Objective To discuss the value of high frequency ultrasound in assessment the changes of knee,ankle and elbow joints with haemophiliac arthropathy in children.Methods Eighty joints of 42 haemophiliac patients were enrolled in this study.Sixty two joints of 29 patients were examined by X-ray at the same time.The correlation of ultrasonography and X-ray on bone aspects were compared.Results Among 80 joints of 42 haemophilic patients,soft tissue swelling was showed in 12 joints,synovial hypertrophy was in 48 joints,the thickness range of synovial membrane was from 2.01 to 11.12 mm [(4.71± 2.26)mm],increased blood flow was in 40 joints,effusion in 53 joints,haemosiderin was in 33 joints,bone erosion was in 36 joints,subchondral cyst formation was in 20 joints,cartilage damage or disappear was in 31 joints.Ultrasonograthy showed bone erosion in 29 joints,subchondral cyst formation was in 16 joints,cartilage damage was in 24 joints.X-ray showed bone erosion in 23 joints,subchondral cyst was in 16 joints,narrowing joint space was in 20 joints.There was high correlation between the osteochondral domain of the ultrasonography and X ray:Kappa value were 0.803,0.832,0.790 respectively(P ＜0.05).Conclusions Ultrasonography is sensitive to detect the signs of enrolled joints in hemophiliac patients.It is an important method on diagnosis for hemophiliac arthrophv.

Objective To evaluate the efficacy and adverse reaction of the first line therapy with rabbit-antithymocyte globulin (ATG) combined with Cyclosporine (CsA) in children with acquired severe aplastic anemia.Methods A retrospective analysis was performed.The clinical data included 44 children with acquired severe aplastic anemia treated with ATG combined with CsA in Beijing Children's Hospital Affiliated to Capital Medical University between June 2006 and December 2013.The SPSS 19.0 statistical package was used for data analysis.Results Sixteen cases were severe aplastic anemia,and 28 cases were very severe aplastic anemia.The median age of treatment with ATG was 8 years old and 10 months.The median follow-up period was 24 months.The hematologic response rate was 66％ (29/44 cases) in 6 months after ATG treatment,and the overall response rate was 77％ (34/44 cases) at the endpoint of follow-up.The median time of partial remission (PR) was 3 months,of complete remission (CR) was 12 months.Eighty-five percent (29/34 cases)effective cases achieved PR during 6 months,while 56％ (15/27 cases)cases achieved CR in 12 months.There was no significant difference between the response rate with ATG treatment and gender,severity of disease,age,interval from clinical onset to ATG treatment,and ratio of CD4 +/CD8 +.The response rate in children without serum sickness was superior to that with serum disease(P =0.006).Thirty-four cases (77％) manifested immediate side-effects with ATG infusion.The side-effects included fever,chill,rash,gastrointestinal distress and irritable cough.The overall 2-year survival rate was 87.3％ (39/44 cases) and the 2-year transplantation-free survival rate was 82.5％ (37/44 cases) (x2 =0.34,P =0.56).Conclusions The response rate with rabbit-ATG combined with CsA in children with acquired severe aplastic anemia was 77％.The adverse reactions were minor.The immunosuppressive therapy should begin as soon as possible in children without chance for hematopoietic stem cell transplantation.

Objective To collect and summarize long-term complications of glucocorticoid (GC) in treatment of Diamond-Blackfan anemia (DBA).Methods A total of 17 DBA patients,treated with GC more than 1 year from December 2009 to November 2012 in Being Children's Hospital,Capital Medical University,were retrospectively investigated.The data of general information,drug treatment,treatment response,height and body mass in different therapy periods,and therapy related adverse reaction were collected.The data entry and the statistical analysis were performed using SPSS 16.0 software.Results Seventeen cases which fulfilled the research criteria were enrolled.The 58.8 percent of cases (10/17) began GC therapy from the age younger than 6 months.The 76.4 percent of the cases (14/17) started prednisone therapy with the dosage ≥2 mg/(kg · d),and the median time of maintenance therapy with this dosage was 2 months (1-5 months).The median time of prednisone dosage greater than 0.5 mg/(kg · d) was 6 months (3-48 months).Patients were divided into 2 groups at the beginning of therapy according to whether their age was younger or older than 6 months.The median height of younger age group was-1.0 SD (-3.5-1.0 SD) of corresponded age-sex-standard height at the beginning of prednisone therapy,and was dropped to-3.5 SD (-3.5--2.0SD)afterhalfyeartreatment.For older age group,it was0.0 SD(-1.5-2.0 SD)and-0.5 SD (-1.5-0.5 SD) respectively.During the therapy,there were 1 fracture,2 measles pneumonia,3 pneumonia,3 hirsuitisms,5 thrushes,and 12 central obesity cases.Conclusions GC related adverse reaction might appear when applying prednisone for the treatment of DBA in long term.It was suggested that GC therapy should start after 6 months old if possible,and the duration of 0.5 mg/(kg · d) GC treatment should be reduced as short as possible.

Objective To analyze the clinical characteristics of juvenile myelomonocytic leukemia(JMML) and the PCNA levels of the hyperoxia -exposure group (6 h)decreased,and the difference in PCNA protein expres-sion levels was significant of gene diagnose for JMML.Methods Clinical data were retrospectively analyzed in 21 pa-tients suffering from JMML based on new 2009 World Health Organization diagnostic criteria from January 201 3 to June 201 4 in Beijing Children′s Hospital,Capital Medical University.Results There were 85.7% (1 8 /21 cases)patients within 4 -year -old children,and the median age was 23 months (2 -86 months).Fever and abdominal symptoms were the prominent clinical symptoms,52.4% (1 1 /21 cases)with fever,38.1 % (8 /21 cases)with abdominal dis-tention,diarrhea and other abdominal symptoms,80.5% (1 9 /21 cases)had splenomegaly (mild 1 9.1 %,middle 33.3%,severe 38.1 %),and some patients had other tissue infiltration,such as rash,yellow tumor and lymphnode enlargement.Peripheral blood cell count showed that the white blood cells increased because of anemia or thrombocyto-penia,ranging from 1 0.40 ×1 09 /L to 82.1 4 ×1 09 /L(median,26.1 0 ×1 09 /L),and the monocyte counts ranged from 1 .46 ×1 09 /L to 21 .60 ×1 09 /L(median,3.79 ×1 09 /L),characteristics of JMML gene abnormality was detected in 1 7 cases:including 1 1 single gene mutation,and 6 cases with double gene mutations.PTPN11 was the highest frequency of occurrence,accounting for 52.9% (9 /1 7 cases),and NF1 mutation was 35.3% (6 /1 7 cases).All the patients were followed up by phone call,the median follow -up time was 371 days (57 -562 days),6 patients were lost to follow -up,7 patients died,2 patients were alive after hematopoietic stem cell transplantation,1 patient converted to acute non lymphocytic leukemia,and 5 patients were still alive after receiving symptomatic treatment.Among dead cases,PTNT11 gene mutation and NF1 gene mutation were detected in 6 patients;among living children after hematopoietic stem cell transplantation,RAS and PTNT11 mutations were detected in 2 patients;among living children after symptomatic treat-ment,RAS mutation was detected in 2 patients and PTPN11 +CBL mutation in 1 case.Conclusions The symptom and laboratory examination of JMML have no specificistics,with poor prognosis,gene diagnose has guiding significance for JMML diagnose and for selecting therapy.

Objective To study the lignans in Patrinia scabra. Methods The constituents were separated and purified by column chromatographies with silica gel, RP-silica gel, and Sephadex LH-20. Their structures were elucidated on the basis of spectral data (IR, MS, 1H-NMR , 13 C-NMR , DEPT, HMQC and HMBC). Results There were four lignans obtained from P. scabra with the structures identified as pinoresinol-4, 4′-di-O-?-D-glucopyranoside (Ⅰ), and matairesinol-4, 4′-di-O-?-D-glucopyranoside (Ⅱ), lariciresinol-4′-O-?-D-glucopyranoside (Ⅲ), and lariciresinol-4-O-?-D-glucopyranoside (Ⅳ). Conclusion All the four compounds are found in P. scabra for the first time. The NMR data of compound Ⅱ are given first.

Objective To study the current status of catheter - related thrombosis(CRT)in Chinese children through a retrospective analysis of the inpatients in the Department of Medicine,Beijing Children's Hospital Affiliated to Capital Medical University. Methods The clinical data of the inpatients with CRT from November 2010 to November 2013 were collected retrospectively,and the causes,clinical symptoms,diagnosis,treatment and prognosis were ana-lyzed. Results There were 42 cases of children with CRT in Beijing Children's Hospital Affiliated to Capital Medical University. Among the cases,the male to female ratio was 1. 0:0. 5;the median age of onset was 88(2 - 186)months with ﹤ 1 year old counted for 16. 7%(7 / 42 cases)and 13 - 14 years old counted for 11. 9%(5 / 42 cases);the distri-bution differences between the male and the female age were not significant(P = 0. 826). The median time from cathe-terization to CRT onset was 9(1 - 81)days,0 - 10 days after catheterization was the peak of onset(52. 5% ,21 / 40 ca-ses)followed by 10 - 20 days(35. 0% ,14 / 40 cases). The protopathy was usually hematologic tumor,kidney disease or deep fungal infection. Slightly more cases developed CRT on the right side(57. 1% ,24 / 42 cases)than on the left side (38. 1% ,18 / 42 cases). All cases were diagnosed by using B - ultrasound,of whom 28. 6%(12 / 42 cases)were symp-tom - free. After being diagnosed,7. 1%(3 / 42 cases)were treated with conservative methods such as immobilization of the affected limbs and hot compress;7. 1%(3 / 42 cases)had catheter removed;anticoagulant and/ or thrombolytics after catheter removal used in 33. 3% patients(14 / 42 cases). After 1 week,22 cases were reviewed,of whom 54. 5%(12 / 22 cases)had thrombosis reduced(all with intervention),thrombosis growing in 22. 7% patients(5 / 22 cases), and thrombosis did not change in 22. 7% patients(5 / 22 cases). Three cases needed re - catheterization after catheter removal,and all of 3 cases had CRT recurrences(100% ). Conclusions CRT is more common among infants and senior children. CRT usually develops within 20 days after catheterization. Children with hematologic tumor,kidney disease or deep fungal infection are more likely to have CRT. Routine ultrasound test should be conducted to monitor CRT in catheterized children. Once CRT is diagnosed,patients need to be treated with anticoagulants and/ or thrombo-lytics. Catheter should also be removed if necessary. Recatheterization can result in CRT recurrence.

Objective:To analyze the clinical characteristics and diagnosis and treatment of children with Kasabach-Merritt phenomenon (KMP).Methods:A retrospective analysis was conducted on the clinical data and follow-up data of 8 patients diagnosed KMP in Beijing Children′s Hospital, Capital Medical University from January 2016 to January 2019.The clinical data included laboratory examination, diagnosis, treatment and prognosis.Results:Among the 8 children with KMP, 6 cases were male and 2 cases were female.The median onset age was 4 (0-17) months, 2 cases of neonatal onset.The median onset to the diagnosis time was 59 (34-140) days; 6 cases with bone destruction; 6 cases had misdiagnosis and mistreatment history, they were misdiagnosed as idiopathic thrombocytopenic purpura, Evans syndrome, abnormal bone and joint development; 4 cases were Kaposiform hemangioendothelioma; 8 cases were used alone or combined with the application of hormones, Sirolimus, and Vincristine, 7 patients underwent interventional therapy.All patients survived with a median follow-up period of 487 (112-1 033) days.Median time of platelet count returned to normal was 24.5 (7-60) days, and median time of fibrinogen returned to normal was 20 (7-30) days.Median time of D-dimer dropped to a normal was 105 (40-240) days.Conclusions:Children with concurrent platelet count and coagulation abnormalities should be considered with KMP.Doctors need to identify the potential visceral vascular lesions.Early diagnosis and treatment are important, which can improve the clinical prognosis of patients.

The clinical and laboratory data of a patient with chronic refractory immune thrombocytopenia (ITP) who had a significant increase in the proportion of inhibitory T cells in the hematological oncology center of Beijing Children′s Hospital Affiliated to Capital Medical University in February 2018 and regularly followed up in the outpatient department received a retrospective analysis.This 8-year-old patient′s clinical features were 6 years of skin and mucous membrane bleeding spots and petechiae recurring, with occasionally nasal epistaxis.Physical examination: cardiopulmonary abdomen and nervous system examinations are normal, and no superficial lymphadenopathy is touched.Blood routine indicated that the platelets were 2.00×10 9/L, and white blood cell count and hemoglobin level were normal.Bone marrow suggested that hyperplasia was significantly active, with more than 300 megakaryocytes.The patient was diagnosed with ITP, and he was treated with first-line treatment with gamma globulin and oral Corticosteroids.The first-line treatment with high-dose Dexamethasone therapy was repeated, and the second-line treatment was low-dose Rituximab combined with high-dose Dexamethasone.Evaluations had been conducted with every relapsed course, and Cyclosporine was administered orally on the basis of the highly suppressive T cells.After half a month, the child achieved partial remission and continued for 3 months, and then reached a complete remission of 6 months (till this paper). It is suggested that, with ITP as an immunological disease with high heterogeneity, the immune abnormality index is expected to become a breakthrough in the development of precise treatment.

OBJECTIVETo investigate the chemical constituents from the whole plants of Senecio chrysanthemoides.

METHODConstituents were isolated by using a combination of various chromatographic techniques including column chromatography over silica gel, Sephadex LH-20, and ODS C18, as well as reversed-phase HPLC. Structures of the isolates were identified by spectroscopic and chemical methods.

RESULTEighteen glycosides were obtained from a H2O-soluble portion of an ethanolic extract of the whole plants of Senecio chrysanthemoides and their structures were elucidated as 5'-methoxyligusinenoside B (1), hyuganoside III b (2), citrusin A (3), alaschanioside A (4), citrusin B (5), dehydrodieoniferyl alcohol 4, gamma'-di-O-beta-D-glucopyranoside (6), osmanthuside G (7), syringin (8), dehydrosyringin (9), 2-(4-hydroxy-3,5-dimethoxyphenyl) ethanol 4-O-beta-D-glucopyranoside (10), 2-phenylethyl beta-gentiobioside (11), phenethyl beta-D-glucopyranoside (12), nikoenoside (13), benzyl beta-D-glucopyranoyl (1 --> 6 ) -beta-D-glucopyranoside (14), 3,5-dimethoxy-4-hydroxybenzyl alcohol 4-O-beta-D-glucopyranoside (15), icariside B2 (16), sonchuionoside C (17), and 1-[(beta-D-glucopyranosyloxy) methyl] -5,6-dihydropyrrolizin-7-one (18).

CONCLUSIONCompound 1 was a new lignan glycoside, and the remaining compounds were obtained from this plant for the first time.

Chromatography ; methods ; Glycosides ; chemistry ; isolation & purification ; Lignans ; chemistry ; isolation & purification ; Plant Extracts ; chemistry ; Plants, Medicinal ; chemistry ; Senecio ; chemistry