Objective To study the diagnosis value of serum retinol binding protein (RBP),cystatin C(Cys C) and β2 microglobulin (β2-M) in early renal injures of gcstational diabetes mellitus (GDM) patients.Methods 85 case of GDM pregnant women admitted to Shiyan Maternal and Child Health-Care Hospital from Jan.2009 to Jan 2015 were chosen as research objects,and were divided into simple diabetes group (35 cases),micro proteinuria group (30 cases) and massive proteinuria group (20 cases) according to the urinary albumin excretion rate (UAER),while 30 cases of healthy pregnant women were recruited randomly during the same period as control group.The 24h urine protein,serum RBP and renal function indicators [blood urea nitrogen (BUN),creatinine (Ser),Cys C and β2 M],the positive rates of RBP,Cys C,β2-M and combined detection of RBP,Cys C,β2-M of the four groups were compared.Results The 24h urine protein in simple diabetes group,micro proteinuria group and massive proteinuria group were significantly higher than that in the control group (t=3.91～ 16.33,all P＜0.01),the difference between the 3 groups were statistically significant (t=6.78～ 16.94,all P＜0.01).The levels of BUN,Scr,Cys C,β2-M and RBP in micro proteinuria group and massive proteinuria group were significantly higher than those in control group and simple diabetic group (t=3.68 ～ 18.54,all P＜0.01),there were significant difference in above indexes between micro proteinurine group and massive proteinuria group (t=4.70～ 10.87,all P＜0.01).The positive rates of RBP,Cys C,β2-M and combined detection of RBP,Cys C and β2-M in micro proteinuria group and massive proteinuria group were significantly higher than those in control group and simple diabetic group (x2 =20.27～38.57,all P＜0.01).There was no significant difference in the positive rates between micro proteinuria group and massive proteinuria group (x2 =0.62～0.93,all P＞0.05).The positive rate of combined detection of the three indicators was higher than that of the single detection in the same group (x2=3.97～6.65,P＜0.05 or P＜0.01).Conclusion The detection of serum Cys C,RBP and β2-M has a high clinical value in the diagnosis of early renal damage in patients with GDM.The positive rate of combined detection of 3 indexes was higher than that of single index.

Objective To explore the clinical application of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation (CPR)in the treatment of critically ill children with cardiac arrest.Methods The clinical data of critically ill children due to cardiac arrest who were treated with ECMO assisted CPR from June 2012 to December 2015 in Affiliated Bayi Children's Hospital,Clinical Medical College in Army General Hospital,Southern Medical University were retrospectively reviewed,and the datas were analyzed by SPSS 20.0 software.Results A total of 17 patients received ECMO assisted CPR treatment,13 cases were male,4 cases were female,aged from 5 hours to 5 years old,the weight ranged from 3 to 16 kg;5 cases survived,and the survival rate 29.41％;12 cases died,the mortality rate 70.59％,of which 5 cases died of hear failure in withdrawal of ECMO,and 7 cases died of complications after withdrawal of ECMO.The age,sex ratio,body weight and other demographic data between 2 groups were not statistically significant (all P ＞ 0.05).There was no significant difference in the primary diseases between 2 groups (P ＞ 0.05).There was no significant difference in CPR time and ECMO support time between 2 groups (t =1.541,0.375,all P ＞ 0.05).Among 11 cases of children with ECMO-related complications,the incidence rate was 64.71％,the incidence of complication in the survival group was significantly less than that in the death group (x2 =8.709,P =0.003).The common complications of ECMO were bleeding,acral necrosis,infection,multiple organ failure,nervous system injury and acute kidney injury.There was no significant difference in the level of lactic acid between the survival group and the death group (P ＞ 0.05) before ECMO support started,but after 24 h of ECMO support,the lactic acid level in the survival group was significantly lower than that in the death group (t =2.896,P =0.014).Conclusions ECMO assisted CPR can improve the survival rate of critically ill children who have cardiac arrest and have no response to the conventional CPR.The serum lactic acid level after 24 h ECMO support has a guiding significance for the prognosis assessment,and ECMO patients' complications are still the most important factor affecting the prognosis of ECMO assisted CPR patients.

Objective Total 21 pulmonary artery sling( PA sling)combined with tracheal stenosis children who received treatment in our hospital were reviewed. The feasibility of treatment strategy including left pulmonary artery( LPA)re-implantation without tracheoplasty was discussed in this study. Methods From April 2009 to November 2015,a total of 21 pediatric patients received surgical treatment due to PA sling with tracheal stenosis. Six patients received LPA re-implantation and trachea intervention simultaneously. The other 15 patients received LPA re-implantation alone to relieve the trachea compression without tracheoplasty. The postoperative strategy including early extubation and CPAP ventilation was employed in PICU. Results A total of 21 PA sling with tracheal stenosis children who underwent surgical treatment in our hospital were recruited. There were 9 females and 12 males. Ages of these children were from 1 months to 10 years old,and body weights were from 2. 9 kg to 25. 0 kg. Five patients needed mechanical ventilation for severe respiratory symptoms preoperatively. Six patients received LPA re-implantation and tracheal interven-tion simultaneously. Among them,3 patients received slide tracheoplasty,and one was discharged after recov-ery. The remaining 3 patients received tracheal stent implantation,but finally died. The survival rate was 16. 7% in these patients. Fifteen patients received LPA re-implantation alone,and slide tracheoplasty was per-formed in 2 patients for extubation failure who finally died of air leakage. The survival rate of 15 patients who received LPA re-implantation alone was 86. 7%. Conclusion The strategy in LPA re-implantation alone to relieve the trachea compression without tracheoplasty and early extubation and CPAP ventilation postoperative may be an ideal treatment for the pediatric patients with PLA sling combined with tracheal stenosis.

Objective To explore the influences of continued nursing care on the recovery of intra-articular fractures of joint function of limbs and the quality of life after operation. Methods A total of 493 intra-articular fracture of limbs postoperative patients,who were discharged from our department from January 2015 to December 2016,were randomly divided into observation group and reference group.After operation,the reference group used self-management mode to practice joint functional exercise,while the observation group uses continued nursing mode to guide physical therapy to recover joint functions.After they discharged 12 weeks,we compared these two groups of patients with satisfaction of nursing care,joint function recovery and quality of life. Results After 12 weeks of operation, in observation group, the patients' joint function recovery rate was close to 79.27%(195/246), which was significantly higher than the rates 55.47%(137/247)in reference group,the difference was statistically significant(χ2=32.947,P<0.01). Respectively, the physiological function score,vigor score, mental health score, physiology role score, body pain score, health condition score, social function score and health score of the observation group in the quality of life assessment were (72.66 ± 4.41), (89.27 ± 4.10), (93.01 ± 3.05), (88.03 ± 3.19), (91.68±3.99),(76.78±4.86),(79.11±4.68),(85.57±7.07).The scores of control groups were(65.71±3.41),(64.02±4.51),(61.43±4.29),(66.49±4.52),(64.24±4.30),(62.02±6.24),(62.94±4.50),(65.02±7.72).The comparative difference of the two groups has statistical significance (t=12.48- 60.15, P<0.05). Meanwhile,in the satisfaction rate of nursing care,the great satisfaction rate of observation group(70.73%, 174/246) was much higher than reference group (37.65%, 93/247), the difference was statistically significant (χ2=59.789, P<0.01). Conclusion Offered outside continued nursing care to the intra-articular fracture of limbs postoperative patients can effectively improve the joint function of patients,their qualities of life and can considerably increase satisfaction of nursing care. Thus,it should to be clinically promoted.

Objective:To analyze clinical factors related to nosocomial infection in children with extracorporeal membrane oxygenation(ECMO)support.Methods:General data, infection data and relevant factors in children with ECMO support in Bayi Children′s Hospital, the 7 th Medical Center of People′s Liberation Army General Hospital and Henan Provincial People′s Hospital from September 2012 to February 2020 were reviewed.Relevant factors of nosocomial infection in them were analyzed. Results:Among 163 cases, 36(22.1%) children supported with ECMO had infections during the period of ECMO, and 72 pathogenic microorganisms were detected, including 67 bacteria (33 Acinetobacter baumannii, 21 Klebsiella pneumoniae, and 6 Pseudomonas aeruginosa) and 5 fungi.Pathogens from the respiratory system, blood system, urinary tract and abdominal cavity were detected in 45 cases(62.5%), 25 cases (34.7%), 1 case (1.4%), and 1 case (1.4%), respectively.Drug sensitivity analysis of the Acinetobacter baumannii showed that it was the extensively resistant strain.Compared with uninfected children supported with ECMO, ECMO support time[(10.0±6.7) d], hospitalization[(34.0±25.3) d], hospitalization cost[(234 368±113 234) yuan], preoperative oxygenation index(52.8±23.0) and lactate value[(9.6±5.9) mmol/L]were significantly higher in nosocomial infection ones[(4.6±3.2) d, (24.3±19.8) d, (161 416±65 847) yuan, 35.6±10.4, (5.6±5.4) mmol/L] supported with ECMO (all P<0.05). There was no significant difference in the mortality between 2 groups ( P>0.05). In addition, lactate level (9.8 mmol/L) and oxygenation index (36.0±12.7) were significantly higher in died children(2.7 mmol/L, 22.1±10.4) with nosocomial infection during the period of ECMO support than those of survivors (all P<0.05). Multivariate Logistic regression analysis showed that ECMO support time( OR=7.054, 95% CI: 2.206-25.525) and preoperative lactate value( OR=2.250, 95% CI: 1.378-4.611) were independent risk factors of nosocomial infection. Conclusions:Correcting underlying diseases of ECMO supporting and shortening the duration of ECMO can reduce the incidence and mortality of nosocomial infection in children who are supported with ECMO.

Objective:To study the effect of video teaching combined with offline training in cardiopulmonary resuscitation training for new nurses outside hospital.Methods:From August 2017 to August 2018, 125 new nurses from Shanghai Changzheng Hospital were selected. New nurses in August 2017 were set as control group ( n=65). In August 2018, the new nurses were set as the observation group ( n=60). The control group used the traditional offline training mode to train cardiopulmonary resuscitation outside the hospital. The observation group used information platform video teaching combined with offline theoretical training to carry out cardiopulmonary resuscitation training. After systematic training, the results of cardiopulmonary resuscitation after training and the satisfaction of teaching were compared between the two groups. Results:Before training, there was no significant difference in the assessment results of cardiopulmonary resuscitation theory and operation between the two groups ( t values were 0.12, 1.23, P>0.05). After training the scores of cardiopulmonary resuscitation theory and operation examination in the observation group were 85.41±3.20, 92.40±2.50, and 82.52±4.50, 85.0±3.60 in the control group ( t value was 1.04,4.24, all P<0.05). Encouraging and enhancing the learning interest of new nurses, cultivating mutual supervision and mutual guidance, integrating theoretical knowledge with practical operation, improving and adjusting self-motivation, overall evaluation of teaching methods and total score in the observation group were 3.61±0.34, 3.54±0.20, 3.61±0.28, 3.87±0.20, 3.32±0.21, 17.95±0.26, and 2.60±0.41, 2.41±0.16, 2.55±0.35, 2.41±0.46, 2.58±0.20,12.55±0.32 in the control group ( t value was 2.187-2.452, P<0.05). Conclusion:Video teaching combined with offline training can improve the performance of new nurses in the training of high-quality cardiopulmonary resuscitation, stimulate the learning interest of nurses, and enhance the effect of high-quality cardiopulmonary resuscitation training.

Objective: To investigate the application and outcome of pediatric extracorporeal membrane oxygenation (ECMO) in a single center. Methods: The clinical data of 52 pediatric patients with cardiopulmonary failure received ECMO support in Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command of PLA were collected from January 2012 to October 2016. All patients were divided into two stages by time. January 2012 to December 2014 was stage one. January 2015 to October 2016 was stage two. A retrospective analysis was done for these patients between two stages. In addition, all clinical data were compared with the data of extracorporeal life support organization (ELSO). The constituent ratio differences in different groups were tested by chi square test. Results: In 52 cases, there were 40 boys and 12 girls, aging from 1 day to 7 years, weighing from 2 to 20 kg. There were 35 cases who successfully weaned from ECMO (67%), and 25 cases were able to be discharged alive (48%). In stage one, there were 24 ECMO cases, 18 boys and 6 girls. There were 15 cases successfully weaned from ECMO (63%). Nine patients survived until discharge (38%). Complications were found in 15 cases during ECMO support (63%). In stage two, there were 28 ECMO cases, 22 were boys and 6 were girls. There were 20 cases successfully weaned from ECMO (71%). Sixteen patients survived until discharge (57%). Complications were found in 12 cases during ECMO support (43%). There was no significant difference in survival rates between two stages. However, the neonatal survival rate was higher in stage two than in stage one (71% (12/28) vs. 31% (5/24), χ²=5.107, P=0.038). The proportion of respiratory support was higher in stage two than in stage one (50% (14/28) vs. 21% (5/24), χ²=4.741, P=0.029), while the proportion of extracorporeal cardiopulmonary resuscitation (ECPR) decreased significantly (21% (6/28) vs. 67% (16/24), χ²=10.835, P=0.001). Application of peritoneal dialysis treatment in stage two was higher (6 vs. 0 cases, χ²=8.097, P=0.025). Mortality of ECMO was still higher than that of ELSO (48% (25/52) vs. 62% (34 655/55 886), χ²=4.281, P<0.05). The constituent ratio of different types of support varied between ECMO and ELSO patients (χ²=19.562, P<0.001). Conclusions ECMO technology can provide effective support for severe cardiopulmonary failure in critically ill children. Due to the multidisciplinary nature of ECMO technology, the complexity and characteristics of pediatric patients, it takes long time to improve ECMO management and prognosis.

Objective To summarize the clinical experience of extrocorporeal membrane oxygena-tion(ECMO) in the treatment of pediatric acute respiratory distress syndrome (ARDS). Methods A retro-spective analysis of children with ARDS who were hospitalized for different causes and received the treatment of ECMO from October 2012 to November 2017 was performed. The clinical conditions and prognostic fac-tors in the course of their disease were compared. Results In 12 cases of ARDS,9 cases (75％ ) had severe pneumonia,2 cases (16. 67％ ) had lung tumor resection and 1 case ( 8. 33％ ) had bronchial foreign body. Seven cases (58. 3％ ) chose VA-ECMO,5 (41. 7％ ) cases chose VV-ECMO. The average duration of ECMO was (225. 03 ± 214. 75) h. With the positive treatment of ECMO,heart rate,mixed venous oxygen saturation and central venous pressure all improved significantly(P < 0. 05),and there was no obvious abnor-mal changes in MAP and lactic acid(P > 0. 05). Arterial oxygen partial pressure,arterial carbon dioxide par-tial pressure,oxygenation index and P/ F were significantly improved after the ECMO support(P < 0. 05). Ppeak,Paw and PEEP after evacuation of ECMO were significantly lower than those before treatment (P <0. 05). Ten cases (83. 33％ ) were successfully removed,8 cases (66. 67％ ) were saved, and 4 cases (33. 33％ ) died. During the ECMO treatment,9 cases (75％ ) had complications,including 8 cases of bleed-ing at the intubation site,3 cases of gastrointestinal hemorrhage,2 cases of hemolysis,1 case of infection,2 cases of acute kidney injury,2 cases of neurological symptoms,1 case of multiple organ dysfunction syn-drome. Conclusion Pediatric ARDS is critical and the mortality rate is high. ECMO should be used as soon as possible when the lung is potentially regained and other treatments are ineffective,so that the lung could be fully rescued to gain time and opportunity for clinical treatment.

Objective: To retrospectively review 4 cases diagnosed with pediatric acute respiratory distress syndrome (ARDS) who were transported with veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) from April 2016 to March 2017. Methods: Four patients were transported to Bayi Children's Hospital Afflicted to the PLA Army General Hospital, with V-V ECMO. Their vital signs, blood-gas analysis and chest X-ray before and after transportation were compared. The length of ECMO, pediatric intensive care unit (PICU) stay and hospitalization, and the prognosis were analyzed. Results: All the four cases were transported to our hospital successfully from distances between 1 000 km to 1 210 km. The 4 cases were 4 to 6 years old with the body weight of 19 to 35 kg, of whom 3 were boys and 1 was girl. The catheters were inserted in the right jugular vein and femoral vein. The vital signs and blood-gas analysis after transportation did not change significantly compared to baseline. The length of ECMO for the four patients were 48, 754, 157 and 438 hours. They stayed in the PICU for 10, 32, 14 and 19 days, respectively. At last, 2 of them were successfully discharged from hospital without any complications; however, the other 2 died of multiple organ failure. Conclusion Transporting ARDS patients with a satisfactory cardiac function under VV-ECMO by an experienced ECMO team is safe.

Objective: To investigate application and safety of pediatric interfacility-transport with extracorporeal membrane oxygenation (ECMO) in China. Methods: The data of 48 patients transported inter-hospital from February 2016 to May 2018 were collected from the following 4 centers: pediatric intensive care unit (PICU) of Bayi Children′s Hospital Affiliated to the 7th Medical Center of PLA General Hospital, Pediatric Hospital of Fudan University, Henan Provincial People′s Hospital and Children′s Hospital of Zhejiang University School of Medicine. The data of patients′ characteristics, ECMO mode and wean rate, and mortality were reviewed, which was further compared with the data of 57 compatible inner-hospital ECMO cases with t test, Rank sum test or chi-square test. Results: All the 48 interfacility-transports were accomplished by ambulance on land, with an average transfer distance of (435±422) km. The incidence of ECMO complications was 13% (6 case), without death. There were no significant differences in lactic acid, PaO₂ or SaO₂ before and after transport (4.0 (2.0, 7.5) vs. 3.0 (1.5, 6.0) mmol/L, Z=-1.579, P>0.05; 112(47, 405) vs. 166(122, 240) mmHg (1 mmHg=0.133 kPa), Z=-0.104, P>0.05; 0.97±0.02 vs. 0.96±0.03, t=1.570, P>0.05). Instead, PaCO₂ and pH were significantly different ((47±8) vs. (42±5) mmHg, t=2.687, P<0.05; 7.3±0.2 vs. 7.5±0.2, t=3.379, P<0.05). The total ECMO weaned rate was 73% (35/48) and the survival rate was 67% (32/48). No significant differences in demographic characteristics, ECMO mode or duration, transport distance or duration, or complications existed between the survival group and the death group (7/25 vs. 2/14, χ²=0.615, P>0.05; 4/28 vs. 2/14, χ²=0, P>0.05; (405±404) vs. (493±465) km, t=0.525, P>0.05; (5±4) vs. (5±5) h, t=0.388, P>0.05; 166 (128, 239) vs. 187(52, 405) h, Z=-0.104, P>0.05; 3/32 vs. 3/16, χ²=0.734, P>0.05). The lowest lactate value in survival group before ECMO transport was significantly lower than that in the death group ((5±5) vs. (8±6) mmol/L, t=2.151, P<0.05). There were neither significant differences in age, ECMO mode or support pattern (9/39 vs. 15/42, χ²=0.845, P>0.05; 6/42 vs. 7/50, χ²=0.001, P>0.05; 29/19 vs. 38/19, χ²=0.441, P>0.05), nor in ECMO weaned rate, survival rate or complications between interfacility-transport group and inner-hospital group (35/48 vs. 37/57, χ²=0.775, P>0.05; 32/48 vs. 35/57, χ²=0.313, P>0.05; 20/48 vs. 22/57, χ²=0.102, P>0.05). Conclusion With appropriate transport equipment and mature teams who handle problems timely during the transport, critically ill children could be safely transported to the destination with ECMO.