Etiology and clinical characteristics of 30 children with tumor-associated precocity / 中华实用儿科临床杂志

Objective To analyze the etiology and clinical characteristics of children with tumor-associated precocity.Methods Thirty children with tumor-associated precocity hospitalized in Department of Surgery of Beijing Children's Hospital Affiliated to Capital Medical University from Jan.2006 to Mar.2012 were selected as research subjects.The causes,clinical characteristics and treatment situation of the patients were retrospectively studied.Results The group of patients included 14 boys and 16 girls,with average age of (3.74 ± 2.44) years.Twenty-two patients (73.3％) were younger than 5 years old,and their etiological distributions listed as follows:8 cases were hypothalamic hamartoma(HH),2 cases were hypothalamic germinoma,1 case was arachnoid cyst,7 cases were adrenocortical tumor (in which 1 case was adenoma and 6 cases were adenocacinoma respectively),5 cases were ovarian cyst,2 cases were ovarian tumor (in which 1 case was endodermal sinus tumor and 1 case was sex cord-stromal tumor respectively),2 cases were MuCune-Albright syndrome,and 1 case was mediastinal teratoma,1 case was penis primitive neuroectoderm tumor,and 1 case was Leydig cell proliferation accompanied with neoplasma.Eleven patients(36.7％) suffered central precocious puberty,with HH (n =8) being the most common causes.Four patients with HH presented with gelastic epilepsy.Precocious puberty caused by HH patients could be safely controlled by gonadotropin-releasing hormone agonists.Nineteen patients(63.3％) suffered peripheral precocious puberty,with adrenocortical tumor being the most common cause for the boys and ovarian cyst being the most common cause for the girls.Besides that,the onset symptom of a patient with adenocacinoma was facial acne accompanied with hypertrichiasis and another patient with ovarian tumor had intermittent abdominal pain,and the onset symptoms of all the boys were external genital development and those of the girls were mammary development or colporrhagia,respectively.Conclusions Tumors are one of the most causes of precocious puberty in children.During the process of diagnosis and treatment of precocious puberty,imaging examinations on pituitary,gonad and adrenal gland should be paid great attention to and seldom occurred tumors should also be considered.For ovarian cyst patients with precocious puberty attention shall be paid attention to the differentiation from MuCune-Albright syndrome.

Relationships between fat mass and obesity associated gene and genetic onset mechanism of obesity in Chinese children / 中华实用儿科临床杂志

Objective To study the association of fat mass and obesity associated gene(FTO gene) and genetic onset mechanism of obesity in Chinese children.Methods Two hundred and one Chinese children with obesity in Beijing Children's Hospital Affiliated to Capital Medical University from Jan.to Sep.2010,were selected as research subjects,183 healthy adult blood donors were selected as normal controls.Mass Spectrometry techniques were used to study the distributions of the alleles and gene type of FTO in patients and controls.And the relationship between FTO gene polymorphism and obesity in Chinese children were studied.Results The distributions of 5 FTO gene polymorphisms (rs9939609A,rs8050136A,rs3751812T,rs1421085C,rs7193144C) in obesity patients and healthy controls had significant differences.And the Haplotype analysis showed that all of the single nucleotide polymorphisms(SNPs) were in linkage disequilibrium,and three out of six (CTGGTCTGG,TCTGCAAAA,CTGGCCTGG) had significant differences between obesity patients and healthy controls (P ＜ 0.05).Conclusions The gene polymorphisms of rs9939609,rs8050136,rs3751812,rs1421085,rs7193144 of FTO gene confer significant susceptibility to obesity in Chinese children.The haplotypes of CTGGTCTGG,TCTGCAAAA,CTGGCCTGG have significant differences between obesity patients and healthy controls.

Immune mechanism and clinical significance of macrophage to medullary hematopoietic injury of immune-related hematocytopenia patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Immune-related hematocytopenia (IRH) is considered to be related with the production of autoantibody, as well as the activation of humoral immunity which is stimulated by B lymphocyte. This study aimed to observe the levels of various cytokines in the blood serum and the in situ active state of macrophage (Mφ) in the medullary hematopoietic microenvironment of IRH patients, and to probe into the immune mechanism and clinical significance of Mφ in hematopoietic cell injury.</p><p><b>METHODS</b>ELISA is used to detect the IL-4, IL-6, IL-12, IL-17, and IFN-γ levels in the peripheral blood serum of 376 patients in pre- and post-therapy. Cytochemistry and cell immunochemistry methods are used to observe the peroxidase (POX), nonspecific esterase (NSE), hemosiderin granules, and HLA-DR activity of Mφ in the bone marrow of patients. Immunofluorescence is used to observe the expression of hemocyte antihuman globulin IgG antibody, lymphocytes CD4 molecule, Mφ membrane FcγIIreceptor (FcγIIR), mannitose receptor (MR), IFN-γ, ICAM-1, IL-12, and IL-17A and the formation mechanism of antibody-dependent cell-mediated cytotoxicity (ADCC) hematopoietic cell islands (HI) in the medullary hematopoietic microenvironment of patients. Glucocorticoid is used for treatment on the basis of anti-infection therapy, and gamma globulin stoss therapy is used for the appearance of ADCC-type HI or serious Mφ bloodthirsty phenomenon; if necessary, association of Cyclosporine A (CsA) should be used and chalybeate should be supplemented.</p><p><b>RESULTS</b>In the patient group, the levels of IL-4, IL-6, IL-12, IL-17, and IFN-γ were increased. After treatment, the cytokine levels gradually became normal. The activated Mφ in the marrow highly expressed NSE and POX, and Mφ swallowed more hemosiderin particles, but the iron in the cytoplasm of immature erythrocytes decreased. The activated Mφ expressed HLA-DR, MR, ICAM-1, IFN-γ, and IL-12. For patients with humoral immunity activation and bacterial infection, Mφ weakly expressed IL-17A but highly expressed FcγIIR, and the phenomenon that ADCC-type HI broke pathological blood corpuscles often occurred; for the cellular immune activation along with virus infection, the white blood count (WBC) significantly reduced, Mφ weakly expressed FcγIIR, secretory highly expressed IL-17A, and the phenomena that Mφ adhered to, captured and swallowed blood cell often occurred. After four weeks of anti-infective and immunosuppressive therapy, nuclear apoptosis of Mφ occurred in the bone marrow of patients, HI and bloodthirsty phenomenon disappeared, and the peripheral blood picture started to improve.</p><p><b>CONCLUSIONS</b>Mφ is an important antigen presenting cell in the IRH marrow for hematopoiesis destruction and an immune effector cell of hematopoietic injury; infection can promote the activation of Mφ, upregulate the impression of immune molecule and receptors, form ADCC HI, aggravate hematopoietic injury, and accelerate the destruction on hematopoietic cell.</p>

Early versus late percutaneous dilational tracheostomy in critically ill patients anticipated requiring prolonged mechanical ventilation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Tracheostomy should be considered to replace endotracheal intubation in patients requiring prolonged mechanical ventilation (MV). However, the optimal timing for tracheostomy is still a topic of debate. The present study aimed to investigate whether early percutaneous dilational tracheostomy (PDT) can reduce duration of MV, and to further verify whether early PDT can reduce sedative use, shorten intensive care unit (ICU) stay, decrease the incidence of ventilator associated pneumonia (VAP), and increase successful weaning and ICU discharge rate.</p><p><b>METHODS</b>A prospective, randomized controlled trial was carried out in a surgical ICU from July 2008 to June 2011 in adult patients anticipated requiring prolonged MV via endotracheal intubation. Patients meeting the inclusion criteria were randomly assigned to the early PDT group or the late PDT group on day 3 of MV. The patients in the early PDT group were tracheostomized with PDT on day 3 of MV. The patients in the late PDT group were tracheostomized with PDT on day 15 of MV if they still needed MV. The primary endpoint was ventilator-free days at day 28 after randomization. The secondary endpoints were sedation-free days, ICU-free days, successful weaning and ICU discharge rate, and incidence of VAP at day 28 after randomization. The cumulative 60-day incidence of death after randomization was also analyzed.</p><p><b>RESULTS</b>Total 119 patients were randomized to either the early PDT group (n = 58) or the late PDT group (n = 61). The ventilator-free days was significantly increased in the early PDT group than in the late PDT group ((9.57 ± 5.64) vs. (7.38 ± 6.17) days, P < 0.05). The sedation-free days and ICU-free days were also significantly increased in the early PDT group than in the late PDT group (20.84 ± 2.35 vs. 17.05 ± 2.30 days, P < 0.05; and 8.0 (interquartile range (IQR): 5.0 - 12.0) vs. 3.0 (IQR: 0 - 12.0) days, P < 0.001 respectively). The successful weaning and ICU discharge rate was significantly higher in early PDT group than in late PDT group (74.1% vs. 55.7%, P < 0.05; and 67.2% vs. 47.5%, P < 0.05 respectively). VAP was observed in 17 patients (29.3%) in early PDT group and in 30 patients (49.2%) in late PDT group (P < 0.05). There was no significant difference between the two groups in the cumulative 60-day incidence of death after randomization (P = 0.949).</p><p><b>CONCLUSIONS</b>The early PDT resulted in more ventilator-free, sedation-free, and ICU-free days, higher successful weaning and ICU discharge rate, and lower incidence of VAP, but did not change the cumulative 60-day incidence of death in the patients' anticipated requiring prolonged mechanical ventilation.</p>

Pulsed release behavior of microgels coated layer-by-layer by polyelectrolyte in vivo and in vitro / 第二军医大学学报

Objective To Investigate the in vitro and in vivo release of chitosan-alginate microgels coated layer-by-layer by polyelectrolyte self-assembly. Methods The cores of the microgels were made by gelatinization using electrostatic microencapsulated and coated by polyelectrolytes using electrostatic attraction. The effects of different layers and ratios of polymer on the in vitro lease of FITC-dextran were evaluated. Histrological examination was carried out to observe the in vivo release process by injecting the coated microgels into mice. Results The results showed that alginate and calcium chloride concentrations and polyelectrolyte layers markedly affected the lag time of pulsed release and the relasing speed after lagging. Conclusion The release of microgels coated layer-by-layer by polyllectrolyte can be controlled in vitro and can be observed in vivo; meanwhile, the microgels are safe and have good biocompatibility.

Preparation of polyelectrolyte layer-by-layer coated microgels for pulsed drug delivery / 第二军医大学学报

Objective To Investigate the preparation method, the release profile and structure of the polyelectrolyte layer- by-layer coated chitosan-alginate microgels. Methods The cores of the microgels were prepared by a high voltage electrostatic system, and the semipermeable membrane outside the microgel was polyelectrolyte deposits on the core surface through electrostatic attraction. The influences of different ratios of materials on the expansion property and the in vitro cumulative release of the coated microgels were evaluated by a single factor experiment. Results The prepared polyelectrolyte-coated microgels were well-shaped, with a narrow range of diameter distribution. The lag time of in vitro release was 2. 67 h; the release was rapid after lagging, with the cumulative in vitro release being 72% within 3 h. Conclusion Polyelectrolyte layer-by- layer coated chitosan-alginate microgels can release payload in a pulsed fashion in vitro.

Three programmed systems for pulsed drug delivery / 第二军医大学学报

Pulsed drug delivery (PDD), which can be released at well-defined time points as the therapy needs, can decrease the frequency and avoid taking drug at night, thus improving patient compliance. Here we introduce three kinds of programmed PDD systems independent of external chemical triggering; they are divided according to the triggering mechanisms, degradation-triggered PDD, osmotic pressure-triggered PDD, and both degradationi and osmotic pressure-triggered PDD. This paper reviews preparing technique, release mechanisms and influencing factors of the three PDD systems. The release profiles of pulsatile PDD can be regulated for different therapeutic needs, requiring no external triggers; especially that the PDD system triggered by both degradation and osmotic pressure has a bright future.

Mutation analysis of the GLUD1 gene in patients with glutamate dehydrogenase congenital hyperinsulinism / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the glutamate dehydrogenase 1 (GLUD1) gene mutation of three patients diagnosed as glutamate dehydrogenase congenital hyperinsulinism (GDH-HI).</p><p><b>METHODS</b>Three patients diagnosed as GDH-HI and their parents were involved in the study. PCR-DNA direct sequencing was used to analyze the exons 6,7,10,11 and 12 of the GLUD1 gene.</p><p><b>RESULTS</b>In the first case, an R269H heterozygous mutation was found in the GLUD1 gene, with autosomal dominant inheritance. In the second case, there was a de novo S445L heterozygous mutation of the GLUD1 gene. No mutation was detected in the third case.</p><p><b>CONCLUSION</b>In Chinese, R269H, S445L heterozygous mutation of the GLUD1 gene can lead to GDH-HI. Genetic analysis is necessary in making genetic diagnosis of congenital hyperinsulinsm.</p>

Blood glucose profile in children and adolescents in Beijing area / 中华儿科杂志

<p><b>OBJECTIVE</b>There are scant data about normal reference values of blood glucose (BG) in children. This study was conducted to learn the BG profile of children and adolescents in Beijing area.</p><p><b>METHOD</b>The population for survey was selected as a stratified cluster sample from 8 urban and 10 rural areas in Beijing. Fasting capillary blood glucose (FCBG) was determined in 19,593 children and adolescents aged 6 to 18 years in 4 urban and 3 rural areas using haemosaccharometer model II [Roche Diagnostic, (Shanghai) Ltd].</p><p><b>RESULTS</b>There were 1 9112 (97.5%) individuals with complete records, the mean age was 12.1 +/- 3.3 years (ranged from 6 to 18.9 years); 9514 (49.8%) were boys, 9598 (50.2%) were girls, 9792 were (51.2%) from urban areas and 9320 (48.8%) from rural areas. The average level of FCBG in boys was higher than that in girls (4.7 +/- 0.5 vs. 4.5 +/- 0.5, u = 28.0, P < 0.01). Among urban children, the trend of variation of FCBG was similar between boys and girls, the levels of FCBG increased with age, the peak of FCBG was reached at 12-13 years in urban girls, and from the age of 15 years, the level of FCBG declined. In boys, the FCBG level increased slowly from 13 years of age, there was no significant variation until 17 years old, and declined at the age of 18. Among suburban children, the trend of variation of FCBG was similar between boys and girls, both of them had two peaks, from 6 to 11 years old, FCBG of both boys and girls increased with age, and both reached the first peak at the age of 11 years. While at 13 years of age, there was an obvious drop in FCBG level. From 14 years of age on, there was a rise of FCBG in both boys and girls, and the second peak of FCBG was reached at 15 and 16 years of age in girls and boys respectively. The FCBG level of urban children was higher than that of rural children (4.7 +/- 0.5 vs. 4.6 +/- 0.5, u = 13.8, P < 0.01). The level of FCBG in overweight and obese children was higher than that of normal children. More boys, more obese and more urban children had abnormal FCBG.</p><p><b>CONCLUSIONS</b>The blood glucose level of children was associated with age, gender, obesity and district.</p>

Determination of the serum mannose binding lectin levels in 738 Han ethnic group children / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the distribution of serum mannose binding lectin (MBL) levels in Han ethnic group children.</p><p><b>METHODS</b>The concentrations of MBL in serum were measured by ELISA in 268 umbilical cord blood specimens from Chongqing, Wuhan and Urumqi as well as in serum of 470 normal children aged from 0 to 6 years and 87 adults in Chongqing.</p><p><b>RESULTS</b>The distribution of serum MBL levels in children (28 days to 6 years) was abnormal but there was no significant difference in MBL serum levels in subjects of different ages and genders. The median concentration of MBL in serum was significantly lower in newborns (median: 1597 microg/L, range: 884 - 1825 microg/L), cord blood group (median: 1462 microg/L, range: 0 - 4604 microg/L) than in other groups (children group median: 2536 microg/L, range 0 - 7860 microg/L; adult group median: 2920 microg/L, range 98 - 6495 microg/L). While among the other sub-groups aged from 28 days-6 years (28 day group median 2299 microg/L, range 214 - 4195 microg/L; 6 months-group median 2622 microg/L, range 5 - 4637 microg/L; 2 years-6 years group 2585 microg/L, range 198 - 7860 microg/L), there was no statistically significant difference. The median serum MBL level in normal children aged from 28 days to 6 years was 2563 microg/L and the P(2.5)-P(97.5) was 171 - 5079 microg/L.</p><p><b>CONCLUSIONS</b>The distribution of serum MBL levels in children (28 days to 6 years) was abnormal type but there was no statistically significant difference among different age and sex groups. The reference value of P(2.5)-P(97.5) in children (28 days-6 years) was 171 - 5079 microg/L.</p>

Human metapneumovirus infection in children with acute respiratory tract inflammation in Urumuqi / 中华流行病学杂志

objective To understand whether human metapneumovirus(hMPV)is one of the pathogens leading to the children's respiratory infections in Urumqi.Methods A total number of 209 samples were collected in the People's General Hospital of Xinjiang Uygur Autonomous Region from November 2006 to April 2007 with Some from the hospitalized children.while the others from outpatient clinic.Specimens included nasopharyngeal aspirates(NPA)and swabs were analyzed.Samples were all tested hMPV M gene by RT-PCR while the two positive PCR amplicons were sequenced and compared with other hMPV in GenBank by Blast and DNAstar.Results Of all the 209 samples.two positive ones were tested.The identities between them were 83.8%.Results from Phylogenetic analysis showed that they might belong to two different clusters.Conclusion hMPV was one of the pathogens leading to the children's respiratory tract infections in Urumqi.with two different hMPV groups existed in the same season.

Prevention and treatment of biliary complications following orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To study the prevention and treatment of biliary complications after orthotopic liver transplantation.</p><p><b>METHODS</b>Clinical data of 183 recipients who had received liver transplantation between May 1995 and December 2006 were retrospectively analyzed.</p><p><b>RESULTS</b>Biliary complications occurred in 15 patients (15/183, 8.2%). The incidence for short-term and long-term complication were 6.0% (11/183) and 2.2% (4/183) respectively. No biliary complications was due to hepatic artery thrombosis(HAT). Four cases who received PTC(percutaneous transhepatic cholangiography) with stent insertion,8 cases who received ERCP( endoscopic retrograde cholangiopancreatography) with stent insertion and 1 who received Roux-en-Y choledochojejunostomy for anastomotic stricture were successfully cured. Two cases required relaparotomy died for fungus infection eventually. The mortality due to biliary complications was 1.1%.</p><p><b>CONCLUSIONS</b>The rapid combined abdominal organ harvesting technique could shorten the ischemia time and ameliorate the injury due to vascular and bile duct variances, which could reduce the incidence of biliary complication. PTC and (or) ERCP combined with stent insertion were main procedure for biliary complications not related to HAT after liver transplantation.</p>

Clinical Analysis of Gitelman Syndrome in Children / 实用儿科临床杂志

Objective To explore the clinical characteristics of Gitelman syndrome in children and the difference between Gitelman syndrome and Bartter syndrome.Methods Clinical date,biochemical tests and therapy of 6 patients diagnosed as Gitelman syndrome in Beijing children′s hospital from Mar.to Dec.2006 were retrospectively analyzed.At the same time,the relative articies of Gitelman syndrome and Bartter syndrome were reviewed.Results The symptoms of 6 patients appeared early.The age of onset of Gitelman syndrome at infancy stage,the main complains were growth delay,weakness,tetany.All patients had normal blood pressure.The biochemical tests showed hypocalemic,hypomagnesium,alkalosis and hyperreninemia.But the concentration of aldosterone was normal or little higher.The manifestations of all patients were relieved after taking both potassium and magnesium.Conclusion Gitelman syndrom and Bartter syndrome have differences at clinical syndrome and machanism of onset.

Studies on Mineral Elements for Cultivated Halenia Ellipitica D. Don in Qinghai Province / 中国中医药信息杂志

Objective To compare the change of mineral element in Tibet herb Halenia ellipitica D. Don before and after the seeds matured. Method We separately collected the cultivated Halenia ellipitica D. Don of several different districts in Qinghai province before and after the seeds matured and analyzed the contents of mineral elements as potassium, sodium, calcium, magnesium by atom absorb spectrum instrument. Results and Conclusion The calcium, magnesium and potassium, sodium elements nutriment has an antagonistic characteristic. The sodium and phosphorus elements nutriment has a coordination characteristic of the cultivated Halenia ellipitica D. Don in Qinghai province during the growth period.

Application of cluster randomization method on typhoid Vi vaccine trails / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the design and application of cluster randomized controlled method on typhoid Vi vaccine trial, and to assess the effect of implementation.</p><p><b>METHODS</b>Simple size calculation of cluster-randomized trial was used to determine the sample size of the two groups and a vaccination campaign was conducted. The study group was given typhoid Vi vaccine and the control group was given meningococcal A vaccine.</p><p><b>RESULTS</b>According to sample size calculation, a total sample of 96,121 participants was required and the study areas were divided into 108 clusters. In practice, 53 study clusters with 44,054 participants and 54 control clusters with 48,422 participants were stratified and matched according to size, location (urban or rural), characteristics (school, department, factory, demography) were randomized respectively. Confounding factors of two groups including age, sex, resident area, income, level of education were compared. It was found that the ratio of all confounding factors between the two groups were comparable and balanced.</p><p><b>CONCLUSION</b>Confounding factors can be better controlled between study group and the control group by applying cluster-randomized method on vaccine trail which enabled the intervention to be more scientifically evaluated; The implementation of cluster randomization trial was simple and easy to be accepted.</p>

Study on HPLC fingerprint of Swertia mussotii var. mussotii from north-west area of Sichuan Province I / 中国中药杂志

<p><b>OBJECTIVE</b>To constitute HPLC fingerprint of the methanol extract from Swertia mussotii grown in Sichuan Province.</p><p><b>METHOD</b>RP-HPLC, methanol and water including 0.02% acid as mobile phase, gradient elution, flow rate 1.0 mL x min(-1), the detection wavelength was 260 nm, temperature was 30 degrees C.</p><p><b>RESULT</b>The RSD values of peak area and retention time of common peaks in precision, repeatability and stability were lower than 5.0%, respectively, similarity was over 0.805 in S. mussotii collected from 10 different habitats.</p><p><b>CONCLUSION</b>All results above exhibit that this method is simple, practicable, and reliable as a standard method in controlling the quality of S. mussotii.</p>

Influence of hepatitis B and hepatitis C virus infection on the outcome of kidney transplantation / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection on the long-term survival of renal transplantation recipients.</p><p><b>METHODS</b>A total of 443 patients who received renal allografts from 1992 to 2002 were analyzed. Outcome and survival were compared among four groups retrospectively.</p><p><b>RESULTS</b>Twelve patients were positive for both hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) (group 1), 18 were HBsAg-positive and anti-HCV-negative (group 2), 26 were HBsAg-negative and anti-HCV-positive (group 3) and 387 were negative for both markers (group 4). The mean follow-up period was 6.1 +/- 2.8 years (range, 0.5-10 years) for all patients. Group 2 had significantly higher liver-related complications (38.9%) and liver-related death (16.7%) than did group 4 (0%, P < 0.01). Among all patients, 4 HBsAg-positive patients had fulminant hepatitis and died within two years of transplantation. Three patients (group 2) who died were seropositive for HBeAg and/or HBV DNA and none had a history of or positive serologic marker to indicate hepatitis of other etiologies. One (group 1), two (group 2), and one patient (group 3) developed liver cirrhosis respectively, and hepatocellular carcinoma occurred in two patients (group 2) and one patient (group 3). Despite high liver-related mortality in HBV-infected patients, no significant differences among the four groups in the long-term graft and patient survivals were demonstrated. The presence of HBsAg or anti-HCV was not associated with poor prognosis as determined by Cox regression analysis.</p><p><b>CONCLUSION</b>HBV or HCV infection is not a contraindiction to kidney transplantation in Chinese patients. However, it should be noted that serious liver-related complications may occur and limit survival in patients infected with HBV and/or HCV after kidney transplantation.</p>

Prevention and treatment of rejection after simultaneous pancreas-kidney transplantation / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To explore methods of preventing and reversing rejection after simultaneous pancreas-kidney (SPK) transplantation.</p><p><b>METHODS</b>Seventeen patients underwent SPK transplantation from September 1999 to September 2003 were reviewed retrospectively. Immunosuppression was achieved by a triple drug regimen consisting of cyclosporine, mycophenolate mofteil (MMF), and steroids. Three patients were treated with anti-CD3 monoclone antibody (OKT3, 5 mg x d(-1)) for induction therapy for a mean period of 5-7 days. One patients received IL-2 receptor antibodies (daclizumab) in a dose of 1 mg x kg(-1) on the day of transplant and the 5th day posttransplant. One patient was treated with both OKT3 and daclizumab for induction.</p><p><b>RESULTS</b>No primary non-functionality of either kidney or pancreas occurred in this series of transplantations. Function of all the kidney grafts recovered within 2 to 4 days after transplantation. The level of serum creatinine was 94 +/- 11 micromol/L on the 7th day posttransplant. One patient experienced the accelerated rejection, resulting in the resection of the pancreas and kidney grafts because of the failure of conservative therapy. The incidence of the first rejection episodes at 3 months was 47.1% (8/17). Only the kidney was involved in 35.3% (6/17); and both the pancreas and kidney were involved in 11.8% (2/17). All these patients received a high-dose pulse of methylprednisone (0.5 g x d(-1)) for 3 days. OKT3 (0.5 mg x d(-1)) was administered for 7-10 days in two patients with both renal and pancreas rejection. All the grafts were successfully rescued.</p><p><b>CONCLUSION</b>Rejection, particularly acute rejection, is the major cause influencing graft function in SPK transplantation. Monitoring renal function and pancreas exocrine secretion, and reasonable application of immunosuppressants play important roles in the diagnosis and treatment of rejection.</p>

Survey of type 1 diabetes incidence in children from 1997 to 2000 in Beijing area / 中华儿科杂志

<p><b>OBJECTIVE</b>The incidence of type 1 diabetes varied in different countries, different nations and different regions. This survey was conducted to clarify the incidence of type 1 diabetes of children in Beijing area between 1997 and 2000, to compare and analyze the difference in incidence of type 1 diabetes between the 2 periods of 1988 - 1996 and 1997 - 2000.</p><p><b>METHOD</b>According to the criteria of WHO Diabetes Mondial (DIAMOND), data were collected from all the children younger than 15 years of age in Beijing area who had the onset of type 1 diabetes during Jan. 1st, 1997 to Dec. 31st, 2000. Using the capture-recapture methods, 95% confidence intervals of incidence were calculated with Poisson's distribution formula. The significance of differences was tested with Chi-square method.</p><p><b>RESULTS</b>The incidences of type 1 diabetes during 1997 - 2000 were around 0.76/100 000 to 1.21/100 000. The average yearly incidence was 1.014/100 000 (95% confidence interval was 0.98/100 000 - 1.16/100 000). There was no significant difference in the incidence between 1988 - 1996 and 1997 - 2000, and it showed the same result when the incidences were adjusted by age according to the Chinese population census in 2000 (The incidence was 0.83/100 000 in 1988 - 1996 and 0.86/100 000 in 1997 - 2000, respectively). The incidence was higher in 10 - 14 year-old group than the younger groups (P = 0.002). There was no significant difference between male and female groups, either.</p><p><b>CONCLUSIONS</b>No significant difference was found between the periods 1988 - 1996 and 1997 - 2000 when the average yearly incidence of type 1 diabetes of children in Beijing was compared. These results were different from the other countries' reports that the incidence of type 1 diabetes was increasing by 3% - 5% per annum. There was no significant difference between male and female groups either and there was a higher incidence of type 1 diabetes in 10 - 14 yr group than the other groups in 1997 - 2000. Although the life-style of Beijing people changed a lot, it didn't affect the incidence of type 1 diabetes in children in this area. But since many people migrated to Beijing from other parts of the country, the changes in constitutive proportions of population might have some impacts on the results of the survey.</p>

Analysis of rejection after simultaneous pancreas-kidney transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To explore methods of preventing and reversing rejection after simultaneous pancreas-kidney transplantation (SPK).</p><p><b>METHODS</b>Seventeen patients performed SPK operation from Sep, 1999 to Sep, 2003 were reviewed retrospectively. Immunosuppression was achieved by triple regimen consisting of cyclosporine, mycophenolate mofetil (MMF)/azathioprine and steroid. 2 patients were treated with Dalizumab, the other three patients used OKT3 as immune induction.</p><p><b>RESULTS</b>1 patient experienced the accelerated rejection, the pancreas and kidney grafts were resected because of failure of conservative therapy. 8 patients experienced renal acute rejection, 2 cases suffered from pancreas acute rejection at the same time. All these patients received daily high dose pulse steroid for 3 days. OKT3 was administered in 2 patients with steroid resistance rejection. All the grafts were successfully rescued.</p><p><b>CONCLUSIONS</b>Reasonable application of immunosuppression after SPK operation and adoption of systemic measures which can reduce sensitivity of high risk receptor before SPK operation are the effective methods of preventing and treating rejection.</p>