Malignant tumors in children are one of the most important diseases that threaten the health and quality of life of children and are the second most common cause of death in children.With the continuous improvement and progress of treatment technology, the long-term survival rate of children with tumor has been significantly improved, but both the disease itself and the treatment can impair the immune function of children, which makes them vulnerable to various infectious diseases and secondary serious complications, and even become a source of infection, endangering the health of others. Vaccination is the most cost-effective measure to prevent infectious diseases. For children with normal immune functions, the benefits of vaccination usually outweigh the disadvantages. However, there is a lack of detailed data on the vaccination situation, efficacy and safety of vaccine use for such immunocompromised tumor survivors, and there are no authoritative and uniform vaccination recommendations. This article reviewed and summarized the literature and consensus of some domestic and foreign scholars on current status of post-treatment vaccination status, efficacy and safety of vaccination for children with tumors after treatment, with the aim of providing a reference for the practice in this field in China.

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.

Osteoporotic fracture is the most major complication of osteoporosis. It is a significant global public health problem which continues to bring serious family and social burden. In order to improve the prevention and treatment of osteoporotic fractures， many countries have carried out new ways of fracture prevention and management， and achieved some results. Prevention mainly aims at those at high risk of fracture， and includes new health education on fracture and the promotion of fall prevention measures. For management， the "Fracture liaison services" mode is mainly applied to the fracture patients， with refined patient management to deal with the fractures that have occurred. This article summarizes the global prevalence of osteoporotic fractures， risk factors， and the current research progress in fracture prevention and management in China and the West.

Objective: To investigate the effects of hepatobiliary metabolie dysfunction on gut microbiota in rats with intrahepatic cholestasis of pregnancy (ICP). Methods: Forty Sprauge-Dawley(SD) rats at 10 days of gestation were randomly divided into two groups,25 for ICP induction and 15 as control. Estradiol benzoate, combined with progesterone, was given to the rats by intraperitoneal injjection from 10 to 14 days after gestation. Hepatic impairment indicators of total bilirubin(TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST),-glutamyl transferase ( GGT), alkaline phosphatase(AL.P), and total bile acids (TBA) in sera of the animals were detected in each group to verify the model construction. Simultaneously, the liver tissues were subjected to pathology examination and fresh faeces samples were collected for 16S rDNA sequencing to explore the gut microbiota profiles. Results: The serum levels of TBIL,ALT,AST,GGT,ALP and TBA in ICP group were significantly elevated compared with the control (P<0. 05 );the ICP rats presented obvious characteristics of hepatobiliary disorders, showing prominent steatosis, necrosis of hepatocytes and infiltration of inflammatory cells, with formation of bile thrombus in some animals. The abundance of Eubacterium, Bacteroides, Parabacteroides distasonis and Bacteroides uniformis remarkably decreased wereas Prevotela and Fusobacterium significantly increased in ICP rats when compared with the control (P<0.05). Conclusion The hepatic injuries and bile acid metabolic disorders occurred in ICP rats,which resulted in dysbiosis of gut microbiota.

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.

Objective:To investigate the influence of long non-coding RNA-CRNDE in stem cell properties and their mechanism in glioma.Methods:The CD133 +U251 stem cells (U251s) were isolated from human glioma cell line U251 by immunomagnetic beads. Cells were divided into U251s group, U251s-CRNDE group, U251 group, and U251-CRNDE group; CRNDE shRNA lentiviral vectors were transfected into cells in the U251s-CRNDE group and U251-CRNDE group to down-regulate the CRNDE expression. The CRNDE mRNA expression was detected by real-time fluorescent quantitative PCR (RT-qPCR); CCK-8 assay was used to detect the cell viability; Transwell assay was used to detect the cell invasion; wound healing method was used to detect the cell migration; plate cloning assay was employed to detect the clone formation; flow cytometry was used to detect the cell cycles; Western blotting was used to detect the expressions of A2B5, CD133, nestin, Sox2, Oct-4 and Nanog, as well as phosphatidylinositol kinase (PI3K)-protein kinase B (AKT)-mammalian target of rapamycin (mTOR) signal pathway key proteins (PI3K, AKT, phosphorylated-AKT, and mTOR). Results:The CRNDE mRNA expression in U251s group was significantly higher than that in U251 group ( P<0.05). As compared with U251s group, U251s-CRNDE group had significantly decreased cell viability, cell invasion and cell migration, statistically smaller number of cell colony, significantly decreased proportion of cells in G2/M phase, significantly increased proportion of cells in G1/G0 phase ( P<0.05); and the same trend was noted between U251 group and U251-CRNDE group. As compared with U251s group, U251s-CRNDE group had significantly decreased expressions of CD133, nestin, Sox2, Oct-4, PI3K, AKT, phosphorylated-AKT, and mTOR ( P<0.05). Conclusion:The CRNDE expression is increased in glioma stem cells, and down-regulation of CRNDE expression can inhibit the differentiation, metabolism and proliferation of glioma stem cells; and this effect is related to the regulation of PI3K-AKT-mTOR signaling pathway.

To examine the feasibility of using a computer tool for stratifying the severity of Coronavirus Disease 2019 (COVID-19) based on computed tomography (CT) images. We retrospectively examined 44 confirmed COVID-19 cases. All cases were evaluated separately by radiologists (visually) and through an in-house computer software. The degree of lesions was visually scored by the radiologist, as follows, for each of the 5 lung lobes:0, no lesion present;1,<1/3 involvement;2,>1/3 and<2/3 involvement;and 3,>2/3 involvement. Lesion density was assessed based on the proportion of ground-glass opacity (GGO), consolidation and fibrosis of the lesions. The parameters obtained using the computer tool included lung volume (mL), lesion volume (mL), lesion percentage (％), and mean lesion density (HU) of the whole lung, right lung, left lung, and each lobe. The scores obtained by the radiologists and quantitative results generated by the computer software were tested for correlation. A Chi-square test was used to test the consistency of radiologist- and computer-derived lesion percentage in the right/left lung, upper/lower lobe, and each of the 5 lobes. The results showed a strong to moderate correlation between lesion percentage scores obtained by radiologists and the computer software (r ranged from 0.7679 to 0.8373, P < 0.05), and a moderate correlation between the proportion of GGO and mean lesion density (r=-0.5894, P<0.05), and proportion of consolidation and mean lesion density (r=0.6282, P<0.05). Computer-aided quantification showed a statistical significant higher lesion percentage for lower lobes than that assessed by the radiologists (x2 = 8.160, P = 0.004). Our experiments demonstrated that the computer tool could reliably and accurately assess the severity and distribution of pneumonia on CT scans.

Objective:To explore the correlation of serum neurogenic exosome MicroRNA-211-5p(miR-211-5p)levels and brain derived neurotrophic factor(BDNF)levels with cognitive impairment in patients with Parkinson's disease and their diagnostic value.Methods:A total of 80 patients with Parkinson's disease(PD)admitted to the Second Hospital of Jiaxing City from January 2017 to April 2018 were enrolled.According to the Montreal cognitive assessment scale, patients were divided into the cognitive impairment group(n=36)and the non-cognitive impairment group(n=44). Meanwhile, 30 healthy people who took health check-ups during the same period were selected as the control group.Exosomes were extracted from peripheral blood of subjects by using the ExoQuick kit, and the neurogenic exosomes were separated by an L1 cell adhesion molecule(L1CAM)biotinylated antibody.BDNF levels in the exosomes were measured with an enzyme-linked immunosorbent assay(ELISA), and the expression level of miR-211-5p in the exosome was determined by real-time fluorescence quantitative PCR(RT-QPCR).Results:There was a correlation between BDNF and miR-211-5p( r=-0.805, P<0.001)in serum neurogenic exosomes( r=-0.805, P<0.001). BDNF was correlated with miR-211-5p in both the PD and control groups( r=-0.785 and-0.867, P=0.002 and 0.001). The miR-211-5p level was higher and the BDNF level was lower in the PD group than in the control group(0.30±0.08 vs. 0.17±0.04, 0.55±0.06 mg/L vs. 0.75±0.06 mg/L, t=7.125 and 6.368, P=0.000 and 0.000). The BDNF level was lower(0.45±0.07 mg/L vs.0.63±0.07 6.368 and 0.75±0.08 mg/L, t=8.999 and 7.608, P=0.000 and 0.000)and the MiR-211-5p level was higher(0.36±0.07 vs. 0.24±0.05 and 0.17±0.04, t=10.923 and 7.520, P=0.000 and 0.000)in the cognitive impairment group than in the non-cognitive impairment and control groups.The receiver-operating characteristics(ROC)curve showed that the area under the curve of miR-211-5p as a measure for cognitive impairment in Parkinson's disease was 0.860(95% CI: 0.770-0.950)with a threshold of 0.32.The area under the curve of BDNF as a measure for cognitive impairment in Parkinson's disease was 0.891(95% CI: 0.822-0.961)with a threshold of 0.67.BDNF seemed to be the target gene of miR-211-5p, since the latter could inhibit BDNF expression by reducing BDNF mRNA levels. Conclusions:Human serum neurogenic exosome miR-211-5p is highly expressed in PD patients with cognitive impairment and has the potential to be used as one of diagnostic parameters for cognitive impairment in PD patients.The high expression of serum neurogenic exosome miR-211-5p may be related to the inhibition of BDNF by reducing its mRNA levels.

AIM: To investigate the clinical features of Axenfeld-Rieger syndrome associated with secondary glaucoma and its surgical treatment.

METHODS: It was a retrospective case series study. The general clinical data and related ocular manifestations in 15 patients(26 eyes)with Axenfeld-Rieger syndrome associated with secondary glaucoma in our hospital from January 2003 to January 2016 were collected and analyzed retrospectively.

RESULTS: Age of the patients ranged from 3-month to 43 years old, and the median age was 11 years old. There were of all 11 patients(73%)had bilateral glaucoma and 4(27%)had unilateral glaucoma. In the aspect of clinical features, hypoplasia or deficiency of the iris was found in 20 eyes(77%), peripheral iridocorneal adhesions was found in 17 eyes(65%)in various extent, and pupil distortion or multiple-pupil was found in 14 eyes(54%); Also posterior embryotoxon was found in 14 eyes(54%)as well; And 11 eyes(42%)had anomalies in corneal size. That root of iris is located at a more anterior position than that of a normal eye was found in all affected eyes by gonioscopy, coupled with different extent of angle synechiae-closure. According to the data, in 15 patients only two had a family history of ARS, while 5 had systematic abnormalities, eyes excepted, in dental, maxillary, cardiovascular, et al. Anti-glaucoma surgeries including trabeculotomy, trabeculectomy, glaucoma valve implantation were performed in 20 eyes. Nine patients(11 eyes)were followed up for 59mo on average. Intraocular pressure was significantly lower than pre-operation(t=2.4185, P=0.0362), and intraocular pressure in 7 followed-up eyes was controlled ≤21mmHg. The long-term success rate of surgery was 64%.

CONCLUSION: The clinical features of Axenfeld-Rieger syndrome associated with secondary glaucoma were diverse. The patients might concomitant with other systematic dysplasia. Although it was tough to treat, surgery for glaucoma could reduce the intraocular pressure effectively.

Objective:To analyse the long-term efficacy in childhood T-cell acute lymphoblastic leukemia (T-ALL) cases enrolled in the national protocol of childhood leukemia in China-acute lymphoblastic leukemia (NPCLC-ALL) 2008.Methods:Clinical data of 96 patients diagnosed as T-ALL and treated with NPCLC-ALL2008 protocol between January 2009 and December 2017 in the Department of Hematology-Oncology, the Children′s Hospital, Zhejiang University School of Medicine were analyzed retrospectively. Predictive value of minimal residual disease (MRD) monitored by flow cytometry was analyzed. Kaplan-Meier method was used for long-term survival analysis.Results:A total of 96 evaluable patients with newly diagnosed T-ALL were analysed, including 72 males and 24 females. The age was 9.5 (ranged from 1.0 to 16.0) years. The follow-up time was 5.7 (ranged from 1.0 to 9.7) years. Among 96 patients, 92 (96%) achieved complete remission. The 5-year event free survival (EFS) and overall survival (OS) rates were (61±6) % and (70±5) %, respectively. Relapse occurred in 18 cases and the 5-year cumulative incidence of relapse was (27±6) %. Twenty-four patients died. The 5-year OS rates of patients with MRD>5% on day 15 of induction therapy was significantly worse than those with MRD≤5% ((60±12) % vs. (72±6) %, χ 2=3.904, P=0.048) . The 5-year EFS and OS rates were obviously lower in patients with MRD>10% before the consolidation therapy ((50±35) %). The 5-year OS rates of patients with relapsed disease was significantly worse than those without ((26±13) % vs. (81±5) %, χ 2=18.411, P<0.01). The earlier the relapse, the worse the prognosis. The 5-year OS rates for patients relapsed within 6 months, within 3 years and more than 3 years, were (25±22) %, (30±14) % and (50±35) % respectively (χ 2=13.207, P<0.01). Conclusions:NPCLC-ALL2008 protocol is effective for childhood T-ALL. The MRD guided accurate risk stratification and individualized treatment can reduce the relapse and improve the survival rate of pediatric T-ALL.