[Prone positioning ventilation therapy in acute respiratory distress syndrome: knowns and unknowns in clinical efficacy].

Prone positioning ventilation (PPV) is considered one of the essential therapeutic approaches in the management of acute respiratory distress syndrome (ARDS). Several randomized controlled clinical trials have demonstrated the efficacy of PPV in the treatment of patients with ARDS. However, it is not clear whether PPV treatment can reduce mortality in patients with veno-venous extracorporeal membrane oxygenation (VV-ECMO)-supported ARDS and corona virus disease 2019 (COVID-19)-associated ARDS. This review aims to discuss the known and unknown aspects of the mechanism of PPV for ARDS, the clinical efficacy of PPV for ARDS, VV-ECMO-supported ARDS, and COVID-19-related ARDS.

[Epidemic trend of tuberculosis in adolescents in China, 2000-2019].

Objective: To analyze the epidemic trend of tuberculosis (TB) in adolescents in China from 2000 to 2019. Methods: We used data from Global Burden of Disease Study 2019 to describe the epidemic trend of TB. The estimated annual percentage changes (EAPC) of the morbidity and mortality were calculated to assess epidemic trends from 2000 to 2019. Results: In 2019, a total of 37 815.670 TB cases and 213.629 deaths were reported in adolescents in China, the morbidity was 25.938/100 000 and the mortality was 0.147/100 000. The cases and deaths of TB in 2019 decreased by 71.84% and 89.90% respectively compared with 2000. In 2019, the incident case number (21 371.747) was 1.30 times higher in male adolescents than in female adolescents (16 443.923), and was 4.11 times higher in age group 15-19 years (30 420.054) than in age group 10-14 years (7 395.616). From 2000 to 2019, the morbidity (EAPC=-3.95, 95%CI: -4.34- -3.55) and mortality (EAPC=-9.18, 95%CI: -9.33- -9.02) of TB in the adolescents showed decreasing trends. The morbidity and mortality of drug-sensitive TB, extensively drug-resistant TB and multidrug-resistant TB all showed decreasing trends. Conclusions: The morbidity and mortality of TB and its subtypes among adolescents in China decreased during 2000-2019. More attention should be paid to male adolescents and adolescents aged 15-19 years due to relatively higher incidence intensity of TB.

[Analysis on the quality control of suspected occupational disease from the characteristics of applicants diagnosed with noise deafness].

Objective: To analyze the audiology and occupational health data of applicants diagnosed of occupational noise deafness, and to explore the influencing factors in the diagnosis of suspected occupational noise deafness. Methods: In May 2022, the information of patients diagnosed with occupational noise deafness in Peking University Third Hospital from January 2018 to December 2021 was collected, and the occupational health data of their working environment, clinical audiological examination results and diagnosis basis of occupational noise deafness were collected and analyzed. Multi-factor unconditional logistic regression analysis was used to analyze independent risk factors for the diagnosis of occupational noise deafness. Results: A total of 129 subjects were included, all of which were suspected cases of occupational noise deafness found in various occupational health examination institutions. Eight cases (6.20%) were diagnosed as occupational noise deafness, and 121 cases (93.80%) were non-occupational noise deafness. After hearing examination, only 27.27% (24/88) of the patients' audiological changes were consistent with the starting point of occupational noise deafness diagnosis. Further analysis of the noise intensity in the workplace showed that 16 patients were identified as non-occupational noise deafness because the noise intensity of the working environment was less than 85 dB. Logistic regression analysis showed that the working hours were more than 8 hours (OR=9.274, 95%CI: 1.388-61.950, P=0.022) and the noise intensity of the working environment (OR=1.189, 95%CI: 1.059-1.334, P=0.003) were independent risk factors for the diagnosis of occupational noise deafness. Conclusion: The exclusion rate of suspected occupational noise deafness found in occupational health examination is higher after adequate rest. The test results of working environment noise intensity provided by the employer can help to determine occupational noise deafness.

[Factors affecting BK polyomavirus infection after kidney transplantation in post-school children and a predictive infection model].

Objective: To analyze high-risk factors affecting BK polyomavirus (BKPyV) infection and to construct a prediction model for BKPyV infection in children after renal transplantation. Methods: The clinical data of 332 children who received allogeneic kidney transplantation in the First Affiliated Hospital of Zhengzhou University from January 2014 to March 2022 were retrospectively collected. According to the BKPyV load level, the dynamic change process of lymphocytes at different time points were analyzed. The factors that have potential influence on BKPyV infection were screened by Cox regression analysis, and the receiver operating characteristic curve (ROC) was used to evaluate the sensitivity and specificity of the predictive model of infection. Results: Among the 332 children, there were 215 males and 117 females; the age of transplantation was (12.2±3.9) years old; 37 cases were preschool (1-5 years old), and 295 cases were post-school age (6-18 years old). BKPyV load in 224 urine samples and 30 blood samples of children were detected. There were 9 cases of BKPyV-associated viruria and 3 cases of BKPyV associated viremia in pre-school children, 76 cases BKPyV associated viruria and 14 cases of BKPyV associated viremia in post-school children. Multivariate Cox regression analysis showed that higher body mass index (BMI) (HR=1.105, 95%CI: 1.020-1.197), antithyroglobulin (ATG) application (HR=2.196, 95%CI: 1.335-3.613), and higher tacrolimus concentration (HR=2.484, 95%CI: 1.298-4.753), higher natural killer (NK) lymphocyte count (HR=1.193, 95%CI: 1.009-1.411), higher CD14++CD16-cell count (HR=1.096, 95%CI: 1.024-1.173) were independent risk factors for BKPyV associated viruria in post-school children. Delayed graft function (DGF) (HR=4.993, 95%CI: 1.555-16.038), Acute rejection (AR) (HR=6.021, 95%CI: 1.930-18.787), higher CD14++CD16-cell count (HR=1.227, 95%CI: 1.081-1.392) were independent risk factors for BKPyV associated viremia in post-school children. The results of ROC curve analysis showed that combined BMI, immune induction drugs, tacrolimus concentration, NK cell count, and CD14++CD16-cell count predicted the occurrence of BKPyV associated viruria in post-school children after kidney transplantation at 0.5, 1, 2, and 5 years with area under curve (AUC) of 0.712 (95%CI: 0.626-0.798), 0.708 (95%CI: 0.612-0.804), 0.754 (95%CI: 0.668-0.840) and 0.767 (95%CI: 0.685-0.849). The sensitivity and specificity of the model were 64.9%, 61.4%, 61.6%, 55.8% and 70.9%, 72.4%, 76.0%, 84.0%, respectively. Combined with DGF, AR, and CD14++CD16-cell counts predicted the occurrence of BKPyV-associated viremia at 0.5, 1, 2, and 5 years after renal transplantation in post-school children with AUC of 0.791 (95%CI: 0.631-0.951), 0.744 (95%CI: 0.547-0.936), 0.786 (95%CI: 0.629-0.946) and 0.812 (95%CI: 0.672-0.948). The sensitivity and specificity of the model were 76.1%, 67.1%, 75.0%, 77.9% and 88.9%, 89.0%, 89.9%, 88.0%, respectively. Conclusions: The postoperative CD14++CD16-cell level can be used as an independent predictor of BKPyV infection in post-school children after renal transplantation. Combined BMI, immune induction drugs, tacrolimus concentration, NK cell count, CD14++CD16-cell count and combined DGF, AR, CD14++CD16-cell count show good fitting effect in predicting the occurrence of BKPyV-associated viruria and viremia after transplantation in post-school children respectively.

Markers of ovarian reserve are associated with reproductive age acceleration in granulosa cells from IVF patients.

STUDY QUESTION: Is reproductive aging in granulosa cells associated with markers of ovarian reserve? SUMMARY ANSWER: Age acceleration was associated with anti-Mullerian hormone (AMH) levels, antral follicle count (AFC), oocyte yield and maturity, and the number of successfully fertilized embryos. WHAT IS KNOWN ALREADY: The rate of reproductive aging varies among women of the same age. DNA methylation can be used to predict epigenetic age in a variety of tissues. STUDY DESIGN, SIZE, DURATION: This was a cross-sectional study of 70 women at the time of oocyte retrieval. PARTICIPANTS/MATERIALS, SETTING, METHODS: The 70 participants were recruited for this study at an academic medical center and they provided follicular fluid samples at the time of oocyte retrieval. Granulosa cells were isolated and assessed on the MethylationEPIC array. Linear regression was used to evaluate the associations between DNA methylation-based age predictions from granulosa cells and chronological age. Age acceleration was calculated as the residual of regressing DNA methylation-based age on chronological age. Linear regressions were used to determine the associations between age acceleration and markers of ovarian reserve and IVF cycle outcomes. MAIN RESULTS AND THE ROLE OF CHANCE: Participants were a mean of 36.7 ± 3.9 years old. In regards to race, 54% were white, 19% were African American and 27% were of another background. Age acceleration was normally distributed and not associated with chronological age. Age acceleration was negatively associated with AMH levels (t = -3.1, P = 0.003) and AFC (t = -4.0, P = 0.0001), such that women with a higher age acceleration had a lower ovarian reserve. Age acceleration was also negatively correlated with the total number of oocytes retrieved (t = -3.9, P = 0.0002), the number of mature oocytes (t = -3.8, P = 0.0003) and the number of fertilized oocytes or two-pronuclear oocytes (t = -2.8, P = 0.008) in the main analysis. LIMITATIONS, REASONS FOR CAUTION: This study used pooled follicular fluid, which does not allow for the investigation of individual follicles. Infertility patients may also be different from the general population, but, as we used granulosa cells, the participants had to be from an IVF population. WIDER IMPLICATIONS OF THE FINDINGS: This study demonstrated that epigenetic age and age acceleration can be calculated from granulosa cells collected at the time of oocyte retrieval. GrimAge most strongly predicted chronological age, and GrimAge acceleration was associated with baseline and cycle characteristics as well as cycle outcomes, which indicates its potential clinical relevance in evaluating both oocyte quantity and quality. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the National Institutes of Health (UL1TR002378) and the Building Interdisciplinary Research Careers in Women's Health Program (K12HD085850) to A.K.K. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding source had no role in any aspect of this study. J.B.S. serves as Vice Chair for the American Society for Reproductive Medicine Education Committee, is a Medical Committee Advisor for the Jewish Fertility Foundation and works with Jscreen. J.B.S. has received funding from Georgia Clinical Translational Research Alliance. H.S.H., J.B.S. and A.K.S. have received NIH funding for other projects. A.K.K., S.A.G., S.G., Q.S.K., L.J.M. and W.S. have no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.

[Analysis of prognostic factors of pediatric kidney transplantation].

Objective: To evaluate the short-and mid-term efficacy of pediatric kidney transplantation and the risk factors for kidney graft and recipient. Methods: The baseline data and postoperative complications of pediatric donors and recipients of 284 kidney transplants were retrospectively analyzed in the Department of Kidney Transplantation in the First Affiliated Hospital of Zhengzhou University from August 2010 to May 2021 and all subjects were followed up until December 31, 2021. According to the survival status of donors and recipients, they were divided into the graft-loss group and the graft-survival group, and the recipient death group and survival group, respectively. Univariate comparison between groups was performed by Log-rank test, and Cox proportional risk model was used to explore the independent risk factors for the graft and recipient survival. Results: Among the 284 children recipients, 184 cases (64.8%) were male and 100 cases(35.2%) were female, and 19 cases (6.7%) were living relative donor renal transplantation, 19 cases (6.7%) were preemptive transplantation, and 8 cases were secondary transplantation. The age of 284 recipients at the time of transplantation was 13.0 (9.0, 15.0) years, among whom 29 cases aged 0-6 years, 96 cases aged 7-11 years old, and 159 cases aged 12-18 years. The 1, 3, and 5 year survival rates were 92.3%, 88.9% and 84.8% for the kidney grafts, and were 97.1%, 95.6% and 94.4% for the recipients, respectively. Multivariate analysis showed postoperative acute rejection (HR=3.14, 95%CI 1.38-7.15, P=0.006) and perioperative vascular complications (HR=4.73, 95%CI 2.03-11.06, P<0.001) were independent risk factors for the survival of kidney graft. Postoperative infection (HR=14.23, 95%CI 3.45-58.72, P<0.001) was an independent risk factor for the postoperative mortality of recipients. Conclusions: Pediatric kidney transplantation shows a good short-and mid-term prognosis. Postoperative acute rejection and perioperative vascular complications are the risk factors for the survival of kidney graft, and postoperative infection is the risk factor affecting the survival of recipient.

[Epidemic situation of HIV/AIDS and change trend in Belt and Road countries].

Objective: To understand the epidemic situation of HIV/AIDS and its change trend in the Belt and Road countries and provide evidence for the improvement of prevention and control of the cross-border transmission of HIV/AIDS. Methods: The 145 countries that have signed the cooperation document of the Belt and Road initiative with China were selected in our study. Age-standardized incidence rate and prevalence rate of HIV/AIDS in the 145 countries from 2013 to 2019 were downloaded from the Global Burden of Disease Study 2019. Age-standardized incidence rate and prevalence rate of HIV/AIDS in 2019 were used to describe the HIV/AIDS epidemics in 145 countries, and the estimated annual percentage change (EAPC) of incidence was calculated to analyze the trend of HIV/AIDS incidence from 2013 to 2019. Results: In 2019, Africa had the highest proportion of countries with HIV/AIDS incidence exceeding 40.00 per 100 000 (56.86%, 29/51), and Asia had the lowest proportion (5.41%, 2/37). The countries with the prevalence rate of HIV/AIDS exceeding 100.00 per 10 000 were almost distributed in Africa, accounting for 20.69% (30/145). From 2013 to 2019, the incidence rate of HIV/AIDS increased in 50 countries, accounting for 34.48% (50/145). The incidence rate of HIV/AIDS showed downward trends in 69 countries (47.59%, 69/145), and showed no significant change in 26 countries (17.93%, 26/145). The most obvious increase of incidence rate of HIV/AIDS was observed in Comoros (EAPC=15.60, 95%CI: 5.84-26.26) and the most obvious decrease was observed in Burundi (EAPC=-14.27, 95%CI: -15.21 to -13.31). Conclusions: In the Belt and Road countries, the most severe disease burden of HIV/AIDS was observed in countries in Africa, and the incidences of HIV/AIDS increased rapidly in some European countries, which means the risk of cross-border transmission still exists. Hence, the prevention and control of HIV/AIDS in China should be further strengthened in the future.

[Epidemic situation of multidrug-resistant tuberculosis and change trend in Belt and Road countries].

Objective: To analyze the epidemic situation of multidrug-resistant tuberculosis in 2019 and the incidence trends from 2013 to 2019 in the Belt and Road countries. Methods: The 145 countries that have signed cooperation documents of the Belt and Road Initiative with China were selected. Age-standardized incidence and prevalence rate of multidrug-resistant tuberculosis from the Global Burden of Disease Study were used to describe the epidemic situation of multidrug-resistant tuberculosis in 2019. The annual percentage changes of the age-standardized incidence rate were calculated to assess incidence trends of multidrug-resistant tuberculosis from 2013 to 2019. Results: In 2019, of the 145 countries, Somalia had the highest incidence rate (30.42 per 100 000) and prevalence rate (48.86 per 100 000) of multidrug-resistant tuberculosis, while Slovenia had the lowest incidence rate (0.01 per 100 000) and prevalence rate (0.01 per 100 000). The incidence trends of multidrug-resistant tuberculosis in six continents from 2013 to 2019 were as follows: multidrug-resistant tuberculosis incidence rates showed increasing trends in 14 countries (27.45%) and decreasing trends in 22 countries (43.14%) in Africa, showed increasing trends in 2 countries (18.18%) and decreasing trends in 3 countries (27.27%) in North America and showed increasing trends in 2 countries (5.41%) and decreasing trends in 23 countries (62.16%) in Asia. The increasing trends were observed in Europe, Oceania, and South America, but it was found that 26 countries (96.30%) in Europe, 2 countries (18.18%) in Oceania, and 1 country (12.50%) in South America had decreasing trends of multidrug-resistant tuberculosis incidence rates. Conclusion: Multidrug-resistant tuberculosis is endemic in 145 Belt and Road countries with the prevalence increasing year by year in some countries in central and southern Africa and decreasing in European countries except Ukraine.

[Epidemic situation and trend of dengue fever in Belt and Road countries].

Objective: To analyze epidemic situation of dengue fever in 2019 and the incidence trends from 2013 to 2019 in the Belt and Road countries. Methods: We used age-standardized incidence rate (ASR) which was from Global Burden of Disease Study 2019 to describe the epidemic situation of dengue fever in 2019. The estimated annual percentage change(EAPC) of the ASR was calculated to assess dengue fever incidence trends from 2013 to 2019. Results: The 2019 GBD dengue fever incidence records showed that in 145 Belt and Road countries, 93 (64.14%) countries had dengue fever epidemics. In 2019, there were 11 countries with the incidence >3 000.00 per 100 000, including 9 countries in Oceania; 16 countries with the incidence of 1 000.00 per 100 000-2 999.99 per 100 000, including 10 countries in Asia. The incidence rates in most countries in Africa (58.14%,25/43), North America (72.73%,8/11) and South America (66.67%,4/6) ranged from 500.00 per 100 000 to 999.99 per 100 000. The incidence rates of dengue fever in 90.00% (9/10) of countries in Oceania showed increasing trend, and the increasing trend in Fiji was most obvious (EAPC=18.22,95%CI:12.91-23.77), and the incidence rates of dengue fever in 18.18% (4/22) of countries in Asia showed increasing trend, the increasing trend in the Philippines was most obvious (EAPC=3.09,95%CI:1.74-4.45), and the incidence rates of dengue fever in 4.65% (2/43) of countries in Africa showed increasing trend, and the increasing trend in Seychelles was most obvious (EAPC=18.20,95%CI:7.82-29.58). The incidence rates of dengue fever showed no increasing trend in countries in South America and North America. Conclusions: In 2019, more than 60% of the Belt and Road countries had dengue fever epidemics. The incidences of dengue fever were high and showed increasing trends in most Oceanian countries, but the dengue fever epidemics in the countries in Asia, Africa and Americas were relatively mild.

[Epidemic situation of malaria and change trend in Belt and Road countries].

Objective: To understand the epidemic situation of malaria and its change trend in the Belt and Road countries. Methods: The 145 countries with which China has signed cooperation documents on the Belt and Road Initiative were selected for this study, and their malaria incidence data were collected from the Global Burden of Disease 2019. The age-standardized incidence rate (ASR) was used to describe the epidemic situation of malaria in 2019. The estimated annual percentage change (EAPC) of the ASR was calculated to assess the incidence trend of malaria from 2013 to 2019. Results: Among the 145 countries, 74 (51.03%) countries had malaria epidemics, mainly in Africa (60.81%, 45/74) and Asia (22.97%, 17/74). The countries with malaria incidence of ≥10 000 per 100 000 in 2019 were mainly distributed in Africa (96.15%, 25/26). From 2013 to 2019, the incidence rates of malaria showed decreasing trends in 32 countries (43.24%), and the incidence rates of malaria in 23 countries (31.08%) showed no significant change, while the incidence rates of malaria in 19 countries (25.68%) showed increasing trends. The obvious increasing trends were observed in Cape Verde (EAPC=151.46, 95%CI: 47.15-329.71), South Africa (EAPC=98.61, 95%CI: 32.11-198.58) and Namibia (EAPC=78.03, 95%CI: 54.30-105.42). Conclusion: About half of the Belt and Road countries had malaria epidemics in 2019, in which 1/4 had increased incidence of malaria. China should continue to strengthen the prevention and control of malaria, especially imported malaria, to maintain the achievements of malaria elimination.

Treatment efficacy and prognosis of pulmonary metastasizing ameloblastoma: a systematic review.

The aim of this review was to integrate the current literature into a comprehensive evaluation of pulmonary metastasizing ameloblastoma (MA). Related articles, published since January 2000, were reviewed. The PubMed, Embase, Cochrane Database of Systematic Reviews, and Web of Science databases were searched based on the PRISMA guidelines. Twenty-four studies, including 28 case reports, met the eligibility criteria. The mean ± standard deviation disease-free interval after primary treatment was 12.1 ± 9.3 years. Adjuvant therapy (surgery and chemoradiotherapy) is considered appropriate for pulmonary MA patients presenting with rapid progression or apparent pulmonary symptoms. The proportion of patients undergoing simple follow-up (observation) has increased rapidly in the past 10 years. Meanwhile, among the three treatment groups (observation, surgery, and adjuvant therapy), no significant difference was found in the efficacy (P = 0.081) or progression-free survival (P = 0.263). The 5-year and 10-year overall survival rates were 72.4% and 52.8%, respectively. This study provides insights that could help surgeons with the management of patients presenting with pulmonary MA.

[Screening of endophytic fungi against southern blight disease pathogen-Sclerotium delphinii in Dendrobium catenatum].

In order to screen the endophytic fungi that can enhance the host(Dendrobium catenatum) resistance to Sclerotium delphinii, the antagonism between each of the 43 endophytic fungi and the pathogen S. delphinii were tested. The results showed that 6 endophytic fungi(DCR2, DCR5, DCR21, DCR22, DCR42, DCR43) have strong activities against the pathogen, the inhibition rates were 49.2%, 49.2%, 47.2%, 56.2%, 53.2%, 48.0%, respectively. Then D. catenatum plantlets were inoculated with both S. delphinii and each of these six endophytic fungi. As a result, the incidence rates of leaves and stems of the D. catenatum plantlets inoculated with DCR2 and the pathogen were both significantly lower than those with other treatments, and the plantlet death rate was 0. It showed that DCR2 Trichoderma polysporum could effectively inhibit the southern blight disease of D. catenatum. Through the endophytic fungal re-isolation test, it was found that DCR2 can colonize in the roots, stems, and leaves of D. catenatum. The research will provide new ideas for the prevention and treatment of the southern blight disease of D. catenatum. It is also significant for reducing pesticide use, ensuring food safety, and promoting the sustainable development of D. catenatum industry. Furthermore, it will provide a basis for the disease control in other crops.

[Level and trend of low birth weight mortality in children under 1 year old in China, 2004-2018].

Objective: To analyze the level and trend of low birth weight mortality in children under 1 year old in China from 2004 to 2018. Methods: The published Data Set of National Mortality Surveillance from 2004 to 2018 was used to analyze the low birth weight mortality rate, constituent ratio and changing trend in boys and girls, in urban area and rural area and in different regions in China. The Joinpoint regression model fitted by the weighted least square method was used to analyze the time variation trend and calculate the annual percentage change (APC), the average annual percentage change (AAPC) and their 95% confidence intervals in each time period. Results: From 2004 to 2018, the low birth weight mortality rate in children under 1 year old in China showed a decreasing trend with an AAPC of -8.0% (95%CI: -10.6% --5.4%). The differences between boys and girls, between urban area and rural area and among different regions gradually reduced. From 2004 to 2018, the constituent ratio of low birth weight mortality showed an increasing trend with an AAPC of 1.6% (95%CI: 0.1%-3.2%). The mortality rate in urban area (38.74 per 100 000) was higher than that in rural area (30.44 per 100 000). The annual average declining speed of low birth weight mortality rate in urban area (AAPC=-3.4%, 95%CI: -7.0%-0.3%) was slower than that in rural area (AAPC=-9.3%, 95%CI: -12.0% --6.6%). The low birth weight mortality rate of boys (36.25 per 100 000) was higher than that of girls (28.22 per 100 000). The low birth weight mortality constituent ratio in western region showed an increasing trend, its average annual percentage change (AAPC=3.2%, 95%CI: 1.7%-4.8%) increased faster than that of the eastern region (AAPC=-0.5%, 95%CI: -2.3%-1.4%). In urban and rural areas and different regions, the rate of low birth weight mortality in boys was higher than that in girls. Conclusions: From 2004 to 2018, the mortality rate of low birth weight in children under 1 year old showed a downward trend, and the constituent ratio showed an upward trend. Boys and children living in central and western regions should be the key population for maternal and child health care.

[The analysis on the change and trend of the congenital heart disease mortality rate in children aged 0-1 in China from 2004 to 2018].

Objective: To analyze the trend of the congenital heart disease mortality rate in children aged under 1 year old from 2004 to 2018. Methods: The mortality rate and constituent ratio of congenital heart disease in different genders, urban and rural areas and regions were calculated by using the publicly available Dataset of National Mortality Surveillance in China from 2004 to 2018. The Joinpoint regression model was used to analyze the changing trend of mortality rate and constituent ratio, and calculate the annual percentage change (APC) in each time period, the average annual percentage change (AAPC) in all time period and their 95% values. Results: From 2004 to 2018, a total of 15 969 children aged 0 to 1 years died of congenital heart disease, of which 58.12% (9 281) were boys and 71.79% (11 464) were in rural areas. The deaths of congenital heart disease in eastern, central and western regions accounted for 34.30%, 37.06% and 28.64% of total deaths, respectively. From 2004 to 2018, the mortality rate of congenital heart disease in children decreased from 106.81 per 100 000 to 38.70 per 100 000, with an AAPC (95%) about -7.2% (-11.5%, -2.6%). The mortality rate of congenital heart disease showed a downward trend in girls [AAPC (95%) =-7.7% (-13.0%, -2.0%)], boys [AAPC (95%)=-6.8% (-12.0%, -1.2%)], urban areas [AAPC (95%) =-5.9% (-9.9%, -1.7%)], rural areas [AAPC (95%) =-7.4% (-10.5%, -4.2%)], eastern region [AAPC (95%)=-8.6% (-14.2%, -2.6%)], and central region [AAPC (95%)=-7.8% (-11.5%, -4.0%)]. The gaps of mortality rate gradually shrank in different genders, urban and rural areas and regions. From 2004 to 2018, the constituent ratio of congenital heart disease in children showed an upward trend [AAPC (95%) = 3.3% (1.7%, 4.9%)]. Conclusion: From 2004 to 2018, the mortality rate of congenital heart disease in children aged 0 to 1 years showed a downward trend, and the constituent ratio showed an upward trend.

Oral administration of alendronate and vitamin D3 for the treatment of chronic non-bacterial osteomyelitis of the jaw.

Chronic non-bacterial osteomyelitis (CNO) is a rare and difficult-to-diagnose disease, especially when limited to the jaws. We report the case of a 5-year-old girl with spontaneous jaw pain and a large pre-auricular facial swelling overlying the angle of the mandible that was non-responsive to previous antibiotic and non-steroidal anti-inflammatory treatment. The diagnosis was confirmed as CNO following evaluation and workup by a multidisciplinary team. The patient exhibited a favourable response to oral alendronate sodium plus vitamin D3 combination treatment. We believe that alendronate sodium is an effective second-line drug for CNO.

Association of FLAIR vascular hyperintensity and acute MCA stroke outcome changes with the severity of leukoaraiosis.

PURPOSE: The clinical significance of FLAIR vascular hyperintensity (FVH), a marker of collateral circulation in ischaemic stroke, remains controversial. We hypothesised that the association between FVH and outcomes varies with the severity of leukoaraiosis (LA), another marker of collaterals, and that their combined significance may vary with time. METHODS: We included 459 consecutive patients with middle cerebral artery (MCA) stroke. Proximal and distal FVHs were distinguished based on location. LA was divided into two grades, according to Fazekas scores of 0-2 and 3-6. Symptom-to-MRI time was divided into two categories: ≤ 14 days and ≥ 15 days. RESULTS: We found no difference in FVH proportion according to LA grade. Multivariate analysis revealed that LA and FVH status were independently associated with unfavourable outcomes (modified Rankin scale ≥ 2) in patients with symptom-to-MRI times ≤ 14 days (P = 0.008), but not in those with symptom-to-MRI times ≥15 days (P = 0.61). In the group with symptom-to-MRI times ≤14 days, patients with LA 3-6 and FVH(+) (OR, 3.044; 95% CI, 1.116-8.305) were more likely to have unfavourable clinical outcomes compared with patients with LA 0-2 and FVH(+) but not compared with those with LA 0-2 and FVH(-) or LA 3-6 and FVH(-). In addition, FVH location did not influence the relationship between FVH and outcomes. CONCLUSIONS: The association between FVH and outcomes was influenced by the degree of LA in the acute but not in the subacute and chronic stages of MCA infarction. FVH predicts clinical outcomes independently only in those with more extensive LA.

[Technical notes and clinical efficacy analysis of full-endoscopic thoracic discectomy via transforaminal approach].

Objective: To study the technical notes and clinical efficacy of full-endoscopic thoracic intervertebral discectomy via transforaminal approach. Methods: We included 16 patients with thoracic disc herniation treated by full-endoscopic thoracic discectomy via transforaminal approach between January 2017 and September 2018 in ours department of orthopedics. The average age is 53.7 years. The compressionare classified by nature: 5 cases of soft thoracic disc herniation, 7 cases of calcified or ossified thoracic disc herniation, and 4 cases of osteophyte protrusion of the posterior edge of the adjacent vertebral body of the diseased disc. All patients had symptoms of thoracic myelopathy before operation, and 7 of them had radiculopathy. Via transforaminal approach under local anesthesia, enlarged foraminoplasty and full-endoscopic thoracic discectomy were used for treatment. Observe the changes of postoperative imaging, pain symptoms and recovery of spinal cord function at 1 week, 3 months, 6 months and 1 year after operation. Back pain and radicular pain were scored with VAS, neurological function was assessed with Nurick score and mJOA score, and thoracic spine function was assessed with Oswestry disability index (ODI). Results: All operations were successfully completed, and no intraoperative conversion of surgical methods occurred. Postoperative thoracic MRI and CT examinations of all patients showed that the spinal cord was fully decompressed without any residual compression. Back pain and radicular pain were all relieved obviously in all patients, and spinal cord function was obviously restored. Transient intercostal neuralgia occurred in 2 cases after operation, and no other surgical complications occurred. Conclusions: Full-endoscopic or fluoroscopic foraminoplasty and full-endoscopic thoracic discectomyvia transforaminal approach under local anesthesia is a safe and effective treatment for soft and hard thoracic disc herniation located on the ventral side of the spinal cord.

Ectopic parathyroid adenoma in the submandibular region: a case report.

Ectopic parathyroid adenomas that affect the submandibular region have not been widely reported. We describe a 34-year-old man who presented with a painless swelling of the submandibular region. The identification of hypercalcaemia encouraged us to engage a multidisciplinary team to evaluate further serum changes. Parathyroid hormone analysis, 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy, and single-photon emission computed tomography (SPECT-CT) were done to rule out hyperparathyroidism. Raised parathyroid hormone together with 99mTc-MIBI and SPECT-CT examination were consistent with a tumour caused by the hyperparathyroidism. Removal of the lesion resulted in rapid improvement in serum calcium and parathyroid hormone, and the normalisation of the serum creatinine, concentrations. Histopathological analysis confirmed a parathyroid adenoma. We conclude that ectopic parathyroid adenomas should be considered as part of a differential diagnosis for tumours of the submandibular region.

The Association between FLAIR Vascular Hyperintensity and Stroke Outcome Varies with Time from Onset.

BACKGROUND AND PURPOSE: FLAIR vascular hyperintensity has been recognized as a marker of collaterals in ischemic stroke, but the impact on outcome is still controversial. We hypothesized that the association between FLAIR vascular hyperintensity and outcome varies with time. MATERIALS AND METHODS: We included 459 consecutive patients with middle cerebral artery stroke and divided them into 3 groups by symptom-to-MR imaging time (group 1, ≤7 days; group 2, 8-14 days; group 3, ≥15 days). The FLAIR vascular hyperintensity score, ranging from 0 to 3 points, was based on territory distributions of different MCA segments. The associations between FLAIR vascular hyperintensity and outcome with time were analyzed qualitatively and quantitatively. RESULTS: No patients underwent MR imaging within 6 hours of onset. The proportion of FLAIR vascular hyperintensity (+) and severe stenosis or occlusion of MCA was not significantly dependent on time. In groups 1 and 2, FLAIR vascular hyperintensity (+) was significantly associated with larger lesions, the prevalence of flow injury, and unfavorable outcome (mRS ≥ 2). There were no such associations in group 3. Multiple logistic regressions demonstrated that FLAIR vascular hyperintensity (+) was an independent risk factor for unfavorable outcome in group 2. Infarction volume tended to increase with the increase of the distal FLAIR vascular hyperintensity score in groups 1 and 2, while declining in group 3. CONCLUSIONS: FLAIR vascular hyperintensity is associated with unfavorable outcome within 6 hours to 14 days of onset, while the wider distribution of distal FLAIR vascular hyperintensity may be favorable beyond 14 days of onset in MCA infarction. Symptom-to-MR imaging time should be considered when assessing the prognostic value of FLAIR vascular hyperintensity.