Acute respiratory distress syndrome (ARDS) is a common clinical critical condition of the respiratory system, with a high fatality rate and lack of effective drug treatment, hence it is a global medical problem to be solved urgently. Recently, with the in-depth research on extracellular vesicles (EVs) at home and abroad, more and more evidences suggest that EVs play a critical role in the initiation, development and progression of ARDS and have potential clinical application value. The role of different cells derived EVs in ARDS will be reviewed in this paper.

Objective To investigate the effect of intralesional lauromacrogol therapy on infantile hemangioma.Methods 30 cases all received intralesional injection of lauromacrogol.The changes of tumor size,texture and color were monitored and recorded.The adverse effects after medication were observed and managed accordingly.The adverse effects after medication were observed.The times of treatment were determined according to degree of reduction of tumor volume.To assess the efficacy,a 4 scales system was adopted.Results All patients had completed the treatment and followup.The overall response was scale Ⅰ in 2 cases (6.7 ％),scale Ⅱ efficacy in 4 patients (13.3 ％),scale Ⅲ efficacy in 5 cases (16.7 ％) and scale Ⅳ in 19 cases (63.3 ％).The smaller the tumor,the fewer the times of treatment,and the better the results.The effects of treatment were better if patient could be treated by intralesional lauromacrogol therapy in early stage.No severe adverse effects were observed during 6 months of follow-up.Conclusions Intralesional injection of lauromacrogol sclerotherapy is a safe and effective way to treat infantile hemangioma.

AIM: To study urinary concentration of aquaporin-2 water channel protein(AQP2) at different stages of chronic heart failure(CHF) rats and its relation to hyponatremia. METHODS: Male Sprague-Dawley rats(200～250 g) underwent either a left coronary artery ligation (a model of CHF) or a sham-operation. At different stage after surgery, urinary AQP2 concentration was measured by Western blot. 24-hours urine volume, serum sodium and urine osmolality were measured at the same time. RESULTS: There were two peaks of urinary excretion of AQP2 in severe heart failure rats model: one was the third day after operation, the other was the 9th week. Serum sodium and urine osmolality were significantly different in CHF rats as compared with sham-operated rats. Seven weeks after surgery, urinary AQP2 concentration was increased significantly insevere CHF rats compared with the mild ones and the control ones(365%?103% vs 179%?81% and 99%?48%, P

Objective To develop Z-score reference ranges for mitral valve-tricuspid valve distance (MTD) in normal fetuses from the measurements of femur length (FL),biparietal diameter (BPD) or gestational age (GA) using fetal echocardiography.Methods A retrospective cross-sectional study of 1216singleton normal fetuses was performed.The gestation age ranged from 20 to 40 weeks.Non-cardiac fetal biometric parameters included FL and BPD and GA based on menstrual age.MTD was measured in a standard apical four-chamber view.Normal Z-score ranges were developed for MTD using GA,BPD and FL as independent variables.These were accomplished by using first standard regression analysis and then weighted regression of absolute residual values for each parameter in order to adjust for inconstant variance.Results Linear regression model was the best description of the data in each case and correlations between MTD and independent variables (FL,BPD,GA) were excellent.The linear regression equations between MTD and FL,BPD,GA were:Y =0.04629 × FL-0.02868 (r =0.827) ; Y =0.04018 × BPD-0.08293(r =0.767) ; Y =0.0098 × GA-0.07075 (r =0.721),respectively.Heteroscedasticity of standard deviation(SD) with increasing independent variables also could be modeled with a simple linear regression.Linear regression equations between SD of MTD and FL,BPD,GA were:Y =0.0149 × FL-0.0095 (r =0.9947),Y =0.0126 × BPD-0.02793 (r =0.9931),Y =0.00305 × GA-0.021 (r =0.991),respectively.According to these equations,MTD Z-score =(the actual measurement of MTD-predicted MTD)/prediction SD.Conclusions Normal reference ranges and Z-scores for MTD have been provided.These normative data may be useful tools for assessment of fetal MTD,especially has potential applications in Ebstein anomaly or other malformations involved atrioventricular valves.

Objective To determine the complete nucleotide sequence of a genotype D hepatitis B virus (HBV) strain from a Uighur patient with chronic hepatitis B in Xinjiang.Methods The complete nucleotide sequence of a HBV strain obtained from a Uighur patient with chronic hepatitis B was amplified by polymerase chain reaction (PCR) and cloned for sequencing.The bioinformatics analysis was done using BioEdit and National Center for Biotechnology Information Basic Local Alignment Search Tool (NCBI-BLAST).Results The complete nucleotide sequence of Xinjiang HBV strain was 3174 bp.The nucleotide homology was 92%-98% between the Xinjiang strain and the published genotype D HBV strains and 91% compared to the published genotype D/C combination HBV strains from China (AY862865).There was a 9 bp deletion from nucleotide 1760 to nucleotide 1768 (ATTAAAGGT).This Xinjiang HBV strain belonged to ayw2 subtype and D genotype without any recombination with other genotypes.In the term of evolutionary relation,the complete nucleotide sequence of this Xinjiang HBV strain was closest to those of two Turkey HBV strains (AY796032 and AY721605) among 34 genotype D strains published in GenBank.Conclusions The complete nucleotide sequence of a genotype D HBV strain from a Uighur chronic hepatitis B patient in Xinjiang is determined.The sequence shows some unique characteristics.

Objective To study the association between transforming growth factor-β1 (TGF-β1) polymorphism and type 2 diabetes mellitus in Han population of Shanghai. Methods In this case-control study , 1 234 cases of T2DM patients were recruited and 1 272 healthy individuals were selected as control. Five ml of blood sample was collected from each subject ,from which the whole genomic DNA was extracted.The polymorphism was detected by the Taqman technology. Result Significant association was observed in TGF-β1 T896C genotypes and alleles with T2DM (P = 0.0001 and P = 0.004, OR = 1.18 [1.05 ~ 1.33], respectively). Conclusion The polymorphism of T896C in TGF-β1 gene may be associated with T2DM in Han population from Shanghai.

[Summary] A total of 165 type 2 diabetic patients were divided into two groups with pigmented pretibial pathes(PPP group) and no PPP( NPPP group). 50 subjects with normal glucose regulation were used as a control group(NGR group). The records of sex, age, diabetes duration, body mass index( BMI), systolic blood pressure (SBP), diastolic blood pressure, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, fasting blood glucose(FBG), 2 h postpradial plasma glucose(2hPG), triglyceride(TG), total cholesterol, HbA1C , retinol binding protein 4(RBP4), cystatin C(Cys C)were analyzed. The results showed that BMI,FBG, 2hPG, TG, and Cys C levels in NPPP group were higher than those in NGR group(all P<0. 01). The levels of BMI, SBP, FBG, 2hPG, TG, Cys C, and RBP4 in PPP group were higher than those in NGR group(P<0. 01 or P<0. 05), while diabetes duration, FBG, 2hPG, HbA1C , Cys C, and RBP4 in PPP group were higher than those in NPPP group ( P <0. 01). Pearson correlation analysis revealed that serum RBP4 and Cys C were in linear positive correlation(r=0. 77, P< 0. 01). The areas under receiver operating characteristic curve of RBP4 and Cys C were 0. 81 and 0. 78, respectively(P<0. 01). The results of binary logistic regression analysis showed that diabetes duration, HbA1C , RBP4 were related to PPP(r=0. 37, 0. 26, 0. 22, P<0. 05 or P<0. 01).

Objective:To evaluate the impact of sample pooling strategy on 2019-nCoV RNA detection results.Methods:Ten negative swabs were stored in 6 ml virus transport medium, mixed thoroughly and diluted 1∶2 and 1∶10. Inactivated 2019-nCoV culture medium was added to simulate pooling samples: 10 pooling samples, 5 pooling samples and 1 swab sample. Extraction and amplification were made using three nucleic acid extraction reagents a, b, and c with different extraction methods and systems, as well as five 2019-nCoV detection reagents A-E with various template loading volumes and sensitivities respectively.Results:For the same sample, the Ct values of extracted templates a were 2.10±0.47 and 3.46±0.62 earlier than extracted templates b and c. For samples with identical amplifying, the Ct valves of N and ORF1ab gene of A reagent were 1.16±0.48 and 2.36±0.54 earlier than that of reagent B. Adding nucleic acid of 10 negative swabs to the amplification system lagged the Ct values of reagent A by about 1.36±0.32 Ct, while Ct values of reagent B were not affected. Extracted by regent a, a lag of 1.66±0.39 Ct on average was observed in C, D, and E reagents in detecting pooling samples of ten swabs as compared with one swab sample. When extracting 400 copies/ml pooling samples of ten swabs by reagent a, N gene could be detected by reagents C and E, but not by reagent D.Conclusion:Large amount of extraneous DNA is introduced by sample pooling, which could interfere the effiency of extraction and amplification. Strategies of using extraction reagents with large loading volume and high effiency, together with amplification reagents with large template volume and low limit of detection are helpful for ensuring detection sensitivity of pooling samples, and greatly reducing the risk of false negative results.

Objective To investigate the clinical manifestations, treatment and prognosis of streptococcal toxic shock syndrome (STSS) in children. Methods One case of STSS was reported in a child who was admitted to Children's Hospital of Fudan University. Search terms such as "streptococcal toxic shock syndrome", "children" and "case report" were used to identify relevant reports from PubMed database, as well as Chinese databases including Chongqing VIP, Wanfang, and China National Knowledge Infrastructure for further review. Results The patient in this report was a 11-year-old female. The main clinical manifestations were fever, red, swelling, and pain in the right lower extremity, associated with impaired walking and hypotension. Imaging examination suggested diffuse abnormal signals in the soft tissue of right thigh. Group A Streptococcus (namely Streptococcus pyogenes) was isolated from the puncture fluid. The patient was improved after active shock-correcting and anti-infective treatment. A total of 6 STSS cases were identified from Chinese databases between January 1, 1996 and May 1, 2017. All the 7 cases (including this one, 4 males and 3 females, 15 months to 13 years of age) reported fever and skin rashes, and rapidly progressed to shock. Respiratory failure was reported in 4 cases and supported with a ventilator. Three patients died, including 2 within 24 hours after hospitaladmission. A total of 38 STSS cases (40 days to 18 years of age) were identified from PubMed database. The main clinical manifestations of these cases were respiratory tract or digestive tract symptoms, and skin and soft tissue infection. In addition, chickenpox was found in 3 cases, Kawasaki disease in 2 cases, neonatal bullous impetigo, pancreatitis, infectious mononucleosis, and lymphohistiocytosis in one case each. Of the 38 patients, 22 survived and 16 died. Conclusions STSS is a rare and severe form of invasive streptococcal infection in children. The early manifestations are not specific, which may be mistaken for upper respiratory tract infection, gastrointestinal dysfunction symptoms, skin and soft tissue infection, or muscle and joint disorder, or even similar to or associated with Kawasaki disease. But rapid progression to shock and multiple organ failure of STSS pose a serious threat to children. Pediatricians should keep alert on STSS. Early identification, timely diagnosis, and adequate treatment are key to improving patient outcome.

Objective To investigate the clinical value of albumin (Alb) in the diagnosis of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD).Methods A retrospective analysis was performed for the clinical data of 90 children with NICCD who visited Children's Hospital of Fudan University from January 2007 to December 2014,and according to the content of Alb,these children were divided into Alb ＜ 30 g/L (LA) group with 20 children and Alb ≥ 30 g/L (NA) group with 70 children.The clinical manifestations,results of laboratory examination,results of blood tandem mass spectrometry and urine gas chromatographymass spectrometry,and gene detection results were compared between the two groups.The t-test and the chi-square test were used for statistical analysis..Results There were significant differences between the LA group and the NA group in splenomegaly degree (3.28±1.95 cm vs 1.92t1.06 cm,P =0.030),aspartate aminotransferase/alanine aminotransferase ratio [3.15 (0.38-5.93) vs 2.14 (0.26-6.67),P =0.010],activated partial thromboplastin time (53.27±11.68 s vs 45.06±9.79 s,P =0.003),and international normalized ratio (1.92±1.35 vs 1.29±0.33,P=0.001).The SLC25A13 mutation 1851_854de14 was associated with Alb (22 =4.76,P =0.025).Conclusion As for the children with Alb ＜ 30g/L who are highly suspected of having NICCD,SLC25A13 gene detection and blood/urine mass spectrometry should be performed as early as possible,in order to initiate intervention treatment as soon as possible,prevent and treat complications,and improve prognosis.