Objective To study the characteristics of immune function,Epstein-Barr virus(EBV) antibodies and EBV-DNA in children with different clinical types of EBV infection,which provide basis for prevention and treatment of EBV infection.Methods Clinical data of 103 patients suffering from EBV infection were retrospectively analyzed in Xijing Hospital of the Fourth Military Medical University.A total of 103 children were divided into infectious mononualeosis(IM) group(n=68),chronic active Epstein-Barr virus infection(CAEBV) group(n=13) and Epstein-Barr virus-related hemophagocytic lymphohistiocytosis(EBV-HLH) group(n=22).The changes of EBV antibodies,EBV-DNA,immunoglobulin levels,lymphocyte subpopulation and complement series were detected and compared among the three groups.A total of 26 healthy children at the same stage were enrolled as a control group,immunoglobulin levels,lymphocyte subpopulation and complement series were detected in control group,then compared with the rest of the three groups.Results The levels of C3 and C4 in CAEBV group and EBV-HLH group were significantly decreased than those in the control group(P<0.05).The levels of IgA,IgG and IgE in EBV-HLH group,CAEBV group,IM group and control group gradually increased(P<0.05,respectively).The levels of IgA,IgG and IgE in EBV-HLH group and CAEBV group significantly decreased than those in control group(P<0.05,respectively).The levels of IgA,IgG and IgE in IM group decreased than those in control group,while there were no statistically significant differences(P>0.05).CD8+T cells in IM group significantly increased than those in the rest of the three groups(P<0.05,respectively).T cells,CD8+T cells,CD4+ T cells,CD4+/CD8+ ratios,NK cells,B cells of EBV-HLH group significantly decreased than those in the rest of the three groups(P<0.05).The positive rates of EBV antibodies in CAEBV group and IM group were significantly higher than those in EBV-HLH group(P<0.05).EBV-DNA in EBV-HLH group were significantly higher than those of CAEBV group and IM group(P<0.05).Conclusion EBV-DNA levels in the serum are positively correlated with disease types and severity,the pathogenesis of IM,CAEBV and EBV-HLH induced by EBV infection are associated with immune dysfunction.Dynamic monitoring of EBV load and cell immune function can reflect disease status and progress risk.

Aim To study cytokine(CK) changes of IL-6,IL-8,sIL-2R and TNF-a levels in sera from patients with juvenile rheumatoid arthritis(JRA) and rheumatoid arthritis(RA) and its correlation with the conventional inflammation indexes,erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP). Methods Levels of IL-6,IL-8,sIL-2R and TNF-a in serum from 30 JRA patients and 34 RA patients,in the synovial fluid (SF)from 4 JRA patients,7 RA patients,6 osteoarthritis(OA) patients and 9 meniscitis(MT) patients were detected by sandwich ELISA. Results As compared with control group,① levels of IL-6 and SIL-2R in sera from 30 JRA patients and 34 RA patients and levels of IL-8 in sera from 30 JRA patients possessed marked difference P∨ 0.01 and P∨ 0.05,respectively.② There were significant difference among serum IL-8 and sIL-2R levels from systemic JRA patients, pauciaticular JRA patients,and serum IL-6 levels from polyarticular JRA patients(P<0.01). ③ There were remarkable difference among SF sIL-2R levels from 4 JRA patients and 7 RA patients and in SF IL-6 levels from 7 with RA patients.④ There were obvious correlativity between serum IL-6,sIL-2R levels and changes of serum ESR and CRP from the JRA patients(r=0.532 and r=0.621,respectively). Conclusion ① IL-6 and sIL-2R exhibit a close correlativity with the activity of JRA and RA,which is the main index of activity of JRA and RA diseases.② sIL-2R might not only participate in systemic pathologic process in JRA and RA diseases,but also serves as a major CK in local articular injuries.IL-6 participates in local articular injuries too,and seems to play a more important role in local articular injuries of RA.③ IL-8 may participate in systemic pathologic process of JRA,but play a minor part in local articular injuries.

Objective To study the clinical characteristics of chronic active Epstein-Barr virus (EBV) infection (CAEBV) in children and to provide a basis for the diagnosis and treatment of CAEBV.Methods Clinical data,laboratory serology,pathological examination,treatment and follow-up results of 10 cases with CAEBV infection who were treated in Xijing Hospital of the Fourth Military Medical University from January 2008 to January 2016 were analyzed retrospectively.Results CAEBV major manifestations were continuous or intermittent fever,hepatomegaly,splenomegaly and lymphadenopathy,and others,including general fatigue,cough,hematemesis,diarrhea,skin rash,jaundice,sore throat,muscle joint pain,and so on.And with liver dysfunction,hematologic abnormality,and so on.All patients in anti-EB virus capsid antigen IgG (EBVCA-IgG)antibodies and EBEA-IgG antibodies had positive,while all patients in EBVCA-IgM antibodies had negative.The median load of EBV-DNA detected by real-time polymerase chain reaction(PCR) in the peripheral blood was 7.15× 105 copies/ml.Six of 10 cases CAEBV patients presented a poor clinical course,1 case died from intracranial hemorrhage,2 cases from respiratory failure,1 case from gastrointestinal bleeding,1 case from liver failure,1 case from severe multiple pathogens infection,rest 3 cases showed an improvement and 1 cases had a recurrence.Conclusion CAEBV infection has varieties of clinical features,with poor prognosis and high mortality.If the patients had unexplained fever,hepatomegaly,splenomegaly and lymphadenectasis,we should be timely detect virology and histopathological to diagnosis as early as possible.

Objective:To observe the application of the controlled respiratory persistence monitor designed based on the principle of rhythmic temperature variations in artificial airways among different populations and in various artificial airways,and to discuss the feasibility and efficacy of monitoring controlled respiration persistence,and to provide a new method for the clinical respiratory monitoring.Methods:A total of 60 adult patients scheduled for general anesthesia,and 30 pediatric patients aged from 1 to 3 years old,classified as American Society of Anesthesiologists(ASA)Ⅰ-Ⅱ,were selected.A total of 60 adult patients were randomly divided into adult tracheal intubation(ATI)group and adult laryngeal mask(ALM)group,and there were 30 cases in each group.Additionally,30 pediatric patients aged from 1 to 3 years old were regarded as pediatric tracheal intubation(CTI)group.After induction of general anesthesia,the patients in CTI and ATI groups were underwent tracheal intubation,while the patients in ALM group were given a laryngeal mask inserted and were connected to the anesthesia machine for mechanical ventilation.Whether or not the device could detect the respiratory rate(RR)of the patients in various groups was observed;the RR detected by the device and the frequency set on the anesthesia machine in various groups were compared.All the patients in three groups were simulated three common clinical scenarios of continuous respiration changes before surgery:disconnection of the breathing circuit,failure to switch from manual to mechanical control on the anesthesia machine,and slow air leakage in the breathing circuit.The ways to report the alert and start time of the atarm by the monitors were compared.Results:The controlled respiratory persistence monitor was able to detect the RR of the patients in three groups,and there was no significantly difference between the RR detected by the device and the frequency set on the anesthesia machine(P＞0.05).In the simulated scenarios of common respiratory persistence changes,all the patients in three groups received an artificial voice alarm signaling"Attention,breathing has stopped.",which was acknowledged.There was no significant difference in the start time of alarm of the controlled respiratory persistence monitor between ATI group and ALM group(P＞0.05).Compared with the start time of alarm of the patients in the same group across different scenarios,compared with slow air leakage in the breathing circuit,the start time to alarm for circuit disconnection and failure to switch from manual to mechanical control was shorter(P＜0.05).Conclusion:The clinical application of the controlled respiratory persistence monitor device designed based on the principle of detecting rhythmic temperature variations within artificial airways is feasible and effective in different populations and artificial airways.This device offers a new method for monitoring the respiratory continuity and ensuring the respiratory safety during surgery.

Objective:To investigate the clinical characteristics and management status of children with Turner syndrome (TS) in China.Methods:As a cross-sectional study, 1 089 TS patients were included in the database of the National Collaborative Alliance for the Diagnosis and Treatment of Turner Syndrome from August 2019 to November 2023. Clinical characteristics (growth development, sexual development, organ anomalies, etc.), karyotypes, auxiliary examinations, and treatments were collected and analyzed.Results:Among the 1 089 TS cases, 809 were recorded karyotypes. The karyotype distribution was as follows: 45, X in 317 cases (39.2%), X chromosome structural variants (including partial deletions of p or q arm, ring chromosome, and marker chromosome) in 89 cases (11.0%), 45, X/46, XX mosaicism in 158 cases (19.5%), mosaicism with X chromosome structural variants in 209 cases (25.8%), and presence of Y chromosome material in 36 cases (4.4%). Among the 824 TS cases, the age of diagnosis was 9.7(6.4, 12.2) years, with a height standard deviation score (HtSDS) of -3.1±1.2. Five hundred and fifty three cases underwent growth hormone (GH) stimulation test, and 352 cases (63.7%) had GH peak values <10 μg/L and 75.9% (577/760) had low IGF1 levels, with IGF1 SDS ≤-2 accounting for 38.2% (290 cases). Among 471 cases aged ≥8 years, 132 cases (28.0%) showed spontaneous sexual development (mean bone age (11.0±1.7) years), 10 cases had spontaneous menarche (mean bone age (12.0±2.2) years), and 2 cases had regular menstrual cycles. Common physical features included cubitus valgus (311 cases (28.5%)), neck webbing (188 cases (17.2%)), low posterior hairline (185 cases (17.0%)), shield chest (153 cases (14.0%)), high arched palate (127 cases (11.6%)), short fourth metacarpal (43 cases (3.9%)), and spinal abnormalities (38 cases (3.5%)). Congenital cardiovascular and urogenital anomalies occurred in 91 cases (19.4%) and 66 cases (12.0%)respectively. Abdominal ultrasound in 33 cases (7.2%) indicated fatty liver, hepatomegaly, intrahepatic bile duct stones, and splenomegaly. Among 23 cases undergoing oral glucose tolerance test (OGTT) test, 2 were diagnosed with diabetes mellitus and 4 with impaired glucose tolerance. Following diagnosis, 669 cases (80.7%) received rhGH treatment at a chronological age of (9±4) years and bone age of (8.3±3.2) years. Additionally, 112 cases (19.4%) received sex hormone replacement therapy starting at the age of (14±4) years and bone age of (12.6±1.2) years.Conclusions:The karyotypes of 45, X and mosaicism were most common in Chinese children with TS. The clinical manifestations were mainly short stature and gonadal dysplasia. However, a few TS children could be in the normal range of height, and some cases among those aged of ≥8 years old had spontaneous sexual development. Some exhibited physical features, congenital cardiovascular and urogenital anomalies, and dysfunction of the hypothalamic-pituitary-IGF1 axis. Moreover, a few of them developed impaired glucose tolerance and diabetes mellitus. Following diagnosis, most of the patients received rhGH treatment, and a few of them received sex hormone replacement therapy.