In October 2020, the American Heart Association(AHA) published the 2020 guidelines for cardio-pulmonary resuscitation and emergency cardiopulmonary resuscitatio, it is a comprehensive revision for adult, pediatric, neonatal, resuscitation education science, and systems of care topics.This article mainly interprets the most important updates of pediatric and neonatal basic and advanced life support.

Objective To prospectively study the effects of different fluid resuscitation on kidney function in pediatric patients with sepsis.Methods One hundred and eighteen pediatric patients with sepsis shock who needed fluid resuscitation in Intensive Care Unit,Zhengzhou Children′s Hospital from June 2012 to June 2015 were selected, and they were randomly divided into group A,B and C by random number in the table.The patients received fluid resus-citation of hydroxyethyl starch,50 g/L albumin and 9 g/L saline.After that,neutrophil gelatinase associated lipocalin (NGAL),α-1 microglobulin,urea nitrogen,creatinine,urine volume,the incidence of acute kidney injury (AKI),and the renal replacement therapy rate accepted by the patients were recorded.Then all the data were analyzed with SPSS 19.0 software.Results Serum levels of NGAL and α-1 microglobulin in group A [(103.50 ±1.23)μg/L,(3.32 ± 0.20)mg/L]were higher than those in group B [(93.54 ±1.42 )μg/L,(2.71 ±0.18 )mg/L]and group C [(79.57 ±1.54)μg/L,(2.08 ±0.14)mg/L],which were statistically different(all P <0.05 );serum levels of NGAL and α-1 microglobulin in group B were higher than those in group C,which were statistically different(all P <0.05).Serum levels of urea nitrogen and creatinine in group A[(5.23 ±0.34)mmol/L,(112.00 ±7.12)μmol/L] were higher than those in group B [(3.56 ±0.31)mmol/L,(77.25 ±5.34)μmol/L]and group C[(2.95 ±0.42) mmol /L,(72.12 ±6.34)μmol/L],which were statistically different (all P <0.05);serum levels of urea nitrogen and creatinine in group B were higher than those in group C,which were not statistically different(P >0.05).The urine volume in group A [(0.50 ±0.12)mL/(kg·h)]was less than that in group B[(0.90 ±0.23)mL/(kg·h)]and group C[(1.30 ±0.14)mL/(kg·h)],which was statistically different(all P <0.05);the urine volume in group B was less than that in group C,which was not statistically different(P >0.05).In three groups,there were 13 cases (34.2%)with AKI in group A,9 cases(23.1%)with AKI in group B,and 8 cases(19.5%)with AKI in group C, the incidence of AKI in group C was less than that in group B and group C,which was statistically different(χ2 =12.74,10.43;all P <0.05).All the groups all had children accepted renal replacement therapy,there were 8 cases (21.1%)in group A,7 cases(17.9%)in group B,and 6 cases (14.6%)in group C,and the cases who accepted renal replacement therapy rate in group C were less than those in group A and group B,which was statistically different(χ2 =11.36,8.73;all P <0.05).Conclusions The adverse effect of 9 g/L saline on kidney function is less than hydrox-yethyl starch and 50 g/L albumin,and hydroxyethyl starch has more adverse effects on kidney.Thus,9 g/L saline is a better option for fluid resuscitation in pediatric sepsis patients.

Objective To investigate clinical effect of patients with PICU multiple organ dysfunction by continuous blood filtration combined with naloxone.Methods 42 patients with multiple organ function failure were selected and randomly divided into 2 groups.The control group were treated by PICU conventional therapy, the experiment group were treated by continuous blood filtration combined with Naloxone.Vital signs, creatinine, creatine kinase and aspartate aminotransferase levels, length of stay and blood filtration were compared after 1 day and 3 days treatment.ResuIts Compared with control group,heart rate, oxidation index,creatinine and aspartate aminotransferase levels of the experiment group were lower(P<0.05).After 1 day and 3 days, compared with cnontrol group, length of stay and blood filtration of the experiment were lower(P<0.05).ConcIusion Continuous blood filtration combined with naloxone in treatment of multiple organ dysfunction syndrome PICU is effective and reliable.It can significantly improve renal function, shorten the length of hospital stay, and remove inflammatory mediators in plasma of patients.

Ultrasound can be used to visually evaluate brain structure, estimate intracranial pressure, and identify the function of cerebrovascular autoregulation and the reactivity of cerebrovascular carbon dioxide.It can also be used in the diagnosis of cerebral vasospasm and systemic circulation evaluation.Critical care ultrasound can help clinicians identify the primary injury of neurological system, prevent and effectively manage the secondary injury through bedside, real-time, non-invasive evaluation and monitoring.It can guide the implementation and evaluate the curative effect of brain protection algorithm.

Objective To explore the application value of pulse indicator continuous cardiac output (PiCCO) monitoring in the fluid management of children with acute respiratory distress syndrome (ARDS).Methods Thirty-two children with ARDS admitted to Pediatric Intensive Care Unit(PICU) of Zhengzhou Children's Hospital,from April 2013 to April 2016,were divided into intervention group (15 cases) and control group (17 cases) by adopting random number table method.Fluid management of intervention group by PiCCO,control group by central venous pressure,the 2 groups' oxygenation index (OI),acute lung injury score,mechanical ventilation time and 28 days mortality were statistically compared.The categorical data were analyzed by using SPSS 11.0 software,and the t test was used for the measurement data.The categorical data and mortality comparison were analyzed by adopting x2 test.The difference was statistically significant at P ＜ 0.05.Results After 3 days of mechanical ventilation,the changes of OI in the intervention group were significantly higher than those in the control group [(175.0 ±-43.7) mmHg vs.(143.0 ± 42.8) mmHg (1 mmHg =0.133 kPa),t =2.090 0,P ＜ 0.05].The intervention group was significantly shorter than the control group [(10.45 ± 3.12) d vs.(12.63 ± 2.87) d,t =2.058 7,P ＜ 0.05].There was no significant difference between 2 groups in acute lung injury score,PICU length of stay and 28 days mortality (all P ＞ 0.05).Conclusions PiCCO monitoring and guidance in the fluid management of pediatric ARDS can improve oxygenation after 3 days,reduce mechanical ventilation time,but can not significantly reduce the 28-day mortality.

Objective To design the circuit used in drug-iontophoresis and interference electric current therapy,which is a multi-functional apparatus. Methods Controlled by singlechip,through the D/A conversion and the functional generator ICL8038,a variety of waveforms were generated. The digital potentiometer was used to amplitude modulation. After the power amplifier and isolation,the signal needed was output. Results It had multiple output channels which could be regulated and controlled independently and could produce a variety of waveforms with adjustable parameters. Conclusion The circuit can complete the drug-iontophoresis and interference electric current therapy,which has simple structure and is low cost and multi-functional. It provides a new type of circuit for the relevant instrument design.

ObjectiveTo discuss the values of fiber bronchoscopy with three-way laryngeal mask airway continuous ventilation in 1-6 month old infants with oxygen-dependent respiratory diseases.MethodsFrom January 2010 to May 2011, 29 cases of 1-6 month old infants with oxygen-dependent respiratory diseases who underwent conventional ifber bronchoscope and 148 cases of 1-6 month old infants with oxygen-dependent respiratory diseases who underwent ifber bronchoscopy with three-way laryngeal mask airway continuous ventilation were enrolled in control and treatment groups respectively. The success rate of ifber bronchoscope and the incidence rate of complications were compared between two groups.ResultsIn the treatment group, the success rate of ifber bronchoscope was 89.2% which was signiifcantly higher than 58.6% in the control group and the rate of laryngeal edema was 9.1% which was signiifcantly lower than 35.3% in the control group. The rates of endotracheal intu-bation ventilation and postoperative hemorrhage were lower than those in the control group, but the difference was not statistical ly signiifcant.ConclusionFiber bronchoscopy with three-way laryngeal mask airway continuous ventilation is superior to the traditional ifber bronchoscope in 1-6 month old infants with oxygen dependent respiratory system diseases.

Objective To investigate the dosimetric properties of PTW 60019 synthetic diamond detector in small photon beams.Methods A PTW 60019 synthetic diamond detector was tested under 6 and 10 MV photon beams,respectively.Linearity with dose,dose rate dependence and off-axis ratio were measured and compared to those measured by an IBA SFD.Percentage depth doses were measured and compared to those measured by an IBA SFD and a PTW 31010 semiflex chamber.Total scatter factors were measured and compared to those measured by an IBA SFD and a PTW 31016 PinPoint chamber.Results The dose response of a PTW 60019 synthetic diamond detector showed a good linear behavior as a function of dose,with observed deviations below 0.2％ over a dose range from 100 to 1 000 MU.The dose rate response was almost independent,with deviations below 0.2％ in the dose rate range from 37 to 614 MU/min.For the fields of 20-100 mm in diameter,there were dose differences in percentage depth doses within 1％ as compared to an IBA SFD and a PTW 31010 semiflex chamber.For the 10 mm diameter field,the differences were up to 5.8％ in the build-up region.Off-axis ratios measurements showed a good agreement among the involved detectors (＜ 1％).The higher differences appeared in the penumbra region.A good agreement was also found in terms of total scatter factor measurements for the related detectors.Conclusions The observed dosimetric properties of the PTW 60019 synthetic diamond detector indicate that it is a suitable candidate for small photon beam dosimetry.

Objective To raise the awareness of the glandularis ureteritis. Methods Five cases with glandularis ureteritis confirmed by pathological examination from Jan 2001 to Jun 2012 were reviewed. The diagnosis was assessed on histopathologic studies in all. The clinical manifestations, the diagnosis and treatment were discussed. Results Resections of the affected ureter and ureteroplasty were undertaken for 2 patients. Ureteronephrectomy was performed for 2 patients because of serious hydronephrosis due to obstruction. Electrofulguration via-ureteroscopy was carried out for another patient. All patients have been well and without recurrence on following up for 15 to 152 months, with an average of 86.6 months. Conclusion Glandularis ureteritis is not frequently seen and the etiopathogenesis is not yet clear. Biopsy is very important for suspected neoplasm of ureter before performing nephrectomy.

Evolutionary psychology holds such an opinion that negative situation may threaten survival, trigger avoidance motive and have poor effects on the human-body function and the psychological quality. Both disgusted and sad situations can induce negative emotions. However, differences between the two situations on attention capture and emotion cognition during the emotion induction are still not well known. Typical disgusted and sad situation images were used in the present study to induce two negative emotions, and 15 young students (7 males and 8 females, aged 27 ± 3) were recruited in the experiments. Electroencephalogram of 32 leads was recorded when the subjects were viewing situation images, and event-related potentials (ERP) of all leads were obtained for future analysis. Paired sample t tests were carried out on two ERP signals separately induced by disgusted and sad situation images to get time quantum with significant statistical differences between the two ERP signals. Root-mean-square deviations of two ERP signals during each time quantum were calculated and the brain topographic map based on root-mean-square deviations was drawn to display differences of two ERP signals in spatial. Results showed that differences of ERP signals induced by disgusted and sad situation images were mainly manifested in T1 (120-450 ms) early and T2 (800-1,000 ms) later. During the period of T1, the occipital lobe reflecting attention capture was activated by both disgusted and sad situation images, but the prefrontal cortex reflecting emotion sense was activated only by disgusted situation images. During the period of T2, the prefrontal cortex was activated by both disgusted and sad situation images. However, the parietal lobe was activated only by disgusted situation images, which showed stronger emotional perception. The research results would have enlightenment to deepen understanding of negative emotion and to exploredeep cognitive neuroscience mechanisms of negative emotion induction.
Adult ; Attention ; Brain Mapping ; Cognition ; Electroencephalography ; Emotions ; Evoked Potentials ; Female ; Humans ; Male ; Occipital Lobe ; physiology ; Parietal Lobe ; physiology ; Prefrontal Cortex ; physiology