脓毒症患儿的全肠道外营养性高血糖与机械通气和住院时间的延长有关

Purpose: We studied the effects of total parenteral nutrition (TPN)-associated hyperglycemia on the clinical outcome in premature septic infants in the neonatal intensive care unit. Methods: The charts of all premature infants weighing less than 1500 g upon admission to the neonatal intensive care unit between January 1, 2002, and December 31, 2002, with sepsis, ventilator dependence, and feeding intolerance were studied. Maximum serum glucose concentrations were compared with duration of TPN, mechanical ventilation, hospital length of stay, and survival using Pearson regression analysis and Student’s t test. Results: Thirty-seven patients met the search criteria. The average caloric intake for all infants at the time of blood culture-proven sepsis was 83 ±19 kcal/kg per day. The maximum serum glucose concentration (milligrams per deciliter) after having positi ve blood cultures (sepsis) was positively correlated with the duration of TPN (r=0.45, P= .005), length of dependence on mechanical ventilation (r=0.45, P= .006), and hospital length of stay (r =0.36, P= .03). The average maximum serum glucose level was significantly higher in the nonsurviving infants (241±46 vs 141±48, P < .0001). Conclusion: Hyperglycemia correlated with prolonged ventilator dependency and increased hospital length of stay in premature septic infants. Avoidance of excessive nutrient delivery and tight glycemic control during periods of acute metabolic stress may improve outcome in this patient population.

Pediatric endoscopy across multiple clinical settings:Efficiency and adverse events

BACKGROUND Endoscopic procedures are becoming increasingly important for the diagnosis and treatment of gastrointestinal disorders during childhood,and have evolved from a more infrequent inpatient procedure in the operating room to a routine outpatient procedure conducted in multiple care settings.Demand for these procedures is rapidly increasing and thus there is a need to perform them in an efficient manner.However,there are little data comparing the efficiency of pediatric endoscopic procedures in diverse clinical environments.We hypothesized that there are significant differences in efficiency between settings.AIM To compare the efficiency and examine adverse effects of pediatric endoscopic procedures across three clinical settings.METHODS A retrospective chart review was conducted on 1623 cases of esophagogastroduodenoscopy(EGD)or combined EGD and colonoscopy performed between January 1,2014 and May 31,2018 by 6 experienced pediatric gastroenterologists in three different clinical settings,including a tertiary care hospital operating room,community hospital operating room,and free-standing pediatric ambulatory endoscopy center at a community hospital.The following strict guidelines were used to schedule patients at all three locations:age greater than 6 mo;American Society of Anesthesiologists class 1 or 2;normal craniofacial anatomy;no anticipated therapeutic intervention(e.g.,foreign body retrieval,stricture dilation);and,no planned or anticipated hospitalization post-procedure.Data on demographics,times,admission rates,and adverse events were collected.Endoscopist time(elapsed time from the endoscopist entering the operating room or endoscopy suite to the next patient entering)and patient time(elapsed time from patient registration to that patient exiting the operating room or endoscopy suite)were calculated to assess efficiency.RESULTS In total,58%of the cases were performed in the tertiary care operating room.The median age of patients was 12 years and the male-to-female ratio was nearly equal across all locations.Endoscopist time at the tertiary care operating room was 12 min longer compared to the community operating room(63.3±21.5 min vs 51.4±18.9 min,P<0.001)and 7 min longer compared to the endoscopy center(vs 56.6±19.3 min,P<0.001).Patient time at the tertiary care operating room was 11 min longer compared to the community operating room(133.2±39.9 min vs 122.3±39.5 min,P<0.001)and 9 min longer compared to the endoscopy center(vs 124.9±37.9 min;P<0.001).When comparing endoscopist and patient times for EGD and EGD/colonoscopies among the three locations,endoscopist,and patient times were again shorter in the community hospital and endoscopy center compared to the tertiary care operating room.Adverse events from procedures occurred in 0.1%(n=2)of cases performed in the tertiary care operating room,with 2.2%(n=35)of cases from all locations having required an unplanned admission after the endoscopy for management of a primary GI disorder.CONCLUSION Pediatric endoscopic procedures can be conducted more efficiently in select patients in a community operating room and endoscopy center compared to a tertiary care operating room.

人体早期发育：极低出生体重儿头围较小的新生儿期相关因素及学龄期结局

头围（HC）小于正常与神经系统功能较差及发育结局较差有关。目的：研究极低出生体重儿（VLBW，〈1500g）小头围的相关因素及学龄期的结局。方法：研究1982—1986年出生的平均年龄为6．8岁的128例VLBW儿童的发育情况，58例正常出生体重儿被作为对照。VLBW队列组包括个别出生体重〈750g的儿童，其配对儿童的出生体重为750-1499go评价指标包括智商、神经心理学技能、学业成绩、适应行为及注意力问题。HC也被定义为从不正常到正常的一个连续变量。控制混杂因素后采用线性及logistic回归分析确定HC对结果的影响。结果：VLBW儿童中有31（24％）例的头围较小，而对照组则无头围较小者。VLBW儿童中头围较小者在以下几个方面显著不同于正常头围组：出生体重（748gvs977g，P〈0．001）、SGA状态（52％vs27％，P〈0．05）、新生儿高危险性（57％vs29％，P〈0．05）、感觉神经受损（23％vs8％，P〈0．05）。即使把这些危险因素都考虑在内，头围小于正常仍与较差的IQ、知觉动作技能、学业成绩和适应行为有关。排除感觉神经受损的儿童后，结果相似。结论：头围小于正常与VLBW儿童不良发育结果相关，且独立于其他危险因素。改善出生前和出生后的生长发育状况可能对学龄期的结局有益。

Hospital-based emergency department visits in children with motor vehicle traffic accidents: estimates from the nationwide emergency department sample

Background:The purpose of this study is to provide nationally representative estimates of children visiting hospital-based emergency departments(ED)for motor vechicle traffic accidents(MVTA)in the United States during the year of 2008.Methods:Nationwide Emergency Department Sample for 2008 was used.All pediatric(age<18 years)ED visits with external cause for injury ICD-9-diagnostic codes for MVTA were selected.Outcomes examined included discharge status following ED visit and presence of concomitant injuries.Descriptive statistics was used to summarize the estimates.Results:Totally 604027 hospital-based ED visits occurred in the United States among children(age≤18 years)due to MVTA.Following an ED visit,91%were discharged routinely,while 6%were admitted as inpatients into the same hospital.A total of 928 children died in the ED.A total of 34004 ED visits required inpatient admission into the same hospital and 768 patients died during hospitalization.Mean charge per ED visit was$1887 and total ED charges across the United States were close to$970 million.Among those admitted into the same hospital following ED visit(n=34004),the mean hospitalization charge was$53726 and total hospitalization charge across the entire United States were$1.8 billion.Conclusions:Study findings illustrate the burden associated with pediatric ED visits due to MVTA.Close to$970 million of hospital charges were incurred by children who made an ED visit due to a MVTA during 2008 and about$1.8 billion was incurred among those hospitalized following an ED visit.

Shexiang Tongxin Dropping Pill（麝香通心滴丸）Protects against Na2S2O4-Induced Hypoxia-Reoxygenation Injury in H9c2 Cells

Objectives: To investigate the protective effects of Shexiang Tongxin Dropping Pill(麝香通心滴丸,STP) on Na2S2O4-induced hypoxia-reoxygenation injury in cardiomyoblast H9c2 cells. Methods: The cell viability and levels of mRNA and protein expression in H9c2 cells were determined following Na2S2O4-induced hypoxia using Hoechst staining, annexin V/propidium iodide(PI) flow cytometry, real-time polymerase chain reaction and Western blot analysis. Results: STP pretreatment signi?cantly increased the viability and inhibited aberrant morphological changes in H9c2 cardiomyoblast cells induced by Na2S2O4 treatment(P<0.05). In addition, STP pretreatment attenuated Na2S2O4-induced hypoxic damage, down-regulated the expression of pro-apoptotic Bax,and up-regulated the expression of anti-apoptotic Bcl-2 in H9c2 cells(P<0.05). Conclusions: STP was strongly cardioprotective in hypoxia-reoxygenation injury by preventing hypoxic damage and inhibiting cellular apoptosis.These results further support the use of STP as an effective drug for the treatment of ischemic heart disease.