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Objective To compare the features and diversity of the immunoglobulin heavy chain variable region (IgH) gene in neonates and adults. Methods DNA was extracted from the cord blood of 10 full term neonates and from the peripheral blood of 8 adults. The IgH gene was amplified using the nested PCR technique, and then cloned and sequenced. Results The usage of variable (VH) and diversity (D) segments in neonates was similar to that in adults: V H3 and D2 usage were preferred, while V H7 was incidentally used. With respect to the usage of joining segments (J H), there was a bias towards J H3 in neonates, while there was a tendency to randomize in adults. N region inserts at the V H-D-J H point of rearranged IgH existed in both neonates and adults. The N region-D gene-N region (NDN) length in neonates was ( 21.2 ± 5.7 ) base pairs (bp), which was shorter than that in adults [( 26.6 ± 6.5 ) bp]. There was no base loss in the neonatal IgH gene, whereas there was some loss in adults. Neonates had a much lower somatic mutation rate ( 29.2% ) than adults ( 77.1% ). Open reading frames (ORF) occurred in the rearranged IgH gene of neonates and adults at the ratio of 91.7% and 100%, respectively. Conclusions Differences in IgH gene rearrangement exist between neonates and adults. Rearranged IgH of neonates is in an activated condition, but its diversity is limited secondary to preferential selection of VH, D and JH segments, short NDN and decreased somatic mutation rate.[

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Objective To study the effect of early minimal feeding on neonatal gastrointestinal motility. Methods Thirteen critically ill neonates who needed mechanical ventilation were enrolled in this study between September, 1998 and February, 1999. The infants were devided into two groups, one of which received early minimal enteral feeding while the other received all fluid requirements via total parenteral nutrition (controls). The minimal feeding group started enteral feeding (2 ml·kg -1 ·2h -1 ) at 2.5 days after birth, and the control group at 13.6 days postnatally. Results Minimal feeding promoted gastric emptying [( 32.6 ± 12.2 )% vs. (16± 5.5 )%] and shortened the time to establish complete enteral nutrition [( 17.5 ± 8.0 ) vs. ( 34.9 ± 17.7 ) days, P< 0.05 ] and the time to establish complete oral nutrition [( 12.2 ± 8.3 ) vs. (31± 11.2 ) days, P< 0.05 ]. There was no significant difference noted in the amount of gastrointestinal reflux, serum levels of gastrin and motilin, days to regain birth weight, and length of hospitalization between the two groups. Conclusions Early minimal enteral feeding could improve the neonatal gastrointestinal motility and reduce the occurrence of feeding problems in critically ill neonates.

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Objective To compare the efficacy of isotonic saline and 5% albumin as a replacement fluid in partial exchange transfusion (PET) for the treatment of neonatal polycythaemia. Methods Sixty two neonates with polycythaemia were randomly divided into two groups: PET with isotonic saline group (n=30) and PET with 5% albumin group (n=32). Haematocrit (HC) was measured before and after the treatment. Results HCT significantly declined at 24 h after PET with either saline or 5% albumin compared with that before the treatment [( 0.72 ± 0.04 ) vs. ( 0.56 ± 0.05 )]; [( 0.71 ± 0.03 ) vs. ( 0.55 ± 0.04 ), respectively; P< 0.01 ]. There was no difference between the two groups. Serum sodium, potassium, and total proteins concentrations were not significantly affected by PET in either group. Conclusions Both isotonic saline and 5% albumin are effective as replacement fluids in PET for the treatment of neonatal polycythaemia. Since isotonic saline is cheaper and free of infection, it may be the fluid of choice in PET.

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Objective To explore the changes of plasma D-dimer levels and their clinical implication in neonates with hypoxic-ischemic encephalopathy (HIE). Methods We measured the dynamic variations of plasma D-dimer levels in 40 neonates with HIE and 20 normal controls using the latex agglutination method and observed the incidence of the systemic inflammatory response syndrome (SIRE). Results The plasma D-dimer level markedly increased in the acute stage of HIE compared with the remission phase, especially in the moderate and severe groups ( 3.50 ± 0.20 ) mg/L vs. ( 0.42 ± 0.04 ) mg/L; ( 8.20 ± 0.35 ) mg/L vs. ( 3.00 ± 0.20 ) mg/L, respectively (P< 0.01 ), and the D-dimer levels were much higher than those of the normal controls (0.26±0.03) mg/L, (P< 0.01 ). There was no difference between the milds and the controls. The plasma D-dimer levels and the incidence of SIRS were positively correlated (r= 0.987 ). Conclusions Plasma D-dimer may play an important role in the pathologic process in HIE and it may be of use as an index in the diagnosis, treatment and prognosis of HIE. [

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Objective To study the relationship between the persistent nephrotic syndrome and damage of tubulointerstitium in children. Methods We observed the clinical and pathological features of children with the persistent nephrotic syndrome, who were divided into two groups according to their response to steroid: the refractory syndrome, and steroid sensitivity. Results ① Cases with damage of tubulointerstitium function had severe injuries of tubulointerstitium in pathology. ② There was a significant difference between the two groups in the level of urine β 2-MG, age, course of disease, and damage of tubulointerstitium in pathology. ③ Degrees of pathological damage of tubulointerstitium and pathological types had no significant difference. Conclusions The degree of tubulointerstitium pathological damage is an index of judgement on the therapeutic effect and prognosis of the persistent nephrotic syndrome.

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Objective To investigate the clinical features, treatment and prognosis of vesicoureteric reflux (VUR) in children. Methods Fifty eight cases of children with VUR were enrolled in this retrospective study. Results Primary VUR accounted for 53% and secondary VUR account for 47% . VUR was likely to occurr in children under three years, and the clinical symptoms of VUR were non specific in most patients. The more serious the reflux, the more likely the scarring. The severity of proteinuria and hypertension was directly associated with the reduction of renal function. Persistent small doses of antibiotics were used as preventive therapy; this was successful in 71% of the cases of VUR. Conclusions Early diagnosis and immediate treatment are necessary to improve the prognosis of VUR.

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Objective To explore the clinical significance of electroencephalographic (EEG) hypsarrhythmia and its variants. Methods We reviewed case histories of 181 patients whose EEG manifested hypsarrhy thmia. Results Of the 181 patients, there were 109 cases of the West syndrome (60%), 60 cases of non West syndrome epilepsy (33%), and 11 cases with no convulsive history (6%). Among the 60 cases with non West syndrome epilepsy, 37 cases were complicated by cerebral organic insults and 21 by psychomotor retardation. The most common hypsarrhythmic variant was burst suppression (n=100, 55%), wherease typical hypsarrhythmia existed in only 74 cases (41%). Other common variants were periodic hypsarrhythmia, interhemispheric asymmetry, and increased interhemispheric synchrony. As sleep advanced, 43 cases with typical hypsarrhythmia changed into a burst suppression pattern. Conclusions Understanding hypsarrhythmia and its variants is important in the diagnostic evaluation of EEGs.

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Objective To observe the differences of peak expiratory flow (PEF), and serum eosinophil cationic protein (ECP) before and after Pulmicort aerosol inhalation for childhood asthma. Methods 113 asthmatic children treated with Pulmicort aerosol [(200～800) μg/d] for (3～12) months were studied. PEF was monitored with a peak flowmeter, and ECP was measured using fluoroimmunoassay (Pharmacia CAP system) before and after the treatment. Results PEF remarkably increased after inhalation therapy. Its percentage accounting for anticipant value after 3 m, 6 m, and 1 year ( 93.6 ± 5.4 , 93.0 ± 4.2 , 94.5 ± 4.5 ) had statistical significance compared with the percentage before inhalation therapy ( 70.4 ± 19.1 ) (P< 0.01 ). Serum ECP after the treatment [( 7.5 ± 2.7 ) μg/L] was significantly lower compared with ECP prior to inhalation [( 24.0 ± 17.1 ) μg/L] (P< 0.01 ). Conclusions Pulmicort aerosol appears to be an effective middle- and long-term therapy to treat and prevent childhood asthma because of its low incidence of side effects, its safety, and simplicity of use.

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Objective To study the infection modes of viral hepatitis in children and the relationship between the modes and liver function. Methods One hundred and fifty cases of children with viral hepatitis were enrolled in this retrospective study. Results Infection with a single hepatitis virus accounted for 77.3% of the cases (HAV ( 54.7% , HBV 18%, HCV 2.7% and HEV 2%). Infection involving two hepatits viruses accounted for 10.7% (HAV-HBV 8%, HBV-HCV 0.7% , HBV-HDV 1.3% and HBV-HEV 0.7% ), and infection involving three hepatitis viruses occurred in 3.3% (HAV-HBV-HDV 2% and HAV-HCV-HEV 1.3% ). Infection with more than one hepatits virus occurred more often in children aged 7～12 years; boys were more likely to have multiple infections than girls. There were no significant differences liver function tests in children with single and multiple viral infections. Conclusions The risk for simultaneous infection with more than one hepatitis virus is influenced by a child's age and sex. Infection with multiple viruses does not appear to result in greater liver function damage than infection with a single hepatitis virus.

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Objective To inverstigate the changes of serum electrolytes and osmolality in the neonates with hypoxic ischaemic encephalophathy (HIE). Methods Serum levels of sodium [Na +], potassium [K +], chloride [Cl -], ionized calcium [Ca 2+ ], and osmolality were determined in 120 neonates with HIE and in 32 normal neonates. Results In all neonates with HIE (mild, moderate and severe), the serum levels of [Na +] ( 130.2 ± 6.0 ) mmol/L, ( 126.3 ± 9.1 ) mmol/L, ( 121.2 ± 12.2 ) mmol/L respectively; [Ca 2+ ] ( 1.0 ± 0.2 ) mmol/L, ( 0.9 ± 0.2 ) mmol/L, ( 0.8 ± 0.2 ) mmol/L respectively and osmolality ( 256.7 ± 11.2 ) mOsm/L, ( 248.7 ± 21.3 ) mOsm/L, ( 241.1 ± 22.2 ) mOsm/L respectively were lower than those in nomal neonates ( 136.1 ± 1.1 ) mmol/L, ( 1.2 ± 0.1 ) mmol/L, ( 262.6 ± 8.8 ) mOsm/L respectively, wheares serum [K +] levels were higher. Serum [Cl -] levels in the moderate and serere HIE neonates were lower compared with normal neonates. Serum levels of [Na +] and [Ca 2+ ] in the dead neonates were significantly decreased and obstinate; and osmolar gap was more than 10 mOsm/L. Conclusions Hyponatremia, hypocalcemia, and serum low osmolality occur in neonates with HIE and may be of prognostic significance.

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Objective To investigate the effect of endothelin (ET) and insulin like growth factor-Ⅰ (IGF-Ⅰ) on the development of restenosis after balloon angioplasty. Methods Using a catheter to induce the endothelium injury, we created a rat model of aortic endothelium injury. *"Pathological changes of the injuried aortic endothelium were assessed, and the plasma concentration of ET and IGF-Ⅰ were determined with radioimmunoassay. Results As demonstrated by pathological examination, aortic injury related restenosis was induced by the proliferation of vascular smooth muscle cells. Plasma concentrations of ET and IGF-Ⅰ increased significantly, and there was a significant correlation between ET and IGF-Ⅰ at different time points (r= 0.62 , P< 0.05 ). Conclusions ET and IGF-Ⅰ, as stimulators of vascular smooth muscle cell proliferation, might participate in the pathological process of restenosis after balloon angioplasty.

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