Anthropometry ; Child ; Child Nutritional Physiological Phenomena ; Child, Hospitalized ; Critical Care ; methods ; Critical Illness ; Enteral Nutrition ; Humans ; Infant ; Intensive Care Units, Pediatric ; Malnutrition ; diagnosis ; prevention & control ; Nutrition Assessment ; Nutritional Status ; Parenteral Nutrition ; Predictive Value of Tests

“Expert consensus for the diagnosis and management of septic shock( infectious shock) in children (2015)” has been published based on the “Recommended protocol for diagnosis and treatment of septic shock in children” which was published in 2006.The definition, diagnosis and early management pro-t ocol of pediatric septic shock was revised partly in the latest expert consensus.The goal of the expert consen-sus was to guide the clinical physicians on early identification and early intervention of pediatric septic shock, and reduce mortality and improve prognosis of septic shock in children.

ObjectiveTo obtain data related to various periods of acupuncture treatment for rat focal ischemia and reperfusion and infer the optimal time point of acupuncture treatment by examining cerebral ROCK expression on the ischemic side in different periods of acupuncture for rats with focal ischemia and reperfusion.MethodOne hundred andeighty male adult Wistar rats were enrolled and randomly allocated to blank, sham operation, model and acupuncture groups. The model and acupuncture groups were separately divided into 5 subgroups: the 6 h, 24 h, 48 h, 72 h and 2 w subgroups. There were atotal of 12 groups, 15 rats each. An animal model of focal cerebral ischemia was made using a thread occlusion method for obstructing rat right middle cerebral artery. The carotid artery was only separated in the sham operation. Materials were taken in the blank and sham operation groups on day 2 after model making. Materials were taken for examination in every subgroup of the model group at 6, 24, 48 and 72 hours and 2 weeks after model making. Materials were taken for examination after acupuncture at Baihui(GV20), Dazhui(GV14)and Zusanli (ST36)in every subgroup of the acupuncture group at 6, 24, 48 and 72 hours and 2 weeks after model making.ResultAcupuncture markedly improved neurological deficits in rats with cerebral ischemia and reperfusion. Areduction in the neurological deficit score was largest in the 6 h acupuncture group and there was a statistically significant difference compared with the other acupuncture groups (24 h, 48 h and 72 h) (P<0.05). There was no statistically significant difference in ROCK expression between the sham operation and blank groups (P>0.05). There was a statistically significant difference in ROCK expression between the model (ischemia-reperfusion 6 h, 24 h, 48 h and 72 h) and blank groups (P<0.05). ROCK expressionreached the peak value at 6 hours after ischemia and reperfusion. There was a statistically significant point-to-point difference in ROCK expression between the acupuncture (ischemia-reperfusion 6 h, 24 h, 48 h and 72 h) and model (ischemia-reperfusion 6h, 24 h, 48 h and 72 h) groups (P<0.05). ROCK expression was down-regulated most markedly in the ischemia-reperfusion 6 h acupuncture group.Conclusion Acupuncture has an inhibitory effect on Rho/Rock in a rat model of cerebral ischemia and reperfusion. Six hours after ischemia and reperfusion is the optimal time point of acupuncture treatment. Acupuncture at that time can protect and improve post-ischemic injured brain tissue to the largest extent.

Objective To explore the clinical effect of refractory atelectasis treated with high dose ambroxol.Methods 112 patients with refractory atelectasis were selected as research subjects.All the patients were divided into two groups with each group 56 patients according to admission order.The control group received symptom treatment,physics treatment and routine dosage ambroxol,while the observation group received high dose ambroxol.The clinical effect and safe between two groups were compared.Results The excellence rate and total effective rate of the observation group were 71.43％ (40/56) and 100.00％ (56/56),respectively,which were higher than 51.79％ (29/56) and 83.93％ (47/56) of the control group (x2 =4.57,9.79,all P ＜ 0.05).There were no statistical difference on the total adverse effect incidence rates between the two groups(x2 =0.15,P ＞0.05).No other sever adverse effects happened in both groups.Conclusion Compared with routine dosage ambroxol,the clinical effect of refractory atelectasis treated with high dose ambroxol was better.The treatment was also safe.It was worth generalizing on the treatment of refractory atelectasis.

Objective: To explore the effect of the application of ICQ technology in constructing a harmonious environment for nursing staff.Method: The Internet,support from Tencent network,ICQ technology are employed to conduct on line communication among nursing staff.Result: the Working and interpersonal connection environment is remarkably improved by the application of ICQ technology,thus it is of great significance in constructing a harmonious relation among nursing staff and enhancing medical service quality.

ObjectiveTo discuss the infiuence of personalized nursing intervention on success rate of holding breathing in patients undergoing dual-source CT imaging.Methods167 cases of patients were randomly divided into the observation group(100 cases)and the control group(67 cases). The control group implemented routine care, on the basis of routine care, the observation group was given pertinent and individualized nursing intervemion according to the factors causing failure of holding breathing, including better psychological counseling for patients, the right guidance, to alleviate symptoms, to improve comfort degree, to give clinical evaluation after inspection, et al.ResultsThe success rate of holding breathing in the observation group and the control group was 99.0％ and 88.1％, the observation group was significantly higher than the control group.ConclusionsHealth education for patients, attention to patients' illness, mental state, cognitive and behavioral changes in a timely manner to give individualized nursing intervention and seriously check the implementation of results in patients, can effectively improve the success rate of holding breathing in patients undergoing dual-source CT coronary angiography.

During cardiopulmonary resuscitation (CPR),ventilation is provided by either mouth-to-mouth or bag-mask technique,and give 12 to 20 times breaths per minute.Ventilation should deliver 8 to 10 times breaths per minute after endotracheal intubation.Compression-ventilation ratio is 30∶2 for one rescuerand 15∶2 for two rescuers.After the return of spontaneous circulation,if no spontaneous breathing or irregular,respiratory insufficiency,mechanical ventilation is required.High oxygen and excessive ventilation after CPR should be avoided.When acute lung injury or acute respiratory distress syndrome occurs after CPR,lung protective ventilation strategy is applicable.

Objective An initial study on the cognition of the relationship between clinical and management staff for the purpose of improvements. Methods Questionnaires were issued to 38 clinical medical staff and 26 hospital management staff, regarding this relationship. Results Consensus is found between the two groups regarding clinical involvement in management, teamwork and exchange, and cognition on the competence and capability of the other party, P>0.05. On the other hand, however,cognitive differences are found regarding mutual penetration, power balance and implementation of policies and systems. Conclusions In-depth cooperation and understanding between the two groups and the mutual conversion of their behaviors and concepts are the cornerstones of an ideal relationship between clinical staff and management staff.

With the development of income per capita,"high personal medical expenditure" shows the wider of disease risk,which is resulted from the increasing medical payment and imperfect risk pooling.The former that is related with the excess delivery of advance medical technology and drug has been a dominating reason since 1980.And the imperfect risk pooling means the imperfect social medical insurance,of which the government should take charge.However,influenced by the reform policies of the economic systems,similar to all the transitional economies reducing the government role in healthcare financing,China has put an increasing emphasis on the payroll tax-based social insurance system and out-pockets payment,moving away from a predominantly general revenue-based financing system under the old command economy.In a conclusion,the Chinese Government should make clear the financing function,and replace fee-for-service(FFS) payment according to the distorted pricing system with aggregated pre-payment for patients covered by social insurance to mitigate the incentive for cost escalation.Meanwhile,the target of the new medical reform that should resolve the problem of high personal medical expenditure is demanding and perfecting the social medical insurance with wider risk pooling.

OBJECTIVE:To determine the content of sophocarpidine in Fuyankang concentrated pill by HPLC.METHO_ DS:The loading agent of chromatographic column was amino bonded silica,the mobile phase was acetonitrile-dehydrated al?cohol-3%phosphoric acid(80∶10∶10),and the detection wavelength was220nm.RESULTS:There was a good linear rela?tionship between sample size and peak area score of sophocarpidine in the range of0.4064?g～2.0320?g,the average recovery rate was99.2%(RSD=1.6%).CONCLUSION:The established method is more accurate than TLC,and it can be used for the quality control of Fuyankang concentrated pill.