Point-of-care testing(POCT)is a kind of testing technology that uses portable testing instruments to test and quickly report the detection results at the bedside of testing object.Critically ill children need bedside examination, diagnosis and treatment in time according to the changes of their condition because of their critical condition and rapid progress.Therefore, the application of POCT in pediatric intensive care medicine has developed rapidly.Blood purification technology and extracorporeal membrane oxygenation(ECMO)are important treatment methods for critically ill children, while POCT is a necessary technology and an important link in the management of extracorporeal circulation.In this review, the application of POCT in blood purification and ECMO therapy is summarized.

OBJECTIVE:To explore the effects and safety of dexmedetomidine combined with remifentanil on postoperative cognition and hemodynamics in patients underwent colon cancer surgery.METHODS:One hundred undergoing colon cancer sur gery in our hospital during Jun.2013-Apr.2016 were selected and divided into control group and observation group according to random number table,with 50 cases in each group.Control group was given Remifentanil hydrochloride for injection 2-4 μg/kg for anesthesia induction,with maintenance dose of 0.5-2 μg· kg/min;observation group was treated with Dexmedetomidine hydrochloride for injection 0.5 μg/kg and remifentanil 2-4 μg/kg for anesthesia induction,with maintenance dose of Dexmedetomidine hydrochloride for injection 0.4 μg·kg/h+Remifentanil hydrochloride for injection 0.5-2 μg·kg/min.MMSE score and the incidence of postoperative cognitive dysfunction (POCD) were observed in 2 groups 1,2,3 d after surgery,and the occurrence of ADR was record ed.RESULTS:The incidence of POCD in observation group 1,2,3 d after surgery were 16.0％,4.0％,6.0％,which was signifi cantly higher than 36.0％,12.0％,10.0％ of control group,with statistical significance (P＜0.05).There was no statistical significance in MMSE score between 2 groups 1,3 d after operation (P＞0.05).2 d after surgery,MMSE score of observation group was significantly higher than that of control group,with statistical significance (P＜0.05).There was no statistical significance in hemodynamic indexes,the incidence of ADR as blood pressure increasing,amyostasia,nausea and vomiting between 2 groups 1,2,3 d after surgery (P＞0.05).CONCLUSIONS:Dexmedetomidine combined with remifentanil can significantly improve postoperative POCD in patients underwent colon cancer surgery and have little effect on hemodynamics with good safety.

Objective:To explore the early clinical features and the prognostic factors of children with septic shock in PICU.Methods:A retrospective analysis was conducted at PICU of the Children′s Hospital, Capital Institute of Pediatrics from January 2016 to November 2018, totally 56 children diagnosed as septic shock were enrolled in the study.According to the prognosis of 28 days, the patients were divided into death group and survival group; according to the lowest pediatric critical score (PCIS) within 24 hours after admission to PICU, the children were divided into non-critical group (>80 points), critical group (70-80 points) and extremely critical group (<70 points). The clinical characteristics of early stage in each group were analyzed and compared.Results:Of the 56 children with septic shock, 32 were males and 24 were females, and the mean age was 12.0(1.0, 180.0) months.The overall mortality rate was 37.5%(21/56). The mortality of non-critical group, critical group and extremely critical group were 12.5%(2/16), 16.7%(1/6) and 52.9%(18/34), respectively.There were no statistically significant differences between survival group and death group in gender and age, PICU stay time, heart rate, mean arterial pressure at 1 hour and 24 hours, ventilator using and the duration of mechanical ventilation(all P>0.05). The vasoactive-inotropic score(VIS) at 6 hours and 24 hours of death group were significantly higher than those in survival group[19.0(5.0-29.5) vs.5.0(0.0-10.0), 22.5(3.5-43.8) vs.5.3(0.0-13.5)]. The scores of PCIS in death group were less than that in survival group(57.3±10.7 vs.72.8±12.0)( t=4.85, P<0.001). The lactate level in survival group before resuscitation was statistically lower than that in death group[1.8(1.3-2.8) mmol/L vs.4.5(2.4-8.4)mmol/L]( Z<-3.70, P<0.05). At 1 hour, 6 hours and 24 hours after treatment, fluid resuscitation volume in death group were markedly higher than that in survival group[1 hour: (41.8±5.8)ml/kg vs.(38.5±5.3)ml/kg, t=-2.22, P<0.05; 6 hours: (69.5±4.4)ml/kg vs.(59.9±3.5)ml/kg, t=-8.96, P<0.05; 24 hours: (122.3±19.6)ml/kg vs.(111.7±16.2)ml/kg, t=-2.20, P<0.05]. Multiple sample comparisons found significant differences between the non-critical group[(60.0±3.5) ml/kg] and the extremely critical group[(65.3±6.0) ml/kg, P<0.05], and pairwise comparison of fliud intake within 1 h and 24 h showed no statistically differences( P>0.05). In the univariate analysis, variables significantly associated with death in septic shock were lactic acid before resuscitation and the 24 h lactate clearance rate, VIS 6 h, VIS 24 h, procalcitonin, ejection fraction, PCIS, 6 h-fluid resuscitation volume and multiple organ dysfunction (MODS). The Logistic regression showed that 6 h-fluid resuscitation volume, PCIS, lactic acid and MODS were independent risk factors.ROC curve analysis showed the AUCs of 6 h-fluid resuscitation volume, PCIS, early lactic acid and MODS for predicting death of septic shock children were 0.947, 0.835, 0.797 and 0.761, respectively. Conclusion:The mortality of septic shock is high, and decreased PCIS, elected serum lactic acid level and early fluid resuscitation, and MODS are risk factors associated with the death of septic shock.

Cystectomy ; Female ; Humans ; Intrauterine Devices

Objective To explore the diagnosis and treatment of intrahepatic biliary cystadenoma and cystadenocarcinoma. Methods Eight patients with intrahepatic biliary cystadenoma and cystadenocarcinoma treated in our hospital were studied retrospectively. The clinical and pathological data were reviewed. Results Most of the patients had nonspecific symptoms and serum AFP level was normal. Uhrasonography and CT diagnosed correctly in 75% and 87.5% of all patients, respectively. All the 8 patients underwent resection and had no recurrence after operation except that 1 case of cystadenocarcinoma died of recurrence 3 years later. Conclusion The diagnosis of intrahepatic biliary cystadenoma and cystadenocarcinoma depends on radiography and pathological examination. Surgery is recommended to get satisfactory results.

Objective To explore the clinicopathological characteristics as prognostic factors in patients with colorectal signet-ring cell carcinoma. Methods Clinical data of 62 patients of colorectal signet-ring cell carcinoma and 281 patients of colorectal low-differentiated adenocarcinoma were retrospectively analyzed. COX Proportional Hazards Model was used in multivariate analysis. Results Colorectal signet-ring cell carcinoma occurred more frequently in young patients and most of them located in the rectum. Gender, preoperative CEA, pathological type and liver metastasis were not statistically different from low-differentiated adenocarcinoma (X2=0.07,0.04,0.06,1.79,P>0.05).Bowel obstruction, operative modalities, tumor embolism, infiltration depth, lymph node metastasis were statistically different from low-differentiated adenocarcinoma (X2=8.96,75.1,18.5,72.0,7.44,P<0.05). Median survival time was 28 months in patients of colorectal signet-ring cell carcinoma and 49 months in patients of colorectal low-differentiated adenocarcinoma. The difference was statistically significant (X2=12.51,P<0.05). Infiltration depth, lymph node metastasis, operative modalities and postoperative adjunctive therapy were independent prognostic factors based on a multivariate analysis of the COX Proportional Hazards Model. Conclusions The biological malignancy of colorectal signet-ring cell carcinoma is higher than that of low-differentiated adenocarcinoma in colorectal carcinoma. Radical resection and postoperative adjunctive therapy were effective treatment methods.

Objective To explore the clinicopathological features, diagnosis and therapy for pancreatic mutinous noncystic adenocareinoma(MNAC). Methods Eleven MNAC cases treated in our hospital were studied retrospectively. The clinical and pathologic data were reviewed. Results Of the 11 patients, 6 were male and 5 were female. The age ranged from 47 to 76 years with average of 60. 5 years.The main complains included upper abdominal discomfort in 8 cases, abdominal mass in 1 case and jaundice in 2 cases. CA199 serum test was positive in all patients and 5-fold high above normal value in 6 cases. The preoperative radiography of MNAC was usually not specific. Tumors located in the head in 5 cases and in the body and tail of the pancreas in 6 cases. The diameter of the tumor was 4 - 11 cm with average of 6. 5 cm.All cases underwent operation, with radical resection in 2 cases. Liver or abdominal metastasis was found in 5 cases. Postoperative immunohistochemistry showed that MUC-1 was negative in all patients. MUC-2,PCNA and Ki-67 were positive in all patients. All 9 cases that were followed-up died within 5 -22 months,with an average survival time of 10 months. Conclusions The diagnosis of MNAC depends on pathology. Its prognosis is poor.

Objective To explore the clinical diagnosis and management of hepatecellular adenoma(HA). Methods Seventeen HA cases treated in our hospital from Janurary 1986 to June 2007 were studied retrospectively.The clinical and pathologic data were reviewed. Results Of 17 patients,9 were male and 8 were female with median age of 46 years.None of the female patients had a history of oral contraceptives.Most patients were agymptomatic.Preoperative liver function test and AFP serum test were normal.Preoperative imaging study yielded deftnite diagnosis in only a fraction of patients.All 17 cases underwent surgical resection and the postoperative course is uneventful.All cases were followed up ranging from 6 to 252 months.Recurrence was not found.Pathology reported atypical hyperplagia in 2 cases and with malignant transformation in 1 case. Conclusions The diagnosis of HA is exclusive and dependent on clinical data,laboratory test and radiography.HA has a tendency to malignancy.Surgery is recommended in all cases.

Objective To explore the prophylactic effect of methylprednisolone combined with granisetron on postoperative nausea and vomiting.Methods Two hundred patients scheduled for lumpectomy of breast were randomly divided into four groups with 50 cases each.The patients in group M1 received a pre-anesthesia intravenous doses of methylprednisolone 25 mg,the patients in group M2 were injected methylpredsisolone 25 mg repeatedly four hours later,in group D received a pre-anesthesia doses of dexamethasone 5 mg,in group N normal saline 2 ml.All the four groups of patients received granisetron 3 mg intravenously at the end of surgery.The incidence of nausea and vomiting in the 24 hours were observed.Results The PONV incidences of group M1,M2,D,N were 36%,18%,38% and 58%.Both group M1,M2 and D significantly decreased the total inci-dence of PONV (P <0.05)in the 24 h.The incidence of PONV was significantly lower in group M2, compared with group M1 and group D respectively (P <0.05).Conclusion Methylprednisolone-gran-isetron combination is as equally effective as dexamethasone-granisetron combination for preventing PONV in lumpectomy,but repeated methylprednisolone after 4 h is more effective than dexametha-sone and single-used methylprednisolone.