Restoration of energy level in the early phase of acute pediatric pancreatitis

Acute pancreatitis (AP) is a serious inflammatory disease with rising incidence both in the adult and pediatric populations. It has been shown that mitochondrial injury and energy depletion are the earliest intracellular events in the early phase of AP. Moreover, it has been revealed that restoration of intracellular ATP level restores cellular functions and defends the cells from death. We have recently shown in a systematic review and meta-analysis that early enteral feeding is beneficial in adults; however, no reviews are available concerning the effect of early enteral feeding in pediatric AP. In this minireview, our aim was to systematically analyse the literature on the treatmentof acute pediatric pancreatitis. The preferred reporting items for systematic review(PRISMA-P) were followed, and the question was drafted based on participants, intervention, comparison and outcomes: P: patients under the age of twenty-one suffering from acute pancreatitis; I: early enteral nutrition (per os and nasogastric- or nasojejunal tube started within 48 h); C: nil per os therapy; O: length of hospitalization, need for treatment at an intensive care unit, development of severe AP, lung injury (including lung oedema and pleural effusion), white blood cell count and pain score on admission. Altogether, 632 articles (Pub Med: 131; EMBASE: 501) were found. After detailed screening of eligible papers, five of them met inclusion criteria. Only retrospective clinical trials were available. Due to insufficient information from the authors, it was only possible to address length of hospitalization as an outcome of the study. Our mini-meta-analysis showed that early enteral nutrition significantly(SD = 0.806, P = 0.034) decreases length of hospitalization compared with nil per os diet in acute pediatric pancreatitis. In this minireview, we clearly show that early enteral nutrition, started within 24-48 h, is beneficial in acute pediatric pancreatitis. Prospective studies and better presentation of research are crucially needed to achieve a higher level of evidence.

乙型肝炎病毒母婴传播及其阻断研究的现状与存在问题

HBV可经血液、母婴、性接触等多种途径传播,其中母婴传播是我国HBV传播的主要途径之一.乙型肝炎母婴阻断是指通过产前、产时,产后采取一系列措施对新生儿进行保护以减少感染HBV机会的方法.近年来,HBV的母婴阻断取得了较好效果,总体阻断成功率约在90%以上,但仍有一定的失败率,在相关机制、方案优化等方面仍面临一些亟待解决的问题.

Predicting mortality, hospital length of stay and need for surgery in pediatric trauma patients

Purpose： Pediatric trauma is one of the major health problems around the world which threats the life of children. The survival of injured children depends upon appropriate care, accurate triage and effective emergent surgery. The objective of this study was to determine the predictive values of injury severity score （ISS）, new injury severity score （NISS） and revised trauma score （RTS） on children＇s mortality, hospitalization and need for surgery. Methods： In this study, records of trauma patients under 15 years old transported from a trauma scene to emergency department of Poursina hospital from 2010 to 2011 were included. Statistical analysis was applied to determine the ISS, NISS and RTS ability in predicting the outcomes of interest. Results： There were 588 records in hospital registry system. The mean age of the patients was （7.3 ± 3.8） years, and 62.1% （n = 365） of patients were male. RTS was the more ability score to predict mortality with an area under curve （AUC） of 0.99 （95% CI, 0.99-1）. In the hospital length of stay （LOS）, ISS was best predictor for both the hospital LOS with AUC of 0.72 （95% CI, 0.67-0.76） and need for surgical surgery with AUC of 0.94 （95% CI, 0.90-0,98）. Conclusion： RTS as a physiological scoring system has a higher predicting AUC value in predicting mortality. The anatomic scoring systems of ISS and NISS have good performance in predicting of hospital LOS and need for surgery outcomes.

Influence of clinical pathways used the hospitals of Traditional Chinese Medicine on patients hospitalized with stroke:a systematic review and Meta-analysis

OBJECTIVE:To evaluate the influence of clinical pathways in the hospitals using the Traditional Chinese Medicine in treatment of stroke in terms of postoperative complications, length of stay(LOS),costs incurred during hospitalization, compared with standard medical care.METHODS:Medline, Embase, China National Knowledge Infrastructure(CNKI) platforms, Wanfang databases and the Cochrane Central Register of Controlled Trials were searched.The search was performed up to August 2014.Each study was assessed independently by two reviewers.The assessment of methodological quality of the included studies was based on the Methodological index for non-randomized studies standard.Meta-analyses were performed using Rev Man software, version5.0.RESULTS:Six studies met the study inclusion criteria and were included in the Meta-analysis for a total sample of 710 patients.The aggregate overall results showed that shorter length of stay in the clinical pathway group was observed during hospital stay was associated with the use of the clinical pathways.No significant differences were found in other effects.CONCLUSION:Regardless the possible limitations,our findings show that clinical pathways can significantly reduce LOS.Although there is no clear evidence that clinical pathways can reduce hospital costs, but the cost of hospitalization path group for each included study were lower than the control group.