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 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 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 establish a fluorescent polymerase chain reaction (PCR) method for rapid, sensitive and specific determination of -88/-123 polymorphisms in Myxovirus resistance protein A (MxA) gene promoter so as to provide molecular biology tool for optimized interferon-a treatment in chronic hepatitis B patients. Methods Hepatitis B virus (HBV) genotyping,serum HBV DNA level,and- 88/- 123 polymorphisms in MxA gene promoter of patients who had been treated with interferon-α were detected. The statistical analysis was done by using SPSS software to understand the relationship between MxA gene polymorphisms and interferon-α treatment. Afterwards, an optimal fluorescent PCR system was established to determine -88/-123 polymorphisms in MxA gene promoter. The sensitivity and the specificity of this system were confirmed by DNA sequencing. P-value of chi square test, odds ratios of regression analysis and 95% confidence intervals were employed. Results Patients with- 88 G/T and - 123 C/A in the interferon-stimulated response element in MxA gene promoter were interferon-α sensitive, while patients with - 88 GIG and - 123 C/C were not interferon-α sensitive. The coincidence rate of this system was 99.65% in comparison with DNA sequencing.Conclusion MxA gene polymorphisms could be rapidly and sensitively determined by this fluorescent PCR system.

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 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 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 investigate the expression level and clinical significance of cyclic citrullinated peptide antigen-specific T cells(CCP/AST)in synovial fluid and synovial tissue of rheumatoid arthritis(RA)patients.Methods A total of 128 RA patients in Shijiazhuang Hospital of Traditional Chinese Medicine from January to December 2021 were selected as the RA group,and 50 patients who needed arthroscopy for joint pain in the hospital during the same period were selected as the control group.Among the RA group,there were 46 cases in the mild group,52 cases in the moderate group,and 30 cases in the severe group.The protein expression levels of rheumatoid factors(RF)and anticitrullinated protein antibodies(ACPA)in synovial tissues of the subjects in each group were analyzed by Western blot.The frequency of CCP/AST in the synovial fluid of the subjects was analyzed by flow cytometry.The intensity of the staining of CCP/AST in synovial tissues was observed by double immunofluorescence staining/laser confocal scanning.Pearson correlation analysis was used to assess the correlation between the CCP/AST expression of synovial fluid and synovial tissue and RF and ACPA.Logistic regression was used to analyze the risk factors for the development of rheumatoid arthritis.Results In the order of control,mild,moderate and severe groups,RF(1.01±0.01,1.53±0.03,2.01±0.08,2.66±0.12 kDa)and ACPA proteins(1.03±0.01,1.61±0.03,2.04±0.10,2.59±0.13 kDa)in synovial tissues of patients were sequentially elevated,and the differences were all statistically significant(F=14.207,12.446,all P＜0.05).The expression of CCP/AST in synovial fluid of patients in the control,mild,moderate and severe groups was increased sequentially(8.26%±1.68%,22.46%±3.28%,33.58%±4.37%,46.15%±5.44%),and the difference was statistically significant(F=25.306,P＜0.05).Meanwhile,the intensity of CCP/AST staining in synovial tissues of patients in the control,mild,moderate and severe groups was also increased sequentially(1.05±0.26,1.35±0.89,2.04±0.56,2.78±0.15 score),and the difference was statistically significant(F=70.67,P＜0.05).The expression of CCP/AST in the synovial fluid and synovial tissues of patients with RA was positively correlated with RF(r=0.861,0.934,all P＜0.05)and ACPA in synovial fluid and synovial tissue(r=0.854,0.913,all P＜0.05).Logistic regression analysis showed that hypertension(OR=3.241,95%CI:1.491～6.752),diabetes mellitus(OR=2.565,95%CI:1.126～5.813),synovial fluid(OR=4.450,95%CI:1.652～11.622),and CCP/AST expression in synovial tissues(OR=5.629,95%CI:2.474～12.390)were independent risk factors for the development of RA(P＜0.05).Conclusion CCP/AST showed high expression in synovial fluid and synovial tissue of RA patients and related to disease activity and joint destruction,which can be used to assess the clinical joint mobility and bone destruction degree in such patients.

Objective To explore the safety and efficacy of Solitaire AB double stents in acute occlusions in bifurcation of cerebral artery (including the ends of internal carotid artery and middle cerebral artery M1 segment).Methods The clinical and imaging data of six cases treated with the double stent retriever technique using the Solitaire AB system in Wuhan No.1 Hospital from January to November 2017 were retrospectively analyzed.And the therapeutic effect and postoperative complications of them were analyzed.Results One patient took the double stents directly,whereas five patients were treated with double stent-retriever thrombectomy after the failure of single stent thrombectomy.All of the six patients achieved recanalization successfully (modified thrombolysis in cerebral infarction (mTICI) 3 in five patients,mTICI 2b in one).All patients had no intracranial hemorrhage immediately after thrombectomy.In the 24 hours,7 days and 2 weeks,the median NIHSS score was 10 (3-17),3 (1-15) and 1 (0-15),respectively.During perioperative period,one patient had asymptomatic cerebral hemorrhage,one died of symptomatic cerebral hemorrhage within 48 hours,and one was complicated with pulmonary infection.Five patients were followed up by outpatient visit,and four patients showed good outcome (modified Rankin Scale score ≤2).Conclusion In the emergency revascularization of acute cerebral artery occlusion at arterial bifurcation,double stent-retriever is better at increasing the efficacy of thrombectomy and is safe compared with single stent mechanical thrombectomy.

Humans ; Pedigree ; Rosacea ; pathology