On 12 May 2008, the Wenchuan earthquake struck in Sichuan, China. Within 1 month after the earthquake, 98 injured children were admitted to the Children's Hospital of Chongqing Medical University. According to clinical manifestations, 50 children were diagnosed with wound infections. Wound secretions were cultured for bacteria. Pathogen distribution and drug resistance were analyzed. A total of 99 pathogens were isolated; 16 (16%) were Gram-positive bacteria and 81 (82%) were Gram-negative bacteria. The distribution of pathogens isolated within 1 month after the earthquake was different to the distribution of pathogens in 546 general hospitalized cases in the y before the earthquake. The pathogens most frequently isolated 1 month after the earthquake were Acinetobacter baumannii (27%), Enterobacter cloacae (18%) and Pseudomonas aeruginosa (13%). The pathogens most frequently isolated in the y prior to the earthquake were Escherichia coli (27%), Staphylococcus aureus (23%) and coagulase-negative staphylococci (9%). The rate of isolated drug-resistant bacteria was higher in the earthquake cases than in the general hospitalized cases. In the cases injured in the earthquake, the rates of isolation of methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing E. cloacae, E. coli and Klebsiella pneumoniae were higher than in the cases from before the earthquake. Multidrug-resistant and pandrug-resistant A. baumannii were isolated at a higher rate in cases after the earthquake than in those before the earthquake. These changes in the spectrum of pathogens and in the drug resistance of the pathogens isolated following an earthquake will provide the basis for emergency treatment after earthquakes.

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BackgroundConventional meta-analyses and randomized controlled trials have shown inconsistent results regarding the efficacy of immunosuppressants for pediatric steroid-resistant nephrotic syndrome (SRNS).ObjectiveTo conduct a network meta-analysis aimed at evaluating the efficacy and safety of available immunosuppressive agents in pediatric patients with SRNS.Study methodsMEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE were searched on January 2017. Data from randomized controlled trials (RCTs) were included. The main outcomes analyzed were efficacy [number/portion with complete remission (CR), number/portion with partial remission (PR), and total number/portion in remission (TR)] and safety [adverse secondary event (ASE) rates].ResultsA meta-analysis of 18 RCTs showed that tacrolimus was more efficacious for achieving CR than intravenous (i.v.) cyclophosphamide, mycophenolate mofetil (MMF), oral cyclophosphamide, leflunomide, chlorambucil, azathioprine, and plaebo/nontreatment (P/NT), and more efficacious than i.v. cyclophosphamide, oral cyclophosphamide, and P/NT in terms of TR outcomes. Cyclosporin was associated with a greater CR rate than i.v. cyclophosphamide, MMF, oral cyclophosphamide, chlorambucil, azathioprine, or P/NT, and associated with a greater TR rate than i.v. cyclophosphamide, oral cyclophosphamide, or P/NT. MMF was found to be more efficacious than i.v. cyclophosphamide and oral cyclophosphamide in terms of TR.ConclusionsTacrolimus and cyclosporine may be preferred initial treatments for children with SRNS. MMF may be another option for this patient population. Further studies of the efficacy and safety of these three drugs in children with SRNS should be pursued.

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Background: Ghrelin is the endogenous ligand of growth hormone secretagogue receptor 1a, which plays a role in regulating immunity and inflammation. The aim of this study is to assess the diagnostic value of plasma ghrelin in sepsis-associated pediatric acute respiratory distress syndrome (PARDS).Methods: We recruited patients who were admitted to the pediatric ICU (PICU) of the Children's Hospital of Chongqing Medical University between January 2019 and January 2020 and met the diagnostic criteria for sepsis. Data on clinical variables, laboratory indicators, plasma ghrelin concentrations, and inflammatory factors were collected and evaluated, and patients were followed up for 28 days. The area under the receiver-operating characteristic curves (AUROC) were determined using logistic regression to calculate and test cut-off values for ghrelin as a diagnostic indicator of sepsis-associated PARDS. The log-rank test was used to compare survival according to ghrelin levels.Main results: Sixty-six PICU patients (30 with ARDS and 36 without ARDS) who met the diagnostic criteria of sepsis were recruited. The ghrelin level was significantly higher in the ARDS group than in the non-ARDS group. The AUROC of ghrelin was 0.708 (95% confidence interval: 0.584–0.833) and the positivity cutoff value was 445 pg/mL. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of plasma ghrelin for the diagnosis of PARDS-associated sepsis were 86.7, 50.0, 59.1, 81.8, 1.734, and 0.266%, respectively. The survival rate of sepsis patients were significantly improved when the ghrelin level was >445 pg/mL.Conclusions: Ghrelin plasma levels were higher in sepsis-associated PARDS, and accompanied by increased levels of inflammatory factors. High ghrelin levels are a positive predictor of ICU survival in sepsis patients. Yet, there is no evidence to prove that elevated ghrelin is a promising diagnostic indicator of sepsis-associated PARDS.Trial registration: Clinicaltrials, ChiCTR1900023254. Registered 1 December 2018 - Retrospectively registered, http://www.clinicaltrials.gov/ChiCTR1900023254.