Juvenile idiopathic arthritis (JIA) is the most common chronic arthropathy in childhood. Immune and genetic factors take part in the development of JIA and influence its consequence. Studies have identified association between JIA and genes encoding the human leukocyte antigens (HLA) . In this article we discuss the principles behind genetic studies of complex traits like JIA, and comprehensively catalog HLA candidate gene associated with JIA to date, and review several validated associations. Studies indicate that the HLA-Ⅰ, Ⅱ gene and their products play an important role in JIA pathogenesis, clinical course, hormonal effect and prognostic judgment. Studies in different ethnic groups indicate the main relationship between JIA and HLA is concentrated upon A, DR and DQ loci, especially the HLA-Ⅱ gene and some haplotypes. The different type of JIA is always with different HLA susceptible locus and protective locus. Different race, different region and different social environment also affect the JIA's susceptible gene polymorphism. Finally we discuss the problems existed in the study of JIA susceptibility and HLA polymorphism.

Objectives To explore the effects of budesonide (BUD) on airway remodeling and the levels of transforming growth factor-β1 (TGF-β1) in bronchoalveolar lavage fluid (BALF) and its expression in lung tissue of asthmatic rats. To provide a theoretical basis for the intervention and treatment of asthma. Methods Sixty healthy adult male Wistar rats were randomly divided into 3 groups: control group, asthma model group and BUD treated group, 20 rats in each group. A rat asthma model was established by ovalbumin (OVA) challenging. BUD treated group was treated with inhaled BUD 1 mg/kg in 30 min per serving every other day for two weeks. After OVA challenge finished, the rats were anesthetized and sacrificed for BALF and lung tissue collection. The level of TGF-β1 in BALF was measured by enzyme-linked immunosorbent assay. TGF-β1 expression and collagen deposition in the lung tissue were tested with immunohistochemical determination and Masson stain respectively. The computer image analysis system was used for measuring respiratory bronchiole smooth muscle thickness (μm) and the extent of epithelial damage score and other indicators of airway remodeling. Results Compared with that in the control group, TGF-β1 in BALF and lung tissue of asthma model group increased and were correlated significantly with the indicators of airway remodeling (P < 0.01) ;while that of BUD treated group reduced statistically significant than model group (P < 0.05). Pathology examination on asthma rat airway epithelial tissue showed the thickness of airway smooth muscle, the airway deposition of collagen in BUD treated group reduced obviously than asthma model group. Conclusions The expression of TGF-β1 in the rat asthma airway worsens the airway remodeling. The effects of BUD on ameliorating the progression of airway remodeling may be partially made by reducing the expression of TGF-β1. (J Clin Pediatr,2010,28(2):173-177)

Objective To explore the long term effects of Toxoplasma gondii infection during pregnancy on memory and learning ability of her child and provide therapeutic strategy. Methods Middle-school students selected according to their mother's pregnant record of Toxoplasma gondii IgM, CAg were divided into three groups: healthy group (negative Toxoplasma gondii IgM, CAg in both mother's blood and umbilical cord blood), non infected group (positive in mother's blood, but negative in umbilical cord blood), infected group (positive in both mother's blood and umbilical cord blood). Infected group was subdivided into treated group (with special training) and untreated group. All objects wereevaluated their memory and learning ability with Mini-Mental State Examination (MMSE) , Tower of Hanoi (TOH-1-TOH-d-TOH-s-TOH-2) and Wisconsin Card Sorting Test (WCST-1-WCST-d-WCST-s-WCST-2). Results The scores in items about calculation, recall and total of MMSE were significantly lower in untreated group than that in non infected group (P < 0.05). The scores of TOH and WCST in infected group was significantly different from uninfected group (P < 0.05). The scores of WCST were significantly improved in treated group (P < 0.05) after training, however, have no difference in the scores of TOH between treated group and untreated group (P > 0.05). Conclusions Toxoplasma gondii infection during pregnancy damages the infected children's mental development. Early cognitive rehabilitation is very important for the infected children.

Objective To explore the heredity susceptibility of children to Kawasaki disease (KD) through studying expression and genomic density polymorphism of peripheral erythrocyte complement receptor-1 (ECRI). Methods Thirty cases of KD patients and 28 cases of healthy children were included in this study. The rates of red blood cell (RBC)-C3bRR and RBC-ICR were detected by method described elsewhere. The ECR1 activity and genomic density polymorphism were detected by Hind Ⅲ restriction enzyme digestion polymerase chain reaction-restriction fragment length polymorphism. Results Rates of RBCoC3bRR of KD patients during the acute phase was significantly lower than that of the control group (P < 0.01), and remained lower than the control group during the recovering phase (P < 0.05). The rates of RBC-ICR were significantly higher in KD patients than that of the control group (P < 0.05). Frequencies of HL and LL genotypes of KD patients were more than those of the control group (P < 0.01). A significant difference was found in the frequency distribution of ECR1 genotype between the two groups (P < 0.01). L allele frequency in the patient group was higher than that in the control group. Conclusions Depressed RBC immune function in KD patients may be linked to the high frequency of L allele, which implies the genomic density polymorphism of ECR1 play an important role in determining susceptibility to Kawasaki disease. (J Clin Pediatr,2010,28(2):160-163)

Ohjective To investigate the associations between the Arg389Gly polymorphism of the β_1-adrenergiecreceptor gene (ADRB1) and vasovagal syncope (VVS) in Chinese children. Methods Genotype of ADRB1 was determined by polymerase chain reaction-restriction fragment length pelymorphism analysis. Case-control studies and quantitative trait analysis were carried out by comparing between carriers (one or two copies of the Gly389 allele) and non-carriers (Arg389 genotype) of the ADRBI in 54 patients with unexplained syncope and in 54 healthy control subjects. Patients were subdivided into two groups according to head up tilt test (HUTT) : positive HUTT, known as VVS group and negative HUTT group. Distribution of Arg389Gly genetype in VVS group and the relationship to three clinical patterns were also analyzed. Results An allele frequency of Arg389 was 73.15% and Gly389 was 26.85% in healthy subjects. Higher Gly389 allele frequency was found in VVS group (n = 30) than that in negative HUTT group (33.33% vs. 14.58%, P < 0.05). In VVS group, the frequencies of the Gly389 allele in cardioinhibitory pattern (n = 6), mixed pattern (n = 9) and vasodepressor pattern (n = 15) was 66.67%, 33.3% and 23.33%, respectively, which had significant differences between the cardioinhibitory pattern from any of the other two patterns (both P < 0.05). Conclusions An association of positive HUTT with a single nucleotide pelymorphism of Gly to Arg switch at position 389 of the ADRB1 was found. This polymorphism may contribute to susceptibility to VVS.

Objective To investigate the prevalence, clinical characteristics and antibiotic resistance of Haemophilus influenzae (HI) in children with acute respiratory tract infection in Suzhou. Methods Data of sputum culture of 3 167 hospitalized childhood patients with acute respiratory tract infection from January 2006 to December 2007 were collected. The incidence of positive HI and the rate of resistance to different antibiotics were calculated and beta-lactamases of the strains were detected. Results About 4.4% of total 3 167 eases were infected with HI. The infection rate was related with season and sex, more frequent between February and June, more common in boys than girls. Children younger than three years old were likely to be infected by HI, eompared with other age groups. The beta-lactamase positive rate of HI was 31.4%. The resistance rates to ampicillin, SMZ + TMP, chloramphenicol, cefaclor, ceftazidime, tetracycline and ampicillin/sulbactam were 29.6% ～ 31.9%, 66.2% -73.9%, 19.7% ～ 15.9%, 2.8% ～ 14.5%, 2.8% ～0、 28.2% ～ 2.9% and 4.2% ～ 1.4% respectively. Isolates resistance to cefuroxime、 ceftriaxone、 imipenem、azithromycin and ciprofloxacin were not found. Conclusions The infection of HI in children with actue respiratory tract infection is closely related with season and sex in Suzhou. Children younger than three years old are at high risk. The beta-lactamase positive rate of HI was high and increased rapidly. Resistance rate to azithromycin, SMZ + TMP and chloramphenicol was high, some isolates were resistant to the second, third generation of cephalosporin. Monitoring the antibiotic resistance of H! should be emphasized.

Objective To screen for biomarkers in urine from patients with steroid-resistant nephrotic syndrome (SRNS) using surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF-MS) Proteinchip technology. Methods Urine samples from 9 SRNS patients, 32 steroid-sensitive nephrotie syndrome (SSNS) patients and 45 normal controls were analyzed using UA gold chip. Proteomic spectra were generated by mass spectrometry. Results Four differentially expressed biomarkers were identified with relative molecular weight of 6 703, 7 212, 11 820, 14 356. It was found that these protein peaks with relative molecular weigh of 7 212, 11 820, 14 356 were highly expressed in SRNS and 6 703 were lowly expressed in SRNS. The diagnostic cast that is constructed with these four protein to differentiate SRNS from SSNS with sensitivity of 88.89% and specificity of 93.75%. Conclusions SELDI-TOF-MS Proteinchip technology is a non-invasive, quick, easy, and convenient, and high-throughput analyzing method capable of screening several biomarkers from the urines of SRNS patients and has better clinical value.

Objectives To determine the effects of Matrine (Ma) on signal transducers and activators of transcription (STAT) 1, 3, connective tissue growth factor (CTGF) and platelet -derived growth factor (PDGF) in glomerular mesangial cells (MC) induced by lipopolysaccharide (LPS), and to explore the protective mechanisms of Ma. Methods Ma were added to cultured glomerular mesangial cells which were exposed to LPS for 12, 24 and 48 hours. Real time polymerase chain reaction were used to determine STAT1, 3, CTGF, PDGF mRNA, The protein expression of STATI, 3 and p-STAT1, 3 were observed by Western blot. Results Compared with the control group, MC proliferation of the LPS group (10μg/ml) significantly increased, which were suppressed in the Ma (320 μg/ml) group (P < 0.01) at 12, 24, 48 hours. The expression of STAT1, 3, CTGF, PDGF mRNA and the levels of p-STAT1 , p-STAT3 protein was significantly increased in MC under LPS medium at 12, 24, 48 hours, which were obviously lower in Ma group than those of the LPS group, especially at 24, 48 hours. Conclusions The protective mechanisms of Matrine is considered to down-regulate the expression of STAT1, 3, CTGF and PDGF.

Objective To improve recognition of posterior reversible encephalopathy syndrome (PRES) in children. Methods Two children with PRES admitted to children's hospital were included. Clinical data were retrospectively studied and related literatures were reviewed. Results The primary diseases of the two patients are systemic lupus erythematosus and nephritic syndrome, respectively. They all developed an acute onset of headache, visual changes, consciousness disturbance, hypertension and seizures. Cranial MRI showed bilateral parietal, temporal and occipital cortical or subcortical lesions with hypointensity on Tl-weighted imaging and hyperintensity on T2-weighted imaging. Clinical symptoms resolved soon and radiographic recovery occurred within 14 to 21 days with prompt anti-hypertension treatment and supportive care. Among the mechanisms which might contribute to the development of PRES, acute elevated blood pressure seems to be the most important factors in these two cases. Prompt anti-hypertension treatment usually can reverse the PRES lesion. Conclusions It is important to improve cognition of PRES in children. Delayed treatment can cause permanent neurological impairment. Doctors should be alert to this syndrome. Early diagnosis and prompt treatment are very important. (J Clin Pediatr,2010,28(2):168-170)

Objective To study the prognosis of infants with bronchiolitis by testing urine leukotriene E4 (LTE4) level and investigating atopy's influences. Methods Urine LTE4 was tested in 38 eases with mild bronchiolitis (47 in acute stage, 17 in convalescent stage), 9 severe bronchiolitis cases, 15 atopic cases, 25 control cases. Peripheral blood was used to determine eosinophils count (EC) in acute bronchiolitis cases. Results (1) The level of urine LTE4 is obviously higher in cases of acute group (62.11 ± 12.23 pmol/L) than that of control group (22.19±1.50 pmol/L) , and the convalescent group (34.86 ±5.75 pmol/L) (F = 132.42, P < 0.01) ;Urine LTE4 level of convalescent group is higher than that of the control group (P < 0.01). (2) Urine LTE4 level is significantly higher in severe group (98.04 ± 8.04 pmol/L) than that of mild group (59.16 ± 12.25 pmol/L) (t = 9.92, P < 0.01). (3) Urine LTE4 level of atopy positive (88.75 ± 10.45 pmol/L) infants with bronchiolitis is significantly higher than atopy negative infants (55.28 ± 11.44 pmol/L)(t = 8.63, P < 0.01). (4) There is no significant correlation between the levels of urine LTE4 and EC for acute bronchiolitis. Condusions The level of urine LTE4 in acute bronehiolitis patients increases and remains high in convalescent stage;Higher urine LTE4 level in severe bronchiolitis cases indicates that urine LTE4 level is related to the severity of the disease;cysteinylleukotrenes is an important mediator of inflammation that may influence the prognosis of atopy positive infants with bronchiolitis;EC is not a good index to present the airway inflammation of infants with bronehiolitis.