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CD4+T cells mediate the pathogenesis of renal ischemia-reperfusion injury (IRI). Emerging research suggests that a Th17/regulatory T cell (Treg) imbalance plays a pivotal role in the development of renal IRI. The recently identified negative checkpoint T cell immunoglobulin domain and mucin domain family 3 (Tim-3) inhibits the immune response by binding to its ligand, galectin-9 (Gal-9). However, the role of the Gal-9/Tim-3 signaling pathway in the regulation of CD4+T cell subsets in renal IRI remains unclear. In this study, the effect of the Gal-9/Tim-3 signaling pathway on Th17/Treg subsets in renal IRI was investigated using a mouse model. Renal IRI induced the expression of Gal-9 in renal tubular epithelial cells and increased the percentages of Tim-3+Th17 cells and Tim-3+Foxp3+Treg cells in the IR kidneys. The administration of rAAV9-Gal-9 suppressed kidney inflammation, reduced the mortality of mice with renal IRI, increased Foxp3+Treg cells, and reduced Th17 cells. In contrast, the blockade of Tim-3 in vivo with an anti-Tim-3 mAb aggravated renal inflammation, decreased Foxp3+Treg cells, and promoted Th17 cells. Thus, Gal-9/Tim-3 signaling pathway activation may protect against renal IRI by inhibiting Th17 cell production and inducing Foxp3+Treg cell expansion. Our study suggests that the Gal-9/Tim-3 signaling pathway might become a target of immunotherapy in renal IRI.

Considering the low-carbon supply chain led by one manufacturer and followed by one retailer, market demand is influenced by the investment of low-carbon product promotion and the degree of emission reduction. Stackelberg game theory is used to construct the game models with no-incentive model and three incentive models, respectively. The equilibrium solutions of the degree of low-carbon products promotion, the degree of low-carbon products emission reduction, the market demand, the cost-sharing ratio of the manufacturer to the retailer’s low-carbon products promotion, the degree of government’s incentive to the manufacturer’s low-carbon products, as well as the manufacturer’s and retailer’s profit are obtained in the four models. Finally, with the results, we provide some policy suggestions for the management and practice of a low-carbon supply chain.

Under the background of carbon cap and carbon subsidy policies implemented by the government, considering a low-carbon supply chain led by a manufacturer and followed by a retailer, the market demand is influenced by the level of emission reduction and promotion of low-carbon products. Stackelberg game theory is used to construct four models, one with no carbon cap and three with a carbon cap respectively. And we get the equilibrium solutions of the degree of emission reduction, degree of promotion, sharing ratio, market demand, manufacturer and retailer profit of low-carbon products. Through comparative analysis, it is found that the MKM model is the optimal one in which the government implements carbon cap and carbon subsidy policies and the manufacturer shares the cost of low-carbon promotion. In this model, the degree of manufacturer’s emission reduction is positively correlated with the influence coefficient of low-carbon emission reduction, manufacturer’s marginal revenue, government unit subsidy for low-carbon emission reduction and the initial price of carbon trading. Meanwhile, it is negatively correlated with the government’s carbon emission quota, elastic coefficient of carbon emission quota and the cost coefficient of low-carbon emission reduction. The results are closely related to the government unit subsidies for low-carbon emission reduction and the government carbon allowances. The manufacturer is more willing to accept the MKM model only when they exceed a certain threshold. Finally, the validity of the models would be verified by a numerical example.

The overuse of smart phone may cause addiction, however, the deaf or hard-of-hearing addicts haven’t gained enough attention. The purpose of this study is to address the characteristics of mobile phone addiction of students who are deaf or hard-of-hearing( hereafter DHH), and to explore the possible formation mechanism of mobile phone addiction of Chinese DHH students through a mediating model. The data were collected by recruiting 570 Chinese DHH students in junior high schools, senior high schools and universities to finish questionnaires of Mobile Phone Addiction Index, Perceived Discrimination Questionnaire and Sense of Security Questionnaire. The results show that: (1) 47.4% of DHH students have mobile phone addiction tendency; (2) the degree of mobile phone addiction of girls is significantly higher than that of boys; (3) the degree of mobile phone addiction of DHH students who can successfully communicate with ordinary people is significantly lower than that of those who can communicate at an acceptable dis-fluency and those who suffer apraxia; (4) there is a significant positive correlation between the discrimination perception of DHH students and their mobile phone addiction; (5) the sense of security plays a complete mediating role between the perception of discrimination and mobile phone addiction of DHH students. It shows that some deaf or hard-of-hearing people may have obvious problems of smart phone addiction. The perception of discrimination is the possible cause of smart phone addiction of the DHH people, and plays an indirect role through the sense of security. In conclusion, this study proposes a possible explanatory model of mobile phone addiction in DHH people, which can provide reference for early intervention in the prevention and intervention of mobile phone addiction in DHH people. Public Significance Statement: The research has put forward an explaining model for Chinese DHH students’ smart phone addiction,which may offer suggestions towards this phenomenon’s early intervention.

This paper studies the problem of the constant pressure control for high pressure tubing. The main factors affecting the pressure change in high pressure oil pipe are the opening time of check valv...

In mainland China, dialysis for children with end-stage renal disease (ESRD) was not introduced until the 1980s. To describe the development of pediatric dialysis in different regions of China, a national pediatric dialysis network, namely, International Pediatric Dialysis Network-China (IPDN-China) ( www.pedpd.org.cn ), was launched in 2012. Original and updated information from the renal centers registered with the IPDN-China was collected between 2012 and 2016 from two sources, namely, the registry and the survey, and demographic features were analyzed. Due to promotion by the IPDN-China, the number of registered renal centers increased from 12 to 39 between 2012 and 2016, with a significant increase in the coverage of the Chinese administrative divisions (from 26.5 to 67.6%) (p < 0.01); and the coverage of the pediatric (0~14 years old) population increased to nearly 90% in 2016. The distribution of renal centers indicated that East China had the highest average number of registered centers per million population (pmp) 0~14-year-old age group. Seventeen relatively large dialysis centers were distributed across 14 divisions. Various modalities of renal replacement therapy (RRT) were available in most centers. The IPDN-China has promoted collaborations between dieticians, psychologists, and social workers on dialysis teams to provide better service to children with ESRD and their families. The proportion of centers with all three types of paramedic support (i.e., dieticians, psychologists, and social workers) as well as the proportion of centers with a partial paramedic team significantly increased between 2012 (25.0%) and 2016 (69.2%) (p < 0.05). In terms of the point prevalent cases of patients (aged < 18 years), data from the survey of 39 registered centers revealed that the number of children with ESRD who were on RRT was 578 (49% received a kidney transplant) at the end of 2016, which was more than that reported in previous surveys. Data from the registry showed that 349 dialysis patients had been enrolled as of the end of 2016. The median age at RRT start was 9.5 years, and the leading cause of ESRD was congenital abnormalities of the kidney and urinary tract (CAKUT). The IPDN-China has helped to promote the development of pediatric dialysis for ESRD in China by improving the organization of care for dialysis patients and increasing the availability and the quality of RRT for patients who need it. To improve knowledge about the epidemiology and outcomes of pediatric RRT around the country, a sustained effort needs to be made by the IPDN-China to increase the enrollment of dialysis patients and increase the number of registered centers in the future.

Background: The lack of consensus criteria of acute on chronic kidney injury (ACKI) affects the judgment for its clinical prognosis. Methods: In this study, we analyzed the data from 711,615 hospitalized adults who had at least 2 serum creatinine (SCr) tests within 30 days. We estimated the reference change value (RCV) of SCr given initial SCr level in adults without known risks of acute kidney injury other than chronic kidney disease (CKD). We proposed a criterion for ACKI based on the RCV of SCr (cROCK), which defined ACKI as a ≥25% increase in SCr in 7 days. We validated cROCK by its association with the risks of in-hospital mortality, death after discharge, and CKD progression in a large cohort of patients with CKD stage 3. Results: In 21,661 patients with CKD stage 3, a total of 3,145 (14.5%), 1,512 (7.0%), and 221 (1.0%) ACKI events were detected by both cROCK and Kidney Disease Improving Global Outcomes (KDIGO), cROCK only, and KDIGO only, respectively. cROCK detected 40% more ACKI events than KDIGO. Compared with patients without ACKI by both definitions, those with cROCK- but not KDIGO-defined ACKI had a significantly increased risk of in-hospital mortality (hazard ratio [HR] 5.53; 95% CI 3.75–8.16), death after discharge (HR 1.51; 95% CI 1.21–1.83), and CKD progression (OR 5.65; 95% CI 3.05–10.48). Conclusions: RCV-based criterion (cROCK) for ACKI is clinically valid in that it has a substantially improved sensitivity in identifying patients with high risk of adverse outcomes.

The surface functionalization of CNCs and the construction of strong interfacial adhesion between CNCs and rubber matrix are effective way to achieve high performance rubber/CNCs nanocomposites. Herein, carboxylation of sulphated cellulose nanocrystals (CNC-OSO3H) was conducted in aqueous medium by using citric acid as modifier. Large amount of carboxyl groups was successfully grafted on the surface of CNC-OSO3H, which endows the carboxylated CNC-OSO3H (abbreviate as CNC-CA) with higher chemical reactivity and thermal stability. Subsequently, carboxylated styrene butadiene rubber (XSBR)/CNC-CA nanocomposites with dual crosslinking design were prepared by using polyethylene glycol diglycidyl ether (PEGDE) as the crosslinking agent and CNC-CA as the reinforcing fillers. FTIR investigation found that in the obtained nanocomposites, the carboxyl groups on CNC-CA and XSBR formed hydrogen bonds (physical crosslinking) with each other, and the carboxyl groups formed covalent bond with the epoxy group on PEGDE simultaneously. The coexistence of physical and chemical crosslinking improved the interface compatibility between CNC-CA and XSBR matrix, accelerated the homogenous dispersion of CNC-CA and realized the crosslinking of the matrix itself. As expected, XSBR/CNC-CA nanocomposites with dual crosslinking network showed remarkable enhancement in tensile strength (up to 500%), modulus (up to 151%), work of fracture (up to 348%). This work provides both a facile and green approach to obtain carboxylated CNCs and a convenient method for the preparation of high-performance rubber nanocomposites with multiple interactions.

Background To evaluate the association between use of proton pump inhibitor (PPI) and the risk of hospital-acquired acute kidney injury (HA-AKI) in hospitalized children. Methods We conducted a multicenter retrospective cohort study in hospitalized children aged 1 month to 18 years from 25 tertiary hospitals across China from 2013 to 2015. Patient-level data were obtained from the electronic hospitalization databases. AKI was defined and staged using the serum creatinine (SCr) data according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results Among 42,232 children analyzed, 11,496 (27.2%) used PPI, 1,760 (4.2%) used histamine 2 receptor antagonist (H2RA), and 3,514 (8.3%) had HA-AKI during hospitalization. Over 85% of PPIs were prescribed for prophylaxis of gastro-duodenal lesions in children. The use of PPI was associated with a significantly increased risk of HA-AKI compared with both non-users [odds ratio (OR), 1.37; 95% confidence interval (CI), 1.23-1.53)] and H2RA users (OR, 1.24; 95% CI, 1.01-1.52). The associations were consistent across children of different age range, gender, subtypes of PPIs and methods of administration. A larger effect was observed in children with chronic kidney disease (OR, 3.37; 95% CI, 2.46-4.62) and those needed intensive care (OR, 1.54; 95% CI, 1.33-1.78). The risk of HA-AKI was increased even within the recommended dosage range of PPI. Conclusions PPIs were widely used and associated with an increased risk of HA-AKI in hospitalized children in China.

ObjectiveThis study aimed to analyze the clinical characteristics and prognosis of pediatric idiopathic pulmonary hemosiderosis (IPH).MethodsPediatric IPH cases that were diagnosed at West China Second University Hospital, Sichuan University between 1996 and 2017 were reviewed. Follow-up data from 34 patients were collected.ResultsA total of 107 patients were included (42 boys and 65 girls). The median age was 6 years at diagnosis. The main manifestations of the patients were as follows: anemia (n = 100, 93.45%), cough (n = 68, 63.55%), hemoptysis (n = 61, 57%), fever (n = 23, 21.5%), and dyspnea (n = 23, 21.5%). There were relatively few pulmonary signs. The positive rates of hemosiderin-laden macrophages in sputum, gastric lavage fluid, and bronchoalveolar lavage fluid were 91.66%, 98.21%, and 100%, respectively. Seventy-nine patients were misdiagnosed. A total of 105 patients were initially treated with glucocorticoids, among whom 102 survived and three died. Among the followed up patients, two died and 32 survived, among whom 10 presented with recurrent episodes.ConclusionsThe classic triad of pediatric IPH is not always present. The rates of misdiagnosis and recurrence of IPH are high. Early recognition and adequate immunosuppressive therapy are imperative for improving prognosis of IPH.

Low molecular weight heparin (LMWH) has a structure similar to heparan sulfate, which exerts anti-inflammatory effects via inhibiting elastase (Ela) activity. Release of Ela along the glomerular capillary wall may induce glomerular injury and proteinuria. The present study aimed to investigate the influence of LMWH on steroid-sensitive nephrotic syndrome (SSNS) and the potential underlying mechanism. A total of 40 SSNS patients and 20 healthy controls were recruited. SSNS patients were treated with LMWH and prednisone simultaneously (LMWH+pred group) or with prednisone alone (pred group). Proteinuria, urinary glycosaminoglycans (GAGs), serum Ela and urinary creatinine levels were measured. The nephrotic period of SSNS was 15.93±5.78 days. The nephrotic period of SSNS in LMWH+pred group was significantly reduced compared with the pred group (14.13±4.56 vs. 18.63±6.49 days; P0.05). Positive correlations were revealed between urinary GAG excretion and proteinuria (r=0.877; P

Therapeutic plasma exchange (TPE) is now widely used in therapy of multiple diseases in children, by removing the plasma with pathogenic agents from patients. However, adverse reactions may limit its application. A retrospective cohort study of 435 hospitalized children treated with 1201 plasma exchange procedures between January 2013 and July 2018 were enrolled. Complications occurred in 152 procedures (12.7%); 90 procedures (7.5%) had ≥2 complications. No death occurred. The most common complications were pruritus and urticaria (7%), followed by hypertension (1.92%) and hypotension (1.17%). One child had an outbreak of disseminated cryptococcosis neoformans infection, another child developed anaphylactic shock, and 3 children presented toxic epidermal necrolysis after TPE. The incidence of pruritus and urticaria was higher in children of the 6∼15 year group (P .05). Compared with other diseases, anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis led to a higher incidence of complications in children (P

Acute poisoning in children is a clinical emergency. Prompt and effective treatment is critical for life-threatening poisoning. Extracorporeal treatment (ECTR) is a practical option for enhancing the elimination of poisons. We conducted a retrospective observational study on 338 children with severe acute poisoning who received ECTR during hospitalization from January 2010 to December 2017. The poisonous substances, utilization of ECTR, adverse reactions to ECTR, and outcomes were recorded. The top 3 poisoning categories, in order of frequency, were found to be pesticides (57.99%), biotoxins (25.15%), and pharmaceuticals (14.20%). Paraquat (35.21%), an organic heterocyclic herbicide with high toxicity to humans, was the most common toxic substance. The main modalities of ECTR use were hemoperfusion (50.59%) and therapeutic plasma exchange (42.60%), followed by continuous renal replacement therapy (4.44%) and hemodialysis (1.18%). There were also 4 patients (1.18%) with a combination of ECTR performed. Adverse events of ECTR included errhysis and hematomas around the catheter exit site, oral cavity bleeding, allergic reactions, hypothermia, hypotension, and blood coagulation. The adverse reactions were mostly mild to moderate and were manageable. During the study period, there were 295 patients (87.28%) who were cured, 9 (2.66%) who experienced some improvement, and 34 (10.06%) who died. ECTR modalities were found to be clinically effective approaches to the treatment of poisoning by pesticides, biotoxins, and pharmaceuticals, indicating they are important modalities in toxicology and treatment, and are well tolerated by children.

Background Renal hypoxia is considered a final pathway in the progression of chronic kidney disease (CKD). Blood-oxygen-level-dependent magnetic resonance imaging (BOLD-MRI) has shown merit for evaluating renal oxygenation in adults. Objective To investigate renal cortical and medullary R2* values by CKD stage and by renal function index in children with chronic kidney disease. Materials and methods Twenty-one children with CKD Stage 1–3, 16 children with CKD Stage 4–5, and 6 healthy volunteers underwent a renal MRI using multigradient recalled-echo sequence with 16 echoes. We measured the R2* values of the renal cortex and medulla on BOLD-MRI. Results The cortical R2* value was ranked as CKD Stage 4–5 > CKD Stage 1–3 > healthy controls, and the medullary R2* value was ranked as CKD Stage 4–5 > CKD Stage 1–3. There was no significant difference in the medullary R2* value between CKD Stage 1–3 patients and the healthy controls. There was a positive correlation between the R2* values in the renal cortex (r=0.73) and medulla (r=0.89), and the serum creatinine level (P<0.001), and the renal cortical and medullary R2* values were negatively correlated with the estimated glomerular filtration rate (r=–0.71 and r=–0.89, respectively; P<0.001). Conclusion BOLD-MRI might contribute to noninvasive assessment of renal oxygenation in children with CKD in vivo but it did not reflect renal function in our sample.

Nephrotic syndrome (NS) can be divided into primary, secondary, and congenital NS 3 types, and primary nephrotic syndrome (PNS) accounts for about 90% of the total number of NS in children, which is a common childhood glomerular disease one. The treatment of children with PNS has been controversial and confused because of hormone tolerance, complications, multiple drug combinations, and other issues, but there are no indicators to assess the rational drug use (RDU) of children with PNS. This study aims to develop a set of indicators to assess the RDU in children with PNS.The study is an observational study and the procedure includes 3 steps:A consensus was reached after 2 rounds of the Delphi survey and each indicator was weighted. The final indicators included 2 first-rank indicators and 16 second-rank indicators. In round 1, modified 3 indicators, increase 2 indicators and delete 6 indicators. In round 2, reached consensus. The first-rank indicators comprised drug choice (46.96%) and drug usage and dosage (53.04%); The second-rank indicators aimed to the specific drug therapy, including the RDU of hormones, immunomodulators, and adjuvant drug. The score of each indicator met the requirements, therefore, childrens PNS RDU evaluation index system had been established and the index was scientific and credible.The first set indicators had been established to assess RDU of children with PNS. Monitoring these indicators will guide people towards the promotion of RDU for PNS. Whats more, the indicator provided a methodological reference for the development of other indicator sets.

Objective Continuous renal replacement therapy (CRRT) is well suited for treating metabolic abnormalities and renal insufficiency associated with tumour lysis syndrome (TLS). However, there is controversy regarding the choice of time for CRRT, the selection of CRRT models, and methods of decreasing complications of CRRT. This study aimed to evaluate the efficacy and outcomes of daytime continuous veno-venous haemofiltration (CVVH) for treating paediatric TLS. Methods The clinical features, technique-related complications, and prognosis were prospectively analysed in eight paediatric patients with TLS who were supported by daytime CVVH in West China Second University Hospital, Sichuan University from January 2007 to July 2016. Results Seven patients were boys and one was a girl. All of the patients had hyperphosphataemia, and there were four cases of hyperkalaemia, four cases of hyperuricaemia, and two cases of hypocalcaemia. All of the patients received one to 10 CVVH treatments. Urine output, renal function, serum uric acid levels, and potassium, phosphate, and calcium levels returned to normal in all of the patients, but recovery of renal function was relatively slow. No significant adverse reactions were observed. All of the patients recovered and were discharged. Conclusion Daytime CVVH is a safe and effective treatment for paediatric TLS.

Background Current definitions of AKI do not take into account serum creatinine’s high variability in children. Methods We analyzed data from 156,075 hospitalized children with at least two creatinine tests within 30 days. We estimated reference change value (RCV) of creatinine on the basis of age and initial creatinine level in children without kidney disease or known AKI risk, and we used these data to develop a model for detecting pediatric AKI on the basis of RCV of creatinine. We defined pediatric AKI according to pediatric reference change value optimized for AKI in children (pROCK) as creatinine increase beyond RCV of creatinine, which was estimated as the greater of 20 μ mol/L or 30% of the initial creatinine level. Results Of 102,817 children with at least two serum creatinine tests within 7 days, 5432 (5.3%) had AKI as defined by pROCK compared with 15,647 (15.2%) and 10,446 (10.2%) as defined by pediatric RIFLE (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO), respectively. Children with pROCK-defined AKI had significantly increased risk of death (hazard ratio, 3.56; 95% confidence interval, 3.15 to 4.04) compared with those without AKI. About 66% of patients with pRIFLE-defined AKI and 51% of patients with KDIGO-defined AKI, mostly children with initial creatinine level of μ mol/L, were reclassified as non-AKI by pROCK, and mortality risk in these children was comparable with risk in those without AKI by all definitions. Conclusions pROCK criterion improves detection of “true” AKI in children compared with earlier definitions that may lead to pediatric AKI overdiagnosis.

Objective This study aimed to analyze the clinicopathological features of pediatric renal biopsies from plateau regions of China. Methods Clinicopathological features of pediatric renal biopsies were compared between plateau and non-plateau regions in patients who were admitted to West China Second University Hospital, Sichuan University between April 2001 and March 2017. Patients were children younger than 18 years. Results The proportion of primary glomerular disease in the plateau group was lower than that in the non-plateau group (45.56% vs 62.09%, respectively). In the plateau group, IgA nephropathy (IgAN) was the major primary glomerulonephritis (GN) pathology. IgAN accounted for 36.54% and 21.63% of GN cases with nephrotic syndrome and hematuria, respectively. Henoch-Schönlein purpura nephritis was the most common secondary GN in both groups. The proportion of hepatitis B virus-associated GN was higher and that of lupus nephritis was lower in the plateau group than in the non-plateau group. Conclusions There are differences in renal pathological types between children in plateau regions and those in non-plateau regions. Among children in plateau regions, IgAN and Henoch-Schönlein purpura nephritis were the most common kidney diseases.

Macrophage activation syndrome (MAS) is one of the serious complications associated with rheumatic diseases, especially systemic juvenile idiopathic arthritis (sJIA). Here we describe a 9-year-old girl with rheumatoid factor (RF)-positive polyarticular JIA, not sJIA, combined with pneumonia who was successfully treated by plasma exchange. She was diagnosed with RF-positive polyarticular JIA based on positive RF and multiple joint swelling and tenderness 3 years ago. She was admitted in our hospital with myalgia for 2 days and a high fever for half a day. Physical examination revealed relapsing joints symptoms and rough breathing sounds of lungs. The laboratory examination showed increased liver enzymes, elevated serum ferritin and procalcitonin (PCT), decreased percentage of nature killer (NK) cells and fibrinogen, and activated macrophage phagocytosing hematopoietic elements in bone marrow. The elevated PCT and chest computed tomography scan confirmed she also had pneumonia. Intravenous methylprednisolone and oral cyclosporine A followed by intravenous immunoglobulin were added on the basis of antibiotics therapy, but clinical symptoms and laboratory findings did not improve. Finally, we changed to plasma exchange once every other day for a total of three times. Within 1 week, the girl recovered from the MAS completely.

Wu, Q., Wang, X. Z., Tang, Y. Y., Yu, H. T., Cui, F. G., Zhang, J. C. and Wang, C. T. 2014. Molecular cloning, genomic organization and functional analysis of the ribosomal protein L4/L1 (RPL4) gene from Arachis hypogaea. Can. J. Plant Sci. 94: 85–97. The ribosomal proteins have been shown to be important in plant polarity establishment, cell proliferation, leaf shape and auxin-related development. The RPL4 protein is crucial for the maintenance of ribosomal translational efficiency and fidelity. This study concerns the RPL4 gene from Arachis hypogaea. The full-length cDNA (1538 bp) of RPL4 consisted of an open-reading frame of 1221 bp encoding 406 amino acids. The genomic DNA sequence of RPL4 gene consisted of 1491 bp containing two exons and one 270-bp intron. The RPL4 mRNA transcript was mainly expressed in roots and leaves, and fewer signals were detected in stems. The sequence data revealed that RPL4 encoded a typical ribosomal protein L4/L1e domain. Phylogenetic analysis for genes encoding proteins showed that RPL4 were conserved within dicotyledonous and monocotyledonous plants. The ratios of nonsynonymous/synonymous substitution rate (ω=d N/d S) were analyzed. No sites were identified under positive selection. In the whole RPL4 sequence, d S greatly exceeded d N in all branches of the tree (d N/d S<< 1.0), indicating that functional constraints (purifying selection) have acted on RPL4 throughout evolution. The differences among plants and animals and Caenorhabditis elegans may indicate functional differentiation during species evolution.

This retrospective study investigated the application of the sedation–agitation scale (SAS) in pediatric bronchoscopy by observing its effects on sedative dosages and adverse reactions. Children who underwent sedation before bronchoscopy, during the period from January 2014 to June 2017, were divided into control and SAS groups. Patients in the control group were administered a single dose of 0.1 to 0.3 mg/kg midazolam, based on physicians’ clinical experience. The initial dose of midazolam in the SAS group was 0.1 mg/kg, and was adjusted based on the SAS score, as evaluated by physicians. Between-group comparisons were made of midazolam dose; adverse reactions of midazolam, such as agitation, delirium, excessive sedation, and respiratory depression; operating time of bronchoscopy; and number of participants. No statistically significant differences in gender, age distribution, weight, or disease composition were observed between the groups. The midazolam dose, operating time, and number of participants at different ages were all lower in the SAS group than in the control group. Fewer adverse drug reactions, such as intraoperative agitation and delirium, were noted in the SAS group. Moreover, the overall number of participants was reduced, and the overall operating time was less than that in the control group. Application of SAS for assessment of sedation during pediatric bronchoscopy can guide individualized administration of midazolam, reduce midazolam dose while achieving an ideal sedative effect, reduce adverse reactions, and improve operator experience. Hence, its use should be promoted for pediatric patients undergoing bronchoscopy under local anesthesia and conscious sedation.

A mathematical model for predicting liquid flow velocity in a rectangular microchannel driven by capillary force and gravity is derived. The model takes into account the additional driving force arising from the wettability gradient on inner surface of a microchannel. The results of model prediction show that the velocity of liquid flow decreases with the length of microchannel and the wettability gradient on channel surface will accelerate the motion of the liquid when the flow-front approaches to the end of the microchannel. The analysis of driving force along the moving path matches well with the flow velocity predicted by the model.

Rationale Calcium-sensing receptor (CaSR) mutations can cause life-threatening neonatal severe hyperparathyroidism (NSHPT). The medical management of NSHPT is often challenging and complex. Here, we present a case of NSHPT caused by a novel homozygous CaSR mutation. Patient concerns A Chinese female infant presented with poor feeding, constipation, severe hypotonia, and periodic bradycardia. Biochemistry tests revealed markedly elevated serum levels of Ca and parathyroid hormone (PTH). Diagnoses Genetic sequencing revealed a previously undescribed CaSR mutation in exon 3 (c.242T>A; p.I81K). A diagnosis of NSHPT secondary to homozygously inherited familial hypocalciuric hypercalcemia syndrome was established. Interventions Cinacalcet was administered after the common treatments (low-calcium intake, hydration, and furosemide), calcitonin, and pamidronate therapy all failed. Outcomes Serum Ca decreased and stabilized with cinacalcet therapy. During a 10-month follow-up, total calcium was maintained within the high-normal range and PTH was normalized. Lessons A trial of cinacalcet therapy might be undertaken in cases of NSHPT while definitive results of the genetic analysis are awaited.