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 evaluate the risk factors of broad-spectrum antibiotic usage more than for two weeks and primary pulmonary disease as a risk factor of nosocomial infections. METHODS A retrieval report which used retrospective case control study to analyze the two risk factors of fungi nosocomial infection was reviewed. Fixed effect model or stochastic effect model were used for statistical analysis. RESULTS Three retrospective case control studyies were investigated. The primary pulmonary disease exposure rate was significantly higher than control group. Broad-spectrum antibiotic usage exposure rate had not significant difference. CONCLUSIONS Broad-spectrum antibiotic more than two weeks isn′t a risk factor but primary pulmonary disease is the risk factor for fungi nosocomial infection.

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.

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 establish a method for the content determination of magnesium in esomeprazole magnesium. Methods:The content of magnesium in esomeprazole magnesium was determined by inductive coupled plasma atomic emission spectrometry. Re-sults:The linear range was 10.0-80.0 μg·ml-1(r=0.999 8). The average recovery was 99.55% with RSD of 1.35% (n=9). The detection limit was 0. 000 75 μg·ml-1 and the quantitative limit was 0. 002 5 μg·ml-1 . Conclusion:The method is accurate, sensitive and reproducible, which can be used for the content determination of magnesium in esomeprazole magnesium.

Objective To analyze the clinicopathological characteristics of upper gastrointestinal submucosal tumors ( SMTs ) . Methods Clinicopathological data of 1 743 patients with 1 775 upper gastrointestinal SMTs in our department from January 2008 to December 2012 were retrospectively analyzed. Results The first finding was that in 702 esophagus cases,leiomyoma(92?59%,650/702) was the most common type of esophageal SMTs. Second, in 1 045 gastric cases, there were 405 lesions at gastric fundus, the most common type of SMTs were 249 ( 61?48%) GISTs and 144 ( 35?56%) leiomyoma. In 307 lesions located at body,the most common type of SMTs were 143( 46?58%) GISTs and 90( 29?32%) leiomyoma. In 191 lesions located at antrum, the most common type of SMTs were 83( 43?46%) heterotopia pancreas and 45(23?56%) hamartoma, followed by 28(14?66%) lipoma and 20(10?47%) GISTs. In 142 lesions located at cardia, the most common type of SMTs was 110 ( 77?46%) leiomyoma. Third, in 28 duodenum cases, there were 19 lesions at duodenal bulb, the most common type of SMTs was 10 heterotopia pancreas, 4 Brunner gland adenoma and 3 GISTs. In 9 lesions located at descending duodenum,the most common type of SMTs was 4 lipomyoma, followed by 2 ectopic pancreas,1 GISTs and 2 others. Conclusion Leiomyoma is the most common type of esophageal SMTs. In gastric fundus and body, the most common type of SMTs are GISTs and leiomyoma. In antrum, the most common type of SMTs are heterotopia pancreas and hamartoma, but in cardia, that is leiomyoma.In duodenal bulb, the most common type of SMTs are heterotopia pancreas, Brunner gland adenoma and GISTs,and in descending duodenum, is lipomyoma.

Background Researchers showed that posterior capsule opacification (PCO) may be associated with the materials of intraocular lenses (IOLs).However,there have long been controversies about the influence of IOLs materials on PCO pathogenesis.Objective This study was to compare the capsule biocompatibility of different materials of IOLs by observing the biological behavior of human lens epithelial cells (LECs) on the surface of IOLs,including adhesion,proliferation,epithelial mesenchymal transition (EMT) and the secretion of transforming growth factor-β2(TGF-β2),interleukin-6 (IL-6),matrix metalloproteinase-2 (MMP-2) and MMP-9 in vitro.Methods Human lens epithelial cell line (HLE-B3) was cultured on the surface of hydrophobic acrylic (Acrysof SA60AT) IOLs,silicone (Crystalens HD) IOLs and polymethyl methacrylate (PMMA) IOLs for 6 hours and 24 hours,respectively.The number and morphology of HLE-B3 cells on the surface of IOLs were observed under the optical microscope.The proliferation states of the cells on the IOL surface were detected with cell counting kit-8 (CCK-8).The expression of α-smooth muscle actin (α-SMA),a mesenchymal cell marker,in the cells was detected by immunofluoreseence technology,and the EMT rates of HLE-B3 cells were calculated.The contents of TGF-β2,IL-6,MMP-2 and MMP-9 in the medium of IOL surface were measured by ELISA assay.The examination results were compared among different IOLs.Results Six hours after cultured,attached cells showed polygon and round in shape on the surface of Acrysof IOLs and Crystalens IOLs,while those on the PMMA IOLs showed the fusiform.Twenty-four hours after cultured,the cells extended obviously.On the surface of Acrysof IOLs and Crystalens IOLs,the adherent cells showed less cobble-stone like and more spindle shape;while those on the PMMA IOLs showed the typical fiber and some cells clustered the pearl rolls.The number of the cells on the Acrysof IOLs,Crystalens IOLs and PMMA IOLs was 0.238 4 ± 0.007 1,0.178 1 ±-0.006 6 and 0.158 9 ± 0.006 9 respectively,showing a significant difference among the three types of IOLs (F =475.947,P =0.000),and the number of the cells was much more on the Acrysof IOLs than that on the Crystalens IOLs or PMMA IOLs (both at P＜0.001).The EMT rats of the cells on the Acrysof IOLs,Crystalens IOLs and PMMA IOLs were (9.99±3.80) ％,(17.33±5.71) ％ and (84.16±10.48) ％,with a significant difference among them (F =127.411,P =0.000),and the EMT rates of the cells on the PMMA IOLs were significantly higher than those on the Crystalens IOLs and A.crysof IOLs(both at P＜0.001).There were significant differences in the contents of TGF-β2,IL-6,MMP-2 and MMP-9 in the medium on the Acrysof IOLs,Crystalens IOLs and PMMA IOLs (F =0.846,0.947,0.255,0.922,all at P ＞ 0.05).Conclusions The hydrophobic acrylic IOLs have the best capsule biocompatibility followed by the silicone IOLs and then the PMMA IOLs.

In August 2018, The Chinese Consensus on Endoscopic Diagnosis and Management of Gastrointestinal Submucosal Tumors, which was formulated by the Surgical Group of Chinese Society of Digestive Endoscopology, the Chinese Physicians Association Endoscopy Branch Digestive Endoscopy Professional Committee, the Gastrointestinal Surgery Group of Chinese Society of Surgery, was published in Chinese Journal of Gastrointestinal Surgery. This consensus is the first guideline in the area of gastrointestinal submucosal tumors (SMTs) in China, and it proposed the diagnosis and management procedure of SMTs from the endoscopists′ viewpoint. This consensus presents case selection principles and technical principles of endoscopic treatment of SMTs. For and the indication and contraindication of endoscopic treatment of SMTs, it is suggested that clinician choose optimal procedure according to disease′s characteristics and techniques of the clinician. In this review, the key contents of consensus are interpreted in detail. The application of endoscopic snare resection, endoscopic submucosal excavation, endoscopic full-thickness resection and submucosal tunneling endoscopic resection at different SMTs was summarized. At the same time, the controversies in endoscopic diagnosis and management of the SMTs, such as biopsy, indication of endoscopic treatment and new techniques of endoscopic therapy, were analyzed.

Objective:To investigate the etiology of pleural effusion in hospitalized children in Beijing Children′s Hospital.Methods:Clinical information of children with pleural effusion admitted to Beijing Children′s Hospital Affiliated to Capital Medical University from January 2016 to December 2018 was retrospectively analyzed.According to the etiology, the children were divided into infection group (parapneumonic pleural effusion, tuberculous pleurisy and empyema) and non infection group.According to the age, the children were further divided into ≤ 3 years old, >3-7 years old and > 7 years old groups.Classification of statistics was performed, and the etiology of pleural effusion were retrospectively analyzed.Results:Among the 1 165 children with pleural effusion, 746 cases(64.0%) were infected with pleural effusion, 697 cases (697/746, 93.4%) of who were parapneumonic effusion.In patients with parapneumonic effusion, 457 cases (61.3%) had Mycoplasma pneumonia (MP) infection.Infectious pleural effusion was more common in children >7 years old(339/479 cases, 70.8%), while non-infectious pleural effusion was prevalent in children under 3 years old(188/324 cases, 58.0%). The difference was statistically significant ( χ2=96.33, P<0.05). Among the patients with non-infectious pleural effusion, 239 cases (239/419 cases, 57.0%) had multi-system diseases and 97 cases (97/419 cases, 23.2%) had malignant pleural effusion.All the 18 deaths were non-infectious pleural effusion. Conclusions:The leading reason for pleural effusion in children is infection.The most prevalent symptom is parapneumonic effusion, which is mainly caused by MP.