OBJECTIVE:To explore the effects of enteral nutrition powder in children with phenylketonuria(PKU)under one year. METHODS:120 PKU children under one year were selected and given enteral nutrition powder(20 g/kg,qd)for consecutive 32 weeks. The level of benzene,height,weight,head circumference,IQ level,nutrition indicators and ADR were compared be-fore treatment,8 weeks after treatment,32 weeks after treatment. RESULTS:8 and 32 weeks after treatment,the level of benzene decreased gradually,and height,weight and head circumference increased gradually,with statistical significance(P<0.05). IQ lev-el of children after 8 weeks treatment were better than before,and those of children after 32 weeks treatment were better than after 8 weeks treatment,with statistical significance(P<0.05). 8 and 32 weeks after treatment,nutrition indicators were improved sig-nificantly,compared with before treatment;ALT,Alb and TP levels 32 weeks after treatment were significantly better than 8 weeks after treatment,with statistical significance(P<0.05).There was no statistically significant difference in BUN,TBil and Pa levels between 32 weeks after treatment and 8 weeks after treatment(P>0.05). 66 cases suffered from 181 times of ADR,mainly including 10 times diarrhea and 126 times upper respiratory tract infection,among which one children developed moderate gastroen-teritis. They were all recovered after symptomatic treatment. CONCLUSIONS:For PKU children under one year,enteral nutrition powder can effectively control the phenylalanine levels,prevent the decrease of IQ and improve the nutritional status so as to meet the normal growth and development of children nutritional requirements,with better safety and tolerance.

Objective:To investigate the off-label drug use in the outpatients of Zhengzhou children's hospital in 2013 to provide the evidence for improving the rational drug use in pediatrics. Methods:The prescriptions of outpatients were randomly selected from January to December in 2013. According to the drug instruction, the off-label drug uses were analyzed in the following aspects: sam-pling conditions, the kinds of off-label drug use, the incidence of off-label drug use in different age groups and drug categories. Re-sults:A total of 8 684 prescriptions with 16 344 medical records involving 410 kinds of drugs were analyzed, and the rate of off-label drug use was 70. 87% for prescription, 51. 21% for medical orders and 71. 95% for category, respectively. The primary types of off-label drug use were over applicable people (50. 83%), dosage(21. 00%) and frequency (19. 04%). The top 3 age groups with high-est off-label drug use rate were neonates (63. 27%), infants (56. 20%) and school-age (44. 98%). The top 5 drugs with highest off-label drug use rate were cardiovascular system medicines (99. 02%), anti-infective agents (64. 14%), vitamin and mineral drugs (62. 89%), hematological system medicines (59. 48%) and Chinese patent drugs (53. 43%). Conclusion: Off-label drug use in outpatients is prevalent. Physicians should master indications, usage and dosage described in instructions, select suitable dosage form, reduce off-label drug use and improve drug safety in pediatrics.

Objective To investigate the pathogen characteristics of perforated appendicitis in children and the perioperative use of antimicrobials in order to provide evidence for the rational use of perioperative antibiotics. Methods The perioperative usage of antibiotics was analyzed to determine the reasonableness of antimicrobial use in children with perforated appendicitis who were discharged from July 2011 to August 2014,based on“guidelines of clinical use of antibiotics”and results of bacterial culture. Results Inflammatory secretions obtained from 126 children(126/ 149)were sent for examination and the examination rate was 84.56%.A total of 117 cases were found positive for cultured pathogens,and the detection positive rate was 92.86%.Three types of bacteria ranking the first three places were Escherichia coli,Pseudomonas aeruginosa and CitroBacter freundii.The utilization rate of antibacterial agents was 100.00%,with a dominant use of cephalosporins and nitrate imidazoles. Rational use of antimicrobial agents was found in 144 cases(accounting for 96.64%). Conclusion The major pathogen in perforated appendicitis is still Escherichia coli,which is highly sensitive to commonly used antibiotics,and drug-sensitivity testing results can help guide the treatment programs and antibiotics selection.

Objective: The main ingredients and the inhibitory effects of essential oil of a compound Chinese herbal medicine Weiqi Decoction (WQD) on AGS cell proliferation were to be investigated. Methods: Chemical compounds of WQD essential oil were detected by gas chromatography and mass spectrometry analysis. Cell viability was measured by methyl thiazolyl tetrazolium method. Cell cycle distribution was detected by flow cytometry. Apoptosis and necrosis of AGS cells were determined by Hoechst 33342/propidium iodine staining. Results: Chemical analysis showed that the main ingredients of WQD essential oil were bornylene and 3-n-butylphthalide. Ligustilide, which is the effective compound of Danggui (Radix Angelicae Sinensis), was not detected in WQD essential oil. The essential oil inhibited cell proliferation in a dose- and time-dependent manner, and blocked cell cycle progression at G(2)/M stage. At the concentrations that resulted in significant inhibition of cell proliferation and cell cycle arrest, essential oil induced both apoptosis and necrosis. Conclusion: The results suggest that WQD essential oil contains some effective ingredients for treating chronic atrophic gastritis and functional dyspepsia, and also has an antiproliferative effect on AGS cells through cell cycle arrest and apoptosis promotion in vitro. Therefore, essential oil should be retained as much as possible during stewing this decoction.

OBJECTIVE:To provide baseline data for the formulation of the strategy for medical institutions in China. METH-ODS:3 600 discharged medical records were randomly collected from our hospital in 2013. According to drug package inserts,the judgment was carried out about whether off-label drug use existed in medical orders. The types of off-label drug use,off-label drug use of children in different age groups and of various drugs were all analyzed. RESULTS:A total of 3 268 hospitalized children were includ-ed,and 35 523 medical orders were analyzed,involving 468 types. Based on children,medical orders and drug types,the incidence of off-label drug use were 91.34%,35.72%and 48.72%,respectively. The types of off-label drug use mainly included pediatric medica-tion information(74.21%), exceeding route of administration(8.12%)and overage(8.45%). The top 3 age groups with respect to the incidence of off-label drug use were adolescents(42.42%),neonate(37.97%)and infant(35.48%). Top 4 drugs of off-label use in the list of medical orders were anti-infective drugs(23.65%),electrolytic,drugs for acid-base balance and nutrition(12.21%), drugs for respiratory system(36.84%)and cardiovascular drugs(63.21%). CONCLUSIONS:The off-label drug use of hospitalized children is common in our hospital. It is urgent to develop related laws and regulations or guidelines to regulate off-label drug use in or-der to ensure the safety of pediatric drug use.

Immune checkpoint inhibitors(ICIs)have become the most widely used drugs in tumor immunotherapy, with ipilimumab and nivolumab as their representatives.However, the use of immune checkpoint inhibitors has brought about many immune-related adverse events, of which myocarditis is one of the most fatal adverse reactions.The pathogenesis of immune checkpoint inhibitor-associated myocarditis is not fully understood, mainly involving autoimmune T lymphocyte infiltration, regulatory T-cell dysfunction, cytokines, autoantibody production, genetic factors, the gut microbiome, etc.The treatment and management of immune checkpoint inhibitor-associated myocarditis require concerted efforts of multidisciplinary experts.

Objective:To observe the clinical characteristics of adult patients with ocular toxoplasmosis (OT).Methods:This study was a retrospective clinical trial. Among the 83 consecutive OT patients diagnosed in the Zhongshan Eye Center of Sun Yat-Sen University, 14 patients (16.9%, adult group) aged ≥18 years were included in the study from January 2017 to December 2019. A total of 14 OT patients (children group) aged less than 18 years who had consecutive visits from July to December 2019 were selected as controls. All patients underwent BCVA, slit lamp microscope, fundus color photography, and B-mode ultrasound examination. Eighteen cases underwent UBM examination, including 6 and 12 cases in the adult group and child group respectively; 23 cases underwent FFA examination, including 12 and 11 cases in the adult group and child group respectively. Snellen visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity in statistics. We compared the two groups of patients' residence (urban or rural), history of contact with dogs and cats, main symptoms, reasons for treatment, course of disease, and clinical and imaging characteristics and so on. For measurement data conforming to normal distribution, t-test was performed for comparison between groups; for Skewness distribution measurement data, rank sum test was performed for comparison between groups. Results:Compared with the adult group and the child group, there was no significant difference in the canine-cat contact history ( Z=2.661, P=0.257) and the time from first diagnosis to diagnosis ( t=-0.186, P=0.351); compared with the children group and the adult group, the patient's living environment was mainly urban, and the course of disease was significantly shorter ( Z=-2.005), and the difference was statistically significant ( P=0.047). The logMAR BCVA of the adult group and the child group were 0.81±1.08 and 2.08±1.30, respectively, and the difference was statistically significant ( Z=-2.811, P=0.004); compared with the child group, the adult group had lighter vitreous opacities, but the difference was statistical significance ( Z=7.847, P=0.048). FFA examination revealed 20 cases of "fern-like" leakage of retinal capillaries. Among them, the adult group and child group were 10 (83.3%, 10/12) and 10 (90.9%, 10/11) cases respectively. Conclusions:Adult patients account for 16.9% of OT patients. Compared with children, adult patients mostly live in towns or cities, have a short course of disease, good vision at first diagnosis, and mild inflammation or hyperplasia of the vitreous cavity. FFA is helpful for the diagnosis of adult OT.