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Objective:To investigate the clinical features of children with kidney diseases who developed posterior reversible encephalopathy syndrome (PRES), explore the risk factors of PRES in these children, improve the understanding of the diseases, and help early diagnosis and effective treatment of the diseases.Methods:The clinical manifestations, laboratory inspection results, magnetic resonance imaging(MRI) material as well as the prognosis of 10 children with kidney diseases complicated by PRES who were admitted to the Department of Nephrology, Xi′an Children′s Hospital from November 2016 to August 2018 were analyzed retrospectively.Results:A total of 10 children were recruited, including 1 boy and 9 girls, with the onset age ranging from 4 years and 3 months to 13 years [(8.53±3.09) years]. The diagnosed kidney diseases in these patients were primary nephritic syndrome (6 cases), lupus nephritis (1 case), Hepatitis B-related nephritis (1 case), polyarteritis (1 case) and hemorrhagic fever with renal syndrome (1 case). Eight children received corticosteroids and 4 of them received other immunosuppressants simultaneously.Nine children suffered from the infections.All of them had acute onset, and the main symptoms were hypertension (10/10 cases, 100.0%), headache and dizziness (5/10 cases, 50.0%), nausea and vomiting (5/10 cases, 50.0%), visual disturbance (3/10 cases, 30.0%) and convulsions by the ways of seizures definitely (9/10 cases, 90.0%). There was nothing positive in the examinations of the nervous system and fundus.Computer tomography examinations of 9 cases showed nonspecific low-density foci.The cranial MRI scan showed abnormal signals on the cerebral cortex of frontal lobe, parietal lobe and occipital lobe in all these 10 cases.The hyperintensities were observed on the fluid-attenuated inversion recovery sequences of all the 10 cases.Slight hyperintensities on diffusion-weighted images of 4 cases indicated that PRES progressed from reversible angiogenic edema to irreversible cytotoxic edema, meaning a poor prognosis.After blood purification treatment and reducing intracranial pressure, these 4 cases recovered.After timely treatment upon PRES diagnosis, patients had no recurrence and showed a good outcome.Conclusions:Children with kidney diseases and PRES also suffer from hypertension, and the treatment with immunosuppressive agents may precede the occurrence of PRES.Cranial MRI is important for the diagnosis of PRES.
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Objective: To investigate the relationship between the expression of glucose-regulated protein 78 (GRP78) and gemcitabine chemotherapy in the patients with non-small cell lung cancer (NSCLC) and the effects of GRP78 on the viability of lung adenocarcinoma SPCA1 cells and the chemosensitivity of gemcitabine, and to elucidate its mechanisms. Methods: The positive expression rates of GRP78 in 32 cases of cancer tissue of the NSCLC patients were detected by immunohistochemical staining. The SPCA1 cells with high expression of GRP78 were selected as the subjects. RNA interference technique was used to down-regulate the expression of GRP78 in SPCA1 cells (interference group) and the cells treated with shNC were used as control group. MTT assay was used to detect the viabilities of SPCA1 cells in various groups. Negative control group, interference group, control + gemcitabine group, and interference+ gemcitabine group were set up; colone formation assay was used to detect the colone formation rates of SPCA1 cells in various groups; Western blotting method was used to detect the expression amount of Akt, p-Akt, PI3K, and p-PI3K in the SPCA1 cells in various groups. Results: The immunohistochemical staining results showed that the positive expression rate of GRP78 in cancer tissue in the remission NSCLC patients was significantly higher than that in the no-remission NSCLC patients after treated with gemcitabine (P<0. 05). The MTT assay results showed that compared with negative control group, the viability of SPCA1 cells in interference group was decreased significantly (P<0. 05), and the viability of SPCA1 cells in interference + gemcitabine group was significantly decresed (P<0. 05). The Western blotting results showed that compared with negative control group, the expression amounts of p-Akt and p-PI3K in the SPCA1 cells in interference group were decreased, and the expression amounts of p-Akt and p-PI3K in the SPCA1 cells in interference+gemcitabine group were decreased significantly. Conclusion: Interference of GRP78 may increase the sensitivity of gemcitabine to chemotherapy, and GRP78 may reduce the sensitivity of NSCLC patients to gemcitabine through PI3K/Akt pathway.
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ABSTRACT:Objective To study the efficacy and safety of oxcarbazepine (OXC)oral suspension on children with different kinds of epilepsy.Methods A total of 83 children with epilepsy were selected from the Pediatric Department of the First Affiliated Hospital of Xi’an Jiaotong University and Xi’an Children’Hospital from June 201 1 to June 2014.They were treated with OXC monotherapy or adjunctive therapy.Use open-label and self-contrast method.The initial dose of OXC was 8 -10 mg/(kg·d),and then was added 10 mg/(kg·d)per 7 days until it reached the minimum effective dose.Generally,the maintenance dose was about 20-40 mg/(kg·d).The follow-up duration was 6 - 12 months.Results 83 cases were eventually included and 5 cases withdrew.We elvaluated the efficacy every 3 months.The results were as follows:the first stage (1,2,3 months)resulted in a 41.0% of full control rate and a 71.8% of total effective rate;the second stage (4,5,6 months)resulted in a 46.2% of full control rate and a 76.9% of total effective rate;the third stage (7,8,9 months)resulted in a 59.0%of full control rate and a 79.5% of total effective rate.There were no significant differences in the efficacy of the three stages.54 cases with partial seizures resulted in a 59.3% of full control rate and a 79.6% of total effective rate;24 cases with generalized seizure resulted in a 45.8% of full control rate and a 62.5% of total effective rate. There was no statistical significant difference in the efficacy of the two seizure types.43 cases with monotherapy resulted in a 58% of full control rate and a 79% of total effective rate,35 cases with add-on therapy resulted in a 40.0% of full control rate and a 57.1% of total effective rate.24 cases with < 2 resulted in a 41.7% of full control rate and a 62.5% of total effective rate,54 cases with 2-6 resulted in a 59.3% of full control rate and a 83.3% of total effective rate.14 cases of children were reported to have at least one adverse drug reactions,the specific symptoms included emotional instability unstable, hypohidrosis, somnolence, dizzness, headache, vomiting, urorrhea,lack of appetite,aggressive behavior and hypomnesia.Adverse reactions were mild and most of them could subside over time.Conclusion OXC oral suspension has a good efficacy and safety when treating children with partial seizures or generalized tonic-clonic seizures of epilepsy.
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Objective To investigate the efficacy and optimal dose of adrenocorticotropic hormone(ACTH) in treatment of infantile spasms (IS).Methods Sixty patients with IS were randomly divided into group A (ACTH 20 IU/d,n =20),group B (ACTH 40 IU/d,n =20) and group C (Depakine syrup,n =20) in a prospective randomized study.Patients in group A and group B were given ACTH in the dose of 20 IU/d and 40 IU/d for 2 weeks,respectively.After 2 weeks of treatment,ACTH administration was replaced by oral prednisone if the seizure frequency decreased by 50.0％ or less.Patients showing incomplete control of epilepsy(seizure frequency reduction less than 50.0％) or failing to respond to treatment were continuously treated with the original amount of ACTH for another 2 weeks,then ACTH was replaced by oral prednisone.Patients in group C were treated with the combination regimen of oral clonazepam and Depakine syrup routinely.All participants were followed up by 0.5-3.0 years.The differences in clinical efficacy,changes in electroencephalogram(EEG) and adverse reactions in 3 groups were compared and analyzed.Results Mter 4 weeks of treatment,the total effective rates (TER) and EEG remission rate (ERR) in group A [TER:75.0％ (15/20 cases),ERR:40.0％ (8/20 cases)] and group B [TER:70.0％ (14/20 cases),ARE:45.0％ (9/20 cases)] were significantly higher than those in group C [TER:30.0％ (6/20 cases),ERR:10.0％ (2/20 cases)] (x2 =10.011,6.624,all P ＜ 0.05),respectively,while no significant difference was found between group A and group B as for seizure control,hypsarrhythmia EEG resolution,and cognitive function restoration (x2 =0.125,0.000,t =1.95,all P ＞ 0.05).During follow-up study,the TER and ERR in group A [TER:30.0％ (16/20 cases),ERR:35.3 ％ (6/17 cases)] and group B [TER:30.0％ (6/20 cases),ARE:37.5％ (6/16 cases)] were also significantly higher than those in group C [TER:5.0％ (1/20 cases),ARE:5.9％ (1/17 cases)] (x2 =4.329,6.455,all P ＜ 0.05),respectively.The incidence of adverse reactions in group A was lower than that in group B (x2 =3.956,P ＜ 0.05).Conclusions ACTH proves to be an effective drug for the treatment of IS.Administration of ACTH in the dose of 20 IU/d for 2 weeks seems to be an optimal treatment recipe with remarkable efficacy with fewer adverse effects and may be worthy of clinical trials in a larger cohort.
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Objective To investigate the drug resistance of Acinetobacter baumannii and antibiotics use density of all kinds of antibacterial drugs before and after special antibacterial drugs remediation , provide evidence for the follow-up intervention strategies . Methods The experimental results of detected 562 cases Acinetobacter baumannii and sensitivity test were analyzed in our hospital in 2011-2012 , combined with using of every type of antibacterial drugs on different time period .Results The number of bacteria detec-ted half year had no significant difference during 2011-2012 .The antibiotics use density of beta-lactam、fluroquinoloncs and aminogly-cosides declined 22.22(31.92%)、4.19(46.29%)、5.24(68.83%) respectively by special antibacterial drugs remediation .Beta-lactam resistance rates declined significantly to 25%~30%, fluroquinoloncs and aminoglycosides resistance rates also declined , from 50%of the critical point to 20%~30%in the second half of 2012 .Conclusion Standardization of antibiotics use density of various antibacterial drugs could help reduce bacterial resistance .