Background: IgA vasculitis nephritis (IgAVN) is a common form of secondary glomerulonephritis and can occur in patients of any age. Our study was designed to reveal renal histopathological manifestations of children and adults with IgAVN and to explore the potential pathogenesis of IgAVN.Methods: Sixty-one pediatric and seventy adult patients with IgAVN were enrolled altogether, and all of them underwent kidney biopsies. General information, laboratory parameters, and renal histopathological manifes-tations of all patients were analyzed. Results: (1) Diabetes, hypertension, and various levels of proteinuria made no difference between children and adults. (2) Global sclerosis and tubular atrophy/interstitial fibrosis occurred more commonly in adults than in children (24.29 % vs 8.20 %, 65.71 % vs 9.84 %, respectively) (P < 0.05). (3) The immunofluorescence depo-sition of complement C3 was more apparent in adults (P < 0.05). (4) The deposition of IgA, IgG, IgM, and C3 in kidneys was unrelated to the pathological types. (5) The deposition of IgG or IgM was related to the deposition of IgA or C3 in children and adults (P < 0.05).Conclusions: Chronic kidney injury occurred more commonly in adult IgAVN patients compared to pediatric IgAVN patients. Immunoglobulin and complement deposits in kidneys were independent of the types of renal pathological injury. Additionally, IgG and IgM were probably involved in IgAVN pathogenesis.

目的 总结儿童噬血细胞淋巴组织细胞增多症(Hemophagocytic lymphohistiocytosis,HLH)的有效诊治方法.方法 对5例HLH患儿的临床资料作回顾性分析.结果 5例患儿均表现为不规则高热,发热时间7～21天,其中伴有皮疹2例、咳嗽3例、眼睑水肿2例、肝脾肿大2例、淋巴结肿大3例.实验室检查血小板<100×109/L 3例、中性粒细胞绝对数<1.0×109/L 3例;血清甘油三酯、乳酸脱氢酶水平升高5例,纤维蛋白原降低1例;血清铁蛋白(SF)≥500μg/L 5例,血清白细胞介素2R水平升高5例;2例患儿骨髓穿刺细胞学检查均可见噬血细胞;EB病毒感染阳性2例,自身免疫性疾病相关抗体阳性1例.5例患儿均予抗感染治疗,同时联合激素、免疫抑制剂治疗,4例患儿好转出院.结论 儿童HLH的主要临床表现为发热,可伴有皮疹、肝脾肿大等.实验室检查、骨髓细胞学检查结合临床表现可明确HLH诊断.抗感染治疗联合激素、免疫抑制剂治疗HLH效果较好.

目的 探讨孕产妇与婴儿ABO血型不合导致新生儿溶血的相关指标检测及意义,为临床诊断及治疗提供参考依据.方法 选取2018年1月-2020年1月在界首市人民医院进行治疗的112例孕产妇与婴儿ABO血型不合患者的临床资料为研究对象.根据是否溶血分为观察组(溶血患儿)32例,对照组(非溶血患儿)80例.比较患者的血清抗体水平、溶血三项检测、溶血发病率与孕妇产前抗体的差异.结果 观察组血清总胆红素、胆红素、组织纤溶酶原激活物、纤溶酶原激活物抑制物-1明显高于对照组,差异有统计学意义(P＜0.05).112例新生儿脐带血中,A型男30例,女26例,阳性率为12.50％(14/112);B型男29例,女27例,阳性率为16.07％ (18/112).A型的红细胞抗体释放试验、直接抗人球蛋白试验、血清游离抗体试验阳性率与B型比较,差异有统计学意义(P＜0.05).溶血发病率与孕妇产前抗体比较发现,IgA(B)抗体效价越大新生儿溶血发生率越高.结论 孕产妇母婴ABO血型不合导致新生儿溶血发生率较多,新生儿溶血病患儿存在纤溶与抗纤溶作用的平衡失调,且与IgA (B)抗体效价相关.

目的:分析小儿消化性疾病的胃电图变化及与临床病理特征和胃镜特征的关联性.方法:选取2018年1月至2019年5月我院儿科收治的经胃镜和病理学两种方式诊断为消化性疾病的患儿54例为观察组,另选取无胃肠道疾病的健康儿童40例为对照组.比较两组胃电图参数(频率均值和波幅均值),54例胃电图诊断后纤维胃镜检查结果,分析消化性疾病患儿HP感染与临床病理特征、溃疡面积的关系.结果:各组胃病患者胃电慢波频率均值各不相同(P＜0.05),三组患者胃电慢波波幅均值相比差异具有统计学意义(P＜0.05);且浅表性胃炎组、胆汁反流性胃炎组患者胃电慢波频率均值、胃电慢波波幅均显著低于胃溃疡组(P＜0.05);浅表性胃炎组患者胃电慢波频率均值显著低于胆汁反流性胃炎组(P＜0.05).胆汁反流性胃炎组患者胃电慢波波幅显著低于浅表性胃炎组(P＜0.05).胃镜检查结果显示,其中浅表性胃炎的诊断符合率较高,达90.00％,胃溃疡符合率为60.71％,胆汁反流性胃炎符合率为83.33％.HP检测结果显示,HP阳性患儿占总例数的77.78 ％(42/54),HP阴性患儿占总例数的22.22 ％(12/54);HP阳性组患儿淋巴滤泡形成、胃黏膜萎缩、胃黏膜炎性活动的发生率明显高于HP阴性组,差异具有统计学意义(P＜0.01);HP阳性组溃疡范围＞2 cm的患儿比例明显高于HP阴性患儿,差异具有统计学意义(P＜0.01).结论:小儿消化性疾病胃电图存在餐后NSWP的下降及节律过缓的上升,胃电图检查和胃镜检查在诊断上有较高的符合率,HP感染科引起胃黏膜组织学改变,可作为小儿消化性疾病的靶向治疗.

Objective To investigate the effect of intestinal flora from children with Irritable Bowel Syndrome (IBS) on intestinal motility and acid-sensitive ion channel expression in mice. Methods Fecal samples of children with IBS identified according to Rome Ⅳcriteria and healthy children were collected and made into fecal microbiota solution. A pseudo-aseptic mouse model was established, mice were randomly divided into two groups:the control group was given fecal microbiota solution of healthy children,and the experimental group was given fecal microbiota solution of IBS children. The intestinal propulsion rate was measured, Serum Motilin (MOT) and Gastrin (Gas) were determined by ELISA, the expression and distribution of ASICs in intestinal tissues of mice were determined by immunohistochemistry. Results Compared with the control group, intestinal propulsion rate, serum MOT and Gas level were significantly reduced in the experimental group (P＜0.05), the expression of ASIC3 in the small intestine and colon of mice from experimental group was significantly increased (P＜0.05);the expression of ASIC3 in small intestine and colon was negatively correlated with the intestinal propulsion rate (P＜0.05). Conclusions Intestinal flora of children with IBS can promote the expression of ASIC3 in intestinal tissue of mice, and the effect of intestinal microorganism on intestinal motility may be related to the activation of ASICs.

Objective To investigate the effect of intestinal flora in children with functional constipation (FC) on expression of acid-sensitive Ion channel 3(ASIC3) in rats and their regulation in intestinal motility. Methods Faeces of FC children identified according to RomeⅣ criteria and healthy children from the First Affiliated Hospital of Anhui Medical University from December 2017 to June 2018 were collected, and then made into fecal microbiota solution.A pseudo - sterile rat model was established, according to the random number table method, and the rats were randomly divided into the treatment group and the control group, with 12 rats in each group, then the treatment group was given fecal microbiota solution of the children with FC and the control group was given fecal microbiota solution of the healthy children.The visceral sensitivity and intestinal propulsion rate of rats were determined by means of abdominal withdrawal reflex (AWR), while the intestinal microorganism of rats and children with FC were determined by 16SrDNA high-throughput sequencing, and the expressions of ASIC3 of intestinal in mRNA and protein were determined by adopting fluorescence quantitative PCR and Western blot. Results The species and quantity of intestinal flora of the children with FC and rats implanted with FC faecal bacteria were reduced(all P<0.05), and firmicutes and bacteroidetes were the main bacteria; compared to the control group, the small intestine propulsion rate(52% vs.74%) and visceral sensitivity(78 mmHg vs.63 mmHg) of the treated group were significantly decreased compared with those in the control group (all P<0.05); the mRNA (0.003 1±0.000 8 vs.0.012 4±0.002 5) and protein levels of ASIC3 (0.013 2±0.001 9 vs.0.072 1±0.008 7) in the small intestine were down-regulated significantly(all P<0.05); and the mRNA (0.002 8±0.000 7 vs.0.009 4±0.001 1) and protein levels of ASIC3(0.038 2±0.004 5 vs.0.089 7±0.009 4) in the colon were down-regulated significantly(all P<0.05). Conclusions Children with FC have intestinal flora disorder, and intestinal flora of FC children may affect intestinal motility by down-regulating the expression of intestinal ASIC3 in rats. Key words: Acid-sensitive ion channels; Intestinal flora; Visceral sensitivity; Intestinal motility; High throughput sequencing

Enterovirus 71 (EV71), as a member of the Picornaviridae family, is characterized by a single positive-strand genomic RNA known to cause hand, foot, and mouth disease (HFMD) in children. Since the first identification of EV71 infection in California in 1969, periodic epidemics have broken out worldwide [1]. In China, the first EV71 strain was isolated in 1987 by Zheng et al. [2]. Generally speaking, EV71 infection follows a benign and self-limiting course with multiple vesicles on the hands, feet and buccal mucosa. However, over the last decade EV71-associated HFMD has posed a great economic and social burden because of more frequent outbreaks with serious complications including neurological involvement, myocarditis and pulmonary edema [3, 4]. Liu et al. carried out an epidemiological analysis of an HFMD outbreak in 2010 in Nanchang city, and found that 12 (11%) patients were co-infected with both EV71 and coxsackievirus A16 (CA16) [5]. In the present report, we describe an unusual case of co-infection of EV71 and Staphylococcus aureus (SA). A 6-month-old male infant with a 4-day history of general malaise, fever, poor feeding and skin lesions was admitted to the Department of Pediatrics at the First Affiliated Hospital of Anhui Medical University in June 2012. The birth and past medical history were non-significant, and the family had no history of similar disorders. On admission, his blood pressure was 70/35 mm Hg, heart rate was 132 beats per minute, axillary temperature was 39.2°C, and O2 saturation (pulse oximetry) was 95%. Physical examination revealed the presence of sporadic pustules and papules on his lower limbs, buccal and perianal mucosa (Figure 1). There was no lymphadenopathy. Cardiac and pulmonary physical examinations were unremarkable. The abdomen showed no clinical signs of peritoneal irritation, masses, or enlarged organs. EV71 was identified from both throat swab and pustular fluid by virus isolation techniques. In addition, two blood cultures from samples obtained at admission were both positive for SA. His initial blood counts were as follows: white blood cell 19.62 × 109/l with 63.7% neutrophils, 21.3% lymphocytes, and 8.1% monocytes, hemoglobin 127 g/l, and platelet 361 × 109/l. C-reactive protein was 27 mg/l. Serum biochemistry and urinary analysis were normal. Echocardiogram demonstrated no pathologic findings. The patient was diagnosed with co-infection of EV71 and SA, mainly according to the results of the physical examination, virus isolation and blood cultures. He was treated with intravenous acyclovir, immunoglobulin and vancomycin, and bed rest for 14 days. The fever and skin lesions gradually resolved. Figure 1 Sporadic pustules and papules on lower limbs and perianal mucosa The latest large epidemic of EV71-associated HFMD occurred in China in 2008. At the epicenter in Fuyang city, Anhui province, of the 6,049 cases reported between March 1 and May 9, 2008, 3,023 patients were hospitalized, 353 cases were severe and 22 were fatal [6]. The diagnosis of EV71 infection relies mainly on laboratory identification, because not all patients have characteristic skin lesions [7]. The combination of throat swab plus vesicle fluid is most useful, and can increase isolation rates from 49% with throat swab alone, and 48% with vesicle fluid alone, to 67% [8]. EV71 is related to more serious complications. The risk factors contributing to severe HFMD are young male children (≤ 2 years old), general malaise, peak temperature ≥ 38.5°C, atypical physical findings (tachycardia, tachypnea, hypertension, pulmonary hemorrhage and limb movement disorder), leukocytosis and hyperglycemia [9, 10]. Therefore, our case was classified as severe due to the existence of several risk factors, including the fact that the patient was a 6-month-old male, with general malaise, peak temperature ≥ 38.5°C and leukocytosis. In the present report, we describe for the first time an unusual case of co-infection of EV71 and SA. Staphylococcus aureus, a Gram-positive bacterium, is one of the most common causes of both healthcare- and community-acquired infections. A large, multi-center study demonstrated that incidence of SA bacteremia in the United States ranged between 19 and 40 cases per 100,000 with the case fatality rates ranging from 19% to 24% [11]. However, the prevalence of SA infection in China is still unknown. A broad variety of infections, ranging from minor infections of the skin to severe infections such as bloodstream infections and endocarditis, can be caused by SA [12]. In the present case, the chief clinical demonstrations were general malaise, fever, pustules, leukocytosis, elevation of C-reactive protein, and a positive blood culture, which might be attributed, in part, to skin and bloodstream infections. In addition, both cardiac physical examination and echocardiogram were normal in our patient; thus there was no evidence for the existence of endocarditis. Decreased host immunity in this EV71-infected infant may place him at increased risk of SA infection. More persuasively, Furuno et al. identified 131 individual episodes of SA bacteremia among HIV-positive patients during the study period between January 1, 2003 and December 31, 2005 [13]. Furthermore, we speculate that individual host genetic factors may also contribute to co-infection of EV71 and SA. Although the pathogenesis of EV71 infection is still not fully understood, and therapeutic effects of antiviral drugs are controversial, the clinical outcome of our patient was satisfactory after intravenous acyclovir, immunoglobulin and vancomycin, and bed rest for 14 days. Vancomycin is now recommended empirically for SA infection [14]. Besides this, several clinical investigations have also indicated that the use of intravenous immunoglobulin can significantly reduce the acute mortality in patients with either EV71 or SA infection [15, 16].

ObjectiveTo investigate the etiological factors of abdominal palns and improve the diagnosis.Methods 200 hospitalized cases with abdominal palns as chief manifastation during from January 2012 to February 2014 were analyzed, including etiological factors, symptoms, physical signs and laboratory ifndings.Results Surgical acute abdomen was seen in<2 year, mesenteric lymphadenitis was seen in 2-5 year, Henoch-Schonlein purpura was seen in>5-12 year, gastritis was seen in>12 year.Conclusions The causes of acute abdomen are complex and various. More attention needs to be pald about early diagnosis.

Objective To discuss the clinical features and endoscopic characteristics of abdominal type Henoch purpura in children and its relationship with Helicobacter pylori to provide the basis for early diagnosis.Methods Retrospective analysis of 460 cases of six years of Henoch purpura in children with abdominal clinical features,as well as 69 children affected by endoscopy and endoscopic characteristics of H.pylori infection in routine testing of 122 test results.Results All children experienced abdominal pain,the location was not fixed,and the symptoms were serious,but the signs were light.After the abdominal pain for 1/2~45 days,the skin presented the purpura.Gastroscopic features included hyperemia and edema of gastrointestinal mucosa,hemorrhagic spots,erosion and ulceration,lesions mainly in the gastric antrum,body,descending duodenum and bulbar,but the duodenum mucous membrane changed in the most serious.Mucosal urease test or Western blot detection showed H.pylori-positive in 54 cases.Conclusion Abdominal type Henoch purpura presented no specific clinical features.Similar skin purpura of the stomach and duodenum are common gastroscopic characteristic,which has value of early diagnosis.Kelationship of Henoch purpura and H.pylori infection needs further study.

Objective and methods: This study established a simple stereological method to obtain quantitative information about two-or three-dimensional structures based on observations from kidney sections in the unilateral ureteral obstruction(UUO) model.Results: Tubulointerstitial area(TA) and TA/the area of a rectangular field(RA) were raised gradually, but significantly, in the obstructed kidney from 1 to 3months post-ligation in comparison to the sham kidney of sham-operated rats(SOR).On the contrary, glomerular area(GA) and glomerular volume(GV) were decreased progressively over time, but significantly, in the obstructed kidney from 3weeks to 3months post-ligation compared to the sham kidney of SOR.UUO caused a progressive decline of TA and TA/RA in the contralateral kidney.More specifically, there were significant decreases in TA at 1,2,3months post-ligation, while in TA/RA only at 3months post-ligation in comparison to the right kidney of SOR.In contrast, GA and GV enhanced in a time-dependent manner in the contralateral kidney, in which the difference in GA reached significance only at 3months post-ligation, whereas the difference in GV reached significance from 1 to 3months post-ligation when comparing with the right kidney of SOR.Conclusions: Our results confirmed two typical features of obstructive nephropathy, including widen interstitial space and glomerular atrophy in the obstructed kidney, and compensatory growth of the contralateral kidney.

过敏性紫癜（henoch-schonlein purpura,HSP）是一种主要累及全身毛细血管及细小动脉的弥漫性小血管炎性变态反应性疾病,儿科较常见。近年来该病发病率逐年增加,且易反复发作并产生多种并

Henoch-Schonlein purpura(HSP) is one of the most common blood capillary allergic disorder in children, and its pathogenesis has not been well explained. The studies show that the main mechanism of HSP is the abnormality of humoral immunity, and the role of IgA is emphaszed. Meanwhile, many agents such as changes in T cell function,participation of cytokine and mediators of intlammation, suscepti-bility gene and other factors also play an important role in the incidence of HSP. The pathogenesis of HSP can be better understood through extensive analysis of the immunology factors,genetic factors,and so on.

Objective To study the allele and genotype distribution of CD14 gene promoter region-159C/T,-260C/T polymorphisms in Chinese patients with Henoch-Schonlein purpura(HSP),and to discuss the association between CD14 gene promoter region polymorphisms and HSP.Methods Under the case-control study,CD14-159C/T and CD14-260C/T site polymorphisms in 144 children with HSP and 180 healthy controls were analyzed with polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP),and the relationship between CD14-159C/T and CD14-260C/T site polymorphisms and the risk of HSP were analyzed.SPSS 13.0 software was used to analyze the data.Results The distribution of CD14 gene-159C/T polymorphism was significantly different between gastro-intestinal(GI)involvement group,renal involvement group and healthy control group(P=0.041,0.010,respectively);but the CD14 gene-260C/T polymorphism was significantly different between simple lesion group,renal involvement group and healthy control group(P=0.003,0.037,respectively)and C and T allele were significantly different between simple lesion group,joint damage group,GI involvement group,renal involvement group,healthy control group(P=0.017,0.035,0.024,0.007)and the relative risk for different types of HSP in T allele carriers was higher than that in C allele carriers(simple lesion:OR=2.097,95%CI 1.131-3.823;joint:OR=1.603,95%CI 1.031-2.493;GI:OR=1.602,95%CI 1.062-2.415;renal:OR=1.843,95%CI 1.175-2.889;respectively).Conclusions CD14 gene promoter region polymorphism is associated with HSP and T alele of CD14-260C/T may be a risk factor for HSP.

Objective To explore whether β-amyloid protein is a kidney injury in the upper reaches of oxidative stress activated factors involved in the occurrence of nephrotic syndrome.Methods The model was established by a single intravenous injection of Doxorubicin(5 mg/kg).Normal control group received the same volume of sodium chloride solution.Maleic dialdehyde(MDA),superoxide dismutase(SOD),total antioxygen capability(T-AOC)were detected by kit.SABC immunohistochemistry was used to observe the conditions of β-amyloid deposition in experimental group.Results 7 days after injection of adriamycin,we found in experimental group the decrement of the activity of T-AOC.During 14 to 28 days,compared with nomal control group,the urinary protein,MDA increased significantly,while SOD decreased in experimental group(P<0.05).Oxidative stress existed in Adriamycin-induced nephropathy in rats.However,there was no β-amyloid protein deposition found in renal glomerulus and artery of cortex.Conclusion From this experiment,it's assumed that the toxic injury mechanism of β-amyloid protein on Alzheimer's disease is different from the oxidative stress induced in rats with doxorubicin nephropathy.

Objective To explore clinical significance of thrombocyte parameter,contents of fibrinogen in acute stage of Henoch-Schonlein purpura(HSP).Methods Seventy patients with HSP were studied using retrospective analysis.Erythrocrit(HCT)、blood platelets count(BPC)、platelet distribution width(PDW)、proportion of big platelet(P-LCR)and contents of fibrinogen(FIB)were compared in each group.Results Contents of FIB in patients with gastrointestinal involvement,renal involvement and mixed pattern were obviously higher when compared with patients with simple cutaneous lesion.There were no significant distinctations found during each group about HCT,BPC,P-LCR and PDW.But the distinctations of PDW,P-LCR and FIB between gravis type and levis type of HSPN were remarkable.No marked changes were observed of HCT and BPC.Conclusions HCT and BPC are not suitable to be used alone as criterions of judgement of hypercoagulabale state and development of pathogenetic condition.PDW,P-LCR and FIB are more valuable relatively and could be monitored dynamicly to estimate the state of blood coagulation,conjecture the light and heavy press of pathogenetic condition,guid clinical medication,especially in patients with HSPN.