ObjectiveTo explore the relation of heart rate variability (HRV) in neonatal asphyxia with myocardial injury.MethodsContinuous electrocardiographic monitoring by 24-hour Holter recordings was performed in 53 neonates with asphyxia and 40 healthy newborn.The difference of HRV with sinus rhythm was analyzed.Time-domain indexs included standard deviation of R-R intervals (SDNN) ; standard deviation of all mean 5-minute R-R intervals (SDANN) ;standard deviation of all R-R intervals for all 5-minute segments of 24 hours (SDNNindex ) ;root mean squared successive difference (rMSSD) ;percent of NN50 in the total number R-R intervals ( PNN50 ).Results( 1 ) Maximum heart rate,minimum heart rate and average heart rate of 24-hour Holter in healthy newborn were faster than those in newborn with neonatal asphyxia ( P ＜ 0.05 ).And the heart rate was faster in newborn with mild neonatal asphyxia than that in newborn with serious neonatal asphyxia ( P ＜ 0.05 ).(2) SDNN,SDANN of HRV index analysis showed significantly difference between healthy newborn and asphyxia newhom ( P ＜ 0.05 ).There were no difference of SDNN,SDANN,SDNNindex,rMSSD and PNN50 between mild and serious neonatal asphyxia (P ＞ 0.05 ).No significant differences of SDNNindex,rMSSD and PNN50 were found among three groups.ConclusionMyocardial injury caused by neonatal asphyxia can lead to damage of cardiac autonomic nevous and affect heart rate changes.The degree of myocardial injury is related to the degree of neonatal asphyxia.

ObjectiveTo investigate the relationship between the change of circulating endothelial cell (CEC) level and coronary artery lesion (CAL) of Kawasaki disease (KD),and to further explore the method for early diagnosis of KD.MethodsThirty KD children were recruited for study,including 23 children with complete type of KD and seven children with incomplete KD.According to the results of echocardiography,the KD group was divided into CAL group (9 cases) and non-coronary artery lesion (NCAL)group (21 cases).Ten healthy children were enrolled as control group.Double-blind and controlled trial was conducted,and Hladovec method was applied for CEC counting.Results The CEC level was ( 1.09 ±0.60) × 107/L in KD group,which was higher than that of control group [ (0.38 ±0.14) × 107/L],and the difference was statistically significant ( t =2.85,P ＜ 0.01 ).The CEC level in the CAL group [ ( 1.84 ± 0.24) × 107/L] was higher than that of the NCAL group[ (2.01 ±0.38) × 107/L],and the difference was statistically significant ( t =2.24,P ＜ 0.05 ).The CEC level was ( 1.16 ± 0.63 ) × 107/L in the complete type of KD group and (0.83 ± 0.45 ) × 107/L in the incomplete KD group,which showed no significant difference between the two groups ( t =1.86,P ＞ 0.05 ).CondusionCEC level was elevated significantly in the acute phase of KD.The CEC level in CAL group was higher than that of NCAL group in acute phase.CEC level detection may be helpful for the early diagnosis of KD.

During cardiopulmonary resuscitation (CPR),PetCO2 monitoring helps to judge the status of circulation.Marked elevation of PetCO2 level is early sign for restoration of spontaneous circulation and successful CPR.PetCO2 level monitoring can predict probability of CPR success and it is also helpful to assist in confirming endotracheal tube placement,to assess for chest compression and ventilation.PetCO2 levels should be monitored during CPR.

Training technologies on life support for pediatric critical illness mainly include basic life support,pediatric advanced life support,neonatal resuscitation program,pediatric trauma life support,pediatric fundamental critical care support,and simulation-based medical education.This article introduced and summarized the contents of training technologies on life support for pediatric critical illness,and elucidated the status on each project and its vision.

ObjectiveTo explore the control factor of pulmonary microvascular endothelial cells in pulmonary hemorrhage with the RhoA-Rock pathway inhibitors.MethodsHuman pulmonary rnicrovascular endothelial cells were conventionally cultured,and were divided into four groups:control group,inhibitor group,hypoxia group and hypoxia group with inhibitor.As different fluorescein lsothiocyanate-phalloidin and filamentous actin (F-actin) in cytoplasm combined,it issued red fluorescence.We observed the dynamic changes of F-actin by laser scanning confocal microscope in hypoxia human pulmonary microvascular endothelial cells and recorded the value of fluorescence.ResultsThe mean fluorescence intensity of F-actin of hypoxia group in 1 h,12h and 24 h was (64.3 ±5.5)％,(60.3±4.2)％,and (47.8 ±4.6)％ as compared with the control group;the ratio of hypoxia group with inhibitor was (66.2 ±3.2)％,(67.1 ±6.2)％,and (72.5 ± 6.1 ) ％ as compared with the control group.The mean fluorescence intensity of F-actin decreased obviously after 1 h hypoxia treated to cells,decreasing to (64.3 ± 5.5 ) ％ of the control group (P ＜0.05 ) ;to 24 h,decreasing to (47.8 ±4.6) ％ of the control group(P ＜0.05).The mean fluorescence intensity of F-actin decreased to (66.2 ± 3.2) ％ of the control group after 1 h hypoxia treated in inhibitor group,which was more than 1 h in the hypoxic group.F-actin decreased obviously to (72.5 ± 6.1 ) ％ of the control group after 24 h hypoxia treated in inhibitor group.There was significant difference comparing with the hypoxia group after 24 h hypoxia(P ＜0.05).The mean fluorescence intensity of F-actin of inhibitor group without anoxic was invariant comparing with the control group(P ＞0.05).Cortex-like structure disappeared and the stress fibers arranged disorderly after hypoxia.Actin depolymedzated and broke gradually with the extension of hypoxia time.If to be hypoxic after pretreated with RhoA-Rock pathway inhibitor,cortex-like structure by the composition of pednuclear F-actin reappeared,distribution and arrangement of stress fibers in the cytoplasm tended to rule.ConclusionThe RhoA-Rock pathway mediates the damage on F-actin of pulmonary microvascular endothelial cells after hypoxia.Interfering with the RhoA-Rock pathway inhibitors can provide a new direction for the treatment of neonatal pulmonary hemorrhage.

ObjectiveTo assess the relationship between serum macrophage migration inhibitory factor (MIF) and sepsis in children with hematologic malignancy.Methods( 1 ) An observational study was performed in a university pediatric intensive care unit.Forty-one children were enrolled in our study,and were divided into two groups:sepsis group (27 cases) and non sepsis group ( 14 cases).(2) Serum samples were taken in the both two groups in 24 h after they were admitted in hospital.Clinical and laboratory parameters,including the levels of serum MIF,cortisol,corticotropin releasing hormone ( CRH),and ferritin were measured and compared between the two groups.Multiple linear regression analysis was used to assess the relationship between MIF and CRH,cortisol and pediatric critical illness score (PCIS).ResultsThe level of MIF was significantly elevated in the sepsis group[ (5 022.71 ± 3 915.82) pg/ml] than that of non sepsis group[ ( 1 722.81 ± 1 738.53) pg/ml] (P =0.001 ).Multiple linear regression analysis showed that CRH as well as PCIS were the correlative factors of MIF( t =- 2.830,P =0.009; t =2.852,P =0.009 ).The higher CRH concentration,the lower PCIS score,and the higher MIF was.ConclusionThe level of serum MIF could reflect the severity of children with hematologic malignancy complicated with sepsis.The higher MIF concentration,the lower PCIS score,then the disease is more serious.To some extent,serum MIF is related with the adrenocortical function of sepsis children.

ObjectiveTo explore the clinical features,etiological factors,diagnosis and treatments in children with hemophagocytic syndromes (HPS).MethodsA retrospective study was carried out to analyze etiological factors,clinical symptoms and sighs,laboratory findings and outcomes of 32 children with HPS in our hospital.Results( 1 ) Etiological factors:virus infection cases accounted for 75.0％ (24/32),in which Epstein-Barr virus infection cases were predominant,making up to 68.8％ (22/32) ; (2) Main clinical features:included persistent fever,hepatosplenomegaly,lymphadenopathy; ( 3 ) Characteristic laboratory findings:included decrease of three lines or two lines of peripheral blood cells,hyperferrttinemia,abnormal liver function and coagulation function,hypertriglycerdema and decreased fibrinogen,hemophagocytosis in bone marrow,high soluble interleukin-2 receptor level,decreased natural killer cell activity.(4) Treatments and outcomes:twenty-four(24/32) virus infection cases received antivirus and high dose of immunoglobulin treatment.Twenty-two cases were treated with glucocorticoid and cyclophosphamide,resulting in 11 cases improvement,5 cases with complete remission,2 cases giving up and 4 death.The other 10 cases were treated under the guide of HLH-2004 protocol treatmemt with 4 cases improved and 6 cases with complete remission.Conclusion HPS is mainly triggered by infections,especially Epstein-Barr virus infection.Serum ferrifin,interleukin-2 receptor level and natural killer cell activity are biomarkers of the disease,so that they should be monitored during the progress of chemotherapy.HLH-2004 protocol is a good guide for the treatment of this disease.

Through analyzing the children's pre-hospital transport,emergency medicine,intensive care medicine,nursing,professional training and research,we reviewed the current status of construction and issues of pediatric emergency and critical care system,then put forward recommendations of its development.

Brain injury is the leading cause of death after cardiopulmonary resuscitation.Clinical care for brain injury remains necessary.Therapeutic hypothermia has been shown to be effective in improving neurological outcome of children with cardiac arrest.We routinely induced hypothermia in children with coma after cardiac arrest,targeting 32 ～ 34 ℃,using cooling blankets and intravenous ice cap as primary methods for induction,for 24 ～ 72 h or much more duration,and vigilant re-warming.The objective of this article was to share our hypothermia protocol for cooling children with acute brain injury after cardiac arrest.

High fidelity simulation training is the results of medical education and teaching method reform in recent years.This article focused on the discussion of simulation training significance,teaching model with simulation devices,establishment of simulation center,and the application and value of simulation training in emergency medical education.The training method which includes brief theory lectures of international simulation,separated technology practice,comprehensive simulation drill and video analysis is a development potential in the pediatric emergency medical education.