OBJECTIVE: To evaluate the prospective association between cumulative resting heart rate (cumRHR) and rapid renal function decline (RRFD) in a cohort of individuals aged 60 and older. METHODS: In the Tianjin Chronic Kidney Disease Cohort Study, the individuals who underwent three consecutive physical examinations between 2014 and 2017, with estimated glomerular filtration rate (eGFR) greater than 60 mL/min per 1.73 m² and aged 60 years or older were enrolled. A total of 27,564 patients were prospectively followed up from January 1, 2017 to December 31, 2020. The 3-year cumRHR was calculated. The primary outcome was RRFD, defined as an annualized decline in eGFR of 5 mL/min per 1.73 m² or greater. Logistic and restricted spline regression models and subgroup analysis were used to investigate the association of cumRHR with RRFD after adjusting for all confounders. RESULTS: During a median follow-up of 3.2 years, a total of 4,347 (15.77%) subjects developed RRFD. In fully-adjusted models, compared with the lowest quartile of cumRHR, the odds ratio (OR) for the highest was 1.44 (1.28-1.61), P < 0.001. Furthermore, each 1-standard deviation (27.97 beats/min per year) increment in cumRHR was associated with a 17% (P < 0.001) increased risk of RRFD, with a linear positive correlation (P for non-linear = 0.803). Participants with a 3-year cumRHR ≥ 207 (beats/min) * year (equivalent to ≥ 69 beats/min per year in 3 years) were found to be at a higher risk of RRFD. CONCLUSIONS The cumRHR is significantly associated with a higher risk of RRFD among older adults. These results might provide an effective goal for managing and delaying the decline of renal function in the older adults.

Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

Objective:To investigate the value of applying B+ M type and shear-wave elastic ultrasound in determining the parameters of the geniohyoid muscles of stroke survivors with dysphagia.Methods:Forty stroke survivors with dysphagia formed an observation group, while 20 healthy counterparts were chosen as the control group. The thickness of the geniohyoid muscle, as well as the movement distance, time, rate and shear wave velocity were measured using B+ M ultrasound and shear wave elastic ultrasound when swallowing nothing or 5ml of water, respectively.Results:The average thickness of the geniohyoid muscle and the average shear wave velocity of the observation group were significantly smaller than among the controls. When swallowing either nothing or water, the geniohyoid muscle in the observation group tended to move farther than among the controls, acting more slowly and taking significantly more time.Conclusion:Ultrasound can quantify the thickness of the geniohyoid muscle and its motor parameters and stiffness. It can be used to evaluate the swallowing function of stroke survivors with dysphagia.

Objective:To analyze the clinical characteristics and influencing factors of children with parent-reported food allergy (FA), thus providing empirical evidence for facilitating the effective utilization of medical history information and promoting better health education for parents.Methods:A cross-sectional study was conducted, recruiting all 596 children under 3 years of age who underwent physical examinations from July to August 2019 at the Department of Child Health Care, Children′s Hospital of Chongqing Medical University. Children were carried out with questionnaires, skin prick test, and diagnosed with FA through oral food challenge (OFC) by pediatricians. The parent-reported incidence rate, symptoms of FA, and the possible influencing factors, including demographic characteristics, family history of allergy, in-utero exposure to smoke and antibiotic use, feeding methods after birth, and residential environment were collected by questionnaire. The differences of clinical characteristics between parent-reported FA and medically diagnosed FA were analyzed by chi-square test. Logistic regression was used to analyze the factors associated with parent-reported FA.Results:A total of 596 children (316 boys and 280 girls) were recruited for this study. The incidence rate of FA by parent-report (22.0%, 131/596) was higher than that by medical diagnosis (9.9%, 59/596) (χ2=32.46, P<0.001). There were 36.6% (48/131) of children with parent-reported FA and 2.4% (11/465) of children without parent-reported FA receiving medical diagnosis of FA. Among children with parent-reported allergic symptoms, 37.5% (24/64) of those with gastrointestinal symptoms and 31.5% (23/73) of those with skin symptoms received medical diagnosis of FA, respectively. Six out of 7 children with co-presenting cutaneous and gastrointestinal symptoms were diagnosed with FA. Univariate Logistic regression analysis showed that family history of allergy ( OR=1.83 (95% CI 1.22-2.73), P=0.003) and damp living environments ( OR=2.33 (95% CI 1.13-4.79), P=0.022) were associated with higher likelihood of parent-reported FA. Conclusions:The incidence rate of parent-reported FA is higher than medically diagnosed FA. Clinicians should be highly suspicious of the possibility of FA in children with both cutaneous and gastrointestinal symptoms. Family history of allergy and damp living environments may increase the possibility of parent-reported FA.

BACKGROUND: Few studies have explored the modifications by family stress and male gender in the relationship between early exposure to traffic-related air pollution (TRAP) and allergic rhinitis (AR) risk in preschool children. METHODS: We conducted a case-control study of 388 children aged 2-4 years in Shenyang, China. These children AR were diagnosed by clinicians. By using measured concentrations from monitoring stations, we estimated the exposures of particulate matter less than 10 μm in diameter (PM RESULTS: The prevalence of AR in children aged 2-4 years (6.4%) was related to early TRAP exposure. With an IQR (20 μg/m CONCLUSIONS Family stress and male gender may increase the risk of AR in preschool children with early exposure to PM
Air Pollution/adverse effects* ; Case-Control Studies ; Child, Preschool ; China/epidemiology* ; Cities ; Family/psychology* ; Female ; Humans ; Male ; Prevalence ; Rhinitis, Allergic/epidemiology* ; Risk Factors ; Stress, Psychological/complications* ; Traffic-Related Pollution/adverse effects*

Children with biliary atresia generally present nutritional deficiency, and often have growth failure and neurodevelopmental impairments.Increasing evidence shows that malnutrition is not only a risk factor for growth failure and neurodevelopmental impairments in children with biliary atresia, but also a risk factor for morbidity and mortality.Nutritional support is extremely important to improve the prognosis.This article reviews the relationship between malnutrition, growth failure and neurodevelopmental impairments in children with BA, and discusses the timing and methods of nutritional support.

Objective: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear. Methods: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( Results: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks. Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
Adult ; Aged ; COVID-19/virology* ; China/epidemiology* ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome

Objective:To investigate the status and influencing factors of diagnosis and treatment of food allergy knowledge in pediatric medical workers, and formulate a targeted training course for pediatricians to evaluate its training effect.Methods:A web-based questionnaire survey was conducted to investigate the current situation of food allergy knowledge among some pediatric medical workers nationwide from April 22 to 24, 2019. Then a 2.5-day training course was designed based on the survey. General pediatricians and primary care pediatricians were recruited into the offline training from November 8 to 10, 2019. The short-term and long-term effects of the training were evaluated through three online questionnaires before, at the end of the training and two months after the training, respectively. The characteristics of the respondents, the correct rate and the qualification rate of questions (more than 60% correct answers) were analyzed. Logistic regression model was used to assess the influencing factors of the qualified rate of food allergy knowledge. Chi-square test was used to analyze the difference of the qualified rate at different time point of the training.Results:Totally 1 187 participants from 28 provinces of China completed the web-based survey. The average correct rate of knowledge related to diagnosis and treatment of food allergy was 38.8% (461/1 187) and 28.8% (342/1 187), respectively. The correct rate of each knowledge related to food allergy ranged from 18.6% (221/1 187) to 63.4% (753/1 187), while the qualified rate was only 12.6% (150/1 187); 86.7% (1 029/1 187) participants could recognize the early symptoms of severe anaphylaxis and 93.3% (1 107/1 187) of them chose epinephrine as a first-line drug for severe anaphylaxis. Logistic regression analysis showed that the professional title ( OR 1.427, 95% CI 1.119-1.818) and hospital level ( OR 1.866, 95 %CI 1.378-2.527) were the independent risk factors for the correct rate of food allergy knowledge. Sixty-nine pediatricians participated in the targeted training. There was a significant difference regarding the qualified rate of food allergy knowledge among the trainees before training (45.5% (20/44)), at the end of training (78.0% (46/59)) and two months after training (13/14) (χ 2=16.8, P<0.01). Conclusions:The knowledge of food allergy on diagnosis and management among Chinese pediatric medical workers is unsatisfactory. Targeted offline training could continuously improve the level of diagnosis and treatment in a long period.

Objective: To investigate the recovery of splenomegaly and hypersplenism after liver transplantation in children and explore the necessity of splenomegaly management before and during liver transplantation. Method: The data of 22 children who were underwent liver transplantation with preoperative splenomegaly and hypersplenism who were not treated with splenomegaly before and during operation and with no recurrence of portal hypertension during postoperative follow-up in Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University from December 2008 to January 2019 were collected. There were 13 male patients and 9 female patients with a median age of 6.5 months. The changes of erythrocyte, platelet, white blood cell and spleen length and thickness were analyzed by paired t-test before and at the 1st, 3rd and 6th months after surgery. Correlation analysis was performed on the change of spleen long diameter and thickness product and blood cell recovery. Results: There were 21 cases of red blood cell decreased before surgery, with a mean value of(3.1±0.5)×10¹²/L, and(3.7±0.7)×10¹²/L, (4.6±0.6)×10¹²/L and (4.3±0.5)×10¹²/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the preoperative and postoperative groups were statistically significant (P<0.05). There were 7 cases of thrombocytopenia before operation, with an average of (70.0±17.0)×10⁹/L, and (191.0±129.0)×10⁹/L, (156.0±79.0)×10⁹/L and (167.0±63.0)×10⁹/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the first, third, and sixth months after surgery were significant compared with that before surgery (P<0.05). Leukocyte count decreased in 5 cases with an average value of (3.30±0.56)×10⁹/L before surgery, (7.5±4.4)×10⁹/L, (7.4±1.4)×10⁹/L, (5.1± 2.5)×10⁹/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the two groups were significant (P<0.05). The average value of preoperative spleen length times thickness was (35.7±12.9) cm² and at the 1st, 3rd, 6th month after surgery it was (26.2±8.1)cm², (25.2±13.4)cm², (27.2±7.4)cm², respectively. The differences between the first, third months after surgery were significant compared with that before surgery (P<0.05). The white blood cell and platelet counts of children before and after surgery were correlated with spleen size negatively (correlation coefficients were -0.902, -0.933, respectively), and the differences were statistically significant (P<0.05). Conclusions In the early stage of liver transplantation, the size of spleen retracts to varying degrees, and hypersplenism can be alleviated continuously. Therefore, it is unnecessary to treat splenomegaly and hypersplenism before and during liver transplantation.

Objective To evaluate the regulatory role of azithromycin-induced persistent Chlamydia trachomatis (Ct) infection in the apoptosis of Hela229 cells.Methods Hela229 cells were firstly co-cultured with Ct for 22 hours,and then cultured with Dulbecco's modified Eagle's medium (DMEM) containing 0.08 mg/L azithromycin for 26 hours to establish a cell model of persistent Ct infection (persistent infection group).These infected Hela229 cells cultured with azithromycin-free DMEM served as a cell model of acute Ct infection (acute infection group).After 48-hour infection with Ct,azithromycin was removed,and infected Hela229 cells in the above 2 groups were successively cultured with DMEM for the resurgence of Ct.Immunofluorescence assay and electron microscopy were performed to verify the persistent Ct infection model.The Hela229 cells in the persistent infection group and acute infection group as well as uninfected Hela229 cells (control group) were treated with staurosporine (STS) for 4 hours to induce the apoptosis,and then cell apoptosis was detected by Hoechst 33258 staining,annexin V/propidium iodide staining and flow cytometry.Results After the treatment with azithromycin,atypical inclusions with aberrant reticulate bodies appeared in the Ct-infected cells.After removing azithromycin,cells were cultured until 96 hours after infection,and infectious elementary bodies reappeared in the Ct inclusions.After the treatment with STS,Hoechst staining showed that there was loose chromatin in the persistently infected cells,while chromatin condensation was observed in the uninfected cells.After 24-hour infection with Ct and 4-hour induction with STS,the apoptosis rate was significantly higher in the persistent infection group (45.567％ ± 2.631％) than in the acute infection group (38.567％ ± 1.701％,t =2.686,P =0.028),but significantly lower in the persistent infection group than in the uninfected group (69.800％ ± 2.835％,t =8.187,P ＜ 0.001).After 48-hour infection with Ct and 4-hour induction with STS,there was a significant difference in the apoptosis rate between the persistent infection group (46.700％ ± 5.257％) and acute infection group (61.767％ ± 1.815％,t =5.781,P ＜ 0.001),as well as between the persistent infection group and the uninfected group (68.667％ ± 3.156％,t =7.421,P ＜ 0.001).Conclusion This study showed that azithromycin-induced persistent Ct infection regulated the apoptosis of host cells,and this effect lasted 48 hours.