Acceleration index predicts efficacy of orthostatic training on postural orthostatic tachycardia syndrome in children.

The objective of this study was to examine the utility of the acceleration index observed in an electrocardiogram (ECG) for the prediction of the effectiveness of orthostatic training in pediatric patients diagnosed with postural orthostatic tachycardia syndrome (POTS). This investigation focused on children diagnosed with POTS and undergoing orthostatic training at the Department of Pediatrics of Peking University First Hospital from January 2012 to October 2022. Specifically, patients hospitalized from January 2012 to December 2019 were included in the training set (54 cases), while those hospitalized from January 2020 to October 2022 were included in the external validation set (37 cases). All children received a 3-month orthostatic training, and the baseline symptom score (SS) was calculated in agreement with the pretreatment orthostatic intolerance symptom frequency. Additionally, we determined post-treatment SS during follow-up via telephone after the 3-month treatment. Children with a decrease in post-treatment SS by ≥ 50% of the baseline were considered as responders; otherwise, they were considered as non-responders. Demographic data (age, sex, and body mass index), hemodynamic parameters (supine blood pressure, time to achieve a positive standing test, maximum increase in heart rate during the standing test, maximal heart rate reached during the standing test, and blood pressure at the point of maximal heart rate during the standing test), and electrocardiographic parameters (RR interval in the supine position, shortest RR interval in the upright position, and acceleration index) were collected from all the children prior to treatment. Univariate and multivariate regression analysis were conducted to investigate factors associated with the efficacy of orthostatic training. The predictive value of these indicators for the therapeutic effectiveness of orthostatic training in children with POTS was evaluated using receiver operating characteristic (ROC) analysis, and the indicators were validated using the validation set. Among the 54 children in the training set, 28 responded to orthostatic training, and 26 were nonresponsive. Compared with the non-responders, the responders demonstrated a significant reduction in acceleration index (P < 0.01). The ROC curve for the predictive value of the acceleration index exhibited an area under the curve = 0.81 (95% confidence interval: 0.685-0.926). With the acceleration index threshold < 27.93%, the sensitivity and specificity in the prediction of orthostatic training efficacy among children with POTS were 85.7% and 69.2%, respectively. The external validation results demonstrated that using acceleration index < 27.93% as the threshold, the sensitivity, specificity, and accuracy of predicting orthostatic training efficacy among children with POTS were 89.5%, 77.8%, and 83.8%, respectively. CONCLUSIONS: Electrocardiographic acceleration index can be used to predict the effectiveness of orthostatic training in treating children with POTS. WHAT IS KNOWN: • Postural orthostatic tachycardia syndrome (POTS) is a chronic orthostatic intolerance involving multiple mechanisms. Autonomic dysfunction is one of the main mechanisms of POTS in children and could be treated with orthostatic training. • In order to improve the efficacy of orthostatic training in children with POTS, it is particularly important to identify the patients with autonomic dysfunction as the main mechanism before the treatment. WHAT IS NEW: • We found acceleration index of the electrocardiogram (ECG) can be used as a satisfactory index to predict the efficacy of orthostatic training in the treatment of POTS in children. • Using the acceleration index to predict the efficacy of orthostatic training on POTS in children is easy to be popularized in hospitals at all levels because it is non-invasive, convenient, and not expensive.

Serum uric acid predicts therapeutic response to midodrine hydrochloride in children with vasovagal syncope: a pilot study.

Serum uric acid (UA) level has been proven to be related to several cardiovascular and metabolic diseases. In the present study, we examined if baseline serum UA level could predict the therapeutic efficacy of midodrine hydrochloride on vasovagal syncope (VVS) in children. The pediatric VVS patients who received midodrine hydrochloride from November 2008 to October 2022 were enrolled. After a median treatment duration of 3 months, the therapeutic effect was evaluated. According to the patients' responses to midodrine hydrochloride, which was determined by the recurrence of syncope, they were divided into effective and ineffective groups. The baseline variables were explored using univariable and multivariate logistic analysis. The predictive efficacy was assessed by receiver operating characteristic curve (ROC), precision-recall curve (PR), Hosmer-Lemeshow test, calibration curve, and decision curve analysis (DCA). Totally, 53 participants were included in the study. Among the 51 patients who were successfully followed up, 29 (56.9%) responded to midodrine hydrochloride (effective group), and the other 22 (43.1%) failed to respond to midodrine hydrochloride (ineffective group). The participants in effective group had lower baseline serum UA level than those in ineffective group (276.5 ± 73 µmol/L vs. 332.7 ± 56 µmol/L, p = 0.004). Multivariable logistic analysis showed that serum UA was associated with the therapeutic response (odds ratio (OR): 0.985, 95% confidence interval (CI): 0.974-0.997, p = 0.01). ROC analysis indicated that using baseline serum UA < 299 µmol/L as a threshold value yielded a sensitivity of 77.3% and a specificity of 79.3% in predicting the treatment response to midodrine hydrochloride. The area under the PR curve was 0.833. Hosmer-Lemeshow test yielded a p value of 0.58, and calibration plot indicated that the model was well-fitted. DCA demonstrated that treatment decision depending on the baseline serum UA level resulted in a favorable net benefit.   Conclusion: This pilot study suggested that the baseline serum UA level could be taken as a predictor of therapeutic effect of midodrine hydrochloride on VVS in children. What is Known: • Empirical and unselected use of midodrine hydrochloride has an unfavorable therapeutic effect on VVS in children. Serum uric acid (UA) is closely linked to cardiovascular events. What is New: • A low baseline serum UA level successfully predicts the therapeutic effectiveness of midodrine hydrochloride on VVS in children.

Machine Learning Classification of One-Chiral-Center Organic Molecules According to Optical Rotation.

In this study, machine learning algorithms were investigated for the classification of organic molecules with one carbon chiral center according to the sign of optical rotation. Diverse heterogeneous data sets comprising up to 13,080 compounds and their corresponding optical rotation were retrieved from Reaxys and processed independently for three solvents: dichloromethane, chloroform, and methanol. The molecular structures were represented by chiral descriptors based on the physicochemical and topological properties of ligands attached to the chiral center. The sign of optical rotation was predicted by random forests (RF) and artificial neural networks for independent test sets with an accuracy of up to 75% for dichloromethane, 82% for chloroform, and 82% for methanol. RF probabilities and the availability of structures in the training set with the same spheres of atom types around the chiral center defined applicability domains in which the accuracy is higher.

Safety and effect of sildenafil on treating paediatric pulmonary arterial hypertension: a meta-analysis on the randomised controlled trials.

BACKGROUND: Efficacy of sildenafil in treating paediatric pulmonary arterial hypertension is controversial. This systematic review aimed to explore the safety and effect of sildenafil on treating paediatric pulmonary arterial hypertension (PAH) through meta-analysis. METHODS AND RESULTS: In this study, the electronic databases, including the Cochran Library database, EMBASE, and MEDLINE were systemically retrieved to identify the related randomised controlled trials (RCTs). Two reviewers had independently completed study selection, data collection, and assessment of the bias risk. Amongst 938 articles researched according to our retrieval strategy, 15 papers that involved 673 cases had been screened. Relative to control group, the sildenafil group had markedly reduced mortality (RR = 0.25, 95% CI: 0.12-0.51; p < 0.0001), but difference within the mortality was not statistically significant between high- and low-dose sildenafil groups (p = 0.152). Nonetheless, difference of the mean pulmonary arterial pressure between sildenafil as well as control group was of no statistical significance. Differences in the length of hospital stay and the incidences of pulmonary hypertensive crisis between children with PAH and controls were of no statistical significance. However, the summary estimate favoured that sildenafil reduced the duration of mechanical ventilation time, as well as the length of ICU stay and inotropic support. CONCLUSIONS: Sildenafil therapy reduces the mortality of PAH patients, but its effects on the haemodynamic outcomes and other clinical outcomes are still unclear.

A highly sensitive electrochemical aptasensor for detection of microcystin-LR based on a dual signal amplification strategy.

In this work, a sensitive and selective electrochemical aptasensor for determination of microcystin-LR (MC-LR) was developed based on a dual signal amplification system consisting of a novel ternary composite and horseradish peroxidase (HRP). The ternary composite was prepared by depositing gold nanoparticles (AuNPs) on molybdenum disulfide (MoS2) covered TiO2 nanobeads (TiONBs). MoS2 nanosheet modified TiONBs provided a large surface area for immobilization of AuNPs and biomolecules. The ternary composite also possesses an improved electron transfer and catalytic capability. To construct the aptasensor, thiolated MC-LR aptamers were immobilized on the AuNP@MoS2-TiONB modified electrode through a gold-sulfur bond. Then, biotin-cDNA with a sequence complementary to the MC-LR aptamer competed with MC-LR for binding to the immobilized aptamer. The current signal catalyzed by avidin-HRP decreased with the increase of MC-LR, based on which a linear range of 0.005-30 nM and a detection limit of 0.002 nM were obtained.

Machine Learning Methods to Predict Density Functional Theory B3LYP Energies of HOMO and LUMO Orbitals.

Machine learning algorithms were explored for the fast estimation of HOMO and LUMO orbital energies calculated by DFT B3LYP, on the basis of molecular descriptors exclusively based on connectivity. The whole project involved the retrieval and generation of molecular structures, quantum chemical calculations for a database with >111 000 structures, development of new molecular descriptors, and training/validation of machine learning models. Several machine learning algorithms were screened, and an applicability domain was defined based on Euclidean distances to the training set. Random forest models predicted an external test set of 9989 compounds achieving mean absolute error (MAE) up to 0.15 and 0.16 eV for the HOMO and LUMO orbitals, respectively. The impact of the quantum chemical calculation protocol was assessed with a subset of compounds. Inclusion of the orbital energy calculated by PM7 as an additional descriptor significantly improved the quality of estimations (reducing the MAE in >30%).

Significance of red cell distribution width in the differential diagnosis between neurally mediated syncope and arrhythmic syncope in children.

OBJECTIVES: The aim of the present study was to explore the predictive value of red cell distribution width as a means to differentiate between neurally mediated syncope and arrhythmic syncope in children. METHOD: Patients were divided into a neurally mediated syncope group (n=72) and an arrhythmic syncope group (n=21) on the basis of clinical history, results of the head-up tilt test, electrocardiography, and 24-hour ambulatory electrocardiography. As controls, we recruited 55 healthy children. Red cell distribution width was determined for children in all groups. A receiver operating characteristic curve was drawn to study the predictive effect of red cell distribution width to differentiate between neurally mediated syncope and arrhythmic syncope. RESULTS: Red cell distribution width was significantly higher in children with neurally mediated syncope than in children with arrhythmic syncope and the control group. A receiver operating characteristic curve on the predictive value of red cell distribution width in differentiating neurally mediated syncope from arrhythmic syncope showed that the area under the curve was 0.841 (95% confidence interval: 0.737-0.945, p<0.05). A red cell distribution width value of 12.8% as the cut-off value yielded a sensitivity of 80.6% and a specificity of 76.2% in discriminating between patients with neurally mediated syncope and arrhythmic syncope. CONCLUSION: Red cell distribution width value of ⩾12.8% might be a useful adjunct for primary-care physicians to differentiate neurally mediated syncope from arrhythmic syncope in children.

The vasodilatory effect of sulfur dioxide via SGC/cGMP/PKG pathway in association with sulfhydryl-dependent dimerization.

The present study was designed to explore the role of soluble guanylate cyclase (sGC)/cyclic guanosine monophosphate (cGMP)/PKG pathway in sulfur dioxide (SO2)-induced vasodilation. We showed that SO2 induced a concentration-dependent relaxation of phenylephrine (PE)-precontracted rat aortic rings in association with an increase in cGMP concentration, whereas l-aspartic acid ß-hydroxamate (HDX), an inhibitor of SO2 synthase, contracted rings in a dose-dependent manner. Pretreatment of aortic rings with the sGC inhibitor ODQ (30 µM) attenuated the vasodilatory effects of SO2, suggesting the involvement of cGMP pathway in SO2-induced vasodilation. Mechanistically, SO2 upregulated the protein levels of sGC and PKG dimers, while HDX inhibited it, indicating SO2 could promote cGMP synthesis through sGC activation. Furthermore, the dimerization of sGC and PKG and vasodilation induced by SO2 in precontracted rings were significantly prevented by thiol reductants dithiothreitol (DTT). In addition, SO2 reduced the activity of phosphodiesterase type 5 (PDE5), a cGMP-specific hydrolytic enzyme, implying that SO2 elevated cGMP concentration by inhibiting its hydrolysis. Hence, SO2 exerted its vasodilatory effects at least partly by promoting disulfide-dependent dimerization of sGC and PKG, resulting in an activated sGC/cGMP/PKG pathway in blood vessels. These findings revealed a new mode of action and mechanisms by which SO2 regulated the vascular tone.

Erythrocytic hydrogen sulfide production is increased in children with vasovagal syncope.

OBJECTIVES: To explore the differences in erythrocyte hydrogen sulfide (H2S) production in children with vasovagal syncope (VVS). STUDY DESIGN: A total of 54 children including 27 with VVS, aged 6-16 years (mean age 11.3 ± 3.3 years), and 27 healthy children, aged 3-17 years (mean age 10.4 ± 1.8 years) were included in the study. Children with VVS had symptoms of dizziness, pallor, blurred vision, nausea, and some had syncope. Erythrocyte H2S production was measured by a sulphur-sensitive electrode. Flow-mediated dilation (FMD) of brachial artery was measured for each patient by vascular ultrasound. RESULTS: H2S production from erythrocytes was significantly increased in the children with VVS compared with controls (P < .01). The erythrocytic H2S production in the VVS-vasoinhibitory subgroup was obviously higher than that in VVS-cardioinhibitory (P < .05) and VVS-mixed inhibitory subgroups (P < .05). FMD in the VVS-vasoinhibitory subgroup was greater than that in the VVS-cardioinhibitory (P < .05) and the VVS-mixed subgroups (P < .05). The erythrocytic H2S production had a positive linear correlation with FMD in children with VVS (P < .05). CONCLUSIONS: Increased erythrocyte H2S production may be involved in the pathogenesis of VVS in children.

Extension of a Highly Discriminating Topological Index.

A highly discriminating topological index, EAID, is generated in our laboratory. A systematic search for degeneracy was performed on a total of over 14 million structures, and no duplicate occurred. These structures are as follows: over 3.8 million alkane trees with 1-22 carbon atoms; over 0.38 million structures containing heteroatoms; over 4 million benzenoids with 1-13 benzene rings; and over 5.9 million compounds from three reality databases. However, in a search of over 20 million alkane trees with 23 and 24 carbon atoms, five and 13 duplicates occurred, respectively, and for over 20 million compounds from the ZINC database, 10 duplicates occurred. To increase the discriminating power of the index, EAID has been extended, and the resulting index is termed 2-EAID. All of the over 55 million structures mentioned above were uniquely identified by 2-EAID except for two duplicates that occurred for the ZINC database. EAID and 2-EAID are the most highly discriminating indices examined to date. Thus, the two indices possess not only theoretical significance but also potential applications. For example, they could possibly be used as a supplementary reference for CAS Registry Numbers for structure documentation.

The value of acetylcholine receptor antibody in children with postural tachycardia syndrome.

Postural tachycardia syndrome (POTS) is characterized by symptoms of orthostatic intolerance. Antibodies of acetylcholine receptor (AChR-ab) affect acetylcholine transmission between the ganglia and result in imbalance of the autonomic nervous system in POTS. This study was designed to analyze the clinical characteristics of POTS patients with AChR-ab positive and explore the value of AChR-ab in children with POTS. In 82 children with POTS, twenty patients (24.39%) were found as AChR-ab positive. Their clinical characteristics and hemodynamic responses to orthostatic changes were compared with the remaining 60 patients with negative AChR-ab. Symptoms of POTS children with AChR-ab positive were significantly severe than those of AChR-ab negative patients (p = 0.001). Preceding infection was predominant in patients with AChR-ab positive compared with that of patients with AChR-ab negative (p < 0.001). Syncope and fatigue were more common in the AChR-ab positive patients (p < 0.05). The change of upright heart rate was increased significantly in AChR-ab positive patients compared with AChR-ab negative cases (p = 0.013). Multiple logistic regression analysis revealed that preceding infection (OR 22.356, 95% CI 2.151-34.920), syncope (OR 11.570, 95% CI 2.098-63.810), and fatigue (OR 11.145, 95% CI 1.658-74.911) were independent risk factors for POTS with AChR-ab positive. In conclusion, POTS with positive AChR-ab was a heterogeneous disorder. Preceding infection, syncope and fatigue were their main clinical characteristics.

[Relationship between 24-hour urinary sodium and renin-angiotensin-aldosterone system in children with postural tachycardia syndrome].

OBJECTIVE: To analyze the relationship between 24 hours urinary sodium and renin-angiotensin-aldosterone system (RAAS) in children with postural tachycardia syndrome (POTS) and to explore low blood volume related pathogenesis of POTS. METHODS: A total of 39 POTS children who were at the clinic or admitted to the Department of Pediatrics, Peking University First Hospital from June 2012 to February 2013 and 21 healthy children (control group) were enrolled, level of RAAS in plasma, 24-hour urinary sodium and plasma sodium were detected, respectively. Baseline data, levels of RAAS and hemodynamic parameters were compared between POTS and control group, as well as groups with different 24-hour urinary sodium levels of POTS. RESULTS: The angiotensin II levels of POTS children were significantly higher than that of control group ((105 ± 50) vs (84 ± 28) ng/L, P = 0.041), while no statistical significance was found in plasma renin and aldosterone (P > 0.05). Pearson correlation analysis showed that 24-hour urinary sodium and angiotensin II in children with POTS was negatively correlated (r = -0.536, P < 0.001). Angiotensin II, symptom score, upright heart rate and changes of heart rate were significantly higher in urinary sodium < 124 mmol/24 h group than that in urinary sodium ≥ 124 mmol/24 h group (P < 0.05). CONCLUSION: The regulating function disorder of RAAS may involve in the pathogenesis of POTS and cause sustained low blood volume in patients with POTS.

Orthostatic plasma norepinephrine level as a predictor for therapeutic response to metoprolol in children with postural tachycardia syndrome.

BACKGROUND: Postural tachycardia syndrome (POTS) is a heterogeneous disorder that creates challenges for treatment. Beta-blocker was one of the most commonly used drugs, but it is inconsistently effective. The purpose of this study is to explore whether orthostatic plasma norepinephrine level could be an indicator of therapeutic effectiveness of metoprolol for POTS in children. METHODS: Twenty-seven children with POTS were enrolled in our study. They received metoprolol treatment, and their orthostatic plasma norepinephrine levels were measured by high-performance liquid chromatography method. Three months after rmetoprolol treatment, 25 patients were followed up. A receiver-operating characteristic (ROC) curve was used to explore the predictive value of orthostatic plasma norepinephrine level. RESULTS: The symptom severity and increment of heat rate from supine position to upright of patients positively correlated with their orthostatic plasma norepinephrine level (r=0.599, P<0.001; r=0.633, P<0.001, respectively). Orthostatic plasma norepinephrine level in responders to metoprolol was significantly higher than that of nonresponders (P=0.028). A ROC curve on the predictive value of orthostatic plasma norepinephrine level showed that the area under the curve was 0.785. Using a cutoff value for orthostatic plasma norepinephrine level of 3.59 pg/ml yielded both sensitivity (76.9%) and specificity (91.7%) in predicting the efficacy of metoprolol therapy for POTS. CONCLUSION: Orthostatic plasma norepinephrine level of>3.59 pg/ml was an indicator of the effectiveness of metoprolol therapy for POTS in children and adolescents.

Clinical features of hyperadrenergic postural tachycardia syndrome in children.

BACKGROUND: Hyperadrenergic postural tachycardia syndrome (POTS) is the main phenotype of POTS. The aim of this study was to present our single-center experience of hyperadrenergic POTS in children and adolescents. METHODS: Thirty-seven patients who met the diagnostic criteria for POTS were enrolled in our study. Their orthostatic serum norepinephrine levels were determined by high-performance liquid chromatography. In a retrospective analysis, based on clinical and serum norepinephrine criteria, we analyzed the clinical features of POTS cases between the POTS-alone group and the hyperadrenergic POTS group. RESULTS: Nineteen patients (51.35%) met the diagnostic criteria for hyperadrenergic POTS and 18 patients were assigned to the POTS-alone group. Compared with the POTS-alone patients, dizziness, headache and tremulousness were more frequent in patients with hyperadrenergic POTS (P < 0.05). During the tilt table test, children with hyperadrenergic POTS had a greater increment of systolic blood pressure and heart rate than POTS-alone patients. CONCLUSION: Patients with hyperadrenergic POTS should be identified and differentiated from those with neuropathic POTS. Hyperadrenergic POTS in children and adolescents should be considered when POTS patients suffer from frequent dizziness, headache, and tremulousness. In head-up tilt testing, children and adolescents with hemodynamic characteristics of hyperadrenergic POTS had greater increments of systolic blood pressure and heart rate.

Orthostatic hypertension in children and adolescents with postural tachycardia syndrome.

OBJECTIVE: We described a heterogenous group of children disabled by postural tachycardia syndrome (POTS) and evident orthostatic hypertension (OHT). METHODS: Twenty patients met the diagnostic criteria for POTS + OHT. Their clinical characteristics were compared with those in 76 patients with POTS alone and 20 healthy age-matched controls. Multivariate logistic regression analysis was used to identify independent risk factors for POTS + OHT. RESULTS: Supine systolic blood pressure (SBP) was lower in the POTS + OHT group than in the POTS group (p < 0.05). Compared with the POTS group, the POTS + OHT group showed markedly increased upright SBP, upright heart rate (HR) and HR changes (p < 0.05). Headache was more common in the POTS + OHT group than in the POTS group (p < 0.05). Logistic regression analysis revealed that low supine SBP and headache were independent risk factors for OHT in POTS patients. CONCLUSIONS: Headache and low supine SBP were the main clinical characteristics of a novel syndrome of POTS associated with OHT.

Comprehensive Evaluation of the Nutritional Properties of Different Germplasms of Polygonatum cyrtonema Hua.

Polygonatum cyrtonema Hua, an edible resource and medical material, is mainly consumed as a food in China. However, few published studies have comprehensively assessed its nutritional components. In this study, the proximate, carbohydrate, and dietary fiber contents as well as the mineral, vitamin, and amino acid compositions of five sources of P. cyrtomena grown in Yuhang district, Hangzhou city, Zhejiang province, were investigated. The nutritional profile of the five germplasms was investigated using analytical chemistry methods. All germplasms had a low starch content and contained greater amounts of carbohydrates (23.25-34.29%), protein (2.96-5.40%), Ca (195.08-282.08 mg/100 g), Fe (29.68-59.37 mg/100 g), and vitamin C (60.49-149.86 mg/100 g) in comparison to ginger, yam, and potatoes. The polysaccharide content ranged from 16.92% to 28.48%, representing the main source of carbohydrates. Fructose, a desirable sweetener, was the most abundant monosaccharide, representing 1.06% to 4.88% of the content. P. cyrtonema was found to be high in dietary fiber, with pectin and resistant starch being the major soluble components and hemicellulose being the dominant insoluble dietary fiber. A correlation analysis (CA) revealed significant correlations for the carbohydrate components and dietary fiber fractions with other nutrients. A principal component analysis (PCA) identified significant differences between the nutritional characteristics of the five germplasms, with Huanggang having the highest comprehensive quality scores. Moreover, ten nutrient components were selected as potential indicators that could be used to further evaluate the nutritional quality of P. cyrtomena. Our results demonstrate the rich nutrient composition and characteristics of P. cyrtonema and provide a valuable reference for the future development and utilization of Polygonatum.

Establishment and validation of a multivariate predictive model for the efficacy of oral rehydration salts in children with postural tachycardia syndrome.

BACKGROUND: The therapeutic effectiveness of the empirical and unselected use of oral rehydration salts (ORS) on postural tachycardia syndrome (POTS) is not satisfactory in children. Therefore, looking for suitable predictors of the therapeutic effects of ORS before treatment is extremely necessary to implement individualised treatment for paediatric patients with POTS. METHODS: A retrospective case-control analysis of 130 patients (aged 5-18 years) who suffered from POTS with a 3-month treatment of ORS was conducted. A nomogram model was developed in the training set (n = 87) to predict the therapeutic response to ORS. Univariate analysis and logistic regression were applied to select the most useful predictors. ROC curves were applied to evaluate the discriminative performance of the nomogram model. The nomogram was then evaluated by calibration curves and the Hosmer-Lemeshow (H-L) test. The results were further validated using 1000 bootstrap resamples. External validation was performed in an independent validation set (n = 43). FINDINGS: Among the ten variables with significant differences between the responders and non-responders in univariate analysis, five variables were found to be independently associated factors for ORS therapeutic efficacy among POTS children in the further logistic regression, including mean corpuscular haemoglobin concentration (MCHC), mean corpuscular volume (MCV), mean arterial pressure (MAP) at the first minute of the upright position, urine specific gravity (SG), and P-wave voltage peaking ratio (PWP). The nomogram model was established in the training set (AUC 0.926 [95% CI: 0.865-0.988], yielding a sensitivity of 87.8% and a specificity of 86.8%). The calibration curves showed good agreement between the prediction of the nomogram and actual observation in both the training and validation sets. The nomogram also effectively predicted the external validation set (sensitivity 82.1%, specificity 73.3%, and accuracy 79.1%). INTERPRETATION: We established a feasible and high-precision nomogram model to predict the efficacy of ORS, which would help implement individualised treatment for children with POTS. FUNDING: This study was supported by National High-Level Hospital Clinical Research Funding (Multi-centre Clinical Research Project of Peking University First Hospital) (2022CR59).

The accumulation of active ingredients of Polygonatum cyrtonema Hua is associated with soil characteristics and bacterial community.

Introduction: With the increasing demand for health products derived from Polygonati rhizoma (PR), people begin to artificially plant Polygonatum cyrtonema Hua (P. cyrtonema) in the middle and lower reaches of the Yangtze River. To promote P. cyrtonema cultivation and increase farmers' income, efforts are needed to understand the ways to obtain high-quality PR under artificial cultivation conditions. Methods: Rhizomes of artificial planting P. cyrtonema and rhizosphere soils were collected across five regions in Zhejiang Province, China. Subsequently, the contents of the main active ingredients of P. cyrtonema and soil properties were analyzed, and both rhizosphere and endophytic bacteria of P. cyrtonema were detected by 16S rDNA sequencing. The relationship between the active ingredients and soil properties, and the dominant bacteria were investigated by correlation analysis. Results: The content of active ingredients of P. cyrtonema from the five regions varied significantly, especially polysaccharides and saponins. High-throughput sequencing demonstrated that Proteobacteria was the dominant bacterial phylum in all samples, and Burkholderia-Caballeronia-Paraburkholderia was the main endophytic bacterial genus in rhizome. In addition, the bacterial diversity and richness of rhizosphere soil samples were higher than those of rhizome samples. Soil physicochemical properties and enzyme activities were significantly different across regions, leading to notable variations in the community structures of rhizosphere and endophytic bacteria. Redundancy analysis (RDA) displayed that pH and urease (UE) were the major factors altering shifting rhizosphere bacteria community structure. Moreover, the composition and diversity of rhizome endophytic bacteria were principally affected by both soil physicochemical properties and soil enzyme activities. Soil properties and bacteria from rhizosphere soil and rhizome had a considerable impact on certain active ingredients in P. cyrtonema under artificial cultivation conditions after Pearson correlation analysis. Polysaccharides were significantly correlated with nutrient-rich soil and endophytic bacteria, such as Burkholderia-Caballeronia-Paraburkholderia, Pseudomonas, Ralstonia, and Bacillus. However, flavonoids were associated with nutrient-poor soil. Saponins were positively correlated with OM and available phosphorous (AP) and were significantly negatively affected by rhizosphere bacterial communities. Conclusion: The study demonstrated that bacterial microorganisms were involved in the accumulation of active ingredients of P. cyrtonema together with soil physicochemical properties and enzyme activities, which provided a theoretical basis for the scientific and effective artificial cultivation of high-quality P. cyrtonema.

Development and uniqueness test of highly selective atomic topological indices based on the number of attached hydrogen atoms.

On the basis of the atomic graph-theoretical index - aEAID (atomic Extended Adjacency matrix IDentification) and molecular adjacent topological index - ATID (Adjacent Topological IDentification) suggested by one of the authors (Zhang Q), a highly selective atomic topological index - aATID (atomic Adjacent Topological IDentification) index was suggested to identify the equivalent atoms in this study. The aATID index of an atom was derived from the number of the attached hydrogen atoms of the atom but omitting bond types. In this case, the suggested index can be used to identify equivalent atoms in chemistry but perhaps not equivalent in the molecular graph. To test the uniqueness of aATID indices, the virtual atomic data sets were derived from alkanes containing 15-20 carbon atoms and the isomers of Octogen, as well as a real data set was derived from the NCI database. Only four pairs of atoms from alkanes containing 20 carbons can't be discriminated by aATID, that is, four pairs of degenerates were found for this data set. To solve this problem, the aATID index was modified by introducing distance factors between atoms, and the 2-aATID index was suggested. Its uniqueness was examined by 5,939,902 atoms derived from alkanes containing 20 carbons and further 16,166,984 atoms from alkanes of 21 carbons, and no degenerates were found. In addition, another large real data set of 16,650,688 atoms derived from the PubChem database was also used to test the uniqueness of both aATID and 2-aATID. As a result, each atom was successfully discriminated by any of the two indices. Finally, the suggested aATID index was applied to the identification of duplicate atoms as data pretreatment for QSPR (Quantitative Structure-Property Relationships) studies.

Gold nanoparticle encapsulated-tubular TIO2 nanocluster as a scaffold for development of thiolated enzyme biosensors.

In this work, a highly sensitive and stable sensing scaffold consisting of gold nanoparticle-encapsulated TiO2 nanotubes, the hydrophilic ionic liquid, 1-decyl-3-methylimidazolium bromide, and Nafion was developed for the fabrication of electrochemical enzyme biosensors. A significant aspect of our work is the application of 12-phosphotungstic acid as both a highly localized photoactive reducing agent to deposit well-dispersed gold nanoparticles on TiO2 nanotubes and an electron mediator to accelerate the electron transfer between an enzyme and the electrode. After characterizing the nanocomposite component of the scaffold by Fourier transform infrared spectroscopy, X-ray diffraction and transmission electron microscopy, thiolated horseradish peroxidase (as a model enzyme) was immobilized on the scaffold and the biosensor was applied to the detection of H2O2. The direct electron transfer between the enzyme and the electrode was promoted by the excellent biocompatibility and conductivity of the scaffold. In addition, a thiolated enzyme has significantly improved the stability and direct electron transfer of horseradish peroxidase on the biosensor, which could be ascribed to the strong affinity between the sulfhydryl group on the enzyme and gold nanoparticles on the biosensor surface. Cyclic voltammetry, chronoamperometry, and square wave voltammetry were used to study the electrochemistry and analytical performance of the biosensor. A dynamic range from 65 to 1600 µM, a limit of detection of 5 µM, and a sensitivity of (18.1 ± 0.43) × 10(-3) µA µM(-1) H2O2 were obtained. The sensing scaffold based on the nanocomposite was demonstrated to be effective and promising in developing enzyme biosensors.