Objective To explore the changes and clinical value of serum insulin like growth factor-1 (IGF-1) and adiponectin in newborns with hypoxic ischemic encephalopathy (HIE). Methods Fifty-two HIE newborns were recruited in this study, including 15 severe, 20 moderate and 17 mild HIE newborns. Twenty healthy newborns were selected as controls. Serum levels of IGF-1 and adiponectin were detected 3-to-5 days (acute period) and 10-to-14 days (recovery period) after birth. Results Serum levels of IGF-1 and adiponectin in the acute period differed signiifcantly among groups of different severity (P<0.05). Serum levels of IGF-1 and adiponectin were decreased with the increase of HIE severity. The level of adiponectin in moderate and severe HIE was lower than that in mild HIE (P<0.05). In recovery period, the level of IGF-1 in severe HIE was lower than that in control (P<0.05). Serum levels of IGF-1 and adiponectin in the acute period was positivity correlated with those in umbilical cord blood of HIE newborns (r=0.531, r=0.611, P<0.01). Conclusions Decreased levels of IGF-l and adiponectin in HIE newborns are correlated with the pathological process of HIE, and can be regarded as indices for severity of HIE. IGF-l and adiponectin is of signiifcance in the clinical diagnosis and prognosis of HIE.

BACKGROUND:microRNA-17 is confirmed to play an important role in the development of pulmonary hypertension. Some research has shown that hypoxia-induced proliferation in human pulmonary artery smooth muscle celldepends on the induction of arginase II. There is no report about whether there is some interaction between microRNA-17 and arginase II in human pulmonary artery smooth muscle cells.
OBJECTIVE:To investigate the possible interactions between microRNA-17 and arginase II in hypoxic human pulmonary artery smooth muscle cells.
METHODS:Passage 4 human pulmonary artery smooth muscle cells were cultured in 21%O 2 and 5%CO 2 (normoxia) or 1%O 2 and 5%CO 2 (hypoxia), and then transfected with mimic or inhibitor of microRNA-17 or arginase II-smal interfering RNA. RNA, microRNA and protein were isolated separately. Expression of microRNA-17 and arginase II was detected with real-time quantitative PCR and western blot assay. RESULTS AND CONCLUSION:The level of microRNA-17 was significantly increased in cultured human pulmonary artery smooth muscle cells exposed to 1%O 2 hypoxia, as was arginase II mRNA and protein expression. Furthermore, inhibition of microRNA-17 expression decreased the mRNA and protein levels of arginase II in the human pulmonary artery smooth muscle cells under hypoxia. Conversely, over-expression of microRNA-17 increased the mRNA and protein levels of arginase II in the human pulmonary artery smooth muscle cells under normoxia and hypoxia. Knockdown of arginase II by siRNA abolished the hypoxia-induced up-regulation of microRNA-17 expression. These findings indicate that arginase II is a target gene of microRNA-17 and can regulate the expression of microRNA-17 in human pulmonary artery smooth muscle cells.

Objective To observe the complications in children after percutaneeus closure of atrial septal defect (ASD). Methods 192 children,who successfully received percutaneous closure of ASD in our hospital were enrolled in this study. Diameter of ASD was 8.0 ～ 33.0( 16.7± 8.0) mm, the diameter of occluder was 8.0 ～ 38.0 ( 18.9 ± 8.2) mm. The follow-up term ranges from 1 month to 4 years, with a mean of 19.0 ± 4.5 months. Standard 12-lead electrocardiography (ECG) and transthoracic echocardiography (TIE) were performed before closure, 24 including: minimal-moderate residual shunt in 3 patients ( 1.6% ), atrial-ventricle block (AVB) in 1 ( 0.5 % ), sinus There were 184 cases of single-hole ASD, with complication rate of 2.7% (5/184) , including the complication rate in diameter of siagle-hole ASD less than 10mm was 0% , that in ASD between 10 mm and 20 mm was 1.7% (2/119) ,that in ASD more than 20 mm was 5.0% (3/60) ,while there were 8 cases of two- and multi-hole ASD, clusion, including 3 cases of minimal-moderate residual shunt, 1 case of atrial-ventricle block, 1 case of sinus brady-cardia, and 1 case of device-micro-malplesition. 2 days to 2 weeks after procedure, 1 case developed pelade ( 1/192 ). completely recovered (57. 1% ), including 1 case of residul shunt, 1 case of atrial-ventricle block, sinus bradycardia and 1 case of pelade. 2 cases of minimal residual and 1 case of device-micro-malposition were not recov-ered. Conclusions Transeatheter closure of ASD is safe and effective with few complications, most of which disapp-eare completely during follow up term. Long-term follow-up is needed to evaluate the progress of some rare complica-tions.

Convulsion is one of the most common pediatric emergencies.It can be caused by many factors,and the most common one is febrile convulsion.A severe or prolonged seizure can cause neurological damage,so it is necessary for timely and standardized treatment.The first step in emergency treatment is to keep the airway unobstructed,and control convulsion as soon as possible.The second step is to look for the cause of the disease,and to follow up the drug treatment for the cause of the disease.Children should be admitted to hospital for further diagnosis and treatment when necessary.

Objective:To investigate the epidemiological characteristics, treatment and prognosis of pediatric severe sepsis in PICU in Shandong Province from 2018 to 2021, in order to provide a scientific basis for the prevention and treatment of severe sepsis in children.Methods:A multicenter retrospective observational study was conducted at PICUs from 19 hospitals in Shandong Province.Patients aged>28 days and ≤18 years, diagnosed with severe sepsis or septic shock who admitted to these PICUs during January 1, 2018 and December 31, 2021 were enrolled.Results:(1)From 2018 to 2021, the total number of hospitalized children and the number of children with severe sepsis admitted to the PICU showed an overall downward trend, with the most significant decrease in 2020.(2)During the study period, among the hospitalized children in PICU, the prevalence rate of children with severe sepsis fluctuated from 1.95% to 2.37%, and the median age fluctuated from 1.29 to 2.00 years old, more males than females.(3)Median pediatric sequential organ failure assessment score fluctuated between 5 and 6 at 24 hours after admission.(4)The most common primary infection site was the respiratory system, followed by the digestive system.(5)Since 2020, the propotion of children receiving fluid resuscitation, blood purification, mechanical ventilation, and glucocorticoid therapy has decreased significantly.(6)The median length of PICU stay was 9.22 to 11.51 days.(7)The median PICU costs decreased significantly from 41 075 yuan in 2018 to 30 972 yuan in 2021.(8)In-hospital mortality showed an overall decreased trend, reaching a maximum of 17.61% in 2019 and a minimum of 12.77% in 2020.Conclusion:From 2018 to 2021, there was no significant change in the incidence of pediatric severe sepsis in PICUs in Shandong province while the overall in-hospital mortality rate and the PICU costs showed a reduced trend.

Sepsis, a systemic inflammatory response syndrome caused by infection, is a common cause of death in ICU patients.Current studies suggest that patients with sepsis have stress-induced hyperglycemia, of which insulin resistance is a direct cause.During sepsis, many factors such as increased hormone release, excessive release of inflammatory mediators and lipogenic factors, oxidative stress, and endoplasmic reticulum stress, lead to the development of insulin resistance by hindering insulin signaling and reducing insulin sensitivity.This article elaborated the mechanism of insulin resistance in sepsis from the above aspects.

Objective:To understand the status of sedation and analgesia treatment and management in pediatric intensive care unit(PICU) in Shandong Province, and to provide the basis for the improvement of sedation and analgesia treatment plan.Methods:This study was a multi-center retrospective study.The PICUs of 6 tertiary hospitals in Shandong Province participated in this study.The data of 1 340 children admitted to these 6 PICUs from January 2016 to December 2018 were collected.The age, gender, the pediatric risk of mortality score Ⅲ at 24 hours after admission, whether they received mechanical ventilation, whether they received sedation and(or) analgesia, whether they were monitored sedation and(or) analgesia, and in-hospital mortality were analyzed.The children were divided into the simple sedation group( n=798), the sedation + analgesia group( n=120) and the non-sedation analgesia group( n=422) according to whether they received sedation and(or) analgesia.The diseases, proportion of mechanical ventilation, incidence of hypotension, average length of stay in PICU and in-hospital mortality were compared among the three groups. Results:The median age of the 1 340 children was (13.3±6.4) months, including 786 males(58.7%). Sedation therapy had been carried out in 6 PICUs, of which 5 PICUs had routine sedation assessment; 4 PICUs had carried out analgesic therapy, of which only 2 had routine pain assessment.A total of 918 children(68.5%)received sedation and(or) analgesia, midazolam was the most commonly used sedative drug, followed by dexmedetomidine, and 526 children(57.3%)were monitored for sedation assessment, the most commonly used assessment method was the Richmond agitation sedation score.One hundred and twenty(9.0%)cases received sedation combined with analgesia, fentanyl was the most commonly used analgesic, and 38 children(31.7%) underwent routine pain assessment.There was no significant difference in age and sex among the three groups.The proportion of surgical diseases and patients received mechanical ventilation(100.0%, 120/120) were the highest in the sedation + analgesia group.The proportion of mechanically ventilated patients was the lowest in the non-sedation analgesia group(11.4%, 48/422). The mean duration of mechanical ventilation in the sedation + analgesia group was slightly shorter than that in the simple sedation group( P>0.05). The incidence of hypotension was highest in the sedation + analgesia group, and lowest in the non-sedation analgesia group[21.7%(26/120) vs.2.1%(9/422), P<0.01]. There was no significant difference in in-hospital mortality and mean PICU stay among three groups. Conclusion:Benzodiazepines are still the main sedative drugs used in PICUs in Shandong Province.In recent years, the usage of dexmedetomidine has gradually increased, but the proportion of analgesic use is very low.At present, analgesic and sedative therapy is mainly used for children after surgery and receiving mechanical ventilation.Although analgesic and sedative therapy does not increase the in-hospital mortality and average length of stay in PICU, it increases the incidence of hypotension.The sedative and analgesic treatment and assessment in the PICU of Shandong Province are still not standardized, mainly reflected in infrequently analgesic treatment and the assessment of sedation and pain, which need to be further improved.

Objective:Through the establishment and preliminary application of standardized, real-time and online database of severe sepsis in children, we can realize the information about management of children with severe sepsis, providing data to support scientific research and clinical work, and building a homogeneous scientific research and clinical platform for multiple units participating in constructing the database.Methods:We designed, developed and established an online database system for children with severe sepsis, which was filled in in real time by 19 member units of Diagnosis and Treatment Collaboration Group for Sepsis in Children in Shandong Province.The basic information, treatment and prognosis of children entered in the database were preliminarily analyzed.Results:(1)A real-time online disease-specific database for severe sepsis in children was established primarily, with the classification, storage, logical retrieval, statistical analysis and map-making of the information of children with severe sepsis.(2)Further analysis was conducted on the clinical data of 602 children with severe sepsis, which had been recorded in the database.There were 341 males(56.6%)and 261 females(43.4%). The median age was 16 months.There were 230(38.2%)children younger than 1 year old, and 274 children aged from 1 to 5 years old(45.5%), 98 children(16.3%)were 6 years old and above.Three hundred and forty-three cases(57.0%)were from rural areas.One hundred and eighty-one cases(30.1%)were found to have basic diseases.The primary site of infection was the respiratory system(40.8%). The in-hospital mortality was 15.6% in children with severe sepsis.Multivariate Logistic regression analysis showed that high pediatric risk of mortality score Ⅲ score at 24 hours after admission, acute respiratory distress syndrome, acute renal injury, mechanical ventilation and vasoactive drug treatment were independent risk factors for in-hospital death in children with severe sepsis( P<0.05). Conclusion:The disease-specific database of severe sepsis in children can provide data for scientific research and clinical practice of sepsis management in children, and contribute to the formulation and improvement of clinical decision-making in the future.Simultaneously, it has also constructed a homogeneous scientific research and clinical work platform, which may contribute to the common development of the participatory units.

Blood adsorption, one of the blood purification, can be classified into hemoperfusion and immunoadsorption.In recent years, double plasma molecular adsorption, a combined adsorption, has also been widely used in clinical practice.Based on adsorption, the toxins in blood of patients can be efficiently removed by hemoadsorbents.There are two kinds of adsorbents commonly used in hemoperfusion: carbon and resin, and two types of adsorbents in immunoadsorption: biological affinity and physicochemical affinity.Adsorption has been widely applied in clinical practice, involving in sepsis, organ transplantation, systemic lupus erythematosus, liver failure, autoimmune diseases and so on.The review described the application of blood adsorption in clinical practice.

Fluid overload is frequently found in critically ill patients with pediatric heart failure.Volume management is one of the important therapeutic measures for pediatric patients with heart failure, the aim of which is to achieve the best individual volume homeostasis.Assessment of volume status is the premise and foundation of volume management.The comprehensive evaluation and effective management of volume status leave clinical doctors a great challenge.In order to provide guidance and evidence for clinicians, this review elucidated the methods for assessment and management of volume status for pediatric patients with heart failure.