Bronchiolitis is the most common lower respiratory tract disorder in infants less than 12 months of age.Wide variation in the management of bronchiolitis exists between Australia and New Zealand, with up to 48% of infants admitted into hospital receiving treatment which is proved by high quality(Cochrane-level) evidence to be no benefit.For this reason, the Australian Guidelines Development Committee has developed the first high-quality Australian guidelines for bronchiolitis.The guideline provide suggestions for the management of children with bronchiolitis in emergency departments and general pediatric wards, and provide evidence for clinical practice.

Objective:To explore the mechanism of motor imagery training (MIT) combined with conventional rehabilitation to promote the functional recovery of upper limbs in stroke survivors. To explore the brain network reorganization resulting when motor imagery training (MIT) is combined with conventional rehabilitation to promote the motor recovery of stroke survivors.Methods:Fourteen hemiplegic patients were recruited as the MIT group. They underwent 4 weeks of MIT (30 min/day, 5 days/week) along with conventional rehabilitation treatment. The upper limb section of the Fugl-Meyer assessment (FMA-UE) and the modified Barthel Index (MBI) were used to assess all of the patients, and resting-state fMRI was performed before and after the treatment. Twenty-eight age- and sex-matched healthy subjects also received one-time resting-state fMRI scanning. Granger causal analysis was performed in the MIT group to calculate the changes in effective connection between the ipsilesional primary motor cortex and the whole brain before and after the treatment, and the results were compared with the healthy control group.Results:After the treatment, the average FMA-UE and MBI of the MIT group had increased significantly. Before the intervention, the effective connection mode of the ipsilesional M1 area in the MIT group was significantly different from that of the healthy controls. The causal flow from the ipsilesional M1 area to the bilateral prefrontal cortex had increased abnormally and the causal flow from the contralesional primary motor cortex, the inferior parietal lobule and the cerebellum to the ipsilesional M1 area had decreased significantly. After the treatment, the effective connection pattern of the stroke survivors was nearly normal, and the causal influence from contralesional motor imagery-related brain areas (the superior parietal lobule, inferior parietal lobule, thalamus and the fusiform gyrus) to the ipsilesional M1 area was enhanced. Effective connection from the ipsilesional M1 area to the contralesional cerebellum before the intervention was positively correlated with the improvement in FMA-UE scores, and the effective connection from the contralesional middle frontal gyrus to the ipsilesional M1 area was correlated negatively.Conclusions:The neural mechanism of MIT's effectiveness when it is combined with conventional rehabilitation might be related to the reorganization of effective connections. That would include enhanced causal flow between motor imagery-related brain areas and the contralesional cerebellum and ipsilesional M1 area. Down-regulation of the effective connection from the contralesional middle frontal gyrus to the ipsilesional M1 area also occurs.

Diarrhea is one of the main disease types of illness and death in children in developing countries, and infectious diarrhea is especially harmful to children′s health.A panel of multidisciplinary experts in management of infectious diarrhea in children and adults was convened in 2012.Panel participants included representatives from the Society for Healthcare Epidemiology of America (SHEA), Center for Disease Control and Prevention(CDC), and the Infectious Disease Society of America(IDSA) Standards and Practice Guidelines Committee (SPGC). In 2017, the panel issued a guideline for the diagnosis and treatment of infectious diarrhea, which was validated and recommended for the management of infectious diarrhea.Now, the part of the content on children in the guide was described.

Objective To explore the changes of left ventricular torsion function in patients with latent obstructive hypertrophic cardiomyopathy ( HCM ) ,and provide quantitative informations for clinical evaluation of cardiac function . Methods A total of 49 consecutive patients with HCM without left ventricular outflow tract obstruction at rest were enrolled . All subjects underwent exercise stress echocardiography . After exercise left ventricular outflow tract pressure gradient ( LVO T‐PG ) ≥30 mm Hg was positive for exercise stress test ( latent obstruction) ,w hile LVO T‐PG＜ 30 mm Hg was negative for exercise stress test ( non‐obstruction) . An ultrasound system obtained two‐dimensional ultrasound images of resting and moving peaks . The global longitudinal strain ( GLS ) ,global circumferential strain ( GCS ) , global radial strain ( GRS) of the left ventricle 16 segments and left ventricular rotation ,twist were analysis using off‐line EchoPAC software . T he differences of the above parameters were compared between the two groups . Results T here were no significant differences in GLS ,GRS ,GCS and Rotation‐B between the two groups in resting and peak period of exercise ( all P ＞ 0 .05 ) ,GRS in both groups were significantly increased compared with that before exercise ( all P ＜ 0 .05 ) . Compared with the negative exercise stress group ,the left ventricular twist and Rotation‐A were significantly increased in resting and peak period of exercise in the positive exercise stress test group( all P ＜0 .05) . Compared with before exercise ,Rotation‐A and left ventricular twist were significantly decreased in the positive exercise stress test group ( all P ＜0 .05) ,while no significantly difference was found in the negative exercise stress group ( all P ＞ 0 .05 ) . Conclusions Left ventricular torsion function is significantly changed in rest and after exercise in latent obstructive HCM patients ,providing valuable quantitative information for clinical comprehensive evaluation of cardiac function .

Objective To measure the efficacy of combining motor imagery training ( MIT) with convention-al therapy in improving stroke patients′upper-extremity function. And to seek a cortical reorganization mechanism as-sociated with the improvement using resting-state functional magnetic resonance imaging ( rs-fMRI) . Methods Ten stroke survivors were selected as an experimental group. They were given motor imagery training for four weeks ( 30 minutes a day, 5 days a week) and conventional rehabilitation therapy ( 40 minutes a day, 5 days a week) . Another 10 healthy counterparts were the control group. Before and after the four weeks of treatment, both groups were as-sessed using the upper extremity Fugl-Meyer assessment ( FMA-UE) and the modified Barthel index ( MBI) . Moreo-ver, rs-fMRI was conducted to assess functional connectivity between cortical regions and the ipsilesional primary mo-tor cortex ( M1) before and after the intervention. The laterality index ( LI) of the primary motor or sensory cortex was also calculated. Results After the intervention, the average FMA-UE and MBI scores of the experimental group had increased significantly. After MIT and conventional therapy there was increased functional connectivity between the ip-silesional and contralesional M1 areas, and between the ipsilesional M1 and contralesional primary sensory cortex ( S1) and frontal lobe, the functional connection between the ipsilesional M1 and the ipsilesional paracentral lobule and the anterior cingutate was also increased. More specifically, the LI relating M1 and S1 decreased after the inter-vention, tending toward the normal level. LIMI decreased significantly. Conclusion The 4-week regimen of motor imagery training and conventional therapy resulted in functional improvement in the upper limbs and greater ability in the activities of daily living. The observed improvements may be due to cortical reorganization, including better func-tional connectivity between the bilateral M1 areas and increased connectivity between the ipsilesional M1 area and some non-motor areas. There is some recovery of symmetry in the bilateral primary motor cortex.

Neonatal pain is a common phenomenon. For a long time neonatal pain had not been focus on properly and managed appropriately. American Academy of Pediatrics Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine published policy statement to emphasize the necessity of neonatal pain assessment,and summarize the neonatal operability pain assessment method,drug and non-drug control measures,also update prevention and management of procedural pain in the neonate in 2016. Until today the guideline for neonatal pain management has not yet been released in China. As the reference for clinicians in domestic,the content of policy statement will be reorganized and introduced.

Objective: To evaluate the predicting value of the 2014 European Society of Cardiology (ESC) guidelines risk prediction model for sudden cardiac death (HCM Risk-SCD) in Chinese patients with hypertrophic cardiomyopathy (HCM), and to explore the predictors of adverse cardiovascular events in Chinese HCM patients. Methods: The study population consisted of a consecutive 207 HCM patients admitted in our center from October 2014 to October 2016. All patients were followed up to March 2017. The 5-year SCD probability of each patient was estimated using HCM Risk-SCD model based on electrocardiogram, echocardiography and cardiac magnetic resonance (CMR) examination results. The primary, second, and composite endpoints were recorded. The primary endpoint included SCD and appropriate ICD therapy, identical to the HCM Risk-SCD endpoint. The second endpoint included acute myocardial infarction, hospitalization for heart failure, thrombus embolism and end-stage HCM. The composite endpoint was either the primary or the second endpoint. Patients were divided into the 3 categories according to 5-year SCD probability assessed by HCM Risk-SCD model: low risk group<4%,intermediate risk group ≥4% to<6%, and high risk group≥6%. Results: (1) Prevalence of endpoints: All 207 HCM patients completed the follow-up (350 (230, 547) days). During follow-up, 8 (3.86%) patients reached the primary endpoints (3 cases of SCD, 3 cases of survival after defibrillation, and 2 cases of appropriate ICD discharge); 21 (10.14%) patients reached the second endpoints (1 case of acute myocardial infarction, 16 cases of heart failure hospitalization, 2 cases of thromboembolism, and 2 cases of end-stage HCM). (2) Predicting value of HCM Risk-SCD model: Patients with primary endpoints had higher prevalence of syncope and intermediate-high risk of 5-year SCD, as compared to those without primary endpoints (both P<0.05). (3) Predicting value of HCM Risk-SCD model: The low risk group included 122 patients (59%), the intermediate risk group 42 (20%), and the high risk group 43 (21%). There was a clear trend towards to higher heart rate, higher values of PTF_V1 and plane QRS-T angle, higher left ventricular mass index (LVMI), elevated maximal left ventricular outflow tract pressure gradient (LVOT-PGmax), enlarged left atrial dimension(LAD) and volume index (LAVI), reduced systolic mitral annular velocity (s'), and higher late gadolinium enhancement (LGE) volume and mass in patients with high risk of 5-year of SCD, as compared to those with low-intermediate risk (all P<0.05). Moreover, 5-year SCD probability was positively correlated with heart rate, plane QRS-T angle, LVMI, LAVI, LGE%, and negatively correlated with s'(r=0.161, P=0.019; r=0.669, P=0.001; r=0.206, P=0.004; r=0.284, P=0.000; r=0.351, P=0.000; r= -0.245, P=0.001; respectively). (4) LAD, LAVI, e' and s' were independent predictors for poor outcomes. HCM patients with LAD≥39 mm, LAVI≥49.6 ml/m², e'≤6.5 cm/s and s'≤6.6 cm/s were more likely to have adverse cardiovascular events (AUC 0.702, 95%CI 0.604-0.799, P=0.001; AUC 0.700, 95%CI 0.567-0.833, P=0.001; AUC 0.716, 95%CI 0.616-0.817, P=0.000; AUC 0.764, 95%CI 0.676-0.853, P=0.000,respectively). Conclusions The HCM Risk-SCD model is of value in predicting SCD for Chinese HCM patients. The plane QRS-T angle and LGE% are the best predictors of 5-year SCD risk in Chinese HCM patients. Moreover, conventional echocardiographic parameters, including LAD, LAVI, e' and s', are useful to predict adverse cardiovascular events among Chinese HCM patients.

Objective To assess whether strain parameters derived from three-dimensional speckle tracking imaging ( 3D-STI) could identify improvement of cardiac function and predict response of patients with immunoglobulin light-chain cardiac amyloidosis ( AL-CA) following chemotherapy . Methods Totally 13 patients with AL-CA [aged (58 .5 ± 8 .9)years;69％ males] were treated with melphalan or bortezomib-based regimens and by regular chemotherapy for 6 months .The clinical data was collected . Maximal left ventricular wall thickness (MLVWT) ,left ventricular mass index (LVMI) ,left ventricular ejection fraction ( LVEF) ,systolic mitral annular velocity ( s′) ,early diastolic mitral annular velocity echocardiography ( e′) , 3D-STI global longitudinal ,circumferential ,radial and area strain (GLS ,GCS ,GRS ,and GAS) ,the standard deviation of time to peak longitudinal strain among 16 left ventricular segments ( TS-SD_GLS ) were obtained by conventional echocardiography and 3D-STI . In addition ,serologic biomarkers including N-terminal pro-brain natriuretic peptide ( NT-proBNP) and free light chains ( FLC) were acquired at baseline and 6 months after chemotherapy . These patients were divided into two groups according to difference of FLC :complete response (CR) group and Non-CR group . The clinical data ,cardiac ultrasound parameters and serological parameters were compared between groups ,each group parameters at baseline and 6 months after chemotherapy were compared within the group.Results ①There were no significant differencein conventional echocardiographic parameters ,GCS ,GRS and GAS ,as well as TS-SD_GLS in either group between before and after chemotherapy . But GLS was improved only in CR group ( P = 0 .036) ,and its improvement was correlated with the decrease in NT-proBNP ( r = -0 .738 , P = 0 .037) . ② In baseline evaluation ,patients in Non-CR group had increased LVMI ,deteriorated e′ and GLS ,and longer Ts-SD as compared to those in CR group ( all P < 0 .05 ) . ③ ROC analysis revealed that these parameters had discriminative ability to forecast those with better therapeutic effectiveness ,esecially for AL-CA patients with baseline LVMI<96 .55 g/m2 ,e′>4 .7 cm/s ,absolute value of GLS>16 .6％ ,and TS-SD_GLS<35 .2 ms ,which may have better hematologic response to chemotherapy . Conclusions GLS can identify early improvement of cardiac function in AL-CA patients after chemotherapy . Moreover ,LVMI ,e′,GLS and TS-SD_GLS are sensitive measurements of pre-treatment ventricular impairment ,and may predict better response to chemotherapy .

Acute gastroenteritis is a common illness in childhood that usually can be treated in the outpatient setting.Despite suggestion that acute gastroenteritis children with mild to moderate dehydration receive oral rehydration therapy as the main treatment,but there are still many children were given unnecessary tests and intravenous fluids.Children's National Medical Center,Washington,District of Columbia published practice guideline to clarify the basic principles of the evaluation and management of illness.The guideline for pediatric acute gastroenteritis management has not yet been released in China.As the reference for clinicians in domestic,the content of this practice guideline will be reorganized and introduced.

Bronchiolitis is a common lower respiratory tract viral infection in infants.Incidence of bronchiolitis is greatly increasing in recent years,and seriously affecting the health of children.In order to better manage bronchiolitis,American Academy of Pediatrics (AAP) convened a new subcommittee to review and revise the 2006 bronchiolitis guideline.This evidence-based guideline amended to provide new evidence of diagnosis,treatment and prevention bronchiolitis for the clinician.