Hypertrophic cardiomyopathy, a genetic hereditary disease, is highly regarded in clinical practice due to its unique pathophysiological changes, course characteristics, and hemodynamic features. With the continuous advance of treatment methods such as medications and surgeries, the prevention, treatment and prognosis of hypertrophic cardiomyopathy has gradually improved. However, inappropriate use of positive inotropic drugs may lead to serious consequences that are difficult to reverse. Therefore, how to smoothly navigate through the perioperative period and ensure clinical safety poses a great challenge for anesthesiologists. This paper discusses the perioperative management of patients with hypertrophic cardiomyopathy, with the hope of enhancing anesthesiologists' management capabilities for this type of disease.

Objective:To explore the clinical characteristics and risk factors for the progression of severe scrub typhus in children.Methods:Clinical data, laboratory and auxiliary examination results, treatment and prognosis data of children with scrub typhus admitted to Xiamen Children's Hospital from July 2014 to March 2024 were collected. The clinical characteristics of scrub typhus in children were analyzed, and the study subjects were divided into severe group and mild group according to their condition. The relevant risk factors for progression to severe cases were analyzed.Results:A total of 42 cases were included, with 34 cases (80.95%) in the mild group and 8 cases (19.05%) in the severe group. All patients(100%) had fever, with the highest incidence of eschar or ulceration (95.24%), followed by lymphadenopathy and splenomegaly. All 42 patients improved or recovered after treatment with azithromycin or doxycycline, with no deaths reported. Compared with the mild group，the severe group had a higher incidence of cough, lymphadenopathy，and hepatomegaly, with statistically significant differences( P<0.05). Compared with the mild group, the severe group showed a decrease in hemoglobin(Hb), platelet, and fibrinogen(Fib) levels, while serum C-reactive protein(CRP), procalcitonin, aspartate aminotransferase, creatine kinase MB, and lactate dehydrogenase (LDH) levels increased, with statistically significant differences( P<0.05). Multivariate Tobit model analysis showed that a decrease in Hb ( OR -0.006，95% CI -0.012-0.000， P<0.05), an increase in CRP ( OR 2.72，95% CI 0.001-0.008， P=0.010), an increase in LDH ( OR 1.76，95% CI 0.000-0.000， P=0.027), and a decrease in Fib ( OR -3.78，95% CI -0.309-0.093， P=0.001) were risk factors for scrub typhus progressing to severe cases. Conclusion:During the epidemic season of scrub typhus, fever accompanied by eschar or ulceration, along with splenomegaly and lymphadenopath aids in the diagnosis of scrub typhus. Decreased Hb and Fib, as well as elevated CRP and LDH, are risk factors for the development of severe scrub typhus in children.

Objective:To investigate the detection and clinical features of human rhinovirus（HRV）infection in children from the Xiamen area.Methods:A retrospective analysis was conducted on children treated at Xiamen Children's Hospital from November 2021 to October 2022.Thirteen types of multiplex respiratory pathogen detection kits were used to screen for 13 common respiratory pathogens. Clinical data of HRV-positive hospitalized children were collected.Results:（1）Among 8 420 children with acute respiratory infections，HRV had the highest detection rate at 20.40%（1 718/8 420），followed by HMPV（10.12%），H3N2（7.46%），HRSV（6.94%），and HPIV（6.59%）.HRV was detected throughout the year，with the highest proportion in May（18.42%）.（2）Out of 1 718 children with HRV infection，863 cases were hospitalized for pneumonia（50.23%，863/1 718）.The median age of hospitalized children was 2.58（1.07，4.20）years old，with 53.77% under 3 years old.（3）The main clinical manifestations of HRV pneumonia were cough（97.68%，843/863），fever（58.05%，501/863），runny nose（57.01%，492/863），nasal congestion（36.96%，319/863），and wheezing（24.33%，210/843）. The HRV pneumonia co-infection group showed statistically significant differences in fever and hospitalization days compared to the single HRV pneumonia infection group（all P<0.05）.（4）Compared to the common pneumonia group，the severe HRV pneumonia group showed statistically significant differences in fever，runny nose，wheezing and hospitalization days the CRP, PCT, LDH levels, and the number of antibiotic applications after hospitalization（all P<0.05）. Conclusion:HRV infection is detected year-round in Xiamen，pneumonia is common，with children under 3 years old being particularly susceptible.It is important to be alert to mixed infections or severe pneumonia.Clinical treatment should avoid unnecessary antibiotic use，actively and provide appropriate treatment.

Objective:To investigate the detection and clinical features of human rhinovirus（HRV）infection in children from the Xiamen area.Methods:A retrospective analysis was conducted on children treated at Xiamen Children's Hospital from November 2021 to October 2022.Thirteen types of multiplex respiratory pathogen detection kits were used to screen for 13 common respiratory pathogens. Clinical data of HRV-positive hospitalized children were collected.Results:（1）Among 8 420 children with acute respiratory infections，HRV had the highest detection rate at 20.40%（1 718/8 420），followed by HMPV（10.12%），H3N2（7.46%），HRSV（6.94%），and HPIV（6.59%）.HRV was detected throughout the year，with the highest proportion in May（18.42%）.（2）Out of 1 718 children with HRV infection，863 cases were hospitalized for pneumonia（50.23%，863/1 718）.The median age of hospitalized children was 2.58（1.07，4.20）years old，with 53.77% under 3 years old.（3）The main clinical manifestations of HRV pneumonia were cough（97.68%，843/863），fever（58.05%，501/863），runny nose（57.01%，492/863），nasal congestion（36.96%，319/863），and wheezing（24.33%，210/843）. The HRV pneumonia co-infection group showed statistically significant differences in fever and hospitalization days compared to the single HRV pneumonia infection group（all P<0.05）.（4）Compared to the common pneumonia group，the severe HRV pneumonia group showed statistically significant differences in fever，runny nose，wheezing and hospitalization days the CRP, PCT, LDH levels, and the number of antibiotic applications after hospitalization（all P<0.05）. Conclusion:HRV infection is detected year-round in Xiamen，pneumonia is common，with children under 3 years old being particularly susceptible.It is important to be alert to mixed infections or severe pneumonia.Clinical treatment should avoid unnecessary antibiotic use，actively and provide appropriate treatment.

Objective:To explore the clinical characteristics and risk factors for the progression of severe scrub typhus in children.Methods:Clinical data, laboratory and auxiliary examination results, treatment and prognosis data of children with scrub typhus admitted to Xiamen Children's Hospital from July 2014 to March 2024 were collected. The clinical characteristics of scrub typhus in children were analyzed, and the study subjects were divided into severe group and mild group according to their condition. The relevant risk factors for progression to severe cases were analyzed.Results:A total of 42 cases were included, with 34 cases (80.95%) in the mild group and 8 cases (19.05%) in the severe group. All patients(100%) had fever, with the highest incidence of eschar or ulceration (95.24%), followed by lymphadenopathy and splenomegaly. All 42 patients improved or recovered after treatment with azithromycin or doxycycline, with no deaths reported. Compared with the mild group，the severe group had a higher incidence of cough, lymphadenopathy，and hepatomegaly, with statistically significant differences( P<0.05). Compared with the mild group, the severe group showed a decrease in hemoglobin(Hb), platelet, and fibrinogen(Fib) levels, while serum C-reactive protein(CRP), procalcitonin, aspartate aminotransferase, creatine kinase MB, and lactate dehydrogenase (LDH) levels increased, with statistically significant differences( P<0.05). Multivariate Tobit model analysis showed that a decrease in Hb ( OR -0.006，95% CI -0.012-0.000， P<0.05), an increase in CRP ( OR 2.72，95% CI 0.001-0.008， P=0.010), an increase in LDH ( OR 1.76，95% CI 0.000-0.000， P=0.027), and a decrease in Fib ( OR -3.78，95% CI -0.309-0.093， P=0.001) were risk factors for scrub typhus progressing to severe cases. Conclusion:During the epidemic season of scrub typhus, fever accompanied by eschar or ulceration, along with splenomegaly and lymphadenopath aids in the diagnosis of scrub typhus. Decreased Hb and Fib, as well as elevated CRP and LDH, are risk factors for the development of severe scrub typhus in children.

Background and purpose:The incidence of autonomic dysfunction(AD)in patients with advanced cancer is approximately 65%-80%.The neurasthenic symptoms such as dizziness,palpitations and fatigue caused by AD are difficult to alleviate even with sufficient rest,seriously affecting the patients'quality of life.Meanwhile,the cardiovascular autonomic nervous system plays a significant regulatory role in heart rate,myocardial function and myocardial blood flow.AD increases the morbidity and mortality risk of cardiovascular diseases in patients.AD is not only a functional state but might also be an early sign of overall myocardial lesion.Research indicates that after adjusting for age,gender and cardiovascular risk factors,previous radiation exposure is associated with AD manifestations such as increased resting heart rate and abnormal heart rate recovery after exercise.However,there are currently few relevant studies on the effect of radiotherapy on cardiac autonomic function,and the specific injury effects and dose threshold of injury occurrence remain unclear.This study aimed to explore the impact of thoracic radiotherapy on the cardiac autonomic function of patients with malignant tumors by comparing the differences in heart rate variability(HRV)analysis parameters before and after radiotherapy,and to explore the dosimetric risk factors for the occurrence of AD by comparing the dosimetry between the case group and the control group,providing a theoretical basis for optimizing the dose distribution of radiotherapy regimens in order to improve patient prognosis and reduce the occurrence of complications.Methods:We prospectively collected data of patients with malignant tumors who underwent thoracic radiotherapy in the Radiotherapy Department of the Affiliated Hospital of North China University of Science and Technology from February 2023 to December 2023.Inclusion criteria:① Patients who were pathologically confirmed to have malignant tumors(lung cancer breast cancer or esophageal cancer);② patients with radiation therapy indications as recommended by the guidelines;③ patients with an ECOG score of 0-1;④ patients with no significant abnormalities in electrocardiogram and echocardiography results.Exclusion criteria:① previously received chest radiotherapy;② patients with obvious palpitation,chest tightness and chest pain before treatment;③ diabetes,heart disease and other serious underlying diseases;④ anti-arrhythmic drugs are currently being used;⑤ patients who cannot tolerate radiotherapy and who were lost or lost during follow-up.HRV analysis was used to evaluate changes in autonomic nerve function after radiotherapy.Patients with AD were included in the case group,and the remaining patients were included in the control group.Univariate and multivariate logistic regression analysis methods were used to explore the dosimetric risk factors and cardiac dose limitations for the occurrence of AD after thoracic radiotherapy.This study was approved by the ethics committee of Affiliated Hospital of North China University of Science and Technology(ethics number:20230228020).Results:A total of 89 patients with thoracic tumors meeting the study criteria were enrolled in the study.Among them,41(46%)patients experienced cardiac AD after radiotherapy.The cardiac Dmax(6 273.500 cGy vs 4 675.900 cGy,P＜0.001),cardiac Dmean(1513.700 cGy vs 452.050 cGy,P＜0.001),cardiac V5(49.000%vs 21.250%,P＜0.001),V20(30.500%vs 7.300%,P＜0.001),V30(18.700%vs 3.600%,P＜0.001)and V40(10.900%vs 1.500%,P＜0.001)were significantly higher in the case group than in the control group.The results of multivariate logistic regression analysis showed that cardiac V30 was an independent risk factor for the occurrence of cardiac AD[OR(95%CI)=1.583(1.093-2.291),P=0.015].Cardiac V30 could predict the occurrence of radiation-induced cardiac injury with an area under the curve of 0.788,and 17.1%was the optimal cut-offvalue of cardiac V30 for predicting the occurrence of cardiac AD.Conclusion:After thoracic radiotherapy,the cardiac irradiation dose-volume was significantly higher in patients with cardiac AD than in the control group.When cardiac V30 was higher than 17.1%,the risk of cardiac AD in patients significantly increased.

Objective:To investigate the incidence and clinical characteristics of Kawasaki disease complicated with arthritis, and explore the relationship with coronary artery disease.Methods:Patients diagnosed with Kawasaki disease at Xiamen Children′s Hospital from January 2015 to June 2020 were included in this study.They were divided into the arthritis group( n=53) and the non-arthritis group( n=401), depending on whether complicated with arthritis.Demographic, clinical symptoms, and laboratory results were retrospectively analyzed. Results:A total of 454 children were included in this study with 53 cases acomplicated with arthritis.There were 32 male cases and 21 female cases.The average age of arthritis group was(5.89±1.35) y, which was older than non-arthritis group[(4.28±1.25) y, P=0.026]. Among the 53 cases of arthritis group, 36 cases (67.92%)of small jiont arthritis, 14 cases(26.41%)of coxitis, ten cases(18.87%)of carpitis, eight cases(15.09%)of gonitis, four cases(7.55%)of anconitis, and three cases(5.66%) of ankle arthritis were involved.There was a statistic difference in the prevalence of intravenous immunogloblin(IVIG)resistant between arthritis group and non-arthritis group(14 cases, 26.14% vs.43 cases, 10.72%, P=0.002). The inflammatory markers(CRP, TNF-α, IL-6) of the arthritis group were significantly higher than those in the non-arthritis group, and the differences were statistically significant( P<0.05, respectively). The incidence of coronary artery disease in the arthritis group(60.38%, 32/53) was higher than that in the non-arthritis group(52.37%, 210/401), but the difference was not statistically significant( P>0.05). Conclusion:Kawasaki disease with arthritis in children is self-limited, with no sequelae.Patients in the arthritis group have a higher rate of IVIG resistance and higher levels of inflammatory markers, but no significant difference in the incidence of coronary artery disease compared with those without arthritis.

Objective To observe the preventive effect of Anduolin(ADL) on radiation-induced lung injury in mice.Methods Totally 180 of Kunming mice were randomly classified into six groups:normal control group ( N ),irradiation control group ( R),irradiation plus low dose ADL group ( L),irradiation plus middle dose ADL group ( M),irradiation plus high dose ADL group ( H),and irradiation plus Dexamethasone group (D).The mice except group N were irradiated with 20 Gy of 6 MV X-rays on whole lung.The mice in group L,M and H were given with ADL 1 d before irradiation and continued for 6 weeks after irradiation.At 2,4 and 6 weeks after irradiation,the general situation and the lung pathological changes of mice were observed.The lung wet weight,collagen contents of the whole lung tissue,hydroxproline concentration,and TGF-β1 expression in the lung were also delected.Results Compared to the group R,the mice breathing rate,hydroxproline concentration,and TGF-β1 expression in the group L were not significantly changed.While in the groups M,H and D,the breathing rate,the generation of hydroxproline and the expression of TGF-β1 were decreased significantly ( F =2.668-161.646,P ＜0.05).In addition,ADL alleviated the pathological changes on radiation-induced lung injury in mice.Conclusions ADL might have the preventive effect on radiation-induced lung injury in mice.

OBJECTIVETo study the chemical constituents of the n-BuOH fraction of 95% ethanolic extract of leaves of Neoalsomitra integrifoliola.

METHODThe compounds were isolated with kinds of column chromatography. The structures were determined by MS and NMR spectroscopic techniques.

RESULTEight compounds were isolated from the n-BuOH fraction of 95% ethanolic extract and their structures were identified as 2-phenylethyl rutinoside (1), rutin (2), kaempferol-3-O-alpha-L-rhamnopyranosyl-(1-->6)-beta-D-glucopyranoside (3), isorhamnetin-3-O-alpha-L-rhamnopyranosyl-(1-->6)-beta-D-glucopyranoside (4), methyl chlorogenate (5), guanosine (6), adenosine (7), myo-inositol (8), respectively.

CONCLUSIONAll compounds were isolated from this genus for the first time.

Objective To explore the relation of donor liver's heme oxygenase-1 level to ische-mia/reperfusion injury and the liver function after liver transplantation. Methods Twenty-eight pa-tients receiving orthotopic liver transplantation (OLT) were divided into two groups according to the donor liver's heme oxygenase level of high HO-1 expression group and low HO-1 expression group.The recipients' serum levels of ALT, AST, bile salt output and the expression of HO-1 mRNA were determined and compared between the 2 groups. Results HO-1 mRNA of low expression group in-creased significantly after the reperfusion. Meanwhile, the HO-1 mRNA of high expression group de-creased. The serum levels of ALT and AST of HO-1 in low expression group were much lower but bile salt concentration higher than those in high expression group. Conclusion HO-1 can be further induced in the liver of HO-1 low expression group during the reperfusion period. The I/R injury in the HO-1 low expression group was less severe than that in high expression group, but the liver function was better. The increase of HO-1 during the transplantation seems better for protecting the liver than the initial HO-1 high expression. Kupffer cells are of the main localization for HO-1 protein in human liver.