1.Characteristics and evaluation of acute liver failure in children
Chinese Pediatric Emergency Medicine 2012;(6):560-563
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.
2.The assessment of sedation and analgesia in critical children
Chinese Pediatric Emergency Medicine 2014;21(2):79-83
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.
3.Colonization and infection of multidrug-resistant organisms
Chinese Pediatric Emergency Medicine 2012;19(4):349-351
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.
4.Effect of scene simulation-based teaching on pediatric advanced life support training in medical students
Quan WANG ; Hengmiao GAO ; Suyun QIAN
Chinese Pediatric Emergency Medicine 2016;23(2):103-106
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.
5.Significance of human papillomavirus for the diagnosis precancerous cervical diseases
Qian DU ; Yongli DENG ; Quan ZHANG
Medical Journal of Chinese People's Liberation Army 1983;0(05):-
normal morphology + cervicitis).
7.HIP BONE MINERAL DENSITY IN VARIOUS BODY POSITIONS AND REGIONS OF INTEREST
Quan ZHANG ; Qian DU ; Ying ZHANG
Medical Journal of Chinese People's Liberation Army 1981;0(04):-
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.
8.Application of airway pressure release ventilation in severe pneumonia-related acute respiratory distress syndrome in children
Zheng LI ; Suyun QIAN ; Quan WANG ; Xinlei JIA ; Jun LIU
Chinese Journal of Applied Clinical Pediatrics 2015;30(17):1347-1349
Objective To investigate the effects of airway pressure release ventilation (APRV) in children with severe pneumonia-related acute respiratory distress syndrome(ARDS).Methods Ten children suffering severe pneumonia-related ARDS with APRV were included in Pediatric Intensive Care Unit, Beijing Children's Hospital,Capital Medical University from March 2011 to October 2014.Ventilation variables, changes of airway pressure and Ramsay scores were collected and compared with that in conventional ventilation (CV).Clinical variables were measured at CV before APRV and at 1,4,12,24 hours after transition to APRV.Results High airway pressure(Phigh) at each time point during APRV was significantly lower than peak airway pressure (Ppeak) or plateau airway pressure (Pplat) in CV[(26.00 ±2.94) cmH2O(1 cmH2O =0.098 kPa) ,(24.40 ±3.34) cmH2O,(23.30 ±3.46) cmH2O,(23.00 ± 3.80) cmH2O vs (31.80 ± 5.59) cmH2O, P < 0.01].Mean airway pressure (Pmean) at each time point during APRV was significantly higher than that in CV [(23.00 ± 2.86) cmH2 O, (21.69 ± 3.12) cmH2 O, (20.89 ± 3.31) cmH2 O, (20.46 ± 3.48) cmH2 O vs (17.50 ± 2.37) cmH2 O, P < 0.05].Fraction of inspired oxygen (FiO2) were significantly decreased at 4, 12 and 24 hours after APRV than that in CV [(73.00 ± 22.39) %, (63.50 ± 20.16) %, (63.00 ± 21.11) % vs (88.00 ± 15.49) %, P < 0.05].Ramsay scores were significantly decreased at each time point during after APRV than that in CV [(3.90 ± 0.74) scores, (2.90 ± 0.88) scores, (3.00 ± 1.15) scores,(3.50 ± 0.71) scores vs (4.60 ± 0.52) scores, P < 0.05].Conclusions Compared with CV, APRV had a lower Phigh and FiO2 ,a higher Pmean and more shallow sedation.APRV may be an effective ventilation mode in children's severe pneumonia-related ARDS.
9.Outcome follow-up and reason analysis in long PICU stay patients
Yeqing WANG ; Suyun QIAN ; Xiaohui WANG ; Quan WANG ; Boliang FANG
Chinese Pediatric Emergency Medicine 2015;22(8):548-553
Objective To analyse the reasons for patients′long PICU stay and to discuss how to de-crease their PICU stay length and optimize medical resource utilization.The another objective is to identify these patients′long-term outcome.Methods We retrospectively analysed the basic information of patients who stayed in our PICU more than 30 days during January 1,2013 to July 31,2014,including pediatric criti-cal illness score on admission,primary diseases and outcome on discharge,in order to determine main reasons for their long PICU stay.Follow-up prognosis was made by Paediatric Overall Performance Category.We used SPSS 19.0 to do data analysis.Results Sixty-seven patients enrolled in this study included 43 boys and 24 girls,49.2%of whom came from emergency department.The median age was 24 months(IQR 8,108), while median length of PICU stay was 39 days(IQR 31,49).Mean pediatric critical illness score on admi-ssion was 78.39 ±9.57.Mean hospital fees was(144 071.74 ±76 944.74)Yuan.Thirty(44.8%)patients did not have any medical insurance.Top three primary diseases were respiratory disease(30 cases),neurolog-ical disease(8 cases)and systemic infection(6 cases).Top three underlying diseases were tracheostenosis or bronchopulmonary dysplasia(6 cases),congenital heart disease(5 cases)and immunodeficiencies(4 cases). Top three complications were respiratory failure(30 cases),multiple organ dysfunction or failure(16 cases), shock(9 cases).Top three reasons for longer PICU stay were weaning off mechanical ventilation difficulty (29 cases),department or hospital transference difficulty(20 cases),feeding difficulty(16 cases).Fifty-four patients were discharged with better health condition,10 patients were auto-discharge.The mortality at dis-charge,1 month after discharge,3 months after discharge and 6 months after discharge were 4.5%,20.9%, 25.4% and 25.4%,respectively.Total 36(53.7%)patients had a good or mildly abnormal Paediatric Over-all Performame Category score(1-2 points)at 6 months after discharge.Conclusion Sequential noninvasive ventilation,timely tracheotomy,timely patients′transference to general ward,development of family ward and rehabilitation wards,appropriate nutrition delivery,regularly difficult disease consultation,reduction of hospi-tal infection and complications may do contribution to shorten these patients′length of PICU stay.Children who survive longer than 3 months after discharge have better long-term prognosis.
10.Effect of Jiaotai Pills on Hypothalamic Orexin A and Gamma-aminobutyric Acid in Sleep Deprivation Rats
Shijian QUAN ; Mengmeng JIAO ; Shangyan HEI ; Lili QIAN
Journal of Guangzhou University of Traditional Chinese Medicine 2015;(1):103-105
Objective To observe the effect of Jiaotai Pills ( JP) on hypothalamic neurotransmitters of Orexin A and gamma-aminobutyric acid ( GABA) in rapid eye movement ( REM) sleep deprivation rats. Methods Rat model of REM-sleep deprivation was established by water small platform method. The rats were randomized into 6 groups, namely normal control group, model group, Diazepam group (3 mg/kg), and high-, medium-and low-dose JP groups ( JP in the dosage of 18.6, 9.3 and 4.6 g/kg respectively) . Enzyme-labeled instrument was used to detect the absorbance ratio of rat hypothalamic Orexin A content, and high performance liquid phase electrochemical detection method was adopted for the detection of hypothalamic GABA content. Results Compared with the normal control group, all of the rats in the model group suffered from insomnia, and the Orexin A content was increased ( P<0.05) . Compared with the model group, insomnia in rats of high-, medium- and low-dose JP groups was markedly relieved, and Orexin A was decreased (P<0.05) . The difference of GABA was insignificant between model group and JP groups (P>0.05) . Conclusion The sedative and hypnic mechanism of JP is probably related with the inhibition of hypothalamic Orexin A.