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Objective To explore the effect of overweight / obesity on the levels of serum immunoglobulin and IGF-1 in children with recurrent respiratory tract infection and its clinical preventive value. Methods In the study, 126 children with recurrent respiratory tract infection admitted to our hospital from January 2019 to June 2021 were included in the analysis, and the BMI standard levels of different age groups were compared to distinguish the children's body types, and then compared with the overweight/obese patients. The information of serum IGF-1 and immunoglobulin levels in infants, obese patients and normal children were analyzed and discussed, and the factors of body type, the expression of serum IGF-1 and immunoglobulin (IgG, IgA, IgM) and the relationship between repeated respiratory tract infection in children were analyzed and discussed. The association between occurrence and disease in order to guide prevention and clinical work. Statistical analysis was performed using SPSS 19.0. Results The average age of 126 children with recurrent respiratory tract infection was (5.24±2.09) years old, including 71 male children and 55 female children, 79 mild children and 47 severe children. According to the BMI standard level of age group, 39 overweight and obese children were detected in this study, 16 were thin children, and the remaining 71 children were normal. The expression levels of IGF-1 and IgG, IgA, and IgM were the lowest among the children with different disease states (P<0.05). The expression of -1, IgG, IgA, and IgM was positively correlated with the children's height, weight and BMI (all P<0.05). Conclusion The decreased expression of IGF-1, IgG, IgA and IgM was associated with the aggravation of recurrent respiratory tract infection, especially in emaciated children. It may be associated with low expression of IGF-1 and poor growth and development, low expression of IgG, IgA and IgM and poor immune level. It can actively prevent recurrent respiratory tract infection, especially severe syndrome recurrent respiratory tract infection, in children with high-risk body type, low growth and development level and immune status.
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Pediatric sepsis is caused by the imbalance of the host immune response caused by severe infection, while hemophagocytic lymphohistiocytosis(HLH) is an excessive immune activation syndrome caused by natural killer cell/CD8 + T lymphocyte dysfunction.The two diseases can lead to life-threatening multiple organ dysfunction, and their clinical features are similar but different.In addition, sepsis may progress for HLH and HLH can also be secondary to sepsis.This review summarized the similarities and differences between sepsis and HLH in order to provide clinicians with a deeper understanding.
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This article gives a review on the application status and clinical effect of behavioral activation （BA） therapy for patients with late-life depression， in which the theoretical content， research status and the characteristics of clinical application of BA therapy for patients with late-life depression were introduced， and the existing limitations and possible directions for future research were summarized， so as to provide references for the localization of BA therapy for patients with late-life depression.
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Objective:To explore the implementation of individualized lung protection ventilation strategy in pediatric acute respiratory distress syndrome(pARDS)guided by transthoracic electrical impedance tomography(EIT)and critical care ultrasound(CCU).Methods:We retrospectively analyzed the therapeutic process of protective ventilation strategy in one case of severe pARDS.EIT and CCU were used to guide the implementation of lung protective ventilation strategy.Results:EIT was used to guide lung recruitment and optimal positive end-expiratory pressure titration.CCU was used to assess hemodynamics and lung status of ARDS patient, and guide the implementation of right ventricular protective ventilation and circulatory protective ventilation.Finally, the patient eventually survived.Conclusion:The idea of ARDS protective ventilation has changed from traditional lung protective ventilation to right heart protective ventilation and circulatory protective ventilation, and finally achieved the protection of pulmonary vascular endothelium.EIT and CCU enrich the understanding of the pathophysiology and protective ventilation strategy in pARDS.
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Objective To evaluate the value of cardiac MRI in the diagnosis of Ebstein anomaly (EA). Methods Twenty patients from February 2014 to April 2017 with EA confirmed by surgery were enrolled into this study. The analysis in all patients was made according to preoperative cardiac MRI, 2D TTE and surgical data, including the changes of tricuspid valve leaflets, Carpentier classification, the size and function of atrioventricle, late Gadolinium enhancement, the total right/left-volume index and cardiopulmonary bypass time,etc.The numbers of apicaldisplaced leaflets and development condition of all the leaflets were compared using the R×C χ2among the three groups.With surgical results as the reference standard, the diagnostic accuracy of the two groups for the development condition of all the leaflets were evaluated. One-way ANOVA was performed to compare the differences of the apicaldisplaced distance of septal leaflet, using these three methods. Comparisons of the total right/left-volume index, surgery-related data between patients with or without late gadolinium enhancement were performed by independent t test.Results (1) The results in anatomicalstructures, such as distance of apicaldisplacedseptal leaflet,displacement of each leaflet and the Carpentier classification, showed nostatistical difference among MRI,2D TTE and operational findings. The leaflet dysplasia defined by MRI and 2D TTE areequivalent to surgically defined severe dysplasia, and surgically defined mild to moderate dysplasia can't be identified by the former two methods. The overall diagnostic accuracy of MRI and 2D TTE to identify leaflet dysplasia were 41.3%(19/46) and 34.7%(16/46), respectively.(2) Functional right ventricular volume index decreased in 1 case, normal in 8 cases, increased in 11 cases;functional right ventricula rejection fraction decreased in 15 cases. Six patients' left ventricular volume index decreased, 13 remained in normal range, 1 showed increased;left ventricula rejection fraction decreased in 14 cases. (3)LGE was identified in 8 patients and non-LGE in 12. Difference of the total right/left-volume index [(7.12 ± 4.06) vs. (3.84 ± 2.10), P=0.029] between two groups was statistically significant. However, there was no statistical difference in extracorporeal circulation time, aorticcross-clamping time, intubation time, ICU residence time and postoperative hospital staybetween the LGE and non-LGE groups.Conclusions Cardiac MRI can relatively accurately evaluate the apicaldisplacement of leaflets and the morphological changes of the atria and ventricles, as well as quantitatively evaluate the ventricular function, which can rovide references for clinical diagnosis and severity evaluation of EA.
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Objective To investigate regional spontaneous brain activity in mild cognition impairment (MCI) patients with amnesic (aMCI) and non-amnesic (naMCI).Methods Twenty-five aMCI patients,21 naMCI patients and 15 normal controls (NC) underwent resting-state functional magnetic resonance imaging.The regional homogeneity (ReHo) map of the whole brain was obtained by calculating the similarity of each voxel with its nearest 26 voxel time series.The differences of ReHo map across the whole brain among three groups were compared.Results In aMCI group,ReHo values were lower in right frontal lobe and higher in left middle temporal gyrus and left cerebellum compared with NC (P＜0.05,Alphasim correction).In naMCI group,ReHo values were higher in anterior cingulate cortex and right middle frontal gyrus and lower in right parahippocampa gyrus,right middle temporal gyrus as well as right precuneus compared with NC (P＜0.05,Alphasim correction).Compared with naMCI,the ReHo values were significantly higher in left prefrontal gyrus,left middle temporal gyrus and lower in right cerebellum (P＜0.05,Alphasim correction).Conclusion There are differences in spontaneous brain activity of left prefrontal gyrus,left middle temporal gyrus and right cerebellum between aMCI and naMCI,which may be used to differentiate brain function between aMCI and naMCI patients.
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Purpose To investigate the feasibility of 30 ml low-dose contrast medium in reducing the accumulation of contrast medium in venous system while maintaining enough artery enhancement in 256-slice CT angiography (CTA) of intracranial and cervical arteries.Materials and Methods Sixty patients with head and neck CTA were recruited prospectively,and they were randomly divided into group A and group B.The scan parameters of the two groups were identical,but the protocol of contrast medium injection was different.Group A was injected 60 ml contrast medium and 30 ml saline successively with the rate of 4.0 ml/s.Group B was injected 30 ml contrast medium and 50 ml saline successively with the rate of 5.0 ml/s.CT attenuation values of aortic arch,common carotid artery,subclavian artery,cerebral middle artery,superior vena cava,innominate vein,subclavian vein,internal jugular vein were measured,and the image quality was evaluated.Results The average CT values of superior vena cava,right innominate vein,right subclavian vein in two groups had significant differences (P＜0.05).The average CT values of left brachial vein,left subclavian vein,left and right internal jugular vein in two groups had no significant differences (P＞0.05).The average CT values of aortic arch,left and right common carotid artery,left and right subclavian artery,left and right cerebral middle artery in two groups had significant differences (P＜0.05).The scores of image quality in two groups also had significant difference (P＜0.05).Conclusion Head-and-neck CTA with 30 ml low-dose contrast medium is feasible and the images are satisfactory for diagnosis,which can reduce the dose of contrast medium and accumulation of contrast medium in venous system,while maintaining enough artery enhancement.
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Objective To explore the relationship between serum 25-hydroxy vitamin D [25(OH)D] concentrations and the risk of Henoch-Schonlein purpura (HSP).Methods A case control study was designed.Serum 25 (OH)D concentrations were measured by radioimmunoassay in 214 participants,including 53 H SP patients and 161 status-matched healthy controls.Information concerning demographic data,genetic,background,and environmental exposures was collected using questionnaire.The study participants were divided into four groups according to quartile range of 25(OH)D concentration and logistic regression modeling was used to evaluate the relation with HSP risk by estimating odds ratios(OR)and 95％confidence intervals(CI).Results The HSP group had a significantly lower concentration of 25(OH)D than the control group (the median in the HSP group was 11.4 ng/mL;controls:15.36 ng/mL,P＜0.05).When the first interval was set as the reference level,the OR (95 ％ CI) of the second,third,and fourth intervals were:0.468(0.341-0.771),0.442(0.302-0.627),0.339 (0.199-0.501).After adjusting the analysis for the presence of pathogenic related confounding fact OR,the OR(95％CI)of the second,third,and fourth intervals were:0.459(0.333-0.741),0.408(0.317-0.611),0.387 (0.221-0.517).The 25 (OH) D level was inversely correlated with the risk of HSP(P＜ 0.05).Conclusion The risk of HSP was decreased with the increase of serum 25 (OH) D concentration,25 (OH) D may be a protection factor in the pathogenesis of HSP.
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Objective We aimed to use 1H-MRS to characterize metabolite concentrations in the bilateral hippo?campus in GPI patient. Methods Metabolite ratios in the bilateral hippocampus were compared between patients with GPI (n=52) and Normal Control (NC) (n=38). Clinical neurological tests were measured in all subjects and were correlat?ed to the metabolite concentrations. Results The GPI patients showed significantly lower concentrations of N-acetylas?partate(NAA)/creatine(Cr) ratios in the bilateral hippocampus region compared to the NC subjects. There was significant?ly difference in the NAA/Cr ratios between the mild GPI dementia and the severe GPI dementia groups on the left hippo?campus region. We found that the NAA/Cr ratios concentrations were positively correlated with Mini Mental state Exami?nation (MMSE) and Montreal Cognitive Assessment scale (MoCA) scores in the left hippocampus region and the mI/Cr ra?tios concentrations were positively correlated. Conclusions GPI Patients have neuronal dysfunction in the bilateral hippo?campus. The severity of cognitive impairments is associated with the severity of the damage in the left side.
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Objective To evaluate the diagnostic value of multi-slice spiral CT (MSCT) in classifying coronary arteries of complete transposition of great arteries (D-TGA). Methods The clinical and imaging data of 367 patients with D-TGA who had undergone MSCT examination from March 2005 to June 2015 were retrospectively analyzed. The origin and course of the coronary arteries of the patients were classified according to the Marie Lannelongue classification. There were four patterns of courses: normal, looping, intramural and miscellaneous. And the four patterns were subdivided into eleven subgroups. The anatomic classification of coronary arteries in D?TGA were recorded, and the ratio of descriptive statistics was used according to categorical variable data. Results All the origin and course of the coronary arteries could be clearly displayed on MSCT. Of 367 patients with D-TGA, 209 cases (56.95%) were normal course (typeⅠ), 138 cases (37.60%) were looping course (typeⅡ), 16 cases (4.36%) were intramural course (typeⅢ), and 4 cases (1.09%) were miscellaneous course (typeⅣ). In looping course, the posterior looping (typeⅡA), anterior looping (typeⅡB) and double looping (typeⅡC) were found in 63 cases (17.17%), 30 cases (8.17%) and 45 cases (12.26%), respectively. The ratios of the anatomic classification of looping courses wereⅡA-1 44(11.99%),ⅡA-2 19(5.18%),ⅡB-1 12(3.27%),ⅡB-2 8(2.18%),ⅡB-3 10(2.72%),ⅡC-1 25 (6.81%),ⅡC-2 17(4.63%),ⅡC-3 3(0.82%). Conclusions MSCT is an effective technique to visualize and classify the coronary arteries in patients with D-TGA. And it is helpful for successful transfer of the coronary arteries and reducing the rate of coronary events after operation.
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Objective To investigate the cognitive characteristics and vascular risk factor between early onset de?pression and late onset depression in late life depression and provide a clue to elucidate the cause of cognitive impairment in late life depression. Method Fifty-six late life depression patients were recruited in our hospital, including 29 early on?set depression patients and 27 late onset depression patients. 25 controls were recruited from Guangzhou community. Cog?nitive evaluation were conducted in all the patients and controls, including MMSE, memory, attention, language, visuospa?tial abilities,executive function and Framingham vascular risk assessment, and analyze the cognitive and vascular risk be?tween the patients. Result There were statistically significant differences in overall cognitive assessment MMSE(24.8 ± 2.9,22.8±3.5,P=0.030), symbol digit modalities test(SDMT)(29.8±10.5, 22.9±11.8, P=0.028), clock drawing test(CDT) (3.6 ± 0.8, 2.9 ± 1.3, P=0.006) and trail making test(TMT) (60.4 ± 20.6, 74.7 ± 28.8, P=0.027) between late onset depression and early onset depression. In addition, the score of vascular risk assessment was significant between late onset depression and early onset depression(14.6±2.7,12.3±2.2,P=0.001). Conclusion Compare with early onset depression, late onset de?pression has much severe cognitive impairments and increased vascular risk factors.
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Objective To explore the plasma levels of soluble CD40 (sCD40) and soluble CD40 ligand (sCD40L) in the patients with Alzheimer’s disease (AD) and those with amnestic mild cognitive impairment (aMCI). Methods The levels of plasma sCD40 and sCD40L were measured in 20 patients with AD, 35 patients with aMCI, and 32 cognitively normal controls (NC) using commercially available ELISAs. The cognitive function of AD and aMCI patients was mea?sured by mini-mental state examination (MMSE). Results There were significant differences in plasma sCD40 among AD, aMCI and NC groups (P<0.05) as the medians (the upper and lower quartiles) of plasma levels were 123.3 (97.4, 149.5) pg/mL, 102.9 (63.6, 124.0) pg/mL and 70.66 (51.0, 90.8) pg/mL, respectively. There were significant differences in plasma sCD40L among AD, aMCI and NC groups (P<0.05) as plasma levels were 537.0 (316.0, 1134.0) pg/mL, 316.0 (190.0,546.0) pg/mL and 167.0 (107.5,478.0) pg/mL. A negative correlation between the plasma concentrations of sCD40L and the MMSE scores was found in aMCI patients (r=-0.736, P<0.001). Conclusions There are relevant chang?es of plasma sCD40 and sCD40L levels in patients with AD and aMCI. The present results suggest that plasma levels of sCD40 and sCD40L may be appropriate biomarkers for AD patients and indicate that CD40-CD40L signaling may be in?volved in AD pathophysiology.
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Objective To investigate the CT and MRI features of intraductal papillary neoplasm of the bile duct (IPNB).Methods Thirty eight patients with IPNB finally diagnosed by puncture biopsy or surgery were enrolled in this study.All the CT or MRI data were investigated retrospectively.Twenty one patients underwent CT examinations,17 patients underwent MRI examinations.The features of IPNB including the distribution features of the nodules or masses,CT and MRI features of cholangiectasis,mucus were analyzed.The accuracy differences of CT and MRI for the preoperatively diagnosing mucus and tumor growing along mucous were compared by nonparametric test.Results The lesions (including 5 patients with solitary lesions and 19 patients with multiple lesions) were located in intrahepatic bile duct in 24 patients,3 patients occurred simultaneously in intrahepatic and portal bile duct,2 lesions occurred in portal bile duct,8 lesions occurred in common bile duct,the lesions of 1 patient occurred simultaneously in common bile duct,cystic duct and gallbladder.Seventeen and 11 patients appeared nodules locating in dilated bile duct on CT and MRI,respectively.Four and 5 patients appeared cystic lesions with multiple nodules of the liver on CT and MRI,respectively.Higher contrast enhancement on CT and MRI in arterial phase than that in portal vein and equilibrium phase were observed in 18 and 12 patients,respectively.Excluding the patients undergoing puncture,CT was better than MRI in evaluating whether the mucus was present,with the accuracies of 30.0％ (6/20) and 6.3％ (1/16) for CT and M RI,respectively (Z =2.58,P ＜ 0.05).CT was worse than MRI in preoperatively evaluating the features of tumor growing along mucous,with the accuracies of 77.8％ (14/18) and 92.6％ (13/14) for CT and MRI,respectively (Z =4.23,P ＜ 0.01).Conclusion IPNB had the features of growing along mucous of the bile duct,nodule or mass in dilated bile duct and other features,CT and MRI are important in diagnosing the IPNB.