Objective To evaluate the post-puncture complications in children,and to evaluate the difference in the occurrence rate of headache and backache between patients who had 1 hour of supine recumbency and those who had 4 hours of supine recumbency,to provide evidence for the standardized lumbar puncture (LP) procedure of children.Methods Inpatients who were older than 3 and had diagnostic LP in the course of their treatment between Nov.2012 and Apr.2013 were enrolled.The LP was performed by the same investigator under the standardized institutional guideline for LP and the information of number of LP attempts,duration of LP and cerebrospinal fluid (CSF) drainage volume were recorded.After the procedure,all the children were randomly assigned into 2 groups:the test group had supine recumbency for 1 hour after LP,and the control group had it for 4 hours.For the first 5 days following LP,reports of headache and backache were recorded by another physician who didn't participate in this study.The difference in the occurrence rate of headache and backache between test group and control group was assessed by the chi-square test or Fisher's probabilities in 2 × 2 table.And a Logistic regression analysis was performed to assess the risk factors for the occurrence of the headache and backache.Results The overall frequency of headache was 4.6％ (4/87 cases).The frequency of headache was not significantly different between the test group (2.4％) and control group (6.7％) (P =0.617).And the overall frequency of backache was 19.5 ％ (17/87 cases),and it was not significantly different between the 2 groups (test group:21.4％,control group:17.8 ％,P =0.668).In a Logistic regression analysis,age (P =0.011,OR:6.884,95％ CI:1.398-33.906) and the previous history of lumbar puncture (P =0.018,0R:0.126,95 ％ CI:0.026-0.618) were significant risk factors for the occurrence of backache.The risk of backache in children with more than 2 times of LP was decreased.And the risk was higher in the children older than 6 years than those younger than 6 years.Conclusions Headache and backache were the most frequent post-puncture complications in children.There was no difference between short duration (1 hour) of supine recumbency and long duration (4 hours) in preventing the occurrence of headache and backache after LP.

Objective To investigate the serum concentrations of protein-bound uremic toxins of hippuric acid ( HA) , indoxyl sulfate ( IS ) , p-cresyl sulfate ( PCS ) and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid ( CMPF ) in patients with chronic kidney disease(CKD) 3-5 stages(CKD3-5) and to assess the correlation between renal function and pro-tein-bound uremic toxin concentrations in CKD3-5 patients.Methods Serum concentrations of HA, IS, PCS, and CMPF from 60 healthy volunteers and 112 CKD3 -5 patients were measured by liquid chromatography mass spectrometry/mass spectrometry ( HPLC-MS/MS ) .Correlation analysis was conducted between the levels of HA, IS, PCS, CMPF and the estimated glomerular filtration rate( eGFR) .Results Compared with healthy subjects, serum concentrations of these four solutes were significantly increased in CKD3-5 patients (all P<0.01).The serum levels of HA,IS and PCS in CKD3-5 patients were significantly increased (all P<0.05),while those of CMPF did not significantly change (P>0.05).Linear correlation analysis showed that HA, IS, PCS and CMPF were in significantly negative correlation with eGFR.The curve regression analysis showed that the curvilinear regression fitting equation was Y=-46.171lnX+209.464(R2 =0.601,P<0.01)for HA and eGFR, Y=-62.570 lnX+279.537(R2 =0.633,P<0.01)for IS and eGFR, Y=-84.297 lnX+383.172(R2 =0.529,P<0.01)for PCS and eGFR, and was Y=-7.648 lnX+53.546(R2 =0.172,P<0.01)for CMPF and eGFR .Conclusion The levels of the four types of protein-bound toxins in CKD3-5 patients increase significantly compared to healthy subjects.The serum levels of HA,IS and PCS are increased when the renal function decreases, but the level of CMPF changes little.Renal dysfunction can lead to significantly elevated levels of HA,IS and PCS in CKD3-5 patients, but has little effect on CMPF.

Objective To evaluate the clinical value of three-dimensional power Doppler ultrasound (3D PDUS) in diagnosing cervical cancers.Methods 162 patients with cervical lesions were enrolled.All the cases were confirmed by autopsy or surgery.Vascularization index (VI),flow index (FI) and vascularization flow index(VFI) were all measured and compared.The pathological findings was taken as golden standard.ROC curve was used to find the best cut-off value.Results 3D PDUS indices of benign and malignant lesions were statistically different (P ＜0.0001).The best cut-off value of VI was 4.63 using ROC curves,the area under the curve (AUC) was 0.94,the sensitivity and specificity were 89.10％ and 86.30％,respectively.The best cut-off value of FI was 34.39 using ROC curves,AUC was 0.76,the sensitivity and specificity were 73.40％ and 76.70％,respectively.The best cut-off value of VFI was 1.60 using ROC curves,AUC was 0.93,the sensitivity and specificity were 87.50 ％ and 86.30 ％,respectively.Conclusions 3D PDUS was a new and noninvasive way for the clinical to differentiate benign and malignant cervical lesions.

Objective To evaluate the application of partial cpsA-cpsB serotype prediction system as a serotyping method for streptococcus pneumonia.Methods Ninety-four isolates in this study were provided by Microorganism Research Room of Beijing Pediatric Research Institution,Beijing Children's Hospital Affiliated to Capital Medical University.The quelling test was applied to determine gold standard of serotypes of isolates.Polymerase chain reaction (PCR),sequencing,sequence data management and alignment were implemented previously.Results Eighty-three out of all 94 isolates were serotyped by quelling reaction,and 11 isolates were non-serotype isolates.Among the 83 isolates,67 (80.72％) isolates got positive PCR results and 60 (89.55％)isolates got results consistent with gold standard or containing gold standard.Among 12 isolates belonging to 19F,10 isolates were correctly predicted,and 2 isolates were predicted to be 6A,23F/10A.Among 19 isolates belonging to serotype 19A,1 isolate was predicted to be 35 F/47F,and the other 18 isolates were correctly predicted.Among 10 isolates belonging to serotype 14,9 isolates got results consistent with gold standard,and 1 isolate was predicted to be 19A.All 7 isolates belonging to serotype 6B were predicted to be 6A/6B and 4 isolates belonging to 23F were predicted to be 23F/10A.3 of 11 (27.27％) non-serotype isolates got positive PCR results and were predicted to be 6A/6C,6A/6B,19A.Conclusions Partial cpsA-cpsB sequencing system is a useful method for detecting streptococcus pneumoniae serotypes.

Objective To explore the clinical value of real‐time elastography in evaluating rabbit carotid vulnerable plaque . Methods Thirty male New Zealand rabbits ( weighted from 2 .0 to 3 .0 kg) were all fed with high cholesterol diet for one week before balloon injury of their right common carotid arteries . Then they were categorized randomly into two groups which were continued fed by high cholesterol diet for 6 and 12 weeks ,respectively . Ultrasound and real‐time elastography of their right common carotid arteries were applied after their anesthesia by ear marginal vein . Strains of the carotid plaques were measured and analyzed statistically by two independent experienced sonographers . All the rabbits were sacrificed by air embolism method after all the examinations . The atherosclerotic rabbit common carotid lesions were dissected ,fixed for pathologic examination , and graded according to the standard of American Heart Association ( AHA) ,which were compared with the real‐time elastography findings . Results Real‐time elastography had well repeatability between different operators . Consistency between elastography and the AHA pathology was quite good ,with the Cohen′s kappa= 0 .803 (95% CI 0 .669 to 0 .938) . Strains of different regions in a plaque had statistically significant difference ( P <0 .000 1) . By using strain higher than 0 .37% ,the sensitivity and specificity of detecting a lipid core were 88 .0% and 81 .6% ,and area under ROC curve was 0 .902 (95% CI 0 .810 -0 .959 , P < 0 .0001) . Conclusions Real‐time elastography can display the inner elastic characteristics of the rabbit carotid plaques ,and may help evaluate the grading of a plaque . The strain value may help detect a necrotic core ,thereby help evaluate the stability of a plaque .

Objective:To explore the clinical characteristics, drug resistance and the serotype distribution of the isolates from peadiatric patients with pneumococcal meningitis (PM).Methods:Clinical data, follow-up outcomes, drug susceptibility of isolated strains and serotyping results of 72 children diagnosed as PM and hospitalized in Beijing Children′s Hospital, Capital Medical University, from January 2012 to December 2017 were retrospectively analyzed, and the independent risk factors of mortality in the PM patients were analyzed.Results:There were 46 males and 26 females.In 72 PM cases, with the age ranging from 1 month to 9 years, and hospital stay from 1 to 363 days(median, 22.0 d). A total of 71 cases (98.6%) had community-acquired infections.There were 28 cases (38.9%) with definite underlying diseases, the top 3 of which were cerebrospinal fluid rhinorrhea(6 cases), head trauma (4 cases)and immunodeficiency diseases (4 cases). Fever (72 cases, 100.0%) was the most common clinical symptom, followed by depression of spirit, change of consciousness (46 cases, 63.9%), vomitting (45 cases, 62.5%), convulsion (42 cases, 58.3%), increased tension of anterior fontanelle (27 cases, 37.5%) and headache (17 cases, 23.6%) .There were 44 cases (61.1%) of neurological complications, including 29 cases (40.3%) of subdural effusion.Bacterial meningitis recurred in 2 cases, both of which were recurrent Streptococcus pneumoniae infection.The intracranial infections were divided into meningitis (43.1%, 31/72 cases) and meningoencephalitis (56.9%, 41/72 cases) .The penicillin nonsensitive rate of meningitis isolates was 74.3%, and their resistance rate to Erythromycin, Clindamycin and Tetracycline were 95.7%, 95.7% and 89.1%, respectively.All meningitis isolates were susceptible to Levofloxacin, Vancomycin and Linezolid.The serotypes of 24 cases (33.3%) were identified, among which 8 strains were type 19F (33.4%), 5 strains were type 14, 4 strains were type 23F, 3 strains were type 6A, 2 strains were type 19A, 1 strain was type 1 and 1 strain was type 15B, with a 13-valent protein-polysaccharide conjugate vaccine (PCV13) coverage rate of 95.8%(23/24 strains). Among all children that were followed up, 51 cases got better, 21 cases (case fatality rate was 29.2%) were confirmed dead, and 21 children (29.2%) had sequelae.The multiva-riate Logistic regression analysis suggested that respiratory failure and peripheral blood white blood cell count <4×10 9/L were independent risk factors for death of children with PM(all P<0.05). Conclusions:Most PM cases in this center are children under 5 years old.Cerebrospinal fluid rhinorrhea, head trauma and immunodeficiency diseases are common underlying diseases in children with PM.Respiratory failure or peripheral blood leukopenia during the course of the disease may indicate a poor prognosis.

Objective:To explore the effectiveness of the comprehensive healthcare management model for children with bacterial meningitis after discharge.Methods:This study was a retrospective cohort study that included 268 children with bacterial meningitis who were discharged from the infectious medicine ward of Beijing Children′s Hospital from September 2018 to September 2023. The children were managed with a multidisciplinary collaborative comprehensive healthcare management model after discharge. Outpatient data at 1 month and 6, 12 and 24 months after discharge were collected, including (height, weight, body mass index, nutritional feeding status, hearing and vision screening results, Gesell developmental assessment results and intervention guidance services. The follow-up interval or frequency was dynamically adjusted or increased according to the child′s situation. The paired sample t-test and chi square test were applied to compare the differences in Gesell developmental quotient (DQ) and developmental delay rate between the first and last assessments to preliminarily explore the effectiveness of the comprehensive healthcare management model for children with bacterial meningitis after discharge. Results:All the 268 children completed their first assessment one month after discharge, and 37 children were found to have abnormal physical growth, mainly obesity (28 children), and another 9 children were malnutrition. Nutritional intervention and feeding guidance services were provided to all the 37 children, and as of the last follow-up, 20 children′s physical growth evaluations had turned normal. A total of 188 children completed at least 2 developmental assessments, with an interval of (14.2±9.4) months between the first and last assessments (range: 3.1-49.5 months). The DQ values of in the energy region of adaptability, gross motor skills, fine motor skills, language, and personal social skills at the last assessment were significantly higher than those at the first assessment [(91.93±13.28) vs (80.73±15.96) points, (91.69±12.96) vs (78.31±16.58) points, (89.32±16.11) vs (80.68±15.63) points, (90.10±16.65) vs (82.04±18.43) points, (92.01±14.05) vs (77.82±17.42) points]; moreover, the rates of developmental delay in each energy region were significantly lower than those at the initial assessment (9.6% vs 35.1%, 9.6% vs 42.0%, 18.1% vs 33.0%, 13.3% vs 31.9%, 9.6% vs 42.0%) (all P<0.05). Among the 200 children who completed the hearing screening, 18 were found with hearing abnormalities, and 2 were diagnosed with hearing loss in the Otolaryngology Department. Among 217 children who completed vision screening, 23 had abnormalities, and 5 were diagnosed with ophthalmic abnormalities in Ophthalmology Department (2 with strabismus, 2 with refractive errors, and 1 with optic nerve injury). Two children were found to have autism-like behavior during monitoring, and were referred to a developmental behavior clinic to be diagnosed with autism spectrum disorder and were given early diagnosis and intervention guidance. Conclusion:The comprehensive healthcare management model for children with bacterial meningitis after discharge can integrate clinical and healthcare resources, which is beneficial for improving the prognosis and enhancing the quality of life for children with special health status.

[Abstract] Objective: To investigate the mechanisms of carnitine palmitoyltransferase 1c (CPT1c) expression to affect the proliferation and apoptosis of human thyroid papillary cancer B-CPAP cells through the AMP-dependent/activated protein kinase (AMPK) pathway in the low glucose and hypoxic conditions. Methods: Firstly,humanthyroidpapillarycarcinomaB-CPAP cells were cultured under normal condition or low glucose and hypoxic condition respectively, followed with the treatment of AMPK inhibitor compound C. Western blotting was used to detect the expressions of AMPK, p-AMPK, peroxisome proliferator-activated receptor α (PPARα) and CPT1c; the proliferation and apoptosis were detected by CCK-8 and Flow cytometry, respectively. Then PPARα-siRNA was synthesized and transfected into B-CPAP cells to knock down PPARα, and then the cells were cultured under normal or low glucose and hypoxic condition respectively.Above indicators were also detected to verify the regulation of PPARα on CPT1c. Finally, the human luciferase reporter plasmid containing CPT1c gene promoter was constructed, and the effect of PPARα on the activity of CPT1c promoter luciferase activity was observed by immunofluorescence. Results: The expressions ofAMPK, p-AMPK, PPARα and CPT1c were significantly increased in B-CPAP cells under low glucose and hypoxia condition (P<0.05 or P<0.01), while cell proliferation and apoptosis rate did not change significantly (P>0.05). After the treatment of AMPK inhibitor compound C, the expressions of p-AMPK, PPARα and CPT1c in low glucose and hypoxia group were significantly decreased (P<0.05 or P<0.01), the inhibitory rate on cell proliferation and apoptosis rate were significantly increased (P<0.05). However, the change range was smaller than that in the normal culture + compound C group (P<0.05).After PPARα knockdown, the expressions ofAMPK, p-AMPK, PPARα and CPT1c in cancer cells cultured under normal conditions were significantly decreased (P<0.05 or P<0.01), and the inhibitory rate on cell proliferation and apoptosis rate were significantly increased (P<0.05). While under low glucose and hypoxia condition, the expression of CPT1c in cells after transfection was significantly decreased (P<0.05), and the inhibition rate on cell proliferation and the apoptosis rate were significantly increased (P<0.05); However, the change range was still lower than that of normal condition group after transfection (P<0.05).After PPARα overexpression, the ratio of fluorescence in the empty vector group was not significantly different from that of the blank group (P>0.05), and the ratio of fluorescence was significantly increased in PPARα over-expression group (P<0.05). Conclusions: AMPK can increase the expression of PPARα to promote the expression of CPT1c in thyroid cancer B-CPAP cells under low glucose and hypoxia conditions, thereby inhibiting cell apoptosis and maintaining cell proliferation ability.

Objective:To analyze the characteristics and prognosis of hearing loss in children with bacterial meningitis.Methods:This was a single-center retrospective cohort study. Patients diagnosed with bacterial meningitis who were hospitalized in Beijing Children′s Hospital between 2010 and 2016 and older than 28 days and younger than 18 years at symptom onset were included in this study ( n=573). All clinical information including hearing assessment results during hospitalization were reviewed. All patients with hearing loss were followed up to repeat their hearing test and assess their hearing condition with parents′ evaluation of aural and (or) oral performance of children (PEACH). Patients were grouped according to their hearing assessment results, and Logistic regression analysis was used to analyze the risk factors for hearing loss in patients with bacterial meningitis. Results:Five hundred and seventy-three patients were enrolled in this study, including 347 males and 226 females. The onset age ranged from 29 days to 15.8 years. Two hundred and forty-six patients had identified causative pathogens, among whom 92 cases (37.4%) were pneumococcal meningitis cases. Hearing loss was found in 160 cases (27.9%) during hospitalization, involving 240 ears. Permanent hearing loss was found in 20 cases (16.9%), involving 32 ears. In the patients with permanent hearing loss, 87.5% (28/32) of ears were identified as severe or profound hearing loss during hospitalization. Logistic regression analysis showed that dystonia, the protein concentration level in cerebrospinal fluid>1 g/L, glucose concentration level lower than 1 mmol/L and subdural effusion were independent risk factors for hearing loss ( OR=2.426 (1.450-4.059), 1.865 (1.186-2.932), 1.544 (1.002-2.381) and 1.904 (1.291-2.809)). Conclusions:Hearing loss is a common sequela of bacterial meningitis in children. Most patients have transient hearing loss, but patients with severe or profound hearing impairment have a higher risk of developing permanent hearing loss.