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Expression and significance of keratinocyte growth factor-1 in kidneys of septic rats

Shuyang YU ; Yubin WU ; Min ZHANG ; Ran WANG

Chinese Pediatric Emergency Medicine.2011;18(3):254-257,后插3. doi:10.3760/cma.j.issn.1673-4912.2011.03.020

Objective To investigate the expression and significance of keratinocyte growth factor-1(KGF-1) in the kidneys of septic rats.Methods Eighty male Wistar rats were randomly divided into the sepsis group and sham operation group.Either group was divided into 3-hour,6-hour,12-hour,24-hour and 36-hour subgroups,with 8 rats in each.Sepsis models were established by cecum ligation perforation (CLP).The kidney and blood samples were respectively taken for pathological study.Serum creatinine (Cr) and blood urea nitrogen (BUN) level determination and leukocyte counting were performed.KGF-1 protein was detected by immunohistochemical method and the expression of KGF-1 genes by real time PCR.Results The renal tubules in sepsis group were injured most at 24h after operation,which were infiltrated by considerable neutrophilic granulocytes,leukomonocytes and mononuclear cells,with vacuolar degeneration,focal hemorrhage and necrosis under the light microscopy.Serum Cr and BUN increased from 6h after operation,and reached the peak at 24h after operation in sepsis group,which were significantly different in those of sham operation group (P< 0.01).Compared with sham operation group,the expression of KGF-1 protein and genes of sepsis group increased significantly and reached the peak at 6h after operation.KGF-1mRNA was positively correlated with BUN and Cr (r=0.504,P<0.01;r=0.382,P<0.05).Conclusion KGF-1 was also expressed in normal kidneys,mainly in tubule epithelial cells of renal medulla and also in that of renal cortex.The expression of KGF-1 in sepsis group was obviously higher than that of sham operation group,and was positively correlated with the degree of kidney damage after infection.KGF-1 was speculated to be one of the protective factors affecting the repair of impaired kidneys caused by infection.

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Security problems of continuous blood purification

Guoping LU ; Xiaodi CAI

Chinese Pediatric Emergency Medicine.2012;19(2):118-120,127. doi:10.3760/cma.j.issn.1673-4912.2012.02.005

As a kind of effective treatment,continuous blood purification (CBP),still left some risk factors in critically ill children.The risk factors include catheter-related complications such as bleeding and mispractice at the acute phase,long-term complications such as catheter infections,tube jam;complications occurred in the process of CBP such as low blood pressure,hypothermia and abnormal coagulation;metabolic complications such as lost syndrome and imbalance syndrome.CBP should be implemented safely and effectively in pediatric field by mastering the skill proficiently,continuously monitoring vital signs,tackling complications and accidental episodes.

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Common gram-negative bacilli lower respiratory tract infection in PICU: analysis of pathogens and drug resistant pattern from 2004 to 2009

Jing ZHENG ; Qing XIAO ; Ni LIAO ; Ning ZHANG ; Guoying ZHANG

Chinese Pediatric Emergency Medicine.2010;17(5):418-420,423. doi:10.3760/cma.j.issn.1673-4912.2010.05.015

Objective To study common Gram negative bacterial pathogens and their drug resistant pattern in sputum isolates from patients in pediatric intensive care unit (PICU) of Chengdu children' s hospital. Methods Comparing to the period of 2004-2006 with 2007-2009, we retrospectively reviewed eligible sputum isolates of common Gram negative bacilli and their drug resistance pattern. All specimens were processed according to standard microbiological methods for both quantitative and qualitative cultures. Pathogen was the single predominant growth after two consecutive cultures. Strict quality control was used in all test agents and paper disk for drug resistance analysis. Results Total of 598 Gram negative bacterial isolates were identified in patients over 6 years. The first 5 bacteria respectively were Escherichia coli 167 samples(27.93%), Klebsiella pneumoniae 109 samples ( 18.23% ), Enterobacter cloacae 93 samples ( 15.55% ),Acinetobacter baumannii 64 samples ( 10. 7% ), Pseudomonas aeroginosa 43 samples (7. 19% ). They were mostly sensitive to Imipenam, Amikacin, Piperacillin/Tazobactam. Most drug resistance rate was found in Amoxicillin, Ampicillin, Cephalosporin. Apart from Pseudomonas aeroginosa and Acinetobacter Baumannii,no Gram negative bacteria was found to be resistant to Imipenam. Klebsiella pneumoniae and ESBL secreting Escherichia coli isolates were obviously increasing when compared to 3 years ago. Conclusion Comparing the period of 2004-2006, the Gram negative bacterial isolates were increasing in our PICU patients during 2007 to 2009. Close monitoring of drug resistance pattern changes in PICU would guide rational use of antibiotics in these critically ill children.

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Comparison between 3% hypertonic saline and 20 % mannitol intermittent intravenous Infusion in the treatment of acute brain edema in children

Tuxun SI ; Zhiwei XIE ; Jianhui ZHANG

Chinese Pediatric Emergency Medicine.2009;16(3):228-230,239. doi:10.3760/cma.j.issn.1673-4912.2009.03.008

Objective To compare the clinical efficacy of 3% hypertonic saline with 20% mannitol in the treatment of acute brain edema in children.Methods Twenty children with acute brain edema were randomly divided into hypertonic saline(HS) group and mannitol group.HS group and mannitol group were given 3% HS solution or 20% mannitol respectively.Main outcome measurements included intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure (CPP),serum electrolytes,plasma osmolality,renal function and urine volume.Results Both 3% HS and 20% mannitol were effective in reducing ICP(P ＜0.05).Therapeutic effect lasted(4.5±1.2) h in HS group and(3.2±1.5) h in mannitoi group.3% HS had a longer duration of action than marmitol(P＜0.05).At the time point of 2 hours after treatment,MAP and CPP of HS group increased more than those of mannitol group(P＜0.05).Conclusion Both 3% HS and 20% mannitol could rapidly decrease ICP.3% HS has a longer duration of action in reducing ICP than 20% mannitol.3% HS is more effective in stabilizing circulation and improving CPP than 20% mannitol.

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Clinical analysis of rotavirus enteritis in children in Yueqing city

Xiaoya HUANG ; Danqing RUAN ; Qinbi ZHANG ; Yuandi ZHENG ; Xiaochun YANG

Chinese Pediatric Emergency Medicine.2014;21(7):433-435,439. doi:10.3760/cma.j.issn.1673-4912.2014.07.009

Objeetive To explore the situation of rotavirus infection and extraintestinal organe damage in children in Yueqing city.Methods Two hundred and eighty-seven cases with acute rotavirus gastroenteritis in our hospital were analyzed for prospective study from October 2011 to January 2013 by stool tests.Results Rotavirus infection was found to be more common in autumn and winter.There were 223 cases (17.7％) got extraintestinal organe damage,175 cases (60.80％) got myocardial lesion,and 78 cases (27.18％) got respiratory infection.At the same time,there were 51 cases (17.77％) and 21 cases (7.31％) got liver function lesion and convulsion respectively.Among the metabolic acidosis(48 cases),39 cases were combined with myocardial lesion.While non metabolic acidosis were 239 cases (81.25％),and 136 cases were combined with myocardial lesion.Therefore,the myocardial lesion was significant correlation with metabolic acidosis (P ＜ 0.01).Iron deficiency anemia was 123 cases and combined with 15 cases (12.19％) convulsion,while the convulsion prevalence rates of non iron deficiency anemia was 6 cases (3.65 ％).There was a statistically significant difference between the convulsion prevalence rates of iron deficiency anemia and that of non iron deficiency anemia (P ＜ 0.01).Conclusion Rotavirus diarrhea can lead to extraintestinal organe damage,and the clinical doctors should pay attention to them.

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Goals and objectives of sedation and analgesia in PICU

Feng XU

Chinese Pediatric Emergency Medicine.2014;21(2):68-69,73. doi:10.3760/cma.j.issn.1673-4912.2014.02.002

Pain of recent side effects including a children's breathing,circulation,metabolism,immune and nervous system.The long-term side effects including mental,physical and mental growth,development,behavior and so on.Pain at the same time,the children will also have a negative impact to their families and the society.Implementation of analgesia and sedation therapy for children and is therefore clinicians morality and responsibility,need to clinicians from the perspective of professional and humane thinking and understanding.Use of analgesic and sedation therapy to keep children safe and comfortable is the most basic link in PICU treatment.

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The expression and clinical significance of CD62p, CD63 and CD64 in children with sepsis

Jinying LI ; Shunxiang DI ; Zhiying XU ; Ying ZHANG

Chinese Pediatric Emergency Medicine.2014;21(1):16-18,30. doi:10.3760/cma.j.issn.1673-4912.2014.01.006

Objective To investigate the expression and clinical significance of platelet glycoprotein CD62p,CD63 and neutrophil surface CD64 in sepsis.Methods Fifty-six children with sepsis from March 2010 to March 2013 in Communicable Disease Department of our hospital were divided into severe sepsis group(n =16) and general sepsis group (n =40),normal control group included 34 subjects from health check.CD62p,CD63 and CD64 were detected by flow cytometry in children with sepsis,and compared with normal control group.Results The levels of CD62p,CD63 and CD64 in severe sepsis group were higher than those of general sepsis group (P ＜ 0.01).The levels of CD62p,CD63 and CD64 in general sepsis group were higher than those of normal control group (P ＜ 0.01).Correlation analysis indicated that CD62p and CD63 were in positive correlation with CD64 in children with sepsis(r =0.817,0.796,P ＜0.001).The positive correlations of CD62p,CD63 and CD64 with pediatric critical illness score were also found(CD62p:r =0.883,P ＜0.001;CD63:r=0.862,P ＜0.001;CD64:r=0.805,P ＜0.001).Conclusion CD62p,CD63 and CD64 are closely related to the severity of infection and diseases,and may be used as immune parameters for the estimation of the clinical severity and the prognosis of acute and severe diseases.

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The sedation and analgesia agents in PICU

Wenliang YU

Chinese Pediatric Emergency Medicine.2014;21(2):74-78,83. doi:10.3760/cma.j.issn.1673-4912.2014.02.004

Almost all children in PICU need analgesia and/or sedation.A therapeutic plan for analgesia and sedation should be established for each patient and regularly reviewed.The most often used sedation agents in PICU patients are Morphine or Fentanyl alone or in combination with Midazolam.There are several agents that have been used to provide sedation and analgesia in the PICU patient including benzodiazepines,opioids,ketamine,propofol,chloral hydrate,barbiturates,NSAIDs and paracetamol and α-adrenoreceptor agonists.This review described the various agents for sedation and discussed their advantages and disadvantages as they pertain to the PICU.Consequences of and treatment strategies for adverse effects with sedation and analgesia including respiratory depression,hypotension,withdrawal syndrome and propofol infusion syndrome were reviewed.

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Analysis of clinical feature and antibiotic resistance of pathogenic bacteria in PICU

Mei LI ; Dan WEI

Chinese Pediatric Emergency Medicine.2014;21(2):93-96,100. doi:10.3760/cma.j.issn.1673-4912.2014.02.008

Objective To investigate the distribution and antibiotic resistance of pathogenic bacteria in PICU and to provide evidence for use of antibiotics rationally.Methods All the basic clinical features and pathogenic bacteria isolated from patients in PICU of our hospital from October 2009 to September 2012 were analyzed retrospectively.Results A total of 672 pathogenic bacterial strains were isolated (positive rate 16.7％ 672/4 020),75.1％ and 24.9％ were gram negative bacteria and gram positive bacteria,respectively.Pseudomonas aeruginosa was the most common bacteria isolated in gram negative bacteria,followed by Klebsiella pneumonia and Escherichia coli in this order.And Staphylococcus was the main strain in gram positive bacteria.Positive specimens were mainly from lower respiratory tract and bloodstream infection.Most Staphylococcus were resistant to penicillin,oxacillin and erythromycin but susceptible to vancomycin,teicoplanin and linezolid.Gram negative bacteria were resistant to ampicillin,ampicillin-sulbactam,piperacillin and cephalosporin,but susceptible to imipenem,cefoperazone-sulbactam,piperacillin-tazobactam,ciprofloxacin and amikacin.Conclusion Gram negative bacteria is the prevalent strains in PICU of our hospital,Pseudomonas aeruginosa,Klebsiella pneumonia and Escherichia coli are common bacterium isolated.Most isolates are highly drug-resistant.Analysis of pathogenic bacteria and drug-resistance surveillance are of vital importance to guide treatments for critically ill children and reduce drug-resistant bacterial strains.

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Diagnosis and emergency treatment of increased intracraniai pressure in children

Fei YIN ; Xiaolu DENG

Chinese Pediatric Emergency Medicine.2011;18(5):397-399,402. doi:10.3760/cma.j.issn.1673-4912.2011.05.005

Increased intracranial pressure is one of the most severe complications with significant mortality in children,so early diagnosis and treatment of this disorder is critical to save the patient's life.This article reviews etiologies,pathophysiology,and general principles of diagnosis and management of increased intracranial pressure.Based on primary diseases and clinical presentations,the goal of therapeutic strategy is to decrease intracranial pressure,avoid neurologic sequelae,and improve the outcome in patients.

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