Hyponatremia and hyponatremia are the most common diseases in the PICU,which are easily lead to serious complications.If severe hyponatremia,hypernatremia or high sodium crisis happened,it can be expressed as repeated convulsions,coma and other serious neurological symptoms,even life-threaten-ing.The most causes are diarrhea disease,intracranial disease,the heat syndrome and so on.We can formulate the best management method of these disease based on they different causes,pathogenesis,clinical manifesta-tions and clinical manifestations.

Objective To investigate the characteristics and clinical significance of increased procal-citonin( PCT) in infant muggy syndrome( IMS) .Methods A total of 23 IMS cases admitted in PICU from Nov 2011 to Apr 2012 were enrolled.All cases were devided into three groups according to pediatric critical illness score,high risk group(n=5),medium risk group(n=12),and mild risk group(n=6).And 23 cases were also divided into infection group and no infection group according to baseline disease before onset.The relationship of PCT and pediatric critical illness score,primary infectino and infection index weer observed, and the possible causes of icn reased PCT in IMS were explored.Twenty age mathc ed infants reec iving exami-nation in clinic served as control gor up.Re sults PCT inrc eased significantly in IMS cases.The PCT level was(91.5 ±90.9) ngm/l ni high risk group,(81.1 ±74.1) ng/ml in medium risk group,and(112.1 ± 74.9) ng/ml in mild risk group,there were no significant differences among trh ee groups( F=0.371,P =0.732).Other infection index like leukocyte conmt,neutrophil and C reactvi e prto ein in IMSg roup were higher thant hose int he cno trol group,and the results had significant differences( P<0.05,reps ectively) .The PCT level was(72.5 ±74.4) ng/ml in infce toi n group,(101.5 ±76.6) ng/ml in no infection rg oup,and there was on sing ificant difference between two groups(t=0.873,P=0.392).There was no relevance be-tween increase of PCT and the incidence of infection before IMS.But PCT had higher correlation to the body tem-perature after IMS(r=-0.362,P=0.049).Conclusion There is correlation between the increased PCT and fever in IMS,and fever in IMS would lead to inflammation and then resulted in the increase of PCT.

Clinical risk index for babies( CRIB) is applied in low birth weight preterm neonates to assess the initial severity of illness,predict mortality risk rates,evaluate their own performance,and audit the performance between different medical institutions.CRIB plays an important role in the progressive develop-ment of neonatology.The scoring rules and advantagse of CRIB scorni g system were introud ced in this arti-cle.Teh scoring system is able to correctly predict mortaliyt probabilities and long-term neurodevelopmental outcomes for low birth weight preterm infants.

PlexinC1 is a large transmembrane protein widely distributed,which belongs to receptor system. PlexinC1 is expressed by monocyte,T-cells,B-cells,dendritic cells,neutrophils,and platelets. Recent researches showed that plexinC1 was intensely associated with lung injury,asthma and pulmonary fibrosis. PlexinC1 binded to its corresponding ligand and activated cellular signal pathway,which then participating in pathophysiologic processes of diseases mentioned above. Reasonably,PlexinC1 influences the development, prognosis of lung diseases and would provide a new target in control and treatment of lung diseases. This pa-per reviewed simply the formation,distribution,function of plexinC1 and the role of it playing in the associat-ed lung diseases.

Adrenal insufficiency is a common complication in sepsis patients, with a higher morbidity in septic shock patients.Adrenal insufficiency is closely related to coagulation disorders, inflammatory mediators and glucocorticoid resistance.The mechanisms of adrenal insufficiency in sepsis have not been discussed clearly.In the present review we detail the mechanisms of adrenal insufficiency that are active during sepsis.

Heated humidified high-flow nasal cannula(HHFNC) is a relatively new noinvasive method for respiratory support,initially used in premature infant apnea.In recent years,the development of HHFNC applications is rapid,and HHFNC is gradually used in older infants and children.Compared to other noninvasive oxygen supply devices,HHFNC can be used effectively in clinic because of its high comfort,good tolerance,easy care,and reducing the rate of endotracheal intubation.

Objective To explore the correlation analysis of plasma TNF-?,D-lactate levels and serious case score and clinical significance.Methods Plasma TNF-?,D-lactate levels and results from serious case'score was contrastingly studied in 120 cases of serious sick children during hospitalization in our PICU.Results The study findings showed that the plasma TNF-? and D-lactate levels had produced an obviously influence on score.Conclusions The more high plasma TNF-? and D-lactate levels,the lower score and the more dangerous condition in children with serious disease.

Objective To analyze the clinical features of the hyperamylasemia in critically ill children and investigate the related risk factors in order to provide the basis for prevention and treatment. Methods A total of 1036 critically ill children admitted in pediatric intensive care unit (PICU)from April,2011 to Oct,2012 were studied.They were divided into the high amylase group (n=82)and the normal group (n=954).According to the outcomes,the high amylase group was divided into survival group (n=61 ) and death group (n =21 ).The related risk factors of the occurrence and outcome of hyperamylasemia were analyzed by univariate and multivariate Logistic regression.Results There were statistically significant differences in rates of coagulation disorders, convulsions, disturbance of consciousness,pediatric critical illness score (PCIS)≤80,multiple organ dysfunction (MODS)≥3, sepsis,shock,and lactic acid (LA),procalcitonin (PCT),blood glucose (BG)between the high amylase group and the normal group (P<0.05 ).The differences in the rates of coagulation disorders,convulsions, mechanical ventilation,PCIS≤80,MODS≥3,and LA,PCT,oxygenation index,albumin,C-peptide,BG were statistically significant between the survival group and the death group (P <0.05 ).Multivariate Logistic regression analysis showed that the risk factors of the hyperamylasemia's occurrence were LA,PCT, BG,PCIS<80,MODS>3.Adjusted ORs confidence intervals of them were 1.662 (1.236-2.234),1.042 (1.025-1.060),1.612 (1.411-1.843),3.219 (1.311-7.905),3.411 (1.370-8.494),respectively. The hyperamylasemia's prognostic risk factors were PCT,C-peptide,PCIS ≤80,MODS >3,shock. Adjusted ORs confidence intervals of them were 1.066(1.021-1.113),1.437(1.017 ~2.030),16.137 (1.876-138.836),10.437(1.528-71.925),20.928(1.938-226.009),respectively.Conclusions The severity of the disease,the levels of LA,PCT,BG in critically ill children were positively correlated to the occurrence of hyperamylasemia.The severity of the disease,the incidence of organ failures,the levels of PCT,C-peptide combined shock in children with hyperamylasemia were positively correlated to the prognosis of hyperamylasemia.

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 comment the severity of severe hand,foot and mouth disease(HFMD)by pediatric risk of mortality score(PRISM),and assess the performance of PRISM in predicting mortality or complication probability in HFMD.Methods Four hundred and twenty-four severe HFMD pediatric patients were recruited in the study from 1th Jan 2010 to 31th June 2013.Information on the outcome and the varia-bles required to calculate PRISM score were collected.The logistic regression model developed in the learning sample was evaluated in the test sample by calculating the area under the receiver operating characteristic (ROC)curve to assess discrimination pneumorrhagia and death.Calibration across deciles of risk was evalua-ted using the Hosmer-Lemeshow goodness-of-fit χ2 test.Results The area under the ROC curve were 0.87 (95%CI 0.80~0.94 )for PRISM in predicting pneumorrhagia probability.The area under the ROC curve were 0.87(95%CI 0.80~0.95)for PRISM in predicting mortality probability.The PRISM in observed and expected pneumorrhagia did not demonstrate good calibration at ten mortality risk intervals (χ2 =36.66, P<0.001 ).The PRISM in observed and expected mortality did not demonstrate good calibration at ten mortali-ty risk intervals(χ2 =41.11,P<0.001).Conclusion The PRISM score is demonstrated good discrimination of pneumorrhagia and death in HFMD pediatric patients,but the performance of calibration is not good.