OBJECTIVETo analyze the clinical value of 24-hour urinary sodium determination in children with postural tachycardia syndrome (POTS).

METHODFifty-eight POTS children and 10 healthy children (control group) from Peking University First Hospital during June 2012 to May 2014 were enrolled. Their 24-hour urinary sodium and plasma sodium levels were compared. Correlation analysis was done between 24-hour urinary sodium and symptom scores in children with POTS. All patients were treated with oral rehydration salts. The POTS patients were divided into hyponatriuria group (urinary sodium < 124 mmol/24 h) and hypernatriuria group (urinary sodium ≥ 124 mmol/24 h). Kaplan-Meier curve was used to analyze the effects of different 24-hour urinary sodium levels in children with POTS receiving rehydration salts therapy.

RESULTThe 24-hour urinary sodium levels of children with POTS were significantly lower than that of control group ((110. 0 ± 45. 8) vs. (221. 3 ± 103. 6) mmol/24 h, t =3. 339, P = 0. 008), while no statistical significance was found in plasma sodium between the two groups ((139. 7 ± 2. 1) vs. (139. 7 ± 2. 3) mmol/L, t = 0. 082, P = 0. 935). Pearson correlation analysis showed that 24-hour urinary sodium and severity of symptoms in children patients were negatively correlated (r = - 0. 654, P < 0. 001) . Urinary sodium < 124 mmol/24 h was used as the cut-off value, there were 43 cases in hyponatriuria group and 15 cases in hypernatriuria group. The symptom scores were significantly higher in hyponatriuria group (10. 2 ± 3. 7 vs. 5. 0 ± 1. 8, P < 0. 001), there was no significant difference in other basic information and hemodynamic data between groups (P > 0. 05). Logistic regression analysis revealed that urine sodium < 124 mmol/24 h was independent risk factor for effectiveness of rehydration salts in POTS patients (OR = 0. 043, 95% CI:0. 004 - 0. 499, P = 0. 012). Kaplan-Meier survival analysis showed the long-term effect of patients receiving oral rehydration salts in hyponatriuria group was significantly better than that in hypernatriuria group (86. 0 % vs. 60. 0%, χ2 = 8. 471, P = 0. 004).

CONCLUSIONTwenty-four hours urinary sodium is a good indicaor for guiding children with POTS receiving rehydration salts therapy.

Case-Control Studies ; Child ; Fluid Therapy ; Hemodynamics ; Humans ; Postural Orthostatic Tachycardia Syndrome ; urine ; Rehydration Solutions ; Salts ; Sodium ; urine

Objective To investigate the level and the source of inflammatory factors in patients with paroxysmal atrial fibrillation.Methods Thirty patients with paroxysmal atrial fibrillation were selected as observation group,and 20 cases of patients with paroxysmal supraventricular tachycardia were selected as control group.The blood samples of coronary sinus,right atria,left atria and femoral vein were consecutively collected during the procedure of radiofrequency ablation.The level of tumor necrosis factor (TNF)-α,soluble tumor necrosis factor receptor-1 (sTNFR1),and interleukin(IL)-6 was detected by ELISA separately and compared between two groups.Results The level of TNF-α and IL-6 of coronary sinus,right atria,left atria and femoral vein in observation group was significantly higher than that in control group [TNF-α:(4.45 ± 1.76) ng/L vs.(0.59 ± 0.36) ng/L,(6.67 ± 1.43) ng/L vs.(0.51 ± 0.30) ng/L,(8.35 ± 2.03) ng/L vs.(0.85 ± 0.50) ng/L,(9.97 ± 2.70) ng/L vs.(0.28 ± 0.29) ng/L,P=0.000;IL-6:(2.02 ± 0.87) ng/L vs.(1.04 ± 0.63) ng/L,(1.51 ± 0.68) ng/L vs.(0.74 ± 0.26) ng/L,(2.00 ± 0.51) ng/L vs.(0.88 ± 0.35) ng/L,(1.32 ±0.47) ng/L vs.(0.48 ±0.28) ng/L,P =0.000].The level of high sensitivity C reactive protein (hs-CRP) in observation group was significantly higher than that in control group [(2.41 ± 1.35) mg/L vs.(1.10 ±0.53) mg/L,P =0.002].The level of TNF-αof left atrium in observation group was significantly higher than that of other three sites (P=0.000).The level of IL-6 in the coronary sinus and femoral vein was significantly increased,compared with that in the right atria and left atria (P ＜ 0.05).The level of sTNFR 1 in the femoral vein,right atria and coronary sinus difference was not statistically significant (P ＞ 0.05),but was significantly higher than that in the left atria(P ＜ 0.05).The level of TNF-α,IL-6 and hs-CRP was correlated with the diameter of left atrium (LAD) (P ＜ 0.01 or ＜ 0.05).The level of sTNFR1 in left atria was positively correlated with LAD,and the level of sTNFR1 in right atria was negatively correlated with LAD (P ＜ 0.01).Conclusions The level of TNF-α,IL-6 and hs-CRP is increased in patients with paroxysmal atrial fibrillation.TNF-α and IL-6 may come from the heart and is related with the enlargement of left atrium.

Objective To compare the therapeutic effect of Midodrine hydrochloride plus oral rehydration salts,Metoprolol plus oral rehydration salts and simple oral rehydration salts on children with postural tachycardia syn-drome(POTS). Methods One hundred and ninety - two children with POTS were divided into Midodrine hydrochlo-ride plus oral rehydration salts group(84 cases),Metoprolol plus oral rehydration salts group(54 cases)and oral rehy-dration salts group(54 cases). The patients were followed up at the outpatient department after 3 - months treatment. Short - term effect was analyzed by reevaluating the symptom scores,repeating upright test and studying the side effects of the drugs. All the children were followed - up by telephone,mainly investigating on the syndrome recurrence and symptom - free survival by Kaplan - Meier analysis. The follow - up time was 3 to 122(42. 7 ± 24. 3)months. Results Short - term effect showed that the symptom scores were decreased after treatment(t = 21. 536,P ﹤ 0. 001). Head -up test showed that delta heart rate was decreased. The effective rates in the Midodrine hydrochloride plus oral rehydra-tion salts group and the Metoprolol plus oral rehydration salts group were significantly higher than those of the simple oral rehydration salts group(χ2 = 10. 905,P = 0. 004). But no statistical difference was found between the Midodrine hydrochloride plus oral rehydration salts group and the Metoprolol plus oral rehydration salts group(χ2 = 0. 042,P =0. 837). Long - term effect by Kaplan - Meier curve showed that the therapeutic effect of Midodrine hydrochloride plus oral rehydration salts group was significantly higher than any of the other two groups(χ2 = 13. 299,P ﹤ 0. 01),but no statistical difference was found between the Metoprolol plus oral rehydration salts group and the simple oral rehydration salts group(χ2 = 0. 150,P = 0. 699). Conclusions In terms of the short - term result,the effective rates in the Mido-drine hydrochloride plus oral rehydration salts group and the Metoprolol plus oral rehydration salts group were signifi-cantly higher than those of the simple oral rehydration salts group. The therapeutic effect of the Midodrine hydrochloride plus oral rehydration salts was superior to that of the Metoprolol plus oral rehydration salts and the simple oral rehydra-tion salts for POTS children by the long - term follow - up study.

Objective To investigate the clinical efficacy of dexmedetomidine (DEX) combined with pentazocine intravenous anesthesia in percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) in the elderly.Methods A retrospective case-control study was performed to analyze 63 elderly OVCF patients treated with PKP and admitted to Tianjin Hospital from June 2018 to December 2018.There were 20 males and 43 females,aged 65-86 years [(74.7 ± 1.1)years].There were 15 patients with thoracic compression fractures and 48 with lumbar compression fractures,in whom the vertebral height loss was ＜ 30％ without posterior ligament complex damage.Nineteen patients received local anesthesia with lidocaine (Group A),21 patients received intravenous anesthesia with pentazocin and propofol (1 mg/kg) (Group B),and 23 patients received intravenous anesthesia with pentazocin and DEX (0.5 μg/kg) (Group C).Heart rate,systolic blood pressure,respiratory rate and blood oxygen saturation (SPO2) were recorded at 5 time points:at rest in the operating room (T0),after intravenous injection of pentazocine (T1),when the balloon dilated (T2),after the injection of cement (T3),and blinking after being called or at the end of the operation (T4).The levels of plasma cortisol were recorded before and at T3 in three groups.Visual analogue score (VAS) at T4 was recorded.The operation time,patient satisfaction and incidence of adverse reactions were recorded.The wake-up time and orientation recovery time of groups B and C were recorded.Results The heart rate,mean systolic blood pressure,respiratory rate in Group A at T2,T3 and T4 were higher than those in Groups B and C (P ＜ 0.05),but there was no significant difference between Groups B and C (P ＞ 0.05).There was no significant difference in SPO2 at only time among the groups (P ＞ 0.05).No significant differences were found in cortisol between the three groups before surgery.The cortisol level of Group A at T3 was higher than those of Groups B and C with significant difference (P ＜ 0.05),but no significant difference was found between Groups B and C (P ＞0.05).The VAS in Group A was significantly higher than those in groups B and C (P ＜ 0.01).The operative time in Group A was longer than those in Groups B and C (P ＜ 0.05),but no significant difference was found between Groups B and C (P ＞ 0.05).There was no significant difference in patient satisfaction between Groups B and C,and both of them were higher than Group A (P ＜0.01).There was no significant difference in the incidence of adverse reactions between the three groups (P ＞ 0.05).The wake-up time and orientation recovery time of Group C were shorter than those of Group B (P ＜ 0.01).Conclusion For elderly OVCF patients,pentazocin combined with propofol or DEX can be applied in PKP,which has satisfactory analgesic effect,slight effect on respiratory and circulatory,less adverse reactions,and good patient feedback.DEX has more advantages of awakening and orientation recovery and is worthy of clinical application.