Objective:To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China.Methods:This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis.Results:Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) ( Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS ( Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion:Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.

Objective:To observe the efficacy of maintenance treatment of thiopurines after exclusive enteral nutrition (EEN) therapy for Crohn′s disease (CD) children, and explore the influencing factors of recurrence.Methods:A retrospective case-control study was conducted. CD children treated in the Children′s Hospital of Zhejiang University School of Medicine from March 2013 to March 2021 were included retrospectively. Data before EEN were collected including general demographics, Paris classification, the pediatric Crohn′s disease activity index (PCDAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and serum albumin levels. According to the recurrence at 1 year of follow-up, patients were divided into remission group and recurrence group. The differences in clinical data before EEN between the 2 groups were analyzed. The factors influencing the recurrence were analyzed.Results:Thirty-five children were enrolled, including 25 (71.4%) males and 10 (28.6%) females. The age at diagnose was (11.2 ± 3.1) years old and the disease duration was 3.5 (2.2, 6.9) months. After 1 year of follow-up, 15 children had recurrence at least for one time and were divided into the recurrence group. Twenty (57.1%) children continued to maintain 6-mercaptopurine (6-MP) monotherapy and were divided into the remission group. There was no significant differences in gender, diagnostic age, and CRP, ESR, serum albumin and PCDAI before EEN between the two groups (all P>0.05). There was significant difference in the percentage of patients with disease duration of longer than 1 year before EEN between the two groups ( P = 0.026) . Conclusions:The children with the disease duration of longer than 1 year before EEN may be in high risk of recurrence on the regimen of maintenance treatment of thiopurines after EEN.

Objective:To observe the efficacy of maintenance treatment of thiopurines after exclusive enteral nutrition (EEN) therapy for Crohn′s disease (CD) children, and explore the influencing factors of recurrence.Methods:A retrospective case-control study was conducted. CD children treated in the Children′s Hospital of Zhejiang University School of Medicine from March 2013 to March 2021 were included retrospectively. Data before EEN were collected including general demographics, Paris classification, the pediatric Crohn′s disease activity index (PCDAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and serum albumin levels. According to the recurrence at 1 year of follow-up, patients were divided into remission group and recurrence group. The differences in clinical data before EEN between the 2 groups were analyzed. The factors influencing the recurrence were analyzed.Results:Thirty-five children were enrolled, including 25 (71.4%) males and 10 (28.6%) females. The age at diagnose was (11.2 ± 3.1) years old and the disease duration was 3.5 (2.2, 6.9) months. After 1 year of follow-up, 15 children had recurrence at least for one time and were divided into the recurrence group. Twenty (57.1%) children continued to maintain 6-mercaptopurine (6-MP) monotherapy and were divided into the remission group. There was no significant differences in gender, diagnostic age, and CRP, ESR, serum albumin and PCDAI before EEN between the two groups (all P>0.05). There was significant difference in the percentage of patients with disease duration of longer than 1 year before EEN between the two groups ( P = 0.026) . Conclusions:The children with the disease duration of longer than 1 year before EEN may be in high risk of recurrence on the regimen of maintenance treatment of thiopurines after EEN.

Objective:To analyze the efficacy and safety of adalimumab in the treatment of pediatric inflammatory bowel disease (IBD) patients.Methods:Clinical data of pediatric IBD patients who switched to adalimumab therapy after the failure of infliximab in the Children′s Hospital, Zhejiang University School of Medicine from January 2019 to September 2020 were analyzed retrospectively. A descriptive method was used to analyze the general information, disease activity index and mucosal inflammation before and after the treatment of adalimumab. The pediatric Crohn′s disease activity index (PCDAI) and pediatric ulcerative colitis activity index (PUCAI) were used to evaluate the disease activity. The Crohn′s disease endoscopic index of severity (CDEIS) and ulcerative colitis endoscopic index of severity (UCEIS) were used to evaluate the mucosal inflammation.Results:A total of 10 children diagnosed with IBD were treated with adalimumab, including 9 patients of Crohn′s disease (CD) and 1 of ulcerative colitis (UC) . There were 6 males and 4 females, with disease onset age of 0.3 to 13.3 years and median duration of 38 (3 to 81) months before the treatment of adalimumab. In lesion location of 9 CD patients, 2 patients only involved the small intestine (L4a+L4b) and 7 patients involved the whole digestive tract (L3+L4a+L4b) according to Paris classification. The reasons of switching infliximab to adalimumab were as follows: primary loss response to infliximab occurred in 1 patient, secondary loss response to infliximab in 6 and severe anaphylaxis in 3. According to PCDAI and PUCAI, the clinical remission was achieved in 1, mild activity in 4, moderate in 3 and severe in 2 before the treatment of adalimumab. Clinical remission was achieved in 6, clinical response in 1 and non-response in 1 at the 10th week. After the median follow-up period of 25 (10 to 86) weeks, clinical remission was achieved in 8, the clinical symptom of 1 non-responsive patient was improved during the follow-up. The left 1 non-responsive patient stopped treatment of adalimumab and received gene sequencing test, and the results showed a hemizygote mutation of X-linked inhibitor of apoptosis protein ( XIAP) gene and the X-linked lymphocytic proliferation syndrome was considered. Five cases of side reaction occurred in 10 patients, mainly the respiratory infections, and no other serious side reactions occurred. Conclusion:Switching to adalimumab attains good outcome in pediatric IBD patients after the failure of infliximab.

Objective:To analyze the efficacy and safety of adalimumab in the treatment of pediatric inflammatory bowel disease (IBD) patients.Methods:Clinical data of pediatric IBD patients who switched to adalimumab therapy after the failure of infliximab in the Children′s Hospital, Zhejiang University School of Medicine from January 2019 to September 2020 were analyzed retrospectively. A descriptive method was used to analyze the general information, disease activity index and mucosal inflammation before and after the treatment of adalimumab. The pediatric Crohn′s disease activity index (PCDAI) and pediatric ulcerative colitis activity index (PUCAI) were used to evaluate the disease activity. The Crohn′s disease endoscopic index of severity (CDEIS) and ulcerative colitis endoscopic index of severity (UCEIS) were used to evaluate the mucosal inflammation.Results:A total of 10 children diagnosed with IBD were treated with adalimumab, including 9 patients of Crohn′s disease (CD) and 1 of ulcerative colitis (UC) . There were 6 males and 4 females, with disease onset age of 0.3 to 13.3 years and median duration of 38 (3 to 81) months before the treatment of adalimumab. In lesion location of 9 CD patients, 2 patients only involved the small intestine (L4a+L4b) and 7 patients involved the whole digestive tract (L3+L4a+L4b) according to Paris classification. The reasons of switching infliximab to adalimumab were as follows: primary loss response to infliximab occurred in 1 patient, secondary loss response to infliximab in 6 and severe anaphylaxis in 3. According to PCDAI and PUCAI, the clinical remission was achieved in 1, mild activity in 4, moderate in 3 and severe in 2 before the treatment of adalimumab. Clinical remission was achieved in 6, clinical response in 1 and non-response in 1 at the 10th week. After the median follow-up period of 25 (10 to 86) weeks, clinical remission was achieved in 8, the clinical symptom of 1 non-responsive patient was improved during the follow-up. The left 1 non-responsive patient stopped treatment of adalimumab and received gene sequencing test, and the results showed a hemizygote mutation of X-linked inhibitor of apoptosis protein ( XIAP) gene and the X-linked lymphocytic proliferation syndrome was considered. Five cases of side reaction occurred in 10 patients, mainly the respiratory infections, and no other serious side reactions occurred. Conclusion:Switching to adalimumab attains good outcome in pediatric IBD patients after the failure of infliximab.

Objective:To observe the effects of alprostadil at different doses on C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in patients with angina pectoris.Methods:From August 2017 to April 2018, 120 patients with angina pectoris admitted to China Coast Guard Hospital of the People's Armed Police Force were selected and divided into control group (60 cases) and observation group (60 cases) by random number table method.Both two groups received routine anti-angina treatment, while the control group received 10 μg alprostadil, the observation group received 20 μg alprostadil for 2 weeks.The changes of CRP, TNF-α, IL-6 and hemorheological indicators before and after treatment were compared between the two groups.Results:Before treatment, there were no statistically significant differences in the CRP, TNF-α and IL-6 between the two groups (all P>0.05). After treatment, the CRP, TNF-α and IL-6 levels in the observation group were (4.63±0.62)mg/L, (0.46±0.08)μg/L, (46.59±4.72)ng/L, respectively, which were significantly lower than those in the control group [(6.18±0.74)mg/L, (1.19±0.28)μg/L, (58.62±5.07)ng/L]( t=12.437, 19.418, 13.452, all P<0.05). The high shear viscosity, low shear viscosity, plasma viscosity and platelet aggregation rates in the observation group were (4.27±0.46)mPa/s, (8.07±0.18)mPa/s, (1.03±0.25)mPa/s, (37.42±1.05)%, respectively, which were lower than those in the control group [(5.14±0.588)mPa/s, (10.43±0.42)mPa/s, (2.01±0.46)mPa/s, (40.19±1.86)%] ( t=9.103, 40.006, 14.499, 10.046, all P<0.05). Conclusion:The conventional dose of alprostadil (20 μg) is effective in the treatment of angina pectoris.It can improve CRP, TNF-α, IL-6 and hemorheological parameters of patients.

Objective:To observe the efficacy of meglumine adenosine cyclophosphate (MAC) in the adjuvant treatment of chronic congestive heart failure(CHF) in the elderly, and its effects on cystatin C(Cys-C) and plasma B-type natriuretic peptide(BNP).Methods:From August 2017 to August 2018, 110 elderly patients with chronic CHF admitted to Zhejiang Provincial Armed Police Corps Hospital were selected and randomly divided into control group(55 cases) and observation group(55 cases) by random number table method.The control group was treated with routine treatment, while the observation group was treated with MAC on the basis of routine treatment.Both two groups were treated for 2 weeks.The clinical efficacy, left ventricular ejection fraction (LVEF), cardiac output, Cys-C and plasma BNP were compared between the two groups.Results:The total improvement rate of the observation group was 94.55%(52/55), which was higher than 78.18%(43/55) of the control group, the difference was statistically significant(χ 2=6.253, P<0.05). Before treatment, there were no statistically significant differences in LVEF, cardiac output, BNP and Cys-C between the two groups(all P>0.05). After treatment, the LVEF[(44.16±6.82)%], cardiac output[(8.07±1.45)L/min] of the observation group were significantly higher than those of the control group[(40.71±5.38)%, (6.44±1.37)L/min], and BNP[(1.65±0.24)mg/L], Cys-C[(552.79±10.46)mg/L] of the observation group were significantly lower than those of the control group[(2.31±0.48)mg/L, (681.73±12.71)mg/L], the differences were statistically significant( t=2.945, 6.060, 9.121, 0.551, all P<0.05). Conclusion:MAC has significant effect in the treatment of elderly patients with chronic CHF.It can improve the cardiac function of patients and reduce the plasma concentrations of Cys-C and BNP.

Objective: To evaluate the efficacy and safety of compound Lactobacillus acidophilus tablets or Saccharomyces boulardii Sachets combined with standard protocols for eradication of Helicobacter pylori(Hp) in children. Methods: From March 2017 to March 2018, 120 children aged 3-10 years with Hp infection were admitted into the Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, including 67 male and 53 female childen.They were divided into 3 groups (control group, compound Lactobacillus acidophilus group, Saccharomyces boulardii Sachets group) by the method of random number table.Control group was given Clarithromycin+ Amoxicillin+ Omeprazole, for 14 days orally; compound Lactobacillus acidophilus group and Saccharomyces boulardii Sachets group were given drugs respectively on the first day, 500 mg of compound Lactobacillus acidophilus was added, twice a day or 250 mg of Saccharomyces boulardii Sachets group, twice a day orally, for 14 days, respectively.The adverse reactions in children were observed during the treatment, andurea ¹³C breath test or the stool Hp antigen test was performed at least 4 weeks by the end of the treatment, and the children with negative results were judged to be eradicated successfully.The ulcer healing, Hp eradication rate and incidence of adverse reactions(nausesa, vomiting, loss of appetite, constipation, diarrhea) among the 3 groups were observed and the Hp eradication rate and the incidence of adverse reactions (nausea, vomiting, loss of appetite, constipation, diarrhea) were compared. Results: The eradication rates in the control group, the compound Lactobacillus group, and Saccharomyces boulardii Sachets group were 80.0% (32/40 cases), 85.0% (34/40 cases), and 87.5% (35/40 cases), respectively, and the difference was not statistically significant (P=0.646); the ulcer healing rate was 100.0% of 101 Hp eradicators in 3 groups, and the ulcer healing rate of 19 cases without Hp eradicated was 48.15%, and there was a significant difference between them (χ²=51.30, P<0.01). However, there was no significant difference in the total effective rate among 3 groups (P>0.05). The overall incidence of adverse reactions in Saccharomyces boulardii Sachets group (P=0.021) and the incidence of diarrhea (P=0.002) and loss of appetite (P=0.021) was lower than that in the control group, and the differences were statistically significant.There was no significant difference in the incidence of adverse reactions between the two probiotic groups (P>0.05). Conclusions Both compound Lactobacillus acidophilus tablets and Saccharomyces boulardii Sachets group can reduce the overall incidence of adverse reactions and the incidence of diarrhea and appetite declines in children′s standard Hp eradication regimen without affecting Hp eradication rate.

Objective To establish the HPLC fingerprints of petroleum ether parts from five traditional medicine (Alpinia officinarum Hance, Alpinia galangal ( L.) Wild, Alpinia galanga Will., Alpinia katsumadai Hayata, and Alpinia oxyphylla Miq), and to explore the similarities and differences of chemical composition,as well as the correlation between the genetic relationship and the chemical composition. Methods HPLC method was used to analysis the five traditional medicines. The data were evaluated by using the"similarity evaluation system for chromatographic fingerprint of TCM" software. Results The similarity chemical composition from Alpinia officinarum Hance,Alpinia galangal(L.) Wild,Alpinia galanga Will.,Alpinia katsumadai Hayata,and Alpinia oxyphylla Miq in ethyl acetate were 0.741,0.855,0.610,0.510, 0.680,respectively. Conclusion Though there were differences of fingerprint peak of petroleum ether parts between five the traditional Chinese medicines, similarities were also observed among them.

Objective To assess the efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis.Methods Double-blind randomized controlled multicenter clinical trial was designed and conducted.Totally 437 patients were included,219 in the control group and 218 in the experimental group.Cases of purulent or gangrenous appendicitis were enrolled and assigned to each of the two groups.The control group received ornidazole injection for 5 to 7 days while the experimental group received morinidazole injection.Both groups underwent appendectomy.Clinical response,micrombiological outcomes,overall response were evaluated.Adverse events and side effects were recorded.Results No significant difference was observed between the two groups regarding the clinical healing rate at 5-10 days after medicine withdrawal,anaerobia clearance and overall healing rates.Adverse events occurred in 140 patients (32.1％).Incidence of adverse events in the control group and the experimental group was 34.7％ and 29.4％,respectively (P ＞ 0.05).The overall incidence of side effects was 15.1％ (66 cases).Side effects were less seen in the experimental group compared with that in the control group (11.5％ vs.18.7％,P ＜ 0.05).The most frequent side effects were aminotransferase rising,thrombocytosis,nausea,vomiting and electrocardiographic abnormality.Conclusions The effect of morinidazole plus operation was comparable with ornidazole in treating purulent or gangrenous appendicitis.The safety of morinidazole is better than ornidazole.