Syncope is one of the most common emergencies in the pediatric population.Autonomic -mediated reflex syncope,including postural tachycardia syndrome and vasovagal syncope,is the main cause.Although the clinical manifestations are similar,each subtype has its optimal treatment option.With the development of translational medicine in recent years,as well as the emergence of biomarkers,precision medicine has become possible,and will be the main direction in the future researches.

Objective To evaluate the efficacy of β-blockers in treatment of postural orthostatic tachycardia syndrome( POTS) in children. Methods Clinical controlled trials were collected from a variety of medical electronic databases including PubMed(1990-2014),Excerpta Medica database(EMBASE 1990-2014),ELSEVIER(1990-2014),China National Knowledge Internet(CNKI 1990—2014) and WANFANG(1990—2014) by 2 researchers simultaneously and respectively based on same inclusion and exclusion criteria. Studies were assessed based on the Juni scale evaluation,and the Meta-analysis was conducted using the Rev-Man 5. 0 software. Results In total 8 clinical trials were included out of over 200 papers. Possible publication bias were assessed by Funnel plot analysis. Meta analy-sis of the 8 studies demonstrated that compared with the placebo group, metoprolol group showed significantly better ef-ficacy in treating children with POTS(RR=0. 37,95%CI:0. 21-0. 64,P=0. 000 5). Furthermore,these included trials were divided into different subgroups based on trial design ( randomized controlled trial/non-randomized con-trolled trial and Scored/N-scored) . Although no statistical heterogeneities were detected within each subgroups by the subgroup analysis,marked heterogeneities were found among subgroups; there was no significant difference of efficacy between metoprolol and placebos in treating POTS in non-randomized controlled trial group(RR=0. 68,95%CI:0. 45-1. 02,P=0. 06). Conclusions Low-dose metoprolol is effective in treating POTS,but the conclusion still needs to be tested by more large-scaled,multi-centered and standardized clinical randomized controlled trials.

Biomarkers ; Cardiovascular Diseases ; diagnosis ; therapy ; Humans

Lurasidone is a new atypical antipsychotic drug, it was approved by the Food and Drug Administration ( FDA ) for treatment of schizophrenia on october 28,2010.The article is to provide an review about pharmacological effects, clinical applications, pharmacokinetics, dosage, drug interactions, adverse reactions of Lurasidone.

Objective To discuss the biomechanical factors in the nonunion of femoral fractures and raise corresponding measures. Methods Sixty eight cases with nonunion of femoral shaft fractures were treated with interlocking intramedullary nailing and 13 with nonunion of distal femoral fractures fixated with dynamic condylar screw (DCS). Inner and outer intramedullary bone graft was performed simultaneously. Results The follow up time was 8 24 months with an average of 14 months in all cases. Sixty eight cases got bone healing except for five cases with breakage of nail or lock nail, which were all cured with again interlocking intramedullary nailing combined with bone graft. Thirteen cases with nonunion of distal femoral fractures were healed after DCS internal fixation treatment. The healing time averaged 6.5 months in 81 cases. According to synthetic standards including bone healing and function recovery, 54 cases won excellent bone healing, 21 good and 6 poor, with an excellence rate of 92.6%. Conclusions The failed femoral fracture operation is mainly due to the failed internal fixation caused by the biomechanical factor of the abductor muscles. Therefore, intramedullary nailing system should be the first choice for internal fixation of femoral shaft fractures and nonunion; and DCS should be used for condylar fractures and nonunion.

ObjectiveTo explore the effects of hemofiltration on serum enzyme (SE),endotoxin (ET) and malonaldehyde (MDA) of dogs with heat stroke caused shock.MethodsSixteen healthy male hybrid dogs were randomly divided into 2 groups,8 for each:as heat stroke group (HS group ) and hemofiltration group (HF group).Severe heat stroke model was induced with high temperature.The dogs were taken out of the heating cabin when it reached heat stroke level,and then observed under normal temperature without treatment.The dogs in HF group was immediately treated with hemofiltration.The changes of SE,ET,MDA of two groups of dogs were observed and the survival time between two groups was compared,ResultsThe time from heat exposure to shock was ( 107.00 ± 28.52 ) and ( 111.38 ± 22.24 )minutes in HS group and HF group respectively ( t =- 0.354,P =0.729 ).The SE ( CK,LDH,ALT,AST) of the dogs were all higher after heat stroke,and the dogs of two groups showed no siginificant difference (P ＞ 0.05).At three hours after heat stroke,the SE increased apparently in HS group and HF group,but the level was significantly lower in HF group. Before heat stroke,the serum ET showed no siginificant difference between two groups ( P ＞ 0.05 ).After heat stroke,the serm ET was much higher than before ( P ＜0.01 ),but there was still no siginificant difference between two groups ( P ＞0.05 ).At three hours after heat stroke,the ET increased both in HF group and HS group,but the level was lower in HF group.Before heat stroke,the serm MDA had no siginificant difference between two groups ( P ＞ 0.05 ).After heat stroke,the serm MDA was much higher than before ( P ＜ 0.0l ),but there was still no siginificant difference between two groups (P ＞ 0.05 ).After heat stroke in three hours,the MDA of HS group rose apparently while HF group slowly declined.The median survival time of HF group was 180 min while HS group was 75 min,the survival rate showed siginificant difference (P ＜ 0.01 ).Conc4usions HF can improve the prognosis of dogs with heat stroke caused shock,prolong its survival time,reduce mortality.The mechanism is probably that HF clear serum MDA,partially clear serum ET and then eventually reduce cell and tissue injury and reduce SE.

Objective:To establish a presenilin enhancer-2 (PSENEN) gene-silenced human immortalized keratinocyte (HaCaT) cell model, and to evaluate the effect of PSENEN gene silencing on the proliferation of and γ-secretase expression in HaCaT cells.Methods:Three shRNAs targeting the PSENEN gene were constructed, and inserted into the linearized LV3-pGLV-h1-GFP-puro vector to establish a recombinant lentiviral expression plasmid. After restriction enzyme digestion and sequencing, lentiviral packaging and purification were performed, and lentiviral titer was determined. Cultured HaCaT cells were divided into 5 groups: shRNA1, shRNA2 and shRNA3 groups treated with the lentivirus solutions containing PSENEN gene-targeted shRNA1, shRNA2 and shRNA3 respectively, NC group treated with the lentivirus solution containing a negative control shRNA (shNC) , and blank group treated without lentivirus solution. After transfection, inverted fluorescence microscopy was performed, and transfection efficiency was determined by flow cytometry. Cell counting kit-8 (CCK8) assay was performed to evaluate the effect of PSENEN gene silencing on the proliferation of HaCaT cells, and real-time fluorescence-based quantitative PCR (qPCR) and Western blot analysis were conducted to determine the mRNA and protein expression of PSENEN, nicastrin (NCT) , presenilin-1 (PS1) and anterior pharynx defective 1a (APH1a) genes respectively. Statistical analysis was carried out by using repeated measures analysis of variance, one-way analysis of variance, and least significant difference t test for multiple comparisons. Results:Inverted fluorescence microscopy showed that fluorescence was observed in the shRNA1 group, shRNA2 group, shRNA3 group and NC group, and flow cytometry showed that the transfection efficiency was over 98% in the above 4 groups. qPCR and Western blot analysis revealed that the mRNA and protein expression of PSENEN gene significantly decreased in the shRNA1 (0.187 ± 0.010, 0.219 ± 0.097, respectively) , shRNA2 (0.163 ± 0.022, 0.208 ± 0.014, respectively) and shRNA3 (0.174 ± 0.009, 0.185 ± 0.062, respectively) groups compared with the NC group (1.054 ± 0.272, 1.076 ± 0.075, respectively, all P < 0.001) . CCK8 assay showed that the cellular proliferative activity significantly increased in the shRNA1 group compared with the NC group at 0, 12, 36 and 48 hours (all P < 0.05) , and there was no significant difference between the 2 groups at 24 or 60 hours (both P > 0.05) ; the cellular proliferative activity was significantly higher in the shRNA2 and shRNA3 groups than in the NC group at 0, 12, 24, 36, 48 and 60 hours (all P < 0.05) . There was no significant difference in the mRNA expression of NCT, PS1 and APH1a genes among the shRNA1 group, shRNA2 group, shRNA3 group, NC group, and blank group ( F= 8.168, 4.644, 1.981, respectively, all P > 0.05) , while the relative protein expression level of mature NCT (mNCT) , immature NCT (imNCT) , carboxyl-terminal fragment of PS1 (PS1-CTF) and APH1a significantly differed among the above 5 groups ( F= 39.268, 5.929, 27.842, 20.663, respectively, all P ≤ 0.01) . Compared with the NC group, the shRNA1, shRNA2 and shRNA3 groups all showed significantly decreased protein expression of mNCT, PS1-CTF and APH1a (all P < 0.01) , but insignificant changes in imNCT protein expression (all P > 0.05) . Conclusion:The PSENEN gene-silenced HaCaT cell model was successfully constructed, and the PSENEN gene silencing could lead to an increase in the cellular proliferative activity of HaCaT cells and a decrease in the protein expression of γ-secretase subunits mNCT, PS1-CTF and APH1a.

Syncope is one of the most common emergencies in the pediatric population,which cause serious in-fluences on the quality of life of children. With the in - depth studies on the pathogenesis mechanism,the evaluation and management level of pediatric syncope has gotten great improvement. The concept of the individualized treatment has been proposed and make the treatment of syncope in children enter a new stage.

Syncope is a common emergency in children and adolescents, which has serious influence on the quality of life.After nearly 30 years′ exploration, great progress has been made in the diagnosis and treatment of children′s syncope in China.We have established the diagnosis procedure of syncope in line with health economics.We have also proposed the concept of individualized precise treatment of syncope in children for the first time.The disease spectrum of syncope in children has been continuously enriched.Relevant progresses have been cited by the guidelines of the United States, Europe and Canada, which has also been unanimously recognized by international experts.

Objective: To analyze the delay on detection, care seeking, diagnosis and treatment of tuberculosis among students in Inner Mongolia Autonomous Region (Inner Mongolia) from 2011 to 2022 and its influencing factors, so as to provide support for the prevention and treatment of tuberculosis among students. Methods: The general demographic indicators of students with tuberculosis in Inner Mongolia from January 1, 2011 to December 31, 2022 were collected from the infectious disease monitoring (new) module of the China Disease Prevention and Control Information System. General characteristics and trend of four types of delayed pulmonary tuberculosis patients in students were analyzed. The influencing factors were analyzed using univariate and multivariate Logistic regressions. Results: From 2011 to 2022, there were 6 032 cases of pulmonary tuberculosis among students in Inner Mongolia. The rates of delayed detection, delayed care seeking, delayed diagnosis, and delayed treatment were 51.71%, 64.01%, 7.82 %, and 2.30%, respectively. The results of multivariate Logistic regression analysis showed that tracking ( OR =1.51) in the patient source,league level diagnosis ( OR =3.16) in the diagnostic institution level,and county level diagnosis ( OR =2.41) were positively associated with delayed discovery ( P <0.05). At the level of diagnostic unit, league city level diagnosis ( OR =2.69), and county level diagnosis ( OR =3.67) associated with more delayed care seeking ( P <0.05). Referral ( OR =1.58) and follow up ( OR =2.55), floating population ( OR =2.05), further consultation with a doctor ( OR =2.11), and no results in imaging manifestations ( OR =2.19) were positively associated with delayed diagnosis( P <0.05). The factors contributing to delayed treatment were referral ( OR =1.84), follow up ( OR =4.91), active screening ( OR =5.46), and floating population( OR =1.95)( P <0.05). Conclusions From 2011 to 2022, the delay on detection and care seeking for tuberculosis patients among students in Inner Mongolia is at a relatively high level, while the delay in diagnosis and treatment is at a relatively low level but shows an increasing trend. It is necessary to focus on the factors associated with delays in identification, diagnosis and treatment in tuberculosis outbreak in the context of school to prevent or reduce school tuberculosis outbreak.