Clinical observation of belimumab in the treatment of 12 children with active lupus nephritis / 中国小儿急救医学

Objective:To analyze the clinical data of children with active lupus nephritis(LN) with poor first-line treatment and further treatment with belimumab, and explore the efficacy and safety of belimumab in the treatment of children with LN, so as to provide experience and guidance for clinical treatment of children with LN.Methods:From August 2020 to September 2021, 12 children with LN whose systemic lupus erythematosus disease activity index(SLEDAI)score was ≥8 and with poor first-line treatment were collected, and their clinical manifestations, treatment process, SLEDAI score, complement C3, complement C4, anti-dsDNA antibody titer, and proteinuria relief were analyzed retrospectively.Results:Before treatment with belimumab, the SLEDAI score was 8 in 3 cases, 10 in 5 cases, 12 in 2 cases and 16 in 2 cases.Theurine protein was positive in 6 cases.The anti-dsDNA antibody titer was higher than normal value in 8 cases.The complement C3 decreased in 8 cases and the complement C4 decreased in 6 cases.The SLEDAI scores and the anti-dsDNA antibody of 12 children and 24-hour urine protein quantification of 6 children with positive urine protein began to decrease within 4 weeks after treatment with belimumab.Anti-dsDNA antibody decreased to normal in 12th week and 24 h urine protein decreased to normal in 16th week.The levels of complement C3 and C4 began to rise within 4 weeks, complement C3 returned to normal within 24 weeks, and complement C4 returned to normal within 28 weeks.Conclusion:For LN children with poor response to first-line therapy or persistent disease activity, the addition of belimumab resulted in increased complement, decreased disease activity index and anti-dsDNA antibody titer, and effective relief of proteinuria.The application of belimumab has a certain effect on active LN children with poor response to first-line therapy, which is worthy of clinical promotion.

Clinical analysis of hyperphosphatemia in children with steroid-sensitive nephrotic syndrome / 中国小儿急救医学

Objective:To analyze the relationship between hyperphosphatemia and steroid-sensitive nephrotic syndrome(SSNS)in children.Methods:A retrospective study was carried out in 61 children with SSNS at Department of Paediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2018.The changes of serum phosphorus levels during the active and remission stages were observed, and the correlation between serum phosphorus level and serum albumin, blood lipid, renal function, blood calcium, blood phosphorus, urine protein and other indicators were analyzed.Results:Serum phosphorus level of 61 children with SSNS was 1.79(1.65-1.91)mmol/L in the active phase of the disease, of which 33 patients(54.1%)had hyperphosphatemia, while serum phosphorus level was 1.64(1.46-1.79)mmol/L after the complete remission, and 15(24.6%)patients had hyperphosphatemia.Serum phosphorus level was positively correlated with ratio of urine protein/creatinine, serum lipoprotein A and calcium-phosphorus product( r=0.239, P<0.05; r=0.188, P<0.05; r=0.623, P<0.05), and negatively correlated with levels of serum albumin and serum calcium( r=-0.201, P<0.05; r=-0.195, P<0.05). Conclusion:The morbidity of hyperphosphatemia in children with SSNS is quite high during the active stage of the disease.The disorder of blood phosphorus significantly improve with remission of the disease.

Clinical analysis of nine cases of childhood malignancy who initially present with arthritis / 中国小儿急救医学

Objective:To explore the clinical characteristics of malignant tumors with arthritis as the first symptom in children, so as to strengthen the early recognition of juvenile idiopathic arthritis(JIA) and avoid misdiagnosis and treatment.Methods:Nine cases of children with malignant tumor with arthritis as the first symptom were collected from February 2015 to August 2019 in our hospital.The clinical manifestations, laboratory and imaging features of nine cases were analyzed retrospectively.Results:There were nine children, including five males and four females, with an average age of 6.2 years and an average course of 61.4 days.There were seven cases of acute lymphoblastic leukemia(ALL), one case of neuroblastoma(NB) and one case of anaplastic large cell lymphoma(ALCL). Joint symptoms: polyarthritis in four cases and oligoarthritis in five cases.Eight cases had extraarticular symptoms.Nine cases had elevated inflammatory indexes, six cases had mild abnormal blood routine examination, one case was positive for HLA-B27, and other rheumatoid factor, anti CCP antibody, RA33 antibody and antinuclear antibodies spectrum were negative.Bone destruction was found in five cases.There was no significant difference in clinical manifestations and examinations between nine cases of children with malignant tumor and JIA.Conclusion:Arthritis can be the first manifestation of malignant tumor in children.However, JIA lacks specific diagnostic indicators.In clinical practice, malignant tumors with the first manifestation of arthritis can be regarded as JIA and treatment will be delayed.Clinicians need to raise awareness.

Clinical analysis and follow-up of 16 children with methylmalonic aciduria combined with renal injury / 中国小儿急救医学

Objective:To analyze the clinical characteristics and prognosis of children diagnosed as methylmalonic aciduria(MMA) with renal injury.Methods:Sixteen patients diagnosed as MMA with renal injury hospitalized in Shandong Provincial Hospital Affiliated to Shandong University from January 2010 to August 2019 were included.The clinical data and prognosis of the patients were summarized and analyzed retrospectively.Results:Sixteen cases were diagnosed as MMA from 1 days to 7 years old(median 6 months). Renal involvement of 16 patients included isolated hematuria(5 cases), isolated proteinuria(1 cases), hematuria and proteinuria(6 cases), nephritis nephrotic syndrome(2 cases), hemolytic uremic syndrome(2 cases), among them 4 cases accompanied by renal function injury.MMACHC mutation was detected in 2 patients diagnosed as MMA CblC type.One child refused to be treated with vitamin B 12(lost to follow-up after discharge). Among the remaining 15 cases, 5 cases died of multiple organ failure, 5 cases abandoned, 5 cases were saved and the urine routine returned to normal after 1-4 months. Conclusion:The manifestations of MMA combined with renal injury are complicated.Early diagnosis and regular treatment are very important to control the disease and improve the prognosis.

Effect of Dexmedetomidine on the Anesthesia Recovery Period in Obese Patients / 中国医科大学学报

Objective To explore the effect of intravenous dexmedetomidine (0.4 μg·kg 1 ·h 1) on the recovery period in obese patients undergoing laparoscopic Roux-en-Y surgery.Methods Thirty patients (ASA Ⅰ to Ⅱ,body mass index ≥ 30 kg/m2) presenting for laparoscopic Roux-en-Y surgery under general anesthesia were randomly assigned 1:1 to the dexmedetomidine group (group D) or control group (group C).Dexmedetomidine was infused at 0.4 μg·kg-1·h-1 at the beginning of the operation and was discontinued 30 minutes before the end of the surgery in group D.Simultaneously,normal saline was infused at 0.4 μg· kg-1· h-1 in group C.The two groups received the same method of induction and maintenance anesthesia.The intraoperative variables measured included heart rate (HR),mean blood pressure (MBP),low frequency (LF),high frequency (HF),LF/HF ratio extubation time,Silverman-Andersen score (SAS) at the time of extubation,level of agitation during the recovery period,and adverse events.Results HR,MBP,and LF/HF of group C were higher than the baseline values and that of group D (P ＜ 0.05) during the recovery period.LF was higher in group C those in group D (P ＜ 0.05) during the recovery period.MBP was lower than the baseline values (P ＜ 0.05) and SAS at the time of extubation and level of agitation during the anesthesia recovery period were lower in group D (P ＜ 0.05) than in group C.There was no significant difference in HF and extubation time between the two groups (P ＞ 0.05).Conclusion Infusion of dexmedetomidine during anesthesia in obese patients may improve the quality of emergence from anesthesia without increasing the duration of the anesthesia recovery period.

Effects of pseudolaric acid B on apoptosis of bladder cancer cell 5637 / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the apoptosis of bladder cancer cell 5637 induced by pseudolaric acid B in vitro and its mechanism.</p><p><b>METHOD</b>The cell proliferation was detected by MTT assay;the cell cycle was measured by flow cytometry; the cell apoptosis was observed by flow cytometry with Annexin V-FITC/PI double staining; the expressions of survivin protein and caspase-3 protein were detected by Western blot assay.</p><p><b>RESULT</b>It showed that pseudolaric acid B remarkably induced apoptosis of 5637 cell line. Moreover, pseudolaric acid B suppressed survivin and up-regulated caspase-3 expression.</p><p><b>CONCLUSION</b>Pseudolaric acid B inhibits the proliferation and induces the apoptosis of 5637 cells. The molecular mechanism of pseudolaric acid B inducing the apoptosis of 5637 cells may be associated with its action of down-regulating the expression of survivin, and up-regulating the expression of caspase-3.</p>