Eighty percent of unexplained syncope children can be diagnosed of vasovagal syncope (VVS). Positive head-up tilt test (HUTT) leads to the diagnosis of VVS. However,organical diseases which can cause syncope should be excluded before HUTT was taken. The therapies of VVS include nonpharmacological therapy (health education, head-up training, water and salt supplement), pharmacological therapy (β-blockers, α-receptor agonists, fludrocortisone, selective serotonin reuptake inhibitors, angiotension converting enzyme inhibitors, et al.) and pace maker.

Objective To explore the effects of oral rehydration salts [Ⅰ] (ORS Ⅰ) for autonomic nerve mediated syncope(NMS) in children with different hemodynamic patterns.Methods A total of 105 patients with unexplained syncope and prodromal symptoms of syncope who were confirmed as NMS by head-up tilt table test(HUTY) and treated in the Department of Pediatric Cardiovasology,Children's Medical Center,the Second Xiangya Hospital,Central South University,from March 2012 to February 2015.Their ages were from 4 to 18 years old,the average age was (11.96 ± 2.86) years old.Totally 73 cases were diagnosed as vasovagal syncope (VVS) (46 cases were vasodepressor type,27 cases were VVS mixed type or cardioinhibitory type),while 32 cases were diagnosed as postural orthostatic tachycardia syndrome(POTS).Simple random method was used to divide them into conventional therapy (health education and tilt training) plus ORS Ⅰ group (55 cases),and conventional therapy group (50 cases).Patients were followed up for 6-25 (14.82 ± 6.13) months.The recurrence of syncope and review of HUTT outcome assessment in 6 months,treatment was studied to evaluate short-term efficacy of 2 different therapies for NMS in children with different hemodynamic patterns.Taking recurrence of syncope as outcome events,Kaplan-Meier curves were drawn to compare long-term efficacy of different therapies in treating NMS children.Results There was no statistical difference in the short-term efficacy among the different hemodynamic patterns when treated with conventional therapy plus ORS I,or conventional therapy(all P ＞ 0.05).The cumulative efficiency of the conventional therapy plus ORS Ⅰ was superior to that of the conventional therapy for NMS children through the long-term follow-up study (74.5％ vs.52.0％,x2 =14.424,P ＜ 0.01).Patients with vasodepressor patterns had a better response than those with mixed or cardioinhibitory patterns to conventional therapy plus ORS I (90.0％ vs.61.1％,x2 =4.435,P ＜ 0.05).Conclusions Compared with VVS mixed type or cardioinhibitory type,children with VVS vasodepressor patterns are more appropriate to take ORS I as initial treatment.

Objective To explore the changes in serum and urine electrolytes of children with neurally media-ted syncope (NMS)after oral rehydration salts (ORS)[Ⅰ]treatment.Methods The study group included 135 patients [60 male and 75 female,aged 4 -16 years,average of (10.20 ±2.68)years old]with unexplained syncope and prodro-mal symptoms of syncope in our hospital between May 2014 and April 2015.The patients underwent head -up tilt test (HUTT),and completed serum electrolytes and 24 -hour urine electrolytes,and the serum electrolytes and 24 -hour u-rine electrolytes in different hemodynamic type of HUTT were compared.Positive HUTT patients were treated with health education and ORS[Ⅰ],while negative HUTT patients were received health education.Then 21 -154(42.63 ±27.71) days later,the patients returned to hospital,for the inquiry of symptom improvement,and review of HUTT,24 -hour urine and serum electrolytes.Results (1)The total effective rate of ORS[Ⅰ]treatment was 62.96% (17 /27 cases),while negative conversion rate of HUTT was 48.15% (13 /27 cases).(2)There was no significant difference in serum electro-lytes,24 -hour urine electrolytes or 24 -hour urine volume between HUTT positive group and negative group during the first visit (all P >0.05).(3)In return visit,serum calcium [(2.30 ±0.10)mmol/L vs (2.20 ±0.09)mmol/L,t =2.72,P <0.05]and serum phosphorus [(1.73 ±0.22)mmol/L vs (1.51 ±0.23)mmol/L,t =2.671,P <0.05]in HUTT positive group were significantly higher than those in negative group.The serum sodium,potassium,chloride,mag-nesium and 24 -hour urine electrolytes,24 -hour urine volume had no statistical difference(all P >0.05).(4)24 -hour urine sodium [(159.06 ±72.76)mmol/24 h vs (118.97 ±52.75)mmol/24 h,t =2.712,P <0.05],24 -hour urine chloride [(139.08 ±66.53)mmol/24 h vs (111.34 ±47.33)mmol/24 h,t =2.116,P <0.05]and 24 -hour urine volume [(1 564.21 ±829.39)mL vs (1 058.95 ±509.92)mL,t =3.371,P <0.01]after ORS[Ⅰ]treatment were sig-nificantly higher than those before ORS[Ⅰ]treatment.The serum electrolytes and 24 -hour urine potassium,calcium, phosphorus,magnesium had no statistical difference (all P >0.05).(5)There was no significant difference in serum elec-trolytes,24 -hour urine electrolytes or 24 -hour urine volume between vasovagal syncope group and postural orthostatic tachycardia syndrome group during the first visit(all P >0.05).Conclusions ORS[Ⅰ]treatment can obviously increase the 24 -hour urine sodium,24 -hour urine chloride in children with NMS.ORS[Ⅰ]is an effective therapy for NMS.

Objective To explore the familial genetic characteristics of twins syncope in children.Methods Four pairs of twins with unexplained dizziness,headache,chest tightness,chest pain,pre-syncope and syncope were received head-up tilt test (HUTT) and family history of syncope were inquired.The age,gender,clinical manifestations were analyzed and the HUTT hemodynamic response were performed,and interviewed via telephone.Results The onset age of 4 pairs of twins ranged from 7 to 12 years old,less than 15 years,the median age of the first syncope episodes.Cause of syncope was primarily standing(4/5 cases),2 pairs had syncope positive family history.HUTT hemodynamic response type was mainly vasodepressor syncope (4/5 cases).HUTT result and hemodynamic response type were not completely consistent in the same twins.One case of the first twins was vasodepressor syncope and postural orthostatic tachycardia syndrome.One case of the second twins was vasodepressor syncope,while the other was negative.The third twins were vasodepressor syncope.The fourth twins were negative.HUTT results of the 4 twins were diverse,indicating that environment,psychological factors may get involved in syncope episodes.Conclusions The familial genetic factors of the children with syncope may play an important role in the young age group.Environment and psychological factors may be induce syncope attack.HUTT results of twins are diverse.HUTT result and hemodynamic response type can be inconsistent in the same twin.

Objective To analyse the 24 h ambulatory blood pressure monitoring(ABPM)character-istics and effect of health education in children with orthostatic hypertension (OHT)retrospectively.Methods A total of 19 children[1 1 males and 8 females with mean age of (1 1.26 ±2.16)years]who were outpa-tients or had been hospitalized in the Second Xiangya Hospital of Central South University due to unexplained syncope,presyncope,and finally diagnosed as OHT after head up tilt test(HUTT).HUTT and ABPM were reexamined at 12 ~190(47 ±48 )days after receiving health education (including psychological guidance, avoiding sudden changes in posture,increasing the amount of water,avoiding syncope inducement,etc). Results (1 )ABPM parameters:there were no significant differences of ABPM parameters before and after health education respectively(P ﹥0.05,respectively).(2)After the health education,HUTT 3 min diastolic pressure[(71.89 ±1.60)mmHg vs.(76.47 ±8.49)mmHg,1 mmHg =0.133 kPa,t =2.785,P ﹤0.05]and diastolic blood pressure change[(7.37 ±4.98)mmHg vs.(12.42 ±3.27)mmHg,t =3.560,P ﹤0.05]de-creased than those before health education.(3 )Blood pressure pattern changes:after the health education,“dipper blood pressure”increased and “non-dipper blood pressure”decreased[42.1 %(8 /19)vs.31.6%(6 /19)and 57.9%(1 1 /19)vs.68.4%(13 /19),χ2 =0.452,P ﹥0.05,respectively].(4)OHT cure rate:after health education,to review the HUTT,within 3 minutes in HUTT,blood pressure changes of 14 cases were normal range.The cure rate was 73.7%.Conclusion OHT children's blood type is given priority to with “non-dipper blood pressure”,and the ratio of“dipper blood pressure”increase and the HUTT 3 min di-astolic pressure and diastolic blood pressure change decrease after health education.It suggests that the health education of OHT children has a certain clinical effect.

Objective To investigate the relationship of fascin-1 protein expression with the metastasis of basal cell carcinoma and squamous cell carcinoma. Methods Skin specimens were obtained from 10 normal human controls, 13 patients with basal cell carcinoma (8 nodular variant and 5 superficial variant) and 24 patients with SCC (11 SCC in situ and 13 invasive SCC). Immunohistochemical staining was performed to analyze the expression of fascin-1 protein. The staining results were quantitatively assessed with computer image analysis system (Image-pro Plus 6.0). Results The optical density of fascin-1 averaged 0.1152±0.04574 in SCC in situ, 0.1257±0.03096 in invasive SCC, and 0.0293±0.00981 in normal controls; the expression of fascin-1 was significantly higher in SCC tissue than in normal control skin (both P<0.05). Increased optical density was also observed for fascin-1 in nodular variant of SCC (0.0808 ±0.05642) and superficial variant of SCC (0.0806±0.04346) compared with the normal controls, whereas no statistical difference was observed between nodular and superficial variant of SCC. Conclusion In BCC and SCC, there is an over expression of fascin-1, which may be linked to the local invasion of carcinoma,

Objective To explore the circadian rhythm of neurally mediated syncope (NMS)in children. Methods There were 21 6 children with NMS included in the study,including 91 male and 1 25 female,aged from 4 to 1 7 years old with a mean age of (1 1 .34 ±2.65)years,who came from the Specialist Syncope Outpatient Department or Inpatient Department of the Second Xiangya Hospital of Central South University from December 201 3 to October 201 5. The patients were divided into vasovagal syncope (VVS)group and postural tachycardia syndrome (POTS)group ac-cording to head -up tilt test (HUTT)results,including 1 78 VVS patients and 38 POTS patients.Ninety -four patients with NMS were in the <1 2 years old group[(8.88 ±1 .88)years old]and 1 22 subjects with NMS were in the ≥1 2 years old group[(1 3.24 ±1 .1 8)years old].All patients or guardians were carefully asked about the number of synco-pal attacks and the periods in which episodes occurred in before HUTT [24 hours of a day were divided into 4 periods:morning (0600 AM-1 200 AM),afternoon (1 200 AM-1 800 PM),evening (1 800 PM-2400 PM), night (0000 AM-0600 AM)].Results (1 )General data:the total syncopal episodes of 21 6 children with NMS were 61 4 episodes,including 1 78 VVS patients with 471 syncopal episodes in total and 1 43 attacks of 38 children with POTS.There were 273 episodes of 94 patients in the <1 2 years old group and 341 episodes of 1 22 subjects in the ≥1 2 years old group.There were no significant differences in the diurnal variation of syncopal episodes between the VVS group and POTS group regarding age and gender (P >0.05).(2)The number of syncopal episodes in patients with VVS which occurred in the morning hours was strikingly higher than that of afternoon,evening or nighttime (P <0.05).But there was no significant difference in the frequency of episodes in different periods through the day in the POTS group (P >0.05).Patients with VVS had a higher proportion of episodes in the morning but a lower proportion in the evening when compared with the POTS group (P <0.05).(3)The male children with NMS tended to have a higher proportion of episodes in the morning than the female patients(χ2 =1 1 .001 ,P =0.01 2).(4)There seemed to be no difference in the frequency of syncopal episodes through the day between the <1 2 years old group and the ≥1 2 years old group(χ2 =1 .995,P =0.573).Conclusions The frequency of syncopal episodes in children with VVS displayed a clear circadian rhythm,with a peak in the morning,but the POTS patients did not show a circadian variation.The male children with NMS tended to have a higher proportion of episodes in the morning than the female patients.

Objective To analyze the significance of the Calgary Syncope Seizures Scores (CSSS)and the Modified Calgary Syncope Seizure Scores (MCSSS)for differential diagnosis of syncope or epilepsy in children. Methods Totally 201 children[95 male,and 1 06 female,aged 5 -1 8 years,mean age (1 1 .76 ±3.03)years]with syncope or epilepsy who visited the syncope clinic or admitted to the Department of Nerve Specialty Clinic of Pediatrics, the Second Xiangya Hospital of Central South University from October 201 3 to April 201 4 were included in the study. Patients were eligible if they had ≥1 loss of consciousness.The diagnosis was analyzed by the CSSS and the MCSSS and receiver operating characteristic (ROC)curve was used to explore the predictive value of different scores in differential diagnosis of syncope or epilepsy in children.Results There were significant differences in the CSSS be-tween syncope[-4(-6,1 )]and epilepsy[2(-3,5)]in children(Z =-1 1 .63,P <0.01 ).When the score was ≥1 ,the sensitivity and specificity of the differential diagnosis between syncope and epilepsy were 91 .46% and 95.80%, respectively;and Youden index was 0.87.Epilepsy should be considered when the score was ≥1 .There were significant differences in the MCSSS between syncope[-4(-6,1 )]and epilepsy[3(-3,6)]in children(Z =-1 1 .71 ,P <0.01 ).When the score was ≥1 ,the sensitivity and specificity of the differential diagnosis between syncope and epilep-sy were 92.68% and 96.64%,respectively;and Youden index was 0.89.Epilepsy should be considered when the score was ≥1 .Conclusions CSSS and MCSSS might be used as an initial diagnostic method in differential diagnosis be-tween syncope and epilepsy in children,based on the history of the patients.MCSSS in the differential diagnosis between syncope and epilepsy in children was more objective,easier to operate in the clinical work than CSSS.

Objective To compare the clinical efficacy and safety of pegylated interferon α-2a (Peg IFN α-2a) or adefovir dipivoxil(ADV) monotherapy and their combination therapy in HBeAg positive chronic hepatitis B (CHB) patients. Methods An open randomized controlled multicenter clinical trial was performed. One hundred and twenty cases with CHB were divided into 3 groups: Peg IFN α-2a monotherapy (group A), ADV monotherapy (group B) and Peg IFN α-2a plus ADV combination therapy (group C). The virological response (VR), serological response (HBeAg, HBsAg clearance and seroconversion), biochemical response (BR) and sustained response (SR) were tested at week 24 and 48 of therapy and week 48 of follow-up after end of treatment (EOT) for'evaluation of therapeutic effects, safety and drug resistance. The efficacy was compared using X2 test. Results At week 48 of treatment, the VR (HBV DNA ≤500 copy/mL) rates were 36. 8%(14/38), 37. 5%(15/40) and 62. 9% (22/35), respectively in groups A, B and C; that in group C was higher than those in groups A and B (X2 = 4. 933, 4. 801, respectively; both P < 0. 05); HBeAg seroconversion rates in three groups were 44. 7% (17/38), 17. 5% (7/40) and 51. 4% (18/35), respectively. At week 48 of follow-up,SR rates in three groups were 34. 2%(13/38), 15. 0%(6/40) and 48. 6% (17/35), respectively; those in groups C and A were higher than that in group B (X2 = 9. 894,P<0. 01;X2 =3. 903, P<0. 05, respectively). Conclusions VRs at week 24 and 48 of Peg IFN α-2a plus ADV combination therapy are better than Peg IFN α-2a or ADV monotherapy. SRs at week 48 of follow-up after Peg IFN α-2a monotherapy and combination therapy are both better than ADV monotherapy.

OBJECTIVE: To study the difference between age and gender in patients with micturition syncope (MS). METHODS: A total of 56 patients with MS were diagnosed from 1 542(3-72 years old) cases with unexplained syncope or symptoms of presyncope during micturition in our hospital. The age, onset age, positive rate of head up tilt table test (HUTT) and their correlation with age and gender were analyzed. RESULTS: The average age of patients with MS was older than that of patients with nonmicturition syncope (NMS)[5-67(35.5)years old vs. 3-72(12)years old,Z=-7.587,P<0.01]. Among the patients with MS, adults (>18 years old) were more than children (≤ 18 years old) (9.4% vs. 1.0%,χ2=65.689,P<0.01). There was gender difference in the onset rate of MS (male 5.0% vs. female 2.5%,χ 2=6.858,P<0.01). There was no difference in the positive rate of HUTT between the MS and NMS groups, and between the males and females with MS. There was no difference in age and onset age between the HUTT positive and negative group, and between the males and females. CONCLUSION MS occurs more often in adults and males. Bezold Jazisch reflex may play a role in the mechanism of MS.
Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Posture ; physiology ; Sex Factors ; Syncope ; diagnosis ; etiology ; Tilt-Table Test ; Urination ; Young Adult