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Hemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening clinical syndrome in children, and the knowledge of it is still limited. Two hundred twenty-seven children with HLH in our hospital were retrospectively analyzed from January 2001 to December 2018. The age of the patients on admission ranged from 1 day to 14 years old. The 3 most common clinical manifestations include fever (98.7%), hepatomegaly (95.6%), and splenomegaly (92.1%). The decrease of high-density lipoprotein cholesterol (99.1%) is very common in children with HLH. Albumin65 s, and lactose dehydrogenase >1000 U/L were independent risk factors for poor early prognosis in children with HLH, and their odds ratio values were 2.515, 3.094, and 2.378, respectively, while age >28 months was identified as a protective factor (odds ratio=0.295). Of the 227 children, 67 (29.52%) died within 30 days of onset. The mortality rate in 2013 to 2018 was significantly lower than that in 2001 to 2012 (16.35% vs. 40.65%, P=0.000). The shortening of the time from onset to admission and the reduction of time from admission to definite diagnosis could be some of the reasons for the decrease of HLH mortality in 2013 to 2018 (P

Candida haemulonii forms part of the non-albicans Candida species. The candidemia caused by C. haemulonii is extremely rare but fatal in neonates. We reported the first two neonates with C. haemulonii candidemia in China which were treated with fluconazole and reviewed two papers previously reported. Our report adds further awareness on C. haemulonii candidemia in critical neonates and points out the importance of an early diagnosis and treatment of this fatal infection.La Candida haemulonii forma parte de la especie Candida no albicans. La candidemia por C. haemulonii es sumamente infrecuente, pero mortal, en los recién nacidos. Se informa sobre los dos primeros recién nacidos con candidemia por C. haemulonii en China tratados con fluconazol y se revisan dos artículos informados con anterioridad. Nuestro informe incrementa la sensibilización sobre la candidemia por C. haemulonii en recién nacidos críticos y resalta la importancia de un diagnóstico y un tratamiento tempranos de esta infección mortal.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with the neurocognitive deficits as a result of the neuronal cell injury. Previous studies have shown that adenosine A1 receptor (ADORA1) played an important role against hypoxia exposure, such as controlling the metabolic recovery in rat hippocampal slices and increasing the resistance in the combined effects of hypoxia and hypercapnia. However, little is known about whether ADORA1 takes part in the course of neuronal cell injury after intermittent hypoxia exposure which was the main pathological characteristic of OSAHS. The present study is performed to explore the underlying mechanism of neuronal cell injury which was induced by intermittent hypoxia exposure in PC12 cells. In our research, we find that the stimulation of the ADORA1 by CCPA accelerated the injury of PC12 cells as well as upregulated the expression of PKC, inwardly rectifying potassium channel 6.2(Kir6.2) and sulfonylurea receptor 1(SUR1) while inhibition of the ADORA1 by DPCPX alleviated the injury of PC12 cells as well as downregulated the expression of PKC, Kir6.2, and SUR1. Moreover, inhibition of the PKC by CHE, also mitigated the injury of PC12 cells, suppressed the Kir6.2 and SUR1 expressions induced by PKC. Taken together, our findings indicate that ADORA1 accelerated PC12 cells injury after intermittent hypoxia exposure via ADORA1/PKC/KATP signaling pathway.

A newborn boy presented to the neonatal intensive care unit with dyspnoea at birth. He was born at 40+1 weeks’ gestation and weighed 2950 g, with Apgar scores of 9 at one minute and 9 at five minutes. On examination, his left lung breath sounds were absent and bowel sounds could be auscultated in the left thoracic cage. His respiratory rate was 70 breaths/min and there were no other …

A 1 year old boy presented to the neurosurgery clinic with a sac-like protrusion at the occipital region that had been present since birth. He was born at full term by caesarean section. He had no neurological symptoms and the swelling had not enlarged since birth. On examination, his head circumference was normal for age. The protrusion was 2.5×2.5 cm and his cry impulse was positive. A systemic examination …

The current oil depot environmental risk is big with a wide range of environmental impact, although we have increased environmental protection efforts, but the situation is still grim. The transceiver of petroleum materials in the oil depot, storage and the oil vapor and water resulted by other operations will pollute the environment, and environmental pollution will limit the development of oil depots inevitably. So, we must pay attention to environmental protection for the sustainable development of oil depots. This paper mainly Analysis of the factors influencing petroleum materials on the environment of the oil depot.

Objective To exam the relationship between snoring and morbidities of multiple systems in children. Study design Children with snoring were enrolled and divided into primary snorer (PS) group and obstructive sleep apnea hypopnea syndrome (OSAHS) group based on polysomnography. The healthy children served as the control group. The growth parameters, maxillofacial malformations, blood chemistry, electrocardiogram, and echocardiogram were recorded and intelligence testing was performed in the enrolled children who were ≥6 years old. Results The weight and height were similar in the control group (n = 60) and the PS group (n = 63), but lower in the OSAHS group (n = 89; P

The intracavity absorption spectra of water vapor in the atmosphere were observed in situ using a multimode unidirectional traveling-wave ring dye laser. Water vapor lines with absolute absorption coefficients of 10-7 to 10-9 cm-1 were measured with uncertainties of a few percents and their values were consistent with those in the HITRAN database within 10%. The sensitivity of the present apparatus was estimated to be 1 ×10-10 cm-1.

A 13 year old boy presented to the orthopaedic clinic for a painful wrist after a fall forward. On examination, he had a swollen painful right wrist and no limb deformities could be found. Anteroposterior and lateral radiography for the wrist was taken (fig 1⇓). What is the diagnosis? Fig 1 (a) Anteroposterior and …

A pregnant 18 year old woman had an antenatal examination at 30 weeks’ gestation. She was healthy and had no history of smoking, drug abuse, or positive family history of chromosomal disease or encephalodysplasia. She had experienced mild flu-like symptoms during the first month of pregnancy but had not taken any medication, and the symptoms had disappeared after three days. During the antenatal appointment she had an ultrasound scan (fig 1⇓). What does the ultrasound image show? Fig 1 …

To study the clinical effect of continuous thoracic close drainage using central venous catheter instead of repeated thoracocentesis in the treatment of tuberculous pleurisy in children.Thirty-nine children with tuberculous pleurisy, who received continuous thoracic close drainage using central venous catheter in addition to conventional antituberculous chemotherapy, were used as the observation group and 42 children with tuberculous pleurisy who underwent repeated thoracocentesis in addition to conventional antituberculous chemotherapy served as the control group. The two groups were compared in terms of time to pleural effusion absorption, improvement in pleural thickening, length of hospital stay, and puncture-related expenses.Compared with the control group, the observation group had significantly faster pleural effusion absorption (8 ± 4 d vs 12 ± 6 d; P0.01), significantly more improvement in pleural thickening (1.50 ± 0.25 mm vs 3.10 ± 0.30 mm; P0.05), a significantly shorter length of hospital stay (11 ± 3 d vs 18 ± 6 d; P0.01), and significantly lower puncture-related expenses (269 ± 24 yuan vs 475 ± 50 yuan; P0.05), as well as alleviated pain.Continuous thoracic close drainage using central venous catheter is superior to repeated thoracocentesis in the treatment of tuberculous pleurisy in children, and it holds promise for clinical application in pediatric patients.

A 1 year old girl presented to the paediatric orthopaedic clinic with abnormal gait. Her parents noticed that she had a “duck-like” waddle when she had first started to walk a month previously. On examination, there were asymmetrical skin creases on her buttocks, and her legs were of similar length. There were no other external congenital malformations. Anteroposterior radiography of the infant’s pelvis was carried out (fig 1⇓). What is the diagnosis? Fig 1 ### Answer Bilateral developmental dysplasia of the hip. ### Discussion The image shows changes typical of developmental dysplasia of the hip (DDH). …

A 16 year old girl presented to the orthopaedic clinic with a deformed left wrist from birth. The girl had progressively increasing pain in the left wrist, and dorsiflexion was limited. On examination, she has a bayonet deformity of the left wrist, which leads to loss of grip strength, decreased extension, and supination. There were no other external congenital deformities. Anteroposterior and lateral radiographs of the left …

Scrub typhus is caused by Orientia tsutsugamushi. Any delay in diagnosis can result in delayed treatment and severe complications, including secondary hemophagocytic lymphohistiocytosis, which is rare but potentially fatal. In this paper, the authors present 3 cases of secondary hemophagocytic lymphohistiocytosis associated with scrub typhus, successfully treated with chloramphenicol without additional antineoplastic therapy. All patients cured and achieved complete resolution. This report highlights the effectiveness of chloramphenicol without the need for chemotherapy in the treatment of scrub typhus-associated hemophagocytic lymphohistiocytosis in a pediatric population under the age of 8 years.

To explore the role of endoplasmic reticulum stress in brain injury following chronic intermittent hypoxia (CIH) in weanling rats.A total of 48 male healthy Sprague-Dawley rats (3-4-week-old, 80-100 g) were randomly divided into 4 groups: 2-week-CIH (2IH) group, 4-week-CIH (4IH) group, 2-week-control (2C) group and 4-week-control (4C) group. The morphologic changes were observed by hematoxylin-eosin (HE) staining and cell apoptosis detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay. Then hippocampus and prefrontal cortices were collected for transcription and expression analysis of glucose regulated protein 78 (GRP78) by reverse transcription (RT)-PCR and Western blotting respectively. And the expressions of Caspase-12 mRNA and Caspase-12 protein in prefrontal cortex were analyzed by RT-PCR and immunohistochemistry.The neuronal apoptosis in hippocampus and prefrontal cortices in CIH exposed groups were more pronounced than those of the control groups (all P0.01), especially in the 4IH group (hippocampus: 8.78% ± 0.71% vs 3.26% ± 0.45%, cortices: 6.02% ± 0.32% vs 2.91% ± 0.29%). The expression levels of GRP78 mRNA (hippocampus: 0.424 ± 0.033 vs 0.326 ± 0.013 and 0.444 ± 0.028 vs 0.310 ± 0.015, cortices: 0.514 ± 0.038 vs 0.430 ± 0.017 and 0.524 ± 0.038 vs 0.439 ± 0.033) and GRP78 protein in hippocampus and prefrontal cortices (hippocampus: 0.221 ± 0.032 vs 0.178 ± 0.014 and 0.241 ± 0.019 vs 0.170 ± 0.013, cortices: 0.307 ± 0.012 vs 0.226 ± 0.022 and 0.311 ± 0.023 vs 0.225 ± 0.025), and the expression levels of Caspase-12 mRNA (0.396 ± 0.004 vs 0.323 ± 0.014, 0.417 ± 0.011 vs 0.313 ± 0.011) and Caspase-12 protein (0.334 ± 0.035 vs 0.197 ± 0.023, 0.368 ± 0.079 vs 0.215 ± 0.024) in prefrontal cortex in the IH groups all were more than those in the 2C and 4C groups (all P0.05).Chronic intermittent hypoxia can up-regulate the GRP78 transcription and expression in brain regions associated with learning and memory. This may induce the endoplasmic reticulum stress and activate the Caspase-12 mediated apoptosis signaling pathway. In the end, neuronal apoptosis occurs. All these factors may play an important role in the impairment of learning memory during the exposure of growing rats to chronic intermittent hypoxia.

To investigate the positive rate of hepatitis B surface antibody (HBsAb) in children.Blood samples from 3022 children who received a physical examination in outpatient departments from 2009 to 2011 were subjected to serological test using ELISA to measure the positive rate of HBsAb.The positive rate of HBsAb decreased with age (P0.01). There was no significant difference in the positive rate of HBsAb between boys and girls (P0.05), however the positive rate of HBsAb in boys aged one year and over was lower than in girls of the same age (P0.01). The positive rate of HBsAb in boys aged between 3 and 4 years was higher than in girls of the same age (P0.01). The positive rate of HBsAb decreased with age in boys, and was lower in those aged two years and over than in those aged one year and over (P0.01). The positive rate of HBsAb also decreased with age in girls, with significant differences between different age groups (P0.01).The positive rate of HBsAb decreases with age in children, so younger children have a higher risk of infection with hepatitis B virus. Serological monitoring of hepatitis B needs to be enhanced.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) may cause serious morbidities, such as systemic hypertension, diabetes, and cor pulmonale. However, currently no many reports on study of OSAHS in children are available. This study aimed to explore the effects of OSAHS on children's multiple systems.A total of 89 cases of children who came to the Sleep Treatment Center in the authors' hospital from March 2009 to December 2010 with snoring were tested with overnight polysomnography (PSG). They were classified into mild OSAHS group (n = 59, mean age of 5.71, SD = 2.46) and moderate to severe group (n = 30, mean age of 5.30, SD = 2.73) based on the PSG results, and 100 healthy children were selected as the control group (n = 100, mean age of 6 years, SD = 2.98). Data including height, weight, body mass index and blood pressure, peripheral blood routine, blood lipids, glucose and insulin, electrocardiogram and echocardiography were collected. Patients' adenoid face and abnormal occlusion were also recorded. Comparisons of the data were made among those groups.Mild OSAHS and moderate to severe group had significantly higher prevalence of adenoid face (23.7%, 26.7%), and abnormal occlusion (74.6%, 60.0%) than that in control group (0, 40%) (P0.05). There were no significant differences in terms of BMI between the OSAHS group and the control group, but the weight (kg) and height (cm) in the mild OSAHS group (23.3 ± 10.1, 114.9 ± 16.2) and moderate to severe group (21.9 ± 8.4, 110.8 ± 13.3) were lower than those of the control group (31.8 ± 10.1, 136.1 ± 15.1) (all P0.05). Compared with the control group, the level of HDL-C (mmol/L)and insulin (mU/L) in moderate and severe group decreased [(1.20 ± 0.30) vs. (1.40 ± 0.27), 2.79 (0.84 - 16.16) vs. 4.92 (0.76 - 16.80), P0.05], while the LDL-C (mmol/L) increased [(2.61 ± 0.75) vs. (2.32 ± 0.62), P0.05]. The red blood cell counts (× 10(12)/L) and the blood platelet counts (× 10(9)/L) in the mild OSAHS (4.93 ± 0.37, 292.92 ± 75.64) and moderate and severe OSAHS group (5.23 ± 0.22, 292.50 ± 63.05) were significantly higher in contrast to the control group (4.70 ± 0.31, 255.60 ± 69.12) (all P0.05), systolic blood pressure (mmHg) in mild group (98.54 ± 10.44) and moderate to severe group (99.13 ± 19.13) was significantly higher compared to control group (87.88 ± 11.37), and the heart rate (beats/min) in moderate to severe group (94.43 ± 10.64) was higher than those in control group (87.12 ± 16.20) (all P0.05). The mild OSAHS and moderate and severe OSAHS group had decreased right ventricular internal diameter [(14.24 ± 1.64) mm, (13.17 ± 2.07) mm ], increased main pulmonary artery diameter [(17.05 ± 3.33) mm, (16.33 ± 3.14) mm] and the thickness of right ventricular wall [(3.43 ± 0.26) mm, (3.57 ± 0.20) mm] compared to control group [ (16.10 ± 2.96) mm, (14.11 ± 2.52) mm, (3.32 ± 0.25) mm] (all P0.05).OSAHS in children may be associated with craniofacial malformations, and may contribute to slow growth and development, elevated blood viscosity and blood pressure, metabolic abnormalities, and change cardiac structure.

To study the effect of chronic intermittent hypoxia on p38MAPK in partial cerebral tissues of weanling rats.Randomly, fifty male SD rats (3-week-old-4-week-old) were divided into five groups: 2-week-CIH group (2IH), 4-week-CIH group (4IH), 4-week-recovery group (4F), 2-week-control group (2C) and 4-week-control group (4C). Intermittent hypoxia model was induced by an intermittent hypoxia cabin. The expression of p38MAPK mRNA and the phosphorylation levels of p38MAPK (p-p38 protein) in the hippocampus and prefrontal cortex were measured by RT-PCR or Western blot respectively.No matter in the hippocampus, or in the prefrontal cortex, the expression of p38MAPK mRNA and p-p38 protein in 2IH, 4IH and 4F groups were respectively higher than 2C and 4C groups (P0.05, respectively).Chronic intermittent hypoxia can activate the p38MAPK in partial cerebral tissues of weanling rats.

To investigate the upper airway structure of sleep-disordered breathing children.Seventy three children with obstructive sleep apnea hypopnea syndrome (OSAHS), 53 children with primary snoring (PS) and 40 control subjects underwent pharyngeal magnetic resonance imaging (MRI). Upper airway structure images were analyzed and measured.The cross-section area of the nasopharyngeal and palatopharyngeal airway in subjects with OSAHS and PS are smaller (P0.01) than that of the control group. The cross section area of OSAHS patients are smaller than that of PS subjects (P0.01). The above parameter of oropharyngeal airway in OSAHS patients is smaller than that of control group (P0.01), but no statistic difference compared with that of PS subjects. The cross-section area and length of the adenoid in OSAHS group are bigger and longer than that of PS group (P0.01) and bilateral tonsils are larger (P0.01); in OSAHS patients the cross-section area of the soft palate is larger and the length of the soft palate is longer (P0.01) than that of PS group, while this parameter of PS group is similar to that of the control group. And the maximum width of the soft palate, the cross-section area of bilateral fat pad, bilateral pterygoid and tongue are similar among OSAHS, PS and the control group. The skeletal measurement: the length of H-C2C3 in subjects with OSAHS is longer (P0.01); The angle(alpha) in OSAHS patients is smaller (P0.01) than that of other 2 groups. The angle (beta), the cross-section area of the mandible, the spine-clivus oblique, the length of the hard palate and the distance of the mandible are similar among the three groups.In children with OSAHS or PS, the upper airway is restricted by both the adenoid and tonsils; however, the soft palate is also larger in OSAHS, adding further restriction. Otherwise, downward movement of the hyoid bone and decreasing of the angle (alpha) in OSAHS influence laryngopharynx airway. MRI is of clinical significance for evaluating OSAHS children's upper airway.