Relationship between syncopal symptoms and head-up tilt test modes.

OBJECTIVE: Head-up tilt test (HUTT) is an important tool in the diagnosis of pediatric vasovagal syncope. This research will explore the relationship between syncopal symptoms and HUTT modes in pediatric vasovagal syncope. METHODS: A retrospective analysis was performed on the clinical data of 2513 children aged 3-18 years, who were diagnosed with vasovagal syncope, from Jan. 2001 to Dec. 2021 due to unexplained syncope or pre-syncope. The average age was 11.76 ± 2.83 years, including 1124 males and 1389 females. The patients were divided into the basic head-up tilt test (BHUT) group (596 patients) and the sublingual nitroglycerine head-up tilt test (SNHUT) group (1917 patients) according to the mode of positive HUTT at the time of confirmed pediatric vasovagal syncope. RESULTS: (1) Baseline characteristics: Age, height, weight, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and composition ratio of syncope at baseline status were higher in the BHUT group than in the SNHUT group (all P < 0.05). (2) Univariate analysis: Age, height, weight, HR, SBP, DBP, and syncope were potential risk factors for BHUT positive (all P < 0.05). (3) Multivariate analysis: syncope was an independent risk factor for BHUT positive, with a probability increase of 121% compared to pre-syncope (P<0.001). CONCLUSION: The probability of BHUT positivity was significantly higher than SNHUT in pediatric vasovagal syncope with previous syncopal episodes.

Oral rehydration salts: an effective choice for the treatment of children with vasovagal syncope.

To explore whether oral rehydration salts (ORS) is effective in the treatment of children with vasovagal syncope (VVS). One hundred and sixty-six consecutive patients with recurrent syncope and positive head-up tilt testing (HUTT) were recruited, randomly divided to conventional therapy (health education and tilt training) plus ORS (with 500 ml of water) group (Group I, 87 patients) and conventional therapy group (Group II, 79 patients). Therapeutic effect was evaluated by changes of syncopal episode and reperformed HUTT response. At the end of 6-month follow-up, syncopal episode did not reoccur in 49 (56.3 %) patients, decreased in 34 (39.1 %) patients, and had no obvious change or increased in four (4.6 %) patients in Group I, and the results were 31 (39.2 %), 37 (46.8 %), and 11 (14 %) in Group II, respectively. The difference was significant (χ (2) = 7.074, P < 0.05). When HUTT was reperformed, 57 (65.5 %) and 28 (35.4 %) patients had negative response and 30 (34.5 %) and 51 (64.6 %) patients had positive response, respectively, in Group I and Group II. The difference was also significant (χ (2) = 13.808, P < 0.01). In Group I, the two aspects had no difference between vasodepressor type and mixed type; however, syncopal episode had a significant difference between children aged ≤12 and >12 years (χ (2) = 6.371, P < 0.05); there was no difference in reperformed HUTT response. ORS with 500 ml of water is an effective therapy for VVS. It can be recommended as one of non- pharmacological treatment measures in children with VVS.

Transient aphasia: a rare complication of head-up tilt test.

Head-up tilt test (HUT) is widely used as a diagnostic tool. It reproduces vasovagal attacks in many susceptible patients. Although it is known to be safe and well tolerated, it is a procedure with potential neurologic complications. We observed that it could cause transient aphasia in some patients. To explore clinical characteristics and possible pathogenesis of aphasia induced by HUT, we reviewed the data of patients undergoing HUT in our hospital. 13 patients experienced transient aphasia in 3,488 cases. According to the hemodynamic changes, the incidence in vasodepressor, mixed, cardioinhibition and the negative response were 6.67, 5.52, 0 and 1.14 ‰ orderly, and not significantly different among the groups. It had significant difference between the positive response and the negative response and between vasodepressor and the negative response (both p < 0.05). The incidence in adults was significantly higher than that in children (<18 years) (p < 0.01), but not different between female and male. The average onset time was 11.33 ± 6.66 min (range 4-17 min) during baseline HUT or 4.90 ± 2.69 min (range 2-10 min) during sublingual nitroglycerin-provocated HUT. The duration was 3-60 min, except for one who was completely relieved of the disorder 4 h later. In conclusions, there is a risk of provoking transient aphasia during HUT. It reminds that performer should alert the possibility of transient aphasia during the test, especially when the patient is an adult and has a positive response.

[Evaluation of psychological fear in children undergoing head-up tilt test].

OBJECTIVE: To investigate the effects of different tilt angles of head-up tilt test (HUTT) and different responses to HUTT on the psychological fear in children undergoing the test. METHODS: HUTT was performed on children with unexplained syncope or pre-syncope (107 cases: 52 males and 55 females), aged 5.5-17.8 years (mean 12.0±2.8 years). All subjects were randomly assigned to undergo HUTT at an angle of 60°, 70° or 80°; the negative cases underwent sublingual nitroglycerin-provocation HUTT at the same tilt angle. The Wong-Baker Faces Pain Rating Scale was used for self-assessment of psychological fear in subjects during HUTT at the end point of the test. RESULTS: The positive rate, hemodynamic changes and distribution of response types showed no significant differences between children at tilt angles of 60°, 70° and 80° (P>0.05). The greater the tilt angle, the higher the degree of psychological fear in children undergoing the test, but there were no significant differences between them (P>0.05). The degree of psychological fear in children who showed a positive response to HUTT (n=76) was significantly higher than that in children who showed a negative response (n=31) (P<0.01). CONCLUSIONS: HUTT can cause psychological fear in children undergoing the test, and the degree of psychological fear increases in children tested at tilt angles from 60° to 80°, but the differences have no statistical significance. A positive response to HUTT can significantly increase the psychological fear in children.

Efficient Large-Area (81 cm2) Ternary Copper Halides Light-Emitting Diodes with External Quantum Efficiency Exceeding 13% via Host-Guest Strategy.

Ternary copper (Cu) halides are promising candidates for replacing toxic lead halides in the field of perovskite light-emitting diodes (LEDs) toward practical applications. However, the electroluminescent performance of Cu halide-based LEDs remains a great challenge due to the presence of serious nonradiative recombination and inefficient charge transport in Cu halide emitters. Here, the rational design of host-guest [dppb]2Cu2I2 (dppb denotes 1,2-bis[diphenylphosphino]benzene) emitters and its utility in fabricating efficient Cu halide-based green LEDs that show a high external quantum efficiency (EQE) of 13.39% are reported. The host-guest [dppb]2Cu2I2 emitters with mCP (1,3-bis(N-carbazolyl)benzene) host demonstrate a significant improvement of carrier radiative recombination efficiency, with the photoluminescence quantum yield increased by nearly ten times, which is rooted in the efficient energy transfer and type-I energy level alignment between [dppb]2Cu2I2 and mCP. Moreover, the charge-transporting mCP host can raise the carrier mobility of [dppb]2Cu2I2 films, thereby enhancing the charge transport and recombination. More importantly, this strategy enables a large-area prototype LED with a record-breaking area up to 81 cm2, along with a decent EQE of 10.02% and uniform luminance. It is believed these results represent an encouraging stepping stone to bring Cu halide-based LEDs from the laboratory toward commercial lighting and display panels.

[Clinical significance of changes in T wave and ST segment amplitudes on electrocardiogram from supine to standing position among children with unexplained chest tightness or pain in resting stage].

OBJECTIVE: To investigate the clinical significance of changes in T wave and ST segment amplitudes on electrocardiogram (ECG) from supine to standing position in children with unexplained chest tightness or pain in resting stage. METHODS: A total of 122 6-14-year-old children with a chief complaint of unexplained chest tightness or pain (resting stage) underwent head-up tilt test (HUTT). According to HUTT results, these children were divided into HUTT-positive (n=61) and HUTT-negative groups (n=61). They underwent 12-lead ECG in the supine and standing positions, and heart rate and T wave and ST segment amplitudes in II, III, aVF and V5 leads were measured. RESULTS: In the HUTT-negative group, heart rates were significantly higher in the standing position than in the supine position (P<0.05), T wave amplitudes in II, III, aVF, and V5 leads were significantly lower in the standing position than in the supine position (P<0.05), and ST segment amplitudes in II, aVF and V5 leads were significantly higher in the standing position than in the supine position (P<0.05). In the HUTT-positive group, heart rates were significantly higher in the standing position than in the supine position (P<0.05), T wave amplitudes in II, III, aVF and V5 leads were significantly lower in the standing position than in the supine position (P<0.05), and ST segment amplitude in V5 lead was significantly higher in the standing position than in the supine position (P<0.05). There were no significant differences between the two groups with respect to ST segment amplitude and T wave amplitude in II, III and aVF leads of the supine or standing position (P>0.05). Compared with the HUTT-negative group, the HUTT-positive group had significantly greater T wave amplitude differences in II, III, aVF and V5 leads, and heart rate difference from supine to standing position (P<0.05). CONCLUSIONS: Among the children with unexplained chest tightness or pain in resting stage, T wave amplitude differences in II, III, aVF and V5 leads and heart rate difference from supine to standing position are greater in the HUTT-positive group than in the HUTT-negative group. This suggests that the changes in T wave amplitude on ECG from supine to standing position can indicate autonomic nervous system dysfunction.

[Investigation of 24-hour blood pressure monitoring for evaluating treatment outcome of nerve-mediated syncope in children].

OBJECTIVE: To investigate the clinical significance of 24-hour blood pressure monitoring (ABPM) for evaluating the treatment outcome of nerve-mediated syncope (NMS) in children. METHODS: Twenty-eight children with NMS confirmed by a head-up tilt table test (HUTT) (12 males and 16 females, aged 6-13 years) and with a chief complaint of unexplained syncope or pre-syncope between February 2010 and August 2012, were included in the study. These children received health education combined with therapy using oral rehydration salts solution and were then reexamined for clinical symptoms as well as HUTT and ABPM results. RESULTS: Of 28 NMS cases, 22 were vasodepressive type, 5 were mixed type, and 1 was cardioinhibitory type. The follow-up showed that 27 (96%) of all cases had improved clinical symptoms, and 18 (64%) had improved HUTT results. The ABPM follow-up revealed no significant changes in 24-hour mean systolic pressure, 24-hour mean diastolic pressure, daytime mean systolic pressure, daytime mean diastolic pressure, nighttime mean systolic pressure, nighttime mean diastolic pressure, day-night difference of systolic pressure, and day-night difference of diastolic pressure after treatment (P>0.05). The percentage of children with a dipper blood pressure pattern increased from 29% (8/28) before treatment to 50% (14/28) after treatment; the percentage of children with a non-dipper blood pressure pattern decreased from 71% (20/28) before treatment to 50% (14/28) after treatment. CONCLUSIONS: As an effective, objective and non-invasive monitoring means, ABPM is of some clinical significance for evaluating the treatment outcome of NMS in children.

Berberine Induces Autophagic Cell Death in Acute Lymphoblastic Leukemia by Inactivating AKT/mTORC1 Signaling.

INTRODUCTION: Berberine has been reported to inhibit cancer cell growth by apoptosis induction and exhibits a protective role against cancer progression. The current study aims to investigate the effects of berberine on acute lymphoblastic leukemia (ALL) and the mechanism beyond apoptosis. METHODS: Cell viability was determined in ALL cell lines EU-6 and SKW-3 using trypan blue staining. Cell autophagy was determined by immunofluorescence and Western blot. ALL xenograft mice were established to investigate the anti-tumor effects of BBR. The molecular mechanism was explored in ALL cell lines using siRNA and signaling inhibitors. RESULTS: Herein, we show that berberine treatment significantly inhibits ALL cell viability and promotes cell death by inducing autophagy in a dose-dependent manner. Moreover, berberine significantly alleviates the aggressive pathological condition in ALL xenograft mice. Mechanistic studies exhibit that berberine induces autophagic death in ALL cells by inactivating AKT/mTORC1 signaling. Chemically targeting AKT/mTORC1 signaling controls berberine-induced cell autophagy in vitro, and blockade of autophagic process blunts berberine-alleviated pathological condition in vivo. DISCUSSION: In conclusion, our study reveals that berberine could induce ALL cell autophagic death by inactivating AKT/mTORC1 signaling that could be used to develop small molecule drug for ALL treatment.