Therapeutic Efficacy of Wuhu Decoction Plus Tingli Dazao Xiefei Decoction Combined with Budesonide Atomization for Children with Bronchopneumonia and Its Effects on Inflammatory Response / 广州中医药大学学报

Objective To investigate the clinical efficacy of Wuhu Decoction plus Tingli Dazao Xiefei Decoction combined with Budesonide atomization for the treatment of pediatric bronchopneumonia with phlegm-heat obstructing the lung syndrome,and to observe its effect on inflammatory response.Methods Seventy children with bronchopneumonia of phlegm-heat obstructing the lung type were randomly divided into an observation group and a control group,with 35 cases in each group.The children in the control group were treated with atomized inhalation of Budesonide suspension,and the children in the observation group were treated with Wuhu Decoction plus Tingli Dazao Xiefei Decoction orally on the basis of treatment for the control group.Both groups were treated for a period of 7 days.The changes in the traditional Chinese medicine(TCM)syndrome scores and the serum levels of inflammatory factors of interleukin 6(IL-6),procalcitonin(PCT),and hypersensitive C-reactive protein(hs-CRP)in the two groups were observed before and after the treatment.Moreover,the clinical efficacy,time for the relief of symptoms and signs,and the incidence of adverse reactions in the two groups were compared.Results(1)After 7 days of treatment,the total effective rate of the observation group was 91.43%(32/35),and that of the control group was 71.43%(25/35).The intergroup comparison(tested by chi-square test)showed that the therapeutic efficacy of the observation group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the TCM syndrome scores of the children in both groups were significantly lower than those before treatment(P＜0.05),and the decrease in the observation group was significantly superior to that in the control group(P＜0.01).(3)After treatment,the time for the relief of symptoms and signs such as wheezing,cough,lung rales,constipation and fever in the observation group was significantly shortened compared with that in the control group(P＜0.01).(4)After treatment,the serum IL-6,PCT and hs-CRP levels in both groups were significantly lower than those before treatment(P＜0.05),and the reduction in the observation group was significantly superior to that in the control group(P＜0.01).(5)The incidence of adverse reactions in the observation group was 5.71%(2/35)and that in the control group was 8.57%(3/35),while the difference was not statistically significant between the two groups(P＞0.05).Conclusion Wuhu Decoction plus Tingli Dazao Xiefei Decoction combined with Budesonide atomization exert certain effect for the treatment of pediatric bronchopneumonia with phlegm-heat obstructing the lung syndrome,which can effectively relieve the clinical symptoms and alleviate the inflammatory response of the children.

Decreasing complexity of glucose time series derived from continuous glucose monitoring is correlated with deteriorating glucose regulation / 医学前沿

Most information used to evaluate diabetic statuses is collected at a special time-point, such as taking fasting plasma glucose test and providing a limited view of individual's health and disease risk. As a new parameter for continuously evaluating personal clinical statuses, the newly developed technique "continuous glucose monitoring" (CGM) can characterize glucose dynamics. By calculating the complexity of glucose time series index (CGI) with refined composite multi-scale entropy analysis of the CGM data, the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes (P for trend < 0.01). Furthermore, CGI was significantly associated with various parameters such as insulin sensitivity/secretion (all P < 0.01), and multiple linear stepwise regression showed that the disposition index, which reflects β-cell function after adjusting for insulin sensitivity, was the only independent factor correlated with CGI (P < 0.01). Our findings indicate that the CGI derived from the CGM data may serve as a novel marker to evaluate glucose homeostasis.

Role of podocyte injury signaling pathway in steroid-resistant nephrotic syndrome and research progress in traditional Chinese medicine intervention / 中国中药杂志

As one of the main diseases leading to end-stage renal disease, steroid-resistant nephrotic syndrome(SRNS) can cause serious complications such as infection. Without effective control, this disease can further lead to the malignant development of the renal function, bringing serious social and economic burdens. As previously reported, the formation of SRNS is mostly related to the podocyte injury in the body, i.e., the injury of glomerular visceral epithelial cells. Phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt) signaling pathway, nuclear transcription factor-κB(NF-κB) signaling pathway, mammalian target of rapamycin(mTOR)/adenosine monophosphate(AMP)-activated protein kinase(AMPK), transforming growth factor(TGF)-β1/Smads, and other signaling pathways are classical signaling pathways related to podocyte injury. By regulating the expression of signaling pathways, podocyte injury can be intervened to improve the adhesion between podocyte foot processes and glomerular basement membrane and promote the function of podocytes, thereby alleviating the clinical symptoms of SRNS. Through the literature review, traditional Chinese medicine(TCM) has unique advantages and an important role in intervening in podocyte injury. In the intervention in podocyte injury, TCM, by virtue of multi-target and multi-pathway role, can regulate and intervene in podocyte injury in many ways, alleviate the clinical symptoms of SRNS, and interfere with the progress of SRNS, reflecting the unique advantages of TCM. On the other hand, TCM can directly or indirectly inhibit podocyte injury by regulating the above signaling pathways, which can not only promote the effect of hormones and immunosuppressants and shorten the course of treatment, but also reduce the toxic and side effects caused by various hormones and immunosuppressants to exert the advantages of small side effects and low price of TCM. This article reviewed TCM in the treatment of SRNS by interfering with podocyte injury-related signaling pathways and is expected to provide a reference for the in-depth study of TCM in the treatment of SRNS, as well as a theoretical basis and a new direction for the clinical application of TCM to shorten the course of treatment of SRNS and delay the progression to end-stage renal disease.

Network Meta-analysis of oral Chinese patent medicines in treatment of acute exacerbation of chronic obstructive pulmonary disease / 中国中药杂志

This study aimed to evaluate the effectiveness and safety of eight oral Chinese patent medicines in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) by network Meta-analysis. Randomized controlled trial(RCT) on the treatment of AECOPD with eight oral Chinese patent medicines was retrieved from databases including CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, EMbase, and Cochrane Library from database inception to August 6, 2022. The information was extracted from the included literature and the quality of the included studies was evaluated using the Cochrane risk of bias assessment tool. The data were analyzed using Stata SE 15.1 and ADDIS 1.16.8 software. Finally, 53 RCTs were included, with 5 289 patients involved, including 2 652 patients in the experimental group and 2 637 patients in the control group. Network Meta-analysis showed that Lianhua Qingwen Capsules+conventional western medicine were optimal in improving clinical effective rate, Shufeng Jiedu Capsules+conventional western medicine in improving FEV1/FVC, Qingqi Huatan Pills+conventional western medicine in improving FEV1%pred, Feilike Mixture(Capsules)+conventional western medicine in improving PaO_2, Lianhua Qingwen Capsules+conventional western medicine in reducing PaCO_2, and Qingqi Huatan Pills+conventional western medicine in reducing C-reactive protein(CRP). In terms of safety, most of them were gastrointestinal symptoms, and no serious adverse reactions were reported. When the clinical effective rate was taken as the comprehensive index of efficacy evaluation, Lianhua Qingwen Capsules+conventional western medicine were the most likely to be the best treatment for AECOPD. There are some limitations in the conclusion of this study. It only provides references for clinical medication.

Effect and Mechanism of Yiyi Fuzi Baijiangsan on Apoptosis of Human Colon Cancer HCT116 Cells / 中国实验方剂学杂志

ObjectiveTo investigate the effect and mechanism of Yiyi Fuzi Baijiangsan （YYFZBJ） on the apoptosis of colon cancer cell line HCT116. MethodYYFZBJ at different concentrations （0.5， 1， 2， 4， 6， 8， 10， 12， 14， 16 g·L-1） was used to intervene in HCT116 cells for 24， 48， 72 h. The cell counting kit-8 （CCK-8） method was used to determine the effect of YYFZBJ on cell proliferation in vitro. The cells were divided into a blank group， a capecitabine group（1.8 g·L-1）， and low-， medium-， and high-dose YYFZBJ groups （6， 10， and 14 g·L-1） and treated for 48 hours. Flow cytometry was used to detect the apoptosis. Hoechst 33342 staining was used to observe the apoptotic morphology of cells. Mitochondrial membrane potential （MMP） was analyzed by a mitochondrial-targeted deep-red fluorescent probe （Mito-Tracker Red CMXRos）. The expression of proteins related to the mitochondrial apoptosis pathway， such as B-cell lymphoma-2 （Bcl-2）， Bcl-2-associated X protein （Bax）， cytochrome C （Cyt C）， cysteinyl aspartate-specific protease （Caspase）-9， Caspase-3， cleaved Caspase-9， and cleaved Caspase-3 was detected by Western blot. The mRNA levels of Bcl-2， Bax， Cyt C， Caspase-9， and Caspase-3 were determined by real-time polymerase chain reaction （Real-time PCR）. ResultCompared with the blank group， YYFZBJ （8， 10， 12， 14， 16 g·L-1） significantly inhibited the proliferation of HCT116 cells in vitro （P<0.05） in a dose-dependent manner. Compared with the blank group， the medium- and high-dose YYFZBJ groups and the capecitabine group showed increased apoptosis rates of colon cancer cells （P<0.05）. The YYFZBJ groups and the capecitabine group showed reduced number of colon cancer cells with significantly changed cellular morphology and cell apoptosis manifestations， such as strong dark blue fluorescence， nucleus concentration， shrinkage， and fragmentation. With the increase in the mass concentration of YYFZBJ， the blue fluorescence intensity was significantly enhanced. Compared with the blank group， the YYFZBJ groups and the capecitabine group showed reduced MMP in a dose-dependent manner， decreased protein and mRNA levels of Bcl-2， and increased protein expression of Bax， Cyt C， Caspase-9， Caspase-3， cleaved Caspase-9， and cleaved Caspase-3 and mRNA expression of Bax， Cyt C， Caspase-9， and Caspase-3 （P<0.05）. ConclusionYYFZBJ can induce the apoptosis of colon cancer HCT116 cells through the mitochondrial apoptosis pathway.

Radiofrequency ablation for infants with incessant ventricular tachycardia and heart failure / 中国小儿急救医学

Objective:To investigate the effect of radiofrequency ablation on infants with incessant ventricular tachycardia(IIVT) and heart failure.Methods:Twenty-eight infants with IIVT combined with heart failure admitted to Beijing Children′s Hospital of Capital Medical University from January 2006 to December 2021 were selected, including 16 boys and 12 girls; 26 cases were treated with radiofrequency ablation.The characteristics of IIVT and heart failure and the results of radiofrequency ablation were analyzed.Results:The average age of the first diagnosis of 28 infants was 13.9 months old, and all of them had heart failure.Eleven infants had cardiogenic shock, three infants had cardiogenic syncope, two infants had respiratory failure for respiratory support, and one infant died.Color Doppler echocardiography showed that the left ventricular diameter increased and/or left ventricular systolic function decreased.Anti-heart failure treatment was effective in 27 cases(96.4%), electrical cardioversion in five cases, effective in three cases, and anti-arrhythmic drugs were effective in 17 cases(60.7%). Twenty-six cases(92.9%, 26/28) were treated with radiofrequency ablation, with immediate success in 23 cases(88.5%, 23/26) and effective in three cases(11.5%, 3/26). During the follow-up period for 3 to 36 months, cardiac function returned to normal in 25 cases(96.2%, 25/26) and recurred in three cases(11.5%, 3/26 cases), which were cured after radiofrequency ablation again.Temporary complications of atrioventricular block occurred in one case(3.8%, 1/26). In 26 cases of surgical children, 15 cases were measured by X-ray two-dimensional mapping and 11 cases were measured by three-dimensional mapping.The cumulative X-ray exposure was 87.0(51.5, 151.5) mGy and 1.2(0, 15.9) mGy, respectively, and the dose area product was 39.8(19.2, 427.8) μGy/m 2 and 2.8(0, 44.3) μGy/m 2.The cumulative X ray exposure and the dose area product were significantly reduced under the three-dimensional mapping method( P<0.001). Conclusion:The infants with IIVT combined with heart failure are prone to serious complications, and the effects of cardioversion and anti-arrhythmic drugs are limited.Radiofrequency ablation should be performed as soon as possible after heart failure is controlled.The application of three-dimensional mapping technology in surgery can significantly reduce ionizing radiation.

Progress on treatment of tachyarrhythmia in infants / 中国小儿急救医学

Infant tachycardia is a critical disease, mainly with supraventricular tachycardia and ventricular tachycardia.The treatment of tachycardia in infant is quite different from that of older children, and there is no relevant guidelines at present.Drug therapy in the acute stage of supraventricular tachycardia and atrial fluttery is mainly intravenous adenosine injection.Digoxin is widely used in neonates.Propranolol is the first choice for prophylactic treatment, and landilolol is in the development stage.Ventricular tachycardia can be spontaneously subsided, the treatment is dominated by intravenous lidocaine.For non-drug therapy, heart cardioerter is the emergency treatment for serious rapid arrhythmia.Radiofrequency ablation is used in infants with more severe conditions and where the onset of tachycardia can not be controlled.Bury cardioverter-defibrillator is effective in preventing infant ion channel disease complicated with malignant ventricular tachycardia induced sudden cardiac death.Subcutaneous implantion of a defibrillator may be superior to intravenous implantation in infants and young children.

Intermedin inhibits lipopolysaccharide-induced polarization of macrophages by activating AMPK signaling pathway / 中国药理学通报

Aim To evaluate the mechanism by which intermdin(IMD)inhibits lipopolysaccha ride(LPS)-induced polarization in RAW264.7 cells.Methods RAW264.7 cells were divided into control groups, LPS groups, LPS+IMD groups, LPS+IMD+Compound C groups.The mRNA expressions of tumor necrosis factor-α,(TNF-α,), CD86, inducible nitric oxide synthase(iNOS), Arginase-1(Arg-1)and CD206 were detected by Realtime-PCR.The protein expressions of p-AMPK, AMPK, TNF-α, intereukin-6(IL-6)and intereukin-10(IL-10)were detected by Western blot.The proportion of CD86+ M1 type cells was detected by Flow cytometry.In addition, the expression levels of supernatant cytokines, including IL-6 and TNF-α, were detected by ELISA.Results Compared with control and LPS groups, IMD treatment could up-regulate the expression level of p-AMPK and the ratio of p-AMPK/AMPK.LPS promoted M1 polarization, since the expressions of CD86, TNF-α and iNOS increased, while the expressions of CD206 and Arg-1 decreased by LPS induction.The proportion of M1 type cells increased and the secretion of TNF-α, IL-6 in the cell supernatant increased.And IMD treatment could inhibit the polarization of M1 induced by LPS.These effects were reversed by Compound C, an inhibitor of AMPK.Conclusion IMD can inhibit the M1-type polarization of LPS-induced macrophages by activating AMPK signaling pathway.

Application of metagenomics in the diagnosis of ophthalmic diseases / 国际眼科杂志(Guoji Yanke Zazhi)

@#In recent years, metagenomics(MGS)is the fastest growing fields in microbiology, and has been broadly applied in the detection of pathogenic microorganisms. Comparing with the traditional poly merase chain reaction(PCR)-based detecting technology which relies on microbial culture, MGS can directly detect the sequences of the total microbial DNA from uncultured samples with the high-throughput sequencing platform. It can help the doctors identify the involved pathogens more quickly and provide better medication guidance. Among the known ophthalmic diseases, a lot of them are caused by the infection of pathogens and have many difficulties in clinical diagnosis and treatment. The development of metagenomics provides us a more effective and reliable way for detecting the pathogens of ophthalmic diseases. This article was aimed to review the development of MGS, applications and in the field of ophthalmology, as well as its current deficiencies and the possible development directions in the future.

Clinical and genetic characteristics of catecholaminergic polymorphic ventricular tachycardia in children with CASQ2 variants / 中华实用儿科临床杂志

Objective:To summarize the clinical and genetic characteristics of catecholaminergic polymorphic ventricular tachycardia (CPVT) in children caused by CASQ2 gene variants. Methods:The clinical data of 8 children (4 males and females, respectively) with CPVT caused by CASQ2 gene variants admitted to Beijing Children′s Hospital, Capital Medical University from January 2017 to November 2018 were retrospectively analyzed.The targeted next generation sequencing was employed to identify CASQ2 variants and Sanger sequencing was conducted to conform the candidate variants and determine the parental origin. Results:As for 8 children in this study, the average age of onset was 6.4 years, the mean age at diagnosis was 9.4 years, and the average interval from onset to diagnosis was 3 years.Only 2 cases had clearly diagnosis at onset, other 6 cases had a delay to diagnosis and 3 cases of them were diagnosed at other hospitals as having epilepsy and did not respond to anti-epileptic therapy.During physical activity and/or emotional stress, 8 cases presented with recurrent syncope and were able to regain consciousness after a few minutes.They had no a history of sudden cardiac death or family history.There was no abnormality on resting electrocardiogram during the paroxysmal interval in 6 cases and mild sinus bradycardia in 2 cases.Typical bidirectional ventricular tachycardia (VT) and/or polymorphic VT were detected in 8/8 cases and 5/5 cases, respectively, based on Holter electrocardiography and cardiac stress test.The CASQ2 gene variant was found in all children, with 6 cases carrying compound heterozygous variants and 2 cases carrying homozygous variants.A total of 9 different CASQ2 variants were detected in 8 cases, of which 5 had not been previously reported.According to the family-line verification, all of them had a familial variant, with no novel variants.All 8 cases were treated orally with β-blockers, with asymptomatically recurrent episodes, with a mean follow-up of 1.5 years, during which implantable cardioverter defibrillation was performed in 1 case owing to severe sinus bradycardia.There was no death case among them. Conclusions:CPVT with CASQ2 variants is characterized by early onset before preschool age, recurrent syncope after exercise or emotional stress and bidirectional/polymorphic VT.Early diagnosis of CPVT remains challenging due to delayed diagnosis or misdiagnosis.Treatment with β-blockers can achieve favorable effectiveness and safety.Five novel variants in this study would further expand the database of CASQ2 genes.

Perioperative nursing of robot assisted percutaneous kyphoplasty for senile osteoporotic vertebral compression fractures / 中国实用护理杂志

Objective:To summarize the perioperative nursing points of percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic vertebral compression fractures assisted by robots, so as to provide reference for orthopedic nursing.Methods:From July 2019 to February 2021, the data of 72 patients undergoing robot-assisted PKP in the spinal surgery of the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. The perioperative nursing points were summarized, and the nursing experience was summarized. The nursing under the new measures of precise minimally invasive treatment was analyzed and discussed. The length of hospital stay, postoperative ambulation time, complications and satisfaction survey results of patients were collected and recorded. The Numerical Rating Scale(NRS) score, Self-rating Anxiety Scale(SAS) score and Oswestry Disability Index (ODI) score before and after surgery were compared. The correlation analysis of the scores of various factors was combined to comprehensively evaluate the surgical and nursing effects.Results:All patients had no complications related to machine use during and after operation, and their symptoms were improved to varying degrees. Fifty-seven cases of indwelling catheter, catheter time (19.00±14.24) h. The preoperative hospitalization time was (6.16±2.22) d, and the postoperative hospitalization time was (1.94±0.99) d. Postoperative bed time was (16.34±6.81) h. Postoperative nursing satisfaction was (98.55±2.44)%.The postoperative NRS and SAS scores were (1.00±0.55) and (32.06±5.33) points, respectively, which were lower than those before operation (3.51 ± 0.71) and (39.08±8.86) points, and the differences were statistically significant ( t values were 33.976, 8.184, P<0.01). There were statistically significant differences in six indicators of ODI scores before and after surgery, including low back pain, walking, standing, sitting, sleep and self-care ( P<0.01). Correlation analysis showed that there was a strong correlation between the six ODI score factors and the NRS score. The four factors of sitting, walking, low back pain and standing were highly correlated with SAS. Conclusions:The implementation of good perioperative nursing management for patients with PKP assisted by robot can effectively promote the rehabilitation of patients, reduce the incidence of complications and improve patient satisfaction.

Compliance and effectiveness of screening in population with high risk for liver cancer in Xiaolan town, Zhongshan city / 中国肿瘤临床

Objective: To evaluate the compliance of participants to recommended liver cancer screening and to assess the incidence of subsequent liver cancer. Methods: Cancer Research Institute of Zhongshan City launched liver cancer screening in 2012, in agreement with the requirements of the Committee on Early Diagnosis and Treatment of Cancer Foundation in China. Enzyme-linked immunosorbent assay (ELISA) for hepatitis B surface antigen (HBsAg) was the initial screening test performed in the population. We proposed that subjects positive for HBsAg undergo biannual screening using serum alpha-fetoprotein (AFP) tests and ultrasonography. All subjects were followed up till the end of December 2017. The prevalence of liver cancer and patients' compliance were statistically analyzed. Results: 1) We identified 2,882 HBsAg-positive participants among the total of 19,386 participants in 2012. The HBsAg positivity rate was 14.9%. 13 patients with liver cancer, identified in the preliminary screening, were excluded from the study, and the remaining 2,869 participants were followed-up. During four consecutive years (2014-2017), the compliance to AFP testing (58.9%) was higher than that (57.2%) to ultrasonography (P0.05). 3) The liver cancer patients in the high compliance to ultrasonography screening and HBsAg-positive groups had better survival rates than those in the low-compliance and HBsAg-negative groups, respectively (P<0.05). Conclusions: The rates of compliance to screening and the early diagnosis rate of liver cancer are low in HBsAg-positive participants. The liver cancer survival is relatively good in the cohort with high ultrasonography compliance. Improving the compliance of HBsAg-positive population is one of the important ways to increase the early diagnosis rate and survival rate of liver cancer.

Clinical significance of changes of serum cytokines in children with Kawasaki disease / 中华实用儿科临床杂志

Objective:To summarize the changes of serum cytokines in 301 children with Kawasaki disease(KD) and analyze their clinical significance.Methods:Three hundred and one pediatic patients with KD admitted to Beijing Children′s Hospital, Capital Medical University between June 2018 and July 2019 were enrolled and divided into the immunoglobulin sensitive group and immunoglobulin non-response group according to the therapeutic effect.The levels of interferon gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), interleukin-6 (IL-6), interleukin-4 (IL-4), and interleukin-2 (IL-2) were compared between the 2 groups.Results:(1)Fifty (16.6%) children had no-response to immunoglobulin.Before treatment, the level of serum cytokines in the immunoglobulin non-response group and the immunoglobulin sensitive group were as follows: IFN-γ[11.32(10.88) ng/L vs. 4.52(5.09) ng/L], TNF-α[7.43(11.25) ng/L vs. 4.42(6.04) ng/L], IL-10[14.44(20.3) ng/L vs. 8.32(7.99) ng/L], IL-6[100.28(126.39) ng/L vs. 41.34(49.32) ng/L], IL-4[1.06(1.79) ng/L vs. 0.98(1.42) ng/L], IL-2[0.48(0.90) ng/L vs. 0.40(0.62) ng/L]; there were significant differences in IFN - γ, TNF - α, IL-10 and IL-6 between the 2 groups (all P<0.05); there was no significant difference of IL-4 and IL-2 between the 2 groups (all P>0.05). (2)Before treatment and after the temperature was normal, the levels of cyto-kines in the immunoglobulin non-response group were as follows: IFN-γ[11.32(10.88) ng/L vs. 1.26(2.10) ng/L], TNF-α[7.43(11.25) ng/L vs. 1.52(3.46) ng/L], IL-10[14.44(20.3) ng/L vs. 4.63(7.00) ng/L], IL-6[100.28(126.39) ng/L vs. 22.85(39.95) ng/L], IL-4[1.06(1.79) ng/L vs. 0(0.25) ng/L], IL-2[0.48(0.90) ng/L vs. 0(0.02) ng/L]. Before treatment and after the temperature was normal, the levels of cytokines in the immunoglobulin sensitive group were as follows: IFN-γ[4.52(5.09) ng/L vs. 0.79(1.53) ng/L], TNF-α[4.42(6.04) ng/L vs. 1.60(3.4) ng/L], IL-10[8.32(7.99) ng/L vs. 3.59(3.74) ng/L], IL-6[41.34(49.32) ng/L vs. 11.90(18.84) ng/L], IL-4[0.98(1.42) ng/L vs. 0(0.88) ng/L], IL-2[0.40(0.62) ng/L vs. 0(0.14) ng/L]. The levels of cytokines decreased significantly after treatment in between 2 groups (all P<0.05). (3) Logistic regression analysis showed that IFN-γ, IL-6, fever duration and albumin were independent risk factors for no-response to immunoglobulin. Conclusions:Children with abnormally high serum IFN-γ and IL-6 levels before treatment are more likely to resist immunoglobulin.Therefore, the change of the condition in such children should be closely monitored.If there is no response to immunoglobulin, immunoglobulin should be used again as soon as possible or second-line drugs should be applied to improve the prognosis.

Clinical study of transcatheter closure of atrial septal defect in children guided by echocardiography / 中华实用儿科临床杂志

Objective:To study the method and clinical effect of transcatheter closure of children′s secondary atrial septal defect (ASD) by femoral vein under the guidance of echocardiography.Methods:A total of 306 children (137 males and 169 females) with secondary ASD undergoing transcatheter closure surgery in the Department of Car-diology of Beijing Children′s Hospital from January 2017 to October 2019 were enrolled.The age of the patients was 2.1-15.0 years old [(6.18±2.45) years old], and the weight was 10-63 kg [(23.05±9.97) kg]. Among 306 children, 259 cases had single central ASD, with the defect diameter of 5-25 mm; 47 cases had ethmoid ASD, and the shunting range was measured to be 11-31 mm by echocardiography.Patients had normal cardiac function, and no other cardiac malformations were found.Eighteen children are complicated with other system malformations, including funnel chest in 5 children, chicken chest in 4 children, scoliosis in 4 children, epilepsy in 2 children, and Down′s syndrome in 3 children.In addition, there were 8 children with ASD and arrhythmia.Specifically, 3 cases were complicated by preexcitation syndrome, 3 cases by ventricular premature beat and 2 cases by supraventricular tachycardia.Three patients with ventricular premature beat, 1 patient with supraventricular tachycardia and 1 patient with preexcitation syndrome had indications of radiofrequency ablation.All the operations were performed in the same time with ASD occlusion via femoral vein under basic anesthesia.ASD occlusion was guided by transthoracic or transesophageal echocardiography.Results:Of all 306 cases enrolled, ASD occlusion was successfully performed in 301 cases under the guidance of echocardiography, but it failed in 5 cases due to the large ultrasonic defect during the operation.For these 5 patients, the occluder was successfully released by the method of left superior pulmonary vein under X-ray.The operation time (from the beginning of anesthesia to the sheath extubation) was 17-45 min, with an average of (21.25±8.84) min.The occluder model was 10-30 mm.The operation process was smooth, and there were no serious complications during and after the operation.Conclusions:ASD transcatheter closure by femoral vein puncture under the guidance of echocardiography is safe and feasible operation for children with ASD.It is minimally invasive and causes no radiation injury.

Effect of kangaroo care on neurological behavior in neonates with neonatal intensive care unit asphyxia / 中国实用护理杂志

Objective:To explore the effect of kangaroo care on the neurological behavior of neonatal intensive care unit (NICU) neonates with asphyxia.Methods:Totally 76 cases of neonatal asphyxia admitted to NICU from January 2018 to December 2018 were randomly divided into observation group (40 cases) and observation group (36 cases). The control group was given routine nursing care, while the observation group was given kangaroo nursing intervention on the basis of the control group. The neurobehavioral changes, the occurrence of nervous system damage and the physical development after 42 days of birth were compared between the two groups.Results:The scores of behavior ability (11.64 ± 0.26), original reflex (5.89 ± 0.32), passive muscle tension (7.64 ± 0.46), active muscle tension (7.83 ± 0.55), general reaction (6.17 ± 0.46) in the intervention observation group were significantly higher than those in the control group (11.02 ± 0.39), original reflex (5.53 ± 0.31), passive muscle tension (7.21 ± 0.47), active muscle tension (6.17 ± 0.46) Tension (7.41 ± 0.41), general reaction (5.88 ± 0.41) ( t values were 8.227, 4.970, 4.027, 3.740, 2.888, P<0.05). The incidence of neurological damage in the observation group was 2.50% (1/40) which was significantly lower than 16.67% (6/36) in the control group ( χ 2=4.117, P < 0.05). The growth of body weight (2.17 ± 0.42) kg, length (7.15 ± 1.74) cm and head circumference (4.38 ± 0.93) cm in the observation group were significantly higher than those in the control group (1.68 ± 0.39) kg, (5.89 ± 1.81) cm, (3.81 ± 0.79) cm ( t values were 5.252, 3.093, 2.863, P<0.05). Conclusion:Kangaroo nursing can effectively promote the neurological development and physical development of neonatal asphyxia, and reduce the nervous system damage of asphyxiated neonates, and the operation is simple and easy, which is worthy of clinical application.

Ultrasound diagnosis and grading of neonatal respiratory distress syndrome: a multicenter prospective study / 中国小儿急救医学

Objective:Lung ultrasound (LUS) has been used in the diagnosis of neonatal respiratory distress syndrome(RDS) successfully, but there have been no multicenter prospective studies to verify its reliability or determine how to grade RDS with LUS findings.This study aimed to discuss the necessity and feasibility of using LUS findings to determine RDS grades through a multicenter prospective study.Methods:Every researcher participated in the National Neonatal Lung Ultrasound Training Course and receiving 3-6 months of lung ultrasound system training at the National Neonatal Lung Ultrasound Training Center.Patients between June 2018 and May 2020 who met the RDS ultrasound diagnostic criteria and had full available clinical data were included in this study.The LUS examination was completed immediately after the patients were admitted to the hospital.Some of them also underwent chest X-ray examination.Arterial blood gas analysis was completed immediately before or after the LUS ultrasound examination.RDS grading was performed according to the LUS findings and whether the patient had serious complications.Results:A total of 275 qualifying cases were included in this study, which included 220 premature infants and 55 full-term infants, and the primary RDS occurred in 117 cases (42.5%), and secondary RDS occurred in 158 cases (57.5%). LUS manifestations of RDS patients can be divided into three categories: (1)A ground-glass opacity sign: which could be found among 50 infants when they were admitted to the hospital (that was, at their first LUS examination). Twenty-eight of these infants were considered to have wet lungs and were not sent for special management on admission, but LUS showed typical snowflake-like lung consolidation within 0.5 to 4 hours.Twenty-two of them were given mechanical ventilation with exogenous pulmonary surfactant; Eighteen cases were controlled within 6-12 hours, but the lung lesions became more severe in the other 4 infants (due to severe intrauterine infection). (2)Snowflake-like lung consolidations: the first LUS on admission showed typical snowflake-like lung consolidation involving areas ranging from 1-2 intercostal spaces to 12 lung divisions in 204 cases.Thirty-eight infants among them the lung consolidation only had involvement of 1-2 intercostal spaces at the time of admission; Fifteen of them received invasive respiratory support and recovered within 4-12 hours.Twelve patients received noninvasive respiratory support; Seven of them recovered, while five cases developed severe lung illness.The remaining 11 patients who were not given any form of ventilator support developed severe conditions within 1-4 hours.Thirty of them showed snowflake signs involving 12 lung regions at admission.The remaining 136 patients had lung consolidation degree between the two degree above condition.(3)Snowflake-like sign with complications: Twenty-one patients had severe complications such as pneumothorax, pulmonary hemorrhage or/and persistent pulmonary hypertension of the newborn or large area atelectasis, etc, although snowflake lung consolidation did not involve all lung regions.Conclusion:(1) LUS is reliable and accurate for diagnosing RDS.RDS has the same characteristics on ultrasound for both preterm and full-term infants, both primary and secondary RDS.(2) To facilitate the management of RDS, it is necessary to classify RDS according to the ultrasound findings and the presence of severe complications.(3) Based on the results of this study, it is recommended that RDS can be divided into mild, moderate and severe degrees.The exact standards for grading are as follows: Mild RDS: the early stage of RDS, in which lung consolidation shows as a ground-glass opacity sign on ultrasound; Moderate RDS: lung consolidation shows a snowflake sign on ultrasound, not all of the lung fields are involved; Severe RDS meets one or more of the following criteria: lung consolidation shows as a snowflake sign on ultrasound and all lung regions are involved, or regardless of its degree and extent, lung consolidation has caused serious complications, such as pulmonary hemorrhage, pneumothorax, persistent pulmonary hypertension of the newborn, or/and a large area of pulmonary atelectasis.

Clinical study on relationship between renal artery involvement and renal function in acute Stanford A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To evaluate the involvement of renal artery in acute Stanford type A aortic dissection (TAAD) using CT angiography (CTA) and to analyze the difference of renal function among different types of renal artery involvement. Methods    From January 2016 to November 2017, 151 patients of acute TAAD with renal artery involvement were included in the study. There were 118 males and 33 females, with an average age of 47.93±10.53 years. All patients underwent aortic CTA to confirm the TAAD. According to CTA，involvement of one side of renal artery can be divided into four types: type A, large tear near renal artery orifice, difficult to distinguish true or false lumen; type B, the orifice of the renal artery originates entirely from the false lumen; type C, the orifice of the renal artery originates entirely from the true lumen; type D, renal artery dissection is observed, renal artery intima can be seen. The levels of serum creatinine (sCr) and creatinine clearance (CC) in all groups were analyzed and compared. Results    The results of one-way ANOVA analysis showed that there was no significant difference in sCr or CC among the groups (P>0.05). There was no significant difference in age, sex, proportion of hypertension history and onset time among the above groups (P>0.05). Conclusion    The three most common types of renal artery involvement were BC type, CC type, and AC type. The types of renal artery involvement do not affect renal function.

Effect of extracorporeal membrane oxygenation measures on prognosis of children with fulminant myocarditis / 中国小儿急救医学

Objective To investigate the clinical features and the clinical effects of extracorporeal membrane oxygenation(ECMO) in children with fulminant myocarditis. Methods The data of one hundred and sixty one pediatric patients with fulminant myocarditis at Beijing Children′s Hospital from March 1,2007 to May 31,2018 were analyzed retrospectively,including clinical manifestations,electrocardiogram,echocar￣diography,myocardial enzyme,the application of ECMO,curative effect and prognosis. Results Among 161 cases of children with fulminant myocarditis,74 cases (46. 0%) had respiratory tract symptoms,54 cases (33. 5%) had digestive tract symptoms,24 cases (14. 9%) had nervous system symptoms,only 33 cases (20. 5%) had cardiovascular symptoms. One hundred and thirty￣two cases(82. 0%) had elevation of crea￣tine kinase isoenzymes( CK￣MB) and/or cardiac troponin I( cTnI),and 107 cases(66. 5%) had abnormal echocardiography. One hundred and fifty￣two cases ( 94. 4%) showed abnormal electrocardiogram, and the changes of ST￣T and atrioventricular block were most common. Five cases survived in 8 children treated with ECMO. They underwent ECMO with an median supporting time of 101. 5 (52. 75,142. 8) hours through a venous￣arterial ECMO model. After the application of ECMO,blood pressure,the heart rate and oxygen satura￣tion were obviously improved in the 8 children,and the level of blood lactic acid was statistically reduced com￣pared with that before the application of ECMO(P<0. 001). During the follow￣up period of 1 months,the 5 surviving children recovered with normal cardiac function,without abnormal function of other organs. There were a total of 17 cases(10. 6%) died,4 children(8. 9%) in 45 patients died since the application of ECMO and the other 13 children(11. 6%) in 116 patients died before that time. This proportion of death was reduced after the application of ECMO,whereas the difference was not statistically significant(P>0. 05). Conclusion Our study indicates the diverse symptoms in children with fulminant myocarditis. Comprehensive application of electrocardiogram,echocardiography,and myocardial enzymology markers may be of benefit to the timely diag￣nosis of fulminant myocarditis. The application of ECMO in fulminant myocarditis remains an effective approach in reduction of mortality rate,and can effectively support recovery of cardiopulmonary functions.

Clinical characteristics of anomalous origin of coronary artery accompanied with myocardial damage in children:A report of 72 cases / 中国实用儿科杂志

OBJECTIVE: To investigate the clinical characteristics and treatment strategies of anomalous origin of the cor⁃onary artery accompanied with myocardial damage,so as to improve the level of clinicians' diagnosis and treatment of this disease. METHODS: The clinical data of 72 cases of anomalous origin of the coronary artery accompanied with myo⁃cardial damage admitted in Department of Cardiology,Beijing Children's Hospital,Capital Medical University from2015 to 2017 were analyzed retrospectively. The clinical characteristics,diagnosis and treatment methods were analyzed.RESULTS: In 42 cases(58.3%),chest pain,chest tightness and palpitation were the main clinical symptoms. ECG abnor⁃malities were mainly ST-T changes(62.5%). Echocardiography showed 13 cases(18.1%)of cardiac enlargement,4 cas⁃es(5.6%)of left ventricular systolic dysfunction. Coronary artery CT angiography(CTA)showed that the anomalous ori⁃gin of the left coronary artery was the most frequent(73.6%),followed by the anomalous origin of bilateral coronary arter⁃ies(13.9%),and the anomalous origin of the right coronary artery was the least frequent(12.5%). The whole group was successfully treated with no death. CONCLUSION: There might be a correlation between the anomalous origin of coronary artery and ischemic myocardial damage. In the examination of patients,pediatricians should pay more attention to the judgments of the position and movement of the coronary artery by CTA,and attach importance to the differential diagno⁃sis between ischemic myocardial damage and myocarditis.

Rhabditis axei found in urine routine examination: a case report / 中国血吸虫病防治杂志

Rhabditis axei is a free-living nematode, which can occasionally invade into humans through drinking and contacting wastewater. It is usually parasitic in the digestive and urinary systems, causing the disease of rhabditelliasis axei. This paper reports a case of R. axei infection found in the urine routine examination.