Objective To explore the effect of recombinant human tumor necrosis factor-α receptor Ⅱ:IgG Fc fusion protein injection (rhTNFR:FC) on the expression of cartilage oligomeric matrix protein (COMP) in the synovial fluid and peripheral blood of juvenile idiopathic arthritis (JIA); and to explore the clinical significance of COMP for JIA and the relationship between rhTNFR:FC and COMP in JIA.Methods Thirty-five patients with JIA (JIA group),30 patients with traumatic arthritis (trauma group) and 30 patients with indirect inguinal hernia hernioplasty (normal group) were included.Peripheral blood from all enrolled patients and synovial fluid from 15 JIA and 10 trauma arthritis were obtained for COMP detection before the treatment.Fifteen JIA (group A) patients were treated with combined rhTNFR:FC,diseasemodifying antirheumatic drugs (DMARDs) and non-steroid anti-inflammatory drugs (NSAIDs),20 JIA (group B) were treated with combined DMARDs and NSAIDs.After three to six months' treatment and when the disease were in remission,peripheral blood from group A and B were drawn for COMP detection.In group A,the synovial fluid from 5 patients were obtained for COMP detection after treatment.At the same time,such as tender joint count (TJC),swollen joint count (SJC),time for morning stiffness,blood routine,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) and other parameters before and after treatment were measured.The level of COMP was tested by double antibody sandwich enzyme-linked immunosorbent assay.The measurement data were tested for variance and independent sample t-test; and the enumeration data were tested by chi-squared or Fisher's exact test.Pearson's correlation analysis was adopted to analyze the association among the variables.Results ① The blood COMP level before treatment was (0.77±0.29) ng/ml in the JIA group,(1.00±0.28) ng/ml in the traumatic arthritis group,and (1.33±0.37) ng/ml in the normal control group.The level in the former two groups was obviously lower than that in the normal control group.The variation was statistically significant (F=25.345,P＜0.05).The comparison between any two groups was statistically significant (P＜0.05).② The COMP level in the synovial fluid before treatment were (14.8±1.6) ng/ml in the JIA group,(15.1±1.0) ng/ml in the traumatic arthritis group.The variation was not stati-stically significant (t=0.523,P=0.606).③ The serum COMP level of the systemic JIA group was obviously lower than that of the oligoarticular JIA patients,and patients with enthesitis-related arthritis and polyarticular JIA (0.26± 0.03 vs.0.87±0.17,0.89±0.22 and 0.70±0.35 ng/ml,respectively; F=9.244,P＜0.05).④ The serum COMP level of JIA at the acute phase was negatively correlated with white blood cells count (WBC),CRP and ESR (r=-0.556,-0.582 and-0.684,respectively; P all＜0.05).By contrast,no correlation was detected between the serum COMP level and joint tenderness index,joint swelling index,morning stiffness duration,hemoglobin level and platelet count(r=0.06,-0.206,-0.107,0.15 and-0.185,respectively; P all ＞0.05).⑤ The serum COMP level was obviously lower in the JIA with joint destruction than that without joint destruction (0.52±0.22 vs.0.92±0.22 ng/ml; t=5.207,P＜0.05).⑥After treatment,the blood COMP level in group A was (1.33±0.21) ng/ml and (0.96±0.22) ng/ml in group B,which was obviously higher than that in the JIA group before treatment (0.77±0.29) ng/ml.In addition,the level in group A was higher than that in group B.The variation was statistically significant (F=24.681,P＜0.05).⑦ After treatment,the COMP level in the synovial fluid (18.4± 1.1) ng/ml (n=5) was higher than that before the treatment was (14.8± 1.6) ng/ml (n =15).The variation was of statistical significant (t=4.565,P＜0.05).Conclusion The COMP level in blood and synovial fluid declines before treatment and increases after treatment.The increase is more obvious after combined with rhTNFR:FC treatment.The serum COMP level is remarkably decreased in JIA at the acute phase,systemic JIA,and the JIA with destruction of joint,and showes a negative correlation with WBC,CRP and ESR.Serum COMP may be a useful marker of active disease,destruction of joint and growth inhibition for patients with JIA.rhTNFR:FC treatment for JIA can facilitate the recovery of COMP.

Objective To study the expression levels of N-terminal pro-brain natriuretic peptide (NT-proBNP),serum albumin of Kawasaki' s disease (KD),incomplete Kawasaki' s disease (IKD),and children whose fever were unexplained and to explore the clinical significance of the levels of NT-proBNP and serum albumin in the early diagnosis of IKD.Methods The levels of NT-proBNP of 246 cases of KD (KD group),61 cases of IKD (IKD group) and 301 cases of children with unexplained fever (fever group)were measured by the enzyme-linked fluorescence analysis (ELFA) at the day of admission,meanwhile,the levels of albumin were tested in KD,and IKD children were underwent ECG and echocardiography.Based on the test results,patients were further divided into the group with cardiovascular damage and the group without cardiovascular damage.SPSS 19.0 was used for statistical analysis.The t test was used to compare the parameters between each group,the variance analysis and association analysis were carried out with Pearson's correlation analysis.The ROC curve analysis was done to identify the cardiovascular damage threshold.Results ① The level of plasma NT-proBNP of the KD group,the IKD group was significantly h igher than the fever group [(789.1±4.7) ng/L,(824.8±4.4) ng/L vs (92.5±2.3) ng/L,F=230.736,all P＜0.05];② The level of albumin of the KD group and the IKD group was significantly lower than that of the fever group [(33.9±2.8) g/L,(33.8±3.1) g/L vs (40.8±3.6) g/L,F=355.648,all P＜0.05]; ③ The levels of NT-proBNPs between the cardiovascular damage group and the groups without cardiovascular damage among the KD group,and those of the IKD groups were compared.In the KD group,the NT-proBNPs level of the two subgroups was (2948±3) g/L (n=103) vs (305±3) g/L,n=143; while in the IKD group,the NT-proBNPs of the two subgroups was (1454±4) g/L (n=38) vs (323±4) g/L (n=23).The dif-ferences were statistically significant (t=16.464,4.356,all P＜0.05).④ The plasma NT-proBNP level higher than 933.5 ng/L was identify as the indicator for cardiovascular damage in both KD and IKD children.Its sensi-tivity was 88.1％,and its specificity was 89％.⑤ When the level of NT-proBNP was higher than 250 ng/L,the sensitivity for diagnosis in the KD,the IKD was 80.9％,85.2％ respec-tively,and the specificity was 85.7％.When the level of NT-proBNP was higher than 250 ng/L and that of albumin was lower than 35 g/L,the sensitivity for diagnosis of KD,IKD was 67.5％,70.5％ respectively,the specificity was 99.7％.Conclusion The level of plasma NT-proBNP (＞250 ng/L) accompanied by decreased albumin (＜35 g/L) may be specific markers for early diagnosis of IKD.In addition,the level of NT-proBNP ≥933.5 ng/L can be used as a diagnostic threshold,which has good sensitivity and specificity for identifica-tion of cardiovascular damage in the KD and IKD in children.

Objective:To study the clinical features, diagnosis and treatment of Bacillus cereus sepsis in premature infants.Methods:From February 2011 to February 2021, 10 cases of Bacillus cereus sepsis in premature infants admitted to the Department of Neonatology of our hospital were retrospectively analyzed.Results:The 10 cases of premature infants with Bacillus cereus sepsis included 5 males and 5 females, with gestational age 27 +2~35 +2 weeks, birth weight 940~2 430 g and the age of onset 7~35 days. At the beginning, all the infants showed lethargy and recurrent apnea as the onset symptoms. 8 cases had gray color skin, 7 cases had fever, 7 cases experienced septic shock, 5 cases had neonatal seizures and 4 cases showed abdominal distension. 7 cases were complicated with purulent meningitis and 3 cases with necrotizing enterocolitis. 9 cases had significantly decreased white blood cells and platelets and significantly increased C-reactive protein and procalcitonin at the onset. Among the 7 cases of purulent meningitis, 5 cases had multiple encephalomalacia. During follow-up of all the infants, 4 cases died, 3 cases cured and 3 cases survived with severe neurological sequelae. Conclusions:Bacillus cereus sepsis is a serious infectious disease for premature infants with acute onset, rapid progress and high mortality. Complication of purulent meningitis and serious neurological sequelae are common.

Objective:To learn about the epidemiological characteristics and trends of brucellosis in Ningxia Hui Autonomous Region (Ningxia), and to provide reference for formulation of brucellosis prevention strategies and identification of key areas.Methods:The case data from 2004 to 2019 were collected from the "China Disease Prevention and Control Information System Infectious Disease Monitoring and Reporting System", and descriptive epidemiological methods were used to analyze the distribution of cases (time, population, and regional distribution).Results:From 2004 to 2019, a total of 15 337 human brucellosis cases and 1 death case were reported in Ningxia. The average annual incidence rate was 15.21/100 000, ranging from 0.02/100 000 to 44.83/100 000. The difference in incidence rate in different years was statistically significant (χ 2 = 14 731.60, P < 0.001). Among them, from 2004 to 2010, the incidence rate was low, with an average annual incidence rate of 1.32/100 000; from 2011 to 2019, it entered a high incidence stage, with an average annual incidence rate of 24.83/100 000. Brucellosis occured in every month of the year, and the onset time was mainly in March to September, accounting for 71.60% (10 981/15 337); seasonal indexes from April to August was all > 100%, with obvious seasonality. The age of onset mainly concentrated in 20 - < 70 years old, accounting for 89.60% (13 742/15 337); males were significantly more than females, with a sex ratio of 2.66 ∶ 1.00 (11 141/4 196); the occupations were mainly farmers and herdsmen, accounting for 86.03% (13 194/15 337). Since 2014, cases had been reported in 22 counties (districts, cities) in the region, all of which were all severely endemic areas; the top three counties (districts) with incidence rate were Yanchi County (103.73/100 000), Hongsibao District (56.01/100 000) and Tongxin County (29.18/ 100 000), respectively, the difference between different regions was statistically significant (χ 2 = 3.80, P < 0.001). Conclusions:The incidence rate of brucellosis in Ningxia is on the rise, and the epidemic situation is severe. It is recommended to carry out active and effective intervention measures in areas with high incidence of brucellosis to curb the further spread of brucellosis.