pg/ml,and ( 114.86 ± 206.37) pg/ml in pneumonia group,sepsis group and severe sepsis group at day 1 of PICU,with no difference among 3 groups.However,the levels of IL-10 were ( 59.50 ± 57.97 ) pg/ml,( 41.27 ±28.37) pg/ml,and(20.05 ±9.14) pg/ml at day 1 in 3 groups,which showed a significant difference(P ＜0.05).The ratio of IL-6 to IL-10 were 1.51 ±2.42,1.48 ±2.50,and 14.47 ±26.97 at day 1 in 3 groups.There was a significant differrence among 3 groups ( P ＜ 0.05 ).No difference was found among 3 groups at day 4.Conclusion IL-10 may be an determinant factor of the severity and prognosis of the sepsis,and measurement of IL-10 or the ratio of IL-6 to IL-10 can be used to evaluate the severity and prognosis of sepsis.

Objective To investigate the clinical characteristics and emergency management of severe hand-foot-mouth disease(HFMD)associated with encephalitis and neurogenic pulmonary edema(NPE)caused by en-terovirus 71(EV71)in children.Method Data of critical patients with severe HFMD associated with encephalitis and NPE admitted to pediatric intensive care unit(PICU)Fuyan city Hospitals Anhni Province from May to June 2008 were reviewed.Results Of 30 patients,the mean age was 15.8 months ranged from 4 months to 48 months.The overall morality was 19.4%.Tha average duration of critical symptoms persisted Was 2.1 days ranged from 12 hours to 5 days.There were no rash found in 12 patients(33.3%).The chinical features of nervous system mani-fested the symptoms of brainstem encephalitis in 27 patients(75%),brainstem encephalitis with myelitis in 6 pa-tients(16.7%),and encephalitis in 3 patients(8.3%).The frothy expectoration tinged with pink or bloody,asyrmmetrical pulmonary edema or hemoptysis were the main features of NPE.The main approaches to the treatment were mechanical ventilation,mannitol,methylpredifiselone,intravenous immunoglobulin(IVIG),and vasoactive a-gents.And nine patients(25%)needed fluid volume resuscitation in addition.Conclusions Young children are particularly vulnerable to the Severe EV71 encephalitis with NPE.The majority of involved fatal patients are aged under 3 years.Patients may die of acute onset of NPE and/or hemoptysis with rapid progress towards cardiopul-monary failure.Early diagnosis and evaluation,respiratory support,lowering intracranial pressure and maintaining hemodynamics ale the essential therapeutic approaches.

Objective:To analyze the clinical characteristics and risk factors for mortality of severe pneumocystis carinii pneumonia(PCP)in pediatric liver transplant(LT)recipients.Methods:The data of severe PCP in LT recipients diagnosed at Shanghai Children′s Medical Center from November 2019 to February 2021 were collected.The clinical characteristics and risk factors for 28-day mortality were analyzed.Results:Fifteen patients were enrolled in the study.Thirteen cases survived and 2 cases were non-survived.There was no routine anti-pneumocystis prophylaxis after LT.The median age of onset of PCP was 12(7, 26)months.The median time after LT was 3.00(0.33, 4.00)months.The onset clustered in November-December and June-August.All patients were mechanically ventilated, and some patients were given prone ventilation(11 cases), neuromuscular blocking agents(13 cases)and high concentration oxygen(more than 60%, nine cases). Fourteen cases were complicated with other infections.Two cases were complicated with pneumothorax and subcutaneous/mediastinal emphysema.There were 2 cases with septic shock-like manifestation, 1 case of right heart insufficiency, 1 case of right heart failure(death), and 1 case of multiple organ failure(death). Compared with the survived group, the non-survived group had higher pediatric risk of mortality Ⅲ score[3.5(0.0, 6.0)vs.8.5(5.0, 12.0), Z=1.993, P=0.046] and lactate dehydrogenase level[1 731.5(1 012.0, 3 270.0)U/L vs.4 387.5(3 606.0, 5 169.0)U/L, Z=2.148, P=0.032]. Conclusion:PCP in pediatric LT is critical and complicated.Pediatric risk of mortality Ⅲ scores and lactate dehydrogenase increase in 28-day hospitalized deaths.

OBJECTIVE Disturbance of K+ ion balance in inner ear is associated in age-related hearing loss. Our study is to investigate the role of NKCC1 and Na-K-ATPase in cochlea and auditory function regulated by with different expression of NKCC1 and Na-K-ATPase. METHODS Auditory threshold of young or old C57BL/6J mice was measured by auditory brainstem response(ABR). The expression of NKCC1 and Na-K-ATPase in mice cochlea were evaluated by reverse transcription polymerase chain reaction(RT-PCR) and western blotting. Furosemide and Ouabain were applied in vivo to inhibit NKCC1 and Na-K-ATPase in C57BL/6J mice. RESULTS C57BL/6J mice developed hearing loss at 12M by ABR threshold shifting to (75±10), (78±26) and (81±14)dB SPL at frequencies of 8, 16 and 32 kHz; PCR showed that the relative expression of NKCC1 and Na-K-ATPase mRNA in the aged group decreased, which were 0.52±0.06 and 0.35±0.04 times higher than those in the young control group, the difference was statistically significant(t =7.466 and 16.11, all P＜0.05). WB showed that relative expression of NKCC1 and Na-K-ATPase protein level in the aged group decreased by 0.79±0.02 and 0.68±0.05 times as much as that of the young control group, the difference was statistically significant(t =8.857 and 6.771, P all＜0.05). After applied with Furosemide and Ouabain to suppress the two ion transporters, the ABR threshold increased to (50±17), (53±21), (55±17)dB SPL and (56±6), (70±17), (73±6)dB SPL at frequencies of 8, 16 and 32 kHz. CONCLUSION In vivo experiment of C57BL/6J suggested that NKCC1 and Na-K-ATPase might be related to age related hearing loss.