Objective To compare the sedative efficacy with oral or rectal chloral hydrate in pediatric patients by using Meta-analysis method.Methods Ten randomized controlled trials about the sedative efficacy with oral or rectal chloral hydrate in pediatric patients were retrieved.Meta-analysis was carried out using the RevMan 5.0 software.Results The results showed that the sedative efficacy with rectal medication was better than that with oral way.Nausea and vomiting occurred in 95 children with oral chloral hydrate,bowel movement occurred in 57 children with rectal chloral hydrate.Conclusions The sedative efficacy with rectal chloral hydrate was better than that with oral way.The safety in pediatric sedation with chloral hydrate should be emphasized in order to avoid adverse reaction.

Objective:To investigate the effects of hydrogen rich-saline (HRS) on intestinal mucosal barrier in rat with intestinal ischemia/reperfusion injury (IIRI).Methods:Twenty-four healthy male Sprague-Dawley rats, aged 8 weeks, were randomly divided into 3 groups (8 in each group) by random number table method: sham group, model group and HRS group.Rats in HRS group were intraperitoneally injected with HRS (10 mL/kg) at 30 min of ischemia, and the same amount of normal saline was intraperitoneally injected in model group.After 45 min of ischemia and 6 h of reperfusion, rats were sacrificed.Serum and ileum were collected for further detection.Tumor necrosis factor alpha (TNF-α), interleukin (IL)- 1β and IL-17A expression levels in serum were detected by conducting enzyme-linked immunosorbent assay (ELISA). The localization expressions of tight junction protein Occludin was detected by immunohistochemical staining (IHC), while the localization expression of tight junction protein zonula occluden-1 (ZO-1) were detected by immunofluorescence staining (IF). The protein expression of Occludin, ZO-1, and Lysozyme were detected by performing Western blot.The mRNA expression of Lysozyme and α-defensin were detected by real-time PCR (qPCR).Results:ELISA results proved that the levels of serum TNF-α and IL-1β in HRS group rats were significantly lower than those in model group [(62.02±29.97) ng/L vs.(113.40±44.58) ng/L, (21.68±0.35) ng/L vs.(28.29±3.49) ng/L], while the level of IL-17A increased [(28.18±5.28) ng/L vs. (15.10±3.60) ng/L] (all P<0.05). IHC staining: compared with model group, the expression of Occludin in HRS group was uniform and continuous, and the staining was darker.IF results: compared with model group, the fluorescence signal intensity of ZO-1 in HRS group rats significantly increased, and the distribution was clear and continuous.Wes-tern blot results: compared with model group, the expression levels of Occludin and ZO-1 proteins in HRS group rats remarkably increased (0.79±0.06 vs. 0.54±0.04, 0.91±0.11 vs. 0.51±0.13), while Lysozyme protein decreased (1.50±0.40 vs. 2.99±0.80) (all P<0.05). qPCR results revealed that the expression level of Lysozyme mRNA in HRS group rats was lower than that in model group (1.64±0.33 vs. 2.20±0.40), while α-defensin mRNA obviously increased (0.82±0.19 vs. 0.47±0.13) (all P<0.01). Conclusions:HRS protects intestinal mucosal barrier by inhibiting the expression of tight junctions and the secretion of antimicrobial peptides in rat suffering from IIRI.

The accuracy of the Sepsis-3 definition in the diagnosis of sepsis has been widely accepted and applied. Indicators such as Procalcitonin(PCT), white blood cell(WBC), C-reactive protein(CRP), platelets(PLT) and albumin are the most extensively and conveniently applied in early alert and diagnosis of urinary sepsis. PCT has a higher specificity and sensitivity compared to other biomarkers, and a sharp drop in WBC is a strong warning for septic shock. However, CRP has a relatively low specificity. IL-6, CD64, Presepsin, miRNA, and PTX-3, among others, are more valuable emerging indicators with higher sensitivity and specificity. However, uniform and standardized technology is necessary for a high quality testing. The combination of multiple biomarkers with a clinical scoring system is more useful than individual biomarkers clinically. This article mainly reviewed the progress of research on indicators related to early alert and diagnosis of urinary sepsis during recent years.

Objective To evaluate the clinical characteristics and the clinical outcomes of perianal abscess (PA) in neonates.Methods A retrospective review was performed on the collected data of 185 patients of PA in neonates prospectively admitted to Binzhou Medical University Hospital from January 2008 to December 2015.Patients were divided into 2 groups on the parents' intention:nonsurgical treatment and surgical treatment,the standard surgical treatment for PA was incision and drainage with the use of packing.The standard surgical treatment for PA was surgical incision drainage of lower abscess under local anesthesia by the use of filling tamponade iodoform gauze,while the patients receiving conservative treatment took hip bath perianally with topical 1 ∶ 5 000 potassium permanganate,besmearing erythromycin eye ointment outside locally.Incision-thread-drawing procedure was recommended in fistula-in-ano (FIA) after 6 months.Antibiotics were administered in all patients in the early days.The clinical data of age,gender,accompanying diseases,abscess amount and location,treatment approach,healing time and recurrence rates were analyzed with statistical method.Results All patients were boys,time of visiting hospital was 1-25 day,the average time 7.5 days;60 cases (32.4％)had neonatal diarrhea,45 cases (24.3％)had neonatal jaundice,but no patients had severe fever.A single skin lesion was present in 145 patients (78.4％),2 lesions in 30 patients (16.2％),and 10 patients had 3 lesions (5.4％).The most commonly affected sites were at 9 o'clock clockwise direction with 115 (62.2％)lesions on lithotomy position,followed by 3 o'clock clockwise direction with 65(35.1％) lesions by 1 o'clock clockwise direction with 3 (1.6％) lesions and 6 o'clock clockwise direction with 2 (1.1％) lesions.Bacteria cultures were obtained from 123 patients (90.4％,123/136 cases) of surgical treatment and 35 patients (71.4％,35/49 cases) of nonsurgical treatment obtained the results of bacteria culture.The average healing time was (21 ±2) days (10-60 days) in the surgical treatment group,and (36 ± 3) days (9-90 days) in the nonsurgical treatment group,7 out of 136(5.1％) patients had a recurrence with surgical treatment,incision drainage was performed again with the use of packing,and FIA was not found,10 out of 49 (20.4％) patients had a recurrence with nonsurgical treatment group,and 6 out of 49 (12.2％) were spontaneously resolves within the first year of life,4 out of 49 (8.1％) developed into FIA,incision-thread-drawing procedure was performed after 6 months.The significant difference was observed between and nonsurgical treatment and surgical treatment in healing time (t =-6.707,P =0.000),recurrence (x2 =11.347,P =0.001) and FIA formation rate (x2 =10.054,P=0.002).Conclusions PA is an entity in neonates.Incision and drainage of PA is an effective and safe therapy in the early days.Surgery for PA may result in low recurrence rates,a low rate of evolution toward FIA,and a short healing time,which should be considered as the primary treatment.The key procedure is to keep the drainage unobstructed by the use of filling gauze drainage to prevent crissum abscess recurrence.Postoperative care with antibiotics is effective to shorten hospital stays.

Objective:To study the relationship of pathogenic bacteria in midstream urine culture and stone composition of patients characteristics with infection stones.Methods:Between January 2016 and December 2020, 989 patients with infectious stones who attended Tsinghua Chang Gung Hospital, affiliated with Tsinghua University, for surgical treatment were enrolled in the study. There were 545 male and 444 female patients, with the mean age (48±14) years. The left and right side stones were 396 and 333, respectively. There were 260 bilateral stones, 264 single stones, 334 multiple stones, and 391 deer-stalker-shaped stones. The maximum diameter of stones was (33.4±26.5)mm, combined with diabetes in 109 cases and hypertension in 235 cases. Clean middle-urine was collected for bacterial culture, and intraoperative stone specimens were collected by percutaneous nephrolithotomy (PCNL). Personal characteristics of the patient such as gender, age, body mass index, clinical information such as stone size, location, comorbidities, results of urine culture and stone composition were recorded. The differences of infectious stone composition was analyzed between urease-producing, non-urease-producing bacteria.Results:Among the 989 patients with infectious stones, 259 were pure infectious stones, 131 were mixed infectious stones, and 599 were combined with infectious stone components. Urine cultures were positive in 627(63.4%) patients with infectious stones. The predominant urease-producing bacteria included Ureaplasma urealyticum(94 case), Proteus mirabilis(58 case), and Staphylococcus spp.(36 case). Pure infectious stones were common in Proteus mirabilis, while combined with infectious stone components were common in Ureaplasma urealyticum and Staphylococcus spp. The predominant non-urease-producing bacteria included Escherichia coli(175 case), Enterococcus spp.(76 case) and Streptococcus spp.(35 case). Escherichia coli commonly contained in infectious stone components and pure infectious stones, whereas Enterococcus spp. and Streptococcus spp. commonly contained in infectious stone components. Escherichia coli (61 case), Proteus mirabilis (44 case) and Enterococcus spp.(20 case) were the most common bacteria in 259 cases of pure infectious stones. Escherichia coli (36 case), Enterococcus spp. (14 case) and Ureaplasma urealyticum (10 case) were the most common bacteria in 131 cases of mixed infectious stones. The most common bacteria in 599 cases of combined infectious stones were Escherichia coli (78 case), Ureaplasma urealyticum (68 case) and Enterococcus spp. (42 case).Conclusions:Urease producing bacteria were not common in infectious stones. It was common for the Ureaplasma urealyticum in combined infectious stone components, while Escherichia coli was common in pure and combined infectious stone components.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.