Objective:To summary the mixed infection as well as clinical characteristics and analyze the risk factors for mixed infection of severe adenovirus pneumonia(SAP) in children.Methods:The clinical data of 114 children with SAP were retrospectively analyzed.Multivariate Logistic regression analysis was performed to assess the risk factors for mixed infection.Results:The incidence age was from 6 months to 2 years(62.5%). High fever(94.7%), cough(98.2%), dyspnea(86.8%) and lethargy(95.6%) were the main symptoms.Laboratory examination showed that children with SAP were prone to increased white blood cell count, C-reactive protein, procalcitonin, aspartate aminotransferase, alanine aminotransferase and CK-MB, as well as decreased proportion of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + and NK cells.The main complications intrapulmonary organ were respiratory failure(80.7%). The main complications extrapulmonary organ were circulatory complications (55.3%). SAP was easily combined with other pathogenic infections.Streptococcus pneumoniae(22.9%)was the most common bacterial pathogen.Respiratory syncytial virus(10.0%)were the most common virus, in addition, mycoplasma pneumoniae(17.1%) was also common.Multivariable Logistic regression analysis showed that the decreasing ratio of CD4 + /CD8 + and NK cells, congenital heart disease and congenital airway dysplasia were the independent risk factors for mixed infection of SAP in children( P<0.05). Conclusion:The SAP patients could easily suffer from mixed infection and high fatality rate.Immune dysregulation is the important risk factors for mixed infection of SAP in children.So immunoregulatory treatment is very important.

In designated hospitals for critical patients with COVID-19 in Wuhan, time-efficient pharmaceutical emergency protection system was of great significance for epidemic prevention. Described in the paper are measures taken by the pharmaceutical department of the hospital as follows. These measures include launching an emergency response mechanism, formulating a catalogue of COVID-19 key therapeutic drugs, urgently purchasing therapeutic drugs, transforming the processes of emergency pharmacy, establishing a drug donation management system, building a COVID-19 pharmaceutical care team, and setting up a " cloud pharmacy" to meet the drug needs of patients with non-COVID-19 chronic diseases, in addition to strengthening personnel protection of pharmacists. During such an epidemic, the pharmacy administration works in a professional, comprehensive, complex and systematic emergency program, which guaranteed the safety of drug supply, medication and enabled the treatment to be carried out in an orderly manner.

After the outbreak of COVID-19, due to environmental pollution in the isolated ward and operational constraints caused by protective clothing and other factors, intravenous drugs in the designated hospitals should be centralized. Combined with the existing process mode, the process of pharmacy intravenous admixture services was optimized, the operation mode of the operation platform was adjusted, the scheduling mechanism was optimized, and the node control process of " first verify and five checks" was explored and developed, so as to meet the 24 h needs of COVID-19 patients. According to the characteristics of COVID-19 drug treatment, the focus of prescription review was adjusted to ensure the drug safety of patients. Other measures included implementing paperless prescription to reduce unnecessary media; implementing segmented infusion distribution management to ensure no cross infection; hierarchical control and configuration environment, strengthening the protection and management of pharmacists, to avoid the risk of personnel infection; optimizing human resource allocation and improving work efficiency. This process reengineering and optimization established the emergency management mode of centralized intravenous drug deployment under the background of COVID-19, which ensured the intravenous drug demand and safety of COVID-19 patients. The treatment work was carried out orderly, and could provide reference for the pharmaceutical department in medical institutions to deal with major public health emergencies in the future.

Objective: To analyze the predictive value of the mortality risk score for severe hand, foot and mouth disease(MRSHFMD) system for the complications and mortality risk of severe hand, foot and mouth disease(HFMD) in children. Methods: This study included 354 children with severe HFMD who admitted in the pediatric intensive care unit(PICU) of Hunan Provincial Children′s Hospital from March 2012 to March 2014.The patients were grouped according to whether they had complicated nervous system damage, pulmonary edema, pulmonary hemorrhage and circulatory failure in the course of disease, and the prognosis was grouped according to their 28 d survival.The worst values of white blood cell count, blood glucose, blood lactic acid, N-terminal pro-brain natriuretic peptide, within 24 hours after admission were used to score MRSHFMD.The predictive value of MRSHFMD for nervous system damage, pulmonary edema, pulmonary hemorrhage, circulatory failure, and prognosis were evaluated using the receiver operating characteristic(ROC)curve. Results: The blood glucose, white blood cell count, blood lactic acid value, N-terminal pro-brain natriuretic peptide and MRSHFMD score of the children with HFMD complicated with nervous system damage, pulmonary edema, pulmonary hemorrhage and circulatory failure were significantly higher than those in the non-complicated groups(P<0.01). When the cut-off value of MRSHFMD score was 3, the area (95%CI) under the ROC curve were 0.723 (0.643-0.804), 0.870 (0.793-0.946), 0.921 (0.85-0.992), 0.944 (0.867-1.000) and 0.954 (0.000-1.000) of nervous system damage, pulmonary edema, pulmonary hemorrhage, circulation failure and death in children with HFMD, respectively.The specificity and sensitivity of predicting nervous system damage, pulmonary edema, pulmonary hemorrhage, circulatory failure and death were 44.6% and 95.8%; 67.5% and 95.5%; 83.3% and 95.1%; 89.3% and 95.1%; 90.9% and 93.7%, respectively. Conclusion MRSHFMD system is an effective tool to predict HFMD complications of pulmonary hemorrhage, circulatory failure, and death, which is worthy of clinical promotion.

Objective To compare the value of three neonatal referal scoring systems in predicting the risk of mortality in preterm and low birth weight infants. Methods Six hundred and fourty-nine prema-ture neonates-fetal age <37 weeks and birth weight <2 500g infants were transported to the neonatal inten-sive care unit of Hunan Children′s Hospital from January 1 to December 31,2016. The score of transport risk index of physiologic stability(TRIPS),mortality index for neonatal transportation(MINT)score and transport related mortality score(TREMS)were conducted for them. Results TRIPS,MINT and TREMS scoring sys-tems of the death group were significantly higher than those of the survival group(P<0. 001). In the multi-variate Logistic regression analysis,systolic blood pressure,reaction of foot hit and the intubation of respirato-ry in the TRIPS entered the regression equation. The birth weight,blood pH value and whether intubation when contacted in the MINT score were included in the equation. Hypotension,hypoxemia and hypercapnia of TREMS were entered the regression equation,indicating these factors were the independent risk factors for death in preterm and low birth weight infants. The area under the receiver operating characteristic and 95%CI of TRIPS,MINT and TREMS were 0. 843(0. 796,0. 889),0. 796(0. 722,0. 871)and 0. 712(0. 639,0. 786), respectively. Conclusion The TRIPS is more accurate than MINT and TREMS in predicting the risk of ref-erral mortality in referaling preterm and low birth weight infants.

Objective To study the clinical characteristics of outpatients with hand,foot and mouth disease (HFMD) caused by different serotypes of enteroviruses.Methods This was a prospective study.From February 2017 to March 2018,563 outpatients with HFMD were enrolled by systematic sampling in the Department of Infectious Diseases,Henan Children's Hospital.Throat swabs were collected to determine the serotypes via PCR.Demographic,clinical,and laboratory data were collected by standard questionnaire.All cases were followed up twice at 2 and 9 weeks after the initial outpatient visit through telephone interview.A total of 563 cases were enrolled and 555 (98.6％) cases were positive for human enteroviruses,including 338 (60.9％) males.Analyses were stratified by enterovirus serotypes,Chi square test or Fisher's exact test,Rank sum test was used for comparison among different groups.Results The age of 555 cases was 24.2 (16.4,41.3) months.Among them 44.0％ (224 cases) were identified as coxsackievirus (CV)-A6,while 189 cases,35 cases,14 cases and 73 cases were identified as CV-A16,enterovirus (EV)-A71,CV-A10 and other serotypes,respectively.Fever (≥37.5 ℃C) was present in 51.4％(285/555) of laboratory confirmed cases.The proportions of fever in cases of CV-A6 (68.9％(168/244)) and CV-A10 (12/14) were significantly higher than those in cases of CV-A16 (31.7％(60/189),x2=57.344,14.313,both P=0.000),other serotypes (43.8％(32/73),x2=15.101 and 8.242,P=0.000 and 0.004) and EV-A71 (37.1％(13/35),x2=13.506 and 9.441,P=0.000 and 0.002) respectively.There was no significant difference between CV-A6 and CV-A10 in presentation of fever (x2=1.785,P=0.182).There were 359 cases (64.7％) with eruptions in mouth,hands,feet and buttocks.Cases infected with EV-A71 had the highest proportions (74.3％(26/35)) of rash emerging simultaneously in mouth,hands,feet,and buttocks.The proportion in cases of CV-A 16,CV-A6,CVA 10 and other serotype were 73.5％ (139/189),61.9％ (151/244),7/14 and 49.3％ (36/73),respectively.The proportion of rash on other parts of body,such as face,limbs or torso in cases infected with CV-A6 (16.8％ (41/244)) was the higherest and the proportion in cases of CV-A16,EV-A71,CV-A10 or other serotypes were 8.5％(16/189),5.7％(2/35),1/14,6.8％(5/73),respectively.None of these cases developed serious complications.Desquamation occurred in 45.5％ (179/393) cases 7.5 (5.0,9.0) days after disease onset and 13.5％ (53/393) cases showed onychomadesis 31.0 (18.0,33.5) days after disease onset.The proportion of desquamation and onychomadesis associated with CV-A6 (64.2％ (95/148) and 31.8％ (47/148)) was significantly higher than CV-A16 (31.8％ (49/154) and 1.3％ (2/154),x2=33.601 and 52.482,both P=0.000) and other serotypes (38.0％(19/50) and 6.0％(3/50),x2=10.236 and 12.988,P=0.001 and 0.000).Desquamation appeared more in cases of CV-A6 than in cases of CV-A10 (2/11,x2=9.386,P=0.002),with the proportion of onychomadesis higher in CV-A6 than in EV-A71 (3.3％ (1/30),x2=11.088,P=0.001).Conclusion Clinical manifestation such as fever,rash emerging parts,desquamation and onychomadesis are different among outpatient HFMD cases infected with CV-A16,CV-A6,EV-A71,CV-A10 and other enteroviruses.

Objective To investigate the safety and efficacy of enteral nutrition in critically ill children with hyperpancreorrhea including hyperamylasemia and hyperlipasemia in order to provide the rationale of nutritional support for such critically ill children. Methods A total of 90 critically ill children with hyperpancreorrhea admitted in pediatric intensive care unit were enrolled for prospective study in a period from January 2014 to December 2015. The patients were randomly(random number) divided into fasting group (n=30), and in those with fasting time exceeded three days, intravenous nutrition was given; ordinary milk group (n=30) and special milk group (n=30) and in this group, those with age<1 year were given AiErShu, while those with age >1 year were given small hundred peptides in addition to the basis of routine treatment. Clinical data and biochemical findings in different groups were analyzed by X2test, t test, F test or non-parametric test to evaluate the safety and efficacy of enteral nutrition in critically ill children with hyperpancreorrhea. Results (1) There were statistically significant differences in rates of nutrition support-related symptoms such as diarrhea, electrolyte imbalance, blood glucose disorder among groups (χ2=6.975,6.074,6.300,P=0.031,0.048,0.043). (2) There were statistically significant difference in rates of serum amylase or lipase levels more than upper limit on the third day among different groups (χ2=7.081, P=0.029). There was no statistically significant difference in rates of fecal elastase-1<200 μg/g 24 hours after admission, on the 3rd day and on the 7th day among different groups (P＞0.05). There was statistically significant difference in procalcitonin on the 7th day among different groups (H=6.251,P=0.044). There was statistically significant difference in oxygenation index on the 3rd day among different groups (F=3.119, P=0.049). There was statistically significant difference in lactate on the 7th day among different groups (F=6.449,P=0.040). There was statistically significant differences in albumin on the 3rd day and on the 7th among different groups (F=5.451,P=0.006; H=24.861,P＜0.01). (3) There were statistically significant differences in PICU stay and hospital stay among different groups (F=3.222,3.891,P=0.045 ; 0.024). There was statistically significant difference in survival rate among different groups (χ2=6.240, P=0.044).Conclusions Early and right enteral nutrition was safe and effective for critically ill children with hyperpancreorrhea, and the special milk powder such asr AiReShu and small hundred peptides suitable for children with hyperpancreorrhea could effectively support nutrition for critically ill children with hyperpancreorrhea,improve the status of illness, promote disease recovery, shorten hospital stay and improve the prognosis.

Objective To investigate the prevalence of pulmonary fungal infection and drug resist-ance of the pathogenic fungi among children with severe diseases in pediatric intensive care unit(PICU). Methods From July 2013 to June 2017,the complete clinical data,results of fungal culture and drug sensi-tivity of bronchoalveolar lavage fluid in 112 critically ill children with pulmonary fungus infection of PICU hospitalization in our hospital were collected. Samples of peripheral venous blood were collected meantime, including blood routine examination,C reactive protein,G test and GM test. Results One hundred and twen-ty-six fungi were isolated from sputum samples in 112 critically ill children. Severe pulmonary infection (30. 36%,34/112) was the most common form of the primary diseases, the next were severe sepsis (16. 07%,18/112)and severe malnutrition(15. 18%,17/112). Classified based on age difference,the first one was ＜1 year old (43. 75%,49/112),the second one was 1 to 3 years old(29. 46%,33/112). The fun-gal strains were predominantly Candida albicans (61. 90%) and Candida tropicalis (16. 67%),among the infectious cases 14 were diagnosed as mixed infection. Two cases of 3 cryptococcal infectious children were HIV infection,another one was malignant tumor,Cryptococcus was cultured in both sputum,pleural effusion and cerebrospinal fluid. The drug resistance rate of fluconazol in 126 strains of fungi was 12. 70%,the rate of itraconazole was 7. 14%. Generally,the fungi cultured were with very low resistance to 5-fluorocytosine,vori-conazole and amphotericin B. However,the strains of Aspergillus fumigates,Candida kruse,Candida parapsi-losis and Cryptococcus were highly resistant to fluconazol and itraconazole,but with very low resistance to 5-fluorocytosine and amphotericin B. Conclusion Candida albicans is the main pathogenic fungus of pulmo-nary fungal infection among children in PICU,and we could choose voriconazole and amphotericin B as treat-ment of critically ill children with pulmonaty fungal infection.

Objective To analyze the risk factors for postoperative nosocomial infections in the department of otorhinolaryngology,and provide guidance on improving the quality of life for patients.Methods The clinical data of the patients tmdergoing surgical procedure in the department of otorhinolaryngology form January 2011 to December 2016 were reviewed to identify the potential risk factors of nosocomial infections.Chi-square test and multivariate logistic regression model were used for the analysis.Results A total of 152 (2.25％) cases of nosocomial infection were identified in 6 753 cases of surgical operation.Univariate analysis revealed that sex,age,length of stay,patient referral,class of surgical wounds,length of operation,and complications were related to postoperative nosocomial infections.The patients without nosocomial infection showed higher cure rate than those complicated with nosocomial infection (P＜0.05).Multivariate logistic regression analysis identified that male (OR=2.831,95％ CI:1.758-4.558),older (OR=5.833,95％ CI:4.491-7.577),patient referral (OR=1.790,95％ CI:1.008-3.178),higher class of surgical wound contamination (OR=34.866 for Class Ⅰ,OR=2 120.995 for Class Ⅱ,and OR=43 917.453 for Class Ⅲ wounds),and longer length of operation (OR=9.384,95％ CI:18.168-47.525) were the independent risk factors for postoperative nosocomial infections in the department of otorhinolaryngology.Conclusions Multiple risk factors are associated with postoperative nosocomial infections in the department of otorhinolaryngology.Integrated measures must be taken for prevention and control of nosocomial infections based on the specific conditions of the patient.

Objective:To investigate the pharmacokinetics of erlotinib in SD rats with undernourished status. Methods:The ani-mal model of undernourished status was established. The rats were randomly divided into the normal control group and the undernour-ished model group. The different groups were administered with erlotinib(6.25 mg·kg-1) via tail vein,and administered with erlo-tinib (13.5 mg·kg-1) oral solution or oral suspension. The plasma concentration of erlotinib was determined by HPLC. The pharma-cokinetic parameters were calculated. Results:Compared with that of the normal control group, Tmaxin the rats with undernourished status was significantly delayed(P<0.05),while AUC0~tand AUC0~∞were without notable changes(P>0.05). As for the oral sus-pension,Tmaxwas shorter,and AUC0~tand AUC0~∞were higher in the rats with undernourished status than those in the rats with nor-mal status(P<0.05). CL in the rats with undernourished status treated with oral solution or oral suspension was 10% lower than that in the rats with normal status(P<0.05). Conclusion:Undernourished status has a significant impact on the pharmacokinetics of er-lotinib in vivo. It is suggested that the treatment regimen of erlotinib should be adjusted for the patients with undernourished status.