Tumoral calcinosis on thigh in a hemodialysis patient and literature review / 中华肾脏病杂志

The paper reported a patient under maintained hemodialysis for 11 years, with a large mass appeared in the right thigh after local injury. The mass was clinically considered as tumoral calcinosis combined with clinical, imaging and pathological findings. Several treatments such as enhancing dialysis adequacy, low calcium dialysate, calcimimetic agent, non-calcium- phosphorus binding agents, parathyroidectomy and intravenous infusion of sodium thiosulfate could not vanish the mass. Finally, the lump was surgically removed. The treatment of tumoral calcinosis in the hemodialysis patient can provide a instruction for similar situations in clinical practice.

Gut-lung axis: The crosstalk between gut microbiota and lung / 中国小儿急救医学

Human gut is a huge microbial habitat.Gut microbiota provides nutrition for human body, regulates metabolism and intestinal epithelial development, and induces innate immunity, and has significant impacts on growth, development and aging.Gut microbiota is influenced by genetics, living environment or life pattern, diseases and other factors, and also interacts with organs of the whole body through various of ways.The lung and the large intestine have embryological homology, common mucosal immune system, secretory function and other modern biological basis.Gut microbiota not only regulates the function of the gastrointestinal tract, but also affects the health and disease of the respiratory system, forming the " gut-lung axis". Intestinal microecological mediation and regulation based on the theory of gut-lung axis has achieved beneficial effects on the prevention and treatment of respiratory tract infection, asthma, and other respiratory diseases.

Interpretation of 2022 World Health Organization fungal priority pathogens list / 中华实用儿科临床杂志

The global morbidity of invasive fungal diseases (IFD) tends to increase, especially in immunocompromised people.Due to the atypical symptoms, unclear etiological mechanism, and emerging antifungal resistance, IFD challenge current clinical diagnosis and treatment.The World Health Organization (WHO) developed the first WHO fungal priority pathogens list in 2022.The most concerning fungal pathogens were listed and summarized to promote further understanding of the epidemiology of IFD and antifungal drug resistance.It is hoped to provide a basis for the prevention and interventions of IFD.

Characteristics of obstructive sleep apnea in children with allergic rhinitis / 中国小儿急救医学

Objective:To analyze the characteristics of sleep disordered breathing (SDB) in children with allergic rhinitis (AR), and improve the diagnosis and treatment at AR combined with obstructive sleep apnea (OSA).Methods:The clinical data of 120 patients with AR and OSA (AR and OSA group) admitted to the respiratory department at Shenzhen Children′s Hospital from May 2019 to December 2020 were retrospectively analyzed.A total of 120 children diagnosed with OSA and excluded AR during the same period were selected as control group.The SDB day and night symptoms, sleep structure characteristics and sleep breathing events were compared between two groups.Results:The average course of disease in children with AR and OSA was significantly longer than that in control group ( P=0.030). The main manifestations of children in AR and OSA group were mouth breathing (100.0%), snoring (99.2%), nasal obstruction (88.5%), and restless sleep (68.0%). There was no significant difference in sleep structure between two groups ( P>0.05), but the sleep efficiency of AR and OSA group was significantly lower than that of control group ( P=0.028). The respiratory events apnea hypopnea index, obstructive apnea index, obstructive apnea hypopnea index, hypopnea index and oxygen desaturation index of each sleep period in AR and OSA group were significantly higher than those in control group ( P<0.05). Among the children in AR and OSA group, moderate and severe OSA were the main manifestations, and the difference between two groups was statistically significant ( P<0.001). Conclusion:The combination of AR delayed the course of OSA in children.The main characteristics of sleep disordered breathing in children with AR are mouth opening, restless sleep, snoring and nasal obstruction.The sleep efficiency is decreased.Obstructive hypopnea and apnea are the most common respiratory events, and oxygen deficiency often occurs in rapid eye movement phase.Children with AR are more likely to have moderate or severe obstructive sleep apnea.

Risk factors for postinfectious bronchiolitis obliterans after severe adenovirus pneumonia / 中国小儿急救医学

Objective:To investigate the clinical characteristics and risk factors of postinfectious bronchiolitis obliterans(PIBO)after severe adenovirus pneumonia(SAP).Methods:We retrospectivly analyzed 78 children who were hospitalized for SAP at Shenzhen Children′s Hospital from April 2015 to April 2020.The cases were divided into PIBO group( n=26) and non-PIBO group( n=52) based on the diagnosis results.The general conditions, clinical characteristics, and laboratory data from two groups were analyzed, and the risk factors for PIBO were explored. Results:A total of 78 children were included in this study.There were 18 (69.2%) males and eight (30.8%) females in PIBO group; the average age of onset in PIBO group was younger than that in non-PIBO group[(11.77±3.24)months vs.(15.08±6.48)months, P=0.027]. The cough duration[(11.35±7.35)days vs.(7.15±5.67)days, P=0.010], and heat duration[(13.12±6.78)days vs.(8.62±4.76)days, P=0.007] were longer in PIBO group than those in non-PIBO group.The white blood cell count[(12.46±7.23)×10 9/L vs.(9.17±3.66)×10 9/L), P<0.05], platelet count[(390.12±209.03)×10 9/L vs.(284.69±83.33)10 9/L, P<0.05], C-reactive protein[(37.04±32.16)mg/L vs.(18.14±18.33)mg/L, P<0.05], procalcitonin[(3.51±3.33)μg/L vs.(1.09±1.37)μg/L, P<0.05], lactate dehydrogenase(LDH)[(1 155.88±842.94)IU/L vs.(414.00±218.94)IU/L, P<0.01] were all higher in PIBO group than those in non-PIBO group; The roportion of patients with mycoplasma pneumoniae infection[5(19.2%) cases vs.4(7.7%) cases, P<0.05], admitted to PICU[18(69.2%) cases vs.8(15.4%) cases, P<0.01] , using invasive mechanical ventilation[10(38.5%) cases vs.5(9.6%) cases, P<0.01], using hormones[23(88.5%) cases vs.21(40.4%) cases, P<0.01], and using human immunoglobulin[20 (76.9%) cases vs.10(19.2%) cases, P<0.01] were higher in PIBO group than those in non-PIBO group.The multivariate Logistic regression using stepwise method showed that older age ( OR=0.942, 95% CI 0.890-0.997) was a protective factor for PIBO, while higher LDH levels ( OR=1.005, 95% CI 1.002-1.008), using intravenous corticosteroids ( OR=6.622, 95% CI 0.924-47.436), and using human immunoglobulin ( OR=9.681, 95% CI 1.742-53.802) were the risk factors for PIBO in SAP ( P<0.05). The receiver operating characteristic curve was constructed through the combination of age of onset, LDH level, using intravenous hormone, and using human immunoglobulin.The area under the curve reached 0.954.The overall best cut-off value of the prediction model was 0.272, the sensitivity was 92.3%, and the specificity was 86.5%.When LDH=462 IU/L, the area under the curve reached the maximum value of 0.882, the sensitivity was 100.0%, and the specificity was 61.5%. Conclusion:SAP children with characteristics such as younger age, long cough and fever duration, high inflammatory index, LDH level higher than 462 IU/L, admitted to PICU, mechanical ventilation and need hormones and human immunoglobulin, should be alert to the risk of PIBO.

Characteristics of severe adenovirus pneumonia complicated with plastic bronchitis in children / 中国小儿急救医学

Objective:To summarize the clinical characteristics and investigate risk factors associated with the development of plastic bronchitis(PB)in pediatric patients who have severe pneumonia caused by adenovirus(HAdVs)infections.Methods:We retrospectively reviewed the clinical manifestations, laboratory results, radiological examinations, and treatment courses of 258 children who were diagnosed as HAdVs associated severe pneumonia between 1st January, 2015 and 31st October, 2019 at Shenzhen Children′s Hospital.According to the presence of PB, patients were divided into PB group( n=45)and non-PB group( n=213). Results:In PB group, the male to female ratio was 1.65∶1(including 28 boys and 17 girls)and the median age was 41.0(18.5, 65.5)months.Patients younger than 6 years of age accounted for 80.0%(36/45)and older patients accounted for 20.0%(9/45). The major clinical symptoms of patients in PB group were high fever(95.6%, 43/45), cough(100.0%, 45/45)and conjunctivitis(33.3%, 15/45). Physical examinations revealed that most patients had tachypnea(80.0%, 36/45)and crackles(80.0%, 36/45). Compared to patients in non-PB group, the duration of fever in PB group was significant longer( Z=-13.519, P<0.001). Compared to non-PB group, there was a significant decrease of the lymphocyte count[2.24(1.44, 3.84)×10 9/L vs.1.75(1.21, 3.03)×10 9/L] and a significantly increase of the procalcitonin level[0.46(0.19, 1.73)ng/mL vs.1.54(0.37, 2.96)ng/mL] in PB group( P<0.05). Chest radiological examinations revealed that patients in PB group had higher rates to develop pleural effusion(62.2% vs.42.3%) and atelectasis(57.8% vs.22.1%) of the lungs compared to non-PB group( P<0.05). The majority of patients improved after resolution of symptoms(97.8%, 44/45) in PB group.Only one patient(2.2%, 1/45) died due to discontinuation of treatment.Conjunctivitis( P<0.001, OR=108.514, 95% CI 17.476-673.791), tachypnea( P<0.001, OR=18.788, 95% CI 5.172-68.246), pleural effusion( P=0.007, OR=3.363, 95% CI 1.389-8.139) were independent risk factors associated with the development of PB in children with HAdVs associated severe pneumonia. Conclusion:Pre-school age children are at higher risk to develop HAdVs related severe pneumonia that complicated with PB.Fever and cough remain the main clinical symptoms.The presence of PB is associated with longer period of fever and higher risks to have pleural effusion and atelectasis.Conjunctivitis, tachypnea orpleural effusion are higher risk to develop PB in those with HAdVs associated severe pneumonia.

Nebulization of intravenous Tobramycin for treatment of Pseudomonas aeruginosa in children with cystic fibrosis / 中华实用儿科临床杂志

Objective:To investigate the feasibility of nebulizing injectable Tobramycin for the treatment of Pseudomonas aeruginosa (Pa) in pediatric cystic fibrosis (CF) patients. Methods:The clinical data of 3 CF children with Pa infection who were treated by nebulizing injectable Tobramycin in Shenzhen Children′s Hospital from September 2017 to March 2021 were retrospectively analyzed.The efficacy and safety were explored.The nebulized injectable Tobramycin (160 mg/dose) was given twice daily after airway clearance.After one-month treatment course, oral Ciprofloxacin would be given [30 mg/(kg·d)] to patients for another 1 month if Pa was still positive in repeat sputum cultures.Results:There were 2 males and 1 female in 3 cases recruited.The youngest patient was 1-year-old when receiving Tobramycin treatment.After airway clearance and inhalation of injectable Tobramycin, all had improvements in respiratory symptoms and chest CT scan.Two cases took additional oral Ciprofloxacin as Pa was still positive after the 1-month treatment course of Tobramycin.Pa turned to negative in all 3 cases after treatment for 3 months to 1.5 years.Besides, after treatment all the 3 patients had normal liver and renal functions, and normal hearing in multiple follow ups.One patient had a normal brainstem auditory evoked potential in the reexamination.Conclusions:Nebulizing injectable Tobramycin would be a reasonable alternative to inhaled Tobramycin solution for treating pediatric CF patients with Pa in view of the present condition in mainland China.However, it is still worth further study and discussion.

Application of the emm cluster typing system in related studies of Group A Streptococcus / 中华实用儿科临床杂志

Group A Streptococcus (GAS) is one of the most important pathogens leading to children deaths all over the world.Bacterial typing is the commonest approach to analyzing the epidemiological characteristics of pathogenic microorganisms.The emm typing is frequently adopted to study GAS.The emm cluster typing is a recently proposed typing method based on the amino acid sequence homology of M proteins and the ability to bind to the host serum protein.This typing system has been extensively used for epidemiological investigation, strain selection and vaccine deve-lopment in foreign countries.However, it has not been applied in China yet. emm typing is based on a small variable region of emm genes, while the emm cluster typing system defines GAS types according to nearly intact sequences of emm genes.Besides, the emm cluster grouping system is acquired directly by emm typing comparison, so it is simple and feasible.Furthermore, the emm cluster typing can provide more information regarding the functional and structural properties of M proteins in different emm types of GAS.In this review, the methods, principles and applications of the emm cluster typing system in GAS research were summarized, in order to promote its application in China.

Analysis of emm typing and genomic polymorphism of Group A Streptococcus from children with scarlet fever in Shenzhen 2016-2018 / 中华实用儿科临床杂志

Objective:To identify the epidemic types of Group A Streptococcus (GAS)causing scarlet fever, to compare the gene structure and variability of GAS with different emm types, and to elucidate the epidemiological pattern of scarlet fever pathogens in Shenzhen. Methods:Pharyngeal swab samples were collected and analyzed retrospectively from children diagnosed with scarlet fever in Shenzhen Children′s Hospital from January 1, 2016 to May 31, 2018.The GAS strains were preserved for emm genotyping analysis.The strains of representative emm types were selected for whole-genome sequencing.The genomic polymorphism of GAS strains was described by comparative genomic analysis.Moreover, a phylogenetic tree was constructed based on the whole genome core-gene single nucleotide polymorphisms(SNPs) to clarify the evolutionary relationship between strains.Data between groups were compared by Rank sum test. Results:Among 176 GAS isolates that caused scarlet fever in children, 8 emm types were detected.The most common genotype was emm12.0 and its subtype(108/176 strains, 61.4%), followed by emm1.0 and its subtype(53/176 strains, 30.1%). These two genotypes accounted for 91.5% of all isolates collected.Comparative genome analysis was made taking GCA-900984775 as a reference sequence, and the results showed that the genomes of GAS strains had high levels of SNP and insertion or deletion (InDel) polymorphisms.There were more SNPs in emm12.0 strains[183(163, 213)] than those in emm1.0 strains[63 (54, 75)], and the difference was statistically significant ( P<0.05). As for InDel, more insertions and deletions [4(3, 6), 8(6, 10)] were observed in emm12.0 strains than those [1(0, 2), 5(3, 7)] in emm1.0 strains.According to the phylogenetic tree built by taking MGAS5005 as the reference sequence based on the whole genome core-gene SNPs, 18 strains and reference strains formed two clades. Conclusions:The emm12.0 and emm1.0 types are the most common GAS strains leading to scarlet fever in children.There are differences in the genome composition of different GAS strains.The emm12.0 strains have higher genetic diversity.

Epidemiology, prevention and control strategy of Group A Streptococcus infection / 中华实用儿科临床杂志

As a pathogen of public health significance, group A Streptococcus (GAS) infects 18.1 million people and leads to 500 000 deaths all over the world every year.GAS is often transmitted through respiratory droplets and contact with damaged skin.Children, the elderly and immunocompromised people are highly susceptible to GAS infection.Schools, kindergartens, hospitals, nursing homes and other densely populated areas are high-risk areas for GAS transmission.Prevention and control measures should highlight the improvement of living conditions and hand hygiene.Adherence to infection prevention and control measures should be emphasized in high-risk environments.In this paper, the risk factors, prevention and control strategies of GAS infection and transmission were summarized, so as to provide basis for the prevention and control of GAS.

Clinical feature analysis of 541 children with adenovirus pneumonia / 中华实用儿科临床杂志

Objective:To summarize the clinical characteristics of adenovirus (HAdVs) pneumonia in children.Methods:The clinical manifestations, laboratory results, imaging features and treatment courses of 541 children with HAdVs pneumonia treated in Shenzhen Children′s Hospital from January 2017 to August 2019 were retrospectively studied.Results:The number of children diagnosed with HAdVs pneumonia increased year by year.A total of 541 patients were included in this study (214 females and 327 males, median age 31 months). The majority of patients (89.3%, 483/541 cases) were less than 6 years of age.Cough (98.3%, 532/541 cases) was the most common symptom, followed by fever (93.7%, 507/541 cases), tachypnea (36.6%, 198/541 cases) and wheeting (32.5%, 176/541 cases). Thirteen point three percent patients (72/541 cases) had existing primary diseases.Severe HAdVs pneumonia was observed in 33.8% of patients (183/541 cases), the most common intrapulmonary complication were pleural effusion(18.6%, 101/541 cases) and respiratory failure (7.0%, 38/541 cases). In co-infection cases, 46.9% of the patients (254/541 cases) suffered from co-infection with mycoplasma pneumoniae, 21.6% of the patients (117/541 cases) suffered from bacterial co-infection.Ninety-eight point five percent of the patients (533/541 cases) were cured, and 1.5% of the patients (8/541 cases) died or discharged voluntarily.Convulsions [ P=0.026, OR=7.312 (95% CI: 1.267-42.191)] and bacterial co-infections [ P=0.030, OR=2.724 (95% CI: 1.101-6.741)] were independently correlated with the occurrence of severe HAdVs pneumonia. Conclusions:Pre-school aged children are at higher risks of developing HAdVs pneumonia.The majority of patients presents with fever and cough as primary manifestations.Tachypnea and wheezing are also common clinical features of HAdVs pneumonia patients.Approximately a third of children with HAdVs pneumonia may develop into severe pneumonia.The presentation of convulsion and the exis-tence of bacterial co-infections may help to predict the development of severe HAdVs pneumonia in pediatric patients.

Clinical analysis of infantile laryngopharyngeal reflux disease with cyanosis / 中国小儿急救医学

Objective:To analyze the clinical characteristics of infantile laryngopharyngeal reflux diseases(LPRD) with cyanosis as the main manifestation, improve diagnosis of the disease and avoid missed diagnosis.Methods:Clinical data of children diagnosed with LPRD at Shenzhen Children′s Hospital from September 2015 to October 2018 were retrospectively analyzed.Results:Cyanosis was the predominant symptom in all 5 cases.The course ranged from 3 days to 4 months.Laryngomalacia was observed in 4 cases.Two patients were treated with esophageal atresia, 1 with esophageal stenosis and 1 with severe tracheomalacia.All 5 cases had vocal cord and arytenoid mucosa edema.The Ryan index was 65.92-1 444.5 in the upright position and 3.73-431.44 in the supine position.Three cases were treated with erythromycin and ceftriaxone according to the etiology.Two cases were treated with motilium at the same time, and 3 cases were with omeprazole oral.One case was recovered after 8 weeks and the Ryan index became normal.Symptoms were alleviated in 3 patients after 4 weeks, drugs were stopped by parents.One case still had cyanosis during medication, the symptoms were significantly relieved after tracheal stent implantation.Conclusion:LPRD is closely related to children′s respiratory and digestive system diseases.LPRD should be taken into account when children show unexplained clinical symptoms of respiratory and digestive system, and laryngoscopy and DX-pH detection should be performed as soon as possible to avoid missed diagnosis.

Study progress of chronic granulomatous disease in children / 中华实用儿科临床杂志

Chronic granulomatous disease(CGD)is a rare primary immunodeficiency disease with X-linked or autosomal pattern of inheritance, which belongs to monogenic disorders, mainly manifested in repeated infection, granuloma formation caused by inflammatory response disorder and other inflammatory diseases.Detection of neutrophil respiratory burst function can screen the disease, and gene sequence analysis can identify the pathogenic genes.Now, the latest research on gene therapy was updated, and the clinical manifestations, diagnosis, routine treatment and hemato-poietic stem cell transplantation(HSCT)were summarized in order to strengthen the clinicians′ understanding of CGD.

Immunodeficiency diseases with interstitial lung disease as major clinical manifestations: report of six cases / 中华儿科杂志

Objective@#To summarize the clinical features of immunodeficiency diseases with interstitial lung disease (ILD) as major clinical manifestations and to improve understanding etiology of ILD.@*Methods@#The clinical features and clinical clues for diagnosis of six cases with immunodeficiency presented with ILD in Shenzhen Children′s Hospital from January 2014 to December 2016 were retrospectively analyzed.@*Results@#The patients′ age ranged from 3 months to 5 years and 9 months, 5 cases were male. All cases had cough and tachypnea, 3 cases had lung infection and respiratory failure, 2 cases had chronic hypoxia and one had clubbing. Three cases had skin rashes; 5 cases had failure to thrive. Chest CT scan showed diffuse ground glass opacity in all the 6 cases, and 2 cases had cystic changes and one had "crazy-paving" pattern. Five patients were suspected to have surfactant dysfunction and genetic testing was performed before diagnosis of immunodeficiency, of which the results were negative. With human immunodeficiency virus antibody test or immunologic laboratory testing and/or immune genetic panel, acquired immune deficiency syndrome was confirmed in one case, hyper-IgM syndrome was confirmed in two cases and hyper-IgE syndrome in one case, Wiskott-Aldrich syndrome in one and STAT3 gain of function genetic mutation in another. All cases had clinical clues indicative of underlying immunocompromise.@*Conclusions@#The clinical features of immunodeficiency diseases with ILD are cough, tachypnea or hypoxia, respiratory failure with infection, diffuse ground glass opacity in Chest CT imaging. With thorough medical history and immunology screening, there would be clinical clues indicative of underlying immunocompromise. Screening for immunodeficiency disease should be emphasized in the differential diagnosis of ILD, otherwise it may lead to misdiagnosis or unnecessary testing.

Different long non-coding RNA expression profiles in diabetes and diabetic nephropathy mice kidney / 中华肾脏病杂志

Objective To find the differentially expressed long non-coding RNA (lncRNA) between db/db mice that with nephropathy (DN) or not (DM).Methods In this study,3 DM db/db mice and 2 DN db/db mice proven by renal biopsy were randomly selected,and 3 healthy db/m mice as normal control group.Then,differentially expressed lncRNAs,mRNAs and their fragments per kilobase million (FPKM) in kidney samples were detected by high-throughput next generation sequencing technology.Sequencing data were analyzed to filter out the differentially expressed lncRNA,and theirfunction was preliminarily investigated by bioinformatics analysis and functional enrichment analysis to predict their target genes.Total RNAs of kidneys from these 8 mice were extracted to run real time PCR (RT-qPCR) for verifying the outcomes of the high-throughput sequencing.Results The urinary microalbumin/creatinine ratio (UACR),serum creatinine,and glomerular basement membrane thickness of DN db/db mice were higher than those of DM db/db mice (all P ＜ 0.05),while there was not significant difference in glucose between DM and DN mice.Totally 160 lncRNAs were up-regulated and 99 lncRNAs were down-regulated in kidneys of DN mice compared with those of DM mice,in which the differentially expressed lncRNAs with FPKM value≥2 and differential expression≥ 1 fold between groups were screened and verified by RT-qPCR.Finally three lncRNAs whose variation trend were consistent with the outcomes of the high-throughput sequencing were obtained.Conclusion There was a significantly different expression pattern of lncRNA between the kidneys of DN and DM mice,which may be involved in the progress of DN.

Plastic bronchitis associated with bleeding in child: A case report and literature review / 中国综合临床

Objective To analyze the clinical diagnosis and treatment of a child with hemorrhagic plastic bronchitis, and to explore the etiology of hemorrhagic plastic bronchitis with review of relevant literature,so as to improve the clinicians′understanding of plastic bronchitis.Methods Clinical data of a female children with hemorrhagic plastic bronchitis was retrospectively reviewed.The patient had congenital heart disease,with repeated cough and hemoptysis as the first symptom.Chest CT scan showed cylindrical bronchiectasis of the right lower lobe and the bloodly bronchial cast was removed by bronchoscopy.The related literatures were review.Results After treatment,the symptoms of cough and cough were improved significantly.Conclusion When patients with recurrent hemoptysis and conventional treatment has no effective,it should be alert to the possibility of plastic bronchitis.The bronchoscopy can identify the causes and remove the casts,also need to pay attention to rebleeding.

Podocyte-specific knock-in of PTEN protects kidney against high fat diet / 中华肾脏病杂志

Objective To evaluate the effect of over-expression of phosphatase and tensin homolog does on chromosome ten (PTEN) in podocytes on kidney under high fat diet (HFD) in vivo and clarify the mechanism how PTEN regulates scavenger receptor A (SR-A) expression exposed to oxidized low density lipoprotein (ox-LDL) in podocytes in vitro.Methods The podocyte-specific PTEN knockin (PPKI) mice were fed with HFD to establish mouse model of lipid-induced renal injury.Mice were divided into four groups:ND+Ctrl group,ND+PPKI group,HFD+Ctrl group and HFD+PPKI group.After 24 weeks of dietary intervention,all mice were tested for clinical and biochemical parameters,including serum creatinine (Scr) as well as urine albumin excretion rate (UAER);renal lipid content was measured by oil red O staining and cholesterol quantitative analysis;the pathological changes of glomeruli were observed by PAS staining and electron microscope.Podocyte injury was induced by ox-LDL in vitro.Western blotting was used to detect the changes of SR-A expression induced by ox-LDL after YAP-siRNA interfering (si-YAP),as well as YAP phosphorylation induced by ox-LDL after interfering by PTEN-siRNA (si-PTEN) and PTEN phosphatase inhibitor (Bpv-PTEN),and overexpressing by recombinant adenovirus (ad-PTEN).Results Compared with ND+Ctrl group,HFD+ Ctrl group significantly aggravated the levels of Scr and UAER,the expression of SR-A in podocytes,renal lipid content,mesangial matrix expansion,effacement of podocyte foot processes,and incrassation of glomerular basement membrane (all P ＜ 0.05).Conversely,compared with HFD+Ctrl group,HFD+ PPKI group obviously alleviated the above lipid-induced renal damage (all P ＜ 0.05).In vitro,the expression of SR-A in podocytes was up-regulated when stimulated with ox-LDL (P ＜ 0.05),and the knockout of YAP significantly down-regulated the expression of SR-A induced by ox-LDL (P ＜ 0.05).Exposed to ox-LDL,the expression of p-YAP increased in podocytes (P ＜ 0.05);over-expression of PTEN inhibited p-YAP up-regulation induced by ox-LDL (P ＜ 0.05),while either knockdown of PTEN or inhibition of PTEN phosphatase activity displayed opposite effect (all P ＜ 0.05).Conclusions Over-expression of PTEN in podocytes protected the kidney against damage from HFD in vivo and PTEN might suppress SR-A mediated lipid uptake via dephosphorylating p-YAP to prevent podocyte injury from ox-LDL.

Review and analysis of the treatment of polycentric osteosarcoma in China / 中华骨科杂志

Objective To investigate the clinical and epidemiological characteristics of osteosarcoma in China and analyze the incidence and clinical treatment of osteosarcoma.Methods The clinical data of 1 593 patients with osteosarcoma in 7 bone cancer treatment centers from January 2000 to February 2017 were analyzed.We retrieved large samples of documents in the database,extracted the relevant data and compared the data with this study.SPSS 13 software was used for statistical analysis and each factor was tested by x2.Results Of 1 593 patients,984 were males and 609 were females.The ratio of male to female was 1.62∶ 1.The average age was 23.2 years (range from 3-80 years).The peak age of onset was 11-20 years (52.4％).There were 217 elderly patients (＞ 40 years old).The tumors occurred in 1 524 limbs and 69 in axial bone.The most common sites of disease were distal femur 706 cases,proximal tibia 375 cases,distal humerus 117 cases and others 395 cases.There were 1 154 cases (71％) around the knee joint.The axial bone included 18 cases of spine,49 cases of pelvis and 2 cases of rib.Preoperative biopsy was performed in 1 111 cases and incisional biopsy in 280 cases.Preoperative diagnosis could be made in 1 345 cases (84.4％ of all patients,accounting for 96.7％ of biopsy patients).There were 79 cases with metastasis at first visit,accounting for 5％.Preoperative chemotherapy was performed in 1 185 cases (74.4％).With the DIA preoperative chemotherapy 271 cases,DIA+MTX 251 cases,AP 149 cases.220 cases of tumor cell necrosis rate was evaluated after operationaccording to the Huvos classification.There were78 cases of grade Ⅰ,105 cases of Ⅱ grade,35 cases of Ⅲ and 2 cases of grade Ⅳ.There were 1 299 cases undergoingpostoperative chemotherapy (81.5％),1 306 patients undergoinglimb salvage surgery (82％).Thespecific operation with prosthetic replacement is the most common (911 cases,69.8％).The postoperative chemotherapy included DIA+MTX regimen 471 cases,DIA regimen 266 cases and AP regimen 98 cases.Before and after the operation,379 cases were treated with the same chemotherapy regimen and 666 cases were changed.A total of 18 large sample documents were retrieved in Chinese data base (5 684 cases).The sex ratio,age range,peak incidence and location of the disease were similar to those of this study.The average age was 1-2 years old younger.The percentage of lung metastases associated with initial visits washigher.The rate of preoperative and postoperative chemotherapy and limb salvage waslowand the rate of tumor necrosis wasbetter after chemotherapy.A total of 22 large sample literatures were searched in foreign database (12 850 cases).The ratio of men and women is 1.30∶1 and the proportion of women is higher than the domestic data.The average age was 1-2 years older.The ratio of the knee joint was lower.The percentage of lung metastases associated with initial visits washigher.The rate of preoperative and postoperative chemotherapy and limb salvage were similar to that of this study and the rate of tumor necrosis was better after chemotherapy.Conclusion The general situation of the incidence of osteosarcoma (sex,age,location of the disease) is not significantly different from the previous reports both at home and abroad.In the treatment,preoperative and postoperative chemotherapy rate and limb salvage surgery rate have improved significantly compared with the past.The chemotherapy program from the coexistence of various programs,gradually to the DIA+MTX and DIA program as the mainstream program.

Role of ROCK1 in the podocyte injury induced by oxidized low-density lipoprotein / 中华肾脏病杂志

Objective@#To explore the role of ROCK1 in oxidized low-density lipoprotein (ox-LDL) induced podocyte injury and its possible mechanism.@*Methods@#The conditionally immortalized mouse podocyte cells were cultured in vitro and exposed to 20 μg/ml ox-LDL for 24 h. Western blotting was used to analyze the expression level of p-MYPT, nephrin, LC3-Ⅱ, p62, p-ULK1 in groups of control, ox-LDL, ROCK1 siRNA with ox-LDL, wtROCK1 with ox-LDL. Podocytes were incubated with DiI labeled ox-LDL for 4 h and fluorescence microscope was used to analyze lipid distribution.@*Results@#Compared with control group, ox-LDL increased cell cholesterol accumulation, activated ROCK along with decreased nephrin, LC3-Ⅱ(P<0.05), and increased p62, and p-ULK1 expression (P<0.05). Over-expression of ROCK1 significantly decreased the expression of nephrin and LC3-Ⅱ, but up-regulated the levels of p62, p-ULK1 and cell cholesterol accumulation in ox-LDL stimulated podocytes (P<0.05). In contrast, Inhibition of ROCK1 protected podocyte by improved lipophagy.@*Conclusion@#ROCK1 mediated disfunction of lipophagy contributes to the ox-LDL induced podocyte injury.

A multicenter randomized controlled study of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea in infants and young children / 中华儿科杂志

Objective@#To evaluate the efficacy and safety of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea (AAD) in infants and young children.@*Method@#From November 2012 to September 2013, ten research units of large teaching hospitals or children′s hospitals participated in this multicenter randomized controlled clinical trial. Hospitalized young children aged between 1 month and 3 years (nongastrointestinal infection and antibiotic therapy required)were involved in our study. The children were randomly divided into control group and prevention group by means of block random allocation method. The control group received antibiotic therapy and other conventional treatment. The prevention group was given additional Saccharomyces boulardii (250 mg/d) orally. Diarrhea rates of two groups were compared both during the usage of antibiotics and within 14 days after the antibiotics withdrawal. The adverse reactions of Saccharomyces boulardii were observed all through this study. The results were analyzed by χ2 test or Kruskal-Wallis test or t test.@*Result@#Totally 408 cases (213 cases in prevention group and 195 cases in control group) were enrolled. The age ranged from 1 month to 3 years, with an average age of 1.14 years. The basic diseases were parenteral infections: 368 cases with different kinds of respiratory tract infections or pneumonia, 10 cases of bacterial meningitis, 9 cases with septicemia or sepsis, 6 cases with pertussis or pertussis like syndrome, 5 cases with urinary infection, 5 cases with skin or subcutaneous tissue infections, 3 cases of Kawasaki disease, one with scarlet fever and one with congenital syphilis. During the administration of antibiotics, the incidence of AAD in prevention group was 10.3% (22 cases), which was significantly lower than that of control group (57 cases, 29.2%, χ2=23.296, P<0.05). Within 14 days after the discontinuation of antibiotics, the percent of new diarrhea cases in prevention group (2.4%, 5/213) was also significantly lower than that in control group (16.4%, 32/195, χ2=23.4, P<0.05). Further analysis revealed that the rate of AAD in children less than or equal to 1 year old (25.1%, 52/207) was significantly higher than that of over 1 year old (13.4%, 27/201, χ2=8.922, P<0.05). The incidence of AAD in children treated with antibiotics for more than 5 days was 22.2%(60/270), which was significantly higher than that of less than or equal to 5 days (13.8%, 19/138, χ2=4.180, P<0.05). Although no significant difference was observed, the AAD rate of patients with combined use of two antibiotics was higher than that of using one. During the antibiotic therapy, compared with the control group, the risk of AAD in children under 1 year old was reduced by 52% (χ2=9.217, P<0.05), and 91% (χ2=20.35, P<0.05) in the children over 1 year old in prevention group. The risk of AAD of prevention group decreased by 66% (χ2=13.67, P<0.05) in patients treated with one antibiotics, and 65% in children with combined use of antibiotics (χ2=10.57, P<0.05). In patients treated with antibiotics for less than or equal to 5 days, the risk of AAD decreased by 74% in prevention group (χ2=7.38, P<0.05); and 63% if the course lasted for over 5 days (χ2=16.87, P<0.05). Within 14 days after the withdrawal of antibiotics, compared with the control group, the risk of diarrhea in the prevention group decreased by 82% (χ2=13.35, P<0.05) in infants (≤1 year old) and 93% (χ2=12.00, P<0.05) in children (>1 year old); the risk of diarrhea was reduced by 86% (χ2=9.57, P<0.05) and 87% (χ2=17.71, P<0.05) respectively in prevention group with single and combined use of antibiotics. In patients treated with antibiotics for more than 5 days, the risk of diarrhea in prevention group was reduced by 63% (χ2=22.79, P<0.05), while there was no significant difference if the antibiotics course was less than or equal to 5 days (χ2=2.97, P>0.05). No adverse effects related with Saccharomyces boulardii were observed in our study.@*Conclusion@#Saccharomyces boulardii is effective and safe to prevent AAD of infants and young children both during the usage of antibiotics and up to 14 days after drug discontinuance. It can be one of the drugs of for choice prevention of AAD in infants and young children. Trial registration Chinese Clinical Trial Tegister, ChiECRCT-2012-25.