Objective To investigate the clinical outcome and treatment characteristics of viral encephalitis with bilateral thalamic damage so as to improve its prognosis.Methods Twelve cases of viral encephalitis with bilateral thalamic damage were collected during September 2012 to June 2013 by head MRI.These cases were retrospectively studied with the data of medical history,physical examination,laboratory and brain function monitoring and treatment.The relationship between treatment and prognosis was studied during 2 years of follow-up.Results All patients began with the rapid onset,accompanied by fever,coma,and convulsions.Delirium and involuntary movement occurred during the recovery period.Six cases(50.0％) received ventilator assisted ventilation.In the acute phase,electroencephalogram (EEG) showed diffuse slow wave and 4 cases(33.3％) had status epilepticus on EEG.Ten cases discharged from hospital had long-term oral anti epileptic drugs,which lasted 6 months in 3 cases,1 year in 4 cases,and 2 years in 3 cases for maintaining EEG stability.Head MRI indicated white matter demyelination besides the gray matter damage within the thalamus.All 12 patients underwent methylprednisolone impact treatment and 6 cases had effective reversal within 1 week of onset with better tolerance,and the other 6 cases received treatment in subacute stage and 5 of them accelerated recovery and 1 case had sense improvement,but died after giving up therapy.After 3 months courses,8 cases(66.7％) got gross motor and swallowing function recovered to normal,and 3 cases had left unilateral limb movement disorder.After 2 years of follow-up,11 cases had normal motor,intelligence returned to normal in 9 cases,and 2 cases had mild mental retardation.Conclusions Viral encephalitis complicated with bilateral thalamic damage is characterized by acute onset,serious manifestations,idiopathic progress;in the subacute stage it is most likely to develop white matter demyelination.The key to control the disease is to block the inflammatory immune response quickly,and give patients large dose methylprednisolone treatment can effectively curb the progress of the disease.In the sub acute phase,it can promote the recovery,safe and effective.The long-term prognosis will be good with the reasonable treatment at early stage of the disease.

Objective This study aimed to explore the clinical characteristics and treatment of congenital central hypoventilation syndrome(CCHS),to raise awareness on the CCHS for early diagnosis and treatment.Methods The clinical data of 4 babies with CCHS were analyzed,all of the babies were repeated bruising,hypercapnia,and difficult-to-wean.After the relevant checks,we precluded the primary diseases of heart,lung and neuromuscular dysfunction that lead to low ventilation,and detected the major pathogenic genes,Phox2b of CCHS,refer to literature and diagnostic criteria of CCHS.Results Four babies all had typical clinical features of CCHS:enough ventilation when awake.But when they were asleep,their respiratory rate slowed down,hypoventilation,cyanosis and hypercapnia appeared,and they can not be awaked by hypercapnia and hypoxemia caused by hypoventilation.Genetic testing confirmed the presence of Phox2b mutations.Two infants were supported by non-invasive biphasic positive airway pressure(BiPAP),an infant was discharged home at 3 months of age with non-invasive BiPAP,and an infant was discharged home at 1 month of age.Both of them were monitored and treated at home,and showed normal development.Conclusion For babies who were repeated bruising,hypercapnia,and difficult-to-wean,but no primary diseases of heart,lung and neuromuscular dysfunction that lead to low ventilation,CCHS must be considered.Genetic testing of Phox2b can be used as an important diagnostic tool,and non-invasive BiPAP is one of the efficacious methods in the treatment of CCHS.

Objective To evaluate the value of lung ultrasound in diagnosing infectious pneumonia (IPN) of newborns. Methods Seventy-two infants hospitalized from September 1, 2012 to May 30, 2013, in Bayi Children's Hospital, General Hospital of Beijing Military Command were divided into two groups. The study group consisted of 32 newborn infants diagnosed as IPN by medical history, clinical manifestations and chest X-ray, while the control group consisted of 40 neonates without any lung diseases. In a quiet state, the infants were placed in supine, side or prone position for lung ultrasound examination. The lung field was divided into three areas by the anterior and posterior axillary line. The regions of the bilateral lung were scanned by the probe which was vertical with the ribs. Fisher's exact was performed for stastical analysis. Results The most important ultrasound imaging findings of IPN included lung consolidation of varying size and shape with irregular and serrated margins (100%, 32/32), dynamic air bronchograms (100%, 32/32), A-line disappearance (100%, 32/32) and interstitial syndrome (100%, 32/32). Other common ultrasound signs included pleural line abnormalities (91%, 29/32), lung pulse (38%, 12/32) and dynamic air bronchograms (66%, 21/32) under real-time ultrasound. Pleural effusion was an infrequent sign that existed in 9%(3/32)of IPN patients. None of these abnormalities was observed in the control group. Conclusion Lung ultrasound is reliable for the diagnosis of IPN and can be routinely performed in neonatal intensive care units, and a large area of lung consolidation with irregular margins A-line disappearance, interstitial syndrome and pleural line abnormalities are the main image findings.

Objective To explore the effects of prenatal taurine supplementation on the expression of protein kinase A(PKA) and c-fos,Ca2+/calmodulin-dependent protein kinase Ⅱ (GaMK Ⅱ) in fetal rat brains with intrauterine growth restriction and its significance.Methods Fifteen pregnant Sprague-Dawley rats were randomly divided into 3 groups:the control group,the intrauterine growth restriction (IUGR) group and the IUGR with prenatal taurine supplementation group(the taurine group),with 5 fetal rats in each group.All the fifteen fetal rat brains were detected as following:the expression of PKA,c-fos,CaMK Ⅱ mRNA in fetal rat brains was detected by way of real-time polymerase chain reaction(real-time PCR),while the expression changes of PKA,CaMK Ⅱ,and c-fos protein in fetal rat brains were detected by using Western blot,and the number of PKA,CaMK Ⅱ,c-fos positive cells in fetal rat brains was detected by using immunohistochemistry.Results The control group,the IUGR group and the taurine group:Comparison of the expression of PKA,CaMK Ⅱ,c-fos mRNA among 3 groups were of significant differences(F =7.934,P =0.021 ; F =5.568,P =0.043 ;F =7.332,P =0.024).Comparison of the expression of PKA,CaMK Ⅱ,c-fos protein among the 3 groups were of significant differences(F =57.743,P =0.000 ; F =163.405,P =0.000 ; F =160.136,P =0.000).Comparison of the number of PKA,CaMK Ⅱ,c-fos positive cells among the 3 groups were of significant differences (F =42.903,P =0.000 ;F =329.123,P =0.000 ; F =43.674,P =0.000).Compared with the control group,the expression of mRNA,protein,positive cells of three indicators in IUGR group was less,and the difference was statistically significant (P ＜ 0.05).The expression of mRNA,protein,positive cells of three indicators in fetal rat brains of the taurine group were not different from the control group.The expression of mRNA,protein,positive cells of three indicators in fetal rat brains of the taurine group were significantly more than the IUGR group(P ＜ 0.05).Conclusions Prenatal taurine supplementation can improve PKA-CaMK Ⅱ,c-fos mRNA and protein levels in fetal rat brain tissue with IUGR,and increase its number of positive cells and may enhance the regenerative capacity of the central nervous system,so as to reduce the IUGR brain injury and promote its role in brain development.

Objective To study the clinical features of early-onset Group B streptococcal(GBS) sepsis to improve the management of early-onset GBS sepsis.Method To review the clinical data of 27 cases of early-onset GBS sepsis in the Hospital over the past 5 years (January 2013 to November 2017),and analyze its clinical features,laboratory results,complications,prognosis and perinatal characteristics.Result A total of 27 cases of early-onset GBS sepsis were enrolled within 5 years,accounting for 0.85‰ (27/31 936) of total hospitalized patients over the same period.Among them,6 were premature infants and 21 full-term infants.The time of onset was within 24 hours.In all the cases,except for one full-term infant with fever as the initial symptom,the remainder had dyspnea as the initial symptom,accompanied by poor response and low poor muscle tone.Among them,17 patients required assisted ventilation.One of the full-term infant treated with ECMO within 48 hours after birth because of dyspnea,pulmonary hypertension and persistent hypoxemia,etc.,and improved and discharged;another 10 patients needed hood oxygen supply.5 cases (18.5％,5/27) diagnosed with purulent meningitis.In complete blood count,white blood cells ranged from (0.8～34.2)× 109/L,the minimum platelets counts was 16× 109/L,the maximum CRP was 249 mg/L,and maximum procalcitonin was＞ 100 ng/ml.All blood cultures were sensitive to penicillin.of the 27 patients,2 died despite of medical treatment,and 5 patients died as their parents worried about possible sequelae and discharged against medical advice.Therefore,tlhe total mortality rate was 25.9％ (7/27).All children were administered penicillin after the blood culture results were known,meropenem was subsequently added or replaced with vancomycin according to the clinical progress of the child.The remaining 20 patients recovered and discharged.Conclusion The clinical manifestation of early onset GBS septicemia is critically ill,with early onset,rapid progress,and high mortality.Special attention should be paid to high-risk cases during perinatal period,and early recognition with effective treatment would reduce morbidity and mortality.

Objective:To compare the clinical characteristics of congenital chylothorax in preterm and term infants.Method:From January 2011 to December 2019, the clinical data of infants with congenital chylothorax admitted to our hospital were retrospectively analyzed. The infants were assigned into preterm group (<37 weeks) and term group (≥37 weeks) according to their gestational age. The general information, clinical manifestations, laboratory results, treatment and prognosis of the two groups were compared.Result:A total of 34 infants with congenital chylothorax were included, including 11 premature infants and 23 term infants. No significant differences existed in gender, delivery mode, prenatal diagnosis of pleural effusion, congenital heart disease/chromosome abnormality, birth asphyxia, dyspnea, fetal edema, and location of effusion between the two groups ( P>0.05). Compared with term group, preterm group had significantly fewer leukocytes [3 245(1 007, 7 403)×10 6/L vs. 10 214(6 233,16 458)×10 6/L] and lower protein level [(28.1±7.6) g/L vs. (33.3±6.3) g/L] in the pleural fluid ( P<0.05). No significant differences existed in the proportion of pleural lymphocytes between the two groups ( P>0.05). The proportion of mechanical ventilation (MV) in the preterm group was statistically higher than that the term group [100%(11/11) vs. 65.2%(15/23)], and the duration of MV was statistically longer than the term group [(16(10,25) d) vs. (1(0,11) d)] ( P<0.05). No significant differences existed between the two groups in the application of other treatment options (thoracentesis/drainage, fasting, octreotide and erythromycin pleural injection), time needed for the disappearance of effusion, duration of hospital stay and cure/improvement rate ( P>0.05). Conclusion:Preterm infants may have lower leukocyte count and protein level in the pleural effusion than the term infants. Both preterm and term infants have higher proportion of lymphocytes in the pleural effusion fluid. Although most preterm infants need ventilator support after delivery, most of them achieve complete remission after conservative treatment and the overall prognosis is as good as term infants.

OBJECTIVE：To compare the protective effect of atomization inhalation and intraperitoneal injection of edaravone on acute lung injury in smoke inhalation lung injury model rats. METHODS ：Thirty male SD rats were divided into normal control group（group A ），injury group （group B ），intraperitoneal injection group （group C ），low-dose aerosol inhalation group （group D），high-dose aerosol inhalation group （group E ）according to random numble table ，with 6 rats in each group. Group B-E were placed in smoke generator containing pine sawdust to induce smoke inhalation lung injury model. In group A ，the operation was the same as above except that the pine sawdust was not placed. Thirty minutes after modeling ，group C were injected intraperitoneally with edaravone 18 mg/kg（every 70 min，4 times in total ）. Group D and E inhaled edaravone 9，1.8 mg/kg（every 60 min，lasting for 10 min each time ，4 times in total ）. The rats were treated by no means in group A and group B. Six hours after last medication，arterial blood gas analysis was performed ，and the lung wet to dry ratio （W/D）and water content of lung tissue were calculated. The levels of TNF-α，IL-6 and IL- 10 in serum were detected by double antibody ELISA. The contents of MDA ，MPO， SOD and Caspase- 3 in lung tissue were determined by ELISA and other methods. HE staining was used to observe the pathological changes of lung tissue. The apoptotic rate of cells in lung tissue were determined by TUNEL assay. RESULTS ：No abnormality was found in lung tissue of group A ；in group B ，hemorrhage and edema were found in lung tissue ，alveolar structure was difficult to identify，and inflammatory cells and red blood cell infiltration were seen. Above symptoms of rats in group C-E were improved to different extent. Compared with group A ，PaO2/FiO2 and SOD content of lung tissue were decreased significantly in other groups （P＜0.05）；water content of lung tissue ，W/D，serum contents of TNF-α，IL-6 and IL- 10，the contents of MDA ，MPO and Caspase-3 in lung tissue ，apoptotic rate were increased significantly （P＜0.05）. Compared with group B ，PaO2/FiO2 and serum contents of IL- 10 were increased significantly in administration groups （P＜0.05）；water content of lung tissue ，W/D，serum contents of TNF-α and IL-6，the contents of MDA ，MPO and Caspase- 3 in lung tissue ，apoptotic rate were significantly decreased，in dose-dependent manner （P＜0.05）. CONCLUSIONS ：Edaravone has a certain protective effect on smoke inhalation lung injury model rat. It can reduce the production and release of inflammatory mediators and/or cytokines ，reduce the peroxide damage and inhibit cell apoptosis in a dose-dependent manner. The effect of atomization inhalation is more obvious than that of intraperitoneal injection.

The cultivation of medical humanistic quality is indispensable in the standardized training of pediatric residents, and it is urgent to explore new educational methods to improve their medical humanistic quality level. In this study, 60 standardized pediatricians participated in the standardized training, 36 in the experimental group received innovative interactive medical humanities education, while 24 in the control group were set up to receive traditional medical humanities education. Short-term and long-term test scores were conducted by questionnaire at the beginning of the standardized training and 2 years later. The results showed that there was no significant difference between the experimental group and the control group in the self-scores of professional quality, moral cultivation, communication skills, legal knowledge and innovative spirit (P>0.05) , but the scores of teaching teachers were improved except innovative spirit (P<0.05) . In addition, compared with the control group, the number of pediatricians with professional honor increased, the doctor-patient communication ability improved, the medical disputes reduced, and the family satisfaction improved in experimental group were increased (P<0.05) . These results indicated that innovative interactive medical humanistic education is an effective method to improve the medical humanistic quality of pediatric residents in standardized training.