Critically ill patients often undergo endotracheal intubation to facilitate mechanical ventila-tion in in tensiv e cra e unit.As these patients er coev r,r espiratory support is gradually reduced until the patient can breathe unadi ed and the endotracheal tube can be removed.There are some complications during the en-dotracheal intubation.Some of them are life-threatening.Such complications might lead to a prlo onged stay in intensive care unit,additional costs,potential morbidity,and mortality.In this article,we wi ll talk abotu two special rp oblems during endotracheal inut bation.

Pediatric severe sepsis and septic shock is one of leading causes of death in PICU.Although antibiotics and comprehensive treatments have continuous improvements,its mortality rate is still high.Present study confirms early goal-directed therapy can significantly reduce the mortality of severe sepsis and septic shock.The purpose is to introduce the early goal-directed therapy protocol and to guide Chinese pediatrician to improve outcome of pediatric severe sepsis and septic shock and increase the survival rate in clinical practice.

OBJECTIVE:To establish the Second-order Derivative UV-spectrophotometry for the determination of transdermal osmolality of metoprolol tartrate (MP)in vitro.METHODS:The quantitation of the vibration amplitude (?A)between the characteristic valley and the characteristic peak of MP appeared at 224nm and 234nm in UV-scanning.RESULTS:The linear concentration range of metoprolol tartrate was 5～60?g/ml,the average recovery was 98.89%with average RSD at 2.05%.CONCLUSION:This method can accurately determine the transdermal osmolality of MP in vitro yet without the interference of skin exudates,its operation is simple and fast and the results are accurate and reliable.

The hypothalamo-pituitary-adrenal (HPA) axis modulates the inflammatory response during sepsis.Macrophage migration inhibitory factor (MIF) is a unique cytokine and critical mediator of host defenses in sepsis and septic shock.MIF counteracts the anti-inflammatory activity of glucocorticoid (GC).The interaction of GC and MIF might cause adrenal insufficiency.MIF could be a valuable clinical marker of adrenal insufficiency in sepsis.

Objective To explore the relationship between the type of TORCH infection and pregnancy outcome through the de-tection of TORCH infection in pregnant women with IgG avidity index (AI) .Methods Collected each type of TORCH pathogens IgM positive maternal serum ,and detect the IgG avidity index and track the outcome of pregnancy .Results The rate of TORCH pathogens recent infection (AI<30% )in pregnant women ,HSV ,RUB ,CMV ,TOXO respectively were 0 ,3 .8% ,9 .3% ,7 .9% ;In the group of pregnant women with TORCH-IgG AI<30% ,there were 2 cases of pregnancy outcome of abnormal (missed abortion) and one case of fetal malformations (hydrocephalus) .Conclusion In the recent infection of TORCH pathogens in pregnant women , mainly are non-primary infection ;The damage of cytomegalovirus and Toxoplasma gondii primary infection to the fetus is much larger than the non-primary infection .

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 assess revascularization and vessel anastomosis in digital replantations with DSA.MethodsTwelve cases of digital replantations underwent digital subtract angiography during 2 to 4 days after fingers reattachment. The vessel anastomosis,hemodynamics,stenosis and discontinuation were investigated.The unobstructed and smooth anastomosis was suggested as early stage survival of the reattached fingers,the spasm and stenosis of the reattached vessels were considered as mild vascular crisis,and the discontinuation of hemodynamics were indicated as severe vascular crisis.ResultsThe total 27 vessels were clearly displayed on DSA.Of these vessels,23 vessels were unobstructed and smooth,all digits were survived.Diagnosis coincidence of early stage survival was 100%(23/23). Two vessels were obstructed,which were testified having thrombus by operation research.The other 2 vessels were spasm,the digits were also survived ultimately by expectant treatment.All 4 abnormal vessel anatomosis were found by DSA.Conclusion DSA is important modality in assessing revascularization and blood circulation for digital replantations,guiding in dealing with the vascular crisis,and in predicting early stage survival of the reattached digits.

Objective To understand the changes of schistosomiasis epidemic situation,so as to provide the evidence for for?mulating schistosomiasis control strategy in the Hexi reservoir area. Methods From 2012 to 2015,Xinyuan Village,Meishan Town in the north entrance of Hexi reservoir was selected as a monitoring site. According to the requirements of the monitoring program of schistosomiasis surveillance in Zhejiang Province,the Schistosoma japonicum infection was investigated by using the serological screening(IHA),and the basic situation of the surveillance site was also investigated. Results From 2012 to 2015,167 environments(21.68 hm2)were surveyed,and 2 slices(0.1 hm2)were found with Oncomelania hupensis snails. The detection rate of frames with snails was 0.12%,and the living snail density was 0.0192 snails per 0.1 m2. Totally 374 snails were dissected and no schistosome infected snails were found. A total of 970 local residents and 8 748 mobile people were investigated with the serological tests,and no schistosome infected people were found. In addition,3 085 cattle were investigated and no in?fected ones were found. Conclusion The schistosomiasis epidemic situation is stable in the Hexi reservoir area,but we still should strengthen the monitoring of imported source of infection and snail status,and increase the efforts of environmental trans?formation.

Objective To explore the safety and therapeutic efficiency of continuous renal replacement therapy(CRRT) without anticoagulation for critically ill children with high risk of bleeding.Methods We retrospectively analyzed 51 patients undergoing bedside CRRT in the PICU of our hospital from December 2007 to July 2015.Patients were divided into two groups induding CRRT with anticoagulation(n=33) or without anticoagulation (n=18).The therapeutic efficiency and complications were compared between two grous.Results Totally 168 CRRT circuits were performed in these 51 patients including 62 (36.9％)circuits without anticoagulation in 18 patients with high risk of bleeding and 106(63.1％) with anticoagulation by heparin.The circuits life of CRRT without anticoagulation was (12.31±6.64) h,which was shorter than that of CRRT with anticoagulation [(17.43±9.97)h] (P＜0.001).The levels of blood creatinine,blood urea nitrogen,C-reactive protein,and lactate significantly improved after both therapies (P＜0.05).PT and APTT did not change in CRRT without anticoagulation for hemorrhagic complications(P＞0.05).APTT[(52.36±5.00)s vs.(76.48±9.02)s,P=0.013] and PLT[(127.3±20.85)×109/L vs.(95.52±15.46)×109/L,P=0.041]were significantly longer in CRRT with anticoagulation by heparin compared with those before treatment.Conclusion CRRT without anticoagulation reduces bleeding risks and achieves an acceptable circuit life.The strategy can be applied as an alternative to critically ill children at high risks of bleeding who need continuous blood purification.

BACKGROUND: The dramatic increase in use of the IgG test for toxoplasma, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV) [TORCH] has led to the requirement for a high-efficiency method that can be used in the clinical laboratory. This study aimed to compare the results of BGI-Array ELISA TORCH IgG (BGI-GBI, China) screening method to those of Virion/Serion TORCH IgG ELISA (Virion/Serion, Germany). METHODS: Serum specimens (n=400) submitted for routine IgG testing by Virion/Serion ELISA were also tested using the BGI-Array ELISA method. The agreements of these two kinds of method were analyzed by kappa-coefficients calculation. RESULTS: Following repeat testing, the BGI-Array ELISA TORCH IgG assays demonstrated agreements of 99.5% (398/400 specimens), 98% (392/400 specimens), 99% (396/400 specimens), and 99.5% (398/400 specimens), respectively. The BGI-Array ELISA IgG assays provided results comparable to Virion/Serion ELISA results, with kappa-coefficients showing near-perfect agreement for the HSV (kappa=0.87), rubella (kappa=0.92) and CMV (kappa=0.93) and substantial agreement for the toxoplasma (kappa=0.80) IgG assays. The use of the BGI-Array ELISA TORCH IgG assays could reduce the turnaround time (1.5 hr vs. 5 hr by Virion/Serion ELISA for 100 specimens) and were easy to use. CONCLUSIONS: BGI-Array ELISA TORCH IgG shows a good agreement with Virion/Serion ELISA methods and is suitable for clinical application.
Antibodies, Viral/blood ; Cytomegalovirus/immunology/*metabolism ; *Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin G/*analysis/blood ; Protozoan Infections/diagnosis ; Reagent Kits, Diagnostic ; Rubella virus/immunology/*metabolism ; Sensitivity and Specificity ; Simplexvirus/immunology/*metabolism ; Toxoplasma/immunology/*metabolism ; Virion/*immunology/metabolism ; Virus Diseases/diagnosis