Acute poisoning occurs in age of children and threatens children's life.In developed country,monitoring network about children's poisoning showed related risk factors,which helped preventing and managing poisoning quickly.The fatality rate of children's poisoning is high in China.There is no monitoring network in our country.We summarized the influencing factors and treatment of acute poisoning in children.

Heated humidified high flow nasal cannula oxygen therapy (HFNC) has the characteristics of improving the work of breathing,creating the effect of positive end-expiratory pressure,being setted up easily,well tolerated by patients and high safety.At present,it has been widely used in neonatal respiratory support,but lack of its extensive use and research in infants and children.HFNC is suitable for use in infants with viral bronchiolitis,pneumonia,asthma,ARDS,and postextubation respiratory support from the aspect of the mechanism of action of HFNC and the pediatric physiology.HFNC should be the preferred mode of conventional oxygen therapy in pediatrics.

Objective To analyze the status and the distribution of causes of injuries as well as disease burden in children under 5 years old in Sichuan Province.Methods The death information cards of children who died because of injuries in Sichuan Province in 2012 were analyzed,and the years of potential life lost and working years of potential life lost were calculated to evaluate the disease burden.Results 22.87％ (1 502/6 567) of children lost their lives because of injuries,the mortality of injury was 4.13‰,63.45％ of children died at the age between l and 4,and most of the children died at home or on the road; The top 3 causes of children death of injuries below 5 years old were drowning,accidental suffocation and traffic accidents.The years of potential life lost and working years of potential life lost were 73.05 years and 58.30 years.Conclusion Injury is one of the most mainly risk factor of health and life of children,the government should further prevent and control children injuries.

Objective To compare the skills level before and after pediatric advanced life support course and analyze the effect of the training. Methods The pediatric advanced life support was used as the textbook. The skills were got through attending theory classes, watching demonstrations and taking part in the simulator training. The questionnaires were filled strictly and the data was analysed. Results The test scores were increased after the training (P＜0. 01). There were only 8.7% of the trainees had used the rescue equipments and 61.3% had never seen the rescue equipments before training. More than 80% of the trainees were satisfied with the training about the utility and novelty. Conclusion pediatric advanced life support course can successfully deliver a large number of healthcare providers with international unique pediatric emergency treatment skills ,and raise the participants abilities of rescuing critical children.

Objective To formulate a five-level pediatric emergency triage standard and evaluate the efficacy and reliability of it in determining severity of emergency pediatric patients.Methods According to the assessment methods in Pediatric Advanced Life Support recommended by American Heart Association and American Academy of Pediatrics,we formulated a five-level pediatric emergency triage standard based on the situation of our hospital and analyzed the data one year before and after the application of it.Results Before and after the application of the triage standard,the average satisfaction rate of emergency patients were (81.28 ± 3.97) ％ and (94.13 ± 4.62) ％,and there was significant difference (P ＜ 0.01) ; the proportion of whom became worse during waiting time were 1.83％ (628/34275) and 0.04％ (16/36 187),and there was significant difference (P ＜0.01) ;the average waiting time of emergency admission patients were (12.71 ± 2.32) min and (3.34 ± 1.95) min,and there was significant difference (P ＜0.01) ;the misjudgment rate of severity were 3.78％ (1 296/34 275) and 0.57％ (205/36 187),and there was significant difference (P ＜ 0.05).Conclusion The five-level triage standard is objective,easy to master,and suitable for pediatric triage.It can quickly sort out critical cases from emergency pediatric patients,which can improve the effectiveness of emergency service,make use of medical resources rationally and somewhat solve the problem of overcrowding.

Objective To investigate the correlation of Bax and apoptosis in enterocytes of neonatal rats with necrotizing enterocolitis (NEC).Methods Forty-eight neonatal rats (1 day) were randomly divided into control group (n =24) and NEC model group (n =24) by use of odd and even.The rats in control group were maternal breast-fed.The rats in NEC model group were separated from their mothers.To be given formula feeding,cold exposure after hypoxic-reoxygenation treatment.The intestinal tissue located at the boundary of ileum and caecum of two groups were gained on the 24 h,48 h and 72 h with which that all rats were sacrificed by cutting neck.Section of intestinal tissue were stained with immunohistochemistry to detect the expression of Bax and were stained with TdT mediated dUTP nick end labeling(TUNEL) to evaluate the apoptosis in each group.Results The integrate optical density (IOD) value of expression of Bax in the NEC model group began to increase on the 24 h [(1 005.06-± 11.96) IOD] and reached the summit on the 72 h [(3 340.66 ±68.72)] compared with the control group[(666.55 ± 15.77)IOD].A few of TUNEL positive cells began to increase with time dependence.A lot of TUNEL positive cells could be found in NEC model group on the 24 h [(15.04 ± 0.24) ％],and the apoptotic index reached the peak on the 72 h [(35.65 ±0.61) ％] compared with the control group[(4.73 ±0.04) ％,P ＜0.01]-There was a significantly positive correlation between the cell apoptosis and the ratio change of Bax in NEC model group (r =0.94,P ＜ 0.01).Conclusion There is a significantly positive correlation between the cell apoptosis and the ratio change of Bax in enterocytes of neonatal rats with NEC.The cell apoptosis in enterocytes of neonatal rats with NEC maybe be induced by Bax.

Objective To investigate the clinical effect of pernasal heated humidified high flow oxygen therapy (HFNC) on treating children with severe pneumonia.Methods For the children with severe pneumonia by treatment of HFNC in PICU in 2016,the changes of respiratory rate,heart rate,p(O2) and p(CO2) after one hour of HFNC and intubation rate,time of oxygen therapy and curative rate were analyzed.Results The HFNC was able to alleviate the respiratory rate,heart rate and increased p (O2) significantly (P ＜ 0.05),and for children with severe pneumonia complicated with type Ⅱ respiratory failure,the HFNC also can reduced p (CO2) significantly (P ＜ 0.05).There was no significant difference of intubation rate between children with type Ⅰ and Ⅱ respiratory failure,but both were significantly higher than children without respiratory failure (P ＜ 0.05).The mean oxygen therapy time of children with type Ⅱ respiratory failure was 7.38 d,which was significantly longer than 5.45 d of children with type Ⅰ respiratory failure and 4.45 d of children without respiratory failure (P ＜ 0.05).The curative rate was 100％.Conclusion HFNC can effectively relieve the respiratory rate,heart rate and hypoxemia in children with severe pneumonia.It can also significantly reduce p(CO2) in children with type Ⅱ respiratory failure.

Objective To investigate the clinical effect of pernasal heated humidified high flow oxygen therapy (HFNC) on treating children with severe pneumonia.Methods For the children with severe pneumonia by treatment of HFNC in PICU in 2016,the changes of respiratory rate,heart rate,p(O2) and p(CO2) after one hour of HFNC and intubation rate,time of oxygen therapy and curative rate were analyzed.Results The HFNC was able to alleviate the respiratory rate,heart rate and increased p (O2) significantly (P ＜ 0.05),and for children with severe pneumonia complicated with type Ⅱ respiratory failure,the HFNC also can reduced p (CO2) significantly (P ＜ 0.05).There was no significant difference of intubation rate between children with type Ⅰ and Ⅱ respiratory failure,but both were significantly higher than children without respiratory failure (P ＜ 0.05).The mean oxygen therapy time of children with type Ⅱ respiratory failure was 7.38 d,which was significantly longer than 5.45 d of children with type Ⅰ respiratory failure and 4.45 d of children without respiratory failure (P ＜ 0.05).The curative rate was 100％.Conclusion HFNC can effectively relieve the respiratory rate,heart rate and hypoxemia in children with severe pneumonia.It can also significantly reduce p(CO2) in children with type Ⅱ respiratory failure.

Objective:To combine ultrasound and clinical characteristics for predicting the treatment time of strontium 90( 90Sr) radioisotope applicator therapy for pathological scars when the therapeutic effect meets the clinical effective criteria. Methods:From September 2022 to October 2023, 48 patients (90 lesions) with pathological scars who underwent 90Sr radioisotope applicator therapy at the Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University were prospectively collected. The clinically effective criteria of 90Sr radioisotope applicator therapy for pathological scars were defined as a reduction of the superficial height of the scar higher than 50%. All lesions were divided into short period treatment group (2 months, 38 lesions) and long period treatment group (>2 months, 52 lesions) according to the duration of treatment when the therapeutic effect met the clinical criteria. Univariate comparative analyses of ultrasound and clinical characteristics between the two groups were performed. The statistically significant variates were used to build a multivariate logistic regression model for analyzing the independent predictors of the treatment time of 90Sr radioisotope applicator therapy for pathological scars. Results:Family history, blood flow signal, disease duration, age, and scar Young′s modulus were independent predictors of the effective treatment time of 90Sr radioisotope applicator therapy for pathological scars (all P<0.05). By using the selected variables, a predictive model was developed, area under the ROC curve (AUC) were 0.886 (95% CI=0.817-0.955, P<0.001), and the calibration curve showed that the model was well calibrated(χ 2=5.668, P=0.684). Conclusions:The multivariate logistic regression model with family history, blood flow signal, disease duration, age, and scar Young′s modulus could be used to predict the treatment time of 90Sr radioisotope applicator therapy for pathologic scars, which can help to guide the design of treatment plan, reduce unnecessary radiation damage, and improve patient compliance.

BACKGROUND:The gluteus medius not only abducts the hip joint,but also plays an important role in limiting the external movement of the femoral head.At present,there is a lack of research on the correlation between gluteus medius status and non-traumatic femoral head necrosis. OBJECTIVE:To investigate the relationship between the gluteus medius width ratio and the medial space ratio of the hip joint and the progression of non-traumatic femoral head necrosis,and to explore the effect of gluteus medius atrophy on the surface and necrotic zone stress of the femoral head necrosis through finite element analysis. METHODS:Retrospective analysis of unilateral non-traumatic femoral head necrosis patients admitted to Third Affiliated Hospital of Guangzhou University of Chinese Medicine was performed.All patients were followed up for an average of more than 2 years.They were divided into a collapsed group and a non-collapsed group based on whether there was collapse of the femoral head during the follow-up.Medial space ratio,gluteus medius width ratio,Sharp angle,gluteus medius length ratio,and gluteus medius activation angle were measured and calculated.The differences in these indicators were compared between the two groups.At the first visit and follow-up at 3,6,12,and 24 months,the medial space ratio and gluteus medius width ratio were measured and calculated to explore the changes of these two indicators in the course of non-traumatic femoral head necrosis.In addition,using three-dimensional finite element analysis,a Japanese Investigation Committee classification C1 type femoral head necrosis model was constructed based on CT data.At the same time,based on MRI data,a model of the gluteus medius muscle was constructed and divided into a gluteus medius muscle atrophy group(gluteus medius width ratio:74%-76%)and a gluteus medius muscle normal group(gluteus medius width ratio:94%-96%).Each group constructed 10 models,with 6 degrees of freedom of the distal femur constrained to zero.600 N pressures were applied along the Z-axis to the upper surface of the sacrum.The stress distribution,maximum stress values on the surface and necrotic area of the femoral head,and the maximum displacement of the necrotic area were compared between two groups of models. RESULTS AND CONCLUSION:(1)A total of 153 patients(67 males and 86 females)with 153 hips were included in this study.(2)At the 24-hour follow-up,the medial space ratio of the collapsed group was significantly higher than that of the non-collapsed group(P<0.05).The gluteus medius width ratio of the collapsed group was significantly lower than that of the non-collapsed group(P<0.05).There was no statistically significant difference in Sharp angle,gluteus medius activation angle,and gluteus medius length ratio between the two groups(P>0.05).(3)Since the follow-up time exceeded 3 months,the gluteus medius width ratio of the collapsed group was lower than that of the non-collapsed group(P<0.05).Since the follow-up time exceeded 12 months,the medial space ratio of the collapsed group was higher than that of the non-collapsed group(P<0.05).(4)Pearson correlation analysis showed a significant positive correlation between follow-up time and medial space ratio in the collapsed group(P<0.05),and a significant negative correlation between follow-up time and gluteus medius width ratio(P<0.05).The regression coefficient of gluteus medius width ratio was larger than that of medial space ratio.(5)The group with middle gluteal muscle atrophy showed significant stress concentration on the surface of the femoral head,and the stress zone was significantly located on the outside.The maximum stress on the surface of the femoral head in the group with middle gluteal muscle atrophy was significantly greater than that in the group with normal middle gluteal muscle(P<0.05).There was significant stress concentration in the necrotic area of the middle gluteal muscle atrophy group,and the maximum stress was located at the edge of the necrotic area.The maximum stress and maximum displacement in the necrotic area of the middle gluteal muscle atrophy group were significantly greater than those of the normal group(P<0.05).(6)It is indicated that gluteus medius width ratio is an effective indicator for evaluating changes in gluteal muscle atrophy.In the progression of non-traumatic femoral head necrosis,atrophy of the gluteus medius muscle first occurs,followed by widening of the medial hip joint space.The mechanical mechanism may be that the atrophy of the gluteus medius muscle affects the stability of the hip joint,leading to external displacement of the femoral head,and increasing stress and displacement on the surface and necrotic area of the femoral head.