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Objective:To explore application effect of early respiratory training schemes based on 4E mode (Engage, Educate, Execute, Evaluate) in children with bronchiolitis obliterans (BO) and provide evidence for the clinical implementation of early respiratory rehabilitation in children with BO.Methods:This was a quasi-experimental study. The children with BO who were admitted to 2 wards of the Department of Respiratory Medicine of Hunan Children's Hospital from January 1 to December 31, 2021 were selected as the research objects. They were randomly divided into the control group and the experimental group, with 23 cases in each group. The control group received routine treatment, nursing and rehabilitation guidance. The experimental group established a multidisciplinary team based on the control group, and used the early respiratory training program based on the 4E model to implement intervention. The clinical symptom severity scale was used to evaluate the improvement of the clinical symptoms of the children within 24 hours of being diagnosed as BO, the day of discharge, and 1 and 3 months after discharge for re-examination, and the hospitalization time of the children and the incidence of adverse events related to respiratory training were counted by using medical records and questionnaires.Results:The clinical symptom severity scores of the experimental group within 24 hours of admission diagnosis and the day of discharge were (20.00 ± 2.51) and (11.30 ± 2.46)points respectively, while those of the control group were (20.57 ± 2.21) and (11.70 ± 2.42) points respectively, with no statistically significant difference ( t=0.81, 0.54, both P>0.05). The clinical symptom severity scores of the experimental group were(10.52 ± 2.31) and (8.55 ± 1.06) points, lower than (12.32 ± 1.39) and (12.45 ± 2.19) points of the control group when they returned to the hospital for re-examination 1 and 3 months after discharge, with a statistically significant difference ( t=3.14, 7.25, both P<0.05). The experimental group was hospitalized for (11.78 ± 1.17) days, which was showter than (13.74 ± 1.63) days in the control group, with a statistically significant difference ( t=4.68, P<0.05). No respiratory training-related adverse events occurred in both groups of children during hospitalization. During home respiratory training after discharge, 1 and 2 respiratory training-related adverse events occurred in the experimental group 1 and 3 months after discharge, respectively, compared with 6 and 9 in the control group. The difference was statistically significant ( χ2=4.64, 5.94, both P<0.05). Conclusions:Early respiratory training solutions based on the 4E mode can improve the clinical symptoms of BO children, shorten the hospitalization time, reduce the number of adverse events related to respiratory training, and promote the recovery of children.
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Objective:To investigate the clinical features of pertussis in children and analyze the risk factors of severe pertussis.Methods:The clinical data of 248 children with pertussis hospitalized in Hunan Children′s Hospital from March 2018 to March 2022 were analyzed retrospectively.According to the age at admission, the patients were divided into two groups: ≤3 months and > 3 months.According to the patient′s condition, they were classified into ordinary group and severe group.According to the pathogens detected, the children were divided into single infection group and mixed infection group.The independent sample t-test, chi- square test were used to analyze the clinical indexes of the infants in above groups. Results:(1)Of 248 hospitalized children with pertussis, 204 cases (82.2%) were less than 1 year old, 92 cases (37.0%) had contact with a coughing family member before, and 169 cases (68.1%) were unvaccinated.Among 248 children, 193 cases (77.8%) had an elevated white blood cell count, and 145 cases (58.4%) had mixed infections.The most common pathogen was respiratory syncytial virus [29/248(11.6%)]. About 173 cases (69.7%) had concurrent pneumonia, and 35 cases (14.1%) had pulmonary consolidation.(2)Compared with the group > 3 months of age, more patients in the group ≤3 months of age had contact with a coughing family member before, and suffered from cyanosis, dyspnea, respiratory failure, heart failure and pertussis encephalopathy ( χ2=4.612, 20.810, 7.882, 16.617, 13.740, 7.846, all P<0.05). The proportions of patients in the group ≤3 months of age required intensive care unit(ICU) hospitalization and mechanical ventilation were higher than those in the group > 3 months of age ( χ2=14.810, 21.436, all P<0.05). The mortality of the group ≤3 months of age was higher than that of the group >3 months of age ( χ2=12.016, P<0.05). Children ≤3 months of age had a higher WBC level [(27.83±27.70)×10 9/L vs.(23.34±15.28)×10 9/L, t=22.244, P<0.001], longer duration of spasmodic cough [(16.56±9.33) d vs.(15.06±6.16) d, t=10.145, P=0.002] and longer hospitalization time [(11.47±10.48) d vs.(9.48±4.80) d, t=20.050, P<0.001] than those >3 months of age.(3)Compared with the ordinary group, a higher proportion of children in the severe pertussis group were under 3 months old, and had not been vaccinated against pertussis vaccine ( χ2=14.803, 4.475, all P<0.05). The ratio of patients with dyspnea, an lymphocyte count/neutral cell(LC/NC) ratio <1, mixed infections, lung consolidation and pleural effusion in the severe pertussis group was higher than that in the ordinary group ( χ2=116.940, 43.625, 13.253, 106.370, 11.874, all P<0.05). The patients in the severe pertussis group had a higher WBC [(61.66±29.63)×10 9/L vs.(18.83±10.00)×10 9/L, t=112.580, P<0.001] and a lower LC (0.494±0.186 vs.0.676±0.132, t=13.752, P<0.001) than those in the ordinary group.(4)Compared with the single infection group, the proportions of children with fever, dyspnea, fine moist lung rales, an LC/NC ratio <1, and lung consolidation were higher in the mixed infection group ( χ2=8.909, 6.804, 7.563, 8.420, 12.458, all P<0.05). More children in the mixed infection group required ICU hospitalization and mechanical ventilation than those in the single infection group ( χ2=11.677, 7.397, all P<0.05). The mixed infection group had higher respiratory failure and death rates than the single infection group ( χ2=7.980, 4.267, all P<0.05). Compared with the single infection group, the mixed infection group had a higher WBC level [(27.73±24.13)×10 9/L vs.(21.25±14.65)×10 9/L, t=13.318, P<0.001], longer hospitalization time [(11.593±9.010) d vs.(8.339±4.047) d, t=17.283, P<0.001], and a smaller LC ratio (0.626±0.165 vs.0.684±0.132, t=7.997, P=0.005). (5) Logistic regression analysis showed that age ≤3 months, peak WBC and dyspnea were risk factors of severe pertussis. Conclusions:Hospitalized pertussis children are prone to pneumonia and pulmonary consolidation.Patients aged ≤3 months with a large WBC and dyspnea easily develop into severe pertussis.Monitoring blood routine is helpful for judging the severity of the disease.Mixed infections increase the incidence of complications and can impair the treatment effect.
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Objective:To assess the clinical effectiveness and safety of Omalizumab for treating pediatric allergic asthma in real world in China.Methods:The clinical data of children aged 6 to 11 years with allergic asthma who received Omalizumab treatment in 17 hospitals in China between July 6, 2018 and September 30, 2020 were retrospectively analyzed.Such information as the demographic characteristics, allergic history, family history, total immunoglobulin E (IgE) levels, specific IgE levels, skin prick test, exhaled nitric oxide (FeNO) levels, eosinophil (EOS) counts, and comorbidities at baseline were collected.Descriptive analysis of the Omalizumab treatment mode was made, and the difference in the first dose, injection frequency and course of treatment between the Omalizumab treatment mode and the mode recommended in the instruction was investigated.Global Evaluation of Treatment Effectiveness (GETE) analysis was made after Omalizumab treatment.The moderate-to-severe asthma exacerbation rate, inhaled corticosteroid (ICS) dose, lung functions were compared before and after Omalizumab treatment.Changes in the Childhood Asthma Control Test (C-ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) results from baseline to 4, 8, 12, 16, 24, and 52 weeks after Omalizumab treatment were studied.The commodity improvement was assessed.The adverse event (AE) and serious adverse event (SAE) were analyzed for the evaluation of Omalizumab treatment safety.The difference in the annual rate of moderate-to-severe asthma exacerbation and ICS reduction was investigated by using t test.The significance level was set to 0.05.Other parameters were all subject to descriptive analysis.A total of 200 allergic asthma patients were enrolled, including 75.5% ( n=151) males and 24.5% ( n=49) females.The patients aged (8.20±1.81) years. Results:The median total IgE level of the 200 patients was 513.5 (24.4-11 600.0) IU/mL.Their median treatment time with Omalizumab was 112 (1-666) days.Their first dose of Omalizumab was 300 (150-600) mg.Of the 200 cases, 114 cases (57.0%) followed the first Omalizumab dosage recommended in the instruction.After 4-6 months of Omalizumab treatment, 88.5% of the patients enrolled ( n=117) responded to Omalizumab.After 4 weeks of treatment with Omalizumab, asthma was well-controlled, with an increased C-ACT score [from (22.70±3.70) points to (18.90±3.74) points at baseline]. Four-six months after Omalizumab administration, the annual rate of moderate-to-severe asthma exacerbation had a reduction of (2.00±5.68) per patient year( t=4.702 5, P<0.001), the median ICS daily dose was lowered [0 (0-240) μg vs. 160 (50-4 000) μg at baseline] ( P<0.001), the PAQLQ score was improved [(154.90±8.57) points vs. (122.80±27.15) points at baseline], and the forced expiratory volume in one second % predicted (FEV 1%pred) was increased [(92.80±10.50)% vs. (89.70±18.17)% at baseline]. In patients with available evaluations for comorbidities, including allergic rhinitis, atopic dermatitis or eczema, urticaria, allergic conjunctivitis and sinusitis, 92.8%-100.0% showed improved symptoms.A total of 124 AE were reported in 58 (29.0%) of the 200 patients, and the annual incidence was 0(0-15.1) per patient year.In 53 patients who suffered AE, 44 patients (83.0%) and 9 patients (17.0%) reported mild and moderate AE, respectively.No severe AE were observed in patients.The annual incidence of SAE was 0(0-1.9) per patient year.Most common drug-related AE were abdominal pain (2 patients, 1.0%) and fever (2 patients, 1.0%). No patient withdrew Omalizumab due to AE. Conclusions:Omalizumab shows good effectiveness and safety for the treatment of asthma in children.It can reduce the moderate-to-severe asthma exacerbation rate, reduce the ICS dose, improve asthma control levels, and improve lung functions and quality of life of patients.
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Objective:To study the clinical features of children with pertussis and the risk factors of severe pertussis.Methods:A retrospective analysis was performed based on clinical data and laboratory examination results of hospitalized children with pertussis who admitted to the intensive care unit, respiratory department, and emergency general department at Hunan Children′s Hospital from January 2019 to March 2020.According to the age, the patients were divided into age ≤3 months group( n=58)and age >3 months group( n=64). According to sputum culture, 63 cases were divided into negative sputum culture group and 59 cases were positive sputum culture group.The patients were also divided into vaccinated group( n=19)and unvaccinated group( n=103). Severe disease was seen in 28 cases, and the other 94 cases had the modest disease.The clinical characteristics between two groups were compared, and the risk factors of severe pertussis pneumonia were analyzed. Results:The hospitalization days in age ≤3 months group was higher than that in age >3 months group.It was also found that shortness of breath, apnea, cyanosis after coughing, heart rate decline were more common in age ≤3 months group than those in age >3 months group( P<0.05). The incidences of respiratory failure and heart failure in positive sputum culture group were higher than those in negative sputum culture group.Clinical characteristics such as hospitalization days, hospitalization expenses, peak white blood cell count, peak lymphocyte count, and incidence of bacterial infection were higher in severe pertussis group than those in non-severe pertussis group( P<0.05). Four patients were treated with exchange blood transfusion, and one patient died.Logistic regression analysis revealed that fever, wheezing, cyanosis after coughing and white blood cell count>20×10 9/L were risk factors for severe pertussis.White blood cell count of 20×10 9/L and lymphocyte count of 14×10 9/L had the highest sensitivity and specificity in predicting severe pertussis(0.71, 0.78; 0.54, 0.79). Conclusion:The younger the children are, the more likely they have shortness of breath, apnea, cyanosis, heart rate falls, and the longer the hospital stay.Bacterial infection will aggravate pertussis.Patients with fever, wheezing, cyanosis after coughing, and white blood cell count>20×10 9/L are more likely to develop severe pertussis.The white blood cell count >20×10 9/L and the lymphocyte count >14×10 9/L are associated with severe pertussis.
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Objective:To investigate the clinical characteristics and prognosis factors in children with pneumocystis carinii pneumonia (PCP) without human immunodeficiency virus (HIV) infected.Methods:From January 2017 to December 2020, 35 non-HIV infected patients with PCP were admitted to Hunan Children′s Hospital.According to the prognosis at discharge, they were divided into survival group and death group.The clinical characteristics of two groups were compared, and the prognostic factors were analyzed.Results:The age of 35 patients ranged from 1 month to 15 years, including 24 males and 11 females.Seven patients(20.0%) had primary immunodeficiency, 5 patients(14.2%) had autoimmune disease, and 4 patients(11.4%) had renal disease.Eighteen patients were treated with long-term hormone and 13 patients were treated with immunosuppressive agents before the onset of the disease.Clinical symptoms included shortness of breath or dyspnea, cough, fever and so on, while with few pulmonary signs.Peripheral blood lymphocyte count was less than 1.5×10 9/L in 18 cases.The median LDH was(654.94±57.66)U/L; Fungal D-glucan increased in 13 cases.The median P/F was(121.29±23.25)mmHg, and P/F was less than 200 mmHg in 16 cases.CD4 cells were less than 500/μL in 15 cases and less than 200/μL in 8 cases.The imaging findings were mainly consolidation or patellar shadow, diffuse ground glass shadow, 3 cases with pleural effusion, and 1 case with pneumothorax.Twenty-two cases survived and 13 died, with a mortality rate of 37.1%.There were statistically significant differences in hospitalization days, CD4 cell count, Fungal D-glucan, P/F, ICU admission and invasive mechanical ventilation between two groups( P<0.05). Logistic multivariate analysis showed that decreased P/F value was an independent risk factor affecting the prognosis of non-HIV infected children with PCP ( OR=0.006, 95% CI 0.975-1.000). Conclusion:The clinical manifestations, laboratory examinations and imaging examinations of non-HIV infected patients with PCP lack specificity.When a diagnosis is suspected, high-resolution CT should be performed based on the results of peripheral blood lymphocyte count, CD4 cell count, fungal D, LDH, and blood gas analysis results as soon as possible, compound sulfamethoxazole should be used timely.Decreased P/F value is an independent factor affecting the prognosis of non-HIV children with PCP.
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Objective:To investigate the clinical characteristics and prognosis factors in children with pneumocystis carinii pneumonia (PCP) without human immunodeficiency virus (HIV) infected.Methods:From January 2017 to December 2020, 35 non-HIV infected patients with PCP were admitted to Hunan Children′s Hospital.According to the prognosis at discharge, they were divided into survival group and death group.The clinical characteristics of two groups were compared, and the prognostic factors were analyzed.Results:The age of 35 patients ranged from 1 month to 15 years, including 24 males and 11 females.Seven patients(20.0%) had primary immunodeficiency, 5 patients(14.2%) had autoimmune disease, and 4 patients(11.4%) had renal disease.Eighteen patients were treated with long-term hormone and 13 patients were treated with immunosuppressive agents before the onset of the disease.Clinical symptoms included shortness of breath or dyspnea, cough, fever and so on, while with few pulmonary signs.Peripheral blood lymphocyte count was less than 1.5×10 9/L in 18 cases.The median LDH was(654.94±57.66)U/L; Fungal D-glucan increased in 13 cases.The median P/F was(121.29±23.25)mmHg, and P/F was less than 200 mmHg in 16 cases.CD4 cells were less than 500/μL in 15 cases and less than 200/μL in 8 cases.The imaging findings were mainly consolidation or patellar shadow, diffuse ground glass shadow, 3 cases with pleural effusion, and 1 case with pneumothorax.Twenty-two cases survived and 13 died, with a mortality rate of 37.1%.There were statistically significant differences in hospitalization days, CD4 cell count, Fungal D-glucan, P/F, ICU admission and invasive mechanical ventilation between two groups( P<0.05). Logistic multivariate analysis showed that decreased P/F value was an independent risk factor affecting the prognosis of non-HIV infected children with PCP ( OR=0.006, 95% CI 0.975-1.000). Conclusion:The clinical manifestations, laboratory examinations and imaging examinations of non-HIV infected patients with PCP lack specificity.When a diagnosis is suspected, high-resolution CT should be performed based on the results of peripheral blood lymphocyte count, CD4 cell count, fungal D, LDH, and blood gas analysis results as soon as possible, compound sulfamethoxazole should be used timely.Decreased P/F value is an independent factor affecting the prognosis of non-HIV children with PCP.
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The increasing incidence of allergic diseases in children has become a global public health problem, which not only endangers physical health, but also imposes a heavy economic burden on society and families.Allergen immunotherapy is a cause-specific treatment therapy for allergic diseases in children, which can change the natural course of allergic diseases and works by inducing the body to establish immune tolerance to allergens.Allergen immunotherapy can not only reduce the clinical symptoms and medication use of children, but also prevent allergic reactions to new allergens, and has good efficacy and safety.This paper reviews the research progress of allergen immunotherapy in children with allergic diseases, especially respiratory allergic diseases, in order to provide more treatment options and new ideas for clinical practice.
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Objective:To investigate the types and distribution of non-polio enterovirus (NPEV) in acute flaccid paralysis (AFP) cases in Henan Province in 2019.Methods:A total of 513 cases of AFP were reported in Henan Province in 2019. Two stool specimens were collected from each case for virus isolation. The VP1 gene of NPEV-positive strains was amplified and sequenced. Sequence alignment and construction of the phylogenetic tree were completed by MEGA5.1 software. The epidemiological data of NPEV-positive strains were statistically analyzed by Excel 2016 and SPSS19 software.Results:A total of 39 NPEV strains were isolated from 513 AFP cases, with an isolation rate of 7.60% (39/513). Among them, 18 strains were group A viruses and 21 strains were group B viruses. Both group A and group B viruses contained seven serotypes. No viruses of group C and group D was isolated. Coxsackievirus A type 4 (CVA4) and CVA16 were the predominant types in group A, and echovirus type 11 (Echo11) was the predominant type in group B. The nucleotide identity between the NPEV-positive strains was 67.4%-100.0%, and their nucleotide identity with the prototype strain was 71.4%-85.6%. NPEV was mainly detected in scattered children under 7 years old with an isolation rate of 84.62% (33/39), and the ratio of male to female was 2.07∶1. No statistically significant difference in the isolation rate was found between different age groups or between different sexes ( P>0.05). Among the group A viruses, CVA2, CVA4 and CVA16 were widely distributed. Echo3, Echo11 and Echo30 were the widely distributed group B viruses. NPEV could be isolated throughout the year except for January. Group A virus infections mainly occurred from April to July, accounting for 66.67% (12/18) of the whole year. Group B virus infections mainly occurred in September, accounting for 28.57% (6/21) of the whole year. Conclusions:The main serotype of NPEV isolated in Henan Province in 2019 was Echo11. The pathogen spectrum and regional distribution of NPEV as well as the isolation rate in different age groups changed significantly compared with those in 2018. Therefore, it was necessary to strengthen monitoring and conduct targeted prevention and control to effectively reduce the occurrence of AFP.
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Objective:To analyze the clinical and chest CT features in a family with interstitial lung disease(ILD), and assess the probable causative gene mutations for the family.Methods:In order to identify the etiology of the proband′s ILD, the pedigree was investigated.The clinical data of five proband′s pedigree members were collected, and the chest HRCT examination was performed on four proband′s pedigree members with respiratory symptoms.The human whole exon sequencing was performed on the proband′s blood samples, then its deleterious effects were assessed.Subsequently, the strong pathogenic mutation was validated by Sanger sequencing.Results:According to the family survey, there were five patients with ILD in the family, including three males and two females.One of them died.The surfactant protein C(SFTPC)gene(exon4, c.342G>T, p.K114N)was found in all four surviving patients.The mutation was considered to be originated from the father of the proband, and the pathogenic mutation was considered, which was not included in the databases and was a noval mutation.In addition, the clinical manifestations of different patients in the family were significantly different.Conclusion:The novel mutation of p. k114n in SFTPC gene can lead to ILD in children, and the mutation has incomplete exons in family members.Chest CT and whole exon sequencing play an important role in the diagnosis of ILD in children.
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Pediatrics tuberculosis remains a global public health problem, despite substantial progress in the diagnosis and treatment of this disease due to the improvement of social living standards and increasing global attention.Bacillus Calmette-Guerin (BCG) is recognized as one of the important means to prevent severe tuberculosis infection.As a country with high burden of tuberculosis, China classifies BCG as a vaccine for routine immunization of children in the national immunization programs.Most infants have no adverse reactions after BCG vaccination with, but a small number of babies will develop BCG infection, disseminated infection and even death in severe cases.In this article, the common adverse reactions were described, and it appealed that attention should be paid to the primary immunodeficiency diseases behind severe abnormal reactions.
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Objective@#To investigate the clinical presentation pathological diagnostic features and molecular genetics of paediatric-type follicular lymphoma (PTFL).@*Methods@#Eight cases of PTFL at Fujian Cancer Hospital between January 2003 and May 2018 were analyzed by hematoxylin-eosin stain, immunohistochemistry, polymerase chain reaction (PCR) and fluorescence in situ hybridization (FISH). The relevant literature review was performed.@*Results@#All patients were male with age ranging from 12 to 27 years (median age of 18 years and average age of 19 years). Clinical manifestations included painless lymph adenopathy, primarily involving head and neck lymph nodes (6/8). According to Ann Arbor stage, there were 7 patients at stage Ⅰ A and 1 patient at stage Ⅱ A. Histologically, the structure of the lymph nodes was effaced with pushing borders visible at the tumor periphery. The lesions consisted of expanding, irregular follicles that were arranged in back to back fashion along with thinning or disappearing sleeves. The starry sky phenomenon in the follicle was prominent with loss of polarity. Under high power magnification, the follicles were composed of uniform, medium-sized blastic cells in 5 cases or centroblast in 3 cases. The neoplastic cells were positive for B cell markers and germinal center markers primarily confined to the germinal center. Bcl-2 was negative in 7 cases and 1 case showed weak bcl-2 staining. MUM1 was negative in all cases. Ki-67 demonstrated a high proliferation index of great than 70% in 7 of 8 cases. Eight cases showed Ig clonal rearrangement. No bcl-2, bcl-6, and IRF4/MUM1 gene rearrangements by FISH were detected in all cases. One patient was treated with 6 cycles of CHOP after surgical resection. Other patients underwent only simple surgical resection. All patients were alive upon clinical follow-up.@*Conclusion@#PTFL is a rare subtype of B cell lymphoma with unique clinical and pathological features. It should be distinguished from reactive follicular hyperplasia, nodal marginal lymphoma in children, large B-cell lymphoma with IRF4 rearrangement and usual follicular lymphoma.
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Objective@#To investigate the clinical presentation, clinicopathologic features, diagnosis and differential diagnosis of adult T cell leukemia/lymphoma (ATLL).@*Methods@#Four cases of ATLL from Fujian Cancer Hospital between October 2017 and May 2018 were analyzed using hematoxylin-eosin and immunohistochemical stains and polymerase chain reaction (PCR) for HTLV-1 provirus genes. The relevant literature was reviewed.@*Results@#There were two males and two females, age range 38-80 years. All patients were from coastal cities of Fujian province. Clinical presentations including lymphadenopathy, hepatomegaly and splenomegaly were detected in most patients; skin lesion, hypercalcemia and lymphocytosis were also commonly detected.Histologically, there was diffuse effacement of the normal architecture by tumor cells infiltration. The inflammatory background is usually sparse, with scanty eosinophils. The atypical lymphoid cells were typically medium to large sized with pronounced nuclear pleomorphism, irregular nuclei, chromatin clumping and prominent nucleoli. Blast-like cells with transformed nuclei were present in variable proportions. Giant cells with convoluted or cerebriform nuclear contours may be present. Rare cases may be composed predominantly of anaplastic tumor cells. Characteristic "flower cells" with large multi-lobated nuclei can be seen. The tumor cells were strongly positive for CD2, CD3, CD5, CD4 and CD25, but negative for CD7, CD8 and cytotoxic molecules (including TIA-1, Granzyme B and perforin). In three cases, the large transformed cells were positive for CD30. In one case, the anaplastic large cells were diffusely and strongly positive for CD30. All cases were negative for EBER, but positive for HTLV-1 provirus.@*Conclusions@#ATLL is a rare type of T cell lymphoma with unique clinical and pathological features, and should be distinguished from peripheral T cell lymphoma, NOS, ALK negative anaplastic large cell lymphoma and mycosis fungoides. Hypercalcemia, systemic disease, characteristic "flower cells" and specific immunophenotypic profile of CD3+, CD4+, CD25+, and CD7- are highly suggestive. However, ATLL can only be confirmed if the presence of HTLV-1 provirus.
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In the evaluation of tear film stability based on corneal topography, a pretreatment algorithm for tear film video was proposed for eye movement, eyelash reflection and background interference. First, Sobel operator was used to detect the blur image. Next, the target image with highlighted ring pattern was obtained by the morphological open operation performed on the grayscale image. Then the ring pattern frequency of the target image was extracted through the Hough circle detection and fast Fourier transform, and a band-pass filter was applied to the target image according to the ring pattern frequency. Finally, binarization and morphological closed operation were used for the localization of the ring pattern. Ten tear film videos were randomly selected from the database and processed frame by frame through the above algorithm. The experimental results showed that the proposed algorithm was effective in removing the invalid images in the video sequence and positioning the ring pattern, which laid a foundation for the subsequent evaluation of tear film stability.
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Algorithms , Cornea , Corneal Topography , TearsABSTRACT
Objective To assess the clinical ultrasound value of layer‐specific strain in evaluation of left ventricular systolic myocardial dysfunction of uremia patients after long‐time dialysis at different time . Methods A total of 68 uremia patients accepted maintenance hemodialysis ( M HD ) were enrolled . T he patients were divided into two groups according to the dialysis duration :dialysis time ＜3 years ( group B , n＝31) and dialysis time ≥3 years ( group C , n ＝37) . T he age and sex mached healthy cases were selected as control group ( group A , n ＝ 30 ) . T he standard dynamic two‐dimensional echocardiographic viewes of apical four‐chamber ,three‐chamber ,two‐chamber and the short‐axis view at three levels of mitral valve , papillary muscle and apex were acquired for three cardiac cycles . T he highest value of peak systolic longitudinal strain ( LS ) ,circumferential strain ( CS ) at different levels ,left venrticular global longitudinal strain ( GLS ) and global circumferential strain ( GCS ) were respectively assessed from endocardium ,mid‐myocardium and epicardium using GE EchoPAC workstation . T he comparisons of those parameters were performed among the 3 groups for differences . T he efficacies of GLS and GCS at different myocardial layers in diagdosing the left ventricular systolic function of M HD patients were analyzed by the ROC curve . Results ① Global transmural parameters :compared with those in group A ,the values of GLS at three myocardial layers in both M HD groups were significantly decreased ( all P ＜ 0 .01 ) ,the value of GLS at three myocardial layers in group C was also decreased ,and was statistically different from that in group B ( P＜0 .01) . Compared with those in group A ,the values of GCS at mid‐myocardium in group B and three myocardial layers in group C were also decreased ( all P ＜0 .01) . T here was no significant difference of GCS between group B and C ( P ＞0 .05) . ②Longitudinal transmural parameters at different levels :the values of LS at three myocardial layers of mitral valve ,papillary muscle and apex were decreased in group B and C compared with those in group A ( P ＜0 .05 or P ＜0 .01) ; T he values of LS at three myocardial layers of mitral valve ,papillary muscle and apical levels were also decreased in group C compared with those in group B ( P ＜0 .05 or P ＜0 .001) . ③Short‐axis transmural parameters at different levels :compared with those in group A ,the value of CS at mid‐myocardium of mitral valve level was decreased in group B ( P ＜0 .05) ,the values of CS at three myocardial layers of the mitral valve level and mid‐myocardium of papillary muscle level and apical level were decreased in group C ( P ＜0 .05 or P ＜0 .01) . Besides ,compared with those in group B ,the values of CS at mid‐myocardium and epicardium of mitral valve level were also decreased in group C ( P ＜0 .05) . ④ROC curve showed that determining left ventricular systolic dysfunction in M HD patients using GLS ,GCS at different myocardial layers ,when the area under the curve ( AUC ) of GLS of intima was 0 .851 ,the cut‐off value was －21 .45% ,the sensitivity was 72 .7% ,and the specificity was 93 .3% ; when the AUC of GCS of mid‐myocardium was 0 .683 ,the cut‐off value was －17 .08% , the specificity was 58 .5% , and the specificity was 83 .3% . Conclusions T he left ventricular systolic myocardial function is progressively damaged with the extended dialysis duration time . Ultrasonic layer‐specific strain technology could be used to quantitatively evaluate left ventricular systolic transmural myocardial dysfunction and might contribute to the evaluation of the severity of left ventricular myocardial dysfunction clinically for a more accurate intervention .
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Objective To evaluate the efficacy and value of autologous fat transplantation and anesthesia of the anterolateral femoral fascial flap (ALT) in the clinical treatment of progressive hemifacial atrophy (PFHA).Methods From April 2014 to June 2017,42 patients with progressive hemi-facial wretched malformations who were treated in our hospital were randomly divided into observation group (using autologous fat transplantation).And 21 cases with anastomotic anterolateral femoral fascial fat flap transplantation were enrolled in the control group.Then the therapeutic effect was compared between the two groups.Results The rate of facial asymmetry in the observation group and the control group were (10.96 ±1.35) ％ and (11.98 ± 1.37) ％ in the 6 months after operation,significantly lower than that before operation [(20.13 ± 1.59)％ and (24.65 ± 1.81)％],and the difference was statistically significant (P ＜0.05);While there was no significant difference between the two groups (P ＞ 0.05).The volume of facial defect [(14.16 ±2.98)ml and (8.95 ±4.31)ml] in the observation group and the control group 6 months after operation was significantly lower than that before the operation [(43.17 ± 12.15)ml and (46.83 ±16.21)ml],with statistically significantthe difference (P ＜ 0.05);While the difference between the two groups was not statistically significant (P ＞ 0.05).The operation time and hospital days in the observation group were significantly lower than in the control group,and the number of operation times was more than that of the control group (P ＜ 0.05).The volume retention rate of the actual transplanted tissue in the observation group was lower than that of the control group [(28.12 ± 6.11) ％ vs (77.21 ± 5.33) ％],with statistically significant difference (P ＜ 0.05).There was no significant difference in the maximum and average 3-D deviation,as well as the the postoperative complications between the two groups at 6 months after operation (P ＞ 0.05).In the observation group,the satisfaction rate of the patients was significantly better than that of the control group (P ＜ 0.05),but there was no significant difference between the satisfaction degree of doctors and the third party (P ＞ 0.05).Conclusions Autologous fat granule transplantation in the clinical treatment of severe PFHA patients can effectively restore the patient's facial symmetry.At the same time,it has the characteristics of simple operation,easy operation,rich material,quick recovery of surgical trauma and no rejection.It is worth widely spreading in clinical practice.
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Objective To analyze the characteristics of chest CT in children with invasive pulmonary fungal infections(IPFIs),and to explore the influencing factors on chest CT manifestations in children with IPFIs.Methods A retrospective case-control study was conducted to select 97 children with IPFIs from October 2010 to October 2016 in the department of respiratory medicine,PICU and hematology.The children were divided into CT characteristic change group(39 cases) and CT non-characteristic change group(58 cases) according to the chest CT manifestations. Non-conditional multivariate Logistic regression analysis was used to identify the independent influencing factors of CT characteristic changes in children with IPFIs. Results The ratios of less than 3-year-old infants, Candida, the proportion of ICU admission in the CT characteristic change group were lower than those in the CT non-characteristic change group(P<0.05). The proportions of more than 3-year-old, neutropenia,Aspergillus,central venous catheter,hematological malig-nancies were higher than those in the CT non-characteristic change group(P<0.05).Multivariate Logistic regression analysis showed that the hematological malignancies was an independent influencing factor for the characteristic changes of CT in children with IPFIs.Conclusion When children with blood system malignant tumors manifest as fever,cough and other symptoms of infection,chest CT manifestations show characteristic changes,Aspergillus infection should be considered,and empirical antifungal treatment should be focused.
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Objective To evaluate the coupling relationship between segmental longitudinal strain and left ventricular volume at different phases of the cardiac cycle by two dimensional speckle tracking imaging. Methods 2D grey scale images of 41 healthy adults were acquired,and time curve of left ventricular volume (LVV),segmental longitudinal strain(LS)and segmental longitudinal strain rate(LSr)were outputed by analysis software.The correlations between LVV and LS or LSr in isovolumic relaxation time(IVRT),the rapid filling time(RFT),the atrial filling time(AFT)and the ejection time(ET)were analyzed respectively. Results ①IVRT:LS in basal segment,middle segment,apical segment of interventricular septum,in apical segment,basal segment of the lateral wall,and in middle segment of inferior wall were low-moderate negatively correlated with LVV;only LSr in middle segment of anterior wall was negatively correlated with LVV(P<0.05).② RFT:LS in middle segment,apical segment of interventricular septum,in apical segment of the lateral wall were negatively correlated with LVV;LSr in basal segment,middle segment, apical segment of interventricular septum,in apical segment,middle segment,basal segment of lateral wall, in middle segment,basal segment of inferior wall were low-moderate negatively correlated with LVV(P <0.05).③AFT:LS in basal segment of inferior wall,in apical segment,basal segment of the anterior wall were low negatively correlated wtih LVV(P <0.05).④ET:LS in basal segment,middle segment,apical segment of interventricular septum,in apical segment,basal segment of the lateral wall were low negatively correlated with LVV(P <0.05);only LSr in apical segment of lateral wall was negatively correlated with LVV(P<0.05).Conclusions LS or LSr in special segments of interventricular septum,lateral wall, anterior wall and posterior wall are actively participate in the volume change of the left ventricle in healthy adults,specific myocardial segments of left ventricular wall are involved in left ventricular volume changes.
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To investigate the prevalence of Toxoplasma gondii infection among hepatitis B virus (HBV) patients in northern Shaanxi Province,139 patients and 43 healthy controls were recruited.All the plasma was screened for IgG antibody of Toxoplasma gondii.Then,the association between Toxoplasma gondii infection and HBV were analyzed.Results showed that the prevalence of Toxoplasma gondii infection was relative low with just 5.04％ in HBV patients but zero in healthy control.Most of those infected with toxoplasma gondii were male,HBeAg positive or with higher HBV viral load.However,no significant relationship was found between Toxoplasma gondii infection and gender,HBeAg status or viral load in univariate analyses.This study indicated the relative low infection rate of Toxoplasma gondii,which had no association with HBV infection in northern Shaanxi Province.
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It was generally considered that patients with chronic HBV infection and normal alanine aminotransferase (ALT) level had no or mild liver pathological changes,but in recent years,a large number of studies have found that such patients may also have marked inflammation and fibrosis in the liver.This article discusses the association between clinical features and liver pathological features in patients with chronic HBV infection and normal ALT level and points out that age,sex,HBeAg status,HBV DNA load,ALT level,and liver stiffness measurement are associated with liver pathological changes.Monitoring of these clinical indices helps with early detection of liver pathological changes in patients with chronic HBV infection and normal ALT level.
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Objective To analyze the genotypes and homology of MSP?1 and CSP gene of Plasmodium vivax in Shandong Province,so as to provide the evidence for case traceability. Methods A total of 12 blood samples were collected from P. vivax?infected cases in Shandong Province in 2011. Parasite genomic DNA was extracted. Primers were designed according to MSP?1 and CSP gene sequences of P. vivax. Then Nested PCR,enzyme digestion,sequencing and sequence alignment,and homolo?gous analysis were performed. Results The MSP?1 gene of all the 12 samples from P. vivax?infected cases were detected with a 470 bp PCR amplification band,and 350 bp and 120 bp enzyme digestion fragments,which were identified as type Sal?1. An analysis of phylogenetic tree of MSP?1 gene showed that the sequences of 9 indigenous case samples in Shandong Province were located in the same branch,one case sample infected from India was located in the same branch with India strains. All the 12 P. vivax?infected samples covered GDRA(D/A)GQPA sequences in CSP gene,which were identified as type PV?Ⅰ. Of the CSP gene among 12 P. vivax?infected samples,10 samples of indigenous case in Shandong Province and one sample of the case in?fected in Guangdong Province were detected with both 560-840 bp and 150-230 bp PCR amplification bands,which were iden?tified as temperate zone family strain of type PV?Ⅰ. However,one sample from the case infected in India was detected only with a 560-840 bp band,which was identified as tropical zone family strain of PV?Ⅰ. An analysis of phylogenetic tree of CSP gene showed that the sequences of 10 samples from the indigenous cases in Shandong Province and one sample from the case infected in Guangdong Province were located in the same branch,one sample from the case infected in India was located in the same branch with India and Indonesia strains. Conclusion Of all the indigenous isolates in Shandong Province,MSP?1 gene is geno?typed type Sal?1,CSP gene is genotyped temperate zone family strain of type PV?Ⅰ,with a high homology found among the in?digenous isolates.