Objective To investigate the protective effect of erythropoietin (EPO)on the kidney of renal anemia rats and further explore the renoprotective action and possible mechanisms.Methods A total of 90 SD rats were randomly divided into 5 groups:normal control rats (NC),simple anemia group (SA),iron + EPO group (IR+EPO),erythropoietin group (EPO),and iron group (IR)with 18 in each.The rats were sacrificed after 4 weeks’ treatment with intragastrically-injected adenine.Serum creatinine (Scr),blood urea nitrogen (Bun),hemoglobin (Hb),hematocrit (Hct),and hepcidin were measured with automated hematology analyzer.The expressions of bone morphogenetic protein-6 (BMP-6 ),a serine/threonine kinase receptor-1 (SMAD-1 )and serine/threonine kinase receptor-4 (SMAD-4)in the kidney were detected by immunohistochemistry and Western blot.Results ①The results of general indicators:BUN and Scr in IR + EPO group and EPO group were lower than those in SA group (P <0.01).Hb and Hct in IR + EPO group and EPO group were increased significantly compared with those in SA group (P <0.01).Hepcidin was significantly increased in simple anemia group (P <0.01).② ELISA results showed that Hepcidin was lower in IR + EPO group and EPO group than in SA group (P <0.01).③ The results of pathological observation indicated that EPO could reduce rat renal pathology and function.④ Immunohistochemistry revealed that SMAD-4,SMAD-1 and BMP-6 were expressed in the rat glomerular cells and renal tubular epithelial cells.⑤ Western blot further indicated that the expression of SMAD-4 was significantly decreased in IR + EPO group and EPO group (P < 0.01 ).The expression of SMAD-1 in IR+EPO group and EPO group was decreased (P <0.05)while that of BMP-6 was elevated in IR+EPO group and EPO group (P <0.01 ).Conclusion The expression and secretion of hepcidin were inhibited by EPO via the BMP/SMAD pathway,which further corrects anemia and exerts a renal protective effect.

Objective To describe the early use of nasal continuous positive airway pressure (nCPAP) ventilation for infants presenting acute congestive heart failure (CHF) complicated by congenital heart disease (CHD) and pulmonary artery hypertension (PH).Methods Sixty infants with CHD treated for acute CHF were randomly divided into the nCPAP group (n =32) and the non-nCPAP group (n =28).Data were analyzed,which included lactic acid value (Lac) by arterial blood gas analysis,calculation of oxygenation index [pa (O2)/FiO2],detection of serum N-terminal pro-brain natriuretic peptide of type B (NT-proBNP) level,determination of left ventricular end diastolic volume index (LVEDVI),left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) by noninvasive bedside ultrasonic cardiogram (UCG).Results 1.Comparison of arterial blood gas between the 2 groups:1 d after treatment,there were significant differences in pa (O2)/FiO2 and Lac between the 2 groups (t =4.743,5.402,all P ＜ 0.05).A significant difference was found in the pa (O2)/FiO2 between the nCPAP group and the non-nCPAP group 3-7 d after treatment(t =6.366,P ＜ 0.05).The level of Lac had no significant difference between the 2 groups 3-7 d after treatment(t =1.812,P ＞ 0.05).2.Comparison of index of heart function between the 2 groups:after 3-7 d treatment,LVEDVI,LVEF,and PASP were statistically different between the 2 groups (t =2.052,2.704,2.019,all P ＜0.05).3.Comparison of serum indexes between the 2 groups:3-7 d after treatment,serum NT-proBNP level was improved dramatically compared with the non-nCPAP group(t =9.869,P ＜0.05).4.Comparison of clinical prognosis between the 2 groups:the differences in needing endobronchial intubation rate,mechanical ventilation time,time in PICU and mortality rate were all statistically significant between the 2 groups (x2 =5.505,P =0.019; t =4.788,P =0.000;t =5.068,P =0.000 ;x2 =4.284 ;P =0.038).Conclusions The early use of noninvasive nCPAP for eligible patients with acute CHF complicated by CHD and PH seems to improve their prognosis by improving pa (O2)/FiO2,reducing left ventricular and right ventricular afterload and improving the left ventricular function.

OBJECTIVETo explore the repair effects of acupuncture for promoting the governor vessel and tranquilizing the mind (acupuncture technique) on cerebral white matter injury of premature infants.

METHODSA total of 56 cases of cerebral whiter matter injury of premature infants, the fetal age less than 35 weeks were selected and randomized into an observation group (27 cases) and a control group (29 cases). The routine basic rehabilitation therapy was used in the two groups. Additionally, in the observation group, the acupuncture technique was added, once a day and the treatment for 15 days was as 1 course. Totally, 3 courses of treatment were required. Before and after treatment, the cranial magnetic resonance imaging (MRI) and the diffusion tensor imaging (DTI) were adopted to observe the location and severity of cerebral white matter injury. The Gesell developmental scale was used to assess the nerve motor development.

RESULTSAfter treatment, the difference was not significant statistically in the severity of cerebral white matter injury in the infants between the two groups (>0.05). The FA value of cerebral white matter in the interesting zone was increased as compared with that before treatment in the infants of the two groups (both<0.05). The result in the observation group was higher than that in the control groups (<0.05). After treatment, DQ value of each function zone in Gesell scale was all increased as compared with that before treatment in the two groups (all<0.05). After treatment, the DQ values of gross motor, fine motor and social adaptability in the observation group were higher than those in the control group (all<0.05). After treatment, the difference was not significant in DQ value of individual-social and speech behaviors between the two groups (both>0.05).

CONCLUSIONAcupuncture technique for promoting the governor vessel and tranquilizing the mind promotes the repair of the function in the premature infants with cerebral white matter injury and further benefits the promotion of the intelligence.

Objective:To explore the clinical characteristics and the therapeutic approach in children with pulmonary embolism(PE).Methods:The clinical data of 8 patients with PE who hospitalized at the Children′s Hospital of Chongqing Medical University from March 2001 to October 2018 were retrospectively analyzed.Results:Among the 8 cases with PE, 3 cases were male and 5 cases were female, the age of subjects ranged from 0.6 to 11.7 years old, the median age was 7.96 years old.All of them had underlying diseases, among them, congenital heart disease with infective endocarditis accounted for 37.5%(3 case). Among the 8 cases, 4 cases presented with symptoms of respiratory tract infection, 7 cases had shortness of breath, 5 cases had cough, 3 cases had chest pain, 2 cases had hemoptysis, and 1 case had typical triad of PE with chest pain, dyspnea and hemoptysis.Among the 8 cases, 7 cases did the arterial blood gas analysis and showed hypoxemia; 6 cases did the D-dimer and the value>500 μg/L; 5 cases did the electroca-rdiogram and 4 cases(80.0%) showed sinus tachycardia, and 2 cases(40.0%) had ST-T changes, all of them did echocardiography and 3 cases(37.5%) of which indicated pulmonary artery excrescence, 7 cases of which did spiral CT pulmonary angiography and 5 cases(71.4%) of them prompted pulmonary vascular filling defects, 6 cases(75.0%) of which were embolized in the lower lobe of the lung.Three cases received anticoagulant therapy, and 1 of them was treated with combined thrombectorny, 1 case of them died.Two cases received thrombectomy, 1 case of them died.Three cases were not treated with thrombectomy and anticoagulation therapy, 2 cases of them died.Conclusions:The mortality of PE in children is high.The clinical manifestations of PE in children are not typical and difficult to distinguish from respiratory infections.For children with high risk factors of PE, once clinical symptoms related to PE occur, D-dimer, echocardiography, and spiral CT pulmonary angiography should be done soon for early diagnosis and treatment.

Objective:To explore clinical features, etiology and mechanism of pulmonary bullae in children.Methods:The clinical data of children with diagnosis or suspected diagnosis of pulmonary bullae, including the general situation, etiology, pathogen composition, number and location, prognosis and so on, in the Inpatient Department of Children′s Hospital of Chongqing Medical University from March 1993 to August 2019 were retrospectively analyzed.Results:Among the 163 patients, there were 130 cases of respiratory tract infection, and 11 cases of pneumothorax alone.Totally, 22 cases were found pulmonary bullae in the chest CT examination without typical symptoms.Etiology: viruses accounted for 19.02%(31/163 cases), with mainly respiratory syncytial virus (9.20%, 15/163 cases); bacterial infection took up 28.83%(47/163 cases), mostly Haemophilus influenzae (13/163 cases, 7.98%) and Staphylococcus aureus (10/163 cases, 6.13%). Pulmonary bullae was more common in the right lung (82 cases). It took 7 days to 9 months for bullae to reduce, shrink or disappear.In some cases, there was no significant change in bullae even after 19 months. Conclusion:Pulmonary bullae can be seen in infection, tumor, auto-immune diseases and so on, most of which are bacterial infections.Bullae may exist for a long time.The mechanism of pulmonary bullae may include the narrowing of lumen, followed by the thickening of bronchial wall, ischemic necrosis and alveolar expansion due to the clogging of distal small vessels or capillaries, the degradation of connective tissue and dissociation of elastic tissue, the destruction of the bronchiolar wall, disturbing ion channels and mitochondria metabolism and destroying the connection of epithelial cells.

Objective:To investigate the clinical characteristics, long-term prognosis and changes of pulmonary function in children with idiopathic pulmonary fibrosis (IPF).Methods:The clinical data, long-term prognosis and changes of pulmonary function of children with IPF admitted to the Department of Pediatric Respiratory Center in Children′s Hospital of Chongqing Medical University from January 2008 to December 2018 were retrospectively analyzed.Results:A total of 28 cases were included, with the median age of 3.9 years (range: 0.5 to 15.7 years). Cough (28 cases, 100.0%), tachypnea (25 cases, 89.3%), cyanosis (19 cases, 67.9%), dyspnea (11 cases, 39.3%), Velcho rales (12 cases, 42.9%), inspiratory three concave sign (11 cases, 39.3%), clubbed fingers and toes (6 cases, 21.4%) and diminished breath sounds (5 cases, 17.9%) were main clinical manifestations.Chest high-resolution computed tomography (HRCT) mainly displayed grid shadow, irregular sac-like light-transparent shadow with ho-neycomb changes and dense shadow, partial (7 cases) pulmonary interstitial emphysema/emphysema/pneumomediastinum.Three cases of lung biopsy showed hyperplasia and consolidation of alveolar space and alveolar septal fibrosis, thickening of alveolar wall and coexistence of new and old lesions.In this group, 4 cases did not receive drug therapy due to other reasons (3 cases abandoned therapy, and 1case died of respiratory and circulatory failure during hospitalization). Twenty-four cases were treated with single or combination of oral Prednisone, N-acetylcysteine and Azithromycin.Eleven cases had improved symptoms when discharged, and 13 cases showed no improvement.Twenty-four cases continued to receive oral medication therapy according to the original protocol.Eight cases were followed up for chest HRCT for 3 months to 4 years, the chest HRCT lesions of 7 cases were similar to before, and those of 1 case increased than before.All cases received telephone follow-up for 2 to 7 years; the maximum duration of medication was 4 years.Twelve cases were lost to follow-up, 7 cases had motion limitation, 3 cases died, and 2 cases had no clinical symptom.Three cases were followed up for pulmonary function for 2 to 3 years, among which 2 cases had pulmonary function decreased than before; 1 case had improvements in forced vital capacity as a percentage of the predicted value and peak expiratory flow as a percentage of the predicted value, but decline in forced expiratory volume in the first se-cond as a percentage of the predicted value.Conclusions:The clinical manifestations of children with IPF are lack of specificity.Chest HRCT is of great value in the diagnosis of IPF and preliminary monitoring of the activity of lesion.In the long-term follow-up, some of cases have improvements in symptoms; pulmonary function mostly decreases, but part of indexes can be improved.

To prepare a lipid nanoparticle (LNP)-based subunit vaccine of Mycobacterium tuberculosis (Mtb) antigen EsxV and study its immunological characteristics, the LNP containing EsxV and c-di-AMP (EsxV: C: L) was prepared by thin film dispersion method, and its encapsulation rate, LNP morphology, particle size, surface charge and polyphase dispersion index were measured. BALB/c mice were immunized with EsxV: C: L by nasal drops. The levels of serum and mucosal antibodies, transcription and secretion of cytokines in lung and spleen, and the proportion of T cell subsets were detected after immunization. EsxV: C: L LNPs were obtained with uniform size and they were spherical and negatively charged. Compared with EsxV: C immunization, EsxV: C: L mucosal inoculation induced increased sIgA level in respiratory tract mucosa. Levels of IL-2 secreted from spleen and ratios of memory T cells and tissue-resident T cells in mice were also elevated. In conclusion, EsxV: C: L could induce stronger mucosal immunity and memory T cell immune responses, which may provide better protection against Mtb infection.
Animals ; Mice ; Mycobacterium tuberculosis ; Antigens, Bacterial ; Immunization ; Nanoparticles ; Vaccines, Subunit ; Mice, Inbred BALB C