Long-term outcomes of childhood steroid-sensitive nephrotic syndrome / 中华儿科杂志

Objective: To investigate the long-term outcomes and risk factors in children with steroid-sensitive nephrotic syndrome (SSNS). Methods: A retrospective cohort study was conducted on newly onset SSNS admitted to the Department of Pediatrics of the First Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2010 and 105 cases with follow-up for more than 10 years were included. Clinical data including general characteristics, clinical manifestation, laboratory tests, treatment and prognosis. The primary outcome was the clinical cure, and the secondary outcomes were relapse or ongoing immunosuppressive treatment within the last 1 year of follow-up and complications at the last follow-up. According to the primary outcome, the patients were divided into clinical cured group and uncured group. Categorical variables were compared between 2 groups using the χ2 or Fisher exact test, and continuous variables by t or Mann-Whitney U test. Multiple Logistic regression models were used for multivariate analysis. Results: Of the 105 children with SSNS, the age of onset was 3.0 (2.1, 5.0) years, and 82 (78.1%) were boys, 23(21.9%) were girls. The follow-up time was (13.1±1.4) years; 38 patients (36.2%) had frequently relapsing or steroid-dependent nephrotic syndrome (FRNS or SDNS) and no death or progression to end-stage kidney disease. Eighty-eight patients (83.8%) were clinically cured. Seventeen patients (16.2%) did not reach the clinical cure criteria, and 14 patients (13.3%) had relapsed or ongoing immunosuppressive treatment within the last year of follow-up. The proportion of FRNS or SDNS (12/17 vs. 29.5% (26/88), χ2=10.39), the proportion of treatment with second-line immunosuppressive therapy (13/17 vs. 18.2% (16/88), χ2=21.39), and the level of apolipoprotein A1 at onset ((2.0±0.5) vs. (1.7±0.6) g/L, t=2.02) in the uncured group were higher than those in the clinical cured group (all P<0.05). Multivariate Logistic regression analysis showed that patients treated with immunosuppressive therapy had an increased risk of not reaching clinical cure in the long term (OR=14.63, 95%CI 4.21-50.78, P<0.001). Of the 55 clinically cured patients who had relapsed, 48 patients (87.3%) did not relapse after 12 years of age. The age at last follow-up was 16.4 (14.6, 18.9) years, and 34 patients (32.4%) were ≥18 years of age. Among the 34 patients who had reached adulthood, 5 patients (14.7%) still relapsed or ongoing immunosuppressive treatment within the last year of follow-up. At the last follow-up, among the 105 patients, 13 still had long-term complications, and 8 patients were FRNS or SDNS. The proportion of FRNS or SDNS patients with short stature, obesity, cataracts, and osteoporotic bone fracture was 10.5% (4/38), 7.9% (3/38), 5.3% (2/38), and 2.6% (1/38), respectively. Conclusions: The majority of SSNS children were clinically cured, indicating a favorable long-term prognosis. History of treatment with second-line immunosuppressive therapy was the independent risk factor for patients not reaching the clinical cure criteria in the long term. While it is not uncommon for children with SSNS to persist into adulthood. The prevention and control of long-term complications of FRNS or SDNS patients should be strengthened.

Identification of Armeniacae Semen Amarum Adulterated in Persicae Semen by Allele-specific Polymerase Chain Reaction / 中国实验方剂学杂志

Objective:Due to the limitation of traditional identification methods of Chinese medicinal materials， the study established a rapid method to identify Persicae Semen mixed with Armeniacae Semen Amarum by allele-specific polymerase chain reaction （PCR）. Method:By comparing the ribosomal DNA internal transcribed spacer （ITS） gene sequences of Persicae Semen and Armeniacae Semen Amarum， single nucleotide polymorphism （SNP） sites were searched and specific primers were designed. Different Persicae Semen and Armeniacae Semen Amarum samples were amplified by PCR， the effects of annealing temperature， primer concentration and cycle number on the PCR reaction system were optimized， and the specificity and detection limit of this method were investigated. In addition， the established PCR method was used to detect the samples of Persicae Semen mixed with different proportion of Armeniacae Semen Amarum from different sources and producing areas. Result:A specific PCR method for identifying Persicae Semen mixed with Armeniacae Semen Amarum was established. When the annealing temperature was 63 ℃ and the number of primer cycles was 30， only Armeniacae Semen Amarum could be amplified with 432 bp specific band， while Persicae Semen samples did not have this band. The minimum detection limit of this method for Armeniacae Semen Amarum was 0.2 ng， and the detection limit for Armeniacae Semen Amarum adulterated in Persicae Semen was 1%. Conclusion:The established allele-specific PCR method can accurately detect whether there is Armeniacae Semen Amarum in Persicae Semen， which can provide experimental basis for the quality control of Persicae Semen and guarantee the safety of its clinical use.

Determination of forbidden and restricted pesticides in Angelicae Sinensis Radix / 中国中药杂志

The present study is to establish a method for simultaneous determination of 50 kinds of pesticides in Angelicae Sinensis Radix by using liquid chromatography tandem mass spectrometry. The forbidden,restricted and customary pesticides were picked out as detecting indexes according to the principals of risk management. The factors affecting the extraction,purification,and detection were optimized,and the final condition was established as follows: the samples were extracted with acetonitrile. The separation of target compounds were performed by liquid column,and quantitative analysis was carried out by LC-MS/MS with MRM model. The calibration curves were linear in the range of 1-100 μg·L~(-1) with correction coefficients of greater than 0. 990. The recoveries of more than 93. 9%pesticides were ranged from 60% to 140% at three spiked levels. The detecting indexes in the method cover most forbidden and restricted pesticides,which is meaningful for the safety supervision of the Angelicae Sinensis Radix. With the advantage of rapidness and accuracy,this method can be used for routine determination of multi-pesticides in Angelicae Sinensis Radix.

Experts consensus statement on Xiyanping Injection in clinical practice(children) / 中国中药杂志

Xiyanping Injection is a commonly used medicine in clinical treatment,which is recommended by many pediatric disease guidelines/consensus. However,the instraction is relatively simple and lack of guidance for clinical application,which affects the efficacy and brings safety risks. Therefore,more detailed clinical guidance is urgently needed. This consensus is formulated by clinical experts of traditional Chinese medicine and Western medicine in pediatrics. This consensus follows Manual for the clinical experts consensus of Chinese patent medicine which published by China Association of Chinese Medicine. The study identified clinical problems using clinical investigation,searched the literature based on PICO clinical problems,using GRADE system to carry out evidences evaluation,classification and recommendation,and adopted the nominal grouping method to reach expert consensus. The consensus combines evidence-based evidence with expert experience,sufficient evidence of clinical problems would lead to " recommendations",and clinical problems with insufficient evidence will lead to " consensus suggestions". This expert consensus recommends the indications,intervention time for treatment,route of drug administration,dose conversion,the indications of being used alone,suitability and taboos of medicine combination,and introduces the safety and clinical application,to provide reference for clinical using.

Efficacy and Safety of Bacterial Lysates for Recurrent Respiratory Infection of Children:A Meta-analysis / 中国药房

OBJECTIVE:To evaluate the efficacy and safety of Bacterial lysates(hereinafter referred to as"Broncho-Vaxom") for recurrent respiratory tract infections (RRTIs) of children,and to provide evidence-based reference for clinic. METHODS:Retrieved from PubMed,EMBase,Cochrane Library,CBM,CNKI,Wanfang database and VIP database,domestic and foreign published randomized controlled trials (RCTs) about Broncho-Vaxom (trail group) vs. placebo (control group) for RRTIs of children were collected during database establishment to Jan. 2018. After literature scanning and data extraction,the risk of bias of included trials were evaluated by using Cochrane 5.1.0 risk bias evaluation tool. Meta-analysis was performed by using Rev Man 5.3 software. RESULTS:A total of 13 RCTs involving 1 228 children were included. The results showed that the trial group was superior to control group in frequency of respiratory infection [MD＝－1.14,95%CI(－1.29,－0.99),P＜0.001],total response rate [RR＝9.47,95%CI(2.33,38.54),P＝0.002],the time of antibiotics use [MD＝－4.36,95%CI(－6.52,－2.21),P＜0.001], infection duration [MD＝－3.89,95%CI(－4.47,－3.04),P＜0.001],febrile time [MD＝－1.81,95%CI(－3.40,－0.22),P＝0.03],serum immunoglobulin (Ig)G level [MD＝1.25,95%CI(0.13,2.37)),P＝0.03],IgA level [MD＝0.77,95%CI(0.07, 1.46),P＝0.03] and the level of T cell subgroup CD4+[MD＝1.33,95%CI(0.90,1.76),P＜0.001] and CD8+[MD＝0.64,95%CI (0.24,1.04),P＝0.002],there was statistical significance. Trail group was similar to control group in respect of cough time [MD＝－6.00,95%CI(－13.86,1.86),P＝0.13] and IgM level [MD＝－0.10,95%CI(－0.32,0.12),P＝0.39] and the incidence of ADR [RR＝0.76,95%CI(0.43,1.35),P＝0.35]. CONCLUSIONS:The current evidence shows that Broncho-Vaxom could effectively prevent the RRTIs of children with good safety.

Clinical application evaluation and revision suggestions of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for upper respiratory tract infection in children / 中国中药杂志

Questionnaires and case investigation methods were taken in this paper, taking the clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for upper respiratory tract infection in children published by the Chinese Medicine Association as the research object. Doctors from 187 hospitals in 29 regions across the country were invited to evaluate the applicability of the Guideline and clinical application effects, so as to collect the opinions on revising the Guideline. Clinicians about 508 accepted the applicability survey of the Guideline, and considered that the structure and content of the Guideline were reasonable, with the proportions being as high as 98.23% and 98.03%, respectively. In the content of syndrome differentiation-based treatment, the factors with higher rationality included therapeutic principle and method (99.41%), diagnosis elements (98.82%), and syndrome differentiation classification (98.03%); while the factors with lower rationality included the rehabilitation and health preserving (97.05%) and complication prevention (97.24%). 98.03% of the clinicians considered theat the Guideline was to be fully applicable and basically applicable, and 1.97% of the clinicians considered it to be applicable after revision. By observing 491 cases, the Guide was applied for evaluation and analysis. The factors with higher compliance included diagnosis of Western medicine disease (100%) and the diagnosis of TCM disease (99.18%); while the factors with lower compliance included the treatment measures, with a compliance rate of 77.18% and 83.05% respectively for simple preparations and other treatment method. The safety and economy of the Guideline were good, 97.35%, 93.89%, respectively. The comprehensive evaluation was good, and 99.41% of the respondents were willing to follow the treatment schemes recommended in the Guideline, suitable for clinical application. The opinions on revision were mainly focused on dialectical treatment, complication prevention and rehabilitation. It indicates that only by actively and extensively soliciting opinions to revise the Guideline, can we improve the quality of the Guideline for clinical practice, so as to raise the level of clinical efficacy.

A commentary of literature research of traditional Chinese medicine for acute upper respiratory tract infection in children / 中国中药杂志

Acute upper respiratory tract infection is the most common infectious disease in children's respiratory system. The pathogen to the main virus, can account for more than 90% of the primary upper respiratory tract infectio. However, there is no specific anti-viral drugs specifically for the disease, in addition to the existence of excessive, widespread use or even abuse of antibiotics.Long-term clinical practice has confirmed that Chinese medicine is safe and effective in treating acute upper respiratory tract infection in children. The author reviews the literatures of multiple databases, and analyzes the advantages of Chinese patent medicine in the treatment of acute upper respiratory tract infection in children from the perspective of clinical research and experimental basic research. It also puts forward the existing problems and possible research directions of Chinese patent medicine in the treatment of acute upper respiratory tract infection in children.

Heavy metal poisoning and renal injury in children / 中国当代儿科杂志

Along with global environmental pollution resulting from economic development, heavy metal poisoning in children has become an increasingly serious health problem in the world. It can lead to renal injury, which tends to be misdiagnosed due to the lack of obvious or specific early clinical manifestations in children. Early prevention, diagnosis and intervention are valuable for the recovery of renal function and children's good health and growth. This paper reviews the mechanism of renal injury caused by heavy metal poisoning in children, as well as the clinical manifestations, diagnosis, and prevention and treatment of renal injury caused by lead, mercury, cadmium, and chromium.

Literature review of application of shenmai injection in special populations (children) / 中国中药杂志

<p><b>OBJECTIVE</b>Analyze the characteristic features of Shenmai injections as used in pediatric clinics, to improve the specifications for use in children in order to decrease risks.</p><p><b>METHOD</b>We preformed statistical analyses on data from the CNKI and VIP databases relevant to the clinical application of Shenmai injections in children. Pediatric indications, usage and dosage, length of treatment, solubility of the drugs in mediums and adverse reactions were summarized.</p><p><b>RESULT</b>Shenmai injection is widely used in clinical pediatrics, and is reported to show effectivenss for conditions such as viral myocarditis, pneumonia, neonatal hypoxic ischemic encephalopathy, neonatal scleroderma, diarrhea and other diseases. However, there are no specific specifications regarding usage and dosages, length of treatments, or instructions regarding solvents. Adverse reactions reported include, drug rash, heat, blushing, and chest tightness amongst others.</p><p><b>CONCLUSION</b>Effective measures should be adopted to standardize the clinical regulations regarding Shenmai injections for use in children, to reduce risks, and thereby raise clinical treatment standards.</p>

Analysis and countermeasures of adverse drug reactions of traditional Chinese medicine injections in children / 中国中药杂志

<p><b>OBJECTIVE</b>We aimed to analyse the adverse drug reactions (ADR) in children due to traditional Chinese medicine (TCM) injections and the related factors, and explored the rational use of medicines and safty countermeasures in clinical.</p><p><b>METHOD</b>We preformed statistical analyses on data from the CNKI and researched on literatures, from April 1987 to May 2012, relevant to the TCM injections which lead to reactions of clinical adverse, to conduct a analysis of the species, cases, clinical manifestations and related factors of these injections.</p><p><b>RESULT</b>The incidence of ADR in children leaded by TCM injections is high and the manifestations were chiefly characterized by the luscious of skin and appendages. In addition to the correlation with the physiological and pathologic characteristic in childhood, the ADR is also closely related with preparing technology, irrational use and imperfect supervisory system.</p><p><b>CONCLUSION</b>Because of the high incidence, we should taking appropriate measures, such as constructing strict supervision system and strengthening rational drug use, to reduce the occurrence of ADRs to the greatest extent.</p>

Nevirapine related hepatotoxicity: the prevalence and risk factors in a cohort of ART naive Han Chinese with AIDS / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the incidence of hepatotoxicity in acquired immunodeficiency syndrome (AIDS) patients on combined anti-retroviral therapy (cART) containing nevirapine (NVP) and to assess the risk factors and its impact on cART.</p><p><b>METHODS</b>330 AIDS patients from March 2003 to June 2008 at local county were enrolled and a retrospective study using Kaplan-meier survival and Multivariate logistic regression modeling was conducted.</p><p><b>RESULTS</b>267 out of 330 patients received NVP based cART and 63 cases received EFV-based cART. The deference of prevalences of hepatotoxicity between the two groups is statistically significant (Chi2 = 6.691, P = 0.01). 133 out of 267 (49.8%) patients on NVP based cART had at least one episode of ALT elevation during a median 21 months (interquartile ranges, IQR 6, 37) follow-up time, amounts for 28.5 cases per 100 person-years. Baseline ALT elevation (OR = 14.368, P = 0.017)and HCV co-infection (OR = 3.009, P = 0.000) were risk factors for cART related hepatotoxicity, while greatly increased CD4+ T(CD4) cell count was protective against hepatotoxicity development (OR = 0.996, P = 0.000). Patients co-infected with HCV received NVP-based cART had the higher probability of hepatotoxicity than those without HCV co-infection (Log rank: Chi2 = 16.764, P = 0.000). 23 out of the 133 subjects (17.3%) with NVP related hepatotoxicity discontinued cART temporarily or shifted NVP to efavirenz.</p><p><b>CONCLUSION</b>NVP related hepatotoxicity was common among ARV naive HIV infected subjects in our cohort. Baseline ALT elevation and HCV co-infection were associated statistically with the development of hepatotoxicity. Hepatotoxicity led to discontinuing cART temporarily or switching to other regimens in some subjects. It suggested that NVP should be used with caution in patients co-infected with HCV among whom anti-HCV therapy before cART initiation may contribute to minimizing the probability of NVP associated hepatotoxicity.</p>

Incidence of JAK2V617F mutation in myeloproliferative diseases and its clinical significance / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the incidence of JAK2V617F gene point mutation in patients with myeloproliferatives diseases (MPD) and its clinical significance.</p><p><b>METHODS</b>Genomic DNA from bone marrow and peripheral blood cells were extracted from 68 patients with MPD. Allele specific polymerase chain reaction was used to amplify the exon 12 of JAK2 gene which harbours V617F mutation. The PCR products were identified by DNA sequencing. JAK2V617F gene point mutation and its impact on peripheral blood cells were analyzed.</p><p><b>RESULTS</b>The incidence of JAK2V617F mutation in 68 patients with MPD was 65.28 %. The positive rate of JAK2V617F point mutation was 77.77 % in patients with PV (36/59), 56.52 % in patients with ET (23/59) and 44.44 % in patients with IMF (4/9). In all groups, the incidence of JAK2V617F point mutation in bone marrow and peripheral blood were equal. Patients with JAK2V617F mutation in PV group had higher counts of white blood cell and hemoglobin in peripheral blood than patients without JAK2V617F point mutation (P <0.05). Patients with JAK2V617F mutation in ET group had higher counts of white blood cell than those without JAK2V617F mutation (P <0.05); there was no significant difference in platelet count.</p><p><b>CONCLUSION</b>JAK2V617F point mutation can affect the hematologic features, which may be of diagnostic value for MDP with negative BCR-ABL gene.</p>

Clinical Observation on Primary Infantile Tonic-Clonic Epilepsy Manifested as Syndrome of Convulsion due to Phlegm-Heat Treated by Xiaoer Dingfeng Decoction / 中医杂志

Objective To observe the effectiveness and salty of Xiaoer Dingfeng Decoction(Decoction to stop wind in children con- vulsion)in the treatment of syndrome of primary infantile convulsion due to phlegm-heat in tonic-clonic epilepsy.Methods Totally 90 infantile patients were randomized into three groups,which were treated by Xiaoer Dingfeng Decoction,Kangxian(Capsule to treat epilepsy)and Xifeng Capsule(Capsule to calm the wind)respectively.Frequency of seizure,lasting duration,and change of electroen- cephalogram(EEG)were observed 12 months later.Results The total effective rate of Xiaoer Dingfeng Decoction group was 86. 67%,better that that of Kangxian Capsule group(P0.05). It could greatly reduce the frequency of seizure,shorten the lasting duration,and improve the EEG.Conclusion Xiaoer Dingfeng De- coctions is effective and safe for the syndrome of primary infantile convulsion due to phlegm-heat in tonic-clonic epilepsy.

Changes of Hydrogen Sulfide and Heme Oxygenase-1 of Children with Congenital Heart Disease Combined with Pulmonary Hypertension and Those Significances / 实用儿科临床杂志

Objective To explore the clinical significance of hydrogen sulfide(H2S)and heme oxygenase-1(HO-1)on pulmonary hypertension(PH),by detecting their levels of patients with congenital heart disease(CHD).Methods Forty-eight patients with CHD who had left-to-right shunt were selected randomly from cardiac surgery in the Fourth Hospital of Hebei Medical University.Forty-eight patients were performed successfully on radical operation under complex intravenous anesthesia,and they were divided 3 groups according to pulmonary artery systolic pressure(PASP)detected by doppler echocardiography before operation:no PH group(PASP0.05).Conclusions H2S plays an important role in the formation of PH and restructure.There is no correlation between PASP and HO-1 activities in serum,but HO-1 may be play an indirect action in the formation of PH and restructure.Measuring the levels of H2S may be a reliable method to follow the change of pulmonary pressure and worsening of PH.

Reform Microbiology Experiment Teaching Methods, Enhance the Students’ Comprehensive Abilities / 微生物学通报

In order to cultivate the students’ abilities of thinking and practicing and enhance their comprehensive abilities in microbiology experiment, the authors try to search for some new teaching ways and assessment methods in microbiology experimental teaching and also attempt to make some improvement in the textbook and adjustment in teaching schedule so as to develop the students into specialized talents.

IDIOTYPE-ANTI-IDIOTYPE THEORY IN THE DETERMINATION OF ABNORMAL IM-MUNOGLOBULIN (aIgG) IN SERA OF PATIENTS WITH GRAVES DISEASE / 中华内分泌代谢杂志

According to the theory of in vitro radioassay, using TSHAb as binder and 125I-staphylococcal protein A (125I-SPA) as tracer agent, a new method for detecting the abnormal immunoglobulin (aIgG) in the sera of patients with Graves disease (GD) was reported. In the initial study of the method, the most appropriate interacting conditions of TSHAb with aIgG were explored and compared with ELISA using ganglioside (GLS) as a binder. The relationship between aIgG and thyroid-stimulating imunoglobulin(TSI) was probed into. The results showed that TSHAb could interact specifically with aIgG in vitro; but it could not interact with IgG from sera of normal subjects, systemic lupus erythematosis (SLE) patients and diabetic patients. With aIgG as an evaluating index, the mean value in 29 normal subjects was 1. 06?0. 17. When the sera of 72 patients with GD in different clinical stages were studied, the aIgG index was positive in 83% of untreated GD patients (n = 24), in 12% of GD patients in clinical remission (n = 25) and in 82% of relapsed GD patients (n = 23). Very significant difference was observed between normal subjets and untreated and relapsed patients with GD (P