Objective:To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China.Methods:This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis.Results:Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) ( Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS ( Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion:Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.

Esophageal squamous cell carcinoma (ESCC) is one of the leading causes of cancer death worldwide. It is urgent to develop new drugs to improve the prognosis of ESCC patients. Here, we found benzydamine, a locally acting non-steroidal anti-inflammatory drug, had potent cytotoxic effect on ESCC cells. Benzydamine could suppress ESCC proliferation in vivo and in vitro. In terms of mechanism, CDK2 was identified as a target of benzydamine by molecular docking, pull-down assay and in vitro kinase assay. Specifically, benzydamine inhibited the growth of ESCC cells by inhibiting CDK2 activity and affecting downstream phosphorylation of MCM2, c-Myc and Rb, resulting in cell cycle arrest. Our study illustrates that benzydamine inhibits the growth of ESCC cells by downregulating the CDK2 pathway.
Humans ; Benzydamine ; Esophageal Neoplasms/drug therapy* ; Esophageal Squamous Cell Carcinoma/drug therapy* ; Molecular Docking Simulation ; Phosphorylation ; Cell Proliferation ; Cell Line, Tumor ; Apoptosis ; Cyclin-Dependent Kinase 2

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

Objective To study the clinical efficacy and safety of double incision double plate internal fixation in the treatment of complex fractures of tibial plateau .Methods According to the different treatment methods , 83 patients with tibial plateau complex fractures were divided into double plate group ( 51 cases ) and locking plate group ( 32 cases ) .The surgical indicators , treatment efficacy and complications were compared between the two groups .Results The time of implantation ,hospital stay and fracture healing time in the observation group were signif-icantly shorter than those in the control group [(9.36 ±2.14) d vs.(13.24 ±2.99) d;(11.71 ±1.32) d vs. (13.41 ±2.23)d;(13.27 ±1.83)weeks vs.(15.82 ±2.18)weeks],the differences were statistically significant (t=6.813,4.368,5.736,all P<0.05).The excellent rates of HSS score in the observation group and the control group were 94.12％and 93.75％,respectively,and there was no statistically significant difference (χ2 =0.746,P>0.05).The incidence rate of complications in the observation group was significantly lower than that in the control group(5.88％vs.21.88％) (χ2 =4.746,P<0.05).Conclusion Double-incision plate internal fixation surgery for tibial plateau complex fractures is effective ,has fast postoperative recovery ,high safety,and it is worthy of clinical application in a wide range of popularization .

OBJECTIVETo investigate the association of serum folate level with the severity of white matter hyperintensity (WMH) and presence of cerebral microbleeds (CMB).

METHODSClinical data of WMH patients from the second affiliated Hospital, Zhejiang University school of Medicine during July 2011 and February 2016 were retrospectively reviewed. According to Fazekas score based on T2-Flair images, patients were classified into mild WMH (0-3) and severe WMH (4-6). The presence of CMB was assessed on susceptibility weighted imaging (SWI). Binary logistic analysis was conducted to identify the independent predictors for severe WMH and the presence of CMB.

RESULTSTwo hundred and twenty eight patients with WMH were included, among whom 149(65.35%)had severe WMH. In patients with high folate (≥ 15.68 nmol/L), low folate (6.8-15.67 nmol/L) and folate deficiency (<6.8 nmol/L), the proportions of severe WMH were 52.88%, 73.33% and 89.47%, respectively. Binary logistic regression analysis revealed that compared with high folate group, severe WMH was more common in groups with low folate (=2.109, 95%:1.112-4.001,<0.05) and folate deficiency (=6.383, 95%:1.168-34.866,<0.05). Eighty-eight(48.09%) of 183 patients receiving SWI scan presented with CMB. Although the subjects with CMB had lower serum folate level than those without CMB(13.42 vs 16.51 nmol/L,<0.01), binary logistic regression analysis did not reveal the independent association between serum folate level and the presence of CMB after adjusting for hyperhomocysteinemia (>0.05).

CONCLUSIONSLower serum folate level is independently associated with severe WMH, but not with the CMB concurrence.

ObjectiveTo investigate the etiology and prognosis of asymptomatic hematuria in children.MethodsThe etiological factors, clinical features and prognosis of asymptomatic hematuria were analyzed retrospectively in 431 children from Jan. 2001 to Dec . 2014. ResultsIn 431 children (197 males and 234 females) with asymptomatic hematuria, the mean age of ifrst visit was 5.52±2.77 years (8 months-17 years). Four hundred and twenty-ifve cases had persistent microscopic hematuria and 6 cases had gross hematuria. Three hundred and iffteen cases (73.1%) were glomerular hematuria, among which 286 cases were isolated hematuria, 5 cases were acute glomerulonephritis, 13 cases were minimal change glomerulopathy, 4 cases were IgA nephropathy, 4 cases were mesangial proliferation glomerulonephritis and 3 cases were thin basement membrane nephropathy. One hundred and thirty-six cases (31.5%) were non-glomerular hematuria, among whom 113 cases were left renal vein entrap-ment syndrome, 17 cases were idiopathic hypercalciuria, 4 cases were kidney stone, 1 case was urinary tract infection and 1 case was left kidney absence. The mean follow-up period was 3.05±2.69 years (0.5-13.5 years). One hundred and forty-ifve patients showed the resolution of microscopic hematuria, among whom 110 cases (75.8%) had the resolution in 3 years after the ifrst visit. In 24 cases with family history of hematuria, only 6 cases showed the resolution. At the end of the follow-up, renal function remained stable in all children.ConclusionsThe onset age of asymptomatic hematuria in children varies widely, and most of them are glomerular hematuria. Most children with isolated hematuria show resolution within three years after the ifrst visit. The children with familial hematuria may last longer. The isolated hematuria has good prognosis but needs to be followed up.

OBJECTIVETo estimate the cost-effectiveness of esophageal cancer endoscopic screening once-in-a-lifetime and to predict the optimal screening age for people in high-risk areas of rural China.

METHODSA Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long-term epidemiological effectiveness and cost-effectiveness were predicted by simulation of the model.

RESULTSCompared with the control group, strategies starting at 40, 45, 50 and 55 year-old had saved life-years of 629.51, 769.88, 738.98 and 533.21 years per 100 000 people, respectively, of which the strategy starting at 45 year-old saved the maximum life years. All strategies were cost-effective and starting at 40 year-old cost the most per life-year saved. Among all alternatives, strategies starting age at 45 year-old and 50 year-old were incremental cost-effective, and the incremental cost-effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively.

CONCLUSIONSThe strategy starting at 40 year-old implemented at present and other strategies were cost-effective in high-risk areas of rural China. However, the 45-year-old group is more aligned with the principle of cost-effectiveness. Considering the cost-effectiveness of different strategies and social economic status, 45 year-old is regarded as the optimal starting age of esophageal cancer once-in-a-lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year-old which could obtain better screening effects would be preferable in wealthy regions.

Adult ; Age Factors ; Case-Control Studies ; China ; Cost-Benefit Analysis ; Early Detection of Cancer ; Esophageal Neoplasms ; diagnosis ; Esophagoscopy ; economics ; Humans ; Markov Chains ; Middle Aged ; Rural Population

Objective To estimate the cost?effectiveness of esophageal cancer endoscopic screening once?in?a?lifetime and to predict the optimal screening age for people in high?risk areas of rural China. Methods A Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long?term epidemiological effectiveness and cost?effectiveness were predicted by simulation of the model. Results Compared with the control group, strategies starting at 40, 45, 50 and 55 year?old had saved life?years of 629. 51, 769. 88, 738.98 and 533. 21 years per 100 000 people, respectively, of which the strategy starting at 45 year?old saved the maximum life years. All strategies were cost?effective and starting at 40 year?old cost the most per life?year saved. Among all alternatives, strategies starting age at 45 year?old and 50 year?old were incremental cost?effective, and the incremental cost?effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively. Conclusions The strategy starting at 40 year?old implemented at present and other strategies were cost?effective in high?risk areas of rural China. However, the 45?year?old group is more aligned with the principle of cost?effectiveness. Considering the cost?effectiveness of different strategies and social economic status, 45 year?old is regarded as the optimal starting age of esophageal cancer once?in?a?lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year?old which could obtain better screening effects would be preferable in wealthy regions.

Objective To estimate the cost?effectiveness of esophageal cancer endoscopic screening once?in?a?lifetime and to predict the optimal screening age for people in high?risk areas of rural China. Methods A Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long?term epidemiological effectiveness and cost?effectiveness were predicted by simulation of the model. Results Compared with the control group, strategies starting at 40, 45, 50 and 55 year?old had saved life?years of 629. 51, 769. 88, 738.98 and 533. 21 years per 100 000 people, respectively, of which the strategy starting at 45 year?old saved the maximum life years. All strategies were cost?effective and starting at 40 year?old cost the most per life?year saved. Among all alternatives, strategies starting age at 45 year?old and 50 year?old were incremental cost?effective, and the incremental cost?effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively. Conclusions The strategy starting at 40 year?old implemented at present and other strategies were cost?effective in high?risk areas of rural China. However, the 45?year?old group is more aligned with the principle of cost?effectiveness. Considering the cost?effectiveness of different strategies and social economic status, 45 year?old is regarded as the optimal starting age of esophageal cancer once?in?a?lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year?old which could obtain better screening effects would be preferable in wealthy regions.

Objective To summarize the experience chest small incision closure of atrial septal defects treatment,evaluation of the efficacy and safety of operation.Methods Eight patients with secondary pore pathogenesy,atrial septum defect size 16-45 mm,take right next to the sternum surgery incision between 3 or 4 ribs 3-4 cm,in the cardiac ultrasound guided into occluder.Results All successful surgery,no postoperative shunt and abnormal,1 huge successful closure of atrial septal defect in 45mm.Conclusion After transcatheter closure of atrial septal defect with small incision in the chest,easy,small trauma,recover fast,safe and reliable.