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This is a case report of the diagnosis and treatment of atrial flutter with atrial septal aneurysm in a preterm infant. A male neonate born at 35 +2 weeks was delivered by emergent cesarean section due to fetal tachycardia (230-240 bpm) observed during electronic fetal monitoring. The baby was admitted due to tachycardia, tachypnea, and grunting for 15 min after birth. The electrocardiogram demonstrated atrial flutter with the atrial rate of 440 bpm and the ventricular rate of 220 bpm, and 2∶1 atrioventricular conduction. The echocardiography revealed atrial septal aneurysm, patent ductus arteriosus, and patent foramen ovale. Cedilanid and amiodarone were administered firstly. The sinus rhythm was restored after synchronized electrical cardioversion with 4 J (1.8 J/kg). There was no recurrence of atrial flutter during follow-ups till December 18, 2019, with a corrected gestational age of 41 +4 weeks.
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Objective To evaluate the impact of Montessori-based intervention on eating ability of the elderly with dementia.Methods Sixty-four patients with dementia were randomly divided into intervention group(n=32) and control group(n=32).Patients in intervention group were given Montessori-based intervention,and patients in control group received regular care.The effect of Montessori-based intervention on eating ability,eating difficulty and self-eating time were assessed by the simplified Chinese version of EBS (C-EBS),simplified Chinese version of Edinburgh feeding evaluation in dementia scale (C-EdFED) and stopwatch respectively at pre-intervention,post-intervention,1-month and 3-month follow-up.Results Compared with the control group (EBS:(12.42± 3.59);EdFED:(10.48± 3.83);self-eating time:(15.28±6.04) min)),the average scores of EBS(14.31±2.63) increased and the self-eating time ((21.44±7.17)min) increased after 8 weeks intervention in intervention group,while the average scores of EdFED (7.86±4.16) increased.The C-EBS scores and self-eating time in intervention group were significantly higher than that of control group while the C-EdFED scores were lower than that of control at all time points(P＜0.01).The difference in time effect between the two groups was statistically significant (P ＜ 0.05)Conclusion The Montessori-based intervention can improve the eating ability of elderly people with dementia,reduce eating difficulty and increase self-eating time.
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Objective To summarize the clinical data of atypical hemolytic uremic syndrome (aHUS) and analyze the treatment and prognosis.Methods A prospective cohort study was conducted on 66 cases in Beijing Children's Hospital affiliated to Capital Medical University from January 2011 to December 2017.The children were divided into positive and negative auto-antibody groups according to the results of anti-factor H autoantibody test.The clinical characteristics,treatment plan and prognosis of the two groups were compared.Results Among the 66 children who met the inclusion criteria,there were 43 cases (65.2％) in the positive group,with an average onset age of (8.0±2.9) years.There were 23 eases (34.8％) in the negative group,with an average onset age of (3.0± 2.6) years.On the basis of plasma treatment,in the positive group,the usage rate of hormone was 83.3％ (35/42) and the usage rate of immunosuppressive agents was 42.9％(18/42),while in the negative group,the rates were 63.6％(14/22) and 13.6％(3/22) respectively.The average follow-up time was 19.3 months.One child in each group was lost to follow-up.In the positive group,8 cases recurred (19.0％)and the average recurrence interval time was 16.1 months.In the negative group,7 cases recurred (31.8％) and the average recurrence interval time was 9.3 months.And the recurrent interval time in the positive group was more longer than the negative group (P ＜ 0.05).A total of 85.9％(55/64) children had complete hemolysis control and complete recovery of renal function,in which the positive group was 85.7％(36/42) and negative group was 86.4％(19/22).However,7.8％(5/64) children had abnormal renal function,in which the positive group was 9.5％(4/42) and the negative group was 4.5％(1/22).And 4.7％(3/64) children died,in which the positive group was 2.4％(1/42) and the negative group was 9.1％ (2/22).The one left (1.6％) showed dialysis dependence,which was positive for the auto-antibody.Multifactor Cox regression analysis showed that the age of less than 3 years old was the risk factor of poor prognosis (HR=4.651,95％CI 0.988-21.898,P=0.047).Conclusions The positive proportion of anti-factor H autoantibody in children with aHUS is high.The age of these children is older.Individualized therapy based on anti-factor H autoantibody and immunosuppressive therapy is of great significance for disease remission,preventing recurrence and improving the prognosis.Age less than 3 years old is the risk factor for poor prognosis.
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@#Objective To develop the Dementia Caregivers' Nursing Ability Scale and test its reliability and validity. Methods Based on the model of Caregiver Skill Building/Effectiveness, the item pool was formulated through literature review and semi-structured interview, the items were selected by experts consultation and the pilot survey of 30 dementia caregivers. Totally 293 dementia caregivers in the hospital and the elderly homes were selected for investigation to test the reliability and validity. Results The Dementia Caregivers' Nursing Ability Scale consisted 5 subscales and 36 items, the exploratory factor analysis identified five principal factors which explained 79.44% of the total variance. The item content validity index ranged from 0.857 to 1, the scale content validity index was 0.985. The Cronbach's α coefficient of the scale was 0.936, the split reliabilit was 0.970, and the test-retest reliability was 0.980. Conclusion Dementia Caregivers' Nursing Ability Scale has good reliability and validity, which can be used as a tool to measure the dementia caregivers' nursing ability.
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@#Objective To develop the Dementia Caregivers' Nursing Ability Scale and test its reliability and validity. Methods Based on the model of Caregiver Skill Building/Effectiveness, the item pool was formulated through literature review and semi-structured interview, the items were selected by experts consultation and the pilot survey of 30 dementia caregivers. Totally 293 dementia caregivers in the hospital and the elderly homes were selected for investigation to test the reliability and validity. Results The Dementia Caregivers' Nursing Ability Scale consisted 5 subscales and 36 items, the exploratory factor analysis identified five principal factors which explained 79.44% of the total variance. The item content validity index ranged from 0.857 to 1, the scale content validity index was 0.985. The Cronbach's α coefficient of the scale was 0.936, the split reliabilit was 0.970, and the test-retest reliability was 0.980. Conclusion Dementia Caregivers' Nursing Ability Scale has good reliability and validity, which can be used as a tool to measure the dementia caregivers' nursing ability.
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Objective To analyze the clinical features of pediatric sepsis with initial symptoms of autoimmune hemolytic anemia(AIHA) and acute renal failure.Methods Ten cases of pediatric sepsis with initial symptoms of AIHA and acute renal failure were selected from January 2000 to January 2014 in Department of Nephrology,Beijing Children's Hospital Affiliated to Capital University of Medical Science.The clinical data were retrospectively analyzed and long-time follow-up was taken.Results There were 8 boys and 2 girls of the 10 cases.The ages ranged from 8 months to 12.8 years.There were 8 children less than 6 years old having a prevalence of 80％.There were sudden dark urine and progressive anemia in all the cases,jaundice in 9 cases,abdominal pain and vomiting in 6 cases.Urine volume decreased in 7 cases and anuria in 3 cases.Four cases showed disorder of consciousness and 2 developed shock.Respiratory failure and disseminated intravascular coagulation happened in 1 case respectively.In terms of pathogens,2 cases were infected by mycoplasma and 1 case was infected by hemolytic streptococcus.The rest of the pathogen was unknown.The Coomb's test was 3 +-4 + positive.Serum urea nitrogen and creatinine gradually increased.High level total serum bilirubin and unconjugated bilirubin were shown in 8 cases and low level complement in 7 cases.Bone marrow films showed hyperplasia in all the cases.Renal biopsy was taken in 3 cases and no microthrombus was found.Corticosteroid was used in all 10 cases for 6 months.Blood purification was taken in 8 cases.Respiratory support was used in 4 cases.Nine recovered and 1 case gave up treatment.Further follow-up was taken for 2.2-8.1 years.Eight cases had normal urine and blood routine test and renal function.Relapse happened in 1 girl 1 year later.One case lost follow-up.Conclusions Once sudden hemoglobinuria,anemia and progressively decreased urine output occur in sepsis cases,the clinicians should consider AIHA and acute renal failure.Based on active infection control,the early use of steroids and blood purification treatment can improve the prognosis.
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Objective To investigate the treatment of atypical hemolytic uremic syndrome (aHUS) in their acute phase and relate the prognostic factors.Methods Twenty-eight patients with aHUS treated in Department of Nephrology,Beijing Children's Hospital Affiliated to Capital Medical University from January 2011 to March 2015 were collected,the outcomes of the treatment were summarized.Results All the patients were given plasma exchange (PE)treatment,21 patients with hemodialysis (HD) treatment;13 patients with H factor (FH) antibody were further treated with corticosteroid therapy,and 1 patient was treated with the combination of mycophenolate mofetil.Evaluation of patients' indices were conducted at month 3.Out of the 28 patients,there were 13 patients with complete remission;of the 14 patients showed improvement,6 patients were complicated with hypertension and 4 patients with renal dysfunction.One patient,with ongoing hemodialysis,did not show restoration of renal function.There was no death in children.Statistical analysis showed that the acute phase serum creatinine levels were (430.0 ± 124.7) μmol/L and (265.6 ± 90.8)μmol/L for the group with remaining kidney injury and the group with complete remission,respectively,the difference was statistically significant(P ＜0.01).The levels of FH for the 2 groups were (206.5 ± 134.9) mg/L and(415.4-±214.1) mg/L,and the difference was statistically significant (P ＜ 0.01) as well.Statistical analysis showed that differences were no statistically significant between the 2 groups of patients on their age,platelets,complement C3,complement C4,hemoglobin and lactate dehydrogenase (all P ＞ 0.05).For the group with positive antibody,its average serum creatinine was (346.4 ± 112.5) μmol/L.For the group with negative antibody,its average serum creatinine was (297.0 ± 89.3) μmol/L.The FH for group with positive antibody and group with negative antibody were (307.4 ±187.3) mg/L and (379.8 ± 203.5) mg/L,respectively.The differences were not statistically significant (all P ＞0.05).Conclusions PE is an effective treatment for aHUS at acute phase,and corticosteroid and immunosuppressive therapy are effective for patients with positive anti-FH antibody.For patients with severe kidney injury at acute phase,the possibility of long-term kidney damage is high.Low concentration of serum FH indicates a poor prognosis.
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Objective To translate the Eating Behavior Scale (EBS) into Chinese and test its reliability and validity. Methods The Chinese Version of the scale (C-EBS) was developed through translation, back-translation, cross-cultural adaption and pre-test. A convenient sample of 100 old people with dementia was investigated with C-EBS to test its reliability and validity. Results The Cronbach′s α, Guttman Spilt and test-retest reliability of C-EBS were 0.842, 0.865 and 0.840, respectively. The I-CVIand S-CVI of C-EBS were 1.00, and the score of C-EBS was negatively correlated to the total score of The Chinese Edinburgh Feeding Evaluation in Dementia scale(C-EdFED) (r = 0.727,P < 0.01). Conclusion The C-EBS is reliable and valid and can be used as a valid tool to measure the eating ability among the old people with dementia in China.
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Objective To study the patients' clinical characteristics and prognosis when only C3 deposition exists in endocapillary proliferative glomerulonephritis and try to understand deeply the role of C3 in kidney damage deeply. Methods The patients who were diagnosed with endocapillary proliferative glomerulonephritis but only had C3 deposited in immunofluorescence(to avoid false positive,C3≥2 ﹢ was included)were selected from Beijing Children's Hospital Affiliated to Capital Medical University during November 2010 to October 2014. Their clinical manifestations,la-boratory examinations,treatments,prognosis,and pathological changes were analyzed,and literature review was performed. Their clinical characteristics and prognosis were summarized. Results There were 11 patients diagnosed with endocapil-lary proliferative glomerulonephritis which had only C3 deposition(≥2 ﹢ ). Nine of them had onset with acute nephritis syndrome(81. 8% ),and 2 cases presented recurrent paroxysmal gross hematuria(18. 2% ). Seven cases were diagnosed with acute post streptococcal glomerulonephritis(63. 6% ). Eleven cases' clinical manifestations were relatively severe, and the complement C3 was significantly lower than the normal(100. 0% ). Their light microscope showed capillary proli-ferative glomerulonephritis,and the electron microscope showed the immune complexes were deposited in the endothelium,the epithelium or the mesangial area. The patients received corresponding treatment respectively,and all the patients had good prognosis during following up of 7 months up to 39 months. Conclusions Streptococcus infection is a common cause in endocapillary proliferative glomerulonephritis with only C3 deposition. The clinical manifestations of some children are similar to post streptococcal glomerulonephritis but relatively severe. Only deposition of C3 without IgG may be involved in another complement activation mechanism.
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Objective To explore the clinical feature of spontaneous bacterial peritonitis (SBP) in children with nephrotic syndrome (NS).Methods Eleven cases of SBP in children with NS from Department of Nephrology,Beijing Children's Hospital Affiliated to Capital University of Medical Science between January 2010 and June 2014 were analyzed retrospectively.The clinical features,laboratory data and efficacy of therapy were reviewed.Results In this study,12 episodes of primary peritonitis were detected in 11 patients.One patient had 2 attacks.There were 11 cases including 9 boys and 2 girls.The age of the patients ranged from 2 years and 11months to 14 years and 11 months.Nine cases of them received steroid therapy and/or cytotoxic drugs.Peritonitis was characterized by abdominal pain,mild abdominal pain occurred in 7 cases with slow onset.Ten cases had fever of varying degrees,8 cases had abdominal distention,5 cases had diarrhea and 4 cases had nausea and vomiting.Shock signs were present suddenly in 2 cases before therapy of antibiotics.Apparent edema and severe ascites were present in all cases.Five of them were presented with increasingly rapid severe ascites and showed no response to diuretic drugs.Blood investigation showed leukocytosis and high C-reactive protein.Serum albumin levels and IgG and CD4 ratio were very low in all cases.Ascites were like cloudy pus with raised neutrophil cells.Streptococcus pneumonia was positive in both blood culture and ascites culture in 2 cases.Cephalosporin was used empirically to all cases for 7 to 10 days in 9 cases and 4 weeks in 2 cases with positive blood culture.Paracentesis to release ascites fluid was performed in 5 cases with constant ascites.Eleven cases recovered from peritonitis completely.The proteinuria was negative in 2 cases after they recovered from peritonitis.Conclusions SBP was atypical in children with NS and sometimes patients might have to abdominal pain and rebound tenderness,which may be ignored and may induce deterioration suddenly and clinicians should be aware of it clearly.SBP could lead to relapse of NS and the cure of SBP by treatment could help the children recover from NS.
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Objective To analyze the clinical characteristics,prognosis and the risk factors in 48 children with lupus nephritis combined with renal insufficiency.Methods The clinical data from 48 pediatric lupus nephritis with renal insufficiency from January 2000 to January 2013 were retrospectively analyzed.Results Forty-eight cases showed renal insufficiency among 168 children with lupus nephritis,and the incidence rate was 28.6％.The age ranged from 5.8 to 16.2 years.The male to female ratio was 1.0 ∶ 2.2.Among 48 children,43 cases had hematuria,41 cases had heavy proteinuria,25 cases had anaemia and 23 cases had persistent hypertension.Totally 20 cases underwent renal biopsy,and among them,15 cases(75.0％) were diagnosed as diffuse proliferative lupus nephritis(class Ⅳ).The histological activity index was ≥7 in 13 cases and the histological chronicity index was ≥4 in 3 cases.Corticosteroid and/or cytotoxic drugs were used in all of 48 cases.Thirty-five cases had normal urine and renal function,5 cases had stable renal function with persistent proteinuria,4 cases developed into chronic renal failure and 4 cases died.Persistent hypertension (x2 =4.274,P =0.039),the time of starting therapy (x2 =28.830,P =0.000),and histologic chronicity index(P =0.008 8 by Fisher's exact probability test)were the prognostic factors.Conclusions Among pediatric lupus nephritis with renal insufficiency,class Ⅳ (diffuse proliferative lupus nephritis) is the most frequent finding.Persistent hypertension,the time of starting therapy,and histologic chronicity index are the prognostic factors.The outcomes of lupus nephritis with insufficiency can be improved by adequate and appropriate treatment.
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Objective To assess the indications,effect and complications of plasma exchange(PE) application in children.Methods A total of 93 patients treated with PE were enrolled,and the clinical mani-festations before and after treatment were analyzed retrospectively.Results Ninety-three cases of children received PE treatment 2 to 1 1 times,an average of 5.5 times,53 cases with combination blood purification treatment.In 93 patients,there were 36 cases with hemolytic uremic syndrome,among them,22 cases (61.1 %)were healed,14 cases(38.9%)remained hematuria,and proteinuria and 5 of them(13.9%)with injured renal function.There were 9 cases with Guillain-Barre'syndrome and 8 of them got improved.Six in 8 cases with anti-N-methyl-D-aspartate receptorencephalitis got better after treatment.All of the 3 cases with myasthenia gravis got recovery.There were 4 cases with acute disseminated encephalomyelitis and 4 cases with chronic inflammatory demyelinating polyneuropathy respectively.The treatment effect rate was all 3 /4. Four in 9 patients with poisonous mushroom poisoning also got improved.The adverse reactions were ob-served in 12 cases(12.9%),including allergic in 9 cases and hypotension in 3 patients.No serious adverse reactions were found during treatment.Conclusion PE is an safe and effective blood purification method, with less adverse reaction,for treatment of the atypical hemolytic uremic syndrome and some serious nervous system diseases,such as myasthenia gravis,Guillain-Barre syndrome,etc.
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Plasma exchange is a commonly used blood purification method, h includes plasma exchange,double filtration plasmapheresis and immunoadsorption.Many nervous system diseases have the antibody. Guillian-Barre syndrome is caused by antibodies of the nervous system demyelinafing disease; Myasthenia grads is caused by the acetylcholinc receptor antibodies. CIDP also has autoimmune-mediated mechanism. Plasma exchange can be apphed effectively to remove antibodies, and to quickly improve the patient' s clinical symptoms and shorten the course of disease.
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Objective To investigate the characteristics of Wegener granulomatosis in children and to improve its recognition. Methods Ten pediatric patients with Wegener granulomatosis were studied retrospectively by clinical manifestations, serum examination, pathological data, treatment, etc. Results All children had clinical evidence of upper respiratory tract and lungs involvement; kidney lesion occurred in 6 cases(6/10); joints, skin, eyes and nervous system were also involved with different degree, cANCA (PR3) showed positive in 8 cases; Pathological examination (1 kidney sample, 2 nasal mucosa samples, 2 skin samples) showed granulomatous vasculitis and crescents were found in renal biopsy; 7 cases were treated with corticosteroid plus cyclophosphamide, 1 case was treated with corticosteroid plus methotrexate, and improvement were seen in all of them. Conclusions Wegener granulomatosis in children have diverse clinical manifestations and clinical diagnosis is difficult. The upper and lower respiratory tract and kidney are most commonly involved organs. ANCA inspection is characteristic. Treatment with corticosteroid and immunosuppressive can achieve good outcome.
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Objective To explore the feature and the optimal treatment of kidney stones in children associ-ated with infant formula which had been aduherated with melamine.Method Total of 47 cases of urinary stone and 31 cases of acute renal failure caused by urinary multiple obstruction in children associated with infant formula which had been adulterated with mlelamine in Beijing Children's Hospital University of Medical Science,form Jan-uary to November,2008 were retrospectively analyzed.Results Infant formula which had been adultemted with melamine may lead to kindey stones in 15 days.The mean age was 11-month and the ratio of male to female was 2.6:1.The kindey stones were usually multiple and mostly located either in the ureteropelvic junction or all through the ureter.In the view of the renal function resuming duration,there was no statistic difference among the acute renal failure group,operation group and the conservative group(P=0.683～0.846).In children with uri-nary obstruction and acute renal failure,hemedialysis or peritoneal dialysis was performed.83.9%were relieved by posting catheter through panedoseope and blood purification.100% of the patients resumed normal renal func-tion.81.3% of the patients without acute renal failure had recovered after conservative therapies such as infusion.Conclusions The patients associated with infant formula which had been adulterated with melamine were Usually little infants.Male were more vulnerable than female.Most of them had recovered smoothly and the renal function resumed normal after effcient therapies.
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To study the effects of different post design on retention. 27 simulated tooth roots made of PMMA were divided into three groups, then manufactured the cement-expanded composite screw post-core system (CECSP), cement screw post-core system (CSP) and cast metal post-core system (CMP). The root and post-core system was tensiled by the speed of 10 mm/min on the Instron 4302 and recorded the retention force. It appeared significantly different between retention force of CECSP and CSP and CAM (P < 0.05). As a result, the retention mechanical properties of CECSP was much better than those of cement screw post-core system and cast metal post-core system. Therefore, it is possible to find a new way for restoration of endodontically treated teeth.
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Humans , Acrylic Resins , Cementation , Composite Resins , Crowns , Dental Materials , Chemistry , Dental Prosthesis Retention , Dental Stress Analysis , Polyurethanes , Post and Core Technique , Tensile StrengthABSTRACT
Objective To study the protection of Kangnaoling capsule to free radical injury and influence on the expression of caspase-3 and Bcl-2 in neuron of VD rat. Methods VD rat model was duplicated. Using spectrophotometry to detect contents of SOD, MDA and NO, spectro-fluorimeter to detect the expression of caspase-3, spectrophotometric method to detect the expression of Bcl-2 after traditional Chinese medicine interference. Results Kangnaoling capsule can markedly reduce the contents of MDA, raise contents of SOD and NO, degrade the expression of caspase-3, enhance the expression of Bcl-2. Conclusions Kangnaoling capsule can markedly protect VD rat from free radical injury, which probably correlated with increasing expression of Bcl-2, decreasing expression of caspase-3.
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Objective To investigate the significance of non - concentrated proteinuria electrophroresis in early diagnosis of type 1 diabetic nephropathy(DN). Methods A total of 47 selected patients with type 1 diabetes and 30 healthy controls were recruited in the study. Fourty seven patients were divided into diabetes mellitus(DM) group and DN group based on the rate of urinary excretion of albumin. Sodium dodcyl sulfate - agarose gel electrophoresis(SDS - AGE) was used to analyze the proteinuria in patients and controls group. Results The positive ratio of urinary albumin SDS - AGE was significantly higher in DN group than in DM group and normal control(group P