Objective To explore the effect of irbesartan on cardiac endothelial-mesenchymal transition (EndMT) in diabetic rats.Methods The model of diabetic rat was induced by intraperitoneal injection with streptozotocin (STZ,35 mg/kg) in spontaneous hypertensive rats (SHR).Diabetic rats were divided into diabetic group and the Irbesartan treated group.The pathological changes were investigated by fluorescence microscope and electron microscope.The EndMT was studied in human aortic endothelial cells (HAEC) exposure to high glucose.The concentration of angiotensin Ⅱ in the supernatant was detected by radioimmunoassay.Immunofluorescence staining was performed to detect the co-localization of CD31 and FSP1.Results The significant myocardial fibrosis was presented in the diabetic group.Endothelial protrusions were prominent feature in myocardial microvascular of diabetic rat compared with the control group rats.Double staining of HAEC showed co-localization of CD31 and FSP1,which was decreased by the treatment of Irbesartan (P ＜ 0.05).When HAEC was exposed to high glucose,it showed some cells acquired spindle-shaped morphology and lost CD31 staining,and FSP1 and α-SMA protein expression levels were markedly upregulated,which attenuated by the treatment of Irbesartan.Conclusion Irbesartan might prevent diabetes from myocardial fibrosis via inhibition of EndMT in diabetic rats.

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In recent years, rituximab has been gradually used in the treatment of idiopathic membranous nephropathy (IMN). Compared with traditional treatments, the safety and effectiveness of rituximab in the treatment of IMN have been confirmed, which induces remission in 60%-80% of patients. For the remaining 20%-40% patients, several mechanisms can explain rituximab resistance: decreased rituximab bioavailability; internalized by targeted B cells; the generation of anti-rituximab antibody; chronic and irreversible damage to the glomerular filtration barrier; autoreactive B-cell clones in secondary lymphoid organs that cannot be effectively eliminated. The treatment of patients with rituximab-refractory IMN remains controversial and challenging. The recognition of IMN as an antibody-mediated autoimmune disease has rationalized the use of immunosuppressive drugs such as B cell-targeted therapies, plasma cell-targeted therapies, and complement inhibitors. This review mainly summarizes recent advances in the understanding of the physiological mechanisms of rituximab resistance, and in the management of rituximab-refractory IMN, aiming to aid in the clinical management of IMN.

Objective:To compare the laboratory diagnostic methods of Mycoplasma pneumonia(MP) and evaluate its clinical value.Methods:A prospective study.Throat swabs and double sera of children with MP infection were collected from December 2016 to January 2017 in Shengjing Hospital Affiliated to China Medical University; throat swab samples of healthy children aged 3 to 5 in Chaoyang District, Beijing were collected from March to May 2017.Passive agglutination (PA) was used to detect the double serum.Taking the 4-fold increase or decrease of the specific antibody titer of the double serum as the gold standard, the receiver operating characteristic curve (ROC) was drawn, and the laboratory methods for detecting MP infection were compared and evaluated.Results:(1)A total of 93 children with MP infection were clinically diagnosed, including 42 males (45.2%) and 51 females (54.8%), with an average age of 5.5 years.Sixty cases (64.5%) of MP infection were diagnosed.There were 349 healthy children, 198 males and 151 females, with an average age of 4.3 years.The positive rate of throat swab culture was 0.6% (2 cases), and the positive rate of fluorescent quantitative PCR(qPCR) was 18.9% (66 cases). (2) The culture specificity was the highest (100.0%) and the sensitivity was the lowest (65.0%). PA and enzyme linked immunosorbent assay (ELISA) were used to detect a single serum in the acute phase, the sensitivity was 71.7% and 86.5% respectively.ROC curve suggested that the current clinical diagnostic threshold MP specific antibody IgM ≥ 1∶160 was not the best diagnostic threshold.Molecular biological diagnostic methods were the most sensitive, RNA simultaneous and testing (SAT) was 85.0% and qPCR was 93.0%; while the specificity was low, 75.7% (SAT) and 63.6% (qPCR), respectively.(3) At the same time, MP nucleic acid (SAT, PCR) of throat swabs and a single serum (ELISA, PA) of children in acute phase were detected, the sensitivity was increased to 95.0%-100.0%, and the specificity was 63.6%-75.7%.Conclusions:Molecular biology is highly sensitive in diagnosing MP infection.It has asymptomatic infection or is carried after infection.Whether it needs treatment needs to be combined with clinical practice, when MP detection is positive.The detection of a single serum in the acute phase with a course of about 1 week has high sensitivity and is of reference value for the diagnosis of MP infection, but the diagnosis needs to be combined with clinical practice.The sensitivity and accuracy of detecting MP infection by single serological test combined with SAT in acute phase are higher than that by single application.

With the emergence of new respiratory virus, it is more apparent for the vulnerability of population to respiratory viral infection.Non-pharmaceutical interventions (NPIs) for respiratory virus infection have become the main way to prevent corona virus disease 2019.Some studies had proven its effectiveness.In addition, the NPIs also significantly reduced the incidence and hospitalization rate of other respiratory disease in children.NPIs for respiratory virus infection in children have its particularity and challenge.In daily life, it is important to guide children how to do the NPIs, so as to protect susceptible children and reduce the disease burden in children′s health system.Therefore, the aerosol transmission, the specificity of the NPIs in children, and the impact on childhood respiratory diseases are described in this article, to improve the prevention of common respiratory diseases in children.

Severe asthma imposes a significant burden on patients, families, and healthcare systems.Management is difficult, due to disease heterogeneity, co-morbidities, complexity in care pathways and differences between national or regional healthcare systems.Better understanding of the mechanisms has enabled a stratified approach to the management of severe asthma, supporting the use of targeted treatments with biologicals.However, there are still many issues that require further clarification.These include selection of a certain biological, the definition of response, strategies to enhance the responder rate, the duration of treatment and its regimen.

Recently, the number of children with asthma reported after thunderstorm weather in China has increased rapidly, which has aroused the public concern.At present, there are 28 documented episodes of epidemic thunderstorm asthma in the world, which can be life-threatening in severe cases.Children with allergic rhinitis or uncontrolled asthma were more susceptible to thunderstorm asthma.This article introduces the epidemiology, mechanism, risk factors, manifestations, management strategies and prevention of thunderstorm asthma, in order to improve pediatricians′ understanding of thunderstorm asthma and reduce the impact of it.

Type 2 immunity involves Th2 cells, type 2 innate lymphoid cells(ILC2), and type 2 cytokines such as interleukin (IL)-4, IL-5, and IL-13.Invasion by allergens or harmful substances can cause an excessive type 2 immune response, resulting in type 2 inflammation characterized by the increase in type 2 cytokines, eosinophils, and serum total IgE/specific IgE.Type 2 cytokines are the core of type 2 inflammation, of which production and secretion involve Th2 cells and ILC2.Disruption of barrier function can activate type 2 inflammation and contribute to the vicious cycle.Type 2 inflammation is a common pathophysiological mechanism in many diseases, especially allergic diseases.Type 2 inflammatory disease in children mostly affects the skin, respiratory tract, and gastrointestinal tract.Multiple type 2 inflammatory diseases often co-exist, increasing the disease burden in children.With deepening research on the mechanism of type 2 inflammation, the biotherapy has gained more and more attention.This paper focused on the mechanism, identification and biologics of type 2 inflammation in order to improve clinicians′ understanding of type 2 inflammatory diseases in children.

Fungus is one of common allergens in allergic disease that affects the susceptibility, severity, and disease control of allergic airway disease in children.A spectrum of respiratory diseases associated with fungal sensitization has been described as allergic fungal airway disease (AFAD), including severe asthma with fungal sensitization, allergic bronchopulmonary aspergillosis, thunderstorm asthma, and allergic fungal rhinosinusitis.Glucocorticoids, biologics, antifungal therapy, and immunotherapy can reduce the airway inflammation, fungal burden, and tissue damage associated with AFAD.This review introduced fungus, the mechanism of fungal sensitization and the detection, as well as the scope and treatment of AFAD in children, aiming to improve the understanding of AFAD among pediatricians.

Trained immunity has been a novel term in immunology for over a decade, referring to the memory immunity produced by the innate immune system upon re-stimulation.Non-specific training of the immune system enhances the immune defense function and is also involved in allergic inflammation and autoimmune diseases.An increasing number of researchers are focusing on the role of immune training in the prevention, treatment, onset and progression of diseases.This review explains the definition, mechanism, and inducers of immune training and its impact on children′s health and disease, in order to enhance pediatricians′ comprehension of trained immunity.