Objective To prepare mouse polyclonal antibody against human Nanog by genetic immunization and to identify this antibody by Western blot and immunofluorescence. Method The antigenicity fragment (A16-V101) of human Nanog (hNanog) was chosen by analysis of Accelrys software, and its cDNA (258bp) was amplified from plasmid containing full-length cDNA of hNanog, then it was cloned into pBQAP-TT to construct recombinant plasmid pBQAP-TT-hNanog for genetic immunization. Mice were immunized with this recombinant plasmid and two other adjuvant plasmids-pCMVi-GMCSF and pCMVi-FIT3L, which help to enhance the antibody's generation. After 12 weeks, we obtained mouse anti-hNanog antibody from mice blood serum. The antibody titer was determined by enzyme-linked immunoadsordent assay (ELISA), and its specificity was identified by Western blot in human renal protein. Using this antibody, we detected hNanog expression in HKC cells of hNanog-AAV2 transfection. Results Recombinant plasmid pBQAP-TT-hNanog for genetic immunization was confirmed to be correct by restriction digestion and sequencing. The result of ELISA showed that the antibody titer was 1∶3 200. This antibody recognized a band of 34kD hNanog protein in human renal protein by Western blot. Immunofluorescence showed that Nanog protein was mainly located in the nuclei in hNanog transgene HKC cells. Conclusion Genetic immunization can offer mouse anti-hNanog polyclonal antibody of high titer and high specificity.

Objective To evaluate the application value of the micro movement sensitive mattress sleep monitoring system(MSMSMS) in the diagnosis of children with obstructive sleep apnea syndrome (OSAS).Methods One hundred and twenty-nine children aged from 3 to 14 years who visited the sleep center of Beijing Children's Hospital Affiliated to Capital Medical University from June 2013 to June 2015 due to sleep snoring were enrolled.Children with acute respiratory infection,cranial facial abnormalities,chronic lung diseases and neuromuscular diseases were excluded.According to the criteria,36 children were diagnosed as OSAS with average age of (7.3 ± 2.5) years,including 28 males and 8 females.Ninety-three non-OSAS children were recruited with average age of (6.3 ± 2.3) years,including 61 males and 32 females.Subjects were monitored with polysomnography(PSG) and MSMSMS simultaneously.Apnea/hypopnea index (AHI) ＞ 5 or obstructive apnea index (OAI) ＞ 1 were used to define whether OSAS existed.The consistency between MSMSMS and PSG in the diagnosis of OSAS and the determination of sleep efficiency were compared.Results The Kappa consistency coefficient of MSMSMS and PSG in the diagnosis of OSAS was 0.70(95％ CI:0.57-0.84),Z =7.99,P ＜ 0.000 1,which indicated the consistency between PSG and MSMSMS was good.The consistency of sleep efficiency of MSMSMS and PSG were compared.Bland-Altman results showed that there were 3％ (5/129 cases)points out of 95％ consistency bound and the interclass correlation coefficient (ICC) was 0.69 which indicated the consistency of 2 methods was good in determination of sleep efficiency.MSMSMS was able to detect respiratory event that was associated with sub-cortical arousals with no electroencephalogram arousal or blood oxygen reduction.Conclusions There is an adequate consistency between MSMSMS and PSG in the diagnosis of children with OSAS and determination of sleep efficiency.The MSMSMS has an advantage in detection of sub-cortical arousals and respiratory event.

Objective:To explore the variation of hospitalization expenses and its influencing factors under the same main diagnostic disease(children′s unilateral inguinal hernia), and group them based on regression tree model, so as to provide reference for diagnosis-related groups(DRG) grouping of the disease.Methods:The data of the first page of medical records with unilateral inguinal hernia(ICD-10 coding K40.3 and K40.9)as the main diagnosis discharged from a children′s special hospital from 2016 to 2018 were extracted. With hospitalization expenses as the outcome variable and gender, age, operation type, length of hospital stay and complications as the predictive variables, a regression tree model was constructed to classify the children into subgroups.Results:The regression tree model showed that the variables that had a significant impact on the total hospitalization costs were the length of hospital stay, operation type and complications. Age and gender had no significant impact on the hospitalization expenses. According to these three significant variables, the children were divided into five subgroups and the median hospitalization expenses were 1 190.8, 6 387.2, 7 037.7, 11 413.7, and 18 499.1, respectively. Except that the coefficient of variation of hospitalization expenses in group 1 was greater than 1, the coefficient of variation of the other four groups were≤0.5.Conclusions:Children with unilateral inguinal hernia can be divided into groups according to the length of hospital stay, operation type and complications, and the grouping results are relatively reasonable.

Objective To determine the appropriate criteria of obstructive sleep apnea syndrome (OSAS) in children.Method Children with snoring and healthy children were recruited from October 2014 to September 2015.Subjects were divided into four groups based on polysomnography (PSG).Group 1:children with obstructive apnea hypopnea index (OAHI) ≥ 1 (the OSAS criteria of the International Classification of Sleep Disorders,ICSD) but their AHI≤5 or OAI ≤1 (under the OSAS criteria of AHI ＞ 5 or OAI ＞ 1 by the American Thoracic Society,ATS);Group 2:children with OAHI ＜ 1 (the primary snoring criteria of the ICSD);Group 3:children with AHI ＞5 or OAI ＞ 1;and Group 4:normal children as controls.Sleep disorder scales and polysomnography parameters were compared among the four groups.Results A total of 1 115 children were included.There were 143,345,529 and 98 children in each group.After adjust for age,gender and body mass index(BMI),children in group 1 had higher total sleep disorder scale score (P＜0.01),as well as sub-scores for severe snoring (P ＜ 0.01),daytime behavior problem (P ＜0.01) and sleep related nighttime abnormality (P ＜0.05) compared with normal controls,and they had longer mean and longest duration of obstructive apnea and hypopnea and lower minimum oxygen saturation compared with children with obstructive AHI ＜ 1 (all P ＜ 0.05 or ＜ 0.01).Conclusion OA-H＞ 1 should be defined as the criteria of OSAS in children.

Objective To explore methods of culturing peritonealdialysate pathogen in patients with peritoneal dialysisrelated peritonitis, providing reliable basis for more effective clinical treatment. Methods 235 patients with peritoneal dialysis related peritonitis were selected from the Department of Nephrology of Xijing Hospital Affiliated to the Air Force Medical University from January 2015 to December 2018, and they were randomly divided into four groups. Group A (traditional group,n=58): 10 ml peritoneal dialysate were directly extracted and then injected into blood bottle culture. Group B (suspension group,n=58):10 ml extracted peritoneal dialysate were placed for 1 hour then injected into blood bottle culture. Group C (centrifugation group,n=59): 50 ml extracted peritoneal dialysate were centrifuged for 15 min, and whose supernatant sediment was suspended by 5 ml sodium chloride solution of 9% and then injected into the blood culture bottle. Group D (suspension+ centrifugation group,n=60): After the dialysate were given to patients and placed for 1 hour, 50 ml peritoneal dialysate was extracted and centrifuged for 15 min, and whose supernatant sediment was suspended by 5 ml sodium chloride solution of 9% and then injected into the blood culture bottle. The positive culture rates were observed and compared in these four groups. Results There was a statistically significance in the differences of the positive culture rates of the 4 groups, which were 55.2 %, 70.7 %, 76.3 %, and 86.7 %, respectively(χ2=15.233,P＜ 0.01). Further pairwise comparison indicated that the positive culture rates of centrifuge culture group and suspension + centrifuge culture group was significantly higher than that of traditional culture group(χ2=5.787, 14.262;P＜ 0.01). Conclusions The positive culture rate of peritoneal dialysate pathogen would be increased through the culturing method of suspension + centrifugation, providing basis for the subsequent treatment and estimation of peritonitis.

Objective:To analyze the impact of COVID-19 on the number of hospitalization and the disease spectrum of children′s hospitals in China, so as to provide scientific basis for improving the epidemic response policy of children′s hospitals and restoring hospital operations.Methods:Discharged patients from 27 children′s hospitals from January 1, 2019, to December 31, 2020, were selected from the FUTang Updating medical Records(FUTURE) Database. The ratio of discharge number in 2020 to that in 2019 was calculated. Age groups, disease types, and discharge months were further divided to calculate the ratio of discharge numbers under different conditions.Results:The total number of discharged patients in 2020 was 76.76% of the total number in 2019. In terms of discharge time, the ratio rose slowly from the lowest values in February and March, and reached about 90% of the same period of 2019 at the end of 2020. In terms of age, the biggest change in the discharge number was among children aged 1-3 years, which was 71.87% in 2019. In terms of disease classifications, respiratory diseases changed the most in the number of discharged patients in 2020, accounting for 56.03% of that in 2019. The top five hospitalized diseases of children did not change, while the other ranks changed slightly.Conclusions:COVID-19 has a huge and lasting impact on the number of hospitalizations in children′s hospitals, and the hospitals should develop multiple approaches such as online medical care to cope with the long-term negative impact of the pandemic.

Objective:To analyze the gastroscopy treatment technology in a Children′s Medical Center based on the diagnosis-related groups(DRG) and put forward suggestions for resource optimization.Methods:The data of the front pages of medical records of 22 medical institutions in a Children′s Medical Center in 2018 were divided into DRG groups. The patients in gastroscope treatment operation group(GK3)were selected, and the disease diagnosis, operation and payment methods of the patients in this group were analyzed.Results:Of the 22 medical institutions, 16 had GK3 group cases, and the number of cases was significantly different, ranging from 2 to 917. Among them, the institution with code M was characterized by multiple endoscopic treatment of esophageal stricture, but most other institutions rarely carried out the treatment of esophageal stricture. In GK3 group, the main payment method of children in Institution M with the highest constituent ratio was at one′s own expense, followed by non-local medical insurance. The main payment type of O and P institutions with the second and third constituent ratio was local medical insurance.Conclusions:The gap of the technology of gastroscopy in the treatment of esophageal stricture is large in all institutions. The high-quality medical resources can be sunk through the construction of pediatric medical alliance, and the gap between the regional medical technology can be continuously leveled.

Objective:To analyze the clinical and prognostic characteristics of rapid eye movement sleep related obstructive sleep apnea (REM-OSA) in children.Methods:A retrospective analysis was performed on the clinical data of 62 children aged from 2 to 14 years who were admitted to Beijing Children′s Hospital, Capital Medical University from December 2017 to April 2021, diagnosed with moderate to severe OSA by polysomnography monitoring (PSG), underwent adenoid tonsillectomy, and completed follow-up 6 months after surgery. There were 45 males (72.6%) and 17 females (27.4%). The age range was 2.0-12.3 years. All children completed the clinical data collection, PSG, OSA-18 quality of life questionnaire and Children′s Sleep questionnaire-sleep related breathing disorder subscale at baseline. PSG and OSA-18 quality of life questionnaire were reexamined at 6 months after surgery. Children were divided into REM-OSA group (33 cases) and non-REM-OSA group (29 cases) according to whether the obstructive apnea-hypopnea index (OAHI) during rapid eye movement sleep and OAHI during non-rapid eye movement sleep ratio was≥2. Baseline PSG parameters and scale scores, 6-month postoperative cure rate and OSA-18 quality of life questionnaire scores of the 2 groups were compared, and statistical analysis was performed using SPSS 23.0 software.Results:There were no significant differences in age, sex, body mass index, neck circumference/height ratio, overweight or obesity, history of disease, tonsil and adenoid size between the two groups (all P>0.05). Compared with non-REM-OSA group, REM-OSA group had higher oxygen desaturation index and proportion of SpO2<90% of total sleep time ( Z=-2.723, P=0.006; Z=-3.414; P=0.001 respectively), and lower SpO 2 nadir ( Z=-3.957, P<0.001). The proportion of obstructive apnea in total respiratory events (related to anatomical factors) in REM-OSA group was higher than that in non-REM-OSA group ( t=2.840, P=0.006). However, the proportion of central apnea in total respiratory events and arousal index (related to functional factors) in REM-OSA group was lower than that in non-REM-OSA group ( t=-2.597, P=0.012; Z=-2.956, P=0.003), and there were no significant differences in other PSG parameters between the two groups (all P>0.05). There was an interaction effect between the two groups in the change trend of OSA cure rate at 6 months after surgery under different baseline OAHI (χ 2=4.282, P=0.039). Conclusions:The weight of anatomic factors and functional factors in the etiology of children with REM-OSA and non-REM OSA was different, and the postoperative OSA cure rate of children with different baseline OAHI changed in reverse trend.

OBJECTIVE: To review the research progress in the construction strategy and application of bone/cartilage immunomodulating hydrogels. METHODS: The literature related to bone/cartilage immunomodulating hydrogels at home and abroad in recent years was reviewed and summarized from the immune response mechanism of different immune cells, the construction strategy of immunomodulating hydrogels, and their practical applications. RESULTS: According to the immune response mechanism of different immune cells, the biological materials with immunoregulatory effect is designed, which can regulate the immune response of the body and thus promote the regeneration of bone/cartilage tissue. Immunomodulating hydrogels have good biocompatibility, adjustability, and multifunctionality. By regulating the physical and chemical properties of hydrogel and loading factors or cells, the immune system of the body can be purposively regulated, thus forming an immune microenvironment conducive to osteochondral regeneration. CONCLUSION Immunomodulating hydrogels can promote osteochondral repair by affecting the immunomodulation process of host organs or cells. It has shown a wide application prospect in the repair of osteochondral defects. However, more data support from basic and clinical experiments is needed for this material to further advance its clinical translation process.
Hydrogels ; Cartilage ; Bone and Bones ; Tissue Engineering/methods*

Objective: To evaluate the endothelial function in obstructive sleep apnea syndrome(OSAS) children and to identify related factors of endothelial dysfunction. Methods: This was a cross-sectional study. Children with habitual snoring (snoring ≥3 nights per week) admitted to the ward of otolaryngology, head and neck surgery, Beijing Children′s Hospital were recruited to this study between 1^st June 2015 and 1^st March 2016. All children aged 3 to 11 years and of them 245 were boys and 110 were girls. All subjects underwent an overnight polysomnography (PSG), as well as endothelial function testing. All subjects were grouped into primary snoring (PS) and OSAS group according to the obstructive apnea hypopnea index (OAHI). T test or Wilcoxon test were used to compare the differences in PSG results between the two groups, and univariate and multivariate correlation analyses were used to explore the relevant factors affecting the endothelial function. Results: A total of 355 subjects were enrolled and 248 had OSAS, and 107 had PS. There were no significant differences in age, gender and body mass index (BMI) Z-score between the two groups (all P>0.05). OSAS group had higher OAHI, oxgen desaturation index and respiratory related arousal index (5.2 (2.2, 13.2) vs. 0.4 (0.1, 0.7), 4.1 (2.0, 13.1) vs. 0.5 (0.1, 1.0), 2.5 (1.0, 4.8) vs. 0.4 (0.1, 0.9), Z=-14.957, -11.790, -10.378, all P<0.01), and lower minimum oxygen saturation and reactive hyperemia index (RHI) than those of PS (0.89 (0.85, 0.92) vs. 0.94 (0.91, 0.95), 1.2±0.2 vs. 1.1±0.1, Z=-9.337, t=5.354, P<0.01). Univariate regression analysis showed that RHI was linearly correlated with age (parameter estimate=0.017, P<0.01), gender (parameter estimate=0.065, P<0.01), OAHI (parameter estimate=-0.023, P<0.01), oxygen desaturation index (parameter estimate=-0.019, P<0.01), respiratory related arousal index (parameter estimate=-0.031, P<0.01), and oxygen saturation nadir (parameter estimate=0.067, P=0.045). The relationship between BMI Z-score and RHI was quadratic. Multivariate regression analysis showed that age (parameter estimate=0.015, P<0.01), BMI Z-score (parameter estimate=0.040, P<0.01), BMI Z-score quadratic form (parameter estimate=-0.010, P<0.01), respiratory related arousal index (parameter estimate=-0.020, P<0.01) were independently correlated with RHI. Conclusions Children with OSAS have significant endothelial dysfunction compared with PS. Frequent arousals due to obstructive respiratory events during sleep may be a candidate risk factor for endothelial dysfunction in children with OSAS.