OBJECTIVE: To investigate the efficacy of bone marrow mesenchymal stem cells (BMMSC) on children with refractory graft-versus-host disease (GVHD) and to judge the efficacy of BMMSC by dynamically monitoring the changes of cytokines in children with GVHD before and after infusion of BMMSC, so as to provide a theoretical basis for clarifying the mechanism of BMMSC. METHODS: 17 children with refractory aGVHD including 7 of grade II, 6 cases of grade III and 4 cases of grade IV after allo-HSCT were enrolled. All the children with aGVHD, who received routine immunosuppressive therapy, but the state of disease not improved, were treated with immunosuppressive drugs combined with BMMSC infusion. Study endpoints included safety of BMMSC infusion, response to BMMSC, and overall response of aGVHD. The serum levels of IL-2α, IL-6, IL-10, IL-8 and TNF-α in aGVHD patients were measured by chemiluminescence before infusion of BMMSCs and Day 7, Day 14 after infusion of BMMSCs. RESULTS: The cumulative median dose of BMMSCs was 5.5 (3.4-11.1) × 10/kg for average of 3.7 times, and the median time of 16.5 (4-95) days for the first infusion of MSCs. In 17 cases of refractory GVHD, 14 responded to treatment, whereas 3 patients failed. The total effective rate was 82.4% and no adverse reactions occurred. Of the 14 survived cases (82.4%), the median follow-up time was 944 (559-1245) days from the first infusion of MSCs. The levels of TNF-α in children with grade II, III and IV GVHD before treatment were 9.5±4.3 pg/ml, 16.3±10.9 pg/ml and 35.8±21.2 pg/ml respectively. The difference between grade II and IV, III and IV was statistically significant (P<0.05). Compared with the ineffective group of BMMSC infusion, the serum TNF-αlevel in the BMMSCs treatment effective group was 10.8±5.6 pg/ml vs 40.6±14.8 pg/ml (t=-3.901, P<0.05) before treatment. In the effective group of BMMSCs infusion, IL-10 20±17.4 pg/ml of day 14 was significantly higher than that 7.3±3.1 pg/ml before the treatment (t=-2.850, P<0.05), while , the serum levels of IL-2α, IL-6, IL-8, TNF-α were not statistically significantly different (P＞0.05). CONCLUSION The infusion of BMMSC is safe and effective in the treatment of refractory GVHD in children. TNF-αlevel relates with the severity of GVHD. BMMSC may play an anti-GVHD role by up regulating the level of cytokine IL-10 in vivo.

OBJECTIVE: To study the changes in the serum levels of Chemerin and Omentin-1 in children with Kawasaki disease (KD) in the acute stage after intravenous immunoglobulin (IVIG) treatment and related clinical significance. METHODS: A total of 60 children who were diagnosed with KD from January 2015 to April 2019 were enrolled as subjects. Forty healthy children and 40 children with acute infectious diseases were enrolled as the healthy control group and the infection control group respectively. According to the sensitivity to IVIG treatment, the children with KD were divided into an IVIG sensitive group with 51 children and a non-IVIG sensitive group with 9 children. According to the presence or absence of coronary artery lesion, the children with KD were divided into a CAL group with 13 children and a non-CAL group with 47 children. ELISA was used to measure the serum levels of Omentin-1 and Chemerin before and after the treatment. RESULTS: The children with KD had significantly higher serum levels of Chemerin and Omentin-1 than the healthy control and infection control groups before treatment (P<0.05). After 48 hours of treatment, the IVIG sensitive group had a significant reduction in the serum level of Chemerin (P<0.05), while there was no significant change in the serum level of Omentin-1 after treatment (P>0.05). Before treatment, the non-IVIG sensitive group had a significantly higher serum level of Chemerin than the IVIG sensitive group (P<0.05), and the CAL group had a significantly higher serum level of Chemerin than the non-CAL group, while there was no significant difference in the serum level of Omentin-1 between the IVIG sensitive and non-IVIG sensitive groups, as well as between the CAL and non-CAL groups (P>0.05). CONCLUSIONS High serum levels of Chemerin and Omentin-1 may play an important role in the development and progression of KD. Chemerin may be involved in the development of CAL in children with KD. The serum level of Chemerin may be used as a new index for predicting the sensitivity to IVIG treatment.
Adipokines ; Chemokines ; Child ; Coronary Artery Disease ; Humans ; Immunoglobulins, Intravenous ; Mucocutaneous Lymph Node Syndrome

Dengue virus(DENV) has been identified by World Health Organization as a major public health problem in tropical and subtropical regions. In recent years, dengue outbreaks have become more and more frequent in the world. In 2019, dengue outbreaks of varying degrees have occurred in the Philippines, Thailand, Bangladesh, Myanmar and Chongqing City in China. The laboratory diagnostic method of DENV is of great significance to the prevention and control of dengue epidemic. Therefore, the methods and strategies of DENV laboratory diagnosis are reviewed in this paper. By reviewing the traditional diagnostic methods and looking forward to the emerging diagnostic strategies, this paper aims to provide a reference to select the appropriate laboratory diagnostic scheme for the outbreak of dengue.

Objective To explore the antioxidant mechanism ofhistone deacetylase 2 (HDAC2) regulating Nrf 2 acetylation in lipopolysaccharide (LPS)-induced type Ⅱ alveolar epithelial cell injury.Methods The experiment was divided into two parts.The first part was the routine culture of type Ⅱ alveolar epithelial cells of mice.The cells were stimulated with different concentrations of LPS (10 ng/ mL,100 ng/mL and 1 000 ng/mL).CCK-8 was used to detect the cell activity at 0 h,6 h,12 h,24 h and 48 h,respectively.The second part:Alveolar epithelial cells of type Ⅱ were cultured and divided into the normal control group (control group),LPS group,HDAC2 lentivirus interference group (siRNA-HDAC2 group) and HDAC2 lentivirus overexpression group (LV-HDAC2 group).The expression of HDAC2 and Nrf2 were detected by Western blot,the acetylation of Nrf2 was detected by immunoprecipitation,and the stability of nrf2 was detected after actinidone action.The activity of superoxide dismutase (SOD) and malondialdehyde (MDA) were detected by chemical colorimetry.SPSS 23.0 statistical software was used.LSD-t test was used for comparison between two groups,and one-way ANOVA test was used for comparison among multiple groups.Results Compared with the control group,the expression of HDAC2 protein in the LPS group increased (t=5.974,P=0.027),the acetylation level of Nrf2 decreased (t=7.223,P=0.002),the Nrf2 protein level increased (t=2.929,P=0.043),the protein stability of Nrf2 increased,the SOD activity decreased (t=121,P＜0.01),and the MDA content increased (t=10.45,P=0.000 5).Compared with the LPS group,Nrf2 acetylation level decreased in the LV-HDAC2 group (t=1 1.29,P=0.000 4),Nrf2 protein expression increased (t=3.194,P=0.033),Nrf2 protein stability increased,SOD activity increased (t=4.678,P=0.009),and MDA content decreased in the LV-HDAC2 group (t=5.417,P=0.005 6).While the opposite trend was observed in the siRNA-HDAC2 group.Conclusion After LPS stimulation,oxidative stress of type Ⅱ alveolar epithelial cells was aggravated.HDAC2 could decrease the level of Nrf2 acetylation,increase the expression of Nrf2 protein,and alleviate LPS-induced oxidative stress.

Objective To explore the efficacy of continuous renal replacement therapy (CRRT) in the treatment of neonatal acute kidney injury (AKI).Methods Totally 17 critically ill neonates treated with CRRT were selected who were hospitalized at Department of Neonatology,Shanghai Children's Hospital,Children's Hospital Affiliated to Shanghai Jiaotong University,from June 2012 to June 2017,and among them there were 15 cases with AKI,and the clinical data of these 15 patients were retrospectively analyzed,while 15 AKI neonates were treated with CRRT combined with conventional treatment.The model for CRRT was continuous veno-venous hemofiltration dialysis (CVVH-DF) in 13 cases,plasma exchange (PE) in 2 cases.The changes of blood pressure(BP),renal function,electrolyte,acid-base balance index and hemodynamic indicators were analyzed respectively before CRRT treatment,12 h,24 h,48 h after treatment and by the end of CRRT treatment.The efficacy of CRRT treatment was evaluated in these 15 AKI neonates.Results Gestational age of 15 AKI newborns was 33 +4-40 +1 weeks,admission day age was 2-28 days,birth weight was 2.25-4.00 kg.Primary diseases were severe asphyxia in 6 cases,neonatal septicemia in 5 cases,congenital hereditary metabolic disease in 2 cases,traumatic asphyxia in 1 case,and liver failure in 1 case.CRRT treatment persisted for 49-190 hours.BP value [(50.8 ± 6.57) mmHg(1 mmHg =0.133 kPa)] could reach normal level after 12 h CRRT treatment,and blood pH value (7.31 ± 0.25) increased significantly after 12 h CRRT treatment,while blood K+[(5.51 ±1.86) mmoL/L],urea nitrogen (BUN) [(9.5 ±3.7) mmol/L],creatinine(Cr) [(93± 14)μmol/L] significantly decreased after 12 h CRRT treatment,and reached the normal range [K + (4.78 ± 2.95)mmol/L,BUN (7.5 ±2.1) mmol/L,Cr (54 ± 13) μmol/L] after 24 h treatment,but urine volume[(0.8 ±0.2)mL/(kg· h)] significantly increased after 24 h treatment.Partial pressure of oxygen/fraction of inspired oxygen reached 200 mmHg after 12 h treatment and more than 300 mmHg after 24 h treatment.CRRT treatment of 15 AKI neonates turned out to be effective.Conclusions CRRT can effectively improve the internal environment of AKI neonates and reduce the death rate of neonatal AKI,which can provide an effective adjuvant treatment measures for the treatment of AKI neonates.

Objective To evaluate the safety,feasibility,complications and outcome of continuous renal replacement therapy (CRRT) in neonates weighting less than 3 000 g.Method A total of 6 neonates weighting less than 3 000 g treated with CRRT in the Department of Neonatology,Shanghai Children's hospital,from January 2015 to December 2017 were studied.The birth weight,primary disease,indications of CRRT,treatment duration,age,complications and outcome of the neonates were collected and analyzed.Serum creatinine (Scr),blood urea nitrogen (BUN) and blood ammonia were analyzed before and after CRRT.T test was used for statistical analysis of the data.Result (1) Among the 6 neonates,2 were full-term infants and 4 were premature infants.The average gestational age of the neonates was (35.0± 2.1) weeks and the average birth weight was (2 542±586) g.(2) The catheterization was successful in all of the 6 neonates.The model for CRRT was continuous veno-venous hemofiltration dialysis,and the duration was 50(48,154)h,the neonates' age of CRRT was 3.0(2.0,4.5)days.The primary disease included 3 perinatal asphyxia,1 hemolytic uremic syndrome,1 ornithine transcarboxylase deficiency,1 jejunal atresia.There were 5 patients with acute kidney injury and fluid overload,and another one with hyperammonemia.(3) Compared with before CRRT,serum creatinine,urea nitrogen and serum ammonia all decreased significantly and reached the normal range after CRRT.(4)The complications of CRRT in the 6 neonates included 2 hypotension,1 hypokalemia,1 hypocalcemia and 1 hypophosphatemia.Catheter related infection,blockage and other complications had not occurred.(5) After treatment,3 patients survived,1 witdrew and 2 died.Conclusion The application of CRRT in neonates with weight less than 3 000 g is safe and feasible,the prognosis and survival rate of which can be improved with fewer and controllable complications.

Objective To explore the epidemiological analysis of complications in premature infants.Methods From January 2017 to March 2018,1800 premature babies in Ningbo Women and Children Hospital were selected in the study.The clinical data of pregnant women,premature infants and premature complications,and so on were investigated,and summarized epidemiology of premature infant complications.Results The probability of premature birth was 9.09％.The differences between different gestational age(x2 =2 481.34) and different body weight (x2 =3 088.21) were statistically significant (all P ＜ 0.05).Premature rupture of membranes occurred as the main one of the common factors lead to premature birth,the fetal distress was also more common factors,so in different gestational age,the difference was not statistically significant (P ＞ 0.05).However,compared with other factors,the difference of premature infants at different gestational weeks was statistically significant (P ＜ 0.05).Conclusion Epidemiological study of preterm infants,can promote their perinatal management level and quality,and then pointed to strengthen perinatal health education and health care,for the effective prevention and treatment of common diseases of perinatal,key management and monitoring work earnestly strengthen the high-risk pregnancy,attaches great importance to the establishment of collaborative relationship between made in pediatric claims intrauterine transhipment,making pregnant women can be produced in the hospital for treatment for premature babies,and reduce the mortality and morbidity rates of premature and low birth weight,can reduce the risk of intellectual disability,eventually making the birth population overall quality improved.

Objective To review the nomenclature and terminology, diagnostic criteria, classification and evaluation of intellectual disability using WHO ICD-11 and ICF.Methods The theories and approaches of ICD-11 and ICF were adopted to analyze the nomenclature and terminology, diagnostic criteria, classification and evaluation of intellectual disability.Results ICD-11 and ICF had established the nomenclature and terminology, diagnostic criteria, classification and evaluation of intellectual disability from the perspectives of content model of ICD-11 and functioning of ICF respectively. Intellectual disability had used nomenclature of disorder of intellectual development and one of sub-categories of mental, behavioral or neurodevelopmental disorders. Intellectual disability was also defined as both impairment of intellectual function (b117) and functional limitation of adaptive behaviors (d1-d9) using ICF. Occurrence age of intellectual disability was before 18 years old for diagnostic criteria of ICD-11 and ICF.Conclusion The nomenclature and terminology, diagnostic criteria and classifications of intellectual disability have been reviewed and updated using the theories and approaches of ICD-11 and ICF. It provides theoretical supports, approaches, and standardized tools for the development of rehabilitation service for people with intellectual disability.

Objective To analyze the unmet needs of services and support, and design structured, standardrized and individualized service and support plans for people with intellectual disability using ICF framework.Methods In respective of intellectual function and adaptive behavior, a structured, standardrized and individualized service and support plan had been constructed according to process of individualized plan using ICF.Results Based on ICF model of functioning and disability, the structured and standardized service and support plan had been constructed, including functional diagnosis and service needs reporting, and individualized services protocols.Conclusion With the analysis of functioning and reporting of unmet needs of service using ICF, the structured, standardrised and individualized service and support plan can be developed to promote the total rehabilitation for people with intellectual disabilities.