Sepsis is a life-threatening organ dysfunction caused by the body's dysfunctional response to infection. There is currently no definitive symptomatic treatment for sepsis inflammatory response in the clinic. Blood purification treatment exerts immunomodulatory effects by non-specifically eliminating endotoxin and/or inflammatory mediators and shows a good prospect of application in sepsis. However,most studies on the treatment of sepsis with blood purification have not shown significant improvement in patients' prognosis. This article reviews the research progress of immunoregulation mechanism of blood purification therapy for sepsis,as well as the advantages and disadvantages of different blood purification methods.

Severe acute pancreatitis(SAP)is a severe inflammatory disease with persistent organ failure for more than 48 hours,resulting in a high mortality rate. The abnormal release of pancreatic enzyme and cytokines is accompanied by the occurrence and progress of SAP. Blood purification can not only continuously or intermittently remove excessive water and solutes from the body,but also regulate the balance of pro-inflammatory and anti-inflammatory factors,thus reducing organ function damage,which may be a new effective treatment method for SAP. At present,the application of blood purification for SAP is still controversial and still in the exploratory stage.

The immune diseases of nervous system are a kind of nervous system diseases mediated by immune mechanism.High mortality and disability rates are its important characteristics. Early intervention and treatment can significantly improve the clinical outcomes of patients. At present, the main treatments for this kind of diseases include corticosteroid hormone, intravenous immunoglobulin(IVIG)and blood purification. Blood purification therapy has become the focus of current research because of its fast effect and other advantages.The main modes of blood purification therapy for this kind of diseases are plasma exchange and plasma immunoabsorption.Early application of blood purification therapy in patients with the acute attack and critical illness may lead to more significant clinical improvement. Therefore,blood purification may be an effective treatment for patients with the critical illness or when other medications are ineffective for the patients.

Systemic lupus erythematosus,anti-neutrophil cytoplasmic antibodies associated vasculitis,thrombotic microangiopathy,Henoch schonlein purpura,Guillain-Barre syndrome and myastheniagravis are common rheumatic autoimmune diseases in children. Severe cases can be life-threatening,and medication is sometimes ineffective in controlling the condition. In recent years,blood purification therapy has been widely used in pediatric rheumatic autoimmune disease. This paper reviews the new clinical research,consensus and guidelines.

Acute liver failure(ALF)is a life-threatening clinical syndrome in children,which has a high mortality. Extracorporeal liver support systems include bioartificial liver,nonbioartificial liver and hybrid artificial liver,with the aim of supporting children with ALF,as a bridge to recovery or liver transplantation. The theoretical basis of non-bioartificial liver support system is blood purification. Although biochemical efficacy has been demonstrated by these devices,the effect on the final prognosis has been unclear. Compared with adults,there are less data on the treatment for children with ALF,and some new blood purification modes and combined blood purification modes have shown potential in the treatment of ALF in recent years. The aim of this review is to introduce the practice of blood purification and to provide references for the treatment of children with ALF.

Renal replacement therapy(RRT)is effective in supporting impaired kidney function,maintaining homeostasis,as well as removing inflammatory mediators,harmful metabolites and toxin in critically ill children. The accepted timing of initiating RRT in acute kidney injury(AKI)patients are severe metabolic acidosis(p H<7.1),hyperkalaemia(K+>6.5 mmol/L),uraemic associated encephalopathy and bleeding diathesis,and fluid overload when medical management fails. Continuous renal replacement therapy(CRRT)has become the preferred technique to manage fluid administration in septic AKI or hemodynamically unstable patients,but its adequate timing remains unclear. The dose of CRRT can be divided into renal replacement therapy dose[ultrafiltration dose 20-35 mL/(kg·h)]and sepsis treatment dose[ultrafiltration dose≥35 mL/(kg·h)]. The use of high volume hemofiltration(HVHF)[replacement dose≥50 mL/(kg·h)]has demonstrated clinical benefits in septic shock patients by reversing the abnormal hemodynamics.

OBJECTIVE: To evaluate the efficacy,safety and tolerability of recombinanat human interferon α2 b(rhIFNα2b)spray in treatment of acute upper respiratory tract infection(except the flu)in children. METHODS: In total,575 children who met the inclusion criteria were enrolled from January,2019 to July,2019. They were divided into rhIFNα2b spray group(291 cases)and ribavirin group(284 cases). The children in rhIFNα2b spray group were given the rhIFNα2b spray(P.putida),and those in ribavirin groups were treated with the ribavirin spray. The curative effect and safety between the two groups were compared. RESULTS: The per-protocol set(PPS) comprised 448 patients(233 in the rhIFNα2b spray group,215 in the ribavirin group). The primary efficacy endpoint was antipyretic time which in rhIFNα2b spray group(25.0 h)was significantly shorter than that in the ribavirin group(33.6 h)(P=0.0001). In the comparison of symptomatic relief time,the relief time of nasal congestion,runny nose,sore throat and cough in rhIFNα2b spray group was shorter than that in ribavirin group(P<0.05). The recovery time in the rhIFNα2b spray group was 92 h,which showed significant decrease compared with the ribavirin group(112 h)(P<0.0001). The incidence of adverse events had no statistical differences between the two groups(P=0.2461). CONCLUSION: The rhIFNα2b spray treatment for acute upper respiratory tract infection in children is proved to be significantly effective;particularly,it can evidently relieve fever symptoms and promote the disappearance of nasal and pharyngeal symptoms. It has good safety and tolerability,so the rhIFNα2b spray is worthy to be promoted in clinical application.

OBJECTIVE: To analyze the clinical features and risk factors of severe influenza virus A(IVA)pneumonia in children. METHODS: Clinical data of 617 children diagnosed with influenza virus A pneumonia who were hospitalized in Children's Hospital of Chongqing Medical University from January 2014 to March 2018 were analyzed retrospectively. Of these children there were 144 cases of severe IVA pneumonia. Logistic regression analysis was used to analyze the risk factors of severe IVA pneumonia. RESULTS: The prevalence of pneumonia associated with IVA in children was seasonal in Chongqing.The peak of IVA-associated pneumonia in 2017 was from March to May,August to October, and December to February of the following year. About 74% of patients were younger than 3 years and boy accounted for 64.1%. Among them,201(32.6%)children had underlying diseases,which were mainly malnutrition,congenital heart disease,congenital airway dysplasia and asthma. Fever and cough were the main clinical manifestations,and some were combined with gastrointestinal symptoms.Among the 617 cases,51.2% were positive for bacteria,13.9% were positive for virus other than IVA,and 12.2% were positive for Mycoplasma pneumoniae. Severe pneumonia cases progressed rapidly,and 127 children of the 144 children with severe IVA pneumonia had respiratory failure,acute respiratory distress syndrome,cardiac insufficiency and toxic encephalopathy within 3-5 days after illness onset. The multivariate analysis found that congenital heart disease(OR3.98,95%CI 2.31-6.86),nervous system disease(OR 3.33,95%CI 1.42-7.80)and malnutrition(OR 2.21,95%CI 1.29-3.79)were independent risk factors of severe pneumonia associated with IVA. CONCLUSION: Pneumonia associated with IVA in children is prevalent in winter and spring,with some summer epidemic peaks in Chongqing. Congenital heart disease,nervous system disease and malnutrition are independent risk factors for severe pneumonia associated with IVA.

OBJECTIVE: To use skin prick test to understand the main allergens in patients with bronchial asthma and allergic rhinitis,and to provide important evidence for its prevention,diagnosis and treatment. METHODS: A total of 2252 patients diagnosed with bronchial asthma or allergic rhinitis between August 2015 and July 2017 in the outpatient department of Children's Hospital Affiliated to Suzhou University were tested for allergens by skin prick test,and sex and disease types were analyzed by SPSS 21.0. RESULTS: The skin prick test was performed in 2252 patients,1390 cases were positive,and the positive rate was 61.7%;the ratio of male to female was 1.75∶1;the positive rate in boys was(925/1433,64.5%)higher than that of girls(465/819,56.8%)(P<0.05). The positive rate in children with bronchial asthma was 65.3%(607/929),the positive rate in allergic rhinitis was 58.8%(664/1129),and the positive rate in bronchial asthma combined with allergic rhinitis was 61.3%(119/194). The positive rate of bronchial asthma group was higher than that of allergic rhinitis group(P<0.05). Dust mites(60.3%)and house dust mites(43.4%)were most common,followed by grass pollen and cat hair. CONCLUSION: The most common allergens in children with bronchial asthma and allergic rhinitis in Suzhou Children's Hospital are mites;skin prick test provides a basis for the diagnosis of allergic diseases.

OBJECTIVE: To investigate the etiology and clinical characteristics of pertussis-like syndrome. METHODS: Thenasopharyngeal secretionscollectedfrompatientswithpertussis-likesymptominChildren's Hospital Affiliated to Soochow University from February 2016 to December 2017 were detected for pertussis DNA using PCR assays and other microbiological assessment. RESULTS: A total of 197 children were enrolled in the study,of whom 119(60.4%)patients were positive for Bordetella pertussis,and 37 cases(37.8%)were positive for other pathogens,including 14 cases(37.8%)of rhinovirus,14 cases(37.8%)of Mycoplasma pneumoniae,4 cases(10.8%)of human bocavirus,3 cases(8.1%)of parainfluenza virus and1 case(2.7%)of respiratory syncytial virus,and 1 case(2.7%)of Haemophilus influenzae. There were no significant differences in mean age,paroxysmal cough,inspiratory whoop,posttussive vomiting,paroxysmal cyanosis,or pulmonary signs between pertussis group and pertussis-like syndrome group(P>0.05). The proportion of male in pertussis group(57.1% vs. 35.3%),white blood cell counts[(18.83±11.54)×10~9/L vs.(12.46±6.01)×10~9/L)],lymphocyte counts[(10.62±8.48)×10~9/L vs.(6.54±5.13)×10~9/L)]were significantly higher than those in pertussis-like syndrome group(P<0.05). CONCLUSION: Rhinovirus and Mycoplasma pneumoniae are the main pathogens of pertussis-like syndrome. Leukocyte and lymphocyte counts can be used as an index to differentiate pertussis from pertussis-like syndrome.