Objective To study the relationships between the level of blood glucose in critical ill children with the degree of critical illness and the variation of immunoreactive insulin (IRI) and true insulin (TI).Methods Fiftyeight children form the Neonatal Intensive Care Unit (PICU) and Department of Respiration were enrolled in this study.The children were divided into PICU group (42 cases) and control group (16 cases).The PICU group were scored pediatric critical score in 24 hours after admission.The 42 critical ill children were divided into stress hyperglycemia group (20 cases) and non-stress hyperglycemia group (22 cases) according to their blood glucose levels.The IRI,TI,C-Peptide and blood glucose were measured.Results The pediatric critical illness score of stress hyperglycemia group [(74.80 ± 8.07) scores] was significantly lower than that of non-stress hyperglycemia group [(84.36 ±9.46) scores] (t =1.964,P ＜ 0.05).The death rate of stress hyperglycemia group (45.0％,9/20 cases) was significantly higher than that of non-stress hyperglycemia group (13.6％,3/22 cases) (x2 =5.05,P ＜ 0.05).The IRI,TI and C-Peptide of stress hyperglycemia group were significantly higher than those of non-stress hyperglycemia group and control group(F =136.90,61.25,45.89,all P ＜ 0.05).The TI/IRI of stress hyperglycemia group was significantly lower than that of non-stress hyperglycemia group and control group (F =27.64,P ＜ 0.05).The TI,IRI and C-Peptide of stress hyperglycemia group were higher than after admission (t =2.241,2.087,2.014,all P ＜ 0.05).Conclusions The children with critical illness have stress hyperglycemia and the component of insulin is changed,and the absolute level as well as the rate of TI and TI/IRI are descended.

Objective To explore the efficacy and safety of clinical application of bronchofibroscope (BFS) in PICU. Methods Seventy-nine critically ill children in our PICU were operated with BFS in 89 cases and the etiology of these children was analyzed. The blood-gas analysis and oxygenation index both before and after the treatment had been compared, and syndrome was observed as well. For 40 cases in which critically ill children received bronchoalveolar lavage in addition to mechanical ventilation, and the index of respiratory mechanics was analyzed. Analysis and summary had been performed on the culture results of bronchoalveolar lavage fluid in 74 cases. Results The primary disease in these cases was mainly respiratory diseases (64/79). There was no major change in oxygenation index and blood pH ( P ＞0. 05 ) before and after operation with BFS. No severe syndrome,such as sudden cardiac arrest and pneumothorax, was recorded. However,transient decrease in SpO2 was most frequently observed in minor syndromes (15/79). The children treated with mechanical ventilation were recorded with significant decrease in air way resistance ( P ＜ 0. 05 ) after bronchoalveolar lavage. However,dynamic compliance and work of breathing only changed slightly (P ＞0. 05 ). The culture positive rate of bronchoalveolar lavage fluid was 29. 1% (23/79) ,mainly gram-negative bacteria, which coincided with disease spectrum of PICU. Conclusion The application of BFS in PICU can improve salve and tracheobronchial management for critically ill children. The diagnosis and treatment is safe and reliable by strictly grasping the examination indication by BFS under the custody of PICU.

ObjectiveTo study the causes and risk factors of childhood accidental injuries as a reference for prevention.MethodsA retrospective analysis was made on the clinical data of 4 116 cases of childhood accidents admitted to children's hospital of Fudan university from Jan 1,2005 to Aug 31,2009.ResultsThe 4 116 cases with accidental injuries were found to account for 4.35 ％ (4 116/94 579) of all inpatients during the same period.Ratio of male to female was 2.01∶ 1.The most common causes of injury were accidental falls (30.73％,1 265/4 116),traffic accidents (23.71％,976/4 116) and accidental drops (11.59％,477/4 116).Accidental falls were mainly seen in children over one year,traffic accidents mainly occurred in children aged four to seven,while the accidental drops were mainly seen in infants less than oneyear-old.The top three causes of accidental injury with highest mortality rate were airway foreign body,drowning and poisoning.Bone and joint injuries were mostly seen in accidental injury.ConclusionAccidental injury of children has been a serious threat to the lives of children and we should base on the characteristics of children to take preventive measures.

PurposeTo study the changes of serum nitric oxide(NO)and endothelin(ET)levels by L-Arg therapy in acute hypoxic model. MethodsNADPH diaphorase histochemical staining method, Griess biochemical assay and radioimmune assay were applied to investigate the changes of nitric oxide synthase (NOS) ,NO, cGMP and ET in normal, hypoxic and L-Arg treated hypoxic rats. Resultsduring acute hypoxia, while serum ET rose up significantly, both the levels of serum NO and cGMP and the activity of NOS were significantly lower. After the application of L-Arg therapy, the activity of NOS did not change significantly, but the levels of serum NO and cGMP rose up significantly, and the level of serum ET was to the opposite direction. ConclusionsNO and ET may modulate hypoxic pulmonary hypertension, and acute hypoxia can result in acute hypoxic pulmonary hypertension. L-Arg can reverse the acute hypoxic hypertension.

ObjectiveTo investigate the influence on efficacy and quality of life of amisulpride in schizophrenia with predominantly negative symptoms.MethodsSeventy cases of schizophrenia with predominantly negative symptoms were randomly assigned to amisulpride group and clozapine group for 12weeks.The clinical efficacy and side effects were evaluated with SANS,BPRS and TESS before and 1,2,4,8,12 weeks after treatment respectively. GQOLI-74 were used to evaluate the patients' quality of life before and after drug administration.ResultsFor the last assessment,the score of BPRS decrease to 30.68 ±4.62 in amisulpride group,was significantly lower than the beginning(P＜0.01 ) ; the score of BPRS decrease to 31.31 ±4.78 in clozapine group,was significantly lower than the beginning (P ＜ 0.01 ).Two groups showed similar effects,with no significance.12weeks after treatment,the scores of emotional dull,poverty of thought,volition abulia,interest-social lack,attention dysfunction in amisulpride group were 12.31 ± 4.43,9.66 ± 3.07,8.91 ± 2.56,10.29 ± 2.68,5.58 ± 1.43 ; and the scores of emotional dull,poverty of thought,volition abulia,interest-social lack,attention dysfunction in clozapine group were 14.62 ± 4.27,9.32 ± 2.81,8.22 ± 2.60,9.54 ± 2.67,6.62 ± 1.59,and the efficacy of amisulpride in emotional dull and attention dysfunction were better than those of clozapine.And the scores of material life,physical function,psychological function,social function in amisulpride group were not higher than those in clozapine group(P＞ 0.05).And the scores of four domains in GQOLI-74 had been improved significantly in two groups(P＜0.01).The domains of physical function,psychological function,and social function in amisulpride was superior to clozapine(P＜0.01).The side effects were more in clozapine group than those in amisulpride group.ConclusionAmisulpride is as effective as clozapine for the treatment of schizophrenia with predominantly negative symptoms,but it has more advantage than clozapine to improve emotional dull,attention dysfunction and quality of life in schizophrenia with predominantly negative symptoms.

Objective To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing. Methods PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence. Results A total of 276 PLWHA were surveyed,According to the evaluation criterion of Center for Adherence Support Evaluation (CASE),252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking,progress of the disease and side effects,reminding of taking drug and age were correlated with self-reported HAART adherence. Conclusion It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young,suffer from side effects,have no reminding methods for taking drug.

OBJECTIVETo study the effect of thrombelastography (TEM) in the diagnosis of disseminated intravascular coagulation (DIC) in children.

METHODThe data of 117 children suffering from DIC in the pediatric intensive care unit (PICU) and Cardiologic ICU (CICU) in the authors' hospital from January 2010 to June 2012 were collected. Ninety-four children without DIC were enrolled into the control group. The platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimers and TEM were determined. The sensitivity and specificity of TEM were measured and the relevance of TEM and DIC was investigated to evaluate the effect of TEM and the conventional tests of the coagulation system in the diagnosis of DIC in children.

RESULTThe average R reaction time in the DIC group was significantly longer than that in the control group[(13.3 ± 3.3)s vs. (4.5 ± 2.6)s, P = 0.000 5], and the average α-angle in the DIC group was smaller than that in the control group significantly (37.2° ± 1.4° vs. 55.6° ± 3.8°, P = 0.001 0). There was significant decrease in the maximal amplitude (MA) and amplitude (A) in the DIC group, compared with the control group. The OR value (95%CI) of the R reaction time,α-angle and MA was 3.538 (1.298-5.389), 2.472 (1.820-2.224) and 0.256 (0.263-0.831) respectively, which suggests good correlation with the existence of DIC (all P < 0.01). The specificity of R reaction time, α-angle and MA was higher than that of PT, APTT and D-dimers (85.7%, 73.5% and 72.9% vs. 27.0%, 42.1% and 68.2%) . The average R reaction time of children suffering from hemorrhage of severe liver disease(n = 36) was significantly longer than that of 40 healthy children [(9.2 ± 2.7) vs. (2.3 ± 1.8)s, P = 0.001 0], while the α-angle (42.8° ± 7.6° vs. 59.2° ± 10.8°, P = 0.040 0) and the MA value [(33.9 ± 5.1) vs.(56.0 ± 8.1) mm, P = 0.020 0] were significantly smaller. The average R reaction time of children suffering from congenital coagulopathy was significantly longer than that of healthy children [(6.8 ± 3.1) vs. (2.3 ± 1.8)s, P = 0.003 0], too.

CONCLUSIONTEM, which has high specificity, is beneficial to the diagnosis of DIC in children.

Blood Coagulation ; Case-Control Studies ; Child ; Child, Preschool ; Critical Illness ; Disseminated Intravascular Coagulation ; blood ; diagnosis ; Female ; Fibrin Fibrinogen Degradation Products ; analysis ; Humans ; Intensive Care Units ; Logistic Models ; Male ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; ROC Curve ; Sensitivity and Specificity ; Thrombelastography

OBJECTIVETo understand the incidence of drop out of antiretroviral therapy (ART) in people living with AIDS/HIV and related factors in Nanjing, Jiangsu province, and Yuncheng, Shanxi province.

METHODSRetrospective cohort analysis was conducted. The cumulative incidence curves of drop out of ART, mortality and drug withdrawal were drawn with Kaplan-Meier method. The related factors were identified with Cox proportional hazards regression model.

RESULTSA total of 1 006 patients were included in Yuncheng, the median length of ART follow-up was 49.59 months (QR: 20.02-92.84), and 976 patients were included in Nanjing, the median length of ART follow-up was 19.93 months (QR: 11.48-34.07). The cumulative incidence of drop out of ART at 3 months, 6 months, 1 year, 2 years, 4 years, 8 years after ART was 8.19%, 9.23%, 11.08%, 13.75%, 17.74%, 27.66% in Yuncheng, and 3.01%, 5.17%, 7.47%, 10.97%, 17.45%, 28.72% in Nanjing respectively. Age, marital status, infection route, baseline CD4 cell count, the clinical stage classified by WHO at the end of the observation were correlated with the drop out of ART.

CONCLUSIONIn order to reduce the drop out of ART among people living with AIDS/HIV, it is necessary to conduct effective interventions targeting the patients with young age, the patients who divorced/widowed, the patients who were intravenous drug users, the patients with higher CD4 cell count at the beginning of ART and clinical stage III or IV at the end of the follow-up and increase the coverage of HIV test.

Acquired Immunodeficiency Syndrome ; drug therapy ; Anti-Retroviral Agents ; administration & dosage ; CD4 Lymphocyte Count ; China ; Communicable Diseases ; Humans ; Incidence ; Medication Adherence ; Proportional Hazards Models ; Retrospective Studies

OBJECTIVETo understand the economic burden caused by antiretroviral treatment for people living with HIV/AIDS and influencing factors in Nanjing.

METHODSPeople living with HIV/AIDS were divided into two groups, HIV infected patients and AIDS patients. The data about their direct medical expenditure, direct non-medical expenditure and indirect economic loss in the past year were collected. Univariate and multivariate analysis were conducted to identify the potential influencing factors.

RESULTSThe median of direct medical expenditure and total costs for 133 HIV infected patients were 1,200 yuan RMB and 1,972 yuan RMB respectively. The median of direct medical expenditure and total costs for 145 AIDS patients were 1 060 yuan RMB and 2 826 yuan RMB respectively. The differences in direct medical expenditure and total costs between HIV infected patients and AIDS patients showed no statistical significance. The results from univariate analysis indicated that the sample source influenced total costs significantly. Multivariate analysis showed that onset time and CD level were negatively correlated with direct medical expenditure. The patients infected through heterosexual contact had more direct medical expenditure than those infected through homosexual contact. The patients receiving HIV test in hospitals had more direct medical expenditure than those receiving volunteer counseling and testing.

CONCLUSIONFurther efforts should be made to expand HIV testing and treatment coverage in order to detect HIV infections as early as possible. Early antiretroviral treatment should be given to HIV infected patients to maintain their immunity and reduce their medical expenditure.

Acquired Immunodeficiency Syndrome ; drug therapy ; economics ; Anti-Retroviral Agents ; economics ; therapeutic use ; China ; Cost of Illness ; Counseling ; HIV Infections ; drug therapy ; economics ; Health Expenditures ; statistics & numerical data ; Heterosexuality ; Humans ; Mass Screening ; Voluntary Programs