Objective To conduct a Meta-analysis to evaluate the efficacy and safety of interfer on-α for treating HBeAg-positive chronic hepatitis B in children.Methods PubMed and Chinese Biomedical Database were searched from the beginning to April 2006,and the references of eligible studies were manually screened.Randomized controlled trials published in the English and Chinese literature comparing interferon-α with non-antiviral interventions(placebo or no treatment)in children with chronic hepatitis B were eligible for inclusion.Studies were included if patients were treated for at least 3 months and followed up for at least 6 months after cessation of therapy.Two investigators independently assessed the quality and extracted the data.The methodological quality of trails was assessed by the Jadad-scale plus allocation concealment.Heterogeneity was examined by Chi-square test.Fixed effects model or random effects model was used to pool the data.Sensitivity analyses were used in the treatment course.Results Seven randomized controlled studies with a total of 360 child chronic hepatitis B virus carriers who were positive for hepatitis B surface antigen and hepatitis B e antigen werc identified.It was found by Meta-analysis that,compared with the control,at the end of therapy,interferon-α could significantly clear HBeAg[22.1%vs 6.7%,OR 3.56,95% CI(1.74, 7.28),P=0.000 5],HBV DNA[33.7% vs 12.6%,OR 3.50,95% CI(2.03,6.06),P＜0.01], HBsAg [6.5% vs 0.5%,OR 7.10,95% CI(1.52,33.12),P=0.01],and achieve HBeAg seroconversion [17.3% vs 2.9%,OR 5.62,95% CI(1.65,19.18),P=0.006],but was not more effective in HBsAg seroversion[2.0% vs 0,OR 3.55,95%CI(0.35,35.93),P=0.28]and alanine aminotransferase(ALT)normalization[24.2% vs 16.2%,OR 1.72,95% CI(0.84,3.52), P=0.14].Conclusions Interferon a may be efficacious in clearance of HBeAg,HBV DNA and HhsAg, and achievement of HBeAg seroversion.Little evidence is available on HBsAg seroversion and ALT normali zation.Rigorously designed large sample size randomized double blind clinical trials with large sample size are required to further confirm and support the conclusion.

BACKGROUND:During the process of acute brain injury after stroke, matrix metaloproteinase can undermine the integrity of vascular basement membrane, promote the migration of neutrophils and inflammatory factors, and cause secondary brain injury. OBJECTIVE:To investigate the activation of matrix metaloproteinase 2/9 and the degradation rule of claudin in rat models of middle cerebral artery ischemia at different ischemic durations. METHODS:Thirty-nine male SD rats were randomly divided into three groups according to different ischemic durations (3, 5 and 7 hours) . Middle cerebral artery occlusion (stroke) model was established using modified suture method,i.e., separation of the external carotid artery, inserting the suture into the internal carotid artery through the external carotid artery, and eventualy reaching the middle cerebral artery. The ischemic duration in these three groups was respectively 3 , 5 and 7 hours. After 2 hours of reperfusion, Zea-Longa score and Ludmila Belayev score, brain infarct area, matrix metaloproteinase 2/9 activities and claudin 5 degradation were determined in each group. RESULTS AND CONCLUSION:With the extension of ischemic duration, brain infarct area gradualy increased, central nervous system damage gradualy aggravated, matrix metaloproteinase 2/9 activities gradualy increased, and claudin-5 expression gradualy decreased. There were significant differences between any two ischemic durations in terms of each of above-mentioned indices. The results indicate that after long duration of ischemia, the progressive damage of brain tissue can cause the gradual increase of activation of matrix metaloproteinase 2/9 and the gradual degradation of claudin 5.

Objective To compare the clinical effects of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in the treatment of intertrochanteric fractures in elderly patients.And provide a reasonable basis for clinical treatment of elderly patients with intertrochanteric fractures.Methods The clinical and follow-up records of 58 elderly patients with intertrochanteric fractures treated by PFNA and DHS were retrospectively reviewed.For times of operation,blood loss in operation,length of incision,incidents of complication and Harris's hip functional standard score were compared and analyzed.Results PFNA group operation time[(59.61 ± 8.27)min],amount of bleeding[(234.51 ± 38.80)ml] were both better than the DHS group of[(83.54 ± 11.12)min and (446.57 ±54.01) ml] respectively.There were significant differences (t =9.80,18.10,all P ＜ 0.05).The satisfactory rate was 92.8％ in PFNA group,higher than the DHS group's 83.3 ％ (x2 =6.18,P ＜ 0.05).There was significant difference between two groups in the incident of complication,DHS group was higher.Conclusion PFNA internal fixation with a minimally invasive,fixed solid and recovery fast,is the better internal fixation in the treatment of elderly intertrochanteric fracture patients.

The relaxation therapy is a common method in the psychological rehabilitation in the injured and disabled patients,which can release the negative emotions,improve the quality of sleep,decrease the pain of the injured and disabled parts of the body and build up the confidence of life of the patients after the earthquake.After the long-term practice of the psychological rehabilitation in the injured and disabled patients and the experience of the psychological rehabilitation in the injured and disabled patients after the 5·12 Earthquake,the author thinks during the relaxation training psychotherapy of the injured and disabled patients after the earthquake,the choice of technique and procedure of the relaxation therapy should depend on the specific situation of the patients.The author introduces a idiographic method of the relaxation therapy and some suggestions of the implied treatment after the relaxation which is suitable for the injured and disabled patients.

The earthquake always results in a great number of the injured and disabled patients.So timely and effective psychological rehabilitation interventions are very helpful,especially for those survivors to relieve their psychological traumatic response caused by the earthquake,and renew their healthy psychological situation.The present article analyzes the chief psychological symptoms and influencing factors of the injured and disabled patients after the earthquake,and further provides some principles and strategies for the psychological rehabilitation,such as how to cope with the early stress response(anxiety,depression,self-abasement,and so on),or how to deal with the social phobia.

Objective To investigate the effects of MG132 on diabetic nephropathy (DN) rats induced with streptozocin. Methods Seventy-two male SD rats were randomly divided into three groups: normal control group (NC, n=24), DN group (n=24) and DN treated with MG132 group (DN+MG132, n=24). At the end of 4, 8 and 12 weeks, 24 hour urinary protein excretion rate (UPER) was detected. Morphology of kidney was examined by special staining of periodic acid-schiff (PAS). Renal 26S proteasome activity was determined by quantifying the hydrolysis of S-LLVY-AMC in a fluorescence reader. Urinary malondialdehyde (MDA) level and renal SOD and GSH-PX activity were detected by commercial kits. Renal SOD, GSH-PX and p47phox mRNA expressions were determined by real-time fluorescence PCR. Renal p47phox protein expression wasdetermined by Western blotting. Results Compared with NC group, the DN group showed a significant increased of UPER at week 4, 8, 12 (all P<0.05), of mesangium proliferation and mesangial matrix expansion at week 12. In DN+MG132 group, UPER was significantly decreased compared with DN group at the end of 4, 8 and 12 weeks (P<0.05, respectively), and the glomeruler pathological alteration induced by diabetes was attenuated. Increased renal 26S proteasome activity in DN rats was significantly inhibited after MC132 administration (P<0.05). Moreover, renal p47phox mRNA expression in DN group was 155%, 149% and 120% more than those in NC group at 3 time points (all P<0.05), and so was the renal p47phox protein expression, 139%, 152% and 186% more (all P<0.05). Urinary MDA levels in DN group were 1.95-, 2.04-and 2.62-folds more than those in NC group (all P<0.05). In addition, compared with NC group at 3 time points, in DN group, renal SOD activity was decreased by 23.09%, 33.59% and 53.31% (all P<0.05); renal GSH-PX activity was decreased by 28.57%, 33.06% and 48.76% (all P< 0.05); renal SOD mRNA was decreased by 38.09%, 61.44% and 76.53% (all P<0.05); renal GSH-PX mRNA group was decreased by 29.16%, 37.26% and 62.40% (all P<0.05). Compared with DN group, renal p47phox mRNA and protein expression, and urinary MDA levels were significantly lower in DN+MG132 group (all P<0.05); renal SOD and GSH-PX activity as well as mRNA expression were significantly increased in DN+MG132 group (all P<0.05). Conclusions MG132 treatment can provide renoprotection for DN rats effectively maybe through enhancing renal anti-oxidative ability.

Objective To investigate the effect of 4-phenylbutyric acid(4-PBA)on the renal pathogenesis of rats with streptozotocin-induced diabetes and its mechanism. Methods Fifty-four male SD rats were randomly divided into three groups:normal control group(NC group,n=18),diabetic nephropathy group(DN group,n=18),diabetic nephropathy plus 4-PBA treatment group(4-PBA group,n=18).At the end of 4,8 and 12 weeks,index of kidney weight/body weight ratio(KI)were measured and calculated.Serum creatinine (Scr),blood urea nitrogen(BUN),urinary MDA levels,urinary SOD activity,and 24 hour urinary protein excretion ram(UAER)were detected by HITACHI automatically.Morphology of kidney wag examined by special staining of periodic acid-schitt (PAS).The p47phox and nitrotyrosine (NT) expression in kidney were determined by real-time fluorescence PCR and Western blotting. Results Compared with the NC group, the DN group rats showed a significant increase of KI(P＜0.05), UAER(mg/24 h) (4.92±0.70 vs 0.26±0.07, 5.29±0.83 vs 0.28±0.08, 5.54±0.81 vs 0.29±0.04,respectively, P＜0.05]for indicated time, mesangial cells proliferation and mesangial matrix expansion at 12 week. However,4-PBA treatment could significantly inhibit the increase of KI (P＜0.05), decrease UAER (mg/24 h) (3.71±0.37, 3.47±0.36, 3.28±0.40, respectively, P＜0.05]for indicated time, and prevent the glomeruler pathological alteration induced by diabetes. Moreover, the mRNA expression of p47phox in the kidney of DN group was 154.72%, 148.60% and 91.95% more than that of NC group (all P＜0.05) for indicated time. The protein expression of p47phox was 118.00%, 140.10% and 177.82% more than that of NC group (all P＜0.05), and the protein expression of NT was 45.29%,59.13% and 89.28% more than that of NC group (all P＜0.05). In addition, urinary MDA levels in DN group were 2.05-, 2.26- and 2.43- folds of NC group, and urinary SOD activities were decreased by 64.78%, 71.29% and 79.32% of NC group. Compared with the DN group, the mRNA and protein expression of p47phox, and protein expression of NT in 4-PBA group were decreased markedly (all P＜0.05) at the end of 8 and 12 weeks. The urinary MDA level was decreased, and the urinary SOD activity was increased significantly in rats with diabetes after 4-PBA treatment for indicated time (all P＜0.05). Conclusion 4-PBA treatment can significantly inhibit the renal pathogenesis of rats with diabetes through inhibition of oxidative stress.

Hyperlipidemia pancreatitis in children is mostly genetic metabolic disease.The incidence of acute pancreatitis in children is only (3-13)/100 000, and pancreatitis caused by hyperlipidemia accounts for 9% of acute pancreatitis.A child suffering from V-type hyperlipidemia pancreatitis was admitted to the Children′s Hospital Affiliated to Nanjing Medical University in July 2019.The missense mutation at position c. 2770G>A of CFTR gene (nucleotide 2770 in coding region changed from guanine to adenine) in children was detected by gene sequencing, thus resulting in amino acid change p. D924N.It is extremely rare to report that CFTR gene mutation causes hereditary pancreatitis, and there is no literature report on c. 2770G>A site.This case is reported as follows, hoping to provide reference and inspiration for pediatricians.

ObjectiveTo explore the state of intelligence and adaptive behavior of children with cerebral palsy and the correlation between them.Methods169 children with cerebral palsy were evaluated with Wechsler Intelligence Scale for Children (Chinese version) and the Infants-Junior Middle School Students' Social-Life Abilities Scale for the intelligence and the adaptive behavior.ResultsThe average scores of verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ) and full intelligence quotient(FIQ) of the patients were lower than the normal children and the average scores of PIQ and FIQ were less than 70; the PIQ deficiency was significant more than the VIQ deficiency(P<0.001). 93 cases had mental deficiency, including 43(46.23%) for mild, 36(38.71%) for moderate, 13(13.98%) for severe, 1(1.08%) for extreme severe. There were 113(66.86%) for the deficiency of full social-life abilities, 104(61.54%) for Self-Help, 147(86.98%) for Locomotion, 133 (78.70%) for Occupation, 73 (43.20%) for Communication, 115(68.05%) for Socialization, 90 (53.25%) Self-Direction. The damage of Locomotion was the most serious, while the damage of Communication was the least serious. The outcomes of Wechsler Intelligence Scale was significantly correlated with the Infants-Junior Middle School Students' Social-Life Abilities Scale(P<0.001).ConclusionThe cerebral palsy causes not only intelligent damage, but also intelligence deficiency in most patients and the major level of the intelligent deficiency is mild to moderate. The damage of the performance intelligence has more influence on the full scale intelligence in the children with cerebral palsy. Most of the children with cerebral palsy have inconsistent deficiency of different aspects of the adaptive behavior.

Objective To study the role of endoplasmic reticulum stress in phenotypic change of cultured human glomerular mesangial cells induced by high glucose.Methods Cultured human glomeruar mesangial cells were divided into three groups: control group,high glucose group and high glucose+ 4-phenylbutyric acid (4-PBA) group.Cell number of proliferation was assessed by MTT assay.Cell cycle was measured by flow cytometric analysis.Expression of α-SMA was assessed by immunohistochemistry and was observed by laser scanning confocal microscope.Involved mRNA and protein expression were measured by real-time PCR and Western blotting.Results (1)Cell number of proliferation and S transition proportion in high glucose group significantly increased than that in control group (P ＜ 0.05).High glucose could induce α-SMA expression significantly (P＜0.05).4-PBA could significantly inhibit human glomerular mesangial cells proliferation (P＜0.05),S transition arrest (P＜0.05) and expression of α-SMA (P＜0.05) induced by high glucose.(2) Compared with control group,high glucose could significantly increase the expression of glucose-regulated protein78(Grp78 ) mRNA and protein (P＜ 0.05),which could be inhibited by 4-PBA treatment (P＜0.05).(3)High glucose could induce the mRNA and protein expression of TGF-β1 and FN significantly,which could be inhibited by 4-PBA treatment (P＜0.05).Conclusion Endoplasmic reticulum stress plays an important role in phenotypic change of cultured human glomerular mesangial cells induced by high glucose.