It is very difficult to make diagnosis on pediatric rheumatic diseases,because of the great variety of the diseases,being unclear of the etiology and pathogenesis,the complex clinical manifestations involving multiple organ damages.Knowing the classification of pediatric rheumatism,training of thought on systemic diagnosis,exception of infection and tumors,and combining with necessary examinations,might be made correct diagnosis.

Of B cells derived from bone marrow hematopoictic stem cells,bone marrow (poultry,as the bursa of fabricius) is a place of B cells development and mature.The growth of B cells can experience from progenitor cell B,pre-B cells,immature B ceils and mature B cells stages in the bone marrow.The differentiation process of B cells can be divided into antigen independ stage and antigen depend stage.CD5 + B1 cells and B10 cells of B cell subsets probably associated with autoimmune disease,B1 cells may play roles of promotion in inflammatory reaction,and B10 cells may suppress autoimmune inflammation.

By destroying tumor vessels or directly killing tumor cells, high-intensity focused ultrasound ( HIFU) kills tumors or reduces tumor volume and decreases metastasis,lessens patients pain in advanced stage tumors and improves patients life quality. HIFU in combination with other therapies can kill more tumor cells, reduce long-term recurrence rate and achieve synergetic effect. HIFU therapy has many advantages, such as little trauma, small side effects and repeatable treatment and so on.

Objective:To analyze the etiology,clinical manifestations,pathology and prognosis of 87 cases of acute interstitial nephritis in children.Methods:Clinical features and pathological data of 87 patients with AIN admitted in our hospital from October 1996 to October 2006 were retrospectively analyzed.Results:Of total 87 cases,64 were infection-associated(73.6%),and respiratory and intestinal infections were most common.The other 23 cases(26.4%) were caused by surgery and other reasons.Renal impairment in 55 cases(60.9%)was medication-associated,especially NSAID and antimicrobials.A total of 35 cases(40.2%)were virus-associated(IgM positive in blood),and among those,EBV was the most common one.Clinical manifestations for all cases were variable ranging from mild proteinuria,hematuria and leucocyturia to accomparied acute renal failure(31/87,35.6%).Renal biopsy was performed in 11 patients.Mononuclear cell infiltration in the renal interstitium with tubular degradation was typical.Crescent was seen in 3 cases.A total of 12 cases(28 person-time) with ARF needed blood puritication(hemodialysis or hemofiltration),1 case was treated with peritoneal dialysis.A majority of patients with ARF had complete recovery,and only 3 of them were treated with steroid in low dosage.Conclusion:Infection and drug associated AIN are common in children.Clinical manifestations are variably ranged,mainly with the change of urine,and the extreme situation is with ARF or multiple organ failure(MOF).Interstitial and tubular damage is typical in pathology.Prevention of infections and reasonable drug administration are keys to the prevention of AIN in children.

0.05). In bone defects PeroGlas granales bond to bone and new bone formation were observed 4 weeks after operation. The bone defects were repa ired by new bone 12 weeks after PerioGlas implantation. Conclusion: PerioGlas may induce new bone formation in osseous defects.

Objective To observe the treatment effect of low molecular weight heparin (LMWH) in the treatment of unstable angina pectoris.Methods LMWH (0.4～0.6 ml Bid) was used through subcutaneous injection in 36 cases of unstable angina pectoris for 14 days on end.Results The clinical effective rate was 66.67%.The drug was effective in the decreasing of the frequency and time of angina pectoris,and also in the decreasing of nitroglycerin consumption as well as in the improvement of the scope and severity of cardiac ischemia by ECG.Conclusion LMWH is an effective and safe drug for the treatment of unstable angina pectoris.

Objective To analyze the functional alteration of natural killer (NK) cells from patients with macrophage activation syndrome (MAS) in active phase and after treatment.Methods Peripheral blood samples were collected from 12 healthy subjects,12 patients with systemic onset juvenile rheumatoid arthritis (SoJIA) but without an episode of MAS and 12 patients with MAS.Flow cytometry analysis was performed to detect NK cells and their expression of perforin,granzyme B,interferon (IFN)-γand tumour necrosis factor (TNF)-α.The cytotoxicity of NK cells to K562 cell was also analyzed.All of the patients with MAS were diagnozed by clinical features and the pathologic examination of hemophagocytosis in bone marrow.The function of NK cells were analyzed before any treatment and on the fifth day as well as in third month after treatment with glucocorticoid,intravenous immunoglobulin and/or cyclosporin A.Results Compared with healthy subjects and patients with SoJIA,patients with MAS had lower NK cell counts,reduced cytotoxicity and decreased expression of perforin and granzyme B before or on the fifth day after treatment (P＜0.05).However,increased production of IFN-γ and TNF-α by NK cells were observed (P＜ 0.05).In the third month after treatment,the cytotoxicity of NK cells and the expression of perforin and granzyme B in patients with MAS were lower than those in healthy subjects and patients with SoJIA (P＜ 0.05),but no statistically significant differences with NK cell counts and production of IFN-γand TNF-α were observed beween the patients with MAS and healthy subjects (P＞0.05).Conclusion NK cells from patients with active MAS were characterized by reduced cytotoxicity and enhanced production of IFN-γ and TNF-α.Upon medical treatment,the number of NK cells in patients with MAS were up-regulated and their production of IFN-γand TNF-α were down-regulated.However,the cytotoxicity of NK cells and the expression of perforin and granzyme B were not affected.Reduced cytotoxicity and decreased production of perforin and granzyme B with NK cells might be the durative features for the patients with MAS.

Objective To investigate the incidence of thyroid space occupying lesion by ultrasound imaging in patients with breast cancer.Methods From 2009 to 2012,150 patients with breast cancer as experimental group and another 150 patients with breast benign diseases as control group underwent thyroid ultrasound examination.Ultrasound results of the two groups were analyzed to find the differences.Restult More obvious space occupying lesions were found in experimental group than those in control group (P＜0.05).Conclusion The incidence rate of thyroid space occupying lesion in the patients with breast cancer is higher than that in the patients with no breast cancer.

Objective To explore risk factors of unintentional injury among left-behind children in a rural poverty county and to provide evidence for injury intervention.Methods 2 909 students,including 1 630 left-behind children,were recruited from a poor counties of five schools by Multi-stage stratified cluster random sampling method,and were surveyed applying designed questionnaire,interview method and observation method to collect the data of the injury accidents and related factors in the last one year.Results The incidence of unintentional injury among the left-behind children in rural area was 34.0％,higher than the rate of 27.7％ among non-left-behind children and the difference was statistically significant (c2 =13.541,P＜0.05);in the top five injury type were falling injury (14.0％),burus (5.6％) and sharp instrument injury (3.6％),bite (3.0％),parts (1.6％) among left-behind children.Low age,often miss my mother,fighting in school,outdoor activities,road and traffic state were risk factors for injury of left-behind children.Corcltsion The unintentional injury of left-behind children has become a social problem that can not be ignored,and targeted intervention should be carried out.

Objective To explore the clinical efficacy,adverse effect and prognosis of infliximab in treatment of the patients with juvenile idiopathic arthritis (JIA).Methods Thirty-two cases of infliximab-treated JIA patients and 30 cases of JIA control patients were investigated in this prospective study,and their tender joint count (TJC),swollen joint count (SJC),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),visual analog scale for general health (GH),disease activity score (DAS) 28,as well as adverse reactions of treatment and follow-up outcomes were analyzed.The infliximab-treated patients were intravenously infused with infliximab at the low dose of ＜ 5 mg/(kg · time) or the high dose of ≥ 5 mg/(kg · time) in 0,2nd,6th,14th,22nd,30th week.The JIA control patients were treated with conventional therapy.Results The treatment of infliximab ameliorated the TJC,SJC,ESR,CH,CRP and DAS28 of JIA patients.In the dynamical analysis of these clinical indexes of the infliximab-treated JIA patients,the index of SJC was found to fall firstly in the 2nd week,the indexes of TJC,ESR,CH and DAS28 were found to decline secondly at 6th week,the indexes of TJC,SJC,ESR,CRP and DAS28 continued dropping till 22nd week,and only the index of GH progressively declined to 30th week.The high-dose infliximab-treated group had lower levels of ESR,GH and CRP than the low-dose infliximab-treated group (t =2.14,3.04,2.33,P =0.04,0.01,0.04).But there were no statistical difference in TJC,SJC,DAS28 and the incidence of recent adverse reactions between the high and low infliximab dose groups.In the infliximab treated group,2 cases of patients (6.25％) failed in the therapy of infliximab;9 cases of patients (28.13％) continued therapy with infliximab to 46th-62nd week; 7 cases of patients (21.88％) stopped therapy with infliximab in the 30th week had good improvement of joint symptoms and inflammatory indexes; 14 cases of patients (43.75％) relapsed and retreated by infliximab after cease the first course of treatment; 1 case of patient died of severe chickenpox infection after therapy with infliximab was ceased.Conclusions Infliximab can alleviate the joint symptoms,inflammatory indexes and DAS28 of JIA patients,and is an effective and safe therapy for JIA patients in the short-term study.