Clinical data and radiological findings of 78 patients with distal radial fractures,who underwent plain X-ray film and muhislice CT (MSCT) examinations,were retrospectively analyzed.Twenty nine associated carpal bone factures were detected on X-ray film in 21 cases;while 47 associated carpal bone fractures were detected on MSCT in 29 cases (P ＜ 0.05).The missed diagnosis rate of X-ray was 38％.Results indicate that MSCT can significantly improve the detect rate,which should be recommended for diagnosis of associated carpal bone fractures in distal radial fractures.

Objective To study the sensitivity of the real-time polymerase chain reaction (RT-PCR) in detecting group B streptococcus (GBS) in late pregnant women and the influence of vaginal/rectal GBS colonization on maternal and neonatal outcomes. Methods Microbiological culture and RT-PCR for GBS were both performed for each sample taken from the vagina and rectus in 617 gravidas at 35-37 weeks of gestation, with an average age of 30.1, among which 80 aged over 35. Forty-one out of the 617 women were multiparous and 576 primiparous. The laboratory results were collected and the pregnant outcomes were followed. Results (1) Out of the 617 gravidas, 21 (3.4%) were GBS positive by culture (all positive in RT-PCR) and 57 (9.2%) were GBS positive by RT-PCR. Thirth-six cases with PCR positive but culture negative results were analyzed by sequencing, and 34 showed GBS positive and 2 negative. (2) The sensitivity and specificity of RT-PCR was 100% (55/55) and 99.6% (560/562) respectively. (3) The average age of GBS positive gravidas was 30 ± 4, without significant difference compared with that of GBS negative women (31±4), P>0.05. The GBS positive rates were also similar between the primiparas and the muliparous [7.3% (3/41) vs.9.4% (54/576)] , between elderly women and those under the age of 35, and between those women who had abortions over and less than 3 times (all P>0.05). (4) No significant difference was found in the cesarean section rate between the GBS postitive and negative group [54.4% (31/57) vs.44. 6% (250/560), P>0.05]. (5) Compared with the GBS negative group, the GBS positive group had higher incidence of intrauterine infection [6.6% (37/560) vs. 15.8% (9/57)], postpartum hemorrhage (2.9% vs.10.5%) and fetal distress (25.9% vs. 38.6% ) all P <0.05, but had similar incidence of premature rupture of membranes [25.0% (140/560) vs. 33.3% (19/57) ], pretcrm birth and meconium-stained amniotic fluid. (6) The neonatal infection rate in the GBS positive group was significantly higher than that of the GBS negative group [29.8% (17/57) vs. 13.2% (77/560), P < 0.05]. One neonate in the GBS positive group developed early-onset severe GBS infection and achieved better outcome under proper treatment. Conclusions Maternal GBS carrier at 35-37 weeks of gestation can lead to adverse pregnant outcomes by increasing the incidences of intrauterine infection and neonatal infections. However, RT-PCR could be a routine method to detect GBS status in late pregnant women with its higher sensitivity and specificity.

Objective:To explore the early clinical features and the prognostic factors of children with septic shock in PICU.Methods:A retrospective analysis was conducted at PICU of the Children′s Hospital, Capital Institute of Pediatrics from January 2016 to November 2018, totally 56 children diagnosed as septic shock were enrolled in the study.According to the prognosis of 28 days, the patients were divided into death group and survival group; according to the lowest pediatric critical score (PCIS) within 24 hours after admission to PICU, the children were divided into non-critical group (>80 points), critical group (70-80 points) and extremely critical group (<70 points). The clinical characteristics of early stage in each group were analyzed and compared.Results:Of the 56 children with septic shock, 32 were males and 24 were females, and the mean age was 12.0(1.0, 180.0) months.The overall mortality rate was 37.5%(21/56). The mortality of non-critical group, critical group and extremely critical group were 12.5%(2/16), 16.7%(1/6) and 52.9%(18/34), respectively.There were no statistically significant differences between survival group and death group in gender and age, PICU stay time, heart rate, mean arterial pressure at 1 hour and 24 hours, ventilator using and the duration of mechanical ventilation(all P>0.05). The vasoactive-inotropic score(VIS) at 6 hours and 24 hours of death group were significantly higher than those in survival group[19.0(5.0-29.5) vs.5.0(0.0-10.0), 22.5(3.5-43.8) vs.5.3(0.0-13.5)]. The scores of PCIS in death group were less than that in survival group(57.3±10.7 vs.72.8±12.0)( t=4.85, P<0.001). The lactate level in survival group before resuscitation was statistically lower than that in death group[1.8(1.3-2.8) mmol/L vs.4.5(2.4-8.4)mmol/L]( Z<-3.70, P<0.05). At 1 hour, 6 hours and 24 hours after treatment, fluid resuscitation volume in death group were markedly higher than that in survival group[1 hour: (41.8±5.8)ml/kg vs.(38.5±5.3)ml/kg, t=-2.22, P<0.05; 6 hours: (69.5±4.4)ml/kg vs.(59.9±3.5)ml/kg, t=-8.96, P<0.05; 24 hours: (122.3±19.6)ml/kg vs.(111.7±16.2)ml/kg, t=-2.20, P<0.05]. Multiple sample comparisons found significant differences between the non-critical group[(60.0±3.5) ml/kg] and the extremely critical group[(65.3±6.0) ml/kg, P<0.05], and pairwise comparison of fliud intake within 1 h and 24 h showed no statistically differences( P>0.05). In the univariate analysis, variables significantly associated with death in septic shock were lactic acid before resuscitation and the 24 h lactate clearance rate, VIS 6 h, VIS 24 h, procalcitonin, ejection fraction, PCIS, 6 h-fluid resuscitation volume and multiple organ dysfunction (MODS). The Logistic regression showed that 6 h-fluid resuscitation volume, PCIS, lactic acid and MODS were independent risk factors.ROC curve analysis showed the AUCs of 6 h-fluid resuscitation volume, PCIS, early lactic acid and MODS for predicting death of septic shock children were 0.947, 0.835, 0.797 and 0.761, respectively. Conclusion:The mortality of septic shock is high, and decreased PCIS, elected serum lactic acid level and early fluid resuscitation, and MODS are risk factors associated with the death of septic shock.

Objective To identify one runny mucoid-like Gram-negative bacteria with pink pigment isolated from clinical pus sample. Methods The pus sample was aseptically extracted from a deep lesions of one patient, then stored in Amies medium at room temperature for transportation. One sheep blood plate and one chocolate plate were used to detect the possible pathogens from the specimens. After inoculation, the plates were placed in a humidified incubator with 5% CO2 at 35 ℃. To identify the obtained isolates, we used the commercial Vitek2 and API systems, combining some traditional morphological examination and classical biochemical and physiological characteristics. For pure cultures, the cellular fatty acids were extracted, methylated, and determined by gas chromatography method. The 16S rRNA gene was amplified and sequenced by a commercial broad-spectrum PCR primers. The phylogenetic tree based on 16S rRNA gene was constructed by Mega 4.1 software using the neighbour-joining methods with 1 000 bootstrap replications. Results One runny mucoid-like Gram-negative bacterium, named K8756, was isolated both on sheep blood and chocolate plates after 72 h incubation. The API 20NE profile was 1245045 after a 3-day culture, which would be identified as Ochrobactrum anthropi with a good confidence of 98% probability. It was identified as Ralstonia pickettii and Bordetella bronchiseptica by VITEK 2 GN kits. However, further comparative 16S rRNA gene sequences showed that strain K8756 was closely related to the valid published Roseomonas mucosa MDA 5527 with 100% identity. Colonial morphologic features, phenotypic characteristics and major cellular fatty acid composition were also with high similarity to Roseomonas mucosa. Conclusions Strain K8756( = GIMCC 1.0030 ) is identified as Roseomonas mucosa by the polyphasic phenotypic and genotypic characteristics. The comparative analysis based on 16S rRNA gene sequences is a useful method for identifying the problematic and newly named bacteria.

Objective To study the value of cervical length(CL) by transvaginal sonography in the mid-trimester and late-trimester for the prediction of preterm delivery.Methods The CL was measured by transvaginal sonography for 5277 pregnant women between 22-24 weeks and 28-32 weeks gestation,who were prenatal cared and delivered at the First Hospital of Peking University from June 2008 to November 2009.The pregnancy outcomes were followed,and the relationship between CL and preterm delivery and preterm premature rupture of membrane was studied.Results ( 1 ) The incidence of preterm delivery was 5.4％ (289/5370) total,among of them the incidence of therapeutic preterm delivery was 1.7％ (93/5370),spontaneously preterm delivery was 1.2％ (62/5370),and preterm premature rupture of membrane was 2.5 ％ (134/5370).There are 4 cases (4/5370) who occured late abortion.(2) Excluding the 93 women who had therapeutic preterm delivery,the mean CL of 22-24 weeks was ( 38.8±4.0) mm.The relative risk for preterm delivery when the CL＜30 mm was 5.2,when CL＜25 mm,the relative risk was 11.1,and when CL ＜15 mm the relative risk for preterm delivery was 13.8.The average CL during 28-32 weeks of gestation was ( 34.6±4.8) mm,was significantly shorter than that of 22-24 weeks ( P＜0.05 ).During this period the relative risk for preterm delivery when the CL＜30 mm was 6.9,when CL＜25 mm,the relative risk was 11.1,and when CL＜15 mm the relative risk for preterm delivery was 20.0.(3) A CL＜30 mm as the cutoff value for predicting preterm delivery during 22-24 weeks of gestation has only a 3％ sensitivity and 19％ positive predictive value,but had a 99％ specificity and 96％ negative predictive value.The sensitivity,positive predictive value,specificity and negative predictive value for a CL ＜ 30 mm as the cut-off value for predicting preterm delivery during 28-32 weeks of gestation was 33％,21％,95 ％ and 97 ％ respectively.(4) The total number of preterm premature rupture of membrane pregnant women was 134 (2.5％ ),who had a mean CL of (38.4 ±4.7) mm during 22-24 weeks of gestation,was similar with the women without preterm premature rupture of membrane ( PPROM),but during 28-32 weeks of gestation the women who occured PPROM had a mean cervical length of ( 30.6 ± 8.1 ) mm,and was significantly shorter than that of women without PPROM ( 34.7 + 4.6 ) mm.Conclusions ( 1 ) CL in 28-32 weeks of gestation issignificantly shorter than that of in the mid-gestation,but more than 90％ of women has a CL≥30 mm.(2)The shorter the CL is,the greater the relative risk of preterm delivery.According to different CL for clinical consulting objective relative risk could be provide.(3) The CL during 28-32 weeks of gestation can also predict preterm delivery,the sensitivity is obviously better than that of 22-24 weeks of gestation.(4) The CL during 28-32 weeks of gestation is valuable for predicting of PPROM.

Objective To evaluate the accuracy of realtime polymerase chain reaction (PCR) assay in the detection of group B Streptococcus (GBS) in pregnant women. Methods Samples were collected from 1 395 women at 35-37 weeks of gestation from March 1 to December 31, 2009 at three hospitals in Beijing. Samples were obtained from the lower one third vaginal wall and perianal area and tested for GBS using standard culture and PCR. Standard culture and gene analysis for GBS were applied as the gold standard, and the sensitivity and specificity of the rapid assay were determined. Results Of the 1 395 women qualified for PCR testing, 40(2.9%) were identified as GBS positive on the basis of the results of specimen culture, compared to 114 (8.2%) on the basis of PCR assay. The culture was negative and the PCR positive in 77 patients. The results which were not in agreement using the two tests were evaluated by the gene analysis for GBS. Among the 77 samples which were GBS positive by PCR, 66 samples were determined as GBS positive by gene analysis. The sensitivity of the PCR assay was 97.2%(103/106) and specificity was 99.1%(1 278/1 289), the maternal GBS colonization was 7.6%(106/1 395). Conclusions Realtime PCR assay allows rapid and reliable detection of GBS in last trimester with high sensitivity and specificity.

Objective:To summarize the clinical phenotype and genetic characteristics of children with neurodegeneration caused by UBTF gene mutations in childhood. Methods:The clinical and genetic data of 3 children with neurodegeneration in childhood diagnosed in the Department of Neurology, Children′s Hospital Affiliated to Zhengzhou University from February 2020 to January 2023 were retrospectively analyzed. All the 3 probands were found having UBTF gene mutations through the whole exome gene sequencing, and the first generation Sanger sequencing method was used to verify the UBTF gene in their family members. The variation characteristics of the UBTF gene were analyzed, and the treatment and follow-up results of the 3 children were summarized. Results:Among the 3 children with childhood onset neurodegeneration, 2 were male and 1 female, aged 9 months, 4 years and 6 months after birth, respectively. The clinical phenotypes mainly included motor retardation, speech and mental retardation, and dystonia. Among them, case 1 and case 2 had seizures, case 1 had dysphagia, feeding problems, no weight gain and ataxia. Brain MRI plain scan showed that case 1 and case 2 had different degrees of cerebral atrophy, case 1 had hypoplasia of corpus callosum, ventricle expansion and softening focus, and case 3 showed non-specific widening of the subarachnoid space. There were no abnormalities in the chromosome copy number variation and mitochondrial ring gene testing in the 3 children; the whole exon gene testing suggested the de novo missense variant in the UBTF gene [NM_014233.4: c.1414(exon14) G>A (p.Gly472Ser), c.1392(exon14)G>T(p.Lys464Asn)] and the maternal nonsense variant [NM_014233.4:c.520C>T(p.Arg174 *)], which were unreported site variants. In terms of treatment, the 3 children received comprehensive rehabilitation function training, and achieved a certain degree of language and intelligence improvement. Seizure control was effectively managed in case 1 with a single antiepileptic drug. Epileptic seizures were effectively treated and controlled in case 2 using more than 4 types of antiepileptic drugs. Conclusions:Neurodegenerative changes caused by UBTF gene mutations in childhood are relatively rare, and some cases may be accompanied with brain atrophy. De novo missense variation and maternal nonsense variation of the UBTF gene are the genetic etiology of the 3 probands.