A cohort study of vincristine-induced peripheral neuropathy in children / 中国当代儿科杂志

OBJECTIVES@#To study the characteristics of vincristine-induced peripheral neuropathy (VIPN) in children with acute lymphoblastic leukemia (ALL) and the factors influencing the development of VIPN.@*METHODS@#The children with ALL, aged 1-18 years, who were treated with CCCG-ALL2015 or CCCG-ALL2020 regimen in the Affiliated Hospital of Guizhou Medical University from January 2018 to February 2022 were enrolled as subjects. According to the influence of age on risk, the children were divided into 1-10 years group with 91 children and >10 years group with 29 children. VIPN was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (5th edition), and the incidence rate, severity, and type of VIPN were compared between different groups.@*RESULTS@#A total of 120 children were enrolled in this study, among whom 56 (46.7%) developed VIPN. The >10 years group had a significantly higher incidence rate of VIPN than the 1-10 years group (69% vs 40%, P<0.05). Among the 56 children with VIPN, 12 (21%) had grade 3 VIPN or above, and 44 (79%) had grade 2 VIPN. There were 77 cases of autonomic nerve symptoms (59.7%), 42 cases of peripheral nerve injury (32.5%), and 10 cases of cranial nerve injury (7.8%). There were no significant differences in the severity and type of VIPN between the groups with different ages, sexes, degrees of risk, or treatment regimens (P>0.05). The results of binary logistic regression analysis showed that age is the influencing factor for the occurrence of VIPN (P>0.05).@*CONCLUSIONS@#There is a relatively high incidence rate of VIPN in children with ALL, with the highest incidence rate of autonomic nervous symptoms. The incidence of VIP in children over 10 years old is relatively high.

Percutaneous foraminal endoscopy for the treatment of lumbar lateral recess stenosis in elderly / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly.@*METHODS@#The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred.@*CONCLUSION@#The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.

Treatment of intrauterine adhesions in rats with hypoxia-cultured BMSC-derived exosomes / 中华妇产科杂志

Objective: To perform intrauterine adhesion modeling, and to investigate the repair effect of hypoxic treated bone marrow mesenchymal stem cells (BMSC) and their derived exosomes (BMSC-exo) on endometrial injury. Methods: BMSC and their exosomes BMSC-exo extracted from rats' femur were cultured under conventional oxygen condition (21%O2) or hypoxia condition (1%O2). Intrauterine adhesion modeling was performed on 40 healthy female SD rats by intrauterine injection of bacterial lipopolysaccharide after curettage. On the 28th day of modeling, 40 rat models were randomly divided into five groups, and interventions were performed: (1) NC group: 0.2 ml phosphate buffered solution was injected into each uterine cavity; (2) BMSC group: 0.2 ml BMSC (1×106/ml) with conventional oxygen culture was injected intrauterine; (3) L-BMSC group: 0.2 ml of hypoxic cultured BMSC (1×106/ml) was injected intrauterine; (4) BMSC-exo group: 0.2 ml of BMSC-exo cultured with conventional oxygen at a concentration of 500 μg/ml was injected into the uterine cavity; (5) L-BMSC-exo group: 0.2 ml hypoxic cultured BMSC-exo (500 μg/ml) was injected intrauterine. On the 14th and 28th day of treatment, four rats in each group were sacrificed by cervical dislocation after anesthesia, and endometrial tissues were collected. Then HE and Masson staining were used to observe and calculate the number of glands and fibrosis area in the endometrium. The expressions of angiogenesis related cytokines [vascular endothelial growth factor A (VEGFA) and CD31], and fibrosis-related proteins [collagen-Ⅰ, collagen-Ⅲ, smooth muscle actin α (α-SMA), and transforming growth factor β1 (TGF-β1)] in endometrial tissues were detected by western blot. Results: (1) HE and Masson staining showed that the number of endometrial glands in L-BMSC group, BMSC-exo group and L-BMSC-exo group increased and the fibrosis area decreased compared with NC group on the 14th and 28th day of treatment (all P<0.05). Noteworthily, the changes of L-BMSC-exo group were more significant than those of BMSC-exo group (all P<0.05), and the changes of BMSC-exo group were greater than those of BMSC group (all P<0.05). (2) Western blot analysis showed that, compared with NC group, the expressions of collagen-Ⅲ and TGF-β1 in BMSC group, L-BMSC group, BMSC-exo group and L-BMSC-exo group decreased on the 14th and 28th day of treatment (all P<0.05). As the treatment time went on, the expressions of fibrosis-related proteins were different. Compared with BMSC group, the expressions of collagen-Ⅲ, α-SMA and TGF-β1 in the BMSC-exo group and L-BMSC group decreased on the 28th day (all P<0.05). Moreover, the expressions of collagen-Ⅲ and TGF-β1 in L-BMSC-exo group were lower than those in BMSC-exo group on the 28th day (all P<0.05). And the expressions of collagen-Ⅰ, α-SMA and TGF-β1 in L-BMSC-exo group were lower than those in L-BMSC group on the 28th day (all P<0.05). (3) The results of western blot analysis of VEGFA and CD31 showed that, the expressions of VEGFA and CD31 in BMSC group, L-BMSC group, BMSC-exo group and L-BMSC-exo group increased on the 14th and 28th day of treatment compared with NC group (all P<0.05). Treatment for 28 days, the expressions of VEGFA and CD31 in BMSC-exo group and CD31 in L-BMSC group were higher than those in BMSC group (all P<0.05). Moreover, the expressions of VEGFA and CD31 in L-BMSC-exo group were higher than those in BMSC-exo group and L-BMSC group on the 28th day (all P<0.05). Conclusions: Treatment of BMSC and their exosomes BMSC-exo with hypoxia could promote endometrial gland hyperplasia, inhibit tissue fibrosis, and further repair the damaged endometrium in rats with intrauterine adhesion. Importantly, hypoxic treatment of BMSC-exo is the most effective in intrauterine adhesion rats.

Clinical observation on syndrome-differentiation acupuncture combined with rehabilitation training for autism spectrum disorder / 中国针灸

OBJECTIVE@#To compare the clinical efficacy and safety between syndrome-differentiation acupuncture combined with rehabilitation training and simple rehabilitation training for children with autism spectrum disorder (ASD).@*METHODS@#A total of 60 children with ASD were randomly divided into an observation group and a control group, 30 cases in each group. In the control group, routine rehabilitation training was applied; in the observation group, syndrome-differentiation acupuncture (the main points were Baihui [GV 20], Dingshenzhen, Niesanzhen, etc., the supplementary acupoints were selected according to syndrome-differentiation) combined with rehabilitation training were applied, all the treatments were given once a day, 5-day continuous treatment with 2-day interval, 12 weeks were required. Before treatment and after 6, 12 weeks of treatment, the autism treatment evaluation checklist (ATEC), childhood autism rating scale (CARS) and autism behavior checklist (ABC) scores were observed, the therapeutic effect and safety were evaluated in the two groups.@*RESULTS@#After 6 and 12 weeks of treatment, except for the sensory perception score after 6 weeks of treatment in the control group, the item scores and total scores of ATEC, CARS scores and ABC scores were decreased compared with those before treatment in the two groups (P<0.05). After 6 weeks of treatment, the social score and total score of ATEC, CARS score in the observation group were lower than those in the control group (P<0.05); after 12 weeks of treatment, the item scores and total score of ATEC, CARS score and ABC score in the observation group were lower than those in the control group (P<0.05). The total effective rate in the observation group was 80.0% (24/30), which was higher than 56.7% (17/30) in the control group (P<0.05). There was no serious adverse reactions in the two groups, and there was no significant difference in the incidence rate of adverse reactions between the two groups (P>0.05).@*CONCLUSION@#Syndrome-differentiation acupuncture combined with rehabilitation training could improve the core symptoms in children with ASD, especially sensory perception and social ability, and with good safety, which is superior to simple rehabilitation training.

Survival status of HIV/AIDS patients aged ≥ 50 years old receiving antiretroviral therapy in Shanxi, 2011-2019 / 中国热带医学

@#Abstract: Objective　To analyze the survival status of HIV/AIDS patients aged above 50 years receiving antiviral therapy (ART) in Shanxi Province from 2011 to 2019, and to provide evidence for further improvement of antiviral therapy. Methods　Basic information and follow-up information of HIV/AIDS patients aged above 50 years who first received HIV/AIDS antiviral therapy in Shanxi Province from 2011 to 2019 were collected. Excel database was established and SPSS23.0 software was used for analysis. Retrospective cohort study was conducted. Cox proportional risk regression model was used to analyze the factors influencing survival time. Results　A total of 1 183 subjects were included, of which 172 died, including 84(48.84%) from other causes, 74(43.02%) AIDS-related death and 14 (8.14%) from accidents, suicides and undetermined deaths. Setting AIDS-related deaths as an outcome event, life table analysis showed that the cumulative survival rates at 1, 3, 5, 7 and 9 years after receiving ART were 96.61%, 93.59%, 90.35%, 87.57% and 83.44%, respectively. Multivariate Cox proportional risk model analysis showed that the risk of death in patients aged 60-<70 years group and over 70 age group was 2.53 times (95%CI: 1.51-4.23) and 3.59 times (95%CI: 1.74-7.40) for patients aged the 50-<60 group , respectively. The risk of death in patients with baseline CD4+T lymphocyte (CD4) counts of ≥200/mm3, 50-<200 /mm3 was 0.22 times (95%CI: 0.12-0.41) and 0.37 times (95%CI: 0.21-0.67) for patients with CD4+T lymphocyte counts of <50/mm3. The risk of death in patients with opportunistic infections at baseline was 1.99 times (95%CI: 1.16-3.39) for patients without baseline opportunistic infections. Conclusions　The survival rate of HIV/AIDS patients aged above 50 who received antiviral therapy (ART) in Shanxi Province from 2011 to 2019 was relatively high. To further improve the quality of antiviral treatment in our province, the strategy of "early detection and early treatment" should be continued and improved in the future, and information collection of specific causes of non-AIDS-related deaths among this population should be further strengthened.

Diagnosis and treatment of inherited platelet function disorders / 中华实用儿科临床杂志

Inherited platelet function disorders(IPFD)is a rare hereditary disease characterized by various degrees of bleeding tendency with or without thrombocytopenia.Due to the lack of standardized evaluation system in laboratory test, the diagnosis and classification of IPFD are difficult.Thus, the incidence of IPFD may be underestimated.At present, combined with symptoms and laboratory tests, the second generation sequencing technology is conductive to the fast and accurate diagnosis of complex hemorrhagic diseases of this type and can prompt assessment and treatment.However, there still exists no effective targeted treatment for IPFD.This paper was aimed at introducing the diagnosis and treatment of IPFD.

Treatment of upper lumbar disc herniation with percutaneous endoscopic lumbar discectomy through two different approaches / 中国骨伤

OBJECTIVE@#To explore clinical efficacy of percutaneous endoscopic lumbar discectomy through two different approaches in treating upper lumbar disc herniation.@*METHODS@#From March 2015 to August 2019, 32 patients with upper lumbar disc herniation treated by percutaneous endoscopic lumbar dicecromy(PELD) were analyzed retrospectively and divided into percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) group according to different methods. There were 19 patients in PETD group, including 10 males and 9 females aged from 30 to 65 years old with an average of (44.70±12.08) years old;5 patients on L, 6 patients on L, 8 patients on L;6 patients were central herniation, 8 patients were paracentric herniation, and 5 patients were migration of herniation. There were 13 patients in PEID group, including 4 males and 9 females aged from 25 to 55 years old with an average of (42.23±12.09) years old;the courses of disease ranged from 1 to 7 months with an average of (2.90±3.02) months;3 patients on L, 4 patients on L, 6 patients on L;2 patients were central herniation, 4 patients were paracentric herniation, 3 patients were migration of herniation, 4 patients were prolapse free type protrusion. VAS and ODI score before operation, postoperative at 3 days, 3 and 6 months were compared between two groups, advanced MacNab standard at 1 year after operation were applied to evaluate clinical effects.@*RESULTS@#Operation were successful operated in 32 patients and obtained following up without nerve injury and infection of intervertebral space. One patient in PETD groups occurred dural sac tear in operation, but no adverse reaction afteroperation. PETD group was followed up from 12 to 24 months with an average of (15.80±3.48) months, while PEID group was followed up from 12 to 30 months with an average of (16.70±4.66) months, while there was no statistical difference between two groups (>0.05). VAS and ODI score at different time points after operation were higher than that of before operation (<0.05). According to advanced MacNab standard at 1 year after operation, 11 patients obtained excellent results, 6 good, 1 moderate and 1 poor in PETD group;while 7 patients got excellent results, 4 good, 2 moderate in PEID group.@*CONCLUSION@#Both of two surgical approach could achieve satisfactory efficacy in treating upper lumbar disc herniation, PETD is more suitable for central herniation, paracentric herniation and patients with mild displacement, PEID has advantage on prolapse free type protrusion.

Prognostic factors in immune thrombocytopenia in children / 中华实用儿科临床杂志

Objective@#To explore the prognostic relationship between initial absolute lymphocyte count(ALC) of peripheral blood and primary immune thrombocytopenia (ITP) in children, in order to provide basis for judging the prognosis and treatment of ITP in children.@*Methods@#Clinical data of 166 children with primary ITP in children admi-tted at the Affiliated Hospital of Guizhou Medical University from January 2014 to March 2018 were analyzed retrospectively, and they were followed up by clinic and telephone, the prognostic factors (gender, age, ethnicity, inducement, bleeding, initial ALC, platelet count and treatment) were statistically analyzed, and the relationship between ALC of peripheral blood and the prognosis of children with ITP was observed.@*Results@#Of 166 children with ITP, 89 cases (53.6%) had remission within 3 months, 18 cases (10.8%) within 3-12 months, 20 cases (12.0%) within 1-4 years, a total of 39 cases (23.5%) were refractory (no remission in 1-10 years), the remission rate within 1 year was 64.5%, the total remission rate was 76.4%.ALC of remission cases was (4.58±2.87)×109/L within 3 months, (4.47±2.04)×109/L within 3-12 months, and (2.86±1.61)×109/L within 1- 4 years.Thirty-nine cases (23.5%) were refractory(no remission in 1-10 years), ALC of them was (2.07±0.98)×109/L, and there were significant differences among different groups (F= 12.06, P<0.01). Univariate analysis showed that age (F=27.28), pre-morbidity history of infection and vaccination history(χ2= 9.31), initial ALC (F=12.06) at initial diagnosis were related with the prognosis of children with ITP (all P<0.05). Multivariate analysis showed that the history of infection before onset, the history of vaccination(95%CI: 0.19 to 1.51, P<0.05)and initial ALC(95%CI: -0.64 to -0.23, P<0.001) at the time of initial diagnosis were independent factors affecting the prognosis of children with ITP.The receivers operating characteristic (ROC) was drawn with the development of chronic disease (course >12 months) as state variable and ALC as test variable.The area under curve(AUC) was 0.765(P<0.05), cut-off point was 3.925×109/L, sensitivity was 0.542, and specificity was 0.966.@*Conclusions@#Initial ALC can be used as one of the prognosis index of ITP in children, and low ALC is the risk signal for chronic development of ITP in children.

Preliminary analysis on X-ray in youth neck type of cervical spondylosis with upper crossed syndrome / 中国骨伤

OBJECTIVE@#To analyze the X-ray characteristics in youth neck type of cervical spondylosis with upper crossed syndrome(UCS).@*METHODS@#The patients who had a neck type of cervical spondylosis with or without UCS were selected from January to October 2017, 20 cases in each group, and 10 normal volunteers were chosen in the study. X-ray examination of lateral and hyperextension-hyperflexion of cervical spine were performed to observe cervical spine angle, angular displacement and adjacent vertebral body slip.@*RESULTS@#The cervical spine angle was (-0.40±9.64)° in the UCS group, significantly less than (14.35±9.01)° in the normal group and (12.34±5.65)° in the non-UCS group(0.05).@*CONCLUSIONS@#In young patients who has a neck type of cervical spondylosis with UCS, the cervical curvature prone to straighten or reverse, the upper cervical flexion and extension are limited, while the lower cervical is in a flexion.

Prognostic factors in immune thrombocytopenia in children / 中华实用儿科临床杂志

Objective To explore the prognostic relationship between initial absolute lymphocyte count(ALC) of peripheral blood and primary immune thrombocytopenia(ITP)in children,in order to provide basis for judging the prognosis and treatment of ITP in children. Methods Clinical data of 166 children with primary ITP in children admi_tted at the Affiliated Hospital of xuizhou medical University from January 2014 to march 2018 were analyzed retrospec_tively,and they were followed up by clinic and telephone,the prognostic factors( gender,age,ethnicity,inducement, bleeding,initial ALC,platelet count and treatment)were statistically analyzed,and the relationship between ALC of pe_ripheral blood and the prognosis of children with ITP was observed. Results Of 166 children with ITP,89 cases (53. 6%)had remission within 3 months,18 cases(10. 8%)within 3_12 months,20 cases(12. 0%)within 1_4 years,a total of 39 cases(23. 5%)were refractory(no remission in 1_10 years),the remission rate within 1 year was 64. 5%,the total remission rate was 76. 4%. ALC of remission cases was(4. 58 ± 2. 87)×109/L within 3 months, (4. 47 ± 2. 04)×109/L within 3 _12 months,and(2. 86 ± 1. 61)×109/L within 1 _ 4 years. Thirty_nine cases (23. 5%)were refractory(no remission in 1_10 years),ALC of them was(2. 07 ± 0. 98)×109/L,and there were significant differences among different groups( F = 12. 06,P <0. 01 ). Univariate analysis showed that age( F =27. 28),pre_morbidity history of infection and vaccination history(χ2 = 9. 31),initial ALC( F=12. 06)at initial diagnosis were related with the prognosis of children with ITP(all P<0. 05). multivariate analysis showed that the his_tory of infection before onset,the history of vaccination(95%CI:0. 19 to 1. 51,P <0. 05)and initial ALC(95%CI:_0. 64 to _0. 23,P<0. 001)at the time of initial diagnosis were independent factors affecting the prognosis of children with ITP. The receivers operating characteristic(ROC)was drawn with the development of chronic disease(course >12 months)as state variable and ALC as test variable. The area under curve(AUC)was 0. 765(P<0. 05),cut_off point was 3. 925×109/L,sensitivity was 0. 542,and specificity was 0. 966. Conclusions Initial ALC can be used as one of the prognosis index of ITP in children,and low ALC is the risk signal for chronic development of ITP in children.

Multiple mediation effect on perceived stress and abnormal eating behavior through different emotion regulation strategies among medical students / 中国学校卫生

Objective@#To explore the relationships among perceived stress, emotion regulation strategies, and abnormal eating behavior among medical students, in order to provide healthy eating behavior reference for medical students, especially under pressure.@*Methods@#Chinese Perceived Stress Questionnaire, Emotion Regulation Questionnaire, and Dutch Eating Behavior Questionnaire were administered among 777 students from three medical universities in Shanxi seleceted by a stratified random cluster sampling method.@*Results@#There were significant differences in unhealthy eating behavior by gender and major. Abnormal eating problem score of clinical medicine students was significantly higher than that of non-clinical medicine students (t=3.56,P<0.01); Scores of restrained eating behavior, emotional eating behavior, and exogenic eating behavior of clinical medicine students were all significantly higher than those of non-clinical medicine students (t=3.45, 3.04, 4.19, P<0.01). Abnormal eating behavior, and restrained eating behavior and exogenic eating behavior in female students were significantly higher than those of male students (t=2.28, 2.58, 2.46, P<0.05). The perceived stress significantly and positively correlated with the abnormal eating behavior (P<0.01); Cognitive reappraisal and expressive inhibition significantly and negatively correlated with abnormal eating behavior respectively (P<0.01); No significant association was found between expressive inhibition and abnormal eating behavior. Cognitive reappraisal mediated the association between abnormal eating behavior with perceived stress which accounted for 36.89%, mediating effect in boys was higher than that of girls. However, expressive inhibition showed no similar effect and gender difference.@*Conclusion@#Perceived stress can influence abnormal eating behavior of medical students through cognitive reappraisal directly or indirectly, while expressive inhibition shows no such mediating effect. For medical students under pressure, the skill of emotion regulation through cognitive reappraisal, emotion expression as well as appropriate coping style under pressure should be developed.

Treatment of displacement-type lumbar intervertebral disc protrusion on L2-L5 with percutaneous endoscopic interlaminar discectomy / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the operative characteristic, safety, clinical effect of percutaneous endoscopic interlaminar discectomy (PEID) in treating displacement-type lumbar intervertebral disc protrusion on L₂-L₅.</p><p><b>METHODS</b>Form November 2015 to October 2016, 15 patients with displacement-type lumbar intervertebral disc protrusion were treated with percutaneous endoscopic interlaminar discectomy. There were 9 males and 6 females, aged from 19 to 63 years old with an average of 42 years. All the patients with single-segment displacement-type lumbar intervertebral disc protrusion were diagnosed by clinical and iconography data, and complicated with low back pain and single lower limbs radioactivity pain. Lesion occurred in L₄,₅ of 8 cases, L₃,₄ of 4 cases, L₂,₃ of 3 cases. The patients were divided into 4 regions according to Lee standard (displaced nucleus pulposus location on spinal canal), I region was 2 cases, II region was 3 cases, III region was 5 cases, IV region was 5 cases.Preoperative, postoperative 3 months, final follow-up, lumbago-leg pain and lumbar function were assessed by VAS, JOA scores;at final follow-up, MacNab was used to evaluate the clinical effect;postoperative 3 months, rechecked lumbar MRI to observe discectomy condition.</p><p><b>RESULTS</b>All the operations were successfully complete under local anesthesia, and no complications such as injuries of nerve root and dural sac, postoperative hemorrhage, local infection were found. Operative time was 45 to 90 min with an average of 54.8 min;and hospitalization time was 3 to 4 days with an average of 3 days. All 15 cases were followed up for 12 to 13 months with an average of 12.2 months, no recurrence was found. Preoperation, postoperative 3, 12 months, VAS scores were 8.2±1.4, 3.0±0.6, 1.7±0.5, JOA scores were 8.76±3.32, 23.61±2.14, 24.82±3.43, respectively. Postoperative VAS, JOA scores were obviously improved(<0.05). According to MacNab standard to evaluate the clinical effect, 9 cases obtained excellent results, 5 good, 1 fair.</p><p><b>CONCLUSIONS</b>PEID is a micro-trauma surgical method and has advantage of safe and effective in treating displacement-type lumbar intervertebral disc protrusion on L₂-L₅, but requires laminoplasty during operation, and under local anesthesia to operation maybe can induce neurostimulation.</p>

Application of broad easy immediate surgery in percutaneous transforaminal endoscopic technology for lumbar lateral recess stenosis in the elderly / 中国骨伤

<p><b>OBJECTIVE</b>To explore the safety and effectiveness of percutaneous transforaminal endoscopic BEIS technology for lumbar lateral recess stenosis in the elderly.</p><p><b>METHODS</b>From February 2014 to May 2016, 21 patients with lumbar lateral recess stenosis in elderly were treated with percutaneous endoscopic BEIS. There were 13 males and 8 females, aged from 70 to 85 years old with an average of 74.3 years. Preoperative, 1 and 12 months postoperative visual analogue scale(VAS) scores and Oswestry Disability Index(ODI) were statistically analyzed. MacNab was used to assess the clinical effects.</p><p><b>RESULTS</b>All the operations were successful. The time ranged from 90 to 130 min with an average of 110 min. All the patients were followed up for 12 to 38 months with an average of 18 months. Preoperative, 1 and 12 months postoperative VAS scores were 8.47±1.23, 1.78±0.72, 0.68±0.32, and ODI scores were 32.48±10.03, 19.53±3.55, and 5.15±1.02, respectively. Postoperative scores of VAS and ODI were obviously improved(<0.05). According to modified MacNab standard to evaluate the clinical effects, 14 cases obtained excellent results, 5 good, 2 fair. Lower limb paresthesia occurred in 1 case, and the condition was restored at 3 months postoperatively with conservative treatment. One patient was complicated with emphysema before operation secondary to pulmonary infection, and was effectively controlled with regulate antibiotic therapy. No infection of vertebral body or intervertebral space, no injuries of blood vessels or nerve root, no tear of dura, or the leakage of cerebrospinal fluid were found.</p><p><b>CONCLUSIONS</b>Percutaneous transforaminal endoscopic BEIS is a safe and effective method for lumbar lateral recess stenosis in the elderly.</p>

Analysis of malnutrition status in pediatric acute lymphoblastic leukemia patients dur-ing the induced remission stage / 中国肿瘤临床

Objective: To investigate the nutritional status of children acute lymphoblastic leukemia (ALL) during induced remission stage. The effects of the disease itself, treatment, and complications of malnutrition were all analyzed. Methods: From the medical re-cords of children with ALL in the pediatric hematological department of the Affiliated Hospital of Guizhou Medical University, we col-lected basic information of the children; monitored the height and weight of the children on the first, 15th, and 33rd days of induced remission treatment; and calculated their body mass index (BMI), as well as results of laboratory tests such as serum albumin and se-rum prealbumin. SPSS 23.0 software was used for data analysis. Results: In 40 children with ALL, there were 16 cases of malnutrition on the first day of induced remission treatment accounting for 40%, 14 cases on both the 15th day and the 33rd day of treatment ac-counting for 35%. Among children with malnutrition, 4 cases of moderate to severe malnutrition occurred on the first day of treat-ment accounting for 25.0%, 9 cases on the 15th day accounting for 64.3%, and 12 cases on the 33rd day accounting for 85.7%. Com-pared with day 1 and day 33, the difference was statistically significant (P<0.017). In the induced remission period, the BMI on the first day was (15.98±2.17) kg/m2; on the 15th day, it was (15.65±2.20) kg/m2; and on the 33rd day, it was (15.66±1.92) kg/m2. The differ-ence between the three was not statistically significant (P=0.730). In the single-factor analysis of factors related to the nutritional sta-tus of children, infection, digestive system involvement, and serum albumin levels were related to the occurrence of malnutrition, and we performed multifactor analysis of these three factors. The difference between the level of infection and serum albumin and the oc-currence of malnutrition was statistically significant (P<0.05). Conclusions: During the induced remission, the malnutrition degree of some children with ALL was aggravated. Infection was a high-risk factor for malnutrition in children with ALL. The decrease in serum al-bumin level may indicate the occurrence of malnutrition. Dynamic monitoring of nutritional status in children with ALL is necessary.

Standardized management of thalassemia / 中华实用儿科临床杂志

Thalassemia is inherited hemolytic anemia caused by globin production disorder,clinically known as beta thalassemia and alpha thalassemia resulted from beta and alpha chain synthesis disorder.Significant anemic clinical manifestations are observed in intermediate -level and severe -level patients with the 2 types of anemia, affecting greatly the growth and life quality of children patients who need blood transfusion to stay alive.The incidence rate of thalassemia is as high as 7% -20% in South China,so the prevention and standaridized treatment of thalasse-mia and the management over target population draw more attention.This paper is a review on the latest development of blood transfusion,chelation therapy,health education,birth intervention for thalassemia.

Percataneous endoscopic lumbar discectomy for the treatment of lumbar intervertebral disc protrusion / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of percataneous endoscopic lumbar discectomy for lumbar intervertebral disc protrusion.</p><p><b>METHODS</b>The clinical data of 46 patients with lumbar intervertebral disc protrusion underwent percataneous endoscopic lumbar discectomy were retrospectively analyzed. There were 21 males and 25 females, aged from 23 to 65 years old with an average of 42 years. The course of disease was from 5 to 87 months with an average of 13.4 months. Protrusion located in L₂,₃ of 2 cases, L₃,₄ of 3 cases, L₄,₅ of 28 cases, L₅S₁ of 13 cases. There were 5 patients with central type, 34 with para-side type, 7 with extreme lateral type. VAS, ODI and JOA scores were used to analyze the condition of pain releasing and lumbar functional improvement. According to MacNab standard to evaluate the clinical effect at final follow-up.</p><p><b>RESULTS</b>All the operations were successful, operative time was 125 to 210 min with a mean of 153.6 min; and all the patients were follow-up for 6 to 12 months with an average of 8 months; no injuries of nerve and blood vessel, infection were found. Postoperative 3 days and final follow-up, VAS score was 3.1±0.7, 2.2±0.6 respectively, and was obviously lower than preoperative 7.3±1.2(<0.05). At final follow-up, JOA and ODI were (23.5±2.4) points, and (22.10±9.26)%, respectively, and was obviously improved compared with preoperative (13.2±2.8) points and (69.12±13.15)% (<0.05). According to modified MacNab standard to evaluate the clinical outcome, 30 cases got excellent results, 14 good, 2 fair, no recurred and overhauling were found.</p><p><b>CONCLUSIONS</b>Percataneous endoscopic lumbar discectomy is a minimally invasive technique, with advantage of safety and effectiveness, and apply to treatment of lumbar intervertebral disc protrusion.</p>

Clinical characteristics and treatments of anti-coagulant rodenticide poisoning in children lacking of poisoning history / 中国小儿急救医学

Objective To summarize the clinical characteristics,diagnosis and treatments of 50 chil-dren with no history of anti-coagulation rodenticide poisoning.Methods Fifty children lacking of poisoning history were admitted to our hospital from Feb 2011 to Dec 2015,who were due to hemorrhage and finally di-agnosed as rodenticide poisoning.The clinical manifestation,characteristics of blood coagulation dysfunction, toxicology screening results and treatments of 50 cases were retrospectively analyzed.Results All 50 cases were from rural area,and denied the history of taking rodenticide by mistake.The time from the onset to ad-mission to the hospital was from 1 d to 120 d,with an average of 11.66 d.Major clinical manifestations in-cluded:34 cases(68%)of skin ecchymosis,26 cases(52%)of epistaxis,10 cases(20%)of bleeding gums and 4 cases(8%)of hematoma at the injection site,with PT 20 to over 200 s and APTT 31 to over 200 s (maximal detection value).The children were diagnosed as rodenticide poisoning when one of brodifacoum, bromadiolone,and diphacinone-sodium or combination of brodifacoum and bromadiolone were detected from their blood specimens,with an concentration of 5 to 3 270 μg/L.The diagnosed children were intravenous dripped with specific antagonist vitamin K1 and the critically ill children were added fresh frozen plasma.All children recovered from hemorrhage within 24 hours after treatment.The level of PT,APTT was close to nor-mal after 3 to 7 days of treatment,and the using of vitamin K1 was accumulated about 30 to 70 mg.The chil-dren were given maintenance treatment of vitamin K1 for three months after discharge until the condition was stable.Conclusion Commonly used rodenticide has the characteristics of fat soluble, easy to accumulate, long incubation period,and long treatment period and so on.Children with no bleeding performance have the clinical tendency of acute bleeding,prolonged PT and APTT should be considered the possibility of rodenti-cide poisoning.Blood or urine samples should be screened for toxicology as soon as possible,and meanwhile children should be given antagonist treatment with special antidote vitamin K1 until the coagulation function is stable in normal range to avoid recurrence of the illness.

Spatiotemporal expression spectrum of Rap1 gene in zebrafish early development process / 重庆医学

Objective To choose zebrafish as the experimental animal model for studying the spatiotemporal expression rule of rap1 gen in zebrafish embryo early development process .Methods The Rap1 gene fragment was cloned from the zebrafish emby‐oscDNA ,then the Rap1 gene fragment and pCS2+ plasmid were performed the in vitro connetion and recombination was extracted , the combinant plasmid was correct after the double enzyme digestion ,colony PCR and sequencing identification .T3 RNA polymer‐ase in vitro transcription system was used to obtain the digoxin (DIG)‐labeled anti‐sense mRNA probe of Rap1 gene .The whole mount in situ hybridization method was adopted to detect the Rap1 expression in zebrafish embryo early development process . Results The positive hybridization signal of Rap1 gene was detected at the cell division junction region of 0 .75 hpf ,animal pole of 3 .70 hpf and 6 .00 hpf ,and notochord of 12 .00 -72 .00 hpf .Conclusion Rap1 gene might be involved in the early development process of notochord nervous system in zebrafish .

Effect of coenzyme Q10 on the expression of tumor necrosis factor-α and interleukin-10 in gingival tissue of experimental periodontitis in rats / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of coenzyme Q10 on the levels of tumor necrosis factor-α(TNF-α) and interleukin-10 (IL-10) in gingival tissue of experimental periodontitis in rats.</p><p><b>METHODS</b>A total of 48 healthy Wistar rats were divided into 3 groups of 16 randomly, normal group, coenzyme Q10 treatment group (Q10 group) and periodontitis group.Normal group was fed with normal diet and water. Periodontitis models were established in other two groups.Q10 group received coenzyme Q10 for 12 weeks and periodontitis group was fed with the same dose of normal saline.Four rats in each group were sacrified before administration and 4, 8 and 12 weeks after administration. Gingival tissue samples from mandiblar first permanent molar were taken. The levels of TNF-α and IL-10 were detected by immunohistochemistry.</p><p><b>RESULTS</b>The expression of TNF-α in periodontitis group [54.9% (52.9%, 57.3%)] was significantly higher than that in Q10 group [15.1% (12.7%, 17.5%)] at 12 weeks (P < 0.0167) . The expression of IL-10 in periodontitis group [8.9% (7.9%, 10.0%)]was significantly lower than that in the Q10 group [38.9% (38.0%, 40.4%)] (P < 0.0167) . The expression of TNF-α in periodontitis group was significantly higher than that in Q10 group at 12th weeks (P < 0.0167) . The expression of IL-10 in periodontitis group was significantly lower than that in the Q10 group (P < 0.0167).</p><p><b>CONCLUSIONS</b>Coenzyme Q10 inhibits the expression of TNF-α and promotes the expression of IL-10 in periodontal tissues of experimental periodontitis rats. Coenzyme Q10 may play a role in treating periodontitis.</p>