Objective To investigate the predictive value of spiral CT in composition changes of pediatric urinary.Methods A total of 25 pediatric patients with urinary stones were investigated.Eighteen patients with renal stones were stratified into two groups:an alkalization therapy alone group ( n =9 ) and a comprehensive therapy group (n =9).Flame atomic absorption spectrum (AAS) was employed to measure calcium level of the pediatric urinary stones.Spiral CT was employed to measure the peak CT number in vitro of all the pediatric urinary stones and 61 adult urinary stones,which served as controls.Results All pediatric urinary stones contained calcium ( 0.11％ - 26.30％ ).A positive correlation was observed between the CT number of pediatric urinary stone and its stone calcium level ( r =0.855,P ＜ 0.01 ).Compared to the alkalization therapy alone group,the CT number and stone calcium level of pediatricrenal stones in the comprehensive therapy group were significant higher (stone CT number:162 ± 60 HU VS.783 ±476 HU,P ＜ 0.01 ; stone calcium level:1.30 ± 1.52％ VS 19.83 ± 7.48％,P ＜ 0.01 ).Compared to ≤400 HU pediatric renal stones,＞ 400 HU renal stones contained more calcium (21.71 ± 5.27％,1.65 ±1.82％,P ＜ 0.01 ) and failed to dissolve by alkalization therapy alone ( x2 =11.455,P ＜ 0.01 ).Conclusions CT could be a predictive tool for composition changes of pediatric urinary stones.In clinical CT scanning setting,＞400 HU pediatric urinary stones probably will contain more calcium and not be suitable for alkalization therapy alone.

Objective To explore the clinical manifestation, diagnosis and prognosis of Leigh syndrome in children. Method Clinical data from 4 cases of Leigh syndrome conifrmed by genetic testing were retrospectively analyzed. The related literature were reviewed. Results In 4 cases, 3 were boys and one was a girl, 3 cases were onset in infant and one case was in school age. The main manifestations were mental retardation, low muscle tone, convulsions, feeding dififculties, drooping eyelids, extraocular muscle paralysis and nystagmus, irritation, activity intolerance etc. The brain magnetic resonance imaging (MRI) revealed symmetry long T1, T2 abnormal signal in brainstem, bilateral globus pallidus, thalamus, cerebellar dentate nuclei, and periaqueductal, 3 cases involved midbrain, one case involved thalamus, and one case involved cerebellar dentate nuclei;2 cases had encephalatrophy. Electromyography was normal in all cases. The levels of lactate in blood and cerebrospinal lfuid were increased. Mitochondrial DNA (mtDNA) detection found the mutation of mtDNA 8993 T>G in one case, and the mutation of mtDNA 9176 T>C in another 3 cases. The case onset in school age died of respiratory failure one month later, and another 3 cases were still in follow up, there were mental retardation, but no signiifcant setback. Conclusion The clinical manifestations of Leigh syndrome in children are diverse. The diagnosis is based on the typical clinical manifestations and MRI, blood and/or cerebrospinal lfuid lactate levels. The genetic testing is the golden standard for diagnosis.

Objective To investigate the value of serum angiotensin-converting enzyme 2(ACE2),tumor necrosis factor-like weak inducer of apoptosis(TWEAK)and CC motif chemokine ligand 5(CCL5)levels in the diagnosis and severity assessment of attention deficit hyperactivity disorder(ADHD)in children.Methods From October 2022 to October 2023,125 children with ADHD in Hebei Children's Hospital were selected as ADHD group,and 105 healthy children in Hebei Maternal and Child Health Center were selected as control group.According to the Clinical Global Impressions-Severity(CGI-S),the children were separated into a mild to moderate group(n=83)and a severe group(n=42).ELISA was applied to detect levels of ACE2,TWEAK,CCL5,luteinizing hormone(LH),and prolactin(PRL).The combined raven test(CRT)and conners parental symptom questionnaire(PSQ)were applied to score the cognitive and behavioral status of children with disabilities.Spearman correlation was used to analyze the correlation among serum ACE2,TWEAK,and CCL5 with CGI-S,CRT,and PSQ scores in the severe group.Receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of ACE2,TWEAK,and CCL5 for ADHD and severity.Results The serum ACE2(284.35±92.34 pg/ml)and TWEAK(2.56±0.76 pg/ml)levels in children with ADHD were lower than those in the control group(379.23±106.28 pg/ml,3.52±1.12 pg/ml),while CCL5(7.36±2.37 ng/ml)level was higher than that in the control group(5.24±1.63 ng/ml),and the differences were statistically significant(t=7.244,7.703,7.753,all P＜0.05).The levels of CRT,serum ACE2 and TWEAK in the severe group were lower than those in the mild to moderate group(t=5.318,6.686,6.490),while the levels of PSQ and CCL5 were higher than those in the mild to moderate group(t=5.220,6.134),and the differences were statistically significant(all P＜0.05).Spearman correlation analysis results showed that the serum ACE2 and TWEAK levels in the severe group were negatively correlated with CGI-S and PSQ scores(r=-0.432,-0.453;-0.421,-0.426,all P＜0.001),but positively correlated with CRT scores(r=0.427,0.418,all P＜0.000 1).CCL5 was positively correlated with CGI-S and PSQ scores(r=0.421,0.433,all P＜0.001),but negatively correlated with CRT scores(r=-0.446,P＜0.001).The AUCs for diagnosing ADHD by serum ACE2,TWEAK and CCL5 were 0.814,0.803 and 0.807,respectively,and the AUC of the combined diagnosis of the three was 0.945,which was better than individual diagnosis(Z=5.439,4.258,5.576,all P＜0.001).The AUCs for diagnosing severe ADHD by serum ACE2,TWEAK and CCL5 were 0.853,0.796 and 0.805,respectively,and the AUC of the combined diagnosis of the three was 0.930,which was better than the individual diagnosis(Z=2.604,3.851,3.567,all P＜0.001).Conclusion Serum ACE2 and TWEAK are low expressed in the serum of children with ADHD,while CCL5 is highly expressed.The expression levels of the three are correlated and have high diagnostic value for the occurrence and severity of ADHD.