Objective·To investigate the therapeutic effect of combined vitamin D and docosahexaenoic acid(DHA)supplementation on preschool children with attention deficit hyperactivity disorder(ADHD).Methods·From April 2021 to May 2021,a total of 1 412 children aged 4 to 6 years from eight kindergartens in Pudong New Area of Shanghai,including Tangqiao Street,Chuansha Town,and Heqing Town,were randomly selected by stratified cluster random sampling method.Attention and hyperactivity symptom assessment was performed using the Conner's Scale,Diagnosis and Statistical Manual of Mental Disorders(fifth edition,DSM-Ⅴ),and Swanson,Nolan,and Pelham(version Ⅳ,SNAP-Ⅳ)Scale,and other neurodevelopmental disorders were excluded using the Wechsler Intelligence Scale.A total of 82 preschool children with ADHD were enrolled,and after fully informing them of the intervention measures,they were divided into an intervention group(n=64)and a control group(n=18)based on their parents' choice.The control group received routine health education.In addition to routine health education,the intervention group received daily supplementation of Vitamin D(800 IU)and DHA(400 mg).Venous blood samples were collected from both groups at baseline,3 months,and 12 months for the measurement of serum 25 hydroxy vitamin D[25(OH)D]and DHA levels.ADHD symptoms were evaluated using Conner's Scale,SNAP-Ⅳ Scale,and DSM-Ⅴ.Results·After 3 and 12 months of intervention in the intervention group,serum 25(OH)D levels and DHA levels were significantly higher(P<0.05),the ADHD symptom scores,including impulsivity-hyperactivity and hyperactivity index scores in Conner's Scale,the attention and hyperactivity/impulsivity scores in SNAP-Ⅳ Scale,and the attention and hyperactivity/impulsivity scores in DSM-Ⅴ,were significantly reduced compared with the scores before the intervention(P<0.05).There was no significant difference in serum 25(OH)D and DHA levels,or ADHD symptom scores,at the 3-and 12-month follow-ups compared to baseline.After 3 months of nutritional intervention in the intervention group,the hyperactivity/impulsivity scores in SNAP-Ⅳ Scale and DSM-Ⅴ were significantly improved compared to the control group(P<0.05).After 12 months of intervention,conduct problems,impulsive-hyperactivity and hyperactivity index scores in Conner's Scale,and hyperactivity/impulsivity scores in SNAP-Ⅳ Scale and DSM-Ⅴ showed significant improvement compared to the control group(P<0.05).Conclusion·Combined supplementation with vitamin D and DHA significantly improves serum 25(OH)D and DHA levels and alleviates ADHD symptoms in preschool children.

Objective·To investigate the therapeutic effect of combined vitamin D and docosahexaenoic acid(DHA)supplementation on preschool children with attention deficit hyperactivity disorder(ADHD).Methods·From April 2021 to May 2021,a total of 1 412 children aged 4 to 6 years from eight kindergartens in Pudong New Area of Shanghai,including Tangqiao Street,Chuansha Town,and Heqing Town,were randomly selected by stratified cluster random sampling method.Attention and hyperactivity symptom assessment was performed using the Conner's Scale,Diagnosis and Statistical Manual of Mental Disorders(fifth edition,DSM-Ⅴ),and Swanson,Nolan,and Pelham(version Ⅳ,SNAP-Ⅳ)Scale,and other neurodevelopmental disorders were excluded using the Wechsler Intelligence Scale.A total of 82 preschool children with ADHD were enrolled,and after fully informing them of the intervention measures,they were divided into an intervention group(n=64)and a control group(n=18)based on their parents' choice.The control group received routine health education.In addition to routine health education,the intervention group received daily supplementation of Vitamin D(800 IU)and DHA(400 mg).Venous blood samples were collected from both groups at baseline,3 months,and 12 months for the measurement of serum 25 hydroxy vitamin D[25(OH)D]and DHA levels.ADHD symptoms were evaluated using Conner's Scale,SNAP-Ⅳ Scale,and DSM-Ⅴ.Results·After 3 and 12 months of intervention in the intervention group,serum 25(OH)D levels and DHA levels were significantly higher(P<0.05),the ADHD symptom scores,including impulsivity-hyperactivity and hyperactivity index scores in Conner's Scale,the attention and hyperactivity/impulsivity scores in SNAP-Ⅳ Scale,and the attention and hyperactivity/impulsivity scores in DSM-Ⅴ,were significantly reduced compared with the scores before the intervention(P<0.05).There was no significant difference in serum 25(OH)D and DHA levels,or ADHD symptom scores,at the 3-and 12-month follow-ups compared to baseline.After 3 months of nutritional intervention in the intervention group,the hyperactivity/impulsivity scores in SNAP-Ⅳ Scale and DSM-Ⅴ were significantly improved compared to the control group(P<0.05).After 12 months of intervention,conduct problems,impulsive-hyperactivity and hyperactivity index scores in Conner's Scale,and hyperactivity/impulsivity scores in SNAP-Ⅳ Scale and DSM-Ⅴ showed significant improvement compared to the control group(P<0.05).Conclusion·Combined supplementation with vitamin D and DHA significantly improves serum 25(OH)D and DHA levels and alleviates ADHD symptoms in preschool children.

A 41-year-old female patient took decoction of Chinese medicine (containing 10 g of Fructus Lycii, 10 g of Radix Ginseng Rubra, and 15 g of Cortex Acanthopanax Radicis) by herself due to trigeminal neuralgia. After about 6 hours of medication, the patient developed palpitate suddenly, woke up in sleep, accompanied by dizziness. Her blood pressure was 95/63 mmHg. The electrocardiogram showed atrial fibrillation, and ventricular rate was 45 beats/min. Symptomatic treatments such as elevation of hypertension and improvement of myocardial metabolism were given, but the patient′s symptoms were not improved. After that, she developed nausea and vomiting, her heart rate decreased to 35 beats/min, and blood pressure decreased to 87/36 mmHg. Electrocardiogram showed junctional escape rhythm and T-wave change. Electrocardiogram monitoring and continuous oxygen inhalation, and symptomatic and supportive treatments such as continuous IV pumping of dopamine and dobutamine, and polarized solution were given. Eight days after treatment, the patient′s condition was improved. Electrocardiogram showed sinus rhythm. The patient sent the traditional Chinese medicine to a professional institution for identification, and found that it contained Cortex Periplocae, while the original prescription was Cortex Acanthopanax Radicis. Therefore, it is considered that the patient′s arrhythmia was caused by mistakenly use of excessive Cortex Periplocae.

A 41-year-old female patient took decoction of Chinese medicine (containing 10 g of Fructus Lycii, 10 g of Radix Ginseng Rubra, and 15 g of Cortex Acanthopanax Radicis) by herself due to trigeminal neuralgia. After about 6 hours of medication, the patient developed palpitate suddenly, woke up in sleep, accompanied by dizziness. Her blood pressure was 95/63 mmHg. The electrocardiogram showed atrial fibrillation, and ventricular rate was 45 beats/min. Symptomatic treatments such as elevation of hypertension and improvement of myocardial metabolism were given, but the patient′s symptoms were not improved. After that, she developed nausea and vomiting, her heart rate decreased to 35 beats/min, and blood pressure decreased to 87/36 mmHg. Electrocardiogram showed junctional escape rhythm and T-wave change. Electrocardiogram monitoring and continuous oxygen inhalation, and symptomatic and supportive treatments such as continuous IV pumping of dopamine and dobutamine, and polarized solution were given. Eight days after treatment, the patient′s condition was improved. Electrocardiogram showed sinus rhythm. The patient sent the traditional Chinese medicine to a professional institution for identification, and found that it contained Cortex Periplocae, while the original prescription was Cortex Acanthopanax Radicis. Therefore, it is considered that the patient′s arrhythmia was caused by mistakenly use of excessive Cortex Periplocae.

Objective:To investigate the influencing factors for pancreatic endocrine and exocrine insufficiency after pancreaticoduodenectomy.Methods:The retrospective case-control study was conducted. The clinicopathological data of 168 patients who underwent pancreaticoduodenectomy in the Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2017 were collected. There were 96 males and 72 females, aged (64±13)years, with a range from 38 to 75 years. Of the 168 patients, 36 had pancreatic endocrine insufficiency while 8 had pancreatic exocrine insufficiency preoperatively. All patients underwent pancreaticoduodenectomy. Observation indications: (1) surgical situations and follow-up; (2) analysis of influencing factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy; (3) analysis of influencing factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy. Follow-up using out-patient examination and telephone interview was performed to detect postoperative condition of blood glucose control, diet and nutrition, tumor recurrence and metastasis up to June 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were described as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Surgical situations and follow-up: all the 168 patients underwent pancreaticoduodenectomy successfully and recovered well after operation. All patients were followed up for 6 months. The level of fasting and postprandial blood glucose of the 168 patients after surgery were 7 mmol/L(range, 5-9 mmol/L) and 10 mmol/L(range, 7-14 mmol/L), respectively. The defecation frequency was (2.4±1.2)times per day. No tumor recurrence or metastasis occurred in either patient. One hundred and thirty-two of the 168 patients were included in the study excepting patients with pancreatic endocrine insufficiency before operation. At postoperative 6 months, 47 patients developed pancreatic endocrine insufficiency, with an incidence of 35.61%(47/132). One hundred and sixty of the 168 patients were included in the study excepting patients with pancreatic exocrine insufficiency before operation. At postoperative 6 months, 68 patients had pancreatic exocrine insufficiency, with an incidence rate of 42.50%(68/160). (2) Analysis of influencing factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy. Results of univariate analysis showed that gender, metabolic syndrome, chronic pancreatitis, excision point, and postoperative chemotherapy were the related factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy ( χ2=5.300, 6.270, 4.473, 4.392, 5.397, P<0.05). Results of multivariate analysis revealed that male and metabolic syndrome were independent risk factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy [ hazard ratio ( HR)=5.252, 5.364, 95% confidence interval ( CI): 1.362-6.382, 1.891-12.592, P<0.05)]. (3) Analysis of risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy. Results of univariate analysis showed that body mass index (BMI), chronic pancreatitis, total bilirubin, excision point, postoperative pancreatic fistula as grade B or C, and pancreatic fibrosis were related factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy ( χ2=1.691, 4.910, 7.763, 5.605, 4.663, 7.700, P<0.05). Results of multivariate analysis showed that BMI<18.5 kg/m 2, chronic pancreatitis, total bilirubin ≥171 μmol/L were independent risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy ( HR=3.695, 5.231, 7.623, 95% CI: 1.232-7.324, 2.161-6.893, 1.562-5.235, P<0.05). Conclusions:Male and metabolic syndrome are risk factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy. BMI<18.5 kg/m 2, chronic pancreatitis, and total bilirubin ≥171 μmol/L are risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy.