Qualitative Study on Psychological Experience of Close Contacts with COVID-19 during the Centralized Isolation Medical Observation Period / 中国医学伦理学

To analyze the psychological experience of close contacts with COVID-19 during the centralized isolation medical observation (centralized isolation for short) period, 17 close contacts of COVID-19 who received medical isolation observation at designated locations in a city of China were selected by purposive sampling using qualitative study methods, and the interviewees were interviewed by full-coverage structured telephone. By analyzing the obtained data and summarizing the themes, it was found that the psychological status of the COVID-19 close contacts during the centralized isolation period could be classified into three themes: obvious negative emotions, somatization of psychological problems, and demand for social support. During the epidemic, when close contacts were quarantined as high-risk groups, they often had complex and difficult psychological experiences. Relevant departments should actively carry out online guidance channels and offline knowledge dissemination, actively conduct psychological interventions for close contacts, assist them to develop life plans to enrich the life of the centralized isolation period. At the same time, relevant departments should do a good job in logistics and life support services, create a comfortable isolated living environment, and effectively relieve the negative emotions of close contacts of COVID-19 during centralized isolation through a variety of positive and effective measures to ensure physical and mental health.

A case of neurodevelopmental disorder of microcephaly-epilepsy-cortical atrophy caused by VARS1 gene mutation and molecular genetic analysis / 中华神经科杂志

Objective:To investigate the clinical characteristics and genotypes of neurodevelopmental disorders of microcephaly-epilepsy-cortical atrophy caused by VARS1 gene mutation.Methods:The clinical data of a child with VARS1 gene mutation who visited Anhui Children′s Hospital in December 2021 were reviewed and followed up. Using "VARS1" "VARS" "VALYL-tRNA synthetase" "Valyl-tRNA synthetase" as the search terms, the Chinese data bases (China National Knowledge Infrastructure database, Wanfang database) and PubMed database (the database establishment until 2022). Articles related to genetic diseases were searched and clinical phenotypes and genotypes were summarized.Results:This case was a 3-month-old girl. After birth, she suffered from repeated convulsions and feeding difficulties, and gradually developed microcephaly, hypotonia, and overall developmental delay. Brain imaging showed cortical atrophy, corpus callosum dysplasia, and craniosynostosis. The results of whole exome sequencing indicated a new homozygous gene mutation in VARS1: gene mutation in exon 27 of chromosome 6 c.3203C>T(p.Thr1068 Met), which was from the patient 's parents. She took phenobarbital, levetiracetam, and sodium valproate for anti-epileptic treatment regularly, and then convulsed as a seizure every few days. A total of 19 patients were reported in 5 literatures that met the search criteria, all of whom presented with neurodevelopmental disorders. A total of 20 VARS1 gene mutation sites have been found so far. Conclusions:Neurodevelopmental disorders of microcephaly-epilepsy-cortical atrophy should be considered for children with neurodevelopmental disorders such as microcephaly, epilepsy, developmental delay, and cortical atrophy. Gene sequencing plays an important role in the diagnosis of the disease.

Ciltacabtagene autoleucel—a novel BCMA-directed CAR T-cell therapy in patients with relapsed or refractory multiple myeloma / 中国临床药理学与治疗学

On February 28, 2022，the U. S. Food and Drug Administration (FDA) approved Ciltacabtagene autoleucel (Cilta-cel) for the treatment of relapsed or refractory multiple myeloma (RRMM) in adults. Cilta-cel is the first FDA-approved cell therapy product in China and the second chimeric antigen receptor (CAR)-T cell immunotherapy to target the B cell maturation antigen (BCMA) approved by FDA around the world. Recent studies have found that patients with RRMM treated with Cilta-cel have an overall remission rate (ORR) of 97% and a 12-month progression-free rate of 77f; common adverse effects include neutropenia, thrombocytopenia, anemia, cytokine release syndrome (CRS), neurotoxicity and so on. In this article, we summarize the mechanism of drug action, indications, pharmacokinetics, clinical studies and adverse effects of Cilta-cel briefly.

Clinical efficacy and safety of omalizumab in the treatment of chronic spontaneous urticaria / 中华皮肤科杂志

Objective:To evaluate the clinical efficacy and safety of omalizumab in the treatment of chronic spontaneous urticaria (CSU) .Methods:Clinical data were collected from 60 patients, who were diagnosed with CSU and received subcutaneous injections of omalizumab at a dose of 300 mg once every 4 weeks for 3 sessions in Hospital of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College from March 2020 to September 2020, and retrospectively analyzed. At weeks 0, 2, 4, 6, 8, 10 and 12, urticaria activity score over 7 days (UAS7) and chronic urticaria quality of life (CU-Q2oL) score were used to evaluate clinical symptoms and quality of life of patients. Changes in the use of other drugs were evaluated before and after the treatment with omalizumab. Paired t test was used to compare UAS7 or CU-Q2oL score before and after treatment. Results:All the 60 CSU patients received 12 weeks of omalizumab treatment. The baseline UAS7 score was 22.37 ± 8.88 points; after one session of the treatment, the UAS7 score dropped to 2.01 ± 5.13 points, reaching the treatment plateau; at week 12, it dropped to 0.6 ± 2.63 points, and 0 point (complete control) in 93.3% of the patients, 1-6 points (favorable control) in 3.3%; the time required for UAS7 score to decrease to 0 point was 22.4 ± 3.2 days. The baseline CU-Q2oL score was 34.10 ± 15.01 points; after one session of the treatment, the CU-Q2oL score dropped to 2.41 ± 7.18 points, reaching the treatment plateau; at week 12, it was 0.56 ± 2.90 points; the time required for CU-Q2oL score to drop to 0 point was 21.15 ± 16.02 days. After the combination treatment with omalizumab, a gradual decrease in dosage or withdrawal of previous therapeutic drugs was realized. At week 12, 39 patients (65%) achieved complete control, and withdrew all therapeutic drugs except omalizumab. During the treatment and follow-up, omalizumab showed good safety, and no adverse reactions were observed.Conclusion:Omalizumab at a dose of 300 mg once every 4 weeks is markedly effective and safe for the treatment of CSU, providing a new treatment option for CSU patients with poor response to traditional therapy.

Clinical characteristics of 3 children with severe tuberculosis and analysis of the results of metagenomic next-generation sequencing / 中华实用儿科临床杂志

Objective:To explore the clinical characteristics of children with severe tuberculosis (TB) in pediatric intensive care unit (PICU) and the diagnostic viability of metagenomic next-generation sequencing (mNGS).Methods:The clinical data and mNGS results of 3 children with severe TB admitted to PICU of Anhui Provincial Children′s Hospital from January 2018 to December 2020 were retrospectively analyzed.The literature reporting children with TB diagnosed by applying mNGS were searched in China National Knowledge Infrastructure, Wanfang data, VIP and PubMed data bases, all of which were searched from the establishment of the database to March 2021, and the relevant literature was reviewed.Results:(1)All of 3 cases, including 2 males and 1 female, all had fever.One case was diagnosed with X-linked severe combined immunodeficiency (X-SCID). Acid-fast stain tests of body fluid, purified protein derivative (PPD) tests and T-cell spot tests of tuberculosis infection (T-SPOT.TB) were conducted in 3 cases, with the test results being negative, and the early diagnosis was confirmed with mNGS.Two cases were discharged from the hospital after being switched to special anti-TB treatment.(2)A total of 3 articles were retrieved, in which 7 children were reported.One male with X-SCID combined with bacillus Calmette-Guérin-associated hemophagocytic syndrome and 6 children with tuberculous meningitis were subject to early diagnosis with mNGS (detection of Mycobacterium tuberculosis complex).Conclusions:It is promising for the application of mNGS in rapid pathogen diagnosis of children with severe TB, especially in children with immunodeficiency.It could optimize early diagnosis and treatment to improve prognosis.

Association of estrogen receptor gene polymorphisms with type 1 diabetes mellitus in children / 中华内分泌外科杂志

Objective:To investigate the relationships of estrogen receptor-α (ESR1) gene PvuⅡ (rs2234693, C>T) and XbaⅠ (rs9340799, A>G) polymorphisms and susceptibility of type 1 diabetes for female children (T1D) .Methods:From Jan. 2016 to Dec. 2019, 86 female children with newly diagnosed T1D who were admitted to Chongqing Three Gorges Central hospital were selected as the study subjects, and 100 healthy children who underwent physical examination in our hospital during the same period were selected as the healthy control. The height, weight and related metabolic indexes of the subjects were measured. The ESR1 gene was genotyped by capillary electrophoresis and SNaPshot. The mRNA expression of ESR1 gene was detected by real-time fluorescence quantitative polymerase chain reaction (RT-PCR) .Results:Genotyping results showed that PvuII genotype distribution between T1D group and the control group was statistically significant ( χ2=11.672, P=0.003) , but XbaI genotype distribution between T1D patients and controls had no significant difference ( χ2=5.433, P=0.066) . PvuII locus T allele frequency and XbaI locus G allele frequency were significantly in T1D group higher than in the control group (PvuII T vs C: OR=1.909, 95% CI=1.261-2.892, P=0.002; XbaI G vs A: OR=1.815, 95% CI=1.112-2.961, P=0.016) . Glycated hemoglobin (HbA1c) and total cholesterol (TC) levels in T1D patients with PvuII T allele were significantly higher than those with CC genotype (all P<0.05) . Low-density lipoproteins (LDL-C) and total cholesterol (TC) levels in T1D patients with XbaI G allele were significantly higher than those with AA genotypes (both P<0.05) . The relative expression of ESR1 gene mRNA in T1D patients was significantly lower than that in the control group (0.42±0.05 vs 1.04±0.16, t=6.227, P<0.001) . The relative expression of ESR1 gene mRNA in T1D patients with PvuII CC, CT and TT genotypes was statistically different ( F=5.823, P<0.001) , and the relative ESR1 gene mRNA in T1D patients with XbaI AA, AG and GG genotypes was also statistically different ( F=5.415, P<0.001) . Conclusion:PvuII and XbaI olymorphismsof ESR1 genes may be involved in the occurrence and development of T1D in female children by influencing gene expression.

Risk factors and prognosis of acute kidney injury in children with sepsis in pediatric intensive care unit / 中华危重病急救医学

To investigate the risk factors and prognosis of acute kidney injury (AKI) in children with sepsis in pediatric intensive care unit (PICU). Methods A retrospective analysis of clinical data of PICU sepsis children in Anhui Children's Hospital from May 2015 to May 2018 was performed. The children were divided into AKI group and non-AKI group according to whether AKI occurred within 48 hours of PICU [referring to the diagnostic criteria for Kidney Disease: Improving Global Outcomes (KDIGO)]. The general data, physiological data and clinical outcomes of the two groups were compared; Logistic regression analysis was used to analyze the risk factors of AKI in children with sepsis and the prognostic factors. Results AKI occurred in 55 of 127 children with sepsis, the incidence of AKI was 43.3%, and the overall mortality was 28.3% (36/127), with 41.8% (23/55) in AKI group and 18.1% (13/72) in non-AKI group.① Compared with non-AKI group, oxygenation index, albumin, the pediatric critical illness case score (PCIS) and urine volume in AKI group were significantly decreased, while cystatin C, procalcitonin (PCT), prothrombin time (PT), activated partial thromboplastin time (APTT), pediatric multiple organ dysfunction score (P-MODS), the proportions of mechanical ventilation, vasoactive drug use, shock, septic shock and mortality were significantly increased, while there was no difference in age, gender, mean arterial pressure (MAP), white blood cell count (WBC) and C-reactive protein (CRP) between the two groups. Multivariate Logistic regression analysis showed that low serum albumin [odds ratio (OR) = 0.627, 95% confidence interval (95%CI) = 0.495-0.794, P = 0.000] and homocystatin C (OR = 2.641, 95%CI = 1.157-6.032, P = 0.021) were risk factors for AKI in children with sepsis. ② Compared with the survival group of children with sepsis AKI, the proportion of mechanical ventilation, septic shock, vasoactive drug use, positive balance ratio of liquid for 72 hours, 6-hour lactate clearance rate < 10%, and AKI 3-stage patients in the death group of children with sepsis AKI were significantly increased. Multivariate Logistic regression analysis showed that 72-hour positive liquid balance (OR = 8.542, 95%CI = 1.956-37.307, P = 0.004) and 6-hour lactate clearance rate < 10% (OR = 5.980, 95%CI = 1.393-25.676, P = 0.016) were risk factors for the death of children with sepsis AKI. Conclusions Serum albumin and cystatin C should be closely monitored in children with sepsis. Early detection and intervention of positive fluid balance and low lactate clearance rate can reduce the mortality of AKI in children with sepsis.

Etiology and prognosis of thrombocytopenia in children: a case analysis in 683 children within 10 years of pediatric intensive care unit / 中华危重病急救医学

Objective To analyze the etiology and prognosis of children with thrombocytopenia (TP) in pediatric intensive care unit (PICU). Methods The data of children with TP (exclusion of congenital and unknown TP) admitted to PICU of Anhui Provincial Children's Hospital from January 2008 to December 2017 was analyzed retrospectively. According to the age of onset, the children were divided into infantile group (29 days to less than 1 year), early childhood group (1 to less than 3 years), preschool group (3 to less than 6 years), school age group (6 to less than 10 years) and puberty group (more than 10 years). Moreover, according to the lowest platelet count (PLT), the children were divided into PLT≤20×109/L group, PLT (21-50)×109/L group and PLT > (50-100) ×109/L group. The distribution and mortality of TP were analyzed, and the relationship between age, PLT decrease and prognosis were analyzed by Pearson method. Results Among 6 725 children admitted to PICU in our hospital from January 2008 to December 2017, there were 683 children with TP, with the incidence of 10.2%. Among 683 children with TP, there were 387 males and 296 females, with the median age of 2.72 (0.61, 3.08) years, and 92 children died, with a total mortality of 13.5%. Analysis of primary disease showed that TP caused by non-hematological malignant tumor disease accounted for 73.9%, with the mortality of 11.1% (56/505). TP induced by hematological malignant tumor disease accounted for 21.4%, with the mortality of 24.7% (36/146). Pseudothrombocytopenia accounted for 0.6%, with the mortality of 0% (0/4). Other children who gave up treatment accounted for 4.1%. It was shown by further analysis that multiple organ dysfunction syndrome (MODS) caused by TP associated with non-hematological malignant tumor disease accounted for 26.9%, with the mortality of 15.4% (21/136). Sepsis, severe trauma, pneumonia, central nervous system infection and disseminated intravascular coagulation (DIC) accounted for 17.4%, 16.6%, 12.7%, 11.7% and 11.5%; with the mortality of 8.0% (7/88), 2.4% (2/84), 0% (0/64), 20.3% (12/59) and 24.1% (14/58), respectively. The main causes of TP associated with hematological malignant tumor disease were hemophagocytic syndrome [accounting for 27.4%, with the mortality of 32.5% (13/40)] and bone marrow inhibition [accounting for 21.2%, with the mortality of 25.8% (8/31)]. The younger were the children with TP, the higher would be the mortality. The mortality of infantile group was significantly higher than that of early childhood group, preschool group, school age group and puberty group [18.8% (53/282) vs. 14.0% (28/200), 6.7% (7/104), 4.3% (4/92), 0% (0/5), all P < 0.01]. The lower was the PLT, the higher would be the mortality. The mortality of PLT≤20×109/L group was significantly higher than that of PLT (21-50)×109/L group and PLT > (50-100)×109/L group [18.1% (39/215) vs. 13.0% (32/247), 9.5% (21/221), both P < 0.05]. It was shown by correlation analysis that there was no association between age and 28-day death time in children with TP (r = -0.037, P = 0.727), but PLT was positively correlated with 28-day death time in children with TP (r = 0.844, P = 0.010). Conclusions MODS, infection, sepsis, severe trauma and DIC are the common causes of TP in PICU. The younger are the children with TP, the lower is the PLT, and the worse would be the prognosis.

The safety and feasibility of dual axis rotational angiography for the diagnosis of coronary artery disease in aged Chinese patients / 介入放射学杂志

Objective To evaluate the clinical safety and feasibility of dual-axis rotational coronary angiography (XperSwing) in diagnosing coronary artery disease in aged Chinese patients through comparing it with standard coronary angiography. Methods During the period from April 2011 to December 2012, a total of consecutive 151 patients with an age ≥ 65 years underwent diagnostic coronary angiography at authors’ hospital. The patients were randomly divided into the standard angiography group (n = 75) and XperSwing group (n = 76). The used dose of contrast, radiation exposure dose and operation time of each patient were recorded. Besides, the occurrence of procedure-related symptoms and arrhythmia during the procedure was recorded, and the blood pressure (BP), heart rate (HR) and creatinine level immediately before-and-after the procedure were estimated. The number of additional acquisition needed to be performed was used to evaluate the efficacy of the two methods. Results Coronary angiography was successfully accomplished in all patients of the two groups, and no significant difference in the number of additional acquisition existed between the two groups (P > 0.05). The used dose of contrast in XperSwing group was reduced by 44% when compared with that in the standard angiography group, i.e. (29.28 ± 5.06) ml vs(22 755.97 ± 11 239.22) mGycm2, (P 0.05). No contrast- induced nephropathy occurred in both groups, although the difference in postoperative changes of creatinine level between the two groups was statistically significant (P < 0.05). Conclusion This study indicates that in diagnosing coronary artery disease in aged Chinese patients, dual-axis rotational coronary angiography is more safe and effective than conventional coronary angiography, as XperSwing can significantly reduce the contrast dose and radiation exposure for the patients.

Construction and application on website of dental laboratory center in stomatology hospital / 医疗卫生装备

This paper utilizes ASP technique and SQL database to design and construct the website of dental laboratory center in stomatology hospital. With basic content,the website consists of foreground display and back management,which shows good interaction and maintainability. The construction of the website is beneficial to the development of dental laboratory center.