Acute liver failure (ALF) is rare in children but carries high mortality.It can progress to multi-organ failure and death.The etiology,clinical manifestations,diagnosis and prognosis of pediatric acute liver failure (PALF) are different from that of adults,and vary with age.The classic adult symptoms are often absent in children and the clinical encephalopathy may not be present.Children correctly diagnosed with well-characterized causes of PALF may benefit from the early implementation of directed medical therapies.Early recognition,diagnosis,and identification of prognostic factors will help in optimizing treatment and selecting patients for liver transplantation or artificial support,and improved their survival chances.

Nearly every patient admitted into PICU is administered sedation and analgesia therapy.The precise control of the depth of sedation and the intensity of pain are often not well managed.Inappropriate treatment will cause more adverse effects.Self-assessment is considered the gold standard in pain rating,other complementary methods being the behavioural measures and the biological measures,that reflect the body's answer to pain.There is a growing need for reliable and valid sedation and pain instruments that can easily be incorporated into daily care.There are many methods for assessing pain and sedation in critical children,but none is completely accepted as an objective measure or suitable for all ages of children.The clinicians should choose appropriate assessment tools and even combine different tools according to the environment,condition and the characteristics of patients.

There are much more multidrug-resistant organisms (MDRO) in the intensive care unit than ever.If the doctors could distinguish the colonization from infection of MDRO,they can make right decision on the rational clinical use of antibiotics to reduce resistant organisms and nosocomial infection.However,it's a confused problem for clinicians to distinguish between colonization and infection.Bacterial culture combined with clinical symptoms and signs maybe helpful,but it is limited.There should be more objective indicators.This article was aimed to state the definition and relationship between colonization and infection,and how to determine the colonization and infection of MDRO.

0 05). It is suggested that: ①When foot brace fixed the femur at inward rotation of 0?, 15?and then 15? after moving body position, and ROI was near the neck, BMDs of the neck and the trochanter were not affected in either of the three positions, with femoral neck with highest BMD; ②When BMD value of the femoral Ward′s triangle is taken as the index, it is better to take the mean of 3～5 scannings at one position.

Child ; Continuous Positive Airway Pressure ; Humans ; Pediatrics

Objective To assess the effect of scene simulation-based teaching on pediatric advanced life support(PALS)skills in medical students.Methods The students of two grades of Department of Pedi-atrics in Capital Medical University participated in the PALS training.All of them had the examination of the-ory and skills of critical illness management and cardiopulmonary resuscitation in children before and after the scene simulation-based teaching on PALS.The questionnaire was filled out and the data was analyzed after the training.Results Fifty-one students completed the training.The average score after the training was sig-nificantly higher than that before the training(86.51 ±7.16 vs.53.85 ±14.24,P ﹤0.05).After the training, the error rate of ECG recognition,etiological identification and treatment of the disease,and the dosage as well as usage of medicine was significantly decreased (64.7% vs.15.7%,71.0% vs.10.5%,73.2%vs.25.9%).All of the students could use the defibrillator correctly and the students'satisfaction rate was more than 94%.Conclusion Scene simulation-based teaching on PALS skills can improve the theory and skills of critical illness management and cardiopulmonary resuscitation of children in medical students.

normal morphology + cervicitis).

Objective To study the clinical features of invasive pneumococcus disease (IPD) with resistance to antimicrobial agents in children,and to improve the diagnosis and treatment of this disease.Methods The clinical data from 21 IPD patients younger than 13 years old were collected from January 2008 through December 2010 in Pediatric Intensive Care Unit in Beijing Children's Hospital for retrospective analysis. Specimens of blood,pleural effusion,cerebrospinal fluid and soft tissue aspirated were collected from these children,and 23 strains of streptococcus pneumonia (SP) were cultured,isolated and confirmed,and the antibiotics susceptibility to penicillin and other antibiotics of these strains were assayed.Results Among the 21 IPD children,the ratio of male to female was 0.9∶1,and the age was 5 months to 13 years,with 61.9％ of them under 2 years.Of them,12 patients (57.1％ ) had purulent pleurisy,and 1 (4.8％ )patient had an underlying disease diagnosed to be X - linked agammaglobulinemia (XLA).There was no seasonal difference in the occurrence rate of this disease. Eight (38.1％) patients were cured,11(52.4％ ) were improved,while 2 (9.5％ ) patients not improved without death.There was no statistically significant difference in the annual detection rate of invasive SP (x2 =3.711,P =0.156).The incidences of penicillin-intermediate susceptibility SP (PISP) and penicillin-resistant SP (PRSP) were 47.8％ and 26.1％ respectively.The rate of resistance to multiple antibiotics was 91.3％.Conclusions Children aged less than 5 years,especially younger than 2 years,are prone to IPD,and purulent pleurisy and septicemia are often seen in this disease. Some patients had the underlying diseases.The complications included hemophagocytic syndrome,acute respiratory distress syndrome,septic shock,bronchial pleural fistula and so on.The multidrug resistance rate was 91.3％.It is important to put great emphasis on the monitoring antibiotics resistance to invasive pneumococcal disease.

Objectives To learn the effect of self-recognition-based healthy management on community diabetics. Methods A total of 40 community diabetics were evaluated and trained for 3 months.SPSS11.5 software was used for data analysis. Results At 3 months, some risk factors of diabetes,including body weight, body mass index (BMI), waist circumstance (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP) and 2 h postprandial blood sugar (PBS), were improved (P ＜0. 05). Male patients showed statistically significant reduction in body weight, BMI and WC ( P ＜ 0. 05 ).However, female subjects were found to have significant decline in body weight, BMI, WC, SBP and DBP (P＜0. 05). Those ＞60 year-old had significantly decreased body weight, BMI, WC, SBP, DBP and 2 h PBS ( P ＜ 0. 05). Lower levels of WC, SBP and triglyceride were seen in individuals ＜ 60 year-old ( P ＜0. 05 ). Conclusion Self-recognition-based healthy management could effectively reduce diabetic risk factors and prevent the development of diabetic complications.

Objective: To observe the effect of mild moxibustion on cancer-related fatigue, serum ghrelin and adiponectin in patients undergoing chemotherapy after colorectal cancer surgery. Methods: Seventy patients were divided into a control group and an observation group according to the random number table method, with 35 cases in each group. Patients in both groups were treated with conventional FOLFOX4 chemotherapy regimen. Patients in the control group also received routine treatments such as symptomatic treatment of complications, health education, nutritional support, and exercise intervention. Patients in the observation group received mild moxibustion on the basis of interventions used in the control group. The Piper fatigue scale-revision (PFS-R), Karnofsky performance status (KPS) and spleen and kidney yang deficiency syndrome were scored, and serum ghrelin and adiponectin levels were measured before and after treatment. Results: After treatment, total score of PFS-R in the control group did not change significantly (P>0.05), while in the observation group it was significantly reduced (P<0.05) and lower than that in the control group (P<0.05); KPS scores in both groups were increased (both P<0.05), and it was significantly higher in the observation group than in the control group (P<0.05); total score of spleen and kidney yang deficiency syndrome in the control group did not change significantly (P>0.05), while it was significantly reduced in the observation group (P<0.05) and lower than that in the control group (P<0.05); serum ghrelin and adiponectin levels in the control group had no significant changes (both P>0.05), but the levels were significantly increased in the observation group (both P<0.05) and higher than those in the control group (both P<0.05). Conclusion: Based on the routine treatments, mild moxibustion can relieve fatigue, improve quality of life, and improve the symptoms of spleen and kidney yang deficiency in patients undergoing chemotherapy after colorectal cancer surgery, which may be related to the regulation of serum ghrelin and adiponectin levels.