Multiple system atrophy (MSA) is a rare neurodegenerative disease with complex clinical manifestations, presenting substantial challenges in clinical diagnosis and treatment. Its symptoms and the eight extraordinary meridians are potentially correlated; therefore, this article explores the association between MSA symptom clusters and the eight extraordinary meridians based on their circulation and physiological functions, as well as their treatment strategies. The progression from deficiency to damage in the eight extraordinary meridians aligns with the core pathogenesis of MSA, which is characterized by "the continuous accumulation of impacts from the vital qi deficiency leading to eventual damage". Liver and kidney deficiency and the emptiness of the eight extraordinary meridians are required for the onset of MSA; the stagnation of qi deficiency and the gradual damage to the eight extraordinary meridians are the key stages in the prolonged progression of MSA. The disease often begins with the involvement of the yin and yang qiao mai, governor vessel, thoroughfare vessel, and conception vessel before progressing to multiple meridian involvements, ultimately affecting all eight extraordinary meridians simultaneously. The treatment approach emphasizes that "the direct method may be used for joining battle, but indirect method will be needed in order to secure victory" and focuses on "eliminate pathogenic factors and reinforce healthy qi". Distinguishing the extraordinary meridians and focusing on the primary symptoms are pivotal to improving efficacy. Clinical treatment is aimed at the target, and tailored treatment based on careful clinical observation ensures precision in targeting the disease using the eight extraordinary meridians as the framework and core symptoms as the specific focus. Additionally, combining acupuncture, daoyin therapy, and other method may help prolong survival. This article classifies clinical manifestations based on the theory of the eight extraordinary meridians and explores treatment.

OBJECTIVE To investigate the effects of dexmedetomidine （DEX）-assisted general anesthesia on hemodynamics and cognitive function in elderly patients undergoing painless enteroscopy. METHODS From July 2020 to February 2022， 180 elderly patients undergoing painless enteroscopy in the outpatient operating room of the Second People’s Hospital of Jiaozuo were selected and divided into a control group （n＝90） and an observation group （n＝90） according to the random number table method. The control group was given routine general anesthesia （induced with sufentanil and propofol anesthesia， maintained with propofol anesthesia）， while the observation group was given DEX-assisted general anesthesia after preoperative preparation. The hemodynamic indexes [mean arterial pressure （MAP）， heart rate （HR）]， dosage of general anesthesia， awakening time， cognitive function [minimized mental status examination （MMSE）]， and the incidence of adverse drug reactions were compared between the two groups. RESULTS There was no significant difference in various indicators before anesthesia （T0） between 2 groups （P＞ 0.05）. Compared with T0， MAP and HR of the two groups were reduced significantly 10 minutes after anesthesia （T1）， at the time of enteroscope reaching the ileum and cecum （T2）， enteroscope withdrawal after the examination （T3）， and 10 minutes after surgery （T4）； but MAP and HR of the observation group at T1， T2， T3， and T4 were all higher than those of the control group （P＜0.05）. Compared with the control group， the dosage of general anesthesia and the recovery time in the observation group were significantly reduced or shortened， the MMSE scores at 1， 2 and 3 days after the operation were significantly increased， while the incidence of cognitive dysfunction and adverse reactions were significantly reduced （P＜0.05）. CONCLUSIONS DEX can effectively improve the hemodynamics and cognitive function of elderly patients undergoing painless enteroscopy， which is beneficial to reduce the dosage of general anesthesia， shorten recovery time， and has better safety.

Humans ; Child ; Adenoids/surgery* ; Palatine Tonsil/surgery* ; Adenoidectomy ; Hypertrophy/surgery* ; Tonsillectomy

Objective:To explore the effect of fully automatic image segmentation of adenoid and nasopharyngeal airway by deep learning model based on U-Net network. Methods:From March 2021 to March 2022, 240 children underwent cone beam computed tomography（CBCT） in the Department of Otolaryngology, Head and Neck Surgery, General Hospital of Shenzhen University. 52 of them were selected for manual labeling of nasopharynx airway and adenoid, and then were trained and verified by the deep learning model. After applying the model to the remaining data, compare the differences between conventional two-dimensional indicators and deep learning three-dimensional indicators in 240 datasets. Results:For the 52 cases of modeling and training data sets, there was no significant difference between the prediction results of deep learning and the manual labeling results of doctors（P>0.05）. The model evaluation index of nasopharyngeal airway volume: Mean Intersection over Union（MIOU） s （86.32±0.54）%; Dice Similarity Coefficient（DSC）: （92.91±0.23）%; Accuracy: （95.92±0.25）%; Precision: （91.93±0.14）%; and the model evaluation index of Adenoid volume: MIOU: （86.28±0.61）%; DSC: （92.88±0.17）%; Accuracy: （95.90±0.29）%; Precision: （92.30±0.23）%. There was a positive correlation between the two-dimensional index A/N and the three-dimensional index AV/（AV+NAV） in 240 children of different age groups（P<0.05）, and the correlation coefficient of 9-13 years old was 0.74. Conclusion:The deep learning model based on U-Net network has a good effect on the automatic image segmentation of adenoid and nasopharynx airway, and has high application value. The model has a certain generalization ability.
Child ; Humans ; Adolescent ; Adenoids/diagnostic imaging* ; Image Processing, Computer-Assisted/methods* ; Pharynx ; Cone-Beam Computed Tomography ; Nose

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 changes of inflammation and immune function in children with chronic tonsillitis after tonsillotomy. Methods:Prospectively collected 60 children with obstructive sleep apnea （OSA） diagnosed as chronic tonsillitis with adenoids and tonsillar hypertrophy from January to June 2021. Two groups were divided, the experimental group （n=30） underwent bilateral partial tonsillectomy + adenoidectomy by hypothermia plasma ablation, and the control group （n=30） underwent adenoidectomy by using the same hypothermia plasma ablation method. The number of tonsillitis attacks before surgery and within one year after surgery was recorded, and the serum immunoglobulin IgM, IgG, IgA, complement C3 and complement C4 levels before operation, one month and three months after operation were measured. Results:The number of tonsillitis attacks in the experimental group and the control group at one year after surgery was lower than that before surgery（P<0.05）; The number of inflammatory attacks in the experimental group was （0.50±0.63） times/year, which was lower than that of （1.33±0.80） times/year in the control group. There was no significant difference in the five immunization results of the two groups at one month and three months after operation compared with before operation, and there was also no significant difference between the experimental and the control groups. Conclusion:Partial tonsillectomy can be applied to children with chronic tonsillitis, which can effectively reduce the number of tonsillitis attacks and has no effect on the immune function of children.
Child ; Humans ; Tonsillectomy/methods* ; Hypothermia ; Tonsillitis/surgery* ; Adenoidectomy ; Palatine Tonsil/surgery* ; Inflammation ; Chronic Disease ; Immunity

Objective:By analyzing factors associated with lower urinary tract symptoms in middle-aged and elderly women aged 55-65 years old, a nomogram model for lower urinary tract symptoms was constructed to assist the clinical development of targeted interventions to reduce the incidence of lower urinary tract symptoms in this population.Methods:In the cross-sectional study, 798 middle-aged and elderly women aged 55-65 years receiving physical examination in the Health Management Center of Third Xiangya Hospital from November 2013 to December 2020 were selected as research participants.Univariate regression analysis was used to compare differences in the basic data related to lower urinary tract symptoms in the population.Multivariate Logistic regression analysis was used to identify related influencing factors, and a nomogram model for lower urinary tract symptoms in the population was established.Results:Among 798 middle-aged and elderly women surveyed, the prevalence of lower urinary tract symptoms was 81.08 %(647 cases), and the rate of urinary tract infections was 21.48 %(139 cases). Variables with statistical significance in univariate regression analysis were included in multivariate Logistic regression analysis.The results showed that body mass index, vaginal delivery, strength of pelvic floor type Ⅱ fiber muscle, pelvic and abdominal coordination and mental health were independent influencing factors for lower urinary tract symptoms in middle-aged and elderly women aged 55-65 years( OR=1.099, 2.681, 0.895, 0.658, 1.057, P=0.010, 0.030, 0.040, 0.010, 0.038). The monogram model based on the five risk prediction indexes produced a consistency index(C-index)of 0.651 and a diagnostic sensitivity and specificity of 66.9% and 58.9%, respectively.The correction curve showed that the predicted results of the model were essentially the same as the actual probability of condition. Conclusions:In this study, the independent influencing factors for lower urinary tract symptoms in middle-aged and elderly women aged 55-65 years were screened by univariate regression and multivariate Logistic regression analysis and a nomogram model for risk prediction of the population was constructed, was proved to have a good ability for accurately and effectively predicting the risk of lower urinary tract symptoms in middle-aged and elderly women aged 55-65 years, and will assist clinicians to screen for high-risk patients, formulate targeted interventions, and reduce the incidence of lower urinary tract symptoms in middle-aged and elderly women aged 55-65 years.

Objective:To investigate the clinical diagnostic value of joint test of retinol-binding protein (RBP), cystatin C (CYSC) and urinary (albumin/creatinine ratio, ALB/Cr) ALB/Cr in early diabetes nephropathy.Methods:Data of 50 early diabetic nephropathy patients (EDN group) from Jan. 2020 to Jun. 2021 in our hospital, another 50 pure type 2 diabetic patients (T2DM group), and 50 healthy subjects (control group) were compared and analysed. RBP, CYSC and urinary ALB/Cr were tested for the 3 groups. Then the clinical diagnostic value between single index test and joint test for the early diabetes nephropathy were compared.Results:Group EDN had higher RBP, CYSC and urinary ALB/Cr [ (114.66±0.56) mg/L, (2.64±0.33) mg/L, (351.81±15.48) ] mg/g than group T2DM [ (83.58±0.83) mg/L, (1.41±0.29) mg/L, (113.65±12.55) mg/g] and control group[ (38.61±0.66) mg/L, (0.53±0.26) mg/L, (16.36±5.61) mg/g]. The difference was statistically significant ( P<0.05). The specificity and sensitivity of early diabetes nephropathy were 95.38% and 96.21%, both higher than single index test. Conclusion:The combined detection of serum RBP, CYSC and urine ALB/Cr has certain reference value for the clinical diagnosis of early diabetic nephropathy.

Objective:To explore the effects of scenario simulation combined with case-based learning (CBL) teaching method on the operation skills, learning initiative and family satisfaction of pediatric nursing students.Methods:In the study, 51 nursing students who interned in Bengbu First People's Hospital from March to November in 2019 were selected as the control group, having the traditional teaching method; another 51 nursing students interned from March to November in 2020 were selected as the research group, taking the scenario simulation combined with CBL teaching method. The theoretical knowledge and operation skills of the two groups of nursing students were assessed, the learning initiative and various abilities were evaluated by using the relevant scales, and the nursing students' satisfaction with teaching was investigated. SPSS 22.0 was used for t test and chi-square test. Results:The theoretical knowledge and operation skill scores of nursing students in the study group were significantly higher than those in the control group ( P<0.05). The scores of each dimension and total score of learning initiative of nursing students in the study group were higher than those in the control group [(68.71±9.03) vs. (50.21±9.86)], including integrating theory with practice [(8.06±1.13) vs. (6.12±1.54)], learning ability practice [(8.15±1.18) vs. (6.53±1.37)], interpersonal communication ability [(8.13±1.07) vs. (6.28±1.39)], clinical thinking ability practice [(8.04±1.26) vs. (5.97±1.42)], ability to analyze and solve problems [(8.46±0.97) vs. (6.51±1.25)]. The scores of various abilities and overall satisfaction with teaching in the research group were significantly higher than those in the control group ( P<0.05). Conclusion:The implementation of scenario simulation combined with CBL teaching method for pediatric nursing students can improve their scores of theoretical knowledge and operational skills, enhance their learning initiative and abilities, and improve their satisfaction with teaching.

Objective: To investigate the application of metagenomic next-generation sequencing (mNGS) in detection of the rare or difficult-to-cultivate pathogens. Methods: One patient with acute lymphoblastic leukemia who went through allogeneic hematopoietic stem cell transplantation (allo-HSCT) developed symptoms of infection after transplantation. Conventional microbial culture, polymerase chain reaction (PCR), and mNGS combined with biological information analysis were performed with plasma and cerebrospinal fluid samples, the anti-infective treatment was adjusted according to the test results, and the efficacy was assessed. Results: No suspected pathogens were detected by microbial culture and PCR in the cerebrospinal fluid and plasma samples since the patient developed infection symptoms. However, Legionella pneumophila was analyzed by mNGS in the cerebrospinal fluid specimen on day 23 after allo-HSCT (reads count: 19 655), and it was considered as the principal pathogen after comprehensively evaluating the patient's clinical manifestations and the test results. Then the antimicrobial treatments were adjusted according to the patient's clinical manifestations and laboratory test results, and the number of gene sequences of Legionella pneumophila was monitored by mNGS method. Azithromycin, tigecycline, and other antibiotics effective for Legionella pneumophila were used after detecting this pathogen. A total of 15 mNGS analysis were performed during the 5-month period, and the highest number of Legionella pneumophila sequences monitored in the cerebrospinal fluid was 2 226, the lowest was 253 and eventually turned negative. The clinical symptoms and treatment outcomes were consistent with the mNGS monitoring results. Conclusions The mNGS technology has significant value in detection of the rare and difficult-to-cultivate pathogens. The mNGS technology provides a valuable supplement to microbial culture and PCR methods.