Mycoplasma pneumoniae pneumonias are common in children.In recent years,the incidence of refractory mycoplasma pneumonia has been increasing,and some of the severe children have a poor response to macrolide antibiotics.However,the effect of glucoconicoid therapy may have unexpected results.The recognition of severe mycoplasma pneumonia risk factors may contribute to intervent with glucocorticoid early,reduce the occurrence of severe mycoplasma pneumonia,and improve the prognosis.Clinical studies have found that clinical manifestations,imaging findings,laboratory tests and other factors are related to the occurrence of severe mycoplasma pneumonia.In this paper,the risk factors that may be associated with accurrence of severe mycoplasma pneumonias are reviewed.

Asthma, a complex polygenetic disease, has individual differences in patient′s response to asthma drugs,which is mainly related to gene polymorphism. These genes include beta 2-adrenaline receptor genes(ADRB2),the glucocorticoid receptor genes(NR3C1) and leukotriene synthase genes(LTC4S and ALOX5),etc. Pharmacogenomics can realize individualized treatment of asthma,reduce the admission rate and the mortality rate,and reduce the cost of treatment. Pharmacogenomics of children asthma is reviewed in this arti-cle,hoping to provide help for the individualized treatment of asthma.

Objective To observe the clinical efficacy of Honggui capsule combined with chemotherapy in the treatment of lung cancer. Methods 61 cases of lung cancer patients were randomly divided into group A of 30 cases, treated with Honggui Capsule and chemotherapy, and group B of 31 cases treated with chemotherapy only by the envelope method. After both groups were treated for 21 days, the clinical effect, life quality improvement, improvement of TCM symptoms and the incidence of toxic and side effects in 2 groups were compared. Results After treatment, there was significant difference between group A and B in the tumor response rate (26.7% vs. 3.2%; χ2=4.927, P=0.026), Karnofsky (23.3% vs. 3.3%; χ2=5.410, P=0.020), and improvement of TCM symptoms (13.3% vs. 0.0%; χ2=4.423, P=0.035). During treatment, there was significant difference between group A and B in bone marrow suppression (33.3% vs. 58.1%; χ2=4.778, P=0.029), and gastrointestinal disturbance (16.7% vs. 58.1%; χ2=11.124, P=0.001). Conclusion Honggui capsule combined with chemotherapy has an enhanced efficacy and a detoxicating effect, besides it improves clinical symptoms and reduces the side effects of chemotherapy.

Objective Multiple carboxylase deficiency(MCD) is an autosomal recessively inherited defect of organic acid metabolism.The underlying mechanism is biotinidase(BT) or holocarboxylase synthetase(HLCS) deficiency.The authors reported 15 cases of MCD(clinical characteristics,diagnosis and treatment) and outcomes of long-term follow-up.Methods The clinical data of 15 patients with MCD admitted to Guangzhou Women and Children's Medical Center between Aug.2001 and Feb.2013 were analyzed.The diagnosis was confirmed by urinary organic acid analysis with gas chromatography/mass spectrometry (GC/MS),blood enzymatic determination and gene analysis.The patients consisted of 12 male and 3 female.The onset age ranged from newborn infants to 16 months.Results 1.Remarkable elevations of urinary lactate,3-oxy-butyric acid,3-OH-isovalerate,methylcitrate,3-methylcrontonylglycine,3-OH-propionate were detected in all of 15 cases.Fourteen cases with HLCS deficiency and 1 case with BT deficiency were confirmed by gene analysis.2.Most of patients with HLCS deficiency presented in the neonatal period or early infancy.The main clinical manifestations were skin rash (14 cases),tachypnea (9 cases),developmental retardation (8 cases),vomiting(5 cases),poor feeding (3 cases),developmental regradation (1 case),convulsion (1 case).Laboratory evaluation showed persistent metabolic acidosis and varied degree of ketosis,lactic acidosis,hyperuricacidemia,ammoniemia and hypoglycemia.Biotin was given to 13 patients in 10 mg/d and their metabolic disorders were corrected within 48 h,except one who gave up treatment and died.Treatment with Biotin in 5 mg/d provided clinical stability and normal neurodevelopmental outcome on follow-up for 3-11 (6.47 ± 2.70) years.3.One patient with BT deficiency presented with severe neurological symptoms(impaired consciousness,limbs trembling,tachypnea with irregular respiratory rhythm) at 16 months old.Demyelination of corpus callosum was evident on magnetic resonance imaging.Biotin treatment was given to him on the second of onset,and 1-year follow-up indicated significant improvement of his clinical symptoms,but the right limb weakness did not completely recover.Conclusions The main clinical features of HLCS deficiency include frequent skin rash,tachypnea,and metabolic disorders.BT deficiency may produce variable neurologic manifestations including demyelination of corpus callosum.Urinary organic acid analysis with GC/MS is critical to the early diagnosis of MCD.Prompt biotin treatment is recommended to correct metabolic derangements and continued therapy is essential to the improvement of long-term prognosis.Delayed commencement of therapy in BT deficiency can result in irreversible neurological damage.

ObjectiveTo investigate the effect and medical cost of different revascularization strategies for acute myocardial infarction (AMI) patients with multi-vessel disease (MVD).Methods A prospective randomized controlled trial (RCT) was conducted. From January 2009 to June 2012, patients with AMI and MVD undergoing primary percutaneous coronary intervention (PCI) were enrolled. They were randomly assigned to group A [staged PCI for non-infarction related artery (non-IRA) within 7-10 days after AMI] and group B (subsequent PCI for non-IRA recommended only for those with evidence of ischemia). All of patients were given optimized medical therapy according to clinical guideline, and they were followed up for 24 months at regular intervals. Major adverse cardiovascular events(MACE) including recurrence of myocardial infarction and death due to cardiac ailments were recorded. Meanwhile, re-hospitalization from cardiac causes, recurrence of angina, heart failure, and re-PCI, number of stents, total hospital stay days, and total medical expenditure were recorded.Results A total of 428 patients accomplished the 24-month follow up. All the patients underwgennt PCI for non-IRA in group A (215 patients), while 62 patients in group B (213 patients) undergone PCI for myocardial ischemia, and 51 patients received non-IRA treatment. There was no significant difference in MACE incidence between group A and group B [8.4% (18/215) vs. 10.8% (23/213),χ2= 0.727,P = 0.394]. The difference of death rate due to cardiac causes (5.1% vs. 6.6%), recurrence of myocardial infarction (4.2% vs. 6.6%), and heart failure (4.2% vs. 7.0%) were not significantly different between groups A and B (allP> 0.05). The rate of recurrence of angina (14.4 % vs. 32.9%), re-hospitalization from cardiac causes (14.4% vs. 33.8%), and re-treatment of implanting stents (12.6% vs. 29.1%) were significantly lower in group A than group B (allP< 0.01), and the rate of revascularization was significantly higher in group A than group B (10.7% vs. 5.2%,P< 0.05). The total number of stents (610 vs. 366), mean number of stents per patient (2.83±0.91 vs. 1.72±0.91,t = 12.725,P = 0.000), and total cost per patient (kRMB: 63.7±12.6 vs. 51.5±12.3,t = 10.107,P = 0.000) in group A were significantly higher than those in group B. Total hospital stay days in group A was significantly less than group B (days: 8.21±2.45 vs. 9.89±3.23, t = 6.071,P = 0.000). Because non-IRA-vascular reconstruction rate was low in group B, the rate of usingβ-blocker and anti-anginal agents during the 24-month follow up in group B was significantly higher than group A [59.2% (126/213) vs. 47.0% (101/215),χ2= 6.371,P = 0.012; 56.3% (112/213) vs. 17.6% (36/215),χ2 = 64.704,P = 0.000]. Conclusions In patients with AMI and MVD undergone emergency PCI, staged PCI within 7-10 days for non-IRA cannot decrease the incidence of myocardial infarction and death due to cardiac causes, recurrence of angina and rehospitalization for cardiac causes was diminished, and it may increase the number of stents and medical cost significantly.

Objective:To observe the effects of low intensity pulsed ultrasound(LIPUS) on the osteogenic differentiation of rat bone marrow mesenchymal stem cells(BMSCs) on titanium surface.Methods:BMSCs from Wistar rat bone marrow were respectively cultured on the flat titanium surface and the large grain blast acid etched(SLA) titanium surface,and induced by mineralization medium.Then,the cells were interfered by LIPUS and a control condition.Alkaline phosphatase(ALP) were quantitative determinated after 3 and 7 d mineralization induction respectively,ALP staining were observed after 14 d induction.Alizarin red staining were observed after 21 d mineralization induction.Osteogenic related protein and gene expressions were detected after mineralization induction.Results:ALP in culture medium of LIPUS group was higher than that of the control group after 3 d and 7 d mineralization induction(P＜0.05).LIPUS group showed stronger ALP staining and alizarin staining,and more mineralized nodules than control group.The expression of osteogenic related proteins,including Runx2,BMP2,OPN in LIPUS group increased.Osteogenic related genes expression,including ALP,Runx2,BMP2,OPN,OCN and Col-1 of the LIPUS group increased.Conclusion:The osteogenic differentiation of BMSCs on the fiat titanium surface or SLA titanium surface can be promoted by LIPUS.

Objective To explore the Chinese medicine syndrome characteristics of mild cognitive impairment (MCI).Methods The papers of MCI syndrome research were reviewed and collected in China National Knowledge Infrastructure,Wan Fang Data and VIP Data from January of 1990 to December of 2014.Statistical analysis was made on the Chinese medicine syndrome types and syndrome factors.SPSS 17.0 software was adopted to make cluster analysis.Combined with experts' experience,related symptoms to the syndrome factors were carried out.Results Totally 32 papers were included.Mter terminology normalization,there were 24 syndrome types of MCI.Top 5 syndromes with high frequency were syndrome of orifices confused by phlegm,syndrome of deficiency of kidney essence,syndrome of deficiency of both Qi and blood,syndrome of internal exuberance of heat toxin and syndrome of blood stasis blocking brain.In syndrome factors of disease location type,kidney and brain covered the highest proportion,30.83％ and 30.00％.In syndrome factors of disease cause and character types,Qi deficiency covered the most,16.50％.According to results of cluster analysis,combined with experts' experience,15 syndrome factors were extracted,including 69 symptoms.Conclusion Chinese medicine syndrome types of MCI were mainly syndrome of orifices confused by phlegm and syndrome of deficiency of kidney essence.The disease locations were mainly kidney and brain.The disease character was Qi deficiency.

OBJECTIVE:To observe clinical efficacy of urinary kallidinogenase in the treatment of acute cerebral watershed in-farct (WSI). METHODS:128 patients with WSI were randomly divided into control group and treatment group,each of the 64 cases. Control group was given Shuxuening 15 ml added into 0.9% Sodium chloride 250 ml,ivgtt,qd;treatment group received urinary kallidinogenase 0.15 PNA added into 0.9% Sodium chloride 100 ml,ivgtt,qd. Both groups were treated for consecutive 14 days. Neurologic impairment score(NIHSS)and clinical efficacy were observed in 2 groups before treatment and 3,7 and 14 days after treatment. The blood specimens were collected after 7 and 14 days treatment,to determine serum levels of TCC. RESULTS:After treatment,NIHSS and total effective rate of treatment group were significantly higher than those of control group,with statis-tical significance(P<0.01). There was no statistical significance in TCC between 2 groups before treatment(P>0.05);7 days af-ter treatment,TCC level of 2 groups increased significantly,to 14 days,and a declive;the treatment group was higher than the control group,with statistical significance (P<0.05). CONCLUSIONS:Urinary kallidinogenase can improve clinical efficacy of WSI significantly,and promote neurologic impairment symptom and TCC levels.

Background/Aims: MicroRNAs (miRNAs) play critical regulatory roles in the pathogenesis of pulmonary fibrosis. The aim of this study was to explore whether miRNA antagomirs could serve as potential therapeutic agents in interstitial lung diseases. Methods: A mouse model of pulmonary fibrosis was established by intratracheal injection of bleomycin (BLM). Using microarray analysis, up-regulated miRNAs were identified during the development of pulmonary fibrosis. miR-155 was chosen as the candidate miRNA. Fifteen mice were then randomized into the following three groups: BLM + antagomiR-155 group, treated with BLM plus intravenously injected with antagomiR-155; BLM group, treated with intratracheal BLM plus phosphate-buffered saline (PBS); and a control group, treated with PBS only. Lung tissues were collected for histopathological analysis, hydroxyproline measurement, and Western blotting. Enzyme-linked immunosorbent assays were used for the measurement of cytokines associated with pulmonary fibrosis. Results: Histological changes and hydroxyproline levels induced by BLM were significantly inhibited by antagomiR-155. The levels of interleukin 4 (IL-4) and transforming growth factor-β (TGF-β) expression were increased after BLM treatment. However, miR-155 silencing decreased the expression of IL-4, TGF-β, and interferon-γ. TGF-β-activated kinase 1/mitogen-activated protein kinase kinase kinase 7 (MAP3K7)-binding protein 2 (TAB2) of the mitogen-activated protein kinase (MAPK) signaling pathway, was activated by BLM and inhibited by in vivo silencing of miR-155 via antagomiR-155. Conclusions In vivo treatment with antagomiR-155 alleviated the pathological changes induced by BLM and may be a promising therapeutic strategy for pulmonary fibrosis.

Objective This cross sectional study was designed to estimate the intensity and duration of DTP by analyzing serum anti-Bordetella pertussis toxin (PT) IgG antibodies among children in Shanghai. The results may provide scientific evidence for developing vaccination protocol and assessing vaccination effect. Methods Blood samples were obtained from 372 children (0-18 years of age) in Shanghai. The serum level of anti-PT IgG was determined by commercial ELISA kits. Anti-PT IgG level ≥30 IU/mL was defined as positive if no pertussis vaccine was vaccinated in the past year, which indicates recent contact with Bordetella pertussis. Anti-PT IgG level ≥100 IU/mL suggests an acute infection. Results The mean concentration of anti-PT IgG antibody was 16.21 IU/mL in the 372 subjects. Serum anti-PT IgG was positive (≥30 IU/mL) in 42 (11.29％) children. The highest positive rate was found in the age group of ＜3 years old (18.60％), followed by the age group of 10-12 years old (11.43％), and the lowest positive rate in the age group of 3-5 years old (7.46％). The mean level of anti-PT IgG antibody was 21.82 IU/mL in the age group of ＜3 years old, 21.16 IU/mL in the age group of 10-12 years old, and the lowest (9.74 IU/mL) in the age group of 6-9 years old. Conclusions Atypical B. pertussis infection is prevalent among younger children in Shanghai. Booster dose of pertussis vaccine may be useful in reducing the incidence of pertussis in children.