Early outcomes of anterior segment parameters in patients with high myopia after implantable collamer lens V4c implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the early outcomes of anterior segment parameters after implantation of an implantable collamer lens with a central hole(ICL V4c)in patients with high myopia.METHODS:A total of 82 cases(160 eyes)with high myopia, including 42 males(82 eyes)and 40 females(78 eyes), aged 26.0±4.6(21 to 37)years, who underwent ICL V4c implantation at our institution from February 2019 to September 2022 and were followed up for 1 a, were included. The general characteristics of the anterior segment of the eye were measured preoperatively: spherical equivalent, mean horizontal corneal curvature, white-to-white(WTW), and axial length(AL); intraocular pressure(IOP), endothelial cell density(ECD), central anterior chamber depth(CACD), anterior chamber volume(ACV)and anterior chamber angle(ACA)were measured preoperatively and at 1 d, 1 wk, 1, 3 and 6 mo postoperatively. Furthermore, the distance from the centre of the posterior surface of the ICL V4c optical zone to the anterior surface of the lens(vault)was measured at 1 d, 1 wk, 1, 6 mo, and 1 a after surgery.RESULTS: The mean preoperative spherical equivalent of the patients was -7.56±2.55 D, mean horizontal corneal curvature was 42.89±1.47 D, WTW was 11.64±0.37 mm, and AL was 26.64±0.93 mm. The baseline IOP was 15.97±2.13 mmHg, and the differences in IOP at each time point after ICL V4c implantation compared to preoperative were not statistically significant(F=0.875, P=0.504); ECD was 2 989.30±140.78 cells/mm2 at baseline, and ECD at 6 mo after ICL V4c implantation was not statistically significant compared with preoperative ECD(t=1.475, P=0.142); CACD was 3.19±0.21 mm at baseline, and ACV was 210.30±27.7 mm3, and CACD and ACV were significantly lower than preoperative at all postoperative time points(F=111.10, 288.38, all P<0.001). The baseline ACA was 35.44°±11.27°, and the ACA at each time point after ICL V4c implantation was significantly lower than preoperatively(F=21.23, P<0.001). The vault was 665.32±184.03 μm at 1 d postoperatively, and continued to be significantly reduced at 1 wk, 1, 6 mo, and 1 a postoperatively compared with 1 d(F=52.10, P<0.001). However, it remained stable at 6 mo and 1 a postoperatively, and the difference was not statistically significant compared with vault at 1 mo postoperatively(P>0.05).CONCLUSION: ICL V4c has certain safety and efficiency in 1 a postoperative follow-up, and the parameters of the anterior segment of the eye stabilized in the early period.

Role of SIRTl/Nrf2/HO-l pathway in attenuation of learning and memory impairment by sevoflurane postcondition in a mouse model of hemorrhagic shock and resuscitation / 中国药理学通报

Aim To explore the role of SIRT1/Nrf2 / HO-1 in alleviating the cognitive function impairment by sevoflurane treatment in a mouse model of postoperative cerebral reperfusion. Methods C57BL/6J mice were randomly divided into five groups: sham operation group, hemorrhagic shock reperfusion group, sevoflurane postconditioning group, sevoflurane postcondition-ing + SIRT1 inhibitor group and sevoflurane postconditioning + Nrf2 inhibitor group. Mice were subjected to Morris water maze test after cerebral ischemia reperfusion. The ATP, superoxide dismutase (SOD), ROS and MDA contents in tissue of mice were detected. SIRT1, Nrf2 and HO-1 proteins in tissue were detected by Western blot. Results After hemorrhagic shock, the learning and memory ability of mice was reduced.ATP and SOD concentration in hippocampus was reduced , MDA and ROS concentration increased, and the SIRT, Nrf2 and HO-1 concentration was reduced. Sevoflurane improved the cognitive dysfunction and oxi-dative damage in postoperative mice, and the neuro-protective effect of sevoflurane on hemorrhagic shock and resuscitation mice was weakened followed with SIRT1 and Nrf2 inhibitors. Conclusion Sevoflurane probably alleviates the oxidative reaction damage and cognitive impairment caused by cerebral reperfusion in mice through SIRT1/Nrf2/H0-1 pathway.

Visualization of nasal powder distribution using biomimetic human nasal cavity model

Nasal drug delivery efficiency is highly dependent on the position in which the drug is deposited in the nasal cavity. However, no reliable method is currently available to assess its impact on delivery performance. In this study, a biomimetic nasal model based on three-dimensional (3D) reconstruction and three-dimensional printing (3DP) technology was developed for visualizing the deposition of drug powders in the nasal cavity. The results showed significant differences in cavity area and volume and powder distribution in the anterior part of the biomimetic nasal model of Chinese males and females. The nasal cavity model was modified with dimethicone and validated to be suitable for the deposition test. The experimental device produced the most satisfactory results with five spray times. Furthermore, particle sizes and spray angles were found to significantly affect the experimental device's performance and alter drug distribution, respectively. Additionally, mometasone furoate (MF) nasal spray (NS) distribution patterns were investigated in a goat nasal cavity model and three male goat noses, confirming the in vitro and in vivo correlation. In conclusion, the developed human nasal structure biomimetic device has the potential to be a valuable tool for assessing nasal drug delivery system deposition and distribution.

Research progress on the epidemiology of human adenovirus infections / 预防医学

Abstract@#Human adenovirus (HAdV), which is characterized by infectivity, complex pathogenesis and multiple target organs, causes multiple organ infections in the respiratory system, gastrointestinal system and eyes, which seriously endangers human health. Various subspecies of HAdV has different tissue tropism, which presents diverse clinical symptoms and epidemiological characteristics. Based on the molecule biological characteristics of HAdV, this review summarizes the clinical symptoms and epidemiological characteristics of HAdV infections depending on tissue tropism, and describes the trends in HAdV epidemiology, so as to provide insights into prevention and control of HAdV infections.

Spontaneous intracranial hypotension: analysis of 118 patients ' clinical characteristics / 中华神经科杂志

Objective:To summarize the clinical features, radiological characteristics, therapy, and outcome of patients with spontaneous intracranial hypotension (SIH).Methods:The general information, clinical manifestations, auxiliary examinations, treatment, and outcomes in consecutive patients of SIH hospitalized in the Xuanwu Hospital, Capital Medical University from November 2018 to October 2022 were analyzed.Results:A total of 118 patients with a female-to-male ratio of 5∶4 were included and the ages were 17.00-71.00[39.00(34.00,46.75)]years with a preponderance in the age of 30-49 years. Almost all patients had orthostatic headaches (117/118, 99.2%), accompanied by nausea (90/118, 76.3%), vomiting (70/118, 59.3%), neck stiffness (88/118, 74.6%), tinnitus (57/118, 48.3%), and ear fullness (57/118, 48.3%). Brain magnetic resonance imaging (MRI) showed dural enhancement (97/113, 85.8%), enlarged venous sinus (88/113, 77.9%), subdural fluid collection (46/113, 40.7%), decreased suprasellar cistern (86/113, 76.1%), effacement of the prepontine cistern (86/113, 76.1%), diminished mamillopontine distance (80/113, 70.8%). The cerebrospinal fluid (CSF) leaks were detected in 90.7% (107/118) of the patients by magnetic resonance myelography but 54.3% (25/46) and 52.6% (20/38) by CT myelography and magnetic resonance myelography with gadolinium. Lumber puncture found CSF pressure<60 mmH 2O (1 mmH 2O=0.009 8 kPa) in 18.4% (19/103) of patients, increased CSF red blood cell counts in 50.6% (44/87) of patients, CSF pleocytosis in 44.8% (39/87) of patients, increased CSF protein concentrations in 57.5% (50/87) of patients. The headache completely disappeared after conservative treatment in 24.6% (31/118) of patients and after a single targeted epidural blood patch in 89.7% (78/87) of patients. A rebound headache after epidural blood patch treatment occurred in 66.0% (58/87) of patients. Conclusions:The patients with SIH almost manifested with orthostatic headache, and brain MRI and magnetic resonance myelography were suggested in those patients instead of CSF pressure by lumber puncture. Targeted epidural blood patch was effective and safe in SIH patients.

Spontaneous intracranial hypotension caused by high-flow spinal cerebrospinal fluid leaks: analysis of 6 patients / 中华神经科杂志

Objective:To analyze the clinical features of 6 patients with spontaneous intracranial hypotension caused by high-flow spinal cerebrospinal fluid leaks.Methods:The clinical characteristics, auxiliary examinations, treatment, and outcomes in 6 patients of spontaneous intracranial hypotension caused by high-flow spinal cerebrospinal fluid leaks enrolled in the Xuanwu Hospital, Capital Medical University from February 2021 to April 2022 were retrospectively reviewed.Results:All the 6 patients had orthostatic headaches. Brain magnetic resonance imaging showed dural enhancement and brain sagging and magnetic resonance myelography showed longitudinal extradural collection in all the patients. The high-flow spinal cerebrospinal fluid leaks were demonstrated in upper thoracic segments by the dynamic myelography. The headache disappeared after conservative treatment in 2 patients and treatment with targeted epidural blood patch in 4 patients.Conclusions:The diagnosis of spontaneous intracranial hypotension caused by high-flow spinal cerebrospinal fluid leaks with typical orthostatic headache and brain magnetic resonance imaging and myelography findings is not difficult. However, the localization of the site of high-flow spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension depends on the dynamic myelography. Targeted epidural blood patch is effective, but conservative treatment does not always work.

Characterization of an IDS pathogenic variant in a family with mucopolysaccharidosis type Ⅱ / 中华内分泌代谢杂志

Objective:To identify the genetic variation in a mucopolysaccharidosis type Ⅱ(MPS Ⅱ)family, and conduct a functional study of iduronate-2-sulfatase(IDS): c.323A>C.Methods:A five-generation MPS Ⅱ family of 83 individuals including 4 patients from northern China was collected. Urine mucopolysaccharide and Alder-Reilly body were tested to assist the clinical diagnosis of MPS Ⅱ. IDS enzyme activity was detected on core family members. By the whole exome sequencing of a MPS Ⅱ patient in this family and bioinformatics analysis, the variant was screened and further identified by PCR-Sanger sequencing. Finally, to validate the function of the variant in vitro, the wild-type IDS overexpression plasmid(pCMV-hIDS-WT)and the IDS overexpression plasmid carrying the mutation site(pCMV-hIDS-c.323A>C)were transfected into COS-7 cells and the IDS activity was detected. Results:The proband(Ⅳ3)and Ⅳ4 were diagnosed as MPS Ⅱ by urine mucopolysaccharide, Alder-Reilly body, and IDS enzyme activity tests. Ⅳ3, Ⅳ4, Ⅲ19, and Ⅲ32 were determined to carry IDS: c.323A>C missense variant through the whole-exome sequencing, and diagnosed as MPS Ⅱ. Meanwhile, Ⅱ2, Ⅱ4, Ⅱ8, Ⅱ12, Ⅱ14, Ⅲ5, Ⅲ7, Ⅳ14 in the MPS Ⅱ family carried IDS: c.323A>C missense variant, and were excluded as MPS Ⅱ. The in vitro experiment in COS-7 cells showed that the missense mutation led to a significant decrease in IDS enzyme activity. Conclusion:The variant IDS: c.323A>C: p.Y108S significantly decreases the activity of IDS enzyme in vivo and in vitro, and it is identified as a pathogenic variant for MPS Ⅱ.

Effect of Enolase inhibitor on autophagy and motor function after spinal cord injury in rats / 中华创伤杂志

Objective:To investigate the effect of Enolase inhibition (ENOblock) on autophagy- related protein expression and motor function promotion after spinal cord injury in rats.Methods:A total of 160 female SD rats were divided into sham-operation group, 3-methyladenine (3-MA) autophagy inhibitor treatment group (3-MA group), spinal cord injury group and ENOblock treatment group (ENOblock group) according to the random number table, with 40 rats per group. Back laminectomy without injury to the spinal cord was performed in sham-operation group. Spinal cord injury at T 8 was induced by using a modified Allen weight-drop apparatus to establish a spinal cord injury model in the rest three groups. 3-MA and ENOblock groups were injected 3-MA (2.5 mg/kg) and ENOblock (100 μg/kg) into the caudal vein immediately after injury, respectively. Sham-operation and spinal cord injury groups were injected same dose of isotonic sodium chloride solution into the caudal vein. At 1, 3, 7, 14 and 21 days after injury, BBB score was used to evaluate lower limb motor function. At day 3 after injury, the ratio of microtubule-associated protein 1 light chain 3 (LC3)-II to LC3-I and protein expressions of autophagy effector protein (Beclin-1) and polyubiq-uitinbinding protein (p62) were detected by Western blotting. At day 7 after injury, LC3-Ⅱ and Beclin-1 positive cells in the injured area of the spinal cord were determined by immunofluorescence staining. At day 3 after injury, the mRNA expressions of Beclin-1 and Enolase in the injured area of the spinal cord were detected by RT-PCR. Results:At 1, 3, 7, 14 and 21 days after injury, BBB score was lowered in 3-MA group [(1.4±1.1)points, (2.4±0.9)points, (3.8±1.8)points, (7.6±1.1)points, (9.0±2.1)points], spinal cord injury group [(0.8±0.5)points, (1.8±0.9)points, (3.6±0.9)points, (6.2±1.3)points, (8.0±0.7)points] and ENOblock group [(2.0±0.9)points, (2.2±0.8)points, (4.8±1.1)points, (10.6±1.5)points, (13.2±0.8)points] compared to sham-operation group [(21.0±0.0)points at all time points] (all P<0.05). Moreover, the score in ENOblock group was significantly higher than that in spinal cord injury group at 14, 21 days after injury, and the score in 3-MA group was significantly higher than that in spinal cord injury group at day 21 after injury (all P<0.05). At day 3 after injury, Western blotting showed that the ratio of LC3-II to LC3-I and protein expressions of Beclin-1 and p62 were 0.46±0.10, 0.41±0.03, 0.81±0.03 in sham-operation group, 0.66±0.06, 0.69±0.02, 0.59±0.05 in 3-MA group, 0.85±0.06, 1.07±0.03, 0.41±0.02 in spinal cord injury group and 0.68±0.06, 0.66±0.08, 0.55±0.02 in ENOblock group. By comparison, spinal cord injury group showed significantly higher ratio of LC3-II to LC3-I and protein expression of Beclin-1 and significantly lower protein expression of p62 than sham-operation group (all P<0.05); 3-MA and ENOblock groups showed significantly lower ratio of LC3-II to LC3-I and protein expression of Beclin-1 and significantly higher protein expression of p62 than spinal cord injury group (all P<0.05); there was no significant difference in the ratio of LC3-II to LC3-I and protein expressions of Beclin-1 and p62 between 3-MA and ENOblock groups (all P>0.05). At day 7 after injury, immunofluorescence staining showed that LC3-II and Beclin-1 positive cells in 3-MA and ENOblock groups were less than those in spinal cord injury group. At day 3 after injury, RT-PCR showed that mRNA expressions of Beclin-1 and Enolase in spinal cord injury group (1.08±0.16, 0.98±0.17) were higher than those in sham-operation group (0.25±0.06, 0.29±0.03). Moreover, mRNA expressions of Beclin-1 and Enolase in 3-MA group (0.77±0.11, 0.72±0.04) and ENOblock group (0.81±0.10, 0.64±0.09) were lower than those in spinal cord injury group (all P<0.05). There was no significant difference in mRNA expressions of Beclin-1 and Enolase between 3-MA and ENOblock groups (all P>0.05). Conclusions:Autophagy activity is significantly up-regulated after spinal cord injury in rats. ENOblock can inhibit autophagy and promote motor function recovery in rats by regulating the expression of autophagy-related proteins.

Role of P2X7/NLRP3 inflammasome pathway in cognitive impairment in sleep deprived mice / 中华行为医学与脑科学杂志

Objective:To investigate the possible role and mechanism of purinergic ligand-gated ion channel 7(P2X7)/nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3) inflammasome pathway in cognitive impairment induced by sleep deprivation (SD)mice.Methods:SPF grade male C57BL / 6J mice aged 6-8 weeks were randomly divided into 3 groups according to the random number table method with 6 mice in each group.They were normal control group (CC group), SD group and SD+ P2X7 receptor antagonist brilliant blue G(BBG) group (SD+ BBG group). Modified multiple platform method was used to establish a 5-day SD model in mice.During the SD intervention period, the mice in SD+ BBG group were injected with BBG(50 mg/kg) intraperitoneally once a day, while the mice in CC group and SD group were injected with the same volume of 0.9% sodium chloride solution.Morris water maze was conducted to evaluate the cognitive function of mice.The protein expression levels of P2X7, NLRP3, caspase-1, apoptosis-associated proteins(ASC) and interleukin-1β(IL-1β) in hippocampus were detected by Western blot.RT-qPCR was used to detect the mRNA expression levels of tumor necrosis factor-α(TNF-α), IL-1β, interleukin-18(IL-18) and microglial polarization surface markers CD206 and CD86 in hippocampus.Graph pad Prism 8.0 software and SPSS 25.0 software were used for statistical analysis and mapping.Results:(1) The interaction effect between time and groups of escape latency in three groups of mice was significant ( F=15.76, P<0.001). From the 2nd to 5th day, the escape latencies of mice in SD group were higher than those of CC group, while the escape latencies of mice in SD+ BBG group were lower than those of SD group (all P<0.05). (2)The results of the space exploration experiment showed that there were statistically significant differences in target quadrant residence time and the times of crossing the platform( F=6.65, P=0.009; F=12.39, P<0.001). The target quadrant residence time ((23.42±0.55) s) and times of crossing the platform ((17.67±0.71) times) of the SD group were both lower than those of the CC group ((29.48±1.78) s, (23.33±0.95) times) (both P<0.05), while the target quadrant residence time ((28.62±1.19) s) and the times of crossing the platforms ((21.33±0.76) times) of the SD+ BBG group were both higher than those of the SD group (both P<0.05). (3)There were statistically significant differences in the protein levels of inflammatory related proteins such as P2X7, NLRP3, caspase-1, ASC and IL-1β in the hippocampus of mice among the 3 groups( F=8.23, 8.97, 8.45, 54.42, 8.12, all P<0.05). Compared with CC group, the protein levels of P2X7 ((0.93±0.02), (0.71±0.04)), NLRP3 ((0.97±0.04), (0.62±0.09)), caspase-1 ((1.00±0.03), (0.76±0.07)), ASC ((0.96±0.02), (0.77±0.04)) and IL-1β ((0.85±0.07), (0.54±0.04)) in SD group were all higher (all P<0.05). Compared with SD group, the protein levels of P2X7 (0.74±0.05), NLRP3 (0.78±0.02), caspase-1 (0.74±0.04), ASC (0.67±0.02), IL-1β (0.53±0.07) in SD+ BBG group were all lower (all P<0.05). (4)There were statistically significant differences in the mRNA levels of IL-18, IL-1β, TNF-α, CD86 and CD206 in hippocampus among the three groups ( F=12.80, 12.28, 105.80, 7.06, 30.19, all P<0.05). The mRNA levels of IL-18, IL-1β, TNF-α, CD86 in SD group were all higher than those in CC group(all P<0.05), while the mRNA level of CD206 in SD group was lower than that in CC group( P<0.05). Compared with SD group, the mRNA levels of IL-18, IL-1β, TNF-α, CD86 were lower in SD+ BBG group (all P<0.05), while the CD206 mRNA level of SD+ BBG group was higher than that in SD group( P<0.05). Conclusion:SD intervention can lead to cognitive impairment and increased expression of P2X7 in hippocampus of mice, which may be related to the activation of P2X7/ NLRP3 inflammasome signaling pathway, promoting the polarization of microglia into pro-inflammatory type and up-regulating the expression of pro-inflammatory cytokines.Inhibition of P2X7 can improve the cognitive function of mice.

Effects of different carbon dioxide pneumoperitoneum pressures combined general anesthesia with sevoflurane-propofol on cerebral oxygenmetabolism balance and stress response in elderly patients undergoing colorectal cancer surgery / 中国医师进修杂志

Objective:To study the effects of different carbon dioxide (CO 2) pneumoperitoneum pressures combined general anesthesia with sevoflurane-propofol on cerebral oxygenmetabolism balance and stress response in elderly patients undergoing colorectal cancer surgery. Methods:A retrospective collection of 100 colon cancer cases from February 2020 to February 2021 in the Jiading Branch of Shanghai First People′s Hospital (Jiangqiao Hospital, Jiading District) and the Shanghai First People′s Hospital were divided into low pressure group and high pressure group according to different CO 2 pneumoperitoneum pressure values, each with 50 cases and 12 mmHg(1 mmHg = 0.133 kPa) and 18 mmHg CO 2 pneumoperitoneum pressure values were used to inflate, and the perioperative status, cerebral oxygen metabolism status, and stress response of the two groups were observed. Results:The take food time, first time out of bed in the low pressure group were lower than those in the high pressure group: (45.67 ± 7.34) h vs. (49.67 ± 8.16) h, (34.69 ± 8.26) h vs. (39.87 ± 7.16) h, there were statistical differences( P<0.05). The time of first anal exhaust and hospital stay in the two groups had no significant differences ( P>0.05). Repeated measures analysis of variance results showed that the levels of partial pressure of carbon dioxide in artery, oxyhemoglobin saturation, arterial blood lactate acid, benous blood lactic acid were different followed the time and treatment methods ( P<0.05). The levels of heart rate, mean arterial pressure, cortisol and thyroid stimulating hormone in the low pressure group were higher than those in the high pressure group: (73.68 ± 6.35) beats/min vs. (84.84 ± 6.86) beats/min, (81.67 ± 13.68) mmHg vs. (93.68 ± 14.37) mmHg, (100.24 ± 12.34) μg/L vs. (135.68 ± 13.69) μg/L, (3.12 ± 0.43) mU/L vs. (3.54 ± 0.34) mU/L, there were statistical differences ( P<0.05). Conclusions:Different CO 2 pneumoperitoneal pressures affect the brain oxygen metabolism of patients, and clinical attention should be paid to them.

Effects of transversus abdominis plane block on pain, rehabilitation indexes and immune function in patients undergoing laparoscopic colorectal cancer surgery / 中国医师进修杂志

Objective:To observe the effects of ultrasound guided transversus abdominis plane block (TAPB) on pain, rehabilitation indexes and immune function of postoperative in patients undergoing laparoscopic colorectal cancer surgery.Methods:A total of 100 patients undergoing laparoscopic colorectal cancer surgery admitted to Jiading Branch of Shanghai First People′s Hospital/Jiangqiao Hospital of Jiading District and Shanghai First People′s Hospital from February 2020 to February 2021 were selected as the study subjects, including 43 patients performed epidural block (control group) and 57 patients performed TAPB (observation group). The clinical indicators, vital signs parameters, pain degree, immune function in the two groups were compared.Results:The exhausting time, defecation time, getting out of bed time and hospitalization time in observation group were shorter than those in control group: (2.71 ± 0.54) d vs. (2.99 ± 0.66) d, (3.02 ± 0.49) d vs. (3.49 ± 0.56) d, (3.20 ± 0.89) d vs. (3.85 ± 1.08) d, (6.81 ± 0.98) d vs. (7.71 ± 1.08) d, there were statistical differences ( P<0.05). The diastolic blood pressure, systolic blood pressure and heart rate at pre-anesthesia, immediate incision of the skin, end of the surgery between two groups had no significant differences ( P>0.05). The scores of visual analogue scale at 4, 24, 48 and 72 h after surgery in the observation group were significantly lower than those in the control group ( P<0.05). The levels of CD 3+, CD 4+, CD 4+/CD 8+ and IgM after surgery for 3 d in the observation group were higher than those in the control group: 0.512 ± 0.054 vs. 0.487 ± 0.051, 0.280 ± 0.036 vs. 0.222 ± 0.032, 1.36 ± 0.29 vs. 1.17 ± 0.26, (152.53 ± 34.3) kU/L vs. (138.86 ± 31.18) kU/L, there were statistical differences ( P<0.05). Conclusions:TAPB can effectively reduce the degree of postoperative pain and immunosuppression after laparoscopic colorectal cancer surgery, so as to promote postoperative rehabilitation of patients.

Application of endoscopic retrograde cholangiopancreatography on diagnosis and treatment of pediatric chronic pancreatitis / 中国小儿急救医学

Objective:To investigate the value of endoscopic retrograde cholangiopancreatography(ERCP)and related techniques in the diagnosis and treatment of chronic pancreatitis in children.Methods:The clinical data of 16 children with chronic pancreatitis diagnosed in the Department of Gastroenterology at Beijing Children′s Hospital from January 2021 to January 2022, who had ERCP indications were analyzed retrospectively, including age, sex, operation time, postoperative complications and follow-up data.Results:Thirty nine ERCP operations were performed in 16 children, with the age of (7.20±2.51) years old, and the minimum weight of 13 kg.There were 7 males and 9 females.The clinical manifestations were upper abdominal pain in all cases, 3 patients with dyspnea, 1 patient with gastrointestinal bleeding, and 1 patient with diabetes.In terms of etiology, 16 cases were diagnosed by ERCP including, 7 cases with pancreatic divisum, 1 case with abnormal pancreaticobile duct confluence.Among the 16 children, 11 had gene examination with 9 gene mutations (including 7 cases SPINK1 mutation, 1 case PRSS mutation, and 1 case CFTR mutation).The operation time was 30 to 65 minutes, and the median was 43 minutes.The operation time was negative correlation with age, while there was no correlation with the anatomical structure abnormality or the gene mutation.Among the 16 children, 15 were placed with pancreatic duct stents, with a success rate of 93.8%.Three children had postoperative pancreatitis, the rest had hyperamylasemia.Postoperative complications were not related with the age, the anatomical structure abnormality or the gene mutation.All children had been followed up for more than one year.All children have not suffered from pancreatitis again, and the body mass index had increased significantly after operation than before( P<0.05).The ERCP operation was performed 2 to 4 times in children after stent replacement, and the time of stent replacement ranged from 3 months to 12 months. Conclusion:The main causes of chronic pancreatitis in children are anatomical abnormalities or gene mutations.ERCP and related techniques are minimally invasive, safe and effective in the treatment of chronic pancreatitis.

Early assessment and treatment of severe acute pancreatitis in children / 中国小儿急救医学

Due to the high mortality rate of severe acute pancreatitis in children, early and adequate evaluation of children with acute pancreatitis, early identification of risk factors leading to severe acute pancreatitis, and active intervention therapy have important impacts on the outcome of acute pancreatitis.This review summarized clinical guidelines or consensus worldwide, and elaborated the diagnosis and treatment of severe acute pancreatitis in children from the aspects of epidemiology, clinical features, early screening evaluation and treatment measures.

Etiology and prognostic factors of necrotizing enterocolitis in infants after neonatal period with hematochezia / 中国小儿急救医学

Objective:To analyze the etiology and prognostic factors of necrotizing enterocolitis(NEC) in infants after neonatal period with hematochezia.Methods:The clinical data of 62 infants older than 28 days with NEC and hematochezia diagnosed at Beijing Children′s Hospital, Capital Medical University from January 2016 to December 2021 were retrospectively analyzed, summarizing the etiology of NEC in this age group and analyze the factors affecting the prognosis of NEC.According to IgE detection results of food allergens, the infants were divided into milk protein positive group and milk protein negative group.According to the absolute value level of peripheral blood eosinophils, they were divided into increased eosinophils group(≥0.5×10 9/L) and normal eosinophils group(<0.5×10 9/L). They were divided into three groups according to co-infection: NEC group(no co-infection), NEC+ clostridium difficile associated diarrhea(CDAD) group, and NEC+ other infection group(salmonella infection or sepsis). According to different feeding methods, they were divided into normal amino acid group(osmotic pressure 310 mOsm/L), diluted amino acid group(osmotic pressure 233 mOsm/L), and deep hydrolysis group(osmotic pressure 185 mOsm/L). The relief time of clinical symptoms, the recovery time of intestinal gas accumulation, feeding time to achieve physiological requirements, and the length of hospital stay in each group were compared. Results:Among 62 cases, there were 27 males and 35 females.The median age of onset was 1.4(1.2, 2.3) months.The median birth weight was 3.2(2.9, 3.4)kg.Full-term infants accounted for 87.1%.Cesarean accounted for 62.9%.Fifty-three patients(85.5%)had allergic symptoms.Thirteen patients(21.0%)had family history of allergy.Cow milk protein allergy was diagnosed in 29 cases.Thirty-two cases(51.6%) had elevated peripheral blood eosinophils.The hospitalization time of milk protein positive group was longer than that of negative group( P=0.047). The clinical remission rate after hypoallergenic formula feeding for 1 day of increased eosinophils group was higher than that of normal eosinophil group(100.0% vs.65.0%, P=0.002). Ten patients(16.1%)were complicated with clostridium difficile infection, two patients(3.2%) with salmonella enteritis, and four patients(6.5%) with sepsis.Both the hospital stay and feeding time to achieve physiological requirements of NEC+ other infection group were longer than the other two groups( P<0.05). NEC+ CDAD group had a higher rate of repeated hospitalizations(40.0%, P=0.004). The mean recovery time of intestinal gas accumulation was(4.5±2.9)days.After(3.9±3.0)days, hypoallergenic formula feeding started.After one day of feeding, the clinical remission rate was 79.0%.The average time to achieve physiological requirements was(5.8±3.2)days.The clinical symptom relief time of diluted amino acid group was shorter( P=0.006), but there was no statistical difference in feeding time to achieve physiological requirements and hospitalization time between each group( P>0.05). Conclusion:Cow′s milk protein allergy and infection(especially CDAD)are closely related to the occurrence and development of NEC after neonatal period with hematochezia.The administration of diluted amino acid-based formulae close to the osmotic pressure of breast milk and targeted anti-infective therapy could shorten the clinical remission time of NEC and reduce the risk of repeated hospitalization.

Efficacy of ultrasound-guided sclerotherapy combined with radiofrequency ablation on the treatment of complex lymphatic malformations in children / 中华实用儿科临床杂志

Objective:To investigate the safety and efficacy of ultrasound-guided sclerotherapy combined with radiofrequency ablation on the complex lymphatic malformations (LM) in children.Methods:The clinical data of 21 children with complex LM treated with ultrasound-guided sclerotherapy combined with radiofrequency ablation in the First Affiliated Hospital of Zhengzhou University from June 2018 to October 2021 were retrospectively analyzed.Intraoperative and postoperative complications were recorded.Imaging examinations were performed at 1, 3, 6, 9, 12, 18, 24 months postoperatively to observe the recurrence, the volume of the lesions and their reduction rate were calculated, and the efficacy was analyzed. Friedman test was used to compare the lesion volume at different time points before and after surgery, and the reduction rate of lesion volume at 1 month postoperatively and other time points after surgery. Results:A total of 21 children were included in this study, among them, there were 12 males and 9 females, age range from 1 month to 5 years and 6 months, with a median age of 23 months.A total of 26 LM in 21 children were successfully treated, and no serious complications like organ damage occurred during and after surgery.One patient with abdominal LM had a postoperative infection, which was controlled by 3 weeks of catheter drainage.Four LM in 3 children recurred at 3 or 6 months after surgery, while all lesions were significantly narrowed down than those before surgery and they were cured after 1-3 sessions of continued sclerotherapy.There were significant differences in the lesion volumes before surgery and 1, 3, 6, 9, 12, 18 and 24 months postoperatively [222.26(159.57, 316.40) cm 3vs.43.06(22.74, 62.53) cm 3, 31.56(15.49, 45.94) cm 3, 25.21(9.63, 36.22) cm 3, 19.80(6.79, 28.81) cm 3, 12.80(3.93, 20.38) cm 3, 7.13(0, 11.34) cm 3, and 2.79(0, 4.93) cm 3; all P<0.05]. There were significant differences between the volume reduction rates at 1 month postoperatively and 3, 6, 9, 12, 18, and 24 months postoperatively [79.36(73.30, 87.81)% vs.85.40(81.09, 91.61)%, 88.85(84.70, 93.61)%, 91.67(87.87, 95.05)%, 94.15(94.47, 97.35)%, 97.11(95.02, 100.00)%, and 99.04(97.93, 100.00)%; all P<0.05]. Patients were followed up for 24 months, and all of them were cured. Conclusions:Ultrasound-guided sclerotherapy combined with radiofrequency ablation is a minimally invasive, safe and effective therapeutic strategy for children with complex LM.

Progress in the pathogenesis of eosinophilic gastrointestinal diseases / 国际儿科学杂志

Eosinophilic gastrointestinal diseases are a group of diseases with repeated or persistent gastrointestinal symptoms and the increase of eosinophils in gastrointestinal mucosa.Pathology shows an increase in the number of eosinophils in gastrointestinal mucosa.Fibrosis can be seen in the lamina propria of esophageal mucosa in patients with eosinophilic esophagitis.A variety of cytokines may be chemotactic to the aggregation of eosinophils, including Th2 cytokines, eotaxin, thymic stromal lymphopoietin, macrophage migration inhibitory factor, sialic acid-binding immunoglobulin-like lectin, integrin and extracellular matrix protein.The intestinal tissue injury of eosinophilic gastrointestinal diseases may be related to eosinophil degranulation and secretion of specific products, inflammatory response, oxidative damage, fibrosis, tissue remodeling and impaired barrier function.

Targeted metabolomic analysis of phenylpropanoid metabolites in Astragalus membranaceus var. mongholicus in response to Fusarium solani infection / 药学学报

Root rot severely restricts the sustainable development of Astragalus membranaceus var. mongholicus (AMM) industry. Resistance breeding is an economical and environmentally safe way to manage the disease and its key lies in the obtaining of resistance indicators. This study aimed to quickly and accurately screen the resistance-related (RR) metabolites so as to provide reference for the screening of indicators of AMM breeding for resistance. LC-MS-based targeted metabolomics and real-time quantitative PCR technology were employed, in combination with multivariate statistical analysis, in analyzing the dynamic changes of phenylpropanoid metabolites in AMM in response to root rot pathogen Fusarium solani (FS) infection and identifying the differential metabolites. The LC-MS method established showed high sensitivity; each metabolite had a good linear relationship (R2 ≥ 0.968 9) in the corresponding linear range of the respective standard curve; the recoveries and the relative standard deviations (RSDs) (n = 6) ranged from 70% to 107% and from 1.2% to 9.9%, respectively. Obvious disturbances were observed in the changes of the targeted metabolites in AMM infected by FS. These metabolites, compared with the mock-inoculated (CK) group, showed different up or down regulation with time series. Calycosin-7-O-β-D-glucoside, ononin, calycosin and formononetin were identified as differential metabolites, and they all belong to flavonoids. The first three compounds were significantly negatively correlated (r ≤ -0.97, P < 0.05) with the content of FS in the root of AMM. As potential RR metabolites, they are helpful in obtaining promising resistance indicators for AMM against FS infection.

Investigation of viral etiology with sever acute respiratory infection of hospitalized patients in Guangdong Province from 2019 to 2021 / 公共卫生与预防医学

Objective To investigate the infection status and epidemiological characteristics of viral pathogens in hospitalized patients with severe acute respiratory infection (SARI) in Guangdong Province from 2019 to 2021, so as to provide reference for clinical diagnosis and prevention. Methods The respiratory tract samples of SARI patients collected from 2019 to 2021 were detected and analyzed for respiratory syncytial virus (RSV), adenovirus (ADV), human rhinovirus/enterovirus (HRV/EV), human metapneumonic virus (HMPV) and other common respiratory viruses using Luminex respiratory multi-pathogen detection technology. Results A total of 1 948 influenza-negative cases were collected, of which 24.28 % were positive detection of virus infection. HRV/EV was the highest (10.32%), followed by RSV (4.31%). The detection rates were statistically significantly different among different age groups (χ2=176.186，P2=0.042，P>0.05). The detection peaks of RSV were mainly concentrated in summer and autumn, while HMPV was prevalent in winter, and HRV/EV and ADV had no obvious seasonality. Mixed infection was found in 39 samples, and the mixed infection rate was 2.00%. In the mixed infection cases, HPIV and HRV/EV combined infection was the most common. Conclusion HRV/EV, RSV, HMPV and ADV are predominant viral pathogens in SARI influenza-negative hospitalized cases in Guangdong Province from 2019 to 2021. It is recommended to strengthen the surveillance of SARI cases in children under 5 years old.

Evaluation of the clinical effect of acupuncture in treatment of neck pain in cervical spondylosis based on propensity score matching / 中国针灸

OBJECTIVE@#To observe the clinical effect and safety of acupuncture in treatment of neck pain due to cervical spondylosis.@*METHODS@#According to the patients' preference and acceptance for the interventions of neck pain induced by cervical spondylosis, an acupuncture group (221 cases) and a non-acupuncture group (251 cases) were divided. After the control of confounding factors with propensity score matching, 218 cases were included in either acupuncture group or non-acupuncture group. In the acupuncture group, acupuncture was applied to Dazhui (GV 14), Baihui (GV 20), ashi points, bilateral neck-Jiaji (EX-B 2), Fengchi (GB 20), Houxi (SI 3), Shenmai (BL 62), etc. The treatment was given once daily, one course of intervention was composed of 5 treatments and 3 courses were included. In the non-acupuncture group, the oral administration of imrecoxib tablets and cobalt tablets was prescribed for 2 weeks. Before and after treatment, the scores of Northwick Park questionnaire (NPQ) and the simplified McGill pain questionnaire (SF-MPQ) were observed, and the safety was assessed in patients of the two groups.@*RESULTS@#After treatment completion, the scores of NPQ and SF-MPQ were all reduced when compared with those before treatment in each group (P<0.001), and the scores of NPQ and SF-MPQ in the acupuncture group were lower than those of the non-acupuncture group (P<0.001). The incidence of adverse reactions was 6.0% (13/218) in the acupuncture group and was 10.1% (22/218) in the non-acupuncture group, without statistical significance in comparison (P>0.05).@*CONCLUSION@#Acupuncture is effective and safe in the relief of neck pain and the improvement of comprehensive quality of life in the patients with cervical spondylosis.

HBsAg non-reactive but HBV DNA reactive blood donors in Wuhu area: infection status and tracing results / 中国输血杂志

【Objective】 To detect and analyze the infection status of HBsAg non-reactive /HBV DNA reactive blood donors by individual donor-NAT (ID-NAT) and chemiluminescence technology, and to explore the feasibility and potential risks of reentry. 【Methods】 The blood screening results of blood donors in Wuhu from January 2018 to October 2021 were queried by blood station information management software. The blood donation information of all HBsAg non-reactive /HBV DNA reactive blood donors was collected and then recalled by telephone. After informed consent, samples were taken for HBV DNA nucleic acid single test, enzyme-linked immunoassay for HBsAg, chemiluminescence assay for HBV seromarkers(including HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc), and alanine aminotransferase (ALT) test. All the results were statistically analyzed. 【Results】 From January 2018 to October 2021, there were 142 051 donations, and the positive rate of sole HBV DNA was 0.06% (91/142 051), and 33 people (37 person-times) were successfully followed up. The yield rates of HBsAg, anti-HBs and anti-HBc were 6.06% (2/33), 39.39% (13/33) and 96.97% (32/33), respectively; None HBeAg was yielded. After two times of ID-NAT, 8 patients remained non-reactive to both systems, with a negative conversion rate of 24.24% (8/33). Meanwhile, 25 patients were at least once reactive to ID-NAT, and 23 of them were occult HBV infection with serologically reactivity. There were 2(6.25%) patients with HBsAg positive conversion and HBV DNA persistent reactivity, which were window period infection. One person was confirmed as false reactivity (no HBV infection) as he remained unreactive to both repeated ID-NAT and serological tests. 【Conclusion】 Chemiluminescence assay is more sensitive than ELISA in detecting HBV serum markers, which is beneficial to early detection of HBV samples in window period. The yielding rate of anti-HBc among HBsAg non-reactive/HBV DNA reactive blood donors detected by blood screening in this region is very high, and most of them are occulting infection, so the ID-NAT should be no less than 2 times in the reentry strategy.