ObjectiveTo investigate the effect and outcome of critically illness with acute kidney injury (AKI) treated with continuous veno-venous hemodiafiltration (CVVHDF) in children.Methods Twenty-four cases of critically illness with AKI were treated with CVVHDF in our pediatric intensive care unit from Jan 2008 to Dec 2010.The levels of creatinine (Cr),blood urea nitrogen (BUN),K +,Na + and HCO3- were observed before CVVHDF and 6,12,24,48,72 h after CVVHDF.ResultsCatheter was successfully established for CVVHDF in 24 cases of AKI.The average duration of CVVHDF was 46 h ( 16 ～142 h).The blood levels of Cr and BUN were significantly decreased at 6 h after CVVHDF [ ( 196.3 ±112.4) μmol/L,( 13.3 ± 8.5 ) mmol/L] and 12 h after CVVHDF [ ( 106.1 ± 84.2) μ mol/L,( 10.2 ± 9.7 )mmol/L] as compared to those before treatment [ (340.6 ±298.2) μmol/L,(31.6 ± 11.3) mmol/L] (P ＜0.05,P ＜ 0.01 ).After 48 h of CVVHDF,the Cr,BUN returned to normal range.The imbalance of blood K +,Na +,and HCO3- improved at 6 h after CVVHDF and returned to nomal levels at 24 h.Total 28 d fatality rate was 29.2％ (7/24),and all death cases were complicated with multiple organ dysfunction syndrome.ConclusionCVVHDF therapy for AKI can quickly clear Cr,BUN and excess water,correct electrolyte disorders,improve kidney function in children.

Objective To study the role of suppressor of cytokine signaling ( SOCS ) in the pathogenesis of primary biliary cirrhosis( PBC),the levels of SOCS protein and the changes of function of dendritic cell(DC) were respectively observed from PBC patients.MethodsThe study population consisted of 10 patients of PBC and 8 healthy controls.Phenotypic analysis of cultured peripheral blood mononuclear cells (PBMC)-derived DC was performed by flow cytometry (FCM),such as CD83,CD86 and human leukocyte antigen DR (HLA-DR).The levels of interleukin-10 (IL-10),interferon-γ( IFN-γ) and IL-12 in culture supematant of DC were measured by enzyme linked immunosorbent assay ( ELISA ).The protein levels of SOCS1 and SOCS3 were detected by Western blot ( WB ).The features of changes in these parameters were analyzed between the two groups.ResultsThe expression of CD83,CD86 and HLA-DR in PBC patients were ( 79.4 ± 4.8 ) ％,( 86.5 ± 6.3 ) ％ and (90.0 ± 3.5 ) ％,which were significantly higher than those in healthy control group[ (68.3 ±4.1 )％,(74.2 ±6.3)％ and (83.6 ±7.6)％ ],respectively (t =5.340,4.120,2.514,P ＜0.05).The levels of IL-12 and IFN-γin PBC patients were (53.5 ± 11.1)and (32.0 ±9.0) ng/L,which were significantly higher than those in healthy control group[ (32.1 ± 10.7) and (15.4 ± 8.1 ) ng/L; t =4.123,3.818,P ＜ 0.01 ].There were not any significant difference of IL-10 level between PBC patients [ (7.0 ± 4.6) ng/L ] and the healthy controls [ ( 5.8 ± 4.2) ng/L; t =0.563,P ＞ 0.05 ].The proteins levels of SOCS1 and SOCS3 in PBMC-derived DC from PBC group were decreased significantly than those in healthy control group.ConclusionsThe results suggest that the PBMC-derived DC in PBC patients has greater ability of potent maturation and antigen presentation function.The decreased expression of SOCS levels may be associated with the excessive immunological reaction and the breakdown of self-tolerance.

Objective To evaluate the safety and feasibility of transurethral resection of paragangliomas in urinary bladder.Methods Clinical data of 11 patients (5 males and 6 females) with paragangliomas in urinary bladder who underwent transurethral resection in Peking Union Medical College Hospital from June 2008 to February 2014 were analyzed retrospectively.The age ranged from 30 to 76 years (mean 54± 14 years).All cases were diagnosed as single primary tumor.The preoperative CT or MRI showed the tumors located in bladder wall.The diameter of tumors ranged from 0.9-3.0 cm (mean 1.9±0.8).Nine cases presented with hypertension after micturition and 2 cases presented with sustained hypertension.The tumors were localized by B ultrasound,enhanced CT or MRI.The diagnosis was confirmed by detection of 24 hours urinary catecholamine,Octreotide scanning or 131I-MIBG scanning.Transurethral resection of tumors was performed after pharmachological preperation.Eight cases underwent conventional transurethral electroresection and 3 cases underwent transurethral resection with 2 μm thulium laser.All cases were followed up every 3 to 6 months and 24 hours urinary catecholamine and CT scan were performed.Results All tumors were successfully resected without open conversion.The operative time was 20 to 45 min (mean 34±8 min).The estimated blood loss ranged from 10 to 100 ml (mean 27±26 ml).Fluctuation of blood pressure during operation occurred in 9 cases.The maximum systolic blood pressure during operation rised to 220 mmHg (1 mmHg =0.133 kPa) and sodium Nitroprusside was administed to control blood pressure.Blood pressure of all cases returned to normal after operation.No perioperative complications occurred.No recurrence was found during follow-up (3-58 months,mean 26 months).Conclusions For small localized paraganglioma (the diameter less than 3 cm) in urinary bladder,transurethral resection could be a safe and feasible choice of treatment.And 2 μm thulium laser resection has an advantage over conventional electroresection for tumors located in lateral bladder wall to avoid obturator nerve reflex.

Objective To explore the clinicopathologic features,diagnosis,treatment and prognosis of ACTH-independent subclinical Cushing syndrome caused by cortisol-secreting and hypo-androgen black adrenal cortical adenomas with lipomatous metaplasis.Methods The clinical and pathologic features of 1 patient presented with hypo-androgen and atypical signs and symptoms of Cushing syndrome were reported.The patient's 24 h UFC (235.62 μg) was higher than normal range,his plasma ACTH concentrations (＜1.1 pmol/L,was lower than normal range and his serum cortisol concentrations lacked diurnal rhythm.There was absence of serum cortisol suppression in overnight dexamethasone suppression tests.Serum levels of androgens (1.2 nmol/L) were lower than normal range.24 h urine catecholamine was normal,NE was 160.5 nmol/24 h (5-591 nmol/24 h),E was 23.1 nmol/24 h (0-82 nmol/24 h),DA was 1496nmol/24 h (424-2612 nmol/24 h).Aldosterone lying and standing test:ALD1 138-415 pmol/L,AT-Ⅱ1 64.54 ng/L,PRA1 0.80 μg · L-1 · h-1 Abdomen CT showed right adrenal mass (3.1 cm).131Ⅰ-MIBG scanning was normal.Adrenocortical carcinoma was considered as a possible diagnosis based on cortisol hypersecretion,hypo-androgen and the imaging characteristics.This patient accepted laparoscopic adrenal adenoma resection.Results The adrenal tumor size was 3.5 cm.Immunohistochemical (IHC) staining showed Melan-A,CgA,α-inhibin and Syn positive and Ki-67 ＜ 1％.Histopathologic results showed black adrenal cortical adenomas with myelolipomatous change.After surgery,patient's serum androgen was normal,and the signs and symptoms of Cushing syndrome and oligo-androgen disappeared.There was recurrence after 1.5 years follow-up.Conclusions Although most patients with corticotropin-independent Cushing syndrome associated with abnormal androgen proved to have adrenocortical carcinoma,the clinician should be aware of the possibility of benign,black adrenal adenoma.

Objective To identify one umbilical blood sample with abnonnal gap-PCR products of three bands of α2,-α3.7 and-SEA.further family pedigree were analyzed for the source of genetic variations,Methods One fetal umbilical blood sample was drawn from a woman of 24-weeks pregnancy.Gap-PCR for α-thalassemia was routinely conducted and abnornlal three bands of α2.-α3.7 and-SEA were observed.which could not be interpreted according to the kit manual and suspected as rare variation.With informed consen,DNA samples from the parents and grandparents were obtained for further study.Singleplex andnested PCR techniques were utilized to analyze the molecular characteristics of DNA samples from this fetus and its parents and grand-parents.Results Hematological phenotype study showed that fetal Hb Ban's was 7.6%,and its mother and maternal grandfather were both with typical α-thalassemia.while its father,grandfather and grandmother and maternal grandmother are without abnormal hematological change.Molecular study showed that fetal blood DNA was a heterozygosity for HKaa and-SEA.its father and grandfather are both HKαα/αα,its mother and maternal grandfather are both-SEA/aa,its grandmother and maternal grandmother are with both normal alleles of αα/αα.Then after genetic counseling the fetas was saved and iS a she baby now.Conclusion ThroUgh careful molecular tests one case of prenatal heterozygosity of HKαα/-SEA was identified,and the fetus is kept successfully through careful clinical counseling.

Objective To evaluate the feasibility of laparoscopic nephroureterectomy with bladder-cuff resection by TUR for upper urinary tract carcinoma. Methods Eighty-two patients with upper urinary tract transitional cell carcinoma(69 cases in renal pelvis and 13 in ureter)underwent retroperitoneal laparoscopic nephroureterectomy and bladder-cuff resection by TUR. This group of cases was retrospectively summarized including operative time, blood loss, drainage mounting days, catheterizing days, post-operative complications and hospital stays. Results All 82 operation procedures were successfully performed without severe complication. The mean operative time was 135 minutes.The mean length of hospital stay was 7 days postoperatively. The mean time with drainage and Foley catheter were 3 days and 6 days respectively. Follow-up time ranged from 6 to 76 months for 74 patients. The 3-year carcinoma recurrence was 10.6% (5/47). Only 1 patient was found incision tumor recurrence in 8 month after the procedure. Conclusion Retroperitoneoscopic nephroureterectomy with bladder cuff resection by TUR could be a feasible procedure to treat upper urinary tract transitional cell carcinoma.

OBJECTIVETo study the objective diagnostic mechanisms on Chinese medical (CM) syndrome patterns of rheumatoid arthritis (RA), and to research different titers of rheumatoid factor (RF)/citrullinated protein antibody (CCP) in CM syndrome patterns of RA.

METHODSTotally 230 early RA patients were assigned to five CM syndrome pattern groups, i.e., the dampness-heat blockage group (50 cases), the cold-dampness blockage group (50 cases), the Shen-qi deficiency-cold group (50 cases), the Gan-Shen yin deficiency group (40 cases), and the blood stasis blockage group (40 cases). Another 100 healthy subjects were recruited as the healthy control group. RF-IGM, RF-IGA, RF-IGG, and anti-CCP antibody were detected and compared.

RESULTSThe titers of RF-IGM, RF-IGA, RF-IGG, and anti-CCP antibody were higher in all groups than in the healthy control groups (P < 0.01). As for the 5 groups, RF-IGM, RF-IGA,RF-IGG, and anti-CCP antibody were higher in the RA active stage than in the nonactive stage. They were higher in the dampness-heat blockage group in the RA active stage than in the Shen-qi deficiency-cold group, the Gan-shen yin deficiency group, and the blood stasis blockage group.

CONCLUSIONTiters of RF-IGM, RF-IGA, RF-IGG, and anti-CCP antibody could be taken as judging indicators for differentiating objective lab indices of CM syndromes and assessing the active stage of RA.

Adult ; Aged ; Arthritis, Rheumatoid ; blood ; diagnosis ; immunology ; Autoantibodies ; blood ; Case-Control Studies ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Peptides, Cyclic ; immunology ; Rheumatoid Factor ; immunology

Objective To investigate the expression of sialic acid-binding immunoglobulin-like lectin-one (Siglec-1, also called CD169) in lymphocytes, monocytes and neutrophils in peripheral blood in patients with coronary heart disease(CHD), and explore the relationship between Siglec-1 expression and atheresclerosis. Methods CD145 CD169 positive cell proportion and CD169 mRNA levels were respectively measured by flow cytometry and real-time quantitative reverse transcription-polymerase chain reaction (FQ-RT-PCR) in 57 CHD patients and 38 healthy controls. And the levels of serum hpids were determined by automatic biochemistry analyzer. Results The flow cytometry analysis showed that CD169 protein was not found in lymphocytes and neutrophils in both CHD patients and healthy controls. The rate of CD14 CD169 double positive ceils in monocytes in CHD group was significandy higher than that in healthy controls [(12.7±2.4)% vs (1.0±0.3)% ,t =23.2,P<0.01]. And FQ-RT-PCR analysis showed that the mean CD± mRNA copy number in PBMCs in CHD group was significantly higher(3.2 fold) than that in healthy controls [t = 6. 59, P < 0.01]. However, neither differences of CD169 protein positivities [[(12. 2 ± 2. 3) %vs (13.4±2.5)% ,t = 1.87,P >0.05] nor mRNA levels [3.64 fold vs 2.79 fold when compared with healthy controls,t =0. 98, P > 0. 05] were found between CHD patients with normal and abnormal levels of serum Lipids. Conclusions CD169 is mainly expressed in human tissue-resident macrophages but not expressed in peripheral blood monecytes. And when the monocytes is stimulated by inflammation, the expression of CD169 is increased. In patients with CHD, the increased expression of CD169 protein and mRNA level has demonstrated the activation of monocytes in peripheral blood. CD169 and CD169-mediated monocytes activation may play an important role in the development and progression of atherosclerosis.

OBJECTIVETo explore the risk factors of children with high dmft.

METHODSIn suburban of Guangzhou, oral health of 401 3 - 4-year-old children were examined and structured questionnaire were completed by their parents. 120 children with highest number of dmft (dmft > or = 5) and 118 caries-free children were chosen for case-control analysis.

RESULTSThe results of logistic regression analysis showed that the factors associated with high dmft were developmental defect of enamel, visible plaque index, frequency of toothbrushing, frequency of sugar consumption, and income.

CONCLUSIONSAdvocating brushing teeth at least twice daily, controlling the frequency of sugar consuming, reducing the developmental defect of enamel and paying more attention to the oral health of lower income population may effectively reduce dental caries of the children.

Child, Preschool ; Dental Caries ; epidemiology ; etiology ; Health Behavior ; Humans ; Logistic Models ; Oral Health ; Oral Hygiene ; Risk Factors ; Surveys and Questionnaires ; Tooth, Deciduous

OBJECTIVETo isolate and identify Streptococcus mutans (Sm) and Streptococcus sobrinus (Ss) in dental plaque of children with high dmft and no caries by selective medium, biochemical methods and arbitrarily primed-polymerase chain reaction (AP-PCR).

METHODSA total of 401 3-4-year-old children from seven kindergartens were recruited using cluster sampling and their dental caries status were examined. From 30% of children with the highest dmft score (dmft >/= 5), 20 children were chosen randomly as test group and 20 age and gender-matched caries-free children were selected as control. Plaque samples were collected from buccal surfaces of the molars and plated onto TYCSB plate. Sm and Ss were primarily identified by colony morphology and biochemical characteristics. Then chromosomal DNA of the strains was isolated and Sm or Ss were confirmed by AP-PCR.

RESULTSThe proportion positive for Sm and Ss in children with high dmft was 100% and 40% respectively while that in caries-free children was 75% and 5% by AP-PCR analysis. The differences were statistically significant between the two groups.

CONCLUSIONSThe proportions positive for Sm and Ss detected by AP-PCR method were significantly higher in children with high dmft than in caries-free children and it is a risk factor for high dmft in deciduous teeth harboring Sm and Ss.

Child, Preschool ; Dental Caries ; microbiology ; Dental Plaque ; microbiology ; Female ; Humans ; Male ; Streptococcus mutans ; genetics ; isolation & purification ; Streptococcus sobrinus ; genetics ; isolation & purification