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Aklapskd and rkfractore Blinkagk acutk lemphoblastic lkuckmia is an important causk of lkuckmia rklatkd dkath in childrkn. CD19 as a potkntial targkt for thk trkatmknt of B ckll malignanciks has attractkd much attkntion in rkcknt ekars. T cklls modifikd be chimkric antigkn rkckptor(CLA-T)havk a significant kffkct in thk clinical trials of Blinkagk acutk lemphoblastic lkuckmia in childrkn. Lt thk samk timk,doctors should pae attkntion to mane problkms, such as cetocink rklkask sendromk,skvkrk nkurotoxicite,meocardial toxicite. Optimizk thk dksign of CLA-T cklls,rka-sonablk prkconditioning and ckll infusion schkmk,and pae attkntion to thk prkvkntion and trkatmknt of complications, maebk furthkr improvk thk safkte of CD19 CLA-T ckll thkrape.
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Objective To observe the effect of transcranial direct current stimulation (tDCS) with mirror neuronal rehabilitation training system (MNST-V1.0) in post-traumatic unconscious patients after severe craniocerebral injury. Methods A prospective, self controlled and open-label method was used. Thirty-six post-traumatic unconscious patients with severe craniocerebral injury from January 2016 to July 2017 were selected. Four cases of the patients did not complete the treatment and the last 32 cases completed the study. All patients were given routine wake-up therapy, and tDCS combined with MNST-V1.0 (20 min/time, 1 time/d, 6 times/week, a total of 8 weeks) was given at the same time. The Glasgow coma scale (GCS), JFK coma recovery scale and Four coma rating scale before treatment and 2, 4, 8 weeks after treatment were recorded. Results The scores of open reaction, language and motor response score of GCS 2, 4, 8 weeks after treatment were significantly higher than those before treatment:(1.56 ± 0.82), (2.06 ± 1.01) and (3.11 ± 1.45) scores vs. (1.00 ± 0.45) scores, (2.23 ± 1.06), (2.56 ± 1.08) and (3.02 ± 1.04) scores vs. (1.00 ± 0.61) scores, (2.79 ± 1.12), (3.22 ± 1.33) and (4.44 ± 1.07) scores vs. (1.00 ± 0.54) scores, and there were statistical differences (P ＜ 0.01 or ＜0.05). The scores of hearing, vision, movement, speech response, communication and arousal of JFK coma recovery scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.01). The scores of open reaction, sport reaction, brainstem response of Four coma rating scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.05); there was no statistical difference in respiratory score of Four coma rating scale before and after treatment (P＞0.05). Conclusions The tDCS combined with MNST-V1.0 can improve the consciousness level in post-traumatic unconscious patients with severe craniocerebral injury, and have the effect of promoting awakening.
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Objective To investigate the regulation mechanism of microRNA - 9(miR - 9)by ecotropic viral integration site1(EVI1)its impact on proliferation of AML cells and its role in the pathogenesis of myelogenous leuke-mia. Methods EVI1 was forced to express in Uocm1 cell lines by murine stem cell virus - EVI1(MSCV - EVI1) plasmid infection. EVI1 overexpressed Uocm1 cells were then treated with 0. 1 μmol/ L 5 - aza - 2′ - deoxycytidine (5 - AZA)dissolved in dimethyl sulfoxide (DMSO). The methylation level of miR - 9 promoter was tested by DNA bi-sulfite sequencing technology. The cell cycle was observed by flow cytometry (FCM). The proliferation ability of the cells was detected by the colony forming assay in semi - solid Methylcellulose medium culture. Results EVI1 level was dramatically increased after being infected by MSCV - EVI1 plasmid. Forced expression of EVI1 in Uocm1 signifi-cantly downregulated miR - 9 by inducing hypermethylation of miR - 9 promoter. Relative expression level of miR - 9 was lower in EVI1 overexpressed group(0. 004 ± 0. 000)than that of the control group(0. 006 ± 0. 001)(t = 4. 09,P <0. 05). When EVI1 was overexpressed in Uocm1,the rate of G0 / G1 cells decreased markedly(P < 0. 05),while rates of S phage and G2 phage increased significantly(all P < 0. 05). Seven days after 500 cells plated in semi - solid medium, EVI1 overexpressed Uocm1 cells gave rise to more colony (122. 3 ± 7. 8)than Uocm1 cells infected with vector (45. 7 ± 6. 1)(t = - 13. 44,P < 0. 01). 0. 1 μmol/ L 5 - AZA recovered miR - 9 expression(P < 0. 01)by decreasing EVI1 induced hypermethylation of miR - 9 promoter. G0 / G1 phase cell proportion was(48. 25 ± 2. 19)％ in control group,while (65. 90 ± 2. 90)％ in 5 - AZA group (t = - 6. 85,P < 0. 05). 5 - AZA group formed less colony (51. 00 ± 10. 01)than the control group (123. 40 ± 8. 12)(t = 9. 59,P < 0. 01),which indicated that 5 - AZA inhibi-ted cell proliferation by G0 / G1 cell cycle retardation in EVI1 overexpressed uocm1 cells. Conclusions EVI1 may en-hance proliferation ability of myeloid leukemia cells by downregulating miR - 9 through inducing hypermethylation of miR - 9 promotor,which plays a crucial role in the pathogenesis of AML. 5 - AZA may be an effective hypomethylating agent in the therapy of EVI1 high acute myeloid leukemia.
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Obstructive sleep apnea (OSA)is a high incidence of potentially dangerous disease,characterized by intermittent hypoxia or hypercapnia.It is an independent risk factor for ischemic stroke.Currently a number of studies have confirmed OSA closely associated with oxidative stress.In this paper,the complex mechanisms of oxidative stress in the OSA and the occurrence of stroke will be reviewed,such as promoting atherosclerosis,damaging the mitochondria,ischemia -reperfusion injury,ischemic preconditioning.To investigate the relationship between OSA,oxidative stress and stroke from molecular mechanisms.
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Objective To investigate the therapeutic effect of Budesonide inhalation for the children with chronic cough after Mycoplasma pneumoniae infection and its influence on the improvement of sleep quality.Methods One hundred children with chronic cough after Mycoplasma pneumoniae infection treated at Shsnghai Tongji Hospital(Tongji Hospital Affiliated to Tongji University) were selected from June to December 2016,and they were randornly divided into the Budesonide group and the Azithromycin group.The Budesonide group received the Budesonide inhalation,the atomized inhalation 1 mg each time,2 times a day,for 3 consecutive days,and 3 days later,they received ato-mization treatment once a day,for a total of 7 days.The patients in the Azithromycin group were given oral the Azithromycin treatment 10 mg/(kg · d) for 3 days.The efficacy and sleep scores of 2 groups were compared during the period.Results The cure rate of cough in the Budesonide group[8.0％ (4/50 cases),32.0％ (16/50 cases),38.0％ (19/50 cases)]was higher than those in the Azithromycin group[0 (0/50 cases),4.0％ (2/50 cases),6.0％ (3/50 cases)] during 3,7,14 days,and the differences were all statistically significant (x2 =4.167,13.279,14.918,all P ＜0.05).The improvement rates of cough in the Budesonide group [28.0％ (14/50 cases),28.0％ (14/50 cases),26.0％ (13/50 cases)]were higher than those in the Azithromycin group[10.0％ (5/50 cases),10.0％ (5/50 cases),8.0％ (4/50 cases)] in treatment 3,7,14 days,and the differences were all statistically significant (x2 =5.263,5.263,5.741,all P ＜ 0.05).Nighttime sleep scores returned to normal ratio and improvement rates during 3,7,14 days in the Budesonide group [8.0％ (4/50 cases),32.0％ (16/50 cases),42.0％ (21/50 cases);30.0％ (15/50 cases),30.0％ (15/50 cases),30.0％ (15/50 cases)],which were significantly higher than those in the Azithromycin group [0(0/50 cases),4.0％ (2/50 caes),6.0％ (3/50 cases);12.0％ (6/50 cases),12.0％ (6/50 cases),10.0％ (5/50 cases)],and the differences were all statistically significant (all P ＜ 0.05).Conclusions The inhalation of Budesonide can effectively treat chronic cough in children with Mycoplasma pneumoniae infection in children,and significantly improve the quality of sleep.Chronic cough after Mycoplasma pneumoniae infection may be related to airway hyperresponsiveness due to nonspecific inflammation.Inhaled corticosteroids should be selected rather than anti infective therapy.
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Objective To analyze the efficacy of different doses of intravenous immunoglobulin (IVIG) in the treatment of acquired severe aplastic anemia (AA) in children. Methods The clinical data of hospitalized children with severe AA who received adjuvant immunosuppressive therapy of IVIG from January 2000 to December 2015 were retrospectively analyzed. According to different doses of treatment, the children were divided into low dose group ( IVIG 200-400 mg/ (kg·d) once every 4 weeks for 6 times), high dose group (IVIG 1 g/ (kg·d ) x 2 days once every 4 weeks for 6 times). Results All the children were followed up until December 31, 2015. Among the 61 children, it was effective in 41 children and total effective rate was 67.2%. The effective rate of anti thymocyte globulin (ATG) treatment in high dose group was higher after 3 months than that of low dose group, and there was statistical difference (P=0.020). The interval between first dose of IVIG and first dose of ATG in 20 cases of ineffectiveness was 2.0 (2.0-5.0) d, while that in 41 cases of effectiveness was 8.0 (7.0-9.0) d, and the difference is statistically significant (P<0.001); Among the 20 ineffective children, 18 children had the interval <7 day. The survival rates of the two groups were 80% and 87.1%, respectively, and there was no difference between two groups (P>0.05). The incidence of severe infections in the high-dose group was lower than that in the low-dose group after the use of ATG for 6 months, and there was statistical difference (P=0.008). Conclusions High dose of IVIG therapy can increase the early response rate in children with acquired severe AA, but it does not increase the long-term effectiveness, cure rate and 5 year survival rate. In addition, it can reduce the severe infection rate, but cannot reduce the total infection rate and infection related mortality rate.
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Objective To analyze the percentage and functional changes of natural killer T (NKT) cells in peripheral blood and bone marrow of severe aplastic anemia (SAA) children before immunosuppressive therapy (IST) comparing to that of healthy children.Methods Ten children with severe aplastic anemia were included in the study and ten healthy children at the same age were selected as the control group. By lfow cytometry, the percentage of CD3+CD1d tetramer+ NKT cell in peripheral blood and bone marrow were detected from March 2014 to December 2014 in our hospital. Immune magnetic bead separation was used to isolate and purify iNKT cells .The puriifed iNKT cells were cultured in the OCH(50 ng/ml,100 ng/ml or 200 ng/ml)+rhIL-2+rhG-CSF culture systems. The ampliifcation of iNKT cells after cultured in different systems were calculated. Elispot method was used to analyze the spotting form cells (SFCs) of IFN-γ or IL-4 expressed by activated iNKT cells.Results The percentage of CD3+CD1d tetramer+ NKT cells in peripheral blood of SAA group(0.72±0.03)% was signiifcantly lower than that of the control group(0.92±0.02)%(P=0.000). The percentage of CD3+CD1d tetramer+ NKT cells in bone marrow of SAA group(0.82±0.02)% was signiifcantly lower than that of the control group(1.05±0.05)%(P=0.000).In vitro iNKT cell ampliif-cation ability of bone marrow in SAA group was signiifcantly lower than the control group, and in medium concentration(50±6) and high concentration OCH group(52±6), the ampliifcation ability was higher than that in low concentration OCH group(30±5) (P<0.05). The secretion of IFN-γ in the iNKT cells of SAA bone marrow was signiifcantly lower in medium concentration(33±3) and high concentration(35±3)OCH group than that of the low concentration(50±3)OCH group(P<0.01). The secretion of IL-4 in the iNKT cells of SAA bone marrow was signiifcantly higher in medium concentration(50±3)and high concentration(75±3) OCH group than that of the low concentration(33±3) OCH group(P<0.01).Conclusions The quantity and function of NKT cells from children with SAA are lower than that of the healthy children.In vitro, they had better ampliifcation ability and could improve IL-4/IFN-γ imbalance in medium concentration and high concentration OCH group than in low concentration OCH group.
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Objective Previous study found that ifbroblast growth factor-2(FGF2) expression was at a low level in bone marrow of children with aplastic anemia. In this study, we established a bone marrow failure animal model to investigate whether FGF2 is involved in bone marrow failure. Methods BALB/c mice were irradiated by 5.0 Gy ray, and then infused with 1×106 lymphocytes from allogeneic mice lymph node. Peripheral blood cells and bone marrow mononuclear cells counting and bone marrow pathology were done. FGF2 protein in bone marrow mononuclear cells was measured by ELISA. Results Compared with the control group, the counting of hemoglobin, white blood cell, platelet and bone marrow mononuclear cell in aplastic anemia mouse model were signiifcantly deceased (P<0.05). Moreover, FGF2 expression in aplastic anemia mouse model were signiifcantly reduced (P<0.05). Conclusions 5.0 Gy ray irradiation and then 1×106 lymphocyte infusion in mice can induce bone marrow failure similar to the features of aplastic anemia. The low expression of FGF2 in bone marrow of aplastic anemia patients may play an important role in the pathogenesis of aplastic anemia.
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The standardized training for pediatric residents is a necessary route to promote their clinical ability and make them grow up.With the aim to improve the residents' basic theory,clinical skills and medical quality,we set up training plans according to the requirement of standardized training in shanghai,earnestly implement the related training in the process of training content,method,time node and stage appraisal system,formulating personalized training plan and implementing one to one teaching.Besides,we attach importance to the cultivation of scientific research and teaching ability of residents and set up a perfect evaluation system.Residents are required to obtain a certificate of training through the unified comprehensive examination before graduation.Here,the problems existing in the process of pediatric resident standardization training and preliminary countermeasures are also discussed.
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Myelodysplastic syndrome (MDS) is a rare disease of hematological malignant disease in children.Advanced MDS constituted about 50％ of the MDS patients and have a poor outcome in children.There are significant differences in advanced MDS between children and adults,including clinical manifestations,morphological features,cytogenetic findings and prognostic factors.This article reviews clinical research progress of advanced MDS in children.
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10.3969/j.issn.1000-3606.2013.06.007
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Objective To explore the application value of PBL combined with medical simulation training in pediatric clinical practice for long-schooling program medical students.Methods Totally 41 long-schooling program medical students in pediatric department were taken as study group while 40 medical students as control group.PBL combined with medical simulation training was used in study group while traditional method was used in control group.Teaching effect was evaluated using score analysis,PBL learning performance rating scale and student questionnaire.Results Scores of theory test and clinical skill exam after course completion in study group were significantly higher than those of control group (P ＜ 0.01).PBL learning performance rating scale and student questionnaire showed that the student's comprehensive ability has significantly improved.Conclusions Application of PBL and medical simulation training in the pediatric clinical practice for long-schooling program medical students can enhance students' problem analyzing and summarizing abilities,problem-solving ability and practical operation ability.It can effectively cultivate team collaboration and doctor-patient communication skills as well as improve the quality of teaching.
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Objective: We studied the differences in intelligence,self-concept and behavior problem between girls with true precocious puberty and the normal girls.Methods: 35 girls with true precocious puberty aged 8 to 10 years was put into the research group;another 35 girls was put into the normal group(n=35).Both the research group and normal group completed the Piers-Harris Children's Self-concept Scale(PHCSS) and Raven's Standard Progressive Matrices in order to evaluate their levels of self-concept and intelligence respectively.Their parents completed a Child Behavior Check-list(CBCL) and a questionnaire on background status.Results: ①Children in the research group had significantly higher intellectual level than those in the control group.②The PHCSS yielded significantly lower scores of total self-concept,behavior and somatic appearance in the research group than those of the control group.③Higher scores of internal behavior problems,external behavior problems,depression,poor social communication,somatic complaints,delinquent behavior and aggressive behavior at CBCL showed in the research group than those of the control group.Conclusion: ①The level of intelligence of the children in research group was higher than that of children in the control group.②Girls with true precocious puberty showed more behavior problems and lower level of self-concept than those in the control group.