Objective:To comprehensively analyze the clinical characteristics,classification of causes,treatment methods,and outcomes of pediatric convulsions in the emergency department,providing a scientific basis for the diagnosis and treatment of pediatric convulsions and optimizing emergency management for these cases.Methods:The clinical data of 18 217 children with convulsions in the emergency department of Capital Institute of Pediatrics' Children's Hospital from January 1,2016 to December 31,2020 were retrospectively analyzed.Results:A total of 18 217 children were admitted to the emergency department due to convulsions,accounting for 2.3% of all visits.Among them,58.7% cases were male and 41.3% cases were female,with an average age of (2.00±0.03) years.The main age was 1 to 3 years old (54.2%).Generalized convulsions were the primary type (82.3%),with focal seizures accounting for 17.7%.Most convulsions lasted less than 5 minutes (82.4%),and approximately 55.2% of the patients could self-resolve.Febrile convulsions were the primary cause (69.2%),followed by benign convulsions with mild gastroenteritis (11.7%) and epilepsy (10.5%).Regarding treatment,54.0% of the children recovered without medication.In the triage system of "three zones and four levels," the usage rate of anticonvulsants in the red zone was 93.1%,with 21.6% requiring combined treatment.After treatment,48.2% of the children returned home,92.2% showed improvement or recovery,and the mortality rate was extremely low at only 0.03%.Conclusion:Febrile convulsions are the main cause of pediatric convulsions in the emergency department,and an efficient triage system play an important role in improving treatment response.Different treatment zones and outcomes vary,providing important reference for optimizing emergency management.

Objective:To evaluate the characteristics of carotid plaque and the immediate outcomes after carotid artery stenting (CAS) in diabetic and non-diabetic patients by optical coherence tomography (OCT).Methods:Patients underwent CAS and OCT before and after operation in the Department of Neurology, Jinling Hospital from January 2014 to March 2019 were enrolled retrospectively. The clinical features, the characteristics of carotid plaque on OCT and the immediate outcomes after CAS were compared between diabetic group and non-diabetic group. The risk factors of stent malapposition were analyzed.Results:A total of 46 patients were enrolled. Their age was 64.02±8.32 years and 41 were males (89.1%). There were 20 patients (43.5%) in the diabetes group and 26 (56.5%) in the non-diabetes group. The proportions of atherosclerotic plaque with thin fibrous cap (40.0% vs. 7.7%; χ2=5.166, P=0.023), plaque rupture (55.0% vs. 23.1%; χ2=4.945, P=0.026) and macrophage infiltration (60.0% vs. 30.8%; χ2=3.930, P=0.047) in the diabetic group were significantly higher than those in the non-diabetic group. Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.208, 95% confidence interval [ CI] 1.033-1.413; P=0.018), coronary heart disease ( OR 15.953, 95% CI 1.142-222.952; P=0.040), alcohol consumption ( OR 6.192, 95% CI 1.098-34.923; P=0.039) and lower systolic blood pressure ( OR 0.944, 95% CI 0.894-0.997; P=0.037) were independently associated with stent malaposition. Conclusion:Compared with the non-diabetic patients, carotid plaque in diabetic patients may be more unstable. Older age, coronary heart disease, alcohol consumption and lower systolic blood pressure were associated with stent malaposition after carotid stenting. OCT can reveal the characteristics of carotid plaque and the immediate outcomes after CAS, which can provide strong evidence for treatment decision.

Objective:To screen and identify differentially expressed long non-coding RNA (lncRNAs) in peripheral blood of children with sepsis, and to explore the role of lncRNAs in the pathogenesis of sepsis in children.Methods:The peripheral blood samples of 3 children with sepsis admitted to the ICU of Children′s Hospital of Capital Institute of Pediatrics from January to December 2016 and 3 healthy children who underwent physical examination in our hospital during the same period were selected, and the differential expression profiles of lncRNAs and mRNAs were screened by lncRNAs sequencing technology.The target genes of differentially expressed lncRNAs were predicted and the relationship pairs of lncRNA-mRNA related to F 1F O-ATPase activity were constructed according to the results of GO analysis.Further increasing the sample size, we verified the expression of some F 1F O-ATPase activity-related mRNAs and lncRNAs which were differentially expressed in the screening results by real-time fluorescent quantitative polymerase chain reaction(qRT-PCR). Results:Sequencing results showed that there were 252 lncRNAs with significant differential expression in peripheral blood of children with sepsis compared with healthy children, of which 86 were up-regulated and 166 were down-regulated; meanwhile, there were 2 652 mRNAs with significant differential expression, of which 955 were up-regulated and 1 697 were down-regulated.The results of qRT-PCR showed that the expression of lncRNA ENST00000621933.1, ENST00000616950.1 and ENST00000595748.1 in peripheral blood of children with sepsis increased( P<0.05), while the expression of MT-ATP8, ATP5E and ENST00000624705.1, ENST00000615535.1 in peripheral blood of children with sepsis decreased( P<0.05), which was consistent with the sequencing results. Conclusion:lncRNAs are differentially expressed in peripheral blood of children with sepsis compared with healthy children.The expression levels of lncRNA ENST00000621933.1, ENST00000616950.1, ENST00000595748.1, ENST00000624705.1 and ENST00000615535.1 which their target genes are MT-ATP8 and ATP5E may be related to the development of sepsis in children.

Objective:To investigate the correlation between mental health and symptom distress in breast cancer patients.Methods:The clinical data of 110 female breast cancer patients at Shanxi Bethune Hospital from June 2017 to March 2018 were collected. The patients were assessed for symptomatic distress with depression self-rating scale (SDS). Functional assessment of cancer therapy-breast (FACT-B) and the functional assessment of chronic illness therapy-spiritual well-being (FACIT-SP) were used to make the mental assessment. Multiple linear regression analysis was used to analyze the effect of symptom distress on the mental health of the patients.Results:The scores of symptom distress, mental health, FACT-B and FACIT-SP were (19.94±5.78), (50.68±10.64), (16.85±4.75), (33.83±8.33), respectively. Multivariate analysis showed that mental health score of the patients with symptom distress > 18 scores was reduced by 5.15 points ( P=0.01) compared with the patients with symptom distress≤18 scores. Compared with the patients with annual household income < 50 000 yuan, the mental health score of patients with annual household income of 50 000-79 000 yuan was increased by 9.46 points ( P < 0.01), and the mental health score of patients with annual family income ≥ 80 000 yuan was increased by 5.92 points ( P < 0.01); compared with the patients in phase I, the mental health score of the patients in phaseⅡwas decreased by 2.62 points ( P=0.02), and the mental health score of the patients in phase Ⅲ was decreased by 4.98 points ( P < 0.01). Conclusions:Symptom distress is an independent risk factor for affecting mental health of breast cancer patients. Solving symptom distress of patients can improve mental health status of the patients.

Objective: To study the clinical characteristics of children with adenovirus pneumonia and provide evidence for clinical diagnosis and treatment timely. Method: This retrospective study included 89 children who were confirmed to have adenovirus pneumonia in hospital from January 2015 to December 2016. All the immunofluorescence test result of the 89 children showed that the exfoliated nasopharyngeal cells from the 89 children were all adenovirus antigen positive. All the severe type children reached the diagnostic criteria of severe pneumonia by the respiratory group in the society of pediatrics, Chinese Medical Association. The children were divided into 2 groups (severe type group and common type group). Different factors such as epidemiologic feature, clinical manifestation, laboratory examination and imaging data were analyzed. Results: Among the 89 pediatric patients, the male to female ratio was 1.5∶1. The ages ranged from 1 month to 14 years. Children under 5 years of age accounted for 96.6%(86/89). The incidence was 37.1%(33/89)in winter and 30.3%(27/89)in spring. The lengths of hospital stay were 3-48 days and the median length of stay was 8.25±4.75 days. All of these 89 cases had fever and cough. The proportion of severe adenovirus pneumonia was high among male, under 2 years of age, those with dyspnea, hepatosplenomegaly, tachycardia, leukocytosis, elevated C-reactive protein (CRP), PCT, myocardial enzymes, electrocardiogram abnormality and cluster shadow in chest CT. Differences were statistically significant (P<0.05). Conclusions Special attention should be paid to the male children under the 2 years of age with abnormal related indicators to consider severe adenovirus pneumonia. Early detection and treatment are the key to improve treatment and reduce death.

Objective: To investigate the effects of high mobility group box-1 protein (HMGB1) exocrine promoted by G protein-coupled estrogen receptor (GPER) in cancer-associated fibroblast (CAF) combined with the small molecule compound G1 on the autophagy and proliferation of breast cancer MCF-7 cells. Methods: The GPER-shRNA lentiviral vector specifically interfering GPER gene expression was constructed and used to infect CAF (CAF-shGPER), while the CAF infected with a negative control lentivirus was used as the control (CAF-shNC). The expression levels of GPER mRNA and protein in CAF-shNC and CAF-shGPER cells were detected by real-time fluorescent quantitative PCR and Western blotting, respectively. The GPER-specific agonist G1 was used to treat the CAF-shNC and CAF-shGPER cells, respectively. Then the expression levels of HMGB1 mRNA and protein in CAF-shNC, CAF-shGPER, CAF-shNC+G1 and CAF-shGPER+G1 cells were detected by real-time fluorescent quantitative PCR and Western blotting, respectively. The secretion of HMGB1 protein in the conditioned medium of four groups was detected by enzyme-linked immunosorbent assay (ELISA). The conditioned medium of four groups was collected and used to treat MCF-7 cells. Then the expression levels of Beclin1, p62 and LC3 proteins in MCF-7 cells were detected by Western blotting, while the proliferation of MCF-7 cells was detected by CCK-8 assay. Results: After the lentivirus carrying GPER-shRNA was stably infected into CAF, the expressions of GPER mRNA and protein were significantly inhibited (both P<0.01). The expressions of HMGB1 mRNA and protein in CAF-shNC cells were significantly up-regulated by GPER specific agonist G1 (both P<0.05), while the secretion of HMGB1 was increased in the conditioned medium (P<0.05); However, the above effects of G1 were opposite in CAF-shGPER cells. Furthermore, the exocrine HMGB1 in conditioned medium up-regulated the expressions of Beclin1 and LC3 proteins (both P<0.01), down-regulated the expression of p62 protein (P<0.01), and increased the autophagy and proliferation abilities of MCF-7 cells (both P<0.01). Conclusion: The small molecule compound G1 can promote the expression of GPER in CAF in tumor microenvironment and increase the secretion of cytokine HMGB1, thus induce the autophagy of MCF-7 cells and promote the growth of MCF-7 cells.

Objective To discuss the alterations of functional brain properties in patients with idiopathic trigeminal neuralgia (ITN) based on graph theoretical approaches.Methods A total of 20 patients with pain in the distribution of left trigeminal nerve and 22 matched healthy controls were recruited in our hospital from May 2013 to January 2015.Resting-state functional MRI data in both groups were collected and analyzed with GRETNA software to obtain the matrices of brain network.From these connectivity matrices,a number of key characteristics were computed,including network efficiency,weighted shortest path length,weighted clustering coefficient and small-wordless.A two-tailed t test was used to appraise the significance of any inter-group differences in complex network measures investigated.Network-based statistic (NBS) approach was used to localize specific pairs of brain regions in which functional connectivity strength were altered in patients.Pearson's correlation analyses were performed to identify the correlations between clinical data and altered network properties in patients.Results ITN patients had significantly increased weighted clustering coefficient in the right calcarine (CAL) and bilateral thalamus,increased total efficiency in the left superior frontal gyrus (SFG),and increased regional efficiency in the right SFG,right CAL,bilateral cuneus and left pallidum,and significantly reduced weighted shortest path length for regional nodal characteristics in the right superior parietalis lobules (P＜0.05).The total efficiency in the left SFG and regional efficiency in the right SFG in ITN patients were negatively correlated with course of disease (r=-0.500,P=0.035;r=-0.501,P=0.034).As compared with the healthy controls,the ITN patients had enhanced functional loop connection between left SFG and right supplementary motor area,between left SFG and right SFG,between left SFG and right middle frontal gyrus,between left SFG and right orbital middle frontal gyrus,between left SFG and partes opercularis of right gyrus frontalis inferior (IFGoperc),between left SFG and bilateral putamen (PUT),between left SFG and right PAL,between right PUT and left interior superior frontal gyrus,and between left PUT and right caudate nucleus.The connectivity strength between left SFG and right IFGoperc was negatively correlated with disease duration (r=-0.487,P=-0.041).Conclusion Alterations in regional nodal characteristics may suggest central sensitization and modulation in ITN patients.

Objective To identify the diffusion alterations of deep gray matter(GM) and white matter (WM) among Alzheimer's disease (AD), mild cognitive impairment (MCI) and healthy people by atlas?based analysis (ABA), and to investigate the respective relationship with cognitive function. Methods Twenty?one AD patients (AD group), 8 MCI patients (MCI group) and 15 normal controls (control group) were performed by conventional MRI and diffusion tensor imaging (DTI). The raw data of DTI was processed by using DTI studio software to generate the fractional anisotropy (FA) images. Then ABA was used to quantify the FA value in 58 deep GM and WM structures. The differences of FA value among three groups were compared by using one way ANOVA, with a post?hoc analysis. In AD and MCI groups, the partial correlation was further investigated between mini?mental state examination (MMSE) score and FA value in the brain regions that have significant differences between AD and MCI group or between MCI and control group. Results Compared with control group, AD patients showed wide?spread FA decrease in most deep GM and WM regions (corrected P<0.05). The FA values of the hypothalamus, the fornix, the superior longitudinal fasciculus (SLF) and the cingulum in AD group were significantly lower than those in MCI group (corrected P<0.05). The FA value of the right splenium of corpus callosum (SCC) in MCI group was significantly lower than that in control group (MCI:0.550±0.018 vs. Control:0.585±0.026, P<0.05). In AD and MCI group, the FA values of the left hypothalamus, the right hypothalamus, the left cingulum, the right cingulum, and the left SLF were positively correlated with MMSE scores(r=0.502, 0.515, 0.535, 0.527, 0.512; P<0.05). No significant correlation was found between the FA value of the right SCC, the right SLF, the right fornix/stria terminalis, the right fornix and MMSE scores(P>0.05). Conclusion Based on ABA, this study found the diffusion changes not only in the WM but also the deep GM in AD patients, but only WM diffusion disruptions in MCI group. The decreased FA value in the right SCC appeared early, but had no correlation with the cognitive impairment. The FA value in the hypothalamus, the fornix, the SLF and the cingulum decreased with the disease progression, and correlated positively with the cognition decline.

Objective To observe the formation of the biofilm in endotracheal tubes,the characteristics of etiology,drug resistance and effect on the biofilm and ventilator-associated pneumonia (VAP) of inhaled N-acetylcysteine (NAC).Method We selected 117 tracheally intubated and undergoing mechanical ventilation for ≥48 h in our hospital ICU from September 2010 to August 2012.All the cases were randomly divided into control group (60 cases) and study group (57 cases).The patients in the study group were treated with different doses of aerosolized NAC according to different ages,starting the first administration within 12 hours of mechanical ventilation,once every 8 hours,until stopping mechanical ventilation.Comparison was performed on the two groups in biofilm structure under the scanning electron microscopy,biofilm culture positive rate,VAP incidence,the etiology and drug resistance of the lower airway secretions and biofilms.Result (1) Electron microscopy showed that biofilm had formed in the endotracheal tube inner wall in early period of mechanical ventilation.With prolonged mechanical ventilation,biofilm structure improved.At the same time of mechanical ventilation,the thickness of biofilm in the study group decreased as compared with the control group.(2) Biofilm culture positive rate and incidence of ventilator-associated pneumonia decreased in the study group compared with in the control group (65％(37/57) vs.80％(48/60),P＜0.05;11％ (6/57)vs.32％(19/60),P＜0.01).(3) Alarge number of pathogenic bacteria colonized in the biofilm and gram-negative bacilli dominated.With prolonged mechanicalventilation,theculturedpathogensconvergedfromthelowerairwaysecretionsandbiofilm.Conclusion With prolonged mechanical ventilation,biofilm structure was improved.Inhalation of NAC can inhibit biofilm formation and reduce the incidence of VAP.

The risk of death and chronic kidney disease will increase if severe patient development of acute kidney injury (AKI).International organizations in multiple disciplines of experts dedicated to the study early recognition and diagnosis AKI.And 3 new classification systems were recently developed in order to improve the ability of early diagnosing AKI.Sepsis is a common cause of pediatric hospital.It is also the most common cause of severe ill children developed AKI.Development of AKI during sepsis increases patient chronic kidney disease morbidity,predicts higher mortality.So it is crucial to early identify AKI to avoid delay in initiating renal protective and appropriate therapeutic measures.