Analysis of clinical features and risk factors of systemic lupus erythematosus concomitant with interstitial lung disease in children / 中华实用儿科临床杂志

Objective:To explore the clinical features and risk factors of systemic lupus erythematosus(SLE) concomitant with interstitial lung disease(ILD) in children.Methods:A retrospective analysis was performed.A total of 111 hospitalized children diagnosed with SLE in the Department of Rheumatology and Immunology, Children′s Hospital of Soochow University from February 2016 to November 2018 were selected as the research subjects and divided into the SLE-ILD group(18 cases) and the SLE-non-ILD group(93 cases)according to the lung high-resolution CT manifestations. T-test and Wilcoxon rank sum test were used to compare and analyze the general situation, clinical manifestations and laboratory results.Multivariate Logistic regression was used to analyze the risk factors of SLE-ILD. Results:The prevalence of SLE-ILD was 16.2%(18/111 cases). There were significant differences between the SLE-ILD group and the SLE-non-ILD group in the course of disease [14.00 (12.00-24.25) months vs.1.00(1.00-2.00) months], the incidence of serositis [55.6%(10/18 cases) vs.8.6%(8/93 cases)], post-activity shortness of breath [83.3%(15/18 cases) vs.25.8%(24/93 cases)], nervous system damage [27.8%(5/18 cases) vs.6.5%(6/93 cases)], cardiovascular system damage [38.9%(7/18 cases) vs.9.7%(9/93 cases)], the occu-rrence of increased erythrocyte sedimentation rate [66.7%(12/18 cases) vs.31.2%(29/93 cases)], the decreased C 3[88.9%(16/18 cases) vs.62.4%(58/93 cases)], positive anti neutrophil cytoplasmic antibody (ANCA) [88.9%(16/18 cases) vs.18.3%(17/93 cases)], positive anti-Sm antibody [61.1%(11/18 cases) vs.15.1%(14/93 cases)] and anti ribonucleoprotein antibody (anti RNP antibody)[66.7%(12/18 cases) vs.16.1%(15/93 cases)](all P<0.05). Logistic regression analysis demonstrated that serositis( OR=30.535, 95% CI: 2.167-430.336, P=0.011), shortness of breath after exercise( OR=55.115, 95% CI: 1.117-2 579.852, P=0.041), positive ANCA( OR=65.090, 95% CI: 4.488-944.071, P=0.002) and positive anti-RNP antibody( OR=10.007, 95% CI: 1.362-73.500, P=0.024) were risk factors for SLE-ILD. Conclusions:The longer the course of SLE, the higher the incidence of ILD; serositis, shortness of breath after exercise, positive ANCA and positive anti RNP antibody may be risk factors for SLE-ILD.

The relationship between acute kidney injury and acute respiratory distress syndrome and pathogenesis / 中国小儿急救医学

Acute kidney injury and acute respiratory distress syndrome are the most common organ failure in intensive care unit with high mortality.Both lung and kidney are involved in maintaining acid-base balance in the body, and both organs contain a large vascular network, which is the primary target organ for distant organ effects in the failure of each other.This article reviewed the possible pathogenesis of lung-kidney cross-talk in renal injury or acute respiratory distress syndrome, in order to deepen the understanding of both diseases and improve the prognosis.

Advance on diagnosis and treatment of children with severe Takayasu arteritis / 中国小儿急救医学

Children Takayasu arteritis(c-TA)is a potentially life-threatening macrovasculitis that occurs during childhood.The early clinical manifestations are nonspecific, and the damage often leads to ischemic dysfunction of the organ.Non-invasive techniques such as magnetic resonance angiography has been included in the diagnosis and follow-up of children.At present, the conventional treatment plan is the combination of glucocorticoid and immunosuppressant.In the cases of refractory venereal diseases, biological agents should be considered as soon as possible to prevent the damage of ischemia to the terminal organs.When artery stenosis is severe, intravascular(stent or balloon)or bypass intervention is needed to reconstruct the blood vessels of the affected organs.Early diagnosis and timely and correct management are of vital importance in reducing the incidence rate and risk of injury.

Early predictive value of urinary nephrin in acute kidney injury for critically ill neonates / 中华实用儿科临床杂志

Objective:To explore the early predictive value of urinary nephrin in acute kidney injury (AKI) for critically ill neonates.Methods:A prospective study was conducted to neonates who were admitted to Neonatal Intensive Care Unit (NICU) Children′s Hospital of Soochow University, from July to October 2016.According to whether AKI occurred during the NICU′s hospitalization, neonates were divided into AKI group and non-AKI group.Urinary nephrin levels were detected at the first 24 h of NICU, and the score for neonatal acute physiology (SNAP) was assessed within 24 hours of NICU.Multivariate linear analyses were applied to analyze potential variables that were asso-ciated with urinary nephrin level.Multivariate Logistic regression analysis was adopted to evaluate the relationship between urinary nephrin and AKI after adjusting for confounding factors.A receiver operating characteristic(ROC) curve and the area under the ROC curve (AUC) were calculated to assess the early predictive value of urinary nephrin for neonatal AKI. Results:Among the 156 neonates enrolled in the study, 16 cases(10.2%) developed AKI.The median of urinary nephrin, urinary albumin and SNAP scores were 0.27 μg/mg uCr, 0.48 g/g uCr and 9 scores with AKI group, while the median of urinary nephrin, urinary albumin and SNAP scores were 0.16 μg/mg uCr, 0.16 g/g uCr and 7 scores with non-AKI group.When compared with non-AKI neonates, urinary nephrin ( Z=-3.201, P=0.001), urinary albumin ( Z=-2.652, P=0.008) and SNAP score ( Z=-2.611, P=0.009) were significantly higher in AKI neonates.Multiple linear regression analysis proved that urinary nephrin levels were significantly correlated with urinary albumin ( B=0.488, SE=0.117, P<0.001). Multivariate Logistic regression analysis revealed that urinary nephrin remained significantly associated with AKI ( P=0.018) after adjusting for confounding factors, including gestational age, birth weight, gender, SNAP score, mechanical ventilation and apnea.Urinary nephrin achieved AUC of 0.746 (95% CI: 0.606-0.886, P=0.001). Conclusions:As a biomarker of glomerular injury, urinary nephrin is significantly related to the occurrence of AKI and has early predictive value for AKI in critically ill neonates.

Evaluation of glomerular filtration function in critically ill children by means of fibroblast growth factor 23 / 中华实用儿科临床杂志

Objective To analyze the relationship betWeen serum fibroblast groWth factor 23( sFGF23)and glomerular filtration function in critically ill children,and to investigate the predictive value of sFGF23 in glomerular fil﹣tration rate in critically ill children. Methods This prospective study included the children from the Pediatric Intensive Care Unit(PICU)of Children＇s Hospital of SoochoW University from May to August in 2012. A total of 143 critically ill children aged 1 to 156 months and Weighing 2. 5 to 46. 0 kg Were included. The levels of sFGF23 Were measured on the first day of admission. The pediatric risk of mortality Ⅲ score( PRISM Ⅲ)Was calculated based on 16 items Which Were collected during the first 24 hours of admission. Multivariable linear regression analysis Was used to assess the rela﹣tionship betWeen sFGF23 and estimated glomerular filtration rate( eGFR). A receiver operating characteristic( ROC) curve and the area under the ROC curve(AUC)Were calculated to assess the predictive strength. Results Of the total 143 children,8 cases(5. 4%)died during the first Week of admission to PICU. Regression analysis shoWed that sFGF23 levels Were significantly associated With eGFR,even after adjusted for age and body Weight,and sFGF23 achieved AUC of 0. 741 for predicting eGFR,Which Was statistically significant(95%CI:0. 624－0. 858,P﹦0. 002). Conclusions sFGF23 has a good correlation With glomerular filtration function in critically ill children. The sFGF23 has certain clinical application value in evaluating glomerular filtration function in the critically ill children.

Clinical significance of sPD-1 and sPD-L1 in serum and urine of children with primary nephrotic syndrome / 中华肾脏病杂志

Objectives To detect the level of soluble programmed death 1 (sPD-1) and soluble programmed death ligand 1 (sPD-L1) in serum and urine of children with primary nephrotic syndrome (PNS),and explore its clinical significance.Methods From July 2017 to November 2017,children with PNS admitted to the Children's Hospital Affiliated to Soochow University were divided into onset group (36 cases) and remission group (33 cases).Thirty healthy children who underwent medical examination for enrollment,undersize or overweight in the outpatient department of pediatric health care and inpatient department of Endocrinology were selected as healthy control group.Serum and urine samples were collected,in which the levels of sPD-1 and sPD-L1 were detected by enzyme-linked immunosorbent assay (ELISA).The correlation between serum and urine sPD-1,sPD-L1 levels and lymphocyte subsets,urinary protein were analyzed by Pearson and Spearman correlation analysis.Results The level of sPD-1 in serum was lower in remission group than those in healthy controlgroup [1.60(0.48,8.15) ng/ml vs 7.38(2.15,19.02) ng/ml,P ＜ 0.01].The level of urinary sPD-1 in onset group was higher than that in remission group [1.21(0.61,2.56) pg/μg vs 0.51(0.31,0.97) pg/μg,P ＜0.001] and healthy control group [1.21(0.61,2.56) pg/μg vs 0.82(0.34,1.15) pg/μg,P ＜ 0.01].The levels of sPD-L1 in serum and urine were higher in onset and remission group than those in healthy control group (P ＜ 0.001).The level of sPD-1 in the serum was positive correlated with the numbers of CD3+,CD3+CD4+,CD3+ CD8+ T lymphocytes and CD3-CD19+,CD19+CD23+ B lymphocytes (r=0.537,0.478,0.454,0.429 and 0.374;P=0.002,0.008,0.012,0.018 and 0.042).The level of sPD-1 in the urine had positive relation with the ratio of 24 hours urinary albumin and weight (24 h UmAlb/Wt),N-acetylglucosaminidase and urinary creatinine (UNAG/Cr) and β2 microglobulin and urinary creatinine (Uβ2MG/Cr) (r=0.409,0.588 and 0.276;P=0.016,0.000 and 0.032).Conclusions The dynamic changes of sPD-1 and sPD-L1 in serum and urine suggested that PD-1/PD-L1 signaling pathway is involved in the development process of childhood primary nephrotic syndrome.

Effects of cystic fibrosis transmembrane conductance regulator on neonatal rats with bronchopulmonary dysplasia / 中国新生儿科杂志

Objective To study the effects of cystic fibrosis transmembrane conductance regulator (CFTR) on neonatal rats with bronchopulmonary dysplasia (BPD).Method The hyperoxia (FiO2＞ 90％)-induced neonatal BPD rat models were established and assigned into three groups:the model group,the agonist group and the antagonist group.Room air (FiO2 21％) was inhaled by the rats in the control group.50 μl of phosphate buffered saline (PBS),genistein (50 mg/kg),arachidonic acid (500 mg/kg) and PBS were injected intraperitoneally respectively in the model group,the agonist group,the antagonist group and the control group at 24,48 and 72 h after birth.The survival rates of the neonatal rats were calculated,the survival curves were drawn,the pathological changes of the lung tissues were examined (the control group and the model group:3,14 and 21 d after birth;the agonist group and antagonist group:14 and 21 d after birth),and the expression of CFTR were studied using western blot method.The acute lung injury scores of the model group,the agonist group and the antagonist group were compared and the gray value was analyzed using Graphpad software.Result (1) The survival rates in the control group,the model group,the agonist group and the antagonist group were 96.8％,93.3％,100％ and 34.5％ respectively.The antagonist group had significantly lower survival rate than the other three groups (P＜0.001).(2)The alveoli developed gradually with age in the control group.The pulmonary pathology of the model group showed:alveolar congestion,hemorrhage,infiltration or aggregation of neutrophils in airspace or vessel wall,thickness of alveolar wall,with some enlarged alveolar spaces and reduced alveolar cavities.As the inflammation gradually decreased,some alveolar spaces significantly enlarged and the numbers of alveolar cavities significantly reduced.No significant differences existed of the acute lung injury scores among the agonist group,the antagonist group and the model group at 14 and 21 d after birth (P＞0.05).(3) The expressions of CFTR in the lungs were lower in the model group than the control group 3 d after birth (P＜0.01).No significant differences existed of the CFTR expression between the model group and the control group 14 d after birth(P＞0.05).The CFTR expression was much higher in the agonist group than the model group (P＜0.01) and also higher in the antagonist group than the model group (P＜0.05) 14 d after birth.The CFTR expression was lower in the model group than the control group,and higher in the agonist group than the model group 21 d after birth (P＜ 0.05).No significant differences existed of CFTR expression between the antagonist group and the model group 21 d after birth (P＞0.05).Conclusion CFTR may play a protective role in the pathogenesis of BPD.

The significance of glomerular fibrinogen deposition in childhood Henoch-Sch?nlein purpura nephritis / 临床儿科杂志

Objective To explore the significance of glomerular fibrinogen (Fib) deposition in Henoch-Sch?nlein purpura nephritis (HSPN). Methods The clinical and pathological data of 82 children with HSPN diagnosed by renal biopsy were retrospectively analyzed. The clinical and pathological characteristics of each group were compared according to whether there were glomerular Fib deposition and deposition intensity in the kidney. Results Glomerular Fib deposition was observed in 63 cases (76.83%) in 82 cases, including Fib+23 cases (28.05%), Fib++37 cases (45.12%) and Fib+++3 cases (3.66%), and no deposition had been found in renal tubules. The levels of high sensitivity C reactive protein (hs-CRP), D-Dimer (DD), CD19+CD23+lymphocyte subsets, and urinary albumin to creatinine ratio (UMA/Cr) were significantly different among non-deposition group, mild deposition group and severe deposition group (P<0.01). The levels of hs-CRP and CD19+CD23+in severe deposition groups were significantly higher than those in the mild and non-deposition groups (P<0.05). The level of D-D in the severe and mild deposition group was significantly higher than that in the non-deposition group (P<0.05). The UMA/Cr in the severe deposition group was significantly higher than that in the non-deposition group (P<0.05). Glomerular Fib deposition is positively correlated with IgA deposition (r=0.64, P<0.001). The proportion of glomerular IgG deposition among three groups was significantly different (P<0.05), and the proportion of IgG deposition in the severe group was the highest. Conclusions When children had glomerular Fib deposition, especially in the case of severe Fib deposition and immune dysfunction, inflammatory response and hypercoagulability are more serious and renal function damage may be more serious.

Childhood hypomyopathic dermatomyositis combined with interstitial lung disease: two cases report / 临床儿科杂志

Objective To discusses the effectiveness of tocilizumab in the treatment of hypomyopathic dermatomysositis (HDM) combined with interstitial lung disease (ILD) in children. Methods The clinical characteristic, treatment, and prognosis of HDM combined with ILD were analyzed in 2 patients. The related literatures were reviewed. Results Both ten-year-old girl and 8-year-old boy had shortness of breath after activities, but had no clinical manifestations of muscle damage; both of them had typical rash, but had nornal muscle strength and muscular tension. Laboratory tests showed the elevation of serum ferritin, lactate dehydrogenase, glutamate aminotransferase, and aspartate aminotransferase. Creatine kinase slightly increased in the initial test, and then was in the normal range in the following tests. The high resolution computed tomography showed that pulmonary interstitial lesions. HDM combined ILD was diagnosed clinically. The girl died after treatment with high-dose hormones, cyclophosphamide, cyclosporine, pirfenidone, and gamma globulin failed. The boy was stabled after conventional hormone treatment plus tocilizumab (240 mg twice). His laboratory indicators were in the normal range in the follow-up. Conclusions The clinical manifestations and laboratory indicators aren't typical in childhood HDM. The mortality is high. Combined with tocilizumab treatment is effective in one case.

Association of fluid overload with acute kidney injury and prognosis in critically ill children / 临床儿科杂志

Objectives To investigate the association of fluid overload (FO) with the development and mortality of acute kidney injury (AKI) and to evaluate the predictive value of FO in mortality of critically ill children. Method A prospective study was conducted among critically ill children who were admitted to the children's intensive care unit (PICU). FO levels were assessed during the course of the disease and PRISM Ⅲ scores were evaluated within 24 hours of admission. Binary logistic regression analyses were conducted to evaluate the association of FO with the development and mortality of AKI after adjusting for confounding factors. The area under the receiver operating characteristic curve (AUC) was calculated to assess the predictive value of FO for mortality. Results In 362 children included, there were 26 children (7.18%) having average FO≥5%, and AKI in 24 children (6.63%) and 18 children (5.0%) died. The mean FO (OR=1.26, 95%CI: 1.10～1.43, P=0.001) and the maximum FO (OR=1.12, 95%CI: 1.02～1.23, P=0.018) were significantly correlated with the development of AKI in critically ill children within 7 days of admission to PICU. However, after adjusting for age and PRISM Ⅲ, both factors had no association with AKI (all P>0.05). After adjusting for the potential confounders such as AKI and the severity of disease, the average FO was significantly associated with mortality (AOR=1.34, 95%CI: 1.12～1.60, P=0.002). The AUC of mean FO that predicted mortality risk was 0.801 (P<0.001). Conclusion Fluid overload is associated with the development and the prognosis of AKI in critically ill children, and has important predictive value for mortality.

Clinical analysis of 81 children with urinary system injury after hematopoietic stem cell transplantation / 临床儿科杂志

Objectives To investigate the etiology, renal pathology, treatment, and prognosis of children's urinary system injury after hematopoietic stem cell transplantation (HSCT). Methods Clinical data of 81 children with urinary dysfunction after HSCT admitted to the Hematology Department in Children's Hospital of Soochow University were analyzed, and relevant literatures were reviewed. Results In 81 cases (50 males and 31 females), the age ranges from 8 months to 17 years old. Thirty cases (37%) with prerenal injury were recovered after active rehydration and other symptom specific treatment. There were 9 (11.1%) children with renal injury, four cases were given up therapy or transferred to other hospitals, thus lead to an unknown prognosis. Kidney biopsy was performed in the remaining five cases for pathological investigation. After active symptom-speific and etiology-based treatment, serum creatinine and glomerular filtration rate of four cases return to normal. But in the long-term follow-up,one case died of recurrence of primary disease, reinfusion of hematopoietic stem cell combined with renal failure. The remaining 3 patients were with chronic kidney disease (CKD). One case with renal thrombotic microangiopathy was in the chronic dialysis. Postrenal renal injuries were mainly hemorrhagic cystitis (28.4%) and urinary tract infection (16%). After a large dose of rehydration, urine alkalization and anti-infection therapy, they were recovered in the short term with a good prognosis. Conclusions Urinary injury after HSCT is mainly divided into three categories: prerenal, renal and postrenal, in which renal injury is prone to frequent recurrence.

Clinicopathological comparative study of IgM nephropathy and IgA nephropathy in children / 临床儿科杂志

Objective To compare the clinical and pathological differences between IgM nephropathy (IgMN) and IgA nephropathy (IgAN) in children. Methods Clinical manifestations, laboratory examination results, and renal patholog-ical data from 38 children with IgMN and 40 children with IgAN were compared. Results The mean age of onset in IgMN group was younger than that in IgAN group (P0.05). In IgAN group, the incidence of proteinuria, RBC casts in tubular, C3 and ifbrinogen deposition, and foot process effacement were higher in the cases with severe glomerular injury than those in the cases without severe glomerular injury (P<0.05); the degree of impairment of renal function, the incidence of severe mesangial cell proliferation, and glomerular sclerosis were more serious in the cases with severe tubular injury than those in the cases without severe tubular injury (P<0.05). Conclusions The clinical and pathological features are different between IgMN and IgAN in children. The renal damage is less in IgMN than that in IgAN children. Different from IgAN children, there is no parallel relationship between tubular and glomerular injury in IgMN children.

Predictive value of fluid overload for mortality in children with severe sepsis / 中华实用儿科临床杂志

Objective To investigate the predictive value of fluid overload for mortality in children with severe sepsis.Methods In this retrospective study,the children with severe sepsis who were admitted to the Pediatric Intensive Care Unit (PICU),Children's Hospital of Soochow University between January 2011 and March 2015.Fluid accumulation was calculated in the first 72 hours after admission.Pediatric index of mortality Ⅱ (PIM2) score was calculated during the first 1 hour after admission.Multivariate Logistic regression analysis assessed the relationship between fluid overload and mortality after adjustment for confounding factors.The predictive value of fluid overload for mortality was assessed by the receiver operating characteristic curve and au area under the receiver-operating-characteristic curve (AUC).Results Of the 199 children admitted,62 cases (31.2％) died during PICU stay.Among the children,133 cases (66.8％) had fluid overload of＜5％,55 cases (27.6％)had fluid overload of≥5％-10％,and 11 cases (5.6％) had fluid overload of≥ 10％.Multivariate regression analysis showed that a high fluid overload percent (OR =1.263,95 ％ CI:1.113-1.434,P ＜ 0.001),a high PIM2 score (OR =1.028,95 ％ CI:1.012-1.043,P ＜ 0.001) and multiple organ dysfunction syndrome(OR =4.160,95％ CI:1.728-10.012,P =0.001) were independent risk factors for mortality in children with severe sepsis.The fluid overload was significantly associated with mortality (OR =1.309,95％ CI:1.158-1.480,P ＜0.001),even after adjustment for age and illness severity assessed by PIM2 scores.Fluid overload achieved AUC of 0.741 (95％ CI:0.661-0.820,P ＜ 0.001) for predicting mortality in children with severe sepsis.Conclusion Fluid overload developed during the first 72 hours after admission is independently associated with and predictive of PICU mortality in children with severe sepsis.

Urinary protein markers predict the severity of renal histological lesions in children with IgA nephropathy and IgM nephropathy / 中华实用儿科临床杂志

Objective To compare the clinical manifestations,renal histological lesions,and the levels of urinary protein markers between the children with IgA nephropathy (IgAN) and those with IgM nephropathy (IgMN), and to determine whether urinary protein markers could predict the severity of renal histological lesions in children with IgAN and IgMN.Methods Seventy-four children with renal biopsy-proven IgAN and IgMN from January 2002 to October 2014 were enrolled in the study.The levels of IgG, albumin (Alb), transferrin (TRF), α1-microglobulin (α1-MG) ,β2-microglobulin (β2-MG) and N-acetyl-β-glucosaminidase (NAG) in morning urine samples before biopsy were measured.The semi-quantitative scores of mesangial hypercellularity (MC), glomerulosclerosis (GS), and tubule-interstitial damage (TID) were used to assess renal histological lesions.Multivariate Logistic regression analysis was used to determine whether urinary protein levels were independently associated with renal histological lesions.The area under the receiver-operating-characteristic curve (AUC) was calculated to assess the predictive ability of urinary protein markers.Results Seventy-four children (44 cases with IgAN,30 cases with IgMN) were included.The urinary levels of α1-MG and Alb were significantly higher in children with IgAN as compared to those with IgMN.The differences, however, did not remain significant after adjustment for age.The urine protein, as an independent factor associated with severe MC(＞ 5 mesangial cells per mesangial area) was TRF(B =0.010), and severe GS (≥ 10％ glomeruli showing segmental adhesion or sclerosis) was significantly correlated with Alb(B =0.001) ,and severe TID (focal or diffuse tubular and interstitial lesions) was significantly correlated with NAG(B =0.038).Urinary β2-MG was not significantly associated with severe MC, GS and TID.Urinary TRF, Alb and NAG achieved the best AUC of 0.85 (P ＜ 0.001) ,0.78 (P =0.002), and 0.78 (P =0.003), respectively, for predicting severe MC, GS, and TID.Conclusions Urinary proteins are useful to predict the severity of renal histological lesions in children with IgAN and IgMN.Urinary TRF, Alb and NAG have better predictive value.

Predictive value of urinary cystatin C for mortality in critically ill neonates / 中华实用儿科临床杂志

Objective To determine if urinary cystatin C (uCys C) level can predict mortality in critically ill neonates.Methods This prospective study included neonates admitted to the intensive care unit within the first 6 hours of life from May.2011 to Oct.2012.Neonates were assigned into survivor and non-survivor groups based on whether they died during the first week of life.The uCys C level was measured on the day of admission.The score for neonatal acute physiology (SNAP) was calculated based on 28 items collected during the first 24 hours of admission.Multivariate Logistic regression analysis was used to determine whether uCys C level was a predictor of mortality.A receiver operating characteristic (ROC) curve was constructed and the area under the ROC curve (AUC) was calculated to assess the predictive strength.Results Of the total 155 neonates,12 cases (7.1％) died during the first week of life.When compared to survivors,the gestational age (t =2.810,P =0.006) and birth weight (t =3.245,P =0.001) in non-survivors were significantly lower; but the uCys C level (z =-3.426,P =0.001),the SNAP score (z =-3.308,P =0.001),and the use of mechanical ventilation (x2 =23.877,P =0.000) were significantly higher.Logistic regression analysis revealed that uCys C remained significantly associated with mortality after adjusting for gestation age,birth weight,or the SNAP score (P =0.024).uCys C achieved AUC of 0.81 (95％ CI:0.71-0.92,P =0.001).When combined with SNAP and mechanical ventilation,the predictive performance of uCys C improved AUC 0.93 (95 ％ CI:0.86-1.00,P =0.000).Conclusion uCys C is significantly associated with adverse outcome of death and independently predictive of mortality in critically ill neonates.

The research of the influence of Pingyangmycin on c-myc and Ras-P21 protein expression in penile cancer / 实用肿瘤学杂志

Objective To evaluate the influence and significance of Pingyangmycin chemotherapy on the c-myc and Ras-P21 protein expression in penile cancer .Methods A total of 100 penile squamous cell carci-noma cases was retrospectively studied and divided into two groups .Data were obtained from 1995 to 2005 .In the chemotherapy group ,50 cases of patients were selected to perform preoperative chemotherapy before surgery .The patients were treated by Pingyangmycin .After 7 times of medication ,partial excision of penis plus improved ingui-nal lymph node dissection was performed .In the control group ,50 cases of patients were selected for partial exci-sion of penis plus improved inguinal lymph node dissection directly without any pre -operative chemotherapy .All pathology specimens were detected of c -myc and Ras-P21 protein expression by immunohistochemical staining assay.Theχ2 test was used for the statistical analysis .Results In chemotherapy group,the positive expression rates of c-myc and Ras-P21 were 30%,27%,respectively.However,in control group,the positive expression rate of c-myc,Ras-P21 were 52%,48%,respectively.By theχ2 test,the expressive differences of c -myc,Ras-P21 positive expression rate between chemotherapy group and control group were all significant (P<0.05). Conclusion The protein expressions of c -myc and Ras-P21 is significantly decreased in the tissue of Pingy-angmycin chemotherapy of penile cancer .

Expression and role of CD40/CD40L and B7-1/CD28 interaction in folic acid-induced nephropathy / 中华肾脏病杂志

Objective To explored the role of CD40/CD40L and B7-1/CD28 interaction in the immunopathologic process of folic acid-induced nephropathy(FAN) and investigate the intervention effect of the anti-B7-1 monoclone antibody(B7-1mAb). Methods GD1 mice were administrated by i. p with FA only or co-treated with B7-1 mAb for the intervention study. Kidneys were harvested for immunohistochemical, Western blot assays and serum for renal function evaluation at day 1, 3,5, 7, 14 and 21. Results Continuous expression of CD40, B7-1 from day 1 to day 21 on the renal tubular epithelial cells was detected in this model. CD40 was up-regulated more than five times in the kidney at every test time point (P

Adriamycin increases podocyte permeability: evidence and molecular mechanism / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the increased podocyte permeability by evidence of adriamycin (AD) and its molecular mechanism.</p><p><b>METHODS</b>In this study, we explored the direct effects of AD on cultured mouse podocytes and the potential protection effects of Dexamethasome (Dex).</p><p><b>RESULTS</b>After 24-hour AD (5 x 10(-7) mol/L) treatment, albumin passage through podocyte monolayers was increased by 2.27-fold (P < 0.01). AD caused a 62% decrease in Zonula Occluden-1 (ZO-1) protein (P < 0.05), suggesting that AD might increase podocyte permeability by disrupting tight junctions. Dex (1 x 10(-6) mol/L), co-administered with AD, protected podocytes from AD-induced increased albumin passage. This may be linked with an increased P-cadherin protein level to 1.93 fold of control (P < 0.01).</p><p><b>CONCLUSIONS</b>AD has a direct, detrimental effect on podocyte permeability, probably through disrupting tight junctions; Dex could protect against AD-induced high podocyte permeability by upregulating adherent protein P-cadherin.</p>

Therapeutic effect of Jianing Decoction on experimental autoimmune thyroiditis / 中成药

AIM: To evaluate the therapeutic effect of Jianing Decoction (Rhizoma sparganii, Rhizoma curcumae, Radix bupleuri, Fructus schisandrae chinensis, Spuama manis, Radix polygoni multifrori, Spica prunellae, Flos chrysanthemi indici, Fructus ligustri lucidi) (JN) on autoimmune thyroiditis. METHODS: An animal model of experimental autoimmune thyroiditis (EAT) in rats was developed by using thyroglobulin of porcine (PTg). These animals were divided into JN group, triptolide (TP) group and control group. Pathological changes were observed in the thyroid tissues and serum thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TGAb) were determined by the method of radiorimmuoussay. RESULTS: The serum TGAb and TPOAb were significantly higher in EAT model group than those in normal group (P