The improvement of blood purification technologies in the recent years brings new methods of treating autoimmune diseases. Blood purification therapy mainly includes plasma exchange, immune adsorption and cell purification etc. It can rapidly remove a great amount of circulating pathological elements like autoantibodies,or remove the immune cells. It is effective for the treatment of refractory rheumatoid arthritis,severe systemic lupus erythematosus, acute autoimmune hemolytic, myasthenia gravis and other autoimmune diseases. But this is only a symptomatic treatment. Long-term steroid and immunosuppressive therapy are still needed to consolidate the curative effect.

Biological agents has opened a new chapter in the targeted therapy of rheumatism,and provides a new choice for the rheumatism children who is refractory to traditional disease-modifying antirheumatic drugs.This article described the classification,application,efficency,side effects and precautions of the cytokines antagonists and the cell targeting biological agents,to provide a reference for rational application in clinical work.

Objective To summarize the clinical and pathogenic characteristics of urinary tract infection(UTI)in infants,and to provide reference for clinical diagnosis and treatment.Methods One hundred and eighty-eight cases of hospitalized infants with UTI diagnosis standard in Department of Pediatric Renal Rheumatism Immunology,Shengjing Hospital Affiliated to China Medical University from January 2012 to January 2015 were collected,and on the basis of the imaging they were divided into complex group(complicated UTIs) and non-complex group(non-complicated UTIs),the differences between 2 groups in the general condition,clinical manifestations,serological examination,urine culture and distribution of pathogenic bacteria and drug sensitivity results were analyzed.Results Among 188 UTI infants,148 were male and 40 were female,50 cases were in complex group (26.6％),and 138 cases were in non-complex group (73.4％).In complex group,the prevalence of prenatal ultrasound abnormalities (34.0％),the incidence of recurrent infections(24.0％),the number of fever incidence(78.0％),and peripheral WBC count [(16.4 ± 4.3) × 109/L] were higher than those in non-complex group[1.5％,10.9％,58.7％,(14.6 ± 3.5) × 109/L] (all P ＜ 0.05),and the naked eye hematuria incidence was lower than that of the non-complex group (14.0％ vs 34.8％,P =0.006).In complex group,pneumonia klebsiella bacteria positive rate was higher than that of non-complex group (22.0％ vs 2.9％,P =0.000),and the positive rate of Escherichia coli was lower than that of non-complex group(26.0％ vs 46.4％,P =0.000).There was no difference in the drug sensitivity and resistance of the pathogenic bacteria in the urine culture of 2 groups.Conclusions For fever,increased peripheral WBC,repeated infection and urine culture for Klebsiella pneumoniae UTI infants,in particular,should be alert to the prese-nce of urinary tract abnormalities,timely improve the urinary system ultrasound and urinary tract contrast is very necessary.

Autoimmune hemolytic anemia is a disorder of immune function caused by various reasons, by produceing autoantibody or complement which can react with erythrocyte autoantigen, increasing the destruction of red blood cell and beyond the compensatory ability of bone marrow hematopoiesis.Children usually have acute onset and the clinical manifestations are related to the pathogenesis.As the first-line treatment of glucocorticoids, Most children respond well to glucocorticoids.Some children suffer from steroid dependence and resistance; or recurrence due to different types of antibodies, often requiring second-line treatment, such as splenectomy, immunosuppressive, etc.This article reviews the recent progress in the treatment of children with autoimmune hemolytic anemia.

Systemic lupus erythematosus (SLE) is a serious multisystem autoimmune disease with different clinical manifestations.Childhood-onset SLE (cSLE) is similar to adult-onset SLE, while its morbidity and mortality are higher than adults, and it is prone to damage important organs.Therefore, early diagnosis and treatment are very important.With the in-depth exploration of the pathogenesis and the development of cell and molecular biology, the progress of drug therapy for SLE has been promoted.Immunosuppression still remains the cornerstone of treatment, and glucocorticoids still plays a leading role.Biologics bring the gospel to SLE patients, and non-specific immunotherapy gains treatment time for refractory and severe SLE patients.Treatment options are led by the level of disease severity.It is of great significance to understand the treatment progress of cSLE and combine theory with practice together to control the disease activity and improve the prognosis.This article reviews recent advances regarding the update on the treatment of cSLE in recent years.

Objective To investigate the expression of β-arrestin2 and microtubule-associated pro-tein light chain(LC)3 in renal of rat with acute renal ischemia reperfusion injury,and to analyze the relation-ship between them and renal injury. Methods Fifty-four male SD rat(3-4 weeks old) were randomly divid-ed into three groups:control group,sham group,acute ischemic reperfusion injury group. We established the acute renal ischemia reperfusion injury model through removing the right kidney and clamping the left renal for 45 minutes with noninvasive arterial clip. We obtained the kidney and blood samples respectively at 12 h, 24 h,36 h,48 h,72 h,96 h after the surgery. Expressions ofβ-arrestin2 and LC3 protein were detected by the immunohistochemistry method and Western blot method. The renal function and morphological changes were assessed. Results Compared with control group and sham group,the serum creatinine and kidney pathologi-cal grading of acute ischemia reperfusion injury group obviously rised. The kidney injury was the most serious at the 24 h after acute ischemic reperfusion injury. The expressions of β-arrestin2 and LC3 were little in the control group and sham group. However,the expressions of these two indicators were obviously higher and reached the peak at the 12 h after acute ischemia reperfusion injury. All these results suggested that the chan-ges of these two indicators were anterior to the histopathological changes. The expressions ofβ-arrestin 2 and LC3 protein were in positive correlation with the kidney injury(r=0. 821,P<0. 05;r=0. 913,P<0. 05). Conclusion In the acute renal ischemia-reperfusion injury,β-arrestin2 may be as a kind of upstream regula-tory protein involving in the kidney pathological process through the regulation of the autophagy.

Objective To study clinical manifestations and imagine features (CT and MRI) on toxic encephalopathy after inhaling heroin. Methods 13 patients with toxic encephalopathy induced by inhaling heroin were observed and analyzed on its clinical and imagine features (CT and MRI).Results 13 patients all were male, and were intoxicated by way of inhaling heroin vapour. Nine cases had appearances of clinical manifestations during abrupt abstinence. The main clinical manifestations of the disease were of the sub-acute diffuse cerebral lesions, especially of early mental symptoms and cerebellum ataxia. The CT of all 13 cases showed multiple white matter lesions involving in the frontal, parietal, occipital,temporal, and cerebellum hemisphere dentate nucleus. There was no occupational mass shown in general. The MRI of 6 cases showing focus was the same as of the CT. Conclusion The diagnosis of HTE should be dependent on the definite inhaling heroin vapour and their clinical features and neuroradiological appearance. CT should be valuable for the diagnosis of HTE, and the MRI as well. Corticosteroids show less therapeutic effect on such diesease.

Objective To summarize our clinical experience of prophylaxis and treatment for complications associated with catheterization of brachial artery. Methods 87 patients underwent endovascular treatment via brachial artery. Complications associated with catheterization of brachial artery were retrospectively analyzed. Results Under ultrasonic guidance the catheterization procedure of brachial artery was successful in all 87 patients. The success rate of cannulation was 100%. In 53 patients(61% ) ultrasonic guided cannulation was successful at the first attempt, the other 35 (39% ) with 2 or more than 2 times puncture. Complications associated with catheterization of brachial artery were detected in 16 cases. The complication rate was 18. 4%. Guidewire insertion into peri vascular compartment took place in 4 cases (4. 6% ). Episodes of local hematomas were noted in 11 cases( 12. 6% ) and in three of the 11 cases nerve injuries were detected (one of which was of late-onset type). Brachial artery pseudoaneurysm was found in 1 case(1.2%). Conclusion Familiarity with the anatomical features of the brachial access, skillful application of the techniques for the catheterization, full understanding of complications and sufficient preparation of treatment strategies can prevent those complications effectively.

PAX2 gene encodes a nuclear transcription factor and plays a pivotal role for embryonic kidney development.It is expressed during the entire developmental process of pronephron,mesonephron and metanephron,involving in the regulation of embryonic kidney development at various fetal stages,but its expression disappeared in mature nephrons.Recently,it was found that PAX2 was re-expressed in nephropathy.Gene mutation and re-expression of PAX2 are closely related with congenital and acquired renal diseases.This paper reviews the role and significance of PAX2 expression in kidney disease from the aspects of normal expression,gene mutation and abnormal expression.

Objective To investigate the mechanism of the kidney injure in the newborn rats with endotoxemia.Methods Eighty Wistar rats aged 7 days were randomly divided into 2 groups:control group (intraperitoneal injection of saline of 0.1 ml;n = 40),lipopolysaccharide(LPS) group(intraperitoneal injection of LPS of 5 mg/kg;n =40).The rats in either group were killed at 1 h,4 h,8 h and 12 hours after intraperitoneal injection,respectively.The expressions of NF-κB and TGF-β1 in the kidney were detected by using the immunohistochemical assay.Renal ultrastructural changes was observed with a CM100 Philips electron microscope.Results The NF-κB in control group had no expression.NF-κB in LPS group mainly expressed in the renal tubular epithelial cell,increased at 1 h after test and peaked at 8 h,and slightly descended at 12 h.The expression of TGF-β1 in control group was slight,and had not show significant difference from control group at 1 h,4 h and 8 h,but significantly higher than that in control group at 12 h.In LPS group,newborn rat renal glomerular basement membrane was complete,part epithelial cell foot processes were fused and renal tubules epithelial cell mild mitochondria vacuolization was found at 4 h.Renal glomeruli epithelial cell foot processes obvious confluenced,quantities of mesangial cells mitochondria vacuole,and renal tubules epithelial cell mitochondria expanded to bubbles at 12 h.Conclusion The NF-κB involves in the pathogenesis of kidney damage induced by endotoxemia,but TGF-β1 may help to repair the damaged kidney,and may repress the production of NF-κB.