Objective To systematic review the methodological quality of guidelines for Guillain-Barré syndrome (GBS) in children, to provide a reference for clinical evidence-based medicine. Methods Guidelines concerning GBS were electronically retrieved from PubMed, EMbase, CBM, Wanfang data, CNKI and Vip. The guide databases includes major medical institutions and industry sites such as NGC, GIN, TRIP , CDC, IDSA, AAP, WHO, Chinese Health and Family Planning Committee website, library of clinical guidelines China and Chinese clinical guidelines for collaboration. All the data were searched from inception of the database or network to Oct. 2013. Two reviews independently screened literature according to the inclusion and exclusion criteria, and assessed the quality of guideline using the AGREEⅡ. Intraclass correlation coefficient (ICC) was used to examine the conformance of the raters' evaluation scores. Results A total of 5 guidelines concerning GBS were included, with a time range from 2003 to 2012, and origins from USA, EU and Canada. The final recommendation levels of the 5 articles were level B. According to the AGREEⅡ, domain 3 and 4 showed the higher scores, and scores were generally low in domain 5. Plasma exchange (PE) and intravenous immuneglobulin (IVIG) showed positive effects on the treatment of GBS. But it was not recommended that combined PE and IVIG. Corticosteroids are also not recommended for GBS treatment. Conclusions The recommendations of medicines for GBS are basically consistent. However, the classification criteria of the levels of evidence and recommendation are still unconsistent and suboptimal. The guidelines on GBS should be improved in“Applicability”in future.

OBJECTIVE:To establish the method for the content determination of2,3,5,4'—tetrahydro-xystilbene—2—O—?—D—glucoside in Yangxueshengfa capsules by RP-HPLC.METHODS:Alltima-C 18 was used as the chromatographic column;the acetonitrile-water(15∶85)was taken as the mobile phase with flow speed at1.0ml/min and detection wave?length at320nm.RESULTS:In the range of0.45?g～2.26?g,2,3,5,4'—tetrahydro-xystilbene—2—O—?—D—glucoseide were in direct proportion to the peak area value(r=0.9996),the mean recovery rate was98.32%(RSD=1.58%,n=6). CONCLUSION:This method was simple,convenient and accurate,which can be used for the content determination and the quality control of Yangxueshengfa capsules.

OBJECTIVE:To systematically review the related evidence-based guidelines of purulent meningitis in children,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,EMBase,CBM,Wanfang Data-base,CJFD and VIP,NGC,GIN,TRIP and websites of domestic and international medical associations and industry bodies,the treatment guidelines about purulent meningitis in children were collected. Evidence-based evaluation was performed after data extrac-tion and quality evaluation. RESULTS:Finally 3 guidelines were enrolled in total,with development time ranging from 2004 to 2012,from USA,Britain and Australia,respectively. All of the recommendations were level B,scope and purpose and clarityshowed the higher scores in AGREEⅡ,more than 70%,and applicability showed generally low scores. Penicillin and cefotaxi-me were recommended in purulent meningitis of neonates,and vancomycin combined with cefotaxime or ceftriaxone were recom-mended for infants and children(it was combined with vancomycin when Streptococcus pneumoniae infection was suspected). The dose and duration of each guideline were certain different,and the period of treatment should be longer in neonates. In addition, the glucocorticoid was recommended in all guidelines. CONCLUSIONS:The recommendations of medicines for the treatment of pu-rulent meningitis are basically unanimous,with no regional difference,but there are some differences about dose and the course of treatment. In addition,the classification criteria of the levels of evidence and recommendation are still suboptimal,which needs fur-ther improvement. And guidelines on purulent meningitis should be improved inrigourandapplicabilityin future.

Objective:To investigate the correlation between MRI signal for infrapatellar fat pad (IPFP) and pathological changes in knee osteoarthritis (KOA),and to analyze the role of IPFP in the development of knee osteoarthritis.Methods:A total of 114 subjects (without special knee disease) were enrolled for this study.The intensity of MRI signal for IPFP was determined by fat-suppressed proton-density-weighted turbospin-echo magnetic resonance imaging.Based on the cartilage defects and osteophytes of knee joint,the subjects were divided into a KOA group and a control group.The difference of MRI signal for IPFP between two groups was analyzed.Results:After excluding the potential confounders of age,gender and BMI,the intensity of MRI signal for IPFP was positively correlated with defections in patellar,medial femur,lateral tibial or knee joint (OR 1.333 to 2.168,P 0.006 to 0.023);the intensity of MRI signal for IPFP was also positively correlated with osteophytes in patellar,medial femur,lateral tibial or knee joint (OR 1.309 tol.781,P 0.004 to 0.046);the intensity of MR/signal for IPFP in the KOA group was significantly higher than that in the control group (P=0.028).Conclusion:The increase in the density of MRI signal for IPFP is an imaging manifestation for knee degeneration.IPFP inflammation and endocrine abnormalities may play an important role in KOA.

Purpose MRI is one of the most effective methods in examining anterior cruciate ligament (ACL),but probability of misdiagnose and missed diagnosis still might exist.This research aims to investigate the effect of oblique coronal MRI views in individualized bent-knee position on the imaging findings of ACL.Materials and Methods Seventy healthy volunteers recruited by the Third Xiangya Hospital,Central South University from September 2016 to March 2017 were involved in this prospective study.3-T MRI combined with independently designed knee joint dynamic imaging auxiliary instrument was employed to perform a dynamic scan in the sagittal plane;the optimal bentknee angle with ACL basically in straight layers (angle of the individualized bent-knee position) was measured.Afterwards,oblique coronal MRI views (PDWI+FS) in both regular extended-knee position and individualized bent-knee position were conducted.And their separate effects on ACL imaging findings in oblique coronal MRI views were compared.Results Oblique coronal MRI scan in extended-knee position and individualized bent-knee position were 92.9％ (65/70) and 45.7％ (32/70) respectively in displaying the imaging of the whole ACL.The former outperformed the latter,and the difference was statistically significant (P＜0.001).Conclusion In contrast to oblique coronal MRI scan in extended-knee position,the scan in individualized bent-knee position elevates the performance of whole ACL imaging.

China is the rank 1st of gastric cancer in the world,and the incidence and mortality of gastric cancer rank the 3rd among various malignant tumors in China.It has been found that tumor cells have their own energy metabolism characteristics.Even in the presence of sufficient oxygen,tumor cells are more inclined to use glycolysis to produce energy,also known as"aerobic glycoly-sis".Aerobic glycolysis can lead to an increase in lactate,promoting the acceleration of tumor cell proliferation and invasiveness,and the key enzyme driving this phenomenon is lactate dehydrogenase(LDH).LDH levels are significantly elevated in patients with gas-tric cancer,and LDH can contribute to the occurrence and development of gastric cancer in many ways.This article will discuss the role of LDH in tumor glycolysis,which is correlated with gastric cancer as well as its clinical application value.It will also discuss the research progress of LDH in targeted therapy for gastric cancer.

BACKGROUND AND OBJECTIVEBronchopulmonary carcinoid (BPC) account for less than 2% of all primary lung malignant tumors, but few related studies were reported. The aim of this study is to analyze this rare disease's clinicopathological characteristics.

METHODSThe clinical data of 28 patients with BPC in Cancer Center of Sun Yat-sen University, from January 1994 to June 2009, were enrolled into retrospective analysis. First, the corresponding paraffin blocks reexamined, slice up and stained, multiple pathologists re-consulted, and its subsets (typical carcinoid, TC; atypical carcinoid, AC) defined. Second, the clinical characteristics and immunohistochemical markers and its relationship with prognosis were analyzed.

RESULTSFirst, the 5-year survival for overall and TC, AC was 56% and 70%, 41% respectively in 28 cases. The markers CD99, Bcl-2 and Ki-67 expression correlated significantly with the BPC subsets (P = 0.017, P = 0.043, and P = 0.033 respectively). Further univariate analysis revealed that advanced TNM staging (P = 0.037), lymph node metastasis (P = 0.001) and Ki-67 nucleolus's positive expression (P = 0.009) are poor prognostic factors. Second, the overall, TC, AC 5-year survival rate was 73%, 83%, 57% respectively in 20 cases underwent the radically surgical resection. Further univariate analysis revealed that AC subset (P = 0.013), lymph node metastasis (P = 0.004) and Ki-67 nucleolus's positive expression (P = 0.006), advanced TNM staging (P = 0.047) are poor prognostic factors in this 20 cases. Third, as univariate analysis, local recurrence and metastasis (n = 4) correlate significantly with Ki-67 nucleolus's and Bcl-2 positive expression (P = 0.027, 0.045, respectively).

CONCLUSIONThe prognosis of BPC was better than other types of primary lung cancer. Ki-67, Bcl-2 high expression and advanced TNM staging are the poor recurrence and prognostic factors of BPC. The radical surgery remains the treatment of choice for resectable candidates in BPC as NSCLC.

Adult ; Carcinoid Tumor ; mortality ; pathology ; therapy ; DNA-Binding Proteins ; analysis ; Female ; Humans ; Immunohistochemistry ; Ki-67 Antigen ; analysis ; Lung Neoplasms ; mortality ; pathology ; therapy ; Male ; Middle Aged ; Prognosis ; Proto-Oncogene Proteins c-bcl-2 ; analysis ; Retrospective Studies ; Transcription Factors

Objective:To retrospectively compare the clinical efficacy of two PDE3 inhibitors, oplinone and Milrinone, in order to evaluate which drug has better effects on the improvement of cardiac function, protection of renal function and adverse effects of arrhythmia.Methods:A total of 41 neonates with congenital heart disease after biventricular treatment under cardiopulmonary bypass in the Department of Cardiothoracic Surgery at Soochow University Children's Hospital during 2018-2022 were collected. The experimental group was divided into two groups: Oprilinone(25 cases) and Milinone(16 cases). A retrospective study was conducted on the incidence of renal function, cardiac function improvement and arrhythmia in the children.Results:On the first day after operation, EF in both groups decreased significantly compared with that before operation( P<0.01); On day 4 after surgery, EF in the oprilinone group was significantly higher than that on day 1 after surgery( P<0.01), Milrinone group was slightly higher than that on day 1 after surgery( P<0.05), and EF in oprilinone group was significantly higher than that in Milinone group during the same period( P<0.01); EF in Milinone group continued to increase on day 7 compared with day 4( P<0.01), but there was no significant difference between the two groups. Long-term follow-up showed that there was no significant difference in EF value in the oprilinone intervention group on day 7 after surgery( P<0.05), and the long-term EF in Milinone group was higher than that at 7 days after surgery( P<0.05). The creatinine level in the oprinone intervention group continued to decrease on the 4th and 7th day after surgery( P<0.01; P<0.05); The creatinine level of Milinone group on day 4 after surgery was significantly lower than that on day 1 after surgery( P<0.01), the decrease was not significant on the 7th day after surgery compared with the 4th day after surgery; The creatinine level in the oprilinone group was lower than that in the Milrinone group on day 7 after surgery( P<0.05). The rate of arrhythmia in children was slightly decreased in the intervention group of olplinone. There was no change in the Milinone group. Conclusion:Oplinone improved cardiac function better than Milrinone, and the recovery time to normal cardiac function was shorter. In terms of renal function protection, oplinone was stronger than Milrinone, and the protective effect of oplinone on kidney lasted longer. No significant abnormalities were found with respect to adverse reactions, such as the incidence of arrhythmia.

Objective To systematically evaluate the efficacy and safety of hydroxychloroquine(HCQ)in obstetric antiphospholipid syndrome(OAPS).Methods PubMed,Embase,Cochrane Library,Web of Science,SinoMed,Wanfang Data,CNKI,and VIP databases were searched electronically to collect clinical research on HCQ treatment for OAPS from inception to January 31,2023.Two researchers independently screened the literature,extracted data,and assessed the risk of bias of the included studies,Meta-analysis and GRADE evaluation were performed using RevMan 5.4 software and GRADE Profile 3.6 softwares.Results Five cohort studies and three randomized controlled trias(RCTs)were included,with a total of 644 OAPS patients(732 pregnancies).The results of Meta-analysis showed that compared with conventional treatment,HCQ supplementation significantly increased the live birth rate of OAPS(RR=1.29,95％CI 1.10 to 1.51,P=0.001),the negative conversion rate of lupus anticoagulant(RR=1.29,95％CI 1.13 to 1.47,P＜0.001),the anticardiolipin antibody negative conversion rate(RR=1.27,95％CI 1.12 to 1.45,P＜0.001)and the anti-β2 glycoprotein I antibody negative conversion rate(RR=1.31,95％CI 1.12 to 1.52,P＜0.001),the rate of early abortion(＜10 weeks)was significantly reduced(RR=0.31,95％CI 0.10 to 0.93,P=0.04).However,there was no significant difference between the two groups in reducing the rate of premature birth,late abortion(＞10 weeks)and the incidence of preeclampsia(P＞0.05).In terms of safety analysis,two studies described HCQ adverse effects including skin reactions and dry eyes,symptoms are mild.Three RCTs were used to compare the incidence of adverse reactions between the two groups,the incidence of adverse reaction of HCQ group was lower than that of control group(RR=0.40,95％CI 0.25 to 0.66,P＜0.001),and no serious adverse reactions occurred in both groups.The sensitivity analysis results were robust and reliable.The results of GRADE evaluation showed that the quality of index evidence included in this study were low or very low,with weak recommendations.Conclusion HCQ can significantly improve the live birth rate of OAPS and the negative conversion rate of antiphospholipid antibody,and reduce the fetal abortion rate before 10 weeks with fewer adverse reactions,but there is insufficient evidence to reduce the incidence of premature birth,fetal abortion after 10 weeks and preeclampsia.Due to the limited number and quality of included studies,the above conclusions need to be confirmed by more high-quality studies.