Table of Content

15 February 2014 Volume 32 Issue 2

  

Original Article

The revision points for Chinese guideline of childhood asthma 

HONG Jianguo

. 2014, 32(2):  101-103. 

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　The current guideline for the diagnosis and optimal management of asthma in children, published in 2008, has played a positive role in promoting the clinical practice level on the management of childhood asthma in China. With the deepening of understanding of the disease, there have been some new technologies on the management of childhood asthma in recent years. It is necessary to revise the existing guidelines accordingly for better use in clinical practice. This paper puts forward some exploratory points of view on the revision of childhood asthma guideline. The main contents are involved in disease diagnosis, monitoring and evaluation, and treatment.

Mediators of inflammation in children with respiratory syncytial virus bronchiolitis 

CHEN Qiufang,ZHANG Hailin,YU Gang,CHEN Xiaofang,WEN Huaikai,LI Jinyan,LI Changchong

. 2014, 32(2):  115-117. 

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　Objectives　To investigate the clinical significance of the airway inflammation mediators， eosinophil cationic protein (ECP) and urinary leukotriene E4 (LTE4)， in children with respiratory syncytial virus (RSV) bronchiolitis. Methods A total of 120 inpatients with RSV bronchiolitis were classified into atopic and non-atopic groups. And 30 healthy subjects were selected as normal controls. Urinary LTE4 was determined by ELISA and ECP concentration in nasopharyngeal secretions (NPS) was tested by UniCAP100 allergen detector. The differences among groups were compared. Results The urinary LTE4 level in atopic group (172.21±67.29 pg/ml) was elevated significantly (P<0.01) than that of non-atopic group (78.21±28.78 pg/ml) and control group (44.22±16.14pg/ml). Significance was also found between non-atopic and control groups (P<0.01). Statistical analysis indicated that urinary LTE4 positively correlated to serum IgE and ECP in children with RSV bronchiolitis (r=0.57，0.49; P<0.01). Conclusions The level of urinary LTE4 and ECP in NPS can provide the reference for treatment and prognosis of children with RSV bronchiolitis. #br#Key words：　respiratory syncytial virus;　bronchiolitis;　leukotrienes;　eosinophil cationic protein;　children#br#

A comparison of clinical features between rhinovirus and respiratory syncytial virus infection in lower respiratory tract in children SUN Qiufeng, CHEN Zhengrong, HUANG Li, ZHU Canhong, WANG Yuqing, WANG Meijuan, JI Wei, SHAO Xuejun, YAN Yongdong (Department of Respiratory Medicine, Children's Hospital Affiliated to Soochow University, Suzhou 215003, Jiangsu, China)

SUN Qiufeng, CHEN Zhengrong, HUANG Li, ZHU Canhong, WANG Yuqing, WANG Meijuan, JI Wei, SHAO Xuejun, YAN Yongdong

. 2014, 32(2):  118-121. 

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　Objectives　To compare the clinical features between rhinovirus and respiratory syncytial virus infection in lower respiratory tract in children. Methods　From December 2012 to May 2013, direct immunofluorescence assay was performed to test RSV in 1 037 nasal aspirate specimens with LRTIs. RT-PCR method was used to test HRV RNA. The medical records of patients with a positive test of HRV or RSV were reviewed and compared. Results　The isolating rate for HRV and RSV was 8.78% (91/1 037) and 17.16% (178/1 037) respectively. The frequency of co-infection of HRV with other virus was 18.68%, higher than that of RSV (7.30%, χ² =7.867, P=0.005). The age distribution had significant difference between children infected with HRV and RSV (Z=5.40, P<0.001). 78.38% patients with HRV infection were younger than 3 years old, and 83.03% patients with RSV infection were younger than 1 year old. Dyspnea, hyoxemia and wheezing were more common in patients with RSV infection. Admission occurred much later in the course of the HRV infection (P<0.01). Leukocytosis, eosinophi-lia, and an elevated total serum IgE were more common in patients with HRV infection (P<0.05). Conclusions　HRV is one of the important causes of LRTIs in Suzhou. The susceptible population, clinical presentation and laboratory results of HRV infections are different from that of RSV infections.

The significance of peripheral blood CD4⁺ T cell-derived leptin in asthmatic children　

XU Qinglei,ZHU Baolin,MA Xiaobo,ZHANG Wei,LIU Lingling,WANG Shengjun,CHEN Jianguo

. 2014, 32(2):  122-125. 

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　Objectives　To explore the role of CD4⁺ T cell-derived leptin in peripheral blood mononuclear cells (PBMC) in asthmatic children. Methods Peripheral blood mononuclear cells were isolated from peripheral blood of both healthy subjects and asthmatic children in attack and remission stages. CD4⁺ T cells were purified from PBMCs by magnetic beads and were cultured in vitro. Supernatants were used to detect the levels of leptin by ELISA. The expression of the orphan nuclear receptor (ROR) γt was detected by real-time quantitative PCR (qRT-PCR) method. Results There was significant difference in CD4⁺ T cell-derived leptin levels of asthmatic children in attack stage (68.46±13.08 pg/ml), remission stage (36.73±6.13 pg/ml) and normal controls (32.82±5.79 pg/ml) (P<0.01). Through pairwise comparison, the leptin levels in children in attack stage were significantly higher than those in remission stage and normal control groups (P<0.01). But no statistical significance was found between remission stage group and normal controls (P>0.05). The plasma leptin of children in attack stage and remission stage, as well as in normal subjects were 16.64±3.53, 14.91±3.24 and 13.72±5.79 ng/ml respectively with no significant differences (P>0.05). The levels of RORγt mRNA were 0.341±0.175, 0.089±0.028 and 0.068±0.018 in children with asthma during attack stage, remission stage and in normal children respectively (P<0.01). Compared to remission and normal control groups, the RORγt mRNA level of children in attack stage was markedly higher (P<0.01), but there was no significant difference between asthmatic children in remission stage and the healthy controls (P>0.05). Furthermore, the result of this study showed CD4⁺T cell-derived leptin positively correlated to RORγt in asthmatic children in attack stage (r=0.681, P<0.01). Conclusions CD4⁺T cell-derived leptin is elevated in asthmatic children in attack stage and its level is closely related to the pathological process of asthma.

Risk factors for infants and young children with wheezing in Zhongshan city　

YANG Sai,WANG Guilan,RONG Jiayan,LIU Xiangteng,WANG BingJie 

. 2014, 32(2):  126-130. 

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　Objectives　To analyze the risk factors associated with infant wheezing in Zhongshan city. Methods A multicenter, large sample of case-control study was applied and the data related to risk factors was collected by questionnaire survey. T test and chi-square test were firstly used for univariate analysis, and then the multivariate stepwise logistic regression was used to analyze the independent risk factors associated with infant wheezing. Results A total of nine factors were found relevant to infant wheezing by univariate analysis including parental allergic history, way of birth, respiratory syncytial virus infection, Mycoplasma pneumoniae infection, personal allergic history, like crying, parents have constant disagreements, home near the road, and factory around (P<0.05). Parental allergic history (OR=3.441, 95%CI :1.914-6.186, P<0.001), respiratory syncytial virus infection (OR=2.910, 95%CI:1.793-4.723, P<0.001), Mycoplasma pneumoniae infection (OR=2.277，95%CI:1.110-4.667, P=0.025), home near the road (OR=2.036, 95%CI:1.280-3.239, P=0.003) and like crying (OR=1.521, 95%CI:1.049-2.206, P=0.027) were approved to be the independent risk factors of infant wheezing in ZhongShan. Conclusions Nine factors have relationship with infant wheezing, including parental allergic history, respiratory syncytial virus infection, Mycoplasma pneumoniae infection, home near the road, like crying, personal allergic history, and that the former five factors are the independent risk factors.

Significance of electronic bronchoscopy in diagnosis and treatment of lung diseases with pulmonary mass lesion in children　

YIN Fang,ZHOU Weifang,HUANG Li,ZHU Canhong,WANG Meijuan,WEN Fang,YAN Yongdong,JI Wei 

. 2014, 32(2):  131-135. 

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　Objectives　To investigate the significance of electronic bronchoscopy and bronchoalveolar lavage in diagnosis and treatment in children with pulmonary mass lesion. Methods A total of 74 hospitalized children from January 2011 to June 2012 whose imaging examinations showed massive patchy shadow were examined and treated by electronic bronchoscopy and bronchoalveolar lavage. Their clinical data were retrospectively analyzed. Results The major cause for the massive shadow was infection according to electronic bronchoscopy examination (68/74, 91.89%), 65 cases of them were lobar pneumonia, 3 cases were pulmonary tuberculosis followed by 5 cases of foreign body (6.76%) and one case of pneumorrhagia (1.35%).The lower left lung was the most frequently seen site of infection, followed by lower right lung. The agreement between infection sites and imaging examination was 97.30%. Bronchoalveolar lavage fluid showed that the primary pathogen of lobar pneumonia infection is Mycoplasma pneumoniae (MP) (42/65, 64.62%). The highest detection rate of MP was found in preschool group and the detection rate between different age groups indicated statistically significant difference (P<0.01). The imaging examination showed pulmonary lesions in 61.54% children with lobar pneumonia improved significantly in one week. The improvement rate of pulmonary lesions was higher in infected children with short duration (1-2 weeks, 90.91%) between disease onset and electronic bronchoscopy inspection than those with longer duration (2-3 weeks, 51.72% and >3 weeks, 35.71%) (P<0.05). Conclusions Electronic bronchoscopy and bronchoalveolar lavage play dual roles in etiological diagnosis and therapy in children with pulmonary mass lesion.

Surveillance of pathogen distribution and antimicrobial resistance of bacilli among children with otitis media 

HE Ping,JI Zhenghua,XU Jun,TAO Yunzhen,ZHU Hong,WANG Yunzhong

. 2014, 32(2):  136-139. 

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　 Objectives　To analyze pathogen distribution and antimicrobial resistance of bacilli among children with otitis media. Methods Pathogenic bacteria was isolated from children with suppurative otitis media. The VITEK32 was used for identification. The bacterial susceptibility testing was done by Kirby-Bauer method. According to CLSI standard the antimicrobial susceptibility was determined. Results From Jan 2010 to Dec 2012, 425 children with suppurative otitis media were examined. 347 strains were isolated, of which the detectable rate was 81.65%. The detectable rate of bacteria and fungus was 93.37% (324/347) and 6.63% (23/347), respectively. Among bacteria, the detectable rate of streptococcus pneumoniae was 40.92% (142/347) and staphylococcus aureus was 33.43% (116/347). The detectable rate of haemophilus influenza was 7.78% (27/347). The prevalence of streptococcus pneumoniae is high in children aged 1-3years, with detectable rate at 47.09%. There was no statistical difference among different age groups. The prevalence of methicillin-resistant staphylococcus aureus (MRSA) in middle ear secretion was 1.11% （5/45）, 18.75% （9/48） and 30.43% （7/23） in 2010, 2011 and 2012 respectively, with no statistical difference (χ²=3.86, P=0.145). The prevalence of penicillin -resistant streptococcus pneumoniae (PRSP) in middle ear secretion was 9.26%, 3.92% and 27.03% in 2010, 2011 and 2012 respectively, with statistical difference (χ²=11.47, P=0.003). Conclusions Choosing correct therapy according to the result of middle ear secretion culture and antibiotics sensitive test can increase the recovery rate of otitismedia.

T helper lymphocyte subsets and cytokines in children with systemic-onset juvenile idiopathic arthritis　

XU Lingyun,TU Zhiqiang,XUE Haiyan,CAO Lanfang 

. 2014, 32(2):  140-143. 

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Objectives To explore the changes of T helper (Th) lymphocyte and its related factors in children with syste-mic-onset juvenile idiopathic arthritis (SoJIA). Methods A total of 36 SoJIA inpatients, hospitalized from January 2012 to June 2013, were divided into active phase group and remission group. In addition, 20 healthy children were selected as normal controls. Th1, Th2 and Th17 cell ratios in peripheral blood mononuclear cells were detected and compared between each group by flow cytometry. Serum interferon-γ (INF-γ), interleukin-4 (IL-4), interleukin-17 (IL-17) levels were measured by enzyme-linked immunosorbent assay. Results The proportions of Th17 cells over CD3⁺CD8^- cell were (3.30±2.15)%, (1.78±1.14)% and (1.22±1.14)% in active phase group, remission group and control group. The difference among three groups was significant (H=14.437, P=0.001), and the active phase group had higher proportion of Th17 than the other two groups (P<0.05). The ratio of Th1 and Th2 over CD3⁺CD8^- cell between each group was not significantly different (P> 0.05). The serum IL-17 levels were (125.82±45.87) pg/ml, (57.79±25.84)pg/ml and（50.02±18.37）pg/ml in active phase group, remission group and control group with significant difference among three groups (F=31.82, P=0.000), and the active phase group had higher level of IL-17 than the other two groups (P<0.05). But serum INF-γ and IL-4 were not significantly different between each group (P>0.05). Conclusions Acquired cellular immunity is involved in pathogenesis of SoJIA, the increased proportion of Th1 and Th17 cell and the changes of related cytokines seem to correlate with active phage of SoJIA.

The application of hemoperfusion in severe juvenile dermatomyositis　

LI Chunzhen,ZHANG Dongfeng,LIU Ling,CUI Jieyuan,YUAN Xiaoying,LIU Fujuan,YANG Yanjun 

. 2014, 32(2):  144-146. 

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　Objectives　To investigate the clinical effect of hemoperfusion in severe juvenile dermatomyositis. Methods　Two patients with severe juvenile dermatomyositis, who accepted hemoperfusion treatment, were retrospectively analyzed. Results　In these 2 patients, the hemoperfusion process were smooth. The muscle pain was reduced and the muscle enzymes were decreased. After hemoperfusion, one patient refused to continue treatment and the disease recurrent. The other patient continued to accept the immunosuppressive therapy and eventually improved. Conclusions　For juvenile dermatomyositis, hemoperfusion was a safe and effective auxiliary treatment. It could be applied when the general treatment was invalid.

Correlation of liver X receptor and abnormal lipid metabolism in school-age children with obesity 

ZHU Qingling,YE Xinhua,YANG Shengping,LIU Qian,CHEN Hong,

. 2014, 32(2):  147-150. 

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　Objectives　To explore the relevant factors of liver X receptor (LXR) and lipid metabolism in school-age children with obesity. Methods A total of 80 obese children were selected by indexes of physical growth from pupils in Grades 1-6, aged 7-14 years from June 2011 to October 2011. Fifty-one age and sex matched children with normal BMI were chosen as normal controls. The metabolic indexes including aspartate transaminase (AST), alanine aminotransferase (ALT), glutamyl transpeptidase (GGT), total cholesterol (CHOL), triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and expression of LXR were detected in fasting blood. Results The expression level of LXR in obese children (9.14±1.15) was higher than that in control children (2.84±3.68) with significant difference (t=4.55，P=0.000). Eighty percent (80%) of obese children were LXR> 1 (64/80) which was higher than that of control children (23/51, 45.1%), and significant difference was found between the two groups (χ²=17.01, P=0.000). Compared to controls, the levels of AST, ALT, GGT, CHOL, TG and LDL-C were higher while the level of HDL-C was lower in obese children (P<0.05). The correlation analysis found that AST, ALT, CHOL, LDL-C and BMI were positively correlated with LXR (r=0.18~0.26，P<0.05). Logistic regression ana-lysis showed that AST ≥40IU/L (OR=1.076), ALT≥40IU/L (OR=1.036), CHOL ≥5.20 mmol/L (OR=2.038), LDL-C ≥3.36 mmol/L (OR=2.176) and BMI ≥18.9 kg/m² (OR=1.131) were risk factors for LXR>1 (P<0.05). Conclusions Obesity in school-age children can up-regulate the expression of liver X receptor and cause liver damage and abnormal lipids metabolism.

Efficacy of hCG and hMG on testicular morphology and function in male patients with multiple pituitary hormone deficiency

TANG Lin,LI Guimei,WANG Qian

. 2014, 32(2):  151-155. 

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　Objectives　To study the impact of initial age of treatment on testicular morphology and function in male patients with multiple pituitary hormone deficiency using human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG). Methods Patients with multiple pituitary hormone deficiency were treated with hCG and hMG while keeping other hormone levels normal. Correlations among their testicular volume, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and height, bone age were analyzed. Results After 6-month hCG and hMG treatment, the penis length of 54 male patients was significantly increased from (2.58±0.69) cm to (4.19±0.77) cm , and penis circumference was also increased from (3.71 ± 1.36) cm to (5.95 ± 1.26) cm; the testicular volume was increased from (1.76 ± 1.49) ml to (5.20±2.30) ml; height was increased from (147.01 ± 12.29) cm to (151.98 ± 11.52) cm and bone age was increased from (11.22 ± 2.71) years to (11.64 ± 2.72) years; the differences before and after treatment were statistically significant (all P <0.01). As the patients' age increased, their testicular volume and testosterone level increased slowly, and significant differences amongst each age group were found (P<0.05). The increased value of testicular volume, serum FSH and LH levels, and height growth tended to be negatively correlated to the initial age of therapy (r=－0.517~－0.334, P<0.05). Conclusions Early and proper treatment in male patients with multiple pituitary hormone deficiency using hCG and hMG improves testicular function and secondary sex characteristics.

Clinical and pathological characteristics of childhood Henoch-Sch?nlein purpura nephritis with proteinuria　

LUO Wei,FENG Shipin,WANG Li,XIE Min,ZHANG Wei,LI Sha

. 2014, 32(2):  156-159. 

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Objectives To explore the clinical features and pathological types of childhood Henoch- Sch?nlein purpura nephritis (HSPN）with proteinuria. Methods Clinical and pathological data of 180 children with HSPN presenting with proteinuria were retrospectively analyzed in groups according to 24-hour urinary protein levels. Results The moderate proteinuria (57 cases, 31.7%) was the most common clinical type, followed by high-grade proteinuria (51 cases, 28.3%), mild proteinuria (46 cases, 25.6%) and microalbuminuria (26 cases, 14.4%). According to the International Study of Kidney Disease of Children , the major pathological type of HSPN are grade II (92 cases, 51.1%) and grade III (73 cases, 40.6%). The main pathological changes of moderate proteinuria were grade II (31 cases, 54.4%), and the main pathological changes of high-grade proteinuria were grade III (33 case, 64.7%). The pathological grade was progressively increased along with severity of proteinuria. The difference was statistically significant (χ²=39.54, P=0.002). The main immunopathological type was IgA+IgM (84 cases, 46.7%), followed by IgA+IgM+IgG (55 cases, 30.6%). No correlation was found among immunopathological typing, pathological typing and clinical typing (P>0.05). Conclusions The HSPN children with massive proteinuria show more severe pathological changes, but the severity of clinical symptoms is not completely consistent with the pathological damages.

A case of blindness caused by nephritic syndrome with cerebral venous sinus thrombosis

 SUN Tao,XIA Zhengkun,FAN Zhongmin,SHI Zhuo,GAO Yuanfu

. 2014, 32(2):  160-163. 

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　Objectives　To explore the clinical manifestations, treatment and prognosis of a case of blindness caused by nephrotic syndrome with cerebral venous sinus thrombosis (CVST). Methods　The clinical manifestations, diagnosis and treatment of a case of NS with CVST were analyzed. The latest domestic and foreign reseach progresses in treatment for CVST in children were reviewed. Results　Epilepsy suddenly appeared with diplopia, binocular vision loss and blindness in anticoagulant therapy for the child with NS. Brain magnetic resonance venography (MRV) suggested CVST. MRV reexamined showed that the intracranial thrombosis was completely dissolved after urokinase thrombolysis for one month followed by ineffective heparin anticoagulation. At present, international standards of anticoagulant therapy have been adopted in the treatment for CVST patients. Coagulation function (e.g.APTT) and international standardization ratio were monitored in order to prevent bleeding. Conclusions　It is better to perform neural imaging examination early in suspected CVST patients. Anticoagulation and thrombolytic therapy should be given immediately once the risk of bleeding was excluded and used for 3-6 months.

Clinical analysis of childhood eosinophilic gastroenteritis in two cases　

TANG Yunping,XU Junjie,WEI Xuxia,LI Hua 

. 2014, 32(2):  164-166. 

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Objective　To explore the clinical characteristics of eosinophilic gastroenteritis. Methods The clinical data of 2 children with eosinophilic gastroenteritis was retrospectively analyzed. Results Eosinophilia was found in both cases and pathological examination indicated eosinophil infiltration in intestinal mucosa. The clinical symptoms were improved after hypoallergenic diet, amino acid formula and anti-allergy treatment. Conclusions Eosinophilic gastroenteritis is characterized by eosinophil infiltration with unknown pathogenic factor leading the treatment of eosinophilic gastroenteritis lacking of sound evidence.

Influence of congenital human cytomegalovirus infection on hepatitis B vaccine's immune effect　

HAN Qijun,WEN Tianlian,SHEN Guohong,GUAN Changli,DOU Dongdong　

. 2014, 32(2):  167-169. 

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　Objectives　To investigate the immune effect of hepatitis B vaccine under the influence of congenital human cytomegalovirus (HCMV) infection. Methods　The newborn rat model of congenital HCMV infection was developed by intraperitoneally inoculating pregnant rat with HCMV suspension，while the offsprings of healthy rats were used as the control group. Offspring rats in all groups were inoculated with hepatitis B vaccine in the postnatal 1st, 3rd and 5th week and were taken blood from hearts separately in 3rd, 5th, 7th and 11th week. Antibody to Hepatitis B surface antigen (HBsAb) titer in all groups was detected by ELISA method. Results　The serum HBsAb titer in both groups all showed a trend of increasing gradually with added vaccinating times and decreased differently with time extending after completed vaccinations. Differences among changes of HBsAb titer along with prolonged time in each group were all statistically significant (P < 0.001). At all time points (3^rd, 5^th, 7^th, 11^th week), the titer of serum HBsAb in congenital HCMV infection group was lower than that in the control group respectively, and there were statistically significant differences (P < 0.01). Conclusions　Congenital HCMV infection could weaken the immune effect of hepatitis B vaccine.

Expression of CNP/NPR-B axis and NPR-C/NEP elimination pathways in rats with unilateral ureteral obstruction　

ZHAO Xueqi,WANG Jing,KONG Haibo,HU Bo,HU Peng

. 2014, 32(2):  170-177. 

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　Objectives　To study the expression features of C-type natriuretic peptide (CNP)/ natriuretic peptide receptor-B (NPR-B) axis and two parallel elimination pathways, natriuretic peptide receptor-C (NPR-C) and neutral endopeptidase (NEP) in unilateral ureteral obstruction (UUO) rats. Methods CNP, NPR-B, NPR-C, NEP, Col-IV and type IV collagen (Col-IV) mRNA and proteins were determined by in situ hybridization, real-time PCR, immunohistochemistry and western blot in UUO rats at 24h, 72h, 1w, 2w, 3w, 1m, 2m and 3m. Results CNP expression tended to be higher immediately after ligation and declined along with the progression of disease, occurring predominantly in tubular epithelial cells. A high-level CNP may attribute to the elevated expression of NPR-B in the early phase of UUO. Conclusions NEP and NPR participate in the regulation of CNP expression in tubulointerstitial fibrosis. The gradual increased expression of NPR-C and NEP may cause the subsequent decline of CNP.

Influence of IL-17 on mesangial cell and its molecular mechanism　

WANG Li,LI Qiu,LI Cuicui,YANG Haiping,WANG Lijia,LIU Wei

. 2014, 32(2):  178-182. 

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　Objectives　To investigate the effect of IL-17 on proliferation and secretion of IL-1β in the human mesangial cell line (HMCL) and explore the molecular mechanism. Methods The proliferation of HMCL induced by IL-17 was detected by MTT, the secretion of IL-1β in HMCL was measured by ELISA and the expression of NF-κB was detected by immunocytochemistry. Results IL-17 did not impact HMCL proliferation (P>0.05) but dose-and time-dependently promoted the secretion of IL-1β (P<0.05). And the expression of NF-κB induced by IL-17 increased comparing to that in the control group (P<0.05). Conclusions IL-17 may induce HMCL to secrete IL-1β via NF-κB pathway that results in kidney injury.

Cloning and prokaryotic expression of rat surfactant protein C in E.coli　

TANG Wei,LU Hongyan,GAO Chuchu 

. 2014, 32(2):  183-185. 

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Objectives To construct prokaryotic expression plasmid of rat surfactant protein C (sp-c) gene under hyperoxia and expression in E.coli. Methods Twenty-one-day-old SD premature rats were exposed to 85% hyperoxia 12 hours after birth. The rats were executed after 7 days and their RNA were extracted from lung and cDNA was synthesized and amplified. And then the cDNA was cloned into pMD18-T vector and confirmed by enzyme digestion and sequencing. After the prokaryotic expression vector pET-28a(+)-sp-c was constructed, the recombinant plasmid was induced by IPTG and expressed in E.coli BL21 strain. The fusion protein was analyzed by SDS-PAGE and Western blotting. Results The pET-28a(+)-sp-c plasmid was constructed and the fusion protein with relative molecule mass of 21000 was highly expressed. Conclusions SP-C is successfully expressed in E. coli, which can be used to study the mechanism of action between SP-C and endoplasmic reticulum, the expression of SP-C in lung epithelial cell A549 and the impact of SP-C on proliferation, differentiation and apoptosis of AECIIs in future.

Anxiety disorders in preschool children　

ZHU Mingzhe,ZHANG Xiaolei

. 2014, 32(2):  186-188. 

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Anxiety disorders are the commonest emotional disorders in children, who may be at increased risk of the later development of other types of mental disorder. Early diagnosis and intervention should be applied. In this article, epidemiology, major factors relevant and effective therapy of anxiety disorders in preschool children are summarized.

Advances in epidemiology, etiology and pathogenesis of Kawasaki disease

 YANG Bo,ZHU Yijie

. 2014, 32(2):  189-192. 

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　Kawasaki disease (KD) is an acute systemic vasculitis that primarily affects young children between 6 months and 4 years old. Coronary arteritis is an important clinical feature of KD because it is associated with aneurysms and thromboembolic events that can lead to severe complications, even sudden death. To date, the etiology and pathogenesis of Kawasaki disease has not been understood completely. In this paper, we will review the recent advances in epidemiology, etiology, pathogenesis and genetic susceptibility of Kawasaki disease.