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ObjectiveTo study the effect and mechanism of Xiangsha Liu Junzitang combined with phlegm-removing and detoxifying traditional Chinese medicine on immune escape in Lewis lung cancer mice. MethodA total of 60 specific-pathogen-free （SPF）-grade C57BL/6J male mice were injected subcutaneously with 0.2 mL of Lewis cell suspension （containing 2×106 cells·mL-1） in the right mid-axillary line. After 7 days， the mice that had been successfully modeled were randomly divided into six groups： the model group， the cisplatin group， the Xiangsha Liu Junzitang low-， medium-， and high-dose groups， and the combined group， with 10 mice in each group. The Xiangsha Liu Junzitang low-， medium- and high-dose groups were gavaged with 17.88， 35.75， 71.50 g·kg-1 Xiangsha Liu Junzitang solution once a day， respectively， and the dosage of cisplatin intraperitoneally injected into the mice was converted to 5 mg·kg-1 twice a week， and the tumour volumes of each group were measured every two days. The intervention lasted for 14 consecutive days. At the end of treatment， the tumour mass of mice in each group was weighed and the tumour inhibition rate was calculated. The morphological characteristics of tumours in each group were observed by hematoxylin-eosin （HE） staining. Fluorescent quantitative real-time polymerase chain reaction （Real-time PCR） assay was used to detect messenger ribonucleic acid （mRNA） contents of the natural killer group 2 member D （NKG2D） receptor， ribonucleic acid export-1 （RAE-1）， and γ interferon （IFN-γ） in the tumour tissues of each group. NKG2D， RAE-1， and IFN-γ mRNA in tumour tissues of each group. Immunohistochemistry （IHC） and Western blot were applied to detect the expressions of RAE-1， NKG2D， and IFN-γ in tumour tissues of each group， and Western blot was used to detect the expressions of interleukin-6 （IL-6）， Janus kinase 2 （JAK2）， p-JAK2， signal transducer and activator of transcription 3 （STAT3）， and p-STAT3 in tumour tissues of each group， as well as the protein levels of NKG2D， and RAE-1 in spleen tissues of each group. ResultCompared with that in the model group， the tumour mass decreased in all dose groups of Xiangsha Liu Junzitang， with no statistically significant difference. The tumour volume was reduced （P<0.05， P <0.01）. The pathological morphology was improved. The mRNA contents of NKG2D， RAE-1 and IFN-γ were increased in the medium-dose group （P<0.05， P<0.01）， and the protein expressions of NKG2D， RAE-1， and IFN-γ in tumour tissues were elevated （P<0.05， P<0.01）， and p-JAK2 and p-STAT3 protein expressions were decreased （P<0.05， P<0.01）. In spleen tissues， the protein expressions of NKG2D and RAE-1 in all dose groups of Xiangsha Liu Junzitang were significantly elevated （P<0.01）. Compared with those in the cisplatin group， NKG2D， RAE-1 and IFN-γ mRNA contents were elevated in the middle-dose group of Xiangsha Liu Junzitang， and the difference was not statistically significant. IHC showed that the protein expressions of NKG2D and IFN-γ in the combined group were significantly elevated （P<0.01）， and Western blot results showed that the protein expressions of RAE-1， NKG2D and IFN-γ were elevated （P<0.05， P<0.01）. p-JAK2 and p-STAT3 protein expressions were decreased in the combined group （P<0.05， P<0.01）. NKG2D and RAE-1 protein expressions were significantly increased in spleen tissues of the medium-dose groups and the combined group （P<0.01）. ConclusionXiangsha Liu Junzitang combined with phlegm-removing and detoxifying traditional Chinese medicine can inhibit the growth of tumours in Lewis lung cancer mice by up-regulating the expressions of RAE-1/NKG2D， promoting the activation of NK cells， and inhibiting immune escape， the mechanism of which may be related to down-regulation of the JAK2/STAT3 pathway.
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In order to implement the teaching philosophy of "early clinical, multiple clinical, and repeated clinical", this study takes the "New Medical Professional Experience Social Practice" as a research course, analyzes the reform of pediatric clinical teaching, and evaluates the teaching effectiveness through classroom interviews and post-class questionnaire surveys. The results showed that through the combination of online and offline learning and multiple evaluation models, it was found that students with more hands-on teaching content in offline teaching were more interested and evaluated. Eight-year students had higher participation in offline teaching than five-year students, and 8-year students also rated online teaching higher than five-year students. A total of 151 [84.36%(151/179)] students have learned about the clinical work of pediatricians through this course. The reform of pediatric clinical teaching based on the concept of early clinical teaching can achieve the teaching goal of early clinical practice and early contact for medical students.
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Objective:To explore the characteristics of patients with Alagille syndrome(ALGS), so as to provide evidence for early clinical diagnosis.Methods:The clinical data of 13 children diagnosed with ALGS in Children′s Hospital of Chongqing Medical University from February 2014 to November 2018 was retrospectively analyzed, and some children were followed up.Results:Among the 13 patients, 12 cases(92.3%) had cholestasis, 8 cases(61.5%) with heart malformation, 5 cases(38.5%) with characteristic facial features, 5 cases(38.5%) with pruritus, and 1 case(7.7%) with a positive family history.Among the 7 pediatric ophthalmologists, 2 patients suffered from ocular lesions.Seven patients underwent spine radiography, and 1 patient had typical butterfly vertebra.In the 9 cases with hepatic pathology, 4 cases had partial hepatic sinus pressure or occlusion, 1 case had no small bile duct in part of the portal area, 4 cases had small bile duct hyperplasia, and 5 cases underwent biliary tract exploration.Genetic testing of 12 children with ALGS showed JAG1 gene mutation in 8 cases and NOTCH2 gene mutation in 4 cases.Among the 11 followed up patients, 8 cases were in stable condition, 1 patient with progressive cirrhosis was registered for liver transplantation, 1 patient died of liver failure, and 1 patient developed with drug-induced liver injury at the age of 4 months had progressive liver failure, and the jaundice was gradually subsided after liver transplantation. Conclusions:ALGS may appear on multiple systems involvement, and it demonstrates variable clinical expressivities and incomplete penetrance, thus bring certain difficulties to clinical diagnoses.It′s easily misdiagnosed as biliary atresia in infancy.Genetic testing is integral in the diagnosis of ALGS.
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Food protein-induced enterocolitis (FPIES) is a non-IgE mediated food allergy that occurs primarily in infants and children.Although the hypotension or even shock occurs and might need to go to emergency department in severe patient with FPIES,there is an overall lack of knowledge about FPIES.Misdiagnosed or delayed diagnosis might be due to the absence of non-invasive diagnostic biomarker or diagnostic program specifically for FPIES,an overall lack of understanding of FPIES,and a combination of nonspecific symptoms.A clinical history and oral food challenges are the main diagnostic tools.Take care to exclude other potential causes before diagnosis established in the case of the history unclear.Avoidance of trigger food is the main treatment.During a acute episode,intravenous fluids may be required,and the complications need to be treated as well.
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Objective To investigate the clinical characteristics and etiology in infants undergoing colonoscopy in order to improve the understandings of lower gastrointestinal tract diseases and their endoscopic manifestations.Methods The clinical and endoscopic data of the infants aged ≤ 3 years old who underwent conoloscopy at the Department of Gastroenterology,Children's Hospital of Chongqing Medical University,from July 2010 to December 2014,were retrospectively analyzed.A total of 223 children were included,148 male and 75 female.The age range was from 26 d to 3 years old(＜6 months:41 cases;6-12 months:68 cases;1-3 years old:114 cases).Results A total of 235 colonoscopies were performed under deep sedation by single or double manipulators.Cecal intubation was successful in 192 colonoscopies and terminal ileal intubation was completed in 29 colonoscopies,with a high success rate of 94.0％ (221/235 colonoscopies).The main symptoms included hematochezia (124 cases,55.6％),persistent/chronic diarrhea (55 cases,24.7％),hematochezia with chronic diarrhea(22 cases,9.5％),and others(22 cases,9.5％).Of the 223 patients,clear diagnosis were established for 215 children (96.4％),with food protein-induced proctocolitis (FPIPC) (78/223 cases,35.0％),colonic polyps (50/223 cases,22.4％),colitis (29/223 cases,13.0％),antibiotic associated diarrhea (AAD) (19/223 cases,8.5％),FPIPC with AAD (10/223 cases,4.5％).Conclusions Colonoscopy serves as a very important tool for the accurate diagnosis of lower gastrointestinal diseases with hematochezia and/or chronic diarrhea.FPIPC and colonic polyps are the most common causes for hematochezia and/or chronic diarrhea.AAD may be another important cause of chronic diarrhea and bloody stool in infants.Moreover,ghe application of colonoscopy in combination with histopathology can also play an important role in the diagnosis of some rare diseases,such as intestinal tuberculosis,primary intestinal lymphangiectasia,Behcet's disease and primary immunodeficiency disease.
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Autoimmune hepatitis (AIH) is a chronic and progressive inflammation of liver caused by the disorder of immunoregulation,and characterized by the presence of autoantibodies,elevated level of immunoglobulin G,and interface hepatitis histologically.As its clinical feature is not particular and the international diagnosis criteria is rarely applied in children,the diagnosis of pediatric AIH is difficult to make.It's essential for the good prognosis to recognize and diagnose the disease in early stage,as well as to treat it promptly and maintain regular follow-up.Now,the recent progress of pathogenesis,diagnostic criteria and management of AIH in children were summarized.
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Objective To assess whether the delivery of 100% of the nutritional target from days 4 to 8 in the ICU with enteral nutrition plus supplemental parenteral nutrition(SPN) could optimize clinical outcome .Methods A total of 300 critically ill patients who had received less than 60% of their energy target from enteral nutrition(EN) were randomized to treatment group(n=150) and control group (n=150) .After using the stochastic indicator method after day 3 of admission to the ICU ,one received EN and the other received EN plus SPN during days 4 to 8 ,then we calculated energy targets with indirect calorimetry repeatedly .Results The mean energy delivery between day 4 and 8 was 28 kcal? kg -1 ? d-1 for the EN plus SPN group ,compared with 20 kcal?kg -1 ?d-1 for the EN group .Between days 9 and 28 ,the EN plus SPN group had a lower incidence of nosocomial infection com‐pared with EN group (P0 .05) .Conclusion Individually optimized nutritional supplementation with enteral nutrition plus supplemen‐tal parenteral nutrition starting 4 days after ICU admission could reduce nosocomial infections and should be considered as a strate‐gy to improve clinical outcome in patients in the ICU for whom EN is insufficient .
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<p><b>OBJECTIVE</b>To explore the influence of vitamin E (VitE) concentration in serum on peripheral nerve conduction in patients with infantile hepatitis syndrome (IHS).</p><p><b>METHODS</b>A retrospective study was carried out in 58 infants suffered from IHS without congenital biliary atresia and 31 of them were followed up. Thirty-two healthy infants were as control. The level of VitE in serum was detected with high performance liquid chromatography and nerve conduction was tested with surface electrodes along the nerves of limbs. The relationship between the level of VitE or total bilirubin (TB) or direct bilirubin (DB) and the nerve conduction velocity was analyzed comparatively.</p><p><b>RESULTS</b>(1) The serum level of VitE was below the lower limit of 90% the normal value (13.78 micromol/L) in 71% (41/58) of patients, and was below the lower limit of 99% the normal level (9.17 micromol/L) in 48% (28/58) of patients. (2) The level of DB was more than 25.7 micromol/L in 86% (50/58) of the patients and was more than 102.6 micromol/L in 47% (27/58) of patients. Severe conjugated hyperbilirubinemia with cholestasis was demonstrated in most patients. (3) At least one abnormal parameter in nerve conduction test was found in 86% (50/58) patients. In 144 nerves tested, 60.4% (87/144) had at least one abnormal parameter. (4) Analysis for the association between bilirubin levels and VitE concentration in serum: in groups of DB > or = 25.7 micromol/L and DB < 25.7 micromol/L, the percentage of decreased VitE concentrations was 78% (39/50) and 25% (2/8), respectively, and the difference was significant (P < 0.01). Similar association between low VitE concentration and increased level of TB in serum could not be demonstrated. (5) Analysis for the association between abnormal nerve conduction and VitE concentration in serum: in the two groups with low and normal level of VitE, the percentage of abnormal nerve conduction was 93% (38/41) and 71% (12/17), respectively (chi(c)(2) = 4.93, P < 0.05). (6) Analysis for the association between abnormal nerve conduction and bilirubin in serum: There was no significant association between abnormal nerve conduction and serum level of either DB or TB. (7) Eight patients died and 9 patients had motor development delay in 31 patients during follow up. In these 17 patients with poor outcome, 88% (15/17) had very low VitE levels (< 9.17 micromol/L), which was markedly higher than the proportion of cases (43%, 6/14) with better prognosis (chi(c)(2) = 7.235, P < 0.01).</p><p><b>CONCLUSIONS</b>(1) Low VitE serum levels were found in excess of the two thirds of patients with IHS and severely decreased levels in nearly a half of them. (2) A conjugated hyperbilirubinemia with cholestasis could be found in most patients (86%) suffered from IHS without congenital biliary atresia and about a half of them had serious cholestasis. (3) Conjugated hyperbilirubinemia with cholestasis could be the predominant cause of decreased serum VitE level in this study. (4) Abnormality of nerve conduction in patients with IHS might be related to VitE deficiency.</p>
Subject(s)
Female , Humans , Infant , Male , Bilirubin , Blood , Cholestasis, Intrahepatic , Blood , Follow-Up Studies , Hepatitis , Blood , Peripheral Nerves , Retrospective Studies , Syndrome , Vitamin E , BloodABSTRACT
Objective To investigate the safety,therapy and prophylactic effect of Omeprazole on stress ulcer in children with epidemic type B encephalitis.Methods Before and after medication,chest X-ray examination was performed.The result of occult blood(OB) was confirm by Colloidal gold assay in stool and/or gastric juice.Based on the result of OB,the patients were divided into therapy group[besides conventional therapy for encephalitis,Cimitidine group and Omeprazole group with positive result OB,was administered with 0.9% normal sodium 100 mL+Cimitidine 20-40 mg/(kg?d),iv,q12 h and normal sodium 100 mL+Omeprazol 0.5-0.8 mg/(kg?d),iv,qd,respectively] and prophylaxis group(Cimitidine group,Omeprazole group and control group,with negative result OB,were administered with same medicines as therapy group,respectively.Except control group being administered only 0.9%NS 100 mL,iv,(q12 h)).The effects of drugs on hemostasis,preventing hemorrhage,and the potential risk of acquired pneumonia result from drugs used were observed.Results In therapy group,the average time of hemostasis in Omeprazole group was obviously shorter than that of in Cimitidine group,there was significant difference between two groups(P0.05).Conclusions Both of the drugs is safety and effect to therapy or prophylaxis for the latent stress ulcer in short term.The effect of Omeprazole is better than those of Cimitidine.Using Cimitidine and Omeprazole,neither therapy nor prophylaxis for stress ulcer increaseds the potential risk of acquired pneumonia in children with epidemic type B encephalitis in this study.