The value of the ratio of heparin binding protein to albumin in evaluating the state of shock syndrome in Kawasaki disease / 中华急诊医学杂志

Objective:To investigate the value of the ratio of heparin binding protein (HBP) to albumin (ALB) in diagnosis and predict the severity of Kawasaki disease shock syndrome (KDSS).Methods:This study was a retrospective study. Pediatric patients with Kawasaki disease (KD) admitted to the Children's Intensive Care Unit and department of Pediatric Emergency Center of Hunan Children's Hospital from January 2019 to May 2022 were enrolled. The HBP/ALB ratio was calculated according to HBP and serum ALB. The children were divided into three groups (low, medium, and high ratio groups) according to the median and upper and lower quartiles of the HBP/ALB ratio. The differences of each index among the three groups were compared. The receiver operating characteristic curves were drawn to evaluate the clinical value of the HBP/ALB ratio in diagnosis of KDSS and the severity of the disease.Results:A total of 111 cases were included in this study, including 28 cases in the low ratio group, 56 cases in the medium ratio group, and 27 cases in the high ratio group. There were 24 cases with coronary artery damage, 87 cases without coronary artery damage, 27 cases with abnormal ECG findings, and 17 children with KDSS (including 5 cases in the medium ratio group, and 12 cases in the high ratio group). The incidence of KDSS, coronary involvement, and abnormal electrocardiogram proportions in the high ratio group were significantly higher than those in the other two groups. Compared with low and medium ratio groups, the levels of cardiac troponin I, N-terminal pro-brain natriuretic peptide, lactate, stroke output variation, trends in thoracic fluid content, white blood cell count, C-reactive protein, procalcitonin, and D-dimer levels were higher in the high ratio group, while ALB and blood sodium levels were lower in the high ratio group (all P<0.05). There was no significant difference in above indicators between the low and medium ratio groups (all P>0.05). The HBP/ALB ratio had a higher area under the curve, sensitivity, and specificity (0.942, 0.882, and 0.883, respectively) in predicting KDSS compared to HBP alone (0.776, 0.842, and 0.670, respectively). Conclusion:The HBP/ALB ratio could reflect the severity of children with KD and has certain clinical value for prognostic evaluation.

Significance of serum insulin combined with cardiac markers in evaluating sepsis associated encephalopathy / 中华急诊医学杂志

Objective:To explore the clinical value of serum insulin combined with cardiac-related markers in evaluating the severity of sepsis associated encephalopathy (SAE).Methods:The clinical data of 130 children with sepsis who admitted to the Pediatric Intensive Care Unit of Hunan Children's Hospital from January 2018 to December 2021 were analyzed retrospectively, and the differences of serum insulin and cardiac-related markers in children with sepsis and SAE were compared.Results:The levels of serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide in the SAE group were significantly higher than those in the non-SAE group ( P<0.05), but there was no significant difference in heart rate and lactic acid ( P>0.05). The levels of serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, N-terminal cerebral urine peptide and lactic acid in the death group were significantly higher than those in the survival group ( P<0.05), while the heart rate was not significantly different ( P>0.05). The area under ROC curve of serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide in predicting SAE were 0.841, 0.599, 0.700, and 0.667, respectively; in terms of judging the prognosis of sepsis, the area under ROC curve were 0.647, 0.669, 0.645, and 0.683, respectively; and in terms of judging the prognosis of children with SAE, the areas under the ROC curve were 0.509, 0.682, 0.666 and 0.555, respectively. Binary logistic regression equation was established with serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide: Y=8.153×NT-proBNP+1.704×CTnT-hs+27.121×insulin+0.946×CK-MB+1.573. The area under the ROC curve of the new variable Y in predicting sepsis SAE, evaluating the prognosis of sepsis, and predicting the prognosis of children with sepsis and SAE was 0.890, 0.756, and 0.729, respectively. Conclusions:Serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide can be used alone to determine the severity of sepsis and sepsis in children with SAE. The combined value of the four indicators is obviously better than that of the single indicator. The combined application of the four indicators may better evaluate the severity of sepsis and SAE.

Clinical features of pertussis and risk factors of severe pertussis in children / 中国小儿急救医学

Objective:To study the clinical features of children with pertussis and the risk factors of severe pertussis.Methods:A retrospective analysis was performed based on clinical data and laboratory examination results of hospitalized children with pertussis who admitted to the intensive care unit, respiratory department, and emergency general department at Hunan Children′s Hospital from January 2019 to March 2020.According to the age, the patients were divided into age ≤3 months group( n=58)and age >3 months group( n=64). According to sputum culture, 63 cases were divided into negative sputum culture group and 59 cases were positive sputum culture group.The patients were also divided into vaccinated group( n=19)and unvaccinated group( n=103). Severe disease was seen in 28 cases, and the other 94 cases had the modest disease.The clinical characteristics between two groups were compared, and the risk factors of severe pertussis pneumonia were analyzed. Results:The hospitalization days in age ≤3 months group was higher than that in age >3 months group.It was also found that shortness of breath, apnea, cyanosis after coughing, heart rate decline were more common in age ≤3 months group than those in age >3 months group( P<0.05). The incidences of respiratory failure and heart failure in positive sputum culture group were higher than those in negative sputum culture group.Clinical characteristics such as hospitalization days, hospitalization expenses, peak white blood cell count, peak lymphocyte count, and incidence of bacterial infection were higher in severe pertussis group than those in non-severe pertussis group( P<0.05). Four patients were treated with exchange blood transfusion, and one patient died.Logistic regression analysis revealed that fever, wheezing, cyanosis after coughing and white blood cell count>20×10 9/L were risk factors for severe pertussis.White blood cell count of 20×10 9/L and lymphocyte count of 14×10 9/L had the highest sensitivity and specificity in predicting severe pertussis(0.71, 0.78; 0.54, 0.79). Conclusion:The younger the children are, the more likely they have shortness of breath, apnea, cyanosis, heart rate falls, and the longer the hospital stay.Bacterial infection will aggravate pertussis.Patients with fever, wheezing, cyanosis after coughing, and white blood cell count>20×10 9/L are more likely to develop severe pertussis.The white blood cell count >20×10 9/L and the lymphocyte count >14×10 9/L are associated with severe pertussis.

Application of heparin-binding protein in severe adenovirus pneumonia / 中华实用儿科临床杂志

Objective:To explore the application value of heparin-binding protein (HBP) in the early diagnosis and assessment of severe adenovirus pneumonia.Methods:A total of 90 children diagnosed with adenovirus pneumonia admitted in the Department 1 of Emergency and Pediatric Intensive Care Unit 1 in Hunan Children′s Hospital from January 2019 to March 2020 were recruited.HBP levels in children with adenovirus pneumonia were detected.The correlation between HBP with white blood cell count (WBC), neutrophil ratio (N), C-reactive protein (CRP), interleukin-6(IL-6) and erythrocyte sedimentation rate (ESR) were examined.Receiver operating characteristic(ROC) curve analysis was conducted to explore the value of HBP in the early diagnosis and assessment of severe adenovirus pneumonia.Children with adenovirus pneumonia were divided into severe adenovirus pneumonia group (severe group) and non-severe adenovirus pneumonia group (non-severe group) according to their severity.Those in the severe group were further divided into bronchiolitis obliterans(BO) group and non-BO group according to the occurrence of BO.Results:(1) The HBP level in children with adenovirus pneumonia was (49.47±34.19) μg/L, which was significantly higher in the severe group than that of non-severe group[(82.88±44.02) μg/L vs.(35.15±13.08) μg/L, t=15.349, P<0.05]. Children in the severe group were significantly younger, and they had a significantly longer length of stay, lower Pediatric Critical Illness Scores (PCIS), and higher inflammatory markers like HBP, WBC, N, CRP, IL-6, and ESR compared with those of the non-severe group (all P<0.05). No significant difference in the procalcitonin (PCT) level was detected between groups.(2) The HBP was positively correlated with inflammatory markers like WBC ( r=0.38, P<0.05), N ( r=0.26, P<0.05), CRP ( r=0.47, P<0.05), IL-6 ( r=0.76, P<0.05), and ESR ( r=0.35, P<0.05). However, HBP did not have a significant correlation with PCT ( r=0.097, P>0.05). (3) In the severe group, the HBP level of the children with invasive mechanical ventilation, oxygenation index(P/F index)≤ 200 mmHg (1 mmHg=0.133 kPa) and BO was significantly higher than that of the non-invasive mechanical ventilation, P/F index> 200 mmHg and non-BO (all P<0.05). (4) The area under the ROC curve of HBP, WBC, N, CRP, ESR and IL-6 in predicting the severity of adenovirus pneumonia were 0.915, 0.748, 0.770, 0.740, 0.820 and 0.798, respectively.When the cut-off value of HBP was 45 μg/L, the sensitivity and specificity of HBP were 81.48% and 85.71%, respectively. Conclusions:As an inflammatory mediator, HBP is involved in the inflammatory response of the body.It may be a useful new marker for the early diagnosis of severe adenovirus infection, which also has a certain value in the evaluation of the severity and prognosis of the disease.The findings provide a basis for early clinical intervention and treatment of adenovirus infection in children.

Analysis of a pedigree affected with propionic acidemia by trio whole exome sequencing / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical characteristics and genetic basis for a pedigree affected with propionic acidemia.@*METHODS@#Trio whole exome sequencing (WES) was used to screen potential variants in the proband and his parents. Sanger sequencing was carried out for the elder sister of the proband, and prenatal diagnosis was carried out at 18th gestational week upon the next pregnancy of his mother.@*RESULTS@#Two novel heterozygous variants, PCCA c.1845+1G>A and c.446delA, were detected by WES, for which his father and mother were respectively heterozygous carriers. His elder sister also inherited the PCCA c.1845+1G>A variant from her father, while the fetus was heterozygous for the PCCA c.1845+1G>A variant. Above results were confirmed by Sanger sequencing.@*CONCLUSION@#Identification of the PCCA c.1845+1G>A and c.446delA variants by WES has facilitated genetic counseling and prenatal diagnosis for this family.

Application of NGS-based SNP haplotyping for preimplantation genetic diagnosis for beta-thalassemia and HLA matching / 中华医学遗传学杂志

Objective@#To assess the value of next-generation sequencing (NGS)-based single nucleotide polymorphism (SNP) haplotyping for preimplantation genetic diagnosis (PGD) for beta-thalassemia coupled with human leukocyte antigen (HLA) matching.@*Methods@#Three couples were recruited. Couple 1 both carried a βIVS-2-654 variation and had previously given birth to a son with β thalassemia major. Couple 2 respectively carried βcd41-42 and βIVS-2-654 but had no history of pregnancy. Couple 3 respectively carried βCD17and βIVS-2-654, and had a daughter carrying βCD17.@*Results@#For couple 1, NGS-SNP typing identified two embryos not only unaffected with thalassemia but also with matched HLA. One blastocyst was transferred and resulted in successful pregnancy. A healthy baby was born at 39th week of gestation. Its umbilical blood was used to treat the sick brother through hemopoietic stem cell transplantation. For couple 2, seven blastocysts were obtained. Second transplantation has resulted in successful pregnancy. Prenatal diagnosis was consistent with PGD. For couple 3, two blastocysts not only unaffected with thalassemia but also with no pathogenic copy number variations were obtained. Transfer of one blastocyte resulted in successful pregnancy, and prenatal diagnosis was consistent with PGD.@*Conclusion@#NGS-based SNP typing is an useful tool for selecting embryos unaffected with beta-thalassemia and matched HLA through PGD.

The predicted performance of cTnⅠ for outcome or severity in children with sepsis / 国际检验医学杂志

Objective To explore the predicted performance of cTnI for outcome or severity in children with sepsis.Methods 374cases of children with sepsis were collected in pediatric intensive care unit (PICU) in our hospital from August 2012to June 2015.The patients were dividided into the common sepsis group, severe sepsis group and sepsis shock group according to the sepsis severity, and improved group, uncured group and death group according to outcome, and the cTnI>0.01μg/mL group and the cTnI≤0.01μg/mL group according to the levels of cTnI.Data on cTnI, PCT, CRP, Cr, Lac, PaO2/FiO2, BUN, PT, INR, WBC and PLT were collected in this study.Results The level of cTnI was significantly higher in children with septic shock (P<0.05) .The level of cTnI in improved group was significantly lower than those of uncured group and death group (P<0.05) .The incidence of severe sepsis and septic shock in the cTnI>0.01μg/mL group was significantly significantly higher than that of the cTnI≤0.01μg/mL group.The levels of Lac, PT and INR in the cTnI>0.01μg/mL group were significantly higher than that of the cTnI≤0.01μg/mL group (P<0.05) .A positive correlation between the level of cTnI and Lac (r=0.324) , or PT (r=0.291) , or INR (r=0.340) were found in the study (P<0.05) .Conclusion Sepsis is prone to be associated with myocardial injury, which is related to the severity and prognosis of sepsis.Insufficient circulatory perfusion, metabolic imbalance and abnormal coagulation function may be the reasons for the rise of cTnI and myocardial injury in children with sepsis.

Application of NGS-based SNP haplotyping for preimplantation genetic diagnosis for beta-thalassemia and HLA matching / 中华医学遗传学杂志

OBJECTIVE@#To assess the value of next-generation sequencing (NGS)-based single nucleotide polymorphism (SNP) haplotyping for preimplantation genetic diagnosis (PGD) for beta-thalassemia coupled with human leukocyte antigen (HLA) matching.@*METHODS@#Three couples were recruited. Couple 1 both carried a β (IVS-2-654) variation and had previously given birth to a son with β thalassemia major. Couple 2 respectively carried (cd41-42) and β (IVS-2-654) but had no history of pregnancy. Couple 3 respectively carried β (CD17) and β (IVS-2-654), and had a daughter carrying β (CD17).@*RESULTS@#For couple 1, NGS-SNP typing identified two embryos not only unaffected with thalassemia but also with matched HLA. One blastocyst was transferred and resulted in successful pregnancy. A healthy baby was born at 39th week of gestation. Its umbilical blood was used to treat the sick brother through hemopoietic stem cell transplantation. For couple 2, seven blastocysts were obtained. Second transplantation has resulted in successful pregnancy. Prenatal diagnosis was consistent with PGD. For couple 3, two blastocysts not only unaffected with thalassemia but also with no pathogenic copy number variations were obtained. Transfer of one blastocyte resulted in successful pregnancy, and prenatal diagnosis was consistent with PGD.@*CONCLUSION@#NGS-based SNP typing is an useful tool for selecting embryos unaffected with beta-thalassemia and matched HLA through PGD.

Status analysis of the emergency ability of the pediatrics in township hospitals / 中国小儿急救医学

Objective@#To understand the present situation of the emergency ability of the pediatrics in township hospital of Hunan province, and to provide the basis for improving the treatment of critical diseases and strengthening the medical quality in basic hospital.@*Methods@#Status survey, expert consultation, on-spot examination, and questionnaire were conducted.One representative of the 1 217 township hospitals participating in the appropriate health technologies for pediatric emergency was sent to a face-to-face survey by investigators.@*Results@#In 1 217 township hospitals, only 965 pediatricians had been certified.Among them, 58 township hospitals did not purchase the first aid equipment in the scope of the survey, and 211 township hospitals were not equipped with first aid drug.Less than 30% of township hospitals had tracheotomy kits, cardiac defibrillator and first aid equipment such as neonatal incubator, newborn radiation table and infusion pump.Among the trained 1 095 general practitioners, only 305(27.85%) understood the basic first-aid knowledge of this training in pediatrics; 258(258/1 217, 21.20%) township hospitals could not carry out 7 pediatric emergency projects of this survey.The proportion of the capable of carrying out rescue treatment including acute respiratory failure (191/1 217, 15.69%), heart failure (201/1 217, 16.52%) and shock(227/1 217, 18.65%) in township hospitals were less than 30%.@*Conclusion@#The primary hospital is the basis for the treatment of critical diseases in pediatrics, but the level of diagnosis and treatment and basic equipment need to be further strengthened.The urgent task is to strengthen the training of medical and nursing staff in the treatment of critical diseases in pediatrics.

Correlative study on thrombelastogram and hemorrhagic transformation after acute ischemic stroke / 国际检验医学杂志

Objective To investigate the correlation between indexes of thrombelastogram (TEG) and hemorrhagic transformation (HT) after acute ischemic stroke.Methods The cases of acute ischemic stroke but not receiving early reperfusion therapy were recruited in our hospital from January to November 2016,and were divided into HT group and non-HT group.Their general clinical characteristics and TEG indexes were retrospectively analyzed,and comparison between two groups and multivariate Logistic regression analysis were performed.Results A total of 71 cases were enrolled and 11 of them were divided into HT group.The percentages of massive cerebral infarction and cardio-embolic stroke were significantly higher in HT group than those in non-HT group (P<0.05),whereas the levels of CI in HT group were significantly lower than thoes in non-HT group(P<0.05).Multivariate Logistic regression analysis showed that massive cerebral infarction (OR=13.172,95%CI:1.414-122.671) and CI(OR=0.554,95%CI:0.321-0.956) were independently correlated with HT(P<0.05).Conclusion CI is independently correlated with HT after acute ischemic stroke,and may be a potential predictor of HT.

Observation on the effect of calcium gluconate oral solution combined with psychological intervention on preventing the advertise reaction in blood donation by plateletpheresis / 中国生化药物杂志

Objective To study the effect of calcium gluconate oral solution combined with psychological intervention on preventing the advertise reaction in blood donation by plateletpheresis.Methods From February 2015 to February 2016, 114 cases were collected in Shaoxing downtown blood bank, and were divided into the control group and the experimental group 57 cases in each group.In the blood collection process, the control group were not given any treatment, the experimental group was given calcium gluconate oral liquid combined with psychological intervention.The total incidence adverse reactions and SAS scores in the two groups was compared.Results Before blood donation, Before blood donation, SAS scores in the two groups has no statistically significance.After blood donation, the SAS scores and the total incidence of adverse reactions in the experimental group were significantly lower than those in the control group, the differences in the two groups were statistically significant.(P<0.05).Conclusion Calcium gluconate oral liquid combined with psychological intervention can prevent the adverse reactions in the process of blood donation by plateletpheresis, which is worthy of promotion in the process of plateletpheresis.

Designing and evaluating of the project of health education pathway for primary apheresis donors / 中国输血杂志

Objective In order to improve blood donors to understand the health education knowledge,this study designed and evaluated a new project,that is the health education pathway for primary apheresis donors.Methods A total of 2900 primary apheresis donors participated in the current study,who were randomly divided into the experimental group and the control group.The experimental group was performed the health education pathway for primary apheresis donors,while the control group was conducted in the traditional health educational ways.We compared the basic information,the awareness rate of apheresis donation knowledge,the number of regnlar/repeated donors,and the frequency of donations.Results Two groups were matched with no group differences in basic information (P＞0.05).After performed the health education pathway for primary apheresis donors,the awareness rate of apheresis donation knowledge was significantly improved from 23.6％ to 84.3％ (P＜0.01).Moreover,the percentage of regular donors (40.2％) in the experimental group higher than the percentage (26.7％) in the control group(P＜0.01).The average donation times of experimental group (3.8) was also higher than the control group.There were 79.2％ donors changed to regular/repeated donors higher than the percentage (66.4％) in the control group,and the average frequency of apheresis of those regular/repeated apheresis donors (7.4) in the experimental group higher than the control group (6.4) (P＜0.01).Conclusion As showed in our results,the health education pathway for primary apheresis donors could effectively help donors to understand the knowledge of blood donation and health care,and promote team construction of regular donors.We hope,in the future,the health education pathway for primary apheresis donors could be widely spread.

Demographic and clinical characteristics and risk factors for Staphylococcal scalded skin syndrome in Hunan / 中南大学学报(医学版)

OBJECTIVE@#To realize the risk factors, clinical features, and treatments of Staphylococcal scalded skin syndrome (SSSS).
@*METHODS@#The clinical features, laboratory findings, and treatment were retrospectively analyzed in 290 patients from Hunan Children's Hospital.
@*RESULTS@#Of the 290 patients, less than 3 years old children were 76.6%. One hundred and nine patients had induced factors, and 177 patients had elevated white blood cell count. There were 168 patients with SSSS accompanied with fever, 34 patients accompanied with diarrhea, and 58 patients associated with septicemia. Eighty-five patients performed the bacterial cultures of the skin secretions, 21 did the throat swab, and 13 did both of the skin secretions and throat swab. Bacterial culture results showed that 119 samples were positive for Staphylococci. All patients were cured after antimicrobial therapy. The skin lesions were improved in 3.26 d. The mean hospital stay was 6.55 d. Recovery time of the body temperature was 3.48 d in average.
@*CONCLUSION@#SSSS predominates in infants and children under 3 years old, and has tendency to combine with multi-organ symptoms. The early diagnosis and active antimicrobial treatment are the keys of successful treatments.

Significance of the Calgary Syncope Seizure Scores and the Modified Calgary Syncope Seizure Scores for dif-ferential diagnosis of syncope or epilepsy in children / 中华实用儿科临床杂志

Objective To analyze the significance of the Calgary Syncope Seizures Scores (CSSS)and the Modified Calgary Syncope Seizure Scores (MCSSS)for differential diagnosis of syncope or epilepsy in children. Methods Totally 201 children[95 male,and 1 06 female,aged 5 -1 8 years,mean age (1 1 .76 ±3.03)years]with syncope or epilepsy who visited the syncope clinic or admitted to the Department of Nerve Specialty Clinic of Pediatrics, the Second Xiangya Hospital of Central South University from October 201 3 to April 201 4 were included in the study. Patients were eligible if they had ≥1 loss of consciousness.The diagnosis was analyzed by the CSSS and the MCSSS and receiver operating characteristic (ROC)curve was used to explore the predictive value of different scores in differential diagnosis of syncope or epilepsy in children.Results There were significant differences in the CSSS be-tween syncope[-4(-6,1 )]and epilepsy[2(-3,5)]in children(Z =-1 1 .63,P <0.01 ).When the score was ≥1 ,the sensitivity and specificity of the differential diagnosis between syncope and epilepsy were 91 .46% and 95.80%, respectively;and Youden index was 0.87.Epilepsy should be considered when the score was ≥1 .There were significant differences in the MCSSS between syncope[-4(-6,1 )]and epilepsy[3(-3,6)]in children(Z =-1 1 .71 ,P <0.01 ).When the score was ≥1 ,the sensitivity and specificity of the differential diagnosis between syncope and epilep-sy were 92.68% and 96.64%,respectively;and Youden index was 0.89.Epilepsy should be considered when the score was ≥1 .Conclusions CSSS and MCSSS might be used as an initial diagnostic method in differential diagnosis be-tween syncope and epilepsy in children,based on the history of the patients.MCSSS in the differential diagnosis between syncope and epilepsy in children was more objective,easier to operate in the clinical work than CSSS.

The clinical value of amino-terminal pro-brain natriuretic peptide in septic children / 中国医师杂志

Objective To investigate the prognostic value of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with sepsis.Methods A total of 162 patients was enrolled with consecutive pediatric intensive care unit (PICU) admissions during the study period of Jan 1st,2013 to June 30th,2013 at Hunan Children's Hospital.The 162 septic patients were divided into sepsis group and severe sepsis group,sepsis group and septic shock group,and survival group and death group.NT-proBNP was tested in the first and third day after 162 septic patients in hospital.Pediatric critical illness score (PCIS) score was assessed in all patients.NT-proBNP was compared between groups.The change of NT-proBNP was summarized between groups.The relationship between NT-proBNP and PCIS was analyzed.Results (1) The plasma NT-proBNP level of the first day after admission in the severe sepsis group and septic shock group was higher than sepsis group,the PCIS in the sepsis group was higher than severe sepsis group and septic shock group,with significant difference (P ＜ 0.05).(2) The plasma NT-proBNP level of the first day after admission in the death group was higher than the survival group,the PCIS in the death was lower than the survivor group,with significant difference (P ＜ 0.05).In the death group,the plasma NT-proBNP level of the third day after admission was higher than the NT-proBNP of the first day after admission (P =0.037) ; contrarily,the plasma NT-proBNP level of the third day after admission was lower than the NT-proBNP of the first day after admission in the survival group (P =0.023).Conclusions NT-proBNP could be used to assess the condition of septic patients,and dynamic test NT-proBNP can help to predict septic patient’s prognosis.

The relationship between the hemodynamic changes in head-up tilt test and the height, body quality and body mass index in children / 中国小儿急救医学

Objective To explore the relationship between the hemodynamic changes in head-up tilt test(HUTT) and the height,body quality and body mass index in children.Methods We choosed 1906 cases of unexplained syncope,headache,dizziness in children who came from Children Syncope Outpatient in the Second Xiangya Hospital of Central South University from Jan.2000 to Aug.2012,Male 964 cases and female 942 cases.Their ages were 2 to 17.92 years old.The average age was 10.84 ± 2.97 years old.The height and body mass in children was measured,BMI was calculated.After obtain written informed consent subjects or guardian,the HUTT was carried.According to the result of HUTT and reaction type,the children were divided into HUTT negative group,orthostatic tachycardia syndrome(POTS) group,vasovagal syncope (VVS) vascular inhibitory type group,VVS heart inhibited type group,the VVS mixed group.Results Compared to the HUTT negative group,the age increased in POTS group and VVS vascular inhibitory group and VVS mixed group(P ＜ 0.05),height and body quality and body surface area increased in POTS group and VVS vascular inhibitory group and VVS mixed group(P ＜ 0.01).Compared to POTS group,body quality and body surface area reduced in VVS vascular inhibitory group and VVS mixed group(P ＜ 0.05).VVS heart inhibitory group was no statistically significant difference compared with the other groups (P ＞ 0.05).Conclusion There is a certain relationship between the hemodynamic changes in HUTT and the height,body quality and BMI in children.

The clinical value of N-terminal pro brain natriuretic peptide in septic children with myocardial damage / 中国小儿急救医学

Objective To evaluate the clinical value of N-terminal pro brain natriuretic peptide (NT-proBNP) in septic children with myocardial damage.Methods From Jan 1 to Jun 30,2013,162 children confirmed with sepsis in PICU of Hu'nan Children's Hospital were enrolled in the study.Patients were divided into myocardical injury and non-myocardical injury group according to whether accompanied with myocardial injury.NT-proBNP,lactate dehydrogenase,creatine kinase isoenzyme (CK-MB),troponin Ⅰ (cTnⅠ),myoglobin(MB) of patients were measured within 24 h after admission.The NT-proBNP level between two groups was compared.The correlations between NT-proBNP and cTnⅠ,CK-MB were studied respectively.Results The NT-proBNP level[M(Q)] in myocardial injury group[3 632 (668.5,15 453.5) pg/ml] was higher than that in non-myocardial injury group[349 (169,1 500) pg/ml],which was significantly different(Z =91.881,P =0.000).The levels of NT-proBNP,CK-MB,cTnⅠ,MB were abnormal distributions.There were positive correlations between logNT-proBNP and logCK-MB (r =0.367,P =0.000),logcTnⅠ(r =0.304,P =0.001) and logMB (r=0.302,P =0.000).NT-proBNP value of 1 163 ng/ml had a sensitivity of 76％ and a specificity of 74％ to diagnose myocardial injury.Conclusion NT-proBNP could help to diagnose sepsis with myocardial damage.

The characters of behavioral inhibition system and behavioral activation system in clinical depressed adolescents / 中华行为医学与脑科学杂志

Objective To explore the characters of behavioral inhibition/activation systems in clinical depressed adolescents.Methods According to CCMD-3 diagnostic criteria,46 depressed adolescents and 35 healthy adolescents were selected and assessed by Behavioral Inhibition/Activation System Scale,Beck Depression Inventory and Hospital Anxiety and Depression Scale.Results (1) Compared with subgroup of mixed depression-anxiety (15.84 ± 2.36),depression only subgroup (13.70 ± 1.72) and control group (12.71 ± 2.55) scored higher in BIS (P＜0.01).And the two depressed subgroups (34.00 ± 4.94,35.88 ± 6.80)scored lower than control group (39.11 ± 5.06) in BAS (P ＜ 0.05).(2) Compared with healthy controls (39.11 ± 5.06),depressed adolescents in first-episode(15.28 ± 1.56) and recurrent (14.96 ±2.63) scored higher in BIS(P＜0.01).Adolescents in recurrent (34.58 ± 6.63) scored lower in BAS(P ＜ 0.01).(3) Compared with healthy controls,medication (15.30 ±2.48) and unmedicated depressed adolescents(14.60 ± 1.82) scored higher in BIS(P ＜ 0.01).Medication adolescents (34.52 ± 5.78) scored lower in BAS (P ＜ 0.01).Conclusion The BIS/BAS of depressed adolescents have their characters.BIS reflects mixed depression and anxiety.BAS reflectsdepression and may be a vulnerable index of clinical depression.

Clinical characteristics and treatment of 89 patients with head-up tilt table test induced syncope with convulsion / 中南大学学报(医学版)

OBJECTIVE@#To study the clinical features and intervention strategies of head-up tilt table test (HUTT) induced syncope triggering convulsion.@*METHODS@#HUTT was performed in 2377 cases (male 1116 cases and female 1261 cases) with syncope, dizziness, headache, chest tightness at Second Xiangya Hospital of Central South University from September 2000 to August 2011. They were 2.00-78.00 (18.57±14.36) years old, 1719 cases were younger than 18 years (the children group) [(2.00-17.92 (10.88±3.02) years] and 658 were older than 18 years (the adult group) [(18.00-78.00 (38.66±12.87) years]. We analyzed the related factors for inducing syncope triggering convulsion symptom and other serious side effects in HUTT.@*RESULTS@#1) Eighty-nine patients (3.74%) induced syncope with convulsion symptoms during HUTT, with more adults (62.92%) than children (37.08%) (χ(2)=87.842, P<0.01). 2) Sinus cardiac arrest and heart rate recovery time: 25 (28.09%) out of the 89 patients had sinus cardiac arrest. The sinus cardiac arrest time was 3.00-14.60 (7.90±3.44) s. After the HUTT, the heart rate recovery time was 0.50-37.00 (3.05±4.11) min, 70 of which (78.65%) resumed 3 min. 3) INTERVENTIONS: when all patients completed the HUTT, they would take oxygen and drink milk and other measures to relieve convulsions and recover heart rate and blood pressure. No one died, and the vital signs of 2 patients returned to normal after intravenous administration.@*CONCLUSION@#Induced syncope triggering convulsion symptom in HUTT is more common in adult patients. Convulsions disappear and heart rate and blood pressure return to normal after taking oxygen and milk and other measures. HUTT in clinical practice is safe, and can be used in patients of all ages.

Application of mini-clinical evaluation exercise in clinical neurology practice / 中华医学教育探索杂志

ObjectiveTo evaluate the feasibility and value of mini-clinical evaluation exercise (Mini-CEX) in clinical neurology practice.MethodsNinety-four interns were randomly divided into observation group and control group,students in control group were teached and managed in accordance with existing management while those in observation group were evaluated by teachers after the 1 st,2nd and 3rd week.At the end of clinical practice,all the students( including students in control group and observation group)were cross assessed by teachers based on the methods mentioned above.Results The time to complete the assessment was about 25 - 40 min.The scores of nervous system examination at the end of the training were significant different between observation group and control group and the scores of diagnosis and treatment on the basis of examination were also significant different between observation group and control group ( P ＜ 0.05 ).ConclusionThe Mini-CEX assessment and feedback to promote teaching effect is feasible in the practice process of neurology,it can make up for the deficiency of current examination.