Blood purification therapy for severe rheumatic autoimmune disease in children / 中国实用儿科杂志

Systemic lupus erythematosus,anti-neutrophil cytoplasmic antibodies associated vasculitis,thrombotic microangiopathy,Henoch schonlein purpura,Guillain-Barre syndrome and myastheniagravis are common rheumatic autoimmune diseases in children. Severe cases can be life-threatening,and medication is sometimes ineffective in controlling the condition. In recent years,blood purification therapy has been widely used in pediatric rheumatic autoimmune disease. This paper reviews the new clinical research,consensus and guidelines.

Influence of PAX2 gene silencing on renal interstitial fibrosis in rats / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the influence of silencing PAX2 gene in vivo on epithelial-mesenchymal transition (EMT) of renal tubular cells in rats with renal interstitial fibrosis.</p><p><b>METHODS</b>A total of 64 Wistar rats were anaesthetized, and unilateral ureteral obstruction (UUO) was performed to establish a rat model of renal interstitial fibrosis. The 64 rats were randomly divided into negative control and PAX2 gene silencing groups (n=32 each). The rats in the control group were transfected with 200 μL NC-siRNA-in vivo jetPEI(TM) solution. Those in the PAX2 gene silencing group were transfected with 200 μL PAX2-siRNA-in vivo jetPEI(TM) solution. Each group was further divided into 4 subgroups based on the post-transfection time (3, 5, 7 and 14 days after transfection), with 8 rats in each subgroup. Renal tissue samples were harvested in each group. Real-time PCR and Western blot were used to measure the mRNA and protein expression of PAX2 in the renal cortex, as well as the mRNA and protein expression of E-cadherin and α-SMA.</p><p><b>RESULTS</b>Compared with the control group, the PAX2 gene silencing group showed significantly lower mRNA and protein expression of PAX2 (P<0.05). In the two groups, the mRNA and protein expression levels of E-cadherin were gradually reduced over the time of obstruction, while those of α-SMA gradually increased. At 14 days after transfection, the PAX2 gene silencing group had significantly higher mRNA and protein expression of E-cadherin but lower mRNA and protein expression of α-SMA compared with the control group (P<0.05).</p><p><b>CONCLUSIONS</b>PAX2 gene silencing can significantly inhibit the process of EMT of renal tubular cells in rats with advanced fibrosis, suggesting that PAX2 gene silencing may have a therapeutic effect on renal interstitial fibrosis.</p>

Prevalence of overweight and obesity among children and adolescents in Shenyang and its relationship with birth weight / 中华实用儿科临床杂志

Objective To determine the prevalence of overweight and obesity among children and adolescents in Shenyang and the relationship between the birth weight to overweight and obesity in the childhood aged 7 to 17 years.Methods A stratified cluster representative sample of 5800 children and adolescents aged 7 to 17 years from 27 schools among 3 regions in Shenyang was selected.The study was carried out by using questionnaire about birth weight and physical examination including weight and height.Overweight and obesity were defined according to body mass index cutpoint.The body mass index classification criteria recommended by the Chinese Working Group on Obesity for Children(WGOC) was adopted,and the relationship between birth weight and overweight or obesity in children and adolescents were analyzed by collecting the information associated with overweight or obesity.Results The overall combined prevalence of overweight and obesity was 21.13％ with obesity as 7.12％ based on the WGOC criteria,and children of 10 to 12 years old were high-risk population groups.The risk of a male becoming overweight or obesity was 2.01 times higher than the risk of a female.The prevalence of overweight and obesity in Shenyang were level Ⅱ,especially for males the incidence of overweight and obesity of high birth weight babies was 1.73 (95％ CI:1.51-2.87) times higher than that of normal birth weight babies,while the incidences of overweight and obesity between low birth weight babies and normal birth weight babies were not statistically different.Conclusions The study indicated that the prevalence of overweight or obesity children and adolescents are level Ⅱ in Shenyang.There is high risk to be overweight and obesity in adolescences and especially for males.To decrease overweight and obesity in children and adolescents we should pay greater attention to fetus period.

Effects of glutamine on extracellular signal regulated kinase and p38MAPK expression in the kidney in young rats with endotoxemia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Glutamine has protective effects against renal injuries. This study was designed to explore the possible mechanism underlying the protections by examining the effects of glutamine on extracellular signal regulated kinase (ERK) and p38MAPK expression in the kidney in rats with endotoxemia.</p><p><b>METHODS</b>One hundred and twenty-one 18-day-old Wistar rats were randomly injected with LPS (4 mg/kg; n=55), LPS (4 mg/kg)+glutamine (1 mL/kg) (n=55), or normal saline (control group; n=11). The two LPS groups were subdivided into five groups sacrificed at 2, 4, 6, 24 and 72 hrs after administration (n=11 each). ERK-2 and p38MAPK mRNA and protein expression in the kidney were measured by RT-PCR and immunohistochemistry.</p><p><b>RESULTS</b>Compared to the control group, the mRNA and protein expression of both ERK-2 and p38MAPK in the LPS group significantly increased 2, 4, 6, 24 and 72 hrs after administration (P<0.01), and reached a peak at 6 hrs (P<0.01). In the LPS+glutamine group, the trend of ERK-2 and p38MAPK expression was similar to the LPS group but their expression levels were significantly lower than those in the LPS group at all time points (P<0.05 or 0.01).</p><p><b>CONCLUSIONS</b>Both ERK-2 and p38MAPK expression increased in young rats with LPS-induced endotoxemia. Glutamine alleviates renal injuries possibly by decreasing the expression of both.</p>

A prospective multicenter clinical control trial on treatment of refractory nephrotic syndrome with mycophenolate mofetil in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of mycophenolate mofetil (MMF) plus prednisone on refractory nephrotic syndrome (RNS) in children.</p><p><b>METHODS</b>One hundred and forty-two children with RNS from ten clinical trial centers were divided into two groups: MMF (n=87) and control (n=55). The MMF group patients were administered with oral MMF (30-40 mg/kg daily) for at least 6 months. Afterwards the patients who responded to MMF received another 6 months MMF treatment at a dosage of 10-20 mg/kg daily. The controls were treated with pulse intravenous infusion of cyclophosphamide (CTX) (10 mg/kg daily) for 2 days every 2 weeks for 3 months. Then CTX was administered at a dosage of 500 mg/m2 once a month 4, 7 and 10 months after treatment. While the patients received MMF or CTX treatment, they were treated with oral prednisone (0.5-1 mg/kg daily) for 2 to 3 months, and then the dosage of prednisone was gradually reduced. Urinary protein, liver and renal functions, and side effects of drugs were examined at regular intervals for one year.</p><p><b>RESULTS</b>Of the 87 patients, 58 achieved complete remission, 16 achieved partial remission, 9 achieved early remission and 4 had no response to treatment. In the control group, 35 achieved complete remission, 9 achieved partial remission, 1 achieved early remission and 10 had no response to treatment. The total remission rate in the MMF group (95.4%) was significantly higher than that in the control group (81.8%) (P<0.01). After treatment 67 patients (65.4%) in the MMF group had negative proteinuria compared with 36 patients (65.4%) in the control group (P>0.05). MMF was found to be more effective in reducing proteinuria, and improving hypoproteinemia, oliguria, hyperlipemia, and edema than CTX. MMF was better tolerated with lower incidences of adverse reactions than CTX.</p><p><b>CONCLUSIONS</b>The combined therapy of MMF and prednisone is more effective and tolerable than pulse intravenous infusion of CTX for treatment of RNS in children.</p>

Effect of dexamethasone on nitric oxide synthase and Caspase-3 gene expressions in endotoxemia in neonate rat brain / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the gene and protein expressions of three isoforms of nitric oxide synthase (NOS) and gene expression of Caspase-3, and effect of dexamethasone on them in neonatal rats with lipopolysaccharide (LPS)-induced endotoxemic brain damage.</p><p><b>METHODS</b>Expressions of the three isoforms of NOS and caspase-3 mRNA in the brain were investigated by RT-PCR in postnatal 7-day Wistar rats with acute endotoxemia by intraperitoneal administration of LPS. Regional distributions of NOSs were examined by immunohistochemical technique.</p><p><b>RESULTS</b>nNOS and Caspase-3 mRNA were obviously detected. eNOS mRNA was faintly expressed, but iNOS mRNA was undetectable in the control rat brain. The expressions of NOS mRNA of three isoforms were weak 2 h after LPS (5 mg/mg) delivery, peaked at 6 h, and thereafter, reduced gradually up to 24 h. The expression intensity was in the order of nNOS> iNOS> eNOS. Widespread nNOS, scattered eNOS distribution and negative iNOS were identified in the control rat brain and all isoforms of NOS could be induced by LPS which reached the apex at 24 h in the order of nNOS> iNOS> eNOS as detected by immunostaining. Although Caspase-3 mRNA could be found in all groups, DNA fragmentation was only seen at 6 h and 24 h. The expressions of NOS and Caspase-3 mRNA were inhibited in the rat brain when dexamethasone was administrated.</p><p><b>CONCLUSION</b>LPS-induced NO production induces apoptosis of neurons through mechanism involving the Caspase-3 activation, which may play an important role in the pathogenesis of brain damage during endotoxemia, and neuro-protective effects of dexamethasone may be partially realized by inhibiting the expression of NOS mRNA.</p>

Changes of platelet endothelial cell adhesion molecule-1, tissue type plasminogen activator and plasminogen activator inhibitor-1 expression in the lung tissue of neonatal rats after intraperitoneal injection with lipopolysaccharide / 中华儿科杂志

<p><b>OBJECTIVE</b>To further explore the pathogenesis of neonatal acute lung injury and neonatal pulmonary hemorrhage by establishing the animal model of neonatal acute lung injury (ALI) and by investigating the changes of platelet endothelial cell adhesion molecule-1 (PECAM-1), tissue type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) in ALI.</p><p><b>METHODS</b>Totally 88 neonatal rats which were divided into 8 groups randomly including one normal saline control group and 30 min, 1 h, 2 h, 4 h, 8 h, 16 h and 24 h post injection groups. The changes of lung pathology in newborn rats were observed at different time after LPS was injected intraperitoneally. The changes of PECAM-1 protein, t-PA and PAI-1 mRNA expression were measured by immunohistochemistry and RT-PCR.</p><p><b>RESULTS</b>The expression of PECAM-1 protein and mRNA was decreased and the lowest level was reached at 8 h and 16 h post injection, respectively. The average values were 95.1 +/- 9.76 and 0.861 +/- 0.016, respectively, which were significantly lower than those in the control group (129.5 +/- 6.15, 1.192 +/- 0.035, P < 0.01). The expression of t-PA and PAI-1 mRNA was increased after LPS was injected. The highest level of t-PA mRNA expression was observed at 2 h after injection. The average value was 1.195 +/- 0.036, which was significantly higher than that in the control group (0.781 +/- 0.017, P < 0.01). The highest level of PAI-1 mRNA expression was observed at 2 h, 4 h and 8 h post injection. The average values were 1.178 +/- 0.069, 1.153 +/- 0.036 and 1.176 +/- 0.044, respectively, which was significantly higher than those of the control group (0.681 +/- 0.019, P < 0.01).</p><p><b>CONCLUSIONS</b>The expression of PECAM-1 protein and mRNA was decreased after LPS injection, suggesting the disruption of the tissue protective mechanism; the expression of t-PA and PAI-1 mRNA was increased, indicating the presence of a hypercoagulability state. At the same time, the expression of t-PA mRNA was increased which caused the extra-cellular matrix degradation at the early phase after LPS injection. These three phenomena might be the contributory factors to pulmonary hemorrhage.</p>

Influence of Dexamethasone on Ultrastructure of Renal Cells in Rats with Endotoxemia / 实用儿科临床杂志

Objective To explore the mechanism of endotoxemic injury in kidneys and protective effect of dexamethasone on renal cells.Methods Fifty-four eighteen-day Wistar rats were divided into control,endotoxemic(LPS)and dexamethasone groups randomly,18 rats in every group.Rats in control group were injected intraperitoneally with the same volume(0.1 mL)of 9 g/L sodium chloride as other two groups.All rats in LPS group were injected with a single bolus of LPS(4 mg/kg).The rats in dexamethasone group received LPS(4 mg/kg)and dexamethasone(5 mg/kg).Then they were sacrificed at 6,24 and 72 hours after injection.The ultrastructure was observed by electron microscope.Results In LPS group,glomerular basement membrane became thick and foot processes had coalescent partly,mitochondrial cristae became dissolved in proximal tubular endothelial cells and microvillus of distal tubular diminished at 6,24 hours after LPS injection.The morphological changes of apoptosis were found in the proximal tubular at 72 hours after LPS injection.These changes were in dexamethasone group.Conclusion Apoptosis participates in LPS injury of kidneys and dexamethasone have protective effect on injuried renal cells.