OBJECTIVE To optimize the simmering technology of Rheum palmatum from Menghe Medical School and compare the difference of chemical components before and after processing. METHODS Using appearance score， the contents of gallic acid， 5-hydroxymethylfurfural （5-HMF）， sennoside A+sennoside B， combined anthraquinone and free anthraquinone as indexes， analytic hierarchy process （AHP）-entropy weight method was used to calculate the comprehensive score of evaluation indicators； the orthogonal experiment was designed to optimize the processing technology of simmering R. palmatum with fire temperature， simmering time， paper layer number and paper wrapping time as factors； validation test was conducted. The changes in the contents of five anthraquinones （aloe-emodin， rhein， emodin， chrysophanol， physcion）， five anthraquinone glycosides （barbaloin， rheinoside， rhubarb glycoside， emodin glycoside， and emodin methyl ether glycoside）， two sennosides （sennoside A， sennoside B）， gallic acid and 5-HMF were compared between simmered R. palmatum prepared by optimized technology and R. palmatum. RESULTS The optimal processing conditions of R. palmatum was as follows: each 80 g R. palmatum was wrapped with a layer of wet paper for 0.5 h， simmered on high heat for 20 min and then simmered at 140 ℃， the total simmering time was 2.5 h. The average comprehensive score of 3 validation tests was 94.10 （RSD＜1.0%）. After simmering， the contents of five anthraquinones and two sennosides were decreased significantly， while those of 5 free anthraquinones and gallic acid were increased to different extents； a new component 5-HMF was formed. CONCLUSIONS This study successfully optimizes the simmering technology of R. palmatum. There is a significant difference in the chemical components before and after processing， which can explain that simmering technology slows down the relase of R. palmatum and beneficiate it.

Objective To develop a rapid and accurate Monte Carlo program(simplified code for dosimetry of carbon ions,SPEEDO)for carbon ion therapy.Methods For electromagnetic process,type Ⅱ condensed history simulation scheme and continuous slowing down approximation were used to simulate energy straggling,range straggling,multiple scattering,and ionization processes.For nuclear interaction,5 types of target nuclei were considered,including hydrogen,carbon,nitrogen,oxygen,and calcium.The produced secondary charged particles followed the same condensed history framework.The study simulated the transport of carbon ions in 4 materials(water,soft tissues,lung,and bone),and the calculated doses were validated against TOPAS(a Monte Carlo simulation software for radiotherapy physics),followed by a comparison with dose measurements in a water phantom from the HIMM-WW(a medical heavy-ion accelerator facility in Wuwei).Results SPEEDO's simulation results showed good consistency with TOPAS.For each material,in the voxel region where the physical dose was greater than 10％of the maximum dose point,the relative maximum dose error of both was less than 2％.At treatment energy of 400 MeV/u,SPEEDO's computation time was significantly less than that of TOPAS(13.8 min vs 105.0 min).SPEEDO's calculation results also showed good agreement with HIMM-WW measurements in terms of lateral dose distribution and integrated dose depth curve.Conclusion SPEEDO program can accurately and rapidly perform Monte Carlo dose calculations for carbon-ion therapy.

Wiskott-Aldrich syndrome (WAS) is a rare X-linked recessive genetic disorder characterized by thrombocytopenia, eczema, recurrent infections, and susceptibility to autoimmune diseases. The renal complication of WAS is mainly manifested as IgA nephropathy. Membranous nephropathy (MN) in children mostly has secondary factors, and its occurrence is related to immune disorders. This paper reports a case of WAS in an infant with bleeding tendency and recurrent infections, complicated with nephrotic syndrome during the course, confirmed as MN by pathological examination. After treatment with glucocorticoids, tacrolimus and hematopoietic stem cell transplantation, nephrotic syndrome was manifested as steroid-resistant and partially sensitive to tacrolimus. Proteinuria continued to relieve 3 months after hematopoietic stem cell transplantation and renal function remained stable. WAS complicated with MN is extremely rare, and its renal prognosis is still unclear, which deserves the attention of clinicians.

AIM:To investigate the effects of astragalin(AST)on activation status of astrocytes and the ex-pression level of autophagy-related proteins in the cortex of the anterior cingulate cortex of mice with a complete Freund's adjuvant(CFA)-induced inflammatory pain model.METHODS:Twenty-four 6-month-old male C57BL/6 mice were ran-domly divided into four groups:control group,saline group,CFA model group and CFA+60 mg/kg AST administration group,and six mice in each group.Mice in the AST administration group received 60 mg/kg AST by intraperitoneal injec-tion on a body weight basis for 21 d.The paw withdrawal threshold in each group of mice was evaluated by the von Frey test.The expression levels of autophagy-related factors LC3,p62,ATG12 and beclin-1,and astrocyte activation were de-tected by multiplex immunofluorescence staining in the anterior cingulate cortex of mice in each group.Western blot was used to measure the levels of autophagy-related proteins LC3,p62,ATG12 and beclin-1 in the anterior cingulate cortex of mice in each group.RESULTS:Behavioural tests showed that AST significantly increased mechanical pain thresholds in CFA mice(P＜0.05).The results from multiple immunofluorescent staining showed that AST significantly increased the fluorescence intensity of LC3(P＜0.01),ATG12(P＜0.01)and beclin-1(P＜0.05),attenuated the fluorescence intensi-ty of p62(P＜0.05),and inhibited the activation of astrocytes in the anterior cingulate cortex of CFA mice.Western blot results further confirmed that AST significantly increased the expressions of LC3(P＜0.01),ATG12(P＜0.01),beclin-1(P＜0.01),and decreased the expression of p62(P＜0.05)in the anterior cingulate cortex of CFA mice.CONCLU-SION:AST relieves CFA-induced inflammatory pain of mice,and its analgesic mechanism may be related to the inhibi-tion of activation of cortical astrocytes in the anterior cingulate cortex and the promotion of autophagy in CFA mice.

Objective:To analyze the application effect of information health education combined with teach-back method in patients with posterior fossa tumor during perioperative period and provide experience and reference for clinical practice.Methods:From March 2022 to October 2022, a total of 80 patients diagnosed as posterior fossa tumors in the neurosurgery department were divided into a control group and an experimental group, with 40 patients in each group to conduct an experimental research, based on the length of hospitalization. The control group was given the conventional health education combined with the teach-back method, and the experimental group was given the information health education combined with the teach-back method. The scores of standard swallowing assessment, quality of life, awareness score of health education and incidence of respiratory aspiration were compared between the two groups.Results:On the 7th day after surgery and 1 day before discharge, the standard swallowing score of the experimental group were 25.29 ± 2.21 and 22.97 ± 3.36, which was significantly lower than that of the control group 26.45 ± 2.01 and 24.92 ± 3.56, ( t=2.44, 2.52, both P<0.05). The total score of quality of life on the day before discharge was 64.55 ± 4.27, significantly higher than 61.80 ± 4.82 in the control group, with a statistically significant difference ( t=-2.09, P<0.05). The patients in the experimental group were familiar with preoperative guidance, various dietary requirements, various drug effects and precautions, the prevention of various complications, various rehabilitation training methods, and the purpose and precautions of the head drainage tube, with the score of 4.70 ± 0.56, 4.52 ± 0.71, 4.65 ± 0.57, 4.67 ± 0.52, 4.72 ± 0.50, 4.77 ± 0.47, were higher than the control group 3.40 ± 1.05, 3.62 ± 0.97, 3.77 ± 0.94, 3.80 ± 0.88, 3.75 ± 0.89, 3.92 ± 0.88. The difference was statistically significant ( t values were -6.86 to -4.69, all P<0.05). The incidence of respiratory aspiration in experimental group was 0, significantly lower than that in control group 12.5%(5/40) ( χ2=5.33, P<0.05). Conclusions:The application of information health education combined with back teaching can improve the quality of life, health education awareness rate and reduce the incidence of aspiration in patients with posterior fossa tumor.

Objective:To explore the efficacy and safety of Rasburicase therapy in critically ill children su-ffering from advanced Burkitt′s lymphoma.Methods:A retrospective analysis of children with advanced Burkitt′s lymphoma was admitted to Pediatric Intensive Care Unit, the First Affiliated Hospital of Sun Yat-Sen University, from January 2015 to May 2020 and accepted treatment.According to the uric acid-lowering therapies, patients were divided into 2 groups, namely Rasburicase group (Group R) and traditional treatment group (Group T), to compare the effects of hypouricemic treatment and the prognosis between the 2 groups.Results:Twenty-nine children with advanced Burkitt′s lymphoma were included in this study, with 13 cases (44.83%) of stage Ⅲ and 16 cases (55.17%) of stage Ⅳ.Abdominal mass/ abdominal distension (13 cases, 44.83%) and abdominal pain (7 cases, 24.14%) were the main reasons of initial medical visit attendance.The most common primary tumor site was abdominal/ pelvic cavity (21 cases, 72.41%), followed by head or neck (6 cases, 20.69%). There were 15 cases in Group R and 14 cases in group T. No significant differences in serum creatinine, lactate dehydrogenase and uric acid were detected between the 2 groups (all P>0.05). The proportion of serum uric acid recovery rate of 24 hours and 72 hours after initial treatment in Group R were significantly higher than those in T group (85.71% vs.25.00%, 100.00% vs.25.00%, all P<0.01). Although there were no obvious differences in the incidence of tumor lysis syndrome between the 2 groups (33.33% vs.64.29%, P=0.096), the incidence of acute renal injury, renal replacement therapy requirement, serious complications and the 28 day mortality in Group R were remarkably lower than those in Group T (33.33% vs.85.71%, 13.33% vs.64.29%, 20.00% vs.78.57%, 0 vs.35.71%, all P< 0.05). Conclusions:Rasburicase can effectively reduce the serum uric acid level and decrease the incidence of acute kidney injury and other severe complications, thus improving the prognosis of children experiencing advanced Burkitt′s lymphoma.

Objective:To compare the consistency in diagnosing and staging acute kidney injury (AKI) in children with chronic kidney disease (CKD) according to three criterias.Methods:Children with CKD hospitalized in the First Affiliated Hospital of Sun Yat sen University from January 2013 to December 2019 were analyzed retrospectively. These patients underwent serum creatinine examination more than twice during hospitalization. The AKI diagnosis and staging were performed for each patient according to the 2007 pRIFLE, 2012 KDIGO and 2018 pROCK criteria respectively. All the children were followed up for 1 year after discharge through outpatient visit, re-hospitalization or online consultation. The clinical characteristics and prognosis of CKD children with or without AKI that were diagnosed by 3 criteria were compared. Analysis of variance and chi-squared tests were used for the comparison among groups. Concordance between the different diagnostic criteria was evaluated using Cohen′s kappa coefficient.Result:A total of 2 551 children with CKD were included in this study, with an age of (8±4) years. There were 1 628 boys and 923 girls. Nephrotic syndrome was the most prevalent primary disease (55.4%), followed by lupus nephritis (11.2%) and purpura nephritis (8.2%). Among all stages of CKD, CKD category G1 was the most common type (2 146 cases, 84.1%), followed by CKD category G2 (221 cases, 8.7%). AKI occurence rates according to pRIFLE, KDIGO and pROCK criteria were 33.9% (866/2 551), 26.2%(669/2 551) and 19.5% (498/2 551) respectively (χ2=136.3, P<0.01). The diagnostic consistency within three criteria for AKI was high in children with CKD ( κ=0.702), but AKI staging consistency was low ( κ=0.329). Both the diagnosis and staging consistency of three AKI criteria were poor in children with CKD category G5 (all κ<0.400). The length of hospital stay (LOS), hospitalization costs, the occurence of intensive care unit (ICU) admission and in-hospital mortality were significantly higher in children with AKI diagnosed by different criteria ( P<0.05). After 1-year follow-up, the repeated admission rate and CKD staging progress significantly increased in children with AKI ( P<0.05). In children with baseline serum creatinine≥200 μmol/L, compared with children who did not experience AKI during hospitalization, the LOS and the hospitalization costs in children who were diagnosed AKI according to pRIFLE or pROCK criteria was significantly higher ( P<0.05). However, there was no significant difference in the LOS and hospitalization costs between children with or without AKI who were diagnosed according to KDIGO criteria (all P>0.05). Conclusions:AKI diagnosed by all of the three criteria (pRIFLE, KDIGO and pROCK criteria) was associated with the poor prognosis in children with CKD. However, in those whose baseline serum creatinine≥ 200 μmol/L, AKI diagnosed by pRIFLE and pROCK criteria could better reflect the poor outcomes than by KDIGO criteria.

Neurostimulation remarkably alleviates the symptoms in a variety of brain disorders by modulating the brain-wide network. However, how brain-wide effects on the direct and indirect pathways evoked by focal neurostimulation elicit therapeutic effects in an individual patient is unknown. Understanding this remains crucial for advancing neural circuit-based guidance to optimize candidate patient screening, pre-surgical target selection, and post-surgical parameter tuning. To address this issue, we propose a functional brain connectome-based modeling approach that simulates the spreading effects of stimulating different brain regions and quantifies the rectification of abnormal network topology in silico. We validated these analyses by pinpointing nuclei in the basal ganglia circuits as top-ranked targets for 43 local patients with Parkinson's disease and 90 patients from a public database. Individual connectome-based analysis demonstrated that the globus pallidus was the best choice for 21.1% and the subthalamic nucleus for 19.5% of patients. Down-regulation of functional connectivity (up to 12%) at these prioritized targets optimally maximized the therapeutic effects. Notably, the priority rank of the subthalamic nucleus significantly correlated with motor symptom severity (Unified Parkinson's Disease Rating Scale III) in the local cohort. These findings underscore the potential of neural network modeling for advancing personalized brain stimulation therapy, and warrant future experimental investigation to validate its clinical utility.
Adult ; Aged ; Brain Mapping ; Connectome ; Deep Brain Stimulation ; methods ; Female ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neural Pathways ; diagnostic imaging ; physiology ; Oxygen ; blood ; Parkinson Disease ; diagnostic imaging ; pathology ; therapy ; ROC Curve ; United Kingdom

Objective To assess the performance of pediatric clinical illness score (PCIS), pediatric risk of mortality scoreⅢ(PRISMⅢ), pediatric logistic organ dysfunction score 2 (PELOD-2), and pediatric multiple organ dysfunction score (P-MODS) in predicting mortality in critically ill pediatric patients. Methods The data of critically ill pediatric patients admitted to Pediatric Intensive Care Unit (PICU) of First Affiliated Hospital of Sun Yat-Sen University from August 2012 to May 2017 were retrospectively analyzed. The gender, age, basic diseases, the length of PICU stay were collected. The children were divided into survival group and non-survival group according to the clinical outcome during hospitalization. The variables of PCIS, PRISMⅢ, PELOD-2, and P-MODS were collected and scored. Receiver operating characteristic (ROC) curve was plotted, the efficiency of PCIS, PRISMⅢ, PELOD-2, and P-MODS for predicting death were evaluated by the area under ROC curve (AUC). Hosmer-Lemeshow goodness of fit test was used to evaluate the fitting degree of each scoring system to predict the mortality and the actual mortality. Results Of 461 critically ill children, 35 children were excluded because of serious data loss, hospital stay not exceeding 24 hours, and death within 8 hours after admission. Finally, a total of 426 pediatric patients were enrolled in this study. 355 pediatric patients were survived, while 71 were not survived during hospitalization, with the mortality of 16.7%. There was no significant difference in gender, age, underlying diseases or length of PICU stay between the two groups. PCIS score in non-survival group was significantly lower than that of survival group [80 (76, 88) vs. 86 (80, 92)], and PRISMⅢ, PELOD-2 and P-MODS scores were significantly increased [PRISMⅢ: 16 (13, 22) vs. 12 (10, 15), PELOD-2: 6 (5, 9) vs. 4 (2, 5), P-MODS: 6 (4, 9) vs. 3 (2, 6), all P < 0.01]. ROC curve analysis showed that the AUCs of PCIS, PRISMⅢ, PELOD-2, and P-MODS for predicting death of critical ill children were 0.649, 0.731, 0.773, and 0.747, respectively. Hosmer-Lemeshow test showed that PCIS predicted the mortality and the actual mortality in the best fitting effect (χ2= 7.573, P = 0.476), followed by PELOD-2 and P-MODS (χ12 = 9.551, P1= 0.145; χ22 = 10.343, P2= 0.111), while PRISMⅢ had poor fitting effect (χ2= 43.549, P < 0.001). Conclusions PRISMⅢ, PELOD-2 and P-MODS can discriminate between survivors and moribund patients well, and assessing the condition of critically ill pediatric patients with relatively accuracy. PCIS was the best fitting effect in predicting mortality and actual mortality, followed by PELOD-2 and P-MODS, while PRISMⅢ had poor fitting effect.

According to the 2015 American Heart Association guideline and 2016 European Pediat-rics Pulmonary Vascular Disease Network expert consensus statement for pulmonary hypertension,the impor-tance of early identification and standard treatment in pulmonary hypertension had been emphasized. The guidelines also introduced the drugs and precautions in pulmonary hypertension treatment. These may play an important role in the management of pulmonary hypertension.