Inflammation,immune suppression and oxidative stress is the main pathogenesis of sepsis.In recent years,more study have found ω-3 polyunsaturated fatty acid(ω-3PUFA) can inhibit inflammation by some mechanisms namely,reducing metabolites from arachidonic acid(AA) by competing with it through a variety of ways,alteration of membrane lipid rafts,inhibition of nuclear receptor activation(specifically nuclear factor NF-κB)to modulate production of inflammatory mediators,and metabolism into novel pro-resolving and antiinflammatory mediators (resolvins and protectins).In addition,ω-3PUFA can reduce oxidative stress by improvement the antioxidant defense system,etc.Many clinical studies have demonstrated that ω-3PUF is effective in the for sepsis patients.The paper reviews the specific mechanism of ω-3PUFA treatment for sepsis.

Acute respiratory distress syndrome (ARDS) is a common clinical critical disease threatening patient's life,inflammation caused by diffuse alveolar damage is the essence.Omega-3 polyunsaturated fatty acid(ω-3PUFAs) can inhibit inflammation by decreasing arachidonic acid metabolites through competing with arachidonic acid by a variety of ways,by changing the nature of cell membrane signal platform lipid rafts,by involving in inflammation regression and tissue repairment using its metabolites,by reducing the activation of nulear factors-κB and inhibiting the release of inflammatory mediators in local lung tissue.So,ω-3PUFAs has become the research hot spot in ARDS drug treatment.The clinical study on ω-3PUFAs enteral nutrition in the treatment of ARDS has not yet reached the consistent conclusion,therefore,the multicenter randomized controlled trial is needed.

Autoimmune encephalitis with GABAB receptor antibodies has been rarely reported.Two cases of GABAB receptor antibodies encephalitis were presented here.Epilepsy was the onset symptom,followed by declined consciousness and frequent seizures.Fever was presented in the whole course of the disease.Myorhythmia of the two hands and pilomotor seizures were shown in the later course of the disease.No specificity was demonstrated in electroencephalograms and magnetic resonance imaging.Sensitive response was shown to the first-line immunotherapy.

OBJECTIVE: To determine the risk factors for developing severe pneumonia in children under 5 years old with pneumonia. METHODS: A case-control study was conducted 246 children with pneumonia between 2 and 59 months old who were admitted to the department of emergency of the Children's Hospital of Nanjing Medical University from May 2019 to May 2021 were enrolled. The children with pneumonia were screened according to the diagnostic criteria of the World Health Organization (WHO). Case information of the children was reviewed to obtain relevant socio-demographic, nutritional status and potential risk factors. The independent risk factors for severe pneumonia were analyzed by univariate analysis and multivariate Logistic regression respectively. RESULTS: Among the 246 patients with pneumonia, 125 were male and 121 were female. The average age was (21.0±2.9) months, 184 children with severe pneumonia. The results of population epidemiological characteristics showed that there were no significant differences in gender, age and place of residence between the severe pneumonia group and the pneumonia group. Prematurity, low birth weight, congenital malformation, anemia, length of intensive care unit (ICU) stay, nutritional support, treatment delay, malnutrition, invasive treatment, history of respiratory infection were all related factors affecting the occurrence of severe pneumonia (severe pneumonia group vs. pneumonia group: the proportion of premature infants was 9.52% vs. 1.23%, low birth weight was 19.05% vs. 6.79%, congenital malformation was 22.62% vs. 9.26%, anemia was 27.38% vs. 16.05%, length of ICU stay < 48 hours was 63.10% vs. 38.89%, enteral nutritional support was 34.52% vs. 20.99%, treatment delay was 42.86% vs. 29.63%, malnutrition was 27.38% vs. 8.64%, invasive treatment was 9.52% vs. 1.85%, respiratory tract infection history was 67.86% vs. 40.74%, all P > 0.05). However, breastfeeding, type of infection, nebulization, use of hormones, use of antibiotics, etc. were not risk factors affecting severe pneumonia. Multivariate Logistic regression analysis showed that history of premature birth, low birth weight, congenital malformation, treatment delay, malnutrition, invasive treatment, and history of respiratory infection were independent risk factors for severe pneumonia [history of premature birth: odds ratio (OR) = 2.346, 95% confidence interval (95%CI) was 1.452-3.785; low birth weight: OR = 15.784, 95%CI was 5.201-47.946; congenital malformation: OR = 7.135, 95%CI was 1.519-33.681; treatment delay: OR = 11.541, 95%CI was 2.734-48.742; malnutrition: OR = 14.453, 95%CI was 4.264-49.018; invasive treatment: OR = 6.373, 95%CI was 1.542-26.343; history of respiratory infection: OR = 5.512, 95%CI was 1.891-16.101, all P < 0.05]. CONCLUSIONS Premature birth history, low birth weight, congenital malformation, delayed treatment, malnutrition, invasive treatment, and history of respiratory infection are independent risk factors for severe pneumonia in children under 5 years old.
Infant ; Pregnancy ; Humans ; Child ; Female ; Male ; Child, Preschool ; Case-Control Studies ; Premature Birth ; Pneumonia ; Respiratory Tract Infections ; Emergency Service, Hospital ; Malnutrition

Objective To evaluate the effect of fluid load on the prognosis of severe hand , foot and mouth disease in children. Methods The patients with severe hand foot and mouth disease in the emergency department of PICU in our hospital were enrolled as the research object. We would collect demographic characteristics , labora-tory tests and clinical data: age, gender, focus, basic disease, and simplified acute severity score (SAPS)Ⅱ and record the cumulative amount of fluid balance at 24, 48, 72 hours after admission. Results There was a signifi-cant difference on fluid balance at 48 and 72 hours between the survival group and the death group , the death group appeared the positive liquid balance , and there were significant differences in PICU retention time , mechani-cal ventilation rate, MODF involved organs, mortality and other prognostic indicators between the negative fluid balance group and the positive fluid balance group. Conclusion Fluid balance is an important treatment for severe hand foot and mouth disease, and positive liquid balance is related to mortality and other adverse prognosis.

Objective To investigate the clinical effects and mechanism of naloxone treatment in drowing children.Methods A total of 97 drowing children were divided into treatment group(n=45)and control group(n=52)depending on whether the naloxone was administrated.General treatment was adopted in two groups.Treatment group Was given naloxone.The clinical effects were observed and the levels of betaendorphin(β-EP)in blood plasma were measured with radioimmunoassay(RIA)before and after treatment respectively.Results The total effective rate of treatment group(93.3%,42/45)Was significantly higher than that of control group(76.9%,40/52)(P＜0.05).As compared with that of control group(65.0%,26/40),nervous system disability rate in treatment group(33.3%,14/42)decreased significantly(P＜0.01).Continuous days of poor blood circulation,abnormal respiratory rhythm,convulsion and coma in treatment group were significantly shorter than those of control group respectively(P＜0.01).The level of β-EP was significantly lower in treatment group than that of control group(t=17.1,P＜0.01).Conclusion Clinical use of naloxone in the drowing children has curative result by reducing the level of blood plasma β-EP.

ObjectiveTo investigate the relationship between gastrointestinal dysfunction and both severity and prognosis in patients with heatstroke (HS).Methods A retrospective analysis was conducted. Clinical data from 39 patients with HS seeking for treatment in Department of Critical Care Medicine of Chinese PLA General Hospital from January 2013 to September 2014 were enrolled. The patients were divided into two groups: gastrointestinal dysfunction group and non-gastrointestinal dysfunction group. The acute physiology and chronic health evaluationⅡ(APACHEⅡ) score within 24 hours of admission and 28-day mortality were compared between two groups. In gastrointestinal dysfunction group, the gastrointestinal dysfunction score, the duration days of gastrointestinal dysfunction, the length of intensive care unit (ICU) stay, and the duration of mechanical ventilation were collected. Pearson correlation analysis was used to analyze the relationship between gastrointestinal function and the severity of the ailment as well as the prognosis.Results Among 39 patients with HS, 32 of them showed gastrointestinal dysfunction with an incidence of 82.05%. In gastrointestinal dysfunction group, the gastrointestinal dysfunction score was 2.3±0.8, the duration of gastrointestinal dysfunction was (17.3±15.2) days, the length of ICU stay was (37.8±25.0) days, and the duration of mechanical ventilation was (27.8±14.0) days. APACHEⅡ score in gastrointestinal dysfunction group was significantly higher than that of the non-gastrointestinal dysfunction group (26.30±6.00 vs. 17.40±6.00, t = 3.555,P = 0.001). The 28-day mortality in gastrointestinal dysfunction group was slightly higher than that of the non-gastrointestinal dysfunction group without statistically significant difference [43.75% (14/32) vs. 14.29% (1/7),P = 0.216]. It was shown by Pearson analysis that gastrointestinal dysfunction score was positively correlated with APACHEⅡ score (r = 0.727,P = 0.000), and the duration of gastrointestinal dysfunction was positively correlated with the length of ICU stay (r = 0.797,P = 0.000) and the duration of mechanical ventilation (r = 0.634,P = 0.000). Conclusion The results suggest that gastrointestinal function in patients with HS reflects the severity and prognosis of the ailment.

Acute respiratory distress syndrome (ARDS) is an acute diffuse inflammatory lung injury.Mechanical ventilation is the cornerstone of the treatment from ARDS, which aims to minimize ventilator-induced lung injury while maintaining effective oxygenation.The level of driving pressure affects the volume injury, pressure injury, biological injury and shearing injury during mechanical ventilation of ARDS patients.This study reviewed the mechanical ventilation strategy with driving pressure as guidance in ARDS patients.

Sepsis associated disseminated intravascular coagulation is a common complication of sepsis and one of the major causes of increased mortality in pediatric intensive care units.When sepsis occurs, the inflammatory factor storm will cause damage to various tissues and organs of the body, and its complication DIC will further aggravate the organ dysfunction.Therefore, the early detection of DIC is crucial in the treatment of sepsis in children.Since the first diagnostic criteria were proposed by the ministry of health and welfare of Japan (JMHW) in 1983, new diagnostic criteria have been proposed in recent years.At the same time, timely diagnosis is helpful for early intervention to improve the prognosis, so a variety of treatment schemes have also emerged.This article reviews the establishing history, advantages and disadvantages of the diagnostic criteria for sepsis associated DIC, as well as the research progress on various anticoagulants and anticoagulant therapies.

Sepsis-associated encephalopathy (SAE) is a serious complication of sepsis, which can greatly increase the mortality of patients with sepsis, and may result in prolonged cognitive dysfunction in SAE survivors.Therefore SAE has received more and more attention in the field of critical illness.However, there are few studies on the mechanism of poor prognosis and possible predictors of SAE, and no specific rehabilitation methods have been reported.In this article, progress in the research on the prognosis and rehabilitation of SAE is summarized, in order to provide a reference for the long-term prognosis and rehabilitation treatment of severe sepsis in children.