Objective To determine the vitamin D status in children with sepsis/severe sepsis in pediatric intensive care unit (PICU) in order to explor the association between vitamin D status and clinical outcomes,in turn to provide evidence for optimizing nutrition support.Methods It was a prospective,observational,multi-center study,carried out in patients with sepsis/severe sepsis from March 1,2013,to March 30,2014,in the PICUs of three tertiary-care children's hospitals.Total serum 25-hydroxy vitamin D [25 (OH) D] was measured by using an enzyme-linked immunosorbent assay at admission.The association of vitamin D status at admission with length of PICU length of stay,total hospital stay,in-hospital mortality,28-days mortality and costs were analyzed.Results A total of 194 patients includng 117 boys (60.3％)and 77 girls (39.7％) were enrolled.There were 96 patients with sepsis and 98 with severe sepsis.The mortality on discharge and 28 days were 6.7％ and 24.2％ respectively.The median vitamin D level was 9.79 ng/mL (5.32,18.46) at admission.Of them 77.8％ (151/194) had vitamin D deficiency and 50.5％ (98/194) had severe vitamin D deficiency.Patients with severe vitamin D deficiency,had higher mortality on discharge (P =0.011).Vitamin D status had no significant correlations with 28 days mortality,length of PICU stay,total hospital stay and costs.Conclusions More than three-quarters (77.8％) of children with sepsis/severe sepsis in PICUs had Vitamin D deficiency.Patients with severe vitamin D deficiency at admission had higher risk of mortality at discharge.

China ; Critical Care ; trends ; Pediatrics ; trends

Obejective To explore the effect of combined use of dexmedetomidine and ultra-low dose naloxone on postoperative hyperalgesia induced by remifentanil. Method 80 ASA gradeⅠ-Ⅱ female patients who were scheduled to perform endoscopic sinus surgery (ESS) were randomly divided into four groups: purely remifentanil group (group R) and remifentanil plus different dosage dexmedetomidine and ultra-low dose naloxone group (group RDN1 ~ RDN3). Then the postoperative VAS on 30 min, 1 h, 2 h, 4 h, 8 h, 12 h and 24 h together with the firstpostoperative pain time , PCA press numbers , fentanyl usage and adverse reaction rate were recorded and evaluated. Results Average VAS of group R are higher than other groups in all 7 time points at the adjusted significant level of 0.0083, and group R > group RDN1 > group RDN2 > group RDN3, while differences between group RDN2 and RDN3 in all time points are not statistical significant.There is no difference between group RDN1 and group RDN2 inthe first postoperative pain time and the PCA press time at 1h after operation. Difference between group RDN2 and group RDN3 in the PCA press time at 24 h after operation was not significant, and the fentanyl usage of RDN groups are significantly less than group R. Conclusions Combined use of dexmedetomidine and ultra-low dose naloxone induced by remifentanil can improving patients′postoperative hyperalgesia , effect increase with the dose of dexmedetomidine increas , and the increasement is more sensitive in acute pain.

Objective To explore the impact of sulfentanyl on sufentanil epidural block during abdominal panhysterectomy. Methods 90 patients scheduled for panhysterectomy were randomly divided into three groups. Tthe control group received epidural administration of 1% ropivacaine of 0.2 mL/kg after 2% idocaine of 3 mL , while the study group 1 received 10μg sufentanil and the study group 2 received 20μg sufentanil in addition to the medications used in the control group. The anesthetic effect, changes in vital signs, and incidence of adverse reactions were compared among the three groups. Results In group S1 and group S2, the onset of epidural anesthesia was faster , time to the highest plane of sensory blockade and time to degree 3 in the Bromag scores were faster , duration of sensory blockade was longer , and OAA/S score was better , as compared with group D , with significant statistical significances (P<0.01);and the effect was better in group S2 than in group S1. There was no difference among the three groups in adverse reactions. MAP , HR and SPO2 were lower in groups S1 and S2 than in group D during the procedure, with a statistical difference (P<0.05). Conclusions Proper dose of sufentanil plays a positive role in ropivacaine epidural block during panhysterectomy , not only increases the onset of anesthesia, but also makes the anesthestic effect better, and has higher safety It is worth popularizing clinically.

Objective To review multi-center experience on rescue use of extracorporeal membrane oxygenation(ECMO) in pediatric patients with respiratory failure and to investigate its short-term outcome in China.Methods The survey was conducted in 4 tertiary hospitals in China mainland.All children<18 years old who had been supported with non-open chest ECMO to rescue respiratory failure in PICU were reviewed.Results Twenty-one patients with ECMO support were diagnosed respiratory failure.Male was 14,female was 7.Twelve patients successfully weaned off ECMO, 8 patients survived to discharge and 13 died.The largest part of protopathy was severe pneumonia(33%)and acute respiratory distress syndrome(29%).Their mean age was 29.0(9.0,81.5)months, mean weight was 12.0(9.0,20.8)kg,and mean OI index was 31.5(19.2,41.0).The average length of ECMO run was 149.0(91.2,242.0)hours.The blood gas analysis showed that PO2 increased from 49.5(40.4,61.9)mmHg(1mmHg=0.133kPa) at the beginning to 65.0(42.6,120.5)mmHg at 24h after ECMO treatment,and the increase of PO2 was higher in the survival compared with the nonsurvival[52.0(1.8,89.4) mmHg vs.8.2(-15.1,33.9) mmHg,P=0.036].The SO2 increased from 80.0%(70.4%,91.8%)at ECMO initiation to 98.0%(95.6%,100%)at 24h after ECMO treatment,and increase of SO2 was higher in survival group compared to that of nonsurvival group[23.5%(11.4%,27.1%) vs.4.3%(2.4%,23.8%),P=0.039].VV mode had higher survival rate than VA mode(3/3 vs.5/18).The longer the use of ventilator before ECMO,the mortality rate increased as well.The mechanical ventilation time before ECMO was significantly longer in nonsurvival group than that in the survival group[4.5(2.5,12.0)h vs.1.6(1.0,2.2)h,P=0.015].The most common complications during ECMO run were bleeding and disfunction of oxygenator.Conclusion ECMO is an effective support treatment for the pediatric patients with respiratory failure,which significantly improves oxygenation.

Tumor metastasis is one of the important biological characteristics of malignant tumor,which is closely related with the prognosis of the cancer patients.High expression of ADAM8 in varieties of tumors was revealed in many recent studies,and such aberrant expression played a crucial role in regulating of tumor metastasis.Studies showed that overexpression of ADAM8 attenuated the intercellular adhesion effect,promoted tumor angiogenesis,and enhanced the degradation of ECM as well as the releasing of cytokines.Therefore,suppression of ADAM8 may lead to inhibition of tumor metastasis,which makes ADAM8 a particular attractive target as it can be used as a prognostic indicator and a potential therapeutic target of malignant tumor.A review about the relations between ADAM8 protein′s abnormal expression and tumor occurrence was discussed in this paper,also include discussion about the mechanisms of ADAM8 protein′s disorder-induced tumor formation,as well as therapeutic strategies based on ADAM8-targeted,which may provide references for follow-up research and clinical treatment.

Objective To evaluate the relationship between the change of the aortomitral angle (AMA) with left ventricular systolic function in patients with ischemic cardiomyopathy (ICM) by echocardiography.Methods Thirty-one patients were enrolled in the ICM group,and 59 healthy subjects were selected as the control group.On the parasternal left ventricular long axis plane,AMA were measured at the R wave apex (R-AMA),J-point(J-AMA),ST-segment midpoint(ST-AMA),T-final wave (T-AMA)and P-final wave (P-AMA).The angle difference(⊿ θ) =AMAmax-AMAmin,the angle changing rate =⊿ θ/AMAmax.The global left ventricular longitudinal strain (GLS) and global circumferential strain (GCS) were obtained by 2D-speckle tracking echocardiography.Left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV) and left ventricular end-systolic volume(LVESV) were measured using Simpson biplane method.Results The J-AMA was the largest in the control group,while the ST-AMA was the largest in the ICM group.The levels of LVEDV,LVESV and AMA in ICM group were significantly higher than those in control group,while LVEF,GLS,GCS,⊿ θ/AMAmax and ⊿ θ were decreased (P ＜0.05).In the control group,there was a correlation between T-AMA and LVEF (r =-0.349,P =0.007),and ⊿ θ was negatively correlated with GLS (r =-0.372,P =0.004).In the ICM group,⊿1 θ/AMAmax and ⊿ θ were correlated with LVEF (r =0.424,P =0.018;r =0.490,P =0.005).Conclusions AMA in ICM patients is significantly increased.The angle difference and the rate of its change are closely related to the LVEF,which is a manifestation of three-dimensional structure change of the myocardial.

Objective To summarize the clinical features and technical key points on brain death during decision-made process in children with suspected brain death.Methods Twenty-four coma children with Glasgow coma scale score 3 and no spontaneous respiration were collected from May 2015 to February 2017 in Beijing Children's Hospital,Capital Medical University to make the brain death determination.All children received at least one confirmatory test.According to the Chinese standards for determining brain death (pediatric),all patients were divided into brain death group and non-compliance group.The clinical features were analyzed.The sensitivity,specificity,false positive rate and false negative rate of electroencephalogram (EEG),short latency somatosensory evoked potential (SLSEP) and transcranial Doppler sonography (TCD) were calculated.Results Among these 24 cases,there were 16 males and 8 females,aged 5.6 (2.0,8.8) years old.Ten cases met the criteria of brain death.Twelve (50％,12/24 cases) cases received autonomic breathing test.A total of 25 tests were conducted,of which 21 were successful.The completion rates of EEG,TCD and SLSEP were 100.0％ (24/24 cases),83.3 ％ (20/24 cases) and 54.2％ (13/24 cases),respectively.EEG had the highest sensitivity (100％) and specificity (79％).SLSEP had good sensitivity (100％),but the specificity was only 40％.The combination of EEG with SLSEP had the highest specificity and sensitivity,both of which were 100％,and the false positive rate and false negative rate were 0.Conclusions The key to determine brain death successfully is to make adequate preparations,to receive formal training and to apply standard operation.In the determination of brain death in children,EEG has a good sensitivity and specificity in single confirmation test,which is the priority item.The combination of EEG with SLSEP is the most advantageous.

The study on tumor metabolism has been gradually be-come a hot spot in recent years .A lot of proteins involved in the regulation of tumor metabolism especially the glucose transporter protein 1(GLUT1).As a key regulatory factor mediating energy metabolism within tumor cells , GLUT1 can regulate the glucose intake and maintain the basic level of metabolism in tumor cells . More importantly, the abnormal expression of GLUT1 was asso-ciated with many kinds of tumors , of which GLUT1 was used to meet the energy requirement for the fast growth of tumor .Thus GLUT1 also played a crucial role in growth , differentiation and metastasis of tumor cells and prognosis of tumors .Meanwhile , as three-dimensional crystal structure of GLUT 1 was determined , it is possible to design the small molecular inhibitors of GLUT 1, which can realize “starve to death” tumor cells.GLUT1 can be a particularly attractive target for tumor treatment and interfer-ence.The relationship between abnormal expression of GLUT 1 protein and tumor metabolism was reviewed . Moreover , the mechanism of tumor metabolism regulated by GLUT 1 protein ex-pression and treatment of cancers were discussed , which may provide references for future research and clinical treatment .

Objective:To investigate the electrocardiographic characteristics of left and right ventricles origin of premature ventricular contractions(PVCs) during V3 transition of precordial leads, right ventricular outflow tract (RVOT) anterior septum and right coronary sinus (RCC), and RVOT middle-posterior septum and left coronary sinus (LCC).Methods:From January 2017 to September 2019, 91 patients with ventricular extrasystole of outflow tract who had V3 transition in precordial lead and had successful radiofrequency ablation in RVOT anterior septum, middle posterior septum, LCC and RCC were selected for retrospective case control study.The electrocardiography measurements of PVCs were compared between the anteroseptal RVOT group and RCC group, as well as the middle-posterior septal RVOT group and the LCC group, respectively.The measurements included the R-wave amplitude in lead Ⅰ, Ⅱ, Ⅲ and aVF, R amplitude ratio in leads Ⅲ to Ⅱ, Q-wave amplitude in lead aVL and aVR, Q amplitude ratio in leads aVL to aVR, R-wave and S-wave amplitude from leads V1 to V3, the V2S/V3R index, the transition zone index, and the V2 transition ratio.Results:Thirty-six cases originated from the anteroseptal RVOT, and 11 from the LCC.Lead I R-wave amplitude in anterior septal RVOT was higher than LCC group((0.22±0.25) mV vs.(-0.17±0.33) mV; P=0.003). R-wave amplitude in lead Ⅱ was lower than that in the LCC group((1.59±0.35) mV vs.(1.76±0.27) mV; P=0.035). R-wave amplitude in lead aVF was lower compared with the LCC group((1.53±0.35) mV vs.(1.78±0.39) mV; P=0.050). The V2S/V3R index showed a significant difference between these two groups(1.99±0.66 vs.0.76±0.38; P<0.001). The V2 transition ratio also appeared a significant difference between the two groups(0.69±0.43 vs.1.05±0.35; P=0.005). PVCs arose from the middle-posterior septal RVOT in 32 cases, and from the RCC in 12 cases.Compared with RCC group, lead Ⅰ R-wave amplitude showed lower ((0.25±0.31) mV vs.(0.57±0.12) mV; P<0.001); R amplitude ratio in leads Ⅲ to Ⅱ higher (0.89±0.14 vs.0.72±0.18; P=0.002); Q amplitude in lead aVL((0.72±0.24) mV vs.(0.51±0.16) mV; P=0.002)higher, and Q amplitude ratio in leads aVL to aVR higher in the middle-posterior septal RVOT(0.76±0.23 vs.0.50±0.21; P=0.002). Conclusion:Among the cases with lead V3 transition, PVCs originated from the anteroseptal RVOT show significantly different R wave in lead Ⅰ, Ⅱ, aVF, V2S/V3R index, and the V2 transition ratio compared with those from the LCC.The PVCs from the middle-posterior septal RVOT and the RCC have different R wave in lead Ⅰ, R amplitude ratio in leads Ⅱ and Ⅲ, Q amplitude ratio in leads aVL and aVR.Combined with its different characteristics, it can help to identify the origin of left and right ventricles.