The idiopathic inflammatory myopathies encompass a diverse array of autoimmune diseases,characterized by muscular inflammation and various extramuscular manifestations.These conditions have the poten-tial to impact multiple organs,including the lungs,skin,joints,gastrointestinal tract,and heart.The defining features of these conditions are muscle weakness and myalgia.Although cardiac involvement is infrequent,its clinical manifestations are subtle and easily overlooked.Cardiac damage represents a significant contributor to mortality and morbidity in patients with idiopathic inflammatory myopathy.Early and accurate identification of cardiac involve-ment may facilitate improved patient outcomes.This article provides an overview of the potential etiology,clinical presentations,risk factors,biomarkers,and imaging studies for early diagnosis of cardiac involvement in idio-pathic inflammatory myopathy.This review aims to enhance clinicians'understanding and diagnostic capabilities re-garding cardiac involvement in idiopathic inflammatory myopathy while promoting early intervention strategies for lifelong management and improved prognosis.

Objective:To explore the correlation between the expression level of the serum CircRNA_ 0005853 and cognitive impairment in elderly patients with acute cerebral infarction (ACI).Methods:A total of 120 elderly patients with ACI admitted to Haikou Third People′s Hospital from January 2019 to March 2022 were retrospectively selected. According to the Montreal Cognitive Assessment (MoCA) score of the patients 4 weeks after treatment, they were divided into a cognitive impairment free group (MoCA score≥26, 55 cases) and a cognitive impairment group (MoCA score<26, 65 cases). The cognitive impairment group was redivided into mild group (MoCA score 21-25, 16 cases), moderate group (MoCA score 15-20, 38 cases), and severe group (MoCA score<15, 11 cases) based on the severity of cognitive impairment. The serum CircRNA_0005853 expression level of each group was compared. multivariate logistic regression analysis was applied to identify the risk factors for cognitive impairment after ACI. A receiver operating characteristic (ROC) curve was drown to analyze the value of CircRNA_0005835 expression level in predicting cognitive impairment. Using Pearson correlation analysis, the correlation between the expression level serum CircRNA_0005835 and MoCA score in patients with cognitive impairment was analyzed.Results:There were statistically significant differences in age, infarct size, and triglycerides between the cognitive impairment group and the non cognitive impairment group (all P<0.05). The MoCA score of the cognitive impairment group was lower than that of the non cognitive impairment group [(19.62±2.73)points vs (28.10±1.05)points, P<0.001]. The expression level of Serum CircRNA_0005835 in the cognitive impairment group was higher than that of the non cognitive impairment group (2.48±1.02 vs 1.25±0.46, P<0.001), and in the severe group, the expression level of the serum CircRNA_0005835 (2.90±1.26) was higher than that of the moderate group (1.87±0.84) and the mild group (0.92±0.35) ( P<0.001). Multivariate logistic regression analysis shew that age ( OR=1.662, 95% CI: 1.140-2.873), infarct size>3.0 cm 2 ( OR=1.853, 95% CI: 1.317-4.112), and CircRNA_0005835 ( OR=2.217, 95% CI: 1.635-5.540) were risk factors for cognitive impairment after ACI. The area under the curve (AUC) of CircRNA_0005835 expression level predicting cognitive impairment was 0.837(95% CI: 0.779-0.894), with a sensitivity of 80.2% and a specificity of 83.7%. The AUC of CircRNA_0005835 expression level predicting cognitive impairment was 0.837(95% CI: 0.779-0.894), with a sensitivity of 80.2% and a specificity of 83.7%. The correlation analysis shew that the expression level of serum CircRNA_0005835 in elderly ACI patients was negatively correlated with MoCA score ( r=-0.773, P<0.001). Conclusions:The increased expression level of serum CircRNA_0005853 is related to the occurrence and development of cognitive dysfunction after elderly ACI, and has certain value in predicting cognitive dysfunction.

Objective:To analyze the clinical features of the recurrence of febrile seizures(FS), and observe the efficacy of levetiracetam(LEV)in preventing FS recurrence.Methods:We retrospectively analyzed the clinical data of 101 cases of FS recurrence who were admitted to the Department of Neurology of our hospital from May 2017 to May 2020, and collected the information of the recurrence after discharge and adverse effects of LEV application.Cox proportional hazards model regression was applied to explore the relationship between FS recurrence and LEV prophylaxis.Results:Among 101 cases of recurrent FS, the section of 18-60 months(63/101)composed the dominant proportion, of which the episode of 18-36 months(40/101)took the biggest recurrence rate.All 101 recurrent FS cases occurred within 24 hours of fever-beginning time, and 74.3%(75/101)occurred within 3 hours of fever onset.39.6% cases(40/101)were non-high febrile seizures, of which 30.0%(12/40)even had a temperature ≤38°C at the onset.Ninty-five cases of FS were included in the retrospective cohort study.Thirty-eight cases(4 lost to follow-up)were treated with LEV, while 57 cases(7 lost to follow-up)were not treated with any anticonvulsant drugs.The recurrence rate in the prophylactic group was 17.6%(6/34), compared with 44.0%(22/50)in the control group.The recurrence rate of the prophylactic group was statistically lower than that of the control group( χ2=6.325, P=0.012). Cox regression analysis was used to explore the relationship between FS recurrence and various factors, suggesting LEV prophylaxis( OR=0.325, 95% CI 0.129-0.821)and family history of FS( OR=3.060, 95% CI 1.427-6.560)affect the recurrence of FS.Then FS family history was stratified, LEV prophylaxis still statistically reduced the recurrence of FS( OR=0.316, 95% CI 0.124-0.802). Conclusion:The risk of recurrence increases significantly after 18 months of the age.Besides, FS recurrence is relatively common in the initial episode of fever and in the stage of low fever.For children at months of high probability of recurrence, prophylactic drugs should be used in the initial episode of fever and in the stage of low fever.LEV prophylaxis therapy is effective, with mild adverse reactions.

Objective:To investigate the clinical features of Herpes simplex virus encephalitis(HSE) with cerebral hematoma as the prominent manifestation and the significanc of metagenomic next-generation sequencing (mNGS) in the diagnosis of HSE.Methods:The clinical manifestations, diagnostic process, clinical treatment and prognosis of a case of HSE with cerebral hematoma as the prominent manifestation at Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine in June 2019 were retrospectively analyzed.The relevant literatures were also searched and reviewed.Results:A 4-year-old boy presented with slight fever, headache, convulsion and vomiting was considered to have intracranial space-occupying lesions and possible intratumoral hemorrhage after undergoing imaging examination at a local hospital.The patient was checked by head CT in Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, which showed that there were many bleeding foci in the brain, indicating the possibility of complications of blood system diseases.Therefor the child was given the examination of blood routine and coagulation routine, but the results were normal, the bone marrow cytology was negative, the cerebrospinal fluid(CSF) of lumbar puncture was biochemically normal, and mNGS were 8×10 6/L.Besides, CSF smear, culture and next-generation sequencing were negative, the autoimmune encephalitis CSF testing was negative, and brain biopsy suggested inflammation.The mNGS brain tissue showed herpes simplex virus 1 was positive in two specimens, confirming the diagnosis of HSE.After 3 weeks of antiviral treatment with Aciclovir, the child′s condition improved.After a 5-month follow-up, the patient had quadriplegia and only had activities such as blinking and swallowing. Conclusions:When the intracerebral hemorrhage such as hematoma caused by encephalitis clinically can not be ruled out, the possibility of HSE should be considered, and mNGS is helpful for identifying the central ner-vous system pathogen.

Objective To summarize the efficacy and adverse reactions of incremental corticotrophin (ACTH) therapy in the treatment of infantile spasms (IS),and to provide new clinical treatment options.Methods The clinical data of 40 children with IS who were hospitalized in the Department of Neurology,Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine,treated with ACTH from January 2016 to January 2018 were collected and retrospectively analyzed.All the children were treated with intravenous infusion of ACTH with an initial dose 12.5 U/d for 3 days.If the spasms did not disappear,dosage of ACTH increased to 25.0 U/d for another 3 days.If the spasms could not yet be fully controlled,the dosage increased to 40.0 U/d,and the total course of treatment did not exceed 2 weeks.If the spasms disappeared at each dose stage or the course of treatment reached to 2 weeks,ACTH would be changed to Prednisone 2 mg/(kg · d) orally,which gradually decreased in 2 months.All children underwent electroencephalogram examination before and after treatment.Results Forty patients with IS were treated with ACTH increasing therapy.The disappearance rate of spasms was 40.0％ (16/40 cases) totally,with 7.5％ (3/40 cases) at the dosage phase of 12.5 U/d,16.2％ (6/37 cases) at the dosage stage of 25.0 U/d,and 22.6％ (7/31 cases) at the dosage of 40.0 U/d.The disappearance rate of hypsarrhythmia on electroencephalogram was 60.0％ (24/40 cases) generally,and 5.0％ (2/40 cases),10.8％ (4/37 cases),58.1％ (18/31 cases),respectively at above different dosage phases,while 37.5％ (15/40 cases) of the children had mild adverse reactions,mostly respiratory infections.Conclusions The short-term efficacy of the ACTH incremental therapy in the treatment of IS is positive,and the incidence of adverse reactions is low.

Objective·To compare the clinical features between different subtype bipolar patients with first mania episode, and to contribute to early identification of bipolar disorder. Methods·This study was based on the database named as National Bipolar Mania Pathway Survey (BIPAS). From November 2012 to January 2013, bipolar patients from 26 mental health facilities in China were enrolled in current study. The clinical features were compared between mania patients of different subtypes, including hypomania (groupⅠ), mania without psychotic symptoms (groupⅡ), mania with psychotic symptoms (group Ⅲ) and mixed state (group Ⅳ). Results·There was significant difference in the percentage of clinical symptoms between different subtype bipolar patients with first mania episode, especially the mania and anxiety related symptoms. Group Ⅰ, Ⅲ , Ⅳ were further compared with groupⅡ, which was considered as the typical bipolar disorder. The results showed that the mania related symptoms was significantly higher in group Ⅱ, but anxiety related symptoms was significantly higher in group Ⅰ, Ⅲ, Ⅳ. Moreover, Logistic regression analysis revealed that more eloquent or humor and unusually restless could be in favor of the diagnosis of hypomania; younger and mania or hypomania as first episode might be in favor of the diagnosis of mania with psychotic symptoms; older, national minorities and unusually restless could be in favor of the diagnosis of mixed state. Conclusion·The clinical features between different subtype bipolar patients with first mania episode are various, and analysis of the clinical features can contribute to early identification of bipolar disorder.

Objective: To explore the application of real-time three-dimensional ultrasound in locating the course, the brand and the blind end of internal opening of congenital preauricular fistula. Methods: Congenital preauricular fistula patients from Changhai Hospital were studied. All the cases were evaluated using two-dimensional and three-dimensional ultrasound before surgeries. The surgery findings were utilized as the gold standard. The imaging features of 3D ultrasound were described to determine the accuracy of the blind end location, the course of the main fistula tract and the branch tracts. The diagnosis was compared with the surgery findings. Results: In 89 cases, among which there were 21 branch fistulae. There were 68 bend fistulae without branch. The diagnostic accuracy of both two-dimensional ultrasound and three-dimensional ultrasound was 100%. The accuracy in locating the blind end of internal opening, the course of the branch tracts with 3D ultrasound was 92.1%(82/89), 85.7%(18/21) , compared to 80.9%(72/89), 57.1%(12/21) with 2D ultrasound. It was obvious that 3D ultrasound had more advantages. These differences were statistically significant (χ²=4.8, P<0.05; χ²=4.2, P<0.05). Conclusions Compared with 2D ultrasound, 3D ultrasound can accurately locate the blind end of internal opening, the course, and the branch of preauricular fistula, clearly display the morphology and the spatial structure of preauricular fistulaand its surroundings. It has high clinical application value in preoperative imaging examination.

Rapid on- site evaluation (ROSE) had gradually become an essential tool in interventional section, especially in pulmonary diseases. People were no longer limited to routine endoscopic operation. ROSE combined with fine-needle aspiration (FNA) enhanced the diagnostic efficiency and diagnostic accuracy of routine bronchoscopes, endobronchial ultrasound- guided transbronchial needle aspiration (EBUS-TBNA) and percutaneous lung biopsy. ROSE can read out the specimen on site , give preliminary diagnosis, and provide help for next operation. The ROSE included cytological ROSE (C-ROSE) and microbiological ROSE (M-ROSE). Now in clinic, C-ROSE was used more broadly. C-ROSE expanded the check range of routine endoscopic operation, and it had been proven to be safe and useful tools.

Objective To investigate the drug use in the pediatric outpatient department of Ningbo Women & Children′s Hospital ,summarize the existing problems and analyze the causes in order to ensure the safety and effectiveness of the drug use .Methods A total of 9 000 prescriptions were randomly sampled from January to December 2015 for the statistical analysis of the drug use ,the amount of money spent on the drugs and the number of irrational prescriptions at the pediatric outpatient department in our hospital .Results Based on the amount of money spent ,the four most commonly used drugs were Chinese traditional drugs ,anti-infective ,respiratory and digestive system drugs .A total of 122 electronic prescriptions were considered as irrational drug use (1 .34% ) which include improper administration method ,wrong dosage or indications ,computer input errors ,etc .Conclusion Overall ,the drug use is appropriate at the pediatric outpatient department in our hospital .The Chinese traditional drugs are the most commonly used medications .However ,clinical doctors and pharmacists still need the comprehen-sive trainings to promote the rational drug use ,which could reduce unnecessary disputes between patients and doctors .

Objective To investigate the effect of chronotherapy (chemotherapy plus timely medication) on neutrophils in breast cancer patients with neoadjuvant chemotherapy.Methods Fifty breast cancer patients with neoadjuvant chemotherapy were selected from 2011 to 2014 and divided into chronotherapy group and conventional treatment group (conventional group) by random number table method with 25 cases each.Conventional group received conventional neoadjuvant chemotherapy and conventional drug treatment.Chronotherapy group received neoadjuvant chemotherapy combined with chronochemotherapy and timely medication treatment,and applied clinical nursing care pathway.Both groups were conducted three cycles of chemotherapy,three weeks after the first and the second chemotherapy,the results of routine blood and liver function were compared in patients between two groups.The number of readmission and fever because of agranulocytosis were calculated.Results The two groups of patients were successfully completed three cycles of chemotherapy,after the first cycle of chemotherapy,the neutrophil was (4.40 ± 2.20)x109/L in chronotherapy group,and (3.18 ± 1.35) × 109/L in conventional group;after the second cycle of chemotherapy,the neutrophil was (3.95 ± 1.58) × 109/L,and (2.83 ± 1.49) x 109/L in conventional group,the two groups were statistically significant,t=2.375,2.563,P ＜0.05.Two cases needed readmission in chronotherapy group during chemotherapy,accounting for 8％(2/25),much lower than conventional group of 8 cases accounting for 32％(8/25).Conclusions The use of chronotherapy in breast cancer chemotherapy has less neutropenia,mild side effects of bone marrow suppression.It is an effective and safe viable option.