Objective To investigate the clinical characteristics and risk factors of the occurrence of hypoxic hepatitis(HH)in children with shock.Methods Clinical data(general situation,clinical situation and prognosis)of 234 children with different types of shock admitted to the pediatrics department of Hainan Women and Children's Medical Center from January 2016 to December 2023 were collected.Serum biochemical indexes on day 1(d1),day 2(d2),day 3(d3),day 5(d5),day 7(d7)of children with shock were collected,including serum alanine aminotransferase(ALT),glutamate aminotransferase(AST),lactate dehydrogenase(LDH),alkaline phosphatase(ALP),albumin(ALB),total bilirubin(TBIL),urea nitrogen(BUN),C reactive protein(CRP),international standardized time(INR)and lactate.And the clinical characteristics and risk factors of the occurrence of HH in children with shock were analyzed.Results A total of 234 cases(150 cases of males)of different types of shock in children were enrolled,ages ranged from 1 month to 16 years old.According to whether developed HH,the children with shock were divided into HH group(32 cases)and non-HH group(202 cases).The total incidence of HH was 13.7%(32/234).Septic shock was the main disease of the occurrence of HH in children with shock,accounting for 65.63%(21/32).According to the prognosis,children with shock combined HH were divided into survival group(17 cases)and death group(15 cases).The case fatality rate of children with shock combined HH was 46.9%.The ALT and AST values in children with shock combined HH were more than 20 times of the upper limits of normal ranges.The peak values of enzymatic indexes in the survival group appeared at the onset time d 1 to d 2,they were close to the normal ranges at the onset time d7,while the enzymatic indexes in the death group were higher than the normal ranges during the whole disease stage.Compared with the survival group,the peak values of ALT,AST,ALP,TBIL,CRP,BUN,and INR in the death group were obviously higher(P<0.05,both).The lowest value of ALB in the death group was lower than that in the survival group(P<0.05).The results of multivariate Logistic regression analysis showed that pediatric critical illness score(PCIS),lactate,multiple organ dysfunction syndrome(MODS),decompensated shock and cardiogenic shock were the risk factors for the occurrence of HH in children with shock(P<0.05 or 0.01),and left ventricular ejection fraction(LVEF)and mean arterial pressure(MAP)were the risk factors of the death of HH in children with shock(P<0.01).Conclusions Children with shock who have the risk factors as decreased PCIS,increased lactate level,MODS,decompensated shock and cardiogenic shock are apt to suffer from HH.Poor prognosis in the chil-dren with shock combined HH is associated with worse condition and lower LVEF.There is a high fatality rate of shock combined HH in children,so that liver function indicators should be closely monitored to early detect HH,and reasonable treatment should be given.

Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease characterized by progressive lung fibrogenesis and histological features of usual interstitial pneumonia. IPF has a poor prognosis and presents a spectrum of disease courses ranging from slow evolving disease to rapid deterioration; thus, a differential diagnosis remains challenging. Several biomarkers have been identified to achieve a differential diagnosis; however, comprehensive reviews are lacking. This review summarizes over 100 biomarkers which can be divided into six categories according to their functions: differentially expressed biomarkers in the IPF compared to healthy controls; biomarkers distinguishing IPF from other types of interstitial lung disease; biomarkers differentiating acute exacerbation of IPF from stable disease; biomarkers predicting disease progression; biomarkers related to disease severity; and biomarkers related to treatment. Specimen used for the diagnosis of IPF included serum, bronchoalveolar lavage fluid, lung tissue, and sputum. IPF-specific biomarkers are of great clinical value for the differential diagnosis of IPF. Currently, the physiological measurements used to evaluate the occurrence of acute exacerbation, disease progression, and disease severity have limitations. Combining physiological measurements with biomarkers may increase the accuracy and sensitivity of diagnosis and disease evaluation of IPF. Most biomarkers described in this review are not routinely used in clinical practice. Future large-scale multicenter studies are required to design and validate suitable biomarker panels that have diagnostic utility for IPF.
Humans ; Idiopathic Pulmonary Fibrosis/diagnosis* ; Biomarkers ; Lung Diseases, Interstitial ; Lung ; Bronchoalveolar Lavage Fluid ; Disease Progression ; Prognosis

Hemorrhage/etiology* ; Humans ; Image-Guided Biopsy ; Lung/diagnostic imaging* ; Lung Diseases/etiology* ; Lung Neoplasms ; Retrospective Studies ; Risk Factors ; Ultrasonography, Interventional

Objective To explore the value of MRI in differential diagnosis of primary central nervous system lymphoma (PCNSL) and high grade glioma (HGG) in deep brain.Methods Features of routine MRI and DWI of 28 PCNSL (PCNSL group) and 30 HGG patients (HGG group) with single lesion in deep brain confirmed clinically and pathologically were analyzed,then apparent diffusion coefficient (ADC) and relative ADC (rADC) were measured.The optimal diagnostic threshold (OT) and diagnostic performance of ADC and rADC values were calculated according to the ROC curve.Results The incidence of capsule,necrosis,hemorrhage,enhancement heterogeneity and DWI signal strength were significantly different between the two groups (all P＜0.05).ADC values were statistically different between lesions and the control side of the brain white matter in PCNSL and HGG patients (both P＜0.001).ADC values and rADC values of PCNSL lesions were significantly lower than those of HGG lesions (all P＜0.001).Taking ADC=0.86 × 10-3 mm2/s as a threshold,the sensitivity,specificity and accuracy in differential diagnosis of PCNSL and HGG was 92.9％,80.0％ and 86.2％,respectively,and the area under curve was 0.946 (P＜ 0.001).Taking rADC =1.02 as a threshold,the sensitivity,specificity and accuracy in differential diagnosis of PCNSL and HGG was 92.9％,86.7％ and 89.7％,respectively,and the area under curve was 0.957 (P＜0.001).Conclusion MRI differential diagnosis can provide reliable information for clinical treatment of PCNSL and HGG in deep brain.

Objective: To detect the single nucleotide polymorphism (SNP) at locus 1 165 of β1-adrenoceptor (β1-AR) and to investigate the association between the SNP and the infection by enterovirus A71(EV-A71). Methods: Polymerase chain reaction (PCR) amplification technique was used to detect the SNP at locus 1 165 of β1-AR between hand, foot and mouth disease (HFMD) and healthy controls by sanger sequencing method . Results: There was a G1165C SNP and three kinds of genotypes (GG, GC, CC) in β1-AR gene in the 77 cases of EV-A71 HFMD patients and 66 cases of healthy controls. For HFMD patients, frequencies of GG, GC and CC genotypes of the G1165C locus were 10%, 47% and 43%, respectively, and alleles frequency of G and C were 34% and 66%, respectively. But in healthy children, GG, GC, CC genotype frequencies were 7%, 41% and 52%, respectively, and G and C allele frequencies were 28% and 72% respectively. Chi-square analysis showed that there were no significant differences in distribution of genotypes (χ²=1.154, df=2, P=0.562) and alleles frequency (χ²=1.091, df=2, P=0.296) between the EV-A71-infected group and the healthy control group. Between mild and severe EV-A71-infected group, there were no significant differences in distribution of genotypes (χ²=3.945, df=2, P=0.139) and alleles frequency (χ²=3.763, df=2, P=0.052). Conclusions The 1 165 SNP in the coding region of β1-AR was not associated with EV-A71 infection and its severity.

Objective To analyze the epidemiological characteristics of Mycoplasma pneumoniae(MP)infection in children with acute respiratory tract infection in Haikou area and surrounding area to provide a scientific evidence for the prevention and treatment of MP infection in children.Methods A total of 1 699 children inpatients with acute respiratory tract infection in our hospital from 1 January to 1 December,2014 were collected.The serum MP antibody was detected.The MP infection status of different sites,genders,ages and months was retrospectively analyzed.Results Among 1 699 children patients with acute respiratory tract infection,the total positive rate of MP infection was 17.60％,in which male was 15.73％ and female was 21.59％,the positive rate of female was higher than that of male with statistical difference(P＜0.01).The lower respiratory infection rate was 18.75％ and upper respiratory tract infection was 13.70％,the difference was statistically significant(P＜0.05).The MP infection rates was common in children aged >1-4 years old,in which children aged >3-4 years old had the highest infection rate.MP infection was sporadic in the whole year and was highly epidemic in March and April.Conclusion MP was an important pathogen of acute respiratory tract infection for children in Haikou during 2014,and its epidemic characteristics were manifested by higher incidence in female than that in male.Children aged within 4 years old are a high onset group and MP infection occurs all year round,March and April are the relatively high onset period of MP infecting.

ObjectiveTo evaluate the efficacy of sphenopalatine ganglion stimulation with acupuncture for moderate-to-severe perennial allergic rhinitis.MethodsA total of 50 patients were recruited into a sphenopalatine ganglion stimulation group and a routine acupuncture group according to order of presentation, with 25 in each group. The sphenopalatine ganglion stimulation group received sphenopalatine ganglion stimulation with filiform needle, 1-2 sessions/week for 4 weeks. The routine acupuncture group received traditional acupuncture, withyingxiang(LI 20),yintang(GV29),fengchi(GB20),fengfu(GB16),zusanli(ST36) as the maln points, andyingxiang(LI 20),yintang(GV29),fengchi(GB20),fengfu(GB16),zusanli(ST36) as the adjunct points, 1-2 points from both the maln and adjunct points in each session, 2 sessions/week for 4 weeks. The nasal symptom score (2004 version), the total nasal symptom score (TNSS) and the total non-nasal symptom score (TNNSS) were used to evaluate symptom improvement. The Rhinoconjunctivitis Quality of Life Questionnalre (RQLQ) was used to assess the patients’ quality of life. The time to symptom alleviation, duration of symptom alleviation in every session and the recurrence duration during 1 month after the treatment were compared between the two groups.Results After the treatment, the score of the nasal symptom score (99.74 ± 31.89vs.196.83 ± 31.22;t=-4.912,P=0.001), TNSS (33.63 ± 12.37vs.71.82 ± 19.21;t=-3.463,P=0.003), TNNSS (33.63 ± 12.37vs.71.82 ± 19.21,t=-3.463,P=0.003) in the sphenopalatine ganglion stimulation were significant lower than those in the routine acupuncture group. Compared with the routine acupuncture group, the time to symptom alleviation was significant shorter (13.85 ± 4.21 minvs.45.63 ± 7.87 min;t=-1.763,P=0.008), while the duration of symptom alleviation was significant longer (37.92 ± 9.94 hvs.3.35 ± 1.23 h;t=7.637,P<0.01) after each session in the sphenopalatine ganglion stimulation group. Four weeks after the treatment, RQLQ score in the sphenopalatine ganglion stimulation group was significant lower than that in the routine acupuncture group (8.48 ± 3.71vs.37.68 ± 12.46;F=-7.312,P<0.01). The recurrence duration during 1 month after the treatment in the sphenopalatine ganglion stimulation group was significant longer than that in the routine acupuncture group (4.12 ± 2.15 dvs.23.53 ± 4.63 d;t=-8.879,P=0.003).ConclusionSphenopalatine Ganglion stimulation is superior to routine acupuncture in treatment of patients with moderate-to-severe perennial allergic rhinitis.

Objective To investigate the relationship of programmed cell death 4(PDCD4) with the invasion of astrocytic glio-mas .Methods Using the immunohistochemical method to detect the expression of PDCD4 in astrocytic gliomas in different grades . Measuring the peritumoral low-density area on MRI scan ,then compared with the results of immunohistochemical expression .Re-sults The downregulation of PDCD4 was with the increasing of the malignant grade of astrocytic gliomas .The tumor grade malig-nancy was positively correlated with the grade of the peritumoral low-density area on MRI scan(P<0 .05) ,while the expression of PDCD4 was negatively correlated with the grade of astrocytic gliomas (P<0 .01) .Conclusion PDCD4 might serve as one of the in-dicators of invasion and malignant phenotype for astrocytic gliomas .