Objective To investigate the better medical resource allocation scheme by analyzing the overall situation and regional characteristics of intraocular lens diopter in cataract patients on Lifeline Express.Methods The total of 27 663 patients data from seven administrative regions of China on cataract surgery in China Lifeline Express from 2014 to 2016 were collected.All diopter values of IOL were recorded to grasp the overall distribution of IOL diopter in cataract patients,and the distributive difference among administrative regions was analyzed.Results The distribution of IOL diopter in 27 663 cataract patients presented a skewed trend,with peak value in 21-＜22 D.The greater frequency of IOL diopter was mainly concentrated in 19-＜24 D,accounting for 72.48％ of the total.The IOL diopter peak was present in 22-＜ 23 D in Northeast China,North China,Central China,East China,and the overall waveform offset to a large degree direction.The IOL diopter peak was present in 21-＜ 22 D in Northwest,Southwest,South China,and the overall waveform showed the trend of small degree direction.The occurrence frequency of IOL with diopter ＜ 10 D was significantly more obvious in Northwest,Northeast China,North China and East China.At the same time,the occurrence frequency of IOL with diopter ≥25 D was significantly more obvious in Central China,Northeast China,East China,North China.Conclusion The IOL diopter values of cataract patients in different administrative regions present a skewed distribution and there are subtle differences between different regions.The results can provide the basis for resource allocation for large scale cataract surgery in each area.

Humans ; Postural Orthostatic Tachycardia Syndrome

Objective:To remove murine embryonic stem cells(mESC)from the differentiating cell culture and purify the differentiated cells by Magnetic Activated Cell Sorting(MACS).Methods:Neural differentiation of mESC was induced by a 5-stage method.The specific cell surface marker,SSEA-1,was used to identify ES cells in the differentiating cells.The optimal dilutions of mouse anti mouse SSEA-1 IgM primary antibody and FITC conjugated goat anti mouse secondary antibody were determined before the flow cytometry test.The incubation time and incubation temperature of primary antibody were all optimized to make the cytometry test accurate.After the optimization,stage 4 cells were dissociated into single cell suspension,incubated with antibody of SSEA-1 and microbeads conjugated goat anti mouse IgM,and then sorted through the magnetic field.The rate of SSEA-1 positive cells in pre-and post-separation groups was assessed by flow cytometry,and the viability of cells was evaluated by trypan blue staining counting under light microscopy.Results:The proportion of SSEA-1 positive cells in the separated cells can be reduced from(7.19?1.36)% to(1.34?0.80)%.The survival rate of sorted cells was more than 92%,similar to that of pre-separation cells.Conclusions:The MACS system we used can effectively remove mESC from the differentiated cells.The sorted cells will be well provided for the subsequent studies about transplantation therapy.

Objective To investigate the fluctuation of the iodine deficiency disorders(IDD) through continuous monitoring on it. Methods During 2005-2008, 10 monitoring countis (city,district) of IDD were selected in Jiangxi Province. Five townships were selected in each monitoring county, one school was selected in each townships, and 40 students in 8-10 years old from each school were selected to inspect their thyroid glands and determined the idodine content of salts from their home. Among the 40 students, 20 of which were selected to determine the intelligence quotient(IQ) and 6 of which were selected to determine urine iodine. Thirty pregnant women were also selected to determine the urine iodine in each monitoring county. Twenty students of 5th grade in each school and 5 housewives living nearby the school were selected to carry out the questionnaire survey of health education about IDD. Results Monitoring results showed the average goiter rote of 8-10 years old students was between 2.00% and 4.60% during 2005-2008. The rate of IQ of the students higher than 90 was all above 76% each year. The median of urine iodine of students and pregnant women was higher than 100 μg/L, and the proportion of people whose urine iodine content was lower than 50 μg/L was below 4% each year. The rate of inhabitant taking qualified idodine salt wasn't lower than 95%. The pass rate of the questionnaire survey of health education about IDD was between 11.67% and 43.50% in students and 92.50%-99.60% in housewives. Conclusions The situation of iodine deficiency in Jiangxi Province has been greatly improved, reaching the standard of eliminating IDD.

OBJECTIVEThe study was designed to explore the value of the New York University Pediatric Heart Failure Index (NYU PHFI) for diagnosing and grading chronic heart failure in children.

METHODSTotally 105 children with chronic heart failure or structural heart disease but without signs and symptoms of heart failure were enrolled. They were diagnosed using modified Ross score, NYU PHFI and NT-proBNP, respectively. According to modified Ross score as the referent criteria, the diagnostic value of NYU PHFI in quantifying chronic heart failure severity in children was studied. Furthermore, according to the grading of heart failure using modified Ross score, the area under the ROC curves of NYU PHFI was examined, respectively, in order to find out the optimal cut-off point.

RESULTSNYU PHFI score was positively correlated with the modified Ross score (r = 0.909, P = 0.000). According to modified Ross score, NYU PHFI scores in different severity of heart failure in children differed significantly (F = 80.034, P = 0.000). A significantly positive correlation was found between plasma NT-proBNP and modified Ross score, and between NT-proBNP and NYU PHFI score. Correlation coefficients between plasma NT-proBNP and modified Ross score, and between plasma NT-proBNP and NYU PHFI score were 0.752 and 0.918, respectively. The correlation between NYU PHFI and plasma NT-proBNP was superior to that between modified Ross score and plasma NT-proBNP. According to modified Ross scores of 0 - 2 as being without heart failure, 3 - 6 as mild degree of heart failure, 7 - 9 as moderate degree of heart failure and 10 - 12 as severe degree of heart failure, the areas under the ROC curve of the NYU PHFI diagnosing if heart failure was present, differentiating moderate from mild and severe from moderate heart failure were 0.982, 0.942 and 0.918, respectively, and the sum of sensitivity and specificity was favorite when 6, 10 and 13 scores were set as cut-off value diagnosing the presence of heart failure, differentiating moderate from mild, and severe from moderate heart failure, respectively. According to above classification of heart failure based on NYU PHFI score, plasma NT-proBNP concentration was significantly different in different degree of heart failure (F = 53.31, P < 0.001). Plasma NT-proBNP concentration in those without heart failure was significantly lower than that of mild heart failure, and it was also significantly lower in mild heart failure than that of severe heart failure.

CONCLUSIONNYU PHFI was highly valuable for diagnosing chronic heart failure in children and 0 - 6 scores as being without heart failure, 7 - 10 scores as mild degree, 11 - 13 scores as moderate degree and 14 - 30 scores as severe degree of heart failure could be used as the reference criteria of different severities of heart failure.

Adolescent ; Child ; Child, Preschool ; Chronic Disease ; Female ; Heart Failure ; diagnosis ; Humans ; Infant ; Male ; Severity of Illness Index

Objective To master the level of iodine nutrition among population in Jiangxi province,and to provide a scientific basis for establishing the strategy for prevention and control of iodine deficiency disorders (IDD).Methods Retrospective method was adopted to analyze the goiter rate and frequency distribution of urinary iodine of children aged 8-10,the qualified rate of iodized salt,the coverage rate of iodized salt and the consumption rate of qualified iodized salt in residents of Jiangxi province from 1995 to 2010.The method of correlation analysis was used to analyze the relationship between goiter rate of children (by palpation) and the qualified rate of iodized salt,iodized salt coverage rate and residents consumption rate of qualified iodized salt.Results The goiter rates (measured by the method of palpation) of children aged 8-10 were down from 40.17％(482/1200) in 1995 to 0.80％(16/2000) in 2010(x2 =4.864,P＜ 0.05).The median of urinary iodine of children was higher than 200 μg/L; the proportion of people whose urinary iodine content higher than 300 μg/L was above 25.00％ and the highest propoaion was up to 58.01％ (210/362) between 1995-2010.The minimum median of salt iodine was 17.77 mg/kg in 1995,and 29.30-39.10 mg/kg in other years.The qualified rates of iodized salt,the iodized salt coverage rates and the consumption rates of qualified iodized salt increased from 43.58％(452/1037),86.42％(1037/1200) and 37.67％(452/1200) in 1995 to 97.95％ (1916/1956),99.95％(1956/1957) and 97.90％(1916/1957) in 2010,respectively; there was a growth trend over the years(x2 =5.240,6.118,5.631,all P ＜ 0.05).The goiter rates of children were related to the qualified rates of iodized salt,the iodized salt coverage rates and the consumption rates of qualified iodized salt,and the correlation coefficient(r) was-0.833,-0.881 and-0.918 (all P ＜ 0.05),respectively.Conclusions The level of iodine nutrition among residents in Jiangxi province has already gone beyond the appropriate level,and the iodine concentration in salt should be cut to ensure the appropriate iodine nutrition level among people.

OBJECTIVESyncope is one of the common problems in clinical pediatrics. In recent years, vasovagal reflex was identified as the most common reason for unexplained syncope. Head-up tilt test (HUT) was regarded as one of the important diagnostic criteria. But the sensitivity of baseline head-up tilt test (BHUT) is low. To improve the sensitivity of HUT, we evaluated the diagnostic value of head-up tilt testing potentiated with sublingual nitroglycerin (SNHUT) in children with unexplained syncope.

METHODSTwenty-five patients (11 male and 14 female, mean age 11.8 +/- 2.1 years, ranged from 8 to 15) with unexplained syncope and 10 healthy children in control group (5 male and 5 female, mean age 11.4 +/- 2.1 years, ranged from 9 to 15) were studied. The patients and healthy children were tilted upright to 60 degrees for 45 minutes at BHUT. If syncope did not occur, sublingual nitroglycerin (4 - 6 microg/kg, maximum dose 300 microg) was administered, and continued at same degree for 20 minutes.

RESULTSCompared with controls, there was no significant difference in sex, age, supine blood pressure and supine heart rate of syncopal group (P > 0.05). During BHUT, 12 patients (48%) and none of the controls had positive response, whereas another 8 patients and 2 controls had positive response during SNHUT. In syncopal group, total positive rate was 80%. The sensitivity, specificity, and diagnostic value of SNHUT were all 80%. During SNHUT, the mean time to positive response was 5.9 +/- 2.9 minutes (from 4 to 11 minutes), and only 1 patient had mild headache.

CONCLUSIONHead - up tilt testing potentiated with sublingual nitroglycerin (4 - 6 microg/kg, maximum dose 300 microg) as pharmacological provocation test was a useful and an objective diagnostic tool for evaluating vasovagal syncope in children.

Adolescent ; Child ; Diagnostic Techniques and Procedures ; Female ; Humans ; Male ; Nitroglycerin ; administration & dosage ; Posture ; Sensitivity and Specificity ; Syncope, Vasovagal ; diagnosis ; Vasodilator Agents ; administration & dosage

OBJECTIVELightheadedness, dizziness, chest discomfort, headache, pallor, palpitation, blurred vision, fatigue, and syncope are main symptoms of postural orthostatic tachycardia syndrome (POTS), but they are also common problems in clinical pediatrics. Besides, most of POTS cases have normal findings in routine examinations on cardiac and central nervous system. Therefore, they are often unable to be correctly diagnosed and treated in time. Since head-up tilt test (HUT) was introduced to diagnose unexplained syncope in children, it was discovered that the most common pattern of unexplained syncope in children was vasovagal syncope. But in the course of the investigation, we and other groups identified a large subgroup of patients who had a less severe form of orthostatic intolerance characterized by postural tachycardia, lightheadedness, dizziness, and chest discomfort, etc. This disorder has become generally known as the POTS, which in children is not rare, but its report was not seen in China so far. The aim of this article is to recognise the clinical pictures of POTS in children and to explore its diagnostic criteria and therapeutic protocol.

METHODSAll 28 pediatric patients of POTS who met the diagnostic criteria were selected to be the observation group. Age and sex distribution were observed, and the duration of symptoms, baseline heart rate and blood pressure were also recorded. The frequency of symptoms, the rate of misdiagnosis and the efficiency of therapeutic protocol were also analysed.

RESULTSTwenty-eight patients were diagnosed as POTS, occupying 31.8% of all unexplained syncope or lightheadedness in children. Eleven were males and 17 females. The ratio of male to female was 1:1.5. All the 28 cases were from 6 to 16 years old, 5 of which were < 10 years and 23 were from 10 to 16 years old, including 10. The duration of symptoms of POTS in children was from 1 month to 6 years. The average was about 13 months, and more than one half were in 6 months. The most common orthostatic symptoms were lightheadedness or dizziness, syncope, chest discomfort, pallor and blurred vision associated with nausea and/or vomiting. During HUT or standing, an increase in heart rate > 35 beats per minute within 10 minutes was the most common finding, and some were associated with > 120 beats per minute within 10 minutes after HUT or standing up. The average time of the occurrence of abnormal responses was about 5 minutes. Especially, we found only 36% of patients were diagnosed with standing up test. Most of them were diagnosed with HUT. POTS in children was misdiagnosed as epilepsy or myocarditis in 43% patients. Multiple treatment protocol including health education and supportive, physical and medical therapy were most helpful in children with POTS.

CONCLUSIONPOTS is commonly seen in school-aged girls. The common symptoms include dizziness, syncope and chest distress. HUT is an important tool in its diagnosis. A comprehensive therapeutic regimen is recommended in the treatment.

Adolescent ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Postural Orthostatic Tachycardia Syndrome ; diagnosis ; etiology ; therapy ; Tilt-Table Test

Objective To investigate insulin resistance and the effect of physical training on it in the pa- tients with chronic heart failure (CHF). Methods One hundred and twenty NYHAⅡ-ⅢCHF patients were ran- domly divided into a training group( n = 65 ) and a routine therapy group (n = 55 ). Another 35 healthy subjects were recruited as control group. All the patients were treated with routine anti-CHF drugs, and the training group patients had received physical training twice a day in addition. The HOMA-IR, insulin sensitivity index (ISI) , left ventricu- lar ejection fraction (LEVF), left ventricular fractional shortening( LVFS), 6-minute walking distance, heart rate and mean blood pressure were compared between the training and routine therapy groups before and after physical ex- ercise in both groups, and a comparison was made between the patients and the controls before the intervention with regard to HOMA-IR and ISI. Results Comparing with control group, ISI was reduced while the HOMA-IR in- creased (P

OBJECTIVESyncope is a common problem in children and adolescents. Such an event may have multiple possible causes, ranging from benign conditions to life-threatening diseases. Syncope is a major challenge for the practicing physicians. It is very important to know the etiologic and clinical characteristics of syncope in children. This study aimed to improve diagnostic efficacy of syncope in children by analyzing the etiology and clinical characteristics of syncope.

METHODSThe investigators retrospectively analyzed the causes of syncope and diagnostic workup of 154 consecutive children seen in Department of Pediatrics, Peking University First Hospital because of a syncopal event.

RESULTSAutonomic-mediated reflex syncope (AMS) was the most common cause of syncope (65.6%), whereas cardiac disorders were found in 10 cases (6.5%) comprising the second cause of syncope in children. Other causes included psychologic problems and neurological and metabolic disorders. Although many causes were studied, 25 cases (16.2%) were found to have uncertain etiologies yet. The children with AMS were commonly seen in pubertal girls, and they had clear inducement of syncope and prodromes. The children with cardiac syncope often had history of cardiac diseases, and they were often younger than those with AMS. Lack of prodromes of syncope, exercise-related syncope, syncope spells seen in any body position, frequent syncope spells and sudden death in family were clues of cardiac syncope. Neurological disorders should be considered if there are any of the followings: syncope with seizure activity, syncope spells seen in any position, and a postictal phase of disorientation or neurologic abnormal signs. A metabolic cause was entertained when the child had a history of metabolic diseases, prolonged anger, or violent vomiting and diarrhea. Children with psychiatric disorders were adolescent girls with prolonged syncope spells, and had more frequent syncopal episodes. Most children with syncope were evaluated by many of diagnostic tests, but most of those tests were not goal-directed approach. Since persons with cardiac syncope were at increased risk for death from any cause, electrocardiography was recommended in almost all children with syncope. Neurologic testing including electroencephalography, computed tomography, etc. were rarely helpful unless neurologic signs and symptoms are present. Holter electrocardiography and echocardiography were most useful in children with suspected cardiac syncope. There was little benefit of screening cardiac enzyme in children with syncope. Routine blood tests (blood electrolytes and blood glucose, etc) rarely yield diagnostically useful information unless the children had the history of metabolic diseases. Head-up tilt testing was most useful in children with recurrent syncope in whom heart disease was not suspected. The children with frequent syncope, long lasting syncopal episode and clear psychiatric inducement of syncope should be evaluated by psychiatric testing.

CONCLUSIONSyncope in children may result from a wide variety of causes, and clinicians often use a wide range of investigation to try to achieve a diagnosis. But most of investigations have low diagnostic yield. Thorough history taking, physical examination and electrocardiography are the core of the syncope workup.

Adolescent ; Child ; Child, Preschool ; Electrocardiography ; Female ; Humans ; Male ; Retrospective Studies ; Syncope ; diagnosis ; etiology