Homocysteine has been confirmed as the independent factor for cardiovascular disease.Hyperhomocysteinemia remains the prominent manifestation in the cases of chronic kidney disease, atypical hemolytic anemia,methylmalonic aciduria combined with kidney injuries.As the recognition of the kidney injuries caused by homocysteine remains obscure, this review tries to show the synthesis, metabolism of homocysteine and the possible mechanism of homocysteine-induced heart and kidney injuries.Besides, summarize the current treatment of lowering-hyperhomocysteinemia in order to arouse the pediatricians' attention of homocysteine which has endothelial cell toxicity and causes the wide lesions in great, middle and small vessels, and thus improve the outcomes of the patients.

Objective To investigate the detection rate and possible factors of hyperhomocysteinemia(HHcy) in children with chronic kidney disease(CKD).Methods The clinical data of children with CKD between July 2012 and September 2016 in the Department of Pediatrics,Peking University First Hospital were retrospectively collected.The homocysteine(Hcy) level of patients were measured.The other data included the general information,diagnosis and laboratory test results.Results Seventy-six pediatric patients with CKD were enrolled including 49 boys and 27 girls.The average age of the patients was (9.9±3.4) years old.The main cause of the patients in the study was primary glomerulopathy(48.7%,37/76 cases),and the rest were congenital and inherited glomerular diseases(36.8%,28/76 cases),secondary glomerular diseases(9.2%,7/76 cases)and renal tubular diseases(5.3%,4/76 cases).Fifty patients (65.8%,50/76 cases) had normal level of Hcy which was 10.40(7.30,11.62) μmol/L.Twenty-six patients(34.2%,26/76) were detected with HHcy whose Hcy level was 17.93(16.76,24.11) μmol/L.The detection rate of HHcy in CKD stage 1,stage 2,stage 3,stage 4 and stage 5 was 13.9%(5/36 cases),22.2%(2/9 cases),50.0%(4/8 cases),57.1%(4/7 cases) and 68.8%(11/16 cases) respectively,and the detection rate increased with CKD stages and the difference was statistically significant (χ2=17.574,P<0.001).The level of Hcy was 10.05(7.04,12.47) μmol/L,11.75(10.78,16.44) μmol/L,13.73(10.09,18.23) μmol/L,15.81(11.12,20.71) μmol/L and 17.39(11.86,24.76) μmol/L in CKD stage 1,stage 2,stage 3,stage 4 and stage 5,respectively.The Kruskal-Wallis test revealed that the distribution of homocysteine in CKD stages had statistically significant difference(P=0.001).Multiple linear regression model showed that creatinine clearance was an independent predicator of HHcy.Conclusions In this study of the CKD patients,the detection rate of HHcy was high and increased with the progression of CKD.HHcy is mainly influenced by creatinine clearance in CKD.The level of Hcy should be monitored regularly in children with CKD and HHcy should be treated with proper measures.

Objective To investigate the efficiency of closed tracheal suction system (CTSS) using novel splash-proof ventilator circuit component on ventilator-associated pneumonia (VAP) and the colonization of multiple-drug resistant bacteria (MDR) in patients undergoing mechanical ventilation (MV) prevention.Methods A prospective single-blinded randomized parallel controlled intervention study was conducted. 330 severe patients admitted to the intensive care unit (ICU) of the First Hospital of Jiaxing from January 2014 to May 2016 were enrolled, and they were divided into open tracheal suction group, closed tracheal suction group, and splash-proof suction group on average by random number table. The patients in the three groups used conventional ventilator circuit component, conventional CTSS, and CTSS with a novel splash-proof ventilatorcircuit component for MV and sputum suction, respectively. The incidence of VAP, airway bacterial colonization rate, MDR and fungi colonization rate, duration of MV, length of ICU and hospitalization stay, and financial expenditure during hospitalization, as well as the in-hospital prognosis were recorded.Results After excluding patients who did not meet the inclusion criteria, incomplete data, backed out and so on, 318 patients were enrolled in the analysis finally. Compared with the open tracheal suction group, the total incidence of VAP was decreased in the closed tracheal suction group and splash-proof suction group [20.95% (22/105),21.90% (23/105) vs. 29.63% (32/108)], but no statistical difference was found (both P > 0.05), and the incidence of VAP infections/1000 MV days showed the same change tendency (cases: 14.56, 17.35 vs. 23.07). The rate of airway bacterial colonization and the rate of MDR colonization in the open tracheal suction group and splash-proof suction group were remarkably lower than those of closed tracheal suction group [32.41% (35/108), 28.57% (30/105) vs. 46.67% (49/105), 20.37% (22/108), 15.24% (16/105) vs. 39.05% (41/105)] with significantly statistical differences (allP < 0.05). Besides, no significantly statistical difference was found in the fungi colonization rate among open tracheal group, closed tracheal group, and splash-proof suction group (4.63%, 3.81% and 6.67%, respectively,P > 0.05). Compared with theclosed tracheal suction group, the duration of MV, the length of ICU and hospitalization stay were shortened in the open tracheal suction group and splash-proof suction group [duration of MV (days): 8.00 (4.00, 13.75), 8.00 (5.00, 13.00) vs. 9.00 (5.00, 16.00); the length of ICU stay (days): 10.00 (6.00, 16.00), 11.00 (7.00, 19.00) vs. 13.00 (7.50, 22.00); the length of hospitalization stay (days): 16.50 (9.25, 32.00), 19.00 (10.50, 32.50) vs. 21.00 (10.00, 36.00)], and financial expenditure during hospitalization was lowered [10 thousand Yuan: 4.95 (3.13, 8.62), 5.47 (3.84, 9.41) vs. 6.52 (3.99, 11.02)] without significantly statistical differences (allP > 0.05). Moreover, no significantly statistical difference was found in the in-hospital prognosis among the three groups.ConclusionsCTSS performed using novel splash-proof ventilator circuit component shared similar advantages in preventing VAP with the conventional CTSS. Meanwhile, it is superior because it prevented the colonization of MDR and high price in the conventional CTSS.Clinical Trail Registration Chinese Clinical Trial Registry, ChiCTR-IOR-16009694.

Objective To explore the effect of lentiviral vector-mediated somatostatin (SST) expression on seizures induced by hippocampal kindling in rats.Methods Adult Sprague-Dawley rats were randomly divided into the sham group (Sham),epilepsy group (EP),Lenti-pSyn-EGFP (LV-EGFP) group and Lenti-pSyn-SST-2A-EGFP (LV-SST) group.The rats in LV-EGFP group were subsequently electrically hippocampal kindled and LV-EGFP (5 μl) was injected into dentate gyrus (DG).The rats in LV-SST group were kindled and LV-SST (5 μl) was injected into the dentate gyrus (DG),medial entorhinal cortex (MEC) or amygdala (Amy).Seizure severity was evaluated and immunohistochemical staining was employed to detect the expression of SST,neuron specific nuclear protein (NeuN) and microtubule associated protein 2 (MAP2).Results The current values to the first stage V seizure of LV-SST (DG) group,LV-SST (MEC) group or LV-SST (Amy) group ((143.8±3.8)μA,(142.5±4.1)μA,(142.5±5.3) μA,respectively) were significantly increased compared with that of epilepsy (EP) group ((136.3±5.3)μA),and V stage current values of LV-SST groups in each stimulation day were higher than that of EP group except the fifth stimulation day (P<0.05).After kindling,SST expression and NeuN-positive neurons of EP group and LV-SST groups were less than that of Sham group in CA1,CA3 and DG.SST and NeuN neurons loss in LV-SST groups were less than that of EP group (P<0.05) and MAP2 immunohistochemistry stainings in LV-SST groups were higher than that in EP group.Conclusion Lentiviral vector-mediated somatostatin expression suppresses seizures and can rescue the neuronal damage of seizure induced by kindling in hippocampus,which may provide a new method of gene therapy for temporal lobe epilepsy.

Objective21 -hydroxylase deficiency ( 21-OHD) patients are at high risk of developing metabolic syndrome.Low dose of glucocorticoid is crucial in the treatment.This study is to investigate the effect of glucocorticoid therapy on potential metabolic disorders.Methods Thirty-two treated and 31 untreated 21-OHD patients were recruited.The components of metabolic syndrome were investigated in both groups.Results Serum testosterone [ (0.61 ±0.12 vs 4.10±0.66) ng/ml,P＜0.01 ],17-(OH) progesterone[ 17-OHP,( 14.83±3.48 vs 48.52±4.72 )ng/ml,P＜0.01 ],dehydroepiandrosterone sulfate[ DHEAS,(55.7±23.6 vs 405.2±65.7 ) μg/dl,P＜0.01 ],and ACTH[ ( 105.8±44.7 vs 617.4± 163.3 ) pg/ml,P＜0.01 ] levels were significantly reduced,whereas body mass index [ ( 23.2±0.9 vs 21.1 ±0.5 ) kg/mz,P＜0.05 ],systolic blood pressure [ ( 120.5 ± 1.3 vs 115.5 ± 1.8 ) mm Hg,P＜0.05,1 mm Hg =0.133 kPa ],serum triglyceride [ ( 1.8±0.2 vs 1.1 ±0.1 ) mmol/L,P＜0.05 ],and homeostasis model assessment for insulin resistance [ HOMA-IR,( 2.07 ± 0.27 vs 1.16 ± 0.12 ),P ＜ 0.01 ] were markedly increased in glucocorticoid treated group.Multivariates regression analysis showed that body mass index was the most important risk factor for HOMA-IR.The correlation of glucocorticoid replacement and HOMA-IR was not observed after adjustment of age and body mass index.ConclusionGlucocorticoid treatment increases body weights,which leads to insulin resistance and metabolic disorders for 21-OHD patients.More attention should be paid to control BMI and metabolic disturbances in 21-OHD patients.

Obej ctive Abnormal proliferation of T cells plays an important role in the development of autoimmune diseases. The article aimed to study the inhibitory effect of small molecule compound BD691 on T cell proliferation and its mechanism. Methods Human peripheral blood T-lymphocytes were isolated and purified by the immunomagnetic microbeads,then T cells were ac-tivated with anti-CD3/CD28 mAbs or alloantigen.The inhibitory effect of BD691 on activated T cell proliferation, the cytotoxic effect BD891 on resting T cells and the expression of activated T cells marker CD25 were measured by flow cytometry.Furthermore, ELISA was used to detect the secretion of cytokines associated with T cell differentiation. Results BD691 significantly inhibited the prolif-eration of T cells being stimulated by anti-CD3/CD28 mAb or alloantigen in a dose-dependent manner, and IC50 values are (8.5 ± 1.5)μmol/L and (7.2 ±1.3)μmol/L, respectively.However, BD691 had no obvious cytotoxic effects on resting T cells and periph-eral blood mononuclear cells, even at a high concentration ( up to 100μmol/L) .In T cells which were not activated by anti-CD3/CD28 mAb, the percentage of CD25+T cells is only 1.6%of the total cells, while the number increased to 68% after activating treatment.Mean-while, in T cells which were activated by 0, 3.3, 10, 30μmol/L BD691, no obvious change of CD25 expression were observed, while immunosuppressant FK506 (0.1μmol/L) significantly decreased the expression of CD25 +T cells (14.9%).In unactivated T cells, 95.6%cells were at G0/G1 phase, while after activation, the percentage of cells at G0/G1 phase reduced to 57.7%.In addition, BD691 inhibited the secretion of IFN-γ, IL-6 and IL-17 in activated T cells, but had no effects on the secretion of IL-2, IL-4 and IL-10. Co nclusion BD691 exerts no effects on T cell activation, but it inhibits T cell proliferation by inducing T cell cycling arrest at G0/G1 phase.Moreover, BD691 inhibits the secretion of key cytokines (such as IFN-γ, IL-6, IL-17) closely related to the differ-entiation of Th1 and Th17 cells.The results suggest that BD 691 is a potential lead compound to develop a new immunosuppressant for the inhibition of abnormal proliferation and differentiation of T cells.

Objective To explore the pain beliefs in acute phase in elderly patients with lung cancer undergoing thoracotomy using qualitative analysis. Methods Using the phenomenological research method, a total of 15 elderly patients with non-small cell lung cancer undergoing thoracotomy from February to May 2017 in the First Hospital of Jilin University were recruited by purposive sampling method. On the 5th day after thoracotomy, semi-structured in-depth interviews were conducted to describe the pain beliefs and the data were analyzed by Colaizzi analysis. Results Through the analysis of the data, 4 main themes were summarized:pain cognition, negative emotion, controllability, social and family support. Conclusions There are negative pain beliefs and negative emotion in the acute stage in lung cancer patients after thoracotomy, which provides a theoretical basis for the development of pain care after thoracotomy in elderly patients with lung cancer.

In daily medical work, most of the critically ill patients who cannot move by themselves are pulled and lifted by manpower, often relying on the cooperation of many doctors and nurses, which not only increases the risk of transfer and patients' discomfort, but also causes certain skeletal and muscle damage to the porters. The emergency department of the First Hospital of Jiaxing City, Zhejiang Province designed a kind of patient transfer device, and obtained the National Utility Model Patent (ZL 2018 2 0579844.X). The transfer device is composed of upper frame, lower frame and base. The upper frame and the lower frame are rectangular and in a horizontal position. The upper frame can slide laterally through the circular tubes which are fixed on the lower frame. The lower part of the base is provided with four universal foot brake wheels. During the usage, the booster frame facilitates the transfer of patients by the rolling and two sliding tracks of the circular tube, which can make patients move smoothly and comfortably, and reduce the working intensity of the transporter. This device has good practical value.

Objective: To investigate the incidence and prognosis of hypophosphatemia in critically ill children treated with continuous blood purification (CBP). Methods: The medical records of the critically ill patients, who were treated with CBP, admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from May 2014 to April 2017 were retrospectively analyzed. The serum phosphorus levels were tested before CBP, at 48-72 h during CBP, at the end of CBP and on the next day after CBP finished. Phosphorus supplement was given to the children with severe hypophosphatemia. Results: A total of 85 patients met the inclusion criteria. The serum phosphorus levels at the 4 indicated time points were (1.4±0.5), (0.7±0.3), (0.8±0.3), (0.9±0.4) mmol/L, respectively (F=45.21, P<0.05). Among the children, 66 cases (78%) had hypophosphatemia during CBP. The incidences of moderate and severe hypophosphatemia were 32 (48%) and 9 (14%), respectively. There were 41 patients with CBP replacement rates of (35-49) ml/(kg·h), while 44 patients with CBP replacement rates of 50-70 ml/(kg·h). There were significant differences at 48-72 h during CBP, the end of CBP and on the next day after CBP ((0.8±0.4) vs. (0.5±0.2), (1.0±0.3) vs. (0.6±0.2), and (1.1±0.4) vs. (0.8±0.2) mmol/L; t=7.672, 4.060, 14.440, P<0.05). Atotal of 9 cases were treated with sodium glycerophosphate. Among the 85 children, 24 (28%) patients died while 61 (72%) survived. There were no significant differences between the two groups in serum phosphorus levels at the indicated time points ((1.4±0.5) vs. (1.4±0.5), (0.7±0.3) vs. (0.7±0.3), (0.7±0.3) vs. (0.8±0.3), and (1.0±0.3) vs. (0.9±0.3) mmol/L, respectively, P>0.05). Conclusions Hypophosphatemia is prone to occur during CBP, which probably related to the replacement rate. There was no significant relationship between hypophosphatemia and mortality in critically ill children after giving phosphorus supplementation.

Objective To analyze the characteristics and to evaluate the application of quantitative CT spectral parameters in patients with suspected lung cancer.Methods One hundred and thirty two patients with occupying lesions of the lung underwent chest plain and two-phase contrast enhanced CT scan with gemstone spectral imaging (GSI) mode.The CT images of patients with confirmed lung cancer by pathological evidence were analyzed with GSI viewer.Optimal energy value supplying optimal contrast-tonoise ratio (CNR) was recorded.The CT values of lesions at 40 keV,70 keY and optimal energy level were measured.Spectral curve slope at different intervals of 40-70 keV,40-100 keV and 40-140 keV was computed.Effective atomic number (Zeff),iodine concentration (IC) and water concentration (WC) were measured and analyzed by statistical methods.Results Sixty six patients with confirmed lung cancer were included in the analysis.The optimal energy values for optimal CNR on plain scan,arterial phase and venous phase were (63.09±5.33) keV,(52.65±6.44) keV and (54.06±5.53) keV,respectively.The difference of CT values at different energy levels on each scan phase was statistically significant (F=4.561,P=0.025).The spectral curve slope values among three different energy intervals were significantly different (F=2.137,P＜0.001).The differences of the slope between arterial phase and venous phase at same energy interval were not significant (40-70 keY:t=1.165,P=0.248;40-100 keV:t=1.102,P=0.274;40-140 keV:t=1.118,P=0.268).Zeff on plain scan,arterial phase and venous phase was 7.73±0.14,8.35±0.37 and 8.39±0.30,respectively.There was positive correlation between IC and Zeff on enhanced phase (arterial phase:r=0.998,P＜0.001;venous phase:r=0.998,P＜0.001).Conclusion CT spectral imaging can supply the optimal energy value for optimal CNR.CT value at optimal energy level and spectral curve slope at 40-140 keV are suitable for analysis.IC and Zeff can be used jointly in evaluation of patients with suspected lung cancer.