Risk factors and optimal predictive scoring system of mortality for children with acute paraquat poisoning.

BACKGROUND: There is no suitable scoring system that can be used to predict mortality in children with acute paraquat intoxication (APP). AIM: To optimize a predictive scoring system for mortality in children with APP. METHODS: A total of 113 children with APP from January 1, 2010 to January 1, 2020 were enrolled in this study. These patients were divided into survivors and non-survivors. We compared the clinical characteristics between the two groups and analyzed the independent prognostic risk factors. The survival rates of patients with different values of the pediatric critical illness score (PCIS) were assessed using kaplan-meier survival analysis. The best scoring system was established by using the area under the receiver operating characteristic curve analysis. RESULTS: The overall mortality rate was 23.4%. All non-survivors died within 20 days; 48.1% (13/27) died within 3 days, and 70.3% (19/27) died within 7 days. Compared to survivors, the non-survivors were older, had higher white blood cell count, alanine aminotransferase (ALT), aspartate aminotransferase, serum creatinine, blood urea nitrogen, glucose, and pediatric early warning score, and had lower platelet count, albumin, Serum sodium (Na+) and PCIS. ALT and PCIS were the independent prognostic risk factors for children with APP. The survival rate of children classified as extremely critical patients (100%) was lower than that of children classified as critical (60%) or noncritical (6.7%) patients. The specificity of ALT was high (96.51%), but the sensitivity was low (59.26%). The sensitivity and specificity of ALT combined with PCIS were high, 92.59% and 87.21%, respectively. The difference in mortality was significantly higher for ALT combined with PCIS (area under the receiver operating characteristic: 0.937; 95%CI: 0.875-0.974; P < 0.05). CONCLUSION: In our study, ALT and PCIS were independent prognostic risk factors for children with APP. ALT combined with PCIS is an optimal predictive mortality scoring system for children with APP.

Idiopathic membranous nephropathy in children: A case report.

BACKGROUND: Minimal change disease is a common cause of nephrotic syndrome (NS) in children and has a good prognosis. Idiopathic membranous nephropathy (IMN), a rare cause of NS in children, may progress to chronic kidney disease. However, there is little data on how to evaluate and treat IMN in children. CASE SUMMARY: In this article, we report the case of a 7-year-old boy with steroid-resistant NS. After cyclophosphamide pulse therapy combined with oral prednisone, the urinary protein results remained positive. Renal biopsy confirmed the pathological diagnosis of stage II MN, with positivity for phospholipase A2 receptor. Other immunological and infectious diseases relevant to secondary MN were ruled out by laboratory tests. Subsequently, tacrolimus plus prednisone was administered, and the therapeutic effect was satisfactory. CONCLUSION: IMN is rare in children. The main clinical manifestation is NS. The diagnosis depends on renal biopsy. There is little evidence-based data on the treatment of IMN in children. Therefore, large-sample randomized controlled trials need to be performed. Individualized treatment should be used to improve the prognosis of the disease.

[Risk Factors for Sepsis Associated-Acute Kidney Injury in Intensive Care Unit Patients].

OBJECTIVE: To explore the risk factors of acute kidney injury (AKI) in patients with sepsis in intensive care unit (ICU). METHODS: The medical records of patients diagnosed with sepsis in ICU of West China Hospital of Sichuan University from March 2009 to June 2016 were retrospectively analyzed. Differences between AKI group and Non-AKI group in general data, background disease, ICU entry and exit dates, complications, laboratory data and other related data were analyzed through univariate and multivariate statistical methods. RESULTS: A total of 2331 patients with sepsis were included in the study, including 626 patients in the AKI group and 1695 patients in the Non-AKI group. The multivariate logistic regression analysis revealed that age >40 yr. (odds ratio (OR) =2.752), diabetes (OR=2.563), hypertension/coronary heart disease (OR=1.851), chronic kidney disease (OR=15.876), heart failure (OR=2.295), acute respiratory distress syndrome (OR=2.067), severe acute pancreatitis (OR=2.725), hypotension (OR=2.140), hypoproteinemia (OR=1.596), lactic acidosis (OR=2.164), organ failure>1 (OR=4.480), WBC>10×10 9L -1 (OR=4.166), serum creatinine (OR=4.401), PCT (OR=1.816), Cys-C (OR=7.046), mild anemia (OR=2.107), moderate anemia (OR=3.817), and severe anemia (OR=6.091) were all independent risk factors of SA-AKI. CONCLUSION: Several risk factors are related to the occurrence of SA-AKI in the ICU. Early identification and monitoring of risk factors for SA-AKI and early prevention of AKI can improve the prognosis of sepsis patients.

Nephronophthisis: A review of genotype-phenotype correlation.

Nephronophthisis is an autosomal recessive cystic kidney disease and one of the most common genetic disorders causing end-stage renal disease in children. Nephronophthisis is a genetically heterogenous disorder with more than 25 identified genes. In 10%-20% of cases, there are additional features of a ciliopathy syndrome, such as retinal defects, liver fibrosis, skeletal abnormalities, and brain developmental disorders. This review provides an update of the recent advances in the clinical features and related gene mutations of nephronophthisis, and novel approaches for therapy in nephronophthisis patients may be needed.

P2Y1 receptor antagonists mitigate oxygen and glucose deprivation­induced astrocyte injury.

The aim of the present study was to elucidate the effects of blocking the calcium signaling pathway of astrocytes (ASs) on oxygen and glucose deprivation (OGD)­induced AS injury. The association between the changes in the concentrations of AS­derived transmitter ATP and glutamic acid, and the changes in calcium signaling under the challenge of OGD were investigated. The cortical ASs of Sprague Dawley rats were cultured to establish the OGD models of ASs. The extracellular concentrations of ATP and glutamic acid in the normal group and the OGD group were detected, and the intracellular concentration of calcium ions (Ca2+) was detected. The effects of 2'­deoxy­N6­methyl adenosine 3', 5'­diphosphate diammonium salt (MRS2179), a P2Y1 receptor antagonist, on the release of calcium and glutamic acid of ASs under the condition of OGD were observed. The OGD challenge induced the release of glutamic acid and ATP by ASs in a time­dependent manner, whereas elevation in the concentration of glutamic acid lagged behind that of the ATP and Ca2+. The concentration of Ca2+ inside ASs peaked 16 h after OGD, following which the concentration of Ca2+ was decreased. The effects of elevated release of glutamic acid by ASs when challenged by OGD may be blocked by MRS2179, a P2Y1 receptor antagonist. Furthermore, MRS2179 may significantly mitigate OGD­induced AS injury and increase cell survival. The ASs of rats cultured in vitro expressed P2Y1 receptors, which may inhibit excessive elevation in the concentration of intracellular Ca2+. Avoidance of intracellular calcium overload and the excessive release of glutamic acid may be an important reason why MRS2179 mitigates OGD­induced AS injury.

[Expression of heparanase in kidney of rats with respiratory syncytial virus nephropathy and its relationship with proteinurina].

OBJECTIVE: To explore the role of heparanase in the pathogenesis of respiratory syncytial virus (RSV) nephropathy in rats model. METHODS: Twenty 150-200 g Sprague-Dawley (SD) rats (n = 5 per group) were inoculated with 6 x 10(6) PFU RSV and sacrificed on days 4, 8, 14 and 28 postinoculation (RSV4, RSV8, RSV14 and RSV29). Five SD rats inoculated with Dulbecco's minimum essential medium were served as normal control. The expression levels of heparanase protein and mRNA in the rat renal tissue of each group were determined by immunohistochemical staining and real-time quantitative RT-PCR respectively. The proteinurina was also measured and then the relationship between the expression level of heparanase and the 24-hour urinary protein was studied. RESULTS: The rats with RSV nephropathy exhibited higher proteinuria in comparison with normal rats, and the 24-hour urinary protein level was significantly different between each RSV nephropathy group (RSV14 > RSV8 > RSV28 > RSV4, P < 0.05). Compared with normal control, the rats with RSV nephropathy showed up-regulated expression of heparanase protein in glomeruli. The expression levels of heparanase protein in RSV8 and RSV14 group were higher than those in RSV4 and RSV28 group (P < 0.05). There was a linear positive correlation between the expression level of glomerular heparanase protein and the quantity of 24-hour urinary protein (r = 0.783, P < 0.05). Compared with normal control group, the expression levels of heparanase mRNA in the kidney from RSV4, RSV8, RSV14, and RSV28 group were elevated (RSV14 > RSV8 > RSV4 > RSV28 , P < 0.05). There was a linear positive correlation between the expression level of renal heparanase mRNA and the quantity of 24-hour urinary protein (r = 0.725, P < 0.05). CONCLUSION: The increased expression of heparanase in kidney may be important to the loss of glomerular negative charge in glomerular basement membrane which is involved in the pathogenesis of RSV nephropathy in rats.

[Mechanical ventilation in acute respiratory distress syndrome].

The goal of mechanically ventilating patients with acute respiratory distress syndrome (ARDS) is to ensure adequate oxygenation and minimal ventilator-associated lung injury. Non-invasive ventilation should be cautiously used in patients with ARDS. Protective ARDS mechanical ventilation strategies with low tidal volumes can reduce mortality. Driving pressure is the most reasonable parameter to optimize tidal volume. Available evidence does not support the routine use of higher positive end expiratory pressure (PEEP) in patients with ARDS. The optimal level of PEEP may be titrated by the inflection point obtained from static pressure-volume curve. Promising therapies include prone position ventilation, high frequency oscillatory ventilation and extracorporeal membrane oxygenation as salvage treatment. While mechanically ventilating, it is also important for ARDS patients to maintain spontaneous breathing via assisted ventilation mode such as bilevel positive airway pressure, pressure support ventilation and neurally adjusted ventilation assist. Exogenous surfactant, inhaled nitric oxide, bronchodilators, airway pressure release ventilation and partial liquid ventilation are not recommended therapies.

[Mechanism for promoting repair of renal ischemia reperfusion injury by mesenchymal stem cells].

OBJECTIVE: Preclinical studies have demonstrated that exogenous mesenchymal stem cells (MSCs) may ameliorate kidney damage and enhance repair of renal ischemia reperfusion injury (IRI). This review will focus on the mechanism for accelerating repair of renal IRI by MSCs. Several chemokine receptors such as CXCR4 and CD44 are related to MSCs trafficking to post-ischemic kidney. MSCs differentiate into tubular epithelial cells, which is not the predominant mechanism for repair of the damaged kidney. Instead, MSCs exert their therapeutic effect mainly through paracrine action via a variety of cytokines and microvesicles, and the paracrine actions of infused MSCs work to activate intrinsic kidney cells, promote angiogenesis, inhibit oxidative stress and reduce apoptosis, inflammation and renal fibrosis.

[Primary culture and identification of rat glomerular podocytes].

OBJECTIVE: To establish an easy and feasible method for primary culture and identification of rat glomerular podocytes. METHODS: Glomeruli from Sprague-Dawley (SD) rats weighing 60-100 gram were isolated by the method of different size combination of screen. Isolated glomeruli were appropriately digested with 2 g/L type IV collagenase and cultured in 25 cm2 plastic flask coated with rat tail collagen in K1-3T3 medium with ITS-X (containing insulin-transferrin-selenium). Subculture of primary cultured epithelial cells was performed at 9-10 days after implantation of collagenase digested glomeruli. Podocytes were identified by the morphology study with scanning electron microscope and inverted microscope, as well as the immunohistochemistry staining (SP methods) study for the expression of keratin, desmin and Wilms' tumor suppressor-1 (WT-1). RESULTS: Epithelial cells outgrowth from isolated glomeruli appeared after 3 days primary culture and grew to confluence with cobblestone-appearance at 9-10 days. These cobblestone cells were subcultured at this point and gradually conversed into large, flat arborized cells with well-developed processes and microvilli. These arborized cells were negative expression with desmin staining and showed positive expression of cytokeratin and WT-1, which indicated that they were podocytes. CONCLUSION: Implantating collagenase digested-glomeruli is an easy and feasible method for primary culture of rat glomerular podocytes. WT-1 may serve as a good marker to identify rat glomerular podocytes.

Autostereoscopic three-dimensional projector based on two parallax barriers.

An autostereoscopic 3D projector using several 2D projectors, a projection screen, and two parallax barriers is proposed. Parallax barrier 1 facing the 2D projectors collimates the images that have aberrations on the edge of the projection screen. Parallax barrier 2 facing viewers acts as the parallax barrier in ordinary autostereoscopic 3D displays. The operation principle of the system, the calculation equations for the parallax barriers, and the capture and correction of parallax images are described in detail. A 60-inch autostereoscopic 3D projector prototype having four 2D projectors was developed. The presentation of 3D static, animation, and video images is realized by the prototype. The prototype's stereoscopic images without aberrations and with a little cross talk are sharp. Especially, its 3D resolution is the same as its 2D resolution.

[Regulatory effect of IkappaBalpha on NF-kappaB activity during viral gene transactivation in patients with steroid responsive simple nephrotic syndrome].

OBJECTIVE: To investigate the expression of inhibitory kappa B alpha (IkappaBalpha) and it's regulatory effect on nuclear factor kappa B (NF-kappaB) during viral gene transactivation triggered by respiratory tract viruses in steroid responsive simple nephrotic syndrome (SRSNS). METHODS: Children with SRSNS (including at active and remissive stage) were examined for this research project, and healthy children were chosen as controls. TaqMan reverse transcription-PCR (RT-PCR), Western blot, electro-mobility shift assays were performed to study the protein expression of IkappaBalpha gene and the activity of NF-kappaB in peripheral blood mononuclear cells (PBMCs). Simultaneously, RT-PCR was used to detect the gene expression of respiratory tract viruses (including respiratory syncytial virus and influenza virus), and viral antibody was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Comparing with that from SRSNS at remissive stage and healthy children, the activity of NF-kappaB from SRSNS at active stage was much higher statistically (P < 0.05). The positive correlation between NF-kappaB activation and the gene expression of respiratory tract viruses was observed (OR = 27, Kappa coefficient = 0.59, P <0. 05). In addition, levels of IkappaBalpha protein from children with SRSNS at active stage were much lower than those from healthy children and those from children with SRSNS at remissive stage (P < 0.05). There was a linear negative correlation between the activity of NF-kappaB and the protein level of IkappaBalpha (r = -0.884, P < 0.05). On the other hand, levels of IkappaBalpha mRNA from SRSNS at active stage were much higher than those from healthy children, but much lower than those from children with SRSNS at remissive stage (P < 0.05). CONCLUSION: Abnormal expression of IkappaBalpha, which is attributed to regulate activity of NF-kappaB, occurs during viral gene transactivation triggered by respiratory tract viruses in SRSNS.

[Heparanase expression of peripheral blood cells in steroid responsive nephrotic syndrome patients].

OBJECTIVE: The beta-D-endoglycosidase heparanase (Hpa) is HS-specific which leads to the degradation of heparan sulfate (HS). An increased permeability of the glomerular basement membrane (GBM) for proteinuria was suggested to relate to a decrease of HS side chains in the GBM. However, whether an up-regulated expression of Hpa exists in steroid responsive nephrotic syndrome (SRSNS) remains unknown. The purpose of this study was to evaluate the role of Hpa in the development of SRSNS and the correlation with the proteinuria. METHODS: Forty-three children with SRSNS were selected and included the active stage group (n = 23), the restoration stage group (n = 10) and the remission stage group (n = 10). There were 23 nephritic nephrosis children, 15 purpura nephritis children and 15 healthy children as controls. By using the method of reverse transcriptase-PCR (RT-PCR), Hpa gene expression in the peripheral blood leukocytes (PBLs) was assayed. RESULTS: (1) All patients with nephrotic syndrome exhibited higher levels of Hpa mRNA than those of the healthy group (P < 0.05). The highest expression was in the active stage group of SRSNS (1.27 +/- 0.36, P < 0.001), while there was no difference between the patients of nephritic nephrosis group (0.62 +/- 0.15) and purpura nephritis group (0.55 +/- 0.17) (P > 0.05). (2) In contrast with the healthy group, there was a significant difference in the active stage group of SRSNS (P < 0.001). So was the restoration stage group (P < 0.05), but there was no difference to the remission stage group (P > 0.05). (3) There was a positive correlation between the expression level of Hpa mRNA and the quantity of urinary protein (r(s) = 0.751, P < 0.001). CONCLUSION: Up-regulated expression of Hpa mRNA may be important to the loss of glomerular negative charge in GBM and lead to proteinuria in SRSNS.