Objective The purpose of this study was to evaluate the importance of the interhospital transport of critically ill pediatric patients by analyzing the epidemic characteristics of pediatric patients transported from 2009 to 2012.Methods Nine thousand two hundred and thirty-one referral patients from January 2009 to June 2012 were evaluated by a cross-section study.Epidemiological data such as sex,age,seasons,and referral radius were collected.Results Among all the interhospital transport of critically ill pediatric patients,male to female ratio was nearly 2.24 to 1 and 87.39％ (8067/9231) patients were neonates and infants.Of all patients,66.32％ (6122/9231) patients were from department of pediatrics,neonatology or gynaecology and obstetrics in referring hospitals.The distribution of referring department among years was statistically significant in referring patients (x2 =227.53,P ＜ 0.000 1).Among the patients,56.88％ (5251/9231) were transported over 150km radius and only 12.18％ (1124/9231) patients in 50 km.52.89％(4882/9231) were transported in spring and winter.The seasonal distribution of interhospital transport of critically ill pediatric patients was statistically significant(x2 =1201.88,P ＜0.000 1).The majority of referral telephones were received between 9 AM to 12 AM.Conclusion With the limitation of equipment and technical measure in primary hospitals,critically ill pediatric patients should be transported to tertiary hospitals.According to the epidemiological characteristics of interhospital transport of critically ill pediatric patients,some measures should be adopted for the timely,safe and effective interhospital transportation.

OBJECTIVE: This study was to investigate the clinical symptoms, characterization of imaging technique and the effect of endonasal endoscopic surgery. METHOD: Following 38 cases of isolated sphenoid sinus disease patients, among whom 35 cases treated with nasal sinus CT (including 5 cases of MRI at the same time), 3 cases undergoing sinus MRI, 1 cases going through the CT cisternography. All patients underwent endoscopic sphenoid otomy, of which 33 cases underwent nasal olfactory cleft approach, 5 cases anterior ethmoid sinus and posterior ethmoid sinus approach (Messerklinger technology). RESULT: All patients were followed up for more than half a year, of which 34 were recoverd and 4 were improved. No obvious complications came up during or after endoscopic surgery. CONCLUSION Isolated sphenoid sinus disease clinical symptoms are not typicaland without specialty; nasal examination had no positive sign, only with headache as the chief neurological symptom, often difficult to diagnose at an early stage. The CT and MRI are the best methods for the diagnosis of isolated sphenoid sinusitis. The nasal endoscopic operation is the preferred method for treatment of this disease.
Adolescent ; Adult ; Aged ; Child ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paranasal Sinus Diseases ; diagnosis ; surgery ; Retrospective Studies ; Sphenoid Sinus ; Treatment Outcome ; Young Adult

Objective To investigate the effects of propofol on the release of noradrenaline ( NE) from the locus coeruleus in the brain of rabbits trying to elucidate the central mechanism of the cardiovascular inhibition induced by propofol.Methods Nine healthy male New Zealand rabbits weighing 2.0-2.5 kg were used in this study. A trocar (0.8 mm in diameter) was inserted into locus coeruleus using the stereotactic technique and fixed. Four days later push-pull perfusion of the brain was performed. 37℃ artificial cerebrospinal fluid (aCSF) was infused through the trocar at 0.1 ml?min-1 . A loading dose of propofol 2 mg?kg-1 was given i.v. followed by continuous infusion at 150 ?g?kg-1?min-1 for 30 min. The experiment was concluded at 20 min after propofol infusion. The perfusate having passed through the locus coeruleus was collected before and every 10 min during and after infusion. The NE concentration of the perfusate was measured by high performance liquid chromatography. Results The NE concentration of the perfusate from locus coeruleus significantly decreased after the loading dose and during the infusion of propofol and reached its bottom level at 10 min after loading dose. The maximal decrease was 75.5% [from (15.9 ? 3.2) pg??l-1 to (3.9?0.5) pg ? ?l-1]. Conclusion Intravenous propofol decreases the NE concentration in locus coeruleus. The cardiovascular inhibition induced by propofol may partly be explained by this central mechanism.

Objective To establish case database of critical illness and explore the effect of critical case-based learning in the anesthesia teaching program as well as its influence on clinical thinking ability of students. Methods Case database of critical illness was built with foxtable software and ASAⅢ~Ⅴpatients undergoing anesthesia were included in the case database. Patients' information were recorded according to the sequence of pre-operative evaluation,intra-operative management and post-operative recovery. We designed a student questionnaire to investigate the effect of critical case-based learning. And we also compared the effect of critical case-based learning and traditional teaching on undergraduate interns, residents, and graduate students by scores of case analysis test. Data analysis used t test. Results The critical cases database is characterized by authenticity, hierarchy and for-wardness. Survey result of questionnaire shows that the proportions of students who believe critical case-based learning helps to strengthen the links of theory and clinical practice, to improve expression skills, and to promote active classroom atmosphere, solidarity and cooperation are 80%, 71.6% and 68.3%respectively. Compared with those who received traditional teaching, the residents and graduate students who received critical case-based learning get significantly higher scores in case analysis test. However, the difference of scores between undergraduate interns receiving traditional teaching or criti-cal case-based learning has no significance. Conclusion The establishment of critical cases database and its application in anesthesia teaching program have effectively improved clinical thinking ability of anesthesia residents and graduate students.

Objective To evaluate the mode of referral by response time for inter-hospital transfer of critically ill pediatric patients,and subsequently some measures taken for minimizing the response time in referral process.Methods A total of 9231 patients (≤14 years) transferred from primary hospital were included in a cross-section study.Information about age,sex,referral radius,the seasonal variation for inter-hospital transport of critically ill pediatric patients,time of referral telephone call and response time were collected.All computations were performed using the Statistic Package for Social Sciences for Windows version 18.0.Differences between groups were assessed by x2 tests or Wilcoxon test or Kruskal-Wallis for categorical data.Results Among all critically ill pediatric patients for the inter-hospital transfer,male to female ratio was 2.24:1,and the majority of patients were neonates and infants.Median retrieval mobilization time was 30 min (interquartile range,20-50 min).This study has demonstrated that referral time,age categories,referral radius,different years and seasons were associated with response time.Conclusions With the improvement of technologies and management mechanism,the response time was apparently minimized since the beginning of interhospital transportation.But there is still plenty of room for shortening rsponse time compared with advanced Westem countries.

Objective To investigate the adrenal histopathology damage in critically ill non-survival children,and the incidence of adrenal damage,and to explore the risk factors for the adrenal hemorrhage and necrosis in critically ill children.Methods A total of 141 critically ill non-survival children was admitted in this study in Hunan Children's Hospital from January 1,2005 to December 30,2012.Clinical data in children were systematically collected,including age,sex,sodium,potassium,blood gas analysis,liver and kidney function,blood clotting function,etiology,treatment and pediatric clinical illness score (PCIS) or neonatal critical illness score (NCIS),and pathological data.All data were analyzed by SPSS 18.0.Results Logistic regression analysis showed the factors of adrenal hemorrhage and necrosis of critically ill non-survival children were sepsis,PCIS score ＜ 80 critically ill children are risk factors for adrenal hemorrhage necrosis (P ＜ 0.05),ORwas 3.659 (95％ CI:1.344-9.965),and 2.325 (95％ CI:1.028 -5.258).Intravenous corticosteroids were protective factors for critically ill non-survival children with adrenal hemorrhage necrosis (P ＜ 0.05),and ORwas 0.377 (95％ CI:0.163-0.875).Conclusions There were two significant risk factors of adrenal hemorrhage and necrosis:sepsis and critical illness score less than 80 points.Intravenous corticosteroid is a protective factor in critically ill children.

Objective To analyze the clinical features of critically ill children with abnormal pancreatic ultrasound findings in order to explore the related risk factors for offering evidence-based diagnosis of pancreatic damage secondary to critical illness.Methods A prospective study was performed in 531 critically ill children admitted to pediatric intensive care unit(PICU) of 17 children' hospitals from January 2012 to March 2014.All patients were divided into control group(513 cases) and abnormal group(18 cases) according to the pancreatic ultrasound findings.Comparison of clinical features and biochemical indicators were made between two groups.The related risk factors associated with abnormal pancreatic ultrasound findings were analyzed by using Logistic regression analysis.ROC curves were used to evaluate the role of amylase and lipase in the diagnose of abnormal pancreatic ultrasound findings.Results The incidence of abnormal pancreatic ultrasound findings in critically ill children was 3.39%, the average age of abnormal group was significantly older than that in control group (P<0.01).There were not statistically significant differences in gender and primary disease between two groups.The incidence of hypotension was 22.2% and the incidence of abdominal muscle tension was 16.7% in abnormal group,which were statistically higher than those in control group (P<0.05).The levels of calcium, albumin of abnormal group were significantly lower than those in control group (P<0.01), and levels of serum amylase, lipase, lactate dehydrogenase in abnormal group were significantly higher than those in control group (P<0.01).The risk factors associated with abnormal pancreatic ultrasound findings were age, blood pressure, calcium,amylase.Area under the ROC curve of abnormal pancreatic ultrasound findings determined by amylase and lipase were 0.803 and 0.745,respectively (P<0.05).The sensitivity was 0.667, specificity was 0.881 when the serum amylase was 101.5 U/L, the sensitivity was 0.722, specificity was 0.928 when the serum lipase was 96.9 U/L.Conclusions The incidence of abnormal pancreatic ultrasound findings was rather low in critically ill children.The risk factors associated with abnormal pancreatic ultrasound findings were hypotension, hypocalcemia, and hyperamylasemia.The elevated serum amylase and lipase might be the most likely factors associtaed with abnormal pancreatic ultrasound findings.

Objective To determine the fecal elastase-1 (FE-1) in critically ill children in order to investigate the relationships between FE-1 and trypsin,sepsis as well as the severity of the disease.Methods Totally 402 critically ill children admitted in pediatric intensive care unit (PICU) of Hunan Children' s Hospital from July 2013 to March 2014 were studied.The formed stool of patients was collected during the first 24 h after admission.Subjects were divided to 3 groups according to FE-1 concentration:＞ 200 μg/g for normal pancreatic exocrine function (group A,n =300),100-200 μg/g for mild to moderate exocrine pancreatic insufficiency (group B,n =52),＜ 100 μg/g for severe pancreatic exocrine insufficiency (group C,n =50).The analyses of the relationships between FE-1 and pancreatic enzymes,sepsis severity,shock,the number of organ dysfunction,PCIS (pediatric critically ill score),SOFA score,and APACHE Ⅱ score were carried out.Chi-squared test was used for data statistics.The median and four percentile interval were used for the measurement data of abnormal distribution or non-neat variance,the rank sum test of each two of multiple samples compared each other was used for non-parametric test,only when it was statistically significant,and the Spearman method of correlation analysis was used for correlation analysis.Results (1) There was significant difference in serum lipase between group A and group B (P ＜ 0.01).(2) There was statistical difference in FE-1 level between sepsis group and non-sepsis group (P ＜ 0.05).Children with sepsis were divided into three groups according to the severity of sepsis:mild sepsis group,severe sepsis group and septic shock group.There were significant difference in FE-1 level among different severities of sepsis groups and as well as non-sepsis group (P ＜ 0.01).(3) The proportions of FE-1 in septic children of A,B and C groups in comparison with those in non-septic children of three groups were 65.79％ vs.78.13％,15.79％ vs.11.80％,18.42％ vs.10.07％,respectively.The proportions of FE-1 in septic children of B and C groups escalated were higher than those in children without sepsis.(4) The general trend in FE-1 concentrations varied along with the severity of sepsis.There were no significant differences in FE-1 concentration between non-sepsis group and mild sepsis group,and between severe sepsis group and septic shock group,but other paired comparisons between the four groups had statistical significant (P ＜0.01).(5) Along with FE-1 level decreased,the number of organ dysfunction,SOFA score,APS score (This is a part of APACHE Ⅱ score and other part,CPS,is excluded) increased and PCIS score decreased (rs1 =-0.194,P =0.000; rs2 =-0.348,P =0.000; rs3 =-0.176,P =0.000; rs4 =0.185,P =0.000).Conclusions Pancreatic exocrine function damage is associated with sepsis,the pancreatic dysfunction in patients with mild sepsis may not be significant,but its incidence increases gradually with the development of sepsis or with the deterioration of the disease.

Objective To evaluate the effect of the traditional Chinese medicine (TCM) knowledge and skills training on non TCM community physicians in Shanghai, and provide important basis and feedback for future adjustments and training improvement.Methods The current situation of the TCM knowledge and skills training on non TCM community physicians in Shanghai was reviewed. The community physicians participated in the training courses in 2014 in Jiading district were randomly selected for investigation. The TCM theory and skills scores of all the 65 trainees were compared before and after training, a self-made questionnaire survey on assessment of training was conducted after training, and the influencing factors of training effect were analyzed. Results After training,test results of TCM theory and skills were significantly higher than before(P<0.01). According to the survey of trainees after TCM training, 84.6% thought the training was necessary,95.4% liked the teaching form, 93.9% accredited training content difficulty level,92.3% thought the training was practical, 98.5% were willing to provide Chinese medicine services for community residents, 60.0% thought training to promote the general medical work was very helpful. The existing problems were short training periods(43.1%), only 10.8% could skilled TCM appropriate technologies and 60.0% were basically master. Conclusion The TCM knowledge and skills training on non TCM community physicians in Shanghai had achieved better effect. There still were some deficiencies, which require further exploration in order to better carry out future training.

Objective To investigate the operative methods and treatment outcomes of replantation of amputated complex mini tissue mass of the fingers Methods Seventeen severed complex mini mass in 16 cases were replanted with microsurgery technique using different revascularization procedures Results Fifteen replanted masses were survived completely,proximal partial skin margin necrosis in 1 case,only one case was failure Both function and appearance in surviving replantations were excellent after 6～24 months follow up Conclusions Replantation of amputated complex mini tissue mass of the fingers is rewarding as long as the mass remained intact and the vessels for anastomosis could be found