Objective To understand the cause of chest pain (precordium indisposition) in children and explore the thread of thought in its analysis.Methods Clinical data of 314 children with chest pain who visited the cardiovascular department for children of our hospital were collected and analyzed to study its causes.Results The cause could be attributed to organic cardiac diseases in 43 of 314 children (13.7%) with chest pain,to non-organic cardiac diseases in 108 (34.4%),to psychiatric-psychological factors in 60 (19.1%) and to unknown cause in 41 (13.1%).Average age of children with organic cardiac diseases was younger than that of children with other causes (P<0.05).Symptoms accompanied simultaneously in children with organic cardiac diseases were much more frequent significantly than those in them with non-organic cardiac chest pain and unknown causes (P<0.05).Conclusions Chest pain in children could be caused by a few causes,which was non-specific symptom for organic cardiac diseases,so, more should be taken into account in analyzing the cause of chest pain in children.

Studies have indicated approximate 50% cases of coronary heart disease are closely associat-ed with genetic factors and it. It is well evidenced that lipid abnormality is the important risk factors of coronary heart disease. Many single nucleotide polymorphisms that influence levels of blood lipids were found and con-firmed in recent years. The article summarized the single nucleotide polymorphisms associated with the level of lipid.

IgA vasculitis (IgAV) is a common systemic small-sized vessel vasculitis.It's characterized by non-thrombocytopenic palpable purpura,arthralgia/arthritis,bowel angina,and nephritis,but some details of etiology and pathogenesis is not very clear.The disease course is usually benign and self-limited,however,it is necessary to discuss the therapy of severe or chronic cases,especially there is not enough evidence-based basis for using key drugs to IgAV.Excellent clinical trails is expected to establish scientific system of prediction and evaluation of disease course,which will be helpful to individualize treatment of IgAV.

Objective To investigate the coronary arterial lesions (CAL) in Kawasaki disease (KD) in Jilin Province and Inner Mongolia Autonomous Region from 1999 through 2012 and evaluate the influence of glucocorticoids (GCs) on prognosis.Methods We performed a retrospective study among patients of KD in Jilin Province and Inner Mongolia Autonomous Region from 1999 to 2012,in order to observe CAL in KD,the incidence of sequelae and the influence of CGs on disease outcome.Comparison between groups was carried out by Chi-square test.Results Eight hundred and ten KD cases were reported from 32 hospitals and 787 patients accepted an Echo examination,as the main objective of this study.Fivehundred and forty were boys and 247 were girls,with the male to female ratio of 2.19:1,of which 498 cases (63.3％) had CAL.Most CAL occurred in patients at 58 day to 14 year old (2.7±2.4).The most common abnormality was CAL including dilatation (49.5％) and stenosis (13.4％).Compared incomplete to complete KD,the result showed that the occurrence of CAL was similar between these two groups,no significant differences could be found between different gender.Nineteen (2.4％) of them had cardiac sequelae and the male/female ratio was 3.67:1.The younger the age,the higher the incidence of cardiac sequelae.The most frequent cardiac sequelae was coronary artery dilatation.GCs therapy could increase the occurrence of CAL [80.2％(97/121) vs 62.6％ (419/666),x2=8.71,P＜0.05].Conclusion CAL is not different between patients with complete or incomplete KD and the occurrence of CAL is not associated with gender,but with age.The younger the age,the higher the incidence of CAL and the higher the incidence of cardiac sequelae.It is possible that patients treated with GCs are prone to CAL.

It has been well established that immune surveillance plays critical roles in preventing the occurrence and progression of tumor. More and more evidence in recent years showed the host anti-tumor immune responses also play important roles in the chemotherapy and radiotherapy of cancers. Our previous study found that tumor- targeting therapy of anti-HER2/neu mAb is mediated by CD8(+) T cell responses. However, we found here that enhancement of CD8(+) T cell responses by combination therapy with IL-15R/IL-15 fusion protein or anti-CD40, which are strong stimultors for T cell responses, failed to promote the tumor therapeutic effects of anti-HER2/neu mAb. Analysis of tumor microenviornment showed that tumor tissues were heavily infiltrated with the immunosuppressive macrophages and most tumor infiltrating T cells, especially CD8(+) T cells, expressed high level of inhibitory co-signaling receptor PD-1. These data suggest that tumor microenvironment is dominated by the immunosuppressive strategies, which thwart anti-tumor immune responses. Therefore, the successful tumor therapy should be the removal of inhibitory signals in the tumor microenvironment in combination with other therapeutic strategies.
Animals ; Antibodies, Monoclonal ; immunology ; therapeutic use ; Breast Neoplasms ; drug therapy ; immunology ; pathology ; Cell Line, Tumor ; Female ; Humans ; Immune Tolerance ; immunology ; Mice ; Mice, Inbred BALB C ; Neoplasm Transplantation ; Receptor, ErbB-2 ; immunology ; Tumor Microenvironment ; immunology

Objective: To screen and identify the mutations in Kawasaki disease by targeted enrichment of genomic region sequencing technique and investigate susceptibility genes associated with coronary artery lesion. Method: This was a case-control study.A total of 114 patients diagnosed as Kawasaki disease treated in Shanghai Children′s Hospital between December 2015 and November 2016 were studied and another 45 healthy children who were physically examined in outpatient department were enrolled as control group. Patients were divided into two groups based on the results of echocardiogram. Peripheral venous blood was obtained from patients and controls. Genomic DNA was extracted. SeqCap EZ Choice libraries were prepared by targeted enrichment of genomic region technology. Then the libraries were sequenced to identify susceptibility genes associated with coronary artery lesion in patients diagnosed as Kawasaki disease.Susceptible genes were identified by Burden test, Pearson chi-square test or Fisher′s exact probability test. Result: There was statistically significant difference in TNFRSF11B(rs2073618)G>C(p.N3K)mutation and GG/GC/CC genotype between Kawasaki disease group and control group(χ²=15.52, P=0.00). There was statistically significant difference in TNFRSF13B(rs34562254)C>T(p.P251L)mutation(χ²=10.40, P=0.01)and LEFTY1(rs360057)T>G(p.D322A)mutation(χ²=8.505, P=0.01)between patients with coronary artery lesions and those without. Conclusion Targeted enrichment of genomic region sequencing technology can be used to do primary screening for the susceptible genes associated with coronary artery lesions in Chinese Kawasaki patients and may provide theoretical basis for larger sample investigation of risk prediction score standard in Kawasaki disease.

Juvenile idiopathic arthritis (JIA) is a genetically heterogeneous group of connective tissue diseases that are commonly characterized by chronic joint synovial inflammation with unknown etiology in childhood.It is cu-rrently incurable and the main therapeutic goal is to achieve clinical remission.The drugs currently used to treat JIA mainly include non-steroid anti-inflammatory drugs, glucocorticoid, disease modifying antirheumatic drugs, and biological agents.In this article, recent advances in the understanding of JIA treatment and related clinical research were reviewed, in an attempt to provide prospects for the future direction of drug development and treatment concepts.

Objective:To discuss the value of ultrasound in the diagnosis of pelvic lipomatosis and analyze the causes of misdiagnosis.Methods:A retrospective analysis of 68 cases of pelvic lipomatosis confirmed by operation or imaging in Peking Union Medical College Hospital from January 2000 to December 2018 was made to summarize the characteristics of ultrasonic manifestations.Results:Ultrasonographic findings were as follows: 6 cases (8.8%) had increased fat-like hyperecho in pelvic cavity; 60 cases (88.2%) had abnormal bladder; 42 cases (61.7%) had pyelectasis and 24 cases (35.3%) had ureterectasis. Of the 68 cases, 6 cases (8.8%) were correctly diagnosed; 54 cases (79.4%) were missed; 8 cases (11.8%) were misdiagnosed, including 7 cases (10.3%) of bladder tumor and 1 case (1.5%) of retroperitoneal giant mass.Conclusions:Pelvic lipomatosis has characteristic sonographic features.When urinary tract obstruction and bladder wall thickening are observed, pelvic lipomatosis should be considered. Bladder shape and existence of increasing fat-like hyperecho in the pelvis should be further scanned to reduce the misdiagnosis rate of pelvic lipomatosis.

Objective: To analyze the situation of AIDS knowledge and discrimination among freshmen in Chengdu city, and to explore possible effects of AIDS knowledge on discrimination. Methods: A cluster random sampling was employed to investigate 1 053 college students from 11 universities in Chengdu about their HIV/AIDS knowledge and discrimination. The scores of AIDS knowledge and discrimination of students with different characteristics were analyzed, and the influence path of AIDS knowledge on AIDS discrimination were further analyzed based on different peer relationships. Results: The total scores of AIDS knowledge was negatively correlated to AIDS discrimination( r s =-0.13, P <0.01). After adjusting for confounding factors, the total score of AIDS knowledge was associated with the total score of AIDS discrimination( β =-0.12, P <0.01). AIDS knowledge played a role in AIDS discrimination in intimate, general and unfamiliar peer relationships, with standardized path coefficients of -0.20, -0.24 and -0.18 respectively( P <0.01). Conclusion AIDS knowledge are correlated with discrimination among freshmen under different peer relationships. More anti-AIDS discrimination courses should be added to AIDS education to reduce the students’ fear and stigma of HIV/AIDS patients and related risk groups.

Objective: To investigate the effects of definitive repair surgery on health-related quality of life (HRQOL) in patients with bile duct injury after laparoscopic cholecystectomy (LC). Methods: The retrospective case-control study was conducted. The clinicopathological data of 181 patients with bile duct injury caused by LC for benign gallbladder diseases who underwent definitive repair surgery and 50 patients without complications after LC for benign gallbladder diseases in the Mianyang Central Hospital from January 2000 to December 2017 were collected. There were 82 males and 99 females of 181 patients with bile duct injury, aged from 31 to 68 years, with an average age of 47 years. Definitive repair surgery was performed according to different types of bile duct injury, and questionnaire of HRQOL was conducted preoperatively and one year after operation. There were 18 males and 32 females of 50 patients without complications after LC, aged from 35 to 69 years, with an average age of 41 years. Questionnaire of HRQOL was conducted on LC patients without complications one year after operation. Observation indicators: (1) classification of bile duct injury; (2) intraoperative situations of definitive repair surgery; (3) postoperative situations of definitive repair surgery; (4) follow-up; (5) results of the SF-36 scale assessment. Follow-up was conducted by outpatient examination and telephone interview up to December 2018. Patients were reexamined liver function and color Doppler ultrasonography once every 6-12 months, and further magnetic resonance cholangiopancreatography (MRCP) or computed tomography examination to detect recurrence of anastomotic biliary stricture and cholangitis. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was analyzed by the paired t test. Measurement data with skewed distribution were described as M (range), and count data were described as absolute numbers. Results: (1) Classification of bile duct injury: of the 181 patients with bile duct injury, there were 64 cases of E1 type, 70 cases of E2 type, 35 cases of E3 type, 9 cases of E4 type, and 3 cases of E5 type. (2) Intraoperative situations of definitive repair surgery: all the 181 patinets with bile duct injury underwent definitive repair surgery successfully, including 61 undergoing end-to-end biliary anastomosis, 109 undergoing Roux-en-Y choledojejunostomy, 11 undergoing hemi-hepatectomy combined with Roux-en-Y anastomosis. There were 52 patients combined with hilar cholangioplasty. The operation time and volume of intraoperative blood loss of 181 patients were (190±126) minutes and 601.5 mL (range, 150.0-2 100.0 mL). There were 24 cases with blood transfusion and 18 cases with T-tube stent. (3) Postoperative situations of definitive repair surgery: 40 of 181 patients had complications, including 14 cases of incisional infection, 10 cases of bile leakage, 8 cases of perihepatic effusion, 7 cases of pulmonary infection, and 1 case of abdominal hemorrhage. The patient with postoperative abdominal hemorrhage underwent reoperation for hemostasis, and other patients with complications were cured after ultrasound-guided puncture and drainage or conservative treatment. Duration of postoperative hospital stay of 181 patients with bile duct injury was 12.6 days (range, 6.0-34.0 days). There was no perioperative death occurred. (4) Follow-up: 157 of 181 patients were followed up for 8.2-201.3 months, with a median follow-up time of 92.7 months. Twenty-eight patients had anastomotic stricture recurred, 16 of which were treated with reoperation, 10 were treated with endoscopic stent implantation, and 2 cases were treated with balloon dilatation in interventional department; the stricture was repaired again in all cases. Thirteen patients had recurrent cholangitis, showing no obvious anastomotic stricture on MRCP, and symptoms can be effectively controlled after conservative treatment. (5) Results of the SF-36 scale assessment: 181 patients with bile duct injury completed the SF-36 scales before definitive repair surgery, and 157 completed one year after definitive repair surgery. All the 50 patients without complications completed SF-36 scales one year after LC. The scores of HRQOL in physiological function, role functioning, somatic pain, general health, vitality, social function, emotional function, mental health, the scores of physical component summary, and mental component summary of 181 patients with bile duct injury before surgery were 79±15, 65±12, 40±17, 42±14, 59±20, 27±15, 48±23, 56±22, 60±11, and 56±11, respectively. The above indices one year after definitive repair surgery were 87±10, 78±15, 71±20, 64±20、68±19, 70±25, 67±21, 69±23, 71±13, 68±15, respectively. The above indices of 50 patients without complications one year after LC were 90±13, 81±20, 87±16, 72±20, 73±15, 86±17, 79±22, 77±19, 82±18, 79±18, respectively. The 181 patients with bile duct injury had significant elevation in above indices one year after definitive repair surgery (t=2.051, 2.016, 3.875, 3.014, 2.563, 3.225, 2.964, 2.357, 2.150, 2.203, P<0.05). The 50 patients without complications also had significant elevation in above indices one year after definitive repair surgery (t=2.817, 2.206, 3.641, 3.112, 3.202, 3.310, 3.011, 2.899, 2.150, 2.118, P<0.05). There were significant differences in the general health and mental health one year after definitive repair surgery between 181 patients with bile duct injury and 50 patients without complications (t=2.014, 2.011, P<0.05), and no significant difference in the physiological function, role functioning, somatic pain, vitality, social function, or emotional function between the two groups (t=0.852, 0.915, 0.907, 1.102, 1.284, 1.120, 0.863, 1.109, P>0.05). Conclusion Definitive repair surgery can significantly improve HRQOL in patients with bile duct injury caused by LC.