Efficacy of adrenocorticotropic hormone in children with frequently relapsing or steroid-dependent nephrotic syndrome / 中华儿科杂志

Objective: To investigate the efficacy and safety of adrenocorticotropic hormone (ACTH) in children with frequently relapsing or steroid-dependent nephrotic syndrome. Methods: The clinical data of 38 children with frequently relapsing or steroid-dependent nephrotic syndrome who were admitted to the Department of Nephrology, the Children Hospital, Zhejiang University School of Medicine from January 2015 to December 2020 were retrospectively analyzed. The general information, clinical manifestations, laboratory data of the children and follow-up (till 12 months after treatment) were collected. The patients were divided into ACTH group and Glucocorticoid (GC) group according to treatment plan. Cumulative remission, average recurrence rate, GC dosage, height and weight change and peripheral blood CD19+B lymphocyte count were compared between the two groups to evaluate the efficacy and adverse reactions of ACTH. Fisher's exact test, t test or rank sum test was used for comparison between groups. Results: Among the 38 patients, 28 were male and 10 were female, aged 84 (24, 180) months; 19 were in ACTH group and 19 were in GC group. The cumulative remission rate of 12 months in ACTH group was higher than that in GC group (9/19 vs. 2/19,χ²=6.81,P=0.009), the average recurrence rate was lower than that in GC group ((0.7±0.8) vs. (1.7±1.1) times, t=-3.27, P=0.011), and the average dosage of GC was lower than that in GC group ((0.27±0.16) vs. (0.51±0.27) mg/(kg·d), t=-3.21, P=0.014). The increase in height was higher than that in the GC group (4 (3,5) vs. 3 (2, 3) cm/year, Z=2.58, P=0.010), and the peripheral blood CD19+B lymphocyte count was lower than that in the GC group ((223±149)×106 vs. (410±213)×106/L,t=-3.35, P=0.009). In safety, 19 cases had transient decreased urine volume, 7 cases had hyperglycemia, and 3 cases had hypertension during the infusion of ACTH, which could be relieved after drug withdrawal. Conclusion: ACTH has a better effect on children with frequently relapsing or steroid-dependent nephrotic syndrome, which can improve cumulative sustained remission rate, lower relapses rate and decrease the dosage of GC, with good safety.

Clinical Efficacy of Modified Shengyutang in Treatment of Active Stage Psoriasis Vulgaris due to Qi and Blood Deficiency / 中国实验方剂学杂志

Objective:To study the clinical efficacy of modified Shengyutang on patients with active stage psoriasis vulgaris due to Qi and blood deficiency. Method:The 134 cases were randomly divided into control group and observation group， with 67 cases in each group. The control group was given avic a capsule + Danggui Buxuewan， while the observation group was given avic a capsule + modified Shengyutang for 4 weeks， respectively. The psoriasis area and severity index （PASI）， dermatological life quality index （DLQI） and psoriasis vulgaris due to Qi and blood deficiency syndrome were observed before and after treatment. The serum growth factor ［endothelial cell specific molecule-1 （ESM-1）， transforming growth factor-<italic>β</italic>₁（TGF-<italic>β</italic>₁）， vascular endothelial cell growth factor （VEGF）］， hemorheological indicators ［high cut blood viscosity （HBV）， low cut blood viscosity （LBV）， erythrocyte sedimentation rate （ESR）］， CC cphenotype receptor（CCR）6， CC cphenotype ligand 20 （CCL20）， monocyte chemotactic protein-4 （MCP-4） in serum and tissue fluid of lesions were detected. Clinical efficacy and recurrence follow-up for 12 months were compared. The safety was evaluated between two groups. Result:Three cases in control group and one case in observation group fell off during the study period. The total effective rate was 96.97% （64/66） in observation group， which was higher than 81.25% （52/64） in control group （<italic>χ</italic>²=5.064， <italic>P</italic><0.05）. During the 12-month follow-up， the recurrence rate was 20.31% （13/64） in observation group， which was lower than 51.92% （27/52） in control group （<italic>χ</italic>²=6.038， <italic>P</italic><0.05）. Compared with control group after treatment， PASI， DLQI， TCM syndromes， ESM-1， TGF-<italic>β</italic>₁， VEGF， HBV， LBV， ESR， CCR6， CCL20 and MCP-4 in observation group were significantly reduced （<italic>P</italic><0.05）. No obvious blood and urine routine， or heart， liver and renal dysfunction was observed in the two groups. The incidence of adverse reactions was 3.03% （2/66） in observation group， which was lower than 26.56% （17/64） in control group （<italic>χ</italic>²=5.764， <italic>P</italic><0.05）. Conclusion:Modified Shengyutang can significantly improve the clinical symptoms of patients with active stage psoriasis vulgaris due to Qi and blood deficiency， with a low recurrence rate and the incidence of adverse reactions.

Mechanism of Mahuang Lianqiao Chixiaodou Decoction in treating eczema by network pharmacology and molecular docking technology / 中国中药杂志

To study the molecular mechanism of Mahuang Lianqiao Chixiaodou Decoction in the treatment of eczema by means of network pharmacology and molecular docking. First, the TCMSP database was used to excavate the active ingredient of each drug in Mahuang Lianqiao Chixiaodou Decoction and predict its target, and the Uniprot database was used to standardize the names of target proteins, in order to obtain the disease targets of eczema through GeneCards, OMIM, PharmGkb, DrugBank and other databases. And next, the potential targets on which drug targets and disease targets work together were selected to make a Venn diagram, the Cytoscape 3.6.1 software was used to screen out and construct the "active ingredient-core targets" network. STRING database was used to construct a protein-protein interaction(PPI) network, and the R language was used to perform GO enrichment analysis and KEGG pathway analysis. Finally, the molecular docking verification of main active ingredients and core targets of the drug was performed by AutoDock software. The study showed that 74 active ingredients and 103 targets of Mahuang Lianqiao Chixiaodou Decoction for the treatment of eczema were screened. The main active ingredients included quercetin, luteolin, wogonin, kaempferol, and the main targets included PTGS1, ESR1, PPARG, and MAPK3. In addition, eight key targets, including MAPK8, MAPK3, JUN, MAPK14, TP53, MAPK1, ESR1 and RELA, were calculated by PPI network. GO enrichment analysis involved 2 024 biological processes, 81 cell components, and 140 molecular functions. KEGG pathway enrichment analysis was performed to screen out 158 eczema-related pathways, which mainly acted on AGE-RAGE signaling pathway, IL-17 signaling pathway, virus-related pathways, and the results of molecular docking showed that the main active compounds could respectively bind to representative targets and exhibit a good affinity. The study proved that the treatment of eczema with Mahuang Lianqiao Chixiaodou Decoction involved multiple signaling pathways and biological processes, and the combination of main active ingredients(such as quercetin, luteolin, wogonin, kaempferol) and key targets(such as MAPK8, MAPK3, JUN, MAPK14, TP53, MAPK1, ESR1, RELA) may be one of the important mechanisms of action.

Suggestions for standardized management of nomenclature and classification of neonatal diseases / 中国当代儿科杂志

Nomenclature and classification of diseases are not only related to clinical diagnosis and treatment, but also involved in the fields such as management and exchange of medical information, medical expense payments, and medical insurance payment. In order to standardize clinical physicians' diagnostic and treatment activities, medical records, and the first page of medical records, this article elaborates on the basic principles and methods for nomenclature and classification of diseases with reference to international nomenclature of diseases and international classification of diseases. Meanwhile, in view of the problems in clinical practice, this article proposes the classification of neonatal diseases, the basic procedure and writing rules in the diagnosis of neonatal diseases, and death diagnosis principles.

A Meta-analysis on tea drinking and the risk of lung cancer in Chinese population / 中华流行病学杂志

Objective To examine the association between tea drinking and the risk of lung cancer in Chinese population.Methods All relevant published articles in Chinese and English literature database were identified.Meta-analysis was conducted.Combined odds ratio (OR) and 95％ confidence interval (CI) were calculated to estimate the associations and dose-response relationship between tea drinking and the risk of lung cancer.Results Twelve studies were included.An inverse association with lung cancer was observed on tea drinkers when compared to non-tea drinkers (OR=0.66,95％CI:0.49-0.89).Conclusion Tea drinking might serve as a protective factor on lung cancer in the Chinese population.

Prevalence of hypertension and glucose/lipid metabolism disorders in 4960 inpatients with chronic obstructive pulmonary disease during 2000-2010 / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the prevalence of hypertension and glucose/lipid metabolism induced by chronic obstructive pulmonary disease (COPD) in hospitalized patients and their correlations to age and gender.</p><p><b>METHODS</b>A retrospectively prevalence survey was conducted among the in-patients with COPD treated in General Hospital of PLA, Peking Union Medical College Hospital and Beijing Hospital between January 1st, 2000 and March 20th, 2010.</p><p><b>RESULTS</b>A total of 4960 COPD patients were selected, including 3570 male and 1390 female patients with a mean age of 72.2∓10.4 years. Among these patients, hypertension had the highest prevalence (40.3%), followed by diabetes/impaired glucose tolerance (18.8%) and then by hyperlipidemia/fat protein metabolism (6.9%). The prevalence of hyperlipidemia/lipoprotein metabolism in the COPD patients over 80 years old decreased significantly with age. The prevalence of hypertension increased with age. In patients over 50 years old, the prevalence of hypertension was significantly higher in female than in male patients (P<0.05). The prevalence of diabetes/impaired glucose tolerance increased with age in male patients but decreased in female patients aged :80 years (P<0.05). Female patients in 60-69.9 and 70-79.9 years groups had significantly higher incidence of diabetes/impaired glucose tolerance than male patients (P<0.05), but not at older ages. The incidence of hyperlipidemia/lipoprotein metabolism disorder increased with age in both male and female patients aged below 80 years (P<0.05), but in 60-69.9 and 70-79.9 year groups, female patients had a significantly higher incidence than male patients (P<0.05); at the ages :80 years, the incidences was lowered in both women and men without a gender-specific differences (P>0.05).</p><p><b>CONCLUSIONS</b>The data we obtained concerning the prevalence of hypertension and glucose/lipid metabolism disorder, age distribution, and gender characteristics of the COPD patients provide a clear target for secondary prevention of COPD.</p>

Clinical application of tacrolimus with low-dose prednisone in 21 children with steroid-resistant nephrotic syndrome / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze and evaluate the efficacy and safety of tacrolimus and low-dose steroids in the treatment of steroid-resistant nephrotic syndrome in children.</p><p><b>METHOD</b>Twenty-one children with steroid-resistant nephrotic syndrome enrolled from October 2008 to July 2010 into this retrospective longitudinal study received oral tacrolimus treatment, 0.1 to 0.15 mg/kg per day and once every 12 hours, and prednisone 0.2 to 0.75 mg/kg per day simultaneously. During the treatment, the plasma concentration of tacrolimus, urine volume, urine, serum creatinine and liver function were regularly monitored.</p><p><b>RESULT</b>After 1 to 3 months treatment, 14 cases showed complete remission and 7 cases had partial remission. Sixteen patients received renal biopsy, of whom 6 revealed minimal change nephropathy with complete remission in 3 cases, 3 cases had partial remission;4 cases revealed focal segmental glomerulosclerosis with 2 complete remission and 2 partial remission; other 5 children with IgM nephropathy and 1 mesangial proliferative glomerulonephritis achieved complete remission. Within treatment period, 6 patients presented transient adverse reactions, without altering the principle treatment strategy, but only taking the symptomatic treatment. During follow-up, 1 case was lost to follow-up and the remaining 20 cases were followed up from 2 months to 21 months. In 4 patients the disease relapsed within 1st-year follow-up, while at 2nd-year follow-up, 4 cases had (6 times) recurrence.</p><p><b>CONCLUSION</b>Tacrolimus showed a reliable effect in children with steroid-resistant nephrotic syndrome. Less adverse reactions were seen, and most of them could be tolerated. Nevertheless, the patients had a higher relapse rate after 1 to 2 years treatment. Therefore, the long-term effects of tacrolimus for steroid-resistant nephrotic syndrome remains to be further evaluated.</p>

Retrospective study on the prevalence of cardiovascular comorbidities in 4960 inpatients with chronic obstructive pulmonary disease in Beijing / 中华流行病学杂志

Objective To retrospectively explore the prevalence of cardiovascular disease (CVD) in inpatients with chronic obstructive pulmonary disease(COPD)in Beijing.Methods The COPD patients who were discharged from the General Hospital of the Liberation Army,Peking Union medical college Hospital and Beijing Hospital between January 1st,2000 to March 20th,2010,were investigated.The prevalence of CVD were calculated.The tendency of the prevalence of CVD by age or discharge year and the difference of the prevalence of CVD between male and female were estimated by using chi-square analysis.Results There were 4960 COPD patients who were in accordance with the inclusion criteria with 3570 males and 1390 females.The mean age was 72.2±10.4 years.Of the COPD patients,48.8% were diagnosed as cardiovascular diseases.The age-adjusted over-all prevalence of CVD was 26.4%.Chronic pulmonary heart disease and other disease of pulmonary artery(15.8%)was the most frequent diseases,followed by heart failure(13.6%),ischemic heart disease (10.6%).In COPD patients,male was more likely to have angina,pulmonary heart disease and other disease of pulmonary artery and acute kidney failure (P＜0.05),while less likely to get arrhythmia (atrial fibrillation/atrial flutter),heart failure,pulmonary embolism,hypertension and diabetes mellitus (P＜0.05).The prevalence of arrhythmia increased with age,however,the ischemic heart disease and heart failure decreased.The proportion of CVD decreased in male patients while increased in females.Conclusion The overall prevalence of CVD comorbidities was 48.8% in 4960 patients with COPD who were older than 40 years in Beijing.There were differences among the groups of various age and sex in the distribution of CVD comorbidities frequencies year by year.

Clinical features of 121 infants below 3 months of age with congenital syphilis / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features and diagnosis of infants under 3 months of age with congenital syphilis.</p><p><b>METHOD</b>Data of 121 infants below 3 months of age with congenital syphilis were collected from January 1997 to May 2007 at the authors' hospital. Their clinical features, laboratory findings and treatment were reviewed.</p><p><b>RESULT</b>Clinical manifestations of congenital syphilis in the infants were diverse. The disease involved multiple systems such as the skin, respiratory, digestive, blood, and nervous system, skeleton and so on. Among the 121 infants, the manifestations included increased leukocyte count (89.3%), skin damage (59.5%), hepatomegaly (56.2%), splenomegaly (41.3%), anemia (38.8%), fever (28.9%), pathologic jaundice (24.0%), growth retardation after birth (12.4%) and bone damage (54.3%), etc. The rate of misdiagnosis was 17.4 percent, and the kinds of disease misdiagnosed were up to 10.</p><p><b>CONCLUSION</b>Clinical manifestations of congenital syphilis in infants under 3 months of age were complicated and nonspecific, therefore doctors misdiagnosed it very easily. Clinicians should attach great importance to it. At the same time, the restoration of antemarital examination, vigorously carrying out screening for syphilis and strengthening the management of immigrants are necessary to prevent congenital syphilis.</p>

Relationship between perinatal characteristics and later activities of daily living in Chinese elderly people / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are no reports on the association between perinatal characteristics and comprehensive physical function in Chinese elderly people. In this study, we traced 875 subjects who were born at the Peking Union Medical College Hospital (PUMCH) of China from 1921 to 1941. The purpose of this study was to determine the effects of perinatal characteristics on activities of daily living (ADL) function in the geriatric period.</p><p><b>METHODS</b>Birth data of 875 subjects were obtained from obstetric birth records of PUMCH. Adulthood data collection was conducted in the outpatient clinics of PUMCH. During the clinic visits, trained research staff administered physical examinations, activities of daily living scale and a demographic questionnaire. ADLs of all subjects were assessed with the activities of daily living scale.</p><p><b>RESULTS</b>There were 101 subjects whose ADL function was limited and the rate of ADL limitation was 11.5%. Binary logistic regression analyses results showed that the main influencing factors of ADL were age, maternal age at birth, occupation, daily exercise and chronic disease. Subjects whose maternal age at their birth exceeded 35 years were at 2.202 times (1.188 - 4.083) greater risk of ADL limitation when we applied multivariate logistic regression models.</p><p><b>CONCLUSIONS</b>This study validated the relationship between perinatal characteristics and ADL in the geriatric period. An older maternal age at birth could predict a higher ADL limitation rate in the geriatric period.</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>

The treatment of relapsing primary nephrotic syndrome in children / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To explore better therapy and reduce the rate of re-relapse of primary nephritic syndrome in children who had been treated with corticosteroids but relapsed.</p><p><b>METHODS</b>Eighty relapsers were enrolled from Jan. 1994 to Apr. 2000, who were randomly divided into two groups. The treatment group (n=39) had been treated with tripterysium glucosides for three months, with the control group (n=41) members were treated with cyclophosphmide (CTX) by intermission intravenous pulse, with total dose of CTX not being more than 150 mg/kg. Prednisone, meanwhile, was given to both groups. The total treatment period of prednisone was prolonged by 12-18 months.</p><p><b>RESULTS</b>After following up for 3-7 years, the re-relapse rates of both groups were observed. The re-relapse rate of the treatment group was 28.2% to 29.3% in the CTX-controlled group. The re-relapse rates between two groups were almost similar, and with no observed significant difference (P>0.05). The side effect of tripterysium glucosides was less than that of CTX.</p><p><b>CONCLUSION</b>For the treatment of relapsing nephritic syndrome in children, the combination of tripterysium glucosides and prolonged corticosteroid therapy is as effective as the regimen of CTX plus prolonged use of prednisone.</p>