Child ; Humans ; Case-Control Studies ; East Asian People ; Genetic Predisposition to Disease/genetics* ; Methyltransferases/genetics* ; Polymorphism, Genetic ; Wilms Tumor/pathology*

Changes in structure of oral solid dosage forms (OSDF) elementally determine the drug release and its therapeutic effects. In this research, synchrotron radiation X-ray micro-computed tomography was utilized to visualize the 3D structure of enteric coated pellets recovered from the gastrointestinal tract of rats. The structures of pellets in solid state and in vitro compendium media were measured. Pellets in vivo underwent morphological and structural changes which differed significantly from those in vitro compendium media. Thus, optimizations of the dissolution media were performed to mimic the appropriate in vivo conditions by introducing pepsin and glass microspheres in media. The sphericity, pellet volume, pore volume and porosity of the in vivo esomeprazole magnesium pellets in stomach for 2 h were recorded 0.47, 1.55 × 10⁸ μm³, 0.44 × 10⁸ μm³ and 27.6%, respectively. After adding pepsin and glass microspheres, the above parameters in vitro reached to 0.44, 1.64 × 10⁸ μm³, 0.38 × 10⁸ μm³ and 23.0%, respectively. Omeprazole magnesium pellets behaved similarly. The structural features of pellets between in vitro media and in vivo condition were bridged successfully in terms of 3D structures to ensure better design, characterization and quality control of advanced OSDF.

Objective:To analyze the influential factors of hypothermia in congenital heart disease (CHD) after cardiopulmonary bypass (CPB) rewarming using the decision tree model, thus providing theoretical basis for medical staff.Methods:A total of 711 CHD children who underwent surgery in the Shanghai Children′s Medical Center from January 1, 2019 to April 30, 2019 were retrospectively analyzed.A decision tree model was established to predict the risk factors for hypothermia in CHD children following CPB.Results:The decision tree model showed that CPB program, preoperative nutrition score and body surface area were the high-risk factors for hypothermia in CHD children after CPB rewarming.The accuracy, sensitivity, specificity of the decision tree model were 86.45%, 77.14% and 90.97%, respectively, and the area under the receiver operating characteristic curve was 0.851(95% CI: 0.798-0.904). Conclusions:Decision tree model has a high application value in predicting hypothermia in CHD children following CPB.It contributes to identify the influential factors of hypothermia, and provides references for performing preventive treatment and nursing measures to control the risk of hypothermia.

Metal-organic frameworks (MOFs), comprised of organic ligands and metal ions/metal clusters

Objective:To analyze the clinical features of the recurrence of febrile seizures(FS), and observe the efficacy of levetiracetam(LEV)in preventing FS recurrence.Methods:We retrospectively analyzed the clinical data of 101 cases of FS recurrence who were admitted to the Department of Neurology of our hospital from May 2017 to May 2020, and collected the information of the recurrence after discharge and adverse effects of LEV application.Cox proportional hazards model regression was applied to explore the relationship between FS recurrence and LEV prophylaxis.Results:Among 101 cases of recurrent FS, the section of 18-60 months(63/101)composed the dominant proportion, of which the episode of 18-36 months(40/101)took the biggest recurrence rate.All 101 recurrent FS cases occurred within 24 hours of fever-beginning time, and 74.3%(75/101)occurred within 3 hours of fever onset.39.6% cases(40/101)were non-high febrile seizures, of which 30.0%(12/40)even had a temperature ≤38°C at the onset.Ninty-five cases of FS were included in the retrospective cohort study.Thirty-eight cases(4 lost to follow-up)were treated with LEV, while 57 cases(7 lost to follow-up)were not treated with any anticonvulsant drugs.The recurrence rate in the prophylactic group was 17.6%(6/34), compared with 44.0%(22/50)in the control group.The recurrence rate of the prophylactic group was statistically lower than that of the control group( χ2=6.325, P=0.012). Cox regression analysis was used to explore the relationship between FS recurrence and various factors, suggesting LEV prophylaxis( OR=0.325, 95% CI 0.129-0.821)and family history of FS( OR=3.060, 95% CI 1.427-6.560)affect the recurrence of FS.Then FS family history was stratified, LEV prophylaxis still statistically reduced the recurrence of FS( OR=0.316, 95% CI 0.124-0.802). Conclusion:The risk of recurrence increases significantly after 18 months of the age.Besides, FS recurrence is relatively common in the initial episode of fever and in the stage of low fever.For children at months of high probability of recurrence, prophylactic drugs should be used in the initial episode of fever and in the stage of low fever.LEV prophylaxis therapy is effective, with mild adverse reactions.

Objective:To compare the capabilities of different chemotherapy-induced oral mucositis assessment tools, and seek a credible, reliable, highly sensitive and specific chemotherapy-induced oral mucositis assessment tool suitable for children and adolescents in China.Methods:From July 2019 to June 2020, convenience sampling was used to select 88 children from the Department of Hematology Oncology of Shanghai Children's Medical Center. The Chinese version of Children's International Mucositis Evaluation Scale (ChIMES) , Oral Assessment Guide (OAG) , and World Health Organization (WHO) oral mucositis classification were evaluated for all children in the three time periods, namely, before chemotherapy (T1: before the start of chemotherapy) , early chemotherapy (T2: the first to third days of chemotherapy) , and late chemotherapy (T3: the fourth day of chemotherapy and after) . Taking the result of WHO oral mucositis classification as the gold standard, and indicators such as sensitivity, specificity, relative operating characteristic (ROC) , and area under the curve (AUC) were used to evaluate the capabilities and optimal cut-off values of ChIMES and OAG, and the evaluation time-consuming of the three tools was compared.Results:There were statistically significant differences between ChIMES and OAG in the three scores during chemotherapy ( P<0.05) . Taking the WHO oral mucositis classification as the gold standard, the optimal cut-off value for ChIMES was 0.5, and the optimal cut-off value for OAG was 10.5. Both ChIMES and OAG had excellent assessment capabilities for children with chemotherapy-induced oral mucositis (AUC>0.9) . The time-consuming comparison of WHO oral mucositis classification, ChIMES and OAG was statistically significant ( P<0.05) . Conclusions:Both ChIMES and OAG can be used as credible and reliable tools for the assessment of chemotherapy-induced oral mucositis of children in China. ChIMES is more capable of identifying high-risk groups than OAG, and OAG is more suitable for busy clinical work. The assessment tool for children with chemotherapy-induced oral mucositis can be selected according to the assessment object, purpose, and required resources.

Objective:To analyze the clinical characteristics, cerebrospinal fluid (CSF) and other auxiliary examination results of febrile children with convulsions in order to provide the evidence for clinical recognition of central nervous system (CNS) infection and its etiology.Methods:The clinical data of 64 fever patients with convulsions admitted at the Department of Neurology, Shanghai Children′s Medical Center, Shanghai Jiaotong University School of Medicine were analyzed retrospectively.According to the results of the routine biochemical examination of CSF, they were divided into 2 groups as CSF normal group (44/64 cases, 69%) and CSF abnormal group (20/64 cases, 31%). Their age, gender, clinical manifestations, physical symptoms and auxiliary examination results were compared between the two groups. Logistic regression analysis was performed to explore the independent risk factors of abnormal CSF results.Twenty children with abnormal CSF results were divided into the normal glucose group (12/20 cases, 60%) and the glucose reduction group (8/20 cases, 40%) according to the glucose level of CSF.The fever duration, serum inflammation markers, CSF routine and biochemical indexes of the two groups were compared. Results:According to Logistic multivariate unconditional regression analysis, the mental state change ( OR=435.99, P=0.010), abnormal neurological signs ( OR=65.25, P=0.023) and vomiting ( OR=20.56, P=0.048) were the high risk factors of abnormal CSF results.Among the children with abnormal CSF results, in the glucose reduction and normal glucose groups, the fever duration was 12.50 (7.75-16.75) d and 4.00 (3.00-5.75) d, respectively; the level of CSF protein were 3 000 (1 745-3 000) mg/L and 648 (469-1 734) mg/L, respectively; the erythrocyte sedimentation rate (ESR) was 71.50(56.00-97.50) mm/1 h and 20.50 (12.00-26.00) mm/1 h, respectively; the procalcitonin level was 2.76(0.90-20.72) g/L and 0.23 (0.03-1.00) g/L, respectively; the C-reactive protein (CRP) level was 123.00 (33.00-177.75) mg/L and 12.50(4.25-57.75) mg/L, respectively.The fever duration, CSF protein level, ESR, procalcitonin level and CRP level were statistically different between the glucose reduction and normal glucose groups (all P<0.05). Conclusions:In fever children with convulsions, vomiting, the mental state change, and abnormal neurological signs are the high risk factors of abnormal CSF results, suggesting the possibility of CNS infections and the need of early diagnosis by CSF and other auxiliary examinations.In addition, a low level of CSF glucose in children with abnormal CSF results may be a potential and powerful clue for purulent meningitis.Timely etiological tests are required for confirmation, and antibiotics treatments should be applied as early as possible.

Objective:To investigate the clinical features of Herpes simplex virus encephalitis(HSE) with cerebral hematoma as the prominent manifestation and the significanc of metagenomic next-generation sequencing (mNGS) in the diagnosis of HSE.Methods:The clinical manifestations, diagnostic process, clinical treatment and prognosis of a case of HSE with cerebral hematoma as the prominent manifestation at Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine in June 2019 were retrospectively analyzed.The relevant literatures were also searched and reviewed.Results:A 4-year-old boy presented with slight fever, headache, convulsion and vomiting was considered to have intracranial space-occupying lesions and possible intratumoral hemorrhage after undergoing imaging examination at a local hospital.The patient was checked by head CT in Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, which showed that there were many bleeding foci in the brain, indicating the possibility of complications of blood system diseases.Therefor the child was given the examination of blood routine and coagulation routine, but the results were normal, the bone marrow cytology was negative, the cerebrospinal fluid(CSF) of lumbar puncture was biochemically normal, and mNGS were 8×10 6/L.Besides, CSF smear, culture and next-generation sequencing were negative, the autoimmune encephalitis CSF testing was negative, and brain biopsy suggested inflammation.The mNGS brain tissue showed herpes simplex virus 1 was positive in two specimens, confirming the diagnosis of HSE.After 3 weeks of antiviral treatment with Aciclovir, the child′s condition improved.After a 5-month follow-up, the patient had quadriplegia and only had activities such as blinking and swallowing. Conclusions:When the intracerebral hemorrhage such as hematoma caused by encephalitis clinically can not be ruled out, the possibility of HSE should be considered, and mNGS is helpful for identifying the central ner-vous system pathogen.

Objective: To translate the Children′s International Mucositis Evaluation Scale (ChIMES) into Chinese and evaluate its psychometric charateristics in pediatric patients with acute leukemia. Methods: After translation and cognitive debriefing interviews, convenience sampling was used to recruit 105 pediatric patients with acute leukemia in a Shanghai AAA pediatric hospital. Results: The known-group validity was great, and criterion validity was 0.947. Through EFA, the Chinese version of ChIMES included two dimensions which accounted for 75.270% of the accumulated variance, and each item had high factor loading quantity (>0.5). Cronbach alpha was 0.826 and the split-half reliability was 0.590. Relevance between each item and total score was good, with Pearson correlation coefficient 0.424-0.900. Conclusion The Chinese version of ChIMES has been proved valid and reliable and can be practically and feasibly used in the future.

Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.