ObjectivesTo study the treatment timing and method of glucocorticoids in the treatment of abdominal type Henoch-Sch?nlein purpura (HSP).MethodsA total of 201 children with abdominal type HSP hospitalized from September 2009 to April 2013 received either conventional glucocorticoids treatment or rapid titration treatment of glucocorticoids based on the same basic therapy. According to the treatment timing and method of glucocorticoids, all patients were divided into 4 groups including early convention group (n=46), late convention group (n=44), early titration group (n=56) and late titration group (n=55). The duration from the appearance of gastrointestinal symptoms to using glucocorticoids less than or equal to three days was deifned as early treatment and more than three days was deifned as late treatment. The patients in two convention groups (early and late) were treated with methylprednisolone (2-6mg/kg per day).The patients in two titration groups (early and late) received rapid titration of methylprednisolone from an initial low dose of 2mg/kg per day to the ifnal target dose. The gastrointestinal symptoms were evaluated every 12 hours. If the gastrointestinal symptoms were not alleviated, an additional dosage of methyl-prednisolone was given. On the next day, the total dose of methylprednisolone in previous 24 hours was used as the initial dose. The dosage was increased in such a way till the gastrointestinal symptoms disappeared and this dosage was remained for 3 days. Then the dosage was gradually reduced to the maintenance dose and stopped. If the gastrointestinal symptoms were relapsed, the patients were treated again. A follow-up of 3-6 months was performed. The dosage, recurrence of symptoms and the side effects were compared among four groups.ResultsThe time of remission, target dose of glucocorticoids, total dose of glucocorticoids, recurrence rate, incidence of severe symptoms and Henoch-Schonlein purpura nephritis were signiifcantly different among four groups (P<0.05). The curative effect was best in early titration group and worst in late convention group.ConclusionsIn the treatment of abdominal type HSP, early titration treatment with glucocorticoids can signiifcantly relieve the gastrointestinal symp-toms and reduce the total dosage of glucocorticoids.

Objective To investagate the change of creatine kinase MB isoenzymes ( CK-MB ) in children with rotavirus diarrhea and to explore the value of CK-MB/CK in the diagnosis of myocardial damage. Methods A retrospective analysis of the clinical manifestation, laboratory test data and treatment was per-formed in children with rotavirus diarrhea and high CK-MB hospitalized in department of infectious disease, Si-hong Children Hospital. We investigated the dynamic changes of CK-MB in the rotavirus diarrhea patients with and without myocardial damage. Within the non-myocardial damage group, the fluctuation of CK-MB was compared between patients with nutrition therapy and patients with conventional therapy. Receiver operating characteristic ( ROC) curve was used to explore the predictive value of CK-MB/CK for the myocardial dam-age. Results A total of 603 patients (369 males, 234 females, aged 2~48 months) with high CK-MB were enrolled in this study ( 36 cases with myocardial damage ) . There were 54. 6% of enrolled patients showing higher CK-MB and 3. 3% of patients had myocardial damage. The levels of serum CK-MB in non-myocardial damage group reached the peak on day 7 and decreased to normal in 14 days. The levels of serum CK-MB in myocardial damage group reached the peak on day 14 and maintained at fairly high level for 8 weeks and then decreased to normal . Time for CK-MB to achieve peak is different between these two groups. There was no statistical significance in the levels of serum CK-MB on day1 to day 14 between patients with or without myocar-dial protection ( P >0. 05 ) . The ROC curves were constructed with area under the ROC curves of 0. 697 (0. 611, 0. 784, 95%CI). Conclusion Intrinsic dynamics of CK-MB existed in patients with rotavirus diar-rhea. The diagnostic value of CK-MB is limited in patients with myocardial damage.

Objective To investigate the relationship between the severity of infant/toddlers wheezing and hand,foot and mouth disease (HFMD) infection.Methods We selected infant/toddlers wheezing with HFMD cases in respiratory department of our hospital from January 2010 to January 2012,and 30 cases of enterovirus 71 (EV71) were selected as the experimental group and 30 cases of coxsackie virus A type 16 (CA16)as the control group,respectively,according to HFMD pathogen infection.Wheezing cases by severity were divided into intermittent stares with mild persistent group (A) and moderate and severe persistent group (B).HFMD by severity were divided into ordinary and severe cases group.Wheezing severity before and after HFMD,relationship between HFMD severity and wheezing severity and the content of serum cytokines such as interferon-γ(IFN-γ) and interleukin-4 (IL-4) were compared between EV71 group and CA16 group,and statistical analysis was performed.Results (1) Wheezing severity(A,B) corresponding cases:EV71 group(25,5),(5,25),and CA16 group(24,6),(15,15) before and after HFMD.The case-constituent ratio in EV71 and CA16 same group was compared before and after infection,and the differences were statistically significant(P ＜ 0.05).The differences in EV71 group and CA16 group were not statistically significant (x2 =0.11,P ＞ 0.05)before infection,and were statistically significant(x2 =7.50,P ＜0.05) after infection.(2) Severe cases,ordinary group and severe wheezing (A,B) corresponding cases:(17,1),(32,10) before infection,and (2,16),(18,24) after infection.The upgrade cases constituent ratio of wheezing severity after infection were compared between severe and ordinary cases group,and the difference was statistically significant (x2 =5.88,P ＜ 0.05).(3) The content of serum cytokines as IFN-γand IL-4 and IFN-γ/IL-4 ratio were compared in EV7l group and CA16 group before and after infection,and the differences were statistically significant (P ＜ 0.001) ; and the differences compared in EV71 group and CA16 group were not statistically significant(P ＞0.05) before infection and statistically significant(P ＜ 0.05) after infection.Conclusions Infant/toddlers wheezing with HFMD and wheezing severity of severe disease and EV7l infections were exacerbated trend in the short term after infection.The infection of EV71 may promote Th1/Th2 drift.

Objective To investigate the effect of portal vein ligation combined with in situ splitting on liver regeneration in rats .Methods Seventy-five healthy male Sprague-Dawley rats were selected and randomly assigned into sham operation group ( S) , portal vein ligation group ( PVL) and portal vein ligation combined with in situ splitting group ( ALPPS) .On 1 d, 3 d, 7 d, 10 d, 14 d after operation , the hepatic regeneration rate ( HRR) of right median lobe was calculated , the serum alanine aminotransferase ( ALT) , aspartate aminotransferase (AST), IL-6, HGF, VEGF were detected.mRNA of IL-6, HGF, TNF-α, TGF-βwas assayed by real-time PCR, and the hepatic proliferating cell nuclear antigen ( PCNA) labeling index was evaluated by immunohistochemistry .Results Comparing with PVL group , the HRR of the right median lobe obviously increased on day 3, 7, 10 and 14 in ALPPS group (P<0.05), and ALT and AST level were increased on 1 d (P<0.05).On day 1 and 3, the content of serum IL-6, HGF and VEGF were all in-creased in ALPPS group [(70.7 ±14.6) pg/ml vs.(134.2 ±31.4) pg/ml; (0.70 ±0.04) ng/ml vs. (0.74 ±0.02) ng/ml;(82.1 ±12.6) pg/ml vs.(103.5 ±14.7) pg/ml], respectively (P<0.05).The mRNA expression of IL-6, HGF, TNF-α, TGF-βand the PCNA labeling index were also increased in ALPPS group in comparison with those in PVL group on day 1 and 3 (P<0.05).All the indexes in the two groups were all higher than those in the group S ( P<0 .05 ) .Conclusions Portal vein ligation combined with in situ splitting could significantly enhance liver regeneration .The possible mechanisms were related to the inflammation reaction and stress response caused by in situ splitting and up-regulation of cytokines in the regenerating lobe after portal vein ligation combined with in situ splitting , especially IL-6, HGF and TNF-α.

Objective To establish a rat model of associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) and evaluate the liver function after surgery.Methods Fifty male SD rats were randomly divided into two groups: experimental group (ALPPS group) and control group (PVL group).Selective portal vein ligation in PVL group was performed on the caudal lobe, left lateral and left median lobes, while the right lobe, the right median lobe was preserved to regenerate.ALLPS group was treated in the same way as PVL group, but also underwent liver partition in situ.After surgery, 5 rats were sacrificed on day 1, 3,7, 10 and 14 in each group to observe the weight of body and the right median lobe,respectively.The venous blood and liver tissue were obtained for testing alanine aminotransferase (ALT),aspartate aminotransferase (AST), serum albumin (ALB), total bilirubin (TBil) and observing the histological changes in liver injury after surgery.Results After surgery, the body weight decreased progressively, but then increased in both groups.Since the first day after surgery, the body weight began to decrease,reached the lowest value on 3 d, and then on day 7 the body weight in PVL group returned to preoperative levels.However, the body weight was still lower than that before surgery [(3.7 ± 2.7) ％ vs (-3.0 ± 1.9)％, P＜0.05].On day 3, 7, 10 and 14, the hepatic regeneration rate (HRR) of the fight median lobe in ALPPS group was obviously higher than that in PVL group (P ＜ 0.05).On day 1, the serum ALT and AST levels in two groups were elevated dramatically and then gradually decreased, which in ALPPS group were significantly higher than those in PVL group (P ＜ 0.05).There were no significant differences at other time points.On day 1 and 3, the serum ALB in ALPPS group was obviously lower than that in PVL group [(25.4±1.7)g/Lvs (31.4±1.5)g/L, P＜0.05;(25.0±2.0)g/Lvs (31.8±1.5)g/L, P＜ 0.05], respectively.More focal necrosis of liver were observed in ALPPS group on day 1, which were more than those in PVL group.Conclusions This method could successfully establish a ALPPS rat model and proved that ALPPS could induce accelerated hepatic regeneration and more severe early hepatocyte injury compared with PVL.This ALPPS experimental model provides a basis for further research on ALPPS, especially for clarifying the mechanisms of liver regeneration and tumor recurrence, and exploring the reasons for various ALPPS related complications, which play a significant role in its clinical application.

Bladder cancer is the most common malignant tumor in the urinary system.Currently,the clinical treatment options for bladder cancer mainly include surgery,chemotherapy,radiotherapy,immunotherapy,targeted therapy,photodynamic therapy,combination therapy,etc.The conventional treatment and administration strategies for bladder cancer primarily depend on the tumor stage and the extent of metastasis.However,in the process of non-surgical treatment,drugs lack specificity and targeting.Once the dosage is improperly controlled,drugs will damage normal cells when attacking cancer cells,which will lead to poor efficacy and multiple side effects.Nanomedicine is an emerging interdisciplinary field that utilizes nanomaterials and technologies in nanomedicine to provide disruptive technologies for traditional treatments,with advantages such as targeted delivery and high efficiency with low toxicity.Many nanotechnologies have become hot topics in clinical research in the field of medicine.Functionalized nanoparticles can actively or passively target specific cells within target organs,such as bladder cancer cells,by altering their surface properties,thereby enhancing drug delivery precision,reducing damage to normal cells,and improving treatment efficacy.This article provides an overview of the progress in classical and novel treatment approaches to bladder cancer,with a particular focus on the potential applications and future development directions of nanotechnology in the treatment of bladder cancer,providing important reference for personalized therapy and clinical translation in bladder cancer.