H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

Objective:To investigate the clinical effect and indications of the three kinds of pedicled perforator flaps in repairing soft tissue defects around the elbow joint.Methods:The clinical data of patients with soft tissue defects around the elbow joint, admitted to the Department of Center for Orthopaedic Repair and Reconstruction of Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences (Xinhua Hospital Chongming Branch) from December 2013 to November 2022 were retrospectively analyzed. The distal based medial antebrachial neurocutaneous flap in the middle and distal part of the upper arm, the perforator pedicled propeller flap of inferior cubital artery or the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery in the proximal forearm were respectively designed according to the location, appearance, size of the recipient site and the perforating point of the perforating vessel in the donor site to repair soft tissue defects around the elbow joint. The donor site was directly closed or covered by free skin grafting cut from the hidden area of the affected limb. The donor and recipient sites were followed up and observed to evaluate the curative effect from the following three aspects. (1) The self-evaluation of the curative effect was divided into three grades: satisfactory, general and unsatisfactory. (2) Elbow joint function evaluation: according to Mayo’s elbow joint function scoring standard which was divided into four grades: excellent, good, general and poor. (3) Comprehensive evaluation: the evaluation criteria for wound repair around the ankle joint of the lower extremity were used for scoring: 16 to 21 points as excellent, 11 to 15 points as good, 6 to 10 points as general, 0 to 5 points as poor, and the excellent and good ratio was calculated at the same time, that is, the sum of the number of excellent and good cases/the total number of cases×100%.Results:A total of 51 patients were enrolled, including 31 males and 20 females. The age ranged from 16 to 87 years old, with a mean of 56.1 years old. About the defect location, there were 20 cases in the anterior side of the elbow joint, 18 cases in the posterior side of the elbow joint, 8 cases in the medial side of the elbow joint, and 5 cases in the lateral side of the elbow joint. The defect sizes after debridement were from 3.5 cm×2.5 cm to 16.0 cm× 6.0 cm. Among the 51 patients, 21 cases were repaired by the distal based medial antebrachial neurocutaneous flap, 19 cases were repaired by the perforator pedicled propeller flap of inferior cubital artery, and the other 11 cases were repaired by the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery. The sizes of the flaps were from 4.5 cm × 3.5 cm to 18.0 cm × 8.0 cm. Forty-six of the 51 patients got primary healing, and the other five had necrosis of different degrees at the distal edge of the flap (≤1.5 cm×1.0 cm), including 2 cases of the distal based medial antebrachial neurocutaneous flap, 2 cases of the perforator pedicled propeller flap of inferior cubital artery and 1 case of the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery who were healed after dressing change. The patients were followed up for 3 to 60 months after the operation, with a mean of 12 months, the flaps in the recipient sites survived well, at the same time, the color and elasticity of the flaps were close to normal, and the two-point discrimination was 4-9 mm without bloated appearance. The elbow joint of the affected limb was stable and with good movement. No obvious deformity was observed, and the functional recovery was excellent. The incision of the donor site healed well and the scar was easily accepted. Self-evaluation: 39 patients were satisfied and 12 were general. Elbow joint function evaluation: excellent in 15 cases and good in 36 cases. Comprehensive evaluation: excellent in 17 cases, good in 30 cases, general in 4 cases, that meant the excellent and good ratio reached to 92%(47/51).Conclusion:The three kinds of pedicled perforator flaps have constant perforating vessels, abundant blood supply and simple operation. They can be used to repair soft tissue defects around the elbow joint while good clinical result can be obtained. The distal based medial antebrachial neurocutaneous flap is focused on the anterior and ulnar sides of the elbow joint, the perforator pedicled propeller flap of inferior cubital artery is focused on the elbow fossa, and the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery is focused on the posterior and radial sides of the elbow joint.

Objective:To investigate the clinical effect and indications of the three kinds of pedicled perforator flaps in repairing soft tissue defects around the elbow joint.Methods:The clinical data of patients with soft tissue defects around the elbow joint, admitted to the Department of Center for Orthopaedic Repair and Reconstruction of Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences (Xinhua Hospital Chongming Branch) from December 2013 to November 2022 were retrospectively analyzed. The distal based medial antebrachial neurocutaneous flap in the middle and distal part of the upper arm, the perforator pedicled propeller flap of inferior cubital artery or the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery in the proximal forearm were respectively designed according to the location, appearance, size of the recipient site and the perforating point of the perforating vessel in the donor site to repair soft tissue defects around the elbow joint. The donor site was directly closed or covered by free skin grafting cut from the hidden area of the affected limb. The donor and recipient sites were followed up and observed to evaluate the curative effect from the following three aspects. (1) The self-evaluation of the curative effect was divided into three grades: satisfactory, general and unsatisfactory. (2) Elbow joint function evaluation: according to Mayo’s elbow joint function scoring standard which was divided into four grades: excellent, good, general and poor. (3) Comprehensive evaluation: the evaluation criteria for wound repair around the ankle joint of the lower extremity were used for scoring: 16 to 21 points as excellent, 11 to 15 points as good, 6 to 10 points as general, 0 to 5 points as poor, and the excellent and good ratio was calculated at the same time, that is, the sum of the number of excellent and good cases/the total number of cases×100%.Results:A total of 51 patients were enrolled, including 31 males and 20 females. The age ranged from 16 to 87 years old, with a mean of 56.1 years old. About the defect location, there were 20 cases in the anterior side of the elbow joint, 18 cases in the posterior side of the elbow joint, 8 cases in the medial side of the elbow joint, and 5 cases in the lateral side of the elbow joint. The defect sizes after debridement were from 3.5 cm×2.5 cm to 16.0 cm× 6.0 cm. Among the 51 patients, 21 cases were repaired by the distal based medial antebrachial neurocutaneous flap, 19 cases were repaired by the perforator pedicled propeller flap of inferior cubital artery, and the other 11 cases were repaired by the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery. The sizes of the flaps were from 4.5 cm × 3.5 cm to 18.0 cm × 8.0 cm. Forty-six of the 51 patients got primary healing, and the other five had necrosis of different degrees at the distal edge of the flap (≤1.5 cm×1.0 cm), including 2 cases of the distal based medial antebrachial neurocutaneous flap, 2 cases of the perforator pedicled propeller flap of inferior cubital artery and 1 case of the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery who were healed after dressing change. The patients were followed up for 3 to 60 months after the operation, with a mean of 12 months, the flaps in the recipient sites survived well, at the same time, the color and elasticity of the flaps were close to normal, and the two-point discrimination was 4-9 mm without bloated appearance. The elbow joint of the affected limb was stable and with good movement. No obvious deformity was observed, and the functional recovery was excellent. The incision of the donor site healed well and the scar was easily accepted. Self-evaluation: 39 patients were satisfied and 12 were general. Elbow joint function evaluation: excellent in 15 cases and good in 36 cases. Comprehensive evaluation: excellent in 17 cases, good in 30 cases, general in 4 cases, that meant the excellent and good ratio reached to 92%(47/51).Conclusion:The three kinds of pedicled perforator flaps have constant perforating vessels, abundant blood supply and simple operation. They can be used to repair soft tissue defects around the elbow joint while good clinical result can be obtained. The distal based medial antebrachial neurocutaneous flap is focused on the anterior and ulnar sides of the elbow joint, the perforator pedicled propeller flap of inferior cubital artery is focused on the elbow fossa, and the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery is focused on the posterior and radial sides of the elbow joint.

ObjectiveTo investigate the clinical features of patients with severe alcoholic hepatitis (AH) with different underlying liver diseases and the influencing factors for short-term prognosis. MethodsA retrospective analysis was performed for the clinical data of 170 patients with severe AH who were admitted to Tianjin Third Central Hospital from August 2004 to August 2018, and according to the underlying liver disease, they were divided into group A (27 patients without liver cirrhosis), group B (52 patients with compensated liver cirrhosis), and group C (91 patients with decompensated liver cirrhosis). Related scores were calculated, including Maddrey’s discriminant function (MDF) score, Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) score, Model for End-Stage Liver Disease (MELD) score, age-bilirubin-international normalized ratio-creatinine (ABIC) score, and Glasgow alcoholic hepatitis score (GAHS). An analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the chi-square test was used for comparison of categorical data between multiple groups. Univariate and multivariate Cox regression analyses were used to screen out the independent influencing factors for the short-term prognosis of patients with severe AH. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison of survival rate between groups. The receiver operating characteristic (ROC) curve was used to calculate the area under the ROC curve (AUC) and 95% confidence interval (CI), sensitivity, and specificity for each predictive model, and the DeLong method was used for comparison. ResultsThe 28-day survival rates of patients in groups A, B, and C were 88.9%, 80.8%, and 51.6%, respectively, with a significant difference between the three groups (χ2=1983, P＜0.001). The AUCs (95% CIs) of MELD score, MDF score, GAHS score, ABIC score, and CLIF-SOFA score were 0.584 (0.493-0.676), 0.696 (0.605-0.786), 0.644 (0.554-0.735), 0.745 (0.662-0.827), and 0.795 (0.726-0.863), respectively, in predicting 28-day mortality rate, and there were significant differences between CLIF-SOFA score and MDF, MELD, and GAHS scores (all P＜0.05); CLIF-SOFA score had a sensitivity of 79.0% and a specificity of 67.9% at the optimal cut-off value of 850 points in predicting 28-day mortality rate. Different underlying liver diseases (hazard ratio ［HR］=2.296, 95% CI: 1.356-3887, P=0.002) and hepatic encephalopathy (HR=1.911, 95% CI: 1.059-3.449, P=0.031) at disease onset were risk factors for 28-day prognosis. ConclusionPatients with severe AH with different underlying liver diseases have different clinical features and short-term prognoses. Different underlying liver diseases and hepatic encephalopathy at disease onset are closely associated with the 28-day prognosis of patients with severe AH. CLIF-SOFA score can predict the 28-day prognosis of patients with severe AH.

OBJECTIVE: To investigate the clinical features and prognosis of acute myeloid leukemia (AML) patients with the mixed lineage leukemia (MLL) gene rearrangements AF6 (MLL-AF6) positive. METHODS: In the study, 11 patients who were newly diagnosed with MLL-AF6 positive AML were analyzed retrospectively, related literature was reviewed to clarify the clinical features and prognosis of MLL-AF6 positive patients. RESULTS: Among the 11 patients, there were 6 males and 5 females, with a median age of 36 years. Six patients were diagnosed with AML M5 and five with M4 according to FAB classification (French-American-British classification systems). Gingival swelling and pain occurred in 6 cases and fever occurred in 5 cases. At first diagnosis, the median white blood cells were 55.5×10⁹/L. Immunotype showed the expression of myeloid/monocyte and early stem cell series antigens. The expression level of MLL-AF6 fusion gene (real-time quantitative PCR) was 14.2%-214.5%, and 6/11 cases (54.5%) were associated with high EVI1 gene expression. Mutations of KRAS, TET2, ASXL1, TP53, DNMT3A, and FLT3-ITD were detected by next generation sequencing (NGS) in 4 patients. Chromosome G banding examination showed that 2 cases were t(6;11)(q27, q23) with complex karyotype abnormality, 4 cases with +8 abnormality and 2 cases with normal karyotype. Hematological complete remission (CR) was achieved in 8/11 patients (72.7%) after conventional induction chemotherapy, and primary drug resistance was observed in 3 patients. Two of the eight patients with CR were negative for minimal residual disease (MRD), with a median CR duration of 4.5 months. Two patients with positive MRD and three patients with refractory recurrence underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), but all died due to leukemia progression. At the end of follow-up on December 1, 2019, 2 patients were alive and 9 died, with median survival time of 9 months. CONCLUSION The AML patients with MLL-AF6 positive were mostly young, the majority of FAB types were M4 and M5, and most of the patients often had fever as the first symptom, with increased white blood cells, accompanied by organ infiltration, and high EVI1 gene expression. The hematological remission rate of routine chemotherapy is not low, but it is difficult to achieve molecular remission, most of which have early recurrence. Early allo-HSCT in a molecular negative state may prolong the CR duration.
Adult ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia, Myeloid, Acute/genetics* ; Male ; Myeloid-Lymphoid Leukemia Protein/genetics* ; Oncogene Proteins, Fusion/genetics* ; Prognosis ; Remission Induction ; Retrospective Studies

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective To compare the accuracy of three classification systems [determinant based classification (DBC),Revision of the Atlanta classification (RAC),and Atlanta classification (AC)] to stratify severity of acute pancreatitis (AP),and to analyze the association between different severity categories and clinical outcomes.Methods In this retrospective study,we reviewed the clinical data of 458 patients with AP admitted to our unit from January 2015 to December 2017.AP severity was stratified according to the three classification systems (DBC,RAC,and AC) respectively.The classification accuracy of three classification systems was analyzed.Receiver operating characteristic analysis (area under the curve) compared the accuracy of each classification.Multi-factors logistic regression analysis identified the independent risk fators for mortality of AP.Results Among the three classification systems,there were significant differences in the mortality rate,invasive treatment rate,ICU monitoring rate and the average hospitalization time among the three subtypes (P＜0.001).The RAC and DBC were comparable,but performed better than AC in predicting mortality (AUC 0.94 and 0.95 vs.0.63,P＜0.001),ICU admission (AUC 0.90 and 0.88 vs 0.60,P＜0.001).The DBC performed better than the RAC and OAC in predicting the need for intervention (AUC 0.88 vs 0.69 and 0.68,P＜0.001).Persistent organ failure (OR=13.131,P=0.003) and infected necrosis(OR=9.424,P=0.014) were independent risk factors for mortality.Conclusion The accuracy of DBC and RAC to stratify the severity of AP was significantly higher than that of AC.The accuracy of DBC in predicting clinical outcome was genarally higher than that of RAC and AC.Infectious necrosis and persistent organ failure were the independent risk fators for mortality.

Objective To explore the expressions of Sry-related high mobility group box 9(SOX9)and gastrokine-1(GKN1) in gastric cancer tissues and their relationships with clinicopathologic features and prognosis of patients.Methods Immunohistochemistry was used to detect the expressions of SOX9 and GKN1 in 70 cases of gastric cancer tissues and corresponding paracancerous tissues including 27 cases of intestinal metaplasia and 43 cases of normal gastric mucosa. The relationships of SOX9 and GKN1 expressions with clinicopathological features and prognosis were analyzed in gastric cancer tissues.Results The high expression rates of SOX9 in gastric cancer tissues,intestinal metaplasia,and normal gastric mucosa were 92.9%(65/70),77.8%(21/27),and 55.8%(24/43),respectively(=21.722,<0.001). Positive nuclear and cytoplasmic staining was observed. The high nuclear expression rate of SOX9 in gastric cancer tissues was 67.1%,which was significantly higher than those of intestinal metaplasia(37.0%,=0.007)and normal gastric mucosa(23.3%,<0.001). The high cytoplasmic expression rate of GKN1 in normal gastric mucosa was 76.7%,which was significantly higher than those of intestinal metaplasia(44.4%,=0.006)and gastric cancer tissues(37.1%,<0.001). Univariate analysis demonstrated that the nuclear expression of SOX9 in gastric cancer was associated with the degree of tissue differentiation(=0.007),while the cytoplasmic expression of GKN1 was associated with both the degree of tissue differentiation(=0.002)and whether the pathological type was a signet-ring cell carcinoma(=0.009). Furthermore,the nuclear expression of SOX9 was negatively correlated with the expression of GKN1 in gastric cancer(=15.424,<0.001). The 5-year survival rates of patients with high or low nuclear expression of SOX9 were 33.8% and 67.5%,respectively(=0.016).The 5-year survival rates of patients with high or low expression of GKN1 were 60.0% and 35.6%,respectively(=0.044). Further research indicated that 5-year survival rate of patients with high nuclear expression of SOX9 and low expression of GKN1 was 28.8%. Cox multivariate regression analysis showed that TNM stage(stage Ⅱ:=7.435,95%:1.313-42.096,=0.023;stage Ⅲ:=12.214,95%:2.677-55.721,=0.001)and nuclear expression level of SOX9(=3.297,95%:1.199-9.065,=0.021)were independent risk factors for the prognosis of gastric cancer patients.Conclusions Changes in the expressions of SOX9 and GKN1 may be associated with the malignant biological behavior of gastric cancer. SOX9 may be a potential prognostic factor. The combined detection of SOX9 and GKN1 expression and the further study of their molecular mechanism may provide new clues for early diagnosis,targeted therapy,and prognostic prediction of gastric cancer.
Humans ; Immunohistochemistry ; Peptide Hormones ; genetics ; Prognosis ; SOX9 Transcription Factor ; genetics ; Stomach Neoplasms ; diagnosis ; genetics ; Survival Rate

Objective To explore the relationship between the expression of decoy receptor 3 (DcR3) and high-risk human papilloma virus(HR-HPV)infection in cervical carcinoma. Methods Immunohistochemistry and hybird capture Ⅱ assay were used to detect the expression of DcR3 and HR-HPV in 35 cases of normal cervical tissues(NCE), 39 cases of cervical intraepithelial neoplasm(CIN)and 44 cases of cervical squamous epithelial carcinoma(CSES). Specific HR-HPV16 E7 siRNA and nonspecific HR-HPV16 E7 siRNA were synthesized and transfected to SiHa cells by Lipofectamine. The expression of DcR3 at mRNA and protein levels was examined by real-time polymerase chain reaction and western blot. The growth inhibition was examined by MTT assay. Results In NCE, CIN and CSES, the positive expression rates of DcR3 were 8.6%(3/35), 48.7%(19/39)and 77.3%(34/44), respectively, and the expression intensity was increasing(2=36.942, P<0.001). In NCE, CIN and CSES, the infection rates of HR-HPV were 5.7%(2/35), 56.4%(22/39)and 93.2%(41/44), respectively(2=60.322, P<0.001) . The protein expression of DcR3 was positively correlated with the infection of HR-HPV in CSES(r=0.893, P=0.004). Conclusions DcR3 was highly expressed in cervical cancer. Its expression was positively correlated with HR-HPV infection, which may contribute to the occurrence and development of cervical cancer. HR-HPV silencing inhibited cellular growth and proliferation by down-regulating the expression of DcR3.

Objective To observe the effect of hyperlipidemia on pancreatic microcirculation in anintact hyperlipidemic acute pancreatitis animal moldel.Methods Among 30 healthy hamsters enrolled,20were fed normally while,the other 10 were given high fat feed for four weeks.Then 10 animals givennormal feed with normal serum lipids and no ultrasonic changes in the organs including liver,biliary tractand pancreas,were randomly (random number) selected and divided into normal control group (C group)and acute pancreatitis group (AP group) averagely.Five animals given high fat feed with 3 times serumnormal triglyceride level and no ultrasonic changes in the organs including liver,biliary tract and pancreas,were randomly selected as hyperlipidemic acute pancreatitis group (HLAP).The animals in C group wereundergone fake surgery.While the animals in other two groups were carried out surgery based on Schmidtmethod and were injected 3.5％ taurocholic acid sodium into pancreatic duct with a infusion pump.Acridineorange (2 mL/kg) was injected in the inferior vena cava 6 hours later,then laser confocal microscopefluorescence imaging system were utilized to dynamically observe pancreatic microcirculation in living animal models and the variables including average microvascular diameter (MVD),functional capillary density (FCD),microvessel flow velocity (MFV) and leukocyte adhesion were recorded.Pancreatic tissue were collected and cut slices for pathological grading.Result When compared with AP group and C group,pancreas microcirculation function index MVD (μm),FCD (piece/mm2),MFV (μm/s) in the HLAP group decreased,while leukocyte adhesion (piece/mm2) increased significantly [MVD:HLAP group 2.40 ± 0.26 vs.AP group 5.54 ± 0.43,C group 7.56 ± 0.42 (P ＜ 0.05);FCD:HLAP group 4.20 ±0.84 vs.AP group 7.56 ± 1.14,C group 11.40 ± 1.14 (P ＜ 0.05);MFV:HLAP group 58.80 ± 9.63 vs.AP group 131.00 ± 12.94,C group 224.40 ± 15.63 (P ＜ 0.05);leukocyte adhesion:HLAP group 343.60±13.86vs.AP group 114.00 ±8.03,C group 18.80 ±2.28;(P＜0.05)].The pancreatic pathology score was higher in HLAP group [HLAP group 10.00 ± 1.59 vs.AP group 6.60 ± 1.14,C group 1.00 ± 0.71 (P ＜ 0.05)].Conclusion Hypedipidemia may aggravate the impair ment of pancreatic microcirculation and promote microcirculation dysfunction.