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OBJECTIVE: To explore the possible correlation between the expression of the renin angiotensin system (RAS) and renal pathologic lesions, and to study the mechanism of renal progressive damages in children with the nephrotic syndrome (NS).METHODS:  Eighty five children (64 boys and 21 girls) with the primary NS were involved in this study. Renal biopsies were performed in all of them. In situ hybridization was used to semiquantitate ACE mRNA expression in renals. Histopathological lesions of renals were evaluated by the method of counting score. RESULTS: ①The percentage of ACE mRNA positive cells in glomerulars of the children with NS was higher than that in normal glomerulars [( 22.61 ± 12.3 ) % vs ( 3.97 ± 1.43 ) %; P< 0.01 ]; so was it in tubulointerstitiums [( 58.42 ± 17.61 ) % vs ( 19.15 ± 5.96 ) %; P< 0.01 ]. ②No differences of ACE mRNA expression and histopathological lesions in tubulointerstitiums among the 5 different pathologic types (MCD, FSGS, MN, MPGN and MsPGN) were found. There were significant differences in ACE mRNA expression and histopathological lesions in glomerulars of the children with MCD compared with those with FSGS, MN, MPGN or MsPGN (all P< 0.01 ). ③There were significant differences in the percentage of ACE mRNA expression positive cells between the children with different degrees of kidney pathologic lesions [mild=( 30.50 ± 6.52 ) %; moderate=( 45.20 ± 11.06 ) %; severe=( 54.77 ± 11.86 ) %; P< 0.01 ].CONCLUSIONS: The RAS disorder in situ renals might be one of the important causes of progressive renal lesions in children with NS.

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OBJECTIVE: To study the therapeutic effects of recombinant human erythropoietin (rhu Epo) on anemia of prematurity in very low birth weight (VLBW) infants. METHODS: Fifty six VLBW premature infants were randomly assigned into two groups: the treated group (n=30) and the control group (n=26). The treated group received rhu Epo (300 IU/kg) twice weekly for 4 weeks by subcutaneous injection from the 8 th day of life, and was treated with oral supplement of vitamin E (5～10 mg/kg.d) from the 3 rd week of life. Oral supplement of vitamin E (5 mg/kg.d) and folic acid (5 mg/d) was given in the two groups from the 7 th day of life. They were followed up until 4 months of age. RESULTS: ①The Hb, RBC and Reticulocyte (Ret) counts in the treated group and the control group decreased gradually. There were significant differences in Hb, RBC and Ret between the two groups on the 7 th , 14 th , 21 st , 28 th and 35 th day (P< 0.01 or 0.05 ). ②After the treatment, the serum iron protein level in the treated group significantly differed from that of the control group [( 103 ± 25 μmol/L vs (123±24) μmol/L](P< 0.01 ). ③The prevalence of anemia in the treated group was obviously lower than that in the control group (43% vs 89%) (P< 0.01 ). CONCLUSIONS:  Early administration of high dosage rhu Epo can reduce the degree of anemia of prematurity and reduce or even replace the need of blood transfusion.

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OBJECTIVE: To investigate the role of Pax8 in the pathogenesis of congenital hypothyrodism. METHODS: Genomic DNA was extracted from peripheral blood lymphocytes and PCR SSCP Direct DNA sequencing was applied to study exon 2～exon 9 of Pax8 gene in fifty patients who had been detected by neonatal screening or endocrinologists and diagnosed as having congenital hypothyroidism. RESULTS: No mutation was demonstrated in the encoding regions of Pax8 gene. CONCLUSIONS: Structural changes in Pax8 gene may not play an important role in pathogenesis of primary congenital hypothyroidism.

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OBJECTIVE: To evaluate dynamic changes in serum cardiac troponin I (CTnI) levels and myocardial enzyme activities following asphyxia in newborns.METHODS: Serum CTnI levels, and creatine dinase (CK), creatine kinase MB isoenzyme (CK MB), lactic dehydrogenase (LDH) and aspartate aminotransferase (AST) activities were measured by the automatic chemoluminescence and biochemical assay at 0, 6, 12, 24, 72 hr and 10 days in 26asphyxiated newborns ( 16 with mild asphyxia and 10 with severe asphyxia) and in 10 non asphyxiated neonates.RESULTS: Serum CTnI levels, and CK, CK MB, and LDH activities in both mild and severe asphyxia infants were significantly higher than those in the controls (P< 0.01 ). In the asphyxiated infants, the peak values of CK and AST occurred at 6 hr, of CTnI and LDH at 12 hr, and of CK MB at 12～24 hr of life. The levels declined gradually after treatment. CONCLUSIONS: Determination of serum levels of CTnI and CK, CK MB, LDH, and AST activities are helpful in making an earlier diagnosis and in planning effective treatment for myocardial damage following asphyxia in newborns.

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OBJECTIVE:To study the dynamic changes and the role of serum cytokines in the systemic inflammatory response syndrome (SIRS)/and multiple organ dysfunction syndrome(MODS) caused by central nervous system (CNS) diseases and the relationships with the severity of SIRS/MODS. METHODS: Twenty six children with CNS diseases admitted to the PICU were assigned into the SIRS group (n=16) and non SIRS group (n=11). The levels of TNF α,IL 1β and IL 6 were determined using the immulite chemiluminescent immunometric analyzer for the two groups on day 1, 3 and 5. RESULTS: The levels TNF α,IL 1β and IL 6 in the SIRS group were remarkably higher than those in the non SIRS group on day 1, 3 and 5 (P< 0.05 ). In the SIRS group, the levels of TNF α,IL 1β and IL 6 in the MODS cases and death cases were significantly higher than those in the non MODS cases and non death cases on day 1, 3 and 5 (P< 0.01 ). Moreover, these indexes of the death patients remained high continuously. CONCLUSIONS:TNF α, IL 1β and IL 6 may be valuable in assessing the degree of severity and the prognosis of SIRS/MODS caused by CNS diseases. They are helpful in making effective treatments and preventive measures for SIRS/MODS caused by CNS diseases.

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OBJECTIVE: To study the changes and clinical significance of circulating endothelial cells in childhood acute bacillary dysentery. METHODS: Thirty children with acute bacillary dysentery (treatment group), and 30 cases of viral enteritis (control group) were studied. The treatment group was further divided into two sub groups: treatment sub groupⅠ (8 cases with toxic bacillary dysentery) and treatment sub groupⅡ (22 cases with ordinary bacillary dysentery). The number of circulating endothelial cells (CEC) in the blood was determined by the flow cytometry on the 1st day and the 5th day of the disease. RESULTS: The CEC level of the treatment group on the 1st day ( 4.57 ± 0.69 ) was higher than that in the same group on the 5th day ( 1.06 ± 0.15 ), and higher than the control group on the 1st day ( 1.22 ± 0.23 ) and 5th day ( 1.18 ± 0.20 ) (P< 0.01 ). The CEC level of the treatment sub group Ⅰwas markedly higher than that in the treatment sub group Ⅱ on the 1st day [( 5.43 ± 0.50 ) vs ( 4.25 ± 0.44 )] (P< 0.05 ). There was no difference in the CEC level between the two treatment groups on the 5th day. CONCLUSIONS: CEC may be important in discerning children with acute bacillary dysentery, and be a pathologic target in making an early diagnosis and selecting effective treatments.

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OBJECTIVE: To study the features of toxoplasmosis in children in order to develop effective treatment and prophylaxis regimens.METHODS: The levels of IgG and IgM of toxoplasma gondii were measured using ELISA in 807 inpatient children. Meanwhile, the subjects' living habits and dietary habits were studied. RESULTS: Of the 807 cases, the positive rates of IgG and IgM of toxoplasma gondii were 3.22% and 1.98% respectively; the titres rose with age in all the subjects except for neonates. The positive rate of toxoplasma gondii IgG in children who had contact with cats or dogs was higer than that in children who had not contact with cats or dogs ( 6.01% vs 2.04% ), P< 0.05 . The positive rates of toxoplasma gondii IgG and IgM in those who did not consume half cooked mutton and chafing dish food and did not share the same chopping board for cooked and half cooked food were lower than those of children who had bad living and dietary habits ( 2.78% vs 9.43% , 1.06% vs 15.09% ), P< 0.01 . CONCLUSIONS: It is important to emphasize health education and to develop good living habits and dietary habits in order to eradicate toxoplasmosis.

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OBJECTIVE: To investigate the long term effects of a high protein diet on glucose metabolism after early postnatal malnutrition in rats with intrauterine growth retardation (IUGR).METHODS: An IUGR rat model was established by passive smoking. One hundred and twenty nine IUGR pups were assigned randomly into 3 groups: IUGR control group, IUGR low protein group and IUGR high protein group. Forty two normal pups were used as controls. Both the IUGR control group and the non IUGR controls were fed with a 20% (normal) protein diet after birth. Both the low protein and high protein IUGR groups were fed with an 8% low protein diet for the first 4 weeks of life, and then the former were fed with a 20% protein diet, while the latter were fed with a 30% high protein diet. The glucose tolerance test and insulin release test were performed at the 4th, 6th and 48th weeks of life and the insulin sensitive index (ISI) was calculated in the four groups. RESULTS: Although the fasting blood glucose was normal in the low protein and high protein groups at the 4th week, the fasting plasma insulin, and blood glucose and insulin concentrations after glucose loading increased and ISI decreased compared with the controls (P< 0.01 ). At the 6th week the fasting blood glucose was normal and the fasting plasma insulin declined, while ISI increased in the low protein and high protein groups. These were significantly different from the controls (P< 0.05 ). By week 48, both the fasting plasma glucose and insulin concentration in the high protein group [( 5.97 ± 0.88 ) mmol/L and ( 42.28 ± 13.36 ) μU/ml, respectively] and the low protein group [( 5.24 ± 1.35 ) mmol/L and ( 31.22 ± 3.36 ) μU/ml, respectively] were significantly higher than those of the controls [( 4.46 ± 1.11 mmol/L and ( 15.82 ± 1.63 μU/ml, respectively]. At the same time, the level of ISI in the high protein group ( 1.32 ± 0.56 ) and the low protein group ( 1.71 ± 0.44 ) declined compared to the controls ( 2.80 ± 0.15 ) (P< 0.01 ). The fasting plasma glucose was normal and the fasting insulin concentration recovered in the IUGR control group. However, after glucose loading, both plasma glucose [( 11.39 ± 1.23 ) mmol/L] and insulin concentrations [( 32.16 ± 4.76 ) μU/ml] were higher than control values [( 7.99 ± 0.92 ) mmol/L and ( 21.70 ± 2.09 ) μU/ml, respectively; P< 0.05 ]. CONCLUSIONS: A long term high protein diet may result in impaired glucose tolerance and severe insulin resistance in IUGR rats with protein malnutrition in early life. Both intrauterine nutrition and early postnatal nutrition have remarkable long term effects on glucose metabolism in IUGR rats.

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OBJECTIVE: To study changes in plasma fibrinolysis and their relationship with pulmonary artery pressures in neonates with lung diseases. METHODS: Plasma activities of the tissue plasminogen activator (TPA) and tissue plasminogen activator inhibitor (PAI) were measured by chromogenic substrate methods in 27 newborns with lung diseases [10 with the respiratory distress syndrome (RDS), 12 with the meconium aspiration syndrome (MAS) and 5 with pneumonia] and in 25 normal newborns (controls). The ratio of the time of peak velocity (TPV) to the right ventricular ejection time (RVET) was determined using an Aloka SSD650 ultrasound system incorporating pulse waves to evaluate pulmonary artery pressures. RESULTS: PAI activity was significantly higher in infants with lung diseases [( 9.3 ± 4.1 ) AU×10 -1 /ml] than in the controls [( 5.5 ± 3.0 ) AU×10 -1 /ml] (P< 0.01 ). The ratio of TPV to RVET was lower in the newborns with lung diseases ( 0.29 ± 0.05 ) than in the controls ( 0.34 ± 0.08 )(P< 0.05 ). Elevated pulmonary artery pressures appeared to be involved in the fibrinolytic dysfunction in the infants with lung diseases. In 10 infants who developed pulmonary hemorrhage, TPA activity [( 1.8 ± 0.7 ) IU×10 -1 /ml)] and platelet counts [( 98 ±39)×10 9/L] in the acute phase of injury were significantly lower than those recorded during the recovery stage [( 3.7 ± 1.7 ) IU×10 -1 /ml and (180±30)×10 9/L, respectively] (P< 0.01 ). CONCLUSIONS: Following pulmonary hypertension, endothelial cell injury results in a lower release of TPA and increased PAI activity.

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OBJECTIVE: To study if IL 15 or GM CSF, or their combination can activate NKT cells from the normal childhood peripheral blood; and if activated NKT cells can kill neuroblastoma cells. METHODS: T cells obtained from the normal childhood peripheral blood were activated by stimulation under IL 15 alone or GM CSF alone, or their combination. The proliferation of T cells was measured by MTT methods. NKT cells were identified and isolated on the basis of surface phenotype by two color flow cytometry. Cytotoxicity on neuroblastoma cell line LA N 6 mediated by NKT cells was investigated. RESULTS: The proliferation of T cells in the IL 15, GM CSF stimulation group and the combination group was higher than the non stimulated controls ( 1.25 fold, 1.2 fold, 1.4 fold, respectively; all P< 0.01 ); the surface antigen expression of NKT cells was up regulated compared with the controls (2.56 fold, 3.27 fold, 4.39 fold, respectively; P< 0.01 or <0.05 ). The cytotoxicity of NKT cells stimulated by GM CSF alone or by IL 15 plus GM CSF was enhanced compared with the controls (P< 0.01 ). There was no difference in the cytotoxicity between the IL 15 stimulation group and the controls. The proliferation of T cells was enhanced in the IL 15 plus GM CSF stimulation group compared with the GM CSF stimulation group; but there was no difference in the surface antigen expression and the cytotoxicity of NKT cells between the two experimental groups. The surface antigen expression and the cytotoxicity of NKT cells were higher in the IL 15 plus GM CSF stimulation group compared with the IL 15 stimulation group; but there was no difference in the proliferation of T cells between the two experimental groups. There was no difference in the proliferation of T cells, the surface antigen expression and the cytotoxicity of NKT cells between the IL 15 and GM CSF stimulation groups, either. CONCLUSIONS: IL 15 and GM CSF could induce the proliferation of NKT cells of normal children and enhance its function; the synergistic effects of NKT cell proliferation will be achieved if IL 15 and GM CSF are combined.

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OBJECTIVE: To study the effects of exposure to low level lead on neurobehaviors of preschool children. METHODS: Blood lead levels were measured in 211 preschool children aged 4-6 years in a kindergarten without known exposure to lead sources; the 211 children were assigned into two groups: low blood lead level group (LL group, <100 μg/L ) and high blood lead level group (HL group, ≥100 μg/L). Their neurobehaviors were assessed with Achenbach child behavior checklist (CBCL) to study the relationship between blood lead and CBCL total behavior scores (TBPs), internalizing and externalizing scores (Ints and Exts).RESULTS:The Exts and incidence of abnormal behavior problems in the HL group ( 13.28 ± 6.26 and 18.26% , respectively) were much higher than those in the LL group ( 9.98 ± 5.46 and 7.29% , respectively)(t= 4.0677 , χ 2= 5.470 , P< 0.05 ). The blood lead level was positively correlated significantly with the scores for hyperactivity, attack and disobedience (r= 0.3164 , 0.2828 , 0.1886 , P< 0.05 ). When the blood lead levels of children reached or exceeded 150 μg/L, the incidence of abnormal behavior problems increased significantly. CONCLUSIONS: Low level lead exposure can have adverse effects on neurobehaviors of preschool children.

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OBJECTIVE: To evaluate the influence of long term inhalation of beclomethasone dipropionate on pituitary adrenal axis function in asthmatic children. METHODS: The subjects of the study were randomly divided into four groups: normal controls, asthmatic children not receiving inhalation therapy, asthmatic children receiving short term inhalation of beclomethasone dipropionate, and asthmatic children receiving long term inhalation of beclomethasone dipropionate. The levels of ACTH and cortisol were measured using the radio immunoassay. RESULTS: There were no differences in baseline ACTH and cortisol levels between the four groups. However, both the short term [( 328.51 ± 84.62 ) nmol/L] and long term inhalation groups [ 321.79 ± 86.06 ) nmol/L] had lower cortisol responses to ACTH stimulation compared to the asthmatic children not receiving beclomethasone [( 416.16 ± 94.52 ) nmol/L; P< 0.05 ]. CONCLUSIONS: Inhaled glucocorticoid therapy may slightly inhibit the function of the adrenal gland in asthmatic children, but long term therapy does not result in additional pituitary adrenal axis suppression.