Objective To understand the skeletal metabolism in glucocorticoids-treated children with kidney diseases and to evaluate the role of Alfacalcidol plus calcium supplements.Methods A retrospective self-controlled study was performed in children with kidney diseases,admitted to Department of Pediatrics,Peking University First Hospital from July 2012 to November 2014,and they conformed to the inclusion and exclusion criteria.Inclusion criteria:children with renal diseases were included when they were administered with glucocorticoids,Alfacalcidol and calcium at the enrollment and follow-up,whose proteinuria was in remission or improved on follow-up,and renal function defined by glomerular filtration rate was more than 80 mL/(min · 1.73 m2),and they were followed up for at least 3 months.Exclusion criteria:whereas on follow-up,children with renal diseases were excluded if glucocorticoids was discontinued,or the follow-up period was less than 3 months,and related parameters were not available at the initial and finial visit.Serum levels of calcium,phosphate,alkaline phosphatase,25-hydroxy-vitamin D (25-OH-VitD) were detected,and bone mineral density at the left radius and mid tibia was measured by using quantitative ultrasound at the initial and finial visit.The levels of calcium,phosphate,alkaline phosphatase,25-OH-VitD and bone mineral density were compared between the initial and finial visit.Results A total of 29 cases (23 male,6 female) were recruited.Their ages at study entry were 2.4 to 14.9 years.Underlying disorders were primary nephrotic syndrome(17 cases),IgA nephropathy (4 cases),lupus nephritis (3 cases),purpura nephritis (2 cases),acute glomerulonephritis (1 case),Sjogren's disease(1 case),and autoimmune disease(1 case).At the time of enrollment,the course of disease was 1 to 69 months (median course of disease was 8 months),the duration of using corticosteroid was 0-60 months (median duration was 5 months),and the follow-up time was 92-409 days.The serum calcium,alkaline phosphatase and 25-OH-VitD levels at finial visit[(2.29 ±0.11) mmol/L,(153.21 ±71.00) U/L,and (40.96 ± 11.40) nmol/L,respectively] were significantly higher as compared with those at initial visit [(2.17 ± 0.16) mmol/L,(114.10 ±64.48) U/L,and (31.64 ± 10.99) nmol/L,respectively],and the differences were significant (all P ＜ 0.01),whereas there was no significant difference in serum level of phosphorate between initial and finial visit[(1.45 ±0.25) mmol/L vs.(1.48 ± 0.25) mmol/L] (t =-0.452,P ＞ 0.05).Meanwhile,there was significant difference in serum level of albumin level between initial and finial visit [(31.41 ± 9.31) g/L vs.(42.09 ± 4.00) g/L,t =-3.670,P ＜ 0.001].Compared with baseline assessment,bone mineral density at the left radius and tibia improved or maintained in 24/29 patients,whereas that of 5/29 patients declined.However,compared with initial and finial visit of bone mineral density in all patients(0.09 ± 1.58 vs.0.22 ± 1.07 at the left radius;0.93 ± 1.13 vs.1.00 ± 1.35 at the mid tibia),there was no significant difference (all P ＞ 0.05).Conclusions Bone loss can be prevented by Alfacalcidol plus calcium supplement in glucocorticoids-treated children with kidney diseases.

[Abstract] Objective To explore the feasibility of fractional exhaled nitric oxide (FeNO) dynamic changes in guiding stepped treatment of patients with chronic persistent asthma. Methods From Jan. 2016 to Dec. 2017, chronic persistent asthma patients, who were admitted to Shanghai Dahua Hospital of Xuhui District, were enrolled and randomly divided into study and control groups. All patients were given standardized treatment according to Global Initiative for Asthma in 2014 (GINA 2014) and evaluated every 3 months to adjust their medications. The control group was adjusted according to the recommended protocol from GINA 2014, while the study group was adjusted according to the results of FeNO on the basis of the recommended protocol from GINA 2014. All patients were followed for 1 year. The complete control rate, failure rate of de-escalation treatment, Asthma Control Questionnaire (ACQ) score and lung function were compared between the two groups. Results Atotal of 207 patients were enrolled in this study, including 103 cases in the control group and 104 cases in the study group. The condition of the patients was effectively controlled in both study and control groups. There were no significant differences in total control rate, ACQ score or lung function between the two groups (all P0.05), while the failure rate of de-escalation therapy was significantly lower in the study group than that in the control group (7.28% [11/151] vs 13.66% [25/183], P0.05). In addition, the doses of controlled drugs and short-acting on-demand remission drugs in 4-6 months, 7-9 months and 10-12 months were significantly less in the study group than those in the control group (all P 0.05). Conclusion In the treatment of chronic persistent asthma, the dynamic monitoring of FeNO can effectively guide the medication, decrease the failure rate of treatment, and reduce the doses of controlled drugs and short-acting on-demand remission drugs.

Objective To investigate the prognosis and efficiency of glucocorticoid and immunosuppressor in the treatment of idiopathic membranous nephropathy(IMN)in children. Methods A retrospective analysis of 35 cases of biopsy - proven membranous nephropathy without secondary factors was performed,who were found present with ne-phrotic proteinuria and admitted to hospital from March 2004 to July 2013,to explore the efficiency of treatment with glucocorticoid and immunosuppressor and its prognosis. Results The 35 IMN cases included 18 boys and 17 girls,and the ratio was 1. 1∶ 1. 0. The mean age at onset was(11. 3 ± 0. 5)years with a range of 3. 0 - 17. 1 years. Five cases with gross hematuria,24 cases present with microscopic hematuria,8 cases with hypertension,1 case with chronic renal insufficiency,and 2 cases were complicated with thrombosis. According to membranous nephropathy staging criteria,9 cases(25. 7% )were in stage Ⅰ,16 cases(45. 7% )in stage Ⅱ,10 cases(28. 6% )in stage Ⅲ;about 94. 3%(33 / 35 cases)had mesangial cells and mesangial matrix with mild to moderate hyperplasia. They were all treated with glucocor-ticoid initially and one of them showed sensitive to flucocorticoid but developed flucocorticoid resistance after relapse, while all the others were flucocorticoid - resistant. Cyclophosphamide A(CsA)was introduced to 17 cases and at least lasted for 3 months,in which 13 cases(76. 5% )reached complete remission and 3 cases reached partial remission, while 1 case didn't achieve remission,and the mean time for proteinuria to disappear was(4. 9 ± 3. 7)months;5 cases were treated with Mycophenolate mefetil( MMF),among which 4 cases reached complete remission in 2 months,4 months,5 months,and 9 months separately,while 1 case reached partial remission. Cyclophosphamide(CTX)was intro-duced to 6 cases,in which the mean cumulative dosage was(91. 2 ± 46. 5)mg/ kg,among them 1 case(87 mg/ kg) reached complete remission,1 case(160 mg/ kg)partial remission,but 4 cases didn't achieve remission. One case reached remission after Rituximab(RTX)was introduced. One case got partial remission after Leflunomide(LEF)was introduced,and the complete remission rate was higher in those treated with combined therapy of glucocorticoid and CsA than those treated with glucocorticoid only(76. 5% vs 12. 5% ,P = 0. 004),but the total efficacy showed no difference (94. 2% vs 62. 5% ,P = 0. 081). The complete remission rate(76. 5% vs 38. 5% ,P = 0. 042)and total efficacy (94. 1% vs 61. 5% ,P = 0. 040)were higher in those with combined therapy of steroid and CsA than those treated with steroid and other immunosuppressor. The complete remission rate(76. 5% vs 16. 7% ,P = 0. 018)and total efficacy (94. 1% vs 33. 3% ,P = 0. 008)were also higher than those treated with steroid and CTX,but the complete remission rate(76. 5% vs 80. 0% ,P = 0. 687)and total efficacy(94. 1% vs 100. 0% ,P = 0. 773)showed no difference com-pared with those treated with steroid and MMF. Conclusions IMN shows glucocorticoid resistance mostly,while CsA had definite efficiency and may be better than CTX. And the efficiency of MMF should be noted.

Objectives To analysis clinical pathology of organ speciifc IgA vasculitis (IgA nephropathy) and systemic IgA vasculitis (allergic purpura) of purpura nephritis in children. Methods Clinical and pathological data of hospitalized pediatric patients of IgA nephropathy and purpura nephritis were retrospectively analyzed from June 1993 to November 2014. Results There were 405 patients of IgA nephropathy (256 males and 149 females). The ratio of male to female was 1.7:1. The average age was 10.2±2.8 years. The nephrotic syndrome (31.6%) was the most common clinical type, followed by hematuria and proteinuria (27.9%). There were 548 patients of purpura nephritis, 329 males and 219 females. The ratio of male to female was 1.5:1. The average age was 10.2±3.1 years. The hematuria and proteinuria (61.6%) was the most common clinical type, followed by nephrotic syndrome (21.4%). None of the IgA nephropathy progressed to systemic vasculitis (allergic purpura). Conclusions The causes, onset ages and clinical manifestations of IgA nephropathy and allergic purpura may be consistent or overlap, but none of IgA nephropathy (organ speciifcity IgA vasculitis) progressed to allergic purpura (systemic IgA vasculi-tis). IgA nephropathy might have more renal immune disorder mechanisms involved in its pathogenesis.

Objective To evaluate the effect of decompression suction drainage treated mandibular cystic lesions,and compared with the othertreatments such as surgery,decompression,and suction drainage.In order to explore its value in the field of mandible conservative treatment.Methods 36 cases of mandibular cystic lesions were performed decompression and suction drainage.Compared the cystic size before and after the treatment to evaluate the clinical effect.Results According the pathology,29 cases are cyst and 7 cases are mural-ameloblastoma.28 cases which X-ray show a remarkable lessen,6 cases have no change and 2 cases deteriorated.Conclusion decompression suction drainage is one of the ideal treatment for mandibular cystic lesions.

OBJECTIVETo analyze the relationship between hyperuricemia and primary nephrotic syndrome in childhood.

METHODA retrospective study was carried out in 107 children with primary nephrotic syndrome. The clinical data were analyzed with statistical methods to identify the related factors with hyperuricemia.

RESULTThe morbidity of hyperuricemia in children with primary nephrotic syndrome was 45% (48/107). Compared to those in normal serum uric acid group, the incidence of hypertension (33%, 16/48), serum triglyceride [2.59(1.62-3.87) mmol/L], creatinine [43.85(33.38-56.38)mmol/L], urea [6.11(3.77-8.40)mmol/L] and blood uric acid/creatinine ratio [9.30(7.03-12.72)] increased while creatinine clearance rate [141.74(103.57-160.97)ml/(min·1.73 (2))] decreased in hyperuricemia group.

CONCLUSIONHyperuricemia in children with primary nephrotic syndrome correlated with the increase of serum creatinine, urea and blood uric acid/creatinine ratio, the decrease of creatinine clearance rate and the occurance of hypertension.

Child ; Creatinine ; blood ; Humans ; Hypertension ; epidemiology ; Hyperuricemia ; epidemiology ; Nephrotic Syndrome ; epidemiology ; Retrospective Studies ; Uric Acid ; blood

Objective To investigate the hyperglycemia rate and its correlative factors for the undiagnosed diabetes population in Xuhui District of Shanghai, and to provide the basis for early intervention of diabetes mellitus. Methods Multi-stage cluster sampling was adopted by probability proportionate to size method, and physical examination information and questionnaires were made and collected from 10 130 and 9085 people in 2010 and 2015 respectively from 5 000 households, blood-glucose being examined at the same time.Univariate analysis was made by t test and χ² test and logistic regression was used for analysis of related factors. Results In 2010 and 2015, the diabetes incidence rate was 2.21% and 1.93% respectively, and the hyperglycemia incidence rate in 2015 was higher than that in 2010 (15.28% vs. 12.63%), both increased with age and BMI value.The rate was higher in those with lower education, abnormal blood pressure, self-reported hypertension, self-reported coronary heart disease and smokers.The logistic regression analysis results showed the incidence of diabetes was positively correlated with age, BMI, abnormal blood pressure and smoking, while the incidence of hyperglycemia was positively correlated with the survey year, sex, age, BMI and abnormal blood pressure; both were negatively correlated with educational level. Conclusion The hyperglycemia incidence rate is high among the community undiagnosed diabetic population.We should focus on high-risk screening for diabetes mellitus, and key intervention of the population with low educational level, overweight and obesity, hypertension and unhealthy lifestyle.

Objective To investigate the health literacy level and health related behavior of high school students in Xuhui District of Shanghai, and to provide basis for health literacy intervention. Methods Using qualitative and quantitative methods, the quantitative part adopted the multi-stage stratified sampling method.A total of 355 aged 15-18 from senior high schools in Xuhui District were selected for face-to-face survey.The qualitative part adopted the form of group interviews, and 20 students from two senior high schools in Xuhui District were selected for interviews. Results The health literacy level of high school students in Xuhui District was 27.32%, which was lower than that of adults in the same period.Among the three dimensions, the level of basic knowledge and concept literacy was the highest, followed by the level of health basic skills literacy, the level of healthy lifestyle and behavior literacy was the lowest; among the six types of health problems, the level of infectious disease prevention literacy and basic medical literacy was at a low level.Statistical analysis of the correct answer rate showed that the answer rate of various questions in the health literacy survey was quite different.Further analysis of the health-related behavioral characteristics of high school students showed that most students had correct health concept and awareness of health change, but they encountered resistance in the process of knowledge transformation into action, which mainly came from academic burden, school education, peer influence and so on.The main channels for high school students to obtain health-related information were classroom, parents, school and various media.They had a high degree of trust in medical professionals and encountered difficulties in seeking health information. Conclusion The health literacy level of senior high school students in Xuhui District of Shanghai needs to be improved.We should explore a health intervention model more suitable for the behavioral characteristics of this group weak links in their health literacy.