Budd-Chiari syndrome with hepatopulmonary syndrome: a case report and literature review / 中华儿科杂志

Objective: To summarize the clinical features and prognosis of Budd-Chiari syndrome with hepatopulmonary syndrome (HPS) in children. Methods: The clinical data of a child who had Budd-Chiari syndrome with HPS treated at the Department of Pediatrics of the First Affiliated Hospital of Zhengzhou University in December 2016 was analyzed retrospectively. Taking "Budd-Chiari syndrome" and "hepatopulmonary syndrome" in Chinese or English as the keywords, literature was searched at CNKI, Wanfang, China Biomedical Literature Database and PubMed up to July 2023. Combined with this case, the clinical characteristics, diagnosis, treatment and prognosis of Budd-Chiari syndrome with HPS in children under the age of 18 were summarized. Results: A 13-year-old boy, presented with cyanosis and chest tightness after activities for 6 months, and yellow staining of the skin for 1 week. Physical examination at admission not only found mild yellow staining of the skin and sclera, but also found cyanosis of the lips, periocular skin, and extremities. Laboratory examination showed abnormal liver function with total bilirubin 53 μmol/L, direct bilirubin 14 μmol/L, and indirect bilirubin 39 μmol/L, and abnormal blood gas analysis with the partial pressure of oxygen of 54 mmHg (1 mmHg=0.133 kPa), the partial pressure of carbon dioxide of 31 mmHg, and the alveolar-arterial oxygen gradient of 57 mmHg. Hepatic vein-type Budd-Chiari syndrome, cirrhosis, and portal hypertension were indicated by abdominal CT venography. Contrast-enhanced transthoracic echocardiography (CE-TTE) was positive. After symptomatic and supportive treatment, this patient was discharged and received oxygen therapy outside the hospital. At follow-up until March 2023, there was no significant improvement in hypoxemia, accompanied by limited daily activities. Based on the literature, there were 3 reports in English while none in Chinese, 3 cases were reported. Among a total of 4 children, the chief complaints were dyspnea, cyanosis, or hypoxemia in 3 cases, and unknown in 1 case. There were 2 cases diagnosed with Budd-Chiari syndrome with HPS at the same time due to respiratory symptoms, and 2 cases developed HPS 1.5 years and 8.0 years after the diagnosis of Budd-Chiari syndrome respectively. CE-TTE was positive in 2 cases and pulmonary perfusion imaging was positive in 2 cases. Liver transplantation was performed in 2 cases and their respiratory function recovered well; 1 case received oxygen therapy, with no improvement in hypoxemia; 1 case was waiting for liver transplantation. Conclusions: The onset of Budd-Chiari syndrome with HPS is insidious. The most common clinical manifestations are dyspnea and cyanosis. It can reduce misdiagnosis to confirm intrapulmonary vascular dilatations with CE-TTE at an early stage. Liver transplantation is helpful in improving the prognosis.

Survey on job satisfaction and analysis of influencing factors of online contracted nurses / 中华医院管理杂志

Objective:To survey the job satisfaction of online contracted nurses who provide " Internet plus nursing services" for reference of hospital managers in improving their management mechanism in this regard.Methods:Based on the two-factor theory, a questionnaire was designed and a purposive sampling method was used to survey the online contracted nurses in Anhui province in April and May 2022. The motivational factors included such five dimensions as workload, work content, colleague relationship, doctor-patient relationship, and their own development, and the healthcare factors included such three dimensions as salary, job recognition and social status. The questionnaire data and job satisfaction scores were analyzed descriptively, and the correlation between the overall job satisfaction of the online contracted nurses, while each dimension was analyzed by Pearson correlation analysis, and the influence of each dimension on job satisfaction was analyzed by stepwise regression analysis.Results:A total of 335 valid questionnaires were recovered. The mean score of job satisfaction of online contracted nurses was (2.26±0.38), with the highest score of (2.56±0.53) for salary satisfaction and the lowest score of (1.78±0.67) for job recognition, and each dimension was positively correlated with job satisfaction ( r=0.34-0.88, P<0.01). Regression analysis showed that workload ( B=0.07), salary ( B=0.11), job content ( B=0.23), social status ( B=0.12), and self-development ( B=0.15) were the main factors affecting their job satisfaction ( P<0.01). Conclusions:The job satisfaction of online contracted nurses was at a medium level, mainly influenced by workload, salary, job content, social status and their own development. It is recommended that hospitals implement multiple targeted measures to improve the job satisfaction of online contracted nurses and promote the healthy development of " Internet plus nursing services" .

The predictive value of the epithelial cell proliferation pathway genes for the prognosis of elderly non-small cell lung cancer patients receiving immunotherapy / 中华老年医学杂志

Objective:To investigate the predictive value of the epithelial cell proliferation(ECP)pathway genes for the prognosis of elderly non-small cell lung cancer patients treated with immunotherapy.Methods:A total of 106 elderly patients aged 70 years and over receiving immunotherapy in the POPLAR and OAK clinical trials were retrospectively analyzed in October 2022.According to the mutation status, patients were divided into an ECP pathway-related gene mutation group(ECP mutation group, n=25)and an ECP pathway-related gene non-mutation group(ECP non-mutation group, n=81). The primary endpoints were overall survival(OS)and progression-free survival(PFS). Differences in survival and efficacy between the two groups were compared, and subgroup analysis was performed on clinical factors and genes involved in the pathway.Pyclone was used to calculate the distribution of major clones and subclones in each patient, and differences in survival were compared.Results:Survival outcomes were worse in the ECP(+ )group than in the ECP(-)group(mOS: 10.9 months vs.17.1 months, HR=1.84, 95% CI: 1.09-3.08, P<0.05; mPFS: 2.8 months vs.4.2 months, HR=1.58, 95% CI: 1.00-2.51, P<0.05). Of all mutations in ECP pathway-related genes, mutations in the RB1 gene had a significant prognostic effect on all patients, with the negative prognostic effect especially prominent in ECP(+ )patients.Compared with ECP(-)patients, ECP(+ )patients had a shorter mOS(6.9 months vs.12.6 months, HR=3.14, 95% CI: 1.10-8.97, P=0.024). Ten patients had clonal mutations and 15 patients had sub-clonal mutations in ECP pathway-related genes and the former had a shorter mPFS than the latter(1.3 months vs.5.3 months, HR=3.23, 95% CI: 1.25-8.37, P=0.011). Conclusions:Gene mutations in the epithelial cell proliferation pathway are a negative prognostic factor in elderly non-small cell lung cancer patients receiving immunotherapy, and mutations located in the clonal cluster have a stronger impact on the prognosis.

A technique of "de-sharpening" intramedullary elastic reduction with Kirschner wire for the treatment of Gartland type III posterolaterally-displaced supracondylar humerus fracture in children / 中华创伤杂志

Objective:To compare the clinical effect of "de-sharpening" intramedullary elastic reduction with Kirschner wire and traditional three-dimensional manipulation for the treatment of Gartland type III posterolaterally-displaced supracondylar humerus fracture in children.Methods:A retrospective cohort analysis was made on 106 children with Gartland type III posterolaterally-displaced supracondylar humerus fracture treated in Anhui Provincial Children′s Hospital from March 2020 to June 2022, including 58 males and 48 females; aged 1-12 years [(8.7±2.3)years]. The patients were assigned to "de-sharpening" intramedullary elastic reduction with Kirschner wire (study group, n=50) and traditional three-dimensional manipulation (control group, n=56). The operation time, frequency of intraoperative fluoroscopy, fracture healing time, difference of Baumann angle between the normal and injured side at postoperative 3 and 6 months, elbow function Flynn score at last follow-up and complications were compared between the two groups. Results:All children were followed up for 6-12 months [(8.5±1.2)months]. The operation time and frequency of intraoperative fluoroscopy were (32.9±3.7)minutes and (20.6±5.4)times in study group, significantly different from (45.6±10.1)minutes and (32.5±8.2)times in control group (all P<0.05). The fracture healing time was (33.0±5.1)days in study group, similar with (33.8±4.7)days in control group ( P>0.05). At 3 and 6 months after operation, the difference of Baumann angle between the normal and injured side was (3.2±0.8)°and (2.3±0.6)°in study group compared to (6.0±2.1)°and (5.8±1.3)°in control group (all P<0.01). According to the elbow function Flynn score at the last follow-up, the results were excellent in 44 children, good in 5 and fair in 1, with the excellent and good rate of 98.0% (49/50) in study group, and were excellent in 47 children, good in 5 and fair in 4, with the excellent and good rate of 92.9% (52/56) in control group ( P>0.05). There were no following complications in both groups, such as osteomyelitis, poor fracture healing, compartment syndrome, iatrogenic neurovascular injury or myositis ossificans. Conclusions:Both "de-sharpening" intramedullary elastic reduction with Kirschner wire and traditional three-dimensional manipulation for the treatment of Gartland type III posterolaterally-displaced supracondylar humerus fracture in children can achieve elbow joint function recovery, with low incidence of complications. However, the former avoids repeated manual reduction, with shorter operation time, less frequency of intraoperative fluoroscopy and better correction of the coronal plane deformity and rotation deformity.

Clinical characteristics of cardiomyopathy with coronary artery disease in children / 中国小儿急救医学

Objective:To summarize the clinical characteristics of cardiomyopathy with coronary artery disease in children and explore the application value of multi-slice spiral CT coronary angiography(MSCTA) in the diagnosis and treatment of cardiomyopathy in children.Methods:Patients diagnosed with cardiomyopathy who were hospitalized in the Department of Cardiology at Beijing Children′s Hospital from January 2016 to December 2022 and had complete cardiac imaging data were selected as the study subjects.The demographic characteristics, general clinical and cardiac imaging data of the patients were collected for systematic retrospective analysis.Results:Among 93 patients included in this study, dilated cardiomyopathy was the most common(34.4%, 32/93). MSCTA detected 17 cases(18.3%, 17/93) of high coronary opening, ten cases (10.8%, 10/93) of myocardial bridge, and nine cases (9.7%, 9/93) of coronary disease were detected by echocardiography.Compared with echocardiography, MSCTA had a higher detection rate of abnormal coronary artery origin and myocardial bridge, and the difference was statistically significant( P<0.05). Conclusion:Children′s cardiomyopathy can be complicated with coronary artery disease.MSCTA has great application value in the diagnosis of coronary artery disease.

Clinical analysis of 208 children with congenital coronary artery origin abnormalities / 中国小儿急救医学

Objective:To describe the clinical features and prognosis of congenital anomalous origin of coronary artery(AOCA) in children to increase our understanding of the disease.Methods:This retrospective study included children diagnosed with AOCA using computed tomography coronary angiography(CTCA) admitted to the Department of Cardiology, Beijing Children′s Hospital, Capital Medical University, from January 1, 2014 to December 31, 2019.The clinical presentations, laboratory results, imaging analyses, treatments, and prognoses of these patients were analyzed.Results:A total of 208 children, including 105 boys and 103 girls, we evaluated the ages(9.03±4.18)years old with AOCA.Of these, 157 cases(75.5%) presented with cardiac symptoms, such as chest tightness, palpitations, dizziness, syncope, fatigue, and decreased endurance.Three cases(1.4%) had atypical symptoms of paroxysmal crying, dyspnoea and cyanosis, and 48 cases(23.1%) were asymptomatic.Levels of serological markers of myocardial injury were elevated in 59 cases(28.4%), and 140 cases(67.3%) had predominant ST-T abnormalities on electrocardiograms.Transthoracic echocardiography identified 27 cases (13%) with cardiac enlargement and ten cases(4.8%) with left ventricular systolic dysfunction.There were 126 cases(60.6%) with the anomalous origin of the left coronary artery revealed by CTCA, 50 cases(24.0%) with the anomalous origin of the right coronary artery and 32 cases(15.4%) with bilateral coronary arteries of anomalous origin.Five children underwent surgical treatment, and the remaining 203 children were treated conservatively with drugs.The whole group was successfully treated, and no death case was recorded during the follow-up period.Conclusion:AOCA may cause different degrees of myocardial ischemia.Diverse clinical presentations and diagnostic limitations of transthoracic echocardiography often lead to missed diagnosis or misdiagnosis.In contrast, CTCA has high diagnostic accuracy and can be used to identify the location and course of the coronary ostia.Hence, the management of AOCA should be tailored on a case-to-case basis, taking into consideration of the specific type of coronary origin, with surgical intervention being warranted if necessary.

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.

Drug therapy and efficacy of heart failure caused by supraventricular tachycardia in infants / 中国小儿急救医学

Objective:To investigate the effect of drug therapy on heart failure caused by supraventricular tachycardia(SVT) in infants.Methods:Fifty-five infants with heart failure caused by SVT, including 24 boys and 31 girls, were treated at Beijing Children′s Hospital of Capital Medical University from January 2014 to December 2021.The drug treatment effects of heart failure caused by SVT were analyzed.Results:The average age of 55 infants at the first diagnosis was 5.8 months(1-11 months). All of them had heart failure, including three cases of atrial flutter, 23 cases of atrial tachycardia(13 cases of disordered atrial tachycardia and ten cases of monomorphic atrial tachycardia), and 29 cases of paroxysmal supraventricular tachycardia.Ultrasonic cardiogram showed that the left ventricular diameter increased and/or left ventricular systolic function decreased.Anti-heart failure therapy was effective in 55 cases(100.0%). Anti-arrhythmic drug therapy: atrial flutter and atrial tachycardia were mainly treated by controlling ventricular rate, digitalis combined with metoprolol was effective in 21 cases(80.8%, 21/26), digitalis alone was effective in four cases(15.4%, 4/26), and sotalol was effective in one case(3.8%, 1/26); paroxysmal supraventricular tachycardia was mainly treated with sinus rhythm conversion.The success rates of conversion were: ATP 20.7%(6/29), ATP combined with digitalis 26.1%(6/23), propafenone combined with digitalis 42.9%(3/7), amiodarone combined with digitalis 60.0%(3/5), and sotalol 92.9%(12/13). During follow-up period for 1 to 12 months, heart failure symptoms of all 55 cases(100.0%) improved, and ultrasonic cardiogram of 53 cases(96.3%)returned to normal.Conclusion:Anti-heart failure and anti-arrhythmic drugs for infants with heart failure caused by SVT need to be selected individually.Atrial tachycardia, especially disordered atrial tachycardia, is sensitive to digitalis.Sotalol can be used to treat refractory SVT.

Evaluation and management of heart failure with arrhythmias in children / 中国小儿急救医学

Heart failure is the end-stage clinical manifestation of various functional or structural heart diseases, which is an acute and critical condition in the field of pediatrics.Arrhythmias are often complicated with heart failure in children and could also trigger heart failure exacerbation, affecting the prognosis of children.The clinical manifestations of arrhythmias in children are atypical except the malignant types, and children with heart failure should always be alerted to the possibility of arrhythmias.Therefore, it is important for improving the prognosis of children with heart failure by raising awareness of these diseases, thus making a rational assessment of disease and actively managing it.

Analysis on the household secondary attack rates of the SARS-CoV-2 Delta variant and the associated factors / 中华预防医学杂志

Objective: To evaluate the household secondary attack rates of the SARS-CoV-2 Delta variant and the associated factors. Methods: A COVID-19 outbreak caused by the Delta variant occurred in Nanjing in July 2021. A total of 235 cases with current addresses in Nanjing were reported from 171 households. The subjects in this study were selected from household close contact(s) of infected cases. The information on household index cases and their contacts were collected, and the household secondary attack rate (HSAR) and the risk factors were analyzed by the multi-factor logistic regression model. Results: A total of 234 cases of household close contacts and 64 household secondary cases were reported from 103 households, and the HSAR was 27.4% (64/234, 95%CI:22.0% to 33.4%). The proportions of household size for 2 to 3, 4 to 5, and 6 to 9 were 64.1% (66), 26.2% (27) and 9.7% (10), respectively. A total of 35 cases of household cluster outbreaks were reported (35/103, 34.0%). The number of the first case in the household (FCH) was 103 and males accounted for 27.2% (28 cases), with the median age (Q1, Q3) of 49 (9, 56). The number of household close contacts was 234 and males accounted for 59.0% (138 cases), with the median age (Q1, Q3) of 42 (20, 55) and the median exposure period (Q1, Q3) of 3 (1, 3) days. The multi-factor logistic regression model showed that the higher HSAR was observed in the FCH with the features of airport staff (OR=2.913, 95%CI:1.469-5.774), detection from home quarantine screening (OR=6.795, 95%CI:1.761-26.219) and detection from mass screening (OR=4.239, 95%CI:1.098-16.368). Meanwhile, higher HSAR was observed in cases with longer household exposure (OR=1.221, 95%CI:1.040-1.432), non-vaccination (OR=2.963, 95%CI:1.288-6.813) and incomplete vaccinations (OR=2.842, 95%CI:0.925-8.731). Conclusion: The generation interval of the Delta variant is shortened, and the ability of transmission within the household is enhanced. In the outbreak in Nanjing, the associated factors of HSAR are occupation, detection route, vaccination and exposure period.

Isoliquiritigenin suppresses the inflammatory response of vascular endothelial cells via HDAC3 / 西安交通大学学报(医学版)

【Objective】 To investigate the effect of isoliquiritigenin on inflammatory response of vascular endothelial cells and whether the regulatory effect of isoliquiritigenin on inflammation is mediated by histone deacetylase 3 (HDAC3). 【Methods】 Human umbilical vein endothelial cells (HUVECs) were cultured in vitro and treated with LPS, different concentrations of isoliquiritigenin and HDAC3 specific inhibitor, respectively. Real-time PCR and Western blotting were used to detect the mRNA and protein expressions of inflammatory cytokines and HDAC3. Male C57BL/6J mice were randomly divided into vehicle group and isoliquiritigenin treatment group. The vascular inflammation model of C57BL/6J mice was established by ligation of the left carotid arteries. The mRNA expressions of inflammatory cytokines and HDAC3 in the carotid arteries of mice were detected by Real-time PCR. A molecular docking study was performed to investigate the interaction between isoliquiritigenin and HDAC3. 【Results】 Compared with the vehicle group, isoliquiritigenin reduced the mRNA expressions of inflammatory cytokines NLRP3, IL-1β, IL-18, MCP-1 and ICAM-1 and decreased the expression of HDAC3 mRNA and protein in HUVECs stimulated with LPS. In addition, isoliquiritigenin also decreased the mRNA expressions of NLRP3, IL-1β and HDAC3 in carotid arteries of ligated C57BL/6J mice. The docking of isoliquiritigenin in the active site of HDAC3 showed that isoliquiritigenin might act through HDAC3. Furthermore, HDAC3 specific inhibitor RGFP966 further promoted the inhibitory effect of isoliquiritigenin on the expression of inflammatory cytokines in vascular endothelial cells. 【Conclusion】 These results suggest that isoliquiritigenin suppresses the inflammatory response of vascular endothelial cells via HDAC3.

Molecular mechanism of artesunate attenuates the release of proinflammatory cytokines from macrophages / 中国临床药理学与治疗学

AIM: Lipopolysaccharide (LPS) on the cell membrane of gram negative bacteria is closely related to the occurrence and development of severe acute pancreatitis (SAP). Local and systemic monocyte / macrophages play an important role in the inflammatory process of SAP. Artesunate (AS) was reported to protect rats with severe acute pancreatitis by reducing the release of proinflammatory cytokines. This study further explored the molecular mechanism of anti-inflammatory effect of AS. METHODS: The release of proinflammatory cytokines in the supernatant were studied by enzyme-linked immunosorbent assay. Then, the mRNA expressions of PI3K-III and its key molecules in signaling pathway were detected by real-time quantitative PCR. Finally, the phosphorylation levels of PI3KIII were detected by Western blot. RESULTS: AS could significantly inhibit the release of proinflammatory cytokines from mouse macrophage induced by LPS. Autophagy inhibitor 3-methyladenine (3-MA) could significantly inhibit the release of TNF-α from mouse macrophages induced by LPS; LPS significantly increased the mRNA expression of PI3KIII and its key molecules in mouse peritoneal macrophages (PMs). Finally, AS could significantly inhibit the increase of PI3K-III phosphorylation induced by LPS in PMs. CONCLUSION: The anti-inflammatory mechanism of AS is closely related to the inhibition of PI3K-III phosphorylation.

Analysis of 15 cases of bronchial-pulmonary artery fistula / 中华儿科杂志

Objective: To summarize the clinical characteristics of bronchial-pulmonary artery fistula and evaluate the effect of interventional closure of bronchial-pulmonary artery fistula. Methods: A retrospective case study was conducted. Fifteen children with hemoptysis who were diagnosed with bronchial-pulmonary artery fistula in Beijing Children's Hospital, Capital Medical University from January 2018 to March 2022 were selected. Their clinical symptoms and chest-enhanced CT findings were recorded. The children who failed to improve after anti-infection and hemostasis treatment were treated with transcatheter embolization through microparticles under digital subtraction angiography (DSA). The efficacy and post-operation recurrence were evaluated. Results: There were 15 children, including 9 males and 6 females, aged 9.8 (3.7, 12.1) years, weighing 35 (16, 55) kg. There was hemoptysis of varying degrees before surgery. Only 2 children had decreased hemoglobin. Chest enhanced CT showed that their bronchial arteries were thickened and tortuous, including 11 cases of single vessel disease and 4 cases of multivessel disease; 11 children had varying degrees of pneumonia and 4 children had atelectasis. Except for one case effectively treated with medical therapy, the remaining 14 cases were all treated with transcatheter interventional closure with embolic microparticles, among whom 12 had their fistula completely blocked with a single operation and the other 2 children underwent multiple operations because of too many fistulas. One child had extensive bronchial-pulmonary artery fistula which failed to be blocked completely even after multiple operations. Among the remaining 13 children, only 2 patients whose fistula was considered to be completely closed had recurrence presenting with hemoptysis at 3 months and 2 years after the operation, and no hemoptysis was found after the second closure. All children were discharged without chest pain, spinal cord paraplegia, or other serious complications. Fourteen children were followed up for 1.4 (0.9,2.9) years, among whom one still has intermittent mild hemoptysis due to incomplete closure and the rest had a satisfactory outcome. Conclusions: Hemoptysis is the first symptom of bronchial-pulmonary artery fistula. For children with failed medical treatment, transcatheter closure with an embolic pellet is effective, safe and feasible, with a low recurrence rate.

Research progress on immune checkpoint inhibitors in older patients with advanced non-small cell lung cancer / 中华老年医学杂志

Lung cancer is one of the most common malignant neoplastic diseases in the elderly.Immunotherapy represented by immune checkpoint inhibitors mobilizes the body's immune system to achieve antitumor effects.Immune checkpoint inhibitors and their combination with other drugs have played an increasingly important role in the treatment of patients with advanced non-small cell lung cancer.In this review, we summarize the therapeutic effects, adverse reactions and hyperprogressive disease of immune checkpoint inhibitors in the elderly with advanced non-small cell lung cancer, in order to provide insight on immunotherapy strategies for non-small cell lung cancer in the elderly.

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.

Effects of salt intake serum and urinary uromodulin levels in Chinese adults / 西安交通大学学报(医学版)

【Objective】 To explore the effects of dietary salt intake on serum and urinary levels through the chronic salt loading intervention. 【Methods】 Eighty adults （18 to 65 years old） were screened from two villages in Liquan and Lantian counties to participate in a 2-week chronic salt intervention， including a 3-day baseline survey， a 7-day low-salt diet， and a 7-day high-salt diet. Uromodulin levels in serum and urine were determined by enzyme-linked immunosorbent assay （ELISA） kits. According to the baseline blood pressure levels， all subjects were divided into normotensive and hypertensive groups. Pearson or Spearman correlation analyzed the associations of 24 h urinary sodium excretions with serum and urinary levels of uromodulin. 【Results】 At the baseline， serum uromodulin in hypertensive subjects was significantly lower than that in normotensive subjects （26.7±9.9 vs. 57.9±9.7 ng/mL， P=0.033）. Serum uromodulin levels were significantly lower on a high-salt diet than on a baseline diet ［（54.9±8.8 vs. 28.3±4.5） ng/mL， P=0.007］. In addition， daily urinary excretions of uromodulin were lower on a high-salt diet ［（28.4±6.6） ng/mL］ than on a baseline diet ［（282.1±70.0） ng/mL］ and on a low-salt diet ［（154.1±21.3） ng/mL］. The 24 h urinary sodium excretions were inversely correlated with urinary uromodulin excretions （r=-0.40， P<0.001） on both low-salt and high-salt diets， but not correlated with serum uromodulin levels. 【Conclusion】 Variations in dietary salt intake significantly affect plasma and urine uromodulin levels.

Relationship between hypoadiponectinemia and hypertension in young individuals with normal renal function: Hanzhong adolescent hypertension study / 西安交通大学学报(医学版)

【Objective】 To explore the relationship between plasma adiponectin levels and hypertension based on the Hanzhong adolescent hypertension cohort. 【Methods】 A total of 361 young individuals with normal renal function， aged 32 to 41 years old， were taken as the research subjects. We collected or measured data including general characteristics， blood pressure （BP）， height， weight， pulse rate， and biochemistry indexes such as fasting glucose， blood lipid and plasma hs-CRP. The concentration of plasma adiponectin was determined by ELISA method. Binary logistic regression was performed to analyze the relationship between plasma adiponectin and hypertension. 【Results】 The plasma adiponectin level in patients with hypertension was significantly lower than that in normotensive patients ［3.56 （2.57-5.02）） μg/mL vs. 4.82 （3.19-6.89） μg/mL， P=0.012］. Partial correlation analysis showed a weak correlation of plasma adiponectin level with systolic BP and diastolic BP （r=-0.155， P=0.003 and r=-0.144， P=0.006）. Binary logistic regression analysis showed that after adjusting for confounding factors such as age， BMI， and high-sensitivity C-reactive protein， the risk of hypertension was 2.46 times higher in patients with plasma adiponectin in the lowest gender-specific tertile than those in the highest tertile （OR=2.46， 95% CI: 1.22-4.99）. 【Conclusion】 Hypoaponectinemia is an independent risk factor for hypertension in young individuals with normal renal function.

Research progress on the application of Er: YAG laser removing all-ceramic restorations / 口腔疾病防治

@#All-ceramic restorations are widely used in oral restoration because of their beauty and high strength. Glass ceramics and zirconia all-ceramic materials are the two most widely used all-ceramic materials in the clinic. However, when all-ceramic restorations need to be removed due to marginal microleakage and secondary caries, its high strength and high bonding strength greatly increase the difficulty of removal. In recent years, clinicians have tried to use Er: YAG lasers to remove all-ceramic restorations. The Er: YAG laser can be safely and efficiently applied to the removal of glass restorations, and it can also play a role in thinner zirconia restorations. Various factors, such as the material and thickness of the all-ceramic restoration, the type of cement, and the laser power, can affect the speed of removal of the Er: YAG laser. However, the current research is limited to case reports and in vitro studies, lacking systematic clinical research. The specific mechanism of Er: YAG laser removal of all-ceramic restorations and the influence of laser frequency, adhesive type, and abutment on the removal speed need to be further demonstrated by follow-up research.

Analysis and prediction of quality markers of Lonicerae Japonicae Flos / 中国中药杂志

Lonicerae Japonicae Flos, as common Chinese medicine, has been used for thousands of years in the treatment of inflammation and infectious diseases with definite efficacies. The complex composition of Lonicerae Japonicae Flos results in its extensive pharmacological effects, so the assessment of its quality by only a few index components is not comprehensive. Guided by the quality marker(Q-marker), the present study comprehensively analyzed and predicted the quality connotation of Lonicerae Japonicae Flos based on the chemical composition and component transfer, the phylogenetic relationship, chemical composition effectiveness, measurability, and specificity. Chlorogenic acid, isochlorogenic acids A, B, and C, luteoloside, rutin, sweroside, and secoxyloganin were predicted as candidate Q-markers of Lonicerae Japonicae Flos.

YZG-330 regulates the TRPM8 ion channel through the P38 MAPK signaling pathway to reduce body temperature in mice / 药学学报

Preliminary research in our laboratory found that compound YZG-330 can reduce mouse body temperature, which could be blocked by adenosine A1 receptor (A1R) antagonist DPCPX. Based on the downstream signaling pathway of the A1R, the mechanism by which YZG-330 lowers body temperature was further studied. The pharmacodynamics of YZG-330 was evaluated by measuring the rectal temperature; expression of the transient receptor potential (TRP) ion channel, the P38 protein and its phosphorylated form in mouse hypothalamic homogenate were detected by Western blotting. A Ca2+ fluorescent probe, Fluo-3AM, was added to cells to detect the effect of YZG-330 on the Ca2+ content of mouse hypothalamic cells. YZG-330 dose-dependently reduced the body temperature in mice, and the selective P38 inhibitor SB-203580 (20 mg·kg-1, i.p.) significantly inhibited the hypothermic effect of YZG-330. A TRPM8 antagonist 2 (0.1 μg per mouse, i.c.v.) markedly attenuated the hypothermic effect of YZG-330 (0.25 or 1 mg·kg-1, i.p.). YZG-330 (2 mg·kg-1, i.p.) significantly increased the phosphorylation of P38, an effect that could be attenuated by the A1R antagonist DPCPX (5 mg·kg-1, i.g.) in mouse hypothalamus. In addition, YZG-330 also prominently enhanced the expression of TRPM8, which could be blocked by SB-203580; YZG-330 (0.1-10 μmol·L-1) increased intracellular Ca2+ concetration in mouse hypothalamic cells in a dose-dependent manner, and was inhibited by the A1R inhibitor DPCPX (0.5 and 1 μmol·L-1) and TRPM8 antagonist 2 (1 μmol·L-1). In conclusion, YZG-330 exerts its hypothermic effect by activating the A1R to promote the phosphorylation of P38 protein and thereby up-regulating the expression and activity of the TRPM8 ion channel, resulting in increased intracellular Ca2+ concentration to stimulate mouse hypothalamus cells to down-regulate body temperature. All animal experiments were approved by the Ethics Committee of the Institute of Materia Medica, Chinese Academy of Medical Sciences.