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Objective:To investigate the expression of soluble CD40 ligand (sCD40L) in serum of children with Kawasaki disease at acute stage and its diagnostic value in coronary artery disease (CAL).Methods:This study adopts case-control study method. Select 127 children with Kawasaki disease admitted to Xuzhou Children's Hospital affiliated to Xuzhou Medical University from August 2021 to August 2022. They are divided into CAL group and non-CAL group according to the degree of coronary artery involvement. Select 30 healthy children who have physical examination in this hospital at the same time as the healthy control group, and select another 30 children with acute upper respiratory tract infection and fever admitted to this hospital at the same time as the fever control group.Compare the sex, age and laboratory indicators of children with Kawasaki disease with or without CAL, and compare the difference between the serum sCD40L level of children with Kawasaki disease with or without CAL and the fever control group and the healthy control group, the serum sCD40L level of children with different degrees of coronary artery dilation, and analyze the correlation between the serum sCD40L and various laboratory indicators of children with Kawasaki disease and the influencing factors of children with Kawasaki disease complicated with CAL, To evaluate the screening effect of serum sCD40L for Kawasaki disease complicated with CAL. The measurement data with normal distribution is expressed by xˉ± s, the comparison between the two groups adopts independent sample t-test, the comparison between multiple groups adopts one-way ANOVA, and the comparison between two groups adopts LSD method and Bonferroni correction; The measurement data of non-normal distribution is expressed by M( Q1, Q3), and the comparison between the two groups is conducted by Mann-Whitney U test. Pearson method and Spearman mothod were used for correlation analysis. Logistic regression model was used to analyze the influencing factors of children with Kawasaki disease complicated with CAL. The diagnostic value of serum sCD40L level in Kawasaki disease complicated with CAL was analyzed by drawing the ROC curve. Results:All 127 children with Kawasaki disease were divided into CAL group (45 cases) and non-CAL group (82 cases) according to the presence or absence of CAL. The serum level of sCD40L in CAL group was higher than that in non-CAL group, healthy control group and fever control group ((7.03±0.91) μg/L vs (4.66±1.23), (1.73±0.96), (2.21±1.08) μg/L), the difference was statistically significant (all P<0.001). The serum level of sCD40L in children with coronary artery dilation in CAL group was lower than that in children with small CAA, medium CAA and large CAA ((6.04±0.22) μg/L vs (6.95±0.69), (8.02±0.57), (8.23±0.26) μg/L), the difference was statistically significant (all P<0.001). Serum sCD40L level and platelet count (PLT), C-reactive protein (CRP), N-terminal pro brain natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), IL-8 and tumor necrosis factor (TNF-α) in children with Kawasaki disease All were positively correlated ( r=0.31, P<0.001, r=0.32, P<0.001, r=0.26, P=0.003, r=0.58, P<0.001, r=0.27, P=0.002, r=0.39, P<0.001). Serum sCD40L, IL-6 and NT-proBNP were the risk factors of complicated CAL in children with Kawasaki disease (odds ratio 1.21, 1.06 and 1.01, 95% confidence interval 1.03-1.43, 1.01-1.12, 1.00-1.01, P values were 0.022, 0.011 and 0.039, respectively). The area under the curve of serum sCD40L in diagnosing Kawasaki disease complicated with CAL was 0.928 (95% confidence interval: 0.885-0.971), and the optimal critical value was 5.60 μg/L, the sensitivity was 97.8% and the specificity was 79.3%. Conclusions:The level of serum sCD40L increased in children with Kawasaki disease in acute phase, especially in children with CAL. The level of serum sCD40L increased with the severity of CAL, which is a risk factor for Kawasaki disease complicated with CAL, and has certain diagnostic value for Kawasaki disease complicated with CAL.
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OBJECTIVES@#To investigate the clinical features and treatment strategies of multisystemic inflammatory syndrome in children (MIS-C) after severe acute respiratory syndrome coronavirus 2 infection.@*METHODS@#A retrospective analysis was performed on the medical data of four children with MIS-C who were admitted to the Department of Cardiology, Xuzhou Children's Hospital, Xuzhou Medical Universityfrom January to February 2023.@*RESULTS@#All four children had multiple organ involvements and elevated inflammatory markers, with a poor response to standard therapy for Kawasaki disease after admission. Two children were treated with intravenous immunoglobulin therapy pulse therapy twice, and all four children were treated with glucocorticoids. The children had a good prognosis after the treatment.@*CONCLUSIONS@#MIS-C often appears within 4-6 weeks or a longer time after severe acute respiratory syndrome coronavirus 2 infection, and anti-inflammatory therapy in addition to the standard treatment regimen for Kawasaki disease can help to achieve a favorable treatment outcome.
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Child , Humans , COVID-19/complications , SARS-CoV-2 , Mucocutaneous Lymph Node Syndrome/drug therapy , Retrospective Studies , Systemic Inflammatory Response Syndrome/therapyABSTRACT
Objective To understand the acceptability and relevant impact factors of provider initiated testing counseling (abbreviated as PITC) in Liangshan Yi autonomous prefecture,so as to promote strategies for the sustainable development of PITC in AIDS epidemic areas.Methods Four medical institutions were selected with rates of acceptance counted.Multi-factors logistic regression was used to analyze the impact factors from the completed questionnaires.Results Among the 413respondents,197 patients accepted the PITC,with an acceptance rate as 47.7％ (95％ CI:42.9％-52.3％).Factors as being female (OR=7.283,95％CI:3.933-13.465),acceptance of publicity (OR=1.855,95％ CI:1.013-3.395),worried about being infected of HIV/AIDS (OR=2.699,95％ CI:1.616-4.506) etc.were protect factors of PITC,while those who previously received HIV testing (OR=0.226,95％CI:0.124-0.409),afraid of taking blood test (OR=0.052,95％CI:0.024-0.106),knowing more AIDS related knowledge (OR=0.446,95％ CI:0.258-0.773) would significantly reduce the rate of acceptance.Conclusion Nearly half of the outpatients from medical institutions were willing to accept PITC in Liangshan Yi prefecture,thus provided important chance for HIV screening.Ways as strengthening related counseling before and after HIV test,launching effective HIV/AIDS-related publicity and advocating correct knowledge on blood testing,etc.need to be promoted,in order to improve the acceptability of PITC.
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<p><b>OBJECTIVE</b>To explore the effects of transplanted BMSCs (bone marrow mesenchymal stem cells) on cardiac function and ventricular remodeling in rats with isoproterenol (ISO) induced heart failure.</p><p><b>METHODS</b>Wistar rats (n=50) received ISO (170 mg x kg(-1) x d(-1) for 4 days) injection. Four weeks later, rats with left ventricular ejection fraction (LVEF < 70%, n=26) were randomly assigned to receive intramyocardially BMSCs (2 x 10(7)/ml, 150 microl) injection (n=13) or equal volume culture medium (n=13). Another 10 normal rats served as normal controls. Four weeks after transplantation, heart function was assessed again by echocardiography, left ventricular morphology was evaluated through H&E and Masson's trichome staining. Transplanted cells were observed by fluorescent microscope. RT-PCR and Western blot were performed to examine the myocardial expressions of type I and type III collagens, as well as MMP-2 and MMP-9.</p><p><b>RESULTS</b>LVEF [(78.51 +/- 6. 78)% vs. (65.40 +/- 12. 33)%] and LVFS [fractional shortening, (42.09 +/- 6. 53)% vs. (32.38 +/- 10. 22)%, all P < 0. 05] were significantly increased and LVDs [left ventricular systolic diameter, (2.91 +/- 0. 54) mm vs. (3.83 +/- 0.69) mm, P < 0.05] was significant decreased in BMSCs treated rats compared with culture medium treated rats. Myocardial fibrosis was also significantly attenuated in BMSCs rats than that in culture medium treated rats. The myocardial expressions of type I and type III collagens, as well as MMP-2 and MMP-9 were significantly decreased in the BMSCs group compared with those in culture medium treated group.</p><p><b>CONCLUSIONS</b>BMSCs transplantation can significantly improve heart function and attenuate LV remodeling in rats with ISO-induced heart failure mediated by reducing myocardial fibrosis and downregulation of myocardial MMP-2 and MMP-9 expressions.</p>