Objective:To analyze the feasibility of developing clinical pediatrics curriculum for pediatric students at the pre-clinical stage, and to provide a basis for the subsequent curriculum construction.Methods:A total of 90 pediatric medical students were enrolled, including pre-clinical group (G1, third semester of the second year, n=47) and the clinical clerkship group (G2, seventh semester of the fourth year, n=43). A questionnaire survey was conducted to compare the two groups from three aspects: clinical interest, learning methods and learning ability. And 24 and 20 students were randomly selected from the two groups to participate a clinical course respectively. Both of the formative evaluation and in-class test were carried out to compare the learning performance and learning effect between G1 and G2. SPSS 22.0 was used for data analysis. The counting data were described by case number and rate, and the frequency between groups was compared by chi-square test. When the chi-square test condition is not met, Fisher's exact test was performed. Normal distribution test was carried out for measurement data. Two independent sample t test was conducted for the comparison between groups of normal distribution data and Mann-Whitney U test for the comparison between groups of skewed distribution respectively. Results:There was no significant difference in clinical interest and pre-clinical interest between the two groups (Fisher's exact probability method, P=0.252, 1.000). There were partial differences in learning methods: G1 spent more time learning after class ( Z=-2.36, P=0.018), learned more in spare time ( Z=2.53, P=0.011), learned more on the homework ( P=0.020), and had a higher preview rate ( Z=-5.07, P < 0.001). There were also partial differences in learning ability: G2 had better literature retrieval ability ( χ2=10.57, P=0.001); G2 had higher scores on class and extended class performance ( t=-3.18, P=0.004; t=-10.14, P<0.001). In terms of learning effect, G2 scored higher scores on only one multiple choice question ( t=-2.46, P=0.022). Conclusion:The pediatrics students at the pre-clinical stage have certain interest and ability to receive clinical pediatrics courses. Sufficient pre-class preparation and appropriate curriculum design are helpful to the early cultivation of student's clinical thinking.

Objective:The purpose of this study was to investigate the relationship between genotypes and clinical phenotypes of primary distal renal tubular acidosis (dRTA) in children.Methods:Clinical information, genetic testing information and follow-up data (until March 2021) of children with dRTA from Children′s Hospital of Chongqing Medical University (from January 2010 to December 2020) were analyzed retrospectively. According to different pathogenic genes, patients were divided into SLC4A1 gene and ATP6V0A4+ATP6V1B1 gene groups. Age at onset, clinical manifestations and laboratory findings were compared. Self-comparisons of height standard deviation score (HtSDS), weight standard deviation score (WtSDS), blood pH and serum potassium before and after treatment were tested. T-test, Fisher′s exact test and rank sum test were used to analyze among groups. Results:Among 27 children with dRTA (16 boys and 11 girls), the age of onset was 33.4 (10.0, 36.0) months.There were 22 patients (81%) with SLC4A1 gene variation, 3 patients (11%) with ATP6V1B1 gene variation and 2 patients (8%) with ATP6V0A4 gene variation. Totally 22 patients (81%) with renal calcium deposition, 19 patients (70%) hypokalemia, 18 patients (67%) short stature, 16 patients (59%) malnutrition, 16 patients (59%) rickets, and 15 patients (56%) polydipsia and polyuria. Noteworthily, the genotyping results indicated that the age at onset in SLC4A1 gene group was older than that in ATP6V0A4+ATP6V1B1 gene group, with a statistically significant difference (27.3 (12.0, 36.0) vs. 8.2 (2.5, 15.0) months, H=6.33, P=0.012). However, there were no significant differences in clinical manifestations or laboratory test results (all P>0.05). Furthermore, the course of disease was 3.9 (1.3, 6.0) years and the follow-up period was 3.1 (1.0, 4.5) years in 27 patients. In addition, there were no significant differences in recovery rate of clinical manifestations and last laboratory findings between SLC4A1 gene group and ATP6V0A4+ATP6V1B1 gene group (all P>0.05). HtSDS and WtSDS of those patients significantly increased after treatment (-3.2±1.9 vs. -2.1±1.1, -2.5±1.5 vs. 0±1.9, t=-2.94, -5.44, both P<0.01). Serum K + and blood pH were restored eventually ((3.2±0.5) vs. (4.0±0.5) mmol/L, 7.27±0.07 vs. 7.37±0.07, t=-4.92, -5.25, both P<0.01). Totally 14 patients had normalized serum potassium, 12 patients had normalized blood pH, but only 4 patients had normalized serum bicarbonate concentration and normal base excess. Conclusions:The age of onset of patients who had SLC4A1 gene mutation was older than that of patients with ATP6V0A4 gene and ATP6V1B1 gene mutations. However, there was no obvious correlation between the condition and prognosis of the dRTA patients and pathogenic genes. Early diagnosis, early treatment, regular follow-up and timely adjustment of the dosage of medication can significantly improve the prognosis of dRTA in children. Serum bicarbonate concentration and actual base excess might not be the necessory indicators to assess clinical recovery.

Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple systems and organs.Lupus nephritis (LN) is the most common and serious complication of SLE, which is an important cause of end-stage renal disease and death in children.With the in-depth exploration of the immune pathogenesis of SLE, the greatly accelerated development of biological agents significantly improve the prognosis of pediatric LN.This study aims to review the current situation of biological agents in the treatment of pediatric LN, which provides references for optimizing the clinical therapeutic strategies of pediatric LN.

Objective:To investigate the effect of high glucose on scavenger receptor-A (SR-A) in human glomerular mesangial cells (HMC) and explore the mechanism of inflammatory injury mediated by SR-A in HMC cultured in high-glucose medium.Methods:According to the concentration of D-glucose in culture medium, HMC were divided into normal glucose group (5.5 mmol/L) and high glucose group (30 mmol/L), with mannitol group as hypertonic control. High glucose group was transfected with SR-A small interfering RNA (siSR-A) and the transfection control (siNC) group were set up. Western blotting technology was used to detect the levels of SR-A, NOD-like receptor family pyrin domain-containing 3 (NLRP3), interleukin-1β (IL-1β) protein. Immunofluorescent staining was applied to measure the SR-A in HMC. The mRNA of NLRP3, Caspase-1, IL-1β, FN, ColⅣ, α-SMA and GRP78 were detected by real-time quantitative PCR. The relative activity of Caspase-1 was detected by enzyme method and the concentration of IL-1β in culture medium was detected by enzyme linked immunosorbent assay. Flow cytometry was used to measure the cell cycles of HMC. One-way ANOVA and SNK-q test were used for statistical analysis.Results:The protein level of SR-A in high glucose group was higher than that in normal glucose group and mannitol group (1.23±0.21 vs. 0.68±0.10, 1.23±0.21 vs. 0.78±0.13, all P<0.05). In addition, mean fluorescence intensity of SR-A, protein levels of NLRP3 and IL-1β, mRNA of NLRP3, Caspase-1 and IL-1β, relative activity of Caspase-1 as well as the concentration of IL-1β in high glucose group were all significantly higher than those in normal glucose group and mannitol group (all P<0.05).After transfection induced silencing, SR-A protein in high glucose siNC group was higher than that in high glucose siSR-A group and normal glucose siNC group (1.23±0.10 vs. 0.20±0.01, 1.23±0.10 vs. 0.87±0.01, all P<0.01). In high glucose siNC group, the NLRP3, IL-1β proteins, the NLRP3, Caspase-1 and IL-1β mRNA, all of the mRNA levels of FN, ColⅣ, α-SMA, GRP78 and the proportion of DNA synthesis phase were all higher than those in high glucose siSR-A group and normal glucose siNC group (all P<0.05). Conclusion:High glucose can promote abnormal cell proliferation, increase mesangial matrix production and enhance oxidative stress response through upregulating SR-A expression, and ultimately aggravate cellular inflammatory damage in HMC, which may be associated with NLRP3-Caspase-1-IL-1β pathway regulated by SR-A expression.

Objective:To explore the differences in clinical indicators of different pathological types of children with hematuria as the main manifestation, and to establish a BP neural network prediction model based on clinical data.Methods:The clinical data and renal pathological results of children who were referred to Children′s Hospital of Chongqing Medical University from June 2003 to December 2018 for evaluation of hematuria as the main manifestation were collected, the significant differences in these clinical indicators were analyzed, and a BP neural network model for predicting renal pathology in children with hematuria as the main manifestation was established.Results:A total of 438 cases were enrolled in this study, including 232 males and 206 females, with the onset age of (7.00±3.15) years old.According to different clinical manifestations, the children were divided into microscopic hematuria group(179 cases), gross hematuria group(81 cases), microscopic hematuria and proteinuria group (44 cases), and gross hematuria and proteinuria group(134 cases). There were significant differences in sex ratio, onset age, course of disease, inducement, Addis count of urinary red cells, 24-hour proteinuria, blood urea nitrogen, serum creatinine, serum albumin and serum IgA levels among different clinical manifestations (all P< 0.05). Pathological grouping indicated that there were significant differences in sex ratio, onset age, course of disease, family history, Addis count of urinary red cells, 24-hour proteinuria, blood urea nitrogen, serum creatinine, serum albumin, serum IgA and C 3 levels among different pathological groups (all P< 0.05). The BP neural network prediction model was then constructed based on the above indicators, and the accuracy of the prediction model was measured to be 61.19% by using the leave one out method. Conclusions:By comparing the differences of various indicators under different clinical manifestations and pathological types, a BP neural network prediction model for renal pathology in children with hematuria as the main manifestation is established.The model can accurately predict renal pathology with the help of related indicators, and provides a basis for determining the time of kidney biopsy.

Objective: To establish the pathological grades of Henoch-Schönlein purpura nephritis(HSPN) in children with diagnostic prediction models by stepwise Fisher discriminant in children. Methods: Based on the investigation of 28 clinical indicators from 144 cases with HSPN came from Children′s Hospital of Chongqing Medical University, the sensitive indicators were found and stepwise Fisher discriminant model was established and its accuracy in predicting the pathological classification of HSPN was tested. Results: There were 5 laboratory indicators and clinical manifestations with different pathological grades of HSPN.In children with pathological grade Ⅱ, Ⅲ and Ⅳ, 5 indicators were screened (P<0.05) and stepwise Fisher discriminant models were established.And the correct rate of comprehensive diagnosis was (61.371±8.740)% in 100 random sampling diagnostic simulations; in children with pathological grade Ⅲa and Ⅲb, 5 indicators were also screened (P<0.05) and stepwise Fisher discriminant models were established.And the correct rate of comprehensive diagnosis was (68.015±5.736)% in 100 random sampling diagnostic simulations. Conclusions The stepwise Fisher discriminant models established in this research have a better diagnostic accuracy in forecasting for pathological grade of HSPN, and have a certain guiding value on early treatment and prognosis evaluation of children with newly diagnosed HSPN.

Objective: To systematically analyze the risk factors for urinary tract infection (UTI) in children with primary nephrotic syndrome (PNS), in order to provide scientific evidence for clinical prevention. Methods: Eight databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang Database, Chinese Science and Technology Periodical Database and Chinese Biological Medical Literature Database were retrieved for the case-control studies on PNS complicated with UTI in children.According to the inclusion and exclusion criteria, eligible studies were selected for meta-analysis by using RevMan 5.3 software. Results: Finally, 12 case-control studies were included, 917 children in the case group and 2 784 children in the control group.Compared with children without UTI, statistically significant difference existed in children with UTI of elevated 24-hour urine protein [standardized mean difference (SMD)=0.45, 95% CI: 0.02-0.88], decreased serum albumin (SMD=-1.06, 95%CI: -1.14--0.97), elevated serum cholesterol [weighted mean difference (MD)=2.28, 95%CI: 1.61-2.95], elevated serum low density lipoprotein (SMD=0.57, 95%CI: 0.37-0.77), decreased plasma IgG (SMD=-0.76, 95%CI: -0.94 to-0.58), elevated plasma IgM (MD=0.28, 95%CI: 0.11-0.46), high-dose hormone (MD=0.75, 95%CI: 0.58-0.92), and long time hormone use[<15 d odds ratio (OR)=-0.20, 95%CI: 0.10-0.42; ≥15 d OR=5.00, 95%CI: 2.38-10.50]. Conclusions Massive proteinuria, hypoalbuminaemia, hypercholesterolemia, high level of low density lipoprotein, decreased plasma IgG, high-dose hormone and long time hormone use are risk factors for UTI in children with PNS.

Objective To provide a reference for early detection and diagnosis of nutcracker syndrome(NCS) by analyzing the clinical features of children with NCS in different age groups and different gender groups.Methods Data of 112 children with simple NCS diagnosed at the Department of Nephrology of Chongqing Children's Hospital from January 2008 to January 2018 were analyzed retrospectively.Follow-up was conducted.Results In children with NCS,71 girls accounted for 63.4％,mainly in preschool age(82.4％,28 cases);41 boys accounted for 36.6％,mainly in school age(48.5％,8 cases) and adolescence(42.2％,7 cases).Fifty-one point two percent (21/41 cases) of boys presented with both hematuria and proteinuria after activities,60.6％ (43/59 cases) of girls presented with isolated hematuria after activities,while 46.7％ (21/45 cases) children in adolescence were most likely to appear lumbar and abdominal pain after activities,and the incidence of boys(63.2％,12 cases) was higher than girls (34.6％,9 cases),and the differences above were all statistically significant (x2 =6.939,P ＜ 0.05).The 24-hour urinary protein level in adolescent group was significantly higher than that in 2 groups of younger children,and the male children[0.09 (0.02-0.21) g/d] in this group were significantly higher than that in female children[0.06 (0.01-0.21) g/d] (x2 =6.48,P ＜ 0.05).The detection rate of CT angiography (CTA) (95.7 ％,67/70 cases) was significantly higher than that of color Doppler ultrasound (82.4％,75/91 cases),and the difference was statistically significant (x2 =6.721,P ＜ 0.05).Children with NCS in adolescence had smaller aortomesenteric angles (AMA) and larger ratios of the internal diameter of left renal vein(LRV) 's dilation part (a) to the stenosis part(b) (a/b) than those in preschool age and school age,and the difference was statistically significant (F =4.797,P ＜ 0.05).By follow-up of 96 cases for 3 months-7 years,there were 51 cases(58.0％) whose urine was back to normal in 88 cases who had reexamination of urine,and among the 54 patients who underwent color doppler ultrasound,25 cases(46.3％) showed relief of LRV compression.Conclusions There are more girls with NCS than boys,and girls are mainly in preschool age and always present with isolated hematuria,while boys are mainly in school age and adolescence and always presented with both hematuria and proteinuria.Children in adolescence were most likely to appear lumbar and abdominal pain,and boys have a higher incidence rate than girls.Children in school age and adolescence have the relatively higher quantitation level of proteinuria,and the smaller AMA and the larger a/b ratio,the more serious compression of LRV,and it's especially obvious in adolescence.

Objective To explore the risk factors of acute kidney injury (AKI) in very low birth weight (VLBW) infants. Method The clinical data of 313 VLBW newborns aged under 3 days from January 2012 to December 2016 were retrospectively analyzed. According to the improved KDIGO standard of neonatal AKI, the difference between AKI (group AKI) and non AKI (group NAKI) newborns was compared, and the risk factors of AKI and mortality of AKI infants were analyzed. Results In the 313 VLBW infants, 126 had AKI and the incidence rate was 40.3％. There were 53 cases at stage 1 (42.1％), 43 cases at stage 2 (34.1％), and 30 cases at stage 3 (23.8％). Compared with NAKI group, patients in AKI group were lower in gestational age, birth weight, 5-minute Apgar score, critical score and mean arterial pressure. Furthermore, AKI group was higher in mother's age, incidence of premature rupture of membranes and respiratory failure. Also, white blood cells number and procalcitonin level were higher; albumin and sodium levels were lower; more cases had invasive mechanical ventilation after birth; time of mechanical ventilation was longer; mortality were higher in AKI group. There were statistically differences (P<0.05). Multivariate logistic regression analysis showed that gestational age, respiratory failure and invasive mechanical ventilation at birth were independent risk factors for AKI in VLBW infants. More severe acidosis and associated pulmonary hemorrhage at admission were the independent risk factors for the death caused by AKI in children. Conclusions Short gestational age, respiratory failure, and invasive mechanical ventilation at birth significantly increased the risk of AKI in VLBW infants. The more severe metabolic acidosis and pulmonary hemorrhage increased the risk of death in AKI children .

Objective: To analyze the clinical features, etiological distribution and drug sensitivity of primary nephrotic syndrome (PNS) complicated with urinary tract infection (UTI) in children. Methods: The clinical data and etiological characteristics of 221 PNS patients complicated with UTI were retrospectively analyzed, who were hospitalized from January 2008 to December 2017 in the Department of Nephrology, Children′s Hospital of Chongqing Medical University. Results: The PNS patients complicated with UTI were mainly preschoolers (129/221 cases, 58.4%). The incidence of relapsed PNS with UTI (134/822 cases, 16.3%) was higher than that of initial PNS with UTI (87/1 663 cases, 5.2%), and the difference was statistically significant (χ²=83.200, P<0.05). The clinical manifestation was mainly present with asymptomatic bacteriuria (173/221 cases, 78.3%). The proportions of relapsed PNS (112/173 cases) and using prednisone and/or immunosuppressant(126/173 cases) in asymptomatic UTI group were respectively significantly higher than those of the symptomatic UTI group (22/48 cases and 27/48 cases, respectively), and the difference was statistically significant (χ²=5.627, 4.850, all P<0.05). The incidence of recurrent UTI (RUTI)was 13.1% (29/221 cases). Compared with initial UTI group, RUTI group had longer course [(9.3±3.5) months vs.(4.4±3.7) months, t=9.427, P<0.05], and significantly higher proportions of relapsed PNS (29/29 cases vs.105/192 cases, P<0.05), using prednisone and/or immunosuppressant (26/29 cases vs.127/192 cases), decreased hemoglobin(Hb)(14/29 cases vs.51/192 cases) and complement C₃ (14/29 cases vs.31/192 cases) and higher abnormal rate of urinary system (7/29 cases vs.6/192 cases) (χ²=5.480, 5.721, 16.039, 20.094, all P<0.05). Gram-negative bacteria were the dominant pathogens (174/263 cases, 66.1%), and Escherichia coli was the main bacteria (54/263 cases, 20.5%). The proportions of Escherichia coli, Pseudomonas aeruginosa and extended-spectrum β-lactamases(ESBLs) producing bacteria were significantly higher in RUTI group than those in initial UTI group(26/62 cases, 11/62 cases, 21/62 cases vs.28/201 cases, 15/201 cases, 15/201 cases)(χ²=22.776, 5.620, 27.970, all P<0.05). The drug sensitivity test indicated that gram-negative bacteria were more sensitive to Amikacin, Meropenem, and Piperacillin/Tazobactam, and gram-positive bacteria were more sensitive to Vancomycin, Linezolid and Teicoplanin. Conclusions Preschoolers with PNS and relapsed PNS are prone to UTI.The clinical manifestation of UTI was mainly presented with asymptomatic bacteriuria.UTI should be considered when children with PNS relapsed.PNS with longer course, anemia, decreased complement, and urinary system abnormity may be more likely to develop RUTI.Gram-negative bacteria were the dominant pathogens.Escherichia coli was the main bacteria with high drug resistance and ESBLs producing bacteria may be more common in RUTI.Piperacillin/Tazobactam could be the first choice of empirical antimicrobial agents for PNS complicated with UTI.