Multiple organ dysfunction(MODS) can be seen in critically ill children.Modality of extracorporeal life support (ECLS) is the use of mechanical devices to support life when the native organ failure occurs.Extracorporeal devices can effectively support heart,lung,liver,and kidney function of the sick children with MODS.Unlike the adult experience,ECLS is an effective therapy in children with MODS,because the underlying disease possibly is reversible.This article focuses on the different modalities of ECLS which involve extracorporeal membrane oxygenation,continuous renal replacement therapy,artificial liver support system,hemoperfusion and plasma exchange.

Objective To explore prognostic factors associated with early and late recurrences after surgery for patients with gastric adenocarcinoma.Methods 214 patients who underwent curative resection for gastric adenocarcinoma were divided into 2 groups according to recurrence time:an early recurrence group included 143 patients who died within 2 years after surgery,and a late reeurrence group included 71 patients who died more than 2 years after surgery.Indexes such as age,sex,tumor site,tumor size,tumor pathology classification,Borrmann type,TNM staging,lymph node metastasis,operation type and postoperative adjuvant chemotherapy were compared.Results Single factor analysis showed that the tumor diameter,Borrmann type,TNM staging,lymph node metastasis,operation type,adjuvant chemotherapy were asoceiated with postoperative recurrence( test value were 8.32,16.21,24.90,5.22,17.23 and 3.61,respectively;all P ＜ 0.05 ).Multifactor analysis showed that tumor diameter and TNM staging is recurrent independent factors( relative risk were 5.642 and 6.211,respectively ;all P ＜ 0.05 ).Conclusion Tumor size and TNM staging are the most important factors for predicting the timing of recurrence after curative resection for gastric adenocarcinoma.Clinical practice should pay attention to follow up for patients with tumor diameter≥5cm,TNM Ⅲ-Ⅳ stage,especially within two years.

Objective To compare the curative effect and safety between ziprasidone injection and haloperidol injection in the treatment of acute agitation of schizophrenia .Methods Totally 86 patients with acute agitation of schizophrenia were divided into observational group(n=43)and control group(n=43) ,the study used a random ,single‐blinded and clinical controlled experiment . the observational group was given ziprasidone mesylate 10-20 mg every time by intramuscular injection and the amount was less than 40 mg every day ;control group was given haloperidol injection 5-10 mg every time by intramuscular injection and the amount was less than 30 mg every day .Drugs in the two groups could be repeated according to the state of illness after 4-6 hours ,and the daily injections were no more than 3 times and the course of treatment was 3 days .The Positive and Negative Symptoms Scale Ex‐cited Factor(PANSS‐EC)was used to evaluate the agitated symptoms before treatment and 2 ,6 ,24 ,48 ,72 hours after treatment ,the Positive and Negative Symptoms Scale(PANSS)and Clinical Global Impression Scale‐Severity of Illness(CGI‐SI)was used to evalu‐ate the curative effect ;extrapyramidal side adverse reaction(SAS) ,Treatment Emergent Symptoms Scale(TESS)and the related lab tests were employed to assess the adverse reaction .Results Comparing with the baseline ,PANSS‐EC score of observe group de‐creased significantly at 2 h after the treatment ;at other observation time‐points ,PANSS scores ,PANSS‐EC scores and CGI‐SI scores in the two groups both decreased significantly(P<0 .01);but with no significant difference between the two groups(P>0 .05) .There were no significant difference in the total effective rate between the two groups(P>0 .05) .There were no serious ad‐verse events in the two groups .incidences of adverse reactions of observe group were 37 .21% ,which were significantly lower than that of control group 53 .49% (P<0 .05) .Conclusion Effect of ziprasidone injection and haloperidol injection was comparable in the treating acute agitation of schizophrenia ,which could treat acute agitation of schizophrenia with low incidences and excellent se‐curity .

The American Heart Association published a new guideline for cardiopulmonary resuscitation in Oct 2010.One of the most important recommendations is the sequence change of cardiopulmonary resuscitation from ABC to CAB.As pediatrician,we should understand the background of these changes,and give the most reasonable treatment to improve the success rate of resuscitation according to the different locations,different circumstances and different obiects.

It is a brief introduction of necessity of uniform guidelines for pediatric emergency and critical care.Uniform guidelines are very important for development of discipline,safety of patients,protection of medical staff and administration.Uniform guidelines should be enacted according to our national condition with a scientific attitude of rigorous and gravity.

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.

Objective To investigate the training of recruits′psychological stress and its relevant influencing factors ,so as to of‐fer scientific basis for the psychological training and psychological health education of recruits .Methods Questionnaire survey method was used and a total of 720 training of recruits in 2013 was sampled .The application of the stress response questionnaire (SRQ) ,eysenck personality questionnaire (EPQ) ,trait coping style questionnaire (TCSQ) ,symptom checklist (SCL‐90) were used to carry out the psychological test and analysis on these recruits .Results The total score of the SCL‐90 and the score of each factor were significantly lower than the norm of recruits in year of 2000(P<0 .01) .Compared with the norm of SCL‐90 of Chinese sol‐diers in 2004 ,the factor score of somatization ,anxiety and terror were significantly higher than those of domestic soldiers .However , the factor score of hostility and bigotry were significantly lower than those of domestic soldiers (P<0 .05) .The new soldiers who were the only child of the family and was born with urban registered permanent residence had more obvious psychological stress symptoms .The total score of psychological stress and each factor score of new soldiers with different educational level had no sig‐nificant difference (P>0 .05) .According to what was shown in the related analysis ,the SCL‐90 total score .SRQ total score had significant positive correlation with emotional stability and negative coping style(P<0 .01) ,but had significant negative correlation with introversion‐extroversion and waste score(P<0 .01) ,and the total score of SCL‐90 had significant positive correlation SRQ to‐tal score(P<0 .01) .It was shown in the regression analysis that factors had significant predictive effect on the psychological factors of new soldiers during the training period respectively were as follow :negative coping ,stability ,introversion‐extroversion ,psychoti‐cism and whether they are the only child or not .The decisive coefficient of 5 variables was R2 =0 .558 ,F=163 .65(P<0 .01) .Con‐clusion The overall mental health of 2013 recruits training are in good condition ,individual mental health status ,personality traits and coping style training of recruits psychological stress are significant predictors .

Objective To investigate the expression and clinical significance of BRMS1 ( breast cancer metastasis suppressorl ) protein in colon cancer.Methods The expression of BRMS1 protein was detected by using EliVision immunohistochemical techniques in 46 cases of colon cancer,and adjacent non cancerous colon tissues.The clinical significance with histopathologic records was aralyzed.Results The expression levels of BRMS1 ( 34.8％ ) in the colon cancer tissues was significantly lower than those of adjacent non cancerous colon tissues( x2 =23.92,P ＜0.01 ).The expression of BRMSl was significantly correlated with tumor size,clinical stage,and lymph node status (x2 =6.02,4.28,4.35,all P＜0.01) ;BRMS1 had no correlation with age,pathological type.Conclusion BRMS1 might synergistically promote the metastasis of colon cancer.Detection of the expression of BRMS1 may be hdpful in determineing the prognosis of colon cancer.

Objective To compare effects of both ends of the injection cesarean section anesthesia differ-ences.Methods ASAⅠ-Ⅱgrade cesarean section 226 cases were selected and randomly divided into the observa-tion group and control group on the basis of number characterization.Observation group:After the success of epidural puncture needle oblique injection of 1.7% for the end of lidocaine carbonate 5mL,then needle bevel steering head end 3-5min without observing all spinal abnormalities such as re-injection of 5mL of 1.7% lidocaine carbonate,fol-lowed by epidural catheter inserted,modified supine position to continue after injection of 1.7% lidocaine carbonate 5mL;Control group:after the success of epidural catheter tip administered by traditional teaching methods.Two groups of maternal range block plane , intraoperative pain intensity and time of delivery of the fetus were recorded .intraoperative changes in vital signs and Apgar score after the fetus were observed.Results The block wide range for anesthesia of the observation group[(14.43 ±1.21)points]were significantly higher than that of the control group,and intraopera-tive pain was (1.61 ±0.92)points,fetal childbirth lengthwas (1.8 ±0.6)minutes,which were better than those in the control group(t=12.76,13.07,12.86,all P<0.05);The MAP,HR,R,SpO2 between the two groups showed no significant differences(F=4.32,2.73,3.54,3.06,all P<0.05);Intraoperative vital signs and Apgar score was con-firmed no difference between the two groups(all P>0.05).Conclusion Both ends of the epidural injection for ce-sarean section is better than the traditional mode of administration of anesthesia.

Objective To discuss the clinical application of simplified neonatal critical illness score (sNCTS)in comparison with original neonatal critical illness score(oNCIS)published in 2001.Method A total of 705 neonates referred to neonate ICU(NICU)from 1 st January 2007 to 31th December 2009 were prospectively studied with control.The patients were scored by oNCIS on admission day,3rd,7th days after admission and on the day of discharge or dead.At the first scoring on admission,2 items of the PaO2 and pH were excluded from oNCIS's 10 items,and the remaining 8 items were used.Three items of plasma sodium,potassium and creatinine or BUN were scored out from 8 items and the still remained 5 items were used for the subsequent 3 scorings.The remaining 8 and 5 items were used as a simplified neonatal critical illness score.The simplified NCIS was evaluated by comparing the patients'condition that was assessed by the originat NCIS.The consistency rate between oNCIS and sNCIS should be over 80%.Results There were 8 items were used to evaluate the severity of disease on admission, and the consistence rate was 86.7%with the original NCIS.The 5 items selected from the original NCIS were used on the 3rd,the 7th days and the day of discharge or death.the consistence rate with original NCIS were 86.6%to 95.7%.A close correlation existed between the original NCIS and simplified NCIS(P<0.01).There were significant differences in mortality rates of the non-serious,serious and extremely serious groups between original NCIS and simplifled NCIS used for the first and the last seorings(P<0.01).Within a cohort of neonates with the same general condition,the assessments of mortality rates were not significantly different between these two methods (P>0.05).Conclusions Compared with the original NCIS.the simplified NCIS is consistent to a large extent in disease assessment,which is a concise way to evaluate the critical ill neonates objectively and can be easily applied to clinical practice.