Objective:To assess the nutritional status and risk of children with cyclic vomiting syndrome（CVS）and to provide a clinical evidence for nutritional support.Methods:A total of 160 children diagnosed with CVS and 160 healthy controls were prospectively enrolled in the study，who were admitted to Beijing Tsinghua Changgung Hospital from April 2021 to February 2024.Nutritional status was assessed by anthropometric indices（height，weight，and body mass index），and it was expressed in standard deviation score（Z score）.Nutritional risk screening tool STRONGkids was applied to nutritional risk screening，and the laboratory assessment（albumin，pre-albumin，hemoglobin，urea nitrogen and creatinine）were measured.Results:Among the 160 cases，there were 73 males and 87 females，including 18 cases of mild seizures and 142 cases of moderate and severe seizures，with the average onset age of（47.54±2.96）months and an average diagnosis age of（74.89±3.68）months.The average duration from the first attack to diagnosis was（27.35±2.36）months，and the average course of the disease was（41.35±2.63）months.The malnutrition rate of children in CVS was 36.9%（59/160），of which 18.1%（29/160）was severely malnourished.There was a statistically significant difference in the weight-for-age Z-score（WAZ），height-for-age Z-score（HAZ），and body mass index-for-age Z-score（BAZ）between the CVS group and the control group（ P<0.001）.We found a statistically significant difference in laboratory indicators（albumin，pre-albumin，hemoglobin，urea nitrogen and creatinine）between the two groups（all P<0.001）and hemoglobin was positively correlated with WAZ，HAZ and BAZ（ r=0.346,0.250,0.277，all P<0.01）.Using the STRONGkids nutritional risk screening tool，there were 43 cases with moderate nutritional risk and 117 cases with high nutritional risk，and children with high nutritional risk were likely to have lower WAZ，HAZ and BAZ than the children with moderate nutritional risk，and there was a significant difference in WAZ，HAZ，BAZ，hemoglobin，and creatinine between the two groups（ P<0.05）.And there was a correlation between the degree of CVS attack and nutritional risk grouping（ r=0.543， P<0.001）. Conclusion:Children with CVS have a high incidence of malnutrition，and the serum albumin，prealbumin，hemoglobin，urea nitrogen and creatinine levels are of great value for nutritional assessment.The STRONGkids score method helps to evaluate nutritional risk in children with CVS.

Objective:To investigate the characteristics of gut microbiota distribution in children with cyclic vomiting syndrome（CVS）complicated by constipation.Methods:The children with CVS, aged from 1 to 16 years, who were admitted to Beijing Tsinghua Changgung Hospital from June 2022 to January 2024, were divided into constipation group and normal group(non-constipation group) according to whether they were complicated with constipation or not.The clinical data and stool samples of children were collect. The abundance, diversity and composition of intestinal flora in fecal samples of two groups were detected by metagenomics sequencing.Results:A total of 20 children with CVS were collected, including 10 patients in constipation group and 10 patients in normal group.There were no significant differences in general demographic data between the two groups, including age at admission, age at first onset, body mass index, gender distribution, disease severity, endoscopic findings, and abdominal pain patterns.Microbiome analysis yielded 470 operational taxonomic units (OTUs), with 414 OTUs identified in normal group and 56 OTUs in constipation group. The abundance and diversity of intestinal flora in constipation group were significantly lower than those in normal group. Principal coordinate analysis and principal component analysis indicated significant structural differences in gut microbiota composition between the two groups. LEfSe analysis revealed distinct taxonomic patterns between the two groups, with the normal group demonstrating predominant representation of Firmicutes at the phylum level, while the constipation group showed higher relative abundance of Bacteroidetes and Actinobacteria. KEGG pathway analysis revealed that the carbon metabolism pathways was significantly enriched in the constipation group.Conclusion:There are significant differences in intestinal flora between CVS children with and without comorbid constipation.Bacteroides and Actinomycetes play an important role in constipation of children with CVS. The diversity and metabolic function of intestinal flora may be one of the pathological mechanisms of CVS complicated with constipation.

Objective:To analyze hemodynamic characteristics during the initial phase of the head-up tilt test (HUTT) in children with postural orthostatic tachycardia syndrome (POTS) and the value for predicting vasovagal syncope(VVS).Methods:This was a case-control study involving 123 POTS patients who underwent HUTT in the Pediatric Cardiovascular Department at the Children's Hospital,Capital Institute of Pediatrics,from January 2021 to August 2023.According to HUTT results,participants were divided into POTS combined with VVS group( n=82) and POTS group( n=41).The general conditions,clinical symptoms,24-hour urine sodium levels,and hemodynamics changes during the initial phase of HUTT between the two groups were compared. Results:The prevalence of POTS combined with VVS was 66.13% (82/123).There were no significant differences in age,sex,body mass index,24-hour urinary sodium,heart rate,heart rate variability,and maximum heart rate variability during the initial phase of HUTT between the two groups( P>0.05).Compared to the POTS group,the 10-minute systolic blood pressure(SBP10),10-minute diastolic blood pressure (DBP10),and 10-minute mean blood pressure(MBP10) in the POTS combined with VVS group were significantly lower [SBP10: 104(98.8,114.3) vs. 111(105,121.5)mmHg, Z=-3.071, P<0.05; DBP10: 63.44±8.36 vs. 68.29±6.43 mmHg, t=-3.265, P <0.05; MBP10: 78.31±9.74 vs. 83.28±7.30 mmHg, t =-2.879, P<0.05].Receiver operating characteristic curve analysis showed that DBP10,the difference between baseline DBP and DBP at 10-minute (△DBP10),and the in creasing rate of DBP10(△DBPR10) were predictive factors for POTS combined with VVS,with cut-off values of 67.5 mmHg (AUC=0.687,sensitivity 67.5%,specificity 72.0%),7.5 mmHg (AUC=0.633,sensitivity 43.9%,specificity 79.3%),and -2.84% (AUC=0.631,sensitivity 92.7%,specificity 31.7%),respectively.The combined predictive value was more significant (AUC=0.709, P<0.05),with sensitivity and specificity of 70.7% and 67.1%,respectively.In terms of age,DBP10 exhibited a higher predictive value in patients aged 13-18 years,with a DBP10 cut-off of 64.5 mmHg,AUC of 0.762,sensitivity of 92.7%,and specificity of 31.7%. Conclusion:The rate of HUTT-proven VVS in POTS was 66.13%.△DBP10,DBP10 and △DBPR10 have predictive value for POTS combined with VVS.Additionally,DBP10 shows a higher predictive value in patients aged 13-18 years.

To summarize the nursing experience of a patient infected with human parvovirus B19 induced epilepsy after double lung transplantation.The contents of nursing care were as follows:improving the early recognition of epileptic seizures and emergency response efficiency;implementing accurate assessment to master the best time for first aid;paying attention to the fear of epilepsy after lung transplantation,and implementing a matching exercise management program.Dynamic management of anti-rejection drugs and antiepileptic drugs were used to prevent adverse reactions;multipronged infection prevention measures were implemented to reduce the risk of transmission;psychological support and counseling should be paid attention to improve the treatment confidence and compliance of patients and their families.After careful treatment and nursing care,the patient recovered and was discharged 50 days after operation,and was followed up for 8 months with good recovery.

Objective:To explore the effect on cardiac remodeling of combining high-intensity interval training with metformin in cases of type 1 diabetes mellitus (T1DM) and its possible mechanisms.Methods:Sixty male Sprague-Dawley rats were randomly divided into control, model, exercise, drug and combination groups with twelve per group. T1DM was induced in all except the control group using a single intraperitoneal injection of streptozotocin (60mg/kg of body weight). The control and model groups were then housed without intervention, while the drug and exercise groups underwent metformin gavage (300mg/kg/day) or 8 weeks of high-intensity interval training (3 sessions/week), respectively. The combination group receiving both. After the training, body weight, a cardiac index (heart weight/body weight), and fasting blood glucose (FBG) were measured in all of the rats. Echocardiography assessed cardiac structure and function, and myocardial tissue was collected for HE or Masson staining to measure cardiomyocyte width and collagen volume fraction respectively. Protein expression and the levels of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), transforming growth factor-β (TGF-β), collagen (Col), peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), phosphorylated AMP-activated protein kinase (p-AMPK), ryanodine receptor (RyR), and sarcoplasmic reticulum calcium ATPase (SERCA) were determined using western blotting.Results:Compared with the control group, the model group showed significantly increased cardiac indices, FBG levels, and left ventricular end-systolic and end-diastolic diameters. But they had significantly decreased body weight, left ventricular fractional shortening and ejection fraction. Compared with the control group, there was a significant increase in the cardiomyocyte width and collagen volume fraction, as well as in ANP, BNP, TGF-β, and Col levels in the model group, along with downregulated PGC-1α, p-AMPK, RyR, and SERCA protein expression. Compared with the model group, the exercise, drug, and combination groups exhibited varying degrees of improvement in all these indicators, with the most pronounced effects in the combination group.Conclusions:High-intensity interval training combined with metformin promotes cardiac remodeling in T1DM rats, outperforming either intervention alone. The mechanism may involve minimizing myocardial fibrosis and pathological hypertrophy, restoring mitochondrial function and intracellular calcium homeostasis.

Objective:To assess the nutritional status and risk of children with cyclic vomiting syndrome（CVS）and to provide a clinical evidence for nutritional support.Methods:A total of 160 children diagnosed with CVS and 160 healthy controls were prospectively enrolled in the study，who were admitted to Beijing Tsinghua Changgung Hospital from April 2021 to February 2024.Nutritional status was assessed by anthropometric indices（height，weight，and body mass index），and it was expressed in standard deviation score（Z score）.Nutritional risk screening tool STRONGkids was applied to nutritional risk screening，and the laboratory assessment（albumin，pre-albumin，hemoglobin，urea nitrogen and creatinine）were measured.Results:Among the 160 cases，there were 73 males and 87 females，including 18 cases of mild seizures and 142 cases of moderate and severe seizures，with the average onset age of（47.54±2.96）months and an average diagnosis age of（74.89±3.68）months.The average duration from the first attack to diagnosis was（27.35±2.36）months，and the average course of the disease was（41.35±2.63）months.The malnutrition rate of children in CVS was 36.9%（59/160），of which 18.1%（29/160）was severely malnourished.There was a statistically significant difference in the weight-for-age Z-score（WAZ），height-for-age Z-score（HAZ），and body mass index-for-age Z-score（BAZ）between the CVS group and the control group（ P<0.001）.We found a statistically significant difference in laboratory indicators（albumin，pre-albumin，hemoglobin，urea nitrogen and creatinine）between the two groups（all P<0.001）and hemoglobin was positively correlated with WAZ，HAZ and BAZ（ r=0.346,0.250,0.277，all P<0.01）.Using the STRONGkids nutritional risk screening tool，there were 43 cases with moderate nutritional risk and 117 cases with high nutritional risk，and children with high nutritional risk were likely to have lower WAZ，HAZ and BAZ than the children with moderate nutritional risk，and there was a significant difference in WAZ，HAZ，BAZ，hemoglobin，and creatinine between the two groups（ P<0.05）.And there was a correlation between the degree of CVS attack and nutritional risk grouping（ r=0.543， P<0.001）. Conclusion:Children with CVS have a high incidence of malnutrition，and the serum albumin，prealbumin，hemoglobin，urea nitrogen and creatinine levels are of great value for nutritional assessment.The STRONGkids score method helps to evaluate nutritional risk in children with CVS.

Objective:To investigate the characteristics of gut microbiota distribution in children with cyclic vomiting syndrome（CVS）complicated by constipation.Methods:The children with CVS, aged from 1 to 16 years, who were admitted to Beijing Tsinghua Changgung Hospital from June 2022 to January 2024, were divided into constipation group and normal group(non-constipation group) according to whether they were complicated with constipation or not.The clinical data and stool samples of children were collect. The abundance, diversity and composition of intestinal flora in fecal samples of two groups were detected by metagenomics sequencing.Results:A total of 20 children with CVS were collected, including 10 patients in constipation group and 10 patients in normal group.There were no significant differences in general demographic data between the two groups, including age at admission, age at first onset, body mass index, gender distribution, disease severity, endoscopic findings, and abdominal pain patterns.Microbiome analysis yielded 470 operational taxonomic units (OTUs), with 414 OTUs identified in normal group and 56 OTUs in constipation group. The abundance and diversity of intestinal flora in constipation group were significantly lower than those in normal group. Principal coordinate analysis and principal component analysis indicated significant structural differences in gut microbiota composition between the two groups. LEfSe analysis revealed distinct taxonomic patterns between the two groups, with the normal group demonstrating predominant representation of Firmicutes at the phylum level, while the constipation group showed higher relative abundance of Bacteroidetes and Actinobacteria. KEGG pathway analysis revealed that the carbon metabolism pathways was significantly enriched in the constipation group.Conclusion:There are significant differences in intestinal flora between CVS children with and without comorbid constipation.Bacteroides and Actinomycetes play an important role in constipation of children with CVS. The diversity and metabolic function of intestinal flora may be one of the pathological mechanisms of CVS complicated with constipation.

Objective:To analyze hemodynamic characteristics during the initial phase of the head-up tilt test (HUTT) in children with postural orthostatic tachycardia syndrome (POTS) and the value for predicting vasovagal syncope(VVS).Methods:This was a case-control study involving 123 POTS patients who underwent HUTT in the Pediatric Cardiovascular Department at the Children's Hospital,Capital Institute of Pediatrics,from January 2021 to August 2023.According to HUTT results,participants were divided into POTS combined with VVS group( n=82) and POTS group( n=41).The general conditions,clinical symptoms,24-hour urine sodium levels,and hemodynamics changes during the initial phase of HUTT between the two groups were compared. Results:The prevalence of POTS combined with VVS was 66.13% (82/123).There were no significant differences in age,sex,body mass index,24-hour urinary sodium,heart rate,heart rate variability,and maximum heart rate variability during the initial phase of HUTT between the two groups( P>0.05).Compared to the POTS group,the 10-minute systolic blood pressure(SBP10),10-minute diastolic blood pressure (DBP10),and 10-minute mean blood pressure(MBP10) in the POTS combined with VVS group were significantly lower [SBP10: 104(98.8,114.3) vs. 111(105,121.5)mmHg, Z=-3.071, P<0.05; DBP10: 63.44±8.36 vs. 68.29±6.43 mmHg, t=-3.265, P <0.05; MBP10: 78.31±9.74 vs. 83.28±7.30 mmHg, t =-2.879, P<0.05].Receiver operating characteristic curve analysis showed that DBP10,the difference between baseline DBP and DBP at 10-minute (△DBP10),and the in creasing rate of DBP10(△DBPR10) were predictive factors for POTS combined with VVS,with cut-off values of 67.5 mmHg (AUC=0.687,sensitivity 67.5%,specificity 72.0%),7.5 mmHg (AUC=0.633,sensitivity 43.9%,specificity 79.3%),and -2.84% (AUC=0.631,sensitivity 92.7%,specificity 31.7%),respectively.The combined predictive value was more significant (AUC=0.709, P<0.05),with sensitivity and specificity of 70.7% and 67.1%,respectively.In terms of age,DBP10 exhibited a higher predictive value in patients aged 13-18 years,with a DBP10 cut-off of 64.5 mmHg,AUC of 0.762,sensitivity of 92.7%,and specificity of 31.7%. Conclusion:The rate of HUTT-proven VVS in POTS was 66.13%.△DBP10,DBP10 and △DBPR10 have predictive value for POTS combined with VVS.Additionally,DBP10 shows a higher predictive value in patients aged 13-18 years.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.

Objective:To investigate the anemia conditions and characteristics of iron metabolism during different stages of pregnancy in women with different genotypes of thalassemia.Methods:This cohort study selected 3 303 singleton pregnant women who underwent regular prenatal examinations and genetic tests of thalassemia and were delivered at Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2019 to December 2023. According to the results of thalassemia gene testing, the women were divided into groups: those without thalassemia genes served as the control group (1 539 cases), and those with thalassemia genes (1 764 cases) were further divided based on genotype into the -α/αα group (326 cases), --/αα or -α/-α group (649 cases), point mutation α-thalassemia group (201 cases), β 0-thalassemia group (368 cases), β +-thalassemia group (91 cases), and α combined with β-thalassemia group (129 cases). Hemoglobin (Hb) and serum ferritin (SF) levels were measured in the first, second, and third trimester of pregnancy. Differences in anemia and iron reserves among the groups at different pregnancy stages were compared using repeated measures analysis of variance, LSD test, Kruskal-Wallis rank-sum test, and Bonferroni correction. Results:Compared to the first trimester, Hb levels decreased in the second and third trimester across all groups (LSD test, all P<0.05), and the severity of anemia increased (Bonferroni correction, all P<0.017). The severity of anemia varied among the groups at the same pregnancy stage ( Hfirst trimester=918.20, Hsecond trimester=1 224.50, Hthird trimester=980.19; all P<0.001), and Hb levels also differed ( Ffirst trimester=282.54, Fsecond trimester=352.31, Fthird trimester=239.02; all P<0.001). The β 0-thalassemia group had higher rates of moderate anemia in the first, second, and third trimester of pregnancy [38.6% (142/368), 85.3% (314/368), and 73.6% (271/368)] compared to other groups (Bonferroni correction, all P<0.002), and lower Hb levels [(102.1±8.9), (92.0±7.3), and (94.6±7.7) g/L] than other groups (LSD test, all P<0.05). As pregnancy progresses, SF levels in each group of pregnant women gradually decreased (LSD test, all P<0.05), and the degree of iron deficiency worsened (Bonferroni correction, all P<0.05). The iron deficiency rate in thalassemia pregnant women during the third trimester ranges from 21.5% (79/368) to 46.0% (150/326). The degree of iron deficiency varies among groups within the same gestational period ( Hfirst trimester=79.13, Hsecond trimester=203.98, Hthird trimester=130.55; all P<0.001), and SF levels also differ ( Ffirst trimester=17.28, Fsecond trimester=44.60, Fthird trimester=31.87; all P<0.001). Among them, the β 0-thalassemia group had the lowest iron deficiency rates in the second, and third trimesters [9.8% (36/368), and 21.5% (79/368)] (Bonferroni correction, all P<0.002). SF levels in the β 0-thalassemia and β +-thalassemia groups were higher than those in other groups during each gestational period (LSD test, all P<0.05). Conclusions:Pregnant women with thalassemia may experience varying degrees of iron deficiency during pregnancy, with the severity of iron deficiency and anemia increasing with gestational age. The degree of iron deficiency and anemia during pregnancy varies among pregnant women with different genotypes of thalassemia. Clinically, individualized management should be provided for pregnant women with thalassemia based on their genotypes, with dynamic monitoring of anemia and iron metabolism changes.