Objective To understand the molecular epidemiology characteristics and its drug resistance of methicillin-resistant Staphylococcus aureus (MRSA) in the urban area of Jilin and to provide important basis for guiding the clinical medication and prevention of the MRSA infection. Methods One hundred and three strains of MRSA from July 2013 to July 2014 in the urban area of Jilin were selected. The polymerase chain reaction (PCR) technology and multiple polymerase chain reaction were used to detect mecA gene and Staphylococcus chromosomal cassette mec typing (SCCmec) genotype of MRSA. The drug sensitivity test for 13 kinds of clinical common antibacterial drugs were detected by using the K-B method. And the source of the strains were analyzed. Results The results of SCCmec genotype of MRSA showed that SCCmecⅢtype were 62 strains, accounting for 60.2%;SCCmecⅡtype were 39 strains, accounting for 37.9%; failing to parting were 2 strains,accounting for 1.9%. Drug susceptibility test results showed that all of 103 MRSA strains were resistant to cefoxitin, cefazolin, penicillin and benzene, and drug resistance rate was 100.0%. The resistant rate to erythromycin, levofloxacin, ciprofloxacin, tetracycline, gentamicin and rifampin were 96.1%, 93.2%, 95.1%, 91.3%, 90.3%and 55.3%receptively;the resistant rate to sulfamethoxazolewas was only 1.9%;and the resistant strains to vancomycin and teicoplanin were not detected. The top three department of the distribution of the strains source were department of neurosurgery (31.1%), ICU (19.4%) and burn plastic surgery (17.5%). Conclusions The SCCmecⅢtype is the main MRSA epidemic strains, and SCCmec type II is a minor epidemic strainin the urban area of Jilin. The antibiotic resistance of MRSA is a serious problem with multiple drug resistance, but MRSA is sensitive to vancomycin and teicoplanin.

Objective To observe the incidence,clinical types,and prognosis of pulmonary involvement in children with systemic lupus erythematosus(SLE),and to probe the relationship between the relative factors.Methods The clinical data of 61 children with SLE,who treated in Children's Hospital of Shanghai from Jan.2006 to Dec.2011 were analyzed retrospectively.The lung manifestations of the patients were classified according to their clinical symptoms and signs,and lung imaging examination (chest X-ray and CT).Other data of the SLE patients with lung injury or without lung injury were collected,including the course of the disease,activity index [SLE disease activity index (SLEDAI) scoring 0-4 was divided into no activity,5-9 was divided into low activity,10-14 was divided into moderate activity,and more than 15 as severe activity],blood sedimentation,the values of serum complement and the positive rate of dsDNA in autoantibody,and a comparison was made and statistical analysis was performed.Results Pulmonary injury occurred in 17 cases with an incidence rate of 27.9％ (17/61 cases),and the average course of the disease was (8.76 ± 6.96) months.The clinical manifestations of 17 cases included fever,cough,dyspnea,hypoxemia,chest pain,lower breath sound,and lung rale,which were not non-specificity.According to imageological examination,in 17 cases there were 2 cases with pulmonary hypertension (the incidence rate was 11.8％),4 cases with acute lupus pneumonitis (the incidence rate was 23.5％),6 cases with interstitial pneumonia (the incidence rate was 35.3％),7 cases with lesion of pleura (the incidence rate was 41.2％),10 cases with pulmonary infection (the incidence rate was 58.8％).There were no statistical differences between patients with and without lung injury(infectious and non-infectious)in the course,the values of serumn complement,the positive rate of dsDNA and activity index.Lung lesions of the 17 patients recovered quickly after early diagnosis and active treatment.Conclusions Pulmonary manifestation in children with SLE is not uncommon,and it can happen at any stage of the disease,not just on the stage of lupus activity,but it usually indicates disease was not controlled.Pulmonary manifestation of SLE in children involve many parts of lung,including pulmonary parenchyma,interstitial,blood vessels,pleura,etc.Early diagnosis and active treatment can improve the short-term prognosis of lung injury with lupus,and long-term outcome remains to be observed.

To clarify the meaning, role and significance of the new idea of the modern basic theory of traditional chinese medicine, We clarified its origin and evolution starting from the basic concept of idea in this paper, re-vealed the basic connotation and relationship of ideas, scientific ideas, Chinese medicine ideas, and the new ideas of the modern basic theory of traditional Chinese medicine, and tried to give proper definitions; summarized three roles of scientific ideas. According to this basis, we demonstrated the new idea is the scientific ideas with core spirit run-ning through rational questioning, scientific testing, research and conclusion being accepted three-point line cen-tral interlocking; and have three roles changing the theory of traditional chinese medicine, guiding the innovative research on chinese medicine and elevating the scholars' thoughts. We proposed yin and yang to refer to the hypothesis of body's physiology and pathology and prevention and treatment effects, given an empirical analysis a feasible way of medicine and philosophy separation and yin and yang turning to medicine; displayed the guidance of new idea and to show the scientific connotation and scientific value of the theory of traditional Chinese medicine.

Objective To observe the control efficacy of community health education on population with metabolic syndrome (MS).Methods 56 cases of metabolic syndrome patients treated in the community were selected as the research object from June 2012 to 2013,and were randomly divided into the observation group (30 cases) and the control group (26 cases).The patients in the observation group received systematic community health education,and patients in the control group received regular treatment.The blood pressure,BMI Level,abdominal circumference,FPG level,TC,TG,LDL,HDL,2hPG,and HbAlc level of patients from both groups were compared one year later.Results Compared with the result before treatment,the abdominal circumference,blood pressure,blood glucose and lipid levels of patients in the observation group were all superior to the control group; the reasonableness for food taken was compared one year later,the observation group was also superior to the control group.Statistical significancc cxistcd in the differences between both groups.Conclusions The implementation of community health education has a positive significance in promoting the rehabilitation of people with metabolic syndrome,which is worth being promoted.

Objective To explore the relationship between the expression of transient receptor potential cation channel subfamily C member 6 (TRPC6) and podocyte injury in children with primary nephrotic syndrome (PNS) and its clinical significance. Methods The renal tissue of 18 children with PNS was obtained. The pathological changes of kidney were observed by routine section staining and light microscopy. The structural changes of podocyte were observed by electron microscope. The mRNA and protein expressions of TRPC6 in tissues were determined by qPCR and immunohistochemistry, respectively. Further the correlation of TRPC6 mRNA with serum levels of albumin (Alb), creatinine (Cr), triacylglycerol (TG), cholesterol (Tch), complement C3 and 24 h urinary protein quantitation and estimated glomerular filtration rate (eGFR) were analyzed respectively. Results The expression of TRPC6 protein in renal tissue of children with PNS was higher than that in the control group, and the difference was statistically different (P<0.05). The relative expression of TRPC6 mRNA in renal tissue of children with PNS was positively related to the expression of TRPC6 protein (r=0.508, P<0.05), but there was no correlation of expression of TRPC6 mRNA with serum levels of Alb, Cr, TG, Tch, C3, eGFR and 24h urinary protein quantitation (P>0.05). Conclusion The pathological types of PNS were mainly podocyte lesions, and the expression of TRPC6 protein was increased in podocytes. TRPC6 detection may be helpful in the diagnosis of podocyte lesions.

Objective To investigate the expression and distribution of plasmacytoid dendritic cells(pDC) in peripheral blood and renal tissues in children with Henoch-SchSnlein purpura(HSP),and explore the role of pDCs in the pathogenesis of Henoch-Schtnlein purpura nephritis(HSPN).Methods Among the 40 children with HSP,28 cases were in the active phase(renal biopsy performed in 8 cases of them) and the other 12 in remission phase.Peripheral blood mononuclear cells were isolated,and the expression of pDC was detected by flow cytometry.The normal control group was established (n =15).Total RNA of peripheral blood was extracted and transcripted into cDNA.Sybr green dye based real-time quantitative PCR method was used to compare the expression(indicated as 2-△Ct value) of CXC motif chemokine 10 (CXCL10),CC chemokine ligand 5 (CCL5),chemokine CXC subfamily receptor 3 (CXCR3),CC chemokine receptor 5 (CCR5) in children with HSP and those in the controls.Immunohistochemistry labeling technique was used to detect the distribution of pDC in renal tissues from renal biopsy,and the normal controls were established (n =3).Results The expression percentage of pDC in peripheral blood in active phase was 0.051 ± 0.039,significantly lower than those in remission phase (0.181 ± 0.082) and the normal controls (0.166 ± 0.079) (P ＜ 0.000 1).Chemokines genes CXCL10 and CCL5 were overexpressed in peripheral blood ceils of acute phase HSP children,but chemokine receptors CXCR3,CCR5 were lowly expressed compared with normal controls.There was almost no expression of pDC in the normal control renal tissues,while pDC was infiltrated in glomeruli of HSPN children.Conclusions The number of pDC and chemokines' expression in peripheral blood is abnormal,and the pathogenesis of nephritis may be involved with the pDC in peripheral blood to migrate to the renal tissues.

Objective To evaluate the clinical effect of endoscopic retrograde biliary drainage (ERBD) and endoscopic naso-biliary drainage (ENBD) on hilar cholangiocarcinoma (HACC).Methods The clinical data of 87 patients with HACC,who underwent ERBD and ENBD form January 2010 to January 2016,were retrospectively analyzed.The incidence of postoperative severe cholangitis,biliary obstruction again within 4 weeks,reduction of total bilirubin and survival time were studied.Results There were significant differences between ERBD group and ENBD group on the incidence of severe cholangitis[29.2％ (14/48) VS 10.3％ (4/39),x2 =4.689,P=0.030] and bile duct obstruction in 4 weeks after operation [47.9％ (23/48) VS 23.1％ (9/39),x2=5.710,P =0.017].The total bilirubin within 2 weeks and 4 weeks postoperatively was significantly reduced compared with that before operation (P＜0.05).There was no statistical difference in descend range of total bilirubin between the two groups.There was significant difference between ERBD group and ENBD group in the median survival time [14 weeks (range,0-60 weeks) VS 34 weeks (range,2-96 weeks),x2 =10.101,P=0.010].Conclusion Compared to ERBD,ENBD has certain advantages on palliative care for HACC.

Objective To investigate the significance of acute kidney injury biomarkers with calcineurin inhibitors (CNI) related nephrotoxicity in the treatment of refractory nephritic syndrome.Methods Ninety-two patients were included with 59 males and 33 females with average age of (5.67 ± 3.65) years old,who were diagnosed with nephrotic syndrome at Shanghai Children's Hospital from March 2014 to December 2015.66 patients including 44 males and 22 females with mean age of (4.97 ± 3.52) were treated by steroid as the control group and 26 patients including 15 males and 11 females with mean age of (6.59 ± 3.95) were treated by steroid combined with CsA and FK506 as the observation group.The blood,urine samples were collected before drug treatment (0 d) and very early stage of treatment (3 d),early stage (1 month),middle and late stage (3 months and 6 months) as the different observation time points.The change level of neutrophil gelatinase associated lipocalin(NGAL),kidney injury molecular-1 (KIM-1),fibronectin(FN) and tumor necrosis factor-alpha(TNF-α) in serum and urine were detected at different time points to compare with biomarkers such as retinol-binding protein(RBP),N-acetyl-β-D-glucosamccharase(NAG) in urine.Results The serum NGAL(sNAGL) level was more obvious after 6 months of CNI treatment in the observation group than in the control group[(138.00 ±32.49) μg/L vs.(46.54± 11.41) μg/L,t =2.115,P ＜0.05];the level of urine TNF-oα(uTNF-α) was higher obviously after 6 months of CNI treatment in the observation group than in the control group with significant differences [(2.35 ± 0.78) pg/μmol vs.(0.75 ± 0.36) pg/μmol,t =1.840,P ＜ 0.05];the level of urine KIM-1 (uKIM-1) was lower in the observation group than the control group after 3 months treatment of the CNI [(0.15 ± 0.03) ng/μmol vs.(0.33 ± 0.07) ng/μmol,t =-2.077,P ＜ 0.05);the level of urine NGAL (uNGAL) was lower in the observation group than the control group after 3 months treatment of the CNI [(0.09 ±0.03) ng/μmol vs.(0.23 ± 0.04) ng/μmol,t =-2.959,P ＜ 0.05].But the serum TNF-α (sTNF-α),urine FN (uFN),urine RBP(uRBP) and urine NAG (uNAG)did not show any significant change before and after the C NI treatment.Conclusions Compared with other acute kidney injury biomarkers (uNGAL,KIM-1,FN,RBP,and NAG),sNAGL and uTNF-α may be more sensitive to the early evaluation of CNI related nephrotoxicity.The occurrence of CNI related kidney injury shall be watched out at the beginning of 6-month of CNI treatment.

OBJECTIVETo analyze the clinical features and gene mutation of Chinese children with Alport syndrome(AS).

METHODFrom May 2011 to May 2014, clinical and pathological information gathered from 25 patients was retrospectively analyzed. COL4A5, COL4A4 and COL4A3 genes were analyzed using next-generation sequencing in these patients, and gene mutations of related family members were identified by Sanger method.

RESULTOf these 25 cases, 19(76%) had X-linked Alport syndromes (XL-AS), 6 had autosomal recessive Alport syndromes (AR-AS). Twenty five patients had an onset of hematuria and proteinuria and in 8 cases the disease was induced by upper respiratory tract infections. Hearing loss was present in 2 of 25 (8%) cases and ocular lesions in 1 of 25 (4%). Renal pathology showed that 16 of them had minimal change disease (MCD), 8 mesangial proliferative glomerulonephritis (MsPNG), 1 focal segmental glomerulo-sclerosis (FSGS). Extensive lamination and split of glomerular basement membrane (GBM) dense layers were found in 2 (8%) of 25 patients. Twenty one of 25 patients (84%) showed abnormal renal α-chain distribution. COL4A5, COL4A4 and COL4A3 genes of 25 patients (23 families) were analyzed and 24 pathogenic mutations were identified: 18 in COL4A5, 1 in COL4A3 and 5 in COL4A4. It was observed that 13 patients inherited the mutation from the mother, 3 patients inherited from the father, 2 patients inherited 1 mutation from the mother and another mutation from the father, and 7 patients carried the novel mutations.

CONCLUSIONXL is the main inherited type in AS. Most of patients showed MCD and MsPNG in renal biopsy. This research examined 24 mutations and 16 mutations were not reported previously.

Child ; Deafness ; Genes, Recessive ; Genotype ; Hematuria ; Humans ; Kidney ; Mutation ; Nephritis, Hereditary ; genetics ; pathology ; Pedigree ; Phenotype

Objective: To summarize the characteristics of cuffed-tunneled catheters insertion and investigate the values of cuffed-tunneled catheters in pediatric patients. Methods: Between March 2015 and July 2017, all the pediatric patients who received maintenance hemodialysis at least 3 consecutive months in our center were included. Sixteen cuffed-tunneled hemodialysis catheters were inserted in patients for long-term hemodialysis access. The clinical manifestations and complications were retrospectively reviewed. Results: Fifteen pediatric patients with end stage ranal disease (ESRD) were included in this study and they received 16 cuffed-tunneled catheters for long-term vascular access, including 10 males and 5 females; median age at start of catheter insertion was 11.5 (4.2-14.5) years. Body weight was (27.8±8.0)kg (16.0-39.4 kg) . The size and the length of the catheters were based on the height of patients as follows: 28 cm for (115.6±10.6) cm (102.0-130.0 cm) ,36 cm for (148.6±9.9)cm (140.0-167.0 cm) . Cuffed-tunneled catheters outcome: 10 cuffed-tunneled catheters were still functional at the end of the study; 5 catheters were removed after successful kidney transplantation. Catheter failure occurred in 1 out of 16 cuffed-tunneled catheters due to catheter-related infections. The median catheter survival time was 11.9 months (range 3.5-21.3 months). Complications of cuffed-tunneled catheters: Catheter placements operation was successful in 15 cases using ultrasound guidance. No serious complications were observed in any patients receiving catheter inserting operation. The overall rate of catheter-related infections and thrombosis/malposition was 6.3% and 18.7%, respectively. Conclusions Ultrasound guidance is suggested in pediatric patients during the catheters insertion. The size and the length of the catheters should be based on the height of patients. Cuffed-tunneled hemodialysis catheters could be effectively used for maintenance of hemodialysis vascular access for pediatric patients with ESRD.