Inappropriate use of antibiotics is of special concern globally.Nevertheless,antibiotic over use in children remains common.Overall,antibiotic use has decreased during recent years.However,prescription rates of anti-biotics were still high and there is a substantial increase of broad -spectrum antibiotic prescribing.Several factors exist in antibiotic use of children,including vaccination,guideline,clinical pathway management,prescribers,and parents′perceptions of antibiotics,et al.Therefore,the significant evaluation of antibiotic rational use in children needs further studies in detail.

Aim To investigate the effects of predni-sone on trabecular microstructure and biomechanical properties of femur in a rat model of type II collagen-induced arthritis (CIA ) using micro-CT and biome-chanics.Methods Forty 8-week-old male Lewis rats were randomly divided into 2 groups:control (CON ) group with 6 rats,and the remaining 34 rats were used to establish the CIA model.3 weeks after immunization screening CIA rats were randomly divided into CIA group,CIA plus prednisone 4.5 mg · kg-1 · d -1 group and CIA plus prednisone 9 mg · kg-1 · d -1 group.Rats in CON group were given vehicle as well as in CIA group.Rats in the other two groups were treated with prednisone at 4.5 mg·kg-1 ·d -1 or 9 mg ·kg-1 · d -1 .After 90 days treatment,all rats were euthanized,and the left femur was collected for biome-chanics,micro-CT scanning and three-dimensional re-construction.Results Micro-CT data showed that tra-becular thickness,trabecular number,bone volume/total volume,bone mineral density in CIA group were significantly lower than those in CON group.While tra-becular separation,structure model index were signifi-cantly higher than those in CON group.Compared with CON group,biomechanical properties (elastic load, maximum load,break load and stiffness)were signifi-cantly decreased in CIA group.Compared with CIA group,bone volume/total volume and trabecular num-ber were increased,while trabecular separation was significantly decreased in two prednisone groups.Com-pared with CIA group,there was no significant change in biomechanical properties in two prednisone groups. Conclusions Treatment with prednisone for 3 months can ameliorate the damage of trabecular microstructure of the femur in CIA rats,but it has no effect on biome-chanical properties and bone mineral density.

Objective To report the clinical,myopathological and genetic features of a patient with distal myopathy caused by caveolin-3 (CAV3) deficiency.Methods The patient was a 27-year-old female.She had an onset symptom of asymmetric lower extremities weakness.The proximal limb-girdle muscles were involved subsequently.Clinical data of this patient were collected.The leg muscle magnetic resonance imaging (MRI) and an open biopsy of left tibialis anterior muscle were performed.In addition to histological,enzyme histochemical staining and ultrastructural examination,immunohistochemical staining with antibody against CAV3 was done.CAV3 gene was analyzed in the patient and her parents.Results Tl-weighted enhanced skeletal muscle MRI of the lower limbs showed the abnormal signal in distal and proximal muscles.Muscle biopsy showed moderate dystrophic changes and immunostaining for CAV3 showed reduced plasmalemma in the muscle fibers.Gene analysis disclosed a heterozygous c.136G ＞ A (p.Ala46Thr)mutation in the CAV3 gene,and the patient's parents did not have this mutation.Conclusions We report a distal myopathy case caused by c.136G ＞ A (p.Ala46Thr) mutation in the CAV3 gene,who had an onset symptom of asymmetric lower extremities weakness.The proximal limb-girdal muscles were also involved.This would help clinical doctors to know more about this rare myopathy.

Aim To investigate the skeletal effects of ginseng flower bud(GF)on osteopenia induced by D-galactose using histomorphometry and biomechanical properties.Methods Fifty three-month-old male Sprague-Dawley rats were randomly divided into five groups.Rats in NS group(NS)were treated with NS(5 mL·kg-1·d-1)by subcutaneous injection and daily oral gavage with vehicle as control.Rats in the other four groups were given D-galactose at the dose of 100 mg·kg-1·d-1 by subcutaneous injection.Solvent control was performed between NS and DG: gastric irrigation with distilled water of 10 mL·kg-1·d-1.Other groups were: CP was gastric irrigated with integrated medicine(stanozolol 0.54 mg·kg-1·d-1+piracetam 432 mg·kg-1·d-1),GF(L)with ginseng flower bud of 0.486 g·kg-1·d-1 and GF(H)with ginseng flower bud of 2.43 g·kg-1·d-1 for 14 weeks.The longitudinal proximal tibial metaphyseal(PTM),the fifth lumbar vertebral body(LVB)and tibial shaft(Tx)sections were performed undecalcifiedly and used for bone histomorphometric analysis.858 Mini Bionix materials testing system was used to analyze the biomechanic properties of right femur via three-point bending test.The left femur was dried and assimilated,whose bone calcium(Ca),phosphate(P)content and bone hydroxyproline content were tested.Results Compared with D-glagatose group,in PTM of D-galactose treated rats,the％Tb.Ar was increased both in GF(L)and GF(H)treated groups.While the Tb.Sp was decreased.％Oc.S.Pm and Oc.N/mm decreased in GF(L),and those in GF(H)were decreased as well.In Tx,％Ct.Ar was raised,while％Ma.Ar was decreased in GF(L)and GF(H).The elastic load of femur was increased.Conclusions Compared with DG group,there are significant differences in bone histomorphometry of Tx and PTM in all doses of GF,but no significant changes are detected in hydroxyproline,Ca,and P content of femur.

Objective:To evaluate the feasibility and the application values of quantitative susceptibility mapping (QSM) for the assessment of meniscal injury and in distinguishing meniscus degeneration and tears.Methods:The clinical and imaging data of 70 patients suspected of meniscus injury and scheduled for arthroscopy in Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University from November 2019 to June 2020 were analyzed retrospectively. Thirty age-and sex-matched healthy subjects were also examined as controls. All subjects received knee joint QSM and routine MR imaging. According to the results of arthroscopy, the patients was divided into meniscus degeneration and meniscus tear groups, respectively. The conventional MR was evaluated by two radiologists. The meniscus injury area was delineated on the original QSM magnitude images (the central area of the posterior corner of the lateral meniscus was selected in the healthy controls) and mapped to the corresponding QSM maps, and the magnetic susceptibility values were measured. Kruskal-Wallis H test was used to analyze the magnetic sensitivity values of meniscal degeneration, meniscal tear and healthy control groups; and Bonferroni was used to correct the pairwise comparison. ROC curve was established to evaluate the threshold and efficacy of magnetic susceptibility value in the diagnosis of meniscal tear. The results were compared with those of conventional MRI. Results:The magnetic susceptibility values of meniscus of healthy controls, meniscal degeneration and meniscal tear groups were (0.035±0.016)ppm, -0.031(-0.040,-0.005)ppm, and(-0.122±0.115)ppm, respectively, with significant difference found among the three groups (χ2=44.419, P<0.05). The magnetic susceptibility values of meniscus of healthy controls was significantly higher than those of meniscus degeneration patients and meniscus tear patients (χ2=-23.843, -48.253, P<0.05). The magnetic susceptibility values of meniscus of meniscus tear group was significant lower than those of meniscus degeneration group (χ2=-24.410, P<0.05). Taking magnetic susceptibility values of -0.062 5 ppm as threshold, the area under the ROC curve for the diagnosis of meniscal tears was 0.949, with the sensitivity as 87% and the specificity as 100%. The sensitivity and specificity of conventional MRI in the diagnosis of meniscal tears were 86.8% and 87.5%, respectively. Conclusion:QSM can quantitatively evaluate meniscus injury and can be used as an effective supplement method to conventional MRI, which is helpful to improve the diagnosis of meniscus tear.

Objective: To determine the anatomical characteristics of the petrous ridge and trigeminal nerve in trigeminal neuralgia (TN) without neurovascular compression (NVC). Materials and Methods: From May 2017 to March 2021, 66 patients (49 female and 17 male; mean age ± standard deviation [SD], 56.8 ± 13.3 years) with TN without NVC and 57 controls (46 female and 11 male; 52.0 ± 15.6 years) were enrolled. The angle of the petrous ridge (APR) and angle of the trigeminal nerve (ATN) were measured using magnetic resonance imaging with a high-resolution three-dimensional T2 sequence. Data on the symptomatic side were compared with those on the asymptomatic side in patients and with the mean measurements of the bilateral sides in controls. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of APR and ATN in distinguishing TN patients from controls. Results: In TN patients without NVC, the mean ± standard deviation (SD) of APR on the symptomatic side (98.40° ± 19.75°) was significantly smaller than that of the asymptomatic side (105.59° ± 22.45°, p = 0.019) and controls (108.44° ± 15.98°, p = 0.003). The mean ATN ± SD on the symptomatic side (144.41° ± 8.92°) was significantly smaller than that of the asymptomatic side (149.67° ± 8.09°, p = 0.003) and controls (150.45° ± 8.48°, p = 0.001). The area under the ROC curve for distinguishing TN patients from controls was 0.673 (95% confidence interval [CI]: 0.579–0.758) for APR and 0.700 (CI: 0.607–0.782) for ATN. The sensitivity and specificity using the diagnostic cutoff yielding the highest Youden index were 81.8% (54/66) and 49.1% (28/57), respectively, for APR (with a cutoff score of 94.30°) and 65.2% (43/66) and 66.7% (38/57), respectively, for ATN (cutoff score, 148.25°). Conclusion In patients with TN without NVC, APR and ATN were smaller than those in controls, which may explain the potential cause of TN and provide additional information for diagnosis.

Objective:To analyze the clinical characteristics of hospitalized children with sepsis in the Department of Internal Medicine of Tianjin Children's Hospital, and explore the independent risk factors affecting the death of children with sepsis, so as to provide a basis for clinicians to identify, intervene and judge the prognosis of children with sepsis early.Methods:145 septic children (excluding newborns) who were hospitalized in the Department of Internal Medicine of Tianjin Children's Hospital from August 2016 to July 2019 were analyzed. Clinical data was collected through the electronic medical record system to analyze the characteristics of sepsis in these patients and to conduct regression analysis on the risk factors related to death of children with sepsis.Results:A total of 145 sepsis cases were enrolled in this study. Urinary tract infection accounted for 39.3% (57/145), ranking first in the infection site of medical sepsis. There were nine deaths in the study, eight of which had underlying medical conditions. The relevant risk factors of death cases were analyzed, and Logistic regression analysis showed that thrombocytopenia was an independent risk factor affecting the outcome of the disease ( OR=0.991, 95% CI, 0.983~0.998, P=0.019). Conclusions:The characteristics of children hospitalized with sepsis from August 2016 to July 2019 in the department of internal medicine of Tianjin Children's Hospital are as follows: The most common site of infection in the internal department of pediatric sepsis is urinary system infection, which is more common in patients with urinary malformations. Eight of the nine medical deaths had underlying medical conditions. Thrombocytopenia is an independent risk factor for death in patients with sepsis.

OBJECTIVETo study the clinicopathologic features and significance of aberrant CD56 expression in diffuse large B-cell lymphoma (DLBCL).

METHODSThe clinical and pathologic profiles of 10 cases of DLBCL with aberrant expression of CD56 were investigated. Immunohistochemical staining, in-situ hybridization for Epstein-Barr virus encoded RNA and gene rearrangement for IgH and Igκ were carried out.

RESULTSThere were 6 male and 4 female patients. The medium age of patients was 46 years. All of them presented with extranodal lymphoma involvement, with gastrointestinal tract being the commonest site (5/10). Histologic examination showed that most of the atypical lymphoid cells were centroblast-like and demonstrated a diffuse growth pattern. Apoptosis and necrosis were identified in some cases. Immunohistochemical study showed that the tumor cells were positive for CD20 or CD79α and aberrantly expressed CD56. Five cases had the GCB phenotype while the remaining cases had the non-GCB phenotype, according to Hans classification. Bcl-6 was positive in most cases (9/10). All cases showed a high proliferation index by Ki-67. The tumor cells were negative for CD3ε, CD138 and granzyme B. In-situ hybridization for Epstein-Barr virus encoded RNA was performed in 7 cases and none of them showed positive signals. IgH gene rearranged bands were detected in 4 cases (4/6) and Igκ was detected in 3 cases (3/6). Follow-up data were available in 8 patients. Two patients died of disease progression within 5 to 13 months after diagnosis and the other 6 patients were alive 8 to 60 months after therapy.

CONCLUSIONSDLBCL with aberrant expression of CD56 is rare. Most of them present with extranodal involvement, show high frequency of bcl-6 expression and high proliferation index. The patients often have good response to chemotherapy.

Antigens, CD20 ; metabolism ; Apoptosis ; CD56 Antigen ; metabolism ; CD79 Antigens ; metabolism ; Disease Progression ; Female ; Gene Rearrangement ; Granzymes ; metabolism ; Herpesvirus 4, Human ; genetics ; Humans ; Immunophenotyping ; In Situ Hybridization ; Lymphoma, Large B-Cell, Diffuse ; genetics ; metabolism ; pathology ; Male ; Middle Aged ; Necrosis ; Phenotype ; Proto-Oncogene Proteins c-bcl-6 ; metabolism ; RNA, Viral ; analysis

Chronic disease management is seen as a breakthrough point for establishing the hierarchical medical system, also an important task in building a healthy China. We summarized the experiences of the chronic diseases management of Beijing Chao-Yang Hospital, focusing on the establishment of a chronic diseases management team, development of the diagnosis and treatment norms and management procedures, and the interoperable information platform. And we introduced the practical effects, such as guiding patients to primary medical institutions, reducing medical costs, and improving the primary capabilities to manage chronic diseases, and existing problems of the management model.

Objective:To construct cluster intervention strategy with medical adhesive-related skin injury (MARSI) based on multi-criterion decision analysis (MCDA) .Methods:Literatures related to nursing care of MARSI were systematically searched in Cochrane Library, PubMed, EMBASE, Chinese Biomedical Literature Database, CNKI, VIP database, Wanfang Database and other Chinese and English databases. The retrieval period was from January 1, 2008 to December 31, 2018. A total of 10 correspondence experts used MCDA to assign scores to various nursing measures of cluster intervention strategies for MARSI patients. The recommendation score of each measure was calculated to form the recommendation, and the feasibility of cluster intervention strategy was verified through pre-test.Results:The authority coefficient of 10 letter experts was 0.830 and the positive coefficient of experts was 100%. After consultation with experts, 14 nursing recommendations were drawn up and entered into the item pool of cluster intervention strategies. The top 5 nursing measures were strengthening education and training for medical staff, standardization of application and removal of medical adhesives, application of alcohol-free skin protectants before using medical adhesives, complete skin dryness before using medical adhesive products (≥30 s) and correct description of damage type, color, range, etc.Conclusions:The use of MCDA can scientifically construct MARSI cluster intervention strategies.