Objective To analyze the application value of multislice spiral CT in diagnosis of children malformation of large blood vessels outside the heart.Methods The diagnosis results were compared between echocardiography and multislice spiral CT in 110 children with congenital heart disease,and the children had been confirmed by operation.Congenital heart disease was divided three kinds according to the region:heart,connections between heart and large blood vessels and large blood vessels outside the heart.Results One hundred and ten children with congenital heart disease were selected,and they had 366 malformations.The accuracy rates of echocardiography and multislice spiral CT were 90.7％ (332/366) and 95.6％ (350/366) respectively,and there was no statistical difference (x2 =3.284,P =0.070).In 366 malformations,160 malformations were in heart region.The accuracy rates of echocardiography and multislice spiral CT were 98.1％ (157/160) and 97.5％ (156/160) respectively,and there was no statistical difference (x2 =0.776,P =0.378).There were 55 malformations in connections between heart and large blood vessels.The accuracy rates of echocardiography and multislice spiral CT were 94.5％ (52/55) and 100.0％ (55/55) respectively,and there was no statistical difference (x2 =3.083,P =0.243).There were 151 malformations in large blood vessels outside the heart.The accuracy rates of echocardiography and multislice spiral CT were 81.5％(123/151) and 92.1％ (139/151) respectively,and there was statistical difference (x2 =7.377,P =0.01).Conclusion Multisltce spiral CT has great application value in diagnosis of children congenital heart disease,especially in malformation of large blood vessels outside the heart.

Objective To investigate the prevalence of obesity and metabolic syndrome(MS)of children and adolescents in Longquan mountainous area in Zhejiang province.Methods A representative sample involving 2 135 children and adolescence aged 10 to 15 years were randomly surveyed and a total of 2 125 had available data(male/female ratios as:1 109/1 016).Using the standard methods,we measured the weight,height,waist circumference,hip circumference,blood pressure,detected fasting plasma glucose (FPG),high density lipoprotein cholesterol (HDL -C),triglyceride(TG),total cholesterol(TC),and calculated non-high density lipoprotein cholesterol(non-HDL). The prevalence of obesity and MS among the 10 to 15 years old children and adolescence in Longquan was compared with that in six cities in China(Beijing,Tianjin,Shanghai,Zhejiang,Chongqing and Guangxi).Results The preva-lence of obesity was 4.7% in 10 -15 -year -old teenage,in which the male obesity prevalence was 6.3%(70/1 109),female obesity prevalence was 3.0%(30 /1 016).The prevalence of overweight was 9.4% and the prevalence of boys was 11.0%,while the girl was 7.6%.The prevalence of obesity and overweight was 16.4%(299/2 125).The prevalence of MS was 2%(42/2 125)in the survey,but 42.0%in the obesity.The prevalence of obesity in Longquan(4.7%)was lower than that in the national six cities(8.1%)among the children and adoles-cents from 10 to 15 years old(χ2 =31.09,P=0.000).But in the obesity students,the prevalence of MS(42.0%)in Longquan was higher than that in six cities(28.8%)(χ2 =5.43,P=0.02).Conclusion The prevalence of obesity in Longquan mountainous area was lower than that in the national six cities among the children and adolescents from 10 to 15 years old.However,the prevalence of MS among the obesity in Longquan was higher than that in six cities.

OBJECTIVE: To investigate the value of the endoscopy in the operation of microvascular decompression (MVD) for the hemifacial spasm by approach of postauricular suboccipital to the cerebellopontine angle (CPA) with posterior auricular small incision. METHOD: Two hundred and eighty-six cases of hemifacial spasm had received the operation of MVD with endoscopy by approach of postauricular suboccipital to the CPA. RESULT: Responsible blood vessels were found in 285 cases (99.7 percent), including 264 cases of anterior inferior cerebellar artery, 21 cases of basilar artery. The root entry zone of the facial nerve were completely decompressed with Teflon. There is no responsible blood vessels but adhesion in 1 cases (0.3 percent). After surgery, hemifacial spasm immediately disappeared. House-Brackmann(1985) grading system was used to evaluated the recovery of facial nerve function. After 1 week of operation 196 cases' facial nerve function are stage 1/6, 62 cases' are stage 2/6, 23 cases' are stage 3/6, 4 cases' are stage 4/6, 1 cases' is stage 5/6. And after Six months of operation, 274 cases' are stage 1/6, 10 cases' are stage 2/6, 2 cases' are stage 3/6. After 1 month of operation there is no significant change of hearing in 238,there are 35 cases of hearing loss less than 20 dB, 10 cases of hearing loss more than 20 dB, but less than 50 dB,3 cases of hearing loss more than 50 dB. Ear-nose cerebrospinal fluid leakage occurred in 2 cases are cured. During 1 year to 4 years following-up, only 3 (1.0 percent) preliminary suffered relapse,among which 1 case was cured by the secondary operation. The long term cure rate was 99.3 percent without occurrence of serious complications such as death. CONCLUSION The microneurosurgery of MVD for the treatment of hemifacial spasm is an ideally functional and etiotropic operation. It is useful not only to discover the responsible blood vessels which are regarded as those pressing the root entry zone of facial nerve,but also to protect the function of the brain tissue and nerves as well. It is a safe, minimally invasive and efficient operation. To avoid the complications, enough knowledge of the craniotopography and skilled technique of endoscopic operation are primary.
Adult ; Aged ; Cerebellopontine Angle ; surgery ; Decompression, Surgical ; methods ; Endoscopy ; Facial Nerve ; surgery ; Female ; Hemifacial Spasm ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Mycoplasma pneumoniae pneumonia (MPP) complicated with cerebral venous sinus thrombosis (CVST) is rare.We retrospectively analyzed the clinical data of two patients with refractory mycoplasma pneumoniae pneumonia (RMPP) complicated with CVST who were hospitalized in Xi′an children′s Hospital from December 2018 to April 2019, inquired the relevant literature, analyzed the clinical diagnosis and treatment characteristics, and discussed the diagnosis and treatment measures of RMPP complicated with CVST.Two cases were 6-year-old girls with fever and cough as the main symptoms.After physical examination, the respiratory sounds of the affected lung decreased, and the sounds of phlegm and dampness could be heard in both lungs.Mycoplasma pneumoniae (MP) antibody and RNA were positive.Chest CT showed lobar pneumonia with a large number of pleural effusion.The effect of macrolide antibiotics anti infection treatment was not good.Headache symptoms occurred during the course of the disease, and serum D-dimer increased significantly.Brain MRI showed CVST, including 1 case with lower extremity pain, and B-ultrasound showed right lower extremity arterial embolism.After anti infection, thrombectomy, anticoagulation and symptomatic treatment, 2 cases were discharged.When children with MPP, especially those with RMPP, have extracranial thrombosis and/or neurological symptoms, accompanied by elevated serum D-dimer, the possibility of CVST should be considered, and brain MRI examination should be performed in time to confirm and actively treat, which can reduce or avoid the occurrence of sequelae.Thrombosis may be related to excessive inflammatory reaction and vascular endothelial injury caused by MP infection.

Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Humans ; Lymphoma, Follicular ; drug therapy ; Rituximab

Group A Streptococcus (GAS) is a very important pathogen, especially for children.On a global scale, GAS is an important cause of morbidity and mortality.But the burden of disease caused by GAS is still unknown in China and also has not obtained enough attention.For this purpose, the expert consensus is comprehensively described in diagnosis, treatment and prevention of GAS diseases in children, covering related aspects of pneumology, infectiology, immunology, microbiology, cardiology, nephrology, critical care medicine and preventive medicine.Accordingly, the consensus document was intended to improve management strategies of GAS disease in Chinese children.

OBJECTIVEA prospective, multicenter and non-interventional prospective study was conducted to evaluate the clinical features of rituximab combined with chemotherapy (R-Chemo) as first-line treatment on newly diagnosed Chinese patients with diffuse large B-cell lymphoma (DLBCL).

METHODSThis was a single arm, prospective, observational multicenter and phase IV clinical trial for 279 patients, who were newly diagnosed as CD20-positive DLBCL from 24 medical centers in China 2011 and 2012, no special exclusion criteria were used. All patients received rituximab based R-Chemo regimes, such as R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone) and other regimes as the first-line treatment. The treatment strategies were determined by physicians and patients without detailed description for treatment course, dose, interval time and examination. Clinical response and safety of all patients were investigated in 120 days after completion of last dose of rituximab.

RESULTSOf 279 patients, 258 with stage I-IV who received at least 1 cycle of rituximab treatment and completed at least one time of tumor assessment were enrolled into intention-to-treat analysis, including 148 male and 110 female. The median age of all patients was 57.2(12.8-88.4) years. ECOG performance statuses of 0 or 1 were observed in 91.1% of patients, international prognostic index levels in the low-risk and low-middle-risk groups in 76.4% of patients, the tumor diameters smaller than 7.5 cm in 69.0% of patients. All patients received 6 median cycles of R-Chemo treatment every 24.4 days. R-CHOP treatment was shown to improve the clinical response with overall response rates of 94.2%. Common adverse events included anemia, marrow failure, leukopenia, thrombocytopenia, digestive diseases, infection and liver toxicity. All adverse events are manageable.

CONCLUSIONNon-interventional clinical trial of R-Chemo remains the standard first-line treatment for newly diagnosed patients with DLBCL in real clinical practice, which is consistent with international treatment recommendations for DLBCL patients. R-Chemo can provide the clinical evidence and benefit as the first-line standard treatment for Chinese patients with DLBCL.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Child ; Female ; Humans ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; Male ; Middle Aged ; Prospective Studies ; Rituximab ; Treatment Outcome

Entinostat plus exemestane in hormone receptor-positive (HR+) advanced breast cancer (ABC) previously showed encouraging outcomes. This multicenter phase 3 trial evaluated the efficacy and safety of entinostat plus exemestane in Chinese patients with HR + ABC that relapsed/progressed after ≥1 endocrine therapy. Patients were randomized (2:1) to oral exemestane 25 mg/day plus entinostat (n = 235) or placebo (n = 119) 5 mg/week in 28-day cycles. The primary endpoint was the independent radiographic committee (IRC)-assessed progression-free survival (PFS). The median age was 52 (range, 28-75) years and 222 (62.7%) patients were postmenopausal. CDK4/6 inhibitors and fulvestrant were previously used in 23 (6.5%) and 92 (26.0%) patients, respectively. The baseline characteristics were comparable between the entinostat and placebo groups. The median PFS was 6.32 (95% CI, 5.30-9.11) and 3.72 (95% CI, 1.91-5.49) months in the entinostat and placebo groups (HR, 0.76; 95% CI, 0.58-0.98; P = 0.046), respectively. Grade ≥3 adverse events (AEs) occurred in 154 (65.5%) patients in the entinostat group versus 23 (19.3%) in the placebo group, and the most common grade ≥3 treatment-related AEs were neutropenia [103 (43.8%)], thrombocytopenia [20 (8.5%)], and leucopenia [15 (6.4%)]. Entinostat plus exemestane significantly improved PFS compared with exemestane, with generally manageable toxicities in HR + ABC (ClinicalTrials.gov #NCT03538171).