Ventilator-induced lung injury is a serious complication of mechanical ventilation. At present a lot of researches have explored lung protective ventilation strategies to prevent and treat ventilator associated lung injury in adult. But researches on children are relatively rare. This article reviewed the pathophysiological mechanisms of pediatric ventilator-induced lung inju-ry and the clinical application of lung protective ventilation strategies in children.

Adolescent ; Child ; Child, Preschool ; Chronic Disease ; Cough ; etiology ; Female ; Humans ; Male ; Rhinitis ; complications ; diagnosis ; drug therapy ; Sinusitis ; complications ; diagnosis ; drug therapy

Objective To study the differences in clinical characteristics and etiology in bronchopneumonia and lobar pneumonia,and provide the basis for the clinical diagnosis and treatment.Methods A retrospective study was performed on 100 children with lobar pneumonia and 200 children with bronchopneumonia from Dec.2005 to Dec.2007.Antibodies of mycoplasma(MP) and chlamydia(CP) were detected with quantitative enzyme linked immunosorbent assay of serum samples which were collected on addmission.On the second day morning,axenic sputum samples of laryngeapharyngis at pars were collected with onetime asepsis aspiration sputum tube by negative pressure for bacterial culture,and the common seven viruses were detected with direct immunofluorescence,and MP DNA,CP DNA were detected.The results and the clinical data and the characters of sternum were analyzed.Results Lobar pneumonia was more in the elder children,and the features were fever and cough in clinic,absence in physical sign of bellow,and inflammation of one pulmonary lobe in X-ray.Sixty-one percent of childhood lobar pneumonia had MP infection in laboratory examination.But bronchopneumonia was found more in infants and young children,whose features were cough,dyspnea and catarrhus in clinics,wheezy phlegm and stridor in physical sign of bellow,pulmonic shadow of spot and lamellar in X-ray.Bacteria were the most common pathogen in bronchopneumonia.Conclusions Lobar pneumonia was different from bronchopneumonia in age and clinic features and sternum characters of patients,and much more different in etiology.Bacterial infection was important in bronchopneumonia.But in lobar pneumonia,MP infection occupied 61.0%,which was different from traditionaletiology.Moreover,the MP infection rate in infant and young children tend to increase obviously.

Objective To investigate the prevalence, clinical characteristics and antibiotic resistance of Haemophilus influenzae (HI) in children with acute respiratory tract infection in Suzhou. Methods Data of sputum culture of 3 167 hospitalized childhood patients with acute respiratory tract infection from January 2006 to December 2007 were collected. The incidence of positive HI and the rate of resistance to different antibiotics were calculated and beta-lactamases of the strains were detected. Results About 4.4% of total 3 167 eases were infected with HI. The infection rate was related with season and sex, more frequent between February and June, more common in boys than girls. Children younger than three years old were likely to be infected by HI, eompared with other age groups. The beta-lactamase positive rate of HI was 31.4%. The resistance rates to ampicillin, SMZ + TMP, chloramphenicol, cefaclor, ceftazidime, tetracycline and ampicillin/sulbactam were 29.6% ～ 31.9%, 66.2% -73.9%, 19.7% ～ 15.9%, 2.8% ～ 14.5%, 2.8% ～0、 28.2% ～ 2.9% and 4.2% ～ 1.4% respectively. Isolates resistance to cefuroxime、 ceftriaxone、 imipenem、azithromycin and ciprofloxacin were not found. Conclusions The infection of HI in children with actue respiratory tract infection is closely related with season and sex in Suzhou. Children younger than three years old are at high risk. The beta-lactamase positive rate of HI was high and increased rapidly. Resistance rate to azithromycin, SMZ + TMP and chloramphenicol was high, some isolates were resistant to the second, third generation of cephalosporin. Monitoring the antibiotic resistance of H! should be emphasized.

Objective To understand the status and drug resistant patterns of strains of extended spectrum ?-lactamase(ESBLs) in children with lower respiratory tract infection,and to give clinical suggestions for rational treatment.Methods Escherichia coli and klebsiella pneumoniae were isolated from the 2 969 nasopharyngeal secretions which collected from lower respiratory tract of children in our hospital from Jan.2006 to Dec. 2007.Dual-sheets and sheets-diffusing method (K-B method) were used to determine the ESBLs and antibiotic susceptibility was tested by K-B method which included 18 kinds of antibiotics,the results were marked by resistant,intermedial and sensitive.Chi-square test was used to analyze the data.Results Total 135 strains were detected,73 strains were escherichia coli,of which 54 strains(74.0%)produced ESBLs,62 strains were klebsiella pneumoniae,of which 33 strains(53.2%)produced ESBLs.The 2 bacterias were found more in children with 1-6 months old than those in other age groups,the ratio of which were 50 strains and 41 strains,respectively (Pa0.05).The resistant rate of ESBLs-producing strains to penicillins,cephalosporins,quinolones,aminoglycosides and sulfamido was higher than that of non ESBLs-producing strains respectively.And the resistant rates to beta-lactam antibiotics of ESBLs strains were located on a high level.Whether producing ESBLs or not,the 2 bacterias were still sensitive to amikacin,cefoxitin,cefoperazone/sulbactam and imipenem.Conclusions The prevalences of ESBLs-producing escherichia and klebsiella pneumonia were high.There was a multi-drug resistance to the varied antibiotics.It is very important to make sputum culture and use sensitive antibiotics in treatment according to drug sensitivity test to control the occurrence and conveying of the ESBLs.

Child, Preschool ; Dwarfism ; congenital ; diagnosis ; Humans ; Male ; Osteochondrodysplasias ; congenital

Accidents, Occupational ; statistics & numerical data ; Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Hand Injuries ; epidemiology ; etiology ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Young Adult

Objective To observe the efficacy and safety of sorafenib in the treatment of the unresectable hepatocellular carcinoma.Methods According to the inclusion criteria,33 patients with the unresectable hepatocellular carcinoma were given sorafenib (400 mg for twice per day).During the course of treatment,dose was adjusted based on the degree of the adverse effects.Tumor response to sorafenib and safety was assessed every 6-8 weeks using the modified RECIST criteria.The survial curve for the time to progression (TTP) and overall survival (OS) were estimated.Results In this series,there was no patients achieved complete response (CR) and partial response (PR),1 1 patients were evaluated as with stable disease(SD),22 patients were with progressive disease (PD).The median TTP was 5.6 months (2.3-8.9 months).The median TTP was longer in patients with BCLC B than BCLC C stage.TTP was longer in good than in poor performance status patients,and shorter in extrahepatic metastasis than in no extrahepatic metastasis patients.The overall incidence of adverse events was 75.8％.The most common adverse events were hand foot skin reaction,diarrhea,hypertension and rash.Three patients had grade 3 adverse events.Conclusions Sorafenib can extend the median time to progression in patients with unresectable hepatocellular carcinoma.Patients with earlier stage of HCC and better performance status are hopeful for more positive response to the treatment of sorafenib.

Objective To establish a method of analyzing total uranium and 235U/238U ratio in urine using inductively coupled plasma mass spectrometry (ICP-MS) and uncertainty assessment.Methods Urine sample was digested with HNO3 and H2O2,and total uranium was determined using ICP-MS method directly.The digested urine sample was separated to concentrate uranium with tributyl phosphate (TBP) column,and 235U/238U ratio was analyzed using ICP-MS.The uncertainty was evaluated through sample pre-treatment,measurement and standard curve calculation.Results The recovery of total uranium in urine was 98.4％-102.4％,detection limit was 0.002 μg/L.The relative expanded uncertainty of total uranium concentration in urine was 0.26 (k =2).235 U/238 U ratio was 0.001 1 (k =2).Conclusions This study offers a low detection limit,good recovery and precision method for rapid determination of total uranium and 235U/238 U ratio in urine samples.It is potential used for both in occupational exposure assessment and nuclear emergency situation.The uncertainty evaluation of total uranium and 235U/238U ratio in urine are reliable.

Objective To observe the effects of extracts of ginkgo leaves (EGL) on acute myocardial infarction, acute myocardial ischemia and blood hemorheology.Methods The effects of EGL on acute myocardial infarction were observed in dogs model induced by the ligation of anterior descending branch of left coronary artery; effects on acute myocardial ischemia were observed on rats model caused by intravenous injection of pituitrin and effects on blood hemorheology were observed in rabbits. Results EGL significantly reduced the myocardial infarction area, decreased the activities of lactate dehydrogenase and creatine phosphokinase in dogs, reduced the elevation of ST segment of electrocardiogram in rats with myocardial ischemia and decreased whole blood viscosity and plasma viscosity in rabbits. Conclusion EGL has protective effect against myocardial ischemic injury and can improve the parameters of blood hemorheology in rabbits. Its mechanism may be concerned with the reduction of the myocardial infarction area and infarction degree and the relief of acute myocardial ischemia.