Effect of allergic rhinitis on disease condition and treatment in patients with juvenile-onset systemic lupus erythematosus / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the effect of allergic rhinitis (AR) and its intervention on disease condition and medications in patients with juvenile-onset systemic lupus erythematosus (JSLE).</p><p><b>METHODS</b>The clinical data of 96 children diagnosed with JSLE were collected, and according to the presence or absence of AR or other allergic diseases, they were divided into AR group (n=44), non-AR group (n=20), and non-allergic group (n=32). The children in the AR group were randomly administered with or without intervention (n=22 each). All the children were given standard JSLE treatment. The systemic lupus erythematosus disease active index (SLEDAI) and application of hormones and immunosuppressants were compared between groups.</p><p><b>RESULTS</b>The AR and non-AR groups had significantly higher SLEDAI scores, daily cumulative doses of glucocorticoids, and number of types of immunosuppressants used than the non-allergic group before treatment (P<0.05), while there were no significant differences between the AR and non-AR groups (P>0.05). After one month of treatment, the AR group with intervention had significantly lower SLEDAI scores and daily cumulative doses of glucocorticoids than the AR group without intervention (P<0.05), while there was no significant difference in the application of immunosuppressants between these two groups (P>0.05). After 3 and 6 months of treatment, the AR group with intervention had significantly lower SLEDAI scores, daily cumulative doses of glucocorticoids, and number of types of immunosuppressants than the AR group without intervention (P<0.05).</p><p><b>CONCLUSIONS</b>JSLE combined with allergic diseases such as AR has an adverse effect on disease condition and treatment, and the intervention for AR helps with the control of JSLE.</p>

Clinical effect of application of PDCA on reducing the incidence of healthcare-associated infection in department of neurosurgery / 中国感染控制杂志

Objective To study the effect of application of plan-do-check-act (PDCA) on reducing the incidence of healthcare-associated infection(HAI) in department of neurosurgery.Methods Quality control circle activity group was established,programme of activities was formulated,four stages and ten steps of PDCA were adopted,incidences of H AI in department of neurosurgery before (September-November 2015) and after (May-July 2016) the implementation of PDCA were observed,causes were analyzed based on implementation of hand hygiene,aseptic technique manipulation,and environmental sanitation,countermeasures were found out,and continuous quality improvement was performed for 6 months.Results Comparison between before and after implementation of PDCA was conducted,incidence of HAI in department of nerosurgery decreased from 10.9％ to 5.8％,difference was significant(P＜0.05),control rate was 100％,incidence of HAI dropped by 46.8％;hand hygiene implementation rate increased from 27.2％ to 76.9％,aseptic technique implementation rate increased from 76.0％ to 96.9％,environmental sanitation increased from 51.0 ％ to 90.0 ％,differences before and after implementation were all statistically significant(all P＜0.001).Conclusion Quality control circle activities implemented jointly by multiple departments can reduce the incidence of HAI in department of neurosurgery,rules can be observed,measures can be further improved,it is worthy of clinical application.

Application of asthma predictive index-based group therapy in wheezing children under 5 years of age / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the application value of asthma predictive index (API)-based group therapy in wheezing children under 5 years of age.</p><p><b>METHODS</b>A total of 239 wheezing children under 5 years of age were divided into API-positive (n=126) and API-negative groups (n=113). Each group was randomly assigned to inhaled corticosteroids (ICS) subgroup and montelukast sodium (leukotriene receptor antagonist, LTRA) subgroup. The ICS and LTRA subgroups received the same drug therapy at the same dosage within the first four weeks of treatment. In the stable period of disease, the ICS subgroup only received aerosol inhalation of budesonide suspension, while the LTRA group was orally given montelukast sodium only. Asthma symptom scores were assessed and recorded at different time points.</p><p><b>RESULTS</b>In the first four weeks of treatment, ICS and LTRA were effective both in the API-positive and API-negative groups; the two groups showed significant improvements in asthma symptom scores, and the asthma symptom score showed no significant difference between the ICS and LTRA subgroups of each group. After 24 weeks of treatment, the two therapies were still effective; in the API-positive group, the LTRA subgroup had a better treatment outcome than the ICS subgroup, but there was no significant difference in treatment outcome between the LTRA and ICS subgroups of the API-negative group.</p><p><b>CONCLUSIONS</b>For wheezing children under 5 years of age, therapeutic strategies can be chosen based on API in the stable period of disease, so as to better control wheezing.</p>

Research progress of N-Myc roles in hematopoiesis and hematologic malignancies / 中国实验血液学杂志

N-Myc oncogene plays an important role in the process of hematopoietic cell proliferation and differentiation in embryos. Once the body suffers from hematologic malignancies, the expression of N-Myc would increase and significantly associate with disease progression. In this article the structure of N-Myc, the regulatory mechanism in the different hematopoietic lineages, the interaction in each signal pathways, the transgenic animal model of overexpression, and intervention by drugs are reviewed.

Changes of natural killer T cells levels in peripheral blood of children with asthma and clinical significance / 中华实用儿科临床杂志

Objective To study the changes of natural killer T cells (NKT cells) in peripheral blood and the ability of NKT cells to proliferate in response to alpha-galactosyl ceramide (α-Galcer) in children with asthma.Methods Fifty-two asthmatic children who were diagnosed by Pediatric Clinic of Renji Hospital Affiliated to Shanghai Jiaotong University Medical College from Feb.2009 to Mar.2012 were selected as asthmatic group (26 cases in intermittent group,14 cases in mild persistent group and 12 cases in moderate persistent group).Twenty healthy children were selected as healthy control group.Peripheral blood mononuclear cells were collected by way of density gradient centrifugation method from blood samples.The ratio of peripheral blood NKT and CD4 + NKT cells were assessed by immunolluorescence and flow cytometry assays.The relationships between the NKT cells number,CD4 + NKT cells and atopic indexes such as the total IgE,eosinophil cationic protein (ECP) and the severity of asthma were investigated.The levels of IFN-γ,IL-4,IL-10 in peripheral blood were measured by enzyme-linked immunosorbent assay after proliferate in response to α-Galcer.The data were analyzed by using statistics software.Results Compared with healthy control group,the ratio of peripheral blood NKT and CD4 + NKT cells in asthmatic patients were significantly decreased (all P ＜0.01) ; There were no significant differences in asthmatic patients among the subgroups in terms of severity (P ＞ 0.05).There was no significant correlation between the NKT cells,CD4 + NKT cells and atopic indexes such as the total IgE and ECP(all P ＞ 0.05).The level of IL-4 in serum secreted by NKT cells in asthmatic group was significantly higher than that of healthy control group (P ＜0.01) ;The level of IL-10 in serum secreted by NKT cells in asthmatic group was decreased significantly (P ＜0.01) ;There was no significant difference in IFN-γ secreted by NKT cells between the asthmatic group and healthy control group (P ＞ 0.05).Conclusion The pathogenesis of asthma may be related to the ratio and dysfunction of NKT cells and CD4 + NKT cells.

Clinical diagnosis and WISP3 gene mutation analysis for progressive pseudorheumatoid dysplasia / 中华儿科杂志

<p><b>OBJECTIVE</b>Progressive pseudorheumatoid dysplasia (PPD) (MIM#208230) is a rare autosomal recessive disease of cartilage homeostasis characterized by axial and peripheral skeletal dysplasia. Analysis of WISP3 (Wnt1-inducible signaling pathway protein 3, MIM#603400) gene mutation can confirm the clinical and radiographic diagnosis for PPD. This study aimed to recognize PPD based on clinical manifestations and imaging characteristics of bones, and to investigate the mutations of WISP3 gene in three patients with PPD.</p><p><b>METHOD</b>Three male patients (9 - 16 years old) from three unrelated Chinese families, who presented with joint pain, swelling, deformities and motion limitation, were referred to this study. PPD was diagnosed on the basis of the clinical manifestations, imaging characteristics of bones and laboratory evaluation. All five exons and their exon/intron boundaries of the WISP3 gene were amplified by polymerase chain reaction (PCR) from the peripheral blood DNA of three PPD family members, and mutation analysis was performed by bidirectional DNA sequencing.</p><p><b>RESULT</b>(1) Three patients were diagnosed as PPD by characteristic evidences: all patients presented with non-inflammatory multiple joints swelling and stiffness including joints in hand and feet as they age. Radiographs showed platyspondyly, ovoid or wedged anterior end-plate of vertebral bodies, coxa vara, widened epiphyses or metaphyses including capital femoral, metacarpophalangeal, interphalangeal joints and metatarsals. Normal laboratory values were found for the erythrocyte sedimentation rate and C-reactive protein, rheumatoid factors, antinuclear antibodies etc. (2) The three different mutations of WISP3 gene were identified in three patients with PPD, including two small insert mutations (c.624_625insA, c.866_867insA), one was deletion mutation (c.729_735delGAGAAAA). The types of mutation of two alleles in three patients were c.624_625insA/c.729_735delGAGAAAA, c.624_625insA/c.866_867insA and c.866_867 insA/c.866_867insA, respectively. These mutations were found in exon 4 and exon 5 of WISP3 gene, accounting for 50%(3/6) respectively. All three different mutations were novel variations, and none of 3 novel variations was found in the 50 controls.</p><p><b>CONCLUSION</b>The characteristic evidences of PPD were non-inflammatory multiple enlarged joints (including hand and feet), limited movement, normal laboratory values such as rheumatoid factors. It is essential for making diagnosis to carefully examine the entire skeleton including spine. The characteristics of bone imaging are platyspondyly, widened epiphyses or metaphyses including large and small joints and narrow joint spaces. Three different novel variations of WISP3 gene were identified in three PPD patients, they are c.624_625insA, c.866_867insA and c.729_735delGAGAAAA. Each of novel mutations is insert or deletion mutation.</p>

Investigations on allergens of allergic diseases in children from rural Shanghai / 上海第二医科大学学报

Objective To analyse the distribution characteristics of major allergens initiating allergic diseases in children from rural Shanghai. Methods Eight hundred children with allergic diseases from rural Shanghai (rural ease group), 450 children with allergic diseases from urban Shanghai (urban ease group) and 100 healthy children from rural Shanghai (rural normal control group) underwent skin prick tests (SPT), and children of rural case group were subdivided into infant group, preschool age group and school age group according to age. The positive rates of allergens and SPT were compared among groups. Results The positive rate of SPT of rural case group was significantly higher than that of rural normal control group (73.38% vs 26.00%, P<0.05), and was significantly lower than that of urban ease group (73.38% vs 80.22%, P<0.05). Dermatophagoidesfarinae and Dermatophagoides pteronyssinus were the major allergens in rural ease group, with the positive rates of 57.88% and 59.13%, respectively. Except weed and rubber, there were significant differences in positive rates of the other allergens between rural ease group and the other two groups(P<0.05). There were significant differences in positive rates of SPT among different age groups of rural children with allergic diseases (P<0.05). Conclusion Dermatophagoides farinae and Dermatophagoides pteronyssinus are the major allergens in children with allergic diseases from rural Shanghai, whose positive rates of SPT are lower than those of children with allergic diseases from urban Shanghai. The positive rate of SPT is related to age to some extent.

Clinical evaluation for sublingual immunotherapy of allergic asthma and atopic rhinitis with Dermatophagoides Farinae Drops / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of sublingual immunotherapy with 'Dermatophagoides Farinae Drops' in D. farinae allergic asthma and/or rhinitis patients.</p><p><b>METHODS</b>A 25-week double-blind, placebo-controlled, multi-centered trail was conducted in 278 children (aged 4 - 18 yr) with mite-induced asthma and/or rhinitis. Patients were randomly assigned to receive sublingual immunotherapy (SLIT) with 'Dermatophagoides Farinae Drops' (n = 139) or placebo (n = 139) for 25 weeks and the dosage and administration strictly followed the manufacturer's instructions. At the beginning of the 2nd, 3rd, 4th, 6th, 10th, 14th, 18th, 22nd week of the treatment, the patients were asked to accept follow-up visit, during the clinical trial all patients and parents were asked to keep a daily record of their asthma symptom scores, rescue medicine use, rhinitis symptom scores, morning and evening peak expiratory flow. Asthma symptom scores, reduction in use of rescue medicine, rhinitis symptom scores, lung function tests, skin sensitivity to mite, mite-specific immunoglobulin (Ig) E and IgG4, and quality of life and adverse effect were assessed during the study.</p><p><b>RESULT</b>(1) Of the 278 children, 27 dropped out before the study completion. (2) After 25 weeks of treatment, the median variability of PEFR was -1.38 for SLIT group and -0.90 for the placebo (P < 0.05). (3) Besides, the mean variability of medicine score of asthma was -0.08 for SLIT group and 0.52 for the plcebo (P < 0.05). (4) The median variability of rhinitis symptom score was -1.96 for SLIT group and -1.03 for the placebo (P < 0.01). (5) The rescue medicine usage of SLIT reduced but did not show significant differences between SLIT and placebo. (6) After 25 weeks treatment, the increase of D. farinae specific IgE antibody of two groups were similar, while specific IgG4 increased significantly in SLIT compared to the patients in control one (P < 0.01); (7) No severe adverse events happened in the trial and the most-likely adverse events were mild asthma and local rash.</p><p><b>CONCLUSION</b>Dermatophagoides Farinae Drops is safe and effective in treating allergic asthma and atopic rhinitis.</p>

Levels of serum interleukin-15 and the expression of T-helper lymphocyte subsets in peripheral blood of children with juvenile rheumatoid arthritis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the changes of serum interleukin-15 (IL-15) levels and the expression of CD4(+)T (T-helper lymphocyte) subsets CD4(+)CD45RA(+) and CD4(+)CD45RO(+) in peripheral blood of children with juvenile rheumatoid arthritis (JRA).</p><p><b>METHODS</b>The serum concentration of IL-15 was detected using ELISA in 39 children with JRA. The expressions of CD4(+)CD45RA(+)T and CD4(+)CD45RO(+)T in peripheral blood were detected by flow cytometry in 24 out of the 39 patients with JRA. Twenty-six age and sex-matched healthy children were used as the Control group.</p><p><b>RESULTS</b>The mean serum IL-15 level in JRA patients was significantly higher than that in controls (1.37 +/- 0.98 pg/mL vs 0.96 +/- 0.41 pg/mL, P <0.05). Among the 39 JRA patients, the serum IL-15 level in 17 patients with systemic JRA increased remarkably (P < 0.01), but not in patients with the other two types of JRA, the oligoarthritis and polyarthritis (n=13, n=9, respectively), compared with that in controls. The mean serum IL-15 level of the JRA patients was significantly reduced after conventional treatment (P < 0.01). The serum IL-15 level in JRA patients positively correlated with white blood cell count (r=0.347, P <0.05) and C reactive protein (r=0.452, P < 0.01) but not with the erythrocyte sedimentation rate. The patients with high serum IL-15 levels (> or = medium level 1.73 pg/mL) had higher expression of CD4(+)CD45RO(+)T than those with low serum IL-15 levels (< medium level) (16.29 +/- 5.46% vs 11.75 +/- 3.15 %, P < 0.05).</p><p><b>CONCLUSIONS</b>The serum IL-15 levels in JRA patients increased significantly. An increased IL-15 level can transform CD45RA into CD45RO in peripheral blood of patients with JRA, and then result in T lymphocyte activation and mediate the immunopathological impairment. IL-15 may be used a marker for the evaluation of severity of JRA.</p>

Expression of Interleukin-15 in Peripheral Blood of Patients with Mycoplasma Pneumoniae Infection and Bronchitic Asthma Attacking / 实用儿科临床杂志

0.05).Conclusion The increasing of IL-15 in peripheral blood after MP infection may play a role in bronchitic asthma pathogenesis.

Development of Clinical Use of Biological Agents on Juvenile Idiopathic Arthritis / 实用儿科临床杂志

Juvenile idiopathic arthritis(JIA)is the most common rheumatology disease in childhood period with poor prognosis.The biological agents are newly developed drugs with features of clear therapeutic targets and fast effects.But its use in JIA is still limited,so this article focuses on the clinical use experience,timming and sideffects of the biological agents on JIA.

Analysis of Characteristics of Allergens Skin Prick Tests in Children in Chongming Island / 实用儿科临床杂志

3 years old than those in ≤3 years old group.The incidence rate of the adverse reaction after SPT was 1.6%(6/384),there were 4 temporary fieber,1 asthma and 1 anaphylactic shock.Conclusions The common allergens are inhalant allergens of dermatophagoides pteronyssinus and dermatophagoides farina in Chongming island.The SPT is more suitable for over 3 years old children with typical anaphylaxis of respiratory symptom and maybe have the potential danger.

Thirty-Nine Children with Refractory Systemic Juvenile Idiopathic Arthritis Treated by Glucocorticoid / 实用儿科临床杂志

Objective To investigate clinical characteristics of refractory systemic juvenile idiopathic arthritis(JIA)and the efficiency of glucocorticoid in therapy on this kind of disease.Methods Thirty-nine children with systemic JIA were divided into low dose group 0.5-1.0 mg/(kg?d)and high dose group 1.0-1.5 mg/(kg?d).And the efficiency was observed by change of active index after 10 and 20 days.Results The effective power was 58.8% and 72.7% after 10 days,respectively.After 20 days,the power was 76.5% and 90.9%,respectively.The power in high dose group was significantly higher than that in low dose group.It had no difference in statistical analysis for efficiency of 2 kind of glucocorticoid dosage to control fever,but it had obvious difference to control arthralgia,arthrocele,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP).Conclusion Glucocorticoid therapy is very effective to control the activity of disease in patients with systemic JIA.

Changes of Eosinophils Count an Total IgE Levels in Patients With Myocoplasm Pneumoniae / 中国医师杂志

Objective To investigate the number of eosinophils in peripheral blood and total serum immunoglobulin E levels from children during infection of mycoplasma pneumoniae,which may elucidate what mycoplasma pneumoniae plays a role in persistent cough and asthma onset.Methods The number of eosinophils in peripheral blood was counted under microscope and total serum immunoglobulin E levels were determined by ELISA in 20 children with mycoplasmal infection ,30 patients with asthma and 25 control subjects.Results The number of eosinophils and total serum immunoglobulin E levels during mycoplasmal infection were significantly higher than in control group,and lower than in asthma.Conclusion The high eosinophil counts and total serum immunoglobulin E induced by mycoplasma pnemoniae play a key role in persistent cough and asthma attack.