Severe hand, foot and mouth disease (HFMD) may lead to the high mortality due to brainstem encephalitis, encephalomyelitis, pulmonary edema/pulmonary hemorrhage and cardiopulmonary failure in children. Some patients are complicated with severe gastrointestinal dysfunction, manifested as abdominal distension, intestinal paralysis, bleedy stool, haematemesis. "Catecholamine storm" and viral systemic inflammatory response syndrome may be the main mechanisms for gastrointestinal dysfunction. It is important to focus on the monitoring of gastrointestinal dysfunction of severe HFMD. Preventing and avoiding iatrogenic damage of gastrointestinal dysfunction are main treatment strategies.

Objective To investigate the effects of erythropoietin (EPO) on neuron apoptosis and expression of caspase-3 after excitotoxic brain injury induced by ibotenic acid (Ibo) in mice during different developmental stages.Methods A total of 144 healthy KM mice aged 7 d (n =48),21 d (n =48) and 42 d (n =48) were selected,and those of the same age were randomly (random number) divided into 3 groups:sham surgery group (n =16),Ibo group (n =16) and EPO treated group (n =16).Brain injury model was established by Ibo 1μl (5 μg) injected into left hippocampus.In EPO treated group,intraperitoneal injection of 5000 U/ (kg · d) EPO was performed for 3 consecutive days after injection of 1 μl Ibo into left hippocampus.Mice in sham surgery group and Ibo control group were treated with saline in the same dose instead.The pathological changes of neurons in hippocampus were observed 3 d after modeling in each group with Nissl staining,the level and activity of caspase-3 in hippocampus were determined by ABCELISA and spectrophotometry.Result After modeling,degeneration and death of neurons in hippocampuswith substantially decrease in number of intact neurons were found under light microscopy in Ibo group in comparison with sham surgery group.However,compared with the Ibo group,pathological changes in EPO treated group were less serious.The level of caspase-3 in Ibo control group was significantly higher than that in sham surgery group (P＜0.05),and the level of caspase-3 in EPO treated group was significantly lower than that in Ibo group (P ＜ 0.05).Conclusions The level of caspase-3 is significantly up-regulated in hippocampus of mice with Ibo-induced brain injury,leading to neuron apoptosis.EPO mitigates brain injury and plays a role of protection on brain function,suggesting the mechanism is attributed to decrease in caspase-3.

Moraxella Catarrhalis emerged as the third cause of respiratory tract infection in children.Over 90% of the Moraxella Catarrhalis strains isolated currently produced by β-lactamases positive.Moraxella Catarrhalis resist to Ampicillin because of the β-lactamases,such as the BRO-1 type,BRO-2 type and BRO-3 type.The BRO genes appeared to be located on the chromosome and be coded.Twenty-one new mutations were found in the putative promoter region of the BRO genes.

Hemodynamics is monitoring a series of physiological and pathological parameter changes such as blood flow,the chamber pressure of the heart,pressure or resistance of cardiovascular and cardiopulmonary system.Traditional hemodynamic monitoring in septic shock manily includes central venous pressure,cardiac index,blood lactate and pH.In recent years,expanded non-invasive or invasive monitoring technologies include central venous or mixed venous oxygen saturation,continuous ultrasound associated with underlying cardiac output monitoring and pulse indicator continuous cardiac output.Macro-hemodynamic,metabolic and microcirculatory parameters constitute a new hemodynamics network.In order to properly assess the patient's blood volume and circulation function and to overcome the limitations of a single parameter,it is need to emphasize analysis and integration of the various parameters.

According to the hemodynamic changes,circulatory failure is divided into warm shock and cold shock,and severe circulatory failure often co-exist in both conditions in children.Circulatory failure in children is characterized by rapid change on hemodynamic status,pathologic vasodilation,relative or absolute hypovolemia,myocardial depression,altered blood flow distribution,and metabolic disorders.Therapeutic strategies include improving cardiac output and tissue perfusion,achieving SVO2＞70％ and cardiac index to 3.3～6.0 L/( min· m2 ),ensuring the intravascular blood volume and cardiac load.

Multidrug-resistant organisms are growing worldwide public health problem and few therapeutic options remain available.The traditional antimicrobials (glycopeptides) for multidrug-resistant Grampositive infections are declining in efficacy.New antimicrobials that are presently available are linezolid,daptomicin and tigecycline,which have well-defined indications for severe multidrug-resistant organisms infections.Unfortunately,the therapies available for multidrug-resistant Gram-negatives including carbapenem-resistant Pseudomonas aeruginosa,Acinetobacter baumannii and Enterobacteriaceae are limited to colistin and tigecycline only.Distribution of multidrug-resistant organisms are changing in recent years.Strains of multidrug-resistant organisms were dominated by Gram-negative bacteria in most hospital particularly in intensive care unit.Multidrug-resistant/pandrug-resistant Pseudomonas aeruginosa,Acinetobacter baumannii are increasing rapidly in trend.Strategy that includes surveillance,infection control procedures,isolation and antimicrobial principle should be emphasized and implemented to reduce multidrug-resistant organism diffusion.

The etiology of acute pancreatitis in children is infection,drugs,trauma,or anatomic abnormalities.Acute pancreatitis is less frequent in children than in adults,but recent studies indicate that an increasing incidence in the pediatric population.Limited data of severe acute pancreatitis(SAP) remains.Abdominal pain and vomiting are important early symptoms.Also children may initially present with shock,followed by symptoms of multiple organ dysfunction.To date,there is no pediatric prognostic severity scoring system that is available to practice.The prognostic severity tool with 3 variables includes lipase,albumin,and WBC within 24 hours of admission may be applied to predict pediatric SAP.Continuous renal replacement therapy can effectively reduce systemic inflammatory response,improve the organ function and maintain the fluid balance,may be a new potential therapy in children with SAP.

Adrenal crisis is a life-threatening emergency caused by the destruction or altered function of the adrenal gland with a primary deficit in cortisol secretion(primary adrenal insufficiency)or by hypotha-lamic-pituitary pathologies determining a deficit of adrenocorticotropic hormone(secondary adrenal insuffi-ciency).Infection and abrupt end glucocorticoid treatment are the major precipitating causes of adrenal crisis. Patients with adrenal crisis typically present with hypovolemic shock or hypotension,nausea,vomiting,and fe-ver responding well to parenteral hydrocortisone administration.The main laboratory findings include lower serum cortisol concentrations,hyponatremia,hypoglycaemia and/or hyperkalemia.Delay diagnosis of adrenal insufficiency leads to adrenal crisis which is potentially lethal complication.Empirical glucocorticoid replace-ment should be initiated as soon as the suspicious of adrenal crisis,or sooner if the patient presents in adrenal crisis in critically ill children.

Biomarkers are objective tools with an important role for diagnosis in patients with acute myocarditis.Traditional biomarkers,such as aspartate aminotransferase,creatine kinase and myoglobin seem to have low sensitivity.Creatine kinase-MB′s major limitation is short in half-life,which makes monitoring more difficult.To date,cardiac troponins are closest to optimal biomarker with high sensitivity and specificity in the early diagnosis of acute myocarditis.Novel biomarkers,including stromal cell-derived factor 1 ,heart-type fatty acid binding protein and MicroRNA have the potential to be valuable biomarkers for early diagno-sis.Combining biomarkers and clinical features have appeared to improve diagnostic accuracy than either one alone.

The improvement of oxygenation basis on prone positioning in acute respiratory distress syndrome (ARDS) includes increased end-expiratory lung volume,improved ventilation-perfusion (V/Q) matching,and drainage of secretions.Randomized controlled trials report that prone position ventilation in patients with ARDS tends to reduce mortality rates,especially when used in conjunction with lung protective strategies and greater prone positioning durations.At present,the available data suggest that early prone positioning may provide benefit to ARDS with severe hypoxemia.keeping in mind that a risk of positioning-related complications will have to be taken into account when weighing the risk to benefit for patient with ARDS.There is still limited information available of prone position ventilation application in pediatric ARDS.